Alison is the charge nurse today. She looks tired when she comes over, which is really unsurprising because Marian knows for a fact that she was also out at the bar last night and showed no indication of being ready to leave at the point when Marian left. 

"'Sup?" 

...Marian brings over the clipboard of drawings, and maybe they can talk standing in the doorway in hopes of not waking her sleeping patient? 

"So, uh. He's the Walmart stabbing guy, right, and we had no idea what went down before they found him? There's - a bunch of stuff - uh, he doesn't speak any English, that's one thing. He wrote this," she shuffles through to find the relevant bit of paper, "and I don't even know what alphabet that is. And then later he drew a map..." 

Also had a weird amount of interest in Marian/the hospital's religious affiliation, she had kind of forgotten that, but it seems less important to go into right this second.

She finds the map. "I think it's meant to be the country he's from? Also I tried to show him Google Maps and he was, like, astounded, like he'd never seen a smartphone before. Anyway, later I think I tried to ask him what happened and he drew this, uh, incredibly confusing picture, and I tried to ask why he stabbed himself and he drew - this. I'm guessing here but I think what happened is that maybe people were - trying to kidnap him? Maybe some sort of gang thing? And he was worried if he fought back there'd be, like, some sort of shootout or they'd set off a bomb or something and a lot more people would get hurt? I don't know why he didn't call the cops..." 

Ugh she's definitely rambling at this point. Focus. 

"Anyway, he has, like, serious PTSD about stuff like being tied down - I tried to explain why we usually put wrist restraints on intubated patients and he - wait, that one wasn't a drawing, but I think he pretty clearly acted out that he would be was more likely to get combative if he woke up restrained. So I think it's a better idea not to, but - we really shouldn't leave him alone. He's usually really cooperative when he's awake, but I left for like a minute right before he started doing runs of V-tach and he panicked and self-extubated - I mean, he probably thought he was dying, which isn't even wrong, and no one was there..." Shrug. 

A slight sigh. "Marian, you're not in trouble." 

Oh. ...Was it that obvious she was stressed about that, significantly more than she's stressed about the decision itself or the next several hours? 

"Can we make him officially 1:1 so we can do that safely? He's actually really pleasant and cooperative as long as he's not scared." 

"...I'll see what I can do. Can't promise anything for tonight, but we can at least not give you anyone else for this shift." Another sigh. "This seems complicated. We should probably consult social work?" 

"Mmm. ...I was wondering if we should, like, make a police report? Since it seems like there was probably a crime committed? - I don't think it's a crime to stab yourself but, like, the people kidnapping him, if that's what happened." 

Alison makes a face. "Let's just put in a social work consult and they can figure that out, I have no idea." 

"Okay. Seems like a good plan." Somehow Marian feels like this conversation should have involved a lot more of her being asked pointed questions, but she's not actually sure what additional questions Alison - who's clearly busy and juggling a whole unit worth of patients - should be asking. Probably Alison also doesn't want to make it her problem if their patient was involved in criminal activity. It's not like he has a knife or illegal drugs on him now. 

"...Uh. I do kind of want a lunch break. At some point." 

“Sure thing, girl.” Alison glances at her watch. “I can give you ten minutes now, rounds is on pause again while Hulka’s dropping a dialysis line in 109. - lines, drips, anything else I need to know -?”

Oh thank god that’s long enough to pour some stew into her face. “Triple lumen central line - subclavian - he’s maxed on norepi and phenylephrine and I’m trying to wean him down on the epi drip - he’s on fentanyl for pain, no sedation, I wouldn’t say he’s comfortable but he didn’t like the higher dose - uh, if the lab calls about a critical K, we already know and he’s getting IV replacement - defib pads are on him in case he does V-tach on us again, he’s on the 24 maintenance dose of the amiodarone now…” This was probably in fact more detail than Alison wanted but Marian is more comfortable when people know stuff about her patients.

Aaand then she can bolt to the staff room and eat?

Her patient does not wake up during this interval.

It’s not long enough for any kind of mental reset but Marian will survive. It is long enough to eat most of her (cold) stew, chug more water, and pee again so she’ll be set for as long as possible, which are the important things.

Alison has done a bunch of cleaning up the inevitable post-emergency mess in her patient’s room, and reports that he hasn’t budged. “Oh, and I checked his chart a bit - it looks like you only had the one bag of potassium ordered, but he came back at 2.4?”

“- Oh, right, that’s because Dr Hulka was kind of guessing, the labs hadn’t quite come back when he almost coded. He does probably need more than that…” And rounds is on pause so who knows when they’ll make it to her, it might even end up being one of those days when rounds trail into night shift. Though probably not, it’s Dr Hulka who has actual time management skills.

“I’ll bug the team for orders,” Alison promises. “Text me if you need anything, yeah? …And try to find time to write up a narrative note on everything you told me, and I’ll get a social work consult in.”

