#should have gone for surgical tech perhaps

[llycaons]

you know I was so excited to move on from my lab job and do health care because I wanted to do meaningful work that wasn't for the purpose of making a businessman richer, unfortunately I live in america

[bellygunnr]

Post-Augmentation Referral

cw: hospital, post-surgery, body image, nudity

They had told you that the surgeries would not leave you hurting. At the get-go, you had been doubtful, and now your doubts are confirmed: you are freshly post-surgery and hurting. Not immensely, so perhaps the techs and the surgeons and the lone recruiter had meant you would not be bedridden with pain, or maybe none of them were exactly experts, considering none of them had experienced the process.

Still, you hurt. Your hands are sore, your fingers stiff. You limp to the private bathroom because three focused points in your back are knotted with pain. Should you even be walking? Should you be thinking different it is, to be three inches taller, to be held off from grasping the door knob, lest you break it off?

The inside of the bathroom is surprisingly spacious. A shower stall is in the corner, already equipped with a curtain and hygienic products. You pry off the papery hospital gown in front of the full-body mirror, letting it fall to the cold tile with a rustle. The harsh overhead lighting casts you in sharp refrain, but it’s not enough to sour yourself on your own image.

Because not a lot has changed, save for the surgical scars covering your body head-to-toe. Maybe your eyes, too, if the way they catch the light is any indicator. No, maybe everything. The imperfections you wore just hours ago have faded fast. Your bitten-down nails peek past your fingertips, sturdy and grown, healthy upon closer inspection. Acne scars that once made patterns on your cheeks, chin, and nose, have disappeared-- and was this not supposed to be a good thing?

Further, still, the two moles on the left side of your neck: gone. The lack of body hair is not surprising, given the scope of the operation, but you find yourself hoping it will grow back. Your freckles remain, in reduced smatterings all along your forearms and shoulders.

More importantly than even that-- the spots and the freckles and the things that told you who you were-- is the fat still rounding out your silhouette. Somehow, your soft stomach was retained, and your thighs still rubbed together. You feel like you’ve read something about this before. Something about making the transition between old and new easier.

You’re not sure why you are criticizing yourself so closely. The techs outside wanted you to shower and be done with it. Perhaps you’re stalling because the speed of the process seems dangerous. Daunting, at least. How could they change your life in just a handful of hours and expect you to simply get on with it?

It’s probably best you should, however. As you turn and walk into the shower, turning the water onto hot, hot, hot, you discover that the pain in your limbs has already faded fast.

You could even say you feel normal now.

You flex your hands underneath the rushing water, watching the droplets cascade and splash against your skin. 

The absence of a physical, internal reminder, is going to make it very easy to forget the start of your new life.

[aelaer]

The Blood in My Veins: Pt 4

Heyyyy I'm back. Now that one of my big fic projects is done/being rolled out I can concentrate on getting this finished (as well as other prompts). Here are the earlier parts if you can't remember what happened in this long-running prompt fic, since my last update was like, the summer.

Part 1 | Part 2 | Part 3

Prompt (via @ironstrangeprompts that I can’t tag for whatever reason qq): Kidnapped to play doctor for a still unseen other prisoner; Stephen realizes there is only one person on the planet who would have palladium in their blood.

The Warnings: Okay guys, I want to cover all bases for this part and all parts henceforth. The bad guy I've written here really really sucks. He's a complete asshole. Part of his assholeness can include behaviors such as racism, sexism, homophobic remarks, religious bigotry, and overall just being a terrible human being. This terrible human being is not a typical representative of his nation/culture and is very thankfully fictional. There's plenty of Canon-Typical Violence around, too. All of the above are not be in this specific part but could be in future parts (I'm writing this as I go so I truly don't know, I just know he’s a dickwad). I didn't know this section was gonna happen until I finished Part 2, for instance, otherwise I'd have put a note at the beginning. I'd consider the fic a heavy teen fic, if you're looking for a rating, so it shouldn't get to graphical violence beyond what you'd see in high teen rated content. Also, there's going to be Medical Procedures in the future, though more clinical rather than graphic. Hopefully that covers everything, please ask me anything if you have a question.

I always put these longer writings on tumblr into "read more" cuts, but the mobile app does not always work correctly if you're looking at the original post from my tumblr, so I apologise for the length if you're on the app and viewing the original and said cut is not working. Still unbetaed, all errors are mine.

--------------------------

Part Four: Seeing Red Again

Another three days passed with little change in Stephen’s schedule. He went for his sleep shift at 12:30 a.m. New York time, and was woken up by one of the others between 5:20 to 5:30 a.m. It wasn't enough time for even two full complete sleep cycles, but everyone there—perhaps with exception to Steffen Baar, who was a chemist—had gone through grueling schedules during medical school and residency. So they were, in some ways, used to it.

After waking up, he had fifteen minutes to shower, shave, and change into the clothing about his size, provided for by his captors. From there, he then got to work. His sleep shift ended about three hours before dinner came—about 8:30 a.m. New York time—and a small snack arrived at what he assumed was this place's midnight, but was 2 p.m. according to his watch. Breakfast came twelve hours after dinner, at 8:30 p.m. in New York, and he went to bed again half an hour after midnight. Apparently while he slept, another snack break came for those awake.

The one small blessing in all of this was that the people holding them realized the power of caffeine and provided black tea and coffee every time they brought them food. He didn't think there were any cameras in the showers or toilets, either, which was—hopefully true. There was nothing obvious and, truth be told, he didn't really want to look much further for evidence.

Throughout his waking day, Stephen largely helped prep samples for blood analysis. He tried to strategize with Summer about how to best utilize their resources, should a surgery be required, but they had little to go on. They had yet to receive better X-rays of their patient—of Tony Stark, which still baffled Stephen—so much of their planning was about logistics.

"Doctors in the United States are required to complete a surgical rotation in their third year of med school," Stephen said, "so Jada will know basic surgical procedures. Do you need to do the same in the UK?"

"Yes," Summer answered. "All doctors go through the two-year Foundation Programme which always includes training in general surgery. So Dr Mahajan will be able to assist us as well."

"They can serve as our nurses and techs," Stephen muttered. "But what about Dr Baar?"

Summer pursed her lips together. "No medical training—but I would rather have him on hand than not. If we said we can't use him…"

Stephen grimaced and nodded. "Point. He can certainly hold a retractor." He blew out a breath. "We'll need a heart-lung machine. Those aren't easy to come by."

"None of this machinery is," she pointed out, jutting her chin to the advanced machinery scattered around the room. "I don't think that will be an issue for us. Whoever these people are, they have resources."

He pursed his lips together. "We also need an anesthesiologist."

She paused at that and sighed. "Yes. Yes, we need one of those. Unfortunately, I think we're going to be working with someone on their team if the surgery happens."

Stephen made a face. "What makes you think that?"

"When they first showed me the X-rays, I told them I would need another surgeon for the spinal area—you—and an anesthesiologist. They only spoke about finding me a surgeon, so they must have their own medical team that includes one."

He sighed. "Of course they do. He better be competent."

Summer shrugged. "Not much we can do about it. And there's not much more we can plan on this hypothetical surgery until I have better X-rays."

And so that ended that discussion and, three days later, there were no changes on that end. No new X-rays had come in, so both he and the other surgeon were stuck helping prepare samples and input data. And Stephen hadn't been so bored in years.

One wouldn't think that being captive would be boring, especially if one was doing medical work during that time. But when said medical work was repetitive lab work he hadn't done since med school? And doing it for about fifteen hours a day for three days straight with no music, no reading, no nothing to help bring some distraction or variety to his work? It was absolutely mind-numbing. A small part of him wasn't entirely sure if he could survive like this for—how long did Jada said Stark had to live without a cure or intervention? Two months? He couldn't do this for two months. He was going out of his mind after three days.

It was about halfway through his shift on the fourth day that he regretted ever thinking that he was bored.

He was typing up results from various tests performed by Jada when the door to the room was suddenly slammed open. Startled, Stephen immediately turned towards the sound, only to see five men enter, all of them with guns pointed to the rest of the room. Beside him, Jada immediately threw her hands on top of her head, and he quickly followed suit.

"Come quietly! Do not fight!" said one of the men. Stephen couldn't even begin to guess his accent; maybe it was Eastern European? Russian? Former Soviet bloc in Asia? Somewhere in that rather wide region of the world, which wasn't particularly helpful information considering there were some twenty to thirty countries there.

Summer was the doctor currently asleep, though looking over his shoulder, Stephen saw that she had woken up to the sound and was pushing herself up. But he couldn't look at her or the other doctors long as he was grabbed by one of the men and forced to walk. The gun the man carried quickly negated any ideas of retaliation.

They were led down a hall; he could see Steffen, Meera, and Jada in front of him, all being led in the same rough manner he was going through. The walk itself wasn't very long, perhaps a minute, but to Stephen it felt like every second was dragging. Despite his best efforts, his heart was starting to race at this new development.

The man with Steffen finally stopped in front of a door and unlocked it, then shoved the chemist inside. Within seconds, Stephen was at the door and being pushed forward himself. He took a quick look around, as much as he could without moving much: a large room with concrete walls and no windows, just like where he and the other doctors were being kept. Cot in the corner. Table with a computer and covered in bits of wires and electronics that he couldn't begin to label. Two other men armed with enormous guns—some sort of automatic rifles—and then one man who was crossing his arms and staring at him and his fellow doctors with a look that immediately put Stephen on edge. This man, this man radiated the air of a person in charge.

And then there was him. The famous Tony Stark, or Iron Man as he was calling himself these days. He looked like a former shadow of himself, being several pounds thinner and bearing a sickly pallor that Stephen immediately noticed, even during these circumstances.

A look of surprise was upon Stark's hollow face, but even as Stephen focused more upon him, it was quickly replaced by the cool anger of a man biting his tongue.

All five doctors were maneuvered to face Stark in a line before being forced to their knees. Stephen bit his lip to hold back a grunt of pain from his knees hitting the concrete floor.

"You say you are 'calling my bluff' with your medical team," said the man. He pushed himself off the wall and passed out of Stephen's line of sight. "Here they are." He started at Stephen's right as he went through the doctors. "Steffen Baar, chemist." A step closer. "Jada Ferguson, hematologist." Another step, and he heard Doctor Mahajan inhale sharply. "Meera Mahajan, pathologist."

Another step, and the man was behind him. To Stephen's utter horror, he felt cold metal press against the back of his head. "Stephen Strange, neurosurgeon." The metal then left his head and he heard another step. "Summer Weston, cardiothoracic surgeon." Another step, and he could see the man in the corner of his eye again, this time on his left.

Tony Stark kept his lips pressed in a tight line as their captor went through the line. When he finished, the billionaire swallowed and looked at them all. "Good job keeping me alive this long, docs," he said.

"Not good enough, Stark," the man snapped. "Their solution is only a band aid. They give you but a few more weeks. They are called the best doctors in the world, and they cannot yet make a cure?"

Stephen forcefully held back his retort regarding the man's utter ignorance. It was an outright miracle they found any sort of solution as quickly as they did to delay the spread!

Stark, it seemed, agreed with him, and had no such reservations with holding back. "That's insane, Yusifov. It takes teams of doctors months, if not years to create what you're looking for."

He couldn't see it, but Stephen could almost feel the sneer from their captor, this Yusifov. "In that case, you don't need this many doctors, do you?" A couple steps and he was again behind Stephen, further to the right. "I'm no doctor, but as far as I can tell, these two both look at blood and try to fix the problem. Neither of them fixed it, not fully. So who do you want to keep, Stark? The black American or the Indian Brit? One less woman won't make a difference."

Stephen dared a glance to his right when he heard quick breathing. Doctor Mahajan was visibly shaking and starting to hyperventilate; to her right, Doctor Ferguson was quiet, but her lips trembled and tears pricked her eyes.

Stark stepped forward, and several guns rose at the action. He stopped but held his ground, raising his hands. "Don't do this."

"Why not?" the man retorted. "You refuse to work because you are dying. They have failed you and one will pay the price. Perhaps both; they are both from lesser races."

As Stephen processed the fact that he heard a comment like that in fucking 2010, Doctor Mahajan's breathing accelerated into full on hyperventilation. His medical mind noticed it immediately.

But another was quicker to the draw. "Breathe through your nose, Meera," Summer said lowly. "Try to inhale for one-one thousand, then exhale through pursed lips. You can—"

"Shut up!"

Doctor Weston was smacked on the back of her head hard enough to send her sprawling to the floor.

And Stephen snapped.

Now, if one were to ask Doctor Stephen Strange, he would by no means consider himself heroic or noble. His role as a doctor was one of service, but even within his relatively short time as a neurosurgeon, he had already gained a prestige that recognized his rising star and already people in the medical community were considering him in the top ranks of neurosurgeons. Soon, demand for his expertise would be large enough for him to have the option to turn away those who weren't worth his time, and he felt not a lick of guilt for that. His skills were valuable.

But to hear this brute of a man first throw slurs at two of the most brilliant women—no, the most brilliant doctors—in their fields followed by an outright assault on the other caused a protectiveness Stephen hadn't felt since his sister's death to completely overtake him. He saw red.

He leaped up at Yusifov in a fiery anger, no particular idea in mind except stop him from hurting anyone rushing through his head. At this point there was little thought, only adrenaline and a near primal fury running through his veins. It wasn't like him to be so hot-headed; he was a man who kept his cool under the most stressful of circumstances. But perhaps several days of poor sleep combined with the stress of the situation finally got to him. When he thought about it in the aftermath, even he would admit he had no idea what he was thinking.

It was a spur-of-the-moment decision he would come to regret.

In one moment he managed to knock the pistol out of Yusifov's hands and punched him in the face. He recognized screaming, shouting, fighting in the noises behind him, but he was focused on his own target.

Stephen hit him twice more before someone threw an arm around his neck and dragged him back and began to choke him. He clawed at the arm, which did nothing, but then he aimed his heel down right to the sensitive part of his attacker's instep. The man grunted in pain and the grip around his neck loosened. 

A shot shattered through the enclosed space, causing Stephen to freeze in surprise—and that proved to be his downfall. He saw Yusifov raising his pistol just before he was whipped across the face with the weapon. The hit threw him off balance and he fell to the floor and lay there for a second, stunned. He felt wetness on the side of his head.

As Stephen attempted to push himself up, a kick to his back sent him back to the floor. An involuntary grunt of pain escaped him. He closed his eyes, pausing for breath, but was given little time to recover as he was grabbed by both arms and dragged up to his knees. From his new position, he could see the rest of the room once more, and Stephen's heart skipped a beat at what was before him.

