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anastasiaskarsgard · 5 years

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Link to my masterlist for earlier chapters or other stuff I've written

His Queen

Part 3

Bri ripped open the letter, amazed it was handwritten and in cursive! Knowing Roman, he had an assistant write it, but she felt a warmth in her chest knowing he’d truly loved her all along.

To My Queen, Briana Godfrey,

(Admit it! That sounds way better than Tucker, have the lawyers change it.)

Oh, and before I get into it, I wrote this myself. No assistants, so fuck you for thinking it.

Bri smiled a sad smile at how they still knew how the other thought.

I have to start off by saying thank you for reading this letter. That means you're at the white tower. I don't deserve you. I've turned into everything I never wanted to become. Everything you made me believe I could escape. You are the light to my darkness and I'm so sorry I disappointed you. I don’t have a lot of time, but I needed a plan in case I fail. You’re the only person I trust with my company, my money, my daughter, my legacy, my heart, all of it. I am an absolute crack head level blood addict, and I couldn’t trust myself when we got overly emotional to keep my head. Because I love you so much, you can make me so upset, and That last fight we got into, I scared myself. I don’t blame you for slapping me, but to hold back from returning the blow, I literally broke my own hand... but this is not what this letter is about.

Peter and my sick half-sister Annie have stolen my daughter. Peter is hell-bent on destroying me because he killed Destiny's trash fiance, and lied about it, so she blamed me and attacked me and I hurt her bad enough to foresee issues with peter, so I broke her neck to avoid problems figuring it was showing her some mercy since she was heartbroken. Annie was there and when I refused to carry on an incestuous relationship with her, she turned on me and told Peter about Destiny. So he came after me and fucking shot me, we fought and I won, but didn't cut his head off so I knew he’d be fine. Well, he calls me and has my kid and won't turn her over, and says he's going to kill me so even though I doubt it, Nadia needs someone to raise her, and if I'm killed it's not my whore of a sister Annie. I need you to find Nadia and take her home and raise her as she deserves. She’s such a sweet baby and she adores you.

Find Shelley and she can help you maybe. She’s in love with this weird old poet and chooses to live at the old steel mill. Calls it Rooster Poop. Can’t make this shit up.

The entire security team is trying to find Nadia, so contact them and see where they’re at with it.

you are the love of my life and I refused to ever say so, even though we both knew it was true. I would bullshit and say it’s cuz I was saving you from myself, but I’m not that fucking noble. You scared me more than anything ever scared me in my life. God, it's great to admit I love you. Like I need to make up a new word for how I feel for you cuz love isn’t strong enough.

there’s a pretty poem I saw that reminded me of you;

I’d still choose you.

In a hundred lifetimes,

in a hundred worlds,

in any version of reality,

I’d find you and I’d choose you.

Even though I knew you were going to break my heart again and again.

I’d still choose you.

It’s crazy how happy I am writing you a letter, even with every aspect of my life in shambles, you’re my light.

You get everything. Fuck all of them. You were right about everything. If I survive this shit, I am winning you back if it takes 100 years and I have to spend every cent. This is literally a reset.

I tried to forget your baby girl but I never could. No amount of drugs, money, blood, or bullshit could ever distract me from the constant ache in my heart for only you. You’re the only pussy I ever wanna see again. I ran thru a fantastic amount of pussy after you left and none of them made me forget you for even a moment. I pictured you or I could not get off. It was pathetic. I hope I get to see you again and rip up this fucking letter.

I looked back over this and there’s a reason I have other people write shit up for me. A few requests to seriously consider:

-->Blitzky should take over for Pryce. Not only is he a genius, he's a good guy. He's a bit soft, so you may have to be the bad guy.

-->Get a new nanny. The current one looks good on paper but she's an idiot.

--> Live in the white tower. It's secure and safe and you can make as many floors as you like home.

--> if an animal killed me, it's Peter and he's still a wolf. He’ll be white. Kill him, cut off his head and burn him up in the incinerator.

--> if Annie comes around at all, kill her. She's very manupulative and acts religious and nice. She's crazy and not to be trusted.

-->try and convince Shelley to live in the mansion and have her little homeless community there. She doesn't care about money but she cares about people, so offer it as a safe haven. Make sure it stays stocked in necessities like toilet paper, soap, cleaning materials, etc and write it all off as a charity contribution. Make the whole endeavor a big tax write off, but don't tell Shelley that part. Just tell her it was my dying wish she had a home.

--> the loser she's with has legal problems. Have the legal department solve them so he's got no reason to desert her.

-->if Peters mom comes sniffing around, don't tell her a damn thing. I doubt she will tho, she's a wanted fugitive.

--> don't trust any gypsies.

--> Nadia is very intelligent. She can read minds, influence dreams, and kill anyone or anything just by looking at them. She's dangerous and shouldn't be allowed around animals or people until she can understand the concept of death and consequences. There's no way to control her, I have found.

--> I promised a homeless man I ate that id pay for his sons school. Anonymously pay for Mathew Shandwicks classes, books and dorm at Penn State for all 4 years. His father traded his life without a single complaint so it's imperative you keep my word.

-->make sure Nadia isn't a spoiled brat like me. Teach her about her mother and her father and all the good things about us. Leave out we were related if you can swing it. Just say we were young and loved each other very much. I enclosed a pack of photos of me and Letha for her.

I wonder what you’re wearing... That reminds me; if I’m really dead, you have to be in mourning at least two years. That means all black suits and dresses that cover you up, black nails, big black hats like you just left a Catalina Yacht Mixer or you’re going to a royal wedding. I even got you black lab coats just in case.Don’t half ass this. It’s important.

Also I want “Fuck you” by the Archives played at my funeral, if it comes to that.

Hopefully, you never see this letter because I got everything fixed here, and went and found you and you ran into my arms and we lived happily ever after, and I have a whole lifetime with you... But just in case...

