#healthcare triage

[infinitemonkeytheory]

“RFK Jr. is claiming that scientists do not test vaccines with placebo-controlled trials, specifically against a saline placebo, and that all he’s asking for is that they are tested this way, as all other medicines are.

On its face alone, that probably sounds like a reasonable argument. I, too, would like vaccines to be tested in randomized controlled trials – and thankfully, THEY ARE.”

[cliffdog01]

Does caffeine make the voices go faster for anyone else? MandatoryFunDay

I drink Caffenr for Pain relief, and I’m a Graveyard shift worker (10pm to 6am, 5 nights a week +covers). 

Also, I Watched Healthcare Triage's videos that went into the Studies of Tea and Coffee, and there is no evidence that Caffeine has any long-term negative health effects. Sugar is terrible, so if you drink Energy drinks, make sure to get the Sugar-free versions (also from Healthcare Triage, no good nutritional studies are showing Sugar-free alternatives to cause any negative health effects) and try to remember to drink Water as well, mostly to nullify the Acidity of Fizzy drinks.

[roshni99]

One stop access to quality healthcare and wellness. Avail this from the comfort of your home or office. To know more visit https://www.raphacure.com or call our toll free no +91 95551 66000

[humandisastersquad]

also the fact that my manager said i have to prioritise patients who have been waiting the longest, even if they walked in, over prioritising keeping to appointment times, citing patients who have left bc of the long wait times,,, and like ik all management cares about is More Bums In Seats but like a) not honouring appointment times is for sure gonna make patients not want to come back and b) if they don’t want to wait that long they can make a fucking appointment, even if it’s just later that day bc what else did they expect, waltzing into a crowded, busy X-ray clinic

[bittersweetblasphemy]

i never want to ever hear another dipshit say we can't do universal healthcare "bc wait times will be absurd" when i just spent 8 hours in the er waiting room.

[dirtychaiofficial]

So i decided volunteering at a local healthcare organization would be the safest way more me to get my foot in the door with healthcare but tell me why they fucking assigned me to the EMERGENCY DEPARTMENT 😭😭😭

[dranandhinduja]

Assess the Preparedness Regarding Triage Skills Amongst Emergency Medical Professionals in Pune, India

[infinitemonkeytheory]

The 2022 Shkreli Awards have been released! Each year, the Lown Institute passes out awards as a way of reporting on dysfunction in the US health care system. Dysfunction in healthcare is one of our foundational pillars here at Healthcare Triage, and these awards highlight some of the worst examples.

2022 Shkreli Awards

VIDEO: The 2022 Shkreli Awards, featuring guest hosts Dr. Uché Blackstock, CEO of Advancing Health Equity, and Amy Holden Jones, Executive Producer and Creator of Thre Resident.

JANUARY 10, 2023 — Welcome to the 6th annual Shkreli Awards, the Lown Institute’s top ten list of the worst examples of profiteering and dysfunction in healthcare, named for the infamous “pharma bro” Martin Shkreli.

Nominees for the Shkreli Awards are compiled by Lown Institute staff with input from readers of Lown Weekly. An esteemed panel of patient activists, clinicians, health policy experts, and journalists help determine the winners. (press release | previous winners)

#10

Dentist bags a bundle by breaking patients’ teeth

How did Wisconsin dentist Scott Charmoli go from fixing 434 crowns a year to more than 1,000? By purposely breaking patients’ teeth, according to federal prosecutors. Charmoli allegedly drilled into patients’ teeth unnecessarily and submitted photos of the damage to insurance companies to justify expensive procedures. This move elevated his salary by $1.1 million, according to the Washington Post. The scheme was uncovered when Charmoli sold his practice in 2019 and the new owners reviewed his files, noting the absurdly high rates of crown procedures. Charmoli was convicted of healthcare fraud and sentenced to 54 months imprisonment and over $1 million in fines.

SOURCE: Jonathan Edwards, The Washington Post; U.S. Attorney’s Office, Eastern District of Wisconsin

JUDGES’ COMMENTS:

Talk about supplier-induced demand! Oy, pass the laughing gas.

#9

“Dangerous” doctor deemed a star by leadership despite disgraceful malpractice record

Image caption: A February 1999 advertisement for CMC’s New England Heart Institute in the Boston Globe, featuring Baribeau. Source: The Boston Globe

Leaders of Catholic Medical Center in Manchester, NH knew their renowned cardiac surgeon Dr. Yvon Baribeau had one of the worst malpractice records in the country. Yet they continued to support Baribeau, featuring him in hospital advertisements and allowing him to keep operating over the objections of other CMC doctors, the Boston Globe reported. Examples of Baribeau’s alleged harmful behavior include surgical errors that led one patient to require blood transfusions of nearly five times her blood volume, and keeping another patient whose chest cavity had turned “black and necrotic” on life support as a possible ploy to protect his surgical 30-day survival rate.

Throughout Baribeau’s career, he racked up 21 medical malpractice settlements, including 14 related to patient deaths. In a statement provided by his lawyer to the Globe, Baribeau said, “I performed over 10,000 procedures at CMC, always with patient safety as my first priority.”

SOURCE: Rebecca Ostriker, Deirdre Fernandes, Liz Kowalczyk, Jonathan Saltzman, and Patricia Wen, The Boston Globe

JUDGES’ COMMENTS:

The protection of doctors who are known to be dangerous is a national scourge that must be exposed and ended.

When a hospital administration puts “heads in beds” ahead of patient safety, it should be called to account—and not just by the media.

#8

Medical labs bilk Medicare for $300 million in elaborate bribery scheme

Three laboratories in North Texas allegedly found a way to score $300 million in extra Medicare reimbursements, the Dallas Morning News reported. In collaboration with two marketing firms, they bribed physicians to order unnecessary drug tests and blood work, according to a federal indictment. Some physicians got as much as $400,000 in kickbacks. In one case, even a physician’s spouse got an illegal bonus. The founders of all three labs pleaded guilty to the fraud in April 2022.

