#medical provider

[wikipediapictures]

Midwife

“Village Midwife Rachel Yusufu (holding the baby), Mnyiramba, and Ayah Brim Masasi, Msukuma, weighing an infant and giving advice to the mother during an infant welfare clinic session at Kishapu Native Authority Dispensary and Clinic in Shinyanga District, Lake Province.” - via Wikimedia Commons

[wearenotjustnumbers2]

Reminder that Palestinians in Gaza are being deliberately starved by Israel. Families in gaza are boiling plant leaves and eating them. They're also eating animals and birds food to stay alive. There are reported cases of kids and infants who died out of hunger and/ or cold. Starving people is part of genocide too. Remember how fast medicine was provided for the Israeli hostages, while Palestinians are starving for food and water and getting operations and amputations performed with no medication or anesthesia whatsoever.

[avarkriss]

listen. listen to me so carefully right now. (if you're in the eclipse path/planning on viewing). please don't stare directly at the sun tomorrow. i am begging you - do not stare at it. if you got eclipse glasses off of amazon/other, please put them on in your house and make sure you can't see anything; if you can still see like regular sun glasses, they are not safe for eclipse viewing, you will burn your retinas, and we cannot fix that. eclipse glasses should be iso/ce certified, and aas (american astronomical society) approved. please make smart choices and protect your eyes. please.

[inkskinned]

no, but really, we need to talk about the casual objectification that has become the fallback discourse of the internet: if you're pretty and dressed nicely, you're a slut. and if you're even vaguely outside of their body standard, you're fucking disgusting.

too-frequently, people position sex workers as being "the problem". they sneer you're addicted to pornography, you don't know what a real woman looks like. but real women are in pornography. the real bodies on display are not the issue here: the issue is that other people feel extremely confident when commenting on someone's physique.

2000's super-thin is slowly worming its way back into the public ideal. recently i saw someone get told to "go for a run", despite the fact she was on the thinner side of average. not that it would ever be appropriate to say that: but it's kind of like sticker shock when you see it. people think that is fat? holy shit. do they just have no idea about things?

but what are you going to do about it? that's the problem, right. because chances are - you're a normal person. we can say normalize carrying fat on your body, but we are not the billion-dollar diet industry. we are not the billion-dollar fashion industry. we are just, like. people. who are trying to make content on the internet, without being treated shittily.

as someone who has been on both sides of things: you are treated better when you are thin and pretty. this is statistically correct. i am not saying that you cannot be bullied for being thin; i'm saying there are objective institutional biases against certain bodytypes. there are videos of men and women who lost weight all saying: i now know for a fact exactly how much worse you're treated. in the comments, some asshole inevitably says something akin to you deserved to be dehumanized when you were fat.

which means that ... the easiest thing to do is be pretty and thin. it is the path of least resistance, because of course it is, because any time you post a picture of yourself without a thigh gap, someone immediately comments something like you need to try a diet.

the other half is also dehumanizing though, huh, just in a different way. when i put on makeup and nice clothes, i am told i slept my way to the top as a professional. do you know how many women in STEM have told me they purposefully dress to "unimpress" because they already struggle to be taken seriously and if they're ever considered pretty - it for some reason takes away from their authority.

so they make it seem like it's your fault. you, existing in a body - it's your fault! if you didn't want shitty comments, don't have a body. they position us against each other like chess pieces; vying for male attention we don't even need.

and i can be an authority on this unless you think i'm fat and unattractive. when i am pretty and thin, i'm an activist. when i am just a normal person who makes a good point: i am immediately dismissed. nobody fucking believes you if you're not seen as attractive. you literally lose value. you cease to exist.

but the whole time, it feels like - is anyone actually grounded the fuck in reality? the line of "pretty and thin" keeps shifting. nobody seems to understand what "a normal weight" even looks like, because it's not something that exists - you cannot tell a person's health by looking at their body. even if you think you could tell that, even if you're sure a person is dangerously overweight - people are not your dolls. they do not need to be dressed up or displayed properly to soothe your aesthetics. you aren't concerned for them, you're stealing their agency. you don't get to say if they're "allowed" to take pictures and post them on the internet - you don't get to tell them how to exist.

people hide behind "the obesity epidemic" without any actual qualifications. they crow things about "normalizing unhealthiness".

