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high-functioning-lokipath · 3 years

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SH - John Watson x Reader - Better Late Than Never - Words: 2,679

A/N: This was the prompt: Reader went to med school with John, she liked him but never told him so. John gets deployed and they lose contact. A few years later they meet again because of a case.

"C'mon, Y/N," John laughed. "If you don't study for the test tomorrow, I won't give you the ice cream I bought!"

"Is it Death By Chocolate?" You replied, raising your head only slightly from it's spot on the floor.

"Maybe," He replied with a smirk. The two of you were in your dorm, trying to study for the quarter finals. You were in your 6th and final year of med school. You'd met about halfway through your 2nd year and had instantly become close friends. Small displays of affection were normal between the two of you, the type that best friends would share without giving a second thought. John didn't have a clue, but you had developed quite the crush on him. You never told him, though, for fear of messing up the one good friendship you had.

"John!" You groaned, dramatically sprawling out further on the carpet. "I think my brain has died." You had been trying to remember everything you'd studied and were coming up blank.

"Hm, I'm studying to be a doctor, not a coroner, but I would say time of death was somewhere between 6 years ago and now," He teased, leaning over you from his nearby perch on your futon. Pretending to be mad, you threw your foot up and kicked his leg.

"You git!" You exclaimed with a grin.

"Oi!" He replied, dramatically tumbling to the floor next to you. You both lost yourselves in a fit of giggles. You stopped laughing and just stared at him when your brain caught up with your eyes and you had one of your "moments". He looked so happy lying there next to you, laughing his head off. His hair was a mess, his jumper had gotten abit twisted and was creeping up his torso, and his eyes were bright with tears of laughter. "You ok, Y/N?" He asked when he noticed you had stopped laughing.

"Yeah, just thinking," You replied quickly.

"Ok, as long as it's nothing serious," He said. "Really, if anything is bothering you, you can talk to me. You've been zoning out more often recently so," He looked away, a bit embarrassed. "I was worried."

"I'm fine, John," You replied, not having the guts to tell him what was really on your mind.

About a year later, only 3 months after graduation, John called you. You still kept in touch, although you lived in different cities now, and your feelings hadn't changed. John had dated a few different girls but nothing ever worked out. You, though? You had gone on one date but left halfway through when the guy wouldn't shut up about himself and asked if you were splitting the check. John had told you he had applied at a small clinic near his apartment so you assumed his call was to update you on that. "Hey!" You said, picking up immediately.

"Uh, hey, Y/N," He said, sounding fairly upset. "Look, I," He sighed. "You remember that I enlisted a few months ago?"

"Yes," You replied, a lump forming in your throat.

"I've just gotten my deployment letter. They're sending me to Afghanistan. I leave this Friday." Silent tears streamed down your face and you found yourself unable to reply. "Y/N? Are you still there?" He asked.

"Yeah," You choked out. "Yeah, I'm still here, John. I, well, I guess I should wish you well then." You pinched the bridge of your nose and breathed deeply, trying to get ahold of yourself.

"Look, I know you're not a fan of the military but can't you at least congratulate me? This is something I wanted after all."

"Is it? Is it really?" You nearly yelled. "You didn't sound all that cheery two minutes ago when I picked up the phone! Besides, how could I congratulate you when all I can see is you getting blown to bits out there!"

"Sorry," He replied immediately. "That, that wasn't fair of me to ask." You both were silent for a moment before John spoke up again. "I'll write."

"Not with that handwriting you won't, " You replied, falling back into your regular banter.

"I'll try to make it legible for you," He promised. You nodded, though he couldn't see you, and started crying again.

"Alright," You said. "Can I drive over Friday and see you off?"

"Best not," He said. "I think it's better for both of us, yeah?" You reluctantly agreed. The two of you chatted for a few more minutes before saying goodbye. Shaking off the foreboding feeling that had settled on you, you continued with your day and started planning your first letter to him.

The first few weeks went well, his letters arriving regularly on Friday's without fail. Then one week it came on Monday instead, the next on Wednesday, and soon two weeks passed without a letter. When you finally received it, he said that they had gotten to a point where it was getting harder and harder to safely send a receive mail. He asked for you to stop all letters and promised to find you again when, or if, he got home. That night you wrote him one final letter but, of course, never sent it. You were determined to move on with life now but you promised yourself to never forget him.

"Good morning, Molly," You said walking into the hospital with her. You'd moved to London and gotten a job at St. Bart's, working in the outpatient clinic. A few weeks after starting there, you'd met Molly while on break. You exchanged numbers and started meeting in the cafeteria if you both had breaks at the same time. In time you met Sherlock. What an experience that had been. He immediately deduced which department you worked in, how long you'd been there, where you went to college, when you went to college and he even figured out that you'd been in love with someone in uni and never got over them. Needless to say, you were impressed. Ever since then he texted you occasionally for confirmation on medical related hypotheses.

"Good morning, Y/N," Molly replied.

"Have you heard from Sherlock recently? I haven't gotten any texts from him in the past few weeks." Molly chuckled and nodded.

"I've heard from him. He has a new flatmate. A doctor too!"

"Wow!" You replied. "Good for him! Let me know next time he comes by so I can meet him. I'd like to know who my replacement is," You teased. Molly giggled and you continued chatting as you walked over to the elevator. As the doors were about to close, you heard someone yell.

"Hold the lift!" You slammed the open doors button and Sherlock ran in. He nodded at you and you let go of the button. The doors started to slide closed again when another person called out.

"Sherlock!" You froze hearing that voice. You tried to get the doors in time but missed.

"Y/N?" Molly asked, worriedly. "Are you ok? You look like you've seen a ghost!" You nodded and leaned on the wall, trying to get yourself together. You decided to ride up to Molly's floor and see if Sherlock's friend came up on the next lift. Sherlock kept staring at you, confused, while you sat there waiting. A few minutes later, he came storming in the door.

"Sherlock! What were you thinking? Why didn't you hold the lift for me? I had to wait for the next one which happened to-"

"John," You gasped, amazed that it actually was him standing in front of you. "John!" You exclaimed, jumping up and running over.

"Y/N!" He replied, a grin spreading on his face. His smile faltered quickly though. "I," He said. "I need to be going. I forgot I had an appointment. Yeah. That's it. I'll see you at the flat, Sherlock." John quickly limped out the door and off to the elevator.

"He's the one, isn't he?" Sherlock said after a few moments. You nodded sadly.

"Why'd he run off like that?" You asked.

"Well it's obvious he didn't have an appointment. That leaves two possible reasons for his lying. One he could be-"

"Oh shut up, Sherlock!" You cried. "I know why he left. I-" You cut yourself off, choking back a sob. "Just sod it all! I need to go to work. I'll see you at lunch, Molly." You ran off, down the hall and to the elevator.

"Molly, I know that look in your eyes," Sherlock said once you'd left. "What are you planning?"

"The perfect set up. Now help me-"

"Molly," Sherlock interrupted her. "I may not understand a lot of things related to the topic of human relationships but I can tell you this, if either of us were to get involved, we may be maimed." Molly nodded in agreement.

Weeks went by and you worked harder than ever, taking extra shifts whenever you could. Your boss finally told you to take a week off to recharge. After much arguing, you relented and headed home for a week. Being alone all day, however, left your mind wandering. Thinking back to what might have been. To occupy your time, you decided to catch up with one of your good friends who lived nearby. You hadn't had the chance to hang out in some weeks but you texted each other every day. When you didn't hear from her yesterday, you worried but figured she probably was just tired. "Maybe she'll have some good advice for me," You told yourself. Knocking at her door, you checked your phone again to see if she had replied yet. Now you were really worried. You grabbed your spare key to her apartment and went in.

"What do you want?" Sherlock said, answering his phone.

"Sherlock, it-it's Y/N. Can you," You paused, taking a shaky breath. "Can you come down here please? I need your help. Lestrade's already on his way."

"On my way," He replied, grabbing his coat and scarf. "What happened?" As you explained to him everything, he grabbed John's coat and tossed it to him. John was mildly confused of course, but went along.

"I went in and found her in the bathroom," You told him. "I'm probably missing something obvious. I'm sorry," You cried.

"No, you're doing fine," Sherlock said genuinely. John looked at him surprised as they got into the cab, still not aware of who was on the other end of the call. "We'll be there in 7 minutes."

"We?" You asked. But Sherlock hung up before he answered.

"Y/N?" Greg said, coming up behind you. "I hate to say this but, we're going to need a statement. Do you want to wait till Sherlock gets here?"

"No, it's alright. Let's get it over with." A few minutes later, you'd told Greg everything you knew and he'd gone inside with the others to investigate. A cab pulled up and Sherlock rushed out. "Sherlock!" You exclaimed running up to him. As you approached, you saw another person getting out of the cab. "Why did you bring him?" You hissed.

"He's my assistant, flatmate and, if I have deduced correctly, a friend of both of us," Sherlock said.

"Look, that was years ago, I don't even know if-" You started whisper-yelling. You got cut off though when John walked up. You noticed he was limping again.

"John," Sherlock said. "I believe you're acquainted with Y/N. You're much better with people than I am," He stated briefly before going into the apartment.

"Y/N, I'm so sorry," John said once Sherlock left. You nodded, sitting down on a nearby bench before your legs gave way from exhaustion.

"She was a good friend of mine. I don't know what could have happened." John was quiet as he sat down next to you.

"Sherlock will figure it out. If anyone can, it's him," He finally said.

"That is for certain," You replied with a dry chuckle. "So how did you meet Sherlock?"

"Oh, well, you remember Mike Stamford?"

"From uni? Yeah, I remember him."

"Well, he introduced me to Sherlock. We were both in need of a flatmate and he matched us up." John paused for a moment, brows furrowed. "That sounds much too much like a bad dating ad. Mike got us together."

"Nope, that's worse," You replied chuckling.

"You understand."

"I think so," You finally replied. "So," You paused. You were so desperate to ask him more but you weren't sure if this was the best time. "Oh, well, nevermind. Glad that worked out." You quieted again, staring off down the street. John looked at you for a moment before clearing his throat.

"Right, yes. So, what have you been up to?"

"Work. I got a job at St. Bart's about 2 years ago. That's how I met Molly and therefore Sherlock." You were silent for a moment before adding one more thing. "I've missed you, John."

"I've missed you too," He admitted. "I'm sorry I didn't write or call when I got back. I-" He sighed and absently rubbed at his leg. "I couldn't. I was scared, if I'm being honest."

"Why? What happened?"

"You know we got sent into a very dangerous area. That's why I had to stop writing to begin with. But then, well, I got shot."

"Your leg?" You asked since he had been limping and rubbing at it.

"Ah, shoulder actually. The limp is psychosomatic. It comes and goes when I'm particularly worried or upset."

"Oh, I'm sorry," You said, not completely sure of what to say.

"I've been back in London for about a year. I looked you up actually. I found out you were working at Bart's. That's why I ran into Mike that day. I was in a park nearby, trying to work up the nerve to go and see you."

"Why didn't you?" You asked. He looked away, embarrassed. "Sorry, I shouldn't have-"

"No, it's ok. I should be honest." He ran a hand through his hair and chuckled nervously. "I was afraid of what you'd think of me. I didn't come back as some 'war hero'. I'm a washed up medic who can't even walk correctly."

"It's psychosomatic, right?" You asked, tilting your head slightly.

"Sherlock says so."

Well then, you have nothing to fear." He looked at you questioningly. "You know I never cared about the military so I could honestly care less if you came back known as some 'war hero' or not. You're not washed up, just look at you! Out here solving mysteries with the world's only Consulting Detective, Sherlock Holmes! And you can too walk right! You're just too scared to."

"I'm not so sure-" You interrupted him by leaning over and planting a kiss on his lips. Pulling away with a giggle you got up and ran a few feet away.

"You'll have to come here to get another!"

"Oh, you devil," He grinned. He got up and walked over to you quickly, picking you up, spinning you around and giving you another kiss. You laughed happily and leaned on his shoulder.

"See? You did just fine!"

"I suppose I did, didn't I?" He chuckled.

"Oh, John," You giggled. "I should have told you a long time ago. I love you, John Watson." He smiled from ear to ear.

"I love you too, Y/N L/N. But a crime scene isn't really the best place to do this at."

"Why not? We giggle at murders all the time?" Sherlock suddenly butted in.

"How long have you been standing there?" John yelled.

"Well," Greg suddenly said, a few feet away and holding up his phone. "This video is already 4 minutes long, so," He trailed off.

"John," You said, not taking your eyes off the two other men.

"Yes, love?" He asked as you reached for his hand.

"Let's get 'em." You then spent the rest of the afternoon chasing Sherlock and Greg around the neighborhood, enjoying their girly shrieks, until Mycroft showed up and put a stop to it. Later that evening, you and John were enjoying some Chinese takeaway back at your apartment.

"I really can't apologize enough for leaving you in the dark, Y/N," John said. "I should have written," He chided himself.

"It's alright, John," You assured him. "Actually, you just reminded me of something. Wait here a moment." You ran off to your room and pulled an envelope out of a small box in your desk. You returned to the living room and held it out to John. "This is for you. It was my last letter but," You paused, blushing lightly. "I never mailed it."

My Dear Captain Watson,

I hope you're doing well. I hope you're staying safe and helping as many as you can. I hope -

Oh what am I writing. John, there's something you should know and I wish I could tell you in person but better now than never I suppose.

I love you.

There. Feel free to never write me back again or return this with a 'Dear John' letter. Well, you know what I mean. I wish I could have said it better or sooner but I was scared to lose your friendship. Now I'm more scared of actually losing you.

John, please return safely. Even if we never speak again. The world should not be without John Watson.

All my love,

Y/N

"Y/N," John said, tears in his eyes after reading your letter. "Why didn't you send it?"

"Well, you had asked me not to write anymore since it was dangerous and," You paused, shaking your head sadly. "I chickened out again."

"Well, I guess what they say is true then." You looked at him quizzically as he pulled you close to him and leaned his forehead on yours. "Better late than never."

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falseroar · 4 years

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Dog Days Part 26: Just a Few Questions

((In exchange for helping cover up what happened at the studio, Dr. Iplier has a request of Dr. Schneeplestein and you. Abe has some regrets about offering to go with Chase to the Institute, but with Jackie’s “help” decides not to back out now.

This is a long one! (Edit: Never mind. I just checked, and the next two parts are both 7k+ words each. I’m beginning to suspect this is just going to be a theme from here on out.) I also sort of introduced another OC for this one, so hopefully that’s not too distracting. I’ll explain more about that in the end notes.

Here’s links to Part 25 and to the series masterlist.))

The doctor allowed Abe to stay the night in the clinic, on the condition that he didn’t leave the room as much as possible. Abe wasn’t sure if that was so Marvin could keep an eye on him while Schneeplestein was busy, or if he didn’t want the hunter scaring off his other patients. Either way, he had no intention of leaving, and neither did Jameson. With two beds in one room, it was already crowded enough without all of them there, so it only took a little bit of urging from the doctor to convince Chase to go home for the night, with Jackie riding along to keep an eye on him and to get some fresh air.

Jameson was more than willing to answer Abe’s questions and ask a few of his own, the two of them passing his phone back and forth with his notes app open, at least when he wasn’t arguing with Marvin about what the doctor’s definition of “rest” meant. Between the magician and the way Jackie fidgeted restlessly until Chase offered him an excuse to leave, Abe suspected these guys weren’t used to sitting still for long. Not that he could judge them there.

The doctor looked in occasionally, but otherwise the only sounds they heard from the rest of the clinic was the slow but steady stream of patients going in and out throughout the night, about the same number as Abe usually counted when he had been watching from the outside. All those nights watching the doctor, and he didn’t expected to end up here in one of these rooms, keeping an eye on the partner he thought he lost for good.

Or trying to keep an eye on you. It was a long, quiet night, and when you woke up the room was dark. Marvin was lying on the other bed, still wearing his mask, Jameson sitting back in the chair next to him with his head propped up against the wall behind him, while Abe had fallen asleep with his head resting on your bed. A soft snore escaped from the hunter as you looked at the three of them and wondered what time it was, a question that was answered a few minutes later when the door cracked open and Henrik peeped in.

Spotting your open eyes, he whispered knowing that you would be able to hear him even from across the room, “How are you feeling? Need anyzhing?”

“Just thirsty,” you admitted, and he nodded before disappearing from the doorway. A moment later he returned with a cup of water, and you sat up carefully so as not to wake up Abe. “Thanks.”

“No problem,” Henrik answered softly, watching you as you drank with a thoughtful expression. “Dawn is less than two hours away now.”

“Are you going to stay here or go home?” you asked, after nearly draining half the cup in one sip.

“Zhat depends on what you wish to do, I think. I believe you and Marvin would both do well at home, but there are other considerations.” The doctor glanced at Abe, but he said, “I have told Dr. Iplier I will go to zhe hospital today and spend zhe daylight hours there, if you are up to joining me.”

“The hospital? Are you working there today or something?” you asked, and Henrik shook his head.

“No, it is time for my regular check-in, but there is also zhe problem of zhe Institute. Dr. Iplier has agreed to cover for us, should zhey ask about yesterday’s…incident at zhe studio, but only if he has a chance to meet you, again.”

You started to ask, but Abe stirred and asked, his voice slurring a little with sleep, “Wait, what’s happening?”

Clearly you and Henrik hadn’t been as quiet as you had hoped, because Marvin and Jameson were waking up now too.

Henrik sighed and explained, “Dr. Iplier is, rightfully, not big on covering for people he does not know. He is villing to do much based on my word as to Y/N’s character and safety, but he would still like to meet zhem in person and ask a few questions. Since I have to go in anyways today, and Abe and Chase have already made plans…”

“Wait, you have?” you asked, and this time it was Abe’s turn to explain about the call and Chase’s agreement to go in and give a report on what happened at the studio yesterday—or at least his version that covered up the whole werewolf thing. Which brought them around to Abe’s client, or at least the Google that worked for him.

“This little field trip might give us a chance to look into who created those Google units, and who has them now,” Abe said. “The one I met answers to someone who knows way too much about us.”

“Even more now, thanks to you,” Marvin muttered, but while Abe didn’t hear it you could give the magician a look that made him repentant enough to say, “You said one of them’s at the hospital, right? I can go with Y/N and Henrik and…”

He winced as he sat up, a hand going to his head, and the doctor clucked his tongue. “Your body is telling you no on zhat. You vill go home with Jackie when zhey get here and rest, no excuses. We need you back up to stuff, magician, and zhat vill not happen if you are running around willy und nilly.”

“I can go,” Jameson signed. “That is, if you want to go, Y/N.”

You hesitated. Going to a hospital felt risky, even without everything else going on, but Henrik would be there and he had trusted the other doctor enough to bring him in while you were still recovering and stuck as a wolf. And Marvin did have a point about talking to the Google there—maybe he knew something about the others, or you could get a better feel for how these magiteks worked. Using Google’s own rules against him had worked yesterday, after all.

“Yeah, I’ll go,” you said, only to look down at your shirt. While you had healed from the shot without an issue, the same couldn’t be said for your torn and bloody shirt. “I, uh, might need to change first, though.”

“I vill tell Chase to add that to zhe list things to bring,” Henrik said, sounding much more cheerful. “Zhe bathroom is open, if any of you wish to freshen up in zhe meantime.”

Abe frowned, and not just because the doctor seemed to give him a side eye when he said it. He had been okay with going to the Institute with Chase when it seemed like you would be staying here or going home, or at least aware that he would have to keep his distance anyways once that happened, but now that he knew you were going somewhere else he wasn’t so thrilled on his promise to go. Sure, split up and cover more ground, that was great and all, but he hadn’t realized going with you could have been an option. It wasn’t like Chase needed him to be there.

Even knowing there was a chance to find out more about the red-shirted Google, Abe still played with the idea of giving an excuse to go with your group to the hospital. For safety, of course—after all, look how that little field trip to the studio turned out for you.

But it was Marvin who spoke up, while Jameson was out of the room and no doubt waxing his mustache or whatever his morning routine involved and the doctor had taken you to another room for some privacy for another checkup, and muttered, “Wish I was going with you.”

“You mean with them,” Abe said, head tilting in the general direction of the others, but the magician shook his head.

“No, I mean, yes, them too. Just doing something.” Marvin rubbed his face, his fingers disappearing up under his mask before it resettled into place. “What am I supposed to do, sit at home and twiddle my thumbs?”

“…Your magic really is gone?” Abe asked.

“Not gone, just—” Marvin paused, searching for the right words. “Like there’s a—wall, in between me and it, or like…Like breaking your arm, it’s still there, but you can’t use it for anything, you know? No, that’s not really right, but you get the general idea. God, I might as well be totally human.”

“Yeah, I can see how that would be a real shame,” Abe said sarcastically, but the magician just shrugged. Abe found his eyes drawn to that ridiculous cat mask again, and he had to ask, “Your friends know you’re half-fae, right? Not exactly something you can hide for that long, so why are you still wearing the mask?”

“Heh.” The side of Marvin’s mouth twitched upwards and he brushed his hair out of his face before fixing Abe in his gaze. “The eyes of the fae can be…distracting, even if you know what to expect.”

“That, and he’s vain as hell,” Jackie said at the door, looking in with Chase just visible behind him. “Where’s Y/N?”

“Next room over with the doc,” Abe answered, and Chase gave a thumbs-up before disappearing out of sight. “You know, I bet the doctor would be okay with you and Jackie going with Chase instead of me. Not like I have much of a reputation to help whatever tale he’s going to spin them.”

“Yeah, that’s…a bad idea, for many reasons,” Marvin answered, while Jackie shoved his hands into his pockets and leaned up against the doorframe. “I’d rather not attract the Institute’s attention, and Jackie…”

“I’m not going back there unless it’s to burn the place to the ground,” Jackie finished. He drew up his sleeve, revealing a network of scars tracing their way up and out of sight under the rest of his hoodie. “Last time I went into one of their buildings with a couple of hunters, they threw me in with the other guinea pigs to be played with.”

“But you’re human,” Abe said, and then, “Aren’t you?”

Jackie tilted his head and stepped back, out of the room and out of sight, until the prickle of hairs on the back of Abe’s neck made him look over his shoulder just in time to see Jackie step out of his shadow and rest his elbow on the hunter’s shoulder.

“For a certain value of ‘human,’ yes.” It was the movement of Jackie’s eyes returning to their normal grey that alerted Abe to the fact they had just been solid black, like two holes looking into something or somewhere else. “A little less, after they were done with me. Chase is the only reason I ever saw daylight again.”

Jackie’s weight shifted, the elbow on Abe’s shoulder becoming an arm across his chest, pressing him up against the wall as Jackie whispered, “Which is why you’re going to go with him. And you’re going to make sure nothing happens to him. Do you understand?”

Abe grunted, and Jackie relieved the pressure enough for him to mutter, “Didn’t really need the threat. What do you think I am?”

Jackie looked the hunter up and down before meeting his steady gaze with one of his own, his mouth twitching as though fighting back the urge to answer that.

“…I’ll keep an eye on the kid,” Abe said.

Said “kid” had gone to the next exam room and entered to find you lying on the bed while the doctor gently felt around the area where you had been shot yesterday.

“Oh, sorry,” Chase said, immediately starting to back up, but the doctor shook his head.

“Ve are done here, I think. You are sure zhere is no pain, Y/N?”

“Yeah, I…” you sat up slowly, your eyes drifting toward Chase as an all too familiar copper scent hit you. “I’m fine. Chase, are you bleeding?”

“Uh—” Chase sighed and stepped into the room, closing the door behind him. “Yeah, just a scratch from—from yesterday. I was hoping Schneep could take a look?”

“From yesterday?” You immediately thought back to that moment in the elevator, but you didn’t remember any point where Chase could have gotten hurt. That is, until you saw Henrik’s guilty expression and something clicked in the back of your mind. “You drank his blood?”

“I didn’t give him a choice,” Chase answered for him. “It was still the middle of the day, and we couldn’t take you and Marvin home with that hunter and who knows what else hanging around, and I didn’t know how serious your injuries were, so I…”

Henrik heaved a sigh and continued, “So he gives me no time to prepare a better idea. Your cut has started to bleed again?”

Chase nodded and, at the doctor’s gesture, hopped up on the bed to sit next to you and draw up his sleeve. There was a bandage there, already falling off even before the doctor carefully peeled it back to reveal the small cut on his upper arm.

The doctor clicked his tongue and said, “Vampire saliva encourages the bleeding, you see. It is why we try to avoid drinking directly from…donors, or one of zhe many, many reasons. At least you had enough sense not to create zhe cut near an artery or vein, but still.”

“Like I said, I didn’t know how much time we had to work with,” Chase said defensively.

“There is always time to do these things correctly!” Henrik paused and admitted, “Most of zhe time. Zhe effect should wear off on its own, but I have something that may help. Wait just a moment, both of you.”

The doctor walked out of the room, careful to shut the door behind him, and you waited until he was out of earshot before remarking, “You…you really trust him, don’t you?”

“Yeah, of course,” Chase said with a shrug that made you wonder if he really understood what he had done, not just asking but encouraging a vampire to feed on him, with no one else around to step in if the doctor’s worst impulses kicked in and he couldn’t stop himself. “Oh yeah, I picked up some fresh clothes for you while I was at the house. They’re not much to look at, but at least they match a little better than what you have on. Plus, you know, no hole in the middle.”

“…My clothes don’t match?”

“Eh?” Chase shrugged and said, “Maybe we can take you clothes shopping one day, help you pick out some things that are a little more ‘you’ than Jackie’s old hoodies.”

There was a hoodie on top of the pile of clothes, and you could smell Jackie’s scent in the fabric, same as you could tell who the other shirt and pants belonged to. As nice as it would be to have some clothes of your own, you didn’t want to admit to Chase that you kind of liked having that reminder of them with you. Talking about people’s scents felt very much like one of those werewolf things that might make other people feel awkward or uncomfortable.

“What do you normally like to wear?” Chase asked. “Any favorite colors?”

You shrugged, turning over the hoodie in your hands as you said, “I usually had to dress to look the part of an attorney, even on days when I was just in the office.”