All my love,

Roman Godfrey

P.s. - since you're a genius, hopefully you can fix me or bring me back. I hope you still love me even 10% as much as I love you, because then nothing can stop us.

Brianna stared at the page as her tears fell on it swirling the ink in designs and spirals. She knew he’d always loved her, but it was bittersweet seeing him finally admit it. She took the photos out of the envelope and looked through them.

Looking through the pictures was heart-wrenching. There had to be a way to fix all this! She tried to remember everything she’d learned about Upirs from that dreadful Russian women and Pryce. Luckily they’d been a bit of an obsession for her that she delved into when Roman pulled his shit. Being obsessed with Upirs had distracted her from obsessing over the real issue.

Just as she started to wonder when Mueller and Edwards would be back, as if by magic, the elevator doors opened. They had brought Dr. Blitzkey with them as well.

“Oh my gosh! You’re alive! I’m so happy to see you’re ok and still here!” Bri said as she ran up and embraced Blitzky. “Where is Roman? I need to see him.”

Blitzky looked at the ground nervously before meeting your eyes. “It’s not fixable.”

“No matter. I just NEED to see him. Please?” She begged.

“Okay. He has several severe traumatic injuries so please prepare yourself for that.”

“What happened to him?”

“Some Type of animal attacked him in the old mansion and pushed him out the upper story window, fracturing his spine and neck which most likely left him paralyzed and vulnerable. His throat and heart were then ripped out.”

“Peter.” Bri said darkly. He was going to pay for his betrayal. She would make sure of that.

“I mean that’s the most logical conclusion but after all Roman did for that little degenerate, ” Blitzky muttered.

Bri nodded solemnly.

“Hate to interrupt your happy little party but we have several forms that need immediate attention, to get this shit show back on the road,” Edwards interjected.

“They’ll have to wait till after I see Roman. You lead the way Blitzkey, you two stay here.” She said firmly stepping into the elevator with the doctor. Both lawyers looked furious but did as they were told since they were honestly intimidated by this young woman that had all this piled on her, and seemed unfazed.

As soon as the doors closed she sank to her knees and screamed. The tears came flooding out of her eyes as her body was wracked by sobs. It’s like she’d been hit by a truck. The realization that Roman was really gone finally sinking in.

Blitzky didn’t know what he should do. He was a genius, but completely clueless when it came to social and interpersonal skills. He hesitantly patted Bri on the head like a golden retriever, unsure how long was comforting so he just kept doing it. “You’re strong.”

Bri glanced up at Blitzky through her foggy tears and couldn't help but agree. She WAS strong.

The elevator opened to their floor as she looked down at the floor.

“Well” Blitzkey peeped, unsure of what to do, “this is it.”

“We have to fix him Blitzkey. There’s got to be a way.” she said rising to her feet, as if the little display he just witnessed never happened.

“You’re the boss.” Blitzky said as cheerful as he could muster.

“I’m giving you Pryce’s position. I trust you.”

“Thank you! I wasn't sure if maybe you'd want to take charge.... What will you do? Take over for Roman?”

“Until I can bring him back, I guess I’ll have to. I will bring him back Blitzkey.... If I have to make a deal with the Devil himself.” Bri stated adamantly before setting off down the hall like a woman possessed.

#my writing

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i-will-physically-fight-you · 6 years

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Headcannon: Virgil sometimes dances around his room when he’s listening to music and nobody else is around

Title: Not A Chance

Summary: Virgil doesn’t dance. At least not compared to the likes of Roman, whose practically the embodiment of a Disney prince. That’s why he dances in his room by himself where no one can judge him and his terrible dancing.

Pairings: platonic prinxiety

Word Count: 1299

Warnings: Self-depreciation, anxiety because this is Virgil we’re talking about

My sincerest apologies to the dear Anon that sent this to my inbox, four months ago when I had my 100 Follower celebration. In any case, this was such a fun thing to write and a great reprieve from my big bang project so thank you for sending this in, and I hope you get a chance to read this.

“You can’t be serious!”

“I am.”

“You don’t like dancing? At all?”

“I don’t dance.” He affirmed, scowling as he crossed his arms against hischest.

“I know you can.” Roman said in a singsong fashion.

Virgil raised an eyebrow, “Why do I have a feeling that’s areference to some obscure musical?”

He could never tell when Roman was just being his overly-flamboyantself or when he was actually quoting something. It certainly sounded familiar, however.

Roman gave a dramatic gasp, a hand flailing upwards towards hisforehead.

“Obscure musical? ObSCURE MUSICAL?!” He screeched in disbelief,falling backwards onto the couch where Logan sat. The latter, used to Roman’s antics,sighed as he raised the book he was reading just as Roman’s head rested ontohis lap.

“Roman, please. I’m trying to read here.”

“Did you not hear what he said?” Roman said, pausing for amoment as he sat up, “Well, of course you wouldn’t understand, Einstein.”

“What’s with all the commotion?” Patton asked, grinning ashe brought in a fresh plate of chocolate chip cookies from the kitchen.

“It’s a travesty, Patton. An outrage!” Roman made a beelinefor the platter of cookies and picked one up, “He called High School Musical 2an ‘obscure musical!’”

Cookie in hand, he used it to point accusingly at Virgil likeone of his sabers. Virgil considered taking a bite out of the cookie just toget a reaction from Roman. Knowing Patton wouldn’t find it funny, he instead grabbeda cookie of his own to nibble on.

“Well it kinda is,” Virgil said, taking a bite intochocolatey goodness, “I mean, it wasn’t even on Broadway, right?”

“It is a Pop Culture icon, Virgil!” Roman huffed, “I supposeyou know nothing about it, since you only listen to your PG 13 rated music.”“Hey, that’s not fair, I don’t only listen to that type of music,” Virgil mumbled.

Roman perked up, “What was that?”

“I said, I listen to some musicals!” Virgil turned away, faceblushing, as he shoved the rest of his cookie into his mouth.

