#both on nursing and MD side

[doctorweebmd]

by the way there is data behind this. there are worse outcomes at night. Across the board. At all hospital levels. Which is. Well. If you’re dying try to do it during business hours.

[drghostwrite]

Supply Closets & Satin Sheets

Pairing: Addison Montgomery x fem!reader

Summary: Addison finds out about Derek and Meredith and isn't taking it well, you just so happen to stumble in on her while she's having a bad day and the unexpected or so it seems happens.

********************************************************************

You were trying to catch a break, you were working on a procedure plan for some upcoming surgeries, two weeks ago you had saved a patient's life, a 32-hour surgery that was touch and go, the news picked up on it and before long people knew your name. After that you were being chased down for every big surgery, you were there to do one thing save lives, and you didn't mind the attention but it became too much when every time you were transporting a patient from a trauma bay people were chasing you down asking to scrub in.

You quickly turned the corner moving down the hall staring at your chart, you the squeak of sneakers as a nurse stepped out in front of you, "Hey woah," He said quickly dodging you and watching as you kept going.

"I'm so sorry." you said stopping to talk to him.

"It's all good, you're not usually one we have to worry about, you have a reputation." he laughed with a sly smirk. you looked up at him head tilted curiously.

"Only good I hope?" you responded.

"Oh honey only the best," he smirked, "Badass trauma surgeon, drop dead gorgeous and actually has respect for human beings, not just the ones with MD behind their name."

"Oh well, I try my best."

"Yea and that's exactly why patients love you, nurses help you, interns want to get on your service, and every resident wants to scrub in with you."

"Really?" you smirked at him.

He chuckled at how oblivious you were, "Sweetheart just trust me."

"Thanks." you both chuckled.

"Anytime Sinclair, anytime." he said with a smirk, as you turned to leave.

"Oh and by the way Y/N, call me Y/N."

"Nice to finally meet you, I'm Jordan." you turned heading down the hall to your office. You walked by the wall of windows across from your office and saw a group of interns standing outside the door, you quickly turned down the hall to leave and saw another group so you slipped into a supply closet. you out your back on the door closing your eyes and allowing yourself to slide to the floor, head in your lap using the quiet to take a deep breath for yourself. It wasn't long though before you heard a sniffle. You listened waiting to hear it again and that's when you heard it someone was in here with you.

"Hello?" you said, no response so you stood and moved around the first rack, that's when you saw her, Addison Montgomery the fiery, sexy red-head, sitting on the floor head in her hands.

"Addie?" she looked up at you her eyes were red and slightly puffy from crying. You sat down next to her, she turned to look at you.

"Y/n... I-I can't...De-Derek and Meredith...I-I know." she broke down into more tears, you pulled her close to you letting her cry until she couldn't anymore.

"Addie," you whispered softly, "Addison you can't do this to yourself."

"Y/N I came here to fix things and I thought we were getting somewhere, I moved in with him and things were working and then I find out that the entire time he's been with her and he couldn't even tell me about it."

"Addison..."

"It would've been so much easier if he would've told me before but instead he lead me on and then I found out from some nurses and by watching them."

"Addison there are other people for you, that love you, and want more for you... Addison Forbes Montgomery you are gorgeous and smart, funny and compassionate, one of the most skilled surgeons I've ever encountered and you deserve so much more than..." you rambled on and she sat there looking at you, admiration in her eyes and that's when it occured to her, it's you, she quickly grabbed your chin and kissed you, you leaned into her and slowly leaned her back you hand running along her side as she grasped tightly onto your scrub top. Moments later your pager went off pulling you apart, both breathing heavily.

"Addison..."

"It's okay, you have to go."

"I do but this isn't over," you said leaning closer to her eyes interlocked, you glanced down at her lips and kissed her again this time as gently as possible, letting her know that you wanted this.

---time jump---

One 48 hour shift later and you hadn't heard from Addison, you had been through hell in the ER and were finally getting to go home, you now found yourself in black sweats and your old Harvard t-shirt lounging on your couch, a Whiteclaw can on the corner of the table the TV playing in the background, you heard a knock on the door and stood throwing your phone on the couch beside you.

"coming!" you called, you opened the door to be met with Addison, this time though she was dressed in jeans and a henley, her hair laid perfectly, amber eyes staring back into yours.

"Addie."

"Y/N, can we um... I need you." She kissed you, you pulled her closer by her belt loops of her jeans, you laughed against her.

"You sure about this?"

"Never been more sure about anything." she said against you.

"Let's go baby." you said turning her into the apartment and kicking the door close behind you, you both stumbled towards your bedroom only breaking to open the door and guide her around your apartment.

You guided her into your bedroom and she quickly pulled your shirt over your head revealing you had nothing on underneath, she pulled the string on your sweats and allowed them to pool around your ankles, you quickly kicked them aside and Addison stepped back looking over your body.

"God, you're gorgeous." she said scanning your body run her hands over you.

"I can't wait to see what you're working with," you said playing with the button on her jeans and quickly stripping her of all clothing, you looked over her quickly before lifting her and wrapping her legs around your waist, laying her onto the silk sheets covering the bed before crawling over top of her from the bottom.

you placed kisses on her lips before working to either side of her neck and then down her chest leaving marks along her stomach, you could feel the skin shiver beneath you with excitement. "You ever been with a woman before?" you asked moving back up her body and looking into her eyes.

"I-I uhh no... Can you teach me?"

"Baby I can do a lot more than teach you." you responded before going back down on her

--- time jump---

You heard your phone go off in the next room, pulling you out of your slumber, that's when you still felt the weight of an arm wrapped around your torso, you felt the cool sheets against your bare skin, her head on your chest legs tangled together.

You ran your hands through her smooth auburn hair, feeling her shift below you... "mmm, good morning."

"Morning beautiful." she curled herself into you pulling you closer.

"You know slik sheets and your bed are a lot better than some supply closet or an on call room."

"True, so now you know that you always have a place come to."

"So what does this mean for us?"

"Addison this means whatever you want but if we decide to give this a chance, I'm going to do it right."

"I think I'm willing to give us a shot."

"Then Addison Montgomery will you be my girlfriend?"

"Y/N Sinclair I would love to."

"So can I make you breakfast?"

"You cook?"

"Sweetheart that's just one of the many things I can do." you said leaning down to kiss her.

[greghatecrimes]

I don't think you can say house md was not homophobic even with the so called "rep" it's definitely a product of its time but you don't gotta lie and say it was more progressive than it was, you can just like the show while acknowledging it's problems. Yes, there was a bisexual character, who had countless biphobic jokes made at their expense. There was a whole episode where house and wilson talk about how weird it is for one of the nurses to date a trans woman who they call a tranny. There's a whole episode about them discovering a teen girl is intersex and house misgendering her by calling her a man the whole episode and telling her that her anger is due to the cancer she has when she becomes upset about being told she is "not really a girl" I love the show too, but every person that says the show is homophobic and transphobic is right, it's a product of its time, it still more bigoted than "progressive", and liking it even like that is not a crime or makes you a bad person. Let's not lie about what it is just because we like the show, plenty of queer people do but that doesn't make it less bigoted.

Respectfully: I don't think I'm lying at all when I say it was progressive for its time.

You're right, though, anon! It ABSOLUTELY could be bigoted, too, especially in the early seasons (specifically I'm thinking of the moments you mentioned, the one with the nurse House and Wilson discuss, and the entire episode "Skin Deep", etc.) and I can acknowledge that. I agree, it doesn't make someone a bad person to enjoy something like this show that is indeed a product of its time. But even just beyond the "rep" of having Thirteen as a canon bisexual character, the show did so much that was progressive for its time IRT: lgbt+ presence in media.

Just one example of many I could give is "The Softer Side". The entire episode "Skin Deep" is something I like to skip over, but it's not a "forgive and forget" type of thing. I don't approve of the episode and I want to hold the writers who came up with that entire thing and everyone who let it slide accountable. But three seasons later, we got "The Softer Side", written by Liz Friedman. The Softer Side's patient is a child who was born intersex, but was given gender assignment surgery at birth, and whose parents don't want him to know he's intersex. The episode handles his case with such care that I don't think a show today could really even come close to achieving. The issue was never that this kid was intersex. He's not being treated for a condition that was caused by him being intersex. Him being intersex has nothing to do with the diagnosis he gets at the end of the episode! The only reason him being intersex came up during his case is because his parents didn't want him to know, and thus told the doctors at PPTH to lie to him about testosterone he was being given (it's implied his parents had been giving it to him for at least a year/a short while iirc). And the team at PPTH (specifically Thirteen) thought that he had the right to know, that it would be good for him to know and understand this part of himself! They're supportive! The episode doesn't wave away the fact that he was given gender assignment surgery! It pushes for an acceptance of both masculine and feminine and giving people the freedom to decide for themselves, even when they are children (and not saying a child the patient's age is too young to know what he/she wants, etc.)

The way House MD and Liz Friedman handled this absofuckingloutely blows other shows portrayal of intersex people at the time out of the water. Does it make up for Skin Deep, or the t-slur comment? No. But it set a precedent for how other TV shows should handle such subject matter going forward. This is why I don't think the show as a whole is homophobic, despite having homophobic/transphobic/bigoted moments.

It's also worth noting that Liz Friedman, who wrote The Softer Side, is a lesbian herself, was a writer on Xena: Warrior Princess (an earlier example of queercoding), and was one of two LGBT writers who were in charge of writing all of Thirteen's plotlines.

[grison-in-space]

"that ability to just modify your perspective and step into the context someone else is wrestling with and listen, that's such an upsettingly rare skill for knowledge workers and healthcare workers... if you ask people why they're struggling, you can fix it and build a better process!"

You might be interested to know that when I was in pharmacy school, those patient interviewing skills mentioned by you and clockworkcrow in that reblog chain about provider burnout were taught to us as a set of techniques known as "motivational interviewing." It's not really in the scope of the personal vs systemic interventions that that reblog chain is about, but one of the revelational takeaways that I got from learning them was the idea that the healthcare provider cannot assume that their goals for care line up with the patient's; sometimes, the patient really doesn't care about the treatment or its outcomes because they have different goals of care in mind, and eliciting those goals during interviewing (because a lot of the time people are not at all articulate about what they want out of life) is a kind of ongoing step one.

I'm also curious if you or the MDs in this discussion have ever encountered ambulatory care pharmacists practicing the approaches that clockworkcrow talks about? I ask because listening to patients, identifying patient-specific blocks to care, and addressing them was something we were taught to do in pharmacy school (because our program pushed us toward ambulatory care). But since I didn't go into ambcare after graduating, I'm unsure both how much of an impact it has/how widespread such practices actually are, and whether ambcare practitioners actually, on the whole, put their money where the educators' mouths are. Can ambcare clinics actually make a systemic difference?

Oh! I had no idea they taught y'all those skills, but then I don't actually think I've ever had a conversation with a pharmacist about meds beyond a perfunctory question about whether I know what side effects there are. In general I am not used to pharmacists, doctors, or other medical professionals like psychiatrists taking a lot of time to really listen to me. Some of that is probably that all my main health complaints are things that feel normal to me and some is probably that I am a chronic minimizer--like I said in that discussion, it's a coping method.

I have never heard the term "ambulatory care" -- oh, it's outpatient care. Yeah, okay, let's use a specific physical issue: I can't run for more than about two to three without finding myself unable to breathe. This has been a thing for essentially my entire life, and in middle school we did running with heart monitors, so even apart from the physical experience of not being able to breathe and having to stop and take great heaving breaths of air, I was aware that objectively my heart rate was going up very fast no matter how hard I tried.

(We are talking "run until you start getting black spots in your vision, then walk until you can just barely breathe again, and then run, rinse and repeat. Literally the only kid slower than me was excused entirely from running because one leg was an inch shorter than the other.) No one around me seemed to think there was anything unusual about this or that I was anything besides just physically lazy, so I kind of wrote it off until my mid twenties. I mean, I'd been visibly struggling with extended physical exercise my whole life, and no one had called it remarkable yet, but friends were telling me it wasn't normal to experience those kinds of breathing issues, so...

I presented myself with this complaint to a nurse practitioner who basically told me I was just fat and needed to exercise more. I pushed past this and was grudgingly scheduled for an ecg (normal) and a peak flow test (astoundingly poor). There was no explanation presented for the peak flow except that I was out of shape and needed (guess what?) more exercise. Tried a pulmonologist, who confirmed it was not exercise induced asthma (which I had been sort of hoping, because there are fixes for that) and told me I was basically fine.

I more or less gave up until a dentist idly mentioned that my airway was very, very small and told me that micrognathia was something I should look into: my airways might be occluded. So I went to an ENT, who also immediately tried to tell me I was basically fine but did grudgingly agree to scope my airways... and discovered major blockages from my tongue (insufficient room in my jaw, so it gets shoved backwards over the airway), my nasal turbinates (swollen almost completely shut), and I forget what else. It was incredibly exciting to have a reason.

Okay, I say, what do I do with this? Exercise more? But I want to do that, I just can't breathe. I was aware that there is a surgery to artificially extend the jaw; it involves breaking the jaw and encouraging it to heal while maintaining space between the halves. So I brought this up. He was very dubious about this. I asked for a referral anyway and was referred to a plastic surgeon. The surgeon was perplexed by what I wanted to talk about and had clearly expected me to have come in for a cosmetic procedure like a nose job. Eventually I got too exhausted to follow up further; I've been meaning to resume this thing for like six years now.

Generally, my experience of doctors is that they have been trained to be suspicious of patient accounts that don't fit a very specific narrative, and that they are impatient to get on to the next thing unless you are very proactive about your own care. If you don't have a condition in mind that you can point them at without making them decide you're med seeking, they are quick to tell you that you are just making things up in your head. There are a few exceptions but I cannot underscore enough how rare I have found them to be.

And they will all tell you to exercise and lose weight as a first line of response. Not that I'm bitter.

Now, actually working in healthcare, @scientia-rex or @clockworkcrow might have more relevant commentaries than I do. But my experience in this field has not been, to put it mildly, great. Let's not even talk about my history of psychiatric care.

[exeggcute]

I've been seeing some of my doctors for so long and have a pretty good rapport with most of them to the point where I'll occasionally ask about the bureaucratic side of how they work at and/or run their practices and it's honestly pretty crazy how the american healthcare system (by which I mostly but not exclusively mean insurance shit) is fucking everyone over on both sides because doctors are also not having a good time, apparently. one told me that she had to stop accepting [xyz] insurance because they were offering her insultingly low reimbursement rates—thirty bucks per patient, which doesn't translate to a fabulous hourly rate for a credentialed professional even if she did get to pocket all of that, but she doesn't, because she also has to pay her staff and her rent and buy equipment and who knows what else! another told me that he has some dogshit high-deductible insurance plan because the huge practice he works for doesn't offer anything better, and he's an old pro who's been seeing patients for forty or fifty years by now. one told me that she could effectively triple her salary by moving to another state because insurance reimbursement rates are so shitty here but she feels obligated to stay for her patients.

idk. it kinda blows my mind. it's easy to assume that individual physicians are somehow benefitting from all the profit-siphoning because they're the people we interact with immediately before getting slapped with a fat bill, but your rank-and-file MDs are totally getting juiced by the billing companies too. obviously the labor discrepancies are far worse for nurses and other healthcare professionals but I just think about like, man. imagine going through ten years of school to be on your feet all day doing (potentially) life-or-death work and you still have to fight for each paycheck. something something need to instill class consciousness in my allergist

[babyjakes]

I’m so excited for private practice!!🥰 Such a lovely idea. I have a question for the voicemail box. 🙋‍♀️ So, I’m naturally a really anxious person, and school exacerbates that.😅 When I’m stressed, I really need to surrender control to someone else who is very soft and sweet and I know they have my best interest at heart, but who is also condescending and making it clear that I don’t get a choice in what is happening. How would the clinic go about treating this stress, and which provider would I need to see? Thank you!! ☺️

Also, can I be 🍪 anon?

