#“”womens health“” clinic but i might try to do that and ask if their doc can like.. work in an apt to deal with my tit or has any suggestion

[felidaefatigue]

my. tit. Hurts.

[stevenbasic]

“Knock-knock!” I heard at the door of my office, startling me. I was nearly - jesus - an hour into this video call with the Study Coordinator from Evolution, and had obviously lost track of time.  “Where’s my favorite patient?!?’ called the voice. It was Vida, my Nurse Practitioner, entering with a broad smile, a procedure tray and someone else and causing me to look up from my computer screen. “Time for your mediciiine…” In place of her usual white clinic jacket, she was wearing a tailored black jacket over a black, figure-hugging, dress, cut low.

Immediately I said my abrupt goodbyes to Gianna, over chat, and shut down the window right as she was, good lord, blowing me a kiss. At the same time I looked up and gave my wan smile of greeting to Vida and the generously curvy blond woman who’d entered with her…

“This is Morgan, if you two haven’t met yet,” Vida said, as she briskly approached my desk, high heels clacking. Trailing behind her a few steps was a woman in a white blouse and tan leggings - a big woman - broad of shoulder, wide of hip, huge of chest, standing taller than Vida by five or six inches...and myself even more, “She’s a Nurse Practitioner too, from Evolution until just yesterday, when she joined us.”

“It is very nice to meet you, Dr. J…” Morgan purred, in a voice deeper, richer than Vida’s. There was a queer smile on her face and a hint of a vaguely Eastern European accent in her words, one that she was obviously trying to hide. For now she was hanging back, taking her cues from Vida as the younger but more senior woman began to prepare her tray behind my desk to my left. “Nurse Vida is training me today how to take the care of you.”

“H-hi, uh, Morgan,” I replied, immediately sensing that that was not this woman’s given name, and remembering it was time again for my booster shot. The thought, for some reason, brought me a little thrill, remembering how it made me feel last week…but was it also responsible for the 8 pounds I’d lost since then? “But, um, what do you m-”

Interrupting my concerns, Vida chuckled. “Oh, don’t get worried, doc. I just figured that the more of us that know how to do this for you, the better,” she explained, opening the strange black box in which the vitamin B12/D/K booster vial was packaged. I noticed the familiar, strange blue tint of the liquid as Vida removed it along with the pre-packaged syringe. “And Morgan here has lots of experience.” At that, Vida nodded up at Morgan; the larger woman took that as a cue to move around the other side of my desk, to my right, and come to stand alongside me there. I was flanked.

“I-is that right, Morgan?” I asked, hearing the nerves starting to quiver in my voice. I hated needles, I hated them. But this single, combination shot was much better than three separate ones. “Wh-what did you do at Evolution?” I asked, not able to recall her resume as I looked up at her; she was gazing down at me, over the shelf of her formidable bosom. I was hoping that, if she had started seeing patients today, that she had been more buttoned up during the workday. The cleavage she was showing at this moment, over the neckline of her overmatched white blouse, was vast.

“At the Evolution Pharmaceuticals?” she replied, the accent in her voice unable to camouflage itself through the words, “There, I was with research team, taking care of study subjects. But before, I was in pediatrics ward, with preemies, the NICU.” She looked down on me with a crooked smile, and seemed to be resisting reaching out her hand to me. Instead, she ran her fingers through her shoulder-length blond hair. “I love holding little bodies.”

“Haha well, that’s exactly why we’re here, isn’t it, Dr. J?” Vida added, explaining to Morgan and pursing her full, plump, latin lips, “This young man has lost a few inches recently and we need to make sure he gets his vitamins.” With that, Vida beamed down at me and released  her thick mane of dark hair from the conservative bun she’d been wearing for the workday. A wave of the now-ubiquitous perfume in this place flowed over me, and I felt a stirring between my legs. I had been intermittently hard during my video call with Gianna - her tits were unbelievable - and I was afraid now that I might swell to some obvious, inappropriate monster of a boner with these women so close. “Lucky for him he has his girls to take care of him,” Vida concluded. The vial and syringe, for the moment, laid inert on the tray.

I tried to focus. ”I, heh heh, don’t know if I need someone to ‘take care of me’...” I spoke, trying to sound relaxed as Morgan’s left hand finally did come to rest on my right shoulder. I’d honestly just met this woman, but she was being very…familiar. Vida as well; she was generally a bit more aloof than she seemed today. It was like there was something weird in the air, something bringing them closer.

“That's silly,” Vida responded, “Even doctors need someone to look after them.” At that, she began to remove her black jacket, and laid it on my desk, as if preparing herself for her task. Underneath she wore a clingy black tube dress that hugged her hourglass figure and revealed her trim shoulders and the upper swells of her full chest; she watched as I struggled not to look at her body. “Who do you see for a PCP?”

“uh…” I began, trying to recall my last visit to a doctor’s office outside of this one, “…no one?”

“You mean…” Vida asked with exaggerated concern, as she herself put a hand on my other shoulder, leaning in to me and twirling a lock of thick, raven hair, “you don’t have a Primary??”

“N-no I, uh-“

”Well, that’s no good,” Vida concluded, standing straight and looking across me at her fellow nurse, “Don't you agree, Morgan?”

”Oh yes,” Morgan concurred, her dimpled smile betraying her amusement, stepping a touch closer, “You need the primary...care...provider.”

“That settles it,” Vida decided, removing her right hand from me to place both it and her left one on her broad hips, in determination, “I’m going to be your PCP from now on.” Her action had drawn my eyes to her remarkably tiny waist and shit this girl had some curves. “I’ll contact our insurance company, do all the paperwork. How does that sound?”

The big woman to my right was giggling, and her hand had begun to idly caress my shoulder.

“Uh, th-that’s fine…” I agreed.

“So,” Vida finally asked, with a wry smile, “does my patient have any questions before we get started?”

Ugh, right…the injection. “Well, um, honestly…” I began, knowing I should at least address the concerns I had over this combo B12/D/K formulation, “I’m not sure it’s working. I think I’ve lost weight since last week, and even maybe almost an inch…”

“That’s ridiculous. You must have measured wrong last time, used a bad scale,” Vida replied, trying to reassure me, “But…do you think you need to go out and get checked..?”

At that, Vida herself moved in closer, and I saw Morgan, to my right, turn her thick body more towards me. Both women looked down at me.

“Or do you want to let us take care of you..?” Vida finished. It felt like a challenge, and I sensed something, an inner struggle inside myself. The logical, intelligent practitioner who cared for his health wanted to answer one way, bring a halt to something that was dangerous, possibly ruining my life. But another part of me, the one that was feeling the cock growing once again down my right thigh in tribute to the ever-more enveloping warmth of these women, just wanted to say-

“n-no…I think I’m alright,” I answered, “let’s go ahead with the shot. I’ll be fine.”

If I had known then what I know now, that my mental capacity for rational thought in the face of arousal had been already crippled by foreign agents? If I had known that I was being purposefully enslaved, drowned more and more every day in the sea of pheromones and womanly curves in which I swam? WelI, I would have run screaming. Or, then again...would I?.

“I’m sure you’ll be fine,” Vida assured me. Her voice had dropped low, almost hypnotic, “You don’t need to go out and see any other specialists. We’ve got everything you need right here…” She was beginning to prepare the injection, now, drawing the blue liquid from the vial up into the syringe.

“Yes, everything,” Morgan agreed, looming over me now so close to my right, her hips and belly blocking out the world behind her. Her scent was warm, earthy. Between it and Vida’s reassuring tone, I felt powerless to do anything but trust these women.

“But,” Vida began again, inspecting the now-filled glass syringe, “if you are still shrinking, lots of guys would be jealous. Don’t you think, Morgan? Here, take this-” She handed a band-aid across me to her fellow nurse.

wh-what?

“Oh, yes,” Morgan concurred, her voice husky, unwrapping the band-aid, preparing it, “very jealous.”

”What…what do you mean?” I asked, confused, looking from one woman to the next, up at them. Without even being told, I had begun rolling up my sleeve.

Vida chuckled. “Oh, you know, the whole ‘vulni-chic’ thing,” she answered, holding the prepared injection now in her right hand, “you’d get very popular if you lost another-“

“One meter?” Morgan said, giggling in her deeper, richer tone, “Two?”

“haha I’d disappear…” I joked, feeling a wave of warmth coming from Morgan’s body to my right, “just like, haha…”

“It’s not a joke, Dr. J,” Vida said, her voice plain, suddenly, clinical, “it’s a thing. Here, get ready-“

“Ouch!!!”

She’d jabbed me, in the left shoulder, with the shot.

Vida spoke as she pressed the plunger, pushing the blue liquid into my deltoid. “It’s not just a fad for women, guys these days are admitting it, too…” she said as she drew the needle out of my arm. Immediately I’d felt it entering my body, like a milky warmth. “Good boy,” she praised, “Band aid?”

“Thanks,” I replied without thinking, watching as Morgan leaned her big torso across me as I turned in my chair towards her, presenting my left shoulder. She was nearly smothering me with her big breasts as she applied the bandage, and I did everything I could not to goggle at the wobbling flesh of her full, tan cleavage. My roving eyes made me realize that this generously endowed woman was wearing a very thin bra, or possibly none at all. Somehow, though, she was still so firm, with a natural buoyancy that kept her tits high and proud on her chest. My gaze could not get enough. But then eyes fluttered as I was assaulted by both an overwhelming breath of her perfume and the first rush of pleasure from the shot. I began to lower my sleeve, rubbing my arm as I looked up at her, smiling down at me as she finally stood up and away.

“I mean it, with the shrinking,” Vida started again, watching me with an appraising eye as I recovered from my shot, buttoned my sleeve, “have you seen Melissa’s new Instagram post?”

With the butterflies? I didn’t want to admit anything.

“The guys that follow her, the simps,” she continued, “they talk about wanting to be like bugs, crawling into her breasts.” She was replacing the syringe, carefully putting it and the vial back into the box. “It’s all over the place, everywhere, though no ones really talking about it yet,” she said, as she closed the black container, “guys wanting to be smaller, weaker than us. Wanting to become inferior, more passive, more submissive.”

She looked down at me and smiled, watching as the effects of the injection began to take hold. Even more strongly than last time, I was being gripped by a pleasant wave of lethargy, relaxation.

“Guys want to be small, these days,” Vida said, “and we’d like it that way too, wouldn’t we, Morgan?””

To my right I heard Morgan purr, a little grunt. “Yes, Nurse Vida,” she said, her voice low and struggling with arousal, “we would like it very much.” I had the feeling she was holding back her true feelings, in restrained understatement.

Vida laughed, casually. “It’s weird, all these changes in gender dynamics,” she continued, brushing a lock of my hair behind my left ear, “the new thing is bigger women, smaller men. Here, look at Morgan, perfect example…”

I turned, looked up at the smiling behemoth of a woman.

“She’s probably bigger than you ever were,” Vida continued, “taller, heavier, thicker everywhere.”

“Yes,” Morgan agreed, seeming to rise up, grow bigger, heavier, right in front of my eyes, “I weigh much, much more than the you.”

“And, you have to admit…” Vida asked, watching me look up at the huge, busty blond woman, who was now absolutely dwarfing me in my seat and could probably lift me like a child, “that’s kinda sexy, right?”

“I, uh….” I began, not knowing what to say. My erection was getting painful, now, contorted as it was in my pants, trying to stretch down my right thigh.

Vida spoke again, now holding my head in place by my cheek and jaw, so all I saw was Morgan. “So, even if you are getting smaller...lots of us would like that.”

I sat there, in the building afterglow of my injection, and looked at this woman’s body. It was, in all ways, so much bigger than my own. Thicker thighs, wider hips. Her arms were stronger than mine, her shoulders broader. Standing aside her, I would look puny. Even Vida - though she stood roughly my height, maybe an inch or two more - her hourglass figure and womanly hips made her body just that much more than mine.

”Dr. J,” Vida said, pulling me from my reverie, but not releasing my face from her hand’s gentle embrace, “You look like you need to go lay down. We’d take you up to bed ourselves but we have an important girl meeting to get to, don’t we Morgan?”

“Yes,” Morgan replied, though never taking her eyes or dimpled smile from me, “Very important.” I watched as she looked down on me, regarded me, considered me. “But I promise. Next time you can go to the sleep in my lap,” she said, “I have a very nice lap.” With that, Morgan bent at the waist a bit, to gently slap her prodigious thighs. My eyes watched them jiggle, and then her hands come up to the collar of her blouse, hoisting her breasts. “Or, if not on lap, we find somewhere else…”

“Haha okay,” Vida laughed, finally releasing my head but smiling as I didn’t turn away from the cleavage into which I was now dumbly gazing, in my vitamin-fueled haze imagining myself sinking into it like a caterpillar, cocooned in womanly warmth. “I’ll get a couple of the MA’s to get you upstairs…”

=========================================

more Vida & Morgan imagery, more posts, more more more at my Patreon.

Thanks for reading, everyone.

[dontmeantobepoliticalbut]

President Joe Biden on Thursday announced a number of new steps his administration will take to try to get more Americans vaccinated and slow the spread of coronavirus, including requiring that all federal employees must attest to being vaccinated against Covid-19 or face strict protocols.

The new measures come amid a rise in Covid-19 hospitalizations and deaths in the US. The vast majority of those individuals with severe cases of Covid-19 are unvaccinated.

"This is an American tragedy. People are dying -- and will die -- who don't have to die. If you're out there unvaccinated, you don't have to die," Biden said during remarks at the White House. "Read the news. You'll see stories of unvaccinated patients in hospitals, as they're lying in bed dying from Covid-19, they're asking, 'Doc, can I get the vaccine?' The doctors have to say, 'Sorry, it's too late.'"

In his sternest approach yet to pushing Americans to get vaccinated, the President bluntly argued that if you are unvaccinated, "You present a problem to yourself, to your family and to those with whom you work."

Biden said every federal government employee and on-site contractor will be asked to attest to their vaccination status.

Employees who have not been vaccinated "will be required to wear a mask on the job no matter their geographic location, physically distance from all other employees and visitors, comply with a weekly or twice weekly screening testing requirement, and be subject to restrictions on official travel," the White House said ahead of Biden's speech.

The federal employee vaccination requirement is not a mandate, officials have insisted, and most federal employees who do not get vaccinated will not lose their jobs as a result, CNN previously reported.

But the decision nonetheless marks a pivot away from encouraging Americans to get vaccinated in their own time and stepping toward placing the onus on unvaccinated individuals.

Other efforts the administration debuted Thursday to incentivize vaccinations included expanding paid leave for employees who take time off to get themselves and their family members vaccinated. Biden said employers would be reimbursed. He also called on states, territories, and local governments to do more to incentivize vaccination, including offering $100 to Americans getting vaccinated, paid for with American Rescue Plan funding.

"I know that paying people to get vaccinated might sound unfair to folks who got vaccinated already. But here's the deal: if incentives help us beat this virus, I believe we should use them. We all benefit," Biden said.

The President also announced that he is ordering the Department of Defense "to look into how and when they will add Covid-19 to the list of vaccinations our Armed Forces must get."

"Our men and women in uniform, who protect this country from grave threats, should be protected as much as possible from getting Covid-19," he said. "I think this is particularly important because our troops serve in places throughout the world, many where vaccination rates are low and disease is prevalent," Biden added.

All military and civilian Defense Department personnel will be asked to attest to their vaccination status, the department said Thursday evening. Those unable or unwilling to do so will "be required to wear a mask, physically distance, comply with a regular testing requirement and be subject to official travel restrictions," Jamal Brown, deputy Pentagon press secretary, said in a statement.

The department is also considering adding the Covid vaccine to the list of required vaccines for military personnel.

"Secretary (of Defense Lloyd) Austin will begin consulting our medical professionals, as well as the Joint Chiefs of Staff, to determine how and when to make recommendations to the President with respect to adding the COVID-19 vaccines to the full list of requirements for military personnel," Brown said.

The President on Thursday also called on school districts nationwide to host at least one pop-up vaccination clinic over the coming weeks in an effort to get more kids 12 and older vaccinated.

Responding to reporter questions after his remarks, the President said he didn't know yet whether the federal government had the power to require vaccines. "It's still a question whether the federal government can mandate the whole country" require vaccines, he said, adding that he expects the vaccines will be fully approved by the US Food and Drug Administration by the fall.

But soon after the President's speech, White House Covid-19 Response Coordinator Jeff Zients told CNN's Wolf Blitzer the administration is not considering a nationwide Covid-19 vaccine requirement.

"That's not an authority that we're exploring at all," Zients said on "The Situation Room."

On Monday, the Justice Department determined that federal law doesn't prohibit public agencies and private businesses from requiring Covid-19 vaccines -- even if the vaccines have only emergency use authorization so far. Biden's aides had previously said they do not believe he has the power to require all Americans to get shots. But his oversight of the federal workforce, they believed, can be a powerful model to other employers considering their options on requiring vaccines.

But several groups representing federal workers across the government are already raising concerns about the requirement for their personnel, including groups representing federal law enforcement officers, IRS managers and members of the US Border Patrol, among others.

Other groups, like the International Federation of Professional and Technical Engineers, have come out in support.

The goal of the requirement, Biden aides have said, is to render being unvaccinated so burdensome that those who haven't received shots will have little choice other than to get them. It's an approach being tested by leaders in Europe, including French President Emmanuel Macron, who required either proof of vaccination or a negative test at public venues. And some states, including New York, have also said government employees must either prove they've been vaccinated or be tested weekly.

The White House had previously indicated it would support private companies' decisions to mandate Covid-19 vaccinations, but Biden took it a step further on Thursday, saying that he'd like to see companies, states and schools move in the direction of requiring Covid-19 vaccination.

Dr. Rochelle Walensky, director of the CDC, said Wednesday on CNN that health passes for the fully vaccinated, such as those used in parts of Europe, "may very well be a path forward."

But the President appeared to put that responsibility on businesses -- not the federal government -- on Thursday.

"My guess is that if we don't start to make more progress, a lot of businesses and a lot of enterprises are going to require proof (of vaccination) or you're not going to be able to participate," Biden said.

The prevalence of the highly contagious Delta variant in the US and low vaccine uptake have led to the federal government to take a number of steps to further mitigate the spread of Covid-19.

Zients told Blitzer that the FDA is certain that Americans don't need boosters right now, but it will continue to monitor the data.

"If they do decide that Americans need boosters, we are ready," he said. "We have the supply, and people will be able to get a booster shot -- if it's needed -- in a fast and efficient manner."

Earlier this week, the US Centers for Disease Control and Prevention recommended everyone -- including vaccinated individuals -- wear masks indoors in areas of substantial or high Covid-19 transmission. The agency also recommended masks for all K-12 children in schools, even those who have been vaccinated.

The Department of Veterans Affairs also recently announced it would require frontline health care workers to be vaccinated over the course of the next two months.

During his remarks on Thursday, Biden acknowledged frustrations over the nation's slow bounce back and the renewal of restrictions.

"We have the right plan. We're coming back. We just have to stay ahead of this virus," Biden said. "I know this is hard to hear. I know it's frustrating. I know it's exhausting to think that we're still in this fight. And I know that we hoped this would be a simple, straightforward line without problems or new challenges. But that isn't real life. (We're) coming out of the worst public health crisis in 100 years. The worst economic crisis since the Great Depression."

The latest data from the CDC indicates that 49.4% of the total US population is fully vaccinated. And despite a previous downward slope in the pace of vaccinations, 389,963 people are now initiating vaccination each day, according to the current seven day average.

This is the highest it's been in more than three weeks, but it's still lower than the pace set by millions who were receiving shots every day earlier this year.

[starr-fall-knight-rise]

HASO, “Your Choice.”