There were several alarming sights: Tony Stark on his knees just like him, nose bloodied. One of the gunmen near Stark with a screwdriver sticking in his neck and very much dead. Summer in the corner of the room, holding a shaking Meera against her chest.

And Doctor Steffen Baar on the ground, bleeding out from his stomach as Jada desperately tried to stem the blood flow with her sweater. The red dripped through the fabric and onto the concrete.

Stephen felt ill. He instinctively reached forward towards Steffen, to try and help, but the grip on his arms tightened and kept him in place.

Stark was the one to speak first. "Let them help him. I won't fight further. I'll do what you ask."

Yusifov came back into Stephen's line of sight as he stepped in front of him, though his gaze was on Stark. He said to the engineer, "You killed one of my men. A life for a life—that is fair, wouldn't you say?"

"He did nothing," Stark hissed, pulling against the hands that held him down. Stephen could see the men pull him back and tighten their grip in response. "And he's needed. You wouldn't have brought him here otherwise."

"He didn't do anything," Yusifov agreed, then turned to Stephen. "This one did." He then sent a sharp kick into Stephen's stomach, causing him to double over in pain as far as the men holding him  allowed. He almost missed the next statement. "And I should kill him for it. But the surgeon will be needed. The chemist, though? He failed to make a cure for your ailment with a month of time, and you don't have much longer to live, Stark. The chemist failed, and at this point, he's a waste of medical resources."

Then Yusifov nodded at one of his men, and he grabbed Jada by the arm and yanked her up to her feet.

"No—please, no, don't do this!" she shouted as she was dragged away from Steffen. Their captors ignored her and Yusifov walked up to the wounded man. He aimed his pistol at Steffen's head.

"Don't do this!" Stark shouted.

A shot rang through the room. A loud sob came from the corner before it was muffled. Stephen's ears rang, half deafened from the sound. His stomach churned; he felt like he was going to vomit. He hung his head and closed his eyes, trying to breathe slow breaths through his nose.

All he could smell was blood. He forcefully suppressed his gag reflex. 

Stephen missed whatever conversation came next, too busy trying to calm his breathing, trying not to throw up, and not having the energy to make out the words beyond the ringing in his ears. But then the world was moving as he was pulled to his feet and shoved out of the room, leaving behind Tony Stark and the body of Doctor Steffen Baar.

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I was stuck on what I wanted to do with this part with a handful of ideas and consulted my beta for ideas. She suggested death which I wasn't even thinking of because I'm very bad at killing off characters. I blame her fully :P

Tag list (just let me know if you want to be added/removed with a comment - still not on AO3!): @sobeautifullyobsessed, @tashacumberbitch, @babywarg, @nishtha3012, @ragingstillness, @walkin-in-the-cosmos (I think the reason I can’t tag you is because you’ve flagged your tumblr for sensitive media, possibly), @lafourmii20, @asexualchemist, @iveneverbeenmorestressedinmylife, @oo0-will-of-the-wisp-0oo, @animefanfreak45, @rulerofthefandomsnow, @killaspyglass, @renlybaratheon-tyrell, @symmetria42, @kay-lock-key-lock

[meteorstricken]

Sephiroth Week, Day 1 Prompt: Specimen

“Grief”

Months had passed since Gast had gone missing, had died, and the empty tightness lingered still in Sephiroth's chest. It crept up into his throat; it wove tight wires around his fingers so that his nails carved out small, bloody crescents into his palms. Sometimes, the feeling took hold of and destroyed lab equipment. Once, it had uncoiled from his hands and snapped a technician's wrist. He didn't think before he did these things, and never admitted to them, but Sephiroth found relief in pouring the constrictive pain into anything or anyone else. So long as it left his body, but somehow, it always found a way back into him, filling up the emptiness with burning and reminding him of how alone he was.

Professor Hojo grew increasingly amused and irate when he finally figured it out. The angrier he was with Sephiroth, the more hilarious he found his telekinetic fits. He didn't try to stop him; he just watched. He watched him sitting motionless but for a darting eye or twitching finger, trashing machinery, mangling surgical tools out of shape, shattering every fragile glass beaker, test tube, and unrated containment chamber within his line of sight. And he laughed that half-suppressed laugh that meant he'd concocted painful exercises for later to figure out how he'd learned such an ability.

All Sephiroth knew was that the power had come to him with the sadness.

"Do you think your life would be so different if Gast were still with us, hm?" Hojo asked Sephiroth one day when he and his assistants had managed to subdue him, pacing around the examination table where they'd strapped him down. He stopped to motion at the holding cells, computer towers, and sharp, wicked surgical implements surrounding them. "Did you know that he's responsible for all of this? So much of it, all his idea, and yet he abandoned it all in favor of hopeless whimsy. You as well. A fascinating thing, isn't it?"

Sephiroth remained silent, in no small part because of the sedatives, but also because he had no words--nothing that Hojo wouldn't twist against him. It was true that Gast had kept him here and treated him differently too, but he hadn't mocked him. His mind ran over again on how Hojo had left for a week when a rumor started going around about where Gast had gone, but he'd returned alone in the end. Sephiroth knew Hojo had done something to him. He read more violence in him than before, a feeling of accomplishment over the other's death--an obstacle finally removed; not a fellow scientist or a friend lost.

Sephiroth kept his suspicions to himself, and simply continued listening to Hojo's endless gloating. He went on and on until his technicians entered the room. Eventually, Sephiroth faded.

When he woke, he was uncomfortably slumped up against the curved wall of one of the holding cells used for the stronger inhuman specimens. His side ached where a large bandage had been affixed to conceal a freshly stitched-up incision. He wondered what Hojo might have cut out or put in him this time. A rogue thought drifted through his mind about the last time this had happened, but to the other side. Gast had coaxed him to the operating room with gentle words, and he'd woken up in a bed to assurances that 'things had gone well'--whatever those 'things' were.

…He'd never bothered explaining. No one did.

Sephiroth then remembered a conversation he'd overheard between two lab techs. They'd been exchanging photos of their children, and talking about school, friends, and play dates. Not like him--not a never-ending cycle of uncaring or horrified tutors, observation days, and quarterly exploratory surgeries. The tightness that had lived in his chest descended into the pit of his stomach. His ability to read inside people was a newer development, and he'd never gotten the chance to ask Gast why it had to be like this--what made him too different and special to see much of the outside world yet--and he knew Hojo would only dodge the question or lie. Nearly everything he said was half a lie. But Sephiroth knew from the others that wandered near that the first years of his life were all wrong.

Worse, Hojo hadn't been lying about Gast having started everything, and having intended to keep him here too for a few more years at least.

Sephiroth pulled his knees up to his chest, curling into a ball. He didn't want to think about what that might mean, but the thoughts came anyway. His heart raced, and a tiny whine escaped his dried-out throat. Maybe it was true. No one cared. No one. He was just an interesting thing to them. Like a toy.

He wanted it all gone. His thoughts overflowed into energy he could almost touch, and he imagined they were long, silvery electric worms. He sent them slithering up into computers and shorted their circuits. Pops and snaps rose from some of the nearby terminals, and the sparks ignited a stack of binders on the desk. Plumbing and exhaust pipes lining the ceiling groaned and split open next, leaking water, steam, and a small amount of mako residue, filling the room with its putrid stench.

At last, a massive crack formed in the thick glass surrounding him from top to bottom, but the structure held. Exhausted, Sephiroth leaned back against the opposite side, trembling. He needed to become stronger than this. Much stronger, so that nothing could hold or control him. So he could get away from here.

The keycard panel near the door blinked green, and Hojo sauntered in and stood before him, ignoring the flaming stack of paperwork at the far end of the room. "I see you've been busy again, Sephiroth… You should know the data I've extracted from this event will determine our next steps with you," he said, holding up a small disc. "After I explained what has been driving up the SRD's equipment costs over budget of late, President Shinra took a renewed interest in you, but ultimately you're my s--ah, hm." Hojo stopped short to chuckle under his breath. "Perhaps my prized specimen will become this company's crowning achievement after all," he hummed, rocking back on his feet slightly.

Zeroing in on the word Hojo had cut off at first, seeing where it sat unspoken in his mind, Sephiroth froze. So…that's why he was trapped here. He quickly decided it didn't matter, he wouldn't let himself care--though now he wondered if it was Hojo's fault his mother was gone too. More things that, if true, Gast had also kept from him…

Hojo paced back out after one more sidelong glance, muttering only to himself. As the door hissed open, a woman and a small girl dressed in red and pink scurried by, escorted by three infantrymen. He followed after them, and Sephiroth knew that for at least a little while, the man's attention would be split. Those two were toys to him too. Hopefully, they'd keep him occupied long enough that Shinra would order his release before he was due for another operation.

Sephiroth had been able to read at least one thing for certain bouncing around in Hojo's head--that his days living under his thumb were numbered. That's all that mattered.

[nemossubmarine]

Warhammer 40k: Wrath & Glory RP #41

We pick up this session right where we left the other one. Z47r and Sergeant Carl discuss the situation on the floor they’re currently on, and Carl notes that the elevator seems to be stuck, as well as there being a breach in one sector, but other than that they should be ready to head down. Z47r agrees, he sends one of his skitarii with servitors to check the place Carl noted and goes himself to check the elevator wtih the rest of his servitors (including Vivek), letting Carl know that there are supplies for the Sable Swords upstairs, and that he should take the new-comers (aka our heroes) under his wing. Gorm calls out after Z47r and requests a servitor to refill his jump-pack, pointing at a non-Vivek servitor. Z47r waves the servitor forward, and he begins to work. Gorm pretty quickly reprimands the servitor on doing a bad job and requests another, this time pointing at Vivek. Z47r sends instead one of his skitarii to do the job.

Gorm asks Carl if they could talk in private and Carl suggests Gorm and friends come along as he goes to pick up the supplies. So they make their way back to the upper levels of the ship. Gorm explains that the AdMech friend he was asking after is one of the servitors, and Carl says he is sorry to hear that. Gorm also mentions that Uffe has promised to kill him, so they need him back, as they don’t want to do that in front of the tech-priest. Carl asks if there has been a mistake in making him a servitor, and Gorm says no, he’s no innocent but not a bad man either. Carl suggests that doing the killing downstairs would make it easy to make it seem like it was because of the rot, so that’s something they can work with, if need be. Carl has worked with Vivek the servitor, so he could probably get him to the position.

Saef interrupts this conversation by opening up a telepathic channel between himself, Gorm, Gimlet and Uffe. Uffe turns to give Saef a glare. Gorm quickly gets Carl rambling on about the latest exploits of Stuart the Sable Sword, so he doesn’t notice the sudden silence. Saef explains to them that Vivek attempted to communicate with him very much in the same way as Eden had in the past. He isn’t quite sure what it means, but things might be different than what they seem. Gorm points out that Uffe’s promise was to Vivek, not to Eden, and that they agreed not to step in the way. Saef concedes to that, but says they should attempt to communicate with Vivek first anyway.

While they’re on this telepathic call, Gimlet says he has an idea how to get Vivek away from the tech-priest. Technically, he could confiscate Vivek as evidence with his Inquisitional powers. This seems like an agreeable idea. Gorm even says maybe this is a time where Gimlet’s badge might do some good, but there is some information Gorm needs from the tech-priest, so he wants to talk with him first, before Gimlet starts burning bridges. 

With that agreed, they return back to where they left the retinue. Z47r is busy with the elevator, Stuart the Sable Sword is keeping the doors open with his muscles. Z47r finishes whatever he is doing by tossing a fire bomb down the elevator shaft and lets everyone know that once the fire has burned out, they can start moving down.

Gorm pulls Z47r away from the others, and lets him know that he is on a Fenris-sanctioned mission, and he believes that Z47r has some information about a Space Wolf that has been spotted with AdMechs on Orchard Mountain. Z47r says he has no reason not to help Fenris and says that he indeed can track the Wolf in question, but not here. He needs to go back to Triplex Phall for that, but he says he can do this after he is done here. Gorm asks Z47r to promise that he will do so, and the tech-priest says he aims to serve.

Thus satisfied, the two return and Gimlet goes to Z47r next, asking him about the Inquisitor murdered on the ship. Z47r says he doesn’t know anything about it, though he has heard it happened. He supposes one of his servitors might have spotted something, but he asks for Gimlet’s credentials vis-a-vis questioning about this, and Gimlet whips out the Inquistional badge. Z47r says he prefers people keeping their badges visible (Gorm agrees in the distance), and then asks if he should be recording this conversation. Gimlet says there’s no need, but Z47r says he’s going to do it anyway.

Z47r calls over the servitor who delivered the evacuation notice to Inquisitor Engarde, and takes out a video from his eye and shows it on a wrist mounted screen of his (v high-tech). The video shows the servitor going to tell Engarde about the evacuation. As he leaves, he runs into a woman who is hiding her face, who Gimlet recognizes as Inpax. The servitor continues relaying the evacuation notices to people around, and Inpax disappears into the room where Engarde is. They begin a conversation but it is cut off by the door closing. Some time afterwards there is a shout from Inpax: “You did this to me!” and a gun shot. So that’s that then.

Gimlet has another request from Z47r, namely that he needs to get a hold of a servitor in the tech-priest’s retinue. Z47r asks for what purposes, and Gimlet fudges the truth somewhat, saying it is related to his case looking into Inquisitor Inpax. Z47r makes Gimlet sign some forms, and informs him that the Mechanicus are expecting a full report on what the servitor contains, so they can see whether it counts towards the AdMechs’ yearly tithes to the Inquisition. But those things done, Z47r hands Vivek out to Gimlet without any more fuss.

Our heroes feel it prudent to take their servitor-friend to a safe place, so they head off once again, promising to join the rest with Nurgle stuff as soon as they can. As soon as they are off ear-shot from the rest, Vivek opens his mouth and very emotionelessly says that “this is an unfortunate turn of events”. It is very apparent that it is not Vivek talking, but Eden, who has taken over while Vivek is away. Eden is apparently aware of Vivek’s and Uffe’s deal but makes it known that Vivek is not gone, and he could be saved, but he needs help from our heroes. The thing is, that Vivek-Eden were going to leave for Triplex Phall, but got caught between Inpax and Navin (aka Vivek’s brother, Eden uses that name, because that’s what he’s getting from Vivek’s brain). And in that moment, Eden overrode Vivek and chose the tech-priest, and thus the servitor-ing. It was a logical choice, because the whole point of putting parts of Eden into Vivek was about Inquisition not getting their hands on certain things, but obviously Eden is aware that is not what Vivek wanted, hence he argues for saving him. Gimlet asks Eden what it would entail, and more on the situation that led to this. Eden mentions that he can’t no longer feel the other part of himself, that he was previously connected with, the part in Inpax’ prison. That might mean that part is dead, or it might not.

