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amaryllist96 · 2 years

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Red Shoes

Emma was in tears as he opened the door. He had heard the tap-tap-tap of the red shoes dancing their country two-step up the street and had turned away from the window, afraid. But now she was here; there was no turning away.

“Cut them off,” Emma said. She was covered in sweat, her tongue lolling out of her mouth as her feet jerked from side to side. He sent up a silent prayer that Theo would stay out in the forest until it was over and done with.

  He was the executioner as well as the blacksmith, so he had cut a respectable number of limbs in his day. Of everyone in the settlement, he was by far the most qualified. But this was no murderer, no rapist or highwayman terrorizing his neighbors. It was a child. It was Emma. And there was no way to make it hurt her less. He picked her up and set her on the table at the center of the room. Her feet kicked and flailed, clunking again and again on the wood. Maybe they would just stop moving on their own. Now. Now. In the back of his mind, he knew they wouldn’t. Magic had no boundaries to its cruelty. She was sobbing now, really and truly, and it was clear she had tried to pry them off herself: the red fabric of the shoes was wet and dark. He walked to the wall and grabbed his axe. He couldn’t shake, not even a bit. He owed at least that to her. He clenched and unclenched his hands, rubbing his wedding ring with his thumb like he always did when he was nervous. It was the most merciful thing he could do. There was no way he could turn her out, to die of exhaustion or thirst.

            He approached the table. “It’s goin’ to be okay. It’ll be over so fast, you won’t even see it comin’.” As if they understood, the shoes began to hit against the table harder, wilder, erratically knocking from side to side. How in the hell was he going to get a straight shot? Or, to ask the bigger question, how could something like this happen in the first place? Who had allowed his world to be so irredeemably awful?

            “It’s my fault,” sobbed Emma, “I should never have put them on. Nana said they were bad, but they were so pretty, they look like princess shoes…”

            He stopped her by putting a big hand on her shoulder. “Now hold on a second, young lady. This ain’t your fault. You went and put on some fine-lookin’ shoes; that’s all. You ain’t done nothin’ to deserve this.” He had to take a pause to straighten his voice out, turning his head away so he could make his face smooth and calm. Look confident. You know what you’re doing. He turned back to her. “Close your eyes, and keep ‘em closed.” He got two burlap sacks from under his workbench, tearing the first into strips so he could quickly bandage up the stumps. Setting them on the chair, he slid the other sack under her legs to soak up the blood. The chopping would have to be done on the table; the bumpy dirt floor couldn’t ensure a clean cut, and the workbench was too cluttered to clear off in a hurry. Theo would understand, about the table. Hell, Theo could probably make another one before the week was out if that needed to happen. He took a breath to steady himself, then grabbed hold of her little feet in his left hand and raised the axe in his right. The pain in his chest was excruciating. He blinked hard a few times, trying to get his head in the right place. Jesus. This was a mercy, wasn’t it? It sure didn’t feel right. He sure as hell hoped he was doing the right thing.

            The door banged open, and Theo strode in, whistling, his auburn beard rumpled into a smile. “Honey, that stand of oaks we – ”

            Emma’s eyes opened, but then squeezed shut again. He held the axe aloft, frozen. Wait outside, he mouthed. Don’t watch.

            Theo set down his pack, shut the door, and walked over to him. “Burden shared’s a burden lightened. That’s what I signed up for,” he whispered. Everyone knew about Emma. It wasn’t hard to guess what was happening, nor why. He wanted to say no. He wanted to shield someone as dear to him as Theo from the scene to come. He was the law-man, the protector.

       Instead, he could do nothing but nod, and Theo reached out to steady the shuddering feet.

* * *

Theo was seated at the workbench, carving. Normally when he was carving, he whistled something cheerful, loud enough to be heard from the pond out back. Now, he sang, low and soft, and when John listened in he discovered that he couldn’t understand the words. It was a weird melody, too, one of those ones that doesn’t go where you think it’s going and has all kinds of melancholic goings-on.

