#neurology is a weird rotation

[emgoesmed]

12/3/2022

I found @that-premed-student mini 10 day study challenge which seems like a good way to keep myself motivated while I'm studying for my neurology exam next Friday.

Today's to-do list:

anki

uworld 40q

neurology quiz 1

complete required patient encounters (8)

fold laundry + pack suitcase

groceries

[vermilionvector]

Overmind TC

OM's passive, Biochemistry, gives him x1.2 permanent Active and Special Active CDA. This is quite a huge boost to his kit. If you manage to reach 35% CDR, and let's say we use Cure, which in itself also has a Haste trait, its net CD will be:

22 x 0.8 (Passive) x 0.8 (Trait) x 0.65 (CDR) = 9.152 seconds.

Also, with how much MP it restores (55% flat with 3 DMP and +8% at 0 CP; 175% in total if 6m CP), the more max MP you have, the better this skill is. For example, you have 525 MP (400 base + 100 from Eroding Energy and 25 from pet) and 10% MP cost reduction from lv. 90 passive, Neurology:

MP cost: 300 x 0.9 = 270 MP

Healing (base): 63% x 525 = 330.75 MP

Net healing (base): 330.75 - 270 = 60.75 MP

And practically, you'll get 55% x 525 = 288.75 MP back right away, so it's like a free healing skill. Now if we cap MP cost reduction and with 6m CP:

MP cost: 300 x 0.9 x 0.65 = 175.5 MP

Healing (max): 175% x 525 = 918.75 MP

Net healing (max): 918.75 - 175.5 = 743.25 MP

As you can see, the healing potential dethrones Blume Rein which is only a few percentage short (165%). Its downside is the skill animation itself, however. Taking 3 seconds just to heal (and it might even miss the target for god's sake), is too long. I think instead of having the drone dropping the buff, make it follows us (like Dom's Shooting Chaser) and constantly applies the buff, and in return, remove its damage entirely, since its healing is powerful enough to justify it not doing any damage.

Unlike Nyx's Moon's Origin which has a duration of 6 seconds, this skill lasts for 10 seconds. Even though it doesn't have a stack effect, it already has a 100% uptime.

Next is his Master Skill, Genetic Recombination Stage 4 which has an effect of stopping the Database from depleting your DP. The buff has a duration of 20 seconds. With max M. Skill CDR, the net cooldown will be 31.85 seconds, resulting in a 11.85-second downtime.

His first HA, Mass Examination, is weird. There are 4 condition checks before deciding on the result. Basically if you have less than 60% crit/max and 10% P/M def ignore, you won't get as much benefit from this buff. Crit/max are easy to get, but for def ignore, you will need to wear Agate at the very least, then you can wear SotC or BnW + Wind Aura Ornament and make CL/Nyx for ESP collection, but for the latter you will still need 0.3% so unless you wear an IB that gives def ignore (such as HoD) you'll need socketing.

His second HA, Trolley Dilemma, is more straightforward, but it works for only 1 person. I don't think it's going to be changed to party-wide effect since it'd go against the skill's concept, and the effect is already good, especially in a solo-DPS party, but to make it worth using more, how about sharing only 50% of this buff to others? The members who weren't selected will get CDA x 1.25 and MP cost reduction 10%.

However, both HA buffs only last for 30 seconds. Even with Concentrated El's Essence, you'll have a 90 second downtime. Compared to similar buffs that could be done by DeM 24/7, it's really underwhelming. HA buff should last at least 60 seconds (similar to MT, EW and TP. CL's is only 40 second but it buffs skills that can last pretty long, so effective duration is longer than that.)

With how some of his buffs are locked behind HA and Master Skill, he'll still need Nyx to reach his full potential. But this also goes back to the problem. Nyx is currently the only reliable physical buffer in the game, and OM is supposed to alleviate his requirement. But his kit alone already demands that Nyx be with him.

Other reason he can't replace Nyx is because he doesn't have a built-in SoT. I believe this will be saved for either Chung or Ain's 4th path. Since there seems to be only 2 SoT users on the Mag side (MP & DeM), so if Elesis/Noah's 4th path doesn't get more SoT, Chung or Ain will definitely get one.

Anyway, I think his build and rotation are probably like this:

Normal slots:

Stimpack (Atk buff)

Detox (Skill dmg buff)

PCA (Dmg red)

Anesthesia (freeze) or Defibrillator if you have another freezer (Trans slot if Defi)

False Diagnosis (Atk red)

Immunity (Debuff cleanse)

Examination (Res down) or Radio Knife if you have another source of res down

Mental Hygiene (a.k.a. Iron Body) or Venipuncture if you have another source of SA

Cure (Trans slot if low CDR)

Code Yellow (Trans slot for more damage; if they fix the bug ofc)

HA: Trolley Dilemma

Master Skill: Genetic Recombination (Stage 4)

Opening: Awaken > Genetic Recombination (Stage 4) > V > Cure > Detox > Stimpack > Trolley Dilemma (buff to HDPS) > Stimpack > Cure > Detox > PCA/Immunity > Stimpack > Detox > etc. Basically you need to keep Stimpack and Detox active. Practically, you'll need to time Trolley Dilemma with DPS window (e.g. when Annihilator is doing laser in 15-6-3), so you'll have to train a little to know the timing.

[doctor-loboto]

just a little fic I wrote based on Loboto going to pick his kid up at the end of Psychonauts 2, I’ll probably post it on ao3 later (CW: what could be described as parental neglect, references to mental health struggles and therapy, step-parents)

“I’m sorry I was late picking you up, but in my defense, I was a little held up by being kidnapped by the goddanged psychonauts!” A dilapidated hot pink car drove along the country road, two plush molar danglers bobbing from the rear view mirror. It was patched with odd pieces of sheet metal and the back windows were covered in stickers. Caligosto Loboto placed a ceramic thermos labeled WORLD’S #1 BEST DADTIST (DENTIST DAD) back in the cup holder. “Anyway, it’s good to have a little uncertainty in your shelter situation! Roasting berries and trapping fish! It prepares you for when you’re an adult and you have to live in an abandoned shark taxidermy factory because no one will rent a studio space to a neurological marine dentist who ‘doesn’t have the appropriate paperwork’!”

“Except that’s not going to happen to me because I’m not crazy like you. I’m normal, like Mom. We’ve been through this.” Bobby was lounging in the back seat in a way that was probably a car safety hazard, the large shopping tote he used as a suitcase already having toppled upside down onto the carpet. “And yeah, the psychonauts freaking arrested you because you stole everybody’s brains! God, you’re so embarrassing! I hoped they would never meet you because you’re so freaking weird and now- now they met you and you basically kidnapped them and did brain surgery on them! What the fuck?”

Loboto gripped the steering wheel a little tighter. “Okay, I’m gonna give you a freebie on that one, but still, you only get two more F bombs this week.  And I’m going to try to ignore how absolutely mean you’re being to me, when I’m also a victim here! I was hypnotized! Experimented on! Rotated in the air like a deli chicken! Because I realize that… I did a not great thing, a bad thing even, and I knew when I was thinking about taking your brain that it was probably a bad idea and I should just say I did it but not actually do it.” He sighed and looked at his son through the mirror, and their bicolor eyes met. “I’m really sorry, Bobby. I know I’ve done a lot of things that made life hard for you.  But I’m going to start working on myself. They said I could go to therapy at the Motherlobe, and Sasha and Milla have already helped me out a lot! Do you think we can work things out?”

Bobby put his bare feet on the window glass and looked up at the ceiling upholstery. The fabric was beginning to decay and there were little beads of foam on the surface. “I don’t know. I mean, I guess you’re my only dad.”

Caligosto shrugged. “I’ll take that for now!” Just then, his eye caught a figure ahead along the road side. As they pulled closer, he saw that it was a small man in ragged clothing, walking with his thumb outstretched. He was covered in soot and looked exhausted. “Oh look, it’s your stepfather!”

“Wait, what?”

Cal beeped the horn as he slowed down. making the man startle dramatically and turn to face them. His face was bruised, with a dry split cracked open across his prominent lower lip. “Crispin! Get in the car, we’re going home!”

Crispin blinked a few times. “Doctor?”

