#long term acute care hospital

[thedataproject]

Long-Term Acute Care Hospital Admission Criteria | Long Term Acute Care

Long-term acute care hospitals (LTACHs) specialize in treating patients with complex medical conditions requiring prolonged hospitalization, typically longer than 25 days. These facilities are designed to provide intensive care for patients who are too stable for a traditional acute care hospital but too unstable for lower levels of care, such as rehabilitation centers or nursing homes.

Read for more info at: https://www.longtermcarehospitals.com/article/long-term-hospital-admission

[moondirti]

big fan of the headcanon that simon riley is hard to get.

if we're being realistic, he's probably gotten very good at ignoring any inclination he might have towards a person in the years since his families' murder. it's easier to function as a soldier, as ghost, when he doesn't have to carry the burden of concern for someone so vulnerable. whether it's worrying about their safety while he's on deployment and can't afford to, or otherwise repressing his darker tendencies in an effort not to break them; the extra effort just isn't worth it to him. he won't seek you out, he won't take care of you, he won't reassure and coddle and communicate.

and he's not blind, nor is he passionless. he can appreciate a pretty face when one happens to pass by, but that's pretty much the extent of it. he's gotten used to the scorch of the lonely flame that flickers inside of him. if anything, he thinks putting it out and tending to the burns left in its wake would be a more traumatic ordeal than just letting it consume him.

so for him to accept love, it'd have to sneak up on him.

it happens with johnny first. he's the natural candidate, of course. his stubborn subordinate, clever with a fixated loyalty and quick wit – who better than him to get under ghost's skin?

granted, he isn't as guarded around him as he would've been with a civilian. not as cold upon introduction because he doesn't need to be. soap's a soldier, and this is work, and he's confident enough in the sergeant's resilience that it doesn't hinder his routine. he doesn't have to make accommodations, bend backwards or wake up in a cold sweat concerned about the man's wellbeing; not at first, anyway. and such are the floodgates that allow him to embrace johnny's company.

jokes crackled over comms. sitting next to each other on the airlifter. claps on the back after a successful operation. trust in every decision he chooses to take, regardless of whether or not he agrees. he thinks about johnny's eyes, johnny's smile, johnny's fierce little pout and the scar on his chin – but everything in moderation. the perfectly healthy amount. passing appreciation of his best mate's features and nothing more. it's the only meaningful connection he's had in years, and so what if he tugs his cock to the thought of it? people have cum to less.

until the bastard gets himself shot in the liver on solo reconnaissance in cyprus, and almost dies on medevac.

because when ghost gets that call from price – soap's hurt. it's looking grim. – he's wracked with a terror so acute he thinks his heart has given up on him. it's about the worst way to find out that he considers johnny as more than a friend. this sheer desperation, longing, regret. he ponders over it in the plane, tries to scrub the dread from his being. tries to pick apart what went wrong, what makes the sergeant so special.

by the time he reaches the hospital, he's already accepted defeat. all it takes is one look at johnny in his hospital bed – features peaceful, bandages wrapped around his bare chest, mohawk and facial hair grown out – to understand that this isn't going away anytime soon. he'll just have to make his peace with it. readjust to accommodate the protective flare already sparking in his chest.

it's a hassle, but manageable. despite his injury, johnny's still a competent man. they already know how to function in bouts of high stress. they're good– great friends. all this is really is an opportunity for simon to finally dig his cock within an ass he's been eyeing for months – or at least, that's the rationale he uses to come to terms.

and then you arrive. and things get a whole lot more complicated.

johnny's bird, apparently – gaz whispers to him outside of the inpatient room, watching through the window as you fret over the comatose man's pillows – didn' know he had one. m'surprised. you'd think a loudmouth like him would let the world know. she's cute too. really, ghost, did you have any idea?

he can't find it in him to respond, opting instead to march back into the room. you're fussing too much, causing a scene, no doubt disturbing the air with the nervous energy radiating off you in waves.

"he isn' supposed to be elevated like tha'," simon scolds, inflating a bit when you straighten up, eyes blowing wide with distress.

"oh... i just thought- he gets all hot when he lays on his back like this. i wanted him to be comfortable."

he knows that he's being cruel. you've done absolutely nothing to deserve the harsh glare he shoots your way, nor should you be expected to handle it. your eyes are red-rimmed, puffy like you've been crying on the way over. no doubt unused to crises like this one. he should be a help, not another source of stress.

besides. johnny's your boyfriend, not his. he has no reason to be so territorial. he'd only just discovered his feelings eight hours ago.

but–

"are you a doctor?"

"n-no."

"then it's best you keep your opinion to yourself."

he just can't help himself.

over the next week, ghost treats you with nothing more than cold disregard. he side-eyes you when you cry, wakes you up with rough pokes to your shoulder once visiting hours close, and takes every chance to one-up you when it comes down to who knows johnny better. you've got a leg up in the domestic department, but simon knows that nothing can surpass the borderline psychic bond they've built, and he makes sure to emphasise it whenever he can. and fuck, does it annoy him that you take it with grace every time, nodding receptively as though his input is meant to be more than just a searing critique of your shortcomings.

his behaviour doesn't go unnoticed, either. gaz is infinitely perplexed to see that the usually controlled lieutenant is so quick to lose his temper around you, despite your earnest efforts to not be a nuisance, and all price offers are long, disapproving looks that have him itch uncomfortably in his seat.

on the other hand, you must believe that he's just like that – foul mouthed, disparaging, mean – because you don't take it to heart. you remain pleasant, gentle, if not a little bit emotional. never once do you raise your voice at him, or fight back when he extends a particularly hurtful comment. on the occasion that his attitude grows to be too much for you, all you do is slip on a pair of noise-cancelling headphones and spread out your textbooks to spend the evening studying on the other side of the room. not keen on making amends, or discovering the source of simon's malcontent, but not affected by it either. you're peaceful. conflict averse. a good girl.

then, you come back one day with a tupperware of cookies.

"i made them myself last night. couldn't sleep, so..." you shrug, holding it out towards him. he assesses them, assesses you, roving over your chapped lips and hollow under-eyes. when did you get to look so defeated?

"no." he looks away, back to the unconscious man in front of him. in his periphery, your shoulders deflate, and he doesn't know what compels him to add the quiet "thanks."

"you've been here every hour of every day. i don't think i've seen you eat. um–" you dodge his gaze when it shoots to you. you've never tried to hold a conversation before now, have always accepted his gruff responses as an indication to leave him alone. he wonders why you can't catch the hint now. "just- let me know if you change your mind. they're shortbread."

and that's the end of it. at least until an hour later:

you're sitting on your armchair, directly across the bed from him, staring blankly at johnny when you speak up. "lieutenant?"

ghost doesn't remember introducing himself to you. he doesn't respond, but clenches his jaw to let you know he's listening.

"he's been comatose for a while." you warble. meaningless chatter. he sees it for what it is: talking so you don't cry. seeking reassurance in someone who knows how these things go.

"hm."

"is this how it usually-"

"sometimes."

"oh."

"he'll be alright." simon adds. more for himself than for you, but your lip wobbles like it's exactly what you needed to hear.

a few moments later, you speak up again.

"he holds you in such high regard, y'know."

he didn't. his heart aches as he follows the rise and fall of johnny's chest, finds solace in it, calming himself before he rips the hair from his skull. he can't speak, can't muster a rude dismissal, or any hatred for you. not anymore. this hospital has sucked the soul from him, as it seems to have done with you.

