"Gosh, I don't think we have anything like what you said."

Okay, think. Pretend this is one of those mean no-resources scenarios. "...Can you run a towel under really hot water for me and bring that over?" 

The other nurse looks at her like she just said something very clever. "Okay!" She goes and does that and comes back with a hot but slightly dribbly towel.

"Thank you!" Merrin smiles warmly at the other nurse. "I'm Merrin, by the way - this is my first shift here, I trained in a foreign country so we do things a little differently. I owe you a favor, so let me know if you need help later on in the shift! - If I can beg one more favor, could you find me one of the thermometers?"

They don't have one at every bed, which Merrin thinks is very unfortunate planning. Sherry isn't obviously feverish, but Merrin has a very vague recollection that fever can be less obvious in older people who aren't undergoing all the standard dath ilani age-slowing treatments; their immune response to infection is weaker. (Aging is horrible.) 

She goes off for a thermometer, detours by her own patient, and comes back with the thermometer.

The dribbly towel is not optimal but it'll do, and fortunately she has some dry towels right there to mop up the dampness once she's warmed Sherry's arm for a minute. That, combined with the effects of gravity and the slightly greater familiarity with her materials, lets her get the IV in on her first try, though getting the dressing on it is a little fraught. She stares at the IV bag and IV tubing for thirty seconds before she manages to intuit how to connect them together; it doesn't work the same way as the tubing-to-IV, which is at least the same as the syringe-to-needle, these people have heard of standardization at ALL. The IV bag has a sort of rubber seal at the neck, and the tubing has a hollow plastic spike which she eventually figures out needs to be shoved directly through to pierce it, rather than having a screw-fastening, weird. 

- and by this point the other nurse is back with a thermometer for her, and Merrin thanks her again, the friendliest smile she can manage while her brain is mostly full of planning the order of her next tasks and vehemently wishing she had a PREDICTION MARKET to consult.

(She's done scenarios before where she didn't, of course. Quite a lot of the Exceptions to handle involve the premise of losing access to electronic infrastructure, and Merrin has quite possibly had more practice working in isolation like this than any other EMT in dath ilan, and certainly anyone under 30. Most of it wasn't real, though, and...it makes a surprising difference to her stress levels, that this isn't a rehearsal and - worse - that if she screws up, there's no last-ditch cryopreservation to fall back on. If she gets this wrong then Sherry Williams will be GONE FOREVER. Merrin is trying not to dwell on this too much, it's not helping.) 

Sherry's temperature is 38.2. When Merrin checks her blood pressure again, after squeezing the IV bag hard to send the fluids in faster, it's a touch improved. 85/60 or so. Her pulse is less fluttery but her heart rate is if anything more irregular than before. 

Aaaaaaaaaaaaaaaaaaaaaaaaaaah. 

Okay. Focus. She can do this. 

(Merrin is quietly thinking that she almost certainly can't keep doing this level of emergency-handling, with this little support or known procedures to fall back on, for an entire twelve hours without stopping. Her brain is already kind of aching.) 

She doesn't need to be pacing herself for the next twelve hours, though, she needs to be focusing on this patient. 

- diagnostics. If Sherry is bleeding internally, she's going to need a blood transfusion as soon as possible; if it's an infection, then she's clearly headed toward septic shock and needs antibacterial or antiviral drugs right away. She can't do the obvious blood tests because she doesn't know what they are, here, and the doctor is having a bad day or something and doesn't want to tell her. 

So. Pretend this is the sort of scenario where she has literally no diagnostic equipment. What would she do? 

"Sherry, I need to ask you some questions, okay? And I have to have a look at you." If she's bleeding internally, it'll show, there'll be bruising or belly pain. Though belly pain could also hint at a urinary tract infection... 

Sherry seems if anything more confused than before; it's hard to hold her attention long enough to get the full answer to a question. 

She doesn't remember hitting her belly in the fall and there's no bruising there, or anywhere except her elbow and hip. Her lower abdomen is slightly tender, but she finds it a lot more painful when Merrin has her turn a bit and gently thumps her flank, where the kidneys would be. She admits to feeling 'a bit off' for the last few days, and that she was dizzy this morning and had some nausea, before she fell. 

Merrin thanks her for answering the questions and tries to be reassuring and once she's done as thorough an assessment as she can - noting that Sherry's lungs sound a bit crackly and her extremities are cool with notably delayed circulation. 

