Even mostly unconscious, Kalorm really doesn't like having the suction catheter shoved into his sinuses! He makes an agonized expression, whimpers, and weakly tries to turn his head away. 

There's a lot of mostly-pretty-watery nasal secretions, mixed with greenish stomach contents and at least a couple of small unidentifiable chunks of something. 

"I'm really sorry but I need you to be able to breathe through your nose and you can't blow it right now." Merrin holds him down firmly, and goes after the other nostril. "It's going to feel better, I promise, once I get the stomach acid out of there, that looks so uncomfortable. Nearly done. See, there, it's okay." 

Kalorm's heart rate reacts almost immediately to the atropine! By spiking up to 110. 

His blood pressure rises more slowly, though, and levels off at 80/60. 

Someone is doing a quick bedside ultrasound of his heart, in between monitoring his gut while the fourth medtech lubricates the end of the irrigation-suction tube, which is soft rubber but nearly two centimeters across. 

"Contractility looks affected and his preload is down. Fluids should help but he might need colloids or plasma. Guess we're starting epinephrine until he levels out." 

Treatment Planning wants a full suite of emergency bloodwork. Try the epinephrine infusion, but don't let his heart rate go above 130; if it looks like he's going to do that, they'll swap in something like dobutamine that will mostly affect contractility. They would really rather not run epinephrine for very long, or any strong vasoconstricting drugs that will directly reduce the circulation to his gut. 

If the patient is confused or combative with the bowel irrigation and evacuation, they'll need to give him some light sedation, because putting this off any longer is really not an option. They'll need to do it under full general anesthetic if nothing else works to keep him calm. (Diagnostic markets are predicting a 40% chance that Kalorm ends up back on a ventilator for this, if only for a few hours until he's stabilized again.) 

...As soon as that's done and he's roughly stable, they're going on a trip to the imaging suite to get a full MRI and a radioisotope-labelling scan. Markets are currently putting 15% that he has a bleed or something worse and they'll be going straight from there to the operating room, but probably it's just a lot of tissue damage and inflammation. They're going to reconsider the anti-inflammatory drugs to block part of that cascade after his gut is at least washed out and less full of bacteria that his immune system is already impaired at holding off. 

Poor Kalorm! This is not a great day for him! 

Things happen around her. Merrin kneels beside Kalorm on the floor. She wipes his face clean and swaps out the soiled shirt panel of his pajamas, and keeps talking to him, occasionally causing him some minor pain to gauge his responsiveness. 

The main change is that he starts shivering - or maybe just shaking - really hard! It's an expected side effect of epinephrine but it looks so uncomfortable, and he doesn't really need to be burning more oxygen right now. 

His blood pressure responds, though, jumping up almost instantly to 125/80. At which point it doesn't take long before his eyes start to flicker open, though he seems to be having trouble keeping them open. 

"There you are," Merrin says, making sure she's in his field of vision, not that she's sure he's parsing any visual input right now. "Everything's okay. We're giving you a lot of drugs to stop your autonomic nervous system from freaking out and making you pass out again, so you might feel pretty weird. ...I'm going to give you a dose of the pain medication, you're making a face and it'll help with the shaking. Are you cold?" 

Kalorm gives up on trying to get his eyes open; he's only moderately drowsy, he can fight off sleep with some effort, but his eyelids really don't want to cooperate. He nods. 

"Okay. I think you sweated a lot when you were having the bad reaction, your pajamas are damp and we should probably get you clean ones. But I'd rather we do that after we're done helping you have a bowel movement, for now you can have an electric warming blanket. Uh, they're going to go in with a scope and suction tube, and use warm water to help rinse everything and pull it out. Uh, it makes a horrible noise and I'm sure it's not the most comfortable, but it shouldn't hurt, tell us if it hurts. If it's stressful, we can give you a little dose of the really short-acting sedative to help you sleep through it?" 

Headshake. Kalorm wants to be CONSCIOUS. Also it's surprisingly non-bad. He has pretty awful cramps, but he's not lightheaded or faint, and he's the least nauseated he's felt in a long time. His throat hurts again and his mouth tastes awful, but it's a minor problem. The weird shaking is annoying and his heart is beating uncomfortably fast and making him feel faintly panicky, and he's a bizarre blend of restless and incredibly floaty and sleepy at the same time, but it's okay, it doesn't feel like he's dying.

It sort of did, before. He remembers feeling like he couldn't breathe, his body entirely out of his control, and trying over and over again not to fight Merrin because he was pretty sure she was working to keep him alive, and being alive is worth having things shoved in his mouth. Especially when it's pretty clear that he wouldn't be able to breathe without that. 

It was still terrifying. He is maybe pretty freaked out about it, actually. 

