Kalorm rolls his eyes, but he can't hide the hope in his expression. 

His lung scan looks good! There is, at this point, relatively little obvious structural damage visible on ultrasound, though the lingering inflammation and tissue injury would probably show up better on a higher-quality CT or MRI image. 

He does look tired; the last three hours have contained the highest ratio of being-awake that he's endured in days, and there are dark circles under his eyes. But he also looks reasonably cheerful, and he's sitting up straight without much sign of effort. 

This is exciting!!!! Dalthem is excited!!!! 

He toggles the ventilator pressures to the minimum settings. Gives Kalorm a minute to feel things out. "Doing okay?" 

Nod. Eyeroll. 

Kalorm turns to Merrin and makes a hopeful gesture. 

What does that meaaaaaaaaaaaaaaaan. "Kalorm, uh, sorry, I - it looks like you're requesting something from me but I don't know what. Entertainment?" 

Kalorm makes a grabby motion in the direction of his lap-table and drawing supplies. 

With several minutes of deep concentration, he draws:

Awwwwwwwwwwwwwwwwwwwwwwwwwwww!!!!! Kalorm is the BEST patient. 

"You want me to tell you the rest of the mountain rescue sim story?" Sure, Merrin can do that! She's impressed and pleased that he remembers the start of that story, it was from before the sepsis and reintubation, days ago now. And that's, like, a pretty sophisticated picture, to communicate a nontrivial concept? It definitely implies good things about his cognition, even if it took him ages to draw it. 

She'll move on to a different sim story once she gets to the end of it, but try to keep him occupied - and distracted - until and unless he requests something else. Hopefully it'll help him avoid getting freaked out again? And she'll keep a discreet but very close eye on Kalorm's monitor screens, and on him directly. Is he staying within parameters? Does he seem to be putting a lot of effort into breathing? 

She has to bump him up to 50% oxygen after not very long to maintain an O2 saturation above 92%, and then, twenty minutes in, up to 55%. And he's breathing a little bit faster, to make up for smaller per-breath volumes; by thirty minutes in, his respiratory rate is up to 24, but it's still below the cutoff of 25 set by Treatment Planning. He also shifts around in the chair, and eventually settles on leaning forward, his forearms resting flat on the personal table – it's a position that a lot of patients experiencing some degree of shortness of breath will gravitate toward. 

 But other than that, he looks...fine? He's working somewhat harder to breathe than a healthy person would at rest, but it seems like a stably sustainable degree of effort; he's not showing any sign of accumulating fatigue or worsening respiratory distress. His O2 saturation actually creeps back up a little, stabilizing at 94%. His CO2 is comfortably mid-normal-range, and his per-minute ventilation is more than adequate. 

He's sufficiently engrossed in Merrin's third sim story that he doesn't seem to notice when the hour mark passes. 

Merrin glances at Dalthem, who refreshes screens and exchanges a couple of subvocalized comments with her, and they observe Kalorm for fifteen more minutes. He's kind of close to the upper cutoff for respiratory rate; it seems worth checking if a little more time pushes him over it. 

But nope! 75 minutes in, and he's still within all of his parameters, and doesn't look any more tired or anxious. His heart rate is comfortably at 75. 

Dalthem waits until Merrin finishes her story before interrupting. 

"Kalorm, it's been over an hour and your numbers all look really good. How are you feeling? Are you tired at all?" 

Obviously he's tired! He's been in the stupid chair for like FOUR ENTIRE HOURS and his lower back, which was initially delighted to be sitting up, is now starting to ache in a different way just from the muscle fatigue of keeping his torso erect. 

But he's - not particularly tired in a breathing-specific way? Breathing feels doable! He shakes his head, and makes an "okay" hand gesture. 

Dalthem grins. "I'm going to be so smug to night shift if we get you off the ventilator on my shift! But let's get you back in bed and comfy first, and you could probably use a quick bed bath and a change of pajamas so you're not sleeping in dried sweat tonight. We'll pop you back up to the previous ventilator settings for that, and we'll do all the work, since you had a busy day and I predict that all you want to do right now is lie down. And then we can talk about the plan for tonight. Okay?" 

Yeah okay fine whatever, Kalorm is just here desperately fantasizing about flopping with his warm weighted blanket. 

He needs substantially more help with the harness and counterweight to get onto his feet, this time, and he's practically falling asleep standing up; Merrin and Dalthem have to steady him repeatedly against almost falling. But they get him back into bed without actual incident, and he's too physically worn out to be anything but limply cooperative with being bathed. 

Kalorm does make a substantial effort to stay awake. If coming off the ventilator is a real possibility, he doesn't want to miss out on it just because he took a nap. What if they change their minds. 

He is maybe possibly kind of scared and not thinking about it. 

Merrin is pretty used to reading Kalorm's body language, at this point. She doesn't miss that he's nervous. 

Once they have him bathed and antiseptic'd and pajama'd and tucked in cozily with his weighted blanket, she pulls up a chair and sits beside him and takes his hand. 

"Hey. Treatment Planning thinks you're 95%-likely going to do well if you come off the ventilator, and they're only putting 40% that you'll need noninvasive positive pressure ventilation - that's the special big oxygen mask - to get you through the night. You're definitely going to need the regular oxygen mask, your oxygen needs are still too high to switch to just the nasal cannula. But the team thinks you're ready to breathe on your own. I think you're ready." 

She squeezes his hand. "It would make so much sense to be anxious about it, though! If you want me to stay another night even once you can talk and stuff, I will."

Merrin is not allowed to LEAVE yet what if he suddenly can't breathe and he needs her to fix it Kalorm is aware that Merrin is not the only qualified medtech here, even if she's the least terrible person in this hospital and possibly on this continent. Still, he grabs more tightly onto her hand. 