“Yes, it’s me, Doctor Loboto! Now get in the car!”

The passenger door opened and Crispin slid into the seat, carrying with him the smell of unwashed hair and ash.

“Crispin, you need to take a shower. Also, this is my son, Bobby.” He gestured toward the back seat. “Bobby, this is my boyfriend and second in command, Crispin. Good! Everyone knows each other now!”

Crispin turned his upper body and squinted into the back seat. “Er, hello. I’ve heard… about you. Good things, to be clear.”

Bobby rolled his eyes. “Whatever. My mom has boyfriends too. Just don’t be a dick and don’t try to brush my hair.”

“Look at this! Me and my two favorite guys, talking in the car on a road trip!” Loboto said. “Ooh! We should go to that diner with the prehistoric animals!”

[mj-md]

Resident Confessions

Last year when I had my end of year evaluation with my PD, I had to make goals for the upcoming academic year. I decided one of my goals was to become more comfortable with procedures. As an intern I had a fair number of LPs presented to me, but never any successful ones, and so I wanted to get more comfortable doing LPs so I could properly senior my interns for their own procedures.

Procedures are generally pretty difficult to come by in my hospital. LPs are dime a dozen, reserved for high risk febrile neonates or weird neurology cases. They’re pretty much the only procedure we do when we’re on the inpatient side.

And so, when I was rotating in the ED last month and an opportunity presented itself to do an LP on a wee babe, I jumped at the chance... and then, I didn’t get it.

So, I’m a second year pediatric resident that’s never had a successful LP. Which just feels so embarrassing to me and also disheartening because how in the world am I supposed to be a Hospitalist if I’ve never even been able to do an LP correctly?

Thinking about my lack of success and general lack of procedures made me think of all the other embarrassing things I should know as a resident but really don’t. Like, I still barely know the difference between bands and segs 🤷🏽‍♀️

Anyway, anyone else have any other things they should definitely know how to do but just don’t? (And at this point it’s just kind of embarrassing to ask.)

[itsbenedict]

Two-Faced Jewel: Session 7

A half-elf conwoman (and the moth tasked with keeping her out of trouble) travel the Jewel in search of, uh, whatever a fashionable accessory is pointing them at. [Campaign log]

Last time, Saelhen and Looseleaf continued their scouring of the evil torture wizard's evil torture tower for clues as to the identity of the murderer terrorizing the towns of Barley and Wheat. They found a bunch of mysterious documents of ominous character, but they've yet to check out the tower's hidden basement- and the ne'er-do-well lurking within...

The basement doesn't immediately contain any horrors, unless you're the type to get the jibblies from a messy room. There's dirty dishes (recently used), empty beer bottles from a Zeishus Brewery, and discarded clothes everywhere. It's very lived-in, and whoever lives-in here doesn't seem like they were expecting visitors.

Saelhen takes a look at the desk nearest the stairs, next to a well-used recliner and a recently-extinguished candle. She gets a nat 20 on her Investigation, and finds that the desk has been rotated to face the wall, concealing a drawer that doesn't look like it's been opened in some time, judging by the cobwebs.

What's inside is mainly more of the sort of thing they found on the sixth floor- technical notes on neurology and pain magic. With the critical success, she's able to piece together that the odd numbers on the abrasive letter found upstairs were some sort of pain measurements the letter-writer was providing to Lumiere.

They also find a less academic, more personal note, expressing frustration with his own research.

"Why would the Burnscreamer's rituals require Abyssal? Even a god like him shouldn't have any connection to the demons- what is he playing at?" "If I could just correct the sigil, I could bypass so much of this nonsense..."

Saelhen then gets a nat 1 on her Religion roll to know what that means, and assumes the Burnscreamer is the frontman for a metal band her dad likes.

As they search the rest of the room, they notice- at the bottom of the central shaft- a circular basin in the stone floor. It's stained red, but it's dry- not as much blood as you'd expect to see given the carnage on the sixth floor, so it seems like it's been recently emptied or cleaned out.

Oyobi, meanwhile, checks the locked door by the stairs, and finds it... cold? I wonder what that means vis-a-vis-

The extremely sneaky +9 Stealth person hiding braced against the walls of the central shaft fucks up right about then, and slips a little, letting out an involuntary "Gh- shit!", alerting the party to his presence.

Saelhen tries to chase after this person by parkouring off those same walls, gets a 9, and faceplants in the blood basin, leaving the issue to the party member who has wings. As the hider flees through one of the doors in the shaft, Looseleaf uses her darkvision and 24 Investigation roll to pick out the right door and give chase.

(Meanwhile, the rest of the party heads up the stairs normally- and Saelhen orders Orluthe to bust down the front door, so they can go outside and catch anyone trying to escape by rappelling down the side of the building. This turns out to be unnecessary, because when Looseleaf detected that the front door was magic and assumed it was a trap, this was incorrect.)

Benedict I. (GM): ("who knows what kind of trap could be on this magic door? better go up and through the window into the room full of traps, instead") (i was laughing so hard) (it's just an automatic door!) Looseleaf: Honestly, the people in town oversold this place. They made it sound like such a deathtrap and really it was just a bunch of spiky bots. And knives. And comfy pillows. Benedict I. (GM): Well, when they were there, there was a living evil torture wizard actively trying to take them prisoner and torture them.

Looseleaf botches her Investigation roll to search the torture lab she emerges in, but... that doesn't stop her from just checking each and every possible hiding place one by one, manually. She alights upon the correct solution swiftly- checking inside the broken remains of the iron maiden.

bBenedict I. (GM): Anyway, Looseleaf, inside the corpse of the iron maiden, you find. A rather heavy man, performing a downright heroic feat of contortionism to suspend himself inside the door without getting impaled on the spikes. Arnie: "Uh." "Can you pretend you never saw me?" Looseleaf: "That depends on what you're doing here, I guess. Who are you and what are you doing here?" Saelhen du Fishercrown: oh that is a nervous man Arnie: "No one. Nothing. I'm, uh, supposed to be like, dead, probably." "So I'm not here." "Yeah?"

Arnie Zeishus is the deadbeat husband of Cassie, the innkeeper from Barley, who fled town a while back. He explains that after fleeing his responsibilities in Barley, he tried to set up shop in Wheat running a brewery, but got in trouble flouting the brewing regulations of the Ecumene of Harmony. So after getting arrested there and breaking out of prison, he decided to sneak into the torture wizard's tower and lay low as a squatter in the guy's basement. He figured he might get caught and tortured, but it couldn't be worse than what the townspeople wanted to do to him.

Except, as luck would have it, the torture wizard was already dead when he arrived! So he's been making a home of the place with Lumiere's old animated housekeepers, using the torture wizard's fearsome reputation as a way to keep anyone from tracking him down and making him do stuff like clean up a distillery explosion or pay child support or what have you.

On the other hand, someone has been sneaking around his tower doing something sinister on the sixth floor that results in blood pouring down into the basin periodically, and he's stressed out of his mind wondering who the hell is doing that and how he's supposed to avoid getting caught and/or killed by them.

(He notes that the "KEEP SHOUTING" sign was his attempt to get intruders to at least give themselves away by making noise, after they were clearly ignoring the "KEEP OUT" sign he put up.)

Looseleaf also takes the time to ask if Arnie here knows anything about someone named Choss.

Arnie: He looks surprised. "You know Choss?" Looseleaf: "Let's say that Choss is a figure of importance in this investigation." "Anything you could tell us about how they arrived in town and what they did in town would be appreciated." Arnie: He shrugs. "Choss was there before I was- she's a real weirdo." "Knows how to party, but- gotta say, her stuff's a little too strong for me." "A crazy high at first, but it gets- whoof, intense." Looseleaf: "She's an apothecary of some kind?" Arnie: He laughs. "You could say that. She's got herself a little drug lab in town, always smells like burning. Don't know how she gets away with it- some of that stuff's gotta be illegal." Saelhen du Fishercrown: "And how old is she, approximately?" Arnie: "Eh? She's- hard to tell with lizardfolk, s'not like you can read the wrinkles..." Looseleaf: Ah, of course. Lizardfolk. Saelhen du Fishercrown: yep Arnie: "Seems youngish, though? Party girl through and through." "Just, uh, if she offers you a blend, don't take it unless you're ready to spend the next hour feelin' like fire ants are chewin' their way out of your skin." He shudders a little. Looseleaf: "Hm. Sounds painful." Arnie: "You have no idea," he laughs.

