#im interested to see the effects anesthesia will have on me like when i wake up. hee hee

[carcarrot]

clawing and biting like a cat that does not want a bath

[ley-med]

Hello.I’m seriously considering the ICU specialty.Can you tell me please some advantages and disadvantages of it ? :) Im pretty coolheaded,love to solve probs and small invasive procedures are ok ,too for me.. How does a life at ICU look like? I was on an ICU placement just once in my life as an internal medicine resident ,as a student ,and the work there really fascinated me.. Intubations,monitors,cardio versions.. Is it possible to specialise just in intensive care but not in anesthesiology?Thank You!

Hi Anon! You prompted me to ramble about one of my favourite things, my job, so sorry, long answer ahead...

To start with your last question, I know there are countries where intensive care and anaesthesiology are different specialities, but here it's one and the same. It is kind of possible to choose one or the other once you are an attending, and work at the right place, but you have to specialise in both. I started this residency because I was interested in intensive care, but my rotations started with anesthesia, and not gonna lie, I absolutely fell in love! Now doing both, I still say anesthesia is the real love of my life, and I can't imagine doing only intensive care without the relief anesthesia brings to it.

The pros of intensive care is that it's rarely dull, and when it's dull, the patient usually gets admitted back to their ward soon (yay!) (or you know, unfortunately there isn't much else to do for them, then the end of the story is near). It's important to like invasive procedures, because as they say, where there is a hole there's a tube, and where there is no hole, there will be... My favourite part about ICU is that we get to see and treat the patient as a whole human being, not just one organ or the other, because humans are a very complex system and you usually can't focus only on one part. Our job is mostly trying to hold up various balances, which will lead to the balance on the fine line between life and death. It is pretty exciting, in my opinion, but most of all, I just love knowing all these things about the human body. (And there is so much more I need to know...)

If you come from internal medicine, that's a huge advantage, but you will need to forget half of what you know. We don't really care about the long term stuff, we are always working in the present. It all needs to be done (almost) immediately, and needs to have an (almost) immediate effect. If we need some longer lasting solutions, we will absolutely consult medicine :) (Though in our hospital, we don't have any internal med wards, so it's usually the intensivists who get consulted for internal med questions anyway... But no we don't know everything, so far from it)

And many times, it's really only supporting the body until it heals on its own, with a little help here and there. Intensive care is really only about buying time...

The cons of intensive care, is that the stakes are always really really high. It's either an enormous win, which is one of the best feelings in the world, but most of the time, it all ends in death anyway, no matter what you do. Sometimes it feels like I just got a first class seat to watch people's suffering, without any way to help. I don't have any statistics at hand, but I would say 70% of our patients don't leave our ICU alive. We do what we can, but we aren't gods, and we can't cheat death. It can be really taxing, because while providing palliative care is just as important as any other kind of care, seeing gruesome death after gruesome death takes its toll, mental health wise. And that's why I say thank god it's a joint speciality with anesthesia, because when it all gets too much, a day in the OR will fill you up with instant successes (hopefully). When my patient wakes up and smiles at me, because they were so afraid but the dreaded surgery is finally over and they are alive? Always makes the world a brighter place.

One of the hardest parts for me, that sometimes you have to play god in this field, no matter how much you don't want to. The number of patients we can admit to the ICU is a definite number, so we have to decide who gets this chance at survival, and who to spare this torture. It's good that I'm still a resident, and the attending will make the final call, but nonetheless it is our responsibility...

On the bright side, this responsibility also brings me into the position of command sometimes, even if I'm only a mere resident. If they call me in for a consult, or if I end up in a situation which turns into an emergency, I am the team leader, and if I say come on we are putting our shoulders into saving this patient, everyone will work under my hands without a complaint.

This is all a teamwork. I think the whole of medicine is, but it applies to the ICU and OR tenfolds. Most ICU nurses aren't made of some delicate thing, it can be hard to earn their help, but without that, you are lost. Intensive care patients need constant supervision, and the nurses are the ones who are with them, they are the ones who know each beat of the patients' heart, they will be the ones constantly administering life saving medicines, and they will save your (and the patients') ass several times. And in cases where they are needed, we are dependent on our surgeons and traumatologists, because no matter how much we support this or that organ, as long as they don't work their magic, it's all a lost cause. (Honestly, sometimes you have to just stand there in awe, when you are thinking it's all lost, and they come up with such an ingenious solution...) Same in the operation room, it's a constant conversation and a very delicate cooperation between anesthesia, surgery, and the nurses.

