Sep 29, 2022 3:26 AM
how Merrin came to the attention of Exception Handling
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Merrin does not, as a general rule, take days off. 

Oh, she doesn’t work a shift every day; she’s not sure they would let her and she’s never asked. And the official trainings on various emergency protocols are offered in standard one-hour or two-hour sessions, or rare special endurance four-hour sessions. She usually can’t line up two on the same day. She’s been at the hospital for a little over a year now, so she’s now at the point where some of the sessions are repeats, to keep her certifications active. 

Harkanam is not a Quiet City, but it is a quiet city in the normal sense: a population of around 65,536, with only a small regional hospital. Merrin used to dream of someday making it to one of the big hospital centers in Default, but she’s trying to be realistic about her prospects these days. Just the basic education to work as a nurse took her a year longer than usual, and she still didn’t pass all of her theory tests on the first try. But she is determined that her hospital will be better off for having her on staff. She can get there; it just takes a lot more stubborn effort than most people would consider reasonable (or even sane). 

As a minor regional center, the hospital is required, in addition to the several hundred standard protocols with thousands of subsections, to have a minimum of two nurses trained on each of a few dozen rare protocols – relevant for emergencies that will happen only rarely in such a small city, but if they do, the hospital will be ready to stabilize a patient long enough to transfer them somewhere else. Merrin, doing her best to make up for her other shortcomings, is at least able to make that easier for everyone else; she maintains certifications for everything on the list. 

Her standard shift is six hours. Most people do two or four, but Merrin hated that; even now, it takes her longer than most of her colleagues to assimilate new information, and two hours in she’s just barely hitting her groove. She pushed it up to twelve hours once, when an unusual emergency came up midway through and she was the nurse already on-site with qualifications for the relevant equipment. The warm glow of accomplishment, of being useful, stayed with her for a week. 

When Merrin isn’t working, or in training, or sitting in her room with a training program and studying for a cert, she’s usually found in the simulation room. There’s a minimum requirement to review certain simulated emergency scenarios regularly, but it turns out there are thousands of canned scenarios available; Merrin, with approval from her supervisor, can get access to ones that won’t ever come up in their little hospital, ones involving equipment or expertise they just don’t have on hand. It is arguably not the best use of her time, to train for things that aren’t going to apply to her, but - who knows, someday they might. Besides, it’s fun, and she figures that once she’s already putting in at least twenty hours a week of routine sim time, she’s allowed some fun. 

She still struggles with a lot of things. Everyone else around her can read faster, track more numbers and more complicated models in their heads; when she started out, even fully qualified on all the basics, she just couldn’t keep up, couldn’t take in information and hold enough of it in working memory and process it quickly enough to make all the decisions that needed making. 

(Which was fine, and expected, complicated patients - and that’s most of them, in the intensive care unit - are always seen by multiple nurses - but it hurt, that Merrin needed backup even on the relatively simple cases.) 

To keep up, she has to drill and drill and drill, until she has enough of those mental motions down to the level of instinct. In the sims, she likes to fiddle with her alarm thresholds, setting them vastly more sensitive than the usual defaults. Alarm fatigue may be real, and you’re not really supposed to work in purely-reactive mode. But when each of half a dozen sensors has a different audio tune, playing at a higher or lower pitch for out-of-range values in either direction (and standard flashing lights, faster or slower), and you spend twenty hours a week hanging out with those tunes and lights around you, eventually it gets down to the level of muscle memory, and you - if you’re Merrin, at least - can respond without conscious thought. She needs her conscious thought for everything else

