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dilemmaontwolegs · 1 year ago

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The Bucket List || CL16

Pairing: Charles Leclerc x fem!reader Summary: Life changes in the blink of an eye with a diagnosis and you are forced to face your mortality with the help of Charles Warnings: 18+ only, nsfw, implied smut, grief, implied character death.

WC: 5.8k

Story || Death Scene || Two Years Later || Bucket Moments || Five Years Later

The winter break was meant to be a time for Charles to relax but one simple act had put an end to those plans. It had been a little joke between lovers while you were getting dressed. Charles had seen an opportunity and taken it, cradling the swell of your breast in his palm and giving it a quick squeeze.

“Honk, honk!”

You gasped at the sudden pain that flared and rubbed at the aching area. Charles was immediately sorry, apologising profusely as he brushed your hand aside and massaged it gently for you.

“It’s ok, Cha, this one’s been a bit tender lately.”

“What do you mean?” His concern was palpable and his hand flattened so the palm was pressing into your flesh. You couldn’t hide the wince at the spot he touched and he couldn’t hide the fear in his eyes.

“What?!” You stepped away and grabbed your breast, almost immediately feeling what he felt as your heart began to hammer hard in your chest. “It’s probably nothing, boobs are lumpy all the time.”

“Yeah…” he murmured distractedly. “We should probably check just to be sure. Right?”

You tried to nod casually but it was too hurried. “I mean, just to be sure.”

Everything moved quickly after that. The exhaustion was no longer jet lag. The low red blood count was no longer anaemia. The lump was no longer just fatty tissue.

“What happens now?”

You looked at your boyfriend, but his eyes were fixed on the doctor who had been explaining the test results. Charles had done all of the talking while you sat in a state of shock. You didn’t even feel like you were inside your own body but floating somewhere in the room and watching from outside.

“We could take a biopsy to be certain but the tests so far are quite conclusive and I wouldn’t recommend waiting. We could fit you in to remove the tumour in the next couple of days and have you home for Christmas.”

You knew this already. He had spoken about removing the lump. You couldn’t bring yourself to call it a tumour because, benign or malignant, it made it too real. Removing the lump was the extreme simplification of what he really meant. Mastectomy. Double to be precise. The risk was too great to leave the other breast untreated, apparently.

“We’ll take the surgery as soon as possible.”

You blinked at Charles, waiting to see if he would even look in your direction before making such a decision but his chin was resting on the tip of his steepled fingers. He leaned forwards, digging his elbows into his knees as he always did when he was deep in thought.

“No,” you rasped. “I can’t do it.”

“Yes, you can,” Charles replied without even looking at you. He had hardly looked your way since the first appointment a week ago.

“I’ll give you two some time to talk,” Doctor Hall said softly as he rose from his chair and left the room, the click of the door closing too loud in the heavy silence.

“It’s my body, Charles,” you whispered, your throat too hoarse to manage anything louder.

“I know that, but this is your life we are talking about.”

“We don’t even know for certain that it’s…that it’s…”

“It’s cancer,” he said with a sigh, “not saying it doesn’t change the test results.”

Your eyes burned, your tear ducts working overtime all week. The harsh lines on Charles’ face softened as he saw them well on your waterline before spilling over. Pulling you into his lap, he cradled your head to his chest as you ruined yet another one of his shirts with your makeup and tears.

“Mon amour, we will get through this but we have to trust the doctors.”

“I won’t have boobs,” you whispered as your voice broke.

Charles curled his finger under your chin and tipped it back as he searched your eyes for the answer. He found what he was looking for and dropped his forehead to yours with a shake of his head. “You will still be the most beautiful woman in the world. And I need you in the world, mon amour, do you understand that? I need you to fight this.”

A few days turned out to be just one after the oncology department received a large, anonymous donation. The private room in the hospital was filled with bouquets from friends and family, their floral scents were almost able to erase the tart smell of bleach. You still felt numb to the entire experience and Charles watched on with concern as you stood in front of the bathroom mirror.

Your reflection was the same, yet it wasn’t. Permanent marker pen lined the skin that would soon be permanently marred. The outlines accentuated what would be taken from you and you turned to your side profile, trying to imagine waking up without the pieces of your body Charles had loved.

“The surgeon said there are options, if it’s really that important to you,” Charles said as he pushed off the doorway he had leaned against and walked into the room. “But you don’t have to think about that now.”

You let him drape the surgical gown over your arms and they fell limp at your side while he tied the bows to keep your modesty. “Come and lay down with me,” he murmured as he took your hand and led you to the bed. You hadn’t been sleeping well, neither of you had.

It was narrow but Charles made space for you to lay in his arms with his chest pressed to your back. Monaco was alive outside the window you faced but the sounds didn’t reach you. Instead of watching the cars on their journeys you turned your eyes up to the cloudless sky and spotted the gulls that danced in the salt air.

“I lo-.”

Charles’ chest shuddered with the breath he took before he kissed your temple and whispered, “Don’t.”

“I need to tell you.”

“We promised, not until you wake up.”

“But what if I-”

“Don’t,” Charles begged, a wet drop falling into your hair. “Please.”

A knock sounded at the door but you kept your eyes firmly only the white feathers of the bird that landed on your windowsill outside. Charles pressed his lips to your temple once more before releasing you from his hold and climbing off the bed.

“I’ll be right there when you wake up, mon amour.”

“I…I’ll see you soon.”

He smiled sadly as you caught yourself from saying what you wanted to say, that sad smile remaining while your bed was wheeled away. You craned your neck as you were taken further down the hall, wanting to memorise the way he looked in case it was the last time you had the chance.

As promised, you woke up bleary eyed and groggy to those gold and green eyes, his hands holding yours tenderly as he sat beside your bed.

“Hi, beautiful,” he greeted as his smile brightened your day. It was a true smile, one you hadn’t seen for over a week, one that crinkled the corners of his eyes and revealed the dimples in his cheeks. “I love you.”

You felt drunk as the anaesthesia still circulated your body and you were sure you slurred the words you had been banned from telling him before. “I love you.”

You dozed in and out of consciousness until the pain relief began to wear off and breathing itself hurt. The bandages across your chest irritated your skin and the stitches pulled with every little movement. Charles noticed it all.

“I’ll see if they can give you anything for the pain.”

You caught his hand before he could leave and winced as the IV line in your hand tugged uncomfortably. “I’m hungry.”

Charles chuckled, knowing you would be after eating nothing before the surgery, and cradled your cheek gently. “Maman’s on her way with your favourites. I’ll be right back, baby.”

Charles arrived back with a large bag of hot dishes from your favourite restaurants around the city and the promise that the nurse would bring some medicine around soon.

“We’ll have someone come and move you up to the ward shortly,” the kind nurse said after she had given you another dose of pain relief. “You’ll be able to see your visitors there.”

You thanked her since you knew your parents would have been waiting with Pascale, Arthur and Lorenzo too. Charles had been keeping them updated since you woke up and his phone was constantly going off with notifications from your friends.

“How are you feeling?”

You placed your fork down into the empty bowl and Charles whisked it off your lap and tidied up the rubbish with the need to keep himself busy. “I don’t know,” you admitted as your head began to clear from the anaesthesia. “Two weeks ago we were partying in Baku and now we’re here. I still don’t know how this even happened. What if they made a mistake? This was all done so quickly.”

Charles carefully tucked the sheet back around your body after helping you to lie back down. “Mon amour, this is one of the best hospitals, they wouldn’t have done this unless it was the right decision for your health.”

“I know, I know. I just don’t know how to feel anything right now, except confusion.” You took his hand as he sat back into the chair beside your bed and kissed his knuckles. “How do you feel?”

“Me?” His brows pinched together as if he hadn’t been thinking for himself, and he really hadn’t. All of his thoughts and feelings had been focused on you. “I’m relieved, I suppose. You are here, I get to kiss you and hold your hand. That is good.”

You smiled at the hope in his voice. “I don’t remember a kiss.”

“Ah,” he hummed with a nod as he leaned closer until his lips were so close you could feel the heat of them as he whispered, “This one.”

You were warned that day two would be the hardest. The hard drugs had worn off and what you were supplied with took away the dull throbbing ache when you were stationary but did nothing to prevent the sharp pain of moving.

Charles had just lifted you back into bed after helping you go to the bathroom when the surgeon arrived with a forlorn look on his face. Immediately you felt the air leave the room.

Doctor Hall started with the good news, that the surgery went as planned with minimal bleeding from the tissue removal, but then there was a pause. Your fingers tightened around Charles hand as the doctor flipped the piece of paper on his clipboard over and clicked the end of his pen.

“When we began the removal of the tumour we found that the shape wasn’t exactly as we expected from the ultrasound.” He drew an oval shape on the paper before adding webs spindling off in all directions and pointing to them. “We removed as many of the tentacles as we could find but they are invasive and so we would like to start chemotherapy as soon as you have recovered from the operation.”

Charles' knee shook the bed as it bounced nervously. “Chemo?”

“Does this mean it is definitely c-cancer?” you stumbled over the word as you said it aloud for the first time.

The doctor nodded. “We were quite sure before but pathology confirmed it with the sample we sent.”

“What about Christmas?” you asked. “Can I still go home for Christmas?”

The doctor nodded again and you exhaled in relief. Christmas had been organised to be held at your house for months and it would give you a chance to do something normal after your life had been thrown off the rails. You needed this Christmas.

“We will schedule you in for after New Years, but you wouldn’t want to delay it much further than that.”

“Thank you,” Charles choked out for the both of you as you fell silent and he left. “What are you thinking so hard about, beautiful?”

“The menu. It needs to be special. And I want to invite everyone.”

“What, slow down, what are you talking about?”

“Christmas, Cha, I need to start planning now.”

Charles knew you were deflecting, pouring yourself into a future task so you didn’t have to think about the present. You had already gone through enough, so he bit his tongue and took a second to clear the thoughts he wanted to voice. Instead, he asked, “who, exactly, is everyone?”

“Slow down, you’re meant to be relaxing,” Charles warned as you rushed around the house for a last minute tidy up. “Don’t hurt yourself, baby, let me help.”

“I love you, but please leave this to me. I know where everything is.”

“I do too,” he exclaimed, falling silent when you picked up a remote that had stopped working. You had asked him to get the batteries for it the night before, but he hadn’t been able to find them.

“Second drawer in the kitchen,” you said as you tossed it to him and folded the blanket you snuggled under with him every night. “But you knew that right.”

He sent you a charming smile as he backed out of the room. “Of course, honey.”

You chuckled at his retreating figure. “Thought so.”

You had just finished lighting the scented candles around the house when the front door opened and Arthur breezed into the living room.

“Merry Christmas, ma chére. Shouldn’t you have your feet up?” he tutted as he kissed your cheeks, careful not to hug you since your chest still hurt.

“Merry Christmas, Tuthur.” His smile lifted at the old nickname and it only grew as you said, “You know how well your brother cooks. Be glad I don’t have my feet up.”

