Great! Kerrin will start getting ready. 

Merrin said she would look at the Treatment Planning markets dashboard and updates and so she is going to do that, but actually it turns out that her brain continues to be very tired. She can at least keep the grumbling internal. 

"...Hmm, so Treatment Planning suggests we give you a stronger anti-nausea drug a couple of minutes before the others. It'll make you drowsy, but that's actually helpful, for this, and it's the IV short-acting version so the sedating effect shouldn't last much longer than the procedure itself. Okay with you?" 

Kalorm is tired and processing words is hard. If he were less tired he would maybe want to check what Merrin means by 'not much longer', and whether it will make him feel weird in other ways, but that sounds way too hard. Probably Merrin has thought of all the obvious questions, and if there were problems then she would have checked that? 

He nods. 

...It continues to be really weird to watch someone ELSE doing tasks while, herself, not doing anything. Merrin feels awkward about it. Prepping for a bronchoscopy isn't really a two-person job, though, and also Kerrin keeps requesting customized equipment pieces that Merrin didn't even know existed.

If Kalorm were more obviously alert and seemed bored, she would maybe talk to him, but in fact he seems exhausted, so Merrin will just...sit here. 

It takes less than five minutes; Kerrin is experienced at this and very efficient with setup, and Treatment Planning is on the ball and has all their recommendations ready. 

Merrin has been tabbing absentmindedly through all the prediction market screens but she is kind of too tired to parse them. She's almost too tired to parse numbers. It takes her a really embarrassingly long 7-8 seconds to successfully navigate to the most recent Treatment Planning recommendations screen on premedication for the procedure. 

"Kalorm?" Nope his eyes are still closed. She reaches for his hand. "Kalorm! Hey. We're ready for the bronchoscopy but I was going to go through the plan for drugs to give you first." 

Nod. Not a very enthusiastic nod. 

Yeah, enthusiasm is sort of a lot to ask for right now. 

"Right. So we're going to give you about 1.5 times the usual dose of the bolus pain medication that we were using for suctioning, and then run a continuous infusion of it at about 0.2 times the usual bolus dose per minute, until we're done. It's short-acting, so it should still wear off almost entirely within ten or fifteen minutes of that. We already gave you the other nausea drug that they wanted to try and can't give that again, and most of the other options have a sedating effect and last a long time. This procedure in particular shouldn't disproportionately trigger nausea, but since it might be hard on your gag reflex, there's a tentative suggestion that we give you a mouth spray that will numb the back of your throat a little. It'll last a while but not more than an hour, so it still shouldn't be an issue for getting the breathing tube out after the minimum settings trial."

Pause to make sure he's keeping up.

"...And we'll give you a dose of the really short-acting sedative, too, and then I'll have the console up to give you half-doses of it if you request that by squeezing my hand twice. Uh, there's also a suggested protocol to give it to you if you're visibly in distress but not signaling that you want us to stop. Is that okay with you - um, sorry, nod for yes that's okay with you, or shake your head for no you'd rather it only be in response to a direct signal from you? I'm not going to be frivolous with it, I'd only give it if you looked really miserable, and you might be too out of it to communicate." 

Well. Under nearly all circumstances Kalorm would prefer NOT to have someone decide to give him drugs based on their personal assessment that he looked uncomfortable or something!

...Honestly, though, he trusts Merrin with this. He's pretty sure Merrin ALSO wants him to get off the ventilator soon. She might even be more motivated for it because she is - it's pretty obvious at this point - here despite it being her day off. He's managed to effortfully piece together the mental calculations for how many hours it's been since she left, based on the time which she helpfully reminded him of a few times, and he's pretty sure he didn't lose an entire day, in which case it's been, like, fourteen hours maximum? She must still be tired, even if it's not visible to him. 

(He wonders vaguely if it's because Khemeth persuaded her to come. He should try to remember to find out one way or another and then yell at his brother about that later, if so. Once he can actually yell at anyone again. It's not that he doesn't deeply appreciate having Merrin here, and clearly his brother has the capability and inclination to optimize Kalorm's life around him right now, so it's sort of pointless to question whether he has the right. Just. Somehow it's worse if he's dragging Merrin into it?) 

- right, question. Kalorm spends a moment trying to remember which option was a 'yes' versus a 'no', and then nods. 

Huh. Despite all her attempts at reassurance, Merrin hadn't really been expecting him to agree to that? 

She pats his arm. "Okay. Uh, and the last thing is that they want us to give you a different beta blocker – it's longer acting, so it'll affect you for up to half an hour, but you shouldn't subjectively notice anything. The idea is mainly that you'll feel less panicky if your heart rate isn't up as much. Okay with you?" 

