guess who's getting a medical drama now
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Some two and a half hours later, the OR calls over a report to the ICU charge nurse.

Male, probably early 40s, no ID on him (he's in the system as Eighty-Six, Orange), found down with a (suspected self-inflicted) stab wound to his chest and - as they discovered later once they had him on the operating table - significant internal bleeding from apparent blunt force trauma (significantly more mysterious given where he was found), multiple broken ribs, and burns (mostly second-degree, some third-degree) over a large fraction of his torso and arms. Though he at least doesn’t seem to have a spinal injury or head injury. He lost a lot of blood; they transfused six units of packed red blood cells and a bunch more plasma. 

Also - as was unpleasantly discovered an hour into surgery when the initial labs came back - critically low on potassium and phosphate for deeply unclear reasons (burns tend to cause high potassium in the immediate acute phase), and also severely hypoglycemic?? They treated the latter and IV supplementation for the former is in progress but it's going to take kind of a while to normalize his potassium, you can't administer it that fast. 

He's - semi-stable, now? He's maxed out on both phenylephrine and norepinephrine to maintain a systolic blood pressure over 90, but he has at least been maintaining that blood pressure for the last hour (before that, not so much.) He has some surgical drains in place, and a chest tube because it turned out he was slowly filling up his right pleural space with blood. They're sending him over intubated; he hasn't woken up from the anesthesia yet. 

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Marian has spent the last 90 minutes finalizing the transfer to telemetry for her patient in room 103 so she can take the admit in 104! She does actually have some context already - which is how she successfully bid for taking this assignment - but, wow, she did not know about the internal bleeding and broken ribs and she has questions about how that happened in a Walmart. 

...not the point. She's here and ready.

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They have him on a fentanyl drip for pain control, but no other ongoing sedation, and the anesthesia still in his system is already starting to slightly weaken its grip by the time they wheel him into the ICU and carefully slide him across into the bed. 

…There’s too much fog in Leareth’s head to think. It feels like he’s floating in a void. - he’s alive, though, he can feel distant pain -


- where is he -

 

Whatever motion would normally come after forming that question is not working at all.

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He doesn't feel worse than before, exactly, but everything feels more wrong - he can barely feel his body at all, he can tell that it should hurt but it feels so far away - he hates that more than almost any amount of pain -

- he wonders again if that's just what being nearly dead is like, but... he remembers thinking it before and it keeps not happening, so it's probably something else, what are these people doing to him that feels like being nearly dead - 

 

- no point in guessing at incomprehensibly awful things when he doesn't know anything (and the other one doesn't either, so Karal's barely-awake thoughts ignore him in favor of things that he might be able to do anything about) - where is he, is anything different - 

 

It feels like an upsettingly long time before he can even manage to drag his eyes open.  There's... the non-mage lights, again... the young woman from before, he thinks?  He gives her a miserable look, and tries to say something - discovers in the process that there's a strange thing down his throat that makes it impossible to talk or swallow and deeply unpleasant to even try - looks even more miserable.

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Marian has been focused on getting him settled, charting her initial assessment, and reading the OR notes (which she really appreciates being in the system so promptly, Dr Hulka is efficient.) She also double-checked the wrist restraints, because earlier he seemed pretty inclined to fight everything they were doing except when she was right there and continually reassuring and reorienting him. She can't stay right there all the time when she also has to do everything else; it's unfortunately not hard to predict that he's probably really going to hate being restrained, but he now has a lot more tubes in him that would be a very bad idea to pull out. 

 

...oh, he's waking up. That's honestly really impressive! ...He looks so unhappy about the endotracheal tube and Marian is tempted to just start the sedation now, but it would be nice if she can get a better neuro assessment first.

"Hey." She leans in close where he can definitely see her, and reaches for his hand. Ugh it would be really nice if she knew his name. "I'm Marian. You're in the ICU, at Renown Hospital. Can you squeeze my hand?" She'll squeeze his first, as a hint, since he's looking at her like someone having a lot of trouble processing anything. 

