#but i really fucking hope that may 1 is considered 60 days in advance of july 1 and not a day too late

[onesweetbeautifulsong]

really fucking bold of my apartment complex to say you HAVE to hand in a physical written notice in order to move out and then to not have anyone in the goddamn office all day AND not answer the phone

[blizzardfluffykpop]

The Bet

Summary: Kiss me under the mistletoe let’s get that dough.

Oneshot

Mark Tuan X Reader

Not Requested

Prompt: 1. “I bet you can’t make that girl/guy, kiss you under the mistletoe before the end of the night”

Christmas seemed to get more and more boring with each year but when you had friends like I do and clubs that stayed open on that day, it seemed to not matter anymore. I get dressed up, looking nice, to have a few of my friends pick up. We danced for a while, before going up into the VIP booths, and talked about things, everyone but me and the designated driver drinking. Margret fully drunk at this point, not one with a very high alcohol tolerance, but drinks more than all of us do bets me:  “I bet you can’t make that guy, kiss you under the mistletoe before the end of the night” While pointing at the guy, she was talking about, I glare and say, “How much you bet?” “I’ll bet you a hundred” We shake on it and we put it on a napkin so she can’t bail. 

The joke was on her, I’ve known this guy for a long time. We were childhood friends and looking at him now, he looked stunning in that suit. Dancing the night away, when I come over to him and exclaim, “Hey Mark! How has life been?” “I didn’t expect to see you here tonight.” “There’s a lot you don’t expect from me isn’t there~,” I say in a teasing tone, and I continue, “Let me get to the point, you see my friends up there made a bet that I couldn’t kiss you under the mistletoe before the end of the night… And they bet a hundred on it, and I’ll split it half and half with you-” He shrugs his shoulders and tells me, “Well, what are you waiting for?” “Well, can I try to court you?” “Try? I think you already have over the years” That leaves me in shock, “You mean to tell me you liked me after all these years-” He shrugs again, “Yeah, why wouldn’t I? Does this come as such a shock?” Shaking my head rapidly, “I had the biggest crush on you throughout high school, and you didn’t even think to look at me twice, back then” He sighs looking down at his feet before looking back up at me intently, “Well, I was kind of busy making out with Jinyoung to get over you, or at least make you jealous, and try to rile you up so you asked me out… Neither worked” Groaning, “Fuck I wish I knew that sooner, I would have asked you out way sooner.” “Well, what do you say, you take me out on a date after we kiss under the mistletoe, and get that dough?” 

We move over to a branch of mistletoe, and Mark takes the lead, dipping me and kissing me on the lips. Making out for a while, we start slow dancing, I giggle with him. As we twirl around for a bit before, I say I'm going to go get the money, I kiss his cheek and leave; "I can't believe you did it" as they hand me the hundred. I smirk, "Next time, don't pick someone I know" my friend gaps at me like a fish out of water. I sprint down and over to Mark and we go out for the first time, as lovers. 

You see I've loved this man since we were in high school, we lived across the street from each other, our parents always saying how cute we would be together. Once, we became close, they had thought anytime now one of them was going to fall for each other. And this whole time he liked me back, and I simply can't stop thinking about that. The moment I realized how I felt was when I had gotten into a wreck. I called him and he was down there in minutes consoling me, and I notice how much he cared for me. Considering I was on the opposite side of town, and it should have taken thirty minutes to reach me from his house. He only took five minutes, which he claims was because all the lights were green. Considering it is mostly stop signs, and 25 miles per hour through the streets. I don't think he stopped at any, by the time he was there and holding a shaking crying me. To find out he loved me all that time, makes sense because what sane person would disobey every traffic law if it wasn't because of someone they loved. 

