"Uh, okay." Marian logs into the computer and starts poking. 

The most recent set of labs, marked as drawn at 6:27 am, are still PENDING. Marian skims through Ma'ar's overnight blood sugars and med record. She divides her piece of paper into its usual quadrants and starts taking notes. 

The vital signs flowsheet, pulled automatically from the monitor, is set to only update hourly. Ma'ar's 3 am temp was 38.1, 4 am was 38.3, 5 am was already 39.5. Can she change that retroactively...? Apparently she CAN. She sets it to q15min, refreshes it, is able to pick out that he was up to 38.4 by 4:30 and then spiked fast. And hasn't come down since. He's had Tylenol, long enough ago that it should have taken full effect by now, and fluids and antibiotics, and he's still at 39.3. 

The heart rate increase starts earlier, she notes. He was in the 60s most of yesterday. There's a big spike around midnight, he was running in the 150s for a while, and then he settles back down, but doesn't go lower than 80. By 4 am he's running in the mid-90s. By 5 am his baseline is above 100, and it hasn't come down since. She's dubious that it's pain-related; the recent dose of Dilaudid didn't really touch it. And his blood pressures are...fine, but not sky-high like they were during his panic attack yesterday, or during whatever the fuck happened at midnight. He's sitting at 108/62 right now. 

She's still working on her coffee and her worksheet, waiting for Nellie, when the phone rings. LAB, it says. She answers it. 

"- Nellie? We got critical results." To the lab tech, "- yeah go ahead, sorry."

She writes them down. Sodium at 126, e.g. really fucking low. Potassium at 2.7, likewise a critically low result. Lactate is 4.1 - not panic-level high but pretty concerning - blood pH is too low, down at 7.28 despite his also-low CO2. His bicarbonate is in the basement. Metabolic acidosis, partially but not fully compensated, his body is breathing faster to clear extra CO2 and raise his blood pH but not all the way. Probably the lactate is responsible. 

Oh and his white count is 32. Not technically critical but it's gone from normal to pretty damn high. 

Marian is starting to wonder if Ma'ar actually is sick enough - or at least will be soon - to make a 1:1 assignment reasonable. She doesn't like it. 

Nellie squints at the numbers. 

"- Acidosis, huh. I could've seen it either way - I guess a lot of what I pulled out of his NG looked like bile, so he could be mostly losing alkali there." 

"You put his NG to suction? I didn't know you could do that with the small-bore tubes." 

"It's not recommended, s'why I didn't! I sat there with a syringe and a bucket and I did it by hand. ...Hid the bucket behind the sink, if you want to have a look. I got like 400 fucking ccs out. Seemed to help, he's still feeling sick but he's not puking. I was loading him up with meds all night and nothing was helping for long, I eventually figured he was all backed up. We gave him metoclopramide, Dr Agarwal thought that might help more." 

"Oh crap. I'd been hoping we could give him the oral potassium liquid stuff by NG but if he's already nauseous he super won't cope with that. Uh. He's really low. We should tell - someone."

The problem with days when the attending doctor is rotating over is that, one, it's deeply unclear who's in charge, and two, they're going to be in the middle of handover and probably both of them will be pissy about being interrupted. 

...Then again, her brain is kind of screaming at her about how Ma'ar looks right now. 

Her brain is not perfect at this, but she thinks it's more likely to miss something than to red-flag a false alarm. 

Don't be a fucking coward, she tells herself firmly. She stands up. "I'm going to go tell Dr Zee." 

"I'm not done–" 

Nellie stops.

"...I shouldn't go home. I - I might've been exposed to, to an alien disease - I've got a roommate..." 

"- Shit shit SHIT. I went to Timmies just now. There were, like, three other people in line behind me - I didn't wear a mask..." 

The two nurses stare at each other in horror for an endless ten seconds. 

Nellie gets her act together first. "Focus on Ma'ar. We'll figure it out. Go." 

She goes. 

- somehow the incredible stomach-sinking gravity of the situation does not make it ANY easier to approach the two doctors and interrupt. That just seems unfair. Marian feels like if human emotions were SANE, then life-threatening - and potentially Earth-threatening - concerns ought to just overwhelm social awkwardness. However. 

She clears her throat. 

"Uhhhh Dr Zee can I talk to you a moment." 

Dr Zee is on her feet in an instant. "Problem?" 

"I think so. Yeah. Uh." Her entire brain is suddenly throwing a blank at her. "...We got a bunch of critical results on Ma'ar just now. Potassium and sodium and his blood gas was bad too and– and uh I went to Timmies and I didn't wear a mask -" 

Dr Zee, to her credit, can tell when someone is overwhelmed and panicking and does not need to be snapped at. 

"Hey. Take a deep breath, all right? We're going to do this. I've got your back."  

She turns to Dr Prissan. "Unit's yours. Give me an hour to focus on 202. He's riding on the edge right now, and he's also our first contact with an alien civilization and I do not want to screw this one up." 

Dr Prissan's eyebrow lifts. "I've been here half the night, you realize?" 

"I do. And you've done some excellent work, so if you're lucky the rest of the unit won't need much. But I badly need some time with 202 when I'm not splitting my attention– and, no, it can't wait until after rounds. I read the man's ER notes. If - when - he starts decompensating on us again, it's going to be fast and there won't be time for conversation." 

Dr Zee regularly manages to be impressive and terrifying at the exact same time, Marian thinks, but this is an unusually extreme example even for her. 

And Dr Zee is already halfway down the hall, with the speed and energy of someone who does Crossfit three times a week and genetically needs four hours of sleep a night. 

"Nellie? Any chance I can convince you to stay on a little while for some overtime? I know you've pulled worse shifts than this before." 

"Well, I can't go home. Don't want to give my roomie alien smallpox." 

"...I'm so sorry." Dr Zee gives it three seconds of silence. "Could you bring the crash cart over here, just in case? And be nearby to pull meds. Marian and I are going in there and we might be a while." 

Marian pulls several blank sheets of printer paper from the sheaf on her clipboard, and selects a candidate pen to live in the room. At some point she needs to go down her personal checklist and load up a bucket of additional supplies that ought to be easily accessible; respiratory isolation is an enormous headache, she won't have the option to pop over to the supply room if something is missing from the drawers. But Dr Zee doesn't seem in the mood to wait for her right now. 

She starts gowning up, placing her N95 mask with extra care; she could well be in there for an hour. 

Dr Zee is doing the same, still calling out orders to Nellie over her shoulder. "Put in a verbal for another litre of saline, forty mEQs of potassium - any chance he can handle the oral elixir? Maybe put in for both, for now - it's going to take ages to safely correct his level with IV, I'd like to at least try diluting it and trickling it down his NG real slow. And put in for another 2 grams of magnesium sulfate, we can give that faster and it'll cut the risk of arrhythmias. ...And let's give him some IV pantoprazole, might help with the nausea. Marian, can you grab a blood glucose for me? Looks like the last one was trending down and it's been a while." 

Glucometer, right, that should live in the room. Marian is fully garbed now; she's technically not dirty yet but it's poor practice to run around the unit in full isolation gear. "Nellie can you grab that?" 

Nellie is frantically entering verbal orders into the computer. She cups a hand to her mouth and yells down the hallway. "Amélie! We need a glucometer plus supplies and another bag of saline!" 

And eventually, loaded up with supplies, Marian slips through the vestibule inner door into the room. 

Ma'ar opens his eyes as soon as the door creaks open, but doesn't try to Mindspeak Marian until she's at his side. 

:You came back: