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dath ilan marian alt in atlas shrugged
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"I'm sorry about the noise." Earth is apparently really bad at sound-isolation tech in general. She wonders why; she didn't think it was that complicated, and they've got trains. "I haven't forgotten about finding you a book, sorry, it's just that something came up."

And then she forges off in search of the doctor. 

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The doctor is doing some paperwork.

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Merrin clears her throat. "I'm sorry to interrupt, but I have an update on Sherry Williams in room twelve. I think her condition may be deteriorating and we should triage her as higher-priority." She still doesn't really understand what the triage levels are, here, but, "- um, to clarify, probably highest priority? She looks like she's going into shock and I don't know why." 

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"Do what you can for the shock. I'll put in an order for IV fluids." He gives her dose and timing information that's not what Merrin's training suggests as optimal but not wildly wrong either.

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"Thanks. Um, should we go ahead and do some diagnostic tests at the same time? My top guesses are that she's either bleeding internally from the fall or she's got an infection." The treatment at this exact moment will be the same either way, but she has no idea how long blood tests take to get results on, here, and she's feeling pretty antsy about getting that information as soon as possible. Unfortunately she has very little idea what the names of the relevant tests would be, here. 

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"When I want a diagnostic test I'll tell you," he says with some annoyance.

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What. 

"Um, I understand if you want to assess her yourself first, but in that case I would strongly advise that you come do that right now or as soon as you finish your current mental stack," Merrin says calmly. Wow this language is really terrible for communicating. 

(She is not at all considering this a hostile or confrontational interaction; she has information, the doctor has different information, they need to reach common-knowledge on the situation as efficiently as possible and unfortunately are operating at a disadvantage due to their very different training, but she's not actually worried about resolving this, just that it'll take longer than usual.) 

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"Stop telling me how to do my job and go do your own!"

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"Um?" Merrin says blankly. She is utterly caught off guard, and her mind is mostly focused on planning for the patient in bed twelve but she's not so focused on it that she misses the signs of SUDDEN CONFLICT, which from her perspective is totally inexplicable and came out of nowhere.

(Maybe he's...having a really awful day for unrelated reasons, like, he had a fight with his partner or his kid is sick or something? Anyone in a position of responsibility in dath ilan would have the necessary training not to let it slip into their job like this, but she already knows Earth is different. She should remind herself to be charitable.) 

"Where I'm from," she says quietly, "my job involves giving you all of the information that I believe I have and you don't, and that includes my recommendations. Which I've now done. I'll go start the fluids." 

And hopefully give him a minute to cool off and realize that he's slipping on Dignity and recover gracefully from it. 

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He mutters something about new people as she leaves.

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She gets the fluids. (This takes longer than she would really prefer, poking around the supply room, but no one seems available to help and she's also feeling a bit irritated and off-balance, and doesn't want to risk taking it out on someone else before she gets herself calmed down.) 

The patient didn't even have an IV, so she collects those supplies as well; presumably she doesn't need to separately ask the doctor about that, it's implied by the treatment plan. 

This leaves her arms rather full. In dath ilan there would be trays or baskets conveniently placed to deal with this. Earth hospitals are not so well laid out, apparently. 

"- Hey," she calls to the charge nurse as she passes the nursing station. "Just wanted to fill you in - I've taken over bed twelve for Cathy, she seems really busy and my other guy is stable, and twelve is looking shocky. I got some initial orders from the doctor and I'll keep you up to date?" 

This is a MUCH less informative report than she would usually provide, but English doesn't make it easy to give more information in a reasonable number of sentences. It's very frustrating. 

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Squint. "Did Cathy say you could do that?"

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This seems like incredibly not the point to be focusing on! 

"I told her I'd happened to walk past and noticed she looked bad so I did an assessment and her vitals weren't good - I'd expected she would take charge and I could just be backup but I hadn't realized she was so busy, so I offered to take care of informing the doctor for her and getting orders and she agreed?" 

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"Okay, fine, whatever."

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Merrin now has a completely different flavor of alarm screaming in the back of her mind! None of this is going the way she expects it to and she isn't sure what she's missing and now is incredibly not the time to be introspecting on confusing interpersonal dynamics, she's using her brain for other things

Maybe the charge nurse is also overwhelmed? But the unit doesn't look that bad, actually, most of the patients are clearly stable, in need of treatment but not so time-sensitively that their nurses can't take bathroom breaks. (Does Earth medical training just...not include the standard mental exercises for dealing with overwhelm and re-establishing focus?) 