Turns out almost everything is closed on Christmas we were about to just go to one of our houses and make dinner when we see a little restaurant opened. The neon letters, barely noticeable, they were probably haven’t worked on since they were first opened. We rush over, and he opens the door for me, "My love" I roll my eyes, winking at him as I walk through the door. The black and white tiles and the cat clock giving the vibe of the 50s, everywhere you looked was a new decade. The jukebox playing 60s music, the chairs look to be from the 90s. But it all felt so right, and so homey, in a weird way. We sit in booths that seemed to come right out of the movie Grease. An older lady comes out on roller blades, gives a menu and rolls away. I look at Mark, this place is so weird but yet so cozy. As the lady comes back, "Sorry I had to deal with an old friend. What would you two cuties like?" We blush before I could answer Mark says, "A monster chocolate milkshake, two straws please" She smiles at us, "Anything else honeys? Or would you like more time?" I politely ask for more time, and she smiles and rolls away. 

After we order, I casual place my hand on his, he grins at me before intertwining them. "I can't believe we waited this long" He smiles, "Yeah me neither, it seems like yesterday I was fantasizing that you were taking me to prom instead of Jinyoung. Yeah, he was a prince, but he wasn't you." He tells me softly, "I wish I had known Mark, I would have danced with you all night long that night instead of him." He kisses my hand, and I continue to speak, "I'd say we both waited too long, but why talk like that. Because you're going to be stuck with me even longer." He laughs and I slightly chuckle, and we both take a sip from our chocolate milkshake. The little old lady comes out with our food, and she asks, "If you don't mind how long have you two been together?" I look at him before I answer, "Well, officially it's our first date. But I've been in love with him for a long time" he squeezes my hand, "I've loved them longer-" "Nuh-uh" "Yeah-huh" she chuckles, "I hope this is the first date of many! You seem to both be a perfect match for each other, my mother used to tell me when two people are meant to be you can see a heart shape form around them, and I certainly see that with you two. This is a strong bond, yeah you may lose faith in each other, but it's a choice to find that faith again. And I believe you two can do it." And with that, she's gone, again. It seems she likes that gone with the wind idea. 

Our hands intertwine while we eat, not much conversation, my thoughts clouded up in her words. Love is a choice, not a feeling, you have to choose to look in their eyes and find the stars not just wait for them to appear. I have faith we can do it too if we waited this long we can hold up with each other. It's only been a few hours with him as an official couple… but it feels as though we've been together forever. Looking in his eyes I see the stars, and I hope he sees the same in mine. 

Little did I know is that he sees the whole universe and then some in my eyes. We start talking about meaningless things, "Do you wanna spend the rest of the night at your house or mine?" "I don't think you want to see my roommates mess, because I have to tell him three weeks in advance because he's a messy individual…" "It’s your dog isn't it?" He laughs and nods, "Yeah, that lazy bum never cleans." "I think the owner might be the lazy one" He rolls his eyes, "Yeah, but you still love me right?" I laugh, "Sadly" he kisses my hand again. 

She comes out with two big slices of chocolate cake, "It's on the house, you two remind me of my wife and me in the old days. Here's your check, and meet me at the counter when you're done" We thank her, digging in, "Man she's so nice, can we come here again?" I ask, "Anytime babe." I grin as I finish, rushing to pay, because I know he'd tried to pay for us like he used to every time we went to the café to study and we got treats. Its payback time. He grumbles at me, "You took my turn" "I've never gotten a turn, it's only fair" He pouts, as she gives us our change. "You kids are too cute, I hope I see you two soon again!" We tell her we will, thanking her again and walking out with big smiles on our faces. He takes my hand and intertwines our fingers, "So how is the pizza job going" "Strong, I'm the manager there… and I'm planning to save up enough money to buy the shop across the road to make that flower shop I used to always talk about." "Really? Wait is it the building right there?" I nod with a smile on my face, "Oh I was planning on making that a mechanic shop" I stop turning to look at him, "Well how about a flower shop in the front and a mechanic shop in the back? We'd make a fortune… with people usually needing to get their car fixed up, sees flowers that would make their significant other feel loved… they buy it while they get their car fixed. They fix up both their love lives at the same time. Their baby, the car is all fixed, and their romantic relationship or platonic relationship is fixed too." He kisses my forehead, "I knew there was a reason I fell for you… you always have the greatest ideas"

--

Needless to say, we bought the shop together, I quit my job at the pizza place becoming full time at my flower shop. Teaching Mark about the types of flowers and meanings, as he teaches me how to rebuild a motor which consists of the engine and transmission. 

