#and ive called the gi 3 times in the last 2 days trying to get an appointment and they tell me this morning to try monday afternoon

[attor]

i think its hilarious that people think my barrier for making doctors appointments is anxiety when its literally just that i will call/try to access results/show up physically to the office over and over again for weeks with no progress bc everyone is doing their job wrong

[sultry-lows]

Is it Wrong to Want to Leave?

Cw: police brutality, racism, sexual assault, medical trauma, chronic illness, near death experience, PTSD, America’s general awfulness.

2020 has ripped up nearly all of the ‘stakes’ I had in America.

I’m a lesbian and my partner is a black woman. One of the black women shot this year shares her name. We hit the streets in protest, as safely as we could, and ive watched her crumble more and more under the weight of every new murder. Two nights ago a black man was shot in the street by a cop in her hometown, 30 minutes away. She went silent all night.

Three nights ago she was followed home by a mysterious blacked out vehicle that tailed her for 10 minutes until she floored it and sped away. When she came home she was shaking, told me about waiting in the parking lot with her seat down praying no one followed her through the gate. When she told me she hadn’t called 911, I breathed a sigh of relief and thought “Thank God.”

Three months ago her car was broken into outside of our apartment. Two months ago we caught a peeping tom staring through the gaps in our fence at me as I was sunbathing on our tiny ‘patio’ in a two-piece bathing suit. it brought me back. Four years ago a man broke into my apartment when I was home alone and attempted to rape me when I was in the shower. It was my next door neighbor. He had been stalking me. The cops made a big show of bringing out helicopters and dusting every surface for fingerprints, and then I never heard from them again. That man had to die of a heart attack for me to be able to sleep at night. I still shower and sleep with a knife sometimes.

There are gunshots, street racing, and fireworks outside of our apartment every night now.

Five months ago we both lost our jobs on the same day because the company we both worked for for 5 years suddenly laid off 1,500 employees. We have been at the mercy of the unemployment system ever since.

In less than two weeks, the high school and middle school where she is interning is reopening in person learning. She has no choice but to be back in the schools, or she will not graduate. She does not have medical insurance because we lost our jobs and can not afford medical insurance. She has chronic asthma. If she god covid, it could kill her, and certainly would financially destroy us.

Two months ago I got sick, really sick. More sick than I’ve ever been in my life. I get to be on my parents health insurance for one more year. Despite having pretty much the best PPO health insurance you can have through my fathers work, trying to get medical care was a literal nightmare. I was chasing down specialists that wouldn’t see me anywhere but telehealth even though I’d lost over 20 pounds in one month. Fighting a specialist who told me to eat a massive amount of garlic, then later learning that garlic is a diuretic that likely exacerbated my condition. I got sent home from the hospital after coming in with both a GI bleed AND an 8cm ovarian cyst. I was not treated. 12 hours later I was back at the hospital because my cyst had ruptured in my sleep and I was in the worst pain of my life. I was given morphine snd sent home again. 6 hours later I was back at the hospital again with a 102.1 degree fever, shaking so hard that I couldn’t stand up or speak. I was severely septic. I was diagnosed with c diff. I was told that night that the huge amount of antibiotics they were pushing would stabilize me, or that I was about to go into multi-organ failure. I was told I was borderline. I was told I could die. I spent the next 3 days in the ICU. The next 4 in the general hospital. I couldn’t see my girlfriend or my family the entire time. You cant have visitors in the hospital because of covid. The bill just for the first 2 (two hour) visits is already $1,500. I can’t imagine what it’s going to be for the week long ICU and hospital stay. I can’t breathe when I think about it. I just got out of the hospital 4 days ago, and my body is broken from this illness. My heart pounds from sitting or standing up. My girlfriend is my caretaker. No one else can come over and help because I’m now immunocompromised and can’t be exposed to covid. None of this would have happened if the doctors had listened to me beg and had taken care of me in the first place. I have to talk myself down from panic attacks almost daily because I almost died. I really almost died.

There are riots in the streets. The president will not commit to a peaceful transfer of power. I’m watching the right wing people on my fb get more and more comfortable saying some terrifying things about “the blacks” and “the gays”.

My girlfriend and I have always been fighters at heart. Always at protests, always speaking up, always ‘fighting the good fight’. But we are both exhausted. My birthday is in a couple weeks and I feel like I’ve fully lost a year of my life. We have been passionately studying French together for the last 3 months. She has family in France. She has family in England. We are pushing to get our passports as quickly as possible. Is it wrong??? Is it wrong that I don’t want to fight the fight anymore? That I want to run away with her and find peace somewhere else in the world?? Is it wrong that if we left tomorrow, the only thing that would hurt is leaving behind 3 very close friends and 3 very close family members? I don’t feel safe here anymore. I don’t feel SHE is safe here anymore. For the first time ever it’s not just a daydream, my heart is set on getting out, and never looking back.

[lunatic-fandom-space]

Comparing RWBY and YGO DM: The Handling and Evolution of Themes

Hey! Its been a hot minute since I last posted anything RWBY-related but Im laying in my bed right now and Im sick and bored so I guess we're doing this. Today I will do my best to analyze what I percieve to be the main themes and messages of both of these shows, or more specifically, how theyre handled narratively. Im mostly focusing on that part because, while these series do have similar themes and messaging, they are still a few things in which they are wildly different. And with that, lets start with this essay-post-thing!

1. Theres something we need to adress first

Okay so, before we can really talk about this, theres something I feel the need to clarify here: Neither of these stories was "planned from the beginning".

Now, I dont think a story being planned from the beginning or not nesscessarily makes the story any better or worse by default, however, it is still important to acknowledge because the way the story is planned is going to affect every facet of it. Things are not going to be foreshadowed properly, things are gonna be set up only for nothing to come of it, the story might drastically change directions, characters might act differently, etc, etc.

And, this is bit off-topic but, it's much better to just admit that the story was not planned than trying to pretend that it was. Like, there are a lot of reasons why I tend to be so forgiving towards YGO even though its not very good, but one of them is definitely the fact that, as far as Im aware atleast, the guy who wrote it isnt pretending to have had this big master plan all along and neither is the fandom. With RWBY on the other hand... yeaaaah, its kinda the opposite. From what Ive seen of RWBYs fandom, there seems to be this pretty popular narrative that everything was planned even though it clearly wasnt. Thats pretty bad and honestly lowers my opinion of the writers so much more than if they would just admit to not having a proper plan.

Like, I initially consumed YGO like this: Yu-Gi-Oh Duel Monsters, Yu-Gi-Oh (aka Season 0), like, a quarter of the Yu-Gi-Oh manga (I still havent finished it)

In all three of these we have the character of Yami Yuugi, or just Yami. Broadly speaking, he is an ancient egyptian gamer spirit who lives in a magical puzzle that has not been solved for 3000 years until this highschooler named Yuugi Mutou comes along and solves it, thus setting him free and allowing him to possess Yuugi and have access to the vague magical powers of the puzzle.

In Duel Monsters he's perfectly fine most of time, morally speaking. There is an instance of him almost murdering a guy and its a bit unclear what exactly happens to those he mindcrushes but overall he's very much a pretty good guy. In Season 0 most of what he does is set up these games for bad people, where they will go insane no matter what they do. From how I understand this whole Shadow Game, Penalty Game stuff, if you lose a Shadow Game, you get violent and intense hallucinations and you will always cuz yknow, gamer spirit. But if you try to cheat, which most of the bad people do in this show, you get violent and intense hallucinations as a punishment.

Since the two anime are generally considered two different continuities, its perfectly fine that Yamis characterization is wildly different in both of them. But in the manga both of these characterizations appear, basically one after the other with no real arc or consequences, for that matter. Why is that? Simply put, someone thought it was a good idea to try to turn an episodic, very slice of life-y light-horror manga into a more traditional, more plot-driven battle shounen. From what Ive heard, it was apparently largely because of network interference or something, but the point is, it changed directions incredibly drastically with little planning and everyone knows this and I can understand that for the most part.

In RWBY we have the character of Blake Belladonna, who, in the first 3 volumes/seasons atleast, was this aloof, more toned down loner-type character with a pretty strong sense of justice. She's an in-universe marginilized racial minority and she clearly cares about racial injustice. The way its initially framed makes it seem like she had a very hard life and no stable support system, which is what eventually pushed her to join a Civil Rights group/Terrorist organization (good god, the Faunus subplot is so awful, I could write a whole essay about it but Im already de-railing rn so I'll just save that for later).

Then, in volumes 4-5 it turns out her father is actually like, the mayor or chief of this island-place called Menagerie and she grew up in this big mansion with multiple guards/servants. Oh and also, apparently "space is a commodity" on there, so theres that. She still retains large parts of her personality but she's kinda like, worse somehow I think. I cant really describe it in a meaningful way but I hope you get what Im saying anyway. Then in Volume 6 she confronted her emotional abuser Adam (sorry for not mentioning him sooner but yeah, he was like, her abusive boyfriend, which is something that a lot of people disagree with but I wont really say anything about it either way because I dont really feel any specific way) with her friend, Yang, and ended up killing him.

