#I need to get in with an immunologist

[torchickentacos]

[kirby-the-gorb]

[thistlekiss]

Lmfao i always think to myself "i don't have THAT many illnesses" and i just counted my list of combined physical and mental illnesses/disorders and it's 13. 13!! And i've got a couple undiagnosed as yet!!

[oddlittlestories]

Thinking about how Wilson is shown to be just as perceptive and just as much of a “genius” as House (caught the tiniest speck of cancer on his patient’s lung and saved his life)

But in his own way (bc he knows the patient always talks about his grandkids. and then he didn’t. leading him to ID depression and find said cancer)

And because it’s not as flashy as House and bc he downplays it (describes it as suspecting cancer bc of depression), people don’t see him as a “genius” but instead as “renowned,” “accomplished,” etc. and how they treat him differently bc of it

Thinking about how Cuddy made him head of oncology at a SUPER young age bc he’s “caring.” Thinking about how that care, that attention, makes him a ridiculously good doctor.

Thinking about how Chase’s dad came to see Wilson & the narrative implied that Wilson is one of the best oncologists in the world.

Thinking about how all of this implies that nurturing can be just as badass as flashes of insight - that Wilson doesn’t need that to be just as good and brilliant.

Thinking about how Wilson is literally as smart as House. But because he’s nurturing and downplays himself (“I’m an oncologist. I see cancer. Show it to an immunologist and…”) it often goes unacknowledged and OFTEN gets exploited. (Which makes me want to think about the ways the world tries to exploit House and the ways House pushes back for both himself and Wilson)

Thinking about the way the show positions Wilson’s talents as equally formidable. Thinking about the way the show positions Wilson’s talents as eliciting completely different social reactions. Thinking about the way the show implies that Wilson sees it that way too (he thinks his transverse myelitis cure is genius but dismisses his no grandkids talk -> depression -> cancer leap).

Thinking about Wilson.

[covid-safer-hotties]

Also preserved on our archive

By Jessica Wildfire

Our friends and family think they understand their immune system because George Carlin explained it to them in the 90s:

"Where did this sudden fear of germs come from? What do you think you have an immune system for? It's for killing germs. But it needs practice. It needs germs to practice on. If you kill all the germs around you, and lead a completely sterile life, then when germs do come along you're not going to be prepared. What are you gonna do? I'll tell you what, you're gonna get sick and you're gonna die and you're gonna deserve it because you're f-ing weak and you've got a f-ing weak immune system."

George Carlin was right about a lot of things, but he was wrong on this one.

(He got plastic wrong, too.)

Unfortunately, this part of his 11th HBO standup special became permanently lodged into the American cultural memory. I only saw it once as a kid, but it stayed with me for the rest of my life.

Not even AP Biology could dislodge it.

I, too, used to think you built your immune system up by exposing yourself to harmful germs. How could the great prophet George Carlin be mistaken on something that made so much intuitive sense, especially when you dropped a few f-bombs in there? I also thought it was a good thing to exercise your way through a cold. Then I opened myself up to the possibility that I was wrong.

In the words of Carl Sagan, I'd been bamboozled.

In early 2020, this Carlin bit inspired countless reaction videos that still litter the internet. Anti-science zealots have used George Carlin's monologue on disease thousands of times over the last four years to ridicule masks, vaccines, and clean air. Everywhere you look, that piece of standup looms in the background, and it's getting revived again for bird flu. But even George Carlin got the idea from somewhere else.

You can trace this misguided notion back to hygiene theory, proposed by David Strachan in 1989. Strachan argued that a whole range of health problems in the late 20th century had roots in "a lower incidence of infection in early childhood." Basically, our immune systems weren't getting enough exposure to bacteria and viruses. He was mainly talking about the rise in childhood allergies as the result, but the media began printing loose interpretations of his studies and jumping to conclusions that less exposure to disease was a bad thing in general. So the public developed the idea that somehow getting sick was good for you. So began the myth of the "bored immune system" that needed practice in order to stay healthy. Gurus and quacks latched onto this idea. So did talkshows.

And then comedians...

It wasn't until 2003 that Graham Rook offered a more accurate description of the situation. As he explained, "microbes have evolved into an essential role in regulating our immune system... the microbes involved are not infections, but friendly microbes which make up our human microbiome. These are acquired by exposure to other humans or animals and microbiota from our natural environment."

This became known as the "old friends hypothesis."

The old friends hypothesis now serves as the dominant model for how microbes work with our immune system. According to immunologists, kids need to be playing outside more and eating fresher, healthier foods. That's what helps their immune systems.

Getting sick all the time just hurts them.

Like many debunked ideas, hygiene theory and the myth of the bored immune system have become entrenched. A couple of years ago, hygiene theory got repackaged as "immunity debt." Now Americans, Canadians, and many Europeans think they need to get sick to stay healthy. The elites have absolutely no problem with that. It saves them countless billions to let everyone continue thinking they're better off letting diseases run around in their cells.

So:

Your immune system doesn't work like a muscle. It doesn't get stronger the more it's exposed to different harmful germs.

It doesn't need practice.

Phillipp Dettmer gives a vivid, accessible breakdown of the immune system in his 2021 book, Immune. You can show it to any internet troll who brags about their knowledge of the immune system. Dettmer destroys misinformation, explaining how your adaptive immune system actually works, as well as your gut microbiome.

As many articles and books explain, your body has an innate immune system that already knows how to fight off pathogens. You can help your immune system by feeding it the nutrients it needs. (That's an entirely different article.) You can protect your immune system from pollution, cigarette smoke, and other toxins. But genetics determines a lot of your immunological makeup. You can be born with an immune system that doesn't work the way it should, and it's not your fault.

You also have an adaptive immune system that stores chemical blueprints of pathogens in memory T and B cells. According to a 2024 article in Nature, these cells respond better to specific pathogens your body has seen before. Those blueprints last only as long as your memory cells. Sometimes those cells mature and stay around for years, even decades. If they don't, then your body won't remember the pathogen.

Your body doesn't need exposure to viruses.

Your immune system responds to harmful microbes and it can develop memories from previous infections. Most of the time, those memories apply specifically to that specific strain, variant, or clade of the virus. For example, immune memory to one type of adenovirus or rhinovirus doesn't confer automatic, guaranteed protection against all of them, and there are hundreds.

Sometimes, cross-protection can happen, but it's limited and hard to predict. When it does, like with the original smallpox vaccine, it's a big deal. If that were easy, we would already have a universal coronavirus vaccine and wouldn't have to update flu shots every year. Most of the time, getting sick with one virus doesn't train your body to respond any better to other viruses, especially when those viruses aren't related.

Victoria's state department of health puts it very plainly:

"The immune keeps a record of every microbe it has ever defeated, in types of white blood cells (B-lymphocytes and T-lymphocytes) known as memory cells. This means it can recognise and destroy the microbe quickly if it enters the body again, before it can multiply and make you feel sick. Some infections, like the flu and the common cold, have to be fought many times because so many different viruses or strains of the same type of virus can cause these illnesses. Catching a cold or flu from one virus does not give you immunity against the others."

You can add Covid to that list.