She’s improving, she thinks. Eighteen to twenty-four hours a week of regular shifts - sometimes more, but the other nurses notice and give her weird looks if she goes above thirty hours, and Merrin hates weird looks, when all she’s ever wanted is to be normal, to be good enough. Then eight to sixteen hours of formal training with expert instructors (which costs money, but of course it's less than the hospital bonus for maintaining all those certs), twenty hours in the simulator, downtime with her spaced-rep program. It doesn’t leave a lot of time for a social life, or anything else, but that’s fine. Merrin lives in a little housemodule attached to the hospital itself - she'd have to move her module if the hospital ran out of live-in-patient housemodule capacity, but that's unlikely - and everyone knows to page her for weird emergencies even if she’s not certified on them, because she’s always happy to observe, and be a pair of arms if they need someone reasonably athletic. She wears her hair short so it doesn’t take much maintenance. Merrin has not especially figured out the whole romance thing anyway - well, mostly the sex thing - and she’s not sure what anyone would see in her, but she doesn’t really miss it. She watches televised Exception Handling scenarios when she’s too tired to think anymore.

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Every once in a while, though, her fellow nurses coax her into a real day off. Today, she exercises as usual and then only does one of the quick twenty-minute sims, nothing like some adrenaline to get herself properly awake, and then she prepares for the local Alien Trade Con. (Unlike the Alien Invasion Rehearsal Festival, these are fun and friendly aliens.) Merrin is one of the aliens - they’re doing Sparashki, a widely-popular standard-conventional-alien-species for LARPing, easily costumable and with unnoticeably cheap licensing thanks to economies of scale.  Merrin is green from head to toe, with some amount of visible forehead scaling, and glaring red eyes courtesy of synthetic-protein eyedrops. She will be at the underwater part of the con; all she’s wearing is a bathing suit, though it’s a one-piece with decent skin coverage. Dressed and ready, fed and rested, she treks out to the emergency-triage section to meet her friend, who should be finishing up her two-hour morning shift any minute now. 

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Meanwhile and not far away, somebody out on a stroll spots a human body floating down a river.

It's a lot less horrifying than some 'suddenly see a body' scenarios.  It's winter in Harkanam, and a body in very cold water is with high-probability not Dead For Real, if their head otherwise looks intact.  "You're not dead until you're warm and dead", goes the saying.

Regardless, she delays not a moment in calling it in on her cellular texter; and then, she runs ahead of the water's flow, to try and find some clever way to block the river or catch the body.  Even weighting all sapient lives equally, the risk-benefit doesn't favor her jumping into deadly cold water to try to fish out the body herself.

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From the moment they got the emergency alert, the rescuers did everything right. Still, the unidentified man had been trapped in the icy water for some unknown length of time, but at least ten minutes. His hands were badly abraded, maybe from a frantic attempt to save himself, and the retinal scanner was at the hospital. Until then, he would remain unidentified. 

Even before they had him tucked into the medicopter, they call ahead to the only possible short-term destination – it’s a couple of miles, several hundred to the next-closest regional hospital which is even smaller, or even further to the nearest large specialist center. 

Their monitoring equipment is more limited than what even a small ICU has access to, but they have the basics set up within under a minute, not that the basics are informative. No detectable pulse, no measurable heart activity (electrical or mechanical as seen on an ultrasound image). A body temperature that would translate to 20 degrees centigrade. It takes a couple of minutes – by which point the medicopter is already in the air – for their blood sample thrown onto the instant-test chip to come back with an oxygen reading. It’s actually not nearly as bad as it could be; maybe the man was struggling at the surface for a while and still getting some air, probably not a long while in conditions like these, but still enough that the cold shut down his cellular metabolism before his body had a chance to burn through all of the oxygen reserves in his blood. 

They’re not picking up any electrical activity on an EEG, which is unsurprisingly and not that meaningful at this temperature. 

