When Khemeth actually makes it to Kalorm's hospital room - close to ten minutes later, after posting some bland updates to the social-modeling subchat - and clears his throat, Merrin startles, looks up with what seems like some reluctance, and then makes an abjectly miserable face at him. 

"I'm sorry." 

Khemeth glances around, and then slides down to sit on the floor beside her. 

"Why?" he says quietly. "From where I'm looking, you flagged before almost anyone else that something was wrong, you escalated it appropriately every time you noticed something concerning. Given the damage my brother took in the accident, and the constraints of his unusual preferences and dignity – given that we didn't actually, realistically, have the option of keeping him sedated another two days for proactive treatment – I genuinely don't see where or how we could have done anything differently and better-in-expectation. There were just a lot of tradeoffs to be made, and we made them. Right now Kalorm is alive. He's almost certainly going to stabilize and eventually recover. And the most important part is that he's not going to wake up feeling like Civilization betrayed him again. He likes you, more importantly he trusts you, and he isn't experiencing your care as being manipulated for his own good. Two days ago, most of the probability mass I saw on negative outcomes was - in worlds where Kalorm decides to walk out of the hospital before he's well enough. Yes, he ended up with a nasty infection, and yes, maybe we could have nudged the risk of that down by a few percentage points if you were an actual literal alien who didn't need sleep or breaks, but I'm not even sure of the latter, and - look, at least he has a nasty infection here, where we can treat it. He's likely to have more setbacks over the next few weeks. I'm much more hopeful than I was two days ago that he'll be having them here, and he'll trust your recommendations, and he'll be okay." 

No, she is not going to stupidly start crying again. She isn't. She is a grown adult and a trained medtech and this wasn't, in the grand scheme of things, even that scary of an emergency. 

Khemeth wants to smile at her. He doesn’t. He’s pretty sure it won’t help her get to the emotional state she needs to be in for this, which - probably isn’t one that’s incredibly good for her, but she would endorse it as worthwhile for Kalorm’s wellbeing.

“Merrin. I know it’s been an awful day for you, but you made a commitment to stay and you’re not done. Go - take a shower, have something to eat, figure out how to get yourself in the right headspace for this. Let Personnel know what you need to be comfortable sleeping here - it's going to be really important that you get enough sleep, okay?" 

Suspicious look. "If there's an emergency they should wake me. I - that's what I - that's the whole point of staying." 

Khemeth does not sigh. Or roll his eyes. It takes some effort. 

"If Kalorm has a life-threatening emergency of the type that summons eight people in here, I am sure you won't sleep through it - and if it's not bad enough to call in the backup medtechs and whoever's on-site can resolve it, then it's not exactly an emergency anyway. And of course if he looks like he's waking up, they'll call you over right away. Though it sounds like the plan for tonight is to keep him under until he's more stable, so that's unlikely." 

Merrin still looks faintly reluctant, but nods. 

Khemeth looks her in the eye. 

"I know you're an outlier on stamina. But you haven't done something like this before, and this isn't a sim. It's not something where you can fail and it's just a learning experience. So you need to plan, and get it right on the first try – and getting it right is going to require fitting in enough sleep, at the very least, and ideally a bit of awake downtime as well." 

Okay, you know, fair that Merrin totally deserves to be lectured about this, because she was - probably in fact on track to make exactly that mistake. That doesn't make it any less mortifying, though. 

Yeah, this is a lot of lecturing, and while Khemeth does in fact want to convey this to Merrin in a way her emotions and not just her explicit beliefs will update on, he doesn't actually want to humiliate her.

He lets his voice soften. "I know tonight is hard. If you're not able to relax enough to sleep until later, then we'll try our best to give you a chance to sleep in - it's not as though Kalorm is going to be waking up and demanding minimum settings trials every 90 minutes. Just, I think you do need to take a few minutes to at least convince your emotions that you're not the lead opper right now and it's fine if you aren't personally watching every single number update, someone will tell you if you're needed. Okay?" 