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He tries to shake his head when she talks - he doesn't understand - but when she squeezes his hand, he does his best to find the way into his body enough to return the gesture.  It's easier to find that one movement in the fog, when he can feel her touching him - and it's a natural human reaction, when she's talking to him in a tone that clearly means reassurance, even if he doesn't know what she means or what she wants.

 

(Does the other voice understand?  Is this just a language Karal doesn't know?)

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There's a question...? 

Leareth drags himself toward awareness, which mainly has the effect that he’s abruptly very distressed about the extent to which he can’t seem to wake up fully or form coherent thoughts. It feels like most of him is…missing…and he can't quite dredge up the memory of how or why or what happened before this, which makes it particularly upsetting to be in a place he doesn’t know or understand, helpless, with things happening to him that he can't make sense of let alone do anything about. 

 

- he doesn’t understand the language, or even recognize it as related to a language he speaks.

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Marian, however, lights up when the patient squeezes her hand. "Good! That's really good!" 

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Karal does not think moving his fingers a little is an accomplishment to be this pleased about!  He frowns at her in frustration and tries to move his arm.  Which he is apparently not allowed to do!  That gets her a betrayed look - why is she keeping him prisoner if she's so happy about him?

 

 

(He sends a half-apologetic thought at the other one's sharp distress - he didn't mean to hurt him, but he can't really apologize for calling him up, where it might be useful and he thinks the other one would want that, if he was... anything like all right... 

He really isn't, is he.  Karal doesn't know why - he half thought there was just something wrong with them both, because they were wounded and dying, but it's not that...  Something else happened...  He'll remember later, maybe?...  But he's sorry about all this, it's his fault even if he only half remembers why.)

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Leareth also only remembers a hazy sketch of what happened - under attack, Vkandis, tried to get out - something else went wrong but he's not remembering it either...

He does manage to form the thought, very effortfully: not your fault. He doesn't need to remember exactly what happened to feel on priors that the risk assessment of - whatever led up to being attacked - was his responsibility, and his decision. 

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Oh no, poor guy!

...He seems confused and upset about the restraints more than in agonizing pain, Marian thinks? She's kind of unsure how much he's processing what she's saying. He's on 125 mcg/h of fentanyl, which is a pretty high dose (the order parameters let her go up to 200 mcg/h in total). It sounded from the OR notes like the anesthesiologist found it hard to keep him all the way under, at least once the hypoglycemia had been corrected, but now that he's out of surgery it's probably better for him to be more awake, and it might well be making him really groggy. (Also probably dropping his BP; he's still needing a lot of pressors.) 

"You have restraints on your hands so you don't forget and pull out your breathing tube," she says anyway. "I'm going to go down a bit on your pain medication - I'll go back up again if you seem to be in too much pain." 

She eases it down to 75 mcg/h.

(And stays right there to watch closely, restraints or not. He got some midazolam as well as propofol in the OR, probably because propofol was too hard on his blood pressure, but that's also longer-acting and takes hours to wear off. She doesn't want him to start panicking as soon as he wakes up more fully.) 

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The other one gets a soft mental laugh, because it feels very like him to say that, but it's... warm, that he would.

 

The young woman gets another slight headshake and frustrated look, but he does stop trying to move, since it's clearly not going to work and she's... doing things... which might be better or might be worse?  He's not sure, but he can... wait and see?...

 

He lies there, trying to watch her as much as he can, and does feel better after a short while.  Less strange and far away.  Oh, everything hurts more now, but of course it would, and there's no point in minding that.  He gives her a tentative smile?  And might drift off to sleep again, if she doesn't do anything else.  He'd like to stay awake and... do something more useful than this... but he has no idea what that should be, and everything is very exhausting.

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Marian absolutely doesn’t need anything from him! After a bit she’ll draw followup labs (and take a drop of blood for a repeat blood glucose) but she can do that from the arterial line, he won’t even feel it. She peeks at dressings and drains for signs of new bleeding and checks his urine output in the Foley bag and watches his blood pressure closely. Eventually she’ll have to wake him to reposition him in bed but she’s inclined to wait the full two hours for that, it’s going to be pretty unpleasant for him given his injuries. 