Some research has suggested that because catching one virus activates your innate immune system, your body's broad layers of defense offer brief protection against other pathogens. Viruses also compete with each other, meaning that infection from one virus can ward off others. That's called viral interference. Neither option means your immune system benefits from exposure to viruses.

We can't explain all of the human immune system in a single post, but here's the point. It's way more complicated than George Carlin explained. There's a lot more going on. It's not as simple as training your immune system by giving it practice.

That's not how it works.

It just sounds good.

No credible doctor or immunologist recommends building your immune system by welcoming viral and bacterial infections into your life. The costs far outweigh the benefits. Many viruses exact a price on your body and your immune system. Getting infected over and over again makes you weaker, not stronger. Vaccines don't work because they give your immune system practice. They work because they allow your body to develop a memory of a pathogen without all the risk.

Many viruses, like the flu, often leave lasting damage even when your immune system fights them off. Your immune system actually does some of that damage itself by attacking infected cells. In the wake of flu, your entire body including your immune system needs time to recover. During that stage, you're vulnerable to opportunistic infections. Other viruses, like measles and ebola, disable your immune system and even wipe out memory cells.

That's also what Covid does, among many other things.

You can't develop full immunity to viruses that evade, attack, and disable large parts of your immune system. Sometimes you can develop partial immunity, but the virus still invades and still does damage every time. Just because you can recover from these infections, that doesn't mean you're better off afterward.

Think of it like this:

Your body already knows how to heal its skin and bones. You don't have to teach it how to do that by cutting yourself or breaking your arm.

As it happens, many westerners also think bones grow back stronger after they're broken and scar tissue is tougher than normal skin.

That's also false.

Scar tissue remains functionally deficient in many ways compared to uninjured skin. Broken bones form a temporary calcium callus that's stronger than ordinary bone, but it's eventually replaced.

These misguided ideas fit in a culture obsessed with tough love, the idea that abusing someone somehow builds their character. And while it might make you interesting, it's certainly not "good" for you.

Sometimes I wonder what George Carlin would think about having one part of a standup special used to endorse bad science and eugenics. I'd like to think he would have a problem with it.

There's a lot you can do to boost your immune system.

Getting sick isn't one of them.

[amphorographia]

Something interesting about Pathologic that I don't see people talk about very often is the fact that technically none of the protagonists are doctors and, of the three, it's actually Artemy that's the closest to a real physician.

The fact that Daniil is specifically referred to as a "Bachelor" of medicine is something that was always sort of confusing to me but is actually extremely telling when put together with all the other details we get about him.

There's an excellent video essay about Daniil's character by Horror Game Analysis which goes into more detail about this [x], but he points out two things about thanatology that I think are really significant:

It was first conceptualised as a field of study in 1903 by Ilya Mechnikov, a Russian-Ukranian immunologist and microbiologist, who felt that there was not enough known about the phenomenon of death itself; and

Thanatology straddles the line between the humanities and the sciences because it's investigations grapple with the physical, psychological, socio-cultural, philosophical, and spiritual elements of death

With all that in mind and Pathologic's ambiguous time period, Daniil could very much be read as the in-game world's equivalent of Mechnikov. Despite his (sort of) alignment with the philosophically-minded Kains, Daniil is consistently shown to be very much focused on the physical components of death. He came to the town hoping that "[Simon's] tissues will help [him] defeat death." Rubin, Artemy, Victor (and Lara, Yulia, Aspity, Anna, and Clara) all need him to collect and examine blood samples for evidence of the disease. Once the plague begins, his focus in on the creation of a vaccine - a tool for immunisation - instead of a cure.

All of the evidence points to Daniil, at his core, being a microbiologist and researcher. His medical knowledge, while far above average, is highly specialised and doesn't indicate that he has any practical experience as a physician. He's not a doctor, he's a bachelor of medicine using his theoretical and academic expertise to fight an impossible disease in the only way he knows.

Now, Artemy does have some practical knowledge. Isidor taught him about the traditional medicine of the town while he was growing up before sending him to "study modern medicine in the academy" when he was 16. However, in his opening description, all we are told is that Artemy is returning from several years of "travelling from town to town learning theoretical and pratical surgery." In Pathologic Classic, Artemy is canonically 26 years old so if he spent 6-7 years travelling, his formal medical education was likely either short or incomplete. Not to mention that the emphasis on Artemy as a surgeon and menkhu (much like Daniil as a bachelor and thanatologist) implies a very specialised area of expertise which, although closely related to practical medicine, is not the same thing.

This is reinforced in a number of ways. For example, while there are multiple dialogue options which let you dismiss the town's local medical practices, they appear mostly (or only) in conversations with outsiders - responding to Daniil's admission of underestimating the value of "steppe medical knowledge" with "there's nothing medical in their knowledge" and telling Block that he has "an education in the civilized world and ha[s] forgotten two thirds of the specific local practices." Ultimately, Artemy is more consistently aligned with the Kin's more bodily approach to medicine. That distinction between Kin and Town is important, since the traditional medicines Artemy makes are not valued or trusted by townspeople and the kin refuse almost all of the modern medicine (specifically antibiotics) sold in the town.

He also seems to be either unfamiliar or seriously out of practice with the more formal language of science and medicine a university-educated physician should know. At several points, Artemy is shown to be dependent on Daniil's medical knowledge, and various members of the town poke fun at him for asking clarifying questions - Boy: "You graduated from a university and this is your question…?" Rubin: "I thought you were [away] studying." Artemy's story is about trying to fill his father's role and, while he succeeds in becoming a menkhu, his position as the town's doctor is less clearly defined even after the plague. While he begins the game with the most practical experience of the three protagonists, the fact that he's not qualified to be a physician but has to act as one is what drives his story forward.

I won't go into Clara since it's obvious she's not a doctor. If anything, she's more like a personification of a cure for this one specific disease (just like her 'twin' is the plague). She couldn't reset a bone or diognose the flu any more than she could synthesise antibiotics or distinguish between bacteria in a blood sample. Still, she's an interesting comparison point and does serve to remind the player that the protagonists don't really represent different approaches to medicine, but different approaches to healing.

The Bachelor is the modern healer of formal scientific practices who sees healing as the result of understanding the body, disease, and their interactions.

The Haruspex is the traditional healer with the spiritual or ancestral right to protected knowledge and practices who sees healing as a reflection of cultural duty, customs, and community.

The Changeling is the divine healer chosen by a Deity (or Deities) to carry out their will on earth who sees healing as an act of religious faith and demonstration of the existence and power of God(s).

[all-pacas]

#he's good in a crisis ok#and a dumb whore everywhere else

I'm the anon that asked why you think Chase is generally stupid,except for some talents. Can you talk why do you think he's a dumb person with a single talent,instead of a generally smart person who lacks common sense at times?

I mean, the short version is I’m joking. Just like when I call Cameron insufferable. The show itself likes to call Chase a Dumb Whore.

But the fact of the matter is that Chase isn’t stupid. House doesn’t hire idiots, even if he calls his employees stupid roughly twice a week. We see in S4 that he will fire someone immediately (CIA chick) if they can’t pull their weight; Chase does.