Well hello there angel, thanks for leaving a message. Your situation sounds similar to many littles we treat at the clinic. For both providers and treatments, you have some options:

You'd potentially be a great fit for my track of services, and I'd be happy to work you into my schedule. While I'm certainly known as the softer and sweeter head of the practice, I have a good level of authority in me and know just how to use it with patients needing that hint of an edge.

Hansen also seems like he could be a good choice for you, based on the details you've provided. He's made a name for himself with his cruel and sometimes unusual approaches to behavioral correction, but he also has quite the soft side when it comes to the right patients.

Regardless of which you choose, I'm fairly confident that either of us would recommend therapeutic orgasm sessions to help you release some of that pent-up stress. In particular, it sounds like forced orgasm therapy might be in order here. Because Hansen and I have different techniques for carrying out this mode of treatment, it might be best for you to book a consultation with each of us to learn more about our individual practices. Or, you could send another inquiry here for each of us and we'll get back to you as soon as possible.

If you have a preference for an assisting nurse, that can also be discussed during a consultation. Our three wonderful nurses float between the two of us, so your choice of doctor won't limit your options there. And all of our patients also receive care and support from our regression specialist, Dr. Barber.

Hope this answered some of your questions. We look forward to hearing from you soon 💙

— Ari Levinson, MD

[no-goodbyes-no-regrets]

It's finally done!

And only three days late!

my @911reversebang fic

California (AO3) inspired by the awesome art by redpinkdots

TK doesn't move to Austin with Owen after his OD but decides to check himself into rehab to get clean once and for all. Only reading websites is hard and things aren't exactly the way he thought they would be.

A/N: I got this idea the first time I saw the artwork and I was so excited when I got assigned this. But life™ kind of got in the way and I really struggled with this fic in more ways than one. Though I'm pretty happy with the result in the end and I hope you'll enjoy it too. And just FYI - all I know about both California and rehab facilities is what I've seen and heard in various tv shows and quick google searches... so it's probably hella inaccurate... but just go with it.

TW: Mentions of TK's overdose and addiction

TK opened his eyes and closed them again right away. The bright lights hurt his eyes and he groaned trying to remember where he was and how he’d gotten there. Because he definitely wasn’t in his bed in his apartment.

“TK? Are you awake?” a familiar voice asked but the fog in his brain wouldn’t lift enough for him to put a face and name to it.

“Welcome back mister Strand. You gave everyone quite the scare.” Someone else said and this time TK was sure he didn’t know them.

Someone, possibly the same person, adjusted his blanket and suddenly he noticed a beeping noise.

He opened his eyes a tiny bit and saw nothing but bright and white.

His brain needed a minute to process the information.

Hospital.

Again.

Shit.

He squeezed his eyes shut yet again.

“Hey, it’s ok. I’m here. We both are.”

“Dad?” he asked, or more like croaked. His throat hurt and his mouth was dry.

“Yeah, I’m here. It’s ok. You’re going to be ok.” He felt his dad squeeze his hand.

Someone grabbed his other hand and when TK turned his head to look at them, a white hot knife was slammed into his brain.

Or at least that’s how it felt.

He squeezed his eyes shut and breathed in and out a few times to get the pain to subside.

In through his nose, out through his mouth.

Suddenly a familiar scent hit his senses and this time he knew exactly what it meant.

“Mom?”

Her perfume was always a comfort to him. Ever since he was a little boy. Only now it reminded him of how much he’d let her down. Again.

“Yes sweetheart I’m here. I’m right here. You’re going to be ok. I’ll make sure of it.”

He slowly opened his eyes again and saw his mother sitting next to his hospital bed.

“What happened?”

“We were hoping you could tell us.” His dad said from his other side.

“Owen.” Gwyn warned him and then turned to her son. “You’re in hospital… they uh… they had to pump your stomach. Your dad found you in your apartment.”

“You OD-ed. You weren’t breathing. I had to use Narcan to bring you back.” Owen told him and seemed to struggle to swallow past the lump in his throat. “If we’d been just a little bit later…”

“But you weren’t.” Gwyn cut in, clearly eager to move the conversation along. “Just… try to get some rest and when you’re ready, you can tell us what happened.” She squeezed TK’s hand.

“What time is it?”

“About 4.30.” Owen answered after glancing at his watch. “Don’t worry, the nurses won’t kick us out after visiting hours.”

“No… I… I have to go.” TK said, trying to sit up and ignore the pain in his body. “My shift starts at 5. I have to go. I can’t be late.”

“Wow, wow, wow. TK calm down. Son. TK.” Owen tried, getting up from his seat and trying to make TK stay in bed.

“Tyler Kennedy Strand.” Gwyn started and TK knew he was in trouble whenever his mother used his full name. “You stay in that bed and rest until someone with MD behind their name says otherwise.”

TK considered his options for a minute and then relaxed under his father’s grip and sagged back against the bed.

Owen squeezed his shoulder.

“You’ve been through a lot. Just take your time. The guys understand.”

“They know?”

Owen glanced at Gwyn for help before taking a deep breath.

“What? What’s going on?” TK asked.

“Some of them were with me when I found you. The others I had to tell when you didn’t show up for your shift.”

“What? My shift starts at five.”

“No… Your shift started at five on Sunday. It’s Wednesday now. You’ve been in a coma for three days.”

“What? I… how… That… It can’t be.”

“I’ll leave you to it.” The voice from before said and this time TK glanced around and saw a nurse of around his age. “The doctor will be around later to asses you.” She told him and left.

“Asses me? What does that mean?”

His parents shared a look.

“I think they’ll want to do a psych evaluation… to determine if you need to be admitted as a suicide risk.” Owen said after a beat.

TK sighed and closed his eyes.

“Great.”

“Should they?”

He opened one eye.

“Should they what?”

“Admit you as a suicide risk?”

“What? No!” TK said immediately but the look on his parents faces told him he wasn’t very convincing. “I don’t know… I’m pretty tired. I think I just need to get some rest.” He turned away from Owen.

Unfortunately that meant he was now facing his mother.

“Does it have something to do with Alex?” Gwyn asked and TK felt his heart shatter all over again at the mention of his boyfriend’s name. Or ex-boyfriend now he supposed. “I know you were going to propose… and he’s not here now…”

TK threw an accusing glare over his shoulder at his father.

“You told her?”

“I didn’t realise it was a secret. You were all but shouting it from the Empire State building.”

“It wasn’t your news to share! I would have told her myself if there was something to tell!”

“So is there something to tell?” Gwyn interrupted, well trained in stopping arguments between her son and ex-husband before they could explode.

“I don’t want to talk about it.” TK said, pulling the blanket up to his ears and closing his eyes. “I’m tired.”

---

A few days, multiple tests, and a mandatory psych evaluation later, TK found himself back in his childhood bedroom in his mom’s apartment.

He’d fought his parents tooth and nail to let him go back to his own place, insisting he was fine, but they’d blatantly refused.

He’d overheard Owen making calls to clear his schedule so he could be there for him, and his mom had told him she’d be working from home for the foreseeable and it was up to him to decide which parent he’d move in with.

He’d picked her because at least she’d be working and wouldn’t be hovering over him 24/7 like his dad would if neither of them would have anything to do all day.

He knew it was because they cared, but he just wanted to wallow in peace.

He rolled over in the small single bed to check his phone. Mostly out of habit since it had died on him days ago and his charger was still on his bedside table in his apartment.

Deep down he knew that if he’d been left alone with a fully charged phone, he would have ended up doing something he’d regret.

Something like calling Alex and begging him to take him back. Or yelling at him and calling him every name under the sun.

Possibly both.

But he was petty enough not to want to admit that to either of his parents.

Suddenly a knock on his bedroom door snapped him out of his thoughts.

“Permission to enter without you taking your bad mood out on me?”  

TK looked up and pushed himself up on his elbows.

“Enzo?”

“Hey kid, I come in peace.”

“What are you doing here? Did mom send you to check up on me?”

“I can neither confirm nor deny.” Enzo said, sitting down in TK’s desk chair.

“That’s a yes then.” TK said and sat up. “Wait, how did you get in? I didn’t hear the doorbell and mom is at the office.”

Enzo held up a keyring with several keys on it.

“There is this great invention called keys. They let you get into places without ringing the doorbell.” He joked.

“You have a key to this place?”

“Of course.”

TK narrowed his eyes.

“Are you and mom back together?”

“I can neither confirm nor deny.” Enzo replied with a grin. “And I’m not here to talk about me. How are you holding up?”

TK shrugged.

“Mostly bored. Daytime tv sucks and I’m getting sick of staring at these walls. But it’s better than mom and dad constantly hovering over me and checking up on me.”

“Don’t you think they have good reason to do that? It’s not like you stubbed your toe.”

“I know.” TK sighed and let himself fall back on his bed. “I just want to forget it happened. All of it. But I can’t. Dad put me on medical leave and mom made me come back here instead of letting me go back home.”

Enzo nodded.

“She told me.”

TK rolled onto his side, leaning on his elbow.

“She won’t leave me alone for more than an hour. She’s only gone now because she absolutely had to go to the office and couldn’t get out of it. And now she’s sent you to babysit me.”

“I’ve had worse afternoons.” Enzo shrugged.

TK let out a grunt and dropped back onto his bed again, trying to ignore the feeling of being thirteen and grounded for doing something stupid while Enzo tried to get him to talk about why he’d done what he did.

“I didn’t… plan it…” TK started after a while. “I just… I wanted… to stop feeling.”

“And taking a bunch of pills was the way to do that?”

“I know it was stupid alright? But I wasn’t thinking clearly.” TK admitted and sat up again. “I proposed to Alex and he turned me down.”

“Ouch.”

“Yeah. And then he told me he was in love with his spin instructor and they’d been dating behind my back.” He rubbed a hand over his face. “I thought we had a future together, he was just trying to get rid of me. I’m such an idiot.”

“You trusted the guy you fell in love with. That doesn’t sound so idiotic to me.”

TK shook his head.

“I always do this. I fall for a guy who doesn’t like me back or just wants something casual.”

“I know this isn’t what you want to hear right now…” Enzo started and waited until he had TK’s full attention. “But one day, and I hope that day will come soon, you’re going to meet someone who is as crazy about you as you are about him. And you’re going to be so happy. So happy that this will be nothing but a bad memory.”

“You’re right. That’s not what I want to hear.” TK told him and looked down at his duvet. “And it’s never going to happen anyway. I’m damaged goods. Nobody is going to want to be with me.”

---

“If you’re going to my place to get clean clothes you might as well take me with you.” TK pleaded with his father. “I’ll stay where you can see me the whole time, I promise. I just want my phone charger and my laptop. I’m not going to score, I’m just bored.”

It was a few days after his talk with Enzo, and after some pushing from his stepfather, he’d told his parents why he’d taken the pills.

It had both cleared the air and made them hover and smother him even more. He was going stir crazy and would do just about anything to get out of the apartment.

Owen hesitated for a minute but then sighed.

“Fine. We can’t keep you locked in here forever I suppose.”

“Exactly.” TK jumped up from his seat and went to grab his jacket. “Come on, let’s go.”

They decided to walk to TK’s apartment instead of getting the subway in the middle of rush hour.

“Maybe we can stop by the station on the way back. So I can let the guys know I’m ok and I’ll be back at work soon.”

“Back at work? Let’s not get ahead of ourselves. Did you call that therapist for an appointment?”

“What? No. I don’t need one. I just need to get back to work. Like you said, I can’t keep hanging around mom’s apartment all day and you can’t keep getting Enzo to check up on me when you’re at work.”

“He offered to stop by! He wanted to catch up and see how you were doing.”

“Well I’m fine.” TK insisted. “And I’d be even better if you’d let me go back to work.”

“I will. Once your therapist signs off on it.” Owen told him and then lowered his voice. “You nearly died TK. You overdosed. I know why you did it, I know it wasn’t an accident, and I can’t let you go back on shift when you’re not in the right headspace. You’d be putting the whole team at risk.”

TK rolled his eyes and started walking faster, zigzagging between commuters and groups of tourists in an attempt to shake off his dad. It was petty and childish but in that moment he didn’t care.  

He reached his apartment door with Owen far enough behind to not even be in sight, which pleased his inner angry teenager greatly. He put a hand in his pocket to grab his keys, only to remember he didn’t have them on him.

His dad had been to his apartment to get him a change of clothes when he’d been released from hospital and had taken his keys.

“Great.” He muttered and sat down in front of his door to sulk and wait for his dad.

Only when he heard footsteps approaching a few minutes later, it wasn’t Owen who came round the corner.

“Alex.”

“TK. Hey.” Alex smiled and TK hated that he still got butterflies in his stomach from just being near him.

“What are you doing here?”

“Just coming to see how you are. I don’t like the way we left things.” Alex explained. “I’ve been trying to call you but it keeps going to voicemail.”

“Phone is dead.” TK snapped. “And even if it wasn’t, I wouldn’t want to talk to you.”

“Oh come on TK. People break up all the time. We can still be friends, right?”

TK snorted.

“Friends? Do you really think I want to be friends with you?” He stood up. “You broke my heart, Alex. I loved you. I wanted to spend the rest of my life with you! I proposed!”

“Yeah… well… you always were more into it all than me.”

“Just go Alex. Leave me alone.” TK sighed and turned his back to the other man, wishing again he had his keys on him.

“I uh… actually… needed to talk to you…? I uh… lost my sunglasses. The designer ones I bought last summer? Did I leave them at your place?”

“Are you for real?!” TK exploded, just as Owen rounded the corner.

“What’s going on here?”

“I was just asking TK if I’d left my sunglasses at his place.” Alex explained, trying to sound casual. He knew full well Owen didn’t like him.

“After he dumped me for his spin instructor when I proposed to him!” TK yelled. “You cheated on me for god knows how long and if I hadn’t proposed you still wouldn’t have told me!”

“That’s not true. I wanted to tell you. I just didn’t want to hurt you.”

“How considerate.” TK said sarcastically. “Just go away and leave me alone. I don’t have your stupid sunglasses. Maybe ask your other boyfriend if he’s seen them.” He held his hand out to Owen. “Keys please.”

Owen handed him the keys and put himself between TK and Alex, staring the man down.

“TK doesn’t want to talk to you and if you don’t leave now, I know some people in the NYPD who might want to talk to you instead.”

“Breaking up with someone is not a crime.”

“Maybe not. But harassment is.”