Sure, Marian can do that. She watches her patient sleep and wishes she knew his name - though it wouldn’t at all have been reasonable to ask him to talk and tell her during the 10 minutes or so he wasn’t intubated - and hangs the next bag of potassium when the first one finishes. 

The lab does call with more critical results! His potassium during the almost-code was down to 2.1 mmol/L.

Well that’s alarming! It would admittedly be more alarming if they didn’t already know about the problem. Marian is kind of stressed about where he’s putting it and whether the max safe IV rate is even sufficient to keep up, but she now has orders for serial labs every four hours, plus a standing order to repeat labs in case of suspicious ECG changes or worsening hemodynamics.

She double checks the time for her next lab - 4 pm, less than four hours after the last set but Alison clearly put the order in so it would end up falling on a standard easy-to-remember schedule - and then settles in to work on her narrative note some more and be right there when her patient wakes up.

(His sats are slowly dropping - he clearly isn’t keeping up with clearing secretions while he’s asleep - but as long as he’s managing to stay above 90% it’s not worth waking him for.)

He has one of those vague stressful dreams - there's something wrong with him, the details keep changing, and everyone at home's too busy to help - no, he blurrily realizes as he wakes up, he's somewhere completely different...

... And he feels all right?  Well, not by any reasonable standards, he'd be no use with a sword like this, but he thinks he could at least hold up a pen.  (He had no idea his expectations could get that low, but the prospect of being able to move without immediately getting exhausted feels too good for him to get morose about it.) 

He opens his eyes, smiles at Marian, and stretches carefully to test the feeling. Yes, definitely better, although he wishes he could breathe more than this.

He sends Leareth calm-safety-feeling-better in case he's waking up anxious again.

Leareth is actually waking up a lot calmer this time! The new mental habits he’s ingraining, of - helplessness, and resignation to it, the implicit expectation that none of his usual survival reflexes will work or help the situation - are going to be obnoxious to unlearn once he’s no longer in circumstances where they’re necessary. (Especially because it seems like he’s ramming through a sense that he’s utterly dependent on Karal and that frustration about this is unproductive, rather than actually feeling secure and safe in Karal being someone he can rely on as an ally.)  But it seems like this is the shape he can be where he’s mostly likely to survive to have better options later, given how tenuous their situation is and the fact that his panic-responses have definitely made things worse.

He appreciates Karal thinking to reassure him, though, and he’s glad it seems like Marian guessed right and the weakness is in fact improving in response to her dealing with the heart wrongness.

Oh good he’s awake, and looks so much less miserable! Marian watches him stretch out with obvious delight.

His sats have been at exactly 90% for a while now, though - and he’s on 50% oxygen now, the respiratory therapist must have left it on higher after the near-code and reintubation, so he does seem to be doing a little worse than when she first got him. 

Marian swings down her stethoscope and clearly telegraphs what she’s doing before listening to his lungs - yup, fine crackles everywhere again, and significantly decreased air entry to the lower lobes, though it’s symmetrical so it’s probably just that he was taking shallower breaths while deeply asleep for hours and not something wrong with the chest tube on the right. 

She taps the 100%-oxygen-for-two-minutes button on the ventilator, then picks up the tubing and mimes suctioning him. Questioning face?

He sends sorrow that Leareth's situation so obviously goes against all his instincts and needs, but - he's not wrong, that he's nearly helpless and struggling against it makes things worse, and Karal cannot yet do anything about it.  (It's impressive, how well Leareth is dealing with something clearly so awful for him.)

It visibly takes him a moment to remember what Marian means, but - yes, she can do the unpleasant thing that lets him breathe better, and he can cough through it like he's supposed to, and only make a bit of an unhappy face about it.  He doesn't mind this nearly as much as most of the other things that have happened here.

He notices how easy it is to trust that she's doing the kind and helpful thing, and how used he's gotten to her being right here when he wakes up...  How long has it been?  Once the they're done with the tube, he points at Marian, gestures sleep, question?

Huh? Clearly her patient thinks his question is obvious but Marian isn't actually sure what he means. He...did sleep...but it's not like he wouldn't already know that? 

He's pointing at her, though, maybe he wants to know if she was here the whole time? She wasn't but someone was - who Marian trusts would have taken good care of him if he did wake up needing anything - so it doesn't feel too much like lying for convenience to find the picture she drew from earlier, of him not-restrained with her there, and point at herself and then point at it? 

That's... good to know, actually, he nods at her with a grateful look, but it's not answering his question at all!  (Except to clarify that she hasn't gotten to sleep so far, but he didn't think she had, and Empathy tells him that's not what she meant to communicate.)

Luckily he's pretty sure he can draw now, and he might as well start with this reasonably easy thing.  He gestures for the pen, draws Marian sleeping in a bed (the figure has long hair and a dress, which isn't really very distinguishing given that both of them have long hair and Marian is actually the only one who has trousers, but he at least thinks to point to her for clarity).  Questioning gesture?