#hemorrhagic shock

[justkidneying]

Shock

SHOCK! Everyone loves writing about it, so we're gonna talk about it.

What is shock? Shock is a condition in which the blood flow in your body is no longer able to sustain the function of critical organs. We call this hypoperfusion. Blood carries a lot of stuff, but most importantly, it carries oxygen. When your tissues don't have oxygen, they're hypoxic. If they're hypoxic for long enough, they die.

What does shock look like? The patient might have hypotension, syncope (fainting), chest pain, abdominal pain, cool fingers/toes, shortness of breath, and/or altered mental status (I know you guys love that last one, lol).

What are the stages of shock? Trigger Insult -> Compensated Shock -> Uncompensated Shock -> Irreversible Shock (organ failure) -> Death

Not all of those stages are obvious in every patient, but that is the general progression. So, what does that all mean? It means that first, something is going to happen (trigger insult). This could be trauma, sepsis, anaphylaxis, heart attack, etc. Something has gone wrong with the normal blood circulation (we'll talk about what in a moment).

Next, the body will compensate to maintain perfusion and keep blood pressure normal. This can cause an increase in heart rate, constriction of blood vessels, rapid breathing, stress, and cool extremities.

When the body can no longer compensate, shit goes wrong. Mechanisms are failing, blood pressure is falling, and the organs are in dysfunction. You may see confusion, syncope, weak pulses, and metabolic acidosis (that's actually deadly but not as fun to write about, lmao).

Finally, when shit has gone very, very wrong, you get organ failure. If there were no interventions in the previous stages, the organs will begin to shut down. Heart rate, blood pressure, and respiratory rate will freefall. The patient will no longer respond to interventions. The nervous system's electrical activity will fade, and the patient will go into a comatose state. Then they die.

The Five Types of Shock

Distributive: this is from the dilation of vessels, which drops the blood pressure to unacceptable levels. This can be do to anaphylaxis, sepsis (bacterial infection), or adrenal crisis. One thing to note with this type is that the skin at the extremities will be warm, not cold.

Cardiogenic: the heart is not working correctly. This can be do to heart disease, heart attack, arrhythmia, etc. This leads to low cardiac output but constricted peripheral vessels. This may present with pulmonary edema.

Hypovolemic: this is from low blood volume. This can be due to hemorrhaging, severe vomiting (or, on the other end, pissing out your butt), or severe dehydration. The patient will have cold extremities and may be pale. Usually, this type of shock is easy to spot because there's either blood everywhere or some other type of trauma causing internal bleeding.

Neurogenic: this is due to nervous system failure from injury to the brain or spinal cord. Note that this type of shock does not have a fast heart rate. Since the autonomic nervous system is non-functioning, there is no response mounted to the shock.

Obstructive: this is a blockage of circulation to the heart. There are two types, pulmonary and structural. Pulmonary is due to increased pulmonary circulation resistance. This can be due to a tension pneumothorax or a collapsed lung. Structural is due to resistance in the heart, such as with cardiac tamponade (fluid in the pericardial space). This case of shock requires you to realized that there is clinically a right and left heart, as the blockage of either side will result in vastly different symptoms and require different treatment.

How do you treat shock? For treatment, it really depends on the type of shock. For all types (except that caused by pulmonary edema), you should give the patient a saline IV to increase blood pressure and volume. Then, it really depends on the case as to what you do next. For distributive shock, you want to give the patient vasoconstrictors (like norepinephrine or vasopressin). For cardiogenic shock, give them inotropes (to increase cardiac output). For hypovolemic shock, fix whatever was torn up and give them IV fluids. For neurogenic shock, you can give fluids and vasoconstrictors. For obstructive, fix whatever is wrong, like breaking a clot or draining the pleural cavity.

Okay, I hope this is a good guide. I think hypovolemic and distributive shock would probably be the most fun to write about, but I mean you could probably make any of these pretty interesting (except obstructive, maybe). Let me know if you have any questions in the notes (is that what the reply thing is?? or are they called comments??)

[heardatmedschool]

“... the damn pelvis ™...”

About occult hemorrhage in an emergency situation.

I swear, I heard “that damn pelvis” almost more than “primary assessment” during this course.

[ehlnofay]

Martin thinks that he always kind of knew he was going to die today.

But by Akatosh, he didn’t think it would be like this – like Kvatch all over again, Kvatch folded in on itself, the streets overrun with monsters triple-time as thick, all metal and sulphur and blood. They were supposed to make it in time. He was supposed to light the fires. He was supposed to be crowned, and let some new, less visceral kind of horror begin – they were supposed to make it through – they were supposed – they supposed – but the streets are shaking with Dagon’s footfalls, and Martin can’t take a step without kicking a corpse, and the Hero of Kvatch is heavy-too-heavy against his shoulder, and it was always going to be like this. It never could have ended any other way.

He can feel prayer bubbling up from his scraped-raw throat, bitter as bile, held behind his teeth. O Akatosh, first of the gods, steady my hand… He doesn’t say it. Doesn’t mouth it. Tries not to think it, though it’s a rhythm born of years of habit, once a comfort, now just – empty. But it unspools in his head all the same. Pax is leaned heavy against his shoulder, one arm hooked loosely around his, hand pressed against the sticky-dark spot on their armour; they’re short, but they’re not light, and Martin’s arms burn as he tries to hold them up. The sky flares red. His eyes sting with smoke. Grant me the strength to endure. Onward, onward, onward.

Pax’s feet skitter uselessly against the blood-slick cobble. Martin almost trips over a leg, its silver-polished greave shining in the hellish light. The rest of the body is not there. He can taste smoke. He can taste bile. He can see the stained glass, the altars, the prayerbooks, his throat flayed raw begging for a salvation that would never be granted; this is not Kvatch, this is not Kvatch, but the sky burns and the streets are filthy with bodies and there is too much noise to talk, and Pax is damn near dead weight against his side, still holding out their blunt little excuse for a sword. Martin drags her on through the street. Just to the temple doors – just to the temple doors – the side of her head presses fierce against his ear. Martin’s knuckles are white with effort. There is blood on his fine silken robes.

Again, the streets shake; Pax staggers at his side. Akatosh, protect us. Martin doesn’t look up, doesn’t want to see the red-stained sky blurring against body – he can already see the cobbles cracked under the weight of feet too massive for his mind to make sense of it, a body – man or monster, he doesn’t know – crushed beneath the heel. Pax is gesturing at the colossus’ ankle with their sword as if they could possibly do anything at all. They’re bleeding.

“Come on,” Martin says, shallow and jagged; it stings to speak, and there’s so little point, his ears so filled with the clashing of metal and horrible, inhuman screams that there’s not room for anything else. His grip tightens around Pax’s shoulders. Her face is set, stubborn and pale – and she’s so stupidly young – and Martin –

There is an emotion so large it threatens to split him at the seams, and they don’t have time for that, so Martin runs. Staggers past the barely sketched-out shape of the devil menacing the skies, child hero in tow; every breath stinks of fear and ash. His throat prickles. If he doubles over with coughing, Pax will fall, there, onto bloody cobblestone, with their toothpick of a blade and their empty quiver, their sharp-spined bow slung carelessly over their shoulder, pearl-grey gambeson slowly darkening with blood, so Martin doesn’t cough. Blessed are we, the faithful…

They don’t fall, and they aren’t crushed, darting around the earth Dagon stands upon, slow and sluggard and so astonishingly lucky, and Martin gasps, and he does not cough, and Pax kicks at a scamp that gets too close and waves the sword at it just enough to slice a shallow cut down its scrabbly little arm. Martin’s so focused on holding them up that he can’t even cast. It isn’t even the one prayer running inescapable through his head – it’s a mess of them, all twisted and torn to pieces, shreds of one, half a sentence of another. He nearly trips over on the stairs. In the crowd, armour flashes, bright as steel and thoroughly outnumbered. He should pray for the Blades, too; he would, if he thought it would do anything. But it didn’t, last time. And this time, he has something better up his sleeve than prayer.

“Almost there,” he says through the din, and Pax keeps their sword arm raised even though they don’t know how to use the bloody thing, and there’s blood on their Kvatch gambeson, and there’s blood on Martin’s regal robes. (It was going to be him – that dremora’s blade whip-thin and wicked and dark as soot, jabbed thin as a sewing needle through the slippery-soft fabric, hooked under his ribs or pierced through the soft meat of his gut. Pax, empty-quivered, still drawing his sword, angled his own body to intercept; caught it in the thick pillow of his armour, in his own skin. Martin spat a spell from his fingers that sent the thing crashing to the ground and grabbed Pax well before they began to follow.) The earth shakes, again, and Martin’s shin hits the edge of the next step. He can’t hear anything over it all, but he sees Pax suck in a breath, sharp and pained. She takes another step. He follows.

When they reach the dark-stone door, someone screams, high and terrible, and there is no time to stand on ceremony; Martin throws himself at it, shoving it with all his weight behind his shoulder, and together, they stumble inside the temple, ash blowing in behind them to scatter itself on the sacred, stagnant floors.

The door swings closed again; the sound is swallowed up, faint and muffled. Martin can hear them both breathing, ragged, loud. Pax hasn’t lowered their sword. It looks even more dull, here, contrasted against the stonework. They’re so quiet. He hates that he’s learned how they act when they’re in pain.

(It’s holy ground. It won’t be enough – it barely was in Kvatch, it’s nowhere near it now – but it’s not nothing. There’s blood spilling over the tile.)

Martin sucks in a desperate, dragging breath. He doesn’t let go of them.

There’s not much light in the Temple, but it’s enough; it’s clear of smoke and that all that burning reddish tint, outside, and now that Martin has a moment to look them in the face Pax looks awful. His skin is ash-pale and slick with sweat, fringe sticking to his forehead, brow creased as if with concentrated effort and jaw taut. Every breath rattles in his chest and whistles out between his teeth. One palm sticks to the place in her side where her armour is dark and sodden; Martin is afraid to peel it away. It can’t be a wide wound, the cut not even enough to tear more of the gambeson than is covered by her hand, but shit it’s a lot of blood. It’s so much blood. He was never an especially good healer and he can’t even begin to accurately estimate it but it’s too much; it’s entirely too much. And it was because she was protecting him. It’s enough to make a man sick; but there’s no time, so Martin isn’t.

It's so much blood. Pax’s eyes are unfocused, drifting somewhere over his shoulder. His face is so clammy and so young – by the Nine, he’s a child. He’s a child and a hero and Martin’s friend and he’s bleeding out on the Temple floors. Martin hates himself, a bit, for going along with any of this in the first place, for letting them send a fifteen year old child out to risk killing themselves, only to get them here – this place, bleeding out onto sacred marble, where they always would’ve ended up anyway. All roads lead to this.

Inevitability. It’s an idea that showed up often in the sermons Martin used to help give. The Amulet is blood-warm and heavy round his neck.

“Pax,” Martin says; one arm is threaded under her armpits, and he lifts the other to press gently to her cheek. Just under her eye there’s a dark spot of ash; he swipes it off with his thumb, watches the slow, sticky blink she gives in response. “Hey. Are you with me?”

“Always,” she mumbles; her voice is sludgy, like it’s caught in treacle, but the word comes without delay – like it’s instinct, like there’s nowhere else she’s ever imagined being, and doesn’t that just make a man want, a bit, to throw himself off a cliff. (She’s gone to hell, on his word, who knows how many times over; Martin doesn’t need her half-dying drive to affirm her loyalty to him. He knows. He knows. He thinks he might be sick.) She blinks again, and then her eyes sharpen; she throws a tired look over her shoulder at the cool stone of the door, the world beyond muted, as if this moment occurs on its own; like they’re flies, frozen in amber. She says, “It won’t keep them out forever.”

Holy ground was barely enough in Kvatch; it will be barely anything here.

Martin’s arm is aching. He’s not that strong. “Long enough,” he says, with far more brusque certainty than he feels, and he casts a glance over the smooth marble floors, the well-wrought stonework of each plinth and pillar. “Come on. Sit down.”

Arms burning, he helps them to the side of the room, leans them against the leverage of the smooth white wall; still, they don’t sit, and Martin has to help lower them down. Pax grunts like a shot animal as he slowly sinks down to the ground, Martin’s hands still bruising tight on his shoulders, sword slipping from his sweaty grasp to clatter on the floor. His bow, slung over his shoulder, presses awkward against the wall; his empty quiver lies at his hip, useless. His hand is still pressed to the stain on his gambeson.

