Khemeth is ALSO tired-but-not-sleepy. He's going to do his best to be around for the next few hours, especially once Merrin leaves for her much-deserved rest, because Kalorm might be grumpy about the eventually necessary shift change. For now, though, it seems like there may not be much to do for a while. Which makes it a good time to...try to haul himself out of bed, put on clothes, and make his way to Dekan's on-site suite. They've been exchanging messages but it isn't the same. 

Kalorm drowses for a while; the bronchoscopy was apparently tiring, even though he doesn't remember it happening. 

(His oxygenation is slightly suffering from the residual sedative - Kerrin needs to go back up to 30% on the ventilator after not too long - but it's not meaningfully interfering, and he's still getting very reasonable per-breath volumes of over 800 ml.)

Maybe 35 minutes in, he cracks his eyelid open and gestures at the clock display. 

Merrin, embarrassingly, takes a moment to notice this. 

"Huh? - Oh, sorry. Little over halfway done. You're doing great. Feel okay?" 

Kalorm nods, and considers whether it's worth trying to convey via gesture that he wants the picture board so he can communicate that he's BORED again, or if it'll just be easier to try to sleep until he can get the stupid tube out and communicate more easily. 

...Trying to sleep wins, because the former plan has multiple steps and that seems hard. Kalorm closes his eyes. He's visibly slightly restless, though, occasionally trying to shift his leg or arm. 

Merrin is not actually feeling cognitively functional enough to want more conversation with Kerrin, but she is BORED. She wonders if Kerrin is bored. This is so much waiting.   

(Yeah, normal ICU shifts when nothing is going wrong are like that! The system is set up to have enough slack to respond to an emergency instantly at any moment, but during a normal shift, most moments aren't emergencies! Merrin has possibly forgotten this, given all the time she's spent with Exception Handling doing sims where, not only is everything constantly an emergency, but she's having to handle it in unusually, often disastrously low-slack or low-other-resources conditions.) 

Anyway, Kerrin is not particularly bored. In between monitoring her patient and keeping up to date on Treatment Planning discussions – there's some back and forth right now about how fast to try easing down the dose of continuous IV painkillers, and whether they should start adding some non-steroid anti-inflammatory drugs for pain control, which was a bad idea initially given all the random organ damage and immune system weirdness – she's refreshing her memory on basic bed-based physical rehab exercises, and the passive 'exercise' workup toward them. There's some obscure literature on physical therapy-based treatment for gut motility issues that she wants to remind herself of, since it was mentioned in Treatment Planning discussions. Next up in the tab over is a summary page of non-medication interventions for helping patients sleep better in the ICU. 

Merrin super doesn't have the energy to read obscure medical literature! 

...Kalorm sure does seem kind of restless. Merrin wriggles closer. "Hey. Do you want some more leg stretches?" She does at least have one of her screens displaying videos of the various basic range of motion exercises that Kerrin was doing earlier. 

Kalorm WOULD like that! 

Then that should keep both of them occupied and not horribly bored for the remaining 20 minutes of the hour! 

Kalorm's breathing looks comfortably unlabored. He's still breathing a little faster than average, between 18 and 22 breaths a minute, and getting per-breath lung volumes of 600-800 ml except for the occasional deeper sigh breath, but none of this is worrying. His oxygen saturation is solidly 95% or higher on 30% oxygen and minimal ventilator pressure support. 

His lungs had sounded almost completely clear right after the bronchoscopy. There are some audible crackles again, now; his lung tissue is inflamed from the infection and previous damage, he's going to keep producing extra mucus for a while. 

"And that's the hour," Kerrin announces; she's also smiling, if not as enthusiastically as Merrin. "Your numbers all look good. Is your breathing still feeling okay?" 

Nod! Questioning gesture at the tube? 

"Yeah!" Merrin is practically glowing. "Uh, not right this second, estimate five minutes. What's going to happen is - uh, we will need to suction you one last time and do really quick mouth care, just to make sure you're starting off from a good point and aren't at risk of aspirating some icky saliva with mouth bacteria into your lungs, it's normal for it to take a few minutes to a few hours to figure out swallowing again. We'll get an oxygen mask ready, and sit you up more, and usually we boost the O2 concentration you're breathing for a minute or two, just to give you some wiggle room. We'll detach the tube fastener from your face, and pull the air out of the balloon that's making a seal around the tube in your trachea, and then - it's really just sliding it out. We'll ask you to take a big deep breath and then cough. It'll feel weird and might make you gag, but it's quick and it shouldn't hurt. Does that all make sense?" 

Impatient nod. 

Kerrin is getting the oxygen setup ready!

The oxygen mask is 3D printed and should conform perfectly to the shape of Kalorm's face; the main part is clear plastic, firm but not rigid, and the edges are padded with a soft gel lip, to maintain an approximate seal while avoiding putting any uncomfortable pressure on bony surfaces.