(She’s pretty curious what’s going on in his head? In particular, whether he’s upset because he was trying to kill himself and didn’t want to be saved. But there's no benefit to be had in asking him, right now; he needs to rest.) 

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Leareth drifts. He dozes for a while when Karal does, but it's starting to feel easier to form thoughts. ...Enough to notice that there's something else in the way, not just exhaustion and weakness, or even just how fragmented his memories are. 

- he died recently, and came back, that’s why everything is in pieces in his head -

 

- he’s sharing the body, that’s why there were thoughts that aren’t his -

 


He’s…having trouble putting together the rest. Clearly something went very badly wrong - Vkandis, he thinks - he wasn’t careful enough, again, but that still doesn’t explain…this…whatever “this” is…

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The pressure of Leareth's thoughts is enough to pull Karal into wakefulness after a while.  (And he remembers Leareth's name now, which doesn't matter in the large scheme of things but feels so much better.)

 

His mind and memories still feel blurry, but he remembers enough for each question to bring back several pieces that can connect together into something approximating an answer.  He lies still and spends a while slowly doing that, starting with what happened before they were suddenly in this strange place.

 

The priest did some confusing magic, I think?  He attacked us, but you-- couldn't move, or do anything, or think clearly, and I don't think it was because you hit your head.  So I moved instead, and - tried to kill us (he remembers the sudden wave of Leareth's distress and fear more clearly than anything else about the brief fight) - I thought it was all right, you'd come back...

 

And then, because clearly he remembers Leareth better than Leareth remembers him, and the entire situation must be incredibly confusing to a man only now realizing he's sharing someone else's body:  I don't know you very well.  It's only been - a day or two?  But I liked you.  ...You said you might kill me. 

(He remembers Leareth's honesty, the lack of even an attempt at excuses, the way he obviously didn't want his death.  It's strange to like someone for the way they said they might kill you, but he did - for that, and other things that he can't clearly remember yet, but he can tell they were there.)

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That's - well - Leareth is confused (and no longer particularly trying to tuck away any of his thoughts or feelings where Karal can't see them; what's the point, now, they're stuck in this together, but also he's - glad, or some positive emotion in that direction. 

(His thoughts are moving slowly and oddly disjointed; it's not just the fogginess, it's also impossible to take actions on purpose and that's not not affecting his thoughts; he can still react to things, including in Karal's thoughts, and work around it that way, but it's clearly effortful.) 

 

Karal made the right choice, probably, trying to kill both of them? Leareth isn't angry, it would have been worse to be taken prisoner - it was a compulsion, that was the magic they did, and it's still on him - not going to panic about that, if only because he's too tired...

Anyway, he - can't actually remember for sure but he thinks he panic-Gated out; the compulsion seems to be a very clumsy one, overpowered and very broad, he can't volitionally use mage-sight to get a closer look at it (this is incredibly upsetting) but it seems to, at least, not affect actions that count as sufficiently instinctive and involuntary, and Leareth - has a lot of survival reflexes. 

 

...He does not have the slightest idea where he Gated them to

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Karal could probably use the mage-sight, but he doesn't know how...  He might be able to learn?  But that seems complicated, and... probably not urgent?  He's still unhappy and confused about what the strange people here are doing, but they don't seem like they mean them harm, however little sense that makes.

 

He should probably open his eyes and see what's happening now.  But he... doesn't really want to?... there have already been so many confusing changes even before all this started, and he's so tired, and... on some level he just doesn't think anything he'll do will get anywhere...

He opens his eyes anyway.  Maybe this time it'll be a less miserable experience - and if it isn't, then eventually they'll think of something to do about it.

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(Karal will notice that it's at least easier to open his eyes and focus on things in the room.)