“Really?” Roman asked skeptically.

“Yes really,” Virgil smirked, “I mean, c’mon, even you have toadmit there’s some dark crap that goes on in musicals. Like Heathers or SweeneyTodd.”

Roman’s lips twisted upwards.

“I suppose you have me there, Sweeney Downer,” Roman relented,“but surely you can’t have a musical appreciation and not be compelled to moveto the rhythm of the beat.”

Dang, he’d hoped that Roman had forgotten about that mattercompletely.

“Sorry to disappoint, princey, but I don’t dance—not achance.” Virgil said, thanking Patton for the cookies as he scooped up two moreand walked off.

“So you do know the song after all!” Roman screeched afterhim.

A loud, raucous cackle echoed in the hallways.

Virgil didn’t dance. Not when compared to the likes ofRoman. He understood it. Roman, after all, was Thomas’ creativity, all hishopes and dreams. He was the ego—brash and confident in ways that Virgil couldnever be. While Roman feinted off his boundless energy with daring quests tosave damsels from the Dragon Witch, Virgil preferred to snuggle up in a blanketand listen to music.

It wasn’t just that, of course. Dancing had always beenThomas’ weak point in theatre, and Virgil suffered with the same struggle. Hestill enjoyed dancing despite it. He just preferred to enjoy it from within thecomforts of his room, away from peering eyes.

Yes, he knew by now that the others wouldn’t tease him forhis lack of coordination. But as the literal embodiment of anxiety, it was hardconvincing himself otherwise. What if Roman teased him relentlessly about hisatrocious dancing skills? That was the last thing Virgil needed.

He chose to keep to the confines of his room, where his audiencewas an assortment of stuffed animals. Several of them being gifts from Patton.He didn’t dance often, only when he felt his heartbeat racing. It made him wantto punch a wall, and since punching walls hurt a lot, dancing was a betteralternative. He lost himself in the music, as he physically projected what themusic meant to him.

A few weeks after the exchange with Roman, Virgil found himselfin such an occasion once more. Virgil took a deep breath before pressing playon his iPod, waiting for the vocals to start. As the singer’s wistful voicestarted, he moved. He channeled the subject of the song; a young girl wishingto escape her harsh reality through dreams.

He twirled and spun, jumped and leapt and he didn’t stopdancing until the song ended. Afterwards, he collapsed onto the ground in smiling,sweaty heap.

“So you can dance!”A triumphant voice exclaimed.

Standing at the doorway, hands on his hips, was Roman. Helooked beyond thrilled by this discovery.

Virgil shot up from the floor, stumbling over to his iPod toshut off the next song.

“What are you doing here?” He demanded.

Virgil couldn’t believe he forgot to lock his door or thefact he didn’t even hear Roman open the door. Had he even knocked? Or did Romanintended to burst through his door with exciting idea and instead caught him inthe act?

Roman’s smile slipped from his face, “Easy, there. Padre sentme here to tell you that dinner’s ready. I guess you were so busy dancing up astorm that you didn’t hear me knocking!”

Virgil groaned, “Just get on with it, already.”

“Get on with what?” Roman asked, his eyebrows furrowing withconcern.

“You know,” He gestured with his hand, “tell me how much mydancing sucks.”

“Virgil, what?” Roman blinked, “your dancing doesn’t suck,it was magnificent!”

“C’mon, you don’t have to act like it’s good when it’s not;I can take the heat.” Virgil refused to make eye contact with him.

A hand softly rested on his shoulder, “Virgil, look at me.”

He sighed and complied, startled to see an unusually grave expressionon Roman’s face.

“I promise on my honor as a prince that I meant it when I saidyou were magnificent.”

“You mean it?” Virgil asked, anxiety gnawing at his insides.

“Of course.”

“Thanks, I guess.” Virgil swallowed, unsure how to handle thecompliment. Their relationship was built off of banter and witty remarks. Not…whateverthis was.

“Virgil why didn’t you tell me you actually enjoyed dancing?”Roman hesitated, “were you afraid of me…making fun of you?”

He stood there not at all like a dashing, confident princebut more like a kicked puppy with that pitiful expression of his.

“Yeah,” Virgil admitted, “I just figured…you’d tease me aboutit.”

“I know you had good reason to assume that considering how Itreated you wrongly in the past, but know this,” Roman drew a breath in, “Iwould never tease you for something like this. I can see dancing is a passionfor you—a dream! And I don’t destroy dreams, I help nourish them!”

“Is this your way of offering me a dance lesson?”

“Only if you want one.”

Virgil snorted, “Wow, gee thanks, Roman. First you say mydancing’s great and then you offer to teach me. Which is it?”

Roman spluttered, “I do mean it! That your dancing is great,that is! I just—I just thought—”

“Relax, I get what you mean. I was just messing with you.” Virgilbumped his shoulder with Roman’s in a friendly manner as he strode past him, “Weshould get going to dinner. Patton and Logan are probably wondering what’sgoing on.”

“Er, of course. Onwards, we go!” Roman recomposed himselfbefore following after him.

“And Roman?” Virgil turned back to look at him, “I think…Imight just take you up on that dancing lesson after all.”