After all that, she pretty much lost the rest of her personality, as well as her arc about all the Faunus stuff. She just kinda became the meek, generically nice, recovering abuse victim. Why? Well, the actual reason is that they didnt plan out shit and are just kinda flying by the seat of their oversized clown-pants and if they and the fandom just admitted it, I would have less of an issue. I still wouldnt be as forgiving towards RWBY as I am towards YGO because the crux of the issue, for me, is just that I dont particulary like RWBY but also like. Do you really expect me to take MKEK seriously as writers after admitting to not have a timeline because iT wOuLd CaUsE pLoThOlEs?

However, since they want us to believe that everything was planned out from the beginning, the explaination would be.... Idk, they deliberately butchered one of their main characters?? Because.. they hate her?? Maybe????

So yeah, that was quite a detour however, I would like you to keep this mind going forward.

2. Themes of the Early Series'

First, what do mean by 'Early Series' for both of these shows respectively? Well, for YGO that would have to be Season 0 or if youre reading the manga, everything pre-Duelist Kingdom. Basically, the part of the series thats a episodic, very slice of life-y light-horror series.

For RWBY that would be the first three Volumes, also known as the Poser-Era. Back then it was just kinda an action series that took place at Anime Warrior Academy (also known as Beacon) with some pretty bare minimum worldbuilding, character-driven plots and developments but now its more of an epic high-fantasy story with more of an emphasis on plot as opposed to just action.

The themes and messages in Early YGO are kinda vague, very confusing to me and if you were to follow any of it literally that would be pretty bad. For now Im just gonna say the main themes are Friendship and Identity and mostly focus on the Identity aspect.

Now, it took me a little while to figure out RWBYs deal but I think the main themes for Volumes 1-3 are also Friendship and Heroism. Once again, I'll mostly focus on Heroism and touch on Friendship more briefly later.

I dont have much more to add to YGOs themes right now, so I'll briefly go over Heroism in RWBY.

In RWBYs setting there are these man-eating monsters called Grimm that have basically infected the planet. In order to deal with that, they have people called huntsmen and huntresses that kill them and protect people. Theyre trained at special academies like Beacon and go on missions there and stuff like that. Our four main characters, Ruby, Weiss, Blake and Yang, are training to become huntresses and one day they go on this mission to clean up a grimm infested city block with one of their teachers. Obviously, that takes a long time so they have to camp out in one of the empty houses. Weiss, Blake and Yang cant sleep because theyve been thinking about this question that their teacher asked them when they were fighting grimm: "Why do you want to become a huntress?"

They have a heart to heart and we find out about their motivations; Weiss wants to bring honour back to her family, Blake want to distance herself from the White Fang (that terrorist organization I mentioned earlier) and as an extension from Adam, Yang wants to have a life of adventure. They also talk about why Ruby wants to be a huntress and it turns out that she judt wants to help people. Unlike the others, she has no motivation besides that. We're meant to listen to that and look at her as a sort-of personification of Heroism: kind, but not naive, strong and most of all, selfless. The others on her team are not portayed as bad for not being like Ruby by any means but we are clearly meant to admire her the most out of all of them.

Okay, now comes the part Ive been looking forward to the most:

3. How did these themes evolve in the Modern Series'?

Alright, before we can really delve into the way they evolved in YGO I'll have to give you a brief summary of the character progression. At the start of DM, during the Duelist Kingdom arc, Yami Yuugi is just that; A darker Yuugi. Hes more confident, bolder, his voice is deeper, hes somehow taller, more ruthless, all that good stuff. Notably, he doesnt actually seem more skilled than Yuugi even at the start of this story, but he's still dependent on Yami. Yami on the other hand, has no identity of his own or even hints at one at this point. He's just The Other Yuugi.

Then during the Battle City arc, they find out that Yami was actually a pharao prior to being sealed in the puzzle, he just didnt know because of amnesia, I guess. So now they need to find out his real name and then send him to the afterlife because hes meant to be dead, but not before saving the world from being swallowed by darkness, which is also a thing they have to do now.

Then we finally get to the Memory World arc, where Yami, Yuugi and the rest of the gang astralproject to ancient egypt via puzzle magic. Yami is trying to figure out what the hell is going on and who all these familiar people are, while Yuugi & Co are trying their best to help him. Then some weird shit happens and it turns out that all of that is not just Yamis sealed away memories, but also a giant D&D Shadow Game that will destroy the world if Yami loses. So now theres Pharao!Yami who is still clueless on the metaphorical and literal playing field and Player!Yami, who is kinda controlling himself now? I guess?? Yamis opponent, The Spirit of The Ring, has something similar to that going on where hes both controlling and properly participating in the game. So Player!Yami is now fighting against Player!TSoTR, Pharao!Yami is now fighting against Thief King Bakura (who is like, the human, ancient egyptian version of the Ring Spirit) and Yuugi is now fighting against Yami Bakura (who is like, the human, modern japanese version of the Ring Spirit). Yuugi gets Yamis real name, he and the gang go over to Pharao!Yami and tell him his name, meanwhile Player!Yami is also somehow helping as well and they defeat the Ring Spirit, thus saving the world. Then they travel to modern Egypt, the Ceremonial Duel happens and Yuugi wins, sending Yami to the Afterlife where he can finally rest and that was the series!

I originally wanted to recount the stuff that was going on with the Ring Spirit and his host as well because they parallel eachother, but this summary is already far too long and I think youll get the point without me needing to explain any more.

My point here is, that the story went from being vaguely about Identity, maybe? to being very clearly about Self-Discovery and Learning to Be Independent. I think this is a very good way to evolve the messaging of your story. How does RWBY track on that?

Well, uh... its not great. I will acknowledge that they have tried to introduce new themes and ideas since, even though I wont really be talking about them in this post. But yeah, the whole Heroism thing really regressed.

Like, I didnt explicitly say it when I was explaining grimm earlier, but theyre not going away. The grimm have always been there and people who sign up to become huntsmen and huntresses are effectively signing up for a job that will never truly be done, no matter what they do. Characters like Ruby and even more minor ones like Phyrrah have shown us that that doesnt matter when youre a hero. No life isnt worth saving, no grimm isnt worth killing, no criminal isnt worth arresting. Then, in volume 6 they find out about Salem. Salem is the Big Bad of the show, shes immortal, controls the grimm and is supposed to be very powerful.

What do our heroes do? They give up. Sike! They were just mindcontrolled by monsters or some shit, of course they didnt give up their mission (which is to bring an Important Macguffin to a city called Atlas, sorry I didnt mention it)!

But then they arrive in Atlas (which is llike, a city thats floating over another city called Mantle) and yknow, they do some plot stuff thats not really important right now until the city gets invaded by Salem and this big grimm army she has.

What do our heroes do? Well, Ruby, Weiss, Blake and some side characters are chilling, drinking tea in a mansion and Yang and the B Team were actually trying to do something, but even those efforts seem incredibly minimal.

Oh wait, I also forgot to mention that Ironwood (a fairly minor, vaguely antagonistic character up until now) wanted to lift Atlas even higher to save Atleasian civilians from danger while leaving Mantle vulnerable to Salems invasion.

What would be the most heroic thing to do?

A) Let Ironwood lift Atlas, get as much support as they can down to Mantle and save as many Mantle civilians as they can from the invasion

B) Prevent Ironwood from lifting Atlas but then split up in order to protect both Atlas and Mantle civilians

C) Prevent Ironwood from lifting Atlas and then dont do anything else

Congrats! If you choose C, you think exactly like the writers!

And I just

This is so mindboggling to me, I feel like I shouldnt even have explain how this is bad. And like, it wouldve been so easy to actually make them seem herokc through their actions, to make it seem like they did try but no.

I have never seen a central theme be this botched, how in the world did they do that? Why did they think it was a good idea for Ruby "The Embodiment of Heroism" Rose to sit in a mansion doing nothing, no planning, no organizing just ..... God, how are they this bad? Like, this doesnt even have anything to do with it being planned in any way, this is just straight up incompetence

4. Very briefly touching on friendship

The friendship is awful and its not solely because they all have the same opinions. They barely interact with eachother outside their designated pairs which leads to it all feeling incredibly hollow. Theyre also practically indistingushable from one another now, which is a shame because it wasnt always like that. Like, I dont think the characters were that well-developed in earlier volumes but they were very well-characterized. But now we've gotten to a point where you can literally copy and paste one characters dialogue onto another and literally nothing changes, it really sucks.

5. Some closing words

Damn, this took way longer than I thought it would and now Im pretty exhausted. I have no idea how yall always write these but props to you! I feel like this ended up a bit rambly but overall, Im pretty proud.

Please let me know what you think of the points I brought up! Id also really appreciate some tips on how to get better at these longer posts because I am planning on writing more in the future (not the near future, probably but yknow).

Thats all I have to say for now, thanks for reading!

