#general surgery case report

[bubblegumgothglados]

This is my RACK focused judgment free primer for heavy impact play. It covers every part of the body from head to toe and at no point does it say you can’t do something just the risks of doing so. I don't normally put warnings on my posts but most of my writing is fantasy, this isn't. I'm going to talk about any number of painful deaths and heaps more ways of becoming disabled.

In this primer "you" means the one doing the hitting, "victim" is the one being hit, and "tool" is the thing you're hitting with which could be a fist, foot, hammer, bat, anything. I'm writing it this way because its fun for me.

This primer also assumes you know the different types of impacts and how they affect the body, if you don't go look at my other writings.

Finally i take no responsibility for anything you do. All this information is what i could put together from medical journals and car crash reports if I've got anything wrong (and you can prove it) please let me know.

Enjoy

Head. With hits to the head, the two major concerns are concussions and neck injuries. A concussion occurs when a person’s brain impacts with the inside of their skull, this happens because the brain is suspended in fluid so if the skull stops or starts moving suddenly the brain will move out of sync with the skull. Symptoms of concussions can include headaches, confusion, lack of coordination, memory loss, nausea, vomiting, dizziness, ringing in the ears, sleepiness, and excessive fatigue. If your victim lost consciousness for any length of time and is having trouble speaking or understanding your words, you need to get them to the ER. There is no cure for a concussion but the best treatment is pain medication and activities that won’t tax the brain to give it time to recover. There are any number of ways to damage a neck, but generally it happens when a person’s neck is moved suddenly and violently or pushed past its limit. Minor injuries should heal by themselves within a few weeks but if unlucky pain and stiffness can last months or even years. For more major injuries, physical therapy or a neck brace might be necessary but only if the pain lasts longer than a few weeks. It’s also possible to hit someone hard enough to break their neck or fracture their skull but that takes a lot of force. All of these injuries can be avoided by supporting your victim’s head and neck by bracing their head against a surface or holding their head with your hand.

Jaw. It takes surprisingly little force to dislocate a jaw, you can do so with a good slap Dislocations are talked about in Note 3 at the bottom of this primer. Heavy bleeding from gums or a tooth that feels loose could indicate a fractured root. This is a fairly minor issue and if you see a dentist quickly they should be able to fix it back in place with no lasting damage. A tooth that has been knocked out completely should survive; get your victim to rinse their mouth out and rinse the tooth off and shove it back into the gap, and then have them see a dentist to make sure it’s properly seated and avoid chewing with it for a while.

Eyes. A fun combination of fragile and complicated. There's no first aid tips I can give you and it'll be real obvious if something is wrong. I will say you don't have to hit someones eye to give them a black eye, it’s bruising around the eye socket that matters. Also check Note 1 about the use of ice when treating injuries.

Nose. It’s more difficult than you think to break a nose. You definitely can with a good punch but you'll have to really commit. A broken nose isn't that serious (I've broken mine twice now) and isn't even ER worthy. If your victim is leaning backwards after breaking their nose the blood will run down the back of their throat potentially making them vomit or very sick. There is a chance a broken nose will heal in a way that restricts breathing in which case your victim may need surgery.

Cheek bone. Below the temple but above the gum line, running from just bellow their ear to their nose. Special mention to this spot because it’s the best place to hit your victim in the head (in my opinion). This piece of bone is very sturdy and not that risky to fracture. Plus, when you hit them here they have to watch it coming.

Neck. The windpipe, jugular, cranial nerves, vagus nerve, carotid arteries, and spine all live here and damage to any of these can cause permanent disability or death. Seek medical attention if your victim has trouble breathing or swallowing, or a lot of pain or swelling. Stingy tools are far less risky here than thuddy tools.

Shoulders. Note 2 on joints. The shoulder blades can either be an ideal impact location or one of the most risky depending on how it’s sitting. If the shoulder blade is jutting out away from the rest of the back, it’s very easy to damage If it’s laying flat against the back, it’s protected by a thick layer of fat and muscle.

Biceps. Top 4 impact location. The main concern is damaging the elbow and shoulder joints, if hitting in a way that will pull on those joints. Much like with the head, bracing the impact area against a surface will minimize the risk. Repeated hits to this area can temporarily disable the arm, which is fun.

Forearm. As above, the main risk is damaging the adjoining joints. There are also several important blood vessels and nerves running through this area and not a lot of fat an muscle to protect them.

Hands. Very little fat or muscle, mostly tendons, nerves, and cartilage. See Note 2 on joints. Special note to the palm, which hurts like hell but is relatively safe because of the extra muscle and fat in that area, great for punishment. Once again, stingy tools are much less risky than thuddy tools.

Breasts/ biceps. Top 4 impact locations. Thick layers of fat, muscle, and bone protect anything vital.

Sternum. That is the bone running down the center of a person’s chest that connects to their ribs. Not in itself very fragile but the cartilage that connects it to the ribs is easily damaged and will take a long time to heal. A fractured sternum will likely cause shortness of breath and pain when taking deep breaths. There's not much to be done about these injuries just rest and avoiding strenuous activity.

Spine. The single most risky impact location. Any damage to the spine risks permanent paralysis of everything below that point. As ever, stingy tools present less risk than thuddy tools.

Rib cage. Designed to protect a person’s most vital organs, the rib cage is very strong. Fractured ribs will cause pain breathing but aren't particularly serious. Snapped ribs can pierce organs If this happens, it'll be immediately obvious and medical intervention is required to prevent painful death. Special note to the 'floating' ribs at the bottom of a persons rib cage which don't connect to the sternum and are therefore much less resilient. Second special note to the spot right above a persons heart. A significantly hard impact at exactly the wrong moment in their cardiac cycle can stop their heart. They will loose consciousness and you will need to give them CPR until they can be defibrillated. This is ridiculously unlikely but better to mention just in case.

Abdomen. If you feel around your victim’s belly, you can figure out the line where their abdominal muscles sit. If you have them tense these muscles, you can hit them fairly hard with relatively little risk because the muscles plus the fat in that area create a thick layer of protection. (Pro tip: "Stay tense or this will might kill you" is not only true but hot and terrifying). Outside of that area or if they don't tense, there's real risk of bruising or even rupturing their intestines, which carries a 50-70% survival rate depending on how quickly you can get them to the ER. Symptoms to look out for are bloating, diarrhea, loss of appetite, and fatigue. Special note to the kidneys, which sit next to the backbone just below the rib cage and are very easily bruised. The primary symptom to look for is blood when peeing. As always, stingy tools carry less risk than thuddy tools.

Gluteus maximus. That's their butt. Hit it as hard as your victim will let you. Enough has been said about this region; I don't feel the need to recover that ground. Note 4 on bruises.

Genitals. I'm not going to get into CBT, that's a separate kink. But the vagina is very durable as it’s pretty much just flesh and fat on the outside Minimal risk, go to town.

Thigh. Top 4 impact location. Outer thigh will hurt more and bruise more. As with the head and arms, the primary risk is damaging the adjoining joints. Note 4 on bruises because this is the primary place for DVT.

Calf. As above. Shins are also a great location for punishment because they hurt like hell.

Feet. Very similar to hands. The soles of a person’s foot are intended to impact with the ground frequently and with some force, so they can take a fair bit of punishment.

Note 1. Ice. It is no longer suggested injury procedure to use ice to reduce swelling. Yes, it is effective at reducing swelling but we now understand swelling is an important part of the healing process and although ice might make it feel and look better in the short term, it actually increases the amount of time the injury will take to heal. You want the blood to be able to flow to the injury to take away dead cells and bring nutrients and energy.

Note 2. Joints. Neck, spine, shoulders, elbows, wrists, fingers, hips, knees, ankles, and toes. The reason these are almost always labeled "red" or "no go" on impact play body maps is because these are choke points for blood vessels and nerves; they are made of fragile tendons and cartilage, and they have very little padding for protection. They're also important for movement day to day and very difficult to heal properly. If a joint is damaged, you can buy braces for every joint from most pharmacies.

Note 3. Dislocations. If you're lucky, a partial dislocation will relocate by itself if you move the joint around as you normally would, not forcing it or trying to manipulate it with your hand, just moving it with its own muscles. If it does naturally relocate but you still have pain a few weeks later seek a medical professional. If you're unlucky or if it’s a total dislocation, you will have to see a medical professional. DO NOT TRY TO FORCE IT BACK INTO PLACE!

