The markets are watching!  

If Vellis doesn't succeed at stopping the bleeding, this could just imply operator error - especially since Merrin, reasonably given what else she's doing, doesn't want to do it herself, and Merrin is the one with by far the most sim time, especially sim time under moving-helicopter conditions. But probably not. They're a good team.

There is, however, an underlying complication that would predict both 'bleeding' and 'bleeding that is more difficult to stop than it should' be – and also predicts, soon after that, lots of hard-to-stop bleeding everywhere else. Injured patients on three different extracorporeal filter circuits, who have been through a whole lot of other weird medical interventions, are at some risk of disseminated intravascular coagulation - of the platelets and clotting factors responding to an imaginary injury, everywhere, in the process exhausting all the resources they need to (especially in this case) prevent bleeding in a dozen different bruised or torn tissues, or from the various holes they've cut in him. 

The prior is low, but if Vellis fails at this procedure, it's suddenly the top explanation, call it 9:1 odds. And it's a pretty bad sign. A survivable one in the short term, if they do everything right and don't get more unlucky, but a bad sign for the eventual prognosis. 

Aaaaaaaand Vellis is trying it! Very very carefully. So carefully. 

This is indeed an extremely stressful thing to attempt in a moving helicopter! It takes like five minutes before she has a sufficient moment of calm to risk shoving a sharp thing between Kalorm's ribs and cauterizing the leaking artery, during which time he's still bleeding into his chest cavity. 

Buuuuuuuuuut - 

- once she has it cauterized, the bleeding does stop! And appears to stay stopped!

(And still no sign that he's oozing blood from all his orifices, natural and not.) 

The markets breathe a collective sigh of relief; the patient is (at least very likely) no longer having a potentially lethal in transit complication. His survival-through-rewarming odds bounce up to 92%. 

...However, he did just lose an estimated 250 ml of blood, into his chest cavity where it's probably at least somewhat messing with intrathoracic pressure. Vellis is trying to suction some of it out, but most of it has started forming a gelatinous semi-clot that doesn't really want to come up through her soft plastic suction tubing, and they're being very gentle, they don't want to jog that splinter and poke a hole in something else. 

Most of the worry about a complication en route, especially pre-midair-transfer, wasn't about cases as bad as DIC. Just that they don't have a lot of slack on this particular protocol, and Kalorm is in a fragile enough state that any complication on this level of severity, even if by itself it doesn't predict damage, is still a perturbation to a system being maintained in a rather delicate balance. 

During the active bleeding, Merrin has been having to work her butt off to keep his vital signs within parameters. Rendezvous is in less than fifteen minutes. If Merrin's team can't get him a lot more stable than this before that point, then - well, they're going to do the transfer anyway, they do not actually have better options. But they're expecting to spend almost the entire time with the patient randomly outside some number of the narrow parameters, with the predictable result that - even at his current temperature - probably some cell damage, or factors upstream of later cell damage, with accumulate. It'll be really not great. Plus there will be some time on either side of it when Merrin is more distracted.

And then Merrin will still have to try to keep him stable for just over two hours, and her chances of being able to do that at all, if he was unstable going into the transfer and semi-controlled crashing during it, are not great at 18 C. He's still fairly unlikely to die in transport, but they'll lose ground on the stabilization protocol, and may have to abort entirely and bring him back up a higher temperature if it looks like too much for Merrin to handle, or too big a risk of a sudden deteriorating running into a situation that already has no slack. 

The market...is pretty balanced on whether Kalorm will or won't stabilize before transport, which is the strongest predictor of whether Merrin can keep him that way during transport. 40% that he does, 60% that he doesn't. 

- if he does stabilize before the transfer and then tolerates it without crashing, that's actually a modest positive update about his underlying health, and the market thinks it would land on outcome predictions a little better than they were before the bleed. They are expecting that, if that happens, it'll be a 3% increase to 95% chance of surviving-through-rewarming, a 6% decrease to a 55% chance of minor damage, a 3% decrease to 18% chance of moderate damage, and a 1.5% decrease to 8% chance of severe damage. 

