Finnar is not invited. Finnar doesn't actually notice this, because he's holed up in his imitation control room reading about the actual studied manifestations of "minor" brain damage. 

The current lead opper is not even all that busy, but the Medical Crisis Liaison still takes the lead in communicating what comes next. 

They'll keep him chemically paralyzed until there are at least somewhat fewer tubes that he is relying on to stay alive and which could be pulled out by accident. In practice, this probably means sometime tomorrow evening, once the 24h period for keeping him at 32 degrees is over – though that's assuming his kidney function stabilizes and they can take him off the dialysis.

At that point, if nothing else has gone wrong in the intervening time, they can gradually reduce the sedation and see what happens. 

It's not a guarantee, because something might instead go wrong in the intervening time. 

His kidney function might not stabilize enough that they expect to be able to stop the dialysis and maintain normal blood chemistry with only drugs and IV fluids. The markets think this is 25% likely (though they're only putting 5% that his kidneys will fail to recover eventually given medical management and that he'll need a kidney transplant.) They'll be able to rewarm him the rest of the way, which should mean he'll be hemodynamically stable enough to tolerate intermittent dialysis once a day, meaning that he will only have tubes hooked to him some of the time, but it could still be a reason to delay another 24 hours on weaning the sedation. 

His lung function will probably improve, to the point that in another 20 hours he might actually be ready to breathe unassisted with just supplementary oxygen, but they might instead get worse. 20% odds on this. It's not a dealbreaker for waking him up, but it does mean that he would be in serious danger if he pulled out his breathing tube, and based on conversations with Khemeth, Kalorm is not unlikely going to try very hard to do that no matter how firmly they tell him not to. (He might also come out of the sedation very disoriented and not really able to process instructions, if they land on the worse end of 'minor' brain damage.) Also it's just very unpleasant being less than thoroughly sedated while on a ventilator. 

His stressed gut lining might result in a serious GI bleed (10%), sepsis from bacterial translocation (15%), or a full-on bowel perforation requiring surgical intervention (only 5% but it would be pretty flaming bad.) They're monitoring closely and he's getting prophylactic antibiotics even though this is not generally recommended for minimizing-new-antibiotic-resistant-strains reasons. In that case, they're likely to keep him sedated until he's more medically stable. 

He might get a hospital-acquired infection. Given no sign of this so far, and the fact that most of the invasive sensors are out, the odds on this are 20%. 5%, or 1/4 of that, is on a brain infection - low, but it probably does not need to be said that it would, also, be pretty superheated bad. 

A few other miscellaneous low-probability complications: damage signals setting off major vasospasm in his brain requiring intensive treatment to control (5%), a bleed in his brain from a previously weakened blood vessel (4%), random brain swelling and spiking intracranial pressure despite their attempts to do LITERALLY EVERYTHING to prevent this, that doesn't respond to first-line drugs and calls for surgery to open his skull (2%). 

All of these are still very unlikely to be fatal complications. Most don't especially risk additional neurological damage, though the ones that would affect his brain obviously do. Even if Kalorm has the very bad luck to have several at once, it's still very likely that he'll recover with prompt treatment. But it would mean that they probably won't be waking him up tomorrow. 

....Yeah. It's not over. 

Nerdel (having carefully followed all of the infection-control protocols before coming in) sits by her son's bedside - they've finally moved him from the transport bed into a full hospital bed - and holds his hand, strokes his shaved forehead, tries to get used to the fact that he's bald right now. 

She talks to him. Pointlessly, maybe, but it's not as though Merrin let that stop her. 

Kalorm still has (wireless) EEG monitoring sensors across his scalp. The monitor screen is no longer a flat isoelectric line; at this temperature, even under sedation deeper than the default surgical anesthesia, the electrical activity isn't fully suppressed. He spent a long time with a burst-suppression pattern - a flat line interrupted by occasional bundles of random activity - but his EEG is now a slow rolling wave, high-amplitude and low-frequency delta waves that are slightly sawtoothed by the superposition of theta waves. 

