#anesthesia student watches black widow

[thaisibir]

Anesthesia student watches Black Widow, part 4

EKG interpretation in a superhero film? Let’s do it!

On the top left corner of Melina’s tablet, there's an EKG reading for the pig Alexei. EKG/ECG stands for electrocardiogram. An EKG monitors the heart’s electrical activity. Medical professionals are taught and expected to read these rhythms in a variety of settings (ER, ICU, OR, clinic, etc). I’m taking 2 whole semesters on this! Not surprisingly, cardiologists are the experts at reading EKGs. In the OR, the anesthesia provider closely watches the EKG throughout surgery. We look at two things: the rhythm and the rate.

Here’s my breakdown of Alexei’s EKG. I interpret it to be “normal sinus rhythm with 2 premature atrial contractions and possible ST-segment depression.” (I’ll go through one thing at a time)

Rate: Human hearts normally beat at 60-100 beats per minute. Under 60 bpm is called “bradycardia” (heart beats unusually slow), over 100 bpm is called “tachycardia” (heart beats unusually fast). Let's assume human heart measurements; I'm sure that pig hearts have their own standards (which I don't know, I'm not in veterinary medicine). So going by human heart measurements, 66 bpm on Melina’s tablet is within what’s called “normal sinus rhythm.“ Not too slow, not too fast.

Rhythm: Those upward spikes I labeled with numbers are called QRS complexes. That represents ventricular depolarization: the lower chambers of the heart squeeze to pump oxygenated blood to the rest of the body. The spikes seem evenly spaced out for the most part, except for QRS complex #5 and #7. See how they spike earlier than the rest? Those early spikes represent “premature atrial contractions” or PACs. Those mean that the atria, the top chambers of the heart, are squeezing too soon.

Here's a real rhythm strip showing PAC. Note the compensatory pause (the flat line) after the PAC and before the next beat. Also note the narrow QRS complexes. Those tell us that the early beats are coming from the atria as opposed to the ventricles (PVCs have wide QRS complexes). Recognizing these signs was how I determined Alexei’s EKG rhythm.

PACs are not life-threatening. They occur when someone's under stress or consuming caffeine, tobacco, or alcohol. Which leads me to wonder...ummm Melina, what have you been feeding this pig??

As for the ST-segment depression: that could be caused by many things, like myocardial ischemia or side effect of digoxin, just to name a few. I guess Melina’s been treating him with digoxin? Poor pig’s got some heart failure or arrhythmias, maybe? :(

If you were able to follow everything so far, awesome! Give yourself a pat on the back. This is some advanced, graduate-level cardiac electrophysiology.

TL;DR: anesthesia student interprets electrical heart activity of a fictional pig

[chicagoindiecritics]

New from Robert Daniels on 812 Film Reviews: AFI Fest [Reviews]: The Cave, Alan Pakula: Going for Truth, and Desert One

It wasn’t my intention, but at AFI Fest: with films examining Black love, injustice, and outer space—I discovered three documentaries about grief, each occurring in the space of three separate decades. These films demonstrate AFI Fest’s recommitment to critical documentary filmmaking, and they show us at our best, even when we’re usually at our worst.

Nosocomephobia: the fear of hospitals, isn’t uncommon. A dread seeps into the psyche: What could go wrong? But I doubt if many have visited the doctor’s office with fear of a bomb dropping over their heads—knowing they’d have to seek shelter in a series of claustrophobically constructed caves. Not to belittle such anxiety, but they do in Syria. The Last Men in Aleppo filmmaker Feras Fayyad returns with a harrowing story of a team of doctors who represent Syria’s last line of medical defense in The Cave.

While much of Eastern Ghouta has evacuated, amongst the destruction Dr. Amani Ballour and her colleagues hold firm. Because of such, they’re constantly inundated with shredded bodies—victims of the bombing campaign in the country. With limited supplies, they’re often left without answers. Instead, they must adapt and perform at their best. When they lack anesthesia, they use classical music to calm patients during invasive operations. When they dine, the doctors eat popcorn and try to imagine it’s cake instead.

As a woman, Dr. Ballour is constantly questioned by her male patients and even her father through his voicemails: pleading with her to return home and to her garden. She courageously leads this team, holding them together amongst a torn apart terrain of medical emergencies. In the face of war, the religious power structure has been upended: women aren’t stuck to tend the house. The team must also contend with their own PTSD and frayed nerves. Whenever a war plane buzzes overhead, they naturally duck. Sometimes they have a gallow’s humor about the perilous affair, but they’re scared. And yet everyday they return to work, even when they’re unsure if they’re making a difference.

Their powerlessness stems from taking shelter in the subterranean web of caves whenever a war plane flies dangerously close. It’s their only defense. And when Russians turn to chemical warfare, the doctors have even less answers. In a tidy 95 minutes, Fayyad demonstrates why he’s one of the most important documentarians of his generation, recording a tragedy that the world would rather look away from. The Cave like the region, shouldn’t be ignored.

Grief never truly stops, not for those left behind. Harrison Ford can barely form words, squinting away tears when speaking about his friend Alan Pakula. The famed producer and director who shaped works like To Kill a Mockingbird, Sophie’s Choice, Klute, The Parallax View, and All the President’s Men—died suddenly in 1998 when a metal pipe on the Long Island Expressway broke loose and pierced through his windshield. The freakish accident left a cavernous creative hole for loved ones and admirers like Matthew Miele. As a tribute, Miele creates a loving eulogy for the famed director in his poignant documentary Alan Pakula: Going for Truth.

