Fifteen seconds in, it could just be luck. Thirty seconds in, though, the markets start to update on the fact that this is very clearly going better than expected. 

In the Exception Handling control room, there is a discussion happening. It's not heated so much as confused. 

"...And she's only a level-5 medtech?" 

     "She's twenty-three! Were you a level-5 medtech at twenty-three?" 

"She's an endurance EMT. Have you seen her sim records?" 

     "- This is NOT just about endurance! Thellis can do sixteen hours but she doesn't do it for fun – honestly sometimes I wonder if Merrin just enjoys suffering–" 

     "...She really hasn't done this before, though? Even in sims? Just. She's doing 30% better than her extrapolated performance and I thought we were extrapolating in generously." 

"No, we have not made her manage six machine controls, three of which are extracorporeal circuits, while both her and the patient were subject to storm-level random g-forces. Until this happened I would have said that wouldn't possibly come up." 

     "I don't think she's actually carrying all six, not to sim standards - she's simplifying it, see, she's - I think she literally just put the ventilator on standby mode - and she's temp-silenced alarms on the sensor values for the hemodialysis and liver module, see, she's only responding to filter pressure alarms..." 

     Gesture at the screen showing the patient's vital signs. "I mean. Is it or is it not working?" 

Snort. "She should get paid more." 

     "Oh, she doesn't check how much she gets paid. - I mean, I'm not denying she should get paid more, it just won't meaningfully incentivize her performance." 

"......" 

     "WHY does she work horrible sims if not for the performance incentive? I'm serious - have you seen this sim they made her do–" 

"She asked for that. I think it's a competitiveness thing." 

     "She doesn't even like competitions!" 

The update on the Diagnostic markets is enough to get Khemeth's attention. 

He looks at it. 

....He pulls up the last ten minutes of recorded camera footage from the medicopter. Skips to Merrin while she's packing up for transfer. Replays the ten-second loop of her sealing Kalorm's pod and hopping into her own, watching her expression closely...

- he tells Ranthir to place some bids on the markets, and then he sends an urgent recommendation to be forwarded to the medevac-plane crew and the coordinating team that might communicate with Merrin directly. No one should congratulate her on this. They can say it went smoothly and the patient did fine, since that is indeed what happened, but if they have to look impressed, they should do it about Kalorm. Poooossibly they should imply to Merrin that the main update here is how her patient is superhumanly tough. It might even be sort of true! There is some level of patient instability that Merrin couldn't have coped with; he doubts she could have kept a sixty-year-old nearly as stable through that! Anyway, they should mostly be matter-of-fact about the whole thing. 

(And someone should quite possibly talk to Merrin, plausibly him, but...not now. Not when she's trying to save his brother's life, and he really, really wants her to keep performing as well as she just did, and is not even particularly bothered if this means they have to sort of deceive her about how impressive she is.) 

....Personnel is super not going to argue with that. 

At some point, all the bouncing around stops and there's a final thump and rattle and then everything is very still. There's the faint vibration of engines below her, but they're very smooth engines. 

A message flashes on Merrin's screen: transfer complete, patient did fine, given that he's not actively deteriorating and is currently super well secured against acceleration, they're going to leave him in the transport pod while they turn the plane around and get enough altitude to fully clear the storm turbulence, objections? 

Objection, there is something on her screen that isn't a blood pressure, what is Merrin supposed to do with that  Seems fine. Merrin will just stay right here and get back on top of his sodium. 

It's about ten minutes. 

It's so quiet and peaceful in her little pod. Merrin is definitely getting itchy about laying eyes on her patient again, but she diligently deals with all the values that slid off in random directions while she was ignoring them. None of them slid very far, which is why she ignored them.

She flags that the patient's lactate is up again? It's fine, she suspects he just got a bunch of sudden venous return from his extremities, something was sure going on with that, and she can compensate for now by keeping his CO2 right at the bottom of the allowed range, but he's going to need another dose of bicarbonate as soon as they can physically access him. 

And then they crack open Merrin's pod! 

(The others on her team rode up on more normal personnel harnesses, so they could supervise the pods. They're all pretty wet.) 

A level-6 medtech greets her. He nods to Merrin, in a friendly but terse way that implies he does not find Merrin all that interesting. "Decent work. The patient handled it very well. I mean, I know you're watching his vitals, but we've done a repeat scan in the pod - no new bleeding, no worrying changes at all. We're about ready to transfer him to our Complicated Patient Area -" 

"Oh good!" Merrin scrambles up. "Uh, here, let me - some of the machines are really fussy when he's this cold..." 

