The nurse coming down the hallway nearly trips over the prone form in front of her. At first, she thinks it’s a homeless person who’s wandered in and passed out, but as she crouches down to check, she realizes this is a teenager - and he’s badly injured. She presses the call button on her pager immediately.
“Don’t move, sweetie, help is coming,” she says to the dazed boy, even though he doesn’t seem capable of moving much at the moment. She notes with concern how pale and clammy his skin feels, and the blood matting his dark hair. His pupils look unequal and sluggish. Concussion, she thinks, and starts assessing the rest of him for injuries, carefully avoiding moving his head or neck.
Within moments the crash cart team arrives, and she starts rattling off vitals and symptoms to the doctor. They carefully maneuver the teenager onto a backboard, neck brace in place, and start IV lines and oxygen as they rush him into a trauma bay. The nurse squeezes his hand briefly.
“You’re going to be okay,” she tells him, hoping it’s the truth. He seems to focus on her face for a second, eyes full of confusion and fear, before his gaze goes distant again.
In the trauma bay, the staff works quickly and efficiently, cutting away clothes to find and treat the damage. Broken ribs, sprained wrist, multiple lacerations. The head wound is still oozing blood despite compression. His temperature is too high.
“Possible septicemia,” the doctor says grimly. “We need to stabilize him and get him admitted, stat.”
Through it all, the boy remains silent and barely responsive, clinging to consciousness as if by a thread. His eyes keep searching the room as if looking for something familiar, finding nothing. The nurse pats his hand again before they wheel him out to the elevator and up to the ICU.

Lionstar has no idea what's happening to him, but he doesn't try to move. It seems like a bad idea, right now, given how much pain he's in. 

His heart rate is elevated at nearly 140; it's hard to distinguish how much of that is pain and anxiety, versus hypovolemia and shock, though his blood pressure is still tolerable for the moment. They have a difficult time placing the IV; on top of the blood loss, he looks very dehydrated, his veins failing to pop up even with the tourniquet wrapped tightly around his arm. The ER staff are very experienced, though, and have a line in within two minutes and a saline bolus flowing into his vein. 

The initial pulse ox reading is lower than ideal, hovering at 88%; he's breathing shallowly, probably to avoid exacerbating the pain of cracked ribs, and his lungs sound wet and crackly, an obvious sign of pneumonia that might explain the fever. 6L/minute of oxygen by nasal prongs is enough to bring his oxygen saturation up to 100% for the moment, but his breathing is still rapid and shallower than ideal. 

His eyes are still open, and he's clearly trying to track and make sense of his surroundings, but he doesn't respond to any of their questions, except at one point to mumble a few slurred words in a foreign language that none of the staff recognize. (Lionstar can't understand what they're saying at all, and trying to use Thoughtsensing only gets a blurred impression of surface thoughts, and makes his head hurt even worse.) 

They can get him as far as the ICU without any other incidents, though. 

In the ICU, the staff continue monitoring the boy closely. His temperature remains elevated at 103 F, even after aggressive cooling measures. The pneumonia seems to be progressing rapidly, his lungs becoming more congested and wheezy. His bloodwork shows signs of infection - high white count, increased inflammatory markers. The doctors start him on broad-spectrum antibiotics, hoping to curb the spread before he develops full-blown sepsis.
For now, he remains in a semi-conscious, confused state. At times he mumbles incomprehensibly or seems to be talking to people only he can see. His eyes rove the room, frown in confusion at the unfamiliar machines and IV poles surrounding him. When staff check on him or perform examinations, he shrinks back fearfully from their touch at first before seeming to realize they mean him no harm. But he still does not respond to any questions or seem to understand what they’re saying.
The language barrier is proving frustrating. They’ve tried speaking Spanish, the most likely match for his ethnicity, but he only stares at them in confusion. Without knowing his identity, they have no idea what language he speaks or where he might be from. His injuries and state of malnourishment suggest he may have been living on the streets, but his nails are clean and hair is neatly trimmed. The mystery only deepens.
For now, they focus on keeping his fever down, maintaining oxygen levels, and fighting the infection spreading through his lungs. His concussion seems to be the least of their worries, though they continue monitoring him closely for signs of brain bleed or swelling. The most urgent priority is ensuring he lives long enough for them to solve the puzzle of who he is and how he came to appear, as if by magic, in their hallway.

The patient arrived at around 6:00 am, only an hour before shift change, and only reaches the ICU at 6:40; the charge nurse takes him for the remaining 20 minutes of night shift, there's no point in assigning him to one of the night nurses when they're about to leave. 

Marian, a travel nurse from Canada, has been working at Renown Hospital in Reno for about six months. She often floats to other ICU units, but over time she's been more and more trusted in the trauma unit, and apparently today she has an interesting patient to take report on. 

