Which is very much appreciated, because moving a patient on VA-ECMO might be the single scariest thing that Marian has ever had to do in her nursing career. 

It goes very close to as well as it possibly could have gone! Leareth's body really, really doesn't like being jostled at all, and his blood pressure drops and takes a while to recover, but none of the machines die, none of the tubes are yanked, and they make it to the freshly ultracleaned room without incident. 

The room is a really cool concept! It has a main door that shuts and seals, and then there's a separate side door with a little vestibule-antechamber sort of room, so that you can enter and leave by opening only one of the vestibule doors at a time and never having a clear passage from the room to the hallway. The idea is that they're going to be at all times keeping the air pressure inside the room a little bit higher than the air pressure outside, so that any airflow is outward, and the air they're pushing into the room from their ventilation pipes in the walls is more or less guaranteed to be clean and free of anything that could cause an infection. They apparently use this system a lot more often for negative pressure - keeping the air inside the room at lower pressure than outside, so that air leaks in but never out, for cases where a patient is known to have a very contagious illness that they don't want spreading to the other patients. But in this case the priority is to avoid exposing Leareth to anyone else's illnesses, or even to completely harmless tiny-organisms that live in the air or on people's skin or in their noses or whatnot, and never cause problems for a healthy patient but could overwhelm him because he has no defenses. Anyone who goes into the room will need to wear all of this gear so that they're not going to touch Leareth with their skin bacteria or breathe on him. The nurses are complaining about it enormously, because it's uncomfortable to wear for a long time and it makes it really annoying to come and go frequently, but it's really, really impressive that they can do this at all! 

That is really impressive! Are they sufficiently confident in it that they want her to use her last Remove Disease on him now, to get anything he might have been caught before the move before it can do any damage, or should she hang onto it in case he catches something later? And is he due for another Cure Light? Also she needs to go be somewhere out of the way for fifteen minutes to get the Restoration prepped at some point before casting it; if they're sure of the diamonds she should do that sooner than later.

They would like to hold off longer on casting the Remove Disease, because they're predicting from all of their graphs that Leareth's defenses against infection will crater completely sometime tonight, and they can't keep away infections from sources inside him – the gut is full of organisms that are normally a healthy component of its functioning, but will absolutely cause problems if Leareth's gut lining is falling apart and all of the illness-defense cells in his blood are dead. If a Restoration brings back some of those cells, which everyone is really really hoping it might even if they proceed to die again later, then they'll probably want it right away to get him as ahead as possible; otherwise, they want to keep the gap between the last Remove Disease today and the new spells tomorrow as short as possible. 

He's probably ready to benefit from another Cure Light, though, his total life-force is getting pretty weak again and Shavri is suspicious that he picked up some new injurylike damage inside his blood vessels in the process of being moved with lots of gigantic tubes in him. 

...Shavri hasn't been tracking the diamond quest and will need to ask Marian about that. 

Uhhhh going off body language it seemed like Catherine was hopeful she could make Dr Harrison's insane four-hour deadline on this fetch quest? Marian will have to ask around to determine if she told anyone her itinerary before leaving the hospital, though, and if not she'll try to find someone who has Catherine's cell phone number and can text or call for an update. 

Catherine did not tell anyone her itinerary before leaving because until she got to the parking lot she still had hope someone would pick up the Uber and she could call them and ask them to bring her the package and she'd be back at the hospital in under an hour. She remembers somewhere around Placerville that she really ought to have done that. 

She gets to the ARCO Patrick agreed to meet her at, and gets the second bag, and looks in it right there and counts the tubes and makes sure they're the right kind, politeness be damned, and then she thanks him profusely and agrees that they should totally meet up for dinner sometime when she's not having a huge work emergency that will probably end up on the news, and then she gets back in the car and calls Marian with an update.

Cure light wounds, converted from a Remove Sickness.

Marian had not in fact managed to track down Catherine’s cell number yet - as a travel nurse she's not really in the personal-cell-number network at this point - but apparently Catherine can call her just fine on her hospital-portable-phone extension so that's convenient!

"Hey! I was actually just trying to - do you have an update? Are we going to be able to get the diamond dust?" 

There's been a mildly distracting conversation going on next to her. Dr Chadra and Dr Harrison are setting up their work area outside the room, taking up approximately the entire "pod", and Dr Harrison seems to have gotten a specialist on the phone. 

