"I'm joking. Apparently he can cope with suppositories, just wanna make sure he's not about to puke and aspirate before I lay him flat again. In the meantime I think we should draw some labs and give him another bolus, he's losing fluids."

She dumps out syringe #4. That's about a cup of stomach contents and it does not seem like she's done. 

"Right. I, er, want to get a lactate and blood gas - how long has he been having rigors like that? - and two sets of peripheral blood cultures." 

Good kid, she didn't even have to ask. "Great, he'll love that. ...Ma'ar?" She sets down the syringe and puts her hand on his shoulder. "How are you feeling? Less nausea now?" 

He lifts his head, blearily; it's obvious that in addition to everything else, he's still quite sedated, and deeply unhappy to be awake and upright. 

:Less: he agrees. :Still cold. Thirsty: 

"Mmm. I know. Your body wants to get warmer, that's why you're feeling cold, but you're already really feverish. We're going to give you medicine for it and it'll help. And - I don't think drinking any water is wise right now, but we're going to give you more fluids in the IV, and - hmm, here." She retrieves his water cup. "Just rinse and spit, 'kay?" His hands are shaking too much to hold the cup, so she just offers him the straw to sip. 

"Better? Good. How's your pain right now?"

The clipboard seems to be elsewhere. Ma'ar gestures at his entire body and lifts his hand fairly high. 

"Bad, huh? We can get you pain meds, and treating the fever should help too." 

Dr Agarwal is still hovering. "Why don't we try loading him up with Zofran and some metoclopramide?" At Nellie's blank look, "- oh. Reglan. Nausea med, but it helps with gut motility. We should discontinue the antihistamine meds, they can sometimes make that worse. And of course I'd rather we were careful about the opiates, but not if it means leaving him in pain." 

Awwwww, the babydoctor is so much more in his element here! Nellie figures he's probably done a surgical floor rotation; he's familiar with pain management and nausea and random hospital-acquired infections, all common post-op problems. 

"Huh. Don't think we had that in Austin, we just gave everyone domperidone." 

Dr Agarwal shudders a little. "I had a guy once who OD'd on that. Suicide attempt." 

"...Are you kidding, that's got to be some kind of record, who the fuck ODs on domperidone. It won't even kill you it'll just make you shit the bed for a week straight -" She stops herself. "Sorry, Ma'ar. Dr Agarwal, let's try to keep the conversation PG, he's not feeling well." 

Dr Agarwal nods. Clears his throat. "Ma'ar, may I listen to your lungs quickly? We're worried you have an infection, and we're not sure where." 

To Nellie, under his breath: "We'd better culture everything we can think of. Urine culture, sputum culture - how do his line sites look -" 

"Pristine. And they're new. Urine's clear and he's peeing like a horse, low risk for a UTI and I wouldn't expect it to hit him this fast. Seems more likely he picked something up in that ER full of gross people. It is flu season." 

"Oh, is he not–" 

Dr Agarwal stops dead. 

....Wow. She feels like such an idiot. 

She can wallow in it later. Right now, she and Agarwal are exchanging matching looks of horror. 

"Jesus. Of course he hasn't had his flu vaccine, he's not from Earth. Fuck. Fuck. He won't've had any of the standard vaccines..." 

"Or any natural immunity, probably." Dr Agarwal gulps. Looks around. "...These two hallway rooms can do negative pressure, right? Can they do positive pressure?" 

"Probably? Get the charge nurse, she'll know." Nellie hasn't been here long enough to feel familiar with the equipment. 

"Droplet isolation in the meantime. Just in case. I'll talk to Dr Prissan - we should start him on a broad-spectrum antibiotic for sure - and stat chest X-ray, his lungs sound pretty wet but I can't tell how much it's just upper airway. How much O2 is he on?" 

"Two litres–" Nellie stops. "Okay what the everliving fuck, who increased his O2 and didn't tell me. Sorry. 4L by nasal cannula." 

"I'm going to bump him up to 6L. He's burning a lot of O2 right now." 

Ma'ar, head slumped back on his pillow, still pale and shivering with his knees curled up under his gown, reaches blindly in Nellie's direction until she takes his hand again. 

:What is happening?: 

"Oh. I'm so sorry, we've been talking over you." She squeezes his hand. "You seem to have an infection, and we're worried it's one native to Earth and not your world, so your body's never seen it before. We'll start antibiotics - drugs that kill infections - and we'll keep giving you lots of fluids, and treat the symptoms so you don't feel so awful, and we'll take precautions - wear masks and gowns - so we don't give you any of our germs. 'Kay?" 

:Tired: Ma'ar protests. :Just want to sleep: 

"I bet. You're sick and it's five in the morning. Just hang in there, I'll leave you alone to rest as soon as I can." 

It's 5:30 am. 

The next hour or so is packed; Nellie doesn't sit down once. Or leave the room, except for a brief interlude to properly mask and gown up. Mayumi and Kaysi alternate bringing meds and supplies. She insists on drawing the peripheral blood cultures after Ma'ar is pumped full of Dilaudid and nausea meds and is back to falling asleep sitting up. 

And desatting again, but it's at least partly that he's breathing through his mouth and probably not getting all his O2. Once she's sure his stomach is fully empty and he's not going to suddenly vomit in it, she switches him to a facemask at 50%, which keeps his sats at 99%.