Merrin absently turns the vasopressors down to 50%-of-max. "You know what, actually, let's get him properly in pajamas, if he's going to move around that much then just draping the front on him won't stay. ...And can we give him a warming blanket? On the lowest setting, I know we don't want his temperature going above 39, but his body is probably trying to tell him that he's below his temperature setpoint, so I predict he'll be feeling cold and that would make anyone cranky." 

...Sure, they can get Kalorm properly dressed - Halthis grabs the MRI-safe pajama model just in case - and blanketed. Maybe a lightly weighted blanket will help him stay calmer, even. 

And she tries more slowly reducing the sedation to the point at which he woke up last time. 

Kalorm is definitely still hitting 'awake enough to be displeased by something about his current situation' well before he reaches 'awake enough to interact or parse verbal instructions.' He's less panicked about it, though; he's squirmy, but dissuadable from going after his breathing tube, not that he probably has the strength or coordination to actually pull it out but Merrin is being cautious. 

Merrin holds his hand and repeatedly puts the pillow back under Kalorm's broken arm every time he knocks it away by wriggling. And talks to him, repeating the same approximate script over and over.

"Kalorm, it's Merrin. You're still in the hospital, everything is okay. You had a bad infection and you've been unconscious for about two and a half days, but you're doing a bit better now. You're probably going to need to stay on the ventilator for another day or two but you're stable enough that we think you can handle being awake. Can you try to open your eyes yet? Squeeze my hand if you can hear me? It's Merrin..." 

Kalorm drifts in soupy fog. 

He isn't quite awake enough to have fully-formed thoughts, but if he were, he might think that he isn't sure he wants to wake up. That way lies BADNESS and MISERY, and it's okay here. 

There are scattered sense-impressions. Pain, still hard to localize. A sense of effort. Light, off in the distance, and a voice... 

The first actual thought that Kalorm manages to form is noticing that he isn't nauseated. Like, at all?

His chest hurts - not intolerably, there's a floaty distance to it - and his back is achy, and he's definitely dizzy, but there isn't even a hint of nausea. Which...is surprising? 

Trying to trace that thought back to why it's so surprising brings Kalorm most of the way awake. Still floaty and far away, and the whole world feels wrapped in soft fluff, softening its sharper edges while also making all of his perceptions sort of blurry and low-definition, but he manages to open his eyes. 

Merrin is right there! She's beaming at him delightedly! "Kalorm. Hey. Squeeze my hand?" 

Processing words is still very hard. Kalorm has to figure out where his ears are and then untangle the sounds from their cotton batting so he can parse them, and then decoding those sounds into words that mean things is like some sort of very unfair puzzle game. 

It takes him around ten seconds, and then he has to figure out where his arm is, and the fact that his proprioception also feels buried in fuzz makes it kind of hard to figure out how to move, or tell whether he did it successfully. He gives it a solid try, though. 

Merrin lights up again, so he probably did manage it! 

"That's good! I know, you're really sleepy. - Halthis, we can maybe go down by another 10%, I think he's going to be calmer now that he can understand me." She turns back to him, and goes back to speaking very slowly and carefully. "Okay, Kalorm? All you need to do right now is try to stay calm and relaxed. I've been here the whole time, all right? I'm not going anywhere. You can take as long as you need to wake up." 

She keeps talking to him. She's kind of running out of content so it's getting pretty repetitive. 

"...Once you're ready, can you try to tell me yes-or-no if you're comfortable? Nod for yes, shake your head for no. Whenever you feel like you can do that." 

Kalorm is indeed VERY sleepy, and managing to catch at best half of Merrin's words; he's getting that he's in the hospital, but he's still pretty confused about the context, didn't he - already wake up in a hospital - he's pretty sure he already woke up in a hospital and now it feels like he's maybe stuck in some sort of stupid time loop. Kalorm HATES time loop fiction even more than he hates most books just for being books. (His mother used to get audiobooks for him because she thought exposing children to a wide range of fiction was Important For Their Development, and Kalorm is still kind of mad about that even though most of the specific audiobooks were fine.) 

The cotton batting around everything is thinning a little, though, letting clearer light and sound through. And Merrin keeps repeating herself, which on the one hand is incredibly irritating, but on the other hand means that he can try to catch some of the words he missed on the last round. His attention is drifting in and out, so it takes a while, but he eventually manages to parse the question. 

Ugh. Does she think he can't nod or shake his head??? Also it's a stupid question. He's in a hospital, of COURSE he isn't comfortable, it is literally impossible to be comfortable in a hospital because hospitals are terrible. 

He scowls and rolls his eyes at her. 

Kalorm is BACK and being HIMSELF and apparently three days stuck in the same room is enough that Merrin's brain is no longer working at all, or maybe the stimulant that Personnel suggested she rotate onto for today is bad for her, because now she's crying??? Again?????