He does, in show, have a bit of a reputation for being dumb and lazy, and I think both have their… moments? Lazy is easier to prove: Chase tends to be quieter in differentials than Cameron and Foreman. He’s the least likely to argue his points or insist he’s right. Time and time again, he also shows he’s a bit apathetic: in Safe he and Cameron discuss the teenage patient’s boyfriend. They need to test his sperm, and Cameron worries that they should tell the parents, who will not be pleased. Chase shrugs it off. They’ll find out when they get billed for the test. Cameron asks if he’s really okay with them finding out like that; he doesn’t even hesitate before confirming “pretty much.” He prefers to take the easier path.

The dumb is a little more… meta-textual, let’s say. First of all, Chase is an intensivist. Foreman and Cameron are top level experts in their fields of disease. Foreman always thinking neurological is practically a running joke; I’m not sure if fandom has pinged on the fact that Lupus is a running joke because Cameron keeps suggesting it, because she’s an immunologist. They both tend to brainstorm in their specialties, they know a lot of very specific illness and disease stuff for them. Same with House: he has a double specialty in infectious disease and kidney stuff. Chase doesn’t have that kind of background. He’s not an expert in any body part or type of sickness. He’s… good at keeping people alive. And that is not easy, and we see time and again that he’s really good at it. But he doesn’t have that same kind of knowledge specialty, and so in differentials he… contributes, for sure, but he doesn’t have the “it must be lupus!” “it must be neurological!” thing. House also doesn’t defer to him as much — House recognizes Foreman knows more about Brain Stuff than he does, so when it’s a brain thing, Foreman is expected to know. Chase doesn’t have that kind of niche, so he comes off as a little less… brainstorm-y. Cerebral.

There’s also moments here and there in the show where they outright joke or imply he’s a little dim. There’s the “dumb whore” bit and him choosing password as his password. Way back in episode two of the show, he’s doing a crossword puzzle with a medical clue and can’t figure it out; Foreman does instantly. We know about Foreman and Cameron’s very prestigious CV and schooling history (he went to one of the top schools in the US and had perfect grades; she interned at the mayo clinic). All we know about Chase until S7 is that his dad, apparently, got him the job. Also, because Chase is the dedicated Keep ‘Em Alive Guy, there’s a whole bunch of episodes where, say, Foreman and Cameron are trying to figure stuff out or searching the home while Chase is busily working on the patient, so he seems to do “less” than the other two. This is probably where the “Chase screwed up” running theme comes from too: he cuts people open more than the other two, so if there’s a physical procedure (and potential mistake), it’s him and not Cameron who probably made it.

But that all said, all jokes aside, I don’t think he’s dumb. I mean — he’s dumb, but he’s not stupid. He might not be a disease or organ specialist like the others, but he still is able to keep up. He’s very good at keeping people alive. He also has a real penchant for out of the box thinking and creativity that bumps his Solve Rate up higher than any of the other fellows. As early as the Pilot he’s able to come up with a creative solution to prove the patient has Ham Worms. He’s shown plenty of times that he is incredibly good at reading people; he’s a good manipulator and lowkey House’s default “schemes guy” in early seasons, when he needs to trick a patient (or scam money out of the S4 betting pools and Kutner). He’s able to completely see through House and Foreman multiple times; House even goes so far as to say it’s why Chase was hired.

I think if anything it’s laziness that’s Chase’s biggest issue. He’s shown plenty of times he can be brilliant and is observant and creative, he just rarely bothers or cares enough to try. He’s… kind of a spoiled rich kid. He doesn’t have to work hard for things, so he doesn’t. He’s passive and more than a little spineless, and finds it easier to go along than assert himself in early seasons. He might not be dumb, but people see him that way, and I really don’t think he minds. Because it’s easier, and because he doesn’t really care what Foreman (or whoever) thinks. The rare times he does go all out tend to be exceptions: he works his ass off to prove his father wrong in S1, and Treiber in S8, because he’s mad more than because he’s that worried about the case. He figures out the same thing as House in Control, why the patient is really sick, but only because he’s afraid he’s about to be fired. He’s lazy. He works well under pressure.

I’m going to be super pretentious here, but when I was younger I read the short story “A Good Man is Hard To Find.” The main character is a deeply unpleasant and vain older woman. When her life is threatened, however, she becomes desperate and kind and empathetic. One of the last lines is another character’s musing (and I've thought about this line nearly every day of my life since): 

"She would of been a good woman," The Misfit said, "if it had been somebody there to shoot her every minute of her life."

In a way, that’s Chase. He does great when he’s sufficiently motivated; it’s just that most of the time, he’s only motivated for personal reasons.

But he’s not stupid.

[jmtorres]

Hi, this is random, but would you mind sharing more about your gut issues/long covid? (I.e. diagnosis, treatment). I have chronic fatigue, and gut issues that are definitely linked to that, but all of my doctors are being extremely useless about it. (No worries if this is not the kind of info you want to share with a total stranger on the internet)

(This is in reference to my comment on this post)

@reptilerex I appreciate you recognizing the sensitivity of this ask, I am going to go ahead and answer it because I feel like the likelihood that you or someone you know (or even others of my readers) are struggling with long covid and finding adequate medical help vastly outweighs the minuscule probability that you've hacked into HIPAA records and are planning to dox me lol

so in the immediate aftermath of my first bout of covid (despite vaxxing and masking regularly, I'm up to two now 😭) my obvious symptoms were fatigue – going to the grocery store would wear me out for 2+ days – and a 20 year-old scar from a car accident reopened, which sounds like some scurvy ass bullshit, and I do wonder if the fact that my friend @niqaeli, who knew that long covid symptoms are highly correlated with MCAS symptoms and was encouraging me to start MCAS otc treatments like vitamin C supplements, helped. (worth noting that while I didn't hear anything about old scars reopening as a covid/post covid thing before it happened to me, but when I told people about it, they were like "oh yeah, that happened to me or someone I know" SO often) My doctor sent me to a wound specialist for that, and they kept poking it trying to figure out if there was some embedded shrapnel that they hadn't realized was in there originally, but ultimately it just healed back over much redder and angrier than the first time.

so then, the fatigue. My doctor had me wait three months because it wasn't officially long covid until three months. obnoxious as hell. I found out the DMV accepts long covid for a disability placard reason and got my doctor to write me a DMV form about how I couldn't walk hardly any distance. she was willing to do that before the three month mark.

I was Johnny on the spot coming back three months after, the first thing she did was send me for a chest x-ray because the obvious/expected reason for fatigue is you're not getting enough O2 in your blood. There was nothing wrong with my lungs and we were kind of at a dead end until I presented my doctor with more options.