A young person, which is rare - they don't have an exact age for him, or an identification at all, but he apparently looks fifteen or sixteen. Language barrier. And there are several different things wrong with him: the unexplained injuries, a nasty pneumonia, and also the fact that he came in seriously dehydrated and looks like he hasn't been eating properly in months. 

She frowns at the lab results in his chart before going in to see him. His lactate is normal, which is a good sign - he's not seriously in shock, at least not yet - and his hemoglobin is only a touch low. Marian frowns suspiciously at it. He lost some blood, even if the bleeding was controlled fairly quickly, and if he's that undernourished she wouldn't be surprised if he were anemic going into this. The labs were drawn before he had really gotten any IV fluids, and he's had two litres of saline since then; the initial hemoglobin result might be artificially elevated by dehydration and hemoconcentration. She’ll want to ask the resident about doing a repeat set of labs in a bit once all the fluids are in. With the pneumonia, his body is already under enough strain getting oxygen to his cells.

Treatment plan: less solidified than she would like. There’s an order for a CT scan (head, chest, and abdomen), to hopefully rule out a spinal injury so they can get him off the backboard, and to assess for other broken bones and internal injuries. The ER doctor wanted him stabilized a little more first, and the night charge nurse unsurprisingly didn’t have a chance. 

Once Marian actually goes in to see her patient, she’s more worried. He looks pale, despite the red blotches of fever on his cheeks. The fluids have improved his blood pressure, but haven’t touched the elevated heart rate, and he’s breathing at 30 a minute, his nostrils flaring slightly around the nasal cannula with each breath. When she lays a hand on his arm, he tries to look at her, but his eyes aren’t quite focusing.

“Hey,” Marian says softly. “My name is Marian. I’ll be your nurse all day today. You’re in the ICU, at Renown Hospital. You have some injuries, and we’re worried about your breathing, but - we’ll take good care of you, I promise.”

She hunts for any sign of recognition or understanding in his dark eyes, but he just looks confused.

“I’ll be right back,” Marian promises him, squeezing his uninjured hand gently. She goes looking for the resident on duty. 

“Hey. Uh. Our John Doe patient in room 110 is — well, I’m worried. He looks really pale and I don’t super trust the first hemoglobin from the ER, can we run a repeat now that he’s had fluids? Also, uh, his heart rate is still up at 140. BP is okay - highish actually, last one was 130/60 - but he might still be dry. Or it could be pain - he’s got to be uncomfortable, and I’m worried the cracked ribs will mean he doesn’t want to cough and clear his secretions.”

Does the resident have orders or suggestions for her?

The resident, Dr. Matthews, follows Marian to room 110 with a frown. He examines theJohn Doe patient, listening to his chest and noting the rapid, shallow respirations.
“You’re right, he looks poorly perfused still. Let’s get another set of labs, check an arterial blood gas, and bolus another liter of saline. His sats are borderline, even on 6 liters - I don’t like how wet his lungs sound. We need to make sure he’s clearing secretions. Order chest PT, see if they can get him coughing productively. If he’s still tachycardic after the fluids, we’ll start a norepinephrine drip.”
Marian nods, already placing the orders in the chart and preparing to draw a new set of blood samples from the patient. She’s relieved the resident shares her level of concern.
“For pain, start with 2 mg of morphine IV and go up from there. Make sure respiratory stays on top of him after any opioids. If his mental status doesn’t improve with fever control and hydration, we’ll get a head CT to check for complications from that concussion.”
Dr. Matthews looks down at the boy, who seems to have drifted into a restless doze, eyes moving rapidly under eyelids. “Has he given you any ID info yet? Next of kin, medical history?”
Marian shakes her head. “No, he doesn’t seem to understand anything we’re saying. I tried Spanish since that seemed the most likely match, but no luck.”
The resident sighs. “Alright, we’ll keep working on that and notify social services, see if they have any leads. For now, our top priorities are stabilizing him medically and figuring out what the source of infection is so we can properly target our antibiotics. Call me if his condition changes. Good work, Marian.”
With orders in place, Marian focuses on her patient. She administers the morphine, noting his HR begins to slowly drop, though his respirations remain rapid. The new set of labs confirm her suspicion - his hemoglobin has dropped to 9.8, despite IV fluids. She starts the next liter of saline bolus, along with a bag of albumin, and calls the blood bank to prepare 2 units of packed red cells for transfusion.
The chest PT arrives and begins percussion treatments, which finally trigger a productive cough from the boy - though his eyes remain closed, he moans in pain as his body is wracked by coughs. Marian soothes him through it, elevating the head of his bed and giving oxygen to ease his breathing.
His condition seems stabilizing for now, but she knows he’s still in a precarious state. She settles in for a long day at his bedside, hoping her teamwork and diligent care will be enough to solve the mystery of this young man and ensure his recovery.

The percussive chest therapy, followed by nebulized bronchodilators, do improve the patient’s O2 saturation. His temperature comes down by a couple of degrees, to 101 F, and his heart rate steadies out at 120.

