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#the problem is i used all my focus yesterday barely managing to write a 4 page draft of a 5 page paper
tarantula-hawk-wasp · 5 months
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i need to be working so much harder than i am today
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justaredheadf1fan · 2 years
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Back to hell in Jeddah
Well, hi!
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Second race weekend take the cake? I'm not an optimist taking into account Sharl is starting the weekend off with a penalty. Way to go, yay!
I'm gonna keep the same structure as last weekend, I like the organization better. Just gonna add up some color to the subheadings, seeing all the text in white and trying to find the thicker font is giving me a headache. I'm late watching and writing it all since as usual I was entertained by other things. I might even start the chaos of watching everything quite late as last summer since I might be starting work on Formentera almost a month earlier. We'll see how I manage this this time around.
Press conference - Thursday
Honestly, the only interesting comments from the first press round were coming from Yuki. I'm biased, he was the only interesting driver for me on there, but you know. I have to say though, seeing Lando talking about how they need to improve the car and all is so funny to me. Suck it up, Buttercup.
I like how Yuki talks, so eloquently, more analytically maybe, or at least he seems super focus. I'm more used to seeing him they way he's always shown, shouting in the car or joking around with Pierre, but this calmer version of him is also good to see. I really find him super endearing, honestly.
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The second press round looks much better, at least 4 of the drivers are worth listening to.
Poor Estie Bestie talking about the hundred different penalties he got during the race 2 weeks ago. I hope he gets a better race this weekend, at least.
I wanna hug Lance, seriously. It's still a wonder how he's there after breaking his wrists, having surgery, coming back right away and all. Braver than the US marines, my boy.
We don't care about Checo unless he's fighting with his teammate, so moving on. Last but certainly never least, Lewis glowing all around, he's so calm, he's so chill.
Free Practice 1 - Friday
Sunny FP session this afternoon to start the weekend. That must be a hell of a hot day.
Honestly, not much has been going on apart from the stupid rumblings of the Spanish commentators, to which I no longer pay attention at this point. It's a good thing that this is a quiet session since this track is Hell.
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There have been a couple of close calls with a Haas and another car that I can't remember now, but it could've been scary material if you know what I mean. And a few off track trips on Turn 22 maybe? But other than that, not much else. So, that's why I've been making the most out of the session since I barely had to look at the screen to begin with. Nice (?)
The one really fantastic update that's worth mentioning above else honestly is the helmet cam on Lewis. Now, that's a view I enjoy.
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Just a few problems for Checo I see and that's about it and it's right at the end of the session anyway so 🤷🏻‍♀️
Free Practice 2 - Friday
I may be speaking way too quickly but the second session of the day is looking quite like the first one, calm and quiet.
And indeed it was. I haven't paid that much attention due to the lack of interesting stuff going on. A few problems with the traffic, but not much else. I mean, yeah we already know RBR are leading, Aston Martin are pretty much crushing it and blah blah blah.
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The most interesting was seeing Sid the Sloth almost going up against the wall a few times, but we can never get that lucky as to seeing him scratch the car enough as in 2021 during Quali. Ah, good times.
Anyway, more tomorrow and hopefully Quali's a kicker.
Free Practice 3 - Saturday
Sooooooo, here we go again with another session of nothing and a little bit more of nothing. Same as yesterday, I'm afraid.
I hope we get a little more excitement in Australia during Free Practice since it's not this hellhole, at least the chances of half the drivers killing each other accidentally will be a tad lower.
Yeah, definitely a truly quiet breakfast experience watching this at 2pm. There's nothing to comment on about this session, honestly. So I'll just leave it here.
Quali better be something else, for the love of all things... interesting? However that phrase goes 🤣
Peace out!
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alia-turin · 3 years
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Finally chapter 6! This is actually the only fic I will continue updating on this blog, everything else will go to my writing blog and once that is finished, everything goes there.
I’m sorry for the slow update, yesterday and the day before were a bit buy and stressful so I didn’t have a chance to update.
Fic Title: Somewhere in Time (Chapter 6) Previous Chapters: Somewhere in Time - Caranthir/F!OC - 1, 2, 3, 4, 5 Fandom: The Witcher (Aen Elle) Pairing: Caranthir/F/OC Warning: Canon typical violence for this chapter, mention of scars, angst AO3 Link
It had been a few days since he came to the Winter tower after the reception. He spent his time reading and experimenting. He couldn’t stop thinking about her, the few moments when he had been close to her and with her, the way her eyes had looked at him...he wanted to forget, but the more he tried to do it the worse it became.
He felt as if he was becoming obsessive and probably he was. Last time he came here she had been in Tir na Lia behind a door he had enchanted so she could not leave. He had missed her, but he knew exactly where she was. Now it was different. She could be anywhere, with anybody. He still could use the tracking spell but he had also told himself that he was the one to let her go, he would not chase her unless she was in need of him.
Somewhere deep he knew that his behavior was probably wrong, putting spells and curses on her so he knew what was going on, but what choice did he have? The first woman he ever liked died because he didn’t pay enough attention, his only example of true love in his life was a story everyone probably knew, ending in a great tragedy. He neither wanted to see her death nor was going to allow his heart to be shattered, not the way Avallac’h’s had been.
He had gone as far as to dig information on her family which wasn’t that difficult, noble families record keeping was exceptional. Mother was never mentioned, even Aine’s name was not mentioned anywhere officially which made sense, half human bastards were not really a popular topic. Her father had only one legal child, a son, not surprising either, elves rarely had more. The man had a lot of resources, which explained a lot. That was when he had stopped looking, realizing how ridiculous and obsessive his actions had been. He knew a lot about her, some of it not even disclosed by her, and he had volunteered little to nothing about himself.
Caranthir suddenly stopped in the middle of the room feeling the unpleasant sensation going through his body, he had felt that once before, he was younger and he cast a spell he was not ready for, every inch of his body had cramped at the same time. Then feeling the sharp pain in his right leg as if something was ripping him apart, skin muscle and probably even bone hurt in a way he had never felt before. He had to steady himself by grabbing a chair because the pain was so bad he could barely stand on his leg. Took him a second to pull himself together, nothing was wrong with his leg, that was the curse he put on himself in order to feel what she was feeling, but the pain was so bad he felt dizzy. He had to remind himself it wasn’t his leg that was hurting it was all in his mind.  
“Aine…” he whispered as he finally managed to get his thoughts together, he had been injured many times, but that was a level he had never felt, worse if he was feeling it that bad, it meant it felt the same for her. Caranthir opened a portal and it took him just a second to find himself where she was, in the woods where he had first seen her. She was on the ground, her back pressed against a tree, her right leg bleeding and two ugly creatures coming close to her, both of them standing on their hind legs, beastly claws sticking out of their limbs, Caranthir saw a third one lying on the ground, vines pulling him deeper and the earth, she must have cast a spell, that was the first jolt he had felt, spell too powerful for her at her current level. He waved his hand and the two creatures turned into ice sculptures, he cast another spell and they broke into dust.
“Caranthir…” she looked at him in fear and shock, her leg bleeding badly and just now he noticed her arm was also injured, strange he had not felt that probably because of the shock going through her body. Her eyes were glassy, not really focused on anything. He cast a healing spell, those were never his strongest point, but it was enough for now to stop the bleeding and he was going to take care of the rest later.
“Don’t move.” his heart sank seeing how bad the wound was. Skin and flesh had been torn but he could not see the bone, which was probably positive. He wasn’t going to waste time, he took her in his arms and opened a portal.
“I don’t want to...leave me…” she tried to push herself away from him but there was no strength in her body.
He stepped through the portal and found himself in his bedroom in the Winter Tower. He left her gentle on his bed, her face wincing in pain as soon as he let go of her. He tore the pants she was wearing around the wound. Silly girl, she should have listened to him when he told her not to leave. For a second he wondered if that was his fault - did he push  her too far and she left because of him, and if he had acted in a different way, she wouldn’t have left and that wouldn’t have happened...
“No, stop.” Somehow she found strength to try to push him away, but even if she was not injured she was not as strong as he was. Caranthir placed his palm on her leg and cast his spell again, the wound slowly closing not even leaving a scar. Aine’s eyes however still lacked focus, she had lost too much blood and he couldn’t do anything about that. .
“Get off me.” she moaned in his bed. Caranthir raised an eyebrow as he had stepped away, he wasn’t anywhere near her, he needed to go to his lab for some herbs that could help her. She was delirious, he went back to the bed and touched her forehead burning with fever. The creatures that attacked her were unfamiliar to him, and he wondered if their claws were poisonous. A chilling thought crossed his mind.  That couldn’t be happening to him not again. This time he did everything right. He prepared he knew he would be there if she was in danger and he was but he had been moments too late.
He rushed out of the room, running down the stairs to his lab and frantically started going through all his herbs and potions. Healing wasn’t a matter that interested him, he had very few things that could help, but he grabbed everything he could. When he walked back to his bedroom she was attempting to get off the bed, almost sitting.
“I don’t want to be here…” the words were swirling her mouth. Caranthir ignored how he felt about her being so persistent to be as far as possible from him.
“You need to drink that.” he passed one of the potions he was carrying to her pale lips, she turned her head away. He could make her, he could force it down her throat, but somehow he felt like he had already done enough damage to his image, even if he was also sure that once she woke up, she would not remember anything of what is happening here. She pulled away again almost as if she was drunk, no grace in her moves and he used a spell to turn her head toward him and pour the liquid down her throat.
Caranthir walked to the nearest drawer and took out a clean blanket as everything on the bed was soaked in blood. He covered her with the blank and then just sat on the bed next to her. If she had listened to him, that wouldn’t have happened. No, if he had insisted. That’s what the problem was, he could have kept her safe if she had stayed with him and when she said no he should have just made her do so. What did it matter if she wanted or didn’t want as long as she was safe? He sighed, it did matter.  He ran his fingers through the feverish skin on her cheek. He wasn’t going to make the same mistake a third time.
Aine woke up, not really recognizing the place where she was. Memories slowly started coming to her, she somehow had managed to reach her house which did not exist anymore. All that time she had hoped he had been lying, that was just a manipulation, but it was not. He had been truthful. Then the creatures attacked her and then... he had come to rescue her. She looked around in panic again fearing she was in Tir na Lia. The room was very similar, stone walls, bed, dresser, but somewhat smaller. She jumped out of the bed in panic, but her leg was cut by sharp pain. She looked at it, she remembered the creatures attacking her in the forest, she summoned a spell to stop one of them but the other one dug its nails in her leg. There was no injury however just an odd feeling of dull passing pain.
She walked to the dresser, her leg feeling better with each step she made as if remembering how to walk. She opened the old wooden doors - white shirts and dark coats were hanging from the line. Some of the coats had different embroideries on them but the black, white and grey was predominant. She grabbed one of the shirts, it was large enough to fit her as a very short dress and it was cleaner than everything else she was wearing now. Once she changed she looked through the window - that was definitely not Tir na Lia. There were mountains as far as her eyes could see covered in snow and ice. The sun was shining but none of that seemed warm in any way. Where was she?
Aine walked to the door, half expecting not to be able to open it. She had been through that once. She pressed on the handle and...the door opened. She stood for a moment wondering if that was a dream - was she imagining things? She stepped through the door in a small hallway that was empty beside a stairway leading down. She stepped further but beside the coldness of the stone under her feet, nothing else happened. She followed the stairs down, they were twisting until she ended in another room, no hallway this time just a room filled with bookshelves, cupboards and two tables. That was when she screamed.
Caranthir heard the scream upstairs and ran as fast as he could only to see Aine in his lab staring at the creature chained to one of the tables.
“It is dead.” Caranthir placed a hand on her shoulder and she looked at him terrified, but didn’t pull away. Apparently seeing the creature that attacked her all opened up was more shocking than he was which he guessed was some sort of progress.
“What…” she looked back at the creature, chained to the table, gut wide open, blood spilled all over the place.
“Ignore it.” just now he noticed she was wearing one of his shirts, so long on her that it was almost reaching her knees. Caranthir stared, not sure what was making him more aroused right now the fact that this was his short or realizing she had nothing under it.
“What happened to it?” her words brought him back to the creature and that was not what he wanted to think about now. “Why is it chained?”
It was chained because he dragged it here after he finally managed to calm her down. That was the one creature she stopped with magic and he went to look for it. He brought it here, chained it to the table, still alive, and opened it. It did die eventually, but he was angry and he needed to make that ugly thing suffer as much as she had suffered even worse.
“Their organs are good for magic but they are very tough to cut through so I had to make sure it doesn’t fall from the table.” The lie came easy to him, he was not going to admit that he didn’t have an idea where that thing came from, nor was going to tell her he made it painful for the ugly creature on purpose, because that was how he kew to solve his problems, the only way Eredin had taught him, make them suffer and everything will be alright. He did learn something however, whatever these creatures were, certainly did not come from this world which was curious. She was still looking at it, her eyes shifting to the massive head filled with sharp fangs. Caranthir could feel himself getting angry again, the same anger he had felt once he made sure she was safe and wanted to find every single one of these things and just destroy their kind. He had to satisfy himself with one. “Come I need to look at your leg.” he pointed at the empty table on the other end of the room.
“I’m fine.” Aine could feel herself blushing realizing that most likely he had healed her, she barely remembered things after she found the creatures, she remembered casting a spell, in fact she wasn’t even sure if it worked as that was when the other two attacked her before she could even realize what had happened.
Caranthir did not answer her but nodded at the table again and she had no choice to but comply. It was easier to do as he said. She jumped on the table and he stood in front of her, his warm hand almost gently moving the shirt away. She realized she was blushing, she had nothing under the shirt and even if his touch right now was almost medical her stomach curled in a ball thinking of the situation they were in. She pinned her eyes on his hand not wanting to look at him, his tattooed fingers gently brushing where the wound was supposed to be on her thigh but now was gone.
He stepped back realizing how dangerous it was what he was doing. He knew her wound would be healed, he healed it, he was terrible with medicinal magic and he was still better than everyone he knew, of course her leg would be fine.
“My office is downstairs, I bought some clothes for you from Tir na Lia.” there he was again feeling completely inept and unsure what to do or how. He wanted to scream from the top of his lungs that he liked her, that he felt her presence filled a gap in him he wasn’t even sure existed until two weeks ago. The way she reminded him of himself, but also the way she was different from him. He clutched his fists in frustration at his inability to just be normal, it had never bothered him as much as it did around her.
“Caranthir…” she was standing by the staircase, one foot already on the lower step as she turned toward him. “Thank you. For saving me.”
She walked down and he stared, mouth slightly opened, fingers no longer bundled in fists. When was the last time someone said ‘Thank you’ to him? Not Avallac’h, maybe a nod from him when he was younger or pat on the shoulder, never the actual words. Not Eredin either, everything Caranthir did for his king was his duty, they  both knew it and understood it, the navigator did not need to be thanked for what was his job, not Eredin was ever going to thank him for it. He didn’t need anyone’s gratitude and yet...it felt nice. Coming from her, knowing she actually found something nice to say to him.
Aine found the clothes easily, the room downstairs was a study, a large desk in the center and bookshelves circling the wall. She had figured out that wherever they were was a tower and every floor was some sort of a room. She changed as quickly as she could, the clothes that were nicely folded on the desk were the same his servants had brought to her when she was in Tir na Lia, cleaned...she assumed that was hers now or at least until someone decided so. Defgently the riding pants and boots were more suitable for the coldness compared to the oversized shirt.
Once she was done changing she walked to the only window in the room, it had started snowing again, she had never seen so much snow in her life. Her father’s lands were further south and any snow that fell melted almost immediately. She heard Caranthir’s boots tapping on the cold stone as he walked downstairs.
“Where are we?” she asked as she turned to face him.
“The Winter Tower.” he answered, his blue eyes fixed on her. “It used to be a signalling tower for Tir na Lia, many years ago. It’s difficult to access so our ancestors would have made four - five guardsmen living here for a full year. The snows make it almost impossible to reach. Nobody has used it for that purpose in years, I have made it my...laboratory in a sense.”
She looked out again, she could see the lower lands somewhere in the distance, but the snow was reducing the visibility.
“Am I your prisoner again?” she asked not even sure she wanted to hear the answer. If he was to say no and that she can leave...where was she to go? Her home was destroyed and who knew how many of these creatures were there now. She had nowhere to go.
“No.” took him a moment to answer and she might be imagining that but she could see the conflict in his eyes. Did he want to say ‘yes’? What would be the purpose of that? “But I want you to stay as my student. You can leave whenever.”
Caranthir spoke the last words with pain as he knew what had happened last time he allowed her to leave. Despite that, Avallac’h was right, as always. Caging her was not going to bring anything good eventually would kill her.
“How did you find me?” she suddenly asked, that was not what he expected. “In the forest, how did you know I was in danger?”
He forced a smile on his lips that was mostly teeth rather than a grin. Another good intention that he had which was going to backfire on him.
“Put a curse on myself, if you were to feel pain, I would feel it the same way you do.” that and a tracking spell, but he kept that information to himself. It sounded bad as it was, but again he had no idea what else to do. He had never had such a strong desire to protect someone in his life.
Silence followed and he could feel the seconds dragging forever. He would give anything to know what was in her head. It would be so easy wouldn’t it? Everything he had done so far was because he was attracted, but he had to admit he had no idea how to express it or show it. Avallac’h taught him magic, Eredin taught him to kill. That was all he knew, neither skill useful in his predicament.
“If...I stay…” her words made him raise an eyebrow. “I still can leave whenever I decide. Even if I wake up tomorrow and change my mind?”
“Yes.” he nodded. He hoped that won’t happen, he was going to show her the fun part of magic tomorrow, not just moving objects around the room, but the real excitement and power magic could give someone and hopefully after that she would be sufficiently hooked to stay with him a bit longer. All he needed. Just a bit longer.
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artificialqueens · 3 years
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On The Ground (Rosénali) - Moonshot
A/N: So… Guess who is back after a year of not writing fics? Yours truly! What can I say? Rosénali is that powerful of a ship. As always, I hope eveyone enjoys this fic. Feel free to let me know what you think… Who knows, there might be a follow up to this little fluff in the future! Little side note: this is a lesbian au where most of the s13/s12 girls appearing are cis-female, however Mik is still a trans man in the fic.
Summary: The diner girl!Denali x street singer!Rosé AU based on Blackpink’s Rosé’s solo music that nobody asked for!
ao3 link https://archiveofourown.org/works/30267687
Denali stared at the round clock above the entrance of the diner.
4:57 PM. 
Three more minutes until her shift was over.
Three more minutes until the girl who had been a fixed character in her dreams would come from around the corner, set up her guitar, greet the passersby before starting her set for the evening like she did every Wednesday.
“So, gorge, are you going to ask the champagne girl out today, or are you just going to keep on creepily staring at her from afar?”, her coworker, Kade - or as everyone called him, Mik - appeared next to her with an empty tray.
“Her name is Rosé, not champagne girl!”, Denali rebutted, “and also, for the record, I don’t just… stare. I just happen to like appreciating her set without bothering her! It’s not like she was flirting with me that one time”.
“Did I just hear our Nali denying her crush on that pink-haired singer, again?”, Olivia, who was busy running the cash register, chimed in.
“Girl, I think we should start betting against her and maybe we’ll make more money than what they can pay us here!”, Mik joked as he washed some of the dishes in the sink.
The black-haired girl rolled her eyes, ignoring her two best friends and focusing on the performer’s much-anticipated arrival.
Denali didn’t believe in love at first sight but after the first time Rosé and her guitar had shown up on the other side of the road from Tamisha’s Diner, she couldn’t think about anything else. 
There was just something about the other girl that had the Alaskan girl enamored.
The first - and so far only - time she had talked to Rosé was out of necessity as the other girl and who she assumed were her two best friends - the diner girls had dubbed them ‘Pastel Powerpuff girls’ - had decided to dine in just as Denali’s shift at the register had started.
“Hi! Did you enjoy our diner?”, the skater had put on her best smile, not quite able to meet the gaze of the taller girl as she typed out the receipt.
“Oh, sure, the skating gig is cute, the food’s great, and the service… isn’t too bad either,” Denali could see from the corner of her eye the smirk on the pink-haired girl.
“Rosie! Quit flirting with every cute girl that breathes and hurry up or Jan and I are leaving you here, the Uber is going to be here in 2 minutes!”, the blue-haired girl went on with the other girl in the friend group while ‘Rosie’ rolled her eyes at them.
“Sorry about Lagoona, she has the tact of an elephant on rollerskates,” the taller girl joked.
“O-Oh, no problem. So, your total is 20,04$, will you be paying in cash or card? Also, are you splitting the bill?”
“Since dumb and dumber over there already left, I’ll just pay everything with my card,” she replied taking out her purse and taking out her credit card, “here you go, angel”.
Denali tried her best not to blush at the sudden pet name, maintaining her on-the-clock persona as she brought out the card reader. She quickly finished up the operation and handed the pink-haired girl her card back with the receipt, “I just need a quick signature here and you’re free to go to your friends”.
‘Rosie’ scribbled down her signature - she learned her actual name was Rosé, classy yet slightly worrying - and left a tip for her. 
A 10$ tip for her.
“Gorge, she left you a 10$ tip, she was basically asking for your hand in marriage”, Mik reminded her, his eyes darting around the half-empty diner. 
He nodded his head to his left where Denali saw another one of her co-workers sharing a milkshake with her girlfriend, giggling like teenagers, “I’m just saying. If Utica managed to end up dating that self-proclaimed ebony enchantress over there, you got a chance with wine girl”, he ended with his trademark L.A vocal fry.
Denali knew Mik had a point, but as she was about to reply, she heard the familiar sound of a guitar starting a new song. Her eyes glanced back at the clock.
5:14 PM
Damn, she had missed the beginning of the set.
The Alaskan girl didn’t lose any more time as she clocked out, skates still on her feet as she zoomed out of the diner.
“Aaaaand she’s gone!”, Olivia commented, turning her head to Mik, “Do you think this time is the good one?”
“Well, if she doesn’t finally go after her, I might as well go after her myself!”
Denali reached the usual crowd that had already formed around Rosé, trying her best to blend in and not be seen by the singer while still getting a good view of the set.
“Well, aren’t you guys a lovely crowd!”, the pink-haired singer smiled as she got ready for the next song, “I’ve got one last song for today and this is going to be the first time I’ll be performing it, so, don’t hate it too much!”, she chuckled as she checked her guitar before turning her head back to the mic stand, “This is On The Ground, I’m Rosé and I hope you’ve enjoyed the set! Feel free to drop your tips in the guitar case!”
Denali couldn’t take her eyes off Rosé when she heard the guitar’s first chord paired with the honey-like vocals.
My life’s been magic seems fantastic
I used to have a hole
in the wall with a mattress
It’s funny when you want it
Suddenly you have it
You find out that your gold’s just plastic
The black-haired girl quickly pulled out her phone, opened her voice memo app, and hit record. She wanted to treasure the magic Rosé’s voice brought. 
What she failed to notice while she was so into the song was a pair of hazel eyes settling on her as the song reached its climax.
A couple of days later, Denali had just finished with her teaching job at the local ice rink when she spotted Olivia on the railings. 
“The suspicious lack of a certain pink-haired girl makes me think that you still haven’t asked her out” she heard the younger girl say as she skated her way to her.
“You’ll never let it go, won’t you, Liv?”
“Not when I see that you like her and, from what I’ve seen, she is at least interested in you. Mik tried to ask her out yesterday after your shift was over,” the other girl replied.
Denali furrowed her brows, “Wait, he was serious about asking her out? I thought he was just joking!”
“If you don’t act on your cute pink crush, you can’t expect everyone else to stop for you,” Olivia reasoned, “if it’s of any help, Mik did say that, and I quote ‘she didn’t want a piece of this fine ass’”, she finished, air quoting their co-worker.
“To be honest, the dude’s barely got an ass compared to me,” Denali muttered, but her best friend managed to catch it.
“Well, as Symone said, you do have a fat ass,” Olivia commented, causing both of them to laugh out loud.
She continued, “Point still stands though, you gotta do something or you might just end up regretting not doing anything about it”.
The dark-haired girl sighed, “I know, I’m just… scared to get hurt because she seems so cool and unreachable, and I’m just so… me?”, she confessed, resting her arms on the rails.
“Give it a chance, Nali,” Olivia replied, laying her hand on the skater’s arm and giving it a gentle squeeze, “And just in case, if she fucks you over, we’ll just unleash Kandy on her!”, she added, making Denali chuckle.
“Girl, if she knew you said that…”
“She would do absolutely nothing because she’s too busy chasing after that Joey guy”, she didn’t miss a beat with her reply, giving her a knowing look, “Almost forgot to ask, are you coming later to the club with the others?”
Denali shook her head, “No, sorry. I don’t feel like clubbing today, I’ll just skate a bit more and then go home to watch some Netflix”.
Olivia shrugged her shoulders, “You do you, girl. But think about what I said, okay?”
She gave her best friend a small smile, “Thanks, Liv. See you at work?”
The younger girl nodded and left Denali to her thought as she exited the room. The black-haired skater turned her head back to the rink, noticing that only a few people were left on the ice. 
