#I'm not sure if any of you have any experience with sepsis. But if you do you will understand just how terrified I was

[write-it-motherfuckers]

I apologise for not updating you all sooner Darlings, unfortunately the stress of everything ended up hitting me all at once after everything was said and done, and I fell asleep almost the second I arrived back.

As for Bunny, the good news is that she doesn’t have sepsis as I had originally assumed based on her symptoms, and she is already starting to show improvement under the tender watch of the vet clinic. Turns out she was actually just having a reaction to one of her medications, and it had gone unnoticed up until now simply because all of the symptoms up until that point, were easily explained away by the other things she is being treated for. Unfortunately, as time went by, her reaction to the medication was gradually building up as well, which is what made it seem like she had sepsis. 

Luckily, it was a mostly easy fix, but just to be safe she and Bug will be spending tomorrow and the day after at the clinic so that they can watch for any further complications. 

Both cats were very unimpressed at being at the vet again, but were more than happy to soak up all the extra affection and treats once all the poking and prodding and panicking was done.

Thank you all for being so understanding and supportive during all of this. It has made the whole experience significantly less stressful.

Please stay safe and take care of yourselves Darling ones. I will do my best to get something up and posted, I promise 🖤

Typing this in a rush at the train station, so please forgive the lack of info and any typos.

Bunny had a sudden turn last night and despite careful monitoring for the past several hours, she's still steadily declining. I've already called the emergency line for the vet I took them both to originally, and they've agreed to see to her as soon as I get to the clinic.

I'm sorry for having to run off again so soon but there really isn't anything I can do about it. I'll try to update you all as soon as they've looked her over.

Stay safe and take care of yourselves Darling ones, Thannk you for the patience 🖤

[luckyshouse]

hi! im the asker of that not too vague not too personal question, haha. i did want to sincerely thank u outside of a like for responding and talking about it all; more is more, i'm so glad you had more to share!! i've only been able to understand or recognize my alters through fictional media, *ESPECIALLY* character tropes, like you mentioned?!!? it was basically the main tool i had that i could use to mentally cleave the concept of the alter apart from "me," which i also don't have a strong grasp of the desires/etc of, and when i looked around at typical experiences of fictives where they appear clear-cut instead of like blurry bundles of vague tropes and ways that a character acts, i felt for sure that i'd been misjudging myself when i used rules of thumb like "oh these tropes i'm exhibiting in this moment align with chara undertale, the character i bought a sweater to match with and act like, [X] is fronting, i guess??" -- the thing about kankri and having a "rule" about attractiveness hit too, in the sense that i couldn't have an alter from media i found too self-indulgent. this is a lot about moi you didn't need to know but genuinely. thank you for posting. thank you for making the art and the posts you do. i had no idea someone who i follow for it would make me have to sit with a disorder that a week ago i had completely tossed out the idea of despite also having the privilege of pretty persistent external validation from very obvious trauma. have a good one!

i'm so glad you were able to get help and gain something from my posts and art :') genuinely this is one of the sweetest things i've ever been told and i am so happy i could've helped. i understand completely, especially when i first started figuring out my system, i felt exactly like what you're describing. creating fursonas that embody those tropes have helped me so so much, but thats also because i at heart am a furry person. i have been making fursonas since before i could use the internet. and i think its really important that people talk about these things because DID is less so a specific set of rules that someone exists within and moreso a disorder that is extremely personalized to the person experiencing it. i think constantly about how DID generationally would portray in extremely different ways. someone with DID in the 50s is completely different than someone who has DID in the 2020s, because we have computers, we have new forms of media and entertainment and escapism. we have roleplaying and kinning where as a long time ago i'm sure systems were more focused on like television, or books, or spoken word. DID is a disorder characterized by completely dissociating from the body for extended periods of time, attempting to severe and fracture yourself when engaging with your body, but uiltimately, it is a disorder that is about being extremely abstracted from your physical self due to repeated and consistant trauma. i think its silly how people attempt to police how DID presents, becuase its like, how the fuck do you know someones "escapism" is wrong? you think theyre maladaptive daydreaming incorrectly? that doesn't make any sense. and i am so happy that i could portray other examples of DID so people know it isn't exclusively a one-model type of disorder.

this year has been really really rough on me, it's lead me to shedding a lot of things i considered core beliefs or held onto really tightly, due to nearly developing sepsis at one point and everything else going on in my life, i've decided that i'm trying to put all my effort into healing and learning who i actually am and who i want to be. i started making my art because i realized i was putting all of my energy into making art to create something for a bigger audience, and while that was helpful at the time, i want to create for myself. i want things i can be proud of not just because of the reception but because i internally feel proud and pandered to. im so happy my art means something to someone else

i hope you have a good night. :)

[4trackcassette]

anyway cliffnotes on my top 2023 albums late or whatever

lucky for you - bully. saw em live. lead singer was so hot she blew my mind. rock best genre to see live mayhaps. top song: "all i do"

10,000 gecs - 100 gecs. listened to this a couple times driving this particular stretch of i-15 into i-90. half-decent podcast episode on the album. top track: "frog on the floor"

everything is alive - slowdive. unexpectedly one of my favorite albums of the year. top track: "prayer remembered"

bonus singles

"autopoiética" - mon laferte. the feel of this song is just. impeccable. i wasn't super into the rest of the album but here's a nice interview with the artist.

