:I can still see him: Jisa insists. :Maybe if I get in rapport with you, you can -: 

Shavri accepts the mental 'hand', and - doesn't feel any particular way - about the glimpse through her daughter's Othersenses of Leareth's mind to Mindhealing-Sight. There's something there, but it's a garden on fire and nearly all the plants are already gone. She takes Brightstar's offered rapport as well, and - focus inward, downward - 

It's the weirdest fucking way of using Healing-Sight that Shavri has ever experienced. She has her Sight focused on something, but she can't pull back her mental viewpoint or shift the scale. She can see this structure, and if she effortfully refocuses she can end up on that structure instead, and her Sight seems to be under the impression that none of the structures in Leareth's body are in any way related to each other. 

Blasting his shoulder joint with Healing-energy is not going to do anything useful, even if she could technically aim at it right now. If this is going to work at all, she needs to get herself focused on his heart and see if she can smack it around hard enough to get it beating, it doesn't even need to be an effective heartbeat that successfully moves blood, she just needs the energy-loop to exist at all so she can hook her Gift into it... 

...Okay. That sure is a heart that is not doing anything. Seen up close, there's still a little bit of life-force there - it's not completely dark, and Shavri can make out structure, which she's pretty sure doesn't work on dead flesh. (It's historically been inconvenient for research, actually, that Healers can't train Sight on dead bodies, and can't cut up their living patients to look at how things are put together, so it takes a lot of drawings and practice to correlate them.) 

Shavri throws a focused dart of Healing-energy, and - 

 
- it lands, and it drains away and it's gone. Some of these cells are technically in some sense still alive, but they're - in living patients there's something like a cup, something Healing-energy can land in and propagate on from. The others are cracked cups, with both Healing-energy and their own natural life-force slowly but constantly leaking away.

This is a cup with no bottom. She can throw Healing-energy at it, sure, and at a hyper-local level there's something still there that can use it as fuel, but - there's nothing that can hold it even for a moment, let alone distribute it, and so most is pointlessly wasted. Shavri can't get a Healing-link to every cell in Leareth's body independently. 

If she had something to replace the critical vital functions, routing around the damaged pathways entirely, so she could slow down and figure out what can still be repaired– ...but Healing-Gift doesn't work like that. 

She tries again anyway, but she doesn't think it's going to work. She's pretty sure that all she's figured out, here, is an extremely creepy way to make Healing-Sight work on a recently-dead corpse.

And then there’s a burst of unfamiliar magic, vast and strange and definitely not a Gate, and Shavri, with her hands still on Leareth’s chest, is alone with him, falling a couple of feet and landing hard on her knees on a stone floor. No, not exactly stone, weirdly uniform white...porcelain? 

She can't feel Jisa or Brightstar anymore. Or Blai, which means Leareth is doomed anyway. But she was in the middle of trying something, and she's going to keep trying, even though she just lost her tenuous Healing-Sight focus when she was startled and she has to start over. 

From the perspective of the staff of the trauma ICU at Renown Regional Medical Center in Reno, Nevada, most of whom were clustered at the nursing station arguing about the wisdom of involving the US government in their...situation...or the possible awkwardness of tabloid journalists poking around to investigate "faith Healers" - 

- there's a weird flash of light from near Pod Four, the furthest point from the entrance. There's a thud. 

Whoever gets there first will find: 

There's a man sprawled on his back on the floor. He's wearing dark clothes that look about as non-modern as Samora's but definitely aren't the same style. He isn't moving. There are no obvious injuries – his clothes are intact, his limbs are all in the right place, there's no blood – but he does not look particularly alive. 

(He will, however, read Evil.) 

There's also a small woman wearing disheveled green robes, her tightly-curled dark hair combed through with grey despite a face that looks at most early forties. She's currently kneeling by the man's head with both hands on his forehead, completely ignoring everything else in her surroundings. 

Samora has way too little context to participate in the argument and is mostly pacing, waiting for further information on how best to use her spells. When she hears the thud, she's nearby enough and curious enough to stick her head in.

Well that sure is some people who weren't in there a minute ago, and the Evil one on the ground looks to be in bad shape. She gets within ten feet of him and casts Stabilize.

...That's a cleric spell. Shavri recognizes it. 

It also doesn't do anything. It would've been too much to hope for, Shavri thinks, it's the least powerful one she's seen. 

:Don't waste any spells or channels, it doesn't work: she sends at - whoever that was, she's not particularly aiming her Mindspeech - and then goes back to trying to get her Sight on-target again. Brightstar was so much better at this. She's stuck on some confusing mess of structure that she thinks is...stomach-adjacent?? and having trouble figuring out how to refocus back on Leareth's heart. Why doesn't her Sight think that any of Leareth's parts are connected to his other parts??? Well, probably because he's dead, that's the obvious explanation for quite a lot of things, but Shavri is going to be stubborn anyway. 

The Mindspeech catches Samora and also Marian, who had just been talking to Samora about diamond dust and doesn't really have a lot to do right now and is if anything delighted for a distraction from the awkward and stressful argument. 

- what. Oh shit. Shit shit shit. 

"HEY GUYS I NEED HELP OVER HERE!" she yells, and spends about three-quarters of a second considering whether to run for the nearest wall-box-dispenser and put gloves on before she touches the mysterious unconscious man. She decides against and just flings herself down beside the - telepathic person in robes?? - to check for a pulse, which she's really not surprised when she fails to find. This person is extremely dead person colored. 

"CODE BLUE!" she shouts, and starts CPR. The floor is honestly a more ergonomic position for it than climbing on a patient's bed, and the telepathic person in robes isn't actually in her way. 

(Marian is mostly running on instinct and hasn't noticed any confusion about whether Samora would have tried any magic and whether it should have just worked.) 

Oh no, it's magic-resistant. Might be a curse? She didn't prep Remove Curse. What's Detect Magic showing? He's wearing some items but as far as she can tell they're all abjurations. There could be an abjuration that blocks healing, or at least she doesn't know it's impossible, but she's not confident enough to try taking his items off, especially not when Marian seems to know what she's doing and Samora would get in the way. 

Also, that woman just did a Still Silent Message while concentrating on another spell that's nothing she's ever seen before, which is pretty impressive. Probably impressive enough that she'd ping Evil if she was, especially if she did the teleport, so that's interesting.

Shavri had almost gotten her Sight on the right general area and she abruptly loses it and swears loudly in Valdemaran.

Oh, it’s because some new person just showed up and is getting in her way and disrupting her Sight.

:Can you stop that?: she snaps at the bizarrely-dressed young woman. 

“What? No!” 

About half of the total staff on the unit have now caught up.

“Marian,” Fraser says to her. “Marian, trade off, you’re our translator.”

Oh. Right. That makes sense.

Marian scrambles out of the way. She’s shaking slightly, which is just embarrassing even if that was REALLY startling.

“Samora, did you - do you have any idea -“

"She told me healing spells didn't work but not what the problem was. I only tried a Stabilize; it failed like it couldn't find a target. My best guess if he's not actually dead is that he's cursed or has a cursed item, but it's not much of a guess, I'm not a magic expert." Tris would have been able to figure it out if she was here.

…Marian relays that in English to Bella from Pod Four rather than figure out what to do with it. ‘Failed like it couldn’t even find a target’ seems doomier than ‘succeeded for less than a second’ or something but at least it sounds like there are still explanations for it.

Someone shoves the paper documentation flowsheet on its clipboard at her and Marian is briefly stymied by the fact that there is *not* a line included to put cleric healing attempts on. She tries to squeeze in an extra column all the way over by the margin and puts “stabilize” and an X next to the current time.

Fortunately there is an extremely standardized protocol for handling this in the complete absence of any cleric magic! 

Shavri loses her third try at getting any kind of Healing-Sight focus on Leareth and - all right, maybe this is the wrong thing to be tunnel-visioning on and she should, instead, try to figure out where she is and what everyone thinks they’re trying to do exactly and, just, what in general.

She looks up at the cleric and - oh, that’s the Iomedae holy symbol. She’s glad of it. It makes her feel less completely lost.

:Are we in Golarion?: she asks her. It doesn’t look at all like she had been picturing. 

"No, this is a place of healing on Earth. I came here by accident yesterday. Were you just on Golarion? Do you know how you got here?" She's speaking Celestial but it won't be hard for a Mindspeaker to grab her meaning, she's not trying to shield at all.

Clarice would like the mysterious woman in robes to stop touching the patient so they can get a reading off the defib pads. She's kind of assuming a language barrier and is in a hurry and resorting to trying to smack her hands out of the way. 

Shavri is spectacularly confused about every single element of what's happening right now but, okay, it's not like she was getting anywhere anyway, she'll back off. 

:...We were in Velgarth before this. There was a cleric of Iomedae from Golarion who ended up in Velgarth by accident a few weeks ago. I don't know how we got here, I was - kind of trying to focus - it might be the same way the cleric of Iomedae got to our world before.: Or the same way this cleric of Iomedae ended up here in 'Earth'???? Why are there so many accidents transporting people to different worlds!!!

The monitor screen shows asystole. Not even the kind with random useless blips, just a completely flat isoelectric line. 

...Yeah that's not especially surprising, this guy looks like he's been down a while. It's not a great sign but they'll give it a good effort anyway. "Resume compressions," Clarice says to Fraser. 

(Fraser is kind of regretting not escaping the unit when he had a chance, at this rate he's going to be stuck here for ages.) 

Shavri is so confused about what they're trying to do, but there's no way she can get Healing-Sight up again if they're jostling things around like that and they did not seem very amenable to stopping. 

:What kind of place of healing?: she asks the cleric, in case that will result in an explanation. 

"They have no magic at all but really good nonmagical healing for diseases! Nothing as good for injuries as positive energy, but still pretty great. What happened to your friend?"

'Friend'. Ha. ...Shavri's fine to leave it at that, though, it's a lot to explain and it mostly doesn't matter for this.

:A god exploded a country at him.: Wow that was not a very clear description at all. :I, er, I don't really understand it, but there was a country with a miraculous shield around it, and it exploded, and something starting there - some kind of attack - went a hundred miles and straight through ten feet of stone. Hit some other people too, they - it seemed like a channel helped a little, didn't actually fix it but they were alive and conscious when I, er, when the magical accident happened - but we couldn't get to him for almost half an hour. By the time we got to him the spells didn't work anymore.: 

Clarice takes about ten seconds to decide that she's not even bothering to try for an IV on this man right now. "IO kit?" she yells, and someone gently lobs it to her, and then she can skip right to drilling a giant needle into his shinbone. 

What the fuck. Why are they– oh they're putting...something...in him...but why in the world is that supposed to help??? 

:...My colleague has a mind-Gift that lets her see - if there's a mind - even if someone's unconscious, and she saw something: she sends, because that's pertinent information. :But that was - two minutes ago? He might already be gone.: 

Marian documents 9:47 am, rhythm: asostole, pulse: absent (no kidding), IO access established, 1 mg epinephrine. 

...Is Samora possibly continuing to have a telepathic conversation that Marian wasn't invited to. 

She clears her throat. "Samora, um, did you learn anything else about...?" 

"Good heavens! Which god? Uh, she said a god exploded a miraculous shield around a country and something came out of the explosion and went a hundred miles and through ten feet of stone and hit him."

Possibly she shouldn't be hoping he recovers, if he's Evil and a god personally tried to kill him? But maybe she's misunderstanding and he was collateral damage, or maybe an Evil god tried to kill him for Evil reasons she'd object to, and anyway this building is clearly committed to healing everyone who comes in so as long as she's in here that's what she's doing. 

What

That's a thing???????? 

Marian....will re-translate it to English for a hovering Dr Chadra in case he has the slightest idea how to translate that into, like, a diagnosis or a treatment plan. 

