#Best Medical Healthcare for Students

[healthgennie]

🏆 Proud Moment: Health Gennie Awarded Best Health App for Students

🎉 We are thrilled to announce that Health Gennie has been recognized as the Best Health App for students in India at the prestigious Global Skill Summit!🏆 This remarkable achievement is a testament to our dedication to improving student health and well-being. The award was proudly presented by the esteemed Member of Parliament, Shri Sanjay Deshmukh ji.

This accolade belongs to every team member who worked tirelessly to make Health Gennie a trusted companion for students across India. Let's continue to strive for excellence and make a positive impact on the health of our youth.🌟

[renee-mariposa]

Nothing in my day-to-day job shows me the limits of modern medicine like vancomycin does. And it makes me insane.

(extremely long, somewhat incoherent nerd rant below the cut)

See, vanc is really good at, like, three things: treating MRSA (when given IV), treating ampicillin-resistant enterococcus (when given IV), and treating c diff (when administered orally ONLY). Most every use outside of that, like when it’s used to treat methicillin-susceptible staph aureus for “penicillin allergic patients” (don’t get me started on PCN allergies), actually has data that it increases risk of morbidity and mortality (i.e. harm and DEATH).

Unfortunately, due to the prevalence of multi-drug resistant organisms, vancomycin is empiric therapy for a lot of presumed infections. And it's a lot more difficult to actually tell if someone has an infection than you'd think. A lot of medical conditions imitate each other and when time is of the essence to identify what's going on, the most ethical thing is to start an antibiotic and rule out infection as the hospitalization continues. Lab techniques have gotten a lot quicker: I can remember 8 years ago, it would take 3 days just to identify what microbe the patient had in their presumed infection. These days, anno domini 2023, PCR comes back in a matter of hours, identifying gram positive/gram negative staph/strep/bacilli/etc, and it's the sensitivities that take 2-3 days. (Don't get me started on contaminated cultures.) But even with improvements in lab technique, we might not culture any microbe at all or the provider might keep vancomycin on "just in case" because we don't know IF the patient is infected, WHAT they're infected with, or if the infection will get better with a different drug.

And vancomycin is terrible on kidneys. Extremely nephrotoxic. It isn’t as bad as the 80s when the drug first came out and was called Mississippi Mud colloquially, but it will fuck the patient up if not monitored closely.

But finding the correct dose for each patient in a timely manner is nigh impossible. This is because vancomycin is renally eliminated. We have to mathematically estimate how well the kidneys are working. Unfortunately, our mathematic equation is next to useless if you are:

-Less than 50 kg

-Shorter than 5 foot tall

-Have a BMI of more than 40

-Are an adult younger than 45 (twenty-year-olds get astronomical doses that would be destructive in an older patient)

-Are older than 65 (the official definition of 'geriatric', i'm relatively sure)

-Are female (this is really only applicable if the patient is less than 50 kg or older than 65 - think: little old frail lady - we have absolutely no fucking idea how their kidneys are doing until we order the serum drug level. It is next to impossible to accurately dose vancomycin in little old ladies on the first try.)

-Are missing limbs (lots of leg amputations in the older and impoverished diabetic population!!)

-Have a lot of muscle mass (think bodybuilder or really tall guys)

Fun fact: we estimate renal function by looking at height, weight, age, birth gender (few, if any, studies on trans patients taking HRT), and a lab value called serum creatinine. Creatinine is a byproduct of muscle metabolism, I don't know the fine details, but we can generally estimate how well kidneys are working by seeing how much creatinine is in the blood: low creatinine usually means kidneys are excreting it as they 'should' be. High creatinine means there's something wrong, the kidneys aren't able to excrete it as efficiently as they 'should' be. But the effect of low muscle mass and high muscle mass haven't been studied enough to be able to adjust our mathematical equation to compensate for them. And with high BMI: we often overestimate their renal function because we don't know how to estimate their muscle mass vs their body fat.

(I work out in the boonies. ~70% of our patients have diabetes. ~80% of our patients have a BMI of greater than 35. So what I'm trying to say here is: we are shooting in the fucking dark when we're estimating the renal function of the vast majority of our patients.)

Complicating this: vancomycin is useless until it reaches steady-state concentration in therapeutic range. On one side of this problem: a lot, if not most, medical providers assume that vancomycin starts working its magic from the first dose. So we sometimes get orders for "vancomycin 1 gram now and see how the patient is doing in the morning". That isn't going to solve jack shit! That's just going to increase the incidence of microbial resistance!!

OR, like in the multiple situations I dealt with this afternoon, you make an educated guess on what regimen is going to work for the patient. You get a level 48 hours after the dose starts. And you find out that you fucking guessed wrong and the patient is subtherapeutic. It has been two fucking days and the patient hasn't started being treated for their (presumed) infection yet!! And we've increased the possibility of microbial resistance! *muffled screaming in frustration*

So what I'm trying to say here is: on almost every presumed infection that comes into the hospital (which we're guessing like 30%? 50%? of the time), we're starting an extremely toxic drug, oftentimes 100% guessing what regimen will be therapeutic, only finding out in 2 days that it is not therapeutic, and it can sometimes take days and days to titrate the dose sufficiently to find a therapeutic regimen. And sometimes we're really fucking unlucky and we destroy the patient's kidneys temporarily (or permanently! but kidneys can be very resilient so that's thankfully rare) because we guessed a regimen that's too high!! This is a fucking nightmare!!!!!!!!

And if all of this wasn't bad enough, we don't really have any drugs that do what vancomycin does therapeutically. We have things that can be used to cover some of what vancomycin does, but nothing that's equivalent AND less toxic.

Like, to fix this situation, we need:

-Better education to providers on what drugs are appropriate empiric therapy for different presumed infections (we're working on it, we are working on it)

-Better ways to estimate kidney function (there needs to be more research on kidney function in patients with BMI greater than 35!! And little old ladies!! And patients with low body weight and high body weight and amputations and...)

-Better prognostic tools to tell 1. when the patient is infected (looking at you, sepsis!!!) 2. what they're infected with

-Less-toxic antibiotics AND/OR better ways to treat infection (this would be the evolution of medicine as we know it)

And I want to be clear: vancomycin isn't bad. It's an extremely effective tool when used correctly but we often either don't have enough data to use it correctly or the provider doesn't understand that this tool is fucking useless for the job they're trying to perform.