"holidays in the sun" - mykki blanco. this is a tight little EP overall but this is my favorite track. i misheard the lyrics to this song when i first heard it as "home is the synth."

"goodness gracious" - baby gravy. bad taste whatever but also i love the lines "goodness gracious/Tito's got me beyond fucked up/it's ostentatious." endlessly funny to me.

"sepsis" - blondshell. i could recommend this whole album if i hadn't fucked up and waited too long to get my tickets to SEE HER and then the show was sold out. so many good one-liners here but i especially like "he wears a front-facing cap/the sex is almost always bad". thanks @normalgirlism for getting me hooked here.

"vampire empire" - big thief. whatever. i'm not immune.

"afraid of heights" - boygenius. lucy4eva.

"make my day" - coi leray (ft david guetta). yeah this is a interpolation of pump up the jam or whatever but i'm kind of obsessed with it i can't help it.

"i am the river" - lael neale. this entire album was recorded on cassette which imo really worked for this song and not for the rest of the work. this song is really one of my favorites of the year though.

"mbeda wella" - baaba maal (ft paco lenol). a great album by a master but i particularly liked this track.

"quarry" - wednesday. rat rock or whatever but this shit always does it for me. catchy in just the perfect dirtbag way.

"i dormenti i" - brian eno. randomly listened to this while running the other day and it wasn't an altogether awful experience. this has become my most recent migraine-music when i can handle music.

i also listened to every episode of all songs considered's new music friday this year, though i'm not sure that's an accomplishment. my dad says that show is only for old people who want to feel like they're cool. it's about the right level of keeping up with new releases for me and i don't usually go terribly far beyond it. that being said if u have any 2023 must-listens, send them my way!!

[ihazmunchies91]

I give up. I need to tell You all something. Maybe someone can help me.

WARNING TRIGGERS:

Back in August or September, I moved into my aunts home to escape a situation where I couldn't afford where I lived and I realized that she was a hoarder because she was collecting garbage and there were garbage bags all over the house and the house was a complete mess and it looked like an episode of hoarders.

Knowing how much I cared for my aunt, I had the community come and take the garbage away, and I hired a maid to help my aunt get her house clean and back to the way it was, however, my aunt's health began to decline mentally, she refused to take care of herself and bathe herself, and no matter what I did, either by buying her a bath room chair that supported her weight, or getting the shower set up and asking to help her bathe, she refused and let herself sit in a chair and not shower for 2 months.

I called senior service and disability, but they refused to help her because my aunt doesn't have a Medicare plan, even though she is retired, and at the age of 67. "She has too many assets." They said. so I was left to suffer and watch her suffer as well.

Eventually My aunt almost died from a bladder infection, which lead to a kidney infection. which then went to her lungs, and she collapsed, and couldn't breathe anymore. And so she was put on life support with an intubator in her lungs.

My uncle who is a complete ass didnt seem to fully realize how serious the situation was and I was afraid because in 2011, my mother DIED of the exact same illness but they didnt have the medical tech to save her back then so I was reliving my worst nightmare. Just like my mother, she refused my help and ignored my pleas to seek help and she almost died.

After I conscented to them performing surgery on her kidney to flush out a kidney stone that was creating sepsis in her body, she was recovering miraculously, and then they asked to consent a second time to put a central line into her neck, so they could get medications into her faster. I consented it to that as well, and she recovered even faster. Meanwhile, my uncle did absolutely nothing to help in the situation.

My uncle does not like me because I am bisexual, disabled and live on Social Security and can not work as of yet because of my mental and bodily issues. He sees me as a person who is mentally ill, a perversion of nature and cannot take care of myself or needs to be put in an asylum.

Miraculously, my aunt woke up over 14 days? later and they removed the intubator from her after her cuffleak test told the doctors she was ready to breathe on her own and her throat was no longer swollen around the intubator, and I was there for most of the time holding her hand and making sure that she was ok and felt safe.

During all this time, I was absolutely certain that my aunt was not going to make it and I would relive the most horrifying experience of my life all over again.