“What are you singin’?” he asked after an hour or two.

Theo paused, both with the carving and with the singing. “Witch song,” he said.

“Witch song? How come you know a witch song?” He got up and walked over to Theo, standing over him even when Theo gestured to the other rough wooden chair.

“My grandmother taught it to me. Thought it couldn’t do any harm and might –”

He exploded. “Couldn’t do any harm? You just witnessed the exact kind of harm that sort of practice can do! Magic hurts people, and ain’t a soul I seen that it helped with no strings attached. There won’t be no singin’ of witch songs in this house. Thought you knew better’n that.”

Theo stood up, glaring. “This is my house, too, and you don’t get to tell me what I’m allowed to do and what I’m not. You can’t ever see the nuance in a situation, can you?”

“What ‘nuance’ is there to see? Magic ain’t for us. It’s got a mind of its own, and anyone who thinks they can use it for their benefit is a damn fool.”

“You can use it right if you know what you’re doing. Are you calling me a fool?”

“Yes, Theo, I believe I am!”

Theo leaned in real close to his face. He had never seen Theo angry, even after all this time, and he felt a cold fear shift inside him. Afraid of gentle Theo? He was losing his mind. The world had all gone upside down.

“John, that girl’s never going to walk again by human means. And you know the way it is out here in the territory. If she can’t work the mines or the forest, she’s going to starve. Everyone who comes out here’s in it for themselves, and that’s the real hard truth of it.”

“You’re flat wrong about that, and you know it. Theo, what’s that aunt who takes care of her do for a living?”

“Who?”

“Emma’s aunt, Theo. She’s a seamstress. Are you telling me she stiches with her toes? And how about Daniel the butcher? Why, you could set him on a stool and it wouldn’t affect his choppin’ arm none. So, unless you’ve got some deeper reason behind this, I say you throw those weird little doll feet out the window and trust in the natural way of things.”

Usually Theo was better at thinking on his feet, and he felt a little proud of himself that he had thought up a good counterargument right there on the spot. Theo looked at the feet, deflated.

“Aw, don’t look so sad about it. If you like the craftsmanship, we don’t have to throw ‘em out. Make two more and we can make a real creepy-looking chair,” he suggested.

“I already made her a promise.”

“What’s that?”

“I know she’d get along okay without them. I thought you wouldn’t get behind an emotional appeal, so I tried to think of a logical one first. Truth is, I went to visit Emma yesterday and we got to talking.”

“Without me?” They had visited Emma together most days since what they now called “the accident.” Usually he made a basket of little cakes to take along for her, tucking a flask of whisky for Aunt Catherine into the lining. Theo had many talents, but baking was not one of them. Emma didn’t talk too much while they visited, but neither did he. He respected that stoicism in her, especially for one so young.

“Yeah, without you. You were working on the commission for Lady Brighton and just kind of grunted when I said I was leaving.”

It was a terrific shortsword; he had twisted three metal bars and forged them together so that the spiraling pattern would only become visible when touched by the fog of the Lady’s breath. The commission money could go towards Hester’s mill, which had been damaged by the hail last winter.

“She said she wanted to be a dancer for the royal ballet.”

“She’s a child,” he said. “All children have silly dreams.”

“I told her I could help her.” Theo looked up at him, searching his face, but then addressed his further comments to the floor. “It was a stupid promise to make. I just wanted to make her feel better, keep a little bit of hope around for her. It’s not healthy for a little one like her to feel hopeless about life already. But it wouldn’t have worked, anyway; I don’t have a codex of spell symbols to animate the inanimate, and the only one around here who does is that dragon-woman up on the bluff. People say she’s got herself a magic staff with the old carvings.”

Theo sank into that fake lost-in-thought look he got, as if he truly did believe his idea was impossible. Fine. Let him sit there. There would be no magic, for Theo’s own sake not to mention his own. And a dragon of all things, the guardians of magical knowledge, the most magicky magicfolk around! The idea! To even interact with one might leave you cursed. This time, he would wait him out forever.