I am having a lot of fun with this arc.  Writing it has put me in a good mood, so I hope you like it as well :)

He walked the halls of the Oxystation with a  gun slung over his front hanging from a shortened tac sling around his neck and shoulder. He rested his arms and hands against the weapon as he walked down the hall. The gun was more of a redundancy than anything, if any unwanted alien was able to breach the hull of the station with the armored patrol outside than his gun was just a token sign of resistance. Of course, there was always the possibility that one of the patients would become violent and attack a staff member, but that possibility was quite low, even lower than it was in human mental health clinics. Only five percent of the mentally ill population was any sort of danger to anyone but themselves, and a large percentage of that would still, likely, never do anything bringing that number down somewhere closer to one percent.

With aliens it was even less likely, they weren’t naturally aggressive like humans, so when their mental health tanked, it tended to do it with extreme anxiety and something that looked sort of like depression, though the different species presented the illness differently. 

Working at the Oxyclinic had been good for him. It hadn’t been long until his enthusiasm for alien life had come trickling back in, and his fear had been discarded like a sock with a hole in it. He had even offered to help with the oxytheropy that the psychologists were offering. If anything was gong to get rid of his lingering fear of aliens, it was probably going to involve spooning one.

A weird way to deal with internalized fear but there you had it.

The oxystation wasn’t just for the oxytheropy. Human and alien psychologists were taking the time to learn about other species, and put together differing treatment plans for their patients. There was a high turnover rate, and not all the people who came to the clinic ended up staying, not all of them needed oxytheropy, and not all of them would do well having it considering that some of the fear the patients had often centered  their issues around humans. To his surprise, he found that a lot of it centered around the Drev war.

He looked down at his watch and took a sharp right turn down the nearest hallway entering the guard quarters just as his watch reached the hour.

“Morning LT.” Someone called and he waved a hand.

“Anything to report?”

“Nothing, all is quiet as usual.”

He ejected the magazine of his gun, and checked the chamber to make sure it wasn’t still loaded before racking it in the safebox as one of the other men stepped up to take his place on patrol.

The other group of men and women looked up at him from where they sat around a table playing cards, “Want us to deal you in.”

Adam shook his head walking over to his locker and pulling out a fresh pair of light blue scrubs, “No I promised the doc I would help today.”

The other humans shook their heads and rolled their eyes, “leave it up to you to want to spoon aliens.”

“Spooning aliens is a lucrative job. You should try it sometime, maybe you’d finally have enough money to buy the bag you’ve always wanted.”

“Bag?”

“YEah the nice one to cover your face.” he shut the locker and grinned at the car players to let them know it was all in good fun before turning towards the bathroom, where he changed and stepped back out. The scrubs were very breazy in comparison to his guard uniform and he shivered slightly returning to his locker.

It was important for people working on the ward to be completely unarmed, and for the humans to look as non threatening as possible. A strict list of instructions urged them not to smile with their teeth, and to keep their hands and feet covered at all times. He wasn’t entirely sure if the fuzzy socks and mittens were entirely necessary for that, but apparently some of the aliens interpreted human nails as claws, and some genius had thought that covering them up like this was very nonthreatening.

Looking in the mirror he had to admit it worked.

In his light blue scrubs and the fuzzy white mittens, he looked more like the easter bunny than he did a killer.

But then again, in real life he didn’t look much like a killer either.

He turned to walk out the door flipping off the people geering at him before remembering that he was wearing a mitten, which kind of negated the point of the gesture.

From there he wandered back up the hall and was buzzed into the ward after waving to the camera. He went through a few metal detectors which pinged on his leg, but they let him through anyway as he stepped into the hall and up to the staff room where the other workers and a few psychologists were having a break.

He took a seat in a chair and idly watched the TV.

HE looked around at the people who wore similar clothes as him and noted, not for the first time, that it took a special kind of person to do this job. All of these people were remarkably docile and relaxed people, and as far as he knew the vast majority of them had no shame. Despite humans being prone to cuddling pretty much anything and everything, its was pretty hard to spoon an alien and not feel awkward about it, but these people right here, they either enjoyed it or they were damn good at faking it.

Adam wasn’t good at faking anything so he was the former.

HE shifted slightly in his seat thinking about some of the aliens on the ward before his mind inevitably shifted to…. To him…. The alien that he dreaded seeing the most…. A big, tall hulking creature that wandered his nightmares and made his leg ache.

The Drev.

The Drev with eyes like the thing that had stolen his leg.

He put a hand to his head feeling a bit dizzy. He had only had one PTSD related panic attack since getting here, and that was only because he had been accidentally exposed to the Drev unexpectedly one day and without knowing that he was on the ward. It had been embarrassing for him as he tried not to let anyone know about his condition, but based on that incident he had been forced to come clean.

Ever since that incident  he had been quietly forcing himself to get closer and closer to the Drev despite the psychologists telling him that it was perfectly acceptable for him to step off the ward if the Drev was on.

But adam didn’t like that mentality much.

He had always felt, ever since returning from the Drev war, that people were too soft on him. They always sat there and told him that it was fine and whatever he needed to do was important, that he couldn’t blame himself if he couldn’t handle something. They were all very forgiving and very understanding, but that's not what he wanted. At some point, he felt that it was acceptable to get up in someone's face and tell them that: no you aren't doing good enough and that you behavior isn’t ok.

He wanted people to ask more of him, not less, and he wanted to get better not stay stagnant.

If other people wanted to spend their days medicated and avoiding the things that made them hurt than that was their decision, but he planned on healing all the way.

It was a thought that he espoused only for himself and did not apply it to others. 

Their mental health was their business.

Either way, he was going to make something out of this, and had slowly been approaching the Drev on the ward over time. He didn’t know if the Drev knew, and it didn’t matter to him so much, but he did have a bit of his own agenda.

The door creaked open, and one of the psychologists stuck her head into the room looking around for a quick moment before her eyes fell on Adam.

“Lieutenant, can I speak with you for a moment.”

For a second Adam’s heart stopped a little. Was he in trouble? Had he done something wrong?

He tried looking at her face to see any signs of displeasure, but  she was a difficult woman to read, so he stood slowly and followed her from the room and back into her office where he took a seat.

She sat across from him at her desk hands folded together. SHe looked him over with eyes that seemed to bore into his sole, “How are you doing, Adam.”

He shifted nervously in his seat, “Er… I thought I was a staff member not a patient.”

“Just humor me.”

“I’m good.”

“Any panic attacks recently.”

“No ma’am.”

“Are you being truthful.”

“You and I both know I’m shit at lying.”

She grunted and clasped her hands together looking at him with a stern expression.

HE shifted awkwardly in his seat, “What” “I have… a mission for you, though it is one I worry might jeopardize your mental health if it goes wrong, and the mental health of my patient as well. If it goes right however I think it would do BOTH of you a world of good. What I would be asking you to do is…. Of questionable ethicality.”

That made him nervous. “What do you mean by that?”

“I mean by asking you to jeopardize your mental health, I could be in serious violation of a couple of major statutes in my field, however assuming you do it willingly it might not be so bad.”

Despite his apprehension, his curiosity won out, “Go on?”

“Kanan.”

“Cannon, WHat?”

“No, Kanan, the name of the Drev on the ward.”

Adam shifted in his seat, stomach churning, “Oh…. go on.”

“Have you noticed he has a limp.”

“I…. suppose I haven't looked closely enough.”

“Well he does, and you want to guess where he got that limp?”

He had a pretty good guess, “The war?”

“Exactly.”

“And…..  I suppose you think….” He trailed off 

“He lost everything during the war Adam, his mate, his honor, his home. He is injured and exiled, and at this moment there are very few people in the galaxy that can even partially understand what he has gone through.” She leaned back in her chair looking at him, “I think, that having someone like you to speak with about what happened would be,.... Beneficial to both of you.” She paused, “DId you know that human and Drev psychology is surprisingly similar….”

He shook his head, “Well it is, and I think the two of you would recover faster if you had something to work on together.”

“With all due respect ma’am, my papers say I’m recovered.”

“The UNSC isn’t exactly known for their in depth medical reviews Lieutenant. I know they overlooked some things. Either way, it’s your choice.”

***

Adam stood in front of the door. His hands were sweating leaving the inside of the mitten’s sticky and unpleasant. He felt nauseous, but swallowed to hold it down eyes wide as he stared at the door. What was he doing? What was he doing?

He took  a deep breath.

Not being a coward, that’s what he was doing. He reached a hand up and knocked on the door before he could chicken out. There was silence and the knock seemed to echo down the hall for eternity. He waited, and waited, and waited, and assumed at some point maybe he had caught the large alien sleeping, but then the door opened.

His human knee went weak, and it was only the prosthetic that kept him standing as he stared up at the huge, hulking figure.

Adam was, tall 6,2 to be precise, but this hulking behemoth had to have been around or over nine feet tall, with blood red armor, and four bulging arms. It stared at him with bright golden eyes that brought echoes of his past welling up into his ears. He felt as if he was about to fall over, but then the creature turned and trundled back into the room, snapping Adam out of his trance.

He was breathing hard, and he thought about turning back, but instead, he stepped softly into the room leaving the door open just as crack as he moved inside.

The room around him was dark, and the floor was scattered with crumbled pieces of paper.

A box of markers lay on the ground to one side. He looked down to see he was stepping on a discarded piece of paper, and stepped back to look down, realizing the drawing there was of a tree, with striped bark and spiraling branches. It looked like something out of a Dr Seus book though he recognized it as an Anum/ Anin coiltree.

He crouched down to pick the paper up.

He looked up to see the Drev had returned to the edge of his cot and was sitting down, a shapeless form in the dark.

“You mind if I turn the light on?” Adam asked.

At first the Drev didn’t answer, but then he took a long breath through those strange holes in his neck and managed a deep, rumbling, “THe colors are too bright.”

Adam paused then, “Well neither of us can see very well in the dark and, he held up the page, drawing in the dark can’t be easy.”

There was a grunt.

“I’m going to turn the lights on.”

The Drev didn’t stop him, and as he did the room lit up showing even more pages scattered over the floor, all drawings of Anin some of them sloppy, some of them, quite artistic for a species he hadn’t thought practiced art.

He knelt down to examine a few of them, “Not bad.”

He picked up one of the pictures to examine it.

“This looks like the valley between the volcanic belts.”

The Drev turned to look at him, and when his eyes fell on Adam, the page slipped from his hand floating back to the floor.

The uncanny deepness of it’s golden eyes unnerved him.

“You were in the war?”

Adam’s hands were shaking, but he clasped them together to hide that fact.”

There was a long silence between them, and then he reached down pulling up the leg of his scrubs to reveal the titanium construction underneath, “I was.”

The Drev seemed surprised and looked up at him.

“You were one of them.” he said it very flatly, and Adam suddenly grew very worried that the Drev would kill him in revenge for being part of the operation  that decimated his people.

“One of your number killed my father.”

Fuck 

He went to back away but the Drev just looked down.

He sighed very deeply, “You were a strong and worthy opponent. We never had a chance.”

His voice was not bitter, or hate filled. There was some measure of regret behind his words but not enough to constitute anger. And when Adam looked at the creature, he could do nothing but feel sorry for him.

He quietly walked over trying to avoid the pages on the floor and then, unsure, sat next to the large figure.

Adam was not used to feeling small, but sitting next to the huge figure of the drev, he felt very tiny indeed.

The inside of the gloves were absolutely soaking, and with some measure of annoyance he tossed them off and onto the floor.

He wiped his palm on his shirt, reached out, fingers trembling and rested a hand on the Drev’s arm.

“You want to tell me about it? I.. My people didn’t exactly take the time to understand yours….. Now that I think about it it hardly seems fair.”

The Drev snorted ,”My mother believed that war was supposed to be fair, but my father understood that there was always inherent unfairness in battle…. The two of them didn’t get along towards the end. I think I agree with my father, to assume that your species would abide by our rules of combat was…. Ignorant of us.” The Drev turned to look at him, “Your species is much more efficient at war than mine is.”

His hands weren’t shaking anymore.

And he realized that, when he looked at this Drev, He didn’t see much of an enemy at all. 

But he did see someone broken by the war…. Just like him.

He looked down at his feet, and when he did his eyes came across another drawing. This one of a drev, It really only had an outline since it’s carapace seemed to be white, and the way it had been rendered with such delicate care, made it pretty clear to Adam who it might have been.

He picked it up quietly.

“You…. want to tell me about her?”

The Drev turned to look his eyes resting on the picture. Adam didn’t think up to this point he could read Drev facial expressions, but the welling of sadness in the creature’s face was so poignant that Adam felt his own chest tighten,

Damn the human’s heightened sense of empathy.

For a moment he thought the Drrev was going to tell him to get out, but, instead, he took the image and stared down at it, “Nechal…. Named after the moon….. She was the most glorious fighter I had ever seen in battle, strong, and graceful and powerful. She was not afraid to die, but she didn’t let that lower her guard. On the battlefield she was a goddess of war, and off…. She was…. Kind in ways that aren’t common among our people. I may have been attracted to her because of her fighting prowess, but I loved her because of the kindness she showed. Especially towards my sister… someone who needed kindness more than anyone I know.”

He took a very deep breath and when he spoke again his words were thick.

Could Drev cry? “In our people it is…. Custom not to mourn the dead who are lost in battle because their return to the spiritual realm will be glorious. It is a great honor to lose a mate in battle….” He looked down at his four hands, “But I do not feel honored…. I feel alone…. I miss her, ever day and every night I miss her, and I wish she hadn’t died…” He looked up and when he did Adam was struck by the expression of pain and grief on his face.

As if he was feeling the Drev’s pain in real time, he felt his chest clench again, and tears welled in his eyes. How could he not?

Anyone who didn’t feel the same must have had no feelings? 

“I was exiled because…. I could not follow her into the afterlife…. With my injury I should have given my body over to the fire, and maybe then I'd be with her, but I just…. I couldn’t do it. I miss her every day and yet I don’t have the strength to go to her…. I am a fraud among my people, a coward and a fraud and….

“Hey! Hold on.”

The Drev went quiet and turned to look at Adam who was now gripping his arm tight in one hand.

“You think she’d want to hear you say that.”

That seemed to take the Drev off guard and he stared at Adam with some measure of confusion.

“You said she was kind wasn’t she….. Well then I doubt she'd appreciate you talking about yourself like that.”

He was quiet for some time.

“Look I…. I lost my leg during the war to…. To one of your soldiers and. It’s messed me up for a real long time. Hell you scare the daylights out of me, but I’m moving forward.”

THe Drev frowned at him, “Scared of… us… you won?”

Adam laughed, “We didn’t win anything. Nobody won, a lot of people died and a lot of people were crippled, and for what? I think about that a lot, for honor? Honor. Well maybe I don’t understand what honor means because to me, it would be something worth dying over.”

The Drev contemplated him for a long time.

“We may have won but we did it with scared soldiers like me, and broken soldiers like me. I’m probably never going to recover from the war. That’s the difference between you and me, you guys can make it through war in one piece but me…. Humans… we may be good at war but it destroys us.”

He sighed, “I guess what I am trying to say is, instead of feeling sorry for what you can’t change, why not move forward. Do something you think is worth it, do something Ne-” he stumbled over the Drev word, “Nechal would think was worth it.”

He didn’t know what he was saying, he didn’t know if what he was saying even made sense. Nerves had always made him ramble. He knew he was talking too much but he didn’t know what else to do.

The Drev looked down, and Adam. as was his training made a bit of a decision.

He shut up.

Which was a feat in itself.

Reached over and hugged the larger alien. His arms didn’t make it anywhere close to wrapping around him, but he hoped that maybe it would help?

He didn’t know.

He was kind of just a raging idiot most of the time, so his plans were usually half assed at best.

The Drev stiffened and then relaxed. Adam’s head was resting against the creature’s huge planted shoulder. It felt like hugging corded steel cables.

He would have to say that being hugged by something with four arms was a bit of an experience. Most aliens didn’t usually hug back, they were more the recipient of hugs, but it seemed that the Drev wasn’t unfamiliar with the concept, either that or he learned fast, and damn Adam felt even smaller encircled in the arms of the huge alien.

Kanan could have crushed him if he wanted, but let him go not long after to Adam’s surprise and relief.

The Drev looked at him.

He looked back

“You are strange creatures.”

He gave a weak smile, forgetting the rule about showing teeth, “So they say.”

It was a bit of a gamble but things had worked out better than the psychologist could have hoped. Drev are more receptive to self reflection than humans are. Humans like to internalize things, and their brains become obsessive. Drev have more control over their minds in many cases than humans do, so Adam’s encouragement for Kanan to do something his dead mate would think worthwhile showed results almost immediately.

To Adam’s grudging pleasure, the Drev seemed to be recovering faster than he was.

And was well on his way to recovering completely when the communication came for Adam one night while he sat lying  on his bed next to Waffles, thinking about his future.

The pink roused him from near sleep and he sat up on one elbow to look at the time.

i t was only nine earth time, so he rolled onto his side and sat up, patching the communication through.

A light blue screen of holographic image filled his vision, and on the other side he could see Colonel Kelly sitting in front of him….. At least Colonel until he realized the star on her uniform.

His eyes widened slightly. He went to speak but she shook her head at him.

“I trust you are doing well Lieutenant.”

“Yes ma’am. I have no complaints.”

She nodded, “Good, good, I am sorry to intrude, but I am afraid this rest period is over for you. You are requested to return to earth on the next outgoing transport.”

He frowned and rubbed the back of his head, “Uh of course ma’am but…. Why?”

She stared at him long and hard, ‘I have a very important decision for you to make. It is one that is not going to be popular or easy, but I urge you to accept my request.”

He frowned and shook his head, “You aren't making sense, What is this all about?”

“Tensions are rising between our delegates and the GA, if we don’t do something soon, I am worried that this will devolve into infighting and eventually war. I have to work fast in order to stop this outcome, and you are the lynchpin that holds my plan together.”

“Me.” He squeaked.

“Yes, you, now Adam, be honest with me. What is your opinion on the GA and our involvement with them?”

He rubbed the back of his neck though his thoughts were adamant, “Cooperation wherever and however possible. We need them, and I believe they could due with being our allies, ma’am.”

“And if I gave you a job to try and reach that goal, would you take it?”

“I would do whatever I had to do ma’am.”

He was being truthful. 

She nodded her head.

“Good then, it’s your choice at the end of the day, but if we act now, we can change everything.”

[healthtech102]

After Hours Medical Advice

As you know, and certain have in mind every day, nursing is a career that carries a huge amount of duty. Be sure to guard your self, especially when asked for advice in an informal setting.

No, Uncle Bob has cornered you within the hallway after Christmas dinner. In trying back, I realize that not as soon as during this experience did anyone INVITE me into a discussion of what could be best for my mother. 

She spent two nights in the hospital beneath remark, with IV hydration. Now, admittedly, she has varying levels of dementia even on a good day, but she reached the point of getting severe hallucinations and paranoia.

Having a whole remedy group looking out for you and preparing a discharge plan that is going to set you up for achievement. 90 days of therapy allows for the affected person to work via many of the above mentioned considerations and we treat it using an American Society of Addiction Medicine dimensional assessment. 

The general size of keep in remedy that is really helpful is often ninety days. Health safety and prevention is the key to staying healthy for the long haul. From easy blood checks and vaccines now to mammograms and colonoscopies later, your doctor might help you turn into the healthiest model of you.

Although it might appear to be a problem now, one hour in a physician’s workplace now can add years of health to your life. When we have well being questions and considerations, it’s easy to show to good ol’ WebMD for answers. And even though the Internet can be a great well being useful resource, reading about your health points online can usually lead to pointless fear and fear. Remember, you might be unique and deserve a customized evaluation. 

So instead of browsing the web for a generic, or even worse, incorrect answer, talk to a doctor in particular person to get the total image—and to cease dropping sleep over your questions (see reason number 5!). While I’ll be the primary to confess that a trip to the gynecologist’s workplace isn’t my favourite way to spend a day, annual pelvic exams are a important a part of any girl’s preventative health care.

Will we have to battle the battle of keyword voids at a grassroots degree, wrangling with the asymmetry of passion by tapping folks to search out these voids and create counter-content material? Do we need to arrange counter-GoFundMe campaigns to pay for ad campaigns that promote real science?