:Vkandis. Our world has different gods than Golarion.: And a lot of other differences but now really doesn't seem like the time to get into explaining all of that. 

Wow that's spectacularly unhelpful! 

"Ask about the initial presentation, were there symptoms before he collapsed? And how long since the arrest?" 

Marian is feeling kind of overwhelmed at simultaneously being the translator and the person who has to Write Down All The Things, but there is an argument that it saves a step over having to convey the things to someone else who's writing them down and also it should get Marian out of having to do literally anything else.

"Samora, the doctor wants to know if she can tell us what it looked like when he was first injured, were there specific symptoms before he collapsed? Also if she knows how long ago he stopped breathing or his heart stopped beating." 

Samora relays these questions! And adds "I think whatever you're doing is working, I can still see his aura."

!!!!!!!!!!!!!!!!!!!!

Marian hadn't even considered that aspect of Samora's magical powers. What does that mean! How does it work, what can she– nevermind, later. It does leave Marian feeling like it's super fucking weird that Samora's magic can see him but not actually target him? But she's just going to report it to Dr Chadra and wait for answers on the other questions so she can report those too. 

:I don't know his initial symptoms, but the others - a lot of vomiting, disoriented, most of them lost consciousness before the channel but it got them back up. There's some kind of damage everywhere in their bodies and they can't hold life-force properly, either what their body produces naturally or my Healing-energy or the energy from a channel. Lesser Restoration might help somewhat, one of the mages got one and was able to Gate them to safety, but I don't think it fixed the underlying problem. ...I think the most lethal damage was to the blood vessels, especially in the brain, it was causing the tissue to swell and that's dangerous very quickly. I think probably that happened to him and eventually his body forgot to breathe, but I can't actually see very much with Healing-Sight right now.:

Right, and there was another question. :...He was already like when we got to him. I don't know how long it's been. If - if I had to guess, more than a couple of minutes, probably less than ten.: 

Shavri has never actually sat and watched with Healing-Sight after a patient's heart stopped in order to gauge how long it would take to go from a weak but still-coherent life-force to the faint scattered-and-disconnected remnants she's seeing now. 

...Slightly brighter remnants?? That's really weird! Where would he be getting any additional life-force, it wasn't her, she hasn't at any point been able to get a useful link and she would need several million separate links anyway, which she cannot do because Healing-Gift doesn't work that way at all. 

She blinks, re-focusing on what she can see with her actual eyes rather than Sight. :What are they doing?: she asks Samora. 

Right now, Dr. Harrison is preparing to intubate this guy! They know very little about the problem but they've already seen Samora fix someone who was literally brain-dead, it seems plausible that if they can get this guy back into some kind of spontaneous rhythm for, like, three seconds, then Samora might just be able to restore him to perfect health and that would be awesome. 

Ohhhhhhh Shavri thinks she gets the thing they're trying to do and that's actually brilliant! She wasn't going to be able to get anywhere with Healing on convincing Leareth's body to start breathing again, that requires a working energy-loop in the relevant pathways and there's no way, but - if they can just avoid it entirely, make him breathe without any involvement in the process, that solves at least one problem.

Unfortunately it doesn't solve the problem where she also can't get his heart to do anything, and their technique for trying to do that is...doing more than literally nothing, going off the very very slight brightening of the bits and pieces she can still make out with Healing-Sight, but it's not working incredibly effectively. 

9:48 am, patient intubated, still in asystole, pulse still absent, is she due for epi– no, but they're absolutely due to have someone relieve poor Fraser, he started at 9:46 am. "Switch on compressions," she calls out, and Lia takes over. 

(Marian briefly wondered if she should just ask Samora to ask the telepathic woman to include her too, since the telepathy clearly works on her and it seems dumb to be doing this much telephone about it, but on reflection, no, she absolutely cannot document an ongoing code and translate for their D&D cleric from another world and also be the contact point for their newly-arrived telepathic witch or whatever the heck she's supposed to be. That's too many things even if it feels like she's been Excluded From The Conversation and it's mildly upsetting Marian's brain can shut up about her stupid social-rejection feelings that should not even slightly apply here.) 

"Vomiting, confusion, falling unconscious. There's some kind of damage everywhere in their bodies, they can't hold positive energy or generate any life-force themselves, sort of like an ongoing life drain? Lesser Restoration helped at an earlier stage. She thinks the most dangerous problem is damage to the veins in his brain making his brain swell up and forget to breathe? She can usually see a lot of this stuff but not right now, not sure if that's because he got worse or she's having a different problem. She found him like this, probably somewhere between two and ten minutes after he went down."

Relaying! Keeping the Detect Evil going! Being ready to pounce with a Cure Moderate Wounds the second the psion-or-something says it's a good idea! Refusing to feel embarrassed about how useless she's being, because everyone is useless sometimes! Honestly she should probably be being even more useless, she's the worst person to be relaying what with how only one other person can understand her, but everyone is busy and she doesn't want to make anyone do any more thinking unless the current situation becomes unworkable.

Okay. Um. Wait how the hell does the telepathic person know how long, is she just guessing– oh Marian had failed to properly parse the earlier bit, apparently because she can literally see it, like she has CT scan vision or something, that's wild and Marian viscerally covets it. 

Also that would be so incredibly doomy if not for the fact that Samora can fix brain damage. But Samora can do that so they just need to...figure out why this guy isn't currently fixable with Samora's magic at all, and deal with that? Ugh, did Samora mention Lesser Restoration previously, Marian thinks she did but she failed to take notes on it or remember properly what it does except that it didn't necessarily sound like it would fix kidney failure or advanced COPD. 

Relaying to Dr Chadra! "She thinks he's been down somewhere between two and ten minutes? But the arrest was unwitnessed, they only got to him later for some reason. They, uh, I think they can guess his initial symptoms because there were other people affected – uh, vomiting, confusion, loss of consciousness. And an - ongoing...life...drain?" Marian isn't going to attempt to turn that into correct medical terminology because she doesn't know what it means but she feels so stupid saying it like that. "There's a spell called Lesser Restoration that Samora has, that helped, but at an earlier stage with the other patients. There's some kind of central nervous system dysfunction from vascular damage causing edema and rising intracranial pressure? She thinks that triggered a respiratory arrest."

Pause for breath. "She, I mean the robe lady not Samora, can normally - see problems directly? Like some kind of magic scan vision, I think, maybe? But it's not working, either because of his condition or, I don't know, maybe it doesn't work on Earth or something." 

Well, Samora can at least see auras, right? Can she see anything useful for diagnosis? Also (Dr Chadra has been peering at Marian's documentation), she should have unlimited Stabilize, right? Is there any reason not to try that at regular intervals as a test of whether he's targetable yet? 

Oh that's a good question. "Samora, Dr Chadra wants to know if you can see anything in his, um, aura, that might help us figure out what's going on? Also he's asking if you can just keep trying Stabilize on him repeatedly – uh, would there ever be a case where that doesn't work but a stronger spell would, or should it be a decent test for whether he's targetable at all?" 

"The aura just tells me that he's fairly powerful and, ah, Evil, but yeah I can just spam* Stabilize, if it doesn't find a target then a Cure won't and vice versa."

Stabilize. Stabilize. Detect Evil. Stabilize.

*Term for using the same spell several rounds in a row. No etymological relationship to canned meat or bad emails.

There’s nowhere on Marian’s paper to document that a patient is evil

…It’s irrelevant to his medical care and seems kind of personal. “She can just see it or not,” she tells Dr Chadra, “there’s no, like, health metadata.”

Marian thinks to worry that Samora might it distracting to be telepathied and need to relay it when she’s supposed to be casting her spell, which is the impetus Marian needs to realize that the whole telephone situation is dumb. Samora should ask the telepathic healer-themed-superhero-with-CT-vision to talk to, hmm, Dr Chadra directly. 

There is some debate with the less-currently-occupied members of the medical team over what pathologies are implied by the list of symptoms plus “direct attack by a god”, which is foundering on the fact that it’s deeply unclear to anyone what gods can do.

“Let’s get some iSTAT labs and see what we’re dealing with,” Dr Harrison declares briskly. 

Stabilize with an infinity symbol in her margin, mental note to get the iSTAT results written down as soon as anyone yells them because she’s learned the hard way that they don’t sync to the computer if a patient doesn’t exist yet in the hospital system, OH SHIT it’s 9:50 and Marian’s on timekeeping.

“Trade off on compressions! And I think we’re due for epi!”

Stabilize is continuing not to work.

Well maybe they have an explanation for why not! That’s the worst venous blood gas reading that Fraser has seen in his nursing career. Those are not numbers compatible with life.

“I’ve got pH of 6.17, bicarb of four, pCO2 of 110. Lactate is, uh, 21. …pO2 32 but it’s venous.”

     “Can we get an arterial—“ Dr Harrison starts.

“Please feel free, I’m not trying for an arterial stick when I can’t even palpate a radial pulse!”

     “Lytes?”

“I’m working on it, okay, you’re lucky I got a vein on this guy at all, it’s a slow one.”

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.

No! Or, like, fine, if he insists, but it’s been less than two minutes, they’re not even up to the goal flow rate yet, it won’t have changed very much! 

FINE he’s going to harass Shavri instead for Healing-Sight updates in real time. 

If he desperately needs to feel busy he could consider helping the nurses but he’s a resident so he’s not going to do that, is he

Shavri is staring intently.

….It’s really incredibly cool that they can do this and it does, in fact, look like it’s doing a vaguely successful job of artificially replacing the essential vital functions that Leareth’s body cannot handle right now. But that’s not the same as actually getting back any coherent life-force patterns that Shavri can hook her Gift into properly.

She’s going to keep trying, it currently feels very stupid to her that she doesn’t actually…know how…to solidly anchor a Healing-link to anything except the “loop” of a heartbeat, surely there’s got to be something she can link to. There’s getting to be a reasonable amount of life-force brightness! Well, a tiny fraction of what he should have but compared to before. Just, still completely fragmented and not at all operating as a coherent system.

(Shavri includes Samora in her update and also the other young woman she met first whose name she never successfully got, she seems to be responsible for writing things down. It would never have occurred to Shavri to assign a specific person to just doing that but it’s actually kind of brilliant, especially when things are this spectacularly complicated.)

Marian and Eleanor are currently working through yet another checklist which was, uh, supposed to be completed and signed off before they went ahead and connected the circuit and definitely not five minutes later. 

:Thanks: she thinks back at Shavri, but she does not have any boxes in the electronic medical record flowsheet to put any of that so what exactly is she supposed to do with it.

Samora is frowning contemplatively about the difficulty of getting Earth medicine to Golarion. It's not just the number of giant machines, it's that there are multiple different types of trained people involved in operating each one, and even if Samora was confident in her ability to absorb one person's worth of training and willing to stay on earth long enough for it she definitely can't absorb ten. (Stabilize.) And then building and maintaining the machines takes yet more people. And the closest thing she has right now to a plan for getting back to Golarion at all is only one way. (Stabilize.) Even if she founds a church here and enough other clerics get picked that someone will probably get Plane Shift eventually, that won't be enough for the kind of regular trade she's expecting to need for Absalom and Vigil to have hospitals like this one. (Detect Evil. Stabilize.) Iomedae, this is a point where a small change can shift the course of many things; help me find the decisive blow that breaks the stalemate and shifts the equilibrium. Abadar, there is so much value here that can be exchanged, make straight the road so that traders may walk it and reach each end richer than they set out. (Stabilize.)

Shavri discusses with Dr Chadra and during a pause in compressions (the fancy artifice is indeed not really generating enough circulation by itself but it makes pauses less costly) she gets herself aimed and whacks Leareth’s heart with as much Healing-energy as she can cram into a single split-second bolt.

It gets a blip on the monitor and someone actually squeaks and then…nothing happens, to the deep disappointment of everyone who was actually paying attention to that specifically.

