You see a lot of weird shit in Reno as a paramedic, but this is a new one. What even!!!!????? How????? 

Also, a problem on several levels! These injuries...do not, honestly, look incredibly survivable...but they're at least going to try everything they can and get her to the hospital, which is....difficult...for a patient they can't touch without oven mitts, which are not part of regular ambulance stock. Also that looks like fifty pounds of armor, and the woman herself is not exactly small, it's going to be a pain in the ass to move her, but it seems ill-advised to remove it along with most of her skin until they're somewhere a bit more sterile than the side of a highway. 

One of the paramedics will attempt to pad her hands with one of the ambulance blankets and shift the armor enough to get access to her neck and check for a carotid pulse. If she doesn't have a pulse the armor does have to come off, somehow, she's pretty sure you cannot actually perform CPR on someone wearing full plate armor like some kind of fucking historical re-enactor. 

(There is a quiet internal chant of what the fuck what the fuck happening in her head, but you get used to ignoring that.) 

She has a pulse! It's a remarkably steady and healthy pulse, really, for someone who isn't breathing and has now been lying by the side of the highway for at least four minutes (since the call) and plausibly significantly longer. A little fast.

...Okay, great, that's - surprising and also kind of what the fuck, but in a way that's better than the alternative, and she is deeply relieved not to have to try to wrangle a bodybuilder-sized woman out of scorching plate armor right this second. Maybe she only just stopped breathing? 

"Got a pulse," she says, and will whip out an ambu bag and start ventilating her. "- Bill, oy, oxygen me?" She uncoils the tubing and flings it in his direction. 

    "Gotcha." Bill connects the tubing to the portable oxygen tank. "...Do you have any theories, because I'm drawing a blank." 

"I really, really don't. ...Okay, you're the one with the tough manly hands, you're on trying to un-armor an arm for us so we can get a fucking blood pressure." 

     "Annie, do I look like someone who has the slightest idea how medieval knight armor works?" He will gingerly attempt this, though. 

The armor is not particularly amenable to being removed! The leather buckles connecting each of the pieces were negatively affected by the dip in boiling water and he'll have to cut through them. Also her skin is completely melted to it, of course. 

When they put a oxygen mask over her face she coughs, extremely weakly. It's a kind of horrifying sounding cough, like she steam-burned her lungs and then drowned.

Eeeeesh. That is...not great...though the fact that she has an even slightly intact cough reflex is a good sign. 

(Annie's internal monologue is currently a stream of yikes yikes yikes interspersed with utter confusion. She has no explanation for how someone could have ended up...drowning in boiling water???...on the side of a highway in Reno, and separately from that she still has no idea what the fuck is up with the armor.) 

They pretty urgently need to intubate her, her lungs are clearly incredibly fucked, and the near-drowning suspicion means she's probably going to vomit at some point. Annie predicts they're going to have a bit of a time intubating her without sedation, given the intact cough reflex, and they cannot do sedation until they have IV access, which requires having somewhere accessible to try to stick an IV. The woman can have 100% oxygen squeezed into her lungs via the mask over her face, while Annie makes sure the portable suction is right there in case she starts vomiting. 

"Bill, can you hurry it up a bit?" 

     Scowl. "I'm trying." The metal is presumably going to cool down eventually, but it's not doing it fast - it's probably still burning her, though it's hard to imagine it making the damage much worse at this point - and the boiled leather is not very willing to be cut by medical scissors. "...I'm going to run back in and get something better for cutting, one sec." 

She will absolutely vomit a lot of water! Sea water, if anyone is checking! 

Aaaaack great now Annie has mildly scorched the palms of her hands trying to wrestle the woman onto her side and in too much of a hurry to figure out where the stupid blanket went. She's not exactly planning to taste the water for saltiness but it does smell kind of ocean-y, which is EVEN MORE WHAT THE FUCK. Annie isn't sure she's ever had this many questions at once in her entire life. Also she kind of desperately wants an O2 saturation reading and she cannot have this due to fingers being inaccessible under stupid armor gloves. 

Bill is back, great. "Bill, can you prioritize getting one of the armor gloves off for the pulse ox?" 

     Bill snorts. "Seriously, armor gloves? They're called gauntlets." He'll have a go at this, though, while Annie attempts to flomp the woman onto her back again - this time remembering to pad her hands with the blanket - and continue squeezing oxygen into her lungs. 

If he can cut through leather he can get a gauntlet loose. (The gauntlets are in utterly pristine condition, polished and well-fitted.) Some of her skin comes off with it, of course, but that is recognizably a hand, there, badly burned, and it's even possible to hook the pulse ox up to it. 

The pulse ox says that her oxygen saturation is seventy nine percent. Eighty. Eighty one.

That...is actually pretty reassuring???? Though, again, SUPER BAFFLING, Annie didn't feel like she was really getting all that much air in successfully. 

"...Okay, I'm inclined to say scratch getting a blood pressure, pulse is strong and that does not seem like our main problem. We need an IV for sedation so you can tube her, see if you can get one in her hand? And then we should roll, get her to the hospital and let them handle the rest." Probably Renown Regional Medical Center can turn up a pair of oven mitts. From the kitchen staff, at the very least??? " - if you can't get an IV I'll try without any sedation but she's got enough of a cough reflex to make that, uh, really annoying." 

    "- On it, boss." Calling Annie 'boss' is his joke, she has two years' more experience than him. Bill will do a janky wrist tourniquet and look for IV-able veins in the woman's hand. 

The veins in her hand are strong and healthy and diligently doing their job despite the fact that all of her skin has been burned off!!

...Great. Okay. He can get an IV in really easily, the lady clearly works out. ...Securing the IV is harder, the clear dressing does not really stick to her oozing flesh at all. He wraps it in kind of a lot of sterile cling-wrap gauze instead. There's a bag of saline ready with primed tubing; he hooks it up, rams the clamp all the way open to let it flow in freely, and then pulls up a syringe of propofol. "...I'm giving her the full 10 ccs, she's a beast."  

    "Mm-hmm." Hopefully she can get the tube in without having to do a lot of awkward positioning, because she continues to not possess oven mitts. How's the woman's O2 sat reading now? 

Ninety!

She continues coughing vigorously and twitching after getting 10ccs of propofol.

...That's fucking impressive. Or something. Annie has only seen that kind of resistance to sedation before in 250-lb guys on PCP. (Which for some reason has come up twice.) She does not really want to give her any more sedation when they don't even have a baseline blood pressure reading, so she's...just going to push ahead anyway, if the woman is only coughing and not, like, actively struggling in a way that indicates she might be awake. "Bill, can you, uh, help me hold her still?" 

She's still deeply unconscious other than the reflexive coughing and doesn't resist intubation beyond the coughing. Her eyes don't look like they can open, they're sealed shut by the burns.

Yeah she looks horrifying. She's more stable than she has any right to be, but Annie does not at all trust that to last. She makes sure everything is really well secured, and then they can both put their back into it and find out if they are, in fact, capable of wrangling a not-exactly-small woman in full armor onto the stretcher. 

She's very heavy. They've dealt with heavier patients but those probably didn't burn you if you touched them. Moving her also involves shaking a lot of water out of the armor. When they finally wrangle her onto the stretcher she leaves behind a bloody gooey puddle. 

Oxygen sat is 95%!

Yeah, the process is going to involve wrapping her in blankets on top of the armor first, and also some scorched fingers. 

....Okay that's genuinely gross in addition to horrifying. Annie was more or less kneeling in it and now her pants are bloody and gooey all down the knees. 

She is...at this point getting kind of worried that the pulse ox reading is fake? Though false low readings are more common than false high readings, and it looks like it's picking up a very solid signal, unsurprisingly given that her carotid pulse is still quite strong. Annie...is confused, mostly.

Bill drives. Annie stays in the back monitoring the patient - keeping a finger on her radial pulse, since the breastplate is still in the way of where they would put ECG electrodes - and squeezing the ambu bag every five seconds to ventilate her lungs. She radios ahead to the hospital. They're bringing in an unidentified woman, age unknown, severely ??scalded or steam-burned??, vital signs surprisingly stable but she has third degree burns over her entire body surface area and Annie does not really expect her to stay stable for long. Sometimes very fit healthy people can compensate surprisingly well for catastrophic injuries....for a while...and when they do inevitably crash, they deteriorate fast and hard.

Bill is driving fast. 

Iomedae is having a bad time.

She's no longer suffocating! Some oxygen is entering her lungs and they are not too thoroughly steam-burned to get anything out of it! They are only mostly full of salt water and dissolving lung tissue! Her heart is beating, only a little fast. ..she is losing an astonishing amount of fluid to blood/pus/goo because of how she does not have any skin. In a bunch of places the burns are worse than third-degree and the resulting tissue damage is pretty horrifying.

If she were conscious she'd reassure everyone that she just needs a place to rest and a glass of water but she is, in fact, very very deeply unconscious. 

Yeahhhhhh this continues to look...not really survivable. Except it's somehow even more upsetting, now that it's clear how hard the woman is fighting to survive. 

The woman's oxygen saturation is excellent, though admittedly this is because Annie is bagging her with 100% oxygen, and she can feel the resistance she's pushing against to get air in and out of the woman's lungs. You eventually learn to recognize the feel of fluid in lungs; Annie's teacher used to say 'it just has that texture' and she is pretty sure 'texture' is not the word here but she doesn't really have a better description of it. She has a go with the suction catheter, trying to at least get some of the water out, but she's gentle with it, trying not to make any of the internal damage worse. 

They make it to the hospital. There's already a crew of ER staff waiting for them in the ambulance bay. ...Someone, rather remarkably, has turned up a pair of oven mitts. They rush the unconscious woman to the trauma bay, slide her over to the ER gurney, and - great, time to attempt to at least remove the armor from her arms so they can get a blood pressure reading? ...With sterile fields underneath and non-adhesive dressings ready right there, it's a bad idea to leave those burns exposed to infection sources for a second longer than necessary. 

The armor is disgusting and also difficult to remove from her arms. Skin and tissue comes up with it. She twitches. 

Blood pressure is 95/60!

...Oof. They'll get her arms bandaged and place a couple more large-bore IVs - and an arterial line, taking her blood pressure manually is not great for the tissue damage - and run fluids as fast as possible. She can get broad-spectrum antibiotics administered, and a lot of stat bloodwork drawn including a type-and-cross for a blood transfusion, she's clearly lost a lot of blood - still losing it - from the whole not having skin problem. Getting her shoulders more or less exposed does at least mean that they can do a janky 3-point ECG electrode placement. It's not a very good reading, with the weird placement and her lack-of-skin oozing so the electrodes have trouble staying on, but there's now a heart rate tracing up on the monitor. They try to get a temperature reading. 