And most of your days were spent in the office, when you weren’t in court or doing your own investigations. The few casual outfits you did have back then, you never really had much of a chance to actually wear. As for colors, you weren’t sure how much it mattered when you couldn’t actually see any of them.

Well, most of them. Wilford’s absurd pink mustache being the only exception so far.

“I like these pants though. They’re sturdy,” you said, and Chase immediately glanced at the hole in one of your knees that might have suggested otherwise.

“You mean blue jeans?” Chase asked. “Yeah, I think we can find you some more of those.”

“Wait, these are blue?”

Before Chase could answer that, the doctor walked back into the room, a small bottle and some fresh bandages in hand.

“Found it,” he said, shaking the bottle before applying a small amount of the liquid to a spongy white square. You winced and pulled the collar of your shirt up to your nose to try and block out the sharp, acid-like smell, causing the doctor to pause. “I had hoped you could help me vith this, Y/N, but if zhat would be an issue—”

You shook your head, trying to breathe through your mouth even as you answered, “No, it’s fine, the smell’s just a little strong. What do you want me to do?”

Under the doctor’s directions, you took a wipe and cleared off a large square around the cut on Chase’s arm, causing him to wince even before you applied the foul-smelling medicine to the cut. Henrik caught Chase’s opposite hand as it started to move out of reflex until he relaxed, and then applied a couple strips of tape over the fresh bandages you put on to hold them in place. Once that was done, the doctor immediately took a step back and tucked his hands into the pockets of his white coat, but not before you saw the way they trembled. He probably wasn’t just asking you to handle it because you were already sitting next to Chase.

“Thank you, Y/N,” he said, after clearing his throat. “Zhat should help until zhe cut heals over on its own. Just keep it dry, and no more silly stunts.”

“Now when you say ‘silly,’” Chase started, causing the doctor to snort and walk out of the room. Chase jumped down from the bed and said to you, “You should probably go ahead and change, if you’re really wanting to go to the hospital today.”

You nodded, wondering if you should say something, but instead you asked, “Are you and Abe really going to the Institute today? The one you told me about?”

“Just one of the downtown offices, and maybe that lab if we can swing it,” Chase said, but he avoided looking at you until he added, “I’ll keep an eye on your hunter while we’re out, promise.”

He winked and walked out before you could correct him, leaving you to change and try to turn over what about that wording bothered you the most until it was time to go. The hospital was apparently close enough that Henrik felt confident you, him, and Jameson could walk there before dawn, but Marvin and Jackie insisted on at least driving the three of you there before they returned home, leaving Chase and Abe to take the hunter’s car.

Outside, in the predawn darkness, you wondered what to say to Abe. Any reminder to be careful or that you would see him again felt off, when you had so many other things you wanted to talk to him about. Too much to say or ask about in the little time you had, much less in front of the others.

Instead, it was Abe who pulled you to the side and said, “We’re going to talk about…everything later, yeah? So try to stay out of trouble until then.”

You felt a prickle at the back of your neck at his rough tone and answered, “I’m not the one who’s likely to end up in trouble. You think you can avoid shooting anyone today, hunter?”

“Only if they don’t shoot at me first,” Abe said, relaxing a little when he saw you almost smile at that. That is, until your eyes looked past the hunter and caught what Jameson was signing at you, and embarrassment knocked out every other expression as the others tried not to laugh. “What?”

“Nothing,” you answered a little too quickly. “See you soon, hunter.”

Abe turned and watched you squeeze into the backseat with the others before the car drove off, leaving him behind with Chase. “Are you going to tell me what that was about?”

“Not a chance, hunter,” Chase answered, suppressing a grin as he leaned against Abe’s car. “You ready to go or not?”

“Is anyone even going to be there this early?” Abe asked, causing Chase to raise an eyebrow. Of course, most hunters didn’t exactly work a regular 9 to 5 schedule, and the Institute was hardly any different. But then again, “I know a place we can stop on the way. How do you feel about coffee?”

“I’m listening.”

---

“You still got your collar on you?”

“What?” You had been looking out the back window at the streets passing by, and it took you a second to realize Marvin had turned around in the front seat to look at you. Reluctantly, you pulled the dog collar out of the front pocket of your hoodie and asked, “You mean this?”

Marvin relaxed and said, “Good. Make sure you keep it on you, okay? Schneep, Jameson, you still got your wards?”

Jameson nodded, tapping the brim of his hat and the doctor gave an affirming sound before directing Jackie to the right driveway to the hospital.

“I don’t have to actually wear this thing when I’m human, do I?” you asked.

“Nah, that’s only to get the wolf to pass as a dog,” Marvin answered. “As long as you keep it on or near you, no one should be able to trace you. There’s also some protections against other types of magic in it, but…”

“But they don’t do much against bullets,” you finished for him and Marvin shrugged.

“Can’t plan for everything. Sorry, I had planned on having something else for when you were human again, but that idea’s going to have to wait.” As the car pulled to a stop at the front entrance to the hospital, Marvin added, “Call us, if you don’t want to hang around here all day until nightfall. Just because Schneep has to stay here until then doesn’t mean you and JJ have to.”

“We’ll keep it in mind,” Jameson signed before reaching over and showing you how to unlock the back door. Together, you and Jameson climbed out while the doctor walked around from the other side of the car, and he leaned down so that Jackie could see him add, “Be careful going home!”

“Yes, please do,” Henrik said. “Last zhing we need now is Jackie getting caught driving vithout a license.”

“I’m always careful,” Jackie answered, and Marvin couldn’t hold back a laugh at that. “Look, you all can start criticizing as soon as you learn how to drive yourselves around. Until then, keep it to yourselves.”

The car idled there in the driveway after you all said goodbye, Jackie waiting until your group was through the glass doors before he put the car into drive.

“I thought you said you finished the new ward for Y/N,” Jackie said, breaking the silence of the drive back to the house, and Marvin made a noise but didn’t answer. “Just a few cosmetic tweaks—you don’t need your magic to do that, right?”

“Just considering our options,” Marvin answered, his tone doing more to tell Jackie that he wasn’t in the mood to talk right now.

Not that it kept him from saying, “Well, after this we can keep them home for a while, where it’s safer. At least until you’re back to yourself, and the attention’s off of them.”

Marvin didn’t answer, and when Jackie glanced at him out of the corner of his eye it was difficult to tell, between the darkness in the car and the magician’s mask, if he had even heard him. Jackie’s grip tightened on the steering wheel before he forced himself to relax and let it go. Marvin would share whatever was clearly on his mind when he was ready.

Not that waiting until that happened did anything to ease Jackie’s own suspicions about what was on his mind.

Back at the hospital, you stopped short at the sight of the familiar face behind the front desk and Jameson’s hand quickly found your own.

“Do not worry,” Henrik said under his breath. “Zhis is not zhe same Google you met. I know zhis one, and he is…Vell, he is not friendly, but he hasn’t—hm.”

The doctor paused, considering what he was about to say, before deciding to just go with, “Zhe hospital keeps a very close eye on him.”

“Kind of worrying that they need to keep that close an eye on him,” Jameson suggested, but it wasn’t like there was another option except to go up to the desk where Google looked up from the computer and straightened to face you all in a very mechanical set of movements.

“Welcome to Mercy Green,” Google said, his tone so similar to the other Google that you would have had a hard time telling them apart. Even their scents were very close, although this one had a lingering odor of cleaning fluid hanging around him that you hoped was from keeping the magitek unit clean and not related to any incident in particular. “If this is an emergency, I can direct you to our Emergency Room where trained staff are standing by. Otherwise, do you have an appointment?”

“Dr. Iplier is expecting us,” Henrik answered, but before Google could turn to the computer a voice called from down the hall as the doctor himself approached.

“Henrik, right on time,” Dr. Iplier said, glancing at you and Jameson only to pause, his eyes meeting yours for several seconds before he snapped himself out of it and said to Google, “Just following up on yesterday’s appointment. You know, the one I forgot to tell you about?”

“Yes.” Google’s expression darkened and he said, “You would not have to remember appointments if you told me about them before they happened, doctor.”

“Well, it was a bit of an emergency—”

“Emergencies can be handled by trained staff in our—”

“Yeah, yeah, but I owed a favor and the issue was something I could handle on my own. Right, Henrik?”

“Yes,” Henrik said, slowly as he worked out what the other doctor was doing. “Just a simple bad reaction to a potion. Of zhe transforming kind.”

“…Right.” Dr. Iplier shrugged and said, “I’ve got a room set aside for us already. I think I remembered to put that in the calendar, at least.”

“So you are not completely hopeless,” Google muttered under his breath, and Dr. Iplier started to respond before thinking better of it and motioning for you all to follow him back down the hall.

Once the front desk was out of sight, Jameson asked, “What was that all about?”

“If someone is asking for Dr. Iplier, zhey will most likely check with Google,” Henrik answered. “Such as someone from zhe Institute.”

“And he can tell them I took care of a patient who—an adverse reaction to a potion? Really?” Dr. Iplier asked as he took one turn after another. This place was quickly starting to feel like a maze, with one addition after another having been added on over the years, according to the frequent number of plaques on the walls.

“It vas not my idea,” Henrik answered. “But if they do ask, zhe patient came from zhe TV studio, Dark Entertainment.”

“Easy enough to remember,” Dr. Iplier muttered, and you suddenly remembered what Schneeplestein had said about the studio and the number of injuries there before you went. Now, the only surprising thing about that was the fact the doctor had managed to suppress the urge to say “I told you so.”

The doctor stopped and opened one of the doors to reveal a room a lot like the ones at Henrik’s clinic except more spacious and with more equipment that you weren’t familiar with.

He waited until the door was closed behind you before he said, “You must be Jameson Jackson. Henrik’s told me a lot about you.”

Jameson waved and nodded, although his expression suggested he wasn’t quite sure how to feel about that before Dr. Iplier looked back at you.

“And you must be…doing a lot better than the last time I saw you,” he said.

“Thank you, for the medicine,” you said. “It really helped.”

“Not even a trace of silver burns,” Dr. Iplier said, looking you up and down with a fascination that was almost concerning. “Absolutely incredible.”

Schneeplestein cleared his throat and Dr. Iplier added, “I mean, I’m glad. And curious. Which is why I would like to ask you a few questions, if that’s okay.”

You weren’t sure if he was asking you or Henrik, but you supposed you knew this was coming. Still, you said, “Depends on the question, I guess. And why you want to know.”

“Professional interest?” Dr. Iplier suggested before leaning against the desk along one wall, his fingers tapping on its surface. “We don’t get many werewolves here in the city, or at least not any that I know about, but even outside of our walls there aren’t a whole lot of doctors or healers of any kind who have any experience with them. Which means a lot of our medical literature has just enough to identify the signs of a werewolf bite and infection, and the methods to…ease the patient.”

“A nice drink of medicine and wolfsbane to ease the pain before the mob finds them,” you said sarcastically, but neither doctor tried to correct you. “One problem already: I wasn’t bitten by another werewolf.”

“What?”

“A curse, from the same entity that stole my voice,” Jameson explained, with Henrik translating for the other doctor’s benefit.

“Really?” Dr. Iplier gestured for you all to take seats, but he remained standing even as you reluctantly sat on the edge of yet another exam table. As if to make you feel less alone about that, Jameson decided to hop up next to you and place a comforting hand over yours with a smile. Dr. Iplier glanced at Henrik as he said, “Oh, is that why you were so sure they were safe during the full moon? It’s just a cosmetic transformation?”

Cosmetic. Because yes, transforming into another creature against your will every month was just the same as applying some eyeliner, said a bitter thought inside you that you tried to ignore even as you answered, “No. I’m only safe to be around thanks to a spell that helps me stay in control every full moon. Otherwise, I don’t know what I would do.”

Even with the spell, you could feel how thin the line was sometimes. Like yesterday, when you saw Dark and dropping every attempt at control or calm felt so very worth it.

“Could this spell be used for your traditional werewolf?” Dr. Iplier asked, his hopeful ideas quickly crushed by the shake of Jameson’s head.

“Marvin said the spell takes a very long time to prepare, and it was tailored toward the victim of that particular entity,” Jameson explained, with Henrik again translating. He decided against mentioning that Marvin only had that particular spell ready because he hoped to save someone else that night, or how Marvin had admitted, years later, that he hadn’t even been sure it would work that night, or what he would have done if it had failed. “He’s looked for a way to turn back both of our curses, with no luck.”

“Well, even if they are curses, they have physical effects,” Dr. Iplier said, again drumming his fingers against the desk while he thought out loud. “There’s always the chance that a physical solution can be found to counteract them. Henrik, what kind of tests have you done?”

“I have performed physicals, measuring zheir progress as zhey recover,” Henrik said slowly, as though he already knew where the other doctor was going with this.

“Some blood samples might give us an idea of what we’re dealing with—” Dr. Iplier started, but Henrik quickly cut him off.

“Nein, absolutely not, if zheir blood shows up in zhe system it vill—vhat is it—”

“I know how to keep things under the table,” Dr. Iplier said, looking at you as he added, “It would be perfectly safe, and no one else would have access to the samples—”

“Red flags!” Henrik said, snapping his fingers as he found the phrase. “You would need a lab, and someone to do tests, too many people would ask questions of a doctor doing it himself. Und zhat means more eyes, more hands, more chances of someone else finding out. Out of zhe question.”

“But nobody would look twice at Google doing it, and if I give him the right orders even he won’t know what the results are,” Dr. Iplier answered. “Even if we don’t find anything, wouldn’t it be better to have at least tried? Just trying to keep your head above water is admirable enough, I suppose, but if you just keep paddling in place, you’re never going to reach the shore.”

“Or you might just end up swimming out into the ocean if you go about it wrong,” Jameson signed. He sighed and added, “But we haven’t been able to do much to help you, have we? Maybe letting the docs have a shot at it wouldn’t be such a bad idea.”

The way Dr. Iplier talked, you weren’t sure if he was trying to get an idea for how the whole werewolf thing worked, or if he was actually hoping to find a cure. You hoped for his sake that it was the first, because you had laid aside all hope for a cure a long time ago.

“Just knowing how to cope with…some of this, would be nice,” you said slowly, thinking of yesterday, of all the times you had become overwhelmed by the wolf’s senses of smell and hearing, of how ever since the mirror it just felt easier, being the wolf. But you doubted any kind of tests the doctor could do would help with all of that, which is why you looked at Dr. Schneeplestein and started to ask, “Do you—”

You were interrupted by a knock at the door, which was abruptly opened despite Google’s protest on the other side of, “You are not allowed to access this room without permission.”

“A little late for that,” muttered a man beside him, who pushed up his glasses with a sniff, but both of them were overshadowed by the woman who had opened the door and looked around at all of you before her gaze settled on the two men in white coats.

“Dr. Iplier?” she asked.

“Who the hell are you?” Dr. Iplier answered, stepping forward only to be brought up short by the badges the woman and man showed him. From your vantage point, you couldn’t make out any details, but the general shape of the emblem on them did not match what you remembered of any official police or other government badge. As if to answer your curiosity, Dr. Iplier said, “Great. Bronson Institute investigators. Are they in the schedule, Google?”

“No, they are not,” Google answered, moving his hand towards his glasses in a gesture that just so happened to elbow the man next to him in the ribs. “I would have informed you of a scheduling conflict when you set up this follow-up examination if that were the case. These…people, asked where you were, and proceeded to barge their way here.”

“I’ve never barged anywhere in my life!” protested the man, after rubbing his ribs with a wince and not quite as casually elbowing Google back only to realize why that was a bad idea when the other person had a metal interior.

At his words, a device on his wrist pinged with an irritating noise timed to a flashing light that lasted for three seconds but felt like an eternity to your ears. The woman barely suppressed a smile as she said, “Perhaps some barging was involved, but I assure you that this is an important matter. You received our call about the patient from yesterday, correct?”

“Yes, I did,” Dr. Iplier answered, dragging his eyes away from the device to look back at her. “And I thought I answered all of your questions then. What is this about?”

“We like to be thorough in our investigations, especially when such…delicate matters have become so very public. There’s quite the stir going around, after what supposedly happened outside Dark Entertainment Studios yesterday, and the Institute simply must be sure that we have the heart of the matter before we issue a statement.” She smiled and added, “And your Google was so kind as to inform us that the patient from yesterday is still here.”

“Which one of you is it?” asked the other investigator as he walked into the room and sneered at you and Jameson on the exam table. “And don’t even think about lying! We brought this just so we could be sure we got the truth.”

You glanced down at the device on his wrist, which honestly looked like a wristwatch except one with a blank square screen instead of a clock face. This thing made that irritating noise when it heard lies?

Before you could ask, to stall for time while you thought of a way around it, Jameson immediately waved and pointed at himself.

“You?” the investigator asked, and when Jameson nodded, he scowled and said, “I need you to say it!”

“Jameson can’t speak,” you said. “It’s the effect of a curse, we think. But he does know sign language, if either of you…”

The investigator scowled and looked at his partner, who was sizing up the two of you now with the same intensity that she entered the room with, and she said, “That could work, assuming you know how to ask the right questions.”

“Fine, you translate,” he said, pointing at you before asking, “Were you involved in the incident at Dark Entertainment Studios yesterday, involving a suspected werewolf?”

“I was at the studio yesterday,” Jameson answered, and you translated word for word. “There was an unfortunate incident, yes, but luckily Chase Brody was there to assist, and I and my companions were taken to a doctor he is familiar with.”

“You mean Charles Bronson,” the investigator said as he took meticulous notes in a notepad. “What exactly was he doing there?”

“An interview,” Jameson answered. “About ‘nontraditional’ forms of entertainment, although as I told Jim yesterday, you could make the argument that Chase’s series of stunts for views, as well as his performing feats of gaming and even ‘hanging out’ with his fans could all be—”

Dr. Schneeplestein cleared his throat and Jameson flushed before finishing, “But perhaps this isn’t the place for that conversation.”

“And I’m supposed to believe that you’re an actor?” the investigator asked, and beside you Jameson froze before responding.

“And what, my good sir, is that supposed to mean?”

“Well, Charles said it was some actor who got changed thanks to a stupid stunt, but if you can’t even talk, then how are you supposed to be an actor? Subtitles?”

It was only your fast reflexes that kept Jameson from making his own very nonverbal answer to that, mostly with his fists, and behind the investigator his partner sighed and brushed her forehead with her fingers.

“Harold, what could I possibly have done to have to endure having you here for this?”

“Did you see that?! He tried to attack me!”

“Well, if he had, at least you’re already in a hospital,” she answered. “Dr. Iplier, can you confirm this man’s story?”

“I haven’t seen his work for myself, but I do believe he is an actor.”

Good thing you all were in a hospital, because the investigator looked ready to kill a man before she took a breath and asked, “Was the incident at the studio caused by a failed transformation potion?”

“That is what I was told, yes,” Dr. Iplier said. Of course, he didn’t add who told him that version of events, or whether he believed it. “In such a case, the best course of action is to wait for the effects to run their course, but the patient was under good supervision during that time.”

“Zhe best,” Dr. Schneeplestein muttered under his breath.

“I wouldn’t go that far,” Dr. Iplier muttered back, before clearing his throat and saying, “As far as I know, Mr. Jackson’s testimony is entirely honest. And you could put me on the record as saying so.”

Jameson’s testimony, which was so carefully worded to avoid actually saying he was the one who transformed on the street yesterday. You were starting to suspect that device on his wrist wasn’t quite the infallible lie detector Harold seemed to believe it was, although even he looked disappointed when it failed to react at the doctor’s words.

“Tch.” Harold reached into his pocket and pulled out something before tossing it to Jameson with a, “Here, catch.”

Jameson easily caught the coin that flashed in the air between his hands, and opened them to reveal the large, silver coin resting in his palm. He looked from it to the investigator and back again before signing, “Do I get to keep this? Is it my pay for dealing with this nonsense?”

You tried hard not to think about what would have happened if Harold had tossed the coin to you, the burns on your hands worth far more than whatever that lie detector could supposedly tell them.

“I suppose that should settle that, at least,” the other investigator said, while Harold tried to convince Jameson to give him his coin back. Her eyes flickered toward the doctors again as she said, “Very convenient, that Mr. Jackson was still here for this little questioning. Why exactly are you still here, if the potion ran its course?”

The doctors hesitated, but you thought it was your turn to deflect the question by answering, “Dr. Iplier asked if we could come back in, because he wanted to follow up on a few things. Mainly, we’ve just been talking about curses.”

“Right, the curse that took Mr. Jackson’s voice,” she answered, and moved closer to the table. Her hand rested on the padded surface next to you as she leaned in, staring into your eyes with an intensity that was difficult to look away from. “You’re suffering from a curse as well, aren’t you?”

“I—” You swallowed, hard, and caught a brief glimpse of Dr. Schneeplestein on the other side of the room reaching up to tap on the side of his glasses. “Y-yes, I am. My eyes, they were affected by it—I couldn’t even see for a while there, and it’s mostly back but I…I, uh, can’t see most colors still and…”

You trailed off, relieved that the device hadn’t sounded off at that. Your eyes had been affected by the curse, or at least that bit of it that left you so weak to silver.

“Hm. That is interesting. His voice and your eyes…It wasn’t the same curse that caused both, was it?” She said it with a certainty that almost made you think she knew more than she was saying. By this point she was filling most of your vision, to the point that you couldn’t even look away to be sure what Jameson was signing next to you.

“No, I don’t think so. But it was the same…thing that cursed me that took Jameson’s voice.”

You had said it in the hopes it would explain why you were both here, but almost as soon as the words left your mouth you worried that she would ask more questions that you couldn’t answer, because even talking about the entity from the woods felt like it would be straying too close to the real truth. You felt like she had to know more, that she had to know none of you were telling the whole truth.

Part of the reason you were so sure was because there was something eerily familiar about this woman, from the way she commanded attention from the second she entered the room to the look in her eyes whenever she asked a question, like she was looking for more than just what you said next. If you didn’t already know Celine was still there somewhere inside Dark you might have thought…

“You’re not a seer, are you?” you asked, trying to sound like you were joking, and she smiled in a way that somehow made you feel even less certain about what you thought you knew.

“I prefer the title ‘assets manager,’ if I had to choose one,” she said, completely failing to answer your question or give you any other clue what, exactly, that was supposed to mean. The corner of her eyes tightened with a thought and she reached into a pouch on her belt.

You couldn’t help but flinch as she pulled something out and held it toward you, before you realized it was a small business card, very much like the one Bim gave you yesterday.

“Bronson Institute has a department dedicated to researching and treating those dealing with the effects of curses,” she said as you took the card, and presented Jameson with one of his own. “Something to consider, if the good doctors here aren’t able to provide the support you need.”

“Oh, uh, thank you,” you said, Jameson echoing your answer with a sign of his own. “We’ll think about it.”

The device on Harold’s wrist began to beep shrilly at that, causing him to mutter under his breath while he tried to reset it, but the so-called assets manager seemed to suppress a laugh before she responded, “Hang on to the cards, at least. You never know what might make you change your mind.”

You decided to play it safe and not answer this time, and she nodded to you and Jameson before turning to include the doctors as she added, “Thank you for your time, all of you. I think we can safely note for the record that Mr. Jackson here is hardly a werewolf.”

“As of today,” Harold corrected. “We retain any and all right to change our verdict, should future events change that.”

“Of course,” she answered in a flat monotone, showing great restraint not to roll her eyes. “Harold, you can handle the paperwork while I call this in.”

It wasn’t a question, and she walked out of the room without waiting for an answer, leaving Harold to dig around in his bag before presenting the doctor and Jameson with some papers to sign and keep for their records—papers that you insisted on reviewing before either one put down their name, although at least these turned out to be harmless confirmations that they had answered the investigators’ questions in the presence of a “deception detecting device.” That name was about the only thing you would have changed, if only because the thing seemed to have difficulty with anything that wasn’t an outright lie.

All the same, it was a relief when Google finally escorted Harold out of the room, the four of you all exhaling when Dr. Iplier made sure the door was closed and locked behind them this time.

“Vell, at least zhat seems to be behind us now,” Dr. Schneeplestein said, but even from across the room you could see his hands were shaking before he clasped them together. Neither of the investigators seemed to have given him a second thought, but even knowing he has fully registered, being this close to them had shaken him badly.

Badly enough that Dr. Iplier noticed and asked if he had taken his “quota” for the week yet, but Henrik just suggested under his breath that they could talk about it privately, later. At least from that, it sounded like he would tell the other doctor about what happened with Chase, so that was one weight off of your mind.

Only for another to press down again when Dr. Iplier reminded you of the conversation you had been having before the investigators interrupted.

“It’s entirely up to you, of course,” Dr. Iplier added, and you tried hard not to look down at the card in your hand.

Tried not to get your hopes up for anything even as you sighed and said, “I’m willing to try a few tests, if you think it will help. Henrik?”

“…As long as I can keep an eye on zhe process,” Schneeplestein answered, and despite his tone you thought he looked pleased with your answer. “Zhere is nothing to be lost by learning more about your condition, as long as ve keep zhe tests between us.”

Beside you, Jameson tucked his card into a chest pocket and gave you an encouraging thumb’s up, although his smile faded slightly when Dr. Iplier started talking about a few ways to examine his throat as well. It was starting to sound like you both had a long day ahead of you, but if either of the doctors could find something that might help…

After she left the room, the “assets manager” quickly found a quiet alcove in the hospital where she could see anyone coming from either direction at a distance and pulled out her phone. The number she put in wasn’t in her contacts, but one she had long since memorized.

When the other side picked up, she said without any kind of introduction, “The doctor stuck with his story, and they were able to pass the lie detector. Darrensworth is signing off that they’re in the clear now.”

“Really? That must have been an interesting conversation to listen in on. And the silver coin?”

“Doesn’t exactly tell you much if you hand it to the wrong person,” she answered, frowning at the chuckle on the other end of the line. “Say the word, and I’ll bring them in right now. I can think of three ways to walk them out the door without any backup, seven if you don’t mind a couple of casualties.”

“As tempting as that is, I don’t think it’s necessary.”

“What?” She paused long enough to bring her voice back under control before she said, “With all due respect, sir, we are dealing with a highly dangerous creature here.”

