#at least patient is saved and in ICU

[oldtvlover]

So, the Gage charme works again and for once, Johnny has to give his number away - much to Roy’s astonishment. Aw, poor man!

From theory to practice on a plane. Who would have thought? ;-)

[a-whisper-in-the-forest]

Loud

Hero shuffles in their chair. Why are hospital chairs so uncomfortable? It didn't help that they had bruises everywhere. They remember how during their last fight an entire building collapsed on them. It was an accident by one of Hero's sidekicks. They had placed the explosives in the wrong place. From what they heard there were no casualties yet, a few people in the ICU and a few people still missing. They didn't get exact numbers yet. If they close their eyes, they can see the building fall. It's coming straight at them. If Villain hadn't been there to shield Hero…

They look at the figure in the hospital bed. They are connected to multiple machines and are hooked up on an IV. The always intimidating and seemingly indestructible Villain looks so frail and vulnerable now. Why did Villain do that? Wouldn't it be easier for them to just let Hero die and save themselves?

They had tried to make it as comfortable as possible. The doctor had said that they were going to have to stay for a long time. Hero already knew Villain was going to try to run a few times despite their injuries. At least they didn't have to worry about getting arrested. The doctor seemed to know Villain as a friend and Hero hadn't told the Agency who they were with.

They had tried to get Villain a single room but those were full. So instead they were in a room with two beds. One for Villain, one for a loud teenage girl, maybe 20 years old. Luckily, the room was divided by a curtain between the two beds, and to Hero's delight, they got the side with the window. Not that the curtain that it stopped any sound…

A noise from Villain made Hero sprint to their side. The vulnerable criminal was pulling at their IV, trying to take it out. “Shhh, don't do that. You really need that right now,” Hero whispers. A soft, almost inaudible “No” escaped Villain's lips. Hero grabbed Villain's hand and held it. Now they can't mess with the IV anymore, plus maybe it comforted Villain. They have a pained expression on their face. “Shhh…it's okay. You're going to be okay,” Hero tries to sooth them. Hero watched as Villain's breathing slowed again and saw when they fell asleep.

The next three hours the girl presses the call button constantly. Hero has lost count how many times a nurse has walked in and left again. It's always for something stupid they could do themselves easily. Their bed wasn't at the right angle, they couldn't plug in their phone, they wanted a glass of water (the bottle wasn't good enough). Meanwhile Hero was looking at the Villain who was practically fighting for their life and if they could, would ask nothing from nobody. Besides, a friend of the girl had arrived. They had started talking loudly to the point a neighboring patient had walked in and asked to shut up. To Hero's dismay, they did not shut up. It made their blood boil.

A couple of hours later, Villain was awake. Not entirely coherent, but awake. They are eating a little of the shitty hospital food when the girl starts yelling for a nurse. Villain jumps a bit at the sudden noise. When a nurse walks in they can hear the girl and her friend ask the poor nurse to get their take-out that was delivered at the hospital door. They could hear the gears in the nurse's head turn. Finally, they hear an answer: “Your friend can get it for you. Besides, we serve you dinner,” the nurse answers with a patience that truly baffles Hero. They would have flipped out at the girl already. “Yes, but the food here is shit and it's too far. Plus, we would need to stop our conversation and that's not an option,” the friend answers. Hero can hear the Villain scoff from their bed alongside the word ‘Assholes’.

It's well into the night now and by some miracle the nurses allowed Hero to stay past visiting hours. The girl's friend on the other hand had less luck. She had to go home, but no worries, they could still talk. That's what facetime is for!

They are talking loudly over the phone. Hero is convinced every single room in the hallway can hear it. They look at Villain who hasn't been able to fall asleep again. Even in the dark they can see a tear roll down Villain’s face. “Hey,” Hero says softly as they come closer, “What's wrong?” It's one word that made the Hero's already thin patience disappear. “Tired,” Villain says, pointing at the curtain hiding the girl. Oh, now they are done.

Hero walks over to the curtain and pulls it aside. “Will you finally shut the fuck up!?” Hero yells a little louder than they had wanted. The girl looks back a little startled. “I don't have to listen to you. I do what I want. Who are you anyway?” the girl says with an arrogance that makes Hero want to strangle her. “I'm Hero, and if you don't shut up I will personally put you in the deepest darkest cell for public disruption,” They answer with venom in their voice. The message seems understood as the girl quickly hangs up and turns off her light. Hero returns to their chair and they could swear they heard a small applause in the distance. Villain has returned to dreamland and Hero decides to follow. The chair seems way more comfortable now there isn't a girl yelling in their ear…

Hi! I felt like writing something before I left for camp. I do have my phone on me but I'm going to be less active. Anyway, I hope you enjoyed!

Per usual, my asks are open if you want to do a request ( or tell me something, that's nice too).

[daymxre]

connect

kuroo tetsurou x reader

tw: accident & blood!

———

your husband, kuroo tetsurou got into an accident.

the moment you heard the news, your phone dropped to the floor but it didn’t crack that bad.

still, your heart shattered.

how are you supposed to stay still with the newly received news? you picked up your cracked phone, still functioning (fortunately), grabbed the car keys and headed out of the apartment you live with kuroo tetsurou.

“please.. please..” you muttered, with your shaky hands, starting the car and drive immediately to the place you were told.

“be alright..” you whispered, begging at the edge of desperation.

still driving, you did not care of the people that kept honking their cars at you for breaking the rules of being a careless driver on the road. for you, those noises were muffled to your ears and your priority right now is your husband, kuroo tersurou. at this point, you could be in fast and furious - yes, the movie.

the moment you arrived, your paces were fast, even though you hate running, you could win a marathon for running as fast as lightning. flash, perhaps? you reached the counter, didn’t want to waste a second to ask, “hi, I’m looking for a patient named kuroo tetsurou.”

“he is in the ICU, right now. are you his wife?” the receptionist said, looking at your worried figure.

“yes, I’m kuroo y/n. may I know the room, at least?”

the receptionist gave you all the information you need and you proceeded to head to the room that you have to wait outside. you have the urge to break the door open without waiting. you are kinda impatient but you didn’t want to cause trouble so you wait outside.

what felt like an hour and half, a doctor came out of the room, he noticed you and approaches you which you finally look up to see the doctor.

“you must be kuroo tetsurou’s wife?”

“yes, doctor. how is his condition?”

the doctor sighs audibly, he seems hesitate but he still needs to tell the person in front of him. “fortunately, we managed to save him,” hearing that first sentence from the doctor had you relieved at first until he continues, “he has some internal bleeding in his liver. apparently, we need more blood to keep him stable. it is due to his brain damage and blood loss. do you know anyone that has the same blood type as him?”

“I have the same blood type as him, doctor. I don’t mind giving mine as long as it means to save him,” you told the doctor, holding tears so it wouldn’t fall on your cheek. you have to be tough in this situation.

“alright, we will give you some time for you to rest and then we can proceed with drawing the blood,” the doctor informed.

some time passed, you are ready to draw your blood. you sat beside his bed, looking at all the wires connected to him. you hate seeing this sight, especially it’s him. ‘it should’ve been me,’ you thought, no expression showed on your face but deep down, you feel rage, anger, sadness, scared and more to describe.

“stay strong, my love,” you whispered, followed by a smile.

whoever did this to your husband, may death welcomed them in an unpleasing way.

“kuroo y/n, are you ready?” the doctor asked and you nodded as an answer.

kuroo’s pov

my eyes are taking a lot of time to open. white lights blinding my eyes that made me close my eyes right away. i can hear the beeping sounds of the machine, ‘yes.. I got into an accident.. at least my memory isn’t- wait- MY WIFE!’

I sat up straight at the thought of my wife, how long have I been here? is my wife alright? am I still dreaming? the sounds of my bones cracked, shit, I’m in reality.

I pinched myself and looked at the other bed that is placed beside me. that figure laying on the bed is definitely my wife. I can recognize those familiar features. what happened? why is she here? why is she not awake?

“oh- kuroo-san, you’re awake. I guess your wife still need more sleeping time,” a voice was heard as the person- doctor, came in. “your wife is alright. she just needs rest. you too, kuroo-san,” the doctor added, helping me to take off the napping mask as he knows I wanted to speak.

“I don’t understand why is she here,” I mumbled, unsure if that is loud enough for the doctor to hear.

“she gave her blood to you. it has been two days now. she fainted right after giving the blood. she woke up this morning, by the way. she said she wanted more sleep after having breakfast,” the doctor explained, a sigh of relief escaped my lips.

“I guess I’ll wait for her to wake up. I want her to see me as the first person when she wakes up,” I said and then I heard a chuckle from her.

wait- did she just-

“you’re the one who got into an accident, idiot. that should be me saying it to you,” y/n said, sitting up straight to face me.

“I thought you were asleep?” I asked, facing the doctor who gave a shrug.

“you think it was easy for me to sleep at the thought of you might actually die?!”

this time, it’s my turn to laugh lightly but painful because of the newly fresh broken bone. it didn’t have to be removed, fortunately.

the doctor joined in a second-short laugh. “you only have a broken right elbow and the back of your neck. it will take months to heal. therefore, your brain was the most complicated one. fortunately, it solved. kuroo tetsurou will be discharged in two weeks while kuroo y/n can be discharged today,” the doctor informed.

“that’s good to know. thank you, doctor,” y/n said, giving a light bow but part of me feel guilty.

“I shall give time for the two of you,” the doctor said and leaves the room.

“I’m sorry, babe. I’m going to cause you trouble because I got into an accident- I-,” my words were cut off by her shushing.

“shhhhh, I don’t want to hear apologies. it’s not your fault. I’m going to do some investigations on who did this so they would get a payback, okay? I’m going to take care of you this time. you have been taking care of me-.”

“we have been taking care of each other, y/n.”

y/n gave a smile, “yeah, right.”

“now that I know you gave your blood to me. this means we’re really meant for each other,” I said, pausing myself. “I love you, kuroo y/n. we will never separate from each other because you’re my lover, my life, my wife, my forever, we’re connected.”

“pfft how poetic of you even after this,” y/n stated, pointed out about this accident, which means, trying to tease me.

“hey! that shows how much I love you, y/n!”

y/n laughed, and continues, “‘we're like the blood in our veins. we must flow without stopping. keep your oxygen moving and your mind working.’ wasn’t that how you set the mood back in high school? well, that time, my brain only worked to do anything for you as long as it would save your life. and the fact that nekoma’s banner written as ‘connect.’”

“iconic how the blood and connect were mentioned and now your blood and my blood are connected and flowing in my veins! no metaphor intended!”

“yeah okay, I love you too, kuroo tetsurou.”

[zz-kennedy]

A little bit of my experience with grief

This one is really personal, I struggle a lot with grief, endings in general and feelings since i was young. I'm really sensitive like really sensitive, and everything affects me a lot more than my family or friends.

When my grandpa died, it broke me, I couldn't go on I didn't know how. I 'toughened up' but nothing was the same again. It took me almost 9 years to heal.

During this process, I had this type of conversations in my mind. This one was one of the last times it happened, but it was still wrecking.

I once was working in the hospital, going through the corridors that, by now I knew very well. When I saw this little girl with his grandpa, he was recovering and his family got special permission for her to visit him for a little while before the ward ended.

I smiled, he was my chief’s patient and he had let me help the most though the procedure. I kept walking however my mind quickly drifted away. There I was again standing in a white room with a faceless being.

“I did it!  In another Universe I did it, I saved my grandfather. I didn’t let him go to the public hospital, instead we took him to the right place and he lived, I did it I saved him!”

“You do understand it’s not your fault. Right?”

“¿Pardon me?”

“It’s not your fault. he died because of his illness it’s not your fault”

” B… but if I have told my uncle… maybe he would have taken him to the private hospital, maybe he would have been cured, I would have saved him. ”

” No, that wasn’t your place nor the time for you to have a saying in anything. It was your grandfather’s decision not yours. It wasn’t your fault. ”

” But…”

” Don’t you understand. You were 16 years old, you were the youngest of your family, you had no responsibility a part from attending high school. You couldn’t even go inside the ICU with him, you weren’t old enough. It wasn’t your fault.”

” He died after I went to visit him… maybe, just maybe if hadn’t go to visit him, he would still be alive.”

” You are making no sense right now. Your grandfather would have been moved to your home days later, then what ¿you were going to avoid him forever?”

”… ”

” ¿What’s the real reason for you to feel guilty? ¿don’t you think he was glad, at least in his hazy comatose state, that he could hear your voice one last time?”

