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Jan 30, 2023 12:47 PM
Merrin working in Exception Handling
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Tharrim lifts a hand. "Shhh! Merrin's taking a nap." He points. "She'll probably be up soon, but in the meantime -" he holds up the headphones, "- want to watch an edited music video of Merrin eating cookies to one of your sister's songs? We can't show it while she's in here, she'll run away screaming from sheer mortification because she's like that." 

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????????????????????????? but okay fine he will watch the weird music video that someone made for some reason? 

 

 

- it's good? probably? honestly Kalorm is having trouble with the coexistence of an audio and a visual track, even though he obviously knows the song and the visuals are, like, not complicated or hard to parse. He still manages to feel kind of overwhelmed by the end of it. 

On the one hand, this is definitely amusing? He sees why the other medtechs are amused? 

On the other hand, he is now even more confused about...something??...to do with how everyone is around Merrin. It's weird. He doesn't get it and no one seems inclined to explain. Asking in pictorial form sounds impossible, though, and Kalorm is not at all inclined to invite his brother back until he can TALK and thus there's no way that Khemeth can corner him and give him a weird frustrating lecture while he can't do anything about it. Ideally he would like to also be physically capable of getting up and punching his brother, but he can't do that if Merrin is here, it'll scare her and make her sad. 

 

He looks sort of tiredly at Tharrim and waits to find out what he's supposed to do now. 

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Tharrim sits down. "I'm headed out in a few minutes. Dalthem is back, and based on his shift report notes he's very excited about hitting some more milestones with you, maybe even getting you off the ventilator if your next minimum settings trial goes well. Other than that, the plan for the afternoon is to go through some more exercises that will help you get ready to try walking tomorrow. And we're hoping to get you up out of bed again, but rather than having you stand, we're thinking that you can save more of your energy for breathing, and just sit in a chair. It's also easier to do some of the balance and coordination exercises that way." 

He flicks through Treatment Planning screens.

"...Oh, hmm, the GI team does want to do one more colonoscopy. They're tentatively thinking they could do a fecal transplant as soon as tomorrow morning, because if we want to increase your tube feeds, it'll go better if you have all your normal gut bacteria back โ€“ but they do want to check that you definitely don't have any ulcers or other tissue damage in there, because not that many days ago you were really sick from a gut source, and we would all feel very stupid if we gave you a nasty sepsis again. We're not that worried - we think the problem was mainly coming from higher up, in your deep small intestine, which shouldn't normally have a lot of bacteria; they grew there because your gut was stunned and paralyzed after the accident, and because some of the normal bacteria died during the period when we were keeping you cold and that knocked everything off balance and meant that other bacterial populations multiplied out of control. But if you want to be eating normally as soon as possible, so we can stop giving you IV nutrition through the central line, then I think it's a good idea to do that soon. And if we do it today, while you're still on the ventilator, then we can safely give you more sedation and it won't be so uncomfortable." 

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Kalorm vaguely wishes MERRIN could be explaining that instead. Tharrim is not nearly as good at avoiding being incredibly confusing. Also he's sort of lost track again of how many days it's been and what happened when. He doesn't like it. 

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That is not a very happy expression. 

"You can do it while Merrin is here, obviously," he adds quickly. "And it doesn't have to be today, if you'd rather wait for tomorrow morning. ...It did look like you might be bleeding a little bit in your stomach after we gave you the sugar water, but we hadn't seen anything in the gastric tube drainage for days before that, and it doesn't appear to be getting worse. If you have any stomach pain - especially when we put something in there - or if we notice more blood, we'll have to do an upper endoscopy to have a look, but for now we'll hold off and just monitor it." 

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Why does every single part of his body apparently have PROBLEMS. Kalorm rolls his eyes at the ceiling. 

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"Anyway. I'll be out soon, but if you're awake now, why don't I get you set up for some resistance-band arm exercises in bed? That shouldn't tire you out too much for later rehab work." 

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UGH FINE Kalorm will do the incredibly stupid exercises while lying in his stupid bed. 

(They seem to have cleared out the things for his floorbed from earlier. Kalorm would request it again, except that he's not...actually sure how he would stand up from the floor? Standing up from the BED was HARD ENOUGH. Maybe once he can talk, he'll explain to Merrin that he wants her to show him how to get from the floor to standing...maybe if he had one of those dangly grab bar things lower down...) 

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Shift change happens. Tharrim sticks around until Merrin's reappearance from the pod, but - reassured that Merrin is still definitely on the premises - Kalorm is fine with Tharrim leaving and Dalthem taking over while Merrin eats her lunch (of cookies) next door. Dalthem does his assessment, and adds a few more instructions for resistance exercises, but then leaves Kalorm alone to do them and reads Treatment Planning updates.