We live above the shop now, him coming home with grease on his face, and his coveralls dingy, throwing them into the laundry. His white shirt and blue jeans still are the death of me after all these years. Or if I come in later after consulting a client on which flowers would better suit their needs. Which meanings are what, those orange lilies are not so nice especially if you want to live with them for the rest of your life. With dirt splashing the sides of my face, and soil caked under my nails. Even after the long days, we still find ourselves collapsing on the bed to talk, and hold. One of us being shooed off to take a shower, because the other one just got clean and doesn't want soil/grease all over them. 

It's been a while since then and every month we go to the restaurant, called Loving, it was named after her wife, whose last name she took. It's our 3rd anniversary we go there when she smiles at me and winks. I cock my eyebrow up at her, she became our grandmother, so if we ever need advice we come to her. So it's no surprise she would know something before me. 

We sit down eating a special that Bibi cooked up for us, certainly not on the house anymore. But a bit cheaper, since we're veteran customers to this place. I get up and flipping through the songs to find Marvin Gaye's song How Sweet it is to be Loved by You I turn it on and twirl and start walking to our booth to see Mark on one knee, "Did you lose a pen baby?" I ask rushing over, going to help find whatever he lost. When I look down as he shakes his head, "No,... but (Y/n) would you do me the favor, after all these years, be mine…" Before I can answer, he goes on, "I thought long and hard on how to do this, we had talked about getting married before, but I had no idea how to propose to you. So after long talks with Bibi, I decided to do it here. Where our first date took place, where we made it official, where I decided that from then on out that I was going to be there for you 110%. That every day from then on I looked at the lover of my dreams. The one who I knew deep down inside I wanted to spend the rest of my life with, but it was finally becoming true. That when Bibi told us that we were meant to be my heart soared and still hasn't come back down from that high… that I want to make it official with you, I hope it isn't too soon. And if you need more time-" "Mark please stop right there, I've talked to you about marrying you a lot, because I have wanted to spend the rest of my life with you for a long time, and you're truly the man of my dreams. Nothing you can do that can change that. Now the only thing I can see that you lost is your ability to marry anyone else." He slides the ring on to my finger, "That's not a loss for me…" He pulls me in and kisses me deeply just like he did that night at the bar. Bibi comes over, "You're grossing out all my customers-" "There's no one here but us-" "Well, you mushy gushy kids, are grossing me out. I better be the maid of honor. Or so help me, Mark." We laugh at her as she sticks out her tongue. 

To say the least, Christmases with him, became less boring, he made me feel something for the holiday again, and it made me feel so good. Our first Christmas together as a married couple was weird because it was still objectively the same, but the wedding photos decorating our mantle surrounded by garland was different. And yes, Bibi was the Maid of Honor, to clear up any questions about that. It felt like I’ve been married to him a lot longer than that, he never fails to surprise me. I wake up to him coming into our bedroom with Hydrangeas and Carnations, I giggle our first anniversary together as a married couple is what the carnations resemble, while the Hydrangeas resemble our fourth anniversary together. Lasting vows and joy for years to come the Carnations scream; appreciation and gratefulness for the two of us being together, the Hydrangeas. “You’re probably asking yourself, how does Mark know what flowers to get? Well, its simple I listened to you and I also asked Bibi for help” I laugh, hands gesturing for him to come here, I have a vase strategically placed on our bedside table and carefully place them there. Pulling him to my arms, kissing his nose, I reach behind my head, underneath the pillow where the box laid thankfully unharmed. “Bibi and I went shopping for hours for the perfect gift for you. And I don’t know if you’ll like it or need it, but this for you”I say handing him the long but small in width box, “Babe, anything you get me, I’ll like and you know it” He carefully unties it and pulls it up, and it’s a long silver tire gauge with the words engraved on it, ‘I love you, but the tires are low on my car’ He looks over at me with a laugh, and kisses me, “Thank you, I’ll fix the tires tomorrow, but would you mind spending all day in the house?” I nod, and he places the tire gauge on the nightstand and wraps his arms around me, as I wrap my arms around him, “Merry Christmas, Flower” I look up at him, “Merry Christmas, Grease” He rolls his eyes at me, and pulls me closer into him, my arms wrapping around his torso with ease and we fall back to sleep together.