(As they reduce the sedation, in a healthy brain they would expect to see a lower-amplitude but faster pattern, with alpha and beta waves slowly coming back into play, and gamma waves once he's actually awake. They don't know yet how different Kalorm's awakening will look. His EEG isn't especially abnormal currently, given the conditions.) 

This is not the EEG pattern of someone who is processing sensory input on any level. He can't hear her. Nerdel knows that. But sometimes it feels, to her subconscious if not her explicit reasoning, like the spikier sections of theta waves breaking through happen right after she said something to him, and some part of her which is apparently not amenable to updating based on confidently-known neuroscience facts feels like he has to be able to hear her. 

They let her stay for almost thirty minutes before gently suggesting that she is perhaps sort of in the way. 

Khemeth, who is apparently utterly exhausted, sleeps much longer than Nerdel did. He wakes up around midnight, still feeling kind of terrible, but at least he can think again. 

They have an overnight interim Family Support Worker, since Fanthim is asleep. Khemeth asks him for an update, then asks if he can see Kalorm. Is he still stable? 

Kalorm is mostly pretty stable. 

On the bright side: his lungs are improving, at a rate toward the optimistic end of their predictions. He's on a little bit more oxygen - 35% now - but he's requiring less pressure support from the ventilator. Due to being paralyzed he's still reliant on it, but they're hopeful that once he's no longer paralyzed and is slightly less deeply under, as long as they can keep his pain under control (he does have cracked ribs, not to mention a recently closed large incision in his chest), he'll put in enough respiratory effort that they can make firmer predictions on whether he would be okay with just supplementary oxygen.

Inconveniently, some patients are sensitive to the respiratory-suppression effect of sedatives, even when the sedatives are specially targeted to do that less, in which case it will be much harder to tell without actually just letting him wake up. They really want to get him off the ventilator as soon as possible; it's another vector for infection risk and he really has enough of that already. (Though, thankfully, no sign so far of a brewing infection.) 

The less good news: his kidney function is still deteriorating. They did everything right, cleaning the muscle-damage byproducts from his blood, optimizing fluid intake, but sometimes you just get unlucky, and in this case it looks like enough damage was done before rewarming that he will not be coming off dialysis tomorrow. 

They'll let Khemeth in to see him though. 

(The twins and Mallor have actually also visited. Mallor apparently asked how much it would cost to compensate the medtechs for letting her sing. It turned out that Kalorm was stable enough that they weren't having to do much on an ongoing basis, just monitor him, and one of the medtechs was enough of a Mallor fan to pay her for an impromptu private hospital-room concert of all of Kalorm's childhood favorite songs, which one assumes Kalorm was utterly oblivious to.) 

Khemeth goes to see his brother. 

Bored medtechs are having subvocalized side conversations and proposing silly prediction markets like "will his blood pressure at [exact time] be [exact number]." (The markets that are just for amusing oneself through a four-hour night shift are obviously not ones that get much liquidity.) 

...It hits him a lot harder, being actually in the room. He stands where he remembers seeing Merrin standing, puts his hand over Kalorm's like he saw her do a hundred times, and his mental Merrin wakes up on cue and starts gently and calmly explaining to unconscious Kalorm what to expect over the next few days. 

You might be able to wake up in sixteen hours or so, but we might prefer to wait, because your kidneys still need some help and the machine that does that is kind of fiddly. If we think you're strong enough to handle the once a day version - it's a bit rougher on your blood pressure, but I bet you will be able to handle it by tomorrow - then we might be able to wake you up safely, but it's very important that you don't pull out the dialysis line, it was a lot of hassle to put in...

And his mental Kalorm - which his brain has decided to model as a pretty confused and disoriented Kalorm, maybe because actually being here and seeing his brother unresponsive and still (it's so wrong, for Kalorm) is making it feel more real - is very out of sorts, and not previously inclined to pull out his dialysis line but now he's sort of tempted just to be contrary because he hates being told what to do. 

The actual Kalorm is still and silent and indifferent. Or in some sense, isn't there in the room at all. Not yet. Tomorrow, maybe. 