She took a deep breath, putting her earbuds back in and looking through her phone to decide on what song to use for her last routine of the day. Her eyes fell on the voice memo app, immediately reminding herself of the recording she had taken just a few days prior. She hadn’t even listened to it since she had recorded it.
It wasn’t a clean recording, she could hear the sounds of the city and the people around her, but she closed her eyes and focused on Rosé’s voice, letting it guide her. 
The music fully took her over as she performed her usual stunts.
I’m way up in the clouds
And they say I’ve made it now
But I figured it out
Everything I need is on the ground
She found herself in the center of the rink, the bridge of the song was blasting in her ears. She smiled to herself as she started to spin, gradually picking up speed while Rosé’s high notes were all she could focus on.
Just drove by your house
So far from you now
But I figured it out
Everything I need is on the
Everything I need is on the ground
The recording stopped abruptly, she remembered how she had to bolt away, almost missing her bus home. 
Denali could hear her heavy breathing, suddenly aware again that she wasn’t alone. But she had made up her mind.
She was going to talk to Rosé the following Wednesday. 
That Wednesday the diner was busier than usual, giving Denali barely a moment to think, let alone realize she was missing Rosé’s set outside.
She glanced at the clock.
5:26 PM
Shit.
She turned her head and looked outside the diner’s big windows and saw that the pink-haired girl was starting to gather her things.
“Miss Iman just left, go to her! We’ll cover for you and we are not letting you get back in unless you got a date!”, Olivia said quietly enough for just her to hear.
Denali couldn’t help the grin spreading across her face. She grabbed some of the tips that she had made before she bolted outside, faintly hearing the cheering of her friends.
As she reached Rosé on the other side of the road, the singer’s back was facing her, she didn’t seem to have noticed Denali yet.
The black-haired girl took a deep breath, just like she had done on the ice rink, and let the tips fall into the still open guitar case.
The noise of falling change was what made Rosé turn around, a surprised look on her face as she registered Denali’s face.
“Denali?”
Gosh, she could hear the other girl say her name all day.
Wait.
“How do you know my name?”, Denali asked slightly confused.
Rosé didn’t reply but simply pointed at the waitress’s chest.
Oh, right. The nameplate on her uniform.
“That and also I tend to remember a pretty face when I see one,” she added, now her attention fully on the shorter girl.
“Oh, yeah, right”, she fidgeted awkwardly, not knowing where to look, “Uhm, I just wanted to say that you have a really beautiful voice. You can consider me your first fan when you make it big”.
Rosé smiled at her and Denali couldn’t help but notice how beautiful of a smile she had. 
The singer turned back to her stuff, shuffling things around and leaving the brunette to her thoughts. She wanted to ask the taller girl out but felt all her courage leave her body.
Way to go, Nali.
“Well, Uhm, I think I should-”, she started but she was stopped by the pink-haired girl, who had finished packing everything up.
“Here, this is for you”.
It was a jewel case cd, a picture of Rosé in a very 80s inspired attire on the cover with pink marker writing across the front.
‘To Denali
My first (and hopefully not last) fan
     Rosé xo’    
  It was signed with a small rose doodle next to Rosé’s name and, much to Denali’s surprise, a phone number along with the phrase ‘put it to good use’.
She looked up to find the other girl staring at her, her guitar case strapped on her back. She gave her a wink and started walking towards the subway.
Denali stood there for what felt like forever as she watched Rosé disappear in between the crowd of people roaming the streets. 
She looked back down at the cd, committing the number to memory. She turned around to look at the back, her eyes were drawn to the tracklist. 
She smiled when she saw On The Ground. 
Finally, she didn’t have to listen to a shitty phone recording to enjoy it. 
“Wait, what? You had recorded it all secretly and shady, mama?”
Rosé’s laugh filled the room as Denali tried to hide her face on the other girl’s bare chest.
“You’re an ass! I just wanted to use it for one of my skating routines”, she muttered, causing her girlfriend to laugh even harder.
“I find it cute that I’m not even famous and my music has already been pirated!” she commented, “I’m already halfway there to stardom, baby girl,” she added, kissing the top of Denali’s head.
The shorter girl groaned as she hid the increasing blush on her cheeks, rolling her body so that she was on top of the pink-haired girl.
“Well, miss Rosé, is it pirating if it was for personal pleasure only?”, Denali teased, running her hands upwards on the naked skin, slowly lowering herself until her face was inches away from her girlfriend’s.
She felt Rosé’s hands take a firm hold of her behind, “Oh angel, I’ll show you personal pleasure,” the singer replied, eliminating the little space left between their lips as Denali brought her hands to cup the older girl’s face.
Rethinking about those lyrics Rosé had written months prior, Denali knew she was right, she did have everything she needed on the ground.
It was to be right there with Rosé.
24 notes · View notes
ehstarwar · 4 years
Text
under thy own life’s key (4/7)
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“You want to go first?” Ben asks her, moving out of the way.
“Lets go together.”
“Okay,” Ben says. Rey wants to scream never mind and climb down right now, but Ben is holding a hand out to her before she has a chance to do anything.
So, she takes his hand.
-
The gang goes on a tree-top course that goes south, real fast. Also, Ben and Rey try to talk. (They get distracted easily though.)
-
Rating: Explicit
Word Count: 5k
Read on AO3
Notes: thank you all so much for reading! i've gotten more comments on my work in the past week than i have after YEARS of writing fanfic. so thank you to all the reylos. y'all the real mvps. (♥ω♥)
Chapter 4: the torture of the mind to lie in restless ecstasy
-
“Are you sure the line is strong enough to support me?”
“Are you over 500 pounds?”
“No. But, I mean, I had a big breakfast this morning. Like four eggs, at least.”
“Then it will support you just fine.”
Rey grinds her teeth at the exasperated worker, wishing he’d say something just a little more reassuring. She looks across the rickety bridge, seeing Rose and Finn get across with little hardship, just a few missteps here and there. Ben sailed across the bridge like there wasn’t at least of foot of space between each plank; like he wasn’t at least thirty feet off the ground; like it was nothing.
If it could hold Ben, then surly it could hold her.
Rey takes a tentative first step, holding onto her glider for dear life. Hoots and hollers below her  come from Poe and Jannah, but she tries to tune them out and focus ahead of her. Each step is more unstable than the last, and when she makes it more than half way there, she sprints ahead, just to get to the solid base at the next tree. 
“Oh my gosh, Rey! How did you run? I can barely move my legs more than one plank a minute,” Rose says. 
“Sheer force of will and a very good survival instinct. Being on solid wood is better than… not.” She looks at the next course and sees small pegs, almost the size of one foot, stretching across to the next base. A gasp escapes her lips before she can stop it. 
Finn is already halfway there, being coached by Ben, who stayed behind so he wouldn’t wobble the pegs further. 
“The next one is a little further away, so just spring forward a little bit more,” Ben yells. Finn has a death grip on his glider, so much so that Rey can see the whites of his knuckles from here. Its a good five minutes before Finn reaches the next tree and the mocking jeers of her friends below her do nothing to calm her fear. 
Rose goes next, deciding that Ben did a good enough job coaching Finn and deciding she needs that same support going forward. Rose does not account for the fact that Finn is a big scaredy cat and required a lot more input than she does. 
“How are you so good at this? Are you secretly Tarzan, swinging from trees instead of going to a traditional gym?” Rey asks Ben. He laughs at her, but keeps his eye on Rose.
“Guess I’m just used to this more than you, city slicker.” Ben taunts Rey with the same endearment from yesterday. Rey just rolls her eyes, figuring insulting the person who will be coaching her through the rest of this course would not be of the wisest decisions. God knows she needs to make a few more of those. 
“I used to climb these trees when I was a kid, so I guess it’s just engrained in my psyche to not be afraid of it,” Ben shrugs. Rey’s eyes snap up to him. Ben never willingly talks about his childhood. He usually has to be at minimum four bottles of wine deep before he even brings up events that happen prior to him turning 21, so Rey is shocked to hear this information.
“These tree? Like in Chandrila?” 
Ben nods. “This used to be a camp ground. Han, Chewie, and I would stay further towards the lake, but it’s a real possibility that I actually climbed these exact trees, like twenty years ago.”
The admission feels very intimate and Rey’s throat goes dry thinking about that. Images of a ten-year-old Ben, with big ears and braces, climbing trees while Han watches on, probably trying to freak him out more than help him, flashes in her mind. She bites her lip from saying something stupid and ruining the moment, instead just letting out a soft “Oh.”
“I made it!” Rose screams when her foot touches the base, and Finn scrambles to pull her fully on it, to safety. 
“You want to go first?” Ben asks her, moving out of the way.
“Lets go together.”
So much for not saying anything stupid, she thinks.
“Okay,” Ben says, hooking on their gliders together. Rey wants to scream never mind and climb down right now, but Ben is holding a hand out to her before she has a chance to do anything. 
So, she takes his hand.
Ben keeps her close, only one peg between them at any given time, one hand wrapped securely around his rope and the other holding onto Rey. Not that it would take much effort on his part. Rey’s hand is clutching his like a vice, like it’s the only thing keeping her tethered to this equipment. It’s warm and calloused from hours of tugging rope and she tries to think of any other time they held hands for that long.
They haven’t before, she realizes, and she’ll be damned if she ever lets go now. 
They’re halfway across before Rey’s foot catches one peg the wrong way, making the bridge wobble and sway in a very terrifying fashion, and she calls out Ben’s name without even thinking.
“It’s okay, I’m right here,” He says, staying still for her. Her eyes are looking down at the forrest floor that now looks much, much further away than thirty feel. She can feel herself shutting down, which is not the most helpful of experiences when in the middle of a rope bridge. 
Suddenly, she’s eight again, climbing in the junkyard, looking for salvageable parts she can bring to Unkar, at the top of a pile when a marred up television crumbles, making Rey slide down the pile. The cuts and bruises she got lasted months and some of the deeper scars still haunt her skin. 
“Rey, look up. Look at me.” She knows she hears Ben talking, but she can’t move a muscle in her body. “Rey, I need you to look at me, please.”
She thinks even when she was eight, the little Ben wouldn’t have let her slip. Her eyes snap up to his and she can feel the reassuring squeeze he gives her hand. 
“You’re attached to a safety rope. There is a net beneath us. I’m right here. I will not let you fall.” 
If she could move, she would kiss him. Right there. In front of God and her friends. In front of the staff that are waiting for them to be done so they can bring in the next group. On the tree that little Ben climbed. 
“Can you go further? Can you let me help you?” He asks and all Rey can manage is a terse nod. They go even slower now, Ben helping her with each step. Her friends are silent and Rey is grateful for small mercies. When they reach the tree, Rey’s knees give out. She stays on her hands and knees, taking deep breaths and trying to shake off the memory. 
After a few moments, she feels Ben’s hand on her head, brushing back some hair that had fallen in her face. She can’t bring her eyes up to meet him, ashamed that a little jungle gym made her spiral so far. 
“We’re going down now. There’s a ladder right below us. I’m going to go first, okay. Just follow me and we’ll get down.”
“Okay.” Her voice is a whisper, but Ben hears her. She hears him step down the ladder, until his head is the only thing peaking above the wooden base she’s kneeling on. His eyes are impossibly wide with concern and determination and it makes Rey want to cry even more. 
“Just follow me, Rey.”
-
The water coming from the faucet is warm, doing nothing to help cool the redness in her cheeks. Rey looks in the dirty, cracked mirror, seeing her eyes still wide with terror, despite being on the ground for a solid twenty minutes. She curses under her breath and stars counting back from 100 again. 
“Rey?” She hears Janna’s voice call.
“Yeah?”
“Do you care if I come in?”
Rey just opens the door to the bathroom in response. Jannah’s holding a bottle of water and an energy bar, and Rey takes both happily. They lean on the sink while Rey munches down her snack in silence. 
“Feel better?” Jannah asks when Rey’s finished and she nods. She actually does. Leave it to food to cure all the problems in Rey’s life. 
“That was… intense, “ Jannah says, looking at Rey gulp down water.
“I’m fine now, honest.” Janna looks like she doesn’t believe her, but she doesn’t press further.
“I thought we’d have to tie Ben to a chair to keep from busting down the door, but Kaydel and I figured you could use a few minutes.” Rey’s heart lurches when she thinks about making Ben distressed.
“Where is he now?” Rey asks, trying to cover the worry in her voice. 
“With Hux, by the lake. He needed to cool off too, I think.” Rey nods, happy that there’s someone else looking out for Ben too. “Can I ask you a question?” Jannah asks, making Reys’ stomach drop. She nods.
“Is everything… alright with you? I mean, in your life, right now. You’ve just been so… off this week. We’re all a little concerned.”
Rey still can’t believe she has friends that actually care about her, enough to check on her and bring her snacks. She’d fell much better about it if she wasn’t fucking their trip with her inner demons. 
“It’s just been one of those weeks. I’ve felt off, too,” Rey tells her.
“Period?” No, but what the hell.
“Yeah,” Rey says sheepishly. Jannah nods in understanding, then scoops her into a hug. Rey hugs her back with enough force to crush both of their lungs, but doesn’t have the heart to care about that.
-
The ride back to the cabin is actually fine. The whole car is buzzing with the adrenalin from climbing the trees, so Rey’s friends are chatting up a storm without bringing up her episode.
Ben had, in true Ben fashion, been by her side since he spotted her come out of the bathroom. This means that he had to take the unfortunate middle seat, one that a man of 6’3 should absolutely not sit in, but did so without complaint. Their legs are squished together, but Rey wouldn’t have it any other way.
-
The heat from the bonfire was a welcome feel when the sun went down and the forrest got cool. It was a modest fire, despite Poe’s insistence that they build one that rivals the size of the cabin. It was the only illumination, casting a warm glow onto everyone’s faces, sticky with marshmallows that were, in fact, too big. 
Everyone had taken a turn trying to give their best campfire story, which ultimately devolved into who could make their friends laugh the most, but Rey didn’t mind. Despite being in unfamiliar territory, she was surrounded by friends who loved and cared for her. Finn and Rose were sitting very closely, inching closer when the other wasn’t looking; Kaydel, Jannah, and Zorii were still roasting marshmallows, mostly just to light the big globs on fire and poke them towards everyone else; Poe and Hux were wrapped tightly together, with Poe passed out on Hux’s shoulder; Phasma was sitting at Rey’s right side, fueling the bonfire with blocks of wood whenever it looked low.
Ben was staunchly seated to Rey’s left, only mere inches away from her, like he had been all day. He didn’t make a fuss of it, just naturally gravitating towards her while doing the most mundane of things; putting up the gear from their trip, chopping up veggies for dinner, ect.
She hadn’t had the opportunity to be alone with him to tell him how nice it was, him being near. She would tell him when they were in their room together. Maybe while lying in bed. Maybe while doing things that were decidedly unfriendly.
She’d woken up once again with Ben wrapped around her like a vice, but they’d been screeched at by Hux, telling everyone to be ready to go quickly. There was no time to discuss what happened last night or the way they woke up this morning, and Rey was slightly relieved. 
What would she say to him? ‘Thanks for letting me ride your thigh, now please fuck me into the next millennium and date me and love me and be this close to me always.’ And she’d naively thought they’d have a lot to talk about when they just mutually masturbated together. 
There was also something else nagging at the back of her brain. The fact that Ben didn’t tell her until halfway into this trip that he grew up camping here. The small tidbits of info she’d gotten from him only brought more questions to her mind. 
There was a lot to be discussed, to say the least. 
When the fire dwindles out, and Phasma heads back to her personal cottage, the rest of the gang starts dropping like flies. Before Rey knows it, she and Ben are heading down their staircase, shouting ‘goodnights’ to her fellow cabin-mates. She’d thought about it all night, how she was going to approach this. About a way to casually work into the conversation that she was curious why Ben revealed so much to her just today and not before the trip. But, Rey was Rey, and there was really only so much her head could take.
“Why didn’t you tell me that you came here with your father? Before we got here, I mean.”
Being direct is probably a good thing right now, she thinks belatedly.
Ben had just finished taking his shoes off and looked surprised at her question, but not angry at it, which Rey thought was a win.
“It… didn’t seem important,” He says, slipping off his socks too. 
“I think it is important, Ben. I know you don’t have the best relationship with your dad, so I’m sure this trip could be… a lot.”
“It was a long time ago, Rey. I didn’t even realize it until we got here and the roads looks familiar. If I felt like it was too much, I wouldn’t have stayed.”
“Well… okay then. But you’ll tell me if it does get to be too much, right. I can’t have us both being mentally unstable for the rest of the week.” Her attempt to make light of what happened earlier is a cheap shot, only serving to make Ben’s brows furrow. 
“You’re not mentally unstable. You just had an anxiety attack. It happens; it doesn’t mean anything is wrong with you,” Ben’s tone is comforting and Rey can feel tears prick her eyes again. But she doesn’t want that now. She doesn’t want to be sad around him any more today.
“If you say so,” She relinquishes, turning to go into the bathroom. 
Ben is sitting on the edge of the bed, scrolling on his phone when she comes out. He’d changed into his white shirt and boxer shorts (although a different pair than last nights) and Rey suddenly has the urge to ask him what he normally wears to bed. So she does.
“This usually. Why?” He questions. 
“I’d feel bad if you slept in the nude and were wearing clothes just for my comfort.”
Rey see’s his throat bob.
“What do you wear to bed? Normally?”
“A t-shirt,” Rey admits, “and underwear, if I have enough that are clean. Sometimes I go without just so I don’t have to do laundry so often.”
His eyes darken and his gaze feels very hot against her skin. She’s wearing an old-giant t-shirt from college with a pair of cotton sleep shorts that barely peak out from under the shirt. 
“Oh,” He says, eyes still looking her up and down. “You don’t have to wear shorts if you’re… uncomfortable.” 
Without saying word, Rey slowly pushes her shorts down and steps out of them. He can’t see her underwear. Can’t see the damp stain forming on them. But it feels like he can. Ben places his phone on the night stand and Rey decides to be bold and step directly in front of his slightly parted legs. He looks up at her, eyes soft and hungry at the same time. He keeps his body the same, not opening his legs to accommodate her as she wants. After a minute of silent staring, Rey finally finds the will to speak up.
“Will you let me do something for you?”
Ben’s neutral expression doesn’t waiver. “You don’t need to do anything for me.”
“I know,” Rey gently drops to her knees, “but I want to.” Ben’s eyes follow her down, widening when realization crashes over him. 
Rey lightly puts her hands on his inner thigh, pushing them apart with little resistance. She can she his growing erection already beginning in his boxers, spurring her on further. She presses light kisses up his thigh, giving him kitten licks too. She works slowly, feeling the muscles tense beneath her lips and being reminded what it felt like against her cunt. When she finally gets to his crotch, she rubs her mouth against him, now straining against the fabric. She presses her tongue flat against him, licking from root to tip in his underwear. She feels him twitch against her lips, seeing a small bead of wetness form.
When she dares to look back up at him, Ben’s eyes are black. He’s breathing heavily, and she can see the muscles in his chest constricting. 
“Ben, can I do this for you?” She asks, eyes never leaving his, lips brushing against his cock.
“Please.” His voice is strained, like he’s already on the precipice of orgasm. Rey’s hands go to the waistband of his boxers, and he lifts his hips as she pulls them down and off. 
The sight before her is magnificent. Ben’s cock is thick and long, curved up towards his belly. He is flushed all the way to his tip, where a small bead of preccome is dripping onto his white shirt. Rey licks her lips before leaning towards him. Her hand comes up to gently trace a vein with just one finger, and Ben whimpers. It is the most beautiful noise she’s ever heard. 
Her hand wraps around him at the base, brushing against the coarse, black hair there. She hears his breath hitch as she beings to pump her fist. She uses her thumb to swipe the drool of precome now dripping down her hands.  
Rey slowly moves her head towards him, and when she’s only centimeters from the tip, she looks back up at him and extends her tongue to taste him. The strangled groan that comes deep from within him, sends a rush between her legs, and Rey has to adjust herself so that she can rub her thighs together.
Her licks become bolder, as she begins to follow her hand from where she pumps him. He is painfully hard and throbbing in her grasp, so Rey presses light kisses up his length to sooth him. When she makes it back to the tip, she envelopes him in her mouth, tasting the tangy precome as her mouth works down further. 
Rey feels one of his hands shoot up and cradle the back of her head, tangling her hair in his fingers. She’s grateful that she choose to loose the three bun look when she changed into her pajamas, because the tips of his fingers pressing into the base of her skull is heaven. 
She moans around him, sinking even further and taking as much of him in her mouth as she can. She feels Ben’s hips twitch, and she knows that she needs to work faster now, for both of their sakes. So, Rey hollows her cheeks as she begins sucking him in earnest, moving up and down and guided by his hand.
Ben is spilling moans and profanities now, head thrown back and exposing his long, pale neck that Rey wants to devour. She quickens her pace further, feeling his whole body tense. She’s involuntary rocking her hips, seeking friction on the back of her calves, but falling short in an infuriating way. 
“Rey..” His voice is a whine; desperate and pleading for something he can’t put into words. She moans against him and takes him the furthest she can into her mouth, before he hits the back of her throat. His fingers clench in her hair and she knows he’s trying to control himself right now.
But that’s not what she wants. She wants him to use the immense strength he so clearly has against her. He wants her to loose himself within her. She wants him to destroy her. 
“Rey, baby, please…” Ben’s voice is low as he speaks through gritted teeth. “I’m gonna come, baby, I’m gonna come.”
Tears are pricking her eyes once more and she tries to think of a way to tell him ‘yes please! Please come for me, baby’ without taking him out of her mouth. She stares up at him as she sucks up and down his cock, hoping that will convey everything.
He’s looking down at her again, face flushed and body heaving. “Can I come down your throat? Will you let me do that, baby?” Rey nods as best as she can with her face stuffed with his cock. Ben shouts as warm come pulses out of him.
She lets the tip rest on her tongue, and uses her hand to work him through orgasm, letting his come pool on her tongue. It’s tangy and bitter but its Ben, so Rey loves it anyways. She savors the taste, swirling it around her tongue as she gives kitten licks again. 
Ben is sweating. His lips are red, like he bit straight through them. His cock is still hard, but she can feel him softening slowly. They stare into each others eyes as she swallows his come. 
When Rey sits back on her legs, she feels her throbbing center and involuntarily whimpers at the feeling. Her panties are soaked clean through and she’s very, very tempted to just shove a hand down to her pussy and finish herself off with Ben’s eyes taking her in. 
Rey, blessedly, does not get the chance. 
Ben picks her off the floor, and pulls her onto the bed, following her with his own body, and covering her. His head is kissing at her stomach, though the t-shirt that dulls the sensation but still makes her cheeks warm. When he gets between her legs, Ben lick a strip, clean up her center through her panties, before ripping them off and shoving his mouth against her cunt. 
He licks and laps at her, movement only enhanced by his nose that she can feel against her clit. He leaves messy, open mouthed kisses on her folds before using his tongue to circle her clit. Rey shoves a hand in her mouth to keep from screaming too loud. 
His hands grip her thighs and toss them over his broad shoulders so that he can spread her easily. His tongue delves into her, warm and wet and positively sinful. Her hips buck against him with abandon, seeking purchase against his face. His whole face is nuzzled into her, and she’s sure if he looked up at her, she’d she her juices dripping down her face. The thought makes her whole body shake. 
“You gonna come for me?” Ben says against her. “You’re gonna come on my face, baby?”
Rey just chants ‘yes!’ and ‘Ben!’ over and over, until her mouth is incapable of forming words. Her orgasm is white-hot as it races down her spine. She feels her thighs tremble and abdomen clench as she uses her free hand to tangle in his silky locks and push his face impossibly harder against her cunt.
Ben works her through it, tongue relentless against her, lapping up at all the fluids nearly pouring out of her now. His plush lips brush against her clit every now and again, making her twitch in overstimulation that is glorious. 
They stay that way for a long minute; Ben with his mouth still attached to her pussy and Rey with one hand in his hair and the other still stuffed in her mouth as tears run down her face. 
When he starts to pulls back, Rey winces at the contact and he presses a little kiss to the corner of her thing to soothe her. She takes her fist out of her mouth (because, ew, that can’t look nice) and stares up at him. 
Ben is still flushed. Rey is sure she is too. They’re both breath deeply, the hint of musk penetrating the air around them. Her heart is hammering in her chest, blood rushing in her ears.  Ben is still looking at her. 
He looks at her like she’s water and he’s been in the desert for a week.
Rey doesn’t know what motivates her to do it, but she moves anyways. She pushes herself up and grabs a fistful of his shirt and crashes her lips together. His mouth and chin are with with her, but Rey doesn’t care. If anything, she likes tasting herself on him; it’s like a claim.
Ben’s hands immediately go to wrap around her shoulders, crushing her to him with more force than she thought possible. His lips moves against hers, tongue tangling together as he lets her dominate his mouth. Their noses bump and teeth clash occasionally, but it only makes it that much hotter. 
His hands wandered up to her head, cupping her jaw and throat as they kiss. It steadies her as she pressing bruising kisses to him, like she’s trying to crawl within him. She feels her back hit the bed again and the softness of the pillow beneath her, before she realizes he’s laid her down again. Still between her legs as his mouth continues its assault on hers. 