“The next full moon is still some time away,” he answered, and before she could point out that an unstable werewolf hardly needed a full moon to cause more than enough damage, he added, “I’m already making arrangements for someone else to collar them and bring them in, when the time’s right. Don’t you worry about a thing. I know this wolf and exactly what it’s capable of.”

She might have had something to say about his patronizing tone, if his words hadn’t summoned a vivid image in her mind that drowned out the voice on the other end telling her to come back, followed by the abrupt silence of the call ending. The phone slipped in the palm of her hand, but it and the hospital around her faded away into the vision.

An alley, and a shadow low and near the ground, nearly invisible in the darkness except for the silver eyes catching and reflecting the distant streetlights and the moonlight overhead, followed by a flash of white as jaws full of gleaming teeth revealed themselves.

A figure, silhouetted against the light of the street.

The beast, springing forward before she hissed, phone clattering against the ground as her fingers pressed against her temples, the vision fading into nothingness.

But not before she heard the gunshot, and the long, desperate cry.

By the time Harold, firmly escorted by Google, found her, she had recovered from her vision and come to the determination that, by the next full moon, you would be safely tucked away in the Institute. If his plan didn’t play out, then she would happily see to it herself. Whether it was by convincing you to come in search of treatment or by more forceful measure remained to be seen, but she would make sure that vision would be one of the many that never came to be.

For your own good, if nothing else.

((End of Part 26. Thank you for reading! No bonus points for guessing who that was on the phone...

And yeah, the “assets manager” is kind of a play on Celine’s character. Mostly because I got to this scene and realized I wanted that kind of character there, and partially because I’m running low on canon characters to shove into this AU. XD I haven’t decided on a name yet, but maybe Emma? Definitely open for suggestions there, and feel free to let me know what you think.

Link to Part 27: A Visit to the Institute.

Tagging: @silver-owl413 @skyewardlight @withjust-a-bite @blackaquokat @catgirlwarrior @neverisadork @luna1350 @oh-so-creepy @weirdfoxalley @95fangirl @lilalovesinternet-l @thepoolofthedead @a-bit-dapper @randomartdudette @geekymushroom @cactipresident @hotcocoachia @purple-anxiety-blog @shyinspiredartist @avispate @missksketch @autumnrambles @authorracheljoy @liafoxyfox @hidinginmybochard ))

#markiplier #jacksepticeye #fanfiction #monster hunter au #werewolf au #wkm district attorney #wkm abe #henrik schneeplestein #jameson jackson #dr. iplier #chase brody #marvin the magnificent #jackieboy man #traces of silver #so that vision huh

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junggoku · 4 years

Text

(Don’t) Say My Name - Ethan Ramsey x f!MC

book: Open Heart

pairing: Ethan Ramsey x f!MC (Nina Valentine)

word count: 2,513

summary: No, Nina did not think she was working too much. No, she is not that tired. No, she is fine. Really. She’s fine. (*narrator voice* She was not, in fact, fine)

A/N: Okay guys, just take this. I have no idea what this is, but I made a promise to get this out there and I finally finished it. I’ve been working on this for about a month now and honestly, I’m kinda proud of it. I’m proud that I managed to finish it at least. HELLO MY DEBUT AS A FANFIC WRITER MUAHA. Jk, but seriously. Enjoy! Also, let me know if you wanna be added to my tagslist? I’m not sure if I’m gonna write often but I figured I should throw it out there anyway.

Rainy weather always brought with it a certain restlessness in the air. There was something about the rain that made her lose focus, distracted as it falls and showers the earth. With her head resting in her hand, her attention was directed towards the windows in the cafeteria, watching as raindrops patter and hit the side of the glass. Her eyes tracked the movement of one particular drop, following as it slid down the smooth surface until it disappeared over the edge.

Dr. Nina Valentine leaned back in her chair with a sigh, taking her elbow off the table and turning to witness the smattering of doctors and nurses inside the cafeteria at this hour. It was later in the afternoon at Edenbrook and she had been pouring over a patient file in an attempt to distract herself from the bone-aching exhaustion seeping in from working 48 hours straight. In between putting her five hours at the free clinic earlier, studying up on diseases for the diagnostics team, and checking up on her regular patients, Nina was about two breaths away from falling asleep atop her file on one Ms. Rebecca Pope.

With a scrape of her chair, she pushed her hands on the table and stood up, gathering all her materials and drifting back out into the hallways of a bustling hospital. Making her way over to one of the nurses’ stations where a small collection of interns had congregated, Nina noticed the head of her own intern standing on to the side alone, brows furrowed as she focused intensely on a patient’s chart.

“Anything interesting on there, Ortega?”

With a start, Esme looked up, her eyes wide for a split second before schooling her features.

“Not particularly, no,” Huffing, the intern lowered the chart, fixing her eyes on Nina. As the resident reached the counter of the station and set her stuff down, she could feel Esme’s gaze sticking, and glanced up at her intern, an eyebrow raised in question.

“What?”

“You look like the walking dead,” Esme states flatly, zeroing in on the deep circles under Nina’s eyes, purplish bruises broadcasting to everyone exactly how many hours of sleep she got—or did not get—in the past couple of days.

“Gee, thanks. Mind you, I think it’s a great look for me,”

“No, seriously. You look like you’re about to fall over. Do all residents sport eyebags like that or is that just a you thing?”

Rolling her eyes, Nina doesn’t respond as she turns her attention back to some paperwork on the desk. Esme sidles up, and steals a quick glance down at the files and journals Nina had placed on the counter. “Stuff for the diagnostics team?”

“Yeah. Gotta turn myself into a walking disease encyclopedia if I’m gonna be able to do my job,” Nina sighs as Esme pulls out an article on gastrointestinal viruses, ignoring the group of interns that was still hovering nearby, a couple of them glancing over at them curiously. The last few hours are starting to get to her as Nina feels herself slipping a fraction, her eyelids growing heavier as she stands. Her workload had grown significantly, something that she already knew and expected, and while it was challenging to keep up with, thinking about the patients she can help—can still help for who knows how much longer—kept her moving.

Esme flips through some of the pages in the article, “Man, seriously. How do you do it? I’m getting second hand exhaustion just from looking at this.”

The corners of her mouth quirked as she allowed herself to take a breath. “I’m not sure I’m even really doing it.”

It’s getting harder to focus. She’s been putting off sleep so often these days that she knows she’s not going to be able to stand upright for much longer, but she couldn’t afford to. Edenbrook’s situation loomed in her mind so much recently it was hard for her to sleep without thinking about all the patients she could still help if she was at the hospital.

Preparing to head back to check on another one of her patients, Nina started to turn around. She miscalculated though, moving too fast. Esme’s voice rang out in mild alarm, “Hey-”

It all faded to black.

----

“Is she gonna be okay?” Sienna glanced over at Nina, eyebrows furrowed in worry. Her friend was snuggled up in what looked like three layers of blankets, an almost blissful expression on her face. The light sleep medication was setting in, Nina’s nerves stilled and numbed. Sienna knew her friend had been working late hours and forgoing sleep more often lately, but didn’t notice just how much of a toll it had taken until Nina collapsed, head burning with a high fever.

“She’ll be alright. She’s still running a bit high in body temperature, but with some rest she should be good as new.”

With that the doctor walked out, leaving the residents as they all peered at their friend, now snoring lightly without a care in the world. Jackie shook her head, a strand of hair falling into her eyes, “I should’ve noticed. That kid we babysat a few weeks ago saw it right away and even then I didn’t pay attention.”

“Not your fault. We all should’ve said something. We know how she gets about patients,” Bryce sighed.

“We shouldn’t be doing this right now anyways. Let’s go and let her sleep,” Casting one more concerned glance at Nina, Elijah slowly wheeled out of the room, the others trailing closely behind. A soft click of the door closing and the world was bathed in quiet once more.

The air settled, a strip of the moonlight trickled in and Nina opened her eyes, releasing a breath, and tilting her head to look out the slits in the window.

Raising a hand to her forehead, she continued peering out, a small frown crossing her soft features. Stupid. How stupid of her to end up passing out. And from not getting enough sleep? This was the last thing she needed. Feeling annoyed at herself, the brunette huffed and closed her eyes again. The sooner she rested, the quicker she could get back to her patients.

Admittedly, being in a bed again felt nice. Good for her neck at least, to not have to nap on the stiff boards in the on-call room. Allowing the numbness from the medications to kick in, she willed herself to fall asleep and relaxed her muscles. It was pleasant, to be honest. Letting her nerves and senses be dulled for once. It’s been ages since she was able to shut down her brain. Everything had been in hyperfocus mode in the past month.

She needs to be better if she’s going to be helping anyone, if she’s going to save Edenbrook. Her sluggish thoughts are interrupted though, as the sound of the door click signaled a new arrival in her room. Assuming it was one of the nurses, Marlene, coming to check on her, Nina kept her tired eyes shut, “Mar-”

“Nina.”

A pause. It’s in moments like these where Nina swears the world slows down just a little, everything suspended as time lulls for a brief second, like an intake of breath. And while her mother always told her she was a bit dramatic and a bit of a romantic, Nina would argue that she never felt these kinds of sensations, had these kinds of moments and these thoughts before in her life. Not quite in this way. Not until she came to Edenbrook. Not until him.

Even in her befuddled state, she realized how sappy she sounded in her head. The meds must be getting to me. In this condition, she might have been a little too honest.

The way he said her name created a throb in her chest, bringing up an emotion she refused to acknowledge at the moment. Still, she was aware enough to hear something else in his voice. Try as he might to control it, there was a hint of anger there.

“Ah. Dr. Ramsey. To what...” Another pause, “...do I owe the pleasure?” Cracking open her eyes, Nina found the tall figure of Ethan Ramsey by the door, his arms crossed over his chest, face carefully blank.

Even in the low lighting of the room, Nina could see him scanning up and down her frame to make sure she was alright. Ice blue eyes finally connected with warm brown ones and she willed herself not to look away. That bothersome part of her mind started to tickle, but she quickly opted to ignore it.

“I was told you fainted and landed yourself here from exhaustion. Why didn’t you say anything?”

The junior fellow broke eye contact, staring straight ahead at the potted plant on the dresser across from her bed. “I just...it didn’t really matter. I was fine.”

“Clearly, you were not fine, since you’re now lying here in a hospital room.” Voice rising, Ethan crossed the rest of the way over, coming to stand right beside her bed. “If your workload was too much, you should’ve spoken up about it. I understand you wanted to keep working, but you’re not helping anyone in your state right n-””

“You nag too much, Dr. Ramsey.”

“...Excuse me?”

Rolling her eyes up all the way to the ceiling, Nina turned her head towards the window again and tried to drown out the deep facets of his voice. “I passed out from being too sleepy and the first thing you do when seeing me is to nag. How sweet of you.” She was growing frustrated for some reason, the medication making it difficult for her to control her emotions now. Would it kill him to be honest for once?

Ethan’s mouth was opened to respond, but she didn’t let him, her words spilling out. “You always know just what to say. Really. It’s very cute of you. Are you a pine tree? Cause you’re just full of sap, aren’t you,”

A moment of silence as Ethan waited for her to finish.

“...That’s a maple tree.”

“Oh,” The brunette frowned. Was it? She really needed to sleep soon.

They descended into another bout of awkward silence. Glancing back at her boss, she found him peering down at the ground, scratching the back of his neck. In a quiet voice he broke the silence, “I’m sorry.”

Deflated, the junior fellow shook her head slowly. “No. I’m sorry. I got mad for no reason. Thanks for coming to check on me.” Being around him always made her feel a multitude of emotions, but it was worse in her current situation. She didn’t have her usual self-control nor her filter and the fuzziness creeping at the back of her head told her she wasn’t going to actually remember this conversation the following morning. ‘Least I won’t remember calling him a pine tree like a dumbass.

Eyes softening a fraction, Ethan spoke again, voice pleasantly gentle this time, “When I heard you collapsed all of a sudden, I was...it was concerning to say the least.” His hand came up to her forehead, lightly brushing away her bangs. His fingers were cool and felt pleasant against the warmth of her skin. Staring up at him, the soft stream of the moonlight accentuated his sharp, handsome features, and her heart stuttered again.

The furrow in between his eyebrows was irritating her. She hated when he made that face. Like he was disappointed in himself. For not having caught on sooner. As if any of this was his fault.

“I’m okay now though,” Fixing a smile that probably wasn’t all too convincing, Nina tried to reassure him. “And besides, this was on me. If I can’t handle it I’ll let you know next time. Alright?” Stop making that face.

He didn’t say anything for a while, seemingly content to just gaze down at her, as though he were trying to find something. Sadly, the brunette wasn’t in any state to try deciphering it now. His fingers had moved lower, caressing her cheek softly. “I’m sorry again for raising my voice earlier. I guess I was just frustrated you weren’t looking after yourself. You make it very easy to nag at you.”

Feeling slightly indignant at that, Nina pursed her lips into a small pout, but she quickly sagged again, too tired to reply in her usual spirit. Instead, she tried focusing on the feel of his fingers brushing on her skin.

“It’s alright. Really. I’m sorry too. For snarking at you.”

“Mhmm. That was hurtful,” What looked like amusement lit up his eyes, a minute smirk playing at the corners of his lips, “You even tried calling me a maple tree.”

“To be fair, you’re as prickly as a pine tree. So I guess it still works.”

Chuckling, Ethan shook his head a little, a quiet fondness crossing his expression as he watched the junior fellow’s eyes begin to droop.

“I should let you get your rest. It’d be a waste if you didn’t use this time to catch up on sleep,” With that he began to move away, retracting his hand and Nina already missed it. “Goodnight, Nina.” He whispered. As Ethan began to turn around and take his leave, the brunette let the silence linger for a second before speaking up one more time, voice so soft she wasn’t sure he’d be able to hear, “Please don’t say it like that.”

A pause. There were so many pauses tonight.

“...What?” Bemused, Ethan spun back around.

Nina avoided looking at him, keeping her eyes on the ceiling. “Whenever you say my name like that...it hurts.” He’d be able to pick up the rest of what she didn’t say. It hurts to hear you call my name like that. Like you’re saying everything and nothing all at once. Like it’s a wish you want desperately but can never grant. Like you lo- She blinked, turning her head slightly to him.

A deep sadness flashes across Ethan’s face, reflecting her own yearning back at her. He audibly released a breath, piecing together what he wants to say. What he can and should say.

“Nina, I...” It’s always the same game between them.

“...Yeah. I know.”

With that, Nina adjusted herself to at last allow sleep to take over, pulling up her blankets to her chin and shutting her eyes a final time, “Goodnight, Ethan.” In her growing drowsiness, she could hear faint footsteps crossing back to her, but she didn’t open her eyes again, sleep quickly overtaking her senses.

An undefined emotion tickled at the back of her head and her chest throbbed again. She already had an idea of what that feeling was. But tonight, she didn’t want to think about it. She wasn’t ready to give it its proper name. All she wanted tonight was to dream about blue eyes and low chuckles. In her dreams, she could feel a soft brush of her temple, the faintest touch of his lips. It’ll never really be enough, but tonight it was everything.

Fin.

tagslist: @openheart12 @ethandaddyramsey @noboundariesplease @ethanramseysgirl @sekizincimektup @drethanramslay

#open heart #playchoices #choices oph #ethan ramsey #ethan x mc #ethan ramsey x mc #choices fanfic #choices fanfiction #my shitty writing #GFJHSDGFJ pls don't let this flop i am fragile #jkjk honestly be free to make comments and criticisms #i will not take them well but i will read them #man i am so soft tonight #my god this is so long i really felt i had to write a novel #i applaud anyone who reads this till the end #or just reads it in general

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myheartrevealedocs · 4 years

Text

Untouchable- Ch 5: Poison (S1E13)

Summary: A Spencer Reid x OC fanfic that retells select episodes, starting in season 1, from the point of view of Lydia Ambers, a forensic scientist.

Warnings: murder, swearing, drugs

Ch 4 | Ch 6

~ ~ ~

Rain was such a strange thing in Lydia’s mind. The sound of it hitting the window next to her was soft and gentle, and so many people spoke of it like it was cleansing or refreshing. But all Lydia had to attribute it to was mud and sickness. It didn’t leave her excited for spring. She didn’t think of it as food for flowers or a new start. She thought of floods. Confinement. Tears…

“What’s up with you?” Spencer asked, startling Lydia out of her thoughts.

“What’s up with me? What’s up with you! You’re late!” she responded, watching him sit across from her at the booth and put down his coffee.

“I just got back from a case last night,” he defended. “I figured you wouldn’t mind if I took a little extra time to take a shower before leaving.”

She looked up at his hair to find it was indeed damp, but it could easily be from the weather outside. “Fine, you get a pass. Also, I don’t need you anyway,” she joked.

His face changed to one of hurt. “Wow. I mean, you don’t, but-”

“Sarcasm, Spencer.” She couldn’t help the grin spreading across her face. “Although, I am doing alright so far. I’m working on these extra assignments my criminology professor gave me. How was your case?”

“It went well. Found the unsub, saved the kid.”

She nodded. “That’s great!”

And they descended into silence, as they had the last time they’d met, both of them working on their own assignments.

After Lydia and Spencer had talked about helping her get her PhD, they’d made plans to meet off hours at a coffee shop so that Spencer could give her some advice for speeding up the college process. It had been terrifying at first. She’d been ready to completely back out, but Spencer had been insanely patient with her, able to convince her (after some rambling and statistics) that she was more than capable. He’d advised her who to talk to and what to ask teachers about their courses and so on to organize her thoughts. And then he just… sat with her as she worked. If she was ever confused on an assignment, he had her back. It was reassuring.

About halfway through their meeting, Spencer had put away his paperwork in favor of a book, but he found his pace excruciatingly slow. He wanted to invest himself in it, but he couldn’t stop himself from looking up at her when he knew she wouldn’t notice.

When she was extremely focused, her teeth would pull mindlessly on the dead skin on her lips. That’s what she’d been doing when he got there and saw her gazing out the window, not even realizing he’d walked in. But he hadn’t wanted to push her on that. And now all her energy was focused on her online work.

He also noticed another small tick when she was struggling with a question, because she always did it before asking him for help.

“How long have you worn a ring?” he asked her, watching her spin it loosely around her knuckle. It was a thick silver band, which was clearly too big for her fingers, and she was constantly switching it between the pointer and middle finger on her right hand.

She raised an eyebrow, but her manor was curious, rather than questioning. “I’ve had this ring since I was 16. Why do you ask?”

“I’ve just never seen you wear it before, is all.”

“It was my dad’s wedding ring,” she confided. “And you’re right. I don’t wear it when I go on cases, because getting latex gloves on and off is hard enough and I’m terrified of losing it.”

He took this answer gracefully, but Lydia could tell he was dying to ask why she had her father’s wedding ring rather than him. And before she could go back to her work, he spoke up again.

“You know, I’ve been really curious about something and you’ll have to forgive me if it offends you, but when we met, I asked you about why you had a limp and you didn’t tell me.”

She silently let go of a sigh of relief that this wasn’t related to her father (or at least, not to his knowledge). “Yeah, sorry about that. I know I was… weird that day.”

“So was I,” he reassured her. “But I’m kinda weird all the time.”

It was a sweet sentiment, but she was quick to shake her head at him. “Not at all. ‘Weird’ to me is far from the definition of Dr. Spencer Reid.”

It was like his eyes sparkled when he smiled at her. She found herself wanting to see it all the time and had to keep herself from staring.

“Right. My leg. Well, in actuality, my foot. I broke it when I was a teenager and it healed incorrectly,” she explained. “The arch is all sorts of messed up. But it doesn’t hurt and I can’t afford surgery anyway so I just let it be.”

“I’m sorry.”

She laughed, absurdly. “What for?”

“You didn’t want to get your PhD, because you couldn’t afford to go through any more years of school than you needed to and now you tell me that you’ve got this limp for the same reason? I don’t want to make any assumptions about your financial status, but I honestly do feel sorry that you think you need to sacrifice these things for it.”

This comment seemed to trigger something in Lydia and Spencer racked his brain for any indicator of what that may be.

“Well, I’m here, aren’t I?” she responded, but it didn’t have her previous spark of interest in the conversation, so he just agreed and let her go back to her work.

~ ~ ~

“You missed the briefing,” Gideon informed Lydia as soon as she picked up her phone. It had been a week since she’d had her second meeting with Spencer and she was sitting in her apartment, working on her schoolwork.

“What briefing?”

“Jet leaves in 30 minutes. You’re needed on a case.”

Lydia scoffed. “Gideon? That’s not a heads up. This would be my 3rd case before my 50 day limit was up, why am I coming along?”

“Do you want the job or not?” he asked, frustrated, but Lydia could tell it was just his impatience.

“Of course I do. I’m on my way. But I know there’s got to be a good reason to call me in after a briefing and against Chief Strauss’s wishes.”

He sighed on the other end before continuing. “We’ve got a poisoning case. LSD. You’re a chemistry expert, so I need you.”

“Reid’s definitely more of an expert than I am. But I’ll do what I can.”

“If we all determined our worth to the team by comparing ourselves to Reid, it wouldn’t be a team… it’d be Reid,” he argued. “I’ll see you on the jet.”

~ ~ ~

“How do you want to handle the press?” Gideon directed to JJ as they all settled down for their flight.

“We still don’t even know how these people got dosed. I think it would be irresponsible to issue a warning without specifics,” she reasoned. “It’ll just cause panic. I did notify the local PD, though, to be discreet.”

“How is it possible that none of these people knew how they got poisoned?” Morgan asked and before Lydia could stop herself, she murmured,

“It’s possible.”

JJ and Morgan both looked at her with concern, the rest of the team just stayed silent and they considered how this case might affect her after what happened with her roommate. The effects of her sudden drugging had been vastly different, but in the end, Lydia could understand the victims of this situation and how they must be feeling now that they’ve come out of their intoxicated state.

Hotch cleared his throat, returning to Morgan’s question. “None of them remembers anything about the day it happened.”

“These people are so messed up, it’s made it difficult for local PD to retrace the victims’ steps,” JJ explained.

“I suggest we split up the victims, see if there’s a pattern in the victimology,” Gideon began.

“Most of them are still in the hospital,” Hotch told him. “I’ll call local PD to meet us there.”

“I’ll check the lab reports,” Spencer offered. “Maybe there’s a clue to the unsub’s motive in the specific nature of the poison he used.”

“Ambers, you’ll go with him,” Hotch ordered, handing her her own file to review the details of the case. “I want you to be supervising the lab tests and keep us updated on everything you find. Especially if any new victims come in.”

“I-” She blinked down at the reports and pictures she’d just been handed. “Unchaperoned?”

“You aren’t a girl in the Regency Era,” Gideon teased. “You can handle it.”

“Don’t break any lab equipment,” Hotch insisted. “But yes, since we don’t exactly have a crime scene for you to analyze and you have experience in the lab as well, I want you there. Don’t worry about having a supervisor for now.”

She nodded, wanting to accept before he changed his mind. She didn’t miss Gideon’s smirk either as she accepted her new assignment. He was excited for her.

And she was kind of excited, too.

~ ~ ~

Spencer kept pace with Lydia as she navigated the hospital for the clinical lab. She was surprisingly confident in herself, finally getting to work a case that wasn’t up to suspect. She didn’t have to wonder about the colors on little girls’ paintings or try to date the wax underneath a satanic symbol. No, labs were natural sciences.

And she was an expert in those.

They were met at the door by one of the biochemists. “Hi. You must be the FBI agents. I’m Dr. Marilyn Keyes.”

“Hello. I’m Dr. Spencer Reid with the Behavioral Analysis Unit and this is our forensic expert, Lydia Ambers.”

Lydia did her best to greet the woman calmly, but her heart rate picked up when Spencer called her their ‘forensic expert’. She made a mental note to ask him about it later, seeing as she definitely was not considered an expert on the team. She was an intern.

“Alright, I’ve got the results from the blood tests here, but there isn’t much to say. The LSD levels were scarily high.”

“Were there traces of any other drugs in their system?” Spencer inquired.

“Only one,” Dr. Keyes replied. “Rohypnol.”

Lydia raised an eyebrow and turned to find Spencer doing the same. “But rohypnol is a roofie. If the unsub’s goal was to give a bunch of people a wild trip, why give them a sedative?” she asked.

“Because one of the most well known effects is amnesia,” Spencer reasoned, but Lydia shook her head.

“I just don’t see what would make a person poison all these people with a strong hallucinogen and then knock them out before seeing the effects.”

“But it didn’t knock them out,” Spencer argued. “They all still went about their day as normal.”

“Mixing drugs to get a precise effect like that is insanely difficult. This guy has to have some background in science.”

“One of the victims, Jack Fisher, got extremely violent and beat his son almost to death.” Lydia’s eyes shot open. This was news to her, seeing as she missed the briefing. “Are you sure there wasn’t anything like PCP in their systems to cause an aggressive outburst?”

Dr. Heyes shook her head. “We only found LSD and rohypnol.”

“If you don’t mind, I’ve been assigned to oversee the lab work on any new cases brought into the hospital and to keep my team informed of the information as it comes in. May I stay in here?”

Dr. Heyes seemed surprised by the request, but nodded. “Of course. I’ll find you a space to set up.”

As she did that, Spencer turned to go. “I’ll go tell the team what we know so far. Call Gideon or me if you figure out anything else.”

“You got it.”

With him gone, Dr. Heyes paused, her eyes wide. “He’s a doctor?” she asked, completely bewildered.

Lydia laughed. “Yes. He’s got 3 PhDs, in fact.”

If Dr. Heyes’s jaw could hit the floor it would have. “And you, you’re an FBI agent?”

“No,” Lydia said quickly. “No, I’m just an intern. They only sent me here because I’m the only one on the team who was trained in a lab setting. I just got my BS in chemistry.”

She decided not to mention Reid’s credentials, mostly because if the biochemist asked why they didn’t leave Reid here instead, she wouldn’t know what to say.

“But you are so young! You don’t even look like you’re 20 yet!”

“I’m 21,” Lydia assured her. “And he’s 24. Which to be honest, is extremely young to have 3 PhDs, but you know, he’s older than I am, so I think him being an agent is less of a stretch.”

“When did you get a job with the FBI?” she inquired.

