#for standardized testing I just go with the flow and it hasn’t failed me yet

[solardrink]

thoughts on ap world? for the class i had like a 89 avg or smth, but i also got a 5 on the exam after cramming for 3 days straight so idk

also hi solar :] it has been a while :]]

Hi Lexi! 5 ON THE EXAM!!! That’s super impressive congrats ^_^ yeah test taking and actually performing in a class are totally different worlds. I had a consistent A+ in ap gov but got a 4 on the exam cause I didn’t study at all for it

[mallowstep]

Please tell us more! Why did Moth take Jay and not the other two? Who ended up being Jay's mentor? Do they not have any other traditions that could take the place of proving the river accepts cats? Does Jay get looked down upon because of that? How's his fishing skills? Does he get a mate in this au? Anything else you would like to share? Every time I see you post a new au idea I immediately get obsessed lol

why did moth take jay?

because that was the prompt and i liked it. holly goes to windclan because she looks like nightcloud, and lionkit goes to thunderclan because he looks like squirrelflight, and that just leaves jaykit.

who's jaypaw's mentor?

beechfur.

can he be accepted another way?

okay so. being accepted is not like. one thing. it is just. something that proves you are meant to be here. it can be something small, it can be something large, but there's always something. for example, for spottedpaw in stolag, it's this:

She opened her mouth, but before she could say anything, he continued, "Even you, Spottedpaw, carry the blood of the River." He blinked, slowly. "You wouldn't belong here if you didn't, but look. Greypool's kits are sleeping by your side, same as any other cat, and don't think I haven't seen the way you watch the water. You carry the divine in you."

it's a small moment, but this is when the whole, blood of the river thing is explained to her. and that's enough.

my other example would be dovepaw from icbtyssm, but (a) spoilers and (b) most dovepaw scenes are like, 4k words. but for her, it's a very private moment before she's even decided to stay in riverclan. she has a more dramatic moment, but being accepted is when you prove you can do what only riverclan cats can do:

As time went on, only cats with the River in their blood could see the water spirits the Moon made, and they were the strongest swimmers and the best fishers.

so basically, there are three main methods: be able to see spirits, be a good swimmer, or be a good fisher.

jaypaw is blind, so he can't see a spirit (it's specifically a visual thing. riverclan's medicine cat traditions are actually quite visual. they would of course adapt as necessary, but i think for a cat not proven to be riverclan, the clan would have a hard time accepting, "i didn't see a spirit but i did perceive one" as a valid thing).

and swimming and fishing is what they learn during their apprenticeship.

it's how most cats prove themselves! they learn to swim and fish and it proves that they belong. again, it's not like...a formal moment, but it is. it's a little ambiguous, because of riverclan's general culture.

anyway, he can't prove himself as a kit, so leopardstar can't mentor him.

(also jumping in at the end: there are other ways to prove you're part of riverclan. there's no specific list. those three are the big ones that most cats use, but there's no set list.

for example, spottedpaw is accepted by the kits of riverclan treating her like "any other cat."

so there's always, like, a way for a cat to prove themselves. but they might have to find that way out, y'know?)

does jaypaw get looked down upon?

it's complicated.

riverclan believes that cats who carry the river's blood are divine. it's a whole thing.

so in that sense, yeah, he's spiritually inferior to his clanmates until it's satisfied that he belongs.

and that is a huge sore spot for him. because he feels like a riverclan cat from birth. and riverclan you know, just one drop is enough. "the divine cannot be diluted" is a really common idea in my riverclan fics. it comes up in "there's holy water, undiluted; i see the divine", "denouncement", and "the blood is rare and sweet as cherry wine."

but he just, needs to be accepted. it's worth mentioning that riverclan isn't trying to be exclusionary. it's just saying, riverclan cats like to swim and fish and you need to be able to do that to be one of us.

because they don't actually care who your birth parents are, as long as you can effectively pass a citizenship test.

but kids can't take the test, so jaykit grows up with this background worry of what if i fail. and passing isn't complicated. it does not take a lot to pass. but that's after he's been an apprentice.

which is why when breezepaw points out he's not a clan cat by birth, jaypaw gets pissed. like yeah, jay is painfully aware of that.

however, riverclan doesn't strictly look down on him. it's more that. hm okay like, the ending for the story of the river forming riverclan ends in "the river flows in us all" and jaykit knows that, he's not included in that "us all" yet.

but in every other respect, riverclan understands he could be. he's just a kit.

so. it's Complicated.

i don't think any other kits would tease him tho. willowkit would beat them up.

how's his fishing skills?

i'm not sure! i need to do some research into blind cats and fishing. i suspect he'd be able to dive, but i'm not sure. he can't fish in the standard riverclan sense, i don't think, but he should be able to do at least some form of fishing.

although even if he couldn't fish at all, riverclan would still love him.

does he get a mate?

yeah kestrelflight. jaykestrel and hollywillow feat. kestrel and willow pestering each other about their significant others every half moon.

anything else you would like to share?

i'm really excited to explore riverclan from yet Another angle. i know it might be a while before i get here, but for me, like.

riverclan is interesting because of their whole "we're all divine" thing because on one hand. it's why they're so accepting. because they're all divine. if you're different, you can't be worse. you're just different.

it's baked into their spirituality.

but (a) that's not the same as feeling like you're an equal and accepted, and (b) jaykit isn't know to be divine, and he knows it would be so much easier if he could just see.

i don't particularly like narratives about jay wishing he could see in General, but it's definitely a pretty sore spot in this au specifically because it would make matters a lot easier.

anyway, it's a very "once you're one of us, you're one of us, but if you're not, we're all above you" sense.

(again, this isn't put on jaykit because he's a kit and hasn't had a chance, but it's not like he's not aware of that fact.)

but i created this because it's an interesting idea that has given me so many good stories to tell:

spottedleaf being accepted into a very spiritual clan as a very spiritual cat; the fact that it's not enough for her to be fated to go to riverclan, she is also shown to be accepted

mistyfoot hanging on to this idea that she is riverclan, she is divine; that no matter what happens, she is better than tigerstar, that what he is doing to her (and featherpaw) is fundamentally wrong, that there can be no true justification

leopardstar grappling with the fact that tigerstar ruins riverclan; that she is divine and he is mortal and yet he disgraces her, that she is riverclan and she has brought it down

(along with some unpublished ones ;3)

but now i get to add

jaypaw, riverclan by birth (although he doesn't know that), needing to prove himself; all of riverclan wanting to accept him but needing the spiritual significance of proof that he can't provide until he's reasonably old.

[conniejoworld]

DAVE LIEBER Our test of the post office delivers sad results O K, we know the mail is late. Often very late. Now The Watchdog can prove it. I ran a mail test last week by sending letters across Dallas-Fort Worth. The results are an embarrassment. The post office is looking at what could be its worst service breakdown in its 228-year history. You know most of the reasons: Overtime was halted. Blue collection boxes were taken off the streets. Sorting machines were disconnected and decommissioned like old Navy ships taken to a scrap yard. But The Watchdog has discovered another reason for mail not getting delivered on time. You probably didn’t hear about this reason. Starting in late July, before the delivery crisis began, the U.S. Postal Service launched a surprise test for mail carriers. The test came with a name that’s just mumbo-jumbo enough to confuse you. It’s called the Expedited Street/Afternoon Sortation test. A better name would be “the Carriers Only Get 15 to 30 Minutes to Get Out the Door Test.” Its purpose, according to top officials announcing it, is “to assist in reducing the morning office time for city letter carriers by enabling them to get on the street earlier.” The goal was “to enhance customer service by providing more consistent delivery times.” But here’s what happened. The test was unprecedented because it disrupted the normal flow of mail delivery. Almost 400 branches across the nation were ordered to participate, but I’m told that many other branches ended up testing some aspect of it. Inside the post office, it was nicknamed “Grab what’s there and go.” Carriers had 30 minutes (in some cases only 15) to finish prepping their mail for delivery, checking their vehicle, grabbing their scanner and keys and departing. Whatever mail was not sorted before that new grab-and-go deadline was left behind. There was always tomorrow to deliver the rest. Maybe. Within days, mail got backed up almost everywhere. With the elimination of overtime, no one was getting paid to finish the daily delivery. Undelivered mail was stored inside or left on loading docks. USPS’ own delivery standards were ignored. Among the late arrivals: medicines, income checks, bills. (Cue the dying baby chicks.) “The mail being processed was drastically delayed,” said Kimetra Lewis, president of the Dallas chapter of the National Association of Letter Carriers. The stress among her carriers was palpable. “The carriers were calling me on a regular basis” to complain, she said. “Nearly every office was implementing their own version of the test,” she said. “This test was totally different from ones in the past,” says Yared Wonde, president of the Dallas branch of the American Postal Workers Union. “This one is, if the mail is not cleared by 9 a.m., leave it on the floor for the next day.” You may have noticed my sources for this information are two local union presidents. That’s because for the first time in 15 years covering USPS, their media representatives are not allowed to talk to me. “We are not currently providing any interviews,” usually helpful spokesman Albert Ruiz told me. He didn’t give a reason, but I found it in a USPS directive that could have been titled “Our Bunker Mentality.” ‘Consistent message’ Vice.com first reported contents of the order: “The Postal Service continuously strives to project a positive image, protect its brand, and present a unified message to the customers and communities it serves,” the memo begins. “It is imperative that one person speaks on behalf of the Postal Service to deliver an appropriate, accurate and consistent message to the media.” And that one person is new Postmaster General Louis DeJoy, whose fast retreat from enacting his supposed reforms included everything but waving a white flag. After a people’s revolt led to bipartisan criticism from lawmakers, DeJoy issued a statement that he was pulling back. In one of the biggest retreats since Gen. Robert E. Lee fled the Battle of Gettysburg, DeJoy, who has donated more than $1 million to President Donald Trump’s campaign funds, promised to halt drastic actions that he and his minions had pushed in his first weeks on the job. In a forced change of heart, DeJoy vowed to maintain post office hours, leave mail sorting machines and blue collection boxes alone, keep facilities open and restore overtime. DeJoy vowed in his published statement: “To avoid even the appearance of any impact on election mail, I am suspending these initiatives until after the election is concluded.” That sounds counter to Trump’s motives. He has said that he initially opposed more funding for troubled USPS and hoped to avoid “universal mail-in voting” in his reelection bid. Yes, the postal service has massive short-term and long-term problems. But is now the right time to break the vast system into dysfunctional pieces? Ellis Burgoyne, who ran the Texas region as Southwest vice president 15 years ago before his promotion to USPS’ chief information officer, is now retired in Irving. He told me, “Holding mail a day to process was always a no-no. ... Total elimination of overtime and intentionally leaving first-class mail behind was never an option. We never had that, and I worked there for 35 years.” Sorting machines Why would you remove and dismantle working sorting machines in the midst of all these other changes unless you wanted to bog down the system, maybe even make it harder for mail-in election ballots to reach their destination before deadlines? Aside from the people in the processing plants, mechanical sorters are the heart of mail delivery. Wonde of the postal workers union estimates that between Dallas’ Main Post Office near Interstate 30 and the North Texas Processing and Distribution Center in Coppell, a dozen sorting machines have been removed in recent weeks. “They didn’t give any specific reason for that,” he said. “I officially requested how many machines were removed and how many were decommissioned.” He hasn’t heard back. Wonde said workers tried to put one of the machines back in operation at the Dallas plant, but they were missing important parts. My test I mentioned my test. Until a few years ago, a first-class letter mailed within North Texas, from and to a local address and dropped off before 5 p.m., usually arrived the next day. Now USPS service standards allow for a letter mailed locally to arrive in two days instead of one. How’s that working? I took addresses for 50 Dallas Morning News employees who live in Dallas-Fort Worth. On Monday night, I mailed 50 envelopes to them from my city post office. I also emailed my lucky 50 to let them know they’d been drafted into my experiment. Under USPS standards, all letters should have arrived in two days — by Thursday’s mail. But more than half didn’t. Only 21 arrived on time — or 42%. That’s a failing grade. Five more arrived one day late on Friday. As of Saturday morning, as I complete this, I’ve yet to hear back about 24 others, or 48%. Admittedly, this is no scientific survey. But with half of the sent letters failing to meet the goal, it’s an indicator. (The Watchdog wants to check again during early voting.) Burgoyne, the retired former USPS vice president for Texas, added that when he was in management, “Election and political mail, including ballots, had the highest priority.” (We’ll see if that tradition holds.) Lewis of the letter carriers’ union says she worries about the cost of this mess to USPS’ reputation: “We don’t know if our customers lost confidence in us. It’s frightening.” If you desire a mail-in absentee ballot, contact your county elections office for information. You can also request one online. Requests for mail ballots must be made before Oct. 23. Make sure you fill out your ballot and send it back as soon as possible. To qualify, you must be 65 or older, disabled or out of your home county on Election Day. The last day to register to vote is Oct. 5. Twitter: @DaveLieber

[freewheelen]

DEMO RIDE: 2019 Husqvarna Svartpilen & Vitpilen 401/701

Size does matter, and in this case, smaller is better.

It’s no secret that Husqvarna’s dirt bikes and dual sports sell themselves. Touting a storied motocross/scramble history, it’s easy to see why the off-roaders are so popular with the public. On the other hand, the company hasn’t seen much success with its street-oriented lineup. With 2019s still occupying the showroom floor and the pressure of Q3 looming, Husky recently visited Azusa, California to jumpstart the sales of their Svartpilen & Vitpilen lines. Labeled the Real Street tour, the series of demo events featured both models in their 401 & 701 variations, casting a veritable spotlight on their often overlooked street bikes. 

But the Svartpilen & Vitpilen aren’t afraid of the spotlight, you could even say they were crafted to bask in it. The first thing you’ll notice when you gaze at the Svartpilen & Vitpilen is the unconventional design. It’s not a stretch to say that the aesthetics of the lineup resemble something out of a Scandinavian furniture catalog. With minimal, flowing lines, the Svartpilen & Vitpilen would feel right at home with your Poäng and Klippan. 

Yes, beauty is in the eye of the beholder, but the neo-retro style aims directly at a younger, urban demographic that gravitate toward classic, simplistic forms with a utilitarian edge. Whether you fancy the looks of the bikes or not, you have to admit that the fit and finish is quite impressive. However, I do feel the designers tragically overlooked the speedometer, as its more akin to a gym teacher’s stopwatch than a proper gauge. Not to mention, the highly reflective glass and mounting angle make render the information illegible. Aside from the hideous - and quite useless - instrument cluster, the Svartpilen & Vitpilen reek of smart sophistication.  

But I can see how that elevated design could be a barrier for potential buyers. Due to the refined, “Swedish” aesthetics, one could quickly distinguish these models from their intra-brand cousins, KTM’s Duke and Enduro. With hopes that the public will embrace these models the same vigor as they’ve taken to KTM’s lineups, Husky is just trying to get more booties in the saddle, and I’m more than happy to oblige. 

Sharing the motor of KTM’s 390 Duke and 690 Enduro R, Husky’s Svartpilen & Vitpilens benefit from two well-tested mills. Both engines push the boundaries of power that a single-cylinder engine should produce. Despite the lack of pistons to share the load, the vibrations on the 401 & 701 aren’t excessive (take that assessment with a grain of salt - I ride a Harley). 

While the 701 delivers its power in a smooth, linear fashion, I found myself smitten with the 401′s punchiness. Glancing at the spec sheet, I noticed that the 701 reaches peak torque of 53 ft-lb @ 6,750 rpm with 75 hp topping out @ 8,500 rpm. Comparatively, the 401′s max torque (27 ft-lb) hits @ 6,800 rpm and horsepower (42 hp) @ 8,600 rpm. With about half the power and three-quarters of the weight of the 701, the 401 shouldn’t feel nearly as torquey. Additionally, both motors achieve max torque and horsepower at practically identical rpms, leaving me perplexed with my preference for the 401 - aside from the butt dyno. 

No, I can’t support my fondness of the little thumper with cold hard data, but I can attest that the majority of the riders attending the demo agreed. I know anecdotal evidence is the least persuasive argument, but the 401 simply felt like a more agile from side-to-side and provided great acceleration in short bursts. And I may be rationalizing here, but those darting characteristics seemed appropriate for two models that translate to white arrow (Vitpilen) and black arrow (Svartpilen). The 701s weren’t bad motorcycles in the least, they just didn’t imbue the same excitement as they’re diminutive counterparts. Size does matter, and in this case, smaller is better. 

But the size variation didn’t stop at the engine. The differing braking systems on the bikes occupied two different build quality standards. Even with the 401′s “budget” brakes, both systems felt well-suited for their classes with adial-mounted Brembo clampers blessing the 701s and ByBre calipers getting the job done on the 401s. 

Despite the fact that both models lack dual-discs, the calipers delivered a reassuring bite while riding in urban environments. Yes, an extra rotor and caliper up front would certainly push the models in a more performance direction but we didn’t take the Svartpilen or Vitpilen into the twisties and the stock brakes would suffice where most buyers would ride these bikes - in the city.

When judging the two models on ergonomics, I kept their natural habitat - urban environments - in mind, as both maintain a fairly sporty position. Starting with the Vitpilen, I immediately noticed the aggressive, forward-leaning stance. Positioning my head directly over the front wheel, the Vitpilen made me want to slalom through mid-day traffic at full throttle. However, that state of mind prooved more enslaving than freeing. After all, I was on a demo tour. If “it’s better to ride a slow bike fast than a fast bike slow,” nothing is worse than living that platitude in reverse. If you’re looking for a nimble, aggressive, lane-splitter, the Vitpilen has you covered, but make sure your journey is manageable, as I already felt the tension in my wrists by the time we returned from the short ride.

On the other hand, the Svartpilen utilizes high-rise bars to position the rider at ease. From the upright posture, I was content to stay in line and putt along at a legally acceptable speed. Sure, I tugged on the throttle from time to time, but the relaxed stance felt more conducive to congested road conditions. If the Vitpilen’s ergonomics equate to a Supersport, the Svartpilen would be it’s Naked/Standard counterpart. Both bikes are aimed at city-dwellers and while it would be a stretch to say that either of them let you stretch your legs out, neither of them feel cramped. Though I’d probably opt for the Svartpilen in most situations, if I were visiting one of the local canyons (GMR, HWY 39, etc), I’d certainly side with the Vitpilen.

While the ergonomics shift the rider into different postures - and different states of mind - the road manners of the bikes are quite similar. With all models under 6 inches of travel, I could easily flat-foot each bike. Despite its smaller stature, the 401s benefited from the same WP 43mm inverted forks that graced the front end of the 701s. On the road, each bike was compliant and responded immediately to my every input. Particularly, the Vitpilen - with its clip-ons and head-down posture - reacted to every adjustment of my body. 

Not only did the suspension allow the bikes to cut from side-to-side, it also made the 401s and 701s feel planted. From soaking up potholes to providing stable steering at speed, KTM’s proprietary suspenders highlighted how fun these machines can be. On the contrary, the lack of suspension travel on the Svartpilen did beg the question: couldn’t this model be much more fun? Aside from ergonomics and a few bits of design (paint mainly), how does the Svarpilen distinguish itself from the Vitpilen? 

And that’s where I got to thinking about the lack of sales for these two models. After taking everything into consideration, it seems like Husqvarna’s “Real Street” motorcycles are going through an identity crisis. Are these bikes retro or performance? Can you consider a motorcycle “premium” (as the price would suggest) the dash looks more like a digital alarm clock and it doesn’t come with dual-disc brakes? But maybe it’s less of an identity crisis and more of a false identity. For instance, Husqvarna outfits the Svartpilen with dirt tracker styling yet they can’t endorse taking the low slung machine off-road. Even with the aesthetic hinting at dirt-capabilities, the Svartpilen is essentially a naked bike with knobbies. 

Broadcasting a false image can ensnare potential buyers - or it can turn them off (like it did for me). Intoxicated by the snappy acceleration of the 401, I actually looked into purchasing a Svartpilen following the demo. But the lack of off-road capability soon soured my initial enthusiasm. If it can’t hang in the brown, why outfit it with Pirelli Scorpions? Why adopt tracker design cues? What’s the point of making form decision if it’s contrary to the function? That disillusionment made me look at the Svartpilen & Vitpilen differently. 

With an MSRP of $6,299 for the 401 and $11,999 for the 701, it’s easy to see why the KTM-owned brand is having problems moving units. Coupled with the unconventional design (which I actually love but can understand how some wouldn’t), Husqvarna has it’s work cut out. Along with the lackluster sales figures of the Svartpilen & Vitpilen, the Real Street Demo stop in Azusa failed to highlight the full capabilities of models. With the near highway miles away, riders were relegated to a jaunt around the block. As a result, I never got the gearbox past 3rd and that doesn’t instill much confidence in potential customers. The combination of disorganization, bikes-to-rider ratio, wait times, and early wrap-up, I’d venture to say that the demo barely moved the needle on these two bikes.

With all that said, if you’re looking for a stylish motorcycle to ride in the city, Husky’s street lineup may be a good option. The brand continues to promote their 0% APR (up to 48 months), so you may score a new Svartpilen or Vitpilen for a great price. For my intents, the bikes are too niche in design and too specialized in purpose, but that doesn’t mean they won’t work for you. I guess the best advice I can give to potential buyers is to test ride as many motorcycles as possible. I know I will be!

[capmerthur]

THE BODY SWAP

It’s all in the title :) Somewhere end S1 (after 1.11 Labyrinth, but pre 1.13 Morte). In a land of myth, and a time of magic, Arthur awakes inside Merlin’s body (and no, not in that way). Alternating Merthur POV. Bonus Gaius. Mentions of Will and George.

Excerpt PART XIII:

Once alone, Arthur closes his eyes, reaching *inside*.

It's a tool. He tells himself when he senses the flow. Not a weapon.

There had been something in the way Merlin had talked. It had sometimes felt more like mentioning actual events than thinking aloud; especially - even though surprisingly - about...

It's harmless. Merlin says it can be used to make butterflies.

(PREVIOUS CHAPTERS UNDERS CHAPTER XIII)

XIII. PROGRESS (ALTERNATE MERLIN/ARTHUR POV)

"This is what Valiant did! How can we trust this book of tricks?"

There is fire in Arthur's eyes - an anger at Valiant's deeds that Merlin doesn't wish to see grow blinding. Gaius gives Merlin a look, and Merlin understands that Gaius wants to be the one explaining - to protect him, surely. Merlin signals 'no'; but Gaius is speaking anyway before Merlin has even opened his mouth.

"Sire, Valiant's actions were definitely condemnable indeed; but the book is not to blame. It simply explains how to animate figures - it doesn't tell *why* the spell should be used; that intent is entirely the responsability of the one using the spell. So yes, Valiant used such a spell to kill; but such a spell can be used to save or help too; can be useful and good."

Arthur doesn't seem convinced at all, judging by the growling tone in his voice:

"How could such a spell ever be used for good?"

Let's say you need to animate snakes out of a shield at your will to confound an evil man and save a noble one; Merlin thinks but does not say, pleading Gaius to let him deal further with Arthur's ire. Merlin has often pondered of course, even if with little success, about the best way to explain it all to Arthur. But he realizes, suddenly, that using Arthur's own words and opinions might be the most helpful in that regard.

"Remember what you told me, Sire; about Will? So. Having magic is *not* having a weapon. It's simply having *a tool*. You can use an axe to build a shelter or to break down a door - and even then, you might only be breaking that door to save blocked-in people from fire. You can use a shovel to plant an apple tree or to dig a grave - and even then, it might be out of respect and love, in another culture. The axe or the shovel have nothing to say about why they are used for. In the end, maybe, the only thing magic actually reveals is what's truly in one's heart."