Note 4. Bruises. Normally, bruises are nothing to worry about but there are situations where a deep bruise can be a health concern. If the bruise continues to get worse after a week, there could be a hematoma under the skin, which is like a blood clot, and might need to be removed. The other possible complication is Deep Vein Thrombosis, which is a blood clot and can be lethal, if not treated quickly. With DVT, the symptoms are tenderness, warmth, and a "pulling sensation" which are pretty normal impact play symptoms. But if you're doing impact play at the level that could cause DVT, then you and your victim should know their healing process intimately, so if something feels off or isn't healing right, get them to a medical professional; better safe than dead.

[justinspoliticalcorner]

Amanda Marcotte at Salon:

After the Supreme Court ended federal abortion rights in 2022, there was a robust debate between pro- and anti-choice activists over whether or not banning abortion would kill women. Pro-choicers pointed to evidence, from both history and other countries, showing that abortion bans kill women. Anti-choice activists dismissed the record and pointed to toothless "exceptions" in abortion ban laws as "proof" that women could get abortions to save their lives.  The latter argument was frustrating not just because it was wrong but was generally offered in bad faith. Anti-abortion leaders know that abortion bans kill women. They don't care. Or worse, many view dying from pregnancy as a good thing. In some cases, it's viewed as just punishment for "sinful" behavior. Other times, it's romanticized as a noble sacrifice on the altar of maternal duty. But conservatives are aware that this death fetish cuts against their "pro-life" brand. So there was a lot of empty denials and hand-waving about the inevitable — and expected — outcome of women dying. 

We now have another proof point that abortion bans are about misogyny, not "life," as the first deaths from red state abortion bans are being reported. Instead of admitting they were wrong and changing course, Republicans are behaving like guilty liars do everywhere, and destroying the evidence. In the process, they are also erasing data needed to save the lives of pregnant women across the board, whether they give birth or not.  ProPublica has published a series of articles detailing the deaths of women in Georgia and Texas under the two states' draconian abortion bans. They most recently reported the death of Porsha Ngumezi, a 35-year-old mother of two from Texas. Ngumezi suffered a miscarriage at 11 weeks but was left to bleed to death at the hospital, instead of having the failing pregnancy surgically removed. Multiple doctors in Texas confirmed that hospital staff are often afraid to perform this surgery, however, because it's the same one used in elective abortions. Rather than risk criminal charges, doctors frequently stand by and let women suffer — or die.  Ngumezi's youngest son doesn't fully understand that his mother is dead. ProPublica reported that he chases down women he sees in public who have similar hairstyles, calling for his mother. 

A day after this story was published, the Washington Post reported that the Texas maternal mortality board would skip reviewing the deaths of pregnant women in 2022 and 2023 — conveniently, the first two years after the abortion ban went into place. The leadership claims it's about speeding up the review process, but of course, many members pointed out the main effect is that "they would not be reviewing deaths that may have resulted from delays in care caused by Texas’s abortion bans." This is especially noteworthy because it's become standard after one of these reports for anti-abortion activists to blame the victims and/or the doctors, and not the bans. Christian right activist Ingrid Skop, for instance, responded to Nguzemi's death by insisting "physicians can intervene to save women’s lives in pregnancy emergencies" under the Texas law. If she really believed that, however, she would desperately want the state maternal mortality board to review this, and other cases like it, so they could come up with recommendations for hospital staff to treat women without running afoul of the law. Strop, however, is on the Texas maternal mortality board. She was likely part of the decision to refuse to look into whether women like Nguzemi might be saved. 

[...] But despite claims to be "pro-life," anti-abortion activists do not care. Instead, they are on Twitter griping about how comprehensive reproductive health care access "promotes sexual promiscuity." 

Skop also argued last year that abortion bans are justified because "promiscuous behavior declines." It's tempting to point out that all five women whose deaths have been reported by ProPublica were in long-term relationships or marriages. Three of the five planned to bring their pregnancies to term and died because they were denied miscarriage care. But that's the problem with vague terms like "promiscuous." They draw us into debates about how much women are allowed to enjoy sex before their lives are forfeited. Or how many "good girls" should die to punish the "promiscuous" ones. That is the trap of misogyny. It allows women like Lila Rose or Ingrid Skop to pretend that, if you submit to the sexist order and obey all their arbitrary rules, you'll be saved. But these laws punish all women and girls: mothers and non-mothers, wives and single women, women who've had 100 partners and those who were virgins when raped. Abortion bans make crystal clear that, to the Christian right, no woman's life is worth saving. Anyone can be sacrificed, to protect their cruel patriarchal order. 

Want more reason why abortion bans are bad for women? Republicans are working hard to destroy the evidence that abortion bans kill women.

Abortion bans have zip to do with the "sanctity of life", but are a tool for misogyny.

[odinsblog]

Game of Thrones stars and other actors read South Africa's case file charging Israel with genocide at the International Court of Justice.

Transcript:

It was already known that repeated exposure to conflict and violence, including witnessing and experiencing housing demolition, combined with Israel'siege of Gaza since 2007, is associated with high levels of psychological distress amongst Palestinians.

Indeed, the United Nations Security Council Resolution 2712 expressed its deep concern that the disruption of access to education has a dramatic impact on children and that conflict has a lifelong effect on their physical and mental health.

This disruption and its dramatic impact on children must be considered in particular and in the context of the number of Palestinian students and educators who have been killed, 4,037 and 209 respectively, and wounded, estimated at 7,259 and the number of Palestinian schools having been damaged or destroyed 352 or 74% of the schools in the whole of Gaza.

Medical professionals assess that the health effects on all Palestinian children, women, men, older people, people with disabilities and people marginalized identities are immense.

An emergency coordinator for Médecins Sans Frontières interviewed on her return from five weeks in Gaza, describes: It's even worse in reality than it looks. The amount of suffering is just something incomparable. It's really unbearable. I'm speechless when I try and think of the future of these children. Generations of children who will be handicapped, who will be traumatized.

The very children in our mental health program are telling us that they would rather die than continue living in Gaza now.

The extreme levels of bombardment and lack of any safe areas are also causing severe mental trauma in the Palestinian population in Gaza.

Even before the latest onslaught, Palestinians in Gaza suffered severe trauma from prior attacks. 80% of Palestinian children experienced higher levels of emotional distress, demonstrating bed wetting, 79% and reactive mutism, 59% and engaging in self harm, 59% and suicidal thoughts, 55%.

Eleven weeks of relentless bombardment, displacement and loss will necessarily have led to a further increase in those figures, particularly for the estimated tens of thousands of Palestinian children who have lost at least one parent and those who are the sole surviving members of their families.

For the families who remain intact or partially intact, quote, “It's about doing everything you can so your child doesn't realize that you've lost control.”

There are reports of Israeli forces using white phosphorus in densely populated areas in Gaza.

As the World Health Organization describes, even small amounts of white phosphorus can cause deep and severe burns, penetrating even through bone and capable of reigniting after initial treatment.

There are no functioning hospitals in the north of Gaza in particular, such that injured persons are reduced to waiting to die, unable to seek surgery or medical treatment beyond first aid, dying slow, agonizing deaths from their injuries or from resultant infections.

Large numbers of Palestinian civilians, including children, have reportedly been arrested, blindfolded, forced to undress and remain outside in cold weather before being forced onto trucks and taken to unknown locations.

Medics and first responders in particular have been repeatedly detained by Israeli forces, with many being detained in communicado at unknown locations.

Videos published by Israeli media on Christmas Day appeared to show hundreds of Palestinians rounded up inside al-Yarmouk football stadium in Gaza City, including children, older people and persons with disabilities, being forced to strip to their underwear in degrading conditions. United Nations Office for the Coordination of Humanitarian affairs, or UN OCHA, reports video footage showing bruises and burns on the bodies of detainees.

Images of mutilated and burned corpses, alongside videos of armed attacks by Israeli soldiers are reportedly circulated in Israel via a Telegram channel called, 72 Virgins Uncensored, billed as exclusive content from the Gaza Strip.

[maxwellatoms]

I bought a Gartenmeister Fuchsia plant for my birthday back in January. It was a centerpiece all winter long, but recently it started looking a bit sickly. I'm not a "green" gerdener anymore (haha), but I am also by no means a master. I think it was infected with powdery mildew, but I also convinced myself it was spider mites. I try to keep things all -natural out there, so I dried it out and sprayed it with some neem oil after pruning it back a bit. I really should've pruned off all of the infected bits, but I didn't want to lose the flowers.

