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ravennm84 · 3 years

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Of Moldy Bread and Cockroaches

I’ve seen a few fics where Lila reports the bakery to the health department and then plants bad pastries and pests just as the inspector arrives and gets the bakery shut down. I started wondering, what would happen if she got caught doing that? Warm-Fuzzies and please enjoy!!

Lila kept watch as she waited for the health inspector to finally arrive. She had made multiple fake reports about the bakery over the past week to get someone to come out, but no one had come yet. And she had found the perfect spot to make sure she saw the man arrive, too! She was in disguise in the park, on a bench that had a clear view of the bakery entrance, the side entrance that went to the Dupain-Cheng home, and still let her stay hidden. She didn’t have to worry about school at the moment since her stupid class and teacher thought she was visiting the royal family in Spain, and her gullible mother thought school was out for another akuma attack. Both of which gave her an alibi so no one would suspect her when Maribrat and her goody-goody parents were humiliated and lose everything.

She was almost too distracted by her daydream of Marinette crying and homeless to see a very professional looking man step out of a taxi in front of the bakery. He looked at the display with a very critical eye before writing some things down on his tablet. That had to be the health inspector she had been waiting for. Once she saw him entering the front, Lila hot footed it to the side entrance to sneak in.

The door was locked, but she had come prepared with a lockpick set she had gotten a couple years ago. It was really too easy to get inside. In fact, it had been much harder to get the fake evidence she would need to shut the place down. She discovered while going through the dumpster for old pastries that the bakery didn’t throw away much of anything. They sold out most of the time, and the things that didn’t were donated to a local homeless shelter. It took three days of dumpster diving to find anything, which ended up being a single batch of croissants that had burned in the oven. Heck, collecting some cockroaches from a restaurant dumpster down the street had been easier; albet, a lot more disgusting.

Once inside, Lila crept towards the door as she heard Mme. Cheng speaking to the man. He was, in fact, the health inspector. A malicious grin stretched across her face as she put the first moldy croissant on the counter next to the-

“What are you doing here?” A deep voice growled behind her.

Lila froze for a moment, suddenly realizing that she had heard Mme. Cheng speaking with the inspector, but not M. Dupain. She couldn’t let herself get caught! She was facing away from him and he hadn’t seen her face yet, so there was still a chance. Grabbing the first thing she could, she didn’t even look to see what it was, she swung it around at the towering man before trying to run past him.

Despite hearing him curse in pain, Lila didn’t make it two steps before the man grabbed her by the collar of her jacket and lifted her off of the ground. She swung her object at him again, only for the enraged man to grab her wrist and twist, forcing her to drop it with a shout as it clanged to the floor.

The noise drew Sabine and the inspector to the back where they say Tom holding Lila off the ground. Furious and still trying to escape, she tried kicking at him only for him to release her wrist, grab her ankle, and then release her jacket so she was hanging upside down. More items hit the floor as her hat fell off, a couple of croissants and the tupperware container of cockroaches fell from her pockets, and landed next to a bloody knife…

Uh-oh.

Looking up, she saw that his right arm was bleeding from where she had slashed him with the knife, which had her fingerprints all over it. She was going to be in so much trouble unless she could think of a way out of this!

“What happened, Tom?” Sabine asked, worried when she saw her husband’s bleeding arm and was slightly confused by the girl hanging upside-down in their kitchen. It took a moment before she seemed to recognize Lila as the girl that had gotten her daughter expelled a few weeks before.

“I was coming down to meet Inspector LaStare with you and caught this girl putting bad pastries with the others.”

“That’s not it!” Lila yelled in a panic and she wiggled in his grip, resembling a fish on a hook. “I-I-I was- I was getting rid of them! I was taking them off the counter to throw them away!”

“And your container of cockroaches?” Asked Sabine, crossing her arms over her chest and glaring dubiously at the girl.

“Those aren’t mine! I swear! If you would just let me explain-”

“I’ve already heard enough to recognize your voice, young lady,” the inspector snapped as he stepped closer to glare at Lila. “I bet you weren’t paying attention when you called the health department all those times and the recording told you that your call would be monitored and recorded. And when a single business gets over twenty complaints in less than a week, it gets some attention. But when we listen to the recordings and hear the same voice for every message, we figure it’s someone with a vendetta against the establishment. Still, we do our do-diligence and inspect the establishment, but I had no idea how stupid a person would be to attempt to plant fake evidence while I was here, in full view of the security cameras.”

She couldn’t help her surprised gasp as she, while still hanging upside down in the hulking baker’s grip, looked around the kitchen ceiling until her eyes landed on the cameras. One pointed at the side door she had picked open and the other pointed at the counter where she had put the moldy pastry.

Sabine leaned in close, glaring straight into Lila’s upside-down eyes. “Young lady, what is your mother’s phone number?” It was clear that it was more of a demand than a question, but she was still trying to think of a way out of trouble before Sabine grabbed her face and forced Lila to look at her. “You can either tell me her number now, or you can tell the police so she can go pick you up at the station while they tell her all the crimes you’re being charged with.”