Merrin takes a deep breath. Lets it out. Nods as firmly as she can manage. "Okay." 

Taking a decontamination shower totally does help! She swapped her vomit-stained scrub top earlier but it turns out that she still felt kind of gross, and after the latest round of adventures she was also really sweaty. She blasts the water freezing-cold and makes herself stand under it for a full minute before she toggles it to hot.

She does keep desperately wishing that she had a portable waterproof tablet or console to bring in here, and worrying that she might not even hear an emergency, but it's probably actually good for her mental "reset" that she doesn't have that option. By the time she's dried herself under the skin-safe UV lights and dressed in a new pair of certified-sterile scrubs, she feels...not relaxed, not any less worried, but in fact more convinced that Halthis is in charge right now. 

...did anything happen while she was in the attached decontamination cubicle and out of line of sight of Kalorm. 

Nothing very exciting; it was only like 20 minutes.

It's now just past 10:15 pm. Kalorm's cardiac arrest was about two hours ago. They're still tolerating a blood pressure of 80/50 and oxygen saturations between 90-92%, but with more drug tweaks and cautious administration of a little more fluids and albumin, they have his heart rate steady at 85.

Treatment Planning wants to target a rate of 70-80 to optimize filling time for his struggling left ventricle, and are nudging around relative doses of inotropes and exotic vasopressors in hopes of weaning him entirely off epinephrine soon, but they're taking any incremental changes really slowly, because the current state of affairs is tenable and many very closely adjacent states are not. Kalorm's physiology is barely hanging on, and there's very little they can do except provide supportive treatment to hold together various failing systems, and wait for the antibiotics to cut down on the infection raging in his bloodstream enough that his weakened immune system can start to catch up.

(The powerful drugs they gave him to boost bone marrow production of immune cells, hours ago when it looked like things might be headed in this direction, may or may not even work, depending on how bad the underlying damage was, and how successfully his body has managed to point resources at healing it when fifty other things were also screaming damage signals. If it does work, it still takes about 24 hours to have much effect at all – they're less than halfway there – and, given his fragile and resource-limited condition, probably more than a week to get him back to normal range on mature white blood cell counts.) 

His urine output is way down, which is predictable; in a bid to get off the epinephrine, they're giving him a couple of different vasopressors that also have potent kidney-regulation effects - basically convincing his body that he's probably dehydrated and needs to hang onto as much fluid as possible. This is not ideal for a patient with pulmonary edema, especially when he's already on 75% O2 without much room to go up, and they can't risk increasing the ventilator pressures. Especially the baseline post-exhalation, between-breaths pressure to keep his lungs open and squeeze water out of the alveolar cells, because raising the pressure in his chest cavity that will also compress his heart, already struggling both to collect enough returning blood from the rest of his body and to pump it onward. But his oxygen saturation is tolerable, and honestly as low as 85% would be tolerable for a few hours, not ideal for his brain but certainly better than risking another interruption to his circulation. 

Among the limited pieces of good news: the anti-arrhythmics are working! Pretty well! They're barely seeing any abnormal ectopic beats, and it's been an hour since they last saw two in a row. The high dose is probably why it seems to be basically impossible to get Kalorm's blood pressure any better than this, but with the epinephrine rate down to something sane, his peripheral capillaries are less thoroughly clamped down. His capillary refill is delayed, but only to 2 or 3 seconds as opposed to "approximately instantaneous", rather than the veeeery slow trickle from before. His hands and feet are still mottled, but less, and pale but closer to pinkish than bluish. His lips aren't bluish at all now. 

His last round of bloodwork was reassuring, at least relatively speaking. Lactate is still elevated above normal range, but only, like, 50% higher than the usual upper limit, not triple it. His blood gas (measured from an artery, rather than the continuous oxygen saturation which picks up mostly on peripheral capillaries) shows an acceptable pH and a partial pressure of oxygen just barely brushing the bottom of the usual normal range. His white blood cell counts are still bad, but not worse. His inflammatory indicators are mostly unchanged or slightly down, and a couple of the gut-specific ones are significantly down, probably because he's managed to drain another 500 ml of liquid stool from the rectal tube over the last hour, and his poor small bowel is under a lot less tension. 