Everyone arrived steadily after Arthur and as the night grew colder every seat in the living room was taken by your guests. You could have imagined it being just like every other family Christmas as you sat on Charles lap and listened to Joris recount how he had spent the winter break so far.

You could have imagined it being just like every other family Christmas, but it wasn’t.

You were self-conscious in a way you never were before. The dresses you had loved so much were now something you couldn’t bear to wear as it accentuated the changes in your body. You had taken one shopping trip with Pascale so you could buy some presents but by the time you had got home there was a photo circulating the F1 WAG pages. The comments had nearly made you sick as they compared your flat chest to that of a young boy, or joked that the championship wasn’t the only thing that was lost at the end of the season.

You knew it was only a matter of time before the truth came out but you doubted they would feel any remorse, anyone who could say such things through a keyboard didn’t have the emotional capacity to feel guilt.

When midnight came and went, so too did the guests. Tipsy and jolly, they said their goodbyes and well wishes until the house fell quiet except for the music playing softly from the speakers. Charles pulled you into his arms and gently rocked you side to side as you laid your head on his chest. “Merry Christmas, mon amour. I didn’t know what to get you this year, so I was absolutely selfish and got this.”

Charles stepped out of your embrace as he dropped to one knee and held a ring out. Similarly designed to his mother’s, the ring was timeless and elegant with a large princess cut diamond. “Will you make me the happiest man and marry me?”

You had waited years for the question but the answer that fell from your lips went against every fibre of your being. Your hands covered your mouth but there was no silencing the words as they hung in the air. “I’m sorry, I can’t.”

Confusion slapped Charles’ pink cheeks and he swallowed twice before his voice could work again. “Why not?”

“You know why,” you whispered.

“No, I don’t.”

“Because I’m sick, and I don’t want to make plans if I’m not going to be there to…I just don’t think now is the right time.” You took the ring from his fingers and sighed with longing. “It’s beautiful, Char.”

“Hold on to it for me,” he said as he stood up and closed your hand around it. “When you beat this, I’ll be waiting, mon amour, however long it takes. I’ll wait for you.”

You held the ring tight as you closed the distance and put all the words and emotion you couldn’t articulate into a kiss, deepening it until you were breathless and needy. “Come to bed,” you breathed against his lips.

“I don’t want to hurt you.” He looked pained by the very idea, or maybe it was the weeks of celibacy after your surgery.

Lacing your fingers together, you took a step towards the stairs and gently tugged him to follow. “You could never hurt me.”

The moment had been weeks in the making as the chemotherapy took its toll on you. For days after the treatment you had been ill and Charles had been at your side with a bowl ready for when you emptied the contents of your stomach. Then your muscles ached and you could barely hold your own weight up to walk. Just when you thought the worst had come to pass you felt the first strands come loose.

“Hello, my dear,” Pascale answered your call, only to be met with a hiccup. “Sweetheart, what’s wrong?”

“M-my hair,” you stammered as you looked at your reflection in the bathroom mirror. Charles had been out shopping but you saw his face appear behind you as you turned to show him what filled your gripped fist. “It’s my hair.”

“I’ll be over shortly, just let me lock up the shop,” Pascale soothed before ending the call.

“I just brushed it,” you hiccuped as you touched your hair again, more of it floating to the tile floor. “It won’t stop.”

“I know, baby,” he murmured as he took your hand and brushed the hair from your palm. “Maman will know what to do. We’ll get through this like we have everything else, together.”

Pascale promised she could have a wig made for you if you wanted one but it was already late in the evening and you knew she was exhausted from working all day. You did however accept her offer to shave the rest of your head so at least the patches of missing hair didn’t stand out as much. Charles had sat with you in the bathroom and held your hand the entire time before asking his mother to shave his next.

“No, I love your hair,” you argued as he pulled his shirt over his head to save it from getting covered in the short dark strands.

“I told you we are doing this together,” he replied as he kissed your knuckles and nodded to his mum to proceed.

It took a while to get used to the smooth feel of skin on your head but you came to prefer it to the wig that Pascale crafted, somehow finding hair that was almost the exact same shade and texture to your natural hair. The moment you got home from any outing you would pull the wig off with a grateful moan just as you used to do with your bra.

“Are you going to be alright? Maman said she can come and stay with you.” Charles sat on his suitcase so he could zip it closed before looking up to where you sat in bed with a book on your lap. “I don’t like leaving you here alone.”

“I’ll be fine,” you reassured him. “It’s only for two nights.”

His team had let him get away with having one extra night at home before going to Bahrain for the 2024 pre-season testing, but it was still too long away from you in his eyes. You would have been with him but you were due some follow up tests.

“You’ll be so busy you won’t even have time to miss me,” you teased, spurring him to climb onto the bed and cage you beneath him.

“I miss you every second we are apart.”

You recognised the number calling your cell phone because you still had nightmares from the last time they rang. A pit of dread was already opening in your gut as you hovered your finger over the green button. You debated not answering the call but if you didn’t answer it then he would try Charles’ number next - and he needed to focus on driving.

You wished you never answered the call.

You had been quiet the entire drive from the airport to the hotel Charles was staying at. He wasn’t one to push you to talk before you were ready but he was certainly worried when he reached across the gearbox and placed his hand on your lap. He spared a glance to you as he gently squeezed your thigh but still you didn’t react, or take his hand, or even blink.

You didn’t remember the walk from the car to the hotel room. You were busy thinking about how you were going to break Charles’ heart, something you had never imagined you would have a hand in. You never wanted to hurt him, you loved him more than life itself, a life that was going to be shorter than you had once thought.

Charles stood quietly in the doorway to the bedroom, your suitcase still in his hand. He watched as you pulled your wig off for the first time since leaving Monaco and listened as you sighed heavily. His feet only carried him closer when you pulled a piece of paper from your pocket and held it out silently.

“What’s this?” Charles asked as he unfolded the note you had written on the plane. You had almost 10 hours to think of everything you wanted to do while you could and his eyes scanned over the list. “Baby, what is this?”

“It’s my bucket list.”

“A bucket list?”

“It’s a list of what I want to do before I die.”

“I know what a bucket list is!” He took a breath and ran his hand over the fuzz that had grown back on his scalp before lowering his voice as he shook the paper. “Why am I holding yours?”

His green eyes blurred with tears as you bit your lip and looked at your feet. He was already shaking his head in denial, wet droplets soaking into the list.

“My results came back…”

“Non, non, baby, non…”

“I’m sorry, Charles,” you choked as he fell to his knees and let the paper fall to the floor. His arms encircled your hips and you cradled the back of his head to your stomach as he cried against you. You finally let your own tears fall, the tears you had held back since you received the news. “I’m so sorry.”

Charles missed testing the next morning as he held you in his arms. The tears had long run out but the sadness still remained. He had laid with you all night as close as your bodies would allow and together you had seen the sunrise over the desert. He had listened to you quietly recount the doctor’s words but most of it made no sense to him.

Metastasized. Stage four. Terminal. The information ruined him.

“How long?” he finally asked. He looked at the paper that was still on the bedroom floor before clearing his throat and trying again. “How long do we have?”

You didn’t know if answering him would help or not but he was waiting for an answer as you rolled over to face him. The last three months had taken a toll on him and dark circles rimmed his eyes and they no longer held the same brightness. They were only going to dim more at the news. “Six months, maybe a year.”

He was silent, but you knew it wasn’t because he hadn’t heard you. Emotions warred behind his eyes before he climbed out of the bed and walked into the bathroom, locking the door behind him.

You hated the silence but the screaming was worse. The painful wail echoed around the room and you felt it shatter something deep in your chest, before something shattered in the bathroom.

Pulling your knees up to your chest, you held yourself together while Charles fell apart.

You weren’t sure how long he screamed at the universe, how many times he asked it why, what he had done to deserve to lose someone else he loved. You weren’t sure how long it took him to clean the blood from his fist and wash his face of the tears before he unlocked the door and slipped back into the bed.

“Whatever you want, mon amour,” he promised as he unclenched your hands and curled his body around yours. “Anything you want to do, we’ll do it. We’ll do it all together.”

You stood at the edge of the lookout and smiled at Charles as he took the photo, another one for the memory box you were making together. Charles kept his promise, taking you everywhere around the world with him to tick off the items on your bucket list.

You had watched him win his home race for the first time and gone to a couples cooking class.

You visited all the Disneyland Theme Parks you hadn’t been to before: the Tokyo one when he raced in Suzuka, the Chinese one when he raced in Shanghai and the Floridian one when he raced in Miami.

Charles had taken you to Iceland to camp under the northern lights and to Pamukkale in Turkey where the blue waters were meant to work miracles. It hadn’t cured the illness that ravaged your body but each activity you crossed off cured some of the sadness in your soul.

“It’s bigger than I imagined,” Charles commented as he looked up at Christ the Redeemer. “What size shoes do you think he wears?”

“Well you know what they say about big feet.”

Charles’ head fell back with a laugh. “You cannot say that about Jesus.”

You fluttered your eyelashes innocently as he stepped closer to take a photo of you together. “I was going to say he wears big socks, get your head out of the gutter.”

“Of course you were, mon amour.” Charles’ lips curled up in amusement and you relished the way his eyes crinkled before you rose onto your toes so you could kiss him before the smile faded.

The flash of his camera captured the moment and you reluctantly pulled away as the sun began to set on another day spent living. The days were getting tiresome, your energy flagging as the medication changed from treating the illness to managing the pain. You had read enough to know that time was running out.

“We should get going, don’t want to miss our flight to Vegas.”

“About that…” he trailed off as he pulled a piece of paper from his pocket and placed it in your hand. “I made a list of my own.”

Marry the woman of my dreams.

“I can only do it with you by my side.”

—

Pascale had created a beautiful headpiece for your wedding but when it came time to leave you hadn’t been able to place it on your head. A year ago you had only dreamt of the day you married Charles and in all those imagined scenes you had your hair styled up like she had crafted on the wig with pearl pins and a delicate tiara. But a lot had changed in a year, you had changed.

“Oh, sweetheart, you look beautiful,” she said as she wiped her eyes. Your own mother was speechless as she pulled you into her arms and held you tight.

“I’m going to ruin my makeup if you two don’t stop crying.”

“Honey, let her go,” your dad said softly as he placed a hand on your mother’s shoulder. “It’s time.”

Your throat felt as if it were closing and for a second you held on tighter before you both opened your arms. “I love you,” you said to them all as you looked at the proud but sad smiles on their faces. “Thank you for making this possible, for both of us.”

Your father grabbed the wheelchair you had been using, the exhaustion sometimes too much for you to handle, but you shook your head. “I’m going to marry him on my own two feet.”

You knew Charles had a lot of help organising the wedding because there was no way he could have done it on his own. The entire paddock had come to a standstill at the end of Media Day and you found yourself walking down a makeshift aisle on the grid to the starting lights.

Hundreds of friends joined your families on the track and you had no doubt that Charles had flown them all there at his own expense.