“After I graduated this past spring. I’d met them while they were working a case and I guess they were in the market for someone knowledgeable in forensics. Here I am!”

It was a lie, at least to Lydia’s knowledge. The only thing she knew about the offer put in front of her was that Gideon fought for her to get it and Hotch’s boss, Chief Strauss, was not pleased that the position existed at all. But Dr. Heyes took the response and left her to pull out her laptop and try to remind herself about everything she learned about spiking and these specific drugs when she went to UCSC.

~ ~ ~

“We’ve found another victim,” Gideon informed her over the phone. “Her boyfriend worked at the cafe where many of the victim’s had been seen the day they were dosed. We brought him into custody, but it doesn’t look like he did it. And, from what you’ve told us so far about the process of creating this mix of drugs, we’ve ruled out a prankster. They're too disorganized to do this. From a look at other factors we think we’re looking at an avenger here.”

“So, someone’s got a personal vendetta against one of the victims and the rest are just collateral damage? Or was this just his test run?”

“My guess, when he gets the person he’s going for, it’s not exactly going to end in a bad trip and some memory loss.”

Lydia sighed. “One hell of a test run. I mean, I’m looking at these results, Gideon. And the statements from the victims. This guy has made quite the concoction.”

“The profile says he may have an accomplice, but if so, he’ll dispose of them soon. If any new cases come in, let us know immediately.”

“Will do,” she said, hanging up on him.

Not 20 minutes later, her phone was going off again, this time it was Spencer.

“Hey.”

“The hospital’s about to be swamped. We’re on our way there now.”

“Swamped? Why?” she demanded, looking up at all the biochemists and pathologists at work. Shit.

“A leak hit the news. They didn’t mention why or how people were getting dosed, only that it was happening. The people are in a panic and many people are going to come in with completely psychosomatic symptoms.”

“Fabulous,” she grumbled. “Well, I can give you the results of any of the tox screens, but they won’t be in for a while. Especially if people start barging in.”

“We’ll talk to doctors and nurses and find out who is definitely not psychosomatic. Make sure that their blood gets tested first.”

“We’ll be ready,” she assured him.

~ ~ ~

“We’ve got a Lynn Dempsey,” Dr. Heyes said, offering up her lab results. “She just got in, tested positive for rohypnol, but negative for LSD.”

“Interesting,” Lydia said, scanning the file. “Maybe she just got roofied?”

“That doesn’t explain her symptoms, though. She was apparently heavily sedated when she got in, but now, she’s struggling to breath. Nausea, difficulty swallowing, and she’s lost control of leg movement.”

“What are you guys thinking?”

“She was taking an antibiotic recently, which, in the case of a severe overdose, could cause these symptoms, but an overdose like that is not an accident. That plus rohypnol is an interesting mixture.”

“Have you guys looked at any biological toxins?” Lydia inquired and she shook her head.

“We didn’t think that was the sort of thing we should be looking for.”

“It’s hard to determine what we should or shouldn’t be looking for. The LSD and rohypnol combination was interesting enough by itself. If this guy’s as good as he appears, I doubt he’s buying drugs from street dealers. He could have access to all sorts of things.”

“I’ll get on it,” the doctor informed her and hurried off.

Lydia grabbed her phone. “Gideon?”

“Whatcha got?”

“Lynn Dempsy? Rohypnol and something else. The lab technicians are working on it now. But, she’s a bad case. Either the target or the accomplice.”

“You get Garcia, I’ll call Hotch. He’s on his way to the hospital now. JJ and Reid are already there, they might have already seen her.”

“Got it. Calling Garcia now.”

She fumbled with her phone some more and got Garcia’s contact.

“Sugar! How can I help?”

“The team’s gonna need everything you’ve got on a Lynn Dempsey. We’re looking for connections to the substances the unsub’s using or perhaps anything to indicate someone wants revenge against her.”

The sound of her furious typing could be heard over the line. “Alright. I’ll send whatever information I get to their phones. Right now, all I’m seeing is that she works for Hichcock Pharmaceuticals.”

“There’s something to that. Let Gideon know. I’ve gotta go,” she finished, seeing Dr. Heyes already on her way back with papers in her hand. “Did you find something?”

“Lynn Dempsey has been exposed to clostridium botulinum bacteria,” she explained.

Lydia’s eyes widened. “Botulism?”

The doctor nodded.

Lydia was up from her seat in an instant. “I’ve gotta tell Reid. I’ll be right back.”

She threw her phone into her back pocket and ran from the lab to get to the ER.

“Reid!” she called once she reached the waiting room. He turned, JJ following suit. Hotch was on a call over the front desk. She ran up to them, not wanting to disturb anyone around them. “It’s botulism.”

“Is that what the lab reports say?” he demanded, pulling her away from the people and into a hallway.

“Yes.”

“Botulism toxin is the deadliest substance known to man. It blocks acetylcholine receptors, paralyzing it’s victims until basically choking you to death,” he explained, knowing Lydia was already aware of this.

“And without an antitoxin, Lynn Dempsey in there is screwed.”

He put his hand up to his chin. “New Jersey is the pharmaceutical and chemical capital of the US. There’ll be quite a few people with access to the toxin. It could easily be ordered in the form of botox.”

“But, it’d have to be purified,” she reasoned. “Lynn Dempsey is an executive assistant. She wouldn’t know how to do that. And she doesn’t fit the profile. But, she does work for a pharmaceutical company, so if she’s the accomplice, they might have met at work.”

He opened his mouth to add to that, but JJ called, “Reid.”

She was standing in front of Dempsey’s room, looking in.

“I think she’s trying to say something.”

He ran over to enter the room with her and Lydia walked over to Hotch to see if there was anything she could do.

“Then, you should look for Lynn Dempsey, 45,” he was saying over the line. “Garcia’s emailing a picture to your phone.”

There was silence for a moment, and Lydia watched JJ and Reid try and piece together what Dempsey was saying to them. But, the doctor had to rush in as her heart rate started increasing quickly.

“Or working with him,” Hotch offered, but Lydia wasn’t sure of the context. “I’ll call you back. Lydia, what are you doing up here?”

She looked up at Hotch and was terrified for a moment that she’d done something wrong. “I came up here to talk to Reid about Dempsey. She’s been poisoned with deadly toxin found in botulinum bacteria. And without an antitoxin within the first 36 hours, she won’t make it. Reid and I were discussing how the unsub might have gotten this toxin.”

“What were you thinking?” he asked.

“Well, Lynn works for a company with access to this toxin, but it needs to be purified from other drugs. She likely wouldn’t have this ability. We were thinking accomplice.”

He nodded. “That’s what Morgan and I were discussing. We found all the victims went to First New Jersey Federal Bank the day they were dosed and from the security footage, it looks like Dempsey was replacing candies from the candy bowl. The CDC is testing the candies now.”

“Alright. I’ll head back to the lab and start listing off any new victims that come into the hospital.”

“Thank you,” he responded and watched her go.

~ ~ ~

“So, if they worked together, let's start with people who fit the profile who’ve had a recent stressor,” Hotch reasoned, the rest of the team together in the station.

“Like anyone fired from Hichcock in the past 6 months,” Morgan offered. “I’ll call Garcia.”

Gideon’s phone went off beside him. He picked it up and announced, “It’s Lydia. Lydia, you’re on speaker phone.”

“Hey, you said you thought Lynn Dempsey was replacing the candies at the bank?” she started.

“Yes, why?”

“I’m looking through the medical records of the original victims and one of them was severely diabetic.”

“He wouldn’t have taken candy from the candy bowl at the bank,” Reid realized.

“That doesn’t make sense,” Hotch said. “We have the candies here and they’ve tested positive for rohypnol and LSD.”

“Well, not that it means that much, but the amount of LSD in the victims was fairly even across the board, but I’m finding vast differences in the rohypnol. It could be that some of the victims didn’t finish the candies and others did, but I think you should look at those tapes again and check if everyone took a candy. Maybe the unsub contaminated multiple objects at the scene?”

“It’s a bank, what else do you ingest that comes from a bank?” Gideon argued.

“I’ll look over those tapes,” Reid offered. “Thanks, Lydia.”

~ ~ ~

Lydia was finally starting to settle down, thinking she’d done her part in the case now that the last of the tox screen tests had come through and they hadn’t turned up with any strange new victims, when Hotch called her.

“Hello?”

“Ambers, we’ve got a guy named Ed Hill in custody. I want you to search his lab for any indications as to what he planned to do next or who his target was. I’m having Garcia send you the address now.”

“Wait, Agent Hotchner-” she cried, knowing he tended to hang up abruptly. Once she was sure he wasn’t going to cut her off, she continued. “I don’t have a vehicle with me.”

“Nevermind, then. I’ll have Morgan get you.”

“Thanks.”

“And Lydia?”

“Hm?”

“Hotch is fine.”

She bit down on her lip to stop herself from grinning like an idiot. “Got it.”

Once he’d gotten off the phone, she closed up her laptop and grabbed her case file.

“Leaving?” Dr. Heyes asked.

“Yes. I’m off to analyze a scene. Thank you for all your help today.”

She smiled. “Thank you for catching the guy who did this.”

“We’re not sure yet-” she started, but left it there, not sure how to continue. Dr. Heyes understood and let her go, but it left Lydia with an inexplicable feeling.

No one had ever thanked her before for her work. Not that she’d done a lot of work before this and when she’d interned at the police station in Santa Cruz, almost all of her time was spent in a lab. But, it nevertheless felt nice to know that people thought she was doing good.

And as she got to the front of the hospital and waited for Morgan to pull up she realized something. While she was here, working for the BAU, she was doing good.

~ ~ ~

The jet was silent on the way back to Virginia. Almost as soon as they boarded, everyone found a spot to rest and had fallen asleep. Lydia had considered shutting her eyes and trying to join them, but deep down, she knew she wouldn’t fall asleep. And without something to distract her, she’d end up letting her thoughts wander, which recently hadn’t ended well for her.

A quick look at the scene and a confession from Ed Hill was the end of the case. Unfortunately, they weren’t able to prevent his suicide, but she had far too much on her mind to dwell on that as well.

Lydia thought about Jenna fairly often, unsurprisingly. She wondered sometimes if she’d been aware of the other two girls’ deaths, maybe she would have been more alert and able to prevent Jenna’s. And she was constantly thinking about what had happened between the last thing she remembered and the time that Jonathan Carrey drugged her. Did she see or hear him before he was able to sedate her? Maybe she’d tried to scream, but couldn’t. Mostly, she wondered if she’d done something dumb, like opened the door for him or simply asked him why he was there.

She knew that in that memory relapse, if she’d called for help, Jenna could have made it out just fine. That was mostly why it hurt.

The other reason was because she had profited so greatly on Jenna’s murder. She’d gotten a job. And it made her feel guilty that any good could have come to her at the expense of another. She just had to hope that Jenna didn’t despise her for it in the afterlife.

But Jenna wasn’t the only death on her mind. Recent events had reminded her of her mother’s death and despite the fact that Lydia had long since recovered from the emotional toll it took on her as a child, she’d likely never have closure over what happened and it was difficult recently to be reminded of that.

But either way, she was glad her job allowed her to give closure to the families of other tragedies.

“Aren’t you going to sleep?” Hotch asked, sitting across from her and nodding towards the book in her hands.

She smirked and made the same motion towards the cup of coffee he just made for himself. “Aren’t you?”

“I know I’m going to have a lot of paperwork when I get back. I’m preparing myself for that.”

She closed her book and sat up straighter. “I’m not much good at sleeping without help. I’ve had to take sleep aids for most of my life.”

“I’m sorry,” he told her, honestly.

“It’s never really been an issue unless I haven’t had access to any. I’m sorry you have to stay up late filling out paperwork,” she returned.

“Lydia,” he started after a pause. “I’m truly sorry if I’ve ever made you uncomfortable while working this job. I want you to know that I don’t have anything against you, I was just stressed your first few cases.”

“That’s alright,” she reassured him, quickly. “I’m not upset. I was worried that perhaps I was doing something wrong, but I didn’t realize how much my behavior affected your job. And Gideon’s, although I don’t control what he does. I can’t promise that I won’t end up doing something stupid and getting myself fired, because sometimes things happen, but I promise that I will do everything in my power to make it clear that you and Gideon aren’t responsible for my actions.”

“Well, we are,” he argued, which made her giggle, quietly.

“Besides, I get to call you Hotch now. That must mean we’re best friends.”

“Best friends, hm?” He wiggled his eyebrows at her over the rim of his coffee cup and took a large sip.

They’d settled into silence and Lydia was about to pick up her book again, when he said, “Lydia? I want you to know that I was given access to some of your family history when we were considering hiring you…”

A part of her had been wondering if this conversation was going to come up. Gideon had talked to her about her sister, but he never pushed her to talk about her parents. And Garcia had let the topic go after they had their conversation about secrets, leaving Hotch, who she’d never had a private conversation with before, to be the one to confront her.

“Garcia told me that you’d get the information from her background check,” she agreed. “Why?”

“I wanted you to know that sometimes these cases become difficult when they remind us of something personal. And I want you to be aware that if you are struggling while working on a case or something personal is on your mind, we’re all here for you. The team is just that, a team, and many have been through similar things to you. I want you to know that you aren’t alone in this.”

Lydia could feel tears pricking at her eyes. She didn’t think she’d ever reach the point where she broke down in front of one of them. She’d gotten so good at stopping herself that sometimes it scared her. But the offer was one of pure concern. Hotch had built a family in his team and he was opening his arms to her.

And she wasn’t really sure how to show him that she understood.

“On my first case,” she began, “we took Allison Crawford’s brother into custody. Frank. And he had an orange prescription bottle with him.” She remembered the details slowly, trying to piece together what she was thinking at the time. “And it was weird to see. Because it’s not like I don’t see those anymore, I do. But that one made me think of my mom. And it made me angry.” She shook her head, pulling herself out of the memory. “It was gone before I even knew what was happening. I’m not particularly worried about an inability to do the job. But I guess, that’s something.”

She was grateful to look into his eyes and see that he understood. And it had been a long time since she felt like she could speak openly about her life to someone and not feel weird. Or like a burden. Or pitied.

“It’s the same as when people call me Miss Ambers. I know they mean it respectfully, but it always takes me back to sitting in psychiatry or therapy offices with her. The doctors always called her ‘Miss Ambers’.”

Unbeknownst to her, another person on the plane who could imagine what she was going through had been drifting in and out of sleep and heard her confession. Reid didn’t open his eyes, afraid that she might be upset if she found out someone other than Hotch had been listening. But he took in the bits he had picked up and decided that he would keep collecting pieces of Lydia’s story until he could make out a picture of her life.

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chuffyfan87 · 5 years

Text

It's Not Me Is It? Part 3a

Not a word was spoken as Charlie followed Duffy into the room. He sat down on the edge of the bed and watched as she placed the tray on the desk and pulled out the chair to sit on. Reacting to her continued silence he turned his head to explore the room, his eyes quickly adapting to the low light coming from the lamp on the desk. He smiled softly as his gaze came to rest on his daughter who was snuggled up fast asleep in the bed, her hair falling over her face as she sucked her thumb.

Duffy sipped her tea and watched Charlie. Seeing the way he looked at Charlotte made her heart ache. She hadn't meant to hurt him by keeping it all a secret, she'd just... Well, she didn't know what she'd meant to do really. At first her actions had been propelled by fear but over time it had simply become habit, every passing day making it harder to come clean to him.

"Were you just going to not tell me til she was eighteen and suddenly turned up on my doorstep?" He whispered bitterly.

His tone instantly struck a nerve. "If you've just come to pick a fight then you can bugger off!" She hissed, trying to keep her voice low so as not to wake Charlotte.

"Duffy..." He sighed. "Do you honestly expect me not to be angry about this?"

"So this is all about you is it?" She scoffed, rolling her eyes.

"You saw what I went through when Baz took Louis away and yet you still chose to lie to me."

"What would you have done if I had told you?"

"I would have been there for you and them..." He began.

"You'd have 'done the right thing' you mean?" She interrupted bitterly.

"Yes! But you didn't even give me the chance." He sighed.

"I'm not prepared to be settled for Charlie. You made it quite clear who you wanted and it wasn't me."

Charlie sighed. "I thought you felt it was a mistake. I didn't want to make things worse or more awkward."

"You just left, you didn't really give me chance to say much of anything!" She shot back.

Charlie rubbed at the back of his neck. This wasn't getting them anywhere! An awkward silence fell over them as Duffy ate the toast and finished her tea.

Charlotte rolled over in her sleep but didn't wake up.

"Tell me about her." Charlie whispered, changing the direction of the conversation, his eyes fixed on the little girl once more.

"What do you want to know?" Duffy asked, a small smile pulling at the edge of her lips.

"Everything!" He laughed softly. "What does she like to do? When and where was she born?" There were so many things he wanted to ask but he didn't want it to seem like an inquisition.

"Her birthday is May 5th and she was born in Auckland. She loves looking at picture books and running around at the beach. She has lots of friends at the local playgroup we go to twice a week. She's very kind and thoughtful but can also be so cheeky when she wants to be!" Duffy laughed.

"That doesn't surprise me!" Charlie chuckled. "Is she the reason you left Cambodia and went back to New Zealand?"

Duffy nodded. "After what happened with Paul I knew it wouldn't be a good idea to give birth in Cambodia. I originally planned to go back afterwards but the boys were beginning to hate being in Thailand so I made the decision to stay in Auckland and make occasional visits back to the clinic when I could."

"She's a well travelled little lady then?" He smiled. "She looks just like you."

Duffy blushed. "Everyone says that but I see so much of you in her too. Not quite as much as I see in Paul but I guess it's just a matter of time."

Charlie looked up to catch Duffy's eye. "I really wish things had been different." He sighed.

"With the two of us trying to play happy families together?" She couldn't help the edge in his voice.

"Why are you so convinced it would have been a disaster that you weren't even prepared to try?"

"Neither of us has ever been able to make a relationship work for more than five minutes. I didn't want to risk losing you as a friend. It was too much of a gamble."

"Have you ever stopped to consider why our relationships have always failed?"

"Is this where you tell me you've been secretly in love with me for years and that no-one compares to me no matter how hard you try?" She retorted sarcastically.

"And have you laugh in my face? No thanks!" He shot back as he stood up and headed towards the door. There was just no point arguing when she was in this kind of mood.

"And you complain that I'm the one that always runs away..!" She mocked.

"There's no point Duffy. You just seem determined to punish me. I've told you I'm sorry but that's still not enough. I thought I knew you as well as I know myself but it seems not because before today I would never have thought you capable of such cruelty."

Duffy sprang to her feet. "How dare you! How bloody dare you! You think you're so high and mighty that you can just glide through life from one woman to the next unable to make up your mind and then you have the audacity to sulk when one of us decides we're done with your shit and don't want to expose innocent children to it!"

"My shit?! You're not exactly an angel yourself Duffy! You'd rather try and raise four kids by yourself like you're some kind of bloody superwoman than let someone else into your life. I shouldn't really be surprised, it's exactly what you did to Andrew too!"

This time Charlie saw the slap coming and was able to catch hold of her wrist split seconds before it made contact. They were practically toe to toe, their faces so close that despite the dim light he could see the fire burning in her eyes that matched the one that was fast igniting within him once more...

Her closeness and fire were intoxicating to him. He closed to gap between them and captured her lips with his own. Several moments passed as they became lost in the kiss, their tongues fighting for dominance before she pulled back slightly.

"You arrogant son of a bitch!" She hissed but she didn't fight to remove herself from his arms.

"You love it really." He replied smugly.

"In your dreams!" Duffy retorted as she stepped away from him and went over to Charlotte who was becoming restless from all the noise. "Ssh sweetheart go back to sleep." She soothed as the little girl's eyelids flickered open.

"Mama?" Charlotte mumbled sleepily.

"I'm sorry princess, we didn't mean to wake you up." Duffy sighed, rolling her eyes as Charlie's phone began to ring.

Charlie glanced at his phone. Why was work ringing him now? "I'll, um, I'll take this outside." He mumbled, heading out into the corridor but leaving the door slightly ajar. "Hello?" He answered, sighing as Duffy slammed the door shut behind him.

Charlotte's face screwed in confusion as she watched her mum. She rubbed at her eyes. "Mama?"

"Yes princess?" Duffy replied as she sat down on the bed.

"Who that man?"

"He's..." Duffy hesitated. "He's... My friend." She sighed.

"Why you sad?" Charlotte asked, shifting to lay her head in her mum's lap.

"I'm OK." Duffy sighed, absentmindedly wrapping her daughter's curls around her fingers.

"Love you mama." Charlotte murmured as she cuddled closer.

The little girl had almost fallen asleep again when there was a light knock on the door.

"Go away!" Duffy sighed.

"Duffy, please!" Charlie replied. "I need to talk to you, its important!"

"Charlie, I'm tired. Won't Louis be starting to wonder where you are?"

"He's at summer camp." Charlie sighed. "Please will you just open the bloody door? This is ridiculous!"

"Just go Charlie! So help me if you wake my daughter up again..."

"Our daughter, Duffy, you can't keep running away from that!"

Charlie sighed as he received no reply. He really didn't want to have to do this through a closed door but she was leaving him with no choice. "Duffy... That call was from the hospital. Megan has been admitted. It... It doesn't look good..." He choked out.

Duffy gasped. "I swear if this is a ploy to get me to let you back in..." She muttered as she opened the door. The rest of her words died on her lips as she saw Charlie's face. "No..!" She whispered, her eyes filling with tears.

Charlie held out his arms towards her as she crumpled into his embrace, her tears breaking free and running down her cheeks. "Come with me to the hospital?" He suggested softly.

Duffy nodded, wiping the tears from her cheeks as she re-entered the room, emerging moments later with a sleepy looking Charlotte.

Very little was said by either as Charlie drove the familar route to the hospital and pulled up in his usual parking space. He was about to climb out of the car when suddenly Duffy reached out and grasped his hand.

"She has to be OK. I'm not ready..." Duffy whispered, her voice small and breaking.

Charlie pulled her into a hug, placing a soft kiss on her hair. "We'll do this together." He promised.

"OK." Duffy replied before getting out of her seat and moving towards the back of the car.

"Please let me..?" Charlie asked as he opened the back door of the car.

Duffy nodded, allowing Charlie to pick up Charlotte and carry her.

Charlie's heart swelled with love as the little girl moved to wrap her arms around his neck, burying her face into his shoulder.

They entered the department and Charlie quickly located Tess. "Can you take us through to Megan?" He asked.

Tess nodded, giving Charlie a bemused look at his companions.

Noticing the look Duffy forced a smile at the other woman. "Hi, I'm Duffy. I, um, used to do your job." She explained.

"Oh, you're Duffy..!" Tess replied.

Duffy's eyebrow rose in response, her eyes narrowing as she turned to Charlie for an explanation.

"Tess, um, she was working here when I went over to help you with the clinic."

"I see." Duffy commented though her tone betrayed the fact that she wasn't completely convinced.

They arrived at the doors to resus. "Would you like me to keep an eye on her whilst you go in?" Tess offered, turning to Duffy.

Duffy hesitated. The nurse in her knew that resus was no place for a three year old but at the same time she wasn't comfortable with leaving Charlotte with someone she'd just met.

"How about if Tess stays right here with Charlotte so you can still see her through the doors?" Charlie suggested.

Duffy reluctantly agreed but she turned away as Charlie handed Charlotte over.

Charlie reached out to wrap a comforting arm around Duffy's shoulder as he guided her into resus.

Duffy looked around the room that up until a few years ago had been like a second home to her for so long. The comfort of the familar was quickly replaced by stomach churning fear as she took in Megan lying attached to so many wires and machines. Seeing the tools of her trade attached to a cherished friend was something she'd never get used to.

Charlie stepped towards the bed and gently took hold of the older woman's hand. "Megan, we're here." He whispered. Noticing that Duffy was rooted to the spot he reached out with his other hand, taking hold of hers and moving it so that it was nestled between his and Megan's.

Duffy smiled softly, taking great comfort in the familiar warmth of Charlie's hand. Despite the mess they'd made of things between them she couldn't help but feel at home when she was with him. Maybe that's why she'd pushed him away - the fear of becoming so reliant on that feeling for comfort once more. She lay her head against his shoulder. "I'm sorry." She whispered.

Charlie turned and placed a light kiss on her forehead. "I'm sorry too."

"There's so many things I want to say." Duffy sighed squeezing Megan's fingers.

"I know what you mean. Too many things have been left unsaid for too long. She said I needed to let you speak and actually listen to what you say." He sighed. "I've not done a very good job of that have I?"

Duffy chuckled lightly. "Neither of us has ever been much good at that really."

"Please let me be a part of their lives. And yours."

"How do you plan to do that?" She asked.

"Come home Duffy." He begged. "Come back to Holby and we can make things work."

"I can't just rip the boys out of school and uproot them from everything they know."

"You did just that when you originally decided to run away to New Zealand with Ryan and then again when that all went tits up and you decided to move to Cambodia."

Duffy pulled her hand away and step back from him. "You still can't cope with the fact that I decided there was a life for me beyond these walls. You're still stuck and one day very soon this is all you'll have left. You'll be a bitter old man with nothing to show for his life."

"She's got a point Charlie." Megan remarked in a croaky whisper.

"Megan!" Charlie gasped.

"Must you two fight when I'm trying to sleep?" Megan grumbled.

"Sorry." They both mumbled, chastised.

"I'd like to go home now." Megan asserted.

"I'm not sure that's a good idea..." Duffy began.

"I've spent enough of my life in this hospital, I don't intend to die here too."

"You can't go home by yourself though." Charlie countered.

"Lucky I know a couple of highly qualified nurses then isn't it?"

Duffy rolled her eyes. "Subtle Megan." She smirked.

"Indulge an old lady in her final days?" Megan smiled.

"Please stop talking like that!" Duffy begged, her voice breaking.

"Time to face facts Duffy." Megan sighed, growing tired.

"If you rest for a while I'll go see what I can do." Charlie offered.

Megan nodded, realising she'd have to play it Charlie's way if she was to have a chance of getting what she wanted.

"Keep an eye on her and make sure she behaves!" Charlie remarked to Duffy. "I'll be back shortly." He added before leaving resus.