The shrill ring of a phone pierces the silence that had previously been accompanied by the wet slap of their lips. Rey tries to turn away from him to see who would be calling him at this time of night, but his lips chase her. Ben clearly has more important things on his mind.
“Ben,” she mumbles against his lips, when he moves to working her jaw. “Ben, we have to see who it is. It could be… an emergency.” Rey’s voice hitches when she feels him nip at the underside of his jaw. Ben’s movements slow against her before he literally growls. 
His hand quickly grabs his phone to see who’s calling before letting out an exasperated sigh. 
“Fucking Poe,” He mumbles before accepting the call. “What?” His voice is sharp in annoyance and Rey can’t help but chuckle at that. She hears something like screaming happening from the phone and suddenly becomes very worried, before Ben lets out a sigh. 
“Fix the rooms’ A/C yourself.” More shouting happens on the other end and Rey can make out a high-pitched whine. Ben’s head drops to her chest, where his black hair fans out around him. 
“I’ll be there in a minute,” Ben grumbles against her t-shirt before ending the call.
Rey pushes a lock of hair behind his ear and trails her fingertips on the back of his neck, causing him to shudder. Ben abruptly pushes up and back on his legs, still red-faced and a bit angry.
“I have to go fix Hux and Poe’s A/C,” He tells her, with barely contained distain. 
“Okay,” She breaths, not able to form more complex sentences at the moment. She wants to say ‘let those two deal with it themselves and kiss me again before I loose my damn mind,’ but that’s certainly out of the question. 
“Stay right here. Don’t fall asleep.” Ben says as he removes himself from the bed. Ben gives her a pointed look that makes her insides clench. Rey already misses he weigh on her. 
“I won’t,” She vows. Ben takes a long look at her, seemingly contemplating with himself whether or not just to say ‘fuck it’ and crawl back on her. But he doesn’t. With another growl, Ben is out the door and stomping up the stair. 
Rey is asleep before he reaches the top. 
18 notes · View notes
7wanderingpaws · 6 years
Text
9. Surprises. (Another Life)
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Genre: magic / soulamte AU
Pairing: Jackson x reader
Word Count: 5.9K
Song: Ariana Grande - Thinking Bout You
Synopsis: You are more than happy in relationship with Jackson Wang, the hard-working and successful fencer representing Hong Kong. So what happens when you visit a local witch wanting to know more about your future as a couple? Because you always knew he was the right one for you. Even in another life. But would he really be the one?
*** 1. // 2. // 3. // 4. // 5. // 6. // 7-1. // 7-2. // 8. // 9. // 10. // 11.
(( Finally, the promised chapter! Im sorry it didnt go up on time. Its quite long so prepare yourselves and enjoy it. Thank you for reading <3 ))
- - - Surprises - - -
“I can’t because I need to focus on my career at the moment,” he added quickly when he saw your beautiful smile slowly fade. “I’m so busy I would never have proper time to spend with you...”
Hong Kong, 2017
If anyone would have told you that you would land the job, you would probably laugh at them. Nobody ever would have given you a good enough reason.
But you did.
And now you were satisfied.
Working for big companies as an accountant maybe wasn’t that special for everyone but for you it was just okay. You could manage and at least people treated you with higher importance. Furthermore, Sara was now gaining lots of followers because of her life style blog in Hong Kong and since she made a business out of her passion, you were also in charge of her tiny financial department. 
Also, you would sometimes (always) follow her around the city to make instragram-worthy pictures, eat fancy food (that you truly couldn’t afford), talk to people (that you would normally never stop to talk).
On the bright side though, you were almost always packed with work load. There were mountains of invoices, confirmations and documents that had to be briefed, that you literally had a headache every morning when you saw your table in the office.
It was good. Once you started to work yourself through the papers, you would forget about many things. For example, you would forget that you had to meet your parents today, you would forget that Martin was lurking around you with a threat of a proposal, you would forget about the dreadful meetings you would have to sit through later today, forget about the sneaky boss who would touch you whenever he had a chance, forget about the stupid, stupid and ever more stupid dreams you kept having that were making you cry even more than ever before, forget about throwing up. And… And… Forget about Jackson Wang. For a little second at least. Please. Dear heavens, make him disappear.
“You know it’s scientifically impossible,” chirped in Sara as she threw herself on the sofa in your tiny apartment. You still lived in the shabby flat but you were emotionally attached to it. And no money to move. Yet.
“Sara,” you sighed, scratching your head as you were sitting over another invoice. You saw too many zeroes on it. “Not now, please. I beg you.”
Sara thought about your plea for a moment before she decided to shrug her shoulders as if nothing happened. “I know, Y/N, I know but why don’t you at least answer his calls? And messages? We both know he doesn’t have much time for typing away since he is as busy as a 24/7 schedule can be, but your phone does ring a lot.”
“Well, frankly, I don’t have all the time to be on my phone. I actually have to make money with brains in order to survive.”
“Oh damn, look at you, you tough cookie,” Sara laughed out loud. “Today I planned to go to the Kowloon peak-”
“I really can’t make it today, Sara, I’m sorry,” you said, genuinely meaning it as you looked into her fair eyes. She looked so pretty you sometimes were worried you looked too bad standing next to her. She found herself a local Hong Konger (William was a cool guy, you liked him) who was working in the sports business. “I have so much and I have to rush back to the office. I think I can focus there the most.”
“But-but you already work your ass off so much. Why don’t you leave the shitty work place and the sneaky bastard boss and just come to my little firm? I can pay you enough, I promise,” said Sara pleadingly.
She had been talking about this for quite some while now. Sara did get enough money for her to afford to hire you. But the problem was that you needed some sense of work stereotype, so you wouldn’t lose your mind.
“I love my work,” you blurted out and snorted right away.
Sara laughed loudly, pointing at you with her index finger in the process. “Ah, dear, I love you so much. You are so funny.”
You shrugged your shoulders, smiling. “And I love you, Sarita.”
Sara sighed and you both fell into a peaceful silence. The clock on the kitchen wall was ticking away the time that you should be spending on calculating through confirmations but you were there, sitting and smiling.
“Martin confessed,” you said silently as you folded your arms on your chest.
Sara sat up properly, her eyes wide with surprise. “What?” she leaned her elbows on her knees. “Oh my god, do you think he is going to propose?”
“It seems like it,” you muttered, somehow not that excited about the thought. “He said many lovely things and he is a true gentleman-”
“But?”
“But,” you sighed, turning around in your chair. “I don’t think it is possible.”
“Of course it isn’t possible!” exclaimed Sara, throwing her hands in the air and stood up. “You guys are not meant to be, for Christ’s sake.” Her slender figure was walking up and down your small room. It seemed like she was thinking rather intently before her blue eyes snapped to your stiff figure. “Don’t take me wrong, Y/N, he is a great guy and before Jackson appeared I really wanted to hit you two up. But it is not possible anymore.”
Gulping, you nodded. “Yes, I totally agree. Maybe I can just be in a relationship with him like till now and in case he would insist, I would just break up with him and be single forever.”
“Jackson is such a-”
“-asshole-”
“-gorgeous man.”
You glared at your friend.
“How thoughtful of him that he wouldn’t want you to wait for him-”
“Because he doesn’t love me!” you flared up, your heart racing up on the Everest.
“He does love you and if everything he is doing is not a good enough proof, than you have to open your goddamn eyes, Y/N!”
That shut you up pretty quickly. Sara’s words were mingling in your mind, combining, mixing, adding up… Nope. He didn’t love you.
“I can see the doubt all over your face, dear,” sighed Sara as she walked to you and gave your shoulder a gentle squeeze. “He has been writing you ever since 2016 when you guys finally met. Even when he had a new phone number he would let you know. He always makes sure you are good and healthy and if he is in the city, he comes to visit.”
“What are you trying to prove right now?” you asked, dumbfounded. “Because I am suffering without him.”
“And he is suffering without you.”
“He is not,” you said quietly, gritting your teeth. “Sara.” You stood up to face her. “It is because of him in the first place that all of us had to relive our lives just so he could chase his dreams. He was not happy enough, not thankful enough before while I was the happiest in the previous life. I was a doctor, I had a loving family and him beside me since we were freaking fifteen. Yesterday, I had a flashback how he-” your voice broke at the thought.
Sara waited patiently, her eyebrows slowly rising. “How he what?”
You looked her in the eyes but you couldn’t speak.
Phuket, Thailand, 2017
“This place is gorgeous,” you breathed as you stared out of the window of the resort you were currently residing in. There were barely any tourists around this time not to mention the resort and the island itself was quite the little Thai secret.
Jackson who was unpacking from your suitcases smiled fondly at your back. “I’m glad you like it, sweetheart.”
Was the sea covered in diamonds? It was sparkling and glistening from the reflection of the blazing sun that was about to set right in front of your eyes.
“How on earth did you even find this place?” you asked, genuinely curious as you turned to help him out. You grabbed your flowery summer dresses and hang them neatly in the massive wardrobe. 
“That will have to stay a secret,” answered Jackson, smiling cheekily.
“Ah, really? Are you gonna play this game now?”
He shrugged. “I have good contacts and quite a few medals by now. I can weave my way through anything.”
You laughed out loud, not wanting to continue this conversation. “Okay, dear.”
Jackson stopped and pouted at you. “Are you already giving up on me? Why don’t you bother more?”
You looked at him, confused. “Why? Maybe it’s better to keep it a secret. It has a lovely magic to it,” you winked at his puppy face.
He didn’t answer. However when you were about to reach into his suitcase for his pants to place them into the wardrobe, he swiftly snatched them away, trying to look maximally nonchalant as he placed them safely into the wardrobe, hoping you wouldn’t become suspicious.
“I can’t wait to be in that pool,” you hummed contently as you were folding his shirts. “It looks absolutely lush.”
“You will go into that pool under my supervision only,” said Jackson and took one of your clothes. “I cannot have anything happening to you.”
You giggled. “It’s about time I learn to swim.”
Jackson stopped, taken aback by your sudden wish. “Really? Is that what you want?”
“So I won’t drown.”
“Obviously,” Jackson snickered. “I can teach you.”
“I know you can,” you said, not looking his way. “But I will go with that trainer I saw in the lobby.”
Jackson’s smile changed into a confused expression and then into a dissatisfied scowl. “That handsome trainer?”
“I didn’t say he was handsome,” you winked at him, placing the last pieces of clothing onto the shelves. You turned to his tense posture. “You said it. But I agree,” you patted his cheek.
He frowned down at you. “Really, Y/N? Are you gonna play this game?”
“Aren’t we all about games?”
He groaned loudly turning away from you making you laugh hard. 
“You know I love you, babyyy!” you wailed, still laughing.
It had been two days in the wonderland and as expected you didn’t even dare to enter the attractive pool that was overlooking the entire bay. You would sit on the pool’s edge, soaking your feet while Jackson was swimming and working out to not fall out of his training routine.
Sometimes he would stop by your legs, push himself up to steal a kiss with a massive grin and then go back underwater.
There were a few more tourists visiting at the resort and you still barely saw them; this way you had the pool all to yourselves only.
“Hey, Jackson,” you said as he was on the other side just turning for another lap. He stopped, looking up at you in question. “I want to go in.”
He blinked a few times before he smiled happily and swam to you to hold you tight. “And what about the swimming part?” he asked once he ghosted his cold fingers over your thighs, making you shiver. You held onto his arms as you slid your butt down into the cold water. You yelped silently, momentarily dizzy.
“Maybe another time,” you whispered, your warm body now refreshed. You felt his arms tightly around your waist until he grabbed your legs underwater and put them around his waist. You held onto his neck for dear life.
“And here I thought you would join me for my morning training,” pouted Jackson looking at your freckly face.
You smiled at him and looked behind his back at the breathtaking scenery. “I did join you for all of your trainings so far.”
“But you know what I meaaaan,” he whined, squeezing your thighs.
You laughed loudly, hugging him. “Stay still, honey, I want to rest now.”
For your big surprise, he did stop moving around, stilling, not moving an inch.
“You can breathe though,” you remarked and he inhaled sharply, exaggerating every move. “Silly,” you mumbled, entertained.
You stayed like this for some time. You both were talking about everything and anything, his upcoming competition in Budapest, your attestation and eventually your plans to visit some places around Hong Kong.
“And what about…” started Jackson as he was looking mysteriously into your eyes.
You frowned. “What about what?”
“Never mind,” he said quickly, turning his head the other way.
“What? What was it, honey?” you asked and dared to let go of his neck to touch his cheeks.
“Nothing. Really,” he said, looking at you.
You smiled gently, pushing his longer hair out of his face while he was intently watching your every move, your every part of your face. His grip on you tightened to give you reassurance that he was holding you.
You whispered, “Why are you looking at me like that?”
“Because I can,” he whispered back and his eyes eventually fell on your lips. “Nobody else, but I can.”
You were just about to snort when he kissed you sensually, capturing your lower lip, pressing you to the pool’s wall behind you.
Now being 23, he felt like this thing he was preparing for quite a while now, was finally happening. This was the moment. He felt it, he knew it, he was sure of it. He didn’t doubt it at all.
  After wonderful dinner, you both went out hand in hand for a relaxing walk on the beach. You put your long summer dress on, made sure to have sweet amount of make-up on and you curled your hair, your smile widening with each wave.
You talked quietly with Jackson, both of you full of giggles. He managed to lift your body and turn around with you, making you scream with excitement. The waves in the background were a complimenting noise that you made sure to acknowledge every time.
You were laughing hard. “Jackson! Let go of me!”
He stopped and put you down carefully, his smile wide, toothy, goofy. You ruffled his hair, grinning up at him.
“I don’t want to let go of you, though,” he said passionately, bumping his nose into yours. Then, he slowly pulled away to look you properly into your eyes. “I love you.”
“And I love you. So much,” you whispered, standing on your tiptoes to give him a kiss with a loud smack. He smiled and pushed your hair out of you face.
“Y/N,” he paused and licked his lips. Pressing his forehead to yours, he whispered, his lips gently ghosting over your parted ones: “Will you marry me?”
Your breathing stopped half-way in your pipes as you gently pulled away to look into Jackson’s honest eyes. “Jackson?”
“I don’t doubt our relationship, our friendship, anything. For a long time now I know you are the one for me. I always had that feeling. I fell head over my fencing boots for you when I first laid eyes on you. It was like a magic trick. You didn’t even have to try to seduce me; just by breathing you were filling up my bare existence. I simply cannot not have you. I need you. But mostly, I love you unconditionally,” he said, his voice serious but his eyes full of love.
The tears on your eyes were just about to spill when you nodded your head exactly two times before hugging him tightly. “Yes, Jackson. I will marry you.”
His hands were around your back spinning around with you once again.
You both laughed out loud before he put you down and searched for the ring box. His fingers took out a very elegant diamond ring, and then he lowered his body on one knee as he took your hand, putting the ring on your finger. It was glistening as the sunset behind you was in its grand finale, just like you two when you kissed each other passionately, bringing alive everything that was ever dear to the world.
He was kissing you once, twice, thrice until you couldn’t wait to finally be alone as you were eagerly heading back into your hotel room.
The first night as engaged.
Hong Kong, 2017
The office wasn’t as busy as you thought it would be when you sat down by your desk, already taking out all the paperwork. Just as you were prepared to start work, your office phone rang.
“Ms Y/L/N, you have a visitor at the reception. A certain Mr Wang is looking for you.”
You almost dropped the phone. “What! Mr Wang who?” your heartbeat was dangerously fast now.
“A representative of Team Wang Jiaer label is here,” she said. Assuming by her voice, she was also confused.
You groaned internally, not wanting to deal with whatever this was about. Of course, you knew Jackson had a label, he would sometimes ask for your advice when you two would call (those calls were usually when he was extremely tired and already laying in bed ready to sleep but he would insist on talking with you because he was missing your voice, your warmth, your presence but eventually he would be the one to fall asleep, the only proof being his snoring that was so familiar to you and you would be an absolute idiot if you would end the call there, so you would make yourself cosy and fall asleep, imagining he is next to you). Now, you were a bit worried to face Jackson… What if you would accidentally throw your hands around his neck thinking that you’re engaged?!
“Okay, I’m coming,” you murmured quickly, ending the call.
Before heading downstairs, you sprinted to the restroom to make sure you looked at least a little bit decent. Thankfully, you looked just fine. Although that lipstick was a bit faded from drinking milk tea earlier…
“Ah, it doesn’t matter!” you whisper-yelled at your reflection and finally made your way out and down to the reception.
The company you worked for was quite wealthy, everything being from expensive wood and marble.
Through the glass you could see an older man standing there, waiting patiently, his clothes comfortable and on his back a big TEAM WANG written. You furrowed your brows when you didn’t spot Jackson.
The receptionist called after the man who turned around with a friendly smile on his face. “Miss Y/L/N,” he said before he stuck out his hand to shake.
You accepted. “May I ask what the business is about?”
“Of course, but I suppose a little friendlier surroundings would be better.”
“And where is the boss?” you asked, looking around momentarily hoping to see the warm pair of eyes.
“Jiaer boss is very busy at the moment shooting a show in Beijing,” he answered politely.
You nodded. “Alright. Well, there is a lovely cafe just down the road, why don’t we go there,” you suggested, leading the way.
It was his manager, as you found out. He could have been in his forties or fifties and he seemed very satisfied with his life. He showed you some pictures of his kids and his wife.
Once both of your lattes arrived, you looked at him expectantly and with a smile.
“Miss Y/L/N, the reason I visited you so suddenly is because I have a job offer for you.”
That was surprising. A job offer? What for! “Would you care to explain in bigger detail, please,” you smiled nervously, feeling dumb.
“But of course,” he nodded, not showing you any paper or charts, nothing that would help you avoid eye contact. “Our team is missing a strategic accountant at the moment and we heard you were one of the best ones in Hong Kong.”
“Excuse me? I’m definitely not one of the best-”
“Jiaer boss said he did a background check-”
You scoffed, entertained. “There is not much I would be of a help in your label, sir. My Chinese is not that good either. The only thing I’m good at is counting and preventing you from financial crash.”
“We were told you were a very hard-working person as well as responsible and persistent, which are the exact qualities we are looking for in our company.”
Of course those were the qualities Jackson would look for. It was basically him scribbled all over it. However, you were still shocked that he would send a person to try to hire you in his company.
“But as you said yourself, I’m doing very well just where I am,” you said, folding your arms and rested your back against the seat rest. “So why should I change my employer? What benefits would I get at your label?” Challenge.
He didn’t look that budged by it, although he would expect anyone to want to work for the famous Wang Jackson without a single spark of doubt in their eyes. You were not that foolish, however. “Well, let me tell you there is not a single employee who isn’t happy or satisfied at our workplace. Besides, we have the best boss to ever ask for. He treats his employees like his family. We are a small team, miss Y/L/N. As for the benefits, there can be lots of paid free time for you since the schedules vary so much. And as I mentioned, your qualities are a perfect match for our Jiaer boss.”
You wondered what this guy knew about you; what did Jackson tell him about you. Did he know you were “friends”? Did he know how well you both knew each other from every single angle, from head to toe?
You took a sip from your latte. “I understand. I suppose there is not much free time supposing the boss is one of the busiest people on Earth.”
The manager chuckled kindly. “Jiaer boss is certainly extremely busy. That’s not a lie. However, he would never let his employees overwork themselves. He leads a special schedule where all of us have to sign the precise time when we work so this way he can monitor us.”
“How controlling,” you snickered rolling your eyes, entertained. Thankfully, the manager didn’t misunderstand. He must have known something more about you. “I can only imagine Jackson being that way.”
The manager nodded. “He is truly one of the best. You would be the youngest employee. Why not give it a try? Also, following him around the world is eye-opening.”
You smiled, your mind wandering off at the thought of following him around the world. “How much time do you spend with your boss?”
“It depends. His schedules are basically full and if he is in China or working elsewhere on his solo projects, there has to be a managing staff around him. Sometimes it can be nonstop other times we don’t see him at all since he is in Korea working for the band’s company. ”
“I see,” you paused, poking your tongue to the inside of your cheek, thinking.
The manager smiled cutely, covering his mouth as he hastily pointed at you. “Jiaer boss does the same when he is considering something.”
~
Once back in your office, you couldn’t stop thinking about what just happened.
You received a freaking job offer from TEAM WANG. What were you supposed to do? Well, what you did was that you asked for some time to think before making any decisions and the manager did fully understand.
Before you knew it, you were dialling Sara’s number, eager for her to pick up.
“What’s up, Y/N?” She asked light-heartedly.
“Sara,” you made a dramatic pause. After that, you spilled everything. From the beginning till the end.
“What?!” she gasped. “Oh my god, that’s so cool.”
“But I am confused,” you complained.
“What is there to be confused about? He wants you with him whenever he doesn’t have to be in Korea.”
“But-but I can’t work for him.”
“Now there,” she said gently, sensing your panic. “We both know he loves you. He said it, he showed it to you. He already said he can’t ask you to wait for him. He cares about you. He is being selfless just so you could enjoy your young life. Hell, isn’t it strange? In your flashback he was going to propose to you, so basically you were engaged by the end of this year. Now he is making a move to have you closer to him.”
You hummed, trying to see her thoughts.
“He is doing exactly what is supposed to happen, Y/N,” Sara said finally, seemingly satisfied with herself. She was so excited for you she would certainly start jumping once the line went silent.
“I’m scared,” you blurted out. “What if he just pities me? What if he-”
“Stop right there. Don’t you dare finish your sentences or else you’re as good as dead. And Jackson would kill me then. And I don’t feel like dying just yet.” You heard some muffling in the background. “So what your next step should be is that you’ll accept the job.”
“I don’t want to move to China,” you pouted. “I adore my little Hong Kong.”
Sara inhaled through her nose. “To be honest, I’m sure he has a plan for you so I would call him if I were you. That’s the only way to find out what he wants.”
You closed your eyes. “Okay, I will. Once I’m out of office and at home.”
“Alright, darling. So I guess I can’t persuade you anymore to come to my little company, huh? I have no chance against Jackson.”
You giggled, opening your eyes. “We will see about that.”
It was 23:06 when you entered your apartment. There was a mess on your table from all the papers you finished checking but didn’t organise and all you wanted was to throw yourself on the bed just as you were, and sleep. Preferably for a long time, so the decision-making would wait.
You took a slow shower, easing your tensed up muscles and wanting to make a pleasant night for yourself, you threw on just a long pink t-shirt. Your undies were white with small little hearts. Your favourites.
Finally, climbing into your bed, you took your phone (that you managed to not touch the whole day) just to find many missed calls and unseen messages. The last message that you received was literally one minute before you unlocked your phone and it was pretty straight forward for you to not get it.
Sara (23:48): JACKSON IS COMING TO UR PLACE
You froze. “What?” you shrieked, your heart thundering inside of your chest. Just then you heard a soft knock on the door.
You snapped your head up, your hands suddenly trembling. Oh my god. He was here. Jackson was here.
You saw that all the messages and calls were his which made you jump out of your bed and swinging the door open to find him standing there with his hand on the door frame. His hair was parted, one side styled backwards meaning he came straight from work. He was so damn handsome, your throat closed off making you unable to breathe. He stole your breath away.
When he finally looked up, he was going to say something before he stopped abruptly, his eyes wandering down your under-dressed body. You stole his breath away, too.
You gulped. “What are you doing here?”
He snapped his eyes back at you, his cheeks warming up. “I was in the city and-”
“Weren’t you shooting in Beijing today?” you asked, confused.
He smiled gently. “I was. But tomorrow I have interviews all day here in Hong Kong so I’m staying in the city for the night.”
You gulped once again and made a step back to let him in. He thanked before coming in, curiously looking around.
“Sorry for the mess, I literally just came home.”
“I see you are also busy,” he said as he turned to face you. You locked the door as usual and folded your arms over your chest. “I assume you met my manager considering you knew where I have been today.”
You nodded, unable to tear your eyes away from his. His striped shirt was unbuttoned just till his mid-chest and his black jacket was complimenting his figure, paired up with black jeans. So elegant, so charismatic.
“I heard you needed time to think,” he continued.
“Of course I do,” you answered a little too feverishly. “You can’t expect me to just change places so suddenly.”
“I know and I understand. I’m giving you as much time as you need,” he added more quietly. “It’s always open for you.”
You bit your lip, his eyes dropping to your lips. “I don’t know how your company works, you know. It’s all different to what I knew until now.”
He nodded. “I can imagine. Sara told me all about your wonderful company of yours.”
“Sara?” you asked in confusion. “How is Sara in the picture?”
Jackson chuckled, pushing his hands into his pockets. “Without her I wouldn’t know where exactly you work since you are so secretive.”
“I’m not secretive,” you defended yourself, “I just don’t think…” you trailed off, not sure how to word your mixed up thoughts.
He came closer and gave you a squirtle look. “You don’t think what?”
You sighed. “I think you have way too much on your plate so why would it be of any importance for you. And besides, I’m also busy. Oh, wait a moment, did Sara tell you exactly where I’m staying too? Which floor? Which door? Damn, I’m surprised she didn’t tell you the number for the door.”