Removing the rest of the armor is...probably not a good idea right here and now? They might want to literally do it in the OR, actually, and once she's more stable and they have some units of blood ready; taking away the pressure on damaged tissues could set off much worse bleeding. In the meantime they'll...pack ice around the armor still on her, to at least cool it down faster and prevent it from causing any more ongoing burn damage. 

She's running a fever. 103. Her heart is steady at 70 beats per minute. 

The initial bloodwork comes back - a little surprising.

Her hemoglobin is low. That's not surprising. Her white blood cell count is high. That's not baffling. Her sodium is low and her potassium is high, her inflammatory indicators are high - all as you'd expect. Her kidney function looks totally fine. Her blood sugar is fine. Her lactate is high but not nearly as high as you'd expect. Her blood gas results are also surprisingly fine. Her PaO2 is totally normal. Her CO2 is still somewhat high and her blood pH is low but not that far out of range.

Huh. Well, she's continuing to compensate shockingly well for the sheer extent of the damage, and who knows how long that's going to last but at least it buys them time. There's a bed available in the ICU, they should probably relocate her there ASAP. 

The trauma surgeon agrees that taking her to the OR so they can remove the armor and debride the burns at the same time is a better plan than just ripping it all off now. They can plan on it in an hour or two, maybe, if she's still stable then. 

Marian is on shift today and she's getting an admission! Apparently it's weird! She's looking forward to taking report, she likes weird cases. 

...Uhhhhhh. She likes it less after the report. It mostly sounds like it's going to be incredibly tragic, and also what the actual fuck. Reno sees a lot of weird shit in the ICU but usually it's more...mundane...weird shit. 'Patient in medieval-re-enactor armor' and 'patient appears to have picked up third-degree-or-worse steam burns beside the highway somehow' are both baffling. Also apparently the patient is STILL in the armor and they're going to literally take her to the OR to remove it, aaaaaaah. 

She's ready, though. She heads over to the ER to help collect the patient and transfer her over. 

The patient looks horrifying because of how much of her flesh has been boiled off (nearly all of it). She is, in addition to the armor, wearing a leather headband, three different amulets all on the same thin chain around her neck, a ring on one finger of the exposed hand, and a cloak neatly embroidered with heraldry. 

She's still deeply unconscious. They've suctioned up a horrifying amount of lung tissue and she's intubated but her oxygen levels now seem completely fine. All the wounds are still oozing.

Aaaaaahhhh???!!! That's so awful. This is going to mean an awful prolonged recovery even if the woman somehow survives, which...it's starting to look like she has a chance of? 

Also her patient is leaking gross stuff out of the chinks in her armor. Marian is not that squeamish about anything other than lung secretions and saliva, but 'gooey bloody pus oozing from an unseen source' is apparently enough to gross her the fuck out. 

Marian gets the patient to the ICU and transferred into the bed without making anything too much worse, at least. She's mildly irritated with the ER staff for about thirty seconds over the part where they didn't place a catheter and she, one, desperately wants to monitor urine output closely on someone losing that much fluid through their lack of skin, and two, does not want her peeing on her exposed burns. She remembers thirty seconds later that obviously this is literally impossible while the woman is in freaking plate armor still covering nearly all of her body. 

Her fingers are remarkably not very swollen yet but that's not going to last, they've already dumped three liters of IV fluids into her. Marian will have a go at very gently removing the ring without taking any flesh off with it, and then will have a go at the weird headband and jewelry. All of them can go in a labeled baggie for safekeeping. 

The cloak is completely disgusting, having been subject to blood and oozing through the armor, but it's also really cool and - probably an important possession to the woman? Maybe they can, like, wash it. Marian gets it extricated from the patient and wads it up on the counter, in case she manages to find time later to attempt to wash it out in the sink. 

...Vital signs still hanging in there? 

- a little less so, actually. Her heart rate creeps up, and her blood pressure's now going up and down. 

She still seems to not be actively dying, though.

Well, she's losing a ton of fluids constantly, they're running maintenance fluids at 200 cc/h but it's not incredibly surprising that it's hard to stay on top of it. Marian bugs the resident and gets an order for another bolus of Lactated Ringer's, and the blood products from the lab should be here soon, they're hurrying but the patient apparently has a somewhat rare weird blood type and that's delaying things. They can get fresh frozen plasma, though, and run some albumin, both of which will do a better job at retaining fluids inside her circulatory system where they belong. 

The ICU doctor wants to do a bronchoscopy. With sedation; the woman has been unconscious without any sedation, but she's still coughing a lot, and occasionally twitches in response to especially painful stimuli. And this bronch is going to be particularly agonizing, her lungs must be incredibly raw. 

Marian preps the bronchoscopy kit and obtains propofol and fentanyl. The doctor asks her to give 100mg of propofol - apparently that's what the woman got for intubation, and it wasn't even really enough - and 50 mcg of fentanyl. 

Is that enough to settle her down? Marian is also watching her vital signs like a hawk, of course. 

Would that be sufficient for an elephant? 

Because, if not, no. 

(Her vital signs are fine.)

Well, her blood pressure doesn't seem to have even noticed it, so, uh, should Marian give her more? 

...Another 10 mg of propofol and 100 mcg of fentanyl doesn't do it either. Though it also doesn't touch the woman's vital signs, so, uh, possibly at some point they should just conclude that propofol literally doesn't work on her, but they could probably try more...? 

Five minutes later, a whopping total of 500mg of propofol and 400 mcg of fentanyl have...still...not...noticeably sedated the woman. Or, uh, appeared to affect her in any way. ...The fentanyl may have done more than literally nothing, it's not dramatic but according to Marian's vague gut sense the woman seems slightly more relaxed, and her heart rate has maybe evened out a tiny bit, as though she's getting an amount of pain relief from it that you would expect from a standard 25 mcg dose. But she is not coughing any less in response to suctioning. 

Marian is getting...sort of antsy about this. "Uh. I think maybe propofol literally doesn't work on her? I'm - sort of scared to just keep giving her more." Also her vial of propofol is now empty and she would have to go pull another one and is not, actually, sure you can override the Pyxis to give a dose that large. "Can we...uh, try midazolam, maybe that does more?" 

...It does not, it turns out, do more, at least not in a generous-side-of-normal 5 mg starting dose. Buuuuuut Marian is slightly less terrified to just give more, in this case, she's had patients who were on 20mg/h for ongoing sedation and still getting boluses. 

The doctor is now getting antsy too, but - they do need to figure out something that works for procedural sedation, because after this they're taking her to the OR for a much worse painful procedure. He....will consult anesthesia, how about that. Can they come, like, now. 

The anesthesiologist is also really baffled but less nervous about Injecting More Drugs. Being in a lot of pain makes patients harder to sedate even when they're unconscious, and the woman looks like she's well over 200 lbs of solid muscle, and that still doesn't make it normal to shrug off ten times the usual induction dose of propofol but sometimes bodies are weird. Midazolam is better for this anyway, it has a long enough half-life that Marian can keep slowly pushing more of it and not have to worry about the earlier doses already wearing off. If the patient's vital signs are stable then he's not going to worry about it until they hit, like, fifty mg of midazolam. 

...Uh. Marian does not really want to sit here for the next twenty-five minutes pushing syringes of midazolam at a rate of 2 mg/minute. Can she either push it in faster or maybe, like, get a bag for continuous IV administration and run it at...uh she is totally capable of mental math...120 ml/hour until they notice it taking effect? 

...Yeah no that rule is fake. She can push 10 mg at once and then wait a couple minutes and poke the patient and try again if necessary if she's still not out. And might as well alternate it with fentanyl. She can give 50 mcg at once after each successive dose of midaz. 

Anesthesiologists are kind of a way. 

Marian....will do that? Quietly internally screaming the whole time, but the thought of doing a bronch on the poor lady without adequate sedation also kind of makes her scream internally, soooooooo hopefully they can pull this off safely. Aaaaaaaaaaaaaah. 

Ten minutes later she has administered an entire 50 mg of midazolam and another 250 mcg of fentanyl. On top of the propofol which is probably still in her system at all. Iiiiiiiiiiiis that doing anything. 

....looks like it's working the way you might expect a fairly small dose to work? Her heart rate is a bit slower. 

Also, she's doing notably better. Oozing a bit less, and the fever which must have been caused by the being cooked alive has started come down but while you'd expect horrendous temperature regulation problems and eventually hypothermia from a burn victim she's just crept down from 103 to 100 and stayed there. The only thing that's harder to manage than when she arrived is her hydration. 

Marian is....really confused...but also very happy about this! Go mystery patient! You're doing great!!!

...She will un-icepack her, it does not seem like she needs further help cooling down right this second. The ridiculous armor is now cool to the touch, at least. 

The anesthesiologist wants a tox screen sent, his new top theory is that she's on a fuckton of cocaine or something in addition to the being boiled alive or whatever. ...It's not a very good theory, you would really expect to see other signs of it, but it's what he's got.

Aaaand they should probably just go ahead and bronch her, even he isn't comfortable going higher than 50 mg of midazolam when the amount already in her is going to take ages to clear her system. ...On reflection, Marian can push up to another 500 mg of propofol during the procedure, though, if she's coughing or her vital signs look like she's feeling it. Causing someone a lot of pain will partly cancel out the side effects of decreased heart rate and blood pressure, and it'll wear off by the time they finish up. 

....Okay. Marian is not delighted about this but she'll go override the Pyxis to pull another 50ml vial of propofol. Is the woman secretly an elephant under that armor or something. This is surreal. She's also kind of dreading what the woman's lungs are actually going to look like on the bronch screen, aaah. 

Horrifying!!!! She inhaled steam for much, much longer than a normal person could survive inhaling steam. Then she drowned. Then they started suctioning her lungs. Most of her delicate lung tissue is shredded and floating in clumps. It's kind of incredible she's getting sufficient oxygen out of the few parts of her lungs that look relatively less damaged. 

She does seem to be in considerable pain, even with the light sedation. She twitches and her heart rate and blood pressure both pick up. (If Marian lets them they'll go straight to 'intense exercise' range. That's usually the correct response to being in intense pain.)