….You know what else has a kind of cycling energy-loop! Lungs! And this doesn’t actually depend on the patient providing the breathing impetus themselves, it’s pretty intrinsic in the pattern of filling and emptying the lungs.

Shavri can get a link to it!!!! It’s a very tenuous link and it’s not really in the right place but she can squeeze some slightly more targeting Healing-energy into him, and it doesn’t all instantly fall out the bottom, and maybe there’s a trace of catching in his blood and reaching his heart….

10:15 am.

10:20 am. It’s now been more than thirty minutes. It’s a really good thing that Samora’s magic is so good at injuries, Marian thinks, this poor guy probably doesn’t have a single intact rib left.

She documents the results of another blood gas. It’s…less…horrifying…? They’ve probably done incredibly concerning things to his sodium levels by giving him like ten amps of bicarb, but his blood gas level is up to 11 and his CO2 is down to 69 which, like, Marian sees that number all the time with COPD patients, and his pH is about 6.8 now.

Stabilize doesn’t land and it doesn’t land and it doesn’t land and then it DOES!!!!

:Stop something went through I need to—: Shavri sends to the nurse doing compressions.

They have an electrical rhythm! It’s extremely fucked-looking and really looks like it should decay back to a non-rhythm in five seconds, but it…doesn’t somehow.

Samora saw that right!!!! It worked it worked it worked it might not stay working very much longer he’s kind of continuously being injured from the inside by whatever is horribly wrong with him - 

Cure Moderate Wounds!!! He probably has room for a Serious but she wants to hang on to  that last Remove Disease as long as possible.

It lands!!!!

Shavri has the simultaneous realizations that: 

One: she really should have thought to warn Samora that the thing where clerics in Golarion - and, she's inferred from Blai, other spellscasters - gain an absurd amount of extra life-force as they get more experienced, is not a thing in Velgarth, and Leareth can't benefit from the extra positive energy in anything stronger than the weakest Cure spell. 

Two: she should have thought!! about what to do!! if it worked!!! She did not think to warn anyone of the obvious thing Leareth might do if this works well enough to get him conscious and he abruptly wakes up in an unfamiliar and kind of terrifying place, which is to GATE OUT. She knows this because it's the source of their ENTIRE PROBLEM and she still forgot!! 

Then arguably it's fortunate that the spell doesn't work incredibly well!

It lands. It gets...a substantial amount...of the most acute-injury-like damage, including everything that's imminently life-threatening. But it's...not just that the metaphorical 'cup' for holding life-force is too small to capture all that positive energy, it's also still badly cracked enough that most of the remaining energy doesn't even have a chance to do anything before it spills away. 

The single most important part is that, three seconds ago, Leareth's heart had an electrical rhythm but was having a bit of a time actually moving blood. There was an enormous amount of direct injury to the heart muscle, and Stabilize somehow got it to beat anyway but not well. The Cure gets...some amount...of that. Not nearly all, less than half, even of the damage that looks like the same 'kind' to Shavri, maybe because the untargetable-by-a-Cure damage meant he couldn't absorb enough of the positive energy. But his heart is beating and seems like it's going to keep doing that!

It's not a normal electrical rhythm. The spell seemed to only target some of the Leareth's-body-poisoning-itself problem, and of that it only hit a fraction, and meanwhile the unaddressed injury means that the electrical conduction in his heart would be screwy even with perfect electrolytes and blood pH. He's still in some kind of horrible wide-complex ventricular escape rhythm, just...a surprisingly functional one. He has a blood pressure! They can get a pulse oximetry reading! Neither of them are incredibly delightful numbers but they are, at least, "this patient is alive" numbers. 

He doesn't move or show any sign of waking up. 

Shit what if that means the damage to his brain is somehow the wrong kind and Samora won't be able to fix it! 

Shavri gets her Sight over there as fast as she can and...oh, that could definitely be worse. She pushes it at Dr Chadra. The structure is mostly normalish-looking and there's circulation. There's a lot of something wrong, some kind of low-level generalized damage just like everywhere else, and there's inflammation and some swelling from it. He's not imminently dying of it and it looks like a lot of what's wrong should, in theory, be targetable if they can get his body to hold onto life-force or Healing-energy or positive energy or any of the things, but it's not at all surprising he's still unconscious. 

They should try Lesser Restoration? But, uh, possibly first Shavri should explain the Gate thing. 

She includes Samora and Marian. :He's still unconscious, so we don't need to worry about it yet, but - Samora's healing is instantaneous, which means he might at some point go straight from unconscious to Gate-capable. Last time he woke up injured and disoriented he Gated out on instinct. If he does that now it would be....bad.: 

How in the planes do you end up with combat instincts for Gate. 

Well, she already knew Shavri was a very strange and impressive type of caster from somewhere not Golarion.

"Is he the kind where tying his hands and sticking something in his mouth will stop him from casting? Also whether we do that or not you should stand where he can see you so he doesn't think he's been taken prisoner by  necromancers." Ask her how she knows.

Taken prisoner by what– nevermind. 

:Unfortunately that doesn't stop our mages: or else it would be a nonissue because he already has a thing stuck in his mouth that will thoroughly prevent him from speaking. :I can make sure I'm where he can see me but he doesn't actually know my face and he might not recognize the Healers' robes if he's disoriented enough. I'll be Mindspeaking him to explain, obviously, but we've never met and it's possible it would just alarm him more.: 

If they're worried he's going to wake up combative they should just sedate him first???? Like, there are risks to doing that when his blood pressure is kind of crap already, but they're hoping more Samora-healing will fix whatever's causing that to still be the case, right, and at the very least Stabilize should work again if he attempts to die on them. "Guy who tries to portal himself out while attached to an ECMO machine" is not specifically a genre of fighty patient Marian has encountered before, but lots of people are fighty about the whole being-in-the-ICU-with-tubes-in-them situation and there's a known solution to this problem! 

She still isn't sure how to properly telepathy-reply but she'll try to shove that at the telepathic healer. 

Shavri has managed to pick up that they have some kind of bizarre separate-chains-of-command situation where Marian cannot just make decisions about what to do without consulting the trainee-senior-Healer. She can bounce their discussion to Dr Chadra. 

Yes obviously if they're considering doing any healing that might cause their guy to suddenly wake up then he should be sedated and paralyzed first. Hopefully they'll conclude he doesn't need to be on ECMO anymore and they can wean him off it in a controlled fashion and then let him wake up. 

...They can do what. Is that...safe...? 

What, chemical paralysis? Yeah it's totally safe as long as someone's already on a ventilator, they do it all the time. 

Okay but is is strictly speaking necessary if he's not conscious anyway, because that sounds incredibly terrifying Shavri is not going to argue.

She conveys to Samora that they have a plan to make sure Leareth doesn't wake up and do anything he shouldn't, and she should wait until then to cast - how many Lesser Restorations does she have? And how many remaining spells that can be turned into Cure spells? Shavri's inclination would be to hit him with everything they can, Lesser Restorations first and hope it lets him hold life-force better and then another Cure once he can benefit more from it. But if Samora is running low on those, then - he's still steadily leaking life-force, and she knows Lesser Restoration didn't fix that for the other patients, so he's going to keep leaking and it sounds like dawn was not that many hours ago and they have a lot of today and tonight to get through before Samora can get more spells and they might need to keep it to, like, the bare minimum he needs to stay alive. 

"I have four Remove Sickness and a Comprehend Languages I can convert to Cure Light. Two Lesser Restorations and a reserved slot I can prep a third one into in fifteen minutes, any of those can swap to Cure Moderate. One Remove Disease that I'd like to hold onto and try to use on an actual disease, but if we need a Cure Serious it's there. And then one reserved fourth circle slot I can use for Cure Critical Wounds, or for another Remove Disease, or for Restoration if there's diamond dust available which we hadn't fully figured out yet. And three channels but those would ideally be arranged to get multiple people. I can do a Lesser Restoration now but it's not even noon yet I don't think, so if we want to space them out evenly I could do now dusk midnight and then an hour after dawn tomorrow?"

Oh right she still hasn't explained. :There's not going to be much point to the Cures more powerful than what you're calling Cure Light. People from our world don't have the - extra life-force capacity? - that spellcasters from your world seem to get, even if they're very powerful and experienced.:

Pause: :- Definitely use both Lesser Restorations now, or rather after the healers say they're ready for that. That isn't what I wanted to space out. He's got barely any of - the thing our cleric was calling Endurance? - but it's very recent damage, I think Lesser Restoration ought to put it back, and we can keep one in reserve. And then probably burn the Comprehend Languages for a Cure now, I can just translate with Mindspeech anyway if there would be a need for that, and that leaves us with up to four more to spread through the day– er, remind me what Remove Sickness does? I'm not sure if it's going to be directly useful...: 

Samora has fourth circle spells!!!! That probably changes a lot of things but Shavri needs more breathing space to think about it, she'd been forming her own mental plan entirely around Blai only having up to third circle. 

"I can do that. Remove Sickness makes it easier to recover from diseases and if you're nauseous it makes you not nauseous for a little over an hour. I've been expecting to turn them all into Cures." Do the other Earth medics look like it's a good time for the Lesser Restorations now?

(She has, and then tosses aside, the thought that if Leareth starts attacking people once he's healthy the lack of adventurer vitality will help her odds of stopping him. Most Evil people are saner than the ones she's been dealing with under the Gauntlight.)

(Given everyone else's symptoms, something to fix nausea might be a little bit helpful, but it's only an hour, and it's not critical, they can keep him well-hydrated regardless - which is so useful!!!!! - and whether Leareth is comfortable is currently very far from the top of Shavri's priority stack.) 

Dr Chadra would like to see this guy try to cast a portal spell while on 50 mcg/kg/min of propofol and a 100 mcg/kg loading dose of vecuronium plus an infusion at 50 mcg/kg/hour. 

"...Ummm yeah now would be a good time for more healing." His blood pressure really hates it, despite the fact that they've given him at least 15 doses of epinephrine over the last however-long. Marian is briefly filled with a mental image of all of that hitting him at once and him literally turning into the Hulk or something. 

Lesser Restoration! Does it do anything, either to his face or to the beeping Earth machines' symbols?

Marian thinks he looks better! It's the kind of thing where she has no idea what she's noticing, specifically, but it's gone from "she would be incredibly freaked out and frantically trying to summon help if she were alone in the room with him" to "well, it's not great, but he's really only around 80th percentile on Concerning Vibes."

It's also definitely helping with his vital signs! Not the part where he's still in some kind of truly bizarre wide-complex rhythm – it's at, like, 90 bpm, which would be a perfectly sensible and unsurprising heart rate if he were in sinus rhythm, but it's insanely fast to be an idioventricular escape rhythm and not nearly fast enough to be V-tach, what even is that. But - with a lot of additional help from the ECMO, admittedly - it's producing an art line blood pressure reading of 103/63 which is actually a lot higher than the bare minimum she's looking for. O2 sat reading at 97%! That could still be mostly the ECMO and not him but it's a happy number. She likes that number. 

It's a drastic improvement on Healing-Sight! It's a little bit complicated to compare, because Randi had no injuries – a channel would never have done anything for him at any point, she doesn't think – and Leareth has an awful lot of injurylike things wrong with him even if they're not visible to the naked eye, but...the part where some kind of fundamental underlying stamina for being alive is draining away is very recognizable. Leareth...looked about as badly off on that particular aspect as Randi did before his first Lesser Restoration. (And would have died of it a lot faster with only her efforts, because he's also injured and barely had any capacity to absorb or benefit fro Healing; Randi probably had weeks, but even a moderate injury - a fall down some stairs and a broken hip, say - would have finished him off within a day.) 