[supermomva]

Nurse Croc charm, RN Jibbitz charm, cute Jibbitz Charm, cute Shoe Charm, RN shoe,Healthcare worker, Hero, DIY, Unique Gift, nursing students

[americankimchi]

Do you have any tips for writing Obi Wan or any meta in mind with his characterizarion?

hmmm sure why not! i'll give a few tips on how i'd write obi-wan. mind you this is how i interpret the character, so ymmv.

i truly do not like it when fics have obi-wan voluntarily leaving the order. like it's so out-of-character for me in my head that the premise of the story + the writing would have to work triple-time to get me to stick around. now if he's been removed from it by an EXTERNAL SOURCE (not the order. i cannot stress this enough: the jedi kicking obi-wan out is so jarring to me i'll leave the fic in an instant) or somehow unable to return to the order for whatever reason, all is well.

not a prodigy, but a genius. obi-wan is an incredibly intelligent person with an absolutely staggering knowledge base in a wide variety of topics, but all that knowledge was earned through blood, sweat, tears, and time. he sat down with his game face on and put in the work. that's also why he makes an excellent teacher: he knows what most students will struggle with because he struggled too, and knows through experience how best to overcome them. i headcanon that it contributes to why he's such a good negotiator: he's really good at stripping down information to the essentials and communicating that information effectively and efficiently to others because of his intense study habits.

humble, but not ignorant of his skills. it's pretty impossible to fully divorce yourself from pride in your achievements, and i don't think it's healthy to not feel any pride at all, so i think obi-wan has a very clear understanding of his skillset and how best to use it. i don't think he'd be ignorant of how good he is at something, especially since the direct consequence of his aptitude led him to being a member of the jedi council. pretty hard to be blind to your strengths when you're being asked for your input on topics that directly draw from that knowledge.

averse to healthcare. listen i enjoy obi-wan whump just as much as the next obi-wan stan (the desire to put him in the cosmic salad spinner comes with the territory, i fear) but as a character who grew up in an environment that deeply cares for the well-being of all, and knowing that you cannot help others unless you yourself first have the ability to do so, i can't really see him ignoring injuries outside of combat scenarios. like on the battlefield he's got more pressing concerns than a pesky little shrapnel wound or five, but once the battle's over?? he might not be first in line to the medics but i can't see him avoiding them entirely. an army without a general is working at a sharp disadvantage and i don't think he'd risk his men by neglecting his physical health in that manner. note that i said 'physical'. make of that what you will :)

duty. obi-wan is the definition of a paladin. he takes an oath and by the force he's going to keep it. train the boy? absolutely, qui-gon. whether or not anakin chooses to respect that training is another matter, but he did definitively get knighted! refuse to kill anakin? listen he's handed vader his own ass to him twice post order 66 and each time he did it he did it nonlethally. that takes skill. that takes dedication. exile yourself to tatooine for 19 years and then decide fuck it, we ball, and die after Once Again Deciding Not To Kill Anakin Skywalker? step aside casper, there's a new friendly ghost in town. every time obi-wan commits to something the man COMMITS. you GOTTA respect that grind.

flirty but in the sense that he's going to match the energy someone brings to the table. like he's a negotiator. he knows how to read people and figure out the Vibes. if he thinks the other person will be 1) 100% receptive and 2) will respond with a delightful wit, why the hell not? obi-wan's highest stat is charisma and he's got expertise in persuasion. whether they're allies or not does not factor into this equation. he can have a little flirtation with morally dubious and potentially hostile characters. as a treat.

this has nothing to do with his character but i firmly believe that he and quinlan vos had at LEAST a fling when they were padawans. there is zero evidence to back this up aside from a few comics where they were being goofy teenagers together but i stand by this. it is an unshakeable aspect of obi-wan to me that has only gotten worse with the kenobi show.

no matter what, no matter how terrible or devastating or downright apocalyptic it gets, obi-wan kenobi will never fall to the dark side. never. it won't be easy, but that is a line he has never, and will never cross. i will not hear any "obi-wan touched the dark side during the theed generator fight" slander. if that was true tell me why the force theme was playing during his moment of triumph!!! Would John Williams Lie To Us Like That?? to our face?????

anyways i could go on forever about obi-wan because he is My Ultimate Blorbo but this post is getting super long so i'll leave it there. hope this helped even a little or at the very least was entertaining for you to read <3

[andhumanslovedstories]

I’ve been struggling lately with the feeling that my job is pointless. Intellectually I know it is not—nursing is one of those professions where you get to be real smug about knowing the value of your work. But it’s still felt very pointless. Like I’ll start a shift thinking, “what am I even doing here,” and end it thinking, “what have I actually even done.” It’s been a ROUGH couple months.

But I had a really good shift last time I worked, which was good for the soul and also a very useful data point. I got to do pain management advocacy and symptom management, met a bunch of cool patients, did education for new nurses, and had several long heart to hearts, which the kind of midnight heart to hearts that I think are the most important part of night shift, all of that while being well staffed with very pleasant and appreciative patients and coworkers, and I was still like. Pretty depressed. I had a sense of satisfaction and moments of joy and meaning, but it turns out that one good shift did not cure the depression that has been latched on to me for the last few months like some kind of fucked up mental health leech. As I realized I was still depressed and that it was still interfering with my life even when everything was going well, the sense of peace washed over me was the best I’d felt in a while. Because I was like, okay! None of my usual stuff as worked! I have no excuse not to try something new to get my brain out of the shit ditch it’s slipped into.

So I’m applying for short-term disability. I’m worried I won’t get it, and I’m not sure what the next step is if I get rejected, but I feel so much better having decided to pursue it. It’s so much fuckin paperwork for sure, to a degree that’s overwhelming except that that the form could be a checkbox that says, “you want money?” and I’d be like “THIS IS TOO MUCH.” I’m totally not writing this post instead of finishing an email to my manager. I’m definitely not writing this post to avoid dealing with coordinating all my various care providers. I’m certainly not at every moment worried that I’m secretly faking all this so I can get three to nine weeks of a cool summer vacation.