Angry at being caught and forced to call her mother, Lila thought of what she could do as she tried to look and sound pitiful as she recited her mother’s number. Not difficult since she was red-faced from hanging upside-down for so long. She might not be able to get out of trouble, but she’d be damned if they didn’t pay for humiliating her.

After Sabine stepped into the front of the bakery to make the call, Lila tearfully looked up at Tom. “Can you please put me down? I’m getting really dizzy.”

She could tell that the man was tempted to drop her on her head, but he was too much of a goody-goody like his daughter and he eased her gently to the floor. As soon as he let go of her ankle, Lila’s uninjured hand snapped out and grabbed the tupperware of cockroaches, ripped off the lid, and flung the insects across the floor.

Tom and Inspector LaStare yelled in surprise and disgust as Lila attempted to escape, this time running for the front of the bakery. She actually made it out of the kitchen, but ended up face to face with Sabine. Without a word, the woman grabbed Lila’s by the arm, flipped her over her shoulder to the floor, and twisted her arm to where she couldn’t move.

“Are you okay, Tom?” Sabine called, her voice eerily calm to Lila’s ears.

“She flung those cockroaches across the kitchen! They’re everywhere!” Tom yelled as he and the inspector scrambled to try and kill or capture the insects.

“I’ve already called her mother and the police, they’ll be here any minute.”

Lila’s struggles doubled when she heard that. “You said you wouldn’t call the police if I gave you my mom’s number!”

Sabine merely twisted the girl’s arm a little more, halting her struggles rather than letting her arm break. “I said no such thing. I only said you could choose whether to talk to your mother here or at the police station. And I promise you, young lady, your mother is going to hear everything you’ve been up to. Including what you’ve been doing Marinette.”

~oOo~

The fallout had been epic after the police and Lila’s mother arrived at the bakery.

Greta Rossi had been in denial at first, not wanting to think that her daughter was capable of such terrible behavior. But it was hard to argue with the video evidence and eyewitness accounts of Lila attempting to plant moldy pastries, vindictively releasing the cockroaches in the kitchen, or attacking Tom Dupain with a knife, which would require stitches.

It got even worse when school let out for lunch and the majority of Lila’s classmates came rushing over when they saw the police and ambulance at the bakery. Mme. Rossi had asked them why they were all out when there was an akuma on the loose. The class asked her why they were back in Paris since she was supposed to be in a meeting with the royal family of Spain. It became apparent after a few more minutes of back and forth that Lila had been lying for the entire time they’d been in France and Greta would have to meet with M. Damocles and Mme. Bustier soon about her daughter’s absences and failure to contact her.

When the police were placing handcuffs on Lila, she started shrieking. “You can’t do this to me! I have diplomatic immunity! Let me go or I’ll get you fired and Italy will invade France for what you’re doing to me!”

“Wrong!” Greta spoke over Lila as she approached her daughter. “I’m a secretary at the embassy, not a diplomat. Only I have immunity, you don’t. I was lucky to even be able to bring you on assignment rather than leave you with your Zio and Zia in Italy. But I see that was a mistake, and now both of us will have to pay for that mistake!”

Lila continued to shriek and curse as she was forced into the back of the police cruiser and taken to the police station.

In the end; Lila was charged with corporate sabotage, breaking and entering, assault with a deadly weapon, and slander by Tom and Sabine. She was also charged for truancy, forgery, bullying, slander, and cyber bullying for what she’d done to Marinette at school. Lila’s mother was forced to pay for an exterminator to take care of the cockroaches, as well as all of the supplies and pastries that had been at the bakery and had to be thrown out due to the infestation that Lila had attempted to cause. But the worst was having to pay restitution for the time the bakery was closed. Turns out, Tom and Sabine’s bakery really was the top bakery in Paris and had the receipts to prove it.

There had been some worry that the temporary shutdown would hurt the bakery’s reputation, but Inspector LaStare, with the help of Nadja Chamack, had seen to it that none of the problems would blow back on the Dupain-Chengs. Inspector LaStare had gone on record stating that it was a rare occasion where an establishment was completely innocent of the accusations brought against it, but this was one of those times. He then showed footage of Lila planting the moldy pastry, assaulting Tom with the knife, and flinging the bugs into the kitchen before attempting to escape. He also stated that he was personally working with the Dupain-Chengs to make sure that the bakery was up to code and open as soon as possible so all of Paris could get back to enjoying their favorite pastries.

Viewers all over Paris were appalled at the actions of the teenage girl,discovering her vendetta was against Marinette since she knew about Lila’s lies. While laughing at her as they watched Tom hold her upside-down by her leg and Sabine flip the fleeing girl over her shoulder via security footage. The footage ended up being shared by people all over YouTube and gained millions of views, showing their support for the Dupain-Chengs and humiliating Lila on a now global level.

There was also sympathy towards Marinette and outrage towards the Francois Dupont administration when Nadja reported how Lila had also been bullying Marinette without receiving any help from the school. This would result in both Damocles and Bustier being suspended from their jobs until they completed training in regards to handling bullies.