SOURCE: Aria Jones, The Dallas Morning News

JUDGES’ COMMENTS:

Unnecessary tests and procedures are bankrupting us and harming patients. There is nowhere near enough coverage of this.

Unnecessary “care” is a huge part of the $1 trillion (that’s trillion-with-a-T) the US wastes in healthcare.

#7

Patients qualified for financial assistance; hospital sends them to debt collection instead

Nonprofit hospitals are required to provide financial assistance to low-income patients. Providence health system, however, did the opposite in many cases. Rather than ensuring that low-income patients received the financial assistance they were due, Providence hounded them to pay and sent debt collectors after them when they didn’t, according to a New York Times investigation. These actions were part of an official campaign to boost revenue called “Rev-Up” developed with help from corporate consultant McKinsey. The “Rev-Up” campaign directed employees to tell patients about financial assistance only as a last resort. The result: more than 55,000 patients were pursued by debt collectors when they should have been given a discount.

In response, a Providence spokesperson told the Times that they stopped sending Medicaid patients to debt collection, and said that they will issue refunds to about 760 patients eligible for assistance who were previously charged for their medical care.

*Note: The Lown Institute provided data to the New York Times about Providence Health System’s tax exemption for this piece.

SOURCE: Jessica Silver-Greenberg and Katie Thomas, New York Times

JUDGES’ COMMENTS:

Large consulting companies like McKinsey are hospitals’ accomplices in revenue maximization.

Catholic hospitals have come a long way since the nuns of the Sisters of Providence provided services to the poor.

#6

When smokers get sick, this tobacco company has the treatment

Philip Morris has spent 175 years selling products that cause heart disease, chronic obstructive pulmonary disease (COPD), and other serious health problems. Now the tobacco giant is poised to make more money treating the very conditions it helped create by acquiring companies that develop inhaled therapeutics, according to a STAT News report.

Experts told STAT News they are concerned that Philip Morris could potentially use research on inhalation developed by these newly acquired companies to hook even more people on their products. But don’t worry—a representative from Philip Morris stated they have no plans to do so.

SOURCE: Olivia Goldhill, STAT News

JUDGES’ COMMENTS:

When your corporation creates both the problem and the solution to it, you clearly care about one thing: finding and making profits by any means possible.

In the 1980s, the hospital I worked in still used machinery made and branded by Philip Morris to treat lung-cancer patients. This is NOT a novel abuse— it must be stopped.

#5

Pharma giant exploits bankruptcy loophole to avoid legal responsibility for cancer-causing product

Johnson & Johnson had known for decades that asbestos, a deadly carcinogen, could be contaminating their talc baby powder products but continued selling them anyway. Now J&J faces lawsuits from 40,000 cancer patients, many of them Black women, as J&J allegedly marketed its talc-based products specifically to this population. To avoid the lawsuits, J&J created a subsidiary company with all of the baby powder-related liabilities and then declared this shell company bankrupt, NPR reported. Despite this “bankruptcy,” J&J ranked in the top 50 of Fortune’s largest companies last year. The fate of J&J and the lawsuits await appeals. According to the J&J corporate attorney, the bankruptcy will benefit victims by producing a faster settlement.

SOURCE: Brian Mann, NPR; Casey Cep, The New Yorker

JUDGES’ COMMENTS:

Especially egregious because of delay in acknowledgement at the expense of patients

Big Pharma has become an evil conspiracy against public health.

#4

Hospice CEO allegedly tells employees to hasten patient death to avoid caps on government reimbursements

Bradley Harris, the CEO of Novus Hospice in Frisco, Texas, and a dozen other Novus employees were sentenced to a combined 84 years in prison for committing healthcare fraud, according to D Magazine. The US Department of Justice reported that Novus staff were provided with pre-signed prescription pads and directed to dispense powerful medications like morphine and hydrocodone to patients, without guidance or oversight from physicians.

According to an earlier FBI investigation reported by NBC Dallas, Harris allegedly told employees to dose patients with more than the maximum allowed amount of painkillers to hasten patient death, with the goal of reducing the average patient stay to avoid caps on government reimbursement. The FBI investigation revealed that a Novus employee was allegedly sent a text message by Harris, “You need to make this patient go bye-bye.” It is unclear whether any patients were actually given overdoses or died from Harris’ instructions.

SOURCES: Will Maddox, D Magazine; US Department of Justice

JUDGES’ COMMENTS:

This behavior is abhorrent, cold and heartless

Individual and corporate greed, meet well intentioned yet perverse financial incentives.

#3

System keeps community hospital on life support to cash in on drug discount program meant to serve the poor

Image caption: Richmond Community Hospital.

The 340B drug program provides safety net hospitals with deep discounts on medications to ensure access to care for low-income patients. Richmond Community Hospital in Virginia, owned by Bon Secours Health System, has profited heavily off of this program, yet they don’t have an intensive care unit, maternity ward, or even a consistently-working MRI machine. That’s because Bon Secours has been diverting the profits from Richmond Community to its other hospitals in wealthier, whiter neighborhoods, according to a New York Times investigation. “Bon Secours was basically laundering money through this poor hospital to its wealthy outposts,” said a former Richmond ER doctor.

A spokeswoman for Bon Secours Mercy Health told the Times the hospital system spent $10 million on improvements to Richmond Community Hospital over the past decade. But that doesn’t seem like much considering the $108 million expansion at neighboring St. Francis Hospital, a nearby Bon Secours hospital.

*Note: The Lown Institute provided data to the New York Times about Providence Health System’s tax exemption for this piece.

SOURCE: Katie Thomas and Jessica Silver-Greenberg, The New York Times

JUDGES’ COMMENTS:

Skimming profits from the poor is the sleaziest kind of theft.

Care facilities are thin on the ground in low-income areas nationally, which makes this story even more painful.