He’s a lot drowsier after the morphine, though, and despite the albumin his blood pressure is starting to slide downward, which doesn’t leave Marian delighted to take him off to Radiology just yet. He’s hovering at a very borderline 95/45 when the units of blood are finally hand-delivered from the blood bank (apparently he has an unusual blood type, which delayed it.)

Marian co-signs the first unit of blood with another nurse and gets it running, watching the patient closely for any sign of an adverse reaction. It goes fine, though, and it seems to be helping; his heart rate falls to 110, almost within normal range, his blood pressure creeps up to 105/60, and his color looks a little better.

Marian reassures the patient, who as usual looks at her with exhausted and helpless confusion, and then goes to bother the resident again. “I think I feel comfortable taking him for the CT scan now, if that’s all right?”

Dr. Matthews examines the patient again and agrees he seems stable enough for transport to radiology. “His vitals have improved, and the transfused blood should help increase his oxygen carrying capacity. Go ahead and take him for the head/chest CT, but monitor him closely - have respiratory come along in case he needs intubation. Call me immediately if he shows any signs of deterioration.”

Marian nods, already arranging transport and notifying respiratory therapy. She explains the situation to her patient, taking his hand briefly. “We need to take you downstairs for some tests, to get a better look at what's going on inside. I'll be right there the whole time - just try to stay still and breathe normally. We're going to figure this out and get you feeling better.”

Though he still seems confused, the boy offers a faint nod at her soothing tone. She eases an oxygen mask over his face for the trip and, with the help of a transport tech and respiratory therapist, wheels him carefully down to radiology.

The tests go smoothly, and soon he's back in his ICU room, looking worn out but stable. Dr. Matthews examines the scans, frowning. “Pneumonia is apparent in the right lower lobe, but also signs of pleurisy - we'll need to do a thoracentesis to drain fluid and check for empyema. The head CT is clear, no bleeds, but there is minor cerebral edema which could be impairing his mental status.”

He marks up orders for thoracentesis, as well as adding dexamethasone to reduce inflammation. “The steroids may perk him up and help his breathing. Let's see if we can get him off the oxygen mask today - keep up with bronchodilator treatments and chest PT. I'm going to change his antibiotics to ceftriaxone and levofloxacin, to cover pneumonia and any possible infections from those abrasions. If he's awake enough, see if a speech pathologist can evaluate him to determine what language he might speak - that could help in identifying him."

Marian reviews the new orders, relieved they seem to have a clearer picture of her patient's condition and how to properly treat him. She checks on the next bag of blood and albumin, to keep transfusing as ordered. Though still critical, she feels cautiously hopeful they have a chance at pulling him through this - if only they could discover his identity and contact any family he may have. For now, she remains at his bedside, monitoring for any changes and keeping him as comfortable as possible through each test and treatment.

Lionstar drifts, dozing restlessly and slipping in and out of uneasy, confused nightmares of a horizon turning to fire and knowing that everything he had built, everything he had ever cared about, was lost and it was his fault. 

(His memories of his first life are fuzzy - which he had expected - and also all of his personal records are presumed destroyed, which he hadn’t expected. He isn’t sure how the war began, or why Urtho escalated so violently, or what actually killed his first body.)

His surroundings are so baffling. He would be curious about where he is - and possibly terrified for his safety, here among strangers - if he could find the energy for it. But he’s so drowsy, and the headache is more bearable but thinking is still very slow and effortful. He struggles to concentrate and is still having trouble getting much with Thoughtsensing, during the brief moments when ‘Marian’, who seems to be some kind of Healer, wakes him. But he can pick up a few hazy impressions. She’s worried about him, and - she wants to protect him, certainly doesn’t want to hurt him. For now, that will have to be enough.

 
Around noon, Marian notices that his fever is creeping higher again, and his oxygen saturation is dropping again, hovering at 89% even with the maximum flow rate on the nasal cannula. When she goes to wake him and coax him via gestures and mime to take some deep breaths and cough, he still opens his eyes eventually, but it takes longer and more stimulation.