Eventually my aunt made it to a nursing facility, and she was doing quite well, and I would visit her and tell her, I love her every single day and I was astounded that she recovered so quickly. I would bring her comfortable clothes she needed, a book, some hidden snacks when she was bored (I'm terrible I know)

However, during this time, my uncle opted to take me to see her frequently instead of her friend Jerry. and we hardly spoke to each other. I knew he didn't like me because of how he spoke to me, I never understood why he treated me so poorly when he knew me growing up. Being bisexual doesn't change you as a person.

Eventually, just a couple of days ago, my aunt suddenly informed me that I cannot have my companion animals in the home, and I was devastated. She said it was due to her health however her doctors did not say anything whatsoever that the cats would be of great harm to her and they don't cause any issues. she knows how much I can not be without my companion animals. I have legal documentation from my doctor explaining that they're my therapy animals, and I can not be without them because they help me daily with emotional support. However, my aunt strangely and coldly told me that it was not up to me but to her, because she is the owner of the house, and I began to cry, and I called my case manager, who was flabbergasted by the entire situation that my aunt would say such a thing knowing that my companions mean more to me than the world itself as I raised them from kittens. They are my children. As I cried in the nursing home in the room with my aunt, she proceeded to talk to my uncle and my uncle talk to her as though I did not exist, and I was a ghost, yet tears were streaming down my face and I was dripping snot into my mask. eventually my uncle called my case manager, and then my case manager called me to inform me of some disturbing things.

My uncle had sent pictures to my case manager showing previous messes and parts of the house that cannot be repaired from my aunts hoarding that was still yet to be fixed such as: The stained dirty carpet, the broke tiolets seats, old rusted silverware and pots and pans my aunt refused to throw away, piles of paid bills she refused to shred or throw away.

Luckily, thank fucking god my manager already knew of the conditions my aunt was in and informed him (Despite her not wanting to speak under hippa law) that none of that mess was mine and that his sister had hoarding issues that I had helped take care of. But there was still remnants of the past. I had also heard my uncle snapping pictures in the kitchen when I was bawling my eyes out in the bathroom. (He was checking on my aunts car to make sure it was still working because thats what my aunt requested.)

My uncle then began to argue theres no way that was from my aunt and My case manager did not hold back and told him none of that was mine and it's been well documented about what had happened. My uncle then backpedaled and said that I need to move out NOW because of the ridiculous obsession with my cats. And my case manager informed him that I have a right to 30 days because I paid rent to my aunt out of curtesy and he was enraged and snapping at her saying it doesn't matter and I don't care about my aunt.

My aunt is being influenced and poisoned by my uncle, and I have no where to go. I refuse to go into a group home because I was abused in one horrible when I was younger and I refuse to do adult foster care. I live on social security and could afford low income. I refuse to go into a shelter because they do not take companion animals and I would honestly, brutally honestly say that I would not be able to be without them and would off myself at moments notice if they were taken from me.

I tried to see if my brother and sister would take me in, but it turns out they are addicts living in a home with no heat, phone or internet to connect to the outside world. And I'm afraid because I need to see a doctor because of an alarming mass on my breast. But there is no transport, no doctor able to see me because of lack of doctors. I don't know why this is happening to me. I don't know what god is trying to punish me for something I didn't do.

I need HELP. But I don't know where to fucking go or really WHAT THE FUCK TO DO and I'm dying inside painfully. I live in Oregon, in Polk county if that helps. I have a paypal if you want it. But I don't know what I would do with the money to begin with. I'm at a fucking loss. I have never been taught how to drive a car so I don't own one, I'm autistic, sickly and just want to get out of here and not upset my aunt and make her sicker somehow. I have my three cats and a dog in training to becoming a service animal for my panic attacks. All have written notes from my doctor from years ago.

[iwonderwhyitrysohard]

its really hard not to get angry sometimes

i know im a full time college student so doing classwork and networking and whatnot is my job. but like i have two jobs, and im taking 16 hours of classes, and one of my professors is the worst.

this man told me he wouldnt excuse any absences for a surgery i was supposed to have this wednesday. but since i had sepsis and could have died i GUESS i can have that excused.

im on a very liberal campus. and i am a very liberal myself. but jesus christ i'm starting to get why disability gets denied so often and why nobody believes me when i seek help.

im sure some of it is just my anger spilling over, and i feel the need to get angry at people with less severe symptoms than me, but there are also just so many people here who don't have what they claim they have.

you would think as people studying mental health and illness and the brain you would know that not having any sensory or social issues prior to college means you dont qualify for an autism diagnosis. but that just slips right over so many people's heads.

im not even kidding, i had someone tell me that because im diagnosed autistic that i cant make autism jokes because it isnt fair to the people who self diagnose.