This approach works better, apparently. Palpable facts he experienced himself weigh more than rethorical theories in Arthur's thoughts process. Arthur tilts his head, actually considering now, instead of refusing it all at once.

"So. This spell? Let's say you badly injure yourself while alone and away, and you conjure a horse to carry you back home quickly enough to be saved? Let's say a child is crying and you create a butterfly or something, to bring up a smile?"

"A butterfly, Merlin?"

Arthur looks incredulous but sounds, if anything, teasing - which Merlin interprets as a sign of progress, a smile growing on his face. He only shrugs though, playing along.

"What's wrong with a butterfly?"

"Nothing, I guess, indeed. Let's go on then."

They read further for about an hour, Gaius preparing potions behind them. Arthur never shouts out again, but expectantly looks at Merlin on the few occasions he apparently feels like he might maybe be missing the whole picture. And Merlin just goes with it; the surprised yet somehow satisfied glow in Arthur's eyes each time in some way worth the risk of possibly divulging too much...

Until dinner time comes, and Merlin has to go. He takes his leave, telling Arthur he should read on. Arthur's answer leaves him breathless.

"I'd probably see things only one way on my own; who knows what I'll miss... I'd rather bring the book to my chambers while you eat, and you can read further later. Besides, I should work on my water, you know... Be ready for it, in case you find something."

Merlin can only nod, speechless from Arthur's obvious trust.

As he opens the door, Arthur surprises him yet again, talking to his back: "And just so you know, I wouldn't put you in the stocks for sleeping in my bed while you're, well, me."

The tone is more gentle than gloating, and Merlin feels warmed up as he realizes Arthur is being simply honest. It doesn't change his view on the matter though.

"I told you, Sire; I do not find your bed comfortable to start with."

He doesn't dare to look at Arthur as he walks out.

/

Gaius has proposed to bring the book to his chambers. He said he had to bring Morgana her sleeping draught anyway; but Arthur couldn't help but sense that there was more to it - maybe he'd rather not have 'Merlin' seen with such a book, maybe Geoffrey has made him sworn an oath to never let it out of his sight... Anyway, Arthur doesn't have it in his heart to deny Gaius the demand.

Once alone, Arthur sits again in front of his two bowls. He closes his eyes, reaching *inside*.

It's a tool. He tells himself when he senses the flow. Not a weapon.

There had been something in the way Merlin had talked. It had sometimes felt more like mentioning actual events than thinking aloud (Had Will ever performed any of the spells they read about?); especially - even though surprisingly - about...

It's harmless. Merlin says it can be used to make butterflies.

Arthur takes a deep breath; focuses - visualizing in his head what he wishes to achieve.

When Arthur opens his eyes, the water has switched bowl.

Arthur blinks.

Then a loud "Yes" echoes in the room.

.

Arthur makes several times the water switch from bowl; then the books on the shelves from order (size, alphabetical, themes (as it was originally)) - he doesn't dare mess with Gaius's ingredients though, of course. At some point, he eyes the chamberpot and tests it too, like Merlin had mentioned they could once Arthur would have gotten how to. And indeed, it works too! Arthur can't help but feel proud, trying to imagine the look on Merlin's face come morning...

Then Arthur realizes maybe they do not have to be under the spell to start with any longer! What if he can just wish it away? Sadly, though, it doesn't work; no matter how much nor how hard Arthur tries. Feeling a bit defeated now, even though he knows he definitely booked progress, Arthur decides he should go to sleep. With any luck, he might need all his energy tomorrow, if tonight turns out to be as fortunate for Merlin as it has been to him...

Gaius hasn't come back yet - he probably stayed with Merlin to study the book; after all, as Court Physician, no one would question how long he stayed by his injured Prince... Arthur opens the door to Merlin's bedroom - he doesn't intend to keep Gaius out of his own bed tonight too...

/

As soon as possible, Merlin excuses himself from Uther's and Morgana's company to get to his book.

Since Gaius has given it to him, he hasn't really had time to study it - mostly, he's called forth through his magic the necessary spell or information when he needed any. He hopes though that the book will help them again, as it has in the past, and that he will find something useful in the over two thirds of the spells section he hasn't read yet...

It's late into the night when Merlin's heart skip a beat. A spell-breaking spell? This might work, right! After all, one doesn't have to reverse a spell to have it undone! Merlin rereads the pages again, and wishes the morning to hurry in order to show his finding to Arthur and Gaius.

.

Arthur saw magic as a weapon, of course. Which was sort of getting in the way of having his magic work for more than blocking the spoons attacks, because he felt still somehow that he *shouldn't* use it, no matter the need to use it to fix their problem. But now that Merlin has had him understand, at least for a while, that it isn't by definition a weapon, Arthur somehow feels like it is all right to use it. Which is why it works this time? It makes sense in my head, at least?

And imo Merlin wound't link magic to a weapon both because he wants to unmake that precise link existing already in Arthur's mind; but mostly because, well, he doesn't see it that way - HE USES IT TO MAKE BUTTERFLIES, RIGHT (and I love him for it, HUGE sigh...)

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(PREVIOUS CHAPTERS)

I. AWAKING (ARTHUR POV)

Arthur awakes; lying on his back - unusual - and rolls over automatically.

He surprisingly falls, down, hard; and jerks fully awake now - on the floor, near a so very tiny bed, tangled in an unknown blanket (harsher than his standards, even while on errands, he can’t help but notice).

In disbelief, he eyes his surroundings…

Where is he? Has he been abducted?

Think, he admonishes himself - trying to clear his mind; to remember what must have happened, to guess who has dared to commit such an act, and, most important of all right now: Find a way out.

His eyes then suddenly meet Merlin’s, and relief surges through him somehow - Merlin is alive - before his anxiety returns; and double: because poor faithful, loyal Merlin has obviously been taken too; and it’s Arthur’s fault - he must have failed to save them both from being taken, even though he cannot remember anything…

Except when Arthur reaches out to Merlin for him to come closer (they need to share information and plan, but must be quiet as a mouse), he realizes with fright but indeniable certainty that Merlin is in fact a reflection in a mirror; and worse: *HIS* reflection!?

It his NOT his hand indeed that is stretching out in front of him; NOT his clothes on his person; and definitely NOT his own hair falling upon his eyes, as he notices the black strings in his vision range…

Arthur is dumbstruck. He sees Merlin’s mouth shaping a silent O, and he sees the dread in Merlin’s eyes… except they ARE - he feels - *his* mouth, and *his* eyes; and everything is just plainly wrong, and plainly impossible - but undeniably REAL.

He is… Merlin? Or better said, *inside* Merlin? How can such a thing have even come to be?

Sorcery, Arthur understands with horror: Camelot is under attack!

But now armed with the knowledge of his predicament, Arthur realizes he is actually in Merlin’s bedroom. He’s been in here before, once; and he recognizes it all now.

So. Not abducted. All things considered, that still counts as something, right…

And, as it surely doesn’t feel as if Merlin is still somewhere in his own head too while Arthur is inside of it, well… Maybe? Logically? Merlin might then be in return inside his own body?

Arthur suddenly finds himself praying for this to be true. It would be for the best, if Merlin was in his body - if they were the only ones concerned by this unnatural situation; because what if *everyone* was awaking inside someone else’s body this morning? That would be… precarious - the general panic leaving Camelot completely vulnerable to whoever must have plotted this? The worst though would be if the one responsible for this was right now in control of his body, and acting as Crown Prince to do, well, evil deeds… So yes, you bet Arthur truly wants to find Merlin to be the one inside his own body when he finally finds it.

Arthur jumps on his feet, ready for action. Luckily (even though Arthur feels a bit guilty, as he notices his armour in pristine state against the opposite wall - apparently Merlin has been polishing it late into the night then) Merlin hasn’t bothered to undress before falling asleep.

So. First thing first: he has to go to his chamber.

Picking some weapon on the way for good measure, you bet …

/

Simply walking the few paces to open the door though turns out to be a challenge. His limbs are too long, and dangly; it feels like he has two left feet, and he has to try thrice before actually getting a grip on the handle - because he isn’t used to this body, of course - but maybe it is truly NOT Merlin’s fault if he trips over his own feet that often after all…

Gaius is already out - hopefully looking for herbs and not wandering out of his mind… Arthur would have preferred to be able to test right away his theories about how many people were affected by the damn body change; but unfortunately, it would have to wait some more.

The corridors are empty too, except for a stray black cat who walks at his side long enough for Arthur to start questioning himself about asking to the cat if he *is* Merlin - because Merlin HAS to be somewhere, right, as he obviously isn’t where he should be to start with; but then the cat takes another turn… Arthur feels stupid for worrying so much about his silly manservant - but he cannot deny that he definitely will worry less only after having indeed finally found said silly manservant.

Arthur relaxes slighthly though when he enters the kitchen: people are working as usual, apparently not in shock, apparently in their right bodies. He picks up the first tray he finds, along with an extra knife that he hides in his pocket for good measure.

He tries to put on a confident grin as he walks (with the most assurance he can muster in this awkward-feeling body) towards the guards at his bedroom’s door - and can only hope it will look the same as usual to them. They let him pass without trouble, and Arthur isn’t sure whether it’s a good thing. On the one hand, he *doesn’t* doubt Merlin - he simply, intrinsically doesn’t; and would never want him to feel like he did if his guards were to search him whenever he was about to enter his chamber. On the other hand… well, it isn’t Merlin right now entering his chamber, with knifes at the ready… This time, it’s only him; but what if it happens again, and if the one then inside Merlin’s body has ill intentions…

Deciding not to dwell on this for the time being, Arthur enters his bedroom - hoping to find Merlin doing whatever Merlin always does, but preparing for a fight, if need be…

.

II. AWAKING (MERLIN POV)

Merlin awakes as if in a cocoon; literally. He is surrounded by softness, flush, warmth; he cannot remember ever feeling so comfortable - and the world can wait for just another few seconds before he opens his eyes, right… Merlin wriggles, shifting on his back, sighing softly as he nestles some more into the cushions…

When Merlin awakes for the second time - culpability sinking in as he realizes he has overslept - his eyes open to a Pendragon red canopy he would recognize even among hundreds. Merlin freezes: what the hell is he doing, sleeping IN ARTHUR’S BED?!

Merlin sits upright at once - blankets falling all around him to reveal that he wears ARTHUR’S NIGHTGOWN too ?!

Whaaaaaaaat?!

This… just DOESN’T make any sense. The last thing he can remind is sitting on his own bed, polishing the last bit of Arthur’s armour before letting himself fall down to sleep (*AN). He surely doesn’t recall walking to Arthur’s chamber, and even less…

Merlin’s mind is reeling as he shuffles out of bed as swiftly as he can. Oh my… What is Arthur going to think? And come to think of it - true panic now creeping down on Merlin at that thought: *WHERE* is Arthur to start with?

His attention is drawn out right then by Arthur calling out his name (Merlin feels relief, no matter his current embarrassing situation) - in one of those thousands yet unmistakably always Arthurian ways to say his name: a myriad of moods and meanings in those simple two syllables - the voice sounding odd though this morning (is Arthur sick?), and tensed (well, he just found his manservant in *his* bed, that might explain it!).

Merlin turns to face his sovereign, trying to feel less self conscious because he mustn’t look guilty, while wishing for inspiration, and buying time until it hits: “There is actually a perfectly valid explan-”

But it is NOT Arthur he sees: it is… himself? His breath catches as ‘utter confusion’ gets a new meaning, you bet…

At the same moment, Merlin notices suddenly just how *not his* his voice has just sounded, and how he’s wearing a very particular ring around one finger of what’s NOT his hand, and how *blond* hair is falling upon his eyes… And still nothing makes sense; but at least it *does* explain how he awoke in Arthur’s bed in Arthur’s clothes: he *is* Arthur?; and… Arthur… is him? MUST be him. He has been calling his name right the right way, right?!

“Arthur?” Merlin barely dares to breathe out, both in wonder and in plea (because Arthur CANNOT be gone - the fear and pain and simple *impossibility* of such a concept slicing through Merlin’s mind like a knife).

There is a bright smile then appearing on his face - a smile that doesn’t entirely look like his own though - “Yes, Merlin. It’s me,” followed by a relieved sigh: “And it’s you”. And, despite the shock about them having apparently switched bodies (?!?!), Merlin can’t help but feel warm all over - because Arthur (and yes, it is so clearly Arthur, even in HIS body!) has apparently been worried about him.

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(*AN) Headcanon time :

Merlin uses magic to clean Arthur’s armour in the beginning, indeed. And he still uses magic for most of the chores, as much as he can, of course (washing clothes, mending clothes, emptying chamber pots, sweeping fireplaces, preparing baths, refreshing beds, cleaning floors, cleaning everything, really (except for mucking the stables, because there are always others around, grrrr). But he quickly grows nearly *maniac* about Arthur’s food (picking at it as a way to make sure it’s not poisoned etc…) and about Arthur’s armour: it’s one of Arthur’s protections - so you bet Merlin definitely cleans and polishes and repairs and oils the leather ligaments that hold it together and EVERYTHING the hell out of it, with extra ardor and fervor, with his own two hands, all the while continuously trying to put on it any protecting spells he ever finds, and repeating those over and over at each occasion…  Also, mirrors were probably not so advanced at the time… But let’s say Merlin has an enhanced one, after all he has magic, right…

On a side note, I’m never going to be over Arthur’s priority-thinking (I’m in trouble = CAMELOT IS UNDER ATTACK (babyyyy let me hold you - being Camelot Prince/King is NOT your only worth) and Merlin’s priority-thinking (what the hell is happening = WHERE THE HELL IS ARTHUR (babyyyy let me hold you - your devotion to The (brave, kind, admirable (shut up Merlin)) Prat doesn’t have to mean that you always must come second (and a bit self-preservation cannot be harmful)) *SIGH* I just love those two idiots so much !!!

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III. DISABLED (MERLIN POV)

But soon, Merlin is terrified.

And not because of the puzzling body swap.

*HE HAS NO MAGIC!?*

(Not that Merlin knows of any spell to reverse their current situation at once, mind you; so he doesn’t actually try anything about it. But Merlin simply knows: there is nothing but blood running through his veins now - no vigorous warmth, no energic flow; there is simply nothing singing under his placid flesh, as he focuses on it.)

He cannot help but wish he’s wrong though, and desperately tries to move a quill on Arthur’s desk behind Arthur’s back - the simplest of things, really; yet he fails, indeed…

His magic is tied to his body. Not to his mind.

No, no, no, no, nooooooooooo.

Merlin is, to his core, *terrified* - as he has never been. Not only because he feels more powerless and utterly helpless than he has ever felt - and worse, unable to protect Arthur! But also because the longer Arthur stays in his body, the more chances he has to find out that he has magic!? (And even though Merlin has nearly told Arthur, once? He is still not ready for him to know right now… Will after all didn’t lie to protect Merlin’s secret on his deathbed for Merlin to take chances with his life so soon after…)

Merlin though decides to push his panic aside for the moment: he simply MUST focus. No matter which sorcerer has this week decided to deal with the Pendragon line once and for all, Arthur’s life is undoubtedly in the balance; and that’s dearer to Merlin than all the magic in the world - included his own.

Because Merlin’s life *has* tilted, on that rocky beach by The Great Seas of Meredor.

Merlin’s earnest readiness to lay his life down to save Arthur’s had been instinctive, beyond doubt visceral; and the concrete force of the impulse had surprised him. Because it hadn’t been related to his first supposed then anyway indeed wished upon destiny. It had merely been a reflex, a spontaneous reaction: what he had wanted to do; more than what he ought to do. And Merlin had realized right then that he had, somehow, but undeniably, actually come to *LOVE* Arthur? He had known, for some time, that he liked him. And he had felt oddly pleased when Arthur had turned up at Ealdor - maybe Arthur liked him too? But if your first thought when someone is threatened is ‘I’d rather die than see him die’? Well, there is a kind of selfishness, even in seflessness, that goes beyond ‘liking’, right…

It shouldn’t have been such a shocking revelation though. Sure, Arthur could be a spoiled, royal prat; an irritating, pompous ass; an arrogant, moronic bully - to list but the top of the iceberg of his massive shortcomings, and without even mentioning the complete dollophead he could sometimes be. But Arthur could also be truly brave, honest, and kind; willing not only to trust but also to actually defend the words of mere servants, ready to defy his father’s orders in order to save a child’s life, and volunteering to help a village not even belonging to his Kingdom, to note only a few examples. Also: at some point, Merlin had realized how what could at first appear as near manhandling tactility was in fact just Arthur’s disguised way to show (or ask?) affection (because one probably just doesn’t walk around asking for cuddles while growing up between Uther’s judging cold glares and Morgana’s sharp witty tongue; and the physical occasional playfulness of the knights training must have seemed like the only way to go…). And last but not least: Merlin owed Arthur his life - if Arthur hadn’t gone looking for a Mortaeus flower… So, in short: of course Merlin had gotten fond of the man. For his own values; and not because he was meant to be the other side of his coin or something. And notwithstanding how so annoyingly beautiful he always was (for the record on that particular subject: Gwen is so adorably beautiful, and Morgana so petrifyingly beautiful).

But, as Arthur - bound to be King one day Arthur - hadn’t even hesitate before choosing to sacrifice himself, in order to fix what he had recognized to be his error, instead of using the (even offered) life of a simple servant? Well… There is a difference still between having the conviction that Arthur is a good man ready to fight for the greater good, even knowing it could be his death; and knowing as a FACT that Arthur *is* a good man ready to *die* for the greater good, even knowing it *will* be his death. And you bet having been proven *exactly* how pure of heart Arthur intrinsically is has only cemented that burgeoning love deeper into Merlin’s heart - simply; truly; and maybe irrevocably. Merlin would now willingly die a thousand deaths to save his Prince.

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(Feel free to shout with me about 1.11 because *MAJOR FEELS*!)

(And then hug me as I shamelessly cry because this is still NOTHING next to what’s to come - aka Arthur becoming ACHINGLY beautiful, as Merlin turns ready to KILL a thousands times to save his King, blackening his own heart in the process and thinking himself then unworthy of Arthur’s love because Arthur is just so BRIGHT; but wishing for it nonetheless?)

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IV. PLANNING (MERLIN POV)

Arthur, miraculously (even though understandably; because he must be shaken too, right), is unaware of Merlin’s internal crisis as he shares what he’s uncovered until now: “It seems to be just us. The kitcheners and the guards all seem to be themselves.”

“So. Whoever has done this is targetting you - personnally.”

“Nice to see your wits are still so very particularly sharp, Merlin. Is there any reason for the one behind all this to be targetting you?”

It is beyond odd to *hear* Arthur’s usual tone in his own voice; but Merlin still has the grace to sigh, before pushing his point further: “But why you?”

“Well, obviously *you*’ve forgotten, but I am Camelot’s Crown Prince, responsib-.”

“Which is exactly what’s bothering me!” Merlin can’t help but interject. “Why take on the Prince when you can take on the King?”

“Oh… Do you think… Could someone be… training on us, then? Before attacking-”

“I honestly have no idea. Maybe you got targetted indeed because you’re head of security. We shouldn’t rule anything out.”

Arthur brings his fist down on the table, determinedly: “Well, whatever the evil plan might be, we just cannot permit for it to work. We’ll have to find a way to stop this nonsense - no offense. In the meantime, we must act as if nothing unusual is going on. It might be for the time being our best chance at keeping Camelot safe - making whoever planned this think the spell didn’t work?”

Merlin can’t help but let out a helpless (yet realistic) sigh: “That’s… a lot; on both accounts.”

Arthur echoes with a helpless sigh of his own: “I know.”

/

But if they are to keep up pretenses, Merlin is going to need to be prepared: “So. What’s on your agenda for today - besides the monthly open pleas this morning and the daily training this afternoon?”

“Nothing particular. And there are no coming feasts nor abroad visits planned for the coming time, thankfully. (worried sigh) But there’s concil, tomorrow.”

“Well, let’s start at the beginning. I should do fine enough for the pleas. It’s mostly your father’s duty; your presence is required, of course, but mostly you’re to hear and listen…” Fear grips Merlin at once: “But it’s public; so it would be a great opportunity to try to murder you!” He MUST protect Arthur’s body: “Will you please go fetch your chainmail in my room?”

“No.”

The tone is definitive, and Merlin is torn between begging, or growing impatient - because Arthur can be so obtuse sometimes (now really isn’t the time for Arthur to be feeling indignation about being ordered around like a simple servant; even though he *is* one at the moment - not that Merlin would ever think he was one, of course - but what if Arthur thinks he does and enjoys the chance at some payback?): “Arthur, please (again?). It’s the expected type of errands of the body you momentarily (because it MUST be momentarily, right?) inhabit - I can’t - You’re the target. I need your chainmail. I have no fighting skills, nor any kind of skills really to protect yo-”

“I cannot be seen wandering the castle in my chainmail without reason, Merlin; it would attract attention”, Arthur interrupts in a somehow gentler tone; and Merlin realizes that Arthur hadn’t registered at first how Merlin’s concern was about him, more than himself - and is obviously humbled by the thought. “Court clothes are required, anyway. We’re not supposed to look threatening, nor threatened, when our subjects come to present their wishes,” Arthur pursues, killing any possible protest in the bud. “Besides, the guards will be present. So don’t worry too much about anything happening to us”, Arthur ends in a lower voice; as if the last part had been more a thought to reassure himself than a phrase meant to be uttered - and Merlin just has to savour that precious 'us’…

Merlin though isn’t reassured enough about his Prince’s safety: “Please (yes, that’s thrice; adamant much?) Sire, at least allow me to wear your thickest leather under your tunic” - willing his voice to make it sound like a not-to-be-denied demand more than a true question.

Arthur holds his gaze; and it actually feels like a blessing when he finally relents: “As you wish; but it won’t be comfortable against naked skin.”

“I’ll manage.” Merlin can’t help but fidget some before pursuing - asking Arthur to do what is and should be *his* work feeling not only weird but even wrong: “But I’ll need your help to tie it in the back?”

Arthur dimissively tousles his hair, grumbling: “I *know*, Merlin.” 'My clothes’ going unsaid.

Merlin can be relieved about one thing, at least: Arthur obviously isn’t piqued about doing a servant’s work…

/

Merlin picks out the largest fitting of Arthur’s clothes. He puts on the braies and trousers while still wearing the gown, respectfully tying the belt blindly around his waist. He puts on socks, and shoes. Then only does he take the gown off, and turns his back towards Arthur so that he may help with adjusting the leather’s straps.

A surprised but definitely pleased whisper (“Impressive, ain’t I?”) echoes in Merlin’s ears, as the Prat Prince seems apparently unable not to comment about his damn broad back, angling Merlin shortly that way and this way as if to assess it even better.

'Believe me, I know’, Merlin can’t refrain from thinking; feeling a blush coming over his face, and thankful that Arthur is too busy looking at his own back to notice any of it.

“I think I might even have outgrown Sir Leon - in width at least if not in height”, Arthur concludes proudly before finally starting to work the ties - leaving Merlin suddenly ashamed of his initial internal reprimand, and oddly upset. Of course Arthur would only wish to see in his physique the strength of a warrior. Of course his first thought, when finally able to actually see his own back, would be to compare it to his given models - the Knights; and most of all among them, to his own chosen model, Leon - both the noblest and strongest of them all, yet young enough to play the part of the older brother Arthur could look up to while growing up… No one has probably ever told him that he is beautiful, Merlin realizes sadly. But the fact that Arthur is so unaware only makes him even more beautiful in Merlin’s eyes…

Merlin forces himself to tease Arthur, hiding his turmoil under their usual banter: “Well, I could ask Gabriel to take measurements, if you so badly wish-”

“Shut up, Merlin”, accompanied by a rewarding hit in the back of his right shoulder, which Merlin gladly revels in, no matter the unusual fist size. This, no matter their predicament, feels normal.