They also inquire about the locked freezer room- and why Arnie would hide out here, in dangerous torture tower, rather than just running off to a city, which is a little weird that he didn't do. Arnie claims there's just groceries in there, and no stolen wine bottles whatsoever, he certainly isn't a thief and he definitely hasn't been lying low out here because if he goes to a city some old pals from Thunderbrush might find him and want him dead, no sir! He would never ever commit a crime, ["wink wink" in hand-signed Thieves' Cant].

Saelhen du Fishercrown: "Of course. I can't imagine we have any thieves here." [Nudge nudge.] Looseleaf: "In the meantime, Mr. Zeishus, you mentioned having done something that.. makes going anywhere where you might meet someone from Thunderbrush a dangerous thing?" Arnie: He fidgets. "Uh, well..." "I, I try to leave all that behind me." "You just... don't want to get involved with the ghost dryad mafia. Just a tip."

He drops a little bit of exposition about something that may be coming up- apparently, Thunderbrush used to have these huge skyscraper-sized trees, but they got chopped down in some sort of war or raid a while back, and now the Stumps are ruled by the necromancer ghost dryads of those trees who used the last vestiges of their power to cheat death. Apparently Arnie was strongarmed into doing crimes for various ghost dryad mafiosos and made too many enemies, so he fled to Barley to shake the heat.

Looseleaf also comes to a realization regarding some hints dropped earlier in the townsfolks' tragic backstories:

Looseleaf: (actually, wait, i just realized: choss is probably chitch's daughter, the timelines there line up perfectly and maybe this whole dragonborn business is a total red herring we invented for ourselves) (what the shit, lumiere, you kidnap a guy's daughter and raise them as your own child? that's fucked.)

Looseleaf occupies this Arnie guy by interrogating him about these things, while Saelhen slips downstairs to try to pick the lock to the freezer room.

Eventually, after a bunch of failed rolls and more small talk from Looseleaf to keep Arnie occupied, Saelhen pops open the lock. Inside, she finds a fairly large and frigid room. There are meathooks hanging from the ceiling, empty. There are shelves lining the edges full of frozen food.

And to her right, there's another door- this one out of place with the rest of the construction, made of a strange stone shot through with rivulets of glowing orange. There's a symbol on a stone circle embedded in the door:

Before she checks that out, though, she checks the darkened back of the room- which contains some tubs filled with ice.

And those tubs have corpses in them, with the four-pointed wounds.

It is not especially likely that Arnie had no idea these were here, in a room he claims to use to store groceries and has the key to.

Looseleaf, meanwhile, attempts to read Arnie's spirit to determine his alignment and general intentions. His Deception beats her Insight, but what she does manage to get is...

Arnie is afraid. He is filled to bursting with terror and desperation more intense than you've ever felt from anyone before. And the fear does not seem directed at you.

Meanwhile, Saelhen tries to get that door open. What's the deal with that thing, huh? There's no handle, so... she has the bright idea of slapping her mysterious god icon bracer (the one that when previously slapped against a magic thing opened a pit to infinite bats) against it, see what happens. And I get very excited, because ohohoho, I didn't expect that, I had to think through the ramifications of doing that, and...

...then I work through those ramifications, and what I realize is that, as far as the players would know, the end result is just that the door slides open, and nothing else of note occurs.

Saelhen du Fishercrown: "Why am I even here I just wanted to help a nice little girl show up her dipshit inquisitor mom now I'm in a pain room investigating pain machines..." Looseleaf: (looseleaf warned you about getting involved in the case, she warned you dog)

There's also a bunch of weird machines, and more of Lumiere's notes, which Saelhen goes and nabs as many of as she can. Then she beats feet immediately, not wanting to spend any longer than necessary in the hell lab. The problem is, she doesn't want to leave any sign she was in there, so...

Saelhen du Fishercrown: Does tapping the exposed bit of stone with the bracer again close the secret hell door? Benedict I. (GM): Nope. Saelhen du Fishercrown: hmm. poking it with her finger? Benedict I. (GM): Ouch. Nope. Saelhen du Fishercrown: physically pulling the stone upwards while muttering "fuck fuck fuck ow ow ow"? Benedict I. (GM): Oh, hm, yeah, that would work. At first there's no effect, but as you continue to pull and the pain gets worse and worse... Roll me a Constitution save. Saelhen du Fishercrown: 16 CONSTITUTION SAVE (3) Benedict I. (GM): That'll do it! Your pain feeds the door, and, satisfied, the mouth closes. Looseleaf: How extremely concerning!

Cool!

So Saelhen goes back upstairs, the party secretly confers and exchanges information, and... something has to be done about Arnie.

His expression changes, suddenly.

Arnie: "You don't know what you're talking about." "This doesn't have to happen."

Looseleaf continues to try to offer help to this guy, inferring that he's being forced to do someone else's dirty work. She rolls a 20 on Persuasion! So... what happens following them cornering and exposing the culprit is not the rolling of initiative. Still, though...

Arnie: Arnie... backs up a step. "You're morons." "You have no idea." "You're talking like you can help me?" "That's impossible. No one can help me." "I- I'm fucking cursed, dammit!" Looseleaf: is he? i have magic sense, he is clearly not actually magically cursed, right Arnie: "What are you clowns going to do about it? Nothing!" "What are you going to do, kill a dragon?" Saelhen du Fishercrown: "You are entangled here. If Looseleaf says so, then I trust her intuition and her investigative prowess. This doesn't necessarily mean you're entangled in such a way that there is no way out for you." Saelhen shrugs. "Theoretically, the device on my arm is responsible for drowning a small city in vampiric monsters from beyond the stars. And yet there was a way out of that, and a genuine silver lining into the bargain." "I want you to understand that I am absolutely sincere when I say: There is always a way out." Arnie: "That's- there's no way! There's only one way out!" "He'll free me from the curse if I do what he says, and that's the only way!" Looseleaf: ...That is not how dragon-curses work at all. Benedict I. (GM): Not as far as you're aware, no. Doesn't seem like anyone's told Arnie.

They continue to try to convince him that there's hope, that he doesn't need to do what the dragon says, that they can help him. And Arnie just keeps pushing back, refusing to acknowledge any of it, weeping and shouting and doing whatever he can to avoid believing that he didn't have to do any of that, that there was any other way- because if there was, he'd be a monster, right?

Meanwhile, Vayen... is standing a ways away and staring at them all, as usual... but this time, he's smiling. No one here has ever seen Vayen smile before. He looks like his birthday came early. And as they're on the verge of a breakthrough...

Arnie: "Fucking- you don't think I know that?" "I know that! I know he's manipulating me!" "But what else do I do?" Vayen: "You could kill yourself," Vayen suggests. Looseleaf: "Vayen what the FUCK?" Arnie: "What the fuck- shut up, asshole!" "I'm not dying! Not here, not nowhere!" Saelhen du Fishercrown: "...Vayen, you are placing a remarkable number of ticks in the 'leave you at the side of the road' column." Vayen: Vayen shrugs. "It's the most reliable way to neutralize a dragon's curse." "It's the sensible thing to do, if you don't want to cause collateral damage."

It's as though he deliberately picked the one thing to say to ensure that this argument would keep happening, and not reach a friendly resolution. The hell is his problem?

Still, the party keeps trying to talk this guy down.

Saelhen du Fishercrown: "And -- Arnie, surely you don't think the dragon would hunt you down? Dragons don't go out of their way to punish us; they just use us to accomplish whatever it is they're planning. He'll make it someone else's problem." "I know the type. Arnie, it wouldn't care enough to hunt you down. What seems like a personal connection, like it caring about you -- if it tries that at all -- it's just an implement. It's a way of getting you to do what it wants. Go to ground effectively, and it won't bother to spare the effort." Arnie: "What are you, talking like some kinda dragonologist? The hell do you know about dragons?" Saelhen du Fishercrown: "...I am not a dragonologist, no," admits Saelhen. Looseleaf: "...Are you a dragonologist?" Arnie: "Of course it could hunt me down! Damn thing's got magic items out the ass and it flies faster than I can run!" "As soon as it saw me going somewhere it didn't tell me to, I'd get turned into a midnight snack!" "And then I go to ground, and the curse kicks in, and I end up dead or worse anyway. Sounds great." "Or, I stay here, gut a few self-righteous fucks who treated me like dirt for a while, and maybe the thing keeps its end of the bargain and lets me go!"