General Tag List: @fandergecko @yourhappypappypatton @alextheodd@cryingtitan @ultimate-queen-of-fandoms2 @usothemarshmallow @madly-handsome @i-just-wanna-be-alone @alagaesiasdragonqueen @ashrain5 @otaku-marijane @narniasfinestavengingsociopath @remy-alagaesias-dragon-queen

Platonic Prinixety Tag List:

@emokittenlikesgore @completelyclevername @urtrashhq @thegirlwiththedragonheart@tree4life25 @too-random-for-me @hissesssss @deathbyvenusftw @ill-interested @just-another-transblog @inkyroo@theanxietyofbeinganxious @panicatthefalloutphanficfandom @allthemetalsoftherainbow @depressed-alone @theroyalramen@rileyfirstname @hikariyukino @magicmapleleaf @pieces-of-annedrew @saphirestrike @asalwayss @romanssippycup@virgils-anxiety @redundant-statements-for-400 @skylagamingfea @clueingforblogs @ladynikitablack @fairly-close@vampyrsarah @haikyuupaladin @all-these-trees-stealing-mah-o2@migraine-marathon @samidaboss3 @proudhufflepuff@alextheodd @sandersfanders @pansexual-cat @hanramz-the-fander @anastasialestina @prplzorua @darude-sanderstorm@sanders-sides-shambles @thestoryofme13 @a-blog-just-for-sanders @trashfireiplier @the-optimism-of-the-ostriches@sanders-sides-things @callboxkat @kurna-kovite @221biotchplease @pattonly-absurd @starry-eyed-haiku-dreamer@prinxietypreoccupied @pattykrabbies @shygirl4991 @musicphanpie-b @superintrovertfangirl @silversunshine2012@lockolocka @makemeaplant @today-only-happens-once @koalaaquabear @catsandrandomness @rose-gold-roman@musicsavedmefromdeath @devastate-my-space @anachronistic-cat @heythereprincey @dudlebuggs @sanders-trash-4ever@spoonfullofcrofters @siriuswhiskers @thenerdycube @pinkeasteregg @notallpotatoesarefrenchfries @virgilisaneternalmood@multi-fandom-trash-x9000 @kirsten-the-freak @thepusheenqueen @artistictaurean @funsizedgremlin @pal-im-not-clever@poundland-twoface @logan-exe @thecrimsoncodex @unknownsandersfan @yourmomsafalsehood @robanilla @dementeddracon @ive-given-up-on-it @v-blue-writer @sassy-in-glasses @blazeimagines101 @sanders-fam-ily @trashypansexual @paxtonlovestea @lowkey-logicality @do-rey-me @hottopicvirge @rptheturk @candiukas @nottodaylogic@ffsas-side-account @shadow-walker-1201 @micha-like-you-find-in-rocks @milomeepit @grey-lysander @fricksonsticks@baileystarsketches @ace-of-hufflepuffs @voices-and-stardust @deadinsidebutliving @acechirou @ocotopushugs@datonerougecookeh @lana–22 @kentato-kenart @logically-sided @osnapitzbc @areyousirius-noheisdead @ruuworld@floatyghosty @kiwibite @theworldismysupernova @jughead-is-canonically-aroace @mercythemermaids-blog @pearls-of-patton@memesanddreamsinc @jade-dragon226-fan @mollycassmith @juvenile-changeling @ace-v-p-d @sesame-icecream@dreamerhowelll @nyxwordsmith @fireflighyt @roman-is-a-gay @reba-andthesides @thesilentbluesparrow @angered-turtle@fanatic564 @emovirgil @misc-merde @captain-loki-xavier @evilmuffin @k9cat @louisthewarlock @asterias-confused-writings@spacenerrrd @aph-roma @theworldismysupernova @highwarlockofhogsmeade @notveryglittery @cripplingchips @thats-so-crash @literaturegays @cinderlunarcyborg @anony-phangirl @savingshae @minamishipsit @faithhopefelony @smokeyrutilequartz@kfc-chickenyo @AskolotlQuestions @nymphaedoratonks @allaboutme713 @the-feels-are-coming @karalora @karmicmayhem@faacethefacts @radioactivebread @elvishfrenchassassin @ashbash-the-trashcash @thisisshien @angeliclogan @nightlovechild@virgil-is-verge @hoodie-bros @cinquefoilelove @iris-sanders-athena @ono-its-ryane @pensive-patton @roman-is-a-dramatic-prince @vulnerablevirgil @confinesofpersonalknowledge @thought-u-said-dragon-queen @muontsy2 @katesattic @planetsanders@erlenmeyertrashofsandersides @starlightlogan

#thomas sanders #sander sides #virgil sanders #roman sanders #prinixety #logan sanders #patton sanders #kat writes #I actually dont really care for high school musical #but dangit the songs are really catchy #and they throw me back into my childhood

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kristinsimmons · 4 years

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“Essential Oncology”: The COVID Challenge

By CHADI NABHAN MD, MBA, FACP

One harsh Chicago winter, I remember calling a patient to cancel his appointment because we had deemed it too risky for patients to come in for routine visits—a major snowstorm made us rethink all non-essential appointments. Mr. Z was scheduled for his 3-month follow-up for an aggressive brain lymphoma that was diagnosed the prior year, during which he endured several rounds of intense chemotherapy. His discontent in hearing that his appointment was canceled was palpable; he confessed that he was very much looking forward to the visit so that he could greet the nurses, front-desk staff, and ask me how I was doing. My carefully crafted script explaining that his visit was “non-essential” and “postponable” fell on deaf ears. I was unprepared to hear Mr. Z question: if this is his care, shouldn’t he be the one to decide what’s essential and what’s not?

This is a question we are all grappling with in the face of the COVID-19 pandemic. The healthcare industry is struggling to decide how to handle patient visits to doctor’s offices, hospitals, and imaging centers, among others. Elective surgeries are being canceled and advocates are arguing that non-essential outpatient and ER visits should be stopped. Ideas are flying left and right on how best to triage patients in need. Everyone has an opinion, including those who ironically consider themselves non-opinionated.

As an oncologist, these various views, sentiments, tweets, and posts give me pause. I understand the rationale to minimize patients’ exposure and thus prevent transmission. However, reconsidering what we should deem “essential” has made me reflect broadly on our method of providing care. Suddenly, physicians are becoming less concerned about (and constrained by) guidelines and requirements. Learning how to practice “essential oncology” may leave lasting changes in our field.

