Nod. “Yeah. I’m definitely worried he’s going to be scared. …And hurt himself, more than us, he’s still pretty messed up and I think if I have to wrestle him to get drugs in then he’ll lose. I’m mostly worried that Dr Harrison maybe forgot that he could try to portal somewhere if he’s scared.”

Yes that’s definitely worth worrying about! 

:We need a plan for keeping him calm: she sends to everyone. :I can Mindspeak him and try to be reassuring, but I’m not entirely sure that understanding language will happen before the reflex to Gate, in his waking-up order, so I think we need a plan to interrupt that if we have to.:

”Sure, Marian can be parked with a syringe of propofol ready to push if you warn us he’s thinking about portals.” Dr Harrison does not 100% sound like he’s paying attention, and definitely doesn’t look up from the computer screen.

…Marian is not entirely reassured by this plan but she relays it to Samora. “- I’m guessing you don’t have spells that can specifically help with getting someone to calm down or interrupt them doing a thing that’s a bad idea and will hurt them?”

"Not at this moment, but I could in fifteen minutes! I have an open slot at second circle, which I could use for Calm Emotions--does what it sounds like--or for Command or Forbid Action, which won't affect his emotions but would stop him from acting on a desire to leave. All of those can be thrown off by a strong enough will, but if he's delirious that would weaken his will so there's a pretty good chance. Calm emotions is the hardest of those to throw off but if you're worried about him acting on reflex even in the absence of emotion Forbid Action to stop him from using magic might be better. It only lasts for six seconds, whereas Calm Emotions lasts about a minute, so it might depend on how fast Shavri can talk him into calming down the normal way."

“…I feel better about something that calms him down for a whole minute? I feel like magic that stops him from doing a thing without changing how he feels about it would just make him more scared and it’s - kind of only helpful if we’re deciding to just knock him out again and keep him sedated if it’s not going well? But Shavri knows him better.” Glance at Shavri?

:If you can keep him calm even in an objectively terrifying situation, I think that's probably enough that he won't instinctively Gate out? And it should improve his chances of being able to parse what I'm saying. Marian's right, anything that just forcibly stops him for six seconds isn't going to help unless the plan is to sedate him again before it wears off.: 

Great okay then that one. 

Dr Harrison gets an email. It's just a American airlines flight number and an arrival time at Reno-Tahoe International Airport of 12:05 am. 

(Dr Chen miiiiiight have been too distracted to focus on anything other than the maybe-elaborate-stupid-prank or maybe-the-biggest-deal-of-the-century "case", and staring at flight booking pages, and concluding ninety minutes ago that the 7:33 pm departure with a transfer in Dallas was literally the last option for tonight that wouldn't involve, like, instead flying to Vegas and then driving for seven hours to make it there at 6 am, and wavering for a while that was probably actually only ten minutes, and then calling three travel agents and managing to get a seat under one of the 'cancel anytime literally up to the departure time' policy, and then sitting in the airport still not quite decided if she was actually getting on a plane on the basis of something that might be a stupid hoax, and telling herself that if it does turn out to be a hoax then a bunch of residents need to have the fear of God put into them and possibly lose their medical licenses and so really there's a solid argument for going either way. The email hits her inbox as they're taxiing out from the gate, and she downloads and saves the lab-results pdf to read while they're taking off and the in-flight wifi isn't yet live.) 

Holy shit Dr Chadra did not expect that to work. 

Oh no they have a Top Expert Doctor coming????? What if they're scary???? 

Wow that's absurd and really really cool. Shavri will eagerly relate to Samora in Mindspeech how the doctors found someone with expertise in Leareth's exact specific mechanism of injury from her...treatises?...on their artifice-library that can be consulted from anywhere, and they've been exchanging letters, and apparently the expert is now getting in a...giant piece of artifice that flies very fast through the air? And will be here in the middle of the night, even though it's many hundreds of miles!! They can just do that!!! Apparently on a whim, because it hadn't sounded like the expert was entirely convinced this was real and not some kind of strange joke or practice scenario! 

That's so cool! Earth artifice is amazing! She should learn how to make one of the flying things and bring that to Lastwall too she should do some kind of general survey of Earth artifice and pick the five most world-changing things and study those. But right now what she should do is go pray in a corner for fifteen minutes to get that Calm Emotions set up. Her prayers are about how she's maybe going to be doing high-stakes diplomacy with an Evil person who might or might not be Lawful and how she hopes she has the wisdom and the splendor and the education to do a good job of it and find common ground with him.

They got this guy onto ECMO in what had to be record time for a unit that doesn't make a habit of it, and now by God they're going to get him weaned off it - from what was, like, a somewhat higher flow rate than the recommended maximum - in record time too! 

Dr Harrison is in a very good mood and it shows. 

Wow this is great??? He said thank you to Marian twice? Oh no what if she gets too used to this and is devastated when she has a normal shift again with Dr Harrison as the attending and he's an asshole to the nursing staff she had better be pre-emptively anxious so she doesn't forget about that Marian's brain can stop that it's not helping. 

It is, in fact, incredibly satisfying to, within forty minutes, have a patient who is providing ALL OF HIS OWN CIRCULATION - they didn't even have to restart the norepinephrine, despite him still being on a ton of propofol - and maintaining a gorgeous normal-looking art line blood pressure of 103/66. His sats aren't amazing but he's holding up at like 94% on 40% FiO2 and he does have pneumonia, it's not his fault. 