Yeah, that's a confession, and like, not one that makes him look great. Still, given this guy's weirdly high rolls on physical stuff, and his apparent aptitude for murdering people, they're not super sure they want to fight this guy- on top of just, not exactly wanting to fight this guy.

What are they going to do? They have to come up with a plan- and their plan has to take less than three weeks to pull off, since Arnie only has six corpses left in the bathtubs, and the dragon wants two corpses a week to prove he's still doing the job.

(And is it even worth going to all that trouble just to protect this guy from the consequences of his actions?)

Next time: a plan is hatched, and the party gets back on the road.

[goldkirk]

Some thoughts about Tim and Damian and neglect and failure to thrive

Can I make you. really sad for a hot sec about Tim and Damian with neuroscience and something that Jason hinted at in Blackbird and Latchkey but I didn’t go into

so when kids are deprived of touch and loving interaction?? it’s really fucking bad????? like not just in a bad-for-psychology way

everyone can get touch starved and it SUCKS but when young kids are deprived of ENOUGH loving touch—even if they’re getting SOME physical contact—it not only stunts their healthy psychological development but their physical and neural development as well

and you end up with mild to severe cases of failure to thrive essentially, where a kid is undersized no matter how much you feed them through a feeding tube if it gets desperate, and they struggle to hit milestones, and things like the neural centers for a sense of rhythm get halted and stuck at whatever point they ceased to get enough stimulation and development (because sense of rhythm and coordination come as LEARNED skills from hearing spoken language and things like music and experiencing movement, which is why speaking to and singing nursery rhymes to and dancing with little kids is so important)

so like when you see a one year old who can’t even talk yet holding onto a coffee table while they can’t even stand quite by themselves yet, and they’re wiggling their tiny little diaper butt around to some song that they like the sound of, that’s actually critical neuromuscular development not just a cute thing to make us laugh

and when kids don’t get that it affects them for YEARS until someone works with them in like, neurology physical therapy, to develop it from whatever point their missing. And regardless

In severe cases kids will end up underweight no matter what, even with 24/7 hospital care, if they’re not getting the emotional and physical interaction and love they need. so like

Damian obviously got a ton of physical development bc he’s a lean little fighting ninja machine and they started him early probably with things like kid yoga and dance training and all that

but he’s SMALL AS HELL

I would bet that despite being Bruce’sbiological offspring he’s been on the low end of the charts his whole life

like who else?? TIM

Tim, little neglected Tim, left with nannies Tim, who had his parents home when he was little bitty but they left as soon as he required more interaction. Tim who had nannies rotated out often. Tim, who learned real fast that he didn’t get punished if he was good and quiet and didn’t take up space or attention, didn’t ask for things, didn’t need people’s time more than the bare minimum

Tim wasn’t underweight just because of his eating habits—they might have been weird (cough like mine cough) for a few different reasons but he was getting enough nutrients that he shouldn’t have been THAT underweight if at ALL—at most, maybe a couple mild deficiencies. But he WAS. and You Bet Bruce and Alfred noticed immediately, since they’ve raised two teenagers already from very different circumstances and it’s a matter of life or death whether they’re healthy and strong or not—Jason would have had to pass nutrition AND physical tests at least 3 months in a row before Bruce let him out with him in costume I’m sure

Clearly Tim and Damian never got so severe (or noticed) that they ended up with concerned doctors who were stumped, like, admitting them to a hospital or anything—Damian was raised strictly in-house, and Tim’s parents probably only took him to get shots and that was it at best

And a LOT comes down to genetics and epigenetics, of course—Tim doesn’t have the same genes and structure as Bruce or Jason, and Jason and Dick are Very Different, etc.

And also yes they’re young. They haven’t hit puberty yet, or they’re only starting to, blah blah blah. But they were underweight and below the curve for height too and I’m basing that off a lot of people in the COMICS talking about how ridiculously small Tim is, and how small Damian is written most of the time (although yes, he is younger than Tim was. Let me take my liberties with headcanons)

But at the end of the day, Tim and Damian both come to the manor still essentially living with un-caught failure to thrive, and once they start getting (on purpose, whether they’re comfortable with it or not) enough caring touch, compassion, loving interaction, and continue to be fed the same healthy amounts of food both of them ALREADY previously had access to, suddenly both of them started packing on weight and muscle and height at REALLY fast speeds, because their bodies made up for lost time (remember how Tim mentioned to his mom how many sizes he’d grown in a short time??)

and that’s that on that and I hope you enjoyed my mini ted talk on why the family’s care and attention plus Alfred’s continually dependable cooking was critical in repairing some of the damage done by Tim and Damian’s childhoods and why Bruce hides the book talking about all these concepts from the manor library once Tim moves in because there’s no way he’ll be ready to learn that stuff until way down the road, and he doesn’t want to freak Tim out when he knows Tim is going to be following Jason’s lead and reading most of the library within the first year of moving in

(the moral of this story is I possibly need to read a lot fewer books on viruses, child development, trauma’s neurological effects, and biological development, but at the same time, REALISTIC CHARACTER EXPERIENCES?)

[jabbers-of-jay]

Meet Combeferre’s Nemesis.... okay that word is a little strong but.... certainly not Combeferre’s favorite person in the world. 

