Oh, is that what she meant!  He had no idea that could happen!  If it had happened with no warning he'd probably think he was dying again, but as it is he just wonders vaguely if they're doing it by magic, and then he's out.

Unsurprisingly, it does drop his blood pressure, but they have room to go up on the epinephrine, which one of the nurses maxes out immediately when the art line trace starts to fall off a cliff, and it only gets down to 83/49 before starting to turn around. 

His SpO2 also drops all the way to 79% during the brief interval that he’s no longer able to put in maximal respiratory effort but isn’t yet back on the ventilator, but it also starts to recover almost immediately.

And he’s totally out for at least the next 5-10 minutes, so Marian doesn’t feel bad about suctioning him while he can’t yet feel it. Unfortunately he also doesn’t have much cough reflex, but you can’t have everything.

…He’s approximately stabilized now, right? Dr Hulka will strip off her gloves and leave. 

She ALWAYS DOES THAT and it’s great when you’re the one waiting on routine medical decisions while a dozen emergencies happen across the unit - or refreshing the chart to see if notes are in yet - but when you’re instead one of the emergencies, it’s really stressful.

(At least it sounds like Marian has probably avoided any further dressing-down for the circumstances that led to her patient self-extubating while in V-tach…)

…She considers restraining him again now just in case, before remembering the miserable betrayed expression the first time he woke up and realized he was tied down. He was probably almost kidnapped and only avoided it by stabbing himself and being left for dead! She’s not doing that to him. She’s going to stand RIGHT HERE within arms’ reach, watching him, until he shows signs of waking up.

Within five minutes, before he’s shown any sign of stirring, her podmate is at the door. “Marian? Lab for you.”

“…Uh, right, critical results?” Marian doesn’t really want to go even as far as the phone. “Would you mind taking them down and letting the resident know? If it’s his potassium we are already treating that…”

And she’ll go back to hovering.

Karal slowly drifts closer to consciousness.  He's... scared, like something might go wrong at any moment and he doesn't know what to do about it...  That pushes him to wake up faster and try opening his eyes, maybe he can see if anything is wrong, although probably he can't...

He's more awake, and so tired.  He hurts - more than before?... but the thing he's scared of isn't happening, although he can't quite remember what it is.  He does manage to drag his eyes open and focus on Marian with an uncertain look.

“Good! That’s really good.” Marian leans in immediately, reaching for his hand and squeezing it in a way that hopefully doesn’t feel like restraining him even though she is, totally, thinking about her ability to stop him making a grab for any tubes if he's so inclined. She smiles reassuringly. 

...He looks stressed and she's not sure how much of the recent events he remembers. She makes the hand-squeezing heartbeat gesture he was doing before and then smiles and makes a thumbs-up gesture in a way that will hopefully convey that his heart is (for the moment) doing better. 

He doesn't seem at all inclined to grab anything!  He's in fact not moving at all.  (It was important not to do any things... and right now the awful thing isn't happening but if he does anything it might start??...)

... Oh that's what the scary thing was--  He makes a reflexively distressed face as her motion brings back the memory, but once he gets the rest of her meaning (from Empathy, not the unfamiliar thumb gesture), he nods a little to confirm that it's not happening any more.

Leareth is dragging himself to full consciousness as well. He’s - aware that he shouldn’t fight for the body or mage-gift, that much he actually managed to engrain as a temporary instinctive-level habit, during the minutes he was reminding himself of it over and over.

…It’s approximately the only thing he remembers for the first few seconds, other than the distressing fact that he’s trapped and can’t do things. (It’s still clearly harder for him to track down recent memories on waking than it would be for Karal - his mind is still fragmented,  nothing is “where” he expects it to be - and his basic orienting reflexes are getting tangled up because he can’t volitionally use mage-sight.)

Also there’s an enormous amount of pain - though more distant for Leareth than it is for Karal - and he remembers danger and wrongness - where, what -?

(He’s not yet panicking but his stress levels are clearly rising quickly.)

He catches Leareth's distress almost immediately.  It's all right - or at least things are more stable now!  Their heart was... not working right... but the healers fixed it.  That was most of the danger and wrongness, he thinks?  But he should find out whether it's completely fixed or not, it's just that he doesn't know how to ask that, and he's so tired...

The enormous amount of pain is-- fine, he thinks?  Probably?  Maybe he's wrong about that.  He should probably check that too.