I did that a few more times, unable to commit to a hard prune because I kept telling myself "I don't know what I'm doing, so maybe it's not sick. Maybe it'll fix itself. Sure would be nice to have those flowers back." I finally gave up and cut it to the bone yesterday, but yesterday was too late. I had to remove every single leaf because I dithered for too long. It's probably not going to make it.

I feel the same way about our culture. US culture. Western culture (though its really a global problem). The Entertainment Industry. The Media. It's sick. We probably need some rather serious surgery to fix the problem, but we just will not see a doctor. To see a doctor would be to admit there's a problem, and for some that is the greatest sin of the 21st Century. Maybe some of us are just hoping the system will recover on its own so we can have our pretty flowers back.

For me, it was around 2010 or so when I first started to smell something "off". The symptoms had certainly been around a while. This was just when I noticed. This was when I got my first, "Hey, let's not make fun of corporations" note. It's when The History Channel stopped airing stuff about history in favor of aliens because that's where the money was. And rather than rebranding, they just left it as "History", encouraging future generations to believe whatever they felt like. This was also about when traditional news outlets started skewing to clickbait in order to compete with sites that were clearly 100% not legitimate news sites. Again, as long as the money is right it's "just entertainment" and you' can're welcome to believe it if it means you'll watch more.

I'm all-in on Dead Internet Theory now. The disparity between what major news media outlets will report and what you see from actual people on Tumblr or Threads or Reddit is pretty shocking. And those sites are already compromised by bots and bad actors. The tools exist now to actively bamboozle millions of people, and I have no doubt we're already seeing some of this now. In six months or a year you'll find out it (whatever it was) never happened or was generated by an LLM. The time to stop listening to anyone online was a year ago.

Trust no one.

Not even me!

It's cultural rot. It's spreading faster and faster, and I'm not sure what happens when we get to the end of this ride. Actually, I AM sure what happens. If we don't prune back hard now, then the rot takes over. Best-case, you clip the infected branches off too late and it takes years to recover. Worst case? Nature soldiers on but the plant succumbs to infection and dies completely, replaced (eventually) by something that can actually hack it in that spot.

When humans produce art and information, and then comment on that art and information by producing more art and information, we call it "culture". We're moving toward a time when the vast majority of art and ideas we get out eyes on won't be created by humans. Or at the very least won't be created with the purpose of commenting on or enriching the organic human experience. When that happens, what will we call it? What will remain of our culture?

[letters-to-lgbt-kids]

My dear lgbt+ kids, 

Did you know the practice of meditation can have side effects? Some people experience adverse reactions to meditation, such as heightened anxiety or depression or even delusions and hallucinations. 

What does that have to do with being lgbt? Well, nothing - but meditation is often seen as one of those “healthy things everyone should do”, something that just has so many benefits and doesn’t require you to take anything or undergo any kind of surgery, something that it’s widely recommended and accepted as healing… and even THAT super great thing has some people who will regret doing it. 

Not a perfect comparison, nothing ever is, but you see the analogy coming: Transition (social or hormonal or surgical) is super beneficial to many people. And there are also some people who will regret it. 

Any kind of health decision - and really any decision at all - can end with you regretting it. That’s a part of life. 

“Protecting people from making a decision they might regret” sounds like such a noble goal. We want to live in a world where people can make informed decisions. Education, including on risks and side effects, is something to strive for. But it’s important to remember that we can not live in a world where nobody ever regrets anything. 

People can regret getting their ears pierced. People can regret buying a car. People can regret going to university. People can regret having sex with someone. People can regret marriage. People can regret moving to a different state. People can regret coming out as gay. People can regret hip replacement surgery. And yes, people can also regret transitioning. 

If we seriously wanted to protect people from ever regretting anything, we would need to just take any deciding power away  (and then who would we give it to? Whoever makes our decisions for us then, they could also make a decision they end up regretting!). 

Another reason why this analogy works: I told you meditation has side effects and people regret it - but I pretty conveniently left out that it’s pretty rare for that to happen. Meditation is generally very safe and has a really low regret rate. Plus, people who regret it may not regret that they choose to meditate all together but rather report that they regret a specific experience (such as choosing silent meditation over guided meditation or going on a meditation retreat that lasted multiple days). 

Similar to that, transition also has a low regret rate (statistically much lower than tattoos or hip replacement surgery for example!) - and people who regret it may not actually be a case of “I regret it because I realized I’m not transgender”, even if that’s what transphobes tell you. Some people still identify as transgender but regret their surgery because they experienced complications (as they can arise from any kind of medical procedure). Some people regret it because they lost friends or family or job opportunities after coming out. And so on. 

The topic of regret is much more complicated than “meditation is actually bad” or “they woke up one day and realized they were brainwashed into believing they were trans”. And it’s unfair to not only the ones who will never regret it but also to the ones who do regret it to reduce their stories to a cautionary tale meant to stop people from making a decision over their own body.

“We need to protect people from making decisions they might regret” just isn’t a good argument. 

With all my love, 

Your Tumblr Dad 

[dxmedstudent]

What do GPs do?

For the past few years, there's been a constant undercurrent of hostility towards the medical field in mainstream media, particularly GPs. Especially from certain conservative former doctors who write in to the Torygraph.

One of the charges levelled against GPs is that they are purpotedly ruining the NHS by not working enough hours. They need to be making more time for appointments and are all shirking.

How do GPs work?

GP work is measured in sessions, defined by the BMA as a 4h 10 minute time slot. 3 hours of this is meant to be clinical time, with some admin time for tasks - meant to be at least and hour. Typically, a whole day will involve a session in the morning and a session in the afternoon.

What do GPs do? The BMA breaks it down here. I also find articles by GPs can be useful for explaining. When not talking to patients, we are sending referrals or liaising with specialists about their care. We are checking blood test results and other investigations that were carried out by the practice, and then informing patients. We are filling prescriptions- each time a patient asks for their prescription to be refilled, a doctor or pharmacist is checking the order and whether it is safe to give, abd whether we are monitiring blood tests and keeping the patient safe. We are reading letters from specialists and actioning their recommendations.

However, in reality, multiple surveys reveal that GPs spend significantly more time working than what they are directly paid for. Whilst a 6 session GP should be spending around 24 hours at work, it's closer to 38 hours on average. GPs report spending up to 40% of their working time on admin - much of it being unpaid time outside of the hours they are contractually hired for. I and most GPs I know routinely stay late at work in order to make sure patient care is completed. We're in before 9am and leave between 7 or 8pm.

Add to that that many might have further responsibilities, especially if they are a partner in the practice.

Funnily enough, full time in general practice is considered to be 8 sessions. That's 4 long days. Gone are the days when anyone would consider a 5 day working week for GPs, because the workload is increasingly intense and sessions generate more paperwork than they used to.

Demand Is Increasing

GPs may be moving towards working less sessions, but that's because our work is getting more complex. As patients live longer, with more complicated combinations of illnesses and treatments, and we exist in a society that has progressively defunded social care and benefits, and impoverished our most vulnerable patients, there are more calls on our time abd attention than ever before. Stripped hospital services are increasingly rejecting our referrals, often inappropriately and against actual guidelines. Services are being pushed onto GPs via shared care agreements that would once have been handled by specialist teams in clinic. Services that we heavily rely on to serve our patients are sometimes defunded or disappear as contracts end or are transferred to new providers. Long wait lists lead to exasperated patients repeatedly seeing their GPs to manage issues that can't be managed well in the community.

There's a narrative in the media that appointments are impossible to get, but in reality, nationally GP surgeries are providing more appointments per month than they did before the pandemic. For example, 25.7 million appointments (excluding Covid vaccinations) were delivered by GP practices in December 2023, an increase of 9% compared to pre-pandemic. Practices are trying to find how to offer more appointments on a budget and how to improve access and find alterantive ways to serve patients; for example online forms, so that phone lines are freed up for vulnerable patients. Many practices are also offering longer appointments as many patients have complex needs.

Let's talk Pay

People also assume GPs are rich, but that's not really the case, especially given most of us wrent working full time. Average pay for a session is somewhere between 10k and 12k a year for each session a week that you work, depending on things like seniority and location. So for example, a 5 session GP earning 10k per session can expect to earn 50k a year. That's barely above the London average salary of 44k for a job that requires medical school, often an additional bachelor's degree and then at least 5 years of postgraduate training at minimum. That's more comfortable than a lot of vulnerable people, but it's nowhere near what most people think. Even if someone is paid higher per session and working more sessions, the average is still closer to 80 or 90k for salaried GP roles.