It's actually compatible with at least low-key noninvasive positive pressure ventilation, though they won't be defaulting to that. There are magnetic points to quickly attach a more thorough head-harness of elastic straps overtop the basic soft elastic that normally holds it loosely in place, and there's a toggle that will let them sort of suction-cup the gel lip to his face to make a seal, at which point they can replace the standard oxygen feed line with a positive pressure circuit. They probably won't need it, but if necessary they can do the switch without disturbing the patient very much. 

Once that's ready, and hooked conveniently - or as conveniently as they can do with this setup - beside the not-bed station on the floor, she'll give Kalorm a half-dose of the bolus pain medication, which is what Treatment Planning recommended. It'll mean he shouldn't be especially drowsy from it, and she can get away with pretty gentle suctioning, he only barely needs it. 

Kalorm is trying very hard to be patient but this is so annoying. 

"Nearly there," Kerrin assures him, glancing at the screen display she's set up behind his head to check for any last-minute updates. 

(There are none. The 'ready to extubate' market is closed; some people, it looks like Merrin included, will be making some money on this. It didn't end up being the most optimistic scenario - Kalorm has been awake for over 24 hours - but given how things were looking twelve hours ago, they're now doing better than expected. The Diagnostic markets are putting 98% odds that he doesn't need to be reintubated within 48 hours, and 85% that he won't require noninvasive assisted ventilation or more than 50% oxygen. If they do end up having problems and respiratory deterioration, uncontrolled pain - causing him to be uncooperative with repositioning or deep breathing exercises - is the most likely cause, so they should prioritize staying on top of that.) 

"Merrin will hold the tube steady while I peel this adhesive off your face," she tells Kalorm. "It might pull a little, you can tap my arm if I'm hurting you. Try to hold your head still, but nothing very bad will happen if you move a little, it'll just wiggle the tube and make you cough."

She's also going to go very gently, to avoid risking jarring the tube despite Merrin holding it. 

This isn't pleasant but it's tolerable. Kalorm will hold still, though he's grumpy about it. People KEEP TELLING HIM to hold still and he hates it! It honestly makes it even worse that he already separately wants to hold still to avoid torture, and also can't move very much even if he tries! It's less annoying when Merrin does it, but he would still prefer to be able to move when he feels like it. 

Merrin has done this enough times that she has Habits, though it's actually been a while since she did a shift with a real patient in such...normal...conditions. She's holding the oral suction catheter in her free hand, and has nudged the equipment-supporting arm with the oxygen mask hooked to it within easy reach. It's already flowing, with default initial settings in place – medium humidity, warmed to 25 degrees, 40% oxygen concentration which is probably higher than they need but better to start high and conservatively tweak it down. She can feel the faint breeze of warm-but-not-hot humidified oxygen-enriched air brushing her neck. She has a cloth draped over her arm where she can grab it once she's no longer on tube-holding duty and quickly wipe Kalorm's face before they slap an oxygen mask on him. 

...After a moment's thought, she temporarily sets down the suction catheter, and reaches for Kalorm's hand. "Kalorm, here, I'm going to give you this to hold. It's the suction for your mouth - this is probably going to make you drool and it'll be harder to swallow your saliva at first. It's okay if you need help, but I figure you might prefer to control it yourself." 

Kalorm does prefer that! He's also not going to nod right now because what if it does weird tube-wiggling things. He tries to communicate agreement via eyebrows alone. 

Kerrin turned the ventilator oxygen concentration up to 100% about 90 seconds ago, and it took like fifteen of those seconds for Kalorm's O2 saturation to jump up from 95% to 100%, so at this point he almost certainly has lots of wiggle room. 

"I think we're ready," she says. "Kalorm, whenever you feel ready, take a really deep breath, and I'll deflate the balloon and tell you when to cough." 

Why do people keep asking if he's ready????? Kalorm been ready for this for HOURS. He's definitely ready right this second! 

He does the thing Merrin told him to do before - breathes out as much as he can, and then in until it hurts. 

"Very good. Okay, and cough now–" 

Tube comes out! The end of it is trailing a rope of mucus. Merrin doesn't manage to look away from it before involuntarily making a disgusted expression. Hopefully Kalorm is distracted? 

So distracted! That felt incredibly weird, although then it was over fast enough that Kalorm didn't really have time to process whether it was a bad weird. 

He takes a couple of shallow breaths. This seems...fine? 

- he takes a deeper breath and immediately manages to slightly choke on all the saliva his body is making for no reason, which is incredibly frustrating since they repeatedly warned him about exactly this, and now he's coughing again. It's...differently unpleasant from before? It doesn't make him gag, but his throat feels really sore, almost raw, and then it's noticeably more work to catch his breath.