I mean, I was kind of like, my PCP is being useless, I have a PPO, why can't I just go directly to a specialist, but it turns out specialist won't take you without a referral because reasons. I had heard rheumatologist is as good at figuring out weird vague shit so I tried to book there but when I told them long covid, they said that wasn't their department. They said I needed to go see an immunologist which sounded wrong to me, but there was a pretty good HIV specialist immunologist in the area that I tried to book with who said no that's not what long covid is. someone recommended a Long Covid Specialty clinic in a city that is 2 to 5 hours away depending on traffic and I knew I wasn't making that drive in my current condition so was like somebody local gotta help me.

so I went back to my PCP and said to her that I had learned from disability communities online that sometimes a rheumatologist can be helpful. And she said OK we can do some blood tests for inflammation markers to see if I can justify a referral to a rheumatologist. (and I thought of my weird scar issue and thought gee I better have some weird inflammation markers)

So I had some inflammation markers pop and I got a referral to a rheumatologist, and they were actually willing to see me. The rheumatologist ordered so many tests, like an unbelievable number of tests. I think they drew like eight vials of blood. Plus other samples. The rheumatologist was basically like let's look for anything and everything.

I had a borderline response on Calprotectin. To quote from the explainer in the test notes:

Calprotectin in Crohn's disease and ulcerative colitis can be five to several thousand times above the reference population (50 mcg/g or less). Levels are usually 50 mcg/g or less in healthy patients and with irritable bowel syndrome.

so I wasn't high enough to qualify for IBD outright from that test results, but I was high enough that it flagged to the rheumatologist, and I had reported a family history (brother has IBD), so he said that was enough to diagnose and started prescribing me for that.

The thing is, rheumatology is an ass backwards way to get an IBD diagnosis and I was having another symptom that I hadn't reported because I was a dumbass and this is the apocryphal frog boiling slowly thing. I was having fairly regular loose stool/diarrhea. if I had told my PCP that could I have gotten a referral to a gastroenterologist and gotten a less ass backwards diagnosis?

I hadn't told my PCP about loose stools for two reasons:

I didn't think it was relevant to the fatigue, and in fact, I still didn't think it was relevant when the rheumatologist called it, and I was really surprised when taking medication for IBD did actually turn out to help the fatigue

I knew I was lactose intolerant, so I thought it was already explained. However, the rheumatologist and I had this exchange:

Him: so do you still drink regular milk or just Lactaid?

Me: Lactaid

Him: then you shouldn't still be having diarrhea

Me:…

I can't remember the first med he started me on because I was only on it for a couple of weeks before we had to switch. (it helped a lot when I could tolerate it but about every three days I had to throw up and then I felt awful and didn't take the med for a couple of days and you can guess how that went.) the one that I went on long-term that actually worked without side effects for me was mesalamine/lialda. I also started experimenting with some dietary changes, the low FODMAP diet is intended for IBS not IBD, but you are still expected to have IBD triggers so I was playing around with that.

for a few weeks, I had incredible improving energy. It was crazy.

then I made what I can only now think of as a mistake in trying to be proactive about my care. because I had stumbled ass backwards into an IBD diagnosis and I felt like I should have gastroenterologist confirm it, and I went to go see my brother's gastroenterologist. he wanted to do a colonoscopy and he asked me to go off the mesalamine for six weeks so that he could see what my colon was like without treatment and it was the worst fucking six weeks of my life. Hated it. colonoscopy results: he didn't see anything fucking wrong and would not diagnose IBD or prescribe mesalamine based on what he found. I said, but the mesalamine improves my symptoms, what does that mean? He said, it means keep seeing your rheumatologist.

I went back to the rheumatologist and told him about the whole debacle with the gastroenterologist and he was like "so how did he explain your inflammation readings?" like CHECKMATE. And he concluded that any lesions I had must be in the small intestine, not the large intestine and so were not seen by colonoscopy.

I kept taking mesalamine. My improvement was slower after the break from it which sucks but I did get back to normal lab work within six months, hallelujah.

Follow up: MORE stuff that might have been avoided if I had gastroenterologist regularly, had gotten an IBD diagnosis from a gastroenterologist, or had mentioned my shitty symptoms in the immediate: the gallbladder bullshit this summer

I had my second round of covid in May and I didn't notice a lot of fatigue coming out of it, though I was more cautious with myself the second time around, but I was sort of holding my breath for what horrible nonsense is going to come out of this now? so then I had what I thought was a really bad case of Gerd that didn't go away for two weeks even though my Gerd usually resolves in like a day. I went to my PCP twice during this period and then ultimately ended up at the ER when I realized my pain was in my side not central anymore and I was worried about appendicitis. It wasn't appendicitis. It was my gallbladder. and it came out that night. overall, I am very happy with how the hospital handled the emergency for instance, I didn't realize until two weeks later that I seriously could've died because they were so calm about it the whole time but like they don't do same-day surgery unless death is on the line, let's be real.

but here's things that could have been helped if I had better gastroenterology care:

I didn't find this out until I was researching gallstones after the fact, and I would like to think a gastroenterologist would have warned me whereas the rheumatologist wasn't super aware of it but: IBD can lead to gallstones because one of the ways a cholesterol gallstone forms is, if you get an imbalance of bile and cholesterol in your gallbladder; your body wants to recycle bile by reabsorbing it at the end of your small intestine, but if you have IBD, sometimes it loses the bile instead of reabsorbing it, and then you get an overabundance of cholesterol, turning into a gallstone the size of a golf ball

I told my PCP it was a case of Gerd that wouldn't go away, but I didn't tell her I was also having diarrhea. Diarrhea is not a Gerd symptom. Maybe if I had just fucking told her she might've recognized or could've sent me to somebody who would have recognized it as a gallbladder symptom before it turned into an immediate emergency

tl;dr don't hide your gut symptoms from your doctor because you "think" you know what's wrong with your guts or that it's not related to your other problems or you're embarrassed or what the fuck ever just tell them that you're shitting yourself because it might turn out to be important

[gaysie]

one of the things that has driven me the most crazy since i’ve been studying to be an immunologist is learning that basically every time you get sick you’re increasing your chance of developing an autoimmune disease because autoimmunity comes from a breakdown in self tolerance and one of the ways this can happen is if a self reactive T or B cell that would normally be kept unresponsive by anti inflammatory signals happens to see its self-antigen while also receiving inflammatory signals from an infection then Boom you’ve got an activated self-reactive cell Uh oh now over time we can get clonal expansion of that self reactive cell and further tissue damage and autoantibody production and a self amplifying loop that becomes clinically manifest as an autoimmune disease and like WHY IS NO ONE TALKING ABOUT THIS?? and yes it’s rare that your self reactive cells become activated but still like i want to avoid increasing that chance as much as i can!! and just from like my own family full of teachers who get sick all the time from their kids that scares me and i googled it and sure enough there was a study that teachers have an elevated mortality from autoimmune disease and like i think this really needs to be taken more into account for customer facing roles too or anything where you’re in close contact with large numbers of people like customers and employees should be encouraged to wear masks and compensated extra for the risk of illness and this just even more exacerbates the health gap between wealthy work from homers and people for whom that’s not an option and ughhhhh This world . Diseases. I’m always thinking about them

[mariacallous]

On a recent Thursday afternoon, researchers Lanuza Faccioli and Zhiping Hu wheeled an inconspicuous black and white plastic cooler from an operating room at a hospital in downtown Pittsburgh. Inside was a badly scarred liver, just removed from a 47-year-old man undergoing a transplant to receive a new one from a donor.