The stuff they're draining now is dark greenish and tests positive for a moderate quantity of hidden digested blood, and his hemoglobin is low. Not massively low, they're not suspecting a new rapid bleed, but he's probably still oozing in there, and his body desperately needs as much oxygen-carrying capacity as possible. They're recommending giving him another transfusion of packed red blood cells, to run over a whole hour in hopes of avoiding fluid-overloading his lungs any more. 

They're also testing the rectal tube drainage for the presence of (or metabolic byproducts of) the enteral-route antibiotic that they've been trickling down the nasoduodenal tube. Nothing yet, but judging by the ultrasound, at least the upper 2.5-3 meters of his small bowel have reasonable peristalsis now and have cleared their trapped gas and fluid contents, which makes it likely that they're getting antibiotic coverage, as well as a thorough physical rinse-out. 

It's going to be a long night. But it looks like they are starting to at least break even with the infection, and if Kalorm can hang on like this for another few hours they might actually start to pull ahead. 

Also! There's a Merrin sleeping pod in the corner. It's actually just a configuration available on one of the common commercial bed models; some people like to sleep fully enclosed, or just find it less logistically annoying than blackout curtains. Her overnight-supplies care package from Irris isn't here yet, but should be in another twenty minutes. 

(Khemeth already left a few minutes ago. He helped set this process in motion, and then spent five minutes awkwardly sitting at his brother's bedside with most of his brain throwing out alarm signals because it feels like there's nothing there. When he last saw Kalorm face to face he had his eyes open and was drawing pictures to communicate his stubborn alien preference to sleep on the floor. Now it's back to - no signal, nothing for his social-modeling intuitions to take in and run a Kalorm in his head that's in sync with the real Kalorm, because the real Kalorm in some sense doesn't really exist right now.

He hates it. And he's not exactly being useful here - if anything he's anti-useful, he's blocking the medtechs' access - so he leaves. And this time forces himself to go back to the main Family Room even though all he wants is to be with Dekan.)

The Treatment Planning updates aren't maximally reassuring, and reading other medtechs' observation notes doesn't fill in all the gaps that Merrin wants filled. Iiiiiiis Merrin going to be horribly in the way if she just wants to, like, stand and look at Kalorm for a few minutes? 

Merrin will absolutely not be in the way! They're mostly not doing any involved physical care with Kalorm right now; his current equilibrium is still too delicate for Halthis to feel like perturbing it even just by turning him. They have the bed set to "gentle rotate" instead, to shift his weight juuuust enough to protect his skin. 

(Halthis is also going to feel pretty relieved to get a Merrin-check on how things are looking, even if from her perspective things are looking stressful-but-tentatively-positive.) 

She'll stand by the bed, then, and look at her patient. 

It's been forty minutes since she last looked at him up close, and he looks...better? Subtly, barely noticeable, but there's something, because some quiet strain in the back of her mind is easing a little. 

Kalorm is sedated enough to mostly knock out his respiratory drive, so he's breathing entirely per the ventilator set rate, which is at a very reasonable 16. He's actually getting pretty good air volumes, though he clearly still has an issue with the actual gas exchange, his waterlogged alveolae less able to convey oxygen to his blood and CO2 back out.

His circulatory system clearly a little bit on the fluid-overloaded side, at this point; they've now got a continuous central venous pressure transducer hooked up to the femoral dialysis line, since his main central line is very much in use for like eight different drug infusions, and it's measuring as slightly high rather than low. The fluid-intake-and-output table she can pull up shows that he's positive, like, six liters of fluid since he started becoming seriously unstable, some of it from all the fluid boluses they gave him when he was crashing and some of it from the ongoing IV infusions, even at the highest safe concentration for central administration the infusion volume still adds up. (And of course, at the point when Merrin flagged a respiratory problem he was already in pulmonary edema, though probably more because his heart was being incompetent at allocating blood to the right parts of his circulatory system than because he had too much total fluid volume in his bloodstream.)