"he'll be happy to know you've stuck to his side." you smile, stirring from your seat and slinging your bag over your shoulder. "i have to go, got an exam tomorrow. i'll leave the cookies here in case you crave one."

you're halfway out when simon replies. "good luck."

and he's on his third cookie when johnny finally wakes. by then, he's already made up his mind. it's revelation he comes to much faster than the first.

if he can't have just johnny, he'll take you both.

[lowkeyerror]

The Family Business Ch.11

WandaNat x Reader

Word count: 2.7k

Ch. Notes: Violence, Physical assualt

Summary: Fisk is not happy with the way things turned out regarding the docks. He makes his own power play in retaliation that puts everyone on notice.

An: Sorry for not updating yesterday guys but Im planning on posting again before Monday to make it up to you

Series Masterlist | Masterlist

Wilson Fisk was never one to shy away from the reality of a situation. To him, living life in such a make-believe state would not propel him to the success that he craved. He had built an empire, a kingdom, but had no one to share it with. He lost his family, and with them gone, the only thing to fill the void was power.

Fisk was addicted to it. He needed it. It was only thing that made him feel good. So, though his empire was large he was acutely aware that it wasn��t the largest. The Maximoff’s presence cast a large looming shadow over his own. So, he looked to take care of that problem.

Fisk knew he would shoot Dragos Maximoff as soon as they agreed to meet in private. He assumed the Sokovian was a man of his word and would come alone. He was mistaken, and he hated making mistakes.

Knowing that the Dragos was hospitalized was good, at first. Fisk didn’t care if the man lived or died because he thought that without Dragos in the way the Maximoff’s would crumble. He was again, mistaken.

The reality of the situation was that Wilson Fisk underestimated the remaining Maximoff’s. He was foolish to believe that New York city would become his so quickly.

An oil spill was clever. It was big, messy, and destructive, but it would always go over as an accident. Fisk realizes that simply blowing up the pier wouldn’t have halted things as much. The play was high IQ.

His large fist slammed against his desk nearly snapping it in half. While the Maximoff’s were getting calls placing orders, Fisk was taking order cancelations. He was having the people he got on his side retract their support. He was losing the power, and he would not take kindly to giving up anymore.

Watching them retreat would never be enough.  He wanted the Maximoff’s to crumble beneath him, to beg him for mercy. They had embarrassed him in one foul swoop and he would stop at nothing to have them burn with the same feeling.

You weren’t naïve enough to believe retaliation wouldn't be coming. It arguably was giving you anxiety. All the waiting and looking over your shoulder would've taken a larger toll on you if you were dealing with them alone.

However, you weren’t alone. In fact, contrary to your previous belief, Wanda did not forget the terms you agreed to. You spent your nights between the spy and temporary crime boss.

It became somewhat of a routine. Even if you went to your apartment after work, you’d always end up at their place soon after. It’s nice, and that's why you refuse to question it.

It helps you sleep restfull, but occupies too much of your mind when you're awake. It makes you feel like a teenager. The only person you can confide in is Kate. You tell her, but she’s not much help. Kate encourages this and pushes you to take more emotional comfort from the women.

Your feet hit the ground a little harder than normal as you run this morning. You think about the familiar, almost instinctual attraction you have for Wanda. Then your mind turns to the new undiscovered feelings you have for her wife. You found yourself craving to be in proximity with the Russian more and more.

Natasha had a warmth around her. She had no problem taking the backseat and blending in, but the moment she sensed anything was amiss she sprang into action quickly. Recently she had started making sure you had a lunch at work after Kate told her you’d usually skip it. There was no point in trying to turn down anything from the woman. Though you hadn’t known each other long it seemed like she just understood you.

You’re too occupied with your thoughts, and not paying enough attention to your surroundings. When you stop running, you go to turn around but a firm hand on your shoulder stops you. A gun is pressed firmly against your spine.

“We’re going to have a little chat. Now keep walking,” the man says guiding you with his hand.

You don’t say anything, you simply follow his instructions. Your nerves don’t fret, even as he directs you to an alley. Once you’re out of public view, he turns you to face him.

“Y/n, high ranking employee of the Maximoff Family,” he spoke, the gun now aimed at your sternum.

“Fisk,” you’re glare is unwavering.

He sizes you up, “Aren’t you a sweet little thing? Unfortunately, I’m going to have to put a dent in that pretty face you got.”

“Killing me would only hurt you in the long run,” you say to him.

He smiles, “It would, you’re absolutely right, but hurting you sends a message.”

“I’d like to see you try,” you keep your eyes on his.

He laughs, “Me? No, I don’t get my hands dirty for people like you. I’m only here to make sure you relay this to whoever’s in charge. Tell them that I won’t stop, tell them that surrender is no longer an option, and tell them they should keep an eye on the hospital.”

The last line sends you over the edge and before you know it, you’re attempting to disarm the mob boss. Your movements are fast but as soon as the gun is in your hand, you take a blow to the knees. You fall to the floor and the gun slides out of your hand.

Fisk bends down and picks up the gun, he tucks it into his coat. He looks down at you with a smile on his face, “Make sure she's recognizable boys. Until we meet again sweet thing."

You move to the closest man to you and immediately twist his neck with a satisfying snap. He drops onto the floor and before you can get to another you're on the floor with him. The men stomp you out harshly.

That’s when you notice your predicament. The alley that had once been empty was now filled with Fisk’s men. The large man himself, gets into a car at the end of the alley which drives away promptly.

The men circle around you, but you refuse to be fragile in this moment. You slowly stand and look at the men, there’s around 8 of them. It seems like time works in slow motion.

Once they’re certain they have the upper hand they begin to get more creative. They start using their fists and elbows connecting anywhere they can. The screams don't displace the pain you feel.

Your attempts to fight back only anger them further. You don’t know how long the beating continues for. You feel yourself slip in and out of consciousness a few times.

Blood coats your body in multiple places. You can’t tell when it starts or stops. You can barely breathe when they finally stop their assault.

“Send the Maximoff’s our regards,” one of the lackeys spit on you before laying a final nasty kick to your gut. He walks out of the alley with his men behind him.

Your back lay flat against the concrete as you stare up at the sky. Turning your head hurts, but you do it anyway. Carefully, you scoot yourself over to the wall and try to prop yourself up.

It was only a matter of time before someone came looking for you. You should’ve been home by now and you weren’t. Knowing Wanda and Natasha the search party would be deployed soon.

However, keeping your consciousness was becoming a task. Your breaths are shallow and labored. The pain finally starts to set in, and tears fall from your eyes. Everything hurts, so much so that you're afraid to try to stand up.

It couldn’t have been longer than half an hour when a car pulls up in the alleyway. Your head hangs heavy, and you hope to God that these people are on your side.

Pietro is the first to reach you. He can’t find any words to say as he sees you in this state. He begins to shake his head as he bends down to get a better look at you. His hand cups your face gently and it trembles.

It hurts, but you reach your hand out to hold his wrist, “Jesus Christ, Y/n.”

You hear more steps approaching, but you stay focused on the man in front of you.  You’re scared for them to see you like this.

“Y/n,” There’s disbelief on her tongue as she whispers your name. She doesn’t want this to be you, but as your bloody tear-stained face raises to meet her eyes, her resolve crumbles.

Wanda can’t help the tears that immediately begin to fall out of her eyes. Your face had begun to swell, blood dripped from your nose, your lip was bleeding too. They could see the bruises beginning to form over your exposed arms and torso.