(Something that happens with human brains, not unique to Merrin - but which does seem to happen especially to Merrin, who works so heavily from pattern-recognition, and whose thoughts are often only legible even to her if she's prompted to stop and think about it - is that, after coming on two hours of very closely watching a lot of correlated signals and trying to tease out the patterns, you start to develop what one might call SUPERSTITIONS. Usually a dozen of them are completely spurious for every one that's real, but you don't know which one.) 

Merrin is kind of desperate to see her patient with her actual eyes again. 

Kalorm looks....mostly fine? 

- well. In fact he looks super awful! Just. Not worse than he did when they put him into the pod, and better than he has any right to at his current body temperature, blood pressure, and general level of metabolic function. 

They get him transferred properly into the Complicated Patient Area. This is a delicate procedure but Merrin is feeling GOOD about THINGS right now. Her faith in Kalorm was justified!

"Want us to spot you for ten minutes so you can have a break?" Altham, the level-6 medtech, asks her.

(He's about forty-five, nearly as old as anyone gets as an Exception Handling medtech - it's an exhausting job that pays well enough to retire at a sensible age - and he does, actually, have more sim experience than Merrin overall, though perhaps less tilted towards the really intense sims that are made of suffering. He also has way less patient context than Merrin, and he can't cover this complicated a protocol for two hours. He's on the flight team mainly because he was nearby enough to make the takeoff deadline, and because after that many years, there are some obscure procedures he's certed for that Merrin doesn't know, and a lot more that she's only ever done in sims and he's seen half a dozen times with real patients.) 

"I was mirroring your sensors and controls from here for the last while, so can spot you on the cardiac pump and extracorporeal circuits, and one of our team is up to speed on the rest and can cover it without much efficiency loss." 

She glances down at herself. "I...guess I could change out of this wetsuit? And I do have to pee." 

Merrin comes back no longer a Sparashki and now wearing scrubs! It's not going to take her more than three minutes, and she doesn't want a longer break than that, she is feeling sort of possessive of her patient. What if Altham didn't notice the thing where if you let one of the liver functions slip too much then the filter pressure alarm starts going on the ECMO circuit for UNKNOWN AND MYSTERIOUS REASONS. 

Markets are now updated and settled again! 

They're feeling optimistic. Survival likelihood is up more than they'd predicted, all the way to 95%. (The general feeling is that the worst is over, and if Merrin can handle that she can almost certainly handle more random complications as long as they happen in a nice mostly-stationary not-terribly-equipped medevac setup.) 

Prediction for minor brain damage: 50%, which means 50% on 'no permanent damage at all'.

(Though there are very likely to be temporary deficits, and the awkward thing is that the damage markers detected during rewarming don't...seem to be especially predictive of whether those temporary deficits are going to resolve? The sample data is mostly patients with localized strokes, and - some of them were fully back to baseline in 3-6 months, some weren't, the difference is probably something about the brain that isn't directly about the total cell damage. Kalorm's odds are currently judged to be much better than one would predict based on how those patients did - there, it was more like 20% who fully recovered to baseline - because 25 is probably a better age for it than 50, and because 'something about the brain that predicts recovery' is maaaaaaaybe the same sort of thing as Kalorm's general physical resilience.)  

Moderate: 19%. Not as big a drop as hoped, because despite Merrin doing a very impressive job on keeping the patient approximately stable, there was a small spike in damage markers, most likely indicating new concussion-type damage from the forces involved. It wouldn't be a big deal for a patient at a healthy baseline - they can confirm that the patient's brain still looks structurally normal to CT - but the cascade is cumulative.

Severe: ...actually, all the way down to 6%. This wasn't just about Merrin's performance. There are hopeful updates to the timeline on getting access to some particularly obscure proteins and other biomolecules needed for the customized-to-Kalorm version of the rewarming protocol, and there's also, maybe, a soon-incoming update to the interim stabilization protocol that will help them get ahead on things. 

...Also, they did the transfer more efficiently than hoped, and think they can make up some time in the air. ETA to Default is almost exactly two hours. 

They fly. 

This is fine it's fine Merrin is definitely fine, Merrin is not the one having a bad day, but - wow, she hopes poor Kalorm is going to have an easier time of it once they're safely in Default and don't have to keep him so cold. 