She will make a NOTE of this to think about later so she can stop holding it on her mental stack now. Once she's unloaded her supplies. 

"Thanks," she says with a smile. "I may need backup if she deteriorates more, but hopefully she'll respond well to fluids and we can buy some time for the doctor to see her and do some diagnostics." 

She heads off to return to bed twelve. Which apparently is missing the bedside table; there's a little side cabinet by the head of the bed, but it has a box of tissues and some folded hand towels on it, which she can't even move due to her arms already being full. She settles for depositing her loot on top of the sheets at the foot of the bed. 

"Hi, Sherry. It's Merrin again - I'm going to be looking after you for a bit until Cathy can come see you, okay? The doctor would like me to place an IV and give you some extra fluids, so you should feel better pretty soon." 

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Sherry squints at her. "Did you check on my oven?" 

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Aaaaaaah she should have DELEGATED looking up the patient's chart and finding her family contact information and calling her son. Unfortunately nobody she's spoken to has seemed to be in a position where they can afford to take on any more tasks! This makes time management so much harder and this room - cubicle - doesn't even have a WHITEBOARD. 

"I'm so sorry, I haven't had a chance to call your son yet. He's going to want to know that you're getting the best treatment, so I'm going to start these fluids first and then I can tell him that when I call. You're still at the hospital, Sherry, your oven isn't here."

Talking only takes some of her attentional capacity and she uses the rest to dig out a new piece of paper and, using the wall as a hard surface for lack of anything better, label it with Sherry's name and take down the vital signs from earlier and then mark down a todo list. 

"I'm going to put the tourniquet on your arm, okay? It's going to feel tight. I -" gaaaaah she can't figure out how to operate the mechanism on the cot to raise it, this is terrible ergonomics but probably she can get away with it once? "Have you had IVs done before? I just need to look for a nice vein, and then I'm going to clean your skin and then it'll just be one little poke..." 

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"I don't like needles," Sherry complains. "S'not nice." 

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"Hey, I don't think I know anyone who does like needles. The needle isn't going to stay in, though, it'll just be a little poke and then it's all done, it's only a little plastic tube that stays in you." 

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Sherry grumbles a little more about this, and then starts mumbling something about her granddaughter's school play. 

 

Her skin is thin and spotted, the veins fragile and refusing to plump up. Some of that is probably shock or dehydration. Plausibly some of it is just sheer age; Merrin very rarely treats patients in this kind of physical condition, most dath ilani choose cryopreservation before they end up this frail. 

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And, of course, the people of Earth DON'T HAVE THAT OPTION. 

(Merrin carefully nudges that thought out of the way, because the last thing she needs right now - the last thing Sherry needs, and Sherry is her focus here - is for her to start crying again.) 

 

It's probably not the hardest IV placement she's ever done, objectively speaking - dath ilan normally has better tech for this, and all ambulances are stocked with it, but in the field she may end up doing it by hand. The supplies are unfamiliar, though, and this time she was in too much of a hurry to get a practice kit. (Maybe she should nab some supplies before she leaves, so she can practice on herself?) 

She doesn't get it on the first try, which is AWFUL, and she has to do some careful mental re-arrangement to shut down the pointless humiliation-feelings. 

"Sherry, I'm so sorry, I need to give this another go." Although trying the exact same process again and hoping for better results is...predictably not the best decision procedure to follow and so she should try something smarter than that. 

She...should use gravity? Merrin wrangles the bedrail down. The mechanism is surprisingly non-obvious. She doesn't swear at it out loud because that won't accomplish anything and it might be stressful for the patient but it's tempting.

"Sherry, hey, I want you to let your arm hang over the side of the bed like this, okay? To help me find a vein."

She could use heat? The problem is that she really can't walk away right now - the bedrail's down, the patient is confused, she's already got all her things set up in a precarious placement on top of the sheets. 

Are any nurses nearby enough that she can call to them and ask for assistance here? 

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The nurse who had dog bite kid is charting but seems unhurried and generally non-overwhelmed!

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Merrin risks leaving Sherry's side for thirty seconds and darting away as far as the aisle between the wall of cubicles and the nursing station. "Hey!" she calls out. "Do you have a minute to run an errand for me?" She's not going to shout about the reason why; Sherry will hear her, and get even more anxious. 

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"What do you need?"

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"I'm having trouble getting an IV. Do you have any way of applying heat to get the veins to surface more? ...Where I worked, we had instant chemical heat packs," whyyyyyyyy is that four entire words, "not sure if you've got something comparable? Or other tricks worth trying?" 

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