Martin watches him breathe out through gritted teeth, his tongue pressed ragged against the gap behind his lower canine. His head tips back against the wall. His gambeson, blood-spattered, barely protective, is tied with a row of neat leather cords; Martin reaches for one intricate knot and begins to tug on the ends.

Maybe it’s because he’s a bit frantic, that he just can’t get it to untangle – maybe it’s that the whole world is ending outside the door and they have a minute to stop it, if they’re lucky. Maybe it’s that Pax’s head is lolling, a little. Maybe it’s that it’s all on his head – has been on his head since any of it began, since he knew any of it at all, and now another city is falling, and he can still smell smoke, and he has a minute, if he’s lucky. He feels like they should have more time. He needs to undo the gambeson. He needs to make sure they’ll be all right. Martin was always going to die today – he feels it, settled comfortable and hazy over him, an unerring certainty in the very marrow of his bones, a knowledge passed down from the man they call his father – but Pax sure as shit isn’t. Not if he has anything to say about it, which he does, because it’s been on his head since the beginning and he’ll shoulder it all but he won’t bear this. His fingers scrabble, desperate, at the ties; every moment he waits is a murder, but leaving them here would be murder, too, and Martin won’t have that blood on his hands. And the knots won’t just come easy. He’s lost so much time and he hasn’t even gotten half.

Pax is looking at him, her eyes blood-dark. “You’re not going to get it,” she says, and her voice slurs, a little, in her mouth; pain or blood loss or shock, almost definitely, but Martin was never a particularly skilled healer and the magic he spent to get them through that horrible crush outside has left him too tapped to be able to probe. “They’re tied too tight.”

Martin can hear the ringing of metal outside. The earth is still shaking.

“Fuck,” he says, voice cracking on the vowel, and turns to rifle through their quiver. He hears them exhale, long and shaky, as he searches.

They don’t even have any fucking potions – he’d take anything, at this point, anything at all, he’d take the foulest cheapest draught as long as it would slow the bleeding, or even just a bandage, but there’s no bottles or flasks and no loose cloth. There’s one salve, pale and sticky in a purple-stained pot, but that can’t be used without access to the skin and probably can’t be good in an open wound in any case. There isn’t anything. There isn’t anything at all. Time is slithering away between his fingers. There are broken bits of prayer sticking like glass shards under his tongue, again. He doesn’t want to say any of it; it sticks in his throat, anyway. Lord Akatosh, sacred dragon, walk ever with me; under your gaze I will not fall short. Pax is looking at him, brow creased, face the very picture of dedicated focus; their hair, done in a long, simple braid back when they were just supposed to be speaking to the Council, has come half-loose, looping strands hanging about their face and trailing over their eye. Martin lifts a hand – notes, with detached interest, that it is shaking – and brushes it out of the way.

“I’m sorry,” he says – and he is, by the Nine, it settles with all the rest of the guilt in his gut, all to be burned soon enough – “there’s not time for me to heal you properly. How are you feeling? Are you all right?” Their skin is still clammy to the touch, sweat-damp wherever he touches; their eyes are more focused now but still screwed up with pain.

Pax gives a short puff of air. It’s not a laugh, not in his state, but it’s not all that far off; his voice is gravel-rough. “Got stabbed, Martin Priest. ‘S not great.”

Stabbed in the gut, while protecting him – bleeding all over the sanctified floors, the grout will never recover, and why is he thinking about that when the blade could have caught an organ and Martin would never know because he’s never been that good a healer. The ground is shaking again. They’ve been in here a minute, maybe, and he already feels like they’re stealing time. The seconds are slipping away quickly. He’s digging his fingers fiercely into the cloth of Pax’s shoulder; if he doesn’t hold onto her somehow he thinks he might fall down.

(He’s glad she’s here, and he hates himself for being glad. She’s bleeding. It should be his blood.)

His face must be doing something truly impressive, because Pax cracks a grin, wide and crooked and sticky-mouthed. “Calm down,” she says, the words thick as treacle in her mouth, “I got at least ten more minutes in me. What’s the plan?”

“The plan,” Martin echoes. That statement is nowhere near as reassuring as she seems to mean it to be; he shakes his head. Looks back at the doorway, still closed – noise of battle still raging, earth still trembling, but none of it imminent, probably, not within the next three seconds – and surges forward to wrap their shoulders in a fierce hug, careful to keep away from their abdomen, his cheek pressed against their hair. They smell of sweat and smoke and blood; he takes a deep breath, anyway. “I’ll do the rest, Pax, just – rest.” His voice cracks, again. “Be okay.”

(There’s more prayer pressed into those two words than in anything else he’s thought today.)

Pax reaches a hand up to pat his sleeve; her head, still, is resting against the stone, the set of her shoulders a little tauter, a little more alert. “I can still help,” she insists. The sword – blunt little instrument that it is – lies on the floor, tacky with monstrous blood; she doesn’t even try to reach for it. The bow slung over her shoulder is jabbing him in the collarbones. Martin pulls back enough to shake his head.

“No,” he says; because they can’t. The rest is for him and him only, so no-one else has to get hurt. Pax got him this far – got him out of the wreckage of Kvatch – got him out of the stagnant mire in his head – got a blade in the gut, for their trouble, and even if Martin had anything else to ask of them he couldn’t ask for more.

Pax glowers, at that, the crease reappearing between his brows; Martin could laugh, if it was another day, if they had another moment. He presses his face to the top of Pax’s head, instead, nose dug sharply into his hair; and he breathes, and he breathes, and he breathes.

He’s not an orator, but the way Pax talks they seem to think he’s accustomed to giving grand speeches; he’s certainly had enough practice lately. His breath shudders. He dredges up what words he can. They’ve been in the Temple a minute already; he doesn’t think they can ask another.

“I,” he says, and breathes; “I cannot stay to help rebuild Tamriel – that must fall to others.” He couldn’t have been Emperor, not ever – he’s never been able to fix things, not on this scale. The weight of the Empire would have run him into the ground. He would have hated it. It would have killed him. (Didn’t it?)

Pax’s hand skims the fine cloth at his elbow again. Voice slow, they say, “What –”

“I know now what I was born to do,” Martin says, and he tries to smile. He doesn’t know if they can feel it. His hands clasp the sides of their face; their hair is tickling his nose. They feel cool to the touch, dead-fish clammy; but it will be all right, because once it’s all over the healers will come in, better at flesh-craft than Martin’s ever been, and they’ll fix it. They’ll fix it all. And the Blades are here, however little Pax usually chooses to engage with them, so he won’t be alone. And the Elder Council, the whole Empire, will owe him a debt of such gratitude – he won’t be alone, again. He’ll have options. He’ll miss him – but he’ll live. And Martin will, for once in his sorry life, have actually fixed something.

His friend’s hair smells like smoke. Their skin is shining with sweat and grime. “You’ve been such a good friend in the short time that I’ve known you,” he says, and he’s smiling, he knows it, a melancholy thing pressed into their hairline. His voice is shaking, just a little. “I’m sorry I couldn’t – I couldn’t stay to know you better.”

“Martin,” Pax says, and he pulls back. Their face is creased, ash and blood smeared over their cheekbone. Suspicion lines the tilt of their brow.

Martin smiles, still. His palms, rough and dry, cradle her face. “But now I must go,” he says, gentle; “The Dragon waits.”

And Martin, for one, is done waiting.

He pushes what magic he has left into his hands, sunshine-bright; Martin is no great healer, particularly not when his reserves are tapped, particularly not when he can’t even see the wound, but he can at least soften the edge, dampen the overwhelming pull of the pain. His hands sting with the effort, his head spins, the ground shakes; and one of those has nothing to do with expending himself. Right on time, it seems; the Amulet of Kings hangs warm and heavy around his neck.

Martin stands, though his legs shake; stumbles a step backwards; turns to face the dais in the middle of the room, the shallow marble dish of it lying cold, the pillars around it as stark and foreboding as the bars of any cage. He runs.

“Martin!” he hears behind him, because Pax is Pax and of course they won’t let him go easy; the earth shakes, anticipation winding up into a wiry coil in his gut. The Amulet is hot enough to burn, bright as the sun – he heaves himself up onto the raised platform, reaches to unloop it from around his neck –

The ceiling caves in, and Martin throws an arm over his eyes, closing them against the implosion of dust and grit, scraping in a breath thick enough to choke. His ears are ringing. He manages to squint up, catches a glimpse of a massive fist swiping the rubble away from the hole, the glint of a battle-axe, a silhouette against the burning red sky, roiling and howling like a column of storm. Martin can’t even make out a face, but he knows, somewhere deep and solid, that it’s looking at him. He meets its gaze, the Amulet raised high in his hand.

All prayer has deserted him, now, all the rote lines and careful patterns he leant on for so long slipping away from his fingertips as if they were never there at all. All he has is please, weighty, guttural, and he thinks it might mean more than any of the rest of it. Please. Please. You owe me this. The Amulet of Kings burns in his hand.

“Martin!” he hears again, hoarse and desperate; he looks. Just once. Pax has dragged himself across the dust-coated floors, bow and quiver abandoned somewhere behind him; his face is covered in dirt, hair come half-loose, eyes stubborn and fierce and wild. He feels his eyes crease, the lightest echo of a smile. He’ll miss them, wherever he goes next. Pax screams, “Don’t!”

Martin Septim was always going to die today. It is, perhaps, one of the first things he’s ever done right.

Martin smashes the Amulet of Kings on the cold marble dais, and the world erupts in gold.

[lesbians-all-the-way-down]

Cryptic pregnancy with complications. Send tweet.

[writers-potion]

Vocabulary List for Fight Scenes

Combat Actions

Hoist

Dart/Dash

Deflect

Shield

Sidestep

Snatch up

Stalk

Stamp/stomp

Stretch

Stride

Wagger

Oust

Leap

Lose ground

Mimick

Mirror

Negate

Overpower

Parry

Rear to full height

Resurgate

Suanter

Seize

Take cover

Throttle

Twirl

Unleash

Withdraw

Entwine

Flee

Gain ground

Grasp

Cling to

Breach

Duck

Dodge

Hits

Amputate

Bloody

Carbe

Castrate

Collision

Connect

Crush

Defenestrate

Destroy

Disfigure

Dismember

Dissever

Grind

Maul

Perforate

Rend

Riddle with holes

Saw

Smack

Splatter

Sunder

Torn Asunder

Traumatize

Whack

Writhe

Gut

Hammer

Maim

Mangle

Plow

Puncture

Melee

Assault

Attack

Barrage

Bash

Belebor

Bludgeon

Carve

Chop

Cleave

Clio

Club

Crosscut

Dice

DIg

Gore

Hack

Impale

Jab

Kick

Knock

Onsalught

Pierce

Plnt

Punch

Rive

Shove

Skewer

Slice

Smash

Stab

Strike

Sweep

Swipe

Swing

Transfix

Thrust

Visual Flair

Agony

Asphyxiate

Chock

Cough up bile

Cut to ribbons

Flop limply

Fractue

Freckled with blood

Gouts of blood

Grimane

Hemorrhage

Hiccup blood

Imprint

Indent

Resounding

Retch

Rip

rupture

Shiny with gore

Spew

Splash

Slumped in despair

Splatter

Split

Tear

Topple

Void

Vomit

Wedge

With a fell gaze

With a fiendish grin

With blank surprise

Audible Flair

Bang

Barking

Bong

Boom

Crack

Cackle

Clang

Clash

Crash

Cry

Echo

Elicit a curse

Frunt

Hiss

Howel

Hum

Moan

Muttering

Whoosh

Whistle

Whizz

With a keening cry

Thud

Thunk

Thawk

Splat

Snarl

Swoosh

Squeal

Sing

Sickening Pop

Silintly

Shriek

Shout

Snap

Thundering

Effects

Blind

Burn

Cause frostbite

Cauterize

Concussion

Combust

Daze

Dazzle

Deafen

Disintegrate

Electrocute

Freeze

Fuse flesh

Immobilze

Incinerate

Melt

Pralyse

Petrify

Purbind

Radiate

Reduced to

Shock

Sightless

Stun

Transiluminate

Death Blows

Annihilate

Behead

Decapitate

Disembowel

Eviscerate

Extirpate

Murder

Obliterate

Raze

Exterminate

[allthingswhumpyandangsty]

