Subject: RE: Radiation case - urgent questions

REMOVE THE CANNULAS NOW. His coags are a gift (INR 1.3, plt 129, fib 192). You will not get better than this. At this radiation dose he should be in DIC already. If those cannulas are in when he wakes up and he moves wrong, he bleeds out femoral artery in <5 minutes. You cannot get control fast enough. I've seen it. It's bad. He's stable off ECMO support, get them out, do NOT reduce sedation with cannulas in place.

STRICT NPO. TPN ONLY. Do not feed this man! Radiation gut = dead crypts, mucosa can't regenerate. Feeding = translocation = sepsis. If your specialist says cells "alive but can't divide" that's exactly why. 

Will answer other questions at layover.

--

Sent from my iPhone

THIS POOR DOCTOR.

...Okay so it sounds like they have a todo list item to take out the terrifying enormous ECMO cannulas before they do anything else. Great idea! Marian...is kind of scared of them, actually, and is quietly hoping this is not a nursing scope of practice thing to do, or at the very least that Clarice will handle it. 

(Man, it sure would be nice if they'd gotten that information before deciding that Samora should use a Cure spell pre-field trip, because that would be a great way to guarantee a lack of problems by immediately fixing the holes in him, but it's in fact not obviously worth moving one sooner. Marian is becoming quietly background-aware that it's not only the case that they need to get through tonight, it's - there are other patients in the hospital. What if they get a 2 am emergency admission! Also, like, the patients up on 6C are mostly going to have problems a channel won't fix, but the med/surg units are full of post-op patients and in expectation some of them would have complications that a timely channel could repair. It...does seem like saving this one specific guy might be a really, really big deal, given the whole 'can do portals' part and the access to a third world with a different kind of incredibly cool healing magic, but it's not the only big deal at stake here.) 

Dr Chadra is going to remove the cannulas under close supervision from Dr Harrison! It's a learning experience!

(He does look mildly petrified about it.) 

Shavri is entirely capable of making sure nothing goes wrong! She's mostly avoiding doing any active Healing repair-work in favor of just holding an energy-link to support Leareth's metabolism, but - for the moment - he has close-to-normal stamina for absorbing Healing, and large vessels are already actually pretty good at sealing off punctures, she's mostly focused on convincing the femoral artery not to spasm while she knits the layer of muscle in the vessel lining back together and makes sure the inner lining is nice and smooth and not tempting for clots to form on. 

...It's maybe kind of hard. Not in terms of complexity, in terms of straining her reserves, even though it doesn't take a lot of Healing-energy. She's just...really low. Shavri...is perhaps slightly lightheaded. It takes her a surprisingly long time to put together the thought that she isn't sure when she last had anything to eat. (She did use their weirdly fancy privy facilities at a couple of points, and took the opportunity to drink a lot of water from the taps.) 

:Is there any way I could trouble you for something to eat?: she asks the room. 

You know what that's a great idea! Takeout for everyone! Dr Harrison will take a break from his eighteen tabs of medical papers to call the nearest pizza place for delivery. 

God it's like 6 pm. Marian....is not going to be able to drag herself away regardless, is she, but it would probably be a good idea to put some food in her face before she commits to being here for the hours it will predictably take to slowly wean the sedation. And it sounds like they want to leave the pressure dressings on his former ECMO cannula sites for a while, so maybe now is the best time she's going to have to make a cafeteria trip and get COFFEE. 

Does Samora want to come and get a bit of a break from wearing all the iso gear? Leareth is pretty stable right now and Shavri is still glued to him and should see any developing problems in plenty of time for someone to call Marian's hospital portable phone. (Marian can get coffee and food for Shavri too but Shavri does not really look like she feels comfortable leaving.) 

Dr Chen is having the most surreal day. 

(She purchased the American Airlines in-flight wifi because the flight attendant was being such a hardass about "large electronic devices must be stowed until we reach cruising altitude, ma'am" and she was desperately impatient to check her email for updates, and she's now too impatient to wrangle figuring out how to switch her paid-for wifi to a different device when there are, like, less than forty minutes left on this flight.) 

The radiologist's name on the report looked vaguely familiar. She phone-emailed a colleague and got a confirmation that "Dr Sanjay Venkataramani" is, in fact, an actual fully board-certified and very experienced radiologist who would not just play along with a hoax, and a trauma ICU resident might, just maybe, have at some point gotten their attending's email login, but when in the world would they have gotten a chance to steal the radiologist's EMR login. 

She pulls up the stupid tabloid article on her phone, again, and stares at it.

She opens a new Safari tab and Googles "dungeons and dragons priest magic healing". She clicks on the fandom wiki page (????? how is this her life ??????) about "Cure Spells". Wow this site is full of pop-up ads and nearly unusable on mobile. 

