A couple of cars pass without actually stopping, before someone does screech to a stop a few yards down the sidewalk, leaving their car running while they dash into the corner liquor store yelling for help. 

...This is honestly not even the first time that the proprietor of this particular corner liquor store has been frantically summoned because someone was bleeding on the sidewalk outside his establishment. This is the first time it's happened during daylight hours, though, or to someone in cosplay (???) carrying a literal sword (???????). 

He takes one look at the pool of blood, snaps at the random bystander to call an ambulance, and goes back in for the first aid kit.

Where's the young woman bleeding from? Is she conscious? Does she seem to be breathing? 

She's bleeding from kind of a lot of places! They don't look like gunshot wounds or stab wounds, more like something ripped chunks out of her. She's not conscious but is breathing, and her pulse is weak but steady. 

This is definitely beyond what his first aid kit can handle! Also really confusing! It takes three seconds to confirm that the person who stopped did not at all see what happened, and then he'll try to find where she's bleeding the most and put pressure there, he doesn't have enough hands to get all the places. 

It's going to be at least five minutes before an ambulance gets here. He really hopes she doesn't die on the sidewalk in front of him before that. 

She doesn't die on the sidewalk! She actually looks surprisingly okay for how much of her blood is in places other than her body. Which is still not very okay. 

That’s a relief! He’s never seen anyone die before and that would be so upsetting.

The ambulance is there within 6 minutes, lights and sirens on, and pulls over at the corner. Two paramedics spill out with the gurney and equipment bag, and - okay, wild animal attack or something?? (The call they got was somewhat confused and mostly just covered “someone unconscious and bleeding.”)

The bleeding is pretty bad! Doing something about that is definitely a priority! They’ll confirm the patient is breathing and had a pulse, and then one of them will try to get pressure dressings on all the wounds while the other puts an oxygen mask on the woman and checks her vital signs. 

Heart rate of 160, blood pressure 70/40. She doesn't react to anything they do, but does keep a death grip (metaphorical, so far) on her sword and shield. When they manage to pry a finger loose to check her O2 sat, it's 97%.

…Kinda weird but it doesn’t seem like the most salient part of the situation, except that they do actually need to get the sword at least out of her hand so it’s not, like, flopping around being hazardously sharp as well as gross and slimy (????) when they get her onto the stretcher and into the back of the ambulance. They’ll delay actually departing to spend a minute or two attempting an IV to start fluids; it’s a lot harder in the back of a moving ambulance even when the patient isn’t trying to bleed to death and running a really low blood pressure.

The sword can get wrapped in an extra blanket. It looks like it maybe ought to go in a biohazard bag but they don’t actually have one big enough.

It'd just poke a hole in the biohazard bag anyway. Once it's out of the way, she's pretty easy to stick an IV in; her armor only covers her torso and her veins are well-behaved all things considered.

Oh good! They'll start a liter of saline running into her and book it to the hospital. 

How under control is the bleeding after their hasty bandaging work? 

Well, it's not coming out in spurts anymore. It's still leaking around the dressings from some of the more irregularly shaped wounds, including the nasty gut wound, and saturating the others. It doesn't appear to be clotting at all.

Well that's not great! There's a limited amount more they can do from the back of an ambulance, except radio ahead that the patient incoming is likely to need multiple blood transfusions, urgently. 

How are her vital signs doing? 

Her BP is down to 55/30, and her heart has sped up to 175, but it's still beating steadily and somehow keeping her O2 sat at 97.

The ER knows to expect her, and a team of nurses is already swarming out to meet the ambulance and help rush the patient to the trauma bay.

“What’s our IV access - we need a second line -”

     “Let’s get a stat CBC* sent off -”

“She’s still bleeding - someone hold pressure on that one -”

     “I’ve got two units of O-negative here, but can we do a type and cross ASAP, please…”

Within a couple of minutes  they have another two large-bore IVs, running a second liter of saline, the initial offering of blood, and a norepinephrine drip to try to get her blood pressure up to something more reasonable while they work on replenishing her blood volume. Two nurses are occupied trying to manually hold pressure on several of the wound sites, since bandaging them is apparently not sufficient. 

Her oxygenation is somehow still fine, but they definitely need to secure her airway; one of the residents is already unpacking an intubation tray. Is she still completely unresponsive? 

*Complete blood count. 

Yup. She might have twitched a bit back in the ambulance when they took her sword and put the first IV in, but she doesn't react to the new ones at all. She does cough and gag when they go to stick the intubation tube in her throat, not in a way that suggests she's having any subjective experiences about it but enough to be inconvenient.

Yep, that's inconvenient! She can get some sedation for it, which hopefully won't completely tank her blood pressure, they don't have that much room to go up on pressors. 

...The ER attending is going to order another two units of O-negative blood without actually waiting for the type and cross, judging by the amount of blood saturating the second layer of pressure dressings (added on top without disturbing the existing ones, to avoid disrupting any newly-forming clots), they can't afford to wait.

Inconveniently, the OR isn't going to be ready for her for another twenty minutes; ideally they would use that time working on getting her more stabilized for it. Is there any indication that with enough physical pressure on the bleeding sources, they're getting the ongoing blood loss at all under control? 

Well, between the pressure physically holding the blood in like a dike with a lot of fingers in it and the lack of blood pressure pushing the other way, there's definitely less coming out per unit time? The transfusion going in is mostly keeping up with what's dribbling all over the gurney.

Seems likely there are some severed arteries in there.

This…might be the best they can get here without messing around with the deep wounds more than is a good idea in a unsterile environment. They can keep up pressure on the spurting wounds, keep fluids and blood going into her hopefully fast enough to not to lose more ground, and try to prop up her blood pressure to at least 80 systolic in the meantime with heroic doses of vasopresssors. And - since they’re waiting anyway - maybe the doctor will have a go at cleaning and stapling any shallower injuries, so there’s less to deal with later.

The shallow injuries also want to dribble everywhere! Even the ones that can't possibly have hit an artery start leaking like her blood is so much water as soon as the pressure comes off. (She is at least responding fairly normally to the pressors.)

…That’s pretty concerning. 

He’d like them to send a clotting panel ASAP. In the meantime, absent a specific diagnosis of what's wrong, they can prioritize giving her plasma rather than saline, it's at least got a reasonable balance of clotting factors in it. The blood counts should be back soon and will alert them if there's a problem with her platelet count. The shallower cuts that he's already committed to cleaning can get hemostatic gauze slapped on them, and the rest can get left alone under dressings.

It's a really bad idea to take her to the OR like this, sooooo they had better manage to keep her stable or at least alive long enough to figure out what's going on. She looks generally healthy and fit, and it would be a pretty baffling decision for a hemophiliac to equip their cosplay outfit or whatever the heck it is with an actual sword. 

(The nurse is going to put in lab orders for Basically Everything, actually, might as well do all the standard ICU admit orders now.)

It takes twenty-six minutes from her arrival in the trauma bay for the stat complete blood counts to come back, during which time they manage to get three units of O-negative packed red blood cells and another three bags of plasma into her. 

Her blood count, from before a lot of her blood got replaced with other things: 

Hemoglobin: 8 g/dL (too low)

WBC: 12,000 mm^3 (a touch high)

Platelets: 100,000 mm^3 (too low again)

Everything else is reasonable. Also she's (a weird obscure ethnic variant of?) A positive. (Her ethnicity isn't obvious either; she might be white or Middle Eastern or Hispanic.)

...Okay, lowish platelets but not nearly low enough to explain what looks like a complete and utter inability to clot. It’s probably not a bad idea to transfuse a bag of platelets anyway - she’s lost even more blood since the sample was drawn, and had it replaced with packed red blood cells and plasma, neither of which actually include the platelet component. 

He’ll put in an order for that, and then spend a minute or so thinking. She’s still losing blood a lot faster than he’s happy with; it’s going to be pretty hard to keep her stable long enough to diagnose the problem and pick a targeted treatment. The longer they wait, the worse shape she’ll be in when she does eventually make it to the OR.

...They can give vitamin K, which will only help in the scenario where her problem is a vitamin K deficiency, but shouldn't hurt if it's an unrelated problem. And they might as well give tranexamic acid - it's an anti-fibrinolytic and should generically improve clotting ability for a range of underlying causes. Probably not by enough, when they're starting it this late, but it might at least buy them some wiggle room.  

Is her blood pressure holding up? Does anything else seem to be getting worse? 

Her blood pressure is not holding up, actually! Possibly because her heart rate has gone down a bunch.

That's not great! ...They're pretty much maxed on the norepinephrine now. They can start a dopamine drip as well as an interim measure, that will do more to increase heart rate, but it's almost certainly not going to address what the underlying problem is. It looks like the source of the problem is that her heart is no longer compensating as well for her massively compromised volume status, which - could just be exactly what you expect, even a healthy young person can't run a heart rate near their maximum indefinitely without their body starting to run out of steam - but it might be something they can actually address. 

"Hmm. Let's get a blood gas on the iStat. If her hemoglobin is low enough, she could be hypoxic even with a technically normal O2 saturation..." 

The blood gas comes back with an acceptable PaO2, but a seriously low pH and bicarbonate. Also, despite definitely not being hypoxic, she's picked up a blue tinge to her lips.

That’s not ideal! Either her lactate is really high - even higher than you’d expect given the degree of shock - or something else is metabolically wrong. Her CO2 is normal, leaving her pH totally uncompensated, probably because she’s too deeply unconscious to breathe above the ventilator rate. They can increase that, and give her a couple of amps of sodium bicarbonate.

….Someone thinks to check her temperature. It was normal when she arrived and it hasn’t been much more than half an hour, but they did give her quite a lot of room-temperature IV fluids.

Yup, she's gotten closer to room temperature. It doesn't seem to be having any consequences other than blueness yet.

Well, it could be related to the drop in her heart rate! Also, huh, it’s a surprisingly large drop in half an hour. They’ll get a warming blanket on her, and any further fluids and blood products should go into her warm.

- on reflection, given that they can’t take her to the OR anyway while her clotting problem is undealt with, maybe they do want to send her for a scan? If she’s bleeding internally as well as through all the dressings, it would be much better if that didn’t come as a surprise to the surgical team. 

On the other hand, she’s not that stable. He’ll wait and see if the dopamine infusion will do anything about her heart rate, and whether this is enough to scrape them up to a blood pressure of 80 systolic.

Her heart rate and blood pressure pop up a bit once she's warm, but not very much. The donated blood products are doing a lot better at staying in her body than the original flavor was, which also helps.

Okay. Maybe it's not quite a good idea to risk it. For one thing, the rapid infuser that they're now using to deliver warmed blood products (which shouldn't just be popped in the microwave) doesn't have enough battery life to haul to Radiology with them. 

They'll just - wait for lab results. And watch to see if the apparent decrease in bleeding holds up, though it's a bit hard to tell since they don't want to remove the original layer of dressings and disturb any clots that miiiiiight be trying to form. 

...They get a call from the lab. 

It's not for anything related to the clotting panel. The extended electrolytes panel is back and it's mostly totally fine, except for her venous blood glucose, which is incidentally included with the other tests and which, apparently, is a horrifyingly low 37 mg/dL. 

This is bizarre enough that the trauma bay nurse is going to just immediately do a fingerstick to check capillary blood glucose as redundancy, in case there was somehow something wrong with the sample.  

Her current blood glucose is not 37 mg/dL! 

It's 34 mg/dL.

...Which is actually even worse than it looks, capillary blood glucose is normally slightly higher, since venous blood glucose is after the tissues have extracted whatever sugar they need to burn for fuel. This is baffling - did she OD on insulin on top of everything else wrong with her??? - but it does, at least, sort of explain how rapidly her body temp dropped, and why she isn't responding better to the pressors. Her body is running on empty and it's lucky she hasn't started having seizures yet. 

The attending doctor is back at the nursing station trying to answer questions about three other patients, all of whom are less critical but also you can’t just put the whole ER on pause while waiting for test results on your sickest patient. However, this is more than worth interrupting for.

- or sending someone else to do that, actually, she's not going to wait for orders is just going to start giving IV dextrose immediately. 

She gives three amps (75 cc) in a row, and only then pauses briefly to glance at the patient's vital signs and take another blood sugar reading. 

That helps a lot! Her heart rate goes up to 155, her blood pressure just barely hits 80/50, and she looks less like death warmed over. The second finger stick comes back at 56.

That definitely makes it look like they’ve identified one of the things wrong with her! Maybe she is just diabetic on top of being a cosplayer with a bleeding disorder and who was ???attacked by coyotes??? in central Reno??

- not important to make wild guesses at the exact history right now. She’ll give another amp of D50 and then wait for actual orders.

Actual orders are to keep rechecking and giving more dextrose until she’s in normal range, and then continue checking every 5 minutes to make sure she stays there. If she’s diabetic and on long-acting insulin - and, one could guess, running into problems because she’s normally an athletic young person who eats a lot, and right now she’s instead busy losing significant fractions of her blood and doing the cardiovascular equivalent of running a marathon just to maintain her blood pressure - then they shouldn’t assume the problem is fixed for good once she’s above 70 mg/dL.

…Yeah, that checks out. Where is the patient at another three minutes later after her fourth sugar top-up? 

When there was last anything it was like to be Samora, things were going so totally to the dogs that she was expecting to wake up in heaven. That's bad--she had a job--but not worth freaking out over.

As her consciousness starts to pull itself together and it becomes clear that she feels way too awful to be in heaven, she starts thinking Tris and Marshall must have gotten her out somehow. Or possibly brought her back? She's far too groggy to figure out whether that would be a smart decision. 

Then she gets a bit more of her senses online and realizes that she's on some kind of table, with a device sticking down her throat and piercing both arms.

She's not with Tris and Marshall. The necromancer got her, maybe got all of them, and she's in some kind of horrible fiendish contraption like that poor dwarf from upstairs.

To the Abyss with that!

The third finger stick is interrupted by the patient attempting to leap upright (which fails, because her legs are still hamburger) while ripping her IVs out (much more effectively).

Yikes! That was really unexpected! It's not that unexpected for a patient to wake up confused even if they have very serious injuries, and they haven't given her anything for sedation since the 50mg of propofol to intubate her 45 minutes ago, but normally people show some sign of it before the point that they try to get up and rip out all their IVs. 

- the patient did somehow get all three of her IVs yanked out - bad like that they were all in use and thus had tubing connected - which is actually a pretty bad problem, because, one, she needs those, and two, it's going to be pretty fucking hard to put any new lines in place while she's actively panicking like this and they can't give her anything for sedation due to the lack of an IV line to give it in. 

The nurse will try to pin her patient's arms so she can't also go for the endotracheal tube, yell that she needs some help in here RIGHT NOW, and then - are the young woman's eyes open at all? - if so she can try to make eye contact and smile reassuringly and repeat that she's in the hospital and badly hurt and needs to hold still - 

She doesn't speak that language! Her eyes (she has silver irises) are open and working on getting focused, and the clearly-alive human face and lack of detectable Evil are a little reassuring. The attempt to restrain her is NOT reassuring and neither is the absence of her party and her sword. The unfamiliar surroundings are kind of a mixed bag, because it doesn't look like a dungeon but it doesn't look like anywhere normal either.

If she had any spells left she'd prioritize healing herself, but if she had any spells left she wouldn't be in this situation, and anyway she couldn't cast anything because there's still something shoved in her mouth. She makes a valiant effort to cough it up or bite it in half, and only succeeds in making her vision start to grey out again.

