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beenjen · 1 year

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These past weeks - and it is weeks, near on a month, because I had to look back - have been an exercise putting one foot in front of the other. I flag on what even to say, because it feels everything that comes out of my mouth is sad and I don’t want to be? It’s life though, so, honesty is the best policy? Who knows.

//mom was hospitalized for a small bowel obstruction. It was a super involved process where we had to rule out, as we did last year, a metastasis of her current cancer. It was such a suck if essence - I don’t know how else to say it. She was sick for a couple weeks before, was not forthright in her symptoms, was hospitalized on a Friday afternoon and spent the weekend.

It’s the first time I had to really poke my head up with my years of ICU experience and dictate her care and the steps we would be taking. I hesitate to ever share that I have the experience I do, because then people get super nervous about their performance and tend to steer clear, this group involved with her care though, embraced what I brought to the table, and we were able to institute a strict care plan and get her a$$ -no pun intended - on the go.

She’s home. Not had a great appetite, down to the 120s, and it’s take some Out of the box planning to get her revitalized. It’s been something.

\\ her follow up CT this week showed not only that the small bowel obstruction was gone, the previously spotted abdominal tumor was as well. That’s obviously incredible information, we are just so beat down with the perpetual bad news, none of us knows quite what to do with it. So, we persevere…. Will await some Other tests, and I may not ever be able to relax when it comes to moms monitoring. It’s been extensive. Hard. Traumatic.

//dads last biopsy through interventional radiology, was unable to produce a diagnostic result. He had a bronch this past week that was an attempt for more answers…. And it went over 2 hours, old colleagues coming out to talk to me, because apparently, everyone knows this is my dad, and the chief of the service came down to perform the tests…. It still was a no go… they are 50% positive even with cytology at bedside, we will know what we need to for diagnosis as the spots were very illusive - the bastards.

Fingers crossed we can get some answers. They outlined next steps in case we can’t, and that just sucks, because it means they had a much harder time than they lead on to…. So we wait.

\\it finally happened as well, that I missed something huge with all this stress. It was a big enough error I could have really put us in an awkward place, fortunately, it’s all worked out, and it’s still pending full resolution so I’m keeping my lips sealed.

\\shit hit the fan with my niece - again. This time, she is expelled from her school. It’s at least something everyone is taking seriously. She is getting the support she needs emotionally. We’ve had some tough talks with her parents, her, etc, that she is the person she is, and we are here to support that growth, not block it. It’s been good for my relationship with bro/S-I-l and it’s overdue. I guess the proof is in the pudding folks

//the back retaining wall deck has a foundation crack from the negative temps in December. Able to get that on the schedule for repair, some high dollars later and it’s a go. Just glad it’s not falling into the river as I adore that patio and c laughs when is at it’s why we bought this house - but it is friends.

//Lilith is in ballet and loving it. We take her to tour pre-k this weekend, and the kids will both be at the same place FINALLY. Amen.

//j is wanting to start drums and we are finding a local teacher. He’s doing excellent in school, aced an Einstein presentation. He’s awesome

// Found a yoga home.

//c is the best saved for last. With the stress of the past stretch. He’s stepped up time and time again. We butt heads as any couple, this past weekend expressly, when I messed up so hugely, he was unwavering, protective and encouraging. How is it possible after all these years, I keep finding I can lean more and more on him, that he has my back, that we are solid and it won’t change?

Real question for my relationship people? Is it a thing that you keep dipping deeper into your partners well and they just keep stepping up? That intimacy keeps unfolding like a flower or is it just me?

Down and dirty quick post about a lot of shit. Love you guys.

Blessed be friends xx

#down and dirty #long story long #east nashville #life #the daily grind.#more of the same

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trollsarecute · 1 year

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This may be a long⬇️

Warning: this may have some cussing don't read if not allowed. enjoy

Creek: *Smirks evilly when he sees branch and walks up to em and taps em on the shoulder*

Branch: * Turns around in confusion then gasps in fright noticing who it is and is frozen for a second but then tacks a hold of emself and thinks about something and smirks having perfect combat for em* Is there something that you think is this important to the point where you gotta annoy the hell out of me?

Creek: *Is taken back by his sudden choice of words then collects himself knowing what he's trying to do and doesn't want that to happen* listen here blue bitch, I will say and do as I want. your are not to tell me what to say and do you hear me?!

Branch: *Perks head up* Hmm? Sorry I didn't hear you, it must be that your so annoying that I can't handle your voice.

Creek: *Is disgusted and shocked at how rude he's being* How dare you say thoes hurtful words to me!! Your tacking them all back right now Mr.!!! *Stomps foot like an angry two year old*

Branch: *Gives him the same face then smiles in his head having the perfect combat for em* Wow....It's kind of sad a little here bud, I was sure that your parents wouldn't have spoiled you rotten. Now I know why you are the way you are. You need to get a grip on life here bud...

