Dr Sita nods sharply and thumps down off the counter. He leaves. 

(He plucks the drawing off the bedside table as he passes it and takes it with him.) 

Oooooooooooookay then. 

...Marian is going to check all her IV pumps and bags (norepinephrine bag is low, potassium bag looks like it'll be done in another 15 minute or so), and make sure the catheter measurement chamber was recently flipped (it was) so she can get a clean measurement for the 5-6 am hour block. And get the Bair Hugger blanket back on her poor patient, whose temp is currently 34.2 C. And smile reassuringly at Sashy a lot. 

Aaaaaand then she'll do as requested, and dim the room lights and slip out into the hall. She can watch Lionstar's vital signs from here. And FRET. 

Lionstar's vital signs are tolerable! Not, like, amazing, but acceptable! Sats at 90%, heart rate at 109, BP at 89/51 with a mean arterial pressure of 64 mmHg. 

Nnnnnot quite enough that she can ease down the dopamine infusion rate yet, but maybe soon? She'll hover nearby for the next couple of minutes until her heart rate calms down a bit, and then go to the med room to VERY QUICKLY prepare a new bag of norepinephrine. And get a head start by prepping the next bag of atropine, they're going through that fast. The pralidoxime should be fine through the end of her shift, but she'll hurriedly log into a computer and put in a pharmacy request for a new bag anyway. 

Dr Sita has apparently granted the drawing of the wizard battling a cursed demonic goat a position of pride, taped to the bottom of the nursing station monitor showing room 202. 

...

...Marian does not have the slightest idea how to respond to that. She's going to go make sure her new bags of drugs are hung and ready, and then sit at the computer station outside the room and watch her patients' monitors - but mostly Lionstar's - and read the OR documentation. And try to get down some more detailed notes on a fresh sheet of printer paper, because she's pretty sure that by shift change her brain will be DONE and she would like to have a cheat sheet for getting through a vaguely coherent and non-mortifying shift report. 

Tsashi would, ideally, like to have somewhat more idea what happened during the time they had Lionstar elsewhere - she's not blind, or stupid, she can tell that Merr-rayn is stressed and the other Healers are exhausted - and to have any idea at all what the large number of magical artifacts now arranged around Lionstar's body are doing. But that doesn't seem like it's on offer right now. It looks like they want Lionstar to sleep? Tsashi can try to sleep too, curled up in the chairbedthing. 

It's a little past 5 am. 

...It's gradually becoming clear that the trend in Lionstar's vital signs is, in fact, toward (very slow and intermittent) improvement. He's going to need suctioning again at some point (which Marian is putting off as long as possible because it definitely involves a painful stimulus and she's apparently supposed to be avoiding touching him) but his sats are holding up at 91% for now, he's getting very tolerable ventilator volumes, and when she sneaks a listen to his lungs, he sounds crackly and wet but barely wheezy at all. With the Bair Hugger in place, his temperature creeps steadily upward and passes 35 C again. His heart rate eventually settles down to around 100. Marian is able to very, very cautiously ease the dopamine dose down in tiny increments. By 5:30, he's off it entirely and his BP is holding up – well, hovering between 80 and 85 systolic, but they're titrating for a mean arterial pressure above 60 mmHg and he's maintaining that. 

Marian is so proud of him! ...It's actually making her slightly teary, because her 5:30 am brain after 14 hours straight of shift is, apparently, ridiculous. 

At 5:40 am she asks Chantal to please please keep a close eye on 202's monitor so she can duck into 201 for a final morning pass. 

201 is stable and wakes up a little to smile drowsily at Marian when Marian repositions her, and wince drowsily when Marian gives her Lovenox prophylactic blood-thinning injection to prevent deep vein clots. 

Aaaaaaand she's back out at 5:52 am how is Lionstar. 

Fine, at a glance! His blood pressure is up to 92/55 with a MAP of 67, even! 

He's doing SO well and Marian is trying very hard not to be pointlessly emotional about it! 

...She might as well try to batch all the bothering-him as tightly as possible. She's not even going to try turning him, but she does need to turn the lights on enough to check his wound drainage and dressing site, and she needs to do a blood sugar, and there are labs to draw - a lot of labs, actually, they're repeating nearly everything including a bedside iSTAT blood gas - and he's probably very due for suctioning, poor guy - she's maaaaybe going to warn Dr Sita before she attempts that, in case it makes him go into V-tach again - 

Five minutes later, she's hauling everything she needs into the room, glucometer and iSTAT included. She turns on only the sink light, to see if that's enough to get by if she cheats with her penlight. 