Eeeeesh. That's the worst bronch Marian has seen in her entire life and does not look incredibly survivable. Also patients being visibly in pain is really upsetting!!!! ....If the anesthesiologist is sure, and it's still not tanking her blood pressure, Marian will in fact just keep pulling up syringes of propofol and giving them until she's run out again, while the doctor attempts to cautiously wash out her lower airways with saline and suction out the goo and floating chunks of tissue. (Marian is NOT LOOKING at what's coming out in the suction tubing.) She's also keeping a close eye on the woman's O2 saturation reading, because while she was somewhat miraculously managing okay before, they are now doing a lot of stuff to her lungs. 

She's doing a little worse, which is to say an O2 saturation of 90. 

With more sedation her heart rate slows a little and her blood pressure falls back from 'intense exercise' to 'normal human range' and the oxygen dips a bit more, to 85. She's...kind of still twitching? But less so? The hand they freed from her gauntlet flexes like she's trying to grab a hold of something, but it's too clumsy and too injured to actually do it. 

Marian is SO UNHAPPY right now. She would kind of like the doctor to hurry up and finish because the patient's oxygenation is not coping, but she's also worried that if they stop torturing her then her blood pressure will drop even further. Aaaaaaaah. ...She's also going to gently hold down the woman's hand, in case she wakes up slightly more and attempts to go after her tubes. 

- okay they are done, and have at the very least gotten most of the loose tissue and fluid out of her lungs. The doctor pulls out the bronchoscope and the anesthesiologist is going to spend a little bit bagging her with 100% oxygen before putting her back on the ventilator. 

Oxygen bounces back somewhat as soon as they stop messing around in her lungs. Her blood pressure does not drop when they stop torturing her; it, and her heart rate, actually seem to be trying to battle their way back up to 'person doing intense exercise', though with only limited success until the sedation starts wearing off. (Which it does. Surprisingly fast.)

That's, uh, not ideal. Though she probably is in horrifying pain even at rest. It cannot possible be comfortable lying there with raw burned-off flesh pressed right up against metal armor over most of her body. They should, uh, really do stuff about that, probably. ...And maybe she additionally needs more fluids. The blood products are finally here, so Marian will check them with another nurse and then hang a unit of packed red blood cells and run another saline bolus, and then they can consider going to the OR. Marian isn't actually OR-trained and would not normally accompany a patient there but the trauma surgeon apparently wants her to this time. (Aaaaaaaaaaah. She is scared of trauma surgeons.) 

...Patient looks closer to awake. Marian is pretty sure she can't open her eyes even if she wanted to, they're kind of melted shut (aaaaaaaah!) but she places her fingers against the palm of the woman's bandaged hand. "Hey. You're in the hospital, you were badly burned, but you're going to be okay. Can you squeeze my hand?" 

She reflexively tries to grab the sword. It's not a sword but that won't stop her.

Yikes yikes yikes she's really strong!!!! And fast!!!! Marian's arm is now grabbed and ow. 

Marian manages not to yell in startled pain. She clears her throat. "Can we, uh. Sedate her more. Maybe." 

Yep the anesthesiologist will go yoink out a 100 ml bag of midazolam and hook it up to run at...hmm 5mg/minute does not seem insane for this particular patient, though it does mean they'll run through the entire bag in 20 minutes and should have a backup right there. And he'll push enough propofol to get her to let go of the poor nurse, assuming 'enough' is less than another 500 mg and doesn't tank her blood pressure first, and then they can rush over to the OR? 

Her blood pressure remains stable even under ludicrous amounts of sedatives and she lets go of the nurse.

Yeah okay they are just going to keep running the midazolam at an absurd rate, then, and maybe also hang a bag of fentanyl and run that at...hmm, 50 mcg every two minutes seems to do something, so that's...1500 mg/hour, which is insane and requires not using the standard IV pump programming because it does not let you go that high. And hopefully that plus propofol on hand for pushes will let them keep her anesthetized enough to get through what promises to be an extremely horrifying procedure. 

They'll hurry her to the OR, which is fortunately just down the hall, and then...do some strategizing about the best way to remove armor when what's left of the woman's skin is kind of welded to it. 

Marian is going to NOT LOOK at the armor-removing. She will just stand here watching the monitor instead, which is only a normal kind of upsetting, with five 10cc syringes of propofol pulled up and ready on the table beside her for when they almost-inevitably need EVEN MORE DRUGS than the absurd doses of drugs running in the IV pumps, and she'll keep checking and hanging new bags of IV fluids and blood whenever one is empty. And giving drugs if the woman's heart rate and blood pressure start spiking, since that seems to be very shortly followed by IMPOSSIBLY STRONG GRABBING. 

The surgeon will first attempt to saw through all the leather connecting bits, and then irrigate under the armor with a lot of warmed saline to try to get it slightly unstuck before they peel it off. There's going to be bloody water all over the floor but hopefully this gets the armor loosened enough to come off without literally ripping chunks of flesh along with it? 

It actually lifts off relatively cleanly, partially because there's another layer under there. Under it she's wearing the remains of the armor harness, an elaborately embroidered shirt which is covered in blood and pus, and a thick belt made of some kind of soft high-end leather, laced through with what looks like some kind of metal stitching or threading. 

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. 

The patient is unconscious again but in fact getting more oxygen now! Saturation is creeping back up!

...Okay. That's not ideal, unconscious people cannot protect their airways, but Marian is still pretty worried that if they try to reintubate her she will just self-extubate via BITING AND COUGHING again. They could use a bite block but Marian is sort of suspicious that the bite blocks aren't rated for, uh, that. 

"She bit her tube off," Marian informs the nurse who's finally arrived to help. "Also she's really fucking strong and, like, basically impossible to sedate and she might just do it again if we reintubate her. I - think if she wakes up a bit more once her sats are back up, she could be okay on BiPAP? Uh. Maybe help me get her in recovery position to start..."

Honestly it makes no sense that just oxygen by facemask is enough to help at all. Given the visibly awful condition of her lungs and the disaster of her chest X-ray, it doesn't make sense how well she was coping even on maxed ventilator settings. But, sense or not, Marian is not complaining if it turns out that noninvasive ventilation support is enough, since high ventilator pressures are going to risk fucking up her poor lungs even more. 

...She is still really suspicious that the O2 saturation number is FAKE - maybe the lack of skin is messing with the calibration??? - and once they have the patient propped on her side, where her airway will stay open better and she's at least less likely to aspirate if she vomits, Marian is going to draw a blood gas and stick it on the iStat machine. She should have a result in five minutes. 

It's going to be really long and really stressful five minutes. 

...She restarts the fentanyl. At 200 mcg/hour, she doesn't want to risk going higher when she's already expecting an unconscious patient to breathe on her own. 

The oxygen mask does seem to be sufficient to help at least a little, though it's not doing as much as the ventilator. As does the fentanyl; she stops doing quite as much anguished tossing and turning, and continues breathing. 

And, after a little while, is conscious. She's in agonizing pain and her head is gluey and she has no idea what's going on. 

Lay on Hands.

Help, through the permanent Telepathic Bond.

Doesn't work. 

...Yeah that looks like consciousness approaching. Also the woman's flailing around has dislodged a lot of her hastily-done bandages, which is not great, though the burns look...less bad than Marian would have expected??? 

Also, the doctor must have agreed with her assessment, because the respiratory therapist is now here with a BiPAP machine and mask. Also looking at the woman with some trepidation; word has apparently spread. 

Marian puts her hand very gently on the woman's arm, and tries to keep her voice calm and soothing and not at all hinting that there's an emergency. "Hey. You're okay, but we're going to put a tighter mask on your face to help you breathe better. Can you try to hold still for me, please?" 

She doesn't speak the language. She does remember that she injured a random woman. She will hold still and try not to do that. 

Lay on Hands?

Doesn't work.

Why isn't it working. What is happening? She's not thinking clearly. If she was thinking clearly she'd have thought of that question earlier. What is the last thing she remembers happening?

Arazni died.

That is not a sufficient explanation for this though it's probably a necessary one.

What happened more recently than that?

- negotiated assassination. There was a negotiated assassination, and she is out of Lay On Hands because she's far from home, and she is probably being tended to by poor otherworldly healers, and she punched one. 

She can't apologize until she can talk. She can hold still, though.

Marian already has the beginnings of red finger-shaped bruises visible on her arms where Iomedae grabbed her, but she's not actually very injured. She's fine. She will keep talking soothingly to her patient while trying to reposition her in ways that hopefully won't hurt too much, and then making sure to pad her poor burned face with hydrocolloid dressings on the mask pressure points, BiPAP is uncomfortable enough even when you aren't missing a whole lot of skin. She's mostly hoping the woman will be more coherent in a little while and they can have a conversation about reintubating her. 

The mask is indeed pretty uncomfortable but it's by far not the thing that hurts the most, and Iomedae will notice that it takes substantially less work to draw air into her lungs. 

Iomedae is ignoring the agonizing pain. She won't die unless someone decides to kill her while she's helpless, and being in pain is not a novel experience or an interesting one, and is somewhat less bad of one when you cannot be scared about the prospect it'll continue. There are a bunch of people who might kill her while she's helpless, but presently very little she can do about it except wait to recover and try to figure out how to communicate. Greater Angelic Aspect will get her Tongues - no, she tried that and something went wrong, what went wrong - the gag - no, even without the gag, there wasn't enough air and her throat didn't work -

She needs a new plan. That doesn't rely on being able to talk. 

She had something - 

- oh, right. 

Iomedae can cast Telepathic Bond. It's not a paladin spell. She thought at first when she learned the knack that it was a fifth circle paladin spell, and asked for something else like Breath of Life instead the next day, but Aroden didn't cooperate and she figured out eventually it was something else. 

Importantly, Iomedae can cast Telepathic Bond without speaking or moving. 

She'll do that.

I'm disoriented and don't remember anything more recent than the assassination attempt, she reports briskly, and injuring a woman at some point, which I apologize for.

???????????????????????????????????????????????????????????????????????

Marian is, uh, on the one hand incredibly confused and startled and slightly wondering if she's hallucinating right now?????? 

- on some other level, though, she's less confused than she was ten seconds ago. There are a lot of individual observations that keep not quite making sense and 'the patient is some kind of alien telepath' at least condenses all of that down into one impossible observation. 

She can figure out if she's having a psychotic break later, once her patient is okay. 

...uh, okay, can she answer - she tries to think back at the patient. You're in the ICU in Reno, Nevada. You were very badly burned and your lungs were damaged but you're recovering. We - don't really have any idea what happened, someone found you beside the road. - you sort of grabbed me before but I'm okay, I'm not injured, I was just really stressed about you. 

And to the RT, quietly dying of embarrassment, "- Krystal, did you hear that?" 

Krystal is adjusting settings on the BiPAP machine and kind of busy. "- hear what?" 

