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dutchdread · 3 years

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No offense bro, but why are you always so protective of Cloud? No disrespect to you or anything but I've heard quite a bit of different opinions and theories on Cloud myself and I do agree with the people who say that he takes Tifa for granted. Going through trauma in the past is not really an excuse for his behavior. He also does act like he's the only one who has suffered in his life. Do you have other reason to defend him other than the fact that you "relate" to him? Just wondering.

Sorry for the late reply, my life has basically left no room for hobbies these past months. Your question is hard to reply to because I am not sure what you mean when you say I am protective of him. I guess you mean I defend his actions? Specifically in ACC? Firstly let me state that there is a difference between being a good character and being a nice character, there is also a difference between agreeing with someones actions, or just understanding them. Personally, I never really liked Cloud, especially not when I was younger. A lot of my defense of Cloud doesn't come from me personally liking him, but from me thinking he's a good character. I also think Snape is a good character, but I don't like his actions, and I don't defend them, although I still understand them to a certain degree. I should also say that as I started to understand Clouds character more, I also started liking HIM a bit more, although I still don't like the things he did, and would very likely not be friends with him. But I do understand why he did what he did and cannot be too critical of him because of that. You've probably heard that before you judge someone, you should walk a mile in their shoes. That's great advice, if you want to judge someone, you should imagine what it would be like to be them, however, I've noticed that too often when people try to walk a mile in someone elses shoes, they refuse to take their own shoes off first. They don't think "what would it be like to be him", they think "what would I do in that position". But Cloud is not you, and you cannot judge him by how you would act, you've not gone through the same things he has, your thought patterns aren't the same etc. This matters because too often I see people judging Clouds actions in ACC, and establishing his motivations by saying things that boil down to "If I were in his position, I would only do those actions if I loved Aerith/didn't love Tifa/whatever". But they're not Cloud, and they're not understanding how Cloud thinks, and that it's different from how THEY think. But like you said, I do see some recognizable elements of myself in Cloud, which is why I do understand his actions, and why I feel relatively certain in defending them, because I see them coming from a good place. It's common for me to react to things in a way that others find counter-intuitive. Let me give you an example, my brother once was mad at me because I had not told him my girlfriend of several years and I had broken up while I did tell a random stranger at the pub. He said that he felt like he wasn't important to me if I told a random stranger but not him. The truth was the exact opposite, I love my brother, and could not bear to face him for some reason, as I told him: "if not caring enough was the problem, then I wouldn't have told a random stranger". I see people exhibit that same lack of understanding when discussing Clouds actions, where they feel like his actions must be the sign of him just being a bad person, or not caring. But ask yourself what is more likely, that Square-enix wants their hero to be a bad person, or that you simply are misunderstanding the character? I understand why people don't get Cloud, Cloud suffers from obvious mental health issues, and mental health issues simply are not something that the general public understands, even today. Not only that, but Cloud went through the most insane series of traumatic events anyone could ever imagine. He had an alien parasite in him, saw his entire town murdered before his eyes, then saw Zack murdered in front of his eyes, then saw Aerith murdered in front of his eyes, and just when he started living a peaceful life he is forced to watch his child succumb to sickness in front of his eyes, and then he finds he himself is dying. All this on the psyche of a man who had had a fear of failure ever since he was a child, spent most of his life essentially in war, and had a severe identity crisis as well. Do you think you can honestly judge him by going "that's not what I would have done"? Would that not be incredibly

presumptuous? Have you suffered from depression as a result of severe post-war PTSD and a lifelong feeling of inadequacy combined with a fear of failure and the belief that many of your loved ones died because you failed and were inadequate? Because that's the context in which you have to view Cloud when watching Advent Children. Saying "Going through trauma in the past is not really an excuse for his behavior" is just incredibly short-sighted, your behavior is determined by who you are, and who you are is determined by what you go through in the past. You can't expect a broken child to become a well-adjusted adult when being a well-adjusted adult is the result of having a normal childhood.

I also don't want to cause offense, but this really is a mindset you should change, because this mindset is one of the most pervasive and damaging ones in our society, it's the one that probably bothers me most when I hear it because it makes zero sense. It's like breaking a robots self-repair unit, and then being angry at it on the grounds that the self-repair unit should have fixed it. It's also very insensitive in general, it's the equivalent of saying "why are you depressed, just stop being depressed", people don't choose to be depressed, people don't choose to have a fear of failure. People don't choose their emotions, they're just there. They can be influenced by behavior over time, sure, but behavior is equally influenced by who you are and your emotions, which, as mentioned before, is determined for a large part by your past. People don't just "snap out of it". They fight and fight and fight, and sometimes they win and break out of the spiral, and sometimes they lose and it breaks them.

FFVII, and especially Advent children, is all about that struggle, and during those struggles you will have high-points, and low-points. FFVII shows all of those. It shows Cloud trying, it shows Cloud wanting, it shows Cloud failing, but it also, ultimately, shows Cloud prevailing. Judging Cloud for not breaking out of the spiral by the time of Advent children, when he was mentally only barely 18 years old, and when he started at the worst place anyone could ever imagine, is just not reasonable. It's the modern day equivalent of "let them eat cake", something that can only be said from the place of privilege of not knowing what the struggles of the people you're critiquing are actually like. So having that out of the way, lets look at Clouds actions from the perspective of Cloud. Cloud is a young boy, and he's in love with the girl next door, he wants to get her to notice him. One day said girl walks up a mountain and he follows, she falls off a bridge and ends in a coma. Cloud followed her because he's in love with her, and he gets the blame from the adults. Cloud internalizes this, and its important to imagine what this must be like for a child, to have the adults all tell him it's his fault that the person he loves ended up hurt. "your fault", "your fault". Afterwards Cloud starts thinking Tifa hates him and starts acting out. I think this is a good moment to point out btw that this child has no father figure. This is the start of his feelings of failure and inadequacy, he blames himself for not being able to protect Tifa, failure number 1, he thinks that if he were strong, he'd be able to protect her, he thinks that if he were like Sephiroth, then even Tifa would have to notice him. Now until this time Cloud is not an asshole, he's a bit of a rebellious kid yes, but notice that he's not a bad kid as much as he's a kid who wants to protect someone, has no direction, and is acting out. So Cloud thinks he's not good enough, but he leaves town confident that he'll become good enough, and even makes a promise to Tifa. All this follows logically from what we know about Cloud, and tells us a lot about how deeply seated these feelings are. Becoming Soldier wasn't a small thing, not some small passion project that he just came up with one day, it's the result of the things that happened in his childhood and he left everything behind make it so. He told the girl he loved, he promised, he boasted. And then he failed. Failure number 2. He comes back to Nibleheim and can't bear to look Tifa in the eye and admit that he couldn't do it, that he's a failure. His entire life so far has revolved around this and he wasn't good enough. So here we have Cloud, not in a great mindset, thinking he's a failure, and what happens? His entire town is murdered by the person he admired, someone he worked with. His Mother is killed, and Tifa, the girl he PROMISED to protect, gets slashed open so badly that apparently she needed to have her ribcage reinforced with metal. I think we can all agree that this by itself would be enough to potentially scar a person for life. (Cloud, not Tifa XD) So what's next for the boy who left town in order to become a hero? Well, he gets captured and experimented on for 4 years, during which his mind and sense of identity is bombarded with memories and knowledge of the lifestream in the form of mako, muddying up his thoughts. Cloud already had a weak sense of self as a result of his childhood, it's why he failed to enter Soldier and now this distaste for who he is makes him extra susceptible to Jenovas influence. The next thing Cloud sees, (he didn't consciously experience the 4 years of mind-fuckery) is his best friend getting killed trying to protect him, because Cloud wasn't strong enough. Failure #3. At this point, in Clouds mind the list of people dead because he could not protect them, because he's a failure, include his mother, his entire town, his best friend, and as far as he knows, the girl he loves. This is his life. His mind is broken, he hates himself, he doesn't want to be himself,

he has a mind-altering parasite inside of him trying to adjust his identity and Clouds just goes "I reject this reality and constitute my own". And why wouldn't he? Why wouldn't he want to live in a fantasy world where he wasn't a failure, where he made it into soldier, where he was cool and successful and not a disappointing failure? Zack tells him to be his living legacy and Cloud goes with it, then he runs into Tifa, Jenova adjusts Cloud further based on Tifas memories of them and rejoined with the girl for whom he joined Soldier Cloud is unconsciously all too willing to play the part. FFVII starts and it doesn't take long for the cracks in his fake persona to show, he meets Aerith, and becomes her bodyguard. He gets to be the hero he always wanted to be. But then, even as "Cloud strife, soldier first class", Cloud is still a failure, the plate still drops, killing thousands, he gives Sephiroth the black materia, he beats up Aerith, and ultimately, fails to save her as well. Tifa was the First Failure, and Aerith was the Final Failure. Even as a soldier, Cloud still couldn't save anyone, he loses even more faith in himself, he doesn't know who he is, he doesn't trust himself, and then when he also loses Tifas trust in who he is, he just breaks and gives over to Jenova/Sephiroth. Even Hojo calls him a failure. Cloud feels like a nobody. Now mentally weakened, under the influence of jenova cells, he gives Sephiroth the black materia AGAIN, and meteor is summoned. Another entry on the long list of moments Cloud can look back on in shame later on in life. He falls into the lifestream and again his psyche is under attack. We know what happens afterwards, Tifa finds him, cares for him, and saves him through his feelings for her. Cloud realizes who he is, realizes he's weak, and goes after Sephiroth without lying to himself. In the end he defeats Sephiroth mentally and is supposedly rid of his direct influence.

But that doesn't mean that this mentally 17 year old is now fine, we should remember these events when analyzing ACC. Cloud has been in constant fighting/war/peril ever since he left home as a child, and is now a traumatized 17 year old in a 21 year olds body. Novels and other materials give us an insight into how Cloud thinks during these times, and how he thinks about himself. We hear him say that he's going to live because that's the only way he can atone for his sins. He talks about wanting to change, and about believing he can change because he now has Tifa. He's a man (boy) who just exited war, and wants to be positive, but is still clearly blaming himself. We see that this initially goes well, we are told that Cloud experiences peace and happiness that he's never experienced before. We're also told about the things that make it go badly, when he has to deliver flowers to the ancient city for instance. While Cloud regained the sense of who he was the belief that he wasn't good enough, that he was a failure, was never solved, if anything it was put on hold until he got his memories back, and now he is forced to deal with it.

While he is no longer directly manipulated by Sephiroth he's still suffering from PTSD and, most notably, survivors guilt. He blames himself for the deaths of Zack and Aerith in particular, and starts visiting the church. Now most people might think it's natural to avoid places that make you feel bad about yourself, but that's not how a depressed person thinks, Cloud thinks he deserves to feel badly he WANTS to punish himself, he WANTS to feel bad. He's ashamed of the moments where he's carefree and laughing with Tifa. Why should he get to be happy when Aerith and Zack are dead because of him? He shouldn't be happy, he should be in pain, he should remember them, not doing so would be an insult to their memories, he must never forget how he failed them! That's how Cloud is thinking. We know of course that this is non-sense, Aerith and Zack wouldn't want this, if anything it's this mindset that is tarnishing the memories of Aerith and Zack, but that's not how a mentally unwell person thinks. Cloud wants to atone, and thinks he finds salvation in Denzel, whom he finds at Aeriths church. He thinks that by saving this life, he can, in some way, make up for all the death he caused. Tifa has a similar belief when she finds out Denzels parents died in the plate crash. And when Denzel joins the family, and Cloud has path towards redemption in his mind, things start getting better again. Because this is the cause of the problems Cloud is having in ACC. When Nojima says:

first off, there’s the premise that things won’t go well between Tifa and Cloud, and that even without Geostigma or Sephiroth this might be the same

This is the conflict he's talking about, he's not saying "Tifa and Cloud are incompatible, it has nothing to do with Sephiroth", he's saying "if Sephiroth didn't show up during Advent children, Cloud and Tifa would still be having problems because Cloud is going through survivors guilt."

But the good times don't last, Denzel has Geostigma and Cloud cannot find a cure, Denzel....is going to die. Cloud, has failed again. Not only that, but Cloud catches Geostigma....Cloud is going to die. And THIS is why Cloud leaves in Advent children. And you have to look at this as Cloud. Cloud said he was going to live to atone for his sins, but instead he's going to die. He won't atone for his sins, even worse, he's going to leave Tifa and Marlene behind. He failed again. He couldn't protect Denzel, he potentially brought an infectious disease into their house as well. Literally all Cloud can think about is that literally everything he's ever tried has ended in failure, everyone he's ever tried to protect, he's failed at. Do you understand how easy it would be for a person like this to fall into the trap of thinking "I deserve to die", "I don't want Tifa and Marlene to see me die", "Tifa and Marlene are better off without me anyway", "they'd be happier if I weren't here". Etc. Now we know this is nonsense, but come on, how many instances have you heard of depressed people genuinely believing that their loved ones would be happier and better off if they just didn't exist? However, throughout the movie, Zack, Tifa, and Aerith, all confront Cloud, and urge him to not give up. Cloud eventually does try again, and ultimately finds redemption not by being stuck in the past, but by letting the past rest and be beautiful (a lesson Cleriths unfortunately never learned). "I never blamed you you know, not once" "I want to be forgiven. By who?" "Isn't it about time you did the forgiving?" In the end, Cloud moves on, and therefore, so do Zack and Aerith. Aerith and Zack walk into the light, Cloud plants flowers on Zacks grave, and lets Zacks buster sword rest in Aeriths church, now no longer rusting, but shining. Instead of the past being a negative reminder, Cloud lets the past be beautiful. Cloud was doing Aerith and Zack a disservice by remembering them the way he did, because it was ruining his life, it wasn't a good thing, but it did come from a good place, from a good man whose ashamed of not being good enough. Yes, it harmed Tifa, people going through these things often do hurt those around them, but it's not because they're bad people, or even weak, but because people are imperfect and Cloud has gone through hell, both internally, and externally. Are his actions really that weird or deplorable? "He didn't even go save the kids!" Yes, he's hesitant about saving the kids, why shouldn't he be? Everyone Cloud tried to protect or save, ended up maimed or worse, or as Cloud puts it: "I can't even save myself". "He left Tifa alone!" Yes, he thinks he's going to waste away and die, can you blame him for not wanting to put Tifa through that and for thinking she'd be better off without him? "He drinks!" Wouldn't you?! Who wouldn't want to forget that stuff? But in the end, He's only gone for about a week, he never intended to harm Tifa, he never physically harmed Tifa or cheated on her, his entire life revolved around wanting to be better for Tifa and blaming himself when he wasn't good enough, how is it reasonable to say this man takes Tifa for granted when the fact that he thinks he has to BE BETTER in order to be worthy of being with her has been a constant throughout his entire life and story? He DOESN'T take Tifa for granted, that's why he's beating himself up, that's why he leaves, not because he thinks he's better than her, or that he'll always have her, or that she'll follow him like a dog, or something like that. But because of the opposite, because he thinks HE is not good enough, that SHE would be better of without him. Saying Cloud takes Tifa for granted, is honestly, simply, wrong. It's 180 degrees the opposite of what is happening in FFVII, the biggest constant in Clouds life, is that he doesn't take Tifa for granted, and I don't understand how anyone could argue otherwise.

#cloti #FFVII #ffvii crisis core #ffvii advent children #ffvii remake

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epicfales · 4 years

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When I hate My Body, I Remember What It Has Given Me

It is day twenty-seven of strict social distancing. I only know this for sure because I checked my most recent Instagram post, which says that two days ago was day twenty-five. Today is Wednesday, April 8, 2020. I only know this because I checked my watch. The days feel long and short at the same time, and I’m not sure how that can be. There are many things I’m unsure of, these days; and I trust that we all feel that way to some extent. This pandemic has shattered our collective sense of normalcy and routine, as it’s disrupted weddings, graduations, proms, birthdays, and funerals—rituals that many people cannot fathom living without. I cannot go another day without confessing what I know to be true: it’s easy to live without those things when you have no choice.

At some point over the past twenty-seven days—they all blend together—I was talking to my friend, Liv, who was impacted by cancer. I hate how people use words like “fighting” or “beating” when putting verbs alongside a beast like cancer. Because no verb in any language can describe the deeply physical, emotional, and spiritual experience of being sick in that way. Sometimes when I imagine her being pulled from what was her happy and blessedly normal life, I see her being dragged into an arena, and cancer is not the lion—she is the lion—and cancer is this dark amorphous force that engulfs her body. I imagine that she roars, and her voice is so strong that I can see the sound released from every fiber of her being, and then watch as her very essence tangles with that darkness. Other times, I imagine her as she is in a photograph: dressed as Muhammad Ali, strutting down a hospital hallway, bald and in a mask, donning boxing gloves and a cape, staring down the camera. Everyone felt the need to reassure her that even without hair, she was beautiful. This pisses me off, because they all confront that photo with the unconscious premise that hair is a vital part of the human body, and my God, do they not notice the cape?

The Muhammad Ali quote that she boldly posts alongside that photo: “I hated every minute of training, but I said, ‘Don’t quit. Suffer now and live the rest of your life as a champion.’’

I turn to my conversations with Liv in the moments when I feel most defeated. She is one of my only friends my age who knows what it’s like to be chronically sick—sick in a way that doesn’t get better. Our diseases are extraordinarily different, but our shared experiences unite us in a unique bond. Today, I feel a humiliating level of defeat. And of course, it’s all rather absurd, because today isn’t different from any other day. The catalyst for my defeat: a bike ride to the mailbox at the end of my dirt road. I can’t put the words together to confess how difficult this exercise was for me. I’m just too disappointed in myself, and too ashamed. It’s only a mile to the mailbox and a mile back, but the road is hilly, and the terrain is rough. I’m grateful no one saw me. What had begun as a leisurely ride quickly became the most difficult exercise I’ve done in memory. I pushed myself way further than I should have, and my endurance was fueled by a profound anger towards my body’s many inadequacies. It was also fueled by the simple fact that I had no choice but to keep going; I needed to get home, and putting one foot in front of the other was the only way to get there (at that point I was walking alongside the damn bike). When I finally collapsed onto the living room floor, I Facetimed my family in Kalamazoo . . . their first reaction was to laugh. I don’t blame them for this, because I really did look pathetic, and it always takes people a minute to switch from the superficial observation, “Jess is horribly out of shape” to the more somber realization, “Jess is sick”. Nevertheless, I put on an almost childlike tantrum as I raged against my body. I said to my body, “You are weak, and pathetically inadequate. I’m ashamed to look at you in the mirror. Your scars are ugly. You are undesirable. No one likes you.” We all know the guilt and remorse felt after being mean to someone who doesn’t deserve it. My poor body. It has endured so much for me, more than most bodies endure, and I’m ashamed of it. I forget that it has made me a champion.