Anyway, just like with Randi, it hasn't brought him anywhere near back to normal but the relative difference is almost absurd. It's easy tripled his total capacity to hold life-force and tolerate Healing. 

...It didn't do much for the injuries, of course, and it didn't touch the ongoing life-force drain. She knew that already, though, it was the same for Nayoki. 

They have...five?...total Cures that won't come at the cost of stronger spell slots. If she assumes dawn was four hours ago, that's twenty hours - no, twenty-one, the prayer itself takes time - one every four hours. 

She's...not sure that Leareth right now could hold onto enough of the positive energy from a channel to get him through four hours. 

:I think he'd benefit a lot from one more: she sends to Samora. 

He can have another Lesser Restoration, then, and probably she should immediately follow it up with a Cure Light while he's most able to benefit from it, does that sound right to Shavri?

Yes, that's Shavri's thought! It probably doesn't matter much if it's within literally six seconds, she thinks he's going to re-accumulate the damage that the Lesser Restoration addressed but it's a lot slower than the life-force draining out of all the metaphorical cracks in him. 

It really doesn't seem physically possible for him to wake up and try to portal out of here on this much sedation, but apparently Marian is going to be anxious about that possibility anyway!

Positive energy: it solves like 20% of all problems. Minus one Comprehend Languages, plus one Cure Light Wounds.

Okay that was more like it!!!!!!!

...He's still worse off than anyone else looked when she left. Not, specifically, in ways that are going to kill him that much faster? The worst element is the life-force drain and he's...not, actually, leaking faster than the others were. His brain looks okay. Structurally, at least, she's not a Mindhealer and she has no idea if there are subtler problems that will affect his mental functioning. 

There's definitely a lot of other damage they didn't get, damage that has more in common with what was wrong with Randi than with an injury. Some kind of inflammatory nerve damage in particular, she's sure some of that was happening with the others but...Leareth got most of the way to dead, he really should be dead, and it's a lot more advanced, and apparently a Cure doesn't fix it. He's going to have a lot of trouble moving his limbs on purpose even once he's awake and not paralyzed. (And they should not arrange for this to happen in that order! It's very important that it should be the other order!) 

...Also his lungs are surprisingly problematic! Shavri had really thought most of the problem was them having spent more than thirty minutes pounding on his chest as hard as possible, on top of whatever direct injury the attack inflicted, but...there is definitely a non-injury problem in there.

(Shavri is thinking out loud to Samora and Marian and Dr Chadra and honestly anyone else who seems like they might hold still for it. She's having a lot of thoughts very fast and they don't want to stay trapped in her head.)

....It looks like an infection, actually, ohhhhhh, that makes perfect sense, Leareth was alone and slowly losing consciousness and also suffering from a problem that they know caused severe nausea for everyone else, yeah it's not surprising at all that he got a bunch of vomit in his lungs. The Cure fixed all the direct tissue damage but it doesn't get diseases, and that's a surprisingly severe pneumonia for it having been less than two hours, but there was a whole period when his body's defenses were totally down. The lungs have various active processes for getting rid of things that should not be in them and they weren't doing any of that for a while. 

They have a Remove Disease but that's a particularly expensive spell and she'd love to hear other ideas. 

Oh they should definitely put him on alll the antibiotics. And then maybe wait a while and see how much difficulty it's actually causing him? If his lungs are in enough trouble that they can't get him off the ECMO at all, it's probably worth a third circle spell up front to address that, but if he just needs ventilator support for a few days while the antibiotics work, that's fine. There are almost certainly other patients in the hospital who aren't likely to die of an infection today but a Remove Disease could still get them from a 50% chance of leaving the hospital alive to a lot better than that. He's definitely nervous about doing anything other than the maximum they can possibly do for this guy, so...ideally they would keep it in reserve as long as possible in case he does need it today? But he might not, it seems like having an infection isn't nearly at the top of his list of problems by severity. 

(Leareth is going to HATE the tube for helping him breathe, Shavri is pretty sure, so it's not entirely "fine", but...he probably wouldn't want her to prioritize that over maybe saving someone else's life even if it's the probabilistic kind of saving-a-life. She's happy with that plan.) 

"Uh, is Remove Disease more likely to work if you use it early? I remember you said there's a failure chance but I'm not sure if anything affects that or if it's, like, random?" 

"I've never heard of any patterns in it other than some diseases being harder to get rid of--scarlet leprosy is especially difficult, diarrhea is especially easy, that sort of thing. Which doesn't mean there aren't any, but if I had to guess it'll be as good odds tonight as now."

:I’m inclined to wait: Dr Chadra tells Shavri. :But do tell us right away if you see significant deterioration. For now, we’ll leave everything exactly as it is and recheck labs in an hour.:

Shavri has plenty to do but just holding a link and monitoring him with Sight doesn’t take her full attention, and right now Shavri feels a desperate need to be fully occupying her brain with something useful at all moments.

Marian is clearly busy and will resent a conversation but Samora doesn’t seem busy at all!

:I’m curious what you know about how the healing spells work?: she asks. :I never had a chance to get into it much with our cleric, there was an - emergency that wasn’t mostly healing related - more or less the entire time. Or I can answer questions about how our healing works, if you’re curious!:

"It sounds like you know a lot more about your healing than I do about mine; I mostly fight things. Is your healing the sort of thing anyone can learn, or is it inborn or from a god?"

:Inborn! Or, rather, potential is inborn, and sometimes it awakens but we're not sure of the conditions for that. And it has to be learned – I mean, even entirely self-taught Healers will usually figure out how to do basic things without killing their patients, but without any instruction they probably will kill at least one patient in the process of figuring it out, and only genuine prodigies can get very far that way. With training, though, there's - I don't know that there is a limit to how complicated the things you can do are, though there's a limit to how much Healing a given patient can take at once, because even with a really skilled Healer, almost all of it works through the existing pathways for natural healing in a patient's body, and some of the energy has to come from them. I'm mostly avoiding doing any direct Healing on our guy, other than holding a link, because I don't think he would have much stamina for it right now.: 

How does their guy look now? 

Not worse! Like, really terrible, but not deteriorating fast enough that Shavri can see a difference from three minutes ago. 

She'll take it! 

"That's really cool! And it sounds like it might combine well with divine healing, since positive energy basically works by giving the body more energy to heal itself with. If there was some way to 'catch' the positive energy from a Cure spell and feed it to a Healer and their patient at a pace where the Healer could direct it, maybe. Celestial healing works sort of like that but it needs angel blood and I don't have it or the spell for calling an angel to buy blood from today."

Shavri is now so desperately curious to know how in the world angel (??) blood produces positive energy, apparently even when separated from the "angel"!

:Where does positive energy - come from, in other spells? The other thing that's different about your healing is that it's not tiring for you, either.: 

"From the positive energy plane! All positive energy healing involves opening a tiny portal to the positive energy plane and directing the energy that spills out into a person or an area or whatever."

:Huh, that’s fascinating! I wonder if you could imitate it with - tiny Gates, or something - it's the kind of thing Leareth could figure out, I bet, if it would work in principle...: 

Stare stare stare at Leareth. He...continues not to be deteriorating, at least not fast, the life-force leak is still there. Shavri could really wish for some actual improvement, and it would be great if his heart could stop that and do a normal thing instead, but she doubts there's a Golarion spell for that if Stabilize didn't already get it. 

(He's kind of debatably improving! All the epinephrine in his system has got to be slowly wearing off and this isn't causing his blood pressure to rapidly tank! Honestly Marian is mostly relieved that they haven't run into some kind of Horrible ECMO Technical Difficulty That She's Unqualified To Troubleshoot. It's enough of a workload when everything is going perfectly right.) 

Dr Chadra is virtuously resisting the temptation to get new labs any sooner than after an hour. He wants to knoooowwww but it won't be that informative yet. 

...After about ninety seconds Shavri's thoughts are once again too loud and fast and clamoring to be out of her head. She's just going to narrate absolutely everything she's noticing in Healing-Sight to anyone who'll listen. 

Dr Chadra is RAPT. (And starting to be really quite incredibly jealous of the CT Vision which it sounds like is a lot more than just that.) 

By the time another twenty minutes passes, Marian is finally feeling like she has enough of a handle on the situation that a monologue won't throw her off. She'd like to be included. Healing-Sight is really interesting and cool and it makes her feel - oriented - which with this patient she conclusively knows sooooo few medical facts about, other than "was recently clinically dead" and then the interventions they've done about it. They don't actually really know what's wrong with him! "A god did it" is not a diagnosis. 

And finally it's been an hour and they can get a full set of labs and then decide what they're doing next! 

Everyone crowds around Marian's computer to check out the labs!

Those are. Bad labs. Marian doesn't like them!!!!

...They're not dead person labs, though, and honestly a lot of his numbers are better than they have any right to expect? She's definitely worried about the low white count and the clotting dysfunction and the blatant signs of cardiac muscle damage, and he's definitely in frank kidney failure and his liver enzymes are not headed in a happy direction either, but she's...seen worse numbers than this, for most of the individual numbers? Admittedly not all at once on the same patient, that part isn't great. And she's not sure she remembers ever seeing a troponin over 10 before, that's like (hasty mental math) at least 300x the cutoff for an abnormal result, oof. 

Shavri cannot read the numbers and wouldn't know what they meant if she could but she is maybe just going to skim Dr Chadra's surface thoughts to figure it out. 

Their artificial Healing-Sight is very cool! Shavri things a lot of it ought to show up to Healing-Sight in some way, but - subtly, in many cases, and not quantitatively like that, and different Healers always have slightly different training and experience such that it's difficult to compare assessments and reliably follow changes and trends. 

Shavri had been aware and tracking that his body's defenses against infection were substantially weakened, but she hadn't actually quite noticed the problem with his blood clotting – it's very easy to see with Healing Sight if an injury is bleeding more and longer than it should, even when the 'injuries' are the kinds of tiny internal bruises that patients get from being moved in bed, but Leareth has none of those right now, since that's exactly what a Cure spell targets. The underlying propensity-to-bleeding is harder to see. 

...The combination does give her an idea, though, and she goes and has a look and - oh no. She was right and she did not want to be right. 

:His bone marrow is - dying?: she tells Dr Chadra (and Samora and Marian.) :It's not - there's still some life-force there - but I don't think I can Heal it. ...Samora, it's the part that makes new blood and new - the part of blood that defends against illnesses - do you know if there's a healing spell that would put it back, if it's gone?: 

(That is very interesting and Dr Chadra needs to Google something real quick over here.) 

"Hmmm. I'm not strong enough to cast Regenerate but it can grow a whole cut-off arm back, so it's definitely possible in principle. That might be the only thing that can do it, since it's the only thing that can replace bones, but if the bone is there and just not doing the thing that helps fight off illnesses--well, I didn't even know bones were involved in that, but Restoration usually fixes people's ability to fight off illness, if we can get the diamond dust for it."

If Marshall was here he could maybe just fix the dead bones, or find a recently dead creature with healthy bones and swap them in, but Samora is definitely not skilled enough to try that.

They should get diamond dust then!!! …Unfortunately it’s not like they can put in a pharmacy order for it. 

“Clarice, you’re on finding out how we can source some diamond dust this afternoon. Make it happen. - how much does the spell need?”

????????????? Why is this HER job?????????

…She’ll wait to find out how much the spell needs and then, uh, go investigate.

"About this much--actually, here, it's as much as these coins weigh together." She fishes three silver pieces out of her bag and hands them over. "That might be a little heavier than we need but the spell won't consume more even if I'm holding more, you can sell back the extra or save it for another casting." (If anyone has a scale, the coins collectively weigh about 14 grams.)

Catherine thinks going on a quest for magical gemstones finding some diamond dust sounds kind of awesome, actually? She's happy to do it if Clarice will cover her (basically fully healed) patient in the meantime.