it isnt fair to some of the people who take the resources i need and delegitamize my illness.

ok!

and ofc not everyone who self diagnoses is wrong. i mean i cannot tell you the amount of people i know who suspected autism, saved up their money, and bam, autism diagnosis. Even those who can't go get a diagnosis are often correct, they have the symptoms!

but these people literally cannot stop themselves from divulging information about their pasts that proves they just have ADHD and social issues.

if you take psych classes in college people will trauma dump. its inevitable. but to trauma dump, give us a full look at you and the issues you've had, then claim a disability you don't have the symptoms of makes me upset.

i think its hard for me too because i want to pretend that autism is becoming more socially acceptable but it really isnt. the idea of "quirky childlike autism bean" is becoming popular. i miss a lot of social cues, and sometimes i say things that are not appropriate because i misread the room. accepting autism would be like my friends who explain to me why what i said isnt appropriate and help me understand nuance. accepting autism is understanding that i cant go to every social event we plan because i cant handle new people, so you plan events just for us.

it isnt people who coddle my destructive symptoms and let me get away with stuff because "well you have autism."

no autism isnt an excuse you can use for stalking someone. (yes someone tried this excuse after i reported them to administration for threats/harassment)

its not an excuse you can use for why you dont do chores or help around the apartment. (seen this one on our college yikyak)

its not a badge of honor that grants you access to some secret club.

its got perks but its got a ton of downsides. i have to consciously manage my symptoms daily. and its exhausting! but thats what its like to have something like this.

i dont wanna devalue other people's experiences, and i really just want to know why people think its so cool to be disabled. i guess i just wish i could be them. that i could have something mild or not at all and just get to claim the title and manage a couple symptoms.

but that wasnt what i got.

i think everyone who suspects a disability of sorts deserves recognition and the access to doctors who can help them for cheap or free.

even if you dont have what you think you do, you might have something else. or maybe you are even atypical!

i just get upset because i had to jump through all of these hoops and have so many people treat me different just because of some words on paper that i had to pay for. i mean seriously testing is expensive and its all for what? a piece of paper that says i cant make eye contact or handle loud sounds (/s)?

that i had to be so uncomfortable and treated so badly to find out thats whats wrong with me.

and some people just dont have to go through that.

im angry that i did and they didnt.

but thats life. its different for everyone. and i know that. i just wish i didnt get so angry sometimes.

[bellarad]

So with all the abortion talk going on and a lot of people promoting mail-order pharmaceutical abortion, I wanted to go over some of what that entails. I'm going to try not to use too much jargon to make this accessible for folks, but please don't hesitate to PM me with questions. I'm writing this from my experiences as a nursing student and as someone who has taken abortion doula training, but as with anything there may be errors in my post. Please feel free to point them out, and always make sure to do your own research and contact knowledgeable, trustworthy people.

MEDICATIONS

A lot of people see it as an "abortion pill" but actually it is a pair of medications that you're given.

The first is mifepristone or methotrexate and the second is misoprostol. Sometimes all three are used.

Mifepristone is a hormone blocker which blocks progesterone. When a pregnancy is implanted, the fertilized egg tells your body to lower your estrogen and raise your progesterone to maintain the pregnancy. When you take mifepristone, it blocks progesterone so that your pregnancy doesnt continue to develop. It's given in concert with misoprostol to both stop a pregnancy and expel it altogether.

Methotrexate is a bit different. It is also used in concert with misoprostol, but it is actually a cancer drug that is an immuno-suppressant. Its purpose in pharmaceutical abortion is to inhibit rapidly developing cells (as would be present with cancer or with a newly formed embryo) . It can also cause DNA mutations and be teratogenic (cause mutations in an embryo/fetus) which may prevent the pregnancy from being viable. It's less commonly used than mifepristone and may also be given with both misoprostol and mifepristone.

Misoprostol is a synthetic prostaglandin. Prostaglandins are substances produced at the site of inflammation in the body and also help to protect your stomach lining. This is why misoprostol is often given for ulcers caused by NSAIDs (non-steroidal anti-inflammatory drugs) because NSAIDs block prostaglandin production which leads to less protective mucous and thus, ulcers.

But! Prostaglandins can also begin uterine contractions, which are necessary to expel uterine contents, whether that be during your menstrual cycle, a birth or an abortion. So misoprostol is used to begin uterine contractions to help expel a pregnancy. It can also help "ripen" the cervix to make it easier for tissues to be expelled, and these medications can also be topical prostaglandin. (topical meaning, applied directly to the cervix either as a cream or a pill that is placed up against it)

SAFETY & CIRCUMSTANCES

Pharmaceutical abortion is safe in most cases, but generally the cut off is 10-12 weeks of pregnancy. The embryo must still be small enough to pass through your cervix which, while prostaglandins may help relax it slightly, is still a supremely small space. The biggest risks are hemorrhage (excessive bleeding) or failure to expel tissues.

