Lt Casey Landvik < donotreply.zetari@... > wrote to zetari@...:

= Surgical Intensive Care Unit, Infirmary - SB Zetari =

"She was right, he has no family. Not according to records, at least."

Casey took the pad that Avan held out. The intern was right - there was very
little background information on their patient, at least medically and in terms
of contacts. Out of curiosity, Casey would like to ask the man's employers
exactly what kind of employment he engages in. But the doctor wasn't sure if it
would be overly relevant.

From a medical view point, Greg had quite the turbulent journey through the
emergency department, surgery and the post-anaesthesia unit (which he spent a
good 3 hours at - no one dared to transport him to the SICU any sooner, as
everyone was convinced that he would've arrested in the middle of a hallway).

Earlier on, Avan had shown his medical student that a patient's progress notes
are usually stored in a single pad. After ICU admission (if required), the notes
end up needing about 3 pads worth of data storage. Intensive monitoring meant
that everything that happens is recorded and carefully watched over.

"How his sedation coming along?" Casey asked.

Avan checked the notes. "Reduced remifentanil about an hour ago. Stopped the
propofol infusion and started him on low-dose dex. Thinking of weaning him off
that as well?"

"Maybe, we'll see how he responds first."

Casey expects poor Greg to be back in the operating room in a few days. The
surgeons having been working together on an optimal schedule for the 5 surgeries
the patient is expected to require. The most life-threatening surgical problems
have been dealt with for now, but the man's condition can deteriorate any
minute.

Lynn (if Casey remembered her name correctly), nor the other man she was with at
the emergency department, had dropped by to visit yet. The bear attack must've
been quite traumatic - not only physically but psychologically. Casey understood
how it may take her some time to get herself together.

He was reviewing the seemingly endless list of drugs on the drug chart, when
Avan called out to him. "He's waking up," the intern said. Casey walked over,
seeing Greg as he opened his eyes. The man appeared - as expected - very drowsy
and somewhat confused.

"Sir?" Casey called out. "Can you hear me? Nod your head slowly if you can."

Greg's head lifted slightly off of the pillow, and he gave a grunt of effort to
make it rise a little more. Fingers from his right arm crept across his chest,
reaching for the bar on his left hand side so he could pull himself up and off
of the bed. A spike of pain stabbed through his chest as he strained the last
few centimetres, causing him to grit his teeth subconsciously. There wasn't any
coherent thought going on here, just a basic need to keep going.

Casey carefully placed resistance against Greg's shoulders. "Easy there," he
said. "My name is Casey, I'm one of the intensive care doctors. You've just
gotten out of surgery. Your head, abdomen and chest may be very sore, and you've
got a breathing tube down your throat. You're going to need some more surgery
later on as well."

Pain medication had to be reduced in order to wake the patient. The doctor's
main reason for waking Greg up is to check the man's neurological status. Greg
had lost a lot of volume due to the bear attack, and suffered some serious head
trauma. The most crucial thing everyone had been anxious to find out was whether
the man would retain neurological function. That alone was important for them to
decide on their course of management. Unfortunately, only a few things could be
tested, as Greg couldn't speak.

But waking him up meant taking away some pain relief.

Casey knew this would be quite stimulating and uncomfortable, but had to be
done. He gently opened Greg's eyes with his hand, shining a penlight one after
the other, to test pupil reactions. At the same time, Avan tested the man's
reflexes, which were normal.

"Sir, are you able to open your eyes by yourself? Can you do that for me?"

Tiny slits opened in the man's face, his basic reflexes trying to keep them
closed against the harsh lights being shined in his eyes.

Casey also knew the patient wouldn't be able to respond verbally. "I'm Dr.
Landvik, and you're in the intensive care unit. You sustained injuries from an
animal attack, and you've had surgery. You might need to have a few more. If you
understand me, blink your eyes twice."

Strained eyes blinked twice under the light, tears streaming down Greg's face as
he tried to cope with the brightness. He swiped a weak hand in front of him,
trying to push the torch away from him as he tried to get his brain in gear.
"How much," he grunted, wondering what the cost would be for this benevolence.
Or at least he tried to grunt this, as something seemed to be poking down his
throat.