Marian frowns, increasing the oxygen flow rate and elevating the head of the bed again. His respirations seem more labored, and when he does cough, the secretions are thicker and tinged rusty with blood. His lung sounds remain diminished on the right side.
She pages Dr. Matthews immediately, who comes to reexamine the patient. "His condition is deteriorating again. We need to do that thoracentesis now - call the interventional radiologist on call and have them come drain his pleural effusion, and send a sample for culture. In the meantime, start him on vasopressors to improve his perfusion, and increase his steroid dose. We may need to intubate if his oxygenation doesn't improve soon."
Marian quickly puts the orders in place and prepares her patient for the procedure, explaining to him what will happen and trying to keep him calm with her reassuring presence, even though he likely doesn't fully understand. The interventional radiologist drains over a liter of purulent fluid from his right chest, which provides some immediate relief of pressure. His oxygen levels start to climb again, though remaining in the low 90's.
His blood pressure proves more difficult to stabilize, even increasing his norepinephrine dose. Dr. Matthews decides to intubate to control his breathing fully, given his pneumonia is proving difficult to overcome. "We're fighting sepsis at this point. Start dopamine, and increase all IV antibiotics. Watch him closely for signs of septic shock."
Marian stays at the patient's side during intubation, keeping a close eye on his monitors. His heart rate climbs to over 130, and his blood pressure only improves slightly. She starts the dopamine drip as ordered, a knot of worry in her stomach.
Over the next hours, his condition remains tenuous. Culture results confirm pneumonia, with MRSA as the causative agent, so vancomycin is added. Multiple vasopressors are required to combat his slipping blood pressure. Despite transfusions and fluids, his lactate level starts to rise, signaling the start of septic shock.
Marian works tirelessly at his side, following each order precisely, but still fears they are losing the battle. All she can do is keep fighting, apply all her knowledge and skill, and hope it will be enough to overcome the infection ravaging this young man's body - and solve the mystery of who he is before it's too late.

By late afternoon, Marian is feeling run off her feet. After multiple rounds of upping the norepinephrine and dopamine drips and frantically calling the respiratory therapist to increase the ventilator support and oxygen concentration, the patient seems to have found some equilibrium. And he’s finally responding to fever-lowering medications and her repeated cold sponge baths, his temperature falling below 100 F.

He still looks terrible, though. His hands and feet feel cold and mottled to her touch. Now that he’s on the right antibiotics, she hopes that they’re making progress against the infection, but the massive systemic inflammation is already out of control, and self-reinforcing at this point.

She has him on a minimal dose of midazolam for sedation, just to keep him comfortable with the breathing tube; she explained to him before the intubation that they would be giving him drugs to make him sleepy, but she has no idea if he understood. On her neurological assessments, he withdraws from painful stimuli but is otherwise not very responsive, which is separately kind of worrying.

Exhausted, Marian settles herself in a chair by his bed with a portable computer, and starts trying to catch up on her neglected charting, frequently glancing over at the patient for any change in his vital signs or level of consciousness.

As Marian works on her charting, she finds herself struggling to focus, worry for her patient always at the back of her mind. His condition seems stabilized for now, but still precarious - any downturn could quickly spiral into a life-threatening emergency. She's relieved when the night shift nurse, Evelyn, comes in to take report.
Evelyn frowns as she reviews the chart. "This poor guy has been through the wringer. You did great work stabilizing him, Marian, but he's not out of the woods yet. I'll keep a close eye on him tonight. Any changes at all, I'll call the resident right away."
Marian nods. "Thank you. I wish we knew more about him - any family to contact. He's so young..." She sighs, rubbing her tired eyes.
Evelyn pats her shoulder. "You did the best you could. Go get some rest, or you won't have the strength to care for him tomorrow." She shoos Marian out gently but firmly.
At home, Marian eats a quick meal and showers, but sleep eludes her. Her mind keeps returning to the mystery patient, wishing there was more she could do. She finds herself praying he has the strength and will to fight through another night. If he survives, perhaps tomorrow will bring answers as to who he is - and who is missing him.
The next morning, Marian arrives at the ICU early, eager to check on her patient. To her relief, Evelyn greets her with a smile.
"He made it through the night. BP still on the low side, but sats are holding and fever hasn't returned. He seems slightly more alert this morning - tracked my movement across the room. I think the antibiotics are finally gaining the upper hand."
Marian lets out a long breath, feeling tension drain from her shoulders. "Thank God. That's the best news I could have hoped for."
She hurries to his room, taking his cool hand gently in hers. His eyes, less glassy today, meet hers - and for the first time, she sees a flash of recognition. He knows she's there for him.
The battle continues, but hope has returned. Marian smiles down at her patient, giving his hand a reassuring squeeze.

The patient’s morning X-ray is a little better, showing less patchiness, though the pleural effusion is creeping  back a little. His hemoglobin is stable, and his latest white count is, while still elevated, finally dropping slightly compared to the midnight set of labs.

Their top current problem is that, on the dietician’s recommendation, now that the patient is more hemodynamically stable, they’ve tried to start a slow initial rate of tube feeds. The patient is not coping very well with this. His latest electrolytes are out of whack, hinting at refeeding syndrome, and he isn’t even absorbing the liquid nutrition very well; his gastric residuals have been concerning high, even running the feeds at just 20 cc/hour, and he vomited the last time Evelyn repositioned him. 

He really needs some kind of nutrition, though; he’s clearly protein-deficient, his blood albumin levels low, and his body is trying to fight off a serious infection with very little in reserve.