“When you said married in Vegas, I thought you meant the White Chapel,” you whispered with a giggle.

Charles' smile grew at the sound and he took your hands in his. “That’s something tacky Pierre would do.”

“Hey,” the groomsman objected beside Charles. “Elvis isn’t tacky. Focus on your own wedding, mate.”

You laughed at the exchange before Lorenzo cleared his throat and your eyes widened as you realised he was the celebrant. “Is this legal?”

“The online certificate I got says so,” he said with a wink. “But if you’ve changed your mind I can skip the legal bits.”

Your eyes lit up with amusement. “No way, I’m not going to miss having you as a brother-in-law.”

“And I thought we were here because you wanted to marry me,” Charles joked. He had waited so long to marry you but now that the moment was here he was in no rush for it to end. He wanted to stay in this moment forever, where you were lighthearted and smiling. Where you weren’t lost in thought but present in the moment, with him.

“I do,” you said with a grin before peeking back at his older brother. “Does that count, can I kiss him now?”

Lorenzo wrinkled his nose and shook his head. “I’m afraid it’s not quite, shall we get started?”

Charles could hardly keep still with his excitement. “Ready, baby?”

You reached into a hidden pocket in the dress and pulled out the engagement ring he proposed at Christmas with. Slipping it into your finger, you gave him a serious nod. “Now I am.”

—

“Good morning, Mrs Leclerc.”

You smiled as Charles kissed your shoulder blade and rolled you over to face him. He had already showered and dressed for the day before climbing back into bed with you and you peeked at the clock to see he would almost be late.

“You should be at the track already,” you hummed between the sweet kisses he peppered across your skin.

“Wasn’t going to miss watching you wake up as my beautiful wife for the first time.” His smile wavered as he kissed your forehead before pressing the back of his hand to it. “How are you feeling?”

“A little tired, but last night was worth the lack of sleep.”

He smirked and traced your lips longingly with his eyes. “Definitely worth it. But you don’t feel hot or cold?”

“Focus on FP1, Cha,” you said with a little push for him to get out of bed. “You’re going to be late.”

He playfully nipped your collarbone before getting off the bed and blowing you a kiss. “Rest up, mon amour, I’ll come back between the practices.”

“I love you.”

“I love you too, more than the moon and the stars.”

“Hopeless romantic.”

“Love of my life. Fire in my loins. The apple of my-“

“Go away!” You tossed a pillow at him before falling back into the warm blankets with a laugh that turned to a yawn. “Profess your love to someone else and let me sleep.”

“Never,” he chuckled quietly as he watched your chest rise and fall into a steady rhythm. “It will only be you.”

Your health deteriorated rapidly after Vegas and your doctor urged you to return to Monaco, but you weren’t ready to leave just yet. There was only one thing left on your bucket list and it was within your grasp. Charles and Max were neck and neck in the championship but you had faith your husband would triumph in the end. So instead of heading home you remained by his side in Qatar and Abu Dhabi, letting him hire a medical team as a trade off for ignoring your doctor's advice.

It wasn’t just the season coming to an end and you could both feel it as Charles prepared for the final race. You didn’t have the strength to go to the track and see him start from pole, the prime position for the championship deciding race. You barely had the strength to stay awake for the whole race but you fought against the heaviness in your body and scanned the screens that had been brought into your room.

Pride made you heart light as you watched the world through Charles’ eyes. The onboard camera was clear ahead, all his competitors in his rear view, and as the laps passed by his lead grew wider. Charles was flying and he was taking you with him.

Charles took a seat on the centre podium as confetti rained down and fireworks exploded overhead. He wiped the sweat and champagne from his face before reaching into his race suit and grabbing the pen and paper he had tucked away.

Putting a strike through the last line he held it up triumphantly to the camera. “We did it, mon amour, we did it.”

You smiled as if he would see it and closed your eyes as you lost the battle. “I’m ready to go home now.”

The Bucket List:

Sleep under the northern lights

Swim with sharks

Skinny dip (not with sharks)

See Christ the Redeemer

Bowl a strike

Go to every Disneyland once

Ride an elephant

Go to India for the colour festival

Win an escape room

Learn to whistle

Have a mud bath

Teach Charles to cook

Watch the Grand National horse race

Get a tattoo

Learn to use chopsticks

Throw beads at Mardi Gras

Have my palm read

Try absinthe

Ride a luge

Go to a rage room

Join the mile high club

Catch a fish

Make a will

Bathe in healing waters

Charles Leclerc - World Champion

Click here for the requested last day alive.

#charles leclerc fanfic #charles leclerc imagine #charles leclerc x reader #charles leclerc x you #tw: cancer #f1 imagine #f1 fanfic #formula one imagine #formula 1 fanfic #formula one fanfiction #f1 rpf

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celestialprincesse · 10 months ago

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simon reaction to anaemic!reader passing out??😢

Oh my love🥲🎀

Simon is already like helicopter boyfriend with anaemic!reader, he's seen how bad it affects their day to day life and is permanently trying to make things easy for them.

That said, he can't fix everything and sometimes anaemic!reader forgets to take their iron or it completely plummets when they get their period, don't eat well for a few days etc.

The moment they go a little pale, maybe sway on their feet a little, he's rushing to their side, catching them before their knees give completely.

He's got candy on hand, places them on the couch whilst he gets their supplements and a glass of water, or some sort of electrolyte drink, waits until they're a little more lucid to get a heat pad for the inevitable joint pains, asking whether they need him to call the doctor, book in a blood test or transfusion.

I need an anaemia support bf🫠

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doctorvictoria10 · 3 months ago

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Would you be able to write anything more about reader needing a blood draw or cannula please? Her feeling little/ regressing and the doctor being so understanding and comforting (instead of nasty). He uses numbing cream on her and has a bear for his younger patients he offers? Helps her off she starts feeling icky or sick.

Hey anon! Thanks for the great prompt. Here’s something just for you ��

Daisy’s blood test

Daisy sat in the cold plastic chair opposite the mahogany doctors desk. Behind it was a large black leather chair, and beyond that was a little window. She looked around the room anxiously, something she purposely had stopped herself from doing when she first was called in by the nurse. On the counters were boxes of sterile gloves, disposable medical equipment, cotton balls, tongue depressors, and even a clear plastic container full of individually sealed hypodermic needles. She felt sick. Her whole body pulsed with nervous energy, her heart was racing, palms were sweaty, in fact, everywhere was sweaty, she couldn’t remember when she last felt this fearful. She knew the likely outcome of the doctors visit - she knew from her own research of her symptoms that the doctor would probably take her blood and test her for anaemia, and that was honestly what she feared the most. Needles were always something that she had been fascinated with when she could watch someone else have them, whether it was via injection, an IV cannula or a blood draw. But when it was on her, something in her brain and body just lurched her full force into a puddle, no, a lake of anxiety, and as a result - her little space.

She tried to self soothe, she tapped each of her finger tips with her thumbs like her therapist had recommended, focusing on the sensation and regularity. It did nothing. Shit.

A gentle knock at the door had Daisy jumping out of her seat, she could feel her bare thighs under her skirt stick to it with the anxious sweat. The doctor stepped into the space, stethoscope around his neck, white coat and all. He looked young, she thought. Maybe late twenties, not much older than her. Her heart picked up even faster as he came closer and closer until he sat down on the opposite side of the desk. He smiled at her and logged onto his computer, clicking around pulling up her file.

“Okay, Daisy? What’s brought you in today?” He spoke cheerily. When she didn’t reply he glanced over at her. He was taken aback by her reaction to him. He hadn’t properly looked her over until now, and he saw what a nervous wreck she was. She looked clammy, pale, twisting her fingers in her hands and shaking slightly.

“It’s okay, Daisy. You can tell me.” He tried to sound reassuring, but she just burst into tears right in front of him. He was unsure for a moment on how to handle this situation, he hadn’t met Daisy before, knew nothing about her history and he felt it was inappropriate to start clicking through her file on a deep dive whilst she was sobbing in front of him. He clicked once onto her additional information page and saw the yellow triangle symbol. Little. His distressed patient was a little.

“Oh, sweetheart.” He began, standing up from his chair slowly so as not to startle her anymore. “It’s okay, everything is going to be okay. It’s pretty scary having to come to the doctors alone isn’t it? I can imagine you’re probably feeling quite overwhelmed right now.” He spoke so so calmingly. He perched on the desk in front of her, ankles crossed and arms by his side, trying to look non threatening.

“Daisy, can you look at me?” He asked, but she continued to sob. “Okay, that’s okay.” He knelt down in front of her. She couldn’t avoid his eyes anymore as he was probably only half a meter from her face. His eyes were dark but had a strange warmth to them, like cocoa. He smelt clean and like cologne, not like this sterile place.

“Just take some nice deep breaths. I’m not going to hurt you, you’re not in trouble. You’re safe here.” He spoke again in that calming voice. She tried to calm herself down the best she could. Embarrassment was now coursing through her veins at her uncontrolled outburst. She also felt frustrated at herself, she was going to try and make it through this appointment without dropping, and she hadn’t even spoken and she was deep in her little space.

“Mm…mmm” she whimpered, trying to form words. “I…. don’t… want a blood test.” She whined shakily.

His eyes softened even more. “And why do you think I’d need to give you a blood test sweetheart?”

“Because… I think I have ‘naemia.” She hurried out.

He smiled at her little pronunciation of anaemia. “Are you tired lots?” He asked.

She nodded shyly. “And my muscles ache! Fuzzy head…” she trailed off.

“Okay, little one. I think you’re probably right, you probably do have anaemia. But we need to check so we can get you on the right dose of medicine, okay?” He asked gently but firmly.

Chloe shook her head, fresh tears spilling. “But I don’t want a blood test!” She cried.

“I know you don’t, but it’s really not going to be too bad! I have special numbing cream so you won’t even feel it!”

“You do?” She asked sceptically. She’d never been given numbing cream before, and she’d felt every needle.

“I do! I also have a very special job for you.” He pulled out a big teddy bear from under his desk. “I need you to hold my bear! He hasn’t had many cuddles today so he’s a bit sad.”

Daisy reached out her arms for him. “That’s a good girl!” The doctor praised, passing her the bear and moving around to her side. “Can I have a look at your arm sweetheart?” He asked as he began turning her inner elbow to him.

“Gentle gentle?” She spoke in a tiny voice.

“Mm, gentle gentle!” He repeated. He felt her vein on her inner elbow, hummed and then took a pair of blue gloves from the counter and started pulling them on slowly, turned slightly away from his nervous little patient so she couldn’t see. When he turned back she was looking at him with wide eyes and her bottom lip was quivering.

“Oh Daisy, it’s okay. It’s not going to hurt, I promise! What I need to do is clean your arm, put this tight band on it, put the numbing cream on and then that’s it! Do you think you can let me do that?”

She shook her head before burying it in the bears soft fur.

“That’s okay, I’m just going to get one of my friends to come in and help us, alright?” He said as he pushed a button on the side. Daisy looked up to see another man enter the room. He wasn’t in a white doctor's coat, but pale lavender scrubs. He looked at Daisy with a soft smile briefly before turning to the doctor for an explanation or instruction.

