#for minutes at a time about the healthcare system and an out her tells people they have beautiful smiles and another let us prank them with

[rsbry-beret]

I love my friends I love my friends I love my friends. i don’t know them very well yet and i love them. we haven’t known each other long yet and i love them. i love them and it has not fixed any of my problems and i love them. the world is so beautiful with all of us in it.

[alexaloraetheris]

I juat remembered the day, about two months ago, when I went to renew my perscription and ended up derailed by some kind of divine influence that really, really wanted my help. 😂

So I have an appointment at 9. First thing I do is sleep in because my alarm simply did not ring. First time that happened. I cursed out the damn phone and ordered a taxi, which I had specifically hoping to avoid because of the traffic congestion.

My driver is a woman a bit older than me, and she's in a good mood so we chat. She told me she was thinking of moving to [city on the coast] because taxi drivers are paid better there, and I tell her I have family there, we comment on what it's like to drive in a city essentially built into three hills and a cliff. She mentiones she has scoliosis, and it sometimes impacts her ability to sit in a car for long periods of time. I had scoliosis as well, but I had managed to fix it with exercises almost completely so I recommended my physical therapist, and assured her it's not too late, because some of the people in my therapy group were even older than her. When she let me off she thanked me for the help.

Feeling good that, even if I had to pay out the nose for the ride, I got there in time and even managed to do a good deed. I rush in, tell the reception guy I'm here to see my doctor and settle in to wait.

Two hours later, I see people being called in but not my name. I ask why, and doctor looks at me blankly and says I'm not in the system. I have to tell the reception I've arrived so I show up on his schedule.

I'm mentally cursing out the entire hospital, but I wasn't raised by wolves. I thank the doctor, politely tell the different receptionist that the last guy probably didn't hear me when I told him my appointment, got added in and went back to wait.

Ten minutes later, a visibly nervous girl with freshly printed papers sits in the waiting room. I'm in a bit of a mood, but I'm also a firm believer in helping if I can. I paste on a smile and ask 'First time?' and she admits she just got sent here for a potential ADHD diagnosis and she had no idea what to do. Having been there and knowing exactly how hard it was to do it on your own, I gave her the number of the psychologist who made my diagnosis, assured her that the psychiatrist she was here to see is the same one I have and that he's a good guy, explained what ADHD actually was and how the meds work. She was neraly crying with relief by the time I was done, and I promised she could send me questions if she needs to.

I finally, finally go in for my appointment in a slightly better mood, only for my psychiatrist to tell me Concerta is no longer imported, I have to go on some other meds and for that I need my family doctor to sign off on a regular perscription instead of getting an Rx perscription from him.

This is the worst case scenario, because I do NOT want my mother, who thinks ADHD was invented by quack American psychologists to sell expensive meds to parents with unruly children, to know I have ADHD. So I mentally curse out the entire healthcare system, go to the family doctor and explain the situation, that my mother absolutely CANNOT know about my diagnosis. Even though the doctor was not aware of my diagnosis so far, she listens attentively, and we make sure that my mom can't check the insurance we're both under to see what meds I'm on or that if she checks my name in the pharmacy directory she can't see me either.

I thought I handled that situation rather well but I must have looked more worried than I thought, because the doctor admitted her high-school age granddaughter had been asking questions about psychologists and antidepressants and she had so far been dismissive. But if she really needs help, she might do the same thing I did and seek help on her own, and my doctor realized she ought to either change her attitude fast or be left in the dark while her granddaughter is struggling. So I told her which psychologist I went to when I was also a depressed high schooler and how it helped and what I would have wanted my family to keep in mind. She thanks me and hands me a new perscription and sends me on my way.

So by now I am starting to notice a pattern.

Now, I'm actually an atheist, and I have 'Culturally Catholic' as a flaw and a laundry list of Stuff(TM) I have had to unlearn, but sometimes I really wonder if Someone Up There looked at me that day and thought:

"Hmm, looks like I have three problems I can solve with one well-positioned dumbass. Time to ruin her day for the good of the world!"

I mean. Happy to help but I really hope ruining my day won't be necessary next time.

[throwaway-yandere]

I want to be honest (no this has nothing to do with fics lmao youll get it as scheduled)

This post is an explanation as to why I consider myself as "retired". I know I've said it's because of studies, but that'll be 1/3 of the truth. I want to talk about the true three real reasons why, and I'll do my best to be straight to the point. This isn't a cry for help (I swear to the heavens it is NOT). This is just to clear out assumptions.

Here's the other two reasons:

Grief & Mental Health

Writing itself & interactions

Grief & Mental Health:

I'll pour my heart out, so I'm sorry if it's long. As I said, I'll be straight to the point, so: my grandfather around the first week of June. I remember how I received the news so vividly. I was listening to Two Birds while washing the dishes at 12 AM. My mom went down the stairs with my father, crying as they tell me the news that he's gone. We drove half an hour to the hospital where I get to pat his head one last time. I remember mindlessly wandering the hospital halls— I remember mindlessly using the free alcohol attached to a wall. I remember breaking down as I realized I just cleansed away the hand that last had contact with him. I remember every detail, from the ride home where I messaged my good college friend to tell her that she needs to be a good nurse because the public healthcare system in the country is awful. I remember silently hating everyone and everything. I remember thinking about how cruel it was that life took away the one relative who genuinely cared about me and I was sure was related to me by blood. I remember thinking how much I'm distant to everyone else on my mother's side except him. I remember feeling so empty. I remember not sleeping for two days straight.

But let's back track for a bit. Before his death, I did have one final conversation with him. He was sedated and tubed miserably. Deep down, I knew his time was coming. So, I just made jokes about how grandma was growing senile and mistook me for a nurse for ten whole minutes. Then, I thanked him for everything he's done, and told him I'll become an engineer. Just like him.

And now here I am, dorming 3 hours away from home. I dormed because I had nearly decided my life meant nothing after lack of sleep through daily commutes and workloads. But I am lonely and unwell. I don't know what I want in life. I don't know what I actually want to be, but I already shifted courses as a chemical engineering student. I was so stressed to the point I've accidentally cried to my chem professor in a phone call. I don't know what I'm doing with my scholarship and education if it's for no one. And I am scared that I'm draining my parents' already limited resource for nothing. That I'm wasting the scholarship my country had given me nothing. That I am wasting my people's taxes for nothing.

It was only when another friend told me that I seem to live my life based on other's decisions and opinions did I notice just why I'm incredibly miserable.

I know I don't have dreams for myself. And even if I did, how the hell will writing and drawing feed me in the future when the industry in this 3rd world country is absolute garbage?

I guess Asians really do the things they hate so they can get what they love. Okay, I'll stop making jokes.

I miss my long-time friends, Phitre and Frost. I also miss my old blockmates when I was a BSEd-Math student. I am too used to eating alone, studying alone, walking alone. I am too used to being an outsider. But I'm not used to silence. I'm not too used to hearing actual silence.

All I have is Discord and Messenger.

And even then, it's quiet.

Writing itself & Interactions

I love writing and drawing. I just hate posting it at this point, which is why I made another account that's purely interaction-based.

I love writing a lot— my happiness is turning shtposts into something terrifying. I don't like writing romances, I like the thrill instead. I like laughing like I'm Hubert from FE:TH after thinking of an evil plot twist.

But I hate posting it. Because I know, no matter how much effort I put it, it's not enough. No matter how long it is— no matter if you learned basic coding for it— drew art— made interactive google forms— it's just not enough. I literally made two long separate fics with different endings depending on your choices and it just performs less on something I didn't actually put anything on.

Lord.

Lord I hate Creative Differences for that. I finally understood why bands hate their hit songs because of that lol.

Don't comment something like "oh, you content creators are just whining—" I am whining. Why? Because we don't treat artists and writers like they're human enough. Like we're just uploading content and that we don't want to hear what the others have to say. I remember there was one ask telling me how they're gonna miss traumatizing their friend— and I'm just sitting there wondering "why didn't YOU tell me their reactions? Why are you making me feel like I'm talking to a brick wall for 2k words and more?" It's not their fault. I am not mad at this anon. They've done nothing wrong, but lord do I hate feeling like this.

I could follow "part 2???" requests, finish all my drafts for the events. But I know. I know the chances of the person who requested them won't actually answer after all the effort.

[insert Berkut's "all that effort, what is it all for?!" voice line from FE:Echoes here to lighten the mood]

But that aside.

It's just silence. Just notes, when I feel like comments are what matters more. I'm used to being alone, but I really hate silence. I hate it so much. That's why I'm always so grateful to the people who do interact often, and don't say that's not true because I can prove it. You can see me make content just for them, dedicate fics, art, everything. I love them, I love the "noise".

I know we all have lives, I know we're all busy, I know. I respect your time, I respect you.

And I think it's just time I respect myself as well.

So that's why I'm retired. No pressure on events (idol and letters), no pressure on anything. I'm actually taking my time in End Of Year Blues. It's nice.

Edit: I forgot to mention

My father hates that I write. He constantly tells me to stop it, to prioritize my academics, when writing is my only way of coping.

So.

Haha, what the hell do I even do anymore, right?

[imaginemalereader]

Anonymous request: Imagine being Clint Barton’s trans son

Sometimes it was hard to have an Avenger for a dad. For once, that wasn’t actually the hardest part. Him being away a lot had actually made part of this easier. It gave you more time to plan and prepare.