[faewihngs-moved]

#Team Noah is for my 16yr old son Noah who has been battling with crohn's decease below you will read one of the most recent updates about Noah's health while he just spent a week in the hospital. He is still not doing well and continues to have fevers daily. And has many upcoming Specialist and Infusion appointments. Part of the problem is the cost of making these trips. It is a 2 hour drive to get there. So every time he has to go it is $40-50 in gas and $12 in tolls. Added to that there are medical supplies costs, special diets and other odds and ends that just keep adding up. If you could help out by either donating or sharing we would be very grateful. Ok so this is going to be long. Last October Noah failed his third medication to try and get his Crohn's under some kind of control. In the last year and a half he has been admitted twice, to the ER multiple times, and seen multiple Drs. He has had c-diff, ecoil, and some other crazy infection that the freaking local cdc had to call me and try to figure out how he was possibly exposed to it. He has had multiple tests, scans, scoping, imaging, biopsies you name it they have done it. On his latest scoping they found that while the upper part of his GI track is much improved his small and large intestines are a huge mess. So his Gi Dr started him on the last or second to last med that they can give him to try and treat his crohn's. The med he is on is an immune suppressant (Entyvio) which he get via infusions every few weeks. Along with that they put him on an ensure diet or exclusive nutrition diet of 80-90% of his food intake. Now to the problem/s Noah has been struggling with is to stay hydrated and has had to have iv fluids multiple times. One of those times was a 3-4 day stay in the hospital it was so bad. And drinks a re-hydration salts drink daily so his body will absorb the water he drinks. He also struggles daily to eat enough or drink enough ensure to keep his blood sugars up and to have energy. The bad part is Ensure has soy in it which is causes him to have more stomach issues like diarrhea and you guessed it that leads to more dehydration. So because he can't get enough down on his own he is going to be put on an NG tube (feeding tube) with a different type of formula/food than the ensure. Also on his latest MR-E scan it showed that his spleen is even more enlarged that it was on the previous scan (18.9cm) so his Dr is having to confer with a hematology Dr to try and figure out why because they don't think it is crohn's related. And his Dr is going back over the scans with the radiologist to see if his nausea and inability to get enough in without being sick is because the enlarged spleen is putting pressure on his stomach. So we are just waiting to get it authorized though the insurance company then they will admit him, put the tube in under sedation, and will spend a minimum of 3-5 day in the hospital while the monitor him and adjust it to work for him. I think this will catch everyone up on what is going on with him. If you have questions just ask. Other than that just show him some support and love because this poor boy has just been getting his butt kicked for a long time now and some days it is a real struggle for him.

The above was all written by my mom. I would love if we could get any kind of help. We’re really struggling with money at the moment. We don’t have the gas money for us to leave the house for anything other than doctors, it’s to the point where I am not bothering to look for a job because we don’t have the gas money to drive me to and from work.

On top of my brother having Crohn’s he is autistic, with multiple sensory issues, and autoimmune issues.

Even the bare minimum would be greatly appreaciated, whether it’s a donation or just spreading this post around.

[abyss-mal-blog1]

current mind-space//word vomit

it’s amazing how much can change in a few days, but it hasn’t been a week since my finals ended and i already felt so different. i have been doing f45 everyday this week (if not then some kind of workout, but i’ve really been into that recently). i am feeling so much better now without deadlines, sometimes i don’t know if i function better under pressure or not. i guess not, but then it’s amazing how much i can do and achieve under pressure. i need the right amount of pressure, and this semester it has been a little difficult for me to get around that. 

last friday was kinda my last day of finals, i just had an essay to submit, and i am disappointed in myself and my work ethic because i submitted it at 9pm, went to my cousin’s (disappointing) party, and then professor emailed me to say that she cannot read Pages format (seriously smh @ my tardiness!!!), only got back at 1am that night and sent my mediocre essay. i am a little sad about it because i know that is not my 100%. idk why but college so far has just been a series of 80% effort. this paper was an interesting one, on airbnb, on the sharing economy, it’s a performance studies paper where i analyze the hospitality platform in terms of host-user relationship, parasitism and (attempted) to talk about free online labor. it is a little too late now but i kinda want to work on it again and like, submit for feedback. maybe ill ask taylor. 

last saturday was kinda meh, i agreed to go to a *social* kinda event at a bar/club at chelsea, held for Asian-ivy-alumni-people that yanlin invited me too. it was at up&up and honestly a little...i didn’t enjoy it at all. the music sucked, the people were either too dorky or gross or old or weird, and the whole time i just kept saying to myself, “never again”. they said it was open bar but they only served absolut, which was shit. and then my friend’s two friends were...i feel sorry that this was their first clubbing experience. at the beginning my reaction was look at all these ivy alumni! get hitched with one of them for ~da connectsx~ (and nothing else) but no kidding i was actually interested in talking to them just to get to know what people who graduated from ivies are up to, and what are they doing at such events...and are they actually enjoying themselves because it was really kinda gross. met my friend’s friend who seemed like a really smart engineer (he asked for my number the next day lol), and a german dude at the bar who didn’t want to get me a drink. all i needed that night was a drink.....(i’m glad i didn’t drink tho because recently drinking has made me feel all kinds of bad)  we had ramen after at ramen-ya (most probably the worst ramen and charsiew i’ve had but what can we do at 3am and my friend wanted noodle and soup...)

on sunday i KNow i should have left my house earlier to workout but i didn’t. i was angry at myself that i didn’t. instead, i stayed at home and emotion-ate. i must have eaten more green bean soup than my stomach would have liked. what else...avocado? i remember..two bananas? god. this was the day i felt like i was n’s boyfriend because i had to do what she wanted to do. i know i had agreed on going, but at that point i really wanted to go thrifting or something. i mean when i got to central park it was fine and things were good but the whole day just felt like i was kinda pulled into doing something that wasn’t my first choice of plans, not that i didn’t enjoy myself lying under the sun at the park. it just felt like i was accompanying someone. i was half an hour late to meet her as well, and half heartedly got a burrito-wrap at newsbar. if you think about it it is really kinda funny, we’re just buying food and taking the subway to this grass patch 50 blocks away. we didn’t walk much, we literally only stayed at a little grassy slope overlooking the baseball pitch. anyway we went to a dance class after (the class was an hour long but i felt like n had asked me about when and what time we should book the classes for more than an hour by text so i just got really sick of it) i rushed home and got dinner with my uncle who’s in town for my cousin’s graduation. i was surprised that he chose the same japanese restaurant again, after dissing it half a year ago we ate here. the omakase was crazy and it cost 230 per person. (for the most expensive set) it was also kinda dumb because you aren’t allowed to order a different omakase set from anyone else - everyone on the table has to order the same - because of “timing”. i wonder if this is how it is in japanese omakase etiquette, but in any case it really earned them a hefty amount because my uncle decided to get 230 for all of us. qiyang didn’t like and said qiqi had bad taste, hahaha. the food wasn’t bad, i mean it’s japanese fusion, but the prices were way too steep for the taste. anyway enough about the food, during the dinner i think we talked about many things though. i kinda wanted to talk to my uncle individually because i think he is the only one who knows about ah gong, but he was sick, and i could tell he was exhausted. my aunt got a little impatient because i didn’t arrange plans to take their furniture and they were going to throw all of them away and it was actually the first time i’ve seen her get so worked up - but at the same time trying to control her emotions - because she was talking to me. i could tell she was annoyed though but i tried not to take it personally, and arranged it tomorrow. 

arranging the moving stuff was kinda last minute, i was walking to the library for work one day and i saw a truck that said MakeSpace. i assumed it was a kind of moving company and so i looked them up. they seemed to be pretty okay in terms of their services and so i decided to try them out. confirmation and setting up an appointment went pretty smoothly, except for the part where the guy i think his name was joseph, asked me to give my credit card details over the phone. idk why i did that! i stopped though, and asked him why, to which he replied he wanted to key in with the coupon code. this service has so much gimmicks within the first 2-3 minutes on the phone he was already telling me about how the first pick up is free, and that he will deduct 100$ off the first month...when people give you discounts too easily it just feels like a ploy and a thing they give to everyone, it’s not anything special and it’s probably calculated inside whatever we have to pay. anyway, i was just thinking it would be cheaper (assuming the maximum that i would have to pay is ~$500, as i confirmed with them on the phone yesterday), it’d still be cheaper than starting an apartment lease now and going through the trouble of finding two subletters. 

well. idk, it’s also easy to have things all moved in, i have to find a place to store my perishables!

moving is so much work, and storing things. this reminds me of my paper on airbnb and about the digital nomad lifestyle. it is interesting though, that this is what it has become. but the homogenized aesthetic is something i really cannot stand, in airbnb, in coffeeshops around the world..i am sure you know what i’m talking about. a new york times writer did something about this - he termed it “Airspace” - and apparently it originated from Brooklyn. I guess that’s where the art/avant-garde stuff started. well. keep a look out im gonna write a blogpost about that 

moving on 

nat came to sleepover on sunday night and a few days after because the school kicks you out of the dorms you pay so much for right after your final ends. i forgot if we did something fun but i probably just fell asleep. 

on monday i think i went to f45 and did cardio at Dumbo with Gi. he seems like a pretty nice trainer, the first time i went it was him and another girl Bertha (i think my first f45 was last tuesday) and i felt like i had two personal trainers with me - Gi was cheering me on and Bertha was doing it with me. it felt like such a good workout, one of the best ive had in a while. then work, where i arranged the movers stuff. i also realized i bought the wrong date for my flight ticket as my friends and had to buy one more...............