Oh no she's upset. Did Kalorm do something that upset her? He...vaguely remembers that he was worried he was going to literally poop on her, although he can't remember why he thought this was a plausible outcome, presumably it's just covered under "hospitals are terrible." Did he poop on her just now?? Is that why she's crying??? Most of his body is buried in fuzz so he isn't sure he would be able to tell if he had!!!

Kalorm tries to say "I'm sorry" and talking isn't WORKING - which for some reason also isn't surprising, for some reason he wasn't expecting talking to work, though he can't remember why not - and he cannot figure out how to convey via eyebrow wiggles and handwaving that he didn't mean to poop on her and doesn't want her to be upset. 

Merrin remembers to wipe her eyes with a tissue that she disposes of immediately rather than her first instinct of using her sleeve; she is after all still in an immunocompromised patient's room, and even though she showered this morning in the decontamination room, 'not touching her face' is deeply engrained. 

"It's okay," she tells Kalorm, blinking and smiling. "It's just– I'm not upset, nothing's wrong, I'm relieved because you're okay." 

Oh. 

Kalorm...isn't sure what to do with that either?? Since he apparently cannot remember any of the context for why she's reacting like this. (Also it takes him nearly fifteen seconds to unpack the whole sentence into its constituent meanings.) He ends up rolling his eyes again, but sort of half smiling at the same time. 

"Yeah. I know. I'm being ridiculous, aren't I? Obviously you're going to be okay." Pause to let him catch up. "Is anything specific bothering you that you want me to try to figure out and then fix?" 

Merrin isn't going to be able to fix the part where he's trapped in a stupid hospital, and other than that, no, nothing specific is bothering Kalorm all that much. He shakes his head. Probably. His proprioception loop is packed in cotton batting and it's still sort of hard to figure out if his body actually did the thing he wanted it to do, or a different thing instead, or nothing at all. 

He succeeded this time, though! Merrin smiles at him. "I'm glad. Listen - your lungs are still not in great shape, the infection and the treatments we had to give you for it weren't great for them, and you're needing a lot of help from the ventilator." Pause. "When you were unconscious, we had you lying on your front for most of the last 48 hours and that was helping a lot. Your breathing seems okay right now but I think we're going to want to keep alternating this position and that position to give your lungs some extra help. You'll be pretty well secured in the bed and definitely won't fall, but it might be alarming or uncomfortable." Pause. "Can you nod if you think you can cope with that awake? Or shake your head if it sounds stressful or uncomfortable and you would rather be asleep. Either way, I promise I'll be here the whole time and I won't let anything happen that you wouldn't like." 

Does Merrin think he’s some kind of wizard at staying awake even when everything is fuzz. Kalorm is VERY TIRED and was just getting to the point of desperately wishing she would stop TALKING and DOING THINGS so he could stop trying to stay awake for it. He shakes his head.

That’s…uncharacteristic? Merrin blinks a few times. …Reruns the exact wording of what she asked him. 

“Kalorm,” she says carefully. “What I meant to ask was whether you want more sedation for it so you won’t be awake at all. If you just want to nap, that’s totally fine and safe, you can nap as much as you want. Um. Nod if you do want more drugs to keep you asleep and comfortable, shake your head if where you’re at right now is a good amount of drugs?”

Oh.

Kalorm spends a while figuring all of that out, and then shakes his head. He doesn’t think he’ll have ANY trouble sleeping if they just leave him alone.

“Okay. That’s kind of what I thought. You probably will be very drowsy for the next 24 hours. We’re giving you a little bit of sedation to avoid putting too much strain on your lungs, and pain medication because you’re probably pretty sore and because your body was trying to run a fever that was higher than what will actually help you fight the infection, so we wanted you to be shivering less. In 24 hours, if you’ve been stable the whole time and your lungs are doing better, we might be able to start doing minimum settings trials again - the markets think less than 20% that you’ll be ready to breathe on your own then, given how your progress has been the last day, but we should definitely try if you’re up for it. But you aren’t up for it yet, so all you need to do right now is rest, and we’ll take care of everything else. Okay?” 

That was too many words. Kalorm thinks the overall gist is that he shouldn’t do any things because he’s too bad at breathing. This is frustrating, especially if they’re going to enforce it with drugs, but it’s sort of on him if he’s too incompetent at breathing to be properly awake without hurting his lungs somehow. And also he doesn’t want to do things anyway. 

He closes his eyes. 

According to the EEG, it takes him about six seconds to hit light sleep.

Awwww. Sleepy Kalorm. Also cranky Kalorm. It is such a relief to have cranky Kalorm back. (Merrin is at this point very, very used to deciphering his 'just leave me ALONE' face.) 

