Marian speaks English and French, and does not recognize - whatever that was - at all. She's also not sure what the patient is trying to gesture at her? Her main reaction is that at least she's stopped going after her Foley; the balloon holding that in place tends to cause actual damage when you yank it out. (Usually worse in men, given the longer urethral tract. At least her patient is female?) 

"Sorry, I don't understand you." Wow that's a really pointless thing to say given how it seems like probably the patient doesn't understand her either. She didn't realize the historical re-enactment people were that multicultural shut up Marian's brain, not helpful. 

Fuck she needs to try communicating in gestures. She is going to approach, tentatively, and point at the leaking ends of the central line and the now-alarming IV pump, and then - uh - point at the patient's chest and use her hands to mime a heartbeat? That's probably not clear at all but it's the best she can come up with right now. 

Yeah, she should probably do something about the bleeding. She tries pinching the loose end of the tube shut. And then tries to figure out how to mime 'how long do we have before anyone else shows up' by pointing at the door, making the traditional hand gesture for time passing (mining flipping an hourglass) and making an exaggerated quizzical expression.

Marian has never used an hourglass for urgent timekeeping purposes in her life, and in context has no idea what to make of the wrist-flipping gesture. She can get: door, questioning face - is it about where the doctor went, Marian has no idea how to convey that in mime actually - 

There are enough alarms going off on the monitor that Kristy is going to extract herself from her patient's room and stick her head in. "Marian, do you need - oh shit -" 

Oh shit indeed!!! 

"Uh, can you get me more pump tubing, she -" handwave at the whole central line situation, "- she was on pressors - also her incision site looks bad and the resident was supposed to get Dr Harrison but I think they shouldn't come in here yet, she's super freaking out -" 

....Kristy can go get IV tubing. 

Vital signs first. 

Marian is going to make eye contact with her patient and try to smile reassuringly while she goes hunting for the sat probe in her bed and puts it back on her finger, does she allow that? What about a blood pressure cuff so Marian can take a manual BP reading? 

She will put up with both of these with an expression of deep suspicion and further miming to the effect of 'what/why are all these things attached to me'.

Wow okay shit has this patient never been to a doctor’s office before? (Or is sufficiently disoriented to not remember, but she seems pretty alert, just, really confused…)

- Sat probe is less invasive/scary than blood pressure cuff, probably. Uh. Marian can mime taking deep breaths, point at her chest, and then point at her patient’s chest? And then do the heartbeat-gesture again before trying to place the blood pressure cuff. 

If anyone tries to come in, she’s going to attempt to convey by URGENT EYEBROW EXPRESSIONS that they should instead stay back because she’s busy and doesn’t want any of them to get kicked? 

Kristy can follow that and will, uh, toss the IV tubing onto the top of the laundry bin instead? Maybe fortunately, Dr Harrison is not yet making an appearance.

Marian’s train of thought here is not entirely “oh good” given how she does, in fact, really need a doctor here to figure out what to do about the horrifying slime and probable sepsis?? But it’s definitely less socially complicated that backup has not yet appeared.

….What sort of blood pressure and SpO2 reading does she get?

Her sats are still fine but her blood pressure is down to 73/54. The blood pressure cuff is suspicious and alarming but kind-voice is doing a great job of preventing anyone from doing actual violence to her so far, so she's inclined to play along. If she can stay alive until dawn she'll get her channels and domain abilities back even if they stop her from praying for spells.

Okay, shit, that’s - not great. (The blood pressure reading, that is.) 

…Can Marian make sufficiently reassuring gestures that her patient will let her reattach the newly primed tubing for the norepinephrine drip to her central line?

(Marian has also checked that an oxygen mask is within reach - she did have a chance to prepare the room this time -  but it maybe actually seems more invasive to stick an oxygen mask on her patient’s face than to attach something to an existing central line, and also her sats are less concerning than her blood pressure right now.)

No nope and more no. Wait, maybe the gestures mean the guy in charge of this cult-or-something is about to come back and she needs to pretend to still be incapacitated? What if they tuck the tubing ends in like this and made it look like she was still attached to the strange device without actually doing it?

Uhhhh, Marian is not super sure what that gesture means but she's pretty sure that she's missing something and she and her patient are not on the same page? 

- is her patient actually going to stop her from reattaching the new tubing, if she telegraphs very clearly everything that she's doing? 

Arrrgh she wants to have a conversation. But her (untrustworthy, potentially charmed) instincts are telling her this person doesn't mean her harm, and if anything she's started feeling worse rather than better since pulling the tubes out. And she'd rather risk some unspecified horrible fate than risk attacking someone who was just trying to help, so. Yes. She will put up with the tubing, and pray silently for wisdom and discernment, and hope that she's not letting them use her to teleport monsters into the town square or something.

(Samora should start feeling slightly better again once the norepinephrine kicks in and her blood pressure ekes back above 80 systolic.)

The midazolam should not in fact be running on a patient who’s now awake and breathing on her own, even if Marian perhaps regrets not turning it way up earlier. The fentanyl seems like a good idea to reattach, though.