Marian frowns over the latest lab results and notes on the patient's feeding intolerance. She's not surprised his body is struggling after what was likely months of malnourishment, but they need to find a way to provide nutrition before his condition deteriorates further.
When Dr. Matthews makes rounds, she shares her concerns. "He needs nutrition and electrolyte balance to recover, but his stomach isn't handling even minimal feeds. Do you think TPN might be an option at this point?"
The resident nods. "TPN does seem necessary. His electrolytes and albumin need correction, and his stomach will likely need time to heal before regular feeding is possible. I'll order TPN and additional electrolyte replacement." He adjusts some of the antibiotic doses based on the latest levels as well.
Marian gets the TPN and electrolyte solutions from the pharmacy, adjusting the patient's IV lines. She sits by his bedside, checking that the new infusions are running properly. Though still intubated, his eyes open and seem to follow her movements. She lays a gentle hand over his, wishing she could explain what was happening, though also unsure if he would fully comprehend in his current state regardless of language barrier.
"Your body needs nutrition and fluid to get stronger," she says softly. "This will help you heal. I know there are still a lot of tubes and wires, but we're doing everything we can to make you comfortable while you recover."
Over the next couple days, the patient's condition slowly starts to improve on TPN and adjusted meds. His electrolyte levels normalize, fever remains controlled, and oxygen needs decrease. His chest x-ray shows improvement, and cultures indicate the infection is clearing. Marian begins to hope that, if he continues improving, he may soon be ready for extubation.
The mystery of his identity remains, however, and Marian fears what might become of him if they can't discover where he came from before he's medically ready for discharge. For now, she focuses on providing the diligent care that has brought him back from the brink - hoping each small victory will eventually reveal the truth of who he is, and where he belongs.

Lionstar spends most of his time sleeping, even with lighter sedation, but by three days into his hospitalization, he can manage reasonable alertness, if only for brief periods. He’s less dizzy and the headache is finally subsiding. 

The nurses move around him, a blurred progression of unfamiliar faces. He’s starting to be able to get a little more understanding with Thoughtsensing, and the morning before Marian’s fourth day shift with him, he manages to pick up that the night nurse is asking him to squeeze her hand. 

…He’s not sure he wants to reveal yet that he can understand them. It seems like it complicates things.

It’s a relief to see Marian’s face again, though. She’s been there for so much of the last few days, and her surface thoughts are always reassuring; she’s starting to feel familiar and safe. And - he does want some answers, about where exactly he is.

When it’s her turn to assess him, he makes eye contact, and squeezes her hand on request. The delighted, if confused, expression on her face makes it entirely worth it. 

Mindspeech will startle her, she’s not Gifted, but he can’t exactly talk, even if he could speak her language. (He’s been trying to learn a few words by correlating the syllables with surface thoughts, but it’s slow going.)

He gathers his strength and concentration. :Where am I?: he sends telepathically.

Marian starts in surprise when the voice echoes suddenly in her mind. Her patient - staring intently at her, his hand grasping hers. He's communicating with her?
She blinks at him, stunned, her scientific mind struggling with this seeming impossibility. Yet the proof is right in front of her. Tentatively, she forms a thought to send back.
:You're in the intensive care unit of Renown Hospital, in Reno, Nevada.:
His eyes widen slightly. There's a pause, and then: :Nevada?:
:Yes,: she responds, still reeling. :You were brought to our emergency room with severe injuries and pneumonia. You've been here for four days now, intubated and sedated for most of that time. We've been working to save your life while trying to determine your identity.:
Another long pause. She can feel his surprise and confusion, and begins to wonder if he even knows who he is. When his thought comes again, it's tinged with fear.
:I don't know where I am. This place - it's not familiar. I don't remember.:
Her heart sinks at the confirmation of her fears. Amnesia, whether from physical or psychological trauma, will only complicate his recovery further. But for now, she pushes her worries aside, focusing on keeping him as calm as possible.
:It's alright,: she reassures him. :Your memory may return in time. For now, just rest and continue healing - we'll keep working to determine your identity and contact any family. You're safe here.:
Though still disoriented and afraid, she senses her words provide some small comfort. His eyes remain on her, a lifeline in this strange place, as his grip on her hand relaxes into one of simple trust. She smiles at him, giving his hand a gentle, comforting squeeze in return.
:It will be alright,: she promises him again. :Just rest. I'll be here for you.:

Once he’s asleep again, Marian asks another nurse to watch the monitors, and ducks out to hide in the bathroom for a couple of minutes, her head reeling.

Her patient…is telepathic, apparently. Which is impossible, but either she’s hallucinating, or the proof is right there. 

She should probably tell someone. If it’s real, then - it has some serious implications - and also the patient either has amnesia (concerning) or is from somewhere so far away that he’s never heard of Nevada (differently concerning!)

…She’s realizing that she didn’t think to ask his name. Oops.