"Have I reached Dr Chen?" A pause. "This is Dr James Harrison at Renown Regional. Thank you for taking my call." Dr Harrison on the phone to a very busy expert doctor is, apparently, actually polite. "We have a patient presenting with what we believe is acute radiation syndrome from an extremely high-dose exposure - we're estimating at least 100 Gray whole-body based on symptom onset and lymphocyte depletion kinetics -" 

Pause.

"- Yes, in normal circumstances, yes, I'm aware, but we have access to some unusual resources -" Pause. "No, you wouldn't have, it's experimental." Pause. "It's a long story. Can we just -" Pause. "Well, on ECMO, admittedly, but we're planning another, er, experimental intervention that ought to improve his -" Pause. "30 minutes downtime, yes." Pause. "No signs of cerebral edema right now, but the experimental treatment is a temporary palliative, not a fix -" Pause. "Oh, no, sorry, it's - experimental imagery, I would definitely send the file if I could but it's, er, your system won't be compatible to read it -" 

"I have the diamond dust! It's suspended in water but I figure we can filter it out. Also I had to drive most of the way to Sacramento for some of it so I won't be back for another hour and a half and if there's, like, any traffic I'm likely to miss the four hour mark. Can you figure out a filter setup before I get there, it's mostly five micron but there's a tube of three micron in there but I got extras so if that ends up being a problem we'll probably still have enough with just the five."

“Catherine, you are so cool,” Marian says vehemently. “We’ll look into filter question.” And she should find out from Samora if the water is even a problem, it’s not like diamond bits will react chemically with it. “Uh, drive safe, he’s not super dying right now. I’ll tell Dr Harrison.”

...Who is busy, so she'll just write out clearly on a bit of paper that 'CATHERINE 90 MIN OUT WITH DIAMOND DUST IN WATER', after a moment's thought adds 'LONGER IF TRAFFIC DELAYS', and slides that under Dr Chadra's nose. While she slightly dies of secondhand embarrassment about the overheard half of the conversation. 

"- It's a cellular regeneration therapy," Dr Harrison is saying, "and I really can't say more." Pause. "Pure gamma, we think, we got nothing on the Geiger counter, yes we checked that, obviously -" Pause. "We haven't reported it." Pause. "Well, no, I don't see - it wasn't occupational and it wasn't at a nuclear plant, I don't think that would apply. Can we please focus -" Pause. "- What? Seriously? It's not even April 1st." Pause. "All right, fine, sure, we can say it's a training exercise if that gets you to look at this guy's labs and tell me what the fuck to do." 

Longer pause. 

"- Nearly immediate, did I not say that already? Severe nausea, confusion, full loss of consciousness within ten minutes, cardiovascular collapse in less than thirty. - Hm? "Sixteen minutes - er, from when we made the call, which was around five minutes in. Yes, I know, right?" A briefly very smug expression. "We've got a great nursing staff, they were right on it." 

....Awwwww??? Marian is not sure she's ever heard any of the trauma surgeons say nice things about the nursing staff to their faces but it's kind of sweet that Dr Harrison is saying it to a third party. 

"- yes, we're definitely seeing cardiac muscle damage, troponin was over fifteen - yeah, I'll send you the 12-lead, you have got to see the ECG it's the wildest shit -" 

Pause. 

"- positive pressure iso and we've started him on everything, I know that -" 

Pause. 

"- yes, we believe that the, er, biological cellular regeneration therapy can temporarily reverse the GI tract breakdown -"

Pause.

"Okay, yes, I know, but can you just bear with me? We've got imaging, we've checked. - no, I can't send you that file either -" Pause. "Can you just tell us what labs to check, those we can send -"

Pause.

"...Slow down, slow the hell down -" Scribbling notes. "I don't even know what that is." Notes notes notes. "- Seriously? But he's immunocompromised - right, great, send me the paper -" Pause. "Okay, watch for clinical signs, got it." Pause. "...Huh, that would explain some things, we'll - what test - okay, okay, I'm following, you don't have to– I mean, sure, send us the paper, we've only got a hundred pages of reading material to get through -" 

Oh that sounds like so many labs incoming. Though Marian cannot at all read Dr Harrison's handwriting, which puts a crimp in her plan to be incredibly proactive and enter them all as verbal orders while he's still on the phone. 

She goes to ask Samora about the diamond dust instead. "We got it! Catherine is on her way back and she's confident she has enough total diamond dust by weight to cover what you said we needed. But it's mixed into water, I think more water than diamond. Do we need to separate it and give it to you dry? The water doesn't alter the diamond, I just don't know if it's - in the way? - of the spell? We can probably find a way to dry it but it would take longer, especially if it needs to be totally dry and not just more diamond than water rather than mostly water?" 