Yup that seems like a confused and uncooperative patient! Fortunately, what with all the blood loss and ongoing hypoglycemia, she's not actually strong enough to meaningfully resist being held down. Though she is managing to drop her O2 saturation a bit, probably because she's coughing too much to breathe effectively while also struggling as hard as she can. 

The attending doctor is there again, good. "We've got a problem - we've lost all three lines," which is pretty embarrassing to admit it took like a second for the patient to yank them out, there really wasn't time to react to stop her, "- and she won't hold still -" 

Yup, that sure looks like the situation. "Let's give 5mg lorazepam IM, get her settled down enough to put in some new lines - I think her BP can handle it, last one looks a lot better - and then we'll want to start midazolam for ongoing sedation."

One of the other nurses will go prep an intramuscular injection of sedatives, while a couple of the other staff help restrain the patient. Does she actually stay conscious and fighting them for the next minute or two? 

She's in and out, but never out long enough that it seems like a good idea to let go of her. When they come at her with the needle she fights back like she's never seen a needle used for non-malevolent purposes before and manages to kick the nurse in the ribs and incidentally dislodge one of her bandages. But she's not strong enough or coordinated enough to stop them from getting the lorazepam in, and goes limp again shortly thereafter.

(To the extent she's tracking hypotheses at all, which isn't very much, she's guessing these people are enchanted or coerced, or her Detect Evil is incapacitated somehow.)

This is not the first time she's been kicked in the ribs by a confused fighty patient. It's fine. 

Does the patient stay out when they stick her finger again for another blood sugar? (It seems like a good test for whether she'll hold still enough to get a peripheral IV in. Really she needs a central line but that's a terrible idea unless she's sedated enough not to twitch.) 

- also what is her blood sugar, it seems plausible it came up high enough for her to start regaining consciousness, but also since then she's been fighting hard and probably burning a lot of energy. 

(Someone else is trying to get the pressure bandage back on her wound where she dislodged it, though this is also a decent opportunity to get a better look at how quickly it's bleeding.) 

They can take her blood sugar; she tries to pull away a little after the fact, but that's all. It's back down to 43.

The unbandaged wound is still bleeding more than it should, even given the bandage getting ripped off, but it's not the total clotting failure of earlier.

Okay. They'll get a bandage back over it, that's fine. 

...The blood sugar is less fine but not shocking, and fixable as soon as they have IV access again. The nurse is going to have one of her colleagues firmly hold the patient's arm down before she tries placing another IV, but hopefully she can then get one in without too much trouble? 

How are the patient's vital signs? She's not losing blood as quickly as before, but it's now been, like, almost five minutes of not getting any of the fluids or blood products that were running before, and maybe more importantly not getting the vasopressors that were running. Also the lorazepam is getting absorbed and hitting her bloodstream, where it's probably going to depress her cardiovascular function a bit, but really having to stop all the pressors seems like the bigger problem here. 

The IV can go in. She's fit and muscular and completely ran herself out of fight.

Her vitals signs have deteriorated about as expected. Maybe a little better than expected, actually. BP 65/47, heart rate still in the 150s.

Yeah, unsurprising, all of that it really wasn't good for her. They'll get all the pumps hooked up again - it's a bit dubious to run plasma through the rapid infuser into the same peripheral IV as the maxed-out norepinephrine and mostly-maxed dopamine drips, and then also immediately push two amps of D50, and hook up a bag of midazolam as soon as it's ready - but it's a better idea than not getting all the treatments she badly needs started as soon as possible. 

Does that help? And is she still sufficiently out once her blood sugar is up a bit for the doctor to feel comfortable messing around with major veins in her neck to place a central line? 

It does help! The D50 continues to not raise her blood sugar as much or fast as it ought to, but it does go up, and she doesn't put up anything worth calling a fight about the central line.

Oh good. It's sutured in, and the nurse will also tape the tubing running into it firmly in place so that it's not easily grabbable, just in case. 

- this is the point at which someone lets her know that the lab just called about more concerning results? This time it's the full coagulation panel. 

It doesn't look like hemophilia, actually? It's systematically off, but the patient isn't outright missing any clotting factors, just low on - most of them, really? Her prothrombin time is unsurprisingly very prolonged. Her fibrinogen is especially low. 

...All of this is potentially a direct consequence of the massive bleeding and transfusions, except that they hadn't actually transfused that much yet when the sample was taken? 

Also her D-dimer is positive, which in this context is a sign that clots are trying to form and either being broken down or just not being very effective at stopping the bleeding.  

Well shit. 

This is actually a lot worse than a specific and treatable deficiency would be! It doesn’t point at an obvious targeted treatment, and it does hint that the patient may well already have been suffering from disseminated intravascular coagulation (DIC) - her body freaking out in response to her injuries and trying to form microclots everywhere, simultaneously causing diffuse tissue and organ hypoxia by gunking up capillaries, thus the acidosis from elevated lactate, and also depleting the critical reserves of clotting factors that she badly needs to stop bleeding from the important spots.

….Or maybe it’s not that bad, it does seem - better than the alternative - that she’s improved somewhat since this sample was drawn, and in particular that the bleeding might actually be less of a problem.

It does probably mean that there’s no further benefit in waiting to take her to the OR; they’re not going to get more information that will improve her chances of surviving it, and in the meantime she’s now been sitting there for over an hour with a nasty gut wound probably leaking bacteria into her abdominal cavity. 

Is the OR ready for her? 

They can be ready! And also ready to take seriously that no really this patient needs her blood sugar checked every five minutes, she’s probably on long-acting insulin or something, and also anesthesia should be really careful about not letting her wake up and kick someone else in the ribs.

To the OR, then! (And there’s a bed ready for her in the ICU, assuming she survives the next hour.)

…How bad is it when they start removing the pressure dressings? 

Less bad than last time! Also her intestines have been leaking remarkably little ick into her abdominal cavity given how many places they've been sliced open in. Her last meal must have been clear liquids or a long time ago or both.

Surprising but convenient! For once something is going right! (...Also that miiiight explain the degree of hypoglycemia?) 

The surgeon focuses on finding and stopping all the sources of bleeding, first, and then on cutting out any non-viable bowel tissue and stitching the remainder back together. The damage is pretty bad; he’ll also find the furthest-down point where none of the bowel loops higher up were actually severed, and pull that through the skin to make a loop ileostomy. If she survives the next few hours and days, they’ll close it up later once the damaged bowel has had an opportunity to heal.

They very thoroughly wash out her abdominal cavity with sterile saline. She’s likely to still end up with an infection, but they’ll load her up with antibiotics as well, and hopefully it’ll be a survivable one.

How does their patient tolerate all of this?

Pretty well, if they keep the sugar coming as fast as she mysteriously disappears it! She doesn't reveal any additional problems or kick anyone in the ribs or start fountaining blood again.

How much fucking insulin did she fucking take. 

...She's alive, and closed up, and has a blood sugar reading above 70 with the heroic administration of, like, at least ten amps of D50. Onward to the ICU! 

Having not yet received a handover from the OR nursing team bringing the patient over, Marian has the following pieces of information about her patient, relayed via from the ER charge nurse via the ICU charge nurse: 

* Young woman, no ID, in the system as Eighty-One, Violet. 

* Found unconscious in the city, brought in with severe bleeding from traumatic injuries, the cause of which was unwitnessed but that looked like an animal attack (?) 

* In cosplay when they found her (??) Possessed of an actual literal sword, like, a sharp one (???!!) 

* Suspected diabetic with suspected overdose on long-acting insulin, and/or she took her normal dose but hasn't been eating? 

* Originally suspected to have hemophilia but it might actually be DIC (aaaaaah!!!) 

* Had been parked in the ER since like 10 am while they tried to stabilize her enough for the OR and figure out the hypoglycemia and clotting deficit; actually went to the OR two hours ago. 

* Blood type A positive. 

She discharged one of her patients this morning and managed to rush the transfer out of her other patient an hour ago when they needed to urgently free up a bed. Room 104 is ready! Marian is ready! 

She looks pretty good for how shredded she got! Completely out of it thanks to the anesthesia, but she's breathing well and her BP is starting to approach the low end of mildly concerning, and the general vibe is of someone who's more likely to get better than worse.

OR report: they dealt with a lot of bleeding (though fewer torn arteries than it looked like at first), lots of damage to the abdominal wall fascia and muscle, relatively minor lacerations to her liver and spleen, and quite a lot of shredded bowel, though surprisingly little of it was totally non-viable. She has an ileostomy, which isn't draining much because there (rather fortunately) didn't actually seem to be very much in her GI tract, and three surgical drains. She has all the usual lines and tubes: central line, arterial line placed in the OR for blood pressure monitoring, nasogastric tube to suction, Foley catheter (urine output has been pretty decent ever since they got her blood pressure to something at all reasonable.) She's intubated, on pretty minimal ventilator support and 30% oxygen, mostly not having any respiratory issues at this point. 

She's on norepinephrine at the maximum rate, dopamine at around 25% of the maximum rate and Marian should stop that first if she can manage it, midazolam at 2mg/h for ongoing sedation, and maintenance saline at 100 cc/h. She got, like, ten units of blood and fifteen units of plasma since her arrival in the ER, and Marian has a standing order to give two more units of blood if her next hemoglobin comes back below 7. Marian can also start a fentanyl drip for pain control if the patient seems to need it, with the following parameters. 

Marian has orders to do a new set of labs now and another set in four hours, so around 6 pm. She also has broad-spectrum antibiotics due at 6 pm. Other than that, there's - not that much actually on the schedule? Mostly just hoping nothing else goes horribly wrong - 

- oh and the blood sugar. They have never actually felt comfortable stopping checking it every five minutes, even if she was only actually needing top-ups every fifteen or twenty minutes more recently. Sorry about that. 

Oh. Also she should probably be careful with letting sedation wear off, the patient kicked a nurse in the ribs and managed to yank out all of her IVs earlier in the ER. 

Okay. That's - actually not too bad. Marian can do this. 

Labs first, then she'll check all her patient's lines and tubes, then - does she respond at all to a cautious painful stimulus like having her nailbed pinched? (Marian is in fact pretty cautious about this. She doesn't mind getting kicked that much per se but she's feeling really protective of her patient's recent OR repair job and all her lines.) 

Nope. Twitching is a free action but she's not even getting those this round. 

Okay. It doesn't seem like she needs fentanyl for pain control yet, but Marian is absolutely going to be keeping an eye on her to gauge if she starts showing signs of feeling pain even if she's not awake yet. Waking up in a ton of pain and not knowing why is a really understandable reason for someone to freak out.

- fuck it's been more than five minutes since she got in from the OR and presumably there was any transit time involved, Marian needs to find a glucometer right now and check her blood sugar. Is her blood sugar okay. 

67 mg/dL. Previous check was 73.

Which the chart confirms was shortly after receiving D50, her last dose if it was in fact right about fifteen minutes ago. Where is she putting it.

Marian runs to get some - no, actually, she'll get, like, five boxes of it - and tops her up again. ...This poor lady's fingers. Marian is actually going to grab a bunch of 1 cc syringes and start using teeny art line samples instead, it's a pretty negligible amount of blood and in any case if they take too much of this patient's blood, Marian already has standing orders to fix that

How are her heart rate and blood pressure doing? Aaaaaany chance Marian can try to gently ease down her dopamine dose? 

Her blood pressure would get a "how are you walking around" if someone was discovered walking around with it, but it's back over 80 systolic and her heart rate is fine. Backing off on the dopamine a tad doesn't cause any problems.

Marian would leave it alone except for how she kind of feels like the dopamine isn't helping that much? Her heart rate and contractility don’t seem like the main issue. And the patient’s blood pressure does seem like it’s getting adequate circulation to her fingers and toes - her peripheral pulses are reasonable, capillary refill is delayed but not that horribly, and the sat probe on her finger is picking up a perfect waveform. If easing it down in tiny increments isn’t making the numbers worse, Marian is inclined to keep at it.

- and check blood sugar. every. five. fucking. minutes -

- and refresh the chart unreasonably often, the latest hemoglobin (and other blood counts) should be back aaaaaaany miiiiinute now… 

Reducing the dopamine continues to work and her numbers don't get worse. Her blood sugar keeps doing the same weird but manageable thing it's been doing. Eventually the blood count comes back with a hemoglobin of 8.5 and a WBC of 13.

Wow, neat, she doesn’t even need another transfusion yet! (8.5 is still technically significantly below normal but honestly by ICU standards it barely counts.) Her platelets also haven’t gotten lower, which is something. (The clotting factors panel is still pending because of course it is, even stat it takes soooo long.)

If all the patient’s numbers are fine, and she still looks comfortable and doesn’t start freaking out when Marian pinches her nailbed again, then maybe Marian will be an overachiever and pull in her pod neighbor (Kristy, today) to help her tilt the patient onto her side and tuck her in with a cozy nest of pillows. She’s been flat on her back for, like, four and a half hours now, a bunch of than on the OR table.

….If that goes fine then Marian doesn’t actually have anything spectacularly urgent on her plate? And maybe she’ll be incredibly proactive and on top of things, and have a peek inside the bag of blood-soaked clothes labeled “patient belongings”. (Minus, apparently, her sword and a shield, which are…somewhere else…Marian should follow up on that but she’s honestly deeply relieved not to have a sword of all things in her ICU room. Where would you put it. She doesn’t think the drawers or cabinets are deep enough.) Anyway, probably nothing is very salvageable what with having been bled on, ripped up by whatever actually caused her injuries, and then hastily cut off by paramedics, but if Marian had a nice cosplay outfit she would want someone to check? Also she’s definitely heard of the ER staff missing a patient’s ID, if it wasn’t in a wallet findable by a quick pat-down of pockets, and it would be cool to know her patient’s actual first name, you know? 

Eighty-one Violet's total worldly goods, with the very important exceptions of her sword and shield, consist of:

- a medallion with an image of a sunburst behind a sword, on a short chain (still on her neck)

- a nice brocaded headband (still on her head)

- a set of seriously torn and bloodstained clothes, apparently hand-sewn of handspun fabric 

- a breastplate and backplate 

- a nice tooled-leather belt (somehow not shredded, but very bloodstained)

- a cloak (likewise)

- leather boots 

- a dagger (found in the boots)

- a leather belt pouch, which is about six inches in each direction and doesn't weigh much, but turns out to be containing:

- a string of prayer beads with the same sunburst-and-sword symbol as her necklace 

- flint and steel

- quite a lot of rope

- a gilded chess set with folded-up board

- a bar of soap

- a packet of tea or incense or something 

- several pieces of weirdly crappy paper, mostly blank but also including a sketch of a person, a diagram of gears, and a half-written letter in an unfamiliar alphabet, plus pen and ink

- a bottle of blue liquid, corked

- a packet containing several steel caltrops 

- a coin pouch with several gold and silver coins, stamped in the mostly-competent manner of historical coins rather than with the perfection of the US Mint, with a guy's head on one side and some more of the unfamiliar writing on the other

And absolutely no driver's licence.

Marian is wearing gloves and put down one of the quilted incontinence pads on the counter to put everything on. She's trying pretty hard not to let anything touch areas not covered by her gloves (and dumped out the little bag rather than stick her hand in it, on the principle that given the surprise dagger in the boot, it might also contain surprise sharps.) 

This is, like, well beyond cosplay! And actually really cool? Is this young woman part of - shit what are they called again, the historical re-enactment people who make their own clothes using historical fibercraft methods and stuff - huh that might actually be a decent way to figure out who she is, if she can find, like, a website with contact info - though hmm maybe she had better leave that to social work or something, it's not incredibly Marian's job and as a travel nurse she doesn't, for example, actually have a hospital email address... 

