(Oh, he doesn't tune out pain, there's just a way of feeling it where... he doesn't mind? it doesn't matter?  one of those things, or sometimes something more complicated.)

He has now seen the thumb gesture enough times to be reasonably sure about what it means, so he copies it tentatively and smiles.  If he's seeing the effects they expected and were causing on purpose, that seems like a good thing!  He's wondering if there are other effects he should expect soon, with all the various things happening - and how long this current period of things-happening will take - but she still seems busy.

He notices the curiosity and lifts the paper to give her a closer look with a rueful smile - it's not private, but explaining anything is hard and she has more important things to be doing.  But the thought of communication does remind him about something - he grabs another sheet of paper and writes down the handful of words in her language Marian taught him and what he thinks they mean.  Not that writing things down is a good way to learn a whole language, but he'd like not to lose at least these words if some new thing happens to make him too confused and distracted to learn anything properly.  (And then he really will stop writing.  He's unused enough to doing it that his hand is starting to ache, and he's probably going to want to draw things later.  He can go back to sitting there, Empathy-tracking everyone he's seen, and radiating curiosity more than anxiety, at least until things stop happening enough that sleep seems like a good idea.)

The chest X-ray is, unsurprisingly, substantially worse than before, and much more obviously looks like pulmonary edema rather than anything else. He's also accumulated a pleural effusion on the non-chest-tube side - his body is oozing fluid into the space between the membranes around his lungs - but it's not huge and probably not the main contributor to his difficulty breathing. Dr Hulka is inclined to leave it alone unless he fails to improve, rather than do another procedure to drain it. 

Dr Hulka does come back a while later, for just long enough to poke his chest with the ultrasound again (much more briefly) and confirm that the dobutamine is working and his heart is contracting more enthusiastically. It is. 

His troponin comes back only slightly higher than before - it still doesn't look like he's having any new blockages in the coronary arteries providing circulation to his heart, good. 

Dr Hulka orders a couple of bottles of concentrated 25% albumin to be given at the same time as the diuretics, to help pull water out of his tissues back into his bloodstream before they attempt to make him pee it all out. And she's still inclined to go with spironolactone, which isn't as powerful as Lasix but has the advantage that it lets him hold onto all his potassium. He's not actually that unstable, by ICU standards; they can hopefully afford to go slower. 

Despite the diuretics, his blood pressure is responding faster than his lungs to the new treatment; by 4 am, which is how long it takes to feel caught up on all the things, Lisa has him just on norepinephrine, on a steadily-decreasing dose. (She's delighted. It means they're giving him less fluid per hour.) He's now negative an entire 200 ccs of fluids for the last hour, which...isn't that much compared to what you would hope to see with Lasix, but it should start to help at some point. 

Also he's now been awake and sitting up for, like, almost two hours in the middle of the night? His sats are at 99% right now; plausibly he can manage laying back at an incline and actually get some more sleep? Lisa will try to suggest this to him in mime. 

That was a long two hours!  He's used to guard shifts at random times and so pretty good at staying awake when he knows there's a good reason, but he would be very happy to sleep now, yes. Especially since everyone seems to feel like the problem is getting solved - it just seems like a much better idea to ask them to explain it all to him in the morning, when they have a clearer idea of how it's going and when he's not keeping them up in the middle of the night for no good reason.  He feels bad enough about all that disruption already.

He's not... sure about the concept of lying back down instead of just trying to sleep mostly sitting up... but this is obviously silly, he can lie back and see if it works, and Lisa thinks it probably will. Does he still feel like he can breathe once they try that?

Lisa is definitely not thinking of laying him flat! She’s very practiced at getting patients who feel short of breath into sleep-compatible positions, and that won’t work at all. 

Her plan is to get him to scoot his bottom back until he’s actually at the top of the bed - he had scrunched down a little - and then slowly ease him back to about a 45 degree angle, at which point she can prop his shoulders between two pillows making an upside-down V at the top of the bed, so he won't topple sideways if he relaxes. She raises the foot of the bed a little as well and wedges a pillow under his knees, to at least delay the inevitable sliding-down. 

It continues to be incredibly strange how much effort people here put into making him comfortable!  Karal was happy enough to just not feel like he's dying, but if Lisa wants to make an entire battle plan of it, yes, she can definitely succeed at improving on that.  He's out of breath briefly after all the moving around, but it seems like he can breathe well enough to sleep like this, if not well enough to do much else.  He'll try to remember to scoot back up if he wakes up out of breath, since she's right that he'll probably slide down. (That seems doable on his own without disturbing any tubes, right?)

Sleep takes longer, after all the commotion and with the vague worry that next time he wakes up some other confusing thing might be wrong again, but he does manage it.  (And Leareth was quiet this entire time, oh good, Karal hopes that means he wasn't too distressed and can sleep fine.)

(Leareth has mostly been drifting, and is in fact pretty calm. Being distressed wouldn't help, and - he trusts Karal - and when he's briefly paid attention to what Karal is picking up on via Empathy, the Healers' affect isn't what he would expect if they were worried a patient was dying. Something is definitely wrong, and Leareth does vaguely wish they knew what or how it happened, but his sense is that the Healers feel like they caught it early enough to stay in control of the situation.

Also he's still very tired, and is definitely not going to have trouble falling asleep.) 

(It seems like he should be able to wriggle himself up in the bed fine without pulling anything; he doesn't need to move too far and just needs to brace his hands on the bedrails.) 

Lisa will retreat to outside the room and catch up on neglected charting, while continuing to watch her patient closely. 

He looks pretty asleep! His oxygenation isn't particularly getting worse over time - which is itself an improvement over before - and his blood pressure does seem to be steadily improving, enough that she has to keep creeping back into the room to turn down the norepinephrine.