Or not, if he still needs dialysis and the medical team doesn't trust him to cooperate with them about it. 

....Wow, his mental Kalorm HATES THAT. He agrees, grudgingly, that it is understandable for them to keep him nice and asleep while they're keeping him cold on purpose, since that sounds legitimately really unpleasant and also harder to manage at all on an awake patient who can shiver - but it is absolutely not okay for them to keep him sedated because if he were awake he would be inconvenient. 

Khemeth sighs. 

"I know. I don't think I actually endorse letting the medical team make decisions based on what minimizes the stress and hassle for them, as opposed to what you would prefer. But we're going to have to do some workshopping on this." 

He leaves the room, and asks the covering Family Support Worker who walked him over if he can speak to the head of the current medical team about later treatment planning. Or maybe the Personnel on duty right now? It's sort of a Personnel-type issue. 

...Sure, he can come over to the currently-pretty-quiet command room and they can discuss whatever it is with those people.  

Khemeth walks where he is shown. Gratefully sits down. He's still pretty tired. 

"So it's probably already clear from our general situation here that my brother is very neurodivergent. And predictable, given this fact, that we're going to have an...interesting...time when he wakes up. I also know that he would absolutely not consent to being kept under a few days longer to avoid a small risk of a bad outcome and a lot of extra worry for the medical team. If he had put his medical advance directives in writing, that would be included, and since he did not put them in writing – which is partially because his cognitive disability makes that more challenging, but definitely also because he would not have wanted it to be any of Civilization's business – I am the one speaking for him. And I'm saying that I think we should wake him as soon as he's up to normal temperature and medically stable enough for it to be reasonably if not perfectly safe. 

"I think we can set this up so that it does not end up being a disaster. I understand it will still put extra work and strain on your team, and we can obviously offer higher performance incentives for that."

Kalorm sure is going to roll his eyes about how much money they've spent on this, but they can afford it, and Kalorm will, in fact, feel different about it being his family's money rather than, say, Governance paying to try to save him because they don't think it was in his rights to let him take the risk of True Death. 

"However. I specifically need to know if I can have Merrin on duty for it, if she will be cognitively recovered enough that I can give her some pretty specific coaching, and if she'll be physically recovered and rested enough to work at least eight hours. If she needs more than 24 hours after the day she just had, that's very understandable, and I will try to coach whichever oppers you think are most equipped to consider the needs of a patient who is psychologically unusual in ways that are, in this setting, going to be understandably deeply obnoxious. But my preference is for Merrin. I've worked with her before this, I was one of the main contributors to the Merrin-modeling prediction markets and made some money on my bids despite being very distracted, and I'm confident that we can smoothly work as a team. If she's up for it.

"If she is up for it, and if it turns out that Kalorm gets along with her, I want to bid to keep her in Default at least until he leaves the ICU, but," shrug, "we can worry about that when we get to that point. ...Also we are obviously going to fund a very generous performance incentive for it, but since Merrin doesn't actually check, asking her her happy price to do this is not really going to work." 

....Some looks are exchanged. The current Personnel, who doesn't actually know Merrin, looks pretty dubious, but pulls up Merrin's dossier and sim records. 

"...She's done intensive sims with less rest time," she says, sounding impressed. "Two back to back 16 hour sims with only eight hours of rest time in between does result in degraded performance on the second day pretty much from the start, but she's done it, she didn't collapse in exhaustion or even make any really egregious errors in judgement. I don't know if eight hours is realistic just given circadian rhythms, it'll be getting pretty late in her "day", but – flaming craters she's done that too, a 12 hour during daylight then 24 hours off then a 12 hour overnight. Performance degrades a little in the second half of the second shift, and her motivation definitely starts to suffer, but - well, I saw some of the footage of her in there. I don't really foresee motivation being the issue." 