But what if patients could avoid that fate? Faccioli and Hu are part of a University of Pittsburgh team led by Alejandro Soto-Gutiérrez attempting to revive badly damaged livers like these—as well as kidneys, hearts, and lungs. Using messenger RNA, the same technology used in some of the Covid-19 vaccines, they’re aiming to reprogram terminally ill organs to be fit and functioning again. With donor livers in short supply, they think mRNA could one day provide an alternative to transplants. The team plans to begin a clinical trial next year to test the idea in people with end-stage liver disease.

Alcohol use, hepatitis infection, and a buildup of fat in the liver can cause scarring over time. When there’s too much damage, the liver starts to fail. “Right now, if you get end-stage liver disease, it’s irreversible,” Soto-Gutiérrez says. “Well, we found that is not true. It is reversible.”

Soto-Gutiérrez and his team have been experimenting on rats and organs taken from people undergoing transplants at the University of Pittsburgh Medical Center, one of the busiest transplant centers in the US. To help design the mRNA and figure out how to deliver it to the human liver, they’ve partnered with Drew Weissman, a physician and immunologist at the University of Pennsylvania who won the 2023 Nobel Prize in Physiology or Medicine for his pioneering work on mRNA. Together, Soto-Gutiérrez and Weissman lead the Center for Transcriptional Medicine, launched in April with the goal of bringing these medicines to patients.

On the day I visited, I followed Faccioli and Hu through a maze of hallways until they deposited the freshly explanted liver at a pathology lab, where a team of scientists was anticipating the special delivery. After infusing the liver with an experimental mRNA therapy, they placed the organ in an oxygenated bath meant to maintain its function for several days.

A healthy liver is spongy and reddish-brown in color with a smooth appearance. But when the surgeons took this one out of the cooler, it was hard, marbled, and covered in bumps—evidence of cirrhosis, a type of end-stage liver disease. Over time, the man’s healthy liver cells had been replaced by scar tissue, and eventually, his liver stopped working. His only option was to get a new one.

Livers are the second most in-demand organ. In 2023, a record 10,660 liver transplants were performed in the US, driven in part by a steadily growing number of living donors. In a living liver transplant, a piece is taken from a healthy person’s liver and transplanted into a recipient. But even with this uptick in transplants, not everyone who needs a new liver receives one. Patients may have other health problems that disqualify them from a transplant, and others may die while waiting for one. In 2022, the latest year for which data is available, the Centers for Disease Control and Prevention recorded nearly 55,000 deaths due to chronic liver disease.

Living donor transplants are possible because of the liver’s unique capacity to regenerate itself—more so than any other organ in the body. In a healthy person, the liver can regrow to its normal size even after up to 90 percent of it has been removed. But disease and lifestyle factors can cause permanent damage, rendering the liver unable to repair itself.

When Soto-Gutiérrez was studying medicine at the University of Guadalajara in Mexico, his uncle died of liver disease. From then on, he became dedicated to finding a treatment for patients like his uncle. In the early years of his medical career, he noticed that some patients with scarred livers were bound to a hospital bed waiting for a transplant, while other people with cirrhosis were walking around, seemingly living normal lives. He figured there must be cellular differences in these livers.

He teamed up with UPMC transplant surgeon Ira Fox to look for transcription factors—master regulators that can dial up or down the expression of groups of genes—that can potentially reprogram injured organs. Genes rely on transcription factors to perform many essential functions in organs. Together, Soto-Gutiérrez and Fox have analyzed more than 400 failing livers donated by transplant patients. When they compared them with dozens of normal donated livers that acted as controls, they identified eight transcription factors essential for organ development and function.

They zeroed in on one in particular, HNF4 alpha, that seems to act like a main control panel, regulating much of the gene expression in liver cells. In healthy liver cells, levels of HNF4 alpha were turned up, and so were other proteins it controls. But in the cirrhotic livers they examined, HNF4 alpha was almost nonexistent.

The team needed a way to get the transcription factor into liver cells, so they turned to mRNA technology. Used in some of the Covid-19 vaccines, mRNA is a molecule that carries instructions for making proteins, including transcription factors. In the Covid vaccines, the mRNA codes for a part of the virus known as the spike protein. When injected into a person’s arm, the mRNA enters cells and kicks off the protein-making process. The body recognizes these spike proteins as foreign and generates antibodies and other defenders against it.

The Pitt team is using mRNA instead to essentially turn back time in injured organs. “What we’re proposing to do with mRNA is use it to deliver proteins that have the capacity to repair those damaged liver cells,” Weissman says. “Our hope is that we can treat end-stage liver disease and turn the livers around, maybe forever, or at least until patients can get a transplanted organ liver.” Instead of delivering instructions for a foreign protein to generate an immune response, they’re delivering the genetic code for producing a transcription factor—HNF4 alpha.

In a paper published in 2021, the approach revived human liver cells in lab dishes. The researchers have since tested the mRNA therapy in rats with cirrhosis and liver failure. They treated a group of rats every three days for three weeks while a second group served as a control. The animals that were receiving the injection of HNF4 alpha started being more active. The untreated rats continued to decline and eventually died, the expected result at their stage of disease. Some of the treated rats were still living six weeks after receiving the mRNA medicine. Those results have not yet been published in a peer reviewed journal.

The team is also testing the mRNA infusions in human livers removed from patients undergoing transplants—the process I got to observe. Unlike live rats, explanted human livers can’t be observed for weeks on end. Livers have to be retrieved quickly and infused with the mRNA treatment soon after they’re removed from the body. They stay fresh for just four days or so in a preservation fluid. Six hours after the mRNA infusion, levels of HNF4 alpha start going up and last for two to three days. When HNF4 alpha peaks, other essential liver proteins, such as albumin, start to increase as well. That’s important, Soto-Gutiérrez says, because maintaining those protein levels could mean the difference between a patient needing a transplant or not.

Ideally, Soto-Gutiérrez says the mRNA therapy would be something patients could get once a week or every other week in an outpatient facility and go back home. But initially, they’ll need to test the experimental treatment in very sick patients, likely ones that are hospitalized, to make sure it’s safe. The team is gathering data from the rat and human liver experiments to submit a clinical trial application to the Food and Drug Administration in the coming months.

While livers are the first target, Fox thinks other injured organs may be amenable to this approach. “We’ve been wondering whether the same process might be taking place in other organs,” he says. Currently, the team is searching for similar transcription factors in lungs with chronic obstructive pulmonary disease and kidneys with chronic kidney disease.

Josh Levitsky, a liver transplant specialist at Northwestern University who isn’t involved in the work, says new treatments for chronic liver disease are sorely needed. Current therapies can help slow down scar tissue buildup and ease symptoms but don’t address the underlying disease. “The concept of reprogramming and being able to reverse liver failure could be really game changing if it were to pan out in clinical studies,” he says.

But lots of questions remain. How much damage could be reversed? Would patients need to be on the therapy indefinitely? Or would their livers rebound enough to go off it? Could a liver ever be restored back to normal?

“It certainly has a lot of promise,” Levitsky says, “but the clinical development is going to take a long time.”