With all the publicity against Lila Rossi, Gabriel Agreste had been left in a difficult position since Lila had only recently been named a new spokesmodel for his brand. Adrien, however, offered a solution to save face and help the brand in the future. So, when Nadja was doing a followup on the story the following week, Gabriel did a video interview where he very publicly announced Lila’s termination from the company for her actions and announced that he had offered Marinette an internship and a scholarship to the fashion university of her choice, so long as she was accepted. This caused a slew of universities to scout Marinette themselves, as it wasn’t every day a fashion mogul does a public shout out to a girl in college. And just like that, sales and public opinion of the Agreste brand went up.

Lila watched all of this unfold from her prison cell outside of Paris. She had been tried as an adult and was caught committing perjury during her trial, which prompted the judge to give her the maximum sentence for her crimes. She couldn’t even enjoy the pleasure of being akumatized anymore since she was so far out of the city. All she could do was sit in her cell eating moldy bread with cockroaches as her only friends as she sulked on the fact that she had failed, and the entire world was laughing at her.

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#lila lies #lila karma #lila salt #lila gets exposed #marinette dupain cheng #tom dupain #sabine cheng #badass parents #mlbjustice #ml fic #ml prompt

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pazwrites · 6 years

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How about, "their fingers met the silver of the moon, but their feet stayed grounded on the earth,"? Just a random thought that I had and you can interpret however you like.

thanks so much for the prompt!

i’m afraid it’s not that good but hey... it’s the first piece of writing i’ve done in a long time and i’m proud of myself for it.

A SLIVER OF THE MOON

I met Jones on the deployment train to the Franco-Germaine tunnels in the year 2117, a few months after the war started. I noticed almost immediately he was unlike any of the other recruits around, he was a draft overspill in the land of willing recruits. They tried to keep us divided, those willing to fight and those dragged into the front lines, perhaps in hopes those against the war wouldn’t taint such battle-ready brutes like myself. So whether it was a clerical error or just an oversight, there Jones was, short and bespeckled and very much anti-war.

We were lucky to be assigned not to the proto-trenches of New Britain, but to the Labyrinth that lay under the ground of most of the European Union. The proto-trenches were where troops went to die, blown apart by drones and tracer bullets in the Conflict Zones where the majority of the fighting was. They were echoing of the two world wars that predated this one. It was like the world had taken two steps backwards towards barbarism.

But the Labyrinth was a different matter, they were the peak of technology. Untraceable by the enemy, nobody knew they existed except generals and those stationed inside. They transported troops, supplies, people of interest, they housed prisoners of war and factories and our most advanced weapons. Picture a treasure chest that stretched across an entire continent. This was the Labyrinth.

When my platoon and I first got to our section of the Labyrinth, which zigzagged through France to Germany and back again, the Commanders had us stand in the huge bay opening that served as the only entrance for miles around, disguised among the Alps as a cave entrance. There was a beautiful French sunset sinking below the mountains, pink and yellow and orange and all the colors that war was not. First, the Commanders told us to face the sky, so we could kiss the sun goodbye one last time. Then, the Commanders had us turn around to face the dark interior of the Labyrinth so the sun could kiss our asses one last time.

Of all the things I sacrificed for war, fresh air was the one I missed the most.

Jones and I worked in what was called the Armament, guarding the nuclear missiles and the atomic bombs and all the secret weapons I was told to never talk about with anyone. It was the deepest, the most confined part of the Labyrinth, and as our skin grew paler our morale blanched too. Jones and I slept in bunks that were parallel to each other. I slept at night without the worry of ten tons of rock over my head, but Jones was different. I could hear muffled sobs from him, every night. The kid was small, weak, vulnerable… and his cries made my heart break. I noticed he was eating less and less, he was wasting away. His outsides reflected his insides, so it seems.

Once, he collapsed on duty. He came back three days later with sallow cheeks and a bottle of vitamins, and a pensive look in his eye.

“Corbin?” He asked me one day as we lay side-by-side in our parallel bunks. Corbin was my first name. I didn’t even know he knew it, when only our last names were stitched onto the breast of our uniforms and our Commanders exclusively called us “boys”.

“Mhm?” I had hummed back, as quietly as I could. I was staring at the ceiling, at the dome-shaped screen that projected a real-time image of the night sky. An artificial crescent moon hung among artificial stars, displayed like a museum exhibit on an artificial navy-black background. Occasionally, small blips of light would skitter across the screen like tiny race cars. Satellites that looked so innocent from earth, but in reality were peeking down at us like malicious scientists looking at an ant farm, each side studying the others tactics of war, peeking in on their goings-about and trying to get the upper hand.

Thirty miles above us lay the real thing, the real sky, and although the screen never glitched and looked real enough, we all knew it wasn’t the real thing.

“I miss the sky.” Jones replied, his voice as soft and sad as a pillow stained with tears.

“Don’t we all?” I muttered, my eyes chasing a blip across the screen. “At least we got this thing, though. Nice little placeholder for now.” “It’s not the same thing.”

“Close enough.”

