(While all of this is going on, Catherine calls a jeweler and gets told that the gem-cutting part of making diamond jewelry is all done at a handful of centralized shops in New York and Russia and for some reason Arkansas, and retail jewelers only have finished gems.

She checks the McMaster Carr website and looks up their offices and determines that no, they physically don't have any distribution centers close enough to get her lapping grit in four hours even if she could get it by driving to one and making puppy-dog eyes. 

She checks the Grainger website and they have lapping compound, at very reasonable prices too, but it's diamond dust mixed into water and she can only find the MSDS for a different brand of the same stuff so she has to call them to determine what fraction of a 5g tube is diamond. They say ten percent. She says great, she needs thirty tubes right now, do they have thirty tubes? They say they definitely have a bunch but maybe not thirty. She says she really needs thirty, can they check please, it's important. They say they have twenty-four.

She says she'll buy all twenty-four right now over the phone and be by in a tick to pick them up, and when that's done she finds the second-closest Grainger, in Sacramento, which is a two-hour drive away, and they have ten. She buys eight, because this plan is getting crazy enough that she wants margin for error, and says she'll send someone over with the receipt to pick them up. She orders an Uber from that Grainger to the hospital, and paces, and walks out to her car, and nobody takes the Uber request, and nobody takes the Uber request, and she starts driving to the nearer Grainger. At a mostly reasonable speed, because she has seen what happens to reckless drivers. And once she has the first twenty-four tubes, she cancels the still-unaccepted Uber, gets on I-80 and starts driving southwest.)

"So, really pervasive, nonmagical damage, from a source that's not still present, and that can't heal on its own even with multiple days to do it in? That really sounds like the sort of thing Restoration can handle--and if it can't, then I'm afraid there's nothing else I can do that has a chance. But I think the odds are decent; Lesser Restoration did something and Restoration is strictly better."

Marian nods and relays this. They’re pinning an awful lot of their hopes on Restoration working and on being able to get diamond dust on a few hours’ notice but Catherine seemed very busy on the phone and she’s pretty organized, maybe she really can do it. 

Dr Chadra and Dr Harrison have printed off some medical papers with charts in them and have their heads together over them. Dr Chadra just mutters acknowledgement and they go back to whispering and annotating the charts with something, interspersed by Dr Harrison yelling at someone that they need to call the lab and get a differential with an absolute lymphocyte count specifically and they need to repeat the CBC with said differential every thirty minutes, after which point they go back to muttering to each other about whether it's even valid to extrapolate - 

This is probably incredibly fascinating and shiny but Marian will have to get a rundown from Dr Chadra LATER. Do they have a plan to ever get this guy off ECMO. Please tell her there's a time limit on doing this. She will absolutely sign up for a 16h today if it matters but she's not sure she can handle this particular task even for the rest of a normal shift. 

Samora can probably go back to reading about synthetic diamonds for now? At least pending some kind of decision on whether they want her to do anything else, Marian doesn't even know what the plan is now, she feels like there are arguments for both "use the Remove Diseases as soon as possible, because this guy has no fucking immune system" and "hold off as long as possible because he has no fucking immune system and it's only going to get worse." 

Samora will continue reading about high-pressure high-temperature diamond growth procedures with barely restrained glee. How big is a carat? Holy gods and all their saints. How much heat, how much pressure? A lot, wow. (Are there elementals that can do that? Vigil might need to bring in Felandriel Morgethai--side issue, not her job.) New tab, Guidance, new search on copied and pasted keywords. She's taking notes in Celestial; encryption or memorization would be better but she's not reliable enough with either. What's methane? Oh that's doable. (Phrenk would love this.) Carefully copying and labeling press diagrams. (And all this information is just available for free!) How pure does the vacuum have to be? Whole section of notes just on unit conversions with reference to measurable things in physical reality wherever possible. She's not sure which of these options is easiest but there's no world where she does the whole thing herself, she'll write down everything that even might help and the alchemists and wizards will take it from there. The might of Lastwall is behind her and the Inheritor's eyes are on her and when the Comprehend Languages runs out and the page she's on turns to incomprehensible runes she switches from summarizing in Celestial to transcribing it, character by character.