Gorm and Uffe lag a bit behind and talk in Fenrisian. Gorm asks Uffe how he is feeling about what he thinks he should do, and what Vivek exactly asked him to do. Uffe is clearly conflicted. At this point they have gone to the elevator, which Uffe stops, so they or rather he, can make the decision. Saef uses telepathy and says he can feel Vivek in there still. Uffe kneels down and tries to look for Vivek in his empty eyes. He says that he can’t let Vivek suffer, but he can’t let him go either, if there’s a chance he could be saved. (and there is a chance Vivek can’t be fixed, which will be the end to both him and the parts of Eden in him)

So they take Vivek to the medbay. For the operation Eden needs someone who’s decent with Tech (Gimlet) and someone who’s decent with Medicae (Gorm). Saef goes to Larssen to get some tech equipment to help with the procedure, he’ll also remain on stand-by just in case things start going south. Gorm suggests Uffe goes outside for the time, but says he’ll call if he is needed, if things go wrong. Uffe agrees to this.

Eden takes off the top half of Vivek’s jumpsuit, revealing the barely closed surgery scars along his spine, as well as the bullet hole from where Gimlet shot him and a set of extremely poorly healed claw marks on his lower back. Gorm recites a small prayer. Then it is time to start the surgery. It goes mostly well, all things considered, though there is definitely a moment when they’re hovering near Vivek’s spine and brain that Gorm draws in a deep breath that may or may not count as a “woops”. But overall, the operation is a success, and Eden says he’ll reboot Vivek and he should be alright.

Uffe is called back into the room (and Gimlet notices he has been crying a bit), and they wait for Vivek to wake up. He does, after a bit. Vivek sits up on the surgical table and informs everyone he can’t feel his remaining arm anymore (can you say woops?). He asks if Saef has any clothes he could borrow, as grey servitor overalls isn’t really his style, and Saef lends him a kittie-hoodie (and helps him put it on). 

Vivek gets to his feet and goes to Uffe, who pulls him into a tight hug. Vivek murmurs a quiet apology against Uffe’s shoulder and tells him he’s alright. So Vivek is alright, also kind of pissed off at Eden for overriding him, but he doesn’t know what to do about it yet. Gimlet offers him his flask, but Vivek denies the offer. He points out that he heard everything that was said, while servitor, Inquisitor (acolyte, corrects Gimlet). Vivek is clearly in need of a smoke, but unfortunately his current attire hasn’t come with a pack. Uffe pulls out a pack of cigarettes from his pocket, that he got from Terra. Vivek comments about Uffe keeping up a bad habit of his, and Uffe retorts he doubts this would be the moment Vivek would be quitting anyway.

Gimlet asks what Inpax was doing on New Dawn, and Vivek says he didn’t stop to ask, but presumes Inpax had learned of him being there. Gimlet says he didn’t tell Inpax, but perhaps Alex had (though that was not his task?). Gorm says that he hopes this lesson of a friend being untrustworthy resonates deep with Gimlet and Gimlet points out if it was Alex he was just doing his job.

Our heroes question Vivek about the whole Harlequin seer, Nurgle’s rot thing, and Vivek says he doesn’t know if this is going as it was supposed to at all. It was Vivek who contacted his brother, partly because he knew that he could deal with the infestation. But also for another reason, because there was something in Sergeant Kuru’s memories, and that something was the fact that the four AdMechs under Eden’s care are not the only ones with the mutated life-eater virus, Vivek’s brother has it, and so might potentially a large segment of Triplex Phall AdMech population. He was planning on having him and his Triplex Phall friends break into his brother’s base while his brother was busy on New Dawn to look for any clues, but got caught. Vivek suspects that his brother’s sponsor X56r might be behind it, but he isn’t sure. Whatever the case, he needs to find out what is going on, but he can’t full-well drive like this (points at paralyzed arm). Gorm says they’re going to Triplex Phall anyway, so they might as well look into it, as he suspects Uffe might have gotten the virus too, which is not great. It means Vivek’s brother will have to come with. (Vivek lets everyone know he wishes his brother not be killed, at least not for his sake)

Well things are settled then. Vivek will go to Cayenne’s ship once it arrives (soon, says a text message). The others will go help Z47r with the Nurgle. Gorm and Saef give Vivek hugs (and none for Gimlet) and off they go!

[lordsofmedrengard]

🔪 for Zoroastra

As requested, brainwashed traitor remembrancer Atina vs Zoroastra of the Thousand Sons. As of the FW book covering the Burning of Prospero, it’s canon that Horus sent a delegation of his Legion to kidnap psykers, so the idea is that Atina has been attached to the force, to give it the appearance of legitimacy - several thousand Sons of Horus will need some Remembrancers to witness their deeds, no?

Basically, Zoroastra leads a small force of survivours and civilians to a SoH Stormbird, kill the garrision of Cthonian Headhunters, and escape with the prisoners already there. Atina is in a cruiser they steal, and gets wrecked.

——————————————————————————————————-

There was a time, not so long ago, when the thought of killing a fellow Space Marine would have been anathema. A valid criticism of the Legions was that they ground up generations of children as an afterthought, but through that sacrifice were the last and best hope of Humanity born, the pillars upon which the Imperium rested and grew. For one of these heroes to lay hand on another with intent to kill was as near sin as the Imperial Truth allowed – a violation of a primal taboo found in countless human cultures, as well as an insult the process that enhanced and reduced mortal boy into Legionnaire.

All that was in the past, now.

The Vlka Fenryka had come, and Prospero had burned, libraries gardens and citizens alike reduced to so many flakes of ash. Perhaps the greatest centre of learning in the Galaxy, matched only by the Throneworld and the Xenos Library rumoured to exist in the Eldar Warp-paths, all gone and returned to base ignorance.

In due retaliation for the unprovoked assault, the Thousand Sons had fought back against their would-be murderers, though the shock of Custodes and Silent Sisters joined with the betraying Space Wolves had almost been too much to bear. Not merely because their presence proved, beyond a shadow of a doubt, that the Emperor’s sanction was upon them and not their murderers, but because it meant that the other Thousand Sons, scattered in the void, and the other Prosperines also, were marked for death.

The Dark-Blade had drunk richly in this time of horror, and it would drink yet more before the day was done.

Now, in the aftermath of Lord Magnus’ escape, only tattered shreds of companies and squads remained in the city. Most of the civilians were already dead, joined by their protectors.

However, with the murderers of the XV Legiones Astartes eager to complete their Prosperine genocide, opportunities were there – waiting to be seized. And one thing the murderous regime that created Astartes did to perfection, was to weed out those children who hesitated to act when the time was right.

Late was the hour in which inspiration struck him. A scout bore ill news: the Warmaster’s own Sons had joined the assault, but uncharacteristically for the bellicose XVIth, they were avoiding the clusters of Thousand Sons spread around the city, electing instead to kidnap citizens attuned to the Great Ocean and butcher the rest like swine where they stood.

An unforgiveable crime, but also perhaps the salvation for a significant remnant of Prospero – and oh, how he ached to think that a few hundred traumatised souls guarded by less than a century of Legionnaires may well be one of the largest remaining gatherings of Prospero’s beauty!

Significantly, the gathering was small enough to fit in the Legion Stormbirds brought by the Warmaster’s get to Prospero. With those transports, the void could be breached, a Warp-capable ship boarded, and escape – and survival – achieved at last.

————————————————————————————————

The battle had been brief. No thousand Son still alive had held anything back, and with almost a dozen powerful psykers spearheading the attack the token garrison watching over the cargo had been slain in a matter of moments. It had been the work of a moment to tear the relevant codes, frequencies and other military intelligence from the brutish minds of the enslavers, and the work of another to slay them near-instantly with psychic might.

Boarding the cruiser was tougher. The concentration of enemy Legionnaires – and was it not obscene, that fellow Astartes should be thought of as enemies? – was higher here, and they began to suffer casualties. A pair of Contemptor Dreadnoughts had slain almost a dozen of Zoroastra’s fellow scholars before being overcome, but that had been the last major skirmish in the ship. No aid had reached the Sons of Horus – emptying then slaying the minds of the communications personnel had been a priority, and easily achieved from afar.

Hunting down the most fanatical followers of the Warmaster was grim and tedious work, made dangerous by the remaining psi-tech they possessed and used to hide from psychic scrutiny, but necessary to protect the newly freed slaves – thousands of psykers, all inert souls slain on the surface below. In their lives now rested the legacy of Prospero, along the miniscule amount of lore Zoroastra and his fellow truth-seekers had been able to save. Few physical databanks, memory-chips or tomes remained to them – rather, when defending the library, they had ruined the minds of enemy Auxilia and filled them to the brim with psychic imprints, reducing them in a sense to something akin to servitors. Such were the desperate measures required in this time of crisis.

Now, only one remained. Perhaps Horus’ most ardent follower among the non-Astartes personnel sent to Prospero.

It was a Zoroastra was entering one of the many arming chambers that he saw her. Atina the Remembrancer, flower of Terran nobility and once-favoured by the Warmaster, or so the rumours went. With hair like gold and skin like copper, the glory of her eyes outshone both, priceless sapphire gems burning with emotion. They were set in a handsome face, with high cheekbones and a nose that to a practised eye (or as it happened, to the eye of a master biomancer of the Pavoni Cult and veteran Legionnarie) bore the tell-tale signs of mundane alteration. Perhaps the work of a Terran flesh-sculptor, perhaps the work of a Chemosian facial-artist. Be it for reasons of medical urgency or mere vanity, many among the Remembrancers embraced such surgical alteration. The lips also appeared altered, though here the craft eluded him – and just as well. Struck as he was by unexpected beauty in the brutal and war-like environs of a Legion arming chamber, and weary of the days horrific loss of lore and life, her movements had gone unhindered, and she had hefted a charnabal sabre – a good choice of weapon. Light enough to be wielded by an un-augmented human, and wickedly sharp to the point where a skilled wielder could pierce Terminator war-plate, her choice made the danger she posed go from miniscule to notable, however disfavoured she was by the odds.

Odds he had believed would favour the Thousand Sons against any enemy. If the Great Ocean could fail Prospero in its’ hour of need, there was no telling when it might fail again. Absently, he parried her initial strikes, noticing the lack of strength and skill. He considered ending her, then decided that enough death had been dealt. The Thousand Sons had always waged war in a careful and rational manner. He would not dishonour the dead by reneging on that philosophy, not yet.

“You are outmatched, Remembrancer. You should submit”. She was tiring, but his spirit was wearied beyond all endurance. He longed to rest, to end the day, to lick his wounds.

She spoke words of defiance, of mockery of Prospero’s fate, and in doing so her own was sealed. The dam of his rage burst, and without further thought he annihilated her with a psychic bolt of Warp-lightning. He paused, then, walking away and with a wave of his hand, closed the door behind him. In silence, the burning mush that was left of her fizzled out.

https://www.youtube.com/watch?v=F-o8nPAC8MQ

[gothicmagpie]

Vampire Hunter D: The Northern Castle, part 2

Author’s notes: This piece of fan fiction is written for @vampires-and-dhampirs‘s VHDweek celebration. One section will be posted each day, and the final work will be posted to AO3, if you prefer not to read it serially. Readers should be aware that this work contains violence and cursing, equivalent to a PG-13 film. This segment includes graphic description of wounds, and a minor surgical procedure as part of an autopsy. This work is primarily based on the version of the VHD ‘verse as seen in Kikuchi’s novels. Part 1 may be found here: X

"Admit it, you just like the weird cases, and that girl caught your eye. Not that anyone could blame you! Ha! Though I suspect it was her resourcefulness, not her figure, that got you into this." A hoarse voice came from the Hunter's left hand.

"I'm not necessarily taking this case."

"Oh no, you are just examining corpses, weeks out of our way, for fun, since we both know we won't be making a reasonable profit on this job."

"Who said anything about 'we'?" The subtle teasing tone in D's voice might have raised eyebrows if anyone was around to hear it.

"Knock that off! I do plenty for you, slavedriver. Imagine where you'd be without me! Dried jerky in a godforsaken Frontier desert, probably."

There was a notable silence in response as the Hunter draw close to the large building Lidia had indicated, and stopped, squinting into the summer sun. It was a typical Frontier structure, pre-fab metal and high-tensile plastic, utterly practical and just as ugly. As they had been told, a large sign directed visitors to either side, one arrow bearing the red, sideways X that was a traditional indication of medical assistance for which the origin had been forgotten, and the other simply marked "funerals." The elegant young man headed towards the second door, a black wisp across the simple but nicely maintained lawn around the building.

He was ushered into a small, spotlessly clean waiting room by a junior nurse who seemed unable to speak in his presence and backed out of the room slowly, waiting until the last second to look away from his pale face. Alone, the Hunter stood like a statue, back to the wall, holding the wide-brimmed Traveller's hat he had removed on entering the funeral home. It seemed he would have held that position all day, but a door opened after a few minutes and Lidia poked her head around the gap. She looked older and more somber in her uniform, with her hair knotted tightly back and covered with a vacuum-sealed cap. "Hello, D. You can come back here. I've let everyone know you are here." She held the door for him, and shook her head to try and refocus herself as she ushered him through a veritable maze of rooms and hallways.

"This place is well-equipped." The Hunter's voice held subtle admiration. "I wouldn't have expected to see this type of technology here." A hand raised to the blue pendant he wore, doing something to ensure it wouldn't disrupt the delicate tech around them, although anyone watching would have seen nothing more than a man fiddling with a piece of jewelry.

"We are very lucky," Lidia pointed him into a narrow stairwell, moving briskly as she spoke. "Most of this was reclaimed from an old Noble facility; we got it for a reasonable price, since folks are superstitious about their equipment and it didn't exactly come with instruction manuals. I wouldn't be surprised if we are only using half the capabilities of this technology. There are few no one has been able to figure out, even when we had a retired technician from the Capital come through a decade or so ago. Perhaps they are only useful for treating Nobles." She shrugged, and knocked on a door.

They entered their destination, a small exam room mostly filled with a large metal and glass device that looked like a cross between a diving machine and a coffin. Lidia moved towards it authoritatively, stood on tip-toe to see the top display at one end, and tapped out a code, pressing buttons with the many-fingered ease of long practice. With a loud hiss, the top retracted, folding into itself and drawing away until a corpse lay on a fancy exam table before them. 