"- Oh, I know, she is absolutely going to say yes if we ask her. Whether or not it's a good idea for her. Which is why it's on us to decide whether it's reasonable to ask her, even though really Merrin has the best information on that. But - it's sounding like yes? I don't think this should be as hard as a lot of her emergency sims." Shrug. "Hard in a different way, I guess. But - I think she'll have an easier time than almost anyone else being patient with Kalorm if he wakes up and immediately tries to do something very stupid, which is unfortunately likely." 

They discuss it in a few minutes, and do, eventually, decide that Merrin can be asked when she wakes up (which will hopefully not be until closer to morning). Assuming Kalorm is still looking stable enough that they have a chance of getting him off the ventilator, and actually even if he's not but is stable enough to tolerate a few minutes of being mostly awake while they, hopefully, negotiate with him into willingly being more sedated so he's not horribly miserable. 

Yeah, no, very good chance Kalorm will decide that he would rather put up with misery than with being drugged. Khemeth's mental Kalorm is sort of waffling on it. It seems likely it'll depend on framing. 

...They're also going to need a Kalorm customized communication method if they want him to be able to express anything more complex than yes-no answers to questions, which Khemeth thinks they want because he expects it to help enormously if Kalorm can ask for things that no one, maybe even Khemeth, will necessarily think to offer. Usually patients who are unable to talk - for whatever reason, but 'still on a ventilator' is a common one - can write or type, but Kalorm finds written text very hard and frustrating to interact with at the best of times, and is definitely not going to be either able or willing to manage it while bleary from painkillers and almost certainly additionally cognitively impaired. Finnar invented a font for him that he finds somewhat easier, but it still takes his full concentration, which they cannot assume he'll have access to. 

If he has the physical dexterity for it, he can draw? Kalorm is actually really good at drawing, at his baseline, he has pretty amazing visual-spatial abilities aside from the weird difficulties with written text and certain other vaguely-similar areas. But he's likely to be very weak, and impaired fine motor control (that probably improves at least somewhat with rehab) is a real possibility even for minor brain damage. Khemeth can make a board of images, but that goes back to the problem of 'Kalorm can't communicate needs that no one thinks to ask him about', unless he can mouth words and they have someone on staff who's really good at lipreading? 

Sure, Khemeth can do that, but in fact this is not the first time they've encountered this problem. Or the thousandth time. They have lots of potential solutions, though, uh, some of them - like gaze tracking - do kind of assume the patient can read, if not type, because 'hands not functional' is a much more common cause of 'patient unable to type' than not being able to read is. And a lot of the weird clever solutions are for long-term cases, or planned surgical cases where the patient can in advance learn a blinking-based code, which one suspects Kalorm will struggle to do.  

Since he will probably be physically capable of pointing at images, the most comparable population is prooooobably young kids. Very young kids, because even three and four-year-olds can usually read, and very young kids in fact have different and probably simpler needs than an adult. Khemeth can maybe use those picture boards as a starting point? ....And possibly they should have someone go through and replace the existing images with ones that are less 'brightly colored exaggerated drawings clearly drawn for two-year-olds'. 

They've ever run into this problem with blind patients, though not many, but the solution there is usually "the patient knows a tactile script and can operate a specialized keyboard by feel". They can try the standard throat "microphone" for picking up subvocalization. It doesn't tend to work as well especially on the first day, calibration gets thrown off by the endotracheal tube altering how muscles in the throat behave, but it often works better than not having it. They can arrange to have someone in the room who's very good at lipreading. They can attempt to have prediction markets on it, although it's not clear how much better than will be than just 'combining the guesses of everyone in the room'. 

Good. 

Khemeth swings by to very pointlessly tell unconscious sedated Kalorm that this is now the plan. It makes Khemeth feel very slightly better, and it makes the mental Kalorm complaining in his head slightly less grumpy. 

He goes back to the Family Room and posts a bounty on coming up with things that should be included on a communication picture board for a patient who cannot talk, cannot read or type, and will probably be pretty out of it. He spends a while trying to think how one would even set up prediction markets to answer the question, if Kalorm ends up clearly wanting something and neither he with his mental Kalorm nor Merrin can figure out what. 

He reads about actual manifestations of what gets classified as "minor" brain damage.

