#because coming at them fresh??

[zeawesomebirdie]

Oh my god okay hi i havent been online bc ive been reading On Writing by Stephen King and omg okay, i feel so much better about my drafts now

[leqclerc]

I think everything that could be said has already been said regarding Charles’s Monaco win. But I’m just… Wow. It’s so surreal.

Having followed him for several years now, witnessing the hope and subsequent disappointment as yet another chance to win his home race slips away… The heartbreak and helplessness of 2021 and the anger and frustration of 2022… It’s Charles’s dream fulfilled and Charles’s accomplishment but I feel like it’s personal for so many of us who’ve endured all of those emotional rollercoasters and setbacks along with him, invested in his quest to reach for something he yearned for so deeply. We’re all sharing in it now, Charles’s emotions a reflection of our own; disappointments into delights.

The funny thing is, I was completely calm once he secured pole on Saturday, in a way I rarely am, especially when it comes to racing. It’s hard to describe but it was just this serenity, this gut feeling that today is the day, and that there won’t be any more upsetting surprises. That this is the weekend where that chapter of the “curse” ends, where history is made, that this is where the path was leading all along.

It wasn’t really until Charles crossed the finish line, until that team radio, that inflection in his voice, the way he evidently teared up, the way he ran into his team’s waiting embrace and the way he spoke about his father that it hit me, the emotions, the sheer magnitude of the feat – so straightforward at first glance but heavy with the weight of expectation, longing, past disappointment. The palpable relief on the podium, the way he could finally close his eyes and just drink it all in. Maybe it played out exactly the way he had imagined all that time, maybe it was different, maybe it was better. But it was, in some way, fated.

[crescent-moon-mollymauk]

The livestream last night was fantastic for many reasons, but another great thing about the stream: it felt really nice to openly hear Sam and Taliesin describe FCG and Ashton as nonbinary. Like obviously we’ve had their he/they pronouns since day one, but it means so much to hear the two of them use the word Nonbinary, y’know?

[skyloftian-nutcase]

Provider Discretion (LU in Healthcare)

(Lots of technical jargon in this one, lovelies, hope you don’t mind)

Something wasn’t right.

The patient herself was… okay. Mostly. She had called 911 because she’d had back pain that had just been getting worse, and she’d said she couldn’t even get around anymore.

Mo and Hyrule often exchanged a somewhat exasperated look when someone called an emergency line for something that had been an ongoing problem, but today this… was different. She just didn’t look well.

“I’m really sorry,” the patient apologized for the fourth time as Hyrule and Mo loaded the stretcher into the ambulance.

“It’s okay,” Hyrule quickly reassured her. His heart ached a little at how much this woman wanted to seem to shrink into oblivion. Even Mo, who, despite his big heart, often came across a little standoffish, had tried to make her smile multiple times. “This is what we’re here for.”

With a chief complaint of back pain, there wasn’t much to do outside of check vital signs. Mo could easily take this call. But Hyrule just… this felt wrong.

“Let’s get a 12-lead,” he said, already grabbing the cables for it while Mo got vitals. His partner didn’t argue, helping him place the leads in the right positions.

Vitals looked mostly fine. The patient’s blood pressure was high. She said she had a history of hypertension, so perhaps between that and her pain that would explain it. Though 180/98 did not make Hyrule particularly happy. But he couldn’t treat that.

The 12-lead showed normal sinus rhythm. Nothing wrong there. But something just didn’t feel right.

Grabbing the blood pressure cuff, Hyrule checked it again, but on the opposite side.

There was a discrepancy.

Hyrule and Mo looked at each other, eyebrows pinching. Mo took a manual on the left. Hyrule took a manual on the right.

They still didn’t match.

Feeling dread fill him, Hyrule told Mo, “I’m taking this call. Let’s get going. We don’t need lights but… just drive expediently, ok?”

The transport was blessedly uneventful. But the discrepancy remained. Her blood pressure was high, but higher on one side than the other. Coupling that with back pain…

Her aorta. Hyrule was worried about her aorta. The biggest artery in this woman’s entire body could getting ready to tear apart.

When Hyrule texted Warriors later, he got his answer.

Dissection. They rushed her to the OR. You pointing out the BP difference really tipped off the doc. Good catch.

Mo whistled. “Good thing she didn’t rupture in our truck.”

Hyrule blew out a breath. He was just thankful he trusted his gut.

XXX

The dispatch information had been for diabetic emergency. Fire had gotten there first, which Aurora was thankful for since she and Dawn were coming from the hospital and therefore farther away than if they’d responded from the station.

When they arrived, the house was a nightmare. The street was so narrow that the ambulance and fire truck blocked the road entirely, the stairs were so narrow Aurora felt like she had to squeeze her arms in just to climb up them, and the turns were so sharp she wasn’t sure how any kind of equipment could get up there. The patient was lying on his bed, altered, and unable to move.