I may not be an authority on deciding what’s an elective versus non-elective surgery, but I will take a stand and offer some of my thoughts on the current state and what might await us as oncologists in the post-COVID-19 era. Before I offer my opinions on essential oncology, I thought I should ensure that my definition of “essential” matches that of others. Assuming that some patients might have already done so, I Googled the term and found that Oxford defines “essential” as “a thing that is absolutely necessary,” while Merriam Webster’s definition of “essential” is “something necessary, indispensable, or unavoidable.” Neither definition infers perspective, but we can all agree that what’s deemed necessary is in the eyes of the beholder. As such, in tackling this pandemic, oncologists are having to take a long, hard look at what care is necessary to provide and which guidelines are necessary to follow.

First off, some are questioning our current dosing schedules of chemotherapy, including the novel ones such as checkpoint inhibitors. Why not give that chemo drug every 4 weeks instead of every 2 weeks? Maybe we should give nivolumab every 6 weeks? Let’s lower the dose of pembrolizumab and skip a few days of venetoclax. Opinions vary, but the concept is the same: let’s give less chemo because suddenly COVID-19 is riskier than cancer. If our dose modification schemes change (most of which were not based on real basic science or pharmacology) this might throw all our regimens in shambles. If outcomes are not adversely affected, do we go back to our routine dosing and scheduling, or do we maintain the novel COVID-19 approach to chemotherapy? You tell me.

Next, my inbox has been flooded with invitations to attend webinars and virtual meetings on how best to manage patients during COVID-19 and how to balance risks and benefits, as if such balance should never exist outside of a pandemic. Never have I seen the oncology community engage in more debates about the risk/benefit ratio of chemotherapy in late-stage metastatic incurable malignancies. Suddenly, physicians who had been advocating 4th line chemotherapy for a metastatic cancer where data were marginal became loud voices encouraging stopping chemotherapy and offering only palliative care. It took the COVID-19 pandemic for the oncology community to look at itself in the mirror and ask whether chemotherapy should be given in end-stage disease. This may be the only real benefit of COVID-19.

Furthermore, it has been proposed that adjuvant therapies can sometimes be delayed and that some drugs should be avoided. Many have argued that stem cell transplantation should be deferred until we are over the COVID-19 hump. I am certain that there will be studies in the years to come (I even might do one if I’m not too busy tweeting) on whether delays in adjuvant therapies for some cancers had any detrimental effect on outcomes. How would that affect guidelines, recommendations, and future care? Stay tuned; there will be so many papers on this and little time for peer-reviews.

Fourth, how we approach imaging in determining progression-free survival may entirely change. Typically, scans are needed every 6-8 weeks to determine a response to therapy and allow a decision on whether to continue or stop the treatment. I don’t want to bore you with the RECIST criteria (and trust me, it’s boring), but it’s what radiologists use when helping oncologists determine if an anti-cancer therapy is working or not when treating solid tumors. Thanks to COVID-19, oncologists now have to make these decisions based on how patients feel and their perception of whether the drug is providing a clinical benefit. It should have been this way before COVID-19, but it wasn’t. We were so blinded by RECIST that we sometimes missed the larger picture. Could COVID-19 be the death sentence to RECIST? Will we find out that we were overutilizing our scanners? Could COVID-19 lead to saving future healthcare costs when some of these guidelines change? Maybe.

Fifth, follow-up visits for cured patients or those in remission have always been—and should continue to be—considered an essential component of routine care. It might be in the not-so-distant future when hospital administrators decide that some kinds of patient visits need to be conducted virtually. However, the rapport and bond established between a patient and his/her physician extends beyond the duration of chemotherapy administration. Patients need the reassurance that their disease remains at bay. The positive energy from these visits is also welcomed by oncologists as a break from cases where patients are less fortunate and a reminder that patients do get cured. Stripping oncologists and our patients of this right to face-to-face routine visits seems cruel. For now, we can all endure deferring these appointments or transitioning to telemedicine for the greater good, but I fear that this might extend beyond COVID-19. While I agree that virtual visits can save time and money, most would concur that nothing replaces human-to-human interaction—especially now, when we’re all feeling the effects of social distancing. Remembering how important Mr. Z’s follow-up appointment was, I dread the day when hospitals consider converting these routine visits to virtual ones so that new patients can be accommodated.

Finally, will COVID-19 teach us how to better conduct clinical trials? Every oncologist understands the value of clinical trials and how they advance science and help patients. But trials are strictly regulated. Labs have to be drawn within X and Y times, scans must be done within X-days from subsequent therapy, and face-to-face visits are a must. Dispensing an investigational drug requires several staff members present and a verification process that is critical, but sometimes unnecessarily complicated. Now that clinical trials have taken a hit, will this pandemic teach CROs that 700 signatures on an adverse event sheet might not be needed? Would potential changes give patients more sense of autonomy when they are participating in these studies? I predict that if we apply the lessons learned from COVID-19 on how we conduct studies, enrollment in oncology trials will increase. But this means that all of us, including CROs, need to do things differently.

It has taken a pandemic and a relentless virus to get the medical community to think critically about our own behavior and the care that we provide. We will overcome this at some point, and although we will all remember the horror of COVID-19, maybe we can find a silver lining in camaraderie and in adjusting some of the ways we provide oncology care. Until then, please stay home.

Chadi Nabhan ( @chadinabhan) is a hematologist and oncologist in Chicago whose interests include lymphomas, healthcare delivery, strategy, and business of healthcare.

The post “Essential Oncology”: The COVID Challenge appeared first on The Health Care Blog.

“Essential Oncology”: The COVID Challenge published first on https://wittooth.tumblr.com/

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lauramalchowblog · 4 years

Text

“Essential Oncology”: The COVID Challenge

By CHADI NABHAN MD, MBA, FACP

Chadi Nabhan ( @chadinabhan) is a hematologist and oncologist in Chicago whose interests include lymphomas, healthcare delivery, strategy, and business of healthcare.

The post “Essential Oncology”: The COVID Challenge appeared first on The Health Care Blog.

