He can tell that she's trying to explain to him that he doesn't need to be too scared, and, he thinks, essentially answer his question about when his heart - or, not his heart, the thing they're looking for in the blood tubes - was getting better and worse...  But he's not sure what all the lines are doing?  It gets clearer when she starts drawing the actual content and he can follow along a little with Empathy - she obviously means time, and the little faces are what he had been thinking of using too, he's just not sure why her timeline is going up and down like that?...  Well, he can try interpreting the parts he does understand, and seeing if things make sense that way.

The smiley face at the beginning clearly confuses him - his heart was definitely not fine when he first got here!  Or maybe she means before he got here?  Or... the thing-in-tubes was fine even if his heart wasn't?...  Later whatever it was got worse, and then it was worst when he pulled his tube out because he thought he was dying, yes, that definitely makes sense... He thinks the next dots are getting better - oh, that one definitely is - and then he's not sure what's going on at the end but it's at least not awful?

He points at the first smiley dot with an uncertain frown, and if she'll hand him the stack of previous drawings when he gestures for them, he'll search for Marian's timeline one so he can point to various spots on it to clarify whether she means when he first came here or before that. 

In any case, he's unsure about multiple things, which is enough confusion to have him gently tugging at Leareth's attention to help him look at this.  (Leareth, once he looks at Karal's thoughts, will have no trouble noticing that his confusion stems from complete unfamiliarity with the concept of graphs.)

Oh! Leareth can make sense of that part of it almost instantly! There's something in their blood that the Healers aren't just eyeballing, but - measuring, somehow, in a numerical way, so they can see how much and how quickly it's improving or getting worse. 

(And once you have something you're measuring as a number, and you've measured it multiple times and recorded each time in a ledger, you can draw it visually like this. The usual convention is that higher up on the paper is a bigger number, which might or might not be the same as a better number - if you're tracking, say, how many infants die of disease in a city each winter over a period of years, bigger numbers would be worse - but here it seems to be.) 

He's just as confused as Karal about what they're measuring, though; it doesn't seem like it can possibly be just "how well their heart was working" even if you could get a numerical measure of that by studying blood in a tube. It doesn't seem like it can be a measure of blood loss, either, even if that would also explain the weakness; he's pretty sure they did all their almost-bleeding-to-death up front, surely most of it before anyone could possibly looked at their blood in a tube, and that they weren't losing blood at the point when things were getting worse? He's - not actually sure what was wrong with their heart - 

Finding out when the various other dots are supposed to have happened makes sense, and will maybe clarify things? 

- oh, in hindsight Lisa definitely drew this confusingly! The first dot - the good/happy one - is already midway through the morning, before Marian's drawing of having startled him accidentally (and in the process revealed his serious PTSD responses), a bit after he first woke up.

She'll take her graph and awkwardly add a section squished before her previous Y-axis on the page: there's one dot earlier, also in the critically low zone, and she points at Marian's timeline to show that it's from shortly after the figure-bleeding-on-the-ground point. 

Going forward... The slightly higher but still frowny-zone dot is roooughly around the everyone-crowded-in-for-rounds spot on the timeline, and the first of the middle-zone dots is just after the Marian departing footsteps. 

She points to the first couple of times it increased (after the OR, and after they started treating the assumed critical result during his near-code incident), and then picks up the IV tubing where it goes into his body and points at it. Then points at the upward slope between rounds and the 8 pm measurement, picks up and taps the med container of potassium elixir, and points at his gastric tube and stomach. Hopefully that conveys that they were already trying to treat it, but - frustrated gesture at the downward line between 8 pm and midnight - it's apparently not sufficient, and the nausea-causing way is faster. 

(Ohh!!  That is so much better than trying to show degrees of badness purely through the degree of smiling/frowning on the little faces, which is what he had been assuming was going on!  What a great concept, making the line go up and down depending on a measurement.  Karal would have definitely never come up with that, and he's very impressed with whoever did.)

Aha, so he was doing badly to start with, which makes sense, but he got better really quickly the first time around, and then got worse again for... no clear reason?... and now isn't getting better nearly as fast and is sometimes even getting worse, also for no clear reason?  That still seems really worrying!

And they have two different ways of treating whatever the problem is (one through the tubes that he thinks go into his blood and one, if he remembers right, through the tube that goes into his stomach, which would explain the nausea), but... looking at the graph, they both have confusing problems?

Karal points at the IV, and at the first increase, tracing its line going fast all the way up from a very frowny face to a smiley one, and then at the second one increase which doesn't go up fast, but should - he traces the going-up-steeply line that he'd expect to see again the second time, shakes his head and traces the barely-increasing line that's actually there - questioning look?

Look, Lisa is just as mystified! She doesn’t know what’s eating his blood potassium either, or why it started getting harder to counter once he was in the ICU. She shrugs helplessly.

(It’s not that scary from her perspective - they can treat it - and she’s not exactly worried, bit she is uneasy.)