There was a brief period at the beginning of the pandemic when the chronically ill imagined that the rest of the world would finally understand what it’s like to be us. We saw people voice dismay over missed sports games, over canceled proms, and over abandoned vacation plans. We hoped their dismay would turn into empathy, and we waited for them to realize that the sacrifices being asked of them are sacrifices that we’ve had to make for years. It quickly became evident that such empathy could not be expected. We watched from afar as young people descended upon Florida beaches, as friends took advantage of cheap airline tickets, as communities gathered at packed bars, and as people selfishly hoarded toilet paper and hand sanitizer. They will never know what it’s like to be us.

I’ve heard all sorts of justifications for the social shenanigans plastered across our Facebook timelines and Instagram feeds. Mostly, people claim they deserve such festivity, and the use their feelings of “missing out” to rationalize having a good time. There’s the infamous youth on spring break who went viral for saying, “If I get Corona, I get Corona. I’m not going to let it interfere with me partying.” What it comes down to is this: people believe they are entitled to undisrupted lives. Our culture is based on comfort, indulgences, and personal gratification. For many, the mandated social restrictions have quickly become the worst thing to ever happen to them. If social distancing is the worst thing to happen to us by the time this is all over, we will be incredibly blessed.

I could say that I wish we lived in a world where bad things didn’t happen to good people and where life was fair. But I don’t wish that. Not even a little bit. Life is often ruthless, unpredictable, and unjust. When my complex autoimmune disease caused me to go deaf five days before starting college, I involuntarily put my life on hold to get Cochlear implants; and when I recovered from that I then faced a series of dangerous infections over the years, as all immunocompromised people are prone to do. Liv learned she had Leukemia while on a school trip and had to drop everything to return to California for life-saving treatment—a treatment that went on to cause its own disease. Years later, few of our past dreams or expectations for life turned to reality. None of this is fair. Bad things happen to good people. Good things happen to bad people. And we are better for it. Having our lives spontaneously disrupted proves to us that life is hard but reminds us that we can do hard things.

When I was fifteen—before I got sick—I encountered a proverb that fundamentally challenged how I viewed the world: “Tell me what you need, and I will tell you how to live without it.” Sometimes I find myself randomly reciting those words, as a reminder to reevaluate my values and priorities. It’s amazing what we can live without. As this global health crisis unfolds, we are all forced to question what is necessary, and to make the distinction between comfort and survival. I pray that on the other side, we can all call ourselves champions.

#immunocompromised #autoimmune #Cancer #covid-19 #social distancing #priorities

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we-weighlosssurgeyinmexico-blog · 5 years

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Weight Loss Surgery Cost - Search Weight Loss Surgery Cost

Bariatric medical procedure alludes to an assortment of therapeutic methods, including gastric detour, sleeve gastrectomy, movable gastric band, and biliopancreatic preoccupation with duodenal switch. While performed in an unexpected way, these techniques help patients shed pounds by constraining how much nourishment the stomach can hold just as the patient's retention of supplements. Bariatric techniques may likewise influence hormones identified with craving, prompting decreased hunger and improved satiety in the wake of eating.

Hosea settled on the gastric sleeve, a system that takes out roughly 80 percent of the stomach. At last, the organ looks like a cylinder like pocket, making it hard to indulge. This irreversible medical procedure may prompt long haul nourishing inadequacies, however Hosea felt alright with it on the grounds that the two loved ones had it managed effortlessly.

In August 2017, Hosea weigh loss surgey in mexico went from her home in Salt Lake City to the Mexico Bariatric Center in Tijuana for the gastric sleeve activity. In any case, she wasn't the only one; her dad, who additionally battled with his weight, chose to have the medical procedure also. Hosea brought up that she's Polynesian, an ethnic gathering that is defenseless against weight. Local Hawaiians and Pacific Islanders are multiple times bound to be fat than Asian Americans for the most part, and 20 percent bound to be stout than whites.

"My father was prediabetic," Hosea said. "I was not, yet I abhorred how I felt. I couldn't go around after my children. It was truly unpleasant."

Hosea didn't go to the Mexico Bariatric Center until the day preceding her medical procedure, however she and her dad had effectively consented to leave if either felt uneasy. Rather, she found the staff, the vast majority of whom talked some English, to mind and ameliorating, she said. She reviews the anesthesiologist requesting that her check in reverse from 20, and before she knew it, she was in the recuperation room arousing from the system.

Hosea assesses that she spared $9,000 by having the activity in Tijuana rather than stateside. An American specialist gave her a statement of generally $14,000 for the method, while she paid only $5,000 for the sleeve gastrectomy in Mexico.

"It was the best choice I at any point made," Hosea said. "I'll simply turned out straight and state I have no disgrace in what I did. I'm happy I did it. A few people are undercover about it. I�Following one's senses while in an outside nation for medicinal treatment can be lifesaving, as per Josef Woodman, the CEO of Patients Beyond Borders, which gives data to purchasers about universal human services travel. He supports patients considering traveling to another country for human services to altogether inquire about the medicinal office they intend to visit for treatment. He says Americans experiencing medical procedure abroad would be insightful to look for consideration in a multidisciplinary clinic or in a therapeutic focus that is near one, on the grounds that such offices are furnished with crisis rooms, concentrated consideration units, and irresistible infection groups.

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"On the off chance that something turns out badly with the patient, they have prompt access to mind," he said.

The Joint Commission International attempts to improve wellbeing at medicinal services offices locally and universally. The main principles setting and authorizing body for therapeutic treatment in the US, the commission has surveyed in excess of 20,000 human services associations. Progressively, it has offered accreditation to worldwide therapeutic offices, institutionalizing social insurance crosswise over fringes. Accreditation guarantees offices are exceptional, doctors are board-affirmed, plans for follow-up consideration are set up, dangers of going after medical procedure are laid out, and that's only the tip of the iceberg.

As indicated by the American Society for Metabolic and Bariatric Surgery, an ascent in medicinal the travel industry incited the US-based JCI to set up rules for worldwide offices. The general public keep going looked into its information on restorative the travel industry in 2015, noticing that the quantity of JCI-certify emergency clinics worldwide had expanded by right around 1,000 percent over a five-year time span. In excess of 250 offices in 36 nations presently have the accreditation, up from 27 emergency clinics in 2004.

In light of medicinal the travel industry's rising prevalence, gatherings, for example, the International Society for Quality in Health Care and the International Organization for Standardization have additionally ventured up endeavors to execute rules for therapeutic offices all around.

Woodman has voyage globally for therapeutic consideration himself and says that more Americans are doing as such on the grounds that protection inclusion in the US is inadequate. Patients who need bariatric medical procedure might be turned down in light of the fact that they're fat yet not exactly hefty enough. Furthermore, individuals who do meet all requirements for medicinal mediation might not have enough cash to pay for the expense of medical procedure, which as often as possible incorporates covered up or sudden charges.

"With the majority of the copays, deductibles, gotchas — 'Better believe it, we don't cover the anesthesiologist' — you're paying significantly more than cited," he said. "You can be guaranteed yet underinsured, except if you have a Cadillac-level protection plan."

An expected 28 percent of Americans, or 41 million, are underinsured. Sometimes, insurance agencies do cover weight reduction medical procedure yet a patient's manager has not bought the "rider" required for bariatric inclusion. Since run of the mill wellbeing plans do exclude these methods, managers need to explicitly pick in to such inclusion.

The surprising expense of having medical procedure in the US, even with health care coverage, makes bariatric methodology in remote nations "exceptionally, extremely appealing" for individuals frantic to have them, Woodman said.

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septembersung · 6 years

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After Life

TVD. Post-canon. Damon, Elena, and an excuse to try out my own vampire fiction worldbuilding ideas in somebody else’s sandbox.

Spoiler warning: If you haven’t seen through the end of season six, you might not want to read this.

1/7. Til Death Do Us Part

Damon and Elena, human together at last, are starting their new lives together. Damon adjusts to being human again, and a new arrival in Mystic Falls bothers him.

The sun hurt. With his eyes still closed, the formless world was somehow dark and bright blood orange at the same time. He could feel the heat, heavy and thick, on his face and neck - it prickled.

Damon had never felt the sun that way, so intense, so intimate, in almost two centuries of vampirism. Every sense heightened, and somehow he’d never noticed that his daylight ring did more than merely prevent him from frying like a fish in a pan.

His phone rang, muffled under the empty pillow next to him. Damon launched himself up, and stumbled. No vamp speed - it was like being stuck in molasses. Irritated, he slammed his own pillow down on top of the pile to further muffle the obnoxious sound. Someone had changed the standard ring to a fast, tinny version of the wedding march.

The phone stilled, then picked up again immediately.

With a sigh of defeat, Damon slumped down on the bed, inserted his arm under the pile of pillows, and answered the love of his life with the most pained, wrongly injured tone he could muster. “You know, I would do anything for you. I would die for you. In fact, I’m pretty sure I did. But it is—“ he held the phone out to make sure— “Six o’clock in the morning, and I haven’t even had coffee yet.”

“Aw, poor Damon.” Elena’s sweet, mocking voice crackled as the signal jumped. “It must be so hard, being woken up too early, when your only human body is still so tired.”

“The things I suffer for you,” Damon sighed dramatically, tucking an elbow behind his head. “Now what is so urgent it couldn’t wait until coffee?”

“Nothing much,” his fiancé laughed. He imagined her leaning a shoulder against the wall as she talked, twirling the golden ring on her finger, the light flashing on its crown of diamonds. “I just wanted you to be awake and thinking about me when I get to my interview.”

“That’s not til eight,” he protested.

“But I have all this time to pass, alone, in this boring hotel room.”

“You know I wanted to come. It wasn’t my decision that stranded me at home.”

“If you were here, I’d probably never make it to the interview.”

“But it would solve the boredom and waiting problems,” Damon countered cheerfully.

“I’m just so nervous,” Elena confessed, suddenly serious. “Everything depends on this. What if they don’t like me? What if I screw it up and make a fool of myself?”

“Everyone likes you! You’re the sweetest, kindest, most stubborn woman on the planet.”

“Hey!”

“Well, in med school, stubborn also means driven and determined.”

He could practically hear her smile. “Thanks, Damon.”

“Well, now that crisis is averted, I’m facing my own. A caffeine crisis. As in, you’re keeping me from it.”

Elena laughed. “Far be it from me to stand between a man and his coffee.”

They were silent a moment, the white noise of the phone jumping between them.

He heard her take a breath, but before she could go, he jumped in: “I have a lead on a place there. If you’re accepted.”

“Really? Why didn’t you tell me before! That was a good reason for you to come.”

“Because it comes through old connections.”

“You mean…?”

“The v-word, yeah. And you said—“ Damon put on his best imitation-Elena tone, comically high pitched but firm and confidently righteous: “‘We do this my way. The human way. Our way. No vampires. No vampire leads, drama, or favors.’”

“Well, what kind of connection? Is it really worth it?”

“An old friend of mine owned a bar with a little place above it,” Damon said. “But he’s moving on. Willing to let the whole thing go for a song.”

“And it’s nearby?”

“Right down the street.”

A pause. “I’ll… think about it. Maybe we can see it.”

Damon found himself grinning. “You’re gonna love it.”

“I said maybe. And I should probably go… I need to prepare.”

“It’s an interview, Elena, not an execution.”

But she wouldn’t be swayed. “I love you, Damon.”

“And I love you.” Click.

Damon stared at the phone for a moment, then creaked into action.

He actually creaked.

Would he ever get used to this? To living in slow motion, to coffee in the morning before bourbon, to sunshine that hurt? He rubbed the still-pale band around his finger where his daylight ring had rested for so many years. The skin tingled, and he shivered. Would he ever get used to this… heaviness? As a vampire, every sense was heightened and intensified, but as a human, even with duller hearing and molasses reflexes, it was somehow… worse. He felt heavier, in some ways, and lighter in others. The inability to pinpoint the exact difference was infuriating.

Standing in front of the coffee pot, it hit him suddenly, solid as a baseball bat: this is the feeling of mortality.

As he poured beans into the grinder, something else fell out. A small folded paper. He’d completely forgotten - Elena had surprised him the other morning and it was the only convenient place to hide it before she saw.

In just one more month, they’d be standing in front of everyone they loved and committing their lives to each other. Damon had been trying to write his vows for weeks. Everything was inadequate.

I love you more than eternal life. I love you more than anyone else. I love you more than myself. I love you more than I’m afraid.

The coffee percolated.

I died for you once, and I accept the inevitability of a human death for the chance to spend a human lifetime with you.

Something was niggling in the back of his mind, but he couldn’t quite put his finger on it.

You are my life, Elena.

She wanted a real, human wedding, a perfect day, with romance and dancing. And he wanted to give it to her. But their track record with special events was… not good. And what could he say, that would live up to the moment?

He filled his mug, breathing in the grounding aroma. Irritated with himself, Damon stalked to his bar, staring at the full, tempting decanters. Every morning, the same thing. Make coffee. Smell coffee. Resist the urge to exchange it for whiskey.

You’re human now, he told himself. All-day drinking in humans is called alcoholism and leads to liver failure. And - memory flashed - day-drunk is not your most attractive look.

You’ve failed Elena enough for one lifetime.

One lifetime.

That was it - the niggling memory. What had the creepy guy said? That odd morning flashed through his mind. How long ago now? A couple months, maybe. Just as they were finishing building the new church on the edge of town, right before he proposed. He’d been out for a walk, just to get away from people. Past the cemetery, past the road to the original Salvatore estate - he’d walked faster - near the construction site. He turned down its dirt driveway, eyeing the brick, stone, and scaffolding. And there was some kind of Jedi wannabe or something - an old man with a long white beard in a blue and red robe, of all things, flat on his back in the middle of the road.

“You all right?” he’d called, strolling closer.

“Perfectly,” the old man replied. He wore a deep hood, and his face was shadowed.

Damon’s heart pounded. Memories of other roads, dark nights, threatened to flood over him - he shoved them away.

He came closer, until he could see the man’s green eyes and tanned, crease-worn face.

“The church will be finished next month,” the old man said conversationally, unmoving as a stone. His eyes stayed fixed on the clear, bright blue sky above.

“Good for it?”

The old man didn’t say anything else. Damon turned on his heel, heading back the way he’d come.

“That’s what the construction company says,” the old man said. Damon paused. “And they’re right, as far as it goes. But a church isn’t built in a year, or even a century. Like anything true and good, it takes exactly one lifetime.”

“Whatever you say,” Damon replied over his shoulder with a short, dismissive wave of his hand, and kept moving.

The doorbell rang, startling him. That was the worst part about human hearing - not knowing who was coming before they announced themselves.

When he got to the door, there was no one in sight, but a flyer had been stuck through the door handle. Most Precious Blood Catholic Church Welcomes You, the headline proclaimed in bold red letters. In smaller, darker type: The Servants of St. Michael open church and hospital in Mystic Falls. And there at the bottom, was a picture of the old man in the red and blue robe. Fr. Cyriacus, SSM, Pastor.

Damon threw the flier in the trash and went to take a shower.

#my tvd fic after life

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painandinjury · 3 years

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The Good Thing That Came Out of the COVID-19 Pandemic

Dear Readers,

As you know, it has been a really tough 2020 so far, worldwide.

Here in the U.S. we’re still battling COVID-19; dealing with hurricanes, social unrest from racial conflict; a very divisive political situation, and here in California where I live, forest fires (about 400 burning at the same time at one point) enough to cause air quality warnings far away from the fires.

I know some of you are in Europe, Asia, Australia and the Middle East. I hope things aren’t so bad over there.

But enough of that. We must focus on living and make necessary adjustments to carry on with our lives.

There is an old Chinese saying that goes something like this: From crisis, there is opportunity (forgive me if I butchered it; no insult intended).

For the COVID pandemic, this turned out to be true: millions, if not billions of people all over the world learned that they could do a lot of things that they normally did in person, online. And for those who already did this well before COVID, they learned how to do it even better.

Shopping, buying groceries and sundries, attending school, working, holding meetings, attending church services, getting music lessons, and socializing are just some of the activities people learned how to effectively do online, thanks to being quarantined.

And, in my opinion, the most significant thing people are doing more of online, thanks to COVID: healthcare. Telemedicine, also called telehealth involves using a telephone and/or webcam to communicate with a health professional instead of in person, face-to-face for the purpose of improving one’s health. It also encompasses “consuming” health care content in digital format via the internet such as pre-recorded videos, slides, images, flow charts, white papers, and audio files and podcasts. I wrote about this over five years ago when I decided to transition my practice to a telehealth model.

Telehealth was just starting to gain traction right before COVID, but the pandemic accelerated its acceptance. The need to quarantine and social distance forced doctors and their patients to interact online, and things will never be the same (in a good way). We were hesitating at the edge of the swimming pool and COVID pushed us into that cold water, figuratively speaking.

Webcams, Internet, Wireless Connectivity and Mobile Devices Finally Transform Healthcare

The “planets aligned” for telemedicine, and very soon it’s going to be as common as buying groceries. To me, it’s overdue. I hope that telehealth not only enables healthcare for millions more lives on the planet, it will drive healthcare costs down. The cost savings to hospitals are obvious; and those savings should be passed on to the insured and paying patients. We’ll see if that happens. While I know people are used to tradition, starting from the days of the old country doctor with good bedside manners I think in 2020 and beyond, people are going to be just fine seeing their doctor online for simple and routine visits.

And the implications go beyond the actual care: telemedicine will save time and money on a macroeconomic scale, and will be actually good for the environment in more ways than one: less cars on the road (no need to drive to see your doctor); less electricity and other overhead expenses needed to keep a large building operable, less printed paper, etc.

Telehealth Is Ideal for your Average Doctor Visit

The vast majority of things that cause people to seek a doctor are non-emergency, and lifestyle related. Non-emergency means not life-threatening, or risk of serious injury. Lifestyle related means conditions that are largely borne out of lifestyle choices—high-calorie/ junk food diets; alcohol use, smoking, inadequate exercise, occupational/work-related, etc. and are usually chronic; i.e. having a long history–diabetes, high blood pressure, indigestion, arthritis, joint pain, etc. These conditions can be self-managed with proper medical guidance provided remotely via webcam. I believe that if lifestyle choices can cause illness, different lifestyle choices can reverse or minimize those same illnesses, which can be taught via telehealth.

