Oh no. Wait, what labs is she even waiting on right now? - nevermind. She dives for the nearest unit phone and hits the button for line two. “Marian speaking, this is for 104?”

"For Eighty-One, Violet in room 104, yes." The woman on the phone sounds - stressed. "You sent a sample for a wound culture, right? Some - green stuff - where exactly did you take the sample from -?"

Marian does not get the feeling that she's going to like where this conversation is going. "Yeah. She's post-op a few hours for bowel repair, I got the sample from her surgical drains but it's, like, the same stuff leaking out of her incision. We weren't sure if it was bile...?" Presumably it's not, though, if there's no new hole in Samora's guts that it could be leaking out of. 

“Doesn’t seem to be. But it’s full of - some sort of bacterial pathogen - it doesn’t match anything we’ve seen before - it’s remarkably fast-growing, doubling time must be less than ten minutes. It behaves like - a slime mold, almost, when you put some of the fluid on a slide it moves—  Please tell me the patient is in isolation?”

OH SHIT Marian is a terrible person - she had kind of already been treating it like Samora was a contact iso room, except for the part where she took her out of the room to Radiology and it completely slipped her mind to warn the tech that they should clean the room, like, more thoroughly than the standard between-patients precautions. In fairness to her, “surgical wound infection” doesn’t usually indicate isolation unless it’s an antibiotic-resistant organism - to be less fair, the patient was LEAKING HORRIFYING SLIME - 

“Uhhh. Not - officially ordered - I was treating it that way on the unit but I should call Radiology, we were just there -”

“Oh. One sec.” The voice goes muffled. “Joanne, call radiology now and tell them they were exposed to the thing - looks like it was a CT - find out which patients have been seen since, we should alert those units too—”

Aaaaaaaaaaaaah Marian feels terrible about everything!!!!!! 

The voice is unmuffled and directed at Marian again. "We're on it. - it's not your fault, this is really out of left field." 

no you don't understand it should have been obvious how it smelled like bog death and I could smell it

Melting down about how it's all her fault is unproductive. Marian takes a deep breath and clears her throat. "We'll put her in - uh, does it need to be airborne iso, the room she's in isn't set up for that -" 

"No indication it's airborne at all, thank god. And it looks like the standard disinfectants do kill it. Just, be really careful - we may want to lock the whole unit down, if the patient hasn't been in iso - the report will be through in the system in a few minutes." A pause. "Would you mind transferring me back to the charge nurse, actually? I'm sorry, I know this is a lot to throw at you and your patient needs all your focus -"

The lab person is being so nice and Marian still feels teeeeeeeerrible even though she's fully aware that she needs to stop that and focus. 

- she should not leave the room to go get isolation stuff. She may have been kind of mentally treating it like Samora was in contact iso, but she probably wasn't being careful enough - for example, she super wasn't putting on a gown and should assume her scrubs are now Contaminated - and also it might have been contagious before she actually noticed all the slime. 

"Kristy! I need help - uh, my patient has an infection of something the lab's never seen before and they want her in isolation but I don't want to leave. - also can you let Dr Harrison know? And tell Alison the lab is still on line two and wants to talk to her?" 

Aaaaaaaand then she should go figure out how to explain to Samora that she has something wrong with her that they've never dealt with before and also all the staff treating her are going to be in isolation gear from now on. 

(It's going to be pretty obvious to Samora that Marian has been getting increasingly alarmed and upset about whatever conversation she was having.) 

It's very obvious and Samora is worried too! She holds up the picture of her praying at dawn and healing herself and other people again, because that's the most reassuring thing she knows how to communicate.

Marian nods and smiles distractedly but is, honestly, not really in a headspace right now where "reassurance from her patient, the one with the horrifying fast-spreading infection" is particularly landing. 

She puts on gloves and takes the clipboard and - hmm - she'll draw a bandaged stick person on a bed, and circle the stomach area and draw an arrow to a circle where she draws some bacteria-shapes again, except this time she also adds lots of angry-eyebrows faces. 

How to convey 'it could spread to other people'...? She adds another stick figure standing beside the bed - points at herself to convey that she means who it is - then gives the Marian-figure hands and makes another zoomed-in-circle of one hand and draws some squiggly-bacteria on it. She puts all that in a box and draws another box further down with another bed in it, and draws a long arrow going to that room and the Marian-figure beside it with bacteria-shapes beside her, and then some bacteria on the patient in the other room, and a sad face. 

They want to put her in isolation because as far as they know it hasn't spread yet and they want to stop it. Hmm. ...She gets a new sheet of paper (ugh she needs to ask someone for more printer paper since she is officially not leaving this room to go touch things at the nursing station for the rest of her shift) and very quickly sketches the same scene, except this time the Marian figure has a bathroom-figure-dress style sketch of a gown on, and gloves drawn as an outline around the stick-hands, and the bacteria are only on the outside of that? And she'll draw the arrow to a Marian-figure dropping a bacteria'd dress into a cylinder to indicate the trash can, and then walking out with no bacteria with a smiley face beside her? 

Marian . . . caught her dungeon fever? Marian is worried she might catch dungeon fever. Well no wonder she's worried! Civilians getting dungeon fever is way worse than her getting it! She tries to communicate that she understands and that Marian should do whatever she needs to do. Hopefully there's some kind of backup plan for whatever they wanted her to be able to do in a hurry, now that they're not going to want her going anywhere until tomorrow.