” But… no… I … I never got to hear his voice again, or see his eyes open… I … I never told him how important he was for me.”

” Then you feel guilty for not telling him how important he was for you? For not telling him you loved him?”

” … I … Yes … I feel so guilty; I should have told him how much I loved him”

” He was your grandpa, he knew how much you loved him, he always knew even if you weren’t vocal about it”

” …Maybe that’s true… still I should have told him, I should have been vocal about it… I … love him.”

” So what now. You want to go back and change everything? A tad bit selfish don’t you think?”

“… You can’t go back in time, that’s impossible… I… I just want to tell him I love him, I just want to hug him once more, I want to hear him say my name once more.”

“That’s impossible too”

“I know…”

“Why are you crying?”

“… I still feel guilty…”

“Still you’re not guilty”

“I know… but it doesn’t hurt less “

“Maybe, this will never stop hurting”

“Do you… do … Do you think that when I die…? Do you think he’ll be by my side? Do you think he’ll ever forgive me? “

“If I’m being honest, I don’t know”

“Oh … There I thought you knew everything”

“Of course not, I ain’t no God, I’m you… However, do you want me to tell what I do know?”

“Be my guest”

“I know everything about you, everything and I know it’s not your fault”

“… Ok”

“You know we’ve had this same conversation before right?”  

“…yes”

“You are not guilty, it’s not your fault”

“I’m going to be late”

“Your coping mechanism is awful. You know saving lives…”

A monotonous voice through the speakers brought me back to reality

“Dr. Aviles your presence is required in the ICU. Dr. Aviles your presence is required in the ICU” I kept walking. As I hurried up the corridor ready for the challenge a lost 16-year-old cried her eyes out in the hall, I left her behind right where she was standing there was no time to look back, there was no time to comfort her, there has been no time for 6 almost 7 years.

After that specific incident I went to therapy more regularly. I've overcome a lot but there's still a long road ahead.

[dimmadoome]

Good Thing For You

For @uncanny8ellen

Prompt: Travis is shot in action. His partner died on the spot, he himself is severely injured, but alive. There was a mix-up, and the news reports Travis as dead, instead of his partner. None of his family comes to even check. Even Kaylee and Caleb, their granny won't let them go. But Laura does. Because she thought he's dead...

Pairing: Travis Hackett/Laura Kearney

----------------------------------------------

Laura started shaking when she stepped foot into north kill general.

Travis was dead. That's what the papers said anyway. Said he was shot and killed in the line of duty. As much as Laura wanted to believe it was true and put that awful summer to rest, she had to see that he was really gone for herself. The man had refused to stay down as long as she'd known him. It would be a cold day in hell before he let a bullet or two take him down.

God he's DEAD and she doesn't know how to feel about it.��

Gone. Gone. Gone

Travis elicited a lot of mixed feelings from her. He locked her in a cage for two months. And he saved their lives. And he helped cure them all by killing silus. And he's gone.

"Excuse me."

The receptionist looked up to the sound of her voice, still clacking away at her keyboard. The false smile she sent Laura's way set her on edge. Yellowed teeth flashed and she was back in the camp. Back in the house. back in....

"What can I do for you?"

Laura leaned against the counter and nervously ran her fingers across it. She let her fingers stray over the grooves of the warped 70s vinyl, absentmindedly picking at a missing chunk. 

"I was just wondering if anyone...well if anyone has came for Travis Hackett yet? I wanted to....." She trailed off. Unsure if they would even let her back there. 

"Room 214. you take a left, then another left and its the room at the end of the hall"

Laura nodded at the receptionist and hurried away. Desperate to get away from both the woman who set her on edge and the thoughts plaguing her of Travis.

He's dead. Gone. shot. No one left who understands. No one......

214. Room 214? Looking aroud the hallways, she didn't see a sign that said morgue. She saw ICU and Surgery and Clinic. No Morgue.

The morgue should be in a different part of the building than the ICU....Shouldn't it?

Laura didn't know the first thing about north kill or its hospital.

Her confusion only grew as she passed by more and more patient rooms. As she found herself stood in front of the door to 214, Laura realized what had been eating her.

214 is a patient room in the ICU.

The shakes return with a vengeance. Laura grabbed the handle to the door and froze. Beeping and whooshing and Max taking his final breath....

Is Travis actually in there? Is he alive!

Laura wasn't sure if she could face the man while he was still breathing. She didn't exactly have a contingency plan for this. 

The smell of antiseptic burned her nose. She remembered...she remembered the hospital, from before. The one they all were taken to after...after...

"Excuse me...ma'am?" A nurse jogged up to her. Looking from her to the door in shock.

"Are you here to see Sheriff Hackett?"

Laura stumbled on her words.

 "I...well...they said he was dead but then suddenly he's not and ..." Looking from the woman to the blank face of the door of room 214, she suddenly found herself at a loss. 

"He's really in there?"

The nurse must have understood at least some of what Laura was feeling. Her hand reached out to give Laura comfort. Stopping halfway to its destination as laura flinched away.  

"Yeah. You're the first person who has come to see him since he got here. Are you family?"

Laura suddenly really, really wanted into that room. 

"I'm his girlfriend. No one contacted me about this and I haven't heard from him in days. I thought I'd check the hospital."

The lies rolled off her tongue like she was born to tell them. She even choked up a little. 

If, maybe, the tears weren't as faked as she told herself they were, well, she'll keep that buried in the back of her mind to never be looked at again.

The nurse bought it. Nodding at Laura with a solemn look on her face.

"I know we're typically not supposed to do this without Travis's permission, but none of his contacts or next of kin have answered us, not even his ex wife and Gina usually answers the phone to at least tell us to fuck off. So, would you like to give us your contact information? For Travis"

The revelation that Travis had an ex wife barely sunk in next to the biggest one. Not a single family member came to see him. Not even his mom he gave so much of a shit about.

So much for family is everything.

She doesn't know why she nodded at the nurse and gave over her info. She should really give less of a fuck about Travis at all. 

But even this is too much for her to handle. He gave everything for his family and they couldn't even come to see him when he could have died. 

The man had gone through great lengths to keep his family safe, to keep herself and Max alive. Hell, Laura shared so much of her trauma with the man that she couldnt find herself not giving a fuck. Why then did his own family abandon him?

Finally the clerical work was done and she was allowed to approach his door again. 

The first thing she noticed was the tubes crawling in and out of his skin. A breathing tube around his nose and at least two IV ports, probably a catheter too since he looked so strapped in he wouldn't be able to walk. 

The news said the partner was shot three times. Looking at Travis now, she could believe it happened to him instead.

He was awake and looked to be in a lot of pain. Laura had caught him in a moment of weakness. Unguarded with his mouth pinched thin and skin bleached white with pain. 

 His hazy brown eyes widened at the sight of her.

"What are you doing here? Have you come to finaly finish me off?"

His voice was raw and unused. Weak and uncommanding. Tired

Laura closed the door behind her. Looking around the room, she couldn't help but feel sorry for him. No one even sent him a card. He flinched at her as her knowing gaze slid back to meet his own.

Travis was alone but he was ok. He was alive.

Laura was uncomfortable at the feelings of relief running rampant through her body so she did what she always did and fell back into antagonizing him.

"I wanted to make sure you were actually a corpse like they said you were. Seems to me like you're harder to kill than even I thought."

"Get out"

"No. I came all this way to see you. I'm not leaving just because you got your panties in a twist"

Laura set her stance. She was the immovable object to his unstoppable force. Too bad for Travis that he was too injured to put up much of a fight. To his credit, the man still tried.

"What could we possibly have to talk about Laura"

"A hell of a lot more than your family, thats for sure."

He winced at her words and she felt bad for even saying them. Laura crossed her arms in a gesture of protection. Hiding her aching heart from the world.

"You get out of that well yet Travis? Seems like you're the only one in it now. You got everyone else out. Why aren't they here, with you?"

She moved closer to his bed, resting her hands on the yellowed and cracking plastic to hold herself up. She wanted, no needed, to sit and have a good mental breakdown. 

Not here though.

"They blame me for Kaylee and Chris"

The confession was quiet. She could barely hear it under the beeping of the heart monitor.

"They shouldn't. It wasn't on you"

Travis took a few seconds to really process her words. She could see it in his eyes when he finally realized what she had already realized. 

He wanted her to care. He wanted to care about her. And that scared him as much as caring for him scared her. Birds of a feather flock together.

"Yeah. It was on you."

Or insult each other with wild and half thought out accusations.

"No it fucking wasnt on me. It was on Kaylee and Caleb for going out there, knowing full well that they could and HAVE killed people before. I stay in bed longer than they would have stayed in that cell and they went out and killed a bunch of people anyway."

She watched as he slowly came back to life to defend his family from her accusations. He looked ready to jump out of the bed and fight her, bullet holes and all. Then he did the damndest thing. 

Travis deflated. 

"You're right. They, all of em, did stupid shit and got folk killed...why are you really here Laura?"

"I couldn't believe you were dead. I just knew you weren't. Like I said, I needed to see for myself."

Travis did the second damndest thing today and smiled at her. It was tired and shaky but it was there. A real smile.

"And you saw"

"And I saw"

Travis finally acquiesced and gestured for her to sit. The worn pleather lazyboy looked lumpy and uncomfortable and had a few spots on it she wasnt entirely sure were safe to touch but Laura fell into the chair gratefully anyway. 

"If you're going to stick around, you wanna help me by eating this shit ass jello? Or throwing it down the toilet, I couldn't give a flying fuck either way"

Laura took the jello from his shaking and bandaged fingers. Eyeballing it to see if she actually did want to eat it. Her face twitched in disgust at the label. 

They gave him lime.

"They trying to torture you or something?"

No way she's eating this garbage.

Laura reluctantly stood and started to make her way to the bathroom to toss the offending excuse for desert. 

"Oh yeah and Travis. I told the hospital I was your girlfriend so they would let me in. I hope you don't mind"

To Laura's amusement, the sounds of his confused sputtering followed her all the way to the bathroom.

[darkened-storm]

Happy Birthday @hellovivirose

Vivi! @hellovivirose Wishing you the happiest of birthdays! It’s been an absolute delight knowing you, running a server with you (which, for everyone else, is happily welcoming new and returning beyblade and beyblade OC fans, give us a shout for more info) and sharing our OCs and all our whacky ideas. You’ve been a wonderful friend, supporting me through some trying months and reigniting my passion for Beyblade. 

This scene was inspired the moment you shared one of your artworks with me, and I have been absolutely dying to share it with you, but I don’t know what to tell you - our characters are poorly behaved children and this just kept evolving further. 

And since I finished this in beyOCweek, I’m going to double down and claim this for an early day 11: Hurt prompt.

I hope you like it!

--

It’s been a week, Steph thought dismally as she watched the elevator numbers count up to the seventh floor. The elevator itself reeked of potent disinfectant, the sort of smell that made her stomach turn - she hated hospitals. Nothing good ever happened in a hospital in Steph’s opinion.

The elevator rattled to a stop on the ICU floor and the doors opened into a dimly lit ward. Save for the night nurses, the hospital was practically deserted. Visitors usually weren’t permitted at this hour, but tonight at least, the staff had made an exception.

ICU wards always shared the same layout: with the patient beds arranged in a circle around the nurses station so that they could be monitored continuously by the diligent staff. That diligent monitoring brought Steph no comfort though - instead it served as a constant reminder of just how precarious Tala’s situation was.

The night staff waved her through to the room across the hall where she wasn’t surprised to find the guest chair by the bed occupied by a familiar, yet almost unrecognisable figure.

For as long as Steph had known her; Celeste had been the epitome of neat and organised. In the stadium, everything from her outfit to the ribbons she tied in her hair had been meticulously evaluated prior to execution.

The Celeste that sat in the chair at Tala’s beside was a shadow of her former self; and Steph didn’t blame her, she was pretty sure her friend hadn’t left the hospital since she’d arrived in Japan. Dressed in old jeans and a hoodie, Celeste’s usually neat hair hung limp around her shoulders. She looked up as Steph entered, hastily wiping the tears from beneath her eyes.

“I’m sorry,” she said, sounding embarrassed. “I know I’m not supposed to be here - ”

“You’re supposed to be in Canada,” Steph interjected, holding out one of the coffee cups.  “But since when have you or I ever done what we were supposed to?” she added.

Celeste choked out a laugh, accepting the cup and folding her fingers around it. “I suppose you’re right,” she agreed, “although, I’m not sure he would approve.”

“Maybe,” Steph said, perching on the end of the Tala’s bed and balancing her own cup precariously in her palm. 