And in that short moment of normalcy, when everything feels just right as Arthur ends tying the leather, Merlin notices something he hasn’t noticed before, when all he could feel was STRESS.

Oh no.

/

“Arthur?” Merlin can’t help but wince at the intimidated tone in his voice as he turns around; and Arthur is eyeing him now with furrowed eyebrows. “I think I need - I mean you need… to… have to go?”

Arthur makes a face - with his face; except it still looks somehow like a typical outraged Arthur face (damn, this is just too confusing…): “Merlin!”

“He! Do not look at me like this is my fault! It’s *YOUR* body! Maybe you shouldn’t have drun-”

“Well, maybe you shouldn’t have brought a full pitcher at dinner then!”

They eye each other, both unrelenting over who is at fault.

And Merlin can’t help but think that somehow he is, indeed, no matter what. Because there are levels in intimacy; and he IS definitely crossing a line. There is a difference between being around and trying to avoid his gaze when Arthur walks in and out of his bath, or applying Gaius’s healing balm to bruises on Arthur’s back because it’s a place Arthur can’t reach on his own, and, well… watching and touching Arthur’s *manhood*, even if only for urinating, technically ensuring no mess is done while doing it?

Arthur suddenly sighs though, and his voice sounds kinder as he offers: “This will surely happens a few times before we sort it all out, huh. To the both of us. So. How should we proceed?”

Merlin scratches his head, summoning some courage: “Do you want to… hold-”

“Your hand, Merlin!”, Arthur demonstrates, lifting the would-be-culprit in the air and wiggling its fingers for good measure; and that’s a 'No way’ if Merlin ever heard one…

“Would you rather it to be your hand-”

“It’s *your* hand right now!” Indeed. So. Another 'No way’.

But suddenly Merlin has a solution, of sort: “What if I… go sit into the stream? There’s a quiet spot not so far from the castle I found while collecting herbs for Gaius… If I hurry I still can make it back before the pleas.”

Arthur actually claps his hands, obviously relieved: “Sometimes, I swear, you are a genius.” He hurries over, handing Merlin his tunic and grabbing the Pendragon red doublet before marching out: “Let’s go!”

“You’re coming?” (hastening to put the tunic on and grabbing a towel before following)

“Well, as I just said, it’s bound to happen to me - you - so I might just as well tag along, and know where it is.”

/

Once out of potentially spying ears reach, they plan the day further.

“We HAVE to tell Gaius, at the least, about our situation: no one will contest his word if he says you’re not to train for a while - because honestly how am I supposed to spare with your Knights? They will notice right away that something isn’t right. And, well…”

Merlin hesitates, not wanting to incriminate Gaius in any way. As it turns out, he doesn’t have to:

“You’re right. Besides, Gaius has heard about a lot of… stuff, in all his years. I was planning to go around Jeffrey and look for the forbidden books, but I have no ideas how many volumes are hidden down here, nor where they even *are* to start with… If anyone we know might have even the slightest clue about how to fix our problem, it’s him; even if it’s only about finding an adequate book.”

Merlin nods, relieved: “So. After the pleas, I stage a fall, and we go to Gaius, who tells you’re not to train for the time being. That leaves the rest of the day free, both for looking up about our situation, and briefing me on what I should be aware of for tomorrow’s concil. Do you address things in an established order; who’s whose specialisms; what you discussed by the latest concils which might be brought up again tomorrow; and so on…”

“I’m supposed to make the battle plans, Merlin? But as far as plans go, I have to admit this isn’t a bad one. Except I’m not you; I do not trip on my feet twice a day. So. I’ll make you fall. That’s more plausible.”

“No way! You’ll end up in the stocks!” Merlin realizes how - no matter what he might have been thinking just a few months ago - he simply doesn’t want Arthur in the stocks. Ever. “Which is NOT where you should be spending your afternoon.” Merlin quickly amends; hiding his concern under logic’s sake, knowing it to be the best way to persuade Arthur anyway. “So. You fall. I try to help you. But we both fall. I’m clumsy, as ever; you’re noble, as always; everyone get to laugh at me, and praise you; and your father might skip punishing me for you getting hurt in the process, as you obviously didn’t want me hurt to start with?” (pause, before adding earnestly, yet fiercely, as Merlin isn’t able to tone back the surge of threat in his eyes at the mere idea of having anyone disrespecting Arthur in that way) “If he doesn’t though, I’ll stand guard next to you.”

“Would you?” Arthur seems surprised; but touched: “Well, who knows, maybe I’ll return the favor the next time.”

Merlin can’t refrain a whine: “The next time?”

“Even I can’t save you from my father’s wrath every time; it’s bound to happen, either from your two left foots or your snarky mouth.”

They can hear the water now, and Arthur accelerates towards it, as Merlin lags behind, unable not to smile:

“I guess I’m supposed to say 'thank you’?”

“I might have forgotten to mention I’ll probably throw something in your face myself at the last moment. Prince’s privilege and all that…” - Arthur even turns towards him, giving him one of his goofy faces to boot (Merlin didn’t know *his* face could do *that*, by the way).

Merlin just keeps on smiling anyway. He probably hasn’t felt that brightly, positively, ridiculously happy since “I’m rehiring you - because someone needs to muck out my stables”. Arthur has a particular way to express fondness, and Merlin wouldn’t change it for the world.

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V. THERE’S SOMETHING ABOUT MERLIN (ARTHUR POV)

Arthur is the first to reach the stream, and crouches down to test the water with his hand.

“It’s cold”, he warns, while Merlin walks in a straight line towards a tree with a low hanging branch and starts undressing - he does come here often, clearly.

Merlin shrugs: “Be grateful it’s not winter yet. Try bathing around Imbolc - that’s cold.” Merlin goes on; stating an afterthought while hanging his pants on the branch: “Still worth it though; everything here is just more… alive, you know. You don’t get that indoors.”

And Arthur has bathed on patrols enough to know that, honestly?: he prefers his warm baths. He can’t help but feel a smile on his face though at the words; they are so intrinsically Merlin.

/

Arthur had been struck, when they had met. No one had ever defied him, in any way. And it had stung; Arthur could admit. So. He had not been displeased at all when he had overmastered the fool and turned him over. The affront had been too public to be allowed to slide, and Arthur had decided he wouldn’t dwell a further thought about the goodhearted fool (Arthur knew terrorrizing people wasn’t right. He tended though to react badly whenever anyone acted cowardly (which was, well, all the time, around him); especially as he was actually *praised* for it somehow), but fool nonetheless, who should have known to mind his own business…

It had been nothing though in comparison to his surprise when their paths had crossed again. Arthur hadn’t been able NOT to taunt him - hoping, somehow… But the last thing Arthur had been actually expecting had been for Merlin to act *exactly the same*. Surely, now that he knew who he was, he would just scrabble around him as anyone else - not defy him again, knowing it would get him in chains again, right? Arthur had been *delighted* by Merlin’s untamable fire - the words, and then the look he had thrown at him while taking his jacket off? (Maybe Arthur had just been waiting all his life for someone to finally stand his ground to him, indeed…) Of course Arthur had let him go without punishment that second time - and any time since then (which was honestly difficult, as Merlin - always fighting for what was right more than for himself Merlin - frequently got riled up, be it in private OR IN PUBLIC, by literally anyone and anything).

Since he has been to Ealdor though, Arthur can’t help but see things under a new light.

Hunith is everything Arthur believes a loving mother to be. But there had been no father at home, nor any mention of one. (Arthur knows the sting of this kind of wound - missing a parent; and he had been saddened, as he had realized that Merlin bore such a wound too.) Arthur hadn’t dared to ask, but he had wondered: did Merlin ever got a father to start with; or had he been abandoned - intentionally or not? (Arthur knows how even an accident still feels akin to a betrayal in a child’s heart.) Which would be the worst anyway? But what if Merlin had been bullied through his childhood because of it? - children could be particularly malicious, when they intended to… Was it how Merlin had learned, the hard way, that fighting - both with his words and his fists - was the only way to end the pestering? And had decided it wouldn’t be only for his own sake, but for the sake of anyone who might ever need help? Was it what had brought Merlin close to Will - the fact that they both had lost their father? Was it the reason Will had wanted to learn magic to start with? (Arthur knows the near constant anger, too. As does Merlin, obviously.)

Arthur can’t help but feel grateful anew, somehow, and no matter what, still, that Merlin has had Will around: surely, no matter how bad the fights Merlin had jumped into, Will must have kept him safe - at least safe enough - *with his magic*. The thought had been unbidden the first time it had occured, and had definitely surprised Arthur; but he hadn’t been able to deny that it was what he truly felt indeed.

/

Because of course Arthur had come to care for Merlin. Isn’t it why he had gone to Ealdor to start with after all…

Merlin.

Definitely not an ordinary manservant. And probably not the champion manservant by any book (fast learner, and smart, and hard working, he was; but only about what *he* deemed important - hence for example his total disregard for any kind of storage? - but Arthur generally agreed with what Merlin deemed important or not anyway). But honestly the only manservant Arthur now could imagine ever having - or ever want to have.

Because Arthur likes Merlin as his manservant exactly just the way he is, and would now never wish for another - no matter (and specifically because of) how well-schooled and zealous to satisfy his every need (and whim) that hypothetic other might be… Arthur now sees what others might judge flaws as assets (Merlin’s clumsiness and chattiness are more endearing and uplifting than unefficient, especially as his opinions always sound reasonable; his sarcasm and insults are a sure way to keep Arthur’s head from ever getting inflated; and his challenging manners push Arthur to do and be better - from training with the knights to saving people’s lifes), and what others might judge insubordinate as being treated, for once, finally, as an equal, somehow (even though they both know and acknowledge they aren’t) - no matter whenever it comes out at Arthur’s expanse too, food getting shoved into his mouth and getting unceremoniously pulled out of bed included in their everyday banter, as Merlin can give just as much as he gets indeed. But that’s maybe what Arthur values the most: how Merlin’s respect feels earned and honest; neither forced by birthright or fear for repercussions, nor cajoling nor calculated.

Arthur has never had a private servant for longer than a year - his Father’s rule; but you bet Arthur is decided about keeping Merlin at his side when the year would end. He will have to strategize; he will need irrefutable arguments. But if he plays his cards well - and Merlin never ceases to hand him over cards to play - Arthur has no doubt that his Father will actually allow it: it’s in the best interest of the Kingdom after all.

Merlin.

A whirlwind. Always animated, always busy; never still, even when he’s doing nothing. But always so expressive - so easy to read - a fact Arthur has come not only to appreciate after decades around perpetually guarded scheming faces, but even to *trust*.

A chatty nature-loving poet with dangly limbs, gentle heart, and the brightest smile Arthur has ever seen - Arthur has come to know. Yet the sassiest mouth and the most unrelenting fighter Arthur has ever met; his utter lack of skills balanced by sheer defiance - Arthur has learned right from the start. (Merlin just never backs off, no matter the odds; which is very stupid, but also very brave.)

A confusing, clashing mess of contraries. But an admirable man, with a beautiful soul.

And you bet Arthur wouldn’t have him be any different.

Arthur shakes his head. Maybe - just like with his two left feet - it isn’t Merlin’s choice to be such a poet all the time. Arthur hasn’t been inside Merlin’s body for more than a few hours, and already he is turning into a maudlin bard himself, huh…

/

Arthur sighs; bringing himself back to the present - only to be struck by Merlin yet again.

Merlin has by now disrobed of everything except for the leather, which he has rolled up to his chest (logic; it would take too much time to tie it up all once more), and the tunic, which he now holds tightly in a bundle against his chest too, even if (and no doubt exactly because) it must get in his vision range as he enters the water. The lengths Merlin now goes again, simply to avoid to *see* - treating his body with the utmost respect, even when it is betraying him?

It should be insignificant, but the whole endeavour screams once more just how *devoted* Merlin always is, to him; and it is honestly dumbfounding.

He has been willing to die for me. And more than once.

The thought slices through Arthur’s mind; as usual charged with guilt, and heartbreaking, yet oddly sweet.

Arthur doesn’t understand: he has truly done very little to earn such high esteem - and that’s an euphemism. Getting the man in the stocks? Letting him drink poison destined for him? Having his only friend die?

But you bet Arthur cherishes it all the same. And he wants - oh, he WANTS - to be worthy of it. Not because it’s what he ought to do, repaying kindness with kindness, loyalty with loyalty; and definitely not because he owes Merlin a friend - you can’t replace a friend (even if Arthur never actually had a friend, he knows that it’s supposed to be a special, powerful, unique bond). Not even because Merlin does indeed makes him want to be a better man - even if that’s true, and definitely positive for the future of Camelot. But simply because HE. WANTS. TO. Arthur has realized by now how he is always tempted, whenever they are together: either to act silly in order to cause a smile; or to provoke Merlin until he bites. Both reactions feel peculiarly satisfying; spreading a pleasant warmth through his whole being - and Arthur just always has to smile…

So.

On impulse, Arthur disrobes Merlin’s lower half and enters the (indeed very cold) water while holding his tunic bundled up too, keeping his eyes stubbornly fixed on his own body sinking until the water reaches up to above its waist, as Merlin sits on his knees in the middle of the stream. And yes, the fact that Arthur has just chosen to abide by Merlin’s stubborn dedication on that matter, instead of letting his perpetual interest about literally everything run free, for once, (because yes, if he hadn’t witnessed Merlin’s commitment, Arthur might have taken a look at Merlin’s body, out of sheer curiosity; he wouldn’t though, not from now on…), is both a pledge and a self-serving whim.

Merlin, drawn by the sounds, turns to him with questioning eyebrows, and Arthur sheepishly drops on his knees next to him: “I thought it unfair to let you have all the fun on your own. Now, ready to scare the fish?”

Merlin howls with laughter. Arthur decides it’s definitely worth playing silly while freezing his ass off.

.

(Imbolc = 31 january)

Feel free to come and fangirl with me over 1.01 and then scream with me over 1.10 !

On a side note, I’m sorry but not sorry about that fish line? It was *totally* unplanned but then it just rolled out and I went 'yep, sure, arthur would, totally; it stays!’ ?

.

VI. THE PRINCE’S PART (ALTERNATE ARTHUR/MERLIN POV)

They get out; get dried; put their clothes back on. Merlin ties the towel to the branch, for future use.

Then, on their way back to the castle, Arthur asks Merlin about his agenda for the day.

Merlin gives him a look - like he’s unsure whether Arthur means it. Arthur gives him a look back - meaning he isn’t joking indeed.

Merlin smiles, eyes full of mirth: “Your chambers are a complete mess, your clothes need washing, your boots need cleaning, your dogs need exercising, your fireplace needs sweeping, your bed needs changing and, oh, *someone* needs to muck out your stables.” Merlin sobers up. “But we have more pressing matters at hand; so I think you can consider yourself free for the day.”

Arthur is taken aback. He recognizes his own words, of course. It’s both baffling and humbling - that Merlin can quote him, months later? and that Merlin has omitted one part and one part only in his old speech, because they both know his armour doesn’t need any repairing (the devotion Merlin shows those metal pieces echoing the devotion he shows to Arthur himself)? Arthur had first planned to give a playful thankful bow; but it would feel wrong.

“So. I’ll go bother Geoffrey. Try to get him to show me where the secret books are hidden. I’ll tell him Gaius has found a strange herb and wants to make sure it isn’t dangerous or something…”

/

Merlin has to give Arthur that: he is indeed insightful.

The mention of Gaius’s name though has Merlin slightly panicking again: Gaius doesn’t know yet about their current situation. What if he mentions 'something’ upon walking on Arthur thinking he is him? No. Merlin has to be there when they’ll get to see Gaius.

“Speaking about Gaius? Stay clear from his chambers. I doubt he’ll be as magnanimous as I am. He’ll do that thing with his eyebrow and have you pick herbs and brewing healing potions and concocting ointments before you even got a chance to tell him about our predicament - he’s really dedicated in my education as a physician, you know…”

“And I believe you rather enjoy it.”

“I do, indeed. I mean… It’s fascinating - do you know that the same stuff can cure you or kill you sometimes, depending on the dosis? Anyway, who wouldn’t want to know how to save lives?” Merlin can’t help but twitch. “I’m not sure I’m any good at it though…”

/

There is a flash of guilt in Merlin’s disheartened eyes, and Arthur realizes two things:

1) Merlin feels responsible for having been unable to save his friend Will. Which is understandable, because Merlin must have gathered by now some knowledge from Gaius’s lessons; but heartbreaking - because Arthur has seen enough arrow’s wounds to know that Will’s could never have healed - and perplexing - because Will has died to save *him*, not Merlin; so why would Merlin think the guilt was his to start with? and how come Arthur has never felt like Merlin might blame him for it either?

2) Merlin’s face is always *transparent* - a fact Arthur truly appreciates on Merlin’s face - but a fact that could turn out problematic, now that it’s on his own face…

“Let’s get back to my chambers. There is still something you should master better before the pleas.”

/

And that’s how Merlin finds himself positioned by Arthur in front of a mirror.

“What do you see, Merlin?” Arthur asks.

“Well, you?” Merlin feels he’s missing Arthur’s point, but he has no clue…

“Do you? Because I see my body, I see my clothes; but I do not see the Prince of Camelot - I’d like to think I play it better than that - and I must be, because my Father would not allow *this* I assure you - at least I hope or the kingdom is doomed.” Arthur ends on a sigh, shakes his head, and then turns commanding eyes back towards Merlin via the mirror. “Close your eyes, Merlin. Think of me. I mean, *picture* me; and more especially, picture me at any official activity you’ve served me through. See how I walk, how I stand, how I sit, how I move, how I look?”

Merlin does as asked, searching through his memories. After a while, he nods.

“Got it?”

“I think?”

“Then open your eyes, Merlin. What do you see?”

Merlin understands now. He can’t help but sigh helplessly. “Not the Prince of Camelot. Obviously. I’m sorry Arthur, I guess I’m just not… majestic enough to play you.”

“It’s not that hard, Merlin. Come on; I’ll explain. Ready?” Arthur grins at him via the mirror, exuding confidence - trust in him?; and Merlin would face (has faced) monsters to earn it indeed.

Merlin nods, their eyes still linked via the mirror.

“First thing first? You’re slouching.”

“Yes. (Merlin tries not to slouch; but is still not satisfied with the result) I think though the biggest problem is- There’s something wrong with your face.”

“Because you wear your heart on it, Merlin; and you mustn’t. Believe me, you do not want to be lectured for hours about this by my Father…”

Arthur moves away, and Merlin can’t see him anymore in the mirror. His voice is directing though, and Merlin focuses on the words to school his face.

“You’re a prince, so you *must* always look like one. No matter what you do, you must always, *always*, look confident. That’s the first strength of a kingdom - the strenghth of its ruler. That’s what keeps your people safe. So. Chin up, Merlin. Square your shoulders. Stand tall - stand *proud*.”

Merlin realizes the words are not Arthur’s; they’re Uther’s. He wonders how often indeed Arthur has heared those words - most probably often enough to give himself a internal pep talk before any official anything apparently…

“That’s better; but still not good enough. No matter how you feel inside must not show, Merlin. When you’re tired, hide it. When you’re sick, hide it. When you hurt, hide it. When you’re stressed, hide it. When you worry, hide it. When you doubt, hide it. When you’re bored, and even more when you disagree; hide it - it’s disrespectful; and we do not want wounded pride to fester, don’t we Merlin? When you’re afraid, definitely hide it. When you’re sad, hide it. And the trickiest part maybe: when you’re happy, hide it too - or risk whatever is making you happy to be taken away: weakening you is weakening the kingdom; and its enemies will never hesitate to bring you down, if you let them see even an inch of an opportunity.”

Merlin is shaken. He feels guilty, somehow. This is, certainly, too intimate. Merlin feels like he’s intruding. This feels even more trespassing than being in Arthur’s body. It’s like being forced in Arthur’s head, without his consent. It’s nauseating.

“Again, Merlin. Your eyes; focus. It’s a part; but it’s part of your job. So for the love of Camelot, Merlin, please try harder. Your people reckon on you to lead them and protect them; so it’s your duty to be a leader, and to be strong. Work hard; harder than anyone else. You *must* be an example, an inspiration. You must be admirable in everything, so that your people will follow you everywhere. But you must lead, Merlin; never follow. A ruler is alone - *must* be alone. Do not trust anyone; at least do not trust anyone more than anyone else, and surely not more than you trust yourself. Your own judgement must *never* be clouded.”

Merlin can’t help but turn towards Arthur at the words, both in disbelief and in ache… Because Merlin has grown up hiding, but he had never realized that Arthur had, too; and maybe even more than him. Arthur must not only always pretend and perpetually watch over his shoulder; he must pretend and watch over his shoulder *alone*. And Merlin can only imagine how hard that must have been, and be. Back at Ealdor, Merlin had (and still has) his loving mother, and he had Will. Even here, now, Merlin has Gaius. And somehow, yes: he has Arthur too, Merlin suddenly realizes; and then feels ashamed, because he can’t help but feel blessed - Arthur trusts him. Because Arthur is definitely less guarded around him, isn’t he? When it’s just the two of them; Arthur and Merlin? Arthur laughs, Arthur doubts, Arthur *shows*; maybe not everything - but that’s probably not possible as he is so trained - but something at least always shines through; even if it’s by putting his feet on his face… But Merlin knows now, how rare and precious it truly is. They can never be friends, maybe; but Arthur trusts him. That’s undeniable; and that’s everything, somehow.

“Do not look at me; look at the mirror, Merlin. Harden your eyes. Smile; always politely, even when you don’t want to smile at all; more genuinely, when it’s true - but never let it go up to your eyes. First thing about tomorrow too; as we’re at it. Hear everyone out. Listen with your full attention to everyone; whether you agree or not. Never decides right away; except if it’s necessary, in war time. Your decisions must be thought upon; never a spur of the moment. If something is unclear, do not let it show during concil. If you favor a position, do not let it show during concil. If you disagree, do not let it show during concil. You need further advice, or even only further information? Seek the appropriate person in private; ask man to man. They will see the honor in it if it’s positive, and be thankful you kept it private if it’s negative. Also. You must be ready to be impartial, Merlin; because you do not need to be kind, but you must always be fair. You may - and you will, unfortunately - make mistakes; but never ackowledge them. Fix them. If you can’t; repair as much damage as possible. Learn from your errors, in order to never make the same mistake again. But never apologize. Come on Merlin; I’m sure you can do it. You’re nearly there.”

More over, Merlin realizes the Arthur he gets to see nowadays - the true Arthur - has always been there already, even under the pretense of the moron. Kilgarrah is wrong. His destiny isn’t to change Arthur; because there is nothing to change. Arthur already has everything to be a great king, the greatest king, all on his own.

And so, Merlin is *angry*. He has now yet another reason to despise Uther, it seems - scarring his child on the inside in such a way. Of course Arthur always feels inadequate; of course Arthur feels lacking; of course the only bond Arthur values is the one with his fellow knights - ride to glory or death, together? It’s the only bond Uther has authorized him to authorize himself to ever have… But Merlin’s anger is a good thing, apparently - because whenever Merlin thinks about Uther, Arthur finds that he’s playing the Prince’s part better.

“There Merlin, you have it. See? Right there. Lock it; just like that. That’s good enough for anyone looking today; because believe me, someone *will* be looking, even if only my Father and not the one who switched us or anyone else with ill intentions - there is *always* *someone* looking, Merlin.”