“No, it’s not.” Jones took in a deep, shaky breath. I could tell he was crying again. “I miss the sky, so much. When they drafted me I begged for an above ground position, but you know what they said? All full, sir. Not enough room, sir. I must of pissed them off bad with all my insistence for them to stick me in the bottom of the deepest goddamn hole in the world.”

“Maybe it’s just a coincidence.” I suggested. “Besides, we’re doing good work. At least we aren’t in combat.”

“No, but we get traumatized all the same, don’t we?”

I lay in a shocked silence for a few seconds, trying to absorb the meaning of Jones’s words. We’d been told to leave our complaints, our bad attitudes at the surface. I’d readily complied, but Jones seemed stuck in his own doom and gloom.

“I’m going to go crazy down here. Just you wait and see.” I could see the black outline of his figure, his arm raising as if to point at the “sky” above us.

“Orion’s belt, Big Dipper, Cassiopeia…” He started to repeat himself, gesturing at various stars. “Sirius, Canopus, Vega. And there… The moon.”

In the darkness I could see the tip of his finger move in a crescent pattern, tracing the shape of the moon above us. He rubbed his fingertips together as if he could feel the very silver of the moon, tracing it over and over before he let out a huge sigh, letting his hand drop.

“I don’t understand war.” He murmured. “Goodnight, Corbin.” I didn’t understand war either. Nor did I understand Jones, with his lust for the above ground and infatuation with the sky.

Over the course of the next month, I could tell Jones was starting to lose it. We were often stationed next to each other, and one day only a few weeks after our conversation under the faux stars, I could see he was beginning to mouth things, his lips moving ever so slightly without letting any sound escape. These little movements progressed until sound started leaking through, whether he meant for it to or not. I could barely hear it over the constant hum and whir of generators and machinery, but if I strained just hard enough I could hear it…

Orion’s Belt, Big Dipper, Cassiopeia, Sirius, Canopus, Vega, the Moon… The Moon… The Moon.

I was half-tempted to report him, but what good would that do? At best, my claims would just be dismissed. Nowadays they only cared about your health if you got shot or blown up. Reverting back to the old war mindsets. They didn’t seem to care about us ants in the anthill. It was tense, watching Jones slowly build up pressure like a pipe bomb waiting to explode.

Orion’s Belt, Big Dipper, Cassiopeia, Sirius, Canopus, Vega, the Moon… The Moon… The Moon.

He stopped eating soon after that. At first, I thought it might just be a byproduct of stress; our enemies had found out about the Labyrinth and had been launching attacks, stealing weapons, stealing our technology and data… We knew basic combat but not well enough against their violent slash-and-burn squads. Reports came through every day, dozens dead, hundred dead, explosions and blood and prisoners taken. We all felt the terror in the air, and terror fills your stomach more than any food. So I didn’t pay much mind to Jones at first, none of us ate much anymore anyway.

Explosions started to rock our sect of the Labyrinth two weeks after that. There were over fifty levels of the Labyrinth, and the first five had fallen within a day. All our troops, all our weapons were in these tunnels but… somehow they knew how to beat us. The enemy collapsed tunnels and plundered for tools, we knew the layout but they had always been more advanced than us and we were wiped out like a child stepping on an anthill. We were told to stay put, that the weapons we were guarding were worth more than our lives, that we HAD to keep our posts until the enemy was pushed back or we’d lose the war forever.

It wasn’t as if there was any way out, except one.

There was a small service elevator around back of the huge warehouse where we were stationed, designed to allow those with special clearance like generals and scientists and doctors to be able to move between floors quickly. The rest of us took huge bay elevators that could fit whole platoons at a time. Those were destroyed almost immediately, to trap us where we stood. But they didn’t destroy the service elevators.

We were told to stay at our positions, but when the enemy reached the level just above us, Jones made a break for it.

He was little, fast, and agile, and nobody but me noticed he’d even left. The rest of us were too busy watching the ceiling, listening to faint sounds of gunshots and waiting for the fight to come to us. The kid was going to get killed up there… I couldn’t just let him die alone, could I? I could taste the metallic tang of fear on my tongue, the elevator door was half-closed before I slid through, just barely diving inside before they shut completely. Jones looked at me with disbelief. I could tell he was prepared to die alone.

“What… the fuck… are you doing?” My breath came in pants as the elevator started to rapidly ascend.

“This is a lost cause.” Jones replied. “I’m just trying to see the sky for one last time before I become another casualty.”

The elevator was deadly silent.

“Bold.” I whispered. “You’re really brave, you know that?”

“You don’t even know me.” Jones glanced at me with eyes full of tears.

“Would a coward really defy direct orders to go stargazing one last time?” I asked.

“Touche.”

The elevator took three minutes to get to the first floor of the Labyrinth.

“There’s going to be enemies all over the place.” I murmured. I felt… oddly calm. Oddly content with dying his way. I was pulsing with adrenaline, yes, but I’d left my fear in the bottom of the Labyrinth. There was only a cold call about me now, and around Jones too.

The boy nodded.

