Pepper is sound asleep when she is jolted awake by the bustling noises of a nearby body. She startles as if struck by lightning, forgetting momentarily that she is sitting in an uncomfortable hospital chair and reacts instinctively by thrusting her arms out to brace herself. Her hands find the faux wooden supports of the seat she is semi-reclined in, and she quickly realizes that she is still in the emergency room with Tony, who is slumbering somewhat peacefully with his bed lifted to a slight incline. She watches him for a moment without thinking about the movement that had awoken her just a moment ago and she notices that the mask that had been around his airway administering albuterol is gone and in its place is a nasal cannula.

His color has not changed much at all—he remains quite pallid—and the alarming shade of bluish-purple around his mouth is still noticeable, despite the breathing treatment and administration of fever reducers to lower his spiking temperature. Although she is dismayed by his appearance, she feels relieved that he at least seems to be resting comfortably, even if that may simply be a result of the whopping dose of Ativan given to him during his delirious aggravation.

Pepper's attention falls on a nurse who comes to stop at Tony's bedside and she watches as the young woman studies the electronic gadgets monitoring his condition. For the first time since she has woken up, she reads the collection of numbers on the computer screen, narrowing her eyes to focus in on the figures. Her middle clutches at the pulse ox reading—86—a three-point drop regardless of the steroidal drug given to him a while ago.

The nurse watches the screen for a few seconds, then examines the position of the cannula and the prongs in his nostrils, fiddles with the oxygen flow, and then returns her gaze to the monitor. Pepper observes the girl with sharp-eyed intensity. The nurse does not seem to like his numbers either, and positions her stethoscope into her ears, then moves the bell-shaped listening device around his chest.

Pepper cannot see the nurse's reactions, as her back is turned toward her, so Pepper decides to interject. "What's wrong?" she asks softly.

The girl turns, pulling the tips from her ears, then wraps the stethoscope around her neck. "Oh, hello Miss Potts." Her voice is light, cheerful, but Pepper interprets this as a trained response to alleviate panic and exude calm to keep the patient and/or family members from getting flustered. She pulls an aural thermometer from an instrument table and measures his temperature with practiced ease.

Pepper ignores her attempt at remaining composed. "Are you guys certain that the breathing treatment worked? I mean, his color hasn't changed and his numbers are lower than when we got here."

The girl nods, stoic. "Yeah, I noticed that. I was just on my way to grab his doctor for advisement."

"Is it serious?" Pepper asks, a stab of fear penetrating her consciousness.

The nurse chews on her lip. "It can be if left untreated."

"What? What is it?" Pepper moves out of her relaxed state and sits upright, now feeling urgent barbs of fear grapple to the surface.

"My guess is a pleural effusion, which would explain the swollen lining of his lungs, the shortness of breath, and the low pulse ox. But a doctor has to officially diagnose him."

The nurse's understanding grimace is momentary, and the girl puts a reassuring palm on Pepper's shoulder as she passes to head out the door. She looks at her boss, calmly snoozing with intermittent, rumbling coughing fits disrupting what would have been complete tranquility, and gently touches his arm. His body is still overly warm, although not as bad as when she'd driven him into the ER like a woman possessed.

It takes only about half a minute of eying Tony watchfully before the nurse returns with a doctor—Dr. Cordova if she remembers correctly—and another responding nurse, who has a tag on her scrub top that indicates she is a respiratory nurse specialist. Cordova listens to the billionaire's chest similarly as the young woman had, pausing longer over his right lung and frowning in concentration, then examines the monitor readouts, seemingly oblivious to Pepper's intense scrutiny behind him.

"Rales are more prevalent to the right, but I'll need to test the percussions before we make any determination of an effusion," the doctor mumbles to the specialist.

"When was he diagnosed with pneumonia?" the older woman queries, watching Tony's numbers.

Pepper chimes in, virtually ignored. "A couple days ago."

They turn and seem surprised by her presence. The specialist nods. "That sounds about right. Has he been taking a regular dose of antibiotics?" With an affirmation from the copper-headed woman, the respiratory specialist returns her attention to Tony and pulls the neck of his gown to his navel and begins tapping her fingers in multiple locations across his chest, taking special care to avoid touching the arc reactor. "How long has he been out?"

Cordova responds quickly, pulling Tony's x-rays seemingly out of thin air and toward the overhead lights to examine them. "It's been about two hours now. He was pretty combative during the blood gas draw." The man watches her motions patiently, then hands her the images so she can inspect them herself. "I don't see any noticeable effusion, but tell me what you think."

"Was he upright during the x-ray?"

"No, he was lying down."

"Sometimes an effusion can be hard to see when the patient is in a supine or semi-inclined position. With the device in his chest, it also may be difficult to see any fluid since it acts as an obstruction."

"Maybe we should do a chest CT."

The specialist traces a finger over one of the lung images, eyes scanning the black and white picture, seeing something that Pepper cannot identify in her inexperience. "Hang on. There, the pleural space on the right side."

"You see something?"

"Yep. Lower right."

"I knew I'd need your hawk-eyes," Cordova jokes.

"Okay, looks like we're going to need to tap his chest."

Pepper feels utterly confused and rises to her feet. "What are you doing? What does tapping his chest mean?"

Cordova glances at her from over his glasses, and she realizes he does that anytime he addresses her, and she deduces the gesture as patronizing, like she is intrusive or in the way and he just wants her to leave or remain quiet. "It's technically called a thoracentesis. We draw fluid from the interstitial space between his chest cavity and his lungs to alleviate pressure and normally evaluate the sample in our lab to determine the cause. In Mr. Stark's case, we already know the cause, so the removal of the fluid build-up will help his symptoms abate, and return his oxygen saturation to normal."