Lidia had turned to D as soon as the operation began, which was the only reason she saw the swift flash of recognition and dismay that flickered across his reserved features as the maimed body came into view. "Sorry, I got him cleaned up as best I could with the time I had. Summer means a lot of accidents, particularly among the farmers."

D didn't react to her words, simply stepping forward and raising a hand to press one ragged flap of flesh back over a now-shattered cheekbone. He stood frozen there, and Lidia would have sworn she heard a soft, raspy voice say, "shit." D flicked a hank of long, greying, once-blond hair off the face. He had been handsome, even with age etching lines around his eyes and forehead as gravity pulled jowls down to blunt the jawline and heightened the always-bold cheekbones. 

"Mirko Illic." D's voice was low, and Lidia couldn't tell what the emotion she could in the background of it was. Disappointment? He looked up, and met Lidia's confused expression. "I worked with him, for a time. Our approaches were too different, it didn't last. I always knew he was going to end like this. He didn't know when to step back." The bitterness in the last phrases might have been the strongest emotion Lidia had heard from him yet. "Do you have a full record of his injuries? And the other victims? Details on the locations found, too, if you have it." He stooped over the corpse and ran his left hand over the stapled rent in the chest.

He had apparently finished his examination when Lidia returned with a handful of printouts. He scanned them with uncanny speed, then held one out to Lidia. "What was this? A magnetic reading?"

"I suspect it was a computer glitch. We only saw it for a second, not even enough to get a frequency or magnitude. He has quite a lot of augmentation, if it was a true reading it could have been a last flicker of energy stored somewhere in the cyborg implants. I didn't find any batteries, but," she shrugged, "the implants aren't legal anyway. I didn't dig too much. No point in finding anything someone might feel compelled to report."

"Cybernetic enhancements, eh? Does that explain it?" He seemed to be talking to himself, but Lidia saw his left hand twitch oddly. "Do you have a scalpel?"

"Yes, just a minute." Lidia rummaged in one of the cabinets. "Is unsterilized okay?"

D nodded, took the blade and grasped the body's left leg, twisting it until the inner calf faced up. After carefully running his left hand over the muscle, he plunged the blade in and neatly sliced away a section of flesh, pulling it away from the bone. A second stroke severed a metal cable running from the knee before Lidia could caution him that the blade wasn't intended for such hard material. He slid the scalpel in again, flicking it along the bone until it struck something he was seeking. The otherwise silent room echoed with the soft scrape of metal on bone as he pried free a tiny data chip. He held it up, examining the find. "Do you think you have something that can read this?"

"Surely. I can't believe we missed that! I'll go arrange use of the data processing room. There's a sink under the third cabinet, rinse it off if you can." Lidia hurried out, excited by the unexpected find. If nothing else, this would justify her requests for this Hunter.

D rinsed it and put it into a coat pocket before returning to the corpse. "I'm sorry," he said softly, touching the dead man's shoulder before running his fingers over the controls and closing the preservative coffin.

Lidia returned and led him through even more of the medical center's maze. They entered a small room, where they were met by a wiry old man, whose thick glasses and grey beard didn't diminish his sharp gaze and quick smile. "Mr. Tsu is our best cryptographer. He considers this a retirement job after doing government work decoding old Noble files for decades. If anyone can figure out how to get data off that stick, he can." The man in question continued to beam under Lidia's praise, and held out an eager hand for the small piece of technology.

D handed it over. "If we can figure out how to read the files, I'm not concerned about decoding. I have a fair guess what will be needed."

"You do?" The old man tilted his head, examining the beautiful figure with a curiosity he hadn't shown before. "Ahh... I think I know who you are, sir. And if the tales are true, I imagine you probably can access the data, eventually, but I might still be quicker."

The glimmer of a smile traced the Hunter's features. "I'm sure you could hack it more quickly, but I knew the man we took it from, and I believe I know what the password is likely to be. If I am correct, then no guesswork will be needed."

Mr. Tsu nodded. "I see, then we shall try to figure out what device we need." He lifted the chip to his eyes and was peering at it as he opened a door and led them into a truly massive data center. 

Ancient Noble computers, carefully restored, whirred along every inch of wallspace, filling them with bulky monitors, busy screens, and housing of bronze, silver, and copper-plated technology from a dying civilization. A flock of jumpsuited techs moved among them, pressing buttons, adjusting paper feeds, tapping touchscreens, and making repairs. Even D looked impressed, staring around at the unknown wonder. His surprise evidently delighted Mr. Tsu, who took his eyes off the data chip to urge D to wander around and have a look.

D had not gone more than a few paces when a triumphant shout came from the old man, who was holding the chip aloft. "So very simple! You hardly needed me at all. This is a standard configuration, the only difference was this disguising shield over the port. Pry it off, and you are in business. I have a computer for this style over here, it is very common." He ushered Lidia and D to a large silver terminal, with a huge viewscreen and a small keyboard beside a data port. 

He fit the chip to the port, and the screen flickered briefly before a calm female voice said, "Welcome, thank you for using Jezmine's computer system. As a reminder, this is a public terminal and transmissions may be monitored. Please sign in." Mr. Tsu typed something, the screen darkened, then the voice added, "Accessing data files. Please enter your password."

D stepped forward, and his fingers flickered over the keys so quickly that Mr. Tsu and Lidia couldn't guess what the code was, despite looking at his hand as he typed. Any human-made computer might have stalled, unable to process keystrokes that swift, but this was constructed for the Nobility, and kept up without trouble. The screen flickered, and a video began playing.

For a moment, it only showed a bare, minimally-furnished room, but then the camera shifted and Mirko stared into it. He sat down heavily, sighing a bit and pulling the leather armor vest he wore down into a more comfortable position. "Hello, D. At least I hope that is who is seeing this, although given the fact if anyone is seeing this, I'm dead, I don't suspect it makes much of a difference. Anyway, I heard you were in the area and had made sure to mention a few critical things to a young Miss Graczyk who has been aiding me from the hospital. Hopefully that got you here."

"What?!" Lidia clapped a hand over her mouth and bowed her head in an apology for speaking over the recording.

"I've never done something like this before, but I don't think I'm going to make it through this case." He stared silently at the camera for a couple seconds, face somber and contemplative, as if weighing what to say. "I suppose I just wanted to try and pass the information I got together so far to the next Hunter to try having a go at Vasmer. I've spent several days researching his castle and planning this attempt, but I suspect I've missed something. This case... Vasmer feels different, even to my human senses. I wish I had you and your close friend here; he might have an insight. I've got copies of everything stashed. I'm sure you noticed the cabin near the old water wheel, it's exactly your sort of place." The man smiled. "If you cross the creek that splits off about two miles downstream, you'll see a marker flag I left. Walk from there straight to the woods. There is a lightening-struck tree with a hollow spot about 12 feet up. The info is there. Keep an eye out for wild pixies, they seem to be going through the summer breeding season and are feeling pretty fierce. I know you can find it."

He ran a hand over his tightly braided hair and sighed again, shifting forward to stare earnestly into the camera, grey eyes flashing. "That wasn't the only thing I wanted to share. Damn, I hope you're actually the one watching this." He grinned, "it would be pretty awkward if some doctor doing an autopsy is the one who found this. Anyway, I wanted to say sorry. I've always regretted how we parted. I'm an old man now, even all the augments I've had done are wearing out. I can feel it in my bones, and I know you never thought I'd be in this position. How many times did you tell me to be more careful, that there was no point in being a beautiful corpse? Well, what I leave behind at this point won't be. I'm grey, and wrinkled, and half my bones are metal, and..." his gaze dropped. "And I'm scared, D. I've read the reports, I can't take Vasmer and it won't be a clean death. I considered running but, ah! Don't make that face! I'm not going to do it. I'm not that much a coward, but I think Vasmer already knows I'm here."

"I'm going to die without a chance to apologize, or to try and make things right. My pride has gone with my age. I'm not the cocky Grade A Hunter I was back then. I can understand your reasons now, when I mocked those fears as a youth. It just took several decades! You were correct, all the things you said when you left-" D's hand flashed out and stopped the video. He disconnected the chip and pocketed it, his face a harsh, frightening mask that made Lidia and Mr. Tsu step back. Lidia was suddenly very aware of his Noble background. 

"Will you show me out?" His voice was ice, as rigid as his expression. Lidia didn't dare speak, just nodded and hurried them out of the building. She didn't even dare ask him about the info they had just gotten once they were outside. She just watched him stride to the road in a whirl of black coat slicing through the golden summer light, still clutching his hat in one fist.

Part 3 can be read here: X

[peterandviola]

The Upshot

Yesterday, the sky was violent. Rain fell like steel, relentless and cold. We spent the day indoors, except for brief interludes trying to get indoors or to the car. We rose early, too early. I didn’t want to miss my MRI appointment, which was hard won and inviolate.

There is a new MRI machine at UCSF Mission Bay. Rather than the usual donut shaped tube that tends to excite fear and phobia in so many people, it is shaped like an egg on its side. I felt no concern as the techs slide me into it. One, a sweet fellow who likes to tell jokes, noted that I was recovering from a Bronchial infection. He laughed, “I’ll give you a dollar if you manage to get through this without coughing.” And, of course, I instantly laughed and coughed.

Luckily, the rest of my time in the tube was calm and, yes, almost a rest.

Some of you have wondered why I am having yet another MRI. It has to do with something I have not wanted to talk about until now. My ever-thorough surgeon ordered it because there is more than a collapsed vertebra at T-7 in my spine; serious problems have arisen in my neck, as well. I have had years of spurs so long, they look like horse manes. I never gave it much thought. It is the evidence of two kinds of arthritis, Rheumatoid and Osteo. Both of my parents had RA; I expected it would be mine one day.

Diagnosed for years, I have fumbled along with it, trying and rejecting toxic drugs and treatments that didn’t work until my rheumatologist finally shook his head and sighed, “Well, if you threw the meds away, at least you did it in Paris.” It was great that I did! I resumed our Parisian visit by eating my way across the city of light and doting on our dear, dear friend Eddie. I went from Paris to a new medication that has stayed stable and helped a great deal. While I have been X-rayed and examined regularly, RA is like rust; it never sleeps.

Throughout the awful rehab from cancer and six operations, I have tried to ignore RA. The flares, the fumble hands, the numbness and so on, all reviled and unheeded, until now. Odd as it seems, this is good news. All the tests have confirmed that the issues in my spine and neck are NOT due to cancer spreading. Thanks be!

But, it is of importance that I address them, and soon. The first and least invasive surgery is now scheduled for March 28, coming right up. I have lightly referred to this as a cement injection, but it is more complex and perhaps more successful than that phrase implies. Let’s just say, the surgery will take a mere hour, and I will have Dr. Burch as my surgeon. Through an injection in the spine, he will insert a balloon via (a huge) syringe, which will be filled with a cement-like substance that will lift the wrecked vertebra off the spinal nerve. It’s an effective and mostly immediate relief! While his brand of Kyphoplasty requires incision and GPS like markers, the recovery is almost absurdly quick. I might go home that very day! Within a week, I should be fine. Wow!

Now, for the rest of the story. Vertebrae C-4,5,6 and 7 are also in need of immediate surgical intervention. Without it, there could be dire results, more serious than the collapse of T-7, which I will have fixed first. Best news of all is that Dr. Burch, despite his meticulous examinations, finds not a drop of cancer. This has humbled and thrilled me at the same time. I find that I have developed an unhelpful attitude about pain since the onset of my cancer. I like to ignore it and play it down to the sweet inquires of friends and the vital questions of doctors. “Oh, I’m fine,” is not a good thing. I vow from this day forward to never demure when asked. It is not helpful in any way.

The truth? I have chewed leather and bitten my tongue too often. I am in considerable pain a good deal of the time, sometimes actually causing me to be angry, forlorn, distracted or wishful. There! I said it! My great relief has been in extensive Physical Therapy, but it does not keep the pain at bay for long. There were times when I scaled Arthur’s Seat (and I did have active cancer, then undetected in my pelvis) when I practically doubled up from pain. I think the gamma ray therapy has helped the cancer, but the bone pain lingers, viciously.

The good news is that this is a treatable situation. I focus on that and must. The second surgery will involve fusing those unhappy cervical vertebrae. But, it is not the barbaric resection surgery that the first surgeon told me I must have, or put my affairs in order. Once again, I strongly suggest that if you find yourself in my position, get a second opinion.

So here you go. I am ready now, with vital information, straightforward diagnosis, and the assurance of my overall well-being. I feel as if my loved ones have all sprayed Cancer-Be-Gone all over my tired self. You have no idea how much I needed it! Or maybe you do. I have tried to be brave, if dumb about the situation, but I am brave enough now to be honest. I am walking, driving and even playing with little Puccini for short periods of time. I can fix a sandwich, wash a dish, and even cheer the Warriors on with glee, as long as I don’t try one of those cheerleader flips! But soon, it will be much better, and I will be able to travel, spend more time in chilly climes and be hugged with a heartiness that would leave me weeping without the repair. Bless you, each and every one, for all you have given to me—and to Peter—during this time. It has honestly helped us survive. Next up, thriving, thanks to you all.

[cpw-nyc]

Masks May Reduce Viral Dose, Some Experts Say

People wearing face coverings will take in fewer coronavirus particles, evidence suggests, making disease less severe.

Researchers have long known that masks can prevent people from spreading airway germs to others — findings that have driven much of the conversation around these crucial accessories during the coronavirus pandemic.

But now, as cases continue to rise across the country, experts are pointing to an array of evidence suggesting that masks also protect the people wearing them, lessening the severity of symptoms, or in some instances, staving off infection entirely.

Different kinds of masks “block virus to a different degree, but they all block the virus from getting in,” said Dr. Monica Gandhi, an infectious disease physician at the University of California, San Francisco. If any virus particles do breach these barriers, she said, the disease might still be milder.

Dr. Gandhi and her colleagues make this argument in a new paper slated to be published in the Journal of General Internal Medicine. Drawing from animal experiments and observations of various events during the pandemic, they contend that people wearing face coverings will take in fewer coronavirus particles, making it easier for their immune systems to bring any interlopers to heel.

Dr. Tsion Firew, an emergency physician at Columbia University who wasn’t involved in the work, cautioned that the links between masking and milder disease haven’t yet been proved as cause and effect. Even so, the new paper “reiterates what we say about masks,” she said. “It’s not just a selfless act.”