You thought about a letter, an email, a text. Ultimately you decided against them all though. You wanted to tell him face to face. You still wrote out a lot of what you wanted to say but you didn’t want to be reading off a script when you talked to him either.

When he got back from the latest mission, he and Natasha came back to the house. It had been an easy one they said, by Avengers standards of course. Once you were sure that everyone was safe and still as mentally stable as they had been when they left, you asked to pull your dad aside for a minute.

“What’s going on kid?” He asked. He could tell you were nervous, you were fidgety and looked from him and then away and back several times.

“Dad there’s something I need to tell you. About me.”

“Are you okay? Has someone-” His mind raced to a hundred bad things that could be going on before you cut him off.

“I’m fine. I’m just, I’m just not who you always thought I was.”

Was it bad that his first thought was that you were secretly an Asgardian sent to Earth as a baby or something like that?

You read the confusion on his face and quickly continued speaking.

“Dad I’m transgender. I’m a boy. And I want you to call me [Y/N] and your son and a brother and-”

This time you were the one cut off as your dad pulled you into a hug. You wrapped your arms tightly around him and even though you were happy and relieved, you were fighting back tears.

“Son, daughter, anything else. it doesn’t matter buddy. I love you.”

“Thanks dad.” He could here that you were choked up and held you a little tighter.

“Should we go tell your Aunt Nat while she’s here, or do you want to wait?”

“We can tell her now.” You said. 

Your dad let you drop the hug first and stepped back when you let him go.

“Are you okay?” He noticed your eyes were watery but he didn’t want to press you.

“Yeah, I’m good. Happy.”

 He put a hand on your shoulder and guided you back out to the porch where Nat had gone to wait for the two of you so she wouldn’t accidentally overhear anything.

“Aunt Nat?”

“You both good?” She asked, picking up that both of you had been near tears moments ago.

“Yeah we’re good. Aunt Nat, I’m trans. Could you call me [Y/N]?”

Natasha smiled, then put on a fake frown.

“Clint you’re subtracting from my niece tally.”

Your dad smiled and you laughed.

“Sorry to disappoint.” You smiled.

“I guess I can live with it.” She sighed, winking at you.

With those two out of the way, telling the rest of the Avengers was easy. Your dad brought you to the compound and helped you tell everyone and educate them. Thor needed the most help with terminology but everyone was very supportive. Tony immediately had Jarvis update your records and pronouns in the system.

Everyone was lovely about it, truly.

But your dad was on a whole other level, rivaled possibly only by Natasha. Around the house, you got a Nerf gun to correct people if they misgendered or dead-named you. The idea caught on and soon all the Avengers found themselves shot with little darts if they got it wrong. Everyone became remarkably fast learners.

Your dad doesn’t do much press, not like Steve or Tony, but it makes you smile every time he talks proudly about his son.

He made arrows with trans colors on them that spew colored smoke and disorient a person. You helped him design them after all the gender reveal party fails you saw online.

He’s not so good at dealing with all the bureaucratic nonsense that is the American healthcare system, but it’s impressive what doors being an Avenger opens. If/when you decided you want to pursue medical transition, he’s very supportive. Hormones, surgery, he’s got your back through it all. 

The first year after you came out, you asked him to take you to pride. You ended up getting a little more than you asked for.

It started out just the two of you. You walked around, saw the booths. Your dad was happy to see you happy. You got some merch, and your dad bought himself some stuff as well. He asked you questions, you guys talked to people. It was nice, and pretty low-key all things considered.

After some time wandering, you saw a collection of familiar faces approaching.

“I hope you don’t mind, I invited them to join us.” Them of course meant the rest of the Avengers, some of whom stuck out more than others. They all wore varying degrees of pride gear, from Natasha who wore a black shirt with an abstract design in trans colors, to Tony who had gone full rainbow.

The now large group of you walked through the festival together, with everyone talking and laughing. Some asked you questions about words or flags or memes that were unfamiliar. Thor had a lot of questions about how he had become a lesbian icon and what his duties entailed.

At the end of the day, you all went your separate ways.

“Was that good?” Your dad asked as he drove you both home.

“Yeah it was. Thank you for taking me, and for coming, and for inviting them. It was fun.”

“I don’t think I’ve actually said it to you yet, but I’m proud of you. Not just for this, because I know coming out and that is hard. But I’m proud of you. My son. I’m proud of the man you’re growing into.”

You smiled. You wished your dad could be around more, selfishly, but more than that, you were proud of what he did and who he was. You wanted to be like him in so many ways.

“Thanks dad. I love you.”

[nanowrimo]

Raising Kids & Writing Books: Five Tips for Parents Daring to Try NaNoWriMo

Sometimes, it feels like we never have time to write, especially if you’re a new parent! NaNo Guest Ruth Harper-Rhode gives some tips on fitting writing into a busy lifestyle. Writing a book while also being a parent of young children may seem like an impossible feat, and there’s no doubt that both parenting and writing are challenging endeavors. Both can be vastly rewarding, too. I believe it’s healthy for parents to channel their creative muses, and NaNoWriMo is a great way to do that!

I won my first NaNoWriMo in 2019, while working full time and raising my daughter, who was 3 years old at the time. I’ve participated in NaNoWriMo ever since. This year, I’ve got an added challenge: I welcomed baby #2 in August. I debated participating at all this year before I realized something: it’s not about how “good” your book is at the end of the month, but about how much you enjoy the journey that is NaNoWriMo. It’s possible for parents to not only participate, but to have fun! Plus, your determination to write a book in a month can serve as a great example for your kiddos.

Here are a few tips I’d offer other parents – or any busy person, really — who decide to join in on NaNoWriMo this year.

1. Find pockets of time that work for you. For me, getting up 30 to 60 minutes earlier each morning — before anyone else in the house woke up — worked best. I’d also sometimes take 10 or 15 minutes of my lunch break and scoot off to a quiet place to crank out a few paragraphs. Of course, weekends or days off from work lend themselves to longer writing blocks that help you get ahead of thegame during weekdays.

2. Use tech to your advantage: Writing on a laptop or in a notebook works.However, you can also write on your phone while you are waiting in line or on your commute (if you aren’t driving). Then, you can what you wrote to your main document later.

3. Lean on your support systems — and tell them what you’re doing! I made sure to tell my husband I was doing NaNoWriMo and when I would be writing, so he would know why I had to skip Netflix that night or why I decided to go to the library for an hour (or three) on a Saturday afternoon. If people who care about you know you have a goal you’re working toward, they’re bound to want to lend a hand, especially if they know it’s only for a month.

4. Plan what you’ll write. There’s nothing worse than sitting down to a blank page in a tired state of mind with only 15 minutes to spare and no idea of where to even begin. That’s a recipe for giving up! Use October to plan as much as you can. I had my general plot ironed out and wrote scene ideas on index cards. Each writing session, I knew exactly what scene I’d be tackling. I’ve found that the first minute or two of writing is the hardest — but once you get going, it can sometimes be hard to stop! Setting a timer for yourself and putting on some quiet, relaxing music can help with focus.

5. Be easy on yourself. Writing a book as a parent can feel particularly intimidating. Just remember, this is your first draft! It’s not supposed to be perfect. If you only make it to 5,000 or 10,000 or 20,000 words — that’s still more than you started with. You can always keep writing once November is over. In fact, the month may serve as a jump start to a long, happy writing life — one that may continue even as your kids get older.

Ruth Harper-Rhode has participated in NaNoWriMo since 2019, writing stories as an emotional outlet. She works full-time in healthcare communications and is a mom of two humans, two cats and one dog. When she’s not exploring the area around her home in Upstate New York, she enjoys curling up with a book or making something delicious in the kitchen. She tweets @Ruthings and posts on Instagram at @What_Ruth_Ate.   Photo by Jazmin Quaynor on Unsplash

[roundtriptojupiter]

i just sprinted across campus to escape the rain, and now i want to talk about my experiences as a cane user while i remember how to breathe again.

i started using a cane 4 years ago, at the end of elementary school. i’ve been chronically disabled (likely fibromyalgia, but currently diagnosed with myofascial pain syndrome; it’s an inaccurate diagnosis, but at least it’s something) my entire life—i struggled to sit cross-legged in kindergarten because it hurt too much, and the first accommodation i ever needed was permission to sit in a normal chair during circle time. i was born early, and both of my parents had issues with their legs in their lives; my father as a child learning to walk, and my mother in her teens, until she got knee surgery when she was 19, but neither were the same as what i have.

i’ve always been an indoor person. i’ve never enjoyed sports, but to this day i don’t know if that’s because i genuinely don’t like them, or because i always end up hurt. so my parents always thought i was just lazy and exaggerating and needed to get in shape. the third one always makes me laugh. when i look at myself in the mirror, i can count all of my ribs. i inherited it from my dad; his nickname was ‘rice’ in high school because he was white and skinny. maybe i’ll grow out of it, i don’t know. people tell me i look sick, and it kind of sucks to tell them that they’re right.

the old pastor at the church i grew up in was a professional volleyball player. there was an inter-church volleyball tournament held every year, and monthly volleyball games within the congregation. when i was in elementary school, i loved it. i loved volleyball more than any other sport i’d ever played; for the most part, i didn’t have to run anywhere, and that was what made the difference. and players were swapped around a lot, so i got a lot of breaks, and it seemed like... maybe i had just been lazy. maybe this was my lucky break.