Jackson laughed. “I was going to use the number to get in if you wouldn’t answer the door. I was worried about you,” he said, serious out of sudden. “You wouldn’t answer your phone the whole day.”
It was so pleasant to hear him say those words to you. It was like a soothing balm on your aching heart. “I was just… really into my work that I am not so into.”
He let out a breathy laugh and walked to the sofa to sit down. “That’s why I came with another offer.”
You followed him, plopping down on the opposite side. You both faced each other. “What offer?”
His smile widened, his eyes sparkly as he took in your cute confusion. “I will be shooting in Thailand in December. It will be a music video for my new single. The location is top secret and perfectly hidden,” he whispered excitedly, leaning closer to you.
You giggled. “Where in Thailand?”
“Around Phuket. It’s an island that is not so famous and they have this wonderful resort I found there. We are already making steps to rent the entire place out for a few days in December to shoot there.”
Your smile froze momentarily recalling the flashbacks. Wasn’t it the same spot Jackson proposed to you at?
You were staring at him, lost in thought. “So what do you say?” he asked. Unaware, you scooted just a little bit closer to him.
“What do I say to what?”
“I would like you to come with me. This way you could see how the team works.”
Your lips widened. “But, Jackson. I am just an accountant. Why would you need me in Thailand with you? Or any other shooting place?”
Although he knew you caught him, he wouldn’t show you. “Well, there are lots of things an accountant has to do on the set.”
Your left eyebrow quirked up, challenging him. “Like for instance?”
Jackson was running his fingers over his chin as if deep in thought. “You have to make sure I don’t buy all the sweets on the spot.” He looked at you and laughed in one of his high-pitched laughters that made you laugh as well. “You have to make sure others don’t waste money on more sweets,” he continued, his amused face lit up just like thousands of fairy lights. Your face came closer to his as you listened intently. “You have to make sure the resort we are going to stay in is all set and done.” Closer. “Make sure I do my work properly.” A little bit more closer. “Make sure I don’t spend all my goddamn money on spoiling you.” His breath was on your lips, his focus on your lips. Your breath hitched when you felt his lips move against yours, closing your eyes as pleasure and excitement overtook you. “Make sure you are there with me so I can share the experience with you because I need you.” He kissed you passionately, inhaling through his nose and yet you still grabbed his face and pressed it more towards you, unable to get enough of him.
He took hold of your thighs, nudging you to sit on his lap which you gladly did. You moaned loudly when you felt his hands ghost over your butt and sneaking up over your back. You couldn’t help but notice how he wouldn’t touch your bare skin under your shirt even though you wanted it desperately.
Opening you mouth, you let him in and you totally submitted yourself to his control. You could see him behind your closed eyes, you could feel his warm hands while you ran your fingers through his styled hair.
Kisses were loud, smacky, playful, passionate, feverish and moany. You were sure this was the night some magic would happen. After all, you didn’t kiss since 2016 when he took you home. You both were thirsty for each other, desperate, suffering... Finally, you got to get to touch one another.
But Jackson slowed down to a sensual make-out session, not pushing it to the next level until he completely stopped, breathing heavily as he pecked your swollen lips one last time before his eyes fluttered open to look at your blissful face. You hummed at the loss of contact.
“What do you think?” he whispered, not wanting to break the bubble you created.
Your eyes opened as well, meeting his gentle gaze. “For work purposes only,” you started, touching his cheek. “I will go.”
You shared a quiet laugh when you heard another knock on the door. This one was certainly louder than Jackson’s knock.
Jackson frowned, alarmed. “Who is it at this time?” he asked and looked at his (expensive) wrist watch.
You bit your lip, still holding his face in your hands. You knew. You knew but you didn’t want to show it to Jackson.
Another loud knock.
“Is there someone bothering you here?” asked Jackson, searching for your gaze. He didn’t like the idea that someone would harass you, not even in the slightest. Worry was written all over his face as you untangled yourself from him.
“It’s just Martin,” you mumbled once your feet hit the cold floor.
“Martin? The doctor?” asked Jackson in shock.
You unlocked the door and opened it. Just as expected, Martin was there, fuming just a little bit. “Y/N!” he shouted and stormed in, not bothering to look around. “What is this? You aren’t picking up my calls for days now and you just lock yourself up here-“
“Good evening,” Jackson said, standing tall, his face authoritative, his hands in his pockets.
Martin stopped abruptly, staring at Jackson, startled. “Good evening.”
- - - continue - - -
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Wonderbat Week: Day 4 - Holiday
Title: What The Kids Want
Word Count: 2,102
Author’s Note: So so sorry this is late! I just kind of went overboard for with this and I didn’t feel like writing yesterday. Not desire to write and a large word count does not go well together so I just finished this (now I got to go write today’s prompt plus yesterday and today’s prompts for Dickkory Week. Yay :( ). Anyway, in my first entry I added in a mention Donna and Cassie because I didn’t want to erase them. However I have no knowledge of them so they are absent in this fic. Also my first time writing Jason sooo… Idk, it’s really important to me that Bruce’s kids have a role in Wonderbat’s relationship.
@fyeahwonderbat
Gotham was not a pretty city. The gothic buildings gave off a dark aura and the rank trash on its grimy streets gave the stale air a permanent smell. And yet, despite the sky high crime rates and bitter atmosphere, the city almost looked inviting under the mask of freshly fallen snow — especially when one was standing outside of their ancestral manor, sharing a cup of tea with a close friend as one’s kids played and got along.
Bruce Wayne took a deep breath, taking in the crisp winter air. A hot cup of tea warmed his palms but it almost didn’t compare to the comforting heat radiating from the woman next to him. In front of him was his boys. What had started as gentle teasing from Dick had turned into a full blown snow war featuring Dick and Tim vs Jason and Damian. Yeah, the pairings were odd but Bruce couldn’t care less: his kids were having fun together and that was all that mattered.
“This doesn’t happen often, does it?” Diana asked as she sipped her tea, drawing bruce’s attention away from his boys. A harsh wind blew and Bruce squeezed his mug harder. It had almost killed Alfred to put their drinks in big mugs instead of proper tea cups but it was far too cold to drink tea in little spurts.
“What doesn’t?”
“Them getting along? Usually Tim and Damian are going at it and Dick is either trying to break it up or caught in the middle. And I hardly see Jason anymore.”
“Yeah…” A dark feeling stirred in Bruce’s chest, nearly stamping out the joy the sight before him brought. “It’s rare to see these moments. It’s hard to get the kids to get along and a fight to get Jason to willing drop by. But these moments makes it more than worth it.”
“I bet they do. Watching them is like watching my sisters in Themyscira. No matter how hard we fight each other, we know the other would have our back in battle. Same with your boys, right?”
“Same with my boys. They love each other, even if only Dick will admit it.” Bruce looked back towards his boys and frowned. “And they’re plotting something.”
Dick, Damian, Tim, and Jason stood huddled in the middle of the yard, snowball fight forgotten. Occasionally a pair of blue eyes would dart towards Bruce and Diana before returning to the whispered conversation between them. Bruce narrowed his eyes and strained his ears but he couldn’t hear anything.
“What’s going on over there?” he eventually called after accepting that eavesdropping was impossible from this distance. The boys jumped apart with shining eyes and sneaky smiles, an almost believable picture of innocence.
“Nothing!” Dick replied as he strolled towards the pair on the porch. His brothers followed. “We was just going over a case that’s been nagging me. Perhaps you can help?” Bruce raised an eyebrow at his youngest.
“I thought you said no work on Christmas?” Pink highlighted Dick’s cheeks and he briefly bit his lip. Bruce nearly shook his head: he had spent weeks teaching Dick to control such reactions.
“I know, I know: I’m a hypocrite. But I just can’t focus on having fun with you guys with this case on my mind. Can you please help me?” It wasn’t common for Dick to beg for help. Ever since Robin became Nightwing the young man had been adamant about independence, so it was a big red flag that was was begging for help now. But with Diana right there, Bruce found himself not wanting to make a scene.
“Sure, Dick,” the man said, voice flooded with suspicion and resignation.
“Great! I’m gonna grab some hot chocolate and we’ll meet in your study.” With that Dick raced into the manor, a large grin stretched across his face.
“I can also use a refill,” Diana hummed, shaking her empty mug. “Meet you there?”
“No!” Tim  shouted. The two adults looked at him, causing the teen to flush a dark red. “Actually, I - um - was hoping to ask Diana a few questions, if you don’t mind.”
“Later, Tim,” Bruce said with a tone that allowed no arguments.
“Yeah! Diana can’t answer your fangirl questions: she’ll be too busy sparing with me and Damian in the Batcave. Right Diana?” Jason asked with hopeful eyes.
“I’ve always wanted to conquer the Amazon in a sword fight,” Damian added with a shrug of the shoulders. Jason scoffed.
“In your dream, short stack. She’ll wipe the floor with you!”
Bruce pinched the bridge of his nose as Jason and Damian began to squabble and exhaled through his nose. Then he looked at the woman next to him. “Diana, I’m sorry to ask but—”
“It’s no problem. But I must warn you: Damian might be a little grumpy after I defeat him in battle.” Something in Bruce’s chest burned as Diana flashed him a smile before the Amazon was dragged off by his 2nd oldest and youngest sons.  It wasn’t a bad burn; more like the burn of a cup of tea or a fireplace on the coldest day of the year. It almost brought a smile to his face but he quickly stomped that down when he saw Tim still standing there.
“Er, I’m just gonna… go inside…” Tim muttered awkwardly before sidestepping Bruce and disappearing inside. Bruce sighed and followed his second youngest.
By the time Bruce made it to his study, Dick was comfortable seated on his desk with a mug of hot chocolate in hands and stacks of papers spread onto the desk’s remaining surface. Dick gestured him over eagerly. Bruce was barely sat down before Dick started to explain the case to him.
5 minutes later and it was clear to Bruce that this was a waste of time. The case was an easy one with plenty of evidence as to who the perp was and why they did it. There was no way Dick hadn’t figured it out already. But Dick was determined to drag Bruce into it and no matter how many times the older man interrupted and tried to figure out Dick’s real motives, the younger just kept soldiering on and ignoring him. By the time 30 minutes had passed Bruce was completely tuning his son out, more interested in the way Dick’s eyes kept flickering to the watch on his wrist.
“Now, I was thinking —” Dick started around the 45 minute mark but he was cut off as his watch began to beep. Dick let out a breath and quickly jumped off the desk, breathing out a quiet “finally” that Bruce barely managed to catch. Dick began to collect the papers.
“Did you figure it out?” Bruce asked as he watched Dick clean up quickly. He was leaning in his seat, arms crossed and eyebrows raised.
“Hm? Oh! No, I didn’t but it’s Christmas and I refuse to work on this any longer! C’mon, let’s go find the others.” Bruce barely had time to process Dick’s excuse before his son grabbed him by the arm and pulled him out the room.
“Woah - slow down!” Bruce hissed but Dick ignored him, instead pulling him through the hallways even faster as he muttered a chant of “c’mon, c’mon, c’mon,” below his breath. “Dick, where are we going?”
“To find the others - ah ha!” Dick stopped in his tracks before quickly stepping around Bruce so he was behind the man and pushing him forward. “Stay there!”
“Why?”
“Just stand there!”
Bruce rolled his eyes and exhaled harshly. He had learned not to play his kids’ games a long time ago so why was he indulging Dick now? Before Bruce could move, though, the sound of a mini stampede rumbled through the hallway. The rest of his kids were coming.
Bruce stood there and looked ahead, watching as Jason and Tim pulled Diana towards him and Dick, Damian right on their heels. He barely had time to take in the sight - let alone chastise them for their behaviour - before his two middle children sling-shotted Diana forward, right into Bruce’s arms.
“Diana!” Bruce gasped in shock as the woman collided with him. “Are you okay? I’m so sorry—”
“I’m fine. The boys were in quite a hurry to bring me up here. Is everything alright?”
“As far as I know but my sons are acting suspicious and that’s never a good thing.” Bruce shot a glare at all four of his sons. They only smiled in return, Damian’s smile a bit more hesitant and begrudging than the rest. Bruce opened his mouth to demand answers but was quickly cut off as Diana shuffled in his arms. A hot flush flooded Bruce’s face and he quickly let the Amazon go. He let go so quickly that he nearly toppled her balance again.
“S-sorry,” Bruce stuttered, awkwardly rubbing the back of his neck. The heat in his face increased: Batman did not stutter!
“It’s okay,” Diana replied, a faint pink blush decorating her own cheeks. A few awkward beats passed before Jason broke it with a deep groan.
“This is taking too long! Look up already!” Dick and Tim emphasized his words by pointing up towards the ceiling.
As one, Diana and Bruce tilted their heads upwards and looked at the ceiling 25 feet above them.
Oh God, thought Bruce as dread and embarrassment filled him. How did they get mistletoe all the way up there?
Bruce’s heart began to pound and his hands clenched into fists at his sides. The dream/embarrassment mixture only intensified as he heard a small “oh,” slip from Diana’s mouth. Bruce kept his eyes up as he began to stutter, too embarrassed to look at his friend.
“Di-Diana, I’m s-so sorry! I don’t - why would they - oh my gosh!” Bruce’s head fell forward into his palms, his fingers pulling at his hair. He should’ve know his kids would pull something like this: they’ve been trying to push him and Diana together for months now! And inviting Diana over during mistletoe season? Bruce mind as well gotten onto his knees and begged for his kids to do this.
Suddenly, Diana began to laugh.
“S-sorry,” the Amazon snorted between giggles. “Your face right now is just -” Diana cut herself off as she doubled over in laughter. Around them the boys began to laugh too. Was Diana in on it? Did they all team up against him?
How come that idea didn’t upset him as much as it should’ve?
Finally Diana straightened with a sniff as her laughter died out. She licked her lips and, with big blue eyes glinting, the Amazon stepped closer to Bruce and threw her arms around his neck.
“D?” Bruce muttered, questioningly. His own arms moved of their own volition and wrapped around Diana’s waist.
“Your boys put so much effort in this. Mind as well give them what they want.”
“Yes! Kiss her!” Dick yelled from the sidelines, practically buzzing. The others quickly shushed him.
Bruce couldn’t help but noticed the way Damian stood close to Dick, slightly behind his older brother as if the shield himself from the scene before him. The last time he had checked, Damian still held hopes of Talia and him reconciling and the three of them becoming a proper family. But here was help, scheming to get him and Diana to kiss? Was the boy truly okay with this?
As if reading his mind, Damian made eye contact with his father and nodded his consent, latching onto Dick’s sweater as he did so. The young man quickly threw an arm around his little brother and pulled him close.
“Are you okay with this?” Diana whispered. “I’ll understand if your not.” Bruce closed his eyes and thought. Diana was willing to kiss him. His sons wanted them to kiss. And him — Bruce thought harder — he wasn’t against the idea at all.
“Yeah,” he answered. “I’m more than okay with this.”
Diana’s blinding smile was the last thing he saw before he closed his eyes and their lips met. Inside his chest something burst and something else clicked. Bruce found himself deepening the kiss, a low groan coming from deep in his throat. He could feel Diana’s smile against his lips, the heat of her body pressed against his, her fingers in his hair. It felt good. It felt right.
The world around them melted away as Bruce and Diana kissed. And then they kissed again. And again. Lost in the woman in his arms, Bruce almost didn’t hear the cheer and applause coming from his sons.
Almost.
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pinayillustrada · 7 years
Text
Things I Love About Collar X Malice
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The busy summer is over, and so are all my runs of Collar X Malice. I finished it yesterday. A few people have reviewed the game already and I don’t have that much time to write a full review (blame my dissertation and two RA jobs), so to keep this short, I’ll just list my favorite parts of this game, and the various ways this game could possible improve (or things that otome game writers can take note of if ever they are reading this).
Let’s start with the things I love:
1. Ichika
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I did mention my preference for independent otome game heroines, with Code: Realize’s Cardia and Princess Arthur’s Alu, being some of my favorites despite some problems. Ichika too is not perfect.
She’s not exactly the most badass (but she’s an excellent shot though), or the most intelligent, but she is a girl who makes the most of the situation. While it is true that there are certain routes where she gets saved (a number of times in Okazaki’s route), she also does a fair amount of the saving.
She has a family and a life of her own. In the game, one does see her do normal stuff—cooking, her dayjob as a rookie cop, and has occasional spats with her tsundere brother.
Unlike many other otome game heroines, she is not too shy about being the first to admit her feelings to the guys she like. In most of the routes, she is the one who confesses first.
Above all, the story hinges on her unwavering conviction that she can uphold justice without causing malice or sorrow.
She’s a very unique otoge heroine and I wish there were more like her.
2. Datable characters are not easily reduceable to types
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Sure, there is the recognizable tsundere in Sasazuka, but not everyone is can be summed up via a type. Mineo, for example, is also slightly tsundere and baka, but there is more to him than his love for history and theatrics. It’s the same with slightly yandere Shiraishi, but Shiraishi is not exactly the possessive yandere, as he actually does encourage Ichika to spend some time with her girlfriends. They all have interesting backstories that challenge one’s idea of “type” casting characters in the first place.
3. The ethics of the game are on the gray side
As one plays the game, one may find oneself sympathizing with the villains. That, I think, is the point of the game, because the villains themselves also suffer injustice. It makes one ask interesting questions: how does one deal with injustice?
4. Getting bad endings are not too bad
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There are a lot of bad endings in this game, but one may find that getting a bad ending can clue one in to other plots of the game. In many ways, getting bad endings can also function as hints on future narrative choices. Getting bad endings too is can be a way of piecing together a larger narrative, that involves multiple characters with their own subplots.
5. It makes you question the nature of a “good” ending
*Spoilers in Shiraishi’s route*
A lot of people have noted how bittersweet the “good” ending of Shiraishi’s route is. But it can lead one to ask though: is a good ending about the heroine being happy with the guy she falls for, or is it about serving justice to its characters? This game definitely thinks it is the latter. And I agree.
True, Shiraishi and Ichika have to part in that ending, but it does prove that Shiraishi has truly moved beyond being just a pawn of Adonis, and has learned Ichika’s form of justice. Compare that to the tragic ending where they remain happy together, but Ichika is not aware of who Shiraishi really is because she loses her memory. So while the “good” ending does have a bitter aftertaste with not a lot of closure, it is the better ending of the two.
*End spoilers*
6. The yandere route leaves some room for the heroine to be badass
*Spoilers in Shiraishi’s route*
Yes, Shiraishi is the yandere. But unlike in other yandere routes, where the heroine has to comply to the other character’s yandere-ness (ie. MC with Jumin in Mystic Messenger or Toma in Amnesia), it is the opposite here. Ichika sees the signs of yandereness, and does what a reasonable heroine should do: GTFO. And other times when Shiraishi turns yandere, she snaps him right out it. The story makes it super clear that it is Ichika who really saves the day, even if she loses her memory at the end of it.
I usually hate yandere routes, but this is one is not bad.
*End spoilers*
7. It passes the Bechdel test
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Okay, it barely passed it, but at least it did! Apart from Ichika, there are three other female police officers in the game Eriko and Kotoho. Sure, they are part of the Shiraishi Bashing Coalition, whose sole purpose it to shit talk about Shiraishi, but they sometimes talk about other things. After all, they do have cases to solve, and lunches to eat. Kotoho especially loves meat.
In addition to those, Ichika also discusses some other matters with other female suspects. Those contributed too.
8. Characters sleep together and are not too ashamed about it
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Yes, Ichika does end up in bed with some characters, but the game does not cast her off as a slut. She is still very lovable as she is.
9. Getting the villain route does not involve the heroine getting into a creepy relationship
Yes, in a way, the villain has a route. And one gets to see the villian’s side of the story. But at least Ichika does not have to date said character in order to get that side of the story (ie. Sweet Fuse as much as I also love that game)
10. Your perfect husbando can do feminine things.
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This game pretty much casts Yanagi as the almost-perfect husband type. While he used to be a delinquent and has his own dark backstory, you also see him do feminine things like cooking and cleaning. While everyone literally calls Yanagi the Dad of the group, in many ways, he is also their mom.
But of course, Collar x Malice is by no means perfect. Here are some ways the game can improve:
1. Ichika still does a fair bit of emotional labor
Emotional labor is the job of managing people’s feelings. It is highly gendered because women are often the ones expected to do this job. While Ichika is definitely a wonderful heroine, key parts of the game is still about her managing mens’ feelings. Sometimes, I think a heroine should not be made to deal with too much BS in order to be a wonderful.
Moreover, In many of the routes,there seems to be a lot of focus on Ichika’s domestic abilities in the form of her cooking and cleaning skills. While it is not wrong for a heroine to have these and be feminine, writers have to keep in mind that historically, women have been told again and again that they have to excel in these things too in addition to the other jobs that they do.
2. Trigger mode allows one to feel a bit badass for a few seconds, but they are super limited.
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Trigger mode is a timed-mechanic, wherein Ichika has to shoot at the right time. They are found in key parts of the plot, but they are very limited. Usually once per route. While it is true that it drives the point that Ichika only uses her gun in times where it is really necessary, surely the game can think of other ways where Ichika can be proactive and a bit more badass than just that and narrative choices. Also, trigger mode preselects your target for the player. It would actually be interesting if one actually gets to decide who the target is.
3. Investigate mode does allow one to interact with some objects, but this is also limited.
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One could get great deal of story via environments, case in point being Bloodbourne. I am not saying that an otome game has to be Bloodbourne, but more objects to interact with can allow for better world and character building
4. Map is also limited
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There are moments where one can select areas in the police station to go to, but the problem here is that it only allows you to select where one is supposed to go to. Other places are locked. It would be nice to be able to explore other places other ones where one is supposed to go to. Being able to explore the station at least would have given the police station a sense of place.
5. All the characters are straight
There are many other genders and sexualities out there. There’s a problem if all the characters are all deemed to be cis-characters.
6. Stereotypical representation of gamers
One route features a gamer as a villain. Sure, otome games are not really that great with representations of gamers from Yoosung in Mystic Messenger to the MMO players of Period Cube. But it does not help if most gamers in otome games are addicts.
With that, I would say that this could easily be one of the best otome games of the year. That is, if Bad Apple Wars does not upstage it on October.
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thejosh1980 · 4 years
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Travel Update #19 - Quarantine Day 11
Originally Posted on Friday 18th September 2020
Well I woke up today early yet again…. I think I was awake before 3am, I definitely was out of bed by 3:30.
I feel pretty down again too…
I had a bit of a breakdown the other night. The stress, tiredness and missing a special someone from Germany got to me. I know I’m not Superman but (unfortunately) I expect myself to have super human strength in these trying times...
These moments of despair are happening more often than in the past. I just don’t realise how stressful it all is until it overwhelms me. I have to remind myself, to remind myself, that we did move (half way around the world) in a pandemic situation, with delayed flights, too many goodbyes (and so far not one hello) and quarantine go through.
It's been 6 months of constant worries... No wonder I'm loosin' it!!
I make sure that I have a lot to do here, I tend to deal with any of my issues by keeping busy. I don’t ignore them as much as I find time helps, and the best way for me to pass the time, is to keep busy. But usually one needs motivation to keep busy, and that is lacking… I have to really force myself to focus on things… To be honest my “to do” list is long, and I am overwhelmed by it…
I know, I am my worst enemy… I'm working on it...
The 4 walls do creep in on you. My world has gotten so small, I am starting to worry about the outside world! Will I be able to just go shopping without anxiety attack?? What is “normal” life like these days? Has it changed a lot since they locked me in here? Questions to be answered in the future…
I am thankful for the phone calls and messages I receive each day. So much love and support, it really goes a long way to putting a smile on my face. Thank you.
Now, to change the subject, lets go back a few days…
Tuesday both breakfast and dinner were late!!! Shock!! Horror! … It’s those little things that matter the most these days… Alexanne was howlin’ for her dinner! She was Hangry!!! Usually our delivery comes later rather than early, but if we expect it latest 19:30, then 19:31 is not good enough! At least it made us laugh… Honestly the meals have been very good and varied… A little “heavy” but I'm sure we'll loose the quarantine weight once we get out of here and can finally spend some time on the beach ;)
We got fresh sheets and towels!!!
I chose to have a bit of a lazy Wednesday… After receiving a bunch of phone calls (walking for hours in the bathroom as to not wake Alex), I took my first nap during the day since being in here… It felt like a bit of a Sunday. Relaxed… TV… some reading… But that was the night the anxiety and stress got the better of me… Maybe because I wasn’t tired enough to just fall asleep as soon as my head hit the pillow… My mind was racing… The day started good, but it didn’t end well…
It could have been the health check phone call or the daily police visit that messed me up… I mean, they call and you have to wake up… they knock and you have to wake up… Pretty unfair when you’re napping…!!! But in the end, they’re just doing their job… Ever since the “runner” the other week, the police come round to check your name off a list… Maybe it’s a government requirement… I do know the daily health phone calls by the nurses are a requirement, in an attempt to preempt any health issues… Yesterday I was offered sleeping tablets, but I can barely bring myself to take ibuprofen let alone sleeping pills…!!
Thursday, after the mess from the night before, I attacked the morning with focus and positivity. I peeled and ate a mandarin!! Shock!! Horror!!!