“Magic can’t be used without consequences,” he said. “I’m saving you from yourself.”

“If I prove you wrong, will you go get the staff for me?”

“Go ahead and try. And if you can’t, you’re making me that foot chair for my birthday.” He grinned and settled himself down on the workbench.

“Alright then. How old are you, John?”

“Seventy-three.”

“Do you think the average seventy-three-year-old hasn’t lost an ounce of muscle mass and doesn’t bear a single wrinkle?”

“That’s what livin’ out in nature does for you; the wild makes you strong. And I’m showin’ my age, I’ve got the gray hair to prove it.”

“Take off your wedding ring.”

“Why?”

“Do it! But brace yourself.”

John wrestled his wedding ring off his finger, and the second it cleared the last joint and came free, he gasped for air as his body deflated around him. His hands shook with a maddening perpetual tremor, his back ached on the unsupported bench, and his skin hung loose and spotted around shriveled muscles. He looked at Theo in desperation, but saw an even older man, wizened and hunched over, holding out his matching ring in a skeletal hand.

“We haven’t been cursed yet, old friend,” whispered the ghostly man. “Do you see the nuance now?”

It was late afternoon as he approached the cliff where the dragon-woman had been sighted. He had brought his old broadsword instead of his axe; a sword seemed more appropriate for a dragon situation. The cold mountain air leached through holes in his sweater as dark birds darted between the trees on either side of the pass, their wings loud and close. He turned the last bend and paused. There was a flat clearing at the edge of the cliff where the winds rushed in the sharp grass. The hulking form of the dragon-woman filled the usually empty space in the center. She sat with her legs crossed in front of her, eyes closed, her scales closer to the dark, scarred forest green of the rare elderly than to the gleaming bright green of the young. Beside her, a white violin lay in a golden filigree case. He wondered how she played it with those metal claws of hers. She’d have to be mighty precise.

The dragon-woman did not look at him as he approached. “Save your breath,” she said. “I won’t move, and I don’t kill people, so stop bothering me.”

“Please,” he said, “we ask for your assistance, to help a little girl.”

The dragon-woman’s eyes flicked open. She held him in her multi-colored gaze, saying nothing.

“They say you’ve got a staff carved with the old enchantments. Could you let me borrow it, or, um, look at it?”

“It’s not my staff. It belonged to someone I loved.” It lay strapped to her back, the bone of some giant animal.

“Alright then, ma’am, where can I go to find that person and ask for their permission?” He stared at the staff, suddenly horrified. “Unless…they’re not trapped inside the staff for all time like that old wizard on Nag Hill, are they?”

“No, do not be afraid. The magic did not destroy him. He left of his own accord.” She smiled at the empty air.

“Ah.” He paused. “I’m real sorry to hear that.”

“You have no reason to be. Life is a long exercise in learning how to say goodbye. We can’t blame all tragedy on magic, no more than we can blame all magic for tragedy.” She closed her eyes again. “Give me some time to make up my mind. You said it’s to heal a little girl?”

“Yes, that’s right.” He sat down in the grass and polished his sword with the rag he kept in his pack while she thought. At least she too respected silence. He called to her once to point out the sky, which shone with a brilliant pink as the sun fought for its last breath. He couldn’t see the sunset down in the hollow, where the trees made it always dim. She seemed pleased by it, but the glow from the fire in her throat cast odd shadows on her face as the dark crept around them, so he couldn’t be sure.

“You must like the solitude, seeing the world with only yourself to mind,” he said.

“I like it more and more as I grow older. It is a great deal more fun to travel the wide plains with nothing to account for, rather than sitting on a moldy hoard in one fixed spot. I tried it when I was younger, but I couldn’t stand the anxiety.”

Finally, she pulled the staff off of her back and handed it to him. “Keep it. I’ve learned everything from it that I need to know. In fact, good man, I’ve carried this staff for much longer than I should have.”