 

Marian has been hovering, refreshing the chart, and generally considering whether it's time to nudge her patient awake so she can do another assessment and reposition him. She does notice almost immediately when his eyes open, and moves over to him, trying for a reassuring smile. "Hey. How are you feeling?" 

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Another frustrated headshake.  He doesn't look like he's in pain, and isn't even tugging at the restraints - he sees that he can't do anything about the situation he's in at the moment, but he'd like to at least understand what it is, now that he finally feels more up to thinking about it, and he has no idea how to do that when he can't understand her or talk to her. 

... Does she even realize that?  He's not sure.

 

He tries to say something again, which he knows is both impossible and unpleasant, but maybe she can recognize the attempt.

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Marian reaches for his hand. “Hey, it’s okay, don’t try to talk - there’s a tube in your throat to help you breathe - uh, do you want to try writing something?” She mimes writing in the air with her other hand, half out of pure habit and half because this guy still looks really - confused? It’s not obvious if he can hear her.

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He thinks that's writing?  He nods, hoping that gesture at least carries over, and gives a single tug at the restraints on his right hand, because if she means her doing the writing then it's really not going to help.

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Yeah, he seems calm and she’s right here and being able to communicate is important. …She’s still going to go get a clipboard and pen first, and raise the head of the bed just enough that he’ll be able to see what he’s writing, before she actually unties the restraint from the bed (leaving it on his wrist so she can grab the trailing end if necessary.) She holds the clipboard steady for him.

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What is she so afraid of him doing with his one free hand?  She doesn't seem scared of him, so he doesn't understand why she's acting so cautious.  But he doesn't make any sudden movements, just in case.

 

Writing is - harder than he expected... (he doesn't know why he had any sort of expectations, he's never been this close to dead before...) but he can more or less manage.  'I don't understand your language', he starts writing laboriously in large shaky letters, although it's enough effort that he rather hopes she'll get the idea within the first couple of words.  (If he's very lucky, she'll understand what he's writing and will be able to switch to Rethwellani for him.  Probably instead she'll just see something as incomprehensible as her words are to him, but knowing that should still help.)

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Wow. Okay. Marian doesn’t know that - alphabet? presumably that’s what it is - at all. 

She shakes her head apologetically. Ugh. Maybe her patient seems confused and miserable because he doesn’t speak English, in which case - wow, it’s not obvious if he even knows where he is, she’s tried to reorient him but not in whatever that language is and it’s really quite plausible he doesn’t remember the ambulance, he was in bad shape.

She could try drawing it for him? Which is kind of embarrassing, but - okay, she’s going to take the clipboard, turn the paper over, and where he can see it, draw:

- a stick figure with lines forming a pool to indicate blood

- then an arrow to a sketch of an ambulance (truck shape, wheels, lights and sirens with spinny rays and stylized sound-semicircles, the Star of Life caduceus symbol sketched badly on the side) with a stick figure in it

- then another arrow to a building outline with a Red Cross symbol and, inside it, a bed with a figure on it with the chest wrapped in bandages.

She points at the bleeding person drawing, the stick figure in the ambulance, and the bandaged person-figure in turn, then at the patient? 

(It’s going to be super mortifying if she just did all that and it turns out he can understand English fine.)

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He nods at the first figure, which seems reasonable enough (except for his deeply unreasonable impulse to grab the drawing and somehow superimpose a second little man on the first one, which would be unhelpful on so many levels).

He doesn't... have any idea what the next odd shape is... except that there's a person in it which is apparently supposed to be him, so probably it's the small noisy shaking room he vaguely remembers?  He makes an unhappy face at it.  Nods at the more recognizable building, somewhat less unhappily, and again when she points at him.

 

The problem is that none of this answers any of his questions!  And he's not at all sure how to convey any of them in the format of little drawings.  (Honestly she's doing really well, he wouldn't have thought of most of that at all.)

He thinks for a moment before gesturing at the paper.  If she gives it to him, he'll draw another arrow from the bandaged person to an empty spot on the page, then point to all the figures in order, and to the empty spot, and make a questioning gesture.

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