Ideas about the importance of viral dose in the development of disease have cropped up in the medical literature since at least the 1930s, when two researchers formally noted that mice exposed to larger quantities of germs were more likely to die. More recently, scientists have gone as far as to puff different amounts of a flu virus up the noses of human volunteers. The more virus in this nasal plume, they found, the likelier the participants were to get infected and experience symptoms.

That sort of experiment can’t be done ethically for the new coronavirus, given how dangerous it is. But earlier this year, a team of researchers in China tried something similar in hamsters: They housed coronavirus-infected and healthy animals in adjoining cages, some of which were separated by buffers made of surgical masks. Many of the healthy hamsters behind the partitions never got infected. And the unlucky animals who did got less sick than their “maskless” neighbors.

Some indirect data has been accumulating from people as well. Researchers have tentatively estimated that about 40 percent of coronavirus infections do not produce any symptoms. But when some people wear masks, the proportion of asymptomatic cases seems to skyrocket, reportedly surpassing 90 percent during one outbreak at a seafood plant in Oregon. Wearing a face covering doesn’t make people impervious to infection, but these trends of asymptomatic cases could suggest that masks lead to milder disease, potentially reducing hospitalizations and deaths.

Particularly compelling, Dr. Gandhi said, is the data from cruise ships, which pack big groups of people into close quarters. More than 80 percent of those infected aboard Japan’s Diamond Princess in February — before masking had become common practice — came down with symptoms, she noted. But on another vessel that left Argentina in March, and on which all passengers were issued surgical masks after someone onboard came down with a fever, the level of symptomatic cases was below 20 percent.

Some independent experts say the paper is a welcome update, given the pervasive idea that wearing a mask is a mostly altruistic act.

“It’s been a real deficiency in the messaging about masking to say that it only protects the other,” said Charles Haas, an environmental engineer and expert in risk assessment at Drexel University. “From the get go, that never made sense scientifically.”

In other settings, too, from hospitals to hair salons, face coverings may have driven down rates of overall infection, perhaps preventing disastrous outbreaks. And countries like Japan, Taiwan and South Korea, where outbreaks quickly sparked a wave of widespread masking, managed to rein in the number of coronavirus-related hospitalizations and deaths early on.

Even in the United States, the slow upward tick in mask-wearing has coincided with what appears to be a more modest death rate, compared to the surge that occurred after the virus first made landfall in North America. These trends have also likely been influenced by increased testing, a downward shift in the average age of people contracting the virus and improvements in coronavirus treatments. Still, masks probably aren’t hurting things, Dr. Gandhi said.

The idea that face coverings can curb disease severity, although not yet proven, “makes complete sense,” said Linsey Marr, an expert in virus transmission at Virginia Tech. “It’s another good argument for wearing masks.”

Dr. Marr and other researchers are still sussing out exactly how much inbound or outbound virus different types of masks block. But based on a wealth of past evidence and recent observations, the amount that’s filtered out is probably high — perhaps 50 percent or more of the larger aerosols being sent in both directions, Dr. Marr said. Certain coverings, like N95 respirators, will do better than others, but even looser-fitting cloths can waylay some viral particles.

Still, some experts are not ready to embrace all ideas about two-way protection.

What’s outlined in Dr. Gandhi’s paper “is still just a theory, and needs more research,” said Nancy Leung, an epidemiologist at the University of Hong Kong. While there’s good evidence that masks reduce the spread of viruses within a population, it’s much harder to nail down how face coverings influence symptoms, Dr. Leung said, in part “because of the difficulty in conducting those studies.”

Dr. Gandhi acknowledged these limitations. But with no end to the pandemic in sight, the need for masks is only growing, she said, especially as researchers continue to document the virus’s ability to spread silently. Even people who don’t have symptoms can spray the virus into their environment when they sneeze, cough, sing, speak or even breathe. And those who fall ill may be at their most contagious in the days before the first signs of sickness appear.

To tame this pandemic, people should act as if they’ve been infected, “even if you feel right as rain,” Dr. Gandhi said.

Masks alone aren’t a substitute for other public health measures like physical distancing and good hygiene. But unlike sustained lockdowns that keep people apart, shielding our faces is easier and more sustainable, Dr. Gandhi said.

Safeguarding yourself and others from this deadly disease, she added, “is as simple as covering up the two holes in your face that shed the virus.”

[Like the Science Times page on Facebook. | Sign up for the Science Times newsletter.]

Katherine J. Wu is a reporter for The Times, where she covers science and health. She holds a Ph.D. in microbiology and immunobiology from Harvard University.  @KatherineJWu

https://www.nytimes.com/2020/07/27/health/coronavirus-mask-protection.html?utm_source=pocket-newtab

[almondemotion]

I have been writing about advance care plans for a while.

Not necessarily ‘before they were fashionable’ – trend setting has never been my thing, yet, suffice it to say, for a while. (See here from 2017).

We held another of our Covid Conversations on Thursday.

Essentially, it was me, a GP colleague Sara, Colin and Penny from our dementia, frailty and older peoples’ mental health (Yorkshire & Humber) network with others from health, social care and the voluntary sector, discussing, advance care plans (ACP) during the time of Covid.

There is much to be said about all of this, starting with, for example, the ill-fated GPs who thought it an idea at the start of Covid to write such plans on behalf of all of their care home residents, a sort of blanket order to keep them out of hospital.

This was met with outrage from many as it was perceived as old-school medical paternalism, and essentially, one person determining the fate of others without their involvement.

We reiterated our position that this was not where we are coming-from; instead, we began a conversation about what ACPs are (and I guess, are not) – I’ll come to that shortly.

If you haven’t encountered my previous discussions, in essence, ACPs are documents compiled either with the patient (person/resident/client) and a health or social care professional, in which the individual’s preferences are recorded for, in the event of an untoward future development – this is, usually when things go wrong – the patient for example, (let’s stick with the clinical model) becomes incapacitated;

There is no set-format as to the content or structure of an ACP and I have taken it one way, others have proceeded down a different route.

I won’t spend too much time discussing what others are doing, although, indeed, the content and, let’s say, utility of the document is important.

I am still unsure whether people (those who are unfamiliar) have a grasp of where I am heading, for illustrative purposes, see below to the document I have been using.

And, below that, another document called ‘respect’ which is an NHS acronym that stands for ‘Recommended Summary Plan for Emergency Care and Treatment’.

I am not trying to make a stance for which document is better – there are others out there, more, and apologies for the delay in getting to the point, I want to be clear about the purpose of my document.

What is it for?

Well, in many instances, it is important for people to know the details of your next of kin, your preferences for burial or cremation, likes or dislikes of various forms of belief; yet, this is very important. Indeed, there is a whole collective which relates to the concept of ‘What Matters To You’ – aka WMTY – that is, your preferences.

Again, this is a big area, and one I have covered before – see here.

I am quite blunt about the purpose of my document, really, who it is for and when it should be used.

I guess you would call me biased.

It is, essentially, to help people stay out of hospital if that is their preference. More specifically, for those who have a high risk of deterioration and for whom in the past, the best and worst of hospital care has been proven to be ineffective if not harmful, the option to stay away is right.

Covid has made all of this more relevant, given the numbers of people who have gone to hospital with one condition e.g. a fall, urine infection and left having recovered from the fall but acquired Covid.

These are not necessarily large numbers of people, although, during the height of the pandemic (unsure whether the height has passed or yet to come as of late June 2020), the fear/dread of hospitalisation was even more powerful.

Sure, admission to hospital, in certain conditions can be great. It can be life-saving, and life-changing, often for the better – the easiest example being, particularly in older people – those who fall and break their hip or neck of femur; without hospital admission most will never walk again or retain any form of independent living and majority will die as a result (often from pneumonia associated with immobility).

Over the years Orthopaedic surgeons have perfected the procedure to repair and replace broken hips and it is mostly performed with a minimum of complication.

Voila.

From broken hip to fix in a week or two.

Please note, for the record, I don’t often praise Orthopods – this is a situation where they are great.

And yet, most older people, particularly those with either advanced frailty or dementia who are admitted to hospital don’t break their hips; they have a deterioration in mobility or worsening of confusion, possibly related to infection, at other times because of an arrival at various tipping-points.

In these situations, there is little an acute hospital can offer than cannot be provided differently in the community; GPs, district nurses, therapists and others can rally-round an individual and working collaboratively with social or domiciliary care overcome the incident, reverse the point of crisis and allow recovery.

Treatment and recovery in a patient’s own home tends to be quicker, preferred (by the patient), cheaper and more effective than admission to hospital and movement around hospital wards, interferences by multiple doctors, nurses and others, unnecessary and at times in appropriate treatments and investigations.

If this narrative has held together, my point is, we can offer just as good, if not better care, treatment and support for particularly older people in their own homes than is available through high-tech medical interventions.

You don’t need multiple blood tests or an MRI to support someone through a crisis at home; time, caring, compassion and being there is often enough.

And, where is all of this in relation to ACP?

Well, if you recall, at the start of this blog I mentioned our Conversation;

I went into this really thinking I knew what I was talking about (always dangerous) with the belief that my document (Minnie-mouse above) was what was needed.

I still think this and want it to be rolled-out more widely for those people, particularly care home residents or those with significant frailty living at home, yet, it became apparent that others, and some of them even had the word ‘ACP’ in their job title saw the document differently, proposing that it is focused far more widely – including those who are otherwise hale and hearty; more like an organ donor card than a do not attempt resuscitation document.

I do get this although my understanding of the system would suggest that if you want to have an effect, you need to focus your energy. That is, provide treatments or interventions to those most likely to benefit.

An example being those who fall.

It is generally accepted that on average people over the age of 70 will fall at least once a year.

Everyone will agree that falling is a bad thing and we should do all we can to reduce its likelihood.

There are different ways to reduce falling, for example, making sure your heels aren’t too high or rickety, ensuring the surface you walk on is even and the lighting adequate.

None of these are ‘care’ and don’t require investment from H&SC (beyond perhaps sorting uneven paving stones).

These interventions, if you want to call them that, may reduce falls on an individual basis, although there are many other factors involved.

Yet, on a population level i.e. of the 10 million people at risk of falling in the UK, the number who won’t break their hips as a consequence, the percentage (relative risk) reduction is quite small.

If however, you find those who are at highest risk of falling – over 85, five or more prescribed medicines, history of stroke, diabetes, dementia, arthritis and so on and, you further stratify by stating, those who have either broken a hip in the past or who have fallen in the past six months – those people are at very high risk.

Wearing pumps will help, but more needs to be done – multifactorial risk assessment and reduction programmes.

Sure, you fix the lighting; you also sort the drugs that make someone unsteady, you consider networks of activity and support, nutrition, hydration, continence and a host of other factors.

This is all time consuming and expensive; it does however significantly reduce the risk of a person who is already at high risk of falling, falling again and of course, breaking something with all that entails.

It is however my point.

My document is intended to focus on those at highest risk of unnecessary hospital admission and empower them and their families or carers; the other ACP document – more broader preferences for example are important, but likely to have little impact at three in the morning when a paramedic is deciding whether to take you to hospital (easier and less paperwork) or engage with the entire health and social care system (out of hours) which is likely to keep someone at home but is much more involved and risky (risk, for if the patient deteriorates in their home without adequate safeguards, the paramedic could be blamed, whereas, if the same happens in hospital, either the system is blamed or it is considered to be bad luck.)

And so, which ACP?

Well, I think, after all of this my conclusion is that we need both.

We need to know a patient’s preferences, likes and dislikes, these conversations are important – ideally with the patient when they are still able or adequately capacitated to tell you what they wish, yet, the other documents are also important, to prevent the system going into reflex and packaging an individual down an acute medical or surgical pathway that will provide them little comfort or overall benefit.

And, here too another component of the conversation which is worthwhile considering – the different system approaches to care;

I am what might be best described as a secondary care doctor (despite working half-time in primary care) – I support predominantly those who are sick, often in the last year or months of life; primary or community care doctors however are involved with a much broader spectrum of health and disease.

We need both.

Pretending that our patients are somehow different or our intentions at variance doesn’t serve anyone well.

And, the conversation continues.

I’ll post details of the next-one here;

As a network, we are running an event next month – see below for more details; you will need a computer/tablet/phone to attend.

The Yorkshire & Humber Dementia and OPMH Clinical Network will be running an online event focused on,

“Human Rights, Covid-19 and the new world – a focus on people affected by dementia and frailty” on Wednesday 15th July, 1-4pm.

To register for a place, please book here: https://rightscoviddementia.eventbrite.co.uk

Joining details and an agenda will be circulated to registered attendees in due course.

Thursday morning. Not another blog about advance care planning! I have been writing about advance care plans for a while. Not necessarily ‘before they were fashionable’ – trend setting has never been my thing, yet, suffice it to say, for a while.

[supergirl-imagines]

Lena Luthor/you fic pt. 20

“Hey,” Kara enters the room, doing her best to hide the sadness in her eyes, and sat down beside Lena’s bed.  “They’re getting ready to put her under now.  How are you feeling?”

“Just great,” Lena rasps dryly.  

“Lena, listen.  I don’t know how to explain it, but I know she’s still in there.  I saw it in her eyes when I spoke to—“

“Don’t,” Lena interrupts.  “Kara, I can’t handle building up hope right now.  I just can’t.”

Kara’s heart breaks as she stares at the woman curled up under the blankets.  Exhaustion has marred her features and those green eyes that usually shine so brightly are as dull as Kara’s ever seen them.

“You can’t give up.”

“Why shouldn’t I?  And please, save the Supergirl bullshit speech.  She tried to kill me.  Anyone I have ever loved has either died or tried to have me killed.  So, tell me Kara; why the hell shouldn’t I give up at this point?”

“Because she’s there, Lena.  I promise you that Y/N is still in there somewhere.  I told her that she needs to fight for you and I watched tears fall from her eyes, okay?  She’s fighting for you and you need to do the same for her.”

Kara’s words come out a bit harsher than she plans, but she sees the hostile stance slip from Lena’s bones.  She knows it’s in the brunette’s nature to go cold whenever things get bad—it isn’t the first time Kara’s seen it.  That doesn’t mean it doesn’t scare her a little when it happens.  Lena isn’t meant to be cold and watching the familiar warmth in her closest friend’s smile slip is jarring.

“God, how are we supposed to move past this?” Lena whispers, more to herself than to Kara.  Nevertheless, the Kryptonite takes her hand and squeezes it tightly between her own two.

“One step at a time,” Kara sighs.

