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let's find out if Marian's ICU and two different kinds of magic healing can save radiation-poisoned Leareth
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Marian will listen very attentively and take notes to hand Dr Harrison afterward!

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Leareth looks so much more comfortable! It somehow wasn't obvious until now how uncomfortable he was looking before. 

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Oh that's so good. Marian is so pleased and her brain is so soothed. She beams at Samora and then goes to hand Dr Harrison the bit of paper. 

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Shavri looks just as relieved and happy. 

:That makes a huge difference: she tells Samora. :I mean, he's not any clearer-headed yet, he's still very drowsy, but at least he's not mainly experiencing suffering. ...He probably will still get panicky once he's alert enough to try to figure out where he is, I'll tell you as soon as it's a good time for Calm Emotions.: 

She settles in to wait and observe. 

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Type type type type typing furiously.

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RENOWN REGIONAL MEDICAL CENTER - CONSULTATION REQUEST
Patient: PURPLE, NINETY-THREE Time: 20:05
MRN: TEMP-93 Location: Trauma ICU, Pod 4
Requesting Service: Critical Care Medicine Consulting Service: NEUROLOGY
Requesting MD: Harrison, James MD Urgency: STAT
REASON FOR CONSULTATION:
Cognitive assessment for patient with radiation-induced encephalopathy. Will receive experimental regenerative therapy tomorrow, potentially as early as 0800, that can target ONE of three specific neurocognitive clusters. Need to determine priority target based on deficit assessment. Time-sensitive - best assessment window may be limited to next 60 min.
CLINICAL SUMMARY
HPI: 40s male, massive radiation exposure (est. >50 Gy whole-body) → cardiac arrest ~30 min post-exposure. Presented in arrest at 0945, resuscitated with ECMO + experimental cellular therapy. Currently stable off ECMO. Details of therapy and transport mechanism will be explained in person.
Current Status (20:35):
  • Stable hemodynamics, off pressors
  • Intubated/vented (FiO2 30%, PEEP 8)
  • Propofol 15 mcg/kg/min (weaning), fentanyl 75 mcg/hr
  • Emerging from sedation - rousable but agitated
  • No focal deficits, PERRL
  • Language barrier (interpreter available)
CT Head (17:45): Mild reduced gray-white differentiation (frontal/parietal), subtle increased BBB permeability. No hemorrhage/infarct/mass effect. Radiologist noted findings "remarkably benign" for exposure severity.
EXPERIMENTAL THERAPY - DECISION NEEDED
Therapy available at 0800 can target ONE of three neurocognitive clusters (single dose available). Provider describes clusters as:
CLUSTER 1: Math, memory recall, holding complex images mentally, calculation, abstract reasoning
CLUSTER 2: Introspection, situational awareness, prioritization/filtering, judgment, emotional regulation, impulse control
CLUSTER 3: Understanding others, communication, social perception, expressive function
Clinical need: Patient must be functional enough to perform complex cognitive task requiring sustained concentration, spatial reasoning, emotional stability. This is critically important. Situation is highly unusual, but this therapy has produced objectively documented results (see lab trend - pH 7.04→7.32 in 2 minutes). Will explain details in person. Need neuro expertise to guide decision.
CONSULTATION QUESTIONS
  1. Assessment approach for intubated patient with language barrier?
  2. How to differentiate ICU delirium vs sedation effects vs structural damage requiring intervention?
  3. Based on CT findings, which cognitive domains most likely impaired?
  4. If patient shows severe agitation/fear dysregulation on emergence despite appropriate meds - expected post-arrest delirium or specific deficit?
  5. Which cluster (as defined above) likely to be most limiting for patient function?
ASSESSMENT PLAN
Continue sedation wean. Plan comprehensive neuro assessment in next 60 min.
Available for assessment:
  • Interpreter with direct communication capability
  • Diagnostic intervention that may temporarily boost Cluster 2 function for clearer assessment (available once for up to 60 min)
  • Short-acting anxiolytic(duration ~60 sec, single use)
CLINICAL CONTEXT:
Patient Acuity: Stable but time-sensitive
Family/Proxy: None identified
Code Status: Full code
Attending: Harrison, James MD
Primary RN: Daly, Marian
Electronically signed: James Harrison, MD
Time: 20:05
Service: Critical Care Medicine
ADDENDUM (20:11): Attending neurologist paged. Verbal communication to follow. Request acknowledgment of receipt and estimated time of arrival for consultation.
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Marian glances over the note the next time she's in the chart. Wow???? Like, she can kind of understand Dr Harrison's reluctance to just explain the entire bizarre-ass situation in writing, but today is just the day of sending absolutely surreal batshit requests to specialists, isn't it. 

She documents quantity of pee (still fine, 95ml for the last hour, though he's still accumulating a positive fluid balance because of the INCESSANT ANTIBIOTICS running) and the repositioning. She fantasizes about a bathroom break but concludes that she can manage to wait an hour. 

...she ekes the propofol down to 10 mcg/kg/min, because Leareth still looks pretty asleep and they're on a time limit now. She wonders if Dr Harrison actually expects someone to show up on less than an hour's notice when it's after-hours. 

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Another five minutes after that - fifteen minutes after the Remove Sickness onset - Leareth is starting to show more signs of consciousness. 

 

He's breathing well above the ventilator rate now, and occasionally trying to move his arms, though when he reaches for the breathing tube it's still in an aimless half-asleep sort of way and he doesn't actually seem distressed, or to fully notice it at all, when Marian gently redirects his hand away. When an IV pump beeps, his eyes flicker open for a few seconds, though he's still not focusing on his surroundings.