“We’ll find a way.” He murmured. His voice was more lively than I’d ever heard it.

We were both equipped with standard-grade military rifles, and as the door of the service elevator opened we cocked them - locked and loaded. I braved my body for impact, surely they’d notice us as soon as the doors open and they’d riddle us with bullets so fast we’d hardly have time to feel the pain...

The enemy was nowhere to be seen.

The first level of the Labyrinth was all loading bays and storage, but they’d been cleared out, leaving a grey-walled void with nobody in it but us. I glanced at Jones, this was… impossible, wasn’t it? Our footsteps made no noises as we slowly started to walk towards one of the many doors to the outside, swallowed by the vast emptiness.

When Jones opened the door to the outside, I gasped at the taste of fresh air. It wasn’t bright daylight, as I’d expected, it was pitch darkness under the light of the moon and stars I’d only seen in virtual dioramas for the last month. Jones stepped slowly out onto the rocky trail the door led onto, his face wide with disbelief. A slow smile began to stretch across his face… he started to laugh. To whoop, to holler, to scream out cries of victory. We’d lost, the Labyrinth was dead and our platoon was surely being massacred three miles under our feet but Jones… Jones had won.

“Hey,” I whispered, wiping away tears that had been streaking down my face. “Let’s be… Let’s be quiet, okay? In case there’s sentries around here.”

Jones ignored me.

“Look,” he whispered, pointing up at the sky. “It’s a waning crescent.”

I looked up, to the moon hanging in the sky. I said nothing.

“Touch it.” Jones said. “You can almost feel it.”

Without thinking, I stretched my fingers up towards the sky, the silver of the moon, and although our feet stayed firmly on the ground I swear I could feel the satin of the lunar surface under my fingers.

Beside me, I heard Jones draw in a deep inhale, as if to say something else. The words never left his mouth.

There were sentries outside the entrance of the Labyrinth. Snipers.

Jones fell to the ground, dead, with a bullet through his head before he could even exhale.

At least he died under the stars.

The thought barely finished running through my head before the second sniper’s bullet found its home in the back of my neck. It was better than dying three miles underground.

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thesefoblog · 7 years

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6.1.2017

On Tuesday, May 30, Wilson and I went to my regular prenatal check-up. I was 1 day away from my due date, and really anxious to have the baby. I thought about the possibility of going into labor or my water breaking basically every single minute of the day. When I brushed my teeth, I’d wonder if I’d have a contraction before I would finish. When I drove to work, I pictured hitting a pothole and breaking my water. When I sat down at my work desk, I’d wonder if I’d make it to the end of the day without going into labor. I was obsessed. I read this thing that said waiting for your baby to be born is like waiting to pick someone up at the airport. Except you don’t know when the flight is, or who you’re picking up.

At my appointment, everything was looking good/normal. When the doctor took out the doppler to check the baby’s heartbeat, it took her a really long time to find it. I wasn’t worried at all because I could feel the baby moving all day every day, including WHILE she was looking for the heartbeat. She finally found it way up by my ribs, which was NOT where it should be! The baby was definitely not in the “ready position”. My doctor did a quick ultrasound to confirm…and yes, the baby was breech. Again.

My doctor called the hospital to have them schedule me a c section ASAP. She told me that the next evening I’d get a call with my exact scheduled c-section time and I’d go in on Thursday, June 1st.

I called my work and told them I’d see them in September and decided to take Wednesday to prepare myself! I filed my state disability paperwork, installed the car seat, and FINALLY packed my hospital bag. On Wednesday evening, I waited for my call from the hospital to get my surgery time. My doctor told me I’d get the call pretty late because they wait until the very end of the day to schedule for the next day to avoid cancellations/schedule changes. At 9pm, I still hadn’t heard from them, so I decided to call. They had me scheduled….for June 8! I was like, um..no. I need an appointment TOMORROW! They were able to fit me in and told me to be there at 9:30.

I was so excited, I could barely sleep! So a typical night. During my last few weeks (or months?) of pregnancy, I pretty much did not sleep. With the bathroom breaks, constant kicking/punching in my womb and the need for a large crane to reposition me in my bed every time I needed to move…well, sleep did not come easy. To be honest, I’m getting way more sleep now than I did when I was pregnant.

The next morning, Wilson and I made our way to Roseville. I wanted to give birth in the hospital in Vacaville which is way closer to home and where I took the hospital tour…but for a scheduled c section, I had to go to Roseville. Don’t ask me to explain why because I don’t know. But I heard Roseville was super fancy, the best hospital…it was nice, but Vacaville was better. But…after giving birth in the Dominican Republic, I won’t complain!

When I checked in, there was a lady in the waiting area with me who said she thought her water had broken. That was exciting. Anyway, I got checked into a triage room…which are like the smallest, most uncomfortable rooms. But they said I’d only be there for a little while so it was fine. I was in a bed so it didn’t bother me, but there was nowhere for Wilson to sit, except for the spinny stool the doctors sit on when they come to check on you. Typically the triage rooms are just to determine whether or not the women are in labor, and then they get moved to the delivery rooms right away. I got hooked up to the IV, prepped for surgery and I was completely ready to go….and then my surgery got bumped back. Again. And again. And again. Finally, they were ready for me a little after 2pm. So we spent quite a while in that tiny room!

