#like how lucky i am to study medicine and be held to high standards in USA

[duckyfann9871]

MERRY CHRSTMAS

AND TO ALL A GOOD NIGHT

[imaginetonyandbucky]

Keeping Me Alive

Chapter 11: Heathens

by @dracusfyre

They made it to the long-term cruise liner parking lot where Tony had staged an SUV for their escape when James stopped and said, “Tracking devices.”

“Shit.” Of course Hydra would have some way of tracking him; he was an expensive tool, after all, not a person. Tony had Jarvis scan him and found two transmitters, one in the metal arm and one in the back of his neck close to the spine. “I can jam them both until we are in a safe place to remove them,” Tony said, “but I can’t get the one out of the arm without tools. And the one in your neck…” Tony trailed off when James pulled a knife out of the sheath on his thigh and held it out.

“Get rid of it.”

Tony wanted to protest but he bit his tongue when he saw the look on James’ face. He would want it out of him as soon as possible as well; he was lucky that Stane hadn’t thought to put one in him too. He climbed laboriously out of his suit and took the knife as James turned around and bent his head. Guess I get to stick a knife in the Winter Soldier after all, Tony thought with a grim smile. Years of working on circuit boards had given him a steady hand, so even though he grimaced as blood welled to the surface when he sliced through James’ skin, he was quick and efficient. “What should we do with it?” Tony asked when it was on his palm, tiny and shaped like a pill capsule. James took it from him and crushed it with his metal hand, letting it fall to the ground before grinding them into the pavement with his boot.

James helped him pack the suit in the back of the SUV and then they both went for the driver’s seat.  “I have the key,” Tony said, pulling it out of his pocket and closing his hand around it when he saw James eyeing it. “Also, you don’t know where we’re going.�� 

“If Hydra comes, I should be driving,” James said with a scowl.  

“If Hydra comes, you should be shooting,” Tony countered, and James considered that for a second before going around to the passenger seat. He’d already stashed one of the duffle bags of arms and ammunition that they’d taken from the lab in the floorboard, and as Tony pulled out of the parking lot he began methodically loading all of the rifles and spare magazines. It was a funny thing to find relaxing, but it made him feel safer to think that all of the Soldier’s lethality was on his side for once.

By the time they got onto the 5, the car had fallen into a strained silence, so Tony turned on the radio. The news of his demise had made headlines about an hour into their drive, though the police being interviewed were very careful not to officially declare Tony dead. The radio was the only sound in the car until they were four hours north of LA, when James finally spoke again. “Why?” He asked, his voice low and gruff and barely audible over the radio, even though Tony had the volume low.

Tony, who had been waiting for the question since he first took his helmet off in the lab, glanced over to see James studying him. “Do you recognize me at all?” After a moment of hesitation, James shook his head and Tony turned his eyes back to the road. “You and I have a long history,” Tony said finally. “None of it good. I don’t blame you for it,” Tony added hurriedly when he saw James stiffen. “I mean, I did, but I don’t now, because...Well, the point is, I realized recently that we are – were – both prisoners of Hydra. So I figure that means we have a common enemy, and that we should work together."

"You want me to help you take down Hydra?"

"Well, yeah." Tony glanced back over; James' expression didn't say what he thought of that. "Unless you don't want to, I guess. But we should still stick together until it's safe. I don't know about you, but I'm not going back."

James snorted at that. “So where’re we going?”

“Safe house.” There was silence in the car again as Tony pulled off the next exit to get gas. After he started the pump, he climbed back into the car and opened the center console. It was filled with protein bars, candy, chips, and drinks. “Pick your poison,” Tony said as he grabbed a bottle of water and a candy bar. James eyed Tony and then the stash of snacks before picking out a protein bar and bottle of Gatorade.

“What’s this?” He asked as he eyed the unnaturally blue drink.

“Sugar water, mostly.” Tony chugged his water as James took an experimental sip. “Your file says after you, uh, wake up you need a lot of protein and electrolytes and stuff. So drink up, it’s good for you.”

James grimaced at the taste but drank it steadily like a person that is used to taking medicine. When he was done he started making his way through the stack of protein bars with a grim determination that was almost impressive, if Tony hadn’t started to worry that he should have packed more food for the drive. They weren’t even a quarter of the way to their destination and James had eaten more than half the food. Finally the pump turned off with a thunk, so Tony finished paying and climbed back into the driver’s seat.

“If you've read my file,” James said as they got back onto the highway, “then you know a lot more about me than I know about you.”

“That’s not a high bar,” Tony said with a ghost of a smile. “I know more about you than you know about yourself.” James shot him an unamused look and Tony shrugged. “What do you want to know?”

“You said your name was Tony Stark,” James said. He pointed to the radio. “If that’s true, why do the police think you’re dead?”