... First he'll lie there for a moment, try to catalogue all the various unpleasant sensations, and see if anything feels better once he gets used to being awake.  And if Marian has more communication ideas.  It would be so much easier if she could tell them what the important things are.

Breathing is back to being weird with the tube - and of course the tube itself continues to feel deeply uncomfortable - but it’s not especially effortful, especially compared to before; it feels like he’s getting enough air within too much difficulty.

Once he pays closer attention, he can tell that his heart is beating quite fast, thumping in his chest as though he's engaged in some sort of moderate exertion like a hike and not lying perfectly still in a bed. He's no longer especially faint or lightheaded, though; there's some lingering dizziness but it feels maybe more like the remnants of the being-drunk dizziness that happened immediately before he fell asleep, and it's getting better rather than worse. 

He does feel appallingly weak, his limbs heavy and floppy, as though he just marched for days without food. Drawing anything right now is going to be very difficult. Also, though it barely registers next to all the other, worse pains, there's a dull achy stiffness in his back and in the muscles of his arms and legs. 

Marian is definitely thinking about ways to communicate, since she's definitely getting the feeling this is a patient who wants to know what's going on! (As a general rule Marian always tries to explain to patients what's going on if they seem up for it at all, but some people actively find it reassuring.) She'll have more to explain once she knows for sure if the problem was his potassium - oh, actually, she can check that, now that he's awake she thinks it's okay to duck to the other side of the room and haul the computer-on-wheels over so she can log into his chart and see the new lab results. 

...Oh dear, that is indeed a potassium level of 2.4 mmol/L. And this is the older set of labs - if it's some sort of bizarre progressive potassium-loss problem, it probably went lower during the interval between when he started seeming a bit off and when he started actively doing potentially-lethal arrhythmias. (Is there some sort of syndrome that causes excessive loss of specifically potassium in urine or something, without causing weirdly high urine output? Maybe related to the hypoglycemia? Ugh, Marian has no idea, that is in fact a doctor question not a nurse question.) 

At least his troponin is - well, mildly elevated, but to an extent fully explained by damage incurred during the surgical repair of his stab wound - which is really good! Low potassium is treatable - if not as fast as she'd like - but much moreso than a MI or other structural cardiac problem. 

Uh. Okay. She needs to think about how to draw someone...having a mysterious electrolyte deficiency? Ugh. That's going to take some thought. In the meantime she'll make sure she's where he can see her and smile reassuringly some more. 

When she first looks at Karal after seeing the results, he looks surprisingly reassured for someone who was clearly scared a moment ago and hasn't been given any new information! 

(The information wouldn't do him any good anyway, he's absolutely not going to understand the details, but he can tell that now Marian knows why things were so bad, and it's an easily-fixable thing rather than a hard one - which is all he really wanted to ask about, and he didn't even have to figure out how!)

He makes the awful-heart-thing motion, points to the strange large artifact she was looking at and then at her, and draws an X in the air over his chest to show the thing no longer happening?

This guy is impressively good at reading her face!

His problem isn't entirely fixed, but - it seems pretty likely he won't do any more scary arrhythmias, the amiodarone certainly looked effective - at the cost of increasing his vasopressor needs a lot, his contractility and thus cardiac output are plausibly even worse now, but also he's back to only the occasional premature ventricular contractions. And meanwhile his potassium will at least be trending upward, and even if it's going to take, like, four to six hours to normalize it, it should take less than that to get him definitely out of the lethal arrhythmias danger zone, for most people that's only a risk below 2.5 mmol/L.

(Also possibly they can get him up faster if there's any way at all he can tolerate it enterally. Though giving the potassium elixir down an NG tube risks just making him throw up, there's a reason one usually avoids giving it to patients on an empty stomach and he's additionally pretty shocky and recently had major surgery.) 

- anyway it seems close enough that she's happy to nod and smile at his gestures. 

Leareth still thinks he would like to know the details, but - at some point, if they survive this, later once they're recovered and he can do things and there's maybe been an opportunity to learn the local language. (It's significantly more frustrating not having Mindspeech potential in this body than it was when he just thought it would be a minor inconvenience and require relying more on people in his organization.) Right now if they at least know the emergency is over, that's fine. He's very tired. 

Karal is very much looking forward to watching Leareth figure out how all the bizarre local artifacts work!  But yes, definitely later.  (For now he shows him some memories of the two strange machines he probably wasn't paying attention to at the time.) 