I was thinking about how I almost flunked nursing school in my final semester because I turned in assignments late for a class with a “no late homework” policy. The professor said that this was reflective of real life, where if you miss deadlines you’re just fucked. I ended up appealing my grade and passing, because frankly it was a weak reason for making me repeat a final semester when there was no issues with my actual work or knowledge. During my appeal, I was like “I also think this policy is ableist. Harsh penalties for late work hurt students with health problems, especially chronic health problems when you aren’t asking for one week off due to the flu but instead for a general and never ending flexibility. I’m not trying to make an excuse but explain why this policy is a bad one. Disabled healthcare workers are an asset to healthcare.” I’m trying to remember my own argument as I pursue help. My depression and ADHD and eating disorder do help me be a better nurse, not because like depression gives you superpowers, but because I manage my chronic illnesses every day, in ways that range from hardly noticeable to life or death. Being kind to patients means being kind to myself, and vice versa.

I’m rambling. I really do not want to do this paperwork or send these emails. And I’m not sure if I deserve the leave I’m trying to take. But I miss being love with my job. I miss enjoying it. I wouldn’t judge someone else for going on medical leave, and my job doesn’t want me to burn out or quit. It almost feels like I have to be skeptical of applying for leave because no one else is. Everyone I’ve spoken to has been very supportive, including my manager. And considering how many unpaid days off I’ve had to take lately, disability leave would be an improvement over some of my recent paychecks. All in all, short-term disability makes sense and seems like a reasonable response to circumstances. But FUCK. I wish it required like 90 percent less documentation.

[afeelgoodblog]

The Best News of Last Week

1. ‘It was an accident’: the scientists who have turned humid air into renewable power

Greetings, readers! Welcome to our weekly dose of positivity and good vibes. In this edition, I've gathered a collection of uplifting stories that will surely bring a smile to your face. From scientific breakthroughs to environmental initiatives and heartwarming achievements, I've got it all covered.

In May, a team at the University of Massachusetts Amherst published a paper declaring they had successfully generated a small but continuous electric current from humidity in the air. They’ve come a long way since then. The result is a thin grey disc measuring 4cm across.

One of these devices can generate a relatively modest 1.5 volts and 10 milliamps. However, 20,000 of them stacked, could generate 10 kilowatt hours of energy a day – roughly the consumption of an average UK household. Even more impressive: they plan to have a prototype ready for demonstration in 2024.

2. Empty Office Buildings Are Being Turned Into Vertical Farms

Empty office buildings are being repurposed into vertical farms, such as Area 2 Farms in Arlington, Virginia. With the decline in office usage due to the Covid-19 pandemic, municipalities are seeking ways to fill vacant spaces.

Vertical farming systems like Silo and AgriPlay's modular growth systems offer efficient and adaptable solutions for converting office buildings into agricultural spaces. These initiatives not only address food insecurity but also provide economic opportunities, green jobs, and fresh produce to local communities, transforming urban centers in the process.

3. Biden-Harris Administration to Provide 804,000 Borrowers with $39 Billion in Automatic Loan Forgiveness as a Result of Fixes to Income Driven Repayment Plans

The Department of Education in the United States has announced that over 804,000 borrowers will have $39 billion in Federal student loans automatically discharged. This is part of the Biden-Harris Administration's efforts to fix historical failures in the administration of the student loan program and ensure accurate counting of monthly payments towards loan forgiveness.

The Department aims to correct the system and provide borrowers with the forgiveness they deserve, leveling the playing field in higher education. This announcement adds to the Administration's efforts, which have already approved over $116.6 billion in student loan forgiveness for more than 3.4 million borrowers.

4. F.D.A. Approves First U.S. Over-the-Counter Birth Control Pill

The move could significantly expand access to contraception. The pill is expected to be available in early 2024.

The Food and Drug Administration on Thursday approved a birth control pill to be sold without a prescription for the first time in the United States, a milestone that could significantly expand access to contraception. The medication, called Opill, will become the most effective birth control method available over the counter

5. AIDS can be ended by 2030 with investments in prevention and treatment, UN says

It is possible to end AIDS by 2030 if countries demonstrate the political will to invest in prevention and treatment and adopt non-discriminatory laws, the United Nations said on Thursday.

In 2022, an estimated 39 million people around the world were living with HIV, according to UNAIDS, the United Nations AIDS program. HIV can progress to AIDS if left untreated.

6. Conjoined twins released from Texas Children’s Hospital after successfully separated in complex surgery

Conjoined twins are finally going home after the pair was safely separated during a complex surgery at Texas Children’s Hospital in June.

Ella Grace and Eliza Faith Fuller were in the neonatal intensive care unit (NICU) for over four months after their birth on March 1. A large team of healthcare workers took six hours to complete the surgery on June 14. Seven surgeons, four anesthesiologists, four surgical nurses and two surgical technicians assisted with the procedure.

7. From villains to valued: Canadians show overwhelming support for wolves

Despite their record in popular culture, according to a recent survey, seven in 10 Canadians say they have a “very positive” view of the iconic predators. 

Here's a fascinating video about how wolves changed Yellowstone nat'l park:

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That's it for this week :)

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Also don’t forget to reblog.

[techramonic]

What is Pain? : How Austin Eubanks Dealt with Addiction and the Aftermath of Columbine.

Austin and Corey

Stephen Austin Eubanks was a junior and a star student in Columbine High School. Corey Tyler DePooter, his best friend, was also a particularly gifted student who prioritized his studies over anything else. Despite having a wide range of interests, the two kids particularly bonded over their shared passion for fishing.

At the age of 17, Corey had gotten a job doing maintenance at a golf club in order to earn money for a fishing boat that he planned to buy with a friend — likely Austin. The two often used to go fishing together and would talk about the struggles they had as teenagers.

Day of the Tragedy

On April 20th of 1999, the two were inside the library getting ready to get lunch with their friends, Jennifer Doyle and Peter Ball. That was until they had heard shots fired from the outside, not recognizing the sounds and believing that it was only the sounds of construction. Then they heard a bomb go off, a teacher rushing in to scream for the students to hide underneath the table because two students were armed with guns.

In a state of shock and fear, the four duck under the same table near the windows. With 10 minutes passing, the shooters had already entered the library and methodically fired under each table as recalled by him. His best friend, Corey, was one of those who were shot after being aimed with a semi-automatic rifle and shot at the neck, chest, and left arm by Dylan Klebold.

The bullet that hit Austin's hand first passed through his best friend, killing him instantly. With his best friend lying lifelessly beside him and being wounded on his hand and knee, Austin had no other choice than to try to play dead while laying in a pool of blood. When the shooting had stopped, Austin ran through the smoke and out of the backdoor of the library. He was only 17 when the shooting occured.