Like usual, I woke early, and I walked on the balcony most of the morning while listening to a live stream (Slapsteam). It was really cool to spend so much time outside. During the morning, I could see lots of folks down below leaving with their families or in taxi’s… I was a bit jealous, but we are over the hump… Not long to go now… Like usual, I took a few phone calls too…
Between the balcony, bathroom and the phone calls, I managed to walk 13 kilometres or 20,000 steps!!
The news that the Aussie caps would be lifted came in today. It’s a step in the right direction 4,000 to 6,000 per week, but it’s not enough… There’s still too little being done to support stranded Aussies and to get them home… So much in house fighting and State and Federal Government playing the blame game… It’s so hard to describe how this all feels, and unless you go through it, you really don’t know how you’d react or feel… But I can tell you, I’m very disappointed and saddened by my country turning it’s back on fellow Aussies…There’s still no long term plan… and COVID is going to be here for a long time…
I wrote to the local Labor Senator Penny Wong and Health Minister Stephan Wade in my attempt to get access to the park outside the hotel. 3/4 of the hotel rooms don’t have an opening window, and folks are suffering. Fresh air and direct sunlight are really important, especially in these times… I haven’t heard back…
Honestly the social media thing is wearing me down, and I am finding myself less and less online… Have you seen our stories on IG or FB?? I am posting less and less, because I just don’t want to log in and read another heartbreaking and disappointing story. Nor do I want to read comments from folks who’s opinion is very unsympathetic or understanding.
I did manage to focus enough on the Ukulele for an afternoon, figuring out a few songs I might be able to play if I go live on the weekend. I don’t feel very confident, it’s definitely not my strongest instrument… The other problem is the timing, to allow Europeans and Aussies to watch… My initial thoughts are Saturday morning German time/Saturday evening Aussie time… I’ll keep you posted…
We also got to vacuum the room on Thursday. I’ve never seen Alex so happy to have “Henry" in her hands! ;)
Qatar sent me a refund for the 30/09 flight we canceled (after boarding the Singapore flight)… At least that’s a little less financial worry we have…
Alright, so that brings us to this morning, 6:30am Friday morning… After my little cry this morning, I began writing, now the sun is starting to rise, and I hope that today will feel better than those last few down moments I’ve had recently…
Writing down my experiences here has been therapeutic for me… I usually write songs about what’s going on…. Story telling taking on a new form… Always good to try something new...
I appreciate your comments and messages… Thank you everyone…
Stay safe
Josh and @dauntlesscoffee
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soysaucevictim · 5 years
Text
Last week of current challenges... except for the DGC, because I fell a bit behind schedule there. Oops.
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Dec. 21
I woke up pretty much at noon.
Played some cards and wasted a lot of time on the usual. Only did a couple of my planned exercise for the day.
First, today’s DD. 30 infinity circles with EC. Not much to say, other than it was pretty enjoyable!
Last, Day 21 of the ‘19AC. 1′ single leg half squat. This was on the challenging side - mostly because of needing to focus on balance.
By the time I had intended to get the rest of my stuff done, bro went to bed and closed his door (so I couldn’t use his pull-up bar.)
Yeah... Didn’t do DGC stuff again, either. But I did get to bed in the yellow zone. So there’s that.
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Dec. 22
Another day I got up at about noon, having set my alarm for that. Maybe it will press me towards fixing my sleep schedule... but today won’t be that day.
Did much of the usual, with exercise interspersed.
First, today’s DD. 40 single leg bridges with EC. This was pretty doable and a nice way to get my day moving! :D
Second, Day 22 of the ‘19AC. 4′ side leg raise hold (2′/2′, lateral decubitus.) This was pretty doable but intense. I especially wanted to make sure to hips were stacked and not leaning, for a bit more effort. At least, I think so.
Third, Day 25 of the KMC. 160 side kicks, switch halfway. Did 80/80 in one go, pretty handily.
Fourth, Day 25 of the DHC. 2x10″ dead hangs. Not much to really comment on these days. I do like them though, during low energy days.
(After distractions for far too many hours and getting upset over personal stuff...)
Last, Day 22 of the DGC. I’m grateful:
For tofu and it’s culinary flexibility.
I could try these “Devil’s Spit“ pickles grandpa mentioned some time back. They’re pretty good!
Nobuo Uematsu for making some of my favorite music, growing up.
Fuck it. It’s almost 7AM when I’m writing this entry. Thought about putting the DGC shit off. But fuck it.
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Dec. 23
I woke up after 2PM, today. Oof.
Picked up some meds and did a bit more of the usual, before today’s exercises.
First, today’s DD. 3′ half jacks with EC, barely. Took about 3 tries, the problem was too much sugar/caffeine, not enough water, and going too fast to sustain the pace. First go was ~2'+1' = 114+100. Second go, was still too fast/inconsistent, but the third was at a more slow & deliberate pace - with a total of 109 reps. Whew! That was a fun challenge.
Second, Day 23 of the ‘19AC. 30″ push-up plank hold. Did it in one go, but it was kinda sloppy. Regardless, It was just good enough for me. :/
Third, Day 26 of the KMC. 160 turning kicks + 160 side kicks. Did it in 1 set of (80/80) + (80/80). This was made more tough after doing so many half jacks earlier. But I’m glad I was able to manage.
Fourth, Day 26 of the DHC 1′40″ dead hang. Done in 50"+25"+10"+15", with ~20" rest in between sets. That was pretty fucking brutal & required a bit of psyching myself up for it - but I still find it fun.
(After making the family dinner...)
Last, Day 23 of the DGC. I’m grateful:
For the Final Fantasy series of videogames.
For Sanders Sides, for the entertainment and inspiration.
For the patience and encouragement from clients past and present.
I did get to bed like an hour earlier than the night before, but still squately in the red zone. :I
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Dec. 24
I got up a bit before 3PM today. Bleh.
Did much of the usual before exercising.
First, today’s DD. 40 split lunges with EC. This took a bit of willpower to get through - but I'm happy I could manage. :P
Second, Day 24 of the 2019 Advent Calendar. Last day to this challenge. 4 minute relax (child’s pose). I thought this was a wonderful way to end the Advent Calendar. And it was pretty soothing to kind sit there and just meditate a bit. And overall, I rather liked the theme that everything here were holds of some kind - felt very unified! :D
Third, Day 27 of the KMC. 100 double turning kicks. Pretty handily did it in one set of 50/50.
Fourth, Day 27 of the DHC. 2x10″ dead hangs. This was pretty simple and fun. Swung a little more in the second set than ideal. But 10″ is pretty easy, now.
(After spending some time doing planning the next few months’ exercise regimen...)
Last, Day 24 of the DGC. I’m grateful:
That my brother has been doing the dishes more, despite me not telling him to do so (I had intention to do the dishes today, but he just took it upon himself.)
That I have some good foundations to build on in terms of fitness.
For chocolate, existing. :,D
After a shower and some games, I got to bed. It was earlier than yesterday, but still in the red zone. :P
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Dec. 25
I woke up just shy of 1PM today.
Did a bit of the usual before heading out to the grandparents’ place for the holiday.
Had a pretty good dinner, played some cards, had some tense moments. But at least Grandpa didn’t call the cops on the uncle. It’s sad to say that’s an improvement.
First, today’s DD. 2′ meditation with EC. It's always lovely to take a moment to meditate, especially after some tense moments.
Third, Day 28 of the KMC. 3x 40 turning kicks + 40 side kicks. I did it in one superset of 3x (20/20 + 20/20). Pretty simple and to the point work.
Fourth, Day 28 of the DHC. 1′50″ dead hang. I managed it in 1'+25"+20"+8". Wound up with a blood blister though. I was thinking I would stick some bandages on it for the remaining 2 days of this challenge.  but various forums be like "open, clean, and dress it." :I
Last, Day 25 of the DGC. I’m grateful:
That there were some things that were good/okay about how the day went.
That I’ve opted not to go to the facility tomorrow - so I can sleep in.
That I’ve some good ways to plan ahead when it comes to exercise.
I went to bed only a few minutes earlier than yesterday.
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Dec. 26
I got up a bit before 2PM, I think.
After a bit of the usual, I went straight into my exercise.
First, today’s DD. 2′ leg extensions with EC (donkey kicks). I counted exactly 100 reps by the end. This was a bunch of fun! :D
Second, Day 29 of the KMC. “16 balance kicks side & turning both each leg, no putting your foot down.“ Had a few moments of wobbling and nearly losing my center - but I’m glad I could do things pretty well.
Third, Day 29 of the DHC. 2x10″ dead hangs. I decided to approach it with some bandaging on hand with the blister. It was a bit tough, but the blister didn't rupture. That leaves tomorrow with a bit of a question mark. If it's going to pop, that's when I think it'll happen. orz
(After some distractions...)
Last, Day 26 of the DGC. I’m grateful:
That the blister didn’t pop just yet.
For educational YouTubers.
For Leftist voices, in general.
...
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Dec. 27
I woke up just a bit after noon, today. Yay.
I did a bit of the usual, before reserving some more trips and archiving the last couple months’ DDs. Then, I started on my exercise.
First, today’s DD. 2′ arm extensions with EC. I counted 147 reps by the end of it, and I'm happy about keeping it above 1/sec. I had a lot of fun with this one! :D
Third, Day 30 of the Kick Master Challenge. 200 turning kicks + 200 side kicks, done in 2 sets of 100/100. Did get mildly winding, but still manageable.
Fourth, Day 30 of the Dead Hang Challenge. 2′ dead hang. I walked into this with some trepidation, but I got through it better than I expected! It took 6 sets to do it, but I got it done (45"+25"+10"+10"+17"+13"). I bandaged my blistered hand... and it didn't tear open! Huzzah! \o/
Dead/clotted blood mass may've torn a little bit away from nearby capillaries, what with some brighter red being visible. Did rub off a bit of superficial layer for offhand and the calloused ridging is a bit tender underneath - but no surface injuries at least. I count that as a personal victory! And now - my hands will get their much needed break from the pull-up bar.  \o/
Last, Day 27 of the DGC. I’m grateful:
That my hands didn’t tear open, during the DHC. Despite it feeling a bit touch and go for a minute there!
That I only tentatively slotted in the Flex Hang Challenge after that. Because, oh man. That’d be a bad idea.
That I have plans to be excited for, in terms odf exercise... which I’ll get into, right after this sentiment.
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Summary & Plans:
A day late, but I finished all my challenges but the Daily Gratitude Challenge (ETA in 3 days, barring further interruptions), in Dec. 27.
Altogether - I greatly enjoyed the Kick Master Challenge for expected reasons. I also liked how the structure had a few variations to go through. I was mostly able to keep the “in one workouts” to at most 2 sets, shortened the rests between all sets to a bare minimum, and didn’t fall out of the balance days even once! (I did contemplate on bounce-switching more often than I actually did, partly to mind the knees.)
I surprisingly really enjoyed going through the Dead Hang Challenge! I found it more fun than holding planks, DESPITE flirting with tearing my hands open near the end of it. Thankfully, using bandages in the last 2 days were enough to stave that disaster off.
As far as metrics for that went:
I hit a PB of 1′. Which I’m proud of
I had to break incremented days into multiple sets for 9 days (12 & 16-30), ranging from 2-6 sets, with ~15-30″ rests in between.
My plans starting tomorrow (technically today, but shhh...) are as follows.
I’m going to spend the next 6 weeks doing the Knee Conditioning Program I found a bit ago. The first week, I’ll be doing free-form warm-ups for each day. I think I’ll cycle through upperbody, ab, and (low/mid-impact) cardio workouts, as a complement.
Then, by the second week I’ll either jump in with the new DAREBEE Program(s!) Zero Hero, Baseline, or re-run Cardio Go! and use them for some supplementary cardio/rounding and warm-up. This will depend on which I feel will be more compatible with where I’m at.
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07/08/19
Hello, hello,
Well, it takes me a while now to write.
I am afraid that writing this post will be a long process, cause... I have my nails short.
I know, I know, a huge surprise. But look, I’ve had my nails done for past two years, I believe and I never liked them short. Especially last year I had an amazing nail tech, to whom I still go and she makes my nails look super cool and strong, so I didn’t really feel like cutting them down.
Unfortunately, due to my adventures by the seaside and my nails being absolutely long for about a month, some of them broke and I had to cut them as much as it was possible.
They still look cute for me, somewhat shocking, cause I hadn’t seen them like that for such a long time. What is more, I am so not used to using my phone or computer keyboard like that. 
Because of that, I sent a lot of unwanted or wrong messages on messenger yesterday and writing this post could be a bit of a burden, but, from what I can already tell, I am able to write so much faster, I just have to check the spelling more often. 
It actually surprises me, how big is the change of pace. For the longest time I thought that there was something wrong with me, that I couldn’t write just as fast and now it turns out that I actually can. I mean, hello?
There are a lot of thoughts that I have had recently.
First of all, I am trying to exercise regularly. I do a 100 reps butt challenge from blogilates, day 9th today, cause I started earlier (I am leaving next week and I wanted to achieve as much as it was possible beforehand) and I also do a 30 day plank, squat, push-up and crunch challenge.
Apart from that, it is day three of my diet, as I realised that exercising brings results, yes, but it mostly builds muscles, while reducing your fat only for, like, bare minimum. It is mostly dieting that helps with fat loss, especially around stomach region as it is widely known that you build your abs in the kitchen.
Abdominal muscles aren’t really that hard to build, for them to be visible, as I have had them visible for about four years now. It’s just that you have to put a lot of effort to actually make your stomach lean. 
I am working on my thighs a lot too. I am mostly self-conscious about my face, acne on said face, my breasts or rather lack thereof and my thighs.
Honestly, if I could take some fat from my thighs and put it in my boobs, I would do so 100%. 
But, it’s not possible for me for now. So, I am at least trying to make my thighs lean.
It’s just that, I’ve been a dancer for about 8 years. I had very long, harsh Saturday trainings that took up the majority of my day and later, they became Friday and Saturday trainings. 
I had a very lean, slim body at the time, but also my thighs started to grow as a natural result of putting a lot of work into your legs.
Then I quit, the muscles stayed and I also started eating a bit more, which made the thighs grow even more.
So, now we’re here.
It’s quite funny, how I don’t like the plump thighs on myself, but they are my favourite thing on Internet models and I always love how beautiful they look.
I just can’t comprehend it, how much I can love something on somebody else and completely hate it on me. 
Anyways, yesterday I got my glasses. I had an optometric check-up on Monday, although I overslept and I had to schedule another one. 
Basically, when I went to the doctor for the check-up I needed for my driving school, they sent me to a different optometrist, who said that my glasses were too strong for me and I should have my eyes checked. 
I decided to do so and I was postively surprised with how fast i was able to schedule that. I mean, I scheduled the meeting via Internet after gym on Sunday and it was scheduled for Monday, 4 pm. Since I overslept, I had to reschedule, but I did that quite easily and my next meeting was at 5:30pm. I went with my dad and an hour later everything was pretty much done, I chose how I wanted my glasses to look like and I paid. 
Turns out that the doctor was right and the glasses were actually a bit too harsh and strong with power and obviously it is unhealthy to wear glasses or contact lenses that are not suitable for you.
I also desperately needed new glasses, because the previous ones were very beaten-up.
The new ones are super pretty. I actually had trouble picking them, because there was the other pair that I also liked and it was cheaper, but, I have always wanted glasses that would somehow resemble cat eyes and I think I look super pretty in them, even without make-up and with messy hair, which speaks volumes to me. I didn’t know that it was actually possible to feel so powerful with glasses, but well, here we go. 
Besides, I actually passed the theoretical driving test yesterday. It was all a long journey, as at first, I thought that the school was closed, then it turned out that the really nice lady who works as a receptionist had her heart broken and she cried a lot, so I talked it over with her a bit. Later, we had problems with the computer and it shut down in the first half of the exam, which made me mad, cause I was doing well and was pretty sure of the answers. In the second half of the exam that nice lady started weeping really loudly and I was so sad for her, because I remembered how hard I wept after a break-up with my ex. In turn, that made me sort of unable to focus and I got really scared that I won’t be able to pass.
I did pass though, with maximum score, which made me so happy. I can schedule my theoretical exam from tomorrow, the one that actually counts. 
In the meantime, on one of those nights, Black sent me a snap that he was sad. I didn’t reply, cause I have to fix my sleep schedule, gosh darn it, but even later, when I was deep asleep, he sent me another one, which was showing that he was listening to our song and I nearly lost my shit when I woke up.
It’s so easy to throw me off balance, let me just tell you, but I’m working on at least not showing that to everybody.
So, I still haven’t told anybody about my crush on Black. I think that maybe I’ll do it next week, when I will be leaving with my friend to Ukraine. It’s entirely possible that she’ll come to visit me on Tuesday, we’ll go to the movies together and then she’ll come over for the night and her dad will pick us up very early on Wednesday’s morning. 
I think that could be really awesome. Last year’s trip was one of my favourite trips ever, truly freeing and I managed to somehow let go. I remember being in love, but I didn’t love anybody real. I was happy, though.
We’ll see how it will be this year, but I hope that even better than last year. Besides, I wonder whether talking some things out will make me feel better, but I think that it just might.
I’m going to the cinema today, to watch The Hustle with V. We are also going with Su to the cinema next Monday to watch Yesterday and A Rainy Day In New York. I’ll let you know how I liked them. Moreover, I finished the second season of Money Heist and let me tell you, I loved the ending so much.
I am also planning to donate blood on Tuesday, but that requires my dad and my grandma to help, cause my dad will drive us to the blood donation centre and my grandma will stay with me to reassure that I’m okay, since that will be my first time and besides, you might always feel weak and drained after donating. 
So, for now I think I covered all the topics I wanted to cover. It’s really funny, how unmotivated I felt to write yesterday, but how motivated I feel today, after I’ve been woken up and I know I’ll have to leave my house tonight. I might just do my makeup and all that jazz. I am excited, you know. 
Wish me luck.
Today’s light I’m sending to...
Well, maybe I’m going to explain first.
The idea of sending light stems from my acting classes, when our director said that it’s important to send light to people, imagine yourselves giving them light, cause you open yourselves up for possibilities of conversing and working with them.
I tried that as a way of prayer maybe, you know, having someone in your thoughts and wishing them all the best, keeping positive thoughts and creating positive actions because of that. I do have a lot of unhealthy, bad thoughts, like everybody, I believe, so I wanted to make my mind a brighter place as well.
The thing is, often, when I send light to people, something bad happens. I don’t necessarily connect the events, I just believe that I pay more attention to anything bad that might be happening to them and that’s what makes me hurt.
Besides, I also saw a beautiful drawing that sometimes, when you send the light to someone who has been only sucking everything good inside like a black hole their entire life, then also your light will get eaten up and it might not be never-ending.
But, if you give your light to the person who knows how to return it, then you will both blossom and flourish.
It’s all really nice, but well, I will keep on sending light to people that I believe that deserve it and so far, that’s what I’ve done.
Today’s light I’m sending to one of my close friends, Tulip. I have never introduced Tulip to this blog, but she’s one of the people that I am so, so blessed and grateful to have in my life. She is so smart, amazing, loving and organised. I will always keep on wishing her all the best, cause talking things out with her always makes everything so much better. I can’t even remind myself of a situation when I would have been mad at her.
Take care of yourselves,
Love,
C
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art-arch-urb · 5 years
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Refusal after Refusal
What if we acknowledged that we had fallen out of love with architecture and couldn’t remember why we loved it in the first place? That we had given up on building long ago because we had no interest in collaborating with developers, in designing money-laundering schemes or parking garages for foreign capital? And what if we told you that now we even found architectural discourse repulsive? That we had seen the logos for the oil companies emblazoned at the bottom of the biennial posters and couldn’t look away?That we had read the disinterest on the faces of the public and could relate? That we had watched academics lecture about labor practices while exploiting their assistants and overworking their students? That we had tried to warn each other about abusers and assaulters and were reprimanded for it by our heroes? What if we confessed that all this made us depressed, that we could barely summon the energy to get out of bed, let alone to work? What if we told you that we were beginning to think work itself was the problem?
2. The summer was hot. The hottest on record in Los Angeles and Montreal, Glasgow and Tbilisi, Qurayyat and Belfast—though records are easily broken these days. Everything appeared out of focus. The edges of our thoughts were blurred. According to studies, heat makes you lazy and unhappy. But sometimes your unhappiness supersedes your laziness, and sometimes your laziness indicates something about your unhappiness. We decided to try learning from our laziness.
3. It was Karl Marx’s son-in-law, the Franco-Cuban radical journalist and activist Paul Lafargue who first articulated a “right to be lazy.” He equated work, and its valorization, with “pain, misery and corruption.”He argued for its refusal. “A strange delusion possesses the working classes of the nations where capitalist civilization holds its sway,” Lafargue writes. “This delusion is the love of work, the furious passion for work, pushed even to the exhaustion of the vital force of the individual and his progeny.”
4. But, as Marcel Duchamp reminds us, “it really isn’t easy to be truly lazy and do nothing.”
5. “Sleep is a sin,” say the architects. Equipped with coffee or speed, they avoid it at all costs—sacrificing the body for the sake of the project, for the eternally recurrent deadline. When finally the suprachiasmatic nuclei demand submission to the ticking of the circadian clock, they curl up beneath their desks. They wear all black to minimize time spent worrying over clothes. They marry other architects for the sake of having a synchronized schedule. According to a recent study, archi­tecture students sleep less than any others, averaging 5.28 hours per night. More often than not, this is a performative demonstration of their dedication to their studies rather than a necessity, a time-honored ritual of masochistic devotion. In his 2013 book 24/7: Late Capitalism and the End of Sleep, Jonathan Crary interrogates the neoliberal dictum that “sleeping is for losers.” Where time is money, sleeping is “one of the great human affronts to the voraciousness of contemporary capitalism.” Architects embody this attitude, imagining the stakes of the project—a luxury condominium, an arts center—as life or death. In fact, considering that sleep deprivation has been linked to premature death, it is their own lives that are put on the line.
6. Yesterday I woke up around 8:30 a.m. and took 450 milligrams of bupropion, 50 milligrams of Lamictal, 5 milligrams of aripiprazole, and 200 milligrams of modafinil, all swallowed in one gulp of coffee. (The modafinil—a medication used to treat shift work sleep disorder, among other things—is new, added by my psychiatrist last month when I complained I was having trouble working, or doing much of anything.) A few hours later, I took 20 milligrams of Adderall. Only then was I able to write this paragraph.
7. Beginning with their schooling, architects are routinely required to invest more money than they will ever receive in compensation and workplace protections. While the typical college student in the United States accrues an average of $29,420 in student debt, the architecture student is saddled with an average of $40,000.After graduation, the architectural employee can expect to work 70 hours a week for approximately $70,000 per year—or $15 an hour. And yet, as Bjarke Ingels has stated about the profession’s long working hours, “That’s the price you pay but the reward you get is that you do something incredibly meaningful if you actually love what you’re doing and you’re doing meaningful work."
8. In other words, architecture is a form of labor that masquerades as a labor of love. It contains within it the promise of fulfillment, of happiness. In her book The Promise of Happiness (2010), Sara Ahmed interrogates the normative function of happiness, how it serves as a means of orienting behavior and, in the process, is often deployed as a justification for oppression. That is, what it means to be happy is circumscribed culturally. “In wishing for happiness we wish to be associated with happiness, which means to be associated with its associations,” Ahmed writes. Work should make us happy and fulfilled—even more so when it’s “creative,” an assumption imbued with classist undertones. This draws young people toward architecture school; it makes the burden of debt, harsh working conditions, and low wages appear as an acceptable “price to pay.”
9. But, as the figure of the dissatisfied “CAD monkey” illustrates, the labor of architecture falls short of this promise. Conditioned to believe that fulfillment emerges from creative autonomy and expression, architects instead find themselves laboring over bathroom details or stair sections, and a sense of alienation emerges. It’s a feeling that parallels that of the industrial laborer described by Marx—more so than many architects would like to admit. In classic Marxist theory, workers are estranged from the fruits of their labor, which are taken away from them in the process of becoming rendered as commodities. Because it is understood as nonalienating work, to feel alienated in architecture becomes a sort of double-estrangement. Not only are you estranged from the labor, you are estranged from architecture itself.
10. While working as a studio manager at a New York architecture firm, my colleagues would often remark wistfully that they could rarely attend lectures or engage with discourse as I was able to do. Models, budgets, schematics, client meetings, site visits, overtime, and weekends at the studio had ravaged both their physical and spiritual capacities to participate in the field in a role beyond producing architecture with a capital A. Their passion had become their drudgery; their very own commitment to architectural work became the barrier between contributing to what they had imagined architecture could do and how it apparently must be.
11. I read somewhere that depression is the failure of your neurons to fire like they used to. There’s something ghostly to it: you have the memory of a feeling, of an association, but can’t conjure it anymore. Is there such a thing as a depression specific to architecture? How would it be characterized? I wrote a note on my phone: “The loss of belief in the possibility of designing a different world. Nostalgia for the future.”