Fine. Think about Uther; until the pleas are done. Merlin can do it; and he’ll gladly do it. He’ll probably gladly do anything; for Arthur. He can still have a cry or hit a wall afterwards, right…

.

Arthur needs a hug. I volunteer. Anyone with me? (besides Merlin, obviously…)

.

VII. DOOMED (ARTHUR POV)

With a last commanding yet encouraging nod, Arthur leaves Merlin by the Great Hall’s entrance and starts to make his way towards the Library.

He is stopped by Merlin’s name being called out twice - because he has failed to react right away; Arthur chastises himself. It is the headmaster recruiting hands: his Father wants his bath ready when the pleas end.

Arthur doesn’t want to bring Merlin in trouble, of course; so he takes on the ordered job - after all, how complicated can it be?

He is paired with a newcomer answering the name of George who looks up to him as if he holds the sun: the Prince’s manservant! Which isn’t that bad. Until he starts, seemingly embarrassed but curious all the same, to ask questions like “Is the Prince as terrible as they say?” or “Is it true he throws knives?” and such? Arthur tries to explain that the training field is, well, to train? He isn’t sure the message gets across though, as George only holds his eyes with a perplexed gaze…

Arthur can’t help but hope that Merlin at least understands that he’s not only training himself but also trying to get Merlin to know how to defend himself if not to attack whenever he comes at him with a mace or anything… He should maybe make his intentions clearer, apparently…

Anyway. After yet another round of carrying buckets full of cold or warmed-up water up and down and left and right, Arthur realises there is more to it than it looks; and the bath is only half full still…

And when they’re nearly done? His three coworkers and the headmasteer seem satisfied, but Arthur can’t help but think while bringing up the last two buckets that they achieved nothing more than a luke warm bath with a clean but no particular scent. Merlin’s baths are definitely of a superior category on both accounts, and Arthur doesn’t know if he should feel guilty and spoiled for regularly enjoying better baths than the king himself, or more amazed or worried about Merlin’s bath-preparing skills (is he even thinking about his safety? he wouldn’t actually carry boiling water up the stairs, would he?)

Arthur decides he should address the issue. And maybe take baths downstairs from now on just in case - a little backroom near the kitchen would be more practical than his chambers, wouldn’t it? When the space isn’t needed for banquets preparations and such of course…

Arthur misses the first step towards the second floor (it’s actually the eleventh time today that he misses a step - he still isn’t used to Merlin’s feet). This time though, his balance is too lost for him to compensate and he falls backwards, landing on his butt and ready to get soaked and hit by the water and buckets he has released when instinctively freeing his hands (one to help catch his fall; one to protect himself from the falling projectiles). Except nothing comes: no water, no hit - and no falling sound either. And when Arthur takes a look? The buckets and water are… floating above his head?

Arthur gasps in surprise, his mind going both blank and reeling…

Then only does Arthur finally get drenched and hit on the shoulder.

Arthur blinks. Twice.

What has just happened isn’t normal, at all. Only - only magic could make such a thing possible!

Arthur looks around, instinctively - scanning for a threat.

He is alone; the corridors are empty as far as he can see, and he hears no voices, nor steps.

Which is good, because no one is attacking him then.

Which is the worst though - because if there is no one around… then the only person responsible for what he has just witnessed must be - is - HIMSELF?!

Arthur gasps again; this time in panick.

His first instinct is denial. But he knows what he saw. And somehow, it just makes sense, doesn’t it?

It’s not the body of the Prince that whoever switched him and Merlin is after. It’s his mind…

Put him in the body of a servant, give him magic, and sooner or later (and most probably sooner) he is bound to die by his Father’s law. What is he supposed to say in his defense? That he IS the Prince, in another body which had been given an ounce of magic on the sole purpose of getting him executed? Who would ever believe him…

In the meantime, the schieming sorcerer must have judged that a servant in his body may be too delighted by the upgrade in status to be a threat to his plans and would gladly unknowingly collaborate, on top of being totally untrained and incompetent at any of his duties.

Then? One only has to kill the King, either by making him ‘ill’ or using the same trick again and - for sure - Camelot is doomed to get wiped out from the map by the first band of Saxons passing by (and most probably enticed to pass by very soon after its King’s death): its only true heir gone, and the supposed one obviously improper to defend it. All of it without casualties on the attacking side, and without anyone knowing how it all came to be, which means no one, even loyal to Camelot, would have a reason to stand against the new regime put in place.

Arthur is more afraid than he has ever been - and he has been in combat enough for that fact to mean something. He feels crushed; defeated, even before the battle - and honestly? He has never despised himself that much. No matter that he has never felt both so unprepared and so intrinsically useless - and not even able to trust himself: surrender is simply inexcusable. Camelot depends on it.

Besides, Arthur owes it to Merlin to fight, right. It’s after all Merlin’s body that’s to die along his spirit. Oh! The villainy, the cowardice in this attack! Use an innocent victim as a vessel to be sacrificed. Sorcerers definitely have no sense of honor indeed.

So. Arthur is angry now. A much more suited mindset, he decides - as long as he doesn’t allow it to blind him. And he won’t. Merlin’s body depends on it too.

Arthur takes a deep breath. He has been taught strategy even before he could talk, right? Time to make a plan of action.

First. He is not as alone as Camelot’s enemy has calculated him to be. He is, in fact, not alone at all. He has Merlin.

Loyal Merlin; not only willing but even devoted to getting back into his own servant body rather than happily playing the prince. Magic familiar and open-minded Merlin - which means Arthur has not only someone who won’t judge him nor fear him to confide in about his new endangering (and in so many ways) abilities, but also someone who might have some basic understanding of it; since he was Will’s friend? Heart-in-the-right-place Merlin: too kind, maybe (but he can at least get aware of it enough in order not to be lead only by it); but naturally just and fair Merlin. Brave, fierce, tenacious Merlin; too reckless though (but again: he can at least get aware of it enough in order not to be lead only by it). Ressourceful Merlin, fast-learning Merlin: he would master his body’s strength, eventually; and Leon would be here to lead the Knights in the meantime… Arthur takes an oath. Even if they fail to find a solution to their problem, Camelot won’t be left unprotected. Come what may; even the worst? Merlin *will* be ready to take his place. Having Merlin’s unique edges smoothed out feels wrong; but it just has to be for show, right?

Second. Well, there is no really second yet; at least not more than what they have already planned. They need to find some books - and pray that they will be useful. And Arthur will just have to be particularly attentive about not repeating the kind of blunder he just did with witnesses present.

Yes. Merlin. Books. Start at the beginning; and with luck, it might just work out in the end.

Arthur cleans up as best as he can, using and wringing his soaked tunic in the buckets, then runs to Merlin’s room for a set of dried clothes. Turning up to retake his place at 'Arthur’’s side while drenched would only draw unwanted attention…

.

So. Basically? Yep. This is a magic-reveal unreveal fic. But. I mean… It’s Arthur? Also: this fic (to me) is canon (fitting) - so it just can’t be a reveal fic. Bonus: it explains too why Arthur doesn’t get the courage-magic-strength trio hint later on. He thinks Merlin is magic; but only because there is some residual trace to sense from when his body had magic (aka this fic), not that he actually has magic still at the time… Arthur can be at the same time very aware yet very unaware, and he can be so very biased and decided to see things his way, no matter how circumvoluted, right? (Also, of course Arthur thinks in fact then that HE is magic in the trio: he was after all the one inside Merlin when his body had magic; and Merlin IS courage - Arthur has such a low self-esteem to start with…)

On a side note: Arthur would actually trust Merlin with Camelot (even despite his limits). If that doesn’t tell you all there is to tell then I don’t know how to express it. *SIGH* *GROSS SOBBING* (Gwen though is  innately  made to be Queen - but Arthur doesn’t know that yet. He isn’t wrong about Merlin though - for Arthur’s memory? Merlin would do his best to be a great King too, you bet…) *GROSS SOBBING AGAIN*

.

VIII. MERLIN’S CHAINMAIL (ARTHUR POV)

“Merlin! My boy! You’re soaked! Did you provoke Arthur again and end up under the well for it this time?”

Great. Gaius sounds half amused half concerned. Does actually *everyone* think him to be a brute?

Well; nevermind. Merlin knows better; for sure - and that’s what matters. Merlin is never backing away, Merlin is never really complaining nor saying no; Merlin just watches him with mirth in his challenging eyes: I dare you. Of course Arthur HAS TO then… It’s like… kind of a private wordless conversation only the two of them understand. But honestly? Arthur wouldn’t trespass Merlin’s limits - if anything, Arthur would probably even feel guilty, if Merlin ever made one known…

But then, Gaius is patting his shoulder, pushing him towards 'his’ room; and Arthur is stunned silent, as he can’t help but relish on the (for him unusual) affectionate paternalistic small gesture.

“Get changed. Get warmed up. You’ll tell me later. I haven’t heard the bell signaling the end of the pleas, it is already so late? I’ve just finished Sir Kay’s potion, and it should be drinken warm, as you know; so I’d better be on my way. We’ll prepare Uther’s draught and the balm for Little Kathleen’s knee when I’m back. Also, I’m afraid I’ve ruined my coat; if you could work your magic on it next time you’re mending Arthur’s clothes, I’d be very much obliged?”

And then Gaius is gone, and Arthur is still stunned, but now for another reason - it was but a polite turn of phrase, of course, and Arthur knows Merlin just isn’t capable of miracles, as proven by the state of some of his shirts - beyond mending; but Gaius would better not use some idioms that carelessly around the palace - who knows who might hear and takes things the wrong way… Arthur shakes his head as he hurries to change, feeling sorry for letting Gaius down, but not planning to stay around until Gaius comes back - he wouldn’t know anyway how to prepare his Father’s nor Kathleen’s medicine, right…

Arthur opens Merlin’s cupboard.

There are only two folded set of clothes (neckerchief included indeed), and Arthur just takes the one on top.

He’s about to close the door when his eyes fall on Merlin’s chainmail.

/

The first time Arthur had told Merlin that he had been assigned to lead some patrol, Merlin had right away asked:

“When do we leave?”

Arthur had been surprised, then had tilted his head, apprehending Merlin while explaining that coming along was to be Merlin’s choice; and not per se his duty as palace manservant. They usually asked for volunteers; there was extra coin to be earned and such.

Merlin had only repeated:

“Sire; when do we leave?”

Arthur had been surprised again, but definitely pleased:

“Tomorrow at first light.”

“I’d better start packing right away then. What do you need?”

After having listed their necessities, Arthur had mentioned that he would have a chainmail sent to Gaius’s for Merlin to wear. Merlin had countered that he had no wish for carrying extra weight around as it would only slow him down in his chores; and that he would rather wear his everyday clothes. Arthur had said it was folly to go unprotected - they would patrol the borders, and thiefs and saxons could fall on them - and Merlin had finally relented some and agreed to wear a chainmail he would self adapt as he wished above some clothing but under his tunic. Arthur had been suspicious when Merlin had turned up the next morning without even a cap showing out, and had actually moved his neckerchief aside to make sure Merlin was wearing metal under his tunic…

/

Without hesitation, Arthur takes the chainmail out too, deciding he should wear it under his clothes. After all, the longer Arthur might succeed in hiding his new abilities, the more chances there are that the one responsible for their troubles might choose to turn to more expeditive measures of his own. Killing a servant might go unnoticed for awhile, and would work just as well in case whoever had planned this got tired of waiting for Arthur to betray himself and get executed. Which means that Merlin’s body is just walking around as a mark waiting to get hit… and Arthur should do his best to protect it. Merlin’s chainmail is barely worth its name; but it does cover his chest, belly and back, at least.

Arthur makes it back to the Great Hall right on time for the end of the pleas. It was the moment they had planned to stage for Arthur’s injury; but Arthur discretly but authoritatively signals 'no’ with his head. It would be too risky; what if while falling he instinctively uses magic again - in front of the whole court? Merlin gives him a curious look but follows his cue anyway, thanksfully. There is still enough time to create an excuse before training; and they can still tell he fell even without witnesses anyway. It would have been a nice added touch at make-believe, but Gaius vouching for them should be enough on its own, right?

As they walk in silence back to Gaius’s quarters, Arthur feels Merlin’s eyes upon him, boring and questioning. So when they pass by his chambers, Arthur takes the opportunity for privacy. Once behind closed doors, Arthur leads them to the most private corner, as far from the door as possible. Then he takes a deep breath, and turns towards Merlin to explain… everything.

He hasn’t got the time to start though before Merlin hushes out, worry evident in his voice, pointing to Arthur’s side where a hint of metal is visible if you pay attention - and Merlin always pays attention, doesn’t he:

“Sire? Why are you wearing my chainmail?”

.

AN: It’s canon after all that Arthur doesn’t force Merlin to come along - he lets him leave before Camlann, right? But yes, this is just me giving some sense to the 'just let’s Merlin accompany us everywhere without any kind of protection’ unacceptable general policy. So. Merlin *has* some protection. We just don’t see it. Okay? And the few times he’s actually in armor on patrol, it’s because they need a decoy or something… Also, just so you know: Merlin of course thought that Arthur would probably think that he didn’t want to be seen in a chainmail because he didn’t want to look like a soldier in order not to seem a danger nor a target, but Merlin just couldn’t care: he HAD to be an unconspicuous nobody - it made it easier to protect Arthur with his magic if no one really paid attention to him. And to end with a cute note: whenever they ride out ? Arthur always checks that Merlin wears his chainmail - a fact Merlin can’t help but always secretly revel in…

.

IX. REVELATIONS (MERLIN POV)

Arthur looks anxious - which only makes Merlin worry more.

“I found out… why I was put into your body. I’m sorry, Merlin. I wear your chainmail because your body is in great danger; and it’s all because of me… again. ”

“Wha-”

Arthur cuts him with an imperative gesture from his hand, voice hushed - even though it echoes in Merlin’s ears like a shout:

“I have- I mean you have… Magic!”

Merlin’s breath catches; panick rising. Arthur knows! Arthur knows?

Arthur seems to read his struck expression though as simple denial.

“Yes, Merlin; you heard right! Magic! I saw water and wood floating above my head - floating, Merlin! - That’s the only way to explain it! But I have no idea how it gets triggered, I have no idea how to control any of it - I fell and it happened, I guess, instinctively? Now you understand why I couldn’t have us stage a fall… If people find out? *When* people find out? My Father will have me - YOU - beheaded!”

Merlin’s eyebrow furrow. He doesn’t understand. If Arthur knows he has magic? How come Arthur looks *contrite* instead of angry; afraid *for him* instead of afraid of him? Not that Merlin is complaining about the fact that Arthur obviously doesn’t wish to see him beheaded, of course; his evident worry is even heartwarming, in a way… but heartbreaking, too, as Merlin can’t help but feel that Arthur’s reaction must be induced by some reason that he doesn’t comprehend yet but that has little to do about him having magic at all…

Arthur then fully explains his theory about their attacker using his body to get to Camelot by erasing Arthur, then Uther, and marching against a Camelot lead by an unprepared servant playing Prince. Merlin is shocked, and shaken. Because indeed Arthur’s reaction isn’t about him having magic at all, but about Arthur feeling responsible for his body’s impending doom. But what hurts the most yet is the heavy guilt that settles upon Merlin’s chest - crushing, constricting, inescapable - as he realizes that in fact everything is his fault! Arthur’s thinking may be flawed on one account; but the rest of it makes sense, indeed. And so Merlin cannot deny that Arthur has been targeted and put into his own body because whoever did this actually knows that he has magic.

And so Merlin feels panick rising again, and even worse than before. It is already complicated enough for Merlin to hide his powers - and he has had practice at it since his birth. How could Arthur ever successfully hide them for long… And to think that *HE* might be the cause of Arthur’s death? It’s worse than anything; worse than everything. And it’s devastating. Merlin can’t hold Arthur’s gaze anymore.

Arthur probably thinks he is overwhelmed by the surprise of his body being a target though.

“And I’m sorry - again, Merlin - but I can’t go and hide at some random remote place until I’ve worked out how to subdue it at least, if not suppress it. There is no time. I can’t leave Camelot; not when it’s so endangered.”

Merlin feels like screaming: Arthur shouldn’t apologize; Arthur shouldn’t feel guilty - It’s all on him!

“It’s all right, Arthur. I know you’re right: we have to stay here. After all, our best shot to end this mess is to find guidance in some books; and our best shot to find said books is staying here.” (Also, you bet Merlin isn’t willing to leave Camelot either because he is going to consult with Kilgarrah… Merlin had planned to go to the Great Dragon at the first occasion right when he had realized they had switched bodies; but he now can’t help but wish for the night to come even sooner.)

Arthur looks surprised by Merlin’s easy acceptance as he lets out: “I was going to point that out too?”

Arthur seems to hesitate an instant, taking a deep breath; but then, probably finally enticed by the fact that they still are on the same page apparently, he hushes out words that Merlin had never imagined he would ever hear, even in his wildest dreams.

“Now that’s settled… Do you have any idea that might help me keep it in check? I mean… Back in Ealdor? Did your friend Will maybe ever share something with you that we could use? Anything?”

Merlin’s mouth falls open; but nothing comes out of it. He realizes just how surreal it must have been for Arthur to utter those words. But Arthur looks decided, as always. He means it. And that’s when Merlin realizes Arthur is in fact ready to *learn*. Arthur still doesn’t trust magic, and definitely doesn’t trust his magic now that he has some; he only sees it as a treacherous condition. But he is willing to face it outright, instead of wishing or pretending it isn’t even there to start with. And Merlin realizes that this isn’t only proof of Arthur’s mighty heart; but that it also might actually be their saving too, with some luck?

And so Merlin just HAS to take a chance. Anyway, Arthur *needs* him; and how could Merlin ever let him down to start with… Besides, what if it made Arthur realize that magic isn’t only to be feared; that magic can be good, too, actually?

“Maybe you shouldn’t learn how to keep it check, but how to have it *work*?”

Arthur opens his mouth now, either in shock or to retort - or both; so Merlin hurries to push his point.

“Hear me out, please. Even when we do find an helpful book? The spell we’re under must be very powerful - I mean, have you ever heard or thought this could even be possible? - so we might still require magic too in order to perform whatever will be mentioned in the book? So yes, your new abilities are supposed to be our doom; but maybe we can turn them to our advantage? You have MAGIC, Arthur. If you can control it and use it - on your terms? Maybe that’s just what we need to solve our problem?”

Merlin waits. And Arthur isn’t taking the opportunity to repel his idea. Silence goes on; and still, Arthur isn’t refusing. If anything, he looks… thoughtful, even if doubtful. But there’s resolve, too; and maybe, even, a spark of hope? So Merlin just takes the final plunge.

“As you said… I might have… some basic notions about it? It’s worth a try, Arthur. What do you say?”

Merlin’s heart is pounding so hard it’s going to break his chest for sure, as they hold gazes for a long time - Merlin silently pleading for Arthur to just trust him. Then Arthur gives him a firm nod.

“I say this is probably folly but we have to try, indeed. So. You train me? And I train you.”

Merlin tilts his head, unsure about the second part.

“There are things I want to teach you, Merlin”, Arthur explains; pleads even. “In case we stay stuck in each others body no matter what we try; in case your body should- I know it’s a lot to ask, especially as I apparently keep making your life a hell just by existing? But will you please let me prepare you to take my place, if necessary?”

Merlin’s breath is knocked out of him. Arthur would trust *him* with *Camelot*? But Merlin cannot even contemplate it. Arthur cannot be gone; musn’t be gone; will not be gone. Merlin’s voice is fierce as it simply refutes the prospect.

“Sire, it won’t come to-”

Arthur lays a hand on his shoulder.

“It would mean a lot to me.”

And what can Merlin do then, but promise - and mean it:

“Anything, Arthur.”

The hand leaves his shoulder, but Arthur’s eyes stay fixed on him.

“Thank you, Merlin.”

And Merlin takes another oath - this one to himself. They’ll work it out. They’ll make it work. They will.

.

They both feel guilty for endangering the other more than they are worried about themselves *heavy sigh*

.

X. TRAINING (MERLIN POV)

Gaius is working on finishing Uther’s draught when ‘Arthur’ surprisingly comes in without knocking.

“Sire? Do you need-”

Merlin hasn’t prepared a speech on their way (how do you announce this anyway?) So he just blurts it out, as Arthur comes in after him and takes place at his side.

“We need your help, Gaius. Our bodies have been switched. (pointing to himself) Merlin. (pointing to his body) Arthur. We awoke like this this morning.”

Gaius looks stunned - of course. Then, for the shortest of times, he looks unconvinced; but this is after all Camelot, where strange things always happen, indeed - and not only Arthur would most probably have better things to do than playing along with Merlin’s pranks; but also Merlin wouldn’t have the heart to make *such* a prank to start with - not to him. So Gaius looks concerned now, gaze jumping with worry between Merlin and Arthur, holding Merlin’s eyes with a question in his eyes - and Merlin knows what’s worrying him.

Merlin can only give Gaius though a fragile smile to assure him that he is all right along with an apologetic look in return. He isn’t sure Arthur would want anyone else knowing about the magic too, so he will have to wait for a private occasion to explain everything to Gaius. For now, he just sticks to the plan.

“Arthur is expected to train soon, and we thought you could give us a way out of it. No one should be aware that Arthur isn’t Arthur until we’ve fixed this.”

Gaius doesn’t even hesitate.

“Of course (nodding to Merlin). I’ll go and tell you injured your sword arm (nodding to Arthur).”

/

Gaius goes out, mentioning coming back later to make Little Kathleen’s balm. Once the door closes, Arthur says he wonders what Merlin has in mind for 'training’. So Merlin decides he should help them both at once.

Merlin looks around for something basic, and his eyes light up when they fall on two bowls - not only basic but also potentially useful, if it works? He sets them on the table in front of Arthur: one stays empty, the other one get filled with water.

“Here. Try to make the water move into the other bowl.”

Arthur looks at the bowls, then at Merlin; incredulous.

“I’m not sure- I mean, even if I make this work, how am I supposed to put ourselves back into our bodies that way? How can I perform whatever must be performed if I am out of the performing body?”

“This is just a beginning, Sire. This is just a way to have you… feel your magic? Find it, and use it as you wish, when you wish. But if you need a valid reason, I promise this will be useful too, when you’ve mastered it.”

Arthur seems perplexed. Merlin confides, voice low as if sharing a secret: “We won’t have to disturb the fish anymore?”

Arthur is apparently too stressed out to even smile, sadly. But he gives Merlin a satisfied nod. “I’d better start trying then, huh.” A helpless sigh follows though. “Any hint about how to feel it to start with? Where to find it?”

Merlin hesitates. Not only because he wonders how much he can tell without Arthur realizing he knows too much, but also because he struggles about how to put into words what he has always simply felt. He has never had to search for it; it had always just been there. But maybe he can describe it by telling what he doesn’t feel, since he’s in Arthur’s body?

“Don’t search for 'where’. It’s not in one place; it’s everywhere. Not only in your body; literally everywhere - earth, air, water, fire. Like a… warm… tingling… flow? When you’ve found it, try to concentrate on it, focus on it, in order to direct it towards what you want - with your hands, your eyes, your voice; whatever works?”

Arthur’s brow has only deepened from the explanation, and Merlin can’t help but sigh:

“I’m sorry. It’s gibberish. I don’t know how to explain-”

“What you can’t know”, Arthur cuts him with a wave of his hand. “Of course. I have to find it on my own. Thank you for trying, at least?”