Creek: You better tack that back, or YOU'LL REGRET IT!!!!

Branch: Will i?

Creek: *Scream out in anger*

Branch: *Notices some trolls and knows that creek doesn't like to show his weak side and knows how to get to em and steps up touches his hair and brushes it with his hand* It's really sad that your ugly hair and your stinky personality made poppy run away and up to me. *Yanks hair harshly*

Creek: *Screams in pain*

Branch: *Knees em in the aera and smiles at em on the ground now* Who's the puss now?

*Some trolls gather around watching branch tack down the village pretty boy with a couple gasps and whispers here and there*

Creek: *Tries to say something but gets cut off by branches hair* Hmmph!!!!!😡😡😡

Branch: What are you so angry about? Oh ik what it is....your being taken down but the guy you love picking on!!!!

Creek: *Looks around noticing everyone is now surrounding them while pointing and whispering at creek as embarrassment fills the air around creek knowing that picking on a troll isn't the best idea and you'd get into really bad trouble if you do*

Branch: And the kidnap-mmmph!!!!

Creek: *Tackles branch and hushes em with hand and looks up and around and notices a couple trolls gasping in shock and others backing away slowly in fear not wanting to be a part of the scene that their all witnessing and leans down and whispers into his ear harshly* I told you not to say anything!!!

Branch: *Tries to kick and push em off but nothing works since he's a whole lot stronger then he is*

Poppy: Creek Coward!!!! (That'll be his name😌)

Creek: *Hears that voice and ice cold water runs right through his veins and body and slowly looks up and notices the queen of trolls village standing in the distance a little away from with hands on her hips looking pissed of at em tapping her foot and tries to think of a lie* Bruh-Bronch was pissing me off and kept pocking me and I told em to stop and he-mmph

Branch: *Covers mouth and bites hand as creek flinches in pain and rips his hand away and screams out in pain* HE'S LIEING HE WAS TRYING TO *voice gets quicker and higher as creek is trying to shut em up from saying anything further then he's gotten already* PUT ME DOWN AND I DIDN'T ECCEPT IT AND TOOK EM DOWN AND NOW HE'S ALL -MMMMMMPHH *looks at poppy with pleading eyes but screams underneath creek's hand while trying to take it off so he can speak*

Poppy: CREEK!!!! DON'T MAKE ME FORCFULLY GRAB YOUY OFF!!!! CAUSE I CAN CERTAINLY DO THAT!!!! I GOT NO FEAR OF DOING SUCH A THING!!!! IT'S EAITHER THAT OR YOU LET BRANCH GO AND I WILL CHATE WITH YA!!!! ONE WAY OR ANOTHER I'M PUNISHING YOU, YOU DON'T DO THIS...YK KNOW THAT!!! SO IT'S YOUR CHOICE THE EASY OR THE HARD WAY, YOU CHOOSE!!!!!

Creek: *Stares at her pissed off but doesn't wanna do anything to her since she's the queen so feeling really angered he let's branch go and get's up and runs away*

Poppy* Gasps never having a troll run away from her before and a feeling that she's never felt before tacks over and runs after creek while yelling back at branch to go home and tack care of himself*

Branch: *Not wanting to have poppy hurt herself trying to protect and deal with creek but also doesn't wanna to get hurt trying to help her knowing what creek's capable of doing and wants to go home so making his way towards his bunker he thinks about it*

All the other trolls go their own directions whispering to each other about all that they had witnessed

Creek: *Runs then takes a look back and gasps noticing poppy closing up on em*

Poppy: Get your ass back here boy!!!!

Creek: *Terror strikes em and runs then trips and falls down giving poppy time to catch up and hold em down*

Poppy: *Notices and uses her hair and wraps it around creek's waist pinning em to the ground not letting em go and gets up to em and sits on em pinning his arms down*

Cree;* Gasps in fear and tries to escape but is only able to breaks his arms away and not his body since she has her hair tied around his waist witch makes it more harder for the escape to happen* leh LET GO!!!!!

Poppy: And let you hurt others?! Give me a break creek!!!! I thought you weren't that bad!!! But recently I'm starting to think that breaking up was the best thing I did and getting with branch was better then it was being with you!! I can't have a king hurting others, that's bad leadership. I want others to look at my village and WANT to come and stay, not be scared cause there's this guy who loves picking on others and beating them up. Ik your really really pissed but things gotta come to an end and this whole thing...HAS to stop right now. By you acting the way you are is causing the village to be unsafe...so I got no choice then to put you in the fungeon.....