12. To express dissatisfaction or alienation in architecture carries deep risks. For one, it could cost you your job. “If you aren’t happy, then leave. Others would kill to have your job.” It could also brand you as an outcast, as if marked by some internal failure or incapacity for feeling what everyone else does. And such a killjoy would ruin the mood of the office. That is, as Ahmed asserts, happiness is framed as a duty to others.18 Misery is contagious and therefore irresponsible. So, regardless of how overworked you are, how alienated you are from the products of your labor, how underpaid you are, how often the boss touches your ass, you must grin and bear it. There’s a reason why architects rarely organize to fight back against exploitative work conditions. Be happy, or else.13. According to Pierre Dardot and Christian Laval, a mandate to appear happy, which they term the “performance/pleasure apparatus,” underwrites neoliberalism more broadly.19 Today, the individual must not only produce more but also enjoy more—and, pivotally, this surplus of pleasure must be performed. Pleasure serves as a signifier of the subject’s value within a socioeconomic system in which self-edification is substituted for the social and responsibility is privatized. The flip side of the burned-out professional is the determined young architect who spends their free time attending lectures or writing essays or designing their own projects. Such work is valorized as a signal of their commitment to the field and an indicator of their value as an intellectual practitioner. This fuels a culture in which the products of extra-professional labor are exhibited in journals or galleries, often without adequate compensation. We’re told we should feel honored to have such work recognized at all. In other words, today, nothing is work, and everything is work. Even our bodies and minds are objects of labor.14. I was working hard on an essay about work—about the disconnect between discourses on architectural labor and the broader economic context in which the discourses themselves are produced. I stumbled upon an interview with Antonio Negri in which he explains how, by 1965, the architecture school in Venice had become a center for political agitation and organizing. In early 1968, students from Venice and Padua joined forces with the workers at a nearby Porto Marghera factory, the largest petrochemical complex in Italy, where “two kilometers from the most beautiful city in the world hundreds of workers were dying of cancer, literally poisoned by their work.”20 Negri states that the union of students and workers “worked out quite smoothly because they had been in constant contact for a decade: the school of architecture was a gathering place for the working class.”2115. This struggle was a major event in the development of autonomia operaia, or autonomism, a political movement that defined postwar Italian politics and in which Negri played a central role. The solidarity between the academy and the factory was a significant aspect of autonomism, which reconceived of the position of the intellectual within leftist politics. Rather than develop theories upon which to base organizing, the intellectual should learn from work, from the workers and their lived experience. In this way, the autonomists transitioned from a demand for better working conditions to a critique of work itself, in which they understood labor as a totalizing process of subjectivization that sat­urated not only the factory but all of society. They thus displaced the centrality of the static figure of the worker and the working class with an understanding of social class as always in a state of becoming, transforming alongside conditions of work. Work itself—its valorization and the power this gave it over the experience of life—was the problem. “Refusal of work means quite simply: I don’t want to go to work because I prefer to sleep,” writes Franco “Bifo” Berardi. “But this laziness is the source of intelligence, of technology, of progress. Autonomy is the self-regulation of the social body in its independence and in its interaction with the disciplinary norm.”2216. But wait, haven’t we had this conversation before? Isn’t the struggle against work what we studied tirelessly to ace our papers? We worked our bodies and our minds through the night to prove we understood what the refusal of work was about, to prove our political awareness, to garner a critical edge, to be diligent students. But clearly this feverish ambition prevented us from recognizing ourselves as the products of its failure. Why regurgitate the past if not in order to understand how it landed us here, at 4:00 a.m., exhausted, verging on panic, and for what? 17. As Berardi elaborates, struggles for autonomy produced a new monster, laying the foundations for neoliberal economics and governance.23 When workers demanded freedom from regulation, capital did the same. The monotony, rigidity, and harsh conditions of the industrial factory gave way to flexible hours and jobs (in the Global North), but also deregulation, precarity, and the withdrawal of social protections. This shift was ideological and cultural, as well as economic.18. “Work is the primary means by which individuals are integrated not only into the economic system, but also into social, political, and familial modes of cooperation,” argues Kathi Weeks. “That individuals should work is fundamental to the basic social contract.” Under the contemporary neoliberal regime, work has come to be regarded as “a basic obligation of citizenship.”24Within the realms of politics, the media, and even sociology, the persistent messaging of its importance has generated a singular world-building experience where working remains the only means of belonging. “These repeated references to diligent work,” as David Frayne remarks, “function to construct a rigid dichotomy in the public imagination.”25 Those who work acquire social citizenship, while those who do not are leeches. Within this dichotomy, work becomes a choice: there exist only those who choose to be productive and those who choose to do nothing. “Which are you? The sleeper or the employee, the shirker or the worker?”2619. What if we told you we don’t refuse much of anything? What if we told you that we ate up praise like a spoonful of honey? What if we said that the validation always evaporates too quickly? Like a sugar-addled rush, we work on the premise that the next project will leave us satiated. We make promises to stop, to slow down, to regroup, to prevent the inevitable burnout, which leaves us languid and shrouded in shame. We wonder what all the research amounts to, what the interviews and panels in galleries and lecture halls even do or mean. 20. If the autonomist refusal of work helped produce a society in which there is nothing but work, what strategies are left for us? What would it mean to refuse after refusal? To stake out a position of alterity to the contemporary work ethic in order to find the room to question where we’re going, what’s driving us, and to what end?21. To work is to be normal. To work is to be socially acceptable. In order to comprehend the commitment to the drudgery and exploitation of working life, Lauren Berlant argues that normativity must be understood as “aspirational and as an evolving and incoherent cluster of hegemonic promises about the present and future experience of social belonging.”27 To rally for any kind of alternative beyond the moral imperative to work would be to cast oneself almost entirely outside the realm of affiliation, and even personhood.22. Architecture, today at least, is like work, an end in itself. It is autotelic—or, more precisely, a constituent element within the autotelic metabolism of contemporary capitalism. The need for shelter is hardly the driving motivation behind the majority of new builds. Rather, demolition and construction serve as the two poles of a coiling system of endless production for the sake of production. Financial speculation, warfare, and environmental desecration belong to its arsenal. All together, this system constitutes a global force responsible for the lion’s share of global carbon emissions. It results in the mass displacement of the poor and marginalized. In short, shelter is not the ends of architecture—it is its collateral damage. It is a question not of architecture or revolution but, rather, of architecture or survival.23. “If design is merely an inducement to consume, then we must reject design,” said Adolfo Natalini of Superstudio. “[I]f architecture is merely the codifying of the bourgeois models of ownership and society, then we must reject architecture; if architecture and town planning is merely the formalization of present unjust social divisions, then we must reject town planning and its cities—until all design activities are aimed towards meeting primary needs. Until then design must disappear. We can live without architecture.”2824. Let’s back up a bit. What produces this all-consuming, obsessive indifference to architecture? On the one hand, the profession and the academy are sites of violence, ridden with sexism, heterosexism, racism, classism, ableism. But, perhaps even more than that, we have yet to find a work of architecture that is capable of changing the status quo. On the other hand, we’re obsessed with the belief that it could, since, at the end of the day, all architecture changes the status quo—converting land into capital, emitting carbon dioxide, displacing people. In other words, we acknowledge architecture as immensely powerful but find ourselves—and all architects or architectural thinkers—powerless. Architecture, it seems, has been swallowed up by external forces and put in the service of the smooth functioning of the city and of flows of capital. We can’t imagine an architecture capable of disrupting this. Formalism is a dead end—novel forms are just a means to produce new terrains for the expenditure of surplus capital. We have little control over program since we’re beholden to patronage. Meanwhile, criticism has no bite; speculation, no value; theorization, no impact. Academia and institutions defang all thought. 25. We believe that the problem of work is at the center of all this. The need to work—a shared condition for all but the very wealthy—means we can’t really turn down a client or an opportunity to exhibit or an adjunct teaching position. Refusal, done alone, is a privilege few can afford. But, alongside that, the culture of work has seeped into our souls. Affirmation produces dopamine. Success signals security (even if, in actuality, it doesn’t offer it). Everything we do is for the sake of capital, whether social or material. We look for opportunities to tear each other down so that we can rise up an imaginary rung on an imaginary ladder instead. We are cowards, unwilling to bite the hand that feeds us strychnine-laced food. We can’t pause to think. We’ve lost all hope in the future.26. When commissioned to write this essay, we were asked to provide “concrete alternatives” to the present—but how could we? All we can speculate on is having the time to do so. All we can imagine is a horizon, hazy and distant, in which we discover, or remember, how to refuse—together.
http://www.harvarddesignmagazine.org/issues/46/refusal-after-refusal?fbclid=IwAR3OA3zuZGwx0-VuEEM2QWZlP44uF2N6MFKoD8M2fUudNZnkNjnj4brp2nk
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cosmosogler · 7 years
Text
today i got almost everything done!
my mother woke me up at about 5:45, and then again at 6:20. i was super angry. then my brother and sister were in both the upstairs bathrooms so i had to go all the way downstairs and across the house just to go to the bathroom before i went back to sleep.
i dreamed that i was getting annoyed with a conspiracy theorist. “video games are downloading scientific theories into your brain!!!” it was the science that scared them apparently. and the computers. the person wasn’t even present, i was just hearing their voice as i played dream mario, which is only slightly like nintendo mario. i told the voice that video games are just another way to tell a story. i pulled a children’s book out of somewhere, i think it was “goodnight moon” actually. except the cover was wrong. but i was telling the voice that there wasn’t nothin wrong with telling a cute or simple story.
sometimes the story is “i got really good at jumping over hills and across floating spinners and on turtles.”
i only put on the snooze for five minutes because i really, REALLY didn’t want to get up with less than like seven and a half hours of sleep. i got up anyway and showered. i didn’t get to spend long in the shower though... i really need to shave but i haven’t had much time at all the last five, seven days. i shower every other day since it’s a little better for your hair and skin...
anyway as i was heading out to go to therapy dad decided to start asking me to do some chores. i sort of started one, i let eve outside, but i seriously didn’t have time to wait for her to take a sunbath and let her back in. then someone (not naming names, because i’m not 100% sure) decided to park their car in a way that made it impossible for me to pull out of the garage. so i had to go back inside, get that car’s key, move it to the other side of the driveway, go back inside to drop off that key, and then i could get in “my” car and get going. then people on the freeway kept cutting me off without using their turn signals and also were generally going below the speed limit so i would have to stand on the brakes. this happened more than once. then i almost hit someone trying to get over to the exit because as i passed them apparently they sped up while passing through my blind spot so they were farther up than i thought they would be when i started changing lanes. cool!!!!!!!!
in individual therapy i brought up a bunch of emotional problems i had started to explore a little bit in group therapy. i ended up talking for the whole 45 minutes straight basically. like, my therapist asked a few questions, and reassured me a few times, but it was like a huge information dump so hopefully in the coming weeks i can start addressing each problem individually. i also got my semester refund paperwork sorted out with her. i’ll be able to pick it up next week. i mostly focused on how none of my problems feel “big enough” unless they are unsolvable since i really didn’t get to talk about it in group yesterday. i said one thing that i kind of liked though. i said “i feel like if i didn’t have so many problems, i wouldn’t have so many problems.” 
what i meant to say was “if i didn’t have so many mental and personality problems, i wouldn’t have so many life problems,” but the vagueness was silly enough that my therapist made a face and laughed. i said i didn’t know what to focus on first and she said “you’re already working on everything.” i had listed the multiple projects i am trying to keep up with therapy wise... i dunno. i feel like if i can get over that big “problems have to be impossible” hurdle things will start feeling a little more manageable and i’ll be able to make progress more quickly.
guess i gotta spend more time thinking about that. i’ll keep you posted as things come up.
after that i picked up my paperwork from my physician’s office since i was on that side of town and got the number for the radiology lab that wants to do the last test. when i got home i shoved some leftovers in the microwave and called the lab and scheduled my “hida scan,” which is a gall bladder test i guess where they put a bunch of glowing stuff through your digestive system and see if it goes through normally. the scheduler said it normally takes two hours unless they find something, in which case it will take longer. luckily my next therapy appointment is 4 hours after my procedure... i hope that will give enough time. i will have to let her know. i definitely wouldn’t be able to do it on a group therapy day and the lady seemed pretty keen on doing it as soon as possible. and i can’t do it in the afternoon in case it goes long and dad isn’t able to get to work.
so 8 am next tuesday it is.
so i had my ravioli and went upstairs and then after a short break i watched the iron giant with oz. the movie is even better than i remembered. then we talked about physics stuff while i worked on gathering study materials with my classmates. i had a great time, and i hope oz did too. it felt nice to do an activity with someone that took up all our attention, so i didn’t have to, like, feel self conscious about not baring my soul or something.
i think when asher gets back i will talk to him about maybe spending an afternoon at the pottery lounge thing by the amc. it’s not cheap, but last time i checked i didn’t think it was too expensive at least. and i still have the ceramic dog i painted like 15 years ago so the stuff lasts. basically you pick out a little ceramic statue and you get to paint it using a selection from like 200 different shades. and i think you can stay as long as it takes to paint it. the smaller stuff wasn’t too bad cost-wise.
got sidetracked. after i hung up with oz and got all my emails and google docs in order i went and got groceries for mom. she was making quesadillas for dinner. i unfortunately had to pay for them with my own money, and it felt weird buying meat after all these years. but i guess i buy dog treats often enough that it’s not really, like, a compromise of my morals or something. i noticed that the dogs really went wild over the chicken strips i bought last time, so i tried to expand to “turducken.” (spoiler: they loved those too.)
so i dropped off the vegetables and stuff with mom, checked on the cactus mouse, and watched a couple of the videos i had loaded up while talking to oz. i try not to spend too much time reading or watching videos while talking to people because i get super focused on what i’m looking at and don’t hear what they say any more haha.
then i went downstairs and had my veggie quesadilla. it was... ok. i was still a little hungry afterward, but i also felt kind of ill so i didn’t want to eat any more. eating with mom was the WORST. she breathes loud and chews with her mouth open so it’s just a constant avalanche of awful squishy mouth noises. it made me so angry and annoyed that i think that’s what made me sick more than the food. i kind of abruptly stood up and put my plate away and took the dogs outside after trying out the new treats. i tried to play fetch with wiley but he was having none of it today. which is very odd... maybe it was just too hot for him to want to run around. 
i have been experiencing kind of horrible pain between my shoulder blades. i’m pretty sure it’s not my bra pinching anything because it’s way above the strap... probably a pinched nerve. i tried stretching my arms and shoulders and that seemed to help a lot, so i’m thinking i slept in a bad position.
then i went back upstairs and whined to myself about my therapy homework. i did more “self care” research and added a few more posts to my queue. and i talked with some discord guys a little bit. then i caught up on my self esteem journal and picked out one of my “short term goals” from my hospital-issued treatment plan. i used that as a base to expand on for my goal worksheet. i finished all that around 11 so then i got started on the owl picture for 40 minutes or so. now i am 35 minutes into my journal entry, which puts me at a comfortable time to finish up and try to sleep. i got another 10 minutes before i hit my target “get ready for bed” time.
my group mates and therapist expressed interest when i let slip that i like to draw on monday. the therapist asked what i draw. i wasn’t sure how to answer... “furries” isn’t really something i wanted to get into. and i haven’t drawn my own characters except for a reference for one of the art trades in a long time. i suppose i should post the uncolored version of that since i scanned it in and haven’t worked on it with the tablet yet.
so i just said “characters and people.” i like landscapes, but i have trouble spending enough time on them to really get into the details. i’m hoping the coloring pages will help loosen up my patience so i might start feeling like spending a million hours on one picture again. it’s been a couple years since i did anything complicated.
i’m thinking about maybe taking my sketch book... but i don’t want to spend a lot of time on explaining what the picture is of when i have more urgent things to work on.
tomorrow i have more things to do! i NEED to work on the welcome packet for ufl. i need to scan in a bunch of stuff, like my immunization records and my doctors’ notes for my refund file. i need to send an email to the preliminary test coordinator to figure out how to proceed with my studying... i need to know how much to panic about this. then after group therapy i need to drop off my sister’s old prescriptions at the police station. that won’t take too long. if i got energy i’d like to organize my desk and maybe also tidy up my room a little bit. write some things down to put in the jar. then i will work on my self esteem journal, continue reading through the self care resources i’ve got open in a million tabs, and work on the coloring page a little bit. that sounds good. and at some point i need to write my 1- to 2-paragraph essay for the refund. and also i gotta email my apartment complex about stuff like the bed size and some cupboard dimensions and whether there’s a microwave and stuff like that. some of those things i’m pretty sure i can just look up somewhere.
i think i can manage those things. the student orientation videos might have to wait until thursday but i can compile the paperwork and read the faqs and stuff. none of these tasks take long by themselves. so as long as i remember to take little breaks and stay motivated i think i can get it done and not have to worry about it so much any more.
ok, it is 12:30, which is only 5 minutes after my target time! i’m gonna do the daily pokemon stuff for 2-3 minutes and then get ready for bed. gotta practice giving myself credit for reaching/working on goals and stuff, even when i don’t want to.
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kristinsimmons · 6 years
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Commissioning Healthcare Policy: Hospital Readmission and Its Price Tag
By ANISH KOKA MD 
The message comes in over the office slack line at 1:05 pm. There are four patients in rooms, one new, 3 patients in the waiting room. Really, not an ideal time to deal with this particular message.
“Kathy the home care nurse for Mrs. C called and said her weight yesterday was 185, today it is 194, she has +4 pitting edema, heart rate 120, BP 140/70 standing, 120/64 sitting”
I know Mrs. C well. She has severe COPD from smoking for 45 of the last 55 years. Every breath looks like an effort because it is. The worst part of it all is that Mrs. C just returned home from the hospital just days ago.
The youngest of six children, Mrs. C was born with many embedded disadvantages. Being born black in a poor West Philadelphia neighborhood in the 1960s is a story that too often writes itself with a bad ending.  But Mrs. C avoided the usual pitfalls that derail young women in the neighborhood early. No drugs. No alcohol. No teenage pregnancies. Finished high school. Mrs. C. worked for the hospital as a unit clerk, had her own place, health benefits, and even a retirement plan.
Certain life habits, however, carry a heavy price. George Burns, the comedian never pictured without a cigar who died past his hundredth birthday, may have been immune to the effects of tobacco.  Mrs. C was not. She started smoking when she was 16. She doesn’t recall why. Her dad smoking didn’t help perhaps. Nausea racked her body after that first drag. It eased up after. Too bad.
That measly cigarette became the great addiction of her life. Day by day, the exquisitely thin membranes of the lungs that mediate gas exchange were destroyed. By the time the disease manifests with shortness of breath and bluish tinged lips, it’s too late. Short of the very few who qualify for a lung transplant, the efforts of doctors at this point are for mitigation rather than cure.
Complicating things further, in Mrs. C’s case, the normally low pressure vascular circuit of her lungs became a high pressure circuit that places ever increasing demands on the normally thin-muscled right ventricle of the heart.  This jeopardizes the ability of her heart to handle changes in blood volume.
A little extra fluid and the right side of the heart ends up causing unbearable swelling in her legs.  A little dehydration and severe disabling dizziness on standing ensues. Adding to that that her tenuous lung function decompensates with the slightest respiratory infection, that chronic steroid treatment to decrease her wheezing suppresses her immune system, and that the young man down the street helpfully drops off Newports at her home for a few extra dollars, and it’s easy to see why the hospital is her second home.
The most recent admission to the hospital was for kidney failure related to taking too much fluid off with diuretics. What was to be a short stay for gentle hydration turned into a longer stay when a pneumonia complicated the matters (though a trip to the intensive care unit and a ventilator was barely but fortunately avoided).  She was treated by the pulmonology team and sent home on a lower dose of diuretics.
The situation I am now confronting puts me in a quandary.  Her edema and weight are up markedly just a few days after returning home.  Could her fluid overload be because her kidneys are shutting down? Or does she just need more aggressive diuresis?
Should I guess? Knowing her present renal function would be helpful. But even if the Theranos lab I could appeal to for help wasn’t fictional, I would have to get her to my office everyday or every other day while adjusting her diuretic dose.
And so it comes to be that, days removed from a hospital admission, I’m sending her back to the hospital to be readmitted.  According to some, this is not supposed to happen.
A policy on readmission
In 2008, the commission that advises Medicare – the Medicare Payment Advisory Commission (MEDPAC), issued a report that focused on hospital readmissions.
The focus on hospital readmissions had been of great interest to the health policy community for some time. At the core of this interest lies the belief that hospitals and physicians are incentivized to treat patients rather than prevent admissions.
The MEDPAC report wanted to discourage readmissions like Mrs. C’s.  And so it wasn’t a terrible surprise that, rolled into the 2010 Affordable Care Act, was a section called the Hospital Readmission Reduction Program (HRRP) which created a system for Medicare to penalize hospitals with ‘high’ readmission rates.  The program was rolled out in 2013.
At first, the program seemed to work like a charm.  Hospitals significantly ramped up their efforts at care coordination.  Teams of nurses and aids were assembled to make sure patients would get their medications as prescribed upon discharge and to check on patients once they got home.
Hospital readmission rates suddenly dropped and Medicare started saving money.  A staggering 81% of all hospitals suffered penalties in 2018, which translates to ~$500 million or 0.3% of total Medicare payments to hospitals.
A complex analysis
But there’s more to this too good to be true story.
The HRRP penalty schemes are risk-adjusted based on administrative claims data. Risk-adjustment is a statistical procedure to take into account the diversity in complexity and severity of disease among patients so they can be compared.
Physicians know that risk-adjusted claims data are of dubious value because they themselves are often the reluctant data entry clerk in the byzantine scheme that starts with adding diagnostic items to the medical chart and ends with generating a coded billing claim for Medicare.  Needless to say, there’s a huge potential disconnect between what a claim attempts to convey and the actual condition of a given patient.
Yet another major problem is that the risk-adjustment employed by the HRRP does not take socioeconomic status into account, when that is arguably the single biggest driver of poor outcomes and of hospital readmissions.  The creators of the HRRP program seem to believe that a hospital located in poor area shouldn’t get a break for having high readmission rates, perhaps because they believe that hospital systems in general should be mindful of health inequities and address “care gaps” (differences in care provided to poor vs. affluent patients)  in their neighborhoods no matter what.
Finally, the initial out of the gate benchmark for readmission rates on which the HRRP would adjudicate the need for a penalty was a national average.  In such a scheme, a Johns Hopkins Hospital serving inner city Baltimore could be pitted against a regional hospital in rural Montana with an entirely different patient demographics.  This made the regional hospital in Montana very happy.
Gaming the metrics
Regardless of these technical considerations, it is an adage of social science that any metric will be gamed, and healthcare is unfortunately not immune to that law.
One tool increasingly used by hospitals to comply with Medicare payments rules is to admit patients to short stay units, under so-called “observation status.”  Another is to put pressure on emergency departments to avoid readmitting certain types of patients.
So, instead of primarily functioning as a triage operation where sick patients would be turned over to the care of the cardiologist in the hospital, the ER has been increasingly housing and managing heart failure patients to save the hospital money.
But the ER physician or the hospitalist supervising the short stay unit and who just meet a patient in the setting of an acute illness are poorly equipped to know which heart failure patient to discharge after a diuretic dose and which to keep for advanced heart failure therapies.
Source: MedPAC’s June 2018 Report (http://bit.ly/2CXD0fJ)
Nowadays, the cardiologist is increasingly insulated from those decisions.  I have personally experienced with alarming frequency instances where I learn only after the fact that a complex patient of mine has been treated for heart failure in the ED.
And my experience seems to be shared by many of my cardiology colleagues, especially among cardiologists who work in academic centers that are most affected by the policy.  Luckily, some of them are also clinician-scientists that can do more than just whine to colleagues about the new policy.  They can also study its outcomes.
What do the outcomes data show?
In a pivotal study, a group of cardiologists (Gupta et al.) saw that the drop in readmissions that followed the introduction of HRRP was unfortunately accompanied by a reversal in the decade long downward trend in heart failure mortality. This reversal suggested a serious potential harm from the policy.
But the possibility of harm was quickly challenged by another group of researchers led by one of the biggest names in health policy: Harlan Krumholz, a cardiologist who directs the influential Center for Outcomes Research and Evaluation at Yale University.
The Krumholz group analyzed millions of Medicare claims data from 2007 to 2016.  They also found that mortality for heart failure patients increased, but concluded that no causal link between decreasing readmission and increased mortality could be established.
Krumholz at al. noted that mortality rates for heart failure started climbing before the HRRP program was announced and they noted no inflection point in mortality rates with the policy announcement in 2010.  The evidence for their claim is highlighted in the table below:
As can be seen in the boxed row, Krumholz’ team concludes that the increasing mortality slope post-HRRP is no different from that pre-HRRP because the change did not reach statistical significance at the obligatory and arbitrary P<0.05 level.  The actual P-value was 0.11 and the confidence interval for the positive increase in mortality slope of 0.006 is (-.002 to .015).  Even poor students of epistemology would be loathe to conclude this result excludes a signal of harm.  It seems entirely plausible that, with all the limitations of the data set in question, mortality may in fact have accelerated after the institution of the HRRP.  Yet Krumholz insists that no signal of harm is to be considered.