Little longer this time

~~~~~~~~~~~~~~~~~~~~`

Combeferre took his time showering and getting ready, though he didn’t bother styling his hair. The undercut style he had mostly took care of itself. The top might get a little out of control, or just fluffy as Courfeyrac liked to call it. He rubbed a towel over his hair before he walked back to his room to figure out what to wear. Though it was unusual, he pulled out a flannel. It wasn’t his, it was actually Courfeyrac’s and it was really the only item of clothing of Courf’s that fit him. Really it was shared between them, the other typically wearing it after the other. Combeferre was relieved when he could still catch Courf’s scent on it. He put some items in his bag and gathered things he might need before walking out into the kitchen. Enjolras glared at the world, a little bleary eyed, as Marie Courfeyrac bustled around the kitchen cooking breakfast. Enjolras shot him a look.

“You better not be headed to work.” He croaked out. Combeferre shook his head.

“No, I’m just going through routine. It helps. But this is just stuff if I can focus on it.” He explained, “textbooks and other things.” Enjolras nodded.

Combeferre went to get his coffee but his hands were slapped away by Marie. He tried to protest but she marched him to a seat.

“Your routine helps you, my routine helps me. Which means making all of you breakfast and you’ll all eat it.” She said firmly. Combeferre nodded his agreement, though Enjolras looked less sure. 5 minutes later there was food before them all and Grantaire came stumbling from the bathroom, showered but still not awake. Marie tutted as Enjolras pushed the food around his plate. Grantaire glanced up and gently took the plate from him.

“I’ll eat his share, Marie. He doesn’t really do breakfast.” Grantaire said, before shoveling more food into his mouth. Combeferre shook his head.

“Did you have your lip looked at, Grantaire?” he asked. Grantaire shrugged.

“It’ll heal. I’m sure.” he said nonchalantly. Combeferre was going to protest, but one look from Enjolras had the words dying on his lips.

Half an hour later, Marie and Combeferre were headed out the door and Enjolras and Grantaire were waving them off, letting them know they’d drop in with lunch. Combeferre also reminded himself that while his world had stopped, everyone else’s continued to turn and they needed to figure out what to do in response to the riot. Not to mention the work the rest of everyone had to get back to. Combeferre shook his head a little, finding it hard to believe how quickly their lives had changed.

Combeferre still got a few suspicious looks from the staff around, but one look from Marie and they held their tongues. They were technically a little early, but Combeferre also knew that unless they were doing something, it wouldn’t really be an issue. They walked down the halls, Combeferre’s feet already knowing the path.

“I don’t know how you don’t get turned around in here.” Marie said quietly as they walked into the room.

“Well, I get to cheat. I work here.” He replied.

“I suppose that’s true.” She said. “Do you work with… heads?” She asked a little uncertainly.

“Hmm? No, no. I think I worked one rotation in Neurology. It’s a very hard field to get into. I’ve had a number of patients in the ICU.” he explained quietly. Marie nodded her head. The two settled in and Combeferre hesitantly reached out to take Courfeyrac’s hand and started talking again. It always felt weird at first, but he soon found himself quietly talking to Courfeyrac about Enjolras and Grantaire.

“They’re being idiots again. Your Maman though, I’m beginning to think your tendency to meddle is a biological trait.” He teased. He heard Marie tutting in the background. “I’ve also never seen anyone handle them so well.” He complimented. “Grantaire is still trying to be tough. He wouldn’t let me look at his lip. Maybe he’ll have a scar the next time you see him.” He said quietly, his thumb rubbing patterns on Courfeyrac’s hand.

“And that, ladies and gentlemen, is what you should be encouraging from the families of all my patients.” Dr Clermont’s voice interrupted him. Combeferre found himself automatically dropping Courfeyrac’s hand to stand up, hands behind his back.

“Joining us on rounds today? Dr. Combeferre?” Dr. Clermont asked with a pointed look to the chair. Combeferre found himself hesitating, but eventually sitting down, though it felt very unnatural. Marie tightly clasped his hand, which Combeferre was grateful for, it reminded him he was still needed, though in a different capacity today. It was also a good reminder to him that not everyone found medicine the same comfort he did.

“Alright, who is presenting today? Dr. Aris?” Dr. Clermont asked. A young doctor stepped forward and Combeferre let out an inaudible sigh as he saw who it was.

“Felix Courfeyrac. Male. 26. Presenting with multiple, severe fractures, severe brain contusions, a lower activity in brain function, and…” Combferre missed the rest of what the doctor said as his eyes shot up hearing the new information. Then he was looking at the machines surrounding Courfeyrac trying to see what he could tell. His heart racing as he was trying to figure out if anything was wrong with Courfeyrac

“Dr. Combeferre, perhaps you can help Dr. Aris here in understanding how to present when family is present.” He found Dr. Clermont’s words interrupted his thoughts and he shot a confused look as the young doctor looked furious at being called out. Combeferre confused too look confused. “Very well, gentlemen, do you mind if we take this into the hallway?” She asked, and ushered everyone out. Combeferre looked to Marie, who had tears in her eyes and was shaking. Combeferre took her into his arms.

“Shhh. It’s okay. I promise. I promise he’s okay. They’d be doing something if he wasn’t.” he comforted her. She nodded against his chest. He took a step back. “I’m going to go back out there and see what’s going on. Talk to him. Hold his hand. You know how tactile he is. If he has any consciousness right now, you know he’s hating how still he has to lie.” He said. His words had Marie wiping her tears and smiling. She patted his cheek.

“Ah Marcos, you always know what to say.” She took a deep breath before stepping forward to start talking to Courfeyrac.

[missnoodliness]

Large Animal Rotation (aka it was mostly horses)

I spent 4 weeks in the Large Animal Hospital hopped up on a lot of antihistamines which made me seem/feel like a zombie all day. It's been a trip, but my rotationmates were awesome and we all pitched in to get our patients taken care of!

I'm thankful I know what I do about rabbit intestines because I can answer questions

Always keep the horse head in your peripheral vision when assessing digital pulses. Failure to do so may result in being bitten on the ass.

Some horses are clean. Others will trash their stall constantly. Just... Why?

Always check digital pulses! If that horse gets laminitis, these people may not care that you fixed the reason it had colic if this horse can't compete.

Talking to owners who lease their horse and have no idea what's going on when they bring it in is frustrating.

Horses coming in with shippers and no history other than ADR is so useless...

Weather determines how many clients will come in. Polar Vortex = no clients!

Always check your horse's water in summer/winter frequently. Lack of water can lead to intestinal impaction!

Horses will find a way to traumatize themselves because they are giant, only-coordinated-sometimes goons.

Horses are better at the whole calcium thing than rabbits which means alfalfa hay is an okay choice.

If I were going to have a horse, it'd be a Haflinger. They're my size.

Miniature donkey foals ARE SOOOO CUTE. It's like a tiny, leggy, whole lotta ear, floof explosion.

Walking a post-op donkey down the hall is damn near impossible. Donkey brakes are powerful.

Goats live for crackers. Which means they sit still for their acupuncture better!

You need to know if your male goat is urinating appropriately. I cannot stress this enough. He doesn't pee, you come see me!

You can fit your average miniature horse into a truck cab.

Alpacas apparently only make antibodies with heavy chain globulins unlike everything else so they are being tested to see if they can make antibodies to prions.

I was exposed to a neurologic alpaca who has been injected with mouse prions

You don't know the body condition of a fiber producing animal unless you get your hands on them. You gotta feel your floofs, mk?

If your neighbor is nice and says, hey you want these tree trimmings for your goats? FIND OUT WHAT IT IS FIRST. Feeding your goat herd some Japanese yew branches is a good way to lose all your best goats..... and make your clinicians feel like crazy people because this is so rare an intoxication (and sad).

Pygmy goats are 95% rumen, I swear

I appreciate cows and how they can have sepsis, endocarditis, a barely functional rumen, and pneumonia yet be eating and LIVING. Horses get GI pain from gas and think the end is nigh.

Diarrhea, you say? Out to isolation with you!

Take your biosecurity seriously. Many horses can shed Salmonella asymptomatically

I learned a lot on this rotation, about the animals and the way the hospital works. It's weird writing a prescription to get bandage materials. The important part is that now I move on to small animal medicine! The bad news is that it's my emergency rotation... Here's to hoping they treat me well.

[craniuum]

may - june 2019.

it’s been an insane 2 months and i’ve been meaning to write about it for a while now! things are changing so quickly and in the past 10 days alone, i’ve finished taking my first huge medical licensing exam, moved into a new house, and somehow started my third year of medical school???? this is going to be a stream of consciousness/bullet point list of ideas and i’m not sure where exactly i’m going with this but let’s go

DEDICATED. it’s how most medical schools refer to the 4-8 weeks that students spend studying for step 1 of the boards; my school gave us 6 weeks to study, which is CRAZY because the exam encompassed material that we’d learned during the first 2 YEARS of school.... needless to say it was really hard to prepare and after a while i felt like i was going stir crazy. for me, dedicated was may 6th through june 19th and it was... not the ideal way to spend 6 weeks of summer t b h

a typical day for me looked like: wake up at 5 (this was really hard to adjust to given that i am the exact opposite of a morning person), exercise for 30 minutes, shower/eat breakfast, and then drive to my school library to study for 10-12 hrs, and go to bed by 10. it was just as awful as it sounds, and the only thing that got me through everything was...