Then there are the cases that are non-emergency, single incident: fevers, rashes, stomach aches, allergies, minor cuts and scrapes, and things of that nature. Sure, some cases of stomach aches and headaches can actually be something dire like cancer. But doctors know that such “red flag” scenarios are comparatively rare, as in less than one percent of all cases; therefore, the vast majority of them can be handled via telehealth. Besides, the doctor can decide at the initial telehealth session if the patient should come in the office, if he/she suspects a red flag.

A Typical In-Office Doctor Visit

Typically when you go to a doctor/ primary care physician, you are given a list of disorders and told to check off any that apply to you recently—stomach pain, headaches, vomiting, fever, etc.

Then, you are asked a bunch of questions related to your complaint. This is called taking your history (of your condition). The nurse practitioner or doctor may do this.

The doctor may or may not examine you, such as checking your eyes, ears, nose, and mouth; temperature, blood pressure, heart rate, lungs and so on depending on your history and complaint.

The doctor then takes this information and comes up with a diagnosis or two. You may be referred for diagnostic testing, again depending on what you came in for, such as an X-ray, MRI, ultrasound or blood test.

You may get a prescription for medications or medical device, and a printout of home care instructions, and then you’re done with your office visit.

With the exception of a physical examination involving touching and diagnostic tests, everything I just explained can be done via a telehealth visit on your computer. But as technology advances, more and more medical procedures will be performed remotely via a secure internet connection.

I believe that in the very near future, there will be apps and computer peripherals capable of doing diagnostic tests which will allow your doctor to get real-time diagnostic data during your telehealth visit. It’s already possible for blood sugar, body temperature, heart and lung auscultation and blood pressure.

Imagine wearing gloves with special, embedded sensors in the fingertips that transfer sensory information via the internet to “receiver” gloves that your doctor wears, 20 miles away. During a telehealth visit, you can palpate (feel) your glands, abdomen, lymph nodes, etc. and this sensory information is immediately felt by your doctor, as though he was right there palpating and examining you.

Or, imagine an ultrasound device that plugs into your HD port that transfers images of your thyroid to your doctor via the internet.

The possibilities are endless, and it bodes well for global health. Imagine all the people who can be helped, all over the world, via telehealth. It’s truly an exciting time in healthcare.

Telemedicine for Muscle and Joint Pain and Injuries

Every day, millions of people worldwide sustain or develop some sort of musculoskeletal (affecting muscles, joints, tendons, ligaments, bone) pain, whether it’s their low back, neck, shoulder, hip, knee, hand or other body part. If not treated right, it can become permanent or chronic.

Chronic pain, and even acute (recent onset) musculoskeletal pain can effectively be addressed via telehealth (this is the domain of my platform, Pain and Injury Doctor, and it’s my goal to help a million people worldwide eliminate their pain).

Available medical procedures for musculoskeletal conditions requiring an in-office visit such as surgery and cortisone injection are usually not the first intervention choice for such pain. Conservative care is the standard of care for the vast majority of non-emergency musculoskeletal pain and injury–an ideal application for telehealth.

For example, if you were to go to your doctor for sudden onset low back pain, you would most likely be given a prescription for anti-inflammatory medications, if not advised to just take over-the-counter NSAIDs such as Motrin, and rest. You would also be given a printout of home care instructions, such as applying ice every two hours; avoiding heavy lifting and certain body positions; and doing certain stretches and exercises. As you can imagine, such an office visit could easily be accomplished via a telehealth session. No need to drive yourself to the doctor’s office for this.

But what about chiropractic or physical therapy? You can’t get these physical treatments through your webcam. Yes, chiropractic has been shown to be effective for acute and chronic low back pain, but available studies typically don’t conclude that chiropractic for low back pain is superior or more economical than exercise instruction or traditional medical care. Same with physical therapy. However, as a “biased” chiropractor myself, I believe the benefit of spinal adjustments is not just pain relief, but improved soft tissue healing and structural alignment; two things that I believe can help reduce the chance of flare ups/ chronicity.

So get a couple of chiropractic adjustments if you can, but know that you can overcome typical back pain through self-rehabilitation as well (see my video on how to treat low back pain).

Many Types of Pain Can Be Self-Cured

Take a second to look at my logo. It looks like a red cross, but it’s actually four converging red arrows that form a figure of a person showing vitality, with arms and legs apart. The four arrows represent four pillars of self-care that my platform, The Pain and Injury Doctor, centers on:

Lifestyle modification (nutrition, mindset, healthy habits)

Using select home therapy equipment

Rehabilitative exercises

Manual therapy

These are four things that people suffering from pain are capable of doing by themselves, and sometimes with the help of a partner (manual therapy). All of the Self Treatment Videos on Pain and Injury Doctor incorporate these four elements of self-care (some are still being produced as of this writing). Isn’t this more interesting than a bottle of Motrin?

Conclusion

I will close with this: research shows that when patients are actively engaged in their healthcare, they tend to experience better health outcomes and it’s not hard to figure out why. By participating in your own health, you have “skin in the game;” i.e. you are invested in your health rather than being passive and wanting health to be “given” to you by a doctor through medicine or treatments. Mindset is what drives behavior, and those who are passive about their health are the ones who pay no attention until it’s too late—they don’t eat healthy; they don’t exercise enough; they voluntarily ingest toxins (junk food, alcohol, and smoking) and engage in health-risky behaviors. For many health conditions, by the time the primary symptom is noticeable, the disease has already set in; for example, onset of bone pain from metastasized cancer; or the first sign of pain and stiffness from knee osteoarthritis.

Being actively engaged and invested in one’s health will pay huge dividends in one’s quality of life, and longevity. So, in order for telemedicine/ telehealth to work for you, you need to have this mindset. You have to “do the work.” I can show you clinically proven self-treatment techniques to treat common neck pain, but they obviously won’t work if you don’t do them, and do them diligently.

Self-care for managing musculoskeletal pain is a natural fit for the telemedicine model of health care, which made its world debut this year. I’m excited to produce content that can help you defeat pain, without visiting a doctor’s office. I’m especially excited if your are one of the millions of people who don’t have health insurance or access to a health professional, and I am able to help improve your quality of life by showing you how to self-manage your pain.

If there is anyone you know who can benefit from this site, please share. Take care.

Dr. P

#Musculoskeletal disorders #Musculoskeletal pain #PainandInjuryDoctor #Low Back Pain #Muscle Pain

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aggresivelyfriendly · 6 years

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~Meet Me In The Hallway~ Chapter 11- Red Eye

I am red.

I'm wearing red and feeling that way too.

I feel foolish and ignored.

I've painted my Lips crimson, and borrowed shoes with soles to match.

I feel like I'm screaming "look at me! Look at me! Damn it, please look at me."

And the people are. Michael about screamed when I walked out to go to this tour gathering.

"What's that?" He'd pointed at me, gesticulating a bit wildly around.

"What is what exactly?" I tried for nonchalance as I reached down to pull the heel I was stepping into, like someone else's skin, over the back of my foot. I was well aware that I did not look like I usually did and that my big brother would not like what he saw when I suited up.

That's what it felt like to, like I was Superman ducking into a phone booth and putting on a part of me, a secret identity. One that I didn't share, hadn't really wanted to. But, tonight I slid the slinky red dress over the body I usually covered with days-old jeans and pilfered t shirts like it was a spandex scarlet speedo. I wanted to rock like I had a capital S on my chest that stood for sexy. Hester prynne and me wearing the badge like a brand.

"What the fuck are you wearing?" He trailed after me as I breezed by him to the mini br already helpfully supplied with the alcohol I had decided I would imbibe tonight.

I desperately needed the social lubricant I usually scorned. Harry had told me ages ago I could let go with him. It had been months, months ago, that we had gotten close. It wasn't close enough. I wanted more than his secrets inside of me. I had tried my best to be his best friend, but I was sick of that role and tonight I was determined to play another.

I poured the whisky already open over the last melting ice cube I had fished out of the bucket. It was brown grained leather on the outside, but the inside was just as inadequate as every ice holder at any level of hotel ever. I stared at it for a second before I decided I was projecting. I pulled the skirt of my sheath down a little and ignored the accompanying shift in the neckline while I answered Michael.

"A dress," I took a big sip of the brown fluid and coughed. My brother pulled the tumbler from my hand and sat it down harshly.

"I'm not sure that counts as a dress." He scoffed md shot the rest of my drink. He grimaced, "and since when do you drink whiskey straight?"

"Since now?" I poured the last of the bottle into my cup and took a gulp. Forcing myself not to react.

Michael blinked at me. "Listen, I knew you were upset when you came in earlier, and I was an asshole and decided I'd ignore it figuring it was some girl shit and you'd b fine by tonight." He looked me up mr down. "But, your current game of dress up makes me think I should have stopped you to talk then. What's up?"

"Nothing, I'm fi—"

"Fine," he finished for me. "But I'm calling bullshit, because you just used the words nothing and fine within seconds of each other. Where were you last night?"

I laughed. That was a question he probably shou have asked before we left the UK, the carecwas yo little to late. His concern was also the source of my irritation in about a million ways.

Harry and I had been cirque de soleil level acrobats lately based on the skill with which we had been walking the tightrope of friendship over the abyss of more. I wanted to dive in and trust that a blanket of feelings would rise up to catch me, and that he would follow me down. I'm not sure what he wanted; so I walked the line.

I caught him at times. Well, daily, really. He of the lingering stare and the constant touch.

There must have been opposing magnets in his palm and my sacrum. He loved to touch me there, I deduced. The sway of my back a desktop pendulum he carelessly set in motion when in need of a fidgety distraction. The regularity with which he pulled me in and wrapped me up in his spider arms would be alarming if I didn't want to live in his web.

So here I was, ready to ruin the friendship and making every effort to do so.

"I slept over with a friend last night, brother. How about you?" I grinned and took a tentative sip, not ready to brave a full mouthful while I tried to talk tough and declare my independence and outfit determination.

He had the good grace to look chagrined. "That's not the point." He carefully took my glass away and I let him because of the tender look in his eyes. "I think maybe I haven't been looking after you properly. 'Ve been distracted with all the—"

"Perks." I helpfully supplied with air quotes.

We shared a conspiratorial grin before his face pulled a 180. "Have you been enjoying 'perks'?" He didn't like the thought of that.

So I took pity on him and dropped my persona for a minute as told him my unfortunate truth. "No. I haven't." I held up crossed fingers. "But, it's not your business if I had been, Michael." I said it tenderly but meant it with all of my heart.

"Look, I know you are a grown up," he looked around helplessly., at me and then at the ground. "But, I promised mum I'd look out for you, and I think she'd have objections to this get u—"

"And I'd tell her what I'm gonna tell you." I took my drink back, thinking it funny that we're essentially sharing the whiskey. It had loosened our tongues and the reins on our feelings. "I'm a big girl, I'll wear what I like. Lou had the dress and I like the way I look. The way I feel." I put my hand on his forearm. "Let me try this version of me on tonight, when it's safe, and you can keep an eye on me?" I said it like a question, my neville chamberlain attempt at appeasement.

I would give him an inch, but I wasn't changing.

"You look really beautiful," he grinned but it didn't reach his eyes. "Though it pains me to admit it." He looked me over again, "yeah, I really don't like it."

"Luckily, you don't have to like it, mate," I handed him back the tumbler and he finished it. "Ready?"

"Ugh." He shivered with the final gulp. "Yeah, let's go." He offered his arm and I decided to go with the silly mood he was setting.

That crisis was averted, but the current situation has me much madder than my brother's overprotective-ness could evoke.

I'm not sure what I had been expecting that night, I think I had spent so much time ruminating over my feelings and planning my appearance, that I just expected- more.

I knew how I felt about Harry, well I had sight of the iceberg at least. I may not have been sure about the submarine expanse, but I knew. Fuck being best friends.

But, his best friend had been a recent declaration up til that point. Only a month had passed since he had put a label on us. A label that felt like the sweater a rich auntie gives you. Beautiful and special, maybe even rich, but I'll fitting. It felt much to small to contain what I was sure we had.

Those were all of my feelings though. I had not asked Harry directly about his feelings. I only knew about the inadequate vestment he had put upon us. Even now, I'm not sure where he was in those early days.

We mourn expectations more than anything I guess.

My expectations were sky high. Maybe I thought I would walk in, looking like a million possibilities, and bucks, and he would fall at my feet; Fawn over me the way I restricted myself from doing on a daily basis. Far away from prying eyes. Why I thought he would out us, when there was no us, I don't know. He was not as private as he continually became, but we had mutually and silently agreed to be a secret.

I hate comfortable silence.

I especially hate uncomfortable silence. And that is what I encountered. Besides a widening of the eyes when I walked in, there was no acknowledgement of my presence, let alone the moth to flame scenario I had imagined. All of the conversations I had rehearsed as I painted my lips red in preparation for painting the town the same hue, went unused.

Maybe he was not uncomfortable. Maybe the chafe of my dress and the chap of my hide had more to do with how totally at ease he seemed.

He was not fawning over me. There was most certainly fawning however. And Harry, rather than falling at my feet was occupied entirely with the girl at his feet.

She was actually on his lap. And she was perfect. She was not the lady in red and I thought her dress was a size too small. It still fit her better than mine did.

They weren't kidding, but it seemed a matter of time to me.

I couldn't stand the thought of his lips on hers. I had decided earlier, when I chose the lip stain rather than the stick, where I wanted his mouth painted at the end of this night. More expectations unmet.

I was doing my best not to notice how much she was laughing. I wanted to pretend that it was a put upon giggle. His harmony of snort and sneeze was undeniable though. I knew that laugh intimately. Half of the lines I had crafted while curling my hair carefully had been dedicated to drawing it out.

My stomach hurt.

I realized that I didn't remember when I had last eaten. I walked away from the crew member who had shown me the attention I was seeking. He was sweet and attentive, and lacking. His eyes weren't even green.

I don't recall if I said a word in excuse when I walked away.

I found Niall, predictably, by the food. When I took a plate, he looked up in happy surprise.

"Mel, you look cracking!" He exclaimed and hugged me. I loved the exuberance of Niall in theory. In practice, it overwhelmed me. But I wasn't me today, and I was just begging for worthy attention. Niall would do. He was at least answering my call for attention.

"Thank, Niall!" I tried to match his volume If not his enthusiasm. "What's good eating here."

He finished chewing the bite he had taken of the hunk of brown bread taking up most of his plate.

"Well, my Irish heart is currently full because Sarah made me this," he pointed to the piece of loaf.

"Bread?"

"No, dear silly Australian girl! Irish brown bread. Best bread in the world." His expansive gesture nearly sent his precious to the floor. "It's rich and yeasty and fillin. Here try it." He plonked some onto my plate.

"That description sounds like it requires a trip to the doctor, mate. It's less compelling than you think," I looked at the slab as he buttered it dubiously.

"Nah, you'll see, just try it," he assured.

"Bottoms up," I raise it to my mouth.

"That's for Guinness lover, that comes next, but try this first." Niall nodded as I chewed.

"Ummmm," I commented while taking another bite. The bread was wntirely satisfying and was soaking up the sourness in my belly caused by whiskey and emotion.

"Right!" Niall loaded me with another piece and some roast meat and gave me a one second gesture while he ran off. He returned with a beer and I found that I wanted to stay in his warm presence. His warm amber glow has dulled the green of my envy and red of my rage.

I found myself laughing and accepted the beers Niall fetched me, maintaining the buzz in my veins and ignoring the one in my brain.

I knew that Niall was pleasant company. On the few days when everybody was out and about, or bound inside, together he was hard to miss. Often the center of attention, with a guitar on his lap, a song in his throat and a smile on his lips. He was easy to be around. Being the center of his attention was flattering. I also appreciated that he didn't seem to care who saw us.

We had caught a fair few eyes. Lou looked delighted for instance. I'd seen Lottie lean in conspiratorially several times to her ear. It was nice to be part of their clique. They eVen seemed to have enjoyed my distracted behavior at the mall and liked me anyway. I'd also seen Louis nudge Liam not so nonchalantly.

My boys had also noticed. Ashton has even called Niall out for it. But Niall has only raised a glass to him. The cheer that came up as a result warmed my cheeks, but I was surprised how happy I was to stay on the cozy couch even with the focus of the room shifting to us with regularity.

There were two pairs of eyes not as enthused by the boisterous laughs and innocent touches my Irish friend gave and evoked.

Occasionally I could feel the burn of familiar mossy eyes on me. They were not the only pair trained on the way I was tucked under Niall's shoulder giggling. Michael looked particularly sour, his mouth downturned and I wondered when he would come over with some excuse to butt into my lively conversation.

I basked in it. It was not the attention I wanted paid to me, from Harry or Niall, and especially not Michael. I didn't really want anybody else's attention at all, but I could ignore it. Michael was also impressing me. He respected my earlier statements for longer than I expected. My display was being respected, however upsetting my brother found it.

It was effective though. My intended target was thoroughly distracted from the manicured hand currently plowing rivulets through his curly head.

This incarnation of me is unfamiliar. She is useful though, and I for a moment appreciate why so many artist have a persona they take on when they need to be something they are not, or grander than they feel.

I feel as powerful as the color I am wearing and as noticeable. But, the best part?

I'm not the only who is red.

Unbeta-ed as @nocontrolforlouis had better be on a surfboard and I left it to long to ask @emulateharry. Forgive the mistakes, I loathe editing.

#harry styles #harry styles fanfiction #harry styles fanfic #harry styles imagine #meet me in the hallway #mmith #chapter 11 #anybody got blue balls

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gordonwilliamsweb · 3 years

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Addiction Treatment Providers in Pa. Face Little State Scrutiny Despite Harm to Clients

This investigation is a joint project of KHN, a national newsroom that produces in-depth journalism about health issues, and Spotlight PA, an independent, collaborative newsroom dedicated to producing investigative journalism for all of Pennsylvania.

This story also ran on Spotlight PA. It can be republished for free.

When Ian Kalinowski was at work, his mom usually texted him. So when he saw her number show up as an incoming call around lunchtime one Tuesday, he figured it had to be important.

Now, more than seven years later, he remembers her screams, the shock and the questions she asked over and over again.

“Why are they saying this to me? Why are they lying to me?” Ian recalled his mom asking. “They’re telling me Adam’s dead. Why would they do this to me?”