But this did not stop another group of cardiologists (Wadhera et al.) from adding their contribution to the HRRP literature. Using the same data-set that the Krumholz group used — Medicare claims data — these researchers found once again that accelerating mortality coincided with the announcement of the HRRP.  More troubling, they also demonstrated that mortality rose primarily among patients not readmitted to the hospital.
A messy science
Admittedly this whole business of analysis is incredibly messy, with a number of moving parts.
My brief summary doesn’t do justice to a variety of maneuvers taken by the various groups to account for many of the limitations inherent in this type of study. Two of the competing analyses (Krumholz, Wadhera) used Medicare claims data while the other (Gupta) used a more limited voluntary registry.
During the time period in question, there were also other policy changes such as the introduction of new hospital billing codes (MS-DRG) that sought to adjust hospital payment rates to patient complexity. Better patient coding meant higher reimbursement from Medicare.  Armies of “documenters” were then employed by hospitals to capture more revenue.
This means that the claims data gathered by the researchers might look significantly different from one time period to the next even if the patients themselves were ostensibly the same. As the readmission rate is risk-adjusted, it is eminently plausible and likely that systematically upcoding patient risk could actually have been the primary driver of the drop in hospital readmission rate.
The other program playing a confounding role is the Recovery Audit Contractor (RAC) program begun in 2010 to reduce payments for inappropriate hospital admissions. Hospitals responded to denials for inpatient admissions by expanding ‘observation status’ stays. Which was the biggest driver for expanded observation stays? RAC or the HRRP? Once again an exact attribution is impossible.
Denying the obvious?
Despite the messiness of the data and the variety of analytic methods used, a consistent and uncontested observation remains: Heart failure mortality has increased in the last decade. The question being hotly contested is Why?
Oddly, Dr. Krumholz is steadfast in denying the possibility that the policy may have caused harm, even though the independent and contradictory conclusions from the other research groups at least raises a reasonable doubt.  And Dr. Krumholz has been quick to cast shade on research that does not conform to his conclusion.
By tweet he appears to ask for a level of detail his own papers lack, and he questions the legitimacy of another group’s data-set, all the while resisting any calls to put the program on hold despite the paucity of evidence showing benefit, the signal for harm, and perhaps most importantly, the concern of clinicians who see a mechanism for harm.
Greatly admire @rwyeh and his group…appreciate his focus on readmission &public policy. For such high-profile article, really need more info about statistical weighting. Methods should be sufficient so others can reproduce results. Can’t do that here. Look forward to more info.
— Harlan Krumholz (@hmkyale) December 21, 2018
Can you account for why the registry you used had, on average, such a small number of patients per site. Did you determine how many patients coded with heart failure by CMS were in the Registry? Just curious about the selection. It may not explain your results…but is a question. https://t.co/WSvJAN8Jjd
— Harlan Krumholz (@hmkyale) June 2, 2018
Dr. Krumholz also places much weight on an independent analysis carried out by MEDPAC which concluded there was no link between policy and the uptick in mortality. This particular conclusion rests heavily on the assertion that heart failure patients in 2016 were much sicker than patients in 2010. Recall that this coincides with a period of more intensive coding over the same time frame, so it is impossible to say this with any confidence.
The MEDPAC conclusion also relies on an analysis that finds no correlation between hospital level readmission and mortality rates.
While technically true, that conclusion overlooks that a large number of hospitals exhibited reduced readmission rates and increased mortality. Perhaps MEDPAC feels that patients dying at low readmit/high mortality hospitals should be mollified by the knowledge that somewhere there’s a low-readmit/low mortality hospital to balance things out?
That Krumholz and MEDPAC display such certainty about the direction of the signal they observe, and take pains to discount other possibilities seems strange and suggests that pre-existing biases may be at work. What might those biases be?
Conflicts of interest: You get what you pay for
In a world where heads roll for undisclosed personal financial conflicts of interest, it is remarkable that the current dispute, while full of scintillating exchanges about “propensity weighting” and other arcane points of statistics, does not reference any other potential conflicts at work that might affect the conclusions being reached.
Medicare’s decision to start the HRRP program didn’t come in a vacuum. It was inspired by years of research from Dr. Krumholz himself, who suggested that preventing admissions should be a goal for any policy that would aim to move the system from one paying for “volume” to one paying for “value.”
As far back as 2003, Krumholz held the view that:
“Hospitals may not support programs that improve the quality of care delivered to heart failure patients because these programs lower readmission rates and empty beds, and therefore further diminish already-declining revenues.”
If Krumholz’s unfavorable and crudely simplistic view of the operations and motivations of hospitals (and of the still relatively independent physicians staffing those hospitals) informs his position on health policy, it stands to reason that serious blinders would prevent him from seeing any evidence of harm in a particular policy that promotes the same view.
But that’s not all.  Krumholz’s group at Yale received grants from CMS under the auspices of the Measure and Instrument Development and Support (MIDS) program to study and produce the metrics and instruments needed to devise the readmission measures.
The MIDS program supports the “development and use of clinical quality measures which remains a critical healthcare priority and the tool of choice for improving quality of care at the national, community and facility levels” and it allocates $1.6 billion dollars to this purpose.
Thanks to a bipartisan act of Congress, a helpful little website, usaspending.gov, provides contract level detail about payments made to the Krumholz’s group from the MIDS program.  Those payments can be seen in the table below:
The numbers are staggering. I know little about how to interpret these data about federal contracts, but it sure appears that the Yale-New Haven Health Service group led by Krumholz has received $144 million dollars since 2008.
Yet the only clue to these payments in Krumholz’ published analyses of the HRRP program comes in one disclosure sentence in a footnote, as seen here:
It seems to me that the disclosure is hardly proportional to the amount of funding that his group receives and understates the inherent pressures it must be under to demonstrate that the policy did not actually result in higher mortality.
And recall that MEDPAC’s “independent” analysis that also rejected a policy-mortality link came from the organization that recommended the policy to begin with.  The bottom line is this: There’s a tremendous amount of face to lose and a massive source of institutional funding at risk if the policy is found to be harmful.
It now becomes more clear why, in the following tweets, Dr. Krumholz feels that only he can say anything definitive about readmission rates and mortality:
Um, @JAMA_current, even the authors say they cannot say their findings are causal… "but whether this finding is a result of the policy requires further research.” Why do you promote the paper as proving harm? Need to treat twitter like you do any of your Editorial comments. pic.twitter.com/xugasHvPWY
— Harlan Krumholz (@hmkyale) December 26, 2018
6/Hospitals that have improved their readmission rates tended to improve their mortality rates. Published in @JAMA_current… https://t.co/R7FXLwTMPp
— Harlan Krumholz (@hmkyale) December 22, 2018
A diversity of biases
Biases are ubiquitous.  When I was a cardiologist-in-training, spending hours on the hospital consult service for a fixed salary, I vividly recall looking for ways to avoid doing any work I considered unimportant or banal: The minor cardiac enzyme leak in a patient with a widespread infection; The extra heartbeats on the ECG that the ER physician didn’t like the look of; etc.  “Are you sure you need an official consult?”  “The chances we’re going to recommend doing anything about a small enzyme leak in an 80-year-old with a severe lung infection are very low… “ I was even successful sometimes.
Contrast these comments to my demeanor in private practice where I am acutely aware that my income relies on such consults: “I just need the patients name or room number…” “I’ll take care of it!…” “I can put in the orders if you’d like!”
But there are other biases and incentives that motivate human beings, apart from personal financial incentives. Do they pale relative to the financial ones as is so often claimed? How does one begin to quantify them?
When it comes to the HRRP policy, no individual person’s bank account ballooned every time a patient didn’t get admitted. And yet this is a story of ideological bias that drove the design of policy and now claims ‘success’ for its own program.  The HRRP saga is illustrative of the importance of non-financial bias and of the dangers of blinding ourselves to that bias.
The story also highlights the downsides of tweaking healthcare systems that were built to deliver more care.
Clearly, I personally have a direct financial conflict of interest to provide more care. Since I haven’t talked anyone out of a consult in 8 years, I’m probably guilty of participating in a system that detractors appropriately criticize for promoting overuse of healthcare.
But the problem is that some of those consults I was trying to avoid as a fellow ended up really needing a cardiologist. There was the 55-year-old Cambodian woman admitted to the medical intensive care unit with pneumonia who went into atrial fibrillation. I recall rolling my eyes and thinking that the ICU could certainly handle this without a cardiologist. It turned out she didn’t have a pneumonia. It was pulmonary edema from heart failure related to undiagnosed rheumatic mitral valve disease. She had been in the wrong unit. She needed diuresis, heart rate control, and eventual surgery to replace her valve, not antibiotics. Less isn’t always more.
Attempt to reduce inappropriate hospital admissions? Get ready to pay a price.  To contradict Dr. Krumholz, it is entirely probable that we are underestimating the upside of our current system when we contemplate changing the status quo.
We are underestimating the downside of our current system when we contemplate change. We need to take some risks to do better. #abimf2013
— Harlan Krumholz (@hmkyale) August 5, 2013
Final Thoughts
Ironically, the HRRP quagmire offers a number of clarifying lessons.
Empiricism in social policy is a subjective enterprise. The often parroted conclusion is that cold, hard, unbiased evidence trumps the biased, unmeasurable judgment of clinicians. Yet, frequently, real world data-sets are complex, the choice of analytic paths can be highly variable, and the instruments to measure success are often imperfect. As it relates to HRRP, which analysis should we trust? The choice requires faith. And if the currency here is faith, perhaps the concern of clinicians at the bedside has more value than advertised.
Metrics won’t save us. The narrative of metrics is an appealing one that promises hard and objective accountability. The problem comes when the metric (readmission) becomes disconnected from outcomes that actually matter (death). False and blind prophets are good descriptors for those who claim to be unable to see without metrics. The fools in this enterprise are easy to identify as those who think the answers lie with ever better metrics.
Conflicts of interest: Going beyond the simple narrative.  Focusing on biases induced by personal financial interests is a mistake. Personal enrichment is just one bias in a sea of conflicts. In the healthcare context, financial disclosures—while clarifying in themselves—may simply give cover to other, more perverse biases, unless those other biases are equally disclosed.  It requires diligence to ascertain the impact, and direction of bias.  Rarely do we get the opportunity to observe the direction of bias in policy research.  In the case of the HRRP, the presence of bias was made evident because research groups with opposing biases (clinician-scientists versus policy wonks) have reached conclusions that would be expected on the basis of those pre-existing biases.  How often is the problem of such bias examined in the design, implementation, and analysis of health policy?
Beware of technocrats with all the answers.  I am reasonably sure that if practicing clinicians would have been asked to devise a rule to reduce heart failure readmissions for the whole population they would have refused. It seems too challenging a task to get right.  Even if clinicians can be induced to participate in the design of such a policy, most would readily acknowledge the likelihood that it could harm some patients. It requires a special type of hubris to design a policy and refuse to acknowledge its potential for harm. Unfortunately, hubris within a public health community that believes only they can give us a better health system is more feature than bug.
As for Mrs. C, she has been home for 16 days. All fingers on both hands are currently crossed.
Anish Koka is a cardiologist in private practice in Philadelphia.  He can be followed on Twitter @anish_koka. This post originally appeared here on The Accad & Koka Report. 
Commissioning Healthcare Policy: Hospital Readmission and Its Price Tag published first on https://wittooth.tumblr.com/
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isaacscrawford · 6 years
Text
Commissioning Healthcare Policy: Hospital Readmission and Its Price Tag
By ANISH KOKA MD 
The message comes in over the office slack line at 1:05 pm. There are four patients in rooms, one new, 3 patients in the waiting room. Really, not an ideal time to deal with this particular message.
“Kathy the home care nurse for Mrs. C called and said her weight yesterday was 185, today it is 194, she has +4 pitting edema, heart rate 120, BP 140/70 standing, 120/64 sitting”
I know Mrs. C well. She has severe COPD from smoking for 45 of the last 55 years. Every breath looks like an effort because it is. The worst part of it all is that Mrs. C just returned home from the hospital just days ago.
The youngest of six children, Mrs. C was born with many embedded disadvantages. Being born black in a poor West Philadelphia neighborhood in the 1960s is a story that too often writes itself with a bad ending.  But Mrs. C avoided the usual pitfalls that derail young women in the neighborhood early. No drugs. No alcohol. No teenage pregnancies. Finished high school. Mrs. C. worked for the hospital as a unit clerk, had her own place, health benefits, and even a retirement plan.
Certain life habits, however, carry a heavy price. George Burns, the comedian never pictured without a cigar who died past his hundredth birthday, may have been immune to the effects of tobacco.  Mrs. C was not. She started smoking when she was 16. She doesn’t recall why. Her dad smoking didn’t help perhaps. Nausea racked her body after that first drag. It eased up after. Too bad.
That measly cigarette became the great addiction of her life. Day by day, the exquisitely thin membranes of the lungs that mediate gas exchange were destroyed. By the time the disease manifests with shortness of breath and bluish tinged lips, it’s too late. Short of the very few who qualify for a lung transplant, the efforts of doctors at this point are for mitigation rather than cure.
Complicating things further, in Mrs. C’s case, the normally low pressure vascular circuit of her lungs became a high pressure circuit that places ever increasing demands on the normally thin-muscled right ventricle of the heart.  This jeopardizes the ability of her heart to handle changes in blood volume.
A little extra fluid and the right side of the heart ends up causing unbearable swelling in her legs.  A little dehydration and severe disabling dizziness on standing ensues. Adding to that that her tenuous lung function decompensates with the slightest respiratory infection, that chronic steroid treatment to decrease her wheezing suppresses her immune system, and that the young man down the street helpfully drops off Newports at her home for a few extra dollars, and it’s easy to see why the hospital is her second home.
The most recent admission to the hospital was for kidney failure related to taking too much fluid off with diuretics. What was to be a short stay for gentle hydration turned into a longer stay when a pneumonia complicated the matters (though a trip to the intensive care unit and a ventilator was barely but fortunately avoided).  She was treated by the pulmonology team and sent home on a lower dose of diuretics.
The situation I am now confronting puts me in a quandary.  Her edema and weight are up markedly just a few days after returning home.  Could her fluid overload be because her kidneys are shutting down? Or does she just need more aggressive diuresis?
Should I guess? Knowing her present renal function would be helpful. But even if the Theranos lab I could appeal to for help wasn’t fictional, I would have to get her to my office everyday or every other day while adjusting her diuretic dose.
And so it comes to be that, days removed from a hospital admission, I’m sending her back to the hospital to be readmitted.  According to some, this is not supposed to happen.
A policy on readmission
In 2008, the commission that advises Medicare – the Medicare Payment Advisory Commission (MEDPAC), issued a report that focused on hospital readmissions.
The focus on hospital readmissions had been of great interest to the health policy community for some time. At the core of this interest lies the belief that hospitals and physicians are incentivized to treat patients rather than prevent admissions.
The MEDPAC report wanted to discourage readmissions like Mrs. C’s.  And so it wasn’t a terrible surprise that, rolled into the 2010 Affordable Care Act, was a section called the Hospital Readmission Reduction Program (HRRP) which created a system for Medicare to penalize hospitals with ‘high’ readmission rates.  The program was rolled out in 2013.
At first, the program seemed to work like a charm.  Hospitals significantly ramped up their efforts at care coordination.  Teams of nurses and aids were assembled to make sure patients would get their medications as prescribed upon discharge and to check on patients once they got home.
Hospital readmission rates suddenly dropped and Medicare started saving money.  A staggering 81% of all hospitals suffered penalties in 2018, which translates to ~$500 million or 0.3% of total Medicare payments to hospitals.
A complex analysis
But there’s more to this too good to be true story.
The HRRP penalty schemes are risk-adjusted based on administrative claims data. Risk-adjustment is a statistical procedure to take into account the diversity in complexity and severity of disease among patients so they can be compared.
Physicians know that risk-adjusted claims data are of dubious value because they themselves are often the reluctant data entry clerk in the byzantine scheme that starts with adding diagnostic items to the medical chart and ends with generating a coded billing claim for Medicare.  Needless to say, there’s a huge potential disconnect between what a claim attempts to convey and the actual condition of a given patient.
Yet another major problem is that the risk-adjustment employed by the HRRP does not take socioeconomic status into account, when that is arguably the single biggest driver of poor outcomes and of hospital readmissions.  The creators of the HRRP program seem to believe that a hospital located in poor area shouldn’t get a break for having high readmission rates, perhaps because they believe that hospital systems in general should be mindful of health inequities and address “care gaps” (differences in care provided to poor vs. affluent patients)  in their neighborhoods no matter what.
Finally, the initial out of the gate benchmark for readmission rates on which the HRRP would adjudicate the need for a penalty was a national average.  In such a scheme, a Johns Hopkins Hospital serving inner city Baltimore could be pitted against a regional hospital in rural Montana with an entirely different patient demographics.  This made the regional hospital in Montana very happy.
Gaming the metrics
Regardless of these technical considerations, it is an adage of social science that any metric will be gamed, and healthcare is unfortunately not immune to that law.
One tool increasingly used by hospitals to comply with Medicare payments rules is to admit patients to short stay units, under so-called “observation status.”  Another is to put pressure on emergency departments to avoid readmitting certain types of patients.
So, instead of primarily functioning as a triage operation where sick patients would be turned over to the care of the cardiologist in the hospital, the ER has been increasingly housing and managing heart failure patients to save the hospital money.
But the ER physician or the hospitalist supervising the short stay unit and who just meet a patient in the setting of an acute illness are poorly equipped to know which heart failure patient to discharge after a diuretic dose and which to keep for advanced heart failure therapies.
Source: MedPAC’s June 2018 Report (http://medpac.gov/docs/default-source/reports/jun18_ch1_medpacreport_sec.pdf?sfvrsn=0)
Nowadays, the cardiologist is increasingly insulated from those decisions.  I have personally experienced with alarming frequency instances where I learn only after the fact that a complex patient of mine has been treated for heart failure in the ED.
And my experience seems to be shared by many of my cardiology colleagues, especially among cardiologists who work in academic centers that are most affected by the policy.  Luckily, some of them are also clinician-scientists that can do more than just whine to colleagues about the new policy.  They can also study its outcomes.
What do the outcomes data show?
In a pivotal study, a group of cardiologists (Gupta et al.) saw that the drop in readmissions that followed the introduction of HRRP was unfortunately accompanied by a reversal in the decade long downward trend in heart failure mortality. This reversal suggested a serious potential harm from the policy.
But the possibility of harm was quickly challenged by another group of researchers led by one of the biggest names in health policy: Harlan Krumholz, a cardiologist who directs the influential Center for Outcomes Research and Evaluation at Yale University.
The Krumholz group analyzed millions of Medicare claims data from 2007 to 2016.  They also found that mortality for heart failure patients increased, but concluded that no causal link between decreasing readmission and increased mortality could be established.
Krumholz at al. noted that mortality rates for heart failure started climbing before the HRRP program was announced and they noted no inflection point in mortality rates with the policy announcement in 2010.  The evidence for their claim is highlighted in the table below:
As can be seen in the boxed row, Krumholz’ team concludes that the increasing mortality slope post-HRRP is no different from that pre-HRRP because the change did not reach statistical significance at the obligatory and arbitrary P<0.05 level.  The actual P-value was 0.11 and the confidence interval for the positive increase in mortality slope of 0.006 is (-.002 to .015).  Even poor students of epistemology would be loathe to conclude this result excludes a signal of harm.  It seems entirely plausible that, with all the limitations of the data set in question, mortality may in fact have accelerated after the institution of the HRRP.  Yet Krumholz insists that no signal of harm is to be considered.
But this did not stop another group of cardiologists (Wadhera et al.) from adding their contribution to the HRRP literature. Using the same data-set that the Krumholz group used — Medicare claims data — these researchers found once again that accelerating mortality coincided with the announcement of the HRRP.  More troubling, they also demonstrated that mortality rose primarily among patients not readmitted to the hospital.
A messy science
Admittedly this whole business of analysis is incredibly messy, with a number of moving parts.
My brief summary doesn’t do justice to a variety of maneuvers taken by the various groups to account for many of the limitations inherent in this type of study. Two of the competing analyses (Krumholz, Wadhera) used Medicare claims data while the other (Gupta) used a more limited voluntary registry.
During the time period in question, there were also other policy changes such as the introduction of new hospital billing codes (MS-DRG) that sought to adjust hospital payment rates to patient complexity. Better patient coding meant higher reimbursement from Medicare.  Armies of “documenters” were then employed by hospitals to capture more revenue.
This means that the claims data gathered by the researchers might look significantly different from one time period to the next even if the patients themselves were ostensibly the same. As the readmission rate is risk-adjusted, it is eminently plausible and likely that systematically upcoding patient risk could actually have been the primary driver of the drop in hospital readmission rate.
The other program playing a confounding role is the Recovery Audit Contractor (RAC) program begun in 2010 to reduce payments for inappropriate hospital admissions. Hospitals responded to denials for inpatient admissions by expanding ‘observation status’ stays. Which was the biggest driver for expanded observation stays? RAC or the HRRP? Once again an exact attribution is impossible.
Denying the obvious?
Despite the messiness of the data and the variety of analytic methods used, a consistent and uncontested observation remains: Heart failure mortality has increased in the last decade. The question being hotly contested is Why?
Oddly, Dr. Krumholz is steadfast in denying the possibility that the policy may have caused harm, even though the independent and contradictory conclusions from the other research groups at least raises a reasonable doubt.  And Dr. Krumholz has been quick to cast shade on research that does not conform to his conclusion.
By tweet he appears to ask for a level of detail his own papers lack, and he questions the legitimacy of another group’s data-set, all the while resisting any calls to put the program on hold despite the paucity of evidence showing benefit, the signal for harm, and perhaps most importantly, the concern of clinicians who see a mechanism for harm.
Greatly admire @rwyeh and his group…appreciate his focus on readmission &public policy. For such high-profile article, really need more info about statistical weighting. Methods should be sufficient so others can reproduce results. Can’t do that here. Look forward to more info.
— Harlan Krumholz (@hmkyale) December 21, 2018
Can you account for why the registry you used had, on average, such a small number of patients per site. Did you determine how many patients coded with heart failure by CMS were in the Registry? Just curious about the selection. It may not explain your results…but is a question. https://t.co/WSvJAN8Jjd
— Harlan Krumholz (@hmkyale) June 2, 2018
Dr. Krumholz also places much weight on an independent analysis carried out by MEDPAC which concluded there was no link between policy and the uptick in mortality. This particular conclusion rests heavily on the assertion that heart failure patients in 2016 were much sicker than patients in 2010. Recall that this coincides with a period of more intensive coding over the same time frame, so it is impossible to say this with any confidence.
The MEDPAC conclusion also relies on an analysis that finds no correlation between hospital level readmission and mortality rates.
While technically true, that conclusion overlooks that a large number of hospitals exhibited reduced readmission rates and increased mortality. Perhaps MEDPAC feels that patients dying at low readmit/high mortality hospitals should be mollified by the knowledge that somewhere there’s a low-readmit/low mortality hospital to balance things out?
That Krumholz and MEDPAC display such certainty about the direction of the signal they observe, and take pains to discount other possibilities seems strange and suggests that pre-existing biases may be at work. What might those biases be?
Conflicts of interest: You get what you pay for
In a world where heads roll for undisclosed personal financial conflicts of interest, it is remarkable that the current dispute, while full of scintillating exchanges about “propensity weighting” and other arcane points of statistics, does not reference any other potential conflicts at work that might affect the conclusions being reached.
Medicare’s decision to start the HRRP program didn’t come in a vacuum. It was inspired by years of research from Dr. Krumholz himself, who suggested that preventing admissions should be a goal for any policy that would aim to move the system from one paying for “volume” to one paying for “value.”
As far back as 2003, Krumholz held the view that:
“Hospitals may not support programs that improve the quality of care delivered to heart failure patients because these programs lower readmission rates and empty beds, and therefore further diminish already-declining revenues.”
If Krumholz’s unfavorable and crudely simplistic view of the operations and motivations of hospitals (and of the still relatively independent physicians staffing those hospitals) informs his position on health policy, it stands to reason that serious blinders would prevent him from seeing any evidence of harm in a particular policy that promotes the same view.
But that’s not all.  Krumholz’s group at Yale received grants from CMS under the auspices of the Measure and Instrument Development and Support (MIDS) program to study and produce the metrics and instruments needed to devise the readmission measures.
The MIDS program supports the “development and use of clinical quality measures which remains a critical healthcare priority and the tool of choice for improving quality of care at the national, community and facility levels” and it allocates $1.6 billion dollars to this purpose.
Thanks to a bipartisan act of Congress, a helpful little website, usaspending.gov, provides contract level detail about payments made to the Krumholz’s group from the MIDS program.  Those payments can be seen in the table below:
The numbers are staggering. I know little about how to interpret these data about federal contracts, but it sure appears that the Yale-New Haven Health Service group led by Krumholz has received $144 million dollars since 2008.