Focus. This is going to be the most embarrassing conversation of her nursing career to date, but she grits her teeth, squares her shoulders, and goes to hunt down the resident.

“My patient. Um. The experience I remember having is that he, um. Spoke telepathically. I know that sounds really implausible and I guess maybe I’m having a psychotic break and should hand off his care, but - uh. Can you go check and see if he can telepathy you as well? …also he claims to have never heard of Nevada and he doesn’t remember how he got here.”

Dr. Matthews stares at her for a long moment, confusion and concern warring on his face. "Telepathy? I...that does seem rather implausible."
Marian winces. "I know. I feel ridiculous even suggesting it. But I swear that's what I experienced. Please, just...humor me and go see if he'll communicate with you as well?"
The resident sighs, but nods. "Alright. I'll examine him again and see if I notice anything...unusual."
Marian leads the way back to the patient's room, hovering anxiously as Dr. Matthews checks his pupil response and vitals. The patient's eyes open, glancing between them, and after a moment, the resident's brow furrows.
Marian sees his eyes widen briefly before he blinks and shakes his head. When he turns back to her, he seems at a loss.
"He...spoke to me. Telepathically." Dr. Matthews rubs his forehead. "I have no idea how that's possible, but I heard his voice in my mind, asking where he was and who I was."
Marian releases a breath, relief flooding through her. She's not losing her mind. "Then you understand why I thought I should report this. What do we do now?"
The resident thinks for a long moment. "We should keep this between us for now. Run some neurological tests, check for any abnormalities. But beyond the medical side, we have to consider...if what he's said is true, that he has no memory and no knowledge of this area, we may be dealing with someone not, well, from around here."
Marian nods slowly. As improbable as it seems, she can now believe this patient may be from much further away than they realized. "Should we try to get more information from him, then? His name, where he's from - anything that could help in identifying him?"
"Proceed gently," Dr. Matthews says. "Try communicating with him further when he's awake and seems responsive. Reassure him we only want to help. His mental state seems fragile, so take things slowly. I'll order a neuro consult and discreetly investigate...other possibilities. Let me know if he reveals anything else unusual."
Still stunned by the day's revelations, Marian returns to her patient's room. His eyes open as she enters, and his gaze finds hers, waiting. It seems she will continue to be his anchor in this strange place, helping to solve the mystery he himself embodies. She only hopes the answers they find will provide a path for his eventual recovery - and return home, wherever that may be.

Lionstar is exhausted after the brief attempts at Mindspeech, not to mention the overwhelm and struggle of trying to understand where he is and how he could possibly have ended up here. He and sleeps for most of the rest of the morning.

His vital signs are beautifully stable, his oxygen saturation holding up solidly at 99% with minimal pressure support settings on the ventilator and 40% oxygen, his heart rate rock-steady in the mid-80s and his blood pressure acceptable on just a low maintenance dose of norepinephrine.

His sleep is restless, though, plagued by the now-familiar nightmares of everything that he’s lost. Urtho is faceless, when he appears; his features are already unclear across the gulf of reincarnating into a stolen body.

Eyes still tightly closed, he tosses and turns against the arm restraints, his heart rate spiking to 120 and his breathing rapid and irregular.

Marian checks on him frequently through the morning, and frowns when she notices his increased heart rate and agitation. She places a hand on his arm, speaking softly. "You're safe here. Just relax - you need to rest."
His eyes flutter open, finding hers, his fear and confusion evident. She keeps her voice low and soothing, hoping her words can calm his mind where medications have failed.
"The nightmares will pass. I'm here with you, and you're recovering well. Focus on your breathing - slow, steady breaths. You're in no danger now."
Gradually his heart rate decreases and breathing evens out, though he continues watching her through half-open eyes. She smiles reassuringly, giving his hand a squeeze. "That's it. Stay calm and rest. You need to sleep to continue healing."
Though he seems reluctant to close his eyes again, exhaustion eventually wins out and he slips into a peaceful sleep. Marian lets out a relieved breath, hoping the worst of the nightmares have passed for now.
When Dr. Matthews checks on them later, she relays the patient's episode, and what seemed to help settle him. "Continuing verbal reassurance and a calming presence. It's as though he draws comfort from personal interaction and contact."
The resident nods thoughtfully. "That makes sense, given his fragile mental state and lack of memory. Your compassion is invaluable for his recovery. Keep monitoring for any recurrence of distressing symptoms, and continue providing reassurance as needed. The less agitated he is, the faster he may heal - in body and mind."
Marian sits by her patient's side, keeping vigil over his peaceful slumber. There is still so much mystery surrounding who he is and where he came from, but she is determined to aid his recovery in any way she can - through medical care, mental support, and simple human kindness. He will continue to need all three on the journey to find his way home, though for now letting him rest without troubling dreams is the most she can ask for. Home, for today, is here - safe in her watchful care.