The bag with the saline bolus…has completely emptied itself out into a giant puddle on the floor, ugh. Marian has no idea how much of it made it into the patient first.

….She really needs to take a blood sugar but, crap, no more art line - and the patient is alarmed by a blood pressure cuff, Marian soooo does not want to stick her finger until she’s calmed down a little. Uh. Using some of the fresh blood from the art line site, when she goes to put a pressure dressing on that, is preeeeetty sketchy but it should, like, work? (It’s not bleeding a dangerous amount - it’s a small puncture in the artery and the muscular tunic of the radial artery is also trying to clamp it down - but Samora is going to have a truly spectacular bruise on the inside of her wrist.)

Whaaaat is her blood sugar. It’s now been more than five minutes and she’s been exerting herself quite a lot, but she is still conscious so maybe it’s not that bad…

59. 

Samora scowls and makes a "what are you doing with that, give it back" gesture at the blood sample. Though when she thinks about it for a moment surely they could have gotten as much of her blood as they wanted while she was asleep? Maybe whatever they're doing requires fresh blood?

She needs to be able to communicate with this person and they don't seem to be in a huge rush anymore. She mimes writing; maybe pictures will work better than gestures.

Marian can’t give it back! It was already dripping out of her body! …Fine, though, if it helps her chill then she can have the used glucometer test strip to hold onto?

- and, yeah, writing is a great idea, but Marian doesn’t have a clipboard with her in the room and she really wants to resolve the blood sugar situation ASAP.

She is now going to do a slightly mortifying mime routine trying to explain what the 25cc syringe of D50 is before she gives it. (It’s not like she can off the top of her head think of a less mortifying picture she could draw instead, if she had decided to get a clipboard and paper first.) If she mimes rubbing her stomach to indicate hunger, points at Samora, points at Samora’s mouth and makes “no” gestures to indicate that she can’t eat right now, and then slowly brings the syringe to the central line, telegraphing her movements…

(Samora will notice the pain fading back a little as the fentanyl kicks in again, and if she does let Marian give her the D50 again without fighting it, she’s probably going to notice feeling another few increments better.)

Samora has absolutely no clue what the fact that she doesn't need food has to do with the syringe, but she has noticed the painkiller and the ongoing absence of violence and doesn't object to the dextrose. 

Not knowing this person's name is starting to bother her separately from everything else that's bothering her, and it's far from the most important thing but it's also potentially easy to fix. She points at herself and says "Samora", then points at kind-voice and cocks her head.

…Yeah Marian should absolutely have introduced herself already and is now pretty embarrassed that she failed to think of it! "Samora," she repeats, then points at herself. "Marian." 

And then - sats still okay, she might not even need oxygen - she's still missing most of her heart monitor leads but the pulse oximeter is giving her a heart rate number so that's not urgent - last blood pressure reading is okay - Marian will glance at her temperature but that's also not urgent on the level of seconds to deal with, she can hang the IV Tylenol at the same time as whenever she manages to get a replacement saline bolus -

(Actually, grabbing a spare gown from the backup linen drawer and throwing it on the giant floor puddle is a high enough priority to do now, because otherwise Marian will forget about it and slip and fall at some point.) 

- okay, now it does seem like the top priority can sensibly be communication. Marian will go stick her head out the door to try to get Kristy's attention and ask for a clipboard and printer paper and a pen. 

Kristy looks apologetic. "Uh, Dr Harrison came past but I said you were talking your patient down from flipping out and he didn't wait. Said he'd put orders in?" 

Wow Marian normally has better situational aware than that, she absolutely didn't notice the surgeon coming into their pod.

It's on reflection not shocking; Dr Harrison is about median level stressful to work with, as the trauma surgeons go, but his stressful traits aren't that he'll yell at you, just that he hates having his time wasted, seems to consider directly interacting with conscious patients a waste of his time, thinks thirty seconds is too long to spend on the phone - which makes it difficult to page him to get orders for more than one thing unless you talk really, really fast - and also tends not to communicate about his plans. Mentioning out loud with his actual mouth that he was putting orders in is better than usual, really? ...Anyway, normally this trait is really frustrating and Marian would prefer he actually come look at her patient, but this time it really doesn’t feel like another person in the room would have improved the situation.

"Oh. Good. Uh, once you get a clipboard, would you mind looking up what the orders are for me and bringing stuff we need for them over? I don’t think it’s a good idea for me to leave again.”

Kristy nods. “Is she confused, or what?” 

Demonstrably yes but Marian is pretty sure not in the sense that ICU patients normally are! “I think she doesn’t speak English and doesn’t really know why she’s here, but - she seems alert, just not oriented…”

It might be worth trying the interpreter phone service but 1) Marian hates it, 2) she doesn’t actually know how you request it if you don’t know what language to put down, and 3) maybe social work has to actually put the request in? She mostly remembers that last time it came up it was frustrating and complicated. She’ll try this first.