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scientia-rex · 1 year ago

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I had one of those days where I just had too many feelings to fit inside my skin, and I’ll have to recover from it.

Telling a patient she has breast cancer. Telling a patient she has dementia. Calling a patient at 6:30pm, still sitting at my desk, because even though I finished seeing patients at 5pm, I have work to do. Doing an endometrial biopsy on a patient who may have cancer. Calling a company so I can get the password to a website so I can recredential every three months so my clinic can charge for my work. Working with an assistant on whom I’ve also done an endometrial biopsy. My regular MA is out with COVID. I’m getting a year-end bonus for the first time in my life. Some idiot kid thinks I don’t know how ears work. I saw back to back ADHD patients; one is a trans woman who paused her transition because she can’t afford it. One is a kid who did loops around the exam room chairs the whole time I talked to his mother. His mother was frosty towards me at first because I was running late because I was telling a patient she had breast cancer, and she was crying, and her daughter was crying, and when her partner died of a different cancer last year the hospice workers were homophobic and she’s afraid of hospice. A different idiot kid thinks I don’t know how soap works. The ADHD kid’s mom warmed up to me when she realized I cared and knew what I was talking about. The kid said, “AHEM. What’s up, chicken butt?” I laughed and high fived him. I gave his mom the Vanderbilt forms to assess ADD symptoms across multiple environments. I saw a patient who had a certain air about her that I recognized intimately, and at the end I asked what she did, and she was a doctor, too. I knew it had to be something like that. When I explain medical concepts I aim for lay language, but I can see when people get faintly impatient with me for it, and I’ll add in more and more technical language and see when they start looking confused; she didn’t. I could watch every new patient take in my brightly-colored hair, combined with the utterly forgettable rest of me, all browns and grays and dress slacks and comfortable shoes, because the hair is my one concession to my deep need for attention; in the exam room, I need to recede into the background so the patient can be the focus. Studies have shown that patients don’t like it when doctors disclose that they have the same medical issues. It might seem like bonding, but it shifts the focus away from where it belongs: the patient. That island of time is theirs. The breast cancer patient’s daughter said to me, “Thank you for spending the time with us. I know you didn’t have the time.” And I said, “From each according to their something or other, to each according to their needs. It’s lukewarm Marxism.” I don’t think she heard it all, or took it all in, which was good. I had a migraine that made my head feel three sizes too big with a steady drumbeat of pain despite taking two Ubrelvy, two Aleve, and two Tylenol, plus 100mg of caffeine and a propranolol and a Zofran. You have to disconnect each patient from the next. I can’t bring the breast cancer patient’s grief and heaviness into a room where a little boy is doing hand-stands and telling me silly puns. One of the nurses brought me a sublingual Toradol from a stash—someone’s purse, somewhere—because she wanted me to feel better, and I felt tears stinging my eyes because she cared about me. I couldn’t afford to cry. I just told a woman she has dementia and she doesn’t believe me. I told her to bring her husband to our next visit. I ended my clinic day doing an endometrial biopsy, trying to pass a uterine sound through a stenotic cervix, but I’ve done this before enough times to know to have the set of dilators ready. I dilated her cervix gently but firmly, with the back pressure of the tenaculum, until I could get the sound in, and then I left the sound there while my assistant handed me the sampling pipelle, because if you remove it there’s a good chance the cervix will tighten down again and you’ll have to repeat the dilation. The patient was holding her husband’s hand and chanting to him under her breath, in pain despite the Xanax I gave her.

I’m a doctor. It’s everything to me.

#the attending dr. kristophine

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mint-and-authoress · 7 months ago

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Slime HRT - Progress Report I

<<| ⏯️ |>>

“...”

[The video shows a bedroom with a computer setup in the background and an empty chair in the foreground.]

“...gods how do I even start…”

[o-s]“Just talk, love. You’ll be fine.”

“...but I meant like… no, you’re right.”

[A young woman appears from stage left, wearing a green flannel hood atop a t-shirt and leggings. She has brown hair and glasses, standing around 5’8/172cm. She sits in the chair.]

“Hello. My name is Elise, and I’ve decided to make a video documenting my transition. I’ve recently thought about some life choices and more about my identity, and I’ve chosen to undergo human removal therapy. Basically I wanna take all m’ flesh and bones and turn it all into slime. Thanks to experimental drugs and the fact that the FDA is not responsible, I’ve been given an opportunity.”

[Elise holds up one generic prescription bottle containing capsules; two vials for injections, one opaque and slightly coloured green, the other clear and watery; and one tube of ointment that has been emptied.]