"I don't know what he thinks I'm going to do." Megan grumbled.

"I think we've both learnt never to underestimate you." Duffy replied. "You're supposed to be sleeping."

"Hmm..." Megan retorted dismissively. Silence descended and Duffy pulled up a chair. She thought Megan had fallen asleep when suddenly the older woman spoke again. "I'm so pleased you came back."

"As soon as I read your letter I knew I'd never forgive myself if I didn't." Duffy admitted.

"You and Charlie really need to sort things out."

"It's not quite that simple." Duffy sighed.

"That's only because you two insist on making things so complicated."

"How is it not complicated? Me and the kids live in Auckland and he lives here. I can't just uproot them because he's the most bloody stubborn person I've ever met!"

"He's not the only one who's stubborn Duffy."

"So you're taking his side..?"

"I'm not taking anyone's side, pet."

"Urgh!" Duffy ran her hands through her hair. "This was all so much easier before today." She sighed.

"Easier maybe but neither of you can be truly happy til it's all out in the open and resolved."

"I don't have a clue how I'm going to resolve this." Duffy admitted.

"Well you've taken the first step by telling Charlie that he's Charlotte and Paul's dad." Spotting the look of shock on Duffy's face Megan continued. "Yes I know all about that little secret too. Anything else you fancy confessing to whilst we're here?" Megan asked pointedly.

"With Paul I honestly wasn't sure for a long time." Duffy sighed. "I know that doesn't make me sound very good so feel free to judge my 'loose morals'..."

#chuffy #charlie and duffy #charlie fairhead #lisa duffin

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carmintros · 5 years

Photo

@ariwalters / ❛ ｡ ✩ ﾟ my eyes are probably playing tricks on me again, but is that really awsten knight? oh, wait, it’s just adrian “ari” lance walters. yes, that twenty-four year old drummer, who i am pretty sure is a visitor. according to the talk of the town, he is incredibly flighty & unpredictable, yet undeniably outgoing & adventurous. that is precisely why a playground at dawn, a carnival ride that just keeps spinning, chasing waves on a beach, laughing until you cry & jackson pollock paintings remind me of them so much, but then again you know what they say about leos, we’ll see how that one turns out ! penned by kit / mst & they / them

car crash tw, ptsd tw, alcoholism tw

Ari Walters

Age: 24

Gender: Non-binary, he/him

[Between the Bars] - “Haha, not totally sure why this one comes to mind but like everyone says it’s like me with alcohol and stuff but I don’t really see it, I think I’m fine.”

D.O.B: August 15, 1995

Why the name Ari?

“Oh! I was named after my dad ‘cept he was always called Adrian so they called me Ari so no one got confused or anything!! It always worked really good too!”

Ethnicity: white

Relationship Status: In multiple relationships “I fall a little in love with everyone, I think, because everyone is beautiful and wonderful. I’m kind of the classic definition of poly, lol. People underestimate how much communication that takes though!”

Sexual Orientation: pan “Like I said, I fall in love with everyone! I can’t help it, haven’t you ever watched someone go about their life and you can just tell if they’re gentle or rough, if they need love or if they’re loved, et cetera? I love it and I love them.”

Appearance:

Height: 5’7

Ari resembles a puppy with ADHD. He is constantly moving, constantly engaged with the world and constantly interacting with everyone around him. He has to be active. If he sits still he might fall asleep and he still gets nightmares of the wreck.

His signature ‘thing’ has been his dyed hair for years. He doesn’t think he would recognize himself without it at this point. He thought about dying it back to brown for April Fools day one year but realized it’s been so long since seeing his real hair that he didn’t remember what color to get to match his roots.

Ari has an almost compulsive seeming need to be the most colorful person in any space he’s in. He wants to stand out and he does so by being a walking color wheel. Strangely, he manages to make his outfits cohesive.

You can’t get too close to Ari without noticing how tired he always looks. His eyes are always a little swollen and bloodshot and his skin has the uncomfortable thin appearance of someone much older or much sicker than him. If he’s asked about it he jokes that he’s just ugly (though most people would agree he is anything but ugly).

History:

Ari can split his life into a perfect before and after the wreck.

Before. Ari had a perfectly wonderful childhood. He was loved and taken care of in his historical Boston home. His dad taught Marine Biology at Harvard, his mom was the perfect socialite and Ari and his sisters were happy

His days consisted of school and drawing and going to the beach with his dad to learn about the animals. If Ari was to assign an emotion to that period of his life it would be love. If he had to assign a color it would be pink.

His life before was like something from a 50s sitcom. It was perfect. He knows rationally that he’s seeing through rosy lenses. He thinks he remembers his dad having an affair. He knows his sister and he argued a lot and he was such a mischievous child it kept him in trouble a lot of the time. He knows this. But it feels different. It feels idyllic compared to after.

His entire world shattered when he was 13. His family shouldn’t have even been out. If only he hadn’t argued with his sister. If only he had just set the table then maybe his dad wouldn’t have suggested eating out. Maybe if his mom and little sister had been home instead of in California they could have told his dad no, it wasn’t their day for eating out and they would all be fine eating at the house. Maybe if his sister hadn’t forgotten her phone and made them turn back so she could retrieve it because she was so scared of missing a text from her boyfriend.

Maybe….

Maybe they wouldn’t have been crossing the intersection when the other driver plowed through it. Maybe they wouldn’t have spun out and hit another car. Maybe his dad and his sister and the little boy from the other car and the driver who caused it all would still be alive. Maybe…

After. Ari doesn’t remember the crash itself. He doesn’t remember seeing his father’s body crushed against the interior of their car even though he’s since been told he was trying to pull him out. He doesn’t remember his sister’s glassy, dead stare though he was told he screamed at her to wake up. He doesn’t remember the ambulance ride but he’s told he fought the paramedics to try to get to his family.

He doesn’t remember getting to the hospital and being admitted.

He only starts remembering sitting in that big hospital room alone for what felt like hours (he knows now that it was only a few minutes at a time) while nurses bustled past the door outside trying to focus on the lives that were at risk after the crash. Even still, the evening comes in flashes. A teary eyed woman with a heavy accent telling him his mom would be there soon and rubbing his back. A doctor, young and frazzled, bursting into his room to tell the cops to leave and stop asking him about it. The smell of oil and burning metal seared so strongly into his skin it made his head hurt.

He remembers the funeral. Closed casket, both buried at the same time. He remembers packing up the house and selling it and moving to New York. He doesn’t think he felt real during that time. He kept waiting to wake up and find out it was just a terrible dream. Part of him still hopes he wakes up.

–

His mom didn’t try to neglect his mental health when they moved. Despite having help from family she still had to take on two jobs, she had two children to raise alone and she had just lost her husband and little girl. It was hard to be everything Ari needed her to be too.

She did her best. He was sent to a mental health clinic and given regular therapy sessions for a while where he was diagnosed with PTSD and a trauma based phobia regarding riding in cars.

She put him in music lessons to give him an outlet. She enrolled him in an arts high school so he could find similarly minded creative young people and hopefully make friends in their new city.

It didn’t really work. You can’t throw a shattered kid back into society and expect them not to drown. And Ari drowned.

When he was almost 15 he tasted alcohol for the first time at a sleepover. The idea of it had fascinated him since the wreck. How could one liquid be so influential that it would lead you to kill other people? What did it feel like to slip into a haze that strong.

His first sip was revolting. It burned on the way down and he was convinced he could still feel it burning his stomach. He almost put the bottle up and gave up on learning its allure. Something about it still called to be explored and who was Ari to say no?

He snuck the bottle into his bag and drank a little more the next day after school. Just enough to feel warm again and for his brain to quiet and center just a little bit more.

The alcohol made everything better. He felt more human again when he was tipsy. It didn’t take long for Ari to begin to crave it just to function. He started stealing it from his mom’s cabinet and then from the sweet old lady who paid him to take her groceries upstairs. When he was caught stealing from them he started trying to steal it from stores.

He was caught right away, of course, but not by an employee. Instead he was caught by a tall, average looking man in his early 30s. The man, who Ari soon learned was named Sean, offered to buy the alcohol for Ari and invited Ari over to drink with his girlfriend Eliana. Ari agreed immediately.

That night he lost his virginity to the pair. The two adults offered to keep Ari’s alcohol supply always filled so long as he continued to sleep with them. Ari instantly agreed.

—-

After he started drinking he somehow managed to pull his grades up. He felt real when he was drunk. He felt functional. He could do his coursework and practice the drums and paint and even explore New York. He quickly fell in love with the city and learned how to navigate his borough on his skateboard. He learned what buildings he could sneak into and hookup with classmates in without being caught, all the best places for graffiti and where the coolest homeless people hung out.

As Ari progressed through his teenage years his ‘adventures’ got crazier. He broke into the zoo ones and barely escaped getting caught. He hitchhiked out of the city and spent a weekend far upstate before calling his mom from a payphone and getting her to pick him up. He smuggled paint into his homeroom and painted an abstract mural on the teacher’s desk.

Not everything was illegal. He once snuck into an early morning wholesale flower market and convinced a florist to buy him enough white roses to leave one on every grave in The Cathedral Basilica of St. James cemetery and even convinced some of his friends to help him distribute them. He raised money once and bought everyone at his school pizza for lunch so “the lunch people get a day off.”

When he was asked to play drums for a new band that was forming he had to say yes. It was just a chance at another adventure.

—-

He never expected them to get as famous as they did. He figured they would disband rapidly and he could go to college for marine biology. Like his dad. Obviously, that didn’t happen.

Miraculously for all of Ari’s adventures and alcoholism he didn’t have any major scandals during the bands active time. He left that for Jae.

Instead he tried to fly under the radar. He didn’t want anyone picking up on his issues. He maintained his alcoholism, adventured in the cities they toured through and focused on art when they weren’t making music.

—

Slowly he began to tire of not remembering as much of his life as he wanted to. People Ari had no memory of would come up to him as though they knew him. He got an STI without even knowing who it was from. He woke up in places he had never seen before. He destroyed things in his house and drove people away.

The catalyst came just before the band was put on hiatus and he was approached by an ex. Apparently during a drunken escapade he hadn’t used protection and had gotten the girl pregnant a few years ago. She’d had the baby and suddenly he was being asked if he wanted to be a father. He didn’t, of course, but he also didn’t want this to ever happen again.

Ari used the move to California as a chance to change everything. He swore he was going sober and wouldn’t return to the lifestyle he’d had before.

—

Now, freshly sober in California, he’s trying to figure out how to balance his new life. He’s still adventuring but it looks different without drinking. He isn’t sure if he likes it or not.

Personality -

“Ari is a rollercoaster. It could get exhausting except you don’t see him that often since he’s dating half the town at any given time. But he’s a blast anyway, especially when he’s sober enough to know up from down. You will have the most wild dates with him but you’ll have the time of your life. He rented a barn once and hired a band so we could have a ‘good old fashioned barn dance’ because he’d just seen one in a movie. It was insane. Best date of my life. That’s why it’s such a shame that he drinks so much. When he’s sober or only tipsy he’s amazing but the more drunk he gets the more the shine wears away. We actually broke up because he punched a hole through a mirror once and cried that he hated how he looked. I just… couldn’t do that. I hate it but I couldn’t.” Jessica B, ex-girlfriend.

Ari is the pinnacle of a yes-man. He agrees to almost everything so long as no one is hurt and he seems very morally grey. So long as no one gets hurt he’s down to try anything. He is high energy and always seems super cheerful. Ari is the kind of person who draws others to him just by how cheery and upbeat he is.

Ari is a romantic at heart. He says he falls in love with everyone and it honestly feels true. He sees something beautiful in everyone he meets and so he always dates multiple people at a time. It helps that he needs company all the time or the negative emotions he’s pushed away since he was a teenager begin to come creeping up.

He can never let that creep up. When it does it overwhelms him and he feels as scared and as lost as he did the entire year following the crash. He doesn’t talk about those emotions and he definitely doesn’t acknowledge that anything is wrong even when it’s exhausting to keep the smile. He doesn’t want to validate them and make them real. Ari will do anything to keep himself from ever feeling that sad and broken again.

It’s part of why he’s such an adrenaline junkie. His thrill seeking is one of the things he’s most known for in his fame. He has an adventure list a mile wide with everything from “Show up at an airport and take the next flight wherever it goes” to “scattering change along the city streets for people to find.”

Hobbies:

Art. Ari loves abstractivism and unconventional art. One of his projects that he was working on before coming to Carmel was saving every bottle from every drink he had over the course of a year so he could display it as a piece. He wasn’t sure about the title for it yet.

Exploring

Going on dates and adventures

He really wants to get a normal job because he thinks it would be hilarious to, say, work at a deli or diner because he’s technically a rock star.

Health:

Ari has PTSD. He doesn’t acknowledge it but it definitely impacts his ability to exist normally. He’s terrified of cars (he still doesn’t drive but he claims it’s because he would rather just skateboard everywhere) and he acts more recklessly to try to distract from it.

Physically he’s actually pretty healthy (aside from his chronic exhaustion). He eats well and works out, now that he’s quit drinking (besides a few relapses here and there) he is largely a super healthy individual.

wanted connections

Partners!!!! Ari is pan and poly so he is down for however many partners he has at any given time. He loves going on dates and hooking up. The more the merrier as far as he’s concerned, too!

Baby-mama. Ari found out he got someone pregnant and it was the largest catalyst for sobriety. They have a rocky relationship regarding the child because Ari really doesn’t feel ready to be a dad but I’m open to if they’re civil or uncivil outside of that.

Confidant. Everyone needs someone they can trust. Even Ari, who’s close relationships never seem to get past sleeping together and casual dating. This can be a friend, a friend of a friend or even someone he’s sleeping with.

#carm:intro

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patriotsnet · 3 years

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Why Are Republicans Red And Democrats Blue

New Post has been published on https://www.patriotsnet.com/why-are-republicans-red-and-democrats-blue/

Why Are Republicans Red And Democrats Blue

The History Of Party Colors In The United States

Why Red for Republicans and Blue for Democrats? | America 101

Prior;to the United States presidential election of 2000, which party was Red and which was Blue was largely a matter of which color a news outlet chose.;On the October 30, 2000, episode of the Today show, Tim Russert coined the terms red state and blue state.

As far back as the 1888 election blue was used to represent the northern Union states and red the south, but this wasnt consistent throughout time . In the 70s and 80s the major networks starting using lighted maps to illustrate election results. Democrats were often coded blue and Republicans red, but it wasnt consistent. This inconsistent coloring continued throughout the Clinton years and up to the Gore Vs. Bush. This can all be varied by old videos and articles.

Democrats And Republicans: Blue And Red Or Red And Blue

Lycaon pictus said:If you mean “conservative” in the sense of “maintaining as much of the status quo as humanly possibly” there’s a good case that they still are. The Democrats are the ones trying to keep the social safety net intact, while Republicans want to replace it with uh I’ll have to get back to you on that.

Nerdlinger said:The age-old question: On US electoral maps, should the Democrats be blue and the Republicans red, as is recent American practice, or should the Democrats be red and Republicans blue to better reflect the colors more associated with their ideologies on an international level?

ColeMercury

ColeMercury said:Democrats blue, Republicans red. That’s the convention that’s been developed, so there’s no point in flipping it around just because. And if your justification is ideology, the Democrats aren’t a socialist or social-democratic party so they shouldn’t be coloured red anyway.

zoomar

zoomar said:Wow, with my vote it’s exactly 50-50.I don’t know how the current color coding got started, but it makes no sense. Red is almost universally associated with the left. Blue has a less clear ideological meaning, but if you use blue, it should by default refer to conservatives in the US. I vote for Red=Democrats, Blue=Republican.

19942010

While Many Conservative Parties Around The World Are Associated With Blue In Us Elections The Republicans Are Denoted By Red And The Convention Is A Relatively Recent Development

For those who dont follow US politics closely, aspects of the vote might seem confusing from how the electoral college and popular vote work to which swing states can .

The uninitiated might also be unfamiliar with the maps and graphics on TV showing states turn red and blue as the results are announced heres how the colours work.

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Red States And Blue States

Since around the 2000 United States presidential election, red states and blue states have referred to states of the United States whose voters predominantly choose either the Republican Party or Democratic Party presidential and senatorial candidates. Since then, the use of the term has been expanded to differentiate between states being perceived as liberal and those perceived as conservative. Examining patterns within states reveals that the reversal of the two parties’ geographic bases has happened at the state level, but it is more complicated locally, with urban-rural divides associated with many of the largest changes.

All states contain both liberal and conservative voters and only appear blue or red on the electoral map because of the winner-take-all system used by most states in the Electoral College. However, the perception of some states as “blue” and some as “red” was reinforced by a degree of partisan stability from election to electionfrom the 2000 election to the 2004 election, only three states changed “color” and as of 2020, fully 35 out of 50 states have voted for the same party in every presidential election since the red-blue terminology was popularized in 2000.

The Psychology Of Tie Colors In The Race For President

Have you ever asked yourself the question why we only see red and blue ties on presidential candidates as of recently? Some might argue that candidates will choose those ties that best reflects their partys identify, meaning red ties for Republican Romney, and blue ties for Democrat President Obama, but this is only partially true.

Take Tuesdays Presidential debate for instance. Romney wore a bright blue and white striped tie while Obama opted for a burgundy-red piece, a change that I was very happy to see. Pre-debate I was actually hoping that Obama would be wearing a red tie a color that is synonymous with power, confidence, and excitement all things Obama lacked in the first debate.

Obama is Taking Charge, Wearing a Burgundy-Red Tie

I am now making the argument that Obamas red tie helped him step up his game during the last debate. Not only did the tie grabbed the audiences attention, but I strongly belief that it gave President Obama a boost of confidence after taking a look in the mirror.

The psychology & emotional effects of colors is definitely nothing new. In fact, psychologists have been researching the meaning of colors for decades, if not centuries, and evidence does indeed prove that certain colors do evoke certain emotional responses in people. This is nothing new to presidential candidates who pay attention to what colors to pick out for a public appearance.

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Its A Tie: Presidential Debates As Accessory To Democracy

BETHESDA, MD OCTOBER 04: In this handout provided by The White House, President Donald Trump participates in a phone call with Vice President Mike Pence, Secretary of State Mike Pompeo, and Chairman of the Joint Chiefs of Staff Gen. Mark Milley in his conference room at Walter Reed National Military Medical Center on October 4, 2020 in Bethesda, Maryland. Chief of Staff Mark Meadows is also present in the room on the call.

He did not wear a tie. Thus, the media rang the alarm. Reuters, BBC, Newsweek and other outlets singled out President Trumps tie-lessness as part of the news coverage following his COVID-19 diagnosis and hospitalization. In pop culture, the sight of a national leader without a tie is troubling. Think Hugh Grant dancing around Downing Street as Prime Minister in Love Actually or Morgan Freeman announcing the literal end of the world as President Beck in Deep Impact. We are much more aware of subtle political dress codes than we realize. As tensions mount over the upcoming US election, lets take a look at one of its unwavering protagonists through the years. A classic necktie.

TOPSHOT This combination of pictures created on September 29, 2020 shows US President Donald Trump during the first presidential debate with Democratic Presidential candidate former Vice President Joe Biden at Case Western Reserve University and Cleveland Clinic in Cleveland, Ohio, on September 29, 2020.

Which States Are Considered Red And Which Are Blue

To go along with the colors, the terms red state and blue state were popularized by anchorman Tim Russert during and immediately after the 2000 election. Today, these terms are used to refer to which party a state voted for during a presidential election.;

Generally speaking, the Northeast and the West Coast are considered a collection of blue states as most of them have sided with the Democrats since the early 1990s.

The Southern states have sided with Republicans since the 2000s, while the Midwest tends to be tougher to predict. For example, Illinois and Minnesota are currently considered blue states, while Missouri and Nebraska are red. Hawaii and Alaska have been traditionally considered blue and red respectively as neither has switched parties since the late 1980s .

The Southwest has been split since 2000 with Nevada, New Mexico, and Colorado going blue more often than red and Utah and Arizona voting predictably red. Finally, we come to the coveted purple states or swing states,;such as Florida, Ohio, Pennsylvania, Iowa, Wisconsin, and Michigan. These states switched colors in recent elections and are often a key focus of electoral campaigning and strategy. Swing states can vary by election year.

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Trending In London: Fashion Rental Energy Healing And Pigmentation

Democratic presidential nominee Barack Obama and Republican presidential nominee John McCain take part in the first debate of the 2008 elections at the University of Mississippi on September 26, 2008 in Oxford, MS. AFP PHOTO / PAUL J. RICHARDS

;The default color scheme for presidential ties is so conservative that it is nearly impossible to imagine something like pistachio, fuchsia or neon-anything ever making the cut. Sometimes, of course, being an outlier can help secure the needed benefit of the doubt. Bob Dole wore a moderate-green tie to his 1996 debate against the incumbent Bill Clinton. Such a choice helped create an overall image that pundits found informed, thoughtful, and elevated. It briefly albeit unsuccessfully buoyed Doles campaign. Hillary Clinton did not wear ties during her runs for the presidency. Still, her accessories were scrutinized by the media with particular focus on , bracelets, and headbands. Alternately, when democratic primary candidate Andrew Yang showed up to a 2019 Democratic Primary debate with no tie at all, his historic bold move turned heads across the political spectrum from Fox News to the New Yorker. Ultimately, it was a minor side note in what cost him the nomination proving that the country is just not ready for a tie-less president.

Why Do We Have Red States And Blue States

Why Democrats Are Blue and Republicans Are Redâand Why Itâs the Opposite Everywhere Else

If youve watched the news as a presidential election heats up, youre probably well aware that political pundits like to use the color red to represent the Republican Party and blue for the Democratic Party. A red state votes Republican in presidential elections and Senate races, while a blue state leans Democratic.

No matter which news program you favor, they all use these same colors to represent the parties. So it would be reasonable to assume these must be the official colors of these two parties and have been used for over a hundred years, right?

Surprisingly no. Republicans havent always been associated with the color red, nor have Democrats affiliated their party with blue. In fact, the whole notion of consistently attaching a particular hue to each political party is a relatively new concept in the US, not emerging as a common distinction until the 2000 presidential election between Democrat and Vice President Al Gore and Republican Texas Governor George W. Bush.

But why red for Republicans? And why does blue stand for Democrats?

Lets break it down.

Also Check: Who Are Republicans For The Rule Of Law

When Its Time To Head Back To The Office And On The Few Days When I Wear A Suit And Tie I Should Retire My Red Ties Right Unless I Want Everyone To Assume I Am A Trump Supporter Is It Possible For Any Man To Wear A Red Tie Now And Not Immediately Call To Mind The Former President Ken Newton Mass

Though the death of the tie is declared regularly especially given the pressures of both the long-term office-casual movement and our current working-from-home reality Guy Trebay, our mens wear critic, maintains that you should not count the accessory out quite yet. As he said, even if were not wearing them much during lockdown, you dont want to give up on an element of the wardrobe thats been around for 400 years.

Ties can, after all, be used to signal your club, your interests, whether you are a jokester, a brainiac or even a clown. Not to mention, as you say, political affiliation.

The question is whether the party dividing line between red and blue that has swept even the necktie into its maw will remain uppermost in everyones minds now that unity is the word of the moment . Given how central red ties were to President Trumps uniform, it is natural to think that we may now have a Pavlovian response to the color. But the fact is, red ties were a wardrobe staple long before Mr. Trump got hold of them.

Its the combination of shade and style that makes the statement of allegiance, not simply one or the other. Thats what you should keep in mind when getting dressed. Then go ahead: Tie one on.

When Red Meant Democratic And Blue Was Republican A Brief History Of Tv Electoral Maps

Copy Link URLCopied!

Forty years ago this week, TV started telling the story of the presidential election as a battle between red states and blue states.;

When the die-hards and political junkies who stayed up until 3:30 a.m. Eastern time on Nov. 3, 1976, watched NBCs John Chancellor call Mississippi and the election for Jimmy Carter, they saw the win signified on the 14-foot-high molded plastic map of the United States;mounted on a wall behind the anchor.

————For the RecordNov. 8, 3:41 p.m.: The caption for the 1976 photograph of the original NBC electoral map misidentifies Cassie Mackin as Jessica Savitch.————

The state was then lighted up in red the color the network had assigned for the Democratic candidate.

The party colors were eventually reversed. But from that night forward, that;simple piece of stagecraft in Studio 8H at;Rockefeller Center became the visual shorthand in detailing the race for the 270 electoral votes needed for the White House.;

Digital versions of the electoral map have since become a living;tool for on-air analysts ;a way of feeding;election-night suspense as each state turns red or blue. Since 2008, CNNs John King has presented electoral college scenarios on a touch-screen the cable news network called its magic wall.

It is so beautiful I wish that after the election I could take it home, but I dont have a room big enough to hold it. Its enormous and it’s gorgeous.

David Brinkley

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Medias Red Vs Blue Usage:

The Presidential election of 2000 saw the Blue vs Red ideology take hold.; Network anchors and pundits relied heavily on coloured maps in order to display how close the race was between George W Bush and Al Gore. This set a precedent with regards to the coverage of presidential; elections and as a result coined the deep rooted Blue vs Red associations and culture we see today. Over time, the use of these coloured maps not only defined the states that vote Democratic or Republican but also formulated a way to describe the cultural values associated with American electoral geography. Red and Blue terminology can be seen everywhere in American life from Modern Party iconography, in the name of consulting groups such as Blue State Digital, coffee brands such as Blue State Coffee and even fast food joints Red State BBQ in the state of Kentucky. In a study carried out by Business Insider, one can clearly see the differences in Blue America as opposed to Red America:

The Latest Key Updates On The 2020 Us Election Results

Who is winning the US election? Live updates on the latest results

However, in the US blue represents the more left-leaning Democrats, while the Republicans denoted by red, as per Donald Trumps Make America Great Again caps.

One might assume that the colours represent a long-standing tradition, but theyre a relatively recent feature of US elections.

According to Professor David Scott Kastan of Yale University, writing inThe Conversation, the systems origins lie in the spread of colour TV in the late 1960s, when colour-coded maps were first used on election TV broadcasts.

The red and blue colouring was a nod to the British system, The Verge reports, but initially there was no permanent colour association for either party.

