Merrin can definitely keep this up for thirty minutes.  Her emergency sims run a lot longer than that.  But she is concentrating and shouldn't be interrupted.

Okay then.  That works.  Thirty minutes is enough time to fly in a rank-two Keeper special-trained in simultaneous task tracking, who also has some medical training, to take over the simultaneous performance being designed after Merrin gets tired.

Are they sure the monitors shouldn't display info for Merrin on her performance incentive here?

Yes.  Merrin can deduce that some sort of large performance bonus exists if she wants to think about that, and should otherwise not be forced to think about that, it'll distract her.

A number of people who need to bid on the success probability of all these procedures have questions about who this 'Merrin' person is, exactly.  Please transmit full records on her.

Also, why does she look like a Sparashki entering the aquatic phase?

Exception Handling should know better than to ask questions like that last one.  They'll be told if they need to know.

Oh NO she has to run the temporary manual liver machine. Merrin HATES the temporary manual liver machine. ...Or hated it, at least, until she practiced it into submission via about fifty accumulated hours of sim time over the last six months. 

(This is, in some sense, the double-temporary liver machine; the full version requires room-sized controls and about twelve trained personnel on site. Merrin is not trained in it - well, okay, she maybe ran a sim involving it once, and immediately killed the fake patient and slunk away in shame - and her little minor local hospital does not have the equipment or the personnel for it.) 

The version she can use covers about a dozen of the most important liver functions, and is, in fact, beautifully designed. Since even non-Merrin people at least find it kind of tiring and inconvenient to track that many variables simultaneously, it comes with a library of preset ratios, where you can pick a subset of the liver enzyme processes it replaces, and set others based on varyingly-complex functions of those. 

Merrin can run six of them with presets for the rest, which is the cert requirement, and about what it takes to stabilize a patient who is currently dying of liver failure and needs their body to stop poisoning itself so they can survive a medicopter transfer to a better-equipped hospital. 

This is not the source of Merrin's grudge. The source of her grudge is that you can, it turns out, play multi-role sims by yourself, if you are, say, playing them when all of your friends are tired after their shifts - and that running the liver machine along with three others is - if you are, like Merrin is, kind of slow at things - an exhausting attentional nightmare. She eventually figured out how to bounce around between using different sets of three variables, with the rest tied to those, and got to the point that she could keep her liver-failure simulated patients alive solo long enough for the rescue team to arrive. 

Fortunately! This patient is not even in liver failure! (Which presumably whoever is setting this protocol knows, when they decided whether it was even possible for one person to juggle all of these pieces.) All the patient's current values are fine; she just needs to adjust her manual liver to keep them that way. Also, his metabolism is running incredibly slowly, which buys her a vastly longer response loop. 

Great. Fine. She can do this. Bring it on. 

Most of the machines require setup, which Merrin is currently the only person onsite qualified to do, and she's way less happy about splitting her attention for that, but basic maintenance for two minutes on a patient whose entire body is going veeeery sloooowly is probably something she can briefly hand off? 

If not that's fine she'll just set her alarm settings to max sensitivity and let them warn her, just, it'd be nice if someone was comfortable watching the parameters for her instead? 

...this isn't actually a sim.  Merrin has Full Support at this point.

Dath ilani hospitals are organizationally designed with enough slack capacity to have a shot at handling an area-wide emergency, with remote support from the rest of Civilization to teleoperate those machines that can be teleoperated at a reasonable efficiency loss; or, not during emergencies, such that there are enough people around to do all the tasks that need doing without strain, insofar as those tasks can be performed by people with a myopic view of their own task.

Sims require you to handle emergencies all on your own, or with scripted help calls that you're supposed to make with scripted results, because they can't afford real support personnel for you during sims.  Actual emergencies like this one -

At current QALY prices on this patient, Merrin can name any skill this hospital has, and a person with that skill can be in the room within one minute if they're on-duty.

If they're off-duty, she could have them brought in by helicopter.

If she needs coffee from a particular nearby coffeeshop for maximum efficiency, that could be brought in by helicopter.

If the hospital runs out of helicopters to meet her demands they can start renting police helicopters.