“This is the motherload, right here. Everything I’m taking to do this. This bottle is my… ‘my-o-chi-tin-ase’... yeah. This is the main ingredient, turns all your insides to mush and turns that mush into slime. The pills are homolipostat, it’s basically spiro but for human removal. Stops your human parts from regenerating. The other vial and the empty tube are things to help the transition. This is vasopressin, helps with water retention, which I’ll need a ton, since I’m basically becoming 50% more water by mass. And this tube once contained something like 30 grams of salicylic acid, all to break down m’ skin. The myo is 1mL once weekly, the -(pfft)- the homo is 100mg once daily, the vasopressin is 0.01mL once daily, and the ointment is one tube weekly.”

[She sets the medicines down.]

“So…day one of Slime HRT. All that is to say, nothing yet. Though I have heard this human removal therapy business is supposed to work pretty fast compared to hormone replacement therapy. So, hopefully I get some good results out of it.”

“Still haven’t told anybody except my darling wife so…yeah that’s gonna be fun when it happens.”

“Oh, and yeah, this is what I look like right now. It’s decent as far as a human body is concerned, so just to make it obvious to the TERF-y crowd, I am happy I went through this process. Even though the slime is gonna replace all of…this.”

[Elise vaguely gestures to herself.]

“I’m gonna end up uploading this all in one big compilation-esque video at a good stopping point so this is all ya get for now!”

[The woman reaches for the camera and the first segment ends. The next segment opens in a different room, messier and more decorated. In the top right corner a timestamp of ‘14 Days’ is shown.]

“Two weeks later! Still not used to talking to cameras, I’ve had absolutely zero practice since the last time you saw me.”

[Elise brings her right hand and wrist up to the camera.]

“So in terms of changes, I haven’t really noticed much. Pandora - that’s m’ wife, if ya didn’t know - she thinks my skin’s gotten clearer. I think to her-”

[Elise momentarily looks away pointedly, likely towards her wife]

“-it’s just a confirmation bias thing. Not to mention I just cannot imagine. Nope. Nothing. Never been able to. It’s called aphantasia, and if you’ve ever seen that image where it’s the five heads all imagining an apple, I’m the one that can’t see anything. But that’s not really relevant to the slime stuff.”

[The camera switches to the outer camera of a smartphone, pointed down at the back of Elise’s left hand]

“So… just so you can see… even turning my hand over just to show… nothin.”

[The segment ends. The next segment opens with a headshot and the timestamp reads ‘1 Month.’ Elise looks excited, despite having obvious bags under her eyes. Her skin appears more lustrous and is slightly translucent. She is wearing short sleeves.]

“One month! Gods one month! It’s like, impossible to explain how excited that makes me. Anyway, big news! Look!”

[Elise holds her arm up to the camera, the skin looking notably transparent.]

“That’s the first sign! Well, the first visible sign. The actual first sign was like a couple days ago. Turns out the first thing to change is something to do with sweat, probably because slimes don’t want any help in terms of drying out. It got a sweeter smell, weirdly enough. If for some reason you’re using this as a guide, take the extra time in your day to keep your skin clean. Sweat equals bacteria, so while your skin is kinda retiring from the idea of keeping all that outside of your body, do yourself a favour and take preventative measures.”

“...and I guess this’ll be a kinda vlog thing, too. Transition’s not all about the meds and stuff, y’know?”

“I told my boss about it. Honestly, it went pretty decently, all things considered. Most importantly: not fired, which was what I was most scared about. We talked about it for like, an hour while she was in the store for something else. She’s a very human human, so I don’t think she really got the deeper meanings of it.”

“Still haven’t told my friends or my family. My friends are…also human. It took them a while to actually take my transition seriously, and even then it was because I had to tell them to. As far as my family goes…yeah, nah. I’m moving out at some point soon so either way they’re not gonna have to deal with all this for long.”

“I have connected with people more like myself, though! These drugs are experimental so it’s not like everybody can just go for it yet, so that list of new friends is kinda small. There’s a couple little support groups but everyone kinda talks to everyone and wow there’s some nice creatures I know now. So, Mayday, Sandy, Xion, if y’all are watching, hey! I am aware of you!”

“I think that’s everything? Again, not much, but it is still only a month into all this. If something happens, I’ll keep you all posted.”

[The segment ends. The next segment appears to be an Overwatch lobby, where in the top left corner a webcam is set up, showing Elise wearing headphones. The timestamp reads ‘7 Weeks.’The audio from the game is intentionally muted.]

[o-s, distant]“Hey, El?”

“Yeah?”

“...”

[Elise removes her headphones.]

“One sec.”

