He's not in great shape. She's getting a heart rate of 156 and a blood pressure of 73/54. Breathing shallow and unsteady, oxygen saturation on room air 86%. (One of the paramedics is setting up the oxygen cylinder now, but getting fluids into him was the priority, there's kind of a lot of blood now forming a pool under him.) 

The man seems pretty deeply unconscious! Pupils are reactive, but she can't get more response than a twitch in response to a painful stimulus. 

(Leareth is a long, long way off. He's distantly aware of a new source of pain that might be startling if he were closer to consciousness, but it barely registers next to all the other things that hurt, and it's not like he has the ability to do anything about it anyway.) 

(He's... alive, apparently?  For some reason?  And it's important to know where he is, but he's too out of it to even keep his eyes open, or process much of what he sees when someone briefly does that for him.  He tries to drag himself closer to consciousness, but it's so hard, with nothing to hold on to...)

The painful stimuli do get rather lost in all the other pain, but if someone tries to do something that matters, like move him somewhere or take the knife from him, Karal will struggle, ineffectually, and might manage to open his eyes for a moment.

The paramedics are absolutely going to pry the knife out of his hand and also - once the IV and oxygen are in place and they've confirmed that he's not imminently dying - log-roll him onto the backboard. 

When he struggles, Marian dives in. She's mostly focused on securing the IV site, but she'll try to make eye contact with him during the second or two his eyes are open, and smile reassuringly. "Hey, hey - it's okay - just try to relax, we're going to look after you -"

Possibly this person does not actually want to be looked after given how he seems to have STABBED HIMSELF IN A WALMART, seriously, who does that??? ...Also unclear how he, like, got in, Marian doesn't think they would unlock the doors until it's actually 6 am. Not actually useful to spend any mental cycles mulling on that right now. 

She continues to be an extra pair of hands, and can stay close to him and try to be reassuring while the paramedics heft him onto the stretcher and wheel him out to the ambulance. 

He is so very unhappy about being rolled and restrained!!  He can't do much about it, but the increased stress is very obvious.

He does focus when the woman says something to him - he has no idea what, in that dreamlike way where she might be speaking an entirely different language or he might just be too out of it to understand her, but she looks like she means well.  That's enough to make him try, for a while, to remember not to struggle - it might make things better rather than worse? - but he's not very good at remembering, clearly still upset, and remarkably indifferent to causing himself more pain.

...she should probably peel off here and ride her bike to the hospital, there isn't a ton of space in the back of an ambulance and also she doesn't super want to leave her bike locked outside Walmart until such time as she manages to have the energy to retrieve it. And, like, her fresh scrubs are now pretty covered in blood (usually patients reach her in the ICU with significantly less uncontrolled bleeding than this!) and if she goes straight to the hospital from here she'll have to borrow ill-fitting OR scrubs all day and those have way fewer functional pockets. Also she didn't even get her caffeine

But. Uh. The patient seems really confused and combative, and it might be only a six-minute drive to the hospital but she wouldn't want to be alone in the back of the ambulance with him while the other paramedic drives. Also she might be imagining it but it seems like the guy is maybe a little calmer when she's right there and talking to him? 

Yeah, okay, she's ditching her bike at Walmart and going with them. Assuming the paramedics seem cool with that? 

They are SO cool with that. 

Okay, great, Marian will ride in the back with them and mostly focus on reassuring the patient (and holding him down if necessary), since she doesn't know where anything is in an ambulance. She can keep talking out loud to him if this helps, though it's going to involve a lot of inane repetition even over the six minutes or so that it takes to reach the hospital. 

- she's obviously still watching his vital signs. How do they look? 

The oxygen mask seems to help and his oxygen saturation is up to 96%; it seems like he probably didn't puncture a lung by stabbing himself. 

His blood pressure isn't doing great, though. The fluids might be helping a little, but his next reading is down to 67/49 and his heart rate is now at 169. 

Leareth is vaguely aware that things are happening. He's - 

- confused - 

- why can't he do anything...? 

(He fights Karal for control of their body, because that's an instinctive rather than volitional action. He isn't very good at it and wouldn't be able to do anything with it regardless.) 

He usually calms down at the the young woman's voice, and almost always stops struggling when she holds him down (he doesn't want to hurt her), he just keeps starting again when he loses the obvious reminder that he shouldn't.

He pushes the strange other presence back, just as instinctively - he's not very good at it either but he's better than that - but it too feels reassuring or at least familiar, so he tries to be gentle, and to extend his thoughts toward it, blurry as they are.  Vague reassurance, I know you, I won't hurt you, and please don't, it won't work - he doesn't remember why it won't work - wait...

It calms him down, really, all the trying to calm someone else who's panicking more than he is.  The young woman can see him relax and lie more easily, after a while.  Which only makes it harder to stay awake - he'd like to, to know what's happening, but he's not sure he can...

