Oh! Awww that's actually really sweet! Marian is having feelings about it! 

It's - also belatedly occurring that she doesn't think she's actually on the schedule tomorrow? She hadn't marked in in her head as day off because she has no specific reason not to call the hospital at 6 am and ask about doing an overtime shift. Which they'll almost certainly take her up on given the census and acuity level on the unit, and it would be dumb of them not to give her 104 back, just. She's not actually confirmed on that. 

It seems maybe important enough to ask Alison now if she can confirm for overtime tomorrow, though. In the meantime she nods with a wiggly-hand gesture to mean 'probably', and finds the two-day version of the timeline so she can point out tomorrow sunrise on it. 

Oh good!  He looks happy at that, projects trust-safety-appreciation.  He could still be all right here if he just had to interact with a different stranger every day, he thinks - especially now that Marian has explained enough to him that he feels like he mostly understands how this place works - but it would be harder, and... he just likes her and would be sad not to see her again. 

Now he can fall asleep.

(He blurrily hopes she'll wake him up and introduce him to the new person before leaving, and there was also... the other thing, with the eye, to do at some point?  And the regular things she explained earlier - which he can't easily pull up out of his his memory right now, but he remembers they weren't worrying and he'll recognize them when they happen.  In the meantime he should clearly get what rest he can, and his body is leaving him less and less of a choice about it.)

The Radiology tech finally shows up with the portable X-ray machine at 6:30, very shortly before shift change (Karal has had about half an hour to sleep.) They need to sit him up all the way, though this can be accomplished without asking him to do anything, the head of the bed bends up that far. Marian will manage his tubes for him and help him lead forward enough to tuck the X-ray board behind him, and then there's a very large machine that goes at the foot of the bed and casts a grid of light on his chest, and then Marian and the tech both back off and stand out of the way for ten seconds while it does something undetectable to Karal.

The X-ray tech is in a hurry and does not stay to help Marian get him settled comfortably in bed again, but that's okay, she can get the oncoming nurse's help in like ten minutes. Which she's going to spend making sure there are full bags of all the pressors. (Ugh, he's not quite off the epinephrine, that's frustrating - she got it down to basically the lowest rate while he was sleeping, but every time she tried to stop it entirely he would drop his systolic blood pressure below 90 again. He's higher right now but presumably because they just woke him up and moved him around in painful ways.) 

Night shift trickles in. Marian overhears the sound of conversation at the nursing station for a few minutes, and then Lisa comes over. She's one of the permanent staff; she's a few years older than Marian and worked in orthopedic surgery before moving to the the trauma ICU a couple of years ago. 

"Hey. Alison said your guy's the most interesting patient on the unit?" 

"...Heh. I don't know, I've kind of been too busy to pay attention to anything else, but yeah, there's a lot going on with him. - why don't I introduce you now so we don't have to keep bothering him? Uh, he doesn't speak any English but he's really sweet and he actually communicates super well by drawing things or, like, mime." 

And she'll go into the room with Lisa and nudge her patient's shoulder. "Hey." And once he seems awake, she points at herself and makes the walking-away gesture with her fingers, then points at Lisa. "Lisa." 

"Hi!" Friendly wave.

(Lisa is a professional and her face doesn't show it at all, but she's definitely thinking that he's kind of hot.) 

(He cooperates with the new machine, trying to move on his own as much as he can now that he's feeling better again, and looks at its operation in sleepy fascination.  There's light!  What's it doing!)

Oh no, that's a consequence of Empathy Karal hadn't run into or considered before!  Of course he knew women thought about that sometimes, but he really feels like he shouldn't be watching...  He can try to only use receptive Empathy when something important seems to be happening instead of keeping it on all the time like he has been, he supposes, but right now is an important thing happening and he suspects this woman is like Marian in preferring him to be less confused to keeping more of her emotions private, if only because him being less confused will definitely make her work easier. 

He smiles and waves back, although he looks a little embarrassed.  (He's trying to at least not project it.)  He also waves goodbye to Marian and mimes sleep at her.

It’s still only like 7 pm! Her patient continues to be very thoughtful, though.

She’ll quickly look over all his various tubes and and IV meds with Lisa, and then dim the lights for him and duck out so they can finish the report. …She pauses to fish the Spider-Man nets drawing and the building-exploding drawing out of the pile. It wasn’t that topical for rounds but Lisa should know.

It’s a lot to go over but at least Marian has already been over it for rounds, and did have time while he was sleeping and she was catching up on charting to also make herself some notes.

Oh, and they should look at the chest X-ray. The radiologist probably won’t have read it yet, since it wasn’t entered as stat, but it's the single type of scan she's spent the most time staring at, she does kind of know how to read a chest X-ray herself at this point. 

It's not egregiously terrible in any one respect? It's faintly hazy, in a general distributed way but moreso at the lung bases, and there are some patchy areas, and what looks like a small pocket of fluid that the chest tube isn't draining successfully. It's not shocking that he's having the degree of trouble breathing that they've observed, but it doesn't point at an obvious solution to fix it (though at least it also doesn't indicate a problem that's likely to rapidly get worse). 

...Poor guy. He clearly hates being intubated so much, just, not quite enough to prefer to be less conscious for a few days while they wait for his lungs to recover. Maybe by tomorrow he'll at least have improved enough that they can put him on the most comfortable ventilator mode, in Marian's opinion it's just kind of mean to put people on controlled modes when they're fully awake for it. 

