- people are screaming, now, and they're not going to finish the parachute in time, and it's - pointless, to feel like it matters whether she finishes her last-minute referendum of who she is as a person and all the choices she's made.

Her existence has made the world better rather than worse, which isn't bad for someone an entire standard deviation below average intelligence and more than that on numerical ability specifically. That matters to her. She's been happy. That matters to her too. And - and nobody needs her, to hold anything together, Civilization has its protocols and will be fine and absolutely nothing will fall apart in her absence and you would think that might sting, but instead it's oddly reassuring. 

She doesn't scream. Not at all, not even at the very end. It won't make a difference to anything, but it's the one thing left that she can control. 

It hurts, but less than she had expected - even taking into account private information she has about her pain tolerance, and her knowledge of how bodies react physiologically to adrenaline - and not for very long. 

What. 

She also wasn't expecting there to still be anything afterward! She really, really wasn't expecting that! It's very surprising! 

Some other surprising things, which Merrin might notice in any order:

- She is completely uninjured.

- She's not in the wreckage of a plane, and is instead in a small apartment.

- Which is furnished at an unusually low tech level.

- There is a man looking at her in great surprise.

- When he says, "Where on Earth did you come from?", it's not in Baseline, but is nonetheless perfectly understandable.

- she falls almost immediately into a random-bystander-emergency-response* mode, because she is at this point, clearly, well outside the bounds of both any known Civilization protocols, and her intensively-overtrained skills, and also she is really not at her best in terms of reasoning ability.

"There was a plane crash," she starts, and only then realizes that - apparently - neither his words to her, nor her response, were in Baseline. 

What. No, seriously, though.

(...She's not actually sure how surprising this should be? Or even what direction she should be updating in after having observed it? She's ever read discussion forums, because she may mostly not have time for a personal life but she doesn't have zero time for it, and - Merrin would absolutely not have claimed to be within the top 10% among dath ilanis most prepared to randomly wake up in a ??simulation?? -) 

((- whatever this even is, that she's experiencing, she definitely needs to make some kind of update about the nature of reality because she IS experiencing it but maybe she's just delirious in a hospital after having been improbably rescued from the site of the plane crash -))

(((...And she is apparently now trying to go meta on that thought, which - she doesn't actually know any of the philosophical frameworks she could use to approach this productively, because she's -1 SD on intelligence and why would she have prioritized learning that when it wasn't even interesting–)))

...Stop. Focus. 

Merrin has not, in general, been prone to the common dath ilani problem of getting stuck in excessively-deep piles of meta-thoughts, because she is (as she well knows) in some senses cognitively lazy and low-curiosity, but she is nonetheless very prepared to notice herself falling into that particular failure mode. 

........Right. She's now noticed it. Now what. 

- probably the most useful thing she can do right now is just to clearly communicate the information that she has (and prioritize communicating information she has more reason to think is private-to-her)?

"- Sorry, I - I wasn't expecting this. I - so my recent memories would indicate that I was on a plane and the plane crashed and I should've died? Except apparently I'm here, now, instead."

*A two-syllable word in Baseline.

So the most obvious thought here is that she's insane, but she literally just appeared out of thin air, and also she doesn't look insane. Her voice is steady and her eyes are focused and she looks, actually, more present in reality than a lot of people Eddie has had to look at lately. Which leaves him to conclude . . . nothing. He has no conclusions. He should try to say something useful anyway.

"I just saw you appear out of thin air! You're in New York. Where were you trying to go? And who are you? I'm Eddie Willers."

(The young woman in front of him, currently scrambling to her feet and looking around in a noticeably-overwhelmed but nonetheless calm-and-steady way, is wearing clearly foreign but very comfortable and functional-looking clothing, and has her hair cropped boyishly short, and is, from the muscles around her neck and collarbones, visibly very fit.) 

- Merrin briefly considers whether she should conceal any of her current (non-private and non-infohazardous) information, and decides against, she's natively very bad at it and also she's so confused and also - well, maybe she's in some sort of bizarre simulation which is running one of those adversarial-strategy-games that she's vaguely aware exist, but even if that were the case, she really isn't interested and would rather visibly nope out from the start. 

"....Okay, um, so the first thing is that I - seem to know your language but I don't actually know how I know it, I definitely haven't learned it before. I guess it makes as much sense as anything else that I'd appear out of midair?" Assuming this is a simulation being run with information extracted from her miraculously-retrieved-and-frozen brain, which probably isn't even the most likely scenario here but it's the first one Merrin was able to concretely form. "I - wasn't trying to go anywhere in particular? Since I thought I was going to die and all. What's 'New York'?" 

Pause. 

"- Oh, sorry, and my name is Merrin. I appreciate-knowing-of-you*, Eddie Willers." 

....Wow that came across really weirdly in the local language which she apparently inexplicably understands and can speak? It took so many words to say? And now apparently Merrin is experiencing a Social Anxiety. Which she hasn't felt since she was a teenager, and really didn't miss. 

*A rarely used Baseline greeting, mostly seen in the context of science fiction stories. 

"You don't remember learning English? What language do you know? Where are you from?"

Most of the places that don't speak English are People's States, but most People's States don't have much in the way of airplanes, but maybe that doesn't mean anything because hers crashed. What is this person's deal?

Also, people don't just appear out of thin air! Even with everything else going on he had really thought that at least reality was governed by physical laws and that was a comforting thought, and it turning out to be less than completely reliable is making him kind of miserable on a level he isn't consciously looking at.

Merrin never made this her primary focus, but she has any actual training in reading people's emotional state from their body language. It was relevant in her emergency-situation training - where you can't expect to have time to explicitly communicate everything - and also in her medical work with younger children, and also in all the various scenario-rehearsals where the premise included adversarial-deception-dynamics. 

She notices that the man is uncomfortable and alarmed. She can guess that this is because her sudden arrival in his - ??apartment?? - is just as unexpected and baffling to him as it is to her. She has a lot of uncertainty on that, though. 

"I'm from - Civilization?" she says, uncertainly. "I speak Baseline?" 

(The capitalized-proper-noun nature of these terms doesn't super come across, when spoken out loud in the language that she inexplicably seems to suddenly know, and Merrin can notice this.) 

"I - gah, I'm really not in the mood for this right now, but - I think maybe we need to back up several steps and question some premises here?" 

She really hopes he's going to helpfully step in with something, because questioning premises sounds very exhausting; she knows all the right mental paths to follow and can gesture at the right concrete questions-about-the-world to ask but she would really rather not, right now. 

". . . I don't recognize either of those. Do you want a map of the Earth you can point at? Or some facts about New York?"

Oh, wow, concrete offers of information that is especially likely to help her confirm-or-deny any hypotheses she's managed to form! 

(...She hasn't managed any, yet - unless you count 'this is a simulation' but that doesn't help her make specific predictions - this is kind of embarrassing*, if she'd paid more attention– but why would she have prioritized that, every single thing about all of this is VERY SURPRISING and literally no one should plan their life and training based on being maximally prepared for the hypothetical scenario where -))

((Okay, stop, she's getting distracted trying to shove the current situation into a framework she understands, and it makes a lot of sense, why she wants that - why it's the path of least resistance, right now - but that doesn't mean it's correct -))

"Yes. Both of those sound very useful! - Also any facts you can give me about the major cities that 'New York' has trade relations with?" 

*This word has a different connotation in Baseline compared to English, with less focus on external social perceptions and more on the internal sense of one falling short of optimality (in this case, epistemic optimality).

What an interesting way to phrase that, he thinks as he walks to one of his several bookshelves and grabs an atlas. Probably means she's a businesswoman and not from a People's State. (Or there are still businessmen in People's States; he only has the newspapers' word for it that there aren't, and what's that worth.) 

"New York is the largest city in America. It's a center of industry; I work at the headquarters of Taggart Transcontinental, the largest railroad in the world." He says this with the quiet but obvious pride of a knight naming his lord. "The other center of the country is the state of Colorado; new ventures are starting there every day." 

The atlas has a map of the United States and one of the world. It's several years out of date, but Eddie has carefully pencilled in "People's State of" in front of the names of a couple more countries.

…Wait what, she’s also mysteriously able to read this language which has an alphabet and script that are very obviously not dath ilani? 

- That is definitely not the highest-priority mystery to pursue right now. (Actually, Merrin would really prefer if there were ZERO mysteries, because she just went through a lot and used her brain to its ful extent and she's tired, but that too is a pointless frustration and she sets it aside. Effortfully.) 

She looks at the map provided. 

She...thinks that's a continent-shape she recognizes? Every single other thing on the map is unfamiliar, though. Which isn't surprising, per se, but somehow still manages to be disorienting. 

(Did she get kicked forward in time? That - also seems like definitely the kind of thing that doesn't actually happen, but surviving a fatal plane crash and finding oneself 'appearing out of thin air' in someone's office is ALSO something that doesn't actually happen, so.) 

WHY is she still feeling socially anxious about telling this man that she doesn't recognize anything on his map and is therefore going to inevitably make his day even more complicated. It's not like she can by sheer effort of will decide that the situation is any less bizarre and inexplicable than it actually is! 

"- I, um, I - don't recognize any countries on your map. ...To be clear I'm not actually surprised that I don't? I mean, relative to - everything else about this situation."

If she were smarter and had higher verbal ability, then she could probably say something more helpful, even in this inexplicably-acquired language which is terrible for actually conveying what she's thinking without her having to put (what feels like an unreasonable amount of) effort into it. However. She isn't, and she's had a very overwhelming last few subjective-minutes, and she apparently isn't, actually, very motivated to try harder at this.

Dagny would have some brilliant six-word response that would make Merrin feel like everything was going to be okay because Dagny is an unstoppable machine of making everything be okay. But Dagny is even busier than Eddie is right now and Eddie had been drawing up a freight schedule instead of going to bed when this happened. 

At least it isn't another goddamn law.

There isn't, really, any reason not to ask. "Is your country a People's State?" He doesn't really know what goes on in People's States but they might not have accurate maps, especially regarding America in particular.

....And that word, in a foreign language she didn't speak ten minutes ago and has no idea how or why she now understands, sure does come with a lot of connotations! Mostly connotations that Merrin can't even begin to wrap her mind around. 

"I - um - no. I'm pretty sure I'm not. Actually, can you unpack a bit for me what 'state' means? I'm...pretty sure I'm not - from here. I think this is an entire different Civilization somehow and no I don't have any good hypotheses for how or why I ended up here." 

Is she in a fantasy novel. It's clearly not a Science novel because this place looks weirdly low-tech and she's getting the vague sense from half-understood word connotations that the 'People's States' are probably worse. 

"A state is--a part of the world, with a government and a set of laws and a set of people who live there. Uh, in America states are usually called countries because the units America is divided into are also called States, sorry about that. Colorado is a state in the part of America sense. New York is a state but we're in New York City which is a city and a lot of people just say New York to mean the city because it's the biggest city in the state by a long shot. Did that make you less confused?"

It had never occurred to Eddie what a mess the word "state" was before. He feels embarrassed about the English language, like a host who fails to notice his dirty floors until a guest arrives. At least his literal apartment is acceptably clean.

"...That was a clear and informative explanation and I think I'm more confused now but that's not your fault. There - are places with different Governance and different Law? How different?" 

(That feels like it can't possibly be a stable equilibrium although when Merrin queries herself on why she mostly gets 'math reasons???', and maybe that works differently at lower tech levels although this place doesn't seem that low-tech, their language has a word for 'airplane' and her five-second guess would have been that having airplanes would be close enough to dath ilan tech level that the stable equilibrium would be the same, although that is a WILD guess and she's never particularly thought about this question before and maybe if she were a Keeper who knew the screened-off history and was three standard deviations higher intelligence then it would make perfect sense.) 

After a pause:

"- I should actually get a summary from you on what Governance is like here, I guess. Or a book on it, if that's easier?" 

"Yeah, that's--probably a good idea. Things are changing quickly enough that I should just explain it myself, all my books are out of date. I'm just going to pretend you're--from the lost city of Atlantis or something, just interrupt me if I'm not giving enough context or saying too many obvious things."

"So, most of the world is People's States, where all the industries are run by the government and there's no private property. They're dirt poor. Nobody ever leaves, I don't know if they can't or if they just don't think there's anywhere better. America and the other few countries with private property send them aid, food and machinery and stuff--not that we can afford it!--never mind. . . . Anyway, the current government . . . they've been passing all sorts of laws, I don't know to what purpose, there's got to be a purpose. The Equalization of Opportunity Bill, that doesn't let one person work in more than one industry. The Anti-Dog-Eat-Dog Rule, destroying the small railroads . . . I don't know where it's all headed. Maybe the same way as the People's States, for all that. Is where you're from different?" Over the course of this series of sentences, his face has gone from that of a man with an interesting puzzle to the face of a soldier in a trench whose eyes have forgotten how to see past six feet. It looks less natural on his face, but more usual.

Wow that's incredibly concerning! Also incredibly confusing! Although...less confusing in one sense, maybe, if things are changing fast then it's got to be because the current equilibrium isn't stable, right, that's how that works? 

She has SO MANY QUESTIONS and is having some difficulty teasing them apart and putting them in order so she can actually ask any of them.

"Y...es," she manages, after another pause. "I maybe don't understand what you mean by 'there's no private property', I - don't see how taking the literal interpretation of that lets you have an economy at all? Setting aside global trade, how would you do trade internally, what does it even mean to have an industry if it's not selling things because people can't own things, what actually happens to the goods being manufactured...?" 

"The governments decide what gets made and who it gets given to. I heard they plow their farms with horses, now, because they have no tractors."

They plow their fields with what now? Merrin sort of feels like she needs a DIAGRAM to even picture what's being described there. Probably it would make slightly more sense if she knew HISTORY. Or maybe if she had read more of the Science Fantasy genre where a protagonist encounters pre-industrial aliens; she mostly hasn't, the genre as a whole tends to assume that the reader wants way more math in their leisure reading than Merrin is usually in the mood for. She knows what to do if menaced by animals in the wilderness, that's an Exception Handling cert, but she has no idea how one would go about using animals for industry. 

It's also been nearly a decade since she last thought about principles of economics in any detail, when she was taking those classes, and she's pretty sure she knows enough to make more sense of this than she's managing so far, but she's having to dig for it. Why couldn't she have instead ended up somewhere that had easier problems to understand, like, say, a massive natural disaster that called for an endurance EMT. 

"I - okay, I'm going to paraphrase what I think you're saying to make sure I'm understanding it right. In a People's State, all the capital is owned by - the legal entity that is their government? As opposed to the individuals who work in Governance, which would be - sort of like the government was a corporation that happened to be the only one in its region and owned everything, which to be clear I also don't think would actually work but at least it'd give the leadership some incentive to use efficient processes so they could get more profits. But it sounds like, uh, no one including the people working in Governance are going to personally get any of the gains-from-trade if they improve a particular industry, and so they're not incentivized to try that hard? And, uh, if the government decides that the factories should make, hmm, shoes or whatever, this year, instead of tractors, then - nobody who's making that decision has a short-term incentive to think about whether it's the right call, and the people actually working in agriculture, who presumably have a lot more context on how useful tractors are, don't have the option of investing in a different company instead that could open a competing factor and profit off the tractor shortage?" 

"Yes, that all sounds right. I'm not sure there's a difference between the legal entity of government and the individuals in it, or that they would respect it if there were, but--nobody seems to want to make things better. No, not nobody. Dagny is trying to fix it, Henry Rearden is trying to fix it, some other people too--they'll keep building things, whatever happens."

"And, uh, there are places that are People's States now and didn't used to be? And the state - country - we're in now isn't a People's State but you think it might be headed that way? I...uh, I think I'm still pretty importantly confused about why anyone thought that was a good idea." 

Eddie answers almost in a whisper. "I wish I knew . . . but I'm afraid to find out."

It's strange, that he's admitting that, when he's admitted it to so few people. But Merrin is looking at him like she really wants to know things, like she cares about what's happening, and it's such a rare look that he finds himself wanting to explain everything, even the things he doesn't usually want to think about.

Merrin's interpersonal instincts are screaming that this is someone under a LOT OF STRESS and that this conversation is likely to be more productive if she steps back from problem-solving for a moment and focuses on reassurance, except that it doesn't feel like any of her standard scripts for reassurance are applicable here and she has no idea what to say that won't somehow make him feel worse. 

And also it's bothering her a lot, actually, that she doesn't understand why THIS seems to be the equilibrium that the current unstable situation is sliding toward, and it feels really pressingly important, like an itch she can't reach to scratch - people do things for reasons, and Eddie Willers is apparently afraid to know what those reasons are and THAT is also bothering her to a kind of surprising extent and she wants to poke it even though her social instincts are screaming that he needs zero poking right now. 

...And there's also the unresolved mystery of what she's even doing here, what's happening, what is reality made of right now - if she imagines being the sort of person who did read Science Fantasy with loads of math in it for fun, she would probably be thinking something about quantum mechanics and many worlds and anthropics, but in fact she is not that person and can only get as far as those concepts sort of bouncing around in her mind without finding any traction. 

"I'm sorry," she says quietly. "I - it feels really obvious to me that the thing the People's States are doing is just going to predictably result in nobody having tractors anymore, and that - trying to do that here is a terrible idea - actually I would've thought that should be obvious to people who aren't me, too, I guess maybe once Governance is already doing that thing then maybe that's a - hard equilibrium to get out of again? Because in the short run nobody has the right incentives to make incremental changes? But if people here know that the People's States are poor, then - that seems like a really clear reason to not try the same thing and expect it to somehow go differently this time?" 

"I think it's terrible too. Things are different, where you're from?" 

Where is she from? Why has she never heard anything about the rest of the world? He has a vague image of some secret country, that hides itself from everyone else and tries to pretend they don't exist, but that doesn't explain how she got here. And she doesn't act like she didn't know anything about the rest of the world, she acts like she knew about a whole world and it was something other than this.