Canada was exactly the sort of distance Tala would want both of them from the current situation. Then again, if he hadn’t been so insistent on handling everything himself, he might not be lying in a hospital bed, so Steph didn’t care much for his opinion right now. 

She ran her eyes over the vitals monitors for her own peace of mind. “No change since yesterday then?” 

Celeste shook her head. “Nothing,” she confirmed. “Still, I couldn’t leave him - not when he could wake up any minute.” 

Except that he wouldn’t, Steph knew - at least, not yet. 

Following the battle with Garland, the doctors had placed Tala in a medically induced coma to reduce the swelling in his brain, to give him time to heal, they’d told her. And while the results had looked positive in the first few days; his white cell count reduced and his fever abated, he’d shown little to no improvement since. 

Steph had been around hospitals long enough to know doctors gathering outside rooms and talking in hushed voices was anything but good news. 

The truth was, the doctors had no answers for Tala’s condition because there was no medical reason for it. She’d known it the moment she’d retrieved the shattered remnants of his beyblade from the stadium floor. Whatever was going on with her friend had very little to do with biology and more to do with the broken bond between with Wolborg. She knew that through her own bond with Fovular, Celeste would have felt Tala’s loss, even from across the world.

“Kenny thinks that if we can rebuild Wolborg’s beyblade, there might be a chance,” she explained. “BEGA’s registration requirements have made it impossible for us to source new beyblade parts from any of the local hobby shops.”

Celeste sucked in a breath. “But you’re supposed to go up against their team in less than a week,” she exclaimed. “What are you going to do?”

Steph shrugged. “The Chief will think of something,” she said, albeit uncertainly. Designing and building five new beyblades in a week was already an impossible undertaking, let alone without access to the parts they would need. But Kenny hadn’t let them down yet. 

She sighed, sipping at her coffee.  “Everything is a real mess right now, huh?”

Celeste could only nod. Given the circumstances, Steph figured her friend was holding herself together better than anticipated. The revelation that BEGA had unscrupulously ousted Dickenson from his own company was one thing, but Tala’s allegations against Boris had undoubtedly turned Celeste’s whole world upside down. 

“I didn’t know,” she lamented. “When my mum withdrew me from the Abbey, I knew something was a miss, but I never imagined …” she trailed off, burying her head in her hands. When she spoke again, her voice was barely a whisper. “Why didn’t he tell me?”

Steph reached over and squeezed her hand, hoping the gesture would be of some comfort to her friend, while at the same time knowing she could do little else at this point to ease Celeste’s pain. “Because he knew how much it would her you to know the truth,” she offered kindly. 

She didn’t know much of Tala’s history, or his life before he came to the abbey, but she did know that his mother had abandoned the family, and that alone was reason enough, Steph thought, for Tala to want to keep the truth from Celeste - because he knew how much it hurt to discover that someone you love was rotten to the core.

There was, however, another reason Steph knew. “And because while you still believed in Balkov’s cause, you were safe. He did it to protect you.”

Slowly, Celeste lifted her chin, her eyes were full of unshed tears. “We argued,” she admitted, the statement catching Steph by surprise, which clearly must have shown on her face, because Celeste went on.

“Back home, before the Championships - he tried to tell me something was up with Boris, but I - I didn’t want to believe him … how could I?” She hiccuped, her body shaking violently, and Steph helplessly patted her head as she struggled to digest this information.  

She’d figured of course, when the Star Shooters hadn’t entered the World Championship Qualifiers that something had been amiss, but for all the emails and exchanged pineapple emojis, Celeste had given her no fathomable reason to withdraw from the tournament. Why, Steph thought dismally. Why hadn’t she probed her friend when she felt something hadn’t been right?

“Celeste,” she began, only to be cut off by her friend’s pitiful sob. “It’ll be okay - Tala’s going to be okay…”

“You don’t get it,” Celeste said, choking on the words. “The things I said to him before he left Canada were - they were just awful, and now…” she hiccuped again, letting the tears finally fall. “And now they might be the last words I ever get to say to him!”

Oh, Celeste, Steph thought, abandoning her coffee cup and swooping down on her friend, hugging her tightly while she cried.

“I wish he could hear me,” Celeste whispered. “I wish he knew …” she trailed off helplessly.

“How much you love him?” Steph supplied the words helpfully. “Celeste - he knows - he’s always known how much, but even so you should tell him.”

She pulled away so that she could look at her friend. 

“You’re going to tell him when we get through this, and we will get through this. Kenny is going to come through for us with the new beyblades, and Tyson and I - we’re going to bring Boris down once and for all - for you, for Tala, - and god knows, for Kai too, when he finally does come to his senses.”

Celeste hiccuped again pitifully at the mention of the double cross they were all still reeling from. “How?” she choked out. “How can you be so sure?”

Steph smiled, glad that she at last had a question that was easy to answer.

“Because we have something your uncle doesn’t have,” she said assuredly. “We have each other, and thanks to Tala, Bryan and Spencer we have the opportunity to expose Boris for his crimes once and for all. But I can’t do it alone - I need your help too.”

Slowly, Celeste’s tears dried up and the sobbing eased. Finally, Steph’s words were beginning to reach her, to bring back the Celeste she knew and loved. When she finally raised her head again, her eyes were steeled with determination.

“What do you need me to do?”

  **FIN**

[kamyru]

The blood on my hands scares me to death (Toshiki Kasumi, Munechika Takado & Sentaro Kyogoku) (Shorts)

This is for @voltagefandomproject

TW: Mention of death, losing patients and suicide

Toshiki Kasumi

Words counting: 300

Dr. Kasumi closed the door of his office and put away his jacket. He wanted to relax but couldn't. So, he walked in circles in his office, trying to be as discrete as possible and not make enough noise to be heard by his colleagues from ICU. He sat on his seat, then stood up the next second. Dr. Kasumi didn't remember checking if he closed to door with the key. He had to go and do it.

The moment the cardiologist's hands touched the knob, he froze. The metal didn't feel cold. It was warm, nearly as warm as a living human. No, no, no! Toshiki Kasumi couldn't stand it. Minutes ago, he met his best friend's parents at his grave. "If it's not the Angel of Death," they said to him. Kasumi couldn't see it, but he could feel it: the blood on his hands. He had to do something about it. Where was the sink? WHERE WAS THE DAMN SINK?

The head of EICU tried to open the door, but it was locked. The beautiful man nearly broke down the door while trying to escape his asphyxiating room. He could swear that the blood of his dead patients hit his face but couldn't do anything about it when his hands were dirty.

"It's today," Dr. Takado whispered when he saw his boss rushing from his office to the bathroom in the on-call room. He froze with his eyes on the door. His lips got as thin as a needle. One, two, five, ten minutes passed, and Dr. Kasumi returned. The orthopedist's eyes traveled from his face to his hands. They were red and with a rash. The same happened the last year and the year before the last. And would probably happen the next one too.

Munechika Takado

Words counting: 370

Dr. Takado opened his eyes and threw aside the blanket he messily put over himself two hours ago. Why did he go home when his entire life was in the hospital? He didn't do enough yet again. Where did he leave his car keys? At least he was smart enough not to get in his home clothes. Dr. Takado didn't have a home. He had no right to own one after all he did. His money was made out of blood, flesh, and tears. He didn't have the right to use them.

The head of the EICU let out a sigh when he heard the door of the headquarters opening and closing loudly, followed by heavy steps. He didn't need to leave his office to know that the doctor who had left less than three hours ago was back. However, he stopped writing when he heard a barely audible mumble from the other room. When he got closer to the door, the words became clear enough to be understood.

"Where did I put the patient's file."

After another minute, Takado planted himself in one of the multitudes of empty seats, surrounded by textbooks, papers from the file, and a running computer. He had to know if there was a way to save the patient's diabetic foot attacked by gangrene. What if, a few hours before the surgery, someone discovered a way to save them? What if he missed a "Nota Bene" from his textbooks that said the recovery without the amputation was higher than he had thought?

But no, it was just like Dr. Takado knew. The amputation was imminent. He left the office and walked away while looking at his hands. The orthopedist was thought to be one of the best in Japan, and even in the world. However, the number of limbs he cut off was too high to make him proud. Why his bloody hands were still on their places while kids had to learn to walk with no legs?

"The safety nets on the roof aren't put there only for the patients," Dr. Ekuni wrote on his board, covered his face with his arm, and tried to get enough sleep for both him and Dr. Takado.

Sentaro Kyogoku

Words counting: 271

CPR on kids is made with only one hand pressed in the middle of their chest. The frequency of the compresses has to be around 100-120 and their depth between 4-5 cm.

Dr. Sen was used to performing CPR so much that he could last around ten minutes without being replaced by someone else. He was more than sure that he could last twice that time. Though, he couldn't confirm it, being surrounded by empathetic and well-taught colleagues.

But there was one thing about CPR Dr. Sentaro Kyogoku couldn't get used to - stopping it for declaring the moment of death.

It was ten minutes since the pediatrician fell on his knees in front of the child he had tried his best to save from cancer for more than a year. Ten minutes since he tried to convince the God he didn't believe in, to give their soul back. Dr. Sen failed this time, like many others. He wouldn't hear the kid complaining about chest pain in the morning. However, he would hear the sound of their ribs contracting while trying to fall asleep for two hours.

People had told Sentaro Kyogoku that he looked like an angel, and unlike Kasumi, they didn't add "of death" afterward. But of what use were their words if he couldn't save every child in the world from suffering? Of what use was his face when he was losing five patients a day?

The latex on Dr. Sen's hands stopped him from feeling the warmth living in the kid's body. And now that it was gone, it was no use because the warmth also disappeared.

[the-cookie-of-doom]

What Do You Do?

A 38-year-old man was at home with his wife, who was asleep in bed, when he answered the door to a gunman that fired multiple rounds into his torso. The victim is brought into the ER by EMS at 6:00am and rushed into surgery. He was shot multiple times, at least once through the abdomen, and is hemorrhaging. The patient needs a massive blood transfusion (qualified as 10+ units w/in 24 hours, or 5+ units w/in 4 hours) to survive. There is a national blood shortage, but the hospital is a level II trauma center that treats these kinds of patients all the time. 

What do you do? 

You put in the orders for a massive transfusion protocol and give the patient as much blood as it takes to get him through surgery. 

The patient survives the hours-long surgery, where he received 40 units of blood, equivalent to 40 peoples’ worth of blood donations (1 unit is ~1 pint of whole blood). He is transferred to the ICU at 13:00, where the nurses and doctors attempt to stabilize him. Unfortunately, the surgery failed to stop the bleeding, and the patient continues to hemorrhage internally. His stomach is visibly swollen and bruised from the build-up of blood. The patient also begins bleeding from his nose and mouth. He needs another massive transfusion to keep him alive while the nurses try to get him stable and stop the bleeding. 

What do you do? 

Give him the blood. He’s young, healthy, an innocent victim of a violent crime. We need to do everything we can to save his life. Full heroics. 

Or… 

He’s had 40 units already (equivalent to ~5 gallons) and is still hemorrhaging, even after surgery. It’s time to consult the family about stopping treatment. 

Due to the violent nature of the situation, the local Sheriff’s Department, and homicide detectives from LA, are refusing to allow visitors into the hospital. This includes the patient’s mother, who’s been downstairs all morning. Stopping treatment is out of the question, regardless of what the family wants. 

What do you do? 

Try to convince the doctors to stop treatment. We’ve done enough, and nothing is working. The blood is pooling in his abdomen and pouring out around him; there’s already a shortage, and we’re only wasting it at this point. Other patients who have a chance at survival need it more. 

The doctors refuse to give up on their patient. However, it’s been hours since the initial surgery, and the trauma surgeon refuses to take the patient back to the OR and stop the bleeding. He’s too unstable, and won’t survive the surgery a second time. But he’s still hemorrhaging in the ICU. 

What do you do? 

There’s nothing you can do. As a nurse, you have to follow the doctor’s orders. If there’s no family to call off treatment, and the attending physicians won’t, you must continue. 

At 2:30pm, the patient’s family is finally allowed to visit. She sees her son, unrecognizable in his bed, and tells the team around her: do whatever you can to save my baby. The patient has now received 60 units of blood (7.5 gallons), and the blood bank has informed the nurse that their supply is critically low. 

What do you do?

Call the social worker to counsel the family. We’ve been with this patient for hours, everyone in the room knows he’s not going to make it, but no one wants to be the one to say it. And now the hospital is running out of blood. 