[abhisheksingh098]

SAIYAN RAP CYPHER - Lyrics | FabvL

SAIYAN RAP CYPHER - Lyrics | FabvL

SAIYAN RAP CYPHER | FabvL ft. RUSTAGE, Daddyphatsnaps, Dan Bull, NerdOut & More [Dragon Ball] 

Joey Nato:- Ayo, you know what's crazy? I learned that me and that dude Gohan got a lot in common Nato, all the haters that tried me will be first to tell You that you won't get buy me with a perfect sell 'Cause I'm married to my goals like my goals Videl My father taught me how to win, but I learned to fail And pick a low in my life, any low I've had Was in the pickle low key, but the key was fight back Even when I was a teen, I would know I'm bad The way I killed a 16 would make Gohan snap Look, legend in the making, can't stop my story And if a Sensu bein' a little hostile towards mе I'm a power up quick and deliver that fast pain Thеy Saiyaman only as good as his last game I heard you pack a punch, but I guess none landed Dummy, you should know I'll beat you one handed And if you mess with family, take a guess what we'll do We won't wanna fight you, nah, we'll wanna kill you, Nato Dreaded Yasuke:- See me walking in the public Sporting the green and black armor on Bandana with the blood drip I was considered low budget Look at me now, fighting the crowd, take you all by the dozen Judging my exterior, I'm raising my thermals Thinking I'm inferior, making ya soul furlough Beat you down thorough Hoping you can manage my final spirit cannon and make ya blood curdle This the time to panic When you see the golden hair, even battle damaged I give you a thousanf-yard stare Not gonna be fair when I start feeling my rhythm You should be scared, ya blood staining your denim Standing there thinking how did I get my momentum? And will be passing down, cause of nepotism Super Saiyan ain't nothing to playing with Enemies don't gotta chance, even when I show them the tip Dan Bull:- Ay, what you bringing? What you saying? I'm the king of the Saiyans Someone from the southern U.S.A., would say I'm advanced Solving the toughest puzzles There must be tuffles living in my brain Still ruling my people, I don't really care what Frieza claims King Vegeta's staying, like a Fajita stain Firing execution beams and heaps of Ki in waves I've seen regimes and seasons change, how could it be the same? You keep on feeding the flames, you're going to free this ape Vegeta's ancestors stand the test of time I guess it's down to diet, genes and some exercise Best alive 'till my son took the crown Now I rest in the sky up above trunks looking down There's a bright future ahead of him, like every parent's hoping for I might have met my descendents if I never had that broken jaw There's so much lore that I could go through more Than even Goku could hope to when he grows new balls Shwabadi:- Yo, I see you thought it was over But then the fusion tango boosted power roasting opponents The coldest foes that I'm owning, the Ki is flowing an ocean You had the nuts to step to one of us, but now you're facing Bofa These thugs People that keep the beam tucked Lethal when thinking you'd of dreamed to beat us Fetal position, you can clear the tear ducts Crying to yourself 'cus you're weak and we're peerless I got twice the will in me, a Gemini man Don't need a smith, come with quickness when I jeopardise plans Double vision, they can't seem him, 'cus I'm fast with the hands Punisher drive, push 'em aside, now I'm sending 'em back This dual personality, you woulda thought'd be a mismatch Two beefy dudes sandwiched together, that's a Big Mac One man think tank, never skipped gym class Think fast, Kamehameha with a Big Bang Gameboy Jones:- Coming to you live, it's the man from the planet of the apes You