#2

Private equity-backed firm runs rural hospitals into ground, leaves patients in unsafe conditions and employees without health insurance

When Noble Health, a private equity-backed startup, bought two rural hospitals in Missouri, residents hoped this might offer a lifeline to the struggling institutions. Instead, hospital employees faced shortages in supplies and drugs, leading to unsafe conditions for patients, Kaiser Health News reported. Noble Health also stopped paying for employees’ health insurance despite deducting money out of their paychecks that was supposed to be for premiums. Some staff members now face hundreds of thousands in medical bills because they did not know they were uninsured, according to Kaiser Health News. Noble Health closed the hospitals two years later, after taking $20 million in federal COVID relief funds. The company is currently under federal investigation.

SOURCE: Sarah Jane Tribble, Kaiser Health News

JUDGES’ COMMENTS:

Private equity too often puts profits over patients, and is using the proceeds to swallow up the US healthcare system.

Private equity corporations are one of the biggest threats to healthcare quality and justice.

#1

Insurers systematically overbill Medicare Advantage, siphoning billions of taxpayer money

The majority of large Medicare Advantage insurers have been accused of fraud or overbilling by the US government, a New York Times investigation finds. Overpayments to Medicare Advantage insurers were estimated to cost taxpayers as much as $25 billion in 2020. Because the Medicare Advantage program pays private insurers a set amount per patient based on their risk, there is an incentive for insurers to “mine” patients for diagnoses—for example, adding diagnoses for old or resolved conditions.

While Mark Hamelburg, an executive at AHIP, an industry trade group, said to the Times that some coding differences were due to doctors “look[ing] at the same medical record in different ways,” some of the diagnoses were clearly inaccurate. In one case, insurer Independent Health added a diagnosis for prostate cancer to a woman’s record, because “when a married couple has any disease, both were assigned to that disease,” Bloomberg reported.

Among the top 10 Medicare Advantage providers by market share, the following have been accused of fraud or overbilling by the US government or Inspector General and have ongoing lawsuits as of 2022, according to the Times: UnitedHealth Group, CVS Health, Elevance Health, Kaiser Permanente, Blue Cross Blue Shield of Michigan, Cigna, and Highmark. These insurers have disputed the claims.

SOURCE: Reed Abelson and Margot Sanger-Katz, New York Times; John Tozzi, Bloomberg

JUDGES’ COMMENTS:

The overbilling of Medicare Advantage has become nothing but a big game that private insurers play. There are no rules, no morals, no sense of right or wrong.

The “advantage” in Medicare Advantage plans seems to go to the insurers who exploited Medicare for billions.

Weekly news for people who want a radically better health system

Judges for Shkreli Awards

Carole Allen, MD, MBA, FAAP

Immediate Past President

Massachusetts Medical Society (follow)

Special advisor to the president of the Lown Institute and lecturer at the George Washington University School of Public Health (follow)

Director of the Centre for Health Policy at University of Melbourne and senior fellow at the Lown Institute (follow)

Professor and chair emeritus at Duke University School of Medicine (follow)

Chair of the Lown Institute board of directors, former CEO of Denver Health

Assistant professor, NYU School of Medicine (follow)

Associate professor at Yale School of Public Health (follow)

Creator and showrunner,

“The Resident” (follow)

President of Physicians for a National Health Program and retired internist at Cook County Hospital (follow)

President of the Minority Health Institute, Clinical Professor of Medicine at UCLA School of Medicine, author of Blacks in Medicine (follow)

[talesfromthecripglobal]

I Want Them to Want Me Because I Will Need Them to Need Me But If That’s Not Going to Work, I Want a Lawyer.

Every time Gretchen saw the DNR forms on her desk at home, a wave of resentment rose. How did she know what it was like to use a feeding tube? Or a ventilator? Or have minimal brain function, for god’s sake? It was like asking an eight year-old to sign up for – or against – puberty. Choice was such bullshit. It wasn’t really her choice at all. The problem wasn’t too much extraordinary medical…

[theangrycorpsman]

Triage and Mass Casualty Situations: How to Prioritize Care in Emergencies

As a healthcare provider, first responder, or even just an average citizen, it’s important to be prepared for emergencies and mass casualty situations. One of the most critical skills you can have in these scenarios is the ability to triage patients effectively, prioritizing care based on the severity of injuries and the likelihood of survival. In this post, we’ll take a closer look at the…

[michaelwittig]

😷 Bei einem italienischen Künstler habe ich vorhin ein Werk anlässlich des italienischen Gedenktages für das Gesundheitspersonal gesehen. Das erinnert mich einerseits an den März 2020, als Militärlastwagen mit Särgen von Corona-Toten durch die norditalienische Stadt Bergamo rollten, zu dem Zeitpunkt das Epizentrum der Corona-Krise in Europa. Schockierende Bilder gingen um die Welt. Wir lernten die Bedeutung des Wortes Triage. Es erinnert mich zudem an eine kleine Fotoserie, die ich 2020 für eine für 2021 geplante non-profit-Kampagne für die Mitarbeiter in Gesundheitsberufen fotografiert habe. Leider ist das Projekt damals an einigen vor allem bürokratischen Unwägbarkeiten gescheitert. Die Fotos hat nie jemand gesehen. Eigentlich schade, darum zeige ich dank der Erinnerung mal was davon. #model @juuliaschwarz #makeupartist @sabinejonke 📸 @michaelwittigphotography © Gmunden 2020 #gesundheitsberufe #gesundheitssystem #healthcare #healthworker #nurse #krankenschwester #modernheroes #revisted #tired #debilitating #overtime #underpaid #coronavirus #covid19 #pandemic #bergamo #triage #dead #life #love PS: Die Aufnahmen sind kurz vor der verpflichtenden Einführung der FFP2-Masken entstanden. (hier: Gmunden An Der Traun, Oberosterreich, Austria) https://www.instagram.com/p/Co5cFEkMqXI/?igshid=NGJjMDIxMWI=

[bad-tf-fic-ideas]

(348) After Raf recovers from his exposure to dark energon, Ratchet tries to learn more about basic human triage and healthcare from June. June, in her turn, takes a reciprocal interest in Cybertronian biology and healthcare practices.

Ratchet is convinced she can't actually treat anyone even if she understands it (dubious), and so refuses to help her learn. Optimus Prime, who is the boss of him, insists that he be gracious about it and that if she wants to learn Cybertronian first aid, June should be allowed learn it. Who knows if it will come in handy?

