The Renown Hospital staff are understandably stunned by the sudden appearance of the injured, strangely-garbed man collapsed on their floor. Two nurses hurry over; he's pale and shivering, mumbling deliriously in a language they don't understand. His arms are badly burned, oozing infection, and his fever feels dangerously high. They call for a gurney and help, struggling to move his unconscious form without causing further harm.

As they rush him into an exam room, stripping away the filthy bandages to assess the damage, an exhausted-looking resident joins them. "How did he get in here like this?" she demands, checking his vitals. His heart is racing, breath coming fast and shallow. "We need to stabilize him, get IV antibiotics started, and take him up for surgery right away. Call the burn unit."

The nurses obey, working quickly to start an IV, give oxygen, and prep him for the OR. In the hurried bustle of a busy ER, strange arrivals aren't unheard of - but the sight of those severe, infected burns and his ragged clothing nags at the back of the resident's mind. She pushes the questions aside for now; her patient's condition is critical, and whatever mysteries surround his appearance will have to wait.

Altarrin is so confused. He doesn't understand how he got here at all, but - the sight of the strange glass-screened machines around him, and the competent, organized bustle of people who are obviously un-Gifted but highly trained Healers, is familiar to him - 

- could he possibly have ended up in dath ilan by accident? 

Not the time to try to figure it out. His head is foggy from the fever, not to mention the fresh magical exhaustion and backlash from his Gate-gone-wrong, and he can't understand what any of the staff are saying. (Which is to be expected, they speak another language, and given Carissa's translation magic, he never did try to learn Baseline.) 

If he's really in dath ilan, then - at least he's in good hands. He cooperates as well as he can with the medical staff, holding still while they place a mask over his face - which does make breathing easier - and use a needle to place some kind of tube into his arm. 

He tries his best to stay conscious, but he's so tired. 

Once the injured man is stabilized and prepped for emergency surgery in the burn unit, the ER staff turn with relief back to the usual rush of patients in the waiting room. The resident who first examined him retreats to the staff lounge for a quick coffee, mind still troubled by the mystery. His sudden appearance, the strange garb, the severity of his wounds - it all seems off. On impulse, she pulls up recent local news reports on her phone, scanning for anything that might explain it.
Nothing. Frowning, she heads back to her shift, resolved to check on him once he's out of surgery. For now she'll have to be content assisting the rest of her patients, pushing aside her questions about the stranger fighting for his life upstairs.

Marian, a travel nurse from Canada who's been working in the Reno hospital for three months, haaaaaaaaates burn patients. But she's a grownup, and will calmly take a bedside report from the ER nurse on her patient's condition, while she quickly examines him.

How are his vital signs? Do they have any lab results back yet? 

The surgery to debride and graft the stranger's severe burns is long and difficult. By the time Marian gets his bedside report, he's been in the recovery room for over an hour, still intubated and sedated.

His vitals have stabilized, though his fever remains dangerously high. The initial lab results show signs of infection, as expected with burns that severe - his white count is elevated, and the cultures taken during surgery will confirm the specifics once they grow out. The damage was extensive, requiring grafting, and he'll be in the ICU for close monitoring as he starts to wake.

Poor guy. He's going to be in so much pain once he wakes up from the anesthesia. On top of the burns, the CT scan showed that he has some cracked ribs, and internal bleeding that fortunately seems to have stopped on its own before they got him. His injuries actually look several days old, by the look of the now yellow-and-green bruises all down his side. 

Even with the antibiotics now on board, she's still pretty worried about sepsis. He looks fit, like someone who works out regularly, but he's not a young man - she would peg him at fifty, maybe, though they're still lacking any identification and don't have an exact age for him, or even a name. 

He came in surprisingly not dehydrated, given the amount of fluid he must have been losing from those oozing burns. His blood pressure is tolerable now after only a couple of litres of saline and a medium dose of vasopressors that, honestly, might be mostly just compensation for the sedation. His heart rate is down to 120 now, still elevated but she suspects it's mostly the fever responsible for it. She really needs to try to bring his temperature down once he's nicely settled in the ICU; it sounds like the plan is to keep him intubated for now and slowly reduce the sedation. 