There are not that many long-term case studies since the History Screen, because most neurotypical patients in that situation, even if their medical advance directives said they wanted full treatment if there was above X% odds on a good outcome, will still choose cryopreservation at the point when it's clear there are going to be permanent cognitive deficits. But there are a few hundred. 

It's not happy reading. Khemeth is sad about it. He's sad about a lot of things, actually, including that he MISSES HIS BOYFRIEND, and Dekan can't be here because it risks a Finnar-related explosion at a time they incredibly do not need any more emotional upset, and also Khemeth is having enough intense family-related feelings that he feels weird and bad about seeing Dekan without Finnar's knowledge. Khemeth is catching himself having trouble even interacting with that, because he feels guilty that he's keeping Dekan away, putting his immediate family first and he always does that and if Dekan did that to him he would be furious, but Dekan has never done it to him, and Dekan is never angry with Khemeth when Khemeth does it, and he feels terrible about it. Which is why he's having trouble even interacting with their text-message conversation window. 

Khemeth is fully aware that this is a stupid problem with an obvious solution and he could, instead, do Something Else Which Is Not That. But he's not really operating with an abundance of cope right now, and he's reserving it for problems which will actually impact the medical situation. 

Case studies on anoxic brain damage and stroke damage, and traumatic brain injuries, filtered for patients on whom they have at least three months of followup! This includes a small number of patients who were initially diagnosed as likely having moderate damage, but were parents of young children, and tried a few months of therapy in hopes that the most disabling of their symptoms would resolve. (This usually didn't happen, or at least not far enough, but a couple of patients did in fact recover enough – and were stubborn enough – to manage day to day life with the right accommodations but without ongoing help from a care aide, which in this schema means they would now be classified as only having "mild" permanent damage.) 

They don't know for sure that Kalorm will have permanent effects at all. 1 in 3 odds he won't. But basically all the studied patients, even the ones who made complete recoveries to their baseline within six months, had temporary symptoms, often pretty disabling ones. (It's also worth noting that this is measured mainly in 'no subjectively obvious residual symptoms'; basically all of the patients did, in fact, test lower on thinkoomph than before the injury, even if they weren't notably functionally impaired and were able to return to work or studies.) 

There will almost certainly be temporary effects of ongoing reperfusion-injury-related inflammation and the healing processes responding to it, which they have partially but not fully repressed. Kalorm is pretty likely to have a severe headache (80%), double vision, dizziness and vertigo (75%). He might have seizures: this is more common during the immediate recovery in patients who end up in the "moderate" damage category, but it's still maybe 30% likely in Kalorm's case during the immediate aftermath. 

He's pretty likely to struggle with general sensory processing, especially visual and auditory, to be easily overwhelmed and need more time and less distraction to parse complex input (70%). He may additionally have sensory sensitivities and be very bothered by bright lights or loud noises (50%). He might have actual partial vision loss (10%), or weird agnosias where he can't recognize people or objects or some other really specific category (15%, this is more common with strokes in the relevant area of the brain). In addition to the general processing difficulty, he may (40% odds) have language processing deficits, either receptive or expressive – not full aphasia, and this probably will get better in days rather than weeks, but.

He might have some degree of muscle spasticity and overactive reflexes, though for mild damage this is less likely (20%), and likely to resolve fully with therapy. He's likely to have trouble with coordination and/or fine motor function (60%), and might have neurologically-caused muscle weakness (20%, that's more common with strokes), or trouble executing on complex motor movements separate from the executive function impairment (which is itself almost certain at 90%, though it varies in severity and it's hard to know how much to attribute it to the lingering effects of sedation or the fact that being in a hospital with tubes in you is distracting). He'll more likely than not have impaired impulse control and difficulty regulating emotions (60%).

He will very likely have total amnesia for the accident itself (90%) and may have random other patches of amnesia (30%). He will probably seem forgetful due to inattentiveness (80%) and may also unreliably consolidate short-term to long-term memory (50%). He will probably be disoriented to time and place – well, almost certainly he will when he first wakes up, since Default Hospital is definitely not the last place he remembers being, but it's also pretty likely that he will have trouble remembering this and need frequent re-orienting (60%). 