It seems like the second time it got worse after they woke up. - or, no, maybe after Marian startled them awake that one time? It doesn’t seem impossible that they injured something in their heart again by trying to sit up, maybe, and it’s harder for the healers to identify or fix a second time? 

That would make sense - and, again, be pretty worrying, in Karal's opinion - but Lisa is remarkably unworried for how little she knows about why all this is happening?  She seems pretty confident that it can be fixed in a known way despite the problem being mysterious, which doesn't make much sense to Karal, but he is definitely not a Healer. 

Or, no, what he said wasn't quite right - the problem is clear and easily fixable, but the reasons are mysterious?  ... Well, Karal will certainly not figure them out, and if it's easily fixable that's probably fine?  He trusts Lisa to know how much she should be worrying about things.

Except... will the problem keep being easily fixable once they're out of this place, or is it going to involve being attached to tubes forever??

That he wants an answer to, and might be able to get one. 

He'll draw a little lying-down Karal with tubes attached.  Draw a little eye-tube-graph above him - the line on the graph goes down, then he draws little square bags on the tubes and draws the line going back up.  That's how it works, yes?

Then another standing-up Karal - he gestures to Marian's timeline and traces a line from it far-far-far out, many days, he doesn't know - and a little eye-tube-graph.  A line going down, tentatively - he's not sure if that'll happen or not, but it seems like Lisa won't know either.  If it does happen - line either going up or staying flat, questioning look, pointing to the lack of tubes?

Lisa doesn't actually know if this is a new-onset acute problem, or one he's had his whole life and just compensated for by eating an absurd number of bananas.

Either way, though, she’s sure they can get it figured out and stable! At worst he’ll, like, need to go home with potassium supplements and get bloodwork checked occasionally. 

She points at the standing-up drawing and the line going down, and shrugs and makes a wiggly-hand gesture - who knows if this problem will even stick around once he's more stable - and then picks up the med cup, mimes drinking it, and draws the line going up. 

He nods thoughtfully.  Could be worse, but it means that if they want to go back home they really need to figure out what the stuff is...  Or at least grab a sample and hope Leareth's people can do that...  Well, or assume that Leareth's people, some of whom hopefully have proper Healing, can deal with the problem in some other way - they probably can, but there are so many strange things going on here that he's not sure he want to assume that.

In any case, if it's easy to keep track of and fix and easy to measure and Lisa isn't seriously worried about it, Karal is content to also not worry about it much.  (He wasn't making a significant attempt at figuring out why it's happening, since he doesn't at all expect to be able to do that - he just wanted to understand the practical implications, and now he does.)

Also he should stop distracting Lisa with drawings and let her give him the medicine. 

Lisa can see why Marian would get attached to this patient! He clearly wants to know what's going on and benefits from a nurse willing to sit there and explain it to him even if it takes five times as long in pictures. 

...She's going to dilute the concentrated potassium liquid in like half a cup of apple juice - it seems likely to make it easier on him even if it means putting more fluid volume in his stomach, and an extra little bit of sugar really won't do him any harm - and then she'll give it to him veeeeery slooooowly down the gastric tube. 

(The nausea is still pretty bad, but it's not any worse than the previous time.) 

Oh good, he's glad she doesn't find all the explanations annoying! He likes her too, and gives her one of his oddly expressive appreciative looks.

He makes a mildly unhappy face when the nausea starts, but it's a communication rather than a complaint, and he lies there and tries to relax until it goes away.  (He faintly wishes for some sort of distraction, but it's not as if there's much that could be done about it.)

(It might be annoying if she were actually busy! But she’s 1:1 with him and so far it’s actually been a very chill pleasant night.)

…Hmm, that looks more Iike a “please give me something else to think about” unhappy face than “please leave me alone in a dark quiet room” face? Lisa would put the TV on for him but it’s, like, almost one in the morning, and among other things she doesn’t want to disturb the other patients in this pod, one of whom is sleeping normally rather than sedated. She can do a proper head to toe assessment again rather than waiting, though? 

(Ugh, she just suctioned him and she’s still hearing fine crackles. His sats are fine, but he’s awake and putting in more respiratory effort than he will while asleep. …She’ll strategize about it later.)

Karal definitely feels better when Lisa is doing things that make him pay attention to random specific physical sensations that aren't nausea - it's really surprisingly helpful!  Between that and tracking her reactions to all the observations, he's pretty well distracted.

(Oh, she doesn't like his breathing, will she make a happier face if he puts more effort into it?  He should've been doing that anyway...)

Thaaaat's not precisely the dimension on which Lisa is worried, but she does notice and it earns him a smile. 

He looks like he's feeling better by the time she finishes the assessment. She checks his blood sugar again, since it's now basically 1 am - it's down a little but still comfortably in normal range - and then gets him tucked back in with his blankets and pillows, encouragingly mimes sleep at him, and ducks out. 