I've found figures that suggest the average GP salary is just over 100k, but that includes people doing separate private work or being partners, where in reality these are different roles that are paid differently. Partners are effectively shareholders in the practice. Locum or private work is much more lucrative and needs to be considered separately from a standard salaried role.

Some Partners may be earning £100k-150 in a good year, but that will be after working a LOT of overtime outside of their clinics, abd is in line with hospital specialists. The proportion of GPs earning more than that are miniscule. And honestly, if someone is working a ton of extra hours with their local LMC or med school or deanery, or doing a ton of locum work in evenings and weekends, I'm happy for them to be earning more money than me. Extra work and hours should be rewarded.

The Gender Aspect

I think we need to address the fact that complaining about doctors choosing to work less than what is defined as full time, often goes hand in hand with people complaining about women having the temerity to work in medicine. Apparently we're devaluing the profession by making it too female, going part time and having children. Why us ut that nobidy cares about whether men are going less than full time to look after their kids, and whether fathers are missing out on their children's upbringing?

As women, many of us are still facing sexism in our working lives. Whilst still having to deal with the fact that even uf we earn more and work longer hours than our menfolk, we usually end up doing the majority of the childcare and housework. Women in medicine are more likely to go less than full time because we are more likely to feel compelled to take on unpaid labour at home. Like our non medical sisters.

For reference, the full time nursing week in the NHS is 37.5h - with some variation between 36-40h depending on where you work. Working part time would benefit nurses, too. The nursing workforce is mostly women, and yet there's not the same outrage about their working hours or going less than full time, because women being nurses is expected. People don't seem to care about nurses' working conditions or the stresses they are under, and honestly most articles ignore the financial stresses or difficulties of most NHS workers because they are normally focused on doctors as a resource that they want to exploit maximally.

We aren't out there trying to police what hours other professions work - or at least, we shouldn't be. So why does the public feel entitled to dictate what hours doctors should be working? It's not like people are being paid for hours they aren't working!

[cardiacreports2]

Autopsy Report

Case Number: 2024-1125-01 Decedent Name: Chad Evanston Age: 19 Sex: Male Height: 5’11” Weight: 154 lbs (estimated lean build) Race/Ethnicity: Caucasian Date of Death: November 24, 2024 Time of Autopsy: November 25, 2024, 9:00 AM Pathologist: Dr. Robert Linfield

I. External Examination

General Appearance: The decedent is a well-developed, lean, and athletic-appearing 19-year-old male, weighing approximately 154 pounds. He has brown hair, approximately 3 inches in length, and brown eyes. Skin is pale but otherwise unremarkable, with no evidence of external trauma or defensive injuries. Fingernails are clean and well-trimmed.

Clothing: The decedent was found dressed in athletic attire, including a blue baseball cap, black athletic shorts, a running watch on the left wrist, and well-worn running shoes. The clothing was damp due to environmental exposure but showed no tears or stains of significance beyond expected post-mortem findings.

Identifying Marks: A faint scar measuring 2 cm is present on the left knee, consistent with prior minor trauma or surgery. No tattoos or other distinguishing marks.

II. Internal Examination

Cardiovascular System: The heart is notably abnormal upon inspection. Weighing 390 grams (upper end of normal for the decedent's size and build), the heart exhibits significant thickening of the left ventricle (left ventricular hypertrophy). The mitral valve shows marked structural abnormalities, including:

Fibrotic thickening of the leaflets.

Mild calcification at the annulus.

Evidence of prolapse of the posterior leaflet, causing incomplete coaptation during closure. This structural defect resulted in significant mitral regurgitation, which would have led to reduced cardiac efficiency during exertion.

Examination of the coronary arteries reveals no signs of atherosclerosis or narrowing. However, microscopic examination identifies mild interstitial fibrosis in the ventricular myocardium, particularly in the left ventricle. These findings are consistent with chronic strain and early-stage cardiomyopathy, likely exacerbated by prolonged high-intensity physical activity.The conduction system shows mild scarring near the sinoatrial node, likely the origin of the arrhythmias detected on the decedent's running watch.

Lungs: The lungs weigh 520 grams (right) and 480 grams (left), with mild congestion. Examination shows no emboli or aspirated material.

Abdominal Organs: All abdominal organs, including the liver, spleen, kidneys, and gastrointestinal tract, appear normal in size and morphology.

Brain: Examination of the brain reveals no hemorrhages, infarcts, or structural abnormalities.

III. Microscopic Findings

Heart Tissue: Histological examination of the heart confirms chronic myocardial fibrosis and focal areas of myocyte disarray. These findings are indicative of longstanding structural abnormalities and stress-induced cardiac remodeling.

Lung Tissue: Pulmonary alveoli appear congested but otherwise unremarkable.

Valvular Tissue: Fibrosis and calcification of the mitral valve tissue are evident, along with cellular degeneration, consistent with a congenital or acquired valvular defect exacerbated over time.

IV. Toxicology Report

Testing for substances, including recreational drugs, alcohol, and common stimulants, returned negative results.

V. Cause of Death

Sudden cardiac arrest secondary to severe mitral valve dysfunction and associated arrhythmia.

Detailed Analysis of Cardiac Findings

The decedent's heart exhibited chronic and progressive mitral valve disease. The fibrotic and calcified changes in the mitral valve likely originated from an undiagnosed congenital defect, aggravated over time by physical exertion. The incomplete closure of the mitral valve resulted in backflow of blood (regurgitation) during systole, progressively overloading the left atrium and left ventricle. Over time, this stress led to the observed hypertrophy and scarring of the myocardium.

The combination of myocardial fibrosis and conduction system scarring predisposed the decedent to severe arrhythmias. The running watch data corroborates this, showing prolonged arrhythmic episodes throughout the decedent's final run.

The sustained stress of a nine-mile run caused the decedent’s heart to become electrically unstable, leading to ventricular fibrillation—a fatal arrhythmia resulting in sudden cardiac arrest. The autopsy findings, supported by wearable device data, confirm that this event was precipitated by his preexisting cardiac abnormalities.

Despite being otherwise healthy and athletic, the decedent’s heart was structurally compromised, making high-intensity exercise particularly dangerous. The mitral valve's dysfunction was significant enough that even mild to moderate exertion may have posed a risk over time.

Conclusion: Chad Evanston’s death was due to undiagnosed and progressive cardiac pathology exacerbated by prolonged physical exertion. This case highlights the critical need for screening individuals engaging in high-intensity activities for underlying heart conditions.

Final Manner of Death: Natural

[ambiguouspuzuma]

Crooked

They identified the body by her dental records. Her bag was full of them.

"Well, she was definitely some kind of dentist." Detective Sidwell dropped the copies back to the desk. "That should make the identification easier."

"Dr Jane Doe." Sidwell's colleague, Detective Lita, was inspecting the other crime scene photographs. The gory ones. "With a nice big cavity, it seems - carved right in the middle of her chest. She bled out all over the place, although she'd probably say that's because she didn't floss."

"What are we thinking for our suspects?" Sidwell asked, ignoring the jokes. One of them had to stay professional, to focus on the job at hand - and somehow that burden always seemed to fall to him. "A colleague? Patient?"

"No, it looks pretty frenzied to me."

"I'm serious."

Lita took a moment to think it through. "I don't see it, to be honest. I know people hate going to the dentist, but not to the point of murder. In fact, I'll bet you it's nothing to do with her job at all. Dentists can get stabbed for the same reasons as anybody else, right? A fight over her love-life, a mugging gone wrong, heading down the wrong alley at the wrong time, that sort of thing."

"I'll take that action," Sidwell said, holding her to the bet. Professionalism had its merits, but the job could get pretty bleak if they didn't find their own ways to keep things light. "What's your wager? Buy me a coffee?"

"Sure, you can pick me up a latté from the new place downtown." Lita smiled her crooked smile, her teeth stained brown from coffees past. No sugar, though. I wouldn't want to be disrespectful."

With his compensation agreed, Sidwell knuckled down to work on the case. He knew he'd need to do the lion's share of the investigation, as he always did, and the bets were a way of getting something out of it. Or motivating Lita to put a shift in, when it looked like things weren't going her way. She wasn't often too focused on following up leads, but could roll her sleeves up when a bet was in the balance.

Theirs was an unusual partnership, and certainly not an equal one. Lita's lack of professionalism extended far beyond the jokes, and Sidwell often felt that she was less of a help than a liability. He was left to follow up forensics requests she'd forgotten to send, rewrite notes which she'd misplaced on the landfill site that she called a desk, and generally carry her through the working day.