The ER staff removed his clothing, but he's still wearing some jewelry, some bracelets and a necklace and ring, all made of some strangely dense silver metal. His fingers are already a little swollen, and she can't slip the ring off. She'll have to try with lots of soap once they're back in the ICU; she always hates having to cut patients' jewelry off them, what if it's a family heirloom. 

(It is, unbeknownst to Marian, actually a Ring of Sustenance, one of Carissa's Golarion-style magic items, which has been for the last two days keeping Altarrin magically nourished and hydrated. It's actually fortunate for him, and them, that the hospital staff haven't yet removed it.) 

They haul him to the ICU, and Marian keeps the fentanyl drip running at its maximum rate but eases down on the Versed. She watches him carefully for any signs of responsiveness. 

The ICU is dim and hushed, the steady beeping of monitors the only real sound. Altarrin lies pale and still in the hospital bed, bandages swathing his arms, a maze of tubes and lines connected to the machines around him. His fever has dropped slightly in the last hour, much to Marian's relief, though it's still higher than she'd like.

As the sedation starts to lift, Altarrin stirs restlessly. His eyes flicker open, gaze unfocused, breaths quickening in distress as consciousness returns. The discomfort of the ET tube, the IV lines, the pain beginning to register through the haze of medication - it's disorienting and frightening. He starts to cough, choking around the tube in his throat, panic rising.

A young woman's face swims into Altarrin's field of view, and he fixes his eyes on her, fighting to stay calm and in control. He feels like he's choking, but he thinks it's just his body reacting to the unfamiliar sensation, and actually air seems to be reaching his lungs just fine. 

The young woman slips her hand into his, speaking words in a language that Altarrin still can't understand, but her tone is calm and reassuring. Altarrin isn't sure if he's being asked a question or requested to do something, but he squeezes her hand, which seems like the sort of thing Healers would be asking you for. 

Where am I, he tries to mouth around the tube in his throat, though he doesn't expect her to understand his language. 

Marian gives the stranger's hand a reassuring squeeze in return, speaking softly. "It's alright. Try to stay calm. You're in the hospital, in the intensive care unit. We had to intubate you to help you breathe during surgery. I know it's uncomfortable, but the tube is helping. Your injuries were severe, and we need to keep you on oxygen for now."

She keeps her tone gentle, hoping the soothing tone and contact will help keep him from panicking until the sedation wears off further and she can explain properly. His eyes, though cloudy with fever and medication, seem intent on her face. She thinks he's trying to speak, though no sound comes out around the ET tube. "Don't try to talk right now. We have you on IV pain medication, which should start helping with discomfort from your burns and surgery. Just rest - we're monitoring you closely. I'll be here when you wake again."

Altarrin still can't understand any of what she's saying, but the tone comes across. He knows it's important to stay calm and avoid struggling, in case it disrupts any of the technology around him that's keeping him alive. He closes his eyes again, and drifts. 

...

The rest of the unit is very busy, and Marian ends up spending a while in the room next door helping a colleague; she opens the curtain on the glass window between the two rooms, so she can have a view of her patient and make sure that he's still calm and his vital signs are stable. 

He seems fine for a few minutes; he's occasionally coughing and setting off the ventilator alarm, but he seems to be trying hard to stay calm and still, and let the ventilator do its work to help him breathe. 

About half an hour later, though, a different alarm starts pealing plaintively. The blood pressure tracing on the arterial line is dropping below the alarm limit. 

The alarms blare, jolting Marian's attention back to the stranger in the next room. His blood pressure is dropping dangerously low. She hurries in, checking the IV lines and monitors. His skin feels clammy, pulse thready. Sepsis - his fever and injuries have allowed infection to gain ground despite the antibiotics.

This is not very surprising but Marian still doesn't like it. Her standing orders let her increase the vasopressor drip and send a panel of stat bloodwork off to the lab, but she needs an actual order from the resident to give him another bolus of IV fluids. She pages the doctor and then hovers by her patient's side, fidgeting. 

...Her patient's eyes are open again, trying to focus on her. "Hey," Marian says quietly, reaching to take his hand again. "Just breathe and try to relax. You're going to be okay." She doubts he can understand her, given the language barrier, but as she waits for the busy resident to finally make his way over from the crashing patient next door, she still hopes that isn't a lie. 

