This post has the following content warnings:
Merrin working in Exception Handling
+ Show First Post
Total: 2626
Posts Per Page:
Permalink

It's a bit of an unwelcome reminder that no matter how much she gets everything right, the final outcome here is not necessarily going to be one that everyone is happy with. But it's still definitely the case that everything could have been so much worse. 

Permalink

Kalorm spends a while listening to forest sounds and maintaining a steady sustainable jog through the forest focusing on breathing. He still feels terrible in fifty different ways but this one thing is not entirely terrible. 

 

...Eventually his chest is aching more and he's starting to feel like he really needs to cough and also isn't sure he'll be able to catch his breath again afterward. He has no idea how long it's been, but - longer than previous times, he thinks. 

He opens his eyes, and immediately wishes that one of either the room or the nature sounds would go away, dealing with one at a time is tolerable but BOTH AT ONCE is making his brain VERY CONFUSED. He can't see Halthis; he waves a hand to try to get her attention. 

Permalink

Halthis sidles over. "Hey. Just so you know, that was about an hour and fifteen minutes. How are you feeling?" 

Permalink

How is Kalorm supposed to answer that in only hand gestures. 

...Well, he can tap the suction tubing again. 

Permalink

"Yeah, you're pretty due for suctioning. ...You did really well, but I'm inclined not to put you through that - or give you the painkiller - while you're still on minimum ventilator support. Um. How are you on shortness of breath, from 'none' to 'lots' -" she demonstrates by holding her hand at navel height and then lifting it to neck height. 

Permalink

Kalorm - predictably - rolls his eyes, but then actually considers the question. Drags his hand up to mid-chest height. 

Permalink

"Yeah. Your vitals are fine but your per-minute air volume is starting to drop. You did really well and I think you're super close to being ready to breathe on your own, but I'm worried that it's still too much effort to be compatible with sleeping or with any other exertion." 

Permalink

This is, in fact, the conclusion Kalorm had come to on his own. It's still OBNOXIOUS of her to say it out loud.

 

He scowls. But nods. 

Permalink

"...Yeah. I know it's frustrating how long this part of the process takes. But it's a huge improvement from earlier. You're oxygenating really well, you're still only needing to breathe 35% O2 concentration."

Admittedly his O2 saturation has been hanging on barely above 92% for the last twenty minutes, and Halthis would have gone up if she hadn't been expecting this to be a temporary exercise. But still.

"My thought is to bump you up to the pressure support you were at earlier before suctioning, then you're due to change position, and then if you're up for it we can do the lung recruitment setting from before. You responded really well to it, so that might actually let us go down on the maintenance pressure support while you get some rest. Okay?" 

(Halthis, after reviewing the neurological-outcomes predictions and also re-watching some of Merrin's earlier shift, is making extra effort to speak in shorter and simpler phrases, while also not making it sound like she's talking to a five-year-old.) 

Permalink

Fine, whatever, she can do The Thing Which Is Not Breathing to him again if she feels like it. Kalorm is, at this point, mostly just holding out for all of that stuff to be over with so he can take a NAP. 

Permalink

It's not surprising that he's pretty worn out! (And it's sort of convenient that he doesn't have the energy to be contrary about her suggestions.) A nap after this sounds like an excellent idea. 

Halthis by now has significant practice on how to make suctioning and mouth care and repositioning as comfortable as possible for Kalorm specifically while still being quick and efficient about it. She positions him on his back this time, with a gentle-adhesive gel pad over his tailbone; there's already some redness there, lying on his back on the FLOOR is not great especially when they have to keep his head elevated, and being on IV nutrition only puts him at higher risk of pressure ulcers.

Is he up for some lung-recruitment respiratory therapy now? 

Permalink

If it makes her leave him alone sooner, sure. Kalorm is pretty drowsy from the painkiller-and-nausea-drug, which actually makes it a bit easier not to involuntarily fight the ventilator as it does weird things to his lungs. 

His body does start trying to give him a coughing fit halfway through, as the higher pressure and vibration loosens stubborn mucus. It turns out that coughing against a really high post-exhalation pressure is weird and unpleasant.

Also the quick-acting nausea drug must be mostly wearing off, because the combination of having air forcefully shoved into his lungs, and now gagging on the tube, is making Kalorm feel pretty sick. His mouth is watering about it, which makes it even worse. 

Permalink

...Yeah she'll toggle the lung-recruitment setting off and suction him again. They seem to be getting the thicker, stickier secretions now, what must have been mucous plugs in some of his smaller bronchioles. Which is great! Just, also, means that she cannot actually suction him as gently if she wants to get all of that out.  

Permalink

Kalorm tries incredibly hard not to fight it, and manages to hold still up until the point when his body decides it's time to start dry-heaving now. Which REALLY INCREDIBLY HURTS, actually!!! Aaaaaaaaaaaaaaaaah!!!! 

Permalink

Halthis immediately stops, pulls back the suction catheter, and turns Kalorm's head to the side in case he has anything in his stomach that the gastric tube hasn't drained yet. Giving him another dose of the painkiller-blend barely five minutes after the first is really going to knock him out, but he definitely looks like he needs it; she taps the IV pump controls, and gives him more beta blockers as well. 