And so Arthur goes to sit at the table, facing the two bowls, while Merlin starts on the balm for Little Kathleen’s knee (hopefully for the last time, as her recovery seems to be going well, thanksfully) - both to feel useful and to give Arthur some kind of privacy. His moving around though must be disturbing, because Arthur switches place, turning his back to him. But it gives Merlin the freedom to check over his shoulders from time to time without risking to meet Arthur’s eyes.

/

This isn’t working though, Merlin can tell, by the time he’s done preparing Little Kathleen’s balm (he waits for Gaius to check if he got all doses and ingredients right though before finishing; he has only done it once) and a sleeping draught (for the guards guarding Kilgharra’s tunnel) (Gaius has had him prepare Morgana’s draught several times already, and has explained how to up the doses while keeping it safe): Arthur looks nothing but tensed, when he would need to be relaxed in order to feel… Trying too hard is nothing but counterproductive.

That’s when Merlin realizes he’s been going at it the wrong way. Arthur is not him. Arthur is *Arthur*. And when Arthur is at an impasse and needs a clear head? He trains. Activity helps him focus. Exhaustion helps him forget. To find his inner ground, Arthur must be physically busy; not sitting hunched over a table looking at two bowls.

Merlin eyes again his surroundings: spoons should work. Gaius has them in lots of size, both wood and metal. Merlin bundles them all in his tunic, and calls for Arthur as he passes in front of him.

“Let’s try something else. You can work on the water later on.”

Arthur’s eyes follow him questioningly up the stairs. Merlin sets his collection down, then holds a spoon up.

“Try to stop it from falling to the ground.”

Merlin let the spoon fall. It hits the ground, of course; but Arthur surely looks now interested by the new challenge. Merlin smiles, and lets another spoon fall.

After five rounds, Arthur gets up and gathers the spoons before handing them over to a crouching Merlin, instead of having Merlin going down, and up, and down, and up… A few rounds later still, Arthur picks up a spoon he has missed on his way and calls out for Merlin to catch it instead of walking back. Merlin misses it though, and it lands on his arm. And that’s when Merlin thinks his new idea can even be perfectioned.

He takes the offending spoon off the ground and holds it at the ready, eyeing Arthur, waiting for him to understand. And Arthur does, of course.

“Merlin? Are you threatening me with a spoon?”

Merlin grins wolfishly. He throws, and Arthur easily dodges, laughing.

“How long have you been waiting for such an opportunity?”

“Forever?” Merlin lies, before throwing another spoon, which Arthur blocks with an upraised arm.

Merlin can’t help but scowl: “You’re supposed to make the spoon divert its course; not block it or move out of its way.”

Arthur has actually the decency to look apologetic: “I know. Sorry. Reflexes.” Then he smirks. “But please, indulge yourself and do go on.”

And Merlin does. And it’s glorious somehow, how they are suddenly both intent and carefree, spoons clattering everywhere on both sides as Arthur now throws the spoons back to Merlin too. Hits land on both sides too, as they both throw quicker and harder.

/

At some point, the door opens and a spoon hits… Gaius.

“Sorry”, Merlin lets out, hurrying down to check he hasn’t hurt Gaius.

Gaius looks at the both of them with incomprehension, but Arthur explains even before Merlin has even opened his mouth.

“We’re actually working on something, Gaius; not destroying your chambers. (the slightest hesitation - but if Gaius is to be their ally then Arthur has decided he should know, well, everything, it seems) I have been jinxed too, on top of the body swap. It appears I have been given… magic; to be my doom - and well… Merlin’s body end.”

Gaius looks sort of disapprovingly to Merlin at the M word, but his gaze softens somehow, even though it turns outright anxious, as Arthur further explains his theory about their attacker’s plan.

“So, now you know it all, Gaius. And we also need your help for something more than giving me an excuse not to train… We need… information. I thought… You and Geoffrey go way back, right? Maybe you could persuade him to lend you a few special books?”

Gaius nods, eyeing Merlin.

“I’ll see what I can do.”

Arthur nods back.

“In the meanwhile, I have to understand how it works, in order to prevent anyone finding it out until we’ve found a way to lift the spells?”

“Of course. Just let me take what’s necessary and I’ll leave you to it.”

Merlin then shows Gaius his previous work (safely tucked away in his room after the first round of spoons throwing - and yes, it also gives Merlin the opportunity to silently let Gaius know where his book is hidden, so that he will be able to retrieve it later on and present it to them as coming from Geoffrey or something). Gaius proudly tells he got everything right and gathers it all into a bowl.

“I can finish the balm in the kitchens. I’ll be back to bandage your arm though later on, Merlin; our Prince is supposed to be injured, and our King will want to check on his son right when he comes back from today’s hunt and hears about it.”

/

They start again where they had left, but nothing magical ever happens still, and after some time, Arthur exclaims in annoyance: “Maybe you should use knifes?”

And Merlin understands the logic; but Merlin just… can’t. He counters with an idea of his own.

“Maybe I should tie you up on a chair so that you can’t dodge them anymore?”

And Arthur gives a shrug… then goes to sit.

Merlin finds some rope and tie Arthur’s legs and chest to the chair. He hesitates, then tie only Arthur’s left hand behind the chair.

“In case it helps if you aim”, he explains.

Then Merlin is facing Arthur again. The spoons hit; one at a time. But Arthur glares at them - never at Merlin; and so Merlin goes on.

And then… (they’ve been going at it for so long that Merlin has stopped counting rounds) a spoon finally *stops*, mid-air, before simply falling vertically to the ground instead of keeping its course.

Merlin’s mouth falls open as Arthur keeps looking at his hand in wonder.

“Did you see-”

“Yes!” Merlin can’t help but shout happily.

Arthur meets his eyes, looking even more resolute than before.

“Again.”

Arthur doesn’t stop lots of spoons (yet, hopefully); but he regularly stops or redirects one.

And then, Arthur looks at his hand, and then at him, both in wonder.

“It *is* warm!”

And that’s definitely progress in the right direction, if Arthur has *felt* it.

The look they share is actually hopeful, for the first time since this began.

/

After some time, Merlin decides they should take a pause. Arthur still has to prepare him for tomorrow concil too, right?

So Merlin starts asking about what he should know for the coming concil right while untying Arthur’s legs.

“Will was definitely lucky to count you as a friend.”

Merlin’s eyes jump to Arthur’s in surprise; not only from the compliment, but also from the repeat mention of Will. Before today, Arthur had never mentioned Will, since they had left Ealdor.

Arthur doesn’t notice. Or - more probably - Arthur notices but goes on anyway; he is nothing but brave after all.

“I never had a friend, but I believe friends are supposed to help each other out, right? And well, you’re good at helping out, is all. And I know I have little to no right to talk about him; but I think you should know that I’m grateful, and that he has my respect, Merlin.”

Merlin is utterly speechless. Arthur has finally found, it seems, a way to shut him up. And to get him teary-eyed to boot. Merlin lowers his eyes to the ground.

“I believe he was a kind man. I mean- He must have been, of course - I don’t see you befriending someone cruel or-… But even taking only my own judgment into account?  I suppose he could have probably done more harm than a whirlwind. But he didn’t. He wanted to defend, more than to attack; there is nothing malicious in that. It’s unfair his kindness caused his end though. Sometimes, maybe, it’s necessary to be the first to strike; even if you can never know how actually well-founded that decision then is; and you have to live with it.”

Merlin feels guilty, again. And angry. Does Arthur have to remind him that Will’s death is his fault? For all his magic? Merlin is indeed nothing but *useless*, indeed. He works on finishing to untie Arthur as quickly as he can.

Arthur must have read the inwards directed angry shake of his head for something else though, as he lets out a somewhat apologizing sigh.

“I realize I’m very biased, Merlin; because if he had used his powers in a harmful way? I would probably have been the first to accuse him of being a monster. (pause) But he hasn’t. And I haven’t searched for any magical powers - yet here I am.”

Another sigh; nothing but helpless this time. So Merlin *has* to look up. He has failed Will. He won’t fail again. He won’t fail Arthur. Arthur’s gaze is lost inward though.

“Sire”, Merlin pleads, hunting Arthur’s eyes then locking onto them.

Arthur fidgets; Merlin can’t help but note the oddity and rarity.

“I just- I realize this is the strangest thought to have while we are yet again under a sorcerer’s threat, but… Maybe not everything is always as black or white as I’ve been told all my life? Maybe not everyone with magic is actually evil? … Will? Me? … Again, maybe I’m only very biased. Because who knows then how many might have been wrongly punished- (a heavy sigh; wondering and remorseful this time, as Arthur shakes his head, apparently thinking about his Father’s deeds as his own - as he has allowed them to come to pass without opposition for so long…) But I *have* to believe that it’s possible to have magic without being corrupted by it. I mean… What if it sticks? Even after…”

“Arthur”, Merlin starts again as Arthur’s voice falters - even though Merlin still has no exact idea about what he wants to say; at least not in what order. Arthur’s genuine regrets and palpable fear are boring a hole right through his heart; just as Arthur’s words about Will and about magic (it is a step in the right direction; no matter how small) spread warmth through it too. Merlin’s possible soothing or grateful words in return all feel just tangled and messy and worthless and not enough and-

Arthur clears his throat, then softly exhales as he finally looks away: “I don’t really know what I’m trying to say, Merlin. Except… I’m glad you’re here?”

Maybe Merlin has conveyed what he couldn’t put into words through his eyes after all…

/

And then Arthur stands up, and his voice is back to his usual, assured tone.

“Now. One problem at a time, right? About the concil tomorrow…”

And Merlin listens, you bet.

.

So yep, yet another 'I’m glad you’re here’ (MY HEART). And spoons just had to be involved, indeed (I’m weak, blame 5.03)

.

XI. DESTINIES ARE TROUBLESOME THINGS (MERLIN POV)

Merlin can’t help but be on his guard. He has no idea, he realizes as he enters Kilgarrah’s cave after having successfully put to sleep the guards in front of it (after a shortened dinner with Uther and Morgana), about how the Great Dragon will react to a stranger’s presence in his lair.

But Merlin needs some guidance; and so, he calls out to him…

/

“Young warlock, what has happened to you?”

“You know it’s me?”

“Of course. Even though I am surprised indeed by your current appearance.”

“Arthur and I- Our bodies have been switched.”

The Great Dragon straightens up.

“So this is Uther’s heir’s body?”

“Yes. And I need - we need - help. Do you have any idea about how to reverse such a spell?”

“I do not have such knowledge. I can only tell you what you already know; that there is some very powerful magic at work here. (pause, tilting his head) But maybe you are not supposed to reverse it to start with.”

“Excuse me?”

“You are now *literally* two sides of a coin - both at once in the same body. Maybe this was the intent of the prophecy all along.”

(helpless, shocked sigh) “No.”

Merlin cannot believe his ears. But the idea is not only incongruous; it’s also outright enraging, and simply *impossible*.

“No”, Merlin repeats, firmly this time; a denial.

“You would throw away the opportunity to fulfill your destiny? You would carelessly discard the chance to bring forth the greatest time for Albion?”

Merlin doesn’t even flinch under the Dragon’s ire. *Arthur* is his destiny; and only Arthur. Albion’s welfare is in Arthur’s hands. And Arthur *will* be its greatest King; not Merlin. The notion only makes him sick. It’s not even about a possible guilt at cheating Arthur’s crown (which he doesn’t want to start with). It’s simply that Merlin wants - needs, and will not (and never) accept anything less - Arthur to be Arthur, intrinsically. Besides, Merlin knows the burden of pretending already; and he wouldn’t wish for anyone, and certainly not for Arthur, to have to shoulder it too. How can Kilgarrah not realise any of it?

“This just cannot be the way. It only feels wrong.”

“You should at least think about it, Merlin.”

“It is all decided. I cannot and will not abide to the belief that this masquerade could ever be our true fate. And if you don’t - can’t or won’t - help, we’ll look for a solution on our own - no matter how long it might take.”

They hold each other’s gaze; and Merlin won’t relent.

“I can only hope you will not come to regret your choice, young warlock”, Kilgarrah finally says as he flies away.

/

Merlin is still fuming as he enters Arthur’s chambers.

His fingers itch, longing to search through his spells book. He hasn’t had yet the opportunity - between being a Prince taking most of his day, and Arthur being at his side when he had been off duty. Unfortunately, it will have to wait until tomorrow - it would look suspicious if he went out in the night.

So. He should rest. After all, a clear mind will be necessary in the morning, both for council and for finding a way to break the spell they’re under, right?

Only looking at the bed though makes Merlin’s entrails twitch in disgust. This is wrong indeed; and will never feel otherwise. And no matter how comfortable that bed is, Merlin now knows (he might grow understanding of Arthur’s lack of will to leave it on some mornings from now on, huh), you bet he will never even contemplate sleeping in it.

Merlin makes his bed for the night on the floor, wondering if Arthur has been able to fall asleep yet.

.

Bear with me. The Dragonlord bond is an intrinsic link between souls, which is why it isn’t affected by the body swap. Whereas magic inhabits everything it’s in, and is therefore by nature anchored in physicallity. It explains too somehow why magic in general can be learned/found, but that the Dragonlord bond can only be inherited. Oh well, it makes sense in my head, at least…

Also :( I’ve really hurt myself with Kilgarrah’s last line :( Because of course Merlin *will* wonder about this, *for centuries*, later on (my heart:(). Anyone willing to hold me while I cry, pretty please?

.

XII. SOMETIMES, YOU PUZZLE ME (ARTHUR POV)

“Sire, you should rest.”

“Just a little bit longer, Gaius. Until the candles are out.”

“As you wish.”

A respectful bow; then Gaius is on his way to Merlin’s room, giving Arthur space and quiet - and only when the door closes does Arthur realize that he just kicked an old man out of his own bed?

Well, let it be worth it then, right! Arthur closes his eyes, breathing deeply, trying to connect with the magic inside. He actually feels it, now that he knows what to search for. He has no idea still though about how to have it work, apparently…

He can’t help but wonder briefly if Merlin has been able to fall asleep yet, before concentrating again on that damn water…

/

Arthur awakes, wincing, still at the table. Gaius has left bread and jam out for him, and he hastily eats before running out to help Merlin prepare (both physically and mentally) for concil. It is still earlier than he thought it was it seems, luckily. The kitcheners have just begun their work; Gaius does prefer to pick herbs in the early morning indeed. Arthur takes some bread and jam for Merlin, as little else is ready yet, and makes for his chambers.

When he gets in, Merlin is putting his clothes on. He is nearly finished; only the tunic and the coat are still laid out on the already made bed. Arthur approaches to help him with fastening the ties, and so notices the spread-out covers and pillows on the floor behind the bed.

“Merlin? Did you actually sleep on the floor?”

“Well, that bed of yours is way too soft”, Merlin retorts (even though Arthur DID see him getting out of said bed just the morning before: it hadn’t been too soft apparently, when Merlin hadn’t known it was Arthur’s, huh…), trying to cover his embarassment before walking out, heading for the stream. And Arthur has no choice but to follow, shaking his head while wondering if there would ever come a day when Merlin would stop astonish him…

/

After having left Merlin at the concil’s door, Arthur gets back to his bowls and water.

He has no progress to show though still when Merlin comes in and gives him a very detailed summary of what has been discussed. Arthur is thankful - even though he hasn’t doubted Merlin’s capacities (Merlin acting like an idiot or being clueless about etiquette doesn’t mean Merlin isn’t clever, indeed).

Then Merlin takes up the spoons, and helps Arthur train more actively about his magic again. They are both pleased to discover that Arthur is now able to divert about a third of the projectiles.

“Why am I getting better with the spoons and not making any progress with the water?”, Arthur wonders aloud.

“I am certain you will figure it out, Sire”, Merlin only has time to pledge as Gaius walks in, holding out a book and placing it on the table - which definitely ends the spoons training as Arthur and Merlin come to gather around it.

Gaius and Merlin seem to be waiting for his cue, so Arthur is the one to open the book, feeling both hopeful (this book might contains the answer to their predicament!) and worried (what if this book is simply full of evil?).

Arthur starts to read silently, both cautious about eventual passers-by overhearing and unwilling to invoke any probable further disaster on themselves by reading what could be spells aloud, a finger tracing along the opening line.

“Magic is potential, and possibilities. Its use is a choice, and a responsability”, Merlin whispers, echoing what Arthur is reading.

Arthur is stunned, and can’t help but blurt out in disbelief, turning his attention on Merlin:

“You know how to read?”

Merlin only shrugs.

“Sure I do. My mother taught me, along with the other kids from Ealdor. You know, the fact that it surprises you that a peasant can read probably says more about Camelot’s rampant illiteracy than about me?”

And Arthur can only admit it’s true:

“You’re right. We should probably ask Geoffrey to organize something about it.”

Then Arthur points at the book:

“But of course you may read along; it concerns you too. It might be safer though not to read aloud, you know…” (gesturing around, waving a hand)

“I can do that too”, Merlin assures.

So Arthur sits down on the bench, motioning for Merlin to do the same next to him. Gaius sits on the opposite bench - ready to give advice or help if needed; or ensuring they do not damage the book before it gets returned to the vaults?

They read further in silence, two pairs of eyes following the path of Arthur’s finger.

Arthur quickly realizes though that the first part of the book focuses on magical creatures, and skips through it - it might be handy, but it’s not what they need at the moment (he can’t refrain from briefly pausing though passing by the unicorns page)…

Then they reach the spells section, and Arthur turns tense.

And rightly.

When he understands what the first spell is about, he can’t help but shout out, pushing the book away:

“This is what Valiant did! How can we trust this book of tricks?” - this is nothing but evil indeed.

.

Of course Merlin just HAD to read that opening line aloud while in Arthur’s presence, huh…

[kristinsimmons]

The EBM Wars: Manufacturing Equipoise (Part 1)

By ANISH KOKA

The phone rings.  It’s not supposed to be ringing.  It’s 2 am.   The voice on the other line is from an apologetic surgery resident.

Resident: There is this patient..

Me: Yes, go ahead. Please.

Resident: He’s tachycardic.

Me: How fast?

Resident: 160 ?

Me: What’s the blood pressure?

Resident: 130/90

Me: Rhythm?

Resident: An SVT I think.. I gave adenosine.  Nothing happened

Me: Audibly groaning.  I’ll be in..

Forty five minutes later I’m at the bedside of a decidedly ill appearing man.

I want to be triumphant that his heart rate is only 145, and a quick glance at the telemetry monitor above his bed uncovers juicy p waves in a cadence that suggests this is no primary electrical arrhythmia.

Something is very wrong somewhere – the heart in this case is an innocent bystander being whipped into a frenzy to compensate for something.

At the moment the whip is a norepinephrine infusion being used to keep his blood pressure up.

I ask the nurse if the amount of norepinephrine infusing has been stable.  She replies that his dose has been slowly escalating.

Eureka! I think – the heart rate response in this case is being driven by the norepinephrine – a powerful adrenaline that acts on beta receptors and alpha receptors within the body that increase heart rate and constrict the blood vessels to raise blood pressure.  Fix the cause of the low blood pressure, come down on the norepinephrine, and perhaps the heart rate would be better.

But it turns out this particular post surgical patient doesn’t have a medical cause of low blood pressure I can find.  I cycle through cardiac ultrasounds, blood gases, steroid and volume challenges, and try inching down on the norepinephrine.

All of it is to no avail.  I’m growing more and more convinced this problem is surgical in nature. Perhaps an infarcted piece of bowel?  All I know is that the man acts like he has no peripheral vascular tone.

An interesting thing happens shortly after.  The norepinephrine drip runs out.

As one nurse runs to get another bag from the pharmacy – a quick cascade of events unfolds.

The brisk upstroke from the arterial line that marks the pressure wave generated with every beat of the heart starts to dampen.  The color seems to visibly drain from the patients face, and he begins to complain that his vision is getting blurry.  His systolic blood pressure is 70 – an almost forty point drop within a minute of the norepinephrine running out.

I call for help.

I try to keep a level tone.  Project control, not panic.

“Open the code cart, I need a half a milligram of epinephrine”

“You’re going to be ok, sir.  Hang with me.”  I squeeze his hand.

He closes his eyes

The code cart – a fully stocked cabinet on wheels with almost everything you need for resuscitation efforts – is wheeled into the room. The epinephrine vial is handed to the nurse, and hurriedly pushed.

Within seconds, I can see the blood pressure and heart rate rise.  The patient’s grip on my hand relaxes.  Or maybe its my grip on his hand.  I forget which.  His vision returns to normal as his blood pressure ‘normalizes’.

Of course nothing has been fixed.  Why his blood pressure remains low continues to be a mystery.  The bag of norepinephrine soon isn’t enough even at its maximal dose.  The same scenario (hypotension -> pallor -> vision loss ) recurs 30 minutes later, and another bolus of epinephrine aborts a rapid spiral towards pulselessness.

This case is an anecdote, the weakest possible form of evidence apparently.  Yet there are powerful lessons learned that night. Blood flows in pulsatile fashion with a certain pressure head.  Below some threshold of pressure, the end organs of the body stop functioning.  Agents that are active on peripheral vasoconstrictor receptors (norepinephrine, epinephrine) raise blood pressure.  Epinephrine was keeping this patient alive while a team worked to understand why his blood pressure was so low.  My suspicion was that he was in something called distributive shock – a catastrophic life threatening syndrome that requires a furious hunt for cause to save the patient.  Overwhelming infection and an even more aggressive immune response renders normally relatively impervious vasculature to be a sieve.  At the present time the therapy is directed towards replacing the fluid lost in the intravascular space and using medications that act on peripheral vascular receptors that increase peripheral tone.

There is, of course, much that isn’t known about this process.  Hopefully it will come to pass that we will arrive at a better understanding of what specifically creates this mileu so our therapies may be more directed.  But for the time being, our solutions are limited by our current, always imperfect understanding of the world.

The culprit in this case was a leak of intestinal contents into the peritoneal space from two pieces of bowel that should have been exactly apposed.  The body had attempted to tell us this very thing with that high heart rate post-operatively.  It took us, the clinicians, some time to translate.

The uninformed prior: Unlearning what has been learned.

For many, medicine has for too long been an imperfect science.  The history of medicine is replete with physicians acting with certainty in a manner that – in hindsight – was ineffective, or even worse – harmful.  Blood letting to allow the release of bad humors is believed to have hastened the demise of the greatest American – George Washington.  The disconcerting part of this is that the physician players were not motivated by anything but the best intentions.  They relied on their experience, intuition and judgement to deliver exactly the wrong prescription.   Intuition fails.  No matter how many patients died soon after blood letting, operating biases didn’t let physicians link the two events.  After all, the patients may have died even sooner if blood letting hadn’t been done.

The idea that medicine had progressed – by the 1980’s – to the point that doctors were not engaged in the equivalent of blood letting came under heavy fire when it was demonstrated a number of standard practices of the time could indeed be ineffective.  Extra beats (also known as ectopic heart beats) after heart attacks were noted in cardiac units to portend a higher risk of dying suddenly.  The obvious approach to this was to use medications that effectively suppressed ectopic heart beats.  Testing this in a double blind randomized control trial did not just demonstrate ineffectiveness, but harm.  More people randomized to suppression of ectopic beats actually died.  It turns out the anti-arrhythmic drugs being used were actually proarrhythmic as well.  The attack on ‘expertise’ that relied on intuition and experience was on, and it was a rout.

Glue ear – a condition that developed in the middle ears of little kids after ear infections  was treated with insertion of a tube to drain that space.  The trial to determine efficacy using a randomized trial to blindly allocate patients to surgery or no treatment?

Negative.

Many of the children turned out to do just fine if you left them alone.  Given the fact that all procedures have a certain complication rate, the lack of efficacy here was no small matter.

And so it went – the populace had to be on guard not just against the afflictions of disease, but against the intuitions of its doctors.