The compressive bandages are soaked through with foul fluid when the nurse comes to change them. He's barely conscious, shivering with fever and undoubtedly in agony. She smiles reassuringly at him and hums soothingly under her breath as she works, trying to provide some small comfort. Her gloved hands move with practiced efficiency, unwinding the bandages to reveal the damage beneath.
The grafts aren’t taking well. The areas where healthy skin has been transplanted onto the burns are angry red, swollen and weeping. The nurse’s practiced eye notes the telltale streaks of infection radiating out. She clenches her jaw at the sight, worry clenching in her gut. The broad-spectrum antibiotics don’t seem to be helping; whatever infection has taken hold is persistent. She applies silvadene cream as gently as possible, covers the mess of torn flesh and stitches with fresh bandages, and secures them in place.
Job done, she straightens with a quiet sigh. The dressing change done for now, but there are more alarms sounding down the hall demanding her attention. She shoots a concerned look at the pale figure in the bed, hoping the doctors have some new strategy to try, before hurrying off to the next crisis.

The young woman holds his hand and talks soothingly to him in her foreign language while the other, older un-Gifted Healer changes the bandages on Altarrin's arms. He squeezes the young Healer's hand and tries his best to hold still and take slow deep breaths, even though without the tube in place he would probably be screaming involuntarily in pain. 

The young Healer stays with him after the older one leaves, but there's stress and helplessness in her eyes. She seems to be waiting for someone? 

...Altarrin has been trying to stay calm by repeatedly telling himself that he's in the best possible hands, but - everyone here seems so busy, desperately overworked, no one paying more than glancing attention to him except the one young woman who seems to be his dedicated Healer. She's now fiddling with the strange glowing machines beside him, biting her lip as she glances between those screens and the different glass screen of unreadable text and squiggles beside his head. Altarrin wishes desperately that he had the Gift of Thoughtsensing in this body and this lifetime, so that he could read her mind and make more sense of what's happening around him. 

(He...is starting to doubt it's dath ilan. Dath ilan would have more resources than this, surely, and be better organized. This place certainly has advanced technology, but...it still makes him anxious, to feel like the system around him is desperately overstrained.) 

...

Marian sighs with relief as she sees the resident finally come into the room. "Hey! Thank you for coming." You certainly took your time, she holds back from saying out loud, no need to be rude when they're all overwhelmed. "I think the sepsis is getting worse. I'm maxed on the vasopressors now and his BP is still low. Can we give him some more fluids? And, uh, we maybe need to try a different antibiotic, I think it might be time to go for the big guns here." 

The resident examines the monitors, notes the dropping blood pressure and elevated heart rate with a frown. "You're right, this isn't looking good. Go ahead and bolus another litre of NS, and we'll switch him to vancomycin and aztreonam. I don't like how swollen those grafts are - we may need to take him back to the OR." He adjusts the settings on the vasopressor pump, then checks the surgical site with gloved hands, peeling back bandages to reveal the mess of torn and blistered flesh beneath.

The angry red streaks have spread further, the skin around the grafts hot to the touch. The resident curses under his breath. "Call the attending, and book an OR. We need to debride this again before the infection gets any worse." His jaw tightens; losing this patient after struggling for so long to stabilize him would be a bitter defeat. But the battle isn't over yet. He turns to Marian, expression grimly determined. "Let's get him prepped. I want to get in there as soon as possible."

Things finally seem to be happening around him, medical staff flocking into the room, moving hurriedly. It...looks like they're going to take him somewhere else? 

The pain feel more distant now. Altarrin appreciates it, and wonders if they're giving him stronger drugs, but...he has a suspicion it's actually because his condition is worsening and he's sliding toward unconsciousness. He can't seem to move his limbs, anymore. It's very hard to think. 

He keeps his eyes open as long as he can, seeing double as he tries to focus on the young not-Healer's face. Altarrin is vaguely aware of movement, of bright fluorescent lights blurring past overhead, and his vision is fading out, darkening to a tunnel. 

He clings to consciousness as long as he can, but before they reach their destination, his eyes drift shut as the the blackness swallows him. 