Adam was Ian’s older brother. Growing up, it seemed they spent every second together. Football, hockey and tag filled long days outside their Pittsburgh home. When Ian moved away for college, he and Adam turned to online poker to stay in touch. Adam served as best man at Ian’s wedding, and Ian admired his brother’s artistic streak. Adam could turn any piece of paper into an origami swan. His mom’s home is still full of swans.

Adam’s struggle with opioid and alcohol addiction was painful for Ian to watch. The problems began, it seemed to Ian, after Adam dropped out of college and used drugs to deal with his depression. Adam sought treatment, and he relied on methadone for many years, but his problems continued. When he was 32, he typically drank dozens of beers each day. On Feb. 3, 2014, he entered a treatment center run by Addiction Specialists Inc., according to a lawsuit later filed by his family against the facility. The center, in a Fayette County strip mall, was about an hour’s drive south of Pittsburgh.

Less than 24 hours after Adam made it to the facility, he was dead, according to expert reports from doctors in the family’s wrongful death lawsuit. Ian couldn’t understand what went wrong, and neither could his mom, still in denial on the other end of the phone call.

What his family didn’t know was that Addiction Specialists, often known as ASI, had a history of violating state rules. In a later federal investigation into the facility’s billing and drug distribution practices, a grand jury concluded that a litany of problems occurred at the business many months before and after Adam’s arrival.

In the wrongful death suit, a lawyer for the Kalinowski family alleged Adam wasn’t evaluated by a physician when he arrived at ASI, didn’t receive the medication or treatment he needed, became increasingly uneasy and anxious throughout the night and killed himself. An Allegheny County judge in December 2019 said the business, two of its owners — Rosalind and Sean Sugarmann — and an ASI physician were negligent in caring for Adam. The judge ordered them to pay over $1.6 million in damages, although Ian doubts they ever will.

ASI eventually shut down, two years after Adam died.

In recent interviews with KHN-Spotlight PA, the Sugarmanns denied responsibility for Adam’s death and maintained that ASI was a good facility. Rosalind said it helped a lot of people in a rural area with a high drug-overdose rate.

Addiction treatment facilities in Pennsylvania, like ASI, are licensed and regulated by the state to ensure they follow certain rules and keep vulnerable people struggling with addiction safe. Oversight used to fall to the Department of Health. But in 2012, the state created the Department of Drug and Alcohol Programs, a $125 million agency set up to give substance use the attention lawmakers felt it deserved.

At the time of Adam’s death in 2014, the department had taken few disciplinary actions against ASI. It had issued citations and required the company to submit plans to correct them. But the Sugarmanns told KHN-Spotlight PA that, at the time, they didn’t fear the state would shut them down.

Perhaps for good reason.

A KHN-Spotlight PA investigation found that the department has allowed providers to continue operating despite repeated violations of state regulations and harm to clients. More than 80 interviews and a review of thousands of pages of state government and court records revealed that the department lacks resources and regulatory power, uses an inherently flawed oversight system that does little to ensure high-quality or effective care, and rarely takes strong disciplinary action against facilities when so many Pennsylvanians need services.

The department has no standard criteria for when it should force facilities to serve fewer patients and, as of early April, had revoked just one treatment provider’s license in nearly a decade. It doesn’t, as a regular practice, compare facilities to see if any stand out for an unusual number of violations or the most client deaths. And since state inspections focus heavily on records, they can be tricked with fraudulent paperwork, former employees in the treatment field said.

This leaves Pennsylvanians — who suffer one of the highest drug overdose death rates in the nation — in the dark about which treatment facilities have troubling track records.

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Some advocates point out that overregulating or closing facilities could leave people suffering from addiction without options for care. But in the current system, state and judicial records show, some patients have received inadequate treatment or even died; certain facilities have fraudulently billed insurance companies; and owners rake in federal and state tax dollars, as well as private money from victims of the opioid crisis.

“Many of these rehab facilities are not properly run or supervised, and many are in it for the money,” said Peter Friday, an attorney who represented Adam’s family in their lawsuit. “These places have been unbridled.”

Who Polices the Providers?

Even though the Department of Drug and Alcohol Programs provides the licenses that allow addiction treatment facilities to operate, Jennifer Smith, secretary of the department, said it has limited responsibility for them. Law enforcement agencies are often better positioned to take action against troubled providers, she said, and insurance companies that pay for services also offer oversight.

“It’s not our job to really police the providers,” Smith said in an interview. “Our function is to really try to enable them to meet the [state’s] requirements, and by doing so, enabling them to provide quality services.”

Yet, as the regulating body of these treatment facilities, the department collects some of the most critical information necessary to properly police them, including reports of client deaths and physical and sexual assaults.

Smith said most providers are trying to do good work. She said annual inspections ensure facilities meet safety standards, like having enough staff members and a building that’s up to code. But inspections are not meant to evaluate quality of care, she said.

The KHN-Spotlight PA investigation found the department makes little of what it knows about troubling facilities accessible to the public. Its website shows if a facility currently has a provisional license — a designation indicating the provider failed to meet several state requirements and will be inspected more frequently until it resolves those concerns — but not whether it ever received such a sanction in the past, for what issues, nor how they were resolved.

The department does not post the reports it collects about deaths and assaults, which represent some of the most concerning events at treatment facilities.

When KHN-Spotlight PA filed a public records request for those reports, the department shared only incidents that it decided did not warrant investigation. It said it could not provide the total number of such events at specific facilities since it doesn’t have aggregate data prior to September 2019, when it launched a new electronic reporting system. Even the available data from that new system provides an incomplete picture, as less than a quarter of treatment facilities had enrolled in the voluntary system as of March 2021.

Smith said people should pick facilities the same way they do primary care doctors, based on publicly available information, personal recommendations and discussions with insurers.

One of the main public resources the department offers is a website with reports from its facility inspections. Inspectors write these reports after a site visit, listing any violations of state regulations they found. But these reports provide a limited window into the daily reality for clients, as there’s no indication of which violations are more severe than others, and many regulations focus on building conditions and completion of records. One regulation, for example, mandates the temperature at which refrigerated food must be maintained.

In response to each violation inspectors find, the facility submits a plan to address it. If the facility fails to provide a plan or follow through on it, the department has two primary options: force the facility to reduce the number of clients it serves or issue a provisional license. If the department wants to permanently revoke a facility’s license, it must go through an administrative court process to get approval.

In nearly a decade before December 2020, the state issued provisional licenses to fewer than 80 facilities — less than 10% of providers— and forced only three to reduce their capacity, according to data from the department. In ASI’s case, regulators said multiple times that the company failed to document that it provided required counseling and other services. A department spokesperson said it didn’t force ASI to operate under provisional licenses before 2015 because the business submitted plans of correction the department found acceptable. Even if a facility has many violations, the department considers how cooperative it is in working to fix them, Smith said.

After a recent reorganization, the department formed a quality improvement unit with three employees, Smith said. The unit may work directly with treatment facilities but is meant to address broader prevention efforts and other addiction-related programs as well. The department is also working with a national company to provide an online platform where clients can leave reviews of facilities, starting in spring 2022.

But many employees and clients in the treatment field are skeptical of any long-term improvement. For years, they’ve seen troubled facilities make fixes, only to have the same deficiencies arise in later inspections.

The department’s own records show the cycle can persist for years.

Years of Citations, Little Action

At SOAR Corp methadone clinic in Philadelphia, inspectors from the state Department of Health first issued citations for unqualified employees in 2009, before the Department of Drug and Alcohol Programs was created and took over inspections in 2012. Inspectors at the time also found one counselor who was responsible for 40 clients — above the state-mandated maximum of 35.

SOAR Corp responded by saying it had demoted an unqualified counselor, had hired another counselor to lower caseloads and would ensure future hires met the state’s requirements.

But state records show that within a year of those 2009 citations, the facility was cited three more times for similar issues: hiring an unqualified project director, overloading counselor caseloads and lacking enough medical personnel. Year after year, state inspectors found the same problems. Yet the state approved SOAR to open additional locations in Lansdowne, Levittown and Warminster in 2010, 2016 and 2018, respectively.

In interviews with KHN-Spotlight PA, a dozen former employees and nearly a dozen current and former clients across multiple SOAR sites complained about poor hiring practices and chronic understaffing as just two symptoms of their much larger concerns. They believed the company relentlessly pursued profits by getting as many clients in the door as possible, with little care for the quality of treatment.

The Philadelphia location has received three provisional licenses from the state, in 2012, 2019 and 2020, putting it among the 10 most frequent recipients of this sanction over nearly the past decade.

The former counselors felt that expectations to maximize “billable hours” led to their burnout. And they saw high turnover among staffers. The former and current clients said they sometimes went weeks without therapy or were switched from one overwhelmed counselor to another every few months.

Nicole Tihansky was a client at SOAR’s Levittown location for about a year until last fall. She said she waited more than a month before getting her first counseling session, and then was assigned about five counselors, one after the other.

“It makes you just want to get in and out of the session quickly, because you know you’ll get another counselor in a month,” she said.

Understaffing is a problem across the treatment industry, according to employees in the field. But former SOAR employees who have worked for multiple companies said SOAR stood out in their experiences for its high staff turnover and inadequate therapy.

“It’s not about therapy or addressing the needs of clients,” said Esther Kirshenbaum, a counselor who worked at the Philadelphia location from 2017 to 2019. “The attitude is to just get clients in here and make sure we get paid.”

In a statement, SOAR CEO Richard Mangano said the company “makes every effort to comply with local, State, and Federal regulations.”

KHN-Spotlight PA shared with SOAR a detailed list of more than a dozen allegations from their reporting, including violations of state regulations and putting profits over patient care. Mangano did not address them specifically.

“Soar Corp categorically denies any allegation or suggestion of wrongdoing. … Soar Corp has and will continue to work with DDAP to improve the important services it provides,” Mangano wrote, referring to the Department of Drug and Alcohol Programs.

In its responses to state citations in recent years, SOAR explained that clients didn’t show up to scheduled counseling sessions, and that services like drug tests and physician evaluations had been provided but simply not documented properly.

The Department of Drug and Alcohol Programs has never forced SOAR to decrease its capacity, nor have state officials initiated the administrative court process to permanently revoke its license.

Former clients and employees said state licensing inspections were announced ahead of time, causing a rush by SOAR employees in the days before a site visit to complete treatment plans, counseling notes and other required paperwork.

Nicholas Cucchiaro was a SOAR counselor from 2017 to 2018. He shared with KHN-Spotlight PA what he reported to the Department of Drug and Alcohol Programs and the Pennsylvania Office of Attorney General after he was fired. He told the agencies that a senior administrator at SOAR instructed him to make up counseling notes for clients who had gone weeks without an assigned therapist.

“These are notes from therapy sessions that never happened,” he said, adding he knew it was wrong but feared losing his job if he didn’t comply.

About a dozen other former employees and clients described to KHN-Spotlight PA their own experiences of similar practices, ranging from thrusting months’ worth of forms upon clients in the days before an inspection to backdating their paperwork.

The Department of Drug and Alcohol Programs and the attorney general’s office both agreed to look into the allegations, Cucchiaro said, but he didn’t hear of any consequences for SOAR.

The attorney general’s office told KHN-Spotlight PA that it reviewed “a small number” of complaints regarding SOAR and referred the matter to the Department of Drug and Alcohol Programs.

Smith, the department head, said that as a general matter it’s difficult to prevent facilities from falsifying paperwork, because state regulations require advance notice of licensing inspections. But if the department receives a complaint, it can conduct unannounced inspections, she said, and other facilities have been cited for fraudulent paperwork.

Unannounced site visits were made in response to the complaints at SOAR, according to a department spokesperson, and citations were issued for violations that did not include fraudulent paperwork. SOAR’s Philadelphia location received provisional licenses in 2019 and 2020, but as of mid-April all the company’s sites were operating on full licenses after remedying the cited issues.

A Growing Industry

One significant limitation on the department’s oversight is its inability to impose financial penalties on treatment facilities.

In contrast, the state’s environmental protection and health departments can fine polluters and nursing homes for violations.

A 2017 report from the state auditor general’s office urged lawmakers to allow the department to charge licensing fees and assess financial penalties, pointing to other states that do so. Smith told KHN-Spotlight PA that fining facilities would help weed out repeat violators.

A bill introduced in the Pennsylvania legislature to allow the department to generate licensing fees went nowhere two years ago. A similar measure was recently referred to the state Senate Health and Human Services Committee.

“I hope that it’s considered quickly as ensuring drug treatment facilities are given appropriate oversight is of utmost importance,” the bill’s sponsor, state Sen. Judy Schwank (D-Berks), said in a statement.

Meanwhile, with millions of dollars on the line, the treatment industry is growing in Pennsylvania. Over the past four years, the state has seen a net gain of about 40 facilities, the department said, bringing the total to more than 800 treatment providers. State budget documents suggest the industry’s client capacity has grown by about 5,000 over a similar period.

The Department of Drug and Alcohol Programs employed 82 people, including two dozen who conduct facility inspections, as of April. That's about half the number of dog wardens employed by the state to inspect kennels.

Smith said there is “adequate staff to perform our current licensing responsibilities.”

In December 2018 — the same year the department said it received complaints from former SOAR employees and clients — it approved the company to open a location in Warminster. Inspection surveys at the facility since have found it violated state rules by providing a certain medication without state approval and failing to provide the required hours of therapy to some patients.

A former SOAR supervisor who is still working in the treatment industry and asked not to be named doubts the state will ever take stronger action against the company.

“The state knows the demand for treatment and the demand for medication-assisted treatment,” the former supervisor said. “If you took SOAR’s license in Northeast Philadelphia and didn’t give them a provisional, you could be displacing 500 clients.”

The Need for Treatment

The urgency of the opioid crisis puts regulators in a tough position: If they shut down a facility, where will all the patients get treatment?

James McKay, a professor at the University of Pennsylvania’s medical school who researches the efficacy of addiction treatments, said facilities that are committing insurance fraud or actively harming patients should be penalized. But the question becomes more complicated when judging how well a facility is serving its clients.

In Philadelphia, where there are many treatment programs, it might make sense to close one that has ineffective interventions, untrained counselors and many clients dropping out, McKay said.

“But if you’re out in the middle of the state and there’s only one treatment program in any reasonable distance, as long as they're not treating you badly, you’re at least going to get some support and meet others in recovery,” he said. “So much of this depends on what the other alternatives are.”

In western Pennsylvania, an inpatient detox and rehab facility called Clear Day Treatment of Westmoreland has received multiple provisional licenses since it opened in 2018. State inspectors have noted at least six incidents that involved drugs on the premises and have cited the facility at least twice for understaffing, writing that the lack of sufficient staff fails to ensure “efficient and safe operation.”

Despite these concerns, the facility is the only one in the county that provides detox services while allowing patients to stay on any of three medications for opioid use disorder. Many patients in the area need that service, said Colleen Hughes, executive director of the Westmoreland Drug and Alcohol Commission. (The commission is one of more than 40 agencies across the state that the Department of Drug and Alcohol Programs contracts with to coordinate substance use services locally.)

The commission determined in 2017 that a lack of residential rehabs in the county was one factor delaying people’s treatment. Clear Day responded to a request for proposals to meet that need from companies that manage Medicaid-paid behavioral health for the state in that region. Clear Day has been awarded nearly $750,000 in state Medicaid funds left over from previous years to help with startup costs, according to Southwest Behavioral Health Management, one of the companies that put out the request.

Stephen Devlin, executive director of Clear Day, said in a statement that Southwest Behavioral Health Management closely monitored those funds, which helped the facility provide “much needed” addiction treatment services.

“State auditors have been diligent in ensuring that Clear Day addressed all deficiencies that have been identified during audits,” Devlin wrote, “and, further, that Clear Day provides strong and effective treatment to the individuals in our care.”

Hughes said her office has addressed the issues of understaffing and drugs on the premises with Clear Day through meetings and training sessions.

Smith, head of the Department of Drug and Alcohol Programs, said: “None of us want to see providers closing. We want them to be successful. We want them to be able to deliver the services for their benefit and for ours.”

Waiting for Consequences

In Fayette County, ASI came under fire from state and federal authorities in 2015.

The FBI raided the facility that October. The following January, a federal grand jury indicted one of the owners, Rosalind Sugarmann, and an ASI doctor on multiple counts of illegally distributing a medication to treat opioid addiction.

Nearly three months later, a counselor employed by ASI overdosed while staying at the facility, an attorney for the state later said in an administrative court filing against ASI. Ultimately, a bankruptcy case forced the business to close.

In late 2016, Sugarmann pleaded guilty to illegal drug distribution and health care fraud. But that hasn’t kept her and her family out of the recovery business. Less than a year after she was released from prison, Sugarmann — who has talked publicly about her own substance use decades ago — announced she was opening a recovery home.

“I’m not going to stop working with addicts ever. That’s my calling in life,” Sugarmann said in an interview with KHN-Spotlight PA. “Somebody helped me, and I help somebody else.”

But two families said Sugarmann failed their loved ones.

There’s Adam Kalinowski, who died at ASI in 2014, and there’s 37-year-old James Pschirer, who died of an overdose in a recovery home Sugarmann’s family operates. These homes offer peer support and often have curfews and rules designed to help people stay away from drugs after they’ve been discharged from inpatient treatment.

In Kalinowski’s case, Sugarmann said ASI reported his death to everyone it was required to. There’s no indication from department records that the state cited ASI in connection with his suicide.

(The Department of Drug and Alcohol Programs wouldn’t comment on Kalinowski’s case specifically but said it worked with the FBI to investigate problems at ASI.)

Neither Sugarmann nor her husband, Sean, mounted a defense against the Kalinowski family’s lawsuit in court. In a recent interview with KHN-Spotlight PA, Sean Sugarmann placed the blame for Kalinowski’s death elsewhere, saying that the facility was staffed correctly and that, given his eventual suicide, Kalinowski never should have been sent to ASI.

Kalinowski’s family also sued UPMC Mercy, the Pittsburgh hospital where he was treated before going to ASI, and affiliated entities, but resolved the claims against them through a private settlement, according to a family attorney. UPMC denied responsibility for Kalinowski’s death. In a pretrial court filing, an expert witness for UPMC directed blame at ASI, saying Kalinowski was well enough to be safely discharged to a residential treatment facility. That he wasn’t evaluated by a doctor, nurse or professional counselor when he arrived at ASI was a concern, the expert wrote, and “perhaps this tragedy could have been avoided” if ASI had provided a higher level of care.