In the latter case, if any embryonic tissue or clots are retained in the uterus, it could cause an infection that may lead to sepsis. Make sure to monitor for symptoms of infection including fever, malaise, excessive pain, confusion, shaking/chills, heavy bleeding past the first 12hrs after you took the pills or as defined below, and low blood pressure/feeling light-headed or fainting upon standing.

Bleeding is expected with an abortion - it's basically a heavy period and will likely last a few days. However, bleeding should be heaviest in the first 12 hours and be minimal following that. You should seek immediate assistance if you are passing clots larger than an inch (2.5cm) in diameter, if you are soaking a menstrual pad with blood in less than 2 hours, or are bleeding heavily past the first 12hrs.

There are many people out there selling snake oil and saying that they have ways to stop a pharmaceutical abortion once you have already ingested the pills. These claims are false, you cannot stop a pharmaceutical abortion that has already begun. Many of these concoctions or remedies or what have you can be dangerous or cause complications. If you feel on the fence about having an abortion, I strongly suggest you seek options counseling from Planned Parenthood or another choice-based organization to help you clarify your needs so you can be sure this is the best option for you. You cannot stop it once it starts.

WHAT TO EXPECT

Pharmaceutical abortions can be painful. Like I said, they're like a heavy period - there will be cramping, bleeding, maybe bloating and general discomfort in addition to potential emotional reactions to having an abortion. In general, you can take mild pain medications like ibuprofen (advil/Motrin) or acetaminophen/paracetamol (tylenol), but with anything always check with a trusted medical professional about any medications you take, even over-the-counter ones.

I strongly suggest having someone with you or checking in with you when you are going through this process just to make sure you're safe and supported. Planned Parenthood may offer support. You could also look for abortion doulas in your area - many doulas I know offer free abortion support and there may be some around you doing this work covertly. I suggest looking up Birthing Advocacy Doula Training to find resources, workers or organizations in your area.

Abortion can mean different things to different people, and everyone's experiences or reasons will vary. I had my abortion because I was 19, broke, and in a terrible relationship - but I still mourned the loss of what I felt could have been my child. I felt guilty for having gotten pregnant and not being more careful with birth control. That being said, I'm incredibly grateful that I had abortion services in my area and people around me who were supportive.

On the flip side, my mother has had 3 abortions and thinks nothing of it. She never felt guilt, never looked back, only felt relief.

Everyone is different and I strongly suggest seeking emotional support before and after because you never know what kinds of things might come up. It may be difficult, or it may be easy - only you can determine your needs, values and responses.

I hope this was helpful. Again, please don't hesitate to reach out to me for questions or support, or if you see some info that isn't correct in this post. Stay safe, keep yourself informed, and know that your choice is the only one that matters.

[gay-jesus-probably]

Everyone please be aware, today we are celebrating a great and momentus occasion: On December 19th, 2020, exactly one year ago, I had to go to the emergency room over a fucking hangnail. Remember that? With the swollen thumb, giant streak of red going up my arm, the infection rapidly approaching sepsis, and how I spent the entire week up to and including Christmas with an IV port in and having to go to the hospital daily to recieve IV antibiotics... good times! And by good times I mean horrible times. I'm pretty sure I made a lot of tumblr posts complaining about the whole mess, especially during the hours and hours I spent stuck in ER waiting to be seen/reassessed by a doctor. Turns out when you go to the hospital for an infection in the middle of a pandemic peak, you end up pretty low on the triage list. Especially the final assessment, where I was there for so long that they took my vitals and gave me the COVID questionnaire twice, up to and including asking if I'd somehow travelled out of the country in the last five hours that I'd been sitting in the waiting room. So that was fun. Could've been worse though, at least I didn't have to pay to get the treatment needed to avoid amputation. I love not being American.

But anyways it's been a year since that whole ordeal kicked off, and guess what! I do not currently have any hangnails, OR any infections. God bless. Stay safe, everybody. Nobody wants to go to the hospital during the week of Christmas. It's a bad experience, I don't recommend it.

[feynavaley]

I know I'm late, but for the writing ask: 3, 5, 18?

Don’t worry about being ‘late’, questions are always welcome! 😊(list here)

3. On a scale of 1-10 how much to enjoy incorporating romance into the average story?

Uhm… minus 9000? 😅 No seriously, jokes apart. I am… awful at writing romance. Everything I write feels either too cheesy or too stilted or… somehow wrong. So, I’d really really rather stick to friendship or familiar relationships that don’t include any kind of romantic attachment.

