Oh no she wants to hug him. That will not help at all. Crying will ALSO not help at all, Merrin's brain, so stop that.

"I...don't think I'm quite that worried yet," she says carefully. "I think we should get a scan, and then we'll have a lot more information to make that decision. But please tell me if you start to feel sicker, because you might feel it before any of your vital signs change, and we don't have lab results continuously." 

Kalorm stares at her. He looks incredibly overwhelmed. 

(His heart rate is also up at 120, but it's probably just stress; his blood pressure isn't dropping, though it's also not increasing as much as one would normally expect, proportionally.) 

"...Sick...how?" he manages finally. 

"Oh, um, so I guess the most likely deterioration we're expecting is for your blood pressure to drop significantly. You might notice feeling weaker or more tired before we see the change? And flag if you feel dizzy or lightheaded, but if that's a blood pressure thing we'll likely see it before you feel it. Um. If your hands and feet are really cold or you're noticing that your hands don't work as well, that might indicate that your body is shutting down peripheral circulation more to try to keep your central blood pressure up, but I'm also going to be checking for that."

She absently squeezes his nail again, watches it blanch and then slowly turn - not quite pink - again. At least his hands aren't noticeably mottled; if she notices that she's definitely going to start to worry. 

"There's also a fairly high chance of lung problems, from the inflammation or because fluids are backing up. You probably would notice feeling short of breath before your oxygenation started to deteriorate, so definitely flag that. You could start having massive bleeding in your gut, and that and any other problems will probably cause pain or nausea before a chance in your vital signs. We're also worried that you're going to get more out of it, which - I think I might notice before you do, if it's impairing metacognition, but flag if you're feeling irresistibly drowsy or finding it much harder to understand me or something." 

This is an unfair list of criteria. Kalorm is currently having to fight the drowsiness pretty hard, but it's been an exhausting conversation! 

"Will - tube...?" This is probably unclear but saying more words feels hard. 

Merrin frowns at him for a moment. "- Oh! Do you mean, are we going to have to put the breathing tube back if you get sicker? Uhhh. There are a bunch of circumstances where we would, yeah - for one, if we do end up doing the complicated surgery, we'll probably want to keep it overnight at least even if your breathing is okay. And if your blood pressure starts crashing, especially if you're really out of it as a result, we would ideally like to just to take some of the strain off your body, and so we're not caught off guard if something bad happens suddenly. Treatment planning thinks..." refresh refresh, "...60% that this would end up being recommended even if we don't take you to the OR, just to give you better chances." 

Kalorm nods. "Don't - want - but. If you. Think. Have to." His breathing is a little fast, Merrin notices, but it looks more anxiety-related than anything else; his O2 saturation is still 100%. "Just. Don't. Go." 

Oh nooooooooooooooooooooooooo.

"Kalorm, listen - I can't stay on duty around the clock, okay? I have a lot of stamina but not that much." 

Hopeful, pleading look. "Sleep here?" 

That is NOT FAIR. 

Though Merrin was, in fact, pleasantly surprised at how reasonable Kalorm is being about this. She's not sure why he's apparently decided to trust her with this, instead of one of the far more qualified medtechs, but. If what it takes for him to be entirely cooperative and on board with the treatment plan, she'll sleep on his floor for the next week if she has to.

"Yeah. Of course. ...You might not know I'm there, or remember it later, if you're really sick. But I'll be here until you're stable and can communicate for yourself again." Which means that had BETTER HAPPEN, universe, take that. Otherwise Merrin is committing to leaving this room literally never. 

Kalorm nods, sighs slightly, and relaxes quite noticeably. 

Merrin just agreed to do WHAT. 

Personnel is starting to feel like maybe putting both of these WEIRD ALIENS in the same room together for an extended period of time was NOT THE BEST IDEA. And also that he's not sure there exists a real number quantity of labor-hours that would be enough to compensate Merrin for literally not having any real off-time for a week. It's going to be awful on her. Maybe they can get her a pod of some kind so that she's technically 'in the room' but still has soundproofing and privacy, and at least avoid it degrading her performance too much, if not the inevitable month of recovery time that surely even Merrin will need after that. 

(Nobody is considering straight-up vetoing Merrin's decision. It's clear that she just made a hard commitment to Kalorm, and forcing her to break it will be a huge breach of both of their trust. And, overall, most of the team shares Merrin's assessment: that Kalorm is being shockingly cooperative, and they do not want to disrupt that.) 

