Wen Qing does so remember.

"I have a question about the abdominal injuries."

Oooh, food! 

"- Thank you! Sorry, is there any coffee out there?" Marian immediately feels bad, especially since she did in fact trade this morning to get some stimulants for herself, and then took them, and she's - not tired, exactly, her head is sort of buzzing, but she also really just wants something warm to hold onto. 

"I'll fetch it." She's certain that fetching coffee is one of the jobs of apprentices.

Oh no, now Marian feels like she's either being very rude or being....exploitative? Oppressive? She can't think of quite the right word here. 

...She really wants her coffee, though. Even the absolute worst shifts in the Montfort ICU included access to cheap but hot Tim Hortons coffee. 

"Thank you so much! ....I've got some curriculum ideas written down, by the way, we can definitely cover abdominal wounds." 

"Abdominal wounds are what people are most likely to die of."

"- Oh, yeah, right, that makes sense. I'm....guessing people get all sorts of wounds, here? But a broken leg won't kill you on the spot unless you get really unlucky, and it's harder to get fatal thoracic injuries from blunt force as opposed to stabbing or gunshots? ....Uh, sorry, I - I do actually want my coffee before I have to be a prof giving a lecture on this." 

Wen Qing fetches coffee. 

She doesn't really remember the etiquette she learned about apprenticeships; she thought she'd have plenty of time to brush up after the Scholomance. She's pretty sure she's supposed to treat Marian like her mother?

"Awwwww, thank you!" Marian wraps both hands around the paper cup of coffee and holds onto it like it's something precious. 

(It's.....highly mediocre coffee. It reminds her of her clinical rotation attempts to make coffee from the instant-coffee plastic tubes in the patient kitchen plus microwaving water, and then inevitably forgetting to drink the resulting brew until it was mostly cold. Still. It's COFFEE. She is appropriately grateful.) 

"...Uh. Right. So - I had some thoughts about what particular skills and techniques I should teach you ASAP, so that you can make yourself useful if - when - we start getting real emergencies? But, uh, also I wanted to give you a chance to ask questions and tell me what you're interested in first. What do you want to learn about abdominal injuries?" 

"I am interested in the sepsis." (She learned the English word from Grey's Anatomy last night.) "Sometimes people get the bacteria in the belly when the intestines are injured? I'm not always sure how to treat it."

"....Oh, fuck. Yeah. That's - a thing. ...It's honestly pretty hard to treat even with all the expertise we have in a mundane ICU, because a massive systemic inflammatory response causes a fuckton of problems? Like, you can treat the infection itself with antibiotics, but often by the time someone gets to you, their body's already really messed up in a bunch of other ways - you can treat the shock with fluids and pressors, only, we don't have any pressors here, I traded the one bag I had to some trader kid who thought he could maybe get an alchemist student to replicate it–" 

Marian breaks off. 

"- Wow. Sorry. I - that was rambling." Also Wen Qing keeps looking at her with this trusting expectant look which is just terrifying. "Can you, uh, repeat back to me the parts of that you followed?" 

"Sepsis is very difficult to treat with the mundane medicine. I don't know what an ICU is. You treat the shock with the fluids and the 'pressors'-- shock is the cold skin and the shallow breathing, yes? I don't know what 'pressors' are. You treat the infection with antibiotics, like my bacteria-killing spell."

Whoa she has an antibiotic spell–

Okay. Pause and focus and Marian will get back to that. 

"...Uh, sorry. An ICU is also called an intensive or critical care unit, it - was my specialty before I got kidnapped. It's basically for patients who're already really far gone, so if you want to save them then you need them to have a lot of attention from doctors and nurses and a lot of equipment and drugs available. Shock is...yeah, the symptoms are basically your description, it's caused by lack of bloodflow to essential organs but it can be caused in a few different ways. Do you know anything about that yet or should I just explain?" 

"I don't."

"Okay. Right. So - shock is basically when your circulatory system can't get enough bloodflow and oxygen to your organs? The types are - so 'cardiogenic' shock is basically when your heart is in bad shape and sucks at pumping blood? Probably won't happen with students here unless they have congenital heart stuff, it's...mostly an old people thing. Hypovolemic shock happens if you lose a lot of blood volume - can be either literally bleeding out, or dehydration. Septic shock is....complicated, but it's usually a mix of losing fluids - often into tissues rather than out of the body entirely - and also the body's inflammatory response to an infection, if it gets bad enough, messes with how your small blood vessels tense or relax to control blood pressure? So they relax more than they should, bigger diameter, more circulatory space same volume, and so less flow lower pressure - uh, sorry, the physics of why is obvious to me but I don't know if you've got that background?" 

"I take the artificing classes, I understand the physics."

"...Right. Good. So - pressors basically work by mimicking chemicals your body makes, and they making someone's heart beat a bit harder and make their blood vessels constrict - to varying extents depending on which exact kind - and that raises blood pressure. Though it obviously, like, reduces circulation to your skin and extremities, it's not a long term solution– uh, sorry, I don't know if it's actually obvious to you why it does that?" 

Marian is starting to be concerned that she is maybe, possibly, just a bad teacher. 

"It reduces circulation to the skin because the blood pressure is higher so the blood doesn't get that far?"

"I - hmm - so a lot of the way it increases blood pressure is by - basically making the blood need to go less distance? But, like, the way it's doing that is by squeezing the peripheral blood vessels shut, so it's - you can think of it as though it's triaging bloodflow and oxygen, making sure enough gets to the brain and internal organs, skin and limbs are less life-critical in the short term? ...But, like, if you have someone who's really septic and on five different pressors, sometimes you keep them alive and then their fingers and toes die and fall off. Happened to a patient I treated once." 

Pause. 

"Uhsorryifthat'sgruesome." It's.....probably okay? Magic death school and all. It still seems polite to check. 

"Cool. --I'm sorry, ma'am, I think that was disrespectful."

Oh no does Wen Qing think she's offended now. 

"No! I mean, uh, it's fine, I think it's cool– uh, I mean, not for the patient it happened to, obviously, that sucked. But septic shock is really fascinating! And - right, so if someone has an abdominal injury, they've probably lost a lot of blood, yeah? And then on top of that, if their gut's leaking bacteria because it was cut, that's getting into their bloodstream, so they'll be getting hit with septic shock right afterward, and that's pretty lethal without treatment.... Uh. What would you normally do with healing magic, about that?" 

"I try the bacteria-killing spell to help with the bacteria, then the spell that puts more blood into your bloodstream, then I try to encourage the stomach to close up its wounds? I've tried to encourage the body to heal faster but that seems to make the shock worse."

"- Oh. Yeah, it would do that! Actually we often give patients in septic shock specifically drugs that make them heal less well. Uh, I - think you probably know enough things to guess why, if you wanna figure it out yourself -?" 

This is the point at which there's a knock on the door. 

"Uh sorry be right with you!" Marian wants to give her student a chance to answer the question. 

"I think we talk to the patient first? It might be an emergency."