Lionstar's temperature is up to 36.1 C. Finally more or less normal. His heart rate is at 95. Blood pressure 98/57 with a mean arterial pressure of 71; maybe she can finally ease down the maxed-out norepinephrine infusion by a little bit? Sats are hopping between 89% and 90%, probably because he's in fact incredibly full of secretions. Suctioning him can wait until last, though, since it seems most likely to set off some kind of time-consuming and disruptive Badness. 

His dressing site is still pristine. There's some fresh drainage in the vacuum chambers of the two wound vac machines hooked to each railing of his bed - more on the left side - but even combined it only comes to about 250 ml, and it's definitely still bloody but more serous-stained-red than frank blood. Marian marks the level of drainage in the vacuum chambers (with permanent marker, it'll come off with the help alcohol swabs later but won't rub off by accident in the meantime) and notes the time. 

He's peeing - not nearly enough to compensate for his ongoing hourly fluid intake, which must add up to nearly 500 ccs every hour once you include all the continuous IV drugs, but still an entirely adequate and non-worrying 80 ml or so. The capillary refill in his fingers and toes is still a bit delayed, but his extremities feel neutral-temperature rather than cool or cold. 

His blood sugar comes back at the highest Marian has ever seen it, an entire 93 mg/dL. The iSTAT takes longer to read, but it's non-terrible, certainly a lot better than the two readings she found written down in the OR paper flowsheet. PaO2 a touch low at 69 mmHg, PaCO2 actually in normal range, bicarb and pH a bit low but only a bit. 

He doesn't particularly respond to her moving around him or gently touching him; he looks more or less comfortable. 

All of that is reassuring and good! Marian will send her handful of bloodwork tubes to the lab, and give Dr Sita at the nursing station a final warning, and THEN go in and suction him. 

That does get a reaction! No eye opening or especially purposeful movement, but Lionstar tenses and grimaces, and his cough reflex seems a bit stronger.

He does some ectopic beats on the monitor, and his blood pressure drops briefly, but he doesn't go into V-tach or have another seizure. The secretions that Marian gets out in the suction tubing are pretty copious, but otherwise normal-looking, white-clear and neither notably thick nor liquid. 

There's probably a lot more down there but Marian is not going to push her luck. She backs off and leaves him alone until his systolic blood pressure is back above 85, then cautiously attempts some mouth care. 

Lionstar makes a face about it, and gags at one point, but it doesn't seem to affect his vital signs too much. There's definitely a lot of gloopy saliva at the back of his tongue. 

Ewwwwwwwwwwwww. Still, it's really not the most gross thing to come out of this patient's body tonight, and there does seem to be less of an active saliva disaster now that he's on a higher atropine rate. 

Marian is even able to ease down the norepinephrine another notch before she leaves the room and sits down for a final round of charting. 

Chantal comes to see her at 6:10, by which point she's parked outside the room again. 

"I have to figure out assignments. You're back for the afternoon, right? I assume you want 202 back, if." The content of that 'if' can remain unstated. "Does he need to be 1:1?" 

"...I mean, 'need' is putting it strongly, but I think ideally yeah? 201 isn't a bad pair with him if you can't make it work, but, uh, I did kind of neglect her and day shift is more hectic. But, uh, Annie's admit might actually need the 1:1 more." Marian haaaaates saying that but it is, in fact, the case that she's had as many as several moments to sit down during the night, and is 100% caught up on charting. 

"And there's the kid to think about, poor thing. There'll be a social work consult and they'll need to work with the phone interpreter. Not to mention we don't have an ID on him, or the slightest idea what on earth happened last night, except that probably a crime was committed - I put in a police report, they may well send someone this morning to talk to us. There's going to be a lot." 

She frowns down at her staffing paper. "I think I could make him 1:1 with Pascal. He'd be great with the kid. How comfortable do you feel with him handling the, well, medical complexity?" 

...That's actually a pretty hard question to answer! Marian considers it. Pascal is - how to put this. He's wonderful, and incredibly conscientious and organized, but he's not, well, smart. They were in school together and he nearly failed multiple classes. Having a patient on a drug even Marian had never heard of before tonight is going to stress him the hell out. But being 1:1 with a patient makes up for a lot, probably. He's always been good at noticing when he doesn't know something and asking one of the other nurses. And (somewhat remarkably) she's pretty sure Dr Sita likes him. 

"What are the other options?" 

Sigh. "I could give Isobel him and 201 and have Mayumi take 196. But I don't think Isobel would be very patient with the kid."