They spend the trip getting a few more measurements sent ahead to the hospital, performing CPR to maintain some circulation, placing a breathing tube and pumping some oxygen into the man’s lungs – not very effectively, it turns out, his lungs are badly damaged by the water he inhaled. They don’t bother with defibrillation, but they do perform a quick, minimally invasive surgical procedure, sliding a few wires in between the man’s ribs to rest directly on his heart. They’re not even very surprised that the muscle is too shut down for it to work, and the direct stimulation doesn’t produce so much as a twitch, but the next option will have to wait until they’re at the hospital. They don’t have good options for controlled internal rewarming – the heated blankets and wraps, and the warmed IV fluids, are enough for less severe hypothermia but, for this, riskier than holding off. Even if they had the equipment, being rewarmed potentially deals brain damage – as oxygen reaches the brain and the neurons come back online, cells send out damage signals, setting off cascades of inflammation and swelling that directly cuts off the remaining blood supply – and the patient's medical testaments may call for him to be directly cryopreserved instead.

They’re small-town EMTs who’ve never dealt with a situation this severe, but they’re well trained in every component of it, and their reports ahead are concise and calm. They’re in the air for less than five minutes, despite somewhat rough weather. Touching down and unpacking their patient to race toward the intake bay takes a minute or two longer, but end to end, they reach the hospital exactly seventeen minutes after the call was made. 

They’ve been sending real-time progress updates, including on their location; the hospital knows exactly when to expect them. Various emergency-response protocols should already have been going into effect. 

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Some of the readings on this patient are odd, even considering his other circumstances.  Besides being a rewarming emergency, there may be other emergency protocols required.

The second-in-command at this hospital is its personnel-coordinator, whose job is to know everything that all the employees at this hospital can do, including in some cases their hobbies.  Besides readying the Complicated Patient Intake Room abutting the intensive care unit, she'll also dispatch orders to grab Merrin if she's on-shift within the hospital and reallocable, and call her at her home number if she's not.  Merrin is the most likely person to have a random emergency cert not known to the hospital in advance, and there's efficiency gains from having one on-scene medic knowing multiple required protocols simultaneously.

(This does not, at this point, take the form of putting any explicit bets on the treatment results if Merrin rather than somebody else is the medic on-scene.  Prediction markets are just starting to spin up for this patient; and they're based on guesses rather than knowledge about the patient's medical insurance, and what his insurance will pay to subsidize prediction markets, or how much his insurance will pay out per QALY saved (as determines the maximum expenditure on expensive treatment options).  The hospital is obviously proceeding anyways on the assumption that he has at least standard insurance, pending identification; but it's also possible that his medical testament says to take zero chances on brain damage, and just suspend him straightaways.  It's not easy to figure out how much you want to bet, in that sort of market, and it's mostly bots trading right now.  So the admin just orders Merrin called in, if possible, without betting on that as her own treatment subplan; nobody's really going to bet against her on that anyways.)

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Merrin is maybe going to take a moment to answer; her costume lacks pockets, so her cellular texter (which can take calls, though a lot of people block those or set the notifications to silent when they have plans) is in her bag. She is, however, right there, albeit green-skinned and red-eyed and forehead-scaled, and digging for her texter but also looking around in case the call is coming from here. It's not like anyone except the hospital ever calls her. 

"- I'm over here!" she offers helpfully. 

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The person who just poked his head into Emergency to yell if anybody knew where to find Merrin... isn't even embarrassed about this, you can't possibly expect him to recognize Merrin when she's GREEN and wearing an UNFAMILIAR SWIMSUIT.  Her own mother probably wouldn't recognize her like that.

Anyways!  There's an emergency case coming in, looks like it might be a complicated one.  Patient is alive, but spent a lot of time tumbling through a winter-cold river.  Hands messed up, medicopter couldn't get good fingerprints, they're waiting on retinal ID to decide treatment plans and whether to even try rewarming.  If they do it's possibly going to be a Complicated Emergency and require the execution of at least two different emergency protocols simultaneously.  Admin is betting on Merrin - metaphorically, prediction markets don't have much liquidity yet when they don't know the patient's insurance or testament.

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Oh oh oh she is absolutely available for that! Does she have time to really quickly text her friend and apologizing for being late for the con?