In Austin's TedTalk “What Columbine Shooting taught me about pain and addiction”, he recalls:

"I remember how I felt: I was confused, I was afraid, I felt sick and I was vulnerable. And just minutes later, I was playing dead underneath a table next to a pool of blood. I had just been shot and I witnessed my best friend murdered right in front of me as we were huddled together waiting for help to come."

Pain, Grief, and Narcotics

During the time he fled from the crime scene, Austin marked that as one of the most impacting and damaging experiences he has ever experienced in regards to the feeling of pain. His definition of pain was nothing similar to what he describes in his present days.

Pain, in a medical sense, is the variably unpleasant sensation of physiological systems mediated by specific nerve fibers of the brain that are conscious of receiving signals of awareness. According to Austin's TedTalk, the American Pain Society introduced the term "pain is the fifth vital sign" in 1996. This means that when you enter the room, your status is assessed using five different data points: blood pressure, pulse rate, temperature, respiration rate, and pain.

Due to a movement that was certain that we were undertreating pain, patient satisfaction surveys were implemented in order to monitor the campaign's success. To him, in order to uphold this new momentum and cause the patient's pain levels to cease completely, the ethical dilemma instantly arose:

“Do I issue this person with narcotics to make them happy or deny them and potentially hurt my compensation, the revenue of the hospital? Or at worse, open myself up for a grievance for undertreating pain that could potentially result in the loss of my job?”

Austin says that the healthcare system predominantly treats physiological systems and would rather not assess emotional pain into the equation. He akins the emotional pain of dealing with trauma being identical or if not more than when dealing with physical pain. With that, within months after the incident, Austin was prescribed opiate medication for his injuries.

In an exclusive interview with The Fix, he said that his injuries were not to the point of needing an opiate pain medication but was immediately given a 30-day supply and became addicted within three months. From then on, he said, “I used substances every day, day in and day out.”

After the shooting, his parents took him to a therapist who said Austin was too shut down to process his horrific trauma. But the reason no one could reach him was because he was overmedicated. He was addicted to painkillers, and used medication because of his unwillingness to engage in the stages of grief that he dreaded to face. He was haunted by the past. Struggling with survivor's guilt and the death of his best friend, he would rather ignore the intense burdening feelings he bore. According to him,

“Acute Physical Pain ends relatively quickly, complex emotional pain does not.”

The morphine Eubanks received at the hospital that day proved to be the opening dose of a costly addiction to prescription painkillers - one that revolved around commonly prescribed drug Oxycontin, he said.

“I learned to manipulate doctors … I could literally get whatever I wanted. Telling them I’d been shot at Columbine and lost my best friend was like [getting] an open prescription book from any doctor.”

He could not process the grief, moreso, he didn't want to. He didn't want to be haunted by the memories that scarred him. In his own words, he would describe the physical ailments he felt to be a 4 or 5, but the emotional turmoil was a 10.

Austin never set foot back to Columbine. His parents hired a tutor and he then went on to graduate in 2000. He attended the Columbine ceremonies but never went back inside the school. He then went into advertising and married in his early 20s. Around this time his substance abuse escalated, and his first attempt to get sober was in 2006. He went into a 30-day inpatient program but failed within hours of leaving, for  relapsing using pain pills and Adderall. 

Addiction and Sobriety 

He failed both outpatient and rehab twice and it wasn't until 10 years later, in 2009 that he was able to overcome this addiction. Right before Columbine, young Austin had been misdiagnosed with ADD. 

“I didn’t have ADD,” said Eubanks. “I just liked being outdoors and playing golf better than being in school. At that time, if anybody was truant at school they said, ‘Oh, they must be ADD. Let’s put them on a stimulant.’ That was why I got Adderall. I liked it because I could abuse opiate pain medication to the level that most people would be nodding out. With Adderall, I could function. Basically, I was doing oral speedballs. It was like using methamphetamine and heroin.”

His second try at being sober was in 2008. Gaining the motivation to change after recently separating from his wife, he went to treatment, stayed 90 days, and achieved eight months of sobriety. Then, he akinned addiction to a causal sequence, a domino effect. According to him, he achieved abstinence for a period of time, built up enough false confidence to where he thought he could drink, because alcohol was never a problem. From alcohol, he went to weed, then Xanax, then Oxycontin, and then back into the same routine.

In 2011, approaching the age of 30 and estranged from his wife and kids, he hit rock bottom: "My sobriety date is April 2, 2011. I woke up in a jail cell and had no clue how I got there." His downward spiral began with Oxycontin and alcohol abuse, leading to arrests for various offenses like car theft and fraud. Realizing that he needed a drastic change, he recounted that his lowest moment was waking up in withdrawal, hungover, and facing the ruins of his marriage and being estranged from his children. He knew he had to stop or he would die. After unsuccessful attempts at sobriety, he finally sought help, surrendered to treatment, and was now willing to follow any guidance to rebuild his life.

His journey to lasting sobriety didn't hinge on traditional 12-step programs, but rather on understanding behavioral triggers and brain function through a therapeutic community approach. He was five years sober and started working at The Foundry in Colorado, becoming the COO and handling approaches that combined neuroscience with 12-step principles, recognizing that each person's path to recovery is unique. Using comprehensive approaches aiming to rebuild the lives of those in recovery.

During this time, he would also indulge in old activities in remembrance of his bestfriend.

“It’s something I do to connect with Corey. It's always nice whenever I catch a fish that's above the normal or something special about it. I always tend to look up and give a nod to him. And I know he’s still looking out for me."

Sadly, despite his long battle against drug addiction, in 2019, Austin had passed away in his home in Colorado after an accidental heroin overdose. Just a month after the 20th anniversary of Columbine, Austin was 37 at the time.

What is Pain?

Pain, to Austin, encompassed many things: the confusion and vulnerability of not knowing what to do in such a time of terror, the physical wounds that the doctors tried to medicate to bring the pain meter to zero, and most importantly, the emotional hurt of knowing your best friend was gone, taken right in front of you. Knowing that very moment can never be undone.

His advice for survivors dealing with the same guilt is to feel it. Don't run away from it. Survivors often find other things that allow them to detach from the pain, but to him, that's the wrong choice.

“You can heal physical pain while you’re medicating it. You cannot heal emotional pain while you are medicating it, In order to heal emotional pain, you have to feel it ... You want to feel better immediately, [but] you have to have the courage to sit in and feel it, and if you can do that long enough, you will come out on the other side.”

Along with post-traumatic stress, there is also the potential for post-traumatic growth.