Uncertainty reigned, and in search of certainty, the field fled to the warm embrace of ever greater empiricism.  In the early ’80s from the McMaster University in Canada, David Sackett gave voice to a new sheriff – Evidence Based Medicine (EBM).

“EBM de-emphasizes intuition, unsystematic clinical expertise, and pathophysiologic rationale . . . and stresses the examination of evidence from clinical research. In 1960, the randomized trial was an oddity. It is now accepted that virtually no drug can enter clinical practice without a demonstration of its efficacy in clinical trials. Moreover the same randomized trial method is increasingly being applied to surgical therapies and diagnostic tests.” (Sackett et. al, Evidence Based Medicine)

The premise as outlined is simple – don’t believe anything that hasn’t been tested in a randomized control trial.  The only real evidence is that found within RCTs or in reviews that amalgamated RCTs.

The usual response from EBM experts can be found below in the response to the statement that real evidence may come from outside an RCT.

It is quite possible Professor Francis is right on here about the specific subject being discussed, but the point is that there is an established hierarchy of evidence on display.  The RCT is king, everything else is no better than the court jester.

While an RCT may certainly be better than anything cobbled together at a pub, the conventional parallel group RCT certainly isn’t always King of the Hill.   As nicely expounded on by the prolific statistician Stephen Senn, there are plenty of potential errors the conventional RCT finds itself humbled by.

The clinician may thus feel somewhat mollified about conclusions drawn about the effect of epinephrine in the earlier anecdote.

The idea that real evidence may live outside the confines of RCTs was also countered by none other than the godfather of EBM, David Sackett:

“Evidence based medicine is not restricted to randomized trials and meta-analyses. It involves tracking down the best external evidence with which to answer our clinical questions. To find out about the accuracy of a diagnostic test, we need to find proper cross sectional studies of patients clinically suspected of harboring the relevant disorder, not a randomized trial. For a question about prognosis, we need proper follow up studies of patients assembled at a uniform, early point in the clinical course of their disease. And sometimes the evidence we need will come from the basic sciences such as genetics or immunology. It is when asking questions about therapy that we should try to avoid the non-experimental approaches, since these routinely lead to false positive conclusions about efficacy. Because the randomized trial, and especially the systematic review of several randomized trials, is so much more likely to inform us and so much less likely to mislead us, it has become the “gold standard” for judging whether a treatment does more good than harm. However,some questions about therapy do not require randomized trials (successful interventions for otherwise fatal conditions) or cannot wait for the trials to be conducted. And if no randomized trial has been carried out for our patient’s predicament, we must follow the trail to the next best external evidence and work from there. (Sacket et al, Evidence based medicine: what it is.. )”

Sackett also noted that there were therapies whose ” ‘face validity’ is so great that randomized trials were unanimously judged by the team to be both unnecessary, and, if a placebo would have been involved, unethical”.

In effect, there was always an escape clause to let common sense prevail over EBM.  But as frequently happens in movements, the second generation of followers moves in directions unintended by the founders.  If the safeguards in place involve only areas where equipoise exists, but equipoise is itself determined by fallible judgement, the range of unacceptable experiments becomes very narrow.  This especially applies to new therapies where members of the community not involved in design and development have skeptical prior beliefs.  This is, of course, not a bad thing – it is entirely possible that the usually overoptimistic prior of the developers of a new therapy are farther from the truth than the skeptics.  But it is a major problem if we ask doctors to discard their prior beliefs that are not based in RCTs.  In doing so, we are manufacturing equipoise.  This means travel in dangerous ethical waters for physicians and their patients that is at best unwise, and at worst willfully foolish.

The EBM Wars: Manufacturing Equipoise (Part 1) published first on https://wittooth.tumblr.com/

[atticusblog2016-blog]

New Post has been published on Atticusblog

New Post has been published on https://atticusblog.com/apple-could-release-macbook-updates-soon/

Apple could release MacBook updates soon

According to a new document from Bloomberg, Apple is set to launch up to date MacBook and MacBook Pro models. The corporation should announce the refresh at its WWDC keynote on June 5.

The 12-inch MacBook with a retina show hasn’t been updated in a year. The layout nevertheless works quite nicely so I wouldn’t count on whatever greater than a specification bump.

Maybe Apple goes to feature a second USB-C port. That would be satisfactory because it’s a bit irritating that you couldn’t rate your tool and plug something on the equal time without a dongle. The keyboard isn’t as precise as the one inside the most latest MacBook Pro both.

When it comes to the MacBook Pro with the new Touch Bar, it’s nonetheless quite new however Apple likes to replace its computer systems often with higher CPU options, more RAM, and garage.

In particular, the MacBook Pro overlooked the mark for Intel’s Kaby Lake processors. The laptops shipped with Skylake CPUs, but there’s no motive longer to replace the laptops with the new CPUs.

More sudden, Bloomberg is pronouncing that Apple is likewise considering updating the MacBook Air. Based on Apple’s personal press convention, the entry-degree thirteen-inch MacBook Pro without a touch bar is the perfect MacBook Air alternative.

It’s roughly as heavy as the thirteen-inch MacBook Air, however, it’s still more luxurious. That’s why the MacBook Air continues to be round in the intervening time. But Apple should even pass a step in addition and refresh the MacBook Air with better components. I wouldn’t keep my breath for this one.

WWDC is a developer conference, so Apple focuses mostly on software program information for its developer community. This 12 months must be no extraordinary. You can assume a few information around iOS 11, tvOS eleven, watchOS 4 and macOS 10.12.

At the equal time, builders use Macs each day, all day. So it’d make the experience to spend a minute speaking approximately minor Mac updates. Mac customers are also awaiting modern iMac and Mac Pro fashions. But those gadgets aren’t geared up just yet.

Apple Better Hurry Up On The Holographic Handset Or Have A Horrible And Horrendous Death

Here we are again looking forward to the following release of the Apple iPhone as we have 10-times before, this time we are on iPhone 8, and oldsters are questioning what incremental technology it might have engaging us to upgrade our maximum valued private tech tool. Well, the rumors have it that this subsequent model could have greater FRT or Facial Recognition Technology – allowing it to lock or free up your cell phone definitely by means of spotting your face – the ultimate security. Or, is it? Maybe this takes your personal privacy down a notch? Think on that for a minute.

Meanwhile, I’d want to deal with a more critical trouble, and this is it has been 10-years for the reason that first iPhone, consistent with Google Search: On January 9, 2007, Steve Jobs introduced the iPhone at the Macworld conference, receiving considerable media attention. Jobs introduced that the first iPhone would be launched later that year. On June 29, 2007, the primary iPhone turned into release.

Since then, all we’ve gotten have been incremental gains, smaller, sleeker, bigger, better, faster, more reminiscence, longer battery existence, and many others.? Of path, the adjustments within the starting have been more splendid than the ones of new years, I believe that is due to the fact Steve Jobs demanded it. So, permit me to ask; where is the Holographic iPhone – capable of the venture, and test and document 3-D gadgets? Steve could have delivered it with the aid of now, but Captain Tim Cook is no pirate like Jobs.

Perhaps to answer this question you would possibly need to study up on innovation philosophy and the history of Silicon Valley. Thus, I endorse studying “The Intel Trinity” with the aid of Michael S. Malone former reporter for the Mercury News in Silicon Valley. There is likewise a pleasant YouTube video lecture through Malone and numerous interviews.

Also, there has been an exciting article inside the Singularity Institute online information on February 14, 2017, titled; “Holograms Aren’t The Stuff of Science Fiction Anymore,” via Peter Rejcek which stated:

  How About A Voting App So You Could Vote On Your SmartPhone?

During this final 2016 Presidential Election we referred to a substantial turn-out, however even that changed into only fifty eight.6%, which become a hundred thirty-five.6 million people, however, recognize meaning forty-one.4% of our populace did now not vote. The general range of eligible citizens within the US in 2016 become 231,556,622. What passed off to everyone who didn’t vote? Don’t inform me they failed to care. Maybe we make it too tough, perhaps human beings didn’t want to routinely be signed up for jury obligation. Maybe citizens are apathetic for other reasons – but I ask what if it had been easier to vote, in particular within the presidential years?

We have been discussing this in our suppose tank and one individual referred to that the idea of a smart telephone balloting app, an idea which has been previously floated, wouldn’t just be extraordinary for Federal Elections;

“I think this app could be outstanding for government at the local level! So a good deal may be determined quickly after which applied quickly in a while. I additionally suppose that there could definitely be a window of opportunity to vote after the mass textual content turned into despatched out. I think kind of 48 hours would be proper, just to provide everyone time to do final minute research if important.”

Indeed, in considering this myself, nicely, I like the 48-hours to vote as soon as the app sends out the question as it’s not goodbye corporations can bathe the media with ads, or the media can enter the fray with unique programming, smart flow, just lengthy enough to do a bit of research, talk it over with buddies and family after which “vote your thoughts” – talking of which we sincerely are spoken approximately YOUR MIND, that is why these votes must be kept exclusive and those have to believe that, so no dishonest with the aid of NSA and so on, that records are simply now not transferable irrespective of what.

“Yes, most 13 12 months olds have a telephone, however, I do not assume they ought to vote simply yet. I assume as we become older we analyze more and more about ourselves and approximately how we think our country must be. At the age of 13 in the main each child is still under the political affairs with their mother and father so if we give them balloting rights than its almost like giving adults with youngsters a 2d vote. Thoughts on that?”

Oh on the thirteen 12 months antique aspect, nicely, I did not suggest they might in reality vote, extra so, permitting them to exercise vote and show their standard probabilities for all to see, then inside the destiny, they’ll have buy-in to the device, and hence, use it and vote inside the future. I agree their votes will maximum probable mirror that in their dad and mom for the most component.

Maybe we want a rethink about how we vote and perhaps the use of all this new generation may want to virtually help us all take part in OUR authorities. Think in this.

Almost Instant Updates You Can Make to Your Home Style

There are small things we will do to spruce and replace our dwelling spaces. Of route, we would all love to the infinite delivery of cash flow that the layout suggests providing. Most of these recommendations are cheaper and may add a lot persona in your area.

Stop Using Matching Throw Pillows

Commonly while shopping for a settee they come with matching throw pillows, but by including one-of-a-kind color or pattern accessory throw pillows you could replace a room right away. Adding that dash or formidable coloration or hanging patterns can help complement the neutral tones of the room.

Changing Light Fixtures

Instead of using a trendy striking mild fixture strive including an ornamental chandelier or lantern. By adding an easy exchange on your eating room can add a lot personality to the room.

Designate a Cozy Space

Today’s popular design is the open ground plans. Where ground designs are open and wait seamlessly. But, even though this is pleasant for the general fashion of the house try making an area in your property greater comfy.

Decorate Personal Spaces

Most folks spend the maximum of our power on decorating spaces that we show to other people. The guests for our parties or an unplanned go to that can take place at any time. Decorating those areas are critical however shall we no longer overlook places within the residence wherein we spend the maximum of our time. The bedroom, workplace, or lavatory. Take objects which you love and beautify your favorite

Creating a Collection

The first rule of including a group of items to a room is to remember that ordinary numbers go collectively better than even. Take a 2nd to find items in your room which are common in a few manner. For instance, you would possibly have a set of silver items that share a not unusual detail. By placing them together on a console or couch desk.

Painting Inside

If you’ve got a timber piece of older fixtures mendacity round which you want to spruce up try to portray the inside of the cupboard to add a touch of accessory color. Adding accessory shade can right away enliven a space.

[easyweight101]

Asensia Review (UPDATED 2017): Don’t Buy Before You Read This!

What is it?

Asensia is a supplement used to help address an imbalance in progesterone and estrogen. The makers of Asensia claim this product comes with a range of benefits such as increased energy, improved hair, skin and libido and stabilize your weight.

Asensia works to address hormonal imbalances in the body through a blend of herbs and vitamins, including green tea extract, chasteberry and L-arginine. This product may help women in menopause, but it’s aimed at women who have low progesterone, no matter what age bracket they’re in.

After checking out a number of hormone balancing solutions out there, Femmetrinol best helps users finally get some relief from hot flashes, night sweats and the emotional toll this transitional period can take. Click the link here for more reasons why you need to try Femmetrinol today.

Do you know the Best Menopause Supplements of 2017?

Asensia Ingredients and Side Effects

Asensia is made from a handful of active ingredients meant to address low progesterone levels. Here’s a look at the bioidentical formula used to create Asensia:

Chasteberry L-Arginine Green Tea Extract

Chasteberry: This berry comes from shrubs found in Asia and the Mediterranean and is thought to help treat menstrual irregularities, fibrocystic breasts, female infertility, menopause symptoms and PMS.

L-Arginine: An amino acid made naturally inside the body, this ingredient is primarily used to help improve blood flow, which means it has considerable benefits for the cardiovascular system and helps those suffering from a low sex drive. L-arginine is thought to also help stimulate the release of the human growth hormone.

Green Tea Extract: Green tea extract is used to increase alertness and mental energy, and may have an effect on the central nervous system. This ingredient is also loaded with antioxidants and may work to reduce swelling and inflammation, as well as prevent infections in the body.

Green tea extract contains caffeine, and in high doses may cause side effects like rapid heartbeat, nausea, nervousness, headaches, and more.

Click here to learn which menopause solution is right for you — experts share their thoughts on a range of supplements right here.

EDITOR’S TIP: Combine this supplement with a proven menopause pill such as Femmetrinol for better results.

Asensia Quality of Ingredients

Aside from the three ingredients mentioned in the above section, it’s worth mentioning that Asensia also contains several vitamins—A, C, D, E and B complex, along with some minerals. It’s pretty standard multivitamin stuff, so we’ve opted to omit this info.

In looking over the active ingredients, we’re not sure that there’s much possibility of Asensia actually delivering on the benefits it claims to provide, and there are quite a few. This product aims to take on weight gain, hot flashes, brain fog, anxiety and several other bullet points. This all sounds quite enticing, but we just don’t see how a multivitamin with green tea extract and chasteberry could really do all of these great things.

Chasteberry, for example, is a useful ingredient, but without the addition of other herbs, like the phytoestrogen-rich black cohosh, users likely won’t see too many changes with use.

The website does feature a number of doctors that have developed this product, and it was supposedly tested at Stanford University’s lab — but for all this talk, we don’t actually see any clinical studies or detailed explanation about this specific blend of ingredients.

Click here to get the inside scoop on the menopause pills that help treat all symptoms without any negative side effects.

The Price and Quality of Asensia

Asensia is sold on the official Asensia website for $79 per one month supply—a bottle containing 90 capsules. Along with the product, users receive a couple guides entitled, “Growing Younger Every Day” and “Optimize Your Hormone Health.”

Users get a slight price break if they order more bottles at a time. Three bottles of Asensia, plus booklets, will cost $222, while six bottles go for a total of $414.

This product was once available on Amazon, but it seems that the listing has been removed. As it stands, the official webpage seems to be the only place one can buy this item, meaning, users won’t find too many opportunities for a better price.

Asensia, based on the ingredient profile seems like it is being offered at a much higher price point than makes sense for most consumers. All the active ingredients can be found separately for a fraction of the price. Again, this product is essentially a multivitamin with a couple of upgrades and it’s hard to justify anywhere near the asking price of $79 per bottle.

Want to start sleeping better? Learn more about the pills that best eliminate night sweats by clicking here.

Business of Asensia

Asensia is made by a supplement developer known as The Daily Wellness Company. Their contact information is listed below:

Phone: 800.988.4869

Address: 1750 Kalakaua Ave

Ste. 2601

Honolulu, HI 96826

According to their website, The Daily Wellness Company develops and conducts research on supplements targeting the reproductive system — fertility issues, male enhancement and hormonal imbalances.

The site mentions that all products undergo quality testing and rigorous clinical trials, which is great, but we weren’t able to see the results of these tests for Asensia.

We believe that these products have been reviewed at institutions like Stanford, Wake Forest University and others, it’s just that we don’t know what the results look like, or feel like we have a good sense of what this product does. Based on the ingredients and the reviews, we aren’t sure that this product is a consistent option for people looking for menopause relief.

Customer Opinions of Asensia

Asensia is used by a wide range of women with a variety of issues caused by hormonal imbalances. Many of the users were experiencing fertility issues or other problems, all related to hormones, but may not menopausal in nature. With that being said, here’s a brief look at some of the comments we came across during our research:

“I’ve only been using Asensia for a few months, but I’ve found that it has really helped me regulate my moods, as well as improve my focus, energy and stop the weight gain I’ve been dealing with as of late.”

“Only been using this for a couple weeks. It hasn’t done much for me during waking hours, but I have seen some major improvements in my sleep cycle. I’m falling asleep and staying asleep, which is a win.”

“I started taking this in hopes it would help my hair grow in thicker. It didn’t exactly help in that respect, but I’m getting less severe cramps and my PMS symptoms have settled down a bit.”

“I have severe PMDD and PCOS. This product sent me on a complete emotional roller coaster ride. Even though it’s an herbal supplement, I urge you to talk to a doctor before using. It could be dangerous.”

After reviewing a number of comments left by past consumers of Asensia, it was difficult for us to get a good sense as to whether or not this product was all the effective in helping women with menopause. Users mentioned vastly different results—some saw sleep benefits, others experienced less cramping, yet, some did not see any changes, good or bad.

We’re not sure this product contains the right ingredients to make a difference for someone with severe menopause symptoms, but at this point we don’t know how effective Asensia is for the bulk of its user base.

Click here for an in-depth look at the creams and supplements that users reviewed best.

Conclusion – Does Asensia Work?

After looking more closely at Asensia and the ingredients used to make this product, we wouldn’t recommend this product to people looking for a consistent treatment for low progesterone or other issues.

First of all, we looked at the contents of this product, and fail to see how it could possibly yield all these benefits that they list on the website. Chasteberry is the only active ingredient in the mix that has been shown to have an effect on users going through menopause or those with other hormonal concerns.

L-arginine may help with libido, but it’s primarily used in supplements aimed at male sexual dysfunction, as well as for a number of conditions related to the cardiovascular system. Green tea extract, on the other hand, does contain antioxidants, which are always a welcome presence, but we’re not sure what this ingredient is meant to provide other than disease prevention and general wellness.

Finally, this product is far, far too expensive. At nearly $80 for a one-month supply, we challenge users to justify this costly supplement. Ingredients like L-arginine, green tea extract, chasteberry and the multivitamin blend all can be purchased for a much lower combined price.

After looking over a variety of solutions, our team of experts have found that Femmetrinol delivers the most consistent results for users seeking relief from uncomfortable symptoms associated with menopause. Herbs like wild yam, damiana, black cohosh and more provide ample support for regulating hormone levels and helping users feel like themselves again.

Femmetrinol is manufactured according to GMP, and is subject to a several quality control inspections to make sure that customers get the best possible product each time they place an order. Get more information about Femmetrinol and its benefits. Click here.

  from Easy Weight Loss 101 http://ift.tt/2pXVrux via The Best Weight Loss Diet In The World

[capmerthur]

THE BODY SWAP

Summary:

It’s all in the title :) Somewhere end S1 (after Labyrinth, but pre Morte). In a land of myth, and a time of magic, Arthur awakes inside Merlin’s body (and no, not in that way). Alternating Merthur POV, bonus Gaius, bit of George. 

(PREVIOUS CHAPTERS UNDER THE CUT... )

III. DISABLED (MERLIN POV)

But soon, Merlin is terrified.

And not because of the puzzling body swap.

*HE HAS NO MAGIC!?*

(Not that Merlin knows of any spell to reverse their current situation at once, mind you; so he doesn't actually try anything about it. But Merlin simply knows: there is nothing but blood running through his veins now - no vigorous warmth, no energic flow; there is simply nothing singing under his placid flesh, as he focuses on it.)

He cannot help but wish he's wrong though, and desperately tries to move a quill on Arthur's desk behind Arthur's back - the simplest of things, really; yet he fails, indeed...

His magic is tied to his body. Not to his mind.

No, no, no, no, nooooooooooo.

So. Merlin is, to his core, *terrified* - as he has never been. Not only because he feels more powerless and utterly helpless than he has ever felt - and worse, unable to protect Arthur! But also because the longer Arthur stays in his body, the more chances he has to find out that he has magic!? (And even though Merlin has nearly told Arthur, once? He is still not ready for him to know right now... Will after all didn't lie to protect Merlin's secret on his deathbed for Merlin to take chances with his life so soon after...)

Merlin though decides to push his panic aside for the moment: he simply MUST focus. No matter which sorcerer has this week decided to deal with the Pendragon line once and for all, Arthur's life is undoubtedly in the balance; and that's dearer to Merlin than all the magic in the world - included his own.

Because Merlin's life *has* tilted, on that rocky beach by The Great Seas of Meredor.

Merlin's earnest readiness to lay his life down to save Arthur's had been instinctive, beyond doubt visceral; and the concrete force of the impulse had surprised him. Because it hadn't been related to his first supposed then anyway indeed wished upon destiny. It had merely been a reflex, a spontaneous reaction: what he had wanted to do; more than what he ought to do. And Merlin had realized right then that he had, somehow, but undeniably, actually come to *LOVE* Arthur?

It shouldn't have been such a shocking revelation though. Sure, Arthur could be a spoiled, royal prat; an irritating, pompous ass; an arrogant, moronic bully - to list but the top of the iceberg of his massive shortcomings, and without even mentioning the complete dollophead he could sometimes be. But Arthur could also be truly brave, honest, and kind; willing not only to trust but also to actually defend the words of mere servants, ready to defy his father's orders in order to save a child's life, and volunteering to help a village not even belonging to his Kingdom, to note only a few examples. Also: at some point, Merlin had realized how what could at first appear as near manhandling tactility was in fact just Arthur's disguised way to show (or ask?) affection (because one probably just doesn't walk around asking for cuddles while growing up between Uther's judging cold glares and Morgana's sharp witty tongue; and the physical playfulness of the knights training must have seemed like the only way to go...). And last but not least: Ealdor owed Arthur its renewed safety. And Merlin owed Arthur his life - if Arthur hadn't gone looking for a Mortaeus flower... So, in short: of course Merlin had gotten fond of the man. Notwithstanding how so annoyingly beautiful he always was (for the record on that particular subject: Gwen is so adorably beautiful, and Morgana so petrifyingly beautiful).

But, as Arthur - bound to be King one day Arthur - hadn't even hesitate before choosing to sacrifice himself in order to fix his error instead of using the (even offered) life of a simple servant? Well... There is a difference still between having the conviction that Arthur is a good man ready to fight for the greater good, even knowing it could be his death; and knowing as a FACT that Arthur *is* ready to die for the greater good, even knowing it *will* be his death. And you bet having been proven *exactly* how pure of heart Arthur intrinsically is has only cemented that burgeoning love deeper into Merlin's heart - simply; truly; and maybe irrevocably. Merlin would now willingly die a thousands deaths to save his Prince.

.

(Feel free to shout with me about 1.11 because *MAJOR FEELS*!)

(And then hug me as I shamelessly cry because this is still NOTHING next to what's to come - aka Arthur becoming ACHINGLY beautiful, as Merlin turns ready to KILL a thousands times to save his King, blackening his own heart in the process and thinking himself then unworthy of Arthur's love because Arthur is just so BRIGHT; but wishing for it nonetheless?)

.

PREVIOUS CHAPTERS UNDER THE CUT:

I. AWAKING (ARTHUR POV)

Arthur awakes; lying on his back - unusual - and rolls over automatically.

He surprisingly falls, down, hard; and jerks fully awake now - on the floor, near a so very tiny bed, tangled in an unknown blanket (harsher than his standards, even while on errands, he can't help but notice).