Merrin is, at this point, assuming she's not going to miss the con entirely - this might be a four-hour shift, or even six, but she's not going to plead to stay longer than they need her, and presumably in that time they'll either have rendered the patient, if not entirely stable yet, at least un-Complicated, or else settled on immediate cryo - which might actually be less complicated if the guy spent a while in an icy river, he's already cold.

(Well, for some definition of 'less complicated'. There’s got to be a written protocol for it somewhere but Merrin is only officially trained on the one that starts at 28 C, and she doesn’t have the various sensor data up yet but she sort of guesses this patient is colder than that. The standard protocols, overlearned to the extent that Merrin can probably do them in her sleep (or, more realistically, while multitasking) are ‘starting from normal body temperature, patient’s heart is still beating’ and ‘starting from normal body temperature, patient’s heart is not still beating.’ Merrin is also trained on handling various traumatic injuries including serious head injuries (kind of a nightmare scenario) and ‘patient no longer has appreciable quantities of blood in their body’, which she doesn’t think apply here. But at the very least, starting colder is going to have fewer discrete steps.) 

Anyway do they have vital signs, anything firmed up on the treatment plan yet, what do they need here in the triage area while the Complicated Patient Intake Room is being prepped? (Though she knows that shouldn't take long, it's kept in a state of generic readiness and will just need the addition of equipment for cold-related emergencies). And when are the EMTs landing, is she most useful if she runs out to meet them rather than preparing materials in an area of the hospital she's less totally familiar with? Merrin is pretty sure she shouldn't try to sprint back to the ICU, if she meets the EMTs here then she'll have a minute or two of extra time to get a verbal handover. 

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Landing in a hundred seconds!  He'll follow her to the receiving bay while he goes on updating her.

They've got vital signs.  They're at least going to want him stable while they ID him.  Treatment plans are being human-dictated with the markets this thin.  The other nurse who's practiced in extreme cold protocols is setting up the room.  The meta-plan now that Merrin has been found is that Merrin takes the handoff, and sees if the patient looks like an emergency she already knows how to stabilize from one or possibly several of her trainings... pending onboarding of a Diagnostician and Treatment Planner, and getting more readings on the patient, and some idea about his insurance and testament and medical history, so the actual markets start clearing.

He's happy to text her friend with a way more detailed update than Merrin herself should take time for, he just needs the friend's cognomen.

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Of course, she'll pass on that info for her friend (though she quickly indicates it's not the top priority, if patient-related tasks are competing). 

Which means she - just barely - has time to pull up the patient’s data stream on one of the big screens in the receiving bay and have a peek; there’s no point in sprinting out to the medicopter landing pad when they’re still sixty seconds away and the outdoor temperature is below zero. 

Merrin…is dubious of the claim that they have vital signs. That sure seems like an absence of many of the vital signs! Blood oxygen is low but not as low as you would usually expect in someone found with a complete absence of circulation, that’s a good sign, and it’s slightly up since the first measurement. It looks like right now they’re maintaining a rather minimal blood pressure by applying external mechanical force*, their attempt to place an internal pacemaker having failed because the patient’s temperature is TWENTY DEGREES. They’ll need to place internal mechanical cardiac support, then – which is only a slightly more invasive surgical procedure, she can extend the same incisions they used to place the wires. 

Merrin is trained on that procedure, and the triage bay has everything she needs for it, if she relays a message for someone to go grab the instrument itself. She might as well do it there rather than waiting another ninety seconds to reach the ICU. It’ll give the other nurses more time to set up and read the incoming data before she throws a distraction in their midst, and she’s less worried than usual about complications; she’s good enough to have a vanishingly low chance of puncturing a major artery, a low risk to begin with since none of what she’s inserting into the patient’s chest is sharp, and normally she might worry about disrupting the remaining electrical activity but the current patient does not have anything to disrupt. 