It's about 2:40 when Merrin actually makes her way back out to the patient area and joins him. 

"Hey. Feeling rested from standing up earlier?" 

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Kalorm is mainly feeling REALLY BORED. He's in favor of, like, just about any activity that will give him something to DO. 

He sets down the resistance band and looks hopefully at Merrin. 

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"Right!" Merrin pulls up her knees in the chair and clasps her hands over them. Glances at Dalthem. "So I think Tharrim would've explained some of this, but we want to see if you're ready to sit up in a chair! I think you'll like it, it'll feel better for your back - I bet you're getting really stiff from all this lying in bed - and I predict you'll find it easier to be awake and alert, too. If you're up for it, you can sit up for most of the afternoon! The chair's adjustable," and has a custom Kalorm-fitted foam seat but that's so optimized and it will annoy him, she'll elide it, "so you can have breaks to recline with your feet up, and alternate with doing some more exercises! What we really need to work on, if you're going to be ready to try walking a little bit tomorrow, is your core stability - for balancing - and coordination with your feet. Working on that will be a lot easier in the chair. We don't want to exhaust you too much, because it'd be great if you were able to stay in the chair until 6 or 7 pm so we can do a minimum settings trial with you sitting up. Treatment Planning actually thinks that some amount of activity will help your lungs and make it more likely you can come off the ventilator tonight or first thing tomorrow, as long as you're not totally exhausted." 

Pause. 

"Did that all make sense?" 

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It was kind of a lot of things! None of them sounded bad, though? Kalorm definitely wants to get the stupid breathing tube out as soon as possible, and he's in fact feeling less exhausted than before, so if he has to sit up for hours in order to do that, he...can probably manage it? And he didn't really follow what else is involved, but presumably Merrin will explain each thing when it's actually happening. 

He nods. 

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They'll get set up! 

The chair is wheeled in by a third medtech. (Kalorm plausibly doesn't need more than two people's assistance, given how last time went, but "three medtechs in the room within arms' reach" is the universal policy for patients on a ventilator or receiving essential continuous-infusion drugs.) Even in its simplest configuration, it's pretty clearly a very expensive Medical Device. It maglocks to the floor, parallel to the bed; Kalorm won't have to walk to reach it but he will need to pivot around, so they'll put lightweight grippy-soled slip-on shoes on him, rather than the magnetically locking ones. They'll have the harness on him again, with a higher weight-assist if he seems to need it, but probably he can manage to shuffle around without it? As before, they'll have Merrin and Dalthem arranged on either side of him, and the third medtech behind him to catch him if he tries to fall backward, and then coming around the bed to help manage tubes while they turn him around. 

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Kalorm rolls his eyes SO MANY TIMES at the setup. Why do they have to keep overcomplicating literally everything??? He cooperates with Merrin putting the harness on him, though; he's even able to push with his feet to lift his buttocks a little, so she can slide it on without him needing to roll from side to side. 

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They have the standing bar-walker set up with a different magnetic base this time; it will still lock to the floor, but from a single point that it can pivot around, so Kalorm can hold onto it the whole time while he shuffles to pivot around and sit. 

Mmmmmaaaaaaybe he can manage with only 30% weight assist this time? 

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Kalorm CAN do that!!!! Standing up is easier this time! It's still not quite a primitive action, he has to think about what his knees and hips are doing - and he definitely notices that it's more effortful than before, and gives Merrin a suspicious look - but he makes it to his feet! 

 

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He's doing so well!!!!! Merrin really wants to hug him but he'll probably, like, fall over. 

She toggles the harness lift so that it'll only let him drop around 6 inches and then lock, rather than letting him fall all the way to the ground. And then they'll prompt him through pivoting so his backside is facing the chair instead of the bed! 

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Kalorm can do this but he needs a lot of prompting. He's not very good at following purely verbal instructions right now; Merrin has to nudge his left and right foot in turn and tell him whether to move each foot forward or backward or sideways, and sometimes interrupt and correct him when he gets it mixed up. It's an exhausting and wobbly thirty-second ordeal just to get himself turned 90 degrees. 

...How does sitting down work. Last time it just sort of HAPPENED and Kalorm was not tracking things very well.

(He feels fine right now? Out of breath, and his heart is pounding like he just ran a race, but he's not lightheaded or hot or even especially dizzy.) 

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Merrin has herself wedged right up against him, shoulder under his arm, one foot trapping his so it can't slide forward. "That's it. We've got you. We're going to count to three and then lower you down." Usually she would prompt him to let go of the bar with one hand and bend his knees enough to reach down and grip the chair arm instead, but Kalorm seems way too unsteady on his feet to succeed at that. 