Anyway, the clothes do not in fact look salvageable (which is sad, because it sure looks like a lot of craft work went into making them) but a lot of the other possessions seem okay, or like they would be okay with proper washing, which Marian isn't going to attempt because they aren't hers. Marian has questions about some of them but mostly of the variety "this person seems really cool and I want her to wake up and tell me about her hobbies." 

She doesn't try to put things back in the belt pouch; she was distracted when she emptied it onto the counter, and now she's staring at the little pile feeling kind of nonplussed about how the hell everything fit, that must have been such a careful packing job and there's no way Marian can replicate it. She...is going to organize the stuff in biohazard bags instead, not because she thinks the items are biohazardous - they're not actually covered in blood - but because those are the bags that are right there in the supply drawer, and also around the right size. 

Ughhhh it seems...really sketchy...to have an actual dagger stashed in a patient room. The problem is that Marian does not especially trust this hospital to have a system for safekeeping hazardous patient belongings that will definitely result in them not getting lost. She'll...carefully put it back into the boot for now, how about that, and put the boots in a patient belongings bag and stuff it in the bottom of the cabinet. 

It takes Marian, like, an hour to get through all of that, significantly because every five minutes she has to swap out to clean gloves and take a blood sugar and about 1/3 of the time she has to treat it with more D50. Does the patient stay basically stable through that whole period? 

Towards the end of that period she starts looking . . . kind of off, in some hard-to-define way. Also she shifts around in her sleep a bit and makes the one noise it's possible to make with a breathing tube in.

...Shit. 

The rest of the stuff does not have to go in the cabinet all nice and sorted, it can get wrapped in the counter incontinence pad and shoved in there to tidy up later.

Is there anything obviously newly wrong with the patient's vital signs, urine output, stuff coming out of her abdominal drains, et cetera? 

Her temperature is 99.8 where she had previously been a bit on the cool side, and there's . . . something grey-green . . . coming out of the abdominal drains.

Shiiiiiiit. 99.8 isn't a fever yet but it sure is warmer than she was running before - in fact, Marian can check the history and note that her temp is up nearly a degree in the last, like, ten or fifteen minutes. 

...Also WHAT THE FUCK is coming out of her drains. Seriously, what is that??? Bile?? That would already be super worrying, since it would mean that something opened up again in her gut or that they didn't successfully patch all the damage in the first place, but it's not even really a normal color for that. 

Marian sticks her head out the door. "Kristy! Hey! Can you, uh, go find a resident right now to come look at something?" - also, separately, the patient looks like she might be starting to wake up, or at least be uncomfortable? "Oh, and can you pull a bag of fentanyl for me and bring it to cosign?"

And then she’ll do a neuro assessment. She stands at the head of the bed and reaches to take the patient’s hand. “Hey! Can you open your eyes for me?”

At some point the sedation transitioned into regular sleep, but Marian touching her hand wakes her up. 

She orients more quickly, this time. Everything is the same but she feels differently horrible and is more effectively strapped to the surface she's on, which is completely to be expected. Maybe if she pretends to be worse off than she is she'll get some time unobserved to start working on the restraints. Her eyes open just a crack, enough to get a blurry sense of the general sort of room she's in, and then fall shut again.

Okay, that looks like - a little more responsive, which is a good sign, but not fully conscious yet? 

How much does she respond to having her nailbed pinched? 

They won't catch her out that way; she's had way worse. She barely twitches.

(The Inheritor gave Samora the powers She believed would be the most effective, and Samora will not question Her wisdom, but it would be really nice to have a paladin's perfect fearlessness right now.)

In that case Marian is going to go on believing her patient is mostly unconscious! Though, like, surprisingly so given that Marian is pretty sure she was moving spontaneously at least a little bit? 

…She’s still going to talk to her, though. “Sorry about that. My name is Marian and I’m your nurse - you’re in the ICU, you were badly hurt and just had surgery - we’re going to give you something for pain, okay, so you'll be more comfortable..." 

Kristy and a bag of fentanyl and IV tubing make it over well before a resident does to look at the horrifying drainage. "Hey, sorry, they're doing a procedure in 101, it'll be like five minutes." 

Marian would prefer SOONER THAN THAT but sure, okay, the patient is not in fact unstable at this point there’s just clearly a problem. “Uh, I think the order parameters start at 25 mcg/h but that’s, like, almost homeopathic, I kinda want to start at 50 and go down if her blood pressure isn’t coping…”

Samora lies motionless and attempts to assemble various facts into a coherent picture. She's restrained and has various devices attached to her. None of the people who have come near her while she's awake read Evil, and none have reacted at all to her Protection from Evil aura (which was down while she was actually unconscious, but is back up now). They've taken her weapons, armor, boots, Cloak of Resistance, and Belt of Strength, but not her Headband of Wisdom or her holy symbol. That last makes no sense and if she was a little less drained and exhausted and a little more cunning maybe she'd be able to figure out why. Did Tris do something to disguise them somehow, but wasn't able to get her out? Is someone here trying to help her? The person who spoke to her in a strange language had a kind voice, and picked an oddly harmless way to hurt her, but that's not enough evidence to trust her.

Kind-voice fiddles with something and there's a weird sensation from the tube going into Samora's arm. A few minutes later, she feels . . . less pain than she was previously? That's unexpected and probably good but she goes over all her thought processes with a suspicious eye, looking for anything that might be the result of a mind-affecting potion. Everything seems fine, but she can't be certain of that; her will has to be seriously weakened right now. Still, it's a piece of evidence that kind-voice might secretly be on her side. If only she could recognize that language--it's not Taldane or Celestial, she's heard enough Necril to be pretty sure it wasn't that even though she only knows like six actual words of Necril . . . maybe it was Undercommon? This sort of thing was always Tris' or Marshall's job, and she simultaneously wishes they were here and hopes they're safe in Otari.

It's more like ten minutes before anyone comes to see her patient. Marian paces and takes another blood sugar and watches her patient's vital signs closely. Is her blood pressure holding up with the fentanyl? Is her temperature stabilizing at 99.8 or continuing to go up? 

- she also obsessively refreshes the computer, and will see right away when the repeat coagulation panel comes back. 

Her blood pressure is stable, but her temperature is up to 100.4. The coagulation panel looks a lot better when it finally arrives, though.

That's...confusing (DIC does not normally get better) but Marian is certainly not complaining. Maybe the first set of tests was wrong somehow - no, she also got in report that the patient was in fact bleeding uncontrollably with basically no clotting activity - and the D-dimer is still positive... Shrug. Right now it's not something wrong and other things are wrong and it can wait. 

A harassed-looking resident does eventually arrive. "Someone said you were worried about the drainage, is it– holy shit, what is that?" 

"I don't know! I noticed it pretty suddenly, like, ten or fifteen minutes ago? She's spiking a fever and looks - worse -" 

Wow. Okay. He...had better have a look at the incision site? 

Her incision site is also weeping horrible slime! When the dressing comes off and some of it hits the air they will discover it also smells like something fell in a bog and died.

(Samora hears a new voice say something shocked and the potential-ally voice say something nervous and then one of the horrible devices stuck in her is prodded and it smells like one of the necromancer's disgusting puppet creatures. She holds very still and has an internal debate with herself about whether, should the two people start fighting, she should (or can) attempt to intervene on kind-voice's side.)

That’s so alarming and upsetting! Marian has about 10% of a normal human sense of smell (honestly fortunate in her line of work) and even she can smell it, and bile does not smell like that! Nothing she’s ever seen come out of a human body smells like that! Aaaaah! 

The resident swallows hard, like someone unfortunate enough to have nausea hooked up to his sense of smell. “Oh. That’s - bad. I…think I should go get Dr Harrison.”

“Yeah. I think you should do that.”

Thoooough from experience, that might still somehow take another ten or twenty minutes.

“- Uh, I think we should do another set of labs.” It’s only 3:45 pm but she does NOT want to wait until 6 pm. “And should I give her another liter of fluids? Her BP is already marginal and if she’s going septic now…”

At least she already has orders for a second pressor, and if she’s remembering right, dopamine is maybe actually pretty good for sepsis? 

“- oh and IV Tylenol? Her temp is going up really fast and I don’t have anything ordered?”

“….Uh, yeah, that sounds good.” 

The resident leaves.

Marian is going to put in verbal orders and then do everything she can without leaving the room, which involves drawing labs - tubes are in the top drawer, though running low - and hanging another 1L bolus of saline in a pressure bag, using the replacement bag she had hanging for maintenance fluids. 

…Oh and she should probably cover up the disgusting weeping incision site before she leaves the room to send the lab tubes and obtain IV Tylenol. She still has no inkling that her patient is anything other than thoroughly sedated on 2 mg/h of midazolam and 50 mcg/h of fentanyl, but she still reflexively apologizes and explains what she’s doing, since if the patient were awake she’s sure it would really fucking hurt. 

- and then she does actually have to leave. Hopefully it’ll only be for, like, 90 seconds? The patient’s vital signs are still unchanged except for her temperature, and if she does suddenly start crashing, the alarms will go off at the nursing station as well as here.

She does not start crashing! She counts the desired number of sets of footsteps leaving the room and the door closing, opens one eye a crack and pretends to shift in her sleep enough to become confident the room is probably empty, then takes stock of her situation in more detail and starts working on her restraints. By the time Marian gets back, she's gotten her arms free, pulled out her breathing tube and art line, ripped the central line tubing apart between the pole and the taped area rather than spend time figuring it out, and is in the middle of figuring out what in blazes is going on in her nether regions. 

(Also, she had a look at the rest of herself, and whoever pulled a chunk of her guts out and sewed it into place like that can rot in the Abyss.)

What the - 

- all right, focus on the priorities -

There are basically no vital signs up on the monitor except temperature (it’s the continuous Foley catheter probe and the patient seems inclined to go for that next but hasn’t, in fact, yanked it out yet.)

Marian doesn’t have a BP reading because the patient ripped out her art line, but the bleeding from the art line site doesn't look too horrific and clearly she in fact has a BP sufficient to be awake, sitting up, and pulling out tubes. She super doesn't have a SpO2 reading and she's worried about that, given how the patient also clearly just self-extubated, but it's probably not life-threatening on the scale of seconds or even minutes, her main problems aren't respiratory. The heart monitor tracing is confused and showing only artifact but clearly the patient's heart is beating. 

All of this goes through Marian's mind in less than two seconds, and then her main concern is the central line, which is a) slowly leaking venous blood out the broken tube ends, and b) no longer running the fluid bolus, or the still-maxed-out norepinephrine drip that was keeping the patient's blood pressure up until now.

Actually the main problem here might be that the patient seems disoriented and terrified and is probably going to kick Marian in the ribs if she tries to get any closer to deal with this situation? 

This is going to be self-resolving, if her blood pressure drops enough now that she's not getting any fluids or pressors, and also they can't keep giving her IV dextrose shut up Marian's brain, that is a BAD solution. 

...She's going to approach slowly, hands held up and looking as calm as she can manage given how not-okay the situation is. "Hey, I need you to calm down - you're in the intensive care unit, you just had surgery - you were getting some drugs to help your blood pressure and I really need to fix your central line so I can put that back -" 

Okay, that's pretty good evidence that kind-voice is willing to ally with her, which makes the language issue way more pressing. She makes the I'm-not-armed gesture back.

"I don't speak that language. Do you speak Taldane?" And then in Celestial, "Do you speak Celestial?"

(She's handling the sudden absence of pressors fairly well, for the moment, thanks to the home-made adrenaline.)

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.

Kristy will get her writing implements!

Marian brings them to Samora, looking apologetic about the delay. She’s trying to think of things she could draw to explain, but she’s not sure where to start.

Writing implements! Excellent both in themselves and as a further sign of friendliness. They're really weird writing implements, but it's not hard to figure out how to get them to work. 

The first thing she wants to know is where am I. She draws the haunted lighthouse, and a line for ground level, and seven floors of basements with a sword-wielding stick figure in the sixth one, and then the stick figure again horizontal with a wavy line of bloodstain around it, and then an arrow pointing away from the downed stick figure, and hands the clipboard and pen to Marian. She's expecting an answer like "down two more basements" or "through a secret door" or similar but maybe she's farther afield than that, the walls aren't even stone.

????????????????????????

....Okay, Marian has spent a full ten seconds staring at the clipboard and, nope, she's got nothing. 

...Maybe Samora is trying to tell her the last thing she remembers - how she was injured - and asking what happened after that during the interval she probably doesn't remember most of? That would make sense. In theory. The specific drawing makes no sense because, while Marian isn't sure where exactly the patient was found, Reno does not as far as she knows contain any creepy fucked-up towers with unreasonable numbers of underground floors. If she's even interpreting the drawing right. 

She turns over a new page and, tongue between her teeth, sketches an ambulance - trying to distinguish it from just a truck by adding the lights on top with rays around them to try to indicate flashing, and a hopefully-at-all-recognizable attempt at the Star of Life symbol with the caduceus inside it that ambulances have on the side. The ambulance can get a drawing of a gurney inside with a stick figure on it with, uh, a bandage around the stick-figure-middle and a blood pressure cuff on the stick-figure arm? And then she draws an arrow and a building with a red cross symbol on it to represent the hospital? 

Does any of that look like it's reducing Samora's confusion at all? 

So she's not under the lighthouse anymore, then. That's . . . disorienting. Might be good, might be bad. She considers asking if Marshall and Tris are here too, but decides she doesn't want to share any information about them in case they're not here and are planning to rescue her.

She draws a rough map of the inner sea, with the Isle of Kortos especially large and detailed to cover the case where she's still on it and the case where she isn't. Then she draws another stick figure in the corner, carefully tears it out, and presents both it and the map to Marian.

...Marian had not thought she could get more confused than she already was, and yet! 

That's - clearly a map. It's not a terribly drawn map, honestly, it's way better than Marian could do herself. It is absolutely definitely not a map of North America, assuming the middle is in fact ocean. Marian is embarrassingly bad at geography and - isn't sure whether she recognizes it? It's maybe familiar? 

Uh. She's going to sanitize her hands and then get out her phone and go zoom out all the way in Google Maps and scroll around looking for - 

- okay, this patient cannot possibly have been in the Mediterranean sea region the last she remembers? - well, it would explain the not speaking English but it absolutely wouldn't explain how she came to show up in Reno - days of amnesia without other deficits is much more a thing in the movies than real life, and Samora didn't even have a head injury. 

Marian is so confused but she'll show Samora the screen of her phone, point out the area the looks kind of vaguely like the map she drew while making a questioning face, and then - where Samora can see it - scroll with her fingers all the way back to North America and zoom back in until Reno is visible, at which point she points at the Reno dot and then gestures at the room around them? 

Samora is technically not completely out of spells. She makes a gesture Marian will have absolutely no chance of interpreting, says a few words exactly as incomprehensible as all the previous ones, and looks utterly boggled when the phone proves to be totally nonmagical.

She wants to take the thing and poke at it; can that happen?

Marian has never actually handed her phone to a patient before! Part of her brain is objecting but it seems to be the same flavor of objection as handing it to a toddler, which is stupid. And it might be against hospital policy or something, and what if her colleagues notice and judge her about it - that's not completely stupid but it's not like it was covered in orientation - it's arguably unprofessional but it's not like Marian is showing Samora her personal emails, which Samora wouldn't be able to read anyway due to clearly not speaking any English. 