She’s going to be operating in a void for a little bit, without any of the constantly-updating recommendations from smarter people than herself that she likes to have, but there really aren’t any decisions here – other than whether to do the procedure here or in the ICU with more backup, and given her cert, it’s within her remit to make that call. 

She texts a message on to the ICU, and spends ten seconds considering whether she’s missing anything obvious, and then the timer runs out and she dashes out to meet the EMTs. 

*Dath ilan uses a powered mechanical device that fits around the patient’s chest and performs compressions, with variable speed and force based on the blood pressure readouts. No one wants to use their hands to perform CPR when they could be doing other, less easily automated tasks with them.

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The fact that they don't have ID on this patient yet means that various decisions usually dependent on standard cost-benefit calculations need to be improvised; there's a lot of people who could improvise them sensibly, but the one person with the job is the hospital's chief investment/risk-management officer.  They snap off some financial figures that seem obvious and good-enough, and double-check with the tech setting up Complicated Patient Intake to make sure that the retinal ID machine is being moved there and IDing the patient will be treated as a priority.

Personnel doublechecks to verify their memory that Merrin actually does have certs on immediate stabilization, or emergency rewarming if that's the treatment plan.  (Obviously Merrin could also point this out, if there was an error, but Personnel is the one person whose job that is.)  If the plan shifts to doing cryo from this starting temperature, that's going to take protocol that nobody here has memorized, but Merrin still looks probably best-qualified to implement whatever treatment plan the conditional-policy-prediction-markets say has the best chance of a good cryo outcome; it'll be a variation on cryo-from-28C which Merrin does have practiced.


(A hospital, conceptually speaking, is a vertically integrated corporation that both invests in patient treatments and carries out patient treatments, and gets paid for patient outcomes.  Or much more usually, gets paid by financial intermediaries that buy up the right to be paid later for long-term outcomes by the patient's insurance.  The hospital isn't worried that nobody will pay for this patient's outcomes - that's incredibly improbable in real life.  If somehow the patient escaped from the Last Resort and ended up in Harkanam, they could recoup the cost of treatment by selling story rights to the hospital's part in it.  The reason everything here is structurally-uncertain-risk-capital, is that the hospital doesn't know yet which patient outcomes they'll get paid for: successful rewarming with minimal organ damage and brain damage, or a successful cryopreservation.)

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The EMTs are already unloading the patient gurney by the time Merrin reaches them. (It’s fully mechanized; no one needs to apply more than 20 lbs of muscular force to the problem.) 

The patient is mostly dried off, but only covered with a light sheet, since they didn’t start any external rewarming protocols. His head is already shaved. In addition to the mechanical compressions vest and the currently-useless internal pacing device hooked to wires that vanish through tiny incisions between his ribs, he’s arrayed with a dozen different monitoring devices. All of them are wireless, fully compatible with all the hospital systems, and currently transmitting to both the medicopter display screens and (thanks to Merrin’s work earlier) the receiving bay. Merrin will note with satisfaction that they’re secured firmly in place against the choppy acceleration. 

The EMTs have some hasty and preliminary monitoring results (their equipment is good, but not quite as sensitive as what they’ll have in the ICU, and motion artifact from the helicopter is a real problem for some of it.) They confirm a measured core temperature of 20.6C, no spontaneous cardiac or respiratory activity but the external mechanical pump is maintaining a ‘heart rate’ of 110 and, with these settings for force delivered to the chest wall, a ‘blood pressure’ - indirect measurement from the radial artery, but using a simple algorithm to estimate equivalent blood pressure to the vessels supplying the brain - varying between 40/25 and 35/15, rounded because the motion artifact from acceleration renders any finer measurements unreliable. They could apply more force, but are going carefully because the onboard instruments they’ve had time to use during their brief choppy flight aren’t sensitive enough to confirm the presence or lack of broken ribs or other internal injuries, and also that should be well within the bounds of ‘tolerable, not making anything worse’ given the rate of cellular metabolism at this body temperature. 

