Doooes Celestial give Marian the vocabulary to communicate the problem? She’ll try! Their patient’s blood is really acidic. It’s a predictable result of someone spending a long time not breathing enough and with a really low blood pressure, their blood accumulates…waste…from trying to be alive without enough fuel and then without any fuel because his heart stopped beating, and at this point his heart probably isn’t going to do anything even if he’s getting air. Would that explain Stabilize failing? And can Samora think of anything else that might possibly work?

"If his blood is bad--Stabilize and Cures fix blood loss, if his blood is bad you could try taking it all out and I could see if that lets me put good blood in? I don't know if that's brilliant or stupid."

That's - what - okay Marian's job isn't to assess whether plans are brilliant or stupid it's just to relay them to doctors who will make a decision. 

That's stupid. (Even if it could work in theory for a different problem, this guy is right on the edge, and it would take forever, anyway, even with high-quality CPR they're getting a systolic blood pressure of 70 because the guy's vascular tone is shot, people with a blood pressure that low take forever to bleed.) 

...That's it, they're putting him on VA-ECMO.

What, seriously? 

Oh that's a great idea! They'll get him artificial oxygenation and circulation for a bit, ECMO is great at removing CO2, they'll give him a fuckton of bicarb and get his pH normalized and then they really should be able to get somewhere. Like, to be clear, this would be an insane idea if they didn't have Samora, okay, given all the reasons to assume catastrophic brain damage, but they do have Samora so they're going to fix it! Dr Chadra is so excited! 

...No, seriously, they're– what, in the hallway? 

Yeah okay they should probably put him in an actual patient room at this point. That sounds like the charge nurse's job. 

Marian isn't trained on ECMO though

...She spends several seconds trying to figure out how to explain the concept to Samora in Celestial without getting so distracted that she misses another callout, and settles on "they decided it's a good idea to take the blood out of him but we have a thing to fix it when it's out of his body and put it back better." 

Huh, she did not think that was going to turn out to be a good idea. "Okay. I'll keep casting Stabilize unless there's not space to be within ten feet of him."

This is such an insane plan! Why are they doing this! Dr Harrison is glaring at her like it’s personally her fault that they haven’t all drilled on getting fucking VA-ECMO running on a patient they’re actively coding within two minutes. You can’t just do that! This requires setup and planning! 

…She’s going to call the charge nurse up on 6C, the cardiac ICU where they actually ever do this, and BEG. Yes she needs whoever is certified on ECMO and ideally has actually done it within the last year, yes she needs them RIGHT NOW, it’s a really long story— oh, has she seen the news? There might’ve been stuff. Anyway can she get some staff to come down right this moment please! 

Dr Chadra has been interrogating Shavri about Healing-Sight for the last minute or so and she’s going to be incredibly helpful.

They’re going to need everyone in the room to be sterile. (Normally this would be set up in the OR but that’s an entire ninety-second walk away.) Can Samora and Shavri please both wash their hands and put on these gowns without at any point touching the outside of them, here, watch what Dr Harrison is doing…

This is so chaotic! Aaaah! Marian’s auditory processing is getting completely overwhelmed.

Tara from 6C is giving her a Look that means “can you tell me what the hell is going on and why?” and Marian…is apparently too socially chicken to scream “we have a D&D cleric with magic healing and this guy just fell through a portal!” across a crowded room in the middle of a code. And she can’t duck out into the hallway because she’s on documentation. She frantically to get Fraser’s attention in eyebrow semaphore.

…Yeah, sure, Fraser will duck out into the hallway again and fill in the new arrivals.

This is the most beautiful incredible thing that Shavri has ever seen or imagined in her entire life.

When a specialist tells you to follow a ritual procedure you follow it exactly. Samora is so careful about washing her hands and getting the special clothes on. And then she casts Stabilize several more times while trying to telepathy and/or hopeful-glances at the psion lady to the effect that she would like to be included in the conversation but only if it's convenient.

And then she remembers an obscure fact from school about a spell she basically never uses and only prepped this morning because she didn't have any better ideas! Positive Pulse, while it uses positive energy and can fix what's wrong with people, does not actually work by the same way as other healing spells! In particular, it doesn't need to find targets the way Channels and Cures, and it fixes a different set of things.

"I have a spell that might help," she says at a moment Marian and Shavri look marginally less overwhelmed. "It won't directly repair his body, it'll disrupt any process that's trying to kill him. Worth trying?" It's not like she's likely to have a different use for it today, it's first circle and almost never comes up.

Shavri is a lot less overwhelmed than Marian, honestly. She was having an incredibly interesting conversation with the...trainee-senior-healer? She's still trying to figure out their Healers' chain-of-command situation here, it's weird - but now he's off setting up the actual artifice that does the procedure and busy and she has a lot of extra mental capacity and nowhere to put it. 

:Might as well try: she sends to both of them, not sounding incredibly hopeful because she doesn't think something is ongoingly trying to kill Leareth, it's...one-time damage, that's just taking its time to play out. (And is abruptly eyeing Samora as the least busy person in the room and perhaps the most available to think-out-loud-in-Mindspeech at because she feels an urgent and explosive need to do that, but they should see if the spell works first.) 

Here's a burst of undirected positive energy that's just sort of splatted across the entire three-dimensional space Leareth is in rather than trying to fix a specific living system! It . . . maybe does something for a fraction of a second and then dissipates. Now Samora is the least busy person in the room again.