More recently, Rosalind Sugarmann has faced criticism for her involvement with recovery homes.

In February 2019, while still under federal supervision, Sugarmann announced on a blog that she was “back in commission!!” and would open a men’s recovery home called The Second Act outside Pittsburgh.

A 2017 law gave the Department of Drug and Alcohol Programs new power to regulate recovery homes in addition to treatment facilities. The state missed a June 2020 deadline to implement the voluntary licensing process but plans to roll out the program this year.

James Pschirer turned to The Second Act for a place to stay in the fall of 2019. His mom, Andrea Zack, helped him with rent, writing out a $250 check to Sugarmann, according to a photocopy of the check the family provided.

Then, on Nov. 1, 2019, James died inside the home from a fentanyl and cocaine overdose, a photo of the death certificate provided by his family showed.

Andrea and James’ sister, Amanda Pschirer, went to The Second Act to collect his clothes and personal items. Andrea kept the coins in his pockets, knowing he had touched them.

It wasn’t until after James’ death that his family found out about Sugarmann’s criminal conviction, they said.

Amanda knows her brother chose to use drugs, but she thinks he could still be alive if he had stayed in another home with better oversight. And she’s angry that nothing stopped Sugarmann from being involved with one.

“I am worried that someone else will die under her care,” Amanda said.

In interviews, Rosalind and Sean Sugarmann downplayed their involvement with The Second Act. “My kids are involved in the recovery homes,” Rosalind told KHN-Spotlight PA. “I’m not an owner there.” The business is registered in their children’s names, and Rosalind said she’s lived in Los Angeles since early 2020.

Still, Sean Sugarmann acknowledged helping his adult children manage the business, and said in March he was living in the men’s home at that time. One of his daughters referred questions about The Second Act to Sean. Rosalind promotes the business on social media accounts, encouraging people to move in. She told KHN-Spotlight PA, “I’m not gonna deny that I’m a consultant.”

Sean said an overdose death “could have happened anywhere, and I think it happens everywhere.”

Last fall, Amanda Pschirer reached out to state officials with concerns about recovery homes. But she said she didn’t receive a response for four months. The department said a computer glitch with an online form, discovered in January, caused the delay in responding to her submission and about 260 others.

Ian Kalinowski, whose brother died at ASI seven years ago, has followed Rosalind’s posts online and saw that she’s still involved in the recovery business. He’s outraged.

He and his family are still grieving Adam’s loss. Ian wishes his young children had gotten to meet their uncle. He doubts the ASI defendants will ever provide the $1.6 million-plus that the judge said they owe.

Ian recognizes that ASI’s leaders faced some consequences for problems at the business.

“But there have still been no repercussions for what happened to my brother,” he said of the Sugarmanns.

He’s not optimistic there ever will be.

Methodology: How We Investigated Pennsylvania’s Addiction Treatment Industry and Found Weak Oversight of Providers

Pennsylvania is at the epicenter of the nation’s opioid crisis, ranking among the top five states for overdose death rates and top 10 for number of adults suffering from substance use disorder in recent years, according to national data. And the addiction treatment industry there is growing.

Federal grants, state initiatives and Medicaid pump millions of taxpayer dollars into the field annually. The state has seen a net gain of about 40 licensed treatment facilities over the past four years, bringing the total to more than 800.

But an investigation by Spotlight PA and KHN found the Pennsylvania Department of Drug and Alcohol Programs — which licenses these facilities — provides weak oversight and lacks the resources and regulatory power to police them, allowing providers to continue operating despite repeated violations and harm to clients. The department has no standard criteria to determine when it should force facilities to serve fewer patients and, in nearly a decade, has revoked just one provider’s license.

Spotlight PA, an independent, collaborative newsroom reporting on the Pennsylvania state government and statewide issues, began investigating the oversight of addiction treatment facilities shortly after its launch in late 2019. The newsroom later partnered with KHN, a national organization that produces in-depth journalism about health issues.

Our team began by scraping thousands of facility inspection reports from the Department of Drug and Alcohol Programs’ website. We then analyzed them to find the most egregious citations: ones that mentioned a failure to report patient deaths and assault, that noted medication errors or that revealed unsafe staffing ratios.

We also requested from the department historical data about which facilities had received provisional licenses — designations indicating that facilities have failed to meet several state requirements and will be inspected more frequently until they resolve those concerns. The department didn’t have an automated system to gather this data but agreed to compile it manually. It provided the information with the following caveat: “Due to incorrect data entered into the licensing database, the attached report may not include all provisional licenses since 2012. It is as close to accurate as we can determine base[d] on the available data.”

Additionally, the team filed an open records request for reports of unusual incidents. These are certain serious events that the department requires facilities to report, including client deaths and incidents of physical and sexual abuse, among others. The department provided reports of only those incidents that it decided did not warrant investigation. It said it could not provide the total number of such events because it doesn’t have facility-specific aggregate data prior to September 2019, when it launched a new electronic reporting system. Even available data from that new system provides an incomplete picture, as less than a quarter of treatment facilities had enrolled in the voluntary system as of March 2021.

Reporters also reviewed the department’s administrative court history to see cases in which the state had initiated legal action against a facility.

To further inform our reporting, Spotlight PA launched a public callout for readers to send in tips and concerns about facilities.

Using a combination of these sources — facility inspection surveys, provisional license history, administrative court cases, limited reports of unusual incidents and tips from the public — we compiled a list of 34 facilities that appeared to have the most troubling track records.

From the short list of facilities, Spotlight PA and KHN reporters then reached out to current and former employees and clients at various locations. The interviews helped establish whether people’s firsthand experiences matched the concerns that arose in the data.

Our reporters also reviewed the licensing applications that these facilities had submitted to the state, as well as lawsuits filed by clients and employees against the facilities. We interviewed former employees of the Department of Drug and Alcohol Programs to understand the oversight system and challenges within the agency.

The final story was based on interviews with more than 80 people and a review of thousands of pages of state government and court records.

Spotlight PA is powered by The Philadelphia Inquirer in partnership with PennLive/The Patriot-News, TribLIVE/Pittsburgh Tribune-Review, and WITF Public Media. The independent, nonpartisan newsroom is funded by foundations and readers like you who are committed to accountability journalism that gets results: spotlightpa.org/donate

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Chloe's Petals for Hope, Pt. 2 - March 16th, 2021

Chloe’s Petals for Hope is a foundation to bring awareness to and normalize Mental Health issues. The foundation was started by Susan and Kent Rogers with daughters Courtney and Teagan along with support of family and friends after their daughter Chloe’ died by Suicide on June 16, 2020. Chloe was fun-loving and enjoyed life, however, she struggled with Mental Health issues including anxiety and depression.

This is our story:

 Chloe was diagnosed with ADHD in the First grade. She began taking Adderall which managed her ADHD til her Freshman year in high school. She then wanted to stop taking her medication because she was very skinny and she said kids were making fun of her. We agreed she could stop taking the medication as long as her grades did not go down. She did well during high school and did not take ADHD meds again. She was concerned when she began college but again chose to not to take the meds. She struggled some with grades but worked really hard and was able to manage.

Then the end of Freshman year in college came and so began her real struggles. In January, she totaled her car in the dorm parking lot. She was so upset and distraught with herself. She then began serious negative self talk. She began a 3rd shift job at a nursing home and complained of being so tired, etc. When we talked about it, I told her it was probably her messed up sleep pattern working 3rd shift. Then she began having flu-like symptoms so went to the infirmary where she was diagnosed with Mononucleosis. It was hard for her to bounce back from these things happening within a short period of time.

She eventually began feeling better physically, but became so overburdened emotionally. She was constantly worried about student loans, money, grades, etc. She also felt like everyone wanted her to be a nurse because she enjoyed being a CNA and was really good with her patients. She did not want to be a nurse but was trying because she THOUGHT this is what others expected. In reality everyone else just wanted her to do what made her happy and she would enjoy doing everyday of her life. She finally realized that she was pursuing something she had no desire to continue with so she changed her major to Communications and Marketing.

She hid her worries and anxieties from most people. Only those who lived with her or spent days at a time with her truly knew her struggles. She wanted to be and do everything she thought was expected of her and do it while looking like she had it all together.

Her sophomore year of college was less hectic but she struggled with friendships, working and keeping her grades up. Her Junior year she transferred to UK and lived in Lexington. This year was easier but with its own challenges of a new school and becoming adapted to that environment. Then she transferred back to EKU and moved in with her cousin and stayed between there and home. She was working in Lexington at the time in retail and enjoyed this job and working with girls her age and a few older girls who became her “work moms”. In December of what was her 4th year, she moved home and commuted until she graduated as a 5th year Senior in May 2020. During this time she totaled another car on her way to school. When Kent got to the scene the officer told him she was pretty upset- Kent found her in a fetal position. She once again was so down on herself and didn’t know why she had to be so stupid. We repeatedly told her cars can be replaced, she can’t so it really was no big deal in the grand scheme of things. She was so worried about finding another car even though we were able to work out her using a family member's truck til she found something. It was just another stressor that she added to her list of faults.

In September 2019, her anxieties and depression were at an all time high and she was constantly moody and would say things like she didn’t want to be here and that she wanted to go HOME. She would say that she was a failure and that she wasn’t good enough for others. She didn’t feel like we loved her as much as we loved her sisters. She felt so inadequate. We tried talking with her and showing her ways that she was loved. We began asking her to please see a counselor. She had gone to the doctor for anxiety meds during the summer but did not like the way they made her feel so she stopped taking them. I kept pushing her to go to another doctor to try a different medication telling her medications work differently for different people. She agreed to try a different doctor, however this one was worse than before because the nurse practitioner told Chloe that all these things she was feeling were normal for young adults finding their way in the world. Chloe did not feel heard or taken seriously and refused to go anywhere else.

Then in October 2019, she came into our bedroom with Kent’s gun that she had taken at some point. We didn’t even know she knew where it was and had no idea she had gotten it. I believe she had tried to figure out how to load and shoot it but thankfully could not figure it out. That night we called the Sheriff’s office to come and talk with her. When they arrived Chloe was so mad at us for calling them, she had gotten a belt and wrapped around her neck yelling that we were trying to embarrass her. We tried calming her down and wanted her to understand how much we love her and want her to realize that getting help is okay. Thankfully, the officers on duty were very kind to her and one said that his daughter struggled also and saw a counselor. He even told Chloe that she may have to go through a few til she found one she liked.

After this, I tried to schedule counseling appointments with her because she wanted us to go together. However, when your child is an adult it is hard to schedule appointments for them. Chloe did schedule appointments with a counselor in Richmond and went several times. She also made an appointment with another nurse practitioner and began taking a new medication that she seemed to be okay with. This nurse practitioner told her they would keep trying til they found something that worked for her. She had also referred her to a specialist to check out her thyroid. Chloe did follow up on this and found that one of her numbers were low but not really what would cause her heightened anxiety. She had completed suicide before her follow up appointment.

I also made several appointments for us to go together for counseling but by the time the appointment date the crisis was over and she didn’t want to go. When she began to consider counseling her sophomore year of college she found many times she had to wait months and then she didn’t feel she needed it anymore. I feel like this is common for many with Mental Health issues, they make appointments when a crisis occurs but the wait time is weeks to months and by the time it comes around they don’t feel it is necessary anymore.

Then there was COVID-19! Her school shut down in person classes. Her work became more intense. Our spring break vacation got cancelled. Her birthday plans were cancelled. Her college graduation was cancelled. So many things she was excited about did not happen. Of course, we did celebrate her birthday with the usual homemade and decorated cake we made together since she was 3. We cooked her requested meal and played games. Then EKU decided to do an online graduation video to play on Graduation day. We celebrated at home with breakfast and champagne and tried to make it a big deal even though it was not what she had dreamed! So she did get some celebratory moments of these big achievements in life.

I thought she was happy and not struggling with everyday anxiety because we were home together and spending everyday she was off together watching tv, going through childhood memories in totes and closets as we cleaned out. I knew she still had school stress and was wanting to get her work done so she could be finished with this phase of life. She even won an award in the Communication Department for her last project.

Then June 16 came and she woke up in an ok mood I thought because we had been texting about her graduation party before she got out of bed and came downstairs. She was wanting to go to Simpsonville to the outlet mall and that was our plan for the day. Then she got upset about not having a pair of shorts and our day and lives changed forever.

She was excited to be graduating because she was planning to do an internship with the nursing home in which she was employed and working her way up in administration. She had a boyfriend and friends she loved spending time with as well as her family. She had places she wanted to visit and things she wanted to learn. She HAD PLANS!!!

In an instant she took away all those plans and dreams because she just couldn’t deal with the inner turmoil any longer. She made a decision to end her suffering but this decision left those that knew and loved her heartbroken and shattered.

Chloe’s Petals for Hope wants those suffering with Mental Health issues to realize you are not the only one. So many people need counselors and medication to cope and make it in this world of pressure and daily change. Please talk to someone, if not a professional remember Your friends and family love you and are willing to listen! Sometimes it is harder to talk with those closest to us so find a co-worker, an acquaintance, someone at church to talk with -- remember they will have a different perspective!!!

Most of all Remember this world will NEVER be the same WITHOUT YOU!

Susan Rogers, President for Chloe’s Petals for Hope Foundation

#children and family counseling associates inc #cafca #cafca inc #Chloe's Petals for Hope Foundation #Chloe's Petals for Hope #Susan Rogers #mental health #mental health resource #suicide awareness #mental health awareness #suicide prevention #march #march 16 #2021

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drmyler · 3 years

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Kafka - Psychoanalysis

Kafka, Metamorphosis a Psychoanalytical View

Dr Stephen F Myler PhD

Abstract:

Franz Kafka in 1916 wrote a short novella called Metamorphosis (1. Bantam Edition 2004) a book of immense psychological and insightful nightmare into the human condition. Here we will exam Kafka's masterpiece from a psychoanalytical perspective to see that this work was an insightful self examination of depression, mental health and the role of carers when love turns to loathing. To begin our journey for the non-reader of this famous text we will give a brief outline and then turn to the specific role of psychoanalytic insight from Freudian to Burns and beyond.

Introduction:

Kafka was born in 1883 a middle class Jewish boy, introverted, shy and inadequate, believed to be a result of a critical father, (2. Letter to his Father 1919) he was later educated in Prague in a German University however he went on in his spare time to write many works of outstanding literature. Here we are not going to delve into detailed life but satisfy ourselves with a small picture of the man as writer. Kafka was very driven and wrote daily through the night with a dedicated passion. Today he might be seen as OCD (Obsessive Compulsive Behaviour) prone to perfectionism. It is his perfectionist emotional driver that made his literature something very special.

Kafka wrote Metamorphosis in 1916 as a short novella about a young man who was the stalwart of the family, supporting an out of work critical father, a doting mother and childlike sister, in which our hero, Gregor Samsa was not popular at work and under daily stress of travel and deadlines to meet for which he felt a losing battle. In the beginning of the book he awakes from a troubling dream to find he has in fact turned into an ugly giant beetle his mind trapped in an alien body. From this beginning Gregor begins to explore his new limitations and narrow world view, his sight becomes dim, he cannot move without constant pain and great effort. His family are dependent on Gregor going to work, earning their keep and supporting their needs when suddenly he cannot no longer act in this role. His father is disgusted, his mother stricken and his younger sister while becoming his carer is repulsed by this new version of her brother. As time passes and he does not return to his old self – the family must make new plans to survive and now see him as their burden (roles reversed). In the beginning Gregor thought this was just a temporary situation that would soon pass and he would re-uptake his old life and continue forward. However in the end there is no solution and suffers a lonely eventual death.

In writing the following psychoanalytical analysis I have not read the many introductions, essays and critical insights of other writers. This was purposefully done to avoid contamination of my thinking process in treating Gregor as my patient in a psychoanalytical setting. I did not want to have the bias of others opinions to my way of seeing the text as the only evidence of the patients mental health problem.

The Patient:

Like any new psychological patient to the clinic a first one hour session would be usually conducted in two parts – the first – why have you come to see me? The second the clients ability to vent (tell their story in their own words) and so set the scene for further sessions. Lets imagine Gregor's typical answer to why have you come here.

Gregory: My family is very dependent on me to support them but lately I have been feeling very stressed by work and home alike. I had a very bad dream a few weeks ago and woke up in a deluded state in which I found it impossible to get our of bed. I just felt overwhelmed with exhaustion and the loss of will to keep going on with my miserable life. It was like I was some ugly bug that everyone despised and yet took for granted. All they want to do is squash my passion for life and replace it with their needs.

Psychoanalyst: It sounds very much as if you are stressed and reached what me might call a point of exhaustion – this means your energy has been depleted both physically and mentally. So to summarise – you are depressed right now from the burden of work and a non-supportive family environment and you feel you have given up trying to be the one who supports everyone else?

Gregory: Yes, it is like I was a donkey with burden I could no longer carry.

Psychoanalyst: Tell me a little of your background? (second part - venting)

Gregory: I have a very critical, controlling father who tries to dominate the household, however he is unemployed right now and his health has deteriorated through becoming lazy and irritable. My mother cowers to him and goes along with his demands even when unreasonable, I have a younger sister – she is just finishing her education but has not found any real outlet for her abilities just yet, she is kind and sweet but very nieve about the world at large. At work my supervisor while pleasant enough but he is also under pressure from our boss who like my father is controlling and micro manages our every move. This means you feel you are being scrutinized constantly and found lacking. I have to travel a lot for my work and often come home late and exhausted but then am expected to be there for the family as the main stay of their comforts. I do not have time for relationships and I am probably not a very good catch for any girl who might have any interest in me beyond the obvious. At home things have changed now that I have been fired and lost my income. My sister has started to care for me more and tries constantly to rescue me from my mood swings, however my mother has just fell apart and cries insistently about her poor boy yet shy away from actually helping me. As for my father he is even more disgusted by me than ever as I forced him to go out and find work, he even took in some lodgers to help make ends meet and so the burden has passed to my mother and sister to keep the household clean and fed. We have had some cooks and cleaners but they have mostly left because they refuse to have anything to do with me. I cannot really think of much else to tell you – but at least I feel I managed to get it all out.

Psychoanalyst: I think that gives me quite a lot to think about Gregor and you have been very clear and systematic in the way you have explained the background. Tell me how are you actually feeling right now?