WHUMP ALPHABET

*anything that can be triggering is most likely listed here, skip this post if you think it might upset you*

A is for asystole, amputation, amnesia, asphyxiation, asthma, autopsy, asylum, abandonment, anxiety, abuse, assault, aneurysm, anger, addiction

B is for blood, bruises, blunt force trauma, burns, bite marks, blisters, betrayal, beating, blindfolding, bondage, brainwashing

C is for cannibalism, cuts, convulsion, concussion, cardiac arrest, corpse, chains, cult, carnage, craniotomy, craniectomy, chest compression, choking, coughing up blood

D is for delirium, dehydration, disfigurement, dismemberment, demonic possession, death, dehumanization, degradation, depression, disease, drowning, distress, despair, dizziness, drug withdrawal

E is for exsanguination, electrical injuries, electroconvulsive therapy, electrocution, execution, exhaustion, eating disorders, emergency room

F is for fever, flu, fatality, flat-lining, fractured bones, fear, fatigue, force-feeding, flagellation, flogging

G is for garroting, gunshot wounds, grief, gallows, guillotine, guilt, gash, gag

H is for hypothermia, heatstroke, hallucination, hyperventilation, hemorrhage, handcuffing, hospital, hanging, hatred, hate

I is for intubation, infection, injuries, injection, illness, internal bleeding, intravenous therapy, insomnia, illusion, innards

J is for jealousy, jugular veins

K is for killing, kidnapping, knife

L is for laceration, lobotomy, ligature marks, lack of oxygen, loss of consciousness, lies, living weapon, locking up

M is for morgue, miscommunication, murder, manslaughter, massacre, mourning, miscarriage, masochism, mistreatment, manipulation, misery, mental illness, malnutrition

N is for nightmares, nausea, necrophilia, necrotizing fasciitis, necrosis

O is for outbreaks, obeying, operating theater

P is for physical restraints, pain, punishment, poison, panic attack, paralysis, PTSD, penetration, pierced lung

Q is for quadriceps tendon rupture, quadriparesis, Quebec platelet disorder

R is for ruptured blood vessels, respiratory failure, rabies, rape, rope, resentment, ritual

S is for schadenfreude, strangulation, starvations, shock collar, shock therapy, straightjacket, sadism, scapegoat, shame, sacrifice, sadness, sorrow, slaughter, suicide, self-harm, self-hatred, self-destruction, stabbing, slavery, seizures, stress, slash, suffering, surrendering, somnophilia, shackles, sepsis, surgery

T is for torture, trauma, tears, toxicity, trust issues, traps, tying up

U is for urinary tract infection, unresponsive, unconsciousness

V is for violence, vomiting, viruses, venom

W is for wounds, weeping, waterboarding, weakness, whipping, whimpering

X is for x-ray

Y is for yellow fever, yelling, yelping

Z is for zombie apocalypse

[lild00td00t]

Hi, I hope you are doing well! Can I request headcanons on how Crocodile, Buggy, Mihawk and Doflamingo would propose to their s/o or how they would react if their s/o was the one to propose to them? (Which ever you feel like is fine! :))

Have a great day!

One Piece War Lords: Proposing to their S/O

This was so adorable thank you for requesting the War Lords!! I’ll have to write a part 2. Buggy was honestly my favorite for a bit… 👉🏻👈🏻 but these are gonna be so HELLA friggin cheesy. I’m a hopeless romantic.. so please… COURT ME LIKE WE’RE IN PRIDE AND PREJUDICE.

Buggy

• He’s so nervous, his hands are clammy, even on the inside of his gloves sweat is lining along the fabric of them. He’s talked it over to himself multiple times, rationalizing the best and worst case scenario.

• He can’t help but melt when he sees you with the promise ring he gifted. He sweats bullets when you tease him about getting married… at dinner he nearly choked, and poor Mr.3 nearly had a heart attack just trying to dislodge the food that got caught in his throat. But he felt like that a majority of the times you discussed it. Like something was lodged in his throat and cutting off his air.

• So when you’re watching the crew bring a haul back on the ship, hands on your hips in a relaxed stance, you barely notice when he slips a ring on your finger, and he discreetly prays you don’t say anything about it until you screech and throw your arms around him, his body probably splits in 2 out of shock- this poor man -

• “ How does it feel knowing you’re going to be married to the future pirate king ?! Flashy ?! As it should feel?! “ Then the second you romanticize over the idea he practically hemorrhages 🥲

Mihawk

• The most poetic. God - he probably leaves you little poems every where, and they’re all based on you <3

• Your dates are so adorable. Like picnics, or going on row boats. It’s so quiet on the water, so you don’t notice when he slips down on one knee, clasping your hands in his while presenting a ring.

• You nearly flip the boat when you finally comprehend what’s happening but luckily your better half is much more calm and collected.. he was prepared for this reaction.. atleast he thinks he was -

• He kisses your knuckles, then overlaps your hands with his and holds them to his heart

• “ It seems as though the love saga of my poems will continue until death do us part…“

Crocodile

• Posessive..

• He truly is materialistic and is telling the truth. You genuinely will get what you want. But he can see it in your eyes that you’re not after his money, or his valuables or even his status. He can see the way you adoringly look up to him when he talks. And he’s not used to such an innocent form of love you offer.

• He feels that you must be protected, for what you make him feel is vulnerability. Which scares him. Because no one has ever made him feel that way before. So when the time is right, most likely on a starry night when you’re on a walk he’ll stop, just long enough to kneel and pull out the box, just long enough for you to realize what he’s doing. And with that, he confesses his love

• “ With this ring, you are mine.. whatever you want you can have. You will always be treated with my respect and my love, nothing will ever be enough to satiate how I feel for you. No amount of gold compares to that ring on your finger, for it holds the greatest power in all the world.. my promise to you. “

Doflamingo

• Like crocodile he’s possessive.. but with a sweet?? Spin ?? To it ???

• The moment he slips the ring on your finger he brings your hand to his lips for a sweet kiss, giving you that bone chilling smile while keeping his lips pressed to your skin.

• He doesn’t make a big, fancy show out of it. Because he knows that you don’t need everyone to know. It’s obvious that you’re his

• You listen when he talks. You’re never put off by his nightmares or bad moods. You urge him to talk about his brother and family. You talk about starting a new one… as a second chance.

• “ A second chance for the Heavenly Demon.. “ he thinks to himself, lost in thought. You weren’t scared to say that he was flawed, but it didn’t matter, because you could work on it together

• “ As long as you are mine, you will be taken care of and no one, I mean no one, will ever mistreat you ever again, lest they want my wrath… “ And he means it. He means every word of it. He would wage wars in your name, bring cities to the ground, and split the ocean in two if he could, unlike crocodile, who is alittle more materialistic with his promises. <3

[holysmokesblog]

The Gray Reunion

Vi x reader

Words: 1.5k

Warnings: Violence, mentions of illness, blood, slightly spicy kisses ;)

Summary: In the midst of the chaos, you struggle to help the people of the Lanes. The truth behind the disaster sparks a confrontation that will test your bonds

Note:English is not my first language, sorry

In the past few hours, your modest apartment had turned into chaos. At least a dozen people had knocked on your door seeking help, intoxicated by something you hadn’t seen in years.

They could barely fit into the small living room, which also served as your kitchen and bedroom, waiting for you to help them, coughing out toxic fumes. Everyone expected you, just as your father had done in the past, to help or offer a solution, but you were completely lost, fumbling with medical supplies that had been stored away for years.

"The gray," murmured an older woman who was holding her husband as he struggled to breathe.

"That’s impossible," you replied. "We haven’t had problems with that in years, the ventilation system..."

"Then there must be a leak," she interrupted, raising her voice before a violent cough cut her off. You watched as her hand was splattered with blood. She inhaled deeply before continuing, "I’ve been through this before, but we don’t have the years on us anymore. Your father treated it countless times. Doesn’t he have notes somewhere?"

You sighed in defeat. "I’ve lost most of Dad’s things over the years. All I have left is what you see." You placed the stethoscope on a child’s back to listen to his breathing. "There’s nothing I can do. We just have to wait for the lungs to clean themselves... and stay far from the leak."

A collective groan arose from the people packed into your small space. "And how are we supposed to do that? We live there! Where can we go?" Various complaints began to rise.

"I wish I had an answer for you, but I don’t. We just have to wait until they repair the leak."

"They’re not going to fix it! It’s those damn enforcers! They’re killing us to get to Jinx!" Another wave of murmurs rippled through the room.

You tried to remain calm. Could that be true? Were the people above really capable of poisoning everyone just to catch Jinx? Those above had taken so much from you already that it seemed entirely plausible. But then an image came to mind—Violet. She was in Piltover now, and she would never let this happen, not to the place that had been her home for so many years and still was yours. Right?

You continued your work, trying to calm the rebellion brewing in your living room, tending to the most severe cases of nosebleeds and eye hemorrhages. But there wasn’t much more you could do. Around three in the morning, the last person finally left.

Exhausted, you collapsed onto your bed, utterly defeated. Chances were, all the patients you’d seen today would return tomorrow with new symptoms. It was impossible to recover from the gray while constantly exposed to it. You knew that if it was a crack, it would take years to fix. And if it was intentional, if they were hunting Jinx... that would also take time. There was no way they’d catch her.

A knock on the door kept you from falling completely asleep. You cursed under your breath—new patients. Your father’s voice echoed in your mind, reminding you how he wouldn’t rest until he’d helped the last person who needed him. You repeated the phrase to yourself before getting up to answer the door, only to be met with a great surprise.

Vi stood there, but the most shocking thing was her outfit. She was dressed as a full-fledged officer, an enforcer. You couldn’t suppress a gasp of utter disbelief. You had spent years of your life together; you knew her story as well as your own, and never would you have imagined the possibility of her wearing something like that—not even as a joke.

"I’m truly surprised," you murmured. She scoffed in irritation. You stepped aside to let her in, and she dropped her new, heavy gloves onto your floor. You bit your lip to keep from scolding her.

The past few days had been madness: Vi’s return, the search for Jinx, and your responsibilities trying to honor your father’s legacy had left you with barely a moment to breathe.

"Lots of patients?" she asked, trying to start a conversation.

"Too many," you replied, collapsing onto the bed again. She still stood awkwardly in the middle of the room. "You can lie down if you want... Unless you’re scared of dirtying that pretty uniform." She let out a short laugh before lying down next to you.

"I’ve barely seen you since you came back... I don’t think I ever got to tell you how happy I am that you’re here... Despite everything."

"Yeah, I suppose the first hug you gave me said it all."

"I mean it, Vi," you said, turning to face her. "Everything got so hard, but now you’re here, and I feel like things will get better."

She smiled faintly. "Yeah, we just have to fix a few things, and everything will improve." She propped herself up to sit beside you. "You look really pretty," she added. "Those dark circles suit you."

You couldn’t help but laugh. For just a moment, all the bad things disappeared. It was just the two of you in your small apartment—no Jinx, no gray, no problems in the Lanes. Just you two. Without thinking, you leaned in and pressed a quick kiss to her lips. She froze for a moment.

"I thought you missed me," she teased.

"I did."

"That’s not a reunion kiss. This is." Without warning, she leaned over and kissed you deeply. You welcomed her eagerly—it was like a breath of fresh air, something rare where you’d grown up. The kisses grew more intense, and your hands wandered over her torso and back. Vi positioned herself on top of you, using her hand for support on your pillow. But she quickly pulled it back.

"What’s this?" she asked.

You looked to the side, confused, and saw a large bloodstain. You hadn’t even noticed it. You sighed. "I’m really sorry." You sat up slightly, but Vi didn’t move off you. You grabbed the pillow and threw it to the other side of the room. "It’s been such a complicated day with the ventilation cracks."

"Yeah, don’t worry. I’m not at my best, either."

"Doesn’t seem like it." You kissed her intensely again, and she adjusted immediately.

"When all this is over, we should go on a real date. Like dinner and all that cheesy stuff."

You laughed against her lips at her failed attempt at romance. "I just hope it’s soon."