The doctor, seeing that his patient wasn't annoyed with the brightness, tapped
his penlight off. He wasn't sure he heard what Greg had asked; endotracheal
tubes must past through the vocal chords in order to reach the airway, thus
intubated patients simply can't vocalize at all, or do so poorly.

But Casey tried to provide some sort of an answer, while testing the man's arm
strength by getting him to lift them up passively, then against some resistance.
"Sir, you've sustained serious injuries to your head, chest and abdomen. You
lost a lot of blood. You're okay for now, but we need to keep a close eye on
you. You'll need a few more trips to the operating room - the surgeons will want
to make sure everything's fixed."

"Agg arbe me e-ma?" Greg asked, trying to ask exactly why this surgeon seemed so
keen on putting him under the knife again. His question was based on whether an
additional fee would be levied for this extra care and attention.

All the neuro status test results appear to be normal, after checking to see if
the patient can lift his legs. Casey learned over the bio-bed slightly. "I had
to wake you up so we could assess whether your brain is working all right. We
might have to do some more of those tests later. If you feel it's too painful to
stay awake, we can put you back to sleep. Would you like that?" he asked, hoping
for either a nod for 'yes', or shaking the head for 'no'.

"O." Greg replied, frowning. He wasn't about to let them sedate him, seeing as
how he didn't even know these people.

The doctor could somewhat figure out that the patient preferred to stay awake,
even without an actual nod or a shaking of the head. He looked over to Avan,
"Okay then, we probably can do more neuro tests later on, including cognitive
and behavioural checks if the sedation lightens up enough."

Meanwhile, Lynn entered the infirmary and quietly approached a nurse, sensitive
to the fact that the patients probably needed their sleep. "Hi, could you point
me towards Greg please? He came in a while ago with wounds from a bear attack."
she clarified, realising that his first name alone probably wouldn't be enough
to identify in an infirmary this big.

And from the main information desk at the infirmary's atrium, she was given
directions to the surgical ICU, on the 5th floor (deck 396). All ICU's are
'authorized personnel only', but Lynn was, of course, allowed in.

Casey placed a hand on Greg's shoulder. "We'll check on you later, okay?"

Before Greg could gurgle an answer, Lynn's head poked around the door. "Hello?
Is Greg seeing visitors yet?" she asked. The last piece of information she had
was that Greg was undergoing surgery, but the specifics were denied to her as
she wasn't family.

Casey turned around. "Yes, of course," he said, stepping aside to let Lynn come
through. "He's just gotten around the sedation, so he's still pretty groggy.
He's had surgery to repair the most severe injuries, but he'll need to head back
to the operating room sometime later this evening."

"Okay, thank you." Lynn replied, nodding her thanks. "Does he need that?" she
asked, pointing to the tube down Greg's throat.

"I'm afraid he will for a little longer," Casey replied. "He's sustained some
chest injuries, so that's to help his lungs breathe. A respiratory therapist
will be down here shortly to assess his breathing and discuss with the rest of
the team whether he can come off it. But if you wish to talk to him, you can. He
should be able to write on a pad or a piece of paper if he wishes to
communicate."

Behind the doctor's back, Greg's hand moved weakly, and made a gesture that
indicated exactly what he thought about that idea. Lynn suppressed a grin, and
told the doctor; "Thank you, but I suspect he'll be fine. Do you need anything
Greg?" she asked, and saw the patient shake his head slightly from side to side.
"In that case, I should probably go. Please let me know when he's ready to be
discharged." she requested politely.

Casey nodded. "No worries. It'll be some time before he fully recovers. If you
have any information about any contacts you think he might want to get in touch
with, let us know."

As she headed off, Casey and Avan went back to work.

= = = = = = = = = = = = = = =

Dr. Casey Landvik, MD
Medical Officer, PGY-3
RMO Critical Care
Zetari Station 204-A

Dr. Avan Kyler, MBBS
Intern (PRHO), PGY-1
Zetari Station 204-A

(NPC played by Ray)

Lynnette Tocklum
Civilian Store Owner
Zetari Station 204-A

Greg
Civilian
Zetari Station 204-A

(NPC played by Lynn)