“Essential Oncology”: The COVID Challenge published first on https://venabeahan.tumblr.com

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franklongbottxm · 6 years

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Make Me Feel ~ Charity and Moody

13. your muse has been missing for 5 years and suddenly showed up again ~ Charity

1. my muse has lost all memory of yours ~ Moody

13. your muse has been missing for 5 years and suddenly showed up again ~ Charity

It had happened so suddenly. One day they had all been together for dinner, as happened so many times, and the next, Charity was gone. At first they figured she might’ve gone off for a couple days, but when those days turned into weeks, then into months, they were only left with worried. Frank watched for months as Alice became unhinged, looking for her friend. They had swept through just about every part of the U.K., coming up empty handed. Some had even made their ways out to Europe, getting in contact with wizards and creatures a like they they had made connections with. No one had had seen her, but they knew to keep a look out for her. There were nights where Frank just sat with his wife, trying to calm and reassure her that they would find Charity. Tell her that she had to be okay. She would one day walk through their front door and just tell them how it was a misunderstanding. However, he didn’t think that day would take five years to arrive.

A lot had changed in five years. Alice and Frank had gotten back to as close to normal as they were going to get without Charity. Not too long after Charity had gone missing, they found out Alice was pregnant and that following July, their son Neville was born. It was a time of mixed emotions for them. Excitement to see their family grow and meet their son, but it was hard without the woman they expected to be there for everything. Unwilling to accept the idea that Charity was truly gone forever, they still named her his godmother.

Alice had gone out with Neville to pick some stuff up with Frank had stayed home and was about to get dinner ready when he heard a knock on the door. Going towards the door and opening it, Frank felt his whole being stop. The girl on the other side of the door wasn’t at all who he was expecting and he didn’t know what to think. “Charity?” He finally spoke, still looking at her as if she wasn’t real. He didn’t know where she had been all of these years, but he also didn’t know how to ask. Didn’t know where to start. She had given him a small smile and a wave before asking if she could come in. It was almost as if he had forgetten how to respond before he finally nodded his head and moved so she walked inside before closing the door behind her. It felt like he was looking at a ghost as she made her way through his house.

“Charity,” He name felt foreign for some reason. “What- Where- We-” He didn’t even know where to start, but he knew he had to find out what happened. “What happened to you? We’ve been looking for you for years. You just, disappeared. Are you okay?” His questions were simple and felt like a lot to say, but they were the questions that needed to be asked. Answers they had been looking for.

Frank quietly watched as Charity had moved to sit on the couch, motioning for her to sit with him. Slowly, he had moved to go sit down next to her, waiting for her story to come out. Every part of her story made feels this odd sense of worry and relief that she was done with whatever had kept her away. While Charity had been more of Alice’s best friend, Frank had considered her a close friend after spending so much time with her. She was part of their family and having her gone felt like they were missing something. There was also a sense of relief at the fact that her story had reached the worst case scenarios they had all been thinking about over the past few years. “Why didn’t you write? Or anything? Just to let us know you’re alive.” He asked, looking back to her. The response she gave was something he expected as she talked about the fact that they could’ve ended up in danger and such. “Please. You know we would’ve been able to handle ourselves. With everything we’ve been dealing with, I’m sure what you were caught up in wasn’t any worse.” It was true that the war had gotten worse for a while and they had seen things that most hope they wouldn’t, but whatever Charity had done, it could’ve have been worse. She protested a bit more and their conversation had lasted longer than Frank realized when he saw a flash of green in the fire place. Standing, he took in the sight of his wife and son. “Alice,” He was about to continue when she had looked up and taken in the sight of her best friend suddenly back.

He waited for something to happen when it turned out it their four year old was going to speak first. “Who is that?” He had asked, looking between Frank and Alice. His wife didn’t move and Frank wasn’t sure what was going to come next. “Neville, why don’t we go out and check the greenhouse.” Frank finally spoke, nodding for his son to head out back. “Okay!” The child spoke, taking off and heading outside towards their family greenhouse. Frank had followed, knowing that Alice and Charity were going to need some time alone. As his son had tended to the plants, Frank stood in the doorway of the greenhouse, watching inside the house for what might be going on with Alice and Charity. It was a lot of yelling, which everyone would’ve expected from Alice and no one would’ve blamed her. Their conversation took as long as he would’ve assumed it might, and Frank had kept Neville outside, teaching him about some of the plants and even some Quidditch in order to keep him entertained.

After a long while, Alice and Charity had made their way out to the back porch. There seemed to still be some tension, which was to be expected, but things seemed to have settled from the discussion Frank was watching earlier. Neville had stopped playing and tucked behind Frank for a moment, looking at the new woman. It was a little funny to see Neville be afraid of Charity, just because of what he knew of Charity.

Picking up his son, Frank walked up the stairs and joined the girls on the porch, looking between both of them. “Everything alright?” He asked, watching as they both nodded their heads. Charity seemed to have her eyes loved on Neville, making Frank think that she wasn’t expecting to find them like this. “Charity,” Frank spoke, looking to Alice a moment before back to their friend. “This is our son, Neville.” Neville his a little again, still confused by who the woman was. “Neville, this is a very old friend of your Mum and I. Here name is Charity.” A very soft and shy hi escaped the child’s mouth as he waved to the woman. Their was a smile shared between the three adults that almost made it feel like old times. Alice had moved to fix Neville’s hair and the boy sat up looking between his parents before looking at Charity once more.

“Is she staying for dinner?” The son asked, keeping his eyes on Charity. Frank smiled, looking from his son to his wife, and finally back to their friend. “If she would like.” He offered, feeling happy as he watched Charity smile and nod her head. “Dinner it is. Come on, let’s all head back inside.” He spoke, setting Neville back on the ground and watching him take off inside, Charity following behind him, then Alice and Frank.

The night was something like old times, with the addition of Neville. They all talked, laughed, and even drank a bit. It felt surreal because she had been gone so long, but he knew that she was back, things would get back to normal in now time.