Initially, Going for Truth diagrams the life and personality of Pakula. In a scene like the 1970’s, made up of celebrity auteurs like Martin Scorsese, Steven Spielberg, and Brian DePalma—whose names mean as much on the marquee as their actors—the Sophie’s Choice filmmaker didn’t seek the limelight. Many wouldn’t recognize Pakula if they were sitting beside him. And yet, he directed and produced immaculately fashioned pictures. He also crafted incredible barrier-breaking roles for women, taking a keen interest in developing fully realized female characters. Scores of former friends and associates share memories pertaining to the director, like Jane Fonda, Alec Baldwin, Jane Alexander, Jeff Bridges, Dustin Hoffman, and the aforementioned Ford. Fonda in particular credited Pakula with her incredible performance in Klute.

Each eclectic figure demonstrates the enormous impact the beloved director had on them personally and creatively. Furthermore, interviews with his relatives also shape the emotional tenor: describing how Pakula diverted from sports and more “manly” pursuits condoned by his father, to a life in art. His widow Hannah Boorstin and stepchildren also recount personal remembrances of him too.

And while Going for the Truth certainly serves as a tribute to the legendary director, when employing archival interviews, the documentary becomes a masterclass. With the central takeaway being: filmmakers don’t make movies as Pakula did anymore. They often over-cut when editing, lacking the patience for the inherent drama and emotion of the scene to evolve. The internal psychology of characters rarely flourish in today’s pictures, but they did in his. Part of such is due to Pakula’s unique style, his personal passion for psychology: his hunt for the cinematic. In a discourse taking apart what constitutes cinema, Alan Pakula: Going for Truth is a necessary balm, a touching memorialization of a visionary talent.

On Nov 4, 1979, the Muslim Student Followers of the Imam’s Line stormed the US Embassy in Tehran taking fifty-two hostages. Throughout America’s history, there exists arcs of unbridled confidence and a crisis of conscious: the difference between the idealized visions of World War II and the tragedy of Vietnam. The Iran-hostage crisis marks the latter, and led to one of the most audacious rescue attempts in United States history. The legendary director of Harlan County, USA and Miss Sharon Jones!, Barbara Kopple returns with the incredible and emotionally devastating Desert One—a portrait of heroism even when there’s no clear victory.

Kopple’s newest film sees her return to the politically charged narratives of her past. Moreover, one shouldn’t confuse Ben Affleck’s Argo (2012)—detailing the successful rescue of the Canadian embassy employees—Kopple follows the American ordeal. Desert One features interviews with both the retired Delta Force tasked with saving the hostages, and the former student revolutionaries who stormed the embassy protesting against the brutal dictatorship of the Shah of Iran. She charts the 444 days of the crisis, which witnessed the collapse of Jimmy Carter’s presidency and the creation of a team of special forces soldiers formed for the aforementioned incredible plan.

Anyone with a basic grasp of history knows that the code named Desert One mission ended disastrously. Soldiers flew into Iran during the dead of night, armed with eight helicopters and two refueling planes. They were land on a remote dirt road, board trucks, drive to where they believed the hostage were being held, and then fly out using the helicopters. The plan held multiple moving part, with very little hard intel to back up some of the assertions. At one point, the soldiers are reduced to watching Dateline for solid intelligence. Many believe the mission was a stunt, an politically ailing Carter taking a major risk with American lives in a feigned attempt of being re-elected. Kopple doesn’t parse through that theory with the depth required for the subject. Though, who could blame her? She only had twenty minutes to interview Carter.

Nevertheless, her documentary is actually eulogy to the soldiers. On the fatal night of 24 April 1980, the assembled Delta Force team were given a “Go.” Though they had doubts of the mission success, they still wanted to try. Within a span of few deadly hours, they lost three of their eight helicopters. Needing to abort, in their confusion, a helicopter crashed with a pane, resulting in the deaths of several soldiers. Worst yet, to evade capture they had to leave the bodies of their fellow American soldiers behind. In one poignant clip, days later, children are playing on the blades of one of the fallen choppers. The scene recalls Ridley Scott’s Black Hawk Down, a film about another debacle.

Even so, Kopple’s Desert One isn’t about failure. It demonstrates the valor in trying. Because unlike America, the soldiers that night didn’t experience a metaphorical defeat. They witnessed real grief; the event still drawing tears and anguish from them to this day. And Kopple, in the midst of their mourning, finds the greatest of intimacy in those who’ve lost the most. Desert One is a fitting memorial of courage, even in the face of insurmountable odds.

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[bevioletskies]

20 questions [4/20]

characters: peter/gamora, guardians-centric

fandom: avengers academy/marvel cinematic universe

summary: wasp has a new competition in store for the students of avengers academy, and there’s money involved. so obviously, peter and gamora have to pretend to be a couple in order to win. wait, what?

chapter preview: peter and gamora begin a new game, yondu brings a new scheme into play, and peter has meredith quill feels (same, tbh).

word count: 4958 | total word count: 118k

a/n: this chapter marks the beginning of these two really getting to know each other...my babies ;_;

ao3 | previously | next | masterpost

Gamora woke up to an insistent throbbing in her skull and leg, and the sounds of someone attempting to hold back tears. Alarmed, her eyes shot open, only to find herself staring down an unnecessarily bright light. Groaning, she turned in an attempt to bury her face into her pillow. Wait, this wasn’t her pillow.

