So, I have had an ICM OBD1 code in the past and given that these modules are an achilles heel and I'm suspecting an electrical/electroinc issue is causing this misfiring, I pulled it to go get tested.
I have no codes atm, but I have disconnected the battery several times since this issue started.
On the 4-pin connector I noticed this. I'm assuming a new connector is due.
Update: ICM is good. DIYer manager was telling me about watching under the hood while idling when it's dark and looking for arcing. I saw this a few months ago.
I'm assuming this 30 year old wiring all over the truck is to blame.