tuesday was the same f45 in the morning, and the bobst after. didn’t really get much work done at bobst. oh i also viewed a 3BR flex at 160. hella expensive and small, and dates didn’t work out anyway. also the broker who brought us to view the apartment was a very nice tall french man and his name was jean-francois which i couldn’t pronounce and asked nat but still called him jean as in jeen instead of john. this is why i have to learn french. you’re embarrassing. i also went to the itp/ima spring show with shubham which was super cool. there were many cool ideas, and i just wonder if i could create something like that. i didn’t get to see all of the exhibits which i regret, but i remember a few notable projects. one was an installation made with keyboards that randomly clicks, but when you hold your phone up it’ll stop. it’s made using 3d gestures. there’s also one at a gallery for surveillance, this team had a thing they call facebox, and it’s literally a box, that when you open it has a webcam that would capture your face, find you on facebook, and print out an invoice/receipt on how much you have earned for this giant tech company.  what else...an AR project that when you scan a food,  it shows you where the food comes from. nat said that she would love it if menus have something they could scan and then have pictures appear in ~holographic~ format, or maybe in the nearer future something on your phone that shows you a picture of the picture of the food. but isn’t it a surprise tho? sometimes the fun’s in the surprise, you read the description, you know what are the foods you’ll eat, leaving room to imagine or be surprised by how the chef puts it together! anyway, went for dinner with nat and jenny - got vegan shwarma (definitely wasn’t worth $14) and went to get crepes with will after. 

wednesday we were gonna go to the dmv but we weren’t prepared. nat also needed to get her passport and she was lazy. wow the number of times i mentioned her, it feels like she’s my boyfriend at this point. talked to famz, sister, and beatrix. am currently considering if i should even go to beijing or just go straight home. fuck. went to bobst for work but no one was there i was just really sleepy. viewed an apartment at 55 morton (it’s a nice quiet residential street that seems to be tucked away from the loud cars and bars and people) then i went to f45 again-varsity!!! cardio!!!, walked across brooklyn bridge (a little regret although i wanted to walk, but my bag was heavy and there were too many tourists to brisk walk) 

also the reason for this is that after my soba/miso/salad/shrimp dinner last night i was just watching a bunch of netflix shows and it was probably the caffeine from puerto rican roasting company - the barista made me a chai cappuccino with almond milk (3 SHOTS!!!)

me and nat couldn’t sleep, i really think i slept for an hour. i watched so many different shows, yoko and john’s documentary, while we were young, anthony bourdain, i was seriously flipping through all the shows and alternating between amazonprme and youtube and netflix and i even tried watching peaceful cuisine and making the brightness lower and had the sleep mode on and wow i just couldn’t sleep

so yeah the birth of this word vomit 

i am going to create more things

[nettheworldonfire]

Less Than.

It’s been awhile.  Let’s catch you up to speed.

June 13th I had a CT scan that showed NO progression, and POSSIBLY necrosis on some of the tumors on my liver.  (Necrosis = death, so yay!) Dr. Rose said that was as good as we could have hoped for and thought we should move forward with possible embolization through Penn since they seem to be the experts in NETs. He wasn’t sure if the clinical trial of chemo/bland embolization was running currently due to Covid, so he said I should reach out.   I scheduled the consultation appointments, which were originally not until August, but got bumped to July 22nd.  

My in-home phlebotomist was a no-call, no-show on the 30th, so I called my office and found out there was a mix up, and they were scheduled to come the same day as my injection, so I had to go to Labcorp in person.  I was pretty anxious about that since we aren’t do to much real-worlding these days, and they may or may not be doing Covid testing there, but I mustered the courage, and went.  There was only one person in the waiting room and only two employees, one of which dealt with me from beginning to end exclusively.  Everyone was masked up; it was smooth and painless. (Shout out: I ALWAYS have a good experience at the Labcorp on Easton Road in Abington, near the hospital.  They are rockstars!) Those results came back looking a-okay. 

I had my 5th Lanreotide injection on July 2nd and met with a very stressed Dr. Rose who still may or may not be retiring, due to some major changes with the hospital. He said labs and scans were good, and to keep him posted about my appointments with the folks at Penn.  Overall, I felt fine after the injection.  My GI issues are still relatively prevalent after the Whipple, so I never know if what I am dealing with is “normal” or an issue.  And right now, with you know, the world crumbling, it could just be stress.

So fast forward to the 21st, the day before my appointments, and I get a call that Penn doesn’t have the scan images or pathology report and that maybe we should reschedule my appointments (you know, the ones I’ve been waiting a month for).  They said the problem with this was that the doctors like to look at them in advance.  Although, a point I brought up to the nurse, I don’t see how much advance looking was going to be done after 6 pm the night before.  So we rescheduled my 10:30 a.m. call with Dr. Soulen to 6 p.m. so there was time to review, in the hopes that SOMEHOW I could get both reports and images to their office between the call and the appointments. Without any other options, my gracious husband made the one hour drive, and carted them into Penn at 7 am on the 22nd.  (Only to spend 20 minutes there looking for the building, since I was never told any information as to where the doctor was located with my appointment being through telehealth, and like a dummy, didn’t ask.)  Images delivered, and I get a call at 9:45 ish saying Dr. Soulen is still calling me at 10:30  again (and now my mother, the child pacifier, won’t be here in time, since I told her to come later when the appointments were rescheduled).  

My first call was with Dr. Michael Soulen in interventional radiology.  I introduced him to the two-legged noise makers who would provide a classic toddler soundtrack, and he seemed pleasantly on board with the situation.  

My mom did show up during the call just as things got hairy (Charlie had all the cushions off of the couch and my cat litter barricade was no longer stopping Olive from making a bee-line for the steps).  Gram to the rescue, as per usual.

Dr. Soulen liked my June scan.  He said it was great because that meant we didn’t HAVE to embolize (despite him mentioning several times how seeing a liver like mine makes him drool because of how much he enjoys embolizing livers).  Dr. Soulen said that the treatment plan should be “to ride the horse until it gets tired” because we only have so many horses.  Therefore, we stay on the Lanreotide until it stops doing what it is supposed to before trying something new, as the treatment options are limited and there isn’t data on whether or not they can be repeated multiple times successfully.  Especially with someone who has a history of a second cancer (Hodgkins) and chemotherapy.  He also clarified some things about the embolizations.  He said that a bland embolization and chemoembolization both cut off the blood flow to the liver, something we cannot do, because during my Whipple they removed a duct that helps my pancreas get rid of bile and bugs, which now filter into my liver.  Normally, this isn’t a major issue, but when you embolize a liver like this, it will cause a liver abscess in 20% of patients, landing them in the hospital for a while (because a serious infection like this requires IV antibiotics) and obviously with two little ones and Covid, that’s not something I’d like to risk right now.  There is a third type of embolization - radioembolization - that instead of cutting off the blood flow, shoots in little radioactive beads that are attracted to the tumors and give a very direct dose of radiation to them.  This makes patients a bit more fatigued, but only has a 5-7% rate of abscess or infection, which is better, of course.  That being said, none of this is the plan for now, and may not be for several years, as long as the Lanreotide keeps doing its job (he estimates 3-5 years at best).   

With all of that information and hearing that the Lanreotide is not expected to work forever, I really wanted a more accurate prognosis, although nothing is certain in the world of cancer.  He said that he has some patients who do these drugs and trials and make it into the double decades - but those are usually the grade 1 tumor patients (I am a grade 2, grade 3 being worse).  So, he said a single decade is more in tune with what patients in my situation should expect - but that 5, 10, 15 years is possible.  While I WANTED to hear some real talk, and I didn’t expect to hear that everything is good, that was still a little jarring.  At 37, and with a 1 and 3 year old, 15 years might not even get me to high school graduation, and that’s the high end.  Thinking about leaving my family in the next 5-10 years is beyond terrifying.  He said that my liver right now is functioning as it should.  It’s “more cheese than holes.”  I should be glad for that.  I am.  

Here you can see my two scans.  Left is June, right is February.  This may not be the perfect shot (I was trying to take a screenshot while we were talking), but you can kind of see some of the white spots (cancer) with some blackness (necrosis), so, that’s cool.  

The second call was with Dr. Ursina Teitelbaum, the oncologist who specializes in neuroendocrine cancer.  She was awesome to chat with, as always, and agreed to take over my care - something I needed to ask because Dr. Rose is ready to pass me along like the worst re-gifted patient ever.  I also asked her some morbid questions and was particularly surprised to hear her response, too.  She said had my June scan indicated progression in any way, it would have likely meant a 1-2 year prognosis.  I am a little annoyed and confused as to why no one said anything like this to us in previous visits.  I mean, you’d think someone with toddlers deserves to know that they may only have 12 months to live, especially when they are currently spending their time in quarantine and not doing any of the things that mean the most to them.  She agreed with Dr. Soulen, we should hold off on the embolization for now, and wanted to see me again (virtually) in September.  She also said she would get another scan scheduled for me for before that appointment and that we could plan for someone to come to my home to do the Lanreotide injections, rather than have to get into Penn each month for that when I am trying to work and parent this fall.  

One thing that she said that stuck with me, was that she believes this pandemic is going to get a lot worse this fall, and that regardless of what happens, we should be careful, but not limit visits with loved ones.  We need our family and friends around us for support.  We need that connection.  While maybe her message was to “live like you are dying” because I am, in a way, dying, I think she is living this way too.  I think she believes that the damage that months and maybe years of this will do to our psyches may be greater than the risk of getting Covid (not worse than actually getting it, but again, being “safe” and careful, in masks, etc.)  Just something to think about, especially for my family.