don't want the smoke and I ain't talking 'bout a vape Tide pod ship, yeah my whip so clean I've been taking planets way before I even hit my teens Raditz stacking cabbage, I'm banking on being savage Heart is full of malice, unleash it by causing havoc You don't want the beef that's unfortunate, there's no salad If I see my brother, I'm snapping that little carrot No app, but I'm bringing in the discord I'm pedal to the metal, that's how opposition gets floored Microsoft, I'm about to give you one note Facing me is suicide, us Saiyans are to cutthroat Pride of a lion, check the mane But I go ape shit, me and you are not the same Compared to me, you ain't even looking half as nice If you wanna beat me, you'll sacrifice your life! None Like Joshua:- This is for Gohan, so long you robots Krillin's own thot, isn't even the most hot or that nice Like I am when it comes to tough fights Goku taking 20 episodes, I'm taking one slice More humble than any Saiyan here on the track 'Cause I know when to attack and when to hold it back Coming from the future, man, it's all out of whack 'Cause Goku's got to live, so don't shoot, he's not Goku Black Or Zamasu, what I've seen will haunt you Travel to the past seems too paradoxical But I've got to killin' villains, saving my fam Now my sword is shaving off years from your lifespan Simpin for Mai chick, she's searching for my Dragon Balls I don't need to make a wish, I can hurt the baddest gods Immortals underestimate me 'cause my dad's a loser Thia Mai is too young, so it's back to the future Zach Boucher:- They don't hold a single hope if they're alone Find a sacrifice against this elitist, you will need it That's my last advice I'll be undefeated and I mean it though, I pack a fight Handing eveybody, one way tickets to the after life Now they're coming at me assuming they're quick Nah, practically practice, they're done with, I'm over this shit Getting so impatient, God I hate how it's over so quick So I'll let you die for nothing, like the Namek, Tien, and his buddy did Say he's Super Saiyan, but I'm saying that he sucked at it You just need to find the little strength that you've been mustering While I keep it deep inside my veins until it clutters You're like Gohan, how you stuttered Killed your friends and all your brothers I was sick of living deep inside the dark But that's when I met Vegeta, he would teach me where to start They don't realize I'm still alive to tear you all apart You call it destruction, I call that a pockmark Connor Quest:- Goten since I was below ten, I've been hard as stone henge Enemies they curve me like a road bend Broke them limits, making grown men fidget When you see me up in GT, I'm the golden ticket Need a scope lens just to even see the height I'm hitting Deny the physics, these guys are tripping If they think that I could give in Collide the digits, call it popping the Trunks Because I'm riding with him, feel the burn As you get offed by the son Flip round turn the tension high No, these clowns ain't friends of mine Kamehameha drop a body to the floor Get a strike to a vital just to end your life Step with a rush on your neck, bust collarbones This is how you make a hero's son, fuck Boruto Ki on lock, you can fight with us You'll be sweeping up the pieces of your teeth after you bite the dust DizzyEight:- Looking for a hero? Then it's us Had to double up to maneuver when it's clutch Give him big rounds, know for the dough I go nuts Fella, sit down, it's known I bring thunder when I punch Ya'll talk too much, enemies do the most What I speak leave 'em toast, when I spit they go ghost You're not the real thing, I'm in a game full of clones They copy what I'm on, then hope