Oh dear. Okay maybe she is just having a psychotic break. 

- still gotta focus on her patient though. How are her O2 sats with the BiPAP. 

Clinging to 90. 

I am unfamiliar with those place names. Has Urtho or his representatives contacted you? Or Ma'ar, or his? Or the Shining Crusade's? Do you have Aroden here? Iomedae feels stunningly dizzy and her thoughts keep flitting away on her and she's in agonizing pain but none of that is a reason not to communicate like a normal person. And did you remove my armor and possessions?  I need those back, conceivably urgently. 

What. Okay great her patient is PROBABLY FROM ANOTHER PLANET. 

...I don't recognize any of those names. We had to remove all the armor because you're burned badly over your entire body. I think most of the armor is still in the OR - uh, another room where we took you to treat the burns - but there's some stuff here, I have a shirt and cloak and some jewelry, and...it looks like a gauntlet and - whatever arm armor is called? - came with you from the ER, they'd taken that off earlier to have somewhere to put an IV. Also I put your belt back on because your condition mysteriously got worse without it. 

- uh, you're also having more trouble breathing without the tube to help you. I think it would be a good idea to put it back, but I want to explain it first so you don't panic and bite it off again, that was bad. 

- the belt makes me healthier. Please don't take it off. I will recover from the burns and I prefer being armored for the next time someone tries to kill me.

The tube makes it hard to speak and it's fairly inconvenient being unable to speak, I think if you give me back my necklace of adaptation it'll probably solve the breathing problem.

The belt just...makes...her healthier? Just like that? ...Okay, fine, that did kind of look like exactly what happened, it helped with a bunch of disparate vital signs not all of which made any sense with the theory 'it was doing something to intra-abdominal pressure or lower limb circulation'. Though of course the obvious explanation is still that Marian is hallucinating. But she's pretty sure she's not currently doing anything that would be insane, and, uh, if she's sufficiently out of touch with reality that what she thinks she's doing is uncorrelated to what she's actually doing, then telling someone isn't going to help anyway and she'll just have to count on someone, like, noticing and sitting on her. 

Great. 

Okay. We can try the necklace, if you tell me which one it is. ...Nobody's going to kill you, you're in the hospital. 

It is not my intent to impugn the honor of your healers but I am at war with a god right now and I while I think He is too honorable to try to kill me in a hospital I am not sure, and in any event would not in reliance on that be more vulnerable in a hospital.

????????????????????????????????????????????????????????????????????????????????????????????????????

...Focus. Okay. 

Simplest explanation: Marian is in fact having a psychotic break.

Alternate explanations: her patient is telepathic and also insane? Her patient is an alien from another world in a fight with a more powerful alien and her weird telepathy is translating it as 'god'? Both of those seem like MORE likely explanations than 'God exists and is the sort of entity that goes to war and randomly tries to assassinate injured people in hospitals.' 

Uh. 

I can get you the necklace and see if it helps. Where is it? And if it indeed causes the woman to have decent sats and a decent blood gas on room air, that's sufficiently whatthefuck that she can, like, probably just ask the resident to come look and confirm? And if other people are seeing the same thing as her then either she's not crazy or all of them are crazy. 

She is kind of mostly not thinking about the "war with a god" part because she has no idea what to make of it and it's also sort of terrifying. 

It's in the gauntlet but the gauntlet only opens to my touch. Can you bring it here? I think I'm not yet very able to walk.

I can bring it. Please don't try to walk. You're attached to a lot of things and I think you might lose consciousness again if you pull the oxygen mask off. 

She'll carry the gauntlet over. She's sort of past asking questions about bizarre shit, such as how exactly a gauntlet 'opens' to reveal a necklace. (Why it does it to only the patient's touch seems less weird, Star Trek is full of DNA-activated tech.) 

(The respiratory therapist is watching her with a weirded-out expression, but she has like five other patients to see before she can have a break. She'll leave Marian to it, whatever 'it' is.) 

Iomedae taps the back of the gauntlet and it opens to reveal a jewelry box larger than you'd expect to fit in there but not obviously-impossibly larger, and takes out the Necklace of Adaptation, and with some concentration makes her hands behave normally so she can slip it over her head. 

I do need to breathe oxygen, she agrees with Marian absently. If I were healthy I could do without for quite a while but I am in poor health at the moment and am probably going to have to convalesce the slow way.

The patient indeed does not look like she's particularly having an easier time with breathing, and her sats are still at 90%, though at least they're not dropping below that. 

Yeah, I think you still need some help breathing. I am kind of worried that if you put on armor it will put a lot of weight on your chest and make it harder to breathe. 

I have never had that problem before but I rarely survive being injured this badly. If the problem is not that this world has different air I am actually confused about why I am having any trouble breathing.

Marian's brain is making a quiet mental checkmark about the 'if this world has different air' part, yep, alien. ...Five seconds later she runs into a mental stumble, what the fuck is "I rarely survive being injured this badly" to mean?????? 

- probably not the point right now. 

Obviously I don't know anything about the air on your, uh, world, but I am pretty sure you breathe oxygen like humans because it does help and also I think our equipment wouldn't work if your blood wasn't carrying oxygen. I think you're having trouble breathing because you inhaled a lot of steam or boiling water and your lungs are really horrifically burned. I am actually pretty surprised you're not having more trouble breathing, you - didn't seem to be dying without supplementary oxygen, you just weren't getting enough to be conscious. 

Oh, are you providing me with oxygen through some special mechanism that bypasses my lungs or simplifies their job, so I am conscious while they are not functioning normally? That makes sense of how much worse I feel right now than I usually feel when I recover consciousness after an injury. I appreciate it very much, and did not know that was a thing that could be done. 

...Okay, aliens with advanced DNA-controlled artifacts but no modern medicine? Weird. 

Yeah. We're giving you air to breathe that's 100% oxygen instead of only 20% - I guess your world could also have higher atmospheric oxygen? - and the mask you have on now is pushing air into your lungs so your muscles don't have to do as much of the work. The tube you had before let us help you more, but I understand it's frustrating not being able to talk and your oxygen saturation is, like, okay right now, so this is probably okay for a while unless you feel like you're about to get exhausted. ...We can also bypass lungs completely but that's really involved and we did not actually have to do it for you. I would've usually expected to have to do it if someone's lungs were that badly messed up. 

Man it's way harder to be professional and reassuring with patients when you're thinking telepathically at them. Marian is not practiced at this. Hopefully all of that was okay to say and not mortifying. 

What a useful thing to be able to do! I'm curious how it works but am actually having a very hard time remembering and organizing information right now, which I found pretty worrying before your explanation that I am conscious unusually early in recovery from my injuries and now find only worrying in the sense that I dislike being impaired and without my allies. Does this world have any magical mechanisms for interworld communications or transit?

....Uhhh. No. We - didn't previously know there were any other worlds with people on them and I don't have the slightest idea how you got here in the first place. Especially not people who look basically human, that part is really weird. And, uh, yeah, I'm not at all surprised you feel kind of out of it. You should try to rest. 

This is so awkward. Marian is going to have to TELL SOMEONE that her patient is probably an alien, and she doesn't even have obvious proof - if the patient's impossible resilience doesn't cut it - unless she gets her patient on board with taking the belt on and off again, she'd probably survive ten seconds with it off so they could see the difference. Or unless she can telepathy more people. Marian can probably just, like, ask that. 

Can you telepathy more people? I am just worried that if I try to tell the doctor you're from another world, they won't believe me and might think I'm insane. Oops she totally just said-thought that out loud. It's probably incredibly rude to imply that you think your patient might be a hallucination. 

I can do it again but by expending resources that are limited; is the doctor the only other person who will need to be so persuaded, and if not is it possible to get them all in here at once? Honestly I would also prefer that interaction not happen for a few hours so that if they decide to kill me I can more easily leave, but I understand that from your perspective that is a worse bargain. I would for what it's worth be very very surprised if killing me were in your or their interests.

Uh, probably there are some other people who should be convinced, I can think about it? ...Nobody is going to kill you, they're doctors, but uh, if a powerful alien just tried to assassinate you then I guess I see why you would be nervous. I...probably don't have to tell anyone right away, although if you want your armor back I need, like, an explanation of why that isn't a terrible idea medically speaking. 

I have insufficient experience with medicine to tell you confidently it is not a terrible idea medically speaking. This world is one where doctors are - noncombatants, where they have commitments that are incompatible with the doing of violence? I have miraculous healing powers under some circumstances but I am not a noncombatant.

If she has miraculous healing powers (???????!!!!!!!!!!!!!) then Marian is confused about why she's– ...oh, 'under some circumstances', which plausibly don't include being on another world. That must really suck. Well, at least she ended up somewhere near a proper hospital. 

Doctors aren't banned from any violence, I think they're allowed to, like, defend themselves if they get randomly attacked in the street, or if they're working in a war zone or something. They have commitments not to hurt their patients, they have to swear an oath about it and it's super illegal. I won't claim literally no one breaks it but I know the doctors here and I trust them. With not killing patients on purpose, at least, being nice is a different thing. I really really think no one here would hurt you on the orders of a powerful alien from another world that they've never heard of. 

I am willing to do another Telepathic Bond for up to four more people - that's as many as I know how to do in one casting - who you point out to me and who want that. They should know they will also be Telepathic Bonded to one another, and that it lasts for a few hours and I do not presently possess the means to end it early unless you found my sword where you found me.

I didn't hear anything about a sword, sorry. 

Marian takes a deep breath, forces her teeth to un-grit, and squares her shoulders. Whyyyyyyyy is this EVEN WORSE than pushing terrifying doses of propofol while torturing her patient. 

....Okay. I - am going to go find someone to ask. Are you really, really, definitely sure that you're breathing okay and aren't going to run out of energy in the next five minutes? It should hopefully be less than five minutes but it might take me a while to find people. 

I do not have very much experience with any of the techniques you are using to keep me conscious and am seriously impaired. I am not really definitely sure of any related subjects. 

...Okay, I'm not incredibly comfortable leaving you alone. I'm going to go see if I can find one person and tell them which people I urgently need to come over here as soon as they're available, and then I'll come back, okay? I - you're doing great, I just need you to try to stay calm and relaxed and hold still, and don't pull on anything attached to you. 

I will try to do that. When you have more time I'd appreciate an explanation of which problems each of those instructions are meant to solve. She sounds calm and relaxed, though, and she's holding still.

Huh, is medicine really that non-obvious to...well, an alien who usually has miraculous healing powers, yeah actually that would explain it. Marian can explain as soon as she gets back. 