(Leareth can pick up on some of the attempted reassurance, even though it's coming via a deeply unexpected channel, he’s not at all used to someone being in his head, but - there’s some vague cached sense that he should feel reassured, here…)

The patient is in and out of consciousness, that’s not surprising. Marian keeps talking, and - either it’s helping or the patient is sliding further toward unconsciousness again, she’s not sure, the important part is that so far he hasn't yanked out his IV or tried to remove the oxygen mask. 

He's continuing to breathe on his own and maintain an oxygen saturation above 95%. His blood pressure and heart rate are at least not getting worse, the IV fluids seem to be doing that much. 

They make it to the hospital! The patient is still alive, and the paramedics have radioed ahead about the guy who STABBED HIMSELF in the WALMART HOME DECOR AISLE, so there's a huddle of ER staff waiting for them. 

(Leareth and Karal will notice the light changing - it's brighter now - and jostling as their gurney is wrestled out into the ambulance bay and pushed down the hall toward the trauma bay.) 

Marian stays close and - she was honestly running out of things to say in the ambulance and starting to repeat an incredibly inane loop about how they're en route to the hospital and it's going to be okay, and now she can at least swap that out for "we're at the hospital, we just need to get you to a bed." 

The paramedics are going to have to slide him from the ambulance stretcher onto the ER gurney. It's going to involve a lot of jostling. 

The movement and inevitable resulting pain wake him up.  He's more awake than he's been at any point since the Gate, for some reason - maybe just because he rested for... he has no idea how long, but it couldn't have been very long, surely... 

He manages to open his eyes properly, and take in something of his surroundings beyond a vague impression of strangeness and a woman's face.  He tries to make sense of it, but it's incredibly difficult, nothing here looks familiar, or even made of familiar materials, and there's just - so much of everything - maybe it would help if he was thinking more clearly, but he's not sure even about that -

There are people, the young woman he remembers - who keeps repeating something and he still cannot recognize any of the words - moving them from... the small confusing place that was shaking before... to a larger confusing place that at least registers to his mind as a building and isn't shaking?  That seems better, but he's having trouble figuring out where to even start answering the question of where they are or why.

It was the voice in his head that said it was important to know this, so he tries to make sure it can see, pushes an unformed question, does any of this make sense - 

(He's making no attempt to keep his thoughts off his face.  He does not look like someone who has any comprehension of where he is or what he's seeing or hearing - and not because he's too out of it or isn't trying.)

None of this makes any more sense to Leareth than it does to Karal! He manages to form the though that the lights look like they should be magic but they aren't, mage-sight is not working very well but he can at least recognize the near-absence of mage-energies here...

(It's very very difficult to form anything like a coherent thought -) 

Leareth thinks that - unless Vkandis sent them here on purpose, and that seems hard, and unlikely?? - there's no...particular reason to think...that the people here are enemies? They’re not necessarily safe but they’re probably not actively in danger? 

…that’s all he can manage before his thoughts come apart into fog.

The ER staff are going to swap in new monitor wires, and hold down his arm to place another IV and his other arm to draw labs. The ER attending doctor is asking for an intubation tray.

Presumably because the dude seems pretty close to crashing and they’re going to have to rush him to the OR to deal with the STAB WOUND.

"- We need to give you some medication that will make you go to sleep, and then put a tube in your throat to help you breathe," Marian tells him, even though she's really not sure that he can understand her or if he's just reassured by her tone of voice. 

The people don't seem like enemies, they just... keep making no sense... which Karal becomes much more unhappy about when the making-no-sense manifests as holding him down and doing more strange things to him!  Why won't they stop doing that when he clearly doesn't want it!

All the brief struggle accomplishes is a wave of exhaustion that makes him fade faster.

(He wonders if now he's going to be dead.)

Nope! Just thoroughly unconscious from the 50mg of propofol that just went into the IV, which would have had scarier effects on his already deeply questionable blood pressure if not for the fact that the ER nurse was anticipating that and rammed a half-syringe of epinephrine right after it.  

The patient's next blood pressure still drops as far as 54/35, which is moderately alarming, but the reading after that is back above 60 systolic. 

And his airway is now secured and - Marian can probably stop hovering now, given how she doesn't in fact work on this unit and really needs to track down clean scrubs and some source of caffeine in the 25 minutes before she needs to be in the ICU taking report.

...if she gets there early then she can offer to take the new admit, given how she has some context on him already? She's pretty sure it's still Dr Hulka on call and Marian is not that scared of her, as the trauma surgeons go. 

Normally they would take the patient for a scan first, since it's pretty clear he has a lot of broken bones and they haven't actually ruled out a spinal injury, but he's still doing his best to bleed out and that's the highest priority. The non-life-threatening injuries can wait until he's more stable. For now, they have just enough time to get more fluids and vasopressors running before the OR is ready for him. 

Karal did, in fact, manage to aim correctly at his heart. He wasn't actually able to apply enough force to push all the way through the heart muscle (or he and Leareth wouldn't have survived more than a minute or two) but there's significant damage to be repaired; it would in fact have been a lethal injury within ten minutes, without treatment by a well-trained Healer.

(Or by an ambulance crew and fully stocked ER and OR. That will also do.)