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:He's getting a lot closer to the surface: Shavri relays. :He's not really having thoughts, yet, but he's - making wordless observations? Just then he noticed the lights are really bright and was kind of vaguely confused for half a second and drifted off again. He's not really accessing memories yet, or thinking that he's not where he expected to be, I think he's going to really freak out as soon as he's aware enough to remember the part where he was dying.: 

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Time to be SO calm and. chill and non-startling and friendly-looking and definitely not at all reminiscent of a necromancer kidnapper!  ...Time to prevent Leareth from going for his breathing tube again. While being calm and chill. Marian is so chill and is definitely not freaking out that her patient isn't restrained and what if he tries to yank out his dialysis line. Or his catheter! It's right there! Maybe she can, like, pull the edge of the sheet up over his waist and tuck the sheet edges under the mattress on the sides like those horrible properly-"made" hotel beds... 

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Leareth is now close enough to awake to notice the new confinement, seem vaguely distressed about it, and promptly start trying to kick the sheet off. Incompetently. He's really not very coordinated. 

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Oh no if he clearly hates it then Marian will untuck it! She's not going to be mean! Just. Stressed. It turns out she was maybe getting a lot of peace of mind from being able to restrain patients who might flip out so that the continued presence of all their tubes in the correct places is not entirely dependent on her personal reaction times. 

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Something is very bright and it's not painful exactly, everything is very floaty and far away, but it's still wrong. There's a lot of wrongness. The surface is wrong and moving is wrong and breathing is wrong, somehow, and it’s…

 

…taking Leareth a long time to follow that to the “and ???” because everything is very far away but…

 

…wrong?? 

There’s something - needs to do something - if something is wrong -

 

Eventually he manages to form the intention to reach for mage-sight, and he tries, and it’s also wrong, both in that it’s only half working and that nothing makes any sense.

 

...something...to do...to respond to it being wrong??? 

 

Very slowly and effortfully, and still entirely wordlessly, Leareth forms the thought that he doesn't know where he is and that this is bad and he should - needs to - 

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:Leareth, you're safe, you were injured and you're with Healers and you need to stay still DO NOT GATE: 

 

To Samora, :- now would be a good time for the Calm Emotions.: 

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She actually says it right over Marian, who had just started to say "Samora I think you should cast–" purely off the sudden spike in Leareth's heart rate. 

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"Calm Emotions," Samora says, as Leareth tenses and Shavri says "now would be a good time". And now Leareth's emotions are even farther away than anything else, so far away there's no path to them from any of the thoughts he can think.

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That’s very odd. Leareth is awake enough that he doesn’t just slide back under the moment he’s no longer panicking, but he does just sort of…lie there blankly, not really succeeding at any thoughts other than wordless muted puzzlement.

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Shavri has exactly one minute to try to orient him enough that he doesn’t go right back to freaking out as soon as it wears off.

:Leareth, I need you to try to open your eyes. - Good, that’s good. My name is Shavri. I’m a Healer from Valdemar. Do you know who I am?:

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Leareth blearily tries to focus his eyes on her. Shavri. His vision is blurry enough that he can’t see much other than ‘dark curly hair, pale skin, green clothing’, but name is familiar, at least.

Shavri. The…King’s lifebonded??

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He’s not really putting any of his thoughts into coherent sentences, let alone trying to project Mindspeech back to her, but Shavri kind of caught that. It seems like a good sign.

:You were badly injured in an attack by Vkandis: she sends. :I mean, I don’t know if you had any way of knowing it was Vkandis. You’d been trapped in the Foresight dream with Vanyel, the attack happened, you Gated to a records cache. You were unconscious by the time we found you, so you wouldn’t remember that.:

He was more or less dead by the time they found him, actually, but it doesn’t seem like it would help to say that. 

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…Yes, Leareth remembers that. He was alone and he was dying and nobody was going to come. (It’s…very odd to be having that thought and not really feeling anything about it.)

Something - there was something important, what was it, it’s so hard to retrace when there was no jolt of alarm to flag it -

 

Vanyel. Was in the same location as him, unless they separated them. Blai too, maybe? He’s not sure - it had been a long time with no news - but there’s some reason why he thought Blai was in the same base, he just can’t - 

 

(Leareth’s thoughts are still slow and mostly not in words and quite difficult to follow, and he’s not really engaging directly with Shavri’s presence at all.)

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He’s definitely impaired in a lot of different ways but it’s hard to tell exactly what they are.

:Vanyel was affected as well. As were Bard Stefen, Select Artigas, and Seldan. Nayoki too. They all got a channel within seconds and it helped quite a lot, not with everything but they were stable and conscious when I last saw them.: 

She will maybe not go into too much detail on that just now, Leareth does need to know that it’s - bad - but they’re really on a time limit here and she’s not sure how much of what she says now he’ll retain.

:They’re in Haven: she goes on. :We’re - in another world. They call it ‘Earth’. As far as they know they have no magic or active gods, but very advanced technology, including for Healing.:

Does Leareth seem to be following?

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He registered the part about another world! He’s sort of…staring at it blankly. It seems important. Further thoughts on that are not happening.

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Better than not registering it, at least.

:They have artifice to help you breathe, that’s why there’s something in your throat. You mustn’t pull it out. This is Marian, she’s a local Healer - not Gifted, but she’s very competent and you can trust her. She’ll be here all night; I may need to sleep but I’ll be close, since they don’t speak your language. Leareth, do you understand?: 

She really hopes so. They’re more than halfway through the 60 second duration of the spell; Mindspeech is fast but Leareth’s thinking and comprehension right now really isn’t.

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He’s trying to assemble the pieces, at least. Artifice, breathing, tube, no pulling it. That face which he still can’t really focus on: Marian, not Gifted but a Healer, Shavri trusts her? …If there was more he’s lost it. 

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