[Elise walks away and opens the door, still in frame. The video zooms in to mostly show the webcam, though nothing of note happens in the gameplay.]

“What’s up?”

[o-s] “Nah I was just headed to the store and…”

“...and?”

[o-s] “...what the fuck? You feel okay?”

“Uh, yeah. I feel fine. Why?”

[o-s] “Look at your skin, you’re like breaking out or some shit!”

“No, dad, it’s fine. I’m fine, okay?”

[o-s] “No no, it’s not. You’re not! You got like, shiny skin and it’s…”

“...”

[o-s] “You’ve been taking shit behind my back, haven’t you?”

“What? What do you mean?”

[o-s] “Oh don’t you start that bullshit. Come on, El, you know that shit is delusional. You see it on TV, you see those people just throw everything away and kill themselves on that removal shit.”

“You don’t understand! You don’t struggle with identity issues! I want to be something that isn’t human, it literally should not change anything between us.”

[o-s] “Ah don’t give me that shit. This trans species stuff is all just a hoax. Government just wants an excuse to take gullible people and experiment on ‘em, they get away with it every time there’s some international shit to take the heat.”

“This isn’t from the government, though! It’s from Hyper City-”

[o-s] “Hyper- when the fuck did you leave the house that long? No, if your doctor didn’t give that out then hand it over.”

“Not happening. And we really don’t wanna talk about unprescribed meds, do we?”

[o-s] “You know that’s different, you… Whatever. You’re not gonna be around long enough to make it matter anyway. You don’t show any of this to your mother, got it?”

“...Fine.”

[The door shuts loudly. Elise returns to the setup as the scene fades to black.]

}~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~{

YEAH THAT'S RIGHT, PART THREE

finally made some progress thank you to sandy and weiss and the rest of them over at @sandyca5tle for dropping a bomb of inspiration on us earlier this morning

but yeah! finally actually getting the changes documented, as well as the developing lore (tm)

the trans experience on full display today ;-;

#btw this is the new format - easiest to write and it's unique :P #slime girl #slime #slime oc #my gender #slime hrt #animal hrt #therian hrt

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whumpetywhumpwhump · 10 months ago

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Posting one of my actual (fandom-related) full fics on here... be nice!!

This is some good ol' intubation whump because it's my favourite.

(for slight context of character, see this old post)

When the call comes in, everybody in the ER is hoping it isn't Coop. Especially Neela.

Severe asthma attack. 26 year old male.

Somehow, because it's his day off and he really ought to be relaxing, it seems almost impossible for him to find himself back in the hospital as a patient. It just… isn't fair.

That doesn't stop the wheels of the gurney from rolling through the doors, though. Doesn't change the fact that Coop is laying half-conscious on top of it, his quick, shallow breaths fogging a nebulizer mask, his skin so pale it looks ashen.

“26 year old male,” the paramedic conducting the transfer restates. “Severe asthma attack with symptoms pointing to onset of status asthmaticus. Albuterol administered, as well as 0.5mg subcutaneous epinephrine, both to minimal effect.”

Dr Lewis, the attending on the case, moves to Coop’s side, slipping the chest piece of her stethoscope underneath his t-shirt as they continue to move into one of the trauma rooms. Her expression, when she withdraws it, is severe.

“His airways are pretty much closed up. He needs more epi now.”

Abby hurries to drag a crash cart in, and Neela follows the gurney all the way until it's positioned in the trauma room, at which point she starts readying an IV kit with shaking hands.

Coop does not look good. Even when compared to the time she almost killed him with epi. At least then he'd been alert, sitting up, and his skin hadn't lost all of its colour like it has now.

Dr Lewis returns from fetching some more equipment, and as she waits for Abby to arrive with the crash cart, she strokes Coop’s hair reassuringly.

“Hang on, sweetheart, we’re going to help you feel better. Just keep breathing for me, okay?”

Through weak wheezes that emerge from blue-tinged lips, Coop nods. His eyelids are heavy with exhaustion.

Neela hasn't seen an asthma attack this severe in person before, but she knows from med school how dangerous they can be- especially when the patient is as tired as Coop is. It isn't clear how long he's been struggling this much to breathe. The colour of his skin (or lack of, for that matter) tells her it's been too long.

If they don't work quickly, his body will run out of energy. He'll stop breathing, too exhausted to even inhale anymore. He'll lose oxygen.

He'll die.

“Neela, I need an IV of 100mg hydrocortisone.”

She turns to find Dr Lewis’ keen gaze on her. There's a thinly veiled panic in the attending’s eyes that quickly disappears as she turns back to Coop, gently trying to reassure him as he fights for air.