“TK just let me have a quick look around for my sunglasses. I know I wore them last time I came over.” Alex said, attempting to step around Owen to get to TK but Owen stopped him with a glare and a hand on his chest.

“I think you should leave. Now. Before I do something I regret.”

“Are you threatening me Captain Strand?”

“Wouldn’t dream of it. Now leave.”

After a minute Alex decided to cut his losses.

“Let me know if you find them!” he called out to TK before turning and walking down the stairs.

Owen rolled his eyes and walked into TK’s apartment, doing his best to ignore the place he’d found TK barely two weeks ago, pale, cold, and barely holding onto life.

Thankfully this time, TK was alive and well and shoving clothes into a bag.

“Do you need me to grab anything?” Owen offered.

“Bathroom.” TK replied, voice breaking as if he was trying not to cry. Owen decided to leave him be for now and just busied himself gathering TK’s shampoo and shaving kit.

Maybe they could make a quick stop downtown after all on the way back to Gwyn’s place. Seeing the crew might cheer him up and take his mind off things.

---

Despite Owen’s best efforts, TK hadn’t cheered up from a visit to their firehouse and had barely left his bedroom since they’d gotten back to Gwyn’s place.

He was worried about him and he knew Gwyn was too.

Almost a week had passed without TK making any kind of move to pick himself back up and Owen had convinced Gwyn to stage an intervention with him to pull TK out of his own mind.

That’s where they were now. The three of them sat at Gwyn’s kitchen table, staring each other down, none of them really knowing where to start.

“I don’t know what your plan was, but if it was just us sitting here, staring at each other, you can do it without me.” TK said and pushed his chair back and got up.

“TK. Sit down.” Gwyn told him and reached out for his hand. “Please. Your father and I just want to talk to you.”

TK sighed and sat back down.

“About what? That I should go to therapy? Or NA? That you’ll be there for me every step of the way? That it’ll be good for me?” He crossed his arms in front of his chest, gearing up for a fight.

“I got offered a job.” Owen interrupted. “In Austin, Texas. Rebuilding a firehouse that lost almost its entire crew.”

“Ok.” TK said after a minute of letting the sudden change of subject sink in. “Good for you, dad.”

“I think I’m going to take it.”

TK nodded.

“So you’re moving to Texas then.”

“Yeah… I… we… your mother and I… we both think you should come with me.”

“What? No way. My life is here. My friends, my job.”

“You’ll make new friends. Better friends.”

“Friends who don’t use.” TK deadpanned.

“Would that be such a bad thing?” Owen asked. “And you’ll have a job at the firehouse with me.”

“So you can check up on me.” TK said, daring him to disagree. “And why would I move to hate crime, USA? I’m gay, dad. And Jewish. Texas isn’t the most welcoming place for people like me.”

“I’m sure a big city like Austin isn’t so bad.” Gwyn offered. “If you want to go back to temple I can reach out and ask for recommendations for LGBT+ friendly places in Austin.”

“I’m not moving to Texas!” TK yelled and got up and started pacing. “I actually found a rehab place in California. I emailed them to ask if they have a place for me. I didn’t want to say anything until I knew for sure there was anything to tell, but if they get back to me and tell me I can come, I’m going.  A few weeks of yoga on the beach and I’ll be fine. I’ll be able to go back to work and actually do the things I trained for instead of hanging around this place all day.”

“California?” Gwyn interrupted. “When did you find that place?”

“The other day. When we got back from packing up my stuff.”

“Ok. And what kind of place is it? Can you show me the website?”

“It’s just this wellness thing. I don’t have the details right now.” TK brushed her off and turned his attention to his phone when it buzzed in his pocket.

“If it’s yoga you want, I can go to yoga classes with you here. You don’t need to go to the other side of the country.” Owen offered. “Just no goat yoga. I’ve heard weird things about that.” He tried to joke to relieve the tension.

TK didn’t reply just focused on his phone.

“Everything alright? TK?”

“Uh yeah, yeah… I just got an email from that place in California I found… they have a place for me. I can start the program as soon as tomorrow.”

“That’s good isn’t it?” Gwyn asked “That’s what you wanted.”

“Yeah… I uh… just didn’t think I’d be able to start so soon.”

“You don’t have to go.” Owen said, trying to find the right words. “I mean. You can go to NA here, I can come with you. There are clinics and programs here in NYC too. You don’t have to do it all on your own. I want to help you. So does your mother.”

“I know dad… but I… I think I just… I need to get away. I just… need to put as much distance between me and… everything that’s bad for me here.” TK said as if he was telling himself why going to California was the best thing for him.

“Like Alex.”

“No. Yes. Not just him. This isn’t his fault. It’s on me.”

“Him being a lying, cheating…”

“Dad…”

“What?” Owen asked. “It sure as hell didn’t help, did it?”

TK shook his head.

“You’ve never liked him.”

“Clearly with good reason.”

“Tell me more about this place in California you found?” Gwyn interrupted, trying to get the conversation back on track. “What do they offer except yoga?”

“It’s… some kind of retreat. I think. I signed up pretty quickly so I wouldn’t change my mind.”

“But it’s a rehab facility?”

“Yeah. They have medical staff and they offer therapy. I think I’ll be good for me.”

“Why don’t you just come to Texas with me? We’ll start over together.” Owen offered. “I’m sure they have yoga classes in Texas too.”

“No, dad… I need to do this on my own. I want to do this. I want to get clean once and for all.”

“And you think going to California will help you do that?” Gwyn asked.

“Yeah. Yeah I think so.” TK told them. “And there was this guy in the academy with me. Evan B... something. He transferred to LA to be closer to his sister or whatever… I don’t really remember. But maybe I can message him when I’m done, see if there are any jobs going with the LAFD. Stay out west for a while.”

“You have a job here. And I can get you a job in Texas.” Owen said, earning him a glare from his ex-wife. “But if you think California is the right thing to do for you… we’ll both support you.

---   

A few days, a maxed out credit card, a teary airport goodbye, an exhausting flight, and a three hour time difference to mess with his head later, TK stepped off the plane in California and went to the motions of reclaiming his bag.

He threw it over his shoulder and shuffled through the arrivals hall with the rest of the passengers. As soon as he walked through the doors, someone rushed past him. He wanted to snap at the guy and maybe throw in a snide comment or two, but then he saw him practically throw himself at another guy holding a heart shaped balloon and he had to look away. He couldn’t deal with happy couples right now.

Instead he made himself focus on looking for whoever the clinic had sent to pick him up.

He noticed a guy in a simple button down shirt and jeans instead of the usual corporate three piece grey suit holding a sign that, upon closer inspection, said Tyler Strand.”

“Hi. I think you’re here for me.” He told the guy, walking up to him.

“Are you Tyler Strand?”

“Yeah. I uh… go by TK actually. “Tyler Kennedy. Two first names. My parents have never agreed on anything in their lives, naming me was no different… this was their compromise.”

“Oh. Sorry about that. I just copied what was on the form.”

“It’s fine. Someone getting my name wrong is the least of my problems at the moment.”

“Yeah.” The guy said and cleared his throat. “ Uhm… Do you have everything? Your luggage?”

“Just this.” TK shrugged the shoulder his bag was hanging from.

“Alright. Let’s get going then. It’s not that far from here. Only about an hour and a half’s drive.” The guy told him and started walking. “I’m Carlos by the way.”

TK followed him out of the airport and to the parking lot where he unlocked a plain black car, thankfully without any logos or the name of the retreat on it.

“Just throw your bag in the back, it’s open.” Carlos told him and TK did as he was told before getting into the car.

They pulled out of the parking lot and soon they were onto the highway.

As much as TK tried to focus on the random pop songs playing on the radio, the guy sitting next to him intrigued him for some reason and he wanted to talk to him to find out more about him.

“So are you a therapist or just the driver?”

“I’m not a therapist.” Carlos told him, glancing back and forth between TK and the road. “Though I’ve been told I’m a good listener if you want to talk.” He shot TK a quick smile.

“I’ll keep that in mind.”

“I’m more of an activities kind of guy.”

“Activities? What is this, summer camp?”

Carlos laughed.

“Well… in a way. Though a bit unconventional. Maybe more like boy scouts? For adults.”

“I was never a boy scout.” TK shrugged. “Born and raised in Manhattan. The most exotic place my parents took me was the Bronx zoo.”

Carlos laughed.

“I’ll try not to hold it against you.”

They made small talk about the music on the radio, the latest celebrity scandal, an upcoming superhero film, and even the weather, until TK felt himself getting drowsy and rested his head against the window, planning to close his eyes for five minutes.

The next thing he knew was Carlos gently shaking his shoulder to wake him up.

“Hey, you fell asleep about an hour ago but we’re here.”

TK rubbed the sleep from his eyes and looked around.

“Right. Ok. Sorry about that.”

“It’s ok. You probably needed the rest.” Carlos gave him a friendly smile and helped him grab his stuff from the trunk. “Do you want to go over the paperwork now or do you want to get settled in first?”

“Papers.” TK replied right away. “Get it over with.”

“Alright, follow me.”

Carlos lead him into a building and down a few hallways. They met a couple of people along the way and Carlos greeted them all in passing. Though they all seemed to be staff rather than patients and it made TK curious.

“How many people are here.. for uh… help?”

“About 30 in total. Not that many.” Carlos replied, opening a door with a key card. “That way we have more time to curate people’s experience based on their needs.” 

TK snorted.

“Did you just quote the website?”

Carlos shot him a grin.

“What can I say, I like to be prepared.”

He opened another door and entered an office and gestured for TK to sit down.

“Just give me a minute to find everything. I don’t usually do the paperwork thing and this isn’t my office.” He explained. “I don’t have an office.”

“It’s fine.” TK shrugged. “It’s not like I’ve got anywhere else to be.”

Carlos opened a few drawers and pulled out some forms.

“Ok, let’s get started. First question. When is the last time you used?”

“Anything?”

“Hmm.”

“On the plane here…” TK admitted reluctantly.

“What did you take?”

“Just… two little bottles of vodka from the drinks cart. To take the edge off.”

Carlos nodded and wrote down TK’s answers.

“Anything else?”

“No.”

“And before today? What was your drug of choice?”

“Anything I could get my hands on…” TK told him, pulling the sleeves of his hoodie down over his hands. Thankfully the track marks on his arms weren’t nearly as bad as they could have been, but he still felt self-conscious about them.

Carlos’s eyes flicked to his arms but he didn’t acknowledge the move.

“Ok. You said you overdosed in your application, what did you use?”

“Pills… they were easiest to get…” TK answered, squirming in his seat, regretting not choosing to go to his room first.

“Oxy?”

“Yes… do we really have to do this?”

Carlos put his pen down.

“You can fill it in yourself if you’d rather… but one of us has to somehow. These need to be filled in and filed before your treatment can fully start.”

“Right.”

“Look, I know this is a lot but it’s only going to get better from here.”

“Hopefully.”

“You don’t think you can do it?”

TK sighed and leaned back in his chair.

“I want to. For my parents. I’ve caused them so much pain…”

“But…” Carlos prompted.

“But… this isn’t my first time trying to get clean.” TK sighed. “I just… don’t know if I can do it. Maybe this is as good as it gets.” He shrugged. “I get clean for a few months and then just… find a reason to score again.”

“And why shouldn’t this time be different? Why shouldn’t this time be the time you kick the habit for good?”

TK shook his head.

“I don’t know. I’m pretty tired. Can we finish this another time? Tomorrow maybe?”

Carlos smiled and TK felt a little bit of the pent up anxiety slowly slip away.

“Sure. I’ll show you to your room.”

---

The next morning TK was woken up by someone knocking on his door.

He dragged himself out of bed and opened it to see Carlos standing there in work out gear.

“Morning.” He said happily. “Are you ready to start the day?”

“What?” TK blinked and tried to wake himself up enough to figure out what was going on.

“It’s a nice morning. We’re going for a run. The others are on their way too.”

“Others? Run? What?”

“It’s part of the program you signed up for.” Carlos said as if it was the most obvious thing in the world. “Healthy body and a healthy mind.”

“I… I don’t… I… think… uhm… I don’t understand.”

Carlos smiled.

“Not a morning person?”

“No. Yes. I mean. What the hell is going on?”

“It’s time to start the day with a run. And then when we’re done with that we can finish the paperwork from yesterday before the afternoon program starts.”

“Afternoon program?” TK shook his head in an attempt to wake himself up. “I don’t know what you’re talking about.”

“The program.” Carlos said and proceeded to run TK through an itinerary that exhausted him just listening to it.

“I… What’s going on?” TK asked “Is this bootcamp for navy SEALs?”

“Hardly.” Carlos snorted “But this is what you signed up for.”

“No… I think I’d remember joining the army.”

“I know it can be a lot on your first day but you get used to it soon enough. Trust me.”

“I… I think there’s been a mistake. I was under the impression this was more… yoga on the beach and spiritual awareness and all that.”

“Well… I do yoga in my spare time, I know a few poses. I’m not an instructor or anything but we can set something up after dinner maybe.”

“After going through special ops training? I don’t think I’ll be alive.”

“It’s not so bad. Honestly.”

“Somehow I doubt that. I guess I didn’t really read the website that well when I signed up. I uh… I’m sorry for wasting your time. I’ll figure out a way to get back to the airport and see if there’s room on a flight back east any time soon.”

Carlos crossed his arms in front of his chest and TK had to force himself to not let his eyes linger on the way his muscles moved under his shirt.

“So you’re just giving up? I didn’t think you were a quitter.” He uncrossed his arms. “But I guess it’s easier to leave than to admit you can’t cut it.”

“Excuse me?”

“It’s ok.” He shrugged. “Not everyone can handle this program. It’s good to know your limits. I’ll drive you back to the airport myself. Do you need to call anyone? The phone signal is kind of hit and miss out here. Mostly miss.”

TK knew Carlos was baiting him but he wasn’t one to back down from a challenge.

“Give me five minutes.”

---

TK considered himself to be in pretty good shape. His firefighter training made sure of that. He’d been in the top 5 of his class in the academy and could definitely hold his own compared to the more experienced members of his crew.

Only the program he’d apparently signed up for now seemed designed to actually kill him. He was sure even Navy SEALS would think it was too much.

The morning run wasn’t just a few miles in the area or even on a track, but through the woods near the facility. Uphill and down again. Avoiding tree roots, rocks, overgrown areas, and random holes.

They were running in a group but TK, as well as some other patients, were trailing behind.

Just as he was trying to figure out a route back to base camp as he’d started calling the clinic in his head, Carlos caught up with him.

“How are you holding up?”

“I don’t know. Fine.” TK panted. “Is this your tactic? Trying to kill me? If I’m dead I won’t think about wanting to use?”

Carlos chuckled.

“Has anyone ever told you, you can be pretty dramatic?”

TK grinned.

“Often. But it’s part of my charm.” He said and dropped down at the foot of a tree to catch his breath.

Carlos gestured to his coworker and the rest of the group to keep going and sat down next to him.

“So when did you decide to be an army drill sergeant?” TK asked, using his shirt to wipe the sweat from his brow.

“I’m a cop actually. Or… used to be I guess.”

“That explains a lot.”

“It does?”

“You like torturing people.”