At this point in their exchange, Ratchet reminds Optimus Prime that he is due for a long, long maintenance appointment, and can therefore serve as June's first object lesson. Which serves him right.

Or: in which June Darby spends her Tuesday morning watching a big tough big rig receive a moderately embarrassing oil change.

[existentialfailure]

This new old body

Pairing: N/A (Possible Reader x Hawks in future)

Length: Oneshot, 2384

Description: The aftermath of war, Keigo is OK with it all. He is OK with how things have gone. He is OK with how things have changed. He knows if he keeps telling himself it's OK, then maybe it'll be OK.

He just needs to learn to keep walking.

Warnings: Past violence, blood and injury, injury recovery, permanent injury, quirkless hawks.

Notes: Post-war, may continue later

He doesn’t recall too much of the aftermath of his part of the war. The first few glimpses of the world are cloudy, unfocused; like watching an old movie through sandy goggles. 

He felt like a doll, stuffed full of cotton and weighed down with a belly full of rice; fat, heavy, and easily tipped over. There was only one thing that consistently felt out of place, one thought that kept nagging incessantly every time he found himself stumbling forward into a consciousness that was always too bright-

“Can… someone roll… off… back? Wings… ’ll cramp.”

Nobody would answer, or if they did, they were too busy talking slowly and with their mouths full of marbles. It was irrelevant anyway, Keigo was too tired to pay attention, and the heaviness of his eyes pulled him right back into the veil of quiet dreamless sleep.

He learned later that he was too banged up for any quirks to be used as an immediate fix all. Funnily enough to add insult to injury, nobody was really quite sure what exactly to do with Pro Hero Hawks- or rather, Former Pro Hero Hawks. As the triage team had moved in the aftermath of AFO’s grisly departure, he was tagged swiftly as an immediate evacuee- a civilian evacuee. ‘A high ranking civilian,’ he was told, as if to placate his offense. It did, and it didn’t, but he was too exhausted and fucked up on narcotics to care and muddle through his feelings. Besides, he was a reasonable man, and he knew they couldn’t send him to where the wounded Pros were going. He was a waste of resources; they were trying to get all possible weapons back on their feet to deploy right the fuck back out to fight. What could he do by that point? 

He’d have been a cute cheerleader if they gave him a shot, he thinks. Rah, rah, go team go.

The initial shock of waking up quirkless was easy to handle, in the way that he didn’t handle it. He was still blitzed out of his mind on what he was humorously calling ‘The Good Shit’, and it was easy to float in and out of the reality he was currently occupying. He had never been hospitalized to this degree - even when Dabi had tried to flame broil him- and it was apparent that the damage the villains caused had put a definitive strain on the healthcare system. The hospitals were stuck relying on hands-on techniques as quirk usage was being stretched thin and reserved for the critical patients who could survive their application, or couldn’t survive without it.

Keigo certainly wasn’t critical. The nurses and therapists visited him every so often each and every day, wrangling the flailing former hero out of his bed, disentangling him from all his lines and wires like a freshly caught fish. He was encouraged to walk to use the restroom, he was encouraged to walk to sit in a chair, he was encouraged to sit up and eat and talk and laugh and engage.

Walk, walk, walk.

Keigo certainly wasn’t critical. He doesn’t know who the hell his doctor is, the staff was stretched thin, and he really didn’t care, but he liked the practitioner who came in and congratulated him on his progress as time went on. The sound of her voice was nice, but he remembers fuck all she said, just that her voice warbled when she went over all the shit they did to him throughout the day.

Staff continued with their routine. Get up, walk, sit, stand up, move, sit, stand up, walk.

Walk, walk, walk.

Keigo certainly wasn’t critical. He was one of the lucky ones. He got out of the hospital with his face stitched from AFO trying to split his skull open like an egg, his body covered in miscellaneous bruises that looked like constellations if he stared hard and squinted. Furthermore, he felt like one giant exposed nerve, the surrounding air causing his skin to feel like it was electrified and ready to crawl off and leave him hanging there naked and wet. He probably would’ve felt better if it did.

But he was alive, which some others couldn’t say the same. He was supposed to be grateful, he knows. He is, he thinks, somewhere in the hollow of his chest. Nestled between the black of broken ribs, in the sick sinking in his gut, he is ok with the fact he is alive. He is ok with it, and he will repeat it until it's true, because it is, it has to be, or else… 

Keigo walks.

Keigo walks because he isn’t critical. Keigo walks because he is one of the lucky ones. Keigo walks because he is alive. He walks because he is ok with it.

Keigo walks because there is a thrumming emptiness in the hollow of his beating heart where something is supposed to be and there isn’t anymore. He walks because there is no longer a heaviness at his back pulling him up. He walks because there is no longer a heat in his spine, a pressure in his skull, a vibration in his mind, a purpose, a warmth-

He is caught off guard as flashing flames of blue take his vision from him, hands flying up to drive the heels of his palms rough, and harsh into his eyes. The phantom heat licks his cheeks, snapping at his nose like razor sharp teeth. He can feel it just as he had that day when he stood over Bubaigawara, fierce and unforgiving. Keigo bends, hands falling to brace himself at his knees as he is overwhelmed with the need to just breathe.

Eyes wild, and his brain lagging to catch up to the fact that there is no fire and there certainly is no cremation villain anymore, Keigo finally takes a look at where his feet have taken him. For the last several years, since earning his so-called freedom with the HPSC, he spent so much of his time seeing the city from a birds eye view. Now, he found himself feeling out of place; small and insignificant under the looming branches of blossoming trees and their bowing trunks. He doesn’t recall this particular park, or maybe he does, and his mind is just too fluffy with wool to piece together a name. Maybe he just doesn’t particularly care at the moment where he is.