...She also has the more pragmatic objection that there sure is disgusting slime coming out of the patient's abdominal incision and, uh, she doesn't know that her patient didn't touch it in the process of removing various tubes. - ugh, whatever, she'll just sanitize it really well afterward with alcohol wipes, it'll survive. Samora can poke it. It seems - important, both to figure out what the heck is going on here and because Marian has been working quite hard on Building Trust with this patient, who seems really freaked out by everything happening. 

Samora attempts to scroll back to look at Avistan, activates the pinch-to-zoom by accident and is fascinated by it, tries and fails to find the Isle of Kortos, then accidentally hits the home button and stares in confusion at the grid of icons. After some staring and poking that ends with opening Google Docs, she hands the device back to Marian, because despite not being detectably magic it is clearly Complicated Wizard Business and she's not wizard material. Also her next question is important and will take a while to draw.

Marian watches her poke at the phone in almost equal fascination. Has she never seen a smartphone before? Is she, like, somehow from some country (perhaps in the vicinity of the Mediterranean) that doesn't use phones and doesn't have modern hospitals? What countries are near there, are any of them super poor? Or maybe she's a time traveller shut up Marian's brain. 

She puts gloves on to retrieve the phone and scrubs it with the antibacterial sani-wipes (hopefully they won't mess up the screen permanently?) and then wipes it down with alcohol swabs. Samora can have the clipboard back while she's doing that, if she seems to want it? 

She does want it! She spends a long time with it and then shows Marian this.

She points at herself, emphatically taps the top left symbol, then gestures at the whole top row more broadly, then points at Marian and holds out the sheet to her with a deeply serious expression.

(Internally she's apologizing to Shelyn for the terrible sketch and wishing she remembered any of the other Tian or Vudran deities' holy symbols well enough to draw them, and wondering whether she'll be able to notice if Marian lies.)

What????? 

Clearly this is really important to her patient!! Marian feels really terrible that she has NO FUCKING IDEA what the question is! 

She takes the clipboard anyway and stares at it. What. Why is there a grid. What do any of the items drawn (some of which she can't actually recognize as objects per se) have to do with each other. Is this, like, one of those brainteaser puzzles where she's supposed to figure out which of the boxes is not like the others? Why is her patient giving her a confusing riddle as though it's the most intensely serious thing in the world??? 

Nope, sorry, she's still got nothing. She shrugs helplessly at Samora. 

...Actually, is Samora going to object if she takes that sheet of paper off the clipboard and brings it to the door to see if Kristy, who's just getting back from the clean utility room, has any idea what the heck? 

Oh no, they do have different gods in Arcadia. She's fine with Marian taking it; maybe whoever she shows it to will recognize Pharasma or Abadar or Sarenrae at least. (Also she's kind of glad she didn't put much effort into the Asmodean and Kuthite symbols; she wouldn't want anyone who hasn't looked at her getting confused about which ones she thinks about regularly.)

Marian smiles at her, leaves the clipboard and pencil assembly with her in case she wants to make a second attempt at conveying whatever-it-is, and takes the drawing to the door. 

"Kristy, uh, hey - oh, right, you were going to look at the orders - one sec, can I get you to look at this and say if you have any idea what it means? She spent, like, five minutes drawing it..." 

Kristy frowns at it. "....Huh. I don't know. Maybe it's a personality test thing? My dad really likes this personality test thing that has nine types of people..." 

"The Enneagram? I don't - hmm, maybe -" Marian is going to stare at the paper in renewed concentration. "Ugh. I guess swords and bows could sort of be thematically about Enneagram Type One." However, she has no explanation for why her patient would, with deadly seriousness, try to exchange their Enneagram types. "...I guess you could say Enneagram Threes are party people but I don't think Eights are spider people - actually I don't know if that's how the boxes would be numbered, I've only seen the Enneagram in a circle. I think it's probably not that, sorry..." 

Shrug. "Should I go ask Ameera, she was about to go on break? -" 

This is apparently a fascinating and fun distraction, because within a couple of minutes there are, like, six nurses hanging out in the vicinity of their pod, passing around the sheet of paper. 

"Maybe it's like that meme where you pick your spirit animal -"  

     "Wait, what meme?"

"It's on Tumblr." 

     "I don't think anyone's spirit animal is 'the letter X'..." 

"Uh, is top middle - sorry, the one beside the bird - literally meant to be a clitoris -?" 

....Okay this actually seems like a distraction from Marian's more important priorities, which include finding out from Kristy what new orders she has and whether there's a plan for what to do about the patient's horrifying abdominal ??infection?? 

(The patient seems bizarrely unconcerned about her horrifying abdominal infection! If Marian had goo leaking out of her that smelled like bog death she would be way more concerned about that!)

Dr Harrison wants to send a wound culture and blood cultures from two sites and a repeat blood gas and lactate if that’s not already done, and add vancomycin to her antibiotic cocktail pending the culture results, and get an abdominal CT with contrast. 

And then probably back to the OR tonight? Dr Harrison probably didn't say because he's terrible at communicating his plans ever  it seems like it's pretty obviously indicated. Ugh. 

...The much more immediate ugh is that she has to draw blood - multiple times, they need the arterial sample too and she doesn't have an art line to draw from anymore - and Samora seemed really unhappy about it when she was just using blood already leaking out of her to take a glucose–

–also FUCK she's got to be like ten minutes overdue on taking another blood sugar. 

One of the residents - not the one who was previously freaked out by horrifying wound drainage - comes over with the paper. "I swear this thing is, like, the weirdest version ever of the sandwich meme?" 

Blink. "The sandwich meme?" 

"Have you not seen it, it was getting shared all over Facebook and there are all these spinoffs of it - here, one second, I think I can probably Google it... Uh, I think this isn't the original but close enough?" 

Here is the sub alignment chart meme for Marian's enlightenment! 

That is not enlightening!!! It sure is a grid with the right number of boxes but other than that she's not really seeing it! Why would her patient be choosing to communicate in baffling meme format??? It's going to be really upsetting if she turns out to not get the reference her patient considers critically important because she hasn't spent enough time on social media this year

...It feels like she's missing something but she's way too tired for this and needs to call Radiology and find out when they can take her patient. 

It's probably not actually the sandwich meme but it would be sufficiently an incredible story if that turned out to be the solution to their surprise puzzle of the day, that the resident is going to go over and show the patient the picture up on her smartphone, and then make a questioning face? 

Oh no, unfamiliar person! But this one also doesn't attack her, so that's fine actually. She will look at the new person's strange device. 

. . . Why do Arcadians represent their alignments as bread?

Samora stares intently at the chart. Bottom right looks more like a sea monster than bread, bottom middle is unidentifiable but probably inedible, bottom left is . . . food in a box? Food in a trap? Food being eaten by something? Middle and middle right are probably food but questionable. Top row and middle left are all on a unified theme of wholesome-looking bread and vegetables. Given that, her best guess is that these people also tend to draw the Outer Planes with Good on top and Law on the left. She wobbles her hand to indicate uncertainty and then tentatively pokes the top left box, watching the woman's reaction carefully.

The woman smiles and nods at her, mostly because it’s neat that this interpretation wasn’t immediately rejected, but - is still not actually sure how much it solves the mystery here?? The sandwich meme chart isn’t a coherent question?

- also there’s an alarm going off that definitely sounds like the CRRT machine for the unstable patient in the pod next door and she should probably go.

Kristy brought her everything she needed from the clean utility and med room, and Marian is going to hurriedly hang fluids and vancomycin and IV Tylenol (what’s Samora’s temp up to?) and then - probably it’s least stressful and scary to start with the blood sugar fingerstick, since her patient has at least seen the glucometer in action before. Also it's actually pretty time-sensitive and she really hopes she doesn’t have to spend five minutes doing bad drawings to reassure Samora about it…maybe she can stick her own finger first, to show that it doesn’t bleed very much…?

Samora's temperature is up to 100.8, and she puts up with the finger stick (45 mg/dL) largely because, once she paused in her efforts to establish communication with these people, her level of exhaustion started catching up to her. She doesn't, generally speaking, need to sleep, and it's not safe to sleep here, but she switches from sitting up to lying down.

She's probably got dungeon fever again, hasn't she. It would explain the foul-smelling slime. Another thing to deal with when she has spells. She has no idea what time it is, but you know what they say, it's always less than a day until dawn.

Wow she does not look great– ...okay yiiiikes at least part of that is because Marian really should not have waited this long to check her blood sugar and now she's playing catch-up again. What if she gives two syringes of D50 this time and then sets an actual fucking alarm on her phone for five minutes from now, what if that. 

…And now she needs to try to communicate why it’s very important that they take some blood cultures, which is going to involve poking her twice and removing a much more alarming quantity of blood.

She’ll take a piece of paper and draw on the counter so she can take her time at it. Person with stitched-up wound leaking slime, magnifying glass schematic pointing to a circle with stylized wiggly bacteria in it? Then she’ll draw a stylized needle and bottle (she can clarify by holding up the actual sample bottles) - arrow to a Petri dish and zoom in on bacteria - then an IV bag of drugs and a Petri dish of scribbled-out dead bacteria, and st the bottom a drawing of a person sitting up and smiling with no more wound leakage?

…Ugh, that’s probably not clear at all to someone who didn’t seem to know what a blood pressure cuff is? Marian just can’t think of a different way of conveying it other than silly metaphors that only feel appropriate for six-year-olds. Eh, she’ll try it and see if Samora seems reassured?

. . . They think she's got worms and want to do something about the worms? Samora remembers the Worm-That-Walks and thinks that's a very reasonable desire, assuming Marian is telling the truth about wanting fewer worms rather than more.

She's starting to entertain the hypothesis that the box on wheels from the earlier drawing represents one group of people, maybe related to the necromancer from the dungeon, who initially grabbed her and put the thing in her guts, and the building with the + on it represents a different group of people who rescued her from the first group and are trying to undo what they did. It would explain why she still has her holy symbol and her headband, which are definitely the highest-priority items to grab when rescuing her if you don't know she has a backup tattoo and can't tell a masterwork silver sword from a merely good sword, and why they're doing things that make her feel better. It doesn't explain why they haven't brought her to a priest and had her fixed up. Maybe this part of Arcadia is like Rahadoum, and these people object to that and want a priest? It would explain all the effort they're putting into someone who fundamentally isn't that important, if she's the only priest anywhere nearby. Or she could be totally and completely wrong.

She lets Marian take her blood and then considers going for the pencil and paper again to explain how healing works. In the case where they know how it works but not that Samora is an empowered priest, or vice versa, and they can't be trusted, it's a bad plan. In the case where they know at most one of those things and are trustworthy, it's a good plan. If they know both of those things it's a waste of effort whether she trusts them or not. That seems to add up to don't explain, maybe even don't ask how long it is until sunrise, because they can't make sunrise come faster but could keep her unconscious through it. Instead she points at the catheter setup where it's trailing out from under her hospital gown and gestures an emphatic ''???!".

Oh. Fair question, honestly. Though it's going to get pretty frustrating if she has to explain everything by playing Telestrations before she can take her patient for a really urgent scan  though if Samora does start crashing and going into septic shock, this will again become a self-resolving problem

Marian can pick up the catheter bag from where it's hooked to the bed and show her the accumulated pee in it? 

...Possibly that's still, like, insufficiently as an explanation for why. Marian will flip her paper over and do a much hastier drawing of a person flopped with their eyes closed on a bed in a wavy puddle of pee, with a sad face beside it, and then a person with a catheter bag instead and a happy face beside it? 

They thought she was going to piss the bed in her sleep?? Why would she do that?? She draws a (very low-detail) sketch of someone using a chamber pot and mimes pulling the catheter out.

Because she was unconscious! Also her blood pressure is still pretty marginal and her blood sugar keeps tanking and she has an infected abdominal wound that must hurt like hell; Marian does not at all feel comfortable about letting her stand up, and would have thought Samora would prefer not having to move too much.

(Also there’s the much more difficult-to-draw concept that when people are very sick - especially with hypovolemia and persistently low blood pressure followed by an infection unpleasantly near their kidneys and likely to progress to sepsis if it hasn’t already - you want to closely monitor their urine output. Though it’s true that Marian hasn’t had any specific reason to be concerned, so far, Samora’s hourly urine output has been basically fine even with a systolic blood pressure in the 80s.)

Ughhhh. Marian is - not sure this is a battle worth picking? But also it's not actually that she feels totally comfortable on a medical level discontinuing the catheter (and, among other problems, possibly having a sicker, more disoriented Samora later trying to get out of bed to pee when she really, really shouldn't, not to mention missing early signs of her kidneys crapping out from the infection), it's just that it's socially awkward to push back for reasons the patient probably won't follow, and she's really tired of navigating - all of this - and she just wants to get to the freaking CT scan but that's kind of a lot to ask of a patient who clearly continues to be really stressed about the entire hospitalization experience. 

...She's going to sort of nod and shrug and then hold a finger up in a "wait" gesture and go to the door. "Kristy! Um, can you go ask a resident if - the catheter is really bugging her and I think she'll have an easier time with everything else if we discontinue it - can always put it back when she's under in the OR if it seems important..." 

Kristy looks a bit nonplussed but nods and goes off, and Marian heads back over to Samora's bedside. Dooooes Samora seem to have picked up on "we're talking about removing the catheter but need to confer about it" or does Marian need to draw that too? 

No, she gets that these people are working together and consulting each other. And she's willing to wait, because she isn't going to be able to put up a reasonable escape attempt until tomorrow even if she determines one is going to be necessary today, and doesn't want to make it clear how highly she's prioritizing "having as few things as possible between her and the ability to make a run for it" until and unless she's doing that. What's the next weird thing Marian wants to do?

Oh good that’s slightly less awkward than Marian was afraid of!

She needs to take a sample from the drains, which she’ll convey by pointing at the same infection-treatment-drawing and then miming what she’s going to do with the specimen container and the drain before she actually does it? Hopefully Samora won’t object to this? It feels like it should be fairly obviously related to treating the infection and also not too threatening?

(She double gloves to do it, so she can shed one glove layer and still be gloved to put the specimen jar in a biohazard bag. Marian is not normally that easy to gross out but the slime is doing it! It's really concerning! Possibly the patient should be in contact iso, it would be one thing if it were contained in the drains and dressing but there's kind of a lot of slime...) 

She gets those sent and now she needs to figure out how to explain why she needs to take an arterial sample, which is– oh shit her alarm is going off in her pocket and she doesn't want to touch it to turn it off yet because her brain is sort of pre-emptively declaring this an iso room and insisting that her hands are Not Clean by definition as long as she's physically in the room. ...that's stupid, she'll hand-sanitize and then turn off the phone alarm and take. another. fucking. blood. sugar. She really hopes Samora will let her do it again because she's not sure she has the wherewithal to have a Pictionary negotiation about it. 

Everything is taking so long and she's starting to actually get pretty stressed about bringing a patient with this much shit going on to Radiology. Uh. What are Samora's vital signs and blood sugar like right now? Does looking her over give Marian a feeling of doom about leaving the unit? 

She's not going to start objecting to anything she was previously fine with unless she thinks of a new reason it's a bad idea. Her sugars are holding up okay, and her vital signs are fine except her fever is up to 101.3. She looks--kind of awful, though, mostly because of the slime but also pale in the face and slumped tiredly on her pillow.

Marian seems stressed, and Samora apparently has her classified as sufficiently probably an ally that this is her problem now. How to be reassuring without a language . . . ah, there's an idea. Samora says something and does another set of inscrutable gestures and Marian suddenly feels as though whatever she does next she'll be unusually good at it.

It’s not even slightly going to occur to Marian that the feeling is related to the inscrutable gestures! Maybe she’s finally getting enough of an adrenaline boost to outweigh the fact that it’s approaching 5 pm and her brain is kind of fried, significantly from the taking blood sugars every 5 minutes for like three hours, she had not realized how incredibly over that she was going to get by now.

