Awwww that shirt is lovely and it seems really tragic to cut it off. Does it have buttons or anything that would let them get it off intact without having to pull it over her head? (There was way too many tubes in the way to attempt this.) 

The surgeon is definitely going to remove the belt! It's putting pressure on badly damaged tissue, you can't have that. 

The patient deteriorates pretty abruptly, though it's deeply unclear why she waited this long. Her heart rate and blood pressure try to spike again; her oxygen saturation gets substantially worse for no clear reason; a bunch of numbers that were unreasonably close to being all right get worse in the predictable directions.

Aaaaaaaaahyikesyikesyikes!!!! Marian is not, like, spectacularly surprised, but she's glad they're mostly done here because she does not feel incredibly comfortable giving an unstable patient absurd doses of sedation. Actually she's going to ask the surgeon if they're close enough to done that she can drop the dose of midazolam to something less insane. And give more fluids, AGAIN, and more albumin AGAIN. They've given her like eight liters of IV fluids at this point but, to be fair, like half of it is just immediately leaking out of her again. 

...Marian's brain is giving her a weird superstitious feeling like maybe the patient's armor was keeping her stable and they just fucked up by removing it. She tells the feeling to go away please, she's busy. 

The anesthesiologist transfers the patient off the ventilator again and switches to bagging her by hand with 100% oxygen, sometimes that helps. It's not incredibly surprising that her lungs are going downhill but yeah he also doesn't super get why now. 

It's going to take longer to properly dress and cover her burns than they really want to spend here. They will do an improper job of it and hope the patient manages not to code on them before they can get her back to the ICU. 

Her heart really thinks it'd be best right now to be beating at two hundred beats a minute, is that okay? She might be in a fight and really need all that extra work getting blood to her extremities. She is also trying to breathe faster to keep up (this of course doesn't really work when one is being given oxygen by bag), and some of the wounds are oozing more. 

She doesn't code. She does start twitching and trying to move.

That is REALLY NOT IDEAL but, armor removed, it's now much more obvious that this woman looks spectacularly fit, she can probably cope with a heart rate of 200 for a little bit until they can try to figure out what's abruptly gone wrong. Marian is definitely pretty stressed that she's started bleeding internally or something. She does not really want to haul the patient to CT right now in this condition, and when she's not even holding still and sedating her enough that she stops moving might actually make her code. Maybe they can wrangle a bedside X-ray of her chest and abdomen? And, uh, send a bunch more stat bloodwork. And then get her off the operating table back into her ICU bed, where she can ooze through her bandages all over the sheets while they rush down the hall. 

She'll do that. She's shivering violently. Her twitching hand moves to to touch her own chest; she's still unconscious, and it looks reflexive. Of course nothing at all happens when she does it. 

Her blood test results: hemoglobin hasn't gotten worse than its surprisingly-okay initial numbers but hasn't gotten better either even though they put a lot of blood in her. There are signs of deteriorating kidney function, which is profoundly unsurprising; the horrifying byproducts of the near-complete destruction of her skin are in her bloodstream and no body could possibly be up to the task of filtering all of that out. Her electrolytes are now all over the place. White blood cells are still a bit elevated but only a bit elevated, so there's no sign of a blood infection yet, which is good news because she's at extremely high risk of that. (It could be there's a blood infection her immune system is failing to respond to at all, but it doesn't look like it, and the bad numbers are thoroughly explained by the condition they already know her to be in.)

Okay. This is fine. It's actually NOT FINE AT ALL but freaking out will still not help. 

Marian will get her patient tucked under a warming blanket, not on the highest setting because that seems bad for her poor (lack of) skin, but she's probably losing heat like crazy and shivering that hard will send her oxygen needs through the roof.

At least the X-ray didn't show any sign that she's bleeding internally? ...Which is weird because where is all that blood they gave her going, she did definitely lose some more blood from her lungs and the slow oozing everywhere else, but it didn't look like liters of it. 

She's so stressed. 

