Aaaaaahhhh???!!! That's so awful. This is going to mean an awful prolonged recovery even if the woman somehow survives, which...it's starting to look like she has a chance of? 

Also her patient is leaking gross stuff out of the chinks in her armor. Marian is not that squeamish about anything other than lung secretions and saliva, but 'gooey bloody pus oozing from an unseen source' is apparently enough to gross her the fuck out. 

Marian gets the patient to the ICU and transferred into the bed without making anything too much worse, at least. She's mildly irritated with the ER staff for about thirty seconds over the part where they didn't place a catheter and she, one, desperately wants to monitor urine output closely on someone losing that much fluid through their lack of skin, and two, does not want her peeing on her exposed burns. She remembers thirty seconds later that obviously this is literally impossible while the woman is in freaking plate armor still covering nearly all of her body. 

Her fingers are remarkably not very swollen yet but that's not going to last, they've already dumped three liters of IV fluids into her. Marian will have a go at very gently removing the ring without taking any flesh off with it, and then will have a go at the weird headband and jewelry. All of them can go in a labeled baggie for safekeeping. 

The cloak is completely disgusting, having been subject to blood and oozing through the armor, but it's also really cool and - probably an important possession to the woman? Maybe they can, like, wash it. Marian gets it extricated from the patient and wads it up on the counter, in case she manages to find time later to attempt to wash it out in the sink. 

...Vital signs still hanging in there? 

- a little less so, actually. Her heart rate creeps up, and her blood pressure's now going up and down. 

She still seems to not be actively dying, though.

Well, she's losing a ton of fluids constantly, they're running maintenance fluids at 200 cc/h but it's not incredibly surprising that it's hard to stay on top of it. Marian bugs the resident and gets an order for another bolus of Lactated Ringer's, and the blood products from the lab should be here soon, they're hurrying but the patient apparently has a somewhat rare weird blood type and that's delaying things. They can get fresh frozen plasma, though, and run some albumin, both of which will do a better job at retaining fluids inside her circulatory system where they belong. 

The ICU doctor wants to do a bronchoscopy. With sedation; the woman has been unconscious without any sedation, but she's still coughing a lot, and occasionally twitches in response to especially painful stimuli. And this bronch is going to be particularly agonizing, her lungs must be incredibly raw. 

Marian preps the bronchoscopy kit and obtains propofol and fentanyl. The doctor asks her to give 100mg of propofol - apparently that's what the woman got for intubation, and it wasn't even really enough - and 50 mcg of fentanyl. 

Is that enough to settle her down? Marian is also watching her vital signs like a hawk, of course. 

Would that be sufficient for an elephant? 

Because, if not, no. 

(Her vital signs are fine.)

Well, her blood pressure doesn't seem to have even noticed it, so, uh, should Marian give her more? 

...Another 10 mg of propofol and 100 mcg of fentanyl doesn't do it either. Though it also doesn't touch the woman's vital signs, so, uh, possibly at some point they should just conclude that propofol literally doesn't work on her, but they could probably try more...? 

Five minutes later, a whopping total of 500mg of propofol and 400 mcg of fentanyl have...still...not...noticeably sedated the woman. Or, uh, appeared to affect her in any way. ...The fentanyl may have done more than literally nothing, it's not dramatic but according to Marian's vague gut sense the woman seems slightly more relaxed, and her heart rate has maybe evened out a tiny bit, as though she's getting an amount of pain relief from it that you would expect from a standard 25 mcg dose. But she is not coughing any less in response to suctioning. 

Marian is getting...sort of antsy about this. "Uh. I think maybe propofol literally doesn't work on her? I'm - sort of scared to just keep giving her more." Also her vial of propofol is now empty and she would have to go pull another one and is not, actually, sure you can override the Pyxis to give a dose that large. "Can we...uh, try midazolam, maybe that does more?" 

...It does not, it turns out, do more, at least not in a generous-side-of-normal 5 mg starting dose. Buuuuuut Marian is slightly less terrified to just give more, in this case, she's had patients who were on 20mg/h for ongoing sedation and still getting boluses. 

The doctor is now getting antsy too, but - they do need to figure out something that works for procedural sedation, because after this they're taking her to the OR for a much worse painful procedure. He....will consult anesthesia, how about that. Can they come, like, now. 