“I like helping people.” Carlos insisted. “That’s why I left the force. A friend of a friend got me this job. I figured I could do more good here than arresting people for minor offences.”

TK nodded.

“That’s… very noble of you.” He settled on.

“Try telling my family that.” Carlos sighed. “My whole family is in law enforcement somehow. My dad especially wasn’t happy when I quit my job. He wanted me to follow in his footsteps, carry on the family legacy.”

“Yeah… I know a thing or two about following in your father’s footsteps.” TK said and leaned back against the tree.

They sat in silence for a while until they heard the rest of the group coming closer and got up to join them again.

---  

“So how did you end up here? You don’t seem like the typical Californian surfer dude.”

Carlos laughed.

“What do they look like then?”

TK shrugged.

“I don’t know. Not like you. More… bleached blond and beady necklaces. And flip flops.”

“Well you’ve got me there. I’m from Texas originally. Austin.”

“Really?”

“Yup. I grew up on a ranch on the outskirts of the city.”

“A ranch? So you’re a farmer? Or a cowboy?”

“Neither. Both. It’s complicated.”

TK nodded.

“Does complicated have a name?”

“Yeah. Dad.”

It had become a thing. Whenever they could get away with it, TK and Carlos would just hang out and talk. No pressure from the group sessions or the one on one talks with his assigned therapist, but just the two of them.

Since he’d gone through the worst of the withdrawal in hospital back in New York, his treatment mostly consisted of working on his mental health. And thankfully for him, talking to Carlos did just that. They had a similar sense of humour, similar complicated relationships with their families, and just generally got on well.

He’d told him about Alex, Carlos told him about marrying his best friend in an attempt to please his family.

“How did that work out for you?”

“Badly.” Carlos shrugged. “I mean we’re still friends… and my mom had a framed picture of us on display with the rest of the family pictures. For a while I told myself that meant I’d done the right thing. But it wasn’t.”

“If we were allowed to drink here, I’d buy you a beer and we could raise a glass to making bad decisions to please our parents.”

---

A few days later, the group TK was in was going on a hike with an overnight stay in the woods near the clinic.

TK was less than enthusiastic about it, and told Carlos as much (repeatedly) as he helped pack tents and other gear.

“Just think of it as going camping.” Carlos offered. “It’ll be fun. Connecting with nature and stuff. Maybe I can even smuggle in some ‘smores.”

TK gave him a blank look.

“I’m from NYC. I grew up in Manhattan. My parents are workaholics. What makes you think I ever went camping as a kid.?”

“You mean you never pitched a tent in central park?” Carlos joked. “Or maybe swam in that fountain you see in every movie?”

“I’ve done a lot of things in Central Park…” TK started. “But somehow never that.”

“Well, maybe you should. It’s good to have a goal in life.”

“Only if you come bail me out when I get arrested.”

“I don’t know, it’s kind of a long commute from here.”

TK laughed and ducked his head. Their talks had started to get a little, or a lot, flirty and he was fairly confident Carlos liked it as much as he did. Liked him.

Only every time TK thought the other man might make a move, or when he was hyping himself up to do so, Carlos would come up with some excuse that meant he had to be as far away from TK as possible for at least a couple of hours.

He wanted to ask why but also wasn’t ready for a simple answer like Carlos just not liking him like that.

So instead he said nothing and just admired Carlos from a distance and made himself talk to other people.

Which was going fine until about 15 minutes into their hike when one of the other patients tripped and fell down a hill.

TK’s first responders training kicked in and he rushed over to them, skidding and sliding down the hill.

“Let me have a look, I’m a paramedic. Don’t move.” He told the woman. He’d talked to her a few times and vaguely remembered her name was Hannah and she was from Wisconsin. He tried to examine her as best he could without his medical gear. She had a head wound and her leg was obviously broken.

He noticed someone coming down the hill after them and didn’t have to look to know it was Carlos.

“I have a first aid kit. It’s got the basics.” He said, unzipping his backpack.

With Carlos’ help, TK managed to treat Hannah’s injuries while one of the other staff members radioed for a medevac to get her out of there and to a hospital.

“Someone needs to get up there to show the helicopter where exactly we are. It’s the only place they’ll be able to land.” Carlos said, nodding at a an open place higher up from where they were and turned to TK. “How are you with heights?”

“Fine.” TK shrugged. “I’m a firefighter.”

“I thought you said you were a paramedic?”

“I am. Both. I’m dual certified.”

“Really? That’s impressive.”

They carefully climbed up to the landing spot and with help of the rest of the group and the paramedics, they got Hannah onto the helicopter and on her way to the hospital.

“You two make a pretty good team.” Luke, one of the other patients said, and TK found himself agreeing with him.

“Yeah, we do, don’t we?” Carlos said with a smile.

---

“We’ll set up camp on the other side of this river.” One of the other staff members announced as the group walked up to a river a while later.

“And how do we get there?” TK asked, fearing he already knew the answer.

“We cross it.”

“By bridge?”

Next to him Carlos laughed.

“Did they teach you to swim in firefighter training?”

“They did not actually. The only water I handled in that was the kind that’s supposed to save you from burning to death in abandoned warehouses.”

“That’s… oddly specific.” Lexi, the other staff member commented.

TK shrugged.

“It’s the easiest thing to set up for training recruits.”

“Anyway.” Carlos clapped his hands. “I hope everyone can swim because we’re going through the water to the other side of the river.”

“And how do we do that with all of the stuff we’ve been dragging around?” TK asked him.

“You tell me.”

TK raised an eyebrow.

“This is beginning to feel more and more like summer camp. Or boy scouts.”

“I thought you’d never been a boy scout?”

“I’ve seen them on tv.”

Carlos laughed.

“Well in the beginning you were calling this basic training for Navy SEALs so I guess you’re getting used to it all.” He winked and TK suddenly didn’t mind the hiking and the camping so much anymore.

After some arguing and general chaos, the group managed to work together to create some kind of raft to get them and their gear to the other side of the river, without swimming.

Only the raft wasn’t very stable and when it was TK’s turn, he leaned to one side too much, causing the raft to flip and him ending up in the water.

Thankfully it was a warm day so he didn’t mind too much. But he could’ve done without making a fool out of himself in front of Carlos.

Carlos who was getting into the water with him to help him get his stuff onto the river bank.

Carlos who looked unfairly gorgeous in a wet t shirt.

“Are you ok?” He asked TK who was trying to swim to shore with some of his dignity intact.

“Yeah. Just a bruised ego.”

After the rest of the group made it across in one piece, they all helped Carlos and TK get out of the water and see how much of their stuff was still ok to use.

“I think you two should just go dry out in the sun for a while.” Lexi told them. “We’ll lay out your tent, TK, so it can dry too.”

“My tent is big enough for the both of us.” Carlos cut in. “We’ll lay your sleeping bag out in the sun and we’ll just share my tent. If that’s ok with you?” He asked TK who was about to actually jump for joy.

“Sure.” He replied, hoping he sounded a lot more casual than he felt. “I promise I don’t snore.” He joked.

“That’s ok. I can sleep through anything. My sisters used to share a bedroom next to mine when I was a kid and they fought a lot. The walls were paper thin.” Carlos told him as he and TK made their way over to a sunny spot by some rocks near to where the rest of the group was setting up the camp.

TK sat down and closed his eyes, tilting his face up to the afternoon sun.

“We should probably get out of these wet clothes.” Carlos said after a few minutes.

TK opened his eyes and looked at him plucking at his wet t-shirt, obviously uncomfortable.

He grinned.

“Are you trying to get me naked?  

“What? No, no, no. I just don’t want you to catch hypothermia. And neither do I.”

“Well, you know the best way to warm up is sharing body heat.”

Carlos looked at him for what seemed like hours and TK could practically see the cogs turning in his head, working through the various replies, trying to find one that was still the right side of professional.

Fortunately or unfortunately, he wasn’t sure, some of the other patients joined them and their little hang out for two turned into a group therapy session.

“Oh my god, look at that!” TK exclaimed a little while later. “Don’t move guys, you’ll scare him off.”

Carlos followed TK’s line of sight and noticed a small lizard sitting on a nearby rock, observing the intruders in his territory, trying to find out if they were a threat.

“Look at him, he’s so cute.” TK slowly crawled over to the lizard. “Hey buddy. Did you come to say hello?” He carefully moved his hand to try and pet the animal.

“Careful. It might bite.”

“Not if it doesn’t feel threatened. It’s just coming to take a look. He’s just a curious little guy.”

“You like reptiles?” Luke asked, the look on his face making it clear he definitely didn’t.

“Yeah. They’re gorgeous and they can make such great pets. I had a friend in middle school who had a leopard gecko. It was so cute and smart. I was over there all the time.” TK said excitedly. “I practically begged my parents for a lizard for my birthday from then on. I did all the research and worked out where to buy food and everything.”

“Did you ever get it?” Carlos asked.

TK shook his head.

“My dad wanted a dog and my mom had and still has a parrot called Ginsburg.”

“After Ruth Bader Ginsburg?”

“Yeah. My mom’s a lawyer and a politics junkie.” TK said absentmindedly, while still trying to befriend the lizard. The entire group watched with bated breath as he slowly moved his pointer finger closer to the lizard’s head.

Only right before he could have touched it, the lizard decided it had had enough and scurried off.

TK pulled a disappointed face and sat back down.

“Better luck next time.” Luke offered and TK nodded.

“Yeah. Maybe I’ll get a lizard when I’m done here and going back home.”

Their little group spent the rest of the afternoon talking and just enjoying being out in nature.

By the time it started to get dark, they moved back to the place where they’d put up the tents and everyone got comfortable around the fire.

They talked, shared stories of their lives back home, and offered each other advice and support.

As the night went on, one by one people started calling it a night until it was just Carlos and TK left by the fire.

“Alone at last.” TK said as he moved to sit next to Carlos. “I thought they’d never leave us alone.”

Carlos glanced at him at smiled.

“Are you not enjoying spending time with your fellow patients?”

“They’re alright.” TK shrugged. “But I’d rather spend time with one person in particular.”

“Oh?”

“Yeah. He’s kind, helpful, sweet, a great listener, and absolutely insanely gorgeous.”

Carlos bit his lip.

“You’re not so bad yourself.”

“I’m a mess.” TK shook his head.

“Maybe. But you’re a hot mess.” Carlos told him, the late hour and the bubble they found themselves in apparently turning off any filter between his brain and his mouth.

TK felt his cheeks heat up but decided to throw caution to the wind and make his move. He leaned in, looking down at Carlos’ lips and back up into the soulful brown eyes that made his heart flutter.

The moment his lips met Carlos’ he felt himself come alive in ways he hadn’t ever thought possible. It started off as nothing more than a press of lips but soon grew more heated as TK ran his tongue along Carlos’ lips until he opened up for him.

He licked into his mouth while his hands had found their way into Carlos’ hair, running his fingers through the soft curls as Carlos ran his hands over TK’s back, pulling him impossibly closer.

Somewhere in the back of his mind TK knew someone could catch them at any given moment, but the feeling of finally getting to kiss Carlos after weeks of quietly pining for him was too good to stop and he wanted more.

He moved his hands from Carlos’ hair, down to his waist and slipping them under his shirt, letting them roam over his chest and stomach.

Carlos pulled back and started kissing his neck and TK discovered he was really into that.

Only when TK’s hands moved lower and started blindly fumbling with the button on Carlos’ jeans, somehow the spell was broken and the moment was gone.

Carlos jumped up and touched his fingers to his lips.

“This… can’t happen.”

“Why not?” TK asked, getting up and taking a step towards him. “We both want it.”

“I’m supposed to be helping you. I can’t take advantage of you like this.”

TK rolled his eyes.

“It’s not taking advantage if I want it.”

Carlos shook his head.

“We can’t. I… I can’t jeopardise your sobriety like this.”

“My sobriety is my own responsibility. That’s what this program is teaching me isn’t it? To take responsibility for my actions. This is me doing that. I want to kiss you and I know you want it too.”

TK took another step forward and closed the distance between them. He slowly leaned in and put his hand on Carlos’ cheek while looking him in the eye.

“I want this.” He said before pressing his lips to Carlos’ in a soft chaste kiss that couldn’t be more different from the first one.

Carlos seemed to almost melt under his touch and TK felt his resolve slipping as he started to kiss him back.

At least until his brain caught up with the rest of his body and he pulled away again.

“I can’t. I’m sorry I shouldn’t have… I just… I can’t. If anyone finds out I’ll get fired so fast… I’m crossing so many lines.”

“I don’t care. I like you. I want this.” TK told him.

“I do care.” Carlos said, almost begging him to understand. “I want to help people get their life back on track. I can’t… do this. I’m sorry I shouldn’t have… I screwed up. I’m sorry.”

“Do you not like me?” TK asked when Carlos had to pause his rambling to take a breath.

“I do. I like you a lot. And if things were different I wouldn’t hesitate to take you out on a date or cook you dinner… But I can’t take advantage of the situation like this.”

“But you’re not.” TK said, trying to make him understand. “You’re not.”

“I am. I’m supposed to help you. I’m supposed to… I don’t know… guide you. You’re a client. I’m in a position of power.”

“What if we just forget that? Just for tonight. And tomorrow we’ll just go back to how things were before.”

Carlos gave him a small smile and TK could tell he was seriously considering it.

“I wish I could.” He replied. “But I don’t think I could go back if I let myself get lost in you. You are… a force to be reckoned with TK Strand. And I wish things were different. I wish we’d just met in a bar or getting a coffee downtown. I wish I could get to know you without all of this.”

“You could. You can. The program is almost over. Nobody has to know. I won’t tell if you don’t.” TK told him and stepped closer again. “Please don’t make me beg.”

Carlos smiled and ran a hand through TK’s hair.

“You deserve the world.” He told him. “And don’t let anyone convince you otherwise.”

Carlos stepped away and disappeared into the tent, only to come back out with his sleeping bag almost right away.

“I’ll sleep out here. It’s supposed to stay dry anyway.”

“Carlos don’t be ridiculous.”

“I’m not. I can’t share a tent with you and not touch you. I don’t think I would be able to control myself.”

“Then don’t.” TK pleaded and he could tell Carlos was this close to giving in.

He took a deep breath and made himself step away.

“If things were different…” He looked at TK and shook his head slightly. “It’s better this way.”

The rest of his time in California, TK spent mostly on his own, mourning something he’d never really had.

A few other patients noticed he and Carlos weren’t attached at the hip anymore and his assigned therapist noticed his mood had changed.

He fed all of them some line about being homesick and ended up calling his dad and agreeing to join him in Austin.

On his last day, Carlos was nowhere to be found and TK told himself to accept he just wasn’t interested.

He said goodbye to the friends he’d made and made them promise to look him up if they ever found themselves in Austin Texas. He’d slipped a note under Carlos’ door telling him the same.

“Station 126. Just ask for me.”

One of the staff members TK had only seen but never talked to drove him to the airport and wished him the best.

When he landed in Austin, his dad was waiting for him and pulled him into a hug the moment he walked through the doors after the luggage reclaim.

The house Owen had bought looked like something straight from a home improvement show and TK did his best to make it feel like home.