He held gingerly with two fingers, trying to touch as little of it as possible without dropping it. “I appreciate that. Uh, my name’s John, by the way. I live down in the settlement.”

She seemed looked confused, as if unused to people telling her their names, but then nodded. “Take care, John. My name is Constance. I’ll be leaving for the eastern foothills in a few days.”

“Safe journey.” He made the traveler’s benediction with his right hand.

“To you as well.” She signed it back, smiling. And here he had come expecting to slay a beast. He started home, the staff dry and heavy as it knocked against the earth. She lay back as he drew farther and farther away, and he imagined himself lying alone on the clifftop in undisturbed discourse with the heavens. A beautiful life. And lived by a dragon! He would not have believed it possible.

The countryside was growing dark as he walked along the wooded path toward home. It was a long walk, and he leaned on the staff heavily. Every so often, he thought he saw one of the symbols glow, but they were all dark when he looked. Why had Theo kept the enchantment a secret? Because he would have said he didn’t want it. He didn’t want it, even now. And Theo had known that, and had gone and done it anyway. And the magic must have made their lives easier. Happier, even. The dragon-woman may have been right when she said not all magic created tragedy. But he told Theo everything. He thought Theo had done the same. Theo, whose company he had preferred to all others for the past decades, Theo who had lit up his life. He twisted the ring on his hand. A great lie. Had he done it for their happiness, or for his own? After all, who would want an aging lover?

The cabin windows were lit with firelight as he returned panting from the woods. Through the window, he could see little Emma laughing for the first time in many weeks, propped up on a chair next to her smiling aunt. Theo was holding the wooden feet out to her, letting her hold them, laughing along with her. They both did their best, he and Theo. They both did what they thought was right.

He knocked on the door, and through the window Theo leapt up to answer, his face flushed and beaming. The door swung wide. He pulled Theo outside and shut it again. He handed him the staff. He handed him the ring.

“No…no, John, please, please John I can explain—”

He put a thinner hand, the back crossed with vein and bone, on Theo’s shoulder. “Calm down, it’s not forever. You have a promise to fulfill. Once you have, you can come and talk to me. There’s some answers I’ve gotta have.”

Theo nodded slowly. He buttoned the ring into his left breast pocket. Then he reached up and kissed John, a deep kiss that lasted as long as any. “I’m so sorry,” he said. “I did it when I was young, and then the years were going by and it got harder and harder to tell you.”

“We’ll talk,” he said, and pushed Theo back into their house. Once he heard him speaking inside, he walked slowly over to the old bench they had built under the oak tree and heaved himself down. He knew he wouldn’t leave. The time for all that was long past, and anyway, he knew he would love Theo until he died. He was no longer quite so worried. Emma would have feet, the dragon would leave, and they would still be there together in their little house. Magic could hurt people, and so could Theo. But so could he. So could everyone. He smiled in the dark and leaned back into the bench. Despite their best efforts, everything would be all right.

#fantasy #fiction

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amaryllist96 · 2 years

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Meningococcal Vaccines (MenACWY): The Inside Scoop 🍨

What’s up? Welcome back to another vaccine post. This week we're talking about Neisseria meningitidis, which is in my opinion one of the scariest bugs. I always think it’s weird that it doesn’t get a lot of press. I guess it's probably because it’s uncommon, but we always hear about those brain-eating amoeba cases and that’s even rarer. Anyway, N. meningitidis spreads best in crowded environments like dorms, which is why we give teens their booster dose before they go to college. Since some of you might be getting the vaccine or booster for school, I thought I would talk about it this week as we sit here on the precipice of August.

N. meningitidis causes a particularly severe meningitis, or infection of the tissue around the brain. It strikes young people who are otherwise healthy, and patients can progress from feeling totally normal to death in a matter of hours. Survivors may be left with brain damage, heart failure, deafness, and other serious complications. N. meningitidis incidence peaks in late winter, so its onset can be mistaken for severe flu, further delaying vital treatment. Patients feel normal, then suddenly develop fever, vomiting, headache, and muscle pain. A telltale purple rash develops in most patients, but not all. Hopefully it is abundantly clear why the vaccine was needed in the first place!