To sum it up, it's all pretty hard work, with long 12 hour shifts that sometimes feel like 5 minutes because you just can't sit down and everyone is trying to die on you, and in the end you will find that the answer isn't that much different from internal medicine, it's usually either: oxygen, morphine, fluids, and or furosemide; you just have to figure out which one. And at times, figuring out isn't that exciting, it can consist of elevating the PEEP on the ventilation machine every hour or so, and hoping for the best. Those 12 hours will be the longest, with nothing to do, only waiting, and waiting...

[mybeypage]

I'm going to talk about our favorite redhead.

This one:

And specifically about his being a redhead. As a natural redhead myself and having done probably too much research about it, I think there are some HC that I have about him that are directly related to that fact and I thought maybe you'd like to hear as well (and I suppose the things Im going to touch on can apply to Johnny, Salima, and Daichi too but we're not talking about them right now).

As most probably (though maybe not) know, the gene that causes red hair is a mutation in the MC1R gene. What's new information within the past few years is that it belongs to a family of receptors in the brain that are directly related to pain.

It's not that redheads feel more or less pain - we just process it differently. We can be very tolerate to some types of pain and extremely sensitive to others. We're typically more sensitive to temperature changes and specifically cold weather. For me, that contributes to Tala always wearing full jackets, completely closed. I understand Russia is cold (understatement) but Spencer and Ian are literally wearing shirtsleeves and Bryan. And it's common knowledge by now that Kai doesn't care about weather only fashion.

Another thing that I often think about is his time in the Abbey. In the anime, we see that he's experimented on. This has always stuck with me because redheads require more general and local anesthesia when under going procedures. Getting the right dosage is case by case and extremely important. Also, until the early 2000s when several studies came out, it was only an urban legend that redheads require more anesthesia. So it's understandable that any "doctors" Boris would hire might not be aware how carefully they should be treating Tala.

Where surgeries are concerned, obviously too little anesthesia means waking up in the middle of the surgery. Hello, trauma.

Too much and the side effects could be nausea/vomiting, hallucinations, respiratory distress, lingering mental and physical impairment, falling into a coma, brain injuries, and even death. Sounds like fun.

Local anesthesia takes a while to kick in an then burns off easily. Most redheads will avoid the dentist for this reason.

I think most of us HC the boys not being fond of hospitals and doctors, but I think Tala would have a different set of reasons that the others can't relate to. I often have to tell doctors my hair is natural because it alters the way their treatment.

However, redheads are more sensitive to pain killers, requiring a lower dosage than most others to dull the same level of pain. It's also been suggested that because the mutation causes a loss of function, redheads have a higher pain threshold.

That's basically the one that I ruminate the most over. Other things aren't dark.

Redheads and freckles typically go hand in hand, so I like the idea that Tala has a splattering of freckles across his shoulders that only the boys know about.

Redheads are capable of producing their own vitamin D which helps with bone growth and the immune system, so I HC that he doesn't get sick very often.

Redheads make up about 2% of the world's population, and red hair/blur eyes is the rarest combo, making up only about 17% of all the redheads, possibly less than a million in total. He's a rare boy! With how pale his eyes are, he'd get lots of stares and comments.

Anyway, the genetic variant that causes red hair is interesting. Of course, not all characteristics are the same for everyone but it would I think at least some would be true for our favorite redhead!

Another picture for fun:

[bookwyrminspiration]

TW// Drugs n such

you asked for it smh, but I've been thinking a lot about that one scene in Neverseen in Exilliums healing tent (or whatever its called)

I had a whole rant here about what the implication of this 'serum' might mean in the lost cities but it kinda spiraled into nothing so I'm cutting it out. (main point was just the mood towards drugs, Shannon has had previous mentions of both alcohol and drunk people, so (though im not saying she should incorporate this into a middle grade book series a t a l l), Id be curious to see her take on drugs, (if they exist and how they effect people and the elven population // how is it treated? Is it looked down upon or even forbidden (why we might only see it in Exillium territories) or is it so normal and inconsequential that its just part of the norm in the lost cities?

but anyway, back to the thing I was originally thinking of - i feel like this is something rarely talked about but pls tell me I'm not the only one who has picked up on how weird Keefe's relationship with sedatives is. It's such a contrast to Sophie, where she's openly opposed to taking any type of sedative he seems to be really open to them, in fact in Unlocked every time he's knocked out by a sedative his language is pretty much always positive, like he really enjoys it. This probably just ties into something you mentioned a while back about Keefe and dealing with stuff by running away but I find it really interesting.