You gaze over at the other redhead who refuses to look at you. Her body posture is rigid, and her eyes are cast firmly on the ground, you can see how cloudy they are.

“We have to get her to the hospital,” Pietro says.

You nearly scream out, “NO!”

They see the alarm and panic in your face, but Natasha tries to reason with you, “Y/n, you’re hurt badly. They need to check you out or-"

“Bucky,” you cut her off, looking between Pietro and Wanda.

“Y/n, he doesn’t do that anymore and you know that” Pietro says softly.

“Try,” you counter back.

Pietro looks to his sister who nods. He reluctantly leaves his position next to you and pulls out his phone to make the call.

“Why not the hospital?”

You shake your head, but then wince, “It’s not safe.”

“Who said it wasn’t safe baby?” Wanda takes Pietro’s spot and places her hand in yours.

“Fisk, he said- he won’t stop, there’s no surrender, and that we should watch the hospital,” you attempt to struggle to your feet.

“Y/n-"

“We have to get Papa out Wanda. He’s not safe there, we have to move him, we have to,” you begin to work yourself up, the anxiety finally starts to hit you.

It's Natasha’s firm hand on your shoulder that keeps you in place, “Y/n, breathe with me.”

You go to protest, but the look of worry in her eyes causes you to pause. She takes a deep breath in, and you try to copy her, but you end up wincing.

Wanda sees this and lifts up your shirt to see your midsection badly bruised. Her touch is tender as her fingers glide over the faded cut on your side.

“You think anything they did will leave a scar like that?” You say with shallow breaths.

“If they weren't already going to die for doing this to you, I’d kill them for leaving a cut like that on you,” she says pulling your shirt back down.

Pietro walks back over to the three of you, “He said he'll do it, we just have to get her there.”

Wanda scoops you into her arms and walks you to the car. She carefully lays you down in the backseat before getting in herself. Pietro drives and Natasha takes the passenger seat. Wanda’s hand finds its way into your hair, trying to bring you any type of comfort.

“He told them to leave me recognizable, so they didn't focus too hard on my face after awhile,” you say to them.

“How many were there?” Natasha asks.

“8, 7 really, I snapped that guys neck first,”  you recount.

“How did he get you?” Pietro asks next.

You frown, “I wasn’t paying enough attention when I was running. He came up behind me and put a gun to my back.”

“He pulled a gun on you?” You can feel the woman getting upset.

You take your hand and place it in hers, “I will be fine. Bucky’s going to patch me up real nice.”

Once you arrive at the former doctors house, you’re greeted by a less than enthusiastic James Buchanan Barnes or Bucky for short.

“I retired for a reason you know?” He says as he let’s you all into his home.

The sight of you in Wanda’s arms startles him a bit. Wanda asks, “Where are we putting her?”

“Upstairs second door on your right,” he finds himself quickly leading them to the room.

Wanda is careful as she lays you down. They all stand as Bucky begins to prepare for this job.

“What happened to you kid, were you hit by a bus?”

“8 on 1 attack,” Pietro explains.

“The bus might’ve been better then,” Bucky says as he begins to check the extent of your injuries.

You try not to move too much as he pokes and prods your body. Sometimes you hiss, groan, but you don’t flinch.

“So, what’s the diagnosis Buck?” Wanda has her eyes on you as she speaks.

“Luckily, I don't think anything is broken, but her ribs are severely bruised, and I think her right ankle is sprained. Besides that, I think it's just bruising and some small cuts. Her nose is fine, her lips are fine, and her head is fine. She’s going to have to keep her weight off of her leg and wrap her torso until she’s healed.”

Wanda nods, committing the words to memory, “What do I owe you?”

He shakes his head, “Nothing, anything for your family.”

Pietro smiles, “What would take for you to come back and be our family doctor. We’re going to need one soon.”

Bucky rolls his eyes, “What you need a check up?”

Natasha speaks for the first time, “We’re going to war with Fisk.”

He winces, “Definitely sounds like you'll need a doctor, but I’m retired Ms.…”

“Natasha, Wanda’s wife,” she introduces herself.

“Congratulations, I hope you enjoy your marriage like I enjoy my retirement” he speaks genuinely.

“Buck, we could really use you on our side. Without Papa leading us, we need all the help we can get,” Wanda tries to sway him.

“What do you mean Dragos isn’t leading you?”

The room turns somber as Wanda begins to explain the situation to Bucky. The man keeps a neutral face through it all. He lets out a large sigh at the end of everything.

“When this is over, I'm going back into retirement understood?”

Wanda nods, “Thank you.”

After you leave Bucky’s, Pietro drops you all off at home. Wanda and Natasha help you into their apartment. They sit you on the couch with them on either side of you.

“I’ve sent some extra forces to the hospital to keep watch over Dragos. I’ve also told some of my people on the inside to take care of any of those men that did this to you,” Natasha’s jaw twitches as she speaks.

“Good,” you say flatly.

There’s a tension in the room. It’s weird considering how comfortable you’ve all been around each other. However now as you sit silently on the couch the air feels thick.

“You could’ve died in that alley,” Wanda speaks first.

You nod your head slightly, “I could’ve.”

“He could’ve shot you down right there,” she continues.

“But he didn’t,” you counter.

Wanda looks at her wife, silently asking for help. Natasha knows what Wanda wants to do and she supports it.

“Y/n, we have to talk about something, and we don’t know how it’s going to make you feel,” Natasha says taking ahold of your hand.

You nod at her words.

“And please, just listen before you say anything else,” Wanda’s nerves are present in her voice.

“Ok.”

The tension hasn’t left the room. You sit there, between the couple still slightly in pain. You hardly feel it though, all you could feel was the anxious air around you, waiting for the women to speak. It was nerve-wracking, it was stomach churning, and it was scary.

The thought of losing you terrified Wanda. The thought of losing you, without ever telling you how she felt was even more terrifying. She couldn’t wait any longer after the events of the day. It was her sign, and she was ready.

Taglist: @natashaswife4125 @autorasexy @alexawynters @blkmxrvel @toouncreativeforausername @likemick @sgm616 @bstvst @dorabledewdroop @sapphic-simp4015 @natty-taffy @justarandomreaderxoxo @mmmmokdok @tarathia @bgwlsmahf25 @lezzylover @og-kxsh-420 @vanessashands @untoldreader @sxlfishbrokenheart @marvelgirlx @elle161989

[jeewrites]

🌈 Sunshine & Rainbows 🌈

Pairing: Dave York x f!reader Equalizer 2 AU: What if Dave survives the fall from the watchtower?

WC: 10.1k (whoopsies) Rated: Explicit, minors do not interact

Content/Warnings: Dave is divorced from Carol (no kids), reference to previous smut, Dave gets a few nicknames, reader is also an assassin but sassy, reader has a nickname and hair that can be pulled, mention of traumatic injuries to Dave, medical jargon, discussion of physical therapy, stalking/murder/torture not described, please remember I had to google “How to preserve an eyeball” for this fic, is murder a love language?, arson, treadmill hate, use of daddy just once, no y/n

A/N: My first Dave fic and my first fic challenge! I got ‘amnesia’ to pair with Dave for @burntheedges's Roll-A-Trope Challenge! I had so much fun trying to wrap my head around Dave as someone who leans towards fluff and feels, so I hope you enjoy my take on our favorite murder daddy. Thank you to @bloviating-vy for being the best beta-reader and encouraging me to write fics in the first place. Dividers by @saradika-graphics. Roll a Trope Masterlist

It’s the pain that wakes him. Every part of his body screams. The tight stretch of skin, itchy and hot. Bruises to the bone. Bones shattered. The sun shines too bright despite the curtains. The increasing beep of the monitor is too loud. How is it possible to hurt like this?