Marian is preeetty sure Samora followed that? She feels like they're getting really good at communicating in pictures! This doesn't actually improve the medical situation and so doesn't really make her feel better, but it does feel like it matters that Samora is - probably more willing to extend her the benefit of the doubt, if they do need to do some sort of unpleasant and confusing emergency treatment in a hurry? Hopefully? 

- her vital signs still aren't worse, that's something - 

Kristy brings an isolation cart and slaps signs on the door, and Marian dons an isolation gown, which doesn't actually do anything about the feeling that her entire body is Contaminated and she desperately wants to shower and scrub her entire body with chlorhexidine soap and throw her scrubs in the laundry on the Sanitary setting, or possibly just throw them out as not worth salvaging. This is not a feeling Marian gets very often and she doesn't like it. 

Ugh she's late on the blood sugar check again and also completely out of boxes of D50 in the room, the last two went with her to CT and were used up - she'll ask Kristy for a bigger stash and poke poor Samora's finger again, god, at this point it almost feels worth getting her on board with another art line just for the glucose checks (and of course it's always not a bad idea for someone maxed on norepinephrine, even if they've been like that for like the entire day and seem to be stable like that...) Marian is also starting to feel very fried again, though, and drawing a picture of what an art line is for feels hard, and also that requires Dr Harrison or at least a resident and she has no idea where any of them are. 

It's coming up to 6 pm. Marian is simultaneously incredibly ready for her shift to be over, and also feeling pretty aaaaaah about handing Samora to someone else who she doesn't know, but in any case there's still an hour to go. 

The resident comes back again five minutes later. "No OR for now, the radiologist said everything looks intact. There are inflammatory changes that look like peritonitis and there's a lot of free fluid accumulated, probably the same stuff coming out the drains. Dr Harrison wants to see if he can drain it with a paracentesis kit, if she's stable enough - is she?" 

Well, her vital signs aren't great but they haven't changed from their not-great baseline for multiple hours - except for her fever which actually did come down with treatment - and she looks sick but not worse. Also, importantly, Marian thinks she can probably explain 'we would like to take the slime in your body and instead put it not in your body' in pictures, and persuade Samora to let them stick an ultrasound-guided needle in her abdominal cavity. 

"Yeah, I think so." 

"Cool. You can be ready to help in ten minutes?" 

Well, it's not like she can leave the room or anything. 

...Marian will flag Kristy down yet again to ask for an additional stash of printer paper, and then draw a new diagram. This time she shows the person from the side again, so she can draw an oval in the figure's belly full of bacteria-shapes, and then sketch the paracentesis needle and tubing setup and an arrow showing where it goes, and then draw a second picture where the oval in the figure's belly is gone and the bacteria-shapes are instead filling up a jar. She brings it over to Samora and shows it to her. 

Samora doesn't think pouring the slime out of her will cure her, but she doesn't see how it would make things worse either, and the theory where they're secretly evil really isn't holding together very well in her head at this point, so sure, okay. Maybe one of the secrets of lost Azlant is that taking the slime out will make her recover faster. Maybe they just really want her to stink less. She really wants herself to stink less and she's used to this sort of thing.

It's more like fifteen minutes later that Dr Harrison actually shows up to set up for the paracentesis, which brings it frustratingly close to shift change. To his credit, he actually puts on all the isolation gear.

It’s a pretty straightforward procedure, as they go. Dr Harrison checks with the ultrasound machine where the biggest pocket of fluid is, sterilizes the skin, and gives Samora a tiny poke of local anesthetic before placing the much bigger needle. The resident holds it in place while he plugs it into one of the huge vacuum jars.

Does the slime in fact cooperate with exiting this way? (Marian is slightly worried it’s too goopy.) If so, how much of it is in Samora’a body?

It's not quite goopy enough to clog up the needle, but there's a lot of it. Nearly half a liter. Samora looks away, then looks back at it because looking away doesn't make it not be happening and she should be in a position to notice if they do anything that's definitely not what Marian communicated that they'd be doing.

(Nope, they don't do anything other than what Marian said they would, at least broadly construed! A few times the slime-flow is slowing and Dr Harrison has another peek around with the ultrasound to see if there are remaining pockets of slime and then carefully wiggles the needle in her to try to get those too. It takes, like, fifteen minutes before he has close enough to all of it to give up.)

That is genuinely disgusting! At least the smell isn’t worse, it’s all going into the sealed jar, and maybe relieving the pressure in there a bit will make it stop oozing out of her incision long enough for Marian to clean it up and get it covered again. Though maybe at this point the smell has already, like, permeated the walls? Wow this shift must really really suck for people who have, like, a normal human sense of smell.  

It's 6:25 by the time they finish. (Marian has to recheck blood sugars three times during.) Definitely not worth asking Dr Harrison about an art line on this shift, even if "q5min fingersticks" is kind of a horrible and also embarrassing todo item to leave the next nurse with. 

Presumably Dr Harrison is aware how much of a biohazard to treat that jar and tubing as, and harassing him about it would be rude as well as unbearably awkward.

She should catch up on charting but she's actually just going to sit down on the counter for a minute here, first.