"It will be," she declared confidently. "Once they catch Jinx, everything will get better, and life in the Lanes will change—just like Vander always wanted."

Vi’s hands slipped under your shirt as you shared another passionate kiss, but her words lingered in your mind.

"Wait, wait, no," you said, pushing her slightly so she moved off you.

"Oh, do you want to take control, doll?" she teased.

"Did you have anything to do with this?" She looked confused, so you pushed her again to sit beside you. "The gas? Was it you?"

Vi stayed silent, hesitant to answer.

"Is this some kind of joke? You’re poisoning us just to catch your sister?" you shouted, furious.

"Hey, hey, it’s not like that... I mean, yes, but not how you think."

"You bitch," you spat, jumping out of bed. "Do you even understand the damage you’ve caused?"

"Listen to me. We used the gray to clear the streets, to keep people safe," she tried to explain.

"Used? Who’s ‘we’? You and your new enforcer friends? Well, you didn’t protect anyone!" You exploded. "Do you have any idea how many people you hurt? At least fifty came here today!"

"She’s a murderer! She killed half the council, she—"

"She’s not a traitor," you cut her off sharply.

The room fell silent as you watched Vi clench her fists in anger. You’d struck a nerve.

"Did you really do this for her? Or did your new enforcer friend convince you?" you spat, unable to hide your disgust.

"Don’t call her that!" Vi’s hands grabbed the collar of your shirt, pushing you against the wall.

You stayed inches apart for what felt like ten seconds before she let go, though she didn’t step back. Her heavy breathing mixed with yours, and you could smell the perfume from her uniform—a scent impossible to find down here.

"Get out of my house," you whispered.

"You have to understand—"

"Get out!"

Vi sighed loudly, grabbed her heavy gloves from the floor, and walked to the door. You opened it for her, stepping aside. She crossed the threshold without meeting your gaze but stopped in the doorway.

"I hope your new friend is worth it." She didn’t turn around, just kept walking down the dark street, away from your home.

You couldn’t stop the tears from falling.

What had you expected? Nothing had stayed the same over the years.

You locked the door before collapsing into bed. Tomorrow would be another hard day in the Lanes.

[rapeculturerealities]

Porsha Ngumezi Died After Not Getting a D&C in a Texas Hospital — ProPublica

It was clear Porsha needed an emergency D&C, the medical experts said. She was hemorrhaging and the doctors knew she had a blood-clotting disorder, which put her at greater danger of excessive and prolonged bleeding. “Misoprostol at 11 weeks is not going to work fast enough,” said Dr. Amber Truehart, an OB-GYN at the University of New Mexico Center for Reproductive Health. “The patient will continue to bleed and have a higher risk of going into hemorrhagic shock.” The medical examiner found the cause of death to be hemorrhage.

D&Cs — a staple of maternal health care — can be lifesaving. Doctors insert a straw-like tube into the uterus and gently suction out any remaining pregnancy tissue. Once the uterus is emptied, it can close, usually stopping the bleeding.

But because D&Cs are also used to end pregnancies, the procedure has become tangled up in state legislation that restricts abortions. In Texas, any doctor who violates the strict law risks up to 99 years in prison. Porsha’s is the fifth case ProPublica has reported in which women died after they did not receive a D&C or its second-trimester equivalent, a dilation and evacuation; three of those deaths were in Texas.

[justkidneying]

ANOTHER regen question!

Let's see if I phrase this one right it's been rolling in my brain a bit

Assumptions are the character heals a slower than Wolverine and they've just suffered some serious blood loss. Like they lost ~3L of it and the wound has now closed up and the body's working to create as much blood as possible.

Given how bone marrow is where blood comes from, what sorts of things might they have to deal with in the recovery period? Like, as the body is taxing the marrow like that (and/or whatever else it has to)?

I'm going to assume this is a ~200lb man, just to give some leeway. So a big guy like this would have maybe 6 liters of blood in him (most humans range from 4-6 L). If he loses ~3 L, I would say he would probably just die. If blood loss is >40%, that's a Class IV hemorrhage, which presents with absent peripheral pulses, hypotension (low blood pressure), and no peepee output. This person will go into hemorrhagic shock. Since they lack the oxygen-carrying hemoglobin that is found in blood, they will not be able to supply oxygen to their tissues. This stops the usually metabolic processes and switches the body to anaerobic metabolism, which makes lactic acid and very little ATP (energy). Lactic acid leads to acidosis. Acidosis leads to cell death, coma, and plain ole death. He will die.

But wait! He's got regenetative powers to save him, right? No. If his powers aren't magical, then he will still die. Because regeneration is based on being able to replicate cells very quickly, he would need to do it fast enough to beat the cells that are dying. Unfortunately, he doesn't have enough ATP to do normal cell stuff and make a bunch more. Replication of cells requires a lot of ATP (energy). So he will still die.

Now, let me answer the second question, and we will go back to when he is still alive. Let's change it so he only lost ~30% of his blood volume (1.8L). He's still not doing good (he has Class III hemorrhage) but he can live. This will present with pallor, coolness in the limbs, altered mental status, narrowing blood pressure (the top and bottom numbers are getting close together), increased respiratory rate, and increased heart rate. The body is trying to keep blood flow to the vital organs. Let's say he survives and now he's home and trying to recover.

Blood has a lot of things in it, but the important bits are plasma (the liquid bit which makes up ~55% of blood), red blood cells (they carry oxygen), platelets (for clotting) and white blood cells (part of the immune system).

The most important one here are the RBCs. 90% of plasma is water, and you won't die right away without the other ones. The body measures RBCs through the kidney. If the kidney sees that you don't have enough of them, then it sends a hormone (EPO) to the spongey inner bone where blood is made. EPO causes more stem cells to turn into RBCs (instead of WBCs or platelets). To make these, you need iron. The iron stores of the body will be used, and you will take up more iron from your food.

Overall, I'd say the guy will feel like shit, and he should probably take a break for about 3 months while he replinishes his blood supply. He should eat foods high in iron, maybe take an iron supplement. But he'll be anemic while he recovers and be low on those other blood cells. Honestly, his regen powers aren't that useful here. They were useful in fixing whatever caused the blood loss, keeping him from losing a ton of cells to blood supply issues, and that's about it. If he doesn't have an advanced factor, then he can't really be helped with making more RBCs.

I hope I answered your question, and thank you very much for asking it!

[jpopstreaming]

BUCK-TICK's Atsushi Sakurai Passes Away at 57 Due to Brainstem Hemorrhage

An Emotional Farewell to the Iconic Vocalist During a Fan Club-Exclusive Performance

The music world is in mourning as Atsushi Sakurai, the charismatic vocalist of the iconic Japanese rock band BUCK-TICK, passed away unexpectedly at the age of 57. The devastating news was officially confirmed, marking a sudden and shocking end to the artist's three-and-a-half-decade-long career.

On the fateful night of October 19th, Sakurai was performing at the fan-club exclusive event "BUCK-TICK FISH TANKer's ONLY 2023" at KT Zepp Yokohama in Kanagawa. Unfortunately, due to his deteriorating health, the performance had to be halted. Despite being rushed to the hospital, Sakurai could not be saved and passed away at 23:09 due to a brainstem hemorrhage. The family, respecting their privacy in this trying time, conducted a private funeral. However, according to the band's management, a memorial to honor Sakurai will be organized at a later date.

BUCK-TICK, composed of Atsushi Sakurai, Hisashi Imai (Guitar), Hidehiko Hoshino (Guitar), Yutaka Higuchi (Bass), and Toll Yagami (Drums), debuted in 1987. They rose to fame in 1988 with the hit single « JUST ONE MORE KISS », propelling them to national stardom. Celebrating their 35th anniversary this year, the band had just hosted a grand anniversary concert in their hometown of Gunma in September. They were just commencing their 36th year in the music industry when this tragic incident occurred.

Sakurai's untimely demise has sent shockwaves through the fan community and the music industry at large. It's a loss that leaves a void difficult to fill. The late singer was renowned for his mesmerizing vocals and enigmatic stage presence, qualities that have touched the lives of countless fans globally. His voice will forever resonate in the hearts of those who admired him. While the band's future remains uncertain, Sakurai's rich legacy ensures that he will continue to inspire generations to come.

[amelizscribbles]

OK, EXPLAINING DABIS SCARRING because @good-lord-not-books asked

*note these are just my hcs and some medical research

I'm putting this under a cut because it's long as hell, and I apologize in advance for any typos or if it's confusing. I have no problem explaining further♡

His scars are hypertrophic. which 1) explains the discoloration. It's what happens when the smaller blood vessels become partially or fully obstructed with scar tissue. They typcially start off pinkish or light red. (like when he woke up from his coma.)

Typically the treatment for this is laser removal. But if you don't have access the color may naturally shift with age/as it natueally heals. But with continuous damage to the areas.. the scar will get darker as the veins and tissue is further injured (the deeper into the skin and possible muscle it damages)

most hyrpertophic scarring can take a year + to heal. but obviously Dabi just keeps making his worse. The scars themselves are cause by the body over producing collagen for wound healing and not actually being able to break all of it down.

Which leaves collagen fibers in the skin to harden and thicken. Hardened skin doesn't allow much give, lessening the skins elasticity over all. Which can be shown in the way his unscarred skin pulls along the edges where the dermal rings line said scars. (my thoughts on his staples acrually being dermal rings will be at the end)

That's not even going into the nerve damage systemically for him considering hes covered in that kind of scar. So when he says he can't feel a thing it's literal as the nerve endings are shot to shit. And that is only going into skin deep level.

Interal organ nerve damage is a whole other mess due to the scaringbeing from burns. As severe enough burns cause systemic damage. (will also go into atfer the scarring part)

His skin looks TIGHT on him. If he did have and semblance of sensation in his nerves it might feel like hella tight/dry skin. Also I think hypertrophic scars are an inflammation response to the body healing.

His body is literally misshapen from it. (and yes we love him the way he is) You can see in panels where the skin is probably softer where there's lack of muscle definition but can see where it's tighter or pulling over his arms/ shoulders/ribcage because the skins elasticity is non-existent. The instances where it's sifter looking is probably due to his body trying to retain as much body fat it can to keep healthy (or as healthy as it's going to get in his state.)

As far as it going right up to his lower lids and having zero tear ducts. that man has chronic dry eye like it's nobodies business. so itchy and possibly bleeding eyes isn't a shock. he probably has several counts of grand larceny in artificial tears alone.

Ok so as for his scaring being from burns, burns affect the whole body and how it works depending on the severity.

It can effect muscle tissue/muscle mass, bone structure and interior organs.

Given he seems to be perpetually giving himself 3rd degree + burns .. his respiratory system and cardiovascular system are probably shot to shit. Just from smoke inhalation and perpetual injury. (hypertrophic scars fill the veins with scar tissue remember) Assuming how deep the burn and scar tissue goes.

But we haven't seen him with much breathing issues so I'm assuming it's whatever. He has mentioned motion sickness and we've even seen him turning down food. So I can at least go into it's affects on his GI tract.

In the GI tract, burns can result in increased gastric secretions, reduced intestinal motility, decreased nutrient absorption, increased GI mucosal permeability, bacterial translocation and increased intra-abdominal pressure. If it's bad enough he may have ulcers or gi hemorrhaging. Severe burns also cause liver and intestinal damage.

The fact that he's been alive this long is wild if he's been homeless this whole time and just committing small crimes to not die. One thing that irritates me is when people think he would be incredibly unhygienic due to the scars and such.

Like do you understand how CLEAN you have to keep burn injuries to keep them from getting infected?? Even if it's layered over already damaged and scarred skin. He might smell like burnt flesh but I doubt he's letting wounds fester.

Yes he could probably just cauterize himself but that's still just burning burn wounds. Especially with 0% health insurance. I always assumed he kept breaking into the Todoroki family home when he knew no one would be there to do basic things to make sure he didn't die on the street over the years.

Quick add on to my thoughts on his staples just being dermal rings to homd his skin together/as a form of human Kinstugi.

They (the rings) are pretty rounded in the manga, surgical staples aren't nearly that large either so I always assumed human Kinstugi regardless of metal color (between manga gold or anime silver) and it was both decorative and necessary for his skin.

