Now Kalorm's bare feet are on the floor! 

It's kind of startlingly cold, but not in a bad way. Actually, it feels weirdly good to have his feet on something solid. It's as though it helps him remember how balancing is supposed to work. He even somehow feels more alert. 

He smiles at Merrin, and then goes back to breathing hard. 

"Yeah, I know - that was a lot of effort, wasn't it? But you're sitting up! Your heart rate is pretty high right now," it's at 140, "and you're breathing fast, but your blood pressure and oxygenation are doing fine. Think you can manage staying like this for a few minutes?" 

Nod. Smile. If anything, Kalorm thinks, it feels easier to take properly deep breaths like this. 

He looks so happy and it's WONDERFUL. 

(It's probably also helping with deep breaths that Halthis just turned up the ventilator pressure support a bit.) 

She gives him a minute to get used to the position and catch his breath. "...You're still doing amazing. I'm going to take my hands away from behind your back, okay? I want you to try sitting up straight by yourself, just using your abs and holding onto the railing handle." 

She's still going to keep her hands close by in case he tries to topple backward, but she actually wasn't supporting a lot of his weight. 

This is harder! Merrin may not have been supporting much of his weight, but she was definitely helping him balance; he's still very wobbly, and having nothing behind his back to lean against is making him feel weirdly exposed and unsteady. 

He can do it, though! It takes all of his concentration, and his stronger arm is starting to shake, but he's sitting up! 

Merrin is so happy and proud of him (and trying not to wiggle in delight because she's busy being a thing for him to hold onto.) 

She'll count out the remaining four minutes in thirty-second increments.  

Maybe "sitting up for five minutes and doing nothing else" would normally be boring, but right now it's continuing to take ALL of Kalorm's effort and focus. He manages it! Merrin asks him a couple of times if he's tired and wants to lie down, but he is absolutely not backing down from this challenge! 

...By the end of five minutes, his hands are slippery with sweat - at least the railing-handle is conveniently grippy - and every muscle in his core feels like jelly. Even holding up his head is starting to feel unfairly hard. He hates gravity. It's occurring to him that now he still has to get back to lying down and doing any more things sounds impossible. 

Nah, they've got him covered for this! Merrin was pretty sure that going straight to a whole five minutes would push Kalorm to the limits of his strength; it just seemed worth doing anyway. 

"Okay, done! I'm going to hold your shoulders again and Halthis will pick up your feet and we're going to swing you back around," she says, and then prompts him through letting go of the railing and her shoulder, and crossing his arms over his chest.

With the two of them doing nearly all the work, getting him back to lying down - supine, with his head raised to 30 degrees - takes about thirty seconds. 

Hopefully he's allowed to take a nap now because that seems to be what's happening. 

That is very predictable and absolutely fine! His oxygenation is fine, they can probably let him sleep on his back for another 90 minutes. 

(Treatment Planning thinks he'll do better with some more prone sessions, probably including his overnight sleep block for tonight, but they can start weaning the length of his prone sessions during the day. He's still needing a lot of ventilator support, but his lungs are a lot more tolerant, and prone is just a pretty awkward and inconvenient position when he's awake.) 

Message from Personnel: Merrin hasn't eaten yet today and she should eat breakfast! It's ready for her in the adjacent room. Inconveniently Kalorm is asleep but they will get a recording for him if he wants to confirm that she ate her cookies. 

(...Merrin's entire breakfast consists of cookies. There is a protein cookie and a fruit cookie and a caffeine cookie.) 

WHY ARE CAFFEINE COOKIES A THING!!! WERE THEY EVEN A THING BEFORE TODAY OR DID THE KITCHEN STAFF LITERALLY JUST INVENT THIS CONCEPT FOR PURPOSES OF TROLLING MERRIN???

...Merrin eats her cookies. The caffeine cookie is actually decent. 

Kalorm has a good day, and an uneventful night. 