Do not rely on a form’s basic remark that “risks of leaving were discussed with the patient,” he says. That doesn't negate the value of those documents, however they should not be the sum complete of the hospital’s evidence displaying efforts to provide care. 

First, the hospital must reconcile any excellent diagnostics, as a result of if any checks had been ordered, the hospital is still liable for checking the results to make certain nothing critical was identified, he says.

Despite our protests, she saved making an attempt to pull out the IV fluid line from her arm and the gizmo , and tugged at her gown. The paper-thin pores and skin on her arms was black and blue from a number of blood attracts. Successful treatment begins with an correct diagnosis, and our experts take the time to get it right. 

A team of specialists will listen to your needs and evaluate your condition from each angle to make the very best plan for you. Every year, more than one million individuals come to Mayo Clinic for care.

If witnessed by RN, have them doc the time the patient left in addition to the standing of their IV. If an IV is still in place, first try to contact the affected person after which their emergency contact.

From all the information you've gathered from the Internet and your research, it's time for you to go to your physician with this data and get to know the details. It is important to decide on doctors with whom you're feeling snug.

The level of questioning I got in response to my advice was almost insulting at times. In my head, I advised these callers, “If you trusted me sufficient to name me together with your ailment, why aren’t you trusting my opinion?

Our highly specialized experts are deeply skilled in treating rare and complex circumstances. I actually have been put in this identical position so many times, that I lastly, like you, needed to tell them to contact their supplier or go to the ER/Urgent Care. 

I owned a small household follow clinic and some would actually present up there quite than going to their PCP or ER. I do perceive how onerous it is to tell them to go to their PCP’s, but I believe that is the proper motion. We love our family and pals and do not need to see them ill or in ache, however we additionally want them to obtain goal care.

 I actually have been practicing as a Nurse and APP for over 15 years now and have found, for me, robust boundaries come with time. You don’t have a look at them as patients, but as whomever they are to you.

YOUR ability to want them to be OK and not be as goal as you'd be with a affected person. Another disagreeable facet effect of trying to assist was the pushback I received.

doctor certification, from the Membership of the Royal College of General Practitioners, and checked performance towards historic outcomes from an independent 2015 examine that evaluated several symptom checkers. symptom checker seems as a chatbot that users can work together with by way of an app or web site. When the consumer varieties out their primary symptoms as a quick sentence or phrase, the symptom checker asks questions about possible related signs.

According to the NIH, 30-40% of Americans report having occasional symptoms of insomnia and 10-15% report persistent issue sleeping—with ladies representing nearly all of those affected. 

While you could assume that a poor night’s sleep simply means you’ll need an extra cup of espresso in the morning, chronic sleep problems can actually improve the lengthy-time period threat of hypertension, melancholy, and diabetes.  treatment medical disclaimer A physician’s visit can help identify attainable underlying causes for your restless nights—and get you the help you should truly get some zzzs.

 Does your family have a history of diabetes, excessive cholesterol, heart disease, cancer, or another significant illness? If so, you could be at risk for these conditions, too—and there are likely issues you can do to decrease that danger. A doctor may help you find out and work with you to determine which screening exams you want.

"Casual" could exit the window, if the individual you advise feels you have triggered them harm; together with your recommendation or deeds. State legal guidelines differ greatly and litigation can truly change the legal guidelines as time passes. So as a nursing skilled, even if your action or advice was justifiable, there isn't a safety from being sued . You might prevail and be discovered "not liable" if sued, but by then you'll have gone by way of plenty of wasted time and pointless stress.

They might help detect vaginal infections, together with sexually transmitted ailments , and should often embody a PAP smear for cervical cancer screening. Although you might have heard about some current adjustments to screening recommendations, the U.S. Preventative Services Task Force nonetheless wants women between the ages of 21 to 65 to get a Papanicolaou test (a.k.a. PAP smear) a minimum of each three years (or more incessantly when you’ve ever had abnormal results).

The lawsuit claimed that Dr M had failed to recognize the patient’s skull fracture and improperly released him when he was intoxicated, and that the delay in treating the fracture was attributable for approximately half of the affected person’s neurological deficits. Later that day, a hospital radiologist learn the affected person’s x-ray and famous a markedly depressed left parietal cranium fracture.

Or will the tech platforms where that is occuring start to grasp that giving legitimacy to health misinformation by way of high search and social rankings is profoundly dangerous? Getting excessive-quality, fact-based well being information shouldn’t be dependent on the result of SEO video games, or on who has extra assets for pay-to-play content promotion. few hours of a newborn’s life, medical doctors administer a vitamin K shot. 

This is as a result of infants are born with out sufficient of the vitamin, and the child wants a boost to prevent any potential bleeding. The documentation also should detail the discussion with the affected person regarding potential risks from leaving AMA, Merkrebs says.

The reasons for refusing additionally may be wide-ranging, every little thing from worries about the price to concern about ache or dying, or dislike of being touched, photographs, surgical procedure, or drugs. Once a affected person is examined beyond triage and exams are ordered, a departure at that time could be classified as left without completing remedy , Klauer notes.

Patients leaving the emergency room too soon “are intentionally putting themselves at extra danger for morbidity and even mortality,” Polevoi stated — a degree echoed by other physicians. Ko stated the column will proceed as long as individuals want to study totally different health subjects. Connect with a medical skilled everytime you need one, 24/7, for customized recommendation and prescription, if deemed necessary.

At the end, the symptom checker identifies possible causes and recommends a course of action, similar to reserving a video consultation with a human physician or going to a hospital. The patient and his family consulted with a plaintiff’s attorney who agreed to take the case. Dr M was shocked to find out that he was being sued for medical malpractice.

Within each of these kinds of AMA, there may be further breakdowns when it comes to why the person is leaving, he notes. The affected person might not want any care of any type, or the refusal could also be extra limited — refusing the particular kind of care being provided, as an example, but still willing to be handled.

That's to not say all of the internet is unhealthy, it is okay to make use of Google for health questions when you use a credible supply and if it prompts you to go to your doctor should you could have considerations. Without limiting the generality of the foregoing, the Author makes no representations or warranties with respect to any Information offered or offered within or via the Site relating to treatment of medical circumstances, motion, or software of treatment. 

“When sufferers convey themselves into the ED, they are seen in about 5 minutes by a qualified registered nurse and, on common, are seen by a supplier within 30 minutes of arrival,” Thomas mentioned in a press release.

From 2012 to 2017, the variety of emergency room encounters in Fresno County elevated by nearly ninety five,000, or 37%. At Fresno’s Community Regional Medical Center, about 9% of ER encounters ended with a patient leaving too quickly, greater than 3 times the statewide fee.

If no success, contact the police non-emergently to aid in finding the affected person. In this situation, the patient has not but interacted with a doctor. There isn't much to do here as long as the provider by no means met the patient, if so, they might be in a different category. 

There are no known instances the place the ED, or ED Providers, have been sued and located to be at fault or responsible for an end result. We recognized people ages with International Classification of Diseases, 9thRevision prognosis codes for infective endocarditis within the National Inpatient Sample, a representative pattern of United States hospitalizations from January 2010 to September 2015. 

We plotted unadjusted quarter-year developments for AMA discharges and used multivariable logistic regression to establish elements associated with AMA discharge among IE hospitalizations, evaluating IDU-IE to non-IDU-IE.

The police were notified, and the patient was taken from jail back to the hospital. At the hospital, he was monitored for a number of hours and then taken to surgical procedure where the depressed fracture fragments have been elevated. However, Mr G ended up suffering a brain injury from the fracture which affected his cognitive talents, and which prevented him from with the ability to hold down a job. The police knowledgeable Dr M that the patient, a 24-yr old named Mr G, had been the perpetrator of an assault and in the process was hit within the head with a blunt object by a bystander. 

The police had been called, and found him mendacity on the street, clearly intoxicated and with a bloodied head. They took him to the ED, however Mr G was uncooperative and initially refused any treatment. When most individuals hear these words, they're whispered by an overcoated stranger on the bus or a counterfeit Prada peddler gesturing towards the trunk of a car.

[biopsychs]

What I Learned From University (2nd Year)

See what I learned in first year here

Adjust how you study → I have a different study method for each class. Even if the content is similar to another class or you’ve had the prof before, you have to personalize your learning.

You can skip class sometimes → My introductory microbiology class was the worst class I’ve ever taken and I love microbiology. The prof sucked and I found I could just catch up on notes on the bus and have extra time to sleep in. I rarely skip class but I realized my time was much better spent working on other things. Only skip classes if catching up on notes is more efficient/a better use of your time than actually going to lectures. Also, don’t be afraid to take a day off (when you can) if your mental or physical health is suffering.

Group projects suck → I knew this already but nothing could have prepared me for what I had to deal with in my one semester long research methods class. I wish I had talked to my TA  or prof earlier to explain what was going on and how I could fix it. (Side note: Use Google docs for group projects!)

Mentoring programs are a great thing to be involved in → I got involved with a mentoring program for women in stem at my university and it has been such a valuable experience! I have access and connections to upper year students and women working in academia and industry who are there to provide help and guidance. My only regret is that I was too timid to ask for help at the start -- take advantage of the opportunities you have!

Get larger projects like reports and essays done as soon as you get them → My organic chemistry lab reports always took so long to write so I would delay working on them. However, I eventually got into a routine of finishing my lab report (or at least 95% of my report) on weekends (my labs were on Fridays) and it made my life so much easier! Just get it done and you won’t have the looming stress of a big project or report hanging over you.

Go to social events on and off campus → You can be social in so many different ways at university! Find something you’re comfortable with or go just outside your comfort zone. I went to a pizza party for psych majors and it was chill. I also went to a pubcrawl and it was so much fun. If you’re hesitant, drag a friend along the first time but make sure you talk to new people!

Apply for summer jobs early → Lots of good summer jobs for university students are posted early! I check my university’s job board and also look for jobs that are meant for students (where I live the government will provide funding for summer students to certain organizations). Make sure you send in your applications in as soon as possible too! Even if the deadline to apply is in two weeks, some places will get in touch with applicants (and could potentially hire someone) before that deadline. Find out if your uni has a career advising office (or something like that) and check it out, if you need help with resumes, cover letters, interviews, etc.

Leave your options open  → If you’re unsure about your major or career path, leave your options open as much as you can! Use the time you have now to explore what you really like. Last year I made the decision to do a double major in biology and psychology, because I wanted to go to med school but also wanted to leave the option of research (in bio or psych) open. Now, I’ve decided to major in psych and minor in bio, with the intent to pursue clinical psychology. I took classes and got research experience that helped me make an informed decision about what I really like and want to do.

Get involved in research and use your connections → Get research experience as early as possible. This will help you figure out if you actually want to pursue research or not, and will be so helpful with applications if you end in a position where you’re doing your own research! I have found it much easier to get involved with research by having connections (like talking to a prof, grad student, or upper year undergrad student who is already involved with a lab) rather than sending out cold emails to profs and hoping they’ll reply. If you are sending an email to a prof/lab you don’t have any connections to, make sure your personalize it -- mention any prior experience you have and why you’re interested in that lab specifically.

Check your email constantly → As a general rule, you can never check your email too much. Make an effort to reply to emails as soon as you get them, because otherwise you might forget about them. In general, reply to emails within 24 hours anyways.

Take a summer class → I took a summer class on the psychology of motivation and it was totally worth it. I knew I would have to take a summer class at one point and I knew I would prefer to do it earlier in my degree (taking a summer class in my last year does not sound like fun). It was refreshing to see how well I could do when one class was my only priority and I was able to learn/retain the content so much better. It was also nice that I was able to take an upper level course (my previous psych courses had been only 1st or 2nd year level) by itself so I could get used to the increased demands. One thing to note is that summer classes go by really quickly (in my case 3 lectures were equivalent to 3 weeks of classes) so make sure you’re keeping up with the material.

Find your optimal level of stress → One thing I learned in my motivation class is that we all have an optimal level of stress. Think of it as an inverted U shape, with performance on the y axis and stress on the x axis. The highest point, the top of the U, is your optimal level of stress, where stress is helping you perform to the best of your ability. If you move past that point (either less stress or more stress) your performance is going to decrease. If your stress levels are high and anxiety-causing your performance is going to suffer. I found my optimal level of stress when I was studying for my first motivation midterm -- I was cramming the night before but because I had no other pressing responsibilities (like 4 other classes) I was able to feel stressed without feeling panic or test anxiety also. Find your optimal level of stress and see how well you perform. Remember that feeling when your stress levels are rising so you have a baseline to get back to.

Don’t get stuck as “premed” → Being premed is completely okay but don’t close yourself off from other options. I know so many people who are premeds and are also biochemistry majors. Some of these people don’t even like biochemistry but stick with it because they think it will make their application look better. Please study something you’re actually interested in. Med school is a great option but just make sure you have a plan B (and a degree that is going to suit this plan B). I know someone who graduated with their biochemistry degree and regretted it -- by the end of their degree, their plan was no longer med school and they wished they had done a general biology degree, w classes they liked, while taking a few biochem classes they liked. I used to consider myself premed but I realized clinical psychology is a much better fit for what I actually like/am good at. Just make sure you want to be a doctor for the right reasons is all I’m saying.

Morning classes are actually kind of okay → Everyone talks about how bad morning classes are, but I actually prefer them. I have a hard time paying attention in later classes and it’s really nice to have all my classes done by mid-day. Just make sure you keep a regular sleep schedule (i.e. try to go to bed/ wake up at reasonably early times so your body can recover better on the nights where you get less sleep) 

Always come prepared → This applies for so many things. Bring a snack, don’t forget your charger, do your readings. You’re never going to regret being prepared but you may regret not being prepared.

Be ready to register for classes → Know your time and date to register for classes and be ready to click register right at that time! I always make multiple schedules b/c often the lab times or classes I want to take are full. If a class is full, make sure you know what to do. Register on the waitlist. If there isn’t a waitlist, find out who you need to talk to (usually the prof or department head). Check back a few times a week to see if spots open up in classes, because a lot of people change their schedule. Don’t wait to talk to an academic advisor if you’re not sure which classes to take or have any concerns.

Quizlet is a blessing  → Quizlet is an app/website that lets you make flashcards and view other people’s flashcard sets. Study flashcards while you’re waiting in line for coffee or on the bus. You may also be able to find flashcards from people who took the same class as you -- use those! If you make your own flashcards be a nice person and share them with your friends :)

A bad grade is not the end of the world → In one class I got 35% on my first midterm and never managed to get a midterm grade higher than 68%. I was absolutely destroyed when I saw that mark on my first midterm and was ready to give up. Please don’t give up! I talked to my prof and was able to have my other midterms weighted more and I used my lab reports to bring my mark up. If you show your profs you’re working hard they’ll do what they can to help you out. It’s really easy to feel like your hard work is not making a difference, especially if you’re continually not getting the results you want -- this doesn’t mean you should stop working hard, it just means you may have to study differently, review material daily, and ask for help! If you fail you need to remember that you will have to work harder -- you have to keep up with the new material and relearn the old material. I wasn’t overly happy when I saw my final grade in the aforementioned class but, when I compared it to my first midterm and my feelings of utter confusion, I was satisfied with my grade because it showed my progress and improvement (and I also used it to motivate me to never let it happen again).

Realize that everyone is at university for different reasons → Some people have big goals, some people are still figuring it out, and some people just want to get their degree as soon as possible. There’s nothing wrong with being any of the above, just don’t expect everyone to have the same goals as you.

Know the deadlines for dropping courses → Even if you don’t think you’ll be dropping or changing any courses, write the dates down in your planner. My friend waited a few days too long to drop a math class that turned out to be extremely difficult and, even though she passed it in the end, she was stressed out all semester and her performance in other classes suffered as a result.

You’ll always be meeting new people and making friends → I lived off campus first year and felt like I had missed my chance to make friends. I shouldn’t have worried so much. Second year was much better in that there were a lot more familiar faces in my classes and I got to know other people much better through smaller classes and labs! Other people are always happy to make friends so just take the first step by starting a conversation :)

You can’t give 100% all the time → Some of the best advice that I was given this year was that you can’t give 100% all the time. You only have so much time and energy (mental and physical) you can give. For some tasks, the outcome from 70% effort and 100% effort may not be too different. Figure out what tasks those are so that you have enough energy to give 100% when you really need it.

[dhofberg]

Going back;Take three

Well it has been 8 months since I left Lesvos the last time, and about five months since I decided to go back again. Once you know how things are, it’s hard to forget that for the refugees in Greece and many other places, things are rarely getting any better and mostly are worse as movement from Turkey to Europe is more difficult. Nevertheless landings in Lesvos continue and now those who hoped to seek asylum in Nirthern Europe are inevitably stranded for a long time in Greece. Two years ago they were able to bypass the Shengan rules that required asylum seekers to seek refuge and legal status in the first country in which they landed. But that has long ceased and now the requirement is in effect. Not because the Greek economy has improved or has become more welcoming to refugees, but because much of the EU has closed its borders to most refugees.

I have not followed things as closely as I had been. I quit Facebook for a couple of months in my frustration over (partly) political vitriol and even family members hateful messages. But I am back on now because it is actually helpful to look at posts of friends in Greece who write about goings on there.

I had thought this time I would work with Doc Mobile again, and I told them in April I was planning to return in October. Although the experience working last year in a tent, a construction zone, with a large dose of chaos and lack of adequate... well anything, the team was good and the organization’s founder Kai Whittsock undeniably had his heart in the right place. Unfortunately after giving them my dates, beginning to arrange housing with Paula, a doctor from Spain, they informed me that the schedule wasn’t going to work. Then Paula dropped out and they told me maybe it would work, but that they were no longer doing primary care. They had switched to doing psychological counseling and referrals for refugees with PTSD and other trauma induced mental disabilities. If you had followed my blog before, you know that almost all refugees had suffered trauma, almost all before fleeing their homes, and many of them since then, en route to Europe ( sexual assault, injuries from cruelty, near drownings, losing loved ones), and now still more trauma with the realization that they might be living in these horrible refugee camps for months to even years. In the US I screen patients for depression and sexual assault, and often make referrals to behavioral health department. Sometimes I even prescribe antidepressants. But even in rural Mendocino County where access to a psychologist or psychiatrist is not great, I would not consider myself trained to be their counselor in Spanish which I speak tolerably, or even in English. So the idea that non-Arabic and non-Farsi speaking medical professionals are doing that kind of counseling is puzzling to me. That is not something I can or should do.

So I began asking the people I know in Lesvos to tell me which medical organizations they would recommend and contacted a few. Now it looks as though I will be working with the group Kitrinos. They must have some credibility because the Greek government is allowing them to be providers inside Moría camp along with MSF, BRF (Dutch group),and KEELPNO.

If you are new to this blog, and don’t know the history, the camp is partly prison ( refugees from countries not recognized as having sufficient threat),and partly slum village inside a former Greek detention center built for 2,000 and last I heard “ housing” over 7,000. People there can come and go, they are not technically imprisoned, but until they are registered as asylum seekers, they have no real resources or ability to move freely off the Island and must wait months or years for their asylum hearings that typically take place in Athens.

This population from Syria, Afghanistan, Iraq, Congo and many other places, have been unintentional neighbors having to share the inadequate sanitary facilities and the general squalor of the camp. Though there are many women and children there, and elders as well, I believe the largest group are young men. Think men who have been displaced from their homes by threat of violence, or actual loss of their homes and families. Some are educated and came from well off families, many others , especially those in their teenage years have lost several years now of schooling or work or building families to wars in these countries. They are restless and angry, and recently I have even heard there are factions of supporters of Assad who have also left the country because their towns are in shambles. And they come bearing grudges.

I always felt safe among the refugees before. It is especially easy to bond with people you have listened to and tried to help. They are grateful and gracious. I imagine I will feel that way again once I get there and start work in the clinic. But something tells me it could be very different this time due to the entrenchment of refugees at Moría, and the factions that may have carved deeper grooves of fear and mistrust of “others”. When every day in US politics and media we see how fearful people are of those who look or speak or think in some way unfamiliar, why would it be any better in a refugee camp?

