That's all fine! This was planned for; Kalorm has plenty of oxygen in his blood to get him through a couple of minutes of adjustment. 

"Kalorm, I'm going to help you with the oral suction," Merrin says - taking extra care to speak slowly and clearly - and then puts her own hand over his and guides it to his mouth. 

(Kalorm is clearly listening at least somewhat; he opens his mouth for it.) 

"That's really good, I know it's uncomfortable right now, it'll get easier from here..." And then she'll quickly wipe his face before slipping the oxygen mask into place, securing it with the lighter and more comfortable set of elastic straps. "There you go. That's it. You're breathing on your own!" 

It seems like TECHNICALLY he is still breathing with a THING on his face! Kalorm is so tired of there being so many THINGS!

...It's an improvement, though, there is that. 

Also somehow that was exhausting TOO, because now he feels tired again. He closes his eyes. 

(His oxygen saturation stays firmly at 100%. He's breathing at 18/minute, maybe a little shallow, but within the range of normal. And it's clear within less than two minutes that he's substantially more comfortable; his heart rate drops to 60, his blood pressure is actually borderline low.) 

This seems like a hint that he doesn't need his current dose of the continuous pain drugs! Kerrin will ease that down by 25%. (Her default habit is to use one of the IV pump preset routines to gradually decrease it over 2 minutes; for this particular drug, given its half-life in the body, Kalorm isn't likely to notice the difference, but it won't hurt and it can be quite noticeable for some drugs.)

[It's coming up on time to reposition him] she subvocalizes to Merrin. [I'm inclined to let him rest for another 30 minutes, though, see if he spontaneously requests it] 

[Sounds good to me. He still gets tired pretty easily, doesn't he?]

Merrin...isn't sure whether to be worried about this? It's not surprising in an absolute sense – if anything, Kalorm is still ahead of what she would expect, given how sick he was two days ago – but she's now calibrated her expectations based on the fact that he's always doing better than you would naively expect if you were basing your estimates on normal people.

Compared to her recalibrated expectations, she's...maybe slightly worried? They were all so thoroughly warned that Kalorm is stubborn, and it's not false, but she sort of feels like he's sometimes giving up on stubbornness out of sheer exhaustion? Which makes her sad???

Kerrin nods.

[He's working with a lot of deficits right now. The Diagnostic markets are pretty high-uncertainty on untangling how much he's being affected by cognitive dysfunction, versus just physical weakness – or preferring to avoid exertion because of pain or nausea. He's also still likely to feel short of breath on any exertion] Shrug. [In general, the best short-term approach is to rest, and he's resting.] 

Merrin fidgets. [I guess I'll be more worried if he still seems this low-energy tomorrow? ....I know, he has a lot of energy compared to what you'd normally expect, but I don't think this is normal for him in particular] 

Khemeth might have thoughts. Merrin is still intimidated by Khemeth, though, and doesn't really feel like talking to him when her brain is still this fried. 

Kerrin meets Merrin's eyes, her expression serious. 

[...If something is bothering you, that actually seems pretty important to note? You've accumulated more hours working directly with Kalorm, as a patient in this particular context, than any other individual person working on this case] 

This is hopefully not pushing too hard against Merrin's weird discomfort with anyone acknowledging her actual objective skill level? It's just obviously true that Merrin can and does work very long shifts, especially under emergency conditions? Kerrin looked it up, earlier, and even after her rest time, Merrin is highest on total hours (if not total value provided, necessarily). Khemeth is the runner-up, but the market consensus is that, per hour worked, most of his labor-hours were less critically important - and that he spent more time relevantly impaired than Merrin did. 

OH NO that's actually a sort of reasonable point.

But also it implies that Merrin should try to make her vague intuition legible so that they can note something more useful than 'the medtech who's worked most closely with Kalorm is Nonspecifically Worried'. Which sounds exhausting! Merrin is not very smart and she's bad at making her intuitions legible at the best of times, and also she's really tired right now! 

[...Noted] she manages. [I don't, uh, think that I'm worried about anything time-sensitive? Or, uh, I mean, I don't have any ideas for what we should do differently. It just...maybe sort of feels like something is a bit more wrong than we're taking into account] 

The medical prediction markets are definitely going to try to take into account that Merrin has some sort of vague nonspecific concern! It's not the easiest sort of thing to include in expert models, but nobody is expecting Merrin to put in the effort to make her intuition legible when she's this tired, and when the market on 'is there an unidentified problem which is actionable tonight' is at under 10%.