She looks at Samora. She has - moderately doom feelings, but she actually feels like a half-hour field trip outside the unit will probably not be a disaster right now? So she need to figure out how to convey that they need to do that, and stretch goal convey why they need to do it. (…She kind of wants to prioritize that above the blood gas? Samora’s problem really doesn’t seem to be with breathing, she’s pretty sure Dr Harrison only wanted it because of the self-extubation, but without an art line to draw from it seems like a worse tradeoff of scary-for-the-patient versus actually medically useful.)

Clipboard. Pen. She can do this.

She draws a person on a bed again, this time from the side so she can draw the abdominal cavity as having actual area and circle it - she can put question marks to indicate that they don't know how bad things are in there - no damn it, Samora might speak a language with a different alphabet - she will shade it out and then point and make a questioning-shrug-expression. 

And then draw a box-room around the bed and a windy arrow from the person in bed down the page to another box-room; she mimes footsteps with her fingers along the windy line to try to convey "we're going there" (hopefully Samora won't think she has to walk there??) She draws a narrow rectangle below a cylinder, and a stick figure person on the rectangle and then another arrow and them in the cylinder. She draws a big stylized eye above the cylinder and then an arrow down and circling the stick-figure's middle.

...okay, now can she convey "and if it's really bad we might need to go straight to the OR", because it would be so awkward if it is super bad and they do need to go straight to the OR and she hasn't...communicated...this... 

- new sheet of paper. She hastily draws two versions of person-in-a-bed-from-the-side at the top of the page. One of them can get some squiggles to indicate intestines and a smiley face underneath. The other one - can get Marian's best attempt at squiggly guts with a couple of obvious breaks and little rays to indicate leaking, and lots of stylized bacteria, and a frowny face underneath? 

And that side of the paper can get another arrow down to another room-box, and a person-figure drawn from above so she can show the incision being open and, uh, draw some disembodied hands stitching together a break in the squiggly guts, and an arrow going out into a cylinder-bucket where the stylized wiggly bacteria will go? And then she just barely has space to draw another arrow to a person-figure with the incision stitched up again, who now has smiley face beside them? 

They want to look for worms in her guts and . . . cut them out? And then sew her back together??? That seems really excessive and like it's worth explaining how she works just in case they're friendly and doing this because they have no healing and don't know she has it.

She draws herself lying down, an hourglass with sand going through it, the sun coming up, herself kneeling with the sunburst-and-sword symbol above her head, and herself standing up smiling. And then adds herself surrounded by lying-down people with frowning faces and radiating little lines, and herself surrounded by standing-up people with smiling faces, for good measure.

Marian doesn’t look delighted about waiting while Samora draws something, but she’s gone this far trying really hard to respect her patient’s preferences and it’s not urgent on the level of two minutes to get out the door to Radiology. 

- okay, except she has no idea what the request is that Samora is trying to make via that particular drawing??? Something about tomorrow morning and - that she’ll recover then? And so will the other ICU patients? Why does she have a spiky thing above her head??? (Marian did not in fact spend enough time looking at the grid-chart to memorize all the symbols and has honestly barely paid attention to Samora’s necklace, it’s not in the way or administering drugs or reading out vital signs so it’s not important.)

Also, honestly, even if hypothetically Samora did somehow correctly know that she would recover tomorrow morning, Marian really doesn’t want to wait that long! That’s twelve hours away! Marian is not 100% sure that she’s on track to survive the night if they don’t do something about the horrifying infection!

She nods seriously, but then points at the hourglass drawing, stretches her hands apart, and tries to convey via eyebrows that that’s too long. She retrieves her own drawing and points at the CT image more emphatically.

They want her functional, but in a hurry? She's not going to be of any use to anyone until tomorrow unless they get her halfway healed and stick a sword in her hand, but okay. Heaven knows she's been the one telling other people things were urgent and they had to press on enough times. They can go to the place with the eye machine.

(She misses her party and their smooth coordination, how they shared a common language but could communicate without it in the heat of combat, how much easier it was to make decisions she could be confident in with two other people to discuss them with. She'll Sending them tomorrow and find out if they're okay.)

Marian has no idea this is Samora's interpretation of the urgency and would be so concerned if she did!

She's going to call Radiology again and double check that they are, in fact, ready for her if she heads over now. She's not delighted about doing it alone but the rest of the unit is clearly not in any shape where a second nurse can go with her, there are a bunch of alarms going off in an adjacent pod so it doesn't seem hopeful she can get one of the residents, and calling for a transport tech always adds a random wait somewhere between five minutes and half an hour. She will wrestle the norepinephrine IV pump and the pump running vancomycin onto the bed pole, pull out the monitor cassette (the ICU ones come with a tiny screen, and given that she basically only has an O2 sat and temperature reading with intermittent BPs, that seems fine and she's not going to bother trying to track down the portable transport monitor), and disconnect everything else, the saline bolus and the IV Tylenol are done. Not that it seems to be doing much about Samora's fever yet, which is pretty concerning. She shoves an oxygen mask still in its package into the holding space under the bed, just in case Samora picks the next twenty minutes to start having trouble breathing. 

- glucometer and her Styrofoam cup of test strips and fingerstick thingies plus two boxes of D50, that's important. She'll throw a sheet over Samora just because no one in the hallway needs to see all that slime. They should take the clipboard obviously. That - seems like everything she's likely to urgently need? 

The trip out of the ICU involves walking past the other two rooms in their pod, and also the rooms in Pod One.

The rooms have glass sliding doors with curtains, most of which are fully open, and there are more people in beds with tubes connecting them to various equipment. Most of them don't look particularly conscious, but 102 is sitting up in a chair beside the bed and watching TV. 101 is mid getting a blood transfusion; there are a couple of empty blood bags and two nurses busy signing off on a fresh bag before they hook it to the tubing to start running it into the patient. ...Also the thoroughly unconscious and intubated patient looks pretty awful and his head is wrapped in bandages. 

Oh no???? She can't tell what's happening to that person but it doesn't look friendly. She wants to cast Resistance on him but it's touch-range. She goes for Stabilize instead; it won't help if they're trying to kill him, but it'll make them less likely to kill him by accident before she can come back and see if he needs rescuing.

Marian noticeably gives the room a worried look - it sure looks like they could use help, it’s terrible how she absolutely cannot stop right now - and then they’re past the room and she badges them out the double doors into the hallway.

The hallway isn’t too busy.

- however, one of Marian’s colleagues from 6C Cardiac/Medical ICU is outside with a transport tech and a patient.

This patient isn’t actually attached to any especially horrifying devices! He has an IV and an oxygen mask and that’s it! He’s just a frail-looking older man who is pretty clearly in pain and having an enormous amount of trouble breathing and in general looks very ill.

Oh noooooooo and Marian called first and everything to make sure they were free, she should get dibs.

She clears her throat. “Rose? I - what’ve you got—”

Rose gives her the tired look of someone who really wishes this weren’t happening two hours before she gets to go home. “New onset respiratory distress and chest pain, suspected PE but he’s DNR no intubation.” She glances at Samora. “Uh, you?”

“Uh, trauma, post-op for perforated bowel and now she’s got some kind of horrifying infection.” And her vital signs are still technically okay and maybe Marian should let them bump her but aaaah the spiral CT to check for a pulmonary embolism takes like ten minutes and she hates not being in the ICU.

Samora is of course unable to follow this conversation but she'll cast Stabilize on the unconscious person, because he looks like he might need it even more than the previous one. (What is this place. It's either some kind of terrible temple-substitute for a country with no temples or an Evil wizard's torture-laboratory, and she hates that that's a pair of things it's possible for something to be ambiguous between.)

Rose makes an unhappy face. “Sorry, you must be the one we’re bumping - she does look like she might be septic…”

“You should go ahead,” Marian says. “If your guy’s no intubation.”

“Your girl is already maxed on norepi, though?” Rose, who’s just realized that they’re Talking About A Patient Like She Isn’t There (and has no idea that the patient doesn’t speak any English), offers Samora a reassuring smile. She glances at the monitor. “…And my guy is satting fine, apparently.” 

“Her BP hasn‘t actually gotten worse, she’s been on that all day.” Which doesn’t overall make the situation better but it does feel like it makes it less urgent? “I really think we’ll be okay for ten minutes out here, you should go.” 

…Yeah that’s all the back and forth Rose feel like doing, and the previous patient (an older woman with basically nothing attached to her except an IV) is waiting now. She’ll go in next.

Great and now Marian gets to face the consequences of her choices and stand around in a hallway for ten minutes with a patient who definitely isn’t stable.

….she’ll take Samora’s blood sugar again. How are that and her other vital signs doing?

Her blood sugar is doing its usual thing of steadily vanishing into nowhere, but the Tylenol has apparently gotten on top of her fever because it's back down to 100.2. The disgusting slime is still slimy and disgusting.

She wants to try to draw "what are your intentions towards that man" but she's very tired and sitting up feels hard. That isn't actually a good reason not to. Iomedae wouldn't have stopped trying to understand her situation and improve on it just because she was tired, when she was human. Samora draws the man lying down with a frowning face, her best attempt to replicate the eye machine, and two arrows from the eye machine: one to the man standing and smiling, the other to a skeleton. Wait, that might look like a request for a prediction rather than intentions. She accompanies both of them with smiling versions of the other woman. Does Marian want to point at one of these options? (Should Samora believe her?)

Oh noooo is she worried the other guy is dying, that’s such a valid concern, Marian wishes she could be more unequivocally reassuring about it—

- oh NO (?????) is she worried that the other nurse wants her patient to die (??????) That’s not valid at all at least a confusing worry for her to have, but a really upsetting one! 

Uh. Marian is going to take the paper and cross out the smile on the probably-nurse figure’s face beside the skeleton drawing, and replace it emphatically with a big frown and a tear under the eye.

She points at the standing-smiling version of the man and then the skeleton one and tries to convey via expressive shrugging that she doesn’t know for sure which. Just. There is very emphatically no one happy about it if he doesn’t make it!  

That was actually very understandable and they're getting good at this communicating in pictures business! She smiles understanding, mimes praying (hands folded as though around the hilt of a sword or the sheath of a knife, head bowed) and taps the smiling alive man. Hopefully Marian understands that in this case she means the civilian kind of "gods willing he'll make it" and not any indication that she has anything better than Stabilize up her sleeve.

And then she flops back on the pillow again and chews on the question of how much she believes Marian, which is mostly the question of whether she believes her own judgement to be compromised. 

Awwww Samora is really sweet. She’s going to be feeling awful and she’s still thinking about the welfare of other patients. Marian might prefer she spent less energy on drawing complicated pictures to communicate about it, but it’s still very sweet.

She waits until Rose emerges and frets about running out of D50 before their scan is over.

And then Rose is emerging! "Wow, maybe I should've let you go first after all, my guy is still satting fine. Uh, good luck?" She stops, wrinkles her nose, and then lowers her voice. "...God, is that smell her?" 

Moments to be really glad Samora doesn't speak English!! That was not enough of a whisper that she wouldn't have overheard it! She probably wouldn't have, like, been offended, because she's a lovely person (who just very understandably kicks nurses when she has no idea what's going on, but like, Marian does krav maga, if she were that disoriented and being poked with things she would probably try to kick someone too). 

"Uh, yeah, it's bad." And she'll swap places with Rose and push the gurney into the CT room. 

The machine is a lot more elaborate than in Marian's drawing, but it is, in fact, basically a long narrow table with a big hollow cylinder or fat ring at one end. 

Oh no Marian forgot that the order was for an abdominal CT with and without contrast, and therefore forgot to warn Samora that the contrast injection is going to feel pretty weird (in particular, Marian has always been told it feels warm in the crotch like you just pissed the bed, though she's never had a CT with contrast herself to confirm this.) ...Hopefully she's established enough trust that Samora won't freak out about this and try to escape or something. The contrast part of the scan only takes like two or three minutes anyway. 

She gets the tech's help to wrangle the bed up against the table, bedrail down on that side, and get the height adjusted level, and - hmm, if she gestures where they need her to go and then helps hold the IV tubing going to the central line and stuff, would Samora rather wriggle herself over? She doesn't have to, if it turns out she's feeling too tired or weak or it hurts too much - there's a slidey transfer board and Marian can also point at it and try to convey what the alternative is - but Samora is a) really strong, and b) seems like in general she would prefer to move herself rather than be moved. 

Detect Magic still shows nothing but her own headband! Arcadia is amazing and scary and she wishes she was able to talk to these people about their, their secrets of lost Azlant or whatever it is.

She can scoot herself over, sure. Her arms are actually pretty okay and are currently more cooperative than her core muscles, so it's more of a "grab a hardpoint and drag" situation than a scoot per se, but she understands what Marian means by letting her do it herself and smiles even as she admits to herself that she hopes it's several minutes before she needs to do the reverse maneuver.

Marian hooks up the curly contrast tubing to the unused port of the central line, smiles reassuringly at Samora, and then they can slide the CT bed into the machine. 

(And then Marian is going to hover in the room rather than going back to the technician's station, just in case Samora freaks out.) 

The eye-machine does not actually have any visible eyes, but does seem to have a component in the cylinder that spins very fast around Samora. The table she's lying on also moves back and forth down the hollow cylinder at intervals. 

After about five minutes they have all the non-contrast CT slices and the technician hits the controls to inject the contrast. 

She keeps all of her fingers and toes where they're not at risk of getting caught in the machinery, though it seems pretty well-designed to avoid that. 

. . . Did she just piss herself? For no reason?? After specifically saying she wouldn't and also still having the weird thing in her that's supposed to make it impossible??? Possibly she hallucinated it, which would be maybe worse? She has no idea how to ask about this and it was awkward enough the first time and the paper is still in the other bed-cart-thing.

Marian is at least not reacting like she pissed herself, and after maybe thirty or forty seconds the feeling goes away and doesn’t even leave her feeling wet, which might be evidence that she hallucinated it?

Marian watches her very closely the whole time. And is probably going to have to do another blood sugar check the instant they get her out, ugh, she’s already a bit overdue but she can’t get at a finger to stick right now and it doesn’t seem worth pausing the scan for.

Do Samora’s vital signs hold up for the whole 7-8 minutes of scan? Marian is going to feel like an idiot if she let Rose go first and it turns out her patient was the one due to start crashing.

She's hanging in there. Smells utterly foul and is ignoring this with the patience of someone who has been disgusting before and will be again. She'll drag herself back to the other bed-cart-thing when it's time for that, even less gracefully than before.

(If she was back in her room at the Rowdy Rockfish she'd just sleep until dawn, but it'd be stupid to lose situational awareness here when she doesn't have to. Not for the first or the hundredth time she thanks Heaven for the gifts that let her go without sleep.)

Marian would have been inclined to transfer her on the slidey board regardless of her preferences if the radiology tech had been giving her indications of the scan showing something horrifying that could be made even worse by too much exertion and movement on Samora's part, but when she tried to make eye contact they just shrugged at her.

(Which doesn't mean it's not horribly concerning, it mostly means that abdominal CTs are kind of hard to interpret compared to, say, "one entire lung full of blood" on a chest CT, and they'll have to wait for the radiologist to review it to know much about how bad it is.

...Possibly she shouldn't be letting Samora move around much because it might still be really bad, but it - if anything feels more important to respect her patient's dignity while she can if she's about to have a spectacularly undignified next twelve hours? Ughhh or maybe Marian is rationalizing it because she doesn't want to have an awkward interaction where someone is frustrated with her. Whatever. It's done now.) 