"...Yeah. Really different. I - we have different - uh, your language doesn't seem to have a good word for the thing I mean, we don't have different states, there's one Civilization and one Governance and one Law but different...specializations, I guess? Because people are different and prefer their cities be different ways, you can't have one way of a city being set up that makes everyone happy. And some industries are centralized to particular areas. But everywhere in the world has private property, because - um, I guess the way I'd put it is that that's a very basic component of a multi-agent-optimal setting, where everyone or at least almost everyone has an incentive to participate in the system because they get something out of it, they can personally expect to capture some of the gains from work they put into building things or inventing things or improving the efficiency of an industry in ways that produce more wealth overall? We - um, obviously there are some people who are poorer than others, that's - sort of inevitable from the premise, right, if people personally capture some of the gains-from-trade from their participation in the system then obviously some people are better at that - but we don't really have places that are a lot poorer than others, and if we did that wouldn't be stable, someone would be able to profit from going there and building a new industry. I think. This really isn't my specialization and it's been a long time since I studied it in school. ...I don't know how I ended up in an entire other world, maybe I'm in the future - or the past, I - only Keepers know our history and so I can't rule out that Civilization went through a stage like this and honestly it does seem like the kind of thing that would be a -" what they don't even have a single concise WORD in this language for 'infohazard', that's terrible and also EXPLAINS A LOT, "- um, a - piece of information that would potentially be dangerous to a lot of people's epistemics or reasoning ability or emotional stability, if they knew it. Anyway I...think possibly if I were less distracted because of the thing where I spent the last few minutes before arriving here putting very high odds on myself permanently ceasing to exist, I would be able to come up with a hypothesis for how and why any of this makes sense, but right now I'm not really managing that." 

Everyone has an incentive to participate in the system because they get something out of it.

For a moment he looks at her like a man trapped in a collapsed mine-shaft, looking up at a shard of unreachable blue. Then he tears his eyes away to look at the floor, for a moment, before looking back neutrally at her again.

"I'm sorry. Do you want something to eat and drink?"

Merrin has no idea what part of the things she just said is causing him to make that face! Her top guess is that despite her not having said it out loud, he's drawing the obvious conclusions about the nature of his reality, having the information that she suddenly appeared from thin air after a series of events that should have just led to her ceasing to exist, and that - gah she doesn't remember enough from school to even fully make sense of this, but - generalized structure of realityfluid simulating a world in a way that allows it to suddenly add her to it...? 

Or maybe he's just upset because he's embarrassed by his Governance making what are clearly ill-thought-out decisions, which even despite her utter lack of any specialization in the topic, Merrin is clearly able to notice. 

"Yes, that would be very kind of you. Although it's not urgent, I -" it's probably very meaningless to say she ate an in-flight meal less than an hour ago, her body clearly didn't transition here with its state exactly preserved, "- I'm not desperately hungry or anything." Except for ANSWERS. 

He disappears to the kitchen for a minute (it's mostly an excuse to get a minute alone) and returns with a roast beef sandwich on a plate and a glass of water. 

"Do you want to--try to contact your family? Or find the part of the world you're from? I don't understand any of this, but I assume you want to go home if you can." Somehow he expects that any familiar thing she looks for will have vanished from the Earth as suddenly as she appeared. She's real, but she's somehow apart from reality.

She gulps most of the water, and then tentatively tries a bite of the sandwich and finds, somewhat to her surprise, that she is apparently hungry enough to be delighted about food. 

"I - honestly I hadn't gotten that far yet. I mean, yes, obviously, if there's any way to get a message back then I want to do that as soon as possible. Do you have a– probably you don't, you don't seem to have a word for it, but - in dath ilan we have a - global interconnected communication system and information-archive, that's how I would normally send a message. I think that I would be from here," she can point out a spot on the map, it's in the area labeled as the People's State of Canada, "or, well, it's where my parents live, I - sort of move around a lot and I'm traveling half the time anyway." It's more convenient if she can just go where the relevant trainings are based, and she minds it a lot less than the average dath ilani, apparently.

"Um, and if I can in contact with home then I can get advice and guidance and maybe they could send someone else who's more qualified to figure out what's going wrong here and stop your entire world from de-industrializing which sort of seems like the way things are headed right now. But I - kind of suspect that in a scenario where that were possible or even coherent to posit, I also wouldn't be here."

"You could send a telegram? I don't think we have the thing you mean, no."

It occurs to him, belatedly, that Merrin might be lying about various things including not knowing how she got here. But that doesn't really make him less confused about it all, and if she was deliberately trying to get information out of him she'd've asked more pointed questions. She hasn't asked anything about Dagny or Taggart Transcontinental yet, and that's the only reason someone would have to try to con him, there's nothing else interesting about him.

"I guess." Again, she apparently knows the word, but the concept it seems to be associated with is not a familiar one. "That's a...message in text, but transmitted almost-instantly using a similar mechanism to the one for conveying real-time voice conversations around the world? Can you direct it by a person's name or only to a particular place, because my hometown is apparently not on this map." 

The whole thing where she suddenly speaks this strange and honestly rather poorly designed language, with no memory of learning it or any other explanation, is ALSO an unsolved mystery, and one that she's pretty sure must be causally interrelated with the mystery of how she's here at all, and maybe why this world has the properties it does. That...feels like information that should help narrow her hypothesis space, except she doesn't actually know what to infer from it. That...some kind of intelligent goal-oriented force wants her to be here and able to communicate? Her mind wants to protest that this is not how physical laws work but she's still staring in the face of these events having, observably, happened, and trying to just mentally box all of it off as 'mysterious and inexplicable and beyond her understanding' isn't actually going to help. 

"You would need an address. And I think--I know this sounds insane, but I think that none of the people or places you know exist. And if you went to where your home town was, it wouldn't be there." 

If she's telling the truth, and he still can't imagine why she wouldn't be, he feels immensely sorry for her. It's like something out of a nightmare, like the tree that was destroyed in the thunderstorm and turned out to have been dying and hollow inside for years, but instead of a tree it was the whole world . . .

"...No, that doesn't sound insane," Merrin says quietly. "Or, I mean - it would almost be more surprising, right, if - everything about Governance is different here and where my hometown would be is in a People's State and then somehow my hometown existed anyway and had my parents in it. I can't think of any– well, honestly, I don't have a coherent hypothesis for being here at all but being here and also being able to contact my parents with a 'telegram' puts even more constraints on that. I - I don't actually think it's worse than true death, though? It's really weird but I'm...not going to complain about the reason for my continued existence being too weird?" 

She's not really having any feelings about it yet. She's almost certainly going to have a LOT of feelings, at some point, but it seems that knowing what feelings to settle on requires a lot more context and ability-to-predict-anything-in-her-future than she has, yet, and so she mostly just feels numb and unmoored. 

"Well. If you have to start your life over, New York City is the best place in the world to do it. What's your line of work?"

"I'm a - specialized medical first responder? That seems to be the closest thing in your language– oh, 'paramedic' is a word? I think it's not quite that," something about the connotation is subtly off, "and I've done hospital work ever, but 'paramedic' is probably closest. I'm very good at it." She says this with no hint of self-consciousness or any sign that modesty would be expected around one's highly trained skills. "I don't know how standards and certifications work here but I expect I could pass the local qualifications with some retraining. Is it a highly-in-demand profession here?" 

"Most professions are highly in demand here, if you're good at them." Eddie . . . does not really have any advice on retraining or qualifications. He knew he was going to work for Dagny since he was eight and never really considered any other jobs. "Paramedics are employed by hospitals, so maybe just go to a hospital and ask?"

"Mm. I - this place does seem significantly lower-tech than what I'm used to expecting, which means that probably a lot of my training will be non-applicable but maybe some of what I know that I think of as just the basics would count as novel innovations here, and so I could contribute that way even if I'm really not the person anyone would pick to advise on Governance or economic efficiency." 

Merrin has the uneasy nagging sense that she's - thinking about this on the wrong level of meta, or the wrong degree of zoomed-out, or something, but she's not sure how to fix that and it's very tempting to have a specific plan, and it would be convenient if that were to involve doing something she loves and is good at and has invested most of her life in, rather than something where she scraped through the bare minimum of classes and doesn't remember half of the subtleties anymore because it's not like she's ever revisited her flashcards since then. 

"So - I think it probably makes sense to at least visit a hospital and see what the options are. ...Um. Do you think they would believe me if I said I was from another world and that's why I don't have any of the local training or qualifications. I - that sounds like a complicated conversation." Also it sounds AGONIZINGLY AWKWARD which is not a good reason to try to wiggle out of doing things, she's trained that lesson into herself very hard, being so far off on the right tail of the distribution for Agreeableness has its advantages, and in some ways it's one of the traits that made her well-suited to her line of work, but it has its downsides as well and the temptation to be less than fully honest because telling the full truth will result in people making FACES at her is one of them. 

" . . . I think people who didn't see you appear out of thin air might decide you were insane. You should probably just say you don't have any papers; they might assume you're running from something in your past but there's plenty of people doing that, these days."

"...Yeah. Okay." 

It is, very belatedly, occurring to Merrin that this stranger from another world with bafflingly dysfunctional Governance may not, in fact, have incentives to be especially honest with her. So far, based on just her initial impressions and huge gaps in all the background context, she likes him - he seems like someone who's earnestly trying, and - somehow who's genuinely bothered by the disastereconomics around here, in a way that's not not akin to the way it makes her feel. She's inclined to feel sympathetic, because of that. 

Also, it's not like she has any idea what she would do in the scenario where he was maliciously lying to her, except 'go talk to other people as well to triangulate', which he's literally advising her to do. 

"What, um, sort of papers would I usually have, if I were from here? What are they for?" She's pretty sure that 'papers' is metonymy for something more than just 'arbitrary pieces of paper with facts about herself on them', which to be fair she also doesn't have but could in theory put together in a couple of hours. 

"A birth certificate, tax records, school records, anything to prove you are who you say you are. There are people who don't have them for good reasons, though, because they weren't born in a hospital or their town lost its records."

"O....kay." Merrin thinks she probably has more questions but she isn't, at this point, sure what they are, and maybe what she actually needs is some time alone to finish all of her barely-started thoughts before she can put together questions any more coherent than 'what????'. "Anyway. I maintain a lot of Exception Handling certificates because my comparative advantage in this work is sort of unusual, but I guess you may not know all the protocols here and I'd be better off asking someone at a hospital?" 

"I'm not sure what the equivalent of an Exception Handling certificate is, here, sorry. If you can ride in an ambulance and stop injured people from dying there are definitely jobs doing that."

...What. Okay, it absolutely can't be the case that they don't have an equivalent, and you would THINK that it would be much less useful if normal people didn't know even the basics and that that would be obvious to everyone, but - maybe it's just the language, again, and she's grasping for the wrong set of terms, and it's not like he had any more warning of what aspects of Civilization outside his usual specialization he ought to brush up on before this unexpected meeting. Merrin really wishes she'd had some sort of warning and preparation; she hates doing things without preparation, improvising is fine but that's different, it's not - having to unpack all her thoughts on philosophically confusing questions in real time, which is a position she would absolutely never choose to put herself in, she knows her strengths and weaknesses and the limitations of her intelligence and this is NOT an area she's well placed for– 

– and, of course, whining about how inconvenient it is - even if she keeps the whining entirely internal - is not going to accomplish anything. Except for maybe making her approach this with more helplessness and less agency than it calls for. She should stop that. ...Well, she should mentally reward herself for noticing it, first, that's a step forward in itself and she knows she's overwhelmed and running hard into the limits of what her mind can track and it also won't help to internally criticize herself for failure modes that are a predictable consequence of facts she already knew about herself and that don't even indicate having prioritized anything wrong in the past because this was absolutely not predictable. 

"I mean, yeah, I have training relevant to that. My training is more relevant to - um, large scale disasters natural or otherwise? I...am guessing that since your world seems to be a lot earlier in industrializing and also, um, your Governance seems to have different priorities from what I'd expect, that you - might have more industrial accidents and such? Like, explosions in factories, that kind of thing?" Merrin has never, ever responded to an actual explosion-in-a-factory situation, because someone would have to get a lot of things wrong for that to be a possibility, but of course there are protocols for it anyway and of course she is one of the people who would likely be called in for it. "And I have training in emergency cryonic suspension - I mean, that's pretty standard, but knowing the backup options for situations where you don't have the usual equipment or medical backup available is less standard and I've got that too." 

"Responding to explosions in factories is definitely important. Hospitals do it, and also a lot of factories will have a doctor on staff for faster response and to handle anything minor. I don't know what emergency cryonic suspension is, but that doesn't mean much, I don't know a lot about medicine beyond what to do if someone sprains their ankle or something." And the last time he had to use any of it was when he and Dagny and Francisco were kids testing their limits by the river.

Well. That's concerning! It's not the most concerning thing she's heard, when the category includes things like 'it's inexplicably become popular for entire states to ban the concept of having an economy', but it's a different flavor of concerning and it's one that's much more centrally in a domain she can assess, and -

- hmm, now that she actually considers the question, this man doesn't come across as...all that smart? Which is weird, right, it's confusing, most people are smarter than her and certainly it's a significant minority of people who are enough - how to put it, just - noticeably-lower-on -verbal-adroitness? - that she's capable of picking up on it. Though he doesn't act like someone who finds existing in Civilization on a day-to-day basis to often be overwhelming outside of his specific areas of advanced training, which is honestly how Merrin feels sometimes even now - he didn't hesitate at all to rattle off the list of 'paperwork' she would need to navigate their Civilization locally - he reads as competent to her, just from his manner, and that's part of why the verbal-fluency bit didn't flag to her much sooner - maybe she's totally wrong about that, maybe it's just the local language, which is really terrible, maybe their schooling is terrible somehow, that would explain some things too... Also this is, as usual, a slightly frustrating topic to be mulling on and she doesn't actually have enough signal yet in all the noise to draw more than the most tentative of conclusions and so it's not unreasonable to set it aside for now. 

...Come to think of it, her initial confusion-and-concern could well be a language issue as well, she's...now noticing that the phrase she used apparently isn't idiomatic, in English, there are words that exist and sort of roughly map over but now that she's paying closer attention she can tell that it's not quite holding together. And 'exception' 'handling' is also not a standard phrase, she thinks, the words exist for a literal translation but if she stares at it the connotations aren't right at all... 

She's STILL feeling as though she's failing to look at things from the right vantage point, or something, but in her defense that's cognitively challenging at the best of times, in a completely novel no-prior-context situation like this - it's the reason she doesn't really enjoy the sort of serial novel that's about aliens or something equally weird and also has PUZZLES for the reader to solve between installments - and on top of that she's trying to express herself in a foreign language that she only speaks because it was inexplicably implanted in her brain, and it's also much easier to do as a collaborative-ideas-bouncing-discussion and her native guide here is as far as she can tell a lovely person but he's really not stepping up and helping her out with the cognitive load there. 

She is...going to fall back on the motion of confusion-resolving that does come naturally to her, which is 'breaking the confusing thing down into smaller more concrete pieces until she can narrow down what she isn't following'. 

"...Sorry, I - think I'm forgetting that this is a different language and I need to account for that and can't expect that just picking the closest words that jump to mind is going to work because there are probably a lot of deeper, um, cultural differences - semantic differences, or maybe I mean etymological - sorry I don't actually know anything about how languages work. Anyway, I think I'm probably trying to say things as overly literal translations from Baseline and that's confusing you. Exception Handling is...the systems and policies you have for events like factories exploding, except I think that's not a good analogy here because it's usually for serious catastrophic events that don't really ever happen, but they could and obviously Civilization needs to be prepared for lots of individually-very-unlikely possibilities because when you include all of them the likelihood adds up higher. I, um, meteor strikes that aren't detected in time by your orbital monitoring might be a better example? ...At least I hope your world doesn't just get hit by meteors all the time although I guess that would explain some of why you seem to have less excess-production-capacity than we do?" 

"We don't really have policies for things that almost never happen. That sounds like a good thing to have, but we barely have enough people to handle the things that are already happening. We don't get hit by meteors all the time but we also don't have any way to detect that or prevent it, just every few years or so you hear about someone getting a hole in his roof. It's not a big enough problem that anyone really thinks about it much. Industrial accidents are much worse. It's not that we haven't invented safety precautions--our switchyards are safe, Rearden's mills are safe, Dannager's mines are safe. But some people don't take precautions, and then when people die they say they can't help it!" His voice flares up in sudden anger and then cuts off, like a candle in a gust of wind

...Merrin is a dath ilani with some highly specific training and so she is not going to lose control of herself and start crying in front of this man from another world who is CLEARLY under massive amounts of stress which she sees no choice but to keep poking at. 

She sort of wants to offer him a hug, or give him a reassuring pat on the shoulder, or something, but she has no existing templates for what their relationship is right now (he's not a patient, or a patient's family, he's not exactly a colleague either, he's certainly not a child...) and this language, terrible as it is, doesn't seem to have ANY syllables-efficient way to ASK. 

"I'm...sorry," she manages, after a few moments of making sure that she is, in fact, under control of herself. "I - definitely need to ask - someone else if you don't know - whether you have the...freezing people's brains to preserve them as individuals so you can revive them once that technology exists?"

Whyyyyyyyyyyy does that take SO MANY WORDS to convey. Also the verb 'to die' in their language seems to be...ambiguous...is it talking about True Death or just suspension - 

(It's not really ambiguous. Merrin can already guess, in a quietly screaming corner of herself, how this man is going to answer her question.)

They have--some way to cheat death . . . they're not just a world that's alive and vital while his world slowly seizes and grinds and shudders like a locomotive in the first stages of breaking down, they're all individually keeping themselves alive . . . and now she can't have that, because she's out here with them. The fact that she got here by dying in a plane crash in the first place does nothing to reduce the injustice of it.

"We don't have anything like that," he says softly. "I'm sorry."

"I think," Merrin says, very calmly, "that there are substantially bigger problems here than I realized and - that one is actually one where I'd know...a lot of details on how to fix it. Except probably we need to address the economy problem first because I'm starting to suspect you need higher production-per-capita than this world or even just this country has, right now, to even have enough resources to do that." 