I just assumed wherever the rings weren't, it was just spots he couldn't reach.

it's also shown in the manga that he's adjusting/adding more along his scars.

als, in case anyone is unfamiliar with the term Kintsugi, it's this

Kintsugi (Japanese: 金継ぎ, lit. 'golden joinery'), also known as kintsukuroi (金繕い, "golden repair"), is the Japanese art of repairing broken pottery by mending the areas of breakage with urushi lacquer dusted or mixed with powdered gold, silver, or platinum. The method is similar to the maki-e technique. Its the Japanese philosophy that the value of an object is not in its beauty, but in its imperfections, and that these imperfections are something to celebrate, not hide.

which I think suits his character very well when his piercings and dermal rings are gold looking in some of the colored manga art.

ok, I'll shut up now, ♡

[maespri]

your turn to die characters ranked by how painful their death was (and why)

okay. crazy title, i KNOW. but this was actually so interesting to talk and think about. at least for me.

spoilers ahead, and TRIGGER WARNING. this post is going to go into detail about each death. it’s going to get gory and upsetting. if you don’t think you can handle hearing about that, please keep scrolling!

everything is under the cut, because this post is LONG, i'm warning you now.

some backstory: i have a special interest in anatomy and physiology, and i've always thought about how the different deaths in your turn to die worked. my wonderful friend @lovivelle and i talked about this topic extensively last night and they made this tier list with me! so, here's the ranking and explanations!

this ranking ONLY covers HUMAN deaths, because dolls/dummies do not feel pain.

quick glossary: exsanguination: death caused by bleeding out hemorrhaging: bleeding necrosis: cell/tissue death hypoxia: inadequate oxygen supply hypovolemic: loss of fluid in the body, often referring to blood or water shock: life-threatening condition where the body does not have enough blood circulating through it crush syndrome: medical condition where skeletal muscle is crushed for a prolonged time, resulting in shock and organ failure hematemesis: vomiting up blood hemoptysis: coughing up blood TBI: traumatic brain injury immolation: death by burning; being burned alive

the tier list:

OUCH!! (most painful):

nao: nao's death involves her ribcage being crushed. i put her at number one for what i hope are obvious reasons. for starters, her death is drawn-out, making the pain last even longer. while her ribcage is being crushed, any internal organs are being crushed as well. her bones are probably splintering and breaking off and piercing her insides and organs. overall... just horrible pain. official cause of death: internal hemorrhaging and irreparable damage to organs.

kurumada: kurumada's death involved being crushed (between two walls), which is similar to nao's. i would put their pain levels as being equal to each other, but kurumada's has the potential to have been less painful than nao's, because we don't know how quickly the walls crushed his body. if they were moving slowly, the pain would've been drawn-out and agonizing, and in that case, i would make the argument that his death was more painful than nao's. but if it was very quick, he would've just felt blinding pain in his entire body for a few seconds before it would end. we do have to keep in mind that kurumada is clearly quite muscular however, which probably provided some resistance against the walls, but only served to draw out his pain even further. official cause of death: muscle necrosis, internal hemorrhaging, and irreparable damage to internal organs due to crush syndrome.

either way, both definitely experienced, in my opinion, the most painful deaths in the game.

YOWZA! (very painful):

mishima: mishima's death results from his collar slowly heating up and burning his neck until his head disconnects from it. i don't even have the words to describe how painful this would be. the fact that the collar heats up slowly and it is drawn out only makes it worse. if you've ever burned yourself before anywhere on your body, you know how painful it is. imagine that pain centralized around your neck. mishima might have the fortune of his nerves being burned off after a certain amount of time, which would mean he wouldn't feel anything (think third-degree burns burning through to muscle, tissue, and nerve endings). but at that point, because the burning is around his neck and your neck contains- A) your spine/spinal cord and B) your trachea, which allows you to breathe- anyway and burning it in half would definitely kill you, he may be dead before he even has time to not feel any pain. either way, this shit would hurt so bad. official cause of death: cerebral hypoxia due to decapitation.

hinako: hinako technically has two deaths, but we ranked her based off of her being drilled. a lot of questions actually arose when my friend and i were talking about the drill deaths, because we don't know the speed at which the drills move. i mean, whether they're moving quickly or slowly, it would still obviously hurt- but the faster the drill, the quicker the death, which would make it less painful. being drilled would be unbearably painful for the sole fact that she might be alive for a lot of the drilling until it reaches any vital organs. no matter what, it'd be very painful. official cause of death: hard to say for certain, but would most likely be from exsanguination... y'know, from her body being split in half by a giant drill.

kugie (kanna's sister): my friend and i were FLOORED when we looked into kugie's death. in the game, i don't think we get a canonical answer specifically as to how she dies, but in the manga, we do. kugie and kanna have the same first trial as joe and sara, but they don't succeed. in it, kugie's bed literally snaps and essentially folds her in half. in the image from the manga, we can see blood flying out from the bed (implying it happened very quickly, because if it were slow, the blood would instead drip and flow), and kugie's hand sticking out between the two slabs of the bed. i think this death is the most painful out of the entire "YOWZA!" category because kugie was probably alive and in immense pain for at least a few seconds or even minutes after the bed snapped. if i had to speculate official cause(s) of death:

i would guess her lumbar vertebrae (basically the bottom discs of the spine) and spinal cord snapped, cutting off sensation and sending her into shock.

if she was folded in half, her legs would have quickly shot up, meaning her torso was likely unnaturally slammed into by both them and the bed, and sustained massive trauma. this would cause internal hemorrhaging and damage to her organs.

the blood spurting out of the bed was likely from her head. i'm a teenage girl, likely the same height or around the same height as kugie, and when i bend in half, my face is level with my knees. knowing this, her knees probably slammed into her face and broke her skull, causing a TBI.

the combination of all of that would have first caused terrible pain for, like i said, at least a few seconds or minutes- we don't see how extensive the damage really was, so i can't say for certain... but yeah.

aughhh (painful):

joe: joe's death is really interesting to think about, because upon first glance, you might think it's one of the most painful- but there are a few things i considered with him. his death is a result of wrigglers draining the blood out of his body. because we don't know how large the wrigglers are, i can't say how painful it would be when they enter his body- but i'd have to guess they're on the smaller side, like little tubes, because if they were big, they would have difficulty sucking out his blood due to how small blood vessels are. it would hurt horribly to have the wrigglers enter his body and drain the blood. we don't know if they moved around through his blood vessels- if they did, that would definitely exacerbate the pain- or if it was more just like getting blood drawn. but what i considered with him, the thing that makes his death less painful than the others, is the fact that he would probably pass out long before he's even fully dead. the amount of blood he's losing at such a rapid pace would first make him dizzy and disoriented before he just... passes out. his entire body would start shutting down very quickly and he wouldn't even be awake for it. his body would give up on transporting blood to the extremities and non-vital organs and shift only to transporting what little blood it can to keep vital organs running. when that blood runs out, the heart will stop being able to pump enough blood throughout the body and to the brain, and joe would actually be dead. so... yeah. official cause of death: hypovolemic shock resulting in organ failure.

shin: shin dies after being fatally injured by the death game's security system. while it's unclear exactly how the security system killed him, i believe he was stabbed/impaled somehow. there are a few questions regarding exactly where he was stabbed, but i assume he was hit somewhere in the torso because he has blood coming out of his mouth. if you don't know:

blood coming out of the mouth can be a result of haematemesis (vomiting up blood), which is where blood wells up in the stomach/digestive tract due to trauma in that area

it can also be a result of haemoptosis (coughing up blood), which results from being stabbed in the lungs/trachea due to trauma in that area

my guess is he was stabbed in the stomach, because if he were stabbed in the lungs, he'd be coughing and frothing at the mouth struggling to breathe. if i'm remembering correctly, he's also shown to be clutching his abdomen after turning on the joe AI, so... my money is definitely in the stomach.

which, you guessed it, would hurt. a lot. and there's no workaround. he's strong enough to drag himself to the rubble room and turn on an AI before dying. he would've been in blinding pain that entire time before dying.

official cause of death: exsanguination.

reko: reko technically has three canonical deaths, which made her hard to rank. i'll cover them all.

strangulation (hanging by collar): being hung is painful, but i think people underestimate how terrifying it is too. reko would have been terrified and in immense pain for a few minutes before dying. everything in her neck would be getting crushed and pressed on by the collar thanks to gravity. overall... awful death. official cause of death: cerebral hypoxia due to strangulation.

stabbed: same as what i said for shin. terrible pain for however long until she ultimately bleeds out. official cause of death: exsanguination.

fake-reko falling headfirst onto a spike: this one's... interesting! mainly because i think she would actually just be dead instantly. if the spike pierces her brain, she won't even really have time to process "ow!" before just. being dead. official cause of death: severe TBI resulting in death.

owie (painful, but not as painful as others):

q-taro: q-taro is stabbed in the back by mai and slowly bleeds to death over the course of the chapter. the reason i put him so low is because he would definitely be in some pain, but i don't think mai stabbed him very well (no offense girl). he's able to walk around, talk, and do stuff with the others after being stabbed, at least for a little while. it's difficult for me to pinpoint what exactly killed him because of this. i'd imagine his body began repairing the stab wound in his back, but ultimately, blood loss and the disruption to everything surrounding his spine (because mai stabs him in the back) is probably what killed him. depending on how deep mai's knife was, the blade may have even pierced or grazed internal organs such as q-taro's heart or a lung. his body probably put most of its focus on keeping his internal organs running whilst simultaneously trying to repair them, which tired him out over the course of the chapter, before it ultimately couldn't keep up with the amount of blood being lost. a hasty bandaging job using an office first-aid kit is not ideal for stab wounds.

*edit: this person corrected me regarding q-taro's death! i still think the severity of his injury could have killed him before the coffin cremation system actually killed him, plus the information is interesting, so i'm keeping it. but technically, being burned alive is actually what killed him. ouch.

official cause of death: exsanguination OR immolation.

kai: kai's death is kind of up in the air in terms of the specifics, but we know he kills himself during the first main game by cutting his arms. in order for this to kill him, and for him to have bled out as fast as he did, he likely cut his axillary and/or brachial artery. your brachial artery runs down the front of your bicep and is an extension of your axillary artery, which is in your upper arm/armpit. if kai cut deeply into both his brachial arteries, and/or his axillary arteries, he would bleed to death very quickly. it would be really painful, but i think adrenaline and the probability he'd pass out immediately would certainly be on his side here, making it at least a little less painful. either way, he dies quite fast, so. official cause of death: exsanguination.

uncertain (i'm not sure!):

this category is for the characters who have one or more variables that make it difficult or impossible to determine how painful their death was.

kanna: first of all, the way kanna dies is impossible in real life. lets just get that out of the way. you cannot have flowers sprout out of your body. that immediately makes it impossible to tell how painful it would be for her.

if i were to suspend my disbelief for this, however, here's what i have to say about it:

safalin says kanna is numb during her death, which would instantly give her a pain rating of zero. kanna is screaming during her death, but given what safalin says, that doesn't necessarily prove she's in pain. she could just be screaming out of fear.

if she weren't numb, yeah, she would be in a lot of pain. flowers and vines growing out of your body, poking out of your skin, running through your insides- that would hurt insanely bad.

but the fact that:

this death isn't possible in real life

kanna is presumably numb during her death

we don't specifically know how the seeds are working/moving inside her body

kind of made it impossible to rank her.

if i had to guess a cause of death, i'd guess severe disruption by the vines to her internal organs and processes is what ultimately killed her.

hayasaka: hayasaka's head is presumably cut off by a swinging axe. there are two reasons we put him in 'uncertain'; we don't know how sharp the blade of the axe is, and we don't know the velocity it's swinging at.

if the blade is swinging slowly and is very dull, it would take a few swings to fully cut off hayasaka's head, which would make it incredibly painful.

but if the blade is swinging very quickly and is super sharp, his death would be instantaneous, making it essentially painless.

so it's difficult to say, but either way:

official cause of death: decapitation.

ranmaru: ranmaru's death is in 'uncertain' because we

don't know exactly how that happened to his stomach

hear him talk about how he's numb to it

don't know how long he's been sitting there

i imagine he was in some pain and just putting up a front, but we just don't know for sure. and like i just said, we don't know what specifically killed him or how. we just see a wound in his stomach.

probable cause of death: exsanguination/hemorrhaging.

anzu: anzu's was between 'uncertain' and 'so quick.' we see spikes piercing her body, but the angle makes it difficult to tell exactly where they pierce, or how sharp they are, etc. if the spikes didn't hit her face/brain, she probably felt intense pain for some time from the neck-down before rapidly bleeding to death. if the spikes got her head, she'd die instantly. so.

probable cause of death: exsanguination? TBI? damage to internal organs/processes?

ranger: according to ranger's wiki, his human form was stabbed by an assassin. not nearly enough information to rank him with certainty.

cause of death: stabbed?

so quick (too fast to be painful):

both mai and alice's deaths were so fast, they fell into this category.

mai: mai shoots herself in the head. her death would have been immediate and painless since she shot herself in the brain.

official cause of death: fatal TBI.

alice: alice's abdomen explodes. if that happens, you're probably going to feel a very brief flash of pain before immediately dying, because the damage would be so extensive (shrapnel exploded his stomach, but there was undoubtedly collateral damage to his heart, lungs, and other organs around there). he would have been in shock if he did somehow manage to survive for a few more seconds. pain would be minimal or nonexistent in my opinion due to the sheer severity of the injury. and in terms of him being hung in chapter 3, it's the same as reko.

official cause of death: shock resulting from traumatic abdominal injury.

thats it!

if you for god knows what reason read all this, thank you! i'm honestly only posting it kind of for myself and my friend to look back on if i ever want to think about it again, but maybe someone will find it interesting.

questions, comments, concerns (of which i'm sure there are many)- i'm an open book. i'm not a professional by any means, but i am insane. bye!

