Devoid of most of the context of his own life, it feels - absurd, impossible, that this could be the best option. Surely, if the world were sane, there has to be another way?

…Leareth doesn’t actually know what other paths he explored. Just that it’s been a thousand years since he first thought of this plan, and right now he has to trust that his past self wasn’t a complete idiot about it and did try to find alternatives.

And, of course, here they are, he’s trapped in what's probably another world and helpless and in the medium term he can't make his way back to his organization at all without Karal's cooperation. And Karal should know what offering that cooperation would mean. 

(And the other world has different-seeming magic and - maybe that opens new options he hadn't yet explored - Leareth hasn't had much time to think about it but he desperately hopes it is. Just. It still feels important to convey that he would have judged it worth it.

- he could get the dead people back, he thinks, with the help of a friendly god. That made it an easier choice.) 

The thought is a wave of horror.  Karal has seen enough death lately that he can just barely begin to imagine a thousand times more of it, he does not want to imagine it but he can't seem to stop--  (How many people has he seen in all his life, how many times over would all of them have to be dead--)

--His distressed breathing is increasingly fighting the awful tube device, and losing the struggle in a way that feels horrible and isn't working--  he needs to control himself and find some way to make it stop, but he cannot figure out how--  (At least he does remember that he is not supposed to pull the thing out and that it won't help if he does)

--there's a noise - he will upset the poor healer but maybe she can figure out how to fix this...

(Oh no, Leareth had managed to perhaps slightly forget about being physically embodied - he mostly hasn't been interacting with that - and in particular the extent to which Karal's body is in terrible shape and also attached to a lot of bizarre artifacts. ...He still thinks it was important to have this conversation through to the end, but he's apologetic about it.) 

Lisa would have left it alone if it were just his blood pressure being up (or at least, waited a bit to see if it would stick and then tried weaning the phenylephrine drip) but his heart rate is also spiking pretty high, and now he's setting off the high airway pressure alarm on the ventilator - and, when she stands up enough to see the screen, it's pretty obvious that it's because he's wildly fighting it. 

Honestly, it's already kind of a dick move to put someone on a volume-controlled mode without sedation, but especially if they have PTSD about probably-gang-related kidnapping attempts and - she's guessing he was having a nightmare, given how he was just lying there thirty seconds ago and she didn't notice anything that could have startled him? 

She's going to go in and - first of all silence the alarm because it's blaring right next to his ear and that can't be helping with anything, and then she's going to switch it to the basic CPAP mode, where it'll just support his breathing at whatever rate and depth he feels like. (RT hates it when you mess with their ventilator settings, but she'll put it back once he's calmed down.) 

...Does he seem to be awake? 

Yes, awake and clearly distressed, but still giving her a hopeful look when she enters his field of view. 

He does immediately look less miserable once she changes the ventilator setting - he's still breathing hard in obvious distress, but it's clear that he's trying to calm down and at least halfway succeeding.

He doesn't speak English, which limits her options for reassuring him. Lisa can be obviously calm where he can see her, at least, and put her hand soothingly over his, and take slow deep breaths that he can try to match. 

(Nothing is actually wrong, she doesn't think? Well, other than all the things that were already wrong with him, but his oxygenation is fine. His blood pressure is still running pretty high but not dangerously, she's going to wait and see what it does once he's calm before changing any of the meds.) 

...She wants to ask how he's feeling but Marian didn't have a chance to teach him that much English and it's probably not a good time for drawing pictures. Questioning look, in case he wants to try communicating something to her with his remarkable eyebrow game? 

He looks grateful for the contact, and does calm down easily enough with her help.  He still looks incredibly sad, and... cannot very well project reassurance in his current state, but... apology, gratitude, distress-that-cannot-be-helped.

...Wow, something is clearly bothering him a lot. It's late, though, and he's not exactly indicating wanting to talk about it. (Draw pictures about it, whatever.)

Does he seem to object, or otherwise have any trouble, if she goes to turn the ventilator back to its previous settings? 

Something is bothering him very much, and it would help nothing for her to know.

He lifts his hand in a "wait" gesture, just for a few seconds while he tries to convince his body that it'll be fine, and then nods unhappily.