The OR team works with grim resolve, peeling away sodden bandages to reveal the mess beneath. The infection has invaded the surgical site, destroying newly grafted skin and damaging healthy tissue. They debride aggressively, cutting away dead and dying flesh until fresh blood flows, then irrigate the open wounds thoroughly.
Hours later, they emerge exhausted, their pateint once more stabilized. But victory feels hollow; so much lost ground will be hard to recover. Altarrin is taken back to the ICU under close monitoring, his arms swathed in fresh dressings, fluids and heavy-duty antibiotics pumping through IV lines.
In the aftermath, Marian finds a moment to slip into the small lounge and splash water on her face. Her hands shake with fatigue as she grips the edge of the sink, staring at her pale reflection. They're fighting a losing battle here, she fears. If his body can't rally, if the infection continue its relentless advance...She shakes off the thought. Not yet. The fight isn't over while he still draws breath.

Her patient is worryingly less responsive now. He pulls away weakly from painful stimuli, but shows no sign of purposeful movement or being aware of her presence. 

With his body overwhelmed by sepsis, his circulatory system is leaking fluid into his tissues, leaving his extremities swollen (there is definitely no chance of removing the odd ring now, though at least it somehow doesn't seem to be cutting off circulation to his finger.) The massive systemic inflammation is starting to affect his lungs as well; he's requiring higher ventilator pressures to keep his oxygenation within reasonable bounds. 

Marian checks Altarrin's vitals and IV lines again, adjusting the settings on the machines keeping him alive. His fever is still dangerously high despite the cooling measures they've tried, not budging below 104. She lays a cool cloth on his forehead, dabbing at the sweat beading there, and holds his uninjured hand. His palms feel like ice, while fever rages through the rest of his body.
The resident makes his evening rounds, brows knitting as he reviews Altarrin's worsening condition. "He's not responding. His organs are starting to fail." His tone is grim. After days of struggle, acceptance of defeat tastes bitter. But they are out of options, treatments exhausted, infection continuing its relentless march through Altarrin's system undeterred.
Marian swallows hard against the lump in her throat, clinging to her patient's hand. She knows the resident is right, that continuing treatment is only prolonging suffering with no hope of recovery. But letting go, after fighting so hard...her eyes sting, and she turns her face away to blink back tears. The resident's hand comes to rest on her shoulder, a small comfort. "I'm sorry. We did our best." His voice is soft. "It's time."

Marian looks down at her patient's face, expression slack and empty in deep unconsciousness.

She remembers the way his eyes focused on her, before, when it briefly seemed like he might be improving. She remembers the obvious curiosity and intelligence, the way he was clearly trying desperately to understand her across the language barrier. The intent self-discipline he used to hold still, eyes locked on hers, despite the discomfort of his dressing change.

They've lost so much ground since then, and given his age the prognosis is poor. And they don't know the patient's wishes; he never had a chance to speak to them. But - she thinks this particular patient wouldn't want them to give up just yet, even if his chance of recovery is low and the ongoing lifesaving treatments are painful for him and maybe futile. (Not to mention that if they withdraw treatment now, she's never going to learn who he is or how he ended up here, or where he got his mysterious jewelry, or the answers to a thousand questions she's desperately curious about.) 

She grits her teeth, and squares her shoulders, and lifts her head to meet the resident's eyes. "I know, but - I think he still has a chance. I think maybe he's tougher than we realize. Can we - just another twelve hours - see if he starts to improve...?" 

The resident hesitates, uncertainty warring with pragmatism. The odds are still poor, each hour slipping by reducing the chances of recovery. But if there's still a chance...he blows out a breath, scrubbing a hand through his hair. "Alright. Twelve more hours." His gaze meets Marian's, resolute. "But after that, if there's no improvement..."
He leaves the rest unsaid. They both know the likely outcome. With a nod, he moves on to the next patient.
Marian lets out a long breath of relief, turning back to Altarrin. She checks the IV antibiotic bags, making sure the heavy-duty drugs are still flowing in. The machines continue their rhythmic beeping, tracking his struggle. "Hang in there," she murmurs.
Dawn is still a few hours off. The ICU is dimmed for the night shift, the usual bustle slowed to a murmur. She pulls up a chair and settles in to keep her patient company through the long hours until sunrise, watching closely for any signs his condition may be changing - for better or for worse. The battle isn't over yet.