---------------------------------

“Don’t you die on me,” Alex mutters to the body laying before her and subconsciously squeezes the gas mask in her hands.  She finds herself a little surprised to see your eyes locked on hers instead of staring straight up at the ceiling like they had been.  As she moves to put the mask over your face, they don’t waiver from her own and she sighs against the fabric covering the bottom half of her own features.

“Alright, let’s put her under,” she nods to the waiting anesthetist at the head of the operating table.  The wheel of the gas tank squeaks as he turns it and the sound is followed by the hiss of air flowing down the clear tubing and into the mask over your face.  Your eyes don’t waiver from her, even as they flutter shut.

Once she’s sure you’re out, Alex turns around to face the rest of her team and nods towards your still form.  

“Let’s get her flipped over and prepped.  We need to move fast, people.  Let’s go.”

------------------------------------------

You had never believed in out of body experiences, or souls, or really the afterlife.  But, here you are, staring at the back of your own head as Kara’s sister sliced into your neck with a scalpel.  Her hand was steady and the cut she created aligned almost perfectly with the one that had disappeared from your skin after the Kryptonian genes infiltrated your cells.  You realized that every blemish, scar, and remaining bruises on your body was probably gone as well.

“I need a retractor,” Alex set the tool in her hand to the side and waited for one of her assistants to replace it with a new device.

Not particularly wanting to see the inside of your body any further, you turned and walked unnoticed through the operating theater and out the door without needing to open it.  Ghosting through the halls wasn’t an unfamiliar feeling for you; being a criminal was a profession that required you to blend in and not turn any heads.  

You took your time going through the high-tech facility, peeking into every door you passed to try to catch a glimpse of anything familiar.  You didn’t know the layout of the area and started to think you were going in circles when you found the room you were looking for.

The room with Lena.

You stood outside, peering through the window—not ready to be in the same room with her yet, even like this.  Kara, sans Supergirl outfit, was lying beside her in the hospital bed with her arm around her shoulders.  A pang of comfort struck you, knowing that Lena would have someone if you didn’t survive this.  Kara was good for her and could protect her better than you ever had been able to.  The two of them were talking about something and you watched as Kara rubbed her shoulder lightly.  You weren’t quite sure what team the blonde played for, but perhaps she could play for Lena’s once you were gone.  They might be good for each other.

Eventually, you passed into the room.  Neither woman seemed to notice your presence as you stepped closer to the bed.  You froze when your eyes locked on the darkening bruises around Lena’s neck.  It wasn’t difficult to make out the shape of your hands in the pattern of contusions.  

“What’s happening now?” Lena’s rough voice pulled you out of your trance and you looked towards Kara; unable to keep your eyes on the other woman any longer.

“I don’t really understand most of the medical talk,” Kara admitted, but craned her ear towards the far wall.  “But, it doesn’t sound like anything’s going wrong.”

“Do you think she’ll be the same…when she wakes up?” 

“Lena,” Kara sighed and continued to rub the other woman’s shoulder, “I don’t want to sound harsh, but no.  I mean…I know I wasn’t after what happened with the red Kryptonite.”

“It wasn’t your fault.”

“That doesn’t matter,” the blonde shrugged.  “What mattered was that I had hurt the people I love.”

“Do you think she’ll remember it?”

“I know this isn’t optimistic, but I do.  The look in her eyes…she knows.”

“Will you be there for her, you know, when she wakes up?  I want to, but…”

“You’re scared, I understand,” Kara assures her.  You wonder whether she’ll ever be able to look at you again without fear in her eyes. 

That is, if she can even look at you.

“I’ll be wherever you need me to be.  But, Alex will fix her.  She fixes everything, trust me.”

“What about her…powers?”

“Well, to be honest, the DEO probably won’t want her out on the streets until they know she can control them.”

“You’ll help her with that?” Lena asks hopefully.  The thought of spending your days locked in the cavernous headquarters is comforting.  They can keep you from hurting anyone again; especially Lena.

“Of course.  Whatever you guys need from me, I’m here.”

Once again, Kara’s reassurance comforts you as well.  She’s a good person—one of the best you know, actually.  

“You should really get some more sleep.  I promise to wake you if I hear anything happen,” Kara tells the other woman before she can protest.  Your gaze flickers to the bruises marring Lena’s throat as Kara gets to her feet and their positions change.  Kara takes a seat in the chair next to the bed and offers her companion a comforting little smile as she settles under the white blanket covering most of her body.

You took your leave with a sick feeling in your stomach.  The marks you had left brought back crystal clear visions of what had happened at her apartment.  You wonder if this is truly what’s happening or if you psyche is just constructing an elaborate dream to punish you for what you’ve done.  

-------------------------------------

“Update on her Kryptonite level?” Alex’s eyes didn’t waiver from the open incision in front of her as she made the request.  Her hands were starting to cramp, but they still moved expertly around the half-embedded chip in your neck.  

“Dropping faster by the second.  You’ve got around 35 minutes before her cells start regenerating.”

“Damn it,” Alex muttered.  She was running out of time and reintroducing anymore Kryptonite could put you into a coma or worse.  She had to move faster.  

Her eyes widened at a sudden idea.

“Someone get me a handheld sunlamp,” she ordered.  If she could get synthetic yellow sun-rays on the damaged flesh right after tearing out the chip, your body could do the repairing for her.  Alex’s surgical team watched uncertainly as the woman clamped a pair of forceps onto the CADMUS device and wiggled it slightly in order to loosen it up.  

The door to the operating room flew open as the agent who had gone to find the lamp returned and placed it into Alex’s gloved hand.  Her heart raced as she powered it up and made sure to keep it aimed away from you.  After a second of hesitation, she pulled the chip from your neck and immediately held the lamp centimeters away from your neck.

“Her EKG is looking sporadic,” the man monitoring your brain function warned.  Alex chewed her bottom lip anxiously and cranked up the wattage on the lamp.  She eyed the many screens showing your vitals and tried to determine whether or not they were declining or improving.  Two of them had alarms going off while the other three were quiet.  After a few seconds, one turned off.  Alex turned the light onto its highest setting and said a quick prayer under her breath.  The last monitor fell silent.

“She’s stable,” Alex breathed out at last.  The surgical team surrounding her broke out into a round of applause and the corners of her eyes crinkled as she smiled beneath her mask.

She had done it.

Reunion next chapter!  Let me know what you think!

[dortykid]

Short-Story: Magiteched

Been a while, haven't had the urge to write, but here's a new story to quench your thirsts (if you're even thirsty for these). Warning, this one contains a surgical procedure, so if you're not able to handle stuff like that, you don't need to read this.

----------------------------------

A few months had passed since Jukkerbaut's disappearance, shortly after the thing had reached the Ring of Fire. All tracking on him had been shut down, as were all sources of communication or sending messages. Even the vital readings that would have been received and displayed on the screen in the dark lab were offline. Jukkerbaut was completely gone, or at least, completely gone from under control; the metal beast was left to roam the landscape, doing alchemy-knows what.

Although, Zaxaxx knew no better at what had really happened, for he had taken the assumption Dorty had finally eliminated it on the fire isles. In all honesty, he was expecting that to happen in the future anyways; Jukkerbaut was his first creation, after all. A hulking behemoth of a burnt, fleshy charr underneath with a tough, metal exoskeleton on top, surrounding the squishy insides in a protective coating. The mind was wiped of most previous memories, and then imputed with new code and orders to follow, essentially making the charr a loyal servant.

Alas, time was starting to take its toll anyhow. The chip in Jukkerbaut's mind was glitching out, and occasional shut-downs were becoming more and more common. Even after Zaxaxx had made some adjustments himself after such a long while, Jukkerbaut was still loaded with bugs. All he needed was one good push and he would be destroyed, either by the chip being destroyed and shutting down the brain, killing them within, or the armor would be exploited and leave them exposed, easily leaving them open for being killed.

How long was it ago that Jukkerbaut was made? A couple of years, perhaps, or more, but Zaxaxx had improved on his technique since then. He had some practice with working with Scarlet's twisted watchwork, admiring the rather larger one he had acquired, and to which struck his inspiration. After acquiring the corpse of a dead asura, he began working to compress the larger machine down into smaller parts, before cutting up the dead asura and shoving the machinations into them. From there, all he had to do was make some new, more complex coding, and soon Xakat was born, a horrendous watchwork creation cleverly disguised as an asura. Unfortunately, it wasn't the most convincing. While the metal and such inside was almost perfectly hidden, it was rather obvious that this asura was previously dead. He did whatever in his necrotic powers he could do to cover this up, stitching parts back together, a few touch-ups on the face and head, then a cost and other clothes to cover the rest.

Once Xakat was complete and ready, he sent him out to the Wastes to gather intel on the Inquest security development from the local krewe there. For a while it worked, and Xakat had sent back numerous designs for security and such that Zaxaxx could use. Sadly, the krewe leader caught on to some of the issues Xakat was causing, and when he was found out, the watchwork within him sprung into its full form, eradicating anyone it could find in the lab to leave no trace. Sadly, Xakat was destroyed halfway through his rampage, but thankfully the core in the chestpiece that was inside of him was rigged to explode shortly after death, but even that was faulty. In the end, it was another experiment down the drain, but what was learned and earned was going to further aid in this dark research.

Following this, Zaxaxx proceeded to focus more on the same technology used with the Peacemakers armor, throwing in some of the watchwork and golem technology, as well as a few dribbles of the toxic fluids he has developed. These creations that soon came were more focused on single things, rather than balance the usage. Each one he made was more advanced than the next, as he experimented with new ways to gear them, ranging from blades to internal functions.

The next creation he made after Xakat was a norn with their arms and legs sawed off, and replaced with legs like that of a golem dog, if those even existed, and a large turret on their back, which he called the L4Z-Walker. The idea was for them to run around on all fours, while the turret on top shot beams of energy out at targets. The two things worked seperatly, meaning the norn part could focus on one thing while the turret focused on another. A deadly weapon good for laying siege on places, but it had yet to go out into the field for a real test.

After that came what he called the A5A-Leecher. His ideas for this one were more nefarious than before, taking a human female and implanting blades onto their arms, legs, and back, but that wasn't the important part. The important part was the multiple short-ranged mechanical tendrils that were able to puncture into flesh, and suck out blood to power the thing, hence the "Leech" in the name. For good measure and extra terror, one of these replaced the tongue, where as the A5A stabbed into its helpless target, the tendril would come out of the mouth and jab into the victim to speed up the draining process.

Zaxaxx continued to make more of these nightmarish creations for some time, all with watchwork built into them under the surface of the skin, or visible in some areas. All of them had chips implanted into their brains to wipe their memories and replace them with code, if he hadn't removed it himself and just replaced it with pure code, but he found that if a creature can think, they could make decisions and thus be able to deal with targets easier, or escape. After all, a damaged creation dragging itself back to him was better than a destroyed one that was either left dead or stolen.

For the current moment, the A5A and the L4Z were guarding the various doors in the lab, along with the others. His current plan was to make as many of these as he could without being found out, and then send them all out to finally deal with the pathetic asura he always hated. After that would come the attacking of any settlement that wasn't asuran, taking the dead that were taken and making more of these minions for himself, until all that would be left would be the asura race, with no idiotic beings to drag them down. That, however, would be far in the future, should this come to that, and for the moment he was sterilizing tools for his next project.

The dimly-lit green glow from above gave the lab a poisonous look, the light illuminating the center of the lab where his worktable was, or rather his operating table. Strapped down on the thing was a young human girl that, rather than kill, he put to sleep and kidnapped to bring back here. Normally, his creations were revived bodies, but this one was still live, he was curious how this one would differ from the others, and he already had ideas how to make this one. The A5A and L4Z had wandered into the room to examine the being who would soon be their next soldier, sitting above to watch the process.

Done with the cleaning, Zaxaxx set the tools on a rolling table to bring over next to the operating one. Atop it, aside from the tools, were the various pieces of tech he was going to put into her. He wouldn't be able to stick a watchwork endoskeleton into them without killing them, so external and partially internal incisions would have to be done. He had left the sleeping girl in a cooling chamber over the night to reduce their temperature, and minimize blood loss from cuts.

The part of the floor under the asura and the rolling table rose up to a suitable height where the subject was about level with his waist. He looked over their sleeping form, they were almost too innocent to do this to, but he had little to no mercy. Just to prepare for the surgery early, he went ahead and ripped out the left eye while they were still in the cooling chamber, some blood was still visible in the socket where it once was. Zaxaxx grinned, turning to grab a vial off of the roller and uncork it, carefully pouring the contents in a single, straight line across the forearm, close to the girls elbows. The A5A above him tilted its head, and started to climb down from the seat above.

"No, A5A, you may not take the blood directly from the girl." He scowled at it, making it stop for a moment, before he continued. "You may, however, be of assistance and clean up the floor as I work. I believe this will get at least a little bit messy."

Nodding as if in understanding, the A5A crawled down all the way, taking cover under the operating table, the metal tendrils poised to suck up any blood that spilled onto the workspace.

Zaxaxx stood there for a few moments, wondering where else he would pour the fluid, before shrugging and setting it back, picking up a handsaw. He held the tool over the fluid line on one of the arms, bringing it down slowly until it touched the skin. The next moment, he began bringing it back and forth, back and forth, the sound of flesh being ripped through echoing through the chamber, accompanied by the splatters of blood that were gushing out. As he had asked it to, the A5A's tendrils were zipping around frantically to suck up the blood, fueling itself with the life-sustaining cells. The gentle cutting sound was quickly replaced by the grinding sound of bone-against-saw, Zaxaxx hastening the motions and applying more force until it was cut through, and kept going until it hit the metal of the operating table. Lifting the saw back up over his shoulder, he grasped the dismembered arm with his free hand, purposefully dropping it onto the floor beneath him. The sound of metal piercing through flesh rang out from underneath the operating table, Zaxaxx grinning as the A5A punctured the hand and began to viciously suck it dry.

With one forearm off, Zaxaxx leaned over the body and began to do the same with the other one now, just as quickly as the previous one due to the blood oozing out now, cutting through the flesh and bone before dropping the second arm for A5A to consume, though it was still busy with the first one. He set the saw down, picking up two hands, very similar in design to Jukkerbaut's, but different functions. One hand had a hook built into the palm to shoot out to grab someone, while the other had a sword that flipped out from the underside of the arm to use. Green crystals were built into these ones, storing the energy from his latest, unique toxin, that was both deadly and could energize. Rather, it would energize the girl but harm anything else. How he was going to do this however he had already figured out. In the meantime, he stuck the hands over the bleeding stumps, spiked sensors digging into the flesh to pick up nervous signals, allowing the subject to move them around.

