nealran

[nealran]

im going crazy you have GOT to decouple romance/amatonormativity and marriage in your mind. you have GOT to understand that marriage is a legal document that protects you from exploitation especially if you are a woman or a stay-at-home anything. it is not some evil unique to heterosexual people. it is a legal document that says 'this is who i want in my hospital room when i die, this is who i want to have my stuff when i die, THIS PERSON OWES ME RECOMPENSE IF THEY KICK ME OUT OF THE HOUSE I LIVE IN"

You are not immune to being taken advantage of by your partner if you are queer. do not wind up homeless because your garbage live-ins name is on the lease and they decided to drop you like hot coals.

[nealran]

The Onion continues to never miss

[nealran]

Astrology doesn't seem to work.

[nealran]

"i would find you in any universe" but it's very clearly intended as a threat

[nealran]

ive just seen the american psycho characters drawn as my little ponies and honestly i dont think patrick should have been given that cd as his cutie mark. i think you're doing it wrong if you're not making him a perpetual blank flank

[nealran]

Sooooo few people are actually willing to defend the basic human rights of people who have committed crimes. Like I know it's not fun but if you genuinely believe in human rights as a concept you can't be okay with the state violating them in prisons I'm sorrrrry. Having moral principles is not always a fun time.

[nealran]

"Punishment works!!!" We're drowning in three to four generations of people so pants-shittingly terrified of ever being wrong that half of everyone has constructed a worldview wherein they never even consider the possibility that they could be wrong and the other half behaves like one wrong move will make anything or anyone explode violently into a million irreperable pieces. I don't think it works guys

[nealran]

pick up your banjo

[nealran]

They’ll never do a Hitman level set in a Furry Convention because gamers would absolutely ruin it but imagine. like the target isn’t a furry he just owns a hotel that happens to have one every year but you can disguise yourself in a fursuit and some guy will ask you “what species is your sona” and 47 would be like “a wolf. i always felt a connection with…hunters.” and then diana would be like “let’s see if you can sniff out some information, furrty-seven” and then he comes to my house and kills me for writing this

[nealran]

thinking about my wife… thinking about how on earth to draw those armor sets so they look cute

[nealran]

[nealran]

I had a patient come in the other day because she wanted her IUD replaced. It was at the end of it's life and she loved having her IUD, this was her second one. My MA let me know that the patient was very anxious about getting the IUD replaced, she'd had painful experiences in the past with her other replacements and was dreading this visit for that reason.

I spoke with the patient and she was literally shaking with anxiety. I asked her to describe her prior experiences as well as what she liked about her IUD and what she didn't like. She said that she wished she didn't have to get it replaced so often, so I recommended we place a Mirena instead of just inserting a new Kyleena IUD. She was nervous about this because she didn't want an IUD that was big. I explained that the Mirena and Kyleena are essentially the same size but the Mirena lasts 3 years longer and would likely bridge her to menopause given her age whereas with the Kyleena she'd probably need another replacement to get there. She was okay with trying the Mirena.

I then talked to her about pain control during the procedure as this was what she was most worried about. I asked about her prior experiences and then laid out what I wanted to do to try and improve her experience during this procedure. I told her I planned to give her prescription strength ibuprofen, a heating pad, and a very dense anesthetic block in her cervix to hopefully make it a better experience. If she had had someone to drive her home I would've also given her an ativan because we have studies that show patients who report higher rates of anxiety surrounding a procedure also report higher rates of pain associated with it.

She was down for this plan. I gave her a very dense block, she only felt three small injections and then nothing else. She was shocked when I told her that her old IUD was out and the new one was in. She didn't believe me when I told her it was over.

I don't tell this story because I wanna brag about how amazing of a doctor I am because I'm not. I tell this story because this is the way IUD insertions SHOULD go and I want people to know that IUD insertions do not need to be traumatic. And I want other providers who may insert IUDs to know that a paracervical block should be your standard when it comes to IUD insertions.

When people find out I'm an OBGYN, complete strangers, acquaintances, etc. , the two things they like to tell me immediately are their horrible birth trauma story and their terrible IUD insertion story and I'm trying to at least make the latter one a little less common.

If you place IUDs and aren't doing a cervical block, you need to start. This should be the standard but over 90% of OBGYNs in the US aren't doing them and it's unacceptable. We are traumatizing people and it's entirely avoidable. We are scaring people away from one of the most effective and long lasting forms of birth control in a time when people are losing their ability to end unwanted pregnancies all for no justifiable reason.

"It takes too long:" No it doesn't, that visit took me 20 minutes with a highly anxious patient from start to finish.

"It's not worth it for such a short/small procedure." It's worth it for the patient.

"It's too expensive." You can do a paracervical block with just normal saline. You don't even need lidocaine if you use a generous amount of volume. And if you place Nexplanons I know you stock lidocaine in your office, stop being fucking cheap at the expense of women's pain.

"Patient's don't need it, they'll get over it." I'm telling you they do need it and they aren't getting over it as evidenced by literally everyone wanting to tell me about their terrible IUD insertion experience as soon as they find out I'm an OBGYN.

We should do better. The cervix has nerve endings, stop acting like it doesn't.

Make cervical blocks your standard of care, there's no excuse not to.

[nealran]

I was today years old. That is disgusting.

No Child Left Behind is one of the worst things to ever be incentivized in schools. It was signed into law when I was 14. Reading Rainbow was my show as a kid. LeVar Burton played a big part in why I became an avid reader to date. The joy of it. It's an adventure around the globe and through different time periods without stepping on a plane or time machine.

Children parrot behavior. In grade school, I always wanted to read the same amount of books as my teachers (50 books) and managed to double that each year. Before No Child Left Behind, book fairs and Scholastic catalogs were a serious matter like your grandma's Fingerhut catalogs. Libraries were (and still are) a wonderland.

Reading comprehension and proficiency in schools has been declining for decades. A crisis. The joy of books isn't pushed anymore and I'm always saddened by it. It's one of the reasons why I post my book reviews and recommendations on here, as well as posts from others to encourage reading and (novel) writing. Kids will parrot your behavior while the education system sadly fails to return as that example.

[nealran]

This is the only valid use for death of the author.

[nealran]

There's going to be a conclave to elect a new Pope.

I hope it doesn't-- OH MY GOD

[nealran]

[nealran]

BG3. Wyll.

I love him so much. On a fannish level, I think he's my favorite.