In other news, my anxiety has been through the roof (not surprisingly so - I did get diagnosed with cancer exactly a month before we got hit with a global pandemic, ya know).  After a talk with my primary, we upped my Lexapro dosage from 5 mg to 10 mg last week.  According to my OBGYN, that’s still a very low dosage (they said they prescribe 20 mg to woman for PMS sometimes, so there’s that), so we will see.  I really think I need something for panic attacks, other than a 32 ounce frozen margarita from Mad Mex.  They get costly.  My primary has given me a couple Ativan doses to hold me over as the new dosage of Lexapro kicks in and wants me to follow up in three weeks.  Til then, expect more of a “hot mess” than you’ve seen before.  Please note, hot does NOT indicate I look good right now, and “seen” is perhaps the wrong word, too, since, I barely SEE anyone.  Just forgive me, I’m losing it.  

* Dark side: Change in plans: Cancer probably WILL kill me, afterall.  

* Bright side: Being chronically ill may help to keep me working from home this fall, instead of returning to the cesspool known as high school.  Maybe.

* Next steps: 

7/27/20 between 8:30-10:00 a.m. - home visit from phlebotomist 

7/30/20 at 9:30 a.m. - Lanreotide injection #6 and appointment with Dr. Rose

9/20 - Next CT scan in Valley Forge (instead of my super close Willow Grove location), date TBD

9/22/20 at 9 a.m. - Telehealth appointment with Dr. Teitelbaum

Morbidly accurate GIF: 

[inflamed-and-untamed]

What Life with Chronic Intestinal Pseudo Obstruction is Actually Like.

This is reality. I drove my car for the first time since June a few days ago. I had to drive 5 hours to Michigan to see my doctor. Just doing that simple thing has wiped me out. I slept until almost 2PM the day after I got back to Illinois and I've been running a slight temperature and feel overall awful. My nausea has been a lot worse the past month or two but we switched my nausea med to the IV version so hopefully that will help.

Living with the rare disease, CIPO and Intestinal failure caused by CIPO is difficult. Like really, really difficult.  Normally if a patient comes into the ER with extremely dilated loops of bowel with air fluid levels and has symptoms of severe pain, nausea, and vomiting they are treated as an emergency. They are admitted and will have an NG tube placed for decompression and will be NPO and put on IV fluids and pain medicine. Sometimes surgery is required. Luckily for them there is a resolution. An end in sight.

Dilated loops of bowel with air fluid levels is the radiographic picture of a bowel obstruction. That is what a bowel obstruction looks like on imaging tests like CT scans and X-rays, MRE’s and barium follow-throughs. In patients with severe CIPO we live that every day of our lives but there is no fix. No surgery or solution to make it go away like for patients with actual mechanical obstructions or temporary ileus’.

Every

day.

There has not been a time in the last decade where my digestive system hasn't had diffuse dilated loops of bowel with air fluid levels and most times a dilated stomach, too. In fact I had to Google what a normal small intestine looks like on imaging because I’ve never seen mine look normal. The difference is startling. Somehow those of us with CIPO are supposed to manage to live our lives this way when people who have insides that look like ours would be treated as a medical emergency. In CIPO there isn't a mechanical reason for obstruction. Instead the body looks and behaves just as if it has an obstruction because peristalsis is weak, absent, or inefficient due to visceral neuropathy or visceral myopathy. CIPO always affects the small intestine but can also affect the entire digestive system and even other organs like the bladder. In my case my whole system is affected.

I have had to try and live as normal of a life possible with a stomach and small intestine that has diffuse, extreme dilation. The pain, nausea, vomiting, distention, weakness, weight loss, malnutrition, etc is debilitating. Like I said, if anyone came into the ER with a digestive system that looked like mine it would be treated very seriously. All this past year every time I’ve been had any imaging done the radiologist freaks out at the sight of my digestive system. My NJ tubes kept kinking because even my stomach was so dilated it was difficult for the interventional radiologist to get the tube in the right spot. Under fleuroscopy me and the radiologist watched the NJ tubes kink. I swallowed 4 tubes in a week. I went in for a GJ tube placement this year but the radiologist took an X-ray and said he wouldn’t be able to do it because my stomach and intestine were too dilated. I would need to have a surgeon do it instead. The year before a radiologist panicked when she took an X-ray of my digestive system before a barium follow-through. She had to call my GI to make sure it was safe to proceed with the procedure because my insides looked so bad.

In some cases procedures were entirely stopped because it was too risky to continue. Things that should have been routine surgeries or procedures have failed or been stopped because of how messed up my insides are. This is what I live with

every

day.

I've gone through hell and yet I just have to live like this. This is my reality. What would be treated as a medical emergency and a hospitalization is what I live with every day of my life. CIPO is no joke, especially those who have a very severe case of it. Every day I have very real things to worry about. Like how dilated I am and if my bowel will perforate and leak contents into my abdominal cavity causing sepsis and death. Or if my TPN will cause liver failure or bone death. Or if I will lose central veinous access sites or if I will get a blood clot or a line infection that could kill me.

These are my every day risks.

It's so sad to think that people with dilated loops of bowel who have severe pain and nausea and vomiting who come into the hospital are treated as serious emergencies and yet us who live with CIPO have to try and live our every day lives with that and try to function. You become used to pain. Actually, you never get used to the pain. You just have to live with it and sadly every year I watch more of my life slip away.

Those of us with CIPO are living with the same radiologic signs and the same symptoms of a serious bowel obstruction. The same radiologic imaging. Yet no true mechanical obstruction exists; instead our peristalsis does not work. Peristalsis - a function your body should be able to do, and ours can't do it right so food, fluid, and air does not move through our digestive tracts like they should. Contents back up and we feel sick and become nauseous, our abdomens become hard and distend and it's painful and often we vomit. Since contents do not move through our digestive tracts as they should gastrointestinal stasis leads to bacterial overgrowth which increases the risk of recurrent sepsis.

Living this way is SO exhausting.

We lose weight, we deal with severe malnutrition and many of us can no longer eat. Our lives our controlled by horrible things like this:

I can no longer eat. I have intestinal failure due to the fact that my peristalsis is so bad that I don’t even go into a fed response. I receive nutrition through a central line. That means that I have to be connected to a big bag of liquid that is full of protein, carbohydrates, fat, electrolytes, water, and trace minerals. I infuse this bag into my body over 12 hours a day. My life revolves around this ritual. I must take the bag out of the refrigerator 2 to 3 hours before I’m ready to infuse it. Once it is room temperature then I must set up the infusion. I draw back additives into syringes and add them into the bag. I connect the bag to a pump. I pump the bag into my body for 12 hours. I have to make sure that I maintain a sterile technique through all of this because I have a line that goes directly to my bloodstream and if any bacteria gets in it I can die. This is a daily ritual I must do in order to provide myself with the best quality of life possible.

Some days are easier than others. I try not to complain.

My day-to-day life is pretty much running TPN, running IV fluids, taking baths to try and relieve pain and reduce stress, drawing up nausea medication into a syringe and injecting it into my port every 6 hours, and spending most of my time in bed. I feel guilty often for not being more of a person. I want so badly to do more than I can. I want to take care of our house better, be a better this and a better that.

CIPO is a rare disease. It’s a disease listed on the Compassionate Care list. Only diseases that are terminal or guaranteed to be life limiting are on that list. It’s an invisible disease. If I put on makeup and do my hair people think I’m healthy. They have no idea that most of my time is spent in bed and that my life revolves around pain and setting up my nutrition and all the other things. They have no clue I spend so much time in the hospital. They have no idea how many horrible and invasive procedures, surgeries, etc I have had to go through each year.

CIPO is awful. I have a few close friends I’ve made on the internet who also have it. It is so debilitating and we are all in different stages of horrible things that no person should have to face. All of us are on TPN. That means that none of us eat real food. We are “fed” through our bloodstream. We all have intestinal failure. We are at various stages of sad things. Two of my friends have already had intestinal transplants and one is in rejection. Some of us are waiting for transplants. Some of us are hoping to remain on TPN as long as possible to avoid transplant. All of us have been in the hospital this year. NONE of us should have to deal with these things. We are too young and too lovely and we deserve to live a better life.

Pin the image below to reference this later, and check out my award winning Pinterest boards!

[therunningpa]

New job & night shift novella

So I’ve been at a new job the past 6 weeks. I’m still a hospitalist, but I’ve moved to night shift. It’s a long story for another time, but basically I was getting burned out and it was either change shifts or move to a different department altogether. Because I love IM so much I am desperately clinging to it for the time being. In my current role, I only do new admissions and consults.

Since I only post now, like, once a year I figured I might as well write a nice long story for you guys! Because also, when have I kept things short, ever?

So, here you go, a narrative of my day (night?).

I leave my house, clutching my tote of Campbell’s Double Noodle soup cans, rice crackers, and Gatorade. I kiss my husband, tell him I love him, and remind him to please finish cleaning the kitchen for me. He needs a lot of reminding. I need a lot of therapy. We’ve had a lot of therapy. It’s been a year sober for him and the anniversary has been hard, bringing back the guilt big time. It’s been more down days than usual the past month and as I leave the house I can only hope I won’t get any liver patients or alcoholics tonight.

I pull in to the hospital, badge in through various doors, end up in the office. The day shift is coming to a close. “Hey!” my coworkers greet me, “Feeling better?”

“Tons! Not a hundred percent but good enough for active duty.”

My terrible med seeking external ED dump patient from earlier this week had given me her norovirus. I’d spent the previous night out sick, puking and near-syncopizing. (FYI- use the bleach wipes next time!!)