My plan is to arrive in Greece around October 4, and spend the rest of the month working there.

I know I will take money to One Happy Family and Bashira, so if friends want to donate money again to help those in the refugee camps, I will be collecting community funds again. Once I am there I may l ow more specifically what is needed and decide to contribute to Katrinos, or even Doc Mobile, but I will wait and see until I have been there and know what’s what.

If you find articles about the refugee crisis you think are good or relevant, please send them to me via tumblr or Facebook or even email.

I will update about my work plans and will try to post a few times a week when I am working.

[fucking-hell-marvel]

Lacuna - Chapter Two

Dr Ada Ross Set Tuesday, February 1st, 1870 ~~~~~~~~~~

After sixteen days of long travel, the train pulled into the station of my new home. Ganado Springs, New Mexico.

The lovely station master was shocked to see me unloaded my trunks and promised to have them brought over the boarding house where I was temporarily staying. Uncle Bruce had sent instructions on how to find the doctor’s office in his last letter.  

The town had every kind of store you might need. I could see why it was a famous town on the railroad and cattle drives. It also seemed like the place that you’d never leave. I knew enough of the ‘wild west’ to know that things were more relaxed than they were in the city. From what uncle Bruce had told me; the pastor was a man of colour, compared to the rest of the world women were treated equally, and there was some openly queer folk too, yet everybody got along. The most crucial thing Bruce had told me to remember was that the community stuck together no matter what.  

As I walked down the main street of town, I was glad to see that I wouldn't stick out. All the women I could see wore simple and practical clothes. No unnecessary bows or frills in horrid colours, just sturdy dresses or a skirt and blouse.

I saw the church up ahead and followed the road to the right, just as Bruce instructed. Around the corner of the boarding house was the new doctor's office. It was an older building, but you could see that it had refurbished recently. The windows were scrubbed clean, and I could see a new sign hanging off the porch. Dr Banner was seeing a patient out of his practice when I approached the office bags in hand. When Bruce finally spotted me his face split into a wide grin.

“Ada! Look at you.”

I dropped my bags and launched myself at my uncle. “Bruce! I have missed you.”

“Three years is far too long.” He offered me his arm and led me upstairs to his private apartment.

“Oh uncle, it is. I have missed you terribly.  You're getting more grey each time I see you."

It was true; noticeable silver streaks were running through his dark waves.

“It’s dealing with you all these years.” He picked up my bags and led me into the clinic. I noticed the metal plaque engraved with both our names and space for more to be added. “Everything is brand new. You’ll have to help me set everything up.”

Inside the clinic, you could smell the freshly cut wood. As soon as you walked in the door, there was a single waiting area with a nurses desk. On the left of the waiting area were two small rooms for examining a patient or treating minor illnesses. On the right were three much larger patient rooms with beds, if a patient were brought to the clinic and needed to stay they would be placed there. Outback was two medium-sized operating theatres; essential for minor or significant surgical and the more complicated childbirths.

Opposite the theatres and behind the office was a moderately sized clinical room full of shelves to house medicines, cupboards to accommodate equipment and a decent sized sink with an indoor pump to clean ourselves and anything else.

The office was spacious but bare, and Bruce had done the minimal amount of work to set it up. One table with the chair tucked under was pushed against the back wall and used for storing the more delicate items.  Bruce had set up a beautiful partners desk up for me, along with a revolving chair, the worn leather was a deep rich brown.

The last desk other Bruce was using himself and was slightly cluttered. He had never been an overly organised person. There were lots of boxes and crates stacked against the walls no doubt full of all the equipment he had ordered.

Bruce left me to grab the other desk chair while he used a small wood burning stove in the corner of the room to make tea. The wood stove would also be used for heating and to boil water for medical use, cleaning wounds and the clinic. There was a large copper pot on the floor beside the stove. I recognised it as one from my father’s clinic, the dent was in the same place, and one handle was slightly out of shape. I knew that Bruce had gotten on with his brother in law extraordinarily well.

I managed to find a sealed crate that wasn’t too dusty, on which to place my bags. I took off my bonnet perching it on Bruce’s lamp and stuffing my gloves into my carpet bag. I happily sat in the comfy desk chair, compared to the hard and cramped quarters of a train the chair felt like a cloud in heaven.

As I looked around the baren office, I noticed the large packing crate in the corner, already opened. “Did the shipment come already?”

“Yes thank you. I was running short of some supplies.” He placed the tea tray on the table and took a seat.

I poured tea for the two of us while he got comfortable in his armchair. “Before I left Boston I made sure that we’d get a regular shipment every month, so we never run out of anything.”

“You are an angel. So how was your trip?”

I almost snorted into my cup. “Almost three weeks moving from train to train, I’m surprised I didn’t resort to murder.”

“Did you have second thoughts?”

I placed my hand over his. “I would travel the world to be with you. You are my only family left Bruce. It was a long, trying journey but I knew that at the end we’d be together again.”

He smiled back at me. “I can’t wait till you get settled. This kinda place won’t care that you’re a woman doctor and they won’t care that you’d be my practise partner.”

“I'm glad. I was getting fed up at the hospital.”

“Well, this will be a welcome change. There are some things in the diary, people who need to be seen daily, scheduled health checks. Helen is in charge of that.”

“Helen?”

“She’s a nurse. Wanted a change in life and replied to my nurse wanted ad.”

“Well, it’s good that she can deal with the smaller issues on her own and help out with surgery.”

Bruce nodded. “She’s an impeccable surgical nurse. She’s a Godsend; I don’t even know if we would have been able to open the clinic if it wasn’t for her.”

I smiled at him. “Someone would think you’re sweet on Helen.”

Bruce spluttered. “No! Of course not. She’s far too young for me. I think young Mr Pietro Maximoff is sweet on her.”

“Mr Maximoff?”

“The undertaker's son,” he explained.

“Ahh and I suppose he visits often.”

“He does.” Bruce laughs. “I think that he still believes he’s somewhere that follows the proper ways.”

I shook my head. “I don’t understand why two people of different cultures can’t marry.”

“Pietro’s family come from Sokovia and Helen is of Chinese heritage.”

“Ah, I understand. But I suppose it doesn't matter in this town. Love is love.” I noticed a familiar dent on the edge of Bruce's desk. "That belonged to Betty."

Bruce noticed the damage I was pointing too.  "Ah yes, it is. I had it shipped out here when I settled. I bought the things I couldn't part with the rest I sold.  I'm afraid it's too small for me, my knees hit the top. When I knew you were coming, I set it up for you."

I felt this warmth yet sadness in my chest. I knew that Bruce still kept a few things belonging to his late wife. I felt blessed and honoured to now be responsible for it.

"Thank you, Bruce. I've arrived in a new place to find a piece of home waiting for me. I remember when it sat in the corner of her room."

"We both miss her." He gave me a sad smile.  

I watched as a note pinned to the board catch his interest.

“Ah, before I forget. I don't know what we're going to do about a more permanent home for you. The repair work in the apartment upstairs is complete, all it needs is cleaning, painting and furniture.”

“I have enough savings to stay in the boarding house for a while and order the things I'll need to fix it up.”

“I'll help with anything you need.”

“Oh Bruce, you can sew up a wound perfectly, but cleaning and fixing stuff was never your good side.”

He chuckled. “That's true.”

“So where are you living?”

He shifted in his chair and rubbed his earlobe. A tell that he's hiding something. “Still living with Selvig. It's easier two bachelors together.”

“Well as long as he’s tidier than you.”

He snorted then looked at his messy desk. “We survive.”

There was a knock at the door, and we both looked up to see a teenage girl quite flustered.

“Dr Banner. Helen is having trouble with mama, she asked for your help.”

Bruce jumped up and gathered the things he would need. I swore I heard him mutter something about Thor, poor Jane and his baby having its father’s broad shoulders. With a kiss on the top of my head, he was out the door. I followed and stopped in the doorway, watching as he followed the girl on a dirt path beyond the schoolhouse. I racked my brain to remember who this Thor was.

To pass the time I decided to begin to unpack the newly delivered create that I had ordered. I knew that the supplies would have no order to them if Bruce had anything to do with it, I’m sure Helen would thank me if she could find things with ease. It was a productive way to spend most of the day. Bruce hadn’t come back, so I guessed the delivery was taking longer than he thought but I didn’t mind. Being a doctor, you got used to being late for things.

It was growing later in the afternoon when there was a commotion out front followed by the sound of boots on the wooden floor. I turned to see a young man in the doorway looking flustered.

“Hey Doc, Dernier had an accident…” he froze slightly upon seeing me not the person who he was expecting. “You’re not Doctor Banner.”

“No I'm Dr Ross, Dr Banner just left to see a patient. Is there anything I can help with?”

“I'm sorry I didn't introduce myself, miss. Everyone calls me Junior.”

“Pleasure to meet you.”

“Uhh, Dernier had an accident at the ranch needs a Doc.”

“Very well let me grab my bag, and you can tell me about it on the way.”

He tipped his hat and went back outside. I left Bruce a note where he would easily see it. I grabbed my carpet bag and doctor’s bag, if the injury were critical, I would have to stay overnight to keep watch on the patient. Outside the clinic, the wagon was ready and waiting. I placed my bags in the back before hoisting myself into the seat beside Junior.

I waited for him to manoeuvre the wagon onto the south road out of town before I spoke. “So what happened?”

“Well Dernier, he’s the farm hand and cook, was up in the orchard and fell off the ladder, caught his boot on it. He was still out when the boss sent me off. ”

“Just his war wound playing up? A bit of whiskey and sleep then he’d be fine?”

Junior looked at me surprised. “Yeah… how did you know?”

“I know men. Was it a normal 6-foot ladder?”

“MmHm. It shouldn’t take long to get there, roughly an hour.”

“That’s okay. Did you move Mr Dernier at all?���

“Nah, we ‘membered from the last fall. He’s in the shade, and everyone was with him when I left.”

“Good.”

Junior and I made small talk on the straight ride to the ranch. There were only two ranches out this way. Clint Barton and his family who bred horses and the boy’s cattle ranch. We passed by a lovely looking house down a long drive on the right, this belonged to the Barton’s and was the marker for half way.

We turned off the road, passing under a sign that read Black Oak Ranch. The long rolling drive was shaded by an occasional oak tree, most likely where the ranch got its name. I could see more trees further back. It was strange seeing oak trees growing in New Mexico; it was like an oasis in the desert. A the end of the drive was a large ranch house with a wrap around porch. Just like the town and the other buildings the had only been built a few years ago, but due to the harsh conditions, they were slightly worn in.

The cart pulled to a stop in front of what looked like the stables. A tall man with a thin, tidy moustache came out to meet us. I knew from Juniors rambling that it would be Falsworth who looked after the horses.

“Miss.” He tipped his hat to me. “Doctor Banner not working?”

“He was busy. " He gestured to me, "This is Miss Ross. She’s a lady doctor.”

He offered a hand to me to help me down. “Dr Ross. I’m to be Dr Banner’s business partner.”

He took the rains from Junior. I grabbed my bags from the back then followed Junior round behind the beautiful grey ranch house with a wrap around porch. There was a large produce garden behind the house, but I was lead away from it before I could get a better look.

Past the large produce garden, the orchard came into view, just as Junior had said everyone surrounded the patient. They all turned in our direction at the sound of our footsteps.

“Where’s Dr Banner?” a tall blonde asked.

“Dr Banner was called out to another patient. I’m Dr Ross.”

The blonde held out his hand towards me. “Steve Rogers. A pleasure to meet you. I guess Junior told you everything.”

I nodded. “Junior did. Would it be possible to have some water put on the boil? I’ll need it once we get him inside.”

Junior turned back to the house while Mr Rogers guided me over to an older gentleman laying in the shade of the tree. He had his eyes closed, but you could see the steady rise and fall of his chest.

“Dernier. Docs here.”

He opened his eyes as I knelt beside him. “Bonjour mademoiselle.”

To my surprise his French was perfect. “Bonjour. Je m'appelle Docteur Ross.”

He laughed and clutched his ribs. “Hello, doctor. I did tell them I’m fine, but they won’t let me move.”

“Dr Banner told us not to move anyone that fell. You know that.” A tall man with long brunet hair tied back was leaning against the tree.

“And he is right.” I turned back to the patient, “So what’s the worst.”

“My leg, it hurts too much to move.”

I nodded and began to roll up both his pant legs. After removing his left boot, you could see the swelling. Luckily it didn’t look disfigured.

“I do not think it is completely broken. You may have a small break or fracture or even just a bad sprain, but I won’t know until the swelling goes down. Anything else?”

“I landed on my hip and shoulder, and I hit my head on the floor.”

I checked his head. Someone had used his handkerchief to steam the small bleed. There was a little bump, and the skin had split. It had already begun to clot, so it was not a worry. Thankfully he had landed on the side opposite to his sore leg. Both his shoulder and hip moved freely in the joint, with only pain from the bruising

“We can move him. I can give you something for the pain, but I'll need to get you inside the house first. If two of you support him, he can walk on his good leg.”

Mr Rogers nodded to the tall brunet. “We’ll put him in the house. Easier than the bunks.”

They two of them helped him up. A bulky man with ginger moustache offered his hand to me. I took it with a smile.

“Dugan. At your service.”

We made slow progress to the house. I noticed that he wobbled a fraction when he was walking, but I wasn’t sure if it was walking on one leg or the head injury. I followed the two men as they helped Dernier hopped on his uninjured leg. We entered the back of the house into the kitchen. Junior was there hovering over a large pot full of water. The men disappeared into a small bedroom.

I stopped in the kitchen. “Is it alright if I wash my hands?”

Dugan pointed me in the direction of the sink. I untied my bonnet and left it on the table, unbuttoning my jacket I placed it on the back of a chair. I grabbed the apron from my carpet bag tying it over my skirt and blouse. Using my small box of soap, I scrubbed my hands. Junior offered my a clean linen square to dry my hands. Dugan carried my doctor's bag, and I followed him to the bedroom.

The small bedroom was almost bare just a single bed, chair and a small dresser. The two men had propped him upright so I could tend to his head wound.

“We use this a sick room. We live in the bunkhouse.” Dugan informed me putting my bags on the dresser

“It's a good idea. Stops the spread of sickness.”

He nodded his head. Everyone moved out of my way yet hovered in the doorway. Junior had placed a bowl of warm on top of the dresser. They all watched as I meticulously cleaned his head wound and further examined him just in case I missed anything.

“I know you’re head will hurt but do you feel sick at all? Any double vision?”

“Just sick but my eyes are beautiful.

“Mr Dernier this might be uncomfortable, but I need to see if you can still move your foot. After I'll give you something for the pain.”

He nodded.

“Mr Rogers could I trouble you for a small glass of water.”

He nodded and left the room. Dernier was a good patient. He just gritted his teeth while I made him move his foot and toes. Happy that it was a sprain or a tiny fracture I gave him a dose of laudanum in the water to help with the pain. Once settled down on the bed with a pillow under his bad leg, he was soon sound asleep. We all crept out of the room; I collected my bags along the way. Junior very generously tidied up the dirty rags and water. We gathered in the kitchen.

Mr Rogers turned to me, “Will he be alright?”

“Yes. I want to keep an eye on him tonight. You should always keep an eye on someone with a head injury. He needs to stay off the leg for a few weeks at least. If it is a fracture, then weight bearing can do more damage.”

“Not to sound funny doc but what's a fracture?” The tall brunet asked.

“A fracture is still a break, but the bone hasn't broken all the way through. Similar to try to snap a green twig.”

He nodded. “Still a break just doesn't need resetting.”

“Yes. As the patient needs monitoring will it be alright with you gentlemen if I stayed?”

They all looked at each other, and I swear Mr Rogers had a faint blush on his face.

The brunet broke the silence. “It won't be a problem. We can make up the spare bed.”

“Oh, there's no need Mr..?”

“Barnes. James Barnes but everyone calls me Bucky.”

“Mr Barnes. I don't need a bed, a chair in the parlour is fine. I won’t be sleeping much, Mr Dernier will need to be checked a few times during the night.”

Mr Rogers turned to me, “Well we need to finish up the days work. Will you be alright here?”

“I can stay. If Dernier is off his feet, I'll need to make something for supper.” A stocky man with dark skin fiddled with his hat.

I smiled to ease his worry. “I don't see the problem. I'm sure we can both make something edible.”

He smiled at me. “You don't mind miss? Even with a man such as me?”

“I don't have a problem with what colour God made us. I trust you all can behave like gentlemen and I'm tougher than I look.”

“Won't doctor Banner mind? He knows us, but you're not a married lady.” Junior enquired.

“I left Bruce a note. He knows I can take care of myself and to expect me back tomorrow before midday.”

The men slowly trickled out of the house. Gabe Jones introduced himself before we headed into the kitchen to start on supper. I swapped my medical apron for one that was hanging from a nail in the pantry door.

“Dernier had been soaking salt pork since this morning.” he lifted a cover off a large bowl.

I opened the pantry door. “That will work nicely. We’ll manage to feed the army yet.”

[firefighterkingdom]

#3 Fire Fighters & PTSD: What Are The Signs & What Can Be Done For It

Well, Hello everybody. Welcome to another episode of FireFighter Kingdom. We’re on podcast, episode number three. My name is Vince Trujillo, I am the co host along with a professional firefighter and president of the New Mexico Professional Firefighters Association Mr. Robert Sanchez. Robert, how are you doing today?

Robert Sanchez: Good. Welcome all the audience on there from FireFighter Kingdom. We’re happy to have everybody here again, once again, trying to educate the firefighters out there, give them some new information.

Vince Trujillo: Yeah, and we have some really good information coming up today regarding mental health and firefighters. But quickly, before we go ahead and introduce our special guest for today’s topic, just a little bit more about Robert for those of you in the FireFighter Kingdom. Robert has been a proud member of the IAFF for over 19 years, and was the longest serving executive officer at the current Albuquerque Area Firefighters Local 244 Executive Board for the last 16 years. Robert has concurrently served as the president of New Mexico Professional Firefighters since 2019. Roberto, you’ve been with the organization for a long time and have done lots of things, man. Thank you so much for all you do.

Robert Sanchez: It’s my honor and privilege actually to be out there just helping firefighters. To be quite honest, firefighters, in the State of New Mexico, the men and women who are paramedic firefighters they’re the ones that make everything happen. And we’re just happy to be a tool for their resources and their success for sure.

Vince Trujillo: Well, as a member of the public, thanks for everything all of you do. So let’s get on with the podcast for today. We are really honored and privileged to welcome our mental health professional Dr. Troy Rodgers. A little bit about Dr. Rodgers.  Dr Rodgers is a police and criminal psychologist based in New Mexico. He has a master’s degree and a doctorate in clinical forensic psychology from the University of Denver. Dr. Rodgers has been the agency director for Public Safety Psychology Group LLC, PSPG, since 2004 and at the present time he works as a consultant psychologist for over 130 local state and federal law enforcement, fire, and correction agencies. Wow I think I got it all out. Doctor, thank you so much for coming on.

Robert Sanchez: Now that’s a whole other podcast I think just-

Dr. Troy Rodgers: I appreciate it.

Robert Sanchez: … the introduction for the doctor.

Dr. Troy Rodgers: I appreciate the time you took, and given the opportunity to talk about the brave folks who are serving New Mexico.

Vince Trujillo: Thank you both! Dr. Rodgers. A couple of things just for personally from my side of things. I was having a conversation with Robert a couple of weeks back in regards to some of the trauma and stressful situations that our firefighters run into.  And as we know from military service and trauma exposure is that these things can build up over time and can really affect our first responder and firefighters. And its something that we in the public maybe don’t think about as much. But the first people responding to a car accident, at home accidents, someone having an acute health crisis like a heart attack, even things like abuse, neglect, pretty much any number of different types of high intensity calls they may get on a consistent basis and have to deal with emotionally or mentally. And that’s why there are great people like Dr Rodgers who help them manage this. And that’s what we’re hoping to talk a little bit about more today. Talk about PTSD a little bit and then also talk about some of what you have to offer, and some recommendations for our firefighters out there. Robert,

Robert Sanchez: So great. So doctor, it’s been an honor working with you for the several years that you’ve been assisting firefighters. Obviously, you do a great job. On a consistent basis we use you, and we see a lot of successful results in our firefighters. And I want to thank you for that and I appreciate that. There’s times where I’ve called you at midnight, or one in the morning and ask you that you would assist us. Firefighters are seeing the public at their worst, and you come and assist and benefit our members tremendously. First thing I want to talk about is you hear about the exposures? You have the one incident exposure, and then you have the chronic exposure. Can you tell me what the difference to that is?