Yet the only clue to these payments in Krumholz’ published analyses of the HRRP program comes in one disclosure sentence in a footnote, as seen here:
It seems to me that the disclosure is hardly proportional to the amount of funding that his group receives and understates the inherent pressures it must be under to demonstrate that the policy did not actually result in higher mortality.
And recall that MEDPAC’s “independent” analysis that also rejected a policy-mortality link came from the organization that recommended the policy to begin with.  The bottom line is this: There’s a tremendous amount of face to lose and a massive source of institutional funding at risk if the policy is found to be harmful.
It now becomes more clear why, in the following tweets, Dr. Krumholz feels that only he can say anything definitive about readmission rates and mortality:
Um, @JAMA_current, even the authors say they cannot say their findings are causal… "but whether this finding is a result of the policy requires further research.” Why do you promote the paper as proving harm? Need to treat twitter like you do any of your Editorial comments. pic.twitter.com/xugasHvPWY
— Harlan Krumholz (@hmkyale) December 26, 2018
6/Hospitals that have improved their readmission rates tended to improve their mortality rates. Published in @JAMA_current… https://t.co/R7FXLwTMPp
— Harlan Krumholz (@hmkyale) December 22, 2018
A diversity of biases
Biases are ubiquitous.  When I was a cardiologist-in-training, spending hours on the hospital consult service for a fixed salary, I vividly recall looking for ways to avoid doing any work I considered unimportant or banal: The minor cardiac enzyme leak in a patient with a widespread infection; The extra heartbeats on the ECG that the ER physician didn’t like the look of; etc.  “Are you sure you need an official consult?”  “The chances we’re going to recommend doing anything about a small enzyme leak in an 80-year-old with a severe lung infection are very low… “ I was even successful sometimes.
Contrast these comments to my demeanor in private practice where I am acutely aware that my income relies on such consults: “I just need the patients name or room number…” “I’ll take care of it!…” “I can put in the orders if you’d like!”
But there are other biases and incentives that motivate human beings, apart from personal financial incentives. Do they pale relative to the financial ones as is so often claimed? How does one begin to quantify them?
When it comes to the HRRP policy, no individual person’s bank account ballooned every time a patient didn’t get admitted. And yet this is a story of ideological bias that drove the design of policy and now claims ‘success’ for its own program.  The HRRP saga is illustrative of the importance of non-financial bias and of the dangers of blinding ourselves to that bias.
The story also highlights the downsides of tweaking healthcare systems that were built to deliver more care.
Clearly, I personally have a direct financial conflict of interest to provide more care. Since I haven’t talked anyone out of a consult in 8 years, I’m probably guilty of participating in a system that detractors appropriately criticize for promoting overuse of healthcare.
But the problem is that some of those consults I was trying to avoid as a fellow ended up really needing a cardiologist. There was the 55-year-old Cambodian woman admitted to the medical intensive care unit with pneumonia who went into atrial fibrillation. I recall rolling my eyes and thinking that the ICU could certainly handle this without a cardiologist. It turned out she didn’t have a pneumonia. It was pulmonary edema from heart failure related to undiagnosed rheumatic mitral valve disease. She had been in the wrong unit. She needed diuresis, heart rate control, and eventual surgery to replace her valve, not antibiotics. Less isn’t always more.
Attempt to reduce inappropriate hospital admissions? Get ready to pay a price.  To contradict Dr. Krumholz, it is entirely probable that we are underestimating the upside of our current system when we contemplate changing the status quo.
We are underestimating the downside of our current system when we contemplate change. We need to take some risks to do better. #abimf2013
— Harlan Krumholz (@hmkyale) August 5, 2013
Final Thoughts
Ironically, the HRRP quagmire offers a number of clarifying lessons.
Empiricism in social policy is a subjective enterprise. The often parroted conclusion is that cold, hard, unbiased evidence trumps the biased, unmeasurable judgment of clinicians. Yet, frequently, real world data-sets are complex, the choice of analytic paths can be highly variable, and the instruments to measure success are often imperfect. As it relates to HRRP, which analysis should we trust? The choice requires faith. And if the currency here is faith, perhaps the concern of clinicians at the bedside has more value than advertised.
Metrics won’t save us. The narrative of metrics is an appealing one that promises hard and objective accountability. The problem comes when the metric (readmission) becomes disconnected from outcomes that actually matter (death). False and blind prophets are good descriptors for those who claim to be unable to see without metrics. The fools in this enterprise are easy to identify as those who think the answers lie with ever better metrics.
Conflicts of interest: Going beyond the simple narrative.  Focusing on biases induced by personal financial interests is a mistake. Personal enrichment is just one bias in a sea of conflicts. In the healthcare context, financial disclosures—while clarifying in themselves—may simply give cover to other, more perverse biases, unless those other biases are equally disclosed.  It requires diligence to ascertain the impact, and direction of bias.  Rarely do we get the opportunity to observe the direction of bias in policy research.  In the case of the HRRP, the presence of bias was made evident because research groups with opposing biases (clinician-scientists versus policy wonks) have reached conclusions that would be expected on the basis of those pre-existing biases.  How often is the problem of such bias examined in the design, implementation, and analysis of health policy?
Beware of technocrats with all the answers.  I am reasonably sure that if practicing clinicians would have been asked to devise a rule to reduce heart failure readmissions for the whole population they would have refused. It seems too challenging a task to get right.  Even if clinicians can be induced to participate in the design of such a policy, most would readily acknowledge the likelihood that it could harm some patients. It requires a special type of hubris to design a policy and refuse to acknowledge its potential for harm. Unfortunately, hubris within a public health community that believes only they can give us a better health system is more feature than bug.
As for Mrs. C, she has been home for 16 days. All fingers on both hands are currently crossed.
Anish Koka is a cardiologist in private practice in Philadelphia.  He can be followed on Twitter @anish_koka. This post originally appeared here on The Accad & Koka Report. 
Article source:The Health Care Blog
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kristinsimmons · 6 years
Text
Commissioning Healthcare Policy: Hospital Readmission and Its Price Tag
By ANISH KOKA MD 
The message comes in over the office slack line at 1:05 pm. There are four patients in rooms, one new, 3 patients in the waiting room. Really, not an ideal time to deal with this particular message.
“Kathy the home care nurse for Mrs. C called and said her weight yesterday was 185, today it is 194, she has +4 pitting edema, heart rate 120, BP 140/70 standing, 120/64 sitting”
I know Mrs. C well. She has severe COPD from smoking for 45 of the last 55 years. Every breath looks like an effort because it is. The worst part of it all is that Mrs. C just returned home from the hospital just days ago.
The youngest of six children, Mrs. C was born with many embedded disadvantages. Being born black in a poor West Philadelphia neighborhood in the 1960s is a story that too often writes itself with a bad ending.  But Mrs. C avoided the usual pitfalls that derail young women in the neighborhood early. No drugs. No alcohol. No teenage pregnancies. Finished high school. Mrs. C. worked for the hospital as a unit clerk, had her own place, health benefits, and even a retirement plan.
Certain life habits, however, carry a heavy price. George Burns, the comedian never pictured without a cigar who died past his hundredth birthday, may have been immune to the effects of tobacco.  Mrs. C was not. She started smoking when she was 16. She doesn’t recall why. Her dad smoking didn’t help perhaps. Nausea racked her body after that first drag. It eased up after. Too bad.
That measly cigarette became the great addiction of her life. Day by day, the exquisitely thin membranes of the lungs that mediate gas exchange were destroyed. By the time the disease manifests with shortness of breath and bluish tinged lips, it’s too late. Short of the very few who qualify for a lung transplant, the efforts of doctors at this point are for mitigation rather than cure.
Complicating things further, in Mrs. C’s case, the normally low pressure vascular circuit of her lungs became a high pressure circuit that places ever increasing demands on the normally thin-muscled right ventricle of the heart.  This jeopardizes the ability of her heart to handle changes in blood volume.
A little extra fluid and the right side of the heart ends up causing unbearable swelling in her legs.  A little dehydration and severe disabling dizziness on standing ensues. Adding to that that her tenuous lung function decompensates with the slightest respiratory infection, that chronic steroid treatment to decrease her wheezing suppresses her immune system, and that the young man down the street helpfully drops off Newports at her home for a few extra dollars, and it’s easy to see why the hospital is her second home.
The most recent admission to the hospital was for kidney failure related to taking too much fluid off with diuretics. What was to be a short stay for gentle hydration turned into a longer stay when a pneumonia complicated the matters (though a trip to the intensive care unit and a ventilator was barely but fortunately avoided).  She was treated by the pulmonology team and sent home on a lower dose of diuretics.
The situation I am now confronting puts me in a quandary.  Her edema and weight are up markedly just a few days after returning home.  Could her fluid overload be because her kidneys are shutting down? Or does she just need more aggressive diuresis?
Should I guess? Knowing her present renal function would be helpful. But even if the Theranos lab I could appeal to for help wasn’t fictional, I would have to get her to my office everyday or every other day while adjusting her diuretic dose.
And so it comes to be that, days removed from a hospital admission, I’m sending her back to the hospital to be readmitted.  According to some, this is not supposed to happen.
A policy on readmission
In 2008, the commission that advises Medicare – the Medicare Payment Advisory Commission (MEDPAC), issued a report that focused on hospital readmissions.
The focus on hospital readmissions had been of great interest to the health policy community for some time. At the core of this interest lies the belief that hospitals and physicians are incentivized to treat patients rather than prevent admissions.
The MEDPAC report wanted to discourage readmissions like Mrs. C’s.  And so it wasn’t a terrible surprise that, rolled into the 2010 Affordable Care Act, was a section called the Hospital Readmission Reduction Program (HRRP) which created a system for Medicare to penalize hospitals with ‘high’ readmission rates.  The program was rolled out in 2013.
At first, the program seemed to work like a charm.  Hospitals significantly ramped up their efforts at care coordination.  Teams of nurses and aids were assembled to make sure patients would get their medications as prescribed upon discharge and to check on patients once they got home.
Hospital readmission rates suddenly dropped and Medicare started saving money.  A staggering 81% of all hospitals suffered penalties in 2018, which translates to ~$500 million or 0.3% of total Medicare payments to hospitals.
A complex analysis
But there’s more to this too good to be true story.
The HRRP penalty schemes are risk-adjusted based on administrative claims data. Risk-adjustment is a statistical procedure to take into account the diversity in complexity and severity of disease among patients so they can be compared.
Physicians know that risk-adjusted claims data are of dubious value because they themselves are often the reluctant data entry clerk in the byzantine scheme that starts with adding diagnostic items to the medical chart and ends with generating a coded billing claim for Medicare.  Needless to say, there’s a huge potential disconnect between what a claim attempts to convey and the actual condition of a given patient.
Yet another major problem is that the risk-adjustment employed by the HRRP does not take socioeconomic status into account, when that is arguably the single biggest driver of poor outcomes and of hospital readmissions.  The creators of the HRRP program seem to believe that a hospital located in poor area shouldn’t get a break for having high readmission rates, perhaps because they believe that hospital systems in general should be mindful of health inequities and address “care gaps” (differences in care provided to poor vs. affluent patients)  in their neighborhoods no matter what.
Finally, the initial out of the gate benchmark for readmission rates on which the HRRP would adjudicate the need for a penalty was a national average.  In such a scheme, a Johns Hopkins Hospital serving inner city Baltimore could be pitted against a regional hospital in rural Montana with an entirely different patient demographics.  This made the regional hospital in Montana very happy.
Gaming the metrics
Regardless of these technical considerations, it is an adage of social science that any metric will be gamed, and healthcare is unfortunately not immune to that law.
One tool increasingly used by hospitals to comply with Medicare payments rules is to admit patients to short stay units, under so-called “observation status.”  Another is to put pressure on emergency departments to avoid readmitting certain types of patients.
So, instead of primarily functioning as a triage operation where sick patients would be turned over to the care of the cardiologist in the hospital, the ER has been increasingly housing and managing heart failure patients to save the hospital money.
But the ER physician or the hospitalist supervising the short stay unit and who just meet a patient in the setting of an acute illness are poorly equipped to know which heart failure patient to discharge after a diuretic dose and which to keep for advanced heart failure therapies.
Source: MedPAC’s June 2018 Report (http://bit.ly/2CXD0fJ)
Nowadays, the cardiologist is increasingly insulated from those decisions.  I have personally experienced with alarming frequency instances where I learn only after the fact that a complex patient of mine has been treated for heart failure in the ED.
And my experience seems to be shared by many of my cardiology colleagues, especially among cardiologists who work in academic centers that are most affected by the policy.  Luckily, some of them are also clinician-scientists that can do more than just whine to colleagues about the new policy.  They can also study its outcomes.
What do the outcomes data show?
In a pivotal study, a group of cardiologists (Gupta et al.) saw that the drop in readmissions that followed the introduction of HRRP was unfortunately accompanied by a reversal in the decade long downward trend in heart failure mortality. This reversal suggested a serious potential harm from the policy.
But the possibility of harm was quickly challenged by another group of researchers led by one of the biggest names in health policy: Harlan Krumholz, a cardiologist who directs the influential Center for Outcomes Research and Evaluation at Yale University.
The Krumholz group analyzed millions of Medicare claims data from 2007 to 2016.  They also found that mortality for heart failure patients increased, but concluded that no causal link between decreasing readmission and increased mortality could be established.
Krumholz at al. noted that mortality rates for heart failure started climbing before the HRRP program was announced and they noted no inflection point in mortality rates with the policy announcement in 2010.  The evidence for their claim is highlighted in the table below:
As can be seen in the boxed row, Krumholz’ team concludes that the increasing mortality slope post-HRRP is no different from that pre-HRRP because the change did not reach statistical significance at the obligatory and arbitrary P<0.05 level.  The actual P-value was 0.11 and the confidence interval for the positive increase in mortality slope of 0.006 is (-.002 to .015).  Even poor students of epistemology would be loathe to conclude this result excludes a signal of harm.  It seems entirely plausible that, with all the limitations of the data set in question, mortality may in fact have accelerated after the institution of the HRRP.  Yet Krumholz insists that no signal of harm is to be considered.
But this did not stop another group of cardiologists (Wadhera et al.) from adding their contribution to the HRRP literature. Using the same data-set that the Krumholz group used — Medicare claims data — these researchers found once again that accelerating mortality coincided with the announcement of the HRRP.  More troubling, they also demonstrated that mortality rose primarily among patients not readmitted to the hospital.
A messy science
Admittedly this whole business of analysis is incredibly messy, with a number of moving parts.
My brief summary doesn’t do justice to a variety of maneuvers taken by the various groups to account for many of the limitations inherent in this type of study. Two of the competing analyses (Krumholz, Wadhera) used Medicare claims data while the other (Gupta) used a more limited voluntary registry.
During the time period in question, there were also other policy changes such as the introduction of new hospital billing codes (MS-DRG) that sought to adjust hospital payment rates to patient complexity. Better patient coding meant higher reimbursement from Medicare.  Armies of “documenters” were then employed by hospitals to capture more revenue.
This means that the claims data gathered by the researchers might look significantly different from one time period to the next even if the patients themselves were ostensibly the same. As the readmission rate is risk-adjusted, it is eminently plausible and likely that systematically upcoding patient risk could actually have been the primary driver of the drop in hospital readmission rate.
The other program playing a confounding role is the Recovery Audit Contractor (RAC) program begun in 2010 to reduce payments for inappropriate hospital admissions. Hospitals responded to denials for inpatient admissions by expanding ‘observation status’ stays. Which was the biggest driver for expanded observation stays? RAC or the HRRP? Once again an exact attribution is impossible.
Denying the obvious?
Despite the messiness of the data and the variety of analytic methods used, a consistent and uncontested observation remains: Heart failure mortality has increased in the last decade. The question being hotly contested is Why?
Oddly, Dr. Krumholz is steadfast in denying the possibility that the policy may have caused harm, even though the independent and contradictory conclusions from the other research groups at least raises a reasonable doubt.  And Dr. Krumholz has been quick to cast shade on research that does not conform to his conclusion.
By tweet he appears to ask for a level of detail his own papers lack, and he questions the legitimacy of another group’s data-set, all the while resisting any calls to put the program on hold despite the paucity of evidence showing benefit, the signal for harm, and perhaps most importantly, the concern of clinicians who see a mechanism for harm.
Greatly admire @rwyeh and his group…appreciate his focus on readmission &public policy. For such high-profile article, really need more info about statistical weighting. Methods should be sufficient so others can reproduce results. Can’t do that here. Look forward to more info.
— Harlan Krumholz (@hmkyale) December 21, 2018
Can you account for why the registry you used had, on average, such a small number of patients per site. Did you determine how many patients coded with heart failure by CMS were in the Registry? Just curious about the selection. It may not explain your results…but is a question. https://t.co/WSvJAN8Jjd
— Harlan Krumholz (@hmkyale) June 2, 2018
Dr. Krumholz also places much weight on an independent analysis carried out by MEDPAC which concluded there was no link between policy and the uptick in mortality. This particular conclusion rests heavily on the assertion that heart failure patients in 2016 were much sicker than patients in 2010. Recall that this coincides with a period of more intensive coding over the same time frame, so it is impossible to say this with any confidence.
The MEDPAC conclusion also relies on an analysis that finds no correlation between hospital level readmission and mortality rates.
While technically true, that conclusion overlooks that a large number of hospitals exhibited reduced readmission rates and increased mortality. Perhaps MEDPAC feels that patients dying at low readmit/high mortality hospitals should be mollified by the knowledge that somewhere there’s a low-readmit/low mortality hospital to balance things out?
That Krumholz and MEDPAC display such certainty about the direction of the signal they observe, and take pains to discount other possibilities seems strange and suggests that pre-existing biases may be at work. What might those biases be?
Conflicts of interest: You get what you pay for
In a world where heads roll for undisclosed personal financial conflicts of interest, it is remarkable that the current dispute, while full of scintillating exchanges about “propensity weighting” and other arcane points of statistics, does not reference any other potential conflicts at work that might affect the conclusions being reached.
Medicare’s decision to start the HRRP program didn’t come in a vacuum. It was inspired by years of research from Dr. Krumholz himself, who suggested that preventing admissions should be a goal for any policy that would aim to move the system from one paying for “volume” to one paying for “value.”
As far back as 2003, Krumholz held the view that:
“Hospitals may not support programs that improve the quality of care delivered to heart failure patients because these programs lower readmission rates and empty beds, and therefore further diminish already-declining revenues.”
If Krumholz’s unfavorable and crudely simplistic view of the operations and motivations of hospitals (and of the still relatively independent physicians staffing those hospitals) informs his position on health policy, it stands to reason that serious blinders would prevent him from seeing any evidence of harm in a particular policy that promotes the same view.
But that’s not all.  Krumholz’s group at Yale received grants from CMS under the auspices of the Measure and Instrument Development and Support (MIDS) program to study and produce the metrics and instruments needed to devise the readmission measures.
The MIDS program supports the “development and use of clinical quality measures which remains a critical healthcare priority and the tool of choice for improving quality of care at the national, community and facility levels” and it allocates $1.6 billion dollars to this purpose.
Thanks to a bipartisan act of Congress, a helpful little website, usaspending.gov, provides contract level detail about payments made to the Krumholz’s group from the MIDS program.  Those payments can be seen in the table below:
The numbers are staggering. I know little about how to interpret these data about federal contracts, but it sure appears that the Yale-New Haven Health Service group led by Krumholz has received $144 million dollars since 2008.
Yet the only clue to these payments in Krumholz’ published analyses of the HRRP program comes in one disclosure sentence in a footnote, as seen here:
It seems to me that the disclosure is hardly proportional to the amount of funding that his group receives and understates the inherent pressures it must be under to demonstrate that the policy did not actually result in higher mortality.
And recall that MEDPAC’s “independent” analysis that also rejected a policy-mortality link came from the organization that recommended the policy to begin with.  The bottom line is this: There’s a tremendous amount of face to lose and a massive source of institutional funding at risk if the policy is found to be harmful.
It now becomes more clear why, in the following tweets, Dr. Krumholz feels that only he can say anything definitive about readmission rates and mortality:
Um, @JAMA_current, even the authors say they cannot say their findings are causal… "but whether this finding is a result of the policy requires further research.” Why do you promote the paper as proving harm? Need to treat twitter like you do any of your Editorial comments. pic.twitter.com/xugasHvPWY
— Harlan Krumholz (@hmkyale) December 26, 2018
6/Hospitals that have improved their readmission rates tended to improve their mortality rates. Published in @JAMA_current… https://t.co/R7FXLwTMPp
— Harlan Krumholz (@hmkyale) December 22, 2018
A diversity of biases
Biases are ubiquitous.  When I was a cardiologist-in-training, spending hours on the hospital consult service for a fixed salary, I vividly recall looking for ways to avoid doing any work I considered unimportant or banal: The minor cardiac enzyme leak in a patient with a widespread infection; The extra heartbeats on the ECG that the ER physician didn’t like the look of; etc.  “Are you sure you need an official consult?”  “The chances we’re going to recommend doing anything about a small enzyme leak in an 80-year-old with a severe lung infection are very low… “ I was even successful sometimes.
Contrast these comments to my demeanor in private practice where I am acutely aware that my income relies on such consults: “I just need the patients name or room number…” “I’ll take care of it!…” “I can put in the orders if you’d like!”
But there are other biases and incentives that motivate human beings, apart from personal financial incentives. Do they pale relative to the financial ones as is so often claimed? How does one begin to quantify them?
When it comes to the HRRP policy, no individual person’s bank account ballooned every time a patient didn’t get admitted. And yet this is a story of ideological bias that drove the design of policy and now claims ‘success’ for its own program.  The HRRP saga is illustrative of the importance of non-financial bias and of the dangers of blinding ourselves to that bias.
The story also highlights the downsides of tweaking healthcare systems that were built to deliver more care.
Clearly, I personally have a direct financial conflict of interest to provide more care. Since I haven’t talked anyone out of a consult in 8 years, I’m probably guilty of participating in a system that detractors appropriately criticize for promoting overuse of healthcare.
But the problem is that some of those consults I was trying to avoid as a fellow ended up really needing a cardiologist. There was the 55-year-old Cambodian woman admitted to the medical intensive care unit with pneumonia who went into atrial fibrillation. I recall rolling my eyes and thinking that the ICU could certainly handle this without a cardiologist. It turned out she didn’t have a pneumonia. It was pulmonary edema from heart failure related to undiagnosed rheumatic mitral valve disease. She had been in the wrong unit. She needed diuresis, heart rate control, and eventual surgery to replace her valve, not antibiotics. Less isn’t always more.
Attempt to reduce inappropriate hospital admissions? Get ready to pay a price.  To contradict Dr. Krumholz, it is entirely probable that we are underestimating the upside of our current system when we contemplate changing the status quo.
We are underestimating the downside of our current system when we contemplate change. We need to take some risks to do better. #abimf2013
— Harlan Krumholz (@hmkyale) August 5, 2013
Final Thoughts
Ironically, the HRRP quagmire offers a number of clarifying lessons.
Empiricism in social policy is a subjective enterprise. The often parroted conclusion is that cold, hard, unbiased evidence trumps the biased, unmeasurable judgment of clinicians. Yet, frequently, real world data-sets are complex, the choice of analytic paths can be highly variable, and the instruments to measure success are often imperfect. As it relates to HRRP, which analysis should we trust? The choice requires faith. And if the currency here is faith, perhaps the concern of clinicians at the bedside has more value than advertised.
Metrics won’t save us. The narrative of metrics is an appealing one that promises hard and objective accountability. The problem comes when the metric (readmission) becomes disconnected from outcomes that actually matter (death). False and blind prophets are good descriptors for those who claim to be unable to see without metrics. The fools in this enterprise are easy to identify as those who think the answers lie with ever better metrics.
Conflicts of interest: Going beyond the simple narrative.  Focusing on biases induced by personal financial interests is a mistake. Personal enrichment is just one bias in a sea of conflicts. In the healthcare context, financial disclosures—while clarifying in themselves—may simply give cover to other, more perverse biases, unless those other biases are equally disclosed.  It requires diligence to ascertain the impact, and direction of bias.  Rarely do we get the opportunity to observe the direction of bias in policy research.  In the case of the HRRP, the presence of bias was made evident because research groups with opposing biases (clinician-scientists versus policy wonks) have reached conclusions that would be expected on the basis of those pre-existing biases.  How often is the problem of such bias examined in the design, implementation, and analysis of health policy?
Beware of technocrats with all the answers.  I am reasonably sure that if practicing clinicians would have been asked to devise a rule to reduce heart failure readmissions for the whole population they would have refused. It seems too challenging a task to get right.  Even if clinicians can be induced to participate in the design of such a policy, most would readily acknowledge the likelihood that it could harm some patients. It requires a special type of hubris to design a policy and refuse to acknowledge its potential for harm. Unfortunately, hubris within a public health community that believes only they can give us a better health system is more feature than bug.
As for Mrs. C, she has been home for 16 days. All fingers on both hands are currently crossed.
Anish Koka is a cardiologist in private practice in Philadelphia.  He can be followed on Twitter @anish_koka. This post originally appeared here on The Accad & Koka Report. 
Commissioning Healthcare Policy: Hospital Readmission and Its Price Tag published first on https://wittooth.tumblr.com/
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