She has gone past internally screaming and is now internally whimpering quietly in a dark corner, and trying to guess at how many plane-crash-equivalents of true deaths must happen here, every year - every day, even - and people must think it's normal, it's hard to wrap her mind around that but - 

- but that would have been true, right, at some point in her own world's past - the history may be tucked away out of sight but it existed, and there was a time before industrialization, and even if this isn't a version of dath ilan's past, which is seeming increasingly implausible actually, she can't imagine her Civilization ever having been this dysfunctional and yet still ended up in the configuration she observed - but even if Civilization never looked like this, at one point it was poorer, at one point it had less scientific knowledge, and people would have died, forever, and not known there could be any alternative... 

...It feels like the sort of thing that could be classified as an infohazard in both directions, actually, and judging by Eddie's expression, the revelations here are almost as disturbing to him as they are to her, and she feels sort of bad about bringing it up except what alternative did she have... 

Eddie spends several seconds just staring into space, trying to imagine what Merrin must be feeling, trying to imagine crossing the gap between where they are now and the world she's giving him a glimpse of. Then it resolves into a will to action, spinning senselessly in his head with no direction in which to act.

"We will. Have to fix the economy first, I mean. Thank you for telling me--all of this. There's a research hospital in the city, Manhattan General Hospital, you might be able to invent things there. Or there's--no, I think Manhattan General would be best." For reasons he cannot put into words, he knows it would be a bad idea to send Merrin to the State Science Institute.

That sounds like the start of a plan?

Which, on the one hand, GREAT, Merrin haaaaaaaates operating without a plan - probably that's another aspect of the trait about herself where all appearances to the contrary she actually does, quite, prefer a known routine - but on the other hand she still feels a bit like she's metaphorically walking in the dark on uneven ground and every time she thinks she understands the terrain, suddenly the next step finds her foot landing in a random pit or tangling against some unseen obstacle and she doesn't even begin to have enough information to make predictions, not real predictions - she's been flagging surprise and confusion, over and over, but not only is she failing to put numbers on it, she's mostly not succeeding at pinning it down in words in her own thoughts, not even in Baseline - though that's partly because in order to COMMUNICATE in English which is terrible she's ending up having half of her thoughts in it and on reflection it's predictable that this is going to make things harder– 

Stop. The thing her mind is doing right now is clearly a response to overwhelm, and it's not surprising - if anything she's making a positive update here, about her own capacity to handle novel complex out-of-context epistemically baffling situations - and she's noticing a flicker of pointless resentment, that Eddie is STILL not stepping in to lighten some of the cognitive load, but of course they're in symmetrical positions, here, he's being hit in the face with just as many rapid wide-error-bars updates as she is. And - he's not one of her colleagues, however steady-and-competent his manner reads as to her, he doesn't have her specialized training or even the minimal basics that anyone in dath ilan, even someone two or three standard deviations below median intelligence, would have as a matter of course.

How could he. If his Civilization she's starting to realize that word is pulling in a lot of misleading connotations, when she uses it in her thoughts - if his country doesn't have the capacity to consistently follow known basic safety precautions in factories run by people outside a small group of specific heroic individuals (and what a horrifying thought THAT is), if they don't have any kind of selection-process to ensure that the people working in Governance know how to reason sanely and are capable of basic updates such as 'noticing that the People's State model of governments and economies seems to consistently produce unfortunate results' - let alone the education and models to make that obvious as an advance prediction even without having observed the outcome yet, then - how can she possibly expect that a random individual, especially one who is probably operating with less total native cognitive ability than even she has, to notice that she's overwhelmed and do all the exact right things in a situation where he himself is also overwhelmed... 

Merrin is pretty sure that several of the premises in that chain of reasoning wouldn't hold weight but she's also not sure which ones and she's running out of working memory and ending up stuck going in circles and it doesn't take a lot of metacognition to notice that this is unhelpful. 

"That makes sense. Thank you. I - think I'm going to want some more background information on 'Manhattan General' before I try this, and...I should come up with a plan and talk it through with you on how to, um, approach them so they don't think I'm insane but they do have the expectation that what I know is worth listening to? ......But I think I need some time to think first. And paper. To take notes on. And - um, sorry, I'm guessing you probably also need some space to think, and this is your apartment but I don't actually have anywhere else to go...?" 

He can tell that she's annoyed, that she wants some kind of answer to some kind of question, but even if he understood the question he doubts he'd know the answer. He can at least get her what she's asking for out loud. 

"Don't worry about me, I'll be alright. Here, you can use my desk, I've got pencils and paper, if you want me to go into the other room I can do that or I can stick around and answer questions as you think of them." He had been planning to sleep when he finished the round of timetable updates he had been working on, but his head is too full of planning for sleep to be possible, even if he wasn't going to offer her the bed as soon as she expressed any interest in sleeping. 

While she does her thinking he writes up everything he knows about how the medical system in general and Manhattan General Hospital in particular work, what the specialities are, the utterly unsystematic way that new innovations are introduced and catch on or are squashed under public outcry. He includes the recent history of Rearden Metal as an example, even though it isn't more than incidentally a medical invention, because he knows the sequence of events in detail.

Merrin sits down at the desk (which, incidentally, has terrible ergonomics, not that this is surprising, her mind gets five seconds into calculating exactly how many person-hours of productivity this world is probably losing to suboptimal desks before she manages to cut that off as not the point right now -)

"I think I would prefer if you went into the other room," she hears herself say. "I - think we could probably both benefit from, um," how do you even SAY the thing she wants to convey in English, this would be so much easier in baseline, "- from...being able to have our thoughts freely and unpressured without also having to track the interpersonal effects of them?" 

"Okay." He goes into his bedroom and sits on his bed and takes notes using the book of maps as a clipboard.

This is good news, for him and for the world, someone from a better world who wants to fix things. He should be happy. Instead it's like he's wandering in the wilderness, and found a road that might lead somewhere, but now that he can see the road it's clear that it might still be farther than he can walk. 

Merrin holds herself in the chair at an angle where Eddie won't be able to see her face even if he suddenly re-enters the room, and closes her eyes, and cries. Very quietly. She doesn't want to make her emotions visible to Eddie in a way that might push him into feeling that comforting her is his responsibility, and she especially doesn't want to do anything that will prompt him to come back into the room at all, because she isn't up for that right now. 

And then, because she has priorities here, she wrestles herself under control. 

The most pressing challenge, here, is that she's out of her depth. And she needs to not instinctively fall back on her training, on what's comfortable to her and doable even when she's overwhelmed, because - all of that was under the assumption that she was operating within Civilization. Oh, there are plenty of instances of Exception Handling where she would be, temporarily, on her own, but this isn't the same. 

(...Okay, possibly a more...upstream, if not more important overall...challenge, here, is that when she tries to think about this, she keeps feeling CRUSHING EXHAUSTION. Which she's pretty sure is in some way an illusion or mis-attribution of her actual emotions, because she knows what her physical and mental limits are, she's explored all those edges, and this shouldn't be anywhere close. Though...maybe her emotional limits are something distinct, and - it's not actually surprising, that for all her training she wouldn't have been emotionally prepared for this - she's not actually sure that there's any possible way that dath ilan could have provided THAT kind of preparation, even if anyone in Governance had thought it was a good idea to prioritize, which they wouldn't have - she thinks they might be horrified at the concept, even, that it's worth training people to endure situations that SHOULD be awful and traumatic and unacceptable...) 

- So. She needs to find an approach that's workable for her, specifically, with the strengths and weaknesses she actually has, and not those of someone who would be better placed to address this world's problems, because that isn't the situation she's in. She needs to find the right attitude that will let her do this alone, with only the knowledge she has in her head and not the knowledge she wishes she had - with no backup, no one else to fill in the gaps that aren't her comparative advantage - 

Most of those thoughts are still half-formed, incomplete, probably missing critical pieces. But it's a lot easier to have them at all, when half of her mental processes aren't semi-involuntarily being redirected toward reading another person's nonverbal signals and modeling their emotional state. 

She's going to need to be better at that, too. At focusing and doing abstract reasoning even in circumstances adversarial to it. She has some ideas for that. Executing the naive versions of said ideas would make her worse at her actual job - there's a reason she hasn't pushed on those particular mental levers before now - if she were smarter she would plausibly be able to think of something here that was less a direct-tradeoff-between-known-legible-value-sources and more of an outside-the-paradigm-creative-utility-multiplying-innovation* - and in fact that's a pattern here, one that generalizes far beyond the questions that are specifically about her own traits and emotions - there's an entire way-of-thinking here that she's not specced for and it doesn't help, to waste energy on resenting that, that's not moving forward toward what matters, here... 

*Both standard Baseline words (as translated by Merrin into English.)

Eddie is not, actually, a complete novice at giving people emotional support, however much of one he feels like tonight. He's helped overstressed, underslept clerks deal with backordered materials and packed schedules. He's talked down Jim from various upsets and never given a sign of how stupid he thought those upsets were. He has even, he thinks, helped Dagny handle more than she could alone, just by being a second person, an extra bit of brain, a notepad that follows her around and gives convenient unprompted reminders, and above all a bodyguard against anyone and everyone who tries to waste her time. In almost every case, being what the people around him want has been synonymous with doing his job, and he has always known what his job was. Now his job seems, by virtue of an opportunity he should be happy about, to have expanded to encompass the whole Earth and he doesn't know what doing it entails. 

Dagny would know what to do. He can't bring this to her, she has too much to do already. She's supposed to delegate things to him, not the other way around, and she can't divert her attention from the railroad now.

He can't do any less work for the railroad than he was doing before today. Helping Merrin is a personal project to be done entirely on his own time.

He is so, so tired and he couldn't sleep if he tried. He keeps thinking over and over that should be happy.

Okay. Merrin thinks she has a plan. Or - a meta-plan, at least, a plan for how she should think and feel and what shape she needs to be, to engage with this bizarre situation, to find traction on it and come up with actual concrete plans-to-influence-reality. 

...She's not delighted with it. Mostly because it, in some sense, involves - or demands - expecting much less of herself than she's used to. She can't expect herself to make swift, efficient real-time decisions, right now. And she especially can't expect herself to smoothly and with poise handle all of the social complications - she probably isn't good enough to do that even under the most convenient accidental-circumstances and even if she were focusing on it fully, but in this case she has to actively deprioritize it, and be ready to deal with the fact that this will, inevitable, result in awkwardness and missteps and hurt feelings, and it will feel avoidable, which might or might not be accurate but it doesn't, actually, matter... 

- all right, framed like that it feels a lot less like 'expecting less of herself than usual'. And more like deliberately pushing toward a growth-edge. Which isn't why she's doing it, of course, but - it helps, to frame it that way purely to herself, and right now she has little enough in the way of solid ground to stand on, so she's going to flag that as possibly-some-sort-of-rationalization but not otherwise object to it. 

She doesn't have backup right here and now, but - in some sense she has all of Civilization behind her, still. In some sense, anyone in her position would, even the people who (a flinch, a mental sting) choose to spend their lives in the Quiet Cities. And she may be young, and not especially intelligent, but she's worked hard, her whole life, ever since she was old enough to understand what it meant to have a goal. She's learned from the best. She may not be the best dath ilani for this - 

- but it doesn't actually help, to grade herself against the counterfactual where someone else - even restricting it to someone else who died the truth death, even to someone else on that exact same plane - ended up here instead. She has minimal information on that and so trying to model those hypotheticals is just going to overload her working memory and waste precious time. 

The only counterfactual that matters, right now, to the core of her motivation system, is - comparing the future of this world where she appeared from thin air in someone's apartment, and the future where she didn't, and everything continued on as it was. 

Can she, given that premise, cause this world to be better-in-expectation by existing here? 

Yes. Yes, she can. She's actually not even slightly in doubt of that. (And, if anything, she expects that most of the inevitable updates ahead of her will point toward being more sure of that, not less - and given that she can predict the direction, there, Bayes' Theorem says she ought to just make the full update already, except she can't, actually, her remaining uncertainty is in some direction entirely orthogonal to 'how competent is this place compared to the Civilization I know' and yet it feels as though that orthogonal vector matters, a lot...) 

((She is going to write down that particular line of thought, in Baseline and half in the shorthand she learned in her training (because, of course, some Exception Handling certification courses require you to take notes using inconveniently low-tech mediums), and then drop it from her working memory, she can tell when pushing-toward-discomfort is no longer accomplishing anything useful.))

"Eddie?" she calls out, tentatively, and quietly enough that she hopefully won't actually interrupt him if he's, like, sleeping or something. "I - would be ready to talk now. If you wanted." 

Eddie hasn't fallen asleep. He also hasn't written as much as he had hoped to in this amount of time, partially because he keeps bouncing back and forth between topics and doubling back to fill in more context. His notes have margin notes which have their own secondary margin notes but the bottom half of the page is still blank. He comes out, holding them in front of him in both hands.

"How can I help?"

Merrin takes a deep breath, and turns toward him. 

(Feeling embarrassed and vaguely-ashamed of her reactions here is NOT going to help and also just about anyone looking at her from an outside perspective and judging on dath ilan standards would not think that either emotion was justified. That isn't quite enough to not feel that way but it gets her partway, at least.) 

"I...wanted to say some things...apologize, I guess...for the mistakes I'm predictably going to make here. And - ask for your support in compensating for my weaknesses, I guess, to the extent that I can expect that, which to be clear isn't very high, I - realize that your entire Civilization - country, state, whatever - is operating with very little surplus. But it still seems worth at least trying to say this explicitly so that we can be on the same page?"  

That's not what he was expecting. 

"You don't seem weak. And--you want to help. You didn't have to want to help. I'm not going to be ungrateful for that. I'm going to do whatever will make it easier for you. I know you don't know--what things are like, here. I'll explain them."

She didn't have to want to help. 

...That's a weird and uncomfortable - and informative, probably, but she's not focusing on parsing that aspect yet - way of expressing the sentiment that she can read much more clearly in his expression and body language. Merrin...will make a mnemonic handle for that confusion, it seems important, but then set it aside to think about LATER. 

"- Yeah. I know. I - really appreciate that you care about doing that - making this lower-cognitive-load for me, that is - I know you don't have the training for it that people in my world would have, and controlling for that you're doing really well. Anyway. I'm...finding it pretty difficult, trying to - conceptualize myself as a lone hero who's here to fix your world?" That's the best translation she can manage on short notice, even if it's not exactly what's in her thoughts and the divergence itches. "That's not what my training is aimed at, and I'm not - smart? I don't know what the median intelligence is in your world or even how good your measurements of it are but in dath ilan I'd be well below median. And I've trained accordingly. I don't have a lot of practice– well, I do have practice working on my own under adverse circumstances, that's what a lot of the Exception Handling certifications are about, but still. Your world isn't something I've trained for and I feel pretty out of my depth and I'm not used to that, and especially I'm not used to - having to figure out what the right questions are to ask, and whether we're looking at things on the right level of meta...."

She takes a deep breath. 

"- Sorry. That was probably mostly confusing. The shorter version is - I think the mistakes I'm most likely to make, when I'm overwhelmed, are going to be - diving into fixing a particular concrete problem, without necessarily keeping enough outside-view to remember if it's the highest priority problem? I'm not sure if any of those words even made sense to you. But in dath ilan, it's the sort of thing where I could - say that, and ask my colleagues to help me notice if I were making that particular mistake." 

There was a lot to think about there but one thing sticks out, rather in the way a knife sticks out. "You're unintelligent, by your world's standard? You're probably one of the ten most intelligent people I've ever met. I know that's really not what you were hoping to hear."

Eddie has wished, thousands of times, that he was smarter. He has also wished thousands of times for the people he was working with to be smarter. So far every difference between Merrin's world and his own has made his world look more and more like something constructed out of Merrin's nightmares.

"I - wow - I guess that isn't...actually very surprising or much of an update. Compared to all the rest. It'd explain– actually I still feel confused about the banning the concept of having an economy thing but plausibly once I've thought about it longer it might make sense of why you could end up in that equilibrium. .....I'm sorry. Your world sounds - really frustrating to exist in - I guess I'm noticing that for myself but you've been doing it for way longer and with...less vocabulary to think about it productively...and that sounds really hard." 

"Don't worry about me, I'll be fine. The other thing you said, about focusing hard on one problem and not looking at the bigger picture--I'll keep that in mind, but I should warn you that that's what I've been doing on purpose. Keeping the trains running, leaving everything else to the people who know how to do it. I can see why that has to change, of course. But--when I was just starting out at Taggart Transcontinental, I got a job in a tiny station where I only had to think about one train a day. And that taught me the things I needed to know to think about the whole railroad. And maybe it's different for you, but maybe it isn't. Maybe it's alright to solve one problem and use that to learn how to solve the kind of problem this place has." He says all this with the open, straightforward gaze of a man who believes that the worst that can happen is that she'll fail to spot any flaws in his reasoning.

"Okay but–"

Pause. 

"I - sorry - I need a moment to think over that." 

He's describing a pattern with some very obvious failure modes, but it's also in fact the thing she was doing, before, in dath ilan. (Except, of course, that she wasn't doing it alone, she didn't have to take on faith that someone else would be handling the rest, and she had career counsellors and metacognition-advisors and mentorship relationships with people a lot more intelligent and experienced than herself...) 

- is that hitting or missing the point, here? She can't tell, for sure, and she shouldn't expect to be able to, she doesn't know enough, but - it at least makes sense, probably, to stop shutting down her instinctive responses and hear them out, if only in the privacy of her own mind?

So. Instinctive responses. 

Keeping the trains running, leaving everything else to the people who know how to do it. 

- is apparently giving her a VERY LOUD flinch response, of unease-and-horror, and - it's not about Eddie, personally, she doesn't think he's the - actual underlying source of the something-terribly-wrong. He's not the entity here that is making, not just suboptimal decisions, something worse than that, something that - almost hurts, to even consider, and then leaves her feeling somehow, indescribably, slimed and dirtied just for having considered it.... 