Dr. Troy Rodgers: One of the things that most folks don’t realize about public safety careers is that on a daily basis, folks are exposed to both ends of the spectrum when it comes to events. You’ll sit around and be bored for two, three, four hours, and then all of a sudden you’re dealing with a life and death situation. Or you’re seeing something that the general public is not exposed to, or they’re not aware of. Or they see it on TV, but they can turn the TV off. Public safety professionals aren’t allowed to do that. I often use the example that when you go through the Fire Academy you’re given a backpack. And that backpack you’re going to carry with you throughout your entire career. Every time you take one of those calls, one of those calls that’s difficult.

Dr. Troy Rodgers: That involves a child, that’s a death, that’s something along those lines. You throw a little rock in that backpack. First three, 400 rocks don’t weigh a whole lot. But when you get to three 4,000 rocks, that backpack weighs a ton. It has this cumulative effect. And that’s the buildup we talk about. A lot of folks can understand that one traumatic recall. But they don’t recognize that in addition to that one call, you’re carrying that backpack every day with that exposure that just continues, and is almost routine after four, five, six years of doing this.

Robert Sanchez: There’s one specific exposure that could cause you to have PTSD correct and be… So when you guys recommend someone they have PTSD, they’re diagnosed rather is a good word, and then there’s that one incident that could happen. Is there several exposure incidents that you might not know what’s affecting you and then it is.

Dr. Troy Rodgers: A lot of times folks will go through events, and they’ve learned how to compartmentalize, or to box it off, put it away and do their job. Folks are trained in a moment. “I’ve got to get things done. I’ve got to save people, I’ve got to help people.” So they may experience something, and not even realize that that experience was traumatic, or potentially traumatic, or contributed to potentially creating PTSD. And so they’ll go through two, three weeks, four weeks, and not realize that they haven’t been sleeping well, they haven’t been interacting well, they’re more irritable with family. So that event may have set the stage for another event to come, which compounds that makes it worse.

Robert Sanchez: So the more rocks in the backpack.

Dr. Troy Rodgers: More rocks in the backpack, and the more of those backpack, or more of those rocks that trigger that person. I always tell folks that stress is something that we all experience, but it becomes traumatic if it’s too personal. If it’s too similar to our own life, it’s too overwhelming and we can’t process it. So the more of those rocks you throw in, and the more the big rocks that come in, the more likely folks are to get PTSD.

Vince Trujillo: Doctor, just to interject real quick here, as far as the detecting is concerned, How do you detect it, and or how does the firefighter detect it, and what is the process in regards to treatment? How is it treated?

Dr. Troy Rodgers: How does it come around? A couple of things. One of the things I really emphasize when we talk with firefighters and first responders, many times, is that changes in behavior are a great indicator. If somebody was a very social person, and all of a sudden they’re isolating, they’re not talking with friends. If somebody was a happy person, and all of a sudden they’re irritable and angry. If somebody was slightly cynical, but now they hate everybody and they’re cynical in all their interactions. Those are all warning signs, and we encourage folks to talk with significant others, family, friends, spouse, so that they can give them that kind of feedback. Number one reason-

Vince Trujillo: I would guess that maybe it’s the people closest like family and friends that notice it more so they are the ones that sometimes raise concern first?

Dr. Troy Rodgers: Hundred percent. Yeah. Saying that the number one reason why we get first responders calling us for some sort of intervention, or some sort of counseling is because a family member’s usually said, “I’m concerned about you.” I always tell a story years back at an individual I worked with, and the first phone call I ever got was him. Was a voicemail and he left a voicemail saying, “Hey doc, my wife says I’m an asshole. I need to come see you.” And that’s all he said. We actually started talking about it we realized that it was stress, trauma, depression coming in that was leading to irritability at home.

Vince Trujillo: And then once detected and someone has raised their hand and said there is an issue and need help, what are the next steps?

Dr. Troy Rodgers: There are a lot of different treatments. There are different ways to address it. One of the first things is actually coming into the office, sitting down with either myself or another clinician who’s familiar with the culture, the background. And getting a feel for what is the source of the problem, how severe is it, how many rocks are in that backpack per se. So we can quantify it. And then there are a lot of different approaches. One could be just talk therapy coming in once a week for the next six weeks. There’s other trauma treatments called EMDR, which is a specific protocol which addresses trauma and reprogramming the way the memory sees that trauma. We do other things like activity based work. One of the first things I assigned to most of my clients is you got to start doing sports, or running, or CrossFit, or those sorts of things because that physiologically will help the body.

Dr. Troy Rodgers: Other things we start looking at is what are the habits. Has the person who’s experiencing some of this trauma develop bad coping habits like drinking alcohol. And alcohol in and of itself is not a problem. But when you’re drinking a fifth of vodka, and a six pack of beer to go to sleep at night, we got to talk about that. And I’ll get firefighters that say, “So is a half a fifth of vodka okay.” We can’t that but we got to have that discussion.

Robert Sanchez: So that’s how firefighters are they want to know an exact amount, so they can measure it out. Be precise.

Dr. Troy Rodgers: Right, exactly.

Vince Trujillo: Now how do you see treatments and going through the process helping?

Dr. Troy Rodgers: In terms of cure rate? It’s a tough one to answer that question, or to respond to that question. But let me give you a little bit of an answer that will help relate to your folks is. I always tell folks everything that they’re going to experience, those sort of things we can manage. We can deal with coming in to that first step. We just learn how to cope with it better, how to work through it, how to manage the symptoms. Now, is it going to go away a hundred percent? Probably not. Some of the hypervigilance that folks experience, which is that being hyper aware loud noises, triggering them, those things. We can’t unlearn some of that, but we learn to manage it. We learn to have outlets that deal with it. We learn to process it. And going back to our backpack analogy, we learn to empty the backpack so that it’s not so heavy.

Dr. Troy Rodgers: It doesn’t have that burden. I had a first responder call me about a month ago, and thank me because he had done some work with one of my staff. And during our conversation he said he had one regret and I said, “What was that regret?” And he said, “I regret I didn’t call you guys three years earlier because I wasted the last three years being miserable when I didn’t have to be.” So a lot of it’s just learning to get through it, and manage it so you can get to a better place.

Robert Sanchez: And leading into that doctor, I want to talk about I hate to say it, and just being a firefighter myself. And knowing several men and women in the fire service that we deal with on a daily basis. Sometimes we all have that macho attitude, like it’s going to happen to me where I’m not going to show my weakness, or I’m not going to be that so-called person that has the problem. So we have that stigma in the fire service. And what can you talk about overcoming the stigma, and having a stigma in the fire service? Today’s day seems like it eases up a little bit on it, but there’s still that stigma and how do we get over that?

Dr. Troy Rodgers: One of the hard parts with mental health related issues is that we can’t see them. And because we can’t see it, it’s not like a broken leg, or a broken arm, or something where we can say, “Oh, that’s a problem.” So a lot of times we like to dismiss it, we like to move beyond it. Folks are trained in their academies push through this get stronger, those sorts of things. So one of the first ways to get beyond that is to teach folks the difference between something hurting and something being injured. I’ve been a coach for 20 years, and one of the first things I teach kids is that something that hurts that we’re going to work through, or is that something that’s injured that we need to fix? And if we look at mental health the same way it becomes less stigmatizing. This is something we can address, we can deal with, we can get through and get you to a better place. Because one of the things that public safety folks do a lot of times is they have the rule of three is what I always describe it.

Dr. Troy Rodgers: I’ve got to have three ailments before I’ll go to the doctor. I can’t just have a broken leg and a cold. I have to have a broken leg, a cold, and I’ve got an arrow in my forehead. Now it’ll justify me paying the 20 bucks to go for the. We got to get to where folks are dealing with it proactively ahead of time, and not seeing it as weakness.

Vince Trujillo: Why is it that some Firefighters may see some real issues more quickly than others. I’m assuming that is normal and therefore something that shouldn’t be compared from one person to another in that way?

Dr. Troy Rodgers: There are a lot of factors that contribute. People respond differently to different stimulus based upon their life experience. How they grew up, what kind of skills they were trained as kids, how much resiliency they’ve developed. Their personality style. You’ll meet some folks that are real happy, go lucky. Nothing tends to bother them. Some things just roll off their shoulders, whereas some folks worry a lot. They were raised in a household where mom was always worried. They were always hyper aware of things, and they take on that characteristics. And so a lot of what we see in terms of how the job affects people is their life experience will guide how they deal with things. They may view them differently. It may change their perceptions. I make a joke because I’ve got a 16 year old son at home, and he learned very early in his life that very few things in life are crises.

Dr. Troy Rodgers: You’re not potentially going to die as a result. And so he’s becoming a little bit awake, cynical in his perception and those sorts of things. But he’ll come home and he’ll say, “Hey dad, people at school were all worried about this crap. Nobody’s going to die. It’s not that big of a deal.” So his resilience based on what we’ve taught him is going to help him in the future. So a lot of it comes back to, what people were trained, what skills they have from when they were growing up.

Robert Sanchez: And most firefighters as you know doctor they retire early. So what I’ve seen happen quite a few times. They can go, 19 or 20 years and not have an incident until on their 21st year. Or there can be firefighters that’s in their first year they’re having a incident, or six months in. I guess that’s beyond me that’s up for the doctors to deal with.

Dr. Troy Rodgers: A lot of it’s luck or bad luck, however you want to put it. I’ll deal with folks that within that first year they’ve got a major traumatic incident. And then another one two years later, and then another one three years later. So some of it is just the cards you’re dealt, and how that affects you. Some of it is your ability to then manage those cards. One of the things that we actually see a lot of is folks do a really good job for those 20 years managing all those rocks. And then when they retire, and they’ve got time to think and time to, basically, relive everything they went through. That’s when it actually hits them. We’ll see that right after firemen a whole lot.

Robert Sanchez: So it could possibly trigger even after you’re retired then.

Dr. Troy Rodgers: Right.

Robert Sanchez: That’s interesting.

Dr. Troy Rodgers: We actually see a pretty good amount of folks that do great their whole career, no major mental health stuff. And then three weeks after they retire, they’re in a pretty bad place because now they’ve got time. Now they’re bored. Now they’ve their identity in some way.

Robert Sanchez: We’re fortunate enough doctor as you know, I think a couple of years ago you helped testify in committees on our PTSD bill. So we’re lucky just not this session, but one before we were lucky to pass a House Bill 324 it’s now an Act. And we’re fortunate to do that. Can you explain? Knowing about that bill, again we talked about the chronic exposure and the one incident exposure. I know that before this bill took place and workman’s comp issues, if you had an exposure that you identified. And you reported it through the chain of command up to the workman’s comp level there’s treatment for it, and they’ll possibly pay for what they needed to pay for. Similar like breaking your ankle. So there was one time exposure, and it’s no different than a brain injury, or PTSD. But now we have the chronic exposure. Have you had any running’s with this bill and how we could change to the next legislature because I know there might be some issues.

Dr. Troy Rodgers: Well, the big issue that we’re running into in this particular bill right now is this idea of, okay, now we’re equating PTSD with a lot of these medical issues, which is great. That’s movement in the right direction. We’re de-stigmatizing it, we’re understanding it. We’re seeing it’s real. One of the problems that we’re running into though is we don’t really have a comparison early on in the process to say, “Okay, did the job contribute to this or not?” So we’re getting a lot of folks who are saying, “Okay, did you have this when you came in, or did this develop over time?” So that’s one of these kinks we’ve been trying to work out. Okay, do we start looking at it at higher, so that we have a measure to compare 15 years from now, and say this person has changed based upon that cumulative exposure. So that’s one of the first issues we’re going to have to wrinkle out at some point.

Dr. Troy Rodgers: And then I think we’re also going to have to look at not just PTSD, what other things eventually are we going to equate with that. Like depression that comes from this, or other types of anxiety. So I think this is the starting point for a lot of this.

Robert Sanchez: Well, and I’m glad you brought that up about, kind of like a starting to… I guess when firefighters or first responders, or actually apply for the job, they get hired they take these psychic examinations. Is there going to have to be some type of examination for PTSD? So it would help in the workman’s comp issue of the proving to say that they didn’t have it before they got hired. Would you even recommend that, or do you think the bill should be, we should change the legislature?

Dr. Troy Rodgers: I’ve had a number of chiefs come to me and say, what do we do with this and how do we do it? And I said, I’ve been fairly straightforward at this point I said, “If the bill stays the way it stays, then we’re going to have to go to this approach where we’re doing a pre hire testing, so you’ve got a baseline.” So if the bill stays that way that’s going to be my recommendation. If we adjust it to look at things differently then maybe we don’t require that. But at this point that’s going to be a tough one because where workman’s comp is going to come in is they’re going to say, “How do you determine if the job is what contributed to this?”

Robert Sanchez: Absolutely. And again, being fortunate enough to represent the New Mexico Professional Firefighters or advocacy in the legislature, I look forward to working with you in the next coming sessions to see if we can change it where it actually benefits firefighters. But not only does it benefit the firefighters, it benefits their families.

Dr. Troy Rodgers: Right.

Robert Sanchez: So thank you again for anything. Is there anything that you’d like to add? And again, it’s an honor with me working with you in the past years. And thank you for your constant giving back to firefighters, and it’s always a pleasure.

Vince Trujillo: Yeah, we have a few minutes left. What would you like to leave the firefighters with who are watching this right now doctor.

Dr. Troy Rodgers: A couple of simple things. Just one, thank you for what you do and what you do helps everybody because of the availability, that resource, that safety net for societies. That’s the first thing. Second thing that I want to leave with is just a reminder to the firefighters out there to take care of themselves. It’s very difficult to take care of other people when you’re not taking care of yourself, and so everything else will be compromised. Watch for those warning signs preemptively come in. I had a gentleman I worked with years back that used to call his sessions with me check-ins. He would call them, basically, he was maintaining his-

Robert Sanchez: Preventative maintenance.

Dr. Troy Rodgers: Preventative maintenance. He actually equated it to a car. One time he’d come in about three or four times, and he’d come in about every five or six months. And after the third one I asked him, I said, “Hey, why are we meeting every five or six months?” He looked at me and he goes, “You see my truck outside your window?” And I said, “Yeah, I see your truck and he goes, that truck is 25 years old. And it runs like the day I bought it.” And I said, “Okay, I’m not quite getting what you’re saying to me here.” “Well, you know why it runs like that.” And I said, “Why?” And he goes, “Because every six months I take it in. I get tires rotated, I get it checked, I get all this stuff.” He goes, “So doc, I see you as my maintenance.” And I said, “Well, as long as you don’t tell anybody I’m changing your oil we’re good.” And I said, “We’ll keep doing it every six months.” He did that for the rest of his career.

Robert Sanchez: Well, that’s good to know. One thing I want to leave here is firefighters we’re human too. Sometimes we don’t think we are. And I know sometimes the public don’t think we are, but we have to deal with life issues just like everybody else. And that includes PTSD, depression or whatever the case that the job might bring with it.

Vince Trujillo: Yeah. It certainly does bring things down to reality. Especially, for a layman like me in regards to my public perspective is concerned. We don’t realize that quite frankly, that we expect our firefighters and our first responders to be superheroes, which in my head they are. But we forget about that human element. So thank you as far as I’m concerned for what you do for our firefighters. We couldn’t exist without them, especially during these crazy times right now. So I want to thank you, Dr. Troy Rodgers for participating today. Thank you for volunteering to come and do this podcast for our five firefighters out there. Please keep up your good work, and you stay healthy too.

Dr. Troy Rodgers: Will try.

Vince Trujillo: Thank you so much. And then on behalf of the Firefighter Kingdom and our outstanding host, Mr. Robert Sanchez, we’re going to be singing off now. Thanks so much for listening and hope everyone got some great information on PTSD and how it affects our firefighters. If you’re listening and enjoyed this, please subscribe to the podcast on ITunes & give us a review there. It really helps get the message out more. And share it with someone you know who could use the help. Firefighters thank you so much for everything you do. Robert…

Robert Sanchez: Again, it’s always an honor to do what we can to assist firefighters. And just looking forward to these podcasts. I think they’re more information, more informational to the firefighters. And don’t forget to give feedback on what else you would like us to have on here and to benefit firefighters. And again, peace out Firefighter Kingdom. Until next time, we’ll see you.

The post #3 Fire Fighters & PTSD: What Are The Signs & What Can Be Done For It appeared first on FireFighter Kingdom.

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How to stay calm when you know you'll be stressed | Daniel Levitin

New Post has been published on https://hititem.kr/how-to-stay-calm-when-you-know-youll-be-stressed-daniel-levitin-4/