...If the treatment protocol being developed says the patient needs an organ transplant that isn't in stock, it's possible that Exception Handling will start posting bids in Quiet Cities; there's a standard thing that sad people do, when they're otherwise thinking of giving up and going into cryo, which is to enter into a pact with another person where they both get put under, one of them quantum-randomly goes into cryo and has their organs harvested, and the other one wakes up with a lot of money with which to take a second shot at enjoying life.  (This being among the reasons why dath ilani in need of liver transplants, and with sufficiently expensive insurance, have good-enough survival prospects to motivate the existence of complicated liver-replacement machines in the first place.)

The point being, Merrin has nearly infinite money-power that can cause things to happen, if there's any particular chains of causality she'd like to initiate.

....Right, Merrin should probably have remembered that.

(She would have, almost certainly, if she weren't busy aiming approximately all of her working memory and metacognition at keeping this patient ""stable"" under conditions that are well outside the usual operating tolerances for a human body.) 

In that case, Merrin will not feel bad at all about pulling in whoever she has to, however inconvenient for them, to babysit a machine for her while she does the setup procedure for the next one. There are non-her people available for most of them individually, after all; the problem is that for longer than a two-minute interval, they all interact, and her process for managing that is running mostly on the level of instinct. 

...There are efficiency losses. Merrin had hoped to get everything set up and going within ten minutes, and it takes closer to fifteen, because she has to pause a couple of times and make sure that the increasingly complex system is working together rather than falling apart. 

It's actually a lot easier than sims; the sims have treatment prediction markets, but canned-response ones, that don't respond quickly or cleverly if you do something outside the set parameters. Right now, she can apparently get actual liver-function experts (probably not the best in the world given the bizarre secrecy constraints?? but - among the world-class experts in general, probably, given the sheer amount of liquidity in their markets - and it's not hard to be a lot better than her) working on slightly smarter ratio-control algorithms than the preset ones?? This is kind of amazing. As long as she doesn't think too hard about it. 

She is not even slightly tired at the thirty-minute mark. It's exhilarating, actually; it would be fun, if it were a sim, and not a real person who will actually for real go into cryo if she screws this up.

...okay so the Sparashki's performance has noticeably improved between the 15-minute and 30-minute mark.  Who knew that Sparashki had such vigor when entering their aquatic phase?

Somewhat shockingly, the prediction markets say that they should keep running with Merrin, instead of the second-rank Keeper who's now arriving.  Merrin's performance here is a known quantity, she's apparently adequate, there's no obvious qualitative bonuses in reach for doing better.  The Keeper would have slightly better mechanical dexterity on the machines and faster naked reaction times; but she has not actually logged the same number of sim-hours on these machines, or their interactions, as Merrin.

Why is somebody like this working at a small regional hospital, at a small regional hospital salary, instead of, say, a much larger hospital for a much larger salary?

Merrin's not actually all that bright.

Well what does that make their second-rank Keeper, then?

No, seriously, Merrin took a year longer at med training and bulled through on sheer determination, took longer to reach adequate performance levels on sim training, her school records show that she didn't learn to program a computer until age eight.  Merrin is a stamina monster, basically.  She exploited her stamina and determination to run lots and lots of sims, and get lots and lots of training, until she was carrying half of the hospital's emergency-cert load by herself.  But Merrin doesn't meet the minimum recommended intelligence to train for Exception Handling, or for care operations-coordinator at a major hospital -

Part of the point of the intelligence threshold is your prospective capability to pick up lots of skills so you can do that job.  If instead you bulldoze the problem by running twenty times as much training, and end up with all the skills, you have achieved the actual endpoint which the prospective test was meant to measure your future ability to achieve later and never mind your having actually already -

You know, never mind, the Very Serious People can fight about this later.

...look, some of these thoughts have ever occurred to the Chief of Personnel at this hospital - she's sometimes fantasized about whapping Merrin with a banana and telling her to be more ambitious - but Merrin seemed happy where she was, and there's such a thing as being reluctant to disturb that while you personally go replan somebody else's life in a way that you think is cooler.

That medical venture capitalist who had the requisite clearances, who was willing to risk the most capital and make the most daring credible promises, is now taking primary point on developing the actual treatment plan.  Or rather, causing its development.

This plan is going to need, like, around 100 custom proteins, only 80 of which actually exist in the literature.

Is this matter urgent enough that Exception Handling could possibly... you know... happen to find those other 20 necessary protein designs in a forgotten filing cabinet somewhere?

Exception Handling will ask, pro forma, why he thinks Exception Handling can even do that.

Because the people he put on contacting the researchers who allegedly delivered the most relevant existing protein designs all ran into suspicious preliminary stonewalls; which suggests to him that possibly most of the artificial protein design on the planet is actually being done by a secret Governance project rather than those supposed researchers.