Despite not being on any sedation except for his mildly-sedating pain medication infusion, he sleeps for almost two hours after the five minutes of sitting. And wakes up cranky. It takes some convincing from Halthis, but he is eventually coaxed to accept some limb stretches and have his teeth brushed, which improves his mood somewhat. He consents to being flipped to prone again - but on one condition. He very adamantly requests - by gestures and eventually picture board - doing a minimum settings trial on the ventilator.

To no one's surprise, he's absolutely exhausted after about seven minutes, even with Halthis going up to 75% O2. (She refuses to go any higher than that.) He seems pleased with himself, though, and doesn't complain about being put back to full support settings. He naps for 90 minutes. 

This sets the pattern for the rest of the day. Kalorm wakes up, can usually be talked into some basic comfort care (including a quick wipe-down and pajamas-plus-bedding-change at 3 pm and a more thorough bath at 9 pm before they settle him for the night), and then firmly insists on pushing himself to his absolute physical limits. He can at least be convinced that he'll make more headway doing other rehab exercises rather than repeatedly and fruitlessly attempting to breathe without much help - his lungs are definitely not ready for it, and at the current rate of improvement, almost certainly won't be until tomorrow - but he does insist on one more trial later in the afternoon. 

This time, he makes it to almost twenty minutes. 

Treatment Planning approves pulling his dialysis line at 4 pm. His kidneys are doing fine at regulating his electrolytes and fluid balance, and should respond to drugs if they need to help him out with that a bit. He's off vasopressors and his hemodynamics are fine; they're unlikely to urgently need a central venous pressure again, and if they do, all of his drug infusions can be safely paused for 30 seconds. 

By 9:30 pm, when they flip him to prone again - and Merrin convinces him to accept the melatonin spray and another mild sleep-aid patch - he's sat up on the side of the bed twice. The second time went a little better than the first, mostly because Kalorm now knows the routine and wasn't trying to interpret confusing instructions in real time. He can now turn himself from side to side by grabbing the bedrail-handles, or pull himself to a sitting position in the bed by using the trapeze bar; both of these maneuvers are exhausting for him, but as soon as he's able to do them at all, he insists on repositioning himself without any help during his supine periods. (He will reluctantly accept Merrin putting pillows in the right places, since he doesn't have enough arms to do that himself.) 

He's utterly worn out, and - despite still not being on any sedation - sleeps through the night. (Honestly, he's kind of getting used to the breathing tube at this point? It's still uncomfortable, and he hates not being able to talk, but it's not nearly as much of a source of ongoing misery.) 

By 10 pm, when Merrin checks the markets before going to bed herself, the Diagnostic markets are feeling pretty optimistic about Kalorm's future! 

For sitting up, he made it in not quite within last night's 20% interval, but closer to it than the 50% interval, which would have predicted him not managing it until evening. That market is closed, and the rehab experts (and members of the on-site medical team who contributed bets) and who were optimistic about him have made some money off of Kalorm's physical resilience and absurd determination. Most patients who survived a night as bad as the first night after his cardiac arrest (and this would only be a subset of dath ilani patients, because a substantial fraction of people - especially older people, but around 25% of people in Kalorm's age bracket - have advance directives to go to cryo at the point when even heroic treatment is no longer maintaining their basic vital signs within reasonable parameters) – but anyway, most patients who were that sick take weeks to regain as much mobility as Kalorm already has. 

His balance and coordination are definitely still problematic - though it seemed a little better later in the day, with more of the sedation having fully cleared his system - but, leaving aside the fact that he's pretty worn out, at this point he's probably strong enough to stand and support his weight, if they have at least three people within reach and lots of stability aids for holding him steady and preventing him from falling over. They're obviously not about to make him try it now; it's late and he badly needs a solid night's sleep. But at least a solid subcontingent of the rehab experts are in favor of trying it when he wakes up in the morning. Most of the experts are now expecting it to happen at some point tomorrow; the estimates for when Kalorm will be able to maintain a standing position for >3 minutes have tightened up considerably, and the spread is now 9 hours / 13 hours / 22 hours. 