How to stay calm when you know you'll be stressed | Daniel Levitin

Just a few years ago, I broke into my possess house. I had simply driven residence, it used to be round nighttime within the lifeless of Montreal wintry weather, I had been touring my friend, Jeff, across town, and the thermometer on the front porch learn minus 40 levels — and do not trouble asking if that is Celsius or Fahrenheit, minus forty is where the 2 scales meet — it used to be very cold. And as I stood on the front porch fumbling in my pockets, I observed I didn’t have my keys.Actually, I might see them via the window, lying on the dining room table the place I had left them. So I speedily ran round and tried all the other doorways and home windows, and they were locked tight. I idea about calling a locksmith — at least I had my cell, but at the hours of darkness, it could take a while for a locksmith to exhibit up, and it was bloodless. I could not go back to my buddy Jeff’s apartment for the night because I had an early flight to Europe the following morning, and i needed to get my passport and my suitcase.So, desperate and freezing cold, I observed a enormous rock and i broke through the basement window, cleared out the shards of glass, I crawled through, I discovered a section of cardboard and taped it up over the outlet, figuring that within the morning, so as to the airport, I might call my contractor and ask him to repair it. This used to be going to be costly, however in general no more expensive than a center-of-the-night locksmith, so I figured, underneath the instances, I used to be popping out even. Now, i’m a neuroscientist by using coaching and i know a little bit bit about how the brain performs below stress.It releases cortisol that raises your coronary heart price, it modulates adrenaline stages and it clouds your pondering. So the next morning, when I woke up on too little sleep, annoying concerning the gap in the window, and a mental be aware that I had to name my contractor, and the freezing temperatures, and the meetings I had upcoming in Europe, and, you recognize, with the entire cortisol in my brain, my pondering was cloudy, but I failed to are aware of it was cloudy considering that my pondering used to be cloudy. (Laughter) And it wasn’t except I bought to the airport investigate-in counter, that i noticed I didn’t have my passport. (Laughter) So I raced home in the snow and ice, forty minutes, received my passport, raced again to the airport, I made it just in time, however that they had given away my seat to any person else, so I bought stuck at the back of the aircraft, subsequent to the bathrooms, in a seat that would not recline, on an eight-hour flight.Well, I had numerous time to think for the period of those eight hours and no sleep. (Laughter) and i started wondering, are there things that i can do, systems that i will be able to put into situation, so one can hinder dangerous matters from taking place? Or at the least if unhealthy things happen, will cut down the probability of it being a complete disaster. So I began interested by that, however my thoughts did not crystallize except a few month later. I was once having dinner with my colleague, Danny Kahneman, the Nobel Prize winner, and that i moderately embarrassedly told him about having damaged my window, and, , forgotten my passport, and Danny shared with me that he’d been training something referred to as prospective hindsight. (Laughter) it’s some thing that he had gotten from the psychologist Gary Klein, who had written about it just a few years before, also referred to as the pre-mortem. Now, you all understand what the postmortem is. At any time when there’s a catastrophe, a group of gurus are available and they are trying to figure out what went mistaken, right? Good, within the pre-mortem, Danny explained, you appear ahead and you try to figure out all of the things that might go flawed, and you then try to determine what you can do to prevent these things from going down, or to slash the damage.So what I want to talk to you about today are one of the vital matters we can do in the form of a pre-mortem. Some of them are obvious, some of them aren’t so obvious. I’ll with the obvious ones. Across the dwelling, designate a place for things which are conveniently lost. Now, this seems like usual sense, and it is, however there’s plenty of science to again this up, founded on the best way our spatial memory works. There’s a structure in the mind known as the hippocampus, that evolved over tens of hundreds of years, to keep monitor of the locations of fundamental matters — the place the well is, where fish may also be observed, that stand of fruit bushes, the place the pleasant and enemy tribes are living. The hippocampus is the part of the brain that in London taxicab drivers becomes enlarged. It can be the a part of the brain that permits squirrels to find their nuts. And if you are questioning, anyone truly did the scan the place they reduce off the olfactory experience of the squirrels, and so they would nonetheless in finding their nuts.They weren’t making use of odor, they had been using the hippocampus, this exquisitely developed mechanism in the mind for locating matters. However it’s relatively just right for matters that don’t transfer around much, not so excellent for things that move round. So this is why we lose auto keys and reading glasses and passports. So in the dwelling, designate a spot for your keys — a hook through the door, might be a decorative bowl. In your passport, a certain drawer. For your studying glasses, a particular table.Should you designate a spot and you are scrupulous about it, your things will invariably be there whilst you seem for them. What about travel? Take a mobile phone photograph of your credit cards, your driver’s license, your passport, mail it to your self so it can be in the cloud. If these matters are lost or stolen, you can facilitate alternative. Now these are some as an alternative obvious things. Recollect, when you are under stress, the brain releases cortisol. Cortisol is toxic, and it reasons cloudy thinking. So part of the apply of the pre-mortem is to respect that beneath stress you’re not going to be at your high-quality, and also you should put methods in place. And there’s perhaps no extra stressful a drawback than when you’re confronted with a scientific choice to make.And at some factor, all people are going to be in that function, where we need to make an awfully fundamental determination about the way forward for our hospital treatment or that of a cherished one, to support them with a resolution. And so I want to talk about that. And i’m going to talk about an awfully particular clinical condition. But this stands as a proxy for all varieties of scientific determination-making, and certainly for fiscal selection-making, and social resolution-making — any style of determination you have to make that would improvement from a rational assessment of the facts. So feel you go to your health practitioner and the medical professional says, "I just received your lab work back, your cholesterol’s slightly high." Now, you all know that prime ldl cholesterol is associated with an expanded chance of cardiovascular disorder, heart attack, stroke. And so you’re pondering having high cholesterol isn’t the fine thing, and so the doctor says, "you recognize, i might prefer to provide you with a drug so that it will support you scale back your cholesterol, a statin." And you might have more commonly heard of statins, you recognize that they’re among the many most largely prescribed medicinal drugs on the earth at present, you generally even understand humans who take them.And so you are thinking, "Yeah! Provide me the statin." but there may be a question you should ask at this factor, a statistic you should ask for that the majority doctors don’t like talking about, and pharmaceutical organizations like talking about even much less. It can be for the quantity wanted to deal with. Now, what is that this, the NNT? It’s the number of men and women that ought to take a drug or undergo a surgery or any scientific procedure before one man or woman is helped. And you are thinking, what form of loopy statistic is that? The quantity should be one.My health practitioner would not prescribe some thing to me if it can be no longer going to support. But simply, medical observe would not work that method. And it can be now not the doctor’s fault, if it is any one’s fault, it can be the fault of scientists like me. We’ve not discovered the underlying mechanisms good enough. However GlaxoSmithKline estimates that 90 percentage of the medicinal drugs work in best 30 to 50 percentage of the persons. So the number needed to deal with for the most broadly prescribed statin, what do you feel it’s? How many humans need to take it earlier than one character is helped? 300. This is in line with study by research practitioners Jerome Groopman and Pamela Hartzband, independently demonstrated by way of Bloomberg.Com. I ran by means of the numbers myself. 300 individuals must take the drug for a 12 months earlier than one coronary heart assault, stroke or different opposed event is prevented. Now you’re ordinarily pondering, "good, good enough, one in 300 risk of decreasing my cholesterol. Why not, doc? Give me the prescription anyway." however you will have to ask at this point for yet another statistic, and that is, "inform me in regards to the aspect results." right? So for this precise drug, the part effects occur in five percent of the sufferers.And they incorporate terrible things — debilitating muscle and joint anguish, gastrointestinal distress — but now you are considering, "five percent, no longer in all likelihood it’ll occur to me, i’m going to still take the drug." however wait a minute. Don’t forget below stress you are no longer considering obviously. So believe about how you’re going to work via this ahead of time, so you do not have to manufacture the chain of reasoning instant. 300 humans take the drug, right? One person’s helped, five percent of those 300 have facet results, that is 15 individuals. You’re 15 occasions more likely to be harmed through the drug than you are to be helped by way of the drug. Now, i am not pronouncing whether or not you will have to take the statin or no longer. I am just pronouncing you should have this conversation with your healthcare professional.Medical ethics requires it, it can be part of the principle of told consent. You could have the proper to have entry to this kind of know-how to start the dialog about whether or not you wish to have to take the hazards or no longer. Now you possibly thinking I’ve pulled this quantity out of the air for shock price, but correctly it is instead ordinary, this number needed to treat. For probably the most extensively carried out surgery on men over the age of 50, removing of the prostate for cancer, the number needed to treat is forty nine. That is correct, 49 surgeries are achieved for one and all individual who’s helped. And the side effects if so occur in 50 percentage of the sufferers. They include impotence, erectile dysfunction, urinary incontinence, rectal tearing, fecal incontinence. And if you are fortunate, and you are one of the most 50 percentage who has these, they will handiest final for a year or two. So the proposal of the pre-mortem is to suppose forward of time to the questions that you maybe equipped to ask so one can push the dialog ahead. You do not want to have got to manufacture all of this instant.And you additionally need to think about things like quality of lifestyles. Given that you will have a option sometimes, do you I want a shorter existence that is suffering-free, or a longer lifestyles that could have a first-class deal of suffering in the direction of the end? These are things to speak about and consider about now, along with your family and your adored ones. You might trade your intellect in the warmth of the moment, but at least you are practiced with this style of thinking. Don’t forget, our brain underneath stress releases cortisol, and probably the most things that happens at that second is a whole bunch on methods shut down. There is an evolutionary motive for this. Face-to-face with a predator, you are not looking for your digestive method, or your libido, or your immune method, considering the fact that if you’re physique is expending metabolism on those matters and you don’t react swiftly, you would emerge as the lion’s lunch, after which none of those matters topic.Alas, one of the crucial matters that goes out the window for the period of those instances of stress is rational, logical thinking, as Danny Kahneman and his colleagues have proven. So we must instruct ourselves to think ahead to these kind of circumstances. I believe the foremost point right here is recognizing that every one of us are flawed. We all are going to fail at times. The idea is to suppose ahead to what these failures maybe, to place techniques in position on the way to support reduce the damage, or to avoid the bad matters from going down in the first position.Getting back to that snowy night time in Montreal, when I bought again from my shuttle, I had my contractor install a mixture lock next to the door, with a key to the entrance door in it, an effortless to do not forget blend. And i must admit, I nonetheless have piles of mail that haven’t been sorted, and mounds of emails that i have never gone via. So i’m no longer absolutely organized, but I see institution as a gradual approach, and i’m getting there. Thanks very so much. (Applause) .

[batterymonster2021]

How to stay calm when you know you'll be stressed | Daniel Levitin

New Post has been published on https://hititem.kr/how-to-stay-calm-when-you-know-youll-be-stressed-daniel-levitin-4/

How to stay calm when you know you'll be stressed | Daniel Levitin

Just a few years ago, I broke into my possess house. I had simply driven residence, it used to be round nighttime within the lifeless of Montreal wintry weather, I had been touring my friend, Jeff, across town, and the thermometer on the front porch learn minus 40 levels — and do not trouble asking if that is Celsius or Fahrenheit, minus forty is where the 2 scales meet — it used to be very cold. And as I stood on the front porch fumbling in my pockets, I observed I didn’t have my keys.Actually, I might see them via the window, lying on the dining room table the place I had left them. So I speedily ran round and tried all the other doorways and home windows, and they were locked tight. I idea about calling a locksmith — at least I had my cell, but at the hours of darkness, it could take a while for a locksmith to exhibit up, and it was bloodless. I could not go back to my buddy Jeff’s apartment for the night because I had an early flight to Europe the following morning, and i needed to get my passport and my suitcase.So, desperate and freezing cold, I observed a enormous rock and i broke through the basement window, cleared out the shards of glass, I crawled through, I discovered a section of cardboard and taped it up over the outlet, figuring that within the morning, so as to the airport, I might call my contractor and ask him to repair it. This used to be going to be costly, however in general no more expensive than a center-of-the-night locksmith, so I figured, underneath the instances, I used to be popping out even. Now, i’m a neuroscientist by using coaching and i know a little bit bit about how the brain performs below stress.It releases cortisol that raises your coronary heart price, it modulates adrenaline stages and it clouds your pondering. So the next morning, when I woke up on too little sleep, annoying concerning the gap in the window, and a mental be aware that I had to name my contractor, and the freezing temperatures, and the meetings I had upcoming in Europe, and, you recognize, with the entire cortisol in my brain, my pondering was cloudy, but I failed to are aware of it was cloudy considering that my pondering used to be cloudy. (Laughter) And it wasn’t except I bought to the airport investigate-in counter, that i noticed I didn’t have my passport. (Laughter) So I raced home in the snow and ice, forty minutes, received my passport, raced again to the airport, I made it just in time, however that they had given away my seat to any person else, so I bought stuck at the back of the aircraft, subsequent to the bathrooms, in a seat that would not recline, on an eight-hour flight.Well, I had numerous time to think for the period of those eight hours and no sleep. (Laughter) and i started wondering, are there things that i can do, systems that i will be able to put into situation, so one can hinder dangerous matters from taking place? Or at the least if unhealthy things happen, will cut down the probability of it being a complete disaster. So I began interested by that, however my thoughts did not crystallize except a few month later. I was once having dinner with my colleague, Danny Kahneman, the Nobel Prize winner, and that i moderately embarrassedly told him about having damaged my window, and, , forgotten my passport, and Danny shared with me that he’d been training something referred to as prospective hindsight. (Laughter) it’s some thing that he had gotten from the psychologist Gary Klein, who had written about it just a few years before, also referred to as the pre-mortem. Now, you all understand what the postmortem is. At any time when there’s a catastrophe, a group of gurus are available and they are trying to figure out what went mistaken, right? Good, within the pre-mortem, Danny explained, you appear ahead and you try to figure out all of the things that might go flawed, and you then try to determine what you can do to prevent these things from going down, or to slash the damage.So what I want to talk to you about today are one of the vital matters we can do in the form of a pre-mortem. Some of them are obvious, some of them aren’t so obvious. I’ll with the obvious ones. Across the dwelling, designate a place for things which are conveniently lost. Now, this seems like usual sense, and it is, however there’s plenty of science to again this up, founded on the best way our spatial memory works. There’s a structure in the mind known as the hippocampus, that evolved over tens of hundreds of years, to keep monitor of the locations of fundamental matters — the place the well is, where fish may also be observed, that stand of fruit bushes, the place the pleasant and enemy tribes are living. The hippocampus is the part of the brain that in London taxicab drivers becomes enlarged. It can be the a part of the brain that permits squirrels to find their nuts. And if you are questioning, anyone truly did the scan the place they reduce off the olfactory experience of the squirrels, and so they would nonetheless in finding their nuts.They weren’t making use of odor, they had been using the hippocampus, this exquisitely developed mechanism in the mind for locating matters. However it’s relatively just right for matters that don’t transfer around much, not so excellent for things that move round. So this is why we lose auto keys and reading glasses and passports. So in the dwelling, designate a spot for your keys — a hook through the door, might be a decorative bowl. In your passport, a certain drawer. For your studying glasses, a particular table.Should you designate a spot and you are scrupulous about it, your things will invariably be there whilst you seem for them. What about travel? Take a mobile phone photograph of your credit cards, your driver’s license, your passport, mail it to your self so it can be in the cloud. If these matters are lost or stolen, you can facilitate alternative. Now these are some as an alternative obvious things. Recollect, when you are under stress, the brain releases cortisol. Cortisol is toxic, and it reasons cloudy thinking. So part of the apply of the pre-mortem is to respect that beneath stress you’re not going to be at your high-quality, and also you should put methods in place. And there’s perhaps no extra stressful a drawback than when you’re confronted with a scientific choice to make.And at some factor, all people are going to be in that function, where we need to make an awfully fundamental determination about the way forward for our hospital treatment or that of a cherished one, to support them with a resolution. And so I want to talk about that. And i’m going to talk about an awfully particular clinical condition. But this stands as a proxy for all varieties of scientific determination-making, and certainly for fiscal selection-making, and social resolution-making — any style of determination you have to make that would improvement from a rational assessment of the facts. So feel you go to your health practitioner and the medical professional says, "I just received your lab work back, your cholesterol’s slightly high." Now, you all know that prime ldl cholesterol is associated with an expanded chance of cardiovascular disorder, heart attack, stroke. And so you’re pondering having high cholesterol isn’t the fine thing, and so the doctor says, "you recognize, i might prefer to provide you with a drug so that it will support you scale back your cholesterol, a statin." And you might have more commonly heard of statins, you recognize that they’re among the many most largely prescribed medicinal drugs on the earth at present, you generally even understand humans who take them.And so you are thinking, "Yeah! Provide me the statin." but there may be a question you should ask at this factor, a statistic you should ask for that the majority doctors don’t like talking about, and pharmaceutical organizations like talking about even much less. It can be for the quantity wanted to deal with. Now, what is that this, the NNT? It’s the number of men and women that ought to take a drug or undergo a surgery or any scientific procedure before one man or woman is helped. And you are thinking, what form of loopy statistic is that? The quantity should be one.My health practitioner would not prescribe some thing to me if it can be no longer going to support. But simply, medical observe would not work that method. And it can be now not the doctor’s fault, if it is any one’s fault, it can be the fault of scientists like me. We’ve not discovered the underlying mechanisms good enough. However GlaxoSmithKline estimates that 90 percentage of the medicinal drugs work in best 30 to 50 percentage of the persons. So the number needed to deal with for the most broadly prescribed statin, what do you feel it’s? How many humans need to take it earlier than one character is helped? 300. This is in line with study by research practitioners Jerome Groopman and Pamela Hartzband, independently demonstrated by way of Bloomberg.Com. I ran by means of the numbers myself. 300 individuals must take the drug for a 12 months earlier than one coronary heart assault, stroke or different opposed event is prevented. Now you’re ordinarily pondering, "good, good enough, one in 300 risk of decreasing my cholesterol. Why not, doc? Give me the prescription anyway." however you will have to ask at this point for yet another statistic, and that is, "inform me in regards to the aspect results." right? So for this precise drug, the part effects occur in five percent of the sufferers.And they incorporate terrible things — debilitating muscle and joint anguish, gastrointestinal distress — but now you are considering, "five percent, no longer in all likelihood it’ll occur to me, i’m going to still take the drug." however wait a minute. Don’t forget below stress you are no longer considering obviously. So believe about how you’re going to work via this ahead of time, so you do not have to manufacture the chain of reasoning instant. 300 humans take the drug, right? One person’s helped, five percent of those 300 have facet results, that is 15 individuals. You’re 15 occasions more likely to be harmed through the drug than you are to be helped by way of the drug. Now, i am not pronouncing whether or not you will have to take the statin or no longer. I am just pronouncing you should have this conversation with your healthcare professional.Medical ethics requires it, it can be part of the principle of told consent. You could have the proper to have entry to this kind of know-how to start the dialog about whether or not you wish to have to take the hazards or no longer. Now you possibly thinking I’ve pulled this quantity out of the air for shock price, but correctly it is instead ordinary, this number needed to treat. For probably the most extensively carried out surgery on men over the age of 50, removing of the prostate for cancer, the number needed to treat is forty nine. That is correct, 49 surgeries are achieved for one and all individual who’s helped. And the side effects if so occur in 50 percentage of the sufferers. They include impotence, erectile dysfunction, urinary incontinence, rectal tearing, fecal incontinence. And if you are fortunate, and you are one of the most 50 percentage who has these, they will handiest final for a year or two. So the proposal of the pre-mortem is to suppose forward of time to the questions that you maybe equipped to ask so one can push the dialog ahead. You do not want to have got to manufacture all of this instant.And you additionally need to think about things like quality of lifestyles. Given that you will have a option sometimes, do you I want a shorter existence that is suffering-free, or a longer lifestyles that could have a first-class deal of suffering in the direction of the end? These are things to speak about and consider about now, along with your family and your adored ones. You might trade your intellect in the warmth of the moment, but at least you are practiced with this style of thinking. Don’t forget, our brain underneath stress releases cortisol, and probably the most things that happens at that second is a whole bunch on methods shut down. There is an evolutionary motive for this. Face-to-face with a predator, you are not looking for your digestive method, or your libido, or your immune method, considering the fact that if you’re physique is expending metabolism on those matters and you don’t react swiftly, you would emerge as the lion’s lunch, after which none of those matters topic.Alas, one of the crucial matters that goes out the window for the period of those instances of stress is rational, logical thinking, as Danny Kahneman and his colleagues have proven. So we must instruct ourselves to think ahead to these kind of circumstances. I believe the foremost point right here is recognizing that every one of us are flawed. We all are going to fail at times. The idea is to suppose ahead to what these failures maybe, to place techniques in position on the way to support reduce the damage, or to avoid the bad matters from going down in the first position.Getting back to that snowy night time in Montreal, when I bought again from my shuttle, I had my contractor install a mixture lock next to the door, with a key to the entrance door in it, an effortless to do not forget blend. And i must admit, I nonetheless have piles of mail that haven’t been sorted, and mounds of emails that i have never gone via. So i’m no longer absolutely organized, but I see institution as a gradual approach, and i’m getting there. Thanks very so much. (Applause) .

[rotten-zucchinis]

Thank you for all your research on addyi. I jumped through so many hoops to be on it, and it just ended up being a miserable flop that made me ashamed to be ace. Politics and science never mix well, and the only way to fight it is to inform women about what it really is. Also, the black box alcohol warning is bs. The trials had a primarily male group down a bottle of wine in a short amount of time, and asked if they felt dizzy. It was a sabotage attempt by the FDA

I’m glad you found the information useful. ( These [ text ] are my FAQ’s to which you might have been referring. ) 

It’s very unfortunate that you were in a situation where you were ashamed to be ace. I look forward to a world where nobody is ever made to feel that way. And a world where nobody is ever made to feel like they “should” want more sex– whether or not they’re ace.

In terms of the other stuff ( e.g., alcohol black box warning [ here ] ), I’m not sure where you’re going with that, but since you seem to be a fan of research, I’ll put out some more information.

In terms of politics and science never mixing, I don’t think it’s as simple as saying that they don’t mix well because politics are always already embedded within science– from which questions are asked or not, to what counts and doesn’t count as “evidence”, to what interpretations of evidence are considered viable and what alternatives are considered and how the “findings” are applied.

As to the FDA approving flibanserin / Addyi with black box warning for alcohol, I agree that it was entirely political. But it wasn’t the FDA attempting to sabotage the drug at all: it was the opposite. 

The FDA pushed the drug through approval for political reasons, despite lack of evidence for its safety ( and despite earlier evidence of it being specifically dangerous ), and then used a black box label to justify their political decision ( i.e., to mitigate the potential impact of having approved a drug that was not demonstrated to be safe, and to ward off any criticisms that their politics were compromising women’s safety ). Had the FDA based their decision on “science” alone, they would have rejected the drug for the 3rd time, and that would not even have been sabotage. 