She sometimes apologised, or thanked him with a drink, but showed no sign of trying to be better. Even on this case, charged with catching a murderer, she seemed disinterested in the details. A savaged corpse was enough motivation for Sidwell to chase down every suspect, and he wondered what exactly it would take to capture Lita's attention in the same way. If even this case failed to move her, he didn't understand why she'd wanted to become a cop in the first place.

"Tell me again," Lita asked. "You think she was some sort of orthodontist?"

"A rogue one, according to these reports. She messed up people's teeth intentionally, just so they wouldn't match their dental records. That's why she had so many in her bag. It looks like some local crime ring hired her to sort out their goons, so that they'd never be identified if they were killed."

It had been a tough one for Sidwell to get his head around - it felt like getting laser eye surgery to make yourself more short-sighted, or asking a plastic surgeon to add more wrinkles to your forehead, but it did seem to make sense from the perspective of a killer. If teeth could be reshaped at will, anybody on the system could be fitted with a brand new set, removing any prospect of a match. It was certainly easier than having to dissolve them.

He hadn't realised how often the police relied upon dental records to identify bodies - especially those who'd been disposed of carefully, with the rest of the face disfigured and hands removed - or quite how malleable those patterns were. It was like if there was a whole industry for designer fingerprints or DNA, shaping perfect whorls and helixes, and the state still treated them like unique identifiers. How many past matches had they missed because of Jane Doe's meddling? Even she could be on their database somewhere, hidden behind an unrecognisable overbite.

"A heterodontist, if you will." Lita brought him back to the present.

"No."

"I didn't realise the mob had a dental plan. So what are we thinking? One of the grunts saw their disappearance coming, and swung by to give her a stainless steel filling?"

"This feels like a professional hit. Maybe the higher-ups, if she knew too much. But either way, this isn't just a random attack, right? She's not been murdered for something unrelated to all those murders she helped to cover up. You have to concede that would be too big of a coincidence."

"Yeah, yeah, I know what you're saying," she conceded, hands up in mock surrender. "I'll buy you your drink. Where do you want to go?"

Even then she dragged her feet. Lita made him wait outside whilst she went back to get her jacket, then spilt his coffee at the first attempt and had to go back to the counter to replace it. Sidwell might think her a sore loser, if she wasn't like this about literally everything. Even when he finally had the cup in his hand, he suspected that she'd somehow got his order wrong.

"What's in this drink?" He recoiled at the first sip, but went back for a second. It wasn't unpleasant, exactly - just unexpected. Notes of almond, and something he couldn't quite place. "You just asked for normal milk, right?"

She shook her head. "I added a couple of shots. You deserve a little treat."

"That's not going to be good for my teeth."

"I'm sure our victim will forgive you." Lita grinned, as if to prove his point. "You're the one who was right about her, so you're allowed a little indulgence."

Sidwell tried to be polite, to set an example to her as much as anything. No wonder she'd been at the counter for longer than usual. The coffee wasn't awful, if he ignored the other flavours. Was this what she went for every day? He wondered if the sugar was to blame for her performance, which alternated from erratic to lethargic, like a hyper child who crashed in the afternoons.

Lita watched him drink in silence for a while, then seemed to find the courage for a question.

"Do you think that I'm incompetent?"

Sidwell weighed it up - probably for a second too long. So this was why she'd wanted them to grab a drink together, one way or another. She needed to talk about her career, away from the precinct. "I wouldn't use that word."

"So what word would you use?" she pressed. "Competent?"

"Well... okay, maybe not. Sorry."

Lita nodded. "No, that's good to hear. It'll work on the next guy."

"Huh? Are you transferring from the squad?" Sidwell tried to feign dismay, but knew that she'd always been the better liar. "Is this goodbye?"

"Sure," she said. "Call it a leaving drinks."

"You don't want something?" He gestured with his cup before another deep sip. "Gods, this is potent stuff."

"Only the best for my old partner." She sat back, watching him with something almost like nostalgia in her eyes. "A way of apologising, I suppose. How many of our cases have I delayed, or outright obstructed?"

"Oh, I wouldn't say obstructed," Sidwell told her, trying to find something nice to say. The truth was that she'd often been as much a hindrance as a help, and he'd be glad to get a better partner in her place. "That suggests that you were doing it on purpose. You were just... there's a lot to learn. I'm sure that you've always tried your best."

"That's right," Lita said, although she didn't seem too worried about it. "And if criminals profited from my mistakes, even the failed prosecutions, that's just because I was learning the ropes."

"Yes, I'm sure it's something like that." It didn't sound great when she said it. They were supposed to be detectives. Not for the first time, Sidwell wondered how she'd earnt such a sacred responsibility, or why she'd even wanted it. "But that's why you have a partner. To support you."

"Like you've almost solved this dentist case, all on your own."

"Almost, yeah."

"And you're sure it was a professional hit, from the group she did the work for? There's nothing I say that can persuade you otherwise?"

"I'm sorry, but no," Sidwell said. "You can check out the other angles if you like, and I'd never dissuade you from doing so, but I'm pretty convinced by my current leads. Why, do you know anything you haven't shared?"

"Of course not," Lita said, lying through her crooked teeth. Had he ever noticed quite how bad they were? "You've won me over. That's why we're here, right? I'm sure your theory is correct, and you'll get their names in due course. You just enjoy the rest of your drink to celebrate. Like I said, you deserve it - every last sip."

[violetsandshrikes]

ok you have made good science and health posts. Is it worth taking a probiotic as part of my selfcare routine?

Note: Not a doctor! Not medical advice, only a summary of useful information out there.

Ehhhhh, it's one of those things that is debated. Some research points towards usefulness, other research says it doesn't do much. There's also issues with what strains are in said probiotic, if they're even useful for you, if they can even survive your digestive tract (and your personal microbiota)…science is mixed on this too.

A recent review (2024) has concluded there is evidence enough for doctors and patients to consider using specific probiotics for uses in specific people (like supporting gut function during antibiotics, reducing respiratory tract infections, etc.), but not enough evidence to recommend it unconditionally in the population as preventative medicine.

This is another recent (2024) review that's similar, but they've helpfully included a couple pages at the end of specific studies, probiotic strains used, and their specific impact/mode of action studied on specific illnesses/diseases.

Interestingly, they've also just dropped another 2024 meta-analysis that suggests probiotic use saw a 51% reduction in symptoms reported by COVID-19 patients, including cough, headaches and diarrhea. They included 9 studies (3 of which were clinical trials), so they likely will need a larger sample size to say conclusively, but that could be a promising angle in a post-COVID world.

To add another confusing angle, postbiotics are becoming of increasing interest in research. They're bioactive compounds that are produced when probiotic bacteria are feeding on prebiotic foods in the colon (like fibers), and it's beginning to look like health benefits associated with pre/postbiotics actually come from postbiotic production. I have yet to see any available on the market, but apparently they are out there. I would also be aware that as a new frontier (and product) I couldn't say much about their individual efficiency, product contamination, etc.

If you decide to:

You can just make sure to frequently consume probiotic foods (yogurt, kefir, sauerkraut, tempeh, kimchi, etc.) although I would also suggest you make sure you're eating enough fiber to feed the friendly bacteria already inside you.

Bacteria is very specifically named. You'll have a genus, species and a strain - Bifidobacterium longum W11. All three = you got it right, and this is important because probiotics are researched down to these specific strains. It also means that when you read a probiotic bottle, if you don't see all three of those names (as a general rule), it's probably useless to you.

Check your labelling, especially generic store brands. Yogurt starter is typically made with Streptococcus thermophilus and Lactobacillus bulgaricus, and if they advertise these as the "probiotic benefits" they're usually full of shit - these strains usually get destroyed in your stomach by acid and don't provide any benefit.

If you have a weakened or compromised immune system, don't take probiotics without medical advice. This includes if you're having chemo, you're critically ill or you've recently had surgery.

Lots of people experience gas, mild abdominal pain and changes in stools when first using probiotics, but you're probably going to want to keep a note of that for your doctor, just in case. Plenty also have additives and digestive aids, so look out for allergic reactions and things like soy/gluten if needed.