Gregory: A little relieved to have finally explained myself and someone listened without a sneer on their face or laughing at me. Thank you for that. In general I know that everyday I feel sad and tired by life – I just want to lay down and sleep – that somehow when I wake up everything will be normal again – that I can function and have some sort of life.

Psychoanalyst: Well we have had our time today Gregor, an hour can pass very quickly the first visit. I hope to see you are least once a week for an hour, in the meantime I have a little homework exercise for you to complete for me. A one page biography of your family, where you grew up, your education, relationships and the current here and now situation. I know you have told me some of this already but it will help save some time in sessions by having a short version of your life so far. Please send to me via email before our next session so that I can read and analyse the content before you come. Here is my card and details. If at anytime you feel you are in crisis and need me – please call for an earlier appointment.

Gregory: Thank you Doctor, I will see you same time next week.

Psychoanalytical Analysis of the First Session:

For insurance purposes the analyst is forced to write a psychiatric number and diagnosis. This labelling is not a reflection of the true nature of the mental health problem but merely a forced situation in order to get paid. In Gregor's case – Clinical Depression DSM V 296.3.

In reality a psychological outcome may have been Reactive Depression to stress at both home and work leading to a lack of everyday cognitive functioning in both thought and behaviour.

Clearly in this case – depression is the key element from signs of mental exhaustion, a sense of hopelessness and helplessness from the role reversal of stalwart breadwinner to helpless victim in need of rescuing by his sister in particular – the constant disappointment to both his parents and rejection of his work colleagues. At his stage we do not have enough data to surmise the underlying unconscious drives that might be fueling his depressive state other than the external pressures of family and work. In further sessions the need will be met from a more in depth scrutinizing of his emotional world and inner conflicts. He clearly feels alone in his burden although the sister is obviously doing her mother's duty of care. The client mentioned a bad dream – this can be further pursued for unconscious motivations.

Further Sessions:

Over 20 or more sessions – Gregor's analogy of being an ugly beetle are further explored and his relationships with both family and work – more importantly his feelings about himself and his depressive state. It also became clear that his family were now neglecting his everyday needs for nutritious food, care and comfort. They in fact have become physically violent towards him causing him to further withdraw into his delusional world where he feels he is nothing more than an ugly beetle that should be stamped upon. Risk of suicide has now become evident in his demeanour. His appearance shows he is not looking after his ablutions, clothing is dirty and unkempt and he has lost considerable weight. He was also becoming lethargic in that he no longer cared what happened to him as long as this constant pain would cease (pain being mental anguish). His sister although dutiful in looking after him has lost heart in him getting better and so now only is a functional caregiver as opposed to a empathetic one. His biography homework showed that his father was not only controlling but bitter in that he lost a business owing considerable money to Gregor's employer who now expected him to pay off his fathers debts through a reduced salary for his own work putting considerable burden on him to support the family at home. The mother was ashamed of the home situation and was too weak to stand up to her husband in any matters of economy or otherwise. The sister was in the past spoiled and now resented her reduced situation and blamed Gregor for being sick. Again adding to his feelings of alienation and being alone.

Sadly Gregor died after the end of the sessions from self-neglect – basically willing his life to cease as he saw no longer any purpose to it. His father had found new employment, the mother felt relieved to see her son no longer in this life suffering and the sister finally felt free of her own burden that being her brother. While psychoanalysis would have hoped for a different outcome – the book itself determined the ending that we have to accept.

Conclusion:

While Franz Kafka meant his novella of Metamorphosis to be a comic tragedy of a wasted life it springs out at any educated reader in the art of psychoanalysis as a perfect example of chronic depression and futility. Those in this delusional state often contemplate suicide although mostly via ideation (I think it but don't), however self neglect is very common trait that leads to slow death from a lack of self care. When you have a non-supportive family, where their needs are being thwarted by your mental state – then further rejection can cause a spiralling effect of deeper resentment about your own part in the downfall of your mind. Many depressives play victim (3. Berne 1960's) inviting others to rescue them – when in fact they need to rescue themselves – but in the end they become their own persecutor and further victimize themselves to that bitter ending of death.

In real life via treatment for depression a sense of purpose is sought from the client in that he can see a new fresh change to his circumstances despite the battle of a non-supportive family and hostile work environment that is all to common in today's economy. In Gregor's case over time he would have explored his past traumas and realized the underlying demons that led to his lack of self assurance and efficacy to find a new solution to his mood.

Summery:

This paper was an exercise in psychoanalysis from a famous work of literature and reflects the art of the analyst who tries to understand the underlying concepts of the unconscious mind in creating monsters from our own imagination to battle with when we reach that point of exhaustion both physically and mentally called – depression.

References:

1. Kafka F. 1915 – Metamorphosis – Bantam Edition 2004

2. Kafka F. 1919 – Letter to his Father – Bantam Ed 2004

3. Bernes E. 1960's – Transactional Analysis – various volumes.

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secretagentspydetectiveninja · 6 years

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The Misadventures of Prince Kim - chapter 55

Wow, a rare chapter in which Kim doesn’t actually do anything stupid!

Also on AO3 as always where you can read this giant ridiculous thing from the start if you have a lot of spare time

Max sat alone in his room at his desk, hunched over his homework. He had been trying to solve this question for almost an hour now, and yet his answer never matched the one in the textbook! Why? What was he doing wrong? Usually he was supposed to be good at schoolwork!

Erasing yet another wrong answer, he wondered if he should just give up and go ask someone for help with it. But no, he couldn’t do that – he was Prince Max. He had a reputation to keep up. The smart one, the one who everyone else asked for homework help, the one who was clever enough to solve any problem. That was, fundamentally, who he was as a person. For as long as he could remember, that was what he was always referred to as. The smart one. Being smart was pretty much his entire personality.

Then why was he finding his schoolwork so tough these days?

He just put his pencil down and put his head in his hands, his brain too frazzled to concentrate for any longer. This couldn’t be happening. Schoolwork had always been easy for him, right from when he was a little kid and his tutor had proudly informed his parents about how talented and amazing he was. All through his life that had just been reinforced, with constant high test results, and learning new information easily compared to other kids his age. And here at school, he had just shone.

But it wasn’t happening now. Over the past few months things had been getting tougher and tougher. Why? How could someone just stop being smart like that? It simply wasn’t logical!

There was a loud knock on his door. Judging by the volume, that must either be Kim or Alix. Looking at the clock, he could also judge that it was highly likely to be Alix – Kim was too busy preparing for the summer gala later that day, wanting to “impress Max” apparently, whereas of course Alix cared very little about the summer gala. Max pushed his homework aside and said, “Come in.”

Sure enough, it was Alix who entered, looking oddly cheerful compared to how inadequate he was feeling right now. She ran right over to him and waved her arm in front of his face.

“Maxy-Max! Look! My arm’s healed now and they took the cast off!”

He forced himself to look happy about it. “That’s excellent news.”

“Exactly. I can go rollerskating again, finally! In fact, I’m just gonna skip the stupid summer gala thing and go do that instead, it’ll be way more fun. And I won’t get into trouble for dropping any more chandeliers…”

Max was almost disappointed to hear that. The chandelier thing had been very, very entertaining, enough to actually make the spring dance fun somehow. But at least the summer gala was informal, so it wouldn’t be anywhere near as dreary. He couldn’t fully remember what it had been like last year, other than knowing he had spent most of it drinking away his woes with orange juice. This year was bound to be much better.

“So what’s up with you?” she asked, a little less hyper now. “You’re going to the summer gala, right? I just went to see Kim and he yelled at me for interrupting him when he was trying to do his hair, so you’d better go and appreciate his efforts.”

“Of course I will!”

“Are you gonna get ready too? You can’t go in those pyjamas. Well, I guess you could actually. I went to the thing in January in pyjamas.”

“I’m not going to wear my pyjamas! I was just…” He sighed. Part of him didn’t want to say anything, but it would be good to confide in someone. “I was working on a homework problem that I was finding quite tough.”

She looked surprised for a few seconds. “Really? Which one?”

“This one.” He pulled the sheet out and handed it to her.

“Ohhh, friggin’ calculus. I hate this stuff. Why are they even teaching it to us? I have no idea how this is gonna help us rule a country.”

“They are teaching us similar curriculums that our commoner peers would be learning right now,” Max said, “so that we have a roughly equal level of general knowledge. The royalty lessons we have on top of that are what makes this school any different from a normal one.”

“Huh, okay.”

“Anyway, I can’t do it. I’ve already been trying for an hour and haven’t got anywhere. It feels very… unusual.” He clenched his fists. “It may sound selfish, but I really can’t understand why I’m not finding this easy. It’s like I’ve been losing brain cells over the past few months.”

Alix sat up on the desk. “You kinda remind me of Jalil, you know.”

“Really? Why?”

“He used to find school really easy all the time and never bothered putting in any effort, ‘cause he didn’t need to. And then when he was about this age, his natural talent burned out and he actually had to start working hard to keep up.”

“Are you saying I don’t work hard?”

“I dunno, do you?”

Max was about to give a rather indignant reply, before he stopped himself and actually had a think about it. Did he work hard at school? He certainly got all his work done on time, and he easily understood new topics taught to him. But that… that wasn’t hard work, was it? That was just him being good at it without trying! He barely needed to use his brains to get the best marks in class. It all came to him naturally.

The other kids didn’t have that, or not quite to the same extent. Kim usually spent a lot longer working on his homework, getting Max to tutor him, trying to understand new concepts. He certainly worked very hard at it indeed. A lot harder than Max ever needed to. It wasn’t unusual for Kim to spend hours and hours stuck on a single question before admitting defeat and getting help with it.

Which was exactly what Max was going through right now.

He barely even revised for exams. He never asked for help. He never got questions wrong. He wasn’t used to having to work to get things right. It should always be easy!

“I never need to work hard,” he admitted. “I’m smart. Well – I thought I was…”

Was he not smart anymore? If his natural talent had finally come to an end, and he was at the same level as everyone else now – if he wasn’t the smart kid, then who was he?

“I’m not smart anymore,” he said, almost in a whisper. The concept was just so… so horrifying! It made him feel all cold and hollow inside, made his brain feel static, like he was dropping IQ points by the second.

“Of course you’re not smart, you’re dumb as hell,” Alix said. “You always have been.”

“But I used to be good at schoolwork!”

“Pfffffff, you’re logical and like thinking about stuff and you have a good memory. You’re not, like, proper smart. You don’t even know how to cook an omelette or load a washing machine.”

“Well neither do you!”

“Hey, I didn’t say I was smart either. We’re both dorks. You’re just a dork who’s good at school stuff.”

Max looked down at his textbook, disappointment weighing on him. “At least, I used to be… What do I do now?”

“Just start working hard, I guess. That’s what Jalil did. I mean, you’ve still got an edge. You grasp new concepts easily and tend to enjoy learning about new things, even going out of your way to do it, so it’s not all doom and gloom.”

“You sound a bit like a teacher…”

She rolled her eyes. “Listen, Jalil used to vent at me about this stuff for months on end, so I’m an expert at this. Trust me when I say you’re gonna be okay.”

The weight on his mind lifted ever so slightly. He did indeed trust her, and if she said it was going to be okay, then hopefully she was right. Logically speaking, if she knew a lot more about all this than he did, then it made sense to listen to her.

“Thank you,” he said, pushing a smile onto his face. “I suppose I’ll have to start working harder from now on. Especially if I want to carry on tutoring Kim…”

Wait a second – Kim! How many times had he gushed to Max about how smart Max was, and how much he admired it and loved him for it? How crushed was he going to be to realize his sweetheart wasn’t anywhere near as smart as he thought he was?

He thrust his face in his hands. “Kim loves me for being smart – what am I going to tell him?”

To his surprise, Alix just laughed. “See what I mean? You’re dumb as hell! If you really think Kim only likes you ‘cause you’re a nerd, then honestly you’ve gotta have a little more faith in yourself…”

“I’m just being realistic! He has a very strong admiration for my intellect. It’s something he mentions very often. He really seems to care about it a lot.”

“Let’s see about that, shall we?”

She flicked open the lid of her sceptre and started tapping something into it.

“Wait – are you calling him?” Max asked. “You don’t need to–”

“Too late, it’s already ringing!” She pressed the speaker button and set the sceptre on the table in between them both. Kim picked up almost immediately.

“Alix, what is your problem?! I told not to interrupt me when–”

“Your boyfriend is having a bad day and needs some support,” she said, “so I’m pretty sure your hair can wait.”

Kim’s tone changed immediately. “Oh, you should have said so before! What’s wrong?”

“Just normal existential crisis stuff, whatever. Max is right next to me – tell him why you love him.”

Kim didn’t even need to think for a second. “Oh Max, you sweetie! You’re the awesomest person ever, that’s why! You’re always so nice, and really cute, and so much fun to hang out with and talk to and – hm what else – oh yeah! It’s so cool that you’re so different from me! All rational and logical and calm, it’s really inspiring. And you’re really cute. Did I mention that already? And I love spending time with you so much, and…”

He carried on for a few more minutes at least. The whole time Max half wanted to sink right into his chair and melt away, half wanted to jump through the phone and hug him. All this kindness, all these compliments! Being the sweetheart of a person like Kim meant that he got this a lot, but it wasn’t something he could ever really get used to. It felt so special every single time.

And Kim hadn’t even mentioned Max being smart at all.

Logical, rational, yes, and even saying “you make me feel smart because you’re always teaching me stuff!” But he never outright said it.

Something stirred in his memory – the day of the Cupid Festival, when Max and Kim had got together in the first place. They had said a lot of things to each other that day, things that they hadn’t said before. And something that Kim had said suddenly stood out to him.

Please don’t think I only like you ‘cause you’re smart. I like you for a whole lot more than that.

It wasn’t something that Max had paid much attention to at the time, being too overwhelmed at Kim actually liking him back to really take anything in. But there it was. Right from the beginning, Kim had already told him what he needed to hear.

Oh, thank goodness.

“Thank you Kim, I feel a lot better now,” he said finally, really meaning it.

“Aw, I’m glad! Well do you need anything else?”

“I’ll be alright. I was simply being a bit… irrational.”

He couldn’t help but smile. Something about Kim always made him feel irrational. Usually it was a good thing. Occasionally it wasn’t, like just now – how could he honestly have considered that Kim would be disappointed if Max struggled a bit with a homework question?! – but that could always be sorted out.

“Seems like my irrational-ness has been rubbing off on you, huh?” Kim said, the flirtiness practically audible through the phone. Max grinned even more.

“The word is ‘irrationality’. But yes, I suppose it has.”

“Max, I love you a lot, you know?”

“I do know. And I love you a lot too.”

“I can’t wait to see you later!”

“Me too, I’m looking forward to it…”

“That’s enough,” Alix said, snatching the sceptre away, though she was grinning too. “If you guys are gonna be mushy then use your own phone, thanks. I’m gonna hang up now and you can carry on doing your hair for another 2 hours or whatever. Or does one of those hours involve admiring your own reflection?”

“Of course not!” Kim snapped. “I wouldn’t spend an entire hour – 10 minutes maybe, but not–”

“Whatever.” She hung up and shut the lid of the sceptre, then turned to look at Max. “You good now?”

Max nodded. “Yes. Thank you for that.”

“No problem. If I’m being honest, you and Kim are, uh… actually kind of adorable. I hope you guys have fun at the summer gala. Doing your scientific research or whatever.”

Max was aware of his face warming up – he knew perfectly well what she meant by scientific research. Usually, though, he was a little too lovestruck to think about actual science on the odd occasion Kim kissed him for more than a minute at a time.

“The summer gala is, uh, probably not the most ideal place for that,” he said quickly. “But I’m sure it’ll be fun. And I hope you enjoy rollerskating. Make sure to take care, as even with your arm out of its cast it might not be fully up to its usual capacity and–”

She poked him in the arm with the sceptre. “Whatever, nerd, do your homework.”

“You should do yours too!”

“We’ve only got a few more days of school until the holidays, who cares? Not me. But you have to work hard, okay? Don’t be a hypocrite like me.”

He grinned, taking the homework sheet and putting it back in front of him. His brain felt much readier to take on the task now. “I know perfectly well that you work very hard too, as much as you pretend not to. But I will certainly try not to be a hypocrite.”

“Good. See you later – and have fun!”

Taking her sceptre with her, she left the room. Max picked up his pencil again and looked back down at the sheet. There were no shortcuts to this, were there? He really would just have to work at it. Just like Kim did. Yes, that was a good source of inspiration – to be a hard worker, just like Kim!

Feeling much more motivated now, he put his head down and got on with it.

Max arrived at the hall of the summer gala to see Kim waiting for him already. For once he was wearing a more European style of formal clothing, and he looked just as stunning in it – and of course, his hair was done immaculately.

“Kim, you look wonderful!” Max said, running over to him and taking his hand.

“So do you!” Kim replied, leaning down to give him a quick kiss on the cheek. “I don’t think I’ve ever seen you in red before.”

Max smiled, looking down at the red robes he had decided on for today. “It’s your favourite colour, so…”

“Well it looks super awesome! Almost as good as me, I’d say…” Kim winked at him, sending flutters through his heart. “Anyway, my amazing wonderful sweetheart, are you feeling better now?”

“I am, don’t worry. It was just something a little silly. I was having trouble with the homework, and I’m so used to finding it easy that I wasn’t exactly feeling pleased with myself. But I managed it in the end, in part thanks to your encouragement.”

Kim gave his hand a squeeze. “Good work – I’m happy for you!”

“Thank you. I know now that I have to work harder from now on, just like you do. In fact, I’d like a bit of advice. These holidays I really want to intellectually challenge myself. What do you suggest I do?”

“Oh, um, what do you mean? Like, should I tell you to build a robot or something?”

A robot! That would be perfect!

“That’s exactly what I meant,” Max said, hardly able to hide the huge grin on his face that always appeared when thinking about robotics. “This summer I’ll build a robot. In fact, when I was younger I did indeed make a very simple automaton, so I could probably upgrade that one.”

“Is that the one you said you kissed once?”

Oops, he had forgotten he’d told Kim about that! It was so embarrassing to think about that he tended to keep it to himself. “Maybe…”

“That’s adorable.”

“Says the guy who has a habit of kissing pillows.”

Kim blushed bright red. “I haven’t done that in a whole, like… two weeks! I’m over it. I mean, I’ve got you now, so I don’t really need the pillows…”

“And I don’t really need the robot for that either now. But I’ll certainly have fun programming it. I kind of wish I had a computer of my own sometimes…”

“What’s a computer? Isn’t it one of those massive machine things that can do maths on its own?”