Oh good. In that case Lisa will sneak back in at 5 am to check his blood sugar (which seems stable on the 10% dextrose they're now running at a slower rate alongside the more concentrated potassium) and measure his pee, and then slip out again. 

She should probably wake him at 6ish, though, if only to do another proper assessment before she gives report in the morning. Lisa will sidle in around 6:10 and clear her throat before nudging his arm again. 

"Mm?"  Oh, it's morning, and nothing new went wrong and nothing feels terrible!  ... He pushes himself up in the bed so he's sitting properly, and tries to see if he can remember what routine things are likely to be happening.  Does he feel like he needs suctioning again?

He's actually not feeling that short of breath in his current position? It does still feel like his breathing isn't quite working the way it should, though, and like maybe there's something he needs to cough up and then it would be easier? 

(Lisa isn't currently miming a plan to suction him; his sats are still at 96% so it didn't seem urgent.) 

He'd like it if she did, but he'll wait to see why she woke him up before making clearly non-urgent requests.

He looks all right, and projects it a little.

She's going to do a full thorough head-to-toe assessment again first, and help him shift his weight in bed so he's tilted a bit to one side. 

...At that point, yeah, she's hearing some crackles and will suggest via mime that she could suction him. 

Appreciative nod!

It still doesn't feel like it's entirely addressing whatever is making breathing hard - and the process is tiring and leaves him feeling more rather than less out of breath in the moment - but it does seem like it helps more, and feels less frustrating and unsatisfying.

Lisa looks pleased, anyway. (Overall she feels like he looks a bit better than he did at the start of her shift, despite the middle-of-the-night adventures.) She'll get him tucked in comfortably and - does he seem to need anything else or have any questions before she ducks out for a final round of charting? 

Mm... some idea of what's happening would be nice?  He finds the timeline Marian drew for this night, points to it, and draws a blank one on a new page, starting with the sunrise that seems like it's about now and going through noon and sunset.  Offers her the pencil.

Oh, hmm. Do they have much on the schedule for him that's actually...going to happen at a particularly specified time...? Aside from the obvious that he's presumably already noticed, like the fact that they make him change position every couple of hours. 

Uh. She points at the group of figures that presumably represents rounds, shrugs, drags her finger across basically the whole day because who knows when they'll manage to make that happen. Probably earlier than yesterday. He has enough going on that he's likely to be a priority. 

...She should go check the chart and see if there's anything scheduled, she sort of hadn't looked past the end of her own shift... 

Oh, neat, he's scheduled for a followup chest X-ray at noon rather than first thing in the morning, presumably because Dr Hulka thought 7 am wouldn't give them enough hours since they started treatment to tell if it was helping. That's pretty easy to draw and he'll recognize what she means.

There's also a social work consult ordered, which seems like it's going to be an adventure given the language barrier, but that does generally happen in a timely manner - so likely before 8 and 10 am - and also she's way less sure how to draw it. She'll, uh, at least draw a stick figure standing beside the bed with a clipboard and a speech bubble? 

He does know what rounds are, and doesn't mind not knowing the time, he just wants a general idea of what will be happening at all.  He doesn't know what the other person is, someone from... outside the house of healing maybe?... but it's good to know there will be one soon.  Possibly they will ask him difficult questions and he should think about them with Leareth before that happens.

The light-and-board artifact is pretty familiar by now, yes, but what does it do?  (Oh, he wrote himself a note to ask this and then forgot about the note, didn't he.  In his defense he did just wake up.)  He points at that and radiates intense curiosity.  It's just such an obviously strange thing!

Oh! That’s easy. Lisa can just haul one of the computers-on-wheels to where he can see it and pull up the chest X-ray imagery! 

That gets Leareth’s attention! He’s fascinated - it looks like almost full Healing-Sight, but done by an artifact that remembers what it Saw and can show it later to anyone…

That is fascinating!  And also the Healing-Sight is manifesting as visible light for some reason?  Karal did not think that was how anything worked!  He's studying the image so intently.

Now he really wants to try to get his mage-sight working properly before they bring the artifact by again so Leareth can see what it's doing.  Probably that means he should let Lisa do the thing she wanted to have time to do this morning, instead of asking her all his other questions...

On the other hand now that they have a whole Healing-Sight image of his chest, maybe she can just show him what was wrong?  He would really rather like to know that!  He points at his own chest, mimes struggling to breathe, circles his finger over the artifact image, questioning look?

(The visible-light part isn't intractable on its own? A Healer who also had mage-gift could in theory, with enough skill and practice, just cast an illusion of whatever they were Seeing to show bystanders. But replicating Healing-Sight with mage-gift is a sufficiently complex problem that Leareth has yet to solve it in general, let alone putting it into an artifact.) 

Wow, okay, it generally takes years of school to properly learn to read X-rays and Lisa really doubts she can cover that in a couple of minutes of drawing pictures! ...What she can do is find a normal chest X-ray on Google Images? It's a pretty gnarly X-ray, maybe the difference is visually apparent? 

(The picture that's of them also has a lot going on other than the haziness and whited-out lung bases - various tubes are visible on it, along with the monitor wires - but it is pretty visually apparent that it's much less crisp and clear than the other picture.) 

(Oh, Karal thought the light was a more basic part of how the artifact functioned - just because it was the thing he could see happening, which is in retrospect not a very good reason.  Leareth thinks the Healing-Sight is separate and the light is just there to make the image normal people can see?  That does sound less surprising - not that Karal knows how either of those things could work, but they're less surprising than light doing this.)

So there's... stuff... in his lungs?  All right, he did know that, she keeps having to painfully drain it out.  But sometimes that doesn't work?  Is there an explainable reason for that?  He points at his image, mimes suctioning, points at the clean image with an uncertain look.