(Marian is still sort of self-consciously monitoring her own thought process for signs of Having A Psychotic Break, which is probably stupid because this presumably doesn't work if you are having a psychotic break, but - she would have thought the reason is that you can't remember to do it and aren't bothering to ask the question of which things make sense? Marian feels very capable of asking that question, and spectacularly confused, and she seems to be able to multiple 18 x 41 in her head in less than thirty seconds which is usual for her on the amount of sleep she had last night.) 

Great. So...might or might not be crazy, definitely is about to have a mortifying conversation. Sheeeeee is going to chicken out of having the mortifying conversation just yet, and inform the unit clerk that she needs her, the charge nurse, the trauma surgeon, and the resident to swing by her patient's room as soon as they're available, for 'an urgent thing, it's sort of admin related so I need you there too.'

- she jogs back over, kind of fretting. She was gone less than a minute but aaaaaaaaaaaah is her patient still breathing and conscious and stuff??? 

Yep! She is holding still and being calm and relaxed because she is subject to unfamiliar health interventions and those were the instructions about those. She is finding 'relaxed' a slightly difficult state to access because of the agonizing pain but she's managing tolerably.

Yeah she looks like she's doing great, that's really impressive! Marian is inclined to offer her more painkillers than this, they can probably risk somewhat more fentanyl without respiratory depression, but...maybe after providing proof of being a miraculous alien, it probably will make her groggy at a higher dose and she was already complaining of feeling out of it and finding it hard to think. 

Marian plays her eyes over the pumps and monitors, and then pulls up a chair. 

Okay, I'm going to explain everything that we're doing. The mask on your face is helping you breathe by pushing extra-concentrated oxygen into your lungs, and it's attached to a machine by this tube, so if you move a lot it might come loose and then you wouldn't be getting the help breathing and might lose consciousness again. Also this thing on your finger tells us how much oxygen is in your blood, and this thing in your wrist tells us your blood pressure and lets us take blood to do tests without sticking you for it, and the wires here watch your heart rate, if you pull off any of those it won't immediately cause a problem - well, the art line might bleed - but it'll mean we can't monitor whether you're okay or tell as quickly if you need more help breathing. 

(Marian is actually nonzero confused about that - the woman's sats didn't even have a chance to drop below 70% before Marian intervened, most people are perfectly capable of being conscious and unhappy about it - or, actually, people don't even notice, sometimes, other than seeming a bit off and confused, if their CO2 takes longer to rise or if they're COPD folks who chronically hang out with a PaCO2 of 60. But this particular patient's physiology seems to work very weirdly, like the interventions they're providing are...compensating for more damage than they should really be able to?) 

You also have an IV to give you fluids and electrolytes, because you were kind of leaking a lot of fluid from the burns, and you couldn't safely drink water when you were unconscious and probably still shouldn't. It's pretty important not to pull that out, we've also been using it to give you drugs to help with the pain, and antibiotics to try to prevent the burns from getting infected. And you lost a lot of blood, so we were able to top you up with some donated blood from other people, I don't know if your world has blood transfusions either? 

- anyway that's mostly why I want you to hold still, because there's a lot of stuff and it would be easy to pull something off by accident and cause a problem. It helps to be calm and relaxed because you'll take slower deeper breaths, which get more air to your lungs, and being tense means your body needs more oxygen right when it's pretty hard for you to get enough. 

Does that make sense? 

It seemed to. I am very impressed. That is a lot of different things to be doing about a person you found unconscious on the side of the road! 

The burns won't get infected, you can probably cease interventions related to that. If I take slower deeper breaths is it additionally helpful to be calm and relaxed?

I am not 100% confident of that given how presumably our world has different pathogens, and I wouldn't expect the antibiotics to do any harm just in case? Though you're not due for the next dose for four hours anyway. Frown. Is it hard to be relaxed because you're in a lot of pain? That's - super understandable - it's not the most important part, it just might hurt even more if you're tense and you'll need to breathe slightly harder. We can give you more drugs to help you be in less pain but I think it'd be better to do the talking to the doctor first, it can make you a bit more sleepy or groggy. 

I would up to the point of being unable to think about anything but the pain prefer pain to being sleepy or groggy, she confirms. I am in intense pain fairly often and have experience functioning through it, and I am not confident in the safety of your tubes or your facility staff when I am sufficiently disoriented. It should improve shortly anyway, once I have more skin.

...Yep, Marian has in fact experienced this patient while disoriented and is not particularly interested in repeating the experience. 

Also. Uh. What. 

I mean, yes, but - okay maybe you are expecting a different thing because you normally have miraculous healing, but for humans it takes, like, months to recover from burns this serious. And treatments that are more painful than just sitting here with them. 

I expect to be fully recovered by tomorrow, even without miraculous healing. This is not ordinary for humans where I am from either. I am a legendary hero and it is approximately ordinary for legendary heroes. ...I am a little surprised that people would be willing to endure months of more pain than this and am now wondering what your afterlife situation is.

Okay great this woman is not just an alien she's some kind of video game protagonist. What. ...Marian flags after a second that this is a pretty absurdly implausible claim and she's nonetheless surprisingly ready to buy it? Maybe because that sure does look like the rate at which this woman is improving, it's been less than two hours and she's coherent and talking - albeit in fucking telepathy - and breathing tolerably on BiPAP despite the worst lung damage Marian has ever seen or imagined was possible. Despite the ongoing lack of skin and oozing open wounds covering most of her body, Marian's gut instinct is that she looks stable. 

Well, most people are more willing to be completely zorked on painkillers for it - and aren't as dangerous if they're disoriented, I guess. And. We, uh. There are a lot of people on Earth who sort of believe in afterlives but, like, never in ways where it's observable or a thing you could check? I am personally fairly confident that we don't...have them. 

If her patient's world is real and really has afterlives then that is possibly one of the most fucking important facts Marian has ever learned. Her brain is kind of mostly bouncing off thinking about it right now, though. She's busy using her brain for things like monitoring vital signs and does not have room for lifechanging revelations. 

Huh. I'll see what I can do. I am too disoriented to guess right now. I am also surprised that many people can afford months of medicine or months of not working and that may be as important a confusion. - I can pay, and intend to, though I will need some time to figure out how best to do that.

People usually have health insurance? Right, that's probably a concept that an alien wouldn't have. ...I can explain once you're feeling better. There's probably - a lot. 

I would expect so! There would be a lot if I were explaining my world, or the other world I have been to. Insurance translates as related conceptually to maritime loans whose recipient is not obligated in repayment if the venture does not return and probably if I were thinking clearly it would be more obvious how medical treatment would be funded thereby, but all I am thinking of is that everyone's loans are cancellable if they get injured, which does not seem like it would solve the problem quite aside from how you'd have people flinging themselves at wolves left and right. 

Huh. Yeah, it's not that. 

...She should not get nerdsniped into trying to explain insurance to the alien, who is currently brainfoggy and in horrible pain. Especially because it looks like the trauma surgeon is now arriving with the resident, looking moderately disgruntled about it. 

Marian takes a deep breath. "I - need to explain a thing but I want to wait until the clerk and the charge nurse are here so I only need to do it once." 

"Yeah, they're coming." The surgeon is glaring suspiciously at Iomedae. "Heard she self-extubated. Took your eyes off her for too long?" 

"I was right there!" Marian protests. "She was - pretty freaked out - and she's kind of impossible to keep sedated. She's satting okay on BiPAP. I - think it'll make more sense once I explain about the, uh, thing." 

"Hmmphh." The surgeon rolls his eyes at her, and starts pacing. 

Marian takes another deep breath. 

It's okay, nothing is wrong, she tells Iomedae. He's annoyed with me for letting you pull the breathing tube out, or, well, ""pull"" is not precisely the thing that happened, because, like, a normal human patient could have died from that. ...I'm trying to think if there are ways to prove you're from another world that don't use up limited resources, since after the telepathy wears off you won't be able to communicate at all? Would the necklace do anything for other people? 

The necklace provides breathable air for the wearer. It might be noticeable if you have a river available in which you could go diving, or if you can teleport about twenty miles straight up - on my home planet, I guess it might be either farther or less far here. I don't know which capabilities I have are most definitive proof that I'm from another world. Once my throat has healed a bit more I can turn into an angel? That's a - differently scarce resource.

She did not in fact think anything was wrong; the man is important, and annoyed, but he's neither trying to kill her not trying to conceal a lot of complicated planning with respect to her nor trying to follow orders conveyed remotely or convey his own, and she's pretty good at telling. 

She can do WHAT. Marian is currently experiencing her brain rapidly flipflopping on what genre it seems like this bizarre saga is supposed to be. 

It would be pretty inconvenient to send someone to the river, but we do have, like, sinks? I can ask– oh, they're here. 

The charge nurse – Alison, today – looks intrigued. The clerk mostly looks like she would prefer to be getting her break right now. Great. Time for the worst social interaction of Marian's ENTIRE LIFE. 

She forces her teeth to un-grit. "So, uh, everyone has probably already noticed that this patient is implausibly strong and recovering implausibly quickly and implausibly resistant to sedation. I realize this is going to sound, uh, pretty completely crazy, but she, uh, when she woke up, she - okay for one she didn't pull the tube, she bit it off - and then she started communicating with me telepathically. She says she's from another world and she's a, uh, a legendary hero, and that's why she's so tough. And she was fighting a - she called it a 'god' but it sounded more like a powerful alien entity of some kind - and there was an assassination, which is I guess how, uh." Vague gesture at Iomedae and her current very visible condition. "She says she's going to recover fine, but she's worried about another assassination attempt, even though I'm pretty sure the 'god' is not from Earth. ....So. Uh. Yeah. That." 

The surgeon clears his throat. "Well. That went and got a whole lot weirder." 

No one else seems to be sure what to say. 

What is that supposed to mean. Marian was definitely expecting people to argue with her, or inform her that she's having a psychotic break, and she's sort of unsure what to do with the absence of that. 

"...Right. Uh. I figured you would want - proof - and the most conclusive way would be having her do the telepathy - thing - again, she can get four people. But it might be better to save it until the one she has with me wears off, she doesn't speak our language. Other stuff - uh, the necklace she has on provides breathable air anywhere. She thought it might help her breathing problem and apparently it doesn't, but it'd supposedly let you breathe underwater. Uh. The belt makes her healthier, she shouldn't have it off for long but it might not be a disaster to take it off briefly to see the difference and so someone else can try it. Possibly there are other items she has that do things but she's pretty out of it, I didn't get a full list or anything." 

The surgeon snorts. "You missed the obvious test, kid. What's the range on her telepathy?" 