1. my muse has lost all memory of yours ~ Moody

The attacked happened out of no where. Absolutely no one had expected it and it left them in shambles. Members were everywhere with varying injuries. The ones with the worse injuries were quickly taken to Mungo’s in order to get healed. Frank happened to be one of those members. Having been on his own, he was surprised when Death Eaters had surrounded him. Before he even had a chance to react, they were all firing at him and Frank was on the near brink of death. The Orderly’s at Mungo’s had taken him back and worked to get him back to a healing status.

It wasn’t until a couple days later that Frank had woken for the first time, his eyes immediately noticing the small brunette woman who had never left his room. Seeing him wake, she moved towards him quickly and he felt himself panic for a moment, unsure of why she was rushing towards him. She kept speaking some name, it must’ve been his name. There must’ve been some connection between the two of them, but he didn’t know what it was or who she was. Her eyes looking pleading, as if hoping for him to know what was going on. He was quiet for a moment before speaking. “Wh-where am I?” He figured it was a better question for the moment. The brunette woman started to explain what had happened and how he ended up there, but he had no memory of what she had been talking about. His eyes fell to his hands and he noticed the wedding ring sitting on his left hand. Looking up, the woman had one as well. “Are you-” He paused. “Are you my wife?” Frank honestly didn’t know what the answer would be, but he figured it was worth a shot. However, the look on her face both answered his question and made him feel worse. When she asked if he knew her name, his head shook a bit and he watched as she woman seemed to grow angry. He even noticed tears welling up in her eyes, but he didn’t say anything and waited as she powered through her own emotions.

The next day, he was visited by another person, but this time it was some man. He looked angry and odd, but the way the man looked at Frank made him think that he had connection with him as well. The two of them just stood there, staring at each other for a moment before Frank spoke.

“Who are you?” He asked, sitting up a bit more in his hospital bed. The other male looked at him as if he was joking, but Frank just sat confused. “You really don’t fucking remember anything, do you?” The other male spoke. Frank shook his head. “The woman,” He paused. “Alice,” The name felt so weird to him because he didn’t know it, but there was someway it felt familiar. “Must’ve told you? Which means you and I have some kind of connection?” There was a loud scoff as a response from the other male and after a few curse words were thrown out he finally said some actual sentences. The man across from Frank called himself Moody, seems like an odd name. He told Frank about how he had trained him to be an auror. They were all Order members and were fighting the war to stop some wizard named Voldemort and his followers, who people called Death Eaters. It took Frank a moment to follow everything because there was a bit of grunting and cursing mixed in, but eventually he had followed everything.

It was a lot to take in and Frank didn’t know what to think or even do. People had told him he was this great auror and Order member, off fighting these people, but he didn’t remember a bloody thing. “I’m sorry, but I don’t remember any of that.” Frank responded, giving a small shrug of his shoulders. He could tell that wasn’t what the other male wanted to her. Looking up again, Moody was suddenly coming from Frank and grabbing fists full of his clothes. “I don’t want to fucking here that you don’t remember! You just have to fucking remember. You’re wife needs you. We all need you. Don’t fucking try to tell me you don’t remember. That’s not a fucking option.” As the male finished, Frank pushed against him with all his force and sent him stumbling back a bit. “Listen! You think it’s fun sitting here with no fucking memories? You think it was fun watching Alice’s face as she realized her husband had no fucking clue who she was? If I could fucking remember I would. But I don’t! I think it’s best that you leave.” Frank told the man, quickly growing tired of everyone trying to get him to remember things he just couldn’t remember. Moody had scoffed once more and rolled his eyes before walking towards the door.

“I’ll be back tomorrow and we’re going to get that fucking memory back. I’m not going to let you waste my fucking time and training on this bloody excuse.” Moody had told him before walking out the door and slamming it. Frank was now on his own again, unable to think about anything else except for the stories he had heard. How could he forget so much? And was there really any chance he would get those memories back?”

#angelixmoody #ask:charity #meme:charity #ft. charity #ask:moody #meme:moody #ft. moody

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destielrose · 7 years

Text

A Different Kind of Conversion

I don’t know how to do this. I’ve allowed myself to become so invisible that no one can see me anymore. I’ve battled suicide my whole life and I’m so tired. So very tired of fighting. I’m hitting middle age and all of those things I told myself I would do, would become, would conquer: I haven’t done, haven’t become, and haven’t conquered. And I feel like I’ve run out of time.

I want to slay my demons and stand on their fiery carcasses and know that I will not need to fight them anymore. But I’ve lived just long enough to see life cycling back on itself; those demons keep coming back. There isn’t anything to stand on and nothing is certain.

I identified as gay when I was a kid, but was shocked to fall in love with a man. I’ve been married to him for sixteen years and I love him tremendously. There have been a lot of trials and I’ve been sick, too. Mentally and physically. I tried to end my life a lot. One time I came particularly close to succeeding. I lay next to my children and listened to them breathe after I took too many pills, wrote letters to them on their bodies with permanent marker. I think I was trying to make something of myself stay with them. I believed in heaven and was eager to see God. I just didn’t want to be in pain anymore.

But dying hurts. When things started to get painful and my heart sped up, I stumbled to my husband and asked him to drive me to the emergency room. It wasn’t my first stay in the mental ward, but it was my last. When my mother in-law came to pick me up, a woman who almost never shows emotion, she was broken. I began to see how my death would affect those around me. I was mentally ill enough at that point that I genuinely believed I would need to be institutionalized long-term and that I would be a burden on my family forever. But I could see that even this burden would be preferable to my death, in the eyes of my family. So I made the decision to survive.

But suicide is an attempt to solve a problem. When i resolved not to die, there was nothing left to do and no end to the pain. I had already tried everything out there: buddhism, special diets, wicca, medications, spiritualism, therapies, addictions, self help techniques, and lots of quackery. Everything. And there was a great void inside me that nothing could touch. I could see my life swirling around me; I even knew it was a good life; I just could not feel it. It was as if I was under water. Everything was out of focus and far away. Distorted. And cold.