TV networks changed the map coding from election to election, with Prof Kastan explaining: In Cold War America, networks couldnt consistently identify one party as red the color of communists and, in particular, the Soviet Union without being accused of bias.

Indeed, there were famous US election nights where the current colour scheme was memorably reversed.

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Five Years Ago Obama Was Blasted For Wearing A Tan Suit Now Its Used To Contrast Him With Trump

Ronald Reagan wore tan suits during his presidency. So did Dwight D. Eisenhower, George H.W. Bush, Bill Clinton and George W. Bush.

But on Aug. 28, 2014, when President Barack Obama showed up for a White House news conference dressed in beige, the light-colored suit became a matter of national import. Rep. Peter T. King fumed that the suit pointed to a lack of seriousness on the presidents part, cable news shows held roundtable discussions, fashion critics and image consultants weighed in, and TV news reporters conducted man-on-the-street interviews to find out what the people of Northeast Ohio thought of the controversial look.

Five years later, however, Tan Suit Gate has taken on a different meaning, coming to symbolize the relative dearth of scandals during the Obama administration. On social media, just about every news item about potential conflicts of interests within the Trump administration and the presidents flouting of norms is met with some variant of Remember when Obama wore a tan suit? In the past week alone, the tan suit comparison has been leveled against President Trumps assertion that he is the chosen one, his demand that U.S. companies leave China, and his desire to hold next years Group of Seven summit at his Florida golf resort just to name a few examples.

If he wants to wear a tan suit, he can wear a tan suit, one woman said. Another asked, Why are we so concerned about the color of a suit?

Dig Deeper: Fashion + Politics

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toosicktoocare · 7 years

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Modern College AU with Established Enjoltaire

People had bad days, and when Enjolras woke to a painful coughing fit that left him doubled over and gasping for breath, he knew he was in for a crap day.

Nevertheless, he had too much to do to take a sick day, so he fought against the dizziness coating his vision and got ready for class.

His phone blinked with three new texts from Grantaire, but before he could thumb through them, a call from his father came through. With a sigh, he swiped to answer.

“Hey, Da-”

“Are your grades slipping?”

Enjolras frowned. “No, why?”

“Javert emailed me and said you were slipping in his law class. I don’t give that school money for you to fuck everything up!”

Enjolras’s heart began to hammer hard against his chest, and he turned away from the phone to cough harshly into his fist. “I’m not-”

“It’s that boy, isn’t it? Grantaire? He’s a bad influence on you, Enjolras. You shouldn’t be with him.”

The counter-argument that Grantaire had some of the highest grades at the university were hot on his tongue, but Enjolras knew it was pointless. His father would never listen to him, so he only sighed in response.

“Get your shit together, or I’m cutting you off for good.”

After the harsh statement, Enjolras was met with the soft chime indicating that the call ended, but he kept the small device pressed to his ear because he suddenly couldn’t move. His father’s words echoed back at him as he struggled to get a solid breath in.

He felt as if hands were squeezing the breath right from his lungs. When he sucked in a forced breath, he ended up doubled over in a coughing fit that left his eyes watering. His vision wavered in and out of focus as he coughed and coughed, and he briefly thought he was going to black out. But after a few more moments, he was left with a few, weak coughs slipping past his lips.

His entire body was trembling, and he reached with a shaking hand to retrieve his phone he dropped onto the floor. He absently scrolled through his messages as he grabbed his coat and bag and started out the door.

*****

“Do we really have to have a meeting tonight? I mean what’s the point? It’s not like the rally is going to change anything…”

Enjolras glanced up from the food he was pushing around at Courfeyrac’s words. He turned to cough into the crook of his elbow before clearing his throat.

“We have to use our voices to change things. We can’t just remain silent.” He spit out as he fought against a shiver.

Since arriving at school, he had begun to feel cold all over, and the splitting headache that came with it told him he probably had a fever.

Combeferre and Joly were busy at the school clinic, and he hasn’t seen Grantaire all day because the brunet was frantically working on an art analysis paper. He was left with Courfeyrac, Marius, and Bahorel for lunch.

“I know you mean well, Enjolras. But we’ve planned five rallies so far, but nothing has changed.”

Enjolras narrowed his eyes at Marius before he got to his feet. “Nothing will change if you keep an attitude like that.” With that, he turned on his heel and started back into the school building.

Soft tremors coursed through his body as his stomach twisted with anxiety. He knew that nothing had yet to change around the school in terms of positive LGBTQ+ representation, but they couldn’t stop. So many people were relying on them.

His thoughts were interrupted by a coughing fit tearing up his throat. He gripped at the closest wall as he coughed and coughed into his fist for minutes on end. His lungs crackled and wheezed from the strain, and once he was finally able to get in a solid breath, he decided he had enough.

He swapped his course towards the school’s exit and started toward his and Grantaire’s apartment.

*****

The normally five minute walk took Enjolras thirty minutes because he could hardly breathe. His vision was swimming, and his head was throbbing mercilessly by the time he entered the apartment. He dropped his bag onto the floor and curled up on the couch, still in his coat and shoes.

He was shivering hard, and he knew that meant his fever was probably rising, but he couldn’t muster up the energy to get up and get medicine. Instead, he rubbed softly at his chest as he took in short, choppy breaths in order to avoid a coughing fit.

He lied like that for minutes, and before he knew it, he was crying hard. He drew his knees to his chest as loud sobs slipped past his lips. He didn’t know what he was going to do if his father cut him off. He and Grantaire would end up homeless. He could get a job, but his school load was already teetering just over the line of too many classes.

On top of that, he was losing the faith of the Les Amis, and he had no idea how to draw them back in.

He felt as if his world was crumbling. He lied there crying, shivering, and coughing until he fell into a fitful sleep.

*****

“Okay, he’s here.”

Grantaire’s voice followed by the apartment door closing was enough to pull Enjolras from sleep. He blinked tired eyes open as the brunet moved closer to him.

“Yeah, I will. Thanks, Ferre.” Grantaire snapped his phone shut before crouching down in front of Enjolras. “Hey, what’s going on? You never miss a meeting.”

Grantaire’s voice was so soft, so gentle, that Enjolras sat up and wrapped shaking arms around the brunet as a new round of crying took hold.

Grantaire was quick to return the hug, but the worry swelling within his chest only grew. “Enj? What’s wrong?” He asked, voice trembling slightly.

Enjolras shook his head, but when he opened his mouth to talk, another coughing fit took hold that left him frantically pushing away from Grantaire and coughing harshly over and over into the crook of his elbow. He could feel Grantaire moving to his side on the couch, and the steady hand on his back was more than welcomed.

He coughed and coughed until his vision began to blur, but he pushed his focus toward Grantaire’s soothing presence, and after another minute, he was left sucking in sharp, ragged breaths as he sagged against Grantaire’s side.

“Okay,” Grantaire said slowly. He brushed his knuckles against Enjolras’s cheek, not surprised at the intense heat. “How long have you been feeling sick?”

“Since this morning,” Enjolras rasped out, snuggling further into Grantaire’s warmth as another round of shivers took course through his body.

Grantaire tightened an arm around Enjolras’s shoulders with a frown. “Is that why you were crying?”

Enjolras shook his head. “I don’t know what to do, R,” he whispered, and Grantaire tensed beside him. “My dad is threatening to cut me off because my grades are slipping. The Les Amis are losing faith, and I don’t know what to do to fix any of this. I’m failing on all ends.”

Grantaire made a mental note to talk to those who were apparently losing faith in their cause. He cleared his throat and got to his feet, turning until he was once again crouched in front of Enjolras. He took Enjolras’s hands in both of his.

“In the nicest way possible, your father can suck my dick. I told you before that I can handle a job and school. We don’t need his money, E.”

Enjolras shook his head while pulling a hand away and coughing harshly into his fist. “No, I’m not going to ask you to do that.” He wheezed out.

“You don’t have to ask because I’m just going to do it,” Grantaire stated firmly. “I would do anything for you, and honestly, I can’t stand how stressed out your father makes you.”

Enjolras opened his mouth to argue further, but Grantaire stopped him.

“No. Okay, listen we can talk about this later, but right now, you really need medicine and rest. You’re burning up, and you sound like you are going to cough up a lung. I’m not too convinced right now that I shouldn’t call Combeferre back.”

“Don’t,” Enjolras muttered in between light coughs. “I’m okay” he tried, but when he went to stand, everything swayed, and he fell against Grantaire’s chest.

“You really aren’t,” Grantaire snapped back, but the concern coloring his tone was very evident. “Let’s get you to bed, okay?”

Enjolras nodded and allowed Grantaire to help him to the bedroom.

While Enjolras changed, Grantaire stepped out to call Combeferre, and when he returned, Enjolras was curled up under the blankets and already half asleep.

“Combeferre is going to come over for a bit to see if you need a hospital or not,” Grantaire said, taking a seat on the edge of the bed beside Enjolras. He leaned over and cupped Enjolras’s cheek. “Everything is going to be just fine, okay? All I want you to do right now is to rest. I’m going to be right here the entire time.”

Enjolras didn’t realize those were words he needed to hear until they were said, and he felt the anxiety that had been running rampant throughout his body settle significantly.

He wasn’t sure what would happen in the future, but for right now, he knew he would be able to handle it as long as Grantaire was at his side.

#les mis #les amis #sickfic #prompt #enjoltaire #exr #e/r #les miserables #tw: panic attack #barricade boys #god what are prompt endings?#why am i so bad at them?#like here's all this sick angst and then a shit ending #my writing #my les mis writing

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allthetribbles · 4 years

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November 27, 2020 Game Notes - Home for the Holidays... Not!

April 06, 2085

A hospital isn't the most relaxing of places, but most are in a need of urgent care after the fiasco. The doctors recommended at least two weeks of recovery time for Liv, but there's no rest for the wicked. Liv got patched up enough to be able to walk out of the hospital with the promise of following up with an outpatient clinic over the next few weeks.

Alan is also in and out of the hospital with the same promise. Kory registers Tory and gets treated at the same time. The morning is a busy time for the team, except for Te'ani. He's FINE.

Liv gets back her Godkiller when she gets out of the hospital and meets up with him at the office.

When they do drag themselves into the office their appearances are noticed. Director LeAnne asks - "What happened to you?"

Alan answers with "A bar fight." ... "And what are my agents doing in a bar fight?" Liv answers, "I was stabbed. In a mugging. Wrong place, wrong time." Tory supplies, "My sister erupted as a parapsychic and I got injured in the process." Te'ani, "I don't know what happened to these guys. I'm fine!"

It is clear the Director does not believe our stories. She did appreciate the flowers we sent, however. We're been tasked to complete a few normal missions, but in the "downtime" we work on other business.

We reviewed the GIA notes of the Witch sighting. She was last seen on April 3rd in a raid outside the arcology. They were raiding a location that was dealing drugs, weapons, and other illicit gear. Her profile was flagged as a person of interest, but they were unable to capture her. With us knowing that she has shapeshifting or shapechanging magic, we have almost no chance of tracking her if we head to the location. We shelf the information as a point of interest.

Next we follow-up finding the location of the ceremony. Between referencing the maps from the Black Goat Forest case and the book from the Farm, the team is able to narrow down the most likely location - a spot in the North Cascades & Mt Baker-Snoqualmie National Forest. Within that entire 75k square acres of land, while it would make sense... there is another location that would be more opportune for a summoning. There's a spot about six and a half miles northeast that meets all of the requirements - isolation, a good view of the stars.... While Liv has a blond moment, Kory saves the day by pointing out it wouldn't be difficult to use as a summoning point... to supernatural creatures.

We're pretty certain we've narrowed it down. We organize the paperwork and bring it to Director LeAnne. We present the situation and our evidence. She looks at us and the evidence, picks up the phone and starts dialing.

Liv is expecting her to call security and get thrown out.

The phone rings and General Kareebi answers. Director LeAnne demands two squads with power armour to bomb the site. He argues with her, giving excuses for why he can't possibly allocate the resources. He hangs up on her.

Director LeAnne is furious. "He wants to play ball, FINE. I'll play ball... and his are soft and squishy." She picks up the phone and presses a button, looks at us.

"You can be here for this." Liv is intrigued.

"Raimes here." - She has contacted the Global OIS Director Harold Raimes. She lays out the situation and the NEG denial for support.

"Hold please." The hold music is pleasant and last no more than 30 seconds.

Raimes returns and says, "Get him on the line."

LeAnne gets Kareebi on the phone; he's irritated she's calling again. A new voice joins the call. General Simms, head of the Global NEG Military. He demands the support, Kareebi falters, makes excuses.

Simms says, "You are relieved of command. Arrest him." There is screaming and gunfire on Kareebi's end of the line. Simms comes back on the line. There is apparently a situation at the base and he requests LeAnne send a squad to handle the situation until he arrives in three hours. He hangs up.

Raimes says, "Good job, LeAnne. Your team did a good job. Whatever we find there will be a nice feather in your cap."

LeAnne seems pleased when she gets off the phone. "Good job. Make sure this doesn't fall through. Otherwise I assure you it will roll downhill. Take Pahl's team with you."

We prepare for bear in thirty with Pahls at the helm of the Baskerville and head over to the military base.

It is utter chaos. The command is in turmoil, entire units don't have orders - or worse, conflicting orders. No one knows what is going on. Te'ani gets everyone's attention, says he's in charge. Everyone just accepts it, asks him his orders - "No one leave the base." He admits he hadn't thought past that order.

We lock down the base. Around two hours later (3 hours after the telephone call), a transport ship runs low into Seattle airspace and is challenged by Annette's Werewolf. Their IFF codes come back as NEG military and they help to secure the base.

Knowing there are Engels stationed here, we decide to split the party, leaving Annette and her copilot with the dropship to watch things topside. We take three with us to secure the engels and get them in order or under our command. Before we leave, Kory links everyone with a telepathic relay with their permission.

Via Kory's relay Te'ani to our group - "Why am I in charge?" Liv to Te'ani - "Congratulations on being the Director's favorite." Te'ani - "Do we loop them into Kareebi being a shapeshifter?" Liv - "Yes. If they see Kareebi, the orders are shoot to kill."

Everyone locks and loads with those orders.

We make our way down to the mecha hanger and we're confronted by an active Engel - one we're familiar with! The last time we saw it, it was perched on a cargo ship infested with bugs. It turns, looks at us, and waves.

All four engels are active and seem to be protecting the mecha from being piloted. Te'ani asks them to be updated on their situation. They decided because of the conflicting orders, they weren't going to do anything. We inform them that the OIS is in charge, keep pilots away from the armour, and if they see Kareebi... shoot to kill.

The Engel pilot's name is Nigel Otherion, his engel's name is Snick. He'll get the engels in order if we have people up top we trust. We do - Annette! We leave them to their business.

Te'ani relays concerns that everyone in the high command at this base is now suspect as a shifter. When we get to the Tower to lockdown the outside... the situation has escalated. The personnel inside are pointing guns at each other.

Alan gets their attention by demanding they holster their weapons and stand down. Liv mutters she could always just make them lay down their weapons. Te'ani tells Liv to cool it. We discover the personnel are at odds over their orders. Te'ani demands to know who the conflicting orders are coming from - well... from no one. They're using the playbook entry for "lost communications with base command."

Liv, "Are there two books?" Why as a matter of fact... Yes, yes there are.

What a headache. Comparing the books... they're a mess. It's as if anyone who put these into circulation was looking to cause as much chaos as possible. We could choose one or the other to use, but that wouldn't work if any of the personnel transferred out.

We contact the dropship for a copy of THEIR playbook. NONE of the codes are correct.

Kory wants to contact Director LeAnne to give her an update - Liv is against it because our objective of locating Kareebi isn't complete. Kory attempts to contact Director LeAnne... she gets General Simms. She updates him on the situation - the codebooks are all wrong. "Then don't use them. What is the situation with Kareebi?" We haven't located him. "Do not let him escape."

He hangs up. Liv doesn't want to say "I told you so" but...

Everyone seems to have itchy trigger fingers after Te'ani lets it slip there's a shapeshifter on the loose. We regain order by threatening them with our own itchy trigger fingers... on a Werewolf. Annette is happy to oblige the show of power. They fall in line quickly.

She pesters one of the nearest officers for the location of Kareebi's office. "End of the hall, the door with the gold foil. You can't miss it." She gets the attention of the team and they proceed.

It's an absolute bloodbath to put it lightly. When we open the doors, blood rushes into the hall. From what we can tell, there are three fallen soldiers, which the pieces of three more strewn around the room. There seems to be a trail of blood leading into the ventilation shafts. Liv closes the doors of the office after they enter to investigate.

Te'ani - "That's probably too little, too late." Liv - "It can't hurt."

Te'ani was not pleased, considering General Simms directive of "do not let him escape." Liv has a wicked grin on her face when she suggests sending fire through the metal ventilation shafts... but also points out that everyone in the building needs air to breathe.

Alan, "Good idea, but let's hold off on that." Te'ani looks for a way that we can close the ventilation - as a matter of fact... that can be controlled from Kareebi's desk. She spins in the chair before focusing on the controls. She presses a button, the vents close with a "SHUNK!"

New idea! Use electrokenesis, find where an anomaly is in the shaft, then burn it! She closes her eyes, and focuses her electrokenesis. There's nothing in the shafts but... She points to one of the fallen soldiers. "That one is alive." Kory narrows her eyes, looks surprised and shouts. "IT'S KAREEBI!" That probably would have been better shared in the telepathic link.

Kareebi launches tentacles at Kory, who deftly dodges.

Liv, "Hey, I've seen this anime." Kory, "Of course you have." Alan, "It doesn't end well."

Kory reacts by drawing her gun and shooting Kareebi. Te'ani pulls his gun and shoots three times. "Kareebi" is dead. Very, very dead.

We contact General Simms. Kareebi is dead. Simms replies, "That is upsetting. I give you the authorization to get the base under control through any means necessary. I will arrive in three hours."

We make the announcement through Kareebi's office - "The OIS is officially in command of this military base until further notice." With that being officially announced, the confusion on the parade grounds calms down.

We inspect the guy closer - it isn't a monster and it isn't "General Kareebi." We find his TRUE identity. An apparently unregistered sorcerer named Timothy Graine.

A second dropshift arrives promptly 3 hours later. A tall, blond, Nordic viking steps off the craft. The crowd parts for him - even an engel.

He strides into the office, looks at the corpse. "That is not Kareebi. Who is he?" Timothy Graine, an unregistered sorcerer that assumed Kareebi's identity. "He's been here since the graduation. That's upsetting to say the least. You have my thanks. You recovered one of my military bases. I won't forget that." We ask about the air support for our strike. "You have two squads to command. Don't lose any of them and they will follow your orders."

Needless to say, Momma won't be coming Home.

Outstanding Tasks - Thank Patricia Elwood hosting us and humoring our questions (will send dragon tulips) - Follow up with Luanne to see how her status. - Follow up on Weaver's and company's activities. Follow the nightgaunt Itsy Bitsy into the sewers to locate their last known location. Attempt to track them, find the skull. Possibly cross dimensions and locate one of the Society's missing members (Freddy).

Completed - Review the GIA notes from their incident with The Witch. {Date: April 03. Location: Outside arcology. Knowing she has shapeshifting abilities, it will likely be extremely difficult to track her. } - Find "Pristine Forest" for summoning ritual {destroyed with NEG strike}

#ctech #ois #liv frostburn #cthulutech #game notes

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isaacscrawford · 7 years

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Orbiting ORBITA

By ANISH KOKA, MD

I’m sitting amidst a number of cardiologists to go over the most recent trials presented at the interventional cardiology conference in Denver. The cardiology fellow presenting goes quickly through the hors de oeuvres until finally getting to the main course – ORBITA.

ORBITA sought to test the very foundations interventional cardiology was built on – the simple idea that opening a stenosed coronary artery was good for patients. The trial was a double blind randomized control trial of patients with tightly stenosed arteries who either had a stent placed or had a sham procedure. Before the results are presented, the lay media headlines from cardiobrief, the New York Times, and the Atlantic are presented to guffaws from the audience. The indignant smirks are audible as the accompanying editorial remarks from Rita Redberg and David Brown are displayed :

”The results of ORBITA show unequivocally that there are no benefits for PCI compared with medical therapy for stable angina, even when angina is refractory to medical therapy.”

The trial results follow – no statistically significant difference in the primary outcome of exercise time increment between sham and stent, and no difference in angina between the two groups. The meat of the presentation involves the limitations of the trial that make the trial inapplicable – 200 patients total, 6 week follow up, the underlying heterogeneity of the patient angiograms that were randomized, and the wide confidence intervals of the primary outcome that swallowed the actual effect size. Two different angiograms were shown to the audience from the ORBITA appendix.

The images demonstrate two ‘blockages’. To the eye, at least, one appears tighter than the other. The audience was polled on each image – everyone voted to stent the tighter blockage and medically manage the lesser of the blockages. It could be all perception but I could feel the relief in the room as ORBITA was being made irrelevant. The implication clearly was that some angiograms used to show the lack of benefit from stents would not have needed stenting in the first place.

There was no real challenge to the presenter save for one:

“One of the authors – Rita Redberg – is very sharp – why do you think she wrote that editorial?”

There was no good answer – the presenter shrugged and muttered something about an anti-interventional cardiology bias.

It was at that moment that I realized why cardiologists were having such trouble with ORBITA – we were arguing like puritans. Everyone in the room already ‘knew’ stents worked. This was just an exercise in bias confirmation when what was needed was an examination of the source of bias. Instead, faced with the ultimate epistemological challenge we were resorting to a superficial analysis and our supposed authority to dismiss findings we didn’t like. ORBITA may have limitations inherent in any small randomized control trial that’s performed, but the fundamental question raised here relates to the primary evidence that opening a narrowed artery actually can relieve angina.

The conversation in conference had reminded me of sitting across from a young chiropractor years prior trying to explain chiropractic to me. The field of Chiropractic revolves around the concept that misalignment of the spine results in disease, and that returning the spine to its appropriate curvature restores health. The proof is visual – chiropractors show xrays of before and after spines as proof. The wider medical community, of course, scoffs at such presentations. Where are the sham controlled trials of these manipulations, I asked.

Couldn’t this all be a placebo?

The chiropractor rolled her eyes – it was obvious, couldn’t you see?

A few years later and cardiologists sound like chiropractors. One wonders if cardiologists would come to the defense of negative sham trials of chiropractors by citing small sample size, and the other usual suspects we were resorting to.

Clearly, if we hope to maintain some credibility as practitioners of science, we need better arguments than chiropractors to explain what it is we do and why we do it.

Biology matters

A 58 year old woman was sent to me by a concerned primary care physician for chest discomfort on a Friday afternoon. She was leaving to go on vacation with her husband later that evening for the weekend, but had been having this pesky chest discomfort that had started after a renewed effort at exercising after a long hiatus 2 weeks prior. She described chest discomfort in the middle of the chest only when she exercised. The pain was relieved with rest. On inquiring about progression of her symptoms, she noted that she had just felt the same chest discomfort walking the 40 feet from the elevator to my office. She was anxious, but in no distress as she sat in my exam room. An electrocardiogram was completely normal. I grimaced and told her she should cancel her weekend plans as her story made me highly suspicious that she may have a tight narrowing of an artery that was feeding her heart muscle. She protested that the ECG was normal! I told her an ECG at rest was unlikely to reveal a significant narrowing. She reluctantly went to the hospital with a plan for a coronary angiogram on Monday. Three hours later I received a sheepish call from the resident now taking care of her in the hospital. She wanted to leave against medical advicen – Her initial set of cardiac enzymes had been negative. I trudged over to talk to her. I told her I was happy her cardiac markers were negative, but I was concerned about the workload she was having symptoms with – it would appear she had progressed from having symptoms with running only to having symptoms walking down my hallway. While it was entirely possible she could have a quiet weekend at home and come back for her procedure, I thought it was safest to hang out 15 minutes from a cath lab just in case her symptoms progressed and necessitated an urgent intervention. The next morning she had an episode of chest pain that was instantaneously relieved by nitroglycerin, and on Monday she had a cardiac catheterization that demonstrated a 95% proximal lesion in her left anterior descending artery. She had a stent placed immediately after. Since the stent was placed she has had multiple episodes of chest pain – none as typical as her presenting complaint.

This is supposedly a happy outcome, but the immediate question in light of ORBITA that emerges regards the proof that the symptom relief in this case wasn’t a placebo? Specifically, would a sham procedure have resulted in similar results?

Based on a negative sham trial, the charge has been made that arteries have been opened for 40 years with no basis. Answering this charge requires a basic understanding of how the status quo in cardiology emerged.

It has long been believed based on clinical observation that angina relates to an imbalance of myocardial oxygen supply and demand. The first textbook of cardiology written in English by Alan Burns in 1809 noted:

“A heart, the coronary vessels of which are cartilaginous or ossified . . . can, like the limb, begirt with a moderately tight ligature, discharge its function so long as its action is moderate and quiet. Increase, however, the action of the body and, along with the rest, that of the heart, and you would soon see exemplified the truth of what has been said.”

Demonstrating that the underlying mechanism of angina related to an epicardial obstruction was suspected, but started to solidify after a necropsy study of 355 hearts demonstrated that every patient who developed angina was noted to have significant narrowing or occlusion of the coronary arteries. Importantly, however, the study also noted that “complete occlusion or considerable narrowing of one or more coronary arteries may exist without giving rise to any clinical symptoms or signs”. Thirty eight cases demonstrated occlusions, and an additional 34 cases noted significant narrowing, yet none of these patients had demonstrated any cardiovascular symptoms in their life. The researchers were also able to posit why this may be the case by injecting the coronary arteries with a lead agar suspension that was able to penetrate channels > 40 microns. This was elegantly brilliant.

The normal coronary arteries are split into a right and left coronary system, each with a separate entrances from the aorta. In normal coronary arteries, injection of the lead agar suspension into the right coronary vasculature would not result in any lead agar suspension appearing in the left coronary system. Yet this is exactly what happened in some patients! These patients, as in the image below, had developed a natural autobypass (collateral circulation) from the unobstructed coronary tree to supply the area distal to the stenosis. This was why some patients with severe coronary disease appeared to live their lives free of angina. It was suspected that patients with sudden occlusions that did not have time to develop collaterals were the ones at risk of developing symptoms.