[cushfuddled]

what are your thoughts on the "Arcane Viktor was meant to be ace" that has been said in an interview? Like yes - word of god feel free to ignore - but they said they tried to write him that way. Do you think they succeeded?

Hiya! Thanks for the ask! :D

I was honestly shocked to hear Linke "always" meant to depict Viktor as asexual. It strikes me as a deeply disingenuous comment, not least of all because I want to believe someone who "always thought of Viktor as asexual" and was driven by a desire to make ace people happy would...I dunno...display a slightly better grasp of what "asexuality" even means.

LINKE: I know there are some people who ask this. There is a love. I don't think it's romantic…I remember many, many years ago also thinking about this when we started developing these characters. To me, I can say something here now that would be good for you and bad for me because it will be a wildfire. To me, Viktor was always asexual, and that was always something we talked about from the very beginning. So, a romantic relationship between Jayce and Viktor was just never part of it. There is a love, absolutely, but we also found it a bit... Love and relationships are so complex and take so many different forms. Viktor loves in a different way, and that's okay, no? ...It's something that when we talk to our LGBTQ group within Riot, I remember asking the group many, many years ago, like, "What is something that you never see depicted very well?" And someone said asexuality. They say it's often depicted as, like, emotionless when it's not true at all. It's just that your feelings don't mix with physical. So, to me, that was always part of Viktor. [x]

I didn't feel seen at all by this kind of retroactive ace rep, but I did feel truly, deeply moved by the fandom's response.

Because I know this song and dance. A showrunner or someone with similar "creative authority" describes a character as ace or aro, and the fancops take out their soap boxes and declare,

"All right, everybody! You heard the man! No more sexy fanfic and fan art! This ace/aro character is officially off limits!"

And then aro and ace people like me, who ENJOY smutty fanfic and fan art and want to see our favorite Barbie dolls kiss, are viciously harassed for our hubris. For at least a year I watched my favorite TMA fan artist get dogpiled to hell for daring to draw NSFW art ofJonathan Sims. And yes, this artist was also ace! To fancops, the opinions of aces and aros who like to consume or create smut don't count. We're all "degen" traitors who deserve to be bullied out of fan spaces for the sake of The Good Ones.

So anyway! ᕕ( ᐛ )ᕗ

Christian Linke came out of the hole in my wall and told me Viktor and Jayce aren't gay.

“Was there ever a ship?” LINKE: “It’s strange that people say that’s the only close relationship that two men could have is to be a couple, you know? There’s really close friendships and like, brotherhoods if you will…like, really being there for each other. Um. [That] is something that was…really important for us to explore. So…it seems like there’s no other version, you know? For some fans, they say like, ‘Hey, there must be romance,’ and we’re like…these relationships can be really layered and really complex, you know? I think there is some kind of…there is a love between them. I just don’t think it’s romantic, you know?” [x]

(If I have to hear one more creator clap back at a hopeful "could they be gay?" with a bizarrely defensive spiel about the transcendent magic of platonic bonds and how men aren't allowed to foster close platonic relationships I'm gonna hemorrhage something, but that rant already lives over here so whatever)

First of all...

:3c

...For someone so committed to propping up the ace and aro community with canon rep, this November 28 2024 version of Christian Linke sure doesn't mention asexuality or aromanticism at all. The genergous ellipses from the excerpt above aren't a creative embellishment on my part. Those pauses are very much apparent on the Twitch stream. Linke appears to really dig for the right words here, yet the terms "asexual" or "aromantic" evade capture. But sure, asexuality was "always" a part of Viktor for Linke.

Maybe Linke didn't want to draw fire from fans with a "Dumbledore is gay" moment, so he left any definitive terminology off the table. In any case, I watched the Jayvik community respond to Linke's Twitch stream like so:

This was, to put it mildly, fucking hysterical. I've never seen a community so decisively "...anyway" a showrunner over queer rep before.

This is horribly unfair for me to assume, given I know next to nothing about Linke and his capacity for petty vengeance. His timing could be totally coincidental, his efforts completely genuine. But the fact that Linke dropped this ace Viktor bomb less than two weeks after his Twitch stream smells like a tantrum to me. In my least charitable vision, I see a man who declared Jayvik platonic by order of Authorial Intent, watched his fandom go, "That's nice grandpa. So about that Hextech sex toy fic—", and was so offended by shippers' casual disregard as to "strike back" with something they couldn't possibly ignore. Thus the "Viktor was ace the whole time" card, when

The word you're looking for is "aromantic," Linke. That's the one to do with romantic attraction.

I know it can be difficult to canonize asexuality and aromanticism. If someone tried to kiss Viktor and Viktor pulled back like, "I don't feel things that way"...would that reaction be enough to make Viktor canonically aro? Perhaps Viktor would need to clarify: "I don't feel things that way." "Which way?" "The...romantic way.” “I don't understand." "You are my partner, Jayce. I love you. I want to be with you. But I will never want to kiss you." I’m tempted to champion that second option, but I can see the argument for less stringent criteria. Ambiguity is...organic, I guess. Too much clarification can read as disingenuous and preachy, like one of those after school specials. Still: I've spent too many years dancing for table scraps to ascribe sanctity to headcanons.

At the end of the day I just don't buy Viktor as ace/aro per Linke and Lee's creative vision. Sky felt like such a classic case of "straight key jangling" to me—i.e. a one-dimensional female character who exists to reinforce a male character's straightness. (My favorite example of this phenomenon = the time Cas Supernatural became mortal ((and thus capable of sexual attraction)), met a woman, slept with her, then killed her within the span of a single episode. Why showrunners seem to believe a female love interest invalidates queer readings, I cannot begin to guess). Even as Viktor pulled his hands away from Sky's—even as Sky told him, “No you won't"—I couldn't help but feel like Linke and Lee had a bullhorn to my ear the whole show: "Oh no, these poor lost ships in the night! How tragic, that Sky was so ready to love Viktor with all his faults and cracks, and Viktor could've found love and purpose outside his work had he only stopped long enough to notice! How tragic, that Viktor only came to understand the nature of Sky's feelings for him after his work had stolen her away! How tragic, that the thing Viktor so desperately craved was right there the whole time, from the moment he launched that toy boat to the night he activated the Hexcore!" It felt like Sky was meant to represent potential, a la the limitless expanse of the heavens. In such a complex cast, Sky stands out like a sore (cardboard) thumb. When Viktor lost Sky to his ambition, she was forever frozen as a "what could have been," reduced to a symbol of roads untraveled. With all those Vibes in the air, I'm like...uh...Linke? Tell me again about how you wanted me to read Viktor as aro this whole time???

I'm sure some ace and aro folks were bolstered by this situation, and lord knows I don't want to yuck on anybody's yums. But for me personally, Linke's comments were like a punch to the throat. It felt like Linke wanted to use me as a police baton to beat back the hordes of evil shippers. What meant the world to me was, once again, the fandom's response. NO ONE TOOK THE BAIT. At least here on Tumblr, all I saw were ace, aro, and allo fans A. clarifying ace and aro terminology, and B. creating smut out of spite.

I cannot stress how fucking INSANE this was to witness as someone who's dealt with a lot of shame re: my aegosexuality. I've never felt so seen and supported as an ace person by a fandom community. Every Jayvik fic with a "this one's for you, Linke"-esque note adds another five years onto my life. I seriously love you all. Please keep being your glorious selves.

[dancingtotuyo]

6. play my bloody part

Woman | Joel Miller x Female Reader

Rating: Mature/Explicit

Chapter Summary: You take another step forward. Maria goes into Labor.

Tags: Joel Miller X Female Reader. Age Gap (Reader is 42, Joel is 56). HBO Characters. Mostly cannon compliant for show & game. Timeline is changed.

Chapter Warnings: angst, needles, blood, discussions of selfworth, grief (loss of a spouse), childbirth, graphic descriptions of childbirth, traumatic child birth, hemorrhage, likely very bad medical practices (don't try this at home folks, I am not a medical professional), shock, trauma, anxiety

This chapter is intense!

Notes: Thank you to @janaispunkand @ramblers-lets-get-ramblin for beta reading this! I appreciate all your comments and feedback, and I love you both so much!

Words: 5507

Series Masterlist | Author Masterlist | Playlist

Ellie stops by the clinic a few days later. She stays relatively quiet as you gather supplies. Her eyes track your movements as she swings her legs back and forth from her place on the exam table. You’re not used to her being so quiet.

“Hold out your arm for me?” You give her a reassuring smile.

She listens but seems half a world away. You find a vein with quick precision, letting the blood drip into a glass vial. Your eyes flicker from the collecting blood to her face. “Penny for your thoughts?”

“Oh…” she says. “I guess- why did you agree to do this?”

You cock your head to the side, twisting the top on the vial before you press a cotton ball to the inside of Ellie’s elbow. “You asked. I could at least look at it.”

You press her arm up to hold the cotton there. “Even though you think there’s no point.”

“I never said that.”

Ellie looks you dead in the eye, expression flat. “You thought it. Joel thinks-”

“What does Joel know?” You twist your face, winking at her. A faint smile flashes over her face. “I’m the medical professional here.”

“He talked to Marlene.”

“And Marlene was a doctor? A nurse?”

“No… at least I don’t think so.”

“See, what does she know?” You smile. This time, Ellie actually smiles back. “Now, can I ask you something?”

“Sure.”

“Why did you ask me to do this?”

Ellie bites her lip. “I mean if there’s any chance, I have to try right? People could stop dying from this.”

“It’s not your responsibility, you know.”

“What?”

“To save the world.” You say. “It’s not your responsibility.”

“But I’m immune.”

“It’s okay to want to help.” You place the vial in a holder on the counter. The crimson red stands at stark contrast to the sterile-looking clinic. 

“I have to help. I have to do something.” Ellie can’t meet your eyes. “It can’t be for nothing.”

“What can’t be?” You tilt your head to the side. 

Ellie clenches her fist. Her typically assured demeanor is gone, making her look more like the 15-year-old she is. “Ellie?”

She takes a deep, shaky breath, lip quivering slightly. She doesn’t cry, waiting until she’s more assured to answer. “A lot of people died for me. It can’t be in vain.”

“Do you want to talk about it?”

“No.” She’s quick to answer, looking away.

“That’s okay.” You nod slowly. “But Ellie?”

There’s a pause. She sighs deeply. You can see the tears glistening in her eyes now. She’s fighting so hard to keep it all together. “Yeah?”

“Those people, they made a choice to do that. From what Joel’s told me, it sounds like they did that without even asking you first.” 

“What do you mean?”

You hold out a hand in front of her arm, the one with the bites on it. She’s hesitant at first but eventually lets it rest in your palm. You look over the raised skin where the tendrils of fungus are or were. You’re not sure if they’re still there, or if her body just stopped the progression of them. “You get to decide what happens to you, Ellie. Just because you’re immune doesn’t mean doctors or scientists or whatever form of power gets to make decisions for you.” She meets your eyes. You squeeze her hand. “You don’t owe the world anything for just existing.”