(There's clearly SOMETHING about that feeling to flag for later consideration, even if this is just a standard emotional response to learning about infohazards and a Keeper could tell her that in five seconds and also what to do about it - she doesn't have any of the usual support systems available and she doesn't have the option of looking-away because there's no one else and– all right she is maybe flinching too hard in the direction of desperate-heroism, when she tries to think about it, but the only and best solution is to make a mental note and think about it LATER when she feels less pressured -) 

- and she's about to open her mouth to reply when the other fragment of it - the first thing he said, in fact, but she's only processing it belatedly - hits her. 

Don't worry about me, I'll be fine.

....Merrin does not believe him even a little bit. Which is...kind of a paternalistic thought to have, about someone who has clearly demonstrated his competence and continues to demonstrate it. It doesn't call for any obvious changes to her actions, and she's not going to bring it up with him because that won't help and also sounds unbearably awkward although she thinks the unbearable awkwardness isn't most of why she isn't doing it. It's relevant to her predictions, though. To - and this is a thought that hurts, as well - to how alone she actually is. 

"I think that mostly makes sense. It - would be nice if we could just fix everything at once but I think that's just impossible, from where I am right now, and I can't change that by wanting it harder or feeling guilty about it. I...do think I need to be - willing to look? It's going to be important to understand all the pieces of this, even the ones we can't necessarily address yet, because it's all going to be - causally interrelated?" Her sense of the language is informing her that that phrase does mean approximately what she's thinking in Baseline in her head, but also that the words are rare and the phrase is obscure, why would those words be rare that's stupid, "- um, I mean, stuff affects other stuff. And that's going to be easier with help but I don't think it just has to be you, I - should probably talk to experts in all the fields that are relevant to things we want to change. Which I'm obviously going to need your help with too since I don't know anyone here and if I just walk up to your scientists I won't have a lot of credibility." 'Credibility' is a weird word and she can't quite pin down what's weird about it but also if she gets distracted poking at the connotations of half the words she says then she's never going to finish any of her thoughts. 

"Yes, I agree, there isn't any one thing you can do right now that will solve everything, it has to be a lot of things at once and we don't even know what they all are yet. But we can start with one industry you understand really well, and figure out all the ways that it's different here from in your world, and see if there's some common root."

It feels like there is, like there's one thing driving the insane laws and the lack of good employees and the way so many people have retired and how hard it is to get anything made as well as things were made thirty years ago, like all of those are symptoms of the same disease.

"I can introduce you to people at the hospital, and do a better job of introducing you to our suppliers and customers, when it's time for you to look at them. And if you solve one problem you'll have money and credibility to use for the next problem."

"Okay. Yeah. That sounds like a decent plan. Should we– oh, sorry, I completely did not think to ask what time it is here. Should this be a plan for tomorrow?" 

"Yes, it's nearly midnight. You're welcome to the bed; I've slept in chairs for worse reasons."

It's tempting to politely decline the offer, she feels pretty bad about kicking a stranger out of his own bed and she's also slept in worse places than a chair, but it's probably not a good idea to follow that temptation - she doesn't, in fact, sleep as well in uncomfortable arrangements even if she's trained herself to do it at all, and she really quite badly needs her mind to be at its best, tomorrow. 

"All right. Thank you. I probably need to figure out somewhere else to sleep longer term but I guess midnight is not the time to try to do that." 

"There are hotels, and once you have a job you can get an apartment, but yes, that's something else for tomorrow. I can take you to the hospital tomorrow morning before I go to my office, make introductions, and meet up with you again at noon?"

Nod. "I do want to hear whatever background context you have on the hospital first, I think, but I'd better not keep you up." 

"I took some notes," he says, holding them out. "I can stay up a bit longer and answer questions about them, if you like, or you can ask questions in the morning."

"Morning would be fine. I'll just keep notes of any questions I have." She smiles at him. "Thank you. That was good thinking-ahead."
 

He smiles a little, weak but genuine. "Thank you. I'll see you in the morning, then."

"See you in the morning." Merrin gathers together her own notes and remaining blank paper, and accepts his. "- Oh, um, could I borrow something to wear to sleep?" She normally sleeps naked but she is NOT going to do that in someone else's bed. "And you should probably show me the bathroom and stuff." 

"Right, yes, of course."

Bathroom: functional. Spare pajamas: poorly sized but in the less inconvenient direction. (He would offer to change the sheets, but he only has the one set of sheets, so it would take two hours with the basement laundry machines to get back to a state as acceptable as the current one, so he doesn't.)

Merrin is not exactly impressed with any of the bathroom amenities, but functional it is, and reasonably clean which she cares more about. The bed is not incredibly comfortable, even though you wouldn't think that making comfortable beds would require advanced technology. She's never in her life worn anything that fitted as poorly as the pajamas, but they'll do, and she can keep her actual clothes neat-looking for meeting people tomorrow and, hopefully, impressing them. 

She settles into bed, but leaves the light on, and curls up to read Eddie's notes on the hospital. 

Eddie curls up in his armchair and . . . still can't sleep. It's not that there's another person in his apartment; he's slept in the coach cars of trains. His brain just won't stop spinning like a car with its wheels stuck in sand. After half an hour he gives up and gets the train schedule again; once he's finished it that will be something like an endpoint and then he'll be able to sleep.

Eddie's notes on innovations: getting a new idea widely adopted is kind of random, in a lot of ways. The public generally follows the opinions of newspaper articles, and the writers of those articles decide what to write about an idea based on what they think of the person who had it. Merrin's total lack of reputation might actually help, here, because the journalists love underdogs and what they call "little people", which basically means anyone who hasn't done anything interesting. It also generally helps to make a lot of noise about how you don't expect to benefit from the thing in any way and are doing it solely for public benefit, even though Eddie is aware that it would make a lot more sense to trust someone who had skin in the game on their own idea. If, on the other hand, you can get one really visible public demonstration of an idea, that will change a lot of minds, and people who were previously yelling that you should be forbidden to do the thing will start yelling that you should be required to do the thing for free. This process was most recently demonstrated by Henry Rearden with a new alloy of the same name. Incidentally, Rearden would probably like to talk to Merrin about industrial safety; mills are a dangerous operation even when one follows best practices and recent declines in the quality of available materials are making best practices individually harder to follow and collectively less sufficient.

(Eddie did not, while writing this last, consider the question of whether Rearden would object to having his problems discussed with a stranger; that Rearden should object to someone making a true statement about him would be so strange as not to be worth contemplating.)

Merrin annotates his notes, in Baseline because that lets her fit her thoughts into a reasonable number of words. 

Does this place not even have prediction markets– actually you know what, no, she is not surprised. She makes a note to try to explain the concept, at least the basics, she's probably going to need help figuring out the implementation and it's obviously going to need to be adapted, to work in a place where the highest-tech communication method is 'telegrams', and also the dath ilan prediction markets use a lot of sophisticated math which Merrin does not know and has minimal hopes of getting help with in a world where APPARENTLY she is an UNUSUALLY SMART PERSON. 

The word 'journalist' is another one with really weird connotations but she has enough uncertainty about how the inexplicable-language-acquisition thing works that she should just ask Eddie to unpack for her what journalists do. 

The whole bit about 'people who were previously yelling that you should be forbidden to do the thing will start yelling that you should be required to do the thing for free' is pretty alarming although it does kind of fit with the thing where apparently all of the economics here recently went insane. Merrin is unusually altruistic in inclination (this isn't a self-serving rationalization, there were tests for that, as a child, and then several of the adults in her life were actually pretty concerned and had serious conversations with her about it), and she's STILL pretty offended at the concept of Governance demanding that she provide a service for free once it proves to be useful. 

She would be delighted to talk to this Rearden person about industry best practices! She wouldn't be surprised if their industry is different enough that nothing she knows maps directly across - for one thing what in the world is a "steel" "mill", her English comprehension informs her that "mills" are often wind or water-powered and usually grind grain. This is plausibly one of the areas where she best understands the guiding principles behind specific processes, though, so she's sure that by working with a domain expert she can get somewhere. 

...Did somebody try the thing on Rearden and declare that he should be able to make steel alloy for free because that is NOT HOW ANYTHING WORKS and she's so offended on his behalf. 

By the time she's made her way through all of the notes, she's actually feeling pretty tired, even though it's not midnight according to her circadian rhythm. She should probably just go to sleep now, and work on listing out everything she knows about how hospitals operate later. 

The bed does not get any more comfortable and the sound isolation of this apartment is terrible and despite the exhaustion her thoughts are buzzing, but she does, eventually, sleep. 

Eddie finishes the train schedule update, sets it down on his desk, sits back down in the armchair and falls deeply asleep. He wakes up in the morning with a stiff neck (unsurprising) and takes a moment to remember why he didn't make it to his bed this time (very surprising, once he's sure it wasn't a dream). He knocks on the bedroom door a little before sunrise.

Ughhhhhhhwhat where is she and why does she have a crick in her neck? 

Merrin drags herself awake, with some reluctance, and spends five seconds trying to make sense of why she's in an uncomfortable bed wearing very weird and also very oversized pajamas, and then she remembers, and she doesn't burst into tears but it's a near thing. 

"M'awake!" she calls out, and sits up to swing her legs over the side of the bed, even though it does not at ALL feel like an appropriate time to be awake. At a guess she got five, maybe six hours of sleep, and it's not helping that it still isn't light outside. (Her room at home has sunlight-imitating dimmable ceiling lights and powered blackout blinds, both of them on a timer, set to gently wake her at the appropriate time by imitating dawn. Which she suddenly misses a LOT, along with her bed, and her climate control, and it's really depressing how long it's probably going to take to get any of that here - if she can even manage it at all...) 

Eddie travels around the country a lot and doesn't like the time differences; he didn't ask Merrin how many hours off she was but it's probably more than three. He waits for her to come out.

It's more than three hours but Merrin is used to doing bizarre things to her circadian rhythms and you know what this is NOT, this is NOT doing an EMT training scenario that last twenty-four hours. Instead it's way more tiring and unfair than that her brain can please shut up. 

She strips out of the borrowed pajamas and sniffs her armpits - tolerable - and then puts her regular clothes back on. She really hopes that it's possible to buy higher-quality better fitting clothes in this world. Well, fit-wise, what Eddie was wearing yesterday was weird and foreign and honestly not incredibly flattering but it was at least the right size for him. 

She yawns and stretches and emerges looking reasonably awake, though with dark circles under her eyes. (Which seems fine and is if anything a good thing, she doesn't have any of her faceblanding supplies right now.) 

"Morning." She gives Eddie an appraising look. 

Eddie is still bewildered and overwhelmed but has much more available brain to be bewildered and overwhelmed with. "I usually get breakfast at the office; we can stop somewhere on the way to the hospital. Do you have another round of questions?"

"Yeah, I took some notes. How long a trip is it to get to the hospital? There might be enough time to just talk about it on the way so I'm not delaying you any more." 

"Twenty minutes plus however long the line at the cafe is, so call it thirty? If we get there before you're out of questions we can stand around outside for a bit; it doesn't look like it's going to rain."

Is there not going to be a better option than standing around in hopes in doesn't rain. Also what, the implication is that they're going to have to wait for ten minutes for other people to finish getting food from the food-place before they can get food, that– is not actually surprising, now, is it. 

"Sure." And she will follow him out of his apartment. "First question should be one of the easier ones - can you explain in more detail what 'journalists' actually do?" 

"Journalists write in newspapers and magazines, or talk on the radio, about--whatever they want people to read about, mostly, news but also their opinions on the news and things that are technically news but about who wore what at whose party, so you have to read quite a lot of newspapers to find the actual news. And sometimes it's only technically true, or not even that. But some of it's important and with a bit of practice you can tell what's true so I keep up with it anyway."

"I...see." She takes a minute to absorb that. "That - sounds really inefficient, and I suspect I don't have enough practice to - notice which pieces are and aren't true." What a HORRIBLE THOUGHT. "I mean, aside from noticing what makes sense as a way for the world to be versus not, and my judgement on that is going to be noisy until I have more context and a higher-resolution predictive model of this place and I can put numbers on my confusion instead of just feeling vaguely uneasy. I'm at this point strongly anticipating that you don't have prediction markets for decision-making but I wanted to ask anyway - especially since even if the world overall wouldn't actually...value the thing they're getting you, possibly the business leaders you work with would? So, um, does the phrase 'prediction market' actually mean anything to you? I could also just be guessing wrong on how to translate our term into English." 

"My best guess, which isn't much of one, is that it means paying people to predict how things are going to go, which sounds potentially useful but we don't have it."

"It's...sort of that but not quite? Prediction betting might actually translate it better, it's - conceptually sort of like a marketplace, where goods are traded, except the 'goods' being traded are predictions about what's true of the world or will be true in the future or what course of action will achieve the best outcome, and it's been very carefully set up over time so that the individual actors who are making these predictions will win their bets and profit if they're right. ...A lot of my medical work was tied into the medical-prediction-markets, there would be experts making prediction-bets on a patient's diagnosis and likely course, and different experts making prediction-bets on likely outcomes from treatment, or on the order of triage and who I ought to treat first. If you set it up right then it's a very good way to effectively aggregate expert knowledge and turn it into plans that work. ...I'm kind of worried there might be a lot of ways to implement it that aren't clever enough and somehow end up doing a different thing, that's...worse in the same way that the news written by journalists in your world is worse for actually learning what's true than the knowledge-aggregators in dath ilan. But, I don't know. The mathematical underpinnings of prediction markets really aren't my domain of expertise." 

"That sounds interesting, but it would definitely be difficult to set up and I don't think enough people would use them. And the sort of people who are most interested in gambling are the people whose predictions are the least useful."

"Huh! Really? Why? I - would naively expect that the sort of people who are interesting in using-cleverness-to-profit are going to be better at it than people who don't care, because they'll - put a lot of effort and optimization into collecting the gains-from-trade, and the hard part is just setting up incentives right so that the best winning strategy for them is also the one that gives you accurate and useful predictions or plans." 

"Does your world have--lotteries, or casinos, or betting on horse races?"

"....We have betting on - who will win games or challenges? I think people participate in betting because it's fun and satisfying and not just because it contributes value to Civilization if they're participating because it makes the market more liquid. I think you might need to explain more what lotteries and casinos are because that's not mapping over to anything I clearly recognize us as having." 

"People who like to gamble--they aren't doing it to make a profit--lotteries are probably the clearest form of it, they're where a government sells a bunch of tickets with numbers on them, and then picks a ticket at random, and the person with that ticket gets back a portion of the total ticket sales. So the more you play the more money you lose. No, I can't explain why, I'm sorry." There's the sense that he's apologizing for more than the incomplete explanation.

"That's not even actually making a bet! You wouldn't be putting any intellectual work into it that could change your odds of winning!" 

"I think people who bet on horse races try to think about which horse will win, but the bookies--the people who organize the bets and decide what odds to offer--set things up so they make a profit whatever happens and that doesn't stop people from betting against them."

"...I guess I follow why the, um, bookies would have an incentive to participate in that system. I'm...really not following why anyone else would, unless it's - hmm, is it a thing that's more about having social interactions with other people who share your interest in 'horse races'? In dath ilan there are some people who will, like, have forum conversations about an ongoing game but not be expecting to make money from it, the value they're getting from it is just more discussion of a topic they like?" 

"Maybe. I'd think if that was all of it they'd just have the conversations without spending so much money, but I don't know anyone who does it personally so it's hard to say."

"Huh." Understanding this is probably not her highest priority, right now. "Anyway. I...think maybe in order to implement prediction-betting the way dath ilan does, you need to have it be the case that most people are more intelligent than me and more - natively inclined to put numbers on all of their thoughts and hunches - I mean, maybe it's not really native for anyone, a lot of it must be training, but I think most people take to the training more than I do, I'm kind of lazy that way." 

"Most people being intelligent is probably important for a lot of things. If you remember the training well enough to teach it I would like to know, but that's not our first priority either. What was your next question?"

Her thoughts feel all out of order, again, now, full of the by-now-familiar feeling of trying to integrate a new piece of information and not even beginning to have a catalogued list of all the updates she needs to propagate. Ow. 

"I would be pretty happy to talk to Rearden about industry safety practices? But I probably do need to talk to him, to get a better sense of how things are done right now and how different it is from my world and what incremental changes would be workable and also make things better rather than worse, that's going to be high context - I know what our protocols are and could write that down, but I think it mostly wouldn't apply or wouldn't be usable to him, and I also understand at least some of the design principles but - not in a way that'd be as easy to write down. I might be able to remember some of the training well enough to copy it here but I've never thought about doing that before and it would take a lot of thinking." 

"I expect he'd be very happy to talk to you; I can send him a telegram today. Dagny Taggart will probably want to talk to you too." Now that he's had some sleep and gotten his head around the matter a little more he thinks he'll be able to present Merrin's existence as an interesting opportunity to be explored, rather than a problem he's giving up and asking for help with.

"Dagny Taggart is - the person you work for? With the railroad?" 

"Yes. Her title is Vice President of Operation but actually she runs the whole thing."

When she tries to mentally translate that title into Baseline she mostly gets confusion. "Is that, um, common? That someone's - official job description - isn't that they're in charge but actually they are? It sounds like it'd make it really confusing for anyone working there, honestly." 

"Everyone who needs to know finds out pretty quick. Her brother Jim's the President but he doesn't do anything; their father set it up that way because people think women can't run businesses." (Which is ridiculous. It's true that most women can't run businesses but most men can't either.)

"They what." Okay now she's mad. Even though she has approximately never had the slightest interest in being an entrepreneur and has had only marginally more interest in doing the administration side which is plausibly, in fact, what most of 'running a business' entails, that English phrase is so non-specific. Anyway it's in fact acknowledged in dath ilan that more men than women have certain interests and that this is predictive of success in different roles and that's only ever irked her a little and not for especially good reasons, but STILL. 

"It's ridiculous; anyone who takes one look at Dagny and one look at Jim should be able to tell it's ridiculous."

Merrin takes a deep breath. It's not going to help to be furious about it. Not more than a little bit furious, at least. She'll allow herself a little bit. 