She'll check a blood sugar and treat it with her last syringe of D50 if it calls for it and then they can book it back to the ICU, how about that. 

Yeah, she's going to need that D50. And then back to the ICU and not doing anything for a while sounds good. Possibly she should ask Marian to wheel her around casting Stabilize on anyone else who needs it, but she doesn't know how many injured people are here or how to explain what Stabilize is good for or how to indicate in a drawing that she understands the concept of prioritization, so it's going to take a bit of sketching and she'll wait until she's not on a moving thing to start.

When they get back, the patient in room 101 is - looking kind of okay, apparently? The blood transfusion is done and from this distance his vital signs look basically okay to Marian. She feels sliiiiightly less bad about being absolutely in no way available to help any of her colleagues today. 

One of the residents is already in Pod Two with the CT scan imagery pulled up on the computer screen. 

If communicating required less exhausting pictorial back-and-forth, Marian would totally consider showing Samora what her insides look like! She's not going to bother, though, it's not like it's very easy to make sense of for a layperson. She'll get Samora's bed back where it belongs, plug in her IV pumps again (they have like six hours of battery life but it's still rude to leave them unplugged until the night nurse gets a low battery alarm) and put her back on the big monitor, and then she'll stick her head out of the room. "How does it look?" 

He glances up. “Uh, I paged the radiologist to look at it, but - not that bad? The repairs all look fine and I don’t see any free air or signs of a new perforation. There’s some fluid accumulated behind the incision, but I thiiiink it’s just exudate that the drains aren’t getting?”

“Oh. Huh.” That’s definitely good and maybe they won’t have to rush to the OR after all, but Marian is definitely a little confused about how it got so bad so quickly. “Uh, her fever did come down with IV Tylenol, her other vital signs haven’t changed. Let me know what the plan is once you hear back, I guess—”

The charge nurse is hurrying over for some reason. “Is Marian - oh, good, you are back. Lab on the phone for you, line two, critical results.”

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. 

Samora would really like to know why they keep taking more tiny amounts of blood from her fingers and whether they could just take as much as they're going to need for the rest of the day all in one go, but presumably Marian has thought of that and also she looks too stressed for Samora to want to cause her any more trouble right now. She wants it to be dawn soon so she can fix herself and start solving problems instead of being a source of them.

Okay, it is in fact embarrassing to leave the next nurse with a disaster dressing situation; it didn’t seem justified to fix when they were probably making an emergency OR trip soon but now they are not doing that.

Marian, after three minutes of Sitting, imposes on Kristy to bring her a dressing change tray and this set of supplies, and she’ll do soothing arts and crafts  as nice a dressing as she can manage in ten minutes.

Hopefully she can get away with miming and pointing with her tray and pile of clean absorbent gauze pads and get a nod of agreement from Samora about starting? Also she really is hoping the site is at least oozing more slowly, though she’s budgeted a lot of her gauze just for dipping in saline and using to wipe slime.

(She’s planning to swap out her iso gown and gloves and in between wash her hands SO WELL after this. - and gloves once in the middle so she can take a blood sugar AGAIN, of course.)

Bandages and changing them are something Samora has actually heard of! She's happy to cooperate with this; maybe it will help with the stink situation. Also she's definitely oozing less after the paracentesis.

Yay! It's nice to feel like you've accomplished something! 

6:40 pm. Marian is going to give the room a really quick tidy, and then - oh, right, she should communicate to Samora that she's going home and ??someone?? is replacing her. She would be more confident in asking Kristy to go check whose name is on the board if this seemed less like the kind of assignment that anyone with seniority on the unit would try to pull rank not to get. 

She'll draw a sketch of the room (box, bed, stick figure with bandage) and a stick figure for herself standing beside the bed, and an arrow showing her stick figure going out of the room and winding around the page and eventually another bed and herself lying down. She draws a second arrow going into the box for Samora's room and another smiling stick-figure. Does that convey it? (Hopefully Samora doesn't seem upset or stressed about Marian leaving?) 

Marian going somewhere else to sleep and hopefully not get sick: good and sensible. Someone else coming in here: less obviously sensible but whatever, it's not like she'd sleep even if she was left alone. If she knew whether they were out to prevent her from dying or from trying to leave or some third thing she'd potentially have more to say. She draws a picture of the new person wearing the same gown and gloves as the earlier Marian picture, with a smiling face and no worms.

Yes! Definitely! Marian bobs her head and smiles, mostly because it's really sweet how Samora is concerned about their wellbeing but also because it seems like further evidence that she understood the earlier attempts at communication. 

- and then she needs to try to focus on scribbling some notes to organize her report. It’s been…a lot of day. She didn’t even get this patient until, like, 2 pm, and it still feels like she's had an entire shift in this room in addition to the entire shift she had before that. 

She can already hear the distant bustle of the next shift arriving at the nursing station. 

The huddle at the nursing station seems to go on for longer than usual and involve more arguing, though Marian can't hear what anyone is saying from Pod Two. (She does at one point overhear a "what the FUCK is that SMELL" from the hallway.)

It's 6:49 pm by the time Fraser comes to the door of the room. He's another of the travel nurses in Marian's cohort, a very overweight man in his forties who does "the travel nursing lifestyle", living in an RV and moving to a new hospital gig every few months alternating with road trip holidays. 

"Hey. I drew the short straw again. Heard it's your patient's fault the entire unit is iso?" 

(Samora would be intensely embarrassed if she had the full picture. As is she's only moderately embarrassed.)

Marian likes Fraser. He’s not always the most perfectly professional, but he’s impressively immune to intimidation by scary trauma surgeons and he has the advantage of, himself, not being at all scary to give report to despite having probably an order of magnitude more years of nursing experience than Marian herself. Someday Marian will be in her forties and so much cooler than she is now.

“Yeah, uh, I’m really sorry about that.”

Fraser looks over at Samora, gives her a little wave, and starts pulling on an iso gown. “Wow, she really doesn’t look too bad,” he says to Marian. To Samora, “- let’s have a good night, is that a deal?” 

Oh dear, did Marian not tell him? She says "I only speak Celestial and Taldane" in Celestial and Taldane even though she's not expecting to get lucky and especially not with the latter, and points at the pile of explanatory drawings.

“She doesn’t speak any English, sorry.” Though another thing she appreciates about Fraser is that he pretty consistently treats patients like people - even if he’s at least once jokingly threatened to call a patient’s workplace on them if they didn’t - Marian honestly doesn’t remember what it was over, just that she was vicariously mortified about it. “We’ve been communicating okay but it’s all by drawing pictures.”

"Well, shucks, I can't draw for shit." Fraser shrugs helplessly. "- And the story gets more interesting. Tell me more?" 

"Right. Uh," Marian consults her paper. "She was found unconscious downtown with massive bleeding from multiple injuries - that looked like maybe she was attacked by wild animals? - and, uh, also dressed in weird all-handmade clothes like those historical re-enactment people. With an actual sword on her." 

Wow Marian had kind of lost track of exactly how spectacularly weird this whole situation is! She's managed not to think about the sword and bizarre assortment of personal belongings in hours. Let alone the map thing. ...Which she should get to later, if she goes in anything other than chronological order here she's going to confuse herself hopelessly and miss things. 

"Huh. Okay." Fraser isn't taking notes, Marian isn't sure if she's ever seen him take notes while taking report, but he seems to be listening attentively. 

The not-taking-notes used to stress Marian out but it's not like she's observed him dropping or forgetting anything.

"Right. Uh, she was intubated in the ER, was really hypotensive - obviously, she lost a ton of blood - and they couldn't get the bleeding under control, initially thought she might be hemophiliac but the lab results looked more like DIC so that was stressful, they delayed taking her to the OR for hours."

Whiiiich in hindsight is maybe related to their later problem, though, uh, she's still not sure how Samora would have gotten FUCKED UP SLIME MOLD BACTERIA in her gut to begin with. 

"...It went away, her last coag panel was way better and I haven't had any issues with bleeding since I got her." Yes Marian is aware that makes no sense. "- oh, right, that's also when they would've noticed the hypoglycemia. Her initial blood sugar was thirty-four and she's gotten - uh, I haven't actually counted -" Marian attempts some mental math, Samora has been in the hospital for like nine hours and they probably started treating her sugars an hour in and she's usually gotten D50 at least every fifteen minutes, four times eight, "- she's gotten, like, at least thirty amps of D50." 

Fraser looks impressed. "That's - wow - how many calories is that, that's insane." 

Somehow it hadn't even occurred to Marian to wonder how many calories are in an amp of D50 but it's not like it's hard to calculate - 25 ml of D50 is 12.5G of sugar - so eight of them is 100g, she’s been getting at least four an hour for 8h, so 400g of sugar, times 4 calories per gram of carbohydrate… “At least 1600 calories? I think. ...It was probably a lot more, actually, that was assuming she never got more than four in an hour and she totally got more than four some hours." 

"Yeesh. Okay. Do we know why?" 

Honestly Marian has spent rather little time thinking about the baffling medical mystery of Samora's blood glucose, because it was at least a baffling medical mystery that was well under control even if it was an enormous hassle. She shrugs. "I think they figured she was type one diabetic and took too much long-acting insulin, or took her usual and fasted but normally eats a lot? I don't know."

In hindsight neither of those really make a lot of sense, given how Samora is more than awake enough now to inform them of known medical problems and would definitely have done that. 

"- Anyway, uh, glucose checks every five minutes and yeah it does actually have to be that often. I'm really sorry, she used to have an art line but." 

Raised eyebrow. "I'm figuring she pulled it out at the same time she Houdini'd out of her restraints and self-extubated in under a minute? I did hear about that." 

Oh noooooooooo is everyone gossiping about that, that's so embarrassing. "Uh. Yeah. - she didn't get as far as yanking the Foley out but she did politely request we let her use a bedpan instead, I meant to ask– I think I did send Kristy to ask the resident but I assume we got distracted, it's been. Distracting." She's breaking her rule against going out of order and does now feel like she can't remember where she left off, but she did want to make sure that request got passed on. 

"- anyway. They treated her hypoglycemia and gave her a ton of fluids and blood products while they were trying to diagnose the bleeding problem, and I guess eventually decided to just go ahead and take her to the OR, that would've been at like...noon, I think? Sounds like it went surprisingly smoothly given everything, she had a lot of damage to muscle and fascia and her gut was really cut up but they were able to hook everything back up again, they did a loop ileostomy to let it heal. I got her at twoish, she was on a ton of pressors and tachycardic with a systolic BP in the 80s but - didn't look too bad, given that."

Fraser makes a face. "Okay but I'm in awful suspense over here, when did the horribly-smelling infection turn up?" 

He's also doing his own glance-over of Samora, clearly trying to judge for himself how she looks and whether it's still "not too bad" given all of the everythings. 

"I think around 3:30 or 4– oh crap sorry need to take a blood sugar." Marian gives Samora another apologetic smile and goes to do that. 

Samora is actually feeling way better all of a sudden, probably because that horrible life-draining spell she got hit with finally wore off. She gets herself back upright and gets the weird shirt-dress thing they've draped over her actually arranged with her arms in the sleeves and as much of herself covered as possible.

Not being life-drained has made her alert enough to realize that she's barely dressed--she's seen back-alley girls wearing more clothes than this--and is about to be left alone and unarmed with a strange man who plausibly doesn't know what it means that she's a priest. She doesn't think he'll try anything--even if he was inclined to she's currently disgusting. Still, she's internally cringing at what her parents would feel if they saw her. 

...Huh, her blood glucose is 92. Which is normal, and also the highest Marian has ever seen it. Her heart rate, which had mostly been in the 130s to 150s, is now at 110. Also she looks abruptly vastly better - mostly more awake and alert but also her color is better.

Wow. Okay. Marian definitely isn’t complaining but she is confused.

She gives Samora a questioning look, in case Samora also just noticed something different.

Samora smiles encouragingly, and does a quick series of stick figures: someone pointing at her with jagged lines coming out of his hand, Samora lying down, hourglass hourglass hourglass, Samora sitting up smiling. Then she points at her "clothes" and Marian's clothes and mimes putting on a shirt and pants. 

Fraser leans in to look at the drawing. “…What on earth is that supposed to be, ‘I got cursed by a Harry Potter wizard but I got better’?”

Yeahhh Marian does not so much feel like this particular attempt at communication clarifies anything! …Except for the part where Samora wants pants, which is super understandable but also she does still have a catheter. 

Marian makes the pants gesture back and nods to convey that she understood it, and then shrugs and points at the hourglass she drew, which will hopefully get across “it might be a bit of a wait.” As far as she knows they don’t have pants in the patient linens, someone will have to go to the OR. Maybe Samora doesn’t realize quite how unsalvageable the clothes she arrived in are? 

“Glucose is fine all of a sudden?” she adds to Fraser. “I’d keep checking for a bit, but - maybe whatever the problem was isn’t affecting her anymore?”

Fraser nods sagely. “Harry Potter wizard curse. Insulinio overdoseo.” He makes a wand-waving gesture. “Sorry, where were we?”

That’s a good question. They were at the part where Marian gets to go home soon, right?

She shakes herself slightly. “Right. Uh, she had seemed pretty out of it still - I started fentanyl for pain, I think she just looked kind of uncomfortable and obviously had a big surgical incision, but I didn’t go up on the midazolam. I had just noticed her temp was up a bit and she looked off, and the drains and incision were leaking - I bet someone got a photo from the paracentesis we did later, it was awful - and I had to leave the room to get stuff for some new orders. I came back after a minute or two and - yeah, she was out of the restraints, self-extubated and ripped out the art line, and had snapped the IV tubing for all her drips running in the central line - we’d taped it down really well - so that was leaking blood everywhere.”

Fraser gives Samora a faintly impressed, if dubious, look. “Fun stuff. And looks like she didn’t need to be reintubated?”

“No, thankfully! She’s been fine on room air ever since. I - mostly spent the next while trying to reorient her - oh, right, forgot to mention she’d been really combative in the ER, ripped out all her lines and they had to give her IM sedation to settle her down - but I think she just had no idea what was happening? We had this pretty bizarre Pictionary back and forth about where she was, she drew a map and she’s maaaybe from, like, somewhere in the Mediterranean?”

Raised eyebrow. “I guess that explains the not speaking English, but not what the hell she’s doing in fucking Reno of all places. Do they even let you bring swords on planes?”

“Presumably not in carryon but, like, I think you can bring guns in checked luggage…?” This is a stupid digression that’s pointlessly delaying when Marian gets to go HOME and scrub her skin off in the shower, and also she’s really glad they’re not having this conversation in front of Samora in a language she can understand. “Anyway, she basically agreed to all the things once I drew them. We started a new antibiotic and sent cultures and took her to CT to see if there was a new perforation - there wasn’t, just a lot of inflammation and a big pocket of free fluid, so Dr Harrison went in and drained that.” 

Marian really does hope he got a photo, it’s the sort of thing that’s horrifying and upsetting at the time but later you really want to be able to back up your story and gross out the other medical staff who weren’t there - and it’s probably not a HIPAA violation, Samora isn’t identifiable from it - ugh maybe they would consider it identifying, given the unique “unidentified new pathogen” bit… That’s also a pointless digression and she should stop that.

“Right. Her temp came down with Tylenol and her pressor needs haven’t changed— huh, that was not her BP before!” 

It’s sitting at 146/96, not high enough to trigger an alarm on the default alarm parameters but ridiculously high compared to before! Marian is going to go decrease the norepinephrine right now!

