Halthis has had exactly three patients ever who indicated 'I want to be suctioned' so directly and proactively, rather than trusting the presumably-better-informed medtech to notice if that was a good idea. One was a long-term patient back in the ICU with a relatively minor complication, and two were Keepers. (Both were substantially less impaired than Kalorm is right now. Halthis isn't sure what happens to a Keeper who is as impaired as Kalorm, but it almost certainly doesn't involve trying to directly make medical decisions anyway.) 

Kalorm's request is pretty reasonable, though! And was on her list anyway. Halthis nods. 

"I know, you're pretty due for suctioning too, and I don't mind doing that first if your lung secretions are the thing bothering you most. But in that case there's also something I want to briefly talk about first. Is your breathing okay for the next two minutes?" 

Kalorm rolls his eyes at her again but doesn't actively object. 

...Well, Halthis watched enough of the recorded Merrin/Kalorm interactions to know that that reaction isn't specific to her or an indication that she upset him! It was apparently pretty often how he responded to Merrin, right before going on to be cooperative anyway.

"So one of the things I heard at shift report is that you preferred not to get short-acting painkillers in advance of suctioning, even though it was painful. It sounds like maybe the drug side effects were bothering you more than the pain, but Tharrim wasn’t sure which side effects. I had a look over your other treatments and I have some hypotheses that I wanted to ask you about.”

Halthis is harder to understand than Merrin, somehow. It’s not that she talks too fast, exactly, it’s - some other thing.

Kalorm thinks he mostly followed that, though. He nods.

“Right. One common side effect is drowsiness or brainfog, which I predict you’re already feeling at baseline for other reasons, but - was the short-acting painkiller making it significantly worse?”

Nod. Noncommittal hand-wave. (It is making it worse but if it were only that he would go for it, it's not like it knocks him out less than the sedative.) 

"That sounds like, hmm, 'yes, but not a lot', or at least it's not the main objection?" She waits for his nod. "Next one is - I know you've complained of dizziness before. Does the painkiller make that worse, and is that a more substantial issue for you?" 

Why is she weirdly so much harder to understand than Merrin!!!! She's not talking faster.

Kalorm nods, a bit more energetically. 

"And how about nausea? I don't think you had explicitly flagged that as a symptom, but there are a lot of factors that might be contributing. It's not a common side effect for the painkillers we picked if they're used in isolation, we did think of that, but you have a lot going on right now." 

See, the thing is that conveying "not actually nauseated at this particular moment, but can tell it's riiiiight there waiting to surprise him" is too complicated for picture boards (and he was way too done with human interaction to answer a lot of yes-or-no questions for Tharrim about why agonizing pain was preferable to  the last time, who seems to have then given up on asking more later.) 

This particular question has a less ambiguous answer, though! He nods emphatically. 

Ha! Mystery solved!

“That makes sense. Are there other factors that are triggering nausea for you?”

Yes!!! Kalorm nods eagerly.

Halthis nods.

(That was four of her ten questions. Probably not worth spending any more on trial-and-error guessing which factors are the most significant, since many of them are not going to be trivially solvable anyway.)

“Right. I would guess that, all else being equal, you would rather have pain control for suctioning, if it didn’t have unacceptable side effects?”

Well, obviously! Kalorm rolls his eyes, but does nod.

“I’m going to pull up what Treatment Planning recommends, then, it’ll be a minute or two…”

She refreshes that screen (she has it up on one of the LCD screens behind Kalorm’s head, so he doesn’t have to be distracted by it.)

“- Oh, huh. So Treatment Planning is actually recommending we drop the short-acting sedative that Tharrim was administering for suctioning, and combine the second alternate painkiller we tried with a bolus dose of an anti-nausea drug - it’s not one we were already running, because it’s quite sedating and it won’t help with the major underlying problem, which is that your gut motility is minimal right now and your stomach going to be sending damage signals that trigger the nausea response.”

And when administered continuously, it has some weird effects on cardiac electrical activity, especially in combination with electrolyte abnormalities, but that‘s probably more technical detail than Kalorm really needs to deal with right now? 

“But it’s very good for motion sickness, which is maybe a better model for the immediate drug side effects, and it should cause less drowsiness than the sedative. And it should wear off fast. Sound good to try?”

That was so many words. Kalorm isn’t sure he super followed what the plan is. But he’s really not looking forward to this and, well, if it’s a bad plan at least it’ll be over soon and he won’t have to do it again. He nods.