MY STUDY BREAKS. i would always feel guilty about taking these but there was only so much that my brain could handle and 12 hours of nonstop studying ain’t it chief. for anyone out there about to start their dedicated studying period, i can’t stress how important it is to some time off and recharge. it helped me focus more easily when going back to work, and it was a welcome change from having to memorize yet another mechanism of action for an anti-retroviral drug or some weird ass parasite that you get from walking around barefoot y’know

i gave myself a half-day the day before my exam and i went to the riverside canal in my city (pretty much the only tourist attraction my city has to offer smh) to do some meditation and self-reflection if things didn’t go well on exam day. i had my sufjan playlist on, and the weather was absolutely beautiful that day and i felt okay about things despite having had multiple panicky breakdowns throughout the past couple weeks....

EXAM DAY. june 19th. step 1 was an 8 hour long ordeal.... 7 hour-long sections of 40 questions each, and an hour allocated for break time. it’s nice because if i finished a section early, that extra time got added to my break time, and i could move through the exam at whatever pace i wanted. i finished the exam in about 6.5 hours because i just wanted to get it over with, and i felt really unsure leaving the testing center. i had been scoring relatively well on practice tests during the week leading up to the exam, but encountering questions that i didn’t know the answer to on the real exam (which i knew would be inevitable) was jarring and it  shook my confidence up a bit. 

the first thing i did after leaving the testing site was to get a poke bowl and sleep for 12 hours, which was nice

i get my score in about a month so we’ll see how i did!! tbh i’m really glad that i still have no idea what i want to specialize in, because my step 1 score will be the biggest determinant of the things i’ll be able to specialize in. i’m not too attached to a particular field so we’ll see where my score takes me.

since test day i’ve just been chilling - albeit i only got a week of break time before starting third year, but in that time i got a new haircut and 2nd lobe piercings (something that i’ve been wanting for a while) and i’ve gotten to spend time with family and re-acclimating to society (this is not an exaggeration.... studying for 6 weeks straight literally made me forget how to talk to people)

MOVING FORWARD. my first day of third year was this past wednesday and it feels SURREAL. third year marks the transition from lecture halls to hospital wards, and i’m so excited to start being involved directly with patient care! i’m also very terrified because this is the year to step up and take responsibility and ask attending physicians if i can help with procedures or hop onto research projects, and i’m generally not that assertive of a person at all. this year is going to be a lot of me breaking out of my comfort zone and i hope i can do it.

my rotations are in this order: i start off with a neuropathology elective (which i’m really excited about!!!), then palliative care, family medicine, pediatrics, ob/gyn, neurology, psychiatry, internal medicine, and lastly surgery. i’ll be regularly updating y’all on my thoughts during these rotations because i’m sure i’ll have plenty to say

third year is also going to be a bit lonely - all of my friends are scattered all over the state, with different rotation schedules and sites. it’ll be hard to regularly see them and i’ve been worried about the toll it’ll take on my wellness, since my friend group is largely what kept me sane these past 2 years of med school :^(

WHAT ELSE? i just felt like tacking on this last section of miscellaneous updates just because. 

i moved into my own place!!! these past 2 years, i’ve had a roommate who was a classmate and once a friend, but she was an awful roommate and i’ve been waiting to get my own place for at least a year! the place i live in now is a short drive to the hospital and it comes with its own challenges (....namely no central AC.......... in 100 degree georgia weather lmao)

sufjan dropping an ep out of nowhere for pride month annihilated me

i watched a LOT of youtube during my study breaks and my favorite finds were bon appetit (oh my god... i am in absolute love with claire saffitz), kurtis connor, and lucas cruikshank (yes of fred fame)

i tried out a hello fresh subscription for a few weeks during studying and i guess i like cooking now????

so much is changing and i start rotations on monday !!!!!!!!!!!! i’m scared and nervous and excited AAAAAAAA

[luckyspike]

About the Author: It me!

so i gained a lot of new followers over the past 24 hours and so here’s a little intro post about me

Name: Spike Age: 31 (for like 2 more weeks don’t take this away from me) Species: American Interests: Writing, knitting, riding horses, neurology Pets: In order of tenure with me, Pippin (turtle, 16 years), RD (dog, 9 years), Balou (horse, 6 years), Mick (cat, 1.5 years), some random fish (rotating cast) Job: Nurse Practitioner Fandoms atm: Good Omens, a few weird homestuck AUs, Discworld, Buzzfeed Unsolved sort of, The Adventure Zone Been Writing for: uhhhhhhhhhhhh 20 years omfg how am i so old Ask Box?: open babey, sometimes I even take prompts Archive of Our Own?: Right here aw yisssss Hidden Secret Fanfic not on AO3?: shhhhh don’t tell

And a special addition: Do all your Good Omens fanfics take place in the same universe? Yes! Much like my stabdads AU from homestuck, all my GO stuff thus far takes place in the same continuum. I will make a note if this is not the case for any particular story.

Anyway that’s me! Please enjoy! 

[certified-sane]

Fifteen years of analysis and experiments have concluded, ending my longest examination.

Neurologically, my IQ and ADHD are immeasurable, I have light depression and anxiety, and I have sexual masochism disorder. My social skills are 2 out 100.

Eight female therapists has declared my issues beyond their training.

Five male therapists have declared I don't have issues. I just know more about people and the world than others so it seems weird.

The masochism is an oddball, but everything else can be explained by the ADHD which can be explained by the IQ.

So, medication is being phased into possibly its final phase.

Old cocktail: Citalopram, lithium, risperidone

New cocktail: Adderall, rotating sleeping medication

The results are a decrease in physical pain, physical ailments, anxiety, depression, masochism, and ADHD symptoms. IQ has risen from subsets in 42nd percentile (working memory) to 99th percentile (reasoning) to 99th percentile in all subsets.

Social skills remain untested but I don't believe they've changed.

So ADHD was the cause of all my problems except possibly social skills. The ADHD might be the result of the IQ but nothing indicates that since I had more ADHD when I had a lower IQ.

My lack of social skills might just be the result of my isolation and neglect growing up. Either I can learn social skills, can't learn social skills, or I can learn some social skills. So no matter what the next step is to try to learn social skills.

But everything else is settled and the longest experiment of my life is concluded.

[sidenotelife]

Post-block 3 residency power rankings

My pre-M3 residency power rankings:

1. Pediatrics

2. OB-GYN

3. Psychiatry

4. General surgery

5. Neurology

6. Family Residency

7. Internal Medicine

When I came to med school I wanted to be a doctor for kids with cancer. In college and immediately after college I became really interested in thinking about a little thing that snotty liberal arts college students like to talk about called the meaning of life. I spent a lot of time reading about it, writing about it, talking about it, and I bounced around several ideas. The impression I got is that many people who chase and successfully attain things like money, fame, or career success, things that are commonly chased after by young people, go on to write books about how it turned out how money, fame, and career success turned out to be bullshit and it was mostly about the relationships they developed along the way, or the one’s they burned along the way. Sidenote - there are countless examples of this. The song “Cat’s in the cradle.” Everything Bill Russell (the winningest NBA player of all-time) says about what he valued about his time in the NBA. What people like Bill Gates and Warren Buffet do with their $$$. 

Anyways, at the wise age of 21 I concluded that the meaning of life was about relationships and opening up the opportunity for people to have relationships (broadly defined as community). At this time in life I decided to commit my life, to the best of my limited powers, to further the concept of community. For one reason or another I ended up in med school with the idea that as an introvert I could never be a radical political movement leader, but I had the inspiration that when a radical political movement leader needed a doctor I would be their doctor, and I would make their life easier. Within medicine I became interested in working with families, and also cancer research, so I decided a natural melding of these ideas would be pediatric cancer. I became interested in kids with cancer not only for the kids but for the ripple effect of the sick kids affecting entire families. 

Now that I’ve gone through three clinical rotations I’m starting to get more precise idea of what I like, and more importantly what I don’t like. So far I’ve done my general surgery rotation (6 weeks on the general pediatric surgery service), general pediatrics rotation (6 weeks rotating between various pediatrics services including the newborn nursery, outpatient, inpatient, intensive care), a 3 week electives on pediatric nephrology, and a 3 week elective on neurosurgery. 

The first thing I learned from my rotations is that I love surgery. I liked many aspects of surgery but I thought it was the eff-ing bee’s knees that while you do surgery you can listen to music, and not just like elevator music, but like any music you want. Sidenote - If I was an attending today this is the rotating playlist I would have: 

Sidenote - I spent hours picking that 3 song rotation. Then I would make them play this as the residents are closing:

What I’m saying is it would be great to work with me,

