"...Maybe. Uh, and - I guess if he understands a little English but he's not fluent, maybe he can't follow as well when he's drugged, that'd fit. Uh, why did you sedate him so much in the ER anyway?" 

Ack, how mortifying to be asked outright. Especially by a new grad nurse who has a great point. 

"...In hindsight we should've gone gentler with that. But I did mention the part where he elbowed a nurse in the eye socket?" 

"You did! Weird. He wasn't like that with me at all, he seemed...sweet. I guess I didn't try to stick a rectal probe in him." And she's suddenly VERY glad he wasn't conscious for the Foley catheter and can't blame her for it. 

Emmy takes a deep breath, sets down the used chlorhexidine swab, and carefully lifts the arterial line kit from the sterile tray. 

"Marian, I'm ready when you are." 

Marian finishes tugging on her sterile gloves, twitching her nose under the surgical mask that she threw on. She didn't bother with the sterile gown, since she's not the one placing the line and also she's terrible. 

"Okay, hmm, if I stand - here?" she positions herself at the head of the bed, "and reach under - how's that?" It's not a comfortable position to hold, she has to stretch her shoulder half out of its socket to reach the patient's hand, but it does mean that her head is close to his and she'll be able to talk to him. And gently hold him down if he starts trying to flail out of bed or something. 

"All right. Here we go..." 

Placing arterial lines used to scare the crap out of Emmy, but it's not actually hard. It's a lot easier than a central line, really. She can feel the artery right there under her fingers, not as strong a pulse as one might hope but straightforward enough to aim for. 

Something HURTS.

Ma'ar was fast asleep seconds ago, and he's still very groggy. He tries to pull away from the pain, but his muscles are weak and ineffectual and something is holding him firmly in place. 

...She's there, the girl who - didn't rescue him, exactly, but who took him away from the bad, well, the worse-than-this place. The initial stabbing pain is already fading to a distant sting, and other than that he's...not comfortable, exactly, but a lot less uncomfortable than he was before. Maybe they're just needing to...clean existing injuries? It doesn't really feel like that, but then again he can't feel his body very well.

The girl's voice is nearby, he can't understand any of the words or quite make out the content of her thoughts but he can vaguely sense her intentions, which are...protective? A surprising amount of fierceness in that. Her hand is on his shoulder and it's been such a long time since anyone touched him in a comforting way. 

Marian keeps a firm grip on the patient's hand, watching him slowly relax while Dr Beckett screws in the waiting tubing. He tenses again when she adds a couple of quick stitches to keep the line in place, but Marian holds his arm still, and keeps murmuring reassurance to him, until it's done. 

Emmy finishes placing the dressing and immediately heads over to zero and calibrate the pressure line; it's usually done by the nurse but she doesn't think she's too good for it. 

"You really don't like seeing people suffer, do you?" she says to Marian. "Good plan, holding him still, I think I'd've lost the line if you hadn't been right there." 

"Mmm. I think we'd better risk some extra sedation for the central line. And be thorough with the lidocaine. Uh, want me to put in and send that bloodwork now?"

"Yes, please. ...Send some repeat electrolytes too, it's been - god, how has it been an hour?" It's now 7:45. 

Marian, for her part, feels like it should in fairness be at least nine am, how is she going to survive an entire day. 

Bloodwork gives her an excuse to duck out of the room twice, though, to get tubes and ice and then to send the pneumatic tube to the lab. On each exit and each re-entry, she sneaks a gulp of cooling coffee. 

She's barely finished this when Chantal and Amélie corner her and Dr Beckett in the room. 

"So," Amélie says, yawning. "We have a problem. We're short and we can't give you this guy one-to-one without tripling someone else up - and it'd have to be Nelly, who's all the way in the other corner. Do you think there's any possible way you can handle taking next door as well?" 

     "She's stable," Chantal adds. "Vent, sedated, feeds, all she really needs is turns and antibiotics. Would be a good charge nurse patient, except Amélie's already taking one for the team and has a full patient assignment." 