that they explode You can't copy me If you do, you do it sloppily They're just throwing shots at me But I promise you never stopping me So much potential You can check my credentials You don't know that you in for Greatness what I'm meant for FabvL:- Hold up, I see 'em wanting the prince Throw your best punch, guarantee I won't even flinch I got the drip that'll turn your number 1 to a bitch Shoot this Galick gun unload it, yeah I'm draining the clip So call me sensei I've been healing the game, better than Dende Type a hero that the villains and their friends say Is truly worthy of the crown, never dead weight Hyperbolic rent payed the best way I got the baddest chick in the whole galaxy Used to say that Super Saiyans were a fallacy Now I've learned that evil deeds are just cowardly Richest man on Earth, so fuck your whole salary Really think you could hang with all the best? No way, royal blood, got it running through my chest Don't play, stupid villains, I could kill without regret All day, listen up, you will do whatever that I say! NerdOut:- Y'all done screwed up I acquired the jewels and now I'm fused up You about to get bruised up Best of both worlds, I use superior stragedy You're not even half the man that used to be half of me You choosing defeat If I wave my arm, the wind will put holes in you Now that's shooting the breeze Go ask Majin Buu, oops it's too late I'm out for 60 minutes, but for you? I only use 8 Laughing while I'm waiting for this union to dissolve 'Cause I don't think the ladies are approving a ménage But if Chichi and Bulma wanna cuddle tonight They better watch out 'cause now I got double the pipe And Gogeta's no match, he stay losing He had to do choreographed Tik Tok dances to make a fusion So which Super Saiyan are you choosing? These dim-witted half-pints or pinnacle of evolution Rustage:- Hit that, Wukong with the staff breaking bodies like a Kit Kat Rip your team in half like I'm moses when I split that Whiplash punches like it's gift wrapped, spit facts Treat you all like Frieza with a bitch-slap Saiyan from the planet of the apes, I'm not playing Best be praying to this God I'm raising stakes I ain't waiting, I be saving every person, every race Passion blazing 'cus I'm facing any aliens in my way Say my name, call me Goku Hanuman, stand my ground, yeah I won't move Chris Chan, when I'm loud with a blown fuse Understand, hear the sound of your bones bruise Go through faster than my flows do A monkey but better than Luffy, I'm king of the planets Ain't needing no piracy I'm stunning, just look at my moves, I'm top of the charts And I'm needing no rivalry And finally, they're fighting me bust in beats like it's Chichi Easy your characters tough, but can they beat me? Daddyphatsnaps:- So you made this far, huh? Now you and me Hahahahaha Somebody hold me back, I'm going berserk And at the rate I'm going, bro I'm 'bout to blow up the Earth It's lunch time, eat your every punch, I'm knowing it hurts your pride Legendary Saiyan, I was chosen at birth, I'm the truth 'Cus I always been the hardest, I'm a bad bitch You had to work to get to where I started so savage Had the Super Saiyan gods saying "oh damnit" He's so made bitch, he breaking up the whole planet Well, if it's gonna go, then I got something I should get off my chest And I ain't talkin' 'bout the X, see you sipping the flex I got these little green bitches out here gripping my pecs I'm ill turn you green bitches then your hitting the deck I'm a god damn God, are you out of your mind? It's strange, millions of scenarios, you die every time Murder you without a trace and 'geta brought me the lime You'll get bodied out your body if you rowdy with mine