She reminds Lisa about the hourly glucose checks and that she should check his electrolyte panel again at 8 pm. - oh and she forgot about helping him change position, but if he's already asleep she's inclined to leave it, he's actually surprisingly mobile in bed and she's not that worried about his risk of bedsores, he just seems more comfortable not flat on his back. 

She tiptoes in to try to check whether he's asleep without waking him if he is. 

He is so asleep.

Oh good! Hopefully he'll get a great night's rest tonight around all the inevitable interruptions, and things will be better from here. 

Marian will finish her last little bit of charting and go HOME. 

Lisa is inclined to leave the guy alone as long as he looks comfortable and his vital signs are tolerable off the epi drip. (Which she does immediately; he's down to barely any of it, and her experience is that patients often sort of get used to that last little bit and will drop their BP at first when it's stopped but then adjust.) She has to draw blood at 8 pm but she shouldn't actually have to wake him just to do that. 

His blood pressure does drop, but then steadies out at around 90/50 with an acceptable, if pretty borderline, mean arterial pressure. He's oxygenating better on the volume control mode, staying pretty solidly at 96%. 

Oh goody! In that case she'll leave him be, just tiptoing in and out as quietly as she can to swap out IV bags before alarms go off to wake him. She can draw the repeat blood gas and the eventual electrolytes from his art line without disturbing him. Patient sleep is IMPORTANT.

The blood gas is fine! His next blood sugar is 79, normal. His sats do eventually start to drop a little with him lying still and not coughing, though he's still at 95% at 8 pm when she draws the electrolytes, and only down to 93% when the labs come back 40 minutes later and confirm that his potassium is up to 3.2. 

That's better but still actually below the cutoff for normal range? Ugh. This wouldn't be weird if he were on a Lasix drip or something and ongoingly losing potassium in his pee, or having diarrhea, but as it is she's very confused where he's putting it. 

Also she probably does need to nudge him awake, it’s clearly not ideal for his lungs to lay in the same position for too long and he probably needs suctioning. 

She's going to go bother the resident for orders first, though. Can they swap his fluids for one with potassium in? She realllly doubts running fluids with 40 mEQ per liter at 150cc/h will push him too high. 

And then she'll go very gently nudge him awake. She clears her throat loudly before gently tapping his arm; based on everything Marian said, he sounds like the kind of guy who gets startled easily. 

The noise is enough to get him to open his eyes, so he doesn't startle when she touches him.  He tries to see how his breathing is doing, because he remembers that being an important question for some reason-- gets predictably frustrated with the machine but also does notice that it feels worse-- looks at her questioningly.

Oh, Marian is right, he is weirdly good at eyebrow communication. (This is besides the point of anything and not actually especially distracting or anything, but it is undeniably attractive.)

Lisa picks up the suction catheter and gives him a questioning look right back. 

He nods and mimes coughing!  He remembers how this works.

(And decides he doesn't at all mind her looking at him like that.  It's clear enough that she's not going anywhere with it, just idly noticing, and it is pleasant to be idly noticed.)

Lisa would not have said that “being suctioned” was a skill until she met this patient! He’s clearly trying very diligently to cough effectively and he gets a bunch of gunk up.

(It’s not super concerning-looking gunk? It’s creamy-white and thin, not yellow and goopy like you’d expect with bacterial pneumonia. There is a lot, though.) 

She gives him a minute to recover before going through the rest of her assessment; she listens to his lungs and bowel sounds, examines his various dressings and drains, checks his peripheral pulses and capillary refill, and trying to convey by mime that she wants him to push against her hands with his arms and legs so she can gauge his muscle strength. (These are mostly things that Marian did but Lisa is more systematic about it.)

It's also the only time he gets to do some normal-feeling breathing instead of the weird and uncomfortable version, and it's just satisfying to get to do something that feels useful.  This patient sure seems to have weirdly positive feelings about suctioning.

That is a lot of things she needs to do, but all of them make sense and her emotions are calm and matter-of-fact, so it's all pretty reassuring.  He smiles a little and projects faint appreciation for all this presumably important care.

He can push fairly hard - he's definitely feeling less strangely weak now, and he was very strong to start with.

She’s impressed! Everything else seems pretty good; his capillary refill is delayed and his extremities are pale and cool, but that’s really exactly what you expect from someone still maxed on two pressors.

Marian also said that he clearly preferred repositioning himself and was strong enough to do it if someone helped manage his tubes and wires. Lisa absolutely buys that, and will try to suggest the idea via mime and ask which side he would prefer. 

It's so nice to have gotten through the first day here and know how the basic things work, and to be awake enough to remember it. 

He nods, picks the side facing away from the door for the sake of getting slightly better sleep overnight, and doesn't have trouble doing it himself.  (He wonders if he could do it carefully enough not to need help with the tubes, but he can leave experiments in unauthorized moving around for later.)

Unfortunately she will have to bother him again before morning, but if he’s stable (which she’s not convinced will remain the case, but hopefully!) his next assessment or suctioning can probably wait until midnight, that’s 3h of uninterrupted rest. He actually doesn’t look too bad, for someone with as many problems as he has.

She gets him tucked in and turns out most of the lights and settles herself outside.