He hears the shuffle of footsteps and the murmur of voices just above the screaming of his body before a shadowy figure appears. He can sense them to his left, but not see them. Is this how he dies? Drowsiness steamrolls him and he slips back to a blissful drug-induced unconsciousness.

It’s been 48 and a half hours and no check-in from Dave. You stare at the burner phone, willing it to beep or ring. Anything. But there is no text. No call. Just the flick and snap as you flip the phone open and close.

Dave has never, ever missed a check-in. Has he come close to the 48-hour deadline after an op? Sure. But never late. And never this late.

You’re not exactly in panic mode yet because it’s Dave, one of the most ruthless and effective killers you know. But you can’t help the anxiety starting to build in your belly and another feeling you can’t quite pin down. It’s not like you love him. But god isn’t he a good fuck, perfect for blowing off steam between covert ops. 

And he understands what you do. He understands you and you understand him. Plus, he was the only one who ever almost got a jump on you when a client hired both of you without telling one about the other. That was almost a clusterfuck that ended up being the best fuck of your life.

The burner phone stares back at you, silent. Fuck it. Now it’s time for you to do what you do best. Find people. Find Dave. 

The doctor keeps calling him John — as in John Doe. While he can’t for the life of him recall his name, he knows definitively, John is not his fucking name. He’s also tired of talking. He doesn’t have any answers, just more questions piling on top of the questions the doc, a psychiatrist, keeps lobbing at him. Everything still hurts, a dull, perpetual throb throughout his brain and body punctuated by acute pain if he happens to breathe wrong.

He’s in a different building since the last time he awoke in crippling pain. This place seems like a public-run long-term health care facility out in the boonies instead of the large hospital downtown he was in before. The doctors and other health care professionals seem harried and perpetually understaffed. While his room is relatively clean, the decor is dated, all the walls a sickly yellow or green. And everything smells strongly of disinfectant. It could be worse, he supposes, at least it’s clean here. 

The psychiatrist leans forward towards him, “Let’s call it a day and let you rest. We’ll try again tomorrow.”

He grunts in response.

Something in his gut tells him to be wary of this doctor, of sharing too much if he ever remembers a goddamn thing. He knows he can trust his gut when it comes to reading people. Watching a steady flow of doctors, nurses, aides, social workers, and janitorial staff in his room, he doesn’t know how he knows, but he knows when someone is trustworthy or a threat. He can read body language at the most minute level with startling clarity.

The head nurse Kathleen is no nonsense and won’t tolerate any bullshit. Nurse Sally does the bare minimum and has sticky fingers. Gotta keep an eye on that one. He likes the neurologist who doesn’t sugar coat things. He’s pretty sure his physical therapist, Ryan, is secretly a sadist.

The night nurse, Brian, is a steadying comfort, always checking on him, “Doing all right, boss?” in the quiet loneliness of the evening. Brian alleviates the pressing annoyance of not knowing his own name by constantly switching up nicknames for him. Calling him buddy, champ, or hot stuff much to his amusement. 

He also knows someone tried their damndest to kill him and make it hurt in the process. Gouged out left eye, stabbed between the ribs, sliced tendons, broken bones, internal bleeding, wrapped in a myriad of bruises and tossed from a significant height. He’s been told repeatedly what a miracle it is that he survived at all, washed up on the beach on the brink of death before being found.

For now he bides his time, giving his body the opportunity to heal and recover. He knows he won’t get far in the current condition he’s in after the multiple surgeries and months and months in the ICU. In physical therapy he can barely manage to walk a few steps without assistance, and he’s still adjusting to the eye patch and the use of his remaining eye. He’s relatively safe for now, he thinks, identity a mystery and off the beaten path. Although a small part of him wonders why no one has come to find him. Did he not have family, friends, or anyone who missed him? 

Dave doesn’t make it easy on you to find him. Of course he doesn’t. Before he went private, or over to the dark side he liked to say, he made sure to replace all of his biometrics in various government databases with false ones. You have to go old school and retrace his steps from the sparest details he did share with you. Brant Rock the text message had read.

You find Resnik, Ari, and Kovac in the local morgue shortly after the hurricane blew through. Kovac and Ari are identifiable easily enough, but Resnik takes a moment, having most of his face blown off. It’s a shame about Kovac and Ari, they were good enough guys and you didn’t mind working with them on occasion.

But that bastard Resnik had once joked, thinking you were out of earshot, what a good fuck you’d be and you were so vulnerable with only the four of them around for miles and miles. You had slid the safety off your weapon at the same time you heard Dave threaten to rip his balls off through his throat if Resnick dared to try anything with you. You were planning to do worse, but hey, it was the thought that counts, right? That was when you knew you could really trust Dave. Resnik, not so much. 

As you approach the next cold locker, for a moment you can’t breathe, suffocating in the thought that the next body you pull is going to be Dave. But to your immense relief, it’s not Dave. Dave isn’t in any of them. It’s not until you slip out of the morgue into your car a few blocks away that you realize you’ve been holding your breath. You allow yourself to sob, forehead against your steering wheel. Crying, such an unfamiliar sensation. Where was he?

It takes you nearly two weeks to find Dave. Listed as a John Doe at the big trauma center downtown, you disguise yourself as a nurse and sneak into his ICU hospital room late one night. Nothing prepared you for his condition. 

“Did Mac do this to you, Yorkie?” you whisper as you trace your fingertips along the ashen skin of his forearm. It seems like the only part of him that is uninjured. The only sound in the room is the hiss of the ventilator and soft beeping of the heart rate monitor reminding you he’s actually alive. Barely. He’s unnaturally still for a man always on the move. You gasp softly when you take in his face, his beautiful face marred with wounds and a patch covering his left eye. Your chest tightens as you turn away to collect yourself.

Refocusing, you pull up his chart. The more you scroll, the more your rage builds at Mac or whoever did this to Dave. Your Dave. Severed tendons and ligaments, shattered ribs, crushed vertebra, multiple stab wounds, ruptured spleen, so much internal bleeding it’s a miracle he’s even alive. What the fuck happened?

He is in no condition to be moved. No matter, you think. While he heals, you are going to hunt down who did this to him and exact revenge. Excruciating revenge. Before logging out of the system you program it to send you any alerts to changes in his condition or if he’s moved to another facility.

Before you leave, you take one last look at Dave, gently run your fingers through his soft brown hair, marveling at how peaceful he looks despite the myriad of tubes plugged into him. You almost make it out of the room without shedding a tear until you really see his nose. Broken, shattered, scarred. Even if you don’t love Dave, you love his beautiful, strong aquiline nose. The way he’d nuzzle it into your neck in rare, soft moments. Press it against your mound when he pulled pleasure from you over and over. The quiet moments after you were both sated and sleepy, and he’d let you trace his brow, the strong curve of his nose, his plush lips, as he anchored you against him.

You are going to fucking destroy whoever did this to him.

The doorbell footage at Dave’s apartment confirms that Mac is the culprit behind Dave’s injuries. 

The Robert McCall visit. The tense conversation outside with Dave and his guys and Robert. The false cheerfulness, the underlying tension bubbling underneath in the clench of Dave’s jaw, the threat from McCall to Dave and the guys, “The only disappointment in it for me is that I only get to kill you each once.” You bristle with barely contained rage at his words.