For walking, they'll need to work hard on his balance and motor planning. A lot of the training exercises are going to be pretty tedious and irritating, but Treatment Planning has faith in Merrin's ability to talk Kalorm through why they're important and will get him closer to his key goal of "being able to walk out of this hospital." They're still expecting it to take a while, but...maybe not that long of a while, especially if his lungs continue to improve? The 20% / 50% / 80% predictions are now 42 hours / 64 hours / 80 hours. 

He's not going to be able to walk 50 meters while still requiring a lot of breathing assistance, including noninvasive positive pressure ventilation, but being on a modest amount of oxygen isn't a reason not to work toward it. The 20% / 50% / 80% spread for reaching that milestone is 4 days / 8 days / 10 days. 

By all indications, Kalorm's gut is actually doing really well! He's tolerating the trickled tube feeds with no complaints of nausea or abdominal pain, his gastric tube is draining less than 50 ml/hour, and they actually put him back on an osmotic laxative because his stool was thickening up and threatening to block the rectal tube. (Soon they'll consider removing it, but for Kalorm's comfort and dignity it's preferable to do that once getting himself sitting up and onto a bedside commode isn't a stressful and exhausting three-person production.) At this point, the limitation on letting him have some oral intake is mainly that he's still intubated. If, in the morning, that seems unlikely to change soon, the diet-planning team actually wants to try squirting a few hundred ml of sugar water directly down the gastric tube, to get his stomach used to having contents again and make sure it responds appropriately by emptying into his duodenum. (Treatment Planning wants to do that when he's on his back and sitting up and also awake to tell them if it's setting off nausea.) 

The estimates on, specifically, Kalorm drinking a cup of juice the normal way that involves swallowing, are now 20 hours / 36 hours / 4 days; they'll know more about that once they see how he handles the sugar water. 

For getting most of his nutrition enterally, the fact that his body was regulating itself towards not having liquid diarrhea constantly is actually a very good sign that his intestinal malabsorption isn't too bad, and most of the solutes in the tube feeds are being digested rather than going straight through. Treatment Planning wants to try increasing the enteral feeds rate, though again they'll wait until Kalorm is awake and alert and can tell them if this prompts cramps or nausea. The predictions for Kalorm being able to meet more than half of his nutritional needs by drinking liquid meal replacements is now 60 hours / 4 days / 7 days. 

The only area where he's not doing as well or better than previously expected is respiratory.

36 hours ago, the 20% / 50% / 80% spread for getting him off the ventilator was 26 hours / 40 hours / 4 days, though, as usual, the 20% end was mostly assuming that Kalorm would make ill-advised medical decisions as soon as he was awake enough to do that. As it is, he's pushing himself pretty hard on minimum settings trials - and he probably would be able to manage with noninvasive positive pressure ventilation, though he'd need a higher oxygen concentration - but he isn't demanding to come off the ventilator, and is unlikely to do it in the early hours of the morning. They'll see how he does tomorrow morning once he's rested, and if he does well, maybe float the possibility of getting him extubated and retaining noninvasive ventilation as a backup. He's more than alert enough for it now and, with his gut disaster finally improving, he isn't at nearly such high risk of vomiting and aspirating. They're not expecting to see a huge improvement overnight, though, and the spread on getting him extubated is still 14 hours / 20 hours / 32 hours.

His oxygen needs are decreasing more slowly than the amount of help he needs moving air in and out at all. The spread on how long he'll require supplementary oxygen is 4 days / 7 days / 9 days. 

It was such a good day! 

Merrin goes to sleep. 

Dalthem is the one working the 8 pm - 2 am shift again, and after the bedtime bath and getting Kalorm properly settled in for the night, he doesn't actually have a lot to do except read his patient's chart. 

Apparently both Halthis and Kerrin are being recommended days off tomorrow. They're going to have some of the previous 3h-shift medtechs in to cover 2 am - 8 am, and Tharrim can cover 8 am-2 pm, but they don't yet have anyone for the afternoon. 

Dalthem goes ahead and volunteers himself for it. He should be able to get a full night's sleep if he goes to bed immediately, and he likes the afternoon shift better anyway. Especially because he'll get to actually work with Merrin, rather than spending most of his shift with Merrin asleep in a pod in the corner! Also, the markets have a bunch of probability mass on Kalorm hitting some very exciting milestones tomorrow afternoon! Dalthem is, at this point, pretty attached, and would be delighted to be there. 