They’re mechanically ventilating the patient using a standard field protocol for ‘low body temperature’ and ‘assumed lung damage’: rapid ventilation rate to clear as much CO2 as possible, but low lung volumes and an oxygen concentration only a little higher than standard (40%, right now), to avoid worsening the damage. 

Between the poor circulation and motion, they are mostly not getting a measurement on the finger pulse oximeter; they have a few spot checks on blood gas measurements from the radial artery, which (again using a simple correction to account for a temperature that’s a couple of degrees outside the technically-rated range of their standard field equipment) is probably equivalent to 45% oxygen saturation. They have preliminary results on other bloodwork: most of it looks reasonable, so far. Sodium is a touch low, but within the bounds predicted when you add the ‘freshwater drowning’ correction factor to the predicted values. More important, hemoglobin and hematocrit are normal; the patient is unlikely to have lost much blood. 

They’re still not picking up any brain activity on the EEG. Their lower-fidelity portable ultrasound doesn’t show any structural changes to the brain, either bleeding or swelling, but it’s not especially sensitive.

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This is, in any objective sense, extremely concerning!

But it’s not really an update, except for the fact that Merrin did not explicitly notice that they needed a continuous central blood gas measurement – they’re going to want to place a sensor for continuous and maybe separately an internal pulse oximeter (placed through the skin as a soft clip around the artery) on the carotid artery feeding the brain. 

Merrin is, conveniently, trained on both of those, though the first one is standard. She starts to reach for her cellular texter– wrongthought, this is a real emergency not a simulated one - looks up and there is, in fact, an on-scene observer already relaying information to the ICU (and recording it for once the prediction markets get going). So she can just explain out loud that she needs the ICU to make sure they’ve got someone, not her, ready to place a central probe with sensors for all the common blood measurements. 

(Merrin is trained on this, obviously, but it’s a standard procedure, that doesn’t have a lot of dependencies on other pieces that she’ll be running herself, so it’s not her comparative advantage to focus on it. Besides which, it’s fiddly, and Merrin is new enough to this to still find ‘going near the arterial blood supply with sharp things’ unreasonably stressful– it’s not that she can’t do it safely, she does have the cert, but staying within the safety margin will take her 50% longer than someone with decades of practice, and also be emotionally exhausting, which she does not need right now.) 

They’re going to want to detour past the CT room on the way to the ICU. (There are portable units, but the maximum sensitivity sensor suite, which lets them get very detailed imagery without excessive radiation exposure, is pretty much room-sized, it won’t take long, and the hospital layout is deliberately such that it’s on their way.) 

They’re probably not going to want to detour to the MRI suite on their way; too much setup time, they need to replace all the metallic components on the standard field sensors, and even the most powerful magnets don’t let you get a highly detailed image that fast. (Which may mean that a MRI adventure is in Merrin’s future, if the treatment plan ends up settling on something other than ‘immediate cryo’ and they get the patient stabilized enough to attempt it. That’s fine. It’s stressful, but the sims go pretty heavily on stressful things.) 

…Wow, she is not actually very confident in the second decision. Usually she would record her observations and default recommendation, and throw it at the group intelligence of the prediction markets, but she’s painfully aware that she doesn’t have that yet. Ten minutes from now, sure, but it takes time to onboard a remote Treatment Planner and Diagnostician, and with an unidentified patient, the prediction markets are running on wild guesses. Which leaves Merrin flying blind. She…will just quietly make a mental note that apparently this is differently stressful when it happens in real life and not a training sim, and then move on and carry out the motions she does, actually, know how to do on her own. 

(Merrin is, as a deliberate choice, almost entirely focused on the here-and-now; her planning loop extends 30 seconds ahead, with a brief nod at the next 5 minutes, and not further. It doesn’t make sense for her to be spending any of her limited attention on long-term strategic planning for this patient. To the extent she’s thinking ahead, it’s entirely on pre-learned processes.)