She's absolutely going to talk to the medical team about whether they can possibly do a better job of balancing his comfort with keeping his lungs open, but she can't make that decision unilaterally, so she shrugs apologetically before ducking back out of the room; his vital signs are fine and he seems like he might want some space. 

He gives her a sad half-smile.  She is good and nothing here is her fault.

Then closes his eyes and turns his attention back to Leareth, who has been watching his horror and waiting patiently for his answer.  Looks back over the explanations he only half registered a moment ago - they make sense, but they don't really change anything, because it all made sense the moment Leareth first said it.  He's exactly the sort of man who could decide that something that awful was necessary and plan it without flinching, and he has the only possible reason that would be enough...

And then he risked all of it just to make sure Karal knew what choice he made.  (Yes, it was that much of a risk, when Karal can act and Leareth can't.  He can't be sure, but - he could have used the time to look for a way to incapacitate him for the rest of Karal's life.  To drag him back into the gods' power and see if They could do more than that.)  It's another moment of Leareth reaching out toward... fairness, cooperation, something... despite so much reason against it, and Karal stares at it in helpless awe.  Why?  If it's worth all that death, how can it not be worth lying to me?

...It's not that he doesn't already half know, on some level.  It's not as if he wouldn't feel the same impulse.  But it's... so much... too much to move past it silently, as if it wasn't the most important thing in the world, that despite his incomprehensible plans and his thousands of years of who knows how many stolen lives, Leareth is a man who would refuse to lie to him.

...In fairness Leareth is not, actually, entirely sure if he would have told Karal this soon - or at at all - if he had his memories and was less incapacitated. The impulse toward fairness is important to him, but it's still one he might under different circumstances have chosen to ignore. 

(He still almost certainly wouldn't have lied to Karal, in the sense of coming up with a false story of his life and goals - among other things, that's a terrible subterfuge to try to run when you're sharing a brain with someone - but he might have left it at "there are things he can't share", which he's not sure how much Karal would even have objected to or felt wronged by.) 

It felt overdetermined partly because he is incapacitated, and seems in many ways worse-affected than Karal by their physical condition; in the worse moments he's not sure that he's very in control of what thoughts Karal ends up seeing, and it might have gone much worse to let slip something horrifying by accident without context.

And he thinks they need to trust each other, to have the best odds of getting out of this situation at all. Karal could take this and decide to trap him here for the rest of his natural life, but they already are trapped, that's the default, and - even if the compulsion does eventually break on its own, Leareth doesn't love his chances of managing here until he can replicate whatever strange accidental Gate brought them here, not when he has only a few dozen episodic memories.

(Leareth - isn't sure whether Karal could easily do much worse than trap him here indefinitely, without Leareth's cooperation to help him learn magic? Bring him to the attention of the local gods, maybe. They know so little about this place, and it might turn out there's a route to harming Leareth that doesn't require Karal, say, knowing how to use magic. But fundamentally, if they aren't cooperating, and are instead working against each other while sharing a body, that leaves each of them vastly less capable.) 

...Maybe the important part is that, given the general difficulty thinking, he's falling back on simpler reasoning processes. And one of those is that - you always reach for cooperation. The only way to get cooperation is to reach for it a hundred times even when no one is reaching back, that's - not just a fact about being someone like Leareth who uses horrible methods, he thinks it's often true in general, it's true between Valdemar and Karse... You can hold back out of caution, you can be paranoid and trust no one and rely on no one but yourself, and it's safer but it's also - another way for the gods to pin you in a box. 

And in this case, Karal was reaching for cooperation first, almost from the very beginning. It - would take a very strong counterargument for Leareth to ignore that, and "trusting people is terrifying" doesn't count. 

Karal is immensely fond of the way Leareth continues to make sure Karal doesn't think he's an even slightly better man than he really is. 

Yes, he's not at all sure that he could harm Leareth very much, but - Leareth can't be sure he couldn't, either, and that seems like a far greater risk than Leareth is usually inclined to let pass.  Maybe worth it compared to the risk of whatever would happen to them here if they couldn't do anything about it, but - Karal wouldn't have thought so.  And certainly not worth it compared to the alternative of simply not saying anything and relying on Karal's already made decision to help.