Kalorm's vital signs are all normal. His last complete panel of lab results is from 6 pm, and was all fine; they've dropped that to every 6 hours, with basic hematology and electrolyte plus urea and creatinine measurements every 3 hours. The 9 pm result on those was also still fine; his electrolytes are moving in the expected direction for someone with poor-but-slowly-improving kidney function. The market on whether he'll need another dialysis run is tightening; they're now at 92% that he'll need no more than one additional run, probably timed for midmorning though they'll have some wiggle room to time it for when Kalorm is in a relatively good mood. Though based on the rate of apparent improvement, the odds that his kidneys will pick up enough over the rest of the night and they can skip doing any more runs are looking lower, now, 30% –> 15%. 

There are some additional diagnostic tests they could run, to try to isolate a potential unidentified problem from the space of complications that are relatively more likely for a patient in Kalorm's situation. However, many of them are invasive enough to be nonzero-risk, and most are at least going to be annoying. It's late, and ideally they'll respect Kalorm's circadian rhythm and try to leave him undisturbed as much as they can overnight, so he can start tomorrow as well-rested as possible. If Merrin is only slightly concerned, it probably doesn't justify updating that plan. 

Merrin is still embarrassed that she can't give them anything specific enough to be useful! 

She watches Kalorm intently, in case that prompts her brain to fill in more details. 

Based on the EEG, Kalorm is drowsy but not quite fully falling asleep. He looks reasonably comfortable. His breathing is unlabored, his mouth slightly open; his oxygen saturation is still at 99%. His color is good. 

...Okay, right now nothing is flagging as worrying to Merrin. It seems to be something specific to interacting with Kalorm. 

Maybe she'll go have a look at the updated Diagnostic market predictions, to see if that flags anything for her?

Updated 20% / 50% / 80% spread on when they'll be able to wean Kalorm entirely off the strong continuous painkillers at rest, and get a less confounded neurological baseline assessment: 8 hours / 11 hours / 18 hours. The goal is to switch to as-needed doses, and ideally to a patient-controlled system where Kalorm can have his own handheld console to give himself small doses if he needs to cough or shift his weight. 

Estimates for Kalorm's stomach and gut recovering so he can eat and drink: 

Tolerating clear fluids (unrestricted, including juice and not just plain water): 4 days / 7 days / 10 days. They're hoping to introduce limited and closely monitored sips of water sooner than that, for patient comfort, but they're going to have to keep the nasogastric tube as long as it's still draining copious bile. 

(There's a proposal being discussed to do a guided placement of a much longer nasogastric feeding tube, that crosses Kalorm's pyloric sphincter and hangs out further down in his small intestine. It would provide a route for administering drugs – there are drugs that increase motility and promote tissue healing but should be given via the enteral route, and various medications, including drugs for pain and anxiety, are just much safer given that way. It would also let them start slowly and carefully giving him small quantities of calorie-containing liquid nutrition, while minimizing the risk of vomiting and aspirating; once it's been a few more days, giving his gut something to do will help with regaining normal function.) 

For tolerating nutritious fluids by mouth well enough to meet at least half of his nutritional needs: 6 days / 10 days / 14 days. If his gut is working well enough by then to provide the rest via a feeding tube, they might be able to get him entirely off the IV nutrition, which would be pretty good. It's likely going to be a long time before he can consistently eat enough calories the normal way. 

Updated timeline on Kalorm being ready to actively participate in bed based- floor-based physical rehab exercises: 10 hours / 14 hours / 24 hours. Shortness of breath and uncontrolled nausea are likely to be the biggest barriers. 

Estimates on when Kalorm will be able to walk, with assistance, at least 5 m: 72 hours / 5 days / 9 days. 

Unassisted walking at least 50m: 7 days / 12 days / 18 days.

Off supplementary oxygen for a contiguous 24 hour period: 3 days / 7 days / 13 days. 