According to the patient’s friend, he’d heard him fall and came up to check on him. He knew he was a diabetic and figured his blood glucose had to be low. Fire had already checked it, saying it was over two hundred. As the firefighter paramedic gave information to Aurora, he said, “He could be acting like this because of his sugar. Could be a stroke. We’re not sure.”

Honestly, Aurora couldn’t see the patient all that well from her vantage point. Dawn had already walked in and started assessing, they’d handed a reeves stretcher to the firemen, and they were working on loading him on to it. The girl went downstairs to prep the stretcher for their arrival. Once they managed to get the patient into the ambulance, Aurora stared.

This man’s entire right side of his face was noticeably drooping. He was moving his head a little to the left, eyes somewhat moving, pupils equal. Aurora quickly asked him to look at her, to follow her finger. While he could stare at her, he couldn’t track at all, and his eyes wouldn’t move to the right. He blinked once while attempting, and was only able to blink his left eye.

Who the hell thought this could be his sugar??

Once Dawn got in the truck, they were quick to get vitals and a 12-lead. He was hypertensive, all other vitals fine.

“We need to stroke alert this,” Aurora immediately said.

“But he was last seen normal three hours ago,” Dawn said uncertainly. “Isn’t that outside the window? Or is the window four hours now?”

“I think it’s four,” Aurora answered. “And it doesn’t matter either way. This is absolutely a neuro issue. Drive us hot, okay?”

Dawn nodded, heading to the front. She drove to the hospital with the lights and sirens on, allowing them a faster transport time, while Aurora called it in to the hospital. As they progressed, she tried to get the patient to follow commands, but he couldn’t. He held up his right arm but couldn’t hold his left up at all, and he still didn’t really track any movement.

When they arrived at the hospital, they were placed in a major room, transferring him quickly to the hospital bed. Warriors was charge that night, working on coordinating all the help they’d need for this patient. The ED physician entered, looking the patient over, and then turned to Aurora, asking, “So what makes you think he’s having a stroke?”

Aurora stopped in mid motion, looking at him with the most enraged and bewildered expression. “I’m sorry, what?”

“Why do you think he’s having a stroke?” The doctor repeated.

“What makes you think he isn’t?!” Aurora snapped, completely mind blown that this was even a debate. “His face is drooping so low it’s hitting the earth’s fucking crust, he’s altered, not tracking movement, blinking with one eye, down on one side, is hypertensive, and you’re asking why I—do you even know what a stroke is??”

“Let’s just alert it,” Warriors said calmly as he walked into the room, clearly sensing that the paramedic was about to explode. “It’ll get us a CT to rule it out.”

Aurora was fuming, and she stormed out before she could hear a response. Dawn tried to gently check on her, only to be subjected to her ranting for the next hour.

Later, Warriors texted Hyrule, who relayed the message. “You were right.”

“OF FUCKING COURSE I WAS!”

XXX

Legend wasn’t particularly a fan of working triage.

There were aspects of it that were exciting - he was the one to make first contact with patients who didn’t come in via ambulance, and he determined their acuity. But there was also a public relations aspect to it, a patience dealing with impatient people, a kindness and sympathy for those who were genuinely hurting or needing help but had to wait anyway. It was understandable, but public relations… was not Legend’s forte.

There was a reason he was put in triage, though.

It wasn’t always obvious, what was wrong with someone. But there were times when a patient just didn’t look right. Legend saw the man limp over, listened to him as he explained that he had some leg pain that had been going on for the last few days, how he thought maybe he’d strained a muscle but the pain hadn’t improved.

There were always signs to look out for. Little things, cues that something was off. The man looked resigned, reluctant; he clearly had been talked in to coming to the hospital, and he commented that his wife insisted on it. Legend saw the clothes he wore, heard the accent he spoke with, saw his muscles, and pieced together that he was probably a farmer.

Farmers never came to the hospital.

“We’ll get you back as soon as we can,” he finally said after completing his assessment. Usually, this patient would be low on the acuity scale—a muscle spasm or strain was not nearly as important as a heart attack, pneumonia, sepsis, strokes, traumas—but Legend made him a yellow rather than a green. Just to be sure.

That higher acuity score got him a room far faster. That faster room made a doctor assess him and notice that his left leg was bigger than his right. That doctor made sure he got an ultrasound of his leg, found clots in his leg. She also learned the man was short of breath sometimes, which his wife insisted was new, and got a CT scan.

Legend glanced at his chart later to see him being admitted. Confused and curious, he did some digging.

The man had a pulmonary embolism.

Huffing with a small smile of satisfaction, Legend closed out of the chart as another patient approached.