Wow Samora is so focused! And so smart and impressive! She's never used a computer and didn't know the internet existed before yesterday and Marian only showed her the copy and paste shortcuts a couple of times and she memorized them and is handling it practically on her own, Marian will still slip over every so often in case she gets stuck but it's going to be very easy to get stuck head-down in keeping up with all the charting. And labs! And they're starting dialysis, apparently, which on the one hand sounds like a great idea because their guy's scary potassium is not coming down and he has produced zero pee at and his electrolytes are just going to keep getting more fucked which is probably a whole lot of why he's hanging out in that horrible ventricular rhythm, but in the meantime it's the expected amount of rough on his hemodynamics and they're super not getting him off ECMO just yet and aaaaah. It's a good thing the unit is abruptly full of patients who don’t actually need to be there, because “1:1” does not begin to capture how much work this guy is.

That is SO COOL!

Eventually - after more printouts, more annotating graphs and tables on said printouts, another call harassing the lab, some time digging around on a university website and five minutes of Dr Harrison pacing up and down the hall on his cell phone trying to get through on an international call and then ten minutes of muttering - they reconvene for an announcement. 

"So far everything probably fits with the radiation exposure theory," Dr Chadra says. "A really, really high dose exposure, this is worse than any case studies we have data on. If we can extrapolate the models from lower exposures - which might not be valid, but if it is - then we're thinking he took at least 100 Grays, that's ten thousand rads. It could be a lot more, the expert we managed to get on the phone gave that as a minimum based on the symptom onset and progression and how fast his lymphocytes are crashing. We're going to want blood samples for chromosomal analysis, that's the gold standard to assess severity of radiation exposure, but it'll take days for results and it's - not necessarily going to be guiding our treatment very much. We know this isn't survivable without magic. Our job here is just to do everything we can to keep this guy alive long enough to check if magic fixes it." 

That sounds alarming. Marian mostly doesn't have the brain available to consider it in any more detail than that.

It would be really nice if doing everything to keep this guy alive was slightly less work and involved slightly fewer horrible flowsheets, she's completely missing out on her chance to nerd out with Dr Chadra about this patient's fascinating problems ...Marian's brain can stop whining about how her life is hard and FOCUS. 

Dr Chadra glances at Dr Harrison. 

"It's possible the magic - that Samora can access - will fix some of his problems and not everything. That's what we've seen so far. We're hoping that the Restoration spell will hit a lot harder than the Lesser version of it, but we're not sure. It's possible that we can reverse tissue damage and organ failure, but that repairing the underlying DNA damage would take stronger cleric spells than what we have access to. But! Shavri said he was already planning to invent portal transit to get to Golarion. So our backup plan, if Restoration is only partially effective, is to get him stable and lucid enough to invent powerful new magic." A nervous grin. "No biggie, right?" 

...That's the plan??? The plan is to make the wizard from another solve his own medical emergency???? That...is kind of insane...but it's not up to Marian. 

She goes to let Samora know the updates, because it seems like Samora should probably know. Which is the point at which she notices that Samora is now for unclear reasons attempting to exactly copy Wikipedia by hand. 

"- We can make a copy on paper for you?" she says. "It's really fast. You don't need to copy it by writing it." 

"Oooh, that would be really helpful when you have the time, thanks." Way too many of the letters in this language are other letters backwards and she's worried she's going to make a mistake that changes the meaning of a sentence. "Also if Leareth can open portals to Golarion that would be really cool, I think our worlds have a lot to trade with each other."

Though if Leareth is going to end up playing a key part in that trade, that does kind of add some urgency to the thing where he's Evil. Hopefully he's the self-interested kind of Evil rather than the random murder kind or the consorting with fiends kind. If, say, Chafkem or Veldri got access to a portal to another world, that would be a situation to keep a sharp eye on; if someone like Belcorra did, that would be a terrifying emergency.

Does Shavri have a minute to talk?