and my parents signed me up for volleyball camp. i don’t remember how old i was—maybe twelve, thirteen? i could do the math, but my brain is too exhausted. it was only a week long. we did drills, we played games; every day i went back to my parents sobbing and exhausted, with burning red marks on my arms, barely able to stand and far worse than any other child there, even the other ‘lazy’ ones. that was the moment everyone in my life finally realized that something was wrong.

thus started a long, frustrating process and the wonders of the canadian healthcare system.

people love to compliment canada’s healthcare. they love to compare it to usamerica’s, they love to stand on their soapbox and say how great it is— i can always tell whether those people are disabled or not. because, yes. there are a lot of pros. but anybody who preaches that it’s wonderful and flawless will get my cane to their shins. because the reality is, the wait lists span years, and even when you live five minutes away from one of the best youth hospitals in the country, maybe even north america, sometimes they’ll put you through hell for three years straight, then give you the wrong diagnosis, throw an attempt at fixing you at the wall that doesn’t work, and then expect you to move on with your life.

i only have two vivid memories of that three-year process while i was still in elementary school: the beginning, and the end. my first major specialist appointment was with a neurologist. he stuck pins in my leg and arm and sent electric shocks through them to evaluate muscle responses. it was one of the worst pains i’ve ever felt. to this day, i can’t sustain a static shock without my leg buckling or my hand seizing up. my mom held my hand, and i was screaming; i still cry when i think about it. the test came back with nothing.

the end was when i finally saw a physiotherapist. at the time, it felt like a miracle; he spoke to me for what seemed like only ten, fifteen minutes, and gave me a diagnosis and a physiotherapy plan. that was in 2021. the physiotherapy turned out to be hell; i only lasted a few months, even doing the most basic of exercises, and my parents grew sour at the idea of driving me to the other end of the city on a regular basis. so that all shattered into nothingness.

but that’s all just an aside: the real point is, the first time i used a cane was on a school trip to a large city, at the end of elementary school. it was going to involve a lot of walking; something i knew by that point would be difficult. and so my mother gave me a gift. an old, simple, dark red, wooden cane. the same one she’d used in her teen years before her surgery, and kept just in case. i genuinely don’t know if it’s good or not; i don’t know if i could afford a better one. i’m still using it. i think buying a new one would make the reality too real—that i will not get a magic fix, like my mother did.

on that trip, my very first time using a cane, with my grade eight class, was the also the first time that anybody made fun of it. while walking through the city in small groups, another boy in my class called me a grandma from across the street. i ran after him and hit him (not hard) with it, and he kept his mouth shut for the rest of the trip.

when i started grade nine, my high school was a twenty-to-thirty minute walk from my house. (another aside, shorter this time: after almost every other form of exercise was slowly nixed out of my life, walking became my everything. it still kills, but it’s better than anything else.) and it was too much. by the time i reached school every day, i was unable to stand for the national anthem. that was when the cane became a regular part of my life; i took it with me every day for support while i walked, and even when i didn’t need it, it made my disability somewhat more visible. the respectful people saw it and realized that there was something wrong with me. the assholes saw it and were assholes.

here’s another thing about me: i used to have a cousin. i have a lot of cousins, actually, but the one in question was almost my twin. we were born in the same week, and shared a birthday every year growing up, and looked nearly identical—when our hair was the same length, that is. he and i were complete opposites in most other respects; i was a quiet, well-behaved (read: neurodivergent) kid, and he was a loud, trouble-making (read: neurodivergent) kid. but we got along. and we went to the same high school, and it always stunned people to find out that we were cousins.

in grade nine one of my cousin’s friends made fun of my cane, in front of him and me. my cousin shoved his own friend against a locker and threatened him because of it. i wasn’t made fun of for my cane at that school for the rest of my time there (unless you count the things that people say when they don’t mean to be mean, but have also never witnessed someone my age with a cane before. i don’t, but they still hurt.)

my cousin’s gone now. he overdosed on xanax and killed himself in october. it’s my fondest memory of him, when he turned on his own friend to defend me. i didn’t see him for two years before he passed because of covid quarantines and precautions. i genuinely don’t remember the last time i did see him.

and here’s one last thing: people think that growing up disabled with a parent that had suffered similarly would make things easier. but it was the opposite. because my mother wasn’t chronically disabled. she had horrible knee problems that were fixed after years of physiotherapy and a major operation. she was also labeled as gifted and diagnosed with something i forget the name of, which means that it takes more effort for her to perform tasks than it does for other people. and all that has done is this:

a more recent story. i’m currently spending a month living in québec on a university campus. initially, i was slotted to be staying in an off-campus apartment; they moved me to a residence building before i arrived because they knew of my disability. my room is on the fourth floor. there is no elevator. i wonder every day if my would-have-been apartment would have had less stairs.

my mother drove me there. when we arrived, she carried my suitcase up the stairs for me, because i was incapable of doing so myself. and when i complained, mostly lightheartedly—“oh, doing these stairs is going to suck all month”—she turned on me and told me that when she had been just a little bit older than me, she’d done a program in québec and lived on the third floor with no elevator, and she’d just had major knee surgery. and she’d been fine.

it was nothing for her. i still remember her exact words, four weeks later. i don’t know if she’ll ever truly take me seriously, because to her, she was disabled too, and she got through it. i’ve yet to find a way to convince her that it’s different. that not everything has a magic cure if you just work through it.

i’m eighteen now. she was nineteen when she had knee surgery. maybe when i turn nineteen, i’ll finally get a new cane. it’ll be symbolic, of something. i don’t know what. hopefully i’ll figure it out.

[spiciestpotatoes]

Tummy Clinic Chronicles

Patient #1

Lily was disappointed at first. It seems that her advertisement for her tummy clinic didn't register with people because she kept receiving people with all kinds of health issues but none related to what she specialized in.

Not wanting to deny these people healthcare but also not wanting to get a general doctor reputation, she sent all these people to her friend working in a general clinic 15 minutes away from her.

The day was coming to an end, and it had been just another day when she'd turned away at least a dozen patients, but she refused to give up and stayed her full shift. An hour before closing, a knock on her door startles her and interrupts a tense chapter of the book she was entangled in. Ready to turn another poor soul away, she gingerly went to the door. She opened it to find a lady in a maroon bomber jacket leaning against her doorway, looking exhausted.

"Are- Are you dr. Wilson? I saw your advertisement outside.. I- I was wondering if you could take me in, I know I don't have an appointment but my-" she paused as she grimaced and let out a breathy moan, holding onto the door frame with one hand and seemingly holding her tummy with the other, hiding it in her pocket. "My stomach has been killing me and I really need some help." She looked at Lily with pleading, pain filled eyes. Lily felt slightly joyous at the thought of having her first actual client, but she couldn't allow herself to look that happy in front of the poor woman so she gave her a small smile and opened the door wider for her to come in. "By all means, please, come in."

The door opened up to a room equipped with some closets and a coat rack on the right, and at the end of the room, a desk with two cushioned armchairs in front of it. "Please, sit." Lily said, pointing to the two armchairs. The woman carefully took a seat in the right armchair, the movement seemingly paining her.

"So, as you know, my name is Lily Wilson or dr. Wilson and since it's your first time here, I do just need some of your personal information to create a record for you. Let's start with your name."

"Anne Brown." They spent the next few minutes loading all of Anne's information into the system. "Now tell me about what's troubling you. When did the pain start? How and where does it hurt?"

"I first felt it yesterday morning, and I mean early morning. I woke up around 2 a.m., and my stomach just felt off and uncomfortable. It gradually worked up to being incredibly painful and has been hurting in intervals since. The middle of my lower tummy hurts the most. It's almost like cramping, and then the pain radiates all around." Both of her hands were moving slowly over her tummy, as if just talking about it made it worse.

"Okay miss Brown, let's go into the examination room so I can take a look at your belly." Lily says as she stands up and opens the door left to the table. The examination room has several tables, all for various purposes and she takes out a moderately soft one, wanting Anne to relax while she prodds around her tummy.

As Anne goes to lay down on the table, she lets out a small moan, the movement obviously taking a lot out of her. "Could you please lift your shirt up and lower your jeans just so I could have better access to your tummy please?" Lily asked and Anne complied with her instructions.

"I will feel around your abdomen and you can tell me where it hurts the most, okay?" Anne nodded, internally preparing for agony and let her arms fall to her side. Lily started just beneath her ribcage, pressing lightly all around her tummy. When she neared the lower area of her tummy Anne started tensing up as even the lightest touch upset her tummy further. "Is that where it hurts the most?" Lily asked, looking at Anne's scrunched up face. "Yeah that's where it's most sensitive." She let out a small moan. "Okay I'm going to have to go in deeper for a second time just to assess what's going on here, is that okay?" Lily asked, placing her hands to the middle of Anne's lower belly. Anne tensed up but nodded nonetheless. At the first press of Lilly's fingers going that deep, Anne's hands flew to get Lily away as the pain was too much to bear.

"It really hurts when you press it like that." Anne moaned out, guarding her tummy with her hands, breathing heavily. "Okay well I think nothing major is wrong with you, it seems that you are experiencing some intense gas pains so I can either give you some medicine that will hopefully help you get all of it out, or I can try to massage your tummy to manually jump start the process." Lily said with a bit of a smirk.