The park is empty from what he can tell. Despite the haze of dusk beginning to fall, he can clearly see the rubble of what was left of benches and stone carved animals. They must’ve stood proud surrounded by well-placed flowers, if the squashed pedals and shattered colorful stones are anything to go by. Keigo takes his time meandering around the remnants of what had probably been one of the smaller parks in the city. A quiet spot for your average office worker to find respite during lunch hour, or a group of kids to sit and study.

Keigo rounds a few trees, bark scorched and bare wood carved- whether by knives or claws, he doesn’t care to investigate. He pointedly ignores the skulking shadows that follow in his peripherals, diving between bush, tree, and rock as they watch. Those piercing but empty bright yellow eyes that feel like weights on his shoulders. Bodies blackened, smokey, curled and twisted; broken in ways that made no sense but powerful in every move. Phantom muscles at his back twitch with need. He can see their talons now, glinting ebony and sharp, curling over every bit of debris ready to pierce, cut, shred, eviscerate-

“Hey, are you alright?”

For the second time today, Keigo is pulled back into reality feeling as though his chest has caved in on itself. Each rib has shattered itself free, and pierced through his lungs like daggers to fill them up with blood and drown him. His head jerks to the side, noticing now the benign shadows of the trees as they sway with the breeze that filters down to them. Yellow eyes have winked out of existence, there are no talons digging fresh lines into the damaged earth of the park, no great black beast looming around a tree ready to take on the wingless wonder.

Keigo takes his first deep breath and feels like he is going to vomit.

“Hey?” The voice cuts in again, and Keigo turns to give his frazzled attention to his current witness.

You’re not a Pro, is his first thought as his eyes sweep over you. You’re dressed rather plainly, if not smartly for what it looks like you’re doing. Keigo’s eyes flash down to the bucket in your hand, filled with an assortment of flora that you must’ve been pulling from around the shattered statue he notices just behind you. Keigo turns his mind onto investigating you, chest still heaving as he tries to get his body to remember it's supposed to breathe.

He notices you’re wearing an apron, bits of trash sticking out of pockets that you may have haphazardly stowed away as you worked. Your forearms are dusty, if not altogether filthy, and your pants are slick with dark earth.

“What’re you doing?” Keigo fires back, breathless, but jerking his head towards you almost accusingly.

Your eyebrows raise immediately, probably not expecting the minor hostility in his tone. You were a local in the area, trying to do your part in cleaning up the neighborhood after the antics of the war. This particular park had been special to you, and you had joined the neighborhood established cleanup crew trying to salvage as much of the original foliage as you could before the others came in to finish tearing down what the villains had already started. And maybe also swipe a couple of root balls of some of the flowers you’d been eyeballing since you were a kid.

You had just been coming up on one of the flower patches that used to surround the ugliest cement statue of a duck when you had noticed the blonde down near what had formerly been a fountain. Initially you were just going to ignore him, but his thousand yard stare, pale face, and accentuating ‘i’ve-had-the-shit-kicked-out-of-me’ look had drawn you over to investigate.

“Cleaning,” You answered breezily, “and are you OK?”

Keigo tilts his head slightly, bringing a hand up to rub uneasily at his chest. Of course, he is ok. He has to be ok. He is ok.

“Of course.” He answers smoothly, pulling a smile that's all teeth. It doesn’t quite reach his eyes, and you raise a brow at it. The act causes his stitches to scrunch up at his cheek. You imagine he thinks he is charming, but the look falls flat. Keigo’s smile falters a little, and he sighs.

“Really, thanks. I’m alright. Just got a little winded from walking,” He winks, dropping his hand from his chest to stuff both into his pant pocket. He walks around you, swaying a little. You watch him, eyebrow still raised.

“You looked a little more than winded.” You mutter, slightly concerned. You’ve learned over the course of the last few weeks that a lot of people were dealing with the aftermath of the villain's act of war in different ways. While a small minority of people had managed to skate by unaffected, a large portion of the population ended up scarred in some way. Some people lost loved ones, family members, friends. Others who never got to make it into a shelter were left to defend themselves or hide from the roaming villains. Some managed to avoid encountering a villain altogether, while others… Well, they’re left with the scars of their encounter. Some physical, some mental. Some both.

You’re not sure where this guy fell on that spectrum. Studying him, you could tell he didn’t have an easy way of things during the war, if the sheer amount of visible bruising and freshly knitted gashes were anything to go by. His hair looked like it was shorn by someone inexperienced with clippers, uneven and lopsided in spots, what must’ve been bangs clipped impossibly short and laid back.

You watch him as he moves to stand in front of the desecrated cement statue of the duck, his head tilted and lips twisted as though he were lost in thought. His nostrils were flared, and if you didn’t know any better, you’d guess he was trying to hide the fact that he was still struggling to maintain his erratic breathing. You look between him and the remains of the park decor, before finally catching him watching you back.

For a moment you feel glued to the spot. His eyes look sharp and predatory, like there is something that should be there that isn’t. The gold feels molten as it's trained on you, and the deep black discoloration that tips his waterline makes them seem simply feral. He blinks, and the moment is cut, his eyes honey warm and mirthful. You aren’t sure what you feel.

“So, got a name?”

You give him your name, and he nods as he repeats it, as if committing it to memory. He lifts a hand from his pocket again, rubbing mindlessly at his chest. You sidle up beside him, staring down at the defeated duck. He returns his attention to it as well, though he tilts his head slightly acknowledging you beside him. Gently, you pry,

“And you?”

He doesn’t answer for a moment, breathing shallow and calm. His chest still feels tight, and the phantom pain of something webs out from between his shoulder blades. He thinks he wants to cry, but his eyes feel dry and his mouth stays curled in a not-smile grin. His eyes rove over the ruined cement statue, how it had once clearly been a duck with wings spread, neck curled and feet outstretched. Left in a stasis of both flight and landing, neither airborne nor grounded, something in between. Now it was nothing but a crumbled up bit of dust and rock, shattered and broken, and probably not worth the effort to repair. Replaceable with something better, surely. It's just a silly statue, after all, a background piece. Decor.

“You can call me Kei.”