[ruvviks]

current lineup of guys for my original vampire setting below the cut if anyone is interested! including a little section on bloodlines that i came up with so far :^)

CHARACTERS

HEAVENLY ROWIŃSKI — a (in)famous vampire hunter who recently made his way to the city of jericho to drown himself in a life of riches and vices; but instead he meets many familiar faces from his past and gets sucked (haha) into a vortex of mysteries that reveal the threat of a worrying vampire pandemic if not dealt with in the near future

THADDEUS KHAN — a contractor based in jericho who provides vampire hunters with jobs and has been heavenly's main source for private gigs for years now; not too happy about the hunter showing his face in the city considering the possible consequences concerning business and vampire activity, but changes his mind soon enough once shit hits the fan

SUN YEONG — a vampire of the sombra bloodline and young immunologist from chicago, who has recently moved to jericho; they were turned on an old gig involving heavenly and upon reunion they agree to assist him in his future endeavors, all while continuing their own research on vampires, bloodlines, and whether or not becoming a withered vampire is the fate of all

ISAAC SHARPE — a vampire of the letifer bloodline and a priest who runs a church / community center / food/blood bank in jericho; he was hunted down by heavenly many years ago as the latter's first solo gig but left alive, and upon reunion he opens his church's doors for heavenly for him to use as safe haven whenever he needs it

VALESKA MADRITSCH — a vampire of the faelin bloodline and the estranged child of a centuries old rich austrian family, who has found her way to jericho to indulge in its wild nightlife-focused lifestyle; her reputation comes with many benefits, but getting her on the team proves an issue as she is heavenly's ex and takes grudges with her to her grave

ALOYSIUS "DOC" GOODMAN — a vampire with a rare mutation of the noxis bloodline who goes by the name doc and owns a small shop in jericho; he treats vampires, humans and vampire hunters alike in exchange of a small blood donation for him to feed on, and as the eyes and ears of jericho's streets he holds more knowledge than an encyclopedia

MIRAGE & ANDROMACHE BELLEVERE — vampire twins of the oraculum bloodline who sell their clairvoyant powers as services to rich families and individuals seeking to learn more about their future; as some of the oldest vampires to walk the earth one could assume their interest in mortals is nonexistent, yet here they are in jericho seeking to unravel the mysteries behind this new threat, which is quickly proving to be an issue for humans and vampires alike

BLOODLINES

NOXIS BLOODLINE — the most common bloodline, with heightened senses and sunlight sensitivity; vampires of this bloodline can go out in the sun but prefer not to due to the long-term effects on their overall health

NOXIS BLOODLINE (MUTATION) — doc's mutation reduces his sunlight sensitivity allowing him to walk freely in daylight with eye protection, but it causes his puncture fangs (the ones to draw blood for feeding, not the venomous fangs which are used to turn people) to be permanently extended and he is extra sensitive to the smell or sight of blood, forcing him to feed similar to vampires' feral sense

DARKSPAWN BLOODLINE — a bloodline that thrives in darkness; exposure to sunlight for too long can kill them, but in return they are much stronger in complete darkness and they can even camouflage themselves in the shadows

LUMIERE BLOODLINE — lumiere vampires have very mild sunlight sensitivity and can mix with the human crowds without any trouble, as they do not possess puncture fangs (most of them draw blood with their fingernails when they feed), their venomous fangs are a lot thinner and by definition less painful to extend, and their bloodlust is severely reduced; often disliked by other bloodlines because of these traits

FAELIN BLOODLINE — an ancient bloodline with close ties to the fae, making vampires of this bloodline a little uncanny valley in appearance; these vampires possess what is known as the "vampire's kiss", a powerful venom that can enchant their victims to turn them into personal blood bags

SOMBRA BLOODLINE — sombra vampires are a lot more agile than other bloodlines and can climb on walls and ceilings in spider-like fashion; darkness calms them and allows them to enter a regenerative hibernation state which other bloodlines can only achieve in a nest with risk of their feral sense activating, something sombra vampires do not have to worry about

LETIFER BLOODLINE — a rather small and close-knit bloodline with high lethality rate among turned victims, which is why turning a human within the letifer bloodline is done through a ritual due to the venom dosage being highly specific; letifer vampires can never miss a meal as their feral sense can sneak up on them out of nowhere and can be all-destroying, but in return they are a lot stronger and more powerful than other bloodlines

ORACULUM BLOODLINE — another ancient bloodline similar to the faelin bloodline with close connections to the fae; vampires of this bloodline possess clairvoyant abilities (often in one sense only, sight or hearing, but in rare cases more than one and even rarer cases all senses) which allows them to see others' futures, or experience events in certain locations or through specific objects

FROSTBITE BLOODLINE — a bloodline that thrives in the cold; vampires of this bloodline are ice cold to the touch and they can use their frost-like abilities to manipulate water, including water within human bodies

[kirby-the-gorb]

new patreon favorites publicly available. it's been a rough couple months.

[fusionpoweredasexual]

Evil science is not just chemistry!

There is a very common misconception about evil science which is that it´s all chemistry. Most evil scientists in pop culture are chemists with weird colored stains on their lab coats (horribly unsafe and irresponsible but that´s not the point I'm trying to make today). Compared to the amount of test tubes and Bunsen burners you never see any evil radio telescopes or evil MRI machines. I think this stereotype stems from the fact that evil chemists tend to die in very spectacular ways.

Evil chemists usually tend to get incinerated by massive fireballs or swallowed by tsunamis of acid. This is nearly always more dramatic than most other evil scientists, to combat this misconception and spread more awareness about evil science, I´ve constructed a short list detailing the most common types of death for different disciplines of evil science.

Evil physicists tend to get stuck and starve inside the particle accelerators, or they get crushed by the mountains or whiteboards, notebooks and papers that tend to accumulate in their rooms.

Evil zoologists get eaten at an alarming rate during field expeditions, and those that aren´t are usually found with poison in their bloodstream.

Evil geneticists and evil roboticists are more alike than you´d think, since they are usually killed by their artificially created lifeforms in extremely preventable situations usually stemming from treating said creations in very cruel ways.

No one has seen the evil astronomers since they tried to build a death star around Jupiter.

Evil Immunologists, the scientists specializing in weird diseases and their impact on humans, I think their cause of death is quite obvious.

Evil engineers tend to kill each other fighting for an obscure type of screw that only exists in a single IKEA in the world that they somehow all need for their project, and if you care about your personal wellbeing do not suggest that they replace it with a more common type of screw.

So the next time you see an evil chemist dying spectacularly as their laboratory gets swallowed by fire and poison, please do remember that that is not representative evil science as a whole.

This has been an evil science PSA with you friendly neighbourhood supervillain, Fusionpoweredasexual, thank you for listening to my ted talk.

[orcboxer]

you said you were keeping up with the variants and boosters and research, and I'm trying to but it's so overwhelming. how do you know what to read? where to look? do I need access to academic journals? I feel like I'm the only person I know who gives a shit about not dying and not killing the people around me. thoroughly going nuts. thanks for any advice 😞👍

Okay so honestly, for just your everyday layman, most of what you need is right on the CDC's website, that's where you'll find most of the important numbers. The most telling piece of information is usually the covid death rate and the hospitalization rate. It's a lot harder now with so many covid deaths not being reported, but thousands of deaths per week from a disease is not normal or acceptable.

