Marian has been PACING and consuming a dubious blend of one (1) coffee sachet in half a cup of hot water and half a cup of Resource 2.0 meal replacement liquid. (She made Dr Sharma a normal coffee ten minutes ago and earned an actual smile.) She's now noticeably jittery, but at least her brain feels less like glue mixed with sand. She can go find Vanessa, again, and they'll head off. 

The OR room looks slightly as though a tornado hit it, though the accumulated detritus - kind of a lot of it is bloody gauze - is mostly piled out of the way on a bunch of steel tray tables shoved against the opposite wall, and an enormous wadded-up bloodstained blue pile of sterile field coverings on the floor in the corner. 

Lionstar is still flat on the operating table. His legs are partly covered, with a flannel blanket tucked under the straps securing him, but his torso is entirely bare, which might have something to do with the temperature reading on their monitor now being back down to 34.6 C. His heart rate nonetheless is up at 105 – probably because, when Marian glances over, the atropine drip is now at 18 mg/h and he's also on dopamine again. His blood pressure is actually significantly better than the "systolic in the 60s" quote that Marian had been stressing about, but 84/49 isn't, like, good. His sats are at 86%, despite the fact that the anesthesiologist is forcefully bagging him on 100% oxygen and looking like he's extremely tired of this job. 

There's an entire new IV pole, with the pump running midazolam - well, barely running it, the dose is set to 1 mg/h - and apparently dextrose 5% in normal saline at 200 ml/h, so maybe his sugars were dropping again - and a lockboxed bag of fentanyl running at 75 mcg/h. Those are running in one of the peripheral IVs; the profusion of other IV infusions are all running into various lumens of his new triple-lumen central line. That pole also holds several deflated empty blood bags, so apparently those did end up being necessary. 

The wound vac dressing is absolutely gorgeously done under its occlusive transparent film dressing, which isn't even wrinkled. It's also alarmingly extensive; the gritty-textured charcoal-grey sponge used to pack the wound is nearly three inches wide at its widest point, and probably 18 inches long, the upper edge of it nearly touching the defib pads now stuck to his chest. There are actually two vacuum hose attachments and negative pressure machines, one on each side. The drainage chambers hold bloody serous fluid, but at least it looks...normal...and not horrific? 

...He looks surprisingly okay? Is Marian's first thought. His vital signs are crappy and he's on way more drugs than before, but flat on an OR table is probably pretty terrible positioning for his lungs, and - when she actually looks at him, she's...not filled with a feeling of doom? 

(Vanessa slips in to take over breathing for Lionstar. The anesthesiologist looks relieved.) 

"Marian. Hope you had a nap and you're ready to go, because it's go time. Let's get this guy transferred to the bed and nobody jinx it, okay?" 

What are "naps"? Come to think of it what are ""breaks"" that's a fake concept Marian does, actually, feel pretty ready to go. She can help wrestle the ICU bed parallel with the OR table. They have, like, eight people here, if the surgeon and anesthesiologist are willing to chip in. Hopefully they can slide Lionstar over without jostling him too much and while holding all of his way too many tubes steady? 

They can do that! He's going to go into rapid ventricular tachycardia anyway! 

...For, like, eight seconds. Which is more than long enough to make Marian feel like she's at risk of some sort of cardiac arrhythmia, but Dr Sita holds up a finger when Dr Sharma goes in to hit the 'charge' button on the defibrillator, and in fact Lionstar snaps out of it on his own before there would have been time to do anything. His blood pressure doesn't even entirely drop off, the scale has to recalibrate itself but there are still at least little pulse-waveform bumps there. 

"See, it's fine," Dr Sita says. Very tiredly. "Print a strip and let's move. ...We really need to get this guy off dopamine, I'm not at all sure it's worth the headache." 

The anesthesiologist taps the monitor and hands Dr Sharma a long printed-off tape of the relevant 15-second period of ECG reading. She steers an IV pole one-handed while looking at it. "...Thirty-seven beats. Are we, uh, doing anything -?" 

"Hell no I am not giving this man any more anti-arrhythmics right now. We'll take the defib in the elevator." He makes brief eye contact with the charge nurse. "I promise someone will bring it back up when we're done with it. - Marian, c'mon, if we wait for these losers we'll be waiting all day. I can give you a perfectly good report when we're at home base. Let's go." 

Wow. Okay then. Dr Sita is having a bad day. ...Night, whatever. Marian had not up until this point been sure if it was possible to rattle him, let alone how it would manifest. 

They go. 

Whereupon their patient does not code in the elevator! 

Lionstar actually seems noticeably better in the bed, with the head slightly raised to support his head and shoulders at a gentle 20 degree angle or so; even over the course of the elevator ride, with Vanessa bagging him on a travel oxygen cylinder, his O2 saturation noticeably improves. He up to 89% when they reach the ICU room. 

Tsashi is too keyed up to sleep, and the approach isn't exactly quiet. She leaps up as they pull the glass doors fully open to slide the bed back into the room. 

Marian holds up a hand in what she hopes is a reassuring gesture, and smiles, hopefully-reassuringly. They get Lionstar back on the ICU monitor. Dr Sharma runs off to obtain one of the ICU defibrillators so they can return the OR equipment as promised. 

She darts around plugging equipment back in. There are so many things to plug in. The head of the bed is super crowded but she doesn't really want to try to consolidate the IV pumps onto two poles, then they would just be even more dangerously top-heavy and a pain to move. Maybe past this point they can get away with just never leaving this room again? 