The dog he’d adopted was a nice distraction and TK took it out on long walks to explore Austin together.

His new coworkers were nice enough and after a few weeks of working together they’d become a close knit friend group.

He hadn’t told them about Carlos however. He hadn’t told anyone. That kiss was his memory and his alone.

Though maybe he should take Paul and Marjan up on their offer of going out to explore the Austin nightlife on their next day off.

Maybe there would be someone to make him forget about Carlos, even if just for one night.

---

“I’m just saying, when in Rome. Or… when in Texas.” A young woman in a hijab said to a black man standing near her as they cleaned the fire engine. Carlos watched them through the open bay doors for a moment before taking a deep breath and walking in.

“Hi… I’m looking for TK Strand. Does he work here?”

“That depends. Who’s asking?” the woman asked.

“I’m Carlos. I’m a… friend from California.” He settled on, not sure how much TK’s coworkers knew about him.

Confusion flashed over the woman’s face and she looked at the man who just shrugged.

“Ok. Wait here. I’ll go see if he’s available.” She instructed him and turned around and walked up some stairs.

When she returned a few minutes later TK was right behind her.

He stopped at the bottom of the stairs and just stared.

“Carlos? What are you doing here?”

“You told me to look you up if I ever decided to go back to Austin… here I am.”

“I… Yeah… I can see that.” TK stammered, still not quite believing what he was seeing.

The woman and the man from before were still lurking, ready to jump in the moment they deemed it necessary.

“You ok TK?” the woman asked.

“Yeah, yeah it’s fine.”

“You sure?”

“Yeah. He’s alright. He’s not the guy from New York.”

The woman nodded.

“Alright. Just yell if you need anything. There are a bunch of firefighters up there who have your back.” She said, not quite talking to TK anymore.

“I know. Thanks Marj.”

The woman nodded again and walked back up the stairs, the man following close behind.

“She’s…” Carlos trailed off, not sure what to say.

“Yeah. I told them about my ex… and my OD.”

“Oh. Good. I didn’t say anything because I wasn’t sure what you’d told people here…”

“Thanks, but I’ve decided to stop hiding who I am.” TK shrugged. “My addiction is always going to be a part of me. Hiding it won’t change that.”

Carlos nodded.

“That’s… that’s good. I uh… I’ve decided to do the same I guess.” He told TK.

“Not hide your addiction anymore? I didn’t think you had one?”

Carlos shook his head.

“No. I mean… I’m not going to hide who I am anymore. I’m just… still kind of figuring out who that is.”

TK smiled.

“Well… the person I met in California was kind, a good listener, gentle with a slight sadistic streak.” He joked and they both laughed. “What are you really doing here Carlos?”

“I quit my job in California. I’m back in Austin.” Carlos explained. “I’m staying with a friend right now until I get a place of my own.”

“Ok.”

“I just… I know it’s been a few weeks but… I can’t get you out of my head.” He stepped forward and reached out to grab TK’s hand, smiling when TK let him. “I’d like to get to know you… without… everything… from California.”

“But the stuff from California didn’t just go away when I completed the program.”

“I know. But I also know there is more to you than just your addiction.” He took TK’s other hand in his. “Remember when I told you I’d want to cook you dinner and take you out on a date?”

“The night you insisted on sleeping outside because I’d kissed you? Yeah I remember.”

“It was the right decision at the time… but… now things are different… so… if… if you’re still interested… maybe we could… go on that date sometime? And you’d let me cook you dinner?”

“That depends, will you end up sleeping under the stars again?”

Carlos laughed.

“Maybe. If my friend won’t let us use her place. I’ll have to sleep in my car.”

“Do you have a big car?”

“No. Not exactly. I drive a Camaro. Looks cool but limited space for sleeping.”

“Well hopefully your friend will be in a good mood then.”

“Yeah… so is that a yes?”

TK smiled.

“Yeah. It’s a yes.”

Carlos’ smile got impossibly bigger.

“How does Friday sound?”

TK let go of Carlos’ hands and cupped his face.

“It’s a date.” He said and leaned in and kissed Carlos.

Somewhere behind them a chorus of cheers and wolf whistles erupted.

“I think your friends approve.”  

[medicals12]

How to Select the Best Stethoscope for Doctors and Nurses: A Comprehensive Review of Top Models and Their Unique Benefits

In the world of medical equipment, few tools are as essential and iconic as the stethoscope. For doctors and nurses, a reliable stethoscope is not just a symbol of their profession but a critical device that aids in accurate diagnosis and effective patient care. Choosing the best stethoscope can be a challenging task given the wide array of models, features, and price ranges available on the market. This comprehensive guide will help healthcare professionals understand how to select the best stethoscope for doctors and nurses by reviewing top models and highlighting their unique benefits.

Understanding the Importance of a Stethoscope in Medical Practice

Before diving into specific models, it is important to grasp why the right stethoscope matters so much. A stethoscope enables clinicians to listen to heartbeats, lung sounds, bowel movements, and blood flow in arteries and veins. The clarity and precision of these sounds can significantly affect diagnostic accuracy. Poor acoustic quality or an uncomfortable design can hinder medical examinations, potentially affecting patient outcomes.

Key Factors to Consider When Choosing a Stethoscope

When selecting a stethoscope, doctors and nurses should consider several crucial factors to ensure they invest in a device that fits their needs:

Acoustic Performance: The primary function of a stethoscope is sound transmission. High acoustic sensitivity helps detect subtle sounds, such as faint heart murmurs or abnormal lung noises.

Chestpiece Design: Stethoscopes generally have either a single-head or dual-head chestpiece. Dual-head models have a diaphragm for high-frequency sounds and a bell for low-frequency sounds, offering versatility.

Comfort and Fit: Since healthcare workers wear stethoscopes for hours, comfort is essential. Look for adjustable binaurals (the metal tubes), soft ear tips, and lightweight materials.

Durability: A stethoscope is an investment, so it needs to withstand daily use and cleaning. Models with stainless steel chestpieces and high-quality tubing tend to last longer.

Specialty Use: Some stethoscopes are designed for specific uses, such as pediatric or cardiology stethoscopes, which have enhanced acoustic capabilities for particular patient groups.

Price: While premium models come with advanced features, many mid-range stethoscopes provide excellent performance at a more affordable price.

Top Stethoscope Models for Doctors and Nurses

Here is a review of some of the best stethoscopes widely recommended by medical professionals, with unique features that set them apart:

1. Littmann Classic III

The Littmann Classic III is often considered the gold standard for healthcare professionals. It features a dual-head chestpiece with tunable diaphragms on both the adult and pediatric sides. The acoustic performance is outstanding, allowing clear detection of a wide range of sounds. It is also lightweight and comfortable for long shifts. This model is suitable for general practice and nursing.

2. MDF MD One Stainless Steel Stethoscope

The MDF MD One offers excellent durability with a stainless steel chestpiece and comes with a lifetime warranty. Its acoustic sensitivity rivals many high-end stethoscopes but at a more budget-friendly price. The ergonomic design and replaceable ear tips enhance comfort for prolonged use.

3. Littmann Cardiology IV

For cardiologists and those needing superior acoustic clarity, the Littmann Cardiology IV provides unmatched sound quality. Its tunable diaphragm allows precise auscultation of subtle heart sounds, and its durable design withstands intense daily use. This model is ideal for specialists but can also benefit nurses in critical care.

4. ADC Adscope 615 Platinum Series

The ADC Adscope 615 is known for its robust construction and clear acoustics. It features a dual-head chestpiece and soft-sealing ear tips for noise reduction. This stethoscope offers a great balance between quality and affordability, making it popular among nurses and medical students.

5. Welch Allyn Harvey DLX

Welch Allyn Harvey DLX stethoscopes are favored in hospital settings due to their durable build and excellent sound amplification. They come with replaceable components and are designed to minimize ambient noise, aiding precise auscultation in noisy environments.

Specialty Stethoscopes: Tailored for Specific Needs

Apart from general-purpose stethoscopes, there are specialty models like pediatric stethoscopes, designed with smaller diaphragms and bells for better sound detection on children, and electronic stethoscopes that amplify sounds and reduce background noise. These advanced models are especially useful in complex diagnostic scenarios.

Maintenance and Care Tips

To ensure longevity and optimal performance, proper maintenance is key. Regularly clean the chestpiece and tubing with alcohol wipes, avoid exposing the tubing to extreme heat or solvents, and replace ear tips as needed to maintain comfort and hygiene.

Conclusion: Investing in the Right Stethoscope for Better Patient Care

Selecting the best stethoscope for doctors and nurses is a critical decision that combines acoustic quality, comfort, durability, and budget considerations. Whether you choose a trusted classic like the Littmann Classic III or a specialty electronic model, investing in a high-quality stethoscope elevates your diagnostic accuracy and enhances patient care. In the world of medical equipment, a reliable stethoscope is more than just a tool—it’s an extension of your professional expertise.

[kaneinstitute]

Unlock Your Potential with Medical Aesthetics Training in Calgary at Kane Institute

In today’s rapidly changing healthcare landscape, medical professionals are searching for more than just a paycheck—they’re looking for freedom, fulfillment, and flexibility. Many are discovering that path through medical aesthetics, an exciting field that blends science with artistry and opens new doors to personal and professional growth.

In Calgary, one name stands out as a trusted leader in medical aesthetics education: Kane Institute. Whether you’re a nurse, doctor, dentist, or healthcare professional ready to explore a new side of medicine, Kane’s comprehensive training programs offer the skills, confidence, and support you need to thrive.

A Career That Works for You

Medical aesthetics is a booming industry in Canada—and Calgary is no exception. From injectables like Botox and dermal fillers to skin rejuvenation and PRP therapy, the demand for non-surgical cosmetic treatments continues to skyrocket.

But for many healthcare workers, medical aesthetics is about more than beauty. It’s about building something of their own. It’s about:

Taking control of your schedule

Increasing your income

Doing work that’s creative, hands-on, and client-focused

Starting your own business or adding a new service to your clinic

This career path offers a powerful alternative to the traditional 9-to-5, especially for those craving more autonomy and purpose.

Why Calgary?

Calgary is a vibrant, growing city with a diverse population that values wellness, appearance, and preventive care. It’s a prime location for professionals looking to enter the aesthetic medicine space.

Whether your goal is to open a boutique medispa, offer part-time mobile services, or integrate Botox into an existing practice, Calgary offers the perfect environment to attract loyal, long-term clients who are eager for expert, medical-grade aesthetic care.

Why Kane Institute?

When it comes to choosing a training provider, experience and credibility matter. Kane Institute is one of Canada’s leading institutions for medical aesthetics training, known for its rigorous, hands-on approach and outstanding graduate success.

Here’s what makes Kane the top choice for aspiring aesthetic professionals in Calgary:

1. Expert-Led Instruction

Courses at Kane Institute are taught by practicing medical professionals with deep experience in both the clinical and artistic sides of aesthetic medicine. Their guidance ensures you’re learning the safest, most up-to-date techniques—while also gaining insight into client communication, anatomy, and treatment planning.

2. Hands-On, Real-World Learning

Kane Institute believes that the best way to learn is by doing. That’s why each course includes live model injections, where students get supervised, practical experience on real patients. This approach builds confidence and prepares you to start treating clients immediately after graduation.

3. Business & Branding Support

Success in medical aesthetics isn’t just about clinical skill—it’s also about entrepreneurship. Kane Institute helps you understand how to:

Market your services

Build a client base

Price your treatments

Manage risks and legalities

Navigate Alberta’s regulatory landscape

It’s a full-circle education designed to set you up for long-term success.

Who Can Take the Courses?

Kane Institute’s medical aesthetics training in Calgary is open to licensed healthcare providers, including:

Physicians (MD, DO)

Registered Nurses (RN)

Nurse Practitioners (NP)

Dentists (DDS, DMD)

Physician Assistants (PA)

Even if you have no prior experience in aesthetics, the courses are designed to take you from beginner to confident injector in just 1–2 days of intensive, focused learning.

What You’ll Learn

The curriculum is crafted to balance safety, science, and aesthetic judgment. You’ll cover:

Facial anatomy and injection landmarks

Pharmacology of Botox and dermal fillers

Assessment techniques and client consultation

Proper dosage and dilution methods

Injection techniques for different areas of the face

Managing side effects and complications

Legal considerations and documentation

You’ll also explore current trends in aesthetic medicine and how to customize treatments for natural, subtle results that clients love.

Build the Life You Want

One of the biggest reasons medical professionals pursue training at Kane Institute is for lifestyle freedom. Whether you want to:

Supplement your current income

Reduce your clinical hours

Launch a solo aesthetic practice

Travel and offer services on-the-go

...medical aesthetics makes it possible. You decide how much you want to work, where you want to work, and who you want to serve.

It’s a career path with low overhead and high reward—both financially and emotionally.

Real Results from Real Graduates

“Kane Institute gave me the tools I needed to completely change my life. I now run my own mobile Botox business and work half the hours I used to.” – Amanda T., RN

“After just one course, I was able to start offering injectables at my dental office. My patients love the convenience, and my revenue has increased significantly.” – Dr. Henry L., DDS

“I’d been a nurse for 15 years and was burning out. Now, I get to combine my clinical knowledge with creativity. I feel excited about my work again.” – Reema K., NP

The Next Step is Yours

The demand for skilled, certified injectors in Calgary is growing every month. Patients are seeking qualified, trustworthy professionals—and Kane Institute is helping meet that demand by producing confident, capable graduates who go on to build thriving practices.

Courses are offered throughout the year, with limited class sizes to ensure personalized attention. From your first injection to your first client, Kane is with you every step of the way.

If you’re ready to break boundaries, unlock new income potential, and take charge of your career, now’s the time.

Enroll in Kane Institute’s medical aesthetics training in Calgary and take the first step toward a career that combines beauty, science, and independence.