Oh no aaaaaah what did she fail to think of. "I don't know." Iomedae, how far can you telepathy someone? 

It does not seem to reach to other stars. I have not tested other planets that circle the same star - do they do that, around here?

They do, yeah. Uh, so it's definitely fine anywhere on the same planet? 

....Ohhhhhh NOW she gets what the surgeon is angling at. She hadn't thought of it because...mostly because she had vaguely not been modeling Iomedae as able to communicate at all with anyone other than her, but she does have, like, hands. 

"I think she could reach anywhere in the hospital and a lot further," she says out loud. 

It will assuredly work anywhere on the planet and I am reasonably confident about the planet's moons, should the planet have those.

Good.

Marian turns back to the surgeon. "I'm - guessing you want to have her convey something to me when I'm at the other end of the unit, or something? And have someone come over here to check it?" 

"- Okay, fine, you're not hopeless. Is she awake enough to think of a number and tell it to you?" 

"Uh, probably. She can't talk but I guess she can, like, hold up fingers?" He wants you to communicate a number to me when I'm outside the room, and I guess separately tell someone else by holding up that number of fingers. Can you do that? 

"Great. Come with me." To the resident, "- you stay, you'll be the messenger, I'd like you to write down whatever number she gives you in a couple of minutes and bring it to us." And the surgeon sweeps out of the room. 

Marian has to push pretty hard to convince her brain that it's okay to leave the patient's room if three other people are there at her bedside. She grits her teeth and follows. 

The patient is lying there calm and relaxed, aside from keeping an eye out for attempts to kill her. It'll be harder now that she's conscious, but - not that hard, when she's out of armor and healing and reliant on an external air source and collapses every time she does something strenuous. 

The surgeon speedwalks all the way to the double doors that lead to the OR, and swipes his badge to let them through. He leans against the wall. 

"Actually, it's a different plan. I can't think why you would, but you could have colluded with her. So I'm going to tell you some numbers, and - if you really aren't kidding, or insane, and you can talk to her - you'll tell her the change of plan, and pass the numbers along once I give them." 

That's...probably reasonable. 

Actually the surgeon wants to test in the other direction, he's going to tell me numbers and you can convey them to the resident by holding up that many fingers. Are you up for that? 

I can do that. 

The surgeon considers for a few moments. "...Eight." It's impossible to tell from his manner whether he's particularly expecting this to work. 

That's mean, it needs both hands The patient can handle it. She put a necklace on herself. 

Eight, Marian conveys to her. I think there's going to be more numbers after. 

Acknowledged.

Iomedae's fingers are extraordinarily painful to move but she extends eight of them. 

And Marian will additionally relay 'three' and 'seven' and 'four' before the surgeon seems to decide that's enough. Sorry, she tells the patient. I know that probably really sucked. 

Aaaaaaaand now time to grit her teeth and wait and hope that the patient actually pulled it off and that she didn't just hallucinate the entire telepathic conversation 

It seems an entirely reasonable experiment. Are you all right?

I'm fine. I'm worried about you.

The resident wanders out into the hallway holding a piece of paper. 

The surgeon does not actually enlighten him to their location yet. He glares at Marian. "Shoo. Go sit in a conference room or something."

And then, once Marian is definitely not in earshot or line of sight of the resident and cannot possibly collude with him in some sort of absurd prank, he badge-swipes back through the double doors. "Well?" 

"Well, the patient is apparently awake and can hold up fingers."

The resident shows him some numbers. They are, in fact, the same numbers, in the same order. 

The surgeon makes a face. "....What about that. Well, either we're all insane, or that patient is telepathic." He digs a coin out of his pocket. "Heads you have to stick your head in a sink, tails I do." 

Marian sits on a conference table and fidgets. 

They sent me off somewhere to - go discuss, I guess. Wow she hates not having eyes on her patient. Being in continuous telepathic communication with her patient is a bonus she doesn't normally get but it does NOT make up for not being able to see the monitor or hear any alarms. How are you? Still breathing okay? 

Not compared to my usual expectations about breathing but I don't expect to lose consciousness again unless I try to use magic again, and maybe not even then.

Okay. Just try to rest. I know it's hard when you're in this much pain, but it'll be easier if you can keep your body's oxygen needs as low as possible. ...If you do lose consciousness there are more things we can do, we can put the breathing tube back in, but usually we would give people drugs to make it more comfortable and you are kind of absurdly resistant to drugs. 

Marian fidgets and is only slightly screaming internally. 

If you need to put the breathing tube back in I will try not to destroy it again, but I really expect I'll be recovered enough to depart in a few hours. I don't know confidently, I haven't tried to recover from injuries without miraculous healing in a long time, but I am - hard to kill. You should not be worried about me.

....Yeah, Marian is still going to be worried though. 

...The coin comes up tails. 

The surgeon sighs, leaves the resident to supervise the door and make sure Marian is safely staying put - at this point it seems like she's probably not having a psychotic break, and there are several dozen bizarre elements of the situation not explained by that theory anyway - and of people who might try to pull an elaborate prank on the ICU, Marian is near the bottom of the list, but it doesn't cost anything to keep her out of things a bit longer. 

The patient continues to look shockingly stable and fine for someone minus most of their skin. It's not just the numbers on the monitor, which would be stupid to fake, it's a deeper gut sense you get after enough years of clinical experience and seeing which patients turn the corner and which end up deteriorating. 

"I'm going to borrow your necklace," he tells the patient - which she might or might not understand, right. He goes to try to remove it. 

She does not understand! She does not resist, though, at least not once it's clear he's not going for the air-tube on which she is presently reliant. (Before that's clear she does grab at it protectively.)

Wow, he is super not going to steal her BiPAP mask, that would, in addition to being medically dangerous and seriously ill-advised, be a dick move. He'll even smile reassuringly at her if she seems to be looking at him. (He's not very good at it. Bedside manner is not the part of his job that he gets the most practice at.) 

He leaves the room. 

Marian is FRETTING. Also...kind of bored, to be honest? Which is ridiculous, but she doesn't actually have anything to do with herself aside from bother the patient over telepathy, which is sort of rude when she just told her to rest. 

...Also wow she has accidentally been rude about a completely different thing, hasn't she. 

My name is Marian, by the way, she thinks at the patient. The surgeon is Dr Keenes. What's your name? 

Iomedae. Doctor is - a title? Signifying what?

It means someone who's been to medical school and done a lot of additional training, and is qualified to make medical decisions in hospitals. ...We don't have magic or miraculous healing here, just drugs and machines and surgery. I'm a nurse, which is a lower level of training, so I do bedside patient care but there are a lot of decisions I can't make on my own and have to ask the doctor about, like what drugs are safe to give a patient. Though in the ICU nurses work with more autonomy, I kind of just made a lot of decisions about you before I had a chance to explain to Dr Keenes what was going on.  

Great, Marian is definitely coming up on an adrenaline crash and it's apparently the particularly stupid and embarrassing kind that makes her inclined to be weirdly giggly for no reason. At least she's in a conference room by herself and can take a minute to get it under control. 

They seem to have been very reasonable decisions! I do want my magic items back.

I think we can get you everything back! Some of it is just in a bag in your room, I think, and the armor is going to be mostly in the ER but I can get it or make sure someone else does. ...What do the other ones do? 

There are a lot of them, and I usually do not share everything I can do in order to make it a little harder to kill me, but they generally make me not reliant on food and water, improve my defenses against magical and nonmagical attack, make me wiser and more thoughtful, give me better luck, and so on.

That's such a ridiculous list. How. Why.

...I guess the one that makes you not need food or water would help right now - we're giving you IV fluids but we can't give you nutrition as easily that way. Marian is remembering that Iomedae still only has a handful of peripheral IVs, they never did end up finding a moment to place a central line, though at this point it's...probably not a spectacularly high priority. Marian's brain is still insisting on giving her an antsy feeling about it, though. Which one is that? 

It was one of my rings. I think you took it off. It will take a week to reacclimate to my body and will not be helpful in the short term, unfortunately. You also took off another ring, my necklace, my cloak, and my headband, I think? And then the gauntlets and those things contained in them. 

Oh no! Marian feels so apologetic and guilty now, even though there is no possible way she could have known at the time. I'm really sorry. We usually take rings off because people's fingers swell and it can cut off circulation, and also it's an infection risk. You can have it back, it's in the room. ...There's also a shirt that you had on under the armor. It's pretty gross and so is the cloak, though. 

That seems like an entirely reasonable policy for you to have. And one that didn't even kill her, though it probably would have if they'd removed the implanted ioun stones. Do you have some test other than taking off the air mask for determining whether I can safely take off the air mask and go get dressed?

We'd normally dial down the settings gradually and watch your blood oxygen levels on the monitor. Normally we aim for above 90%, and we check blood CO2 levels as well - that's, uh, the waste gas you breathe out, if your lungs aren't able to get rid of enough of it then it accumulates and makes you sleepy and groggy. I can talk to the respiratory therapist once I'm back.

...Uh, I don't 100% know when the doctor is planning to let me go back, he sort of just told me to stay in a room over here and left. I assume he was worried that I might be hallucinating the telepathy with you and not safe around patients, and wants to - finish confirming things about you? 

That makes sense. I have no specific reason to believe retrieving my gear is urgent, I just frequently operate in contexts where it is very ill-advised to be unarmed and unequipped. Can you tell me more about your world? Do most people die? What do they die of? Do you have any form of collective organization at a larger scale than hospitals?

WHAT a set of questions. Marian spends a couple of seconds trying to parse whether the last question in fact means "do governments exist on this planet", and not "are hospitals the basic unit of social organization" which would be a bizarre and hilarious way for a society to work. 

Yeah, everyone dies eventually, we don't, like, have a way to make people immortal. I think in the US - the country we're in now - most people die of illnesses related to aging? Sometimes people die younger of specific illnesses or accidents. Uh, we have countries with governments, and the US is divided into states that have state governments. ...I have no idea if there's, like, a standard process we're supposed to use to tell someone that our patient is an alien. This has not really come up as part of my job before. Also it sounds complicated and messy and like an enormous headache that she would sort of rather keep ignoring. 

Are there rules governing the behavior of visiting aliens? I am in fact human, as are all my ancestors I have specific knowledge of. There are also many planets inhabited by intelligent nonhuman species that seem like a closer match for the word you're using but I have not met very many of them, I've been pretty busy. 

...I have no idea, but we didn't know before now that there were actually other worlds with people on them, so they would be sort of hypothetical rules. I guess I've been thinking of you as an alien because your physiology isn't very humanlike, but that's because of the legendary hero thing and not what species you are? 

