"Uhh. His mental status seems altered. It's not just the sedation. And he's suddenly got all these fine crackles at the bases and he's up to 60% O2 - his lungs were fine yesterday - and, and– I know it sounds stupid but he was way too calm about the NG and the X-ray. It's not like him and it's bothering me." 

Nellie rubs her nose with the back of her hand. "No, you're right. He seems really off to me too. Poor guy, this isn't at all how I hoped the night would go. ...At least if it's the flu it's not alien smallpox?" 

"Don't fucking jinx it. It could be both at once. ...Uh, you're going to, like, sleep at some point, right?" 
 

Shrug. "We'll see. This was my last shift in the stretch. I'm waiting for whoever to talk to the public health wankers, we might not be allowed to leave." She rolls her eyes. "I am way too tempted to steal a gurney mattress and bed down in Ma'ar's bathroom. Not like he hasn't already coughed all over me during the night." 

Marian does not comment on this. She fidgets, glaring at Ma'ar's Foley bag as though his kidneys will start putting out more if she judges them hard enough. 

Nellie drags herself to her feet. "I'll go corner Dr Zee." 

Marian just wants the laaaaabs to come baaaack so she at least knows what's wrong, not that this will necessarily help anything, the wait is just making her itchy. She's claustrophobic again. And also needs to pee. 

Nellie calls her back about three minutes later. "Jesus, when it rains it pours. Asthma kid might have ARDS, they can't maintain her sats, they're talking about positioning her prone but this place does not fucking have the equipment. Anyway. Got orders for Tamiflu and hydrocortisone - you'll have to clamp the NG for the Tamiflu, it's only stocked as a capsule and hopefully he can cope long enough to absorb it. She'd like you to get a sputum sample if you can manage it, I'll bring you a container. ...Oh, and she wants to know what's coming out of the NG and how much of it." 

Marian glowers at the suction canister. "Straight bile, there's like...fifty ccs in there. And a fuckton of gas. Maybe having oxygen blasting him in the face was making him swallow air by accident?" 

Shrug. "Maybe. I'll get everything for you and put it in the vestibule. Might as well load you up on other supplies while I'm at it?" 

"Uh, sure. Thanks." 

Elsewhere on the unit:

Amélie is having a BAD MORNING. 

They've got a guy with an open abdomen, still sick enough that he really should be 1:1 and isn't; she's given him to Anne-Marie and paired him with their Down Syndrome guy, who's easy, except that he's probably ready for extubation today and that's going to need attention from a nurse.

Then there's the flu patient on continuous dialysis, who absolutely has to be be 1:1 - she's assigned him to Alicia, who's CRRT-trained but part of the new grad cohort and really can't handle a double assignment. Marian is CRRT-trained too and probably could, or would at least be game for it, only she's now trapped 1:1 in a negative pressure iso room with their resident wizard, and apparently he's not looking good either. The only way she could make it work was by giving Nicolas a horrible and borderline-literally-unsafe triple assignment, with the tiny stroke guy in 188 and the sundowning lady in 196 and the pneumonia lady in 201. And that's not even going to work longer term because 196 is going for her pacemaker today at noon and she has to be accompanied in the ambulance, that's going to mean losing a nurse for hours.

And now the poor young girl with asthma is crumping on them and SHE should probably be 1:1; right now she's Marc's and paired with ulcer lady in 199. But Esther already has a heavy double assignment, with the pacemaker guy in 194 who coded during the night and is intubated now, and their very sick Crohn's lady in 190. Amélie took the COPD patient in 200 herself, but she hasn't even been in to see him yet, and at SOME point SOMEONE needs to give him an enema and that's going to take hours... 

She called staffing first thing and was informed that seven nurses on the unit should be plenty and can they transfer anyone out to telemetry to free up an admission bed. There was some shouting, and Amélie firmly reminded them that as of last year they're trying to move to a model where the charge nurse doesn't have patients, e.g. there are in fact six nurses, and sure they can bump 196 to tele once she's got her pacemaker in but she needs an extra nurse to go with her and a second extra nurse to take the admit and really they have TWO patients right now who should be 1:1 and aren't. And then she resorted to going down the list of nurses on their days off and calling to beg and plead and bribe someone, anyone, to come in...

Which is the point at which Dr Zee ducks out of asthma girl's room. She is for some reason fully gowned up and wearing an N95, which she strips off in the vestibule and swaps for another surgical mask. 

"- Amélie, we need to think about transferring her to somewhere that has the equipment to prone her and can offer ECMO. ...Also I'm putting her in resp isolation too, she's running a bit of a fever - she's immunosuppressed from the asthma treatments she started last year." 

"What if she's got fucking alien smallpox?" Nicolas mutters. He's angrily shaking a bag of antibiotics at the nursing station counter; he is NOT happy about his assignment today. 

"- Has anyone called public health yet?" 

Crickets. 

Dr Zee slams the palm of her hand down on the countertop. "All right. Fine. I'm doing that now. Amélie, get on the phone with the General or Civic, find out if they've got negative-pressure iso rooms available and...run our situation by them, see how they feel about taking the risk. I do think it's much more likely to be a VAP," ventilator-associated pneumonia, "she's got all the risk factors, and it'd be a fast onset given when she could've been exposed to Ma'ar's germs. ...And I'm leaning toward him just having the flu anyway - we'd actually expect him to get a lot sicker with that, right? If it were a disease from his world, he'd be more likely to have antibodies to it already." 

That sounds like an awful phone call that will take forever, but what's she supposed to say. Amélie nods. 

"I'll be in the conference room." 

Dr Zee makes her way there, sits down, and freshly-sanitizes her hands from the Purell mini-bottle in her pocket, before taking off her glasses and pinching the bridge of her nose. She is not looking forward to this. 

She gets out her laptop and starts hunting for phone numbers. 

The Ottawa Public Health site has a main phone number. Dr Zee uses the conference room phone to dial out; her cell has shit signal in here, and she doesn't especially want to leave the unit. 

She gets an automated menu. It does not include an option to report an infectious disease. It asks for the extension of her party. 

...She pokes around the website some more. Ah, there, a page for 'Reporting a Communicable Disease'. She scrolls down and finds an extension, but by then the menu has obnoxiously timed out and hung up on her. She starts at the beginning. 

And eventually a woman answers the phone. "This is Bridget, how can I help you?" 

"I need to report a–" 

Dr Zee stops. She hasn't prepared a script for this at all, and she expects that letting this public health staffperson lead with the standard phone-reporting script will...not go smoothly. 

"- It's actually a complicated situation, it's possible you'll want to escalate me right to your manager. This is Dr Agnes Zielinski, calling from the Montfort ICU. We have a...patient here, who is - provably not from Earth." 

"You what?" 

"I told you, it's complicated. ...Also quite time-sensitive. He's seriously ill, a number of our unit staff were likely exposed to whatever he has, and it might not be an Earth illness." 

There is a long and noticeable "........" on the other end of the phone line. 

"...I don't think we have any protocol for, uh, for. That." The woman's voice is flat. 

"...If you're assuming this is a prank, I can understand why, but it's not and it's very serious. May I please speak to your manager?" 

"I'm going to put you on hol–" 

"What part of 'time-sensitive' did you fail to understand? ...I'm sorry. I realize this is out of the blue and it sounds insane and you don't have any contingency-plans ready for it. ...Look me up if you want, I'm on the hospital website. Dr Zielinski, Z-I-E-L-I-N-S-K-I. I went to med school at U of T, class of 1994, started residency at Vancouver General in 1995. I'm really not someone who plays pranks."