"I think I'll take the medicine for now, the massage seems a bit too intense at this moment." Anne replied and started pulling her clothes back over her tummy. She leaned forward as she was walking out of the office, holding both her hands over her tummy. Lily felt sorry it caused her too much pain to have her tummy massaged. Before Anne left, Lily put a hand on her back and said "If the medicine doesn't help you, feel free to stop by or call and make an appointment and I can still do that massage for you. It has helped many of my patients so I highly recommend it if all else fails. I'll contact you soon to see how you're doing." She smiled at her and Anne returned the smile, feeling grateful she stumbled upon this doctor and her clinic.

[personal-blog243]

Even if one completely disregards the financial problems with our healthcare system, part of the reason people are frustrated is just because getting sick sucks!

Say you start experiencing symptoms and go to a doctors office, which probably requires you to take time off work, you will probably have to fill out a very specific and detailed medical history not just of yourself, but your entire family. It is understandable that they need this information, but how severely do you describe your symptoms? What counts as “severe enough” to warrant treatment? What if it comes in waves and some days are better than others?

Then when you fill out your paperwork you are taken by a nurse. The nurse is probably a woman in her early 20’s who doesn’t know anything and probably doesn’t believe in vaccines. You regurgitate to her what you wrote on the paper.

Then the doctor comes in. The doctor is probably someone who does somewhat know what they are talking about, but obviously they only know what you tell them. They can’t read your mind after all. You recount your symptoms again and hope that it is specific enough and that you are communicating clearly and it doesn’t sound like word salad at this point.

Then you have to maintain communication with your workplace. What counts as strong enough symptoms to not be able to work? When do you think you will feel better? You thought you would feel better after sleeping it off, but you didn’t and had to call off last minute because you didn’t know you would still feel bad today.

Even if healthcare was free would some of these problems not persist?

[leam1983]

Breaktime

Walt felt like having a fifteen-minute dogpile on breaktime, which means that he has something on the brain. Things unfold as you'd expect by now: he sinks immediately, saws logs for a few minutes and then spends the rest of the break in monastic silence, basking in Sarah and I's closeness. When he spoke, today, it was with a sense of gentle regret - almost melancholy.

"Heat waves are at their record highs, there's floods, droughts, mudslides, tornadoes in Eastern Quebec - and I'm having us book appointments for car dealerships. We should be free, all three of us. We should live without any real material attachments and we should still be inexplicably wealthy. Like vampires."

I sigh. "The fact is we're not, hon. I need to work to pay my insurance policy and my medication, I need to work to afford my privatized GP despite my remaining hooks in with the public healthcare system - and I don't know that I have a Great Anglo-Québécois Fantasy novel in me. Until I know whether or not I do, I need to keep working. Like it or not, I like working with you."

His silence is regretful. There's entire unlived lifetimes hanging in those minutes, in the rise and fall of his chest.

"We're still meant for more, Grem. Sarah's at her prettiest when she's reading, you're at your best when you're worldbuilding settings I'll never really understand. This? Helping the middle class pump CO2 in the atmosphere? It feels like a dereliction of duty."

I laugh, as quietly as I can. "Compliments accepted, but you're the only man I know who elevates Salesperson Sleaze to raw, loving sexiness. I like who and what you are, nevermind your end-of-career crisis."

Sarah squeezes in from her side. "You'll get to be our anchor in a few years. Retired, left at home to cook for his two loving spouses, knowing they'll come back to hug him, kiss him hello and ask about his day.

He waffles. "I know, but morally-"

That ticks me off just so. I tell him he can either wallow in self-doubt and kill the business entirely out of self-defeating measures, or he can embrace the fact that he's got a chance to help people choose the lesser of two evils. None of us are the scientific marvels who'll kick climate change to the curb, all we can do is try and teach people to purchase things sensibly.

He glances at me. "You don't feel like you're betraying our future generations?"

Honestly, I tell him, I'm just trying to survive. Environmental awareness is for people two or three times higher than myself on the pay grade. I do my part off the clock, but I'm not going to self-flagellate in the streets because I helped a single woman buy an over-engineered Mommy-mobile.

[wellthatwasaletdown]

Harrys partnership with gun violence campaign is so tone deaf. They’re replying with lyrics from his song if you text that number for support. Wtf is wrong with whoever approved this. Why are Harry and team so idiotic. First the nazi merch and now this.

....................

Performative activism. He'll stick his name on any cause that's popular at the minute. Its all marketing for him. He's happy to tell Americans who to vote for and what to do with their guns and abortion laws but he can't even vote in that country. The UK has its own problems, his country and somewhere he can actually vote and be part of the change, but he doesn't say a word cause those problems dont get as much global attention. I wouldn't be surprised if the politically righteous king actually doesn't even vote in the coming election.

Also im sorry to bring up 1d but its something that makes the other guys really stand out. They actually are passionate about causes they can make an actual difference to and make their own part of the world a better place. Liam was really involved in the school lunch campaign so children could eat during the lockdown, niall was vocal about saving derby county because it meant so much to his community growing up and the jobs at stake, he's also been active with other causes, Louis is passionate about UK musicians access to the European labour market and also regularly takes part in cancer awareness and fundraising. Both Louis and Niall made it to the Times top 10 list for raising 2 million pounds from their respective livestreams and the entire proceeds went to UK covid relief and touring groups that were affected, zayn focuses on helping the NHS (UK healthcare system), cancer relief, combating racism and other causes. What is harry's cause?? Putting signs at his concert saying "my body my choice" while singing about her skirt is too short for his mother?? Waving flags at his concerts? Walking along with a blm protest? An anti gun violence campaign (its done deaf because he's not affected or passionate about it, just selling his music)??? Telling people who to vote for in a place where he can just pack up and leave when things go to shit??? Asking fans to buy expensive merch so the "profit" goes to the WHO where people can instead donate directly?? Be serious now. And before anyone misunderstands, im not saying he shouldn't do something in the US,im saying he doesn't have passion for any of it because he's just waving around stuff because he thinks thats what he should do, not because he's affected by something or he truly believes in something. He has himself said he hasn't found a "cause" yet and that, that truly infuriates me... millions of dollars, a global platform and there'snot one small thing he truly wants to change? In contrast, the others have taken a position for something THEY believed in, where they knew they would help a situation, pissed people off with their position and put their own money into it, not the fans'. So on the other hand his performative activism feels like a rainbow you can slide on.. an illusion.

*Sorry for the essay but I really have a problem with this kind of activism.

.

[petitmonde]

Arson (Daya centric)

TW: Arson and violence + it's bad

There once was a very angry punk rock girl named Daya. A lot of things pissed her off, but her current coping mechanisms didn't work. Drawing was fun until she tried to post her work online. The internet being mean as fuck, heckled her ability. So that hobby went to the trash pretty quickly.

Her three girlfriends, Gigi, Bosco and Jasmine, all smoked weed. Daya was calm when she smoked weed bunts with them. Truly happiness that was. Until some jerkwad came up to them to be a loser transphobe. He really ruined their vibe, so Daya punched him. Punching the transphobe felt good, so she did it again and again. The dirt bag laid on the floor, bloody face and all. What a loser.

If it wasn't for her three girlfriends pulling her off him, the cockroach of a human would have died.

"He's not worth the jail sentence." Gigi pleaded with her. She was right, logically speaking. So Daya listened to her.

"You're right. I'm sorry I scared you." Daya kissed Gigi and held Jasmine's hand. That little minx liked getting her hand dominated like that. Gigi still tasted like weed.

"Come here babe." Bosco grabbed her face by the finger, then blew smoke into her mouth. So hot. Daya would fuck them later as thanks for being such a hot piece of ass.

Everything would have been fine and Daya would have found a new coping mechanism, if it hadn't been for the cops that arrested her for assault. Apparently beating transphobes was illegal.

After a short stint in jail, Daya was once more free to find new ways to deal with her anger. She took up sewing these cute little grotesque bears to sell on Etsy. It went quite well, though now Daya is rich. Daya hated capitalism, so she dumped all her money into a pyramid scheme to get rid of it. Essential oils would take off any moment now and end the corrupt healthcare system. And Daya couldn't wait for that to happen.

Anyways. Daya still needed to cope with her anger. Reddit told her arson was cheap and available - and Daya couldn't deny fire was pretty. With a new sense of purpose in life, Daya made a list of things that could burn and die in a fire.

US Congress for being bitches

The Supreme Court (no explanation needed)

The Arby's that fucked up her order that one time

Canada

Grocery stores for being retail hell. Fuck you Sally for being such a petty bitch

Suburban housing

Satisfied with her list, Daya got to work on finding the necessary equipment to do the deed. She didn't tell any of her girlfriends of her plans, knowing they'd approve and then beg her to fuck them senseless. That part could wait for later.

Daya stole gasoline from BP oil as a fuck you for the oil spills and found a lot of lighters at a Walmart. To think people won't stop you if you just look angry enough. The Walmart pissed Daya off, and it was on her hit list so the only logical thing to do was to prepare its demise.

She broke into the back of the store then poured a good amount of gasoline on various items that would burn. She flicked the lighter open to set a piece of paper on fire, then dropped it. The fire quickly caught on and then Daya was gone. As pretty as the flames were, she couldn't get caught just yet. She had many places to burn down. Luckily for her the Walmart was close to suburbia, so that one also got crossed off her list.

Faster than a senator can lie about being involved in a scandal, Daya was at the Arby's that had slighted her. Capitalist scum, Daya thought as she put the place ablaze. The fire was glorious. She admired her work for approximately 2 minutes before getting the hell out of there too. An arsonist doesn't rest.