Good thing you know enough about the human body to resuscitate it. Looks like you’ll just have to give Mac a lesson on how to kill someone over and over. How unfortunate for him.

The most popular bets to his previous profession are linguistics professor or foreign service.

He discovered his fluency in Farsi when he overheard family members of another patient speaking it in the hallway outside of his room. It took him a moment to realize he understood what they were saying. Shortly after, he overheard several nurses conversing in Spanish and realized to his amazement he understood them too.

“Wonder what else you can speak, professor,” Brian the night nurse muses as he pulls out an assortment of chocolates in a gift tin. That’s a new nickname. “Here, have some French chocolate. Someone gifted them to me when they were discharged.”

He reaches for one gingerly, focusing on the pincer grip to pick a chocolate up. It has been a struggle learn how to use his entire body again once it healed enough to be subjected to OT, PT, talk therapy, and other forms of torture.

He frowns at the sweetness of the truffle as he takes a bite. 

“No good?” Bri asks.

“Too sweet,” he mumbles. “But thanks.”

Belgian is better, he thinks to himself before pausing. How does he know that?

Brian grins at him before setting down the tin and checking his chart, “That just means more for me, champ.”

Glancing at the tin, Dave stifles a sharp inhale when he realizes he can read the French printed across the lid.

Discovering or rediscovering who he is has been… interesting. Some of the discoveries raised his spirits, like discovering his impressive ability to guess who was walking into his room based on the sound of their gait or how much a person weighed within a few pounds. Some discoveries though left him questioning what kind of person he really was. An emotional rollercoaster he’s ready to get off of immediately. If only he could just fucking remember!

Aside from being able to read people insanely well, he’s put together that he’s a bit of a control freak and likes things neat and orderly. The bullseye tattoo on his left hand had one nurse guessing that he was an olympic sharpshooter, but no olympian in recent memory remotely looked like him. He knew he had been found in a camo pullover and cargo pants, or what remained of it. Another nurse guessed that perhaps he liked hunting for sport. After all the speculation around the bullseye tattoo, Brian started only referring to him as killer. Curiously, he didn’t seem to mind that nickname. The wedding band tanline made him wonder if he is recently divorced or actually married, but took his ring off for more nefarious reasons. Was he a cheater? Did he have kids? What kind of man was he? 

The strangest discovery came the first time orange slices appeared on his lunch tray. He found himself comforted by the smell of citrus as he ate them. Relaxed even, for the first time since he woke up. And also inexplicably aroused. His body had been so broken it had been months since he felt any tingle or whisp of desire, the feeling so unfamiliar it shocks him. What kind of kinky shit was he into?

That night he dreams of rain forests and citrus, relaxing in a familiar embrace he can not name. He wakes up the most refreshed he’s felt since he woke up in the ICU, body screaming in pain. And yet still he can’t explain why.

Sweat pours off of him as he grips the side rails of the treadmill. The PT room is absurdly bright and cheerful for the types of torture it routinely sees.

“You did great, man,” Ryan, his favorite physical therapist, praises. “Going to be running marathons in no time.”

He just grunts in response. He hates running. This he knows in his bones. Hates it. But he has come a long way from barely managing a step with assistance to walking on the treadmill for the first time. A stupid long painful way.

A sudden frustrated yell across the room jerks his attention to one of the newer patients across the room just as an exercise ball is flung in his direction. He reacts before can think, ducking and moving, assessing in a split second the source of the danger and prioritizing three different options in subduing the threat. He misjudges the distance of a table corner, bruising his hip as he dashes by. Damn his depth perception issues, he thinks. Just another thing to work on.

He surprises himself when he finds himself expertly pulling the patient off balance into a chokehold until security arrives. His body knows exactly how much pressure to put to neutralize the threat without killing him. Why does his body know this? Christ.

“Holy shit, man!” Ryan exclaims, helping to pull him up from the ground. “Where’d you learn to do that!”

“Can’t remember,” he groans as he feels his body protest the sudden intense movement. “Think I set myself back with that stunt.” He slumps over in a chair as sharp pain shoots up both his arms. He allows Ryan to fuss over him before one of the aides brings him back up to his room in a wheelchair. One step forward, three steps back it feels like.

It’s not until he’s settled into the privacy of his own room with a healthy dose of painkillers does he start to tally all of his mysterious abilities. He rubs the itchy scruff growing on his face with irritation. He hasn’t had a proper shave since he got here. And he probably won’t, at least not until his fine motor skills get better to do it himself. The staff are just too overworked here. He huffs to himself. He’s probably more of a danger to himself than anyone else right now. 

With all his language skills, keen sense of observation, and now apparently mad jiu jitsu skills, what did it add up to? Who the fuck was he?

In the weeks following your visit to see your Dave in the ICU, knowing he has a long road to recovery gives you the time and space to track and hunt Mac. In true Dave fashion, he didn’t give you much to work with, just one single conversation about Robert McCall, but that is all you need.

Shortly before Dave missed his check in, he let you wrap yourself around him as the big spoon after having his way with you. He was uncharacteristically spooked, he told you, after running into his former team leader while out on a run. Robert McCall, Mac, was presumed dead. Dave swore he saw him die that day over seven years ago, setting off a chain of events leading to Dave going private with his guys. The impact of Mac’s death, the grief and the disillusionment that followed after leaving the service. 

You knew about the job in Brussels—Susan—and the difficulty Dave was having tying up loose ends. Especially now with Mac resurrected from the dead and digging into Susan’s murder. He briefly mentioned Mac showing up at his apartment and confronting him and the guys a few days after the unexpected reunion. The doorbell footage you found confirmed this conversation.

You asked him if Mac was now a loose end.

Turning to face you, his eyes darkened with affirmation, “But I have a bad feeling about it, Sunshine.” 

Mentally you beat yourself up for not pressing Dave more about this bad feeling at the time because you were too busy preening at the pet name. It marked the first time Dave ever met you at your place, raising an eyebrow at your maximalist design choices. It’s like a rainbow and unicorn threw up in here, he had grumbled. Too bright, so sunshine-y. You’re just jealous your place looks like it was decorated by someone allergic to color, you had quipped before he hauled you over his shoulders into the bedroom with a growled I’ll show you jealous, Sunshine.

You tried to smooth the furrows between his eyes. “Can I help?” you whispered before pressing a kiss to the curve of his nose.

He tensed before pulling back to look at you, “No. Don’t want you anywhere near him, baby. Mac’s a killer. He — he taught me everything I know.”

You protested but the look he leveled you with ended the discussion even if you wanted to push back and insist. 

“You’re helping right now,” Dave consoled you, laying you back and slotting himself between your legs. “Reminding me I have this to come home to.”

The brief realization he had referred to you as home, quickly disintegrated at the pace he set, burying himself in you, sliding deep into the place only he could reach— the place you think of as his. He left early the next morning, pulling a black beanie over his head before kissing you goodbye. “See you in 48, Sunshine.” 

You believe Dave when he said Mac was a killer, the best he knew. So you are meticulous in your tracking. In rare form, you make sure your contingency plans have contingency plans, even if you prefer flying by the seat of your pants. You only allow yourself to feel the quiet thrill of the hunt in order to keep the raging fury that threatens to make you slip up at bay. You summon patience you didn’t know you possessed as you slowly lay your trap and draw Mac in. 

Robert McCall has a weakness for damsels in distress. And for extracting his own sense of justice in situations he came across, serving as sole judge, jury, and executioner. It rankles you to see him decide the fate of others, to right a wrong according to him and him alone. 

But who are you to judge him when you decided to be his judge, jury, and executioner? So you lure him in and give him exactly what he always looked for. In the end, he is just like any other man really. A talented man, a ruthless killer sure, but he could never match your cunning combined with your wrath, your fury at what he did to Dave. 

You keep the feelings at bay as you set the trap in motion until he is soundly in your snare. And even then, you don’t let the rage get out of control because you know your weakness in close combat. You won’t give him an opening to escape or kill you because you can’t stay cool and collected.

By the time you’d laid your trap for Mac, you got a ping from the hospital notifying you of Dave’s transfer to a long-term rehab facility. You pat yourself on the back for the perfect timing. Execute the target and then go check on Dave.

In the end, Mac isn’t that much different from any other kill you executed on the job. Just more satisfying in the end. You did it for Dave, afterall. Your Dave.

He decides that even if he doesn’t like the colorful scrubs the new nurse aide wears, she seems trustworthy enough, even if he struggles to get a more accurate read on her. It’s the first time he’s had trouble reading anyone since he woke up. So he sets aside the puzzlement as Brian introduces him to her. Maybe it’s because of how pretty she is, beautiful really, and how attracted he is to her, a pull that takes him off guard.

“Hey Killer, want to introduce you to our new nurse aide,” Brian says, gesturing to her as she stands a bit shyly next to him. “She’s gonna be helping me out so I don’t feel like a vampire all the time with these night shifts.”

“Killer?” she blurts out making an incomprehensible face before hiding behind a small smile.

“Gives me a reputation. I don’t mind.” He shrugs, smirking at the nickname. “At least until I figure out my real name, no one’s going mess with me. Nice to meet you…?”

The aide makes a funny noise in her throat as he extends his hand to shake hers. She recovers quickly as she takes his hand in hers. Something flickers behind her eyes, something warm, familiar before it fades away as she murmurs her name, Sunny, and tells him to let her know if he needs anything. The pull towards her strengthens as soon as his hands envelope hers, so soft and warm, that he doesn’t want to let go. Something feels so right at her touch. He murmurs her name before she pulls away to make the rounds with Brian.

You aren’t prepared to see Dave. You thought you were. You mentally talked yourself through it before you made your way up to his room with your new supervisor, Nurse Brian. You memorized everything from his chart, and know that he still has severe amnesia, still struggling with remembering anything at all, but nothing prepares you to be in the same room as him and not have a flicker of recognition across his face. His remaining deep brown eye levels a coolness at you that you haven’t seen since the first time you met and tried to kill each other. 

This is bad. After everything, the missed check-in, the frantic searching, the revenge-ing to avenge him, the utter lack of recognition across his beautiful face cracks something in you. You barely recover enough to shake his hand and leave his room upright, telling Brian you have to go to the restroom before meeting any other patients.

Tears prick your eyes and you try to calm your breathing, not wanting to face the tsunami of feelings crashing down on you. When did these feelings for Dave get so out of hand? 

You haven’t needed anyone since you cut off your abusive family and left home to find your way in the world. You learned to be alone, thrived at working alone in a corner you carved out for yourself. You filled your home with art and color and brightness after you realized you had the power to make your own sunshine. Who else would? Definitely not your shitty family. 

And plants. So many plants, your bedroom painted a shade of deep, lush green. Filled with plants. It was like your own personal rainforest. So what if you worked in the dark, creeping in the shadows, a killer for hire? It didn’t mean you had to make it your whole damn personality.

Oh, but Dave. He was the unexpected cherry on top, a force of nature who brought more exciting ops to your life, along with mind-numbing pleasure. Intermittently at first, then regularly. You liked the control you’d cede to him after months of dancing around each other, building trust, moving from fucking in seedy motels after ops to his place or yours. The way he could fuck your worries and stress straight out of your pretty head. Apparently something had shifted without you realizing. Pesky feelings.

Fuck. You care. More than you were willing to admit before Dave almost died. You were too full of rage to feel anything else. You convinced yourself that the revenge you sought when you hunted down Mac was exactly that. Revenge. But now that the rage and fury had ebbed, you face down the why behind your need for revenge, realizing you did what you did because you cared. About Dave. Maybe you lo — lov — Fuck. What if he never remembers what you had together? What exactly did you have with him before, anyway?

He looks good though, even with the patchy scruff and fading scars across his face. The slightly lost expression on his face. Even if you can sense his discomfort in his body, in the way he sits by the window pretending to read a book. He looks so different, skin warm and golden, so alive, from the last time you saw him in the ICU. And his nose, the nose you love healed after all, healing back into its original strong curve.

As much as you want to run back into his room, yelling his name and shaking him until he recognizes you, telling him everything, you know you have to steel yourself for this next part, to allow him to heal and remember at his own pace. Wasn’t that what the doctor had written in his chart? Pushing him too hard will have less-than-ideal outcomes. 

You sigh as you wash your face and take a deep breath. This part of the journey is going to be infinitely harder than finding Dave and killing Mac. But at least now he has you to help him jog his memory and watch his back. You lift your head up to walk out of the restroom, refusing to acknowledge the question prickling down your spine. What if he never remembers you’re his Sunshine?

It storms the first night of your shift, winds howling as you make your rounds and tend to the patients assigned to you. You do most of your menial work with one eye watching Dave, learning his routine and keeping tabs on him. It comforts you to know that he has a genuine rapport with nurse Brian, and has been making significant progress in his physical therapy. You get a sense he doesn’t trust the psych doc very much and has been frustrated at recovering his fine motor skills from the nerve damage in his arms. Must be why he doesn’t shave much, you think to yourself. The facility he’s in is fine for a publicly funded place, but you can tell the staff is overworked and underpaid. Your hourly wage is laughable. And everything is painted in this drab yellow that is an insult to the color. You’d read in his chart that the local precinct had put out feelers trying to identify the resident John Doe without much luck. You hope the luck holds out long enough for Dave to heal sufficiently so you can break him out of here before someone who shouldn’t find him does.

The bright flashes of lightning and roaring thunder keep you awake in the wee hours of your shift, strong winds whipping tree branches against the building, even as the patter of rain threatens to lull you to sleep. As you walk the sterile corridors, passing by Dave’s room you hear him yell out in panic, in fear.

It’s all you can do to stop yourself from sprinting into his room, ready to take out whoever is attacking him. You realize in the darkness of his room, illuminated only by a small night light, Dave is alone in his room, still asleep.

You realize he’s having a nightmare as you watch his eye work beneath his eyelid as he mutters, “Show yourself. Show — Show yourself Mac…” before trailing off. His face winces in pain as he jerks under the covers, panting to catch his breath before flinging his arms around like he’s trying to throw a punch.

For a moment you’re frozen, unsure of what to do as you realize he’s likely reliving his last encounter with Mac in real time. Careful not to use his real name, you put a firm hand on his arm to calm him, hey hey hey, to wake him up before he strangles himself in his sheets. As you make shushing noises he jerks the arm out from your grip, grabbing a hold of your throat before gasping awake, right eye wide in terror.

He apologizes profusely once he really wakes up and gets his bearings. It’s the same dream that haunts him every time it storms outside. Bubbling up from his subconscious every time it storms. He’s up high on a tower or lighthouse by some body of water. Rain whips across his face as the waves crash against the shore. He’s impatient, livid, but also… scared? Somehow he knows the before version of him would never admit the last thing.

He’s waiting for someone who is a danger, a threat. What’s taking so long? He remembers yelling, calling a name, Mac, — who is Mac?— before the dream shifts and he’s in indescribable pain. The most pain his body has ever felt slashes through him, punches into his ribs before he’s falling, falling, falling. It’s the icy cold that wakes him every time, shocking him back to consciousness. But this time he wakes up looking into the eyes of the pretty new aide with one of his hands clutched around her throat.

Well, this isn't the first time he’s had his hands around your throat. The dirty thought skitters across your mind, although that situation is preferable to this one. The thought amuses you, even as you start to feel the oxygen deprivation. It is a nice memory though, you think, being bent over your sink while Dave took you from behind. Arching you up with the tug of your hair to watch him in the mirror. It was after the one time you were almost late for a check-in and he was punishing you for it. For making him worry. If you’re early, you’re on time. If you’re on time, you’re late, Sunshine. Simpler times, you think. 

You inwardly sigh and try to figure out how to get out of his chokehold without hurting either one of you. You settle for anchoring one hand to the one on your throat and twisting out of his grip while leveraging his elbow as gently as you can manage to avoid setting him back in his recovery. 

He’s still gasping for breath as you try to soothe him with your voice, now scratchy from his grip. “You’re okay, you’re okay,” you comfort as you pat his back.

He starts apologizing immediately, a litany of shit, I’m so sorrys, until you level him with your best stare and quip, “I see where you get your nickname from, Killer.”

He stops long enough to bark out a laugh, before asking again if you really are okay. 

“I should be asking you that,” you respond. “Seems like a hell of a dream.” You see him retreat back into himself, at whatever horrors had surfaced in his mind.

“Do you want to talk about it?” you venture, sliding a hand over his. It’s clammy and cold. You feel him start to pull away before stopping.

“I think it’s what happened… before,” he finally answers with a thick swallow, looking away. “No one needs to hear that shit.”

You squeeze his hand for encouragement. “Try me.”

To your surprise he does. After Dave recaps his nightmare as best he can, his hand still in yours, you begin to think that you let Mac off way too easily. Shoulda tortured him more before pulling the plug, you frown internally. Because holy shit, that man really put Dave through the ringer. 

“Thanks for — for listening, I think it helped,” Dave squeezes your hand and looks at you with a surprisingly soft expression. Soft Dave, you never thought you’d see the day.

“Of course, Killer,” you squeeze his hand back before offering to get him some water. He accepts and hesitates as if he wanted to ask you something else. You stand but linger by his bedside giving him a moment.

“Will you — will you stay? Just for a bit, until I fall asleep?” 

After you get him some water, you stay — your hand in his — until he drifts off into an uneasy sleep.

He decides he likes Sunny, not just because she’s pretty, but because she keeps him on his toes with her quick wit and dark sense of humor — to match his own he learns — that makes the days go by faster. Just another thing he learns about himself that just brings more questions than answers.

He can’t help smiling as she checks in with him for the day, wanting to know if he needs anything. “Brought you a present,” she smiles at him so brightly it leaves his brain stuttering to respond. “Your room is so boring, figured you could use a plant.”

She places it by the window before turning with a look to see if he approves. He does. He doesn’t know why but the little green thing feels familiar, a comfort like home. He scratches at the irritating scruff on his cheek before finding his words to thank her. 

“I have some extra time today, do you need a shave?” she asks, like she can read his mind. “Looks itchy.”

“Yes. Please.” The look of relief on his face must be palpable because she immediately leaves to grab a razor and shaving cream. 

The thought that she could read him so well, as if his mind is an open book screams to the front of his mind. His stomach twists at the thought. A creeping suspicion fills him as she approaches with the razor. What if she actually knows who he is, but he just doesn’t remember her? It would explain the inexplicable familiarity that came whenever she visited his room. What if the sunny personality is all an act and she’s actually a cold blooded killer sent to finish him off? Perhaps he should be more suspicious of her. He’d only known her for a week and she is the only person he couldn’t get an accurate read on. 

His chest constricts at the recurring fear that someone had wanted him to hurt badly before trying to kill him. It really was only a miracle he survived. And now he was willingly allowing this stranger into his personal space with a sharp object. Could you kill someone with a disposable razor? Not ideal, he thinks, but possible.

“Everything okay?” she asks him as she sets up the side table with shaving accessories. 

He hesitates, conflicted with his most recent revelations as she moves closer to him.

“Look, if I was going to sever your jugular a disposable razor wouldn’t be my first choice,” she dramatically rolls her eyes at him before looking at him for consent to start.

He lets out a nervous giggle, a sound he’s pretty sure he’s never made in his entire life.

“Not my second, third, or fourth choice either, okay?” she continues. “You have nothing to worry about. I’m not the one with the nickname ‘Killer.’” 

She has a point. And she did just bring him a plant. And comfort him after one of his ridiculous nightmares the very first night she was here. If there was a moment when he was most vulnerable, that was her chance. He pushes away the feelings of suspicion and nods, allowing her to get started.

He couldn’t help leaning into her touch as she gently washes his face and smoothes on the shaving cream. The way the fading light from the window caught the flecks of colors in her eyes as she focused on the task at hand. He couldn’t help but think how cute she looks with her furrowed brows, all her attention on him. He decides the odds are low she was there to kill him considering how careful and gentle she is. He closes his good eye and allows himself to enjoy himself. Who knew getting a shave was such an intimate experience? He could feel himself relaxing under the warmth of her touch and the delicate scent of her citrus-y shampoo wafting across his nose at this close proximity. Something tugs on his mind at the scent, but she interrupts the thought.

“So what do you think, Killer?” she asks.

As he cracks open his eye, he realizes she’s holding up a small mirror. Time slows down at the same time his heart rate speeds up as he takes in his clean-shaven reflection. It’s like he suddenly remembered why he walked into a room after forgetting all this time.

His name is Dave. Dave motherfucking York.

When he says his name out loud, you let out an audible gasp you tried to cover as true surprise.

“This is huge! Dave, do you — do you remember anything else? Last Name?” You blurt out. 

His lips briefly purse before his face flickers just for a moment, his tell, before he shakes his head no. 

Liar. You immediately know he’s lying to you. He fucking remembers. You can see the cogs whirring in his brain, assembling all of the new information he unlocked when he looked at his reflection.You busy yourself tidying up the shaving accessories, watching him from the corner of your eye, hoping that he recognizes you.

It’s coming back to him, you can just tell from the way he’s holding himself up now, even just sitting in the chair, his posture is different. The lost expression is gone. The calculated, commanding presence of the Dave York you know is emerging right before your eyes. 

Dave York is remembering.

He startles you when he speaks to you again, low and almost menacing, “Don’t tell anyone else. I’m not… ready to share yet.” His expression flashes dark at you.

Ah yes, the patented Dave I’m-telling-you-not-asking-you York.

“Of— of course. Take all the time you need,” you respond.

The next time you glance at him, he has that expression on his face where he’s assessing someone, assessing you, deciding if they are a threat or not. Great, the last thing you need is Dave trying to off you before he remembers who the fuck you are. 

“I promise. I’m not going to say a word,” you try and reassure him. 

He offers a nod, a dismissal really, before turning to look out the window, back to whatever memories may be emerging from the abyss of his mind.

You’d think that Dave remembering would be a good thing, but unfortunately the feds figure out who he is at the same time. You’re on shift, loitering by the nurses’ station when you see two nearly identical government looking guys turn the corner into the wing of the facility just after dinner. Tweedle Dee and Tweedle Dum, you think. And they reek of federal agents. FBI, specifically. Shit.