It would take another thirty years of technological advances and many failures to accurately measure coronary blood flow in the beating heart. The key to success was the use of perivascular doppler to measure coronary flow under resting conditions and ‘stress’ conditions. During stress conditions (like exercise), increased myocardial oxygen demand requires an increase in coronary blood flow which normally takes place as a result of local release of substances that dilate the coronary artery and increase flow. Narrowing of the coronary arteries should restrict the ability to increase flow in response to stress and cause angina. This was elegantly displayed in a dog model that measured flow serially as a micrometer constrictor was serially tightened around the left circumflex artery. Important point: the % stenosis was calculated not based on the angiographic appearance of the lesion, but rather the change in diameter of the micrometer around the coronary artery.

Coronary blood flow is demonstrated in a left circumflex artery with no constriction (top part of the figure) and with an 82% stenosis at baseline (bottom part of the figure) and after injection of a coronary vasodilator.

Coronary flow is seen to be markedly attenuated in the setting of a significant stenosis after injection of a coronary vasodilator.

Plotting % stenosis vs coronary blood flow generates the famous figure shown below, demonstrating the progressive decrease in maximal coronary blood flow (otherwise known as coronary flow reserve (CFR)) as stenosis worsens.

Resting coronary flow is not impacted until an 85% stenosis is present, and while hyperemic coronary flow in response to vasodilation starts to be affected around ~40% stenosis, significant decreases are noted only with high grade stenosis (>85%).

This same seminal study studied myocardial radioactive tracer uptake at rest and with coronary vasodilation in the stenosed circumflex artery. Uptake of tracer is directly related to flow, so less flow to myocardium means fewer counts of tracer measured in myocardium with poor flow. The left anterior descending artery (with no stenosis) was used as a control. As predicted, at rest, counts in the 80% stenosed circumflex artery were similar to the left anterior descending (LAD) artery with no stenosis. Tracer uptake with coronary vasodilation, however, demonstrated a marked reduction in tracer uptake in the circumflex vessel relative to the LAD.

While most cardiologists will recognize this study as establishing some of the basic tenets with regards to management of patients with stable ischemic heart disease (SIHD) as it relates to coronary stenosis and stress myocardial perfusion imaging, most will certainly not recall the conclusions of the authors with regards to the clinical applicability of their findings.

“Marked impairment of coronary flow reserve occurs with progressive stenosis of 65 to 95 percent by caliper determination, but with lesions of this degree angiography is not sufficiently accurate for measuring small luminal changes having major hemodynamic consequences; this limitation is compounded by multiple or long areas of stenoses. A more physiologic response might be utilized if responses to Hypaque were established for normal and diseased human coronary arteries by clinical studies using a velocity sensing catheter, videodensitometry or gamma camera. Possibly a hyperemic/base-line flow ratio of less than 1.5 would be an indication for surgery. However, further investigation is essential before these concepts are of practical value in managing patients.”

It bears reiterating that the seminal paper that served as the basis for the opening of narrowed arteries seen on angiography warned that angiography alone was unlikely to be precise enough to isolate the truly critical stenoses causing important reductions in coronary blood flow that resulted in angina.

At the time the only recourse for patients with angina was open heart bypass surgery that had been developed and was being perfected by René Favaloro, an Argentine surgeon. It was only a short 3 years later in 1977 that Andreas Gruentzig used a home made catheter balloon to open up the artery of a young man with crippling angina that was desperate to try any option that did not involve open heart surgery.

The audacious but wildly successful attempt by Gruentzig ushered in widespread adoption of coronary angiograms to diagnose coronary artery disease. At the time visual assessments of coronary angiogram was the only assessment of coronary blood flow possible in the cardiac catheterization lab, and it is thus not surprising that cardiologists used the only tool they had at the time in making decisions.

All chest pain isn’t angina

It remains the case that chest pain is the key complaint that starts cardiologists on a hunt for significant coronary artery disease. The satisfying finding of significant coronary artery disease linked the symptom to anatomy and result resulted in therapy. Patient and doctors felt better and all was good in the world. ORBITA challenges this basic paradigm. Instead of an immediate stent, patients were taken off the cath lab table and placed on upto three antianginal medications. 6 weeks later patients had their angina assessed and had an exercise treadmill stress test. Half the group then went on to get a stent. Another 6 weeks passed before all the patients had another exercise treadmill stress test and an assessment of their anginal symptoms.

There was no significant difference in exercise time or in angina frequency. These results form the basis of the unnerving claim made by ORBITA: relieving an epicardial obstruction may not be fundamental to relieving angina. On the face of it, this appears to be a blow to the model of angina and coronary flow that has been forty years in the making. If the physiologic model that tightly links angina-epicardial obstruction and coronary flow together is as described, it shouldn’t take 1000 patient trial to demonstrate this – it should take one. This requires an explanation beyond the usual generic criticisms that can be hurled at any sham randomized control trial.

The problem with ORBITA relates to the sloppy fashion cardiologists over the years have decided chest pain is angina. Before angiograms defined coronary anatomy, angina was defined only with the classic triad of sternal chest pain made worse by exertion and relieved by rest. This hews to the model of coronary blood flow reduction with stress.

Unfortunately there are a number of patients that die suddenly of a heart attack who don’t have typical angina. This creates an environment where every complaint of chest pain needs to be evaluated for the underlying presence of coronary artery disease. It doesn’t help patients much if you confidently tell them they don’t have angina but they drop dead of a heart attack the following day. So it came to be that finding a high grade coronary lesion became the way to link chest pain to angina.

But there’s a clear problem with this approach. Autopsy studies to help establish the prevalence of significant coronary lesions demonstrated that a 55 year old man with chest pain that improved with exertion had a 20% chance of having a >70% coronary lesion.

To be clear, chest pain that improves with exertion is not angina. The coronary stenosis found in this case is akin to the incidental pancreatic cyst found in the millions of CAT scans done in Emergency Departments for abdominal pain. It shouldn’t surprise anyone that opening arteries in these cases may be of limited value.

ORBITA : A study of chest pain or angina?

While meticulous in many aspects, ORBITA was relatively lax at defining angina at entry into the trial. Patients were ‘judged to have angina or an equivalent symptom” by their cardiologist in order to participate. This could mean left arm pain, or something as vague as shortness of breath. In their defense, the investigators were no doubt attempting to mimic the actual practice of cardiologists. They succeeded! It should not, after all, be the investigator’s fault that cardiologists may be loose in their definition of angina if that was indeed the reason for catheterization and stenting.

The contrast between inclusion in ORBITA and the only other similar trial (ACME) to test the effect of angioplasty and medications is striking. ACME was not a sham trial – patients and investigators were aware of having an intervention – but it did compare stents and medication in stable single vessel CAD patients with angina. To enroll, patients had to have stable angina, a markedly positive exercise treadmill stress test (ST depressions > 3mm), or a recent myocardial infarction within 3 months. Patients without ST depression were allowed in, but only if there was significant ischemia noted on myocardial perfusion imaging. Here you can see the investigators clear attempts to not rely on the patients or physicians labeling of ‘angina’. This is the key difference that may explain why the results in ACME were striking in a way ORBITA was not. The average increment in exercise time from baseline was ~ 2minutes compared to 26 seconds in ORBITA.

Statistical hijinks – Homogeneity is a hard friend to find

When we speak of effect sizes ,we are of course speaking of averages. This is how the data is presented, and the comparison of the means is what the analysis of clinical trials in general rests on. The advantage of taking an average effect size of a population is that it effectively smooths out random outliers that may be misleading – the achilles heel of clinical anecdotes – but there is an important assumption inherent within this analysis that may be just as misleading. Specifically, one must assume that the population being studied is homogenous enough to have approximately the same response for most patients. As an example, if 90 patients improved their exercise time 10 seconds and 10 patients improved 60 seconds, the average improvement in the group is 15 seconds – the mean here hides much more than it reveals. As has been discussed already, the entry criteria for ORBITA patients makes it entirely possible patients with and without angina were lumped together. But other clues to ORBITA’s heterogeneity lie in the spread of baseline exercise times seen – the confidence intervals provided demonstrate exercise times that ranged from 1.6 minutes to 14.6 minutes! To paraphrase our loquacious tweeter in chief, this difference is yuuge! Exercise times were measured based on a smoothed Bruce Treadmill protocol which gets logarithmically more difficult the further you go. To average a patient who exercises 1.5 minutes with one who exercises 14 minutes is akin to including me and Lance Armstrong in a trial testing exercise time change from a new erythropoeitic agent, average our responses and then pretend this average would apply to the entire population.

So even if we can be confident ORBITA included patients that had a high probability of exercise limiting angina, the question the clinican reading this should have is: For two patients with similar exercise capacity, how does sham compare to a stent? Lumping a wide variety of patients together makes it hard for ORBITA to answer this question. While there is clearly a group of patients that don’t benefit (perhaps patients exercising 14 minutes) , we can’t rule out another group may benefit (Low exercise time angina limited patients?).

Finding the power in ORBITA

I find many of the other criticisms of ORBITA to be less than fair. Many have problems that the study was underpowered and had too short a follow up to comment appropriately on symptoms. I have a problem with neither. If it takes more than six weeks and two hundred patients to demonstrate a stent will relieve angina, the effect size of stents is considerably more modest than we think. I puzzled over how the investigators arrived at their estimates for their power analysis for some time. It’s worth pointing out that given the standard deviation of baseline exercise times predicted by ACME and observed in ORBITA, the study was underpowered to find a 30 second increment from baseline. The study was instead powered appropriately (Beta – 80%, Alpha 5%) to find a difference in exercise times of 30 seconds between medication/sham and medication/stent arm with an expected standard deviation of 75 seconds. So imagine the average exercise time of me and Lance Armstrong compared to the average of the other group that has Will Smith and Danny Devito. I’m not sure what the average of me and Lance means, and I’m even less sure of what the difference in averages between me/lance and Danny Devito/Will Smith. Regardless of this nitpicking, the fact remains that a large observed effect size (ACME differential between the 2 groups was 90 seconds) would have made all these points moot. While a 30 second increment in exercise time from baseline in patients with single vessel disease who are already maximally medically treated is nothing to be ashamed of, I would be a little embarrassed if this was the entirety of the effect size one derives from the hundreds of thousands of stents placed a year.

Some also point to the aggressive medical therapy (titrating up to 3 antianginals, and up to 3 cardiology consultations / week) resulting in this group overperforming and thus placing stents at a disadvantage. I disagree here as well. Stents are an expensive, resource heavy endeavor that rarely but occasionally can have devastating procedural complications. If the stent can be brought to its knees by phone calls and medications, the world of interventional cardiology has much to be concerned about. The medication regimen in ORBITA was more aggressive than ACME with a higher percentages of patients on ACE/Betablockers/nitrates but it would seem not enough (Long acting nitrates 50-> 67%, betablocker 50->80%, CCB 70->90%) to make a difference in exercise of times between stent and medications of 90 seconds (seen in ACME) disappear in ORBITA.

Spending too much time nitpicking what ORBITA was actually powered to do misses the very real and valid conclusion that for many patients in the population tested, the advantage of stents on symptoms and exercise time was found to be quite small. The appropriate conclusion from ORBITA may very well be that a group of patients being stented in cath labs today will have a small benefit relative to symptoms and exercise time, but this ignores the other major reason cardiologists place stents: they believe it possible stents may prevent future heart attacks.

Stents and hard outcomes: Fact or Fiction

The problem facing cardiologists is that coronary disease remains one of the leading causes of death and morbidity in the population. But while it has been clear for some time that the presence of coronary artery disease made it more likely you would suffer a coronary event, many patients with coronary artery disease lived to a grand old age never bothered by the plaque that obstructed their arteries. It has also been evident for sometime that functional status was a powerful differentiator that placed patients on very different survival curves. This was quantified by having patients do graded exercise treadmill tests with a continuous ECG monitor. The performance on the test could be graded using the now ubiquitous Duke Treadmill Score which combined exercise time, degree of Ecg change seen and the symptoms seem to occur during the test. As crystal balls go, the Duke Treadmill Test was impressive.

It seemed reasonable based on the poor survival of the high risk group to target this population for revascularization. Of course this was not the only group where further study took place. Low risk does not necessarily mean no risk, and it was left to the clinician’s judgement whether or not to offer revascularization. So if a low risk patient found themselves on a Cath lab table and a high grade lesion is found subtending a large area of myocardium, cardiologists have traditionally tended to err on the side of opening the lesion. This occured despite the fact that even data from 1984 that examined the use of bypass grafts for stable single vessel disease did not show a clear reduction in future heart attacks or death. The backlash now faced by the revascularization community stems from the very real phenomenon of overuse in this arena. But as the famed statistician Frank Harrell is fond of saying: the absence of evidence should not imply evidence of absence. Clearly some low risk patients do have bad outcomes, and thus it is plausible that some patients do benefit from a liberal use of revascularization. The difficulty lies in separating the wheat from the chaff and that is understandably much more difficult in low risk patient populations.

The pessimists view of negative trials like the COURAGE trial that randomized (in an unblinded fashion) patients with stable coronary artery disease to stents or medical therapy and did not show a difference in hard outcomes is that no patients benefit from revascularization. The optimist looks for subgroups within the stable coronary artery disease cohort that did benefit.

Just such a signal seemed to emerge when cardiologists started testing a strategy that takes the field back to the elegant coronary flow curves measured at stress and rest. It turned out that Gould & Lipscomb’s concerns in 1974 about angiography had been well founded. They had noted that visual angiography was likely unable to assess coronary flow limitations in a meaningful way, and had urged development of a more physiologic parameter to serve as a guide. Warning forgotten, cardiologists had since relied on an operator visually estimating the severity of a lesion based on a 2dimensional picture. The limitation of reducing a 3 dimensional complex lesion to a 2 dimensional slice means that many lesions may be overestimated, and some are certainly underestimated as well. Interventional cardiologists luckily seemed to have made a leap forward by returning to their physiologic roots. In 1996, De Bruyne and colleagues used a high fidelity pressure wire placed across a stenosis to measure proximal and distal pressures under rest conditions and after injection of a coronary vasodilator to increase coronary blood flow (Sound familiar?). The greater the pressure drop measured across the stenotic lesion, the more physiologically significant the lesion. Perhaps more important than the positive correlation of FFR to the accepted gold standards for ischemia of the time (stress testing, coronary angiography), studies of the prognostic significance of FFR showed it to be an improvement over angiography. The largest and most robust trial of FFR is the FAME-2 trial that randomized patients with stable coronary disease being considered for a stent to an FFR guided approach to stenting. The trial had to be stopped early because those patients with physiologically significant FFR lesions randomized to medical therapy had to be urgently revascularized at a much higher rate than those who had been stented. Half of the patients who had to be urgently revascularized had chest pain associated with ST depressions.

Limitations of the study relate to the lack of blinding – patients and the cardiologists taking care of them knew they had significant unstented coronary lesions and this may have biased the decision to stent. But even if one removes the patients stented without ecg changes or bio markers that demonstrated heart damage, the numbers remain concerning – 25 patients in the unstented medical arm vs 6 patients in the stented arm returned for stenting in an urgent fashion. A recent contemporary review goes to great lengths to minimize the urgent revascularization story by suggesting the simple passage of a wire across a very significant plaque may have caused disruption of the plaque and thus been the impetus for revascularization. However, the survival curves appear to separate early, and keep separating up to one year after randomization, demonstrating a large number of late events that would appear to have nothing to do with passage of a wire months prior.

The FFR story of ORBITA also provides fertile grounds for discussion. On the face of it, the average FFR in ORBITA’s patients was a very low 0.69. This is similar to the average FFR in the FAME trials. Yet an important distinction exists. 28-30% of patients in ORBITA had FFRs in a range that would have been excluded from FAME. The average FFR may be the same, but the spread of FFRs is significantly wider. So once again the heterogeneity of the patients in ORBITA limits its applicability to the patient in room 1 who gets squeezing chest pain after walking for 2 minutes on a treadmill.

Regardless of the spread, there is no debate that ORBITA was not designed to show a difference in hard events. FAME2 randomized ~800 patients and followed them for one year to show a total of 42 hard events (chest pain without ECG changes, or biomarker positive excluded) in the medically treated arm. One patient in the medical treatment arm in ORBITA had an acute coronary syndrome, and two patients had severe bleeding on dual antiplatelet therapy and ultimately needed to be stented. Was this a play of chance, or would a 3% rate of crossover to stents hold up in a 1000 patient trial? Other than 4 stents that had to be placed immediately after plaque disruption related to wiring of the coronary artery, no complications resulted in the stent arm of ORBITA. The study was too small, of course, to capture complications related to stenting – but the best data available from the NCDR registry suggests the risk of dying from elective stenting to be 1 in 500. This number may appear high in isolation, but a fair body of evidence exists to suggest there are real and significant risks that accrue to patients directed towards medical therapy (3/100 patients in ORBITA and 9/100 patients in FAME-2).

Lessons from ORBITA

ORBITA would seem to have confirmed for some that biology does not matter. I think the opposite. Understanding ORBITA, or for that matter, any other clinical trial is woefully inadequate without an understanding of the physiology that underlies the disease being studied. This by no means suggests that understanding biology will keep clinicians and their patients away from dead ends in medicine. We are limited by our current understanding of the world, and can only hope to continue to expand our understanding of the underlying mechanisms of disease if we hope to continue to make progress. Critics point to right turns in medicine as evidence that scientific progress is something that needs to be micromanaged by a department of statistical certainty. As proof, any number of trials that have overturned the overconfident clinician are cited. In the ORBITA space, the paper most often cited to weaken the knees of the experts is a paper that examined a common practice in the mid 20th century in patients with refractory angina: ligation of the internal mammary artery.

It had became a commonplace idea based mostly on case reports to ligate the internal mammary artery to treat refractory angina. Astounding anecdotes were reported of patients with severe angina that were ‘cured’ with this procedure. The procedure did not hold up to the scrutiny of a sham trial. 17 patients with severe limiting angina randomized in a double blind fashion to a sham incision or ligation not only showed no differences in the groups, but some who had a sham procedure even improved. The most marked improvement occurred in patient #14, who demonstrated a marked improvement in angina, and completed the treadmill stress protocol postoperatively even though he had limiting angina with ‘striking’ ECG changes prior. The only problem with this happy outcome was that his internal mammary artery had been untouched.

This would all appear to be a fairly damning indictment of bioplausibility as a basis for making clinical decisions. But this most famous sham trial has some problems bearing up to scrutiny as well. First, while a plausible explanation had been elucidated – IMA ligation was thought to increase coronary flow by promoting collateralization – there was no actual evidence to support this. Part of the impetus for the sham trial was an IMA ligation trial in dogs that had not demonstrated any increase in coronary flow. And the striking ECG changes in patient #14 that served to prove the futility of IMA ligation?

T wave inversions.

T wave inversions can certainly represent ischemia, and when associated with angina, may be concerning. But T wave inversions are a non-specific finding for ischemia. For this reason, the development of significant ST depressions are used to decide if an ECG treadmill test is positive for ischemia or not. It is true that while the stress test was technically negative for ECG evidence of ischemia, even in 2017, a patient with chest pain after a minute on the treadmill with T wave inversions would probably prompt a coronary angiogram to search for evidence of epicardial coronary artery disease. The presence of exertional chest pain, relieved by rest with concomitant coronary obstruction makes the diagnosis of angina. Everything else is suspect. There was no way of knowing if patient #14 actually had angina. In 1959, coronary angiograms were far from routine – Mason Sones had just accidentally injected the coronary arteries with contrast to prove the concept one year prior. Again, if you’re going to study the effect of procedures on angina, it is imperative patients with angina are being tested. In 1959, the cardiologist taking care of the man with typical angina, but without concomitant definitive ECG changes during stress had no avenue available to clarify the diagnosis.

In this case, there are two possibilities if patient #14 had angina that completely resolved with parasternal incisions – either the mind overpowered whatever the mechanism of angina really is, or that this patient never had angina. If you are a cardiologist that believes in the power of the mind to overcome angina, perhaps we can begin to meditate heart failure away as well.

While some are using ORBITA to embrace the placebo effect, it is worth noting that the effect size of the placebo in ORBITA was less than impressive. The sham group improved an average of 11 seconds with a confidence interval that crossed zero. This means that the true effect size of the placebo may very well be zero. It should reassure those who believe in science rather than magic that ORBITA allows us to tell patients that spinal manipulations and ginger root are bound to be ineffective for the treatment of coronary artery disease.

Tying up ORBITA

The notion that the truths in ORBITA will be revealed through a better statistical understanding of the methods used to analyze the data is wishful thinking. Data crunching wizards they may be, but statisticians are limited to the dataset collected. In the case of ORBITA, for instance, only clinicians can speak to the veracity of the dataset collected, if the mean response found is one that is clinically meaningful and how generalizable the mean observed response is to the population seeking treatment.

ORBITA well represents patients being stented in cath labs today. But that does not, unfortunately, make it a good trial to answer the narrower question of whether stents can improve angina or exercise duration. The ACME trial may not have been a sham double blind trial, but the rigorous entry criteria ensured patients enrolled actually had angina – a disease that would be amenable to revascularization. It is also hard to use ORBITA to bury stents because the trial was underpowered to examine the other reason stents are placed in coronary arteries : the prevention of future heart attacks. In the FAME2 trial of stable coronary artery disease, that excluded patients with an FFR of > 0.8 and was therefore more homogenous than the patients in ORBITA, the effect of stents was relatively modest – it took one year to show a 9% event rate with medications vs. a 4% event rate in the stent group. This 5% absolute difference may seem miniscule, but when applied to large populations carries weight. I can guarantee you that if bike lanes demonstrated a 5% absolute difference at 1 year there would be calls to expend massive resources to give everyone a bike from the same group burying the coronary stent.

As I write this, I am a few hours removed from watching a 66 year old burly man clutch his chest 4 minutes into an exercise treadmill stress test. His electrocardiogram showed no significant changes during the event, but he looked uncomfortable enough that I stopped the test to let him recover. He described a feeling of tightness, that resolved as he sat with his chest heaving on the exam room table. He has diabetes, hypertension, and had a carotid stent placed in the last year. He also is being worked up for interstitial lung disease. There is close to a 100% chance he has coronary artery disease – the only question revolves around it’s significance. His low exercise tolerance could be from his lung disease, but could also portend a limitation due to significant coronary artery disease. I’m sending this gentleman to the cath lab to rule out significant coronary artery disease. If he does turn out to have a ORBITA like lesion that is physiologically significant (we can quarrel about thresholds), I can’t say that I am going to lose sleep over a stent being placed even if I can’t be sure his symptoms definitely relate to his coronary lesion. It’s certainly plausible that given his low exercise time (relative to the ORBITA mean) his expected effect size may be much higher than the average observed in ORBITA, and a low FFR suggests that more often than not stenting will make it less likely he needs an urgent revascularization.

Speaking as a preventative cardiologist who has no financial incentive to the placement of more stents, ORBITA makes me think hard about what to say to patients I send to the Cath lab, but shouldn’t lead to changes in the practice pattern of conservative cardiologists loathe to send minimally symptomatic, high baseline functional capacity patients to the cath lab. On the other hand, ORBITA should stay the hand of those in the ER employing a shoot first, ask questions later approach to patients presenting with chest pain. The clinical history, somewhat quaintly, remains paramount.

I have always thought it a particularly dark feature of human nature that relishes in the fall of those who have reached great heights. The jubilation with which some are ready to bury the coronary stent for stable coronary artery disease comes from this same place. Those who overreach, stumbling over themselves to drive the final nails in the coffin of stents do so by ignoring a wealth of clinical data based on a robust physiologic model. Stents in the setting of stable CAD clearly appear to have been overused, and in response to data demonstrating the success of medical therapy in a large number of these patients – stenting in stable CAD since 2007 has fallen 50%. If stents in this group really carry risk with no reward – we should expect lower cardiovascular deaths nationally. Yet the cardiovascular death rate per year isn’t just flat – its rising.

There is a reason sledgehammers are not the tool of choice for sculptors – the tools needed to convert stone to flesh require fine, discriminating tools. ORBITA deserves its place as an important trial adding to the significant body of evidence that should help guide decisions to revascularize patients with stable coronary artery disease. Much of the lay press, as well as those worshiping at the temple of mindless empiricism have naively used ORBITA to malign all stents placed in the setting of coronary artery disease. While it may be tempting to use the recent evidence as a sledgehammer against cardiologists and stents, there is a real danger this approach ends up leaving patients with the greatest damage.

Thanks to Saurabh Jha, Ajay Kirtane, Robert Yeh, Darrell Francis, Frank Harrell for insights. Comments/Trolling welcomed. Twitter: @anish_koka

Article source:The Health Care Blog

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chaosunmasked-blog · 8 years

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Denali is a River That Flows in Egypt...(or something like that)

Watched Legion today. It was amazing! The convoluted story and timeline that it set up was sure to be a head twister! Smart TV strikes again! I was drawn to looking up the story behind the eponymous mutant, and it seems like this show could be quite interesting. I would love to see if any of the characters we see besides Legion turn out to be his split personalities? If so, he's so far down the rabbit hole, I don't know how he'll get out.

Besides being completely absorbed into the storyline to forget that I have lung exercises to do (Yup, incentive spirometry. It's a bitch at first but it's worth it.) and the allusions to A Clockwork Orange, I also saw a little of myself in Legion. Well, I did have hallucinations that were on that level of fucked up. But what really got me was, will this man ever get better? He has a severe case of paranoid schizophrenia, and some extreme powers, which cause him to question reality at every turn. Even when he is somewhat normal and medicated, his hallucinations and delusions continue but in muted form. I felt a similar kind of hopelessness.

Honestly, I'm so far down the medical hole that I'm practically in Wonderland. I'm a mess. The doctor from somewheresville at the Super Specialized Clinic with some of the best doctors around still can't figure me out. I look at my lab results, and I'm a complete mess (before the overmedication bit). Not only are my lungs still not up to par with someone my age, I have recently found out that I lost 3lbs from last week and my calves are hurting like crazy. Also, my blood sugar is consistently a problem. Almost every time I'm in the hospital it's either too high or way too low. So...why hasn't someone checked by blood sugar? Oh wait they have and my fasting is normal, but when I eat. Watch out! The pseudo-diabetic is in!