XXX

Time had to admit, he did not spend as much time assessing his patients as he should. His hours were stolen away in the OR, unpredictable and chaotic as his line of work was. So sometimes he didn’t get to round, sometimes he didn’t have a chance to walk in and chat with the patients and the nurses and the licensed independent providers who took charge of their care.

Today he was glad he did.

The patient was actually calm and pleasant, had little complaint of anything except for some lower back pain. In the world of uncomfortable hospital beds, it wasn’t a huge surprise.

But Time saw something. Some staining, bruising, around the patient’s groin. He peeked around their gown, turned them a little, and saw it.

Their groin was purple. He asked the nurse, who said they were told this had been baseline for a day or two, and that the independent providers over them had acknowledged the finding and moved on.

Time walked into the doc box where the providers were. “I want a CT abdomen for room 3. She’s got some bruising that’s concerning. Her H&H has been down trending steadily.”

“Her JP drains haven’t put out much,” the physician assistant noted, looking over the patient’s chart.

“She might have a retroperitoneal bleed,” Time pointed out. “Let’s just be sure.”

Years of education and even more years of experience had taught the trauma surgeon well. The war was especially humbling and educational. So when he got a text from the PA that the patient did indeed have a retroperitoneal, he wasn’t surprised. But he was disappointed that he had to be the one to notice it.

Sometimes, he supposed, it took the leader to point out the problem.

XXX

Four… didn’t like this.

Report had been bad enough. The day shift nurse spoke of how the patient had been previously septic and was recuperating well before her pressor demand had gone up during the day. She looked… not great. She was so edematous they were constantly changing the sheets underneath her arms because her body was leaking fluid from every inch of itself - they had dumped fluids into her over the last few days just to maintain her blood pressure. She was on a lasix drip to get her lot o pee off the fluid as best as possible, and her kidney function was… decent, but not great.

As Four assessed her, the clenching his chest only worsened. She was alert, oriented, a little miserable but trying to be in good spirits, bless her. She was peeing a decent amount, her pulses were present despite the swelling, her lung sounds were a little coarse but overall mostly clear. Her abdomen was soft and non-tender, her pupils were equal and reactive, and she didn’t have much complaint of pain aside from being sick of laying in bed, which Four could understand.

But still. This just… didn’t look great.

As the night progressed, the woman’s pressor need climbed. Four continued to increase epinephrine, increase norepinephrine. He tried not to increase the vasopressin too much as it had such a profound effect on vasoconstriction that it could cause necrosis. Also, the woman had a history of heart failure and had a pretty weak heart.

Four eventually went to the resident in charge of the patient for the night. “Hey. Can we maybe give 11 some albumin? She has plenty of fluid to give, but clearly it isn’t in her vasculature - she’s peeing ok but her pressure isn’t tolerating it. I feel like it could help.”

The resident shuffled on his feet uncertainly. “The surgeon really wants to make sure we can get this fluid off. I’d rather keep her negative and not give her more fluid, you know?”

“Yeah, I get that,” Four greed before continuing, “But albumin is only 250mL, and if it helps suck in the fluid that’s third spacing, it’ll still help. We’re dumping fluid in her through the pressors anyway.”

The resident continued to waffle, before the night attending asked, “She’s on vaso, right?”

“Yes.”

“Just go up on that.”

Four stared a moment longer, starting to doubt himself. He hadn’t been a nurse for long, and if an attending physician was saying this, then… it had to be true, right?

Sighing, he went back to the room and did as he was told. The patient’s blood pressure improved well enough, and the night progressed fine.

The next night was not as fine. At rounds, Four suggested that perhaps she should be lined for CRRT, a continuous dialysis that would allow for Four to control how much fluid they were pulling and would likely be better for the patient to tolerate. The night doctors shrugged, saying they’d mention it to the day team.

Again, the woman’s blood pressure was tanking. Again, Four had to increase pressors. Vaso had been turned down and was told to be left alone because the woman’s systemic vascular resistance was so high the attending was worried about her heart. (Four couldn’t help but feel a little bitter about it, because he knew that was going to happen)

This time, though, she went into atrial fibrillation as well. As Four called the resident and attending into the room, they deliberated the matter, muttering, “Maybe we should line her for CRRT.”

Four blinked. Stared. Was he… losing his mind?? Was he invisible? He’d suggested this earlier!

Ultimately, Four had managed to keep the patient stable enough so that it wasn’t needed. Ultimately, the shift ended uneventfully.

But when Four came back for his third night, he could hear the woman’s breathing from the door, he could hear how she was drowning in fluid because she couldn’t tolerate losing fluid but had too much for her lungs and heart to handle. The day team had lined her for CRRT, but her pressors were almost maxed out at their dosage, and she was so hypotensive that the renal nurse who had set up the machine was hesitant to start it up, saying it would further bottom out her pressure.