Keeping his basic vital signs within parameters is actually mostly going okay. They're not even having to use the backup vasoconstrictor-dilator much. 

Dialysis is getting less effective as time passes, though, mostly because the blood viscosity at this temperature is really hard on the filter, but also it was janky after the transfer and never quite got back to normal. They super do not want to try to swap out the filter in flight and risk perturbing everything else; it's adequate for now, Merrin can keep gradually decreasing his sodium and should have it down to 155, which is where they want her to pause it anyway, by the time they reach Default. Keeping the other electrolytes in line is easier. Mostly, it just means less wiggle room on taking fluid off, so she has to be very careful about managing filter pressure in the other two circuits via dilution. 

His native liver function is failing - slowly, gradually, but with a noticeable trend. They're probably going to have to switch him to the full-size liver machine once they reach the hospital, even though they think there won't be permanent organ damage; some of the waste products that they can measure on blood panels, but that Merrin cannot correct with the limited version, are going to be pretty bad for his neurons once they start rewarming. 

His hands and feet look awful. There are no detectable pulses, and it's questionable whether even capillary refill is present. 

30 minutes in. 90 minutes to go! 

Treatment Planning has some new recommendations for them!

They have also rejected really quite a large number of proposals for being sufficiently "experimental" that they were judged about as likely to kill the patient as to help. They don't want to do that! The patient has decent odds right now! Not, like, amazing, but 95% that he'll be alive at the end of the rewarming protocol.

(After that point, there is some lesser probability of a fatal complication, but mostly the True Death outcomes are ones where the patient, or his decision-making representative, choose truiicide over the outcome they got on the first try.) 

Anyway, apparently the patient's father is an AMATEUR BIOCHEMIST, and while he is fact surprisingly good, given that his field of expertise is something TOTALLY DIFFERENT, the Exception Handling liaison who has been tasked with hearing his suggestions is very tired. 

(Merrin does not need to know about any of this, to be clear, they are just COMPLAINING.) 

Actual recommendation: they want Merrin to try infusing low-dose magnesium sulfate directly into the brain circulation. It's unlikely to do much harm since it's present in the body all the time, they can stop right away if that seems not to be the case, and it does in fact have metabolism-suppressing effects, well studied in rats even. If it works, they can raise the ceiling on the blood pressure and O2 sat limits and cut the risk of other end-organ damage. 

DO THEY HAVE ANY IDEA WHAT MAGNESIUM SULFATE DOES TO BLOOD PRESSURE BECAUSE THE THING IT DOES IS NOT INCREASE IT 

....It's okay Merrin is okay she is just maybe a little bit stressed and the constant high-filter-pressure alarms on her THREE extracorporeal circuits are maybe kind of getting to her.

(She has been reluctant to make the alarm limits less sensitive, because not intervening until a much higher threshold would be fine for another 90 minutes but she has to budget for 8-12 more hours after that, and guess what Merrin does NOT feel like doing in the middle of a complicated and stressful rewarming protocol. If you guessed 'swap out extracorporeal filter circuits without getting blood everywhere', you were correct!) 

It's...probably tolerable if they're targeting the brain directly? Then it can be actually low-dose, and also she can manually filter it out of the systemic circulation on the dialysis-circuit side and not, like, completely wreck the point of administering it at all. 

Merrin would kind of prefer if Altham inserted the drug-administration line. She doesn't want to multitask any more things right now it wouldn't be fair to Kalorm, the deal was that she does her part as long as he holding up his end of things, which he IS she's so proud of him

The markets are not super sure this is going to work! The main reason to try it is that it's unlikely to be a disaster. 

Call it 30% that it works, 70% that it doesn't. It's judged to mainly impact the mild and moderate damage categories; if it works, markets are guessing a 7% and a 3.5% reduction in those outcomes, respectively. 

If it doesn't work, they're mostly where they started, but a bit worse off: it's not zero risk, and it's time wasted, and weak evidence that similar interventions also won't work. Call it a 3% and a 1.5% increase. 

(There is nonzero risk of the procedure for them to directly access the bloodflow to the brain in order to inject things into it itself being a disaster, but it's not much above zero. Altham has the cert, has a lot of experience, and they're now well out of the storm and cruising smoothly in a quiet peaceful still-dark sky.) 

STRESS