Tony’s eyebrows climbed. He didn’t realize James had been paying attention to the radio; he’d spent the entire drive so far staring out the window and checking the rearview mirror, presumably looking for Hydra. “Because I want them to think I’m dead,” Tony said. “That way I can be free to do what needs to be done.”

“What did Hydra want you for?”

“I make weapons. Made,” Tony corrected. “Their little pet engineer, cranking out planes and tanks and bombs for them,” he added bitterly, gesturing to the weapons in the bag at James’ feet. “I have also been fixing your arm for the past few years.”

That made James’ eyebrows draw together. “Music,” he said after a long moment. “I remember loud music.”

“Yeah, that was me. You remember that?”

“Hydra doesn’t exactly play me tunes on a regular basis,” James said dryly. “It stood out.”

Tony barked out a surprised laugh and turned the radio away from the news to classic rock. They switched vehicles a few hours later, then again at the border with Oregon. When they finally pulled in to Tony's cabin - one left to him by Ana and Edwin, and significantly renovated over the past month - Tony turned off the car and sagged against the seat. It wasn't until he felt his shoulders and jaw relaxed that he'd realized how tense he'd been the whole drive; he was suddenly acutely aware that he had been awake for almost 24 hours. "Home sweet home," he said unnecessarily as the engine ticked and cooled.

"I'll be the judge of that," James said. He climbed out of the car then proceeded to fit an unlikely number of firearms on his person before he disappeared into the woods. Tony shrugged and started to lug the suit piece by piece into the house, and when he took a moment to fire up the surveillance system he could see James evaluating the perimeter, pausing each time he noticed one of Tony's cameras. "I may not be an expert, but I am paranoid," Tony said to the monitors, then went back to the SUV for another load. By the time he had the suit in the gantry and ready for the next time he needed to put it on, James had finished his patrol and was standing in the middle of the living room. "Does my security meet your standards?" Tony asked as he headed for the freezer. For now, the cabin was stocked with shelf-stable food and the freezer was packed with instant meals, enough that they could avoid leaving for a few weeks as long as they didn't want things like milk or eggs or fresh fruit and vegetables.

"I have some suggestions," James said, following Tony into the kitchen. "Mostly involving explosives."

"Then you must not have checked around the foundation," Tony said. He picked out a frozen pizza and, checking the instructions, turned on the oven. He turned around to see James still standing there, looking uncertain, and he cursed internally. He wasn't used to having someone else in his space; it was going to take a while for him to get used to having a roommate. "Come on, I'll show you around."

James' room was in the top of the house, in a renovated attic space. Tony had picked it because the windows gave it excellent views on all sides of the house, and since James' files said he was a sniper he thought James would appreciate it. But as they stood there, Tony realized he had underestimated how tall James was, because if he stood anywhere other than the middle of the room he would have to duck. He'd also have to sleep diagonally on the queen size bed, but from the way James had gone all still and quiet when he'd looked at the room, Tony thought it might be good enough. There was one bathroom and it was on the ground floor, next to another bedroom. That was supposed to have been Tony's, but when he'd tried to sleep there he had woken up multiple times with panic attacks, feeling exposed and vulnerable, so his room was now in the basement. The basement had started life as a cellar but Tony had expanded it and reinforced it until it could probably now be classified as a bunker instead.  "And this is HQ," Tony said as the lights came on to the main room. He'd moved everything important out of the LA home before he'd sent it into the Pacific, including his computers, JARVIS's servers, and all of the tools and machinery he would need to design and build new suits. What drew James' attention, though, was the murder board that took up one wall of the room. It was pretty sparse at the moment because Tony had only just started to dig through the Hydra files he'd downloaded, but there was Stane, Pierce, and Stern, as well as some of their more prominent hangers-on.

There were also the people that Tony had seen last time he was in the lab with Stane. Tony picked up a marker and put an X on all the faces he remembered. James pointed to one that he'd missed and then Tony hesitated, fidgeting with the marker before he finally said, “I was there the last time they…” Tony blew out a breath, unable to finish his sentence. "With the.."

“The chair,” James finished for him.

“Yeah.  And I wanted to say I’m sorry.”

“Why? You weren’t one of…” James made an aborted gesture towards his head. “I knew them. I didn’t remember them, but…I knew them.”

“Because I didn’t stop it earlier. I mean, I didn’t know about it, but it was because I didn’t want to know. I was scared and…” Tony swallowed thickly and forced himself to keep going. “Weak. I let Hydra break me down for so long and they didn’t even need the chair to do it.”

“How long?”

“Over twenty years. Since I was sixteen.”

“Sixteen? Christ, you were a child,” James said with disgust. “Where were your parents?”

“Um…” Tony glanced over at him and grimaced. “They died. When I was eighteen.”

“Died?” James caught the look on his face and cursed long and low under his breath. “It was me, wasn’t it?”