Samora has never actually seen wet diamond dust, but it's probably like wet really fine sand? "I need to be able to sprinkle it on him continuously for eighteen seconds. If you can't get it dry enough to fall smoothly instead of in clumps I could maybe try pouring it out of a cup? It would need to be all in one container and come out smoothly and not be all settled at the bottom and I'd want to do a test run of just the pouring without casting it, just into a bucket or something, for practice. Also if anything is going to be different it's especially important that nobody touch him or me or make a loud noise while I'm casting, there's some wiggle room on the physical end and some wiggle room on the mental end but not on both at once."

"Also there's another thing I'd like to talk to you about for a few minutes beforehand, especially if the Restoration might wake him up."

"Uh, Catherine said it's a suspension in water which I think means it should be evenly mixed and won't settle to the bottom? ...We should try to look that up, I guess. Catherine suggested we filter the diamond out of the water but I feel like that's just going to leave a more clumpy paste and we'd have to - bake it? Or something? To dry it all the way out. And I don't think we want to wait another two hours if we can possibly avoid it. ....Um, does the spell disappear it, or is it still there afterward?"

She's really hoping the spell will eat all the diamond dust - it must, right? Otherwise you could reuse the dust to cast it again? - because if it doesn't then her patient is going to be covered in 5-micron abrasive particulates and Marian does not love that idea! ....Also, ugh, that was another question and it takes her three seconds to guess that it's about the patient being evil. Ughhhh. And Marian will have to confess that she hasn't told anyone because she feels super weird about it! Ugh! 

"The diamond dust will vanish at the end of the spell goes off correctly. And the other thing is that--I don't know what commitments the people here have made and what commitments you understand me to have made by working with you. In regards to this place being willing to heal anyone who comes, and what the acceptable options are if a patient turns out to be dangerous to other people. Not everyone Evil is violent or impossible to work with, far from it, but Leareth is Evil and powerful, and powerful people often get that way through violence, and there are a lot of ways someone who can travel between worlds could wreak havoc on a scale a lot larger than this hospital. So I want to know, in the unlikely event that Leareth and I turn out to be mortal enemies, how I can react to that that won't leave you feeling like I've betrayed you or the hospital."

Ughhhhhhh!!!!!! Wow this conversation is so uncomfortable and bad!!! And is making Marian feel like maybe it was a bad idea to unilaterally decide not to tell anyone else about the patient's alignment, because apparently it might be relevant to his medical care, if Samora could decide to withhold spells over it!! And in spite of that, the last thing Marian wants to do is say a word to Dr Harrison about it, the idea of saying out loud with her actual mouth "hey according to our cleric this patient is evil" makes her want to melt into a hole in the floor. Aughhhh. Why is this topic even so upsetting! None of what Samora just said is at all unreasonable! It seems stupid of her brain to be upset about it! She's admittedly getting kind of low on cope and frustration tolerance and stuff like that, after hours of relentless nonstop stressful-yet-incredibly-tedious ECMO documentation on top of everything else she's trying to do, but still. 

Marian takes a deep breath. "...If you and him get into a fight once he's...not an ICU patient anymore...then I think that's not actually our - I mean the hospital's - business? ...If he tries to pick a fight while he's still, like, ICU-level critically ill, I'm really pretty sure we can just sedate him about it, I don't think he's going to be able to stop us? I - your spells are obviously yours, if you decide based on how he's behaving when he wakes up that you think you're going to - be enemies - and that means you'd rather use the spells to heal other people, I...think that's your decision? I would be sad but it's not - you betraying us - you don't work here? But, um, if you get in a fight and - try to hurt him - and he's still my patient at the time, then I think I'd feel pretty betrayed and so would everyone else." 

"That's a very reasonable set of constraints I'm happy to work within. I hope and expect that it won't come up and that I'll be happy to give him all the healing he needs." She wants him alive and healthy! Evil people dying is in some ways worse than Good people dying because they go to the Evil afterlives.

"Though I'd prefer if you didn't tell him about the synthetic diamonds. The concept has military and geopolitical implications on Golarion and I want to make sure the knowledge ends up in responsible hands."