:If you had a slow continuous version instead of all at once it might get somewhere but I'm guessing it doesn't work that way and you only had one of it.: Maybe. It seems like it's maybe still not really targeting the right thing, just an interestingly different wrong thing than she assumes a channel would. 

Shavri's mental voice is matter-of-fact. :If you can still sense him I think he's not getting worse and we've got time. The thing they're doing is complicated so it's going to be a while, they would normally use it with people when they have some warning a problem is getting worse.: 

Samora still looking not-busy? Okay great Shavri is full of thoughts and they have to exit her head. 

:So the problem is - that we have a lot of different problems, right, and your healing only targets some, and at least one of the problems you can't aim a spell at is advanced enough that he's - kind of fallen apart as a living organism, so any spells that expect to find one of those don't work. There's a lot of very bad injury-like damage, which a channel would work on, but - when he didn't get one, right away, he started dying. He must've hung on for a pretty long time in spite of that, maybe twenty minutes, but - he probably spent most of that time not really getting enough air, and with his heart too weak to move enough blood. When someone isn't breathing or isn't breathing enough, there's - so air has a vital component that the body needs, right, and then a - used-up component that needs to be gotten rid of, like how eating and digesting leaves waste that you need to get rid of. If it builds up instead, then - when it's in tiny bubbles in a liquid like blood, rather than just in the air, it forms an acid. I didn't follow why but they can measure things like that here. ....And then the other problem is that the body isn't getting enough of the vital part of air, and most of the body can work for a short time without it, but it produces a special kind of waste and that waste is also acidic. He has both problems at once, so it's very very bad, they said it was 'incompatible with life', nothing in his body will work right. There's also a kind of - salt? - that leaks out of injured tissue, and having too much in your blood can make the heart beat wrong, and he has way too much. It's...like he's poisoned by natural substances made by his own body. If you had a spell to remove poisons that didn't actually require a specific target, like the positive energy one, that might do it, but I don't know if that even - makes sense as a concept, what makes something a poison is so contextual.: 

Shavri pauses to answer a question from the resident, frowning, then looks animated - though she's very carefully not waving her hands, they're doing delicate work here. After thirty seconds or so she turns back to Samora, her eyes beady-bright with enthusiasm. 

:Anyway! He needs to be breathing and moving blood through his body, to clear the poison – it's that simple for the one that's just used-up air, healthy people just breathe it right out – but his heart can't work with the poison still there, you see the problem? That's why I couldn't get anywhere with Healing, either. I thought, maybe if there were a way to completely replace the heart for a while – and they can do that! They put tubes into the great vessels in his body - they'll go through the groin, where they split, but the tubes are long, they reach further up - and they use a pump to take the blood out and...put it through artifice-lungs? I think I need to see that part to understand what he meant...but they clear the used-up air and and fill it with vital air instead and and pump it back around, like his heart normally would. So he won't die, even if he's not really alive either, and getting all the used-up air out of his blood will make it less acidic, and they can - counterbalance? - the other problem by giving him a different kind of salt that's the opposite of acidic.: Sandra had a word for that in Valdemaran and Shavri has forgoooootten it and it's driving her up the wall. :And then once his body is less poisoned, Stabilize should work, and then you can do a Cure and a Lesser Restoration and...it won't get everything but it should get him to 'not dying' while they figure out what else is wrong.: 

This planet is amazing. This specific part of it might now be Shavri's favorite place ever.

According to Marian's paper, it was 9:51 am when Dr Harrison announced they were trying ECMO. 

They have it fully connected and running by 10:07, which - based on the mutters and looks of incredulity shared among some of her 6C colleagues who got dragged in - Marian is led to believe is incredibly, astoundingly fast to accomplish from a totally unprepared start on a unit that doesn't do it routinely, and was probably only possible thanks to their new resident magic healer with CT vision to supplement the ultrasound guidance. It's still 20 minutes of CPR, and they can't stop yet, they need to titrate up the flow slowly and it won't be enough to support his entire circulation even at max if his heart is doing literally nothing. It's meant to help patients out with heart failure on top of respiratory issues, for actual open-heart surgery or whatever they do full cardiopulmonary bypass. Which they didn't want to risk here because, among other concerns, the injury-healing cleric magic might well consider 'open-heart surgery' an injury in need of healing and no one wants to test what would happen. 

...It's really cool but it hasn't actually worked yet and Marian's main emotion right now is overwhelm about all the FUCKING CHARTING. Eleanor from 6C saw Marian charting for the code and seems to have assumed this is her patient and taken it upon herself to patiently walk Marian through the 58327627 flowsheets she needs to populate. Okay, fine, that's exaggerating, but there are literally sixteen pages to chart on "Ninety-Three, Purple" which is now the patient's name in their system. 

They did it! 

...Is it working??

...Well, the life-force is getting substantially brighter, after having leveled out for the last fifteen minutes. It's still completely scattered. 'Not enough life-force' is a problem but it's not the reason why Samora's spells aren't landing, Samora's spells could fix that. 

:He's still showing up, right?: Shavri asks Samora for about the thirtieth time over the last sixteen minutes. 

Nothing Samora has is designed to deliver its healing any slower than "instantaneously", which is great when you're in combat but inconvenient here. Fortunately the Earth folks have so much incredibly cool nonmagical healing! (Aroden would have loved this.) (She wants Golarion to have it.)

"Yup, still there," she answers for the thirtieth time. Stabilize?

Nnnooooot yet. 

Can they get another blood gas to see if it’s working.