“Yeah.” Tony fidgeted with the marker in his hand. “I told them what was happening, and Hydra had them killed.”

“Ah, fuck. When you said we had a bad history you weren’t fucking kidding.” James ran a hand over his mouth and crossed his arms. “Well, for what it’s worth, I’m sorry.”

“Well, it’s not like it was your idea,” Tony started, and then got cut off when James snorted. “What?”

“Look at us idiots, apologizing for shit that was Hydra’s fault,” he said. “I’m sorry Hydra made me pull the trigger on your parents. You’re sorry Hydra tortured and brainwashed me. I hope you got me out because you have a plan to make Hydra sorry I killed your parents and they brainwashed me,” he said, pointing to the murder board.

Tony met his eyes and felt a smile tug on his lips. He pulled out the picture of Ana, Edwin, and Maria from Christmas out of his pocket and propped it up on his desk. “Yeah. Yeah I do.”

[companionhomecare]

I am in love with this doctor's answer to "What is something you regret doing as a physician?"

On the website Quora, users post questions for other users to answer and then vote for the best answer to each question. I recently read an incredible answer written by Dr. Lacy Wyndham that not only invoked an emotional response in myself but also sums up my view on the importance of quality of life over quantity.  I encourage you to read all the way to the end of Dr. Wyndham's answer. What is something you regret doing as a physician?

I’m going to tell you the story of how I killed a patient.

I was in my 3rd year of medical school. I had just started my clinical rotations. I had just come off of my psychiatry rotation and was starting my internal medicine rotation.

In teaching hospitals, you operate as a team. You have an attending who leads a team comprised of residents, interns, medical students and the occasional pharmacist.

I was nervous when I learned of who my attending was because everyone had warned me that she was the one you didn’t want to get. She was very exacting and brilliant.

It did not take me long to realize that I was actually lucky…BECAUSE she was so exacting and brilliant and held such high standards for her team.

As a medical student, you get assigned a few patients or pick up some new ones when you admit them from the ER. Every day, you go see your patients (round on them), perform a physical exam, write a note, and write your orders. Your intern or resident then comes along later and co-signs your note and your orders if they agree with it. Later you all round as a team on each patient and discuss each patient.

This is where a lot of the teaching occurs as the attending teaches the residents or the residents teach the students. As a student, you are asked numerous questions designed to test your knowledge. Generally, these questions continue until you stop getting the answers right. Then you know the area you need to study later that evening.

Medical students don’t have a lot of autonomy or authority. A nurse cannot follow the order of a medical student until an actual doctor co-signs it. As a medical student, your primary purpose is to learn and to one day become a good doctor.

My internal medicine rotation was at a VA Hospital. These hospitals are among the only places where beer is regularly served on the dinner trays. We were caring for veterans. Many of them were alcoholics.

One of my first assigned patients was an elderly gentleman who had been hospitalized for over a month when I started my rotation. He had metastatic colon cancer. By the time I was assigned him, he had not been fed in several days. He had a bulky tumor in his bowel, and everyone was afraid it would rupture if he took food.

He was receiving some sustenance in the form of IV nutrition, which is completely unsatisfying. The first few times I saw him, he tolerated my history taking and physical exam. Not long after, however, he had a one track mind.

”Please can I have something to eat??” he’d beg me.

I would apologize profusely. I would explain that the surgeon didn’t want him to eat. I explained that his oncologist didn’t want him to eat. And every day he looked dejected.

One by one, all of the doctors signed off (the surgeon and the oncologist and the radiation oncologist etc.). There was nothing they could do for him.

Finally, we were the only team remaining to care for him.

My resident seemed to be at a loss. He looked at me.

”What do you think we should do?” he asked and waited for my reply. It was the first time a medical doctor genuinely wanted my opinion.

”I think we should feed him,” I replied without hesitation.

I wrote the order and he cosigned it.

I went into my patient’s room when the dinner trays came in. He looked like a child on Christmas when I told him he could eat. He maintained a huge smile in between bites.

He died that night.

I still regret it.

I regret that I gave him that tray of hospital food instead of finding out his favorite meal and making it for him.

View the original post on Quora here.  

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About Companion Home Care Inc:  Companion Home Care is a senior home health care, adult care, and child care provider based in Roanoke, VA. Our motto is to provide a "better class of companion for a better quality of life". We accomplish this by hiring the best, most qualified caregivers, and using our knowledge and experience to craft a personalized home care plan for our clients, then match clients with the perfect caregiver based on client needs, personality, and skills required.

Our caregivers help seniors age gracefully, cope with Alzheimer's, dementia, and illnesses, and enjoy healthy and happy lives from the comfort of their own homes. In addition to senior home care, we also provide home care for adults and children with disabilities, traumatic brain injury and diseases, physical injuries, and special needs in Roanoke, Salem, Christiansburg, Blacksburg, and surrounding areas of southwest Virginia.

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