“Well, I’m sorry your shift was awful but I have to say mine seems to be looking up,” Fraser says dryly. “You can go, anything else I’ll look up in the chart. - you should talk to the charge nurse before you leave, I dunno how the whole unit being on lockdown affects your shift.”

AAAAAAAAAH yeah all right that’s a good idea. Marian will wave goodbye to Samora and then strip off her iso gear and wash her hands and…put on a new clean iso gown, actually, since her scrubs are Contaminated. And then go talk to the charge nurse.

Does the patient seem like she needs anything? (Is her blood sugar still fine?) If not Fraser can shed his own iso gear and wash up, and then go ask the resident for an order to d/c the Foley and go run to the OR hallway to get the poor girl some pants.

She's fine for now. She's kind of regretting not having asked for her sword once she and Marian seemed to be getting along alright, because obviously having her sword is a higher priority than pants if they have it somewhere and it would have been a good test. But it also would have been bad diplomacy when neither Marian nor--she'll need to get his name later--is wearing so much as a belt knife and they didn't seem to understand her attempts to declare her goddess's alignment at all. And it's entirely possible that most of her possessions are still under the lighthouse.

(Most of her possessions are in the cabinet in the room, but Fraser doesn't actually know this, since it didn't make it into Marian's report and he hasn't yet thought about it.) 

He gets an order to discontinue the catheter without any difficulty ("look, her kidneys are fine, and would you want a tube up your thingy?") and then runs into the problems that the whole unit being on lockdown apparently means that the charge nurse is parked by the main doors and reminding people that they're not really supposed to be leaving unless they really have to for an urgent patient procedure, does he have one of those? 

- he does not but he does have a friend in the OR and will text her with a bribe (buying her coffee later once he's no longer On Lockdown) if she delivers a couple of pairs of OR scrub pants to the ICU doors. ...Size S, please, they're not for him. 

He checks the chart for anything due before heading back into the room, and whoooooops it looks like Marian missed a dose of the initial standard broad-spectrum antibiotic (the one started in the OR) that was due at 6 pm. He's not surprised - it seems like she had basically no opportunities to leave the room from 4pm onward, also vancomycin runs over 2h and might still have been running at six - he's just going to go grab the antibiotic from the med room and not mention this to her ever. It's only 7:20 pm so it's not even very late. 

He gowns up and goes in with antibiotics and pants and a 10cc syringe to empty the Foley balloon, just in case that drawer in the room isn't restocked. 

If he points at the pants and the catheter and makes a pulling-out gesture, does the patient seem inclined to go along with letting him get in there to deflate the balloon and remove it? He can attempt to draw it if she seems to want more reassurance on how this works, but he really does feel like Marian set the bar unfairly high on drawing ability. 

Yes, getting that thing out is a prerequisite to putting on pants, isn't it. She should have been more insistent about it when it was Marian here. She nods and gestures at him to turn his back for a moment.

See, he’d love to do that, this is not less awkward for him, but unfortunately! There is a big fucking balloon in there and if she tries to yank it out with the balloon still inflated then they’re not going to have a good night after all!

He shakes his head and makes an emphatic “no stop” gesture and holds up the syringe, which hopefully will communicate that it’s an essential part of the process. Honestly he’d be a little inclined to talk her through doing it herself - she’s clearly a smart cookie - but his drawing skills are not up for depicting the steps involved.

He wants to put what in where? What? No! Why?!

She crosses her ankles and gets out the clipboard again. Draws a human silhouette with broad shoulders and narrow hips and short hair. Draws a slightly shorter human silhouette with wide hips and a hint of bust and long hair. Draws a big X through the male silhouette and circles the female one. 

….Yeah okay that’s pretty clear. Fraser isn’t offended. It is objectively really awkward. Fortunately the gender ratio on the unit is favorable toward her request.

He nods, makes a placating gesture, and goes and sticks his head out the door. “Oy! Lisa, can you come in here and pull my girl’s catheter, I think she’s skeeved about having an old fat guy do it.”

   “Uh.” Lisa gives him a dubious look. “She’s got the novel pathogen, right? - think we’re not supposed to have other caregivers going in and out unless it’s an emergency - I don’t want to put my patients at risk…”

“Aww, are you kidding?” Fraser scowls. “Look, I really don’t want to sexually assault my patient, here, it’ll make the rest of my shift so awkward.”

     Lisa shrugs. “Leave the catheter for day shift? I think Marian’s back.”

“I really don’t think she’d be any happier about that.” He turns back to give Samora an apologetic look. He’ll point at her, at his stomach, out at Lisa, and make a demonstrative gagging face, maybe that conveys ‘Lisa is too much of a coward validly worried about her patients and doesn’t want to spread the horrible slime disease any further.’

That's. Very reasonable, actually. It would be cowardice of her to demand someone else risk illness to protect her pride. She's an adventurer and if she ever decides to retire and marry she will already be marrying someone who doesn't mind that (probably another retired adventurer) whether anyone back home hears about any of this or not, so it really is only her pride at stake. It still feels disgusting in a completely different way from the slime.

Okay. Lateral thinking. Marian was clearly employing a lot of that on her shift, what would she do— she wouldn’t have this problem in the first place, she’s a harmless-looking girl…who can also draw better than a preschooler and would probably be more confident in her ability to provide visual instructions that wouldn’t cause the patient to do something absurd and ill-advised while she had her back turned…

Samora cannot imagine the Inheritor, when She was human, hesitating over this sort of thing. She nods stiffly and uncrosses her ankles.

Yeah, okay, but she’s clearly not actually comfortable with it and just wants the catheter out more than she wants a dude who looks like someone’s creepy uncle touching her bits. 

Fraser holds up a hand in a “wait” gesture. Maybe he can get Lisa to go poll the unit and find out who can draw, he bets one of the residents would take up that challenge - 

- or he could just cheat. “Lisa! If you’re not going to come in here, can you get me a new Foley tray?”

     …Lisa is not sure how this solves his problem but sure.

Well, see, he can bring it in and open it up, inflate the balloon, and then show the patient the balloon and how to screw the luer lock syringe onto the port and deflate it. And can she practice with the example catheter where he can see it, before he lets her at the one in her bladder while he has his back turned? 

(This is probably “wasting medical supplies” or something but it’s not like the unit stock budget is his problem.)

She tries pulling on the tube while he isn't looking and it doesn't want to come out, and as soon as he comes back with the demonstration one it's obvious why. She figures out how it works (with a bit of fumbling because she's not very familiar with the concept of things that screw into other things) and competently removes the other one from inside herself as soon as he turns around again. And smiles at him when he looks back, because it's almost certain none of this was his fault and he was a gentleman about it and now that she's wearing pants again she can acknowledge that.

There, awkwardness averted! 

…He should check her glucose again, he’s pretty sure it’s fine or she’d look worse but it’s been way more than five minutes. Also what’s her BP, can he go down on the norepi some more?

Her glucose is totally fine! Also her BP is still on the high side of normal, though some of that may be from the awkwardness of the last couple minutes. Her wound drains are starting to accumulate slime again. 

She introduces herself via pointing again; she isn't sure if Marian gave him her name but it's the easiest way to ask for his.

(Slime contained in drains is fine! He’s not looking forward to the smell when he has to empty them, but so far it’s not yet making things worse than the baseline stink permeating the room, which his nose has almost gotten used to.

Also, whatever the reason for her BP being high, he's going to sneak the norepinephrine dose down.)

Oh right that’s a thing. Marian totally didn’t introduce them by name and, again, Fraser intends to never let her know she forgot. He points at himself. “Fraser.”

It's a pleasure to meet him but she wishes it was under better circumstances. Heh. She's pretty sure the last time she actually said that to someone they were a ghost.

She draws another picture--her belt and belt pouch and boots and sword and shield--and shows it to him while putting a hand to her forehead and peering around in a "where is it" gesture. 

Fraser has no idea but he can have a poke around the room and look in the obvious places! 

It doesn't take that long to find the drawer where Marian shoved all the stuff that actually followed her from the ER. About three-quarters of it is neatly organized in biohazard baggies and the rest is awkwardly wrapped up in a disposable incontinence pad and stuffed in on top. No sign of a sword or shield but Fraser brings over what he could find, minus the bagged up bundle of clothes, which look pretty disgustingly saturated in blood and in any case weren’t in the drawing-list of requests.

He puts the rest on the bedside table and slides it to where she can reach, then points at the sword and shield, shrugs and makes an “I’m not sure” face, and the points at the door and makes a “talking” gesture in front of his mouth, which will hopefully convey that he’ll try to find out.

(It’s probably “against hospital policy” or something to let a patient have a sword in their room? But it does sound like a good idea to find out where the hell it ended up, which Marian didn’t mention, and also who knows, maybe no one ever bothered making a policy since it doesn’t exactly come up often. Also Fraser doesn’t actually work here as a long-term employee and does appreciate the leeway this gives him to ignore policies and pretend he had no idea they were standard.)

That's honestly better than she was expecting! Though she's going to be so sad if she doesn't find her sword again eventually and has to tell her father she lost it. She sets about getting everything back where it belongs, starting with the cloak because it'll help her get over the dungeon fever faster.

Fraser sticks his head out the door again. "Liiiiisa!" 

Lisa is busy, actually! She's in the room with one of her patients in Pod Two. 

- right, Fraser is trapped in the horrible iso room, fine. She'll come over. "Yeah, what?" 

"My patient came in with a sword - and a shield, I think? - and I don't know where they ended up. I bet they're still in the ER. Can you call and check?" 

Why did Fraser's patient have a sword. What the actual fuck. 

"Uh, yeah, sure. - in a minute, kinda busy with a thing." 

Fine, Lisa has two patients and it's pretty valid that she's busy. "Okay, just let me know." Fraser turns back to Samora. 

Samora gets her belt, cloak, boots, and breastplate back on and starts putting everything else back in the bag. It is definitely more stuff than could reasonably be expected to fit in an ordinary bag that size.

She's thinking about the dagger in her boot, and whether she should inform Fraser she has it. Argument for: he might not have noticed it in there, and she's an armed adventurer and he's an unarmed civilian and she's misleading him about something important if she doesn't tell him she has it. Argument against: she's worried that communicating "I have a knife", in this place where nobody even wears the normal kind of knife you use for eating, will be taken as a threat even if she does it in pictures. (The possibility of these people being the kind of people she needs a hidden advantage against is clearly ridiculous at this point.) She needs to draw "I have a knife and have no intention of harming anyone who doesn't attack me first" all in one go.

Fraser turns around and - 

- okay wow he was not expecting her to immediately start putting everything back on including her...armor...? (He hadn't actually been super sure what that item was when he was moving everything over to the bedside table.) It's not technically putting pressure on her abdominal dressings, and Marian had apparently just decided against trying to keep the ECG leads on her so it's not in the way of that either, so...maybe that's fine? It's nonstandard but that's not illegal and if Marian's back she's not going to be weird about it.

....also, uh, that bag is not. Behaving like a normal bag. 

Whatever. Maybe it's some sort of optical illusion? If he has an opportunity to stick his hand in it he might take that up, but he's not going to be rude about it. 

She's not sure exactly what Fraser thinks is weird, and it's not a priority anyway. At least this isn't her party's other bag of holding.

Once that's done she goes back to drawing--and then abruptly stops and flips the paper over, because she failed to realize all the implications of deciding Fraser is trustworthy. A little while later she makes the same "where" gesture as previously and shows a sketch of two people: one short and slight, with an overlarge head and pointy ears; the other tall and very skinny and wearing more armor than Samora. (She's not expecting him to recognize them at all, but it would be foolish to waste a spell slot on a Sending only to find they were somewhere else in this very large building.)

…Wow, he has no idea! Except for how one of them looks like a House-Elf but, like, he was actually joking about the whole Harry Potter spells thing? 

Fraser shrugs and shakes his head. He has questions (for Marian, though mostly for lack of anyone else who might even plausibly know the answers). He doesn’t have any answers for Samora about where her…friends?…have ended up.

That's alright, it was a long shot. Back to her previous drawing!

Samora with her boots drawn exaggeratedly large, and a dagger near one boot with an arrow pointing from the dagger to the boot. Drawing of Samora holding the dagger in the general vicinity of Fraser, very firmly X'd out. Drawing of Samora holding the dagger in the vicinity of a very large wolf. Friendly smile?

…Fraser has Marian’s cell number and would be be really tempted to send a photo of this drawing to her and ask her to use her entire five hours’ worth of context on the patient to interpret it. He’s not going to because, one, Marian clearly needed her time off desperately, and two, he doesn’t usually take his cell phone onto the unit with him and, in fact, it’s still in his backpack in the break room.

Lateral thinking…

Right. Clearly she’s saying she has a knife in her boot and fought a - wolf? some kind of large doggish animal? - with it, but…doesn’t want to attack anyone else with it?? Seems obvious, given how she would get herself into so much trouble if she tried to knife any of the ICU staff. Also, right, they said her injuries looked like an animal attack… 

Whatever. It doesn’t make perfect sense but she can have a knife with her if she wants. Fraser nods ands shrugs and smiles at her.

Excellent. She wouldn't have been very surprised to get some variant of "this is a temple and you're not supposed to bring weapons in here." 

And that's pretty much it for things she wants to communicate right now? She's going to get comfortable in this bed and leak horrible slime and think about things and wait for dawn or for something else to happen.

Fraser is going to apologetically check her blood sugar one more time and, given that it's still on the higher end of fine, make a mental decision that he's not checking it again until the next time he has to wake her up for something or other. The blood pressure is set to cycle every 15 minutes and he'll keep weaning the norepinephrine down if it continues to be high, and hopefully wean her off it entirely?

...He's pretty sure he can wean her off it entirely, given how the Harry Potter wizard curse messing her up seems to have worn off and he's honestly not sure how much he means that as a metaphor. 

Anyway, he's glad she seems to be feeling chill about her entire sucky situation, and he's going to apologetically hover until her blood pressure is fine off pressors - he's not actually surprised at all when this happens twenty minutes later - and then dim the lights in case she wants to get some sleep, wave and smile, and de-gown and wash his hands really thoroughly and duck out. 

Emma, the night shift charge nurse, is at the monitor bank by the nursing station. She rounds on him.

     "Fraser, what the fuck did your patient stick her fucking sword in." 

Fraser blinks at her, and does not say out loud that this sounds like the leadup to a bizarre sex joke. "...Uh, did I miss something?" 

     "Your patient. Had a sword. Which is covered in horrible slime." 

"- Checks out, I guess? Where is it?" 

     Emma scowls. "Well, now it's in Pathology. While the ER clerk tries to track down all the people who might've touched it, since it's definitely a biohazard." 

That does not sound hopeful for Samora getting her sword back, which, well, it was a long shot either way. "How about a shield, was there one of those? She's asking for her stuff back." 

     Emma flings her arms in the air. "Fraser, what the hell, I cannot believe that's your priority here." 

"I mean, I can't blame her, it's got to be really expensive. ...Or a family heirloom, or maybe she made it in, like, one of those Ren Faire places. Either way it'd be special, right?" 

     Emma looks very, very tired. "Fine. Whatever. It might also be a biohazard but so's her entire room so whatever. Call the ER, I think it's still there." 

Great! Fraser is going to sit down at the desk outside room 104 and do that. 

Meanwhile, at the nursing station, one of the on-call residents is peering curiously at a piece of paper. "Huh, that's a sick alignment chart, cool."

     Lisa glances over absently. "A what? ...I need an order for stool softeners for 105, by the way." 

"Sure, colace once a day. - It's a tabletop thing."