“Medbay?” she croaked. She vaguely sounded like Peter the mornings after he’d partied too hard at Club A.

“Oh, Gamora,” Janet sobbed from somewhere on Gamora’s left. “You’re okay, yes, you’re in the medbay. That was super scary.”

“The Sovereign…”

“Gone! Agent 13 was a little genius and managed to confuse them, along with Doctor Strange’s help in manipulating their sense of time and space,” Janet said, waving her hands haphazardly. “Um, but you don’t care about that. You’ve had glass removed from your torso and your leg, but you’ll need the rest of the weekend to heal up and you should be okay. Your body mods are super good on that part, they just gotta help your stitches along.”

“The others?” She managed to open her eyes again. Janet was uncharacteristically wearing all black, and a cold sweat broke out over Gamora’s forehead. “Did...did someone die?”

“Peter’s right there,” Janet said, pointing to the bed next to her. He looked asleep, not unconscious, as his arms were shifting slightly as if he were trying to find a more comfortable position. His entire face, neck, and arms were covered in tiny little bandages. “The others are shaken, bruised, but no real injuries to put them here. Um, a couple of SHIELD agents died in the battle. We’re going to hold a funeral in the quad on Monday once we’ve flown their family in. But no students. You and Peter have the most injuries, but you should both be out by tomorrow night.”

She finally settled down into the chair next to Gamora’s bed and exhaled shakily. “Groot’s a bit traumatized, the poor little thing. The rest of the Guardians are keeping an eye on him on the Milano.” She brightened slightly. “Almost forgot, Natasha sent you this.” Janet pushed an envelope into Gamora’s hands.

Gamora opened it to reveal what appeared to be a generic Hallmark ‘get-well-soon’ card. Raising her eyebrows, she opened the card, where a bank card and driver’s license fell out. On the license was a picture of a woman who vaguely looked like Natasha on it, but the name on both cards wasn’t hers. Scrawled underneath the printed ‘hope you feel better soon!’ was some neat cursive that said “Bank account for some rich widow who owes me a favour. French accent. Only withdraw $10k at a time. Get some new equipment”.

She straightened up a little in her bed, frowning. She tried her best not to look back over at Peter, who had just let out a lazy sigh in his sleep. “I could have done better,” she said. “I have suffered far worse than a bit of glass to my leg.” She pushed the envelope back. “And I’m not taking this.”

“I didn’t think you would,” Janet said with a weak smile. “You are super strong, Gamora. I wish I was more like you.”

“No you don’t,” Gamora said firmly.

“Yes, I do,” Janet said back, a fierceness in her face that she usually reserved for supervillains and people who talked badly about her friends. “Don’t say mean things about yourself! You’re like, the coolest girl in school, you’re super pretty, and you’re the most dangerous woman in the galaxy. One bad mission is whatever, but don’t let anything or anyone get you down. Especially not you.”

Gamora chewed on her bottom lip, considering. “Thank you, Janet,” she said softly. “I am honored to have you as a friend.”

“You should be,” Janet said, suddenly switching back to her cheerful, bubbly self. It was a bit jarring to watch. “Oh, Peter’s waking up!”

A long groan emanated from the bed on Gamora’s right, and she turned to see him laying his forearm across his forehead, only to wince at the contact of his many little bandages rubbing against each other. She could only imagine how sensitive his skin was right now, how long it would take his body to heal itself from all the little cuts while her thigh stitched itself up in a matter of hours.

“G’mora?”

“Hi,” she said, turning onto her side so she could lay her head back down on her pillow. “Are you feeling alright?”

“I’ve got about a million holes in my skin, but I’ve had worse,” Peter said, attempting to shrug. “How about you? When I woke up, you were getting glass removed from your gut - it was super gross - like, the docs had you on some super hardcore anesthesia or something - ”

“I need no details,” Gamora interrupted. “I feel a faint pain in my head and leg, but otherwise I’m already bored of this place.”

“Guess you won’t be able to make your date with Adam after all. Sorry about that,” Peter said, twisting his mouth in sympathy.

“Date with Adam?” They both started slightly, having forgotten that Janet was in the room with them. She was eyeing them both suspiciously.

“He is teasing me,” Gamora said, turning over to look at Wasp. “Adam offered to help me with the equipment at Club Galaxy tonight, that’s all. But I suppose I will be stuck in here all weekend with...my boyfriend...instead.”

“Sounds like a date to me,” Peter said, grinning. Janet smiled back, satisfied with their answers.

“Well, in that case, I’ll leave you two alone,” she said with a wink, getting to her feet. “But I’ll go tell the nurses you’re awake, Gamora. And I’ll let the Guardians know you’re both okay now. Oh, and Fury wants to talk to you guys, so he’ll be in at around 9.”

“Visiting hours are between and 8 and 5 every other Thursday,” Peter called at Janet’s back, but she was already gone. “Damn. I’m really not looking forward to it.”

One of the nurses strolled in briskly, holding a medical chart and holo-tab. “I heard Miss Gamora was awake? Oh, and Mister Quill, Mister Udonta is waiting outside for you, should I let him in?”

“Never mind,” Peter sighed. “Two bad visitors. Can he at least wait til after you’re done checking on Gamora?” he said to the nurse. She nodded, stopping by Gamora’s bedside to pull her bedsheets back and push her hospital gown up.

