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Merrin working in Exception Handling
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Kalorm is busy trying to test if he can swallow. It's weirdly hard. It is, however, very satisfying to be able to run his tongue around his mouth and not have there be anything in the way. 

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He looks so focused. Merrin is pretty sure she can guess exactly what he's trying to do. 

"It's normal for swallowing to feel weird," she says. "Uh, if that's what you're noticing? And your throat will be sore, but it should be a lot better by tomorrow morning. Umm, I don't think it's a good idea to give you ice chips quite yet, but if that sounds appealing, we can try in an hour or two?" 

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Oh. Kalorm had forgotten that ice chips were an option. It...doesn't actually sound very appealing right now? He nods, though. 

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"Um, and are you up for changing position now? It might be convenient to get that done before your mother gets here." 

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FINE Kalorm will do that UNDER DURESS so that Merrin isn't sad he nods. 

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"Sorry to be so annoying." Merrin pats his arm. "Hopefully soon you'll be strong enough to shift your weight on your own and then we won't have to bother you all the time. Here - why don't you try helping us? If you can sort of grip onto my forearm, like so, you can try to pull yourself over..." 

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Kalorm will try that! He'll try really really hard, even. 

 

...Nope, he absolutely can't do it. He can feel his muscles tensing – it's a whole-body effort, not just his arm – but it's like trying to yank a tree out of the ground with his bare hands. It's just not going to happen. It really hurts his sternum, but that's almost an afterthought to the other ways that the exertion is making him feel bad – dizzy and lightheaded, somehow hot and cold at the same time, shaky and nauseated. 

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"- Kalorm, relax, let us do it this time." Kerrin is watching the monitor, and for some reason his blood pressure just tanked, briefly but all the way down to 80 systolic. "Breathe. Deep breaths." 

She was going to turn him on his left side, but actually she doesn't really want to fuss around a lot with pillows right now. Putting him on his back next should be fine, he's got the gentle-adhesive gel pad on his tailbone. She'll lower his head a bit, too; his breathing is okay right now but his blood pressure isn't, and she was not at all expecting that and isn't sure if it'll resolve by itself. 

[Diagnostics, any idea what that was?] she subvocalizes to the command center. 

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They're working on it! At a glance it looks like a vasovagal response to effort – in susceptible people, straining or bearing down with the abdominal muscles can stimulate the parasympathetic nervous system, causing a drop in heart rate and blood pressure, and potentially fainting. Kalorm shouldn't have most of the risk factors – he's not, or shouldn't be, dehydrated or low on electrolytes, and his measured blood sugar is normal – but he does have others; he's generally weak, there may have been autonomic nervous system damage from the prolonged hypothermia and low circulation state, and he's still on a pretty hefty dose of strong painkillers that can depress cardiovascular function and cause vasodilation. 

It's still a bit surprising and concerning that it affected him this significantly, but it looks like the main trigger was exertion, so for now he should just avoid doing that again? 

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Merrin is gripping both of Kalorm's hands. "Hey. Are you okay? Catch your breath first, but when you're feeling up for it, can you tell me what's wrong or what feels bad?" 

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EVERYTHING feels bad!!! Though less bad now that he's no longer trying to move. He feels less faint, but he's still so nauseated, and also for some stupid reason his mouth is full of saliva again. Both of these things make the idea of talking sound terrible. 

 

(Kalorm's heart rate only changed briefly and is now actually up in the mid-90s, and his blood pressure is slowly returning to its previous baseline, but he's still noticeably pale, slightly sweaty, and his breathing is rapid and shallow.) 

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Diagnostic yes-or-no questions to ask Kalorm once he's able to answer: was he in significant pain? (Severe pain can be a trigger for vagal stimulation and fainting). Is he currently feeling nauseated? (This is common after a near-fainting episode; they should be alert and ready to respond if he vomits, though hopefully the nasogastric tube has been keeping his stomach empty.) Did he notice abdominal pain specifically? (Neurological signals from the gut nervous system can cause vagal stimulation too, and they already know he has pretty significant GI dysfunction right now.) Less urgently, they should go through the list of symptoms and find out which ones he noticed. 

Treatment Planning wants to get a quick bedside ultrasound of his heart, just to make sure there's no new problem there, and they're going to advance the scheduled midnight lab work to now. 

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Kerrin will do that right now, if Merrin can be on staying with Kalorm, making sure he doesn't vomit and aspirate it, and asking him questions once he's able to answer them. 