"You're okay, I've got you, deep breaths," she says, trying to juggle speaking in a way which is both soothing and loud enough to get through his considerable distraction. 

Permalink

Kalorm is NOT FINE!!!! He can't BREATHE because his body is instead trying really really really hard to vomit, even though this is not achieving anything except tasting bile in the back of his throat. This is incredibly awful actually and he's pretty panicked about it! 

Permalink

"Kalorm. KALORM. Deep breaths. You're okay. Just try to relax." 

He is (understandably) super not succeeding at that.

"...I'm going to give you a dose of the quick-acting sedative to help you calm down, okay?" 

Permalink

Not super okay but he can't really communicate that, can he, and also the current situation isn't very okay either! 

Permalink

Permalink

It's also pretty unsurprising that having that much sedation on board, when he's already tired, tanks his respiratory drive. And blood pressure. Possibly she didn't really need to give him that most recent dose of beta blockers. 

She can increase the set rate on the ventilator and restart the vasopressors until his vital signs recover a bit. And do really thorough mouth care while he's too unconscious to mind, because yeah he sure was heaving hard enough to push up some bile from further down in his duodenum, and luckily his airway is protected but she would still prefer Not That. He must have been agonizingly uncomfortable. She can at least give his mouth a really thorough rinse and swab around some moisturizing mouthwash that he hopefully won't hate the taste of, and wipe his face and swap in a clean pillow, and still be done poking him before all the sedation starts to wear off. Maybe he'll stay asleep. Halthis would like that. It's nearly 7 pm, she has an hour left, and she ideally wants to start preparing for her handover. 

Permalink

Kalorm is so drugged and so tired. He stays asleep. 

Permalink

She should probably nudge him awake for shift handover if nothing else; it seems...worse...for him to wake up disoriented, with his last memory being the incident that just happened, and with an entirely different medtech he hasn't even been introduced to. She's not looking forward to this; if his sleep cycle continues on the same pattern, he'll be right in the middle of his deepest slow-wave sleep period, and predictably very grumpy about being awakened. (Not to mention, he badly needs the sleep.) 

Does Treatment Planning have anything new to say, particularly on the question of avoiding the thing that just happened? 

Permalink

Treatment Planning has a proposal for a new scheduled anti-nausea drug cocktail, to administer a few minutes before it looks like he's going to wake up. It includes a recently developed experimental drug that's supposed to block the transmission pathways whereby signals from the gut are relayed to the central nervous system and triggers the nausea-and-vomiting pathways. It's not recommended for long-term use because it does weird things to parasympathetic nervous system regulation of heart rate and blood pressure - which can be pretty inconvenient, even dangerous, if someone is more mobile than Kalorm is right now - and it's not incredibly popular with patients because it suppresses vomiting much more effectively than the unpleasant sensations of nausea. Also long-term use may actually reduce gastric motility. In the short run, though, it's not going to make that situation much worse, and might help Kalorm be more comfortable until he's ready to come off the ventilator, which should hopefully be really soon. 

 

They would also prefer she not wake him for shift handover, though. Their plan is to try to get Khemeth or Merrin at least in the room by the time she leaves, so Kalorm wakes up to someone familiar who can introduce the medtech who relieved her. 

Permalink

Merrin is, at this point, technically awake! She made irresponsible sleep choices and slept on and off for, like, ten hours straight, and then was finally mostly awake at 6 pm but kind of lay there in bed for another hour not doing things. She's no longer sleepy, but still feels tired enough that she might honestly be able to get back to sleep not too long after midnight. 

 

...She also has some sort of too-many-long-shifts hangover. Her motivation system really isn't fully back online yet. This does sometimes happen after really brutal sims, but it hasn't previous happened on a real patient case, let alone one where they wanted her to stick around and keep providing not-really-emergency care. 

She mooches around her apartment. Firmly tells her brain that no, today is not a caffeine day, yes she is aware that it was sort of coming to expect caffeine insertion and that is exactly why it does not get caffeine today, a day which is not an emergency. 

(At least, she assumes someone would have informed here if there were emergencies. Honestly she's kind of too drained to worry about it. She considers calling Personnel to check on Kalorm's progress, but that sounds tiring.) 

She flips through four different Exception Handling sim runthroughs with other medtechs that she'd been planning to watch and start prepping for. None of them hold her attention. Her spaced repetition doesn't hold her attention. Writeups on new medical equipment advances don't hold her attention. The fanfic she's been reading in dribs and drabs in her (admittedly really limited) spare time will hold her attention for like thirty seconds at a stretch before she finds herself back in a state of itchy restlessness, bored and wanting something but nothing around her feels entirely real. 

 

...She should probably get that massage. Maybe she can...send Irris a message on her cellular texter and ask if she can cause a massage person to show up and, like, maybe not talk? Today Merrin is not a talking Merrin, apparently. 

Permalink

Sure, Irris can do that. Also, does Merrin want her to call the command center and find out how her patient and the family are doing and text Merrin a summary? 

Total: 2626
Posts Per Page: