#U.S. physicians

[minnesotafollower]

Foreign Physicians Needed To Solve U.S. Doctor Shortage

By 2030 the U.S. expects to need more than 40,000 additional physicians for primary care alone as nearly 25% of our existing doctors reach retirement age and the shortage will worsen as the U.S. population grows and ages. The American Medical Association calls it “an urgent crisis.”[1] At least six states (Tennessee, Florida, Wisconsin, Idaho, Iowa and Virginia) have created laws that allow…

[buried-in-stardust]

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[hislop3]

FTC Bans Employment Non-Compete Provisions - Healthcare Implications Aplenty

On Tuesday, the Federal Trade Commission issued a final rule effectively, banning non-compete agreements, provisions, etc. for employees, including executives. The final rule contains separate provisions defining unfair methods of competition for the two subcategories of workers. Specifically, the final rule provides that, with respect to a worker other than a senior executive, it is an unfair…

[gumjrop]

This year’s flu shot will be missing a strain of influenza it’s protected against for more than a decade.

That’s because there have been no confirmed flu cases caused by the Influenza B/Yamagata lineage since spring 2020. And the Food and Drug Administration decided this year that the strain now poses little to no threat to human health.

Scientists have concluded that widespread physical distancing and masking practiced during the early days of COVID-19 appear to have pushed B/Yamagata into oblivion.

This surprised many who study influenza, as it would be the first documented instance of a virus going extinct due to changes in human behavior, said Dr. Rebecca Wurtz, an infectious disease physician and epidemiologist at the University of Minnesota School of Public Health.

“It is such an interesting and unique story,” Wurtz said, adding that if it were not for COVID, B/Yamagata would still be circulating.

One reason COVID mitigation efforts were so effective at eliminating B/Yamagata is there was already a fair amount of immunity in the population against this strain of flu, which was also circulating at a lower level, said Dr. Kawsar Talaat, an infectious disease physician at Johns Hopkins Bloomberg School of Public Health.

In contrast, SARS-CoV-2 was a brand new virus that no one had encountered before; therefore, masking and isolation only slowed its transmission, but did not stop it.

The absence of B/Yamagata won’t change the experience of getting this year’s flu shot, which the Centers for Disease Control and Prevention recommends to everyone over 6 months old. And unvaccinated people are no less likely to get the flu, as B/Victoria and two influenza A lineages are still circulating widely and making people sick. Talaat said the disappearance of B/Yamagata doesn’t appear to have lessened the overall burden of flu, noting that the level of illness that can be attributed to any strain varies from year to year.

The CDC estimates that between 12,000 and 51,000 people die every year from influenza.

However, the manufacturing process is simplified now that the vaccine is trivalent — designed to protect against three flu viruses — instead of quadrivalent, protecting against four. That change allows more doses to be produced, said Talaat.

Ultimately, the costs of continuing to include protection against B/Yamagata in the flu shot outweigh its benefits, said Talaat.

"If you include a strain for which you don't think anybody's going to get infected into a vaccine, there are some potential risks and no potential benefits," she said. "Even though the risks might be infinitesimal, the benefits are also infinitesimal."

Scientists and public health experts have discussed for the past couple years whether to pull B/Yamagata from the flu vaccine or wait for a possible reemergence, said Kevin R. McCarthy, an assistant professor at the University of Pittsburgh's Center for Vaccine Research. But McCarthy agrees that continuing to vaccinate people against B/Yamagata does not benefit public health.

Additionally, there is a slight chance of B/Yamagata accidentally infecting the workers who manufacture the flu vaccine. The viruses, grown in eggs, are inactivated before being put into the shots: You cannot get influenza from the flu shot. But worker exposure to live B/Yamagata might occur before it's rendered harmless.

That hypothetically could lead to a reintroduction of a virus that populations have waning immunity to because B/Yamagata is no longer making people sick. While that risk is very low, McCarthy said it doesn’t make sense to produce thousands of gallons of a likely extinct virus.

It is possible that B/Yamagata continues to exist in pockets of the world that have less comprehensive flu surveillance. However, scientists aren’t worried that it is hiding in animals because humans are the only host population for B lineage flu viruses.

Scientists determined that B/Yamagata disappeared in a relatively short period of time, and this in and of itself is a success, said McCarthy. That required collaboration and data sharing from people all over the world, including countries that the U.S. has more tenuous diplomatic relationships with, like China and Russia.

“I think the fact that we can do that shows that we can get some things right,” he said.

Sarah Boden is an independent health and science journalist based in Pittsburgh.

[historysisco]

On This Day in New York City History January 26, 1961: Dr. Janet G. Travell (December 17, 1901 - August 1, 1997) became the first female doctor to hold the position of White House Physician.

Dr. Travell was the daughter of New York City physician Dr. William Travell. As history shows the apple didn't fall far from the tree. Dr. Travell graduated from Cornell University Medical School in 1926 and worked as a cardiologist at Sea View Hospital in Staten Island from 1936 - 1945. She would join her father in helping those who suffered from muscle pains at their private practice located on West 16th Street. It was at this point that she would end up working at the White House.

In 1955, then Senator to Massachusetts John F. Kennedy was referred to her practice. Kennedy suffered from pains his his knees and lower back which he dealt with his entire life. Her treatments allievated many of the pains he dealt with. When Kennedy was elected President, he appointed Dr. Travell to the position of White House Physician. She would hold that post until 1965 when she decided to return to private practice.

She would teach, lecture and continue to see patients up to 1996. She would pass away on August 1, 1997.

#JanetTravell #FirstFemaleWhiteHousePhysician #WomensHistory #WomensStudies #HERStory #WhiteHouseHistory #JohnFKennedy #JFK #PresidentialHistory #MedicalHistory #NewYorkHistory #NYHistory #NYCHistory #AmericanHistory #USHistory #History #Historia #Histoire #Geschichte #HistorySisco

(at The White House)

https://www.instagram.com/p/Cn4OMFRu2Z-/?igshid=NGJjMDIxMWI=

[market-insider]

U.S. Primary Care Physicians Market Provide Accessible And Integrated Services To A Large Population

The U.S. primary care physicians market size is expected to reach USD 341.9 billion by 2030, based on a new report by Grand View Research, Inc. The market is projected to exhibit a CAGR of 3.2% from 2022 to 2030. An increasing number of Medicare beneficiaries in the country is expected to create high demand for Primary Care Physicians (PCP). According to a CDC survey in 2019, around 51.2% of physician office visits were made for primary care services.

According to the 2019 Patient-Centered Primary Care Collaborative’s (PCPCC) evidence report, there is a significant gap in investment in improving primary care services in the U.S. One of the main concerns is the growing shortage of primary care doctors and allied healthcare professionals. In a report published on the complexities of physician demand and supply in June 2020, the Association of American Medical Colleges (AAMC) estimated a deficit between 21,400 and 55,200 primary care physicians by 2033. Furthermore, there is a substantial difference between the average annual revenue and salary generated by a PCP in comparison to a specialist physician.

Gain deeper insights on the market and receive your free copy with TOC now @: U.S. Primary Care Physicians Market Report

The U.S. has one of the advanced healthcare systems and compared to any other developed nation its healthcare expenditure is two times higher. According to CMS, healthcare spending accounted for 17.7% of the GDP in 2019 and is expected to reach 19.7% in the next ten years. Primary care services act as a gatekeeper for the healthcare system and play a significant role in improving healthcare outcomes and reducing overall medical expenditure.

The onset of the COVID-19 pandemic resulted in income loss for primary care offices in the United States due to the substantial reductions in revenue caused by physical distancing. Based on volume data for general practices, general pediatric practices, family medicine practices, and general internal medicine practices, researchers from Harvard Medical School and the American Board of Family Medicine estimated that COVID-19 would cost primary care practices USD 15.1 billion in revenue.

[afeelgoodblog]

The Best News of Last Week

1. A branch of the flu family tree has died and won't be included in future US vaccines

A type of flu virus that used to sicken people every year hasn't been spotted anywhere on Earth since March 2020. As such, experts have advised that the apparently extinct viruses be removed from next year's flu vaccines.

The now-extinct viruses were a branch of the influenza B family tree known as the Yamagata lineage. Scientists first reported the apparent disappearance of Yamagata viruses in 2021.

2. Hospitals must obtain written consent for pelvic and similar exams, the federal government says

Hospitals must obtain written informed consent from patients before subjecting them to pelvic exams and exams of other sensitive areas — especially if an exam will be done while the patient is unconscious, the federal government said Monday.

New guidance from the U.S. Department of Health and Human Services now requires consent for breast, pelvic, prostate and rectal exams for “educational and training purposes” performed by medical students, nurse practitioners or physician assistants.

3. Germany approves new law that will allow adults to carry up to 25 grams of cannabis for their own consumption and store up to 50 grams at home.

Germany's upper house, the Bundesrat, cleared the way to partially legalize cannabis on Friday. Adults aged 18 and over will be allowed to carry up to 25 grams of cannabis for their own consumption.

4. Tick-killing pill shows promising results in human trial | Should it pan out, the pill would be a new weapon against Lyme disease.

Tarsus Pharmaceuticals is developing a pill for humans that could provide protection against the tick-borne disease for several weeks at a time. In February, the Irvine, California–based biotech company announced results from a small, early-stage trial showing that 24 hours after taking the drug, it can kill ticks on people, with the effects lasting for up to 30 days.

5. Thailand moves to legalise same-sex marriage

Thailand has taken a historic step closer to marriage equality after the lower house passed a bill giving legal recognition to same-sex marriage.

It still needs approval from the Senate and royal endorsement to become law but it is widely expected to happen by the end of 2024, making Thailand the only South East Asian country to recognise same-sex unions.

6. French Revolution: Cyclists Now Outnumber Motorists In Paris

Official measurements have found that Paris is rapidly becoming a city of transportation cyclists. In the suburbs, where public transit is less dense, transport by car was found to be the main form of mobility. But for journeys from the outskirts of Paris to the center, the number of cyclists now far exceeds the number of motorists, a huge change from just five years ago.

7. 'Miracle' operation reverses blindness in three-year-old girl giving her 'promising' future

A three year old with a genetic condition that causes blindness is doing incredibly well after unique pioneering operation to restore her sight.

The UK is the only country performing keyhole eye surgery to inject healthy copies of a gene into sufferers’ eyes. It is being used to reverse blindness in children born with a rare condition which means they can only distinguish between light and dark. And it has given little Khadijah Chaudhry, born with Leber congenital amaurosis-4, a chance at seeing properly again.

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[inthedayswhenlandswerefew]

Where Will All The Martyrs Go [Chapter 9: Some Days He Feels Like Dying]

A/N: Below are your guesses...let's see how you did!!! 🥰😘

Series summary: In the midst of the zombie apocalypse, both you and Aemond (and your respective travel companions) find yourselves headed for the West Coast. It’s the 2024 version of the Oregon Trail, but with less dysentery and more undead antagonists. Watch out for snakes! 😉🐍

Series warnings: Language, sexual content (18+ readers only), violence, bodily injury, med school Aemond, character deaths, nature, drinking, smoking, drugs, Adventures With Aegon™️, pregnancy and childbirth, the U.S. Navy, road trip vibes.

Series title is a lyric from: “Letterbomb” by Green Day.

Chapter title is a lyric from: “Extraordinary Girl” by Green Day.

Word count: 8.3k

💜 All my writing can be found HERE! 💜

Let me know if you’d like to be added to the taglist 🥰

Let’s go back to the beginning of the end of the world.

On the big-screen tv in the Liberty Center at Saratoga Springs, Wolf Blitzer is saying: “We are receiving confirmation of additional outbreaks of the so-called Florida Fever, the first cases of which here in the U.S. were reported in Miami a little over one week ago. Concern is now growing nationally, especially as the modes of transmission, symptoms, and treatment options remain unclear. Let’s go across the country to Natasha Chen for the latest information. Natasha?”

“Hi, Wolf. I’m here outside the UC San Diego Medical Center where early this morning, two individuals suspected to be suffering from the illness were admitted. I’ve been informed by hospital staff that both patients are currently in stable condition, but there is still so much confusion and conflicting information regarding this ‘Florida Fever,’ and of course that uncertainty is leading to fear, rumors, and honestly a bit of hysteria. Even how to refer to the sickness is controversial, with no official name having been decided upon by scientists. Cases in Australia are known as Ragepox, the U.K. has dubbed it the 21st Century Sweat after a mysterious disease from the 1500s, and Russia is calling it the Ukrainian Flu while Ukraine has opted for the Russian Red Rot, inspired by the skin lesions that some patients experience.”

“Can you tell us what we do know, Natasha? Are doctors classifying this illness as a virus, or as a bacterial infection more akin to tuberculosis or meningitis?”

“At this time, what I’m hearing is that doctors are fairly certain it’s a virus, as patients do not seem to respond to antibiotics when they’ve been explored as a potential treatment. But there’s truly very little information at this early stage, and I think we’re all being reminded of those first days of the Covid-19 pandemic, when no one really knew how to best to avoid contracting the virus or what the long-term effects would be both nationally and globally.”

“There are absolutely some similarities, Natasha, which I’m sure is contributing to the unease surrounding the situation. What precautions are doctors currently recommending?”

“Wolf, doctors are urging the public not to panic, and to exercise common sense measures like avoiding crowded spaces, sanitizing surfaces, and staying home if they’re feeling unwell. Suspected cases of the illness should be reported to primary physicians or local hospitals. Typical symptoms appear to include headaches, fever, gastrointestinal upset, skin discoloration and blistering, and unusual bleeding, as well as behavioral changes, particularly disorientation, aggression, and even violence in some patients…”

“That ain’t what it is,” Rio says. He jabs his index finger at the tv from where he sits on the couch beside you. “Snowflake wasn’t sick, he was dead. He was motherfucking dead, flatline, code blue, crossed the rainbow bridge, he was gone. He was dead and then he woke back up, and he wasn’t a person anymore. He was…something else.”

“Dumbass, people don’t come back from the dead,” Mike says from the ping pong table. People are milling around pretending to play pool, darts, chess, poker, Monopoly, Uno, Parcheesi, but really you’re all here for the same reason. You want to know what’s happening.

Rio turns to you. “Wasn’t Snowflake dead?”

“He definitely seemed dead,” you reply, knees tucked to your chest and still watching the tv. Wolf Blitzer’s voice is calm, but his pale blue eyes have a manic sort of light to them, too large and too rattled.

“Man, fuck Florida,” says Desmond, a utilitiesman born and raised Trenton, New Jersey. “Nothing but psychos and alligators. Saw them off of Georgia and just let them float away.”

“What was that?” Tyler replies combatively. He’s from a trailer park in Tallahassee.

“Ty, why do you care? You’d be fine. You’re already up here. You can stay.”

“They’re lying,” Rio mutters, meaning Wolf and Natasha on CNN. “When the corpsmen called the hospital, they said to be prepared to restrain Snowflake and that he might try to bite us. Why aren’t they warning people about that?!”

Kayleigh, a steelworker from Oklahoma City, looses a frenetic sort of laugh. “Because there’s no non-panic-inducing way to say: Hey, go buy some duct tape and bungee cords to tie up your loved ones, because they might try to fucking eat you.”

Rio doesn’t frown often, but he is now; he slips his phone out of the pocket of his camo pants and types out a WhatsApp message to Sophie. You only know her from photos and quick hellos via video chat, a sweet diminutive woman with white-blonde hair and blue eyes that seem to fill up half her face, as fragile as Rio is overwhelming. She likes baking and romance novels and elephants; whenever Rio finds elephant-themed souveners, he ships them home to Oregon for her, refrigerator magnets and wallets and scarves and snow globes. Sophie wears a lot of long flowing skirts and hand-knit sweaters, and offers strange suggestions when she and Rio discuss baby names: Sage, Fox, Laurel, Coral, Juniper, Karma, Rune, Otter. Otter?! Rio had exclaimed. Babe, if you name our kid Otter, even I’M gonna have to bully them.

“I’m telling Sophie to stay with my parents,” Rio says to you. “They’ve gotten super weird with all the off-the-grid stuff, but they have years’ worth of supplies and grow most of their own food now, and they’re thirty miles from the nearest town. And no one knows how to defend themselves like doomsday preppers.”

“Good idea,” you reply, watching the tv. Now Wolf Blitzer is talking about tornadoes in the Midwest, and you could almost believe the world is normal again.

A few days later all major social media platforms begin censoring content related to the so-called Florida Fever, and then the internet goes down completely, and then the power turns off and on and off again, and finally quits like a car driven to its last mile. The combat units are moved out of Saratoga Springs—never to be heard from again—and the construction projects paused indefinitely, and one of the master-at-arms that Rio is friends with (Rio has a lot of friends, surely you aren’t so remarkable) relays information that he shouldn’t: tales of planned missions, impossible plagues, overrun cities, innumerable deserters in every branch of the U.S. military.

“Hey,” Rio whispers, shaking you awake one night, moonlight streaming through the windows and the pops of distant gunfire you aren’t supposed to ask about. “If I leave, will you come with me?”

It’s a big commitment; it could be a lifetime. You fear he might just be trying not to hurt your feelings. “I don’t want to slow you down.”

“No, you don’t get it,” Rio says. “I’m not leaving without you. Are you going to Oregon by choice, or should I tie you up and throw you in the back of the Humvee?”

~~~~~~~~~~

It’s a young one, maybe a teenager, little buds for horns and only weighing a few hundred pounds. This is good; if it was any heavier, Cregan and Rio wouldn’t be able to drag it back to the ranch. You’re still in Red Desert, Wyoming, and the bison are grazing just off I-80, an asphalt artery that cuts through an endless steppe of sand-colored rocks and tall grass. They gaze lazily in your direction with bulbous dark eyes, perpetually chewing, not terribly intelligent. The Colt pistols of the men who found you at the RV had been loaded with 9mm bullets, the same caliber your Berettas take; there weren’t many, but enough to fill both of your clips, something that feels like winning the lottery. You are lying on the rocky, dusty soil and lining up the shot. If you miss, the herd will scatter, and you’ll watch dinner vanish beneath a blue sky—pale like Aemond’s eye, a weak shallow blue—and rough white scars of cirrostratus clouds.

“Feels kind of wrong to kill a baby,” you murmur. Daeron, Luke, Baela, Helaena, and Ice are back at the house. Aemond, Rio, Cregan, Rhaena, and Aegon are here on the ground with you; Aegon insisted upon being brought along, and Rio agreed to carry him. Aegon had never seen American bison outside of the Oregon Trail computer game, those pixelated brown blobs migrating across the screen no more material than unicorns or faeries or basilisks.

“If the baby didn’t want to get killed, it shouldn’t be made of steak,” Aegon points out. He’s on a lot of Vicodin, the only narcotic Aemond could find back in Ogallala, Nebraska.

“No pressure, Chips,” Rio says, chewing on a long blade of little bluestem grass. “If you miss we’re just going to have to eat each other like the Donner Party.”

Aegon wrinkles his nose in confusion. “The what?”

“She won’t miss,” Aemond says, and Rio snickers to himself and gives you a quick wink that no one else notices.

“I don’t think one 9mm bullet will do it,” Cregan mutters. “Cows got thick skulls, I figure bison are the same way. You’ll have to hit it a few times, and before it can take off and disappear on us.”

Aemond casts him a patronizing glance. “And you’ve killed a lot of cows?”

“Oh yeah. Worked in a slaughterhouse for a while before I got hired by the power company. Hated it, went home and could still smell the blood and brains on myself no matter how many times I showered. Couldn’t get out of there fast enough.”

Aemond looks like he regrets asking. Rhaena frowns worriedly at the bison. “Will they charge if someone shoots at them?”

Cregan shrugs. “Probably not.”

“Probably?!”

You squeeze the trigger five times in quick succession, hit the calf thrice, tiny puffs of scarlet mist that spring from its woolly head. It flops over as the rest of the herd jolts into a gallop, kicking up dust and fleeing across the steppe.

“Yes!” Rio booms as everyone applauds. “We’re in business! We’re having ribeyes tonight! Cregan, my good sir, I take mine medium rare.”

“You’re getting well done,” Aemond tells him. “Everyone is. Just in case the bison has parasites.”

Rio groans. “You’re ruining my life, man.” Then he and Cregan trot over to grab the baby bison, each of them taking one of its back hooves.

“So,” Aegon says dreamily. “Now that Rio is preoccupied, who would like to assist me in returning my disgusting, debilitated body to the ranch? Anyone? Anyone?”

Rhaena turns to you. “When we have more bullets, could you give me shooting lessons?”

“Sure,” you reply, a bit startled. “Really? You’re interested?”

“Well…” Rhaena hesitates. “Baela’s always been the brave one. At home, at school, when we were shopping, even when restaurants would mess up my order, Baela would do the talking and make sure I was alright…and I would literally hide behind her waiting for her to solve all my problems. And now…with the baby, with Jace…it’s been really different being the one to help her for a change, and I don’t think I’m very good at it yet. But Baela deserves to have people to lean on, just like I’ve always had her. And…when I stabbed that guy in the RV…I kind of liked it.” She titters nervously when she sees the shock on your face. “No, not like that! Not the killing part, or the gushing blood, that was all super gross. But the fact that I helped protect Baela and Luke? The fact that I wasn’t useless in that situation? That was a good feeling. Baela is clever, and she’s courageous and caring and funny, and she’s always been better than me at everything, and I never minded because she…she was like my own personal superhero, you know? But now I feel like I need to start learning how to do things myself so I can help her. Even if Baela is still better at everything, and probably always will be.”

Aegon grins toothily and pushes his neon green plastic sunglasses up the bridge of his nose. “I know how you feel. It’s pretty impossible to look heroic next to Aemond.”

“Stop,” Aemond says, but he’s smiling, and a bloom of bashful pink blood appears in his cheeks.

“You already took over the driving,” you tell Rhaena encouragingly. “That was a big help.”

“Yeah,” Rhaena replies, a bit pensive. “Let’s hope I can keep that going.” Between the gas Aemond found in Ogallala and what was siphoned from the would-be attackers’ GMC Yukon, you got enough fuel in the Tahoe to take it halfway across Wyoming; but now the gauge is not just at but venturing below the E, and it can’t have more than five or ten miles left. That might not even get you to the next ranch, let alone a proper town. You need a working vehicle. There are nearly a thousand miles between here and Odessa, Oregon.

Aegon is pawing at Aemond like a cat. “Come on, hero. Help me up.”

~~~~~~~~~~

“This is why we’re friends,” Rio tells you as he shovels forkfuls of bison steak into his mouth, juice dribbling down his chin. Cregan gutted the bison and butchered it, then you helped him cook the steaks—not very uniform in size and shape, yet no one is complaining—on a pan heated in the woodstove. You fed the fire with books you found in the house, mostly religious in nature. “You convince me not to commit suicide when we’re stranded on a transmission tower, you share your Cheddar Whales, you’re good at shooting things…”

“How did you two become friends?” Baela asks. You are all arranged around the dining room table; there are just enough chairs for everyone. Ice lies beneath it mauling on bison bones that Cregan set aside for her. The room is illuminated by flashlights. Baela looks great: in good spirits, glowing, alert, wearing a loose cotton dress that Helaena found in an upstairs closet for her. Baela napped most of the day, something she rarely allows herself to indulge in, and the benefits are evident.

Rio says nonchalantly: “I talked to everybody and she barely talked at all. So of course I had to investigate and figure out what that was about. Turns out she’s kind of cool. You know the Wheel of Fortune game at arcades where there’s like a hundred little lights in a circle you have to press the button when the one that says Spin Zone lights up? She’s a freak, she can hit it almost every time. Can’t sink a basketball or sing karaoke to save her life, but you know, we all have flaws.”

Aegon looks up from his map, which he is scrutinizing as he eats his bison steak. “Do you realize that if we could just stop at gas stations like back when everything was normal, we’d be in Odessa or the Bay Area in fifteen hours? Literally less than one day. Fucking unreal. And yet here we are trapped in yee-haw country, freaky giant animals, no civilization but Jesus billboards everywhere, hell on earth.” He holds up a palm. “No offense, Cregan. You’re okay.”

Cregan smiles mildly. “None taken, Fried Foot. You know you’re a little well done yourself these days.”

“That’s ableist,” Aegon replies.

“We’ll find gas tomorrow,” Aemond says. He sounds confident because he has to; he’s not allowed to panic, to give up. He’s seated at the head of the table like a patriarch. His steak is the smallest and the most ragged. He wouldn’t accept any of the others.

You ask Baela: “Have you decided what to name the baby?”

“Kind of.” She rests both hands on her belly, a globe like a full moon. Helaena glances over at Baela, frowning and preoccupied. “If it’s a boy, I’m going to name it after Jace. We had already picked out Theodore…and Teddy for short, isn’t that cute? But now…I’d want him to have that connection to his father. The baby won’t have any pictures of him, or videos, or memories, or papers he wrote in school, or ties or rings or cufflinks, or…anything. But he could have Jace’s name.”

The rest of you nod, eyes downcast and feeling terribly sorry for her. “I really like that idea,” Luke says quietly.

Now Baela is thinking, her gaze traveling around the room as she chews on a cube of streak. “I’m not sure what I’d call a girl. Maybe something naturey like Violet, Rosemary, Ivy, Indigo, Fern…”

“You should name it Otter,” you say, and you and Rio erupt into raucous laughter. Aemond smiles as he watches you.

Baela is grinning uncertainly, trying not to be insensitive. Perhaps people named their kids stuff like Otter where you came from. “Um, sorry, what?!”

“That was one of the baby names on Sophie’s list,” Rio clarifies. “I vetoed it. Or at least…I think she agreed to cross it off…? Oh my God, imagine I finally get to Odessa only to find out my firstborn child has been named Otter.”

“You’d have to turn right back around,” you say. “Total abandonment would be the only honorable choice. We’d have to start over someplace else. I’ve heard Texas is nice.”

Aegon snorts. “You can’t live in Texas. They don’t even have legal weed there.”

Rhaena squints at him. “I don’t really think that’s a concern anymore, Aegon.”

Aegon smacks his forehead theatrically. “Oh no, I forgot about the apocalypse again!”

“So Cregan,” Baela says. “You were planning to vote for Trump.”

Everyone at the table groans. “No politics,” Aemond says.

“They’re all dead now, so it doesn’t matter,” Rhaena adds. “Biden, Kamala, that insane Kennedy brain worm dude, Trump…”

Aegon says: “If I was a zombie, I wouldn’t eat Trump.”

“I just found that interesting,” Baela continues, looking at Cregan like she’s expecting him to explain himself. Rhaena and Luke exchange a nervous glance. Daeron reaches under the table to pet Ice; you can hear her tail thumping cheerfully against the hardwood floor.

“I was a Trump voter, yeah,” Cregan replies between bites of steak. Aemond is studying him uneasily, but Cregan’s baritone voice is calm. “That doesn’t mean I approved of a lot of the things he did and said. I’m not a monster, I don’t believe in mocking people or all that January 6th stuff. But he was good for the economy. Back when Trump was president, groceries were more affordable, and houses were cheaper, and more companies were hiring. If I had tried to move out of my parents’ place in 2023 instead of 2019, there’s no way I could have done it. And I really needed to get out of there. A lot of people feel that they don’t have the luxury of voting for the nicest candidate, or the candidate they agree with on social issues. Something abstract like climate change isn’t even on the radar. They have to vote for their basic necessities.”

You and Rio understand what he means, you’ve both met plenty of people with the same perspective; everybody else seems shellshocked.

“But I don’t want y’all to think that I’m…” Cregan looks around the table, his eyes catching—interestingly—on Helaena, who observes him with a fully present attentiveness that you’ve learned is rare for her. “You know, like a sexist or a racist or that I hate foreigners or anything. Because I’ve never felt that way, and now I’m very happy to have found you guys, and I respect the hell out of you. And I want to be allowed to stay.”

“You can stay, Cregan,” Helaena reassures him.

“Yeah,” Rio says. “Especially since we’d probably starve without you.”

Cregan beams, clearly grateful, and there are chuckles and the tension breaks; and Baela is placidly skating her palm over the arc of her belly, and now that you’ve eaten all you can, Rio is spearing the remaining chunks of your steak with his fork and gobbling them down. He doesn’t ask before he does this; he knows you don’t mind. You’ve never understood why he’s given you so much over the past nearly five years. You are eternally offering him atonement.

Suddenly, Baela asks you: “What would you name a baby girl?”

You have to think about this before you answer. “Well, if you’re looking for something related to plants…I had a friend when I was growing up named Briar, and I always thought that was pretty.”

“Briar,” Baela echoes, intrigued.

“It means bramble, like a thorny shrub where blackberries grow. I remember her telling me that her mama wanted it to be a reminder that people go through rough patches and that life gets hard sometimes, but you have to keep going, and eventually you’ll find your way out.”

“Briar,” Baela repeats. “Yeah, that’s kind of neat. I’ll add it to the list!”

“And you’d have the same first initial,” Rhaena says. “Baela and Briar. Isn’t that adorable?”

Baela smiles. “And a few Rs thrown in there too. For Rhaena.”

Rio turns to Aegon. “Hey Honey Bun, if you had to name your kid after a plant, what would you name it?”

Aegon says without hesitation: “Marijuana.”

Now it’s an hour later, and Aemond is examining Aegon’s burned leg on the living room floor, Helaena holding a flashlight and you and Rio standing by for moral support. Underneath the bandages is a wasteland of red, weeping flesh…and yet there are spots where the skin seems to be hardening into white islands of scar tissue. Rhaena and Luke are keeping watch by the windows, Baela is passed out in one of the bedrooms, Cregan is showing Daeron how to put his wavy blonde hair up in a man bun.

Aemond points to a blackish patch on the top of Aegon’s foot, only a few inches from his ankle. “I have to debride this part here,” he says like an apology.

Aegon is afraid to ask. “What does debride mean?”

“It means I have to cut it out.”

“Cut it?!”

“It’s getting infected. I have to remove it or it will spread to the rest of the foot and you could get sepsis. I might even have to amputate the whole leg.”

“Okay, cut the dead stuff off,” Aegon swiftly agrees.

Aemond doesn’t have any more injectable morphine. He gives Aegon as much Vicodin as he dares and then begins working, carving away layers of dark disease with his scalpel and scrubbing the area with disinfectant. Aegon clutches your hand, squeezing so hard it feels like your bones might crunch, shrapnel-like splinters of marrow-stained organic glass beneath your skin. Rio has Aegon’s pink Sony Walkman—once owned by Ava—and takes one earbud while giving Aegon the other. They sing along to Sean Paul songs together, laughing as tears stream down Aegon’s sunburned cheeks:

“Well, woman, the way the time cold, I wanna be keepin’ you warm

I got the right temperature fi shelter you from the storm

Oh Lord, gal, I got the right tactics to turn you on

And girl, I wanna be the papa, you can be the mom…”

Now you’re curled up in bed, your arms crossed over your belly as you struggle to fall asleep. Aemond comes to bed late now; each night he waits until Baela is sleeping and then teaches Rhaena about childbirth and recovery: what to expect, what could go wrong. She is a good student, borrowing Helaena’s spider notebook to take notes and asking detailed questions. She wants to know everything she can so she can help when Baela goes into labor.

At last, the bedroom door opens. Out in the living room you can hear Rio asking: “Do you have Wagon Wheel? I love that song.”

Aegon scoffs. “No, of course I don’t have Wagon Wheel. Shut up and listen to your Enrique Iglesias.”

“You are so racist, man…”

Aemond sees that you’re in agony, rummages around in his medical kit, and gives you an oval-shaped white pill to wash down with the can of orange Sunkist on the nightstand; Helaena found a case of it in the pantry. “Why didn’t you tell me it was this bad?”

“I didn’t want to take any Vicodin from Aegon or Baela. They’ll need it more than me.”

“Your pain is as real as anyone else’s.” Aemond’s weight shifts the mattress as he crawls into bed beside you, his arm settling protectively around your waist, his hand covering yours where it rests on your lower belly. “If the Tahoe runs out of gas, will you be okay to walk tomorrow?”

“Don’t worry about me. I had three periods during basic training, I honestly thought I might die. After that I can power through just about anything.”

“I’ve noticed.” You feel the soft smile on Aemond’s lips as he kisses your temple. “Do you want quiet, or do you want to talk?”

“Talking would be a nice distraction.”

Aemond wastes no time. “Do you like kids?”

“Well, since birth control doesn’t exist anymore, I’d hope everybody does.”

Again, he is smiling; you can hear it in his voice. “Okay, but do you intend to have your own?”

“Yeah, I always envisioned myself having kids. I wanted a normal family and figured I’d have to make one myself, DIY it, you know? I don’t think the plan has changed. Gotta repopulate the earth somehow.”

“I wouldn’t try to sway your decision one way or the other. It’s a burden you should only have to endure if you actively choose it. But if you want to have children one day, I’d help you.”

You giggle in the dim orange glow of a single flashlight. “How self-sacrificial.”

“No,” Aemond says, laughing. “Not like, the making them. I mean, I’d help with that too, that aspect would be fun. But I was talking about the delivery, and recovery, and taking care of a newborn. I don’t know everything, but I know a lot. I could help you get through it. So that’s an option I want you to be aware of, if…you know.” Now he pauses. “If you trust me.”

“I trust you.”

“Sometimes I don’t know if you should,” Aemond murmurs; or at least that’s what you think he says as you lose consciousness, plummeting into sleep as if falling from a great height.

~~~~~~~~~~

The Tahoe runs out of gas just east of Tipton—not a city, not a town, just a collection of service roads linking sprawling ranches to I-80, the only continuous route across southern Wyoming—and Rhaena guides the SUV as it coasts to a halt on the shoulder of the highway. You hike about a mile to the nearest ranch house: Luke carrying the siphoning hose and empty gas can in case you can find fuel, Rio carrying Aegon on his back, Baela walking slowly and with great effort, Ice panting as she lopes across the dusty earth. You can’t spot any cattle or horses behind the endless strings of barbed wire fencing. Perhaps they are in a different pasture, or escaped or were stolen, or died of thirst without being tended to, or were consumed by a wandering hoard of zombies, never sleeping and always hungry. The house at the end of the dirt driveway is modest, old, and painted white. The front door is open; the screen door bangs in the wind.

“Rock Springs is the next real town,” Aegon says when Rio drops him to the ground, reading his map.

“And how far is that?” Rio asks.

Aegon deflates. “About fifty miles.”

“Great,” Rhaena says. “What’s the plan, to fly there?”

“Yeah, start flapping your wings, little bird. You’re light enough, you can make it.”

“No car in the driveway,” you tell Aemond. “Nobody home, maybe?”

He’s scrutinizing the house, his blue eye narrow. “Maybe.”

A thought occurs to Aegon. “Do you think ranchers have golf clubs?” he asks hopefully.

“No,” Aemond snaps. Rio is now on the front porch and pounding the butt of his unloaded Remington shotgun against the doorframe to see if anyone appears. Daeron is nocking one of his makeshift arrows as he trots around the perimeter with his compound bow.

Luke, peering through his binoculars, points to a large cylindrical aluminum structure about a hundred yards from the house, by a small red barn. “What’s that thing?”

“It’s a grain bin,” Cregan says. “Full of feed for cattle.” Ice whimpers at his feet, and he twirls his axe in his large, calloused hands. “Are we clearing the house or not? Something’s in there.”

“We are,” Aemond answers tonelessly. “Luke, Rhaena, stay out here with Aegon and watch for trouble. Daeron, you too.”

“Got it.”

“Baela—”

“Can I go inside?” she asks. “Please, Aemond. I’m so sick of sitting around feeling useless and exhausted. I want to help. I want to do something, I’m going insane.”

“Fine,” Aemond agrees. “It should be an easy one.”

It is easy, but it’s not pleasant. The house smells like dark, sickening decay. In the living room are the skeletal remains of two bodies, both children judging by the size; the maroon-stained bones are notched with indents from gnashing teeth. Cregan shadows Helaena as she searches through closets and drawers. She takes no clothing—it would have absorbed the stench of death—but fills her burlap messenger bag with matches, lighters, batteries, pills. She gives you a bottle of Advil before you can ask her for it.

“Thanks,” you say, a bit startled, as you tuck it away in your backpack.

It is not until Ice leads you to the final room, the bedroom at the rear of the house, that you hear the familiar, blood-chilling hissing and moaning of a zombie. It is in the closet, and emerges one limb at a time: one arm and then another, one leg long like a spider’s, streaked with a thick soup of rotting organs that spills from a gaping hole in her belly like the mouth of a mineshaft. Something has happened to its other leg; it is missing, and the corpse that was once a thirties-something woman—a soccer mom, perhaps, with a minivan and propensity to make meatloaf and fish sticks—drags itself across the fawn-colored carpet towards you, slow and pathetic. Ice growls and barks. Rio raises his Remington.

“Wait,” Baela says. Her hammer is in her right hand. “Can I do it?”

“Of course, be my guest,” Rio says; though you can tell he’s slightly disappointed. He loves clubbing things.

Baela approaches the yowling zombie—jaws snapping, claws swiping—and grimaces down at it, this one of millions of monsters that ended the world, that killed Jace and stole all the rest of her life from her too, all those normal things she was supposed to have, all those strings of fate that the plague cut through like a razor and sent floating aimlessly out into the void of the universe. Then with a scream, Baela swings her hammer and a catastrophic impact crater appears in the side of the zombie’s skull, and it crumples to the floor, its mindless brains spilling out onto the carpet.

“Nothing good?” Aegon asks when you reappear in the driveway, popping a Vicodin into his mouth.

“No,” Aemond replies grimly. “No gas, no bullets, no food, nothing to drink.”

“I knew it would be lean pickings once we got out here,” Cregan says, and Aemond looks like he could kill him.

“Well, fortunately, Luke might have some good news for us,” Aegon says with a grin.

Aemond perks up. “Really? What?”

“I saw a truck out there,” Luke says, using his binoculars to gesture to the grain bin. “It’s parked between the barn and the grain thing, I can just see the very front of it sticking out. And if there’s a truck, there might be gas.”

Aemond ruffles Luke’s fluffy dark hair. “Good job, kid.” And Luke lights up like how cities used to look at night, back when the power was on: Washington D.C., Key West, Corpus Christi, Chinhae. Rio stoops down so Aegon can hop on his back, and all of you trek together across the field.

“Nothing,” Cregan announces as he squeezes the little pump on the siphoning hose after opening the gas cap of the ancient Chevy Silverado and threading the hose inside. “Not a drop.”

“Fucking fantastic,” Aegon sighs from where he’s slumped on the ground. His eyes are glazed; he’s pretty stoned. He gazes pitifully up at you; you pat his shoulder sympathetically. You and Rio have already checked the barn, dilapidated but perfectly devoid of zombies. The roof has caved in; one of the two front doors are missing. “What now?!”

“We can go back to the interstate and walk until we find the next ranch,” you say, looking absentmindedly at the grain bin. It’s much larger up close, and rusty in spots. A ladder runs up one side to allow access to the roof. Ice isn’t whining or nudging anyone’s hands, but she’s sniffing the air as if she’s detected something interesting, unfamiliar.

“Yeah,” Luke replies miserably. “We can walk another five or ten miles and then maybe find a safe place to spend the night.”

Rhaena shades her eyes as she peers up at the sky. “It’s past noon already. Maybe we should just stay here.”

Rio barks out a sardonic laugh. “In a house with no supplies and that reeks of dead people?”

“Cregan, go kill us something to eat,” Aegon commands.

He chuckles in his deep, gruff voice. “It’s Miss Chips who is good at the killing, I’m just the authority on butchering at the moment.”

Aemond is watching Ice, his forehead furrowed. “What’s she doing?”

Cregan whistles. “Hey, princess, you okay?” Ice ignores him, still sniffing, her grey ears straight up in the air. Then it appears from behind the barn: a tiny brown creature, a baby bear.

“Aww, it’s so fuzzy!” Aegon squeals, stretching his arm out to pet it. Rio yanks him away; everyone else is backing up towards the grain bin. A second bear cub has now arrived, padding clumsily along, large cartoonish eyes and a little pink tongue poking out from its muzzle.

“Don’t touch them!” Aemond shouts to everyone. “Get away from them! If there are cubs, there’s probably—”

And around the barn comes the mother, a grizzly bear of 400 pounds. She bares her teeth and snarls, saliva dripping in long gluey strings. Ice is barking viciously; Aegon is shrieking and scrambling onto Rio’s back.

“Baela!” Aemond says because she’s closest to him, urging her towards the ladder of the grain bin. She gets the idea and begins climbing. Then Aemond reaches for you. “Come on, you next!”

“Rhaena, go,” you say instead, and she clambers up the ladder after Baela. Cregan is brandishing his axe; Rio has his Remington in his hands, Aegon still clinging to his back like a baby opossum to its mother. Now Helaena is climbing up the ladder, and Daeron nocks an arrow. You whip one of your M9s out of its holster, aim for the bear’s head, and pull the trigger.

Your bullet hits its skull, Daeron’s arrow pierces its chest; and the mother bear does not die but roars and rises up onto her back feet—taller than Rio, taller than Cregan—and then drops back down and charges towards you and the grain bin. Cregan blocks the way, swinging his axe. The bear reluctantly pauses, testing him with swipes of her claws that he evades. Rio is just a few steps behind Cregan, waving his Remington around hostilely. Aegon is screaming and holding on for dear life.

“Don’t shoot!” Cregan yells. “9mm isn’t big enough, you’ll just make her more angry!”

Aemond finally gets a grip on your wrist and drags you to the ladder. You obey and climb until your feet are several rungs off the ground, then you turn to see what’s going on below. Aemond, Luke, and Daeron are at the bottom of the ladder, their backs to you. Cregan is still wielding his axe.

“Fuck off, Mama Bear!” he bellows, standing as tall as possible and swinging his axe above his head. Rio follows Cregan’s lead and holds his Remington aloft. Ice is barking; the baby bears are fleeing in terror. Aegon is sobbing hysterically and saying he’s going to die. “You don’t want us and we don’t want you! Go on! Go get your babies! I’ll put this blade right between your eyes if you don’t change your stupid mind right quick!”

The bear pounds the earth with her front feet and growls, a beastly subterranean rumble, but she seems to be losing her nerve. The rungs of the ladder creak and groan; you see rust like blood-hued moss around the bolts.

“Get out of here!” Cregan shouts. “Go, you hairy old bitch! Go back to your babies!”

The bear glances back to see her cubs vanish behind the barn. Her mouth is open and panting, spittle gleaming on her pointed teeth; her black eyes are uncertain. As you hold onto the ladder with one hand, you have your M9 aimed at the bear’s left eye, just in case. Aemond is watching Cregan; on his scarred face a sharp severity, fascination and resentment and fear.

“Go on,” Cregan says firmly. “Leave us alone. You belong in the mountains, not down here. Go eat something that’s already dead, a nice easy dinner. You don’t want us. We’ll fight you.”

The grizzly bear shakes her head—flopping ears, shaggy fur filthy with dust and pieces of grass—and whirls, lumbering off to find her cubs. When she rounds the barn, Cregan waits a few long, tense, silent minutes and then turns to the grain bin.

“Alright y’all, we oughta hurry up and leave. I don’t think she’ll come back, but she might.”

From the top of the ladder, approximately forty feet off the ground, Baela begins to laugh. “Did that really just happen?! That was insane! Cregan, buddy, you can vote for whoever you want to. You and I are cool forever.”

He smiles up at her, wincing in the bright afternoon light. “I’m very glad to hear it, ma’am.”

Rio sets Aegon down on the ground and stretches his back; it must be hurting him. Aemond is taking your hand and helping you off the ladder, and you are reminded of the transmission tower where he found you in Catawissa, Pennsylvania, one of those middle-of-nowhere places like Tipton, Wyoming. As Helaena climbs down, you go to Rio and—with as much force as you can manage—knead the small of his back with the heel of your hand like you know helps him.

“You okay?”

He sighs loudly, relieved. “Yeah, I’ll be fine. Oh, wow, that’s good. Harder…oh yeah…”

There is a snapping sound, metal squealing as it breaks, and by the time you turn to look she’s already falling: her cotton dress billowing around her, her arms wheeling helplessly. It happens too quickly for her to scream—for her to understand what is going on and what it means—but there is a stunned gasp and then she hits the ground, and you hear a muffled crunch of bone—skull?? spine??—and she is completely, unnaturally still as she lies on her back, no pain, no words, nothing.

“Baela!” Rhaena shrieks, and she rushes down the ladder and runs to her sister. You are all gathering around Baela, petrified to move her—to make it worse—but pleading for her to wake up, examining her with terrified eyes. Baela’s own eyes, dark and glassy and serene, are open only a sliver like obsidian crescent moons. Aemond is asking Helaena for a flashlight and then prying them wide, checking Baela’s pupils.

“There’s no reflex,” he says numbly.

“What does that mean?!” Rhaena cries. “Aemond? Aemond?!”

“She’s…she’s…” He’s in denial; he’s in shock. He’s feeling for a pulse on her carotid, he’s digging his fingernails into her forearm to try to get her to respond to pain.

“Aemond?” you say softly.

“She’s gone,” he tells you, like he doesn’t believe it, like he’s waiting to wake up.

“The baby,” Rhaena says. “Try to save the baby.” And then, when Aemond doesn’t immediately understand, she grabs his backpack and begins ripping it off so he can get the medical kit inside. “The baby, Aemond!”

Now he knows what he has to do. He pulls the scalpel out of his kit as Rhaena moves Baela’s sundress to expose her belly. She was wearing biker shorts beneath, lavender, cute, something you might have picked out in a store. In less than a minute they will be soaked with blood. Cregan leads Daeron away, and he’s telling him that they need to keep watch in case the grizzly bear returns, but you think it is an act of mercy more than anything else. Ice goes with them. Helaena, her face pale and grave, is shining the flashlight on Baela’s belly, just beneath her navel.

“Aegon?” Aemond says.

“What? What do you need?”

“I need people to help hold open the incision once I make it. I have to be able to see the amniotic sac so I can cut the membrane without harming the baby.”

“I get it, I’m here, I’ll help.”

Aemond presses the blade of the scalpel to Baela’s skin and draws a semicircle from the top of one hip to the other. There is blood, but it is slow-moving and thick and dark; it is the blood of a dead woman, not a living one. Immediately, Aegon hooks his fingers under layers of fat, skin, and muscle, and opens the wound as much as he can. You and Rio reach in too, and you do this without thinking, without allowing yourself to feel the horror of it until the work is done.

“I can’t see,” Aemond is murmuring. Rhaena gets another flashlight and helps Helaena illuminate the area. Luke is on his knees with both hands clamped over his mouth, his eyes glistening with dread and disbelief. Aemond is slicing, pausing to probe around with his fingers, cutting again. Then his arm plunges into Baela’s abdomen up to his elbow and, with some difficulty, pulls out the gore-covered baby by its feet, a girl, large and limp and silent.

Rhaena sobs, equal parts grief and joy, a smile appearing on her face. “Is she okay? Aemond? Is she��why isn’t she crying? Aemond?!”

Rio yanks off his shirt and uses it to wipe blood and gelatinous clumps away from the baby’s eyes, mouth, and nostrils. Then Aemond takes the shirt and wraps the baby in it, warming her, rubbing her lifeless little limbs. When she does not stir, Aemond lays her on the earth and begins CPR: compressions with two fingers on her tiny heart, two breaths down the airway she’s never used. There are no sounds except his efforts. There is no crying when the baby wakes, because she never does.

Enough, you are thinking, as if from very far away: an island in the Indian Ocean, the Appalachian mountains in eastern Kentucky. Enough, enough, enough.

Aemond stops trying to revive the baby. He picks her up and holds her against him, and no one says anything. There is only the barrenness of the Wyoming steppe, an anemic blue sky, tall dry grass that bows in the breeze, black vultures that are landing atop the barn and the grain bin.

Aegon jolts out of his paralysis and reaches for his brother with bloodied hands. “Aemond, hey, Aemond, listen to me, it wasn’t your fault. Okay? Are you listening? Aemond, man, you did everything you could. You gave them a chance. You didn’t give up.”

But Aemond doesn’t respond; he only kneels there beside Baela’s butchered body, her dead baby girl in his arms.

~~~~~~~~~~

“Alys?” he calls, seeing that she never came back to bed. He is lying on his stomach, tangled in red sheets damp with sweat. It’s hot, too hot, and there is no humming of the air conditioning. When Aemond picks up his iPhone from the nightstand, it’s still plugged in but only at 87% battery. The power must have gone out.

He gets up, rubs the damp skin by his temple—headache, dehydration—and lifts open the nearest window. It’s odd: there is shouting, distant and indistinct, like the sound of a carnival or a concert. There are car alarms too, and sirens, and horns blaring, all too far away for him to see. It must be because of the power outage, traffic signals thrown into chaos, neighbors relaying the latest information back and forth. That’s the only logical explanation.

“Alys?” Aemond says again, groggy but with increasing curiosity, concern, guilt.

She started to feel sick last night, a pulsing in her skull and chills and powerful nausea. The possibility of it being the so-called Florida Fever barely registered in his mind. Alys gets migraines, and tofu is a migraine trigger, and he took her to a Thai restaurant (maybe he should have known better) and the curry Alys ordered ended up having tofu in it, and by the time she paid the check (as Alys always did) she was swallowing an Imitrex from the box in her snakeskin purse. She said she was going to lie down in the guest bedroom for a while so she wouldn’t wake him if she spent the next few hours dashing to and from the bathroom, a likely outcome, and if he was honest with himself about it, Aemond would admit he was relieved.

He shuffles to the bedroom door—black boxers, bare feet, century-old hardwood floors—and opens it. Now he can hear thudding, like someone tenderizing meat with a mallet. “Alys? Baby, you feeling okay?” There is no answer, only that rhythmic hammering. He realizes that it is coming from the guest bedroom, a door at the end of a long hallway still fuzzy through his half-awake eyes.

It had never felt right, but it had felt good: good in the body when she touched him, good in the soul when she told him he did something right. But lately—especially here, in the vast creaking historic house she shares with her husband and her children, who are presently sailing in Cape Cod—Aemond cannot shake the feeling that this entanglement is a surrender rather than an aspiration, something he fell into and now rests at the bottom of like a swimming pool or the sea, the cold weight of it threatening to pour into his lungs and drown him.

“Alys?” Aemond says, now with profound and inexplicable dread. Outside an ambulance or police car zooms by, sirens blaring. The pounding on the door of the guest bedroom grows faster.

I want to go home, Aemond thinks suddenly. At home, in the Federal-style townhouse his parents rented for him (Criston picked it out, a safe and quiet neighborhood in Beacon Hill, and Viserys paid), Daeron is visiting from California and watching golf tournaments with Aegon on the living room couch, pretending to be interested when Aegon describes the different types of clubs. Helaena, pursuing an Entomology PhD, is researching the Mediterranean mantis, clicking around on her MacBook Pro from the garden in the backyard. Jace and Luke live there too, and so Baela and Rhaena have all but officially moved in, keeping their apartment in Seaport only to have somewhere to retreat to when the Targaryen chaos becomes too much…and so the baby can have its own room. Baela bought a crib, a changing table, a rocking chair, a dresser, and about a million unisex onesies, mostly space-themed. Baela is studying Aeronautics and Astronautics, after all. Maybe one day she’ll work for NASA and fly rockets to the moon.

The door is rattling on its hinges. Aemond’s hand closes around the knob. On the other side is something terrible, and he knows this. But he cannot just leave her. Aemond is not someone who abandons people; he is not someone who turns away from responsibilities.

He opens the door of the guest bedroom, and immediately she is staggering towards him, limp dripping hair and naked like she was interrupted mid-shower: blood bubbling from her gaping mouth and the whites of teeth peeking through the crimson, necrotic skin hanging in strips from her fingers, eyes misty like steam on a mirror.

“Alys, stop! Alys! What’s wrong with you?!”

She’s alive but she’s dead. She’s yowling and clawing at him, but her flesh is the rotting swampland of a corpse. He’s pushing her away; his palms sink into her, places he once noticed and then fantasized about and then at last—euphorically, ashamedly—touched, held, borrowed but never kept. She’s trying to bite him. She’s trying to kill him. None of this is possible, and yet it’s true.

Aemond flings her away, and the woman who was once Alys stumbles backwards and down the staircase, sick wet thumps all the way to the ground floor, bones splitting through dissolving grey skin, organs sloshing around until they spill out. He can hear her still hissing, flailing, trying to get up again.

Without thinking—slipping seamlessly into what he learned during his psych rotation is called automatic action—Aemond races down the steps and grabs her by the skull, cracks it against the antique hardwood floor she once extoled the value of as he fucked her on it: shipped east from Oregon and laid in 1912, the year the Titanic sank. When she lurches up to try to bite him, he slams her head against the floor again and again until she is still.

Then Aemond kneels there alone for a long time, sirens shrieking outside, far-off strangers screaming for help, putrid black blood clotting on his hands.

[minnesotafollower]

“Economist” Magazine Also Predicts Lower World Population

Last month this blogger was surprised to learn about forecasted declines in world population and the resulting challenges of coping with such changes.[1] And earlier this week this blogger was also surprised to discover that due to the aging and forecasted retirement of many U.S. primary- care physicians, the U.S. will need to recruit foreign physicians to move to the U.S. and practice here and…

[determinate-negation]

The Biden administration has been providing Israel with the location of humanitarian groups in Gaza for weeks to prevent strikes against their facilities. But Israel has continued to hit such sites.

The information included GPS coordinates of a number of medical facilities and information on movements of aid groups in Gaza to the Israeli government for at least a month, according to three people familiar with the communications. All were granted anonymity because they feared speaking publicly would make it more difficult for aid groups to operate in Gaza.

Still, Israel has launched operations against Hamas in or near aid sites, including hospitals, leading to the destruction of buildings and the blocking of fuel and other critical supplies.

It’s unclear if the U.S. has compiled a formal “no-strike” list or if it is providing one-off guidance. But officials have helped transmit coordinates of groups that provide food and medical care in Gaza and operate out of hospitals, smaller offices and live in guest houses. Among the sites provided to the Israeli government are medical facilities, including Al-Shifa hospital, parts of which Israeli forces took over on Nov. 15. […]

Aid groups, particularly those working in hospitals in Gaza, said Israel’s operations have made it almost impossible to continue providing care to patients, including premature babies.

“I have spent my entire adult professional life working on basically medical care in conflict zones, and I have never seen anything like this,” said Dr. Amber Alayyan, a physician with Doctors Without Borders. “It’s not only attacks on structures that should be safe, like hospitals and schools, but also holding an entire population without food or water or fuel for over a month.”

The Israel Defense Forces did not respond to requests for comments.

almost like theyre targeting them on purpose

[thatsonemorbidcorvid]

“The women leaders in our study were considered too young or too old. They were too short or too tall, too pretty or too unattractive or too heavy. They had too much education or not enough or their degrees were not from the “right” schools. They suffered from disrespect and misperceptions due to race, color, or ethnicity. Whether they had children or were childless, the women were expected to work harder than men to prove their worth. Women were held back from leadership opportunities due to being single, married, or divorced. There was no personality trait sweet spot, as introverted women were not seen as leaders and extraverted women were viewed as aggressive. The effect, then, means women leaders are “never quite right.””

Full text under cut

https://www.fastcompany.com/90889985/new-research-reveals-critiques-holding-women-back-from-leadership-that-most-men-will-never-hear

A recent study of the 33 biggest multilateral institutions found that of 382 leaders in their history only 47 have been women. And the percentage of women running Fortune 500 companies has only just recently crested a meager 10%.

As researchers we wondered why institutions consistently fail to promote women to top jobs. Our recent study of 913 women leaders from four female-dominated industries in the U.S. (higher education, faith-based nonprofits, law, and healthcare) sheds light on this pernicious problem. As we found, there’s always a reason why women are “never quite right” for leadership roles.

Women are criticized so often and on so many things that they are acculturated to receiving such disparagement, taking it seriously, and working to make improvements. And any individual woman may take it personally, believing the criticism directed at her to be warranted.

But our research reveals that the problem lies elsewhere. Virtually any characteristic can be leveraged against a woman in a discriminatory fashion. Such criticisms often relate to facets of women’s identity in an overt or subtle way, such as race, age, parental status, attractiveness, and physical ability.

Effectively, the surface-level critique functions as a “red herring,” distracting from the inherent gender bias driving the encounter. This type of treatment is so common that we have called it “we want what you aren’t” discrimination.

More specifically, our research revealed 30 different characteristics and qualities of a woman’s identity that emerged as points of criticism creating barriers to women’s success. The clear message to women is that—whatever they are—they are “never quite right.”

Age was a consistent challenge for women leaders in our study. Some of our respondents reported being considered too young to lead, while others indicated being too old hindered them from advancing.

However, being middle-aged didn’t help women’s career prospects either. A physician shared: “I am middle-aged, and men my age are seen as mature leaders and women my age as old.”

Parental status—having children or being childless—emerged as another point of criticism. A higher-education leader described how people assume she “can’t take on a bigger role ‘because of the kids,’” which made her feel that she needed “to work extra hard” to show that she could be both a dedicated mother and a leader.

On the other hand, a childless physician was expected to “work harder/more, accomplish more” than other female colleagues. Mothers were also bypassed for career opportunities, as happened to a single divorced lawyer who was the mother of preschoolers, “due to a perception by my male bosses that I cannot or should not handle [larger matters].”

Likewise, pregnancy was problematic, particularly for lawyers in our study. There was doubt that women would come back to work after maternity leave. Some were no longer given good assignments, while others were forced to quit private practice or work part time. One lawyer described the loss of confidence from bosses:

“Once you are pregnant or trying to have kids, the way management views you deteriorates. The opposite thing happens for male coworkers. I’ve seen it in so many law firms it’s impossible to argue it was just coincidence or based on merit.”

Simply planning on having kids was enough to invoke bias. A woman in higher education reported being denied promotion because she would need maternity leave for hypothetical future children.

Women of color were targets of subtle bias. An African American faith-based leader described being “invisible” and regularly “talked over” by white men. A Native American higher-education executive described being misperceived as weak, “when in fact we are practicing ‘respect’ for ourselves and others.” And a Filipina physician described facing role incredulity, as people assumed that she was “a nurse, and not a doctor and a division chief at that.”

Even physical ability and health played into the women’s experiences. Physical disabilities led to assumptions of not being capable. One higher-education leader who uses a crutch was questioned by men about the way she walks and has been told “to hide my cane, especially for photographs,” as she said.

Regarding health, there were double standards around the way men and women with illnesses were treated. A physician developed ovarian cancer while serving as an officer in the public health service. She explained, “The plan was to discharge me . . . even though men with prostate cancer didn’t have to go through that.”

The women leaders in our study were considered too young or too old. They were too short or too tall, too pretty or too unattractive or too heavy. They had too much education or not enough or their degrees were not from the “right” schools. They suffered from disrespect and misperceptions due to race, color, or ethnicity. Whether they had children or were childless, the women were expected to work harder than men to prove their worth. Women were held back from leadership opportunities due to being single, married, or divorced. There was no personality trait sweet spot, as introverted women were not seen as leaders and extraverted women were viewed as aggressive. The effect, then, means women leaders are “never quite right.”

Organizations that fail to promote and support women in their top roles miss out on performance gains. Fortunately, there are concrete steps that organizational leaders, allies, and individual women can take to mitigate this “never quite right” bias, aiding women’s workplace advancement.

“Flip it to test it”

Leaders can be particularly effective in thwarting sexist criticisms toward women. It’s not about changing the behavior of women—who are the recipients of the unfair treatment—but it is about changing the behaviors of those who justify their actions as somehow merited. Many criticisms fail the “flip it to test it” method miserably. Ask yourself, would the following statements ever be said about a man?

He needs to smile more.

Men are going to have kids and not want to work.

Since Larry has prostate cancer, he can no longer fulfill his job duties.

The clear answer is no. Leaders can infuse awareness of this simple, yet effective, tool to reduce such bias-laden criticisms. And workplace allies can help stop unfair criticism of women by calling it out.

Constructive career-enhancing feedback

Women are almost one and a half times more likely to receive negative feedback that is subjective rather than constructive and objective feedback. Men are often given a clearer idea of where they excel and opportunities for improvement whereas women are given vague feedback that often focuses on qualities like communication style. Even when using formal performance evaluation rubrics, a disparity remains.

Developmental feedback to women focuses on operational tasks, coping with politics, developing resilience, being cooperative, and building confidence. Developmental feedback to men focuses on setting a vision, leveraging power and politics, being assertive, and displaying confidence. Leaders can reduce the gender-biased framing by encouraging all employees to develop both sets of skills.

Do not take it personally

For individual women, hear us when we say, “It’s not you.” We women are conditioned to accept feedback and internalize it as something to “fix” about ourselves. If you are criticized, consider whether it is objective, constructive, and warranted. Disregard identity-based criticisms that are part of a larger pattern of bias against women.

Our research demonstrates that practically any characteristic can be proclaimed problematic for a woman leader to question her competence and suitability for leadership. It takes deliberate effort, but we can turn the message to women from “We want what you aren’t” into “We want what you are.” Doing so will advance women in the workplace and profit the entire organization.

Amy Diehl, PhD, is chief information officer at Wilson College and a gender equity researcher, speaker, and consultant. She is coauthor of Glass Walls: Shattering the Six Gender Bias Barriers Still Holding Women Back at Work.

Leanne M. Dzubinski, PhD, is acting dean of the Cook School of Intercultural Studies and associate professor of intercultural education at Biola University, and a prominent researcher on women in leadership. She is coauthor of Glass Walls: Shattering the Six Gender Bias Barriers Still Holding Women Back at Work.

Amber L. Stephenson, PhD, is an associate professor of management and director of healthcare management programs in the David D. Reh School of Business at Clarkson University. Her research focuses on how professional identity influences attitudes and behaviors and how women leaders experience gender bias.

[odinsblog]

Funny how SCOTUS “originalists” ignore this history

Benjamin Franklin is revered in history for his fixation on inventing practical ways to make everyday life easier. He was a prolific inventor and author, and spent his life tinkering and writing to share his knowledge with the masses.

One of the more surprising areas Franklin wanted to demystify for the average American? At-home abortions.

Molly Farrell is an associate professor of English at the Ohio State University and studies early American literature. She authored a recent Slate article that suggests Franklin’s role in facilitating at-home abortions all started with a popular British math textbook.

Titled The Instructor and written by George Fisher, which Farrell said was a pseudonym, the textbook was a catch-all manual that included plenty of useful information for the average person. It had the alphabet, basic arithmetic, recipes, and farriery (which is hoof care for horses). At the time, books were very expensive, and a general manual like this one was a practical choice for many families.

Franklin saw the value of this book, and decided to create an updated version for residents of the U.S, telling readers his goal was to make the text “more immediately useful to Americans.” This included updating city names, adding Colonial history, and other minor tweaks.

But as Farrell describes, the most significant change in the book was swapping out a section that included a medical textbook from London, with a Virginia medical handbook from 1734 called Every Man His Own Doctor: The Poor Planter’s Physician.

This medical handbook provided home remedies for a variety of ailments, allowing people to handle their more minor illnesses at home, like a fever or gout. One entry, however, was “for the suppression of the courses”, which Farrell discovered meant a missed menstrual period.

“The book starts to prescribe basically all of the best-known herbal abortifacients and contraceptives that were circulating at the time,” Farrell said. “It's just sort of a greatest hits of what 18th-century herbalists would have given a woman who wanted to end a pregnancy early.”

“It's very explicit, very detailed, also very accurate for the time in terms of what was known ... for how to end a pregnancy pretty early on.”

Including this information in a widely circulated guide for everyday life bears a significance to today’s heated debate over access to abortion and contraception in the United States. In particular, the leaked Supreme Court opinion that would overturn Roe v. Wade and states that “a right to abortion is not deeply rooted in the nation's histories and traditions.”

Farrell said the book was immensely popular, and she did not find any evidence of objections to the inclusion of the section.

“It didn't really bother anybody that a typical instructional manual could include material like this,”she said. “It just wasn't something to be remarked upon. It was just a part of everyday life.”

(continue reading) more ←

[batboyblog]

One woman miscarried in the lobby restroom of a Texas emergency room as front desk staff refused to admit her. Another woman learned that her fetus had no heartbeat at a Florida hospital, the day after a security guard turned her away from the facility. And in North Carolina, a woman gave birth in a car after an emergency room couldn’t offer an ultrasound. The baby later died.

Complaints that pregnant women were turned away from U.S. emergency rooms spiked in 2022 after the U.S. Supreme Court overturned Roe v. Wade, federal documents obtained by The Associated Press reveal. 

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It’s happened despite federal mandates that the women be treated. 

Federal law requires emergency rooms to treat or stabilize patients who are in active labor and provide a medical transfer to another hospital if they don’t have the staff or resources to treat them. Medical facilities must comply with the law if they accept Medicare funding.

The Supreme Court will hear arguments Wednesday that could weaken those protections. The Biden administration has sued Idaho over its abortion ban, even in medical emergencies, arguing it conflicts with the federal law.

“No woman should be denied the care she needs,” Jennifer Klein, director of the White House Gender Policy Council, said in a statement. “All patients, including women who are experiencing pregnancy-related emergencies, should have access to emergency medical care required under the Emergency Medical Treatment and Labor Act.”

PREGNANCY CARE AFTER ROE

Pregnant patients have “become radioactive to emergency departments” in states with extreme abortion restrictions, said Sara Rosenbaum, a George Washington University health law and policy professor. 

“They are so scared of a pregnant patient, that the emergency medicine staff won’t even look. They just want these people gone,” Rosenbaum said. 

Consider what happened to a woman who was nine months pregnant and having contractions when she arrived at the Falls Community Hospital in Marlin, Texas, in July 2022, a week after the Supreme Court’s ruling on abortion. The doctor on duty refused to see her.

“The physician came to the triage desk and told the patient that we did not have obstetric services or capabilities,” hospital staff told federal investigators during interviews, according to documents. “The nursing staff informed the physician that we could test her for the presence of amniotic fluid. However, the physician adamantly recommended the patient drive to a Waco hospital.”

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Federal investigators looked into just over a dozen pregnancy-related complaints in those states during the months leading up to the U.S. Supreme Court’s pivotal ruling on abortion in 2022. But more than two dozen complaints about emergency pregnancy care were lodged in the months after the decision was unveiled. It is not known how many complaints were filed last year as the records request only asked for 2022 complaints and the information is not publicly available otherwise. 

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‘SHE IS BLEEDING A LOT’

Other pregnancies ended in catastrophe, the documents show.

At Sacred Heart Emergency Center in Houston, front desk staff refused to check in one woman after her husband asked for help delivering her baby that September. She miscarried in a restroom toilet in the emergency room lobby while her husband called 911 for help.

“She is bleeding a lot and had a miscarriage,” the husband told first responders in his call, which was transcribed from Spanish in federal documents. “I’m here at the hospital but they told us they can’t help us because we are not their client.”

Emergency crews, who arrived 20 minutes later and transferred the woman to a hospital, appeared confused over the staff’s refusal to help the woman, according to 911 call transcripts.

One first responder told federal investigators that when a Sacred Heart Emergency Center staffer was asked about the gestational age of the fetus, the staffer replied: “No, we can’t tell you, she is not our patient. That’s why you are here.”

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Meanwhile, the staff at Person Memorial Hospital in Roxboro, North Carolina, told a pregnant woman, who was complaining of stomach pain, that they would not be able to provide her with an ultrasound. The staff failed to tell her how risky it could be for her to depart without being stabilized, according to federal investigators. While en route to another hospital 45 minutes away, the woman gave birth in a car to a baby who did not survive. 

In Melbourne, Florida, a security guard at Holmes Regional Medical Center refused to let a pregnant woman into the triage area because she had brought a child with her. When the patient came back the next day, medical staff were unable to locate a fetal heartbeat. The center declined to comment on the case. 

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For Huntsberger, the OB-GYN, EMTALA was one of the few ways she felt protected to treat pregnant patients in Idaho, despite the state’s abortion ban. She left Idaho last year to practice in Oregon because of the ban.

The threat of fines or loss of Medicare funding for violating EMTALA is a big deterrent that keeps hospitals from dumping patients, she said. Many couldn’t keep their doors open if they lost Medicare funding. 

She has been waiting to see how HHS penalizes two hospitals in Missouri and Kansas that HHS announced last year it was investigating after a pregnant woman, who was in preterm labor at 17 weeks, was denied an abortion. 

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President Joe Biden and top U.S. health official Xavier Becerra have both publicly vowed vigilance in enforcing the law. 

Even as states have enacted strict abortion laws, the White House has argued that if hospitals receive Medicare funds they must provide stabilizing care, including abortions.

In a statement to THE AP, Becerra called it the “nation’s bedrock law protecting Americans’ right to life- and health-saving emergency medical care.” 

“And doctors, not politicians, should determine what constitutes emergency care,” he added.

Idaho’s law does not allow abortions if a mother’s health is at risk. But the state’s attorney general has argued that its abortion ban is “consistent” with federal law, which calls for emergency rooms to protect an unborn child in medical emergencies.

“The Biden administration has no business rewriting federal law to override Idaho’s law and force doctors to perform abortions,” Idaho Attorney General Raúl Labrador said in a statement earlier this year. 

Now, the Supreme Court will weigh in. The case could have implications in other states like Arizona, which is reinstating an 1864 law that bans all abortions, with an exception only if the mother’s life is at risk. 

EMTALA was initially introduced decades ago because private hospitals would dump patients on county or state hospitals, often because they didn’t have insurance, said Alexa Kolbi-Molinas of the American Civil Liberties Union. 

Some hospitals also refused to see pregnant women when they did not have an established relationship with physicians on staff. If the court nullifies or weakens those protections, it could result in more hospitals turning away patients without fear of penalty from the federal government, she said.

“The government knows there’s a problem and is investigating and is doing something about that,” Kolbi-Molinas said. “Without EMTALA, they wouldn’t be able to do that.”

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The Repeal of Roe V Wade has been a disaster for pregnancy health care, with doctors turning away pregnant women just because they are pregnant out of fear that treatment might violate ever changing extreme and unscientific abortion bans

The Biden Administration's strong stand that EMTALA does cover emergency abortion care has forced hospitals to keep their doors open to people in need. A Republican administration would not enforce the law this way, Donald Trump has already said he'd leave it up to the states and certainly would drop the Biden Administration's law suit against Idaho's restrictive laws.

as horrible as all this is, it can always get worse, this is a preview of what a national Republican Abortion ban would mean for every pregnant person going to the hospital, you or someone you love could be left bleeding in a waiting room.

[mydaddywiki]

Mark Green

Physique: Average Build Height: 5' 10"

Mark Edward Green (born November 8, 1964) is an American politician, physician, and retired U.S. Army officer who has served as the U.S. representative for Tennessee's 7th congressional district since 2019. As a member of the Republican Party, Green has chaired the Committee on Homeland Security since 2023. Before his election to Congress, he served in the Tennessee Senate from 2013 to 2018, representing the 22nd district.

Handsome, looks like he works out and was a powerful House Republican who chaired the Committee on Homeland Security. Who won't want to fuck him. I'll that later.

In 1986, Green graduated from the United States Military Academy, where he earned a Bachelor of Science in quantitative business management. In 1987 he earned a master's degree in systems management from the University of Southern California. After graduating from West Point, Green was an infantry officer. He then graduated from Boonshoft School of Medicine at Wright State University and became a flight surgeon, serving tours of duty in the War in Afghanistan and Iraq War. After retiring from the military in 2006, Green became the CEO of a hospital emergency department staffing company.

Green and his wife, Camie, have two children. In August 2024, Green filed for a divorce from his wife of nearly 36 years citing irreconcilable differences. His wife said he filed for divorce after having an affair with a younger woman. What? Another politician going though a divorce after being caught cheating. Nooooo. Green's wife also issued a harsh warning to the wives of fellow lawmakers to look out for readily available women “predators” that out for our husbands. Don't forget the men “predators” too.

[covid-safer-hotties]

Also preserved on our archive

This is directly tied to covid for a number of reasons including weakened immune systems from frequent infection and vaccine hesitancy strengthened during the pandemic.

By Eilis O'Neill

Whooping cough is spreading nationwide at the highest levels since 2014. There have been more than 16,000 cases this year — more than four times as many compared to the same time last year — and two confirmed deaths. And experts are concerned that the outbreak could worsen in the fall and winter months.

“More children are going back to school now, [which leads to] greater exposure,” said Dr. Eric Chow, the chief of epidemiology and immunization at the Seattle and King County public health agency. “We’re coming up on the kind of winter season when people are spending more time indoors with other people.”

The disease is most dangerous to babies: 1 in 3 who get it require hospitalization.

Whooping cough cases are especially high right now on the West Coast.

King County, where Seattle is, has seen more this year than any year since 2015 — “and the year isn’t even over yet,” Chow said. He said the county is still seeing new cases of whooping cough every week.

Why the big outbreak now? Experts say there are a number of possible explanations for the size of the current outbreak.

Doctors are testing for whooping cough more, so they’re identifying more cases.

It’s possible that the bacterium that causes the disease has mutated.

Also, people got behind on their vaccines during the pandemic, and they haven’t caught up.

“One of the challenges that we have with [the vaccine that protects against whooping cough] is that it is a five-dose series over the course of the first six years of a child’s life, so it does require regular visits to the primary care,” Chow said.

And, Chow said, not everyone can get to the doctor regularly.

But access isn’t the only problem.

“There still is a lot of vaccine hesitancy and anti-vaxers out there that will not vaccinate their kids,” said Dr. Tina Tan, a pediatric infectious disease physician at Northwestern University and the president-elect of the Infectious Diseases Society of America.

For the first couple of weeks, whooping cough looks like a mild cold, but then the coughing fits start.

Babies who get it “are going to be whooping when they cough,” Tan said. “And they may cough, cough, cough, cough, cough, and then look like they're not breathing at all.”

Tan said those pauses in breathing are life-threatening, and a sign that it’s time to go to the hospital.

Whooping cough can also lead to pneumonia and other complications.

But babies can’t get their first dose of the vaccine that protects against whooping cough, also called pertussis, till they’re 2 months old.

“That’s why it’s important for pregnant women to get the pertussis vaccine when they’re pregnant,” Tan said, “so that you can protect your baby for the first two months of life until they’re old enough to be vaccinated themselves.”

Even before the pandemic, only about half of pregnant women got the pertussis vaccine. Now, that number is even lower.

In King County, of the 12 babies who have been seen with whooping cough this year, none of their mothers got the shot during pregnancy.

Vaccine fears, and confidence Dr. Chow, with Public Health-Seattle & King County, said that’s a missed opportunity.

“Sometimes you require a kind of sit-down conversation with the patient who may be a little bit more hesitant or may have encountered misinformation,” he said, “so it just requires a longer time to build trust and rapport.”

Also, not all obstetrician/gynecologists offer the vaccine in their offices, and some people don’t have the bandwidth to go to a pharmacy for a shot.

At a playground in Seattle’s White Center neighborhood, Kay said she has two kids, ages 12 and 4, and she’s always been hesitant about vaccines.

Kay declined to give her last name because she’s concerned about revealing private medical information.

“With COVID, it even made it even more scary, because everybody started coming out saying, ‘The COVID shot’s not actually good for you,’” Kay said. “So I was like, ‘Maybe the other vaccines are bad too.’ And then I went down the rabbit hole of looking up kids who have supposedly gotten vaccinations and passed away.”

Experts say vaccines are very safe and can prevent diseases that once killed or harmed many babies, children, and adults.

Kay eventually got her 4-year-old daughter the shots required for daycare but nothing else.

“It's hard for me to get childcare, and it's just easier for me to say, ‘OK, just give me whatever she needs, just to get her into school,’” Kay said.

So her daughter did get the required whooping cough vaccines — but not any COVID shots, which are not mandated.

Aaron Sittinghorse was at the same playground with his 3-year-old daughter. He said the pandemic had the opposite effect on his thoughts about vaccines.

“It opened up my eyes to how important they are,” he said, “and so now, I'm a believer in vaccines. It's important, even if it's not for yourself, but for everybody around you.”

Sittinghorse said he saw on the news that there’s a whooping-cough outbreak right now, and it worries him a little — but not too much, because he and his family are up to date on their vaccines.