“That doesn’t imply you will ever be the same person again. After a trauma, you will be changed forever.”

[rainboneish]

they could never make me hate you Shoko Ieiri

Shoko is such a tragic character (and to me, the most relatable character in jjk (lolol the numbly depressed med student is jumping out))

she gets a lot of shit for her apathy but to be honest, there’s not much else she can do to protect herself

Shoko has been patching people up and doing autopsies since she was in school. Out of the entire cast of characters, she is probably the one who has the clearest view of how many of her fellow sorcerers die and/or are seriously injured in battle… it is a decently well documented phenomenon that working in healthcare lowers your active empathy levels, as a defense mechanism to distance yourself from all of the pain and loss you are confronted with on a daily basis… it is another fact that in most if not all countries, there are strict laws in place to prevent doctors and other medical professionals from treating their close friends and relatives

Shoko never had that protection… Jujutsu society is small and everyone knows everyone, she is in a position where she is constantly having to stay calm and level headed while her friends and comrades and injured and dying …

in addition to that Shoko, as their best healer, has always been taught to take a passive role in the action (she wasn’t sent out on dangerous missions, she had to stay back during Shibuya etc)

getting emotional over any of this wasn’t going to help her, or anyone else for that matter

Shoko grew up between Gojo and Geto, two once in a generation (once in a century in Gojo’s case) powerhouses who were both highly emotional in their own ways (cue the clip of her leaving the gym when the two were bickering in the hidden inventory arc)

She isn’t like them, and she CANT be like them, cause it would be detrimental to her role in the team

she does not GET to be emotional, so she trained herself out of it till it became second nature

when Geto defected, she did not rage at him or fight him cause there wouldn’t have been a point… she is not a fighter, she knows him well enough to know she is not in direct danger as long as she doesn’t attack first and arguing with him would not have done either of them any good… so she has a last casual conversation with him and calls Satoru, who is the only person who could actually do anything about the situation (either in an argument or in a physical fight)

when he left, all she could do was stay there with Gojo (and she is silently hurt that he never leans on her but she also can’t make him open up against his will)

it’s lonely at the top, but it’s lonely in the morgue too

then, years later, Geto initiated the Night parade of a hundred Demons, forcing Gojo to execute him… we don’t know if Shoko ever saw his body after his death (if Gojo took it to her and didn’t let her cremate him or if he didn’t take Geto’s body to her at all), either way, it can’t have been easy

less than a year later, Gojo is sealed and we see Shoko’s thoughts, about how Gojo felt alone despite the fact that she was there too and that (in my interpretation) they are all monsters on some level (Gojo doesn’t have to be the only monster) waiting for him to come back to them

and when he does come back, (according to Shoko’s own prediction) possibly questionable mental state) he immediately throws himself back into a fight with their two strongest enemies

and for the first time… everyone has to consider the possibility of Satoru Gojo losing… and the students even say, it’s hard to react appropriately cause the possibility of him losing is such a foreign concept

and now to their back up plan for when he does…(the thing my girl gets the most shit for)

Shoko not protesting is rooted in multiple things:

1) They are up against Sukuna and this is the only plan they have in the event of Gojo’s death… if they don’t use every trump card in their deck they WILL die (hence why Yuuta is upset… he is not upset by Gojo’s body being weaponised, he is upset by others hesitating to sacrifice their own humanity)

2) yes she could protest but it wouldn’t help anyone, the last thing you need in a crisis is your doctor getting emotional, if both of the people involved are alright with the procedure, Shoko’s feelings don’t matter and she knows it too, the last thing they need is for her not to be able to do her job

[symptomsofdeceit]

Hello!

This isn’t exactly a question about your game, so hopefully it’s okay to ask you here - feel free to delete this if you’d like! I saw in your bio that you work in vascular surgery at only 23 - first of all, that’s incredible! I didn’t even realize it was possible to enter the medical/surgical field in any way that young. My question kind of relates to this: as someone who wants to get into medicine and healthcare, I’m wondering how you’ve started so young and/or if you have any advice on how to succeed in school/get a job in the industry early on? Thank you so much for your time and have a lovely day :)

You’re good, it’s totally okay! I enjoy my work and talking about it. I’ll put my answer under a cut so people who are just here for game stuff can easily skip it

There are a lot of options in the medical field!! Advice really depends on what you want to do. I’ve only experienced one side of it, so I’m not sure if anything I say would be relevant to what you’re wanting to do. I hope this is at least a little helpful though, and I’m wishing you the best of luck with it!! 🍀🍀✨✨

I’m a vascular interventional radiologic technologist. Every hospital is different, and people with that job title often work in a cardiac cath lab or interventional radiology. I’ve talked about the types of operations I help perform here!

Here it requires 4 years of university with a lot of clinical hours and 2 registry exams at the end to get certified / have proper credentials.

As a student I spent a lot of my clinical hours in the vascular surgery department. I was always told to treat your clinical shifts like an interview! I knew I wanted to work here, so I talked to the manager over the department and actually got hired a few months before I graduated (with the condition of me successfully graduating + passing my exams to get credentials). Most medical programs should have some type of clinical hour requirements, so my biggest advice is to try to spend that time in the department you’re passionate about + try to show that you’re someone worth hiring while you’re a student! A couple of my classmates got hired for cath lab & IR before graduating too.

There are also so many different types of jobs in the medical field!! A lot of people outside of the field have never heard of my position, or they’re only aware of it in interventional radiology. My other suggestion is to make sure you know what you want to do & look at all options! There are many cool positions that would allow you to start working earlier in life :)

I hope this was helpful in some way, and again I’m wishing you the best!!

[bigshoeswamp]

In the last few weeks, I've received many asks from Palestinians asking for support in their GoFundMe campaigns. I don't have much to spare, but I've managed to donate make a total donation of 15 dollars to them. Can you match my donation?

Here's a list of the people who have contacted me and some words from their campaigns' pages. Please take the time to read their stories and, if you can, please share and donate, even if it's a dollar!

Heba Al-Anqar (@heba-baker) - €4,503 - €60,000

Hello, I am Heba Al-Anqar, 21 years old, a university student. My university was suspended due to the war. I am writing about my family: my father Bakr (54 years old), my mother Alaa (46 years old), and my sisters Aya (18 years old), Amal (15 years old), Muhammad (13 years old), and Maryam (8 years old). We have faced many challenges in this war, from the destruction of our home to the famine we continue to suffer in northern Gaza.