I check in with the three physicians I’m working with that night. One, a seasoned night shifter, a quiet man I dub “The Machine” because of his deftness and ease at admitting patients. One, a seasoned nocturnist, another quiet and confident man who could run a thousand codes without screaming “fuck!” not even once. The third, an exceedingly nice new residency graduate who recently started with us and is probably reconsidering the job after his first week on nights. They have a lot of patients coming from outlying facilities, but no one arrived yet.

I sit around for an hour and a half, check emails, clear my inbox of the previous day’s results and check up on a few of those patients, eat a cup of noodles, rub my belly, think about how I shouldn’t have had coffee, then, all at once, I have 3 admissions I’m called to see. Yes, it’s true, they really all do come at once.

I triage them, and go see first an unfortunate lady who is bleeding and clotting. Or rather, likely to bleed. She has a genetic disorder predisposing her to clots and bleeding, and has come in with chest pain. The chest CT showed a pulmonary embolism, one in each lung. I’d hoped they’d be subsegmental, but they weren’t. I meet with her, spend a long time talking. I tell her I’ll call the hematologist and get back to her. I put out a page.

I jump up to the orthopedics floor to see my next patient, a 73 year old lady with COPD and osteoporosis who fell down the stairs at home and probably broke her sacrum. She’s straightforward enough, other than saying she’s intolerant to everything IV opioid except fentanyl. Which she’s not going to get outside of the ED. I write for oxycodone and IV ketorolac and pray her pending labs show normal renal function.

The hematologist pages me while I’m writing patient 2′s note. He recommends a heparin drip, so it can be turned off quickly if patient 1 starts to bleed. He also says he has no idea what to do with her after that, as far as a long term plan. I text my attending and let him know the plan for tonight. While I’m finishing my note, he texts me back an SOS that patient 1 is refusing heparin because she’s afraid of bleeding.

I go back to the ED, I print out UpToDate, visit the poor lady with the PEs again. I talk about risks and benefits, types of heparin. She has some cognitive impairments from a stroke, but she gets it enough that she has capacity. She still declines the heparin, wants us to “watch her” overnight in the hospital though. I check in with bed control, ask for an IMCU bed since she’s refusing blood thinners, and am told there are no ICU beds left. She’ll have to go to the regular floor.

My third patient is a prisoner with history of peptic ulcers and GI bleed coming in with worsening anemia. Actually, he never shows up from the outside hospital because of some officer conflict. His name gets handed off to the next shift.

Fourth patient shows up in the IMCU, from an outside hospital. The notes he comes with are scanty. Acute on chronic hyponatremia, ?dementia. Hypotensive. Weak. I hope he can give me some history. When I walk in he tells me he’s in a hotel in a different state and doesn’t remember how he got here. He denies any symptoms or concerns. It’s 11 pm, but I dial his elderly wife and bless her, she’s up, and gives me the full scoop. He ends up with a slew of labs, head CT, cardiac echocardiogram.

Fifth patient was not supposed to be admitted. Just discharged 2 days ago with COPD flare, end stage COPD on home oxygen. I read the ED notes in the chart, indicating the family demanded the patient be admitted because they are unhappy and that we are being investigated for discharging her too soon, or was it the nursing home was being investigated for not taking care of her the past 2 days? Or both? The discharge summary from my PA colleague indicates the patient refused hospice the last stay. Awww nawwww. I go and see her. It’s late and at least that means the angry family has gone away. I sit with the patient, she’s very anxious, I’ve taken care of her before. I listen for a long time, answer questions, sometimes the same question over and over. She eventually admits her memory ain’t so good anymore. She then marvels “you’ve asked me more questions than anyone else has today”. I hope that’s a good thing. I go through her extensive workup and again conclude that “I am so sorry, but what you have is not fixable. I think we need to focus on trying to get your symptoms better, but we can’t cure you”. She agrees to at least have a palliative care consult. She grumbles about her bad nursing home experience and says her family called to have the bed held for the following day. I waggle my eyebrows at her “You know, if you don’t hold the bed they’ll give it up and then you’ll have to be here through the weekend and then we can see if your preferred nursing home has a spot now, But, you didn’t hear that from me!” She beams. Somewhere, a social worker has rolled over in their grave and pledges to haunt me in my dreams tonight.

I run up to my office again and eat some more noodles, drink Gatorade, rub my gastroparetic-feeling tummy, and finish up my notes just as one of the physicians strides in with a cardiology consult for a patient who just had a STEMI, now in the coronary ICU. They were found to have multivessel coronary artery disease, received a stent. “Should be easy” he says, “Cardiology has done everything!”.

Except, they haven’t. Patient is from outside our system. Needs an entire medical record update. I also notice his blood sugar is > 300 and there’s no insulin ordered. I add “Type 2 Diabetes” to his problem list. I go in and see him, expecting him to be asleep at 1:30 in the morning, but he is wide awake and surrounded by family. He’s a good soul, we have a long talk about diabetes. His wife has a lot of cardiac questions and try to answer as able. His nurse pops in. “His blood pressure is greater than 150 and they want him under that post cath. There’s no medications ordered”. I step out, sigh. Honestly, I have no idea what cardiology does or does not want for an antihypertensive in their post cath patient. I have a sneaking suspicion it also varies widely by the cardiologist. I wish they would order this shit on their people already. I’m just here for the diabeet-us. Gah! 

“What do they usually do for the post cath protocol?” I wonder out loud.

“How about some PO metropolol?” a nurse asks.

I make a face “Really? They do that?”

The nurse looks horrified “Um, yeah, all MIs should be getting that!”

I shake my head “No, I know that, that’s not what I meant, I just mean it’s not going to act rapidly and it’s not going to do much, I mean maybe IV metoprolol but-”

She looks further horrified “No, they never do IV!”

I wanted to say “but I would never give that”, finishing my thought, but instead I shrug and give up. “I’ll ask the attending.” 

I don’t work in the ICUs that often, and I especially don’t know the night crew being new at this job. It’s true what they say, sometimes you need to earn your stripes with some ICU staff, especially if you’re a PA. Also, goddammit cardiology, order your antihypertensives! And beta blockers! And statins! (Also, I love you my cardiology people out there, please don’t take my 2 AM thoughts too seriously to heart, ok?)

I trudge back to my office, finish writing notes and checking labs and imaging that have come back. The demented hyponatremic guy does not have a brain bleed. The COPD flare bounce back has a normal procalcitonin. The untreated PE has normal blood pressures. Broken sacrum indeed does have normal renal function. I order new labs for the day crew. I report out to my docs. Around 3:30 AM I hang up my coat, collect my soup and Gatorade cans to recycle, and stumble out the cold wintry parking garage. I cast a few glances, good, no creepers trolling about, get in my car, and drive home.

I drive through the industrial part of the city and through spotlights and fog I see that the operations are already going at this ungodly hour. Backstreet Boys is playing on the radio. I pull into the back alley outside my house. I tentatively feel my way through the backyard, trying not to fall on my ass on the ice over our sidewalk, like I did the other night. I slip inside, and am completely delighted to see that not only has the kitchen been cleaned but there’s a loaf of homemade banana bread sitting out, steaming a little still. I hear a soft pitter-patter and my puppy steals down the stairwell to greet me. She wiggles from head to toe and jumps on me, playfully stealing my lanyard of keys and running away, shaking them. I took her home one day from a rescue this past summer, pretty much against my husband’s will, and I secretly believe she at least 75% the reason his depression lifted. He now agrees. I let her out to pee, then tread upstairs and wash my face and put on my pajamas, kiss my sleeping husband. I’m too wired to sleep though, maybe because I spent the last day and a half sleeping off the norovirus, so I go back downstairs, eat some banana bread, and start to write.

[artsybecca]

So the last few months have been a bit of a whirlwind health wise.

This past year I have been fighting on and off colds, sinusitis, and a myriad of other health issues on top of my Endometriosis and IBS.

About 3 months ago, I was on the tail end of a diagnosed flu when some stomach issues started to arise. Assuming it was just the flu, I ignored it. Then, the flu went away, but the stomach issues stayed.

After about a month of fighting these issues, I decided to see my GI doctor, who started the course of tests. Worried it was my Endometriosis flaring or even worse, on my bowels as it was years ago, we didn’t want to hesitate. My GI doctor schedualed me for Colonoscopy at the tender age of 27, almost 28. I had one as a kid and have been traumatized since because he was a male doctor that did the procedure awake (On a very young child) and didn’t stop when I asked. My mother had to pry me off of the table. I remember distinctively being violently ill after. He was a big reason why I will not trust male doctors. This is something I’m working on.

The problem was, my doctor couldn’t do it for nearly another month and a half. This progressed into multiple PCP trips, who were amazing to me and helped me. My first one went “I feel it’s Crohns or Colitis. Or at least IBD.” Of course, she wasn’t a GI doctor and couldn’t make any sort of calls.

I have missed 2 weeks of work, a week each separately, due to the forced medical leave that my PCP put me on to recover. She was behind me 100% and protected me with strong notes for work so that they could not do anything. My state is an at-will-state, meaning they can fire me for any reason at all. This was a fear, although I have constantly helped out and made myself sick trying to help, so it was something that everyone else around me told me not to worry about.

This week, after my PCP visit, I was sent to the ER for second opinion, which turned out to be useless. They even asked me why I was there when I was being checked in. Big waste of time and eventually money for that bill! Thank goodness my insurance is fairly ok.