Halthis isn’t sure how much of that he actually followed, but it looks like she has consent to try this variant, at least? 

That was…probably 5 of her 10 questions? Maybe 6 if you count her asking about other nausea triggers in full generality? Though it didn’t look like Kalorm particularly had to do any reasoning to answer it, and “making Kalorm reason through something” is at least a big chunk of what she’s trying to minimize. (She’s not going to count commonly-repeated questions like “okay if I turn you now?”, which shouldn’t require Kalorm to think it through freshly each time, but getting his go-ahead on a different premedication regimen seems like an Actual Question.)

Her next judgement call needs to be on whether to try to have the Dialysis Conversation now, or hope that he’s still up for it after suctioning and turning. …She’ll aim for it after, Halthis decides. That lets her reserve some questions in case Kalorm has a complicatedly bad reaction to the motion sickness drug and she needs to interrogate him about that in order to get Treatment Planning the information they need to propose something else.

“I’ll prepare that now,” she says, smiling at him. “One more quick question: so I realize mouth care is probably unpleasant, but in the longer run, regular mouth care usually does help mitigate nausea. Is it okay if I do it immediately after suctioning, before the drugs wear off and when you’re still drowsy? …To be clear, if you look distressed or try to fight me, I’ll interpret that as you withdrawing your consent, even if you end up being too sleepy at that moment to communicate it more explicitly.”

Sure, combine all the most horrible things, why not. …She probably has a point, his mouth feels disgusting - on top of the fact that he can’t manage to swallow his saliva and it’s starting to feel half dried out into gloopy stuff on his tongue, the stupid flavored swabs seem to leave some kind of nasty residue, and this is not helping. 

Kalorm scowls and rolls his eyes at her again, but nods.

“Okay.” Drugs are ready - she didn’t have to prepare the IV bag herself, there’s a little wall chute for the onsite pharmacy team to send it over, and then it just needs to be hooked into the increasingly complicated IV-infusion-pump monstrosity, and Halthis needs to read over the bolus-dose programming put in by the relevant team member - including “tied to the painkiller bolus so she can’t forget it” and accept it. And then tap the controls to administer. 

She gives it thirty seconds or so to kick in. 

Dazed sleepy Kalorm blinks at her. He’s trying to figure out how to ask what she’s waiting for, can she not get it over with, but his hands are, like, a hundred miles away right now.

One particular thing that Halthis has more experience on than Merrin on, and perhaps more helpfully oriented habits, is with situations that aren’t emergencies, where “stand around for thirty seconds to a minute doing nothing except waiting” is something you can afford to do a hundred times in a shift. She has a finely honed sense of exactly how long it takes for bolus doses of nearly all common ICU drugs to hit peak blood concentration and thus effect.

She also has habits more attuned to making suctioning comfortable - or as comfortable as it can possibly be - for a patient, in contexts where it’s not urgently solving the problem of “patient is failing to oxygenate adequately.”

And her actual physical procedure for it doesn’t assume that she’ll be having to multitask literally all of the time. She uses both hands (which means she isn’t offering Kalorm a hand to hold onto, but they don’t exactly have that sort of rapport anyway) and she does it gentle and controlled, adjusting the suction force up in bursts timed exactly to Kalorm’s coughs.

Weirdly non-torture???? (It perhaps also helps that the drug combination has an effect that makes Kalorm feel half out of his body, as though he’s indifferently observing events happening to it from a room over.)

Yep, that looked more comfortable for him than in the recordings she watched! 

Halthis gives him fifteen seconds to rest and hopefully land at the right amount of drowsy - he’s certainly not showing any inclination to open his eyes or communicate - and then allows exactly one minute for gentle mouth care. She has a Preferred Setup for it; this, too, is something that Halthis has put much more effort into really optimizing than Merrin. When you treat a lot of cancer patients experiencing post-chemo side effects on top of whatever brought them to the ICU in the first place, it’s just inconsiderate to do things that will irritate mouth sores or set off a highly sensitized gag reflex. And chemo patients tend to develop very strong taste and smell aversions to anything they experienced at the same time as severe nausea, so Halthis uses the unflavored antiseptic mouthwash whenever this might be a concern. 

Kalorm still doesn’t like it! But mostly just on the level of strongly dispreferring strangers doing things to his body in full generality. Aside from that, it’s not nearly as sensorily unpleasant, and he isn’t nauseated.

Aaaand Kalorm has now earned being Left Alone for ten minutes while Halthis refreshes various screens of data and prediction market updates.