It's occurring to Tsashi that, just like she hasn't really understood a lot of why things are happening because they can't talk to her, the Healers don't actually know all of what happened to Lionstar, because Tsashi could only "tell" them what she could act out. And she didn't have a horn from the Changecreature to show them, like how Merr-rayn has been picking out things in the room to make her pictures clearer to follow.

She thinks they know Lionstar was attacked – and they know his wound is poisoned, because anyone with eyes would know that – but they definitely didn't know right away that it was the kind of poisoned where just cleaning it and bandaging it wouldn't be enough and it would fester. (To be fair, Tsashi didn't know that either, it's just that in hindsight it wasn't surprising.) And...this is somehow a thought she didn't have before, but it feels like it would follow...they might not know very much about Changecreatures? If they're far enough away that none of their towns were destroyed in the Cataclysm and magic still works fine, they probably don't have problems with Changecreatures. 

....She hesitates, then reaches for the writing-implement that Merr-rayn is holding, stopping short of touching it but making a questioning face. 

NO that's HER pen Sashy cannot just have it ....of course Sashy can borrow the pen, and Marian will flip over the second sheet of paper to the blank side.

Tsashi draws a couple of tiny spirals to make sure she knows how to control the drawing-implement, and then - hmm, she needs to think, how to show the scene so that it's clear at all, at least with some acting-it-out, but without anything to use as a prop... 

Well, if Sashy is going to need a lot of time to think about her drawing, Marian is awfully curious but she's not going to hover, she should really pay some attention to her actual patient. 

 Lionstar is, for the moment, looking surprisingly stable, for someone suffering from what looks like at least two forms of horrifying toxicity! His vital signs are finally recovering from the dual perturbations of the seizure and the drugs they threw at him to stop it; his heart rate is back in the 80s, sats at 98%. His blood pressure is a decent-looking 103/48, though this is perhaps less reassuring after Marian notes that the norepinephrine infusion is maxed out. His temperature is up to 35.5 C, though, the warmest he's been to date, probably still a little cooler than his baseline but not even technically hypothermic. 

Mrrrrrrghhhh his BP is clearly sensitive to the midazolam, 7 mg is pretty big for a bolus dose but it's not that huge and it was a while ago. Maybe the magnesium is contributing, actually? It should be good for his heart, and even be somewhat protective against arrhythmias from the low potassium that takes longer to correct, but magnesium tends to lower blood pressure rather than raise it, Marian thinks by causing some vasodilation? So maybe it makes sense that with that plus the midazolam, plus maybe some systemic inflammation starting - she now has a suspicion the slightly raised white count was more to do with his horrifying wound than his lungs, and could be getting worse fast - he's needing a lot of norepinephrine to counteract it. It's not great, sending him to the OR already maxed on one pressor, but at least it's only one. For now. 

...Anyway. It's now 2:55 am. Hopefully the OR will actually be ready for him soon? 

Well, right this second it looks like Louis-Philipe and Nellie are cleaning up more diarrhea! Someone also just hung another 1L bolus and a 50ml bottle of the more concentrated 25% albumin. There's a fresh bag of potassium running and two more fat little bags hooked behind it on the IV pole. 

Arghhhhhhhhhh and Marian is pretty sure that's only the second 10 mEQ bag of potassium they're running. Which means Marian did not at ALL make optimal use of the last...2.5? 3ish? hours. She's pretty sure she started the IV potassium closer to midnight than 1 am, but she had only put in the one bag as a verbal order, meaning to clarify with Dr Sharma once the repeat lytes were back, and then somehow that didn't happen, and if the pump beeped to announce its completion she totally missed it, and then it feels like more or less the entire hour between 2 and 3 am vanished into the ether. And now he's probably just lost even more potassium in bodily fluids and, in short, aaaaaaaaaaaah. 

...not helpful to stand here beating herself up over not being perfectly organized tonight, even if this one does feel like a pretty seriously bad oversight and she abruptly sort of wants to cry again. She'll put on gloves and help them turn Lionstar to get him on clean bedding. 

He's doing the thing again where his heart rate and blood pressure drop when they move him. Other than that, the process goes fine. 

Marian does NOT LIKE THAT but it's not exactly conveying any new information, and his BP does stabilize fairly promptly once they have him on his back again. 