I have a complaint about the Roseville Kaiser now…

There was a window on the operating room door. So anyone that walked by could see me completely. In the nude. Oh well.

Once I was plugged into all the machines and full of the necessary numbing solutions, I laid down and I felt SUPER nauseous right away. I started gagging, but I was numb, so I didn’t have the strength to throw up. It was weird. I thought I was going to die for a second because I had to really focus to fill up my lungs with air…my chest just felt SO heavy. I was super scared and started kind of panicking! They gave me a shot to make the nausea go away and it worked super fast…within ten seconds. I wished I had a stash of those earlier in my pregnancy! Once the nausea was gone, I felt so much better and my anxiety went away.

They let Wilson in, and I could tell he was really nervous. I didn’t know if he’d survive the OR because he even had to leave the room when Maya got stitches on her foot. He kept rubbing my hair and my face and I think it more to calm himself down than for me! Everything happened so fast, and before we knew it, the baby was out! Everyone kept saying over and over how big his head was. I was grateful that he was breech haha. They also said he was SO big and so chunky, etc. I felt bad for him…they were totally body shaming my newborn.

They weighed him, and I guess they were right! He WAS a big boy- 9 lbs, 2 oz, 20.75 inches long, born at 2:57pm. Wilson cut the umbilical cord, and they brought the baby over to me and I got to hold him. I could not believe that whole baby fit inside of me!

After a while, Wilson went with the baby to the recovery room and I followed a little later. I was pretty amazed that at that point, I could already move my legs a little! I had flashbacks to Maya’s delivery where even the next morning the nurses had to like flip me around to clean me because I couldn’t move still. Things were so different this time…in a good way!

We spent a few hours in the recovery area, where they have a nurse with you 24/7, and during that time we had our first visit from my parents, who brought Maya. Maya is always very shy when we take her to meet babies in the hospital, but this time she was more brve and outgoing and even wanted to hold the baby. It was so exciting and sweet to see my two babies together…she waited so long for that moment! Wilson surprised me with roses and balloons, which was so nice. I love a good balloon bouquet.

After a few hours, they moved us to our regular room. It was nice, but not as nice as the rooms I saw on the tours in Vacaville. But, on the other hand, it was MUCH nicer than my hospital room in the DR. Perspective.

At this point, I could fully move my legs. I had pretty much no pain, but I was still moving pretty slowly because I was just a few hours recovered from major abdominal surgery. I had to keep reminding myself of that, because I honestly felt great. The only time I felt a little pain was when I’d go from a laying position to sitting up….the muscles required for that were just not firing correctly. But it was not bad AT ALL.

My nurse came in to help me stand up. She told me that I could take it slow, and if I got up and realized it was too much, I could just dangle my legs off the side of the bed instead. We just needed to get some blood flowing. In my mind, I was like oh, this is going to be easy! I can like run up the hallways right now! And guess what? It WAS easy! Ok, I wasn’t quite running up the hallway….but not only did I stand, I walked. And the nurse had given me a walker but I didn’t need it at all.

To compare to my recovery with Maya again...the day after my c section I was barely able to stand up straight and I was just barely hobbling along…definitely could’ve used a walker! But this time, it was just like 4 hours after surgery and I was walking fine! It was so crazy. I kept waiting for the pain to come, the meds to wear off or whatever…but it really never happened. My recovery was amazing and fast. Wilson had to keep telling me to slow down because I would kind of forget I just had surgery. I don’t know if they accidentally cut out something that made me feel no pain? Haha. But my doctor was definitely some kind of magician. I never even took anything stronger than ibuprofen (except during surgery, obviously).

Our first night with Luke was…sleepless! Wilson actually had to be at work the very next day at 5am so he had planned to leave and sleep at home, but the baby kept spitting up blood, which was scary. Wilson decided to stay (thank goodness). The doctors told us it was completely normal, especially for c section babies to have blood and amniotic fluid that they cough up for the first few days so they weren’t concerned…but there is just something unsettling about hearing your newborn choking on blood every half hour during the first night of his life.

The next day, Wilson left for work and I was alone!! I was super nervous about this before giving birth…I told Wilson it would be impossible for me to handle the baby on my own right after surgery…but it turns out, I felt great and was able to take care of the baby with no problems! Also, he was sleeping pretty much allllll day, which helped. In fact, at this point, I hadn’t even really seen his eyes! I think he was not ready to be born yet. Sometimes he would like flutter his eyelids and raise his eyebrows and you could just tell he wanted to open them, but he couldn’t quite get it. We had our second round of visitors on Friday- my brother and his family and my mom and Maya came again. I even got dressed for the occasion. Well, just FYI, when you give birth they give you a special lactation hospital gown…with 2 holes for your boobs. So its not really something you want to be wearing to greet visitors.