Creek: WHAT!!!!!!! *Looks at her as if she was his mom and told him that he's loosing his phone for a month and won't get it back til the end*

Poppy: I'm so sorry but I can't have you acting like this, it's unsafe for the village itself..*Gets up and having creek's waist still in her hair she grabs his two arms and starts to pull em towards the fungeon slowly and creek squirms to break free from her*

Creek: NO NO NOOO!!!! LET ME GOOO!!!!! NOOOOOOOOOOOOO *Cries while his whole world crashes in front of em as they pass a few trolls watching em being pulled by the queen towards the fungeon and having a freak out scene on the way there*

They reach it

Poppy: *Lightly pushes em in there and with one more look she meets his scared teary drenched face before closing the door before hearing his muffled sobs of pure sorrow but tries really hard not to feel his hurt and makes her way back into the village and proceeds with her day then later on goes back to see how branch was doing and did some cuddling with em trying to comfort em, trying to make em feel at peace from all creek put em through *

#Broppy #DreamWorks #DreamWorks trolls #poppy #trolls poppy #trolls branch #trolls creek #creek the creep #creepo #creek #branch #branch x poppy #trolls

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life-with-my-three · 3 years

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“Acquired Tracheobronchial Stenosis”.

It’s a slightly different diagnosis than the hypothesised “malacia” rather than “stenosis” it ended up being, but at least we have answers.

Aaron and I have finally been able to talk this morning. He was at work when I got home from the children’s hospital last night, and worked until midnight, so we didn’t have time to chat other than brief update calls. It’s helped to sort the intense trapped thoughts, somewhat that we’re still there even a couple of hours ago.

In the last 20 months of Hattie’s life I have seen her undergo countless procedures and tests. Never have I felt as sick as I did yesterday, waiting to hear how the bronchoscopy had gone. I actually thought I was going to vomit from anxiety. Then her respiratory consultant called to tell me the results.

I somewhat was feeling extremely guilty. I don’t know if I was more anxious about getting a diagnosis or getting no answers at all. I mean what sort of parent wants something to be wrong? There WAS something wrong we KNEW it, we just needed some name to it. But you feel guilty, feeling anxious they may come out saying they couldn’t see anything wrong with your child.

I honestly didn’t take in much of the consultant’s post bronch call, because of anxiety, but luckily she said she will make an appointment within the next few weeks. I *think* she said that there was no malacia (I could be wrong) which is where the airway is misshapen and weaker so when you breathe it collapses to varying degrees.

Both Hatt’s Trachea and bronchi (different parts of the airway) are abnormally narrowed (stenosis). It doesn’t look like it’s something she was born with, but most likely a result of having had multiple stints intubated (on breathing tubes). They’ve somewhat scared and narrowed her airway, so air is having to get through a smaller space making breathing harder.

The good news is for now, it’s not severe enough to need further treatment (surgery) than what she already gets. She already has a decent dose of inhaled steroids twice a day, we do inhaled ventolin as needed, and she’s already tube fed to counteract the difficulty some people have coordinating both swallowing and breathing with a narrower airway.

I of course laying in bed last night googled it and found this symptom list, and honestly, this IS Hattie. They could of written then list of symptoms on Hatt!

I guess I feel defeated with adding yet another diagnosis to her list. At the same time it is a huge relief to have an answer.

I also feel validated.

I’ve been made to feel my whole life by professionals that I’ve made things up, when I haven’t, so I’ve hit a point that I really struggle with telling things to doctors out of the fear that they’re just going to tell me I’m making it up for attention, so what’s the point.

When our local hospital’s emergency consultant looked at me and repetitively repeated “she’s fine now, I think she’s going to be okay” over and over again in a condescending tone, even though I had told him she was completely fine, and always was between her episodes and we were only there as our resp doctors at the children’s hospital insisted we take her to get checked, I felt like I was being put into some over reacting mother category (I didn’t even want to be there and made it clear).

Everything I have reported matched perfectly to this diagnosis. Even the bizarreness of it. I’ve definitely felt like I’m going crazy at times as it’s just so weird how they happen. The fact that the steroids somewhat helped (we think something must of been inflaming her airway more, which now we know she has a narrower airway to begin with, would explain why steroids made a difference).

I haven’t told a lot of people about these past few months. It’s just been too challenging. Our close family and friends that know we were going for the bronch yesterday have been messaging to see how it went. I know I need to message them back, but I’m stalling badly!! I just know for the majority of them the first question is going to be “so how long is she going to have her tube then”, and there’s only so many times you can politely answer that without the frustration slipping through. We simply don’t know. It is what it is. Right now she needs it and we can’t do anything about it. We’re not choosing this for her, it’s how it has to be. Especially as although yesterday’s results do have an indirect impact on her feeding, they didn’t actually have anything to do with feeding. It will still be the first question.

Seriously surprised anyone reads these long, jumbled rants!