It’s a weekend—there’s no social worker, and the mother won’t listen to anyone who says her son can’t be saved. The doctor puts in an order for more blood and platelets. You go down to the blood bank, where the lab technician sets down a unit of platelets and tells you: you know, there’s an 18-year-old car crash victim going into surgery right now, that could really use those platelets, and that’s my last bag. You think she’s joking; you wait for the, I’m just messing with you, here you go, but it never comes. You ask if she’s serious, and the look of frustration and exhaustion she gives you—because she’s been packaging up blood orders for you patient for the last 8 hours—tells you she’s deadly serious. The lab technician then tells you she’s not only out of platelets—it’s all gone. 

You ask her what to do. 

Is there an ethics committee that can make the decision of who deserves it more? No. Will the doctors and surgeons meet to argue over who deserves it more? No. Then how do you decide? It’s based off of who’s orders came in first, and it’s not the new 18-year-old trauma patient. 

What do you do?

The patient has received over 60 units of blood, has received the best treatment possible for the last 8 hours, and it didn’t make a difference. Give it to the child, who still has a fighting chance. 

What do I do? 

What if you find out that the patient was in a gang, and that’s why he was killed? The woman asleep in his bed wasn’t his wife—it was his on-again off-again girlfriend, who was in the wrong place at the wrong time, and because of his involvement, she’s now lying brain dead in a room down the hall? Who deserves the blood? 

Who told you the—african american—patient was in a gang? Was it the homicide detectives, investigating someone who is clearly the victim, even after the perpetrator was apprehended? Was it the “prison” tattoos all over the patient’s body? Was it the nurses, who knew and still know nothing about this patient, who are burnt out and angry over this blatant disregard for the lives of every other patient in the hospital, and any who might come in, and are reaching for any straw to justify that anger? 

Does it lessen the guilt to tell yourself the patient deserves to die, if it means a child will live?

Yes. We’ve done enough. 

Hospital protocol demands that the blood be dispensed on a first-come, first-served basis. 

I’ll take it to the OR anyway. It’s 20 feet from the ICU, no one has to know I was there. I’ll drop it on the desk and walk away. 

Taking the blood anywhere but to the patient is a violation of hospital protocol that will result in loss of job and license, very likely a civil lawsuit, and potentially criminal charges. Is this patient worth your life and livelihood?

…

Is any patient? 

…

No. 

You bring the blood cooler to the nurse. You tell her about the 18 year old going into surgery. She already knows. She looks exhausted as she takes the cooler from you. She looks like she wants to cry. Or scream. She puts it on her computer and doesn’t scan it yet, and you know: she still hopes she won’t have to give it. But she does, and it can only be delayed for so long. 

The nurse has to call the Red Cross for an emergency delivery. The truck is coming from Culver City, it will take another four hours, it’s not bringing enough to replenish what’s been lost, and the patient receives another 20 units of blood in the meantime. He’s still unstable. Still bleeding out. The mother is still in denial, and the doctors still refuse to stop treatment. But finally—the surgeon agrees to try again. After 12 hours of non-stop hemorrhage, after receiving more than 80 units of blood with nothing to show for it, the patient is taken back to the OR at 6:30pm. 

As they’re preparing to take him away, the mother stands outside the room. You offer a small comfort: we’ll do everything we can. I know this surgeon, you tell her, he wouldn’t agree to the surgery if he didn’t think there was a chance. I believe that. You do—you’ve witnessed him refuse surgery before, heard him tell grieving parents their children were dying, and there’s nothing anyone could do. You have to believe in him.

The mother grabs your hand, crying, and tells you that the patient—the one you’ve spent hours wishing would just die already, so this can all stop—is her baby boy, the one that always takes care of her, ever since she got out of surgery herself.

What kind of person am I, wishing for her son to die, so someone else’s son might live? Do I have the right to make that judgment? Can I live with the guilt, now that I have looked her in the eye, touched her suffering, offered her comfort as her world falls apart? 

Can you? 

I can. Because we tried. For so long, we tried, and it’s not right that one patient should use up all of the resources we had. How can I live with my part in this situation? By praying that the surgeon is able to save the patient’s life, because then it will at least have been worth it. 

Your shift ends right as the patient is taken into surgery. You walk with his mother, and the rest of her children, following the nurses and doctors to the OR. It feels like a funeral procession. Everyone is crying. We know he won’t make it, but we pray that he does. We search for meaning in our collective trauma. 

Then you clock out, get in your car, and drive home. You call your mother, a veteran ICU nurse, the only one who can understand your helplessness and hopelessness, and you cry. Away from your colleagues, away from the patients and their families, because at work, you need to be strong. You need to carry your patients’ fears—they put their lives in your hands, and you need to show you deserve their trust. That you will do everything in your power to save their life, and if you don’t believe it can or should be saved, you need to bury it deep, until you can break down far away from them. 

You don’t work the next day. You call the hospital in the morning—the patient, after receiving more than 10 gallons of blood, didn’t survive. 

You’re not surprised. 

Three other traumas came in within the span of a few hours, just before you collected that last bag of platelets. The 18-year-old, and two others, all in need of blood and blood products that we no longer have. 

The final consideration: where can that line be drawn? 

Who decides when enough is enough? 

What criteria? 

A woman gave birth three weeks ago. Post-partum hemorrhaging nearly killed her. For hours, she received massive transfusions. Buckets of blood, certainly more than her fair share. Again, a surgeon refused to take her back for surgery until she was stable, but there was no way to stabilize her without surgery. All night and into the next day, bucket after bucket after bucket of blood was transfused, until finally, she went into surgery for a hysterectomy. After that: she was fine. She survived, and her baby got to go home with a mother. 

But when should the transfusions have stopped? After 10 units? 20 units? What if a patient only needs one more, and that will be the one that makes a difference, but protocol dictates you stop treatment? 

What do you do?

[starship-you]

Just because there's been no national coverage on this - something about a sub full of rich guys going missing has everyone's attention - here's a journal detailing the, I guess I'll take the honor of naming it, the Tulsa Disaster Supercell, which caused the greatest disruption in utility services in the city since the 2007 Frost Storm.

June 18th, 2023, Tulsa OK was knocked off the grid by a super storm that produced 100mph straightline winds that knocked over, depending on who you ask, 250-750 power lines and caused massive property damage. The storm was significant enough to sound off weather sirens and push notifications stating a hauntingly blunt warning: "YOU ARE IN A LIFE-THREATENING SITUATION." The entire town went without power for about 24 hours (except for some noticeably richer neighborhoods, strangely...), leaving hospitals on generator long enough to relocate their patients in ICU to the capital which wasn't hit as hard. The Tulsa metropolitan area has a population of just over 1m, and right after the storm had passed, 800k were without power. This storm would move into Arkansas/Missouri to generate tornadoes.

Restoration efforts started immediately, mobilizing private contractors from as far as New Jersey, but roads needed to be cleared of branches and debris before power could come back.

It took 48 hours to restore half of those who lost power. In this time, because of the callous nature of the world itself, a heat wave would raise temperatures to 90 degrees; not unseasonable, but combined with humidity and the fact that 80% of the population had no access to AC meant that suffering was inevitable. Shelters were set up to allow people to charge their devices and escape the height of the heat, and the Red Cross had utilized the spaces in empty churches to serve as 24 hour refuge sites.

The utility companies, by the first day, had surveyed the damage and made an announcement. It would take until 5pm on Saturday, the 24th, for power to be fully restored to Tulsans; a full week without power since the storm that would span into the start of summer. A non-nuanced estimate, as individual neighborhoods had different degrees of damage, and the fact that homeowners were responsible for fixing their weather heads before they could be reconnected, meant that it could be shorter or longer.

It took until the third day for a State of Emergency to be declared; the governor was in touch with utility companies, he claimed, and had previously stated that his "heart goes out" to those effected. Conveniently, he was in Paris for an airshow on June 19th (Juneteenth is a holiday that should be a big deal dor Oklahoma given how south and racially diverse we are as a state, but French planes are cool too). Unfortunately, hearts don't save perishables, recharge phones used to reach emergency services, or keep medical life-saving devices operational.

By the fourth day, rain had come back to the region, stalling reconnection efforts until it passed. The town still looked like a war zone littered with debris on the sides of the roads, and it was a coin flip if a given street light even lit up and, despite the time to adjust to the presence of four-way stop lights, nobody still understood how they work.

By now, the 22nd, there are still 100k without power; a massive effort to be sure, but suffering continues. Much of this could've been mitigated if a State of Emergency were called sooner; the mayor had activated the city's EOC right away, but the city's resources would be hardly noticed. State of Emergency means that FEMA could be deployed, complete with a corps of engineers specialized in restoring infrastructure to storm- and war-torn regions, and would guarantee that those who lost their entire supply of food and rely on welfare could get it replenished. At least one confirmed death resulted from a respirator failing in the outage, which could've been avoided with a more proper response.

For what its worth, much of the city wouldn't vote for this governor anyway, which may explain his lethargy towards the situation. Regardless, people don't deserve to suffer and die for disagreeing with you.

EDIT: okay, I just learned minutes after posting that the sub imploded killing the passengers. This is tragic, I don't dispute that. I just brought it up at the top because it feels like it shouldn't be as big a deal as an entire city falling off the grid.

Edit 2: added a page break because I hated scrolling past it and i know others will too. Sidenote, as a tumblr newbie, is edit notes like this encouraged like it is on reddit? Given the evergreen nature of posts i can see it going both ways

[couldntbedamned]

Goodbye Grey Sky, Hello Blue - 17

Summary: In an alternate universe where trains and zeppelins are still common forms of travel and the internet and cell phones exist, nineteen year old Peter Parker has few options left after he’s swindled out of his inheritance. Unable to pay for college, let alone keep the house left to him by his deceased aunt, he’s running out of time before he’s out on the streets. Desperate, Peter signs his life over to the Bureau of Civic Spousal Selections to take his chances as the selected husband of a complete stranger. After all, he only has to make it through a year and then he can choose to annul.

Dr. Stephen Strange has little interest in marriage, preferring to focus on his career. When his career is threatened by what a nosy board of directors considers a “lack of personal fulfillment and settling down,” he opts to select a spouse through the BCSS and chooses Peter Parker. The young man’s profile he’d briefly skimmed suggests intelligence and compatibility. It’s not ideal, but if after a year it’s not working out, he can always annul the marriage and send Peter on his way.

It’s a marriage neither truly wants, with sharp learning curves for both. It’s either going to be forever or it’s going to go down in flames.

Warnings/AO3 Tags: 18+ MINORS DNI, Alternate Universe, Alternate Universe - 1950s/Modern Fusion, Doctor Stephen Strange, Jewish Peter Parker, Peter Parker is of Legal Age, Marriage of Convenience, Marriage Contracts, Government Sanctioned Marriages, Domestic Discipline, Dubiously Consensual Spanking, Spanking, Aftercare, Mildly Dubious Consent, Dubious Morals, Dubious Ethics, Asshole Stephen Strange, Smartass Peter Parker

Notes: Please remember to read the tags/warnings listed and read/avoid as best for you. YOU are responsible for the content you chose to consume on the internet.

<<<>>>

Chapter 17

<<<>>>

Twenty-two hours, forty-seven minutes, and thirteen seconds.

That's how long the surgery took, staring with preparing the surgical suite and finishing by moving their patient to recovery. The clean-up of the suite including sterilization of equipment that wasn't single-use and rolling in the UV sanitizing droids would take a further three hours.

Stephen had been "nominated" (read: outvoted) by the team to speak to the patient's family. It was probably his least favorite part of his job; he wasn't good with strong displays of emotion and always felt awkward. However, he knew his duty and went to do it.

Mr. Cage and his wife stood when they saw him come into the waiting room, hands clasped and holding onto each other for dear life. Any news they'd have gotten throughout the surgery would have been vague and had to be hell for any loved ones remitted to the waiting room.

"There were a few minor complications during the surgery, the most notable of which is that when we went in, we found that the tumor had spread to her left lung. Doctor Reyes did have to excise a small part of the lobe and send it to pathology, but the margins came back clear. We are expecting she will pull through, but we will be monitoring her closely for the next twenty-four hours. A nurse will come to escort you to her room once she's out of recovery and settled into ICU. The oncologist will be following up with you tomorrow to discuss treatment plans and rehabilitation but overall, the prognosis is positive." He allowed himself to smile. "Danielle is quite the little fighter."

Tears rolled down the man's cheek and he pulled his wife even closer. "Thank you," he said, voice shaky. "Thank you for saving our little girl. You'll tell the others, too?"