Shavri can talk now, sure, she's holding a Healing-link but other than that she's just kind of just waiting on Dr Harrison to decide what they're doing next. (Which is going to involve MOVING this patient with multiple enormous machines still attached directly to his bloodstream, and Shavri is apparently going to be on-duty making sure nothing is getting jostled in a bad way and she's not looking forward to it.) 

:What is it?: 

:I'm hopeful that we'll be able to get Leareth conscious today or tomorrow, if the Restoration works, and I hear that he's working on traveling between worlds, and I'd like to know--what kind of a person he is? Anyone who gets reliable travel between the worlds working will have a lot of leverage. I know it must seem premature to think about that when he's still so sick, but I'd like to talk to him once he's awake and strong enough for a conversation.:

Oh. That conversation. It does make a lot of sense that they need to have that conversation but does it have to be now. Shavri right now is full of SHINY MEDICAL FACTS and having to switch to, instead, explaining messy interpersonal and geopolitical backstory - that might have a significant impact on whether Samora is willing to help her patient, if she says it wrong! - is making her feel like she just tripped facefirst into a brick wall. 

:He's - a complicated person: Shavri sends. :He can be very ruthless. He's - been fighting the gods of our world for a long time. But - when we nearly ended up at war, recently, that wasn't on him. He was trying to de-escalate the whole time and the gods were - trying to make it look like he'd attacked first, keeping us out of communication - it's complicated. But I kind of think that our real enemies were a lot worse than him. And I think he's someone who - tries to cooperate - and I think he does better things, not worse things, when he has more to work with.: 

Did that make any sense? Shavri has no idea she's already halfway sliding back to thinking about SHINY MEDICAL FACTS.

:That does make sense. Thank you.: Also it sounds like she can probably skip having a crisis of conscience about whether it's okay to refuse healing to someone in a place committed to healing everyone who comes to it when you didn't personally make that committment if they're likely to bring the magic of two worlds to their world's equivalent of Cheliax. Though really, that just means it isn't a crisis, not that she shouldn't sort out her conscience. Every moral dilemma you think through in advance is one less you can get ambushed by. 

She wants to know what commitments the hospital people think of her as having made or would like her to make, but Marian looks too busy to ask about anything that isn't a non-hypothetical crisis, so put a pin in that. What's a better starting point? It's good that places like this can exist, that much would be obvious even if this one hadn't saved her life yesterday. That rules out attacking anyone here. Some people are spending a lot of time and money on diamonds so she can do the Restoration and making plans on the assumption she'll do it, so she would need to either do it or compensate them for the trouble even if she later decided it was a bad idea. Which suggests that she really does need to sort out what her commitments are before she accidentally makes any more like that one. Healing for access to the wondrous knowledge machine is an excellent trade and she wants to keep making it, probably until she leaves the planet, but there should not be a giant ambiguity about which healing she can be expected to do, or for that matter whether there are any expectations around what she does with the knowledge from the wondrous machine. There, that feels like she has reduced the problem to a set of solvable parts. Perhaps Shavri would like to tell her some more medical facts, if she didn't get busy again while Samora was distracted.

Oh, if Samora is no longer very occupied on the library-artifice box then Shavri will absolutely dump medical facts on her! This activity is in no way disrupted by being busy!

…She really does hope that they’re on track to get diamond dust for a Restoration, because Leareth is very definitely steadily deteriorating again, and the only reason this isn’t an emergency is that they’re literally pumping some of his blood for him.

Catherine drives southwest for thirty minutes before she admits to herself that she should have used the bathroom at the Grainger, and another thirty before she decides that if she doesn't pee soon she's going to crash the car, and stops at a Shell in the middle of nowhere. On the way back to the car she scrolls through her Facebook friends for anyone in Sacramento and concludes that Patrick from middle school geometry is not going to drive an hour out of his way to help her. But maybe he'll drive twenty minutes and save her forty. She calls him, makes small talk for two minutes while trying not to snap, and asks if he could do her a huge favor, enormous really, can she text him a receipt and get him to pick up her Grainger order and drive it one exit up the highway, please? It's for an experimental treatment for radiation poisoning. It could literally save someone's life. Literally for real. Thank you so much Patrick you are such a good person. 