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[ratthewrodent]

Hey everyone! I'm currently a PGY-2 general surgery resident and I was hoping to provide some advice for any medical students who may be on clinical rotations. These are the things I wish someone told me when I was a student and would have made a huge difference...meaning I would have moved from the level of "dog shit" student to "mediocre at best" student. Of course this advice is derived from my own experiences so there is always variation when it comes to different programs, attendings, etc. So pease consider this disclaimer before unleashing a torrent of cyber-bullying directed at my well-intentioned post.This is especially important because of the recent change to Step 1. From now on there will be an increasing focus on clinical grades and "wholistic evaluation"...meaning your grades will depend more on your ability to read minds, telepathically communicate with hospital staff, and brown-nose attendings rather than understanding basic medicine.Also before we start, I want to provide a fair warning...this post is long as shit. The reason being is that I believe this topic is so important it warrants nothing less than the painful detail I have provided below. So here it is....--------------------------------------------------------------One of the maxims you hear repeated during medical school is that "the way to stand out as a medical student is to make the life of the residents easier." This made perfect sense in theory but was impossibly elusive once applied to real life. I thought I could help out by writing notes. Wrong! Residents can write notes 10x faster and you'll ultimately double their workload because they will have to fix your notes. I thought I could help with orders. Wrong! I would ultimately just fuck them up and order the renal patient an extra dose of IV potassium.The answer to how to make a resident's life easier (and thus make you stand out as a student) is to follow-up on "action items." I define an "action item" as a discreet step in a patient's daily care plan. Put in simple terms, an action item is the shit we need to get done to get a person out of the hospital. So let me break it down further by working it into a clinical scenario...You have a 58-year-old male patient who is POD#4 (POD=postoperative day) from a strangulated inguinal hernia (bowel stuck in hernia, some bowel is dead, dead bowel has to be resected and healthy ends put back together). It's 6AM, you're the third year student on the surgery team, and all this talk about dead bowel has you regretting your previous night's decision to inhale that re-heated chipotle burrito at 3AM. But you remember the blood oath you made to your over-bearing prestige-obsessed parents and you get your shit together long enough to pay attention to what's going on with "hernia guy."The intern is saying that the patient has not been able to tolerate any oral intake (vomits whenever he tries to drink liquids), has not passed any gas, and his belly is distended. Otherwise the guy is generally stable (meaning he is afebrile, normotensive, and heart rate is in a normal range, 60-80's). The senior resident goes on to say the patient likely has a postoperative ileus (meaning that the gut is slow to wake up after being stuck in a Stone Cold Steve Austin-style rear-naked choke hold for so long). Senior resident goes on to say directly to the intern, "have a NGT (nasogastric tube) placed, let me know how much output you get initially, and follow-up with a KUB (abdominal XR).Despite the growing sensation that your own bowels are suffering from burrito-induced ischemia, you notice that the intern wrote those three things down so you adeptly conclude that those things must be important. You give yourself a solid pat on the back while you B-line it to the nearest non-public bathroom.So lets pause for a moment. The discreet steps that are being used to advance this patient's daily care plan are: 1) Have a NGT placed; 2) Let senior resident know how much initially comes out; 3) Follow-up with a KUB. These are the steps that are going to be taken to address this patient's current problem. And it may not seem like a lot to organize but it quickly becomes overwhelming when your patient census is reaching 60 or 70 and each person has a multiple action items to follow-up on.--------------------------------------------------------------This brings me to my first point regarding action items: in order to carry out action items, you have to remember them, and to remember them, you have to write them down, and to write them down you have to pay attention during rounds. So find a way to fold your list so that each patient has enough room to jot down your action items. I always preferred very fine-tipped pens and the partial right-sided hotdog fold so I could write on the back of the folded edge . If you're not familiar with the aforementioned fold, take the right side of the page, fold over just enough to still see the name/room number but allowing enough blank sheet to write shit down on.I feel compelled to stress the importance of writing down action items. The reason being is that there will always be some wannabe-rainman thinking they can remember all the action items but will end up forgetting 75% of the plans. These people end up shitting their pants once its time to face the music (that person was me for about half of intern year). Therefore the thing to remember about the first point is this: action items are important. Important things need to be written down.--------------------------------------------------------------But as I promised before, we are getting into the weeds with this one and I refuse to leave out any of the juicy details that are guaranteed to have your residents stroking their mental erections at the thought of your action item efficiency.Let me elucidate this point by taking the clinical situation a few steps further....Rounds are done, you found that non-public bathroom, exorcised that demon burrito from the previous night, and now it's time to get to business. You have your action items and tell your intern that you can help out by putting in the orders (often times a student can place orders as "pended student orders" and then cosigned by the intern once he's ready). Since you have everything written down in an organized way you know exactly what to put in the order entry box. Using "hernia guy" as an example, you enter the orders corresponding to your action items.The intern realizes you're not completely useless and has you helping out with other patients too. Before you know it you're putting in dozens of orders on dozens of patients. Things start to get confusing really quick. You start to lose track of which orders were placed and which ones were actually completed.