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This is still not particularly an emergency by Merrin's standards, but it still feels VERY UNFAIR for it to be happening when she's not even technically here as a medtech! 

"Kalorm, can you try taking slow breaths? ...That's better. Um, do you need the mouth suction?" He's breathing with his mouth open again, which means that she can clearly see a saliva disaster in the making. 

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Kalorm had been considering trying to find the mouth suction! Swallowing is still bad. But moving his body is apparently ALSO bad and he's currently feeling very averse to trying it again until he feels slightly less awful. 

He nods. 

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The oxygen mask has a little panel on the side that opens, so Merrin can pop that open and clear out Kalorm's mouth without having to take the mask off entirely and then get it re-settled. She tries to be gentle and apologizes several times. 

"...Okay. Good. Is that better?" He's at least taking slower deeper breaths, and his blood pressure is back to 95/60. "Uh, nod if you want to tell me what felt bad, shake your head if you're not up for talking right now and would rather I ask you some yes or no questions?" 

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Talking considered bad. Kalorm shakes his head. 

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"Okay, uh, were you in a lot of pain from trying to turn yourself? We didn't actually give you any extra premedication for it this time." 

(Nod.) 

"Are you feeling nauseated?" (Nod.) "...Is it bad enough that you think you might vomit?"

(Headshake, but not a very confident one.)

"- Okay, if you do feel like you're going to vomit, you probably still won't because we're trying to keep your stomach empty, but I still want you to get my attention right away, okay? You can, uh, squeeze my hand twice as a signal if talking is too hard, and just in case we'll help you turn on your side so you don't choke on it. Um. Does your stomach or belly hurt?" 

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Kalorm has no idea how to answer that, actually? He's having trouble figuring out what hurts right now, or where specifically the feelings of badwrongness are coming from. He settles on shaking his head, but again looking unsure of it. 

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"Right. Okay, I need to go through a list of things and you can tell me which symptoms you noticed a minute ago? Even if they're better now." 

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Dizziness and/or lightheadedness: emphatic nodding.  

Shortness of breath: no, not really. 

Nausea: yes! so much! 

Feeling too warm: sort of? Kalorm goes with nodding, even though it wasn't like a normal kind of feeling too warm. 

Ringing in his ears: not that he remembers? He shakes his head. 

Tunnel vision or any other visual changes: not that he noticed, but he thinks he had his eyes closed? Headshake. 

Heart palpitations: he...doesn't think so? Kalorm isn't entirely sure he would have noticed, given how hard it is to pick apart all the kinds of physical unpleasantness, but he shakes his head. 

Feeling confused or disoriented: probably not? 

Having trouble thinking or understanding words: he doesn't think he was having extra trouble over and above just being incredibly distracted, so headshake. 

Feeling anxious: well, yeah, it was stressful! Nod. 

 

 

Is he feeling better now: sort of mostly? He nods. (Also this is an exhausting number of questions to have to answer and he really wants it to be done.) 

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"Your heart function looks okay now," Kerrin reassures him. (If there was a transient issue, they missed it.) "We'll know soon about the bloodwork results, but Treatment Planning mostly thinks that you're just still very weak and some of your body's systems are fragile, so pain or significant exertion can dysregulate things. You should flag it for us right away if you start feeling unwell in a similar way while you're resting, but for now everything looks fine, so you may just need to take things gently for tonight and tomorrow." 

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The Diagnostic team wants a thorough bedside ultrasound scan of his abdomen just in case; they're not incredibly expecting to notice anything new, but it's generally an area of concern. 

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Lab results: nothing significantly new. Electrolytes are drifting in the expected direction, but slowly. (High magnesium can cause vasodilation and decreased cardiac function, but his magnesium is still just barely within normal limits, so it's probably not a major factor.) Hemoglobin and hematocrit are normal; it's not likely he's bleeding anywhere. Urea is creeping up, it's now above the normal cutoff, but it shouldn't be high enough to cause problems. Generic inflammatory and tissue-damage markers are still sky-high, but the trend is downward. 

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"Kalorm, I'm really sorry, but we need to get some ultrasound pictures of your abdomen to make sure that there's not a new serious problem there that's causing your symptoms. It shouldn't hurt, but it's probably going to be a bit uncomfortable to have me touching you there, and if it does hurt I want you to flag that for us right away. Okay?"

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