He would not have felt wronged, if Leareth had done that, and only told him all this once Karal was entirely in his power.  Miserable, yes, but not wronged.  It's... the sort of thing you expect to happen, when you make open-ended promises to something that might well be a demon, and Karal is not stupid.  Probably they could have still... been all right with each other, afterward.

But he's glad, that Leareth didn't.  It tells him something it would have been impossible to learn otherwise.  It is necessary, to reach out even when no one is reaching back - in some sense it's the only way to make anything better.  And so it's important to know that Leareth is someone who would, even when it's this risky and this difficult.  (And, somewhere in the back of Karal's mind, relief that the principle is still possible to hold to and worth holding to, when you're someone who has lived for thousands of years and understood the nature of gods.)

And... by the fundamental nature of who he is, Karal is no more capable of not reaching back than Leareth is of abandoning the world to its fate.  Yes, I will help you.  (Not that it hadn't been obvious in his thoughts for a while, that he could do nothing else, but there are things it's important to say in words.)

He's not at all sure that Leareth is right, in anything he means to do - but he's trying to be right, and that's enough for Karal too to take the risk.

Which is in fact how Leareth had predicted Karal would react. Karal is a very odd person, and baffling to Leareth on an emotional level, but he's not actually hard to predict. It’s just - hard for Leareth to put any weight on a promise Karal made to help without knowing what helping him would mean. 

He can actually relax now. It's not the same as being in a room behind wards he set, but he can't have that right now. He’s also untangled the little knot of internal conflict about whether it’s really a good idea to teach Karal to use their mage-gift, and make him more capable.

(If and when they do make it back to Velgarth, Karal should probably have more questions about what Leareth is doing. If Leareth is, in fact, wrong that this is the only way, then he wants to know. But he can’t answer those questions right now anyway.)

…Probably they should rest before working on mage-sight. Leareth is very tired again, and it doesn’t seem that likely that having working mage-sight will be critically important in the next couple of candlemarks.

Karal is very glad to be easy to predict!  And can hope for Leareth to grow to find him less emotionally baffling with time - if they have enough of it, but he expects they will.

He promises to have many questions, once they can have answers. (And likewise predicted that Leareth would want him to.)

Yes, more rest seems like a good idea right now.  They're both tired, and it's the middle of the night.  The fact that Leareth trusts him enough to truly relax untangles some painful knot in Karal's own emotions, and sleep is very easy.

Lisa is having an argument with the respiratory therapist about ventilator modes. 

"Look, the guy's awake. Obviously he's uncomfortable on a controlled mode!"

     "If we're having trouble with his oxygenation and he's having panic attacks or whatever, maybe he should be on more sedation?" 

"I'd really rather not. He's cooperative, he can follow instructions for deep breathing and coughing, and he was fine - he calmed down almost right away, he didn't desat very much, volume control is just really unforgiving. - what was even the goal with changing it, that he wasn't clearing CO2 because he hypoventilates when he's fast asleep?" 

     "Day shift said he was getting tidal volumes all over the place on a pressure assist mode, and it was getting worse over time - not obvious the issue was hypoventilation, his spontaneous rate was fine even when he was asleep, it looked like a problem with lung compliance." 

"Huh. Can we do intermittent alveolar recruitment? I can run it by him but I wouldn't surprised if he'd prefer that if he can spend the rest of the time on a mode that doesn't feel like an alien breathing for him." 

     "Uh, we can try, but day shift said he couldn't tolerate a high PEEP* -" 

"Couldn't tolerate it how?" 

     Shrug. "Hemodynamics, I assume? That's usually it." 

"Ugh." Lisa does not like that. "- I should talk to Dr Hulka about his echo. In the meantime can we at least put him on SIMV, so it won't try to give him the full tidal volume every time if he's triggering breaths faster than the set rate?" 

     Thoughtful look. "We're not weaning him, but - yeah, I suppose there's no reason we can't set it so it behaves like pressure assist mode if he's breathing above the rate." 

"Exactly. He was tolerating that fine when he was awake, and that's when I'm less worried about his tidal volumes anyway - Marian must have told him it's important to take deep breaths and he really took that to heart. ...He might tolerate a PEEP better now anyway, his cardiac function must have been shit when he was running a potassium of, like, two. Should really be better now." 