     "Can we do Miralax actually? - and yeah I saw it's on the table, that doesn't help." 

"Tabletop gaming!" This is the voice of someone who is delighted to have an opportunity to explain. "Like, Dungeons and Dragons. Your character can be Lawful or Chaotic and Good or Evil - or neutral, that's the middle ones - so you end up with a three-by-three grid like this."

     "Ohhhh. Like the sandwich meme!" 

"I can't believe how many people know the sandwich meme and don't know it's from D&D! Whose is this, it looks like they're planning a game -" 

     Shrug. "I think it's there from day shift." 

One of the other residents comes over. "Amir, where in the world do you find time to play D&D?" 

     "I don't much but if someone's planning a game I want to hear about it! - did you see 109's labs, I'm trying to decide if he can tolerate a dose of Lasix -"

Lisa is now fiddling with the paper. "Sorry, now I'm curious, can you explain why it's got all the little drawings?" 

     "I think it's keeping track of all the players' characters and the monsters they're going to fight - and allies, maybe, that's a lot of Lawful Good characters - anyway yeah in high school I played a barbarian who was illiterate and my character sheet was all drawings -" 

Fraser is just getting off the phone with Pathology after sweet-talking them into uploading a photo of the sword to Samora's chart, which seems like a much easier way to convey to Samora that they have it and it's safe (and also she can't have it back yet because it's a slimy biohazard) than trying to solve this problem by drawing. He makes a mental note that apparently someone can draw and he should ask Dr Chadha if he needs a high quality drawing of something later. 

(He wonders briefly if Marian is the day shifter responsible for the artifact currently delighting Dr Chadha. ...Probably not, she seems like the sort of person who would be into tabletop gaming if she had, like, hobbies, but as far as he's aware she doesn't so much have hobbies unless "calling the unit at 6 am asking if they need her for overtime" counts, and also it would be pretty weird to plan a D&D campaign in a city you're only in for three to six months.) 

How does Samora look? 

Samora has been praying; she has most of a page of notes in cramped Taldane curving around the pictures of Tris and Marshall.

What does she know about her current situation?

        With certainty? Not much. But she believes herself to be Greater Teleport distance from Otari, separated from her party but among well-meaning people with surprisingly sophisticated nonmagical healing and limited access to divine healing. She is ill but probably not incurably so; it might be catching.

What would she have done differently earlier, knowing what she knows now?

        The main thing she knows now and didn't previously is that she's not among enemies; the secondary thing is that she might spread disease. She would have communicated several things more quickly, including asking about her party and her belongings but also including warning Marian that she was ill as soon as she realized it herself. If she wasn't ill, she would say she should have offered to Stabilize any dying people present once she realized there might be some, but since they want to quarantine her that's a moot point.

What changes to her way of doing things should she make going forward?

        Be less quick to assume hostile intent? No, that's too general. Be aware that weird things done to her body might not be hostile? Yes, but also too specific. She should prioritize getting oriented more highly whenever she ends up in a deeply surprising situation. (She spends a while contemplating this, imagining herself in various situations and how she might go about getting oriented to them, thinking about how to decide when a situation is too urgent to spend time orienting and when orienting is worth it even in the face of apparent urgency.)

What are her current priorities and plans?

        The obvious first option is: focus on reuniting with her party, getting back to Otari, and stopping Belcorra as fast as possible. They have an unknown but limited amount of time; that hasn't changed. How fast she can get back depends a lot on how she got here; maybe whoever brought her here wants something in particular and will bring her back once she's done it, or maybe she'll need to ask Iomedae for one Plane Shift instead of a full day worth of spells and attempt to get home via Heaven.

        The other option is to spend more than a day or two learning what this place and its people can teach her, and what she can teach them. Depending on why they don't have enough priests, it might be a good idea or a terrible one for her to attempt to start a church of Iomedae here. (The prospect is very daunting, but she can acknowledge that it would be better for the answer to be that it's a good idea.) Depending on how easy their nonmagical healing is to learn, and how effective it is at diseases, it might be a good idea to learn what she can of it while she's here and bring that knowledge back to Avistan.

        She'll be able to fill in a lot of the key unknowns tomorrow; the big one she won't be able to get new information on is what will happen if she takes too long getting back to Otari. Will Tris and Marshall get help from the Dawnfishers and solve everything without her? Will they die? Will Belcorra wreak havoc on Otari? It seems highly unlikely that she'll be able to wreak havoc on Absalom itself, and if the city's wizards can't stop her, Samora's party didn't have a chance anyway. So the questions are: How likely is her prolonged absence to result in disaster for her friends or the town? How much is there to be gained by staying here? Is the potential benefit worth the risk? The latter isn't purely a straightforward comparison of benefits to costs; there's also the matter of duty. People should be able to expect her to finish a job once she starts it and not run off as soon as a better opportunity presents itself. She'll be able to talk the matter over with Marshall and Tris, at least a bit, but at twenty-five words per fourth-circle spell slot she had better have as much of her thinking done beforehand as possible.

Fraser, of course, can't perceive most of that. She's notetaking contemplatively and has leaked a bunch more horrible goo.

The horrible goo would be about 5000% more concerning if she looked particularly ill! It's honestly deeply confusing that everything else seems to be improving, but it undeniably is and Fraser isn't going to complain. 

He's going to gown up and go in with a computer-on-wheels, which he's decided is just going to Be His for the rest of the night. He wants to check her temperature, since they no longer have a continuous temp probe - hopefully he can show her the thermometer and mime where to put it? - and then he'll pull up the image of the sword to show her, and try to convey via gestures that it's somewhere over there and it's safe but she can't have it back due to the slime?

The shield he thinks she can have back when someone over in the ER gets around to hauling it over; he can point at the drawing of it and then point in the direction of the ER and mime someone walking and carrying something heavy? 

Stick goes in her mouth, okay. Her fever is back at 100.6.

They found her sword and shield! That's great! They want to do something with the sword? What would they want to do with it? Oh, he probably means they're cleaning it, because it's covered in drekavac guts. That's very thoughtful of them and she smiles appreciatively.

. . . and then looks uneasy and mimes retching into a bucket.

Fraser had been hoping to try to ask her what she stuck her sword in - she drew a wolf earlier but he’s not sure that was about the same thing and wolves aren’t, or at least shouldn’t be, full of weird slime instead of blood - but he’s not sure he can convey the question in mime without drawing anything, and also it looks like it’s perhaps not a good time? He can get her one of the hospital barf bags from a drawer.

Yes good thank you she will be holding onto this very diligently.

Fraser isn’t delighted about her temp being up again, though it’s probably mostly that the Tylenol is wearing off, she’s getting close to due for another dose.

It’s a little concerning that she’s suddenly having nausea after not having complained of that at all before, but she did mess up her gut pretty badly, on top of the horrible slime peritonitis, it’s not surprising. …He doesn’t have any PRN orders for nausea because Dr Harrison doesn’t use the admission standing orders and never puts in PRNs unless you ask him. Fraser is going to stay in the room, in case this is the first sign of something about to get rapidly worse, but he’ll flag down Lisa as soon as she’s back in Pod Two and relay a request. In the meantime she can have a cold washcloth on the back of her neck if she wants? That helps for some people.

Samora's usual response to nausea is to finish killing whatever is causing it and then vomit; a cold washcloth is less satisfying but much more comfortable. After a few minutes she vomits a small quantity of mixed bile and horrible slime neatly into the barf bag, spits several times, and then looks notably relieved. And unsure what she should do with the bag now.

It's moderately concerning that the horrible slime is apparently growing her GI tract as well as outside it!

Fraser is absolutely not going to look worried where Samora can see it, though. He’ll put some water in one of the little plastic pill cups and offer it to her to rinse her mouth, because that has got to taste utterly vile, and then pull out an empty biohazard trash bag and hold it open so she can drop the barf bag in without him touching it. 

He also gives her several more clean bags to keep in the bedside table in reach, since if the rate of slime production from her incision is anything to go by, it seems pretty likely there’s going to be more later.

(Presumably she had a gastric tube to suction when she came back to the OR and it was a casualty of her tube-yanking-out session that Marian didn’t find important enough to mention. He would consider getting an order to replace it, but that would require explaining it to her and getting her on board with it, which sounds difficult.)

Does Samora seem like she needs anything else before he de-iso-gowns and ducks out to update Dr Harrison or at least one of the residents on the situation? Also there’s still no sign of Lisa so he’ll bother them directly to get an order for Zofran or something, and then keep it in reserve for if and when she gets nauseated again.

She'll be alright for now. (Her mouth still tastes like a demon's latrine, but rinsing it out helped a lot.)

He degowns very carefully and washes his hands so so thoroughly and goes looking for someone on the medical team. ...Dr Chadha is at the nursing station, good, he's the one who's good at drawing and if he wants to do any interventions he can explain them. 

"Hey - you know the girl in 104, right?" 

     Dr Chadha looks deeply unhappy. "What is it?" 

"She just puked some slime. - honestly she's doing better apart from that? The mystery hypoglycemia mysteriously fixed itself right at shift change, heart rate’s normalizing and she's off pressors. Just feverish and oozing unbelievable quantities of slime.” Shrug. “Could use a PRN for Zofran, I haven’t got anything. Might be a good idea to drop an NG in her if you’re up for explaining it to her in pictograms, I heard you can draw. …I’m guessing it’s not worth another scan given the enormous hassle but is there anything we should do?”

     “- Um. When’s our last CBC, should maybe repeat it and check if her white count is spiking…?”

“Last one was at fourish, I think? Moderately elevated but not crazy. I’ll do another.” That one he can pull from the central line and not have to stick her. “And can do a lactate?” He actually expects it’s probably normal, but it would be informative if it’s not and she is in fact headed toward sepsis and just not showing it at all for some reason.

     “Yeah. Sounds good, let’s do that.” Dr Chadka mostly looks very tired. “And, uh, I guess let me know about the NG.”

“Will do. - do we have any idea if the antibiotics she’s on work on this crap? The lab should let us know at some point, right - it’d be great if that were tonight…”

He goes to put orders in, obtains a vial of Zofran so he’ll have it in the room if he’s trapped in there and needs it, and then re-dons all of his protective gear to go in and do bloodwork from the central line. How does Samora look? 

She hasn't puked again. She's drawn a line with three little icons of the sun on the horizon, with little arrows pointing up-down-up to indicate dawn-dusk-dawn, and would like Fraser to point at a spot on the line.

Oh right she's got one of the interior-facing rooms that doesn't have a window to outside, and she probably has no way of knowing how long she was out after surgery. Super reasonable to want to have annnny idea what time it is in the outside world! It's now coming up toward 9 pm, so about 10 hours to go until shift change, which coincidentally in late February is also about when the actual sun is up too. He points to the down-arrow sunset sun icon, and then moves his finger a little further along into the "night". Does this seem to answer Samora's question? 

(Also, does she object to him drawing blood from the central line? Marian presumably did it lots of times and hopefully it's already been explained and he doesn't have to go over all that again?)

She understands that answer and he can have some blood. She'd love to know what they keep doing with it but the simple answer is probably "learn more about how sick she is" and the complicated answer is probably something she's never thought of before and difficult to explain in pictures. And she's worried she'll get nauseous again if she does too much sitting up to draw and then lying back down.

They are indeed trying to learn more about how sick she is, and the complicated answer is indeed complicated! 

...Ugh he forgot to grab more IV Tylenol at the same time and Samora is close enough to due for it that he'd rather get that going now rather than have to exit and re-enter the room again later. He manages to flag down Lisa with that request, and maybe she can also hold out a clean sample bag so he can drop his blood sample tubes into it (and the outside of the bag technically won't be contaminated when it goes through the pneumatic tube.) Presumably the lab already knows that this patient's samples need to be treated with Extra Caution. 

And then he realllly needs to empty the extremely slime-filled surgical drains, an operation which is both disgusting and nervewracking; he dons a mask and faceshield for it in case of splashes, and puts the slime into an unused suction canister which at least has a top that seals. He'll incidentally check to see if slime is coming out the ileostomy end as well? 

Yup, there's some there too. Poor Fraser. She shows him the picture of her healing herself and then other people after dawn in an attempt to convey that he doesn't need to do this if he doesn't want to take the risk.

What the heck is Samora trying to convey with that picture? That she can do faith healing?? But only when the sun is up, possibly because she worships the sun in addition to her sword??? Or maybe some additional Harry Potter curse that wears off the next time the sun rises? 

(This are all batshit theories, obviously, but Fraser cannot manage to think of a non-batshit interpretation of that picture.) 

...Anyway he's still going to empty the drains, it's not like it would be less gross to let them get so full they start leaking all over the bed. At least this way the stuff is slightly more contained. And then he'll shed his gear again and scrub his hands and sit outside refreshing the chart for labs, and of course keeping an eye on Samora in case she starts looking worse or tries to get his attention for anything. 

Fraser seemed like he really didn't understand that picture. Maybe he couldn't tell what it was a picture of, or maybe it was a picture of something he didn't understand. Has Arcadia been without divine healing long enough that they don't know what it is? And how could that happen? Any given god not being known in any given country makes sense, but why would there be somewhere all the gods ignored?

. . . What if there's something here preventing any gods from granting spells. Then all her claims of being able to heal people would be false, and she wouldn't be able to heal herself, and she would have much less ability to trade for knowledge or a heavenly tuning fork or a Greater Teleport home.

She shouldn't panic. Even if she's right about why Fraser didn't understand the picture, and even if it means she won't be able to get spells either, it's not guaranteed that the effect covers this entire continent. She might be able to get somewhere divine magic works normally and work on getting home from there, even if she can't get all the way home without magic. It'll involve a lot of communicating in pictograms and working as a caravan guard or something, but she has skills that aren't magic and it's a rare situation that offers no options.

The labs come back...pretty reasonable. Hemoglobin stable; WBC up to 19, which is high but, like, about what you'd expect for a previously-healthy young person mounting a strong immune response to an infection, and not particularly indicative that she's hours away from going into septic shock. Fraser considers telling Samora this and considers how he could communicate this and then shrugs and gives up. He'll just go update the resident. 

There's a piece of paper on the nursing station desk with a grid and a bunch of weird sketches of things or symbols drawn in the various boxes of the grid. 

Um. 

Fraser stops and - doesn't pick it up, because on reflection wow what a bad idea. "I, uh, am pretty sure my patient drew this." 

     Dr Chadha, who's sitting and staring grumpily at one of the monitors, spins around in his wheely office chair. "Your patient plays D&D?" 

"What? No! ...I mean, seems unlikely, she doesn't speak English." 

     Dr Chadha gives him a bemused look. "Why would she draw an elaborate alignment chart? Don't get me wrong, it's very cool, just..." 

"I have no idea! She's really confusing! Marian didn't say anything about it! I guess they were using it to communicate about something?" Not that he can think what. "- anyway, what I actually came over here for was, her labs are back and they're, like, okay? White count is up some more but it's still below 20." 

     Nod. "Let's repeat in four hours. What's her lactate? ...Oh, and is she awake, I kind of want to ask her what the deal is with her cool-ass alignment chart -" 

Fraser scowls. "That is not an emergency and she's iso. I didn't see if the lactate was back yet." 

     Dr Chadha turns back to the computer, logs in with his badge and tabs over to Samora's chart. "...Lactate is normal. Oh and - that's not a lab result - whoa that's a sick sword. Why on earth is there a picture of it in her chart?"

     "I asked Pathology to upload one. ...I think probably stuff that was in her room shouldn't be here." He's going to put gloves on to pick it up and carry it back over, you know, in case Marian was keeping all the drawings to refer to later.