Probiotics are measured in colony forming units (CFU) - the number of viable cells. They might say 1 x 109 for 1 billion CFU or 1 x 1010 for 10 billion CFU. Some contain up to 50+ billion CFU. A common mistake made is assuming higher CFU = better for you. Most countries only require labelling to list the total weight of the microorganisms in the product (which can include both alive and dead microorganisms, not viable ones). Probiotics can die during their shelf-life and must be consumed alive to be of use. Ideally, you're looking for products labelled with the number of CFU at the end of the product's shelf life (vs at the time of manufacturing).

If in doubt, ask a doctor or pharmacist.

[eternal-echoes]

“But what about the claim that only 1 or 2 percent of all individuals who undergo reassignment surgery regret their choice? Studies that make such claims often lack validity due to four shortcomings:

First, there are no standardized measures for establishing results. For example, one of the most widely used statistics is that only 2.2 percent of individuals experience post-surgical regret.(5) However, this study counted only individuals who applied to change their legal documents to reflect their detransition. Carey Callahan, a female detransitioner said, "Moreover, that study defined a 'detransitioner' as someone who had changed their name and gender legally (an arduous process in Sweden at the time) and then had the motivation and money to go through the name change process in reverse, a standard so strict that I wouldn't be counted, and nor would 90% of the detransitioners I know."(6) Other surveys measure those who had surgical reversal procedures. But again, this would exclude most detransitioners.(7)

A second flaw that weakens the findings of many "low regret rate" studies is that they contain a small sample size. Some have as few as ten or twelve individuals.(8)

A third weakness of many of the studies is that they are based upon short follow-up times. Dr. Paul Rhodes Eddy noted, "The average timespan from a person's medical transition to taking steps to officially initiate detransition is somewhere between eight to eleven years."(9) However, many studies that show low rates of regret are conducted within five years of the operation, and some of them as little as five months (10) Therefore, studies with shorter follow-up times will inevitably underestimate transition regret rates.

A fourth flaw is that these studies are often plagued by extremely high loss to follow-up rates. Many of the studies lost track of between 50 and 86 percent of the individuals!(11) When determining how important this is to the validity of a study's findings, Dr. Joseph Dettori points out, "A good rule of thumb is that <5% loss leads to little bias, while >20% poses serious threats to validity. ... One way to determine if loss to follow-up can seriously affect results is to assume a worst-case scenario with the missing data and look to see if the results would change."(12)

-Jason Evert, Male, Female, or Other: A Catholic Guide to Understanding Gender

—

Work cited:

(5) Cf. Dhejne et al., "An Analysis of all Applications for Sex Reassignment Surgery in Sweden, 1960-2010: Prevalence, Incidence, and Regrets," 1535-1545.

(6) Carey Callahan, "Gender Identity Is Hard but Jumping to Medical Solutions Is Worse," Economist, December 3, 2019.

(7) "An Open Letter to Julia Serano from One of the Detransitioned People You Claim to 'Support," Crashchaoscats, August 8, 2016).

(8) Cf. O. Bodlund and G. Kullgren, "Transsexualism-General Outcome and Prognostic Factors: A Five-Year Follow-up Study of Nineteen Transsexuals in the Process of Changing Sex," Archives of Sexual Behavior 25 (1996), 303-316; M. Stein et al., "Follow-Up Observations of Operated Male-to-Female Transsexuals," Journal of Urology 143 (1990): 1188-1192.

(9) Paul Rhodes Eddy, "Rethinking Transition: On the History, Experience and Current Research Regarding Gender Transition, Transition Regret and Detransition," Center for Faith, Sexuality & Gender, September 2022, 204.

(10) Cf. W. Tsoi, "Follow-Up Study of Transsexuals After Sex-Reassignment Surgery," Singapore Medical Journal 34:6 (1993), 515-17; J. Rehman et al., "The Reported Sex and Surgery Satisfactions of 28 Postoperative Male-to-Female Transsexual Patients," Archives of Sexual Behavior 28:1 (1999), 71-89; P. Cohen-Kettenis and S. van Goozen, "Sex Reassignment of Adolescent Transsexuals: A Follow-Up Study," Journal of the American Academy of Child and Adolescent Psychiatry 36 (1997), 263-271; James Barrett, "Psychological and Social Function Before and After Phalloplasty," International Journal of Transgenderism 2:1 (1998), 1-8; M. Stein et al., "Follow-up Observations of Operated Male-to-Female

11) Cf.G. Weinforth et al., "Quality of Life Following Male-To-Female Sex Reassignment Surgery," Deutsches Ärzteblatt International 116:15 (2019), 253-260; N. Papadopulos et al., "Quality of Life and Patient Satisfaction Following Male-to-Female Sex Reassignment Surgery," Journal of Sexual Medicine 14/5 (2017), 721-730; T. van de Grift et al., "Surgical Satisfaction, Quality of Life, and Their Association After Gender-Affirming Surgery: A Follow-Up Study," Journal of Sex & Marital Therapy 44/2 (2018), 138-148; C. McNichols et al., "Patient-Reported Satisfaction and Quality of Life After Trans Male Gender Affirming Surgery," International Journal of Transgender Health 21/4 (2020), 410-417; L. Jellestad et al., "Quality of Life in Transitioned Trans Persons: A Retrospective Cross-Sectional Cohort Study," Hindawi-BioMed Research International (2018), 8684625, 10.

12) J. Dettori, "Loss to Follow-Up," Evidence-Based Spine-Care Journal 2/1 (2011), 7-10.

—

For more recommended resources on gender dysphoria, click here.

[jomiddlemarch]

By Yonder Shining Star

He had not expected to begin with a reprimand.

“I don’t bite, you can stop lurking in the doorway,” Dr. Blythe said, not glancing up from the chart she was writing in. Foyle suspected she would have sounded much the same if he’d come upon her while she finished closing an incision after a long surgery, the same wry tone that had a hint of impatience in it. There were few enough female surgeons in England, even fewer egalitarian ex-pat Canadians, so it didn’t take much to infer she must be brilliant and driven, used to those around her finding her an anomaly. An Original, they would have said once in London society and been more accurate perhaps, but not a remark he’d offer if he wanted to get anything helpful from her. That’s why he was here, he reminded himself. It had been a long while since he’d needed reminding about his work.

“I didn’t mean to interrupt,” he said. “I’m—”

“You did mean to interrupt and you’re Detective Superintendent Christopher Foyle of Hastings,” she said as she laid the pen down. He’d heard her described as “attractive enough” and had wondered enough for whom before he met her. Now, he found himself pinned by her grass green eyes, startled into silence like a green lad, feeling a fool as he hadn’t for years.

Decades really. Sam would burble in wonder to see him struck dumb while Milner would only give a brief and comradely nod of recognition.

“You’re well-informed, Dr. Blythe,” he said.

“You expected that,” she said. “That’s why you’ve come, to pick my brain, to winkle out some piece of information, some cipher that will break the code you can’t. To solve your case. It is a Godawful mess, I’ll give you that. The pathologist’s report was quite detailed. Almost literary.”

“I’ve come to ask for your help,” he said simply. Because he thought she’d prefer it and because it couldn’t think of what else he might have said.

“You might as well sit down. You’ll have to forgive me—I can’t offer you a cup of tea or even a biscuit,” she said. “I haven’t an assistant who sees me fed and watered.”

Something about the way she’d said it was an alert.

“The other surgeons do. Any of the nurses are glad to fix them a cuppa,” Foyle offered.

“I don’t know about glad, exactly, but it’s in that general way. I’m meant to fend for myself. It’s my own fault I’m not much good at fending. I was spoiled, growing up, with our housekeeper Susan. There was never an evening without a little snack prepared and her solution to any problem was the teakettle on the stove and a slice of fresh pie,” she said. She had a square jaw and her auburn hair was sprinkled with grey and tucked back in a practical snood, but there was a certain whimsical nostalgia in her expression. “She was a splendid bustler, our Susan, and that you may tie to, Mr. Foyle. And now I’ve run on and run and you want my help or whatever help you think I can give you, so you may as well begin winkling.”

“You have a way with words,” he said.

“Flattery will get you nowhere with me. I’m by far the least eloquent person in my family. It’s no accident I’m a trauma surgeon,” she said.

“It was an observation,” he replied. “And it’s because of your family I’ve come to speak with you.”

“It’s Walter,” she said, any dry humor entirely gone from her voice, from those arresting green eyes. Saying the name of her brother dead these twenty odd years aged her; Foyle saw the lines her face fell into when she despaired, the nights of grief that never entirely abated. 