However: what the fuck. 

She clicks on "Cure Serious Wounds" and is informed that apparently this is necromancy. She manages to navigate back and scrolls down and yes, there is indeed one for curing diseases. At least it's not necromancy??? What does any of this mean, this is ridiculous, this makes no sense, this is insane, etc etc etc, but SO ARE THE LABS. 

She navigates back to her email app and starts working on a new draft, though realistically it's going to take long enough to gather her thoughts that it'll need to be finished during her layover or on the next flight. 

A break from the iso gear sounds lovely! "I don't need to eat but I like to do it recreationally, if there's enough for everyone who actually needs it. Also, what's the plan for keeping watch on the patient tonight? If you leave and Shavri goes to sleep I won't be able to talk to anyone, so we should make a phrasebook with the names of my spells and anything else we're likely to need."

Sweet, then they can both de-gear and wash their hands in the antechamber and then head cafeteria-ward! (And Marian is really hoping that there won’t turn out to be an enormous quantity of hospital gossip about Samora that will lead to them getting accosted in line.)

“I might just stay all night,” she tells Samora. “I’m not scheduled tomorrow and it’s a shame to waste half of the language spell duration, and - I don’t know if I can bring myself to just go home, you know? When I don’t know how tonight is going to go for him?” 

Marian is, in hindsight, possibly a bit too emotionally invested in this specific patient, but she’s also genuinely not sure how she could have avoided it. 

Shavri is still parked at Leareth's bedside, Healing-Sight open and focused on him, but her mind is starting to wander. It's really kind of remarkable that it didn't start doing that sooner; apart from all the exciting learning new medical facts, she's been doing the exact same thing for ten-ish candlemarks. 

She's thinking about triage. 

Back in Haven, there are eight patients in the House of Healing, who survived the attack and were able to get out thanks to a timely channel. That early intervention made a huge difference; they were, when she left, nearly all in better shape overall than Leareth is now after the full Restoration.

But worse on Endurance specifically, Leareth is just in a really weird physical state where all of the essential vital functions that maintain his body are in temporarily near-perfect condition and everything else is pretty thoroughly messed up. And Leareth is physically fairly resilient, with what looks like pretty good baseline health on the things she can now flag as related-to-Endurance – certainly he's more robust than either of Van or Stef. Especially Stef, who has never been what anyone would call a physically robust person. 

Blai wasted a Cure spell that didn't work. He only has one channel left. She thinks he had...five?...more spells that could be converted to Cures, and then a Lesser Restoration that hopefully someone else can make the call to use on Stef because he's the least likely to make it through the night and if he dies they'll lose Van too. 

But there's no way that anyone, even Blai or Seldan, would survive nearly an entire day and night on only one more channel. Maybe if they stretch it with Cures, if they had twenty-two candlemarks to cover until Blai's next channels and spells they could space them about eight candlemarks apart and that might, barely, be survivable, with a dedicated Healer supporting each patient all night. But - there aren't enough to go around.

So assume only five people are going to last until dawn. Maybe fewer, if she's wrong about how far they can stretch it. If Blai can last fourteen candlemarks, they could conceivably use one on Seldan and have two each for Van and Stef, and keep everyone alive until the next dawn... 

But it's a losing battle. They'll have more Lesser Restorations, but those only get one problem at a time, so presumably Endurance, and don't seem to get the baked-in damage at all. They'll have two channels - and, again, five Cures, assuming Blai uses his third-circle slot and all of his first-circle slots. Shavri is still not at all sure that's enough to keep anyone except Blai and Seldan alive for another 24 candlemarks until the next dawn. 

But if they can get there sometime tomorrow - if Leareth can get a Gate, while Samora still has spells and channels for other patients - then there should still be at least some patients to save. 

Maybe it's stupid to be agonizing over this, over whether the Healers on duty in her absence will make exactly the right calls and keep as many people as possible alive for one more day. Shavri has no way of affecting it from here. 

But she might, still, have a way to affect whether Leareth is in any shape to pull off a Gate home in the morning. A Gate to Golarion is going to be a much bigger ask, he thought it would take weeks, but a Gate to somewhere he's actually been before...

Maybe it's impossible. Maybe she's clinging to false hopes. 

Gods, she's so tired. 

"That would be really useful, and then I could put tomorrow's Share Language on someone else and give you a break. I'd hate to leave too, right when we're all achieving something together none of us could alone."

Someone on the way to get rid of their tray spots Samora in the line and detours over. "Hi! Are you the lady who was in the news? I'm Kelly. It's very important you should know that only Jesus saves."

Oh noooo. Why is this the thing that’s happening! Can it instead not be happening!