('Stable at point of transfer' doesn't guarantee also stable at point of arrival. The shifts will be bigger after that.) 

If he's unstable at the point of transfer, well, there are still a lot of additional things that have to go wrong before they really start losing ground. It increases the odds of those things going wrong, but by less. Call it a 2% decrease in survival odds, back down to 89%, a 4% increase in minor damage to 65%, a 2% increase in moderate damage to 23%, and just a 1% increase for the worst outcome, up to 10.5%. 

Go Merrin! Personnel is rooting for her! 

(Personnel is not saying anything to Merrin because this never helps.) 

(Ranthir might bet against those 40-60 odds, if she were currently looking at that market, which she isn't because there are, like, eight thousand things to look at, and she's also having a raging family argument with her father and little brother via videoconference over the matter of a certain entrepreneur who does not think he can realistically do the thing Finnar wants within two hours.) 

Come on, Kalorm. You can do this. Merrin believes in you. 

Please?? What if Merrin believes in you even harder than that??

.....Kalorm is not super stable, no. 

He's not getting worse. Merrin is, in fact, maintaining his vital signs within the limits given. But he still has a cupful of blood parked against his lung, and they gave him a blood transfusion of the exact quantity they think he lost and then some more plasma when his heart still wasn't really filling with enough blood, but now he seems to maybe be fluid-overloaded. His lactate keeps trying to rise and they're having to give him bicarbonate again to keep his pH in line, and sodium bicarbonate is the safest, metabolically speaking in general, but she's sure having to work super hard not to let his sodium levels creep up again. 

She can do it. It's not even the single hardest thing she's done before. But it would be rough to maintain for two hours, and maybe impossible while in a separate transfer pod swinging in the wind, operating his machines purely by remote control, without even having a good screen setup for visual sensor data. 

It's okay, Merrin isn't mad, she knows he's trying and honestly he could be doing a lot worse, she's doing her part but he's doing his too and she couldn't do this on her own...

Well, it was a lot to ask. Updated predictions: 89% survival through rewarming, 65% on minor damage, 23% on moderate, 10.50% on major. 

The next part is what's really going to matter. 

The markets...do not really expect Merrin to pull this off. Nothing against Merrin, it's just really really hard. A lot of very smart people having been poring over her complete sim-performance record, and she's never done anything comparable to this. It would normally be insane to expect a 23-year-old to do - well, most of what she's doing, but especially what they're about to ask of her. (Merrin in some sense has more clock-time experience than many 50-year-olds, but sim time isn't the only kind of experience that matters, and the fact that she's 23 and actually looks younger is, perhaps, affecting some priors here.) Also, this isn't a sim, the stakes are even higher than usual for a real-life rescue, and it would be totally understandable for Merrin to be operating at slightly less than peak performance. 

They think Merrin has maybe a 25% chance of pulling this off, 1:3 odds. 

If she can't - well, 100 seconds isn't that long, the damage will be limited by the fact that the patient is at 18 C, and they'll have a chance to regain control of the situation for the rest of the flight. The medevac crew - remarkably - includes an Exception Handling medtech certed for all of the machines and reliably able to interoperate 4 of them, so Merrin will be able to get some breathing room. It isn't going to be the single factor that wrecks the patient's odds going forward. It's not great, but it mostly hits the odds of mild-to-moderate damage.

The market expects another 1% drop in survival odds, a 5% increase in minor damage, a 2% increase in moderate, and a 1% increase in major. 

...If they do get lucky, though - well, it won't mostly be luck, and it will make their odds of pulling off this plan look substantially better. 3% improvement in survival, 15% drop for minor damage, 6% drop for moderate, and an entire 3% drop for severe.

(Based on some more careful analysis of case studies compared against Kalorm's early sensor readings, they're more sure that he doesn't yet have that much damage, and that it would take several different failures at halting the cascade for it to get that out of control. There are some tweaks being made to the eventual neuroprotective rewarming protocol in Default that should, at least slightly, improve their odds, if they can deliver a patient who still has sufficiently minimal reperfusion injury. It's not totally original research, that would be almost impossible in the time they have, but they're comparing different versions of the non-secret protocol that have been tested in different cases actually in humans and have a large enough sample size to count for something, and asking themselves how they can tweak the secret protocol - which has gotten less attention and less direct research effort in humans - to work as well as possible for Kalorm, who is apparently in many ways not a median adult male. It's not clear if the changes will be ready to go in two hours, but it helps a lot, for this situation, that the research is happening in Default and not a tiny regional hospital.) 