It's also been long enough to confirm that he's producing pee, in totally respectable if not breathtaking quantities and only a little brown-colored from all the myoglobin his kidneys are straining to filter out. 

His extremities are warm and pink! He's still completely out on 50 mcg/kg/min of propofol, not even twitching when Marian pinches his nailbed, but he's starting to have a tiny bit of a cough reflex, as the paralytic wears off, and his sats and blood pressure tolerate suctioning just fine. 

Ewwwwww that's disgusting should they get a culture or is it not worth it because Samora will just cast Remove Disease on him. 

"Yeah, sure, let's get a culture." This is possibly the longest that Dr Harrison has ever spent in a patient room and willing to answer questions. Despite needing to wear a N95 mask and face shield the whole time! and he's polite and cheerful when interrupted! "We'll want some documentation that the Remove Disease worked. ...Come to think of it, let's get a head CT while it's a good time for it. He'll tolerate being off the CRRT for a while, we'll keep doing serial labs hourly." 

It'll be something they can correlate the Healing-Sight with, their nice magic healer might even learn things from it, and it has the virtue of coming in a shareable file format and being possible to excerpt images from for the truly incredible case study they're going to write later. ...The drawings can maybe also go in the paper but you can't just have drawings, everyone else would think it was weird. 

What, no, why, does she have to Marian knows better than to argue. At least the CRRT machine is familiar and less terrifying to touch or interact with in any way than the ECMO machine, and she doesn't need handholding to flush all the blood currently in it back into the patient and disconnect it. It's probably a reasonable time to be swapping the filter anyway, Leareth's blood has been incredibly messed up and the filter pressures were already rising and if they do have to restart it later the second filter should stay in good shape a lot longer.

She has not had a break of any kind unless you count over an hour of purifying diamond dust out of goop, during which she did think to grab a bathroom break and eat about eight packages of graham crackers while hiding in the patient bathroom. Who needs breaks, anyway, the sweet satisfaction of a dying patient abruptly turning around and drastically recovering is better than breaks. 

"Are we doing the Remove Disease first or after?" she asks Dr Harrison. On the one hand, Leareth is showing no sign of sepsis yet, given the glorious wonderful soothing perfect blood pressure, and if they do it after then maybe it can also hit anything he was exposed to while out of the positive pressure isolation room and trekking through the hospital. On the other hand, field trips are stressful and Marian miiiight be less stressed if she wasn't thinking about his grotty lungs and wondering how quickly he could start deteriorating more given the lack of immune system. On the other other end, a stat head CT is, like, five minutes, it should really be fine... 

"I'd rather hold it as long as we can manage." Unless the magic Healer thinks the patient needs it immediately? Dr Harrison is actually pretty inclined to defer to her, at this point, and glances over at her expectantly. 

:- I'm pretty sure he can handle it. It's actually barely progressing, your drugs aren't going to be able to clear it up entirely without his body helping but they do work.: 

SPEAKING OF THAT Marian should check when the next doses of his five billion antibiotics and antifungals and antivirals are due! ...oh phew it's only the piperacillin-tazobactam, and she's not late on it quite yet, and everything else is q8h and pre-staggered because they had an even greater shortage of line ports earlier and the pharmacy specifically recommended not running all of them literally simultaneously. 

Did she - oh, she did, past Marian is amazing and thought to crack the seal to start mixing the pre-attached vial of powder hours ago and now it's in her pocket and thoroughly dissolved without having to frantically shake it for several minutes. 

She hangs it, and makes sure they definitely have backup propofol in case the current bottle runs out - it's running pretty fast - and then starts the process of packing up for a field trip. 

"We're going to go take pictures of inside him," she tells Samora. "So we have a record we can actually send to other people using the artifice, Healing-Sight probably sees most of the same things but it's not as shareable. It's the same place we went with you, before, but we shouldn't have to wait in line." In fact, Dr Chadra is going to run ahead and make sure the hallway is literally deserted and the CT tech knows to do a proper job wiping down the table after the most recent patient and wear a mask when they arrive. "...I don't know if we need you, it really should go fine, but I would feel better if you come just in case." 

"I'd be happy to! Do you want his next Cure Light now, or after? It should do more than the previous one now that his Endurance is back up. Also if he starts waking up early I assume the plan is for you to knock him out again and not for me to use the Calm Emotions?"

Marian at one point had notes on paper about Samora's current remaining spells-that-could-become-Cures and channels, to check off. She's misplaced it at some point, and she thinks it might have included spells that they ended up using as spells and not turning into Cures, but at the very least Samora has three channels left, they're just saving those for last because it's pretty wasteful to use them on a single guy shut up in an isolation room (who can't even benefit from nearly the full amount of positive energy that a Samora-channel includes, but Marian has formed the impression that this is just true of all Earth patients).

She should update the tally, though, it'll be so embarrassing if Dr Harrison asks and she's lost track. 

"Remind me how many unused spells you have left that can in theory be turned into Cures? I think we should have plenty to get through the night, especially if he gets more from this one, but I don't want to lose count. ...Also he really shouldn't wake up, he's on an insane dose of drugs to keep him unconscious, but yeah we should save the Calm Emotions for once it's a planned wakeup." 

"I have the Remove Disease, the Calm Emotions, three Remove Sicknesses it's pretty costless to use as Cures, and three channels. How long is it until I'll have tomorrow's ready, sixteen hours or so? So I can do one now, one in three six nine twelve hours, and still have one spare if there's an emergency."