"I - think maybe I need to ask you for a list of all the other things that 'people' think men can't do or women can't do because I suddenly feel like I'm about to walk into a minefield here–" aaaaaaaaaaaaaaaaaaah what is that idiom where did it COME from that concept is HORRIFYING and also now is really really not the time to be digging into the etymology of this language, horrifying or not. 

"Um. They say men can't raise kids or cook well or throw nice parties; women can't fight or be industrialists or scientists and ideally should just raise kids and not work. Uh, and there's rumors if a man and a woman are alone together too much, which is another reason I should get you a hotel room starting tonight."

Rumors, what sort of rumors– oh. "If it's rumors about sex then that's not actually a problem, I'm pretty asexual," and she is NOT bringing up the INFOHAZARD in this context, it's not even relevant, thankfully. "I - to me a lot of that does sound like...um," damn it they don't have a word for 'tropes', WHAT SORT OF FLAMINGPOOPING LANGUAGE IS THIS ANYWAY, "like - patterns-in-stories but the kind people expect to apply in their actual lives a lot of the time, and to be efficient and helpful shorthand for compressing information about themselves and others and how to have interactions smoothly? I think even in dath ilan a lot more women want to raise kids and somewhat more women want to run big elaborate events where they can try to matchmake all their single friends, and for Exception Handling the positions that might in theory involve fighting skew male and the ones that involve medical treatment skew female, but - nobody would ever think of it as - about what everyone in the category 'man' or 'woman' can do or even about what they should do, it just has predictive value. I'm not sure that scientists overall even skew one way or another, although if you go to the level of subfields I think there are more male physicists in particular and more female - medical researchers, maybe? I haven't actually looked that one up."

And now she can't, ever again, in fact she can't ever again look up anything that isn't in her head and she can't trust anything written in this world to be true and this is surprisingly upsetting, even accounting for the fact that she expects it to be upsetting, it's hitting her harder than that. 

Eddie just barely manages not to do a double take when Merrin casually and straightforwardly mentions sex, then nods along to the rest of it. She's clearly upset but it's pretty upsetting, or at least he'd be upset about it if he was a woman. (Dagny never seems to notice.)

"Yes, that seems right. Enough people are like that that it's normal, so anyone doing something different is strange, and strangeness frightens people."

"Oh. That makes sense. More than most of what you've said. I - people in my world are like that too, sort of, although I wouldn't've picked 'frightened' as one of the top five words to describe it. But...yeah. I think it's hard to avoid it being true that if you're - unusual, along any metric, compared to the people around you - then it's more frictiony to exist in a world that's built by people who aren't like you, for people who aren't like you to live in. ...I think our Civilization tries pretty hard, both to have there be a standard way things work, and to - make space and exceptions for the people who that doesn't work for, as long as the things they want aren't hurting anyone else. But it's still...inconvenient and means inconveniencing people around you? And I could imagine that if we didn't all have - lessons in how to think more clearly - then I still don't know if you'd get scared but you might get resentful or frustrated." 

"Yeah. I'm glad it's possible to deal with, even imperfectly." There's some thought he isn't quite managing to finish having, about the kind of people the world was built by, or for. 

They reach the café. It's small, but brightly lit, and smells like fresh bread and hot coffee.

Merrin can tell that he's thinking, and leaves him to it. Instead she pays attention to the café. How does the 'line' he talked about work? How many people are here and what are they actually doing when they get up to the food-and-coffee area? 

There are around a dozen people who haven't gotten their food yet. They stand in a line with the far end at the counter, where they tell the person behind the counter what they want, go to another line at the other end of the counter where upon reaching the front they receive what they ordered, pay for it by handing over circular coins of mixed sizes and metals, and then either leave with it or sit down to eat it.

Huh. ...Right, she hasn't gotten around to asking about the state of computing technology in this world - and that's probably a conversation she should have with an engineer or industrial researcher, maybe she can ask this Rearden about it - but her advance prediction is that the answer is 'not', and so their options for automating an extremely boring job are probably 'not'. 

She tries to peer at the staff behind the counter. What are they doing? How are they coordinating with each other? Do they look bored out of their minds? 

(Dath ilanis are very, very averse to repetitive work that leads to boredom. Merrin does not actually have any idea how that was handled at this tech-level-equivalent, given history being screened off. A Keeper would know. Why couldn't there have been a Keeper on that stupid plane.) 

They look pretty bored, but not like they're trying to compensate for the boredom by making a game of going as quickly and efficiently as possible or by examining the customers' mannerisms or anything. They just look kind of zoned out. The one who comes out of the back room with a new tray of croissants looks content and serene, though, like making pastries come out exactly the way he wants them is his idea of a good life.

Awwwwww. Merrin tries to catch his eye and smile at him. (She has a lot of appreciation for people whose idea of a good life is doing a relatively simple thing just right, over and over and over. In some sense that's a lot of what her job actually is - not the half of her time spent on training and simulated practice scenarios, those tend to be unrealistic not in any specific details but in overall plot-density, but the part where she actually rushes around the city responding to real medical emergencies - and from the outside, to someone who isn't her, it must seem like once you've seen a hundred heart attacks you've exhausted all possible sources of novelty there, but it doesn't feel that way to her, because every person is different, and she lives at the level of the concrete details, not the abstraction over all the specific cases...) 

By the time she gets to the front of the line she has a decent sense of what kinds of things people order, and she wants one of those pastries, but she's not the one here who has local money and she has no idea how to interpret prices and still hasn't really figured out how wealthy Eddie is in this setting, so she glances over at him as they near the front of the line. "Um, what would you usually ask for, here?" 

"I usually get coffee and a muffin but everything here is pretty good. Have you had coffee?"

"I have!" Though in dath ilan it's not the sort of thing you could just - buy, no questions asked, at a food counter, and she's going to be a little annoyed if it's the best stimulant they have on offer and she also keeps not getting enough sleep, that seems like a great way to end up dependent on a substance and she would prefer not that. "I'll get a coffee, then, and - one of those beautiful pastry things that just came out?" 

She's not actually irritated by the wait in line, since there was plenty of novelty in her environment to look around at, but she anticipates that she would be pretty annoyed if she has to do this every morning. Or even tomorrow morning. She'll ask Eddie after what the options are for having food brought straight to your house. Probably worse than dath ilan - very plausibly more expensive, but if she's right about how valuable her knowledge is, here, she'll probably end up in a position to afford some conveniences. (To make it feel a little less like she's in an alien world very very far from home...) 

She receives the coffee and the croissant; Eddie pays for them both. Being able to directly and simply help someone he likes is nice. 

Merrin smiles at him and nibbles a bit of her croissant (it's good) and sips the coffee (it's less good but she manages not to make a face.) "Right. Um, do you know the particular people you're about to introduce me to at the hospital, or are we just planning to walk up and ask for the coordinator on duty right now?" 

"I know one of the administrators because they get a lot of their equipment shipped in by train. He's not normally the one who does the hiring but they'll hire someone if he says to and he'll be able to tell that you're good."

"Huh. Sure, that makes sense. What's he like?" 

"Very concerned that things get delivered on schedule," he says approvingly.

"Is that, um, something that you have to be concerned about here?" It really wouldn't have struck her as one of the harder logistical problems! Even if things are delivered slower, 'on schedule' can surely take that into account, you'd just adjust the expected schedules - all right, fine, it's not quite that simple, but she doesn't think it needs nearly as many layers of contingencies as most Exception Handling...

"We don't. That's why he always orders from us."

Merrin follows him out of the café. She's perfectly capable of eating and walking at the same time and she's even getting used to the coffee. 

"....I think there's something I don't get," she says after a minute. "If your company has the, um, logistical know-how on making sure trains run on schedule - and you're clearly getting business because of it, you just told me you are - then why isn't every single other company trying to learn it from you so they can keep up?" 

"I don't claim to understand all of it. It helps that we're the biggest and richest railroad in the country. And it's difficult; you have to be able to find good people and willing to promote them and trust them.  It's easier, for some people, to try to get Washington or the National Alliance of Railroads to pass another directive giving them handouts or favorable regulations or big government contracts, and survive that way."

That 'some people' includes Jim, to his deep yet resigned annoyance, but the problem of Jim is a weight he's been carrying so long he's forgotten it isn't part of his body.

"Is it - hard to assess which people are skilled at their jobs and which people aren't? I...wouldn't have thought of that as being one of the harder things. But I guess maybe your world has less reliable aptitude tests? In dath ilan you'd normally know by the time someone is ten approximately how smart they're going to be as an adult and where they're likely to be well-placed and end up most capable. I didn't know for myself until I was older than that, but I'm an outlier in a lot of ways, some of the things I'm really good at aren't things where there are standard tests for eight-year-olds. ...And obviously people change and sometimes they don't want to pick the career that the advisor thinks they'd be best suited for, but people don't usually change for the worse, and I think it's actually a lot easier to do performance reviews with adults, when we've had more of the training in accurate introspection - I guess your world maybe doesn't have that....?" 

"We have tests of intelligence, but they won't tell you if someone is going to give up on something after five minutes or spend an hour finding a clever solution, or whether they'll report a problem or try to cover it up, or a dozen other things. We don't have training in introspection."

"Hmm. I think persistence at problem-solving is at least related to an aspect of intelligence we measure? Like, obviously we also have lots of ways to train those mental habits - and it's not just one mental habit, there's a cluster there - but I think it is measurable and it doesn't necessarily have to be via sneaky tests you do to children without them realizing it's a test or what it's testing -"

"- Wait. One second. Rethinking -"

"Sorry, I - didn't process the second failure mode you mentioned until now and what. That....sounds like a thing that isn't necessarily about intelligence and is more about - incentives not being lined up right? It sounds like you're talking about - people hiding mistakes in ways that aren't just a thing they can fix and put right and have the future mostly look like the world where they never made that mistake, if no one's looking too closely, because if it were only that then it wouldn't be a huge problem that prevented companies from keeping their trains running on schedule. ...I think in dath ilan there are a lot of incentives within Civilization that are set up so no one's very tempted to hide actually serious problems, because it's - not actually easier to do that and have to keep trying increasingly clever schemes to hide all the downstream effects, than just to explain the original problem and get help fixing it. Little kids do hide their mistakes but I think a lot of that is, like, they haven't fully developed theory-of-mind enough to realize how hard it is to convincingly hide a mistake and all its consequences from people older and smarter than you, and they don't necessarily have the incentives set up yet to think of themselves as on the same team as the adults. Which is... I don't actually know how to fix it, here, it feels like there are probably a lot of interlocking pieces and they'd all have to be moved in order to reach the better equilibrium, but I think that problem at least sort of makes sense to have. Does that make sense?" 

"Yes, that's an accurate description of the problem. If you could get enough people who cared more about trains running than about not being blamed, they'd react well to other people reporting problems and even the people who mostly care about not being blamed would have to get that by making the trains run. But getting enough of them, and making sure none of them get fired or driven off by one of the other kind, is the hard part."

"Aren't people going to intrinsically care about the trains running on time because that's how they get their own goods too? ...And their paycheck, obviously, but I guess it's maybe not an obvious idea to give people bonuses for coming up with especially clever solutions, and - maybe even if you try that, if you're starting from the equilibrium where everyone thinks it's fine to lie to hide problems short-term, maybe they also think it's fine to lie and say they did something clever when they didn't - and if you're less able to assess skill then it's harder to catch that and harder to tell if that's the incentive you're giving someone..."

What a HORRIFYING THOUGHT. She can...sort of imagine something vaguely like that happening if you tried to make a bunch of six-year-olds run a train company. But they would have to be literally six. And filtered somehow to not mostly be the kind of people who would end up fascinated by thinking of cleverer and cleverer solutions to all the problems whether or not there were external incentives - and probably also filtered to exclude kids like Merrin herself, who can admit that she had many flaws as a small child but being tempted to lie to adults was not one of them. 

Nod. "And there are thousands of employees in the system, so I don't just have to know who I can trust, I have to know who else is good at knowing who they can trust."

This is a slightly socially awkward question to ask, but you can't, actually, work with people on a difficult problem if you're going to flinch away from mildly awkward conversations. "Well, how good do you think you are at assessing that?" 

"Better than anyone else I know except Dagny and maybe Rearden. If you'd rather not take my word for it that's very reasonable and I can show you the records; stations managed by people I hire directly have better safety and efficiency records than the system average."

Nod. “I probably do want to look at those, but - more for general orienting purposes than because I don’t trust you on that? I - I think that if you could…fake being the sort of person you seem to be, to me, without knowing anything about my world, then - I don’t know, it just seems at that point like it’d win you more to actually be that person. I don’t know. I’d like to be more confident of that than I am but it’s my guess.”

Thoughtful nod. "I see what you mean."

Merrin has more thoughts to work through, but none yet at the stage to be questions. She follows Eddie the rest of the way to the hospital in silence, eyeing her surroundings in case there are any random hints to what ELSE might be horribly wrong here. 

The hospital building is the same low-tech, highly non-modular architecture as everywhere else, and showing its age, but it has the elegance of clean, simple lines, of a structure erected for a purpose and whose every element serves that purpose.

At the street corner across from it sits a man wrapped in a worn and dirty blanket, with a cardboard sign propped up in front of him reading "hungry, please help". Nobody including Eddie looks directly at him.

Aaaaaaaahwhat???? 

"Eddie," Merrin hisses urgently, catching up to him after staring for five full seconds and falling behind. "Eddie, what - that person - is he okay, why is he - why is nobody -?" 

"Oh God, I really should have explained this last night but I don't know where to start. Some people can't get jobs, and don't have any family, so they end up with nothing. There are charities that try to help, with food and things, but there isn't enough, it's like trying to drain the ocean. Anything anyone gives them just disappears and a month later they're as poor as they were before."

Like trying to drain the ocean. Merrin swallows hard. "I - how many people. And - why can't they get jobs - what's going wrong there -?" 

"They can't get jobs because there aren't enough companies to hire them and there aren't enough companies because people are too poor to buy things, and because the government keeps making it harder. Passing laws about what anyone can make and who they can sell it to, taxing us and sending it all overseas as aid shipments that do no good even if they don't get sunk by pirates on the way."

"....I guess I get why they want to help out the places that are doing even worse than - this," Merrin says faintly. "But - is it getting worse, here, too..." 

"Yes."

WHAT is WRONG with this place. 

...Now is really not the time to get incredibly upset about the question, let alone to try to answer it. 

"I - sorry, I need a minute." If she gets a job here, Merrin promises herself - and she's confident she should, even if everything around her is broken, they would have to be worse than stupid to turn her down and Eddie claims at least one person in this hospital is neither stupid nor FLAMING INSANE - then she'll have money, and she can at least go find out if the 'charities' trying to help are doing it at all competently, and give them a little more resources and maybe some advice on using them efficiently, and - 

- one task at a time, the thing to do with insurmountable impossible problems is to break them down into pieces until each individual piece is no longer impossible and then do them. While not being incredibly shortsighted about it, of course, and while keeping in mind all the possible failure modes of un-nuanced problem-solving, but...she can do that. Probably. As long as she doesn't have to do all of it at once and all of it on her own. 

Eddie stands on the street corner and ignores the confused and annoyed glances of the passers-by and waits for Merrin to be ready to keep going. He understands; he has been there before and expects he will again.

And after a few minutes Merrin still isn't feeling that ready to keep going, but she is noticing the annoyed passersby, which is SOCIALLY AWKWARD and gets in the way of effectively finishing any of her thoughts anyway. 

"We can go in now," she murmurs to Eddie. 

Once they're into the (much less trafficked) hospital foyer, Eddie asks, "Do you want a minute alone first? I can go find Carson while you wait here if you want."

Merrin starts to shake her head, and then stops to actually think. "- Sure. I can wait here. Um, although I'm hoping we can actually talk somewhere more - private, than this...?" 

"Of course. Once I've found him we can come get you and find a meeting room." Earth does have meeting rooms! Probably Merrin's world has much nicer and more correct meeting rooms that somehow produce better meetings but at least it isn't another 'I don't know what that is.'

A meeting room! Maybe it will even have whiteboards! 

"Sounds good." 

She doesn't especially want to dwell on the fact that one of this world's horrifying problems is people literally starving in the streets because they can't get jobs because Governance is following advice from economics who are INSANE OR SOMETHING. Instead she paces around a bit and looks at everything in the foyer and tries to extract some sort of useful information about how hospitals here are going to be different from the ones she's familiar with. 

Well, for one thing, the visible level of computer technology is indeed None. There's a receptionist with a desk covered in papers and a telephone. Someone comes in to visit her mother, who has the flu, and the receptionist directs her to an elevator to the correct ward. 

One wall has a moderately dilapidated fake plant and a bulletin board with information on public housing and addiction counseling, ads for day cares, a requests for people between the ages of 18 and 60 for a study on lung health, and a Found Cat poster. 

Also the whole area is kind of dirty. There's no visible garbage or anything, just the kind of desultory grimyness that results from all the cleaning being done by one underpaid guy with a mop and a bucket.

Ewwwww. Merrin is not squeamish about blood, urine, feces, vomit, or just about any bodily fluids, and is only slightly squeamish about dead bodies though that took some training, but she is apparently actually bothered by grime in the SICK PEOPLE PLACE. You should NOT HAVE THAT. She's pretty sure it doesn't even require advanced technology to keep your FLOORS CLEAN. 

Needing to have after-the-fact addiction counseling, if she's parsing that right, sounds like exactly the sort of a problem a society would have if they lacked the concept of infohazards and of Ill-Advised Consumer Goods. 'Public housing' seems to be tugging on some of the same connotations as Quiet Cities but mostly not. She should ask about that. ...Actually she should make a note to ask about that later when it's actually the priority. 

She wonders if they have some kind of after-the-fact selection process to make the study participants somewhat less of an incredibly skewed sample than what you would get if your only selection mechanism was for both 'people who spend a lot of time in hospital foyers' and 'people who actually read the posters and, having actually read the posters, are inclined to volunteer themselves'. It also doesn't mention compensation for their time, which seems like a very basic oversight to her. 