[writing-for-marvel]

Triage

[He’s Hazardous To My Health Series]

Paramedic!Bucky Barnes x Resident!Fem!Reader

Series Masterlist | PART 2 > >

Summary: A slightly reckless and exceedingly charming paramedic carries a young girl into your ER, proving that not all superheroes wear capes.

Warnings: strictly 18+ due to the AU, set in an emergency room, I am not a healthcare worker and my medical knowledge is limited to what I’ve seen in Greys Anatomy lol, incident where people are injured from a derailed train, mentions of wounds & surgery & loss of life, injuries to a young child, needles & stitching, my terrible attempt at writing flirty banter

Word count: 3.2k

A/N: based off the winner of this poll, we say hello to paramedic!Bucky ❤️ this is my first entry for the Connect 4: Into an Alternate June-iverse Event by @buckybarnesevents, fulfilling the prompt ‘First Responder AU’. Thank you to @rookthorne who looked this over for me and gave me the confidence to keep writing it 🩵 banners by @vase-of-lilies

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“Incoming trauma. Train collided with a car and derailed. First wave ETA three minutes.”

At the moment your director of emergency medicine announces the tragedy and flood of imminently arriving patients, the televisions in the emergency room switch to breaking news - a presenter, wearing a solemn expression, speaks as a split screen shows what you can only describe as a colossal catastrophe.

The ER becomes silent as all eyes focus on the screens, only the rhythmic beeping of the pulse oximeters cut through the silence, a heavy weight blanketing the room as the realisation of what you’re seeing sets in.

You can’t hear what precisely he’s saying, but you can’t bring yourself to look away whilst watching the live chopper vision of smoke billowing from the train laying unnaturally on its side, barely any movement from the scene makes you wonder if anyone could have survived the incident.

The three minutes before the ambulances arrive go by in a flash, feeling like you hardly have time to mentally prepare for the extent of injuries and potential loss of life you will be facing. Then, almost in an instant, as if flicking a switch, chaos in its purest form descends upon the emergency room.

You watch on as paramedics and firefighters wheel patients in on gurneys, one by one filling up the limited trauma beds in the ER. Dr Stephen Strange directs medical personnel, making sure each case is assigned to an appropriate physician, the more serious injuries bypassing trauma intake all together and heading straight towards surgery.

Your eyes land on one man in particular between the sensory overload of people - tall, broad shoulders with long chestnut hair, carrying a young girl with one strong arm as he pushes a gurney with the other. Who you can only assume is the girl's mother, is unconscious and has blood staining the roots of her long blonde hair. Your heart aches for them as she’s handed over to the surgery team in wait, and even though the ER is filled with many conflicting loud voices, you hear the high pitched cry of the young girl for her mommy. The paramedic, now with his second arm free, pulls her into his chest before making his way to one of the trauma beds.

“You!” Dr Strange’s voice pulls your attention back to the fray and you find he’s pointing directly to you - you’ll forgive him for forgetting the name of a new resident during this moment of crisis. “The young girl with Barnes, she’s your responsibility.” That’s all the instruction he has time for before moving onto the next resident.

As you make your way through the maze of people towards the young girl, your mind flashes back to the footage of the wreckage and how grim it appeared. It seems like a miracle that this young girl is conscious and looks relatively unharmed with the exception of a few abrasions.

“I’m the one who brought her in, she’ll be all alone while her mother is in surgery, all I’m asking is to stay with her while she gets examined.” The well-built paramedic, Barnes, argues with your head nurse, pride and admiration swelling warm in your chest - he’s standing up for a scared, young girl who can’t voice what she needs right now.

“That’s perfectly fine.” You cut in, knowing Christine is a stickler for protocol and would never allow non-family members to stay with patients, even in dire circumstances. If there is a time to bend the rules slightly, you figure this is it. “I think she feels a lot more comfortable with you here anyway, isn’t that right sweetie?” The young girl nods her head, little hands reaching out to grab hold of the paramedics’ large one, eyes brimming with frightened tears.

“Thank you.” He mouths as Christine storms off to deal with the many other patients that require her attention. Your focus now switches to the precious girl in front of you - no matter how hectic the ER gets, how devastating the incident is, your thoughts need to be directed solely on her care, and not ogling at the attractive EMT who is currently soothing her.

“What’s your name, sweetheart?” You ask the scared, little girl, but not before offering your own as a sign of good faith. She looks up to Barnes for reassurance before answering.

“Sasha.” She confesses with a small voice, partially hiding her face in the broad paramedic’s arm as she does so.

“Okay Sasha, I’m here to check you over, help patch up these cuts and make sure you have no other injuries so we can get you up to see your mommy as soon as possible. Can I do that for you?” She nods her head, sitting up a little straighter in the bed all the while maintaining a tight hold on Barnes’ hand.

“Can you tell me who your friend here is, Sasha?” You ask as you start your examination, feeling the medics’ pair of eyes watching you intently, something more than just concern for your patient's well-being has heat creeping up your chest to the tips of your ears in silent attraction.

“Bucky. He pulled me from the train.”

“All by himself? Wow, he must be super strong to do that.” You glance up at Bucky to find him staring at you with what you hope is a mixture of captivation and endearment. He offers an enchanting smile, making butterflies, which have no right to exist in an emergency room, flutter in your stomach.

“He also got my mommy too.” Sasha adds, you suspect with the youthful intent to impress you even more.

“As well!” You say in a dramatic tone which makes her beam a proud smile that she did in fact amaze you. “Sasha, I think you got rescued by a real life superhero.” You continue in a staged whisper that not only has Sasha giggling, but brings a flush to Bucky’s cheeks. The bashful blush only makes him more attractive in your eyes.

As you continue your examination, cleaning and bandaging all lacerations, keeping Sasha distracted by asking about her favourite activities and animals, you can progressively feel her opening up and trusting you more. From your experience, it can be difficult to earn a child’s trust when they are in such a foreign place, surrounded by strangers, and in particular in this scenario, when a parent isn’t around. Having Bucky, whom she formed a bond with as soon as he rescued her from the train, stay by her side through the ordeal, has been to both your benefit.