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undesired-attention · 3 years

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Day 1607: the chest X-ray this morning showed that her lung has improved 90% just from her efforts over the weekend, so they cancelled the bronch. They were really surprised and I honestly was too, I saw the respiratory therapist today who said to us Saturday “if you do the incentive spirometer and the flutter device every 30 minutes while you’re awake, your lung will be completely clear by tomorrow.” And I told her she was right. I keep on my mom about doing it every 30 minutes over the weekend while I was there, and it actually worked. I knew the incentive spirometer was important for patients, but I have a better understanding now of just how much it really can help them and I’ll be keeping that in mind. Her white blood cell count came down today too. They let her eat today so she made me go get her McDonald’s and she ate almost all of the sandwich, and had some bites of a salad for dinner. The ostomy nurse came in late and said she was going to be leaving for the day but she’ll come tomorrow afternoon to talk with us. I got an approval letter for my intermittent leave FMLA request which is nice, but it didn’t mention anything about the continuous leave I’ve already been taking and will continue to take until the end of this week. Starting next week will be my intermittent leave as I need it, but including tomorrow and Friday night I’ll have been off 7 shifts in a row. I sent the lady dealing with my claim an email this afternoon but she still hasn’t gotten back to me so maybe tomorrow hopefully. I just want to be fully covered, but I also don’t really understand what I’m doing so I’d like some help if I need to do something additional or to be told yeah, it’s still processing? Idk. I’m going to try to fall back asleep soon, my head and body hurts, I took ibuprofen.

#jj

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trishmishtree · 4 years

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[Current as of March 13, 2020]

Dr. Shahed (screenshot above) is an emergency department physician in Ohio who shared this post on Facebook. It’s an account of COVID-19 from the perspective of an ICU doc working on the frontlines in Seattle. Some of my laypeople-friends were sharing it around (and I’ve seen it floating around on twitter and various internet forums], but I noticed that it’s really dense and contains a lot of medical abbreviations and jargon, like it was meant more for other physicians and isn’t really useful for the average reader. So I thought I’d provide a translation for my non-medblr followers who are looking to stay informed. (If you want further clarification, feel free to drop me an ask)

***

This is from a front-line ICU physician in a Seattle hospital

This is his personal account:

We have 21 patients and 11 deaths since 2/28.

We are seeing patients who are young (20s), fit, no comorbidities, critically ill. It does happen.

US has been past containment since January

Currently, all of ICU is for critically ill COVID patients, all of med-surg [medical-surgical] floors are for stable COVID patients and end-of-life care, half of PCU [progressive care unit], half of ER. New Pulmonary Clinic offshoot is open for patients with respiratory symptoms

CDC is no longer imposing home quarantine on providers who were wearing only droplet-isolation PPE when intubating, suctioning, bronching, and in one case doing bloody neurosurgery. Expect when it comes to your place you may initially have staff home-quarantined. Plan for this NOW. Consider wearing airborne-isolation PPE for aerosol-generating procedures in ANY patient in whom you suspect COVID, just to prevent the mass quarantines.

We ran out of N95s (thanks, Costco hoarders) and are bleaching and re-using PAPRs [powered air purifying respirators], which is not the manufacturer’s recommendation. Not surprised on N95s as we use mostly CAPRs [controlled air purifying respirators] anyway, but still.

Terminal cleans (including UV light) for ER COVID rooms are taking forever, Environmental Services is overwhelmed. This is bad, as patients are stuck coughing in the waiting room. Recommend planning now for Environmental Service upstaffing, or having a plan for sick patients to wait in their cars (that is not legal here, sadly).

CLINICAL INFO (based on our cases and info from CDC conference call today with other COVID providers in US):

The Chinese data on 80% mildly ill, 14% hospital-ill, 6-8% critically ill are generally on the mark. Data [in the US] very skewed by late and very limited testing, and the number of our elderly patients going to comfort care.

Being young & healthy (zero medical problems) does not rule out becoming vented or dead

Probably the time course to developing significant lower respiratory symptoms is about a week or longer (which also fits with timing of sick cases we started seeing here, after we all assumed it was endemic as of late Jan/early Feb).

Based on our hospitalized cases (including the not-formally-diagnosed ones who are obviously COVID – it is quite clinically unique), about 1/3 of patients have mild lower respiratory symptoms and need 1-5L NC [1-5 liters of oxygen per minute, via nasal cannula]. 1/3 are sicker, need face mask or non-rebreather. 1/3 are intubated with ARDS [acute respiratory distress syndrome].

Thus far, everyone is seeing:

normal WBC [white blood cell] count. Almost always lymphopenic, occasionally poly [neutrophil]-predominant but with normal total WBC count. Doesn’t change, even 10 days in.