“This is Daisy. She needs a blood test but she’s very very anxious of needles. She’s also a little. Are you able to help hold and comfort while I take a sample?” He spoke quietly, but it was loud enough Daisy could hear.

“Hold?” Daisy repeated, the panic in her voice was palpable.

The nurse stepped forwards. “He means cuddle! I see you have doctor's bear. If you cuddle him so he can be brave, then I’ll cuddle you so you can be brave!” He said it with such confidence that it almost made sense to Daisy.

“Mm, I’m really really scared.” Daisy confessed, although it was already obvious.

“I know you are, angel. But I help with lots of blood tests everyday, and I promise they’re not bad, and you’ve got the best doctor in the world. He’s very very gentle.” He comforted her.

She didn’t reply so he continued. “It’s very important we can test your blood. We don’t want you feeling yucky when we can easily make you better, hm? And I think you know that too, because you’ve brought yourself here.” He gently rubbed her back.

“Just, promise it won’t hurt?” She asked, her eyes wide and her cheeks tear stained.

“I promise! Now come and give me a big cuddle and it’ll be over before you know it.” He lifted her under the arms, she held onto him immediately and he smiled at the doctor, he knew they’d be fine. Whilst the doctor was busy preparing the equipment, the nurse arranged Daisy on his lap so she was mostly turned in towards him, teddy bear under her arm, one big cuddle.

The doctor walked towards the cuddle pile. “Okay Daisy, just taking your arm now, as the nurse said, this is not going to hurt, so you just keep having the best cuddle and we’ll be all done, okay sweetheart?” He spoke gently but firmly. Daisy nodded her head against the nurses chest, eyes tightly shut. He was broad and was such a good cuddler. He smelt amazing, clean like the doctor but there were other notes there, maybe cedarwood? Whilst she was in her own head, the doctor had cleaned her arm and was applying the tourniquet.

“Okay a little tight now. This makes it nice and easy for me.” He narrated. “And now the numbing. It’s very very cold but it’s going to make your arm all numb so you don’t feel anything, okay Daisy?” He began to spray her inner elbow and she jumped from the coldness. The nurse held her tightly against him, it was probably the best hug she’d ever had.

“Good girl Daisy. Good little girl.” The nurse spoke over and over as he rubbed her back and kept a tight hold of her. The doctor inserted the needle and she didn’t even flinch. Luckily it was only one vial of blood they needed today, so within a matter of seconds the doctor had his sample. After loosening the tourniquet and removing the needle he quickly applied pressure to the puncture site and taped it down. “All done, angel.” The nurse said happily.

Daisy looked down in disbelief at her arm. She didn’t even feel it! “What?? It’s done?” She spoke loudly and both the nurse and the doctor laughed.

“Yes! It’s all done. It wasn’t worth the tears was it?” The doctor winked at her. And she smiled until she saw the vial of blood on the side with the needle still attached. The needle that had just been in her arm. Yuck. She felt her tummy do a flip and that nervous feeling returned.

“Are you feeling a little faint sweetheart?” The doctor spoke but it seemed like he was far away.

“It's okay, I’ve got her.” The nurse said to the doctor. She felt herself being reclined in his arms, held like a baby while he gently rocked her through her fainting episode. “You’re okay little girl. Just give me some nice deep breaths. It’s going to pass soon.” His reassurance seeped into her and found her in her dreamlike state.

Suddenly something was prodding at her lips and she opened slightly, allowing the intruder inside. Her little side took over and she began to suck. Cool water filled her mouth and she swallowed. After a few moments she opened her eyes to see the nurse still holding her tightly, looking down at her with a reassuring expression. And the doctor also stood over her, mirroring his expression, and holding the baby bottle she was sucking from. Embarrassment washed over her, but then she felt so cared for and so safe.

“There she is, there’s our girl.” The nurse cooed. And the doctor removed the bottle, replacing it with a sweet lollipop.

“For our best little patient.” He smiled. “Feeling better now sweetheart?”

Daisy nodded shyly.

“I’m going to take you to the nursery so you can have a little relax before you leave. Do you have someone who can come and pick you up, angel?” The nurse asked.

Daisy nodded again.

“Okay, we’ll call them and have them come and collect you in an hour or two.” He stood up with Daisy in his arms and carried her effortlessly with the bear to the door. “Say bye bye doctor.” He encouraged.

Daisy pulled the lollipop from her mouth briefly. “Bye bye doctor” she mimicked before returning the lollipop.

“Goodbye sweetheart. I’ll schedule another appointment for a few days time when we have your results. Thank you for being so brave for me today.” He smiled warmly, and she blushed back at him.

The nurse carried her down the hallway and she fell asleep in his arms before they’d even reached the nursery. 🖤

#doctorvictoria10 #story #ask

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yellowbunnydreams · 1 year ago

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The Blood Runs Thicker (part 5) ~vampire!William Afton x F! Reader~

~So I've had a little think and a little looksie at how I want to maybe have this story play out and I have decided that whilst yes, William Afton in this is based off of Movie Afton, I'm going to mess around with some of the dynamics ect to produce what I feel will be a better story. Plus it's FNAF, when has the lore ever made sense?~

Tag-List; @ruh--roh-raggy @randymeeksisafinalgirl @sleepy---head @robin-the-enby @hungrhay @likoplays @slxsher-whxre @nicolezghostz

✧･ﾟ: *✧･ﾟ:* Want more or something different? *:･ﾟ✧*:･ﾟ✧

CW:Minors DNI, (18+ ONLY), Female Reader, legal age gap (Reader- 20's, William - 50's), graphic acts of violence, biting, knife-play, blood, blood-drinking/licking, mention of dead children, anaemia. Graphic description of injuries. The suit stays ON

Afton hadn't attempted to bite you for a few days. Although he seemed to notice your presence less and less each day also in a strange way. He still cooked for you and would force food and drink down your throat if you weren't compliant, and he did keep rebandaging your wounds. But it was like he wasn't all too bothered that you had begun to walk around his home, even permitting you to sit out on his porch for an hour of sunlight each day. Although you had noticed he wore sunglasses when he went outside in bright weather and seemed snappy and irritable afterwards.

You weren't complaining too much though, his demeanour had be wildly varied since you met him and in ways he reminded you of a large house-cat. Aloof to your presence and only appearing when it was time for food. Though where in the house he went during the time that he disappeared, you weren't sure and you didn't want to know. You had managed to secret away a pen and some sheets of paper that you found in a drawer, and you had began to write down things that you noticed simply by observing him, not sure what you would do with the collated information, but you had a feeling that you would need it at some point.

The first was that William moved fast. Preternaturally so. It wasn't like you blinked and he was there, but he certainly moved with a fluidity and speed that was above human capability, his muscles seeming to barely move as he walked and his steps barely made noise as he moved throughout the house. You had tested it once or twice over the days, testing his name at various volumes to determine what he could hear as well. Resulting in a few growled threats about wasting his time due to not needing anything major and making him move from where he had been.

He seemed to be able to hear if you spoke at a regular level even if he was downstairs or where-ever he disappeared to, but struggled with anything quieter unless he was on the same floor. Conversely, overly loud noises bothered him, leading you to wonder how he had managed when you screamed whilst being attacked.

As you padded downstairs, you decided to peer into the fridge whilst he wasn't around. Opening the box on the top shelf and finding it empty, you frowned and put it back. You could almost feel the weight of the bags under your eyes from a sleepless night, and your whole body felt like it moved sluggishly.

You weren't sure what time you had woken up, but a warm wet sensation against your neck had been what jostled you from sleep. Starting in the bed before a large hand had clamped around your throat and jaw, forcing your head away and for you to lie still. Heart pounding wildly in your chest as you felt William lick up your neck, his knees either side of your hips and his beard scratching at your skin, hearing the low growl in his chest as he pinned you like that for a while. Never biting, but seeming to taste your skin, his tongue almost becoming rough after the same pattern was traced onto the thin skin over and over again.

William was out of blood, and you were sure that the previous night had been a barely contained act of hunger. Perhaps there was something human holding him back from biting you, although you severely doubted it as your hand wandered up to your throat where you had some bruises from his grip dotting your jaw and a red mark across your throat from your shoulder to just under your ear. Shuddering as you thought about how much rougher he would be the worse he got. You hoped he would either bite you or go out and get some more blood soon.

Hearing a clunk on the table behind you made you jump out of your thoughts, turning around and seeing William lugging the hauntingly familiar Spring Bonnie head onto the counter. Your body trembling as you took a step back instinctually, not wanting to be anywhere near the thing as you recalled how the white eyes had bored into yours even as you screamed for mercy. Your hand moving to your leg and touching the now somewhat healed stab wound on your leg.

The action did not go unnoticed by Afton, glancing up at you and running his fingers over his slightly longer scruff. Lips curling into a cold smile as he picked up the head and walked over to you slowly, deliberately. Your body shaking as you tried to move backwards and get out of range, heart pounding faster and feeling your eyes watering as you felt the marble biting into your back. Letting him catch you and suddenly enveloping your head in darkness as he placed the head on yours.

"Aww, is the little bunny scared by a rabbit?" He teased, laughing at the oversized thing almost weighing your head down. It smelt like old iron filings and something organic, rotting mixed with moth-balls. You were sure in the low light you could see remnants of your own blood against the teeth of the mask from where he had initially bitten into your shoulder.

But you realised that the sound inside it was muffled, probably how he put up with the screaming. And that his vision was limited, only a letter-slot sized space visible through the teeth, as the eyes were too clouded and painted over to see through viably. And if the smell was heavy to you, you were sure it was almost overwhelming to him, unless he was blind to the stink inside, which wouldn't have shocked you entirely. You blinked rapidly as he pulled it off, your eyes watering more and tears spilling down your cheeks as you struggled in the change of lighting. His face was close, smiling wickedly as he leaned in, grabbing the back of your head and making you yelp as his long tongue raked up your cheek and followed your tears.

"Such a cry-baby. Don't worry blood-bag, this isn't for you today. Although I can only imagine how good you'll taste all filled up with adrenaline and fear." His voice low and gravelly before he released your head, looking at the bruises across your jaw with a satisfied hum before he glanced at your neck. "You should have heard the noises you made last night before you woke up, absolutely shameful."

You knew that you couldn't have made any, that you woke up as soon as his tongue touched your skin, but you couldn't help your cheeks flushing and feeling embarrassed that he could be right and that you had made some noise or movement that only encouraged the vampire and his appetite.

"Who's it for then?" You asked, watching him place the head back on the table and then bring up the torso piece, turning it onto its back and reaching inside with what looked like a deformed alan-key. Turning it in slow careful cranks as you heard the faint 'click' of things settling inside the suit.

"The new security guard at Freddy's, since you know, the last one just disappeared very inconveniently." William chuckled darkly, his eyes flashing as he looked up at you, making you swallow down the panic and bile in your throat and leaving an acidic taste in it's wake. "You'll be coming with me however."