Likelihood of a moderate complication, not necessarily medically dangerous but enough to delay his recovery: 35%

Likelihood of a serious complication: 8% 

Likelihood of permanent (mild) cognitive deficits: slightly up again, to 47%. Much of the increase is in response to Merrin's unidentified vague feeling of concern. 

....Merrin winces. 

- she's not sure she agrees? From the inside, it doesn't feel like approximately 50/50 odds to her, and - it maybe doesn't entirely feel like whatever she's vaguely worried about is explained by Kalorm's underlying neurological function being worse than she'd hoped. It feels like something else, that he's physically sicker than she'd hoped. But that's a very low-confidence observation. Merrin doesn't trust her intuitions as much period when she's tired and out of it, and she's aware that this could, just, be wishful thinking, her wanting the problem to be something they can still fix. 

She sighs, and flops in her floor chair and watches Kalorm half-dozing. 

Kalorm isn't really asleep. He's sort of drifting in and out, but mostly he's trying to drag together the energy to - to something. There's a vague pervasive badness, and it feels like maybe there's something he wants, something that could be different, that would make the situation a little bit more okay.

Not very okay. He hates this. He wants to be somewhere people aren't watching him and constantly making decisions on his behalf. He wants to be able to stand up. He wants having his eyes open and thus having to process his surroundings visually to be less overwhelming. He wants to stop feeling vaguely awful and he wants to be able to think. It's frustrating how anticlimactic it ended up feeling, getting the breathing tube out. He can theoretically talk now - probably, his throat is really sore and his tongue feels like it might be uncooperative and worse yet it might make him cough - but it turns out that there's still a barrier there, namely the fact that if he wants to talk then he needs to think of words in sentence order and then put in the effort to say them. Which feels like it might be really quite a lot of effort, right now. He can manage to breathe without much suffering as long as he's not moving or doing anything, but it feels like he maybe still doesn't have very much slack, there. 

He wants NOT THIS, and even though there are things he could probably ask for that would make it less...this...it feels almost pointless, because even if they're somehow willing to take away all of the monitoring equipment and leave him alone, he still won't be able to walk. And he doesn't really want to be alone, anyway, just to be in the company of people who aren't terrible, instead of people who are terrible

Maybe he can ask Merrin to give him more oxygen and that will make talking possible? Though he's sort of worried that the oxygen mask is going to be somehow in the way, if not of talking then at least of being heard. 

He tries to moisten his lips. "Merrin?" he attempts. 

It's not very audible! Kalorm isn't managing to speak above a whisper volume, and his vocal chords are very confused and not very cooperative, and he badly slurs the word. But Merrin is watching him closely enough to notice that he just tried to say something? 

She shifts closer. "I didn't catch that, repeat?" 

Well, the actual thing he wanted was to get her attention, and that worked, so mission accomplished! 

Kalorm tries to clear his throat. It turns out this is a bad idea. He manages not to start coughing, but it's a close thing, and it really hurts. 

"It's probably going to be hard to talk at first," Merrin says. "Do you need something? You're due to change position, so if you're uncomfortable that might help?" 

Kalorm doesn't want to change position! He wants to communicate. He wants something to happen because he asked for it. Unfortunately this requires figuring out what to ask for. It's terrible. 

"Khemeth," he manages, after fifteen seconds of effortfully trying to think of something and then another five seconds of figuring out how to make his tongue do things on purpose. 

The volume is still a croaky whisper, but Merrin is leaning in close and watching his lips. 

"- You want your brother Khemeth to visit?" 

Kalorm isn't sure if he wants that! He picked it mostly because it was the first thing he thought of. 

He does want to be able to say things and have them affect the world. So, sure, he'll nod. 

Kerrin tabs over to another page on her screen. 

"...Hmm, Khemeth put in a note that he's still pretty tired and is willing to come for emergencies but would rather rest tonight. Your mother has a note that she wanted to visit as soon as you were up for it, though? And a few of your other siblings." 

Ugh. Kalorm doesn't really want his siblings other than Khemeth here right now. Or more than one family member period. If there are two of them then they'll talk to each other. 

"Mother," he manages. 

"He says his mother can visit." Merrin is grinning at Kalorm. She can't help herself. "I expect she'll be so happy to see you doing better and able to talk!" 

"I'll send her a message." Kerrin taps out a note on the screen. "...She'll be here in ten minutes."