By the time Kalorm wakes up fully and actually feels like interacting with the world, it's past 8 am, and Tharrim is there. 

Merrin is also up and showered and ready for her day! She's already had two caffeine cookies. The caffeine cookies are really good.

(The staff have been playing random footage of Merrin eating cookies on a screen where Kalorm can see it. One of the admins on overnight duty even cut and edited it into a music video to one of Mallor's most popular songs, though they're waiting to unveil it until Kalorm is otherwise unoccupied and, ideally, Merrin is in the bathroom or something and they can avoid making her spectacularly self-conscious.) 

After confirming with Kalorm that he wants to get started with his day, she helps Tharrim roll him over to supine and reconfigure the bed. She pulls up a chair. 

"Kalorm, you had a really good day yesterday, and it looks like you had a restful night. Feeling ready to try some more hard things today?" 

Kalorm is SO ready! He thinks breathing is feeling better today? 

He points hopefully at the ventilator. Pointing at things is definitely working better lately. It's mildly annoying how Merrin is right and all the stupid tedious exercises that should not count as exercises seem to have actually helped. 

"Yeah! I am definitely in favor of you trying a minimum settings trial. Your oxygenation was really good overnight, and you were breathing about 40% oxygen when you were lying on your front - that's still double the concentration in room air, but it's better than you were at before. Your pressure support settings are a bit lower than they were at rest yesterday, and you're getting awesome breath volumes now that you're awake. You're back to needing about 45% on your back, but lifting the head of the bed higher might help." 

She offers him the console for the bed controls. It has text labels that he can't read, but also visual-schematic labels, which hopefully he can manage to parse now. "Here. Want to try lifting your head up until it feels like a good amount to you?" 

This is ANNOYINGLY COMPLICATED (Kalorm's fine motor control is, perhaps, still not entirely back to normal) but Kalorm has NO INTENTION of giving up and admitting he can't use a stupid bed control console. He figures it out in about a minute, and then raises his head to around 60 degrees before lowering it a little. 

His pillow is in an annoying position but guess what: Kalorm can FIX THAT HIMSELF! With, again, an enormous amount of effort, and he doesn't get it fixed to exactly how he would like it, but he still manages a tired smile at Merrin. 

Merrin lights up at him in return.

"Good work! ...Okay. Treatment Planning is capping the oxygen concentration we're willing to go up to at 60%, because that is the absolute highest number where we would consider taking you off the ventilator entirely. And we've got the usual parameters for where we would cut the trial short." She pulls up the visual charts for him. "If your CO2 goes above this line, or your oxygen saturation goes below this line, or your respiratory rate goes above 25 - here's the waveform, the ticks underneath are showing the reference rate of 25 - or your moving average past-minute ventilation stays under this line for more than two minutes. Okay? But I'm not going to stop the trial if all your numbers are fine and you just look like you're having to work hard. So if you're working hard and you're tired and want to rest, I'm relying on you to communicate that to me. Got it?" 

Nod. Eyeroll. 

Merrin does not giggle. She smiles in a restrained way. "That's about it. Don't be too disappointed if you aren't ready, okay? The Diagnostic markets are only putting 15% odds that you'll get through an hour, staying within those parameters, without working hard enough to breathe that you're tired by the end. ...Uh, Treatment Planning is suggesting that you might be safe to come off the ventilator even if you do get tired, as long as you can stay within those parameters for the full hour. Do you remember the bigger oxygen mask that made a seal over your face? If you're okay breathing with less help at least some of the time, we can have that available as a backup whenever you want to rest, and the rest of the time you'll find it easier to communicate. Diagnostics thinks it's about 35% likely you can meet those criteria, but even if you do, it's up to you if you want to pull the tube or wait a couple more hours and try the minimum settings trial again. Make sense?" 

Why are there so many EXPLANATIONS. Kalorm just wants to do the thing already!!! He nods impatiently.