"Oh. Right. I...should maybe call the on-call attending about that? ...It's Dr Dalrymple, he'll come in if it's looking bad. Though honestly Dr Zee seems a lot more likely to know and she might not mind if I text her even when she's not on call, it's not like it's super late or anything yet." 

"Oh, she wouldn't, wouldn't she! - She did say weeks ago to text me 'anytime' if something 'interesting' happened, which, I mean, was probably meant to be about Ma'ar specifically but you can't deny the intrigue here. How in the name of Beezlebub did he get that hypothermic in an indoor swimming pool? Without being in any visible distress before it got to that point? It's a medical mystery!"  

"Yeah. I have no idea. Maybe there's some kind of bizarre metabolic issue that causes it? When we were debriefing after the whole Ma'ar thing, Dr Zee told me about a woman she saw once over at Civic who came in with a blood sugar of, uhhh, like twenty or something absurd like that - and also a temp of like 32, and they figure it's because she was profoundly hypoglycemic for a while and not - producing normal metabolic body heat? And was also collapsed on her floor in her nightgown and didn't have great heating in her apartment, but that wouldn't normally give a person hypothermia. Dr Zee said if she'd been on, she'd have considered something like that in the differential diagnosis for Ma'ar, though his sugars weren't really low enough for it to seem plausible. But I wonder if something metabolic like that could be going on?" 

"Huh. ....I should get a blood glucose on him, shouldn't I." 

"- Yes, right, please do that." 

"And a chest X-ray, assuming that positioning him for it doesn't make him code on us. I think we'll want to do a repeat in, like - two hours? And again in four? ARDS takes a while to kick in." 

*Acute Respiratory Distress Syndrome, or roughly "your lungs are incredibly fucked up". 

"Right, of course. You can put in the order for–" 

A muffled and distant loud pinging sound. 

"- Sorry I have to go!" 

Ugh. Does NOT bode well for it being a good idea to show up with this guy at the ICU in ten minutes. Then again, it's not as though it's really a good idea to be hanging out with him here. 

She heads over to get the glucometer, finds that none of them are at the usual charging station, considers heading for the nursing station, and then remembers that she left several items pending delegation when she started this phone call. She's been watching Pool (Maybe Not) Drugs Kid's monitor from the corner of her eye, and he's hovering at a heart rate between 38 and 42 which is honestly super impressive for someone whose body temperature is FUCKING TWENTY SEVEN DEGREES CENTIGRADE but she hasn't actually observed if they managed to get a blood pressure reading or, better yet, an O2 sat. 

She turns to investigate this first. 

Her patient is still alive! Someone has even very thoughtfully gone and grabbed like ten of the chemical instant heat packs and is currently putting them in strategic locations. Someone else is trying for a less sketchy IV. At one point one of the staff must have found a pressure bag for the heated saline bolus, because it's now most of the way in. There's a peds sat probe on his ear and a very very shaky waveform, but it's vaguely timed to his actual heartbeats and is currently reading 96% and a question mark. 

The blood pressure reading is still displaying as ???/??, and one of the staff - Grey Scrubs this time - is trying to get a blood pressure with a manual cuff and stethoscope. 

Wow! Competence! Nellie loves competence! She wonders if this is just a luckier than usual staffing arrangement, or if the ER staff got a pointed lecture after the Ma'ar debacle and it hasn't worn off yet. 

"Dr Beckett wants a portable chest X-ray and a blood glucose on him," she says cheerfully. "I'll put the orders in and call X-ray if someone else can hunt down a glucometer for me, they've all gone and escaped on us." And probably the staff who actually work here have a better sense of where they tend to end up. Also there's a computer right there and a phone and she can do orders-entering and calls without actually taking her eyes off the kid for more than five seconds at a stretch. 

He does not do anything especially new and alarming while she's doing this. 

"Uh," says the nurse currently trying to get a blood pressure. He is presumably old enough to have graduated school, given his RN badge, but he looks about eighteen. "I'm getting I think like eighty over forty, but the monitor isn't picking it up." 