Tonight was different, though. Tonight, the provider in charge of making decisions and orders was a nurse practitioner, someone who was used to this unit. She walked in, saw the issues Four had seen, and she walked right back out, making a call.

Four struggled to keep the patient alive long enough for the ECMO team to arrive as the patient fell apart. He felt frustration boil his blood as he had to hand off her care after fighting for her, had to watch as the CV ICU nurse came in to take over while surgeons put large cannulas into the patient’s body to redirect blood flow around her heart so she could still perfuse her organs. He watched as they wheeled her out of the trauma ICU to go to the cardiac ICU where she would remain while on such extreme support, and he threw his pen on the desk, burying his face in his hands, fuming.

They should have listened to him.

[puhpandas]

sometimes I miss when Gregory was just a homeless kid

[nemmet]

question: how did you discover/get into scooby doo?

this is something i'm always so interested to hear, being that there are few people who don't have at least some small tie to the franchise. whether you would consider it one of your biggest current interests or it's just something nostalgic from your childhood, i'd love to know how you found scooby and what it means to you!

[anxiously-sidequesting]

Yknow I think one of the saddest parts about Malorn being a professor is that his social circle in particular must have taken a hit. Idk if he had any homies before his promotion but with that Teacher and Student relationship having to be almost strictly professional, I can't imagine it would be smiled upon to have Malorn acting buddy buddy with some of his peers anymore. And like that's really sad that one of the many aspects of his childhood is essentially taken from him because he's in this awkward spot of mentally, physically, and emotionally at par with his students but has to be different than that in order to be their teacher

Like imagine how lonely that is bro. He can't be a kid with his students anymore but he's not an adult that can necessarily relate to other adults either so he's just in this separate space all by himself because there are no others like him (except The Wizard who has at least some similarities)

Thinking about how Malorn's former friends just slowly drifting away from him not because they hate him, but because they have to regard him as a teacher FIRST above all else is super sad and once again I'm crying for Malorn in the evening

[frecklystars]

GOD!!!!! 😭😭💓💗💖💓💓💞💞💕💟💝💘💝💝💞💗💘💝💟💓💗💞💕💟💝💘💓💖💓💕💕

[ejacutastic]

there's GOT to be a way for windows to prevent the level of OS corruption I see constantly at work like there's no way this is just fully unavoidable

[boofbuck]

Thinking thoughts about alpha Robin again 🥰

[namenoted]

that being said, any old dynamics that anyone wants to keep, please let me know, otherwise i'm going to do a hard reset tbh

[resizura]

the scene in death island when chris jill and claire are talking about how “bioterrorists sure are stubborn” sums up all my problems w modern resi from a story standpoint

because its like why do none of these characters react differently to their circumstances and just accept them

i know its because theyre video games and they need to do the same thing over and over but still

like as bad of a villain dylan was he read jill Ieon and chris for filth and im shocked at how self aware capcom was because yeah they have those three go thru the same shit constantly and nothing changes and theres only so many times it can happen for me personally before i gotta put a stop to this

and the only emotion the main guys can have is being jaded like idk i dont like re5 and up chris because his only emotion is being jaded. his character trait of always getting his team killed and how that affects him is briefly brought up at the beginning of re6 and then despite getting flashbacks of that finn guy or whoever it Keeps Happening and all that comes of chris is that hes jaded and ‘tired of this’ but they CONTINUE. WHY? SAME WITH L/EON

in a real life situation i couldnt care less about how these people react to their bioterrorism. if it makes all the characters jaded and numb, fine. but this isnt real life, this is a story, a narrative. and to me, the narrative making all the characters react the same to all theyve been through is BORING and i want MORE

[spontaneousmusicalnumber]

Every time I have to settle for Wendy's over the restaurant I was planning to go to, I'm shunted into a fucking circus and my chances of escaping with a semblance of edible food is a toss up.

[keirawantstocry]

.

[astraltrickster]

Autism poll!!

If you vote yes, feel free but NOT OBLIGATED to share your examples in the tags, and reblogs are appreciated but not demanded!

[many-gay-magpies]

okay as far as season four of teen wolf goes i am like. very confused as to what the fuck kate's motive even is? like she came back from the dead and she's screwing with derek and making her berserker servants kill people but like. WHY. ik there was like that one scene with peter where it was implied she wanted to make the argents great again (aka reinstate them to their former genocidal werewolf-hunting glory) but that doesn't make complete sense to me when she herself is now a shifter. or like maybe she's just that hypocritical idk (wouldn't put it past her). but even with that idk it doesn't make SENSE. why did she kill garrett and violet? why did she try to make scott's pack kill him? why did she do all that just to get derek to open the vault? literally what the fuck

if anyone has thoughts please share im at a loss here