Ahmed Altaban (@ahmed4palestine) - $18 309 USD/ $20 000

There are seven members of the family: Heba (the mother), Amjad (the father), their sons Ahmed, Khaled, Soliman, and Abdallah, their young daughter Lamar, and Ahmed (the grandfather). The siblings were all pursuing engineering, design, or completing grade school. Lamar in particular aspires to be a doctor some day.

Eman Zaqout (@rakan2010) - $25 669 CAD- $40 000

My name is Eman Zaqout, from Occupied Gaza, Palestine. I am contacting you at a really desperate and urgent moment. I am seeking your assistance to raise funds for saving our lives, facing the starvation in Gaza and help me achieve my doctoral degree dream after awarding prestigious PhD Fellowship. I'm a wife and mother of two little kids. My husband Mahmoud Zaqout 39 years old, my son Rakan 12 years old and my doughter Seba 10 years old. I am also an employee working in a medical field and at the same time a scientific researcher conducting different research inside and outside Gaza as well.

Mohi (@mohiy-gaza2) - $30,000 USD- $31,000

I am 23 years old. I live under the bombardment and constant aggression against Gaza. Here we struggle with a life of constant death and loss. I lost a large part of my family. We also lost our house in which we used to live. We were displaced more than 10 times from one place to another, searching for safety. In fact, there is no safe place. We had many ambitions and hopes. I graduated from university and intended to travel, work, and many other things. But the war came and destroyed all that. We also had a source of livelihood and clothing shops. The occupation completely destroyed and burned them all, and we no longer have any source of livelihood. (...) Therefore, I hope you can help, even if just a little, as this will help us get out of death."

Islam Al-Najjar (@islamgazaaccount3) - €2,150/ €30,000

My name is Islam Al-Najjar, a 27-year-old Palestinian from Gaza. My life was turned upside down when our home was destroyed, and I lost many loved ones and friends. Now, I find myself homeless, jobless, and struggling to survive. We lack basic needs such as food, water, and healthcare. Despite these hardships, we still hold onto hope, believing that your generous support can help us overcome these adversities. My grandfather is 85 years old. He lost his left hand due to a previous Israeli bombing and suffers greatly from this serious injury. We also suffer a lot in taking care of him due to the scarcity of basic resources like water and food, and their complete absence.

Ahmed (@ahmadresh) - $13,241 USD/ $31,000

Hello, my name is Ahmed, 19 years old from Gaza. I finished high school with a high average and a very good grade, and because of the genocide war on Gaza, I was deprived of enrolling in university. I had dreams and ambitions to study photographic design, but I was deprived of all of that because of the genocide war on Gaza. I was living the best days of my youth. But with the beginning of this war, I became unable to live my normal life. At least our warm house sheltered me and my family until it was bombed for the first time, that damned night. Our house has become like a ghost town. We continued to seek refuge from death there until we were besieged and displaced from our safety under fire to a tent (shelter) in the bitter cold of winter, with the lack of basic necessities of life (water pollution, high cost of living, disease, insect infestation, ‏malnutrition, ‏Difficulty of movement, overcrowding), and many other daily difficulties, especially with the significant increase in prices.

Haya (@hayanahed) - €86,967/ €100,000 target

I'm Haya from Gaza , from a family of 8 people: my parents, two sons, and four daughters (two of them suffer from allergies). I've witnessed the evidence of the tragedy that has struck our lives in Gaza, where my family and I have survived amidst numerous previous wars. But today, we face the most dangerous and fierce battle in the current war. The urgent need intensifies for us, as we have nothing left and are unable to secure our basic needs such as food, water, and safe shelter.

Sara (@sara-97a) - €1,297/ €50,000 target

Before the war, 7 -year-old Sewar dreamed of becoming a doctor to treat people and alleviate their pain. Sewar is a kind, active, intelligent and diligent girl in her studies. Every day, Sewar and her two brothers, Abdul Aziz and Omar, begin a bitter journey to get water and food, collect firewood for cooking and help their father and mother secure the necessities of life. The lives of the three children, Sewar, Abdul Aziz and Omar, have been turned upside down. They were kind and innocent children who went to school every morning with enthusiasm. Please help us arrange the costs of food, water and medicine for the children and their sick grandmother.

Nisreen Suhail/Hazem Shawish (@nisreensuhail - vetted by association) - €7,869/ €50,000

I’m Hazem Shawish, trying to save my family from the war. We’re a family of 8 members, me, my mother, and I have 4 brothers and two sisters. And their kids. Islam (30) years old, Hashem (31), Samer (29), Mohammad (35), Nisreen (37), Noor (36), Amal (12), Kenzy (17), Zoheer (19) In the shadow of conflict, our family has faced unimaginable hardships. The passing of my father, a victim to the cruel grasp of hunger and inadequate healthcare, left a void in our lives, underscoring the fragility of our existence here. My brother, Samer, battles bipolar disorder, a condition exacerbated by the ongoing war and the severe shortage of essential medications. Without access to the necessary treatment, his life is at risk, and we live in constant fear for his well-being amidst the chaos that surrounds us. These personal tragedies have deepened the urgency of our situation.

Dr. Husam Farhat (shamfarhat1) - $8,590USD/ $29,500

Amidst the relentless bombardment, Dr. Farhat faced an unthinkable tragedy: the martyrdom of his beloved sisters, Inas and Amal, along with their husbands and children, and his brother Mustafa. This devastating loss shattered not only their dreams but also their hopes for a peaceful future. (...) Now, after all this devastation, my family and I are living as displaced people, homeless and jobless, with no clear future for ourselves or our children. Every day is a struggle to find food for my children, who have been robbed of every chance at a normal life by this war. Once, we lived in Shuja'iyya, in North Gaza, where we had a home, a life, and dreams. But now, after being displaced over nine times, we find ourselves in the refugee camps of Nuseirat, the war has stripped us of everything—our home, our security, and our future.

Dr. Mohammed Aldeeb (@mohammedaldeeb) - €41,065/ €55,000 target

I am Dr. Mohammed Aldeeb, a dedicated medical professional specializing in emergency care, hailing from the Gaza Strip, We are a family of 4 members. (...) In the chaos and carnage of conflict, I sustained injuries, and the sanctuary of my home was obliterated, leaving my family and me destitute and displaced. Yet, amid the ruins, a flicker of hope persists. At Al-Aqsa Hospital, I continue to extend a helping hand to those in need, drawing strength from the resilience instilled in me through years of education and service. Today, we find ourselves sheltering in a humble tent, stripped of our possessions and livelihoods. The loss of my job, my home, and the comforting presence of my loved ones weighs heavily on my heart. Nevertheless, I refuse to surrender to despair, clinging to the belief that brighter days lie ahead.