By contrived logic, Daya was now at the Supreme Court. It looked mighty flammable, and she was sure the Senate would be just like it. Damn police were around, but Daya was faster and quicker than them. In a mission impossible style breaking and entering, Daya was in the building. With her spite and anger, Daya set the place on fire just like the other places before it and skedaddled. Even the fire brigade showed up with the cops. They would have a hard time putting out all the fire Daya started and it served as the perfect distraction as Daya almost teleported to the senate.

The final destination before Canada. No one had caught her, she was too fast and furious 2 for them. Her final lighter got thrown into the building. "Burn motherfuckers." Daya muttered to herself, and so they did. Everything was fire and soot. She could hear the delicious screams from the scumbags.

Daya casually walked away from the glorious fire. Now only Canada was left. Well, that was until she got sent a nude by someone named Kiara. Fuck she was hot. How could Daya forget all the good booty calls she had in Canada? She shook her head. Canada is saved.

Daya went home to fuck her three weed smoking girlfriends. She deserved it after accomplishing so much.

[sunflowerstudentnurse]

I probably shouldn’t post about this on here because it’s so personal, but what the hell.

Trigger warning: miscarriage

I’ve debated a long time about having kids. I wasn’t sure if that was something I wanted out of life. C and I finally decided to bite the bullet and do it. He always wanted kids, and regardless of my inadequacies of being a mom, he would be a great dad. I’ve always thought he would be a great dad.

We tried for three months and got pregnant on the third month. I was so excited, but so stressed. I tested often and had hcg beta levels drawn twice on 16 days post ovulation, and 20 days. They were adequate for that timeline.

I went for my first ultrasound when I was 7 weeks and 5 days on 4/19, C went with me. The doctor told me I was 6 weeks and 5 days. She said I was probably just off with my dating and my last period. I had that horrible gut feeling in my stomach, but she showed us everything. The gestational sac, the yolk sac, the embryo, that little flickering heartbeat. For two weeks, I struggled. I knew so deeply that something was wrong, but thought it was just the nurse in me overreacting. I finally couldn’t handle it and went to an ultrasound place where they said there was no heartbeat, I knew before they told me, I could see that little embryo with no movement. I was on hold for thirty minutes, but I was able to get an appointment with one of the doctors in my group to do a transvaginal ultrasound to confirm.

Did I mention I work with these doctors? That I’m a L&D nurse that is well aware of what was happening. That the office staff tried to convince me I just needed to go to L&D to be evaluated, but I know we don’t see patients until 18 weeks, that I know I would be in ED for hours with a non emergent situation. When I told them that, they immediately found me an appointment. I shouldn’t have had to tell them that. They shouldn’t be favoring me because I work in the same healthcare system and know the way things work.

The doctor told me I could have asked one of them to scan me on the unit, which I could have, but then everyone at work would know I’m pregnant. She told me the clinic I walked into was maybe wrong because it was an abdominal ultrasound, and 8 and a half weeks was still too early. As soon as she found the sac I knew again though, she pointed out all the things that were there, but I told her there wasn’t a heartbeat, and she agreed. She told me I was measuring at 7 weeks 5 days, so it had been a week since the baby had last had a heartbeat. I already knew all this, I knew that sinking feeling I had at the first appointment was right, I knew there was a reason I couldn’t see us turning our extra room into a nursery, why I wouldn’t talk about the future with C when he’d ask me baby names.

She gave me the options. I could pass naturally in the next 6-8 weeks, I could get a d&c, but she recommended the mifepristone and misoprostol, so I agreed. I took the mifepristone in office, and 24 hours later I took the miso. Thirty minutes later I started cramping, and within an hour I was throwing up and cramping worse than I ever had with periods. A couple hours later, I saw the littlest placenta I’ve ever seen in the toilet.

I feel so empty now. Like all those plans I had in my head don’t mean anything any more, and maybe it’s because I never said them out loud. There won’t be a little dragon baby any more. December 1st will pass and it won’t mean anything to me, even though it should have.

I went out with C a little bit ago, and I kept having to remind myself not to cry. I’m not a crier, but maybe I am now. And now I have to continue like this wasn’t ever going to be. I didn’t tell anyone I was pregnant, so how do I tell them now I’m not?

And then one day, we just try again? I just one day put myself in the position that I might miscarry again?

And then I go back to work on 5/20. I go back, and I deliver other peoples babies and pretend my heart isn’t going to break again and again each time? I go back, and know that I’m going to cry at work one night, and my carefully curated personality is going to be ruined because all my co workers are going to see, they’re all going to know I’m broken inside, and they’re all going to try to make me feel better. I know after my managers saw my doctor’s note from a doctor on my unit that they’re going to know what happened, and they’re going to pull me into their office to try and make me feel better, and they’re not going to know what to do when I cry because I don’t ever cry.

How do people come back from this? How am I ever going to come back from this?

I don’t know how I have anything left to cry, I don’t know how I keep crying.

[an-involentary-bystander]

Transcript:

“What makes us get sick? Look upstream”

|  Rishi Manchanda  |  TEDSalon NY2014  |  August 2014  |

For over a decade as a doctor, I've cared for homeless veterans, for working-class families. I've cared for people who live and work in conditions that can be hard, if not harsh, and that work has led me to believe that we need a fundamentally different way of looking at healthcare.

We simply need a healthcare system that moves beyond just looking at the symptoms that bring people into clinics, but instead actually is able to look and improve health where it begins. And where health begins is not in the four walls of a doctor's office, but where we live and where we work, where we eat, sleep, learn and play, where we spend the majority of our lives.

So what does this different approach to healthcare look like, an approach that can improve health where it begins?

To illustrate this, I'll tell you about Veronica. 

Veronica was the 17th patient out of my 26-patient day at that clinic in South Central Los Angeles. She came into our clinic with a chronic headache. This headache had been going on for a number of years, and this particular episode was very, very troubling.

In fact, three weeks before she came to visit us for the first time, she went to an emergency room in Los Angeles. 

The emergency room doctors said, "We've run some tests, Veronica. The results are normal, so here's some pain medication, and follow up with a primary care doctor, but if the pain persists or if it worsens, then come on back."

Veronica followed those standard instructions and she went back. 

She went back not just once, but twice more. In the three weeks before Veronica met us, she went to the emergency room three times. She went back and forth, in and out of hospitals and clinics, just like she had done in years past, trying to seek relief but still coming up short. 

Veronica came to our clinic, and despite all these encounters with healthcare professionals, Veronica was still sick. When she came to our clinic, though, we tried a different approach. Our approach started with our medical assistant, someone who had a GED-level training but knew the community. 

Our medical assistant asked some routine questions. 

She asked, "What's your chief complaint?" 

"Headache."

"Let's get your vital signs" — measure your blood pressure and your heart rate, but let's also ask something equally as vital to Veronica and a lot of patients like her in South Los Angeles. 

"Veronica, can you tell me about where you live? Specifically, about your housing conditions? Do you have mold? Do you have water leaks? Do you have roaches in your home?"

Turns out, Veronica said yes to three of those things: roaches, water leaks, mold. I received that chart in hand, reviewed it, and I turned the handle on the door and I entered the room.

You should understand that Veronica, like a lot of patients that I have the privilege of caring for, is a dignified person, a formidable presence, a personality that's larger than life, but here she was doubled over in pain sitting on my exam table. Her head, clearly throbbing, was resting in her hands. 

She lifted her head up, and I saw her face, said hello, and then I immediately noticed something across the bridge of her nose, a crease in her skin. 

In medicine, we call that crease the allergic salute. It's usually seen among children who have chronic allergies. It comes from chronically rubbing one's nose up and down, trying to get rid of those allergy symptoms, and yet, here was Veronica, a grown woman, with the same telltale sign of allergies. 

A few minutes later, in asking Veronica some questions, and examining her and listening to her, I said, "Veronica, I think I know what you have. I think you have chronic allergies, and I think you have migraine headaches and some sinus congestion, and I think all of those are related to where you live." 

She looked a little bit relieved, because for the first time, she had a diagnosis, but I said, "Veronica, now let's talk about your treatment. We're going to order some medications for your symptoms, but I also want to refer you to a specialist, if that's okay."

Now, specialists are a little hard to find in South Central Los Angeles, so she gave me this look, like, "Really?"

And I said, "Veronica, actually, the specialist I'm talking about is someone I call a community health worker, someone who, if it's okay with you, can come to your home and try to understand what's going on with those water leaks and that mold, trying to help you manage those conditions in your housing that I think are causing your symptoms, and if required, that specialist might refer you to another specialist that we call a public interest lawyer, because it might be that your landlord isn't making the fixes he's required to make."

Veronica came back in a few months later. She agreed to all of those treatment plans. 

She told us that her symptoms had improved by 90 percent. She was spending more time at work and with her family and less time shuttling back and forth between the emergency rooms of Los Angeles. Veronica had improved remarkably. 

Her sons, one of whom had asthma, were no longer as sick as they used to be. She had gotten better, and not coincidentally, Veronica's home was better too.

What was it about this different approach we tried that led to better care, fewer visits to the E.R., better health? Well, quite simply, it started with that question: "Veronica, where do you live?" 

But more importantly, it was that we put in place a system that allowed us to routinely ask questions to Veronica and hundreds more like her about the conditions that mattered in her community, about where health, and unfortunately sometimes illness, do begin in places like South L.A. 