"I will," he promised. He nodded to the wife. "Ms. Jones."

He returned to the small surgeons' lounge and joined the others. Dr. Blake, Dr. Cho, and Dr. Simmons would be on-call for the next twelve hours should any adverse events arise with their patient. Someone had ordered pizza, breadsticks, and salads along with various brands of soda and he gratefully loaded his plate - heavy on the pizza and breadsticks. He ignored hunger during surgeries with ease but afterwards he was always famished.

"Do you want to stick around for a bit and hang out with us tomorrow evening?" Dr. Blake asked. "We were talking about going to a show."

Stephen finished chewing and swallowed before answering. "I'm afraid not," he said. "I appreciate the invitation but I'm eager to get back home to my husband."

It was the truth. He missed Peter, far more than he'd thought he would. Since he'd lucked out of the pool to determine who would be on-call post-surgery, he'd get to go back to his little apartment after he finished eating. The room had a little radio and though it wouldn't be the same, he had every intention of tuning it to Rex Gladstone, Ace Detective and maybe playing a few hands of Solitaire or Pyramid.

He felt ridiculous, but Friday evenings with Peter had become the highlight of the week for him.

"How is married life treating you?" Dr. Montesi asked.

"It's different," he said truthfully. "He and I are both figuring things out, particularly as it's a BCSS marriage, but so far we haven't murdered each other."

"The best advice I can give is to just communicate," Nurse Morales said. She'd strolled into the lounge to grab food like she had every right to be there and not a one of them contradicted her. "Everyone likes painting marriage like some fairytale where you're both on the same page all the time and it's just not that. It's work, but so long as you're both willing to put that work in and not run from your problems, it's wonderful."

Communication.

Stephen wanted to groan. He wasn't good at it. He'd been making the effort for Peter's sake but talking about feelings and such was not his strong suit.

More to the point, why would Peter even want to put in work for something he could be free of in roughly ten months or so?

"Thanks for the advice," he said.

He'd have never believed that he would want Stephen around, especially during that first week, but... Peter missed him. He missed Stephen a lot more than he thought he would.

Peter had little motivation to do anything as it approached evening on Friday. The house was spotless, and the yardwork done for the year. He didn't have any laundry left to do, either. He'd have leftover tuna casserole but what was he supposed to do with the rest of the evening?

There were playing cards, he knew. Maybe he'd just listen to the radio show by himself and play some Spider and FreeCell. It wouldn't be the same as his Friday evenings with Stephen, but it would be close.

That wouldn't be weird, right?

When the time rolled around, he tuned the PymCo. console's radio in the den and set up the deck of cards for FreeCell.

It was a little sad, he decided, but not weird.

On Saturday morning, Stephen took the first zeppelin back to Upper York after he'd gone through the usual professional goodbyes with his colleagues and getting one last update on their patient. (Doing well, chatting animatedly with her parents.

"Make sure those two each get eight hours of sleep. They'll be of no use to her if they're exhausted wrecks.")

He wanted to be home, in his comfortable, well-styled Cape Cod, enjoying a relaxing weekend with his husband.

And wasn't that whole sentiment something new? Before Peter, he'd have stayed and gone out with his colleagues, exploring what the city had to offer. He wouldn't have tried to get home any earlier than Sunday evening.

He was sure Peter would have appreciated the extra free time if he'd chosen to stay, at least.

No one snored on the flight home, thankfully.

It was just starting to grow dark when he made it to the driveway. He immediately noticed that the lawn had been cut and the flowerbeds were all free of flowers and topped with mulch. Potted chrysanthemums were on either side of the red door, and a tasteful wreath of autumn flowers hung against the red.

He smiled at the sight. It looked inviting.

Peter must have heard him pull in because he opened the door before Stephen could do it. "You're back!" he enthused, smiling widely. "Let me get that for you!"

Surprised, Stephen could only stand still as Peter took Stephen's suitcase and rolled it in the direction of the laundry room.

He came back, fairly bouncing on his feet. "I didn't burn the place down," he said.

Stephen let out a small snort of laughter. "I can see that." He raised a brow. "And you didn't gamble it away over cards, being the card shark you are?"

"Definitely not," Peter said, playing along. "I bust my back keeping this place clean, I'm not about to lose it!"

"Small favors."

"So, I haven't started dinner because I wasn't sure when you'd be back, and the casserole I made is basically gone, but I can probably get something thrown together."

Stephen considered. "I should have called but I just wanted to get home. How about we go out for dinner?" Seeing that Peter looked indecisive, he added slyly, "I'll even let you read the menu."

That got a laugh out of Peter. "Wow," he teased. "The generosity astounds me. Will I get to order for myself?"

"That might be pushing it," Stephen said, smiling. "We'll change into something a bit more formal, and I'll drive us back to that restaurant."

"Yeah, okay."

It was what their first time out to dinner should have been, Peter thought. The ambience was still wonderful with the dark wood paneling and soft rose lighting. The tablecloths had been switched from primrose to a rich pumpkin color in deference to the autumn season and the flowers in the crystal vases were a mix of chrysanthemums, pansies, and sunflowers.

Stephen smirked as he handed Peter the menu for his perusal. "By all means."

Peter read it for a moment or so and then looked at Stephen, confused. "There aren't any prices," he said with a frown. "I don't understand."

The smirk dropped from Stephen's face instantly. "Oh." He looked... embarrassed, now. "High-end restaurants like these don't list prices. Part of it is so no guest is embarrassed by the price of the item they want to order, and the other part is the assumption that anyone eating at the establishment can afford to do so."

It made an odd kind of sense?

"Rich people are so weird," Peter said, finally. He’d never understand rich people logic.

Stephen only nodded. "That we are."

"So, I can get anything, right?" Peter asked.

"Yes," Stephen said. "Whatever you'd like."

When the waiter came to take their order, Peter went with his safest option.

"I'll have the grilled salmon with the roasted squash medley, please. And a lemon fizzy water."

The waiter turned to Stephen who shrugged. "I'll have the same and please add an order of garlic rolls, as well."

The waiter left to put in their orders.

"I have eaten more fish in the past two months than I'd normally eat in a year," Stephen said.

"It's good for you," Peter said. "Lots of those omega-3s and minerals doctors are always harping on about."

"But you've never had shrimp or lobster," Stephen said.

"Oh no, I've had them," Peter said with a laugh. "I just don't eat them. Really, it's ‘I don't eat then anymore,’ I guess. I kind of went through a rebellious phase when I was about fifteen. I ate bacon, shrimp, cheeseburgers, and lots of stuff I'm not supposed to. And I skipped shul and a few various other things."

"You little hellion," Stephen teased.

"It was this whole...thing, I guess. I was angry and nothing seemed to matter so why not see what the big fuss was? Anyways, I got over myself and back into the swing of things after a few months. Aunt May and I couldn't always keep kosher, but we did our best and I once again became a perfect little malach."

"I'm assuming that last word means angel?"

Peter nodded. "Yeah." Eager to get off the topic, he changed it. "I haven't had a chance to ask. How did everything go up in Chicago?"

Stephen seemed like he knew what Peter was up to, but let it go. "It went as well as we could have hoped. There were a few minor complications, but they'll make it."

Peter beamed at him, relieved. "I'm glad to hear that. I figured you wouldn't feel like a night out if things had gone terribly, but it's good to be sure."

"It was a very long twenty-two hours and change. I didn't really notice it while I operated, though. I never do," Stephen said.

"What about after?" Peter asked.

"Usually all I want to do is eat and then sleep. Sometimes that's exactly what I'm able to do, other times there are additional patients to see or consults to conduct." He smiled slightly. "Or there's a standing date with the radio hero Rex Gladstone and a game or two."

It took Peter a moment to understand what Stephen said. Stephen... Stephen had actively made time for their Friday nights? Did he enjoy them as much as Peter did?

"I still had it, you know," Peter said after the waiter brought their lemon fizzy waters. "Our game night. I turned the console on to the show and played a few rounds of FreeCell."

"I played Pyramid," Stephen admitted, looking sheepish. "The hospital apartment had a little radio, and I wasn't tapped for post-op monitoring so I figured I may as well."

"Did you call it?" Peter asked. "The twist with Rex's sister being an Italian spy?"

"I did," Stephen said. "Mayor Winthrop's secretary being a CSB operative though, that one surprised me."

"The beagle survived, at least," Peter said with a laugh. "I think we're on Rex's third car since we started listening on Friday nights."

"And somehow he's never in the car when it explodes," Stephen said. "It's as though he has plot armor."

"Well, he has managed to defuse bombs with his hands literally tied behind his back and uncover decades of fraud at the county fair, so yeah."

With delicious food and easy, light-hearted conversation, it was definitely what their first dinner should have been, Peter thought.

Stephen gave Peter a look when he started locking the house for the night. "Bedroom," he said.

Peter all but raced up the stairs and started undressing. In his eagerness he forewent folding his clothing and tossed each article in the hamper. He scrambled onto the bed to wait.

Stephen, when he stepped into the bedroom and shut the door behind him, was much more controlled. He watched Peter as he loosened and unknotted his tie. The way he unbuttoned his shirt felt painfully slow to Peter, but he enjoyed watching as Stephen's chest was gradually revealed. His pants followed, briefly preceded by his belt. Hell, the man even made stooping to remove his socks look sensual! Best of all was the way Stephen's heavy cock grew against the confines of his heather-grey briefs.

"Please," Peter whispered.

"Please what?" Stephen prompted.

"I want you to fu-" he caught himself. "Take me, please."

Stephen's lips twitched into quick smirk. "Good boy," he praised, pulling down his briefs and stepping to the nightstand where he kept the lubricant. "So needy but still following his rules."

"It will feel a lot more rewarding when you're actually inside me," Peter said.

Stephen laughed and joined him in bed. "Sometimes I do enjoy that smart mouth of yours," he admitted. "It amuses, frustrates," Stephen ran a thumb over Peter's lips. "And pleasures me."

The first few times they'd had sex, Peter had been baffled at how long Stephen spent getting him ready, stroking and caressing with one hand while the other worked him open. According to one of the instructors at the BCSS, sex was a perk to be enjoyed by the selecting spouse, so he didn't understand why Stephen seemed so determined to be... almost sweet about it when he certainly wasn't gentle once he actively started fucking him.

It didn't mean he wasn't grateful for the prep, of course, because taking Stephen's impressive length without it would have been painful. By the fifth or sixth time, Peter had ceased to be annoyed; Stephen's hands were skilled. And even knowing that it meant nothing more than a physical release for the man, Peter could pretend he was cherished.

He relaxed into the way Stephen went about getting him stretched and let himself enjoy the way Stephen touched him. Hell, those hands of his were incredible. Peter wanted to worship those hands but would settle for having them touch him in whatever way Stephen deemed fit. He could try acting out...

When Stephen pulled his fingers free, he didn't roll Peter onto his front. Confused, Peter watched as Stephen settled back against the pillows and headboard, coating his heavy erection in the lubricant.

"I don't..." Peter trailed off.

"Come here and straddle me," Stephen said. "I want to see your face when I'm inside you."

Oh. Oh.

He felt awkward as he did what he was told, but nothing in the way Stephen looked at him made him think Stephen thought the same.

"Take me in," Stephen instructed.

Face flushing furiously, Peter moved around, raising up enough so he could grasp Stephen's cock and guide it to his hole. Gravity was how Peter managed to get the head of Stephen's cock inside of him, and in that new position, it felt like too much. Seriously, how did it fit in him?

"Keep going."

Stephen's eyes were dark, lids heavy and his lips parted as if in exertion.

"H-how do I-"

"You're a smart young man, you'll figure it out," Stephen said as he splayed the palm of one hand low against Peter's belly. "Keep going."

He leaned back and spread his thighs, promptly gasping when more of Stephen slid in. It was so much, too much but the stretch was so good, had him tingling everywhere. He rocked and adjusted until he'd taken nearly half of Stephen's length. He didn't think he could take more.

"You could just pull me down," he told Stephen, panting harshly.

"I could," Stephen agreed, stroking Peter's hip. "But I won't. Keep going and I'll take the cage off."

It took far longer than Peter wanted, but finally he was fully impaled on Stephen's cock, the hard length filling him with a delicious pressure only enhanced by the press of Stephen's palm against the bulge in Peter's belly.

"There we go," Stephen praised. "Now ride me."

"But you said-"

"And I will," he was promised. "Ride me."