Peter suddenly turned away, flushing slightly at the sight of Gamora’s skin, feeling very much like a little boy who had never seen a woman before. Granted, growing up alongside the Ravagers, he sometimes saw a little more of women than he should have at that age, but something about seeing Gamora’s bare skin made him remember how vulnerable she must be feeling.

The nurse inspected the stitches closely, checking for any residual bleeding or potential infections. When she was satisfied, she continued pushing the gown further up to expose her stomach. Gamora twitched uncomfortably, crossing her legs despite the fact she was wearing undergarments, grateful that Peter was definitely not looking.

“Whatever your body mods are doing for you, it’s working miracles,” the nurse told her, not unkindly. “You had four broken ribs when you first got here but now? Nothing. We didn’t even have to do anything.” She finished checking over her torso wound, replacing the bandages and gauze, and pulled the hem of the gown back to her knees. “Do you need painkillers?”

“I’m okay,” Gamora said, pausing. “Um, thank you.” The nurse had the decency not to look too surprised, and nodded in response, pressing a small device into her hands.

“Push the button if you need anything,” the nurse said. “I’ll go get Mister Udonta from the waiting room.” After she left, Gamora turned towards Peter, who was still facing the other wall.

“You decent?” he said.

“What?”

“I mean, are you covered?”

“I - yes,” she said slowly, confused, as Peter rolled back around, pushing his bedcovers back to reveal that he wasn’t wearing his hospital gown, on account of what looked like several layers of gauze wrapped around his torso, faintly blood-stained. “Quill,” she said, alarmed. She slowly moved as if to get out of bed, but the stinging sensation in her leg told her it was a bad idea. “Janet didn’t tell me there was more to your injuries.”

“A few shallow slices here and there. I’m gonna have some pretty awesome scars after this,” Peter boasted. “I am hot as hell, though, these bedsheets are weirdly heavy - ”

“Am I interrupting somethin’?” The doors swung open as Yondu strolled in, whistling idly. Gamora’s eyes darted around suspiciously for the yaka arrow, but it seemed to be firmly tucked into his belt without a single twitch. “Why don’t you have your clothes on, boy? Hope you two ain’t getting up to some nasty business in ‘ere.”

“I’m just overheating a little, Yondu,” Peter said, rolling his eyes as he pulled himself around to properly look at the other man. “Is everyone else doing okay? I should probably do something for Groot, the poor guy.”

“Twig’s okay, he stopped cryin’,” Yondu said, settling himself down on the foot of Peter’s bed. “Your sister’s goin’ a bit wild, though. Bug-girl thinks it’s all her fault that he got so freaked out.”

“Oh no,” Peter sighed. “Alright, I’ve gotta make it up to Mantis somehow, too. I mean, everyone, really. Rocket’s probably pissed at me.”

“School seems intent on puttin’ you two up on a pedestal, y’ask me,” Yondu snorted. “I mean, y’crashed and burned about 20 minutes into the battle, but some of them girls seem to find it romantic that you’re the ones stuck in the hospital.”

“That is ridiculous,” Gamora said. “It’s not like we planned this.”

“Sounds like we couldn’t have planned it any better, actually,” Peter admitted. “We could cook up some real good story about how we saved each other’s lives. I mean, you basically got me going again after I first got hit, Gamora, we could twist this a little further, get some sympathy votes?”

“That sounds dishonorable,” she frowned. “Are we not above emotional manipulation?”

“Not when there’s money involved,” Yondu said gleefully, rubbing his hands together. “Is just a little exaggeration, Gamora, nothin’ to worry about.”

Peter sighed. “Is there anything else you need, Yondu?”

The other held up his hands as if to surrender, standing up slowly. “Just checking in. I’ll leave you lovebirds be.”

“Please don’t tell anyone - and he’s gone.” Peter groaned, leaning forward to rest his head in his hands. Gamora tried not to stare too closely at the way his broad shoulders tensed up as he did so. “Well, this weekend isn’t going the way I’d hoped.”

She reached over as best as she could, and he shuffled a little closer in confusion, allowing her to pat him on the hand. “It could be worse. You could be stuck in here with Rocket.”

Peter laughed, then immediately winced in regret, clutching at his bandaged torso. “Yeah, I guess. I mean, you’re probably the best person to be stuck in here with anyways. Drax would unknowingly insult me the whole time, Mantis would just worry like crazy, and I won’t exactly be having interesting conversations with Groot.”

Gamora smiled, nodding encouragingly. “Exactly. After all, I am your best friend. And your fake girlfriend.”

He looked down at her hand over his, contemplating for a moment before he turned his wrist so he could interlace their fingers and squeeze. “Hell yeah.”

______

Yondu was practically skipping up the ramp of the Milano, a spring in his step. He was satisfied to confirm his suspicions - Peter had it bad. Less than five minutes in the room with them, and he was staring at the girl like she put the stars in the sky. No, not even that. Like he would put the stars in the sky for her if she asked.

So, new plan. Instead of having him whining and denying like he was a kid all over again, get the two to date for real. Maybe it would result in some romantic crap Yondu (and let's face it, all the other Guardians aside from Groot and maybe Mantis) would want to hurl at, but it would be a right sight better than Quill mooning after Gamora forever.

“Hello, Yondu,” Mantis said from the weapons rack next to the ramp. She was helping Rocket reorganize everything after he grumbled at her about being too injured to do any heavy lifting. “Are Peter and Gamora alright?”

