Louis-Philipe seems to be collecting supplies for his own patient's dressing change, and steps out of her way. "Something going on?" 

Marian does not really feel like she has time to explain. "Yeah, kinda." She grabs a roll of paper tape - and sterile gloves and one of the dressing-change kits that comes with a sterile thingy to put saline in, Nellie didn't ask but it's probably not a bad idea - and is out the door again. 

Nellie, tongue between her teeth, is carefully trying to peel away the remainder of the adhesive holding the old dressing in place. "Mmm, thanks. ...Marian, chill, he's not actually any more unstable than he was ten minutes ago." 

Marian is NOT ACTUALLY SURE that logic particularly holds!! Ten minutes ago she thought they had, like, identified and more or less dealt with all of Lionstar's problems? And that the rest of the shift, and probably his next few days, would just be a grind of supportive care and juggling the atropine dosage while they waited for the poison to clear his system. And now it looks like there's something ELSE wrong with him that is PROBABLY NOT EXPLAINED by "he ate some pesticides" (whether accidentally or deliberately) and she has a bad feeling that the suddenly-elevated white count isn't his lungs brewing something after all, and might be getting worse even as they speak and it'll take, like, at least half an hour to actually get him to the OR and get rid of the horrifying damaged tissue before it gets worse... 

- she should probably chill anyway. At least half of her reaction is probably because she just consumed some extra-concentrated caffeine, and if she looks freaked out she's going to freak out the kid and no one needs that. She takes some deep breaths, and dumps everything she's holding on the bedside table so she can free up her hands to retrieve the fentanyl and syringe from her pocket and pull it up. 

Half a syringe of fentanyl does seem to help a little? Lionstar's resting expression is less tense, and he only winces faintly when Nellie dripples cold sterile saline from the bottle over his stomach. 

...With the blanket off, he's noticeably losing ground on body temperature. He's down to 34.8 C again. 

Poor guy, no wonder he's miserable about having the blanket stolen. (Nellie seems to have turned it off entirely, presumably because it's threatening to blow unsterile air at her dressing-change site.) Marian isn't really sure what to do about it right now – and she's a little worried he'll lose even more ground while he's in the ER, patients notoriously tend to come back from them chilly. 

Some instinct reminds her that she was due to check his blood sugar. It hasn't especially gotten less confusing that he keeps going low, but it would explain some of his difficulty with generating any body heat. 

She caps the leftover-fentanyl syringe, hastily tapes it to the empty ampoule in lieu of labeling it, and hides it in a drawer - it's not great practice to just leave them lying around on surfaces - and then looks for the glucometer. Perhaps unsurprisingly, it looks like one of the other nurses nabbed hers from the room while she was occupied elsewhere. She'll go hunt at the nursing station. 

Nellie is accumulating an entire pile of soiled gauzes, heaping them on a towel to one side of the patient. 

Lionstar makes a face when Marian sticks his finger for the blood sugar. The reading comes back at 73 mg/dL. 

Hmmmm. Normal range, but, like, barely. Marian is on an instinctive level tempted to give him more D50 anyway, just because it sort of feels like he could use it, but that is not actually how the standing order works. She'll...make a note to herself to make sure she includes his persistent low blood sugar problem in her report to the OR nurse. 

...How does her patient look, other than that? 

His heart rate is up a bit, at 111, maybe from discomfort. Blood pressure 104/67 with a MAP of 79; he probably doesn't need the norepinephrine running. He does look like he's quite overdue for suctioning; his sats are at 91%. 

Something about the gestalt of how he looks is leaving Marian uneasy, though it's hard to tell how much of that is because he's still visibly in some pain, or because the horrifying wound is VERY SALIENT. 

...Yeah. 

Suctioning him sounds like it might disrupt what Nellie is doing and Marian can't shake the irrational worry that the exertion of coughing will make his laceration burst open and the monster from Alien will crawl out that is not how anything works, and the wound didn't even penetrate his abdominal wall. 

She pulls down her stethoscope to listen to his lungs first, since she can do that without getting in Nellie's way. 

He actually sounds significantly less tight and wheezy than she remembers! Probably a mix of the atropine helping counteract the bronchospasm, and the fact that Marian hasn't irritated his bronchi by shoving a suction catheter down them in, like, over an hour. (He's also getting decent breath volumes on the ventilator, consistently above 600 ml.) 