In that community, substandard housing and food insecurity are the major conditions that we as a clinic had to be aware of, but in other communities it could be transportation barriers, obesity, access to parks, gun violence.

The important thing is, we put in place a system that worked, and it's an approach that I call an upstream approach. It's a term many of you are familiar with. It comes from a parable that's very common in the public health community. 

This is a parable of three friends. 

Imagine that you're one of these three friends who come to a river. It's a beautiful scene, but it's shattered by the cries of a child, and actually several children, in need of rescue in the water. 

So you do hopefully what everybody would do. You jump right in along with your friends. 

The first friend says, I'm going to rescue those who are about to drown, those at most risk of falling over the waterfall. 

The second friends says, I'm going to build a raft. I'm going to make sure that fewer people need to end up at the waterfall's edge. Let's usher more people to safety by building this raft, coordinating those branches together. 

Over time, they're successful, but not really, as much as they want to be. More people slip through, and they finally look up and they see that their third friend is nowhere to be seen. 

They finally spot her. She's in the water. She's swimming away from them upstream, rescuing children as she goes, and they shout to her, "Where are you going? There are children here to save."

And she says back, "I'm going to find out who or what is throwing these children in the water."

In healthcare, we have that first friend — we have the specialist, we have the trauma surgeon, the ICU nurse, the E.R. doctors. We have those people that are vital rescuers, people you want to be there when you're in dire straits.

We also know that we have the second friend — we have that raft-builder. That's the primary care clinician, people on the care team who are there to manage your chronic conditions, your diabetes, your hypertension, there to give you your annual checkups, there to make sure your vaccines are up to date, but also there to make sure that you have a raft to sit on and usher yourself to safety.

But while that's also vital and very necessary, what we're missing is that third friend. 

We don't have enough of that upstreamist. 

The upstreamists are the health care professionals who know that health does begin where we live and work and play, but beyond that awareness, is able to mobilize the resources to create the system in their clinics and in their hospitals that really does start to approach that, to connect people to the resources they need outside the four walls of the clinic.

Now you might ask, and it's a very obvious question that a lot of colleagues in medicine ask: 

"Doctors and nurses thinking about transportation and housing? Shouldn't we just provide pills and procedures and just make sure we focus on the task at hand?" 

Certainly, rescuing people at the water's edge is important enough work. Who has the time? I would argue, though, that if we were to use science as our guide, that we would find an upstream approach is absolutely necessary. 

Scientists now know that the living and working conditions that we all are part of have more than twice the impact on our health than does our genetic code, and living and working conditions, the structures of our environments, the ways in which our social fabric is woven together, and the impact those have on our behaviors, all together, those have more than five times the impact on our health than do all the pills and procedures administered by doctors and hospitals combined.

All together, living and working conditions account for 60 percent of preventable death.

Let me give you an example of what this feels like.

Let's say there was a company, a tech startup that came to you and said, "We have a great product. It's going to lower your risk of death from heart disease." 

Now, you might be likely to invest if that product was a drug or a device, but what if that product was a park?

A study in the U.K., a landmark study that reviewed the records of over 40 million residents in the U.K., looked at several variables, controlled for a lot of factors, and found that when trying to adjust the risk of heart disease, one's exposure to green space was a powerful influence.

The closer you were to green space, to parks and trees, the lower your chance of heart disease, and that stayed true for rich and for poor. 

That study illustrates what my friends in public health often say these days: that one's zip code matters more than your genetic code. We're also learning that zip code is actually shaping our genetic code.

The science of epigenetics looks at those molecular mechanisms, those intricate ways in which our DNA is literally shaped, genes turned on and off based on the exposures to the environment, to where we live and to where we work. 

So it's clear that these factors, these upstream issues, do matter. They matter to our health, and therefore our healthcare professionals should do something about it. 

And yet, Veronica asked me perhaps the most compelling question I've been asked in a long time. 

In that follow-up visit, she said, "Why did none of my doctors ask about my home before? In those visits to the emergency room, I had two CAT scans, I had a needle placed in the lower part of my back to collect spinal fluid, I had nearly a dozen blood tests. I went back and forth, I saw all sorts of people in healthcare, and no one asked about my home."

The honest answer is that in healthcare, we often treat symptoms without addressing the conditions that make you sick in the first place. And there are many reasons for that, but the big three are first, we don't pay for that. 

In healthcare, we often pay for volume and not value. We pay doctors and hospitals usually for the number of services they provide, but not necessarily on how healthy they make you.

That leads to a second phenomenon that I call the "don't ask, don't tell" approach to upstream issues in healthcare. We don't ask about where you live and where you work, because if there's a problem there, we don't know what to tell you. It's not that doctors don't know these are important issues. 

In a recent survey done in the U.S. among physicians, over 1,000 physicians, 80 percent of them actually said that they know that their patients' upstream problems are as important as their health issues, as their medical problems, and yet despite that widespread awareness of the importance of upstream issues, only one in five doctors said they had any sense of confidence to address those issues, to improve health where it begins. 

There's this gap between knowing that patients' lives, the context of where they live and work, matters, and the ability to do something about it in the systems in which we work.

This is a huge problem right now, because it leads them to this next question, which is, whose responsibility is it? 

And that brings me to that third point, that third answer to Veronica's compelling question. Part of the reason that we have this conundrum is because there are not nearly enough upstreamists in the healthcare system. 

There are not nearly enough of that third friend, that person who is going to find out who or what is throwing those kids in the water. 

Now, there are many upstreamists, and I've had the privilege of meeting many of them, in Los Angeles and in other parts of the country and around the world, and it's important to note that upstreamists sometimes are doctors, but they need not be. They can be nurses, other clinicians, care managers, social workers. 

It's not so important what specific degree upstreamists have at the end of their name. What's more important is that they all seem to share the same ability to implement a process that transforms their assistance, transforms the way they practice medicine. 

That process is a quite simple process. It's one, two and three. 

First, they sit down and they say, let's identify the clinical problem among a certain set of patients. 

Let's say, for instance, let's try to help children who are bouncing in and out of the hospital with asthma. 

After identifying the problem, they then move on to that second step, and they say, let's identify the root cause. 

Now, a root cause analysis, in healthcare, usually says, well, let's look at your genes, let's look at how you're behaving. Maybe you're not eating healthy enough. Eat healthier. It's a pretty simplistic approach to root cause analyses. It turns out, it doesn't really work when we just limit ourselves that worldview. 

The root cause analysis that an upstreamist brings to the table is to say, let's look at the living and the working conditions in your life. 

Perhaps, for children with asthma, it's what's happening in their home, or perhaps they live close to a freeway with major air pollution that triggers their asthma. And perhaps that's what we should mobilize our resources to address, because that third element, that third part of the process, is that next critical part of what upstreamists do. 

They mobilize the resources to create a solution, both within the clinical system, and then by bringing in people from public health, from other sectors, lawyers, whoever is willing to play ball, let's bring in to create a solution that makes sense, to take those patients who actually have clinical problems and address their root causes together by linking them to the resources you need. It's clear to me that there are so many stories of upstreamists who are doing remarkable things. 

The problem is that there's just not nearly enough of them out there. 

By some estimates, we need one upstreamist for every 20 to 30 clinicians in the healthcare system. In the U.S., for instance, that would mean that we need 25,000 upstreamists by the year 2020. 

But we only have a few thousand upstreamists out there right now, by all accounts, and that's why, a few years ago, my colleagues and I said, you know what, we need to train and make more upstreamists.

So we decided to start an organization called Health Begins, and Health Begins simply does that: We train upstreamists. And there are a lot of measures that we use for our success, but the main thing that we're interested in is making sure that we're changing the sense of confidence, that "don't ask, don't tell" metric among clinicians. 

We're trying to make sure that clinicians, and therefore their systems that they work in have the ability, the confidence to address the problems in the living and working conditions in our lives. We're seeing nearly a tripling of that confidence in our work.

It's remarkable, but I'll tell you the most compelling part of what it means to be working with upstreamists to gather them together. 

What is most compelling is that every day, every week, I hear stories just like Veronica's. 

There are stories out there of Veronica and many more like her, people who are coming to the healthcare system and getting a glimpse of what it feels like to be part of something that works, a health care system that stops bouncing you back and forth but actually improves your health, listens to you who you are, addresses the context of your life, whether you're rich or poor or middle class.

These stories are compelling because not only do they tell us that we're this close to getting the healthcare system that we want, but that there's something that we can all do to get there. 

Doctors and nurses can get better at asking about the context of patients' lives, not simply because it's better bedside manner, but frankly, because it's a better standard of care. 

Healthcare systems and payers can start to bring in public health agencies and departments and say, let's look at our data together. Let's see if we can discover some patterns in our data about our patients' lives and see if we can identify an upstream cause, and then, as importantly, can we align the resources to be able to address them? 

Medical schools, nursing schools, all sorts of health professional education programs can help by training the next generation of upstreamists. We can also make sure that these schools certify a backbone of the upstream approach, and that's the community health worker. 

We need many more of them in the healthcare system if we're truly going to have it be effective, to move from a sickcare system to a healthcare system. 

But finally, and perhaps most importantly, what do we do? What do we do as patients? 

We can start by simply going to our doctors and our nurses, to our clinics, and asking, "Is there something in where I live and where I work that I should be aware of?" 