“Yes. Because of what he wrote, Dr. Blythe,” he said, wondering if the clarification would bring her any relief. Wondering at himself for thinking of that first. Rosalind, who’d ever been generous, would not begrudge him an interest, a possibility, but he worried what it meant for his duty to the dead men, whose murders he was charged to solve, no matter that other men were dying across the Channel, that he risked making Diana Blythe’s hand unsteady when she held a scalpel or a needle trailing suture. 

“A poem,” she guessed. Hoped? The alternative was most likely one of his letters, perhaps one he’d written to her, one she wouldn’t want to surrender or corrupt by handing it over to be part of a criminal investigation.

“Yes. The poem, the famous one,” Foyle said.

“The Piper,” she said, her color back. “He’d have hated it, positively loathed what happened with that. All the breathless sentiment, the rallying and the women who memorized it, that sickly sweet melody Tremaine wrote for it—I swear it would be tattooed over half of Canada and all of PEI if people thought it was within the bounds of polite society. It’s not even close to his best work, I want you to know—”

“I know. I met him. In the trenches,” Foyle said.

“Fuck,” she said softly. And then, “I beg your pardon, I shouldn’t speak so—”

“Plainly? You can’t imagine I’d take any offense,” Foyle said. “I met your brother only a few days before he died.”

“Before Courcelette.”

“Yes. I was very young and he wasn’t much older, but he’d been fighting for several months longer than I had, maybe a year. I didn’t think anyone could live that long in that hell and still find something worth living for. Could still remember anything beautiful,” Foyle said.

“It was that bad?”

“It was worse,” Foyle said. Something in her face told him she would not challenge this, nor would she make him explain. Rosalind hadn’t done either, which was why he hadn’t cracked up entirely before Andrew was born. “Whatever he wrote to you, it was worse.”

“He didn’t tell us anything. Not even me,” she said. 

“You were close,” he said.

“I thought so. The night before he died, he wrote a letter. To our younger sister Rilla and a friend, Una. She was in love with him, Una, we all knew that, but he didn’t love her that way. I thought we were close, closest to each other over everyone, but he didn’t write to me,” Diana said.

“Perhaps he couldn’t. Perhaps he knew you would be able to tell if he held something back. If he lied to try and protect you,” he said.

“Perhaps. Is that what you did, Detective Superintendent Foyle? Did you lie and keep secrets?” she asked. No one had ever dared before, not Rosalind, who’d admitted once she did not want to know everything about him.

“Christopher. My name is Christopher,” he said. “A long time ago, I was Kit. That was when I knew your brother.”

“I’m Diana. How does Walter’s poem have something to do with a triple murder?”

“There have been five murders thus far,” Foyle said. “It’s complicated, will take some time to explain. There’s a Lyons round the corner, quiet enough this time of night. We might have that cuppa—”

“If there have been five murders and somehow my brother’s poem is crucial to finding the killer, I’ll need something stronger. Bitter will do. I’d offer to stand you a pint, but I imagine that’s not considered ethical,” she said.

“No, nor gentlemanly,” he said, surprising himself.

“We’ll go Dutch,” she said, getting up from her desk and walking around to take down her coat and cram her barely fashionable hat upon her head. The coat flapped around her legs, obscured in a pair of drab tweed trousers, an unremarkable pair of brogues on her feet. She was beautiful.

“We haven’t much time,” she said, passing him at the door.

“I know it’s late. You must have an early surgery tomorrow,” he said.

“Yes, but that’s not what I meant. I ship out in a few weeks,” she said.

“France?”

“France,” she said. “I never wanted to go before. And now I can hardly wait.”

“I won’t waste your time,” he said.

“No, I don’t think you will,” she replied.

[miaou-tseu]

Luigi Mangione: Assassin or Solution?

On December 4, 2024, an event shook the United States: Luigi Mangione, a 26-year-old computer engineer, shot and killed Brian Thompson, the CEO of UnitedHealthcare, one of the world’s largest health insurance companies. This precise act, carried out without collateral damage, raises a crucial question: is Mangione a murderer or a solution to a system perceived as oppressive?

Three Words to Define Him

If Luigi Mangione were to be summarized in three words, they would be: precision, determination, and symbolism. These traits are evident in the methodical way he prepared his act and in the message he sought to deliver.

A Methodical and Thoughtful Act

Mangione used a 3D-printed firearm, accompanied by a silencer also crafted through 3D printing. This choice was deliberate: it reflects a desire to bypass traditional supply chains and avoid traceability. He is believed to have downloaded the necessary files from specialized forums and manufactured the weapon using a personal 3D printer. This method demonstrates meticulous preparation and a determination to carry out an act with significant symbolic weight.

Unlike many violent acts, Mangione executed his plan with remarkable precision. On December 4, outside the Hilton Hotel in Manhattan, he waited for Thompson, shot him with a single bullet, and immediately fled. No civilians were harmed, and no property damage was reported. In comparison, the actions of certain terrorist groups or police interventions often result in tragic consequences for innocent people. Here, the message was clear, direct, and spared any collateral victims.

Brian Thompson: Victim or Symbol?

Brian Thompson, 54, had been at the helm of UnitedHealthcare for nearly a decade. Under his leadership, the company became a key player in the U.S. health insurance system—but not without controversy. UnitedHealthcare’s practices have drawn criticism and numerous lawsuits, accusing the company of prioritizing profits over patient health.

Notable Legal Cases

Denial of Treatments: In 2020, UnitedHealthcare was sued by multiple patients for refusing to cover vital treatments, including chemotherapy and costly surgeries. These cases exposed the company’s restrictive policies, accused of limiting access to care to reduce expenses.

Mismanagement of Claims: In 2022, a class-action lawsuit was filed against UnitedHealthcare for widespread delays and errors in reimbursements, affecting thousands of patients. This case cost the company millions in damages.

Systemic Discrimination: In 2023, the company faced accusations of discrimination, with patients alleging that certain treatments were denied or delayed based on socioeconomic status or insurance coverage.

The Suffering Caused

These practices have indirectly caused significant suffering. Thousands of families have faced impossible decisions: pay out of pocket for essential care or let a loved one go without treatment. Many patients saw their health deteriorate due to delayed care. According to some estimates, tens of thousands of Americans die each year because they lack health insurance. How many more perish because of denials or delays by insurance companies like UnitedHealthcare? Strategic decisions made under Thompson’s leadership likely contributed to premature deaths and a general decline in the quality of life for countless Americans.

For many, UnitedHealthcare symbolizes a system where health is commodified, and financial interests outweigh human dignity. Thompson, as CEO, was the figurehead of these policies.

A Modern-Day Tyrant?

This raises a provocative question: could Thompson’s assassination be compared to the removal of a tyrant? After all, the ruling class itself celebrated the deaths of controversial figures like Saddam Hussein or Osama bin Laden, arguing that such acts served a greater good by ending oppression. If society accepts the elimination of men deemed responsible for massive harm, can Mangione truly be condemned without examining Thompson’s role in a system that caused so much suffering?

The Symbolic Impact of the Act

Luigi Mangione didn’t just kill a man; he struck at the heart of an institution he perceived as a machine grinding down the most vulnerable. In his manifesto, found at the time of his arrest, he sharply criticized the health insurance industry, describing it as “a dehumanizing system where profits take precedence over human lives.”

His act raises complex debates. Some see him as a soulless criminal, while others view him as a modern revolutionary, someone willing to sacrifice his freedom to expose systemic injustice. This duality reflects a society torn between the need for social justice and the rule of law.

Crime or Legitimate Revolt?

Murder is undeniably a crime, but Mangione’s motivations place him in a moral gray area. By killing Brian Thompson, he didn’t just eliminate a person; he sent a powerful message against a system perceived as oppressive. Yet, can this act truly bring about change? Or is it merely an isolated outburst, destined to be co-opted or forgotten?

A Shock to the Ruling Class

This assassination also sent shockwaves through the ruling class. For many CEOs and executives, Luigi Mangione’s act represents a troubling precedent. This targeted killing, carried out without collateral damage, sends an alarming signal: even the most powerful figures, shielded by complex systems and heightened security, are not immune to individual acts of rebellion.

The symbolic weight of this act might force elites to rethink their strategies. Some may seek to further isolate themselves, intensifying their detachment from the realities faced by the populations they impact. Others, more pragmatic, may recognize the urgent need for deep reforms. Mangione’s act has compelled a protected elite to confront their reflection and question whether their decisions render them truly untouchable—or merely visible targets.

