Marian really enjoys seeing Nellie interact with her patients. It always feels like she's learning something. 

...Aaaand now it's just past 2 am and she's antsy to lay eyes on 202. 

Nothing terrible seems to have happened? His sats are creeping down again, now at 94%, probably because he's long-overdue for suctioning. Heart rate at 101, blood pressure 108/61, temperature finally up to 35.1 C.

Even at rest, his expression maybe looks slightly pained? 

It's taking him kind of a while to warm up all the way, Marian thinks. Maybe just because he has some kind of neuromuscular weakness thing going on and can't shiver effectively? ...Also shit she totally missed the 1:30 am hourly blood sugar check, though at least partly because on the half-hour is a counterintuitive time for Tasks to be due and it's actually convenient to shift that to the top of the hour. She'll make a REALLY VERY LOUD mental note and do it after Nellie leaves to avoid admitting to embarrassment and failure.

She frowns. "I think he might be having some discomfort - he wasn't awake-awake before, at all, but he was making a lot of faces, and he looks kinda..." Wiggly-hand gesture. "Uh, we should probably just turn him and then I'll go try to grab Dr Sharma–" Nellie is wearing an odd expression, "...what?"

"Something smells bad in here." Nellie starts lifting the edge of the Bair Hugger blanket to peer under it. 

Cue a grimacing unhappy patient! 

Also a curled-up twelve-year-old sleepily lifting her rumpled head. The Healers aren't speaking loudly, but there was something in the red-haired woman's voice making Tsashi's hindbrain feel like it's a good time to be fully alert. 

Oh no Marian's lack of a functional sense of smell is embarrassing her again (even if it's often convenient in this job.) "Uh, should I get supplies to clean him up again?" 

"Nnno, it's not stool." Nellie flips the blanket out of the way. "Sorry, hon," she says absently to Lionstar, "I know it's nippy.

 - Marian," she adds in the exact same tone of voice. "I'm assuming his gown wasn't soaked with something gross the last time you looked. How long ago was that?" 

"What? Uh. Not...that long before 1:30? I had to weigh him to start the pralidoxime - what is it -?" 

"I don't know, but I think I want gloves on to touch it." Nellie hurries to grab some from the box in the wall dispenser, then wrinkles her nose as she carefully folds back the patient's gown. 

"...Okay, well, that does look like a problem." 

No, not allowed, no more problems Marian hurries over to look. 

The lower half of the gauze dressing taped diagonally over the patient's torso is now saturated with...something. It's not bloody, or the usual yellow serous drainage; it's a thicker, darker brownish-green. 

That looks pretty alarmingly bad! Tsashi makes a tiny involuntary squeak and then holds very still out of the way. 

"I'm really not looking forward to this," Nellie says, and then peels back the gauze. "...Jesus on a cracker. Wow. What the fuck." 

Someone in the ER did a very hasty staple job, but that's not really the most visually obvious part. The lips of the ten-inch-long wound are swollen and discolored, the flesh purplish-gray and sometimes almost black, and the full length of it is crusty and oozing. Now Marian can smell it. 

Marian resists the horrible pointless urge to retort back with 'I thought the idea was Jesus was the cracker.' Shut up, brain. "I'm, uh, going to get Dr Sharma to come look." 

"Yeah. Do that." 

That does seem like kind of what you would expect after getting gored by a venomous Changecreature but it's stressful that the Healers seem to be so surprised and confused about it!!! Maybe Tsashi didn't manage to convey the part about the Changecreature very well. 

Dr Sharma is, unsurprisingly, at the desk outside 196, watching through the window while catching up on charting. Marian clears her throat. "Sorryit'sanemergency can you come see 202 with me right now please sorry -" 

Dr Sharma doesn't ask, just scrambles up and follows Marian at a brisk speedwalk back to the room. 

...She sucks in her breath. 

"Okay. I don't...know what could've caused - that. I, think I want to call Dr Sita," the ICU attending doctor on for this week, "and - maybe poison control would have ideas? But I don't - think - that organophosphates would cause this even if they were - introduced into the wound..." 

She takes a deep breath. "He needs to go to the OR. It's gotten this bad in - three, four hours? He needs to go soon. I need to - make some phone calls - just keep it clean and covered for now - tell me right away if his vitals change -" 

Marian clears her throat. "Can I give him anything for pain? He's," vague gesture at Lionstar, who still isn't moving much but whose face is scrunched in discomfort. 

Dr Sharma breathes out between her teeth. "I - hmm. I don't want to do too much, if he's going to be going under anesthesia soon, but - you can give 25 of fentanyl, see what that does." 

That will PROBABLY NOT DO MUCH but, fine, Dr Sharma has a point, it's not worth risking tanking his blood pressure or something. "Okay, thanks. - Nellie, I can go pull that and grab dressing supplies if you can do a cosign -?"

"Mmhm. Grab me a buncha the non-adhesive pads, and abdo pads, and - hmm a roll of that gentle-skin tape, if he's headed straight for the OR I'll just pin the corners down. - and a towel and a thing of saline, this thing is gunky -" 

Marian is not normally squeamish about wounds, but this one is kind of horrifying her. Mostly it's the suddenness of it, and the fact that Dr Sharma seemed just as baffled and thrown-off-balance about it as she feels. She's feeling an entirely uncharacteristic relief that dealing with it in the OR is going to be someone else's problem. 

She puts in a verbal order for fentanyl and pulls a 50 mcg ampoule from the Pyxis (they're technically supposed to waste the excess but she's inclined to pull it all up in a syringe and keep it in case 25 mcg does nothing and she can persuade Dr Sharma to let her give him the rest), and then heads for the clean utility and loads up her arms with the requested dressing supplies.