“It’s more complex than that, but essentially, yes. And when I make my robot, I will be making use of similar concepts.”

“That’s so cool,” Kim said, staring at Max with such an adoring expression that he was very tempted to engage in some scientific research right on the spot. Instead he changed the subject, deciding to save that for later when they weren’t in a hall full of people.

“So you’ll be staying at Queen Sol’s palace for the holidays, right?”

Kim nodded. “I’m gonna get to meet Princess Penny and Jagged Stone and everything. It’s gonna be awesome! You’ll be there for the wedding, won’t you?”

“Yes, I certainly will. I might bring my automaton friend along if I’ve programmed it enough by that point.”

“Nice!”

“Anyway, I should probably warn you that Jagged Stone has a pet crocodile and you will most certainly be introduced to it at some point.”

“A crocodile?” Kim’s face went white. “As a pet?”

“Nowhere near as dangerous as Alix’s pet cobra.”

“Yeah but… I mean, I’m not s-scared of crocodiles or anything, but…”

Max grinned, knowing perfectly well he was lying. “I’m sure you’ll be well acquainted with Fang by the end of the holidays.”

“Its name is FANG???”

Oh, poor terrified Kim. Max started laughing, unable to help himself. Kim had been afraid of the snake at first too, and he was perfectly fine with it now, so the crocodile was sure to end up the same way!

Hmm, the wedding was in August… would there be enough time to make a somewhat autonomous robot before then? Maybe, with a lot of hard work, it would be possible.

He made up his mind. He was going to do it.

Just outside the main hall, the setting sun barely still visible, Marinette sat stroking Plagg again. This cat just kept coming back to her, over and over again! And even weirder, it tended to always find her whenever she was thinking about Adrien in particular. It couldn’t be a coincidence. This cat was special.

“Kitty! I can’t believe you ran away again!” The cat’s owner was back, running over towards them now. “Stop annoying Princess Marinette, she’s probably got better things to be doing…”

“It’s okay, I don’t mind!” Marinette said quickly. “Really, I don’t. I promise. I love Plagg, he’s practically a friend of mine now.”

Plagg let out a little meow of affirmation.

“I’m glad to hear that,” the noble said. “Plagg really likes you. I still think you should keep him.”

That was what the noble had been saying every single time, and Marinette had constantly refused, not wanting to take a pet away from someone. But her resolve was crumbling. This poor cat… it really didn’t like its owner much. It seemed to want Marinette instead.

Or rather, it seemed to want Adrien…

“Are you sure?” she asked. “Like, really, really sure?”

“I am. I’ve had enough of this cat. I can’t stand to look at this thing for yet another long summer holiday! Just look how he looks at me!”

Sure enough, Plagg was glaring at the noble, hissing slightly, before curling back up into Marinette’s arms.

Well, she couldn’t just leave an unhappy cat with its unhappy owner, could she?

“Fine,” she said. “I’ll take Plagg home with me.”

I’ll take him to Adrien, she added silently.

“Really? Oh, thank you Your Highness! Thank you so much!” The noble crouched down and looked right in Plagg’s face. “Now you be good to Princess Marinette, okay? She’s a princess. No scratching, or biting, or clawing, or–”

Plagg took a swipe at him.

“Ugh, you little dipshit – I’m not gonna miss you at all!” He quickly covered his mouth with his hands. “Oh shoot, I’m not meant to swear around royalty, I’m so sorry–”

“It’s fine,” Marinette said, giggling a little. “Perhaps you should just get out of here before Plagg scratches you to pieces.”

“Good idea. Goodbye, Your Highness, and good luck with him!” The noble took to his heels and ran off.

Marinette picked Plagg up in her arms. He was so small and light, like a little ball of fluff. It was adorable. In fact, bringing a cat back home for Adrien to hang out with would be ideal for him. Pets were good for you, after all! Oh, she just couldn’t wait to see Adrien again. Only a few days left now.

Hang on a second… what even was the noble’s name? It occurred to her that she had never asked. Huh. Maybe Adrien would know?

#i know this is a bit late shush #anyway i'm pretty sure i haven't written anything more relatable in my life like i'm literally max here #aish writes #royalty au #random stuff #miraculous ladybug #le chien kim #max kante #kimax #alix kubdel #marinette dupain cheng #plagg #the misadventures of prince kim

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anoverloadofmusings · 5 years

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To Make Some Sense Of This Year

I’ve lived two very different lives, like many of my generation. I have the presence everyone can see. My social media feeds. The version of my experiences that I get to shape in the retelling. I travel the world, confident and charming. Then there’s the other side, the confusion, the struggles. The loves and the losses. I find this disconnect between the two difficult to handle sometimes. This year, often. It is hard to pretend to be one or the other. Maybe that’s why I’ve finally decided to put this all down. To connect the dots and accept the contradictions, and be comfortable with the multifaceted person I am. It’s cathartic, in a world where it’s a virtue to not find catharsis in a public, online outing. But I want a release from the dualism I’ve been carrying with me and hope this will help with that. I’m sorry if it seems intense, but sometimes life just is.

I hope also, that whoever decides to read this can give me the benefit of the doubt, and believe me when I say that I understand my life in comparison to others. I know where I have benefited where others have not, just where I have struggled where others have not. I do not blame a single person in my life for my struggles this year. I have no bitterness, just feel a hell lot of regret, and a hell lot of love. I am constantly growing, constantly making mistakes. My experiences might have contributed, but I am full, rounded person, and I could’ve done a lot of things a hell lot differently. Feel free to criticise me and my actions, just know that I have often done the same.

The most appropriate place to begin this I guess, is admitting that I’ve been on autopilot for much of the last ten years. After my Dad died in 2010, my Mum married again and moved back to France within three years. That relationship never really healed, after clear, incomparable differences between my stepdad and I, where he insisted through his actions that my Mum would have to choose between us. I let it go though, and got through University, lived abroad for a while, built up an impressive portfolio of photography and filmmaking, before moving back to London in 2017, and I felt generally happy with the way I had restructured my life. I was generally well liked, had interesting travel stories to entertain people with and assumed like everyone else I would fall into journalism.

I was 26 by this point, and was carrying with me an awkward truth I was extremely ashamed of. Not only was I a virgin but I had never even kissed a woman, never been intimate beyond a few chosen words and glances. What might seem trivial to many now at the time was a heavy weight. That summer that finally changed, and though it was a lovely experience with a fantastic woman, I did question why I had put so much emphasis on this for so long. It was intimate yes. But it was fun. Light. There was no earth-shattering sensation. If there was something behind that heavy weight - it wasn’t sex.

A couple years passed, and I did well in my masters, my subsequent job, along with a few dating and hookup experiences along the way. I guess by this point I felt like I had cracked the right autopilot switch. I had given up trying to understand what that heavy weight had been to me for so long, as I had enough fulfilment in my life, enough goals to keep me focused. I just kept busy, barely remembering to count the days as they passed.

Then, in early winter, I started seeing a girl. I then - miraculously - mended the incredibly complex relationship with my stepdad, after years of fighting. In early spring, I left my job and tried somewhere new - in the city. By the end of March all these things had crashed down around me. All the support I had gotten used to, it vanished. I fell into a place where I am only now beginning to recover from. Some words used for this have been depression, deteriorating mental health, emotional immaturity, quarter life crisis etc. Whatever it is, it triggered something extremely deep lying in me. Now I have had anxiety issues - like many people - for a long time, but these were all under my control by this point and I had worked myself into a healthy place to deal with them. This breakdown ruined it all. I lost all control of those anxieties, lost all motivation in my job and the two following jobs. My relationship with my family broke and has not yet recovered. I became so, unhealthy dependent on this girl for my validation that after she left, I felt so inadequate, and all those anxieties from my past swarmed back, infesting into all the corners of the structure of the strong life I thought I had built up, and multiplying like a disease. I do not want to burden any reader with the technicalities of this mental state, as I do not want to indulge them anymore, but for those who can’t identify - you lose interest and passion in everything, so nearly all of those photos and smiles you’ve seen me pull since then have been some of the hardest and forced I’ve ever had. I never hated myself as much as I did then.

I let those issues wreak havoc over my entire life. I dragged friends through months of apathy. Of speaking to them about the same, limited topics. Colleagues had to sit and watch me struggle knowing I could not reach the potential I showed in my interview and they would have to let me go. I saw myself weigh heavily on this girl, even suffocating her and draining her energy. But for so long, when family and work left, she stayed and she cared. When she finally decided to take her happiness into her own hands and make up with her ex, I realised what had happened that I had never experienced before. I had fallen in love. Not the way I imagined I would have, and honestly not how I would’ve wanted to. Not when I was like this, completely unable to show anyone my best self. And not a healthy love either, not a love built around my dependency.

I think I can rationalise the impact people can have on our lives if you consider we are all built up of experiences. Some of them are fleeting, they happen and we forget them with ease. Other experiences, days or people leave a mark. Sometimes that mark hurts, which we then try to hide or run from. It can ache to remember it, so we burry it. Other people can awaken those hidden away experiences. This girl, she wasn’t perfect, but she did not leave a hurtful mark. I can still barely think of a time she insulted me or deliberately tried to hurt me. I still find it so easy to reflect positively on my time with her. What she did - unknowingly to herself and to me - was give me a certain affection I had never experienced, throughout all those years since my dad died, and perhaps before. I think it was so normal for her to give, it’s probably normal for most people come to think of it. But it was quite profound to me. I’ve been fortunate with my friendships - some of them are deep and will last a lifetime, but I did not realise I had lacked what she gave me. It was given even more significance for happening at the same time as the relationship with my family - seemingly the rock that our strength and love is meant to be built on - diminished in the form of multiple emails from my stepdad labeling me a leech and a failure. In the face of that, her affection was an intense reminder of what I did not have from my family. It was a short relationship, and its significance will probably fade in time, but while she was in my life I was endlessly confused. And just because I had no idea how to manage feeling appreciated like that.

It’s easy now to understand why I’ve fallen so far back this year. Without sounding unbelievably cheesy, I’m really not sure what the fuck I was doing before this year began. I was a functioning member of society but I rarely had a moment of pure happiness or fulfilment, satisfied with just feeling good. And that’s not to say a relationship is fundamental to happiness, it’s just, to me, I just felt like a passerby until then. Realising now, that the lack of a constant family figure showing me love in my life - especially in the last ten years - has meant that I just stopped expecting it, if I ever expected it to begin with. And for so long since March I have felt the same, perpetually trying to find the same level of purpose in my life without a lover’s validation. This core understanding about the necessity of self validation takes everyone their own timelines to figure out. And even then, once you realise you need it, it’s another thing finding it. Initially I dated a bit and found myself transferring all that affection and need for validation onto other women so quickly, despite knowing how unhelpful and wrong that was. I’m sorry for the women who had to experience that. I’m sorry for the friends who saw me suffer and said all the right things but knew they would just have to watch me suffer a bit longer before I worked it out for myself. My purpose was gone, and I couldn’t find it anywhere, as I didn’t have a clue where to start. Then I started to indulge it, I started to ‘like’ being so low with no self esteem. It felt familiar, more familiar than confidence or success. Sympathy from others brought out similar feelings of comfort that she had given me. It became like a cruel addiction, as if I wanted to see how far I could dislike myself and drive off the rails. I failed probation after probation, not able to feel even slightly present behind a desk. I somehow kept getting jobs but continuously found faults in them, and indulged them too. I saw issues with managers which were not issues. I lost myself and argued when I didn’t actually care about my point, I just wanted to feel anger. I gave up so easily, so quickly, and forgot all the things I loved, hobbies, friendships.

But this isn’t a sad recollection. At least that’s the paradox I find myself in sometimes. Perhaps another reason why I indulged this negativity for so long was because it felt good to feel. I had never felt as good as I had felt over that winter, with her, in my job, with my family, and never felt as low as I did in the months following. Even in the miserable moments there was a part of me which loved feeling so emotional. It just felt good to realise I wasn't just a passerby anymore. I’ve always been sensitive but I had never felt that level of emotion. And it was a different level at times, both the highs and lows. I still remember a tear falling down her face as we said goodbye and the force of emotion which hit me like a hurricane. I indulged it all. I let the vulnerability which I had once tried to champion completely define me.

There’s a lot of things that could’ve happened differently. I could have gone to therapy years ago, and not dismissed my anxieties so easily. I could’ve acknowledged the emotional impact my Dad dying and my Mum leaving would end up having on me in the future. If I had done that I could’ve taken sick days at work this year and breathed, reflected, then gone into work the next day. I could’ve made better decisions, chosen better places to move to, better jobs to apply for. I could’ve done a lot. If I had tackled this all before, things might have turned out differently. Then again, maybe they would’ve happened just the same. I know now though, that things happened the way they did because I was unaware what I had been missing for most of my life, and when it came I was overwhelmed. But it had to happen at some point. It’s really because of that that I just can’t hate this girl. She was not perfect. Somebody else with different baggage maybe could’ve maybe helped me get through this. They could’ve loved me back. Her preference of talking through social media was tough to deal with at times. But what she did do was help me realise what I had denied, while on autopilot for all those years. In a way, that was her saving me. And she did it with kindness, and a warm heart. If there’s anything I’ve held onto throughout all of this, it’s that I will not let anything that happens after make me forget the countless phone calls to make sure I was alright, the encouragement when I was at my worst. She deserves her happiness now and I’m proud of myself that I can focus on that, when I could’ve hated her for leaving. That gratefulness helps me sleep at night. She is a good person. As traumatic as it all turned out, I am grateful she was my first love.

And people do get better. Sometimes it takes going through an experience like this to give you all the tools you need to get better. And it doesn’t just switch back on like a light. I am building my life up again now, but instead of rushing to the top I’m taking my time firming up the foundations. Bit by bit. I recently dated someone for nearly two months and though things could’ve developed, I found myself controlling my feelings while I was seeing her. I managed to get to know someone while not making them my emotional dumping ground. I kept that in check. That might seem small, but to me that's a success. It’s one small victory on the way to being the Jeremy I know I’m want to be. I know I considering other people's mental space better now. Therapy is helping. Learning how to move on from people who don’t understand your value, even when I want to help them find theirs, is helping. Slowing everything down, is helping. It’s still a terrifying idea, to be out in the world - standing tall and pushing through a challenge again. But it is achievable, and it is achievable because I know so much more about myself now. I don’t quite love myself yet, not to the extent I know I should. But I like my voice. I like my mind. I like how I empathise with people. I like how I earn peoples’ trust.

If you’ve got this far, thank you. I hope you can sense what I’ve felt through writing this. I don’t really want any sympathy anymore for what I’ve been through. I just don’t want to carry this around, in a lengthy, confused state of mind anymore. I want this out there, written down, where I can see the words whenever I lose focus and remember everything happened the way it did for the best. People entered and left when they needed to. I let experiences drag me right down and almost wreck my entire life, and I need to remind myself, and anybody who reads this who doubts me, that no matter how trivial this experience might sound, that pulling myself back up - with the help of a few, extraordinary people - is a sign that I am not broken.

Fuck knows I’ve made mistakes. Fuck knows we all have. I’m sorry for those I’ve hurt during all this. I hope you can forgive me, and understand I will become better because of it, and will reward you for your belief in me if you wish to give me the opportunity to do so.

And finally, though this is purely cathartic, and I am speaking more to myself than to anyone else, I hope if anyone reading can relate to any of this, to reach out like I did. To friends, family, therapy, whichever. You’ll be endlessly amazed about the capacity that people have to love and to help. There are some people I haven’t named here but they know who they are. Perhaps not appreciating that in the people around you, and expecting it purely in the arms of a lover is where I got it all wrong. But I got plenty else wrong too. And now I have a lot of time to make up, and do it all better this time.

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cancerinscorpio · 7 years

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I wrote to my favorite advice column and this is what I said and she said.

Dear Polly,

I feel like a strange amalgam of various others who have written to you, but nevertheless, here I am. I’m 28, single, and dying from a cancer that is breaking my body and spirit down at an alarming rate. Obviously, so many things about this situation scare and sadden me. But the thing that consumes me most, day in and day out, is the fear and heartbreak of not having a partner there with me through the two or so years I have left or holding my hand when it’s finally time to go. Having been confronted by mortality at a young age, I feel I know more about myself than many 28-year-olds do, and one thing I know is that I am a relationship person. I was in one relationship from age 20 to 25, and another from age 25 to 26, and while neither were perfect, I felt whole and truly like myself in both of them. And it’s not just because I love the feeling of being loved (though obviously I do), but I truly love giving my love to someone else. It feels like the thing I was meant to do, and the reality that I may never have that again is devastating.

Despite the fact that my days are mostly spent in doctor’s offices or lying in bed (or, frequently, both), I do the whole Tinder thing occasionally just for a sense of normalcy and, yes, male attention. I’m okay with most of these dates being one- or two-time things. It’s a salve, sure, but it’s fun, it gets me out of the house, and no one owes each other anything, which means I feel no need to disclose the fact that I’m a ticking, tumor-ridden time bomb. But when I do come across a guy where there’s some real potential (as is the case right now), I find myself both weaving an intricate web of lies to keep things cool in the present and steeling myself for the eventual parting of ways when I either tell them who I really am or break things off before that even happens.

So my dilemma is this: How do I square my desire for a loving partner with my reality as it is? I want to believe there’s someone out there who I could not only open up to about my health but who would accept and love me in spite of it. But that feels like a fairy tale (FUCK YOU, FAULT IN OUR STARS etc.). And even if it’s not a fairy tale, and that guy materialized, I would be wracked with guilt at the idea of even asking someone to get pulled into this terrifying, morbid mess. So, Polly, do I keep chasing the fairy tale? Do I give up entirely? Is there some other alternative I’m missing? Or is the salve the best I’m going to get until things are so bad that I no longer have the physical strength for any of it?

Sincerely,

Dying Girls Need Loving Too, Right?

______________________________________________________________________

Dear DGNLTR,

I’m sure you don’t want to hear how sorry I am, but I am sorry. It’s still dark out, and I feel too small and stupid to offer you anything of value. I always tell people to just show up and be honest when people are in crisis (as opposed to trying to fix anything or unloading their big barrel of forcedly optimistic clichés on top of someone’s head). But just showing up and being honest feels inadequate, too.

I’m sure having terminal cancer feels socially oppressive that way. Particularly in the middle of a sea of feeling shitty and confronting the breakdown of your body and spirit, it must be horrible to watch everyone you know flattened and emptied out and inadequate in your presence. I’ll bet that’s why Tinder feels like a giant reprieve from the heavy looks and the weighty silences of other people. Finally, a bubble of mundane chatter and raw attraction where you can encounter someone without the weight of this absurdly unfair diagnosis.