[cleverhottubmiracle]

Puffy skin, otherwise known as edema, is usually caused by fluid that temporarily collects between the cells of the facial tissue, leading to a bloated appearance. “Mildly swollen skin is a common concern, often caused by dehydration, alcohol consumption, high sodium intake, or hormonal fluctuations during the menstrual cycle, pregnancy, or menopause,” says Nicole Ruth, MD, DO, FAAD, a board-certified dermatologist in New York City. “Poor sleep, allergies, and sinus issues can also trigger puffiness, especially around the eyes.” “Genetics also play a role as some individuals have a greater natural tendency to retain water,” says Heather Rypien, RN, an aesthetics nurse specialist at Robert Schwarcz Oculofacial Plastic Surgery. Aging is another factor, as the skin loses elasticity and muscle tone, areas like the under-eye become more prone to swelling. Luckily, there are a few ways you can combat puffiness, ranging from instant-gratification quick-fixes to long-term solutions. Explore all of the options, ahead. Understanding Puffy Skin Puffiness can affect people of all ages—it’s the result of a combination of factors including lifestyle, genetics and hormonal changes. “Younger people may be more prone to intermittent puffiness due to hormonal fluctuations, dietary habits, or lifestyle factors such as alcohol consumption and irregular sleep patterns,” says Rypien. “Older individuals are often more susceptible to chronic puffiness because of age-related skin changes including the loss of collagen, a weakened lymphatic system, and fluid retention associated with underlying medical conditions or medications." Different areas of the face experience swelling for different reasons. For example, the under-eye area is the most common ground for puffiness—because the skin is so thin there, it’s particularly susceptible to edema and lymphatic drainage challenges. “The skin here can also be lax, so fluid collects easily and it’s very noticeable,” says Alexis Young, MD, an assistant clinical professor of dermatology at Columbia University Medical Center in New York City. Other areas of the face prone to puffiness include the cheeks, where fluid retention may be influenced by sleeping positions, and the jawline, particularly in individuals with poor lymphatic drainage. “The forehead and temples can also swell due to inflammation or sinus congestion, while the lips and perioral region may exhibit puffiness from dietary triggers, allergies, or certain medications including lip filler,” says Rypien. "Treatments, such as Botox injections around the crow’s feet can inadvertently exacerbate puffiness," adds Rypien. "This occurs because the muscle’s natural pumping motion, which helps with fluid distribution and lymphatic drainage, is temporarily reduced, leading to fluid accumulation.” Immediate Remedies for Depuffing Skin Dip Your Face in Ice Cold Water Fill a bowl with cold water and ice cubes. “You can submerge your face for ten seconds at a time or massage your skin with an ice cube, applying slight pressure to the areas that are particularly puffy to encourage greater blood circulation and less puffiness,” says Dr. Young. Perform a Facial Masssage Gua sha, which means "to scrape" in Mandarin, is a massaging ritual that uses a flat-edged smoothing tool to stimulate blood circulation and lymphatic drainage, while enhancing oxygen levels in the skin. “It can also reduce muscle tension, reducing fluids in the face,” says Rypien. “Gently apply the gua sha to the face using upward and outward strokes.” A jade roller works just as well—simply roll one in a side-to-side motion, moving from the center of the face towards the lymph nodes located along the jawline and in front of the ears. Both tools provide extra power when chilled. A woman using a gua sha. Getty Images Utilize Stapes Found in Your Kitchen There are things in your pantry and refrigerator that can help with facial swelling. “Cucumbers have anti-inflammatory properties that can reduce puffiness—simply slice and place over your eyes for ten minutes in the morning,” says Dr. Young. “You can also soak plain tea bags—avoid herbal teas like mint or chamomile which can be irritating on the skin—in cold water and place them over the eyes. The caffeine and antioxidants in tea constricts blood vessels and reduces puffiness.” If you’ve got an aloe plant, try applying a little gel under the eyes for soothing benefits. “Aloe contains anti-inflammatory properties, which can help reduce puffiness,” notes Dr. Young. Use Depuffing Skin-Care Products Depuffing skin-care products that contain topical ingredients like caffeine can temporarily tighten and depuff. “Many provide relief by constricting blood vessels and creating a tightening effect that helps reduce swelling,” says Rypien. “They can also improve lymphatic drainage.” Lifestyle Adjustments Optimize Sleep “Sleep deprivation can disrupt the body's natural fluid balance and increase cortisol levels, which can cause fluid to accumulate in the facial tissues,” says Dr. Young. Additionally, “sleeping on your stomach or side can cause fluid to accumulate in your face overnight.” Experts suggest sleeping on your back on an elevated pillow designed to prevent fluid from collecting in the face and to look for a pillow made for back sleeping. Reduce Salt Intake Too much salt can cause your body to hold onto extra fluid, resulting in bloating. “The sodium in salt pulls water into your blood vessels and enlarges them, which can cause your face as well as other parts of your body to swell,” says Dr. Ruth. Avoid eating foods high in sodium at night and check labels—foods with excess sodium usually list salt at the top of their ingredient list. High-sodium foods include processed foods like bacon, sausage and hot dogs, salad dressing, canned foods and soy sauce. Limit Caffeine Drinking caffeine can impact your skin by promoting water loss, as caffeine has diuretic properties that increase urination. “As a compensatory mechanism, your body retains fluid for protection which often results in puffiness, especially around the eyes,” says Rypien. “Additionally, dehydration can leave your skin looking dull and less supple.” Decrease Alcohol Consumption Alcohol dehydrates your skin, resulting in water retention and bloating. It can also cause blood vessels to enlarge, making your face appear puffy. “Alcohol also disrupts your natural sleep cycle, which can make you look more tired and bloated in the morning,” says Dr. Young. Eat Anti-Inflammatory Foods Foods including beans, avocados, sweet potatoes, leafy greens, berries and nuts will help reduce overall inflammation in the body, reducing facial puffiness. “Avoid foods that promote inflammation such as processed meats, refined carbohydrates, and sweetened beverages,” say Rypien. Avoid Excessive Screen Time “Too much time spent staring at a screen can lead to eye strain and swelling around the eyes,” says Dr. Ruth. Long-Term Strategies Use Anti-Inflammatory Skin Care Regularly incorporating hydrating and anti-inflammatory ingredients such as hyaluronic acid, cica, calendula, and niacinamide can provide longer-term benefits. Dr. Ruth also says to look for products with firming peptides. A model with glowing skin. Getty Images Exercise Regularly Engaging in a regular exercise program will promote better circulation and lymphatic drainage, reducing the chances of puffiness. "Stress triggers the release of cortisol, which can induce inflammation,” says Rypien. “Exercising and meditating throughout your day will help get your circulation flowing. Treat Allergies Allergic reactions to environmental factors such as dust and pollen can result in facial puffiness. “Allergens trigger an immune response that increases blood flow and fluid accumulation in the facial tissues,” says Dr. Young. “Treat seasonal allergies with an over-the-counter allergy medication or see an allergist.” Professional Treatments Some professional treatments can be highly effective in reducing puffiness. “Lymphatic drainage facials or microcurrent therapy can improve circulation and promote lymphatic flow, reducing fluid retention,” says Dr. Ruth. “Cryotherapy facials constrict blood vessels, while radiofrequency can firm the skin to reduce puffiness over time.” “Skin tightening with laser and light therapy could theoretically stimulate collagen and elastic fiber production, resulting in tighter skin and a lessened ability for fluid to collect outside of the cells,” adds Dr. Young. Preventative Measures Wash Off Makeup Before Bed Sleeping with makeup on can result in morning puffiness. “It’s usually due to contact dermatitis, an inflammatory reaction triggered by prolonged exposure to an irritant or allergen like makeup,” says Rypien. “This reaction causes the release of histamines and other inflammatories, leading to increased blood flow and fluid leakage from capillaries into surrounding tissues. On the face, where the skin is thinner and more sensitive, this fluid buildup is more noticeable.” Stay Hydrated It may seem contradictory to drink water when you're trying to reduce fluid buildup, but doing so flushes out excess sodium and toxins that can cause fluid retention, leading to a puffy face. “When dehydrated, the body holds onto water to prevent further fluid loss,” explains Dr. Ruth. It’s a smart idea to keep a reusable bottle by your side during the day and refill it when needed.   Conclusion Facial puffiness can often be managed with smart lifestyle and skin-care choices along with some at-home and professional treatments. Source link

[norajworld]

Puffy skin, otherwise known as edema, is usually caused by fluid that temporarily collects between the cells of the facial tissue, leading to a bloated appearance. “Mildly swollen skin is a common concern, often caused by dehydration, alcohol consumption, high sodium intake, or hormonal fluctuations during the menstrual cycle, pregnancy, or menopause,” says Nicole Ruth, MD, DO, FAAD, a board-certified dermatologist in New York City. “Poor sleep, allergies, and sinus issues can also trigger puffiness, especially around the eyes.” “Genetics also play a role as some individuals have a greater natural tendency to retain water,” says Heather Rypien, RN, an aesthetics nurse specialist at Robert Schwarcz Oculofacial Plastic Surgery. Aging is another factor, as the skin loses elasticity and muscle tone, areas like the under-eye become more prone to swelling. Luckily, there are a few ways you can combat puffiness, ranging from instant-gratification quick-fixes to long-term solutions. Explore all of the options, ahead. Understanding Puffy Skin Puffiness can affect people of all ages—it’s the result of a combination of factors including lifestyle, genetics and hormonal changes. “Younger people may be more prone to intermittent puffiness due to hormonal fluctuations, dietary habits, or lifestyle factors such as alcohol consumption and irregular sleep patterns,” says Rypien. “Older individuals are often more susceptible to chronic puffiness because of age-related skin changes including the loss of collagen, a weakened lymphatic system, and fluid retention associated with underlying medical conditions or medications." Different areas of the face experience swelling for different reasons. For example, the under-eye area is the most common ground for puffiness—because the skin is so thin there, it’s particularly susceptible to edema and lymphatic drainage challenges. “The skin here can also be lax, so fluid collects easily and it’s very noticeable,” says Alexis Young, MD, an assistant clinical professor of dermatology at Columbia University Medical Center in New York City. Other areas of the face prone to puffiness include the cheeks, where fluid retention may be influenced by sleeping positions, and the jawline, particularly in individuals with poor lymphatic drainage. “The forehead and temples can also swell due to inflammation or sinus congestion, while the lips and perioral region may exhibit puffiness from dietary triggers, allergies, or certain medications including lip filler,” says Rypien. "Treatments, such as Botox injections around the crow’s feet can inadvertently exacerbate puffiness," adds Rypien. "This occurs because the muscle’s natural pumping motion, which helps with fluid distribution and lymphatic drainage, is temporarily reduced, leading to fluid accumulation.” Immediate Remedies for Depuffing Skin Dip Your Face in Ice Cold Water Fill a bowl with cold water and ice cubes. “You can submerge your face for ten seconds at a time or massage your skin with an ice cube, applying slight pressure to the areas that are particularly puffy to encourage greater blood circulation and less puffiness,” says Dr. Young. Perform a Facial Masssage Gua sha, which means "to scrape" in Mandarin, is a massaging ritual that uses a flat-edged smoothing tool to stimulate blood circulation and lymphatic drainage, while enhancing oxygen levels in the skin. “It can also reduce muscle tension, reducing fluids in the face,” says Rypien. “Gently apply the gua sha to the face using upward and outward strokes.” A jade roller works just as well—simply roll one in a side-to-side motion, moving from the center of the face towards the lymph nodes located along the jawline and in front of the ears. Both tools provide extra power when chilled. A woman using a gua sha. Getty Images Utilize Stapes Found in Your Kitchen There are things in your pantry and refrigerator that can help with facial swelling. “Cucumbers have anti-inflammatory properties that can reduce puffiness—simply slice and place over your eyes for ten minutes in the morning,” says Dr. Young. “You can also soak plain tea bags—avoid herbal teas like mint or chamomile which can be irritating on the skin—in cold water and place them over the eyes. The caffeine and antioxidants in tea constricts blood vessels and reduces puffiness.” If you’ve got an aloe plant, try applying a little gel under the eyes for soothing benefits. “Aloe contains anti-inflammatory properties, which can help reduce puffiness,” notes Dr. Young. Use Depuffing Skin-Care Products Depuffing skin-care products that contain topical ingredients like caffeine can temporarily tighten and depuff. “Many provide relief by constricting blood vessels and creating a tightening effect that helps reduce swelling,” says Rypien. “They can also improve lymphatic drainage.” Lifestyle Adjustments Optimize Sleep “Sleep deprivation can disrupt the body's natural fluid balance and increase cortisol levels, which can cause fluid to accumulate in the facial tissues,” says Dr. Young. Additionally, “sleeping on your stomach or side can cause fluid to accumulate in your face overnight.” Experts suggest sleeping on your back on an elevated pillow designed to prevent fluid from collecting in the face and to look for a pillow made for back sleeping. Reduce Salt Intake Too much salt can cause your body to hold onto extra fluid, resulting in bloating. “The sodium in salt pulls water into your blood vessels and enlarges them, which can cause your face as well as other parts of your body to swell,” says Dr. Ruth. Avoid eating foods high in sodium at night and check labels—foods with excess sodium usually list salt at the top of their ingredient list. High-sodium foods include processed foods like bacon, sausage and hot dogs, salad dressing, canned foods and soy sauce. Limit Caffeine Drinking caffeine can impact your skin by promoting water loss, as caffeine has diuretic properties that increase urination. “As a compensatory mechanism, your body retains fluid for protection which often results in puffiness, especially around the eyes,” says Rypien. “Additionally, dehydration can leave your skin looking dull and less supple.” Decrease Alcohol Consumption Alcohol dehydrates your skin, resulting in water retention and bloating. It can also cause blood vessels to enlarge, making your face appear puffy. “Alcohol also disrupts your natural sleep cycle, which can make you look more tired and bloated in the morning,” says Dr. Young. Eat Anti-Inflammatory Foods Foods including beans, avocados, sweet potatoes, leafy greens, berries and nuts will help reduce overall inflammation in the body, reducing facial puffiness. “Avoid foods that promote inflammation such as processed meats, refined carbohydrates, and sweetened beverages,” say Rypien. Avoid Excessive Screen Time “Too much time spent staring at a screen can lead to eye strain and swelling around the eyes,” says Dr. Ruth. Long-Term Strategies Use Anti-Inflammatory Skin Care Regularly incorporating hydrating and anti-inflammatory ingredients such as hyaluronic acid, cica, calendula, and niacinamide can provide longer-term benefits. Dr. Ruth also says to look for products with firming peptides. A model with glowing skin. Getty Images Exercise Regularly Engaging in a regular exercise program will promote better circulation and lymphatic drainage, reducing the chances of puffiness. "Stress triggers the release of cortisol, which can induce inflammation,” says Rypien. “Exercising and meditating throughout your day will help get your circulation flowing. Treat Allergies Allergic reactions to environmental factors such as dust and pollen can result in facial puffiness. “Allergens trigger an immune response that increases blood flow and fluid accumulation in the facial tissues,” says Dr. Young. “Treat seasonal allergies with an over-the-counter allergy medication or see an allergist.” Professional Treatments Some professional treatments can be highly effective in reducing puffiness. “Lymphatic drainage facials or microcurrent therapy can improve circulation and promote lymphatic flow, reducing fluid retention,” says Dr. Ruth. “Cryotherapy facials constrict blood vessels, while radiofrequency can firm the skin to reduce puffiness over time.” “Skin tightening with laser and light therapy could theoretically stimulate collagen and elastic fiber production, resulting in tighter skin and a lessened ability for fluid to collect outside of the cells,” adds Dr. Young. Preventative Measures Wash Off Makeup Before Bed Sleeping with makeup on can result in morning puffiness. “It’s usually due to contact dermatitis, an inflammatory reaction triggered by prolonged exposure to an irritant or allergen like makeup,” says Rypien. “This reaction causes the release of histamines and other inflammatories, leading to increased blood flow and fluid leakage from capillaries into surrounding tissues. On the face, where the skin is thinner and more sensitive, this fluid buildup is more noticeable.” Stay Hydrated It may seem contradictory to drink water when you're trying to reduce fluid buildup, but doing so flushes out excess sodium and toxins that can cause fluid retention, leading to a puffy face. “When dehydrated, the body holds onto water to prevent further fluid loss,” explains Dr. Ruth. It’s a smart idea to keep a reusable bottle by your side during the day and refill it when needed.   Conclusion Facial puffiness can often be managed with smart lifestyle and skin-care choices along with some at-home and professional treatments. Source link