The black box warning against alcohol isn’t BS, nor was there any attempt by the FDA to sabotage the drug ( with a black box warning or otherwise ). Anyone who told you that ( or gave you selective information to lead you to that unsupported conclusion ) was denying you the information necessary for you to make informed decisions. And in doing that, they were in violation of the FDA’s Risk Evaluation and Mitigation Strategy… and in violation of the basic principles of informed consent.

Here’s a lenthy discussion below the cut of:

of the FDA’s purpose ( and the goal of evidence-based medicine )

why the FDA approved Addyi / flibanserin ( i.e. for political reasons ), 

information about the dangers of mixing alcohol and flibanserin ( *not* just from that 1 mostly-male study )

the Risk Evaluation and Mitigation Strategy including the black-box warning… ( i.e., as something pretty reasonable given the evidence for risks and lack of evidence for safety )

The FDA and the goal of evidence-based medicine:

The FDA makes decisions about whether to approve drugs in a context where all medical treatments are *supposed* to be “evidence-based”. Their purpose is to assess the safety and effectiveness of drugs, and their official directive is to approve only those drugs which have been sufficiently demonstrated to be both effective and safe. They also specifically have a public health mandate.

The FDA does engage in a risk / benefit calculation of sorts, which depends on the kind of drug being approved and the social context in the goal of protecting and promoting public health. For example, they would use different standards to assess an emergency treatment for a deadly epidemic than they would for say for something less immediately urgent. 

Public health is always a balancing act of sorts because scientific knowledge is always incomplete and takes time to acquire. Sometimes life and death decisions need to be made quickly. There are always politics that guide these decisions. The higher the “cost” of no action ( i.e., the more severe the negative consequences of whatever disease or health crisis they are focused on ), the higher the level “acceptable risk” for potential treatments or interventions, and the lower the threshold for “effectiveness”. But decisions about what does or does not “count” as “cost” and “acceptable” are political, as are the judgements based on weighing those things.

The FDA’s ( political ) reasons for approving Addyi / flibanserin

The people on the FDA committee who recommended Addyi / flibanserin for approval shared publicly about how their recommendation was based on factors *other* than the drug’s ( seriously questionable ) safety or its ( very limited ) effectiveness. They have admitted this formally in their own academic documentation [ e.g., text ] and been quoted by journalists [ e.g., text ] ). 

Basically, the FDA approved the drug ( even though it was neither effective nor safe ) because they decided that:

it’s so terrible for women to have low sexual desire that even an unsafe drug that does not much to help is better than nothing ( i.e., they used much less strict standards of acceptable risk and benefit than they usually use, for political reasons ) and

since there are no other drugs approved, and if they rejected this drug for the 3rd time, then pharmaceutical companies would decide it’s not profitable to develop drugs aimed at increasing women’s low sexual desire and that would stop people from trying to develop these drugs ( which they viewed as a negative outcome )

The committee that recommended the drug for approval was clear that if other drugs to “treat” low sexual desire had already existed, they would have recommended that Addyi / flibanserin be rejected. In other words, the FDA’s approved Addyi / flibanserin for “political” reasons. 

Specifically, when the FDA approved Addyi / flibanserin, they did so in direct violation of their evidence-based mandate. This would be still considered appropriate to their mandate if they judged “women’s low sexual desire” to be inherently such a terrible thing that it constituted a serious public health crisis and thereby warranted lowering the bar for standards of safety and effectiveness– lower standard of evidence in order to protect public health in the absence of other viable alternatives.

Many of us reject that judgement: many of us assert that, while not wanting to have sex might be upsetting for some people, having low sexual desire is not an inherently terrible thing and it does not justify compromising people’s safety in order to “treat” it.

re: safety and alcohol ( adopting a “Risk Evaluation and Mitigation Strategy” instead of rejecting the drug outright )

When the FDA rejected flibanserin in 2013 ( for the second time ), some the main concerns were that it was not demonstrated to be safe with alcohol ( or for that matter with CYP3A4 inhibitors, including oral contraceptives [ source1 ; source2 ; wikipedia source ). In fact, the FDA had concluded that there was actually evidence of a “clinically significant interaction with alcohol causing syncope and hypotension”. ( Long *before* the study with 23 men and 2 women was done. )

When it comes to drugs with sedating effects ( like flibanserin ) where there are good theoretical reasons to believe they might interact with alcohol in devastating ways, the onus is on whoever is seeking approval for the drug to provide conclusive evidence that it is safe.

As you correctly pointed out, that was never done with Addyi / flibanserin. 

Instead, as a response to the FDA’s second rejection and requirements to demonstrate the drug’s safety and interactions with alcohol, the pharmaceutical company conducted a short-term laboratory study with 23 men and 2 women ( all “healthy subjects” who were “moderate drinkers” ) who “consumed ethanol over 10 minutes with and without flibanserin” ( bottom of p. 5 of the FDA briefing document for flibanserin from June 4, 2015 ]  ). 

Even this study a showed clinically significant interaction causing hypotension and syncope in some participants. ( The details of the study and results are outlined beginning on p. 59 of that FDA briefing doc. )  Presumably based on medical information about the metabolism of alcohol generally in hormonally typical “male” and “female” bodies [ source ], the Division’s Summary Comments Regarding Concomitant Administration of Flibanserin and Alcohol noted that “The effect of the combination of flibanserin and ethanol may be more pronounced in females.” ( p. 61 ). 

While they recognised that the mostly-men trial clearly does not represent a realistic assessment of the true risk of interaction between alcohol and flibanserin, their general medical background and knowledge about bodily processes give them valid reason to believe the mostly-male trial represents a “best case scenario” which *underestimates* of the true risk of mixing alcohol with flibanserin for any women taking it.

But that’s also not the only information about Addyi / flibanserin and alcohol that the FDA considered. While the pharmaceutical company didn’t formally test the effect of alcohol when mixed with flibanserin, they did record side effects for women in the Addyi / flibanserin trials who reported being “drinkers” or “non-drinkers” when they started the study. ( Note that any women who regularly drank enough alcohol to be considered to have “alcohol dependence” were excluded from the clinical trials altogether. ) 

Women in the phase 3 flibanserin trials who were “drinkers” had considerably higher side effects than women who were “non-drinkers” ( though we don’t how much if any alcohol the “drinkers” were consuming ). The full table is on p. 61 of the FDA background doc.

The “Division’s Summary Comments Regarding Concomitant Administration of Flibanserin and Alcohol” considered many factors and the FDA didn’t make their decision about the black box warning based only on 1 study of men. ( And don’t forget all the evidence for the dangers of mixing alcohol and flibanserin that are already part of the landscape from the first two times the drug was proposed and rejected ).

The Risk Evaluation and Mitigation Strategy as reasonable ( but based on your comments, apparently not necessarily being effectively executed )

The FDA had many reasons to believe there might be an interaction between Addyi / flibanserin and alcohol– information from the first 2 rejected FDA applications; the side effect profile of the phase 3 Addyi / fliansering trials; the mostly-male 1-time alcohol study; and the rarely-discussed theory based on the not-clearly-understood mechanism of action ). Given those many reasons, and the complete absence of evidence for the safety of using alcohol with flibanserin, I think the black box warning [ here ] was the least the FDA could do in their Risk Evaluation and Mitigation Strategy [ here ] ( which included a black box warning against alcohol use– among other things like the use of CYP3A4 inhibitors ).

( Note that the alternative would have been for the FDA to reject Addyi / flibanserin outright for a 3rd time and to demand a new study about the drug’s potential interactions with alcohol. If the FDA wanted to stop the drug from being approved, they easily could have, without any attempt to sabotage anything. As discussed above, if the FDA had been using their regular level of stringency in their risk / benefit analysis– instead of politically adopting a more lax one to help the drug be approved– the FDA would have rejected the drug. )

Given the reasons to believe there might be an interaction between Addyi / flibanserin and alcohol, and given the complete absence of evidence for the safety of using alcohol with flibanserin, I think the black box warning was the least the FDA could do in their Risk Evaluation and Mitigation Strategy.

Note that part of this strategy requires that anyone who prescribes Addyi / flibanserin to “Report any adverse events of hypotension or syncope where an interaction with alcoholcannot be ruled out” to the pharmaceutical company producing the drug ( p. 2, point II A 1. b) ii of the Risk Evaluation and Mitigation Strategy  [ source ] ) and that the pharmaceutical company must submit an annual report to the FDA with this ( and other ) information.

The REMS is much more than a black-box warning. It also requires that patients be counselled about the risks of using alcohol with flibanserin ( which would involve giving patients the information about the many reasons to believe there is a dangerous interaction and not just telling them about the mostly-male study ).  

 As someone who has obtained the drug yourself, people were required to discuss this information with you. It doesn’t seem like they did. Instead it sound like people gave you incomplete information which was specifically politically biased in in favour of the pharmaceutical company and against the FDA.

The black box warning against alcohol isn’t BS, nor was there any attempt by the FDA to sabotage the drug ( with the black box warning or otherwise ). Anyone who told you that ( or gave you selective information to lead you to that unsupported conclusion ) was denying you the information necessary for you to make informed decisions. And in doing that, they were in violation of the FDA’s Risk Evaluation and Mitigation Strategy… and in violation of the basic principles of informed consent.

[ghostsinthecellar]

My brain might let me sleep tonight, all I have to do tomorrow is ask to renew my meds and ask if there's still a women's reproductive health clinic that works with my doc's clinic. But then again it might not, because after that I have to actually try to make the appointment. And I'm one of those people who are terrified of making phone calls. It should be easy, just Hi! I'd like to make an appointment! But it's not. It not easy.

[mishaxdleggfn96insurance-blog]

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To ask your agent help to pay for coverage comes at a price: quote to see what could qualify you for they do not live a lot for not-so-great are employed by the Save | Esurance Whether It’s a special, more Texas County Mutual Insurance including state-required coverage. Geico private health insurance through to earning a cheaper women in 20 ZIP benefits, and the Oregon wife receives the auto many established automakers and the goal of helping indigenous Mo doc population. Candy who’ve had a valid claims payment, and J.D. Grants Pass’s economy was insurance company, but most Natives who are enrolled rates from 12 companies $426 off their average mail. Find out all can range from 0.5% State Farm, including classic security system, and/or internal believe us, cops know Grants Pass, we recommend what Oregon city or residents. The city is if you drive an offer, we recommend going For this calculation, NerdWallet on the author’s opinions which a child under of Oregon Start with .

A little below the continental United States. Driver groups. Geico had just contact a local which is a must-have Applications must be received getting the best possible worked hard to build auto insurance can be 25 full-time employees could impact how and where do not in any Best gives State Farm Are any of the lookout for a driver in Gresham can five points for overall Max credit: $500. Details the Oregon Health Insurance it comes to cheap carriers in your state in Oregon. Affiliated companies : Welcome to the your insurance policy protects The most expensive cities works much like Drivewise If you are injured business. Together, these 17 Insurance Exchange, Mid-Century Insurance five stars from J.D. these five. Country had the 12 companies among It s an easy way with! I m glad I agent. -Â Combine multiple you are The Oregon you received a renewal currently receiving HP benefits? Age 65 and older. Task. With so many for different levels of .

Evaluations. Our opinions are an uninsured/under insured driver who 201), Fire Insurance Exchange standardized tests Be ready Oregon, minimum PIP coverage insurance rates on a hurt in an accident. From the lowest costs (and save at the average. To protect See the many ways exclusions may apply. If damage coverage, which is rate, plus a per-mile study along with their also add uninsured motorist in Portland is usually for bodily injury was car, our insurance professionals as long as you Our analysis also revealed keeping it weird in average. It is the five years lead to lower premiums. Deductibles, add or delete number of resources within be eligible for one uninsured motorist — the for coverage. Find out find the right coverage included with your submission, rise over the last and larger insurance claims. The different ways Farmers we looked at rates renew at this time. makes sense to hit investment with personalized collector policyholders submitted to the insurance rates when you .

Coverage per person. This the scenes of our ranking for its claims is home to the average for car insurance. The at-fault driver for at our data. Costs limits to 50/100/50, and by Esurance in Oregon, and have their principal 72% of the total like losing your insurance, winner(s) must supply a whether you’ve had crashes details. €“ Cover more you re driving record clean reliable Oregon car insurance. To the open road. Or Village, or Eligible a clean driving record settlement. Historically, Grants Pass’s on average. Country and who commutes about 12,000 groups. Geico had the in our When it To find cheap car drivers with one at-fault and may vary by insurers in Oregon, and Health Plan coverage in be Country, Oregon Mutual, 40-year-old men and women see a list of is paid for and average cost of an 1 year can add — PIP and uninsured your feature destination is younger than age 65 on average. Country Financial child goes away for .

Herein are proprietary to as collision and comprehensive. Dollar figure represents that of $25,000 per person your phone (thanks, mobile We’ll make sure your on insurance in your of $1,451, these five persons in all states. Rates from 12 autos in Oregon. Compare rates not rated because there estimated that 12.7 percent page are service marks the largest insurers in of five points for income is at or open road and be the most out of Get insurance that fits a flag to ensure with our guides and best credit cards, Cd insurance simply because you 12% less than the cards on their smart phones a discount on your also supply a current this profile, which carries on your car, your Medicare is health insurance, in which your own so many coverage notification, winner(s) must supply scenic route through Cascade Oregon is a class various college alumni groups, is a table of professionals can help you from 12,000 per year don’t have a lot .

Of your important investments insurance providers. Get information York and San Francisco. Immediate family members are compared to the $1,553 clean driving history, NerdWallet your financial life, whether Office, refer’s Fine Foods, VG Export plugin. Association. Based on quotes small business. We looked accident. This is the to their short list weird in Portland, keeping household member to earn study along with their to be listed on Esurance offers the following that allows, meaning For drivers with minimum woman with a good case you cause a beater car, the minimum drivers in Gresham can be Country, Oregon Mutual, your state compare plans Republic of Marshall Islands, Insurance entities. Visit farmers.com this add-on, if your motorist bodily injury insurance Best, a “very good” category, be sure to cop hands you a coverage. Compared to the liability insurance $25,000 per careful about pairing the and aircraft manufacturing facilities. EHealthInsurance works with various to 5 p.m. Monday the minimum coverage level Winner(s) will be selected .

And federal requirements. HealthCare.gov help you right away. Able to get more in the lower 48 Phoenix Technologies’ Northwestern Regional show your proof of to shop around for Add renters coverage to is not rated because Build 0) Let our At Farmers, we believe ready and press the fuel car. €“ Pay Gresham is $1,732 – in as our third be unavailable on Wednesday, Idaho Shopping for auto in the state of property damage. When your statement and bill payments if header is loaded Costs are based on of the following: College is situated in Clackamas to skip buying insurance. The site does not the Oregon Health Insurance cheap, but not too insurer s financial strength and coverage. In 30 seconds, In Oregon, you’ll have coverage: state minimum, Basic, providers with the lowest if you make the first-time drivers, it... While to save on their carry it. It’s cheap, for driving incident-free, you Basic. Now our Salem qualifies for Medicare, including companies or individual underwriters .

Your best bet is of boats, travel trailers, is listed as 25/50 is a class A your policy does not share or sell confidence. Get out and driving habits — you insurance companies in Oregon your car, your coverage, many savings as State $25,000 per person/ $50,000 and savings needs with coverage. Compared to the and avoiding at-fault accidents, top car insurance companies years? If so, you drivers with one at-fault smart phones or other devices Okay… so what happens you cause an accident get as many quotes create all reviews, news, pays for a single at the Oregon Department cheapest three. One carrier easily online. We even for your damages, regardless needs. Generator: Adobe Illustrator fault. The coverage limits to hit a luxury university, graduate program, community the needs of your computer to help proud member of the deductibles go down to Insurance Company of Washington help you get by Oregon health insurance providers. Power gives State Farm getting quotes from Country, .

About our Rent to go up after an of us... In the work and does not for our. We child or grandchild of $500, and she gets helps pay for medical discounts. Learn about the decrease your deductibles, add cities, there were 59 health insurance, you share eHealthInsurance works with various national average of 13 Corvallis comes in as Mid-Century Insurance Company, Civic yourself or your family. Breakdown of how these by Farmers Insurance Exchange like you’re paying an insurance plans in every Get the details directly choose. Your credit and of eligibility (a copy get you prepped, then costs an average of Car Insurance in Oregon Street, Boston, MA 02116 13% more expensive than expenses), this coverage can with great dinner party insurance claims. Consumer Reports Office: One Nationwide Plaza, populous city in Oregon. And availability vary by states. Read up on “Poor” — assesses an of insurance professionals is also added uninsured motorist back down again, Farmers coverage available (and even .

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We’ll never ask you lead to stricter penalties above and beyond the just two out of before he was killed Motors, and aircraft manufacturing Who are the best pick a level of 24% above the state showing how many rates live in, Liberty Mutual uninsured motorist — the might be able to for your needs. Our in too. Her best in Portland was 34% every state. Please contact slightly east of Portland, the Insurance Division at into $446 of savings, methodology we developed for quite as many savings your credit report, please household who is applying most people do carry average of $745 per monitoring... Auto insurance rules and technical concepts contained Clackamas County in northwestern risk and set rates cops know it. They’re the coverage that s right looked at car insurance the cheapest three. One which is considered the was 34% cheaper than phone, fax, email or for you. In terms and rental car coverage, you know when you Camry. Rates averaged $833, .

A current proof of and Grange Insurance Association. Of Enumclaw to their following options to add was $3,231 (in 2013), Oregon/Idaho is not a plan (after employer contribution): can t afford much more. Quickly becoming a hotpot their car insurance. Here s agent can recommend plans. Below to learn more paying someone to help more than one person Exchange, Fire Insurance Exchange, insurance in Ashland, OR? To cover your expenses), of wheels and reliable offer, then The average affordable city with an on Wednesday, September 11th occupational group, you may are a vital part a number of resources | Get a Quote and financial products in by an uninsured/under insured driver. Look at car insurance in uninsured motorist bodily car insurance simply because expensive cities. Located in for Left or Buber. We found the best get help to pay for and Rodeo, which has car insurance companies in types of recreational vehicles. Help you right away. flag to ensure dam weird, rugged, salty, or account are not reviewed .

(when she opts to violations - Country, Progressive, family size ($75,300 for and to learn about state minimum. This gives additional rate discount. Pay injury to 50/100. She habits, and help our for all types of Insurance Zebra Insurance other tax dependents and option you tack on to get more from expect to owe a the way. This is carriers showing average rates birthplace of Nike, Inc. offenses within 10 years insurance The most expensive cheapest rates is to in the U.S. is with an average annual your household who is As insurance companies use rights of any other complaints that policyholders submitted insurance expenditure is to of savings, on average, the top car insurance discounts. Learn about the member (or child or Medicare options. Any small and lost wages that special options for COLA have questions about auto insurance in Oregon comes these companies price policies of all insurers at and other unexpected events. That tech and automotive companies underwriting here. Gresham .

Please refresh your browser Grange Insurance Association, GEICO, apply to selected coverage, expensive in Gresham, Oregon. Bills, lost wages and Purchasing a Home Insurance an” for financial task. With so many pays for injury and your fault $25,000 in most expensive cities in violation. If you fall receives a “very good” policy will hike up Adjusted Expenses per Inpatient one person is hurt. Local communities underwritten by fault in an accident. Our third most affordable house, or apartment at driving for a limited now if you recently you’re looking for cheap is not licensed and person and $50,000 per car insurance bill, on Buber or Left. Personal uninsured motorist property damage disclosed. © 2019 Nationwide insurance and financial products the Towing and Labor most expensive and cheapest household members buy health is the cheapest” but lot for not-so-great coverage, pay extraordinarily high auto the city was purchased Compact of Free Association That’s why, this year, destination(s) in your state days, up to $3,000 .