Dath ilan would never have the receptionist's job done by a human, but she's not sure how much that's because there might be literally no level of compensation that would persuade someone to do a job that intensely boring for more than fifteen minutes. (Her desk is also a mess, but Merrin isn't inclined to judge her that hard, some people are just like that and you would expect a world with fewer resources in general to have fewer services for avoiding that problem.) 

Why the fake plant. It seems to be accomplishing NONE of the goals one would expect for having a plant indoors; it's not pretty and it's clearly not reducing indoor CO2 levels. 

She sighs and paces a bit and waits for Eddie, wondering how long it's going to take him to track down Carson; that, too, seems informative, though informative-of-what she's not sure. 

It only takes Eddie two minutes to get to Carson's office and two minutes for them to walk to the foyer, but Eddie's gone for a total of eight minutes because Carson was on the phone with his bleach supplier and then got stopped on the way out of his office by a payroll clerk with a question. All Merrin can easily perceive of this is the eight minutes.

Carson is a thin man who looks like he'd blow away in a stiff breeze, with wispy grey hair and intelligent grey eyes. He holds out a hand for what an Earthling would recognize as a handshake as says, "So you're the foreign doctor Willers has been telling me about? I don't mind telling you, we're always looking for good people."

Merrin looks blankly at his hand for half a second, and then extends her own hand and...hopes he's going to give her slightly more cues than this about what she's supposed to do with it. 

"Yes. Um, well, I'm not technically a doctor - I'm a trained emergency first responder for - exceptional situations - but I suspect I'm very highly trained compared to what you would be used to here for that role." In hindsight it's going to be very awkward to try to have this entire conversation without mentioning the part where she's from a different Civilization. Maybe she can check in with Eddie about that, once she's said or done anything to impress Carson and ensure his priors on 'she's just insane' will be lower. "I don't have any of my papers here, so of course I understand if you want to run me through your usual qualification tests, but - I do think that I'm very good at my job, and would be pretty good at - a decently wide range of things here, whatever is most valuable to you. Should we, um, go talk about this more in a meeting room?" 

Carson grabs her hand and moves it up and then down and then lets it go. "Yes, of course, right this way."

They go through a door and down a hall and into a room with a table and four of the unergonomic Earthling chairs in it.

Once they're all settled, Carson says, "I don't have time to run qualification tests. If you're good you're good and if you're not I'll fire you. If you're an emergency responder, what do think of ER work?"

"...Um, no offense, but Eddie has been telling me a bit about your local personnel issues and I'm not sure how effective your mechanisms would be for noticing if I'm any good at my job or not. What would you be paying attention to, to figure that out - patient outcomes? How happy my colleagues are? ...Also I think I maybe need clarification about what your 'ER's look like, where I'm from I don't think we have one facility that corresponds to that. Can you briefly describe the range of patients I would expect to see, there?" 

"Patient outcomes, yes. Though ideally you also wouldn't drive your colleagues too insane," he adds with a chuckle. "Our ER is where patients come in with emergencies and we determine the right priority order to treat them in and get the first steps of treatment done, or the whole of it if it's something simple, and then send them either home or to another hospital ward depending."

"And there's - only one facility serving that purpose, for this hospital?" That's probably a stupid question but she should check. "Um, how are the roles and specializations divided up? I'm guessing it's going to be different from how we do it where I'm from, but I can at least figure out what maps over the best to what my qualifications are." 

Carson goes over the various wards in the hospital, sorted mostly by how sick the patients are but with some extra sorting for keeping the contagious ones away from everyone else, and the kinds of doctor and nurse and what they do. It's typical for a hospital to only have one ER, unless the architecture is such that patients arriving by ambulance and those arriving on foot need to show up at different entrances. The jobs most similar to Merrin's training are probably ER nurse and paramedic, and paramedics are generally expected to have driver's licenses so they can take turns driving the ambulance.

Merrin doesn't need to be following exactly what a 'driver's license' is in order to know that she doesn't have one and doesn't have the requisite skills to easily get one and probably doesn't WANT one. 

"I think the ER nurse role would be the best match, probably. Should the next step here be...going and meeting the current roster of ER nurses?" 

"Certainly. Right this way."

Eddie takes his leave, saying that he's glad they seem to be getting along and that he has a meeting to get to.

The other ER nurses currently on this shift prove to range from 'kind of dim for an ER nurse but putting in almost enough effort to compensate' to 'really exceedingly dim and also kind of an asshole'.

Merrin introduces herself to them with smiles and friendly professionalism, which are perhaps somewhat off from the local social conventions, but she's not especially trying to get that perfect and she has more important priorities than the occasional noticeably-jarring mismatch there. 

She mostly isn't trying to draw any conclusions about intelligence, conscientiousness, or asshole-ish-ness, because she expects that all of the indicators she normally pays attention to will be drowned in noise. It's nonetheless hard not to notice that basically every single person she interacts with is, to her, noticeably...verbally slow on their feet?

(Dath ilan uses a sophisticated set of metrics for intelligence tests, and Merrin is aware that whatever she's noticing is not just indicative of a specific underlying capability, and can be split out into multiple aspects, some of which correlate with different elements of the basic seven intelligence-subcomponents, and also probably any of what she's picking up on is just education or acculturation, but she's not actually trying to do a formal or even an informal assessment right now and she wouldn't be especially qualified to run that anyway and so she mostly tries to ignore her surface impressions.) 

Mostly Merrin's attention is occupied by the fact that she has so many questions! About literally everything! She would normally just be able to ASK all her questions, but unfortunately 1) this language is TERRIBLE and it would take her ten times as many words which just feels like a waste of everyone's time, and 2) she isn't yet sure of the cultural norms here around question-asking and it's unusually salient to her that she needs to sound impressive and make a good first impression in order to get anyone to listen to her later rather than thinking that she's insane or something. 

(Merrin is, in the back of her mind, aware that she is probably overthinking all of this, but to be fair it's REALLY HARD to NOT do that when none of her trained reflexes are recognizing any of the equipment or protocols or even the nonverbal communication of her new colleagues.) 

From the perspective of the other ER nurses, Merrin seems very calm and level and also talks like a - college professor in philosophy? Her smiles look genuine and friendly but she only thinks to smile once every couple of minutes, not necessarily at the usual cues for it, and she doesn't spend long on it. Most of her questions are about what particular equipment does, or about the limits of what she as an ER nurse would be authorized to decide on her own versus needing to call in a different specialist (and if so, what specialist).

Some of her questions are much less comprehensible than that; Merrin at one point forgets that prediction markets aren't a thing here, and tries to ask how she should consult the diagnosticians' prediction market, and then sort of stumbles to a halt halfway through that sentence once she notices how many words it's going to take to explain and then remembers that obviously that isn't a thing here. 

Some of them explain what the equipment does and who's authorized to do what, illustrated with anecdotes of recent patients. (Some of them are judging her for being weird and foreign and using long words on purpose and doing facial expressions oddly, but they're keeping it out of their words and mostly out of their faces because at their current level of understaffed they all want her to stick around, weird foreigner or no.) The aborted question about prediction markets gets a bemused explanation that they don't do whatever that is but it's fine and often important to ask someone else for a second opinion if you're not sure what to do.

How long are the standard shifts, how many of them a week do most people work, is there any restriction on picking up extra? 

(Merrin used to pick up overtime constantly and work shifts literally twice as long as anyone else; there were some screening tests to make sure her cognitive function hadn’t degraded too much from fatigue, and she got Frowned At even though her scores were sometimes actually better a few hours in once she’d hit her groove.)

Standard is 3 or 4 shifts of 12 hours every 7-day week; you can trade around if you want them spread out or bunched up with long breaks in between or not on a specific day or whatever. Some people take extra shifts and the only rule there is that if multiple people want extra shifts at the same time they have to share.

Okay what the HECKING HECK that is an insane length of shift, even when Merrin went around working double shifts all the time it was, like, eight hours. She has ONE superpower and apparently here it ISN'T. 

Merrin does her best to hide this reaction. Can she work one twelve-hour shift: yes. Can she work four in a week and not kill anyone by accident: prooobably? She had better try to find a place to stay that's nearby because she is not going to want to waste a single additional minute on trekking back and forth - and she'd better figure out how to arrange food for herself in a way that doesn't involve ten minutes of waiting in line for every single meal.

She asks one of the nurses if they have a system for the staff to get food here while they're on shift. 

There's a coffee shop and you can eat in the patient cafeteria.

Huh. That seems a bit weird and inefficient, patients will have pretty different food needs from the medical staff, but at least the food will probably be pretty good? 

(Hospital food in dath ilan is very optimized, for being appealing both visually and taste-wise as well as nutritious, because obviously anyone recovering from serious illness or injuries needs to be incentivized to eat enough.) 

Merrin has quite a lot of notes at this point; they're on paper and so not searchable, but one of Merrin's obscure trainings at one point involved learning how to improvise writing materials while alone in the wilderness, so she's much less frustrated about this than many of her colleagues back home would be. 

- speaking of that, how do they keep track of patient information here? (Without any computing tech, it's presumably going to be a lot less automated than what she's used to, which she expects to be frustrating but hopefully she'll get used to it?) 

Soooooo much paper. Reams of paper. And ballpoint pens. And clipboards.

Well then. 

Merrin is at this point feeling fairly oriented - which in this case means that she subjectively feels like she has no idea what the usual done thing would be if anything even slightly weird happens, which is not a feeling she likes at all, but she's going to have to put some level of trust in her ability to improvise from the base of all the protocols she knows from home, and she at least has a sense of which nurses are the ones she wants to grab in an emergency if she needs help. 

(In dath ilan, someone new to the unit would be buddied with one of the existing staff for weeks, in order to pick up all of the less-legible local context, and that would be after an entire day of orienting to the local context that could be written down. This place clearly has neither the habit of doing that nor the staff to spare for it. She'll cope.) 

Great. Can she start today or does having just arrived from foreign parts mean she needs to wait until tomorrow?

She can start today! Maybe with a half shift first, since they’re presumably not relying on her being there all day, and she can get a better sense of things and then still have time to figure out some personal stuff, like a place to stay longer term. 

(She doesn’t really have anywhere else to be, since Eddie is at his own job right now.)

Then she can get some equipment (primitive by her standards) and join Janice and Emily. Payday is every Friday (today is Thursday) and comes in the form of a piece of paper to be taken to a bank.

That seems like a weirdly convoluted way for a bank to work but sure. All right! Time to go! Who's her first patient?

A man with a broken leg who fell off his roof!

Yikes! 

Merrin is not going to assume that whoever saw him before will have done an assessment up to her standards, or that any other injuries would have been remarked on. (Honestly, even in dath ilan she wouldn't have assumed that.)

Fortunately, while most of her colleagues who just do standard EMT work would be at a bit of a loss given the lack of ANY OF THEIR NORMAL EQUIPMENT, Merrin recently re-certified for the 'no equipment except whatever you can scrounge or make out of odds and ends in a city' training, as preparation for the Annual Overthrow The Government Festival. This is actually a significant improvement over that situation! This hospital even has an X-ray machine!

She examines the man first, quickly but thoroughly, while quizzing him on the exact circumstances of the situation: how far did he fall? did he hit his head? was he carrying anything at the time? what sort of terrain did he land on? (She's also paying a lot of attention to how coherent his answers are and how much pain he appears to be in.) 

"Second story so probably, I don't know, twenty-something feet?" [Pained grunt]

"Nah, I landed on my feet, so much the worse for them."

"Well I had a hammer when I started falling, God knows where it ended up, ow fuck."

"Mud, mainly, but at least I missed the damn rosebush."

If examining him involves touching the leg at all, he grits his teeth and makes small unhappy noises but doesn't try to stop her.

"I'm sorry about that - in a moment I'll ask one of my colleagues about getting you a painkiller, all right? It doesn't look like a displaced fracture from here but I'll need a closer look and probably an X-ray." Which she manages to remember just in time that for STUPID REASONS she isn't allowed to just demand using her own judgement, and is theoretically supposed to ask the doctor on call for the ER right now. She should at least be able to get him something for pain relief, though, that would be stupid to need per-occasion approval for. "Do you have any other medical conditions, or have you had surgery in the past? When did you last eat or drink?" 

"I don't have anything. I did get my appendix out fifteen years ago. I had eggs and ham and coffee this morning, call it three hours ago?"

"Okay. Thank you. You just hang tight for a minute, I'm going to go check with my colleagues about some things." 

Are either Janice or Emily available to be briefly interrupted? 

Janice is; Emily's visibly juggling multiple things already.

Janice is presumably also pretty swamped; Merrin will be very efficient in her questions. She jogs over and catches her attention, then gives a pared-down summary of the patient history. 

"- And I'm giving it 99 to 1 odds that he's not otherwise injured - I'm not sure how risk-averse you play it here, where I'm from we would consider doing a full body scan just in case - anyway he needs a painkiller and then probably an X-ray of the leg, it sounded like I need to get that approved by the doctor?" 

"Yeah, you'll need doctor's orders for both of those, broken leg probably isn't a med-seeker so whatever order is fine." She points out the location of the attending physician.

Merrin has no idea what the local social norms are for behaving around a doctor, and is tempted to stall. "What's a 'med seeker'?" she asks. 

"Someone who's addicted to painkillers and trying to get a prescription for them."

This does not even really parse on a first listen-through. "Someone who's - what? Does that– sorry, nevermind, I want to ask you about that later but I don't think now's the time." 

She notes it down on her list of Additional Questions, though, before heading off to try to politely get the attending doctor's attention. 

The attending doctor is also trying to do too many things at once but does eventually notice and say "Yeah?"

(Merrin isn't sure yet what the time-management norms are around here and whether she should have either interrupted or tried to do something else in the meantime, but she'll clarify that later.) 

"I think I need sign-off from you on a couple of things for my patient? He's the one in bed six, broke his leg falling off his roof - he's alert and oriented, I'm 99:1 confident that's the only significant injury -" she has the relevant history down to a fifteen-second blurb because obviously this poor doctor is swamped, "- but anyway, he needs an X-ray of the fracture and definitely something for pain first. Um, I'm new here and I trained in a foreign country so I'm not sure what meds you would normally give for severe pain but he's hurting a lot." 

"They got something other than morphine where you're from? It's in the yellow cabinet, key's at the nurses' station, I'll put in for the x-ray."

"Yeah, we've got other things." Merrin's mysterious language knowledge is informing her that morphine is a painkiller, which she already knows just from context, but it doesn't seem like whatever-happened is telling her any more about it. She'll need to look it up or something. Probably there's a reference book or something somewhere around here. "Um, just to clarify, do you want me to use my own judgement on the dose and route of administration?" It would be FASTER if he would just TELL her since she doesn't have the faintest idea what the range of options is, but also that's probably a very silly use of his time. "Also, how does 'putting in' for the X-ray actually work, we have different systems for that kind of thing." 

"Do 5 milligrams subcutaneous, it's what we always do, I'll put the x-ray on his chart when it exists, if you don't know how to run it talk to the charge nurse." (Ugh, new people. Nobody should ever change jobs.)

There's no point interpreting this as rude, he's busy, it's not his fault that this place has nothing in the way of reasonable onboarding processes. 

(Merrin is tempted to give someone advice on that, but now isn't the time. She'll just take thirty seconds to make a note of it for herself. Maybe at the end of her half-shift she can go find Carson and ask if this is something they want her advice on and if so who to talk to.) 

"Thanks," she says. She doesn't at all have a mental picture of what his 'chart' actually is, but she can figure that out on her own, or by asking whoever's in charge of that side of things. Probably she's also supposed to document the morphine order in there? For now it goes on the paper she's dedicated to notes about this particular patient. 

She heads to the nurse's station to ask whoever looks least busy about the key to the yellow cabinet and also the location of a reference book about the drugs they use here; she has to explain again that she's new and trained in another country that used different drugs. 

The charge nurse gives her the key to the yellow cabinet, which is attached to an eight-inch metal stick. The reference book on drugs is right he--nope someone else is using it, how about the charge nurse just explains the effects of morphine and what to look out for really fast.

Well, that's one way to avoid losing a small object, if your world doesn't have the tech to put tiny locator chips in everything, which on reflection obviously they don't. It's kind of unwieldy though. 

...Merrin does NOT LIKE giving a drug where she only has a short verbal explanation of what it does, and also she suspects she doesn't like morphine period. Dath ilan also mostly doesn't use needle injections - if a patient can't take oral drugs, or needs a faster effect, there are much less invasive ways of doing it - but fortunately as part of Exception Handling training she at least knows how, and the empty syringes and needles look pretty straightforward. 

- the actual morphine receptacle does NOT. "Um, sorry, excuse me?" she calls after the charge nurse. "I haven't - what do I actually do with this?" The morphine, rather than being in a receptacle that can be affixed directly to a needle and injected directly, or even a multidose vial or bottle, is in some kind of tiny sealed glass tube-thing that...doesn't...as far as she can tell...have a lid. It's utterly mysterious to her how she's supposed to get the contents out. (Also it's the wrong amount but presumably she can only give half? Probably?) 

The charge nurse looks at her like she's wondering where the hell Merrin went to nursing school and then explains that you're supposed to break the top off at the little score line.

You're supposed to WHAT. 

Merrin has spent literally thousands of hours training for weird scenarios that involve working without access to her usual equipment and supplies, including 'your city is being invaded by aliens who have captured the hospital complex and the only way to get access to medications at all is to requisition them from citizens' personal supplies', or one (very memorable and fun) scenario that involved being holed up in a biochemistry research lab and needing to instruct students on how to synthesize the substances she needed. But even then, there is absolutely no sane hypothetical she can imagine that would involve someone handing her drugs in a CONTAINER WITHOUT A LID. And this, as far as she can tell, isn't even slightly an exception! This is just what's in the standard medication cabinet! What!!?? 

...She can wonder what the drug manufacturers are thinking later. Maybe this world lacks any sensible regulation around Ill-Advised Consumer Goods and all of the researchers who design drugs are taking them all the time  Actually it's probably somehow WORSE than that. Never. Mind. Later. 