"What, why? In case you need a little pre-murder snack?" The words slipped out of your mouth before you thought about them. William blinked up at you and laughed, a full bodied laugh that would sound perhaps pleasant, perhaps more like a middle-aged dad laughing at his kid doing something funny if there wasn't a tint of bitterness to it.

"Are you offering bunny? I don't take kindly to people offering things they don't end up following through on."

Placing the key down, he stalked over to you again, making your heart race anew and fill your ears with your own heartbeat. His head tilted to one side as his lip curled up and showed off those fangs as his jaw moved slightly. Every fibre of your being hated seeing those fangs, how animalistic they looked, two long and two shorter ones behind. They looked more like they were designed for ripping flesh from bone than they fit into a human mouth.

If you could call William Afton human anymore.

"W-Wouldn't want to ruin your appetite before hand!" You squeaked out as he reached arms length away from you, your hands raising up like they would be able to defend you should he come closer. The darkness remained in his expression, but he huffed and walked back around the counter, picking up the weird key item and going back to cranking whatever device was inside the suit to his satisfaction.

"I'll save you for dessert then."

Being back at Freddy's was surreal, and you felt somewhat disappointed in a macabre way that there was no pool of blood from where you had bled out, or even the furniture you were sure must have moved in all the fuss. Even passing by the security office, there seemed to be a new door on the hinges. It was like you had never been there, and what had happened to you never did.

William led you to a back room, which you realised is where he must have been hiding when you arrived for your own shift. Looking away as he checked the time and began to pull on the yellow rabbit suit with a practised methodology, making you feel sick as you wondered how many times he had put that thing on. How many lives he must have taken in it.

But you wondered why he was so attached to it.

In the room you noticed plenty of dusty boxes and old animatronic parts, before a flash of yellow in the far back corner caught your eye. Going over to investigate as William checked the sharpness of his blade under the low light, his glasses off and tucked into the bag he had brought with him to keep them safe. It was clear to you that he didn't really need them, he simply preferred to wear them, perhaps mimicking what he looked like before he ended up the way he was.

Creeping closer to the yellow, you could only see a little bit underneath a dust sheet. Carefully picking it up, you swallowed back a scream as you found a pair of empty sockets staring back at you. Realising after a few seconds that it was an animatronic bear, sat down in the corner and slumped, loose like it didn't have a skeleton to support it. The mouth slack jawed and you could vaugely see a patch along the jaw where the fur lining it was thinner and discoloured. Like somebody had scrubbed at it repeatedly and worn down the material. Looking back at William, you could see that the suit was a similar design to the bear on the floor. Making you wonder if this was a variant he hadn't used, or perhaps didn't favour, as it didn't have the wear marks that his did. Simply it looked abandoned.

And you couldn't shake the feeling that you were being watched as you covered it back up.

Turning around, William had opened a laptop onto the table inside the room, face intense as he looked at the screen, the light casting long shadows on his features and making his look gaunt. Hollow cheeked and sunken eyed. You could faintly make out that he was running his tongue against his teeth beneath his lip, hearing him sucking against them occasionally as you approached him.

He was watching security cameras, different to the ones you recognised from your time in the office. That's how he'd known where you were, what exits you would try. He knew this place like the back of his hand. The sinking in your stomach made you feel unsteady on your feet and you sat against the edge of the table, swallowing dryly as you tried not to think about him watching you. Not about the still slightly tender spot against your neck. Not about how many he'd lured here before you.

His hand against your thigh made your thoughts snap back to the present.

"You look sick. Don't tell me I've put all this work into you, just for you to get sick on me." He growled, barely taking his eyes off of the screen, perking up slightly as he watched the hunched figure with their hood up unlocking the front doors and entering the building.

"No sir, I just...I'm nervous being back here." Your voice soft as you felt him taking your hand and his lips brush against the still healing fang marks on your wrist, making you shudder as his warm breath followed.

"Oh bunny.... You don't need to worry about that... I'm going to enjoy tasting you as I stand over this guy's corpse, and hearing those little sounds you try so hard to hide when you feel my teeth in your skin." His tone was sickly sweet, honey like and thick where it made your head feel foggy. Your throat felt clogged at his words, like you didn't even want to breathe.

"Won't putting their blood in me make me sick? I-I mean, if you bite me straight after them?"

"Hm....Never thought about that, I suppose nobody's actually lived when I do it. Better hope you're a matching blood type, bunny."

He let go of your hand and left it feeling weirdly cold. Shivering as you realised your whole body felt like it was slowly being submerged in ice. Grabbing the sweater that he had given you to wear and pulling it on despite the oversized nature of it, tucking your legs into the stomach as you hoped you could maybe get warmer that way, considering that you were still barefoot and in shorts.

Suddenly Afton stood up, glancing at the cameras and grabbing the rabbit head, looking at you with a wicked smile.

"Stay here little bunny, hide away in your burrow until I come back for you." Licking over his teeth again before he placed the head on. Pausing as he clearly adjusted to the change in perspective, grabbing the knife from the table and opening the door slowly. Silently. Slipping into the hallway like a shadow despite the bulk of the suit and the man's raw size.

The room seemed to continue to drop in temperature, making you shiver more as you took a seat in the chair William had been in. Looking over the cameras and seeing the new security guard leaning back in the office chair. Arms crossed across their chest from what you could make out in the static filled monochrome.

But what caught your eyes were the animatronics on stage. Chica was looking at you, just like they had that first night in a way that made an icy finger slide down your spine. Catching a glimpse of William moving in the shadows around the stage, watching as the animatronics moved their heads in his direction briefly before they began to move around.

Again however, they kept glancing at the cameras you were viewing them in, and something settled in the pit of your stomach. It was an uneasy feeling, and you found yourself chewing your lip as you wondered what was happening. Apart from a vampire in a bunny suit running around and murdering anybody who came in.

"How long do you think it will last?"

You spun around, heart pounding as you swore you heard a voice in your ear. Quiet, barely above a whisper, sounding more like rustling wind than human, but something made your stomach turn again as you turned your attention back to the cameras. The hairs standing up on the back of your neck as you noticed Freddy and Bonnie staring into the camera. Bonnie's head tilted to one side, as if regarding you curiously.

"Why did she get to live?"

You stood up quickly, half expecting to see somebody stood behind you. Heartbeat filling your ears as you tried to place where the sound could be coming from. Swallowing softly as you moved to the door, making sure it was shut tight, in case it was the wind moving through the door and making your mind go wild. You were already anxious being there, scared even. The plummeting temperature and darkness making it all the worse.

"Hello?" You whispered, shoulders tense before you relaxed, not hearing anything in reply. Laughing quietly at yourself for becoming wound up, moving to go back to the chair when the sensation of somebody brushing past your back made you freeze and the sound of fabric rubbing against itself as it moved.

Looking around, you felt all the colour drain from your face as the blank eye-sockets of the bear animatronic stared at you from behind the shelf. The maw open as if in a mockery of a laugh, you felt as if it was staring at you, backing yourself into the wall and refusing to take your eyes off of it.

It had been in the corner, tucked away and clearly undisturbed judging by the dust on the cover. And the distance it had moved was not possible for being disturbed, not with it's head peering around the corner and looking at you like it was sizing you up.

"She doesn't have a choice." A slightly different voice whispered. You could hear almost a murmur behind it, like the other tiny voices where whispering with it.

"C-Come on out! Don't do this to me, please. Please I won't tell anybody!" You begged, feeling hot tears prickling at your eyes and threatening to spill down your freezing cheeks, body shaking as you kept looking at the bear. Flinching as you heard a muffled but loud 'bang' from within the restaurant, your head turning towards it and the cameras instinctually before you looked back at the bear.

Your breath caught in your throat and strangled a scream as the bear laid across the floor. Arms outstretched like it was trying to drag itself towards you, the top half of the head slightly off-set from the jaw and giving it that same open mouthed snarl.

You could now see a little purple top-hat ontop of the yellow bear's head. But you felt yourself sinking to your knees as the commotion outside continued and you felt like you were trapped in a perverse game of 'What's-the-time-mr-wolf' with an empty thing. Slowly making it's way closer to you every time you looked away from it. The tears spilt down your cheeks, and you let out quiet sobs, straining to not choke on your tears as it felt like your throat gummed up and made it impossible to breathe.

"Don't cry pretty lady."

"We didn't mean to make you cry."

"Who are you?!" You called out, sobbing harder. The voices sounded a little clearer, the space around you almost sub-zero feeling to your skin as you looked at the goosebumps forming along every inch of you.

"He did the same to us you know."

"William did?" You asked, feeling the air around you moving subtly, a tiny influx of cold and warmth that made you feel sickly. Placing your head in your hands for a moment before remembering the bear. Almost screaming as it was closer still, snatching your legs back as it laid at your feet, the articulate hand an inch away from touching you.

"We didn't know his name back then."

"Yellow rabbit."

"Be good, you'll get your dog back."

"Follow me."

"We can help you see miss."

"See what?" You asked, sobbing more as the noise outside continued. Wondering what was taking William so long to finish it and come back, even if he scared you, it was better than whatever was tormenting you in that confined space.

"Put on the head." The tiny voices spoke as if in union. Your hands reached out shakily after a pause. Feeling the cold air move from you as if it was a living thing as you did so. Body shaking as you stared into the empty sockets, taking a few deep breaths before you slotted the empty head over your own.

The lack of eyes inside it made it a lot easier to see out of. But it was like your vision went fuzzy. Blurred as the lifeless body of the suit laid before you like a sacrifice.

Then you spotted them,

Five tiny faces peering out from around the shelves, some with their hands gripping the edges as they looked back and forth between themselves and you. It was blurred though, vague shapes that you could barely make out apart from the fuzzy scarlet against each of them. Pouring down their fronts from places you couldn't see.

"She sees us."

"She's not like him."

"Maybe she can help?"

"Who are you?" You asked again, receiving a pause before one of the five stepped out from behind the shelf. Seeming to give a shy wave. Your hand automatically waved back, feeling stupid that you were probably waving to a hallucination.

"Can you please help my brother?" The small childish figure asked, you could make out what might have been a black and white striped t-shirt. You shrugged your shoulders, body still shaking as you tried to process it all.

"Who's your brother?"

"He's out there. He'll kill him if you don't help." The whispering sounded desperate, pleading with you. Like it was hoping you would agree. A sinking dread settled into your stomach as you realised that the apparition in front of you was talking about William killing the security guard.

"I'll get killed, I-I'm sorry but I'm not like William. I can't do what he does!" Your voice wavered, feeling a wave of sadness coming over you as you realised you were powerless again. You really were just a bunny hiding in it's burrow for the worst to pass.

"You just have to say his name." The figure came further towards you, and you felt fabric against your feet. The suit had moved a little further forwards as the thing approached, and you realised with a sob that it was a ghost. Moving what it could to reach out. Trying to contact somebody, anybody for help.