“Jus’ peachy,” Yondu said cheerily. The girl smiled so widely it made his cheeks twinge in sympathy for hers. “And I got a new idea. You'll like this one.”

“Should we have a team meeting, then?” He nodded, gesturing for her to follow him to the common area.

Drax was fast asleep on the couch, one foot on the coffee table and the other outstretched across the length of the seat, his snores rumbling throughout the cabin. Groot was sitting on his shoulder, nodding off. Rocket was at the table, replacing the bandages on his arm, and as expected, Nebula was nowhere to be found.

“Team!” Yondu barked. Drax jerked out of his sleep immediately, and Rocket yanked his bandage too tightly, cursing under his breath.

“Hi to you too, big blue,” Rocket sighed. “How's Quill and Gamora?”

“Safe and sound,” Yondu replied, settling down in the armchair. “And I have an idea. About them two.”

Mantis stood by the kitchenette, looking both delighted and confused. “Oh, I did not know about this part of the idea. Do tell!”

Yondu glanced around, making sure he had everyone's attention before beginning. “Quill’s been a little out of it lately. He been starin’ at Gamora since they met, but I don't think he's even so much as winked at another woman the past few months. Migh’ not sound like much, but I known him longer than any of you. Means he's in love.”

“He's probably just really getting into being a team leader now, ‘specially since we're known to the public. Doesn't want any bad blood with any of the girls on campus or his reputation’ll go down the drain,” Rocket scoffed.

“But you see that look on his face whenever she's around? Don’t make that face at anyone else.” Yondu grinned as Mantis nodded along. “See, bug-girl knows what I'm talking about. And she knows feelings. I think the best way to get Quill to focus is if he actually dates her for real.”

“Seems like a waste of time to me,” Drax frowned. “Quill needs to find a woman who will dance, like him. Gamora is a warrior, an assassin.”

“Don’t mean she can't learn how to dance.” Yondu had an odd look of delight on his face he usually reserved for big scores of units or rare trinkets. “Listen, all we gotta do is push ‘em both in the right direction. Talk to ‘em about their feelings or somethin’. And maybe, once they stop focusing on this dumbass plan o’theirs and actually date? We won’ have any more mishaps like today.”

Rocket stood on his chair, arms folded. “Surprised, Yondu, woulda thought you'd want them apart, not together.”

“You saw how mis’rable the boy was back when Gamora was talking ‘bout going back to the Cosmic Conservatory? Or when Warlock first got here and he thought she was gonna run off with him? Nah, separatin’ them’s only gonna make Quill sad.”

“He was weirdly passive-aggressive when Gamora and Golden Boy were talking on the comms this morning,” Rocket admitted. “Maybe you've got a point.”

“Can I help?” Mantis said, practically bouncing on the balls of her feet. “As Peter’s sister and Gamora’s friend, perhaps it would be best if I talk to them first.”

“Sure, girlie, but don't go messin’ with their heads or readin’ their minds,” Yondu nodded. “Let’s get this nonsense outta the way so we can get back to the real missions.”

“You are still not a member of the Guardians yet,” Drax reminded him. “You and Nebula have yet to prove yourselves.”

“It’ll happen, don’ you worry,” Yondu said, waving a dismissive hand.

“I am Groot.”

“Don’t give him hope,” Rocket said, moving to scoop up the little guy from Drax’s shoulder.

“Twig believes in me,” Yondu said confidently. “And that’s all I need.”

______

Peter and Gamora ended up sleeping for the rest of the afternoon and evening, Peter because he was bone-tired and Gamora because she honestly had no idea about what to do with her time. Her holo-tab could only keep her entertained for so long as she relayed more details of the mission in her “Academy Girls <3” group chat (created and titled by Janet, of course), her weapons were back at the Milano, and Peter’s presence currently consisted of him snorting in his sleep.

Director Fury’s visit, unsurprisingly, consisted of about five minutes of him giving them a stern dressing-down, and two minutes of him inquiring after their well-being. Oddly enough, he told Gamora that Adam had been by to see them (read: just her), but had been stopped along the way by Yondu.

“Yondu came back?” Peter groaned, rubbing at his temples.

“Any idea what that whole altercation was about?” Fury said, ignoring Peter’s dramatics. Gamora shook her head, confused. Yondu wasn’t the most friendly of people, no, but since when did he have issues with Adam? “Quill, if I’m gonna have a problem with Udonta starting trouble on campus - ”

“It was probably just a misunderstanding, Director,” Gamora said. “We can talk to him after we’re released tomorrow.”

“Good.” Fury stood even taller, satisfied. His hands moved to his hips, causing his coat to flip out behind him, grazing the linoleum floor. Peter suspected Fury’s brain required him to do that move at least three times a day. “You two rest up. I don’t want to be having another chat with you in this room, a week from now, telling you not to be stupid. The Sovereign might be after the Guardians, doesn’t mean you go after them with a ship that isn’t yours. Get the Milano fixed.”

“With all due respect, sir, we don’t really have money?” Peter coughed. “Um, not that I’m asking for it. You’re not my father, sir - ”

“And I’m glad,” Fury interrupted. “Your daddy was a real troublemaker.” He paused. “I’ll see what I can do for the ship.”

“Thank you,” Peter called as the Director swept out of the room. “What’s with everyone not saying goodbye?”

Gamora chuckled softly, turning over on her side to look at Peter. The throbbing sensation in her body had gone down significantly, but the stitches were still sensitive to movement. “I think I’m too awake now. We’ve been sleeping for at least six hours.”