"...I'm fine with that, I don't think it's - critical information for him for, like, informed consent for any treatment we actually have a chance to ask him about." Which is the only kind of decision that has any direct relation to Marian's job. "Though, um, we should find out if he has the telepathy thing like Shavri before we wake him up. ...I think he won't wake up right away even with the Restoration? Unless it does removing poison and it thinks the sedation counts as a poison, but we're keeping him really sedated, we don't want him to move suddenly while he's still attached to all the machines." 

"Restoration doesn't remove poisons; it fixes the damage done by some poisons but if the poison is still in someone's system doing stuff it'll keep doing it. Waking him up slowly with Shavri there to explain is a good idea and I will try not to let him read my thoughts."

Nod. "It shouldn't be causing any damage, just keeping him asleep - it's super short-acting, so once we want him awake, we can decrease or pause it and it'll wear off in minutes, and we can just start it again if he's fighty." 

Marian is pretty used to fighty patients though admittedly they do not usually have the ability to PORTAL SOMEWHERE ELSE if they get too freaked out. Probably she should also find out from Shavri what else the patient can do, since he's some sort of wizard and maybe he can also, like, set the room on fire. 

Anyway, all of that - including the rest of the "is the patient evil in a way that would make him mortal enemies with Samora" part - can wait.

Right now: orders have appeared in the patient's chart for more labs! Holy shit so many labs. Marian doesn't even know what some of those are. 

She can draw them anyway, though, once she looks up instructions for what tube to use for the weird ones.

...And, after a few abortive attempts to google it but not really knowing what search terms to use, she's going to try to find someone else who isn't on charting ECMO and CRRT at the same time and delegate the task of figuring out how to get diamond-dust-suspended-in-water to become dry diamond dust and, if there's a way, how much time it would add to the preparations. Who can she find who seems perhaps slightly less busy than she is? 

Sure, Minata can do that!

> how to extract diamond grit from lapping compound 

> remove diamond grit from water suspension 

> Unmix diamond grit slurry

> "Unmix" diamond grit slurry

> Precipitate diamond grit out of lapping compound 

> Filter 5 micron particles out of water

> What happens if you boil a diamond suspension 

It's looking increasingly like nobody in the history of the Internet has wanted to do this particular thing. There are processes for getting bits of leftover diamond grit off a thing you've been polishing. There are processes for extracting gold from a water suspension, which take hours and use proprietary chemicals. There are procedures for getting 5um particles out of water that work great if what you want is to drink the water afterwards and you don't care about what happens to the particles and also want to buy a filter cartridge. There are several pages saying it's fine to clean your diamond jewelry by boiling it, which is potentially promising.

Dialysis tubing pores are way smaller than the diamond particles they're dealing with. Can they put the water-and-diamonds in a bag of dialysis tubing and dunk it in super salty water and suck all the water out that way? No, that wouldn't work for getting all the way to dry. They could try that and then putting it in the microwave? Might be faster to just put it in the microwave to begin with, at that point. And this stuff is supposed to be sharp, apparently, it might rip a hole in the bag. The problem with microwaving it the whole way is that boiling water bubbles and the diamond particles are so small they might get flung all over the inside of the microwave like so much mishandled soup. Baking it slowly at just under a hundred degrees seems like it should work great, but it would take ages. Can they filter it and then bake it? Not with a coffee filter, apparently, the pore size is way too large. She'll call the lab and ask them what kind of filters they've got.

"Hi, this is Minata from ICU, calling about--do you have any filters with a pore size of five microns or smaller?" Pause. "I need to filter five micron particles out of water and end up with as much particles and as little water as possible." Pause. "Uh, about fifteen grams of solute in a hundred and sixty of water." Pause. "It's not biohazardous! It's, uh, I'm trying to get the diamond grit out of polishing paste from a hardware store." Pause. "Yeah, it's for ninety-three purple." Pause. "You wouldn't believe me if I told you. Just, do you have any filters? Or a centrifuge? Maybe I could centrifuge it out?" Pause. " . . . I cannot promise it won't do something weird to the centrifuge. It's supposed to be abrasive." "Okay. Yeah. Yeah that's--I get it. Sorry." Long pause. "Oh that might work. Do you have any guess how much of the grit is going to be stuck in the filter? We really need to get almost all of it." Pause. "Great, thank you!"

Minata finds Marian and tells her, "The lab has syringe filters they can shove the stuff through to get as much of the water out as possible and then I think we should be able to dry it the rest of the way in the microwave. I can't find any proof it will work. I can try it in one tube and only do the rest if it does. If you want to be more sure than that I can--go to a gardening store and get sand and try microwaving wet sand? I don't know, I think possibly nobody has ever done this exact thing before."