"Does synthetic diamond count? What if it's, like, glued to sandpaper? How finely ground does it have to be, if I get a few bigger diamonds and smash them with a hammer will that work?"

"You can make diamonds? Easily enough that you'd smash one with a hammer?"

"Yeah! They're cheaper than mined ones, I think, and they're chemically identical."

"I need to learn how to make diamonds. That's--if I can get that information home it could change the course of history." 

"I'll pull up some information for you on the computer about it! Do you have an answer to the sandpaper thing?"

"Nobody back home would glue diamond dust to sandpaper! Because diamonds are expensive! I don't think it would work, though, I need to sprinkle the diamond dust on the patient over the whole casting time. Maybe if the sandpaper was shredded really really small, so it was a sort of diamond-dust-and-paper-dust mix?"

"I'll try to find it loose in a bag first. Dr. Chadra, what kind of time versus budget situation are we looking at here?"

"- I think we absolutely need it today but not in an hour - Dr Harrison, what do you think?" Also Dr Chadra cannot answer the budget question because he has no idea whether the hospital has any system for procuring possibly-expense not-strictly-medical supplies in a hurry, and he's a resident, he's personally pretty broke. 

The hospital does not really have such a system and Dr Harrison hates having to talk to management about anything ever. 

"- Here, just take my credit card." And he'll scribble down his PIN for her on a sticky note. "Limit's ten thousand. You've got four hours." 

(Dr Harrison is not a resident and is not broke and they're going to make medical history if they save this guy – and it'll unavoidably be all over the news by the end of the week, probably, so if his wife does get pissy about a mystery jewelers purchase on the credit history, he'll have written documentation of why.) 

(Marian had just been considering whether she could afford to contribute toward emergency diamond dust purchases but she's relieved not to have to make that decision, she doesn't have the slightest idea how much it could end up costing.) 

Neither does Catherine, so she's glad the hot potato won't be on her credit card if management pitches a fit! Does Marian have time to help Samora read about synthetic diamonds online while she makes a bunch of phone calls, she said it was really important.

Samora actually prepared a Comprehend Languages this morning, so she can read English for a little over an hour! Is this a good time for her to spend an hour uninterrupted with the computer? It really is important, not for this patient but for a lot of people back home. Also she doesn't know how to make it show her the information about synthetic diamonds in particular.

(Also, she continues to be very impressed with these people and how much of their resources they're willing to dedicate to healing strangers. They're so rich and so Good.)

(The pharmacy is going to have a precision scale, they can send someone off to determine the weight of the coins.) 

Uhhhh Marian is currently tabbing back and forth semi constantly between the stupid ECMO documentation flowsheets and the vital signs sheet and the pdf protocol and a random png file she found on Google that has some of what she wants to refer to in a less twelve-pages-long format, alternating with nearly jumping out of her skin because the fucking machine made a sound and she doesn't know any of the alarm tones yet, and if she has to do any more things she might cry— oh, if Samora can read Wikipedia herself then Marian can probably manage to help her with page navigation, she has thirty second blocks of not frantically doing anything. 

It's obviously important but Shavri does have other concerns. 

:He's still losing life-force, and - I think kind of almost...developing new injuries? The channel reset it but the underlying problem is still there - I can fight it in his brain but not everywhere, there's something badly wrong with the blood vessels everywhere in his body and with the lining of his gut. He's going to need a channel or a Cure or something every...four candlemarks, maybe? If we're not certain that the Restoration will fix more of it and we don't know how long it'll take to get the materials, then - I do want to track how many more of those we have if you use the Comprehend Languages and can't turn it into a Cure.: 

"I have three more channels and, not counting the slot for the Restoration or the lesser restorations I'm going to use when he's more stable but counting the Comprehend Languages, seven more cures. The information about diamonds will still be there tomorrow, I assume, so if this is a bigger emergency than we expect to happen on a typical day I can wait." It's now pretty clear that she should not stay here indefinitely even if it turns out to be legal, but she should probably make a serious effort to recruit and train at least one more priest of Iomedae before she leaves, but nobody here has the mental slack to deal with that right now.

...Shavri thinks that six should be enough to get them through until tomorrow morning. She is kind of too tunnel-visioned on Leareth to be thinking about the bigger strategic picture, but if Samora thinks it's important to go read things about diamonds in this world, then Shavri won't argue with her about it. 

Great here's a computer outside the neighboring room that nobody is using. Marian will google "synthetic diamonds" and open the Wikipedia page. 

Dr Chadra has twelve tabs open to Pubmed and a bad feeling. 

"Uh. Dr Harrison? I...have a theory about what's wrong with this guy." 

Within five seconds about eight different people are crowded around his computer-on-wheels trying to see the screen. 

Dr Harrison doesn't bother getting up. He spins in the spot on his office chair. "What is it?" 

"Sooooooo. Bone marrow damage with pancytopenia, right, I was thinking - and with the others presenting with nausea and vomiting - and all the diffuse organ damage with no visible external trauma - to me that really smells like acute radiation syndrome. Except the onset is way too fast, right, and I wasn't sure what to make of the cerebral edema, or all the cardiac shit he has going on. ...But, uh, I looked it up and. This all seems like more or less exactly what we'd expect to be seeing with a high-dose exposure? Like, really high, the cardiovascular and central nervous system syndrome show up at 5000 rads and - I think he would've had to have taken a lot more than that for it to just about kill him in thirty minutes, the CDC article here says it's lethal 'within three days'. ...But I think it fits everything we're seeing? I mean. Apart from a god doing it. I don't know what to make of that."

Shavri is of course reading Dr Chadra's mind, because that's the only way she can follow a fraction of what's going on. She's only partially grasping what in the world he means by ""radiation"", it's...light?? but not just light??? Light and - violent explosions of very very small things - what - 

:Vkandis is a sun god, if that's relevant: she sends. 

Is that relevant??? Maybe!

"So. Uh. I think we had better find out right away if this guy is...uh. Super radioactive right now." 

"Well shit," Dr Harrison says mildly. "...We'll need to move him, he needs to be in positive pressure iso. Everyone who doesn't absolutely need to be near him right now, move and go change. I doubt he's radioactive, for what it's worth – attack from a hundred miles away, went straight through stone, sun god – that's some kind of gamma death ray, not a nuclear bomb with fallout. And no one's showing any symptoms. But we'd better check. Clarice, get on the phone and deal with it, there's got to be a Geiger counter somewhere in this place." 

Yeah that's reasonable and Clarice is on it!

"Hey you, magic healer! Are any of us taking damage? You'll want to look for a much milder version of the thing wrong with us. ...Check yourself, if that's fastest, you've been in the closest proximity to him for the longest." 

It takes Shavri a moment to realize she's being addressed. :Hm? ...Oh, right. No, I'm fine, I'd have noticed a problem. It's not - contagious.: 

Dr Harrison rolls his eyes slightly at Dr Chadra. "See? We're fine." 

Nothing about the situation is fine!!!!

"...I think our guy might be pretty fucked," Dr Chadra says, shakily. "Case study of a guy who took 66 Gy and he died in less than two days, but the initial presentation wasn't even close to this bad, this guy took a bigger dose for sure. ...LD100 is, like, 10 Gy. I think we're fucked." 

"- Nah, we've got literal magic. We're gonna save this guy and win a Nobel Prize in medicine and be legends." Dr Harrison leans back in his chair and stretches. "- It's going to be rough for sure, though. Marian! Find out if our lovely cleric knows that radiation is a thing? Maybe they've even got a spell for it." 

Okay right. Three minutes until she has to put more numbers in flowsheets and she's got a phone alarm for it. She can explain the concept of radiation in less than three minutes. Or faster, if the language has a word for it which would be a solid hint that they know it exists - does it? 

Marian's Celestial vocabulary helpfully provides a word for radiation, but Samora doesn't recall ever hearing it. "Is it like a poison, where it's still in him and needs to be gotten out, or is it like a burn or electrical damage where the source is already gone?"

"It - depends - it can be either? It's like...a kind of light you can't see, like the part of sunlight that gives you a sunburn but even more than that, it goes through your body - it's how we take the pictures inside people's bodies, actually, though that's a very small controlled amount - and if it's too much then it kind of...burns all of your cells on the inside? It damages the tiny parts that cells need to work and make the right proteins," huh Celestial has a word for 'proteins', neat!, "and to make copies of themselves so your body can heal and maintain itself. And there are kinds of - rock, or metal - that keep releasing the light all the time, and someone's body can be contaminated by that - we're going to check, we can detect the light - but Dr Harrison thinks it isn't based on the description of the attack."

Marian really hopes he's right! She does not want to get cancer! 

"...Anyway, the difference there is really mostly whether we're in danger and need to protect ourselves from it - it still kills people by burning inside cells, whether he's contaminated with it or was just exposed to the source at the time slightly changes the treatment but getting it out of him wouldn't get rid of the damage it already did, and apparently a Cure won't fix all of it either. It seemed like it was fixing the - large scale tissue damage? But not the very small cell parts damage..."

(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.

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 Rupert 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."

"I, um, I think we should have enough extra that we can afford to waste one tube." Marian would kind of rather think about this in an hour, after she’s dealt with her stupid labs. “I guess if you’re actually not busy you could look at ways to test it sooner? - sorry I was about to go in, I need five billion labs -“

Everything is put in stat, and within twenty minutes or so they are all, once again, crowded around the computer. 

Shavri cannot read the numbers but she demands an immediate mental explanation of what they meaaaaaaaaaan.

Marian is unfortunately limited in being able to explain everything because she's not sure why they're checking a bunch of the new ones!

Cytokine panel is...inflammatory stuff? Marian is not really sure what to make of it because she mostly thinks of it as related to immune response to infection and Leareth does not, currently, have an immune system to speak of, so what gives? 

Going back to the top. Reticulocyte count is - wow this is making Marian feel like she's back in nursing school taking a quiz she forgot to study for - she thinks it's the...baby...red blood cells? She doesn't think she ever learned the reference range, but the lab is nice and provided one, and unsurprisingly given everything they know, Leareth is not making very many new red blood cells. Maybe none at all, those could be all that's left of the number that were in his blood right before this happened. 

Electrolytes are still abnormal but better, that's entirely the work of the dialysis but Marian still feels a quiet internal moment of pride toward her patient. Hemoglobin is fine! Like, technically a little low but by ICU standards that's more or less normal! ...Blood gas got worse again, she doesn't love that, it looks like it's just the lactate going up again by why his blood pressure is adequate he's satting at 100% what's wrong -

- well, his clotting panel is worse across the board, and a positive D-dimer, that's a sign that his body has been making clots, probably everywhere in his body - his vasculature is damaged on the inside throughout his body, there'll be rough spots and tiny "injuries", plus all the inflammation - that's disseminated intravascular coagulation and Marian is scared of it, though admittedly for Leareth it's, like, not even in the top three scariest things wrong with him and she's vaguely hopeful that it's the sort of thing a Restoration fixes. 

Liver enzymes are worse, that's not surprising, if anything they're not rising as scarily fast as Marian might expect - ammonia is high, that's something the liver should handle and isn't, it's not great for his brain especially if it keeps going up but it won't kill him. Cardiac markers are still rising, so there's damage that the latest Cure spell didn't get, but - again, it's not a catastrophic rate of increase. Elevated CK is from muscle breakdown, also not surprising but it's really going to mess with his kidneys, also not going to kill him especially when they've already got him on dialysis.  

LDH, Marian has no idea, what is that, her brain keeps autocorrecting to "the bad cholesterol" but that's LDL. Haptoglobin sounds like it's related to red blood cells but who knows what it means that it's low, except 'be worried'. Ferritin is...iron stores? Marian only knows what it means when it's low (iron deficiency anemia boo), high...is plausibly because his cells are breaking down and the iron formerly in their hemoglobin is loose now? Marian will go with that and look it up later. Procalcitonin is an infection marker! It's high but not 'fifty times the upper-normal cutoff' high, which makes sense, he's got a known infection in his lungs but it might not even make the top ten worst problems. 