Once you cleaned all her cuts, making sure Bucky held her hands so Sasha could squeeze when the disinfectant caused a sharp, stinging sensation, you begin examining her stomach, prodding her abdomen for any signs of tenderness.

“Does that hurt, Sasha?” You enquire when she flinches and whines at your touch.

“Yes, right there.” You're proud she trusts you enough to admit that, though now concerned about potential internal bleeding. You need to act fast, but you don’t want to instil more fear in her given she’s already had a large dose today.

“Okay, it’s nothing to worry about yet, but I’m going to order you a scan so we can see what’s going on in your tummy.” Your eyes flick instinctively to Bucky, to provide some consolation in a time where you’re both worried about the young girl you’ve both become attached to in such a short time. You see the considerable concern furrowed in his brow soften when his eyes meet yours.

“Will it hurt?” Sasha’s frightened voice breaks your heart - she’s had to endure enough pain and suffering for the day, watching her mother cling to life in an ambulance, you’re desperate not to add to it.

“Not at all, it’s as painless as having your picture taken!” You explain, watching the alarm melt from her features, and feeling the tension in Bucky’s shoulders relax simultaneously. “All you have to do is stay really, really still, can you do that for Bucky and I?” The notion that there is a Bucky and you makes something in your chest buoyant.

“Yes!” She promises without missing a beat and Bucky squeezes her small hands with a relieved smile.

When Sasha’s attention turns to the nurse whose job it is to take her up for the scan, you notice Bucky discretely wiping a tear from the corner of his eye. He says a sweet goodbye before she’s wheeled away, knowing this is where a paramedic and hospital patient part ways. Sasha enthusiastically waves back to both of you as the nurses wheels her away, not stopping until they turn a corner and she’s completely out of sight.

Bucky clears the lump in his throat before stating, “I think it’s my turn to leave now.”

“Don’t think I can’t see you wincing every time you move. Sit your cute butt down, you aren’t going anywhere till I check you over too.” You say as you finish completing the form to refer Sasha for the CT scan, missing the downright cheeky smirk plastered on Bucky's face.

“You think I have a cute butt, huh?” You can hear the smugness in his voice and you have to fight the corners of your mouth from upturning in a smile. He does have a cute butt - not that you’ve been staring - but you’re certainly not admitting that to his gorgeous face.

“Not the point - now, shirt off so I can take a look.” Finishing your paperwork, you finally look up to notice his cocked head and flirty smile. Having studied long hours in med school and worked even longer hours all last year as an intern, you recognise it’s been a while since a stranger has looked at you with this level of desire.

“At least buy me dinner before you ask to see me naked.”

“I’m a doctor, I’m sure it’s nothing I haven’t seen before.” You challenge, even though you’re positive his strapping frame, which fills out his uniform completely, will be even more impressive without a shirt. You have to swallow the saliva forming in your mouth so you quite literally don’t drool at the thought of his unclad body.

“Why don’t we find an on-call room and I can prove to you it’s not.” He teases in a low, alluring voice and you have to bite the inside of your cheek to stop yourself smiling like an idiot - it, however, does not stop your face from warming like a heating pad. It’s infuriating how beautiful he is, and it’s definitely criminal to act as cocky as he is right now.

“Only if you let me patch you up first.” You bargain.

Bucky finally concedes, unbuttoning and shrugging off his uniform shirt to reveal a wound in his side about the length of a teaspoon which is still trickling blood. The tightening concern which overwhelms your body at the sight of the gash, which is much worse than you predicted he’d be concealing and will require stitches, distracts you from the allure of seeing his shirtless chest.

You shake your head, knowing he would have been fully aware he was injured since pulling Sasha and her mom from the train, and in an incredible amount of pain, but waited until others received treatment before allowing himself to be tended to.

“You should have told me about this.” Tentatively you place gauze over the cut, gently applying pressure to stop the oozing but not firm enough where he’s in pain. You can feel his attentive eyes following your every careful move, and maybe it’s just your imagination, but you swear you can hear his breath hitch in his throat and feel his thumping heartbeat quicken as your hands graze his bare skin.

“There are many people in need of more urgent care than me.”

You look up at him from your position tending to his abdomen to find his face intimately close to yours. You can’t help yourself, being this close to him, but your eyes flicker to his lips, noticing a faint scar along his top lip you could only perceive by being this close.

“That doesn’t mean you don’t deserve it at all.”

Bucky gazes deeply into your eyes with a vulnerability which makes you doubt whether anyone has ever appraised him that he is worth taking care of. The thought feels like a punch to your gut.

“It’s relatively superficial, I can look after it myself.” He attempts to brush you off. If this weren’t your first time meeting the guy, and you didn’t feel like you were overstepping by protesting, you wouldn’t let him dismiss you so easily. “Can’t you overlook protocol this one time and give me the okay to get back out in the field? We are still looking through the wreckage for survivors, need all hands on deck” He flashes you wide, puppy dog eyes which have you melting at the knees. You suspect this isn’t the first time he’s used this ploy to get what he wants.

As if he can sense your resolve dissolving the longer you look in his mesmerising eyes, he starts to stand. But no, you aren’t going to let those ocean blues and infectious smile stop you from doing your job, and showing Bucky that his well-being is just as important as anyone else who came into the ER today. Placing your hands on his bare, broad shoulders, you push him back down onto the bed.

“You won’t be able to help anyone when you’re back in here with sepsis because this wound got infected.” You comment as you prepare the suture kit and implements you’ll need to first clean out the wound.

“At least that way I’d be able to see you again.” He jests, before sharp intake of breath as you begin disinfecting and debriding the laceration.

Even though you realise he’s joking, hopefully only about not taking care of his wound properly and not about wanting to see you again, you suspect there’s a small sliver of truth he’s hiding. There typically is a grain of truth in every joke - he seriously would have returned to the scene without receiving treatment if you hadn’t stopped him, twice.

“You don’t need the excuse of a life threatening illness to see me again. In fact, I would prefer it that way.”

Bucky eyes you with fondness as you finish up washing out his wound, even through the sharp sting and you expressing your disapproval of his careless actions. You’re not sure what you’ve done to deserve the warmth in his gaze, but you enjoy it nonetheless.