If it serves as an incentive, anyone who sends me proove over at my inbox that they've matched my donation of $15 USD can request a drawing of their choice to me, on my quick commission style, as seen bellow

[healthgennie]

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[irradiatedpiratebooty]

Yall I hate making personal posts like this. Genuinely. I try to keep my personal real life away from social media. But christ I'm struggling here.

I have really severe ADHD. I cannot work or function or do anything without my medication. I physically can't. But right now my medication is completely unaffordable for me.

I've been applying everywhere I can, but I live in a college town so the competition really fucks me over. I mean, which would they rather pick, a competent college student, or an adhd/autistic dropout who never learned how to mask properly?

And recently, I got dropped off my insurance plan. And thanks to me being unable to work decent jobs, I haven't earned enough to file enough taxes to qualify for affordable Healthcare. The only Healthcare I legally qualify for is a Healthcare that's $300 a month when I'm living off pocket change.

I really hate to ask, I do, especially since right now I'm without my medications so I can't get many things done, if at all, but if anyone is willing to help me out, I'm doing $5 doodle commissions. I'll work down the queue as best I can, it'll be slow but I'll do my best.

Link to my Ko-fi for assistance is below. I appreciate the help. Currently I can get a one month prescription of my medications for $45. So I'll be able to get it relatively soon but I need to save up so I can afford it each month.

If you're not able to assist that way, any advice on how to afford medications (I already use GoodRX) or any suggestions on jobs, would be greatly appreciated too.

[scientia-rex]

just found your account! question for you that you might not know the answer to but I would like to ask anyway: are there any accessible careers in medicine for a disabled person? I've pretty thoroughly researched med school and yeah I could not do that lmao. But I'm also not sure I want to give up on all of that? Like maybe there are career paths where the training and work just isn't so physically demanding? if you have any suggestions for me that would be so helpful.

Good question. There ARE doctors out there with a range of disabilities, but it's a very challenging journey because of the omnipresent bias from everyone around you--admissions committees, professors, preceptors, attendings, fellow students. There are also a wide variety of disabilities, so disabilities that would make one job very difficult could be a negligible barrier for another.

If you're interested in health professions but "doctor" doesn't have to be the be-all end-all, here's a list of some of the other professions I work with regularly and consider indispensable that you might want to look into:

-Physical therapy

-Occupational therapy

-Pharmacy

-Mental health counseling

-Substance use counseling

-Nursing (approach with caution; this is another field with a long history of brutal hazing)

-Dentistry

-NOT PODIATRY. Good God. I saw the Podiatry residents at our hospital and they had NO WORK HOUR RESTRICTIONS. They were constantly on the verge of collapse.

-Nutrition

-Respiratory therapy

-Midwife

-Doula

-Lactation consultant

-Sonographer

-CT/MRI technician

-EMT

-Dialysis technician

-Speech Language Pathology

-Chaplain

-Social work

-Healthcare Navigator

-Hospice

-Massage therapy

-Research assistant

You can do so much for people without ever going to medical school. Don't get tunnel vision about your future. Chase what's best for YOU.

[faggotcitosis]

happy disability pride month to all of us who are queer and disabled! we are a gay t4t disabled/neurodivergent couple (autistic/bipolar/fybromialgia & adhd/bpd) couple living in brazil. my partner andrea, who is the primary income earner, had a rapid increase in her chronic illness symptoms for the past few months, making them the current situation has made them not able to work as much + in and out of expensive doctors appts and treatments to try to figure out what's going on. we live in a small town, so specialized healthcare is at least an hour away. this raises the cost of ndrea's healthcare substantially :(

bc of that, we have less money coming in and we're in debt. im unable to work (full time student + small town has no part time gigs) and currently trying to get a formal adhd diagnosis but not having much luck.

our pets also require on-going medical care (chronic conditions) & we help financially support our very close trans lesbian friend who is affected by the russo-ukranian war the best we can.

financial instability has been making everything worse. being able to pay off this month's bills would put us in a much better position.

we are about $300usd behind on our monthly bills but any extra that we would get would go to paying off our debt generally. the conversion rate is around 5.5 so even a little bit helps.

i can offer in exchange art commissions & andrea can do essay editing/writing (humanities).

pa.y.p.al . me: andr3333a

v.e.n.m.o: @Andrea-Glenn-19

we can also take pix (for brazilians) and wise. dm for details!!

0/300$

[afeelgoodblog]

The Best News of Last Week - April 3, 2023

Kentucky Legalizes Medical Marijuana in Bipartisan Vote After Decade of Failed Attempts

The state of Kentucky has legalized the use of medical marijuana. The bill received final passage on Thursday. Democratic Gov. Andy Beshear signed it into law Friday morning after a decade of failed attempts in the state legislature.

The news makes Kentucky at least the 38th state in the U.S. to legalize medical marijuana.

Now Indiana is surrounded by weed states. The encirclement is complete 😂

2. The Maryland House of Delegates voted Saturday to approve the Trans Health Equity Act

The Maryland House of Delegates voted Saturday to approve the Trans Health Equity Act — a bill that just a year ago disappeared from the chamber’s agenda ahead of a floor vote.

The bill would require Maryland Medicaid, beginning on Jan. 1, 2024, to provide coverage for additional gender-affirming treatments, which are currently disallowed in the state’s plan but commonly covered by private insurance. The expanded treatments include hormone therapy, hair alteration, voice therapy, physical alterations to the body, and fertility preservation.

3. FDA approves over-the-counter Narcan. Here's what it means

The approved nasal spray is the best-known form of naloxone. It can reverse overdoses of opioids, including street drugs such as heroin and fentanyl and prescription versions including oxycodone.

Making naloxone available more widely is seen as a key strategy to control the nationwide overdose crisis. Effects begin within two minutes when given intravenously, and within five minutes when injected into a muscle. The medicine can also be administered by spraying it into a person's nose.

4. Boston expands tuition-free community college program to all residents

Boston has expanded its tuition-free community college program to include all city residents regardless of age, income or immigration status.