The anesthesiologist is also really baffled but less nervous about Injecting More Drugs. Being in a lot of pain makes patients harder to sedate even when they're unconscious, and the woman looks like she's well over 200 lbs of solid muscle, and that still doesn't make it normal to shrug off ten times the usual induction dose of propofol but sometimes bodies are weird. Midazolam is better for this anyway, it has a long enough half-life that Marian can keep slowly pushing more of it and not have to worry about the earlier doses already wearing off. If the patient's vital signs are stable then he's not going to worry about it until they hit, like, fifty mg of midazolam. 

...Uh. Marian does not really want to sit here for the next twenty-five minutes pushing syringes of midazolam at a rate of 2 mg/minute. Can she either push it in faster or maybe, like, get a bag for continuous IV administration and run it at...uh she is totally capable of mental math...120 ml/hour until they notice it taking effect? 

...Yeah no that rule is fake. She can push 10 mg at once and then wait a couple minutes and poke the patient and try again if necessary if she's still not out. And might as well alternate it with fentanyl. She can give 50 mcg at once after each successive dose of midaz. 

Anesthesiologists are kind of a way. 

Marian....will do that? Quietly internally screaming the whole time, but the thought of doing a bronch on the poor lady without adequate sedation also kind of makes her scream internally, soooooooo hopefully they can pull this off safely. Aaaaaaaaaaaaaah. 

Ten minutes later she has administered an entire 50 mg of midazolam and another 250 mcg of fentanyl. On top of the propofol which is probably still in her system at all. Iiiiiiiiiiiis that doing anything. 

....looks like it's working the way you might expect a fairly small dose to work? Her heart rate is a bit slower. 

Also, she's doing notably better. Oozing a bit less, and the fever which must have been caused by the being cooked alive has started come down but while you'd expect horrendous temperature regulation problems and eventually hypothermia from a burn victim she's just crept down from 103 to 100 and stayed there. The only thing that's harder to manage than when she arrived is her hydration. 

Marian is....really confused...but also very happy about this! Go mystery patient! You're doing great!!!

...She will un-icepack her, it does not seem like she needs further help cooling down right this second. The ridiculous armor is now cool to the touch, at least. 

The anesthesiologist wants a tox screen sent, his new top theory is that she's on a fuckton of cocaine or something in addition to the being boiled alive or whatever. ...It's not a very good theory, you would really expect to see other signs of it, but it's what he's got.

Aaaand they should probably just go ahead and bronch her, even he isn't comfortable going higher than 50 mg of midazolam when the amount already in her is going to take ages to clear her system. ...On reflection, Marian can push up to another 500 mg of propofol during the procedure, though, if she's coughing or her vital signs look like she's feeling it. Causing someone a lot of pain will partly cancel out the side effects of decreased heart rate and blood pressure, and it'll wear off by the time they finish up. 

....Okay. Marian is not delighted about this but she'll go override the Pyxis to pull another 50ml vial of propofol. Is the woman secretly an elephant under that armor or something. This is surreal. She's also kind of dreading what the woman's lungs are actually going to look like on the bronch screen, aaah. 

Horrifying!!!! She inhaled steam for much, much longer than a normal person could survive inhaling steam. Then she drowned. Then they started suctioning her lungs. Most of her delicate lung tissue is shredded and floating in clumps. It's kind of incredible she's getting sufficient oxygen out of the few parts of her lungs that look relatively less damaged. 

She does seem to be in considerable pain, even with the light sedation. She twitches and her heart rate and blood pressure both pick up. (If Marian lets them they'll go straight to 'intense exercise' range. That's usually the correct response to being in intense pain.)

Eeeeesh. That's the worst bronch Marian has seen in her entire life and does not look incredibly survivable. Also patients being visibly in pain is really upsetting!!!! ....If the anesthesiologist is sure, and it's still not tanking her blood pressure, Marian will in fact just keep pulling up syringes of propofol and giving them until she's run out again, while the doctor attempts to cautiously wash out her lower airways with saline and suction out the goo and floating chunks of tissue. (Marian is NOT LOOKING at what's coming out in the suction tubing.) She's also keeping a close eye on the woman's O2 saturation reading, because while she was somewhat miraculously managing okay before, they are now doing a lot of stuff to her lungs. 

She's doing a little worse, which is to say an O2 saturation of 90. 

With more sedation her heart rate slows a little and her blood pressure falls back from 'intense exercise' to 'normal human range' and the oxygen dips a bit more, to 85. She's...kind of still twitching? But less so? The hand they freed from her gauntlet flexes like she's trying to grab a hold of something, but it's too clumsy and too injured to actually do it. 