She chews on her lip, making you worry that she might draw blood. Her voice is quiet like she’s scared to say the words. “What good am I if there’s no cure?”

“Ellie.” Your heart breaks for her. You want to gather her in your arms and push all the bad thoughts away. You settle for squeezing her hand again “Your value isn’t tied to your immunity. You’re worth something simply because you exist.”

She tries to brush you off, pull away, and not look at you, but you keep a grip on her hand. “Look at me.” You’re stern. She hesitates but listens. You take a deep breath. “I don’t know if it means much coming from me, but you belong here. Here in Jackson, here in the world. You’re not a bother or an inconvenience, and yes, it sucks that we can’t do anything with your immunity, but that’s not your weight to bear. You understand?”

Her chest quivers. She manages a nod as a couple of tears fall from her eyes. You wipe them away. “And you will always, always, always, have a place in my home. Just waltz right in and I’ll set a plate.”

A small laugh falls from her lips. 

“Okay?”

“Okay.” She agrees, a small smile beginning to take over her face. “Thank you.”

“Of course.” You smile back. “Now, what do you want to do?”

“What do you mean?”

“Do you still want me to look at it?” You tilt your head toward the vial of blood sitting on the counter. 

She stares at it for a minute, contemplating the answers. “Maybe another day? I’ll let you know.”

“Sounds like a plan.”

You move away, disposing of the vial. You’re not sure how much weight your words hold, but you feel a little proud of her decision. 

“Are you going to the dance tonight?”

“I guess.” She shrugs. “Dina and Jesse say I have to.”

“Good. You should.”

“Are you and Joel going?”

“Adam beat Joel in Texas Hold ‘Em last night and is making him go.” You laugh a little at the begrudging attitude Joel met you with last night, but a bet is a bet.

“I bet you could get him to dance.”

You laugh a little, images you’d conjured up in your childhood bedroom spring into your mind. They were the daydreams of teenage delusions, but there’s still a little dip of excitement in your stomach at the thought. 

And then you sober up. “I’m not going.”

“If Joel and I are going, you have to come.”

You force a smile. “I don’t go to them anymore.”

“Oh, come on. I bet you’re a great dancer.”

“It’s not about the dancing.” 

“What is it about then?” Ellie wears that goofy little prying grin that’s nothing no short of pure curiosity. If Joel were here. You imagine he’d say her name sternly and give her a look. 

You sigh, keeping a tight smile on your face. “It was something my husband really enjoyed. I haven’t gone since he died.”

“Oh,” Ellie says as the energy shifts. 

“It’s okay, Ellie.” You brush it off. It’s not her fault, and you didn’t have to answer. 

She hesitates, and then she knocks into you, arms flying around your torso, knocking the wind from your abdomen. It takes you by surprise, but it’s a good one. “Thank you.”

“Of course.”

And then she’s across the room, grabbing her backpack off the exam table. You can’t help but laugh, wondering how she’s managed to hold onto all that wonder and spunk.  

“You should still come tonight!” Ellie calls before the clinic door slams shut, leaving you with only your thoughts. 

You drop Carter off with Tommy while you walk that night. Maria is on strict bed rest with her due date fast approaching, making them two of only four people not crowded into the Tipsy Bison. You expect to cry on your walk, expect to feel all the emotions that keep you away from the dances, but it doesn’t come even as you round the corner, passing the building that’s overflowing with energy. 

Light flickers across the dimly lit street from moving bodies. The doors and windows are open to let the breeze filter through. A few people congregate outside on the patio with boisterous laughter and animated movements. A couple of folks stumble about, already intoxicated. You stop in your tracks, taking it all in. In the past, you’ve doubled back to forgo passing the festivities, but things are different now. Maybe… maybe you’re a little bit different now too. 

Then you feel it, almost physically, like someone is pressing on your back, leading you toward the door. The people outside don’t pay you much mind, too caught up in their own worlds. The noise grows louder until you’re inside the Tipsy Bison’s doors.

You pass through the room slowly, almost invisible at first. Then you find him, laughing at the bar with Adam. He’s relaxed. An empty whiskey glass sits in front of him and a full one in his hand. He makes a comment to Adam that earns a playful roll of his eyes. He chuckles, shaking his head as he pulls the glass to his lips. His head cocks to the side. Before his lips make contact with the glass, his eyes lock with yours. He stills, a smile crossing his face. He tips the glass toward you and finishes it off. Then, he’s walking toward you with a determination that makes your insides melt and your toes curl in your boots.

His lips dip to your ear. His voice is low and smooth. “I thought you weren’t comin, Darlin.” His Texas drawl is stronger tonight, not helping the heat that grows in your belly. it sends wicked thoughts through your mind. 

You shrug, almost careless about it, but he sees the heat in your eyes. It burns in his too. “Plans change.”

His hand slides around your waist, landing just above your hips. “I like it when your plans change.”

You bite your lip, fighting the urge to pull him out of here and into your bed. “Dance with me?”

A grin spreads across his face. “I thought you’d never ask.”

He pulls you toward the dance floor. The crowd of bodies seems to part like the Red Sea before you, not that your mind can focus on anyone but Joel. He tugs you close as the band starts their rendition of My Girl. Your arms slide around his shoulders, body flush against him. He smiles at you. It’s like something out of a high school movie. “I’m really glad you’re here.”

“Me too.” 

He kisses your forehead, and then your head falls to his chest, eyes blinking closed. It feels like such a sacred moment, it’s hard to believe you’re in a room full of people. Joel sways on beat to the music, humming along. It reminds you of the faint singing that used to drift through your bedroom window at night when he would sit out on his front porch with his guitar and the stars. You spent countless hours sitting under an open window listening to him when you fostered that crush, imagining him singing to you. 

You never imagined you’d be in his arms at the end of the world, in front of the whole town no less, as you fight your growing feelings for him. It sends a kick-start to your system. Not enough to raise a panic attack, or for onlookers to notice, but Joel feels it in the way your muscles tense and your body straightens in his arms. Your eyes pop open and you catch it- the rumor mill turning. Whispers pass behind shielded hands between pairs throughout the room. Some of them are audacious enough to make contact with you or send a wink your way.

Joel’s breath hits your ear again. “Wanna give them something to really talk about, Sweetheart?”

You look up at him, brows furrowed. He stops swaying, both hands cupping your cheeks. Your breath catches. It feels like the whole room’s does, and then his lips are on you, hot and searing and nowhere near chaste. Joel Miller never struck you as the PDA type, but this feels like more. He’s staking his claim on you, telling them all to shove it. Everyone is here. Everyone can see what’s happening for themselves. For all intents and purposes, this is the night Joel Miller becomes yours in the eyes of the community. You’re off limits, and so is he, and it feels good. There are no words, no spoken acknowledgment of anything, just his actions. 

He pulls away, leaving you slightly stunned and hazy. He chuckles. Spinning you around and then pulling you in as the song ends. People clap around you, for the band of course, but you can only look at Joel with a smile that shines like crystal. 

Another song starts back up. Another wave of people join the dance floor. People seem disinterested in the very thing that held them captive moments ago. Joel looks like he is two seconds away from dragging you out of the bar as you stare at each other, unmoving. 

Tommy runs in, breath ragged and hair a mess. His eyes dart around until they land on you. He calls your name, running toward you. “Tommy, what’s wrong?”

“Maria’s in labor.”

Whatever trance Joel put you under is gone as years of experience snap into place. You turn to him. “Will you grab my clinic key and get the green bag?”

“Of course.” Joel nods and then Tommy grabs your hand, dragging you to the house. Ellie and Joel are not far behind. 

Maria is pacing the guest room when you get there, letting out small groans. Like everything else, Maria handles childbirth with grace and dignity- something you wish you could’ve done. 

You shake the memories from Carter’s birth from your mind. It’s mostly a blur- what you remember from that day haunts you. You were a mess- inconsolable. There was no grace or dignity in it. 

“How far apart are your contractions?”

“Hello to you too.” She pops a smile. Your tight lips don’t budge. She sighs. “About three minutes.”

“Three minutes? Maria!”

She waves you off. “You were never more than two minutes away.”

“We agreed on five.”

“I changed my mind.”

You roll your eyes. “You’re a shit patient.”

“I’ve been on bed rest for two weeks, have I not?”

You quirk an eyebrow. She may not have left the house, but you’re not convinced she was following the rest of your instructions. 

She waves you off like it’s nothing. “I heard you were at the Tipsy Bison.”

You shoot her a glare. “You are literally on the verge of having a baby, Maria. My social life is unimportant.”

“I can still talk in labor.”

“Not about this.”

“Oh come on, I’m going to be here all night. Might as well entertain me.” She grins. 

“No. Now let me check your cervix.”

Maria sighs, sitting on the bed. “I think we’re too close as friends.”

Maria’s labor moves quickly. Before midnight, the baby is crowning. You’re coaching Maria through it as Tommy stays by her side, offering what support he can. Maria lets out low moans as she works through contractions, bearing down when you say. Sweat dampens her brow. She’s tired but determined. “How much longer?”

You meet her eyes, giving her an encouraging smile. “You’re almost there. One or two more, Okay?”

She nods, and then another contraction hits. You feel them in your hands, guiding the newest member of Jackson, Wyoming into the world. There’s a long pause, there always is, you never get used to it, you’re quick to clear airways, and then he takes a deep breath, and tiny little wails fill the room.

Relief fills Maria’s eyes and looks of awe and wonder fill the couple’s faces. You can’t help but let out a joyful little laugh. “It’s a boy.”

You place him on Maria’s chest. The proud parents crowd around him, their voices softening, pitching up as they soak in their first moments of a family of three. 

“Tommy, you wanna cut the cord?”

He nods. You show him where to do it, and then he’s right back at Maria’s side, caressing his son’s head. 

“He’s got so much hair,” Tommy says. Tears gather in the new parents’ eyes. 

You’re quiet as you tidy up. Before you slip out, Maria grabs your hand. “Thank you.”

You smile at your best friend. “Of course. Anything for y’all.” She squeezes your hand and you return the gesture. “I’ll give you a few minutes and then be back in to finish up.”

She nods. You wash your hands in the hall bathroom, shedding the soiled apron you wear. Joel greets you when you come out. He raises his eyebrows. “I heard crying, and it sure as hell wasn’t Tommy.”

You laugh. “It’s a boy.”

You see Joel’s happiness for his brother on his face before the big smile ever crosses it. He wraps his arms around you. You lean in, laying your head on his chest. His heart beats beneath your ear steady as a drum. The stress you’ve been carrying for months over this day starts to dissipate from your body. It’s here. He’s here. It happened. You made it through. 

Tommy peaks his head out. “Maria says she’s ready for you.”

You nod. Joel kisses your head and you pull away, warm energy thrumming in your veins. Maria looks almost annoyed when she sees you, knowing what’s coming. 

“He have a name yet?”

“No,” Tommy looks pointedly at his wife. “She swore we were having a girl. Wouldn’t even discuss boys’ names.”

Maria rolls her eyes, making you laugh. “Tommy, go make yourself useful and get me some water.” 

“Yes, Ma’am.” Tommy chuckles, the grin unwipable from his face. His hand runs over his son’s head before he leaves. 

Maria shifts slightly, careful not to disturb the sleeping infant at her side. She lets out a soft hiss.”

“You good?”

“Yeah, you know how it is. Pretty sure the placenta is already out.”

You nod, kneeling at the end of the bed. You’re relieved to see the placenta delivered, fully intact. There’s some bleeding, but no more than what you’d expect. Another relief. “We should get Tommy in here to move you back to your room. How do fresh sheets sound?”

“Like a slice of heaven.” She smiles. 

You move Maria to their room, Tommy sweeping her into his arms like a groom would carry his wife on their wedding night. They throw baby names back and forth as they cross the hall. You carry the baby, swaddled and sleeping. Once he’s tucked into his mother’s arms, you set to work cleaning up. It’s always the hardest part as the adrenaline fades from your bones. Tommy and Maria’s bickering floats across the hallways as you do, making you laugh. This baby may never get named at the rate they’re going. 