You couldn't help it as you nodded your head, and the mask toppled off, leaving you back in the dark with no sign of the child in front of you.

Your feet moved automatically, pausing as you encountered Bonnie stood in the hallway. The animatronic turning towards you with the soft whir of hydraulics and servos inside, hearing the faint 'click' as it blinked and the ears moved from side to side. One arm sticking out and seemingly sweeping wide to allow you to pass.

He made no move to attack you as you drew closer to the sound of fighting. The sound of William's modulated, gravelly voice snarling through the tiny speaker in the suit making the hair stand up on the back of your neck. But you kept pressing forwards. There was a name on the edge of your tongue, and you felt as if the eyes of the animatronics were something more as they watched from the side-lines. There was a sense of malice in the dining area. It was almost thick enough to cut it with a knife.

William clearly had the upper hand, furniture strewn everywhere and some of it broken in the scrap. You could make out dark splatters across once white tablecloths that you didn't want to look too closely at. A wet, meaty sound hitting your ears as you watched William sitting back on his heels for a moment. The front of the suit covered in darkness as you watched a hand come up from the floor, shocking you as it pummelled him straight on the chin. Making you flinch as the security guard and William began to brawl again.

It seemed like neither was coming undone without a fight.

You felt the coldness slipping at your side again, spurring you to spill the secret on your lips. Something that hadn't been uttered in a long time you felt. Sucking in deep breaths, it felt as if your hand was being squeezed between blocks of ice. Strangely comforting, despite looking down at the empty air before your attention was brought back to the fight before you. Hearing William swearing through the modulator.

"AFTON."

Your voice rang out, shaking, desperate and scared as William's fist connected with the security guard's face one more time before he turned his attention to you. Seemingly glancing down at the once-a-person mess underneath him before he stood up slowly. Taking the head off of his and revealing his sharp features.

He was sweating beneath the suit, something you weren't even sure he could do. His nose streamed with blood and when he approached, you noticed his lip as split too, the start of a swollen black eye forming that you wondered how the hell he'd managed to get through the suit before you saw the faint nail marks along his brown bone. The security guard must have reached in when he realised it was a person and inflicted some damage.

"Bunny, I thought I fucking told you to...to stay in there." He had to pause and take a shaking breath. You suddenly weren't sure that all the blood you could see glistening in the low light was the guard's. Taking a step back as he kept his limping pace towards you. "There's not a lot left in him, so I'm glad you got he....here. I'll still get to eat well tonight." He chuckled darkly, licking over his bloodied teeth, noticing that one of his fangs were gone. Knocked out by the torn gum you got a quick look at.

"M-Michael." You whimpered, William cocked his head to one side as he looked at you. Grinning as gooey strands of blood poured from his mouth and stained his greying beard red.

"What was that bunny? I didn't hear you."

A groan came from behind him, making William pause as you watched the shaking, bloody hand raise from between the turned over tables. Gripping tightly onto it as the security guard lumped himself onto the table, half slung over it. Hair matted against his scalp and face with blood, you almost vomited as you recognised that it wasn't the lighting making half of his face look slightly deformed and strange, but rather that it had seemingly been partly caved in. The whole body shaking as it spluttered, coughing up what looked like more blood that splattered across the ground. A flash of mangled teeth in the light as something akin to a gurgling chuckle came from it's crushed throat.

"I knew you may not recognize me at first but I assure you, it's still me.."

"Michael." You breathed, feeling your heart pounding as the almost corpse gave what you supposed was a smile, William turning on his heel and snarling, spittle dripping from his lip.

"Michael."

"Hello dad. Can't say I missed you."

#steve raglan #william afton #springtrap #steve raglan x reader #william afton x reader #william afton x you #fnaf movie #springtrap x reader #william afton smut #fnaf x reader #vampire william afton

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an-ruraiocht · 1 day ago

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reflections on hormones and medical misogyny and hoop-jumping

in order to start testosterone, i ended up having to pay i think £480 total for three (3) separate appointments with two (2) separate psychiatrists to admit that i'm definitely trans before i could get a referral to an endocrinologist which also cost me several hundred pounds so that they could prescribe testosterone. i was lucky that my GP did the blood tests or i would have had to pay for those too, likewise they took over the prescriptions so i only pay the £9.50ish charge for those rather than the full price, but it was still a hell of a lot of a cash to fork out. i had to pay all of this because the waiting list for a first appointment with the gender clinic is more than five years and bc they make nonbinary people jump through more hoops for referrals than they do for binary trans people following a more conventional transition path. they now test my blood every 3 months to make sure everything's at a healthy level and it's not having a knock-on impact on my organs and they check in regularly about dosage

when i was seventeen i had a single conversation with a GP after which they put me on the combined contraceptive pill, for which i never paid a penny, and which i stayed on more or less continuously (there was one break for a few months) until i was 28. for 11 years this altered my body's hormone levels to the point of suppressing my testosterone to the absolute lowest level that could be considered technically "healthy". it just about performed its required function of making my periods regular and semi-bearable, but along the way this fucked my joints, my muscle strength, my ability to grow body hair, my energy levels, and my ability to concentrate. for eleven years. on the basis of one appointment with a non-specialist as a teenager. they never tested anything except my blood pressure and even that got skipped as time went on and they could dismiss it as "nice and low" while ignoring my chronic anaemia and fatigue

why does fucking with my hormones in one direction require constant oversight and jumping through tons of hoops, and the other doesn't? why are they so alert to the side effects of gender-affirming care, and completely ignoring the side effects of other hormonal healthcare?

it's not that they shouldn't have prescribed me the pill or should have put additional barriers in place; it's that i shouldn't have had to jump through all those hoops to access testosterone. it's not that they shouldn't be monitoring the impact of the testosterone, it's that they should have monitored the impact of the pill. it's not that 17yo me shouldn't have been trusted to give informed consent, it's that 17yo me wasn't informed but was permitted to consent, while 28yo me was informed but not permitted to consent, and had to jump through dehumanising hoops instead to have strangers assess whether they deserved to make choices

they fucked me over with both sets of hormones. they whacked my body's hormone sliders firmly towards the oestrogen/progesterone ends of the spectrum without a second thought, because that was "natural", so fuck the side effects, but they made it as hard for me as possible to try to go the other way. i was anaemic and could scarcely grow body hair and had injuries that refused to heal for years and couldn't concentrate or stay awake for a DECADE but i'm supposed to be scared of the possibility of male pattern baldness? (i mean. i am. but going a bit bald feels a small price to pay for feeling awake when my eyes are open, to borrow a phrase from the raven cycle)

so much of it in both directions is medical misogyny: the idea that i have a particular body which is supposed to behave in a particular way and so the only "solutions" available are those which conform to this, and the lack of research into the actual effects of hormones like oestrogen and progesterone on other health conditions

but what really sickens me is how they say "you can't possibly make this decision, we have to keep people away from these side effects, we don't know what impact this has on bodies long-term" but they'll put a 17yo on the pill and then abandon them despite ten years of chronic illness with no further investigation into how artificial hormone levels might be affecting some of that chronic illness. you can't have it both ways, medicine. either hormones need monitoring and caring about or they don't

access to the pill is healthcare. it should be done on an informed consent model, and needs careful monitoring to make sure it's helping not harming, and adjustments if necessary.

access to gender affirming hormones is healthcare. it should be done on an informed consent model, and needs careful monitoring to make sure it's helping not harming, and adjustments if necessary.

instead you have to fight tooth-and-nail for one and pay through the nose for it, and the other distributed carelessly with little thought or follow-up. i am only now beginning to realise how profoundly i was being fucked over by the pill and just because it also helped me does not mean it was fine that that happened and that, crucially, nobody would have realised it was happening if i hadn't decided to go on T (prompting both investigations into my actual hormone levels, and then perceptible changes once they began to shift). because they did not give a fuck. because it was "natural" for a "female" body to behave like that, right?

anyway idk if i'm gonna stay on T forever but i don't think i could ever go back on the combined pill knowing what i know now about how it's possible for my body to feel when my T level isn't literally 0.5. i'm not thrilled about the idea of going for lucky dip hormone fluctuations given how well that's gone for me in the past but i guess i'll cross that bridge when i come to it. there's got to be some kind of viable option out there for me

#we shouldn't make it harder for people to access the pill but we SHOULD have more follow-up care and holistic approaches #we should make it easier for people to access testosterone while still having follow-up care and holistic approaches #i do not think 17yo me really gave informed consent and i think 28yo me was made to jump through too many hoops #these are tensions that i hold at all times #i don't think fucking with hormones should be taken lightly. bc they have a massive impact on your whole body #i do think too much attention is paid to some hormones and too little to others #we need fewer barriers and more care. not more barriers and less care.#body fuckery

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hearthotchner · 2 years ago

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for @my-mummy-dust

Just a quick little thing where the reader has a doctors appointment, something with needles (like blood work) and Aaron has to force her to go because she refuses bc ✨she passes out at the sight of them✨ so he’d have to deal with her passing out or something

“sweetheart, come on.” aaron softly demanded, tugging on your hand, pulling you into the reception.

reluctantly, you let him lead you in, and stood off to the side, while he spoke to the receptionist, asking about your appointment.

“i never should’ve told you.” you muttered under your breath, but it didn’t go unheard by your very loving boyfriend. raising his brows at you, “really?” he silently asked.

“aaron. you know how i feel about these things.”

he laughed, something he rarely did, when you worked. “yes, (y/n), i know, but just because you don’t like needles doesn’t mean we’re gonna avoid the doctors for the rest of your life, is it?”

you scoffed. “no, i’m an fbi agent.” you proudly admitted, “i’m not afraid of needles.” trying to convince yourself more than him.

“never said you were.” he teased.

“(y/n) (l/n)!” the nurse called out.

you swallowed nervously, while you and aaron followed her into the room. “dr. alexander will be with you, in a moment.” she said hastily, leaving before you could thank her.

aaron sensed your uneasiness, and intertwined his fingers with yours, lifting your hand up, so he could press a loving kiss to it. “hey, it’ll be okay, i’m right here with you.”

you heard the door click shut, when the doctor walked in, and greeted you, “hi, miss (l/n). today, we’ll only be taking a blood sample and running some tests, it won’t take too long.” all you did was smile and nod at her.

only the sound of the keyboard clicking filled the room, until she turned to face you, “alright, i’m going to take some blood out now, so if you could please lift your sleeve up for me.” she smiled, tapping your forearm. slowly, you pulled the soft, grey fabric up to your elbow, as the older woman turned around to grab the syringe she was going to jam into you soon.

your eyes widened, practically bulging out of their sockets, at the sight of the fine, pointed tip that glinted in the bright room, almost looking like it was taunting you.

you shot up. “no- i can’t do this-”

aaron also rose out of his seat, reaching out to you. and, your name barely left his lips, as you felt your eyes roll to the back of your head, and your body give out, falling into the arms of the man you loved.

—

groggily, you open your eyes, squinting at the overbearing bright white that surrounded you.