And obviously it’s not just about music, it’s what the music symbolizes. It’s the absolute control over the environment. It’s the idea that talking is of so little importance that you can literally have music playing while you work. It’s you and the patient getting lost flowing through the surgical dance.

So I knew I was leaning towards procedural, but considering my interest in kids with cancer I figured I should give peds a chance before I completely rule in surgery. Now, having just finished my peds rotation I’m still surprised at how much I disliked my pediatrics rotation. Essentially every day these past five years in medical school I would’ve bet thousands of dollars that I would end up in pediatrics. What I didn’t realize is how extroverted any field of medicine is. The entire job is oriented around talking. You talk to the nurse. You talk to the patient. You talk to the parents. You talk to the night residents. You talk to the residents on your team. You talk to your attending. You talk to the resident from the consulting team. You talk to the attending from the consulting team. You re-talk to your attending. You talk to the new nurse. You re-talk to the residents on your team. You re-talk to the patient. You re-talk to the parents. You re-talk to the nurse. You re-talk to the residents. *head explodes* Sidenote - I hope the breadth of work that has gone into this blog makes it clear that I have nothing but respect for pediatricians and clinicians in general, but in case it is not clear I want to mention that I have great appreciation for pediatricians and clinicians. Anyways, I appreciate the intellectual side of coming up with a differential diagnosis and understanding the different presentations of a disease, but my introvertedness was really challenged during this block, to the point where I questioned if I was cut out to do this. Thankfully, once the six week block ended I could be done with pediatrics.

At this point I kind of narrowed my thinking to pediatric surgery, pediatric neurosurgery, and OB-GYN. Considering my interest was still kids with cancer, I tended to rule out pediatric surgery because (my naive understanding) there’s so few cancers that are best treated by pediatric surgeons. Rather I tend to lean towards pediatric neurosurgery. I can specialize in kids with brain cancer, a natural surgical niche. I can also do other intracranial surgeries like epilepsy surgery and have a diverse but anatomically-specific practice. I thoroughly enjoyed my neurosurgery rotation and I know I would be happy as a neurosurgeon.

So how does OB-GYN fit in? I guess to explain how OB-GYN fits in, I have to backtrack to why kids-with-cancer fits in to community, which is that kids with cancers affects the entire family. The niche within OB-GYN that I’m most interested in is pregnancy, which is kind of the basis of families. OB-GYN is also surgical which is good. One question I have about the specialty is what it will be like working in a field that has more women than men.  I have questions about how I will be treated by both the patients - will my women patients prefer to see a woman provider? And also questions about how I will be treated by my colleagues - better, worse, indifferent? I feel weird asking these questions like does it make me a bad person, but like also I’m kind of curious.

So now I’m down to three specialties. Peds neurosurgery, OB-GYN, and radiology. I plan to do radiology if I burnout on surgery/patient care. I plan to decide between neurosurgery and OB-GYN based on how I like this next rotation on OB-GYN.

My backup plan in case sidenote causes me not to match is to scramble into general surgery and become a rural general surgeon in Wyoming.

Post-block 3 Residency Power Ranking:

1. Pediatric neurosurgery.

2. OB-GYN.

3. Radiology.

4. General surgery.

see you on the other side,

from ken

[questionharsha-blog]

5 Unique Surgical Procedures - Weird or Wonderful?

Since the first human heart transplant in 1967, there are thousands of surgical procedures evolved, transforming people's lives every day.

Apart from those, we take a look at five of the most bizarre surgical procedures.

1) Ankle to knee Surgery

Rotationplasty is an extraordinary reconstructive surgery, where the ankle is used as a knee joint.

In this procedure, the bottom of the femur, the knee, and the upper tibia are surgically removed, and the lower part of the leg is then rotated 180 degrees and attached to the thigh.

In simple terms, the foot is attached to the knee backward.

After fitting the prosthesis, the ankle of the foot functions as a knee.

2) Tooth-in-eye surgery

Osteo-odonto-keratoprosthesis is just using the tooth to restore the sight of a patient.

OOKP is used for patients whose blindness is caused by irreversible damage to the cornea and for whom other treatment methods have failed. The patient's tooth is used as the body is unlikely to reject it.

The patient's canine or premolar tooth, and the surrounding bone is removed for the technique. Firstly, a hole is drilled in the tooth, and a plastic lens is inserted in the hole. To grow new blood vessels, the lens-tooth structure is implanted into the patient's cheek for a few months.

Finally, the structure is removed from the cheek and implanted into the eye. Light travels through the lens, thereby restoring the patient's vision.

3) Removing half of the brain

Hemispherectomy is the partial or total removal or disconnection of one of the two hemispheres of the brain. It seems beyond impossible that removing half of the brain can be a feasible, effective surgical solution for certain neurological conditions, but yes, in some cases, it is.

Hemispherectomy is considered a radical procedure, which can take as long as 12 hours to complete. It is usually performed on patients with neurological disorders that lead to seizures on one side of the brain.

Those neurological disorders include severe epilepsy, perinatal stroke, hemimegalencephaly, Sturge-Weber-Dimitri disease, and Rasmussen's encephalitis (inflammation of the cerebral cortex).

Patients who are undergoing hemispherectomy experience paralysis on the side of their body, opposite to their removed hemisphere. As the benefits of the surgery outweigh the risks and side effects, the procedure is opted in certain conditions.

4) Heterotopic heart transplant

The procedure is also known as "piggyback" heart transplantation. The surgical implantation of a healthy donor heart on the right side of the recipient's damaged heart where both the hearts are surgically attached is known as a heterotopic heart transplant.

The surgical connection between both hearts allows blood from the damaged heart to flow into the new heart, then the new heart can pumps blood around the body.

5) Head transplant

The procedure is named as HEAVEN-GEMINI will involve removing the heads of the recipient and a healthy donor using an "ultra-sharp blade," to avoid spinal cord damage.

The recipient's head and the donor body are placed into deep hypothermia for about 45 mins to reduce nerve damage. The recipient's head will then be attached to the donor body using spinal cord fusion.

The entire surgical procedure is expected to take around 36 hours, and it will require the skills of about 150 surgeons and nurses.

Later, the recipient is kept in a coma for 3-4 weeks to minimize movement and ensure the nerve connections between the neck and the spine have time to fuse.

[writing-while-high-blog]

high post #1 ‘What is time?’

I think time is, in a sense, just notecards that fit together perfectly, but laid out on a coffee table thats really big, like when you’re doing a project and you have to lay all your pictures out on the table then paste them onto your project board. at time is just a number of particles that appear in thin air, so if we time travel all we have to do is hop back to a notecard but you can't go forward because all notecards make each other but each notecard is one fraction of a second that always exists in that entirety. but is it? people say time is a made up thing but if you think about it, it’s not. think of the moon & the earth & the sun, how they all rotate around and how everything conforms to time. there’s a certain amount of times the earth takes to rotate all the way around, wait the moon rotates around the earth, or is it the earth around the moon and sun? i know this     ok wait no but it takes a certain amount of time for sayyyy? OK NO it takes 24 hours to make a full day, correct? and we’ve established hours are a number of seconds of which to make minutes? right so its all strung together. we must have time, we must have some measurable all around-same time systems. because without time-well, we’d be animals, we’d judge by different aspects, wait. ok so I’m imagining a wolf & how it can tell between times but I guess they just sort of judge by light outside, or animals sleeping when they want to, because they have no sense of what we should do for a regular cycle, thats why they’re always so sleepy, holy shit wait what if animals are on a constant RIM cycle of sleep every time they fall asleep and thats why like every time your dog or cat suddenly goes to sleep on the floor or just sitting anywhere its because they haven’t finished their RIM cycle and thats why they actually are always sleepy. omfg I just cracked the davinci code, holy shit wait wasn't; that a movie? I never saw it, my mom wouldn’t let us do stuff like that or i guess watch stuff like that. like harry potter, nope, twilight, nope, we never did any of that but ya girl also read the 50 shades books multiple times over, but not in a sexual way. i should really get to sleep now, but i mean its only 11:30pm & I get up around 6 so I should be fine, apparently we have a senior early graduate meeting tomorrow at like 5, for whatever reason?? and we’re supposed to bring our parents but like I’m not about to try to drag my mother to that school, shell be complaining the whole way there, she’ll be rushing and probably weird that cardigan she always wears to the school because she wants them to think she just got out of bible study. lmao I would fucking kill myself if I had to go to bible study. bt dubs, I’m agnostic I think, all I’ve known religion wise is atheism and christianity, which I'm literally in the smack dab middle of because I’m the kind of person who needs physical hard proof, so the bible, which is really just a book in the grand scheme, like does religion have a play in how the world progresses? like does religion guide our existence as a whole? like wait is, ok this is what I mean, if there’s a god or something god-like guiding us, would we actually know? I mean god gets praise but you never directly get to give him praise and know who HE is, like you never see him face to face I feel like if you created the fucking universe you’d want people to have a clear thought of who you are. but they say god knows every small thought and aspect of every ‘soul’ but like. souls also, do we believe in a soul? because I feel as if death is just like a full round. in the beginning, before we were alive, which life is really just a large stream of consciousness, I feel like we BAM go into consciousness but then when we die we just cease to exist. almost like turning a light on and off, also how are thoughts and memories neurological and not physical, or maybe thoughts are just smaller self made fragments of consciousness. later girlies