Next, he grabbed what seemed to be some kind of scooper, a strange mix between a sharp edge and a double ice-cream scoop. He opened it up, then stuck it down into the skin right above the sternum, and then clamped the two parts together through the flesh, pulling up to remove a spherical chunk from near the top of her chest, perfect in size for the next part of the procedure.

A bright green power crystal was sitting on the roller, which he grabbed, examining it for any imperfections. It was filled with the toxins that were also in the hands, but this had a ring of sockets around it sticking in, just a little off-center. On the very bottom was a single spike of the crystal pultruding out of the almost-perfect spherical shape. Carefully, he lowered the crystal down into the cut he made, the spiked end first, until it was about half-way in and half-way sticking out, just what he had hoped for.

Next, he grabbed two objects for the following part: an eye-visor, as he called those things that work as eye-patches, except they can work like normal eyes and more, and a tiny vacuum. He started with opening the empty eye socket up and using the vacuum to suck out the excess blood that was there, before setting that down. Then, he fastened the eye-visor over the socket, clicking on a single switch on the side just to turn it on. Connecting it to the brain for registering would come later.

Now that most of the risky parts were done, it was time to outfit the subject with some actual clothing so he wasn't seeing them naked. Thankfully for him, he had taken the liberty to scan their form and create a permanent tunic to cover up their torso in. Stepping off of the elevated floor, he waddled over to a control panel that was linked up to a great multi-tool device attached to the ceiling. Normally, he would use this to place watchwork endoskeletons into subjects, but this time it would be used for something else.

A claw reached down and gently grabbed the girl by the sides of their head, lifting them up into the air. Two more claws moved to pick up the metallic tunic Zaxaxx had put together for them, and proceeded to open up the back of it, then placing it over the girls body before folding it around and reattaching it on the back. Another device lowered down to the opening in the tunic that was meant to hold the crystal in, and gently pushed that in place before activating the small coat. Immediately, small plugs extended out of the small holes within the larger hole, and connected into the crystal, pulling the hole around it tightly so as not to leave any gaps.

The two claws from before were already pulling some metallic pants onto their legs, which also had boots connected to the bottom of them, with blades on the heels and knees. They moved away with their job done while the third device started to fasten the clothing into them, making it stay so it wouldn't be able to be taken off, at least not normally.

Now the second to final step of the whole procedure was ready. One final instrument of the large multi-tool, a sharp needle, gently stuck into the back of the girls head, just a little on the left side, inserting the chip that would allow Zaxaxx to program their directives. Meanwhile, one of the claws was attaching a circular device tightly around the needle onto the side of her head, for future fixes if they were needed. The claw holding her up began to lower her back onto the operation table, facedown this time, so the needle could stay in her so this chip could continue to be edited.

Zaxaxx clapped slowly, admiring the newest creation of his. All that was left now was the programming. He stepped away from the controller and over to the larger computer to begin coding. He glanced back at the girl, then back at the computer, starting to type.

>POWER VENOM INSTALLATION:1 >LINK @ E73 >NAME:

He paused here, names were usually difficult to come up with. He tapped his foot impatiently, glancing back at the girl again. A5A and L4Z were looming over her while he was typing. He turned back to the computer, typing in something out of the norm, because this one wasn't his usual creation.

>NAME: L3SSA

He nodded, liking it, then continued to type.

>LINK @ SW-2 >LINK @ GR-2 CHECKING FOR POWER CORE...

Now that everything was linked up, he waited a few moments for the rest of the installation process to go on by itself. One that was done, he could type in directives, and direct her to, of course, kill Dorty. He let out a short laugh, followed by some more hysterical laughter, for this was his finest creation yet.

Suddenly, a red light began to flash on and off above them, his laughter cut short by a grimacing snort as he glared near the main exit. He swung his head to glare at the other two creations, pointing toward the door. They began to scuttle and crawl towards it, while he grabbed one of his saws to bring along with him. Whoever had broken in was going to regret every single little decision they had ever made in their life that led up to this moment.

>POWER CORE DETECTED, INSTALLING ENERGY... >WIPING CURRENT MEMORY... >PREPARING TRACKER INSTALLATION... >ERROR: INSTALLATION INTERRUPTED >PREPARING TRACKER INSTALLATION... >ERROR: INSTALLATION INTERRUPTED

A5A leapt out from behind the corner, metallic tendrils poised, only to be greeted with the closed front door. L4Z and Zaxaxx followed shortly behind to witness the mystery. One of the windows in the door had powered down, and on the floor was a rock.

"This is it?" Zaxaxx huffed, stomping forward to pick it up. "This is what set off the alarm?" He snarled, tossing it aside. He had been hoping some bookah or an asura would be here, but instead whoever it was threw a hard object through his door and ran. If this was their idea of a prank, it was a very poor one.

Zaxaxx slowly turned and walked back toward the two, glaring at L4Z. "Blast the rock." He spoke, turning back toward the central chamber. L4Z's back-cannon took aim, and charged up before releasing a blast that charred the surrounding structure while destroying said rock.

Just outside the door back into the chamber, Zaxaxx looked back at his two creations, wondering just when he should even send them out. The blaring alarm couldn't allow him to think, so for now he just had to go back in and turn it off himself, opening the door.

He stared inside for a few moments, then screamed in rage.

The operation table was empty, the needle broken, the console left on an endless loop of attempts. L3SSA had somehow escaped, but how? Was the rock a distraction? Did they just wake up and walk away?

After some moments thinking, it hit him: the drug he used to capture the girl was a powerful tranquilizer, meant to last for at least a day. It must have run out while she way laying there, giving her the chance to break out and escape.

Even still, Zaxaxx stiffened up in anger, unsure what else to say about the matter. On one hand, at least the procedure worked; he had successfully created a living minion to serve him, one that wasn't resurrected. On the other hand, they had escaped, and now doing something else for all he knew. Or maybe...

Zaxaxx stomped over to the computer, punching a button to turn on all of his devices that were already programmed correctly. He typed in a command:

>SEARCH LAB AND RETRIEVE L3SSA IF HERE

The sounds of mechanical creatures waking up and moving quickly became apparent over the alarm, which was promptly shut off. Zaxaxx sighed, but grinned a little. He could further enhance his future creations with the things he had learned from this one. Already, a new idea was forming, one for specifically dealing with leaders. While his many creations scourged the lab for L3SSA, Zaxaxx began typing in notes for his next creation...

...and all the while, L3SSA was lost, with no memory, in an unfamiliar world.

[nancygduarteus]

The Injection That Melts a Double Chin

I sat back, exposing the vulnerable area under my chin, bracing myself for the pinch of the needle. I clutched an ice pack, ready to apply it, and looked around as my heart raced. I was about to have vials of synthetic stomach acid shot into my double chin, erasing it, I hoped, forever.

The drug designed to treat my “submental fat” (the fat pocket under the chin) is the new cosmetic injectable Kybella, which promises to dissolve fat cells through a series of injections. There’s very little downtime, it’s noninvasive and nonsurgical, and there’s little risk. The drug is the first (and only) injectable designed to contour away the dreaded double chin.

Approved by the FDA in 2015, Kythera Biopharmaceuticals’ drug (which has since been acquired by Allergan) hit the market as an alternative to liposuction or surgery, using a synthetic version of deoxycholic acid—a salt found in human bile that aids fat digestion—to destroy fat cells. In the digestive tract, deoxycholic acid breaks down fat by destroying the cell membrane. When injected into subcutaneous fat, this cytolytic drug does the same thing—in targeted locations. The dissolved fat is now cellular debris, and gets cleared into the lymphatic and circulatory systems by specialized immunologic cells. This happens gradually over the span of several weeks. As for the deoxycholic acid, it follows the same path; it gets metabolized and broken down, and then excreted as waste.

The origins of chemical fat-dissolving (a.k.a. mesotherapy) go back to France in the ’50s. By the ’60s, according to Conor Gallagher, Allergan’s executive director of medical affairs, European scientists started using a compound called phosphatidylcholine to break up fat for medical reasons. After a patient experiences trauma, perhaps from a fracture, tiny globs of fat can enter the circulation. “And often times they'll end up in the lungs and can cause respiratory issues,” explains Gallagher. “So, they're looking for a way to disrupt fat, to help fix that or to treat that. They were using phosphatidylcholine as a potential agent to try and dissolve that fat.” Cut to 1980s Europe, and cosmetic researchers started looking at the compound, thinking, “if it can dissolve fat in the vessels maybe it can dissolve fat elsewhere,” says Gallagher. Bodybuilders began injecting themselves with “PC/DA” (a combination of phosphatidylcholine and deoxycholic acid) off-label to get rid of fat pockets for competition. In the early 2000s, researchers at UCLA discovered that the fat breakdown caused by the PC/DA compound was actually due to the deoxycholic acid—the active ingredient in Kybella. And now here we are. Or should I say here I am, in Beverly Hills, with a needle in my chin.

As I hit my 30s, I began to feel a bit bothered by my so-called double chin. While not especially noticeable, this little pocket of submental fat has been a part of my profile for as long as I can remember; it’s genetic. I’ve often wished it gone, but I never considered a surgical fix. That seemed like an extreme measure for something that’s merely an annoyance in my life. I never saw myself getting any kind of cosmetic procedure at all. Then I saw a magazine ad for a new injectable, noninvasive double chin treatment.

I was able to try Kybella courtesy of Beverly Hills cosmetic spa Alchemy 43. Anxious about being injected many, many times under the chin (the average patient receives 20 or more injections per treatment), I arrived at the “beauty lab.” It’s the kind of chic place you’d imagine one would visit for such a procedure, with futuristic light fixtures, high-end products on display, and luxe gold accents. It feels less like a medical environment and more like an upscale boutique, complete with a velvet couch. The young women staffing Alchemy 43 sport impeccable makeup and totally smooth faces—a look I don’t often see in my life as a stay-at-home mom and writer on the relaxed east side of Los Angeles. Other services offered by Alchemy 43 include wrinkle relaxing, fillers, sculpting, and lash enhancement, and I imagine for a minute what it would be like to have the time and money to get all these treatments. I would never be able to keep up; I don’t even get my hair cut more than once or twice a year.

Owner Nicci Levy says they see about 30 clients per month for Kybella, and that all of their customers have seen a positive result. “People are very interested in this treatment,” she says. “We have seen amazing results.” My expert injector (or “alchemist” as they’re called at Alchemy 43) Katie Saliman is a tall, blonde nurse with a strong jawline. Saliman told me she loves administering Kybella because of its “wow factor.” “This product can absolutely change your profile and really improve the shape and contour of your jawline,” she says. I appreciate her enthusiasm.

Saliman was involved in the clinical trials for Kybella; her experience eased my fears about being stuck in the neck with needles full of acid. In studies, about 4 percent of subjects had nerve damage in the lower jaw, and this was my biggest concern going into the procedure. I asked about the possibility of hitting a nerve and Saliman assured me it hadn’t happened to any of her patients. Even if it did happen, she said, I’d have a crooked smile but only temporarily—the damage typically wears off after a few months. I guess I could deal with some nerve damage, I thought wryly.

Saliman took a series of high-tech, 3-D photos, some “before” shots, and applied numbing cream under my chin. Then she applied a temporary tattoo dot grid; a map of injection sites. With some help from a similarly beautiful assistant, Saliman started poking. I felt each needle go in, but it wasn’t unbearable. If I could survive labor and root canals, I thought, I could definitely deal with this. I started to feel a burning sensation as the drug took effect, and I iced my chin when Katie would pause for a new needle. In all, I had about 30 injections from three vials of Kybella. Though they were many, the shots themselves only took maybe five minutes or so. Saliman recommended I do two more treatments, approximately six weeks apart. “Everyone needs two to six treatments and we are big advocates of ‘treat to complete,’” says Levy.

(Lindsey Hunter Lopez)

For each treatment, the injector uses between one and three vials of Kybella, depending on how much submental fat one has. According to Deanne Mraz Robinson, a dermatologist and the director of the Body Sculpting Center at the Connecticut Dermatology Group, cost for a single treatment ranges from $800 to $1,400, depending on how many vials you need, and the particular pricing of your doctor or spa. Kybella’s cost can exceed that of liposuction (which generally runs between $2,000-$5.000), but many clients are willing to pay a higher price to avoid going under the knife. “People are excited that there is an option for treating their double chin,” says Mraz Robinson, who was one of the investigators in the approval trial for Kybella. “Previously, the only procedure that was available to treat submental fullness was surgical liposuction, which is an invasive procedure with its own inherent risks and benefits.”

Saliman tells me that I’m a great candidate for Kybella because my submental fat is genetic, rather than weight-related. And I’m 34. Younger clients typically do well because they have better skin elasticity, and are less likely to have excess, sagging skin under the chin. “It is important to make sure that the fullness under the chin is from fat under the skin and not caused by other conditions, such as laxity of the skin,” explains Mraz Robinson. “Submental fat can be seen in a wide range of ages, as factors such as genetics, hormone status, and weight can influence the amount of fat under the skin.”

An interesting trend came up in market research and studies, Gallagher tells me: Kybella is bringing in a totally new group of injectable consumers. Around 45 percent of patients getting Kybella are new to aesthetic treatments—they’re people who haven’t previously been in a cosmetic or aesthetic physician's office. (I would be counted among this group.) And the procedure is attracting an unlikely clientele: men. “Many men who wouldn’t have previously considered cosmetic procedures are coming in for Kybella to sharpen their jawline,” notes Mraz Robinson. Levy also tells me that she’s noticed a younger group coming in for “sculpting” procedures like Kybella. Millennials are interested in injectables, it seems.

I’ve never felt more L.A. than I did driving through Beverly Hills with a medical compression bandage around my head. My chin was pretty sore for about two hours after the injections, but I started feeling better fairly quickly. As predicted, the injection area started puffing up like a bullfrog. I slept with my head propped on two pillows, the bandage around my chin.

Swelling typically peaks at 24 hours post-treatment and can last from two days to three weeks. It took me about three weeks to get back to baseline. But that’s normal, according to Saliman. I was told not to drink alcohol or take painkillers for 48 hours before my injections, and luckily I only developed one tiny bruise (the day after treatment). The inflammation hasn’t been pleasant, but swelling means the medication is working to dissolve fat—no pain, no gain. The swelling is caused by the active medication breaking down the fat cells, and some of the volume can be attributed to the solution itself. Sometimes I’m incredulous that I actually went through with something so vain, and sometimes I’m proud that I actually withstood all those needles. “You tolerated it like a CHAMP!” Saliman emailed me afterward. This makes me feel tough, which is weird and horrible because we’re talking about getting injectable cosmetic treatments in Beverly Hills. But I’ll take it! I am a true warrior.