- that is indeed a really horrible sound! Also aaaaaughhhh this round of cramps is pretty awful! He moans. 

Merrin takes his hand. "Is that painful? Stabbing pain or dull?" 

"Not stabbing. Cramps. Can I - hot -?" 

"Giving you pain medication again. You...want the heating pillow on your belly again? Uh, I'm sort of worried it maybe contributed to causing a bunch of vasodilation and making your blood pressure drop earlier, but I guess we can just go up on your drugs. I'll get it for you." 

She tucks it into position, and then drapes one small electric blanket over his torso and another over his lower legs, leaving his butt accessible. 

It's cold! And someone who isn't Merrin is TOUCHING him and Kalorm hates it! ...If he asks for Merrin to do it then she'll be over there instead of here, though, and that sounds scary and bad. 

Something is tickling his nose and making him feel like sneezing. Kalorm makes a halfhearted attempt to reach and see what it is, but his muscles still feel like water. 

Merrin takes his hand again and squeezes it. "You have oxygen tubing in your nose right now, instead of the mask, because I needed to be able to keep your mouth clear when you were vomiting. If you're not feeling nauseated anymore and it's less comfortable, we can switch back? And I think either way you don't need the tent anymore, your oxygen levels are back up again." 

"Nose okay." It's at least less everywhere than the mask, and feels less like it gets in the way of talking. "Can I - mouth -?" 

"You want some mouth care? I'm not surprised, your teeth must feel super gross right now." 

She does that, pausing only when Kalorm winces and groans at another wave of cramps. "- I'm sorry, I know this is uncomfortable, it's halfway to done. And it looks like your colon is managing some more muscle activity, and you're passing a bunch of gas, so you should feel so much better when it's done." 

Talking is indeed better once his mouth no longer tastes like a small animal died and rotted in it. 

"What - happened -" Kalorm manages. "Was - bad -?" 

Merrin squeezes his hand. "You're more stable now, everything's going to be fine, but you definitely worried us for a minute! We think that probably it was just the nerves in your gut reacting to your large intestine being stretched and irritated a little more from the enema, and sent a bunch of panic signals that made your parasympathetic nervous system react - that's sort of the opposite of the fight-or-flight response, it lowers your heart rate and blood pressure and makes your peripheral blood vessels dilate. And you're still pretty sick, so that was hard on your body, and then it looks like the drug we gave you to control the nausea hit your blood pressure really hard, and you lost consciousness for about a minute. We came really close to having to put the breathing tube back in to stabilize you and make sure you wouldn't inhale anything that shouldn't be in your lungs, but you were still breathing on your own and able to cough, so we held off to see if you'd wake up once we treated the low blood pressure, and you did. ...If you're feeling stressed or panicky, that's actually a normal side effect of epinephrine, though we might be able to go down on that, your blood pressure is up to like 140/90 and we don't need it that high." Pause. "Did that all make sense?" 

Nod. "Bodies. Stupid." 

"Hopefully it's just that. But we weren't expecting it, so after this we're going to take you to another room to get more imaging done, okay? We're worried that you might be bleeding or have an infection, or if we're really unlucky, someplace in your gut got enough blood supply cut off that it died and now there's a hole. Or you might just be having a really massive inflammatory response that's confusing everything."

"Diagnostics is thinking, uh," she refreshes the screen, "a 20% chance of the scan showing something obviously really bad and a 40% chance of it showing something ambiguously bad.  In the other 40%, we're still going to have to monitor it really closely, because the symptoms you're having are super worrying even if the imaging looks okay. If we see something bad, we'll need to do surgery and it's likely to be really hard on you. If it's ambiguous, but your vital signs are still off, they're probably going to want to do an exploratory procedure, but that's less of a big deal - they can go in with a probe and camera through a really small incision, and check the inside of your gut with a scope. If you were more stable it could be under local anesthetic and a bit of sedation, but since you're still overall not in great shape, I think we'd want to do it under full anesthetic with a breathing tube. If they didn't find anything scary, we could just wake you up at the end, but if we end up having to do a surgical intervention, especially if there's an infection or you lose a lot of blood, I think we'll keep you on the ventilator and pretty sedated overnight. I know you would prefer not that, but also we want you to be okay. Does that make sense?" 

Glower. 

"Feel better," Kalorm protests. "If - bad - would. Feel worse. Right?" 

Awwwwwwwwwwwww oh no poor Kalorm. 

"Maybe," Merrin allows, squeezing his hand. "I'm glad you feel better, at least. But we're giving you a lot of drugs to stabilize you, and some of them would be pretty bad to have to keep giving you for longer than half an hour. And you're clearly in quite a lot of pain." 

"But. S'not stabbing. Pain. Thought that...was bad...kind."