      Skepticism. "I can ask the resident about trying recruitment maneuvers." 

"- When he's awake and I can explain it to him, please. Would you like it if someone marched in when you were asleep and turned your PEEP up to 40?" 

* Positive end-expiratory pressure (i.e. between breaths.) 

And Lisa tries briefly and fails to find Dr Hulka, shrugs - it doesn't seem that urgent - and goes back to watch her patient sleep. 

...She should probably bother him again on the sooner side if he starts looking like he might need suctioning again. It's poooooossible part of the day shift issue was that Marian (understandably) felt like a dick going in and suctioning him as often as he could really use when he's fully conscious and has broken ribs. 

He makes it to 11 pm with his sats still at 96%, but his mean airway pressure is starting to drift higher, an indication that the ventilator is having to use more oomph to hit the goal volume of air for each breath. 

(His blood pressure is also doing a little better; she was finally able to creep down a few more increments on the phenylephrine.) 

...Yeah okay she's going to go nudge him awake and mime that she wants to suction him and help him turn onto his other side. (Being more aggressive about getting him to change position should also help, if some of the problem is that the lower sections of his lungs are collapsing under gravity.) 

He wakes up a bit more slowly than before - he was asleep more deeply, with both of them relaxed more than they previously could have managed, and with it being the middle of the night (and the less upsetting breathing mode probably contributed, not that he's consciously noticed it yet) - but he doesn't look confused or heartbreakingly sad.  He nods at the predictable and helpful tasks, and continues to be bizarrely... enthusiastic is too strong a word, but something in that direction... about suctioning.

(It's something he can actively do that will help them get better - and it's enough of a difficult and painful ordeal that it feels like he's meaningfully doing something, where basic cooperation with the treatment doesn't.  Karal may have an unreasonably high bar for how much effort and endurance meaningful actions should require of him, and it feels intensely satisfying to have at least one thing that meets it.  Well, that meets it using straightforward pain and effort instead of bewildering unpleasantness and inaction.)

Oh, and he's allowed to breathe faster now!  That feels so much better.  He demonstrates the ability, points to it, looks pleased and appreciative.

He can turn over on his own, given a moment's rest.  He pauses consideringly first.  Does it look like he could manage all the tubes himself, or is that a lost cause?

Awww, Lisa is glad he's more comfortable with it! And he's still getting perfectly respectable tidal volumes anyway. 

He still has a lot of secretions. They're mostly clear to white, not infected-looking, maybe slightly frothy. 

(It seems like probably a lost cause to move safely with the number of tubes and wires he has right now. Just the breathing tube and the nest of IV tubing trailing from the central line in his upper chest would be manageable, but there's also the art line and chest tube, and the surgical drains dangling near his sternum that risk getting caught on stuff and pulling, not to mention the pulse ox probe and blood pressure cuff and all the monitor wires.) 

Mm, that's unfortunate, but he is not an idiot and does not try to do it regardless.  He can definitely turn on his own (and breathe faster while doing it!) if she helps with the tubes, though.

He'd like to know when he's going to have fewer of them, but he can wait until morning, it's not as if they're going to be doing anything in the middle of the night.  (He has not really internalized the extent to which this place is busy regardless of the hour.)

Is there anything else happening?  He tries to remember if there was supposed to be.  Taking his blood and looking at it, he thinks?...

The next set of electrolytes isn’t until midnight - and there's no point doing it early since she has to draw his hourly blood glucose then too. (She already did this hour's blood glucose from the art line before waking him; it was at 82, and 79 at 10 pm, it maybe seems to do better when he's resting?) 

She smiles at him and pats his arm and then ducks out of the room again. 

(He has not figured out yet that it's entirely possible to take his blood while he's asleep, for all that it'd be obvious if he thought about it.)

Does Leareth seem awake?  Karal definitely is, it being rather impossible to get back to sleep immediately after suctioning, so they could spend a little time trying to do something until he's tired again.  Or he could just try to sleep anyway - if Leareth managed to drift through all this then he clearly needs it and there's no reason to disturb him.