Lionstar continues to improve, at least in terms of his physical condition. He’s now gone almost 18 hours without spiking a fever and needing fever-reducing treatments, and by noon, Marian has him entirely weaned off the norepinephrine infusion. He’s maintaining his O2 sats acceptably on only 30% oxygen, his breathing unlabored and comfortable at rest, though he’s able to convey to Marian that he feels short of breath during repositioning and after his still-frequent and painful coughing fits. He still has copious secretions to clear, but he’s figured out how to gesture to Marian when he needs suctioning (which he finds very uncomfortable, but is cooperative with.) When Marian goes in to turn him on his other side at noon, he’s actually strong and coordinated enough to help them, by gripping the bedrail and using his arms to pull himself over. 

Marian is still getting him re-settled when the neurologist arrives at the ICU to follow up on the consult ordered. She’s not sure exactly why they want it; the patient’s last head CT wasn’t too concerning and, according to the chart, his mental status has been improving. 

She goes looking for the resident to get some clarification on what they’re worried about before actually going in to see the patient. 

Dr. Matthews sighs when Marian asks about the neuro consult. "Given the...unusual circumstances with this patient, I thought it prudent to have neurology evaluate him for any abnormalities. His apparent telepathic abilities are outside anything I can explain medically. They may detect something unusual during their exam or testing."
Marian nods slowly. As bizarre as this entire situation feels, they have to follow every avenue to determine the cause behind their mysterious patient's condition - in mind as much as body.
The neurologist introduces herself as Dr. Aisha Patel. Marian provides a summary of the patient's status and recovery so far, leaving out mention of his telepathic communication for now. Dr. Patel conducts a full exam, checking pupil response, motor function, and cognition.
When finished, she asks Marian for details regarding his mental status and interactions. Marian hesitates, then decides the truth, however improbable, needs to be shared if they're to properly help him.
"He has communicated telepathically at times," she says. "Though I know how strange that sounds. He seems confused and fearful, with no memory of how he came to be here or even of his own identity. But he's able to understand and respond to questions when he's awake and alert."
Dr. Patel stares at her for a long moment, brows raised. Then she glances at the chart, the medications, and back to the sleeping patient. "Telepathy should be impossible," she says slowly, "yet cases of supposed mind-to-mind communication, precognition and other 'paranormal' events have been reported before. I can detect no neurological cause for his amnesia or current condition. All we can do is continue supportive care, repeat imaging if his status changes...and keep an open mind, I suppose."
Though scarcely believing her own words, Marian finds herself in full agreement. They have tried and failed to find a scientific explanation - yet the proof of their patient's abilities persists. It seems his mysterious circumstances may point to an identity far stranger than any they could have imagined. For now, they will simply continue to aid his recovery, and hope that in regaining strength of body and mind, the truth may at last be revealed.

Lionstar isn't entirely sure what the point is of all the strange requests that the new doctor asks of him, except that it's...meant to gauge whether anything is wrong with his mind? 

He could certainly be a lot more honest with them than he has been so far. He remembers perfectly fine who he is, and the broad strokes of his first life as Adept Kiyamvir Ma'ar. The details are hazy, true, but a dozen or so memories stand out, bright and clear. 

(Urtho's Tower going up like a candle in a fiery conflagration isn't actually one of them. He wasn't there to see it; he was hundreds of miles away. That part of his nightmares is entirely the product of his imagination.) 

But he remembers Urtho's Tower, remembers standing on a high balcony, looking out at the stars above and the lights of the city below.

He doesn't remember his parents' faces, but he remembers his mother's screams as she died bearing her last child. He remembers an infant girl, who hadn't yet been given a name and never would, because the drought was too bad and too many livestock had died during the dry season and Clan Kiyam couldn't feed another mouth, and so the clan chief crushed her skull with a club in a single blow and - she wouldn't have felt any pain, is really all he can tell himself... 

He remembers the men from the mercenary caravan, remembers waking to sour breath and unwelcome touch, and his shields and his magic were barely enough to get away and then he was alone, again, and didn't eat for days. This is a stupid thing to waste one of a handful of precious memories on, he thinks bitterly, it's not like it was especially relevant.  

He remembers learning to Gate, and how much safer he felt as soon as he knew he could choose to leave any situation he didn't want to be in. 

He remembers building his immortality method, a pocket in the Void, outside ordinary space, a hidden sanctuary. It wasn't his first option, but it was apparently the only one magically robust enough to survive the near-destruction of the world. 

He remembers sitting at a desk, exhausted but still hopeful, in the early days of the war. Writing a letter to Urtho, re-iterating how very badly he wanted peace with Tantara, offering talks. He doesn't know how he could have been so naive. 

None of it is something he feels like telling Marian, yet. He trusts her, but...not that far. She would surely be angry with him if she knew what he had done. 