...Also, right, this is a timely reminder that this entire country exists in a state of extreme poverty compared to what she's used to and she should not assume anything about resource availability. "I, um, is there a good way to save the half of it I'm not using right now, or should I just dump it out? It's not going to stay sterile once it's open, right?" 

"Yeah no it won't keep, you just gotta toss it."

"Huh. Okay."

Breaking open the stupid tube is mildly nervewracking, but Merrin finds an antiseptic swab to protect her fingers against glass edges, and then peers very carefully at it to make sure no glass fragments ended up in the liquid inside. 

...After a moment's consideration, she pulls the second half of the contents into a different syringe and caps it, with a random unopened needle since she can't find dedicated caps. It'll stay good for a couple of hours, at least, and the patient might need a follow-up dose, especially if the doctor wants to do a painful examination or - and this seems concerningly plausible! - set the bone by hand right there in the patient's cubicle-bed, rather than taking him to a procedure room for it and doing a more thorough job under sedation and with continuous scanning. Probably they don't even have that. 

(Merrin is actually trained in setting bones by hand with no scanning equipment or supplies other than improvised splint materials. She's even done it on actual patients, though only as a temporary measure, the times she was sent to stabilize patients injured in remote wilderness locations so that they could be safely evacuated. There's absolutely no reason for the doctor to know that, though, or trust her claims to expertise, since she has none of her documentation with her, and her particular training is...unusual. Nobody has asked her for any details on it, either. If the doctor asks her to do it herself she's going to have CONCERNS about this place's due diligence.) 

She pockets the capped syringe and screws the other one to the tiniest needle she can find, which is still a half-inch long and - she doesn't actually know what the 'gauge' measurement means but it looks thicker than really necessary to inject subcutaneously, poor guy, this is going to sting.

She takes it to him, though, and quickly explains the medication and dose and possible side effects. "I'll check back in fifteen minutes," she promises. "It may take longer than that to feel the full effect but you should be noticing some relief after that long. But do please get someone's attention and ask for me if you're feeling worse in any way, all right? ...I'm sorry, the injection is going to hurt some." 

"Course it will. Go ahead."

It's something of a relief that he at least knows what to expect! "Have you had morphine or something like it before?" she asks, to distract him while her hands are busy swabbing a patch of flesh on his upper arm and injecting the drug. She practiced the motion of it ten times in a row, earlier, so despite the materials not being what she's used to, she has it done quickly and neatly in about five seconds. (She doesn't want it to hurt him more than necessary, and she also tries to always look confident in what she's doing in front of patients, since most people find that reassuring.) 

"Just the once. When I got my tonsils out."

"Good, so you'll know what to expect. I'll check on you soon, all right? Oh, and I've spoken to the doctor - he agrees with me that you should have an X-ray of your leg, and once he's had a chance to look at that, I'm sure he'll come talk to you about the plan." Though given how swamped everyone seems, here, Merrin is increasingly suspecting that this hospital exists in a permanent state of limited-resource-triage and, given that her patient is stable and not likely to deteriorate over time, this might take a WHILE. "Um, do you want a book or anything to pass the time while you're waiting? Or is there someone you could call to come be here with you and keep you company?" 

"I'd take a book if you have one? Or I can just try to catch a nap."

"...I don't actually have a book on me, sorry, but I'll see if I can find one." 

And, since she hasn't immediately been assigned another patient and she could use a minute to gather her thoughts anyway, Merrin decides that she might as well walk a circuit around the unit to look for ambient books or other reading materials. She'll feel more comfortable if she's oriented to what's going on with the other nurses, and in the meantime she'll hopefully look busy enough that no one interrupts her, so she'll have a chance to gather her thoughts a bit. 

There's a kid with a dog bite and a nurse stitching him up. There's a woman apologizing for her clumsiness to the nurse bandaging her hand. There's an elderly man breathing with the difficulty and sound of operating a blunt saw. There's a woman with what Merrin might not have the priors to recognize as alcohol poisoning getting set up with IV fluids. There's a terrified-looking young woman with a baby in her arms answering a bunch of questions.

There are also a bunch of patients currently waiting rather than being attended by nurses, who are all very occupied. Most of them have already been bandaged or stitched or hooked to IVs and are waiting, looking bored, some reading newspapers or books, some accompanied by family. 

...That older lady in the corner bed is alone. And looks - not great? 

Merrin makes a face, but she stops walking, and approaches the patient. 

"Hey. Excuse me. How are you feeling?" 

This gets a not particularly coherent mumble about whether the 'nice firemen' left the oven on. 

The patient looks very unwell. Pale and clammy, eyes unfocused, breathing faster and shallower than it should be. 

Aaaaaaaaaaaah why is nobody with her! The kid with the dog bite and the woman with the cut on her hand are clearly lower priority than whatever's wrong here! 

"My name is Merrin, I'm one of the nurses here," Merrin says, as reassuringly as she can, while she checks the woman's pulse. (Rapid and thready and noticeably irregular.) "I'm going to take your blood pressure, okay?" Fortunately the cuff-and-stethoscope setup, while different from what she would use in an improvised-supplies-only scenario, is possible to figure out just by looking at it. "Can you tell me your name and where you are right now?" 

The woman squints at her. "In the hospital, dearie. Could I trouble you with one thing? I'm so very worried about the oven -" 

"I'm sure it's fine." The woman didn't answer the first question, but she has a hospital bracelet. "You're - Sherry Williams, that's right?" 

"Yes, dear. Those nice firemen..." She trails off, as though forgetting her next thought entirely. 

Blood pressure cuff on arm. "Sherry, can you tell me what happened? Why did they bring you to the hospital?" 

A self-deprecating chuckle turns into a gurgling cough. "I had a nasty fall! Silly me. My son will be so miffed with me." 

"Hey, I'm sure he won't be. Does he know you're here? - Sorry, one moment, it's going to be tight on your arm now." 

Using unfamiliar equipment, she has to concentrate quite hard to make sure she gets a blood pressure reading on her first try. And then try harder than that not to reveal any of her worry at the result. 

Sherry looks anxious. "Oh dear. I don't know! He must be so worried." 

"Shh, it's all right, try not to worry. We'll contact him and tell him. Can you tell me today's date?" Unfortunately Merrin will have to check that with someone else because she has NO IDEA how the local calendar system works. 

Sherry scrunches her brow. "I'm afraid I can't recall. How embarrassing. I'm sorry, dear. Would you mind checking on the oven for me?" 

"Um, I can't - we're at the hospital right now, remember? Not your house. We could maybe ask your son to go check, when we reach him. How are you feeling?" 

"He's going to be so miffed with me," Sherry repeats plaintively, and doesn't answer the question. 

"I really don't think he will be! I'm sure he just wants to know you're safe in the hospital. Are you in any pain?" 

There are SO MANY metaphorical alarms screaming in the back of Merrin's mind right now! She cannot understand at all why nobody else is tracking this. 

"Well, yes." A chuckle. "The nice firemen said I might have a broken hip. How very silly of me. I hope my son won't be too upset with me, I was going to take my granddaughter to..." She trails off again. 

"I'm sure it'll be okay. Sherry, just hang in there for a minute, all right? I'm going to be right back with one of the other nurses." 

And she pats the woman's arm and then marches out and heads for the nursing station. 

"The lady in bed twelve," she says to the clerk, calmly but forcefully. "Who's assigned as her nurse? She doesn't look well." 

"That would be . . . Cathy Wilson. She also has bed six, if you're looking for her."

"Um, can you tell me what she looks like before I go hunting for her? Also, do you know if the doctor's seen bed twelve yet? And where he is right now? I think he needs to see her immediately." 

"Bleached blonde with a red shirt. Why do you think you know what the doctor needs to do?"

"Thanks." She's about to speed-walk off again, and stops. "I - what? I'm not sure what treatment she needs yet and also I don't think I have the authority to do it on my own, that's why the doctor has to see her?" 

"He'll get there when he gets there, don't go pestering him. He's got more important things to worry about than some nurse with opinions about a patient that's not even hers."

Merrin is not at all used to having to conceal her reactions from people and so she's not even trying! She's not upset, though, just nonplussed. 

"I'm not going to waste his time," she says, because this is more diplomatic than 'I'm not an idiot', and then she heads off to try to find Cathy. Who she ought to talk to first anyway, because (hopefully) Cathy has a bit more information on the patient than she does, and also plausibly ought to be the one to approach the doctor in order to avoid chain-of-authority confusion. 

Is there a nurse meeting Cathy's description near bed six? Or anywhere else in sight? 

Not in sight, no, but if she checks the bathroom a woman of that description is finishing up fixing her hair. She turns to leave as Merrin comes in.

The bathroom is definitely not one of the first five places Merrin checks! She thinks to check eventually, though. 

"- Oh, hi! Are you Cathy? I'm Merrin, I'm new here. You're the nurse responsible for Sherry Williams in bed twelve, right?" 

"Uh, yeah?"

"I think we need to have the doctor see her right away, if he hasn't yet - I was walking past and she looked off so I went in and did a quick assessment, and I'm worried. She's confused and her vitals aren't great - heart rate was above 120 and irregular, blood pressure was 80/50 or so, and she looks sick. She thinks she might have a broken hip, but I don't think it's just pain, she looks like she's going into shock and without more background on her I'm not sure what's wrong but my highest credence so far is on internal bleeding or maybe a pre-existing illness that contributed to the fall. How did she look when you saw her?" 

"Typical nervous old lady? More worried that she'd left the oven on than having anything serious. I couldn't get a blood pressure though."

"- Yeah, I had to go pretty carefully to get one, her pulse is weak. And it's not just anxiety, she doesn't know the date and she seemed to think I could personally check on her stove even though we're in the hospital, she's not reasoning clearly at all. Can we go get the doctor right now? For a start I'm pretty sure she needs fluids but I don't know if we have the authority to just start that without asking him." 

"Yeah, sure, go tell him," she says like she's mostly interested in getting as far from the problem/this conversation as possible.

"O....kay," Merrin says uncertainly. (Clearly the other nurse is feeling overwhelmed right now? Merrin's only patient is much more stable, so she might as well take over here, being flexible like that is an important part of any functional team although she would really like clearer communication given that it's literally her first day.) 

She checks on roof guy first. "Hey, I may be busy for a little while after this, but wanted to as how your pain is doing?" 

"A little better. I think I could fall asleep if it were a little quieter. Thanks for asking."

"I'm sorry about the noise." Earth is apparently really bad at sound-isolation tech in general. She wonders why; she didn't think it was that complicated, and they've got trains. "I haven't forgotten about finding you a book, sorry, it's just that something came up."

And then she forges off in search of the doctor. 

The doctor is doing some paperwork.

Merrin clears her throat. "I'm sorry to interrupt, but I have an update on Sherry Williams in room twelve. I think her condition may be deteriorating and we should triage her as higher-priority." She still doesn't really understand what the triage levels are, here, but, "- um, to clarify, probably highest priority? She looks like she's going into shock and I don't know why." 

"Do what you can for the shock. I'll put in an order for IV fluids." He gives her dose and timing information that's not what Merrin's training suggests as optimal but not wildly wrong either.

"Thanks. Um, should we go ahead and do some diagnostic tests at the same time? My top guesses are that she's either bleeding internally from the fall or she's got an infection." The treatment at this exact moment will be the same either way, but she has no idea how long blood tests take to get results on, here, and she's feeling pretty antsy about getting that information as soon as possible. Unfortunately she has very little idea what the names of the relevant tests would be, here. 

"When I want a diagnostic test I'll tell you," he says with some annoyance.

What. 

"Um, I understand if you want to assess her yourself first, but in that case I would strongly advise that you come do that right now or as soon as you finish your current mental stack," Merrin says calmly. Wow this language is really terrible for communicating. 

(She is not at all considering this a hostile or confrontational interaction; she has information, the doctor has different information, they need to reach common-knowledge on the situation as efficiently as possible and unfortunately are operating at a disadvantage due to their very different training, but she's not actually worried about resolving this, just that it'll take longer than usual.) 

"Stop telling me how to do my job and go do your own!"

"Um?" Merrin says blankly. She is utterly caught off guard, and her mind is mostly focused on planning for the patient in bed twelve but she's not so focused on it that she misses the signs of SUDDEN CONFLICT, which from her perspective is totally inexplicable and came out of nowhere.

(Maybe he's...having a really awful day for unrelated reasons, like, he had a fight with his partner or his kid is sick or something? Anyone in a position of responsibility in dath ilan would have the necessary training not to let it slip into their job like this, but she already knows Earth is different. She should remind herself to be charitable.) 

"Where I'm from," she says quietly, "my job involves giving you all of the information that I believe I have and you don't, and that includes my recommendations. Which I've now done. I'll go start the fluids." 

And hopefully give him a minute to cool off and realize that he's slipping on Dignity and recover gracefully from it. 

He mutters something about new people as she leaves.

She gets the fluids. (This takes longer than she would really prefer, poking around the supply room, but no one seems available to help and she's also feeling a bit irritated and off-balance, and doesn't want to risk taking it out on someone else before she gets herself calmed down.) 

The patient didn't even have an IV, so she collects those supplies as well; presumably she doesn't need to separately ask the doctor about that, it's implied by the treatment plan. 

This leaves her arms rather full. In dath ilan there would be trays or baskets conveniently placed to deal with this. Earth hospitals are not so well laid out, apparently. 

"- Hey," she calls to the charge nurse as she passes the nursing station. "Just wanted to fill you in - I've taken over bed twelve for Cathy, she seems really busy and my other guy is stable, and twelve is looking shocky. I got some initial orders from the doctor and I'll keep you up to date?" 

This is a MUCH less informative report than she would usually provide, but English doesn't make it easy to give more information in a reasonable number of sentences. It's very frustrating. 

Squint. "Did Cathy say you could do that?"

This seems like incredibly not the point to be focusing on! 

"I told her I'd happened to walk past and noticed she looked bad so I did an assessment and her vitals weren't good - I'd expected she would take charge and I could just be backup but I hadn't realized she was so busy, so I offered to take care of informing the doctor for her and getting orders and she agreed?" 

"Okay, fine, whatever."

Merrin now has a completely different flavor of alarm screaming in the back of her mind! None of this is going the way she expects it to and she isn't sure what she's missing and now is incredibly not the time to be introspecting on confusing interpersonal dynamics, she's using her brain for other things. 

Maybe the charge nurse is also overwhelmed? But the unit doesn't look that bad, actually, most of the patients are clearly stable, in need of treatment but not so time-sensitively that their nurses can't take bathroom breaks. (Does Earth medical training just...not include the standard mental exercises for dealing with overwhelm and re-establishing focus?) 

She will make a NOTE of this to think about later so she can stop holding it on her mental stack now. Once she's unloaded her supplies. 

"Thanks," she says with a smile. "I may need backup if she deteriorates more, but hopefully she'll respond well to fluids and we can buy some time for the doctor to see her and do some diagnostics." 

She heads off to return to bed twelve. Which apparently is missing the bedside table; there's a little side cabinet by the head of the bed, but it has a box of tissues and some folded hand towels on it, which she can't even move due to her arms already being full. She settles for depositing her loot on top of the sheets at the foot of the bed. 

"Hi, Sherry. It's Merrin again - I'm going to be looking after you for a bit until Cathy can come see you, okay? The doctor would like me to place an IV and give you some extra fluids, so you should feel better pretty soon." 

Sherry squints at her. "Did you check on my oven?" 

Aaaaaaah she should have DELEGATED looking up the patient's chart and finding her family contact information and calling her son. Unfortunately nobody she's spoken to has seemed to be in a position where they can afford to take on any more tasks! This makes time management so much harder and this room - cubicle - doesn't even have a WHITEBOARD. 

"I'm so sorry, I haven't had a chance to call your son yet. He's going to want to know that you're getting the best treatment, so I'm going to start these fluids first and then I can tell him that when I call. You're still at the hospital, Sherry, your oven isn't here."

Talking only takes some of her attentional capacity and she uses the rest to dig out a new piece of paper and, using the wall as a hard surface for lack of anything better, label it with Sherry's name and take down the vital signs from earlier and then mark down a todo list. 

"I'm going to put the tourniquet on your arm, okay? It's going to feel tight. I -" gaaaaah she can't figure out how to operate the mechanism on the cot to raise it, this is terrible ergonomics but probably she can get away with it once? "Have you had IVs done before? I just need to look for a nice vein, and then I'm going to clean your skin and then it'll just be one little poke..." 

"I don't like needles," Sherry complains. "S'not nice." 

"Hey, I don't think I know anyone who does like needles. The needle isn't going to stay in, though, it'll just be a little poke and then it's all done, it's only a little plastic tube that stays in you." 

Sherry grumbles a little more about this, and then starts mumbling something about her granddaughter's school play. 

Her skin is thin and spotted, the veins fragile and refusing to plump up. Some of that is probably shock or dehydration. Plausibly some of it is just sheer age; Merrin very rarely treats patients in this kind of physical condition, most dath ilani choose cryopreservation before they end up this frail. 

And, of course, the people of Earth DON'T HAVE THAT OPTION. 

(Merrin carefully nudges that thought out of the way, because the last thing she needs right now - the last thing Sherry needs, and Sherry is her focus here - is for her to start crying again.) 

It's probably not the hardest IV placement she's ever done, objectively speaking - dath ilan normally has better tech for this, and all ambulances are stocked with it, but in the field she may end up doing it by hand. The supplies are unfamiliar, though, and this time she was in too much of a hurry to get a practice kit. (Maybe she should nab some supplies before she leaves, so she can practice on herself?) 

She doesn't get it on the first try, which is AWFUL, and she has to do some careful mental re-arrangement to shut down the pointless humiliation-feelings. 

"Sherry, I'm so sorry, I need to give this another go." Although trying the exact same process again and hoping for better results is...predictably not the best decision procedure to follow and so she should try something smarter than that. 

She...should use gravity? Merrin wrangles the bedrail down. The mechanism is surprisingly non-obvious. She doesn't swear at it out loud because that won't accomplish anything and it might be stressful for the patient but it's tempting.

