Merrin approves but does not entirely see the relevance of the second part? 

(She doesn't say this, just looks faintly puzzled while nodding along.) 

It is still, of course, obvious to Khemeth, even Khemeth operating on pretty significant sleep deprivation.

What to say about it is significantly less obvious. Merrin's confusion is clearly downstream of her blind spot around recognizing even comparative advantage, let alone any objective, measurable degree of unusual skill. It's weirdly tempting to just...try to have that entire meta-conversation now...because when he runs low on impulse control, and has been running a detailed model of someone for a while, his mind will keep pointing out the affordances he has to poke the system just to see what happens. 

...He should absolutely not do that. He should say something careful and reassuring that won't leave tired-and-understimulated Merrin chewing on what he meant through the end of her shift. 

"You're currently the most familiar-to-Kalorm person here aside from family," he says lightly. "And most of the family is, well, unpredictable enough that I would rather not leave Kalorm with them without either of us present. Finnar in particular is generically unwilling to accommodate other people being less intelligent than him and if he wants to talk to Kalorm it's going to require translation. Selfishly I enjoy working with you and seeing you with him - I noticed that you like him, that sort of thing is very obvious to me - but I think it's a good idea for us to stagger our on-hours to the extent we can." 

....Right, okay, that is not actually confusing. Maybe Merrin is just too tired to make obvious inferences. 

Khemeth has still not...actually moved. 

(He doesn't want to sleep here. If he tries he's going to sleep terribly, Nerdel can sleep through conversation but Khemeth's brain finds it way too salient. However. The Family Room is so far away! Getting there would require walking! Which first requires standing up!) 

Merrin has always been confused by people who can continue to speak in coherent sentences past the point where they can successfully walk for five minutes on flat ground. She can keep going on physical momentum for a while after her brain is approximately no longer online. 

She's not surprised, though. 

[Um, command center?] she subvocalizes. [Can the Family Support Worker arrange something for getting Khemeth back to their rooms?] 

(The regular Family Support Worker is not actually back on duty yet, she's day shifts only, but someone can come by, with a wheeled chair that they park discreetly outside the room in order to first check if Khemeth is mostly failing on initiating-an-effortful-action and can manage once someone literally offers him their hand and says "we're walking back to your room now.") 

(Yeah, this is sufficient, although Khemeth is not very happy about it.) 

The rest of the family does not have the attention span for watching an entire night shift of mostly nothing exciting happening. They're all asleep. 

Message for Merrin, now that she's not doing anything except watching her patient (and her patient's mother) sleep: Is she up for a conversation with her upcoming replacement where she can try to explain some of how she interacts with Kalorm? Especially anything that she isn't necessarily going to want to get into in front of Kalorm, but in addition they're modeling that she might prefer to get some of her verbal handover report out of the way when she's 12.5 hours into a shift rather than 14. 

...Yeah okay she can, uh, at least try? (Merrin absolutely expects her report to be embarrassing; she's at the point in a night shift when she starts to fantasize longingly about being horizontal.) 

Her replacement is an older medtech called Tharrim. He's almost forty, usually does six-hour shifts, and semi-specializes in working with ICU patients who are far enough along in their recovery to be conscious and interactive. Merrin appreciates him. Honestly, she's learned a lot from him on the handful of occasions where she delivered recently-stabilized patients to Default and handed off to him and then inevitably watched the next two hours of his shift. 

Merrin has to try pretty hard to introspect on what process she's even following with Kalorm right now - like with so many things, it's not automatically legible to her, and her metacognition is fried after this many hours awake. But handing off to Tharrim makes it easier. 

[I mostly just avoid anything that sounds like telling him what to do?] she subvocalizes to him while she watches Kalorm, relaxed in sleep, his color good, breathing spontaneously at 14/minute with his heart rate comfortably at around 65 and his blood pressure a gorgeous perfect waveform at 110/60. [Things like "I need you to do this" or "I want you to do that". I've been trying to be really matter-of-fact about everything, and I just - tell him what I expect to happen if he does something? Like, that he can try to talk if he wants but that I predict it will make him cough and we won't be able to figure out what he means.]

Kalorm's breathing slows as the EEG shows him transitioning from phase II to phase III deep sleep, the higher-frequency waves almost entirely replaced by slow delta waves. He doesn't even twitch when this triggers the ventilator backup rate. 

[If I need to do something like suction or turn him] she adds, [I just explain that I'm going to do it and why. I'll ask if he needs additional pain control or anything but I haven't been asking permission, because - I mean, it'd be sort of fake, right, I have to do it anyway and he knows that. Might make sense to give him more choice over the exact timing if he's alert enough later that he ends up, I don't know, watching a TV show or doing a puzzle game to keep himself entertained, but he's been way too sleepy for that up through this point, so I'm mostly having to time everything for when I don't have to rudely prod him awake.]

With Kalorm this deeply relaxed, his blood pressure is gradually dropping; it's now at 95/50. Merrin makes a face at it, and then eases down the dose on his continuous-IV-infusion painkillers rather than restart any vasopressors.