In that void, the nasty voices that I’d tried to keep at bay with all those therapies and religions and addictions had no obstacles, and they chattered at me all day long. Like Lucifer in Sam Winchester’s delusions, self-hatred and loneliness were my constant companions. I was nothing. I was worse than nothing.

But slowly another voice broke through. “Come home to me,” it said. “You belong to me.” And somehow I recognized that voice as Jesus. Yeshua, the Savior I had met as a young child.

“How could you want me?!” I asked. “Don’t you know what I’ve done? I’ve broken every one of your rules. I even tried to murder myself. I’m a whore. A coward. You couldn’t possibly love me.”

But, having nothing else to do, I read the Bible. And I discovered that Jesus has a special affinity for whores and outcasts. And he hates hypocrites and the self-righteous, which is all I knew Christians to be. Slowly, he drew me to himself and one day I decided that I would give myself to him.

“Please,” I cried. “I can’t do this anymore. Please take my life and do with it what you want to do.”

And everything changed. Life bloomed in technicolor and surround sound. I had an anchor. Truth existed. I knew reality. For a blessed six months, I had no depression. There had been so little of me left inside, it was like the Holy Spirit just moved in and filled me up.

Please keep reading. This isn’t a typical conversion story.

Knowing nothing else, I joined an Evangelical church. The biggest roadblock to my conversion had been the whole gay issue. I had identified as gay. Many of the people I loved were gay. But I knew the church thought that homosexual sex was a sin, always. I did research, but the more I dug into the Bible, the less I could hold onto my old way of thinking. I would just have to trust God on this issue, as much as I didn’t like it.

I was not the only one struggling with the gay issue. I don’t have to tell you that it is the singe most hotly debated topic in society today. But I was loyal to my God and my church. I even went to a Christian college and got a degree in theology and English. All of the voices in my echo chamber were saying the same things about sexuality. I knew in my head that my old desires were wrong.

But it never touched my heart. I LOVE gay men. Oh my goodness, I do. I went through a period of time where I was so steeped in slash (Smallville, in case you are curious) fanfiction that I began to think that I might be transgendered. I wanted to inhabit those stories. They kept me alive in the time between my resolve to live and my conversion to Christ. In fact, it was my discovery of dominance and submission in those stories that created in my heart a longing to submit to someone or something bigger than myself, something true and kind and firm and absolute. People laugh (uncomfortably) when I say that BDSM led me to Christ, but it is true.

I had to abandon those stories when I became a Christian, though. Because I felt they were wrong. They were part of a sexual addiction that had nearly decimated my marriage (and honestly a big part of the desire for suicide, too). Unchecked lust can destroy a person. Not to mention a marriage and a family.

Six years later, my teenage daughter and I have just finished watching Gilmore Girls for the second time through, culminating the experience with the newly released A Year in the Life. It was such a good experience. I was amazed at how that show had allowed us to bond. We had a language all our own, and the situations Lorelai and Rory found themselves in always gave us openings to talk about the deep things in life that just don’t come up naturally. But twice through is enough. We needed a new show.

Conveniently, Jared Padalecki had left Gilmore Girls to do another show. It was in the horror genre and I wasn’t quite sure if that would be appropriate for either of us. My girl is pretty young and I’m a big wimp when it comes to the scary stuff. But I was also a huge fan of Doctor Who and I was becoming inured to the gore and the jumpscares in that incredibly safe universe. Also, I’d heard of the SuperWhoLock fandom and knew I was required to at least check out the Supernatural show to keep my fan cred up to date.

So we watched.

And I’m not sure how I got here. Seven seasons in and my worldview is in shambles. It isn’t the kooky pseudo-Christian mythology that has me tied up in knots. It’s the way this fandom has wormed its way into areas I thought could only be reserved for the sacred, has challenged issues I thought I had long since put to bed.

Is it wrong to love a TV show *this much*? What is real? What is virtual? Shouldn’t I be concentrating on real life? Am I just mindlessly consuming? What is worship? Am I worshiping celebrities? What is family love? What is romantic love? Where do the lines exist between them? I didn’t have a good relationship with my parents or brother; is that why I read romantic love into every situation? But the show also seems to be teaching me about the power of family and the depth of love. In fact, it shows me redemption and the face of Christ over and over again. In a show about broken people in a world even more broken than ours.

I have started reading fanfiction again. I even wrote some. And it is slash. And…it. is. so. beautiful. Which makes me question the nature of goodness and of God. I’m reading the other sides of the issue of homosexuality and it turns out that there isn’t a good case on either side. And if that’s true, shouldn’t I default to love and beauty? And shouldn’t I know, of all people, having been on both sides of both issues (homosexuality and Christianity), how much weight either can carry? And if beauty and goodness and true love can be found in homosexual relationships, how can that possibly be a sin?

I have no one I can talk to about these things. I feel like I have come out of the closet in so many different ways in my life and now I feel like there are closets everywhere, fracturing my personhood. Do I walk through the door that leads back to my church? Do I walk through the one that leads to a new (SPN)family? Could they ever, possibly, converge?

How do I know what is true? And who will help me here? Will I never find a home, a community where I fit?

Please respond if this calls to you at all. I am so conflicted over all of these things that I’m feeling suicidal again.

#suicide #spnfamily #gay #destiel #cryforhelp #christianity #supernatural

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kristinsimmons · 4 years

Text

“Essential Oncology”: The COVID Challenge

By CHADI NABHAN MD, MBA, FACP

Chadi Nabhan ( @chadinabhan) is a hematologist and oncologist in Chicago whose interests include lymphomas, healthcare delivery, strategy, and business of healthcare.

The post “Essential Oncology”: The COVID Challenge appeared first on The Health Care Blog.

“Essential Oncology”: The COVID Challenge published first on https://wittooth.tumblr.com/

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