The medical personnel quickly bring their attention back to Tony just as an alarm starts to sound, alerting them to a growing problem. "SATs are down to 85," the younger nurse announces.

"All right, switch to a full, low-flow mask, 10 liters," Cordova demands. "Let's get him prepped for the thoracentesis—Linda, help me roll him to his left side."

Pepper feels like she herself cannot breathe, and her muscles seem like they have seized in terror at the sight before her. Tony is moved to lie on his side, and she is grateful that she will be able to see his face even though the cannula has been replaced with a mask and his eyes remain closed in his medicated slumber.

The respiratory specialist identified as 'Linda' peers over at her from the other side of Tony's bed. "You want to come sit by him, hon'? It'll be okay, as long as you stay on his left side." Pepper nods hesitantly and pulls her chair closer to the bedside, then reaches out and gently takes her boss' lifeless right hand.

"Val, fetch me the Betadine, sterile drape, and some Lidocaine, please." Cordova positions himself next to Linda, loosening the back of Tony's hospital gown and when the young RN returns with the supplies, Pepper is glad she is unable to see the procedure. However, the doctor continues his monologue as an attempt to help her understand every step. She almost wishes he'd simply do it silently and leave it at that, keep all of the medical jargon to himself. "I'm numbing the area between the ribs where the affected lung is and then I will insert a small tube into the pleural space where the fluid buildup is. Mr. Stark should have immediate relief and this will bring his oxygen SATs up again. Val, I need a 21-gauge syringe, a 16-gauge tube, and a three-way." He is quiet as the nurse hands him the necessary items, and he performs his task. "There it is. We've got a steady flow. You were right as always, Linda."

"Output is cloudy," the woman says stoically.

"Yep, that's pretty typical for pneumonia."

"Any blood present?"

"None so far."

Pepper is busy frowning in concentration, but she is pulled from her reverie when she feels fingers tighten in her grip and she quickly glances down at Tony, who should be sleeping pretty soundly. She lets out a sad sigh when she notices that his eyelids have parted a fraction and he is grimacing, although the fathomless, dark brown eyes have that vacant, glazed quality about them indicative of being loaded to the gills and half-conscious.

"Hey, Tony," she whispers as she leans toward him. "It's okay. You'll be all right. They just need to do a procedure and then you'll feel better afterward." Pepper moves to look at Cordova and Linda. "I think he's in pain."

Linda seems unflustered. "He's probably only feeling a little bit of pinch from the syringe and tubing, and then some pressure from the fluid draw. Just in case, we'll give him a little more of a local anesthetic to ease the discomfort."

More silence fills the air and Pepper begins to rub Tony's shoulder and is relieved to see that her touch and the extra boost of the numbing agent to his back seems to have helped him relax. His eyes have fallen shut once again, but his hand maintains its firm grasp. Cordova lifts a small glass jar with fluid, and Pepper stares in morbid fascination as the doctor wiggles the container and then sets it onto a nearby tray. He presses a large gauze pad at the affected site, and after a minute releases his hand. Cordova presses his stethoscope to Tony's back on the right side, and then nods optimistically. "Sounds much better. Good breath sounds."

The doctor once again taps his fingers against the site of the fluid draw. "Oh yeah, there's the percussion I want to hear. Looks like our friendly neighborhood Ironman will be on his way toward recovery and back out to the streets to fight the bad guys in no time." He pulls the dressing away and peeks at the wound underneath, then pushes it back into Tony's skin and tapes it in place. "What are his SATs?"

Val responds quickly. "Returning to normal. They're already up to 90."

"Nice. Okay, why don't we leave the mask on him for now, but check it again in a few minutes. If his SATs are still good, reduce the oxygen flow," Cordova says and pushes his rolling stool away. "All right, that'll do it. Val, after getting another chest x-ray, make sure to monitor his vitals for the next couple of hours, and keep him on his left side. His right will be a little sore for a while. Linda, keep yourself available for any complications during that time, will you?"

"Sure thing, Doc."

"Do you want to do another portable chest, or a CT?" Val asks, pausing by the door.

"Why don't we let Mr. Stark continue to sleep. Let's bring in the portable."

"Okay."

"Thanks for your help."

As the young nurse leaves, Dr. Cordova peels off his sterile gloves and disposes of them as well as ridding himself of the syringe and tubing that he'd been using during the chest tap. "I'll see you in a couple hours," he says to Pepper, before he moves from the room.

Linda is back at Tony's side, performing her own examination of the doctor's efforts, but appears satisfied with the results. She sees Pepper's concern as she studiously watches her busywork and smiles knowingly. "He's a fighter, honey. I know it seems pretty scary, but your boss here is in good physical condition, even with that thing in his chest, and is responding well to treatment. Rest easy. It will be another two hours before we can do anything else."

"Will he need to be admitted?"

The woman shrugs her shoulder, tilting her head to the side, causing her graying hair to fall against her shoulder. "It all depends on how his lung reacts to the chest tap. If he develops a new set of symptoms or doesn't seem to improve, then we'll definitely have to keep him longer. But if he continues down the path he's on, I'd say we'll be able to send him home by 9:00 a.m."

Pepper feels a small wave of relief, but worry still tangles her insides. "What kinds of symptoms should I be watching for?"

"Any growing discomfort, pressure, lightheadedness, or any site leakage. But, we'll be monitoring his vitals, so you can go ahead and take a nap if you want. I'm sure you're pretty tired."

Pepper nods, but she once again leans toward Tony, smoothing his hair with her palm, and then rubs his arm. He does seem better, finally appearing to descend from his feverish, unsettled state and relaxing into a more peaceful, sounder sleep now that he can breathe easier. She lets out a calmed breath and lowers her back into the cushion behind her.