The first time Tommy calls out your name. It doesn’t register. The second time is much more urgent and he’s in the doorway of the guest room. He’s gone pale, breathing heavily. 

Your stomach drops. “What’s wrong?”

“She’s bleedin. It’s soaked through the towel.”

“Shit.” You drop what’s in your hand, grabbing your bag of supplies. 

Tommy is at Maria’s side. You lift the blanket and your heart drops. You glance back up at Maria. She looks tired. You’d expect it, but this feels different. “How do you feel?”

“Like I just had a baby.” She tries to joke, but it falls flat. She knows this is bad too. “A little lightheaded.”

There’s another gush of blood. A clot that’s bigger than it should be. “Fuck, Fuck, fuck.” Your breathing turns ragged. There’s too much blood and more appears bringing another large clot with it. She’s hemorrhaging. 

“What should I do?” Tommy asks. He’s panicking. 

“Go get Joel.” Tommy tries to protest. You cut him off. “Get Joel back in here.” You leave no room for debate, but he still hesitates. “Now!” 

He finally listens. Maria locks eyes with you. She knows. You see the fear in her eyes, and it knocks the breath out of you. You’ve never seen Maria scared. She’s always so sure and sturdy, but not now. Her skin has gone dull, losing its typical vibrance, like the life is slowly draining from her.  You want to sit on the floor and weep, but you have to push through. “Deep breaths, Maria. I need you to stay as calm as possible.”

You dig through your bag, pulling out everything you need. 

Joel is barely across the threshold when you direct him to the chair next to the bed. He doesn’t have time to ask questions. He knows it’s best not to. “You promise you’re O negative?”

“Yes, why?” He hardly gets the words out before you clean his arm with high-proof moonshine and insert the needle in his vein. He winces. You’re efficient, ensuring there’s no air in the tube before inserting the other end into Mari’s arm. You glance down at your watch, noting the time. 

“Keep your arm elevated. If you start to get dizzy, you tell me.” You’re stern. You leave no room for argument. Joel watches as his blood flows through the short plastic tube connected to Maria. 

You have no idea if this will work. She’s probably losing blood too fast and the risk of complications looms in your mind, but you’ve never had someone survive a hemorrhage like this before. It’s your only hope and you will do everything within your power to keep Maria on this earth. 

Maria stays as quiet as she can. She’s focused on her son, memorizing everything about him, so you focus on saving her life. 

“What’s happening?” Tommy stays in the doorway. You don’t turn around. You can’t stop what you’re doing. You have to stop the bleeding. It’s the only thing on your mind now. “Tell me what’s happening to my wife!”

“She’s trying to save your wife’s life!” Joel snaps. “Let her do her job.”Joel keeps his eyes pinned to you. 

“Tommy,” Maria says. “Come here.” Her voice is weak and raspy. You have to push it out of your mind. If you don’t, you’ll break. You can’t break right now. 

Tommy kneels next to Maria and his son. He’s caressing both their heads. You’re sure he’s crying. You’re not convinced you’re not crying too, but you’re too preoccupied to take stock of it. 

You know when she goes unconscious, but you don’t hear anything from Tommy. The room is so silent as you rotate between massaging Maria’s uterus and packing it. You’re running out of semi-sterile material. Has the bleeding slowed down? How long has this been going on? It feels like a lifetime. You can’t spare a second to look at your watch. 

Joel’s arm drops a little. It’s getting tired. “Keep your arm higher than her head.” You spare a look at Joel only because it pertains to Maria’s health. “Stand if you have to, but slowly.” 

The blood loss appears to be slowing down, but you don’t. You keep going and going and going, until you’re sure it’s stopped. Then, you just sit there and wait. Tommy wants to demand answers, but Joel glares him into silence. 

You dare you to step back. You’re on autopilot, the adrenaline wearing off long ago. You check her heartbeat and her blood pressure. Neither is great, but it could be worse. You dare to hope you’ve seen the worst of it. 

Joel stumbles forward a little bit, catching himself on the bed frame. 

“Shit.” You rush over to his side, guiding him back into the chair. 

“I'm fine, I’m fine.” He brushes you off, making sure his arm is still raised. You see the shake of it. 

You check your watch. It takes you longer than it should to do the math. “Fuck, you’ve been hooked up for too long.” 

Joel stops your hand before it can pull. “No, no. I’m fine.”

“No, you’re not. You’re done.” 

“No, Maria… she’s not awake yet… she-” Tommy stands up.

“She’s not waking up.” You face him.

 He loses any color he has left, panic-stricken across his face. “What?”

“Fuck,” you cringe. “I mean tonight, Tommy. She’s not waking up tonight. She needs to rest.”

“So she’s going to be okay?” 

You want to assure him. You look at their newborn baby sleeping in the bassinet in the corner. You don’t know when he was moved and it doesn’t matter. You want to promise Tommy that he’s not going to be a widower, that their son won’t be motherless, but you can’t. 

“I don’t think she’s going to die from blood loss anymore.”

It’s a small assurance, but it’s all you have to give. When you attempt to remove the needle from Joel’s arm this time, he lets you. The bandage feels so delicate and small compared to the trauma you just dealt with. You struggle with it. Joel takes over for you. 

“You need food, something to drink,” you say. 

“I’ll get it,” Joel says. 

You push him back into the chair. “You’re in no condition to walk downstairs.”

“Neither are you.” He says, eyes traveling over your frame. 

You furrow your brow. You don’t understand. You don’t see or feel the blood that dresses you, not yet 

“Ellie!” Joel yells. 

It’s a stark contrast to the quiet encapsulating the room. You hear her footsteps up the stairs. She enters, eyes going wide. She surmised something wasn’t right, but the copious amounts of blood are startling. “Holy shit.”

“Will you bring up some food? Water?” Joel looks to you to confirm. 

“Fruit.” 

Joel nods. “And then take Carter home?”

“I should-” you go to say. 

“No.” Joel cuts you off. He takes your hand, thumb running over your knuckles. “Not tonight.” 

Ellie nods. She knows now is not the time for the many questions running through her mind. “Yeah, of course.” 

Tommy clears his throat, still searching for answers. You sigh. “I can’t promise anything, Tommy. There’s still so much that could happen, but she’s strong.” 

“I know how strong my wife is. I need to know that she’ll be okay.” He’s still pushy and you don’t blame him. You’re all on edge. 

“I don’t know!” The world blurs before you. “The risk of infection is high, she- she could have complications from-” Your chest rattles. Joel’s hand settles on your back. Tommy can’t look at you. “She’s my best friend, Tommy. I’m doing everything I can.”

Tommy nods. He knows it’s true, but he’s scared. This is Maria. She keeps Jackson going. She keeps you going. 

Ellie brings up the food. She wants to do more, you can see it in her eyes. You can’t pull the words out anymore. 

“Thank you, kiddo,” Joel says. 

Ellie makes a face at the name. She shoves a strawberry in Joel’s face. “Eat this, you look like a ghost.” 

“Carter?” You ask.

“Passed out on the couch,” Ellie smiles proudly. You need the relief, you just hate that the 15-year-old bears that responsibility. “Glad he’s potty trained.” 

“Thank you, Ellie.” 

She nods at you. There’s some hesitation like she might wrap her arms around you for a second time that day. Was that really only hours ago? But she ducks out of the room instead. 

You make sure Tommy and Joel eat. You’re amazed that the newborn still sleeps. His chest rises and falls and from your check-up, he seems to be healthy. You check Maria’s blood pressure and heart rate again. It hasn’t gotten worse. 

You clean up as best you can without jostling Maria too much. Tommy joins in, working silently alongside you. Much to his displeasure, you make Joel stay seated. It’s another long silence before you’re finished. 

“Sweetheart, you need to go home.”

You’re dead on your feet. Your arms feel like lead at your sides. It’s so apparent in all of your movements, but you don’t feel like you can leave her side. Fear flares up in Tommy’s eyes and then he takes in your appearance. 

“He’s right,” Tommy says. 

You intend to put up a fight, but it doesn’t happen. You feel the exhaustion in every fiber of your being. You’re not sure you won’t collapse at any minute. 

You pull out a bottle of antibiotics. Maria would hitch a fit you know, but you don’t care. You’ll do anything you can to make sure she recovers, and you can’t keep the medicine forever. It’s going to be fancy water eventually if it isn’t already. You hand the bottle to Tommy with careful instructions. “If her breathing changes, or she starts bleeding, come get me immediately.” 

He nods. “Of course.”

“We’ll stop at Paul and Lindsey’s, she’s still breastfeeding. Little man is going to want to eat any minute.” 

Tommy nods. Joel’s arms come around you, supporting you from behind. Your legs attempt to fold but you regain your balance with his help. Glancing between Tommy and Maria, the urge to stay inflames again, but Joel is leading you out of their home before you have time to comprehend it. 

He leaves you on the front steps, approaching Paul and Linsey’s on his own. You’re worried about him, sure he gave too much of his blood tonight, but he comes back a few minutes later.

Joel leads you through your house. You want to collapse into bed at first sight, but he tugs you back. “Shower first.”

The small protest dies on your lips the moment you catch sight of yourself in the mirror. You look like you have stepped out of a horror film. You don’t even recognize yourself. Blood, Maria’s blood, coats your shirt and arms. Smudges streak your cheeks. Some of it’s in your hair. It’s endless. Your body begins to shake. You don’t think it’ll ever stop. You lean against the vanity for a semblance of stability. It’s useless. You stare at it all, taking it in, but it doesn’t look like you. It’s like you’re in some faraway space floating around, not connected to your body.

Joel tears your shirt down the back. He’s quick and gentle about it. Your bra is next. He slips off your shoes and then your pants until you’re completely naked. Steam fills the room. Blood soaked through your clothes in some places, painting your skin like modern art. Joel backs you into the shower with ease. You’re pliable, muscles turned to liquid. 

Hot water cascades over your body, flooding your eyes. It’s suffocating until Joel pushes your hair out of your face, redirecting the water with his hands. His fingers massage at your scalp over and over. He adds soap to your hair, pulling it through until the grime and blood are gone. 

There are no noises, no tears, but you can’t stop the shaking. You must look pitiful standing under the water like a limp doll as you lose control of your body. 

Joel scrubs your body clean, and then he does it a second time for good measure. When he finishes, his fingers trail up your arms and neck until he cups your cheeks firmly. Your eyes finally focus on his, pulling you back into yourself with a thud. You feel it all at once, his hands on you, the rawness on your skin, the hot water pounding down on you. Joel sees it happen, his hands slide under your arms as your knees give way. The tears fall. Your back hits the cool tiles. Joel presses against your front, keeping you up. 

Finally, tears wet your cheeks. Sobs leave your chest, and your brain spirals through it all: Maria okay one minute and bleeding out the next. The fact that it stopped was little comfort now. So much could still go wrong, and you can’t lose Maria. She’s your rock, probably the only reason you’re alive today. Losing her would be harder than losing Gabe. 

If she dies, it’s your fault because you couldn’t save her.

Your chest constricts with a tight, wheezing inhale. The tears stop as you struggle to breathe. Joel takes your hand, laying it over his chest. “Breathe, I’ve got you, Sweetheart.” 

He models it. You see and feel the slow rise and fall of his chest. His hand stays over yours until the ache in your chest eases and the water runs cold. 

Joel picks you up, tugs a soft shirt over your head, and crawls into bed behind you. He’s solid and warm against your back. You’re locked against him. His fingers dance across your stomach, lips brush against your ear. You lean into him. In such a short time, he’s come to know you so well. Maria is your rock, but Joel is your support. He tore down your walls like cheap construction and built a fucking shelter to keep you warm. You let your brain take you away before the rest of it can sink in because loving Joel Miller would be wonderful, but losing him would kill you.  

He whispers in your ear. “What do you want?” 

Your eyes won’t stay open anymore between the exhaustion and Joel clouding your senses. 

“Stay,” you fumble out. You don’t know if it’s decipherable but it works. 

For the first time, Joel stays the night in your bed. 

[syncope-syndrome]

Every Medical Site Out There: Losing consciousness from blood loss is a symptom of hemorrhagic shock and a sign of loss equaling 40% volume, and when your body reaches that point it’s extremely difficult to save a person from death as organs are beginning to fail, including the heart.

Me, whose favorite part of whump is fainting: So what if I just… ignored that.