...Seriously, though, this is really bothering her! Why did the patient suddenly start crashing when they removed her ridiculous gear. She would wonder if the belt had been holding enough pressure on something to prevent internal bleeding, except that that should have showed up on the X-ray, surely? Aughhhhhh. Maybe it was, uh, somehow in some way fixing some circulatory dysfunction by gently compressing her descending vena cava? Does that make any sense? It does not really make any sense but very few things make sense right now. 

Well. Unlike the armor - which is still back in the OR - the belt and shirt made their way back to the ICU, in a baggie at the foot of the bed, and putting them back on wouldn't be that unwieldy or get in the way of any of their equipment. Marian feels like an utter fool but at least no one else is going to observe her being an utter fool, someone else in the unit is unstable or something and she is, for the moment, alone in the room. 

....Marian will grit her teeth and feel like an absolute fool, and try very gently easing the patient toward one side, and then back toward the other side, so she can get the belt around her waist again. Please please please please no one pick this exact moment to walk in, Marian will die of mortification, but her brain is apparently going to keep bothering her all day if she doesn't test the stupid theory. 

Marian gets the belt around the patient. 

...she looks better almost instantly. It's kind of weird you can get any impression of how good a patient looks when their skin is all missing, but she just does. She's more relaxed; she's shivering less; the reflexive twitching is still happening but it's slower and more deliberate, more like someone trying to reach for something.

Heart rate slows a little. Blood pressure, which has been a bit high, lowers a little. Oxygen has been hanging around above 90 even when they're doing terrible things to the patient but it ticks right back up to 98.

Okay that's pretty weird. But Marian will....take it, for now? Maybe it's somehow the equivalent of that thing where some patients are inexplicably more hemodynamically stable in a really specific position. She's tempted to fiddle with the patient more to see if she can form somewhat more of a model of what the fuck, but this is a situation where you sort of want to leave the patient undisturbed as much as possible.

She puts the warming blanket back over the patient so she can at least buy herself time to figure out how to tell the doctor 'I put the weird belt back and it improved her vitals' without sounding like a crazy person. 

The sedation is probably starting to wear off? (Or, well, it's technically still running, but Marian bumped the rate down on the midazolam and fentanyl to a dose that would probably only suffice for a baby elephant.) Marian will park herself at the bedside, wait for more blood to be delivered from the blood bank, and intermittently yell "hey can you squeeze my hand!" at the patient. 

Iomedae is in agonizing pain and gravely injured. 

Lay On Hands.

....Iomedae is in agonizing pain and gravely injured.

Lay On Hands.

Iomedae is in agonizing pain and gravely injured and - something isn't working - what isn't working - Lay On Hands isn't working? 

Help, she thinks over her permanent Telepathic Bond. 

The patient is definitely getting less sedated. She keeps trying to move her hand to her chest, and she keeps trying to - say something? Maybe?

Oh noooooooo poor woman. She must be in an unbelievable amount of pain right now. 

...The anesthesiologist left really generous parameters on the fentanyl. Marian will bump it back up to 1000 mcg/hour, which is insane but actually still only like three times the highest rate she's seen on an extremely opioid-tolerant patient.

...And decrease the midazolam to only 75 mg/hour, which is, also, still insane, but would probably only be enough for, like, a horse, and not even a baby elephant, which means on this woman it's probably the equivalent of a gentle 3 mg/h or so on a normal person. Hopefully enough to make her slightly less bothered by the tube, but there's a point at which 'semiconscious and confused' is actually worse than 'awake enough to understand an explanation of what's happening.' 

She doesn't really want to put wrist restraints on the patient and risk her ripping off chunks of her own flesh by struggling. She will just try pinning down the arm that she keeps trying to touch her chest with. 

"Please just try to hold still and relax, okay? You're in the ICU at Renown Hospital, you were badly burned, but everything's going to be okay. Don't try to talk, you have a breathing tube." 

Iomedae is badly injured. Lay On Hands? 

....no. 

Call for help?

....no.