[Ummm. I think it's important to prioritize figuring out what he wants, if he starts trying to communicate something? I might play with the picture board file and get some simplified versions that you can pick-and-choose from based on some initial yes-or-no questions. Or you can ask him to draw it, and it's probably good occupational therapy - and neuro assessment - even if he still finds it frustrating and I'm not sure people other than Khemeth can easily figure out what he means] 

Latest electrolyte panel is back. His urea and creatinine are still rising - indicating insufficient kidney function to keep up with clearing waste products - but he is peeing, and it was up to 35 ml/hour for the last few hours. He's still going to need dialysis later in the morning, but - maybe not for very many more days. 

[I think he benefits from reassurance and encouragement more than I expected] she tells Tharrim. [Whatever else is the case, this is pretty scary for him. I think it's helpful to stay really calm, whatever's going on. ...I've been encouraging him pretty hard with minimum-ventilator-settings trials, I think maybe to the point that he's actually tired, so I'm not assuming he'll want to do it again right away when he next wakes up...]

Kalorm spends a full 25 min in deep sleep - he must have really been exhausted - and then his heart rate and blood pressure jump back up as he shifts to REM sleep. 

Merrin managed to get a very rambly set of tips conveyed to Tharrim and since then she's been sitting back, occasionally tuning into the chest-audio-sensor channel and making a face about Kalorm's worsening crackly lung sounds, or grimacing at the gross stuff coming out of his nasogastric tube, it almost looks like he's shedding bits of his stomach lining in there. 

[Expecting him to wake up in less than 30 minutes] she informs the command center. [Let's call Tharrim in once he's awake and I've explained that I'm headed off shift] For which she is SO SUPERHEATED GRATEFUL. It's almost 7 am and Merrin is slowly dying here. 

Kalorm wakes up at 7:25 am. His wakeups are a faster and smoother process, now; he yawns, blinks a few times, but barely looks confused or disoriented at all, and then his eyes land on Merrin and he almost smiles. 

Oh no yawns considered contagious– ...actually, Khemeth thought it was fine for her to let on that she's pretty tired. Also it's not hard to be in a cheerful mood because it is NEARLY TIME TO BE HORIZONTAL.

"Morning," Merrin says. "Feeling okay?" 

Kalorm makes another equivocal so-so gesture with his hand, and experimentally takes an extra-deep breath, which predictably ends in a cough. (Silent, of course, but the rattling vibration in the ventilator tubing conveys clearly enough that he's badly in need of suctioning.) 

He grimaces, and then makes a hand gesture that Merrin cannot quite interpret. 

She raises her eyebrows at him. "...Sorry, I don't know what you're trying to say. Do you want paper, or yes-or-no questions–" 

Kalorm - carefully telegraphing the movement while making eye contact with Merrin, in what's pretty clearly an attempt to convey that he is definitely not about to try to yank his breathing tube out - manages to clumsily reach up and tap the in-line suction tubing. 

Awwwwwwwww that's so weirdly cute. "Yeah. I think you'll feel a lot better if I suction you. Ready?" 

Eyeroll and wiggly hand. 

"...Yeah, fair, it’s unpleasant no matter what. Need extra painkillers for it?”

Kalorm shakes his head. (Figuring out how to convey to Merrin that he is, in fact, currently in some pain and expects coughing to be awful, but also that the extra painkiller they’ve been using is almost worse because it lasts 5-10 minutes and makes him feel dizzy and nauseated the entire time, is way too many steps to deal with right now.)

Merrin peers suspiciously at him - she vaguely suspects there’s something he would be telling her if communicating were less of an enormous hassle - but she, too, is tired and doesn’t feel like navigating that. She’ll discreetly mention it to Tharrim.

She puts her free hand in reach, in case Kalorm wants to hold it. (It’s convenient for her purposes too; suctioning him one-handed is theoretically more inconvenient, but she’s really used to having other tasks, like machine controls, occupying her free hand, so she’s very used to it. And it means she doesn’t have to worry about him panicking or getting disoriented and fighting her.)

This gets an eye-roll too - it’s exactly like having an overly helpful younger sister - but he grips her hand.

….And is shortly later grateful for it because, this time, he IS in agonizing pain, enough that the darkness behind his eyelids bursts into dizzying red-and-black spirals. 

That seems not-great! 

Well. On the bright side, Kalorm’s cough is a lot stronger than when he first started waking up, and his lung secretions are finally decreasing in volume. She can plausibly get away with just one pass.

On the less-bright side, his entire body is going rigid, he’s purple in the face, and overall he is clearly in horrifying pain.

She does the quickest suction pass she can, and rams the ventilator O2 concentration up to 100% because Kalorm is sort of not actually taking proper breaths right now, and she has a brief battle with the stupid manual controls on the ““adjustable”” hard foam wedge to lift his head.

“Kalorm, it’s okay - just breathe - it’s finished, you’re okay, just try to relax…”

Kalorm is not so much processing any sensory input right now.