“I’m going to page Pratt as well, alright, Coop? He can get you some more albuterol so your nebulizer doesn't dry out.”

Neela can't see whether Coop replies, but if he does, it isn't audible. All she can hear is his terrifying wheeze and the hum of the nebulizer, shortly joined by a rapid beeping as a nurse finally helps him take off his shirt and hooks him up to a monitor. She doesn't dare turn around to look at his oxygen saturation. It's likely going to keep plummeting.

Instead, she focuses on setting up the cannula in Coop’s trembling arm, her left hand holding it steady while her right slides the needle in.

“There we are, Coop.” she murmurs. “You're doing so well, sweetheart.”

The pet name feels stranger coming from her lips than Dr Lewis', but at this point her slight blush is the least of their worries. While Coop’s this sick, it doesn't matter what she calls him. He just needs to start breathing properly again.

Once the IV site has been secured with a clear sticker, Neela measures out the dose of hydrocortisone. 100mg. When they're giving it as a steroid over a longer period of time, they prescribe 20-30mg a day, in two doses. The fact that they're pumping him full of this much at once is testament to just how emergent his case is.

“100mg hydrocortisone going in.” she announces. Connects the needle to the cannula. Pushes down on the plunger of the syringe.

Despite her accumulated knowledge surrounding medication, Neela still half expects the effects to be immediate. For Coop to suddenly relax, his airway opening up again, the colour gradually suffusing his cheeks. For the wheezing to fade as he breathes in properly for the first time in hours.

It doesn't. None of this happens.

Minute by minute, Coop continues to deteriorate. Abby brings in the crash cart. Dr Lewis injects the epinephrine beneath the skin of his forearm and, unlike before, he doesn't even react to the needle. His eyes flicker like his awareness is slipping away from him.

By the time Pratt arrives to switch out Coop’s nebulizer, such a small intervention becomes pointless. Even if Coop were able to breathe properly, time has proven that albuterol, on this occasion, just isn't working. Pratt sets down the new nebulizer and instantly crosses to Coop’s bedside, brow furrowed.

“Coop, man, can I listen to your chest?”

A barely perceptible nod.

When Pratt presses the cold stethoscope against Coop’s heaving chest, it seems more of a confirmatory action than one that's actually necessary. He sighs, shaking his head. Coop, as evidenced by the blue tinge to his lips, his rolling eyes, the pallor of his skin, is officially status asthmaticus.

He's in respiratory failure.

Things suddenly grow a lot more urgent. Pratt gives Lewis a gesture that she reciprocates, and a nurse pulls the crash cart closer to the bed. Neela’s heart sinks just as Abby sinks into position right at Coop’s bedside, crouching next to him as she strokes his hair and updates him.

“Sweetheart, your breathing isn't where we need it to be, okay? You're not getting enough oxygen. We need to put you to sleep for a while… intubate you. Do you understand?”

Coop closes his eyes, humming in assent even as a frightened tear slips down his cheek.

“Ju-just… d-d-do… iiiiit.”

His voice is shot. Weak. Resigned to his fate.

It's the same phrase he used when Abby shocked his heart back into a regular rhythm a few months ago. Back then, though, it had simply been a plea to get things over with.

Now, it seems not only a desperate entreaty, but also a solemn reminder:

I’ve been here before.

Neela knows, just as the other staff do, that Coop’s been super sick a couple of times. He knows what it's like to wake up in the ICU feeling like you're breathing through a straw. He knows what it's like for weeks to pass in the span of a minute.

He knows that when he's tubed, he can breathe, and that’s all that matters.

“We’re going to look after you, sweetheart, I promise.” Abby says, her own eyes a little misty. She brushes the sweat-damp hair from his forehead and squeezes his hand. One of the other nurses adjusts the bed so it's laying flat. The tears, terrified, continue to stream silently down his cheeks.

Abby lifts his hand, pressing an almost motherly kiss to the back of it, while Pratt slots a syringe full of medication into the cannula of his other hand.

“Propofol and some muscle relaxants are going to go in now, man. Just relax and let yourself drift off- we’ve got you.”

As the syringe is pushed, Neela can see Coop’s grip on Abby’s hand loosen. The thick tears decorating his cheeks seem, in themselves, to slow down, the scared expression in his eyes melting away beneath the anaesthetic. He blinks once. Twice.

Gone.

There's something so unnerving about Coop being still. How, as Pratt brushes his index finger underneath Coop’s eyelashes, the latter doesn't stir at all to crack a smile. When Dr Lewis gets into position behind his head and adjusts her patient accordingly, he's limp and movable. Floppy.

“Pratt, can you get that nebulizer off?”