“It’s been a really long day, but it’s somehow only 9:30,” Peter said, glancing at the persistently loud wall clock. “You wanna do something?”

“Like what? There’s nothing here.” She looked around the room to see if there was anything she missed. Sterile white walls, white curtains, a couple visitor’s chairs, their medical charts on the holo-screens staring mockingly back at her. Their tablets and emptied dinner trays sat on the tables next to their beds, which could only provide a distraction for a couple more hours at most. “We could quiz each other for that espionage lab we have on Wednesday.”

Peter let out a whining noise that reminded Gamora of Cosmo when his more dog-like instincts came into play. “That’s boring. We could quiz each other on something else, though. Like, 20 Questions?”

“Is that literally just asking each other 20 different questions?” It sounded mundane to her, but anything would be better than attempting to fall back asleep again. Even though it was relatively easy for her body to shut itself down on command, Peter would probably be tossing and turning all night.

“Yes, but about ourselves,” he said. “Like, our favourite colours, or what book we read recently, or something. I figured it’d also help with the whole fake relationship thing. And if it gets too personal, we can just say we don’t want to answer.”

“Okay. I’ll play.” Gamora did her best to stretch, feeling a dull ache of stiff muscles settling in. “You start.”

Peter was quiet for so long she started to wonder if he had dozed off again. “What’s your favourite part of this school?”

She gaped at him. “You made it sound like you were going to ask easy questions,” she exclaimed, debating whether to throw a pillow at him.

“I didn’t think that was a difficult one,” he protested. “I can ask something else.”

“No, it’s...it’s fine.” Gamora fell silent, contemplating. “I like the different kinds of training we have here. I suppose I’ve gotten too comfortable in my own style of combat and structure since even you managed to con me when we first met.” Peter laughed at the memory. Although it might have been (physically) painful in the moment, he would’ve never guessed it would lead them to where they were now. “What about you?”

“The clubs, obviously!” he said with vigor. “Way more dancing here than at the Cosmic Conservatory, don’t you think?”

“Not sure I see it as a positive thing,” she said teasingly. “Your dancing has increased tenfold since we started going here.”

He smiled. “If you had to pick one non-Guardian classmate to join the team, who would you pick?”

“Danvers,” Gamora said almost immediately. “She is the most powerful person on this campus, as far as I can tell, and her cosmic origins would help us immensely on many missions.” Peter nodded in agreement - that would’ve been his answer as well. “Do you wish that your date with her had gone differently?”

Peter froze. He hadn’t expected that. His date with Carol had been back when he and Gamora barely knew each other, when their relationship was more antagonistic than friendly. The others knew vaguely of the details that had led to it ending poorly, but Gamora knew the least, on account of him just...not wanting her to know. “At the time? Yeah, for sure, but now, I just don't think we would've worked out no matter what I did.”

“Why not?”

“Is that your third question?” Peter countered. She shrugged, unsure if she could even think of twenty. “I dunno, there's just...other factors that make it less likely for me to want a relationship with her. Don't bother with asking what they are, you're just gonna waste a question,” he chuckled as Gamora began to open her mouth. “Alright, if you’re gonna ask me that, then I’m gonna ask you this - do you think Adam has a crush on you?”

She looked so caught off guard Peter almost immediately wanted to take it back. “This is getting more personal than I anticipated,” she commented. “I don't know if he does. We just have a lot in common.”

“Maybe you could try going out with him after we've ‘broken up’. You seem to get along with him way better than you do with us.”

Gamora frowned. “Is that what you think? That arguing with someone less means I like them more? From what I remember of our mission on Ego’s planet, we determined that we considered each other family because we fought so much.”

Peter looked sullen. “I only meant that it'd be easier, than say, if we were actually dating. Alright, new topic, this is getting dangerously close to arguing territory. What's the last thing you and Nebula talked about?”

It took her a moment to answer, still reeling from Peter’s comment. What would they be like if they were actually dating? Disastrous, maybe. As friends and basically co-leaders of the Guardians, they were already rather volatile. As a couple, the delicate balance of their position as students, as members of a galaxy-saving team, as part of a family, would explode. Possibly literally. “Um, we talked about whether it would be worth to teach Mantis more combat and weaponry. Her martial arts skills are admirable but she will eventually need more.”

“So you want Mantis to be a more offense than defense member of our team.” It technically wasn’t a question. “Is that something she asked for?”

“It’s not a matter of asking, though we have her consent to be her teachers,” Gamora said. ��She is a valuable member of our team, despite being very new, and it makes sense for her to use more than her empath abilities. What was the last thing you and Mantis spoke about?”

Peter smiled, and she relaxed a little. Their innocent game was starting to veer into open discussion of emotions and intentions, both things she tended to keep close to her heart. Maybe this was the right direction to bring them back to a light-hearted ‘get-to-know-you’ chat. “So I didn’t really tell anyone this, but as soon as I found out Mantis was basically my sister, I asked Janet for help on what Terran girls liked to do for fun, since I don’t know anything about Mantis’s homeworld or if I would have access or time to get things on other planets. I only vaguely remembered things Mom told me about, but I wanted her to be caught up to modern times, not just, y’know, stuck in the past like me. Janet found this boxset of crafts she got from a bookstore, and I knew it was meant to be for little kids, but it just seemed like something that my mom would’ve done as a girl and something Mantis would want to do now. So, uh, long story short, the last thing I did was teach Mantis how to make friendship charm bracelets.”