Yes. I was born an ordinary human to ordinary human parents and was no faster to recover from injuries or harder to kill than other humans until the god Aroden sponsored me as one of his  -

The telepathy is having a bit of a time doing conceptual translation here -

oathbound warrior priests. That was forty years ago and I have become harder to kill in that time.

This is a spectacularly surreal conversation to be having on so many levels. We don't have, uh, oathbound warrior priests here. Or gods who give people legendary hero powers. We also don't have the ability to do - most of the things you described your items doing. I guess we can do some of it with technology–

There are footsteps in the hallway. Marian breaks off. - sorry, one second, someone's coming. She sticks her head out. 

Dr Keenes is strolling down the hall toward her, rubbing his damp hair with a bath towel. Iomedae's necklace is dangling from his wrist. "Well. That was interesting." 

"- All right, all right, you can go back and fuss over your patient again, I know what you're like." 

Is that literally the entirety of the conversation they're going to have about it????? 

"Uh. She wants her stuff back and I think a lot of it's in the OR." 

Dr Keenes waves a hand. "I'll make the resident get it. Get on back there and try not to make a terrible impression on the visiting superhero." 

Marian is - honestly per usual, for a conversation with Dr Keenes - left very unsure how she's supposed to respond to that.

"....Yeah. Okay. Uh, she was asking if we could try weaning the BiPAP settings, she's super impatient to get dressed so she's harder to murder by evil gods or something, is that okay...?" Wow, Marian sure did just say that sentence out loud with her actual mouth. Mortifying. 

Shrug. "Go bother the respiratory therapist about it if you must." 

Great. Marian is just going to scuttle back over to the ICU before this interaction has a chance to get even worse. 

Dr Keenes is sending me back over, she tells Iomedae over the telepathy. He says he's going to send the resident - the younger doctor in training, he was in the room too - to go get your stuff from the OR. 

Thank you! I think I'm feeling a little better and I would bet I can breathe independently.

That would be spectacularly impressive. Marian makes to the room at a jog and stops at the foot of Iomedae's bed, her eyes flashing quickly from her patient to the screens and back. How does she look? What are her vital signs like? 

She in fact looks a lot better. Her burns are mostly bandaged, so it's not like her skin is directly observable regrowing, but she's less tense, no longer involuntarily shaking. Heart rate is at eighty, blood pressure is barely elevated, oxygen saturation is 97.

This is a happy Marian!!! ...She does not do a literal happy dance, that would be undignified and Dr Keenes would judge her for failing to impress aliens legendary heroes empowered by gods from other worlds. 

Yeah, you look better. I'm going to, uh, go find the respiratory therapist to try adjusting settings, but I'll get you the rest of your things first. - sorry, I was going to try to wash the cloak and shirt out for you but I have not really had any downtime. 

The baggie on the counter has Iomedae's necklace-amulets that she was wearing when she arrived, her headband, and her rings. The cloak and shirt are wadded up beside it, and the arm-armor removed in the ER is in the bag that Marian retrieved the gauntlet from. She sweeps a bunch of gauze wrappers and other detritus off the bedside table into the trash, loads it up, and wheels it over to Iomedae. 

Iomedae will put the headband on first - that's the one that's worth more than some kingdoms, and she really misses it - and then will put the utterly disgusting clothes back on over her horrendous burns with only a bit of a grimace. She really hates being unequipped. 

The headband immediately makes obvious some questions she should have asked. Do travellers from other worlds show up here often?

If Marian were in the room at that moment, she might either object to the putting-on-clothes or at least try to help and make sure Iomedae does not get tangled in her IV tubing and monitor wires, but she's instead in the hall sticking her head into every room to try to find the respiratory therapist. 

No! As far as I'm aware it's literally never happened before! ...I guess it's, like, not impossible there's a government department that knows about visitors from other worlds and keeps it secret. But I think that'd be pretty hard - you showed up in a random place, a lot of people saw - so probably not. 

Does this country and state have an accessible list of laws to which travellers are subject?

Marian is slightly distracted by the fact that her colleague Marlene's patient seems to have just pooped and now Marlene has spotted her and is waving for help and Marian is trying to indicate that no actually she is busy right this second. 

Uhhh. The US isn't known for having the least complicated laws ever but most of them you don't have to worry about breaking by accident if you're minding your own business in a hospital? Uh, the obvious ones are that it's illegal to murder anyone or assault anyone or steal people's stuff. Oh, and it's probably super illegal for you to get paid for doing any labor here. Marian is PERHAPS SLIGHTLY BITTER about US visa law. 

...that sounds pretty inconvenient for many things but most immediately for repaying this hospital for my care here. Is that how other countries work also? Can I secure a loan of local currency?

Oh shit. Marian is NOT qualified to give advice on this. How much can three hours in the ICU cost anyway probably way more than is at all reasonable. 

I don't know. I don't think you have to sort it out, like, today? ...Do you have any way of getting back to your world, uh, it seems like probably either you do and can get - something to sell or something - there, (or...not come back...in which case it's not MARIAN'S problem that the hospital won't get paid), or you'll be here for a while and there'll be plenty of time to figure it out. 

I do not possess interworld transit under my own power. I suspect several people of my acquaintance are working on it. I'm pretty confused about how the last several interworld transits happened and can't guess how long it'll take them to find me, or if they'll be able to do so. She doesn't sound distressed about it. Obviously she has important work at home, but it's not actionable and so not a good use of thought, and transiting the worlds is so far turning up a lot more valuable options for her than it did for Aroden and is plausibly worth it even if it forces Him to step in and save Golarion, or even if Golarion is lost.

(That one superweapon of Urtho's - not the time to think about that, either.)

I am sure there'll be time to figure it out. That just seems like an oddly lackadaisical stance towards being paid for a dozen different intended-to-be-lifesaving medical interventions and the attention of several high ranking paid specialists.

(Well, see, Marian gets paid the same amount either way. Possibly the surgeon would have more opinions about it, she thinks they're paid per-case.) 

The respiratory therapist is hiding at one of the computers at the end of the hall with her sandwich. Marian clears her throat. "Hey."

....Oh NO it has somehow ONLY JUST NOW occurred to her that the RT was, in fact, not in the room for The Explanation. Shit. Where's the charge nurse, can she chicken out of explaining, she has already explained once and that was ENOUGH... 

"- The burns patient is satting at 97% on BiPAP and I think we could try nudging the settings down," she says, instead of actually explaining anything. 

The respiratory therapist raises her eyebrows but will follow Marian to the room. 

....She raises her eyebrows a lot more when she sees Iomedae (sort of) dressed. 

Oh no did Iomedae try to get dressed on her own when Marian was in the hallway. Marian is so irresponsible. She will hurry over to check that Iomedae was careful with her IV sites and art line and that her sat probe is still in place. 

She was careful but in the fashion of a person who has never encountered any of these things and has no idea what they're doing for her. The sat probe has fallen off and she pulled out one IV while putting on her shirt. 

She looks better all the same. She smiles at Marian.

...Well, she still has two other IVs that were not at that moment connected to anything, Marian unhooked the blood products line once it was done. She will just swap the fentanyl infusion to a different IV. And put the sat probe back. It doesn't look like the IV site is bleeding (it's hard to tell since it's mostly gauze-wrapped along with the rest of her arms) so Marian will just leave that alone for now. 

Iomedae smiling is mostly not even horrifying now???? Most of her body is bandaged, and her face isn't completely visible behind the slightly humidity-fogged-BiPAP mask and the hydrocolloid dressings padding the edges of it, but it looks like she's no longer leaking blood and pus from her bodily surfaces???? 

You do look a lot better, Marian sends with almost proprietary pride. Her patient is SO COOL. 

The RT is mostly just looking at whether her breathing is labored and what her sats are. (She wasn't the one on hand for the bronch, and overall has incomplete context on this patient, she knows everyone was freaking out but maybe the pulmonologist who bronched her was just overreacting?) 

Her breathing is pretty good! Her sats are staying at 97%!

...All right, sure. She can try breathing only 50% oxygen with moderately lower support settings on the BiPAP, and see how that goes for the next ten minutes. 

"- Can you monitor her?" the respiratory therapist asks Marian. "If you don't mind, I'd like to finish my lunch." 

"Sure. Uh, if she's fine in ten minutes, can I try her on just the regular oxygen mask? I'll put the BiPAP right back if she's having trouble, I do know how." 

Marian is bizarrely impatient about this but fine whatever. 

...She'll park herself by Iomedae's bed and watch her very closely and be available to answer more questions about Earth if they come up. 

I have lots more questions but they can wait if you have other responsibilities, I don't think I need healing supervision at this point. 

She's doing a bit worse with less oxygen - 93% - but hasn't actually noticed because the burns all over her body are a lot more distracting. 

I don't actually have other patients right now, you were in really bad shape when you arrived and we expected based on how normal humans work that (well, most likely that she would die and then Marian would be available to take other patients again) you would stay in really bad shape for longer. 

Marian is in fact obscenely behind on charting, to the extent that she hasn't exactly done any charting, but has honestly been putting it off because there are so many weird things going on. EPIC does not have boxes in the flowchart for legendary superhoeroes who recover from burns that ought to be lethal in a matter of hours.

She...should at least chart the assessments from before Iomedae regained consciousness, though, that's - well, also weird, but a kind of weird that the flowchart boxes will accommodate. ...She is quietly embarrassed at putting down 0 for urine output because from the point the armor came off there was not, at any point, a good time to try to place a catheter on her skinless patient. 

She watches to see if Iomedae's sats stay above 90% for the whole ten minutes. 

They do. 

I think most humans where I am from would have been dead had they sustained such injuries. Though also they probably wouldn't have sustained the injuries in the first place, the initial blast would have killed them.

...Yeah, I don't think anyone super expected you to survive at first, but your heart was still beating and we weren't going to just not try - we didn't know what'd happened and, like, maybe it looked worse than it was somehow, which I guess sort of turned out to be true but not the way we thought. - though you weren't breathing when they found you, I'm not sure how legendary superheroes work or whether that would've fixed itself too? 

She is going to ask Iomedae what happened later, it feels pretty rude right now. Uh, anyway, I'm not sure it's a great idea to go straight to no help breathing - your oxygen levels did drop a bit - but we can try just the normal oxygen mask, it's a lot more comfortable. 

I don't think I have stopped breathing before. I believe it is possible for me to drown. I wouldn't have guessed it was possible for me to drown out of water but I can't say I've given it very much thought. - I die frequently. 