The baby continued to sleep for hours at a time, which was amazing. But right before we got discharged on Saturday morning, a lactation consultant came to see us and said they were concerned about is weight loss. He had lost 8% of his weight…which was not a big deal, as long as he didn’t lose any more. They delivered a hospital grade pump to my house to use and told me to wake up the baby every 2 hours to feed him. And thus ended my sleep.

We left the hospital around noon on Saturday and we actually rode in the elevator with the lady from the waiting room while we were checking in…apparently her water HAD broken because there she was with a baby!

Looking back on my birth experience, I would say I have zero regrets. It didn’t go how I had hoped/planned, but I really can’t complain about how things turned out. Plus, I’m super grateful I did not birth a 9lb baby vaginally. The past 9 weeks have been quite a blur (hence the super delayed post...), but we are completely happy with our sweet baby boy!

You survived this post, time for some pictures!!

Papa and baby in the OR...he was very white at birth! haha

In the recovery room

Meeting big sister

98th percentile head accentuated by extra tight swaddle

Taking home our squishy-cheeked boy!

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sunshineweb · 7 years

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Winning the Doctor Lottery

By ANISH KOKA, MD

A poignant piece recently appeared in the journal Health Affairs and was rapidly devoured on social media by the health policy community. The story is a harrowing first person account of a woman’s multiple interactions with doctors. The doctors in the story are either very good or very bad. One pediatrician turns the author and her sick son away on three consecutive days with colic, only to have a more careful partner sound the alarm and discover pyloric stenosis. The author then recounts the tale of her father’s death at age 42 due to a surgeon who operated for diverticulitis unnecessarily.

My family and I haven’t always won The Doctor Lottery. My father’s surgeon, for instance, had pushed him to have the bowel resection to “cure” him of diverticulitis, a disease in which the colon’s lining becomes inflamed. He stitched up my father’s intestines with a suture known to dissolve in patients who’ve been on steroids and hadn’t read my father’s chart to see that his internist had recently had him on cortisone. Nor did he look at the list of medications my father had carefully written down on his patient intake forms. When the sutures dissolved, my father, who had a bleeding disorder, went into shock. His abdomen was distended and hard.

My mother asked the nurse to page the surgeon. “My husband is in so much pain!” she said. The surgeon, who was playing golf, told the nurse to tell my mother, “Pain after surgery is normal.” By the time my father developed a fever, and peritonitis, it was too late. He died of a heart attack.

It’s a moving anecdote with a tragic ending that has the requisite story elements – arrogant uncaring doctor ignoring patient and family concerns while on the golf course – that policy folks use to argue for remaking the current health care system into a more patient-centric world. Unfortunately, medicine is hard, and while there are certainly errors that are avoidable, many are not. The best surgeon, the best system, and the best medical care are at times no match for the randomness of life. A certain percentage of patients will have an infection after an abdominal surgery despite every current safeguard that is known. The vast majority of patients with abdominal pain and distention after surgery do not routinely need to be reoperated on. Deciding who to reoperate on is often challenging. Is a good surgeon one who takes every patient who has abdominal pain and distention back to the operating room? Is it feasible to have an attending surgeon on hand to evaluate every complaint of abdominal pain? Should we ban all surgeons from playing golf for 48 hours after they operate?

None of these questions have answers that don’t involve tradeoffs in the real world. In policy world, however, solutions are magical constructs that don’t involve robbing Peter to pay Paul. In this fantasy world Peter and Paul find a leprechaun with a pot of gold at the end of a rainbow. As a result, the solutions proposed to ‘ending the doctor lottery’ involves fostering strong patient doctor relationships that align incentives based on number of patients seen rather than the value of care delivered. Apparently, what promises to save us is a large order of payment models based on value, with teams composed of generous helpings of social workers, behavior health experts, and cute puppies.

It is with this noble intent that our physician overlord masters in the Center for Medicare and Medicaid services , at the bidding of the public and congress, have applied themselves to the small task of assigning value to physicians. There are many prongs to this worthy desire to measure the nation’s doctors, but a particularly sharp prong advanced by the Agency for Healthcare Research and Quality is the patient-centered Consumer Assessment of Healthcare Providers and Systems (CAHPS). The CAHPS tool is actually a standardized survey that has been in use since 1997 to measure and report on the experiences of consumers with the health care services they come into contact with. More recently, a sister to the CAHPS tool was born so that physicians in office settings may be measured by their patients – this was named the Clinician and Group – CAHPS survey (CG-CAHPS). The stated goal of this tool is to publicly report survey results to allow patients to choose good doctors.

The assessments are performed by practices and health care systems. Patients receive surveys that seek to get to the heart of what everyone wants in a physician – Does your physician listen carefully? Did your physician spend enough time with you? It appears that practices have some latitude in how the question is asked, what questions are asked, as well as how to interpret the results.

Value-based care sounds good, and enjoys widespread support among every non-clinician that seems to matter in the world of health care policy. Physicians seem generally apathetic, though overconfident about the coming valuations – after all, it’s always the other guy that sucks. Not surprisingly, the worst physicians have the least insight into their own limitations, and suffer the most from delusions of grandeur. While physicians may be excessively poor at grading themselves, the physician community that loves gossip about as much as the Real Housewives of Atlanta are much less forgiving. Yes, that’s right – there is general widespread agreement among physicians of the worst among us.