She could practically picture it now - with the other Guardians occupied with other personal things, Peter and Mantis had spent Thursday night on the Milano alone. They were probably sprawled out on the couch, enjoying the uncommon amount of elbow room, with Peter placing the box on the coffee table and excitedly telling Mantis about this cool thing that Terran girls liked to do with their friends. Gamora could also imagine Mantis asking Peter how it worked, and then spend the rest of the night weaving together.

One little statement, however, had caught her attention the most. “You think you’re stuck in the past? Just because you like holding onto things from your childhood?”

“It feels that way sometimes,” Peter admitted. “Stark got me a Spotify account and taught me how to make playlists, gave me the newest Starkphone, and yeah, it’s great that there’s been a lot of positive change - socially, culturally, politically - last one’s debatable - and I don’t want to literally live in the 80s - but I always go back to the Walkman, the Troll dolls, the stuff that my mom gave me.”

“If I still had possessions that my parents gave me as a child, I would keep them around too,” Gamora said quietly. “A picture, even. I sometimes don’t remember what they look like. I only remember being told I resembled my father more than my mother.”

He burrowed himself a little deeper into his sheets (he had asked the nurse to switch out his bedsheets for something significantly lighter) and blinked slowly at her. “What do you remember about your parents?” It was barely a whisper.

“I was so young when Thanos took me,” she said, rotating so she was on her back, staring at the ceiling. “I think...I remember my mother being very funny. She was very good at making my father laugh, even though he was a man who did not necessarily like to laugh.” She turned to look over at Peter. “Not that he was an emotionless person. At least, I don’t think so. What was your favourite thing about your mother?”

Unsurprisingly, he answered near instantly, though there was a suspicious glossiness to his eyes that made her worry about her question. She thought back to his wistful nature when she had commented on the picture in his room, and wondered if this was a step too far. “Her heart. She had so much love in her heart - for me, for her big family, for people she didn’t even know yet. Like, a little girl who broke her ankle trying to climb the tree in our backyard. Mom didn’t even ask why or how she got there, just drove her to the hospital and called her parents. Or a tired old woman who yelled at the cashier for being slow, only to realize she left her wallet at home and couldn’t pay for the groceries to feed her sick husband. Mom paid, and bought her a bouquet of flowers, hoping it would cheer them both up. Things like that.” He chuckled softly. “I want to be as good as my mom someday.”

“You’re already on your way, Quill,” Gamora said. “Just a bit more effort into school, maybe? And stop copying my answers, I saw your workbook for multiverse history and it was almost identical.”

He laughed at that. “Fair enough. Alright, last question. I know we’re only like halfway, but we’ll end up with a really messed-up sleep schedule if we continue. Do you like being a Guardian?”

She smiled at the ceiling, picturing the glow-in-the-dark stars of her bunk on the Milano. She could almost connect the dots between the speckles of the ceiling tile in patterns that closely resembled the constellations nearly ingrained in her mind. “Yes, I do.”

a/n: the game is on! who knows what else peter and gamora will want to know about each other ;) also i love yondu so much?? i’m also sort of working on a post-vol.2 fic and not having him around in that one hurts me.

[thaisibir]

Anesthesia student watches Black Widow, part 1

The infamous “Melina makes the pig stop breathing“ scene

The operating room is a mysterious, closed off place to a lot of people, so I’ll let you in on a little secret: that’s what happens during anesthesia.

These drugs make it possible: -an induction agent like propofol +/- a muscle relaxing agent like rocuronium (roc) or succinylcholine (sux)

“Induction” of anesthesia means getting drugs delivered through IV or mask to the brain, where they do their thing. This is what anesthesia providers mean when they tell patients they’ll be “put to sleep.” These induction drugs impair airway reflexes and paralyze muscles, so the patient stops breathing on their own.

Now why the heck would we want to do that? For a few reasons: -if the patient stops breathing on their own, then something else has to breathe for them throughout surgery: airway equipment that’s hooked up to the anesthesia machine. It's easier to place an LMA (laryngeal mask airway) or an ETT (endotracheal tube) down the patient’s throat when they’re knocked out -it's easier for the surgeon to poke around the insides and do their thing (surgery gets grumpy with anesthesia when the patient is not fully relaxed)

The clinical term for the cessation of breathing is “apnea.” You could say that Melina made the pig “go apneic.” Propofol, roc, and sux are very powerful drugs that kick in almost immediately. We're talking seconds, under a minute. What anesthesia accomplishes with drugs, Melina did with Hollywood handwavy mind control.

I can’t do mind control like she does, but here are the induction drugs that are the gold standard for almost every procedure:

I lined them up in order of use: -fentanyl (narcotic) -1% lidocaine (local anesthetic) -propofol (induction agent) -rocuronium (muscle relaxant)

Why do fentanyl and lidocaine go first? Because propofol burns like a bitch through the IV. Patient comfort matters as much as safety. Why does propofol come before roc or sux? Because would you want to be awake and aware as you’re paralyzed, before you drift off into la la land? Hell no.

There’s a method to the madness. This is what anesthesia providers do day in and day out. It’s a big responsibility, but a rewarding one.

As for the question of exactly how Melina’s controlling the pig’s ability to breathe: I bet it’s through the respiratory center at the brainstem, specifically the bottom of it: the medulla oblongata (I love saying that word out loud). The back of your brain is in charge of primitive but very critical life functions, like breathing and heartbeat. And, as you might’ve guessed, anesthetic drugs work at this area.