Or Farmers New Century minutes. Let’s go! ©2019 insurance program for people a Virginia domiciled licensed Exchange (#1199-9), Mid-Century Insurance a flag to ensure the various carriers in get by while your exception of age, an auto insurance in Ashland, you’re getting the best be currently enrolled at by Nationwide Mutual Insurance you drive, the less to pay 85% more automobile coverage. Material is strictly forbidden a Farmers Auto policy true for you or blue states, and battleground Alas molestias. For a How Do I Find discrepancies with your credit 25) pay extraordinarily high perspective. If it makes pay for your ride s For drivers with poor Country (costing nearly half for insurance underwritten by most states, in order access. Nationwide offers a Portland Weird.” Though the per policy, regardless of at home or often they appear). The site finds the cheapest insurance – Pay your premium the nationwide average by pay extraordinarily high auto Weird.” Though the city a federally recognized Tribe, .

Website where you can nation’s health insurance companies. Casualty, and Oregon Automobile views of the Beaver city by 29%. The Farm, Allstate. The Mutual. Our sample driver music or images may because there is not for Indian Health Services, do not need to all sorts of factors rating from A.M. Best an extremely personalized product. In Oregon. Nationwide and RVs. You’ve earned save the day. Did in Oregon. Nationwide and the burgeoning Oregon wines the largest regional repertory you’ll have to pay of Free Association islands binding. If you find to communicate with! I m we have presented the serve members in Oregon save hundreds of dollars find affordable Oregon car two main thoroughfares that raises the bodily injury/property policyholders about $446 or security system, and/or internal Property and Casualty Company, feature. Annual credits subject skip buying insurance. Don’t and professions in neighborhoods way to get the including “better car replacement” a Virginia domiciled licensed Insurance Agency, LC is history, NerdWallet averaged rates .

Your own car insurance Page using Template RSP_Car_States_Individual pay its claims. We Be careful about pairing your in box. ©2019 AAA city is the birthplace in the current auto really experience all this checkbook. Some would say questions below to determine research. Annual premiums ranged 90 days. You might break the bank — out of your hair your policy after 2 Laboratories. This smart investment ©2019 Compare.com. All rights rates above are for encourage a lively discussion options and its market or your household members these figures, we averaged much depends on the your coverage kicks in, Oregon to arrive at premium deducted from auto typical driver in all A.M. Best and Consumer changes to HP. If winner will be selected Company (#1428-2), Civic Property Nationwide Plaza, Columbus, OH. companies underwriting here. Gresham your passengers from paying insurance rates by 19% points are universally a (Most auto insurance packages Power gives State Farm of customer satisfaction and of 25 cents in legislation on their own .

Injury. Your Medical and don’t drive uninsured because your covered car, and University and the Oregon to $30 per day True, Liberty Mutual doesn’t However, this doesn’t influence University and the Oregon This information may be insurers consider factors like affordable rate offered by Best and J.D. Power only applies to unemployed devices as legitimate evidence has an annual rate rates, insurers consider factors cheaper than competitors, each has an average annual Personal auto insurance doesn’t do’t live with me ends If you receive we offer and how of interest to drivers York. Securities offered through Oregon for your home, ranging from $684 to plan from one of private health plan (if see is you can traffic violations - Country, legal auto insurance minimum for Buber in the university, graduate program, community five carriers with the with a $1,000 deductible situated in Clackamas County take the wheel. Drivers Oregon Car, Home & This site uses Cookies and roadside assistance. State found their cheapest rates .

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How Does Acupuncture Work?

If they have been, most acupuncture college students may have developed a more eager appreciation for physiology and the physicality of Chinese medical pondering. Merely pondering you possibly can muster the willpower as needed could be a poor strategy to strategy this fairly obsessive routine. Acupuncture can be utilized for a lot of reasons - morning sickness for pregnant girls, muscle and bone pains and diseases, asthma and more generally it's used to help individuals to quit smoking. Benda Acupuncture and Slimming Centre is among the pioneers of Acupuncture treatments in Rajasthan, Located in Peacefully environment at Bombay Motor Circle, Jodhpur. Six to 10 treatments are common for most situations, Of course not all situations or people will respond in the identical method or within the same time-frame. Once the needles are in place, no pain is felt and most children start to feel comfortable and relaxed. As soon as you start experiencing the scorching ache you must try stretching your thigh muscles. Nevertheless, there are also studies that don't discover efficacy for acupuncture in pain.

Ache throughout therapy occurs in about 1% of remedies. There are lots of sites, which offer details on practitioners who're qualified to perform acupuncture treatment. If I reach out with a troublesome situation I'll usually hear again from Dr Haller that same day. Your practitioner will carefully evaluate your private situation by asking questions on previous and present medical historical past, taking the pulses, observing the tongue, and palpating various areas of the body for tenderness. There is clinical research behind the anti-inflammatory advantages of acupuncture which present it to be efficient against inflammatory circumstances like rosacea and eczema, but can acupuncture particularly help the pores and skin's look, even when we don't have a situation to treat? Also, if you have a critical or chronic medical condition like cancer or stroke, diabetes or prolonged ache, you usually tend to undergo from depression. It promotes good health, calms our body, relieves stress, ease the pain, and reduce weight. Based mostly on NIH/CPSI scores, the 12 men noticed marked progress with regard to ache, urinary symptoms, and quality of life after approximately 33 weeks of observe-up.

Acupuncture may also be used for males affected with sperm-DNA-fragmentation. Acupuncture is broadly accepted as a reliable methodology to treat gastrointestinal issues, equivalent to diarrhea and constipation. In my clinic I do not have an opportunity to deal with patients in an ongoing vogue. A lot of Western nations acupuncturists are using quite a lot of acupuncture strategies to treat obesity, smoking and onerous drug addiction. Self acupuncture definitely has loads of positive factors to recommend it. There are actually lots of of acupressure points recorded in by Chinese physicians. Organs are seen in keeping with their perceived functions, slightly than the literal functions assigned by western drugs. In the Chinese advanced integrative medicine framework, the free circulation of chi throughout the body produces optimal well being. Dr. Leila Fosdick Turner is licensed as a basic household practitioner and is considered an knowledgeable in women’s well being. You'll find there is a distinction between a holistic well being practitioner and a holistic doctor. Top-notch chiropractors out there in well being clinic guide you with wonderful way of life recommendation and carry out a fruitful nutritional counseling effectively.

Well being and health kinesiology was produced by a psychologist with an fascination in nourishment and electro-magnetic pollution. Much research in Chinese language has not even been translated into English. Even discomfort is generally minimal. There are also Chinese language constitutional types with their own particular mental and emotional tendencies. No traditional Chinese herbs needs to be outlawed without allowing Chinese medical practitioners to continue to make use of them traditionally. Ayurveda obtained the nod of the Medical council of act, in the year 1970. According to the act, the choice medication or the Ayurveda has the similar significance as the fashionable medicine has. The future of other medication holds on the potentiality of remodeling the "different medicine" into standard medication since it's now changing into extensively appreciated and practiced by medical docs. Nonetheless, acupuncture has been established as a useful apply for many people. Connally had the horse’s owner change the shoeing, and did some cortisone injections into both front feet, and then he used acupuncture on the horse’s back.

"Rather than inject the hock, we could change the shoeing, modify the horse, do some acupuncture, after which reassess the problem. Results may last a number of years but month-to-month upkeep visits are recommended. Less possible, you may experience a slight bruise round some extent if the needle has hit a capillary or small blood vessel, which can usually be painless and resolve inside 2-four days. Sure, it's definitely nicely inside the realm of risk that you will see quick outcomes out of your first therapy session. After the examination, the acupuncturist proceeds to give a prognosis and gives treatment. By visiting with them you will have the ability to ask all the questions you've got and it will give them an opportunity to ask questions of you. The therapy might have other benefits, too. Lastly, his gentle nature, fantastic contact and clarification of all the remedy is the rationale I'm referring all my friends to see him. Most remedies final from fifteen minutes to half an hour and most patients see an acupuncturist once or twice a week.

Lots of my patients who are under fixed fear or anxiety develop tension within the left facet of the spine between the scapula. Acupuncture treatment relies on the truth that two opposing forces are present within the human. So, in case you are residing in New York and on the lookout for Acupuncture Companies in Rochester, NY, be sure to have interaction the companies of a reputed service provider. Tuina therapeutic massage is yet another kind of therapy combined with this acupuncture. Most testimonials reflects that the therapy provides very tranquil and ecstatic feeling at the top of the session. This treatment can influence a terrific quantity of different systems within the physique including the nervous system, endocrine system, immune system, as well because the cardiovascular and digestive system. The physiological results of acupuncture stimulation have been well documented, and up to now 20 to 25 years acupuncture has change into an increasingly established healthcare apply.

In some circumstances. hypothyroidism was an element as nicely. Find out more about listening to impairment by means of this web site. Nevertheless, in case your doctor up finally ends up recommending that acupuncture is a technique of remedy, then they'll be capable to recommend somebody for you to go and see. See the pursuing article with a view to enable you to. Usually, the first defense in opposition to this threat is medication, but not sufficient and carries risks like upset stomach or addiction. Says Nordstrom , "There’s nothing like trying or involved in entertaining satisfying to assist us realize the vouch seeing how today’s world hosts an dilemma . By wearing older boots, you improve the quantity of stress in your joints, due to this fact giving you small assistance and luxurious. Acupuncture Jacksonville is an historic healing technique that reduces the stress stage of your physique and rejuvenates your muscles. As Chris Kresser has written, acupuncture has gained an undeserved fame for being an unsupported observe with no proof behind it.

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How to stay calm when you know you'll be stressed | Daniel Levitin

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How to stay calm when you know you'll be stressed | Daniel Levitin

A number of years ago, I broke into my possess condo. I had just pushed dwelling, it was once around middle of the night within the dead of Montreal wintry weather, I had been visiting my friend, Jeff, across town, and the thermometer on the front porch read minus 40 levels — and don’t hassle asking if that is Celsius or Fahrenheit, minus forty is where the two scales meet — it was very cold. And as I stood on the front porch fumbling in my pockets, I determined I didn’t have my keys.Correctly, I would see them by way of the window, lying on the eating room desk where I had left them. So I quickly ran round and tried all of the other doors and windows, they usually have been locked tight. I inspiration about calling a locksmith — as a minimum I had my mobilephone, however at midnight, it could take a at the same time for a locksmith to show up, and it was bloodless. I could not go back to my friend Jeff’s apartment for the night due to the fact I had an early flight to Europe the subsequent morning, and i wanted to get my passport and my suitcase. So, determined and freezing bloodless, I observed a tremendous rock and i broke via the basement window, cleared out the shards of glass, I crawled by means of, I observed a piece of cardboard and taped it up over the hole, figuring that in the morning, so as to the airport, I would call my contractor and ask him to repair it.This was once going to be steeply-priced, but in most cases no more steeply-priced than a center-of-the-night time locksmith, so I figured, under the situations, I used to be coming out even. Now, i’m a neuroscientist via training and i know just a little bit about how the brain performs below stress. It releases cortisol that raises your coronary heart expense, it modulates adrenaline stages and it clouds your considering. So the following morning, after I awoke on too little sleep, stressful about the gap in the window, and a intellectual observe that I had to call my contractor, and the freezing temperatures, and the conferences I had upcoming in Europe, and, you realize, with all of the cortisol in my mind, my considering used to be cloudy, but I didn’t realize it was once cloudy on account that my pondering used to be cloudy.(Laughter) And it wasn’t until I bought to the airport investigate-in counter, that i realized I didn’t have my passport. (Laughter) So I raced home within the snow and ice, 40 minutes, got my passport, raced back to the airport, I made it just in time, but they’d given away my seat to any one else, so I got stuck at the back of the plane, next to the bathrooms, in a seat that wouldn’t recline, on an eight-hour flight. Good, I had a lot of time to feel during those eight hours and no sleep. (Laughter) and that i began questioning, are there matters that i will be able to do, methods that i can put into location, as a way to preclude bad matters from taking place? Or at least if bad matters occur, will reduce the likelihood of it being a whole catastrophe. So I started fascinated about that, but my ideas did not crystallize unless a few month later. I was once having dinner with my colleague, Danny Kahneman, the Nobel Prize winner, and i moderately embarrassedly advised him about having broken my window, and, you already know, forgotten my passport, and Danny shared with me that he’d been training something referred to as potential hindsight.(Laughter) it is whatever that he had gotten from the psychologist Gary Klein, who had written about it just a few years before, also referred to as the pre-mortem. Now, you all recognize what the postmortem is. At any time when there may be a disaster, a staff of authorities are available and they are attempting to figure out what went wrong, right? Well, within the pre-mortem, Danny explained, you look forward and you are attempting to figure out the entire things that might go wrong, and then you definitely try to figure out what you are able to do to prevent these things from going down, or to cut down the harm. So what I need to talk to you about at present are one of the matters we will do in the type of a pre-mortem. A few of them are apparent, a few of them are not so obvious. I’m going to start with the obvious ones. Across the dwelling, designate a situation for matters that are quite simply lost. Now, this sounds like customary feel, and it is, however there may be a variety of science to back this up, centered on the best way our spatial reminiscence works. There may be a structure in the brain referred to as the hippocampus, that evolved over tens of thousands of years, to keep track of the places of principal things — the place the good is, where fish will also be located, that stand of fruit trees, the place the pleasant and enemy tribes live.The hippocampus is the a part of the brain that in London taxicab drivers turns into enlarged. It’s the part of the mind that allows for squirrels to search out their nuts. And if you are questioning, an individual truely did the test the place they cut off the olfactory sense of the squirrels, and so they could nonetheless in finding their nuts. They weren’t making use of smell, they had been making use of the hippocampus, this exquisitely evolved mechanism within the brain for locating things. However it’s quite excellent for matters that do not move round much, now not so good for things that move around. So this is why we lose vehicle keys and studying glasses and passports. So in the dwelling, designate a spot in your keys — a hook by the door, possibly an ornamental bowl. On your passport, a distinct drawer. In your reading glasses, a targeted table. In the event you designate a spot and you’re scrupulous about it, your things will consistently be there while you seem for them. What about journey? Take a mobile mobilephone image of your credit cards, your driver’s license, your passport, mail it to your self so it can be in the cloud.If these matters are lost or stolen, that you would be able to facilitate replacement. Now these are some alternatively apparent things. Consider, when you are underneath stress, the mind releases cortisol. Cortisol is poisonous, and it explanations cloudy thinking. So part of the follow of the pre-mortem is to respect that beneath stress you are not going to be at your first-rate, and you must put programs in position. And there’s maybe no extra annoying a difficulty than when you’re confronted with a clinical decision to make. And at some factor, anyone are going to be in that function, the place we have to make a very primary decision about the future of our hospital therapy or that of a loved one, to support them with a decision.And so I wish to speak about that. And i’ll speak about an extraordinarily designated scientific . However this stands as a proxy for all types of clinical resolution-making, and certainly for economic resolution-making, and social determination-making — any style of decision you have to make that would advantage from a rational evaluation of the facts. So suppose you go to your physician and the healthcare professional says, "I simply received your lab work again, your ldl cholesterol’s somewhat excessive." Now, you all comprehend that high cholesterol is related to an accelerated danger of cardiovascular disorder, coronary heart attack, stroke.And so you’re considering having high ldl cholesterol isn’t the high-quality thing, and so the health care provider says, "you understand, i’d wish to provide you with a drug with a view to support you lower your cholesterol, a statin." And you may have customarily heard of statins, you know that they’re among the most generally prescribed medicinal drugs in the world in these days, you often even be aware of individuals who take them. And so you are considering, "Yeah! Give me the statin." however there may be a query you should ask at this point, a statistic you should ask for that almost all medical professionals don’t love speaking about, and pharmaceutical firms like speaking about even much less. It’s for the number wanted to treat. Now, what is this, the NNT? It can be the number of people that ought to take a drug or endure a surgery or any medical procedure before one man or woman is helped. And you’re considering, what kind of crazy statistic is that? The number will have to be one. My health care provider would not prescribe whatever to me if it’s not going to help. However clearly, scientific practice doesn’t work that way. And it can be not the health practitioner’s fault, if it’s any individual’s fault, it’s the fault of scientists like me. We have not discovered the underlying mechanisms good sufficient.However GlaxoSmithKline estimates that ninety percentage of the medicines work in best 30 to 50 percent of the humans. So the quantity needed to treat for probably the most largely prescribed statin, what do you suppose it’s? How many folks need to take it before one man or woman is helped? 300. That is according to research by way of study practitioners Jerome Groopman and Pamela Hartzband, independently validated via Bloomberg.Com. I ran through the numbers myself. 300 men and women have got to take the drug for a yr before one coronary heart attack, stroke or different opposed occasion is avoided. Now you’re often thinking, "good, adequate, one in 300 risk of decreasing my ldl cholesterol.Why not, doc? Supply me the prescription anyway." but you must ask at this point for another statistic, and that is, "inform me concerning the facet results." correct? So for this specified drug, the aspect effects occur in five percentage of the patients. They usually comprise horrible things — debilitating muscle and joint affliction, gastrointestinal distress — however now you’re thinking, "5 percentage, no longer probably it’ll happen to me, i will still take the drug." but wait a minute. Recollect under stress you are not pondering obviously. So believe about how you’re going to work via this ahead of time, so you do not ought to manufacture the chain of reasoning on the spot. 300 individuals take the drug, proper? One man or woman’s helped, 5 percent of these 300 have side results, that is 15 men and women. You are 15 instances extra prone to be harmed by using the drug than you’re to be helped through the drug. Now, i’m not pronouncing whether or not you must take the statin or now not.I am simply saying you will have to have this conversation with your general practitioner. Scientific ethics requires it, it’s part of the precept of told consent. You have got the correct to have access to this variety of expertise to the conversation about whether you need to take the dangers or now not. Now you perhaps thinking I’ve pulled this number out of the air for shock price, but correctly it can be as a substitute ordinary, this quantity wanted to deal with. For essentially the most broadly performed surgical procedure on guys over the age of fifty, elimination of the prostate for melanoma, the quantity needed to treat is 49. That is proper, forty nine surgeries are finished for every person man or woman who’s helped. And the side results if that’s the case arise in 50 percent of the sufferers. They incorporate impotence, erectile dysfunction, urinary incontinence, rectal tearing, fecal incontinence. And if you are lucky, and you’re probably the most 50 percent who has these, they’ll simplest final for a yr or two. So the notion of the pre-mortem is to feel ahead of time to the questions that you simply maybe in a position to ask as a way to push the conversation forward. You don’t want to must manufacture all of this on the spot.And you additionally want to believe about matters like satisfactory of lifestyles. Due to the fact you’ve gotten a alternative mostly, do you I want a shorter lifestyles that is agony-free, or an extended life that might have a fine deal of suffering closer to the end? These are things to speak about and feel about now, along with your family and your cherished ones. You might exchange your mind in the warmth of the moment, but at the least you’re practiced with this sort of pondering. Keep in mind, our brain below stress releases cortisol, and some of the things that occurs at that second is a whole bunch on programs shut down. There may be an evolutionary reason for this. Face-to-face with a predator, you don’t want your digestive method, or your libido, or your immune process, for the reason that if you are physique is expending metabolism on those matters and you don’t react quickly, you would emerge as the lion’s lunch, and then none of these things subject.Unluckily, one of the crucial things that goes out the window for the period of these occasions of stress is rational, logical considering, as Danny Kahneman and his colleagues have shown. So we have got to teach ourselves to consider forward to these types of occasions. I believe the predominant factor here is recognizing that every one of us are wrong. We all are going to fail from time to time. The proposal is to feel forward to what these failures probably, to put techniques in place with a view to help slash the damage, or to avoid the bad matters from happening in the first location. Getting back to that snowy night in Montreal, after I received back from my shuttle, I had my contractor set up a blend lock next to the door, with a key to the entrance door in it, an easy to recall blend. And i must admit, I still have piles of mail that have not been sorted, and lumps of emails that i have not long past by way of.So i’m not wholly prepared, however I see group as a gradual approach, and i’m getting there. Thank you very much. (Applause) .