"I mean, he squirms constantly. I think Elle grabbed the care aide to fix him up in the bed, since as usual he was half fallen out of it, that would've been at - nine?" 

"Ah. Thank you." 

Pause. 

"Do you need help with anything in here." 

Isobel glances down at her clipboard. Frowns. "I'm going to run out of norepinephrine in twenty minutes and phenylephrine in thirty-five minutes. And I need to send more labs at midnight. Other than that I'm fine here." 

It would be so much easier to hate Isobel as a person if she didn't always know exactly what was going on with her patients.

"Got it. I'll make sure we get that to you." 

The comatose patient in 195 has only pooped a tiny bit and there's a spare pad on the counter so it barely takes longer to turn him. 

Nellie still has the pending sense that she owes Isobel certain prepared bags of drugs and lab tubes at particular times, and she's really tempted to just give her the dumbass hypothermia kid's leftover bag of norepinephrine that will otherwise go to waste, but that is definitely against policy. And also dumbass kid might be a wizard and might have alien smallpox. She doesn't feel like the latter is very likely even if the former is true, it turned out fine in Ma'ar's case, but still. 

It won't come up for fifteen minutes, which should be long enough to book it back to her patients and actually lay eyes on Ma'ar. 

Emmy has, in the interim, shut the main door, slapped one of the isolation warning posters from the vestibule on it, and turned on the negative pressure system. She's lurking in the vestibule, texting on her phone and frequently looking up worriedly at the patient's monitor. 

The monitor is readable through the door, and it kind of looks like things are improving, actually! The kid's body temperature is up to 29.1. His heart rate is holding steady at 45 or so. Blood pressure a perfectly respectable 105/49. Sats at 92% on 100% oxygen but you can't have everything. 

She raps on the door to the vestibule. 

Emmy twitches, glances up, and then hurriedly stuffs her phone away, Purells her hands, and exits. 

"- Sorry, I was– anyway." She was hiding but she isn't going to say that out loud. "He's seemed stable. I talked to Dr Zee and she wants him on methylprednisolone q4hours. Do we have a weight for him? The dosing in the study she was looking at was in mg per kg." 

"I cannot claim I actually checked before but I did check the bed was zeroed. I'm going to guess sixty kilo, he's tall but he's scrawny. But I'll go get a weight if you really need one." 

"I think I'd be more comfortable with that. Sorry. I know isolation is really convenient. Er, once you've done that, feel free to put in a verbal order for, one sec–" She digs out her phone again and fiddles her way to the text message app. "Dosing protocol is 5mg per kg of ideal body weight - that'll just be his actual weight, he's not fat or edematous - per 24 hours, then divide that into six equally spaced doses." 

Cool. Great. She will GOWN UP and MASK UP and forge into the room. After checking the drawers in the vestibule and shoving a bunch of random items into a styrofoam cup that just happens to be sitting around and hopefully hasn't been drunk out of. There's no point going into an iso room just to do one thing. 

Even with Nellie only putting a bit of effort into removing the excess weight of various tubes and wires and lines from the bed, the patient apparently weighs in at 58.6 kg. 

"That has got to be a BMI in the underweight range," Nellie mutters under her breath, and starts attaching stickers with date-and-time labels to all his IV lines, before transferring them to the shiny new femoral central line. 

The formerly-hot-water bag hooked to the patient's OG tube is now down to its last dregs. The extra-large catheter drainage bag, on the other hand, must have four or five liters in it, and looks almost ready to burst. 

Nellie sighs, hunts for a receptable, finds nothing but the stupid potty-catcher hat for getting urine samples (why do they even have those in standard stock here, there isn't a single patient in the ICU right now who is capable of walking to their adjoining bathroom to pee), and grumpily makes eight trips back and forth to the toilet to empty the bag.

She hooks the OG tube to suction. Notes that the drainage is coming out mostly clear, now. 

The patient's temperature is up to 29.4, which is a third of a degree in ten minutes (Nellie has to spend several seconds doing mental math to ensure this isn't exceeding the safe rewarming rate of 2 degrees per hour; it's not but it's right on the edge of that.) 

His O2 sats are less happy, though, now hovering around 90% and setting off the yellow alarm.

Which Nellie DIDN'T NOTICE immediately because someone must have silenced the alarm from the nursing station before it could get her attention! Grrrrr! 

She...is kind of running low on immediate responses to this. And is really hoping this patient manages not to die on them before they get the fancy Rotaprone bed, now due in seven hours and counting. In the slightly longer term, giving him steroids might help his lungs from getting worse, but she's not sure whether to expect much short-term improvement? 

She can at least raise the head of his bed somewhat and suction him. 

The patient does some concerning ventricular beats on the monitor when she moves him, but settles down quickly. 

When she suctions in his lungs, even more concerning-looking pinkish foam comes up the tubing. 

Also, the patient coughs and tenses all his muscles and then tugs ineffectively at his restraints. 

GODDAMNIT. 

Can she afford to give him any more drugs? His blood pressure is tolerable, she can probably get away with bumping up the midazolam. Though it's not fast-acting, and she really doesn't want him waking up - probably if he can tolerate a higher hourly rate, he can also tolerate a 1mg bolus right now? She'll do that, then. Put it in as a verbal order from Dr Beckett later. Dr Beckett (or Dr Zee) might even have given her an actual order for boluses, Nellie just failed to take any notes and is spectacularly behind on charting.

She does not have any midazolam boluses on her, but she pauses the pump, glances at the current remaining bag volume (94ccs, the concentration is 1:1 and he really hasn't gotten very much at the 1 mg/h rate), then goes in and edits the remaining volume to 1ml, and the hourly rate to 999, and restarts it. It's running into the same line as the dextrose, it should go in quick. 

It does! The pump is beeping for ""empty bag"" seconds later. 

The patient gradually relaxes. Though he might have done that anyway, since she's now stopped doing horrible things to him. 

Great.

She still needs to suction him more, though, she does not like whatever the fuck is going on in his lungs. She...kind of things he should be more thoroughly out, he's just going to get more awake as they rewarm him and he's probably going to start shivering soon and that will just result in burning more oxygen, which he cannot afford to do right now. 

(Also he might be a wizard, in which case he might or might not set things on fire if he wakes up too much.) 

She gives it another minute of puttering around the room and glaring at his O2 sats. 

Which go down to 89%. The patient isn't moving, exactly, he's stopped pulling against his restraints, but the muscles around his neck and shoulders are still tensed. 

Maybe they should chemically paralyze him or something? On the one hand that will make him even worse at clearing his lung secretions, but on the other hand he might stop doing that. 

(On the third deformed monstrosity hand, if he's a wizard and he wakes up while paralyzed he might set something on fire before anyone has the chance to notice something's wrong...) 

She suctions him again.