...That probably should have been easy to follow, Kalorm feels like he understood all the words, it's maybe just that Merrin ALREADY SAID lots of words and he's running out of mental space for them. He nods, though. 

They'll get started, then!

(Kerrin is trying not to feel impatient about waiting for all of Merrin's explanations. She's instead trying to use it as an opportunity to pick up on Merrin's style of interaction with Kalorm, and try to figure out how she's judging what level to explain things at.) 

Drugs go into Kalorm. 

Kalorm was already a bit drowsy from the recent pain medication bolus, and is, indeed, fast asleep about ten seconds after the second dose higher goes in, even before she's administered the sedative. 

Kerrin has very carefully picked out a probe with a slim and soft tip, to hopefully cause Kalorm less discomfort, and she's good enough at this to avoid poking the walls of his airways, though even just sliding an ultra-slippery probe along them is going to hurt a lot; lung tissue is sensitive. Treatment Planning has an order of operations suggested, so they can prioritize getting the worst-affected lung areas first, in case he doesn't hold out long enough to finish everything. 

She starts. 

- Kalorm is awake about 0.5 seconds later, if not exactly alert. His head feels incredibly gluey and he can't actually figure out how to open his eyes, but it feels like someone is stabbing him from the inside!

He tries to scream! This doesn't work at all! 

Yep, that is the expression of someone in horrible pain! 

Merrin leans in closely. "Kalorm!" she says loudly. "It's Merrin. Everything's okay. We're washing your lungs. Ten minutes. Can you try to open your eyes and look at me?" 

That is UNFAIRLY HARD but Kalorm will try his best! Eyes open. He...can't actually see Merrin, his eyes are completely failing at focusing and also full of tears, but he tries to point them in vaguely the right direction. Maybe that counts? 

"Good. You're doing so well. Just try to relax - I know it's hard - I'm going to give you more of the sedative, okay, just getting calibrated on that -" 

She's still talking but at some point the sedative hits and Kalorm sort of loses the ability to process words. There's only vague pervasive horribleness and a single thread of thought, which is that he needs to endure the horribleness because it's very important. And not try to scream. That's also important. 

Kalorm still looks incredibly uncomfortable, but not like he's in agony. His body is slightly more relaxed, and his heart rate had gotten as high as 130 despite the beta blockers but is now down to only like 110. 

Merrin feels horrible about doing this to him! But he did agree to it. She'll just - keep repeating over and over that they're doing a bronchoscopy right now to wash out his lungs, and he should squeeze her hand once if he needs a break and twice if he needs more drugs and slap the floor if he needs them to stop right now. He seems out of it (and distracted!!!) enough that she isn't sure he's hearing her at all, but it's the best she can do. 

At some point Kalorm can sort of parse words again, and also - very effortfully - pull together the reasoning that he shouldn't ask for a break because then it will take longer for this to be DONE and OVER and then it will be easier to breathe because his lungs won't have glue in them. Also Merrin thought he could do this so he has to

This is substantially harder than with a patient under full anesthesia! Kalorm is clearly trying very hard to hold still, but he's not very relaxed, and he seems to be trying to avoid coughing by holding his breath, which isn't great for his oxygenation, especially given that she's also mucking around with his worse-affected right lung. 

She's getting a really satisfying quantity of lung secretions out, though. The secretions higher up in his airways are white or clear at this point, but further down there are still a few pockets of thicker yellowish gunk. She rinses out that bronchiole and suctions out the saline-mixed-with-secretions and then toggles up the positive pressure to pop open any collapsed alveolae and mists surfactant down, and then moves on to that area - and now she's basically done the full right lung, she spot-checks with a quick ultrasound scan for any areas that still look patchy... 

"Finished one side," she tells Kalorm and Merrin. "Pulling back to prepare for left lung." 

"Kalorm, hey, did you hear that? Halfway done! Actually maybe more than halfway, your right lung was the worse one. ...I'm going to give you one more dose of the sedative, your heart rate is way up again so I'm guessing you're in a lot of pain. Slap the floor if you're done and want us to stop?" 

That's stupid. Then he would have asymmetrically washed lungs! 

(Then the drugs hit him and Kalorm is back to 'not really awake enough to process words'.) 

"- Left lung really isn't too bad," Kerrin notes, more for Merrin's benefit than Kalorm's but Kalorm might be listening. "Just need to check out a couple of the spots that were patchy on the scan...I don't actually see anything, must be small mucus plugs further down...oh, there we go, it's coming out in the saline rinse. - this section doesn't look bad at all, I'll skip the saline washout and just drop some surfactant..." 

The left lung takes her barely half the time that the right lung did, and the ultrasound scan spot check doesn't show any remaining opacities or collapsed areas. 

"- And done, pulling out now." She withdraws the probe.