Leareth has mostly been drifting - he's still very mentally tired, and it feels easiest to rest and avoid having to do compulsion-workarounds by not trying to even have thoughts on purpose - but he does think, briefly, that he definitely has very skilled Healers working for him back in Velgarth and it would be surprising if they couldn't figure out something. He wonders vaguely if it's something that would normally be in food, if they were eating - there are a lot of things that bodies need to be healthy - but they aren't eating and somehow the Healers here can isolate it? 

...they should sleep, though, it's not a priority to speculate about right now. 

It would be very good if eating normal food dealt with the problem!  This should become clear pretty easily once they get to that point.

And yes, they should definitely sleep.

Lisa watches him until she feels confident he's actually comfortably asleep and not about to puke up potassium elixir everywhere. She spends some time in the chart looking up earlier notes and reports, and then goes to find a non-busy resident. 

"Something's going on with my guy in 104. His lungs sound really wet - it's not an infection, no fever and his sputum's clear."

     "Oh?"

Great, this is a resident who actually wants her theory on what's wrong, rather than needing everything to be his idea. "I think it's cardiac. His oxygen needs have been higher ever since he had the V-tach stuff, and - I don't know, something's going on. I did actually manage to get him off the epi, and decrease the phenylephrine a bit, but I'm wondering if we shouldn't repeat his echo anyway." She would feel more comfortable putting it off until rounds if rounds were definitely going to happen at 9 am, but this unit does not have a good track record of rounds happening anything like on time. 

     "- Hmm. What was the last echo like?”

“I mean, pretty shit left ventricular function? Dude stabbed himself in the heart and then has a K of fucking two. I don’t think Dr Hulka found it surprising. But that was before he nearly coded, and it was like twelve hours ago, things might’ve evolved.”

    Nod. “Yeah. Seems like something is up. I’ll let her know.”

Her patient is still apparently asleep. 

He is, in fact, desatting faster this time, even though he's getting a full tidal volume each breath and the airway pressures don't seem to be that high. He's already down to 92%. 

Lisa doesn't love that! It's not an emergency but it's also not where she would want to see that trend going. 

...She's going to check his fluid balance in the chart. He's been getting a lot of fluids even just incidentally, and his urine output is, like, adequate? Not concerning by itself? But she's rarely recording more than 50-60ccs in an hour. 

He's peed a total of a bit less than a liter since arriving in the hospital.

He's had, like, fourteen liters go into him, once you add up all the fluid boluses, blood products in the OR, and the many drug infusions and IV meds that also include a certain volume of fluid. 

...Which is at least somewhat misleading because it doesn't count other fluid losses - though he's not actually oozing that much in his drains, that only adds half a liter for the whole time - and also because one assumes he was starting out massively hypovolemic from nearly bleeding to death and a lot of that was just getting him back to baseline. 

But, yeahhhhh, this is definitely compatible with him being really fluid-overloaded, isn't it. 

She kinda wants to check a central venous pressure but she really shouldn't half-ass calibrating it - meaning she should probably wake him and get him to lie perfectly flat on his back, at least the first time she measures it - and also she has to stop all the fluids going into his central line for a minute or so. Which won't matter for the maintenance fluids or fentanyl, but she really doesn't want to test how his blood pressure responds to no vasopressors for that long. Ugh. 

She goes to find the poor resident again. "He's positive like twelve liters since admission. I'm developing a suspicion about why his lungs are soggy." 

     "- Welp. I - sorry, I should have looked at that -" 

Shrug. "I didn't until now. Obviously he’s retaining fluid after major surgery. I’m worried he won’t tolerate diuretics, though.”

     “And it’s not a great combination if he’s in heart failure.” Unhappy sigh. "I'll tell Dr Hulka we need an echo ASAP. - what's his potassium?" 

"After the 40 mEQ we gave him? I don't know, it wasn't due until 4 am - should I run an extra set of labs now?" 

     "Yeah, let's do that." 

Lisa heads back to draw labs - she doesn't have to wake him for it - and then sit outside the room and try to think whether they can possibly get his ongoing fluid intake down. She could double-concentrate his pressors and, uh, swap the maintenance fluid for running the regular bags of potassium (10 mEQ in 100ccs) at a slower rate over two hours each and giving him intermittent D50 again? It would make a bit of a difference, but - really not that much at this point. She'll leave it alone and ask Dr Hulka. 

ASAP is apparently not that immediately, because the labs are back before Dr Hulka is. His potassium is now 3.9 mmol/L. 

His sats are also now hovering exactly at 90%. 

Yusss that's finally back within normal range and hopefully this time the ongoing infusion will keep it that way. 

She goes looking for Dr Hulka, and finds her in room 111 doing a chest tube placement. "Hey. Please tell me I'm next in line for 104's echo." 

     "You're worried?" 

"Kinda. It's not an emergency but I'd rather not let it get that far, you know? - his potassium is finally normal, at least." 

     "About time. I'll be down in - ten minutes, come harass me if you don't see me. Get a blood gas and a CVP in the meantime?" 

"- On it."