Also, message to Merrin from Treatment Planning, the ileocecal valve prosthetic device is ready and should be available at the supply chute within 120 seconds. They're not going to risk the pacemaker-electrode setup, at least not until they have scan images that aren't six hours old and can confirm whether Kalorm's abdominal tenderness is just the result of a really ridiculous level of inflammation, submucosal edema, and damage to the lining sending distress signals, or if he's brewing something worse in there. 

"Kalorm, I'm really sorry, but I'm going to need to use the scope again for this. And, um, then I need to actually slide the thingy in over the scope to get it in the right place, so you're definitely going to feel that. But I still want you to tell me right away if you have any stabbing pain further in, or nausea. Okay?" 

She gets everything set up. Treatment Planning wants her to, while she's at it, flush the terminal ileum with some more of the bowel prep solution and then - and this part is important - wait to make sure it comes out again and measure the amount. So it's going to be a while. 

Kalorm, unsurprisingly, haaaaaaaaaaaaaaaaaates this! He is putting a lot of willpower into keeping his body relaxed and his breathing steady, because he doesn't, mostly, hate it because it hurts or even because it's uncomfortable - though it is - just because there is a THING in his BUTT and this should not be happening and just because he agreed to it, and it's Merrin, does not really make it much less horrible, just more something he's willing to endure anyway out of STUBBORNNESS.

Merrin starts off talking to him, but eventually settles on just focusing all of her attention on accomplishing it as gently and carefully and also efficiently as possible. 

She gets an ooze of sludgy stuff almost immediately once the misbehaving valve is forced open; it's almost too sticky to drain either through suction or the rectal tube, but with some extra irrigation, it comes out easily enough. It's not a normal color, and it's probably good that it's nice and contained inside suction tubing where neither of them can smell it, but it's at least not actively bloody, or the straight tarry black of old, digested blood from further up. 

Trying to irrigate a little ways into the ileum just results in the solution leaking back out, still nearly clear. 

"Kalorm, sorry, I need to position you differently and then try a bit harder at this - uh, let me know right away if there's any pain, especially sharp pain..." 

Kalorm is gritting his teeth. "Why. Doing - what -" 

It's probably a positive sign that he's asking questions, and also Merrin just wants to be DONE this. She's going to talk while using the bed equipment to reposition him (it's so convenient compared to the floor!) "Uh, Treatment Planning just wants me to check that the device we put in is working, by washing out the end bit of your small intestine and making sure something comes out. But I don't want to put the scope in too far and risk irritating things or cause bleeding, so I'm going to see if I can use gravity to get the rinsing liquid in further so it does more. And then I'll have to turn you the other way so gravity helps it come out again. Okay?" 

IF SHE SAYS SO THEN KALORM WILL DO IT. 

The irrigation solution goes in and doesn't immediately leak out. Merrin gives it two minutes, checking in with Kalorm approximately every fifteen seconds, and then - with the probe pulled back so it's no longer in the ileum at all - very gently positions him again so that gravity should help. 

Nothing much happens for another minute. 

"...Merrin?" Kalorm manages. "Feel - cramps. I think." 

That could honestly either be a good sign - that Kalorm is feeling the smooth muscle activity - or a very bad sign. 

Merrin stays calm. "Okay. I'm going to look with the ultrasound, and then I might have to try to use the suction, if your small bowel still isn't managing to empty on its own..." 

- it is, though! Not all the way as far as the rectal tube - there's a lot of colon to traverse, it's still not doing peristalsis very effectively, and gravity isn't helping them on the ascending colon - but Merrin still has the scope in there, and it's very visible. Fortunately the cecum has lots of room, because it looks like it's going to need it. 

On the ultrasound, Merrin can very clearly see the terminal ileum working on ejecting its contents. It's hard to follow it too much further up, especially when Kalorm is kind of squirming around trying to find a less uncomfortable position, but it looks like the stimulation is being propagated for at least fifty centimeters. 

Kalorm whimpers. "...bad...?" 

"Not obviously! I'm worried that it seems to be hurting you and I think we'd better still get that scan, but things are definitely starting to move along in there! Good job!" 

Kalorm really feels like he was at best a passive participant in this. He manages a weak smile, though. "Oh." 

Merrin hovers and waits. She doesn't strictly need to try to get all of that out via the scope, which is pretty inconvenient, it's a small-lumen tube and even liquid stool is thicker than it likes. The colon is meant to have space, and it'll be informative whether it responses to this by trying to squeeze it out the rest of the way.