Dr Sita hovers while Vanessa transfers Lionstar over to the ventilator and messes with settings until he's at least getting decent breath volumes (his sats are still 88% but they'll probably come up over time?) 

...Then he heaves himself, with an enormous groan, to sit on the counter next to the sink. "Well. I did promise you a report, but - give me a moment. That was the most cursed debridement I've ever had the misfortune to witness." 

....At the word "cursed", Marian's eyes involuntarily fly to the bedside table, which is currently (for once) bare and clean, save for Sashy's high-effort pen and paper drawing of the INCREDIBLY CURSED DEMON GOAT. 

Dr Sita raises his eyebrows, following her gaze. "- All right, spill. What is it." 

Marian is going to DIE she is DEAD she is never ever getting over this shift. 

...She picks up the picture and hands it to him. "This is, uh, what the kid drew." DYING. "...Of what she's claiming happened to him, I did, uh, clarify that. I mimed asking what caused the injury and she pointed at, uh." Gesture at the horns. "...Um. Yeah."  

"Well. Huh." Dr Sita puts it down on the countertop beside him. "Ready for a run-down?" 

Hngggggg. "Yeah." 

"Right. Well, we removed - I think it came to over 700 grams of necrotic and damaged tissue. Fair warning, the wound tunnels - Norbin tried not to remove any more skin than he had to, but whatever got him was really eating through the subcutaneous fat. Not that it'll affect you tonight, we're not touching the dressing for at least 24 hours and Dr Norbin wants to be there for the first dressing change. Bleeding hasn't been too bad since we packed it, but it's pretty raw in there, we were in a hurry." 

He sniffs delicately. "Words cannot describe what it smelled like and I'm not going to try. We had to take out some of the connective tissue sheath and underlying muscle, you'll want to be real careful moving him. Estimated 1700ml blood loss but it could be more - he got two units up there, I've put in for repeat hematology at 6 am but don't wait that long if you start seeing heavy bloody drainage in the vac, 'kay? ...Obviously call me immediately if the drainage starts looking or smelling suspicious again, not that I know what we'd do about it. He won't survive another OR trip. Specimens went for pathology, obviously - fortunately for us there was a lot of specimen to work with, we sent some to the General and Dr Norbin is going to bother some specialist research labs in the am, see if they'll bite for a medical mystery. I'm not incredibly hopeful that we'll have answers in time to make a difference for his treatment plan, but, you know. No one likes spectacularly disturbing mysteries. ...We tolerated some utterly shit vital signs over there, so keep an eye on his urine output, I wouldn't be surprised if we shocked his kidneys. Probably wasn't great for his brain, either, but there's not a lot we can do about that now. Try to minimize stimulation for a while, keep the lights off and leave him be. You can go up to 150 on the fentanyl if you think he's in a lot of pain, but really do try not to go higher than 3 mg/h on the midazolam, I'm suspicious he's got some kind of neurotoxicity-related autonomic dysfunction going on and it hits him badly. Okay?" 

That was somehow both way the fuck too much information at once, and doesn't even feel like it answered all of Marian's questions. "...Uh, Dr Sharma said he went into V-tach a couple of times?" 

"He sure did. It took three shocks to bring him out of it the first time - I think they put down 7 minutes for the code duration, he was in PEA for a while even after we got a sane rhythm back. We pushed amiodarone and magnesium, which in hindsight are probably a lot of what tanked his BP, though I'm not sure it was the wrong call, I think it let us run a higher rate of atropine. Though we still didn't get away with a 20mg bolus dose - gave that 'cause his sats were persistently in the 60s and we were desperate, and it just pushed him into V-tach again. Though at least one shock snapped him out of it that time. A few more episodes non-sustained, you know, just for extra fun." 

He shrugs. "The low potassium is really screwing him over. Figure we were barely keeping up with losses, Dr Norbin had the idea of sticking a urinalysis strip in the wound exudate and he was losing electrolytes out that hole on top of all the other holes. Gastric drainage is down, finally, and he hasn't had any more liquid stool, so maybe now we'll start to make some headway. There's a bag of k-phos to hang once the potassium chloride that's running right now is done, do that next over 2h and we'll reassess lytes on the 6 am labs and decide how many more bags to order." 

Wow shit okay Marian had not been picturing a SEVEN MINUTE CODE based on Dr Sharma recounting earlier. Does the OR just...not call those over the intercom at all...? Maybe they thought they had enough personnel on hand already? Anyway, it's really pointless to freak out about it now, an hour later. Her brain should quit that. 

"Uh, I saw we're running D5 now - low sugars again?" 

Nod. "The medical mystery deepens, I have no idea what toxic agent causes recurrent hypoglycemia on top of everything else we're seeing. Keep checking it hourly till shift change - we're aiming for above 85, when he drops he drops fast and I'm more comfortable if he has some wiggle room there. - oh, before I forget to mention, we're on broad-spectrum antibiotics now. I think it was some kind of toxin in the wound, not an infectious agent, but we don't have pathology back yet and I'd rather not take chances. He's pretty at-risk anyway, what with his lungs and the gaping open wound. Won't be on your shift, we gave pip-taz in the OR, but make sure that's in the shift report." 

...Nod. "I, uh, think that's everything - I'll come find you if I have questions...?" Marian is going to READ THE CHART, including the paper OR flowchart, and hopefully take it in better that way.