Up close he looks...well. Bad. She doesn't have better words for it. There's an ashen-grey undertone to his brown skin. His lips are greyish-purple. He's not hypoxic - at least, if that's an accurate O2 sat reading, which given the dubiousness of the waveform she's less sure of than she would like - but his breathing is steady and unlabored. Shallow, though. And slow. The heart monitor leads are picking it up fine, now that he's calm and holding still, but the current reading is 9 breaths/minute. 

Emmy does not like this. 

She glares at the thermometer. It still has the flickering bar that means it's trying to get a reading. It's been saying that for nearly a minute now. 

Eventually the screen blinks, almost apologetically, and changes to LO READING. 

...Well. That is...somewhat less reassuring than 'we couldn't get a reading'. There are lots of ways to fail to get a reading, especially on a combative patient. But this one sure looks like the patient is colder than whatever minimum temp this thermometer can pick up. She's personally used it and seen temps in the 34s, so it's...lower than that. 

Yikes. 

"Patricia?" Emmy calls out. "Pat, hey, do we have a better thermometer than this one anywhere? It's reading LO. I need one that goes lower than, uh, than whatever this one does." 

"...Right," Patricia mutters as she presses a button on the IV pump. "Paramedics said something about that. I figured user error, that they'd gone for axillary when he was in wet clothes or something - they said their machine goes down to 32, and that's got to be wrong, he looks too okay." 

Emmy bites her lip. "...No, I'd buy it. He looks sick to me." 

     "His vitals are all right, though?" 

"We don't have all his vitals. Ask the charge nurse for me, please? You guys should have a low temp thermometer - if not, maybe ICU does...?" She would offer to go ask herself, but right now her instincts feel that staying NEARBY is important. 

There are voices...?

Mostly what Ma'ar feels, right now, is very very far away. Numb, floating.

It's a relief, to leave behind everything that hurts. He's so tired. He remembers urgency, no time to rest, not now, because– he can't remember what was so urgent. But it would be so, so good, to finally rest. 

He remembers an attacker, though the details fade into mist. 

...He remembers someone there, surface thoughts bright and clear and promising he was safe. 

The last thing seems better. Maybe he's going to pick that one, and go to sleep. 

A more urgent pinging from the monitor grabs Emmy's attention.

Heart rate 46. No, 44. The smooth valleys between each spike stretch out longer. 

Down to 39, and the pinging changes to an attention-grabbing RINGRINGRING - and stops a moment later as the patient's heart rate stabilizes around 42. 

Blood pressure - how often - for fuck's sake the monitor is set to take it every HOUR. 

Emmy also doesn't think she's too important to change monitor settings herself. She finds the button for a manual blood pressure and then, with some effort, hunts and pecks her way into the settings menu and changes the frequency to Q5MIN. 

...The automatic blood pressure cuff inflates, and starts to deflate, and loses signal and tries again. 

Something is squeezing his arm really hard, enough to hurt kind of a lot. But Ma'ar is too far away to care, now, and the soft grey fog waits to cushion him, to muffle everything that hurts... 

The monitor eventually gives up and settles on displaying a blood pressure of 71/39, which it immediately starts screaming about. 

Emmy really hates it when her bad feelings are accurate. 

"Pat!" she yells. "Get back here– HEY! I need some HELP in here!"

She does her best to imitate the calm yet commanding voice that some of the older ICU nurses can pull off. She's not them, though, and it instead comes out sounding panicky and hysterical, which she also hates, it makes her sound like a twelve-year-old. 

It does successfully summon a few nurses, though, including Matt, the charge nurse on shift tonight. 

"Dr Beckett. What's going on here?" 

He sounds calm, maybe a little bored. 

Emmy could kiss him for that. 

"It's our ETOH patient." ETOH: medical shorthand, based on the chemical formula for ethanol. Translates to 'drunk as a skunk'. "Paramedics never did get a temp on him. I couldn't either. He did manage to fall in the river, and he was outside for who knows how long before that, I think he's more hypothermic than we realized. And he's looking pretty crashy." 

Matt, to his credit, nods seriously and rubs his hands together and doesn't make any quips about men in skirts. "Right. I already sent Pat over to grab the low-temp thermometer kit. The standard ones go down to...thirty-two, I think–" He breaks off. Scowls. "Can someone silence that motherfucking alarm, I can't hear myself think." 

(One of the newbie nurses does, looking somewhere between excited and sick to her stomach.) 

"Anyway. Other orders?" 

Emmy hasn't gotten that far yet and she could cry. 

She's a big girl, though. She can say some incredibly obvious things while she tries to think of clever things. 

"- Er, right. Prep an intubation kit - get an arterial blood gas for me, I want to know if he's acidotic, given the low resp rate and all..."

She can't remember off the top of her head how hypothermia interacts with blood pH. Presumably in a way which is...bad. How helpful of her brain to produce that information. 

"- get another blood sugar too. Uh. Give him some IV fluids– uh, warm fluids, don't want to cool him down any more -" 

People are hurrying to do this. 

There are voices. 

Far away, there's another pinprick of pain. The grey fog lies heavily over him, though, and Ma'ar doesn't care much. 

Emmy watches the monitor, then turns as Patricia finally makes it back. "- Hey, was he throwing that many PVCs before?" The monitor is binging plaintively again; in between the neat spikes of a normal-but-slow heart rhythm, there are frequent wide, ugly ventricular beats. 

     "I don't think so? Uh, I found the low-temp thermometer, should I...?" 

"Please. And let's get the warming blanket on him, what's-it-called, the Bear Hugger one?" 

     "I think ICU has it?" 

"Well, send someone to get it ASAP." 