Unsurprisingly given all the cascading results of sepsis, a lot of that fluid is no longer in his bloodstream. His face and neck are puffy, his eyelids swollen to the point of translucency. (They've been putting in eyedrops to help with the fact that his eyes aren't staying completely closed and his body may not be reliably producing enough tear lubrication; it makes it look like he's been crying.) His fingers are sausage-like, the skin stretched taut and almost shiny. When she presses down on the back of his hand with her thumb, it leaves behind a thumb-shaped depression that takes a while to disappear. His feet are even worse; the tops are gently rounded, tendons hidden under fluid-swollen subcutaneous tissue.

For once he's not having a saliva disaster; despite Halthis' hourly mouth care, his mouth is dry, lips cracked.

When Merrin lifts his arm, it's not completely floppy and boneless. He's not resisting her in a purposeful way or anything, but there's some muscle tone there. 

His hands are cold, but his torso feels a normal temperature. (With the warming blanket, his actual measured temperature is up to 36.9.) 

Halthis hovers and manages not to clear her throat impatiently. She doesn't want to bother Merrin or stress her out or make her self-conscious but she does very badly want to know what Merrin thiiiiiiiiiiinks. 

Merrin has grabbed the nearest console and is looking things up on some of the screens! She's muttering to herself.

Presumably the fluid balance sheet is taking GI losses into account – yep, it is, but they're draining way less from his gastric tube now, only 50 mls in the last hour (Kalorm's pyloric sphincter seems to have gotten its act together and is no longer letting bile pool in his stomach, and he's presumably no longer swallowing saliva). And yeah he's losing a lot from the rectal tube, but half of that is cancelled out by the bowel prep solution they're putting in, and it's isotonic and shouldn't be yoinking in more fluid from elsewhere anyway, and the rest of the drainage is pretty much explained by four-plus days' worth of feces that were in there already and are finally coming out. 

That's a lot of positive fluid balance. And his urine output is, like, just baaaarely enough not to indicate worsening kidney dysfunction. He'll probably pee wildly as soon as they stop giving him vasopressin and angiotensin ||, both of which are currently incredibly necessary to counteract his body's determined attempt to maximally dilate all of his capillaries in response to the pervasive panic-calls of a systemic infection, and both of which have the advantage of not working via sympathetic stimulation and risking arrhythmias, but which are directly yelling at his kidneys to retain fluid. With older patients, Treatment Planning would usually recommend diuretics as soon as they're off vasopressors and sometimes even if they aren't, because fluid-excess tissue edema can get a lot worse than this – but despite Kalorm's early kidney dysfunction, Merrin kiiind of suspects his body will make that call on its own. 

In the meantime, if a bunch of that excess fluid is in his feet, at least it's not in his lungs? 

...she feels like she's forgetting something, it's right on the edge of her thoughts - she tabs into the 'future planning/discussion' section of the Treatment Planning dashboard and flicks through proposals in case that jogs her memory... 

Merrin doesn't normally stay up to date on this section in real time! During an actual medtech shift, she wouldn't have time, she'd be fully occupied just staying on top of the approved Treatment Planning updates, or at least the ones that made it to the final round of prediction market comparisons. It turns out that the hypothetical future planning discussion collects ALL SORTS of wild ideas. 

(It is, perhaps, possible, that despite the intensity and suspense on the ground over here from Merrin's, some of the experts bouncing in and out between other commitments or leisure activities to contribute to the case are BORED. And sometimes channel five minutes of nothing in particular to do into brainstorming what probably do count as 'insane troll plans'.) 

Wow!!! Nope!!!

Nope not that one either!!!!

DEFINITELY NOPE WHO EVEN WRITES THESE IS IT THE SAME PEOPLE WHO WROTE THE HORRIBLE CAVE SIM!!!!????