Once the area is numbed, you can instantly sense the ease which overcomes Bucky at no longer being in discomfort. Though the grunts and groans that slipped past his lips were rather sexy, you much rather seeing him in an absence of pain.

The two of you stay in comfortable silence as you lend all your attention to the placement and execution of each stitch, knowing that if you do a good enough job, a wound this size will heal to an almost imperceptible scar. Though it’s difficult, you restrain your focus from how the taut muscles of his stomach flex as you're working.

“Alright, almost good as new.” Is what you comment once you’ve thrown the last stitch and placed a bandage over the area. “You’re ready to get back to being a real life superhero.” You tease, knowing the effect the word had on him last time. You’re pleased to see that same blush bloom lightly over his high cheekbones.

“Thanks for lookin’ after me, doc.” Bucky shows his gratitude with a lopsided smile you could get so used to basking in. As he buttons up his shirt, you allow your eyes to linger on his clearly defined abs for a second before they’re covered over. He really has no right to be as gorgeous and charming as he is. “And for being such a bright light in what has otherwise been a very dark day.”

“Same to you, Bucky.” Guilt eats away at a small part of you that during what is for a lot of people in this hospital such a tragic day, you’ve instead actually enjoyed the company of a cheeky paramedic.

“Take care of Sasha for me, won’t you?”

“She’s in the best hands.”

“I don’t doubt that for a minute.” He says with a tone which makes you think he’s only referring to you, when you were in fact meaning the entire hospital staff. Your heart flutters at the implication.

When neither of you say anything more, silence lingering for an almost awkward length, Bucky turns to leave. Even though you know you eventually must part ways, your heart aches that the end has seemingly come so soon. Luckily, you have a reason to call him back and spend an extra moment together.

“Hang on, you need to sign a release form before you’re allowed to go.” You say, hand brushing his as you provide a clipboard and pen, a shiver running up your arm which you hope Bucky doesn’t notice. If he does, he doesn’t mention it as instead he quickly surveils the document and chuckles.

“If you wanted my phone number, all you had to do was ask.” Damn him and that cheeky, smug grin you’re already falling for.

“This is purely protocol.” You counter, wanting to take his cocky persona down a peg. Bucky simply smirks, as if he can easily see through your half-truth like glass.

“So you’re telling me you don’t want my number?” He challenges, and though you don’t want to admit he’s won this back and forth between the two of you, you’ll consider yourself a winner as long as you come away with a means of contacting him after today.

“I didn’t say that.”

He hands you back the clipboard, a corner of the sheet torn off with his number scribbled specifically for you to take. You try not to look too desperate by taking the note immediately and putting it in your pocket as you plan on doing as soon as he isn’t watching you.

“The next time I see you, I hope we won’t be in an emergency room.” The suggestion there will be a next time makes giddiness rise in your chest as if you’re a schoolgirl with a crush.

“Don’t count your luck, James.” You tease, having spied his true first name on his patient form. “I haven’t called yet.” You try to sound calm, even though you can feel your heartbeat quickening the longer those captivating blue eyes regard your every move.

“I have a feeling you will, even if it is just to tell me Sasha’s pulled through alright,” Bucky pauses, slowly leaning in so you have a perfect view of his exquisite eyes, and his dilated pupils, as he lowers his voice. “Or for a rain check on that on-call room rendezvous.” He calls your bluff before flashing what you’re now sure is his signature smirk, leaving you with a fluttering heart and butterflies in your stomach.

As you watch Bucky walk out the exit of the ER, turning to shoot you a wink before the door closes behind him, you know three things for certain: firstly, you’ll definitely call him tomorrow, secondly, this man is going to utterly ruin you, and finally, you’re going to let him.

Part 2 > >

Be added to the series taglist here

[sohcean]

we are literally witnessing a massacre

seriously what is happening right now

[sonobeunitsarecool]

Yuno's birthday timeline convo

Shidou: Thank you, for keeping Shiina-kun company and helping her during her treatment. It's thanks to your aid, Kashiki-kun, that I can help. Both her, and myself. Even if something were to happen to me, so long as Kashiki-kun is here then I can rest easy. Yuno: No way, I could never. I can't really do anything on my own. Helping Shidou-san is about all I can do. It's just a pretense of make-believe nursing. Shidou: No, Kashiki-kun has a real knack for this. You're perceptive, able to keep a cool head, and you have the guts for it. If you haven't yet decided on your prospects for after graduation, how about aiming for a career in healthcare? Yuno: Really? ...hahah, c'mon. I don't want to think about anything like the future. 'Sides, my current involvement in people's lives... I can't find that funny.

Oh? Yuno's being set up as a possible pillar for the others to lean on, particularly if something bad were to happen to Shidou. It's a part to play, and a heavy mantle. It seems to have many similarities with what is known about her story; it was something that is an "adult's task", and yet, she's performing more than admirably. I don't think she's quite sure why she's doing all this to help out the other prisoners, since she appears to have more of a knack for knowing the emotions behind other people's actions and words rather than her own. I may just be projecting, but it reminds me of alexithymia. Yuno seems to downplay her helpfulness and capabilities, dismissing the future as something dull and unsavoury to think of ("I think 40 years would be just right", much?). She has a lack of care for the future, a type of "who gives a damn" attitude, and a desire to fill that lacking "warmth" that appears to be akin to chronic depression. It's not an actively suicidal type, but more... if Yuno got executed in Milgram, I don't think she'd panic, and give a bitter, cutting remark to Es. It's also interesting how Shidou is also setting Yuno up as a makeshift nurse. He doesn't seem to treat her like a child, unlike those not too much younger than her, acknowledging that working in healthcare could be a field of study that she may have an inclination towards. I had thought that Shidou would more or less develop some kind of god complex in trial 3, based off of some of the lyrics in Triage. Here though, he's attributing much of Mahiru's recovery to Yuno, but still seems to set her at more of an arms' distance. Perhaps he's too deep in "doctor mode"?