Starting this fall, any city resident will be eligible to pursue an associate’s degree or certificate at one of six partnering local institutions without paying to attend. The program also includes a $250 stipend for incidental expenses each semester for up to three years, and up to $2,500 of debt relief for students whose account balances are keeping them from re-enrolling.

5. First cheetah cubs born in India since extinction 70 years ago

India has welcomed the birth of four cheetah cubs - more than 70 years after the animals were declared officially extinct there.India's environment minister announced the good news, calling it a "momentous event".

The country has been trying to reintroduce the big cats for decades, and last year brought eight cheetahs over from Namibia as part of the plan. Another 12 cheetahs were brought to India from South Africa last month.

6. BBC education show in Afghanistan helps children banned from school

The BBC has launched a new education programme for children in Afghanistan who are banned from school.It is aimed at children aged 11 to 16, including girls whose secondary education has been stopped by the ruling Taliban.

The weekly programme is called Dars, which means lesson in Dari and Pashto, Afghanistan's official languages. It is hosted by BBC Afghan female journalists who were evacuated from Kabul during the 2021 Taliban takeover.

Each new weekly half-hour episode of Dars will air four times a day, Saturday to Friday, on the newly launched BBC News Afghanistan channel.

7. A Trans Creator Has Raised Over 1.5 Million for Trans Healthcare on TikTok Live

Transgender TikTokers are celebrating Trans Day of Visibility by raising over $1.5 million for gender-affirming care around the world.

Mercury Stardust — a DIY TikToker and trans advocate who calls herself the “Trans Handy Ma’am” — raised $120,000 last year in a livestream for the mutual aid nonprofit Point of Pride, which maintains funds for surgeries, hormone therapy, and free binders and gaffs. This year, Stardust and cohost Jory, a.k.a. AlluringSkull, set themselves a goal of raising $1 million in a planned 30-hour live stream…and then smashed that milestone less than six hours after starting the stream Thursday evening.

----

I have started a Youtube channel with wholesome videos I can find on the internet. Check it out :)

That's it for this week :)

This newsletter will always be free. If you liked this post you can support me with a small kofi donation:

Buy me a coffee ❤️

Also don’t forget to reblog

[munsons-mutiny]

I’ve had this headcanon forever and it’s just never come up anywhere, so I figured it’s time to write about it.

Caleb’s spell that he makes for Veth, Widogast’s Transmorigification, has major implications for Exandria’s trans population! This could be the magical equivalent of top or bottom surgery only it’s down to a biological level! I’m sure they’ve had their own procedures, but a body that you can personally design does seem like an upgrade from whatever technology/magic they have available!

I like to believe that Caleb doesn’t think about the spell in that context at first, why would he? It was designed for someone with a different type of body dysphoria, and he doesn’t interact with too many trans people (at least that he knows, I have no clue if he knows about Yussa, and they haven’t seen Bryce in ages).

But once he starts teaching, and establishes himself as a safe space for queer kids (you can’t tell me the empire is super open minded, especially their most prestigious traditional institution) the application becomes obvious. The first time his favorite student, a small purple tiefling named Aza who reminds him so much of Molly it hurts, comes to him mid-breakdown because of how bad the dysphoria is the solution just immediately pops into his head. He could fix this for her, give her the body she should’ve been born in.

He comforts her the best he can and then calls a meeting of the lgbt club he has set up (it’s run under the radar to make it safe even for students who aren’t out to their peers yet). Where he gives a presentation on the spell, and it’s capabilities, even has Veth come in to show the results and have her talk about her experience and if there had been any side effects.

A couple students in the room cry at the possibility, some remain uninterested, but many are enraptured with the idea.

In what seems like the blink of an eye Caleb has suddenly become an underground queer hero, he starts performing the spell free of cost to anyone who wants it and is above the legal age (you just have to help dig up the clay if you can). Ends up having a whole medical procedure to the spell, where he takes them to the blooming grove (which I imagine has plenty of clays heheh) where it’s peaceful and they can talk everything over with caduceus before and after. Who can guide them through their feelings much better than Caleb though he always tries his best. He always offer the option to go back as well (though they have to wait a year, which is of course stated beforehand) if it isn’t the solution they were hoping for.

(Totally off track but I fully believe Caduceus ends up super involved in Caleb’s queer club, there’s so little aro ace rep and seeing someone whose so confident in it would be so helpful for them, and I think it would be so comforting for Caddy to see others like him and to know he’s not alone in that)

They keep the whole operation quiet, but it spreads silently throughout the queer community, Astrid even stepping in a time or two to keep it off the Assembly’s radar (She may be straight, but she’s poly with a bi partner, and I believe she’ll use her powers for causes she believes in for better or worse. Thankfully this is one of them).

There’s still discrimination against the queer community, but this quiet movement starts to spread to the point that almost every member of the nein is involved. Beau uses her connections at the Soul to get new documentation for people with proper names and pronouns. Yasha starts running Rexxentrum’s first self-sustainable lgbt safehouse for kids with nowhere to go (the garden is incredible). Jester and Fjord turn Fjord’s old orphanage into a second lgbt safehouse after he gets it shut down. Veth adds lgbt education to her camps curriculum, and is an advocate for same sex healthcare in the Nicodranas school system. She has a tunic that says proud mother of a bisexual wizard that she wears a little too often much to Caleb’s chagrin. Even Kingsley (illegal pirate king that he may be, my beloved) ends up becoming as involved as possible in Caleb’s group. Loves learning more about gender identity, and becomes the first Plank King to be openly gender fluid (probably who knows, I don’t know much about Darktows history but I def didn’t get super queer vibes). Makes sure Dark-Tow is accepting of all who turn to piracy, and imposes harsh laws against discrimination.

Essek looks on all of this with pride, so proud of Caleb and even the small role that he got to play in the spells creation. It’s the first time he gets to see something he helped with create good in the world. With Caleb’s permission he ends up sneaking back into the dynasty and leaving a copy of the finished spell on the Bright Queens desk, with a big created by Caleb Widogast across it (with whatever the wizard equivalent of copyright is). In a culture that centers around rebirth in different bodies, the idea that you could choose to have your original body back is a big deal. Dysphoria after consecuted individuals get their magic back is a huge problem within the dynasty, and it does Essek a lot of good to know that he’s done something actually helpful for his country.

Basically this got super long winded and out of hand, and I know Matt has largely cut homophobia, transphobia, and non-fantasy racism from Exandria but this idea would just not leave me alone!! And either way the spells implications for a gender affirming procedure are still super relevant.