In disbelief, he eyes his surroundings...

Where is he? Has he been abducted?

Think, he admonishes himself - trying to clear his mind; to remember what must have happened, to guess who has dared to commit such an act, and, most important of all right now: Find a way out.

His eyes then suddenly meet Merlin's, and relief surges through him somehow - before his anxiety returns; and double: because poor faithful, loyal Merlin has obviously been taken too; and it's Arthur's fault - he must have failed to save them both from being taken, even though he cannot remember anything...

Except when Arthur reaches out to Merlin, he realizes with fright but indeniable certainty that Merlin is in fact a reflection in a mirror; and worse: *HIS* reflection!?

It his NOT his hand indeed that is stretching out in front of him; NOT his clothes on his person; and definitely NOT his own hair falling upon his eyes, as he notices the black strings in his vision range...

Arthur is dumbstruck. He sees Merlin's mouth shaping a silent O, and he sees the dread in Merlin's eyes... except they ARE - he feels - *his* mouth, and *his* eyes; and everything is just plainly wrong, and plainly impossible - but undeniably REAL.

He is... Merlin? Or better said, *inside* Merlin? How can such a thing have even come to be?

Sorcery, Arthur understands with horror: Camelot is under attack!

But now armed with the knowledge of his predicament, Arthur realises he is actually in Merlin's bedroom. He's been in here before, once; and he recognises it all now.

So. Not abducted. All things considered, that still counts as something, right...

And, as it surely doesn't feel as if Merlin is still somewhere in his own head too while Arthur is inside of it, well... Maybe? Logically? Merlin might then be in return inside his own body?

Arthur suddenly finds himself praying for this to be true. It would be for the best, if Merlin was in his body - if they were the only ones concerned by this unnatural situation; because what if *everyone* was awaking inside someone else's body this morning? That would be... precarious - the general panic leaving Camelot completely vulnerable to whoever must have plotted this? The worst though would be if the one responsible for this was right now in control of his body, and acting as Crown Prince to do, well, evil deeds... So yes, you bet Arthur truly wants to find Merlin to be the one inside his own body when he finally finds it.

Arthur jumps on his feet, ready for action. Luckily (even though Arthur feels a bit guilty, as he notices his armour in pristine state against the opposite wall - apparently Merlin has been polishing it late into the night then) Merlin hasn't bothered to undress before falling asleep.

So. First thing first: he has to go to his chamber.

Picking some weapon on the way for good measure, you bet ...

/ / /

Simply walking the few paces to open the door though turns out to be a challenge. His limbs are too long, and dangly; it feels like he has two left feet, and he has to try thrice before actually getting a grip on the handle - because he isn't used to this body, of course - but maybe it is truly NOT Merlin's fault if he falls over his own feet that often after all...

Gaius is already out - hopefully looking for herbs and not wandering out of his mind... Arthur would have preferred to be able to test right away his theories about how many people were affected by the damn body change; but unfortunately, it would have to wait some more.

The corridors are empty too, except for a stray black cat who walks at his side a full minute, which has Arthur questioning himself about asking to the cat if he *is* Merlin - because Merlin HAS to be somewhere, right, as he obviously isn't where he should be to start with; but then the cat takes another turn... Arthur feels stupid for worrying so much about his silly manservant - but he cannot deny that he definitely will worry less only after having indeed finally found said silly manservant.

Arthur relaxes slighthly though when he enters the kitchen: people are working as usual, apparently not in shock, apparently in their right bodies. He picks up the first tray he finds, along with an extra knife that he hides in his pocket for good measure.

He tries to put on a confident grin as he walks (with the most assurance he can muster in this awkward-feeling body) towards the guards at his bedroom's door - and can only hope it will look the same as usual to them. They let him pass without trouble, and Arthur isn't sure it's a good thing. On the one hand, he *doesn't* doubt Merlin - he simply, intrinsically doesn't; and would never want him to feel like he did if his guards were to search him whenever he was about to enter his chamber. On the other hand... well, it isn't Merlin right now entering his chamber, with knifes at the ready... This time, it's only him; but what if it happens again, and if the one then inside Merlin's body has ill intentions...

Deciding not to dwell on this for the time being, Arthur opens the inside door to his bedroom, hoping to find Merlin doing whatever Merlin always does, but preparing for a fight, if need be...

II. AWAKING (MERLIN POV)

Merlin awakes as if in a cocoon; literally. He is surrounded by softness, flush, warmth; he cannot remember ever feeling so comfortable - and the world can wait for just another few seconds before he opens his eyes, right... Merlin wriggles, shifting on his back, sighing softly as he nestles some more into the cushions...

When Merlin awakes for the second time - culpability sinking in as he realizes he has overslept - his eyes open to a Pendragon red canopy he would recognize even among hundreds. Merlin freezes: what the hell is he doing, sleeping IN ARTHUR'S BED?!

Merlin sits upright at once - blankets falling all around him to reveal that he wears ARTHUR'S NIGHTGOWN too ?!

Whaaaaaaaat?!

This... just DOESN'T make any sense. The last thing he can remind is sitting on his own bed, polishing the last bit of Arthur's armour before letting himself fall down to sleep (*AN). He surely doesn't recall walking to Arthur's chamber, and even less...

Oh my... What is Arthur going to think? And come to think of it - true panic now creeping down on Merlin at that thought: *WHERE* is Arthur to start with?

His attention is drawn out right then by Arthur calling out his name (Merlin feels relief, no matter his current embarrassing situation) - in one of those thousands yet unmistakably always Arthurian ways to say his name: a myriad of moods and meanings in those simple two syllables - the voice sounding odd though this morning (is Arthur sick?), and tensed (well, he just found his manservant in *his* bed, that might explain it!).

Merlin turns to face his sovereign, trying to feel less self conscious because he mustn't look guilty, while wishing for inspiration, and buying time until it hits: "There is actually a perfectly valid explan-"

But it is NOT Arthur he sees: it is... himself? His breath catches as 'utter confusion' gets a new meaning, you bet...

At the same moment, Merlin notices suddenly just how *not his* his voice just sounded, and how he's wearing a very particular ring around one finger of what's NOT his hand, and how *blond* hair is falling upon his eyes... And still nothing makes sense; but at least it *does* explain how he awoke in Arthur's bed in Arthur's clothes: he *is* Arthur?; and... Arthur... is him? MUST be him. He has been calling him right the right way, right?!

"Arthur?" Merlin barely dares to breathe out, both in wonder and in plea (because Arthur CANNOT be gone - the fear and pain and simple *impossibility* of such a concept slicing through Merlin's mind like a knife).

There is a bright smile then appearing on his face - a smile that doesn't entirely look like his own though - "Yes, Merlin. It's me," followed by a relieved sigh: "And it's you". And, despite the shock about them having apparently switched bodies (?!?!), Merlin can't help but feel warm all over - because Arthur (and yes, it is so clearly Arthur, even in HIS body!) has apparently been worried about him.

(*AN) Headcanon time :

Merlin uses magic to clean Arthur's armour in the beginning, indeed. And he still uses magic for most of the chores, as much as he can, of course (washing clothes, mending clothes, emptying chamber pots, sweeping fireplaces, preparing baths, refreshing beds, cleaning floors, cleaning everything, really (except for mucking the stables, because there are always others around, grrrr). But he quickly grows nearly *maniac* about Arthur's food (picking at it as a way to make sure it's not poisoned etc...) and about Arthur's armour: it's one of Arthur's protections - so you bet Merlin definitely cleans and polishes and repairs and oils the leather ligaments that hold it together and EVERYTHING the hell out of it, with extra ardor and fervor, with his own two hands, all the while continuously trying to put on it any protecting spells he ever finds, and repeating those over and over at each occasion...

Also: I know mirrors were not so advanced at the time… But Merlin has an enhanced one, after all he has magic right… And on a side note, I’m never going to be over Arthur’s priority-thinking (I’m in trouble = CAMELOT IS UNDER ATTACK (babyyyy let me hold you - being Camelot Prince/King is NOT your only worth) and Merlin’s priority-thinking (what the hell is happening = WHERE THE HELL IS ARTHUR (babyyyy let me hold you - your devotion to The (brave, kind, admirable (shut up Merlin)) Prat doesn’t have to mean that you always must come second (and a bit self-preservation cannot be harmful)) *SIGH* I just love those two idiots so much !!!

[kristinsimmons]

The EBM Wars: Manufacturing Equipoise (Part 1)

By ANISH KOKA

The phone rings.  It’s not supposed to be ringing.  It’s 2 am.   The voice on the other line is from an apologetic surgery resident.

Resident: There is this patient..

Me: Yes, go ahead. Please.

Resident: He’s tachycardic.

Me: How fast?

Resident: 160 ?

Me: What’s the blood pressure?

Resident: 130/90

Me: Rhythm?

Resident: An SVT I think.. I gave adenosine.  Nothing happened

Me: Audibly groaning.  I’ll be in..

Forty five minutes later I’m at the bedside of a decidedly ill appearing man.

I want to be triumphant that his heart rate is only 145, and a quick glance at the telemetry monitor above his bed uncovers juicy p waves in a cadence that suggests this is no primary electrical arrhythmia.

Something is very wrong somewhere – the heart in this case is an innocent bystander being whipped into a frenzy to compensate for something.

At the moment the whip is a norepinephrine infusion being used to keep his blood pressure up.

I ask the nurse if the amount of norepinephrine infusing has been stable.  She replies that his dose has been slowly escalating.

Eureka! I think – the heart rate response in this case is being driven by the norepinephrine – a powerful adrenaline that acts on beta receptors and alpha receptors within the body that increase heart rate and constrict the blood vessels to raise blood pressure.  Fix the cause of the low blood pressure, come down on the norepinephrine, and perhaps the heart rate would be better.

But it turns out this particular post surgical patient doesn’t have a medical cause of low blood pressure I can find.  I cycle through cardiac ultrasounds, blood gases, steroid and volume challenges, and try inching down on the norepinephrine.

All of it is to no avail.  I’m growing more and more convinced this problem is surgical in nature. Perhaps an infarcted piece of bowel?  All I know is that the man acts like he has no peripheral vascular tone.

An interesting thing happens shortly after.  The norepinephrine drip runs out.

As one nurse runs to get another bag from the pharmacy – a quick cascade of events unfolds.

The brisk upstroke from the arterial line that marks the pressure wave generated with every beat of the heart starts to dampen.  The color seems to visibly drain from the patients face, and he begins to complain that his vision is getting blurry.  His systolic blood pressure is 70 – an almost forty point drop within a minute of the norepinephrine running out.

I call for help.

I try to keep a level tone.  Project control, not panic.

“Open the code cart, I need a half a milligram of epinephrine”

“You’re going to be ok, sir.  Hang with me.”  I squeeze his hand.

He closes his eyes

The code cart – a fully stocked cabinet on wheels with almost everything you need for resuscitation efforts – is wheeled into the room. The epinephrine vial is handed to the nurse, and hurriedly pushed.

Within seconds, I can see the blood pressure and heart rate rise.  The patient’s grip on my hand relaxes.  Or maybe its my grip on his hand.  I forget which.  His vision returns to normal as his blood pressure ‘normalizes’.

Of course nothing has been fixed.  Why his blood pressure remains low continues to be a mystery.  The bag of norepinephrine soon isn’t enough even at its maximal dose.  The same scenario (hypotension -> pallor -> vision loss ) recurs 30 minutes later, and another bolus of epinephrine aborts a rapid spiral towards pulselessness.

This case is an anecdote, the weakest possible form of evidence apparently.  Yet there are powerful lessons learned that night. Blood flows in pulsatile fashion with a certain pressure head.  Below some threshold of pressure, the end organs of the body stop functioning.  Agents that are active on peripheral vasoconstrictor receptors (norepinephrine, epinephrine) raise blood pressure.  Epinephrine was keeping this patient alive while a team worked to understand why his blood pressure was so low.  My suspicion was that he was in something called distributive shock – a catastrophic life threatening syndrome that requires a furious hunt for cause to save the patient.  Overwhelming infection and an even more aggressive immune response renders normally relatively impervious vasculature to be a sieve.  At the present time the therapy is directed towards replacing the fluid lost in the intravascular space and using medications that act on peripheral vascular receptors that increase peripheral tone.

There is, of course, much that isn’t known about this process.  Hopefully it will come to pass that we will arrive at a better understanding of what specifically creates this mileu so our therapies may be more directed.  But for the time being, our solutions are limited by our current, always imperfect understanding of the world.

The culprit in this case was a leak of intestinal contents into the peritoneal space from two pieces of bowel that should have been exactly apposed.  The body had attempted to tell us this very thing with that high heart rate post-operatively.  It took us, the clinicians, some time to translate.

The uninformed prior: Unlearning what has been learned.

For many, medicine has for too long been an imperfect science.  The history of medicine is replete with physicians acting with certainty in a manner that – in hindsight – was ineffective, or even worse – harmful.  Blood letting to allow the release of bad humors is believed to have hastened the demise of the greatest American – George Washington.  The disconcerting part of this is that the physician players were not motivated by anything but the best intentions.  They relied on their experience, intuition and judgement to deliver exactly the wrong prescription.   Intuition fails.  No matter how many patients died soon after blood letting, operating biases didn’t let physicians link the two events.  After all, the patients may have died even sooner if blood letting hadn’t been done.

The idea that medicine had progressed – by the 1980’s – to the point that doctors were not engaged in the equivalent of blood letting came under heavy fire when it was demonstrated a number of standard practices of the time could indeed be ineffective.  Extra beats (also known as ectopic heart beats) after heart attacks were noted in cardiac units to portend a higher risk of dying suddenly.  The obvious approach to this was to use medications that effectively suppressed ectopic heart beats.  Testing this in a double blind randomized control trial did not just demonstrate ineffectiveness, but harm.  More people randomized to suppression of ectopic beats actually died.  It turns out the anti-arrhythmic drugs being used were actually proarrhythmic as well.  The attack on ‘expertise’ that relied on intuition and experience was on, and it was a rout.

Glue ear – a condition that developed in the middle ears of little kids after ear infections  was treated with insertion of a tube to drain that space.  The trial to determine efficacy using a randomized trial to blindly allocate patients to surgery or no treatment?

Negative.

Many of the children turned out to do just fine if you left them alone.  Given the fact that all procedures have a certain complication rate, the lack of efficacy here was no small matter.

And so it went – the populace had to be on guard not just against the afflictions of disease, but against the intuitions of its doctors.

Uncertainty reigned, and in search of certainty, the field fled to the warm embrace of ever greater empiricism.  In the early ’80s from the McMaster University in Canada, David Sackett gave voice to a new sheriff – Evidence Based Medicine (EBM).

“EBM de-emphasizes intuition, unsystematic clinical expertise, and pathophysiologic rationale . . . and stresses the examination of evidence from clinical research. In 1960, the randomized trial was an oddity. It is now accepted that virtually no drug can enter clinical practice without a demonstration of its efficacy in clinical trials. Moreover the same randomized trial method is increasingly being applied to surgical therapies and diagnostic tests.” (Sackett et. al, Evidence Based Medicine)

The premise as outlined is simple – don’t believe anything that hasn’t been tested in a randomized control trial.  The only real evidence is that found within RCTs or in reviews that amalgamated RCTs.

The usual response from EBM experts can be found below in the response to the statement that real evidence may come from outside an RCT.

It is quite possible Professor Francis is right on here about the specific subject being discussed, but the point is that there is an established hierarchy of evidence on display.  The RCT is king, everything else is no better than the court jester.

While an RCT may certainly be better than anything cobbled together at a pub, the conventional parallel group RCT certainly isn’t always King of the Hill.   As nicely expounded on by the prolific statistician Stephen Senn, there are plenty of potential errors the conventional RCT finds itself humbled by.

The clinician may thus feel somewhat mollified about conclusions drawn about the effect of epinephrine in the earlier anecdote.

The idea that real evidence may live outside the confines of RCTs was also countered by none other than the godfather of EBM, David Sackett:

“Evidence based medicine is not restricted to randomized trials and meta-analyses. It involves tracking down the best external evidence with which to answer our clinical questions. To find out about the accuracy of a diagnostic test, we need to find proper cross sectional studies of patients clinically suspected of harboring the relevant disorder, not a randomized trial. For a question about prognosis, we need proper follow up studies of patients assembled at a uniform, early point in the clinical course of their disease. And sometimes the evidence we need will come from the basic sciences such as genetics or immunology. It is when asking questions about therapy that we should try to avoid the non-experimental approaches, since these routinely lead to false positive conclusions about efficacy. Because the randomized trial, and especially the systematic review of several randomized trials, is so much more likely to inform us and so much less likely to mislead us, it has become the “gold standard” for judging whether a treatment does more good than harm. However,some questions about therapy do not require randomized trials (successful interventions for otherwise fatal conditions) or cannot wait for the trials to be conducted. And if no randomized trial has been carried out for our patient’s predicament, we must follow the trail to the next best external evidence and work from there. (Sacket et al, Evidence based medicine: what it is.. )”

Sackett also noted that there were therapies whose ” ‘face validity’ is so great that randomized trials were unanimously judged by the team to be both unnecessary, and, if a placebo would have been involved, unethical”.

In effect, there was always an escape clause to let common sense prevail over EBM.  But as frequently happens in movements, the second generation of followers moves in directions unintended by the founders.  If the safeguards in place involve only areas where equipoise exists, but equipoise is itself determined by fallible judgement, the range of unacceptable experiments becomes very narrow.  This especially applies to new therapies where members of the community not involved in design and development have skeptical prior beliefs.  This is, of course, not a bad thing – it is entirely possible that the usually overoptimistic prior of the developers of a new therapy are farther from the truth than the skeptics.  But it is a major problem if we ask doctors to discard their prior beliefs that are not based in RCTs.  In doing so, we are manufacturing equipoise.  This means travel in dangerous ethical waters for physicians and their patients that is at best unwise, and at worst willfully foolish.

The EBM Wars: Manufacturing Equipoise (Part 1) published first on https://wittooth.tumblr.com/

[kristinsimmons]

The EBM Wars: Manufacturing Equipoise (Part 1)

By ANISH KOKA

The phone rings.  It’s not supposed to be ringing.  It’s 2 am.   The voice on the other line is from an apologetic surgery resident.

Resident: There is this patient..

Me: Yes, go ahead. Please.

Resident: He’s tachycardic.

Me: How fast?

Resident: 160 ?

Me: What’s the blood pressure?

Resident: 130/90

Me: Rhythm?

Resident: An SVT I think.. I gave adenosine.  Nothing happened

Me: Audibly groaning.  I’ll be in..

Forty five minutes later I’m at the bedside of a decidedly ill appearing man.

I want to be triumphant that his heart rate is only 145, and a quick glance at the telemetry monitor above his bed uncovers juicy p waves in a cadence that suggests this is no primary electrical arrhythmia.

Something is very wrong somewhere – the heart in this case is an innocent bystander being whipped into a frenzy to compensate for something.

At the moment the whip is a norepinephrine infusion being used to keep his blood pressure up.

I ask the nurse if the amount of norepinephrine infusing has been stable.  She replies that his dose has been slowly escalating.

Eureka! I think – the heart rate response in this case is being driven by the norepinephrine – a powerful adrenaline that acts on beta receptors and alpha receptors within the body that increase heart rate and constrict the blood vessels to raise blood pressure.  Fix the cause of the low blood pressure, come down on the norepinephrine, and perhaps the heart rate would be better.

But it turns out this particular post surgical patient doesn’t have a medical cause of low blood pressure I can find.  I cycle through cardiac ultrasounds, blood gases, steroid and volume challenges, and try inching down on the norepinephrine.

All of it is to no avail.  I’m growing more and more convinced this problem is surgical in nature. Perhaps an infarcted piece of bowel?  All I know is that the man acts like he has no peripheral vascular tone.

An interesting thing happens shortly after.  The norepinephrine drip runs out.

As one nurse runs to get another bag from the pharmacy – a quick cascade of events unfolds.

The brisk upstroke from the arterial line that marks the pressure wave generated with every beat of the heart starts to dampen.  The color seems to visibly drain from the patients face, and he begins to complain that his vision is getting blurry.  His systolic blood pressure is 70 – an almost forty point drop within a minute of the norepinephrine running out.

I call for help.

I try to keep a level tone.  Project control, not panic.

“Open the code cart, I need a half a milligram of epinephrine”

“You’re going to be ok, sir.  Hang with me.”  I squeeze his hand.

He closes his eyes

The code cart – a fully stocked cabinet on wheels with almost everything you need for resuscitation efforts – is wheeled into the room. The epinephrine vial is handed to the nurse, and hurriedly pushed.

Within seconds, I can see the blood pressure and heart rate rise.  The patient’s grip on my hand relaxes.  Or maybe its my grip on his hand.  I forget which.  His vision returns to normal as his blood pressure ‘normalizes’.

Of course nothing has been fixed.  Why his blood pressure remains low continues to be a mystery.  The bag of norepinephrine soon isn’t enough even at its maximal dose.  The same scenario (hypotension -> pallor -> vision loss ) recurs 30 minutes later, and another bolus of epinephrine aborts a rapid spiral towards pulselessness.

This case is an anecdote, the weakest possible form of evidence apparently.  Yet there are powerful lessons learned that night. Blood flows in pulsatile fashion with a certain pressure head.  Below some threshold of pressure, the end organs of the body stop functioning.  Agents that are active on peripheral vasoconstrictor receptors (norepinephrine, epinephrine) raise blood pressure.  Epinephrine was keeping this patient alive while a team worked to understand why his blood pressure was so low.  My suspicion was that he was in something called distributive shock – a catastrophic life threatening syndrome that requires a furious hunt for cause to save the patient.  Overwhelming infection and an even more aggressive immune response renders normally relatively impervious vasculature to be a sieve.  At the present time the therapy is directed towards replacing the fluid lost in the intravascular space and using medications that act on peripheral vascular receptors that increase peripheral tone.

There is, of course, much that isn’t known about this process.  Hopefully it will come to pass that we will arrive at a better understanding of what specifically creates this mileu so our therapies may be more directed.  But for the time being, our solutions are limited by our current, always imperfect understanding of the world.

The culprit in this case was a leak of intestinal contents into the peritoneal space from two pieces of bowel that should have been exactly apposed.  The body had attempted to tell us this very thing with that high heart rate post-operatively.  It took us, the clinicians, some time to translate.

The uninformed prior: Unlearning what has been learned.

For many, medicine has for too long been an imperfect science.  The history of medicine is replete with physicians acting with certainty in a manner that – in hindsight – was ineffective, or even worse – harmful.  Blood letting to allow the release of bad humors is believed to have hastened the demise of the greatest American – George Washington.  The disconcerting part of this is that the physician players were not motivated by anything but the best intentions.  They relied on their experience, intuition and judgement to deliver exactly the wrong prescription.   Intuition fails.  No matter how many patients died soon after blood letting, operating biases didn’t let physicians link the two events.  After all, the patients may have died even sooner if blood letting hadn’t been done.

The idea that medicine had progressed – by the 1980’s – to the point that doctors were not engaged in the equivalent of blood letting came under heavy fire when it was demonstrated a number of standard practices of the time could indeed be ineffective.  Extra beats (also known as ectopic heart beats) after heart attacks were noted in cardiac units to portend a higher risk of dying suddenly.  The obvious approach to this was to use medications that effectively suppressed ectopic heart beats.  Testing this in a double blind randomized control trial did not just demonstrate ineffectiveness, but harm.  More people randomized to suppression of ectopic beats actually died.  It turns out the anti-arrhythmic drugs being used were actually proarrhythmic as well.  The attack on ‘expertise’ that relied on intuition and experience was on, and it was a rout.