I have to admit that, sometimes, I’ll get a sudden whim to write some romance (see Chrysalis), but it’s not often and in that case, the story revolves around it. If, instead, I have planned a story without any romance, you can be sure it will stay without as much as the smallest hint until the very end. 😅

5. What is the plot bunny you’ve been carrying for the longest? Optional bonus question: do you ever wonder why you haven’t written it yet and experience deep existential dread?

Excluding fics I have already published (or started publishing) a while ago, I think one of the very first ideas I had (back in the spring of 2016, most likely) was Beyond the Breaking Point, that I didn’t write until last December.

The idea was initially very simple: an appendicitis fic with Canada as the main character. Offering the perfect opportunity for a lot of suffering and hurt/comfort, appendicitis fics are a favourite of mine. They’re also one of the most overused cliches, I’m quite sure there’s at least one for every fandom  – maybe even every character. But, I couldn’t find any gen one with Canada. So, it was up to me to fill the void. 😅

I didn’t immediately start writing it because I wanted to do some research first (you can imagine my glee when I found out the thing with the appendix rupturing and reduced pain, haha), but the more I thought about it, the more I fleshed out the story with different details (Matthew mistaking the pain for psychosomatic to justify the delayed intervention, him having a compromised immune response to justify a quicker onset of sepsis – that’s why I had him have his spleen removed – and the conflict between Alfred and Arthur for added drama, among others).

As I added details, I realized that there would be enough material to write an entire prequel. The focus started then to shift from Matthew to Arthur and Alfred and the entire family. Having found a way to have them live together as brothers while keeping the canon surnames, I came up with Arthur and Alfred’s first meeting and realized I absolutely wanted to write it, haha. That’s how Arthur Kirkland’s Guide to Being a Big Brother was born. Since I had to focus on developing that first part before I could get to the second one, writing my original idea suffered a lot of delay. (But I’m very happy it did because I think the entire story is much more developed, now – it’s no longer only about Matthew having appendicitis, the appendicitis episode is merely the frame for the surrounding family drama, and Alfred and Arthur are much more important and fleshed-out characters as well.)

18. Tell us about a character who’s very different than you who you love a whole lot

That would definitely be America/Alfred. He’s completely different from me: he’s bold, energic, extroverted, loud, self-centred (in spite of his good intentions), he doesn’t think too much (if at all, haha) before acting or stop to ponder how his actions could impact other people, he’s confident (almost over-confident, even) to the point that, in spite of feeling lonely and knowing he’s not liked by many, he doesn’t think he should change anything about himself (but it’s everybody else’s fault for not accepting him, essentially).

I have to say that getting his voice down was really hard, at first, because it forced me to see things through a completely different mindset (especially in terms of confidence and lack of self-deprecation). I quickly came to love him, however. Writing him is like a breath of fresh air, his positivity, friendliness, and lack of inhibitions always put me in a good mood.

And this might sound mean, but I enjoy emotionally breaking him to see how strong and determined he is in getting back up, after the first moments of discomfort. How he’s genuinely able to smile again. He has his flaws, of course, but I enjoy his tenacity in wanting to stay positive and change things for the better. I think this makes him an inspiring character.

[dxmedstudent]

Hey dx. Any tips for being speedy, efficient and time-effective when on-call (both clerking and ward cover)? I'm a new f1 and struggle with this a lot. I don't know how to be thorough, run everything past a senior AND be time-effective and my seniors are getting annoyed with me.

Hello!There’s no easy way around it; being oncall requires a level of efficiency that is almost superhuman at times. Quite simply, there’s often just a lot to do, and we’re all just trying to do the best that we can. So if you’re still learning the ropes, absolutely don’t let it make you feel bad. Experience really does help, and there’s no easy way to gain experience. But that doesn’t mean that you can’t try to foster some good skills and make a conscious effort to improve; I think it’s great that you’re thinking ahead and trying to do your best. In general, I recommend my hashtag #tips for new docs or #tips for new FY1s, because I’ve got some posts that specifically dump quite a bit of advice for getting through on-calls.

I’m putting this behind the line because it is long :)