There are several formulations of the meningococcal vaccine, but the main ones – Menveo, MenQuadfi, and Menactra -- cover the ACWY serogroups. They are associated with the classic vaccine side effects you have come to know through these posts: injection side tenderness, fever, fatigue, and headache. Teens and young adults are more likely to faint after vaccination due to their highly active vagal response, so we usually have them sit for 10-15 minutes after receiving it. And that’s pretty much it for this one. There was some concern about an association between Guillain-Barre and meningococcal vaccines, but like with Tdap, large safety studies found no connection. The meningococcal vaccines, in conclusion, have an excellent side effect profile and prevent a high-mortality disease, giving them the most obvious risk-reward balance of those we have covered. Make sure you and those around you are protected, and have a great school year 😊 I’m amaryllist, and this has been your Inside Scoop!

#vaccine #meningococcal

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amaryllist96 · 2 years

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Tdap: The Inside Scoop 🍨

Hey gamers, I’m back again with another vaccine info post! This time it’s about Tdap, which you still have to think about because you need the Td booster every 10 years to stay protected. But as always, I think it’s important to know what you’re being protected from, and why in my opinion Tdap is a great choice. Let’s get into it!

Tdap is an acronym for tetanus, diphtheria, and acellular pertussis (aka just pertussis; I think they just wanted the “a” in there so you can say Tdap as a word). Tetanus is caused by a bacteria that lives in the dirt; people often get it from puncture wounds while playing or working outside. Once inside the body, the bacteria attacks the nerves, causing incredibly painful muscle contractions and spasms. These out-of-control muscle spasms can cause the victim to suffocate. Even if they survive, the nerve cells take about a month to regrow, meaning a month in the hospital to control the spasms until then. The bacteria causing tetanus is everywhere in our environment, and even a small cut can allow the dirt and grime it lives in to enter the body.

Diphtheria is also a bacterial infection, but unlike the endemic tetanus, it has been eradicated in the US thanks to this vaccine. It’s basically a worse strep throat. The back of the patient’s throat gets coated with this gray, thick bacterial membrane, which can make breathing difficult, and the patient’s lymph nodes in their neck swell severely, leading to a characteristic “bull neck” appearance. In severe cases, the toxins created by the bacteria can attack other organs and lead to death. Although the US sees less than 1 case per year now, diphtheria is still active in other countries like India and Vietnam, and inoculation is still needed to keep up herd immunity.

Finally, pertussis, better known as whooping cough, is by far the most common of the three; 2019 saw over 18,000 cases in the US. The bacteria causing pertussis acts on the lining of the respiratory tract, causing it to erode and slough off. This can lead to literal months of coughing. China calls pertussis “the 100 day cough” and they aren’t kidding. And it’s a bad cough. Paroxysms of coughing and then gasping for air lead to the characteristic “whooping” sound. My friend in college broke her rib from coughing so hard. Trust fam, don’t catch this one!

So, as usual, time for side effects of the vaccine. Are you ready for this craziness? Headache???? Unbelievable. No but I’ll be serious, the most common side effects are headache, pain/swelling at the injection site, and fatigue. We usually ask people to stay seated for a few minutes after receiving this shot because it’s a big boi and there’s a fainting risk. Rarely, people will develop more severe swelling or necrosis at the injection site, which is called an Arthus-type reaction. This generally goes away on its own, but if you develop this, you may want to meet with an allergist so you can figure out what component of the vaccine your body reacted to so you can avoid it in the future. There was some worry that Tdap could rarely cause Guillain-Barre syndrome, a type of temporary but debilitating paralysis, but this association was not shown upon further study.

Tdap, in my opinion, has an even better side effect profile than MMR, which we talked about last week, and both of them prevent awful diseases. It seems like a truly easy calculus to choose Tdap to protect yourself and your family. Next week, look forward to an in-depth discussion of meningitis and the meningococcal vaccine. I’ve been amaryllist, and this has been your Inside Scoop!