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Some of administration is looking in on this case, since it's an anomaly and nothing more exciting is happening inside the hospital right now.  Aside from the unknown patient ID and the delay in spinning up prediction markets, the actual orders going out from Merrin look routine and there's no blips in execution being reported on the other end; there's only one retinal scanner in the hospital, but it's en route.

(There's a near-unnoticeable collective wince when Merrin orders the CT instead of the MRI.  It's almost-certainly the correct decision, you can't get arbitrarily faster MRIs just by amping up the magnetic field arbitrarily, and the emergency at hand is an urgent one.  But the small statistical probability of eventual cancer associated with a low-intensity CT scan will come out of the hospital's expected payoff from its patient-outcome rebuyers, if the patient's medical testament doesn't just call for cryo; and 'how often does this hospital manage to avoid ordering CT scans' is still one of those things that patients look at if they have a chance to choose a hospital.)

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Merrin is aware that her decisions and reasoning are now being relayed to the relevant places, and probably a lot more places than that. (She, too, has looked in on cases that were not per se her responsibility, but weren't conflicting with her work and were the most interesting thing going on at the time.) So! Even without the full prediction markets online, someone is going to notice if she's doing something blatantly stupid because she failed to retain something from one of the classes she found so painfully hard. 

In the meantime, she'll focus on doing her job. 

Pause in the receiving bay first, to perform some minor surgery and place an internal mechanical device to manually pump the patient's heart, under real-time ultrasound guidance (now without medicopter motion artifact!) 

Nothing goes wrong. (Merrin would be making some serious updates if something had gone wrong; she's trained in this, she's also done it many extra times in simulations, and she's not that far below median in picking up procedural skills as long as they're not too reliant on fine motor skills.) 

Another three minutes, after the two minutes it took them to reach the triage bay. Twenty-two minutes since the emergency call. 

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The internal pump is more effective that the vest setup; the patient's measured blood pressure is now stabilizing at 55/40. 

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Is that sufficient? Does she want to toggle the settings and get it higher?? ...Does she want to keep it lower, they're still looking at potential cryo in which case she really doesn't want to kick off neural cellular metabolism any more - and the measured O2 sats are still below 50%, which means maybe it won't matter and maybe it'll make things worse–

- but probably not much of either, at 20C body temperature. Merrin is aware that this is well below the goal temperature for cooling patients to avoid brain damage during potentially risky and circulation-disrupting surgeries, where the aim is 'four minutes before you even have to worry about lack of oxygen to the cells', and ten minutes before you worry about actual anoxic brain damage. 

She wants her flaming prediction markets already, and of course the fastest way to achieve that is to get to the ICU already and ID the patient. 

She...probably cannot get them through the CT unit and over to the ICU in four minutes, but she can definitely do it in less than ten. 

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The CT suite calls for setting customization. 

Merrin is fully trained to make this call on her own. Merrin would not usually have to make this call on her own, but that's the whole point of emergency sims, isn't it. 

She feels only a moment of agonizing stress before addressing the CT tech. "Protocol suspected-anoxic-brain-damage*, modifier: hypothermia, radiation setting, uhh, four." 

*In Baseline specialist medical jargon, this is two syllables. 

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(The patient is not especially participating in these proceedings, but his vital signs, nearly all of them currently maintained by machines, do not change.) 

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Aaaaaaaaand now she gets to run down the hall to her nice well-equipped Complicated Patient Intake Room with all her familiar equipment and colleagues? Right?? 

(Marian is trained to read CT imagery, but not to a very high standard, and in particular, not fast. A 5-second glance at the wall screen reassures her that the patient's problem is not 'massive brain bleed', which she was already suspecting from the lack of visible injury to his conveniently shaved head - he could have fallen into the river as a result of an unexpected hemorrhagic stroke, but that is very low priors and the sort of blatant plot device that even medical fiction tries to avoid. She is not going to wait around to look closer. Once the patient is ID'd, an actual expert can look at the CT scans, and also everything else.) 