Amylase and lipase are pancreas stuff! His pancreas is kind of dissolving or something, great, just what they needed. 

Central venous O2 saturation is...high...? Why are they even checking that, Marian's lost, but - well, maybe it's just high because his arterial blood oxygenation is high, does that make sense - that can't be all of it, it's saturation (of hemoglobin) not partial pressure (of directly dissolved gas), most people have a baseline hemoglobin-saturation near 100%, so you just can't go much higher than normal, and that's where nearly all the oxygen in the blood is. So Leareth's tissue must be using less? That seems related to the lactate rising - he's not burning oxygen even though it's there, his cells are going anaerobic instead - but the part she's not getting yet is why and what that means in context... 

Shavri will drink all of this in like a person dying of thirst in a desert who's just found an oasis, and then - because there are too many thoughts in her head again and she's got to spread the joy around or explode - rapid-fire it over to Samora with commentary. 

...It is interesting that his blood is full of vital air that his body can't use properly. There's a vague shadow everywhere (it's actually not entirely unreminiscent of Randi's wasting illness, just worse) - it feels like it's got to have something to do with the tiny libraries, maybe the cells need to refer to those instructions in order to do whatever it is they do with the vital component of air, and now some number of the cells are just failing to complete that process at all, or doing it with terrible inefficiency... 

Samora has no idea whether any of her spells can fix the tiny instructions because she didn't know they existed! Not being able to turn air and food into ability-to-do-things sounds like it's either an Endurance issue, which Restoration will fix, or some kind of weird one-off thing there's no magic for. She'd be a lot less worried it was the latter if he hadn't been personally attacked by a god, which is exactly the sort of thing that gets you damaged in weird ways there's no magic for. Can Shavri tell her anything about which god and why, and how strong the other cleric she's met was and which god they were a cleric of, and does she have any speculation about which god or what other mechanism might have sent them to Earth?

Shavri's mind is still very full of MEDICAL THOUGHTS and having trouble parsing why any of that is...important or relevant...but she can answer. 

:The other cleric was of Iomedae, too: and how about she DOESN'T get into any of the complications right now, :and he had up to third circle spells. ...The god who attacked Leareth was Vkandis. Sun god, has a couple of countries run as theocracies, one has been protected by a magical shield-barrier for almost two thousand years and - that's what exploded. It's gone, there's a mile-wide strip of fire all around the border, there's - we hadn't begun to assess the collateral damage but - a lot of people died. A lot of His people. ...He and the Star-Eyed Goddess were both involved in earlier plots to murder Leareth, which he claimed They've been trying to do for a very, very long time. His theory is that they hate - change, including progress, things that make countries wealthier - and that's always been his goal so they hate him. ...I have no idea if what sent us here is related, or the same thing that brought our cleric to Velgarth or brought you here.: 

Probably two gods she's never heard of and not either of Sarenrae or Desna. :If two of the people it's happened to are clerics of Iomedae that suggests She might be involved somehow or at least not actively opposed. Also, you landed here in the hospital, not a mile away where there wouldn't have been help available. That suggests that Someone wants Leareth healed and thinks there's a chance we can do it. It's all speculation and not much to hang a theory on, but it seems more like reason to hope than reason not to.:

:Maybe. I hope so.: It would certainly be baffling for Iomedae to object to Leareth getting healed - or to Blai saving Valdemar from a war - but Blai also thought Iomedae wouldn't be able to intervene in their favor even if She wanted to, so Shavri isn't getting her hopes up. 

She is thinking, though. :I think your magic must be able to act on it, though? On the part that's reducing his Endurance, I mean, I don't know if it can fix the tiny libraries, it might just fix it temporarily but the problem will keep coming back. But - it was hard to see, before, with his life-force so dim, but I think even the Lesser Restorations helped a lot and the numbers they're measuring agree.: 

She'll wait to see if the doctors want her to check anything or do anything, now that they have more information on the problem. 

"That's mitochondrial dysfunction, check, cytokine storm, check," Dr Harrison says dryly. "Well, let's shoot all that over to Dr Chen's email and see what she has to tell us. And now we've got a baseline, we can repeat after the diamond dust spell and find out exactly what it can help us out with." 

Oh no what if the specialist doctor advises them to do more things. Marian is not up for doing any more things than this 

They get a reply within twenty minutes. Again, almost everyone not currently trapped in the room in isolation gear crowds around the computer while Dr Chadra reads particularly choice parts aloud. 

I've reviewed your labs multiple times and consulted with two colleagues. We are collectively baffled.

Your lactate of 14.5 with ScvO2 of 82% is actually pathognomonic for severe radiation injury. This is cytopathic hypoxia; the mitochondria are so damaged they can't utilize oxygen even when it's delivered. It's one of the few results that I can explain.

The cytokine storm (IL-6 of 950) is consistent with massive radiation-induced systemic inflammatory response. That tracks. The absolute lymphocyte count of 140 at ~4 hours post-exposure is compatible with >15-20 Gy exposure. Maybe higher.

Now, the things that don't make sense: His pH is 7.12. With the degree of cellular dysfunction you're describing, he should be much more acidotic. I would expect a pH below 7, which we saw on your earliest labs, followed by a sudden jump. Something is buffering him that shouldn't be possible.

His liver enzymes are very elevated but not astronomical. With this level of radiation plus the ischemic injury from the arrest, I'd expect AST >5,000. Where's the rest of the hepatocellular necrosis?

His hemoglobin is 11.4. At this point post-exposure with severe radiation injury, I'd expect more hemolysis. Your haptoglobin is appropriately low, but his H/H is holding up better than it should.  

Your "experimental cellular regeneration therapy" is doing something. I don't know what, and I'm not sure I want to know. (Do you have institutional ethics board approval for continued experimental therapy in a patient who cannot consent?)

Dr. Harrison, even with your experimental therapy, these labs show multi-organ failure that is incompatible with survival. Even with whatever you're doing, he's still deteriorating. His pH dropped from 7.18 to 7.12 in two hours. His lactate rose from 12 to 14.5. His liver enzymes are climbing. His ANC is in free fall. Whatever you did before is wearing off, and the underlying radiation damage is winning.

Dr Harrison rolls his eyes. "Yeah, yeah, skip ahead, what's she recommending we do?" 

There's a lot of email, especially for having been written in less than twenty minutes. Dr Chadra scrolls down. 

"She's suggesting tocilizumab for, uh, IL-6 blockade? ...Uh, that seems like a really bad idea, that's a biological immunosuppressive drug, right - okay, it says she's aware we're concerned about infection risk but that the cytokine response itself is life-threatening. She says he'll need cryoprecipitate for the DIC, yeah, okay. Consider stress-dose steroids, sure. She's recommending we start TPN now, that he needs calories and protein for cellular recovery, that does make sense... Says he should be on a continuous bicarb drip... Oh, look at this -"

If this is real (and I'm still not 100% convinced it's not an elaborate training scenario), you're attempting something that's never been done. I want to help, but I need to understand what I'm helping with. If you can provide more details about the therapy - even under NDA if necessary - I might be able to give better guidance. Also, for what it's worth: if you pull this off, this will be the case report of the century.

Dr Harrison waves his hand. "I'm not telling her we're doing this with literal divine faith healing magic out of a Dungeon and Dragons setting over the phone. - go call her, you can say we'll tell her everything if she flies out, see if she bites. But this is enough to be getting on with." He makes a shooing motion. "I need to put orders in." 

...Okay, in terms of additional Tasks to achieve, that could be a lot worse. 

Shavri gets caught up via bothering Dr Chadra over Mindspeech, and is almost bouncing as she updates Samora. 

:They can feed him! Even though his gut isn't working! They can - take what's in food and break it down into very very small pieces, so it dissolves completely in water, and they make it completely clean, and they can give it right into his veins, like with the drugs!: It's SO powerful. One of the worst hurdles for Healers is that some of the patients the most desperately in need of Healing can't safely eat, and Healing will rapidly exhaust them if they're not getting any nourishment. 

:That's really cool! Does it go from the blood to the stomach, or does it nourish him just from being in the blood?:

:It doesn’t need to go to his stomach at all! The stomach - well, the intestine mostly - would normally break the food down into tiny pieces so it can transfer into the blood, which takes it all over the body to the tissues that use it as fuel. But if someone’s stomach and intestine aren’t working, they can skip that step entirely!:

:Neat!: She wonders what happens differently when she eats versus when she doesn't and whether Shavri could tell whether she'd been eating recently. :So what was in that letter they were all reading together?:

Shavri catches part of the thought about Samora eating versus not eating and is...confused, because of course people's bodies look differently to Healing-Sight when they've just had a meal, compared to when it's been all night or whatnot, but it seems like Samora means something more drastic than that? Does she regularly fast for days or something? - she can ask later. 

:They talked to a famous doctor from a long way away, someone who's specialized in treating patients who have this kind of injury - she lives in a different city, hundreds of miles away, they can just do that! And then they sent all of the numbers in an instant-letter with their artifice, and she was giving her interpretation. She found it very confusing – it sounds like some of the measurements are very bad, in ways that she didn't find surprising, but some aren't nearly as bad as she would expect and that was more surprising? I think that has to be because the Lesser Restorations and Cure spells were helping, in ways they can’t replicate with artifice. She - I think she isn't sure whether to believe it's real or not, she thought it might be a - practice scenario to test their response systems, or something? But she's playing along. She wants them to give him a drug that will prevent his body from responding to the damage with inflammation, because his body is freaking out hard enough that the inflammation itself is life-threatening rather than helpful for healing. And she was the one who said we should start giving him some kind of nourishment as soon as possible, that it’s urgent because his body will need so much fuel for healing. …I think probably the Restoration spell doesn’t rely on that? But she isn’t wrong that natural healing and my kind of Healing-work both do.:

:That does sound like a good idea. Healing spells still work the same when someone is starving, but they also don't help with it. Is inflammation useful sometimes? What's it good for?;

:Mm-hmm! It's very helpful if there's a local injury or infection - if you break your leg, or have a wound that's starting to be infected - it's how the damaged part of the body communicates to all the rest that it needs extra resources to heal. The cells that are affected will - send messages, that tell the blood vessels nearby to relax and be wider so that more blood with its vital-air and nutrients will reach that spot, and that summon the cells in the blood that fight infections, and the blood vessels will get - leakier? - so that the defense-cells can get out and into the injured tissue, and then your broken leg or your infection will heal much faster. But if it's everywhere at once, like with blood-poisoning - or with Leareth right now, an injury in every part of his body at once - then there aren't enough of those resources to go around, so it's useless if everywhere is asking for them at the same time, and it just makes the blood pressure drop way too low - because there's not enough blood to fill the blood vessels when they're all relaxed at the same time, even if the person hasn't lost any blood, and because the fluid in the blood starts leaking out into the tissues rather than staying - and then even the organs that aren't badly injured will start panicking like they are, and not work very well. And they think that's a lot of why his blood can't clot properly - it's not just that his bones and liver can't make the parts of blood that form clots, it's that everywhere his body is shouting 'I'm injured! help me!' and the clotting-cells think there must be a wound that's bleeding and try to make clots everywhere at once, and actually all it does is gunk up the tiny blood vessels, so now his extremities aren't getting enough blood, and it uses up all the clotting-cells and clotting-substances and there are none left for if he does actually start bleeding from a wound.: 

Shavri looks thoughtful. :Marian said that's actually a problem for a lot of their patients, because their artifice can fix the underlying problem, but the patient's body doesn't know that and will panic about the problem anyway, even when all it's doing is making it worse. So they use drugs to tell the patient's body to stop doing those things, while the artifice handles it. They're nervous about doing that for Leareth because he's already going to have trouble fighting infection, but the expert doctor thought it was worth it and I kind of agree, I think? I think his body wouldn't even notice a true infection-alarm because there are so many spurious ones already.: 

:So it's like the body is an army, or a line of forts, and usually they're all cooperating and sharing resources sensibly, but now a bunch of them are overwhelmed and it's ruining morale across the whole front and also some of the officers are fools or cowards. So you've got to take over and impose some rules and fire some of the worst officers and install replacements.:

:Yes, that's a very good analogy, actually!: Shavri is looking thoughtful. :I think with practice, I could do what they're doing with Healing, and more precisely - they have very good drugs, better than anything we have, but all of their drugs affect most of the body at once, and usually they do more than one thing and some of the things are unintended...: 

Shavri can keep rambling on this and related topics for a while, in between answering Dr Chadra's questions about how things are looking in their patient's body and whether the interventions they're trying are causing any noticeable change. 