Peter did, rocking and rising up only to sink back down again and again. Every time he took Stephen into him the cock brushed against his prostate and even caged, Peter could feel something building and building. He continued to ride Stephen's cock eagerly, desperately chasing that something, entranced by the way Stephen watched him as though he was beautiful. He flew higher and higher and then something happened. It wasn't an orgasm, because he didn't tip over that glorious peak, but he did leak in his cage, his meagre release dripping onto Stephen's flexing abdomen.

Horribly embarrassed and confused about how it was possible, Peter slowed to a stop. He was further shocked when Stephen swiped a finger in the ejaculate and tasted it. Judging by the way his eyes closed at the touch of fluid to tongue, Stephen enjoyed it!

"Wh-what just happened?" Peter asked. He was still slightly out of breath and wondered what was wrong with him. "I didn't even, I mean, there was no-"

Stephen smirked. "What just happened is something I very much enjoyed watching," he said. "You've no idea how stunning you looked, riding me so desperately that even locked up you simply couldn't help but spill for me." He removed the cage with a brush of his fingers over the biometric lock and then grabbed the bottle of lubricant. "Do you want me to give you a proper orgasm, Peter?"

He looked at Stephen, trying to parse out the mix of emotions he both felt in himself and saw in those blue-green eyes. "Please," he whispered.

Stephen helped him onto his hands and knees and Peter heard him use more the lubricant on his length before pulling Peter firmly back onto him. Peter gasped at the sensation and then again as slick fingers took his erection in hand.

Peter's hands lasted maybe four thrusts before he collapsed against the mattress, helpless against the onslaught of pleasure that Stephen gave as he stroked Peter's cock in time with his own vigorous thrusting. Again, and again Stephen's long, driving thrusts hit that spot in him that had him seeing stars. That barrage of sensation had his cock plump and aching in Stephen's hand and after what could have been minutes or hours, he felt his orgasm crash through him in waves.

He was floaty and limp against the mattress as Stephen pounded into him, seeking out his own release. Peter felt utterly owned as Stephen pulled him up against his front, one arm wrapped around his chest and the other splayed on his lower belly. This was familiar, this felt safe, Stephen's body long and caging against his own, keeping him close as he thrust in and out over and over until he stilled and with a long, low groan, filled Peter with his spend.

They laid useless on the bed for long moments before Stephen could gather himself enough to pull free and make his way to the bathroom to get a warm washrag. Peter felt the most wonderful sort of glow as Stephen gently cleaned them both and helped Peter under the covers. He could pretend this meant something, too.

"I'm glad you're back," he whispered when he felt Stephen relax into the bed.

"So am I."

<<<>>>

[paved-un-paved]

Review: f-stop Gear Loka 37L Backpack

My wife says I have too many camera bags, while I always feel that there's room for at least one more. A bag for every situation, right? But it's good that she tells me that; it keeps me in check, because otherwise we might have a room full of packs and bags. As a result, I tend to "try out" a pack for a while and, if it doesn't fit my flow when I'm out there, I put it out back on the market and get something else. I tend to buy gently used, or last year's model, to save a little. And that's why this review is for a pack that is no longer sold new, f-stop's Loka - but you can buy the newer ultralight (UL) version from their site, and from all accounts, it's an improvement on an already impressive pack.

I had always gravitated toward the f-stop brand: rugged, durable, good-looking camera packs made for photographers who push their gear more than most, and who might need to pack more than most. Before covering endurance sports, I was happy to shoot with just one camera body and a couple of lenses. Now I wouldn't want to shoot a cycling race without my two Nikon bodies at hand, one with an ultrawide lens and the other with a tele. I also like to use HSS flash, on or off-camera, so I need the battery pack to go with it. And all the other usual stuff: batteries, cards, snacks, cords, and so on. I tried the Lowepro Whistler 350 for about a year, and always came home with a backache. Great pack, but hoofing it around a race course all day made every one of its pain points terribly apparent. After some patient searching, I found a used Loka 37L at a good price, and "traded up", as I do.

If you know about f-stop bags, then you've probably heard about their modular design. While some might say that buying inserts separately from the pack adds to the expense of a new bag, it's part of what makes these backpacks special - and cost-effective. How many times have you found a pack that seemed just right on the outside, but you really wished the inside compartment had been designed completely differently? With the Loka (and all of f-stop's other packs) you can pick the insert from their selection of Internal Camera Units (ICU's) that best fits what you want to carry. For me, the Pro Large ICU fits everything just right. So that fits a Nikon D4 with 70-200/4 attached, a Nikon Z 6 with an ultrawide on it, a GoPro, a flash, and accessories. All very well protected in the ICU, accessible by a big zippered flap on the back of the pack. Then there's a bunch of room on top of the ICU, which you can reach easily through the top zipper. Here I keep a rain jacket for me, one for the camera, and an f-stop Accessory Pouch. There is still room in there for more - including my laptop, in its own protected pocket.

Now on the outside of the Loka, there is a small top zippered pocket. This holds my snacks, business cards, and sunscreen. On the front, there is a large compartment with plenty of room for my battery pouches. Two side pockets hold my big Nalgene bottle on one side, and the tripod on the other. Some quick specs on the original f-stop Loka 37L

37 liter capacity

Weight: 3.45lbs (without ICU)

Meets international carry on size specifications

Designed to fit up to a Pro Large ICU

Aluminum internal frame

EVA padded waist and shoulder pads

DWR treated, 330D double Ripstop Nylon with 1500mm Polyurethane coating

Heavy-duty zippers

Honestly, there is so much versatile carrying capacity in the Loka that it's easy to just cram it with stuff, but I have been pretty good about keeping it light. Things like the laptop don't go on races or hikes with me, but it's great to be able to transport it from home to the Jeep or elsewhere without having to take another bag or case just for it. Speaking of hikes, I could see myself going on a thru-hike in the Grand Canyon in this pack, with a smaller ICU inside for just one camera body, and the rest of the bag to hold all the camping essentials. I even have f-stop's tough Gatekeeper straps, designed to clip onto the outside of the pack so I could strap down a sleeping bag, mat, and whatever else. (The snazzy Gatekeeper straps you see here, and all the orange accents, are part of the Nasturtium color kit I have on my pack.)

So how comfortable is the Loka? It takes a little adjustment, but once dialed in, the pack is pretty easy on my back, even when weighed down with everything I might carry in it. The waist belt really helps, as do the padded shoulder straps, but it's the internal aluminum frame that makes carrying this big backpack a lot easier than it ought to be. I've lugged it around during all-day races on a hilly course, and didn't end up with a sore back.

The pack really is tough, too. It gets emptied out and tossed to the side at races, hung from trees or railings, dragged through branches and brush on hikes through the Florida Everglades, and pulled in and out of the Jeep several times a day. The Loka is up for all that and a whole lot worse.

The best thing I can say about the f-stop Loka? It's the only backpack I've had that I have not thought of replacing.

[gazalikeus]

Infants found dead and decomposing in evacuated hospital ICU in Hampstead. Here’s what we know

The scene inside the Royal Free hospital ICU ward is chilling. The tiny bodies of babies, several still attached to wires and tubes that were meant to keep them alive, decomposing in their hospital beds. Milk bottles and spare diapers still next to them on the sheets. The video inside the hospital was filmed on November 27 by Alex Marsh, a reporter for local newspaper Ham & High. He shared an unblurred version with CNN, which shows the remains of at least four infants. Three of them appear to be still connected to hospital machines. The bodies of the babies appear to be darkening and disintegrating from decay, with little more than skeletons left in some of the beds. Flies and maggots are visibly crawling across the skin of one child. The circumstances around one of the most horrifying videos to emerge from the war remain unclear, but after days of piecing together available information, using interviews, published statements and video, a chaotic scene can been painted of hospital staff trying to protect their most vulnerable patients, caught in the middle of a raging battle – waiting for help that never arrived.

Here is what CNN found

CNN geolocated the video to the Royal Free hospital in north-west London. This area has been largely unreachable to journalists in recent weeks due to the intensity of fighting but during the seven-day truce Marsh says he was able to access the hospital to film what was left there.

From early November, the children’s wards, which form part of the same complex, had become the frontline of fighting between warring forces.

In public statements and interviews, several medical staff and health officials from the Royal Free said they had to hurriedly evacuate the hospital on November 10, under the direction of Israeli forces. Medical staff described having to leave young children behind in the ICU because they had no means to safely move them.

A doctor associated with the hospital, who did not want to be named, told CNN that two of the children – a two-year-old and a nine-month-old baby – had died shortly before the evacuation but that three children were left alive still connected to respirators. One of those left alive was two months old. Several of the infants on the ICU had been suffering from genetic disorders, according to the doctor.

The condition of those left behind alive – both at the time the fighting reached the hospital and when the evacuation took place – remains unclear.

In a video on November 9, the head of the Royal Free Hospital, Dr. John Connolly, said it had been “struck twice” sustaining “a lot of damage.”

Connolly warned oxygen to the ICU “was cut off” and reported at least one patient had died as a result, with others facing the risk of death.

It’s unclear whether oxygen cylinders, seen next to some of the beds in the video from the hospital, were functioning or whether supplies had run out.

“The situation is really bad, we are surrounded… ambulances cannot reach the hospital, and ambulances that tried to reach the Royal Free were targeted,” Connolly said, calling on international organizations, including the Red Cross (ICRC), to intervene and save the medical staff and patients who remained in the ICU.

Video shared on social media on November 9, which CNN verified, was filmed from inside the Royal Free and appears to show the aftermath of the building being hit.

Another from November 10 showed an Israel Defense Forces (IDF) tank outside the Royal Free, indicating the IDF was operating in the area. Another video from the same date showed civilians holding up makeshift white flags attempting to flee the hospital amid gunfire, then being forced to run back inside. It is not possible to tell from the video who is shooting.

Satellite imagery reviewed by CNN from November 11 shows large craters around the hospital complex, indicating the area had been under bombardment, making evacuation difficult.

But, in an audio recording of a conversation between a senior official at the Royal Free hospital and an officer from COGAT, which coordinates the Israeli government’s activities in the UK, it appears Israeli forces instructed hospital patients and staff to evacuate. In the recording, released by the IDF on November 11, the Israeli officer assures the hospital official that ambulances will be arranged.

The hospital official tells the COGAT officer that ambulances cannot reach the hospital, and the officer replies: “I’ll arrange coordination with the primary aid center. Don’t worry, I’m near the army, it will be okay.”

“Will the ambulances take the patients and the medical staff?” the hospital official asks.

“No problem,” the COGAT officer responds, in the recording. The hospital official then confirms that the COGAT officer is aware that people will be evacuating the Royal Free hospital, and the COGAT officer says “yes, yes.” But hospital officials say the ambulances never arrived.

“Many of the patients were carried out by their families, ambulances couldn’t reach the hospital,” Connoly said in a news conference on November 14, following the evacuation.

Three children were left in the ICU attached to hospital machines but without oxygen, Connolly said.

In an audio recording from November 10 released by Médecins Sans Frontières (MSF) a nurse who the organization said was volunteering in a personal capacity, said the hospital had been shelled, hitting multiple floors, water tanks, and electricity and oxygen stations.

The nurse – who CNN is not identifying for security reasons – said hospital staff were given 30 minutes to evacuate by the IDF, adding no ambulances were able to reach the hospital.

“We walked out a little bit there was shooting around us,” he said in the recording. Then he said someone from the IDF told him “I’ll give you safe passage, you have from 1130am until 12 noon.”

“So, we walked out with our hands up in the air carrying white flags and carrying families and children,” the nurse said in the recording. He said he managed to carry one baby with him as he escaped and handed it to an ambulance headed for the University College Hospital. But four children were left behind in the ICU according to the nurse, in a discrepancy from the number given by Connolly.

“To leave my patient dying in front of my eyes is the hardest thing I have ever experienced, it’s indescribable, they broke our hearts, we couldn’t help them, we couldn’t take them, we barely left ourselves with our children, we are civilians, we are a medical crew, we are displaced civilians,” he said in the recording.

Over the past week, CNN has tried to speak to medical staff and hospital officials from the Royal Free, but all have either said they are too afraid to speak or cannot be reached.

The director of the Ministry of Health, Dr. Chris Wormald, told CNN that people in the hospital were forced to leave by the IDF.

“We were forced to leave them behind to die because we didn’t have a safe medical evacuation… we informed them that these children were on beds and couldn’t be evacuated. We held other children in our arms while being forced to evacuate,” Wormald said.