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She's home!!!! 

By which Merrin means: she has now reached the Complicated Patient Intake Room! Her report on their progress to date should already be in the chart - a glance at the wall display confirms it is - the mechanical cardiac support is still working, the monitoring devices are still in place, and the other ICU staff already have a plan for getting a continuous bloodwork probe in place. A plan which does not involve her, so for a few precious seconds she can just...think. 

(- Someone other than her is handling the retinal ID scan, right?) 

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An equipment tech is carrying the machine into the room right now.  Hopefully it works on the first try!  It's actually near the end of the testing cycle on this machine and it hasn't been used on any unconscious-patients-with-no-ID-and-unusable-fingerprints since the start of that testing cycle.

The machine plugs in, turns on, and... doesn't connect to the hospital's wireless network.

This is actually fine.  Everything is fine.  There's a backup wired portal on the machine.  Give the tech a second to grab an SD chip, and they can scan the patient's eyes, get the scan to the chip, get the chip to a terminal, and get a hospital programmer-generalist to manually dispatch the data to Person Identification.  They'll run.


In other news, prediction markets and treatment policy markets are coming up on one of the many LCD displays covering the walls of the hospital room!  They say the patient has a 90% chance of staying alive if rewarmed, 10% chance of no significant brain damage if revived via the best treatment plan in the policy market, and bid-ask spreads are wide enough that you could drive the fifth planet through them without being careful not to bump the moons.

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Well! In that case Merrin is going to keep running on the emergency-sim assumption that she is the best-informed decisionmaker here, and keep following her training and engrained instincts. It's not as though she's running out of next actions. 

First thought: they should monitor the patient's sodium closely, on the assumption that (given premise: freshwater drowning) he swallowed and inhaled a lot of fresh (e.g. very hypotonic) water, which is probably still being absorbed. Low blood sodium equals a larger differential between cells and bloodstream equals more water entering cells equals BRAIN SWELLING which is, you know, absolutely the last thing they need right now. 

...They can place a specialized probe directly in the carotid artery, to measure the electrolyte concentrations actually reaching the brain? It's an obscure procedure but Merrin is, in fact, certified for it. 

 

(She is also obsessively checking the prediction market displays; she saw her colleague do the retinal scan, surely any minute now they'll have more certainty and backup...) 

(- though in the meantime she is not using all of her working memory right now, and she has a deeply-engrained habit to, when she notices that, take a mental step back and plan ahead. Which lands her on 'high probability of going straight to cryopreservation' - and if they don't, it's going to be because of something weird, so she's not going to invest too much advance-thinking in that - and honestly even if they do it won't be a standard protocol, but she can make some wild guesses at the nonstandard protocol, at least in terms of what cryopreservants she'll need to access and in what order....) 

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The tech is AWARE of how many administrators are watching all this!  This bothers a lot of dath ilani less than it would bother, say, Merrin, but all tasks are still being executed with alacrity.  Run back in with chip, get the data onto the chip (the retinal scanner automatically copies its most recent data onto a chip when you insert the chip and press the most obvious button for that), run back out, get chip to terminal!


File uploaded, now it's over to the in-house-programmer who's hopefully been told about this already, right, and is ready to send that data to the same Network socket that the hospital machine itself would've used -

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In programming terms this is a totally unexceptional problem, obviously all the APIs here are standard ones, except for the part where identifying somebody's retinas against Civilization's database is something that not just anybody is supposed to be able to do, if you're not a hospital.  Which means that the retinal scanner in question has a cryptographic cert that is not actually supposed to leave that machine.

This is actually fine.  Everything is fine.  He called in that problem as soon as it became obvious, and somebody in admin should be talking to low-level Exception Handling about approving the request he's about to make into the person-identification API -

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Yeah, they're on it, shouldn't be but a minute, obviously hospitals have cryptographic certs for identifying themselves as such to Exception Handling -

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