The patient doesn't show any signs of improvement immediately, but his condition isn't deteriorating any further either. It's a very long night. 

Close to dawn, there are finally some small signs of recovery. The latest bloodwork shows that the patient's failing kidney function has turned around, and is actually starting to improve a little. His fever subsides to only 102, still high but less dangerously so. The IV steroids they're administering might finally be starting to reduce the massive inflammation throughout his body; his lungs, at least, are less affected, he's maintaining oxygenation with slightly lower ventilator pressures. 

His cardiovascular system is still struggling, though. His heart rate has been running above 140 for the last twelve hours, struggling to keep pumping blood through his infection-ravaged body, and his heart is starting to feel the strain, with occasional ectopic beats showing on the monitor. 

(Altarrin looks around 50, but he's actually closer to 80. Mages age more slowly, and the Eastern Empire has life-extension magic, but it doesn't entirely hold off the progress of aging.) 

As dawn breaks over the city outside, the ICU slowly comes alive again. The night shift nurses head home, weary but relieved the long night passed without losing any patients on their watch. The day shift begins to trickle in, reviewing charts and checking on those most critical before the usual morning rounds.
One of the new arrivals pauses by Altarrin's room, frowning at the readings on the monitors. His heart rate is still dangerously high, ectopic beats interrupting the rhythm every few minutes in a way that seems to be worsening. She hurries in, laying a hand on her patient's chest to feel his heart pounding erratically under her palm. This isn't good. If his heart doesn't slow, the muscle will weaken further until it gives out entirely.
She pages the resident on call, trying to stay calm. They've come so far; to lose him now would be unbearable. But his heart won't last long at this rate. She adjusts medication settings as far as she dares, watching the monitors closely. All she can do is keep him stable until the doctors arrive and a new strategy is put in place. The battle isn't over yet - but time is running out.

The attending doctor, who goes by Dr Zee on the unit, reads over the patient's chart, frowning at the monitors. She's glad the decision was made last night to continue with lifesaving treatment; she agrees with the previous nurse's judgement, that this patient is fighting hard and still has a chance of recovery. It's an incredibly complicated case to manage, though, all the treatment options from here coming with risks as well as benefits. She's going to need to get creative, if she wants this patient to make it. 

"We need to get a handle on the infection, but I'm worried about kidney toxicity with stronger antibiotics, his kidney function is barely adequate as it is. ...Hmm. He might be able to tolerate continuous dialysis - I wouldn't normally want to risk it, but his electrolytes have been remarkably stable through all of this and he's needing less IV fluids than I would've expected. And if we can clear out some of the toxins from the sepsis, that should take some of the stress off his organs, including his heart." 

(The staff of the ICU are still unaware of Altarrin's Ring of Sustenance, continuing to quietly provide a magical source of hydration and nutrition, but it's noticeable that something is going better than expected.) 

"...Hmm. If we get him stabilized at all, I want to take him back to the OR to clear away abscesses. If he survives that, then - maybe we have options from there." 

Dr. Zee's plan springs into action. The dialysis machine is set up, tubing threaded into Altarrin's veins to filter toxins from his blood. Powerful new antibiotics begin pumping through IV lines, despite the risk to his kidneys. His fever is stubborn, spiking again as his body reacts to the invasive treatments keeping him alive, but the readings on his heart monitor have steadied for now.
Altarrin is taken back to the OR, remaining under close monitoring. The surgeons work carefully around IV lines and tubes, cutting away dying flesh and irrigating deep abscesses. It's a delicate procedure, balancing risk and reward, but necessary if he's to overcome the infection ravaging his body. Finally, bandages are reapplied and Altarrin is moved back to the ICU to recover - if he can.
In the aftermath, all seems stable for the moment. But the coming hours are critical. His body has been through trauma after trauma, battered by treatments as life-saving as they are damaging. The dialysis will continue around the clock, filtering toxins from his blood, but even that precaution comes with cost. And still, despite aggressive measures, his fever remains worryingly high.
Victory seems within reach, the infection's march halted at last - but the battle is not yet won. The slightest misstep could still lose all, if Altarrin's will to survive finally fails. All they can do is watch, and wait, and hope. The long fight has left them exhausted, hanging on stubborn hope and memory of intelligent eyes meeting Marian's own, so long ago now.