(They never did end up turning him on his side, she's realizing. Oh well. Bedsores are currently not her top priority.) 

Dr Sita is on the phone at the nursing station, but comes back to the room thirty seconds later. 

"OR is ready for him if we can transport him. Dr Norbin wants us replacing his phos, I'll put in an order and we can get that hung and then take him." He scowls slightly. "And anesthesia wants central venous access, but I understand why Navya wasn't comfy placing one with his lytes and hemodynamics looking the way they were. I'll plan on placing one over there." 

Oh no a road trip. It's very much the case that Marian has superstitious anxiety feelings about transporting unstable patients anywhere outside the ICU. The OR isn't actually on the first floor of the hospital, either, they'll need to go in an ELEVATOR and elevators are, according to Marian's emotions at least, particularly cursed. She wants an emotional support syringe of atropine in her pocket for it. 

She can prep a bag of sodium phosphate first, though.

Dr Sharma tracks down Vanessa the RT again, who brings a transport oxygen cylinder and seems inclined to just leave the ventilator behind and have Lionstar attached to the ambu bag instead. With two top-heavy IV poles laden with Christmas trees of pumps, there's already kind of a lot of Stuff to wrestle in and out of the elevator. 

They go. 

Sashy watches them leave. She - actually mostly looks calm, with that uncannily adult expression, but Marian is imagining that she's scared. She kind of wants to give the kid a hug but that continues to be weird. 

She goes with the procession. 

(aaaaaaaaaaaaaaaaaaaaaaah) 

It goes more or less fine! Lionstar maintains an acceptable blood pressure even through being jostled a bit. His sats are actually better by the time they reach the OR. 

The OR charge nurse would like a report on the patient. 

Nope, impossible, unfair demand, 3 am is not a time for reports Marian can repeat more or less what she told Dr Sita when he arrived on the unit, and then spend longer on recounting what IVs and other tubes and lines the patient has, where, and exactly what drugs and doses he's currently getting. (The half-full IV bag of dopamine is still hanging behind the norepinephrine, which aaaaah Marian is only now noticing is nearly empty and she's preeeetty sure she's being Silently Judged about that.) 

She gets through it without saying anything incredibly stupid. ...She thinks. Hopefully. Can she go now

The OR staff will take it from here! They'll give the ICU a call when they're wrapping up. They're not really sure when to expect that to be, it could be forty-five minutes for a fairly straightforward wound debridement and cleanup but this does not exactly promise to be straightforward. 

And, of course, leaving the room is immediately very nervewracking! That's HER PATIENT and Marian is STRESSED about not having her eyes on him! Aughhh!!! 

...She has another patient, who she hasn't laid eyes on in like two hours, and now is honestly the only time window she'll realistically have to catch up. She goes back to the ICU. 

Tsashi is still bent over the bedside table in the now-empty room, intently focused on drawing. 

Marian feels like she should go check in with her, but it also feels like there lies the path of never managing to actually see the lady in 201. Sashy does not currently look distressed or anything and probably it can wait. 

She logs into the computer workstation to remind herself of what's even on her todo list, and then heads to the med room to prep her handful of 4 am meds early. 

201 is stable and has clearly slept through the last several hours with no inkling that she was being slightly neglected in favor of the patient next door. It's still too early for 6 am meds but Marian could get ahead on turning her? 

Nellie is happy to help turn her - and even do a quick bath - in exchange for Marian's help with a dressing change for her abdo surgery patient. 

Theeeeeere is not actually a good reason to feel doomy about committing to half an hour of tasks, when Lionstar's procedure is almost certainly going to take at least 45 minutes and possibly a lot longer, and if the OR needs her they'll call. Marian still feels very antsy about it, but it's stupid to waste the next hour hovering near a phone. She'll work with Nellie to bathe 201 and then rendezvous with her at 192 with a basinful of collected dressing supplies. 

The OR doesn't call. It's nearly 3:45 by the time they finish. 

Chantal is at the nursing station, watching the bank of monitors and charting with her feet up on a second office chair. "Marian! Your patient's kid in 202 is such a sweetie. And a budding little artist! She came to show all of us this incredible fantasy scene she drew. We're trying to figure out if it's from a movie." 

Blink. "She...what?" That was definitely not what Marian thought Sashy was going for!