So, imagine my surprise when one of the good guys that I worked and trained with called to tell me that he had the lowest CG-CAHPS scores in his group and he may need ‘remediation.’ Value-based care takes on a whole new dimension when you’re the one that carries the 21st century version of the scarlet letter.

Unpacking the genesis of a bad CG-CAHPS score is an exercise in revealing the idiocy that results from the many good intentions in healthcare. In this particular case, the hospital sends out a survey to patients that have come into contact with its physicians. Those who respond to the survey select answers that range from ‘always’ to ‘most of the time’ to ‘never’. Only ‘always’ counts towards a ‘Top Box’ score, and this Top Box score is then compared to a national average to generate the provider’s percentile. For instance. if 9 out of 10 patients checked off ‘always’ to ‘Did Provider listen carefully to you?’ your Top Box score is 90% – but if the national or health system average for that category is much higher – that score may still put you in the 50th percentile.

The problems with all of this are legion. Of the 1500 unique patients who this physician saw in the prior year, 120 patients took the time to respond to the survey. I’m always surprised that anyone fills out any surveys – I fill out one every 2 years. Regardless, of the 120 patients who responded, six chose not to select the top box, resulting in this physician being labeled a problem in need of remediation. Beyond the problem of generalizing from 120 patients who have an unnatural affinity for filling out surveys in the mail, one wonders if there is more to a physician’s worth than her ability to communicate? As a medical student, I recall a surly surgeon who minced few words in his communication with patients, but was technically brilliant. Many a grateful patient or family was indebted to him for a life saved, but I recall a smattering of patients put off by an approach that had little time for the worried well.

In the name of transparency, CMS plans to publicly share this quality information via an online physician compare tool to allow patients to finally win the doctor lottery, and perhaps more importantly, tie reimbursement to value.

Health systems nervous about decreasing reimbursements related to their bad physicians need not worry because riding furiously to their rescue are health care consultants, who for a pretty penny, promise a smooth transition to this new world. These words from the Studer-Huron health care consultancy appear designed to allay the health system executive’s fears:

“Plenty of evidence shows that patient experience and clinical quality are two sides of the same coin. You already want to provide the best possible care. And now that Clinician and Group Consumer Assessment of Healthcare Providers and Systems is here, there’s a new reason to focus on patient perception: CG CAHPS will impact ACOs, PQRSs, PCMHs, and many other programs, and survey results will link to payments in 2015.”

These same consultants lined up not long ago to help hospitals achieve pay for performance metrics. It surprises no practicing physician that pay for performance metrics and value based payments as currently designed were an abject failure. While there are some like Ashish Jha (Harvard School of Public Health) who have noticed and publicly called out the failure of value-based payment, the answer disappointingly appears to be ever better patient-centered metrics. The latest idea that relates to my scant enthusiasm for basing value on patient surveys, unfortunately, comes from no other than Dr. Jha, who wrote recently in JAMA on a proposal to query Medicare patients 30 to 60 days after discharge on the quality of care they received, and tie up to 10% of a hospitals reimbursement to these scores. I can almost feel the frisson of excitement travel through the offices of the Studer-Huron group at this latest opportunity to manage patient perception and save the day.

I fear a noble profession has lost the plot when it chooses to measure value based on patient satisfaction simply because it is the easiest and most politically correct metric to measure. It seems that the vision of measuring value is what’s important – it matters not that the value quantified by these wonderful tools is the health care policy equivalent of fake news. What matters is that surveys measure something that can be quantified, regressed, risk-adjusted and published. The truth may be shrouded in darkness, but falsehoods found where the light happens to shine now comes to masquerade as the truth.

When it comes to one’s health, the desire for an assurance of quality is an understandable one. We are supposed to assure quality by making medical school admission a privilege reserved for those who have demonstrated intellectual vigor, board certifications that test competency, and continuing education to attempt to demonstrate maintenance of competency. Unfortunately, we live in a time where acceptance into medical school relates more to virtue signaling than intellectual horsepower, and board certification is a mechanism to siphon dollars from physicians to take tests that have little to do with the practice of medicine, and certainly don’t weed out the bad.

The medical profession has done itself few favors by having a remarkably anemic approach to ferreting out physicians who fall egregiously below professional standards. There are no perfect solutions, but I would suggest with much bias that having a healthy pool of primary care physicians not employed and beholden to health systems are vital to improving the chances patients have to win the doctor lottery. I understand the public desire for guarantees when it comes to those we trust with our lives. The only thing the current approach guarantees is the health of the bank accounts of health care consultants, but protecting patients from bad doctors? What a joke.

Anish Koka is a cardiologist in private practice in Philadelphia. Most of the opinions he has aren’t put on surveys, but can be found on twitter @anish_koka

Winning the Doctor Lottery published first on your-t1-blog-url

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