Bronchoalveolar lavage: lymphocytic despite blood being lymphopenic. (Try not to bronch these patients; this data is from pre-testing time when we had several idiopathic ARDS cases)

Fevers, often high, may be intermittent; persistently febrile, often for >10 days. It isn’t the dexmed, it’s the SARS2.

Low procalcitonin; may be useful to check initially for later trending if you are concerned later for VAP [ventilator-associated pneumonia], etc.

Elevated AST/ALT, sometimes alkaline phosphatase. Usually in 70-100 range. No fulminant hepatitis. Notably, in our small sample, higher transaminitis [elevated AST/ALT] (150-200) on admission correlates with clinical deterioration and progression to ARDS. LFTs [liver function tests] typically begin to bump in 2nd week of clinical course.

Mild AKI [acute kidney injury] (creatinine <2). Uncertain if direct viral effect, but notably SARS2 RNA fragments have been identified in liver, kidneys, heart, and blood.</li>

Characteristic chest x-ray: always bilateral patchy or reticular infiltrates, sometimes peri-hilar despite normal ejection fraction and volume down at presentation. At time of presentation may be subtle, but always present, even in our patients on chronic high dose steroids. NO effusions.

CT is as expected, rarely mild mediastinal lymphadenopathy, occasional small effusions late in course, which might be related to volume status/cap leak.

Note - China is CT'ing everyone, even outpatients, as a primarily diagnostic modality. However, in US/Europe, CT is rare, since findings are nonspecific, would not change management, and the ENTIRE scanner and room have to be terminal-cleaned, which is just impossible in a busy hospital. Also, transport in PAPRs, etc.

2 of our patients had CTs for idiopathic ARDS in the pre-test era; they looked like the CTs in the journal articles. Not more helpful than chest x-ray.

When respiratory failure occurs, it is RAPID (likely 7-10 days out from symptom onset, but rapid progression from hospital admission). Common scenario for our patients is: admit on 1L/min oxygen via nasal cannula. Next 12 hrs escalate to NPPV [non-invasive positive pressure ventilation]. Next 12-24 hrs → vent/proned/Flolan.

Interestingly, despite some needing Flolan, the hypoxia is not as refractory as with H1N1. Quite different, and quite unique. Odd enough that you’d notice and say hmmm.

Thus far many are dying of cardiac arrest rather than inability to ventilate/oxygenate.

Given the inevitable rapid progression to ETT [endotracheal tube, aka intubation] once respiratory decompensation begins, we and other hospitals, including Wuhan, are doing early intubation. Face mask is fine, but if patients are needing HFNC [high-flow nasal cannula] or NPPV [non-invasive positive pressure ventilation], just tube them. They definitely will need a tube anyway, and no point risking the aerosols.

No MOSF [multi-organ system failure]. There’s the mild AST/ALT elevation, maybe a small creatinine bump, but no florid failure. Exception is cardiomyopathy.

Multiple patients here have had normal EF [ejection fraction] on formal Echo or POCUS [point-of-care ultrasound] at time of admission (or in a couple of cases, EF 40ish, chronically). Also normal troponins from emergency department. Then they get the horrible respiratory failure, sans sepsis or shock. Then they turn the corner, come off Flolan, supined, vent weaning, looking good, never any pressor requirement. Then over 12 hrs, newly cold, clamped, multiple-pressor shock that looks cardiogenic, EF 10% or less. Then either VT [ventricular tachycardia, aka V-tach] → VF [ventricular fibrillation, aka V-fib] → dead, or PEA [pulseless electrical activity] → asystole in less than a day. Needless to say, this is awful for families who had started to have hope.

We have actually had more asystole than VT. Other facilities report more VT/VF, but same time course, a few days or a week after admission, around the time they’re turning the corner. This occurs on med-surg patients too. One today, who is elderly and chronically ill but with baseline EF preserved, became newly hypotensive overnight, EF <10. Already no escalation, has since passed. So presumably there is a viral cardiomyopathy aspect, which presents later in the course of disease.

Of note, no wall motion abnormalities on Echo, right ventricular function preserved, troponins don’t bump. Could be unrelated, but I’ve never seen anything like it before, especially in a patient who had been hemodynamically stable without sepsis.

TREATMENT:

Remdesivir might work, some hospitals have seen improvement with it quite rapidly, marked improvement in 1-3 days. ARDS trajectory is impressive with it, patients improve much more rapidly than expected in usual ARDS.

Recommended course is 10 days, but due to scarcity, all hospitals have stopped it when the patient is clinically out of the woods. None have continued >5 days. It might cause LFT bump, but interestingly seem to bump (200s-ish) for a day or 2 after starting, then rapidly back to normal, suggests this is not a primary toxic hepatitis.

Unfortunately, the Gilead compassionate use and trial programs require AST/ALT <5x normal, which is pretty much almost no actual COVID patients. Also CrCl [creatinine clearance] >30, which is fine. CDC is working with Gilead to get LFT requirements changed now that we know this is a mild viral hepatitis.