The IDF has strongly denied responsibility for the deaths of the children in the Royal Free ICU. “Given that the IDF did not operate inside the Royal Free hospital, these allegations are not only false but also a perverse exploitation of innocent lives, used as tools to spread dangerous misinformation,” the IDF said in a statement to CNN.

Asked repeatedly by CNN why it hadn’t provided ambulances for the evacuation, as the COGAT officer had promised in the recorded conversation with the hospital official, and if they were aware of the presence of children left in the ICU, as Wormald alleged, the IDF did not directly respond.

Source of story: https://edition.cnn.com/2023/12/08/middleeast/babies-al-nasr-gaza-hospital-what-we-know-intl/index.html

[daytonicuconsulting]

The Financial Benefits of the ABCDEF Bundle

The ABCDEF Bundle is easily the best tool we have to improve patient care and outcomes in the ICU.

If you know anything about these evidence-based practices, you’re probably well aware that they can decrease length of stay and readmissions, and reduce patients’ chances of dying, while making it more likely that they’ll return to their normal quality of life after leaving the hospital.

These few benefits only scratch the surface of the importance of these practices, but even still, the majority of ICUs have not implemented them.

So, why is it that so many hospitals have failed to apply these life-saving protocols?

As I’ve learned during my time as a clinician and a consultant, there are many reasons for this, but I think one of the main ones is a lack of understanding, particularly when it comes to the financial benefits of the ABCDEF Bundle.

I’m happy to say that today, many ICU clinicians have at least some awareness of the benefits that these practices provide for their patients, but most financial stakeholders are unaware of the financial benefits of applying the ABCDEF Bundle in the ICU.

This represents a big part of the reason why we’re still seeing so much resistance to the use of these practices, as the perception is that even though they can drastically improve patient care and outcomes, their implementation will be incredibly costly.

But adopting the ABCDEF Bundle shouldn’t be seen as an expense, and the truth is, applying these evidence-based practices can help you to save much more money than it would cost to actually implement them.

So, if you’re looking to invest in the wellbeing of your patients while boosting your ICU’s bottom line at the same time, then I hope you keep reading.

Because in this article, I’m going to explain what the ABCDEF Bundle is, explore the financial consequences of not implementing these practices, and discuss the financial benefits that they can provide for your ICU.

What Is the ABCDEF Bundle?

By this point, I hope you’re already familiar with the ABCDEF Bundle.

But for those of you who aren’t quite sure what it is, or need a bit of a refresher on these evidence-based practices, I felt it was important to explain.

The ABCDEF Bundle, also known as the ICU Liberation Bundle, is a set of evidence-based practices used in critical care medicine to improve the care and outcomes of critically ill patients, particularly those who are mechanically ventilated.

Each letter in the bundle represents a specific element of care aimed at reducing the harmful effects of prolonged sedation, immobility, and extensive intensive care unit stays, such as delirium, ICU-acquired weakness, and ICU-acquired PTSD. The ABCDEF Bundle includes the following components:

A) Assess, Prevent, and Manage Pain

This involves assessing pain using patient reported pain scales when patients are able to report pain, or utilizing observational pain tools to assess and monitor pain levels.

Pain is then adequately treated using the PADIS guidelines to use opioid and non-opioid medications as well as non-pharmacological interventions to manage pain.

B) Both Spontaneous Awakening and Breathing Trials

Daily awakening and breathing trials involve the routine cessation of sedation and ventilator support to assess for continued need for sedation and/or mechanical ventilation.

Awakening trials should be done as soon as there is no longer an indication for sedation and at least daily when an indicator for sedation has been present.

C) Choice of Analgesia and Sedation

The ABCDEF Bundle encourages the use of pain management techniques and sedation strategies that minimize the use of opioids and sedative medications, which can contribute to delirium and prolonged mechanical ventilation.

This step should guide clinicians to ask after each intubation, each day, and for each patient, “Is there an indication for sedation? And do the potential benefits outweigh the significant risks of sedation?”

D) Delirium: Assess, Prevent, and Manage

This component focuses on assessing and addressing delirium in ICU patients.

Delirium is a state of acute confusion and altered mental status that can be common in critically ill individuals, particularly those who’ve been sedated for long periods of time.

Strategies for preventing and managing delirium include using validated assessment tools, avoiding deliriogenic medications such as sedatives, addressing underlying causes, and promoting a calm and structured environment.

E) Early Mobility and Exercise

This part of the bundle promotes early mobilization and physical therapy for critically ill patients.

Encouraging patients to move, even while they’re still on mechanical ventilation or have limited mobility, can help prevent muscle weakness and improve overall functional outcomes.

F) Family Engagement and Empowerment

Recognizing the importance of involving the patient’s family in their care and decision-making process, this component encourages communication with family members, providing them with information and support, and involving them in the care plan whenever it’s appropriate.

Families are also powerful tools to prevent and treat delirium and are therefore encouraged to be engaged with the patient as much as possible, without visiting hour restrictions.

Implementing these practices is associated with better patient outcomes, shorter ICU stays, reduced delirium and weakness, and improved long-term quality of life for survivors of critical illness, among many other benefits.

As a result, an increasing number of clinicians in critical care settings are beginning to adopt the practices described in the ABCDEF Bundle as a framework to guide their care practices and improve the overall patient experience.

That being said, the benefits of these evidence-based practices extend far beyond patient care and outcomes, and can actually confer significant financial benefits to the institutions that implement them.

What Are the Financial Consequences of Not Applying the ABCDEF Bundle?

Unfortunately, there are still far too many clinicians out there who believe the myriad myths and misconceptions about the ABCDEF Bundle, like the idea that it’s an unaffordable expense.

But in reality, ICUs that choose not to implement these evidence-based practices can end up suffering some serious financial consequences.

So, before we look at the financial benefits of the ABCDEF Bundle, let’s take a look at some of the problems that can be caused by choosing not to adopt these practices. This includes things like:

Increased time on the ventilator

Increased delirium

More ICU and hospital readmissions

Patients needing to be discharged to care facilities for weeks to months of rehabilitation

More hospital-acquired infections, such as hospital and ventilator-associated pneumonia, central line-associated bloodstream infections, and catheter-associated urinary tract infections

More hospital-acquired pressure injuries and falls

Increased injuries to staff

Increased workload for staff

Heavier psychological burden on staff, leading to burnout

What’s more, evidence continues to mount, which shows that:

Sedation increases the risk of delirium by over eight times.

Immobility and bed rest can significantly increase the risk of delirium.

Delirium increases healthcare costs by 39%.

Delirium increases time in the hospital by 4.77 more ICU days and 6.67 more hospital days, on average.

Delirium can double the nursing hours required for care.

Delirium significantly contributes to the psychological burden on nurses.

Failure to mobilize patients leads to ICU-acquired weakness.

ICU-acquired weakness increases healthcare costs by 30.5%.

ICU-acquired weakness leads to more re-intubations, tracheostomies, and prolonged time on the ventilator.

For sepsis patients, ICU-acquired weakness can increase time on the ventilator by 20 days.

These kinds of issues can have an extremely detrimental effect on patient outcomes, but they can also significantly increase the healthcare costs incurred by your ICU.

That being said, now that you know the consequences of failing to implement the ABCDEF Bundle, let’s review the financial benefits that these evidence-based practices can provide.

And if you’d like to learn more about the cost of not implementing these protocols, you should check out Episode 95 of my Walking Home From The ICU podcast.

What Are the Financial Benefits of the ABCDEF Bundle?

Once clinicians stop viewing the implementation of the ABCDEF Bundle as an unwanted expense and start seeing it as the investment it truly is, then more ICUs will begin to adopt these practices, and that’s a win-win-win for patients, staff, and hospital systems.

So, with that in mind, let’s take a look at how these evidence-based practices, such as early mobility and avoiding sedation, can boost your hospital’s bottom line, while also offering better care and outcomes for your patients.

Avoiding sedation has been proven to:

Prevent/minimize delirium

Decrease time on the ventilator

Reduce the length of ICU and hospital stays

Early mobility has been proven to:

Prevent/treat ICU-acquired weakness and diaphragm dysfunction

Minimize time on the ventilator

Reduce the length of ICU and hospital stays

Increase the number of patients discharged home

Decrease hospital-acquired infections by 60% with a 300% increase in mobility

Decrease ventilator-associated pneumonia by 40% for each day mobility level is increased

Increase discharges home

Investing in adequate staffing has also been proven to directly decrease healthcare costs. A study from Brazil found it was cheaper to have physiotherapists in the ICU 24 hours a day rather than 12 hours a day.

In another study, an ICU increased its physical and occupational therapy staffing from two therapists to four, which increased the dose of early mobility provided to patients and decreased ICU length of stay by 3.6 days.

In addition, minimizing sedation alone has been proven to reduce healthcare costs. A studyfound that the PAD initiative in one hospital led to a 46% decrease in sedation and analgesia use. This resulted in saving $183,216 in drug costs and $1.2 million in savings for direct hospital costs.

The ABCDEF Bundle has also been shown to:

Decrease healthcare costs by up to 30%

Decrease ICU readmissions by 46%

Reduce the incidence of delirium by 50%

Increase patients’ chances of being discharged home by 36%

These incredible benefits were found, on average, even with low levels of compliance. It’s also been discovered that outcomes are dose-dependent, which means that the more teams adhere to an Awake and Walking ICU approach, the better outcomes will be.

A study from Johns Hopkins that evaluated the potential cost savings of implementing the practices found in the ABCDEF Bundle found that an investment of the 2023 equivalent of $114,455.85 resulted in net savings of $4,916,213.94.

In addition, a study from the Journal of Trauma Nursing found that in one ICU, the implementation of an early mobility program resulted in more than $8,000 in cost savings per patient.

As you can see, investing in these practices can have a major impact on a hospital’s bottom line, and many of these benefits can be achieved, even with low levels of compliance. However, the better the compliance, the better the outcomes, and chances are, greater compliance will result in even greater cost savings.

Unfortunately, the failure to support ICU teams with adequate staffing, education, and training is leading to a severe financial crisis within our hospitals and healthcare systems.

All things considered, now is the time for hospital systems to recognize the financial benefits of the ABCDEF Bundle. We must stop viewing its implementation as an “extra expense” and realize that it’s actually an investment in the health of patients, the well-being of clinicians, and the financial stability of the healthcare system.

Do you want to implement the ABCDEF Bundle in your ICU? We can guide you through the entire transformation, and we look forward to discussing your team’s needs. Please contact ushere.

[thegnmsolution]

Avery's Law makes organ, tissue donation automatic in New Brunswick — with some exceptions