but it's bullshit. i have visible abs. there is a pair of parallel lines on my body, even when i'm relaxed; where my obliques meet my abdominal wall. i am proud of this because it means i'm strong, because i overcame an eating disorder only to be ripped as fuck. it is genetic and physical luck that i even get any definition, i'm pleased as punch.

but it does mean that my abdominal wall sticks out a little bit. the other day i posted a video of myself dancing, and, for a moment, my shirt slipped. you could see a little bit of my stomach. i was cartwheeling to the floor. moments before this, i'd had my foot over my head.

a guy slid into my DMs. a row of vomiting emojis prefaced: you should really lose some weight before you think about dancing.

i stared at it for a long time. there was a time when i would have been triggered by this, where it would have encouraged me to starve myself. i would have ignored the fact i'm flexible, agile, good at jumping: i would have lost the weight for a stranger's passing comment. i would have found myself and my body fucking disgusting.

and for what? to please what? because why? so that he can exist in this world without an unchallenged eyeball? what would my self-hatred even accomplish? usually i write paragraphs. obviously. on this particular occasion, in this body i've been at war with for ages: i just felt exhausted.

it shouldn't be even worth saying. it shouldn't be hard to explain. all of this emotional turmoil when he cannot even comprehend the most basic truth: i am not an object on display for him.

[thebibliosphere]

Yesterday was my first time in the ER since my hEDS diagnosis was officially added to my file (instead of me having to tell them and hoping they’d believe me), and everyone in my emergency care team was on top of it. Like on the ball, fully engaged and interested in keeping the zebra in the hospital comfortable.

They also all knew what MCAS and POTS were and deferred to me when it came to medication and pain management. Which was also wild, because they were not shy at all about offering pain relief. They straight up offered me narcotics, when usually the most I get offered is Tylenol.

Even the CT tech knew what MCAS was and asked if we should pre-treat with Benadryl because he knew some patients could experience mast cell destabilization from the radiation even without the contrast dye.

He and the nurse even helped brace my neck when I was going into the CT machine because I mentioned having cranial instability, and the position I was in was making my neck click, so they stopped everything to find multiple pillows to brace my neck and shoulders while I was on the table.

Afterward, while being bussed through the corridors in my bed (because they had to dehydrate me to take the CT scan and my POTS was going haywire, and they made sure I had to be upright as little as possible), I commented to my nurse that I was startled that everyone I’d spoken to that day knew about EDS/MCAS/POTS and were so accommodating.

He paused before answering, then told me, “We probably don’t know as much about EDS as we should, but we’ve seen a lot of the other two over the last few years. Covid really messed people up. Did yours start with covid?” No, I told him. We think I was probably born with it and a dental infection turned it lethal. He expressed his sympathy and again reminded me I didn’t need to be a hero and I could press the pain med button whenever I needed to.

Back in my room, they started me on IV fluids to combat the dehydration from the POTS. And I was laying there, I became aware of the nurse bracing my elbow so it wouldn’t hyperextend while he futzed around with the IV and I remember thinking, “this is how it always should have been.”

The kindness and care shown to me were in such stark contrast to past experiences it made me quite tearful. There were no accusations of anxiety, no referrals to psyche, and no implications that I was over-exaggerating my pain. No denying of my experiences.

Just a quiet, vocal acceptance that I “knew my body best” and that they’d do whatever they could to help.

It was nice.

[luna-lovegreat]

I love how warriors is the one who always asks paramedic-style questions when someone’s hurt

He’s asking questions not just to distract, but to see how bad the wound has impacted mental functioning “maybe we should be worried, because that’s not what I asked”

Calling by name to draw attention, asking easy questions…

Like look at his face in each panel, how closely he’s watching while talking to assess the damage

He’s always the one taking action in first aid (though obviously he can’t do magic stuff like hyrule but outside of that it’s him)

Wars is a captain, he’s trained and has had to take care of wounded, so he knows how to take care of not only the physical but the mental impact of injuries as well, and he always comes through for it.

I just kinda think that’s pretty cool

(Credit to Linkeduniverse au)

[reebmiester]

falling grayson

[biggest-gaudiest-patronuses]

This election day, I'm thinking of my Nana.

I'm thinking of how as a young woman, she fled political violence in her native Colombia to build a new home in a more stable country. I'm thinking about how she lived a long life, but not long enough to see her home country elect its first ever progressive president (just a few months ago!).