He's absolutely full of coarse crackles, though. 

"Okay, you know what, I fucking give up. The surgeon's going to debride all of this anyway. ...Can you grab me, like, six more gauzes from the drawer to pat it dry, I used all of mine." 

Gauzes obtained, Nellie pats the wound dry - it's mostly de-crusted, but already leaking fresh greenish-black pus - and stacks non-adhesive pads over it before layering three of the extra-absorbent abdominal pads over that and stretching a few strips of tape over the whole thing to loosely pin it in place. 

It's so much less scary now that she can't see it Marian is not six and her brain should stop that. "Thank you," she says emphatically. "Uh, I guess he could use a clean gown..." There's still one in the room, fortunately, and then she'll put the Bair Hugger blanket back and switch the machine back on at the highest heat setting. And then she can suction Lionstar's lungs out. 

It's around 2:25 am by the time Dr Sharma trudges back to the room. She looks very tired. "Dr Sita is driving in. He was going to page Dr Norbin for gen surg, but he wants to see the patient first, and be on hand in the OR. It sounds like they'll be ready for him in 45 minutes." 

That's SO LONG what if Lionstar is being EATEN FROM THE INSIDE BY THE MONSTER FROM ALIENMarian's brain can stop that please. "Right. Um. Just a head's up that his sugar is still, like, borderline - I can check it again before they take him. Uh, and it would be neat if they could do something to keep him warm in the OR, he loses body heat really fast without the Bair Hugger." 

"Huh. That's a good thought, people always do come back cold and he's already so fragile. ...Dr Sita wants us to type-and-cross him and have matched blood ready, he doesn't have a lot of wiggle room for more blood loss. And we should try to push his magnesium up, Dr Sita actually wants him above normal range, so let's give him another 2g over half an hour. ...Is he otherwise more or less stable?" 

Lionstar is looking more comfortable with the blanket back in place, though his temperature is still only at 34.9 C. He's entirely off norepinephrine. Heart rate at 98, blood pressure 102/62, sats at 99%. 

"He's oxygenating fine when we leave him alone, but he still needs a lot of suctioning and he desats fast with it," Marian says. "He's still on 100% on the vent but I don't really want to go lower yet, given that. ...Um, I do kind of still feel like he could use something for sedation and pain control? I know we wanted to get an accurate neuro baseline, but if he's about to go under anesthesia in forty-five minutes anyway...I think he's, like, just awake enough to be really uncomfortable..." 

...Nod. "I suppose it's kind of mean to be suctioning him a lot if he's feeling it. Maybe it's not a bad idea to try to get a neuro baseline now and then start him on some midaz and fentanyl? I'm not surprised that wound is painful." 

She goes over to the bed, leans in close. "SIR! CAN YOU PLEASE OPEN YOUR EYES?" 

...Nope, but that's apparently loud enough for him to notice, and make a face about it. 

"I'm sorry about this," Dr Sharma says, and then pulls the top of the Bair Hugger blanket down and rubs her knuckles up and down his sternum, quite hard. 

That gets a reaction! The patient tenses noticeably, breathing out suddenly against the ventilator's rhythm and setting off the alarm. His face scrunches and his eyes actually make it partway open, unfocused. 

"Good! I need you to try to wake up as much as you can, just for a minute - can you squeeze my hand -?" Dr Sharma reaches under the blanket for his hand. ...And, when the patient's eyes instead start to slide shut again, sternum-rubs him again. 

...Something hurts, unexpectedly. Something else is loud and bright. Something is wrong. 

Lionstar can't - really - finish a thought, or even start one, but certain reflexes are very deeply engrained. He reacts instinctively. His instinct is to shield himself with magic. 

...It doesn't work. Something is wrong and bad and there's a blazing burst of some-kind-of-sensation, too intense to be pain, and - notsafeunderattack - Lionstar struggles against it, but it only makes it worse - 

There's an unexpected crackle of...static electricity? 

The patient goes rigid on the bed, at least to the extent he can when most of his muscles are clearly not accepting input right now. His eyes roll back, his breathing abruptly shallow and rapid (the ventilator loudly objects.) His facial muscles seem to be spasming, not in a very purposeful or expressive way.