But I’ll bet there are also people who can show up without feeling inadequate. I’ll bet you know people who bring their best, who relish the chance to be there for you. I’ve been trying to trick one of my friends into hanging out on her chemo days or while she’s recovering. I just feel like I could play the role of a good partner, fun or quiet or barely there if necessary. She questions why I’d want to be there, and I guess I don’t really blame her. Even though I see it as a way of showing up and offering her something I’m good at giving, maybe there’s also a little of the ambulance-chaser, disaster-gawker in the mix for me. Even if that’s a side effect of being drawn to the ugly truth at all costs, it can still feel a little suspect. As with any other personality trait, there are good impulses and bad impulses dancing together there.

If you decided to embrace the fairy tale, this would be part of the beauty and the danger of locating potential partners who wouldn’t run away or be dismantled by the prospect of standing by you to the end. Whether you start to tell people your diagnosis very early or mention it to someone you like, there’s still this question in the room: What kind of person might be willing to be there for you? Would it be someone who’s real and true and recognizes something in you that feels vital to his continued existence? Or will it be someone who loves the idea of himself as some kind of a savior or merciful saint, like the Virgin Mary in Michelangelo’s Pieta?

My suspicions on that front are probably distinctly parental. As a parent, I would want to be there for you all the time. I would want you to have a partner if you wanted one, but I’d also want you to know that I would give you everything I had to give. And frankly, that kind of parental devotion and worry might be irrelevant here. What you’re talking about is sex and romance and devotion and someone who’s in love with you, holding your hand at the end. A parent isn’t a suitable substitute when romantic love is what you’re looking for. Moreover, getting hung up on the intricate web of motives that live in any potential partner’s personality is almost always a mistake. Why bother? Are your own motives pure? Can you distill just the love out of a mix of a million different human needs and preferences and urges? No way.

And should you feel guilty about wanting someone to be by your side, or putting someone through such a potentially difficult experience? Hell no, as long as you’re honest with them. In fact, you can balance your own guilt at putting a partner through this against his guilt for having a perfectly human blend of good and bad traits that make him capable of going through it with you.

Obviously, the bottom line is that you should do exactly what you want. No one is going to argue with that. But I think you’re also wondering if it’s a good idea to focus on this, and if it’s a good use of your time to look for love. Your timeline is condensed, after all. You’d have to tell potential partners and watch them react and maybe run away, and that might be harrowing. That said, posting an honest “I’m Dying” listing on Tinder would attract the ambulance chasers.

I think you should experiment with what makes you feel good. It sounds like you’re into someone and it might be time to tell him. So tell him. You don’t strike me as someone who’s going to be traumatized by the wrong reaction. But it also sounds like you want to keep looking if this doesn’t work out. That’s okay, too. If it feels good to look, look. If it doesn’t feel good, stop. I do think you’d want to watch out for control freaks, who immediately want to sign onto all of it and take over everything in your life. But you’re probably a decent judge of character, having lived the life you’ve lived.

The real question is whether the fantasy of love will be a salve or not. Personally, I’m a big fan of choosing your illusion. I think every big, overwhelming event in life — sickness, kids, marriage, death — demands some suspension of disbelief. Fantasies and fairy tales present themselves to us culturally as modes of escape, but sometimes they’re actually a way of savoring the present; it just depends on how we use them. When I was young, I used my fantasy of love to judge all of my moments alone as Not Good Enough. I’d see something beautiful and think, “If only I had someone here to share this with.” I don’t do that anymore. I savor my life in a pretty solitary way, for the most part. Even though I tell my husband a lot, I never feel my moments alone are less worthy than the moments I spend in his company.

But I’ve dramatically changed my view of how love should function in a person’s life. I value my private perceptions and adventures in ways I never did before. And I guess that even with a partner in my life, I didn’t really feel whole until I landed here, in a place where I could treat my solitary trajectory as a romantic one.

That’s what I want for you more than anything else. I think it could bring your life a lot of joy and warmth to have someone who loves you like crazy and is there for you in spite of all “terrifying, morbid messes” to come. You should pursue that if you believe in that, and you shouldn’t feel guilty or embarrassed about it. But I also think that you should cling fast to the fact that this is your life and yours alone, and it’s beautiful already in its own rough, ragged way. It already matters. It doesn’t matter more if someone is there with you. It matters now. I want to challenge you to dare to see yourself through that lens, whether you find someone worthy of your love or not. I would hate for your search for love to rob you of what you already have. I want you to be able to take every fucked up, scary, morbid moment and every glorious, divine, irreplaceable moment and every mundane setback and dreary wait and imperfect, faintly satisfying moment in between and add them up to something truly romantic.

I get that this might sound obnoxious. I sometimes talk like this to my friend who’s going through chemo, and even though she’s a skilled novelist capable of capturing the most heartbreaking moments with a few well-chosen words, she’s not into my pep talks. She’s like, “Fuck you, I’m bald and I feel like shit.” Flowery words of inspiration just make her feel worse. So I give her shit and make jokes now. That’s what she likes.

That would also be one of the toughest aspects of having a relatively new partner under your current circumstances. You need someone capable of major shifts in key and tone and tempo. A person like that is hard to find. And even WITH this very sensitive tonal shifter along for the ride, you will still want some space to savor and honor your private experiences. Understanding that your solitary experience of the world is important, it matters, it’s romantic: This lies at the heart of all happiness as far as I’m concerned. And it’s a challenge we all face no matter what our circumstances are. It’s not easy. But happiness, even within the comfort of a partnership, is impossible without it.

I’m not saying you should milk every last drop of nectar from life even when you’re going through hell. You don’t have to overachieve your way through the time you have left. Just try to view yourself and your life through the eyes of a devoted partner whether you find that person or not. Because the jagged edges of who you are, the sharp corners of what you’re going through, even when they’re sad or chaotic or lonely, are everything.

It reminds me of the very first note of Beethoven’s First Symphony. I can’t get enough of that first note, hanging there like a question mark.

Imagine, sitting down to write your FIRST goddamn symphony at the age of 25, and thinking, “I’ll start with a sudden, jarring, unresolved chord in the wrong key! But then it will resolve quietly, and then I’ll add another jarring chord! And my third jarring chord will repeat and repeat, like a slightly sad, haunting question that hangs in the air a little too long!” I mean, what an arrogant, bold, brilliant choice. And even though it’s incredible how Beethoven manages to move so smoothly from that sweet, melancholy question to this lilting, graceful dance through the countryside, followed by a bouncy triumphant conquest, followed by a strange dark shadow where things get terrifyingly morbid and a little messy, he starts it all with this insistent, melancholy inquiry. And the battling themes, with their absurdly conflicted moods, combine to form a kind of rough, uneven attempt at an answer.

But no matter how much comfort it gives us to cling to the last, forceful note Beethoven offers, it’s clear that he doesn’t really have an answer. He wants us to stay close to the question, to hear the grace in those notes, to hear the anguish and the longing there. That’s what those first chords say to me: Even when your life feels incomplete, suspended, unresolved, your task is to relish that imperfect, unnervingly unfinished space as much as you possibly can.

Anguish and longing live at the heart of every life. We are all totally alone in some ways, but we can believe in love and love it like crazy even in our solitude. I might die alone. We all might. The Earth might stop spinning in the next second. Cultivating the belief that every sigh, every breeze, every melancholy, uncertain moment alone matters: This is my work and yours and everyone else’s. These things are tiny and stupid and inconsequential, yet they matter more than words can capture.

I’m still conflicted about your question. I want you to have the fairy tale and live inside a fantasy and live in reality and savor being alone, too. I want you to have everything.

Most of all, though, I want you to know that this world loves you more than you can possibly imagine. I want you to believe that. Even though the most terrifying and morbid evidence would seem to suggest otherwise, the truth is that this world adores you like the most devoted lover. I can’t prove it, but I know that it’s real. When you struggle, the leaves on the trees shudder, the sun weeps, Beethoven’s violins cry, and the spirits of the dead and the living are on your side. We are all living inside the same terrifying, sweet, sad question with you. Do you feel that? That part is not a fairy tale. That part is real.

Polly

https://www.thecut.com/2017/11/ask-polly-im-dying-but-i-want-to-be-in-love.html

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bewareofchris · 7 years

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Sass prompt! Cool Uncle Kadar takes the kids to his favorite mall food court (or something) then somehow manages to lose them in the crowd (nothing bad happens, they just gorge on samples or whatever), and since it took Kadar hours to convince Malik that he's a perfectly responsible adult able to handle 4 kids, Kadar is in more of a rush to find them than he normally would be.

G | Sass Verse | Terrible mall manners

Kadar had said the phrase: ‘you raised good kids, they won’t be any trouble,’ no less than fifteen times in a single conversation just to convince his brother to take a god damn day off. It wasn’t a lie because all four of Malik’s kids were well-behaved little demons. If one of them wasn’t, they had a way of policing themselves that required very little effort on the part of the adult watching them to resolve. (As long as Jaida was present, without her the triplets were likely to devolve into a mob of in-fighting.)

Altair was over-seas on business that was taking him (thus far) a week and a half longer than projected. (And Kadar assumed that meant someone had pissed Altair off and he was systematically dismantling the entire senior staff because of it. Or he might just have gotten caught in boring meetings, it was very difficult to tell.) Malik had a cold and colds made him miserable. Altair had called Kadar to retrieve the kids and take them somewhere for the day so Malik could sleep.

So here he was, one adult in a mall food court at an empty table. The table shouldn’t have been empty. There should have been an eight year old girl sitting on one side, glaring at her brothers. There should have been three almost seven year olds glaring back at her. Kadar had literally walked six feet to retrieve a plastic fork and come back and in the less-than-a-minute it took him to go that far, all four children had disappeared.

Their food was still present. Their toys were scattered on the floor. Three chairs were even pushed up to the table.

“Fuck,” Kadar whispered. His hands were still held out to either side of his body because he’d been half-way to saying that he thought they should maybe find an indoor playground sort of thing after this. Maybe laser tag or a bounce house. Something to keep the demons moving so they’d fall asleep early.

He looked left (and no children) and he looked right (and no kids). He dropped the fork on the table, tried to think through the sudden panic, and pulled his phone out of his pocket. Claudia answered him on the first ring.

“Yes?” she said.

“I lost them,” he said. “They’re gone.”

Claudia had sounded somewhat preoccupied when she answered the phone but there was a noticeable shift in her tone that meant she’d turned her face into the phone to ignore whoever was speaking to her. “No,” she said. “You cannot lose Altair’s children, Kadar.”

“They’re gone,” he repeated. He took two helpless steps to one side and stopped because the only thing in that direction of the food court was sushi and he didn’t think the kids even liked sushi. There was ice-cream on the other end and also a store full of shiny jewelry things that both Sef and Jaida had spent a solid ten minutes trying to talk him into. So there was a better chance they’d gone that way. (God knows, Jaida could make her brothers do anything.) “They’re not here,” felt like it needed repeating.

“Why did you leave them?” sounded so exasperated.

“They were eating! Aren’t kids supposed to just sit and eat when you provide them with food.”

He didn’t need to see Claudia to know she was covering her face with her whole hand. “Not all children are you,” she said.

“Uncle Kadar,” was a voice from just behind him that accompanied a sharp pull at his jacket. There was Tazim looking up at him with such disapproval. “We hide,” he said (as if it were so obvious), “you find us?”

As if summoned by some kind of magic, Jaida appeared from around the opposite end of the food court with her fist wrapped up in Darim’s hair as he shrieked his outrage at being yanked. One or two adults were staring in outrage and the spectacle had drawn the hesitant-but-amused attention of a security guard.

“It’s fine,” Kadar shouted down the aisle. He grabbed Tazim’s wrist just so he didn’t evaporate into thin air again. “They’re with me,” he shouted as he tried to side-step a couple that were too busy looking horrified to get out of the way. “Jaida,” he called (with as much fairness as he could manage), “let go of your brother’s hair.”

Jaida made a deliberate show of loosening her hand from Darim’s hair and then reaching down to wrap her whole fist into his shirt before she started yanking him forward again. She didn’t let him go until they were back at the table. “Stay,” she said to him. Then she glared at Tazim who shifted so he was half behind Kadar’s body (and who wouldn’t want to hide when being looked at like that).

“Sir,” the security guard said.

“We’re fine,” Kadar assured him, “we’re going.”

Jaida stomped over to a trashcan, one of the big round ones that people threw their paper trash and half-drank sodas into. She reached up to wrap her fingers around the inside lip of it (and Kadar saw his whole life flash before his eyes as he imagined what Altair would do when he found about this) before she yanked it as hard as she could. The lid popped off after a bit of complaint.

“Jaida!” Kadar shouted. He dropped the phone and Darim dove down like he was going to pick it up but Kadar grabbed him by the elbow and dragged him a bit sideways so he could get both boy’s hands with just one. That gave him a free arm to reach out to get Jaida.

Only, there was Sef, popping up out of the trash with ketchup and soy sauce and marinara and God knows what all over his clothes. “Jaida,” Sef said with his hands on his hips. “We said Kadar was it.”

This was it. This was his cause of death. This was the end of his life. Tazim popped up at his right hand (funny because he should have been holding Kadar’s left hand) with the phone pressed to his ear. “No Aunt Claudia we weren’t trying to get anyone in trouble. We were behaving.”

Kadar said, “Jaida, hold Darim,” and he could have predicted that she’d grab him by the shirt front. He picked Sef up out of the trash while an aghast looking custodian clutched her white rag against her chest looking like she wanted to offer help and she didn’t want to get involved. The whole food court was nothing but whispers of inadequate parenting while the security guard was saying:

“Sir, are you sure everything is okay?”

“Yes,” Kadar said. “Usually my wife’s with me. I just expected the kids would behave a bit better. We’re very sorry.” He set Sef down (with a grimace) and took the phone from Tazim long enough to say, “I’ll call you in a bit, everything’s fine.” Then he grabbed Tazim’s hand. “Jaida come on.”

They didn’t stop walking, and the boys didn’t stop complaining about lost food and toys, until they were out in the parking lot, protesting how they were being physically lifted into the car.

“That’s not fair!” Sef was shouting from his booster seat in the back-back seat. “Because it’s not just a Hot Wheel! It was a limited edition roadster and its very hard to find one of those.”

“Your Dad’s a billionaire,” Kadar said as he lifted Darim into the car. He’d finished putting the boys. Jaida stood outside the car with her hands on her hips, head cocked to the side and foot all but tapping on the ground. “What?” he asked.

“Let’s start with thank you,” Jaida said. “I found them all.”

“Tazim came back on his own,” Kadar countered.

“No he didn’t,” Jaida said. “He heard Darim crying.”

“She pulled my hair out!” Darim shouted from inside.

“I came back on my own!” Tazim shouted.

“Thank you?” Kadar offered. It was not even a little bit what Jaida was angling to get out of this situation but he was willing to offer that to see what else she might want.

Her smile did not make him feel better. “You’re welcome, Uncle Kadar. Don’t worry, they did the same thing to Father.” Then she climbed up into the vehicle on her own. Once she was buckled into place, she pulled her sunglasses out of her purse and slipped them on her face. “I want ice cream,” she said. “Maybe Father doesn’t hear about this.”

Kadar leaned against vehicle with one hand on the handle of the sliding door. “You can’t keep them quiet,” he said.

“No,” she agreed, “I can’t. But I can tell them I helped you find them.”

“Hey!” Sef shouted, “you weren’t it.”

Jaida cocked her eyebrows up behind her sunglasses.

“Fine,” Kadar said. “Ice cream, then we have to find somewhere that sells kids clothes.”

–

He called Claudia back while he was scrubbing Sef with a handful of paper towels in a family bathroom at Target. There was a bag of new clothes that looked suitably similar to what he’d already been wearing. The other three were standing with their backs against a wall. “Crisis averted,” he said when Claudia picked up.

“Was Sef really in a trashcan?” Claudia asked.

“I’m cleaning him up,” Kadar countered. “He’s fine.”

Claudia hummed. “Where are you going next? I’ll meet you.”

The truth was, Kadar didn’t want to take the demons anywhere but straight home to their bedrooms. Except that the two boys not being vigorously scrubbed with paper towels were looking at their shoes. Jaida was looking fed up with the world. “I was thinking the bounce house,” he said.

“Fine, I’ll be there. Do not let them out of the car until I get there.”

That settled, Kadar finished cleaning up his nephew as best he could before dumping his dirty clothes into the trashcan.

–

While sitting in the parking lot, Jaida and Sef climbed into the front seat next to him while Darim pressed his face against the back window and blew fart noises into the glass. Tazim sat on the center console and asked him what every individual knob and button on the car did.

Claudia appeared next to the driver’s side window, shaking her head at him (but smiling). He rolled the window down far enough to hear her say, “this is reasons one through fifty why we decided not to have children,” wasn’t accusing but amused. “Let them out.”

Once all the kids were out of the car, Claudia assessed them (and saw they were unharmed with her own eyes). She crouched in front of them, reached out to take Tazim’s hand on one end and Jaida’s on the other. “If you act out here, I’m calling your Father. Do you understand me?”

The thing about Claudia was that she could make anything sound like a nuclear apocalypse. The worst Malik would do was be disappointed in his kids but all four of them (even haughty Jaida) nodded solemnly. So Claudia smiled at them. “Good, lets go. Everyone hold an adult’s hand.”

–

Kadar took the kids to a pizza bar before he returned them home. Malik still looked like shit, but well-rested shit, when his kids came to hug him in the kitchen. Thanks to Claudia’s parting instructions (I better get a call saying you took a shower and went to bed) all of the kids left their Father immediately to go and prepare for bed.

“Is Sef wearing a different shirt?” Malik asked.

“No,” Kadar said. “Don’t think so.”

Malik didn’t believe him for a minute. Maybe he just didn’t think it was worth debating. Rather than protest he said, “thanks for taking them. Altair’s on his way home. And Lucy’s coming tomorrow.”

“No problem,” Kadar said. “You know I love the kids.”

Tazim chose that exact moment to bounce down the stairs wearing nothing but his underwear to proclaim, “Sef climbed in a trash can today!” He was delighted to share that.

“Well I’ve got to go,” Kadar said before Malik could start with the questions.

#sass verse #mall anon #and the next day #Kadar moved to California

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