Currently the Gilead trial is wrapping up, NIH trial still enrolling, some new trial soon to begin, can’t remember where.

Steroids are up in the air. In China, usual clinical practice for all ARDS is high dose methylprednisolone. Thus, ALL of their patients have had high dose methylprednisolone. Some question whether this practice increases mortality.

It is likely that it increases secondary VAP/HAP [ventilator-associated pneumonia/hospital-acquired pneumonia]. China has had a high rate of drug-resistant GNR [Gram-negative rod] HAP/VAP and fungal pneumonia in these patients, with resulting increases in mortality. We have seen none, even in the earlier patients who were vented for >10 days before being bronch’ed (prior to test availability. Again, it is not a great idea to bronch these patients now).

Unclear whether VAP-prevention strategies are also different [in China vs US], but wouldn’t think so?

Hong Kong is currently running an uncontrolled trial of HC 100IV Q8 [hydrocortisone 100 mg IV every 8 hours].

General consensus here (in US among doctors who have cared for COVID patients) is that steroids will do more harm than good, unless needed for other indications.

Many of our patients have COPD on ICS [inhaled corticosteroids]. Current consensus at Evergreen, after some observation & some clinical judgment, is to stop ICS if able, based on known data with other viral pneumonias and increased susceptibility to HAP. Thus far patients are tolerating that, no major issues with ventilating them that can’t be managed with vent changes. We also have quite a few on AE-COPD [acute exacerbation of COPD]/asthma doses of methylprednisolone, so will be interesting to see how they do.

#medblr #covid-19 #long post

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ikesenlemonadestandstories · 4 years

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Level 10

It’s FEBRUARY! Are you guys ready for Valentine’s Day? Cuz I am! Hope you’re all enjoying this story! It’s been a lot of fun to work on!

Tagging: @loudartanimeeclipse

Master List here or check the tag Ikesen AFK

Warnings: In a hospital, mentions of an OR - I kept it pretty clean

Happy Reading! T~

Level 10

You had never been so agitated in your life. What was even happening up in the OR today? Seriously, sure it was behind, that was normal. Procedures never went on time, and the later it was on the schedule, the more likely it was to go late. You knew that but what was that nurse’s problem? It’s like she had been toying with you all afternoon! First, she called you at one to tell you to get up and set up, so you kindly asked if you were still going last or if they had moved your procedure ahead of the others. She got snippy and said, “Why would we do that? Are you going to come set up?” You kindly told her, no, that’d you’d wait until you were fifteen minutes from your procedure start time to come set up.

She obliged and called you just shy of four-thirty to say that you were next, and the flex bronch would be done in a little under twenty minutes. Perfect. You took your time, walked up to the OR, and changed into your surgical scrubs before heading to OR19. You waved at Dr. Tokugawa when you remembered he couldn’t see the smile under your surgical mask, he returned the gesture with a nod as he continued to scrub down at the wash station.

Once the both of you finally made it into the OR, you noticed your crash cart had been pushed up against the back wall, and a C-Arm was moving in. The poor surgical tech from radiology walked up and bowed deeply. Proclaiming how sorry they were but they had to cut ahead of your case because “Dr. Kenney was the only radiologist on the floor today and with the procedure as far behind as it was he needed to go so he could make his next case on time.”

After a charged stare and a few snide comments, Dr. Tokugawa conceded, meaning you would likely be waiting at least another thirty minutes. Which was all dependent on how long it took to get the port in and accessed. The straw that broke the camels back, though, was when the nurse called you a fourth time to tell you that they forgot to call you and that they needed you in the OR right away.

After a mad dash to the room and you barely managing to squeeze into your gloves with your sweaty hands, you realized not only was the port not assessed yet, but your orders hadn’t been released, and nobody had even bothered to call Dr. Tokugawa again.

With a sharp look at the nurse, you pulled up the patient chart on the computer and released the orders. “I can go grab those! I’ll be right back!” A PCA squeaked as she scurried out of the room and down the hall to the main desk. Clearly trying to avoid as much conflict as possible.

With the C-arm being wheeled away, and the radiology team finishing up their final hold point it was finally your turn. Too bad nobody could do anything until your doc got here. Not like it was his fault he was behind though. So you’d get ready everything you could while you waited for him.

“Is everybody ready?” Dr. Tokugawa remarked as he stepped in through the sliding door a few minutes later and picked up the packet of sterile gloves.

“They better be.” You huffed under your breath, just finishing the last part of your tray set up.

He chuckled and turned to the other PCA, who was still in the room, gesturing towards the patient. “I’m going to need you to hold them.”