"- Sorry, one sec," Nellie mutters to the X-ray tech who picked up five seconds ago. "Makes sense, his heart rate is irregular and that throws it off. We'll get an art line over in the ICU but I don't want to stick around here for it. We should start him on pressors, though - I mean, honestly, that blood pressure might be fine at his current body temperature, reduced metabolic demand, and I'm not sure norepinephrine even works if you're under 28 degrees, but we should do it anyway. Start it at 5 and see?" 

"Ummm. Five...of what? - Sorry, I'm not really trained for, uh, this, I just came 'cuz it seemed you needed hands over here." 

Jesus. Perfect. "Start it at 20 ccs an hour, I think that gets us about the right amount for the standard concentration - you'd normally start lower but I'm anticipating his body will respond to it less. Do that and try for another manual BP in five minutes, we'll see if it did literally anything." 

And to the X-ray tech, "- I'm sorry about that, but can you come in five? Portable chest X-ray, stat– yes the order's in the system, did you even check..." 

Someone arrives with one of the wayward glucometers, and goes to check the patient's blood sugar, and then looks confused and restarts the machine to try a second time. 

Nellie does not notice this immediately because she was trying to get literally any charting done, and is now pointlessly refreshing the page with all the PENDING lab results. 

She notices eventually, though. "- Hey. What's up?" 

"Ummm, I think maybe I did something wrong? I got a reading of 42 but that can't be right." 

It might be! Nellie swears under her breath. In hindsight, it would have been an excellent idea to get STANDING ORDERS for this eventuality. 

- you know what, Dr Beckett is definitely not going to be mad, and will probably be grateful, if she puts in a verbal order for it right now. Her hands are already moving to do it. 

"Yeah, no, I could buy it. I don't know what's going on with him or why - and it could be a little off, he's hecking peripherally vasoconstricted from the whole being a human popsicle thing, but it won't be that off. Do another from the other hand anyway, might as well - and we'll grab one from the art line as soon as that exists - but I'm giving him two amps of D50 anyway." 

Orders in. She goes to do that. 

The intercom yells a long loud beep. 

Nellie jumps a foot in the air, which is honestly pretty embarrassing. 

After what subjectively feels like at least a minute of suspense (it's like ten seconds) the intercom announces a code blue in the ICU. Room 196. 

ARE YOU FUCKING KIDDING.

(These are Nellie's personal notes sheet on the current patient assignments.)

202: Ma'ar the fucking wizard. Trying to wean sedation. Keeps setting shit on fire. 

201: [empty] pool drugs guy?? 

200: 98-year-old female, urosepsis, not intubated. Boring af. 

199: 61-year-old female human disaster, ?? weeks post-bleeding ulcer. Obese. Trach, kidney failure. 

198: COPD dude, BiPAP.

197: Flu CEO. Guillaine-Barré? anxious, abuses call bell for work phone calls. 

196: [empty] rave drugs girl?? 

195: Heroine OD, cooked his brain. Technically under arrest. Handcuffed to bed, family is the literal worst, do NOT let mom and GF in the room same time.

194: 74yo frequent flyer, COPD CHF hypertension. Still looks like a TV anchor in Midwest. A sweetie. 

192: open abdo guy, closed now tho. Trach, off sedation, still not awake but consider: midaz fat-soluble & no shortage of fat. 

190: Crohn's mom w questionable NG tube refusal & sepsis. Improving slowly, off sedations, mostly off pressors. Can't tolerate tube feeds, parenteral nutrition destroying her liver. Responds to family members now. 

188: [empty]

Nellie technically has 195 and 198 tonight and has even managed to lay eyes on them and give 198 his 8pm meds early. 198 doesn't have any scheduled meds until midnight. Both are stable, 198's monitor settings will warn anyone if bad things are happening and 195 is used to this whole circus and perfectly capable of using her call bell. 

Still. Nellie had not expected to be trapped in the ER for - jeez, it's looking like it'll end up being a whole hour. And this guy isn't even technically her admit, she was just being helpful. 

(Shows how far that will get you.)