...Oof. You don't tell Merrin that she would have to be very special in order to succeed at something important! Personnel recognizes that they didn't literally say this, but Merrin is absolutely capable of reading between the lines, and Personnel is worried that she's now even less likely to succeed. 

If other people also think this, they superheated thankfully don't have time to actually bet against Merrin before her departure. 

Time to go.

Well. Not quite. The helicopter is matching speeds with the plane, but Merrin-and-team need to load their patient into the transport pod, without disrupting any of his life support equipment or making him start bleeding again. (Vellis did, eventually, sigh and settle on squirting some biodegradable gel around the site of the bone splinter, after judging it was completely not safe to try to extract it while the helicopter was being knocked around by the storm. It'll put a bit of pressure on any other torn vessels and cushion the surrounding tissues against further damage while the patient is being tossed around in the wind as they reel him up fifty meters on a winch. Normally you could do air transfers closer in, but it would be really very bad if either the medicopter or plane were damaged, and they're not actually out of the storm yet. 

Kalorm does not super like being moved! (They're sliding his force-distributing gel mattress and its supporting base on rails into the pod, not taking him off the mattress; they'll be able to do that for the arrival in the plane too, and probably the arrival in Default; it's not quite as good for preventing bedsores in totally immobile patients as the ones they'll have available there, but it would be convenient to avoid moving him any more than necessary until some of those tubes are no longer attached.) 

"I know, I know, I'm sorry - I know this is going to be superheated awful but I know you can do it, it's not for long -" 

She squeezes his hand one last time, and then they seal the pod, and Merrin is (much less carefully) flinging herself into her own pod, Vellis is fastening the straps for her, and then she's sealed in as well and the world goes away. She can't even hear the sound of the storm, which has been a constant throughout. 

She has a thirty-by-thirty centimeters of LCD screen real estate, awkwardly close to her face, and her console, which she can handle basically by feel, and this is going to suck so much but - mostly on Kalorm's side of things, really, she isn't the one with broken ribs. 

She isn't, in fact, the main character of this story at all. Right? Kalorm is the one fighting for his life. She's just here to be encouraging. Kalorm is the one who's weirdly good at that. Merrin is just here to be a supporting character for this particular interlude of his life. 

This is, perhaps, a point at which the market is betting on incomplete information. 

Khemeth would have caught it, if he were fully paying attention. The relevant pieces were starting to come together in his mental model of Merrin, and if he had seen her face when she was packing Kalorm up for transfer and then climbing into her own pod, it would have shifted some of those pieces, and he would have placed some rather large bets that Merrin was about to outperform those odds, and would have made some money (though not all that much money compared to what he's been spending, today.) 

Khemeth is instead trying to convince his father to let him talk to the head of a research lab who may or may not be willing to do something personally inconvenient for them in exchange for a lot of money, while both only saying true things (he doesn't lie to his parents, or anyone, about important things, just his emotions, which aren't) – and while also not once implying that it's because Finnar has a tendency to, well, offend people, especially when he's convinced a problem is the single most important problem in the world and only stupid people would disagree. 

This is why Khemeth isn't going to notice, and make his bets and recommendations, until after the transfer. 

Here are some facts about Merrin: 

Merrin is stubborn, and high-conscientiousness, and may not be that smart, certainly not in terms of raw processing speed or mathematical ability, but she retains information well, and retains procedural skills better than that. Merrin can and does work twelve-hour shifts regularly, and has ten thousand hours of emergency sim time under her belt, which is ridiculous for someone her age (though of course the first several thousand hours weren't on situations like this; that's just what it took her to catch up to her peers.) 