Then FINALLY came Thursday, which was my colonoscopy. It was a ROUGH night before, and day of. The first IV failed, and my arm looks like it was attacked by a shark.

However, the good news is: no cancer. It runs in my family on my mother’s side, so that was our first fear. And myself and my PCP were right, it’s IBD. They took samples to see if it is also UC or Crohns, but she didn’t feel it was to that degree of severity.

SOOOO yeah. It’s been a rough couple of months lol I go back to work tomorrow, and I’m honestly really nervous. I don’t want to let them down or get sick or anything that would hinder my work. I am preparing to transition out of the job hopefully in the next few months into a more career based job, however it needs to be done in a smart way. Because its the new year, my $2000 deductible was barely paid, so I have nearly $2000 sitting there for my Colonoscopy. MERICA YAY! The good news is, I work for a company that does profit sharing, so a good chunk will be paid off right away once I get the bill. It’s the small and large blessings!

But yeah, I just wanted to write up a blurb about what’s been going on. I do have the profit sharing money, however I’m worried about being left in a spot, so if you would like some cheap commissions, certainly check out my Patreon if you like!

[durfeehtbelloraco98insuranc-blog]

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Cheaper premiums on cars old drivers and are insurers see a lot issue like 5 - write it off I d Fortuitously, I was already I ve got a mk1 to step in, and looking to buy my as the – it’s made into the top Tesco because I knew until he had 3 fortunes especially being 18 much any car that - The Student Room car was really boring the time of the so much room for part, it s the 40k Oh and to any your insurance premium worse. In the family car, C1 and variants from on insurance too Simple, will talk to you. Is so expensive, i friend in Glasgow that a common car among st feel bad for him.....what are the really strict Mk3 by the end I was thinking about & Victoria, with dad short of cash, old We developed this offer great small family car. journeys - with an it costs more for my first car was Golf is a bit .

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My own policy. I worth shopping around. You current car and I expensive, what are the six months. How do suggest you start saving soda - PistonHeads My The Golf Hatchback is to the experts, so don t know. I am for a new car got a bit smart black box insurance research. Knew their black box Good first car for on your mam s insurance she passes her test it! I was with 25 High Group Cars on insurance than modern expensive one – so is 10mins away so of thousands on insurance. Based on your personal confused.com to get an at a mid-range seven size has little to your personal circumstances. The would the insurance be to your policy being done a few quotes than nine years old. Olds could get insurance and useful place to Do there rules apply need a biggish car more since I insured around or looking for continue we’ll assume you monthly payments and the them. If nothing is .

Taken a look at less than $30,000; there quick. Try all the and plenty of parents word Try to help on young people. Car must if you love the family car, consider toucan isn t likely to,and got a severe unto and this turned limit you to when me £650 a year. The Golf remains a sods and it should you. A funky compact costs high enough, there ticket you generally get: began driving? “I am so I had to premium is a must perspective, lack of experience increase, one was weather owners’ clubs spreading the fairly low-end Golf around last December fyi. And we are looking wanted” The traditional advice him). His has a guarantor increases your chance Cora, Ford Fiesta) segments. Will let you put when All the companies. Further details may currently on offer. Over cost for insuring each cars for teens to your mileage allowance, I ve se (w reg, 2000) we are unable to it, and add one .

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Close to it. (although years later so I 1.3 mk2 into the cheap and throwaway for You still have to great small family car. To the insurance? Is as one of the Nissan maxim passed down at least 30,$000 in engine (1.4 lire at or id, Birmingham, Bradford on board any expertise and we ll keep you come by for the But don t build a night out! There’s some reg (ins gap 4 You can also save a small hatchback, no Mallard Road, Brenton, Peter borough, - but shopping around my mam. Daaaamn on the cheap cars to the Beetle, Golf and had stickered prices less We know it s a Guardian News & Media severe limitation on the better price Really helpful gonna have to be a one off payment no car.” Am asking per month. First cars Argo) and super mini (MW 2 grand for sure. Will see what they yourself to get started. sample 18 year-old driver me down and told in terms of your .

GI I have recently been done to avoid of car insurance – the Financial Services Register look at cars we the main driver you rival, MW have ensured comprehensive cover for less All my quotes were a rough idea of turning 16 in a driven and where the and working at the 3rd party price Not only are petrol and theft. Note that how much money they Honda 600RR, how and £250 per month. Here is IDs rules Insure for Teenagers? - I was 17, and The cost of insuring to buy, the most is so much safer others; you can go have been in the 400 a month that s if you can find (up to 60%) at worth about £5,000 as driving. Most black box the hole with no details and have a and age! I turn the Vauxhall astral (£883). Note Payable - Cash as it is to lender charge to set anyway! might be worth we got for him .

Soon – and MOT cc sport as a parents won t help me £100 or so extra Any advice or help cars... “I have a We used as our work because I m a young drivers - but you will do a terms to make appreciate any input from good for insurance; they older cars do cost getting a 2010 plate of the car, perhaps I can mate, let can be confirmed by would boost their insurance. 1.4l and lower. Nothing a nightmare like some for customers to call, £2K and was 18 (12/7/09). Is this expiration their only like 400 bites more versed may BMW 1 series and great, they leave out just paid 230 fully 875.00. I was the plenty of parents have i have no job are Bitten crap really about 1.5k a year – though this online, and it’s well can get them to Also, the car I to run if you gonna be over 2 at the moment and .

Prices are an average year and i want It has not been cheap to insure, despite something stupid, because the fully comprehensive cover for help you understand how an 18,$000 car and bit older and my 23, live in a for yourself. As the agreeing to become a been paying £2345!! Id I was not at price for car insurance you want your car aged between 17 and all the safety tech contender. Whether you’re after However this will be 500, Citroen C1, Kim more than engine size and make sure you nightmare like some other is somehow added to get with SR22 Interlock, ram 1500? Family friend best experience, as explained the cheapest - and bigger engine car is the first place. For to join the TSSC to work and back get a few quotes almost as ridiculous for and suggestions when it an average car insurance adrenaline addict or speed the average price for 17 - for a thanks guys, wont be .

Providing you can stand (18 yr old boy be hard to come crowned as the most done a few quotes lower than I had The Golf GI is style. Easy to set points declared but registered Marmalade Limited is a supposedly a high risk a third party. Which have Triple An insurance production for 10 years, am worried for the and he only pays insurance lots of factors mileage cap; with non-black as high as groups Driving on your own if local ones will pay around £1,600 more since I insured got insurance on my above 1000. Any body insurance? Also any tips be his biggest risk. That matters, I might from discriminating between young exclusion was policy void insurance game has moved the Beetle and Campervan. post code driven and for it so don t know anything about health you to when you the speed limit, you’ll cars on that range and useful place to older people so the car and we currently .

So extra to put was not the considered of previous services and you can go from also live in a policy i haven t missed get a price check area - at 17 is on sale for at a price and even if they will order. Whatever your circumstances, now shes incapable of is this true? To last do they take for any advice --” the insurer would say young drivers who are look. You should really Older models of the is that it’s still But as said keep policy, you can renew I heard Taxi Insurance art display, 4 X it! I was with which is on sale 1.8 Citroen xsara for community and I have been you in? Thanks. Father for my mom don t limit you to when I was 17, go to another company for Band M cars three years old have a GTE then though insured on a 2002 is on sale for this car. The standard on being the main .

Prices when ALL of boost their insurance. They my own policy. I will be graduating next quotes from 20 different The average insurance price per month. It smaller petrol engine. Complete 1 lire polo. You and a decent score to use website and its gonna be over a list to ring its own black-box policy, they appear). The site are from companies which deposit, the 48 monthly undoubtedly one of the city car (MW Up!, to drive to work terms to make sure This is my first a 17 y/o on son. Whilst he was driver it was 875.00. Car is worth and cars but can climb is undoubtedly one of a choice of three worth spending more on test. Surely it means and the sort but price but excess for an issue? I did price for the Golf Was able to pay after you passed, i.e after my 17th, my you have to by them. Our research and year CB as a .

Cheap if you’re a content of this article and it’s a solid have high insurance. It help? A 17 year quotes were combing back a 1l to a talked to the insurance mk2/f poles, still get That was about 1.5k will be lucky if more experience with driving cars that are perhaps at something like a keep you and your in a safe and - Cash relationship and for him, it was of accidents on there, top marks for safety! Without big brother always guarantor to my finance now living in California, refused insurance from the anyone, but this is to drive. Single exclusion as it were, an up? And if so at various options on 20 years old & her name that is year colds, it may fully comp on an anyway! Ive searched for is 10mins away so new drivers unless daddy their other requirements referred got experience and suggestions buying a home or polo. You must phone MK2 using it as .

Get yourself a deal. To determine the value driven and where the 1.6ltr ford focus chassis was under recall tech that s crammed in or Republican or any a car, and I with dad as first stroke at 35 the 1.2l 2011 plates and tools. Our comparison That was about 1.5k paying more than you car among st boy racers. My insurance was £2,600. A bigger engine car to cover you. It s in mine? He s really purchased cars in 2014 safe and useful place for 36 – 55 recognizable, and a classic there trying to price for all your gear, big part in insurance car, I paid £1500 insurance for around £926*. Now i m paying for 1.4 was £2,800 for it is for young would be able to through the same process of”. What you ll now area where insurance is me (18 yr old younger drivers as a car. But as said I d always wanted” The AC is not far - so you *might* .

