They're pretty decent! Heart rate 98, blood pressure 97/51 on norepinephrine, oxygen saturation at 92% on the current ventilator settings. Temp 36.6 C. 

That's good! Those are numbers Pascal is happy to be writing down. 

If nothing seems urgently wrong he will methodically do a head-to-toe assessment, skipping the parts of the neuro assessment that would involve a painful stimulus. 

Lionstar does not open his eyes to verbal instructions, even very loud ones, but he does react (with vague aimless distress) when Pascal peels his eyelid open to check his pupils with the penlight. It's a stressful moment, but he does not go on to have a seizure about it, and calms down as soon as he's left alone again.

His lungs sound slightly wheezy on exhalation, and very full of coarse crackles. Marian did say that he tolerated suctioning, "as long as it's not too much at once", but Pascal is definitely noting that he seems distressed and uncomfortable about it. His lungs do appreciate even a fairly gentle and less than completely thorough clean-out, though – his sats drop briefly while he's coughing, but then almost immediately jump to 96%. 

He doesn't have a heart murmur. His skin color is good; if anything, his face is slightly flushed. His feet still feel a little bit cold, and the capillary refill is still delayed in his extremities, but his peripheral pulses are strong.

Based on what's in the tubing and in the suction canister above the line Marian drew, his gastric tube is draining a small amount of mostly-clear fluid. His bowel sounds are hyperactive, but he doesn't appear to have had another recent bowel movement. His urine output is - pretty excellent, actually, nearly 125 ccs in the bag since Marian presumably emptied it at shift change.

His dressing is still clean. The wound vac drainage compartments have about 20 and 45 ccs respectively above the Sharpie marks that Marian made at 7 am, still a normal-looking mix of serous and bloody. 

The vacuum compartments can hold a lot more than they have in them, but Pascal was very specifically instructed to alert the doctor if the wound drainage "smelled bad" and he's not sure how he's supposed to tell when it's neatly sealed up like that. He will write down the exact amount of new drainage since 7 am and then get one of the big plastic graduated beakers and empty the compartments one at a time and sniff the contents of the beaker. 

It smells more or less like you would expect blood and leaking bodily fluids to smell! No sign of cursedness. 

Oh good! Pascal is so relieved! 

He smiles brightly at the kid. Points at Lionstar and makes a thumbs-up gesture, to try to convey that everything looks okay right now. 

Tsashi has no idea what that gesture means but she can recognize a smile, and the fact that Pascal didn't look upset or stressed about any of the mysterious probably-Healing-Sight looking at Lionstar he was doing. Probably that's a good sign? She nods. 

And Pascal slips out to sit down and chart. It's 8:25. His morning started with discussion of a CURSED DEMON GOAT and now he's...not even behind? Rounds is going to be - interesting - on this particular patient, and that theoretically starts at 09:00, with newly-admitted patients and/or particularly sick patients first - he's not actually sure which of 202 and 196 will win that particular match-off, but probably 196 and so he just has to make sure to be ready by 9:15 and realistically it might not be until even later than that? Rounds are very stressful if he hasn't had a good report that morning or enough time to prepare, but today isn't actually looking too bad for that! 

In-hospital social workers do not usually get referrals placed STAT, even when a child's injuries are suspiciously parent-inflicted or a laboring woman tests positive for meth and cocaine and heroin or the police are circling a gunshot victim or a rape kit needs running. When she reads the report, though, Diel can see why someone felt the need to request a referral with extra urgency.

Probable suicide by drinking pesticides, ten to twelve year old undernourished and neglected probable-daughter who doesn't speak a word of English and apparently slept overnight in the ICU.

She gets to the room at 8:35. 

"Hey. Social work, are you the nurse for 202?"

Wow that was really fast. Oh no should he have prepared for this. How are you even supposed to prepare for social work consults, it really hasn't come up enormously often for his patients in the last year and the only notes-sheet in his binder related to it is about discharge planning which is really quite premature here. 

"Yes. I'm Pascal." Smile? "I - guess you're here to try to talk to Sashi? Um, do you have any questions first - I think kind of a lot of things happened last night since the referral was put in - also by the patient is in the system as a John Doe but Sashi, she's the kid, told us his first name is 'Lionstar' - I don't know how it's supposed to be spelled, sorry -" 

There is in fact totally a kid of ten or twelve in the room! She's wearing a flannel hospital blanket like a cape and a sort of short dress or long tunic that looks clearly handmade (and not well made) as well as filthy, and doesn't look like she's bathed possibly at any point this year. She was standing beside the recliner she presumably slept on, staring very very intently at the large array of ICU equipment as though trying to decipher it, but when she sees a new person she takes a few steps over and watches curiously from the foot of the patient's bed. 

"The kid is Sashi? S-A-S-H-I?" She waves at Sashi, tightly. She haaaaates parents who suicide in front of their kids. "Did you figure out what language she speaks, the referral just said that she didn't speak English but it didn't say which translator to bring. And did she get breakfast?"