(The answer is mostly not, or at least not yet. The cytokine-blocking drug doesn't act instantly, and Leareth's body just isn't capable of doing that much with the IV nutrition they've now started, and - just, in general, he's slowly getting worse - probably more slowly than he would be without all the treatments, is the best Shavri can say - and nothing is getting better and that seems unlikely to change without Samora's magic.) 

They're counting down toward 2:30 pm, which would be about 90 minutes after Catherine's call. Marian is really hoping for an absence of traffic, and for the diamond-goop-processing to be fast - or for Samora to decide it'll work fine poured on their patient as a liquid, she can provide nice graduated jugs with pouring spouts (from the clean utility, and definitely sterilized since the last time they contained urine or other bodily fluids) for testing purposes. She is additionally desperately hoping that the spell will get Leareth STABLE and OFF ECMO and she can, maybe, possibly, have a BREAK. 

At 2:18 PM, Catherine is pulling off I-80 at the exit for the hospital and feeling like this might actually maybe work. She is Balto the sled dog. She is the Mail that Must Go Through. That guy had better still be alive to get this stuff used on him when she gets there.

She parks in the employee parking and runs to the building with the bags clutched under her arm like a football, switches to a dignified but still very quick pace as soon as she's inside, and arrives at the ICU just barely able to pretend she's not out of breath.

That woman is obviously out of breath and clutching bags! That's probably her diamond dust delivery! She would rush over and make a gimme gesture except apparently they might be able to get it out of the water it's in and that would really help their odds.

Dr Chadra hurries out to meet Catherine, with the clean graduated jugs that Marian had asked Clarice to stage on one of the wheelie bedtime tables right outside the room. “Where’s Minata gotten to - Marian said she was on figuring out drying the stuff - Catherine, show us what it looks like, is it pourable as-is, I really don’t know that we want to delay even half an hour, this guy’s labs are a trainwreck -“

Minata shows up to take part of the lapping compound relay! Once they get one of the syringes open it turns out to have the consistency of toothpaste.

"Alright, the stuff this is mixed in is water soluble, I think step one is to dissolve it in water whether we want it pourable or dry. Then we check the consistency and either filter it or pour it as is if we don't want to wait." She's grabbing distilled water as she says this.

Samora is observing these proceedings with non-English-speaking interest! "If I'm going to be pouring it it needs to be all in one container," she says to Marian.

(Marian arranged to slip out of the actual room and do the whole de-gowning routine when she saw the commotion of Catherine arriving, and Clarice plus the respiratory therapist and another nurse are still inside, as well as Shavri, but she's still kind of distracted trying to keep an eye on all the equipment through the window of the firmly shut main door.) 

"Will you be able to tell by practice-pouring it if the spell is going to work that way, or are we still just guessing? ...I don't know how long it'll take to dry everything out and he can probably wait forty-five minutes if that's how long it takes but I'm not sure - and what if it still comes out too clumpy and we just have to mix it in water again anyway..."

Marian feels like this would normally be a lot more exciting - a new medical procedure! which is literally powerful magic! and relied on a dramatic and heroic fetch quest by Catherine - but she just really really wants the patient to be stable already, on top of the sheer volume of charting for all the interventions it's just draining to be trapped in an iso room with a patient who is looking concerningly nearly-dead at her at all times. 

Poor Marian. It's too bad she doesn't have a second Share Language that would let her go through someone else. "I won't be able to try it without casting the actual spell, sorry. If it doesn't work I keep the spell slot but also the diamond dust will be all over his clothes and the floor and I don't know how I'd get it back in one place."

“…We probably shouldn’t risk wasting it,” even though aaaaaaaaaaaaaaaaaa about waiting however long it takes to dry it and what if they fuck THAT up, “but if it won’t waste the spell - and it sounds like it doesn’t need direct skin contact? - it’s possible we could cover him in a drape and, like, prop it up higher around the edges and catch all of it? I guess it’s have to be waterproof and maybe that’s not okay even if clothes are -“

She switches back to English to tell Minata that they should test drying, like, one syringe worth of it, to see how long it takes and what rough percentage if any gets stuck inside the syringes. “- Catherine, how much wiggle room do we have on the total weight, can we afford to lose, like, five percent or is that cutting it too close -?”

"It doesn't need skin contact but if the dust is fine enough to go through the cloth we would still lose a bunch if the spell fails."

"We can waste two tubes and still be alright. Try drying the syringe of three micron first, it'll be the most pain in the ass and if we throw it out we'll have all the same size."

Minata digs through the bag of tubes for the three micron one and unless someone says "No stop" she's going to mix it with distilled water until it flows freely enough to look like it won't immediately clog the syringe filter.

(No one calls to stop.)

Marian tries slurping up a syringe full without the filter connector-bit, and then screwing on the filter and seeing whether the application of firm pressure will force out only water and leave mostly-diamond.

….It’s going to take a lot of that just to get back to toothpaste-consistency, honestly? Maybe they should try microwaving a dish of paste directly (covered to avoid splatter? but with something porous so the water won’t just recondense, but not so porous that the diamond can splatter right through it?) and see if that seems inclined to dry it out in an even vaguely reasonable length of time? 

Minata is worried that won't cook off the, what does the MSDS say this stuff is in, polyalkylene glycol. They can try that, maybe in a container that is itself in a plastic baggie with the opening on the side, and then if that just gets them hot paste they can try again after dissolving it?

Google, open. 

> boiling point of polyethylene glycol

Oh no this is an unanswerable question as stated, Marian gets the Wikipedia article and polyethylene glycol isn't one thing it's, like, dozens of things? Miralax is a kind of polyethylene glycol but it's apparently a high-molecular-weight kind, low molecular weight kinds are liquid at room temperature and boil at...like 250 C. That is indeed a problem.

Does the package have a number on it that might be the molecular weight of this kind of polyethylene glycol? ...Also how much, does it say, maybe the thing they would need to do is rinse it out but that sounds like it would require repeatedly liquifying the paste in more distilled water, filtering it with the obnoxious syringe method, and liquifying it again with different water - it's apparently also soluble in isopropyl alcohol but Marian isn't sure how much that helps, except that she does vaguely recall that isopropyl alcohol has a lower boiling point and that would in theory make the final round of paste slightly easier to microwave dry... 

It actually says polyalkylene glycol but that stuff also boils at really hot. She's already got one mixed in water, if that one turns out to take way too much microwaving they can try alcohol next. The one with water in it is gunking up the filter quite quickly but it turns out that it is in fact the diamond dust gunking it up and scraping it very thoroughly out into a container for microwaving gets the filter back to mostly functional again. This is going to take ages, though. Push through the filter, disassemble, scrape. Actually they should maybe just leave the filter cartridge in the container, except what if it catches fire in the microwave. 

Meanwhile, elsewhere: 

Miracle or Malpractice? Strange Happenings at Renown Regional

A Gazette-Journal reporter was invited to the Intensive Care Unit at Renown Regional Medical Center today to investigate reports of "miraculous" healings conducted, not by a medical genius, but by a priest of a previously unknown religion associated with the popular "role-playing game" Dungeons and Dragons. . .

. . . wearing medieval-style armor, and a nurse claimed she spoke no English . . . 

. . . Nonetheless, patient satisfaction seems surprisingly high. One patient's sister described her brother's recovery from a car crash three weeks ago as "absolutely miraculous" . . .

. . . "It's not a joke. I saw a man's skull grow back. I saw a guy the doctors had given up hope for sit up and repent of his sins." . . .

It is unclear at this time whether insurance will cover this treatment. When the attending doctor was approached for comment, he responded, "First of all, who the (expletive) let you in here . . . " . . .

Further investigation is in progress and updates will be provided when available.

The article includes a picture of Samora and a picture of two people in hospital gowns hugging each other.

Wow Marian does not chemistry. ...Google thinks that polyethylene glycol is a subtype of polyalkylene glycol, which is an umbrella term, but yeah that doesn't super help. 

...Maybe she'll text her dad, who is an Actual Chemist, juuuuust on the off chance that there's some obvious hack here that doesn't involve, like, access to an entire university chemistry lab. They should possibly try to arrange that if they're going to have to do this again tomorrow but that's not today-Marian's problem. 

She texts her dad, and then calls Clarice on her hospital phone extension rather than actually stick her head into the positive pressure iso room and lets her know that, uh, they are not confident the diamond dust will work if it's a liquid or that they can recapture it all if it fails to work and so they're going to try to dry it and it'll be, like, an hour. If the patient is deteriorating fast enough that they don't think he's going to last until everything is dry and ready, then they can just mix it all into water again but they do need, like, five minutes' notice.  

...And then she's going to help with the stupid chemistry project, because Clarice and Chris are tag-teaming covering for her right this second on documenting ECMO flowsheets and this is the closest thing she's had all morning to a break. 

On the other side of the country, Dr Chen skims some of the Google search results for breaking news in Reno, Nevada. 

(She's mostly not expecting to find anything; it's probably a ??training scenario??, which wouldn't be in the news, and if there was some kind of radiation leak incident it would probably be classified, but - this entire situation is surprisingly compelling to think about obsessively, and she's not going to keep calling the ICU, because if it's real then they're going to be incredibly busy and don't need their elbows jogged.) 

....

....That does not actually unconfuse her in the slightest! Honestly it would barely unconfuse her even if it was April 1st. She looked up Dr Harrison and he doesn't seem like the type to waste a bunch of people's time with an elaborate and very unprofessional prank?? 

She pulls up the lab results email again and stares at the numbers unhappily. 

...She emails a pile of her colleagues asking if anyone, maybe, possibly, was in med school or residency or college roommates with any of the physicians on staff at Renown Regional Medical Center, such that they would have the person's contact details and the person might be inclined to answer a question for them. 

Dilute. Mix. Transfer to syringe, squeeze water (and poly-whatever-ylene glycol) out until the filter clogs, remove filter - without spilling the remaining liquified-paste - and scrape off with a scalpel into a sterile metal kidney basin stolen from a procedure kit, replace filter and try some more - she would be tempted to swap filters more often, they have an enormous box, but what if they end up with like 30% of the diamond dust gunked inside the filters, they should find out if the fillters are microwave-safe and they can dry them out and shake the dust out of them once it's no longer mixed with water... 

This would be more satisfying if Marian wasn't in a state of slow-motion freaking out that her patient is going to code before they're actually ready. 

Will they be able to microwave it in that metal basin or should Minata find a different container?

Catherine puts a filter in the microwave for thirty seconds and watches it like a hawk for signs of catching fire. It doesn't catch fire. She joins the dilute-mix-filter-scrape party.

Samora can help too! It looks like the sort of thing she can imitate without any special knowledge. It's nice to have something useful she can do that requires neither language nor spell slots.