Text: sent. Back to the highway and the wilderness and the not driving ninety miles an hour even though the road is so empty.

Medical facts are objectively pretty great! She can only hold so many before it feels like every new one is shoving an earlier one out to make room, but hey, she has more of the fancy Earth paper, she can take more notes. Can Shavri be gently nudged by means of excited questions to talk about general principles with broad applicability more than about this specific very weird case? It's fine if not! But it would be nice.

(Marshall would love a chance to have this conversation. What Shavri would think of Marshall is a bit more up in the air.)

It doesn’t take terribly much nudging, though Shavri is definitely almost entirely excited about the advanced technology aspects and in particular how the medical staff are using technology to imitate Healing-Sight so that they can keep tweaking how they're supporting all of Leareth's vital functions, which a healthy person's body is very good at doing by itself but is extremely involved to do with artifice! They're using the new machine to filter waste out of his blood, like what the kidneys would normally do, and to keep the various kinds of salt at the right amounts, and that means they need to check every candlemark how much of all the salts is in there. His blood is incredibly messed up in ways that Shavri has literally never seen before, because you couldn't keep someone alive in this condition long enough to Look without all the artifice helping, but she's starting to learn to correlate changes-to-Sight with changes-on-the-measurements! It's going to take a lot more practice before she can give them even a rough quantitative estimate, but Dr Chadra was very excited at the possibility that Shavri could learn to track the salt changes in real time and use that to guide when they check his blood with the artifice and get the numbers! Also they're messing constantly with both the rate and depth that they're making him breathe with the machine, and a lot of different controls on the blood-pumping-lung-replacing artifice, in order to keep the different parts of air in the right amounts in his blood, he actually had way more of the vital-air-component in his blood than was strictly necessary and they've reduced how much of it they're putting through both of the artifices, it's apparently not actually good for people to be getting too much... 

Excited notetaking! Excited questions and speculations about how positive energy interacts or doesn't interact with all of these systems! Seems like it's a lot better at repairing large-scale damage where things are physically in the wrong place than small-scale damage where things have the wrong chemical composition. That seems like it might have something to do with the thing where adventurers are harder to kill most ways but still drown almost as fast as anyone else once they inhale any water.

Yeah! She’s been saying “injurylike damage” to mean “the precise set of things that a channel or a Cure can fix”, because Blai described those to her as for acute injuries and not illness or, say, the kind of diffuse organ damage that accumulates in the bodies of older people, or for any of a thousand other reasons that put the wrong kind of strain on a particular pathway or process in the body until it starts to break down.

She's still wrapping her head around it, because it's not as though positive energy doesn't get small-scale dysfunction, it just - only seems to target it if it's associated directly enough with an acute injury? And it doesn't seem to be able to "see" or land on the damage that's smaller than a single cell, the "burning" of the tiny parts inside that she's now learned are what provide instructions to every cell on how to be a part of a body, like a tiny library. If it were less damage that this - a lot less - it wouldn't kill him but would eventually cause tumors, as cells followed their corrupted instructions and went off on rogue missions. She checked and confirmed a theory with Dr Chadra that this isn't totally disanalogous to ways that older people's cell-libraries can gradually accumulate mistakes, because the library needs to be "copied" every time a cell splits into new cells, which is constantly, and the majority of people won't die of a tumor but it's a significant minority that do, and even elderly folks who die of something else first - a bad heart, or a winter pneumonia they're too frail to fight off - often have the beginnings of tumors. 