With the bag of IV fluids half in, she takes another blood pressure. It's back down to below 80 systolic, and she's not confident in the diastolic number at all but would guess it's around 75/40, which is what she writes down. 

(Aaaaaaaaaah.) 

...She doesn't especially want to leave Sherry alone, even to go find the doctor, but nobody else is conveniently available at the nursing station, and even if she can get another nurse's attention, she's getting the sense that by default nothing here happens fast. 

She sighs, pats Sherry's arm, tucks her blanket in closer but apologetically refuses to give her another one, and then she takes a deep breath, steels herself, and marches off in search of the doctor, who has HOPEFULLY gotten himself calmed down by now. 

He doesn't immediately snap at her again, at least.

"Hey. Um, I started the fluids for bed twelve but it's not really helping her blood pressure, latest was 75/40. She's running a low grade fever and admitted to feeling unwell before this, that probably contributed to the fall at home. No visible signs of internal bleeding, so my guess is sepsis. Where–"

She was about to start with 'where I'm from, we would start a broad-spectrum antibiotic immediately while waiting on test results' but she is still feeling pretty unsure how much social license she has here to just tell the doctor what orders she needs, versus wait for him to say the incredibly obvious thing himself. (Which seems like an absurd and inefficient way for it to work, but - that doesn't not fit with everything else she's learned so far about Earth.) 

"- Um, what would you like us to do now?" 

He prescribes some antibiotics and explains, a bit condescendingly, how to get the blood tests now that he's put an order for them in the chart.

"Thanks!" There is no point in being irritated at him and so instead she will be friendly and grateful. "Um, do you want to give me some quick guidelines on what changes would be worth interrupting you about?" 

"If the fluids don't bring her BP up and another liter doesn't either come and get me."

Merrin had really been hoping for more thorough instructions than that! Normally she would have standard monitoring protocols to work with, with guidelines on every possible change in status. Though also, normally she would have continuous monitoring data automatically feeding into the patient's anonymized online chart, and prediction markets updating in real time. She's starting to realize exactly how much of her cognition is normally outsourced to people smarter than her. Tracking it all in her own head is...possible, it's one patient and Sherry is not, in fact, that complicated, but it still feels like she's balancing on a tightrope with no ground below, and it's exhausting. 

She gets another bag of fluids from the supply room on her way back to Sherry's bed, hooks it to the IV pump behind the half-empty one, and then steals the blood pressure cuff from the empty cubicle next door as an improvised pressure-bag to squeeze the fluids in faster. 

"Sherry? I need to ask you some questions about your medical history. Are you on regular medications?" 

Sherry blinks at her but takes a while to process the question. "...Pills, you mean? Oh, yes. The nice doctor wants me taking five with breakfast. Five! Can you believe it. There's a pink one, and a blue one, and a big orange one..." 

Wow, this is really not informative! 

A couple more questions discern that Sherry has very little idea what her home medications are for; she says vaguely that she thinks one of them is for her cholesterol and one is for her blood pressure, but of course Merrin doesn't know what the first-line drugs for either of those would be, here. 

She sighs. Checks another blood pressure - it's 80/45 or so - which is technically 'higher' but it's not great and Sherry's hands and feet still look under-perfused, so she manages to remove the empty bag from the spike and place the new one, swapping over the blood-pressure-cuff. 

Sherry watches her work without much curiosity. "I'm very thirsty, dear, could I trouble you for a glass of water?" 

"Um, I'm sorry, I think I should hold off on anything to eat or drink until the doctor has a chance to look at your hip and we know if you need surgery." 

"A surgery!" Sherry gives you an alarmed look. "Surely not!" 

Aaaaaah was that a bad thing to say. "Hopefully you won't need it," she says soothingly (although, in dath ilan, almost any hip fracture would be treated that way.) "Just try not to worry, okay?" Which feels like the most inane reassurance she could possibly give, but all her usual scripts with patients would end up taking three paragraphs to convey in English, and Sherry is clearly still kind of out of it. "I'll be back very soon, all right?" 

And she heads off to see if the clerk at the nursing station is interruptible. 

She's looking as interruptible as she's likely to get.

"Hey! Um, I was wondering if you've got a chart for Sherry Williams in bed twelve with any of her medical history or family contacts?"