Someone is talking. The language they are speaking isn't familiar. That's fine, though, if she can concentrate long enough to cast Greater Angelic Aspect she'll get the ability to speak all languages and to fly and she will feel much better about this situation if she can communicate and fly.

She tries to speak the incantation for Greater Angelic Aspect and runs into the problem that she is gagged.

No! She does not like that at all!

- patient's heart rate spikes again. Also, she grabs at Marian again.

Marian...is going to let herself be grabbed, because at least if the patient is grabbing her she's not trying to rip out all of her tubes. "Hey, hey, it's okay, it's okay - just try to relax -" ow ow ow ow ow. Marian is increasingly certain that if this patient wants to self-extubate, Marian is not going to win a fight with her about it and there is not enough sedation in this entire hospital room to stop her even if Marian could, uh, get to the IV pumps - 

"- HEY I COULD USE SOME HELP IN HERE!" she yells. 

A person in distress! That sounds like an emergency! Iomedae is going to attempt to bite through the gag and spit it out and sit up and - that's not her sword - she lets go of the not-sword and opens her eyes which requires something that feels like tearing skin -

She can bite through the "gag"! However, it seems like quite a lot of it is actually down her throat somehow and this does not enable her to actually speak, and just means that she is abruptly having a drastically harder time breathing through it and it kind of feels like she's choking. 

Once she gets her eyes open, she'll observe that the not-sword she had tried to grab is, in fact, a young woman in loose pale blue clothing - which is incidentally stained with a lot of blood and pus, because Marian has been kind of up close and personal with her oozing patient - looking incredibly freaked out, hands raised like she sort of wants to try to restrain Iomedae and is realizing she's not nearly equipped to do this. 

- oh shit she - did she just BITE THROUGH HER ENDOTRACHEAL TUBE. Who DOES that????????? What the fuck whatthefuckwhatthefuck - it seems kind of unimaginable that they won't end up having to reintubate her, but in the meantime the BITTEN OFF TUBE is not doing her any good and, uh. Marian is...not entirely sure how you remove an ET tube when the end that has the syringe-attachy-bit for removing air from the balloon that forms a seal in her trachea is no longer attached - oh on further thought she presumably bit through that part of the tube too and the balloon is already deflating - Marian does not really want to get in range of her teeth right now but will risk it if the woman doesn't cough the tube out on her own in the next ten seconds - 

- oh no, the woman was screaming in distress because Iomedae had grabbed her. Iomedae immediately raises her own hands in a corresponding gesture, and would apologize, if she could talk, which she can't, because of the tube-gag she is now desperately coughing out -

- also she's very dizzy, she thinks the air here is bad - she should switch out her current necklace for her necklace of adaptation -

- she coughs the bloody pus-covered tube out and simultaneously looks at her wrist and determines that her gauntlet has been removed. 

This is a terrifying and confusing situation. But it's about to get better.

She tries again to say the incantation for Greater Angelic Aspect. Her throat is too mangled to make recognizable sounds. 

Okay. Not about to get better. She is actually getting dizzier, because of the lack of air. She taps urgently at the wrist with the missing gauntlet. Tries to think - what does she have which doesn't require speech or any of her magic items - oh, actually, there is a solution -

Then she collapses.

A machine tells Marian helpfully that the woman's oxygen saturation is now worsening.

Well there's a pretty obvious cause for that and a pretty obvious solution! 

Marian rams the pause button on the IV pumps, because actually the patient does not need respiratory depression right now. ...She's still breathing on her own and does seem to be moving some air, the problem being that it's room-air-oxygen-concentration and that is massively insufficient right now. Marian is, uh, slightly worried that if she tries to bag her with the mask, she will end up getting punched in the face by a confused super-bodybuilder and, judging by how strong she is on other things, probably end up needing a trauma surgeon herself.

She...will put the bag-valve mask in reach and start with just sticking a non-rebreather mask on her, with the oxygen flow turned up as far as it goes, and yelling at her to BREATHE. Which is the position she's in when another nurse does, eventually, reach the room.