“Sure.”

There are red marks across Coop's face from where the straps of the mask dug into his skin for hours. Now, he doesn't breathe at all. He looks dead. According to the dropping numbers on the monitor, he may as well be dead.

“Laryngoscope.”

“Here. Laryngoscope.”

A nurse places the metal instrument into Dr Lewis' awaiting hand. Her other hand gently tilts Coop’s head back.

“Alright… sliding laryngoscope in… got slight cord visualisation. Tube?”

“Tube.”

Neela watches her angle the endotracheal tube in with bated breath- and for good reason.

“C’mon, Coop.” Lewis murmurs, desperately trying to gain access. “I need to help you breathe, sweetheart. Let me help you breathe.”

Pratt steps up next to her, arms crossed. “Difficult airway?”

“Nearly impossible. Haven't seen this level of inflammation in a long time. Poor guy must have been so incredibly uncomfortable.”

The monitor continues to blare. Coop’s oxygen levels continue to drop.

Abby, still positioned right next to him, stroking his hair even as he lays there unconscious, glances worriedly at the screen.

“His sats aren't looking good.”

Dr Lewis sighs. “Yeah, I know, I'm just trying to- there.”

Her relief is palpable, and Neela knows at once that she’s finally in. She watches the tube slot into place before Lewis inflates the cuff, and Pratt connects everything up to the vent.

“Tube’s misting.” Abby says gently, as everyone begins to relax. “Looks like good placement.”

Pratt pulls his stethoscope out from around his neck.

“I’ll check.”

He moves to Coop's side and checks his breathing, first auscultating the left side of his chest, then the right. It's odd, Neela thinks, to observe how natural his breathing looks now, when only moments ago it was erratic and desperate- but of course, it isn't technically him breathing now at all. They've taken over for him.

After a few more checks with the stethoscope across Coop’s chest and neck, Pratt stands up, slinging the device back around his own neck.

“Bilateral breath sounds. You're in.”

Everyone in the room seems to relax at once, especially when the numbers on the monitor start to creep up to normal.

“Alright,” Dr Lewis breathes, turning to Abby. “Secure it, then we'll get him down to ICU. Keep him on max settings until we know it's safe to start weaning him off."

She moves back, as does Pratt, and Abby stands, giving Coop’s hair one last gentle run through with her fingers before she moves away to fetch the tube holder. Neela's eyes remain fixed on him, though. It's impossible not to when he's so completely still.

“You alright, Neela?” Abby asks gently as she returns a few moments later.

Neela nods. “Yeah, I just… it's so different when you know them. I didn't realise how sick it would make me feel.”

Abby gives her a small reassuring smile, then focuses her attention back on the packaging she's just picked up, tearing it open and pulling out the holder before she starts to peel off the tape on the pads.

“I know what you mean. It's not easy seeing somebody you care about like this, and it's somehow even harder with a person like Coop. He's always smiling, always moving, always there, and now…” She presses the first pad against his cheek gently, thumb brushing against it to secure it. “He's not. He's always there to take care of everybody else, and now…” She applies the other pad, movements just as careful and attentive. “He needs us to take care of him.”

Neela hums affirmatively, watching her secure the tube.

“There's just so much at stake. So much that could go wrong, and nearly did. Maybe it even has.”

Abby finishes, standing up fully again and adjusting things ever so slightly. Coop looks like the other patients in the ICU now, and it makes Neela’s stomach roll with anxiety.

“It isn't easy.” Abby responds. “But that's what the ER’s like, even if it happens with one of our own. It's fast-paced, it's risky, and sometimes the worst happens. Sometimes, we can't easily cure a patient, and we have to hope that they'll fight enough on their own to get through things.”

“Do you think he will? Coop?”

“There are no guarantees, but if anyone's going to, it's him.” She looks down at him with a mixture of affection and admiration. Her thumb strokes along the curve of his jaw. “He just needs to hang on long enough for the inflammation to go down. He just needs to do something which is pretty alien to him, and rest. Let us do some of the heavy lifting for a while until he's strong enough to do it on his own again.”

Neela nods. “He'll get through it.”

Abby smiles. “Exactly. He'll get through it… You’re a tough one, aren't you, sweetheart?” She brushes back some more sweat-damp and unruly hair from his forehead. “Let's get you somewhere you can rest, hm?”

Coop remains still, the only sign he's still there at all being the beeping of the monitor and the fogging of the tube. But somehow, as Neela helps Abby raise the railings of the bed ready for transport, she knows he's going to come out of this.

He always does.

#whump #sickfic whump #med whump #intubation whump #asthma whump #er 1994

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