Gallagher confirms that swelling is a good thing. And puffiness after subsequent treatments won’t be as extreme. There may also be bruising, pain, numbness, redness, and areas of hardness (which can feel lumpy, or like small pea-like nodules, caused by swelling) in the treatment area. All of these, he tells me, should be temporary. I did experience numbness and a little pain at the onset, but my side-effects were tolerable.

The process can be relatively slow, with results taking weeks or more often, months. This can be discouraging, especially to people who are self-conscious about their chins to begin with. The good news is that once your months-long process is completed, those fat cells are not coming back. There is no upkeep to consider, or future costs. “You take those fat cells away, they won't recreate themselves,” says Gallagher. Safety studies have been done on the long-term results, and “in general, between 75 and 90 percent of patients are still maintaining their response at up to five years.” Gallagher also notes that most patients really turn a corner after the second treatment, seeing a noticeable reduction in fat.

(Lindsey Hunter Lopez)

After five weeks, I haven’t fully seen my results yet, but in more than 20 studies, nearly 70 percent of the thousands of patients reported physical and emotional improvement. That sounds promising. Two U.S. trials put before the FDA showed that nearly 80 percent of those treated with Kybella noticed a reduction of their submental fat and thus had improved satisfaction about their appearance. And doctors are also happy about the advent of this drug. “Physicians have really enjoyed the precision and the efficacy of Kybella, I'd say,” says Gallagher. “It does what it's going to do … it’s gonna kill fat cells wherever it's injected.” Well, wherever it’s injected within reason.

Kybella could be used on various other small areas. From a clinical standpoint, Allergan is looking at the “bra fat” area—the roll of fat that can be present under the bra line or between the bra and the armpit—and the jowl. “Sometimes that's just skin laxity, but there are times when that's due to fat, as well … so we are certainly actively considering whether we would go into a clinical program there, looking at jowl fat,” Gallagher says. Mraz Robinson tells me “Kybella will likely be approved for use on body areas to reduce subcutaneous fat,” and my injector agrees, noting “This type of practice is already being studied in the anterior bra fat area and upper knees.” So although larger areas have been ruled out (an ample stomach, for instance, would need too much product and would require too many needles), it’s currently being investigated whether other small pockets of fat could be helped with Kybella. Studies would be needed before use on these other areas would be approved by the FDA.

I didn’t see much of a difference after my first treatment, but deoxycholic acid is currently popping fat cells after my second treatment, which was about two weeks ago. I'm just starting to notice a reduction. The second treatment is often the turning point, the experts tell me, and Saliman is optimistic that I won’t need a third go. I had lidocaine numbing injections plus the Kybella shots for the second treatment, and the increased volume caused more swelling. Overall, the second treatment was a little more painful than the first, and I experienced more bruising. One thing I’ve noticed scrutinizing profile photos through my “Kybella journey”: Perhaps there wasn’t much of an issue to begin with! Maybe that softness in my profile is more common than I realized, and not the "double chin" I imagined. But if Kybella does work? I’ll be more than happy to have a slimmer chin.

from Health News And Updates https://www.theatlantic.com/health/archive/2017/06/kybella-the-injection-that-melts-a-double-chin/529893/?utm_source=feed

[ionecoffman]

The Injection That Melts a Double Chin

I sat back, exposing the vulnerable area under my chin, bracing myself for the pinch of the needle. I clutched an ice pack, ready to apply it, and looked around as my heart raced. I was about to have vials of synthetic stomach acid shot into my double chin, erasing it, I hoped, forever.

The drug designed to treat my “submental fat” (the fat pocket under the chin) is the new cosmetic injectable Kybella, which promises to dissolve fat cells through a series of injections. There’s very little downtime, it’s noninvasive and nonsurgical, and there’s little risk. The drug is the first (and only) injectable designed to contour away the dreaded double chin.

Approved by the FDA in 2015, Kythera Biopharmaceuticals’ drug (which has since been acquired by Allergan) hit the market as an alternative to liposuction or surgery, using a synthetic version of deoxycholic acid—a salt found in human bile that aids fat digestion—to destroy fat cells. In the digestive tract, deoxycholic acid breaks down fat by destroying the cell membrane. When injected into subcutaneous fat, this cytolytic drug does the same thing—in targeted locations. The dissolved fat is now cellular debris, and gets cleared into the lymphatic and circulatory systems by specialized immunologic cells. This happens gradually over the span of several weeks. As for the deoxycholic acid, it follows the same path; it gets metabolized and broken down, and then excreted as waste.

The origins of chemical fat-dissolving (a.k.a. mesotherapy) go back to France in the ’50s. By the ’60s, according to Conor Gallagher, Allergan’s executive director of medical affairs, European scientists started using a compound called phosphatidylcholine to break up fat for medical reasons. After a patient experiences trauma, perhaps from a fracture, tiny globs of fat can enter the circulation. “And often times they'll end up in the lungs and can cause respiratory issues,” explains Gallagher. “So, they're looking for a way to disrupt fat, to help fix that or to treat that. They were using phosphatidylcholine as a potential agent to try and dissolve that fat.” Cut to 1980s Europe, and cosmetic researchers started looking at the compound, thinking, “if it can dissolve fat in the vessels maybe it can dissolve fat elsewhere,” says Gallagher. Bodybuilders began injecting themselves with “PC/DA” (a combination of phosphatidylcholine and deoxycholic acid) off-label to get rid of fat pockets for competition. In the early 2000s, researchers at UCLA discovered that the fat breakdown caused by the PC/DA compound was actually due to the deoxycholic acid—the active ingredient in Kybella. And now here we are. Or should I say here I am, in Beverly Hills, with a needle in my chin.

As I hit my 30s, I began to feel a bit bothered by my so-called double chin. While not especially noticeable, this little pocket of submental fat has been a part of my profile for as long as I can remember; it’s genetic. I’ve often wished it gone, but I never considered a surgical fix. That seemed like an extreme measure for something that’s merely an annoyance in my life. I never saw myself getting any kind of cosmetic procedure at all. Then I saw a magazine ad for a new injectable, noninvasive double chin treatment.

I was able to try Kybella courtesy of Beverly Hills cosmetic spa Alchemy 43. Anxious about being injected many, many times under the chin (the average patient receives 20 or more injections per treatment), I arrived at the “beauty lab.” It’s the kind of chic place you’d imagine one would visit for such a procedure, with futuristic light fixtures, high-end products on display, and luxe gold accents. It feels less like a medical environment and more like an upscale boutique, complete with a velvet couch. The young women staffing Alchemy 43 sport impeccable makeup and totally smooth faces—a look I don’t often see in my life as a stay-at-home mom and writer on the relaxed east side of Los Angeles. Other services offered by Alchemy 43 include wrinkle relaxing, fillers, sculpting, and lash enhancement, and I imagine for a minute what it would be like to have the time and money to get all these treatments. I would never be able to keep up; I don’t even get my hair cut more than once or twice a year.

Owner Nicci Levy says they see about 30 clients per month for Kybella, and that all of their customers have seen a positive result. “People are very interested in this treatment,” she says. “We have seen amazing results.” My expert injector (or “alchemist” as they’re called at Alchemy 43) Katie Saliman is a tall, blonde nurse with a strong jawline. Saliman told me she loves administering Kybella because of its “wow factor.” “This product can absolutely change your profile and really improve the shape and contour of your jawline,” she says. I appreciate her enthusiasm.

Saliman was involved in the clinical trials for Kybella; her experience eased my fears about being stuck in the neck with needles full of acid. In studies, about 4 percent of subjects had nerve damage in the lower jaw, and this was my biggest concern going into the procedure. I asked about the possibility of hitting a nerve and Saliman assured me it hadn’t happened to any of her patients. Even if it did happen, she said, I’d have a crooked smile but only temporarily—the damage typically wears off after a few months. I guess I could deal with some nerve damage, I thought wryly.

Saliman took a series of high-tech, 3-D photos, some “before” shots, and applied numbing cream under my chin. Then she applied a temporary tattoo dot grid; a map of injection sites. With some help from a similarly beautiful assistant, Saliman started poking. I felt each needle go in, but it wasn’t unbearable. If I could survive labor and root canals, I thought, I could definitely deal with this. I started to feel a burning sensation as the drug took effect, and I iced my chin when Katie would pause for a new needle. In all, I had about 30 injections from three vials of Kybella. Though they were many, the shots themselves only took maybe five minutes or so. Saliman recommended I do two more treatments, approximately six weeks apart. “Everyone needs two to six treatments and we are big advocates of ‘treat to complete,’” says Levy.

(Lindsey Hunter Lopez)

For each treatment, the injector uses between one and three vials of Kybella, depending on how much submental fat one has. According to Deanne Mraz Robinson, a dermatologist and the director of the Body Sculpting Center at the Connecticut Dermatology Group, cost for a single treatment ranges from $800 to $1,400, depending on how many vials you need, and the particular pricing of your doctor or spa. Kybella’s cost can exceed that of liposuction (which generally runs between $2,000-$5.000), but many clients are willing to pay a higher price to avoid going under the knife. “People are excited that there is an option for treating their double chin,” says Mraz Robinson, who was one of the investigators in the approval trial for Kybella. “Previously, the only procedure that was available to treat submental fullness was surgical liposuction, which is an invasive procedure with its own inherent risks and benefits.”

Saliman tells me that I’m a great candidate for Kybella because my submental fat is genetic, rather than weight-related. And I’m 34. Younger clients typically do well because they have better skin elasticity, and are less likely to have excess, sagging skin under the chin. “It is important to make sure that the fullness under the chin is from fat under the skin and not caused by other conditions, such as laxity of the skin,” explains Mraz Robinson. “Submental fat can be seen in a wide range of ages, as factors such as genetics, hormone status, and weight can influence the amount of fat under the skin.”

An interesting trend came up in market research and studies, Gallagher tells me: Kybella is bringing in a totally new group of injectable consumers. Around 45 percent of patients getting Kybella are new to aesthetic treatments—they’re people who haven’t previously been in a cosmetic or aesthetic physician's office. (I would be counted among this group.) And the procedure is attracting an unlikely clientele: men. “Many men who wouldn’t have previously considered cosmetic procedures are coming in for Kybella to sharpen their jawline,” notes Mraz Robinson. Levy also tells me that she’s noticed a younger group coming in for “sculpting” procedures like Kybella. Millennials are interested in injectables, it seems.

I’ve never felt more L.A. than I did driving through Beverly Hills with a medical compression bandage around my head. My chin was pretty sore for about two hours after the injections, but I started feeling better fairly quickly. As predicted, the injection area started puffing up like a bullfrog. I slept with my head propped on two pillows, the bandage around my chin.

Swelling typically peaks at 24 hours post-treatment and can last from two days to three weeks. It took me about three weeks to get back to baseline. But that’s normal, according to Saliman. I was told not to drink alcohol or take painkillers for 48 hours before my injections, and luckily I only developed one tiny bruise (the day after treatment). The inflammation hasn’t been pleasant, but swelling means the medication is working to dissolve fat—no pain, no gain. The swelling is caused by the active medication breaking down the fat cells, and some of the volume can be attributed to the solution itself. Sometimes I’m incredulous that I actually went through with something so vain, and sometimes I’m proud that I actually withstood all those needles. “You tolerated it like a CHAMP!” Saliman emailed me afterward. This makes me feel tough, which is weird and horrible because we’re talking about getting injectable cosmetic treatments in Beverly Hills. But I’ll take it! I am a true warrior.

Gallagher confirms that swelling is a good thing. And puffiness after subsequent treatments won’t be as extreme. There may also be bruising, pain, numbness, redness, and areas of hardness (which can feel lumpy, or like small pea-like nodules, caused by swelling) in the treatment area. All of these, he tells me, should be temporary. I did experience numbness and a little pain at the onset, but my side-effects were tolerable.

The process can be relatively slow, with results taking weeks or more often, months. This can be discouraging, especially to people who are self-conscious about their chins to begin with. The good news is that once your months-long process is completed, those fat cells are not coming back. There is no upkeep to consider, or future costs. “You take those fat cells away, they won't recreate themselves,” says Gallagher. Safety studies have been done on the long-term results, and “in general, between 75 and 90 percent of patients are still maintaining their response at up to five years.” Gallagher also notes that most patients really turn a corner after the second treatment, seeing a noticeable reduction in fat.

(Lindsey Hunter Lopez)

After five weeks, I haven’t fully seen my results yet, but in more than 20 studies, nearly 70 percent of the thousands of patients reported physical and emotional improvement. That sounds promising. Two U.S. trials put before the FDA showed that nearly 80 percent of those treated with Kybella noticed a reduction of their submental fat and thus had improved satisfaction about their appearance. And doctors are also happy about the advent of this drug. “Physicians have really enjoyed the precision and the efficacy of Kybella, I'd say,” says Gallagher. “It does what it's going to do … it’s gonna kill fat cells wherever it's injected.” Well, wherever it’s injected within reason.

Kybella could be used on various other small areas. From a clinical standpoint, Allergan is looking at the “bra fat” area—the roll of fat that can be present under the bra line or between the bra and the armpit—and the jowl. “Sometimes that's just skin laxity, but there are times when that's due to fat, as well … so we are certainly actively considering whether we would go into a clinical program there, looking at jowl fat,” Gallagher says. Mraz Robinson tells me “Kybella will likely be approved for use on body areas to reduce subcutaneous fat,” and my injector agrees, noting “This type of practice is already being studied in the anterior bra fat area and upper knees.” So although larger areas have been ruled out (an ample stomach, for instance, would need too much product and would require too many needles), it’s currently being investigated whether other small pockets of fat could be helped with Kybella. Studies would be needed before use on these other areas would be approved by the FDA.

I didn’t see much of a difference after my first treatment, but deoxycholic acid is currently popping fat cells after my second treatment, which was about two weeks ago. I'm just starting to notice a reduction. The second treatment is often the turning point, the experts tell me, and Saliman is optimistic that I won’t need a third go. I had lidocaine numbing injections plus the Kybella shots for the second treatment, and the increased volume caused more swelling. Overall, the second treatment was a little more painful than the first, and I experienced more bruising. One thing I’ve noticed scrutinizing profile photos through my “Kybella journey”: Perhaps there wasn’t much of an issue to begin with! Maybe that softness in my profile is more common than I realized, and not the "double chin" I imagined. But if Kybella does work? I’ll be more than happy to have a slimmer chin.

Article source here:The Atlantic

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