Clerking:For clerking, there’s usually a proforma in most trusts that covers the basics, and allows you to work through a system without forgetting anything obvious. If there isn’t, try to stick to a clerking layout that works for you. For example, I’d usually start with presenting complaint and the history of that, work in a review of systems by this point (and add in anything I think of later when I examine them), work my way through their medical and social history, then explore their concerns and expectations, and finish on drug history and allergies (why? Becuase I find writing up drug charts in the middle ruins my flow, but by the end you’re basically just chatting and wrapping up loose ends, and if there’s anything I am likely to forget and have to go back to ask, it’s allergy history, until I realise I can’t prescribe anything without asking that question!). You may find a different order works for you; the only thing that matters is getting all that information down, and letting your brain process it to formulate a diagnosis and therefore plan of action. The tricky thing is that patients will sometimes go off on a tangent, and you have to weigh up the importance of getting back on track with just not being rude or seeming like you don’t care. I usually let them talk for a short while about something that is irrelevant, then explain that we can explore X thing later, and that I’ll make a note of it, but right now we need to focus on Y. They say that at the beginning of a consultation, if you let someone talk for 1-2 minutes, they will almost always give you most of the information that you need. So the general rule is that you start off with open questions ‘What’s brought you in?’ Or ‘What’s the issue today?’ etc, and then, once they’ve had a chance to  say what’s on their mind, you can hone it down with closed questions to find out exactly what you need to know. It takes practice, and some people are still going to be vague, and others will still go on tangents. with time you realise how to most efficiently get investigations done; rather than wait for A&E to do it, sometimes I’ll take bloods/cannulate myself (because waiting longer for the result would be worse for the pt and myself because I’ll be 3 patients down the line by that point), or I’ll request imaging or ask nurses to prepare a treatment before I’m done wrapping everything up and documenting, if I think it needs to happen urgently. Start treatment as soon as possible, but if you are worried, then get senior help involved early. Even if you can’t quite post-take yet, you can always discuss them with an SHO or reg.

Ward Cover:Ward cover is its own kind of hell, and it’s really hard to be efficient when your bleep keeps going off, and you get all sorts of jobs that are different levels of urgency and severity. I would advise you to take a few sheets of paper with you, and be prepared to write down your bleeps and jobs as they happen.Firstly, I triage the jobs I’ve received at handover in terms of severity; sometimes I write numbers next to the names in order of priority, at other times I just remember which order I’ve decided to do things. There will be jobs you’re asked to do at particular times (that ABG in 2 hours’ time, those bloods in the morning) that you’ll need to remember to do. Then, as you get bleeped, write down the number first (in case you get a barrage of bleeps in rapid succession), then, once you call, write down each patient , leaving space between them so you canfill in some details and put a mini tick list next to each one. Do not put down the phone until you have the following: Name and Surname, DOB and hospital number, and bed number on the ward (plus ward name); anyone escalating concern regarding these patients in anything other than an arrest situation has time to get you these pieces of information. Be kind and patient with the nurse or student nurse on the phone, but explain that you need as much information as possible to be able to do your job. Whilst you’re on the phone, you can use the opportunity to ask the nurse to help you; ask for a new set of obs (if not done; usually they’ll call you just after doing one). If they can take bloods, ask them if they can please so. If they can get kit (like a catheter, or NG tube) ready, ask them if they can please do so. Things like bladder scans, female catheters, NG tubes, sometimes bloods and cannulas and cultures can sometimes be done by nurses. Each hospital is a little different, but after a short while you’ll kow what you can reasonably ask for help with. Don’t take the mickey; nurses will value and respect you if you’re clearly not just trying to make them do all your work. Explain that you’ll be around as soon as you can, but that if they can do XYZ it’ll help you deal with the patient faster. In turn, be helpful to the nurses and if you can see they are busy, then do simple things like repeat a set of obs etc yourself. When you walk onto the ward, find the nurse who called you, and make sure they remain accessible for support or to action whatever plan you agree on; sometimes people will want to walk off and do other things, but remember this rule: if the patient is clinically sick enough for them to call you to see them rapidly, they are sick enough for the nurse looking after them to stick around within reach when you are assessing or treating them. If the nurse looking after them is on their break, someone else will ahve to cover and give antibiotics/fluids/nebs etc. Sometimes this means politely asking people to stick around with you if it looks like they are about to walk off to do something relatively unimportant. Yes, they will have their other jobs, too, but a sick patient should be everyone’s priority first and foremost. You should never hold them back from other work unnecessarily, but if things look or sound dire, make sure you have all hands on deck. Even basic life support requires 2 people; you cannot and need not handle a sick patient alone.