Awwwww. Merrin squeezes his hand back. It's okay, she may be getting kind of desperate to sleep in her own bed but she can handle one more day.

"Second thing. You just had a really big eventful day. It's not quite bedtime, I think, but if you want a nap before we pull that tube out, that's okay. Uh, nod if you want a nap first, shake your head if you're ready now?" 

Presumably they'll ALSO let him sleep once the tube is out??? And it'll be easier, he might be kind of used to it by now but you can't get completely used to something like that and it's still not comfortable. And being able to talk again will be so good – though he remembers the last time, it's a LIE that he can talk again immediately, it took a whole night before his voice was working again. But even just whispering is better than only being able to draw pictures. His hands are so tired from drawing. 

He shakes his head firmly, and tries to force his eyes very clearly open so he looks convincingly awake and alert. 

Merrin is not fooled! But it's probably fine if Kalorm is drowsy? If he's not maintaining his oxygen saturation while asleep, they don't have to keep waking him up repeatedly, they can just swap in the positive pressure mask. 

"All right. We do need to sit you up, and suction you once - you don't have a ton of secretions, but just to make sure. Ready?" 

Kalorm is ready to be ASLEEP but sure fine okay they can do annoying things first if that's a mandatory prerequisite. 

It goes fine! Kalorm knows the drill this time, and tolerates it with drowsy exasperation; he doesn't even freak out about being suctioned, a clear sign that despite getting five minutes of chest compressions only a few days ago, he's overall feeling much better and in less pain. 

Kalorm's throat feels raw and swollen, though, and the actual moment of having the tube come out is still very uncomfortable. It tickles his gag reflex, and then seeing the end of the tube dangling a rope of saliva and mucus nearly makes him vomit. Then he has a coughing fit that tickles his gag reflex even further, and he throws up a tiny amount of clear liquid that tastes like pure stomach acid – fortunately, onto the towel that Dalthem put over his lap. He gives Merrin SUCH a betrayed look when she insists on sticking the suction catheter in his mouth. 

He's definitely very dependent on the oxygen. They bumped him to 100% on the ventilator for two minutes before pulling out the tube, and even so, during the thirty-second interval when Merrin is helping him wipe his face and rinse out his mouth before putting the oxygen mask on, his O2 saturation drops to 82%. 

On 60% humidified high-flow oxygen, though, it takes him about fifteen seconds to climb back up to 95%, even though he almost instantly closes his eyes and seems to have declared that this is now naptime. 

Merrin is going to watch him VERY CLOSELY and VERY TENSE for the next hour, even though the Diagnostic markets are optimistic and Kalorm looks, like, fine? Maybe not quite as fine as the last time he was extubated — he’s breathing at 28 a minute now, and a little shallowly — but overall his breathing doesn’t look labored. His oxygen saturation is at 97%. His color is good, and he looks relaxed and comfortable, curled up on his side under the blanket with his head lifted to around 30 degrees.

Kalorm wakes rather abruptly about 45 minutes later. His heart rate jumps to 110, his breathing speeds and deepens - this is actually great for his oxygenation, he jumps up to 100% - and then, about a minute later, his eyes fly open and he flails at the blanket.

Merrin did not quite manage to make a decision on whether to wake him, and Dalthem is already administering the beta blocker for his still-elevated heart rate and blood pressure. 

She did manage to arrange herself to be in Kalorm's field of view, though he looks very disoriented and isn't really focusing on her. She reaches for his hand. "Kalorm. You're in the hospital in Default. It's me, Merrin. Everything is fine. I think you maybe just had a nightmare but you're okay, just try to relax and take deep breaths -" 

Kalorm looks terrified! He's curled up and hyperventilating and trembling. He is also not so much parsing words just yet, but Merrin's soft tone of voice does eventually manage to get through. He blinks hard - there are tears in his eyes - and focuses on her face. 

...Wow, he really wants a hug. From his mother, really, but Merrin is the one who's here. He attempts a reaching-for-a-hug sort of gesture. 

Awwwwwwwwww poor Kalorm he's so sad and scared. And she's still not really supposed to hug patients but he looks like he really needs a hug. 

Merrin hikes the head of the bed up, drops the bedrail and slips in beside him and puts her arm around his shoulders. "Hey, it's okay, it's okay. You're doing really well, your breathing is fine, nothing's wrong. - Dalthem, cameras off please." 

Kalorm is muzzy from sleep and kind of confused in a displaced-outside-time-and-space sense where he can remember that things have been happening but isn't totally managing to put them in order - he remembers drowning but he thinks that must have been a dream because he's definitely not, like, wet right now - but his throat is tight and he feels short of breath and dizzy and hot in a way that's very panic-inducing. But Merrin is there, and sounds calm, and probably if he was actually dying she would be doing something about that instead of hugging him? 

...he has possibly never in his entire life been as grateful to another human being as he is to Merrin for making the cameras go away. He had forgotten that there were cameras, which is a really stupid thing to forget. 

Merrin murmurs reassurance and rubs Kalorm's back and waits for his pulse and breathing to slow down as he gradually relaxes, his head drifting down to rest on her shoulder. His air supply is still mostly separate from hers, but she really hopes she's not asymptomatically carrying a virus that she's about to give him. 

When he seems mostly calmed down, she starts trying to extract herself. "Shhh. You're okay. I just - here, let's get you straightened out in bed and fix your blanket– Kalorm, do not lick your lips, you'll make them chapped. I have lip balm somewhere..." She balms his lips. "Uh, here, do you just want to hold onto this? There's a pocket in the bedrail for small items. You're always welcome to ask for help, but I'll put it there in case you'd rather do it yourself at some point. Come on, let's get you scooted back up in bed, you're all scrunched..."