Coincidentally, I was living in Colombia at that time (in the very city she grew up in), and I was able to witness what felt like a miracle. A very conservative country, suffering from the violent inheritance of colonization and catholic invasion and the war on drugs, against a backdrop of the dangerous global rise of the far right--this unlikely country managed to elect one of the most progressive heads of state in the world, in 2022. That's a pretty big deal.

And I'm thinking about this, this election day, because that election was won by a very thin margin. I'm thinking about how it almost didn't happen. I'm thinking about how it was only possible thanks to the highest voter turnout in 20 year. And I am thinking about the countless number of voters who chose to vote for the first time. I am thinking of the poorest and most disenfranchised citizens who showed up at the polls. I am thinking of the indigenous women who rode 12 hours on public buses to vote at the 'nearest' polling stations. I am thinking of all the money and corruption that went into preventing minority citizens from voting, and I'm thinking about how they showed up in the millions and voted anyway.

I am thinking that I would like to see a miracle like that in my own home country.

So if you're on the fence about waiting in line today to cast your vote, I hope that you will think--about the country you want to live in, the future you hope will unfold, and about all of the people it takes to make a miracle.

Because history may deem us nameless and faceless, but when we show up en masse, we are the ones who make history happen.

And yes, maybe also spare a thought for my Nana. Who was in fact a very angry and judgemental woman who supported the republican party for 50+ years, and who would be turning in her grave right now (if the family hadn't had her cremated). Think about the mean angry ghost of my Colombian grandmother, who very much wants you to not show up at the polls to support abortion and other sinful progressive values. Think about her. Do it for her. Do it for Nana.

[meatballsander]

Decided to get silly and draw the inverse of the iconic "Victory Soldier" poster. And make it Heavymedic, of course.

Inspiration, progress pics, and alt versions under the cut

This poster! Always been a fan.

Initially I was gonna keep the same setting & color scheme, but the original poster distinctly has the top two thirds warm tones/bottom third cool tones. If I wanted to keep the piece cohesive it'd have to be RED Heavymedic vs BLU Soldier. And the more I thought about that the less it felt explicitly like Heavymedic fanart and more like propaganda for the RED team.

So I set it on Snowycoast! Its sky box and layout let me have cool top thirds/warm bottom third. Also it's one of the most beautiful maps in the game and I love drawing night scenes. Literally no downsides.

Progress pics!

Textless version, and an alt text version I made at the request of a friend:

And finally, since you've reached the bottom, some memes I made while working on it.

:)

[acepalindrome]

If you say that healthcare and shelter and food and clean water are human rights, that everyone deserves to be treated with a baseline of decency and respect, you have to accept that includes people you dislike, people you hate, even people you find morally reprehensible. And that’s good! Human rights are not conditional on how likable or good a person is! Everyone is entitled to them, no matter what! You don’t get to cherry pick who deserves to be treated like a human being!

[skunkes]

i may be stupid

[whump-queen]

emergency medical care but it’s a bunch of captive vampires being brought in to clean up the blood and heal the skin of the wounded with their tongues.

[ms-demeanor]

reeeeeeealllly looking forward to being done with this 'wellness for life' class.

[skyloftian-nutcase]

Provider Discretion (LU in Healthcare)

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

Something wasn’t right.

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

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

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

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

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

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

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

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

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

There was a discrepancy.

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

They still didn’t match.

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

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

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

When Hyrule texted Warriors later, he got his answer.

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

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

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

XXX

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

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

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

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

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

Who the hell thought this could be his sugar??

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

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

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

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

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

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

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

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

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

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

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

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

“OF FUCKING COURSE I WAS!”

XXX

Legend wasn’t particularly a fan of working triage.

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

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

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

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

Farmers never came to the hospital.

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

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

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

The man had a pulmonary embolism.

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

XXX

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

Today he was glad he did.

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

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

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

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

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

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

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

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

XXX

Four… didn’t like this.

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

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

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

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

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

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

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

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

“Yes.”

“Just go up on that.”

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

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

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

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

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

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

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

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

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

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

They should have listened to him.

[opens-up-4-nobody]

Thr thing abt me is that I want to know exactly how psychiatric medications work. I don't want the simplified version. Dont give me the "I'm talking to the public" answers. I want the specific mechanisms and how exactly it causes its side effects.