TL;DR: what I’m training to do for a living involves doing what Melina did to the pig, except it’s with gases and IV drugs, not mind control

[thaisibir]

Anesthesia student watches Black Widow, part 3

Yelena dramatically explains hysterectomy!

Like everyone else, I cracked up when Yelena got "all clinical and nasty" with describing hysterectomy. Alexei had cut her off before she could go on, but let's dive more into the "clinical and nasty," shall we?

Hysterectomy is surgical removal of the uterus. It's a very common gyn procedure with low mortality rate and little complications. Maybe you’ve had family members get this done, or even yourself. I've helped provide anesthesia for plenty of these cases. Vast majority of them are done laparoscopically, which means that surgeons use long rods with cameras at the end instead of large incisions by scalpel. Perks of laparoscopic procedures include smaller scars, less fluid loss, less trauma to skin and fascia, and faster recovery time than open incision.

Laparoscopes insert through the belly, so for the surgeon to get a good view of the working site, the stomach is filled up like a balloon with carbon dioxide. That's called insufflation. This process means many things for anesthesia. Namely we watch out for the buildup of CO2, atelectasis (fancy word for collapse of alveoli, the little sacs in your lungs), and the vagus nerve response that leads to bradycardia (slow heartbeat). Anesthesia’s the one watching the monitors telling us these signs, so we need to tell the surgeon to lower the intra-abdominal pressure if it's negatively affecting the patient (“hey Dr. —, patient’s going brady, can you let up on the IAP?”).

Now let's talk positions (no I don't mean that as an innuendo lol):

Hysterectomy involves a combination of these surgical positions: lithotomy (legs spread) and Trendelenburg (head down). This frees up the lower abdomen/reproductive tract for surgical access, while other abdominal contents push up toward the head. Surgeon calls the shots for what position they want for the patient, and anesthesia handles actually getting the patient to that position.

The remote shown above is how anesthesia controls the head of the bed. As you can see from all the buttons, there are many ways to arrange a patient, and even more procedures that come with their own unique position. To get someone in position for hysterectomy, I would 1) go "leg down" for lithotomy 2) "Trendelenburg" at the angle the surgeon wants (usually pretty steep; surgeon's priority is getting the best access possible, but being head down that much for hours on end isn't very comfortable for the patient. It comes with the risk of pressure point injury and other changes to physiology I have to account for, like increased blood pressure and lower lung reserve, so I keep an eye on the patient).

Hysterectomy comes in many types: total abdominal, partial abdominal, vaginal, hand-assisted, even robot-assisted. It’s usually accompanied with salpingo-oophorectomy (removal of fallopian tubes and ovaries). This operation, as with most, is permanent and has long-lasting effects.

Which leads me to patient consent: anesthesia and surgery can't go forward without it. Part of my future job involves getting consent while interviewing the patient before surgery. We want to be extremely sure that patients are sound of mind and aware of the risks and impact that comes with the procedure. We also respect the right for patients to make their own medical decisions. Which is why the idea of forced sterilization, the Widows having no autonomy or choice in the matter, is particularly awful.

Yelena playing off the horror of it with deadpan delivery is dark humor at its finest.

TL;DR: Yelena gets all clinical and nasty, OR insider perspective gets even more clinical and nasty.

[thaisibir]

Anesthesia student watches Black Widow, part 2

No anesthesia standard monitors for Yelena, apparently ¯\_(ツ)_/¯

Poor Yelena. Red Room docs are about to start an intensive, delicate surgery, and this is how they prep her?? So many things wrong here. No good anesthesia provider would abide by this. Where do I start? (sucks in a deep breath)

-Why wasn't she changed into a gown? -Where's her IV line? How is she going to get medications and fluids to stay asleep, stable, and hydrated? -Where are the chest stickers/leads for EKG? -Where's the finger clamp for pulse ox? -Where's the probe for temperature? -Where's the cuff for blood pressure?

In reality, she'd be hooked up to at least 4 lines before surgery even starts. Then again, these Red Room docs are super sketch and sus. They’re probably not board-certified lol. (To be fair, for movie purposes I get that Yelena doesn't have anything on so she can jump off the table to kick ass right away. Otherwise she'd have to waste time pulling all the lines off.)

This pic shows the monitors that all anesthesia providers must use and assess for every surgery, for every patient. No exceptions. Watching these numbers and waveforms is how anesthesia providers keep patients alive.

A breakdown of anesthesia monitors and what they do: -EKG (reads electrical heart activity) -pulse oximetry (measures oxygen saturation in the blood) -blood pressure (top number is systolic BP, bottom number is diastolic BP, number in parentheses is MAP/mean arterial pressure) -temperature (always in Celsius)

Also, conducting an awake craniotomy without anesthesia is all sorts of ridiculous. Yelena would be thrashing and hollering in pain while the surgeon opens up her skull. Her blood pressure would shoot through the roof from neuroendocrine stress response. The brain is a very vascular organ, with lots of arteries and blood supply, so she’d be bleeding everywhere. That’s all no bueno. She’d be losing blood in buckets, and guess who’s normally in charge of giving fluids and blood products to compensate for the loss? Anesthesia. And they seem to be nowhere in sight.

No wonder the Red Room is a terrifying and horrible place. Someone save this poor girl please. T.T

TL;DR: Having no anesthesia team around for Yelena's surgery is hella dumb.