In the meantime, now that they've established the problem where they nearly died is getting fixed (even if Marian is frustrated about how long it'll take), maybe he could find out about fixing some of the other problems?  He really is incredibly tired and weak, but he's mentally feeling better, which makes it more frustrating how difficult it is to move.

He holds up his arm in an exaggerated floppy way, and makes a questioning gesture?

Hmm, why is he feeling so weak? …Honestly it seems pretty normal and expected for any critically ill patient, but in his case it seems…worse than before…when he was able to roll over in bed unassisted and even sit up (however ill-advised it might have been.)

He’s anemic, but not low enough to necessitate any more transfusions, and his hemoglobin was stable across a couple of checks. He’s on a lot of pressors in addition to his body’s natural shock response, both of which will be redirecting blood flow and oxygen away from his extremities to prioritize vital organs, but that can’t explain all of it, surely.

…Honestly that might also be a direct effect of a potassium level that low. She wants to Google that really quickly - okay, yeah, she was right and hypokalemia totally causes fatigue and muscle weakness.

She points at the computer again, makes the heartbeat gesture and also imitates his floppy-arm gesture, then points at the IV tubing, taps her watch and mimes clock hands turning, and then makes the X gesture over her patient’s chest and also adds a bicep-flexing gesture.

Hopefully that conveys “fixing the heart problem will also help with the weakness and fatigue” and also that he should expect it to take a couple of hours?

Oh!  That's very good, if the two problems are somehow really one problem.

He has no idea what the wrist gesture was, but he can get from her emotions that it's about time, long but not days?  That's not bad at all, really, but it is going to be frustrating to spend that much time unable to draw reasonably.  Moving his hands is hard enough!  He would maybe like to be done with that for a little while, since everything seems to be all right.  (Well, relatively speaking.)

He mimes sleep, questioning gesture?

That’s an excellent idea! Marian nods and smiles and repeats the same “sleep” mime-routine back to him. …And then points at him and mimes rolling over, because he’s now flat on his back again after the reintubation and might be more comfortable in a different position? …She’ll also point outside the room, and make a walking gesture into the room with her fingers and count to 2 on her fingers while pointing to herself and across the bed, to convey that they’ll help him? He might assume she wants him to roll over by himself again but not feel up for that in his current condition.

Questioning face - does he want that? (It’s not urgent, he’s fine to lay on his back again for a couple of hours, but she thinks he seemed comfier before on his side.)

Shrug?  It seems like a lot of effort to go to for something that doesn't matter, especially if he'll be able to do it on his own in not too long, but if she thinks it's important he's not going to argue with her.

Well, it’ll help Marian feel better so she doesn’t mind if it’s more work! Also he’s spent a lot of hours on his back today, but if she puts him on his other side she’ll be happier about leaving him be to sleep for two or three hours. And the unit seems less hectic now, she thinks she can get someone to help without too much time elapsing. 

This proves correct, and she’s able to nab Elliot, one of the other travel nurses, to help gently slide her patient up to the top of the bed again - people always slide half down to the bottom when the head is raised - and then turn him and tuck him in with a nest of pillows. He can have a blanket from the warmer too. (Marian feels that making patients comfortable in small ways is especially important when they feel awful in big ways that she can’t immediately fix.)

And now he can sleep, if he wants! She’ll stay nearby (though maybe after asking Elliot to keep an eye on him while she pees and gets water.)

Healers have very strange priorities, but it is really comfortable, so he gives her a sleepy smile and closes his eyes.

He has no idea what time of the day it is, but with everything that's happened in the last days, it hardly matters to his ability to fall asleep within a minute.

It’s early afternoon. Marian is actually really hungry, but getting anyone to cover her for a lunch break - even just long enough to bolt down the stew in a container in her backpack without heating it up first - would require actually explaining to someone why restraining this guy is a really bad idea and they need to instead park themselves next to him for the duration. 

Ugh. She needs to...do something about that. She's not behind on charting in the sense of vital signs and assessments but she's arguably very behind in the sense that she hasn't even tried to figure out where to document any of the tenuous facts she knows-or-is-guessing about her patient's history. And waiting for rounds is starting to seem less tenable. Dr Hulka tends to round on new admits last rather than first - which Marian minds a lot less given how she actually does her notes in a timely manner and puts in standard admission orders - but it does mean that rounds on him may not happen until like 4 pm. (Also, explaining what she knows about his deal in front of the entire medical team sounds way more awkward than having it already in the chart.) 

She manages to flag down Kasey, her podmate today, and ask if she can send over the charge nurse when she has a chance.