But, the question for me is, will I ever get better? Will anyone be able to get to the bottom of what's causing my body to fail so quickly before the end? Or will I be stuck like Legion with my increasingly worsening health as my only company? But, it was kind of liberating to think like that. I guess the reason is that I dislike going to the doctors and hospitals as I have all these tests and nothing conclusive pops up. Oh yeah, there's something wrong with you, but whatevs let's just chalk it up to Conversion Disorder instead of figuring out why your blood glucose is dangerously low when you have your "freezing episodes". The amount of ignorance and lack of intellectual curiosity or even the simple fact of doctors not doing their jobs properly, does wear on me. I've been to about 50 doctors and I haven’t even blessed the age of 25 yet. About 90% don't do their jobs correctly which puts the other 10% into crisis mode to try and save what's left of my wretched body.

Even this new doctor was considering Conversion Disorder. I didn’t even want to argue with the man. It's been brought up so many fucking times. I even decided to see a psychologist regularly to starve off the possibility, but it still gets brought up by medical doctors. I mean the doctor I have at the Super Specialist Clinic in the middle of somewheresville is a neuropsych doc. I mean wouldn't he have caught it? Jesus. I've actually been to three and all have been a resounding, no you don't have that.

Shit, if I did. I probably would be better right now living out my dreams with my husband turned wife, whom I may or may not divorce. (I do have a guy in mind, but I'm not sure where his sexual interest lies nowadays.) I would have been a cinematographer capturing stories and trying to save what little human empathy we have left. I can tell all who question me, but it's medically necessary for me to live like a hedonist as stress is but too much for my weak constitution to handle. But no, I'm here typing on a computer as my hands scream bloody murder.

My parents have gone off the wagon as well. My mom doesn't want to deal with it and neither does my father. They think that I'm just taking some time off, not really acknowledging the fact that I'm really sick and may never regain the ability to work again. However, my dad does have moments of clarity when he realizes how dire my situation is, but then he slips off into a mad delusional state asking me why I'm not doing anything for myself. (Maybe it's because I can barely walk 300ft without passing out and suffering a heart attack? I'm not joking. I actually did acquire some mild heart damage from doing the laundry. Yep. Just doing the laundry causes a mild myocardial infarction.)

But, can I blame them? Nope. I don't even want to dwell on that too much. It's useless as my therapists say because there is nothing certain in the future for me. It's best to live in the present and appreciate what is working for you, which is the rule I live by.

So, I just focus on my upcoming physical therapy appointment. I'm hoping that it'll lead to some improvement on my end instead of becoming the overwhelming disappointment late last year. One medication change wiped out months of accomplishments. But, we'll see what occurs this time.

My hopes for now is that I'll be able to go back to my college or a college abroad. Frankly it's getting too expensive for me, and my future is wildly uncertain. It's not the time to be making $1 million bets right now. Seriously, it'll get that high if my dad has his wish.

But the thing that led me here was me. I should have sought a second opinion, but I don't like doctors, probably more than most so... Whatevs. I wouldn't have gone anyway even if me from the future pulls up with a ventilator and a foot in the grave. I probably would have told her, but we had fun right? *Winky face* And I really did. I regret nothing. I just hope that I have enough juice left in the tank to pay off my massive debts at least.

Random side note. I just discovered my college offered a major course online and I was thinking of switching because at least I could work from home right? Well, it turns out the courses are few and far in between. Up to a year wait in some cases, and you can't even follow the course sequencing if you take it online. No college student should ever come across something like that at all, which makes me wonder. How many online students have actually graduated?

Peace, till the next time.

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1990spleen-blog · 8 years

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What are the implications of Freud’s revision of his theory of female Oedipality for our conception of psychoanalysis’ politics of gender? 

Freud's text—and perhaps any text on hysteria—is 'hysterical' too: it tantalizes us, waving a cape that hides nothing behind it. But it is that illusion of power, that very blindness which, ironically, will allow Freud to move forward.--Kohon

In a passage from Freud’s late text, 'Female Sexuality' (Über die Weibliche Sexualität), from 1931, he partly exposes a link—described as a mere "suspicion"—that returns the new discoveries, about to be presented in this late text, to his some of his very earliest preoccupations on the aetiology of hysteria, work from the mid 1890s, at the very origins of psychoanalysis:

Among these [new ideas] is a suspicion that this phase of attachment to the mother is especially intimately related to the aetiology of hysteria, which is not surprising when we reflect that both the phase and the neurosis are characteristically feminine.

Freud is talking about the hitherto unnaccounted for intensity between the girl and the mother in the pre-oedipal phase. But Freud does not explicitly say more about the suspicion this discovery arouses, except for obliquely. We are left to wonder how pre-oedipal female sexuality and the aeitology of hysteria are related, what links the late discovery to the curiosity of the early work, and what is characteristic femininity.

Unlike the connection between it and hysteria—which Freud tells the reader should not be surprising—the new discovery, is surprising for Freud, as it exposes a region of female sexuality that is seemingly both impossible to see and also paradoxically, abundantly present in his field of vision:

Our insight into this early, pre-Oedipus, phase in girls comes to us as a surprise, like the discovery, in another field, of the Minoan-Mycenean civilization behind the civilization of Greece.

Female sexuality is, for Freud here, a region hitherto hidden in plain sight, of which he is only now aware. The nature of Freud’s discovery is curious. It is not based on one single particular case history, but is seemingly built over innumerable observations over several decades of clinical practice. The discovery, with its element of 'surprise' seems sudden, with an important immanence. And Freud’s metaphor seems to be drawing our attention to his own unconscious mind, and the importance of his own role in not having been able to see the 'facts' about the pre-oedipal phase in girls until now. It seems to strike him at a particular moment, like an after-blow. He claims the main reason for his inability to see the facts was a lack of transference towards him—the analyst—by the female patient: 'It does indeed appear’, he writes, 'that women analysts—as, for instance, Jeanne Lampl - de Groot and Helene Deutsch—have been able to percieve these facts more easily and clearly because they were helped in dealing with those under their treatment by the transference to a suitable mother-substitute.' The paradox of this discovery therefore is that, as Freud concedes, it had already been discovered before, by female analysts. But it somehow still remains a palpable discovery on his part. The moment of discovery is Freud’s, but it is belated. As Gregorio Kohon reminds us of psychoanalysis' origins, bound up in the case of Dora, 'His exaltation is no longer that of a young doctor on an ambitious quest for a name and fame; there is now a persistent search for the truth—although we do not know whether it is Dora's truth or Freud’s.'

Gregorio Kohon’s article, 'Reflections on Dora: The Case of Hysteria', highlights the significance between the phenomenon of hysteria—a phenomenon as Elaine Showalter notes, that has now 'disappeared from consulting rooms, hospital wards, and psychiatric textbooks' [hystories]—with a particular moment in the oedipal drama for the girl. Against the backdrop of a disappeared, universally rejected notion of hysteria, Kohon, following Freud, makes a case for examining its essential link to women, clinging to the value of something persistent, common, and tragic, to 'female' sexuality in particular. In a moving passage towards the end of his essay, he describes Dora’s sad fate:

What Dora does is to get interested in the relationship between two people, never as two separate people. The identification with one of them only makes sense to her if seen from the perspective of the other one. That creates the game of multiple identifications, which ultimately leaves the hysteric empty and desperate: the labyrinths of her desire lead nowhere, except to the preservation of that very desire…In that blind alley the hysteric cannot answer the fundamental problem that is posed to her: since there is a difference between the sexes, who is she, a woman or a man?

It is because of trauma, and of the knowledge of castration, that Dora realises the truth of sexual difference, but paradoxically because of the knowledge of this difference that she cannot know who she is. Her identity is always masked and eclipsed by the other two. Her oedipal drama, tragically, cannot be overcome. But why is this? And why does Kohon claim that: 'The hysteric cannot define herself as a man or as a woman because she cannot finally choose between her father or her mother'? And what is the difference between that claim and this other one?: 'a woman always at heart remains an hysteric. What I am referring to is not unknown to psychoanalysts in their practice: a female patient will say that she is in love with her male analyst but nevertheless make a maternal transference to him.' Both of these claims in Kohon’s essay inscribe the female gender in the subject who, as Kohon himself tells us, cannot choose her object, or her own gender. At the very least, these claims deploy a kind of erasure of the position of the analyst, whose own transference is not taken into account (as Josh Cohen notes 'in Freud’s accounts, transference-love is always that of a female patient for a male analyst'). At the most, they are violent exercises of patriarchal law. Saying that 'a woman always remains a hysteric at heart' is making a structural, categorical claim, that the category of identifying as female is itself a hysterical position. I will attempt to point to Kohon’s notion of 'divalence' in the 'hysterical stage'. I will then explore ideas of character and disposition and gender-identity as formulated by Judith Butler to see how these theories complicate oedipality and gender; In the second section of my essay I will attempt to perform a reading of a footnote from Freud’s essay 'Female Sexuality' in relation to Dostoevsky, to see how it might illuminate some of the questions raised.

Divalence

Kohon writes that 'Psychoanalysis truly began with women…the connexion between women and hysteria makes sense to me, and Freud never seemed to have abandoned this idea which in fact has been present in psychoanalysis ever since. Freud first mentioned it in 'Heredity and the aetiology of the neuroses' (1896); reaffirmed it in the 'Three essays ...' (1905b); and finally stated it in 'Inhibitions, symptoms and anxiety' thus: "there is no doubt that hysteria has a strong affinity with femininity, just as obsessional neurosis has with masculinity"'. Now that hysteria is now so much outside of our own language for illnesses and disorders, it perhaps has an altogether different kind of value: it has been removed, just like a hysterical symptom itself, and we now have a psychoanalysis whose origins have been retroactively split: hysteria has vanished, but psychoanalysis—a field whose origins are in the study of hysteria, goes on without it. Perhaps this should leave us to question: what has happened to this lost object of psychoanalysis? Has it been incorporated into the very fibre of psychoanalysis, and does it allow us to read psychoanalysis afresh?   Kohon formulates the notion of an 'hysterical stage', 'a stage, not in a developmental sense, but more as a place where something happens, on which a performance takes place, a drama is developed, and at the same time, as a distance between two stopping places.' For Kohon, the distance between two stopping places is the decisive moment between the choice of father-as-object or the choice of mother-as-object in the oedipal drama which occurs simultaneoulsy as the gender-formation of the female subject. But it is a stage outside of a developmental or chronological viewpoint, and as such retains its own sense of time, and also a sense of being outside of a proper sense of time. It also fits with Freud’s thinking on hysteria, that hysteria is not merely the manifestation of symptoms, but an internal state. As such, it is hidden, and only reveals itself through symptoms, partially and in a occluded manner. Kohon also draws to our attention Freud’s separation of hysteria and biological sex as early as 1886, but, in continually re-affirming the link between hysteria and femininity, he argues that 'Freud’s attempt took him even further than he intended at the begining: hysteria is not just a psychiatric diagnosis which would include conversion hysteria, anxiety hysteria, etc., but is a human problematic, specifically female, present in all of us.' He concludes that what particularly characterises the hysterical stage as female is the divalence in the sub-oedipal phase, by which objects (mother, father) are constituted as 'whole' at the same time as the subject is required to choose between them, in the foundational moment of her oedipal drama. For Kohon, the 'ambivalence' which is primary in the case of the male child in his relation to his father in the model of the route to the 'normal' Oedipus complex, is secondary to the female child in this moment of confusion. For her, divalence is primary. This divalence points to the impossibly split sense of object-choice and its relation to her formation of gender-identity. The hysterical moment is therefore one of a return to this divalence, a time more primal than its inherited ambivalence towards only one figure. Female oedipility is perplexing, in part because it represents the precise place where the child, at the moment of their definitive libidinal choice at the foundational moment of their gender identity, encounters for the first time a kind of politics, and in which, the infant comes out badly (Freud talks about the unbound desires of the infant, and the impossibility, realised in the oedipal drama, of these desires reaching fulfilment). In female oedipality, the girl is presented with an additional problem in relation to her early erotic attachment to ther mother. According to Freud, she must either relinquish sexuality altogether; or fortify her masculinity complex; or transfer her early attachment to the mother over to the father, thereby abandoning the mother, her primary love-object. Whereas the threat of castration in the boy leads to the dissolution of the oedipal phase, in the girl it is responsible for leading her to it by a route which is itself foreshadowing of her own dissolution of the complex. In the 'normal’ outcome of the female Oedipus complex—by which the girl has tranferred her early attachment to the mother over to the father, the girl has reached the complex through the destructive manoevre of relinquishing the mother which has seen the boy (who relinqueshes the mother out of fear) escape from it.

Giving over to femininity

Freud says we should not find it surprising that female pre-oedipal sexuality and the aeitiology of hysteria are 'intimately related', but perhaps this betrays an implicit sense of surprise at the stubborness and insistence of a common denominator between the new discovery and hysteria—namely, the shared character femininity.

Ideas of 'charactology' in Freud, as James Stachey’s editorial note to 'Libidinal Types' suggests, are particularly rare; but Freud is keen to return to them at this stage in his thinking: he discusses character in 'Libidinal Types' which was written in the same year as 'Female Sexuality', as well as more implicitly in Civilization and its Discontents. He also makes speculations about Dostoevsky’s character, biography and neurosis in 'Dostoevsky and Parricide' from 1928, as we will see. In 'Libidinal Types', Freud lays out a schema that points to three main libidinal types: the erotic, the obsessional, and the narcissistic, within which there are further 'mixed' combinations (erotic-obsessional, erotic-narcissistic, narcissistic-obsessional). As such, these ideas of character are part of a libidinal economy, which does not permit, as Freud makes clear, for a mixed combination of all three types, (the erotic-obsessional-narcissistic), because such a type 'would no longer be a type at all: it would be the absolute norm, the ideal harmony.' Instead, Freud seeks to show how 'the phenomenon of types arises precisely from the fact that, of the three main ways of employing the libido in the economy of the mind, one or two have been favoured at the expense of the others.' The libido then can be seen to function as if set-up to be primarily out-of-balance, the result of a decisive choice, and only made manifest through this negative principle, which is based on an exclusion, as well as a giving-over. In this way, we may see how character-formation in Freud could be said to be based around an a priori lack, that brings it into being as a manifestation of positive attributes that is definitively lacking: character in this way, is like a ruin: a manifestation that points to its own sense of lack. This sense of lack as foundational to character would ring with associations regarding female infantile sexuality, oedipality and the castration complex in girls in Freud, Lacan and others, which sees the girl coming to terms with the fact of her castration, the trauma of her lack as the spur to the choosing of a love-object and the fixing of her gender identity. We may see the idea of character itself, following this route, as essentially feminine or at least as illuminating as to what 'femininity' might signify. What 'Libidinal Types' shows is that while the lack structures female sexuality, it is also a categorical lack that structures character types. In this way, just as in questions of hysteria, a principle in Freud that has an uncanny sense of femininity, has broader and more universal applications and schematic resemblances. In 'Libidinal Types', Freud proposes a possible question that may arise from his exposition of these types, and that is whether the particular libidinal types have a particular relation to the origins of pathology and neurosis. Here, he is sure to exclude any possibility of this: 'The answer is that the setting up of these libidinal types throws no new light on the genesis of the neurosis.' And he goes on to conclude in the essay that while the aeitiological preconditions or neurosis 'are not yet known with certainty', neuroses can occur due to 'conflicts arising within the libidinal economy in consequence of our bisexual disposition'. Our innate bisexual disposition, is, as his postulation goes, that the libido is made up of both masculine and feminine components, (each with a heterosexual aim), a point he re-states in 'Female Sexuality'. But it is significant to note that, in 'Libidinal Types’, Freud is careful not to propose a link between any particular character (here the libidinal types he has set out), and the aeitology of neuroses. Later, in 'Female Sexuality', we should note, he does so in regard to specifically gendered character—femininity, and a specifically gendered kind of neurosis—hysteria. This perhaps shows in what way he constructs hysteria an exceptional neurosis as femininity is an exceptional character. Judith Butler questions the implications of Freud’s notion of the inherent bisexual disposition in humans and its relation to character. By pointing to the notion, first put forward by Freud in Mourning and Melancholia, she notes that 'identifications substitue for object relations', and that the character of the ego is formed from loss, from the incorporation of the lost object into a part of the psyche, 'where the quarrel magically resumes as an internal dialogue between two parts of the psyche'. Character, is then, in Freud’s own terms, not just formed on the basis of object-relations, but also on the basis of loss, and of mourning. She shows that for Freud, there is no primary homosexuality, and that bisexuality 'is the coincidence of two heterosexual desires within a single psyche', a formulation in which 'there is no homosexuality, and only opposites attract.' But she questions what is really involved in these dispositions. She compares melancholia to the oedipal drama, as each is potentially responsible for the loss of a love object as the precipitation for the fixing of gender, and exposes a taboo more primary than the heterosexual incest taboo—the taboo against homosexuality. Here she oultines the notion of a 'dsposition':

The language of disposition moves from a verb formation (to be disposed) into a noun formation, whereupon it becomes congealed (to have dispositions); the language of "dispositions" thus arrives at a false foundationalism […] dispositions are not the primary sexual facts of the psyche, but produced effects of a law imposed by culture and by cthe complicitous and transvaluating acts of the ego ideal.

She discusses how these dispositions 'are the result of a process whose aim is to disguise its own genealogy'; in other words, where Freud takes masculine and feminine dispositions for granted, each with a heterosexual aim, (as Kohon also implicitly does when he claims 'The hysteric cannot define herself as a man or as a woman because she cannot finally choose between her father or her mother'), Butler exposes the cultural prohibition that is productive of this compulsary heterosexuality. In the case of the girl caught in the Oedipus complex, Butler writes that 'In repudiating the mother as an object of sexual love, the girl of necessity repudiates her masculinity and paradoxically, "fixes" her femininty as a consequence.' Butler shows that this is a cultural compulsion, an operational feature of a cultural system of sexuality that 'both produces sexuality in the form of "dispositions" and appears disingenuously at a later point in time to transform these ostensible "natural" dispositions into culturally acceptable structures of exogamic kinship.' Thereby, the law 'forecloses the possibility of a more radical genealogy into the cultural origins of sexuality and power relations.' When the girl transfers her affection over to her father in the 'normal' course of the Oedipus complex, she is, as Parveen Adams writes, attempting to exit the complex through the door on which she reads "femininity", but, as she notes, for the girl, there is no door marked 'Exit from the Oedipus Complex'. She writes that 'Her sexuality, feminine or masculine, is going to be out of line. For her there is no ideal exit from the Oedipus complex; the Oedipus complex neuroticizes the girl. It is one thing to say that the Oedipus complex is the source of all neurosis; it is quite another to recognisze that the Oedipus complex pathologizes femininity and feminine sexuality.' Both Butler and Adams point us to the fact that the Oedipus complex is itself perhaps a disguise for its own geneaology, and that it is a political schema which itself produces prohibitions and pathologies in the subject, in this case, specifically the subject gendered 'female', who finds themselves trapped in it.   Regarding the more radical potentialities of Freud’s formulation of bisexuality, Jaqueline Rose writes:

Given a primary, universal bisexuality, sex, Freud said, is an act involving at least four people. The ‘cis’ – i.e. non-trans – woman or man is a decoy, the outcome of multiple repressions whose unlived stories surface nightly in our dreams. From the Latin root meaning ‘on this side of’ as opposed to ‘across from’, ‘cis’ is generally conflated with normativity, implying ‘comfortable in your skin’, as if that were the beginning and end of the matter.

Rose allows us to consolidate somewhat the position between Freud and Kohon on the one hand, and Butler and Adams on the other. By pointing to the multifarious nature of gender combinations that Freud’s theory of primary bisexuality permits, she enables us to see that only the 'cis' position is necessarily a mask for an innumerable number of gender-positions underneath. While Freud’s theory of primary bisexuality might be premised on heterosexual aims, as Judith Butler has shown, these aims would, as Rose shows, whether they are heterosexual, or indeed homosexual, still be 'the outcome of multiple repressions'. The oedipal drama, with its taboo structure, would signify that it would be impossible for any subject to feel 'comfortable in their skin' whatever the resulting gender-identity/object-choice combination; so in the case of female oedipality—an oedipality we are suggesting is linked to hysteria—in which the (female) subject faces, as we have shown an impossible situation, one could revise Kohon’s statement that 'a woman at heart remains an hysteric' to say 'everyone at heart remains an hysteric', but this would be the equivalent of using "all lives matter" in response to "Black Lives Matter"—a fundamentally reactionary position. Instead 'a woman at heart remains an hysteric' could be used to dramatise the many ways in which the subject is liable to fall into an impossible moment of divalence, as a result of the bisexality that constitues them, and the law that underlies the compulsary heterosexuality of this bisexuality. In other words, it could be used to point to the plight of the subject of whom it is demanded by the sub-Oedipal complex, that she becomes a woman, and loves a man.

"A knife that cuts both ways": Freud’s warning to feminists

At at critical juncture of his exposition of oedipality and how it pertains to character in 'Female Sexuality', Freud disrupts our reading, as he so often does, with a footnote, (with added commentary by Strachey):

It is to be anticipated that men analysts with feminist views, as well as our women analysts, will disagree with what I have said here. They will hardly fail to object that such notions spring from the 'masculinity complex’ of the male and are desiged to justify on theoretical grounds his innate inclination to disparage and suppress women. But this sort of psycho-analytic argumentation reminds us here, as it so often does, of Dosteovsky’s famous 'knife that cuts both ways'. The opponents of those who argue in this way will on their side think it quite natural that the female sex should refuse to accept a view which appears to contradict their eagerly coveted equality with men. The use of analysis as a weapon of controversy can clearly lead to no decision.—[The Dostoevsky phrase (a simile applied to psychology) occurs in the speech for the defence in the account of Mitya’s trial in Chapter X of Book XII of The Brothers Karamazov. Freud had quoted it already in his paper on 'Dostoevsky and Parricide' (1928b)..The actual simile used by Freud and in the Russian original is 'a stick with two ends'.]

Freud’s address intimates a community of feminist analysts to come, and defensively, he pre-empts against criticism from them, which would designate his theories as arising from the 'masculinity complex' from a set of pre-conditions that will have constructed his views; Psychology, following Dostoevsky, is 'a knife that cuts both ways', the English phrase carries the lingering threat of castration, and of the danger of being-cut in the act of cutting. It combines the desire of the father to enforce the law against taboo, with the castration anxiety of the child. The use of psychoanalysis as a weapon for feminism, Freud warns, would backfire on feminism, and so he warns them to remain passive. By this gesture, Freud separates psychoanalysis from politics, but in doing so, completely effaces his position as the father, who in wielding the castrating knife, and simultaneously pointing to his own implied castration-anxiety, is an integral part of the psychoanalytical-political system.  In The Brothers Karamazov itself, the 'stick with two ends' dramatises a phallocentric economy. But one whose phallic element is comic, arbitrary and undermined. The defence makes the joke:

While still in Petersburg, still only preparing to come here, I was warned—and I myself knew without any warning—that I would meet here as my opponent a profound and most subtle psychologist, who has long deserved special renown for this quality in our still young legal world. But psychology, gentlemen, though a profound thing, is still like a stick with two ends.” (A chuckle from the public.)

As in Freud’s footnote, the defence pre-empts the use of psychology as a weapon. He proceeds to turn a psychological reading of the overdetermined events of the murder of the father in the garden, in a way that favours Mitya, saying: 'There you have psychology; but let us take the same psychology and apply it to this case, only from the other end, and the result will be no less plausible….' Freud, using Dostoevsky’s metaphor seems to suggest that the hermeneutic potential and power of psychoanalysis is here being subordinated to the deterministic nature of events that have occurred: the power with which psychoanalysis can be used to interpret or justify our actions is great, but in excess of the truth of real events. But the deterministic reading of the events is also undermined by Freud:

This other person, [Smerdyakov, the 'real' murderer] however, stands to the murdered man in the same filial relation as the hero, Dmitri; in this other person’s case the motive of sexual rivalry is openly admitted; he is a brother of the hero’s, and it is a remarkable fact that Dostoevsky has attributed to him his own illness, the alleged epilepsy, as though he were seeking to confess that the epileptic, the neurotic, in himself was a parricide. Then, again, in the speech for the defence at the trial, there is the famous mockery of psychology—it is a 'knife that cuts both ways': a splendid piece of disguise, for we only have to reverse it in order to discover the deepest meaning of Doestoevsky’s view of things. It is not psychology that deserves the mockery, but the procedure of judicial enquiry. It is a matter of indifference who actually committed the crime; psychology is only concerned to know who desired it emotionally and who welcomed it when it was done. And for that reason all of the brothers…are equally guilty.

These small details—a footnote, a quote by Dostoevsky, raise big questions. To what extent is psychoanalysis concerned with the 'real' events? With the 'real' scene of trauma? And to what extent does it account for the psychological forces which, in the subject, actually produce the trauma? The question of hysteria and female oedipality perhaps lies in between these two ends of the stick. Here, Freud is seen forbidding the activity of the feminist-analyst to come, with the same threat of an enforced punishment, the stick, the knife. In the words of Jessica Benjamin: 'How has the history of psychoanalysis been marked by the move from passivity to activity, and how is this move fundamental to the problems of the transference between unequal persons—doctor and patient, male authority and woman rebel? How did Freud’s way of formulating that move reflect his ambivalence about attributing activity to women?'

Hysteria, female sexuality, a radical sense of internal activity, at the heart of a passive body, could be conceived in much the same way that Jean Laplanche understands 'Nachträglichkeit', the après-coup, (afterwardness), the latent phenomena in Freud, whereby, paradoxically, the later event constructs, and changes the earlier traumatic scene, disrupting our notion of chronological time, and with it, both the sense of being able to interpret both the 'real' events and the psychological forces that construe them. We may read the après-coup even more literally, as the cut that comes after it has happened: the girl realises the fact of her castration only after she has been castrated. Life, for the girl, is after the cut.

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