Are there barriers to health that I'm just not aware of, and more importantly, if there are barriers that I'm surfacing, if I'm coming to you and I'm saying I think have a problem with my apartment or at my workplace or I don't have access to transportation, or there's a park that's way too far, so sorry doctor, I can't take your advice to go and jog, if those problems exist, then doctor, are you willing to listen? And what can we do together to improve my health where it begins?

If we're all able to do this work, doctors and healthcare systems, payers, and all of us together, we'll realize something about health. Health is not just a personal responsibility or phenomenon. Health is a common good. 

It comes from our personal investment in knowing that our lives matter, the context of where we live and where we work, eat, and sleep, matter, and that what we do for ourselves, we also should do for those whose living and working conditions again, can be hard, if not harsh. 

We can all invest in making sure that we improve the allocation of resources upstream, but at the same time work together and show that we can move healthcare upstream. 

We can improve health where it begins.

Thank you.

[buzzerbeaterbin]

Sean, my new PT

I saw a sports medicine doc back in the spring for my lower back pain, which has persisted since April 2022 despite ample rest, medication, 4 months of physical therapy, all kinds of exercises, and plenty of copays. This doc was amazing - so much so that I am now considering going into the specialty despite never having given it a second thought prior. Her treatment plan essentially boiled down to having me try working with a new PT, someone on her team with lots of experience with athletes in my age group and spine/hip pathology in particular. I finally had my first appointment with him today after booking it right after my MCAT (I know I'm generally healthy and in no place to complain on my own behalf but seriously smh @ our healthcare system bc patients always have to wait forever to be seen).

I love physical therapists, and in general, the study of physical therapy and kinesiology. For reasons similar to why I fell in love with yoga, I am consistently amazed by how such seemingly subtle stretches, movements, and form adjustments can make a world of difference in someone's pain or mobility, and how people I've met for mere minutes can tell me things about my own body that I've never known despite being the sentient soul living inside of it. I remember meeting Marcus (a personal trainer I got one free session with at my gym) and Kim (my physical therapist from Oct-Jan) and feeling stunned by how quickly they were able to catch on to my left hip instability. Today, Sean took my awe to the next level, and I knew he'd be different when the first thing he told me was that he could tell I was left-handed simply from the way that I walk.

He spent a solid hour and a half on his physical exam + teaching me about the how and the why my spine, sacrum, and - news to me - shoulder and cervical have been doing tons of compensatory work (possibly to restore equilibrium from my wack vestibular system. tbd on that) to, at the end of the day, protect me from collapsing, which in my case has resulted in a chronically stiff lumbar region. Yes, my unconditioned glutes, hamstrings, and core may be subject to improvement, but that fact alone can't explain the chronic pain, because if that were the only reason - wouldn't everybody on earth be feeling the same way? For the first time since onset, everything finally made sense. His clinical reasoning took into account all of my unique presentations and deficits, which was extraordinarily appreciated, because up until today I was only ever treated like a generic back pain patient.

E.g. My left hip is unstable when I squat. But why? Unlike the "general weakness" conclusion that I was fed since learning how to do compound lifts, so much clicked for me today when Sean said, yes, the left gives out first - but because the right hip flexor is severely tight, likely from the compensatory work that my spine has been teaching it to do. We did a series of stretches and adjustments together to try and loosen up my hip joint. I felt no different sensation afterwards, but when I tried squatting again - like magic, my left hip didn't give out nearly as much as before. The video evidence proved to me everything I needed to know. I scheduled another appointment with him about a month from now (because I will not realistically have to time or money to drive 30 min away on a weekly basis while I'm in school, also I never understood why I was seeing my other PT weekly because how much progress can I really make in a week?) and he gave me a program to follow until then. I plan on committing to it religiously.

Now that it's been over a year with this pain and consistent disappointment in my lack of progress, I was beginning to accept that this was my new normal. I went in to my appointment today, having almost forgotten about it since I scheduled it months ago, fully expecting to be given generic advice and planning on not seeing him again. I guess I still went because my subconscious had hoped that maybe, just maybe, something would be different this time. And maybe, just maybe, this time it will be.

[sanyu-thewitch05]

Custody War Part 3

Part 1

Part 2

Tw: Mention of death, neglect, mention of the American Healthcare System, and hypothermia. Also, sidenote: Don't do what Yuu did. That might cause pain to your skin if you're hypothermic.

Ugghh! Where am I?

Yuu's vision clears up, and she sees a white ceiling.

I'm in a hospital. Wait...I'M IN A HOSPITAL!

Yuu jolts up with life, scaring the doctor and the few friends in her hospital room.

I've got to get out of here before I pay $20,000 for needed medical services! That's money I don't have!

Yuu jumps out of bed and runs out of her room. She dodges the people stopping her and dashes to the hospital door. Phillip tackles Yuu and holds her down.

"NO! NO! YOU CAN'T MAKE ME PAY YOUR OUTRAGEOUS PRICES FOR HEALTHCARE!" Yuu screams, struggling in Phillip's grip.

"Yuu, stop! Nobody is making you pay for healthcare! It's free!" Phillip exclaims, holding Yuu by the waist.

"Oh...that-that's great. Why am I in the hospital?" Yuu asks, calming down and going back to her room.

"Yuu, you fainted during our morning jog when your friends from NRC and Coach Vargas attempted to take you back. Your body couldn't take the physical and mental stress. The doctor said you need to rest and not put more stress on your body. Come, I'll take you to the RSA carriage, and you can sleep on the way," Phillip explains, picking up Yuu and carrying her princess style. "Neige and Thorne are already packing up the gifts people gave you in the hospital."

Yuu clings to Phillip's shoulders as he walks out into the hospital parking lot. He opens the door to the carriage and puts Yuu inside, and gets in next to her. Phillip knocks on the door, and the carriage starts to move.

"Phillip, what time is it?" Yuu asks, wondering if she slept through the whole day.

"1:30 PM. You were out for about an hour and thirty minutes. You'll be back in time for lunch," Phillip answers, letting Yuu rest on his shoulder. "Don't worry about Grim. He's still learning magic and getting fed."

"Yay..." Yuu whispers, falling asleep on Phillip's shoulder.

Yuu slept through the rest of the carriage ride, and Phillip carried her sleeping body inside. He goes to the cafeteria and places her next to Neige. Then he leaves to get food for her and him. Yuu wakes up to the sound of plates and looks at the food in front of her.

"Hi, sorry I woke you up. I got you baked chicken, rice, strawberry tarts, and a nice cold glass of lemonade," Phillip says, kissing Yuu's hand. "Eat up."

Yuu takes a fork and knife and begins to cut her chicken, only to be stopped by Phillip.

"Ah-ah. Didn't I tell you? From now on, you won't be lifting a finger. You need R&R," Phillip says, cutting Yuu's food.

~~~~~~

"UGGGHHH! I can't stand this Phillip fucker!" Crowley screams, using his magic to spy on Yuu.

"I know! He's so-so-so chivalrous!" Deuce yells, going back to his thug demeanor. "Why do our plans keep being foiled?!"

"Don't know! But why don't we get Malleus to transport Yuu back to Ramshackle dorm?" Crowley suggests, even though Malleus already got caught.

"Yeah, that might work. Besides, you can already see where Yuu is. We just have to tell Malleus when to teleport to Yuu," Ace says, looking at Yuu eating.

Crowley summons Malleus to his office, and the moment when Yuu goes to her bed to take a nap, he sends Malleus in. Malleus gently picks up Yuu and teleports her back to Ramshackle. Yuu stayed asleep for the rest of the day and into the night until she woke up freezing cold.

Why do the ghosts look so weird? They look less puffy and more human.

Yuu forces herself up and walks to the nearest mirror.

I look like Idia. My lips are blue!

"Hey, ghosts, what's wrong with me?" Yuu asks, looking at the concerned and sadness-struck ghosts.

"Yuu, you don't have much time left. Warm-up before it's too late," The sporty ghost says, feeling mercy for the poor girl.

Unfortunately, Yuu had been left out in the cold for too long due to Ramshackle having no heating. Now it's up to Yuu to survive or become another ghost in Ramshackle.

I've got to get out of here before I die.

Yuu runs out of Ramshackle and into the forest, hoping her body will warm up if she keeps running. She comes across the cottage and runs straight to the bathroom. She throws the shower onto hot and jumps inside, not caring that her clothes are on. The hot water delivers a painful sensation to her skin, and she screams.

Someone come and save me! Help me, please!

Yuu passes out in the shower, her body warming up. Warming up all alone.

~~~~~~

"Yuu...Yuu...Yuu!" Someone calls, shaking Yuu up.

Yuu's eyes open, and she sees the blurry figure of what looks like Phillip.

"Phillip..." Yuu mumbles as Phillip puts a towel over her.

"Yes, it's me, Phillip. Everyone was searching for you. Come on, keep your eyes open. What's your favorite song?" Phillip says, frantically trying to keep Yuu awake until everyone else gets there.

"Into the woods. I liked the movie and play version," Yuu answers softly. "Into the Woods, It's time to go, I hate to leave, I have to though. Into the woods-it's time, and so I must begin my journey."

"Into the Woods, And through the trees, To where I am, Expected ma'am, Into the Woods, To Grandmother's house- Into the woods, To Grandmother's house-" Phillip whisper-sings, putting his forehead next to Yuu's.