Conclusion

Luigi Mangione’s trial, scheduled for January 2025, will be closely watched—not just to determine his fate but to understand the broader implications of his actions. A criminal to some, a revolutionary to others, Mangione has highlighted an often-ignored truth: when systems become merciless, they create the conditions for their own reckoning, sometimes at the cost of violence.

In a world where millions of lives are crushed by faceless economic mechanisms, Mangione’s act raises an unsettling question: how far must one go to make a stand against injustice?

Luigi Mangione: Criminal? Hero? Or an Example? Is the assassin of an assassin truly an assassin?

Jeanne Acœur de Pierre

[darkmaga-returns]

Scientists have predicted that the vaccinated population will soon see a sharp rise in turbo cancer diagnoses in the next few years.

Following the news that Fox News contributor and doctor Kelly Powers died Sunday following a heart attack and a battle with turbo cancer, scientists have warned that the majority of the public should be prepared to suffer a similar fate.

Dailymail.co.uk reports: Dr Powers — who did ballet, running and horse riding and was otherwise in good health —tragically leaves behind a young son. 

And experts are worried there will be more cases like hers in the coming decades because glioblastomas on the rise among all age groups.

Dr Powers is one of the 10,000 Americans to die from glioblastoma every year, including Senator John McCain and Beau Biden. 

But diagnoses are expected to rise by up to 75 percent by 2050.

What’s particularly concerning about these cancers is not only the speed with which they kill, there are also a lack of treatments able to successfully combat it.

Dr Powers had started suffering from frequent headaches in 2020 when she eventually had a grand mal seizure, the most serious type. 

In an interview with Preferred Health Magazine, she said her father found her passed out on the floor foaming at the mouth. 

She was rushed for a CT scan, which revealed the tumor and required emergency surgery. 

Dr Powers underwent three brain surgeries, as well as chemotherapy, radiation, and immunotherapy.

During the first operation, doctors even told her that her surrogate was pregnant with her son, who is now three years old. 

[unopenablebox]

oh ok i finally looked at my surgeon's report and there are at least two different reasons why i would be having unusually slow recovery relative to the generic postop advice for this surgery. i do kind of wish they'd. mentioned that. but the advice isn't actually different in my case it just seems probably normal that im still having pain a week later rather than mysterious

also on actually researching it more i apparently did in fact qualify as ~~~~diagnostically medically requiring~~~~~ this surgery given various facts rather than from just a commonsense human well-being perspective. still havent heard from hospital billing though so :) we'll find out i guess :)

mostly im just sincerely relieved that my current actions (doing lighter work, taking a bunch of precautions to avoid/minimize pain, complaining frequently in order to receive sympathy) make sense rather than either being a sign something is very wrong or that i am a huge baby who sucks

[c-rowlesdraws]

so apparently according to twitter if you cover a hyena's head they think it's nighttime and go to sleep (safe for transport) -- I have to wonder...would this work on gnolls? would this work on sweetpea?

that claim sounds really weird to me (that reaction doesn’t exist in cats or dogs or any other mammal as far as I know), so I did a brief google and the only result saying that is someone quote-tweeting a picture of some wild spotted hyenas lying down with cloth wrapped around their heads and wadded into their ears; I’m positive they’ve been conventionally sedated for some sort of vet and/or scientist thing, and the cloth is for comfort and to further reduce external sensory stimulation, like when humans get their eyelids taped closed while under general anesthesia for surgery. Another google search for how hyenas are sedated gets me results from zoos, papers, and field reports talking about various drugs and using tranquilizer darts, like I’d expect.

Hyenas are really smart animals— I’d guess that an aware and alert one won’t think “oh, it’s naptime” if a cloth sleeve gets slipped over their head, they’ll think, “wow someone just put this annoying thing on me, I hope I can paw it off and bite them right away”. And even if that trick did work and make them immediately go limp, a person would still have to get close enough to a fully awake hyena to pull the cloth over their head. They’d have to do the pulling impossibly quickly and skillfully— and maybe with their least favorite arm, just in case.

I know this is probably more of a serious answer than you were hoping for, but I do think it’s important to double-check things that might be misinformation— even if it’s just a silly “did you know!” thing from a tweet.

[nothorses]

Hi there! I have a quibble that I hope comes across as good faith and not anon hate: you quote statistics from the 2015 Transgender Study in a way that I think decontextualizes them. For example, trans men are more likely to be denied coverage for surgery (but not top surgery, which is considered cosmetic for trans women. Also, FFS was not included in the study and is almost never covered). Trans men face more harassment from police but trans women are more likely to be incarcerated, etc.

The point of the post (which is here) was just to debunk the myth that trans women are categorically "more oppressed" across the board. The stats I pulled were just a number of (fairly random) examples to that end, and I clarify in the text of that post, in reblogs, and in subsequent posts that the point is not to create a definitive list of The Ways Transmascs Are Most Oppressed- it's to demonstrate that the common assumption that trans women always have the highest rates of violence/discrimination in all areas is, y'know, patently not true.

All of those statistics represent only a narrow slice of a much more complicated issue.

To use your first example, "trans men are more likely to be denied coverage for surgery (but not top surgery, which is considered cosmetic for trans women. Also, FFS was not included in the study and is almost never covered"...

From the 2015 USTS Report:

"Transgender men (57%) were more likely to be denied surgery coverage than transgender women (54%) and non-binary people, including non-binary people with female on their original birth certificate (49%) and non-binary people with male on their original birth certificate (35%)" (p.95)

To my knowledge, the USTS did not actually outline surgery coverage rates for specific surgeries. But they do talk about the rates at which different people want, or have had, specific surgeries:

So, right off the bat: you can see FFS (Facial Feminization Surgery) reported in Figure 7.14. But what strikes me more about these charts in this discussion is that it really does speak to a more complicated issue on the whole.

You could absolutely say trans men (26%) have top surgery more than trans women (11%), but that would also be misleading. 97% of trans men have had or want to have chest reconstruction or reduction, compared to 51% of trans women who have had or want augmentation mammoplasty... well, yeah, it makes a bit of sense that trans men have had this kind of surgery more. They want it more.

But for kicks, let's look at the "have had" vs. "want someday" ratios, for a better picture of what those denial rates might be: 37% of trans men who wanted top surgery (97%) have actually had it, vs. 27% of trans women who wanted it (51%). We don't know that "denied coverage" is the reason all of these people have not gotten it yet, but it's probably a factor; and yes, that does indicate a 10% gap with trans men ahead.

And for kicks, let's apply that same concept to a few other procedures. To use your other example, 14% of trans women who want FFS have had it. But that's also not a super popular surgery for trans women; electrolysis/laser hair removal is the most popular, and 50% who want it have actually had it. In comparison to the most popular surgery for trans men- top surgery; 37% who want it have had it- that's a 13% gap with trans women ahead.

Granted, electrolysis is generally less invasive and more accessible (though it also requires repeated appointments), but I also couldn't tell you how often it's covered by insurance.

You might also compare bottom surgery rates: 66% of trans women want or have had vaginoplasty, vs. 27% of trans men want metoidioplasty (meta), or 22% want phalloplasty (phallo). Of trans women who want it, 18% have had it. Of trans men who want it, 7% (meta) or 15% (phallo) have actually had it. That's a gap of 3% or 11%, with trans women ahead in both cases.

You may also note that for trans women, surgical procedures are not super popular; vaginoplasty is the most sought-after surgery, and it's also third on the overall list of procedures for trans women. Trans men do not have non-surgical transition procedures listed (or generally available, afaik). Which is, imo, important context for another relevant statistic: "Transgender men (42%) were more likely to have had any kind of surgery than transgender women (28%)".

My point is, again, just to say that this stuff is complicated. I grabbed those statistics because they were a quick way to demonstrate the more general point that this is not a black-and-white issue, that trans men do not oppress trans women (and vice versa!), and that trans men are not actually More Privileged In All Areas.

And like, yeah, when you look closer at the issues those statistics reference, there are more layers- that's the point! It's a 300 page document, you could have a lot of conversations around all of these numbers and what they mean.

The fact that I didn't have all of those conversations in that post was not an attempt to hide these complexities. It was a request that we start to engage in them, especially without gearing it toward the question "who has it worse?", when the actual questions we need to be answering are "why does that happen?", and "how do we solve it?"

What I wonder, also, is- what is your point in bringing this up? The examples you brought up were lacking context, and in one case fully untrue. I want to assume good faith as well, but your ask comes off as if you're trying to argue that transmascs never actually struggle in a comparable or unique way.