Scientific journals are a great resource if you can access them, but I understand not everybody can do that. And realistically speaking, most people aren't gonna be able to parse the language in those, and you don't necessarily have to know all the fine details to be safe. If covid cases are going up, take the precautions and don't take risks. If there's a new vaccine, get it. Wash your hands. If you get sick, do everything in your power to not spread it to other people. Covid precautions are not primarily a choice you're making for yourself, they're a choice you're making for everyone else. Periodically search if there's a new strain, because if there is, there will be tons of articles about it. If you're gonna get your info from social media, which tbh I don't really recommend, you're gonna want to be following immunologists, virologists, the people who actually study this.

And understand the emotional and social forces at play in all of this. Nobody wants to deal with a pandemic, they want things to feel normal, so it becomes incredibly easy to just tune out all the data. And on top of that, there's increasing social pressure to play along. But if someone's so sure covid is no longer a problem, ask for numbers. How many cases are we at now compared to 2020? How many deaths? What's the current wastewater data? Anyone taking covid seriously will either tell you the most recent data they saw, or they will look it up on the spot if necessary. If they give you vague generalizations instead, if their attitude is lackadaisical or apathetic, then they're just going on vibes, which I don't have to tell you is not a reliable source of information.

Anyway, I hope that's at least sort of helpful

[shion-yu]

Day 5: Rogue Organ

I believe this is the oldest I’ve ever written Cliff and Elliot, and it’s a bit different. Not so much a whumpy sickfic as a cozy family story, if that’s not your thing I get it. Featuring Mia: Cliff and Elliot’s 5-year-old daughter. 2,354 words, no TW/CW. @sicktember

The spleen wasn’t a necessary organ to live, Cliff’s doctor said. He pressed on Cliff’s distended abdomen, eliciting a wince of pain. At this point it was causing more problems than there were benefits of keeping it, so they might as well remove it. 

“Are you sure you’re not just trying to sell it?” Cliff asked dryly. He’d been coming to see Dr. Thomas, his immunologist, for over five years now. They’d developed a mutual understanding by now that while Cliff did not like beating around the bush, he also had a dark sense of humor. 

“Believe me, no one would pay much for this spleen of yours,” Dr. Thomas said with an amused smirk. “It’s covered in lesions still, despite your last few courses of steroids.”

Cliff sighed deeply. He didn’t want another surgery, nor did he want to spend time in the hospital. He’d had his lung transplant a bit over two years ago, an event that while traumatic, had been an incredible success in the end. He hadn’t needed oxygen since recovering and while he was still working on his stamina, it was nothing compared to the all-consuming illness of his months in the hospital waiting for a pair of lungs. He’d managed to stay away from being hospitalized since then, an achievement he was very proud of. For the first time in his daughter’s life, he felt like he could be just a dad to her and not her dad that was always needy and never home. 

Now Mia was five and a spitfire at that. She had Moira’s wavy red hair and dainty looks, but could be so headstrong that Cliff couldn’t believe she was raised by him and Elliot. How could someone so curious, loving and intelligent be theirs, he sometimes wondered? And right now, he dreaded telling her that he'd have to be in the hospital again.

Cliff returned from his appointment with a heaviness in his heart, knowing he had bad news. Elliot had already picked Mia up from daycare and he found them in the living room. Mia was coloring independently, their dog Clover at her feet while Elliot sat at the piano testing different notes for what Cliff knew to be his debut solo project. This was Cliff’s little family, he thought fondly as he came upon them. The family he chose and never wanted to leave, even though he’d come terrifyingly close to doing so before he had his transplant. He watched them silently at the doorway for a few seconds before he made himself known with a warm, “I’m home.”

Mia hopped down from her coloring table immediately, rushing over to him and giving him a hug. “Daddy!” She exclaimed happily, Clover standing next to her wagging her tail. Cliff put a hand on each of their heads and smiled.

“Hello my darlings. How was your day?” When Cliff spoke like this it was natural now. But had anyone ever told teenage Cliff that he’d ever have a family he loved more than life itself, whom he spoke to with open affection so confidently, he would have scoffed at the ridiculousness. 

“We did birthdays today,” Mia informed him. “For Addie and Vincent.” Every month the preschool had a joint birthday celebration at snack time for the kids whose birthdays were that month. Cliff had made funfetti cupcakes with strawberry frosting for it last night. 

“That’s so fun,” Cliff said. “Elliot?”

Elliot did not look up from the piano at first. “I’m almost done with this verse,” he said. He was clearly concentrating, but tilted his head anyways for Cliff to kiss his cheek as he did every day. Cliff gave him one, lingering longer than usual and taking in the familiar smell of his husband. “Oh, how was your appointment?”

Cliff didn’t answer right away. He didn’t want to say it in front of Mia, yet. “I’ll tell you after dinner,” he said. Elliot immediately looked up then, his brow furrowed in instant confusion. If it had been good, he knew Cliff would have said so right away. He frowned but nodded. 

Dinner felt mostly normal. Mia chattered about preschool and playing outside and petting the neighborhood dogs. Elliot told her to eat her vegetables; Cliff told her she could have ice cream if she ate them all. He was always the softer parent, but he wanted to give Mia all the affection he himself had never gotten as a child. Since the day he’d met her, right after she was born, Cliff looked at her and thought to himself: how could anyone *not* love their child this much?

After dinner, Mia waited on the couch playing with her doll until Cliff brought her with him for his evening walk with Clover. Cliff told her to give him ten minutes, then went to the kitchen where Elliot did the dishes. Cliff rested one hand on Elliot’s shoulder, promoting Elliot to turn the water off. He was already frowning, the lines of concern that were permanently etched into his features creasing. “What happened?” He asked.

“I need it out,” Cliff said quietly. “Too many lesions.” 

Elliot sighed and toweled his wet hands dry. They'd been delaying the inevitable as long as they could, but they had both known this was coming for a while. In the last two months though, the pain in Cliff's abdomen had grown worse and now he was having night sweats and weight loss. 

“Well. We’ll make it through,” Elliot said simply. 

“I want to tell Mia,” Cliff said. “When we go on our walk. I don’t want her to think it’s as serious as when I got my transplant.”

“But it is serious, Cliff,” Elliot said. “It’s a whole organ.”

“An organ that I can live without,” Cliff said. “It’s serious, but it’s not lungs. It’s not gonna be like that again.”

Elliot grimaced but nodded. Mia hadn’t been able to see Cliff for almost a month after his transplant, the doctors not willing to risk exposing him to kid germs. The team had urged them to wait longer, too, but they’d refused. “Do you want to come on our walk with us?” Cliff asked. Elliot nodded again. “Let’s go then.”

They leashed up Clover and Cliff put Mia’s socks and shoes on. She was old enough to do it herself now, but when she wasn’t in front of her friends she loved having her dads do everything for her still. Cliff didn’t mind. He knew she’d only be little once, and they weren’t planning on having another kid. Cliff held the leash in one hand, Mia’s in the other, and they headed downstairs. “Daddy’s joining us today too,” Cliff told her with a smile. Mia grinned happily, looking back to Elliot for confirmation, which she got. 