Marian is SO UNHAPPY right now. She would kind of like the doctor to hurry up and finish because the patient's oxygenation is not coping, but she's also worried that if they stop torturing her then her blood pressure will drop even further. Aaaaaaaah. ...She's also going to gently hold down the woman's hand, in case she wakes up slightly more and attempts to go after her tubes. 

- okay they are done, and have at the very least gotten most of the loose tissue and fluid out of her lungs. The doctor pulls out the bronchoscope and the anesthesiologist is going to spend a little bit bagging her with 100% oxygen before putting her back on the ventilator. 

Oxygen bounces back somewhat as soon as they stop messing around in her lungs. Her blood pressure does not drop when they stop torturing her; it, and her heart rate, actually seem to be trying to battle their way back up to 'person doing intense exercise', though with only limited success until the sedation starts wearing off. (Which it does. Surprisingly fast.)

That's, uh, not ideal. Though she probably is in horrifying pain even at rest. It cannot possible be comfortable lying there with raw burned-off flesh pressed right up against metal armor over most of her body. They should, uh, really do stuff about that, probably. ...And maybe she additionally needs more fluids. The blood products are finally here, so Marian will check them with another nurse and then hang a unit of packed red blood cells and run another saline bolus, and then they can consider going to the OR. Marian isn't actually OR-trained and would not normally accompany a patient there but the trauma surgeon apparently wants her to this time. (Aaaaaaaaaaah. She is scared of trauma surgeons.) 

...Patient looks closer to awake. Marian is pretty sure she can't open her eyes even if she wanted to, they're kind of melted shut (aaaaaaaah!) but she places her fingers against the palm of the woman's bandaged hand. "Hey. You're in the hospital, you were badly burned, but you're going to be okay. Can you squeeze my hand?" 

She reflexively tries to grab the sword. It's not a sword but that won't stop her.

Yikes yikes yikes she's really strong!!!! And fast!!!! Marian's arm is now grabbed and ow. 

Marian manages not to yell in startled pain. She clears her throat. "Can we, uh. Sedate her more. Maybe." 

Yep the anesthesiologist will go yoink out a 100 ml bag of midazolam and hook it up to run at...hmm 5mg/minute does not seem insane for this particular patient, though it does mean they'll run through the entire bag in 20 minutes and should have a backup right there. And he'll push enough propofol to get her to let go of the poor nurse, assuming 'enough' is less than another 500 mg and doesn't tank her blood pressure first, and then they can rush over to the OR? 

Her blood pressure remains stable even under ludicrous amounts of sedatives and she lets go of the nurse.

Yeah okay they are just going to keep running the midazolam at an absurd rate, then, and maybe also hang a bag of fentanyl and run that at...hmm, 50 mcg every two minutes seems to do something, so that's...1500 mg/hour, which is insane and requires not using the standard IV pump programming because it does not let you go that high. And hopefully that plus propofol on hand for pushes will let them keep her anesthetized enough to get through what promises to be an extremely horrifying procedure. 

They'll hurry her to the OR, which is fortunately just down the hall, and then...do some strategizing about the best way to remove armor when what's left of the woman's skin is kind of welded to it. 

Marian is going to NOT LOOK at the armor-removing. She will just stand here watching the monitor instead, which is only a normal kind of upsetting, with five 10cc syringes of propofol pulled up and ready on the table beside her for when they almost-inevitably need EVEN MORE DRUGS than the absurd doses of drugs running in the IV pumps, and she'll keep checking and hanging new bags of IV fluids and blood whenever one is empty. And giving drugs if the woman's heart rate and blood pressure start spiking, since that seems to be very shortly followed by IMPOSSIBLY STRONG GRABBING. 

The surgeon will first attempt to saw through all the leather connecting bits, and then irrigate under the armor with a lot of warmed saline to try to get it slightly unstuck before they peel it off. There's going to be bloody water all over the floor but hopefully this gets the armor loosened enough to come off without literally ripping chunks of flesh along with it? 

It actually lifts off relatively cleanly, partially because there's another layer under there. Under it she's wearing the remains of the armor harness, an elaborately embroidered shirt which is covered in blood and pus, and a thick belt made of some kind of soft high-end leather, laced through with what looks like some kind of metal stitching or threading.