This time, Ma'ar doesn't respond at all to the thermometer under his tongue. 

He was more responsive before. Emmy has an uneasy feeling about this new convenient calm. "Pat, how much Haldol did you end up giving him?" 

     "I gave him five, like you ordered." 

Emmy nods. She can't exactly get annoyed about orders being followed exactly; she'll have to settle for being annoyed at herself for not thinking it through. "Well. I don't like how sedated he is. Can you try to -"

     Patricia interrupts her with an alarmed sound. "Uh. Temp is...I don't know if that can possibly be accurate, it's reading 29.3?" 

"God." Emmy takes a deep breath. "God. Maybe he wasn't drunk. If he's really that hypothermic, it'd explain the mental status changes." And if that's the case then she's going to be so embarrassed when she has to explain it to the attending in a few hours. "Guess we'll know when the tox screen comes back. Is someone getting that warming blanket right now?" 

Patricia is still staring blankly at the thermometer. "Uh. Not sure. Matt?" 

     "I'll call them, maybe they can send someone over with it." 

"Right." Patricia sets down the thermometer. "You wanted fluids? Matt, can you put saline bags in the microwave?" 

     "...Honestly I have no idea. I think the OR has something for it? Maybe ICU knows, I'll ask them too." 

This conversation - or maybe just the fact that it's 3:30 in the morning and excluding catnaps she's been awake for thirty hours - is making everything feel so surreal. Emmy's brain is helpfully remembering to her that the blanket-warming cabinet has a sign on it mentioning saline bags. Except it explicitly says NOT to put them in the cabinet.

"Civic had a rapid blood transfusion machine that came with a warmer? It was a bitch to set up though, and I'd rather get a move on this, I don't love that BP. Umm." She's tempted to just Google whether you can microwave IV fluids– actually, that's a good idea. If the Internet thinks this is safe then it might also have directions... 

...The Internet rapidly answers her question: yes, someone has thought of this before and tested it for emergency situations, you can, 2-3 minutes recommended. 

She relays this to Patricia while Matt waits for someone to answer the phone, and conveys his request, then confirms that the ICU can send someone over in a couple of minutes. Which probably means ten minutes. 

"Pat? In the meantime let's at least get some heated blankets from the cabinet on him? Maybe, like, five of them?" 

Ma'ar is having a nightmare. He knows it's a nightmare, and yet for some reason it's impossible to wake up. 

In the dream, he can't move. The reason for this keeps shifting. Now he's in a coffin, about to be buried alive; no, he's in a giant grey spider's web; now he's on a frozen lake and his limbs are iced in place... 

There are voices, and in his nightmare the voices belong to Urtho's armies, as he evacuates his Tower. Because Urtho was willing to sacrifice his own life to keep his works out of Ma'ar's hands, but not the lives of those loyal to him... 

He knows it's too late. Some part of him remembers that Urtho is already dead. That even if he could free himself, he couldn't stop it. 

Still, he tries to call out - a warning, an apology, a final farewell, he isn't sure which. He tries, but his throat doesn't obey him, and Urtho isn't listening, any more than he listened to Ma'ar's letters during the war. 

He watches Urtho die, and he tries to scream but can't, and the horizon is flashing to fire but somehow it's cold. So cold. 

Emmy shakes out the final blanket from the stack, fresh from the heating cabinet, and drapes it over the patient, tucking it in around his chin and then checking that the IV line from his now-buried arm isn't kinked. The freshly-warmed bag of half-saline half-5% dextrose is flowing well, but she absentmindedly gives it a squeeze anyway, frowning at the patient's face and trying to decide if she thinks he looks dehydrated. 

...Wow, she really isn't liking this guy's complete lack of reaction to anything being done to him. She doesn't think 5mg of Haldol should be hitting him this hard? And she's uncertain enough that this calls for consulting Doctor Google again, but she doesn't think a temperature of 29 C should result in complete unconsciousness? And he was responsive before... 

She replays the brief report from the paramedics again in her head. He had a loss of consciousness on the scene. Very suddenly, it sounded like, if right before that he'd climbed out of the water on his own. 

A head injury? He did supposedly jump from the bridge - come to think of it, it's possible she ought to check for broken bones or internal injuries, she doesn't know how long a fall that was - and he could have slipped and hit his head when he was climbing out onto the ice. Maybe this calls for a head CT. Not that she especially wants to take him off the unit right now. 

...Well, she can do a more thorough neuro exam, at least. 

She checks the patient's pupils with her penlight. Dilated, and reacting sluggishly to light, but they're equal sizes and do react at all. 

In Ma'ar's drifting semiconscious-semi-dreaming state, the sudden blinding light is a world on fire. The fire swallows him - oddly, without pain - and he remembers dying and why is he dying again? 

- no, this isn't real - 

- was the war real? He can't keep track anymore. Maybe that was all just part of the same nightmare - 

Emmy watches the patient grimace, his muscles tensing. That's...some sort of a reaction, at least? 

"Hey! Can you hear me? Please open your eyes! Can you squeeze my hand?" 

There's a voice calling to him. Shouting, demanding, almost pleading.

In the dream/nightmare, it becomes his mother's voice. He can't see her face, and he can't move to look around, but he can see the blood. So much blood. If he could go back, then maybe he could save her. But he can't. He's caught in a grey spiderweb of mistakes he can never undo, and it's too late, and he's lost everything. 

I'm sorry, he tries to say, but his throat isn't obeying him either, and all he can manage is a sort of croaking exhalation. 

Was that a response? Technically, Emmy supposes, but not a very reassuring one. 

"I'm sorry about this," she says on reflex, and pinches the patient's nail against her penlight.