--------------------------------------------------------------This brings me to my second point: the importance of knowing the status of each action item so that you remember which orders were placed, completed, or need to be re-addressed. As I like to say (after which I receive near universal eye-rolls) this helps keep your action item list "organized and prioritized".To know the status of the action items I use a "double box" method. This means that when I write down action items during rounds, I put a symbol next to the item to help me keep track of the status. For myself, I draw a small box within a bigger box (hence "double box"). Whenever the order is placed for the action item, I fill in the small box. Whenever the order was completed and I get the information I need (i.e. NGT placed with 1.1 liters on bilious output), I cross out the bigger box and write the result next to the action item.It doesn't matter what symbol you use, it just matters that you use something. The great thing is as you keep track of all the action items, you can see clearly what items need to be followed up on to ensure the order was carried out. Additionally you can update your residents on the status of each item so they can be reassured that someone is on top of it. If an important action item (i.e. NGT placed) was ordered but you see it still was not completed, you can prioritize that in your head so you make sure you address it sooner rather than later.It can also be used on any type of action item. For example, if a patient's action item was "follow-up CT scan," I would fill in the small box once it was ordered and I would cross out the big box once it was completed. For consults, you fill in the small box once you call the consult, cross out the big box once the recommendations are in.The classic mistake is when people only write down action items. Once they get through about 20 or so patients it becomes really easy to forget which orders were placed, which are pending, and which are completed. Once this happens a full state of panic is induced, invariably followed by the frantic re-checking of all orders, which comes at the cost of following-up the results of the action items. The end result is that its 12PM and no one knows shit about how the patients are doing.--------------------------------------------------------------Now that we belabored the actual mechanics of action items and how they are used to "make your resident's life easier," it is important we discuss the most important point of all and something that even some senior residents and attendings never truly understand. My final point regarding action items is this: in the majority of cases, to have action items completed, they will have to be catalyzed by a human being. By "human being" I mean the lowest person on the totem pole (intern in most cases). And by "catalyzed'" I mean phone calls have to be made, nurses have to be talked to, techs have to be cajoled.Action items are not just something you place an order for and passively wait around for a nurse to call you with a result. This is the part where students can have the greatest impact on "making the life of their resident's better." In the real-world hospital environment there is a never-ending supply of bullshit hurdles that get in the way providing meaningful healthcare. If you can help alleviate some of that burden, your residents will worship the ground you walk on. That worship will inevitably make its way to the program director, I can guarantee you that.--------------------------------------------------------------So what does this look like? To answer that questions lets go back to our clinical scenario....So you just finished putting in all your orders, filling out those small boxes, and you're feeling pretty good. Its been a good bit of time since you placed those first orders so you think its time to get some results. You start following up and realize that nothing has been done.Instead of sitting on your ass and stalking your ex on Facebook, you decide to start making some calls. You realize that the nurse is having trouble placing the NGT because the patient is not tolerating a rubber tube being shoved in his nose. You bring this to the attention of your intern who dutifully orders 1.0mg of vitamin D (aka dilaudid) to help cool his jets. You call back 30 minutes later and the NGT is in. You can physically see the burden being lifted off your intern's shoulders. You instantly feel a wave of euphoria in the form of peer approval. Now that you've hopped on the golden dragon, it's time to go looking for your next fix. You're busting out calls left and right, putting out fires, and cooling off jets like you're the fucking man/woman.--------------------------------------------------------------One final thought on the subject...medical students often find themselves in the awkward position of being hopelessly task-free while the residents are frantically entering orders, hammering out consults, and generally making shit happen. Understandably this is one of the most unenviable positions because who wants to be the schmohawk sitting around while everyone else is busting their ass. Many of us endearingly refer to these medical students as "meatballs lost in the sauce."The universal response by medical students in this predicament (my previous self included) is some variation of the question..."is there anything I can help with?" Whenever this question enters the space between medical students and residents you can guarantee the resident is thinking "yes, there are a million things you can help me with but you were obviously not paying attention on rounds where we discussed literally everything we need to get done."It is precisely this encounter that induces the "I feel like I should be doing something" sensation in medical students. This is nearly always coupled with some degree of indignation at the medical school system for having so improperly prepared you for clinical rotations (and yes, that indignation is justified).And it is ok to not know how to do something. It is much better to ask "what is the best way to follow-up the CT scan?" rather than "how should I help?" The former indicates you were paying attention on rounds, understand the important to be followed up on, and are willing to make the resident's life easier. The latter question ("how should I help") makes you just another task to be completed by a resident who is running dangerously low on happiness and is one condescending comment away from a full mental breakdown.So if you don't take anything away from this post, please take this...In order to avoid being just another meatball lost in the sauce, do the following: pay attention on rounds, write down action items, follow-up on action items, report the results of those action items to the appropriate party. If you do these simple things you will "make your resident's life easier."--------------------------------------------------------------I hope this helps. via /r/medicalschool