Once you have taken some messages, your triage order of priorities might have to change; ‘review patient’s sore toe’ has to come below ‘ patient is wheezy and struggling to breathe’ or ‘febrile patient, ? sepsis’.  That way, when you work through, you’ll feel like you are dealing with the most urgent things first. Anything non-urgent left at the end of the night can be left for the day team; you can chat with them in the morning if you want to make sure it’s not missed. Meanwhile, if you find yourself overwhelmed with sick patients, talk to your seniors. Call your fellow FY1 covering the other side. Call your SHO. If things are dire, call your reg. You have people who can help you, so let them know if you have too many sick patients to handle, or if you’re not sure how to triage them. If you’re swamped with bloods/cannulas, most ward sisters can help with those in a pinch, as can site managers. Most site managers can also certify the dead; this is a low priority job for me overnight (dead patients aren’t getting any deader if you ‘confirm’ they are dead 1h later, and live patients are more important), but you’re usually not the only person who can do that job. Remember to prioritise based on clinical urgency first and foremost. It’s OK to tell whoever is calling you that ‘I’ll try to come when I can, but I have sick patients to see, first”. If the issue is something non-clinically urgent like “relatives want to discuss grandma’s laxatives at 10pm but you’ve never met grandma and you have 3 septic patients and a crash call first”, it’s perfectly OK to tell the nurse this: you will try to come when you can, and the relatives are free to wait (visiting hours permitting) as long as they wish. But you cannot guarantee that you will come any time soon, or at all, as you have sick patients to see at this point in time. If they wish to speak about a plan put in place by the day team, you recommend they call the ward in the morning to book a meeting with the day team to discuss their concerns. I rarely tell my colleagues or patients ‘no’ outright, because I do want to help whenever I can, but I’ll be honest if a particular job has to be low on my priority list because I have sick patients to see. This is also true for talking to the nurses escalating concerns on the phone, or cheekily grabbing you in passing to rewrite 5 drug charts once you finish seeing a sick patient, when you’re power-walking your way to your next patient. Do those jobs if I have nothing to do, but if you’re busy, apologise and explain that you’ll do them when you can; people are reasonable when you are.

If you miraculously have not too much on your plate, then I like to ask the ward if there are ‘any other issues’ before I leave it to go to the next ward (because walking those long corridors after they bleep you for paracetamol 30 mins later is a time waster). You can still tell them that you’ll come back to do some jobs, or just tell them that some jobs are something the day team can handle, if you think it can/should wait. But it can avoid that annoying ‘running between the same 5 wards constantly every 15 mins for pointless stuff they could have told me earler’ feeling’. Also, just let the nurses know that you’re one person covering X number of wards (and probably hundreds of patients) so it’ll take you a while; many of them just don’t know what ward cover looks like at night from a doctor’s perspective. A lot of nursing students or nurses are shocked when we chat about that kind of stuff. There’s absolutely ways to have that conversation without being snippy or coming off as defensive. Take your break when you can. I like my break around 2-3 am on a night shift, because that’s when things tend to settle. But if things pipe down for you a bit sooner, take that opportunity whilst you can. Try to drink plenty of fluids, even if it means availing yourself of vile NHS tea or coffee or tap water. When you feel like the world is ending, it’s time to drink something and have a biscuit. 

Ward Rounds:For ward rounds; make sure your blood requests are always out for the phlebotomists before they come around. If you have new patients in the morning, try to see if you can get those cheeky requests put in in the morning just before the phlebs come around.  For the ward round, you’ll have to work out a system to prepare the notes for your consultant as fast as possible, depending on how many juniors you have, and your consultant’s personal way they like things done. If there’s 2 or more juniors, I usually tag team it with them; we both see half the patients, but whilst I’m getting the notes for one ready, they can see one with the consultant. Some consultants love this approach, others hate it. In terms of the ward notes, different specialties will like different kinds of basic notes. I’ve laid out mine quite differently depending on consultants’ preferences and how different specialties run things. But most are amenable to something like the following layout as a rough rule:

(date and time in the margin)

Dr X ward round.(I use the  Dr Y/Dr Z, bleep 1234 model when it’s just me and the registrar)

(age) (gender) and brief summary of salient points/presenting complaint.

e.g 64 year old female presenting with SOB and cough, purulent sputum, 4 days.

Then their brief medical background

Then a list of current issues.For example 1) CAP, on day 3 amox and clarithro. 2) UTI, 3) hyponatremia, 4) ongoing physio

You can then briefly write out any bloods and investigations under their own heading.

Following this, I leave a gap for talking to the patient and examining them. There will usually  be a SOAP framework for assesing them on observation. I draw out my little lungs and hexagonal abdomen so I leave enoug space.

Finish up with impressions/issues (leave a gap for a list), and then plan (definitely leave a gap for a list).

The best notes I ever saw utilised a lot of bullet points and numbered lists; it was care of the elderly/geriatrics, so everyone naturally had like 5 comorbidities minimum, 6 issues at any one time, and long, long lists of plans. And I’ve taken that with me into future jobs. Never be afraid to take up space in notes; making things clear, well-spaced and easy to read will always serve you better than cramped-close set notes that are barely legible. Give your notes space to breathe, but don’t write any more words than you need to, when preparing them.

It’s a rough and meandering, far from exhaustive bunch of tips, literally off the top of my head, but I hope this helps :)

[wallabywannabe]

Really frustrated that I can’t solve the ethical problem of animal experimentation in one Sunday afternoon.