Anyway they're not going to have to worry about that in this case because the damage is a lot worse - not just garbled library-instructions that will send cells off on rogue missions, but instructions shredded to the point that the cells will just die the next time they try to divide. Which is a serious problem because many parts of the body rely on continually dividing cells to replace ones that are destroyed. Skin, for example, or the lining of his gut, which is...more or less completely "dead", not in the sense that all the tissue is already dead now but in the sense that there's no remaining underlying vitality to keep replacing the "disposable" cells, that in the ordinary course of things are expected to die and be replaced on the scale of days or weeks. The Cure spells seem to consider the surface damage - areas where enough cells died and sloughed off to leave a internal wound - as injurylike, but it ignores the underlying lack-of-vitality, so the wounds are just going to keep reappearing. The bone marrow is the next biggest problem – the vital cells in blood, the ones that help it move the vital part of air to where it's needed, usually last weeks, but a lot of Leareth's were damaged, and he has no innate capability to make new ones because the libraries in the bone marrow cells that would divide into new blood cells are too corrupted to allow this. The bone marrow also makes the cells that cluster on wounds to form a clot and then a scab, and the cells that fight disease, and both of those turn over faster, so Leareth has dangerously few already. Cure spells do, actually, seem to put the vital cells back, and if it's not enough they have the capability here to give Leareth someone else's blood - it's actually an idea Shavri had had, but in Valdemar it's at the risky experiment stage, different people have different flavors of blood and the wrong flavor will make someone very ill in the same way that some unlucky people get very ill from a bee sting - 

She's very grateful that the damage to Leareth's brain does, significantly, seem to be "injurylike". Brains are delicate organs that can't go long without the vitality of blood reaching them, and even a little bit of inflammation and swelling, in the confined space of the skull, will start squeezing the vessels that deliver that blood, which is a rapidly escalating vicious cycle because starving the tissues causes more damage and more swelling. At the worst point, Leareth's brain was...pretty destroyed, actually. But the Cure got all of the gross damage and reset the swelling! It's just that it's going to keep coming back, because the cause is corrupted libraries in the cells lining every blood vessel in Leareth's body, and the cells so corrupted aren't going rogue in the sense of becoming tumors but they are sending all sorts of alarm signals - say, imagine a messenger trying to relay messages in an emergency, but they're also delirious with fever and making up additional emergency messages at random, and so are all of the messengers along the relay - 

The Earth doctors cannot actually make Leareth heal. They can fight infections for him - they’re giving him drugs that poison only the diseases and not him, or, well, probably some of them are poisoning him a little but it’s worth the risk when his innate defenses are so weakened. They can do remarkably complex surgeries - to repair injuries, or fix internal problems caused by diseases or old age - with surprisingly low risk to the patient, but "surprisingly low risk" is still a lot of risk for a patient as sick and fragile as Leareth is right now, and in any case most of what's wrong with him isn't the kind of - gross structural disruption - that a surgery can fix.

The plan right now is to give him ALL the drugs that kill infections, and other than that it's just "supportive care", which is a term that made perfect sense to Shavri - in Valdemar it would just mean, like, keeping a patient comfortable and helping them eat and drink and cleaning them and moving them enough that they don't get bedsores - but what incredible options they have here! On top of all the artifice to support Leareth's heart and lungs, they have extremely specific drugs for EVERYTHING! And their artificial Healing-Sight is in many ways "narrower" than Shavri's Sight, but it's so precise – they can exactly track improvement or deterioration on dozens of different measures, that Shavri doesn't begin to understand how to tease apart even if her Sight can perceive the underlying qualities at all... 

And meanwhile Dr Chadra is planning the move to a different room! It's less than fifty feet, but they're nonetheless throwing a degree of coordination effort and contingency-planning at it that would normally be associated with large military operations. They've explicitly discussed a dozen different things that could hypothetically go wrong, mostly to do with various tubes getting yanked or one of the machines losing power even though they've checked and double-checked and they should all have at least sixty seconds of battery life which should be enough if they do this efficiently. 

(They're not asking Samora to help, mostly because the translation-through-Marian step means she would take longer to receive any urgent instructions.) 

All the medical information is very important and interesting and makes her think that maybe Golarion has done a worse job than other planets at learning how bodies work because they have all this healing magic that doesn't need you to know anything. There's a complex tradeoff there, between healing more people without that knowledge and learning more to be able to heal more people later, but possibly it's a tradeoff Golarion can cheat at by copying other planets, which is the best kind of tradeoff.

Samora notices that the earth medics look like they're planning to do a well-defined important difficult task and excuses herself from the education for a moment to go around and tap them all with Guidance.