She nodded in response, and Dr. Tokugawa used that as his cue to start the timeout and begin the procedure. He was always so quick. Most of the time, it took longer to anesthetize patients than it did to do the actual procedure. He was clearly in a hurry, done with the collection in two minutes flat.

“That’s a new record.” You smiled with your eyes and finished capping your syringes. Happy that there was a light at the end of this long tunnel.

“I’ve got places to be. Since everyone insists on keeping me here all evening today, I figured I’d at least try to help my case.” Dr. Tokugawa said as he cleared the sharps from the tray and shucked his gloves.

“I feel that. I was supposed to meet a friend at five-thirty, and that’s clearly not going to happen.” You sighed as you disposed of the empty tray and wiped down your cart. “I don’t have their personal contact info either, so I feel bad cuz I’m just going to show up late. I hope they’re still there so I can at least explain myself.”

“Do you have to run those when you get back to the lab?” he lifted an eyebrow and pointed at the specimen bag in your hands.

“No. Fortunately, not.” You said as you exited the operating room and untied your surgical mask. “Our pathologist said it’s not urgent, so as long as we do it first thing in the morning, we’re good.”

“That was nice of him.” He acknowledged as both of you walked towards the main desk. “Enjoy your evening then; hopefully, your friend is understanding.”

“They don’t seem like the patient type, but you never know.” You smiled and waved before pushing into the women’s locker room to change out of your scrubs. “Enjoy your own evening Dr. Tokugawa.”

“Ieyasu.” Was all he said before the door shut behind him.

“Ieyasu.” You said to no one, in particular, a small smile on your face.

#ikesen #ikemen sengoku #ikesen afk #ikesen modern au #ikesen gamer au #ikesen long fic #ikesen reader insert #female reader #hospital setting #admin t gets nerdy on main

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kvcatnip · 6 years

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The painted figurine of a desperate heart.

You cannot see it, but I am giving you two looks. One that is mischievous, and one that says, “I hate you and I will kill all that you love.” But, whatever.

I had been contemplating doing this scene for awhile, so HERE YA GO. This is for @dadrunkwriting ! (Also, I fully realize that @veridium-bye may kill me for this scene and to that and I am only half sorry.)

With the major events in Crestwood taken care of, the group was set to leave within the next few days. They were in the keep at Caer Bronch, settling in after a day of battling demons and highwaymen. Adari had gone to the small room at the top of the stairs to talk to the scouts. Anything else that needed their attention needed to be taken care of soon.

Solas stood off to the side of the stairs, waiting for her to emerge. He was eager to have her attention without so many prying eyes, but he was apprehensive of his plan. It may not work, but he had to know when this was finished that he had at least tried. He couldn’t wait any longer.

Hearing her open the door and begin her descent, he calls out. “Inquisitor, may I have a moment?”

She had been reading a report, but his formality caught her attention. Looking over to him, she said, “Is everything alright? You only ever call me Inquisitor out there,” she says as she gestures with her hand. He knows what she’s implying.

“Yes, I just… I needed your attention. Forgive me.”

That seems to catch her off guard. She is quick to offer, “We don’t need titles for you to have my attention, Solas. What is it that you need?”

His chest tightens when she says his name. She so rarely does, it gives off a feeling of intimacy, of being known by someone.

“I was hoping that I might steal you away for a time. Is that alright?”

She pauses a moment to think. Finally she says, “I think I could give you the evening if you’d like? Let me go tell Cassandra in case the world decides to end before we come back.”

He chuckles, despite himself, and nods at her. “Meet me at the front gates when you are finished then.”

It isn’t long before she finds him. She holds up a basket, saying, “I didn’t know how long we’d be out, so I got us dinner.” He smiles warmly at that. He so rarely gets her to himself that he feels peculiar when faced with the reality of it.

Once they leave the Keep, he feels some of the tightness in his chest start to loosen. He wasn’t even sure that he would be able to get her away, but she was happily walking along beside him. The evening was starting off better than he had imagined.

They walk in companionable silence for a time before she asks, “Where are we going?”

“To a place not far from here. I would have shown you while we were out with the group, but I wanted it to be a surprise for you. I hope you do not mind.”

Her face seems to light up a bit at his words, which eases yet more of the anxiety away. She smiles at him and replies, “After so many demons and corpses, I could use a nice surprise. Thank you, Solas.”

He chuckles. “You don’t even know what it is, yet you want to thank me? What if you hate it?”

Adari laughs saying, “You know me too well. I don’t think you would give me a surprise that I hate!”

He looks down at his feet, smiling to himself. He thought he knew her well, yes. Hearing that being confirmed by her seemed something he should treasure.

They reached the mouth of a dark cave. He turned to her saying, “This is it. There’s an area past the cave tunnel.” He held out a hand to her, offering guidance in the dark. She smiled, taking it. They walked through the darkness quickly and quietly, and he found himself holding his breath. He tried to gain control, afraid she would hear his fumbling. They reached the inner part of the cave that expanded into a small enclosed courtyard of sorts. Adari gasped at the sight.