Outside, the weather was nice. Cliff tried to think of how to tell Mia the news. She was five, yes, but she knew far too much about the hospital and illness already. He didn’t want to scare her, but he also knew she did better when she was as prepared as possible.

“Baby girl? You know how I went to the doctor today?” He started.

“Uh huh,” Mia said, looking up at him with her hazel eyes that matched Cliff’s perfectly. Cliff’s grip on her hand tightened.

“Well, I have to get another surgery. There’s something in my belly called the spleen, and I need to have it taken out. But it’s not as serious as when I got my new lungs. We won’t have to be apart for more than a few days.” Cliff spoke slowly but clearly; they had never been ones for baby talk. They knew that even before Mia could speak, she knew Cliff had special needs. They figured if they let her know everything they could, she would be able to process it better.

Mia didn’t say anything at first, but she let go of Cliff’s hand and took Clover’s leash with a stony expression on her face. Cliff knew Elliot wanted to jump in, but he held up a hand. ‘Give her a minute.’

Finally, Mia spoke. “I don’t have to not see you like before?” 

“Nope. Papa will be very sleepy for a few days afterwards, so just then,” Cliff said. He didn’t go into the what ifs; what if he didn’t wake up from the anesthesia? He refused to entertain that possibility.

“Okay,” Mia said. Her little brow was furrowed in thought, and Cliff hated he was the reason she had to think of such big things at a young age. “Does it hurt?” 

“The surgery?” Cliff asked in surprise. 

“No, your belly. Does it hurt now?”

“A little,” Cliff said. “It’s not so bad. But we should fix it before it gets worse.”

Mia nodded seriously. “I don’t want you to hurt, Papa. So that’s why they should take it out.”

“That’s right,” Cliff said warmly, his heart swelling with emotion. “You’re so smart and caring.” He glanced back at Elliot, who’d stayed quiet through this conversation, and he suddenly thought that maybe Elliot had needed to hear this just as much as Mia had. He could see tears in Elliot’s eyes, and when Cliff smiled at him Elliot wiped them away quickly.

“When’s it come out?” Mia asked.

“Hmm. I think the doctor will tell us soon. But probably this month,” Cliff said. “Is there something special you want to do before then?” Even if the surgery went entirely well, Cliff was pretty sure he'd be down for a while afterwards. 

“I’ll think about it,” Mia said very seriously. Cliff laughed. Their daughter had a fierce memory, and they knew by now not to offer her anything that they didn't intend on following through with. He was sure she'd think of something she really wanted, and Cliff knew he’d give her whatever it was within reason, and slightly beyond it. 

Four weeks and one family trip to San Francisco to visit Moira later - Mia’s favorite place - Cliff went into surgery. Mia was with Elliot’s mom in the apartment and Elliot was by Cliff’s side. All the scary memories from Cliff's transplant hovered in their minds at full force, but they told each other it was going to be so much better this time. And despite all their fears, it was.

Cliff woke up from the anesthesia quickly, the best blessing they could have hoped for. He was confused and in pain, but his vitals were stable and he asked for Elliot until they let his husband into recovery. Elliot stood by his stretcher, immediately holding his hand and brushing Cliff’s face comfortingly. “I’m right here baby. You did so well,” Elliot told him.

“Where’s Mia?” Cliff asked dizzily. Now that he had Elliot accounted for, he needed Mia, too. 

“She’s with mom,” Elliot said. “Everybody’s safe. Just relax.” He told Cliff all of it as many times as he needed to hear it. He’d happily do this as opposed to waiting with bated breath for Cliff to be extubated, as he had too many times before. There has been concerns about putting Cliff under anesthesia and intubating for the first time since his transplant, but he’d done even better than expected. It was all that Elliot could have hoped for.

Mia got to come visit Cliff on his second day post-op. She seemed shy at first, but once she realized that Cliff really was awake and as okay as one could expect after a major procedure - that he was himself and not hooked up to a million things as she’d seen him before - she gave Cliff a hug and excitedly told him about what he'd missed at home over the past few days. Cliff let her sit on the bed with him and talk all afternoon, even though he had trouble keeping his eyes open. It didn't matter, because he had his family safe and sound next to him. 

When visiting hours were over, Elliot took Mia home. “I’ll be coming home in just a few more days,” Cliff told her when she looked reluctant to leave. “Keep being such a good girl and helping Daddy out, okay?” 

“Okay,” she said. Still, she hugged Cliff and didn’t let go until Elliot picked her up and carried her out. 

A few days later, when Cliff was home and still doing better than they ever hoped for, the three of them sat in bed together and Elliot read out loud to Mia from her Disney storybook. She was between the two of them, her little body tucked into a sleeping Cliff’s side as close as she dared to without hurting him. “Daddy?” She interrupted Elliot suddenly. 

Elliot stopped reading. “Yes baby girl?” He asked.

Mia took a long few seconds to get whatever it was she was trying to tell him out. “Is Papa all better now?” 

“He’s doing very well,” Elliot said. “And he’ll be back to normal in no time.”

“I mean all the way better,” Mia said. “Like he’ll never have to go back to the hospital again?” 

“Oh,” Elliot said, his gentle smile faltering. He looked at Cliff, sleeping soundly and Mia in his arms, growing so big and yet still so small. “Papa’s body is always going to be a little different,” he said carefully. “But everybody is different in their own way, it’s not a bad thing. We just have to keep on loving him, and being a family like we always do. That’s what’s important.” 

“Okay,” Mia said. “Can I sleep with you tonight?” 

Elliot hesitated. They were trying to get Mia to sleep in her own bed at night, but he decided just this once wouldn’t hurt. It had been a hard week after all. “Fine, just tonight,” Elliot said. The triumphant grin he got back reassured him that he’d made the right choice. He gave Mia a kiss, then leaned over her to kiss Cliff, too. “Goodnight, my loves,” he said. Then he turned off the light and they slept in bed the three of them, safe and together, just how they liked it.

[plague-of-insomnia]

fuck doctors istg

my immunologist today said he can’t do the prior auth (no reason why just a “polite” fuck you very much) despite the fact we explicitly said i do NOT HAVE ANOTHER FUCKING DOCTOR I CAN GO TO and have not been properly treated in a year and a half

We’re exploring a couple other avenues and MAY be able to get me into a specialty clinic at Baylor in the med center… it’s not for my disease but they basically have a doc who works as your “guide” and coordinates with the other specialists etc, which I have needed for years…. But no idea if they’ll take me or how long it may take to get in there if they will.

But once I do get a doctor to manage me I am reporting both my immunologist and rheumatologist to the state medical board.

I almost died multiple times this year already because of lack of proper care and they have essentially cut me off without making sure I have someone who can continue my care. This is a major failure and if we didn’t live in Texas (that caps medical malpractice so it makes suing not really worth it, especially since as a patient you often will end up blacklisted… it sucks, not the first time we looked into suing a doctor/insurance company) we would sue them.

I probably also will blog about them, by name, and go on every review site I can and tell about their unprofessionalism.

Makes me wish I had an Othello like in Synch… he may be cold and see Seb a bit as a science project, but he does care about him as a patient.