"You gonna stop long enough to tube this guy?" the RT asks, a bit irritably. 

Dr Prissan taps his foot. "We'll see after this set. Time?" 

"Thirty more seconds," Chantal confirms. 

Seconds pass. 

"All right, time." 

This time, the throbbing she feels changes, but it doesn't stop. 

"- Can I get a second check on this?" Nellie says immediately. "Think we got a pulse." 

It's slow, but not actually that slow; the monitor is calling it a heart rate of 44. Other than that, it looks pretty similar to the previous rhythm. 

Nellie grins at Dr Agarwal. "Looks like the same as before - complete heart block, ventricular rhythm taking over - but faster. Probably the epi we gave him. Get us a BP?" 

She watches him hunt around for the button to cycle it and doesn't smirk even a tiny bit. 

The respiratory therapist is eagerly grabbing the chance to get some good bag-mask ventilation going, and the O2 sat curve is coming back. 

...At 63%, but you know, that is technically still oxygen being transported by his blood, and it bumps up to 65% within five seconds. 

"All right," Dr Prissan says dryly, "now we can tube him. See? Much better, don't need to pause compressions– oh and we've even got some wiggle room in his BP." 

It's 164/92. 

"Oh yeah, remember his BP was perfect with a heart rate of thirty? How bad is this dude's hypertension at baseline anyway? His arteries must be like copper pipes." 

"He's on like six meds for it at home," Dr Agarwal offers helpfully. "Dr Prissan, did you want me to...?" 

     "Great idea. He's an easy intubation - see, nice long neck. Let's hope you never have to tube Rick here." 

"Hey," Rick says, with zero heat. Then turns, and his tone changes. "...Hey! Hey there, buddy - just relax, we've got you -" 

Nellie cranes to look. The patient is, indeed, awake; his eyes are spinning around the room. Through the mask, his nose and lips are clearly still blueish; his sats are rising, slowly, but only up to 74%. 

She turns and focuses on prepping meds - she doesn't even need to ask, she knows what Dr Prissan always uses - but watches out of the corner of her eye, amused, as Rick explains the situation to his patient. The words he uses are straightforward, but somehow his tone makes it sound like a minor and inconvenient yet slightly exciting misadventure. The patient mouths something through the mask. Rick calmly tells him to quit talking he's got one job and it's breathing. The patient rolls his eyes when the breathing tube is mentioned, but makes a sort of shrugging 'what can you do' gesture. 

Rick is great with his patients and she's a little jealous. Not very jealous. He can be as mild-mannered as he is because just looking at him convinces his patients that they'd better stay on his good side. It wouldn't work nearly as well when you weigh 100 lbs. She suspects Mayumi has that issue a lot, which is why the charge nurse tries to avoid ever giving her the 'old men with dirty minds' archetype of patient. 

They get the patient intubated. It goes pretty smoothly; he's one of those lucky fuckers whose blood pressure seems to barely respond at all to propofol. Rick informs Dr Prissan in level but unyielding tones that he is staying in the room until the patient is paced again, one way or another, even if it means pulling the line entirely and putting in a new one. 

Nellie stays to prime and hang a propofol drip for ongoing sedation, and prep norepinephrine as a backup if his BP drops, and she draws labs - peripherally, the guy has incredible veins for his age and Dr Prissan is busy mucking with the 'central line' to make it be a pacer again. She places a new IV, a nice big 18G in his forearm, because why not. 

It's 4:35 am by the time she leaves the room and, again, collapses in a heap at the nursing station. 

Pascal, watching monitors, spins his chair around. "Oh hey! I answered your patient's call bell at like four-fifteen. He threw up a bit in his bag. I gave him some water and fixed his blanket because he was cold - he told me using the picture clipboard thing, that's such a good idea - and I pulled some Compazine for him in case that works better than Benadryl. Oh and took his blood sugar, I saw the sign on the door about hypoglycemia and nausea. It was fine, 77 I think, I charted it." 

"Oh good. Thank you." She would have apparently forgotten about the 4 am check. "He settled down after?" 

"Yeah. I checked five minutes ago and he's asleep again. ...Is he really a wizard? He didn't telepathy me." 

"He probably read your mind, he can't understand us otherwise. But yeah, I made the board so he wouldn't have to, it's tiring when he's sick." 

And she should really go have a look but it's so far.

She logs into the nearest computer instead and starts catching up on charting. 

"...Pascal?" 

He spins around guilty. "What, did I–" 

"You gave him a prochlorperazine suppository?" 

"Yeah? IV was out of stock, it's a standard substitution." 

"I mean, fair. I'm not mad - it'd work fine - I'm just honestly amazed he let you. Didn't you hear about how he elbow-striked an ER nurse for trying to shove something in his butt?" 

Pascal has apparently not heard. The story is related, with appropriate flourishes. 

Afterward, with Pascal looking mildly disturbed, she shakes her head. "You must've seemed very trustworthy. I would say 'or else he's snowed out on sedatives' but I'm pretty sure the elbow incident was AFTER they'd given him way too much Haldol." 

"Huh." Pascal actually smiles a little. "Maybe I did a better job explaining why? I didn't know if he understood but I mimed out as much of it as I could." 

"Maybe. Did OR call about your patient coming back here, by the way?" 

"Mm-hmm. Ten or fifteen minutes. You don't have to help, though! You did so much earlier." 

"Eh. I've got one of the easiest assignments tonight, and your guy's interesting. Hmm, sounds like Ma'ar is set until the next blood sugar comes due, so I'd better get everything I possibly can done in 199 and then we can see what that lovely surgeon is bringing us." 

The OR patient, when he's hustled back down the hall into the unit accompanied by what looks like the entire on-call staff of the OR - surgeon, anesthesiologist, RT, three nurses - almost instantly summons the entire staff of the ICU too, as everyone crowds around with the eager fascination of eight-year-old boys informed that there is something REALLY GROSS to be seen. 

The patient looks like hell, though there's one minor improvement; he's flat on his back on the OR gurney and not even slightly about to code. 

There's a long incision in his abdomen, left open, the surface of his innards covered in what looks a bit like sterile Saran Wrap. He has three drains stitched in place; two are skinny pigtail drains going to plastic suction bulbs and draining a little bit of blood, a third is more involved and flows to a chest tube drainage kit, temporarily unhooked from the wall suction, and seems to be mostly draining clear pinkish-yellow serous fluid. 

Nellie can't help grinning at Pascal's gobsmacked expression. "See? Is that not the most metal thing you've ever seen?" 

His face flickers through half a dozen expressions before settling on a tentative smile. "Huh. I guess it is."