Of course, it would have taken him longer to arrive at that guess if he'd had lower priors on it.

Superheated lovely.  This shit gets harder to keep up literally every year.

Can there be a plausible story for the other people in his organization about how somebody who wasn't Governance found the extra 20 protein designs in a dusty filing cabinet somewhere.

Naturally.  He's arranged all of the previous steps in this procedure with that eventuality in mind.

So long as they're talking about this sort of stuff anyway, why is the chief operator-coordinator on this patient a Sparashki?

Exception Handling asked for the best, not the best human.

It takes Merrin an embarrassing-in-hindsight length of time (about twenty minutes, from the point after she has everything set up and running smoothly enough that she theoretically has some free metacognition) to notice that her decision-making right now is…definitely sub-optimal. 

It’s not that she isn’t asking for help. She is delegating literally everything that she reasonably can. Of course, the bounds of ‘reasonable’ here are very different from the usual ones. It would never, under normal circumstances, occur to Merrin to ask someone else to go pull the internal blood temperature-monitoring lead back a centimeter for her because she’s paranoidly worried (despite having no conscious logical reason for it) that the vasoconstriction/vasodilation mechanism is interfering, and also she doesn’t feel like standing up. Merrin did, in fact, remember that under THESE conditions, her physical energy and stamina, which has never before in her life been an important limiting factor on shift length, is perhaps a more limited and critical resource than usual. 

She’s even been making copious use of her assigned personal assistant and transcriber, who listens to everything she subvocalizes into her throat microphone (to avoid noise clutter in the room) and, on request, puts up whatever she wants on the big display screens. 

…She failed to remember that, in addition to the support of the colleagues she knows and feels at least vaguely asking for advice from, AND the unusual but within-the-space-of-her-preconceptions external resource of a highly trained specialist medical assistant, she can also ask for other expertise. 

When, for example, she keeps repeatedly noticing that she’s starting to grab at the edges of a pattern, one she’s pretty sure the treatment recommendation markets haven’t picked up on it yet, she’s…doing the same cycle of adjustments over and over on her stupid manual vasodilation-constriction control (which is supposed to be a backup) to deal with O2 fluctuations, and something is interfering with getting a stable control state but she can’t hold enough of the pieces in her head at once to figure out what -

Merrin knows exactly what she wants to ask for - not exactly who she wants to ask to do it, she’s not up to date on programmer-specialist jargon, but surely someone can figure that out. It is still really uncomfortable - not the least because if the markets, with world-class treatment experts betting on them, aren’t pointing out a solution, maybe she’s just imagining it?? But she’s aware that this is a cognitive error, and also that wasting any more of her limited attention on feeling awkward is just adding to the problem where she’s allocating resources stupidly like a stupid person. 

Right. She wants a visualization of…whatever type is good for visualizing this sort of data?? someone else should make that decision?? of the fluctuations in O2 and her manual corrections to brain bloodflow, graphed against literally everything else she’s doing. Presumably in separate graphs for each different intervention, because maybe smart people can make sense of visual projections of high-dimensional spaces but Merrin is not a smart person and she cannot do that. She’s just pretty sure that something is going on here and the treatment markets haven’t settled on a way to make it stop happening.

Also maybe someone who’s really good at making sense of high-dimensional-space graphs should look at it?

But Merrin kind of wants to see it herself too, just, if she can get the pattern in her head visually then she can probably react a bit faster. 

…Oh, and, can she, ummm, maybe, possibly, get a programmer on the task of looking over the last ten minutes of just her vasodilation-constriction manual changes, and automating the response-pattern? She’s not sure she can tell them when to trigger it, because she’s…apparently doing it instinctively enough that she has no idea and her first two ideas for triggers are wrong–

(This is embarrassing, she should be able to make her thoughts legible, she probably even could if she had slightly more room to think after all the adjusting machines -)

…But she definitely keeps doing the same pattern of three adjustments in a row and then sometimes a fourth if that doesn’t stabilize it, so maybe they can figure that out, and if she can just toggle the machine once to set off that response pattern, it’ll free up way more attention to focus on the liver machine. Which is actually fine right now but she’s expecting it to get problematic in a couple of hours, on the assumption that everything takes four times as long to spiral out of control for this patient – and four times as long to fix so she needs to be ready to stay on top of it.