"Sherry, hey, I want you to let your arm hang over the side of the bed like this, okay? To help me find a vein."

She could use heat? The problem is that she really can't walk away right now - the bedrail's down, the patient is confused, she's already got all her things set up in a precarious placement on top of the sheets. 

Are any nurses nearby enough that she can call to them and ask for assistance here? 

The nurse who had dog bite kid is charting but seems unhurried and generally non-overwhelmed!

Merrin risks leaving Sherry's side for thirty seconds and darting away as far as the aisle between the wall of cubicles and the nursing station. "Hey!" she calls out. "Do you have a minute to run an errand for me?" She's not going to shout about the reason why; Sherry will hear her, and get even more anxious. 

"What do you need?"

"I'm having trouble getting an IV. Do you have any way of applying heat to get the veins to surface more? ...Where I worked, we had instant chemical heat packs," whyyyyyyyy is that four entire words, "not sure if you've got something comparable? Or other tricks worth trying?" 

"Gosh, I don't think we have anything like what you said."

Okay, think. Pretend this is one of those mean no-resources scenarios. "...Can you run a towel under really hot water for me and bring that over?" 

The other nurse looks at her like she just said something very clever. "Okay!" She goes and does that and comes back with a hot but slightly dribbly towel.

"Thank you!" Merrin smiles warmly at the other nurse. "I'm Merrin, by the way - this is my first shift here, I trained in a foreign country so we do things a little differently. I owe you a favor, so let me know if you need help later on in the shift! - If I can beg one more favor, could you find me one of the thermometers?"

They don't have one at every bed, which Merrin thinks is very unfortunate planning. Sherry isn't obviously feverish, but Merrin has a very vague recollection that fever can be less obvious in older people who aren't undergoing all the standard dath ilani age-slowing treatments; their immune response to infection is weaker. (Aging is horrible.) 

She goes off for a thermometer, detours by her own patient, and comes back with the thermometer.

The dribbly towel is not optimal but it'll do, and fortunately she has some dry towels right there to mop up the dampness once she's warmed Sherry's arm for a minute. That, combined with the effects of gravity and the slightly greater familiarity with her materials, lets her get the IV in on her first try, though getting the dressing on it is a little fraught. She stares at the IV bag and IV tubing for thirty seconds before she manages to intuit how to connect them together; it doesn't work the same way as the tubing-to-IV, which is at least the same as the syringe-to-needle, these people have heard of standardization at ALL. The IV bag has a sort of rubber seal at the neck, and the tubing has a hollow plastic spike which she eventually figures out needs to be shoved directly through to pierce it, rather than having a screw-fastening, weird. 

- and by this point the other nurse is back with a thermometer for her, and Merrin thanks her again, the friendliest smile she can manage while her brain is mostly full of planning the order of her next tasks and vehemently wishing she had a PREDICTION MARKET to consult.

(She's done scenarios before where she didn't, of course. Quite a lot of the Exceptions to handle involve the premise of losing access to electronic infrastructure, and Merrin has quite possibly had more practice working in isolation like this than any other EMT in dath ilan, and certainly anyone under 30. Most of it wasn't real, though, and...it makes a surprising difference to her stress levels, that this isn't a rehearsal and - worse - that if she screws up, there's no last-ditch cryopreservation to fall back on. If she gets this wrong then Sherry Williams will be GONE FOREVER. Merrin is trying not to dwell on this too much, it's not helping.) 

Sherry's temperature is 38.2. When Merrin checks her blood pressure again, after squeezing the IV bag hard to send the fluids in faster, it's a touch improved. 85/60 or so. Her pulse is less fluttery but her heart rate is if anything more irregular than before. 

Aaaaaaaaaaaaaaaaaaaaaaaaaaah. 

Okay. Focus. She can do this. 

(Merrin is quietly thinking that she almost certainly can't keep doing this level of emergency-handling, with this little support or known procedures to fall back on, for an entire twelve hours without stopping. Her brain is already kind of aching.) 

She doesn't need to be pacing herself for the next twelve hours, though, she needs to be focusing on this patient. 

- diagnostics. If Sherry is bleeding internally, she's going to need a blood transfusion as soon as possible; if it's an infection, then she's clearly headed toward septic shock and needs antibacterial or antiviral drugs right away. She can't do the obvious blood tests because she doesn't know what they are, here, and the doctor is having a bad day or something and doesn't want to tell her. 

So. Pretend this is the sort of scenario where she has literally no diagnostic equipment. What would she do? 

"Sherry, I need to ask you some questions, okay? And I have to have a look at you." If she's bleeding internally, it'll show, there'll be bruising or belly pain. Though belly pain could also hint at a urinary tract infection... 

Sherry seems if anything more confused than before; it's hard to hold her attention long enough to get the full answer to a question. 

She doesn't remember hitting her belly in the fall and there's no bruising there, or anywhere except her elbow and hip. Her lower abdomen is slightly tender, but she finds it a lot more painful when Merrin has her turn a bit and gently thumps her flank, where the kidneys would be. She admits to feeling 'a bit off' for the last few days, and that she was dizzy this morning and had some nausea, before she fell. 

Merrin thanks her for answering the questions and tries to be reassuring and once she's done as thorough an assessment as she can - noting that Sherry's lungs sound a bit crackly and her extremities are cool with notably delayed circulation. 

With the bag of IV fluids half in, she takes another blood pressure. It's back down to below 80 systolic, and she's not confident in the diastolic number at all but would guess it's around 75/40, which is what she writes down. 

(Aaaaaaaaaah.) 

...She doesn't especially want to leave Sherry alone, even to go find the doctor, but nobody else is conveniently available at the nursing station, and even if she can get another nurse's attention, she's getting the sense that by default nothing here happens fast. 

She sighs, pats Sherry's arm, tucks her blanket in closer but apologetically refuses to give her another one, and then she takes a deep breath, steels herself, and marches off in search of the doctor, who has HOPEFULLY gotten himself calmed down by now. 

He doesn't immediately snap at her again, at least.

"Hey. Um, I started the fluids for bed twelve but it's not really helping her blood pressure, latest was 75/40. She's running a low grade fever and admitted to feeling unwell before this, that probably contributed to the fall at home. No visible signs of internal bleeding, so my guess is sepsis. Where–"

She was about to start with 'where I'm from, we would start a broad-spectrum antibiotic immediately while waiting on test results' but she is still feeling pretty unsure how much social license she has here to just tell the doctor what orders she needs, versus wait for him to say the incredibly obvious thing himself. (Which seems like an absurd and inefficient way for it to work, but - that doesn't not fit with everything else she's learned so far about Earth.) 

"- Um, what would you like us to do now?" 

He prescribes some antibiotics and explains, a bit condescendingly, how to get the blood tests now that he's put an order for them in the chart.

"Thanks!" There is no point in being irritated at him and so instead she will be friendly and grateful. "Um, do you want to give me some quick guidelines on what changes would be worth interrupting you about?" 

"If the fluids don't bring her BP up and another liter doesn't either come and get me."

Merrin had really been hoping for more thorough instructions than that! Normally she would have standard monitoring protocols to work with, with guidelines on every possible change in status. Though also, normally she would have continuous monitoring data automatically feeding into the patient's anonymized online chart, and prediction markets updating in real time. She's starting to realize exactly how much of her cognition is normally outsourced to people smarter than her. Tracking it all in her own head is...possible, it's one patient and Sherry is not, in fact, that complicated, but it still feels like she's balancing on a tightrope with no ground below, and it's exhausting. 

She gets another bag of fluids from the supply room on her way back to Sherry's bed, hooks it to the IV pump behind the half-empty one, and then steals the blood pressure cuff from the empty cubicle next door as an improvised pressure-bag to squeeze the fluids in faster. 

"Sherry? I need to ask you some questions about your medical history. Are you on regular medications?" 

Sherry blinks at her but takes a while to process the question. "...Pills, you mean? Oh, yes. The nice doctor wants me taking five with breakfast. Five! Can you believe it. There's a pink one, and a blue one, and a big orange one..." 

Wow, this is really not informative! 

A couple more questions discern that Sherry has very little idea what her home medications are for; she says vaguely that she thinks one of them is for her cholesterol and one is for her blood pressure, but of course Merrin doesn't know what the first-line drugs for either of those would be, here. 

She sighs. Checks another blood pressure - it's 80/45 or so - which is technically 'higher' but it's not great and Sherry's hands and feet still look under-perfused, so she manages to remove the empty bag from the spike and place the new one, swapping over the blood-pressure-cuff. 

Sherry watches her work without much curiosity. "I'm very thirsty, dear, could I trouble you for a glass of water?" 

"Um, I'm sorry, I think I should hold off on anything to eat or drink until the doctor has a chance to look at your hip and we know if you need surgery." 

"A surgery!" Sherry gives you an alarmed look. "Surely not!" 

Aaaaaah was that a bad thing to say. "Hopefully you won't need it," she says soothingly (although, in dath ilan, almost any hip fracture would be treated that way.) "Just try not to worry, okay?" Which feels like the most inane reassurance she could possibly give, but all her usual scripts with patients would end up taking three paragraphs to convey in English, and Sherry is clearly still kind of out of it. "I'll be back very soon, all right?" 

And she heads off to see if the clerk at the nursing station is interruptible. 

She's looking as interruptible as she's likely to get.

"Hey! Um, I was wondering if you've got a chart for Sherry Williams in bed twelve with any of her medical history or family contacts?" 

She does have a chart. It has her address and the name of her usual doctor.

Does it have anything else. Like, for example, her son's phone number. Or her doctor's phone number. Or maybe even a list of her daily medications??? 

Nope! It has what the firemen managed to get out of her when they picked her up. One of them did note that they turned the oven off at her request.

Well, that's nice of them at least. 

"Excuse me," Merrin says to the clerk. "If I have a name for her doctor, is there any good way to get in contact with him? I have some questions about her history." 

Oh, sure, no problem, here's a phone book. Doctors are in this section and it's by last name within that.

Merrin is pretty sure that flipping through this phone book, which isn't even searchable because it's on paper, is NOT A GOOD USE OF HER TIME, and surely it would make more sense to delegate it to someone with less specialist expertise, but she's feeling pretty done with getting into confusing time-wasting arguments with the other staff here over how things are done, and she's the foreigner here, it's on her to adapt and avoid disrupting other people's work while she figures out their protocols. 

It takes her a deeply frustrating several minutes of hunting, but she manages to find the phone number, and write it down. Then a quick dash to bed twelve again, just to make sure that Sherry is conscious and responsive and doesn't look visibly worse, and then she needs to bother the clerk again to ask how to use the telephone and input what is hopefully the doctor's phone number. 

Ring ring ring "Hello, Bill Lawrence's office," says the woman on the other end.

"Hi! This is Merrin, I'm calling from Manhattan General about a Sherry Williams - I believe she's one of Dr Lawrence's patients? I was hoping to speak to him or one of his staff to get some background information; she's one of my patients, and the chart we have on her here is very minimal." 

"Oh dear, she's in the hospital again? I'll put you through to Dr. Lawrence." . . . "Hello? You have some questions about Mrs. Williams?"

Merrin thinks that if Sherry is in the hospital 'again', implying that she's been here before at least once and probably multiple times, then, one, she would have liked to KNOW THIS FACT, and two, she's a lot more confused about why the hospital doesn't have a more detailed chart on her. 

"Thank you for taking my call, Dr Lawrence. Yes, I do. She came in this morning after a fall at home, and her condition is a bit worrying. Her chart is very uninformative - I was hoping you could fill me in on her medical history and home medications? Also whether she's been hospitalized before, and if so for what. - Oh, and if you have contact information for her son or another family member, that would be amazing, I don't think they've been notified." 

She has chronic high blood pressure and had a minor heart attack a few years ago; she's not much the worse for wear but he prescribed this that and the other for the blood pressure and told her to eat less red meat. She's had some UTIs, too, but they always clear up with a quick course of antibiotics. Her son is one of his patients too and he has his phone number. Good luck, she's a nice lady and we'll be praying for her.

Huh, okay, on the one hand what but on the other hand now is not the time to get into a whole discussion to clarify what 'praying for her' MEEAAAAAAAANS. Her language knowledge is helpfully providing a tiny bit of context but honestly that mostly results in her having additional questions. 

(She's going to make a note of it, though, to add to her growing list, because this seems like the sort of confusion that might be important.) 

She asks a couple of followup questions - what exact medications and doses, they'll need to know that if Ms Williams is sick enough to be admitted overnight which seems very likely, also allergies if any and what antibiotics he's prescribed in the past for her UTIs. 

She thanks the doctor warmly for his help - he's been more helpful than almost anyone else she's interacted with today, and also friendlier about it, not that she says that out loud. 

Sherry is still conscious and the bag of IV fluids is still in progress, and she doesn't really have enough to update the doctor, so she takes thirty seconds to brave herself for some NEW flavor of weird unpleasant social interaction, and then dials the number for the patient's son. 

Ring ring ring "Terrence Williams speaking."

"Hi, Mr Williams. My name is Merrin, I'm a nurse at Manhattan General. I understand your mother is Sherry Williams?" 

"Yes?" he says, in the exact tone one would expect from someone who just got a call from a hospital asking about his elderly mother.

Poor guy! 

"I'm afraid she had a bad fall this morning, and likely broke her hip - um, she just got here recently and we haven't had a chance to get through all the diagnostic tests yet. We think she also has a urinary tract infection, again, which I understand happens semi-regularly for her, but I think may have contributed to the fall. She's getting IV fluids and we'll be giving her antibiotics and running some more tests for that. Mostly I wanted to make sure you were notified - she was asking after you - but I was wondering if you might have any other background that would be useful to know for treating her." 

"Thank you. Um, the UTIs always make her confused, she might not be able to talk to you much." He names the antibiotics she got last time and says if she has to stay overnight she'll want to be somewhere she can see out the window and wants to know if there's any more specific questions he can help with and whether he can come in and see her.

Merrin notes all of this down, hoping that there's a place in the chart to add information like her room-window preferences. 

"Of course you can come in and see her! I think she would be very happy to see you, and given that she's confused, I think it would be very good for her to have someone there with her who can answer any questions as they come up." And also speak on her behalf and make sure she's not neglected by busy nurses, which is APPARENTLY a problem that Merrin needs to worry about, here.  

"Okay. Thank you again, I'll be there in an hour."

"I should be thanking you! See you then. Um, she's in bed twelve - I can't promise I'll be available when you arrive, it's pretty busy here, but I'll do my best to swing by and give you an update as soon as I can. I'll go let her know that you're coming." And that the 'nice firemen' switched off the oven for her. They must have told her that at the time, so it's not the most reassuring sign, that she apparently forgot. 

Aaaaaaaand back to her growing task list! She goes to hunt for where the doctor actually 'put in' the orders for tests, so she can double check the exact details and then check with one of the other nurses what supplies she needs to grab. 

Sherry's chart now has an order for a set of tests to check for a range of plausible infections. Here are the vials to collect the blood in, for those tests she needs the ones with these colors of cap, here's where to bring them afterwards.

Okay. So far so good. Merrin gathers up her supplies and decides to prepare the antibiotic at the same time, so she can administer it right away after she draws the blood, though obviously to get accurate results she needs to do the test before starting the treatment.

(A glance at the clock tells her it's already been nearly an hour since she first stopped by bed twelve, which Merrin feels TERRIBLE about, that is NOT a good response time and would by itself merit an incident report and debrief at a dath ilani hospital.) 

She explains to Sherry what she needs to do and why while she looks for a vein. Fortunately, she doesn't need nearly as good of one just to draw blood, and the needle looks reasonably easy to use. 

"I looked at the notes in your chart, and it says the firemen turned off your oven," she reassures Sherry. "So there's no need to worry about that. Also, I got in touch with your doctor, and your son Terrence! He's going to come see you, he'll be here in about an hour." 

Sherry is looking a bit brighter-eyed after the second bag of IV fluids. "Oh, good! You're a sweetheart." She grimaces. "I - have a bit of an embarrassing confession to make." 

"Oh? I'm sure it's not embarrassing. Sorry, this is going to be a poke." Stab. 

"- You're very good at that, I barely felt it!" Sherry still looks very sheepish. "I...think I might have wet myself just a little." 

Oh no! This is absolutely Merrin's fault for not even thinking to check if she needed to pee! 

"I'm so sorry about that. I'll check just as soon as I send this blood for testing, and we can get you changed." 

It takes her another ten minutes, though, before the blood is sent and the antibiotic is running and she's taken another blood pressure - it's up to 90/50, which isn't amazing but at least it's headed in the right direction - and then confirmed that Sherry is, indeed, lying in a puddle. She tracks down clean sheets and, since she can't find any wet wipes, some small face towels. 

And then she's faced with the problem that Sherry is in a lot of pain, with a probably-broken hip, and definitely not able to turn herself in bed. 

"I'm sorry, I need to find someone who can help me out with this," she says, and goes off to hunt for the least-busy fellow nurse. 

There's a readhead patiently explaining to a very angry middle-aged man that she cannot "just fix" his pneumonia while he coughs all over her and interrupts whenever he isn't coughing. She's not exactly non-busy but looks like she would love an urgent interruption right now.

(Is the nurse wearing any kind of personal protective equipment? If not: added to the tally of aaaaaaaaaaaaaaaaaah.) 

Merrin sidles up. Smiles at the patient and gives him a tiny wave, then turns to the nurse. "Hi! I'm Merrin, I'm new here. Um, I need a hand changing some bed linens - if you have time to help now, I'd be happy to help you out with something else after." 

"Oh yes of course, I'll be back in a moment Mr Sidlington." She gives Merrin a little smile of thanks once they're both facing the other way.

Merrin leads her back down the aisle. "It's for Sherry Williams in twelve, she's wet herself - I feel awful about it, I didn't even ask if she needed to go, and she's likely got a UTI and just got two liters of fluids. Everything I need is there, she just can't turn on her own. Um, want me to try having a chat with your patient after? What's he upset about?"