Glue ear – a condition that developed in the middle ears of little kids after ear infections  was treated with insertion of a tube to drain that space.  The trial to determine efficacy using a randomized trial to blindly allocate patients to surgery or no treatment?

Negative.

Many of the children turned out to do just fine if you left them alone.  Given the fact that all procedures have a certain complication rate, the lack of efficacy here was no small matter.

And so it went – the populace had to be on guard not just against the afflictions of disease, but against the intuitions of its doctors.

Uncertainty reigned, and in search of certainty, the field fled to the warm embrace of ever greater empiricism.  In the early ’80s from the McMaster University in Canada, David Sackett gave voice to a new sheriff – Evidence Based Medicine (EBM).

“EBM de-emphasizes intuition, unsystematic clinical expertise, and pathophysiologic rationale . . . and stresses the examination of evidence from clinical research. In 1960, the randomized trial was an oddity. It is now accepted that virtually no drug can enter clinical practice without a demonstration of its efficacy in clinical trials. Moreover the same randomized trial method is increasingly being applied to surgical therapies and diagnostic tests.” (Sackett et. al, Evidence Based Medicine)

The premise as outlined is simple – don’t believe anything that hasn’t been tested in a randomized control trial.  The only real evidence is that found within RCTs or in reviews that amalgamated RCTs.

The usual response from EBM experts can be found below in the response to the statement that real evidence may come from outside an RCT.

It is quite possible Professor Francis is right on here about the specific subject being discussed, but the point is that there is an established hierarchy of evidence on display.  The RCT is king, everything else is no better than the court jester.

While an RCT may certainly be better than anything cobbled together at a pub, the conventional parallel group RCT certainly isn’t always King of the Hill.   As nicely expounded on by the prolific statistician Stephen Senn, there are plenty of potential errors the conventional RCT finds itself humbled by.

The clinician may thus feel somewhat mollified about conclusions drawn about the effect of epinephrine in the earlier anecdote.

The idea that real evidence may live outside the confines of RCTs was also countered by none other than the godfather of EBM, David Sackett:

“Evidence based medicine is not restricted to randomized trials and meta-analyses. It involves tracking down the best external evidence with which to answer our clinical questions. To find out about the accuracy of a diagnostic test, we need to find proper cross sectional studies of patients clinically suspected of harboring the relevant disorder, not a randomized trial. For a question about prognosis, we need proper follow up studies of patients assembled at a uniform, early point in the clinical course of their disease. And sometimes the evidence we need will come from the basic sciences such as genetics or immunology. It is when asking questions about therapy that we should try to avoid the non-experimental approaches, since these routinely lead to false positive conclusions about efficacy. Because the randomized trial, and especially the systematic review of several randomized trials, is so much more likely to inform us and so much less likely to mislead us, it has become the “gold standard” for judging whether a treatment does more good than harm. However,some questions about therapy do not require randomized trials (successful interventions for otherwise fatal conditions) or cannot wait for the trials to be conducted. And if no randomized trial has been carried out for our patient’s predicament, we must follow the trail to the next best external evidence and work from there. (Sacket et al, Evidence based medicine: what it is.. )”

Sackett also noted that there were therapies whose ” ‘face validity’ is so great that randomized trials were unanimously judged by the team to be both unnecessary, and, if a placebo would have been involved, unethical”.

In effect, there was always an escape clause to let common sense prevail over EBM.  But as frequently happens in movements, the second generation of followers moves in directions unintended by the founders.  If the safeguards in place involve only areas where equipoise exists, but equipoise is itself determined by fallible judgement, the range of unacceptable experiments becomes very narrow.  This especially applies to new therapies where members of the community not involved in design and development have skeptical prior beliefs.  This is, of course, not a bad thing – it is entirely possible that the usually overoptimistic prior of the developers of a new therapy are farther from the truth than the skeptics.  But it is a major problem if we ask doctors to discard their prior beliefs that are not based in RCTs.  In doing so, we are manufacturing equipoise.  This means travel in dangerous ethical waters for physicians and their patients that is at best unwise, and at worst willfully foolish.

The EBM Wars: Manufacturing Equipoise (Part 1) published first on https://wittooth.tumblr.com/

[kristinsimmons]

The EBM Wars: Manufacturing Equipoise (Part 1)

By ANISH KOKA

The phone rings.  It’s not supposed to be ringing.  It’s 2 am.   The voice on the other line is from an apologetic surgery resident.

Resident: There is this patient..

Me: Yes, go ahead. Please.

Resident: He’s tachycardic.

Me: How fast?

Resident: 160 ?

Me: What’s the blood pressure?

Resident: 130/90

Me: Rhythm?

Resident: An SVT I think.. I gave adenosine.  Nothing happened

Me: Audibly groaning.  I’ll be in..

Forty five minutes later I’m at the bedside of a decidedly ill appearing man.

I want to be triumphant that his heart rate is only 145, and a quick glance at the telemetry monitor above his bed uncovers juicy p waves in a cadence that suggests this is no primary electrical arrhythmia.

Something is very wrong somewhere – the heart in this case is an innocent bystander being whipped into a frenzy to compensate for something.

At the moment the whip is a norepinephrine infusion being used to keep his blood pressure up.

I ask the nurse if the amount of norepinephrine infusing has been stable.  She replies that his dose has been slowly escalating.

Eureka! I think – the heart rate response in this case is being driven by the norepinephrine – a powerful adrenaline that acts on beta receptors and alpha receptors within the body that increase heart rate and constrict the blood vessels to raise blood pressure.  Fix the cause of the low blood pressure, come down on the norepinephrine, and perhaps the heart rate would be better.

But it turns out this particular post surgical patient doesn’t have a medical cause of low blood pressure I can find.  I cycle through cardiac ultrasounds, blood gases, steroid and volume challenges, and try inching down on the norepinephrine.

All of it is to no avail.  I’m growing more and more convinced this problem is surgical in nature. Perhaps an infarcted piece of bowel?  All I know is that the man acts like he has no peripheral vascular tone.

An interesting thing happens shortly after.  The norepinephrine drip runs out.

As one nurse runs to get another bag from the pharmacy – a quick cascade of events unfolds.

The brisk upstroke from the arterial line that marks the pressure wave generated with every beat of the heart starts to dampen.  The color seems to visibly drain from the patients face, and he begins to complain that his vision is getting blurry.  His systolic blood pressure is 70 – an almost forty point drop within a minute of the norepinephrine running out.

I call for help.

I try to keep a level tone.  Project control, not panic.

“Open the code cart, I need a half a milligram of epinephrine”

“You’re going to be ok, sir.  Hang with me.”  I squeeze his hand.

He closes his eyes

The code cart – a fully stocked cabinet on wheels with almost everything you need for resuscitation efforts – is wheeled into the room. The epinephrine vial is handed to the nurse, and hurriedly pushed.

Within seconds, I can see the blood pressure and heart rate rise.  The patient’s grip on my hand relaxes.  Or maybe its my grip on his hand.  I forget which.  His vision returns to normal as his blood pressure ‘normalizes’.

Of course nothing has been fixed.  Why his blood pressure remains low continues to be a mystery.  The bag of norepinephrine soon isn’t enough even at its maximal dose.  The same scenario (hypotension -> pallor -> vision loss ) recurs 30 minutes later, and another bolus of epinephrine aborts a rapid spiral towards pulselessness.

This case is an anecdote, the weakest possible form of evidence apparently.  Yet there are powerful lessons learned that night. Blood flows in pulsatile fashion with a certain pressure head.  Below some threshold of pressure, the end organs of the body stop functioning.  Agents that are active on peripheral vasoconstrictor receptors (norepinephrine, epinephrine) raise blood pressure.  Epinephrine was keeping this patient alive while a team worked to understand why his blood pressure was so low.  My suspicion was that he was in something called distributive shock – a catastrophic life threatening syndrome that requires a furious hunt for cause to save the patient.  Overwhelming infection and an even more aggressive immune response renders normally relatively impervious vasculature to be a sieve.  At the present time the therapy is directed towards replacing the fluid lost in the intravascular space and using medications that act on peripheral vascular receptors that increase peripheral tone.

There is, of course, much that isn’t known about this process.  Hopefully it will come to pass that we will arrive at a better understanding of what specifically creates this mileu so our therapies may be more directed.  But for the time being, our solutions are limited by our current, always imperfect understanding of the world.

The culprit in this case was a leak of intestinal contents into the peritoneal space from two pieces of bowel that should have been exactly apposed.  The body had attempted to tell us this very thing with that high heart rate post-operatively.  It took us, the clinicians, some time to translate.

The uninformed prior: Unlearning what has been learned.

For many, medicine has for too long been an imperfect science.  The history of medicine is replete with physicians acting with certainty in a manner that – in hindsight – was ineffective, or even worse – harmful.  Blood letting to allow the release of bad humors is believed to have hastened the demise of the greatest American – George Washington.  The disconcerting part of this is that the physician players were not motivated by anything but the best intentions.  They relied on their experience, intuition and judgement to deliver exactly the wrong prescription.   Intuition fails.  No matter how many patients died soon after blood letting, operating biases didn’t let physicians link the two events.  After all, the patients may have died even sooner if blood letting hadn’t been done.

The idea that medicine had progressed – by the 1980’s – to the point that doctors were not engaged in the equivalent of blood letting came under heavy fire when it was demonstrated a number of standard practices of the time could indeed be ineffective.  Extra beats (also known as ectopic heart beats) after heart attacks were noted in cardiac units to portend a higher risk of dying suddenly.  The obvious approach to this was to use medications that effectively suppressed ectopic heart beats.  Testing this in a double blind randomized control trial did not just demonstrate ineffectiveness, but harm.  More people randomized to suppression of ectopic beats actually died.  It turns out the anti-arrhythmic drugs being used were actually proarrhythmic as well.  The attack on ‘expertise’ that relied on intuition and experience was on, and it was a rout.

Glue ear – a condition that developed in the middle ears of little kids after ear infections  was treated with insertion of a tube to drain that space.  The trial to determine efficacy using a randomized trial to blindly allocate patients to surgery or no treatment?

Negative.

Many of the children turned out to do just fine if you left them alone.  Given the fact that all procedures have a certain complication rate, the lack of efficacy here was no small matter.

And so it went – the populace had to be on guard not just against the afflictions of disease, but against the intuitions of its doctors.

Uncertainty reigned, and in search of certainty, the field fled to the warm embrace of ever greater empiricism.  In the early ’80s from the McMaster University in Canada, David Sackett gave voice to a new sheriff – Evidence Based Medicine (EBM).

“EBM de-emphasizes intuition, unsystematic clinical expertise, and pathophysiologic rationale . . . and stresses the examination of evidence from clinical research. In 1960, the randomized trial was an oddity. It is now accepted that virtually no drug can enter clinical practice without a demonstration of its efficacy in clinical trials. Moreover the same randomized trial method is increasingly being applied to surgical therapies and diagnostic tests.” (Sackett et. al, Evidence Based Medicine)

The premise as outlined is simple – don’t believe anything that hasn’t been tested in a randomized control trial.  The only real evidence is that found within RCTs or in reviews that amalgamated RCTs.

The usual response from EBM experts can be found below in the response to the statement that real evidence may come from outside an RCT.

It is quite possible Professor Francis is right on here about the specific subject being discussed, but the point is that there is an established hierarchy of evidence on display.  The RCT is king, everything else is no better than the court jester.

While an RCT may certainly be better than anything cobbled together at a pub, the conventional parallel group RCT certainly isn’t always King of the Hill.   As nicely expounded on by the prolific statistician Stephen Senn, there are plenty of potential errors the conventional RCT finds itself humbled by.

The clinician may thus feel somewhat mollified about conclusions drawn about the effect of epinephrine in the earlier anecdote.

The idea that real evidence may live outside the confines of RCTs was also countered by none other than the godfather of EBM, David Sackett:

“Evidence based medicine is not restricted to randomized trials and meta-analyses. It involves tracking down the best external evidence with which to answer our clinical questions. To find out about the accuracy of a diagnostic test, we need to find proper cross sectional studies of patients clinically suspected of harboring the relevant disorder, not a randomized trial. For a question about prognosis, we need proper follow up studies of patients assembled at a uniform, early point in the clinical course of their disease. And sometimes the evidence we need will come from the basic sciences such as genetics or immunology. It is when asking questions about therapy that we should try to avoid the non-experimental approaches, since these routinely lead to false positive conclusions about efficacy. Because the randomized trial, and especially the systematic review of several randomized trials, is so much more likely to inform us and so much less likely to mislead us, it has become the “gold standard” for judging whether a treatment does more good than harm. However,some questions about therapy do not require randomized trials (successful interventions for otherwise fatal conditions) or cannot wait for the trials to be conducted. And if no randomized trial has been carried out for our patient’s predicament, we must follow the trail to the next best external evidence and work from there. (Sacket et al, Evidence based medicine: what it is.. )”

Sackett also noted that there were therapies whose ” ‘face validity’ is so great that randomized trials were unanimously judged by the team to be both unnecessary, and, if a placebo would have been involved, unethical”.

In effect, there was always an escape clause to let common sense prevail over EBM.  But as frequently happens in movements, the second generation of followers moves in directions unintended by the founders.  If the safeguards in place involve only areas where equipoise exists, but equipoise is itself determined by fallible judgement, the range of unacceptable experiments becomes very narrow.  This especially applies to new therapies where members of the community not involved in design and development have skeptical prior beliefs.  This is, of course, not a bad thing – it is entirely possible that the usually overoptimistic prior of the developers of a new therapy are farther from the truth than the skeptics.  But it is a major problem if we ask doctors to discard their prior beliefs that are not based in RCTs.  In doing so, we are manufacturing equipoise.  This means travel in dangerous ethical waters for physicians and their patients that is at best unwise, and at worst willfully foolish.

The EBM Wars: Manufacturing Equipoise (Part 1) published first on https://wittooth.tumblr.com/

[kristinsimmons]

The EBM Wars: Manufacturing Equipoise (Part 1)

By ANISH KOKA

The phone rings.  It’s not supposed to be ringing.  It’s 2 am.   The voice on the other line is from an apologetic surgery resident.

Resident: There is this patient..

Me: Yes, go ahead. Please.

Resident: He’s tachycardic.

Me: How fast?

Resident: 160 ?

Me: What’s the blood pressure?

Resident: 130/90

Me: Rhythm?

Resident: An SVT I think.. I gave adenosine.  Nothing happened

Me: Audibly groaning.  I’ll be in..

Forty five minutes later I’m at the bedside of a decidedly ill appearing man.

I want to be triumphant that his heart rate is only 145, and a quick glance at the telemetry monitor above his bed uncovers juicy p waves in a cadence that suggests this is no primary electrical arrhythmia.

Something is very wrong somewhere – the heart in this case is an innocent bystander being whipped into a frenzy to compensate for something.

At the moment the whip is a norepinephrine infusion being used to keep his blood pressure up.

I ask the nurse if the amount of norepinephrine infusing has been stable.  She replies that his dose has been slowly escalating.

Eureka! I think – the heart rate response in this case is being driven by the norepinephrine – a powerful adrenaline that acts on beta receptors and alpha receptors within the body that increase heart rate and constrict the blood vessels to raise blood pressure.  Fix the cause of the low blood pressure, come down on the norepinephrine, and perhaps the heart rate would be better.

But it turns out this particular post surgical patient doesn’t have a medical cause of low blood pressure I can find.  I cycle through cardiac ultrasounds, blood gases, steroid and volume challenges, and try inching down on the norepinephrine.

All of it is to no avail.  I’m growing more and more convinced this problem is surgical in nature. Perhaps an infarcted piece of bowel?  All I know is that the man acts like he has no peripheral vascular tone.

An interesting thing happens shortly after.  The norepinephrine drip runs out.

As one nurse runs to get another bag from the pharmacy – a quick cascade of events unfolds.

The brisk upstroke from the arterial line that marks the pressure wave generated with every beat of the heart starts to dampen.  The color seems to visibly drain from the patients face, and he begins to complain that his vision is getting blurry.  His systolic blood pressure is 70 – an almost forty point drop within a minute of the norepinephrine running out.

I call for help.

I try to keep a level tone.  Project control, not panic.

“Open the code cart, I need a half a milligram of epinephrine”

“You’re going to be ok, sir.  Hang with me.”  I squeeze his hand.

He closes his eyes

The code cart – a fully stocked cabinet on wheels with almost everything you need for resuscitation efforts – is wheeled into the room. The epinephrine vial is handed to the nurse, and hurriedly pushed.

Within seconds, I can see the blood pressure and heart rate rise.  The patient’s grip on my hand relaxes.  Or maybe its my grip on his hand.  I forget which.  His vision returns to normal as his blood pressure ‘normalizes’.

Of course nothing has been fixed.  Why his blood pressure remains low continues to be a mystery.  The bag of norepinephrine soon isn’t enough even at its maximal dose.  The same scenario (hypotension -> pallor -> vision loss ) recurs 30 minutes later, and another bolus of epinephrine aborts a rapid spiral towards pulselessness.

This case is an anecdote, the weakest possible form of evidence apparently.  Yet there are powerful lessons learned that night. Blood flows in pulsatile fashion with a certain pressure head.  Below some threshold of pressure, the end organs of the body stop functioning.  Agents that are active on peripheral vasoconstrictor receptors (norepinephrine, epinephrine) raise blood pressure.  Epinephrine was keeping this patient alive while a team worked to understand why his blood pressure was so low.  My suspicion was that he was in something called distributive shock – a catastrophic life threatening syndrome that requires a furious hunt for cause to save the patient.  Overwhelming infection and an even more aggressive immune response renders normally relatively impervious vasculature to be a sieve.  At the present time the therapy is directed towards replacing the fluid lost in the intravascular space and using medications that act on peripheral vascular receptors that increase peripheral tone.

There is, of course, much that isn’t known about this process.  Hopefully it will come to pass that we will arrive at a better understanding of what specifically creates this mileu so our therapies may be more directed.  But for the time being, our solutions are limited by our current, always imperfect understanding of the world.

The culprit in this case was a leak of intestinal contents into the peritoneal space from two pieces of bowel that should have been exactly apposed.  The body had attempted to tell us this very thing with that high heart rate post-operatively.  It took us, the clinicians, some time to translate.

The uninformed prior: Unlearning what has been learned.

For many, medicine has for too long been an imperfect science.  The history of medicine is replete with physicians acting with certainty in a manner that – in hindsight – was ineffective, or even worse – harmful.  Blood letting to allow the release of bad humors is believed to have hastened the demise of the greatest American – George Washington.  The disconcerting part of this is that the physician players were not motivated by anything but the best intentions.  They relied on their experience, intuition and judgement to deliver exactly the wrong prescription.   Intuition fails.  No matter how many patients died soon after blood letting, operating biases didn’t let physicians link the two events.  After all, the patients may have died even sooner if blood letting hadn’t been done.

The idea that medicine had progressed – by the 1980’s – to the point that doctors were not engaged in the equivalent of blood letting came under heavy fire when it was demonstrated a number of standard practices of the time could indeed be ineffective.  Extra beats (also known as ectopic heart beats) after heart attacks were noted in cardiac units to portend a higher risk of dying suddenly.  The obvious approach to this was to use medications that effectively suppressed ectopic heart beats.  Testing this in a double blind randomized control trial did not just demonstrate ineffectiveness, but harm.  More people randomized to suppression of ectopic beats actually died.  It turns out the anti-arrhythmic drugs being used were actually proarrhythmic as well.  The attack on ‘expertise’ that relied on intuition and experience was on, and it was a rout.

Glue ear – a condition that developed in the middle ears of little kids after ear infections  was treated with insertion of a tube to drain that space.  The trial to determine efficacy using a randomized trial to blindly allocate patients to surgery or no treatment?

Negative.

Many of the children turned out to do just fine if you left them alone.  Given the fact that all procedures have a certain complication rate, the lack of efficacy here was no small matter.

And so it went – the populace had to be on guard not just against the afflictions of disease, but against the intuitions of its doctors.

Uncertainty reigned, and in search of certainty, the field fled to the warm embrace of ever greater empiricism.  In the early ’80s from the McMaster University in Canada, David Sackett gave voice to a new sheriff – Evidence Based Medicine (EBM).

“EBM de-emphasizes intuition, unsystematic clinical expertise, and pathophysiologic rationale . . . and stresses the examination of evidence from clinical research. In 1960, the randomized trial was an oddity. It is now accepted that virtually no drug can enter clinical practice without a demonstration of its efficacy in clinical trials. Moreover the same randomized trial method is increasingly being applied to surgical therapies and diagnostic tests.” (Sackett et. al, Evidence Based Medicine)

The premise as outlined is simple – don’t believe anything that hasn’t been tested in a randomized control trial.  The only real evidence is that found within RCTs or in reviews that amalgamated RCTs.

The usual response from EBM experts can be found below in the response to the statement that real evidence may come from outside an RCT.

It is quite possible Professor Francis is right on here about the specific subject being discussed, but the point is that there is an established hierarchy of evidence on display.  The RCT is king, everything else is no better than the court jester.

While an RCT may certainly be better than anything cobbled together at a pub, the conventional parallel group RCT certainly isn’t always King of the Hill.   As nicely expounded on by the prolific statistician Stephen Senn, there are plenty of potential errors the conventional RCT finds itself humbled by.

The clinician may thus feel somewhat mollified about conclusions drawn about the effect of epinephrine in the earlier anecdote.

The idea that real evidence may live outside the confines of RCTs was also countered by none other than the godfather of EBM, David Sackett:

“Evidence based medicine is not restricted to randomized trials and meta-analyses. It involves tracking down the best external evidence with which to answer our clinical questions. To find out about the accuracy of a diagnostic test, we need to find proper cross sectional studies of patients clinically suspected of harboring the relevant disorder, not a randomized trial. For a question about prognosis, we need proper follow up studies of patients assembled at a uniform, early point in the clinical course of their disease. And sometimes the evidence we need will come from the basic sciences such as genetics or immunology. It is when asking questions about therapy that we should try to avoid the non-experimental approaches, since these routinely lead to false positive conclusions about efficacy. Because the randomized trial, and especially the systematic review of several randomized trials, is so much more likely to inform us and so much less likely to mislead us, it has become the “gold standard” for judging whether a treatment does more good than harm. However,some questions about therapy do not require randomized trials (successful interventions for otherwise fatal conditions) or cannot wait for the trials to be conducted. And if no randomized trial has been carried out for our patient’s predicament, we must follow the trail to the next best external evidence and work from there. (Sacket et al, Evidence based medicine: what it is.. )”

Sackett also noted that there were therapies whose ” ‘face validity’ is so great that randomized trials were unanimously judged by the team to be both unnecessary, and, if a placebo would have been involved, unethical”.

In effect, there was always an escape clause to let common sense prevail over EBM.  But as frequently happens in movements, the second generation of followers moves in directions unintended by the founders.  If the safeguards in place involve only areas where equipoise exists, but equipoise is itself determined by fallible judgement, the range of unacceptable experiments becomes very narrow.  This especially applies to new therapies where members of the community not involved in design and development have skeptical prior beliefs.  This is, of course, not a bad thing – it is entirely possible that the usually overoptimistic prior of the developers of a new therapy are farther from the truth than the skeptics.  But it is a major problem if we ask doctors to discard their prior beliefs that are not based in RCTs.  In doing so, we are manufacturing equipoise.  This means travel in dangerous ethical waters for physicians and their patients that is at best unwise, and at worst willfully foolish.

The EBM Wars: Manufacturing Equipoise (Part 1) published first on https://wittooth.tumblr.com/