Emmy is the one who objects, before Marian can agree. "I don't feel great about this plan. Is there any way someone could...stay from night shift? Even just an hour - even just half an hour - so we can get our bearings with this guy and get all his lines and stuff done? - The nurse last night was splitting her attention and I think we missed him decompensating, I don't want that to happen a second time." 

Chantal rubs her nose. "Was worried you'd say that. I can stay an hour." 

"I can take report now if you want? And then take over on her at, uh, 8:30 or so." 

There are voices. It sounds, from the tone, like some sort of dispute is being resolved. 

Ma'ar struggles, over and over, to wake up enough that he can at least parse how many voices and which emotions are represented, but he's very foggy and he can't make sense of it. 

He's clearly a little less drugged than before, though, because when the girl approaches again, he can actually sort of focus on her surface thoughts; it hurts his head, more than he would expect, but he can do it briefly.

He even manages to open his eyes a crack, assessing wherever it is they've brought him now. 

He's lying in what is much more obviously a bed rather than a weird cage, though it does have a sort of rim or low wall on each side. The ceiling is out of focus, but there are weirdly bright lights - mage-lights? - and something is making an almost birdcall-like sound in the distance. 

And Marian. "Hey there! That's really good. See, I said I'd be here when you woke up? You're in the ICU now and - uh, right, sorry. My name is Marian and I'll be your nurse for all of today. We have a couple more procedures to do that might hurt, but we can make sure you're asleep for them, and once that's all done we won't need to keep sticking you any more." 

She speaks slowly and loudly, holding eye contact and trying to decide if she thinks he understands her. 

"Right. Uh, are you in pain right now? Just nod or shake your head. If you can." 

She said a lot of things in a row and Ma'ar understood some of it but he can't hold onto it when she won't stop saying things. 

...That's a question. He can get just enough from her surface thoughts that he can guess what she's asking. Yes, he's hurting, his head hurts a LOT now. He manages a very slight nod, surprised by how hard even this small motion is. 

"Oh. I'm sorry. Do you need more medicine for pain, right now?" 

Ma'ar isn't sure he understood that question right, but he shakes his head anyway. This feels like a reaction-headache. ...And something else as well, he feels wrong in a way he can't make sense of, but he was sleeping before, and there isn't much to be done for backlash except rest. 

He's not going to be able to get out of here unless he conserves his strength and rests when he can. Ma'ar closes his eyes again. 

Huh. Well, he definitely understood her that time, which on the one hand is good, but on the other hand he's clearly waking up more - the propofol must be close to worn off entirely, it's short-acting, and 1 mg an hour of midazolam is barely anything. 

She double-checks the patient's restraints and then ducks out of the room. "Emmy? I'm going to put him up to two an hour on the midaz. Just now he was awake enough to follow commands, and he's in pain. I think his BP can tolerate it." 

The arterial line is actually reading a bit higher than the cuff was. He's sitting at 112/58 right now. This happens sometimes and usually the arterial line is the more accurate one. The mean arterial pressure calculation is supposed more accurate as well; Marian's understanding is that it's based on the true area-under-the-curve, whereas cuff blood pressure is a simple calculation. In this case, the MAP is lower than she would expect from the approximate formula, at 69. It's above 65, though, the minimum safe number to know he's getting enough perfusion to his brain. 

Though, as Marian watches, the blood pressure curve straggles up and down within a fifteen-point range. The MAP is less variable but it does sometimes briefly drop under 65. 

Marian frowns at the variability, trying to figure out if it's correlated with the humps showing each breath on the ventilator screen. 

"...Uh, Dr Beckett? His BP is doing that thing -" fuck there's a technical term for this but she's blanking on it, "- you know, where it's changing based on the vent. That...means he might still be dry?" 

"Hypovolemic in general, but yeah. Huh. What's our urine output been?"