"I don't know for sure how you spell it. And, uh, sorry, I don't think we made any progress on figuring out what language she speaks. She seems really smart, the night nurse was trying to communicate by drawing and -" oh fuck he has to explain the cursed goat. He does not want to explain the goat. How do you even explain that. "...I got her Jello and juice, I haven't had a chance to figure out anything else but she should probably get real food at some point." 

"Can I get a normal breakfast delivered up here? I haven't done a call to the ICU before, I don't know if there are extra rules about food in the rooms or anything." She squints at Sashi, trying to guess her ethnicity. "Hablas español? Parlez vous frances? Uh, deutsche? Hindi?"

"We can get normal meals delivered for patients if they're eating but I don't think there's a system for getting meals for relatives - I guess I could put it in as though it's for him but I'm worried that would be really confusing for someone later..." 

The kid is definitely not white, but her ethnicity is pretty hard to place. Tanned medium-brown skin - a bit lighter and less coppery than what Diel can see of the patient - dark brown eyes, dark brown hair that might be very tightly curled or might just be matted.

She takes another step closer, smiles cautiously at Diel, and does seem to recognize that this is an attempt at communication – she says an entire sentence in what's presumably her native language, which is utterly unrecognizable. 

Diel smiles back, unhappily. "Maybe we can get her, uh, a globe to point at?" Though if you neglect your kid this badly they probably don't have an amazing geography education. "I just don't want to take a kid into foster care without a translator on hand, what a nightmare. Patient didn't have any identifying documents on him?"

Wow, yeah, Pascal does not want to be in any way involved in involuntarily hauling a kid into foster care without even being able to explain why. That's horrible. 

"...No. Sorry." Pascal isn't sure why he's apologizing for the patient's lack of ID. It's not like it's even that rare. "I don't think we have a globe." Why on earth would the ICU have a globe, when would that ever come up. "I could try to pull up Google Earth or just Google Maps of the city if you want her to point. - or we could try to get her to draw where she's from, if you can figure out a way to, like, Charades to her that that's what you're asking? She's really good at drawing." 

Which they know because– he still does not want to explain the goat AT ALL but should probably actually explain some of last night's events? He didn't have a lot of time to spend reading the exact wording of the social work referral, but it was put in around midnight, so definitely before things got, well, weird. 

"- I don't know if this helps at all with figuring out where she's from, but we were probably wrong about what happened to him. He ended up having to go to the OR at 3 am because the laceration he came in with was really horrifyingly necrotic, and - we don't really know what it was, pathology is still pending, but the surgeon thought it was maybe some kind of weird venom? And that that was also causing the symptoms we thought at first were organophosphate poisoning, because it'd be weird for it to be unrelated, right." 

Pascal is trying to be immaculately professional about it but he does, while saying that, look kind of visibly unnerved. 

"Huh, okay," says Diel. "So probably some kind of snakebite or something rather than a suicide attempt? ...is he likely to pull through?"

...Pascal is so glad right now that Sashi can understand neither the question nor his answer to it. "Yeah, no, I don't think it makes any sense for it to be a suicide attempt, I hadn't even realized they were thinking that earlier."

He hesitates. Probably you don't have to be as exquisitely careful talking about a patient's chances of surviving to a social worker as with a family member, but it still feels weirdly more fraught than if one of the other nurses on the unit were asking. "I...think things look better now than last night?" he says cautiously. "He's - definitely in pretty bad shape, but at least right now he's improving. ...We definitely need to figure out something better for Sashi either way, though, even if he does recover it's going to be a while." 

"I think we've got to figure out a placement for her, yes. She can't live in the ICU, and it can't be good for her watching him go through all of this. I'll go see about getting her a globe, and breakfast, and whatever else we can try to figure out how to talk to her - we can get a translator on the phone if we know which translator - are you all right having her in the room until that's sorted out?"

"Yeah, it's fine, she's not causing any trouble." Substantially less trouble than some GROWN ADULTS he could name, if he remembered their names instead of just the room numbers of the patients they were related to. "...She should really have a shower and get clean clothes, at some point, I get why no one on night shift prioritized that but it's not very sanitary." 

"Yeah it seems like it! I will also look for clothes for her. Do we have a surname?"

"No, sorry. I can try to ask but I'm not thinking of how to Charades the question if she didn't already think of it?" 

Pascal is abruptly self-conscious because the patient is also really dirty and this is kind of a worse sanitary problem. It's not like the social worker can tell, she's presumably not going to go peeking under the Bair Hugger blanket, but he's still finding himself mentally preparing an explanation about how he would LOVE to get his patient clean but it's not safe to move him too much while his electrolytes are messed up because it makes him do arrhythmias. ...Possibly the self-consciousness is less about the social worker and more about the imaginary voice of his final clinical preceptor, who had a whole thing about patients being clean.  

"I'll put down John Doe and Sashi Doe, and I'll wait to fill out the rest of these until she's not covered in dirt and has had breakfast, because they're going to take most of the morning." She sighs heavily. "Poor kid. I'll give you my cell in case she starts being disruptive or he starts coding or something and you need her out -" and she does that, and then trots out to round up food and maps and clothes.