Yuu and Phillip sing the entirety of Into the Woods until the RSA staff come to get Yuu back.

~~~~~~

"Is Yuu going to be alright?" Phillip asks, sitting down next to Yuu in the nurse's bed.

"She'll be fine. She'll need extra rest and warm fluids," Ambrose answers, getting angry at what happened to Yuu. "Tell me when she tells you what happened. I've got a call to make."

Ambrose storms to his office, everyone steering clear of his path. The door to his office slammed, and Ambrose furiously dials Crowley.

"Oh, hi Ambrose. Why are you calling so late?" Crowley asks, putting his feet up on his desk.

"Crowley, you've gone too far! Did you even know where Yuu was today?!" Ambrose yells, shocking the birdman.

"As far as I know, Yuu's in Ramshackle. Why are you asking?" Crowley asks, wondering why the old man is so upset.

"Tell me why Yuu was found in Snow White's old cottage, shivering, lips turning blue! She was dying of hypothermia, and I had to lie to one of my students that Yuu might actually be ok! Yuu was going to be dead!" Ambrose yells, silence on the other end.

"I'm sorry..." Crowley says, hanging up the phone afterward. "I'm so sorry, Yuu. I'm sorry I failed as your guardian."

Part 4

Tag list: @lizzileth @hipsterteller @leabbmao @kingfargas @justarandomhumaninthisworld @shi-mel @iwant2dienow @nai17 @nerdy-diamonds @naughtybodypillow @felfei @tinnyflute @r-0-tt-3-n-m-1-lk @marrondrawsalot @iamfriedpotato @pookiedragonfire

[miekasa]

future nostalgia (eren jaeger)

↯ pairing: eren jaeger x (fem) reader, armin is absolutely putting in the work and deserves wingman of the year, mikasa is your well-reasoned, protective friend how you like them apples

↯ genres and warnings: college au, fluff, everybody is a little bit of an idiot, armin and eren supremacy, i will find a way to make levi captain of something in any and every au

↯ word count: 1.5k

↯ summary: armin arlert is the greatest wingman a boy could ask for; unfortunately he’s also oblivious as hell and painfully single himself, but you know what, he’s doing his best (aka you and eren putting your friends through the mental wingman/wingwoman olympics).

↯ notes: i’m running out of gifs to use i’m going to have to learn how to use photoshop to make headers rip in peace to me, also this an old piece, reworked for eren again, sometimes i cheat off of myself it’s okay  

“Just come by the rink during practice,” Armin pleas, “I promise, he can put his hot-headedness to good use!”

“I don’t doubt that,” you chuckle, your voice booming through the speaker of his phone, “But I’m pretty sure the rink is closed to non-athletes or team members, Armin.”

“But I can get you access! Manager’s privileges!” Armin boasts.

“While I appreciate the reminder about how single you think I am—and, I do, truly, Armin, from the bottom of my heart, thank you—you don’t have to try and set me up with one of your hockey jockeys.”

“They’re not jockeys!” Armin protests.

“Reiner Braun is most definitely a jockey.”

Armin slumps down a bit. Okay, most of them are good people. Most of the time. Look, Reiner is the exception, not the norm, but even he could be analytical and composed when he needed to be. 

“I’m going to tell him you said that,” Armin threatens.

“Fine, then I’ll tell him that you almost leaked his nudes to the entire girls volleyball team freshman year.”

“You play dirty,” Armin pouts, face growing red at the memory. (In his defense, it was freshman year, pretty much the first time in his life he’d had alcohol unsupervised, and in his drunken haze he thought he might have been doing Reiner a favor; he was pining over Christa pretty hard). “Which is exactly why you’ll love Eren!”

“Eren, still?” you question, trying to hide the amusement in your tone. “What’s the infatuation with me and Eren? You know, if I’m being honest, Jean is more my type, or even the captain—what’s his name again?”

“You mean Levi?” Armin questions, incredulous, “He’s the exact opposite of your type, don’t lie to me!”

“He’s still hot.”

“Is he really?” Mikasa’s voice questions doubtfully; and you can practically feel her rolling her eyes from across the receiver, “You can do better than him, (Y/N).”

“Wait, am I on speaker?” you ask.

“Maybe, doesn’t matter,” Armin hums, brushing away the topic, “Like I was saying, Eren is great, and you’re great, so you’d be great together! Plus, he’s kind of loaded, and very generous. Not that you’re shallow or anything, but I’m just saying, he’d take you on nice dates.”

“You’re kind of loaded and you don’t take me on nice dates.”

“Because we’re not dating.”

“You could take me on a friend date,” you muse, “Don’t be stingy, Armin.”

“She has a point,” Mikasa quips, “You always go to the fancy museums and don’t invite us.”

“Because the last time I did, you fell asleep! In the middle of the coral reef exhibit!” Armin whines.

“Because it was boring as fuck,” Mikasa deadpans, prompting you to chuckle.

“I have to agree. I’m afraid if you and Eren have the same taste in dates, it will never work out.”

“We don’t!” Armin insists, “Look, Eren is exactly your type, (Y/N), I’m telling you! He’s cute, athletic, but not bulky, and little clumsy, but it can be charming! Plus he loves puppies, cares about the environment, believes the healthcare system is corrupt, and hates most branches of law enforcement! What more could you want!”

“Armin,” you pause, holding back your laughter, “Maybe you should set yourself up with Eren if you think he’s that great.”

Armin chokes on the other end of the line, and your chuckles stumble out; you can imagine the blonde growing red and increasingly embarrassed with every passing second.

Mikasa hums. “Armin and Eren do have good chemistry—”

“Hello?! I don’t want to date Eren!”

“—but, I’ll vouch for Eren on this, too,” Mikasa continues, “I think you two would be good together.”

You bite the inside of your cheek. You’d always known Mikasa was in support of setting you up with Eren too—albeit much more subtle than her blonde counterpart—but she’d never said it explicitly; showing her approval in contended nods and hums whenever Armin would scheme to get you and Eren together. It was somewhat reassuring to hear.

You’re about to continue teasing Armin about the subject, when you hear your apartment door unlock. You shift your phone to your other hand, as you hear the sound of keys clanging onto the hook near the door.

“Look, guys, I gotta go,” you tell him, “This is been fun, but maybe focus on working out your feelings before setting me up, yeah? I wouldn’t want to get in the way of such a beautiful friends to lovers story.”

“Will you—I want you to date Eren, not date him myself! There—be quiet, Mikasa—there are no feelings to work out, I don’t even like g—”

“Sounds, good Armin,” you chuckle, words hurried as you hear footsteps approaching you, “Try and get Levi’s number for me, would you? Rumor has it he’s loaded, too—old money rich and everything.”

“But Eren is perfect—” is all you hear before you end the call, a pair of arms wrapping around your waist from behind, just as your thumb presses against your screen.

Ruffled, brown hair falls onto your shoulders as a chin is propped up against your neck; a flurry feather light kisses greeting you soon after. You hum, reaching your hand back to curl into the brown tresses, a final, exaggerated kiss pressed into the juncture of your neck and shoulder.

“Why are you trying to get Captain’s number,” Eren questions, voice muffled as he nuzzles his nose behind your ear, “No offense, but I think you’d have to line up behind his hundred and one fangirls first, babe.”

You chuckle lightly, neck growing warm as Eren continues to bury himself into your skin. His is cold from the winter air, but you don’t know why he insists on inflicting it onto you, when you know he’ll be back to furnace temperatures within the next ten minutes.

“I’m just messing with Armin,” you answer, resting on of your hands over Eren’s at your waist and giving it a squeeze, “He’s still trying to set us up.”

Eren chuckles, undoing his hold on you to spin you around to face him, cold hands cupping either side of your face. You scrunch your nose at the frigid feeling, but Eren finds it cute, leaning forward to press a kiss to the tip of your nose as an apology.

“Well, Armin is nothing if not loyal,” Eren muses.

“He’s too good for you,” you jest, poking at Eren’s forehead playfully, “He’s putting in all this work to be a good wingman, and you’re slacking off.”

“Technically, he’s not doing any work, we’re already together.”

“Yeah, but he doesn’t know that.”

“And who’s fault is that?” Eren questions, using his hands to squish your cheeks together, “I wanted to tell him two months ago.”

“First of all, this secret thing was your idea to begin with,” you point out, “Which—oh, by the way, I told you Mikasa approves of you; she said we’d be cute together on the phone.”

“That doesn’t mean she still won’t castrate me if we ever break up,” Eren says, a shudder running down his spine at the thought of it.

It’s not that he wanted to keep your relationship a complete secret from all of your friends forever, but he was hesitant at first, unsure of how your two friend groups would merge and take the news. And, he knew how much Mikasa cared about you, and truthfully, the dark haired girl scared him a little.

But it was bordering on half a year now, and he was certain that somebody would catch on soon enough. That, or Eren would accidentally let it slip to the entire hockey team one of these days—he almost has on a handful of occasions, but you don’t need to know about all of that.

And while a part of him did like the privacy that came along with dating in secrecy, Eren was finding it increasingly difficult to pretend to not be in love with you whenever you two went out with your friends; and to not brag that he had a super hot, super supportive girlfriend to wear his jersey during games, and Jean didn’t.

“You have plans to break up with me, Jaeger?” you question, but there’s a playful lilt in your voice.

It makes Eren grin, using his grip on your face to pull you closer, words ghosting over your lips before he pulls you in for a kiss, “Not in a million years.”