Lionstar seems exhausted again after the neurological examination, and sleeps. He is, in truth, mostly pretending to sleep, because he doesn't want to talk to the not-Healers caring for him right now, not until he has half of a plan. Marian keeps reassuring him that he's safe, here, but he isn't - or if he is, it's contingent on the staff not yet knowing the truth about his past. 

It's the calmest afternoon to date. By 3 pm, Lionstar has been hemodynamically stable off vasopressors for hours, and he's more effectively able to clear his secretions. Marian is going to go ask Dr Matthews if he thinks her patient might possibly be ready for extubation today. He hasn't asked about having the breathing tube out, but he's still on minimal sedation - she wants him to be alert enough to telepathy her - and it's clearly bothering him. 

Marian finds Dr. Matthews reviewing test results at the nurses station. "His vitals have been solid all day," she says. "Oxygen needs are minimal, he's coughing and clearing secretions effectively. Do you think he could be ready for extubation today?"
The resident considers, checking the latest stats and exam findings in the chart. "His condition has improved remarkably," he says. "As long as he remains stable, extubation does seem appropriate to trial this afternoon. Have respiratory on standby in case he shows any distress after tube removal, but if he tolerates it well, this would be a big step forward."
Marian smiles, relieved, and heads to prepare her patient. When he awakens, she takes his hand, speaking gently. :The doctor has approved removing your breathing tube. I wanted to let you know before taking any action. Do you feel ready to breathe on your own?:
His eyes widen, and she senses his flash of anxiety at the thought. Then determination sets in, and he gives a short nod.
:I will be here monitoring you closely,: she assures him. :Just remain as calm as possible. Deep, steady breaths.:
The respiratory therapist arrives to suction the tube and remove it slowly while Dr. Matthews stands by. At first, Lionstar coughs and struggles to find his breath, panic threatening to rise, but Marian keeps her gaze locked with his, projecting reassurance.
:Breathe with me,: she says. :In...and out. Slow and steady. You're doing fine.:
Gradually his breathing evens out, the panic subsiding. His throat will be sore for some time, but he's breathing independently at last. Marian smiles down at him, giving his hand a proud squeeze.
:Well done,: she says. :Rest your throat - don't try to speak just yet. But the tube is out, and you're handling breathing on your own beautifully.:
Exhausted but relieved, Lionstar manages a hint of a smile in return. Extubation is behind them, and his condition continues to improve step by small step. Marian knows the road ahead remains long, but in this moment, she allows herself to feel simply grateful for another victory won - and the privilege of walking beside him on the journey home.

Medically speaking, her patient is doing really well. Marian keeps him on the humidified oxygen mask for probably longer than he strictly needs it, to provide a gentler transition, but by 5 pm she's weaned him to nasal prongs at 4L per minute. The respiratory therapist is keeping a close eye on him, but he's cooperative with the deep breathing and coughing exercises, and a nebulized bronchodilator treatment deals with one brief episode of shortness of breath and wheezing after she repositions him and the exertion proves a bit too much. His blood pressure is a gorgeous 125/70. His extremities are puffy with tissue edema, from all the fluids he got during the worst of the sepsis, but his kidney function lab tests look great; she's wondering if he might benefit from a single dose of a diuretic, just to help him pee out some of that excess fluid sooner. She certainly wouldn't be delighted about having balloons for feet. 

They're still giving him painkillers, since with the cracked ribs it would be really mean not to, but once he was extubated Dr Matthews transitioned him to oral hydromorphone - or, well, crushed and splooged down his nasogastric tube. They had the tube hooked to the wall suction for a day, to handle his vomiting, but it's been clamped for a couple of days now and he's not complaining of nausea. 

He's even able to swallow a couple of ice chips without any disasters. They're not going to start him eating right away, given how much trouble he had with just tube feeds, and she's getting a little antsy about the fact that he's now gone four days without a bowel movement, despite mild stool softeners, and gives her a blank look when she asks if he's passing gas.

Still, physically speaking he's recovering just about as well as she could possibly ask. 

...She is nonetheless starting to get pretty worried about him. 

He seems very withdrawn, moreso than when he was first telepathically communicating with her this morning. He's probably exhausted, it's been a big day for him, but - she has a suspicion it's not just that. He's still having frequent nightmares, and waking up disoriented and in distress. She can usually calm him down quickly, but she has a feeling he's using a lot of self-discipline to force himself to stay calm, rather than, well, actually feeling safe here. There's sometimes a disturbingly haunted look in his eyes, so much older than his years. 

What happened to this kid? Marian doesn't know, yet, but she suspects it's something. 

She should...talk to him about how he's feeling, honestly, but it sounds unbearably awkward and Marian does not feel incredibly qualified for that conversation. 

At 5:30, when she's properly caught up on all of her charting and has started his scheduled antibiotic, she tracks down the resident again. She wants to ask about the diuretic and about giving him some stool softeners - and then, shyly, mentions her concerns about his emotional state.