[rimofwell]

i just need to vent!!!!!!!!!! and collect my thoughts (& what’s better than a sleep med induced ramble bc i can’t study, but need to keep busy)

- i went to this luncheon on sunday where alum from my school who graduated and went on to medical school etc. came back and answered questions on a panel and then afterward we broke off into smaller groups and interacted w/ the doctors one on one. when i was listening to the panel i made note of three doctors i wanted to speak with afterward and one of them coincidentally ended up sitting at my table !! we were talking and such and he asked what kind of doctor i was looking into being and i said that i want to get my md & phd in a combined program thing and that i’d want to either specialize in psychiatry or neurology and maybe do research on neurodegenerative diseases. we finished talking and then it was time to rotate to different tables so we shook hands and i thanked him and that was that. then maybe like 10 minutes later when i was at another table talking to the people there, the first doctor i spoke to earlier came up to me and was like, “i just wanted to let you know that i have to leave now, but here’s my card. i wrote my personal email on the back. keep in touch and let me know what’s going on, i mean it. it was great meeting you and i hope to hear from you” and it was really nice and i was flattered that he actually sought me out to tell me that/give me his info. & then when i was at my last table (talking to the second doctor on the panel i wanted to interact with) we spent a lot of time talking about meaning, and the connections he’s made with patients and how important that is. and i was talking to him about literature too and we were just having honestly such a great convo. i made a point to seek him out bc he was different than the other doctors. he’s a surgeon but he’s more offbeat than the others (he double majored in music and physics and decided to go to med school after doing time in the air force). he was giving me tips on how to come up with an academic writing style for journals and grants and how important that is. and i really appreciated all of the tips. when it was time to depart he was like, “right now you’re a sophomore so the most important thing is to keep the gpa up and get the grades etc. but i’m going to give you my email so we can keep in touch. i’d love to help you out, especially as you get nearer to when you’re looking for internships etc.” and that was neat !!!! glad i ultimately ended up going bc i really was not planning on it at all

- and also lmao hi not to be this person but hello yes i am going to be this person bc i am stressed!!!!!! i had one research paper due on friday and i have another research paper due tomorrow (like an actual paper not a 7 page essay ugh i hate when ppl call essays papers like lol!! that’s not a paper buddy chum pal). and i have my eukaryotic cell exam friday and then 3 exams and another paper due next week and then another exam the following week along w/ ANOTHER darn paper!!!!!!! like alright chill @ everyone who is assigning things. i sort of feel like i am drowning like 100% there’s so much to study for and so much to write and i’m like alternating between reading about how eif2-gtp binds to met-trna and brings it to the small ribosomal subunit 40s, and how female mallard’s energy allocation differs from males and then psych and then spanish and then back and forth and yikes!!! my brain is everywhere my dudes

- also i went over guy’s apartment on friday for a wine night and actually didn’t hate it?? and i like him. i think i misjudged him before. we actually talked for like 5 hours and it was so chill and he asked me if i wanted to stay the night and i almost said yes but then i was like nah fam i have to study tomorrow sorry (a+ decision on my part). but yeah i’m feeling weird that i didn’t end things

- i’m a little tiny bit like lowkey mad at my suite mate bc she just like.... seems to get jealous very easily and like bitch i can tell. like i’ll be talking about something cool or good example 1. the cool people i met at the alum panel event and 2. the fact that i don’t hate my guy and she literally has to find the negatives to everything and point them out!!!!!!!!!!!!!!!!!!! and esp w/ the guy  she’s like, “well i just don’t see this going anywhere. he’s graduating and you guys just seem really different” and it’s a little irritating bc if you think i don’t think of these things u really don’t know me at all bc trust me!! if u can think of a possible con i’ve thought of it ages ago and also just like it’s very annoying???????? and when i talk to people i’m never really like seeking validation or looking for an opinion bc i’m undecided (unless i specifically say i want advice, my opinion/mind is probably resolved) so it’s not like her cynicism / negativity makes me feel less excited about the thing it just makes me annoyed bc i’m like why are u the way that u are!!!!! i just truly don’t understand bc i’m legitimately always happy for the ppl in my life who are doing well or when good things happen for them i’m never like jealous and pessimistic / lowkey bitchy so it’s frustrating. a part of me wants to like call her out on it and be like “soooo want to explain to me why you’re acting like a child or should i just condition myself to expect less from you???” but then the other part of me is like, ‘i don’t even have time for drama i have to do work / write / study’ 

- honestly i don’t even think i will go to the gym that much this week which is a really big deal bc i don’t not go (i feel like i’ve said this before but true) and i’m a little distressed bc that is my #1 stress reliever ugh ugh

- i really suck at doing any/all update posts bc i forget everything i want to talk about and tend to only make them when i’m frenzied and stressed so everything is all ~woooooo~ umm i may come back and add things to this when i remember or don’t idk but hope everyone is doing well and less stressed than i am lol!!

[petshrink]

More updates

Ok, so I finished the neuro rotation, because I get to spend a week at GP. I feel like I’ve just been a crummy intern overall, but it was partly because I couldn’t function with lack of sleep and partly because we had a TON of very strange cases and I couldn’t do enough research to keep up with it all! Here’s the rundown.

- 5 year old small breed dog with a history of chronic back pain. Went down the day prior to MRI, but thankfully still had motor. MRI looked WEIRD. Three vertebrae with changes to the bone and at L1 there was stuff causing extradural compression of the cord...but not disc, which is what we expected! Owner wanted an answer so we did surgery and removed a small piece of the lamina but not the facets for fear of causing destabilization. The stuff we removed was strange and not consistent with an abscess. We were actually able to take a core biopsy of the vertebral body with just a 20g needle! After receiving negative infectious disease test results, we started prednisone and finally got his pain under control. Then this week we got a call from the lab...someone ran one test incorrectly and this dog was absolutely positive for Coccidiomycoides!!! So he’s been started on fluconazole but the doc was freaked out about the prednisone...we’ll see how he does.

- Little dog transferred from another ER Monday after becoming acutely mentally inappropriate on Saturday. Signs were very strange, with lack of menace, rhythmic head swaying, getting stuck in corners and howling. Unfortunately after two days being hospitalized the owner was pretty tapped out financially and couldn’t pursue an MRI. Dog had been sedated with different meds all weekend long and we just halted all that. Within 24 hours she was having fewer episodes. So after infectious disease testing we started prednisone and doxycycline for suspected encephalitis and she went home on Wednesday with her menace returning, ability to walk, and everything else vastly improved. Fingers crossed on that one.

- Cat belonging to a vet that underwent a dental and then had persistently elevated third eyelids and dysphagia. Also had ears flushed under anesthesia. The MRI showed fluid in the left bulla, which could explain the possible Horner’s but should have nothing to do with the hypoglossal nerve. A feeding tube was also placed and upper GI endoscopy performed due to inability to get food in himself and a thickened stomach wall. He looked great until mom arrived to pick him up, when I found him in his kennel coughing up blood-tinged saliva. We stayed quite late working on him, and finally an echo confirmed congestive heart failure that was likely exacerbated by the fluids during long anesthesia. The poor doc I was working with is devastated :(

- Geriatric poodle that was adopted by a wonderful family who reports she has just never been right. MRI confirms hydrocephalus. Question: what kind of dog will they have if and when the treatment starts to work???

Outside of neurology, I worked my first GP shift today and the doctor on and I split the appointments. Went pretty well, but one of the techs’ dogs was brought in for being really off. Young dog with acute fever, hematochezia, tachypnea, tachycardia...we sent him straight down to the ER. The ER doc kept me updated and reported evidence of sepsis with pleural effusion. They found a suspected abscess in a caudal lung lobe?? We suspect it must have been due to a migrating foreign body, because what else and we do have those devil seeds here. Poor thing had to be euthanized and now we have a heartbroken staff member. This SUCKS.

But on the awesome side, Molly is going to have her teeth cleaned tomorrow because I can get it ridiculously cheap if I run it all myself. And it needs to be done! She’s gonna be mad.