…They should not microwave metal. They probably shouldn’t microwave plastic either, they want, like, glazed ceramic? The ramekins that the kitchen sends for soup and pudding and stuff might work but Marian is not psyched about washing a used one in the staff room sink, maybe they should call the kitchen and get a delivery of ones fresh from the industrial dishwasher…

Dr Chadra does, finally, manage to escape the patient’s room again, and hide in the conference room to try to call Dr Chen back. 

“Hi, it’s Dr Chadra from Renown, have I reached—“

“Were you aware that your unit made the news today?” Dr Chen says, a bit waspishly. (It doesn’t explain everything, or even come close, but her top theory right now is that a bunch of med students are the ringleaders on a stupid prank and “Dr Harrison” wasn’t.)

“I - no - what does that—?” Dr Chadra had a whole script mentally lined up and it’s now throughly thrown off. “Why do you— ohhhh. Shit.” 

The journalist!!! He forgot about that!!! Dr Harrison brushed it off with a confident pronouncement that obviously no one would take a tabloid journalist seriously, but in hindsight obviously the specialist in Tennessee who they just dumped a bizarre and concerning and pretty fake-sounding case on would be inclined to get on Google. Awkward.

That…does, in fact, sound like the reaction of someone whose mind was entirely on something big and important and genuine and who was bemused at the concept that they would have had time to read the news today.

“So what did you call about, if it’s not to confess that this is an overly elaborate med student prank?”

…Back on the script. “Your expertise would be invaluable on this case but Dr Harrison isn’t comfortable saying more about the, er, biological cellular regeneration treatment over the phone. If you would consider flying here and signing an NDA, we can read you in on everything.”

“And I’ll be listed as a coauthor when you publish the case study later, huh? Is that what he’s thinking.” If this ISN’T a baffling prank then this would, in fact, be an excellent bribe for cancelled everything this week and getting on a plane to the west coast on zero notice.

That was not part of the script but Dr Chadra can react on his feet. "Probably? I assume so? I mean, like, that seems super reasonable, if you're consulting on it?" 

"...I need to think about it."

What she in fact needs is to find someone, anyone else who can confirm, as a third party, whether their puzzling and incredibly concerning radiation syndrome patient actually exists. If the patient is real, then - well, maybe she doesn't need to understand what the actual fuck is happening in Reno to know that they need her help. 

Well, she's in, what, Tennessee or something, she's not getting here until late tonight one way or another and by then either their patient will be dead or he'll be fixed or he'll be temporarily stabilized and they'll have until tomorrow morning to figure out what the fuck to do next. 

"Okay," Dr Chadra says.

“Keep emailing me updates,” Dr Chen says after a brief unsuccessful battle with temptation; she’s full of desperate morbid curiosity. “You’re setting up to do your secret treatment intervention again, yes? I’d consider getting the full set of labs immediately before and after, for the comparison.” 

...That's a good idea, actually, given that it's now looking like it could be another hour until they can use the Restoration and Leareth's labs are probably still getting worse - it's not imminently a life-threatening crisis but only because he's on all the life support - and it does seem valuable to know exactly how much the Restoration helps with all the myriad horrible problems. 

"Will do," Dr Chadra promises. "I'd better get back to it." 

Leareth is hanging on but, if Shavri's Sight is tracking the same things then his labs are definitely going to be getting worse. His cardiac output is deteriorating again, probably from a mix of counterproductive response to inflammation signals and the fact that his cells are getting less and less able to use all the oxygen being moved around in his blood. Oh and possibly the tiny arteries that feed blood to his actual heart muscle are having inflammation-related tiny blockages? ...It's not an emergency, they can go back up on the ECMO flow rate, just, it's pretty non-ideal, if Leareth's heart stops then that might make him non-targetable by Golarion magic again even if they're supporting his circulation. 

If Samora is not 100% definitely required for preparing the diamond dust then Shavri would kind of like her back in the room and on-call to cast Stabilize? 

Absolutely. She prepped the Restoration before Catherine got back so there's nothing else she in particular has to do. She can stand here casting Stabilize every six seconds if that's what makes their odds best, or she can stand here with one on the tip of her tongue waiting for Shavri to say Now.

She still has one Remove Disease, three Remove Sicknesses, and an open slot that can all be turned into Cures, plus three channels.

Wow Shavri is really tempted to demand that Dr Harrison authorize using both the Remove Disease and another Cure immediately! But it’s probably not worth it, they’re going to have an entire night to get through after this and the pneumonia continues to be very far down the list of Leareth’s worst problems, and it’s not clear how much a Cure will help right now, increasingly many of his problems look more like deteriorating Endurance than like injuries. Probably they should hold off unless he starts bleeding internally or something - he’s not, right now, he’ll just be in serious trouble if it does happen while his blood’s ability to clot is destroyed.

Casting Stabilize every six seconds seems great, though, if it’s not going to wear Samora out and result in her being exhausted later.

Marian continues to work as fast as she reasonably can, which is not that fast because it would be so stupid to fumble a container and drop a bunch of their desperately-collected diamond dust on the floor. 

Doooooes it at least seem like the final product, after three rounds of dilution and re-filtering with water and rubbing alcohol and then microwaving the paste in a clean ramekin inside a sideways biohazard bag, is a sprinkle-able powder? 

Marian's phone buzzes in her pocket to announce a reply to the text she sent her dad most of an hour ago. 

Hmmm. You might be able to evaporate away the solvents. I don’t think you could burn them away, since diamonds burn quite nicely. I’m not sure a centrifuge would work. There are recipes to make diamonds from methane.

There are WHAT NOW 

Marian immediately drops everything she's doing to google "recipe to make diamonds from methane".

It sounds like this is in fact just one of the industrial production methods, and requires a high pressure high temperature chamber (and a pre-existing diamond crystal to seed the carbon deposits). 

....In hindsight it's not actually surprising at all that there does not exist, like, a recipe to make diamonds out of methane IN YOUR KITCHEN, which is kiiiind of what her dad made it sound like, and you would need an actual chemistry lab or something. 

Marian passes on that diamonds are APPARENTLY FLAMMABLE and they should be careful about not microwaving them past the point that all the visible water has evaporated off in case the microwave can get them hot enough to CATCH FIRE. Maybe someone else already turned up this fact on Google - and it does feel vaguely not-totally-surprising, possibly it's something she learned in school once a really long time ago - but it had not been top of mind for Marian until now. 

She keeps going with the tedious process. 

(Diamonds being flammable doesn't come up very often, but when it does come up it's a big problem!)

Casting Stabilize every six seconds is no problem; Samora doesn't get sleepy and isn't going to get worn out just from making spell gestures.

Dilute. Filter. Scrape. Nuke. Dilute. Filter. Scrape. Nuke. This is boring but medieval alchemists would think they were the coolest motherfuckers. It does seem to be coming out pretty powdery but Catherine doesn't want to get it all over her gloves trying to sprinkle it. Sometimes it turns into a sort of crumbly cake in the microwave but it's easy enough to crush it back into powder with the edge of a spoon. Putting the microwave on half power makes the paste way less prone to blorping onto the inside of the baggie for only a little longer per nuke. As soon as they're done she's going to order a can of the dry grit from McMaster Carr with one-day shipping so they never need to do this again, and then she's going to give Dr. Harrison his credit card back.

They get to the point that Shavri thinks the occasional Stabilize is doing something, because Leareth keeps trying to slide from his horrible-but-surprisingly-functional heart rhythm into a more horrible and unsurprisingly-less-functional one, which would not in fact immediately kill him because the artifice at this point providing two-thirds of his circulation but Shavri isn't complaining that the spell considers this a targetable step-toward-dying that it can reset. 

...And then Leareth does start bleeding into his gut, which Shavri catches immediately because she's watching very closely for it, and that does justify a Cure even though Leareth would benefit from one a lot more after the Restoration, it doesn't seem like it can wait - and Leareth is not holding life-force very well but it does actually manage to get just enough of the accumulating injurylike damage to his heart that his electrical rhythm steadies out on the horrible-but-functional thing - 

Marian finishes filtering-and-nuking her most recent syringe of the three-times-rinsed diamond and delicately scrapes it into the central bowl of powder and de-cakes some of the crumbly bits with the edge of a spoon and then goes to schlorp up more and the container of diamond liquid is empty???

Are they. Done. Are they ready???? Is that definitely all of the diamond dust syringes, they weren't wasting a lot with the method but they don't have a ton of wiggle room, but if they're actually ready then she should maybe be gowning up to rush in there right now? ...Not rush. Make a careful and stateful trip in there. Possibly with the dry-diamond bowl inside a biohazard bag in the unlikely but horrible event that she manages to trip or something. But it sounds like if they're ready she should definitely not delay???? 

Shavri is skimming surface thoughts outside the room occasionally - the room feels like it should be shielded, what with all the positive pressure isolation, but of course nothing is shielded against Mindspeech here - and she's considering that enough reason to relay to the nurses that now is probably a good time to draw all those labs they urgently wanted. And poke Samora to let her know that her materials might be incoming soon?

Excellent! The current situation is mostly stable (heh) but they're metaphorically running in place and Samora is not a fan. She's ready to go, just stick a bowl in her hand.

There are a lot of "pre" labs to draw but fortunately their guy has all the lines and Clarice has no trouble pulling all the tubes before Marian actually makes it into the room. 

Here she is! Gowned and masked and so so so carefully carrying their precious bowl of purified diamond particles over to Samora!

(Wow her patient looks concerningly awful! Marian isn't entirely sure if he's actually gotten worse in a visible-at-a-glance way or if it's just that she was desensitized before and has now spent an hour outside of the room and forgotten how bad he looked, but it's definitely punching her in the eyeballs now.) 

Samora has seen worse but only on ghouls. She takes the cup of diamond dust, picks up a pinch and sprinkles it back into the bowl, and smiles in satisfaction as she starts adding more in a careful pattern of lines and curves on Leareth's chest. After the first line is complete she starts chanting in Celestial, a prayer of healing and life and the steadfast endurance that overcomes all ills in time.

When the last graceful S of diamond dust is complete and the last "by my will and Yours" falls into silence, all the diamond dust on Leareth vanishes.

And abruptly Leareth looks enormously less like he's inches away from dying!

The ECG tracing on the monitor transitions from the bizarre ventricular rhythm to something almost normal. His blood pressure bops up to a beautiful 118/73 and then...keeps going up, probably because he's getting a suddenly-totally-unnecessary amount of pressors and also an extra 3.5L/min of oxygenated blood squirted back into his descending aorta. 

He doesn't move, and his breathing doesn't change, because he's sedated and paralyzed and on a volume-control mode on the ventilator. But there's some indefinable sense that he would breathe okay on his own. 

Wow shit okay he does not need to be maxed on norepinephrine and in fact possibly he needs to be on zero of it! And they should start weaning the ECMO flow rate because it sure does not super look like he needs it! 

...This is not a stressful problem. Like, it's mildly suboptimal for his blood pressure to be rapidly approaching 150/100, but Marian is having a very hard time getting worked up about it when her entire subconscious mind is feeling deeply soothed by her patient being healthy-person-colored with great peripheral circulation. 

....Clarice draws labs. 

Most of them will need to be sent off - along with the "pre" labs already bagged on the table - and take twenty minutes to come back even if they're processed at the very top of the queue, but the iSTAT blood gas is almost immediate. 

Before, they were getting moderately worse numbers than the last one threeish hours ago: pH 7.04, pCO2 39, pO2 288, HCO3 9. Lactate on its way up again and now hitting 17.2.

Now it's...very close to normal? pH 7.32, pCO2 38, pO2 285, HCO3 19, lactate...only down to 6.8, which is still pretty high by any objectively standard, but that's still a completely physically impossible decrease to happen in two minutes. 

It's not very dignified to grin and bounce slightly while she decreases and documents decreasing the pressors, but Marian is doing it anyway!!!!!