She checks the market updates. 

It's 9:45 am. A little over 24 hours since Tharrim checked the updates at the start of his shift. The markets on Kalorm tolerating lighter sedation (both the one on 'to the point of responding purposefully to painful stimuli' and the later one on responding to verbal instructions) have now closed.

For tolerating bed-based rehab exercises – well, it's going to depend a lot on Kalorm's mood, but despite the additional time he spent chemically paralyzed and then sedated too deeply to move spontaneously, his raw muscle strength actually seems better than he did on his first wakeup? They're inferring a lot based on exactly how effectively Kalorm was squirming himself around in bed while not fully awake, but - it seemed like substantially more effectively than before? He knocked one of his armrest pillows onto the floor, like, five times. And he's still on vasopressors, but his blood pressure and O2 saturation both tolerated his initial panicky-combative response to waking up disoriented. So, probably, his hemodynamics and oxygenation won't end up being a barrier, if Merrin wants to encourage him in some gentle exercises in a few hours?

It does seem very possible that, on the amount of sedation they need to keep him from fighting the ventilator, Kalorm will be too sleepy to feel like participating. (It's also possible that they've just burned through a lot of his willingness-to-cooperate with anything that Kalorm finds tiring or unpleasant, but Merrin is really good at coaxing him into things, and - probably once the best course of action for his longer-term outcomes involves coaxing him to be more active rather than convincing him to chill and accept invasive treatment, Merrin will be on that?) Getting Kalorm doing things with his body before he loses any more muscle strength or flexibility is a priority, though, and he tolerated waking up better than expected. They suggest dropping the sedation another 10%, and the opioids by 25%; they're now committed to giving him scheduled fever-reducing drugs, so the anti-shivering function isn't as badly needed, and he wasn't complaining of pain. If he does express later that his sternum or ribs are bothering him, they can afford to try a stronger local nerve block, since he's definitely not coming off the ventilator today and is still on a set rate. 

...Anyway. The 20% / 50% / 80% spread for when he'll end up starting rehab exercises is now the narrowest it's been to date, at 6 hours / 9 hours / 14 hours, though the rehab experts are definitely going to recommend a cautious and gentle progression. But most of the complications that Kalorm is still at risk of in the next 24 hours won't actually prevent him from doing any physical exertion, and a lot of the late complications that are an inherent risk to any long hospitalization – blood clots, skin breakdown, loss of muscle and bone mass – are ones where getting him mobile as soon as possible is the best prevention. So the medical team (including Merrin) should consider this one of their top priorities today, secondary only to keeping Kalorm's vital signs in normal range. 

In terms of getting him up out of bed and walking– well, now that he's actually getting kind of close on this, and it makes sense to drop more liquidity on the rehab-specific prediction markets, they're adding in more detailed interim outcome-endpoint predictions, based on the various stages of the progression that they want Kalorm to work through. The first step is to get him sitting up on the edge of the bed – not even standing, yet, but able to, with his feet on the floor and some help from the medtechs, have good enough core and abdominal muscle strength and balance (not to mention his heart and lungs tolerating it) to hold himself sitting upright for five minutes. There are a number of interim steps to work through to reach this goal, and right now Kalorm's hemodynamics and respiratory function would be a barrier. (Though still being on a ventilator, or requiring some vasopressors, is not by itself a reason not to attempt this.) The current spread for when he'll get there is 24 hours / 60 hours / 4 days. 

After that, the next goal is for Kalorm to stand for 3-5 minutes - with assistance from his medtechs, especially for the sitting-to-standing transition, but once he's upright his legs will need to be strong enough to support most of his weight, the help is mainly there for balance. This obviously puts much higher demands on his heart and lungs, and given the risk if he suddenly drops his blood pressure, Treatment Planning would prefer not to approve it until he's off the ventilator and maintaining adequate oxygenation on less than 50% O2 at rest, and has been off vasopressors and hemodynamically stable for at least 24 hours. The current spread for when he'll get there is 48 hours / 4 days / 7 days. 

(Even before they're quite at the point when it's medically safe for Kalorm to try standing for an extended period in preparation for walking, they can have him briefly stand in order to pivot and deposit himself - with a lot of help - in an armchair, or on a bedside commode once he has the rectal tube out. This is often a pretty big deal for patients, subjectively speaking, even though the standard hospital bed can be transmogrified into basically an armchair without their help, and highly optimized bedpans - along with the 'bedpan hole' mattress mod - aren't even especially uncomfortable to sit on.) 

For getting all the way to assisted walking at least 5 meters, the spread is 72 hours / 5 days / 9 days. For making it 50 meters on his own, 5 days / 8 days / 12 days.