(Sorry if this is an uncomfortable ask to get, I know not everyone is comfortable with drug talk and I hope this Isn't overstepping a line.)

you're fine, don't worry! no lines overstepped. I appreciate you including the warning at the top, even though I'm alright talking with the subject. if there's something I'm uncomfortable with, that's not on you to know or worry about because I haven't shared any of my specific triggers, and the more anxiety-inducing ones are so specific to my personal experiences that I highly doubt they'll ever have any effect on any conversation ever. but I do genuinely appreciate your concern <33

I don't remember specifically what I asked for, but this is a topic I hadn't even realized was so fascinating, so thank you for bringing it up! That scene is kinda funny (as in weird) looking back on it, but Keefe was completely out of it and being a lot more vulnerable than he probably wanted to be due to his state of mind. I think it was intended to mirror something like anesthesia or laughing gas (note: in my brief research trying to find info about the boobrie dude I made a mental comparison between tam and sandor, so I'm just making note of it here so I don't forget), at least as far as Keefe's reaction goes. I think part of this was strategic so that we could get some information and vulnerability (although unwillingly) from Keefe and get that first glimpse of "the boy beneath all that swagger" (paraphrased from Sophie). But that's not what your ask is about so I'll move on before I get even more distracted.

wine, at the very least, exists in the lost cities. we've got fizzleberry wine, which is blamed by some for Caprise Redek's accident. Aside from that we've seen no mention of it, as this is a middle grade series about a young teen girl in a fantasy world, and in a "perfect" world there isn't a lot of talk about recreational substances. And I agree with you! this isn't to say that I think drugs and alcohol should be this huge thing in keeper or that it even needs to be address, just commenting that the attitude the general public has towards substances and intoxication is likely even more severe in the elven world, as has been the pattern with other things. We can tell from Caprise's incident that their wine functions similar if not identical to ours, as it was said to have impaired her motor control and thinking, hence how she fell off that balcony. So I think we could assume that drugs in the Lost Cities would be similar to those in the Forbidden Cities in function. Not in name though, likely named after some strange elven thing. Though if we go with the wine example, Fizzleberry is likely an exact description of what it is--the wine probably fizzes and is made from berries.

the elves highly value the mind, so I anticipate that anything that messes with it past beneficial medicinal uses prescribed by a physician are frowned upon. they think of your mental capacity and capabilities as integral to who you are, and composure as essential. drugs take that away and can impair your reasoning, hence my conclusion they're not well liked. however, I propose that this mindset is mostly those who are very proper, for example Lord Cassius. Dex was more than ready to take concentration serums of his own making--and convinced Sophie to take one (note: dex has almost killed both Sophie and Fitz. that can't be fun to know)--which directly messed with his limbic center. However, as he was raised in an apothecary and is already a little less in line with all other elvin values, I don't think him being an outlier is enough to completely through out my assumption. overall: looked down upon because it messes with the mind and the mind is crucial to elven society, and the way it impairs your thinking would make you a lesser person

and you're right! keefe's relationship with sedative is weird. we have this teenager who grew up without stable supports or a loving family having very little regard for how substances will effect his body, prioritizing the possible--not guaranteed, possible--benefits over all the risks. this is not to say drug use is inherently bad, just that the situation he's in makes me very cautious because he feels more at risk of falling into bad habits. also, your observation about tying that into him running away is very astute! i've talked a lot about him running away from his problems in more ways that physical, and I think this is an excellent example of that

he doesn't like his reality, the world he lives in when he's awake and aware and lucid. it's full of all these problems and people and he doesn't know what to do. but when he's asleep? he doesn't have to deal with any of that. he doesn't have to do anything, but he's also troubled enough and anxious enough that sleep doesn't always come easy, and he can be plagued by nightmares. but those sedatives mess with his mind and not only make him sleep faster and longer, but they can mess with your dreams and alter the reality you experience while asleep. i guess it could be a way of trying to take control of a situation he had very little control over, especially in unlocked when everyone else was trying to fix things without consulting him. with his waking world that bad, of course he's gonna like anything that takes him away from it.

it stands out especially when we switch to him as a narrator and he's praising these things and wanting to be sedated, as we've spent so long in Sophie's head and she's so against them from the trauma she experienced in the first book. that could mean his attitude them is more jarring just because we're used to Sophie and it wouldn't seem as dramatic if we'd switched from say, Fitz's head. but that doesn't mean there's nothing here.

i think i've said it before, but Keefe doesn't have any healthy coping strategies right now that he consistently relies on. his deference towards avoidance and making the problem go away, even if it's just in feeling induced by drugs, is a more extreme example of how he doesn't know how to just exist without hurting.

I jumped around a bit between topics so if I missed something you wanted to talk about more in depth please feel free to send another ask! Keefe's relationship to experiencing reality is fascinating and covers things from denial and refusal to change all the way to drugs and literally altering the way his brain perceives reality. This boy is on a collision course with destruction in both body and mind.