He's going to be really tired. This is kind of guaranteed just physically speaking, but everything is going to be much harder for him, mentally as well as physically, probably for weeks. Even if he gets incredibly lucky, he's going to be brainfoggy and out of it and will probably find any kind of cognitive effort aversive. This may actually be adaptive, the same way that preferring not to stand up when one has the flu is adaptive. 

The presence of a symptom initially, and even its initial severity, are less predictive than one might expect on whether a patient who decides to wait around in hopes of a better recovery will still have that specific symptom in six months. Usually, like, half of the things resolve and a lot of them become less disabling. But having more, and more severe, initial symptoms is overall predictive that not all of them will fully resolve even given time. 

The one almost-universal complaint of patients with residual deficits – and the top reason they report for choosing to go into early cryo, sometimes years later – is fatigue. Day to day life is just harder, and they have less to work with, and even when they're able to return to work, it's usually with less stamina, shorter shifts, and generally more constant uphill struggle. Even leisure activities can be exhausting, if they're cognition-heavy, which is, you know, a pretty common preference to have about one's entertainment. 

Dath ilanis are already not starting out from a great baseline on this. 

Kalorm, on the other hand, is starting from a much higher baseline stamina! 

...He will also not cope well at all with having that much less of it. 

Khemeth...is not actually sure how much Kalorm's day to day activities were intellectually taxing for him before. Possibly not very?

The interesting thing about Kalorm is that, for all that he has very different interests than most people, and except for his weirdly specific disability (it's a known problem, but having it at his level of severity is very rare), Kalorm...is actually fairly smart. Spiky, the spread on his cognitive abilities is unusually wide, but on areas that aren't hit by his text-processing issue, he tests at around +2 SD on visual-spatial reasoning. (He's probably incredible at dead reckoning ocean navigation.) If he's tested on purely spoken-out-loud verbal processing, which is what his school did when he was a child, he's like, fine, and he likely tests lower than his true underlying raw ability because, as someone who has pretty low interest in reading even apart from his difficulty with it, he has just...encountered way, way less language training data than most people. At baseline he has an incredibly good memory, especially for places and directions. His cognitive abilities are uneven, yes – this is true of a lot of their family, honestly – but he's actually significantly smarter than, say, Merrin, who seems to do fine. 

On the other hand, Merrin doesn't have executive function deficits, or impulse control deficits, and you end up feeling like that would be way more disabling than just being kind of bad at math. 

...His mental Kalorm is - not really settling on a response? 

Which is fascinating. This almost never happens! Khemeth almost always has a pretty strong prediction of how people will react in almost arbitrary situations. 

But with Kalorm, waking up confused and in pain, hearing his eventual odds of a complete recovery (which will probably update after they see how bad the initial symptoms look, but there will still be uncertainty), and deciding just how hard to try and for how long...

He feels like it depends on factors he doesn't actually know, yet. An equation with too many unknown variables to solve in isolation. Which direction Kalorm's stubborn contrariness ends up landing. How much he feels like this is a situation where he is ultimately in control. How much it feels like a matter for the family versus a case of Civilization sticking its nose in his personal business for the thousandth desperately unwanted time. 

Some of that is framing, and Khemeth can workshop it with Merrin. Some of it...is maybe down to facets of his brother that, for all their years growing up together, and for all the time Khemeth has spent shaping the inside of his head to be other people and accurately predicting what they'll do, Khemeth has never directly observed and doesn't actually understand. 

Khemeth's head hurts again, his vision blurring with exhaustion, and maybe more than just exhaustion. He's not making progress on anything useful at this point. Everything hurts and he is bizarrely longing to be six again and fit in the curve of his mother's arms. Khemeth has not wished he could go back to being a child...possibly ever, actually, being a child was in most ways terrible. 

He drags himself to his actual bedroom, this time, and falls asleep without even managing to pull the covers over himself.