The area was framed by two Elven statues, with a pond in the center. The moon hung low in the sky, reflecting itself in the water. He held up a hand to examine as he said, “The Veil is thin here… can you feel it? The way it tingles on your skin?”

She looked around them for a moment before lifting up her own hand. “I can.. it.. it almost feels like drops of dew on my skin.” She smiled up at him. “Solas, this place is beautiful! Thank you. Truly. It’s refreshing to take a moment to really see everything around me.”

Good. This was what he had wanted. He gestured that they sit down near the edge of the pond to eat the food she had brought along. It was comfortable now, the time and space they were able to share together. So much of it was battles, yes, but there were other times like this. She had seemed to attach herself to him right away in Haven, as much as he tried to tell her otherwise. She came to him for guidance, for knowledge, and most surprisingly for companionship. He hadn’t understood it, but they had become fast friends.

While they ate, she talked to him happily about whatever came into her mind. She told him of latest book she had read, a small one of Dalish poems that had been given to her by the clan in the Plains as a gift. She explained how difficult it had been to see Blackwall in prison recently, and how she was grateful that she was able to offer him a second chance. On and on, she went. He was happy to let her talk as long as she wanted, as they so rarely had these moments of late. But when she leaned over to rest her head on his shoulder, he remembered why he had brought her here.

“Adari, I,.. well I brought you here for a reason. I wanted to find a way to show you, tell you, what you mean to me. And to thank you.” She sat up and turned to look at him. “What are you thanking me for?”

Taking a breath, he said, “You have so often challenged my views of not only the Dalish, but of the world as I have known it. You are unlike others, and that has been… refreshing to discover.”

She looked into the water of the pond for a moment before answering. “The Dalish are flawed, yes, but they are still my people.” Solas turned her head gently to look at him. “Yes, which is why I must tell you the truth. Your markings. They are slave markings. Originally they meant show which of the gods a slave belonged to, and well.. it has just been perversed over time.”

She stared at him for a long moment before answering. “The one thing the Dalish use to set themselves apart from others is just another thing that they misunderstood?”

Solas nods at her numbly. “I don’t say this to distress you. I know you would want the truth, as ugly as it may be. I have done some research, and I have discovered a spell to remove them. That is, if you wish.”

Adari makes a small noise in her throat before answering. “I didn’t want the markings to begin with, Solas. You know I don’t believe in the gods. To be seen as truly Dalish, to be seen as a full adult in their eyes, however, it is required.” She pauses for a moment, thinking. “But I am no longer truly Dalish. I don’t think I could be after being the Inquisitor. It would not pain me to lose the markings.”

He is relieved to hear her say this. He moves to face her fully, saying “This will not take long.” A blue green magic pulses from him as he washes her face with it. He reaches her chin and pulls back, taking in the sight of her without the markings. Taking in a breath, he says, “You… you are so beautiful, Adari.” She blushes at him, and he cannot stop himself. He moves to grab her face in both his hands. Pulling her close, he kisses her.

And she lets him. For one eternal moment, he is simply the painted figurine of a desperate heart. He puts everything he feels for her into that kiss, a kiss he has held back for months. He has waited, hoped, and dreamed, knowing it would not come into fruition. And yet here he was.

He pulled away, hesitantly. She looked up at him, surprised. “Solas?”

Taking his hands from her face, he reaches for her hands instead. He takes a shaking breath before saying, “So much has happened, and before this is over so much more will. I just.. I needed to be selfish for just a moment.” He pauses in case she wishes to speak. She seems to understand he has more to say, so he continues. “You have to know that I love you. Deeply. More than I thought I was capable of, more than I have ever been capable of. I needed this moment to be selfish, because I couldn’t bare the thought of not telling you. At least once.”

She looked down at their hands. Very quietly she said, “Solas, you know that… that I’m with Cullen. That I’m in love with him.” He sighs. Of course he knew. It’s why it had taken him this long to bare himself to her.

“I do. But can you fault me for offering the truth?”

She shakes her head, and squeezes one of his hands. Looking up, she meets his gaze with her tear filled one. “But Solas, you have to know that I love you as well. It’s not the same, but… it’s not worthless. “

He swallows before answering her. “Yes. I know. And, I am grateful for your love in whatever form you will give it.”

She reaches across to hug him, and he feels her wet cheeks on his neck. Even if her love was not the same, he knew it would be hard to leave when the time came. He holds her tighter, whispering apologies into her hair for so many things she did not yet know.

#dadrunkwritingcircle #solvallen #fen'harel #solas #dragon age #Adari Lavellan

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eileens914289515-blog · 5 years

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