“She doesn’t speak English,” Marian says sweetly through gritted teeth.

Maybe she’s being uncharitable? Due to overexposure to the topic and the agonizing secondhand embarrassment - and firsthand embarrassment! - of imagining herself translating, and thus being forced to spectate in and arguably participate in, this conversation? It does seem really unfair to shut Samora out from getting to talk to anyone else and learn more about Earth just because Marian is going to find it awkward! 

She switches back to Celestial. “Samora, do you want to have a conversation where someone tries to preach an Earth religion to you? If you want to I can translate, I guess, but we don’t have any evidence that the religions here are…true…and I think it might be confusing and frustrating.”

"I really want to know how people can disagree on whether a god exists or not but I know you came here to rest and it would be unfair to ruin your rest. If I don't learn now there will be another chance later, right?"

"Probably, but you have limited total opportunities, right, if you're still in a bit of a rush to get home?" And it doesn't feel restful, no, but maybe that's just because Marian is being awkward about it and she could instead, not be awkward about it. "...I don't mind translating while we're stuck waiting in line.

The thing she said is," wow this is not even going to make sense literally directed translated word for word into Celestial, because of the whole assumed cultural background that Samora doesn't share, but Marian did not promise to unpack the claims made by Christianity herself and anyway there are so many different things people believe about it, if she tried she would probably manage to completely misrepresent this poor woman's faith, "- that 'it's very important you should know that only Jesus saves.' After trying to confirm if you were the person in the news doing magic healing."

On the one hand: Marian is going to dieeeeeee of mortification over being a shit translator, probably actual translators in like diplomacy are supposed to explain stuff where it's obvious there's non-shared cultural context. On the other hand, all she has to go on here is the phrase 'Satanic panic' that at some point lodged in her head and the vague sense that it refers to Christians freaking out over D&D being evil for some reason. It was not covered in high school Comparative World Religion. Also if she lets herself editorialize at all for clarity then she's going to be so tempted to editorialize for less awkwardness even if it totally changes the meaning and she's pretty sure that would be super unprofessional! Probably actual translators are trained in what's professional and allowed and stuff but Marian ISN'T and is ALSO not trained in handling the SECONDHAND EMBARRASSMENT professionally and is. just. going to be as word-for-word and literal as possible and pretend she's not here. 

"I'm Samora! I don't know anything about Jesus because I'm from another planet. Can you tell me about them? Also what does 'saves' mean in this context?"

"Jesus is the only one who can get you into Heaven and save you from Hell, and you'll have to stand before him when you die."

" . . . Pharasma? Uh, created the world and the afterlives, judges the dead for their deeds?"

"Yes, that's him! We call him Jesus here. Do you acknowledge him as your Lord and Savior?"

Huh, Pharasma gets called male here. Weird choice for the goddess of birth but it's not like She was ever human so it's hard to say it's incorrect. "I . . . pray to Her--Him--at the appropriate times? I pray to all the Good and Neutral gods at their appropriate times*. And I acknowledge that He created the world and judges the dead." 

*There are very few times Samora would consider it a good idea to pray to e.g. Calistria, but it's not in principle impossible the way it is for e.g. Asmodeus.

"And he died for your sins, you know that part?"

"What???"

"He was born on Earth as a human and died for our sins and rose again after three days and ascended into Heaven! And if we accept the free gift of his sacrifice we can all go and be with Him in Heaven no matter our sins."

(At this point Marian and Samora get to the front of the line and the translation has to pause a moment while Marian grabs them both some food.)

There are so many layers of misunderstanding going on here and Marian is KIND OF DYING but continues to feel like she has absolutely no idea how to add her own opinions to the conversation without being appallingly unprofessional or, like, giving in to the temptation to literally mistranslate on purpose to smooth the awkwardness over, which would be completely unfair to Samora who probably wants to actually understand what Christians on Earth believe. Anyway Marian is maybe going to have to move to Antarctica and never speak to another human being after this but in the meantime she will do her best to be like one of those phone interpreter translators who are kind of like talking to a computer. 

Both of them need CALORIES. She loads up two plates on a tray with (somewhat congealed) lasagna and garlic bread and adds saran-wrapped Rice Krispie bars and pudding cups from the dessert section.

Samora takes the opportunity to chew on this statement. Surely if Pharasma had actually died the universe would have ceased to exist? Maybe it was actually Her herald that died or something? Either Pharasma has started letting everyone go to the good afterlives, in which case that's the biggest news of all time, or it's wrong, in which case it sounds like something an Evil god would make up--do as much Evil as you want, don't worry about the effects on your afterlife. But telling someone you think they've been lied to by an Evil god is a tricky thing to be kind and polite about even if you're sure, and she shouldn't jump to conclusions.