Shift Seven: The Midnight Agitation

How could a basement drain twenty feet below ground force hot marsh vapor straight through the ward floor vents in under a minute? Pima took the stone stairs two at a time, smelling the rot before the iron ward door even came into view. It was a thick, humid reek of cooked silt and brackish river weeds that coated the tongue like grease. She needed to reach cot nine before the sudden wave of moisture swelled the fibrous runners inside the patients' airways and choked them in their sleep.

Jala shoved through the double doors behind her, his boots leaving wet, dark smears across the threshold.

South Ward was pandemonium. The air hung so thick with gray steam that the ceiling lanterns were reduced to murky yellow halos. Across both rows of iron beds, seven patients were thrashing violently against their canvas restraints. Iron cot frames screeched against stone flags as chests heaved with wet, whistling rattles. In cot nine, Muka’s fingers clawed frantically at the bedposts, his throat producing a dry, clicking wheeze like pebbles ground inside a mortar.

Sari stood in the center aisle, gripping a zinc medicine tray with white-knuckled hands. Her pinned hair had already begun to frizz in the sudden heat.

"Delirium protocol," Sari shouted over the shrieking cot frames, her voice strained to a thin wire. "It’s an acute fever spike. Jala, hold cot four! I need forty drops of black poppy tincture per patient to suppress the convulsions."

"Put the bottle down," Pima said, lunging for the supply cart.

"Step aside, nurse! The Lanu compendium is explicit—"

"Their throats are closing," Pima snapped, grabbing the brass bottle before Sari could unstopper the dropper. "Poppy tincture depresses the breathing reflex. If you paralyze their diaphragms while the silt runners are swelling from the steam, they won't wake up. They'll suffocate in three minutes."

"You don't alter the attending physician's standing dosage!" Sari's jaw trembled, her face mottled with red patches of frantic outrage. "You were expelled for this insubordination!"

"Then report me to the proctors at dawn," Pima said. She turned her back on the ward manager and slammed a wide ceramic basin onto the utility table. "Jala, bring the coarse pickling salt from the pantry bin. All three quarts. And get me boiled water from the kettle."

Sari reached out to snatch the syringe back, but Jala stepped between them. The heavy orderly did not raise his voice, yet his broad shoulders formed an immovable gray wall against the supervisor.

"The academy proctors never had to scrape damp mold off a living tongue," Jala murmured, setting a tub of coarse gray rock salt beside Pima's basin. "Kettle's still simmering on the wash hearth."

Pima dumped two handfuls of salt into the boiling water, stirring rapidly with a wooden spatula until the brine turned cloudy and hot. The principle was simple: raw freshwater swelled organic fiber; concentrated saline drew moisture out of living plant tissue through osmosis. The Academy treated the patient's throat as diseased muscle; Pima treated it as saturated timber.

She grabbed the long brass suction cannula and her carved cherry-wood leverage peg from her pocket, rushing to cot nine.

Muka’s eyes were rolled back in his skull, the whites mapped with burst vessels. His teeth were clamped shut so hard that blood seeped from his gums where the jaw muscles locked.

Pima did not hesitate. She wedged the angled tip of the cherry-wood peg between his back molars, planting her left thumb firmly against the hinge of his jaw. "Hold his shoulders, Jala."

Jala leaned his bulk across Muka’s flailing torso, pinning the man's arms to the mattress. Pima twisted the wooden peg with a sharp, levered snap of her wrist. Muka’s jaw popped open.

Inside his mouth, the soft tissue at the back of his palate was already swollen into a tight, pulpy knot, threaded with pale white tendrils that reached toward the base of his tongue. The airway was no wider than a quill.

Pima drew four ounces of steaming saline into the brass syringe, slipped the tip past his teeth, and washed the back of his throat.

Muka gagged, a violent spasm racking his ribs. Pima jammed the suction cannula deep into the pharynx, working the hand-pump with rhythmic, forceful pulls. The suction tube shuddered. A thick, dark plug of brackish mucus and shriveled fibrous threads tore free with a wet sucking pop, rushing through the glass inspection chamber into the collector jar.

Muka drew in a sudden, ragged gasp of air. His ribcage expanded, shuddering as oxygen filled his starved lungs. The violet tint in his lips faded to pale ash.

"He's drawing air," Pima said, wiping the slime from the cannula tip with a clean towel. She turned to Sari, whose hands were still frozen around the useless poppy bottle. "The same procedure for cots four, six, and eight. Flush the tissue with brine, clear the plug, keep the airway open. If you want them alive when the sun comes up, start pouring."

Sari stared at the black debris floating in the glass collector jar. Her lips pressed into a bloodless crease. She did not argue. She set the sedative bottle on the tray, picked up a clean basin, and moved stiffly toward cot four.

For twenty minutes, the ward echoed with the sound of clattering basins, splashing brine, and the harsh clatter of suction pumps. Pima worked down the row, her tunic soaked through with sweat and saltwater. By the time the third quarter bell chimed from the courtyard, the thrashing had ceased. The seven beds were quiet, filled only with the slow, steady rasp of regular breathing under damp gray sheets.

The steam began to vent through the ceiling louvers, carrying the worst of the marsh stench out toward the sea cliffs.

Sari finished bandaging cot six's wrist where the restraint had abraded the skin. Without meeting Pima's gaze, the supervisor washed her hands at the zinc basin, dried them on a fresh towel, and walked out into the corridor, her rigid stride faltering just once as she crossed the threshold.

Pima let out a long breath, leaning her hips against the frame of cot nine. Her forearms ached from holding the leverage pegs, and the bitter taste of salt hung at the back of her throat.

Beside her, Muka lay motionless, his weathered face relaxed against the flat horsehair pillow. His eyes were fixed on the rusted ceiling vent directly above his head as he hummed a slow, three-step melody—the very tune Tano had whistled on the harbor pier throughout their childhood.

Pima released his wrist and stepped up onto the iron corner bracket of the bedframe, her eyes locked on the dark square of the vent grate.

"Don't climb up there," Jala warned from the doorway, wiping gray brine off his forearms. "Sari's coming back with the morning log in ten minutes."

Pima reached into her pocket, her scarred fingers closing tightly around the brass scraper.

"Ten minutes is enough," Pima said. "I'm pulling the cover."