[chilimili212]

Puffy skin, otherwise known as edema, is usually caused by fluid that temporarily collects between the cells of the facial tissue, leading to a bloated appearance. “Mildly swollen skin is a common concern, often caused by dehydration, alcohol consumption, high sodium intake, or hormonal fluctuations during the menstrual cycle, pregnancy, or menopause,” says Nicole Ruth, MD, DO, FAAD, a board-certified dermatologist in New York City. “Poor sleep, allergies, and sinus issues can also trigger puffiness, especially around the eyes.” “Genetics also play a role as some individuals have a greater natural tendency to retain water,” says Heather Rypien, RN, an aesthetics nurse specialist at Robert Schwarcz Oculofacial Plastic Surgery. Aging is another factor, as the skin loses elasticity and muscle tone, areas like the under-eye become more prone to swelling. Luckily, there are a few ways you can combat puffiness, ranging from instant-gratification quick-fixes to long-term solutions. Explore all of the options, ahead. Understanding Puffy Skin Puffiness can affect people of all ages—it’s the result of a combination of factors including lifestyle, genetics and hormonal changes. “Younger people may be more prone to intermittent puffiness due to hormonal fluctuations, dietary habits, or lifestyle factors such as alcohol consumption and irregular sleep patterns,” says Rypien. “Older individuals are often more susceptible to chronic puffiness because of age-related skin changes including the loss of collagen, a weakened lymphatic system, and fluid retention associated with underlying medical conditions or medications." Different areas of the face experience swelling for different reasons. For example, the under-eye area is the most common ground for puffiness—because the skin is so thin there, it’s particularly susceptible to edema and lymphatic drainage challenges. “The skin here can also be lax, so fluid collects easily and it’s very noticeable,” says Alexis Young, MD, an assistant clinical professor of dermatology at Columbia University Medical Center in New York City. Other areas of the face prone to puffiness include the cheeks, where fluid retention may be influenced by sleeping positions, and the jawline, particularly in individuals with poor lymphatic drainage. “The forehead and temples can also swell due to inflammation or sinus congestion, while the lips and perioral region may exhibit puffiness from dietary triggers, allergies, or certain medications including lip filler,” says Rypien. "Treatments, such as Botox injections around the crow’s feet can inadvertently exacerbate puffiness," adds Rypien. "This occurs because the muscle’s natural pumping motion, which helps with fluid distribution and lymphatic drainage, is temporarily reduced, leading to fluid accumulation.” Immediate Remedies for Depuffing Skin Dip Your Face in Ice Cold Water Fill a bowl with cold water and ice cubes. “You can submerge your face for ten seconds at a time or massage your skin with an ice cube, applying slight pressure to the areas that are particularly puffy to encourage greater blood circulation and less puffiness,” says Dr. Young. Perform a Facial Masssage Gua sha, which means "to scrape" in Mandarin, is a massaging ritual that uses a flat-edged smoothing tool to stimulate blood circulation and lymphatic drainage, while enhancing oxygen levels in the skin. “It can also reduce muscle tension, reducing fluids in the face,” says Rypien. “Gently apply the gua sha to the face using upward and outward strokes.” A jade roller works just as well—simply roll one in a side-to-side motion, moving from the center of the face towards the lymph nodes located along the jawline and in front of the ears. Both tools provide extra power when chilled. A woman using a gua sha. Getty Images Utilize Stapes Found in Your Kitchen There are things in your pantry and refrigerator that can help with facial swelling. “Cucumbers have anti-inflammatory properties that can reduce puffiness—simply slice and place over your eyes for ten minutes in the morning,” says Dr. Young. “You can also soak plain tea bags—avoid herbal teas like mint or chamomile which can be irritating on the skin—in cold water and place them over the eyes. The caffeine and antioxidants in tea constricts blood vessels and reduces puffiness.” If you’ve got an aloe plant, try applying a little gel under the eyes for soothing benefits. “Aloe contains anti-inflammatory properties, which can help reduce puffiness,” notes Dr. Young. Use Depuffing Skin-Care Products Depuffing skin-care products that contain topical ingredients like caffeine can temporarily tighten and depuff. “Many provide relief by constricting blood vessels and creating a tightening effect that helps reduce swelling,” says Rypien. “They can also improve lymphatic drainage.” Lifestyle Adjustments Optimize Sleep “Sleep deprivation can disrupt the body's natural fluid balance and increase cortisol levels, which can cause fluid to accumulate in the facial tissues,” says Dr. Young. Additionally, “sleeping on your stomach or side can cause fluid to accumulate in your face overnight.” Experts suggest sleeping on your back on an elevated pillow designed to prevent fluid from collecting in the face and to look for a pillow made for back sleeping. Reduce Salt Intake Too much salt can cause your body to hold onto extra fluid, resulting in bloating. “The sodium in salt pulls water into your blood vessels and enlarges them, which can cause your face as well as other parts of your body to swell,” says Dr. Ruth. Avoid eating foods high in sodium at night and check labels—foods with excess sodium usually list salt at the top of their ingredient list. High-sodium foods include processed foods like bacon, sausage and hot dogs, salad dressing, canned foods and soy sauce. Limit Caffeine Drinking caffeine can impact your skin by promoting water loss, as caffeine has diuretic properties that increase urination. “As a compensatory mechanism, your body retains fluid for protection which often results in puffiness, especially around the eyes,” says Rypien. “Additionally, dehydration can leave your skin looking dull and less supple.” Decrease Alcohol Consumption Alcohol dehydrates your skin, resulting in water retention and bloating. It can also cause blood vessels to enlarge, making your face appear puffy. “Alcohol also disrupts your natural sleep cycle, which can make you look more tired and bloated in the morning,” says Dr. Young. Eat Anti-Inflammatory Foods Foods including beans, avocados, sweet potatoes, leafy greens, berries and nuts will help reduce overall inflammation in the body, reducing facial puffiness. “Avoid foods that promote inflammation such as processed meats, refined carbohydrates, and sweetened beverages,” say Rypien. Avoid Excessive Screen Time “Too much time spent staring at a screen can lead to eye strain and swelling around the eyes,” says Dr. Ruth. Long-Term Strategies Use Anti-Inflammatory Skin Care Regularly incorporating hydrating and anti-inflammatory ingredients such as hyaluronic acid, cica, calendula, and niacinamide can provide longer-term benefits. Dr. Ruth also says to look for products with firming peptides. A model with glowing skin. Getty Images Exercise Regularly Engaging in a regular exercise program will promote better circulation and lymphatic drainage, reducing the chances of puffiness. "Stress triggers the release of cortisol, which can induce inflammation,” says Rypien. “Exercising and meditating throughout your day will help get your circulation flowing. Treat Allergies Allergic reactions to environmental factors such as dust and pollen can result in facial puffiness. “Allergens trigger an immune response that increases blood flow and fluid accumulation in the facial tissues,” says Dr. Young. “Treat seasonal allergies with an over-the-counter allergy medication or see an allergist.” Professional Treatments Some professional treatments can be highly effective in reducing puffiness. “Lymphatic drainage facials or microcurrent therapy can improve circulation and promote lymphatic flow, reducing fluid retention,” says Dr. Ruth. “Cryotherapy facials constrict blood vessels, while radiofrequency can firm the skin to reduce puffiness over time.” “Skin tightening with laser and light therapy could theoretically stimulate collagen and elastic fiber production, resulting in tighter skin and a lessened ability for fluid to collect outside of the cells,” adds Dr. Young. Preventative Measures Wash Off Makeup Before Bed Sleeping with makeup on can result in morning puffiness. “It’s usually due to contact dermatitis, an inflammatory reaction triggered by prolonged exposure to an irritant or allergen like makeup,” says Rypien. “This reaction causes the release of histamines and other inflammatories, leading to increased blood flow and fluid leakage from capillaries into surrounding tissues. On the face, where the skin is thinner and more sensitive, this fluid buildup is more noticeable.” Stay Hydrated It may seem contradictory to drink water when you're trying to reduce fluid buildup, but doing so flushes out excess sodium and toxins that can cause fluid retention, leading to a puffy face. “When dehydrated, the body holds onto water to prevent further fluid loss,” explains Dr. Ruth. It’s a smart idea to keep a reusable bottle by your side during the day and refill it when needed.   Conclusion Facial puffiness can often be managed with smart lifestyle and skin-care choices along with some at-home and professional treatments. Source link

[darkmaga-returns]

In a three day span, I was told by four different patients of errors made by both physicians and nurses that harmed them, ranging from the catastrophic to the concerning.

Pierre Kory, MD, MPA

Oct 16, 2024

As the title of this post reflects, I recently developed a growing concern that health care providers are “not as sharp” as they used to be and, as you will learn from the cases I will present below, that may be putting it mildly.

Why would I hypothesize about a sudden deterioration in the cognitive and technical abilities of health care providers? Couple of reasons;

The most mRNA vaccinated sub-population in the United States are almost certainly our health care providers. They make up the entire class of employees mandated by the Centers for Medicare and Medicaid Services (CMS), the agency that governs the two federal/state health insurance plans for the elderly and poor. Recall that 25 states fought back against CMS by issuing injunctions against the mandate until the Supreme Court granted CMS the authority to do so. Which meant that all CMS facility employees (every hospital, nursing home, and home health agency employee in the country) had to get the mRNA vaccine otherwise they would not be eligible for reimbursement for their services from those entities. That does not make for a valuable employee.

The mRNA “vaccine,” like Covid itself, causes immense amounts of cognitive dysfunction, i.e. “brain fog” and worse. In my Leading Edge Clinic specialty practice where we treat Long Covid/Long Vax (70% are Long Vax) of the almost 1500 chronically ill patients we have encountered, the vast majority report new-onset cognitive dysfunction.

The real tragedy is that the mandate from CMS specified that “accommodations” (i.e. exemptions) should be offerred by the involved health care facilities, however, as we well know, in the vast majority of facilities, exemptions were nearly impossible to obtain. Numerous lawsuits are ongoing to address the horrific negative consequences of the mass firings that resulted. The bright side is that I am hearing from my Covid litigation experts that these cases are now being regularly won .

[medicineforcare]

Xpreza

Xpreza Injection is used in the treatment of some kinds of blood cancer. It is used for the treatment of adult patients with all subtypes of Myelodysplastic Syndrome (MDS). It may be also used to treat other conditions, as determined by the doctor.

An injection of Xpreza is administered under a doctor's medical supervision. Your doctor will determine the appropriate dosage and how frequently you should take it. This may vary over time depending on the condition you are being treated for. It is important that you follow your doctor's instructions exactly. If taken improperly or in excess, it might have extremely harmful negative effects. You might not notice or feel the effects of the medication for a few weeks or months, but unless your doctor instructs you otherwise, keep taking it.

The most frequent adverse effects of this medication include nausea, vomiting, weakness, and injection site reactions (pain, swelling, and redness). Inform your doctor if these cause you any discomfort or seem significant. It's possible to prevent or lessen them. Prior to receiving any vaccinations while using this medication, you must notify your doctor. It's necessary to have routine blood tests to examine your heart, liver, kidneys, and blood cells. 

Inform your doctor before using it if you have kidney or liver issues, or if you are currently taking any medications for infections. Inform your doctor about all of the medications you take because this prescription may interact with or be affected by many other medications. It is not advised to use this medication while nursing or when pregnant. 

Benefits of Xpreza Injection

In Blood cancer

Leukemia, another name for blood cancer, is a type of cancer that affects the tissues that create blood and weakens the immune system. Xpreza Injection kills cancer cells or stops them from growing, and it also keeps them from multiplying. You should go over the advantages and disadvantages of this strong, highly poisonous medication with your physician. Throughout this treatment, you should abstain from alcohol and stay hydrated by drinking lots of water. 

In Treatment of Myelodysplastic syndrome

Myelodysplastic syndrome is a set of disorders where the bone marrow fails to create enough healthy blood cells and instead produces blood cells with aberrant form and function. Xpreza Injection is used to treat this illness. Xpreza Injection kills cancer cells or stops them from growing, and it also keeps them from multiplying. You should go over the advantages and disadvantages of this medication with your physician as it is both highly poisonous and effective. Throughout this treatment, you should abstain from alcohol and stay hydrated by drinking lots of water.

Side effects of Xpreza Injection

Most side effects do not require any medical attention and disappear as your body adjusts to the medicine. Consult your doctor if they persist or if you’re worried about them

Common side effects of Xpreza

Injection site reactions (pain, swelling, redness)

Vomiting

Weakness

[nursingscience]

160 NURSING BULLETS: Medical-Surgical Nursing Reviewer

1. Bone scan is done by injecting radioisotope per IV and then x-rays are taken.

2. To prevent edema on the site of sprain, apply cold compress on the area for the first 24 hours.

3. To turn the client after lumbar Laminectomy, use the logrolling technique.

4. Carpal tunnel syndrome occurs due to the injury of median nerve.

5. Massaging the back of the head is specifically important for the client with Crutchfield tong.

6. A one-year-old child has a fracture of the left femur. He is placed in Bryant’s traction. The reason for elevation of his both legs at 90º angle is his weight isn’t adequate to provide sufficient countertraction, so his entire body must be used.

7. Swing-through crutch gait is done by advancing both crutches together and the client moves both legs past the level of the crutches.

8. The appropriate nursing measure to prevent displacement of the prosthesis after a right total hip replacement for arthritis is to place the patient in the position of right leg abducted.

9. Pain on non-use of joints, subcutaneous nodules and elevated ESR are characteristic manifestations of rheumatoid arthritis.

10. Teaching program of a patient with SLE should include emphasis on walking in shaded area.

11. Otosclerosis is characterized by replacement of normal bones by spongy and highly vascularized bones.

12. Use of high-pitched voice is inappropriate for the client with hearing impairment.

13. Rinne’s test compares air conduction with bone conduction.

14. Vertigo is the most characteristic manifestation of Meniere’s disease.

15. Low sodium is the diet for a client with Meniere’s disease.

16. A client who had cataract surgery should taught to call his MD if he has eye pain.

17. Risk for Injury takes priority for a client with Meniere’s disease.

18. Irrigate the eye with sterile saline is the priority nursing intervention when the client has a foreign body protruding from the eye.

19. Snellen’s Test assesses visual acuity.

20. Presbyopia is an eye disorder characterized by lessening of the effective powers of accommodation.

21. The primary problem in cataract is blurring of vision.

22. The primary reason for performing iridectomy after cataract extraction is to prevent secondary glaucoma.

23. In acute glaucoma, the obstruction of the flow of aqueous humor is caused by displacement of the iris.

24. Glaucoma is characterized by irreversible blindness.

25. Hyperopia is corrected by convex lens.

26. Pterygium is caused primarily by exposure to dust.

27. A sterile chronic granulomatous inflammation of the meibomian gland is chalazion.

28. The surgical procedure which involves removal of the eyeball is enucleation.

29. Romberg’s test is a test for balance or gait.

30. If the client with increased ICP demonstrates decorticate posturing, observe for flexion of elbows, extension of the knees, plantar flexion of the feet.

31. The nursing diagnosis that would have the highest priority in the care of the client who has become comatose following cerebral hemorrhage is Ineffective Airway Clearance.