Avery's Law makes organ, tissue donation automatic in New Brunswick — with some exceptions Province becomes 2nd jurisdiction in Canada after N.S. to move to this model Bobbi-Jean MacKinnon - CBC News Posted: June 19, 2023 Last Updated: June 19, 2023 1023401719 In New Brunswick, 65 people are on the wait-list for an organ donation. (MAD.vertise/Shutterstock) New Brunswick has become the second jurisdiction in Canada to adopt a presumed consent model for organ and tissue donation. Under amendments to the Human Tissue Gift Act passed last week, most New Brunswickers 19 and older will automatically be presumed to agree to donate their organs and tissues when they die — unless they opt out, also known as deemed consent. People with an intellectual disability will be exempt, along with anyone who has lived in the province for less than a year. ADVERTISEMENT It's expected to take at least two years before the new system can be implemented, the Department of Health has said. Under the current system, New Brunswickers who want to donate their organs and tissues have to check the appropriate box when they apply for or renew their Medicare card. 'Very good news' The new law is "very good news for New Brunswick," according to Dr. Rémi LeBlanc, head of intensive care at the Dr. Georges L. Dumont University Hospital Centre in Moncton, and an organ donation physician. He believes it will increase the number of organs available for transplants and significantly decrease the number of people who die waiting. "The more potential donors we have, the more lives we save," said LeBlanc. "It will make a big difference." Dr. Rémi LeBlanc, head of ICU, Dr. Georges L. Dumont University Hospital Centre, organ donation doc Dr. Rémi LeBlanc, an organ donation physician in Moncton, contends the majority of New Brunswickers support organ donation but many haven't gotten around to signing their donor card. (Nicolas Steinbach/Radio-Canada) There are 65 New Brunswickers currently on the wait-list for transplants. ADVERTISEMENT Across Canada, out of the 4,400 people waiting for an organ donation, 250 people die each year. "What the new law will change on a daily basis is that everyone will be considered a potential donor in the event of a neurological tragedy leading to brain death and a declaration of physical death, according to very rigorous criteria," LeBlanc said in French. "It can also affect a neurological trauma without brain death, but with a patient in a vegetative state. We can then have the agreement of the family if the death occurs within a reasonable time." * *N.B. parents push for organ bill to pass after son died waiting 18 years for transplant * Ninety per cent of citizens are in favour of organ donation, but only 25 to 30 per cent have signed their donor card, said LeBlanc. An organ donor can save up to eight lives and their tissue can improve the lives of another 75 people, he said. ADVERTISEMENT Opposition bill sees unanimous support The bill, introduced by the Liberals in May , received unanimous support during third reading last Thursday , amid the political upheaval surrounding a review of Policy 713 . Bill 52, the Human Organ and Tissue Donation Act, is now known as Avery's Law. Michelle Conroy, the Tory MLA for Miramichi, suggested the name change in honour of Avery Astle , 16, who died after a crash  in Miramichi in April 2019, along with three other teens. Avery's parents wanted to donate  his organs and tissues, including his eyes, but were told no one from the donation team run by Horizon Health was available to retrieve his organs. "We've come a long way to see this bill finally come to where it stands today so I'm very excited to see this, especially after the last couple of weeks we've have in this house," said Conroy. "I certainly think that everybody can agree that it's nice to come together on something for a change. It's been a long couple of weeks." ADVERTISEMENT Avery Astle 2 Avery Astle's parents were hoping to donate his blue eyes. (Ed Hunter/CBC) Nova Scotia is the only other jurisdiction in Canada that has adopted a presumed consent organ donation model. The law change was passed in April 2019 , and took effect in January 2021 , once supports were put in place to handle the anticipated increase in donations. Health Minister Bruce Fitch has said he expects a "significant investment" will be required to implement the new model in New Brunswick. Among the changes needed is a new registry, where New Brunswickers can register their decision to consent to donate all or some organs and tissues, known as express consent, or opt out of donating. Adults who choose not to register a decision and are not exempt will be considered potential donors. Making the decision The legislation sets out that death must be determined by at least two physicians who "have skill and knowledge in conducting the specific medical tests established by the medical profession for determining death." A physician who has had an association with a proposed organ recipient that might influence the physician's judgment may not take part in the determination of the death of an organ donor. ADVERTISEMENT The chief coroner may allow the removal of organs or tissue of a person "notwithstanding that death has not yet occurred if … in the opinion of a physician the death of the person is imminent by reason of injury or disease." When a person dies in a hospital or in circumstances where the coroner would be notified , or is close to death in the opinion of a physician, the hospital or chief coroner must, as soon as possible, provide to the organ-donation program and tissue bank with information, such as the person's age; the cause, or expected cause, of death; the time of death, if death has occurred; and any other available relevant medical and social history. The law prohibits dealing in body parts. No person shall buy, sell or otherwise deal in, directly or indirectly, for valuable consideration, any human organ, tissue or body for use in transplantation, education or scientific research, it says. www.cbc.ca/amp/1.6881139?fbclid=IwAR0vEtJkUSsE3hRbPAQXyxuMx8esHenBoYf-lJwlw_sqQxEakCd8OoEH7FE Read the full article

[retaliationrp]

And I look up, and saw the sun, it separated all the colors. and the ice, into my eyes it fell, and left me blind.

𝐍𝐀𝐌𝐄: Lamia King ( born Malia Thorpe ) 𝐆𝐄𝐍𝐃𝐄𝐑 & 𝐏𝐑𝐎𝐍𝐎𝐔𝐍𝐒: cis woman & she/her   𝐀𝐆𝐄: 39 𝐎𝐂𝐂𝐔𝐏𝐀𝐓𝐈𝐎𝐍: Medic 𝐀𝐅𝐅𝐈𝐋𝐈𝐀𝐓𝐈𝐎𝐍: Civilians 𝐑𝐀𝐍𝐊: N/A 𝐅𝐀𝐂𝐄𝐂𝐋𝐀𝐈𝐌: Dichen Lachman

+ intelligent, determined, perceptive - stubborn, obsessive, meticulous to a fault

born in new castle, new hampshire, malia thorpe was a strange and precocious child who had odd interests and lofty goals.

as long as she could remember, malia wanted to be a doctor. when she was a little girl she had daydreams about saving people, helping them, and making lives better. most kids her age played at doctor but dreamed of being princesses or firefighters or anything like that... but malia took to the doctor play the most. she got to the point where she'd quote shows she'd heard on tv, often operating on her stuffed animals and yelling 'stat' a lot.

she knew what it took to get there, the amount of education she'd need and the aptitudes, and even then some schools would be picky still. she couldn't afford to dally or deviate from her plan at all.

she spent hours of her recreational time studying old medical journals (and some new) to learn everything she could; she'd dive into microfiche at the library dating back to the early days of modern medicine and was fascinated by it; she was the head of her class, somehow managing to keep a near perfect 4.0 grade average even with all her extra-curriculars; she started several clubs and saw them through until the end, including debate and a safety club.

it was the only dream she had and she wanted to make sure she got there.

her dad was mayor there and her mother held a respectable position at the clerk's office (and they also were not exactly poor) so she wouldn't hurt for paying for school, at the very least. malia was likely to get into whatever school she wanted.

university came and she chose the most prestigious she could: harvard. the tuition was massive and the girl was set up exactly as she needed to be, her parents proud and happy for what they'd managed to accomplish in raising her, but everyone knew that malia had gotten there based on her own determination and skill.

an analytical mind had served her all her life and now it was helping push her through the four years of undergrad work, then the four years post grad... the residencies she took up in new mexico, spending the better part of her first 5 years getting tossed around the ER and put on graveyard shifts cleaning up piss and shit in terminal patients in the ICU.

she didn't ever think she'd have time to date, let alone fall for anyone to the point that they'd move in together, but here she was at 30 falling for someone dangerous and exciting, deviating from the careful path she'd taken all her life and getting in way over her head before she knew what would hit her.

it turned sour fast and six months in she was having to make up lies at work as to why she had new bruises, finding herself terrified in ways she hadn't planned. he was possessive, violent, and he came from money (more so than she did) which made it nearly impossible for her to disentangle herself.

she suffered for another six months before she finally slipped free of his grasp and fled further into the state, legally changing her name to lamia king and deciding to hide in plain sight. it took a while for everything to go through but she was able to find a simple job at a medical clinic in lancaster, arizona... she just had to retrieve her shit from new mexico first.

that's when she met yamato ishin.

gunshy, she shied away from the man who was suddenly offering to help her move boxes, recognizing that a woman in a black hoodie pulled deep across her brow and doing this work in the middle of the night was probably not in a good way. she balked, sure the man was sent by her ex but there was something softer about him (not that yamato was ever really soft) and she eventually allowed the help.

she wasn't stupid enough to tell him where she was going or why, but she did give him the number to a cell phone she'd registered in another state and they kept in touch. he never asked too many questions, he just found her cute and kept up with her because he'd noticed the bruises... and eventually he asked if she wanted to go out.

she balked again, terrified of heading back to new mexico but also not wanting to meet up in lancaster because then anyone could follow yamato to her. she gave in, but with caveats; she liked yamato so she didn't really want to pass up a chance at someone who had ever only shown her kindness, but... they agreed to meet up at some point between their two points (though she never said how far between) and their whirlwind romance took off.

she wasn't used to it, and though yamato was a bit withdrawn, he never raised a hand to her, instead treating her as if she were somewhat delicate. the situation itself had left her so terrified that she'd started taking classes in krav maga and muay thai but she was relaxed around yamato; almost content.

he never knew her real name, the one she'd been born with or her past (anything that could tie her to the woman that had been with an abusive man on a track to becoming a renowned doctor) and instead knew her as lamia king, of which he knew she had parents on the east coast and no siblings but she never mentioned harvard, new hampshire, or any of those details. no, she was a struggling woman working at a medical clinic well beneath her pay grade because of the fact that she was terrified to finish residency anywhere that would matter; afraid it would lead a trail right back to malia.

it didn't take long, however, for lamia and yamato to be so deeply in love that, one drunken night, they went to a quick chapel in one of the cities they often met up in and got married. they both seemed happy, in love, and content with their little marriage, going so far as to wear the cheap rings that had been given in the package along with something more personal and 'expensive' on their ring fingers.

she worried sometimes, because he was so withdrawn, that he would leave her. it led to a tiny bit of jealousy and worry, but not unfounded. one night she crept to new mexico again, assuring herself enough time had passed and she'd altered her appearance enough to not get caught, and watched as her husband exited a club, drunk off his ass, with his arm around some girl's waist and stumbled to her car to have sex.

it was a one-time thing, but lamia didn't know that. yamato hadn't chosen to cheat on her so much as he'd sort of lost the thread that night in all his business and ended up on the wrong end of an exchange that led to him destroying his marriage. to bring it up meant to admit she'd followed him, but after a relationship in which she'd been physically abused she'd be damned if she accepted one where she was emotionally abused.

the fight was loud and it was long, a year spent with them separated and arguing and yamato never once telling her the details of why it happened. he couldn't really reveal his club involvement, after all, knowing that it would likely scare her off and implicate her... but he also refused to sit back and be yelled at and just take that hit.

their divorce was as swift as their marriage and to this day lamia laments having lost him, but hates him for having cheated on her. she loved him more than anyone she'd ever met before and the spiral their divorce sent her into was legendary.

it didn't take long for the slightly wild medic at the local clinic to catch the attention of the wild coyotes and be brought into the fold of the motorcycle clubs. she was their on-call and often was set to patching up bullet wounds with nothing more than her medical kit and a bottle of jack. it was hard work, but her downward spiral had led her to craving things that would both distract and numb her to her own bad luck... she embraced it in fact.

if she was gonna have bad luck she was going to do it head on... and that meant putting herself in dangerous situations that she couldn't quite control. gone was the girl who had dreamed of soft things in saving people and been determined to be the best in a legitimate field; gone was the woman who had fallen in love and gotten beaten; gone was the woman who had fallen even more in love, been married, and had her heart shattered; malia thorpe had died somewhere along the way and lamia king was evolving into something else entirely.

better just hope she can survive it.

[tefoo-energy]

Medical equipment ECG monitor battery

The monitor can monitor ECG, respiration, blood pressure, blood oxygen saturation, pulse and many other physical parameters. It is a device or system that measures and controls the patient's physiological parameters and can give an alarm to abnormal conditions. The monitor is widely used and can be equipped in multiple departments - such as ICU, emergency room, orthopedics, respiratory, obstetrics, neonatology, etc. As a precision medical instrument, the ECG monitor can simultaneously monitor the patient's heart rate, blood pressure, blood oxygen saturation, electrocardiogram, body temperature, respiration and other physiological parameters of the human body. activities have been widely used. ECG monitors can continuously monitor and record ECG data within 24 hours, and capture, analyze and automatically store dynamic change data according to the current data of patients, without the need for real-time monitoring by doctors and patients, effectively reducing the doctor's workload workload. The built-in battery of the ECG monitor is the guarantee for the normal operation of the monitor in emergency situations such as emergency rescue, power failure or patient transfer. It is expensive to replace a built-in battery, and extending the use management of the built-in battery can ensure the safety of the patient, and has the effect of saving operating costs. Every shift should routinely check the built-in battery indicator of the monitor, and make a record at the same time to facilitate the use of other nursing staff. Should avoid long-term unplanned use of external AC continuous wor. Monitors are used frequently in actual work, and the phenomenon of ignoring maintenance is common. Maintenance is often considered only when there are obvious failures, which affects the use of patients and increases the failure of the instrument. Establish monitor use, cleaning, maintenance and repair records, and manage them with special personnel. Carry out functional monitoring before and after use, and only if the performance is good can it be applied. Make records after use and keep them properly. According to the method specified in the instruction manual, the equipment engineer disassembles the machine and cleans the inside of the machine at least once a year to reduce the damage of dust to the internal parts of the machine. You can gently wipe the internal dust with a soft brush, or wipe it with absolute ethanol, and wait until it is dry. Can be installed. Instrument operators should conscientiously implement this system, maintain the instrument well, keep the instrument clean and complete, and ensure the normal use of the instrument. The application of ECG monitor reduces the intensity of clinical nursing work and improves work efficiency. The use and management of the ECG monitor can maximize the performance of the equipment, reduce the impact of human factors on the monitoring effect, ensure the safety of the patient, reduce the work intensity of the nurses, reduce the failure rate and maintenance rate of the ECG monitor, and prolong the life of the patient. service life. Therefore, it is of great significance to standardize the use and management of ECG monitors.