They count it off and sit him down. 

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Kalorm is SITTING in a CHAIR!!!!! ...Okay, fine, a weird highly optimized medical chair contraption, but still. It's actually really comfortable! And he does feel like he can take deeper breaths than before! 

 

It's in fact noticeably more effortful to sit up straight like this than it was to lie in bed? Even though he has the back of the chair to support him, he still apparently has to do something with his abs to avoid toppling forward. He grips the chair arms tightly; it's a while before he feels safe and balanced enough to let go. 

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Merrin is beaming and looking incredibly pleased with herself! 

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She SHOULD! She just did all the really annoying work of helping Kalorm sit up in a chair even though he's incredibly incompetent at everything right now! Kalorm spends a while trying to figure out what to point at to convey that he's pretty sure both of them should get a cookie (and Merrin should, of course, eat hers right now.) He eventually settles for requesting paper so he can draw it. 

(The really stupid finger exercises are helping. His hands are already significantly better at being hands; he still needs the weird dumb easy-to-hold writing utensil, he doesn't think he could manage a normal pen or stylus, but he can draw way better! It's not, like, nearly up to his usual standards for drawing, but he thinks he almost got it to look recognizably like Merrin.) 

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It's a huge improvement over his first drawing! Merrin is proud of him! And fiiiiiine, she's still kind of full from lunch but she will eat a cookie behind a plastic divider. 

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It's about 3 pm. 

 

The next several hours feel so long. It's not that Kalorm isn't very determined to do all of the physical therapy exercises they give him! Or that the chair isn't comfortable! It's just that - even if he's breathing more easily - sitting up, even when he's not doing a specific exercise, is still kind of tiring. Also the exercises are all ANNOYING, but at least Merrin is very patiently explaining exactly what he's practicing and how it will help him walk. 

The stupidest exercise, in Kalorm's opinion, is the one where they take the back off the chair and all he has to do is sit up straight without it. It's sitting, it shouldn't be hard! And yet! It's hard enough to hold his torso upright without wobbling when the arms of the chair are in place and he can hold them, but then Merrin takes them away too, leaving him on a stupid armless backless stool-thing, and makes him sit up without holding onto ANYTHING. First with his arms crossed, which is bad enough, and then with his arms held out, which he can do for, like, ten seconds before his shoulders turn into jelly. 

After he does that for a while, Merrin mercifully puts the chair into a recliner mode, with a footrest, and lets him take a nap. 

And then he has to do another exercise which is almost as stupid! In some ways stupider! They recline the back of the chair even further and put his legs in leg-sleeves supported by counterweighted pulleys, and Merrin shifts the counterweight until the sleeves are holding his legs in place, but let him slide them up and down. And then they bring in a bizarre vertical contraption and he has to ""walk"" on two sliding vertical belt thingies with grippy rubber surfaces, which are marked with "footprints" and he's supposed to move one foot at a time from the bottom "footprint" to the top one and then "step" by pushing his leg back - well, down - against some sort of resistance on the belts. The contraption is dumb and it's also somehow ridiculously hard. He keeps missing the footprints. Merrin says that it's supposed to help him work on coordination, which he APPARENTLY REALLY NEEDS TO WORK ON because it's unreasonably hard to make his feet go where he wants them to on purpose, even when he's basically lying down and not even supporting any of his weight. He manages about twenty minutes of it - well, of alternating thirty seconds of "walking" and two minutes of flopping exhaustedly - and then he naps for almost an hour. 

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Merrin can tell that Kalorm is getting pretty irritated with all of this! As well as trying to avoid letting him push himself to the point of abject exhaustion, she's trying not to stretch his patience too far. 

He's doing so well, though! He needs 45% oxygen on the ventilator pretty much the whole time, but it's getting to the point that he doesn't need it increased by nearly as much when doing any exertion; bumping him up to 50% just during each set of exercises is plenty. And they're steadily weaning down the ventilator pressures. He's not quite down to minimum settings, but it's going to be a lot less of a jump when they try the next minimum settings trial. 

At 6:00 pm, when he finally wakes up from his second chairnap, she has the ultrasound probe with her. "Kalorm, we're going to get a scan of your lungs again, and if everything looks good, Treatment Planning thinks you're ready for a minimum settings trial." And they're a lot more optimistic about his odds this time! They're still going to want him in the bed before actually pulling the tube, it's not unlikely that he'll be less tolerant of exertion for at least the first few hours, but they think there's an 85% chance that he can stay within parameters the whole hour, if he avoids having a panic attack about shortness of breath โ€“ and a 55% chance that he manages the whole time without notable fatigue or increased work of breathing. 

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