The little "typing" dots pop up instantly. 

They do this for a while. 

[Logging into chart remotely]

[Name & room?]

[Still trapped in Resus] 

[Entered as a John Doe] 

This time, there's a longer pause before the answer. 

[Looks like saltwater drowning not fresh] 

[Very prolonged exposure] 

[Like shipwreck-style long exposure] 

[Looking at case studies now to compare] 

[Yeah still have that impression] 

[What are you doing for him] 

[Mostly really aggressive rewarming] 

[OG & Foley warm water lavage set up here] 

[Gonna hook up the CoolGard on heating mode once we're on the unit]

[Wanted to plan ahead for the ARDS tho] 

[Last patient I had tanked 4h post admission]

[So we're looking around midnight] 

[Hmm so if it's real saltwater drowning that's a good prognosis for ARDS] 

[He should be proned but your unit doesn't have a rotaprone bed in stock] 

[Maybe better to transfer out, checking] 

...

[Damn Civic is full] 

[Flu season] 

[Calling the General] 

...

[They can't take him but they can deliver a bed by tomorrow morning] 

See this is why Dr Zee is one of her favorite people in the entire world. She gets nerdsniped and then she gets emotionally invested and then you literally can't keep her away. 

Nellie busies herself hooking up the warm water OG "feeds" - too bad it doesn't come with separate lumens for intake and suction, her old hospital stocked those but Montfort doesn't - and the tube placement isn't technically confirmed by a doctor but it's clearly pulling stomach juices along with all the water, there's like 500 ccs of it and yep when she lifts the suction lid it sure does smell like the seaside. 

(She is not about to taste it.) 

She charts atropine pushes and ""verbal"" orders and checks blood glucose again - it's 68 - and she gives another amp of D50 and charts that and finally her phone buzzes again. 

[Rotaprone bed incoming 6 am] 

[This things costs as much as a new Ferrari so don't break it] 

[Should I come in] 

[I mean you're not even on call & probably Dalrymple should just come in already] 

[But he might appreciate the backup] 

[I'll call Dalrymple] 

[texting Beckett that I'm putting orders in] 

[do NOT give any more saline] 

[next bolus try half-NS 1L] 

[& get him to the goddamned ICU] 

This is going to be easier said than done because all of a sudden she has loads of things on IV poles! Which is kind of exactly what Nellie wanted to avoid here! 

She requests the accompaniment of the care aide and a respiratory therapist if they can track one down, and gets a microwaved back of 0.45% saline going (half the salt concentration of 0.9% "normal saline") - that can go on the built-in pole with the gurney - she's going to pause the hot water "tube feeds" and clamp that and give the OG a couple of minutes on suction because it would be especially inconvenient if the kid pukes mid-hallway. The 3L bag hooked to the Foley catheter is already swaying precariously, so she sighs and clamps that and just sticks it between the patient's legs. 

And they're off! 

Mayumi is outside 201. "I think tonight is too exciting! Marika has a triple assignment until Rick gets here! I have the machine ready for you and a sterile tray for the central line but Dr Beckett needs to finish an art line in 196 before she can come place it. Also I heard we're going to be proning him? On one of the fancy beds meant for that? I've never used one before! Have you?" 

"Oh, yeah. Couple times. Helped other nurses more times. What...do you guys normally do if you have to prone someone?" 

"One time we tried to put a lady just facedown on the normal bed but this did not work very well." 

"Jesus on a stick. I'm not surprised!" And she should really stop being surprised that this understaffed under-resourced hospital resorts to things that sound incredibly sketchy to her. 

"She was very doomed! She had decided to take all of her colchicine for some reason." Mayumi peers at the portable monitor brick, which is pinging anxiously. ".....Does your patient normally do that?" she says mildly. 

"God why would you do that– sorry what? I can't see from here?" Nellie is trying to maneuver the stretcher right up next to the nicely made clean bed. 

"He did a pause. I think three or four seconds? And heart rate at twenty now." 

"Oh, yeah, he does that. One sec, I've got a syringe of atropine in my pocket. Can we get some more hands in here to help transfer him? Best time to move him will be right after I give it, he seems to handle anything and everything we to do him by doing that." 

"Yes, of course." Mayumi hits the 'nurse assist' button on the wall, which rings faster and more urgently than a patient call bell, and then starts absently checking for pedal pulses. "....I can't find any pulses. Did he have them before?" 

"Doubt it." Nellie pushes the atropine. "Do we have a glucometer in here? On top of all the other crap, he's doing some wacky hypoglycemia." 

Mayumi pauses. ".....Really? That sounds a little bit like Ma'ar." 

"I guess, but he can't be a–" 

She stops. 

"........You know. Now that I think about it, another thing he has in common with Ma'ar is that the history is baffling. Everything looks like a saltwater near-drowning with prolonged exposure to cold water but they found him in a blasted swimming pool." 

Mayumi hooks up the monitor bring and starts unscrewing and transferring the norepinephrine and midazolam pumps from the gurney pole to the IV pole already in the room, with a triple-bank of pumps already on it and ready to go. "If he's a wizard too, maybe he did a portal there?" 

"You know, personally, if I was drowning in the ocean, I wouldn't do a portal to somewhere else where I'd keep drowning. But tastes could vary on that one, I guess." 

The care aide arrives and they slide the patient over onto the ICU bed. 

The patient startles again when moved, but this time Nellie is ready for it and has a hold on the trailing end of his restraints, and again his movements really aren't very purposeful or competent.