Marian switches out the tight uncomfortable mask for a significantly less uncomfortable mask, that feels like it probably wouldn't even interfere very much with talking. (She's setting it to 50% oxygen for now, the same as on the BiPAP, but she can go higher if Iomedae seems to need that to compensate for losing the pressure support.) 

...If you had been on another world near a body of water right before all - this - that would explain some extremely confusing observations, they found you with your lungs more or less full of water. Reno's in a desert so it was pretty baffling. 

Aaaaaaaaand then Marian's brain finishes processing the last part and she has. Different questions. 

Is is, uh, a legendary hero thing to - not, uh, die permanently. We don't have that here. I guess unless you count some things as dying that are things we can fix.  

I was on a raft in the ocean when someone detonated a weapon that boiled the ocean for at least ten miles around, one estimate I got in advance of the event claimed it'd be fifty. I tried to fly away, but I inhaled a lot of steam, fell unconscious, fell into the boiling ocean, and then, I assume, would have drowned, except instead I arrived here. 

The gods can empower their priests to resurrect people. It is costly, if you don't get to it near-instantly, and ordinary people cannot afford it. I have been resurrected more often than most people because I am a legendary hero and usually worth resurrecting even when it's costly. 

If I die here I would expect to be resurrected at home, but that's not what happened when the superweapon went off so now I am moderately confused about how interworld resurrection and so on work. 

AAAAAAAAAAAAAAAHHHHHHH??????!!!!!!!!!!!

- unprofessional to give any sign of her internal screaming. Marian takes a deep breath. I'm so sorry that happened. And yeah, that's sort of confusing. Both of which are super inane things to say but she's out of insightful things. 

Is Iomedae's oxygen saturation managing to stay above 90% even without the BiPAP support? 

Yep!

It actually worked out quite well, she says. I think no one else got hurt - they gave me an ultimatum, so I was able to go to an isolated location - and hopefully it will not be disruptive to the ceasefire I was negotiating.

Marian is starting to get the feeling that there might have been KIND OF A LOT GOING ON wherever Iomedae was before this, and she's not sure how much if any of it is relevant to Iomedae's treatment but it's giving her an itchy feeling behind her shoulder blades, which is in conflict with the embarrassed feeling that it's really rude to interrogate recovering ICU patients about their lives outside the hospital. 

Ceasefire? 

- they had multiple governments, which were having a war, which is where they settle a political dispute by having people good at doing violence take control of territory previously belonging to the other government, and I was working to get them to agree on assignments of territory to each government which neither of them were motivated to fight over in light of my being there and opposed to them continuing to fight. Where I am from this is done with a formal written agreement to stop further troop incursions and other forms of destruction related to the conflict and to appoint monitors to check if the other side is abiding by their side of the agreement and to have procedures for complaining about further incidents which are not 'resort right back to having the whole war'.

...We do have that there, sorry, I was unclear. Not that Marian knew all of the details of how it's executed and it's actually pretty interesting! I was more asking about, uh, who was having a war, but I guess it's sort of none of my business and you don't have to tell me. 

Maaaaaaybe she will try easing the oxygen concentration on the mask down to 40%? 

92. 

There are a lot of things I am unwilling to share for secrecy reasons but the names of the countries involved in the war isn't particularly one of them, though I also don't expect them to be very meaningful to you. The war was between a country called Tantara and a country called Predain.

Huh. Was that a different war than the war with the, uh, god, who tried to blow you up? Marian frowns at the monitor. ...Also, do you feel okay? Your oxygen levels are a bit lower than they should be for a healthy person. They're above 90%, which is fine if it's not bothering you, but if you feel weaker or more short of breath then your body probably wants more oxygen. 

I feel vaguely unwell but until prompted wouldn't specifically have characterized it as shortness of breath? The god that tried to blow me up was likely irritated by my intervention in the war, but was not Himself a combatant in it, and His church did not endorse the assassination.

That sounds weird and complicated and Marian doesn't know what to make of it. She doesn't really like having to form opinions about politics at the best of times, and it seems even worse if there's a "god" involved. 

Okay. It's possible you're feeling vaguely unwell because your oxygen levels are lower than your body wants them to be? I'm, uh, really not sure how things work physiologically for humans with legendary hero powers. I'm guessing it won't cause any damage, but it may or may not slow down your recovery a bit, and I wouldn't be surprised if you feel a lot better with a higher O2 sat. I can turn the oxygen flow up higher again and you can tell me if you feel better, if you want? 

That sounds useful, thank you! It seems like it'll be a little while until it's a good idea for me to have no mask and given that I don't have a particular preference that the mask be supplying less oxygen.

Iomedae is not just an unusually-epic-and-cool-at-recovering-from-lethal-injuries patient, but also polite and reasonable! Marian is pleased. She turns the mask up to 70%; she can go down from there. 

I kind of want to check a blood gas too? I can take it from the art line, (fortunately still in place despite the shirt-placement, probably because it was sutured in), you probably won't even notice. It'll tell me if you're retaining CO2 at all, which is a different thing that could be making you feel unwell and is something I might expect after suddenly stopping the BiPAP, since that helps with getting more total volume of air in and out of your lungs so you can get rid of CO2? 

I do not know what that is and will defer to you about whether it should be done.

Marian will draw the blood. She mostly asked Iomedae's permission because it's rude not to for awake patients, and also who knows maybe it's mysteriously unexpectedly harmful to alien originally-probably-human legendary warriors from other worlds, to have blood taken out of them. 

She sticks it in the iStat machine, which is still on the windowsill. ...Remembers that she definitely drew an ABG and put it in the iStat some time ago and...did not actually get around to putting it in the chart, oops. (The machines are supposed to sync directly to EPIC but this functionality has been broken the entire time the hospital has owned them.) 

Okay, that'll be five minutes. Tell me if you're feeling worse or better. And she'll watch Iomedae's sats to see if they come back up on 70% oxygen. Uh. I am pretty curious about the war and - mostly whether it means you're likely to be in danger here, since you're my patient and I feel sort of responsible. 

96%!

The war started before I arrived on their planet in a magical accident a week ago. I spoke to both sides and arranged the ceasefire, I was not a major combatant in it except in one engagement that occurred after the ceasefire and in violation of it. It was about - pretty normal things for a war to be about. One country was expanding and conquering its neighbors and a much larger and more powerful neighbor became afraid of having a regional rival who was also breaking a bunch of taboos on the use of human sacrifice for powerful magic. If the god isn't operative here I'd be surprised to be in danger from that war. ...I might be in danger from Tar-Baphon, my enemy in my world of origin, if he can find this place. I don't have any inexpensive ways to test that and will attempt an expensive test when I'm a little more recovered. 

Your oxygen levels are better, I don't know if you can feel the difference but I think this is probably a good amount of oxygen for now. 

Marian glances at the iStat machine but of course it doesn't have a reading back yet. 

- wait, sorry, are there two different worlds involved here? Also, uh, who's Tar-Baphon and how worried should I be - or, like, what sort of precautions would help you be safer if it turns out he can find you here? 

I think I do feel better, she says, after reflecting on it for a moment. And yes, the world I was on immediately before I arrived here is not my world of origin. My understanding is that there are in fact millions of worlds, maybe more than that. Tar-Baphon is a powerful lich, a kind of person who traps their soul externally so as to make themselves unkillable, and a powerful wizard. If he encounters this world he will probably try to conquer or destroy it, and my personal safety should not really rank very highly among our considerations except insofar as I can help with coordinating your response. Precautions that would be helpful -

Most places I'd just try to get in touch with the local gods and tell them what to look out for, they'd be able to see it better. Without gods, uh -  the ability to detect dimensional transit anywhere on or near your planet - that's considered a very hard problem where I'm from, but it's about what it'd take - and teams of people who can do scrying searches for a long list of people Tar-Baphon might conceivably send to scout for him - and the ability to notice unusual disappearances anywhere on your planet, probably in rural areas selected in the expectation they'd go unnoticed.

Well that's horrifying on about eighteen different levels. Marian both feels like she has a duty to tell someone who's more of a grownup than her immediately, and also she does not even slightly want to have that conversation. 

I don't think we can detect, uh, 'dimensional transit' unless it, like, has a lot of waste heat or something and it'd be obvious on satellite imagery. The police would usually notice disappearances pretty quickly, but - 'quickly' being like in a day or two, and probably longer in rural areas. 

Marian isn't sure how the telepathy works or whether she's going to have to explain some of those words to Iomedae. 

That makes sense. I would be very surprised if Tar-Baphon could follow me here, but it'd be catastrophic if he did so it's worth checking if there is anything this world could do to prepare. If he can follow me here, that makes it likely I am - closer to home - and the gods probably do have some capacity to act or communicate with me here; I'd be very surprised were it true that Tar-Baphon could reach here and my allies could not at any price, and if necessary I can ask Aroden to order them to pay a high one. 

She's getting impatient with lying down; she attempts to sit up.

Marian has reflexes about this! They may not be entirely appropriate to the current situation, but she dives in anyway to support Iomedae's back and hold the IV and art line tubing steady. 

Hey, take it easy. If you want to sit up on the side of the bed or something, I can help manage the tubes and stuff? 

I don't know what management they require but I do not object to you performing it. She can support her own weight; she's solidly back into territory where she could pick up a sword if she had to and had a sword.

Marian stops trying to touch Iomedae - she can tell when a patient doesn't want or need her being right there in their personal space supporting them - but arranges herself where she can easily and quickly catch Iomedae if she collapses. She reaches around to hold the various tubes and wires (oxygen tubing, monitor wires, O2 sat probe wires, art line wire and tubing, IV tubing, there's kind of a lot) and make sure they have enough slack. 

She doesn't exactly looked worried, or stressed - she mostly expects this to go fine, because her gut sense is telling her that Iomedae looks fine - but she is definitely very much on alert and ready to respond to anything going wrong. 

Are you feeling okay? 

I am feeling deep appreciation for how nice it ordinarily is not having been dipped in boiling water. I'm no longer dizzy, though, and I am reasonably confident I'm thinking clearly. Do you know where my armor is now?

Oh good. ....I'm not sure, the last I heard is that the resident was going to bring it over. I can go look for him if you want but, uh, I would sort of be more comfortable leaving the room if you were lying down. I know that probably seems really unreasonable to you as a legendary hero but. 

Iomedae feels more comfortable able to surveill her surroundings with Detect Magic, which she has an ioun stone for, and with Detect Evil, which would actually if she spotted it be mostly reassuring - it'd mean she was in the range where Pharasma's judgements were functioning as normal. Her surroundings are very strange-looking.  The armor can wait.