“aaron?” you mumbled.

“hi,” he smiled, you’d never get tired of waking up to the sight of him. “so, good news, honey, they managed to get the blood sample. now, we’re just waiting for your results to come back.” and his voice. you loved his voice.

groaning, you pushed yourself up on the examination bed, “yeah? how long did they say?”

“i don’t know,” he sighed, leaning back in his chair, after pressing a kiss to your forehead, “but, we would’ve been out of here sooner if you didn’t pass out.” he said, feigning annoyance.

“well, none of this would’ve happened if you didn’t drag me here.” you huffed, rolling your eyes.

“i’d rather me wait an hour at the doctors office, than have you with undiagnosed anaemia, angel.”

#aaron hotchner #aaron hotchner x reader #aaron hotchner fluff #request

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themultifandomgal · 1 year ago

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Will Halstead- Role Play

This was requested by @zaidatorcuatomorgado

I hope I understood the assignment as there is a slight language barrier but I hope you enjoy.

I’ve been training to be a doctor for the last year now and I’ve got an exam coming up. The only problem is I learn better on the job, not looking at textbooks. Thankfully my boyfriend Will has been helping me out. Right now I’m lying in bed while Will has his stethoscope around his neck

“Ok you have a patient come in complaining about pain all over there body, yellowing of the eyes and skin they also have frequent infections. What would your first thought be?”

“Well the yellowing of the skin can be liver cancer, but with the pain and infections I would be leaving to sickle cell anaemia”

“And how would you test for that?”

“I would do a blood test and a genetic test”

“Well done. Ok next let’s take your blood pressure” Will puts the cuff around my arm and turns the machine on “what’s the top number called?”

“Systolic number and the bottom is the diastolic number”

“Good. So your systolic number is 113 and your diastolic number is 72. Are you low, ideal, pre high or high?”

“Normal”

“Ok if your low, what can you do to help?”

“Get up slowly. Eat small meals but more frequently and drink more water”

“Your gonna pass this exam with flying colours” Will says helping me sit up “let’s get some food and we can continue to practice. You can even practice on me” Will wiggles his eyebrows

“I do like a man in a white coat”

“Oh really” he wraps his arms around my waist while I wrap my arms around his neck “maybe then I should wear my coat before bed”

“You telling me you have a doctor patient kink?” I say making Will laugh shaking his head

“I have a you kink”

“Eww” we both laugh heading to the kitchen and getting some lunch.

After lunch Will asks me if there’s anything I need help with

“I do need help with 1 thing in particular”

“What’s that?”

“Doing auscultations. I know what I need to look out for but the actual sounds confuse me”

“Ok well that’s something I can help with. Take off your shirt”

“Not the first time I’ve heard you say that” I laugh

“Won’t be the last. But come on if you want my help” I take my shirt off and Will places the stethoscope in my ears “ok ready?”

“Yeah” first I listen to my heart and describe what I can hear. Will then listens

“Your hearts racing”

“Always is when I’m with you” I then I listen to my lungs. Then he moves the diaphragm to my back making me shiver a little at how cold it is. I listen as I take in a deep breath. This goes on for the rest of the evening, Will helping me through more things my exam may cover.

The following day when Will gets home from work he notices my ankle looks swollen

“Hey go sit down for a minute”

“No it’s ok don’t worry”

“YN go and sit”

“Fine” I roll my eyes and walk over to the couch and sit down. He grabs a cushion and placed it on the coffee table then gently placed my foot on to the cushion

“What happened?”

“Must have gone over it or something. It doesn’t hurt”

“Will hurt tomorrow most likely. Let me get you some ice” Will walks over to the kitchen and takes out an ice pack and brings it over to me and places it on my ankle

“You need to be more careful”

“I know I know. Can you help me again later with my exam”

“Of course. Just rest up for now and I’ll get you something to eat”

“Thank you. I love you Will”

“I love you too”

#one chicago imagine #one chicago #chicago med imagine #chicago med #will halstead x reader #will halstead x you #will halstead x yn #will halstead #will halstead imagine

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queerstudiesnatural · 2 years ago

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being autistic is like. so nothing is ever going to be easy? it's always going to be this hard? no amount of medical appointments will ever make me better? my entire life i'm going to be told that it can't be that bad if i was able to get a job and get along with people and there's really not much they can do for me. that they can address the symptoms (depression, anxiety, etc) but i need to do a blood test first to see if it's not just anaemia, and have i considered that i'm just tired out from work? and i seem fine honestly it's probably not even autism, everyone gets a little bit overwhelmed sometimes. here, have some magnesium. if you eat more vegetables you'll be fine. there's nothing else we can do. my computer says you're not autistic because you were able to make friends and you show signs of empathy. no i haven't updated my autism research since 1996. you're making a big deal out of nothing you seem fine. we can't help you. you seem fine. we can't help you. we can't help you. we can't help you.

#guess who saw another doctor today #well she did diagnose me with depression which is something at least #but when i talked about autism and the possibility of it being an autistic burnout she was like #do you have friends? a job? ok then it's probably not autism #it could just be regular burnout why does it have to be about autism?#Because I Know Myself And It Is.#and the worst part is every time they ask me why i think i have autism i suddenly forgot all of the symptoms i'm just like umm i feel weird #next time i'm writing it all down beforehand so when they ask me i can just hand them the piece of paper #with all the (up to date) autism research and all the symptoms i have (which is all of them)#anyway i feel so defeated it's so hard to think that life is just never going to get easier #rain.stuff

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griddlebait · 8 months ago

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Will Harrow Ever get a blood test? She’s doing it anaemia-style 🩸💪

maybe in however many years it takes for palamedes to become a doctor or if she’s on death’s door

#asks #sckl #her stubborn ass is not going to the doctor (willingly)#she’s just liek me

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jcsmicasereports · 18 days ago

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End-stage renal disease patients developed left ventricular hypertrophy, Gezira State- Sudan by Dr. Nahla Ahmed Mohammed Abdurrahman in Journal of Clinical Case Reports Medical Images and Health Sciences

Abstract

Background: Left ventricular hypertrophy is the strongest independent predictor of cardiovascular death, and it is worsening in association with SCD. According to studies from the main international registers, cardiac disease is the leading cause of unexpected mortality in dialysis patients. Several studies have found that the prevalence of LVH is high among patients on maintenance haemodialysis, and that numerous risk factors linked with it, such as anaemia, hypertension, and volume overload, are common in these patients. Many clinical and nephrologist researchers are focusing their attention on the processes and factors that are present in these patients in order to prevent and regress the development of LVH.

Aim: The purpose of this study is to investigate the prevalence of left ventricular hypertrophy and associated risk factors among patients receiving routine haemodialysis at Gezira Hospital for Renal Disease and Surgery.

Method: This was a cross-sectional research with 70 patients receiving routine haemodialysis. Personal and clinical information was collected. The measurements included blood pressure, ECG, and echocardiogram. The concentration of haemoglobin was determined.

Result: Patients in the study ranged in age from 20 to 80 years old. Male made up 57 % (n=40). 75% of the individuals had LVH, with 68% undergoing echocardiography and just 7% receiving an ECG diagnosis. LVH affected 30 of the 40 male patients and 15 of the 30 female patients. Anaemia was detected in 44 (88%) of the 48 LVH patients with Hb12 gm/dl. In 74 % of the patients, systemic hypertension (BP>140/90mmHg) was present, and it was identified in 42 of the 48 patients with LVH. According to the evaluation, volume overload was evident in 63 % of the patients (32 out of 48 patients with LVH). The Chi-squire test was performed to determine the frequency and distribution of study participants based on several characteristics (age, gender, anaemia, volume overload, HTN, and dialysis duration) and LVH; the link between age and LVH, HTN and LVH, and DOD and LVH was statistically significant. P-values of 0.001, 0.013, and 0.005 were all significant.

Conclusion: We concluded that LVH is common among haemodialysis patients, and that there is a link between age, HTN, and DOD and LVH in this study.

KEY WORDS: Left Ventricular Hypertrophy, End Stage Renal Disease, Gezira State, Sudan

ABBREVIATION: CKD= Chronic kidney disease, ECG= Electrocardiograph, ESRD=End stage renal disease, Hb=Haemoglobin, HD=Haemodialysis, IVS=Interventricular septum, LVEDD=left ventricular end diastolic diameter, LVH=Left ventricular hypertrophy, LVM=Left ventricular mass, MRI=Magnetic resonance imaging, PW=Posterior wall.

Introduction

When kidney function declines and renal replacement therapy is required, the heart and vascular tree undergo major structural and functional changes, and the prevalence of cardiovascular disease is higher than in the general population (Usrds, 2017), with 40 % of all deaths in patients with end-stage renal disease (ESRD) due to cardiac causes ( Steddon, S, 2014). Left ventricular hypertrophy (LVH) is a typical indication of cardiac structural disease in ESRD patients, defined as an increase in left ventricular mass (LVM) due to increased wall thickness. Anaemia, hypertension, hypervolemia, and mineral metabolism problems are all linked to a loss in renal function, which increases the risk of LVH (McCullough et al., 2016). The researchers discovered that the strongest independent predictor of cardiovascular mortality in patients with chronic kidney disease is LVH (Shlipak et al., 2005), and that worsening of it is associated with SCD in haemodialysis patients (Kim H et al., 2015), which is a major cause of mortality in these patients (Paoletti et al., 2004). In individuals with chronic kidney disease (CKD), the prevalence of LVH is around 40%, and it increases with CKD progression until it reaches 75% in ESRD patients (McCullough et al., 2016).

Chronic kidney disease CKD is defined as kidney damage or a GFR of less than 60 mL/min/1.73 m2 for at least 3 months and is divided into five stages ('K/DOQI clinical practice recommendations for chronic kidney disease: evaluation, classification, and stratification, 2002). Left ventricular hypertrophy LVH, reduced LV function, regional wall motion abnormality, pericardial effusion, and valvular calcification are among the anatomical and functional cardiac abnormalities seen in ESRD patients. LVH is a common complication in ESRD patients and is a preventable risk factor (Charytan, 2014). HTN, vascular calcification (Nitta et al., 2004), anaemia, and volume overload (Vaiinien et al., 2017) are all risk factors for LVH in ESRD patients. The prevention or regression of LVH was achieved with early and effective management of these risk factors (Kim et al., 2015; Erdan et al., 2018).

LVH was caused by a variety of pathophysiologic variables in CKD and ESRD patients, who were categorized into three groups (Ritz and Wanner, 2008):

Afterload: an increase in systemic arterial resistance, raised arterial blood pressure, and impaired large-vessel compliance, which necessitates a rise in intra cavity pressure during ventricular contraction (Mominadam et al., 2008).

Preload: a condition caused by intravascular volume expansion (salt and fluid loading), anaemia, and an AV fistula (Di Lullo, et al., 2011; Cuadrado et al., 2004).

Not related to afterload or preload.

Arterial hypertension and poor control of blood pressure is the most common cause of chronic pressure overload of the left ventricle and cardiac adaptation in response to chronic pressure overload is LVH (Sweety et al., 2014).