32. The initial nursing action—for a client who is in the clonic phase of a tonic-clonic seizure—is to obtain equipment for orotracheal suctioning.

33. The first nursing intervention in a quadriplegic client who is experiencing autonomic dysreflexia is to elevate his head as high as possible.

34. Following surgery for a brain tumor near the hypothalamus, the nursing assessment should include observing for inability to regulate body temp.

35.Post-myelography (using metrizamide (Omnipaque) care includes keeping head elevated for at least 8 hours.

36. Homonymous hemianopsia is described by a client had CVA and can only see the nasal visual field on one side and the temporal portion on the opposite side.

37. Ticlopidine may be prescribed to prevent thromboembolic CVA.

38. To maintain airway patency during a stroke in evolution, have orotracheal suction available at all times.

39. For a client with CVA, the gag reflex must return before the client is fed.

40. Clear fluids draining from the nose of a client who had a head trauma 3 hours ago may indicate basilar skull fracture.

41. An adverse effect of gingival hyperplasia may occur during Phenytoin (DIlantin) therapy.

42. Urine output increased: best shows that the mannitol is effective in a client with increased ICP.

43. A client with C6 spinal injury would most likely have the symptom of quadriplegia.

44. Falls are the leading cause of injury in elderly people.

45. The client is for EEG this morning. Prepare him for the procedure by rendering hair shampoo, excluding caffeine from his meal and instructing the client to remain still during the procedure.

46. Primary prevention is true prevention. Examples are immunizations, weight control, and smoking cessation.

47. Secondary prevention is early detection. Examples include purified protein derivative (PPD), breast self-examination, testicular self-examination, and chest X-ray.

48. Tertiary prevention is treatment to prevent long-term complications.

49. On noticing religious artifacts and literature on a patient’s night stand, a culturally aware nurse would ask the patient the meaning of the items.

50. A Mexican patient may request the intervention of a curandero, or faith healer, who involves the family in healing the patient.

51. In an infant, the normal hemoglobin value is 12 g/dl.

52. A patient indicates that he’s coming to terms with having a chronic disease when he says something like: “I’m never going to get any better,” or when he exhibits hopelessness.

53. Most of the absorption of water occurs in the large intestine.

54. Most nutrients are absorbed in the small intestine.

55. When assessing a patient’s eating habits, the nurse should ask, “What have you eaten in the last 24 hours?”

56. A vegan diet should include an abundant supply of fiber.

57. A hypotonic enema softens the feces, distends the colon, and stimulates peristalsis.

58. First-morning urine provides the best sample to measure glucose, ketone, pH, and specific gravity values.

59. To induce sleep, the first step is to minimize environmental stimuli.

60. Before moving a patient, the nurse should assess the patient’s physical abilities and ability to understand instructions as well as the amount of strength required to move the patient.

61. To lose 1 lb (0.5 kg) in 1 week, the patient must decrease his weekly intake by 3,500 calories (approximately 500 calories daily). To lose 2 lb (1 kg) in 1 week, the patient must decrease his weekly caloric intake by 7,000 calories (approximately 1,000 calories daily).

62. To avoid shearing force injury, a patient who is completely immobile is lifted on a sheet.

63. To insert a catheter from the nose through the trachea for suction, the nurse should ask the patient to swallow.

64. Vitamin C is needed for collagen production.

65. Bananas, citrus fruits, and potatoes are good sources of potassium.

66. Good sources of magnesium include fish, nuts, and grains.

67. Beef, oysters, shrimp, scallops, spinach, beets, and greens are good sources of iron.

68. The nitrogen balance estimates the difference between the intake and use of protein.

69. A Hindu patient is likely to request a vegetarian diet.

70. No pork or pork products are allowed in a Muslim diet.

71. In accordance with the “hot-cold” system used by some Mexicans, Puerto Ricans, and other Hispanic and Latino groups, most foods, beverages, herbs, and drugs are described as “cold.”

72. Milk is high in sodium and low in iron.

73. Discrimination is preferential treatment of individuals of a particular group. It’s usually discussed in a negative sense.

74. Increased gastric motility interferes with the absorption of oral drugs.

75. When feeding an elderly patient, the nurse should limit high-carbohydrate foods because of the risk of glucose intolerance.

76. When feeding an elderly patient, essential foods should be given first.

78. For the patient who abides by Jewish custom, milk and meat shouldn’t be served at the same meal.

79. Only the patient can describe his pain accurately.

80. Cutaneous stimulation creates the release of endorphins that block the transmission of pain stimuli.

81. Patient-controlled analgesia (PCA) is a safe method to relieve acute pain caused by surgical incision, traumatic injury, labor and delivery, or cancer.

82. An Asian-American or European-American typically places distance between himself and others when communicating.

83. Active euthanasia is actively helping a person to die.

84. Brain death is irreversible cessation of all brain function.

85. Passive euthanasia is stopping the therapy that’s sustaining life.

86. Voluntary euthanasia is actively helping a patient to die at the patient’s request.

87. A back rub is an example of the gate-control theory of pain.

88. Pain threshold, or pain sensation, is the initial point at which a patient feels pain.

89. The difference between acute pain and chronic pain is its duration.

90. Referred pain is pain that’s felt at a site other than its origin.

91. Alleviating pain by performing a back massage is consistent with the gate control theory.

92. Pain seems more intense at night because the patient isn’t distracted by daily activities.

93. Older patients commonly don’t report pain because of fear of treatment, lifestyle changes, or dependency.

94. Utilization review is performed to determine whether the care provided to a patient was appropriate and cost-effective.

95. A value cohort is a group of people who experienced an out-of-the-ordinary event that shaped their values.

96. A third-party payer is an insurance company.

97. Intrathecal injection is administering a drug through the spine.

98. When a patient asks a question or makes a statement that’s emotionally charged, the nurse should respond to the emotion behind the statement or question rather than to what’s being said or asked.

99–105. The steps of the trajectory-nursing model are as follows:

Step 1: Identifying the trajectory phase

Step 2: Identifying the problems and establishing goals

Step 3: Establishing a plan to meet the goals

Step 4: Identifying factors that facilitate or hinder attainment of the goals

Step 5: Implementing interventions

Step 6: Evaluating the effectiveness of the interventions

106–107. Two goals of Healthy People 2010 are:

▪️Help individuals of all ages to increase the quality of life and the number of years of optimal health

▪️Eliminate health disparities among different segments of the population.

108. A community nurse is serving as a patient’s advocate if she tells a malnourished patient to go to a meal program at a local park.

109. If a patient isn’t following his treatment plan, the nurse should first ask why.

110. When a patient is ill, it’s essential for the members of his family to maintain communication about his health needs.

110. Ethnocentrism is the universal belief that one’s way of life is superior to others’.

111. When a nurse is communicating with a patient through an interpreter, the nurse should speak to the patient and the interpreter.

112. Prejudice is a hostile attitude toward individuals of a particular group.

113. The three phases of the therapeutic relationship are orientation, working, and termination.

114. Patients often exhibit resistive and challenging behaviors in the orientation phase of the therapeutic relationship.

115. Abdominal assessment is performed in the following order: inspection, auscultation, palpation, and percussion.

116. When measuring blood pressure in a neonate, the nurse should select a cuff that’s no less than one-half and no more than two-thirds the length of the extremity that’s used.

117. When administering a drug by Z-track, the nurse shouldn’t use the same needle that was used to draw the drug into the syringe because doing so could stain the skin.

118. Sites for intradermal injection include the inner arm, the upper chest, and on the back, under the scapula.

119. When evaluating whether an answer on an examination is correct, the nurse should consider whether the action that’s described promotes autonomy (independence), safety, self-esteem, and a sense of belonging.

120. Veracity is truth and is an essential component of a therapeutic relationship between a health care provider and his patient.

121. Beneficence is the duty to do no harm and the duty to do good. There’s an obligation in patient care to do no harm and an equal obligation to assist the patient.

122. Nonmaleficence is the duty to do no harm.

123–128. Frye’s ABCDE cascade provides a framework for prioritizing care by identifying the most important treatment concerns.

A: Airway. This category includes everything that affects a patent airway, including a foreign object, fluid from an upper respiratory infection, and edema from trauma or an allergic reaction.

B: Breathing. This category includes everything that affects the breathing pattern, including hyperventilation or hypoventilation and abnormal breathing patterns, such as Korsakoff’s, Biot’s, or Cheyne-Stokes respiration.

C: Circulation. This category includes everything that affects the circulation, including fluid and electrolyte disturbances and disease processes that affect cardiac output.

D: Disease processes. If the patient has no problem with the airway, breathing, or circulation, then the nurse should evaluate the disease processes, giving priority to the disease process that poses the greatest immediate risk. For example, if a patient has terminal cancer and hypoglycemia, hypoglycemia is a more immediate concern.

E: Everything else. This category includes such issues as writing any incident report and completing the patient chart. When evaluating needs, this category is never the highest priority.

129. Rule utilitarianism is known as the “greatest good for the greatest number of people” theory.

130. Egalitarian theory emphasizes that equal access to goods and services must be provided to the less fortunate by an affluent society.

131. Before teaching any procedure to a patient, the nurse must assess the patient’s current knowledge and willingness to learn.

132. Process recording is a method of evaluating one’s communication effectiveness.

133. Whether the patient can perform a procedure (psychomotor domain of learning) is a better indicator of the effectiveness of patient teaching than whether the patient can simply state the steps involved in the procedure (cognitive domain of learning).

134. When communicating with a hearing impaired patient, the nurse should face him.

135. When a patient expresses concern about a health-related issue, before addressing the concern, the nurse should assess the patient’s level of knowledge.

136. Passive range of motion maintains joint mobility. Resistive exercises increase muscle mass.

137. Isometric exercises are performed on an extremity that’s in a cast.

138. Anything that’s located below the waist is considered unsterile; a sterile field becomes unsterile when it comes in contact with any unsterile item; a sterile field must be monitored continuously; and a border of 1″ (2.5 cm) around a sterile field is considered unsterile.

139. A “shift to the left” is evident when the number of immature cells (bands) in the blood increases to fight an infection.

140. A “shift to the right” is evident when the number of mature cells in the blood increases, as seen in advanced liver disease and pernicious anemia.

141. Before administering preoperative medication, the nurse should ensure that an informed consent form has been signed and attached to the patient’s record.

142. A nurse should spend no more than 30 minutes per 8-hour shift providing care to a patient who has a radiation implant.

143. A nurse shouldn’t be assigned to care for more than one patient who has a radiation implant.

144. Long-handled forceps and a lead-lined container should be available in the room of a patient who has a radiation implant.

145. Usually, patients who have the same infection and are in strict isolation can share a room.

146. Diseases that require strict isolation include chickenpox, diphtheria, and viral hemorrhagic fevers such as Marburg disease.

147–155. According to Erik Erikson, developmental stages are:

•Trust versus mistrust (birth to 18 months)

•Autonomy versus shame and doubt (18 months to age 3)

•Initiative versus guilt (ages 3 to 5)

•Industry versus inferiority (ages 5 to 12)

•Identity versus identity diffusion (ages 12 to 18)

•Intimacy versus isolation (ages 18 to 25)

•Generativity versus stagnation (ages 25 to 60), and

•Ego integrity versus despair (older than age 60).

156. An appropriate nursing intervention for the spouse of a patient who has a serious incapacitating disease is to help him to mobilize a support system.

157. The most effective way to reduce a fever is to administer an antipyretic, which lowers the temperature set point.

158–163. The Controlled Substances Act designated five categories, or schedules, that classify controlled drugs according to their abuse potential.

▪️Schedule I drugs, such as heroin, have a high abuse potential and have no currently accepted medical use in the United States.

▪️Schedule II drugs, such as morphine, opium, and meperidine (Demerol), have a high abuse potential, but currently have accepted medical uses. Their use may lead to physical or psychological dependence.

▪️Schedule III drugs, such as paregoric and butabarbital (Butisol), have a lower abuse potential than Schedule I or II drugs. Abuse of

▪️Schedule III drugs may lead to moderate or low physical or psychological dependence, or both.

▪️Schedule IV drugs, such as chloral hydrate, have a low abuse potential compared with Schedule III drugs.

▪️Schedule V drugs, such as cough syrups that contain codeine, have the lowest abuse potential of the controlled substances.

164. During lumbar puncture, the nurse must note the initial intracranial pressure and the color of the cerebrospinal fluid.

165. Cold packs are applied for the first 20 to 48 hours after an injury; then heat is applied. During cold application, the pack is applied for 20 minutes and then removed for 10 to 15 minutes to prevent reflex dilation (rebound phenomenon) and frostbite injury.

[dogma1999]

Birthday Countdown Revchase Snippets - Day 3

To celebrate Valentine's month as well as my birthday month, I'm going to post a snippet of Revchase every day until my birthday, using these prompts- there are 25 so it leads right up to my birthday!! I'm a bit behind bc it's been a few days into a month but here is the third:

3- Write about your ship holding hands in a tense moment.

Pairing: Robert Chase/Reverie (oc)

Media: House MD

Word Count: 444

Rating: T

CW: Surgery, gore, blood

This isn't their surgery. Neither of their names are written on that whiteboard next to this patient's name. They shouldn't be so concerned about the outcome. And yet Reverie and Chase stand behind the window of the upstairs to the operating theater, anxiously watching the open splenectomy being performed before them.

Perhaps the anxiety comes from the fact that any splenectomy is scary. A ruptured spleen is nothing to sneeze at– it's entirely possible the patient could bleed out. And when that spleen is being cut out, there's an enhanced risk of such a thing. The anxiety could definitely come from that.

Or maybe it's because this isn't just any patient. This is one of House's patients. And even if Chase doesn't work for House anymore, and Reverie never did, it doesn't stop them from being concerned for this person under his care.

They watch as Taub, Thirteen, and Kutner work with other surgical staff to remove this patient's ruptured spleen. And then, through the glass, they can both see and hear the vitals tank. The beeping of the monitor, the yelling of the doctors and nurses in the OR.

Though they truly have no reason to care, other than the fact that it's the life of an innocent person at stake, Reverie and Chase are scared when Thirteen screams that the patient is going into ventricular tachycardia, and Kutner grabs the defibrillator, despite the fact that the man shouldn't be handling it based on his history, and Taub makes sure everyone's hands are out of the way. And then Kutner screams, “clear!” And shocks the patient.

Nothing.

Reverie is chewing on the thumbnail of one hand, and the other has found its way to Chase's at her side. He looks at her, noticing the tears pooling in her eyes, and his fingers lace through hers. A barely audible gasp can be heard from her, and she does it again when Chase's hand gently squeezes hers.

She squeezes his hand back, and then they both hold on tight, watching and waiting as the crew in the OR fight to revive this patient. This patient they shouldn't be caring about.

Kutner calls “clear!” again. He shocks. There's nothing. The paddles charge, and the process repeats. Three rounds of this before heart rhythm is restored, and everyone in the OR is washed in relief. As are the two watching over it.

Reverie and Chase squeeze each others’ hands one last time before letting them fall loose at their sides– Chase’s going to run his fingers through his hair, pushing it from his forehead, and Reverie's going to fidget with the St Christopher pendant around her neck.