Merrin is also deeply neuroatypical, sometimes in ways that help - nearly everyone likes working with her, even people who are often cantankerous - but often in ways that are ongoingly costly to her. It's not just that thinking about being unusually good at something - especially if it's in a way explicitly represented by numbers - has a tendency to send her entire brain into a panicky spiral. That, just about everyone who works with her has been willing to accommodate. It's not even just about the chronic imposter syndrome, which no one has even pushed her on that much because of the panic spiral, and because she's psychologically unusual enough that it's sort of unclear what would happen. 

(A couple of instructors tried, and the thing that happens at least sometimes is that Merrin starts crying, which seems, you know, pretty bad? And like they should super not keep doing that thing?) 

It's also that, compared to most dath ilani, rather a lot of Merrin's mind is specifically attuned to social threats, and it's really hard for her to turn that off. She does vaguely know this is a problem when it actually makes her lose focus at a particularly bad time, but often it's not very salient to her, and she certainly doesn't go around thinking that other people don't have a constant background internal monologue running on how other people are perceiving them. She's gotten better at not letting it distract her, but as long as she's being watched, it's pretty hard to tune out. 

...Another fact about Merrin is that her relationship to tests is, well, weird. Particularly in sims, she's especially aware of being watched – and not just watched, but judged on her performance. This is, after all, part of the point. Merrin can cope with it - Merrin can even sort of cope with the fact that way more people are going back and assessing her sim performance, as long as she mostly avoids thinking about that too hard - but it's still distracting. It means that unless she is literally too busy to have thoughts, her mind is running an ongoing thread of commentary, not just on how she thinks she did, but on what the imaginary shoulder-version of her instructor thinks. 

(Merrin is not like Khemeth. She does somewhat more social modeling than median, but not especially well. There's a vast gulf to cross, when it comes to really understanding and accurately predicting the minds around her, and Merrin's social instincts often makes unjustified assumptions. Usually that someone is judging her in a particular way. Merrin's conscious mind knows this, of course, and with enough years of catching herself in the act, she might mostly stop. But it's hard, in a world where it's very salient to Merrin that she is constantly worse at some things than the people around her.) 

Anyway. Roughly, what this means is that while Merrin's performance in sims does improve, by about the rate one might expect based on her general intelligence and other psychometrics, her performance in sims is not a perfect correlate of her performance in real-life situations, which are not tests – and where, very saliently in this particular real-life situation, she is currently in a sealed pod swinging from a cable in a stormy void, and no one is watching her. 

(Well. A lot of people are certainly watching every patient-oriented action she takes. To Merrin's brain, right now, this doesn't count. Kalorm is the main character, and everyone including her is quite reasonably watching Kalorm, and so of course that includes what happens to the settings on his life-support machines.) 

Another Merrin fact is that she assimilates information pretty slowly, by dath ilani standards - especially in Exception Handling, where most people are above median thinkoomph - and particularly dense numerical information. She did flip past those screens, shortly before embarking into her pod, but she completely missed any commentary that might have been about her, and honestly she only half-parsed the numerical probabilities given, seriously, she had like eight other numbers in her working memory, she was sort of instantly dumping numbers that were not ones she could directly change by poking her console. 

This is not normally an advantage, but right now it's plausibly decreasing Merrin's anxiety. 

Also, Merrin is filling basically the entirely of her social-modeling-slot with Kalorm and Kalorm only, because (yeah, okay, fine, after the fact she will admit that she was doing a weird anthropomorphizing thing where she attributed volition to a system when that was not meaningfully present, but it worked okay.) 

(And even Merrin's social instincts are not insane enough to think that Kalorm is judging her right now.)

Merrin's mind feels quiet and spacious and the world feels very small and it's all so simple, really - it's hard, it's a lot, but it's not complicated, not the way everything else is complicated.

There are just a handful of numbers that matter (and a much larger list of numbers that also matter, but, like, less, she can just straight-up ignore his flaming sodium levels for 100 seconds) and the alarms sing to her and she reacts and in one way it's like there's no Merrin at all, because there's nothing at the center of her but shifting numbers, certainly no Merrin that is aware of her own existence why would she bother using any cognitive capacity on that - and in another sense she's never been more alive -