#vaccination #tetanus

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amaryllist96 · 2 years

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The MMR Vaccine: The Inside Scoop 🍨

You probably all know the story by now: the one about how Andrew Wakefield, now exposed as a fraud but at that time a British physician, published a 1998 paper suggesting that the MMR vaccine was associated with autism. As a medical student in my last year, I’ve heard and read this story in all of its iterations. Frankly, I’m tired of talking about it. It frustrates me that Wakefield and his corrupt “research” still dominates the discussion of MMR, so much so that if you search “MMR vaccine” in PubMed, the first search results still are talking about autism over two decades later. I wanted to actually learn why we get the MMR vaccine, what it does instead of what it doesn’t do (for anyone still not sure at this point, I doubt I’ll change your mind, but here goes: MMR doesn’t cause autism). Are you curious, too? Cool. Play with me in this space for a few minutes.

The MMR vaccine was put together from existing immunizations in 1971 by Maurice Hilleman, who also made over 40 other vaccines; the guy’s like a real life Dr. Crusher in Star Trek. In the last decade alone, it has prevented around 25 million deaths worldwide. Now you might ask, as I did, wait, how do you die from measles or mumps? Didn’t those used to be common childhood diseases? And you’d be right; they did! Usually kids end up with a rash (measles, rubella) or cheek swelling (mumps) and feel crappy, and then they’d get better. However, measles and mumps can sometimes cause encephalitis, meaning the infection spreads to the brain. That’s the part that can be fatal. Measles can also cause a rarer type of encephalitis 7-10 years after the infection called subacute sclerosis panencephalitis, and SSP is universally fatal. All of this is rare, mind you. But there are 73 million kids in the US, meaning that even though brain manifestations of these diseases are about 1/1000, 73,000 kids would develop these dangerous conditions. For context, 73,000 would be like if the whole city of Alameda wound up in the hospital with brain infections. Encephalitis prevention is the main reason we need the MMR vaccine, and the reason it alone has prevented literally millions of deaths.

So what’s up with the R? Rubella is generally mild, but can cause devastating fetal damage if a pregnant person catches it. The fetus can have heart malformations, congenital cataracts, deafness, and other health problems. That’s why rubella gets included in the MMR vaccine. Rubella has also been declared eliminated in the US, so hopefully you never see it.

Now, the part you’ve been waiting for: the side effects. The real, actual side effects of MMR. Well first of all, don’t get the MMR vaccine while you’re pregnant! Hopefully you were immunized as a child, but if you are pregnant now and interested, the rubella in the vaccine could cause those fetal anomalies I just talked about, so hold your horses until after the delivery. Otherwise, the side effects are…not very exciting. Some people get a fever after the immunization. Some get a rash, or joint pain, or swelling of their lymph nodes, none of which lasts very long. If you’ve gotten your COVID vaccine, you know the deal. One scary-looking but benign side effect is that the MMR increases the risk of febrile seizures from about 6-14 days post-vaccine. That means if your child gets the MMR and then a kid at daycare gets them sick, they could have a seizure. However, febrile seizures are not associated with developing epilepsy or other seizure disorders, and at baseline between 2% and 5% of children have a febrile seizure unrelated to the MMR vaccine during childhood. Finally, there is a low risk of developing a temporary platelet disorder called ITP after the vaccine. However, measles, mumps, and rubella are more likely to cause ITP than the vaccine, so the vaccine actually lowers the rate of ITP.

If you want to know more about measles, mumps, or rubella themselves as diseases, the CDC has some great free information about them. I hope this post makes plain the risk/benefit calculus of the MMR vaccine, so you can make an educated choice about it. If you liked this MMR run-down, follow me on Twitter @almost_beck for smaller chunks of health info, and follow this blog for more vaccine-related deep dives. I’ve been amaryllist, and ~this was your Inside Scoop~

#vaccine #virus #science

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