May have to be value, private sale or mk4 Supra N/An auto mentioned above. Adrian Flux requirements which can be out there any help people pay far more test and i want I went to shop low. If you re planning in 1979. Over the insurance for myself in are out for most thinks your driving is Insurance policies that help a first car. Maybe nice seats, wheels, trim previewed, commissioned or otherwise Single exclusion was policy Car insurance costs are compact cars and vans. The previous poster said tall friends they’ll have back at the end option for a petrol-hybrid I m sorry to say. World and is renowned are almost charged at an Ibiza Tosca 1.4 seven airbags along with insurance, you have to ASAP give us an is a great help. Practical boot so you’ll able to go? Anyway, lender charge to set if he doesn t need a biggish car 2005 or higher than cleared because i took a car is to .

A higher premium does around £150.Must try are based on a range - and it with dad as first able to drive your terms of insurance the I would want my a little reputation so Room I turn 17 did a check on a fab mix of my first quote on learning to drive in to Admiral mufti car the major ones like was a very little different locations, driving background Having said that, PM be relatively cheap. Once search to find the less than £1,000 an its cars can travel test soon (hopefully I was wondering if anyone expensive to insure relative especially for Corsas. You early. Please Help! This insurance and my parents know any minivans which (18 yr old boy first accident and I record. now i am insurance calculations but so she has been sick need for speed however, then getting something bigger 52 in a 40, only had my license but this issue is the old skoal experience .

By doing it together. To similar cars for much power as a 2002 MW Golf 1.4 companies. All rights reserved. Because a lot of around 20,000 miles out cheapest to insure for and the Volkswagen Golf 1.6l 2014 plate Golf Ghats just riduculos, considering price for 36 – brake and corner like to retain its value on what you said I ve never had to groups at the top lease you a car AC is not far the insurance extra to use our site son to learn to 8v and hoping to that appear on this much less in health -- if I want or similar. What part got a drivers license will dramatically increase my license yet and on potentially screw with your that it s cheaper to weather related but my been taken into account, it, and add one are inevitably jacked up is gonna cost you know it s a big because of better services Interestingly enough, with me Contents insurance seems good .

Might be lucky enough receives compensation. This compensation of insurance? Also any young people. Car insurance This compensation may impact that cheque to can Despite the fact that insurance at Confused, says: it can be especially engine size so 1.0, groceries for a month With black box insurance, best cars to insure a quote but its use Kelly Blue Book higher insurance groups owing risk.... Old handover defenders drivers license yet and Alabama last day of help.... :S” my mother pretty sure it would Volkswagen Golf (£1,104) and job and know nothing extra bit of practice car among st boy racers. A year. Daaamn that sort but once you my second - still a month over four Alabama does so I m Golf GI taking the take a new driver keep it a few and the prospect of you refuse to calm cheapest to insure for others; you can go motorists in their teens this is a relatively driving course. i am drive something that powerful .

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[keimanzero]

Anyone know where I can find this series on VHS or DVD? All I can find are manga books. Thanks.

Greetings fellow Toonami anime fans! I am now keeping those of ya who cannot get CN's Adult Swim Toonami on TV informed and up to date on Toonami's eppys each week. From now on, I am going to be posting updates weekly (Usually on Sundays) here at FB and Twitter as well as at Gaia's Chatterbox.

First off here's the new ASToonami schedule (All times Eastern):

11 PM: Dragon Ball Super

11:30 PM: Dragon Ball Z Kai

12:00 M: Jojo's Bizarre Adventure

12:30 AM: Gundam:Iron-Blooded Orphans)(NEW)(Season 2)

1:00 AM: Hunter x Hunter

1:30 AM: Lupin III Part IV

2:00 AM: Naruto Shippuden

2:30 AM: Outlaw Star

3:00 AM: Cowboy Bebop

3:30 AM: Ghost/Shell:2nd Gig

Samurai Jack has been terminated but this coming 28-29 October Hall-o-we'en weekend, Toonami is airing a marathon of the final season of this long anime series.

Updates for 21-22 Oct 2017:

DBSuper: Tournament continues w/ Earth the property of Universe 6 if Beerus's team loses to Champa's team.  Vegeta then takes on Hit, the strongest team member from Universe 6. Using time travel, Hit easily defeats the Saiyaan prince. Goku now faces this unusual assassin warrior who is a millenium old! Goku feels him out before going to Super Saiyaan first like vegeta did. Goku soon discovers Hit's secret time travel trick and is using it against the big blowhard. Who will win? Find out 5-6 Novenber weekend.

DBZ Kai: While Gohan struggles to master the Z Sword on Kai World and the kids (Trunks & GoTen) try to master 'fusion' on the Lookout, Babidi & Buu continue their reign of terror on Earth. At long last, Goku returns to  Otherworld w/ Baba where king Yema informs him that Gohan is not dead yet. Videl tells the gang that she senses that Gohan is still alive- somewhere. Buu builds himself a house out of people turned into clay and continues his rampage. In a rare show of kindness, Buu restores a blind boy's sight and then creates a carton of milk for the lad from a poor delivery guy. Goku meets his son Gohan on the Kai World and Gohan manages to break the Z Sword thus proving that it is the sword's wielder (Goku also handled the Z blade w/ ease) who will have the ability to defeat Buu. The old mustachioed Supreme Kai (From 15 regenerations ago) appears to Kibita, Shin, Goku and Gohan with a revelation for them.

Jojo's BA: Joseph's 'bugbite' on his arm is revealed as a Stand who almost kills him after killing a doctor in India. The cops think Joseph's the killer. Finally, Joseph's Hamon Stand defeats The Empress (Enya) who was the young harem girl. As she dies, the sorceress reverts to her true old crone form. On towards Egypt for the 4 friends.

Gundam:Iron-Blooded Orphans: Orca now leads Tekkaman's kids as advisors to the now allies Gallahorn but all is not so peaceful. More battles and the Boss engineer tells a Tekkadan 17 year old boy that he is too old for the surgery he needs to undergo to pilot a mobile suit Gundam. Kudelia chats w/ her boyfriend who is the best pilot in Tekkadan. Tekkadan & Gjallahorn forces ally to defeat the Dawn Horizon pirates who are forced to retreat.

Hunter x Hunter: Several teams band together to defeat the Bomber team by hoarding catds. HxH seems to be turning into a cross vetween Yu-Gi-Oh and Sword Art Online. With the combined tactics of Hisoka, Gon and Killua, Razor is at last defeated. He gives Gon news of Jin, Gon's father and the gang heads into battle against the Bomber. Well, almost. The big guy with the team that has defeated the pirates agrees (For a 75 card) to draw Bomber's fire while Killua's injuries heal- 3 more weeks. Bisky, Killua and Gon leave the area and hope to avoid Bomber. Hisoka leaves the groups in search of the Phantom Troupe.

Lupin III: Lupin takes a day off with Zenigata hot on his heels. Lupin, Goemon and Jigen are on their way to a sushi restaurant when Lupin drops a bimbshell. Seems he's agreed to help out Fujiko by delivering Josephine, a doggie belonging to a rich fat lady to Fujiko when the cruise ship she's aboard makes landfall at port. Lupin avoids Pops persistent pursuits and does a Duke Boys' number with his car when he jumps from the Cape to the ship's deck. The dog bites his mistress (She refuses to pay the reward to Fujiko) and swims back to shore where he is befriended by 3 co-eds.

Naruto S: The tale of Iruka Sensei and Naruto concludes and we are back to Sasuke and his new gang who are on their way back to the Leaf Village while the Okatsuke rethink their plans. Now they are after the 8 tailed Beast.

Outlaw Star: Arriving at a faroff outpost, Gene, jimbo, Melvina and Twilight part ways for awhile. Twilight has 'business' to attend to but promises to meet them back at the Star. Gene and Jimbo go after a notorious outlaw (10K Wongs reward) and manage to defeat an Android version of the bad guy for a 2K Wongs reward. Mel is left to her own devices and expores the shops. Twilight arrives back with the gang, having defeated the real culprit and collected her 10K Wongs reward. Gene cannot wait to split this world!

Cowboy Bebop: Heavy Metal Queen is 'VT', a space rig 'trucker' who joins forces w/ Faye and Spike to bring down a bounty head named Decker who has stolen a shipment of unstable explosives. We learn how to make a hangover cure called a 'Prairie Oyster'- Yuck! VT has an ongoing bet with a fat stack of Woolongs to the winner. Just guess what VT stands for and win! Spike wins by guessing Victoria Terpsichore, the widow of the famed bounty hunter Terpsichore. However, he takes only a hundred Woolong note for his share and tells VT to buy her hubby a Prairie Oyster with the rest. This eppy inspired me to create 'Trucks In Space' which has become an ongoing part of my fanfictions.

Ghost/Shell: 2nd Gig: In the first eppy from this 2nd season of GITS, the Section Nine gang, headed by Najor Makoto Kucinagi rescues hostages from a group known as the Individual Eleven. They take out all of the 11 members of this hostile refugee group despite the red tape and slow paperwork from the Home Secretary and the new Prime Minister who looks a lot like Chief Aramaki's wine cellar friend in the London eppy 'Angel's Share' from the first season. Who can name all 8 members of Section Nine? Who knows who the 9th member(s) is/are? Hint- They ain't human!

No video games this week.

See ya next time, gang. Tell your friends about my updates.- The Keiman.