Renal dysfunction and poor cardiovascular prognosis are linked to the coexistence of anaemia and LVH (Chang et al., 2014). Non-hemodynamic and hemodynamic adaptations are used in anaemic persons to maintain adequate tissue oxygenation. Increases in erythropoietin synthesis and intra-erythrocytic concentrations of 2,3-diphosphoglycerate (2,3-DPG) lower the affinity between oxygen and haemoglobin, resulting in a shift to the right of the oxygen haemoglobin dissociation curve (Oski et al., 1971).

When compared to conventional haemodialysis, short haemodialysis reduces LVH due to proper fluid control (Ayus et al., 2005), and intensive HD (McCullough et al., 2016). While frequent haemodialysis resulted in LVH regression (Trinh and Chan, 2016;Chan et al., 2018). In comparison to traditional haemodialysis, the improved clinical outcomes resulted in a higher frequency of vascular access procedures complications (Slinin et al., 2015).

Despite the numerous research that have been conducted to improve the quality of haemodialysis, it remains a complex procedure that necessitates a coordinated effort from your entire health-care team, including your nephrologist, dialysis nurse, dialysis technician, nutritionist, and social worker.

Diagnosis of LVH is by

ECG: This is the first non-invasive test, although it is less sensitive in diagnosing LVH (Vanezis and Bhopal, 2008), and there are various criteria for diagnosing LVH:

Limb lead voltage criteria: R in a VL > 11 mm, R in a VL > 13 mm if left axis deviation is present, and S in L III > 15 mm if left axis deviation is present. >25 mm R in LI + S in LIIII

Sokolow-Lyon criteria for chest lead: S in V1 + R in V5 or V6 >35 mm (Sokolow and Lyon, 1949).

Romhilt-Estes criteria: deep S in V1/V2 and tall R in V5/V6, with the aggregate of both exceeding 7 large squares or one of them exceeding 5 large squares (Romhilt and Estes, 1968).

Echocardiography: is a more sensitive and specific method of diagnosing LVH than an ECG. ECG criteria must account for ethnicity in people of African descent (Vanezis and Bhopal, 2008), and they must be correct in patients with HTN to rule out LVH (Pewsner et al., 2007). Left ventricular mass (using the Troy formula according to the American Society of Echocardiography ASE recommendation):= 1.05 (LVEDD+IVS +PW)3 LVEDD3.

The LVMI is calculated by dividing the LVH mass by the body surface area. LVH was characterized as an LVMI of greater than 150 g per m2. (from the Framingham Heart Study) (Armstrong and colleagues, 2014).

MRI: is the gold standard for assessing left ventricular mass, cavity volume, and pattern of LVH, whereas M-mode echocardiography (ECHO) overestimates LV mass in haemodialysis patients when compared to CMRI (Ebeid et al., 2017)

ESRD: but they are not commonly utilized due to cost and lack of availability. In practice, echocardiography is a good all-around instrument that is well-suited to long-term research studies.

Sudden cardiac death is the most prevalent cause of mortality in dialysis, accounting for 40% of deaths, most of which occur in the first three months of dialysis due to difficulty adapting to the cardiovascular stress that is characteristic of dialysis. And it could be due to LVH after a period of acclimatization. LVH is becoming more common among ESRD patients, particularly those on haemodialysis. It is also one of the most common causes of mortality among such patients. Many risk factors for LVH in such people could be treated to reduce the prevalence or regress LVH, and thus the risk of death. As it stands, diagnosis is not difficult and can be accomplished using less invasive techniques such as echocardiography and ECG.

MATERIALS AND METHODS

Study area: The study was conducted in Gezira hospital for renal disease and surgery- Gezira State- Wad Madani Central Sudan, which service the Gezira and whole nearby areas.

Study design: In Gezira hospital for renal disease and surgery, a descriptive, cross-sectional study was done among haemodialysis patients.

Study population: The study comprised 70 patients on daily haemodialysis, both male and female, ranging in age from 20 to 80 years. Each of the patients in this study dialyzed twice a week at the Gezira hospital for renal disease and surgery. Time and duration of dialysis, symptoms of volume overload, blood pressure, and lower limb oedema were among the personal, demographic, and clinical data obtained. The concentration of haemoglobin was determined. In patients with patent arterio-venous fistulae, blood pressure was monitored in the contralateral arm with a mercury sphygmomanometer. Standard limb and chest leads were used, with a paper speed of 25mm/s and a gain of 10mm/mV (or 5mm/mV). Sum of S wave in lead V1 and R wave in lead V5 or V6 35mm and/or R wave in lead aVL 11mm was classified as Sokolow-Lyon LVH. A physician performed the ECG interpretations. IVS, LVPW, LVEDD, and LVESD were measured using M-mode echocardiography and 2-dimensional ultrasonography.

Haemodialysis: The blood is filtered and cleaned out of the body, then reintroduced to the body in this operation, three times a week, for 4-5 hours. which has been used to treat advanced and permanent kidney failure.

Inclusion criteria: All patients who receive regular haemodialysis are eligible.

Exclusion criteria: Patients with established congenital heart disease or a history of heart disease, diabetics, and hypertensive patients prior to dialysis are also excluded.

Data analysis: The data were analysed using statistical package of social science (SPSS) version 24 .

Ethical consideration: All participants in this study were fully told about the study's goal and were promised that any personal information regarding their health status would be kept private.

Ethical clearance: Ethical clearance was acquired from the Gezira university faculty of medicine's ethical committee. Permission to conduct research in the Gezira hospital for renal disease and surgery from the director.

RESULTS

This study included 70 patients on regular haemodialysis in Gezira hospital for renal disease and surgery, including 40 males and 30 females ranging in age from 20 to 80 years. The Chi-square test was performed to determine the frequency and distribution of research participants based on various characteristics. At 0.05, the P-value is considered significant.

There is a significant relationship between duration of hemodialysis and LVH P value (0.005 )

DISCUSSION

Many risk factors contribute to the prevalence of left ventricular hypertrophy in CKD and ESRD patients, which has encouraged clinical nephrologists and researchers to focus their attention on processes and factors that are present in these patients for many years. LVH, which worsens with SCD in haemodialysis patients, is the strongest independent predictor of cardiovascular death in patients with chronic renal disease (Shlipak et al., 2005). The goal of this cross-sectional study was to find out how common LVH is and what the risk variables are among haemodialysis patients.

The main conclusion is that, 68 % of patients had LVH, accords with Foley et al, 2010 who found that LVH was present in 62 % of the study group, implying that the prevalence of LVH is dependent on the degree of renal impairment (Amoako et al., 2017). The current study found no statistically significant link between gender and LVH (p= 0.141), in contrast to the study of Amoako et al. and Paoletti et al., 2016. The link between age and LVH was confirmed in this investigation, with a substantial rise in patient age (P-value 0.001), which was constant with previous findings of (Paoletti et al., 2016).

The drop in haemoglobin concentration begins at levels of creatinine clearance of around 70 ml/min in men and 50 ml/min in women (Hsu, et al., 2002). As a result, the majority of ESRD patients suffer anaemia. In the current study, 88 % of patients have anaemia, defined as Hb 12 mg/dl, with a P-value of 0.512. Many studies have found that a haemoglobin level of 12-13 mg/dl in ESRD patients is related with a better outcome (Regidor, 2006), while a higher haemoglobin level is associated with a higher risk of mortality and arteriovenous access thrombosis (Phrommintikul et al., 2007). The goal haemoglobin level was not reached in the majority of patients due to poor management, blood loss in the dialyzer, and repeated blood sampling, however the basic underlying issue is erythropoietin insufficiency. Sweety et al. (2014) found an association between anaemia and LVH. Anaemic patients have insufficient tissue oxygenation, which is compensated for by increasing blood volume, resulting in an increase in left ventricular mass and assuming an eccentric geometry LVH (Metivier et al., 2000). This finding was consistent with our finding of blood volume in 42 of LVH patients, which was confirmed also by Nasri and Baradaran, 2005. Moreover, their study was confirmed our findings that 40 participants with hypertension had a significant connection between HTN and LVH with P-value of 0.013. Because volume overload is the most common cause of hypertension in ESRD patients (Bellizzi et al., 2006), insufficient clearance of this excess fluid leads to resistant hypertension (Fishbane, et al.,1996). The target blood pressure for adults with CKD is 130/80 mmHg, and for hypertensive individuals without target organ damage is 140/90 mmHg (Chobanian et al., 2003). However, this aim is not met in most patients, resulting in chronic pressure overload of the left ventricle and LVH.

When it comes to volume overload, 15% extracellular volume overload equates to around 2.5 litres of extra fluid in an HD patient (Wabel and colleagues, 2008). As a result, total fluid evacuation during dialysis may not be completed, and normal fluid status may not be achieved even immediately after dialysis. We discovered that 62% of patients were overloaded based on clinical assessment and the presence of lower limb oedema, and that 32 out of 48 patients had LVH (presence of lower limb oedema and shortness of breath does not indicate haemodialysis patients have LVH), but there was no significant relationship between volume overload and LVH P-value 0.238. While Unver et al. found a substantial positive link between hypervolemia and LVH in a study of 97 patients on regular haemodialysis (Unver et al., 2015), and that the presence of lower limb odema and shortness of breath does not mean that haemodialysis patients had LVH. Observational studies have shown that more frequent or longer haemodialysis sessions are associated with proper fluid management and a lower prevalence of LVH (Ly and Chan, 2006). However, another study found that more frequency and longer dialysis did not improve clinical outcome (Slinin et al., 2015).

Significant connection between haemodialysis duration and LVH was found in this study, with P-value of 0.005. Because all patients in this trial have just two- four hrs. sessions per week, they will not achieve their dry weight and will stay hypovolemic even after dialysis, as their Intera-dialytic weight gain will be more than 3 kg between sessions. Foley et al. (2010) investigated whether the incidence of LVH correlates with the length of dialysis in 596 incident haemodialysis patients with no prior history of heart disease. According to the study, 62% of the patients had an elevated LV mass volume index, and 49% of them developed overt LV failure.

Conclusion

We concluded that LVH is common among haemodialysis patients, and that there is a link between age, HTN, and DOD and LVH in this study.

RECOMMENDATION: • Follow up with a nephrologist and a nutritionist on a regular basis to ensure adequate anaemia management during the pre-dialysis phase and after the start of haemodialysis, as well as blood pressure control and prober volume management.

Before starting haemodialysis, all ESRD patients must have an echocardiogram to see if they have LVH and be treated as high-risk patients.

ACKNOWLEDGMENTS: Our best regards and thanks to the staff member of Gezira Hospital for Renal Disease and Surgery , and our appreciate is extend to the patients who participate in this study.

#cardiovascular death #cross-sectional research #Gezira State #Sudan #Left Ventricular Hypertrophy #End Stage Renal Disease #jcrmhs #Clinical Images submissions #Clinical decision making

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