Dave has been more withdrawn since remembering his name. Brooding by the window. Typical Dave. You keep up your act, checking on him and chatting with him, hoping really for any glimpse of recognition, but still none so far. You can tell he’s still assessing you, trying to decide if you really are just a peppy aide or dangerous foe waiting to strike.

You busy yourself nearby as the feds chat with Brian, eavesdropping on the conversation.

“Wait, that guy’s wanted for murder AND treason??” Brian exclaims. “But he’s so… docile.” You quietly snort to yourself at that word being used to describe Dave York.

“And a whole list of other things, but those are the big ‘uns,” one of the feds responds.

They continue to chat with Brian, trying to determine how much Dave remembers and what condition he’s in in order to transport him.

“Psych notes still say he doesn’t remember very much. But physically he’s actually almost ready for out-patient rehab,” Brian scans the electronic chart.

“Gotta put in the transfer ’n get him to our medical facility,” Tweedle Dee nods to Tweedle Dum. “We’re going to post someone on the floor to make sure he doesn’t go anywhere.”

Shit, shit, shit.

“Well, as long as they’re discreet,” Brian warns. “Don’t want to disturb the other patients on the floor.”

“Roger that,” Tweedle Dum responds before pulling out his phone to make a call.

The agents nod at Brian before walking back down the hallway. You see them briefly stop outside of Dave’s room before continuing on their way. 

Well, it looks like you’re breaking Dave out of here whether he remembers you or not. This should be fun. Hopefully he doesn’t try to kill you in the process.

Dave senses something is off before he even sees the two feds walk by his room on the way to the nurses station. He knows they’re there for him. By their gait and posture, they don’t seem like they’re in a particular rush to storm his room, so he bides his time, even as he slips a scalpel up his sleeve. He can’t run. All he can manage is a quick walk with a limp. There’s no way he can run fast enough or long enough to evade two federal agents, even if they look like Tweedle Dee and Tweedle Dum. Fuck, he thinks. He should have pushed harder in PT. 

He resumes sitting by the window, angling himself into a better position to attack if they decide to take him in today and waits. Hopefully, it won’t come to that. 

He holds his breath when the agents walk by his door again, pausing for just a moment. He makes sure to observe them so he’ll be able to identify them again if, when, they return. Fuck, he needs to come up with an escape plan. 

He lets out a sigh of relief as they walk away. What the fuck is he going to do? Where is he even going to go? He’s sure he doesn’t have much time, a day at most. Of everything that has returned to him, he still cannot remember any of the safe houses or stashes of money/fake IDs he’s sure he has… somewhere. 

Remembering has been… more bitter than sweet. His rough childhood and divorced parents both deceased, his own divorce from Carol, the stint in the military, black ops, the DIA, before going private. Then it all gets hazy. Were the dreams about Mac real? But how could they be if Mac was dead? Was Mac actually still alive? Remembering all of the heavy stuff was like grieving it all over again, all at once. It was fucking depressing.

As he shuffles to the bathroom to splash water on his face to help him think more clearly, he hears someone walk into his room. By the sound of the light stride, it’s the pretty aide that still talks to him even if he almost strangled her in his sleep. What if she’s making the move to kill him now, after all this time, because she saw the feds coming to take him away? As she rounds the corner, he moves out of instinct, pinning her against the wall with a forearm to her neck, scalpel out and ready. 

She lets out a squeak as he expects, before he cuts off her airway. What he doesn’t expect is her to roll her eyes at him as he presses a scalpel to her jugular.

You aren’t sure when Dave got a hold of a freaking scalpel, but it doesn’t surprise you in the least. Of course he found something sharp to play with.

“Why the fuck aren’t you scared?” he demands. “You got a death wish or something??” 

He eases his forearm off of your throat, but still holds you pinned against the wall. You inwardly sigh. In another time and place, this would just be foreplay, but right now the scalpel is still just a little too close to comfort. Probably shouldn’t push it with him, not too much anyway.

“That’s what you want to ask me, Yorkie?” you croak. You decide on no sudden movements though, in case it spooks his hand to twitch in the wrong direction.

He frowns at the pet name. Right, he never told you he remembered his last name. Oopsies. 

“You’d never hurt me,” you whisper. “At least, the Dave I remember wouldn’t. Not — not unless I liked it.”

Your eyes search his brown one, for anything, any recognition, but still none comes. Why are you tearing up? It’s not like he’s crushing your windpipe anymore. 

“How do I know you’re not the one trying to kill me?” he growls. Well, at least he sounds like the Dave you love. Love? Wait, what??

“Don’t you think if I wanted to kill you, I woulda done it the first night?” You roll your eyes again. You’re getting impatient now, if anything just to have the pointy blade removed from the vicinity of your neck. Maybe you could have done without the eye roll though.

His brows are still furrowed and you are so tempted to raise your hand and smooth the double crease away with your thumbs. You miss the way he’d melt under your touch, even if he’d never admit to liking it. He stares you down for a handful of breaths before you see the moment he makes a decision that reflects across his face. 

The moment he shifts the blade an inch away, you pounce, leveraging the blade away from him and reversing your positions. Shoving him up against the wall, you flinch when you hear his head smack the wall a little harder than you prefer, even if you know you’re not strong enough to hold him there very long. You press the dull side of the blade against his inner thigh, right at his femoral artery.

“This bring back any memories, Yorkie?”

He blinks hard a few times, as if he is surprised to find himself pinned against the wall by you. He glances down at where you have the scalpel pressed against his inner thigh before looking back up again and you brace yourself because you think he’s about to fight you off. Then you realize he’s looking at the plant you left on his window sill and then back at you, really looking at you like he’s seeing you for the first time.

His eye widens as he softly inhaless, “Sunshine?”

The citrus bodywash, the plants, all the fucking plants, the too colorful scrubs. His Sunshine. Unlike all his other memories that came back gradually in waves, with you it was like a switch was flipped and he went from not knowing you to now remembering everything. He feels a surge of emotion — relief, excitement, desire — but the most prominent is trust. He has someone he can truly trust, who knows him, again. 

All it took was a scalpel to his femoral artery. Figures. How he met you is a core memory after all. 

He feels you lessen your hold on him, tucking the scalpel away, eyes wide as you pull away from him in disbelief. But he doesn’t want you to be further away from him, he wants to keep you close. And so he tugs you flush against him.

“Say my name again,” you ask, eyes still wide.

He brushes a thumb across your soft cheek and takes in your bright, discerning eyes. “My Sunshine.”

“You really remember,” you whisper, pressing your face into his chest for a deep inhale, before looking back up at him. “I missed you so much, Yorkie.”

He just looks at you, takes you in, tracing the outline of your lips before pressing his mouth to yours.

You and Dave don’t get much of a reunion, a single kiss, before you hear footsteps approaching. By the sound of the gait heavily favoring the right side, it’s your supervisor Nurse Brian. You immediately move, pretending to prop Dave up over one of your shoulders like you’re helping him to walk before Brian turns the corner.

“Everything okay here, Sunny?” Brian calls out as he approaches.

“Yep, all good. Just helping Killer here back from the bathroom. Looks like he… tweaked his knee pretty bad in PT,” you respond, trying to hide how breathless you are from one kiss. Dave gives you the most dubious expression before you elbow him in the side and give him a look that says just go with it okay?

Dave has never been a fan of improvisation like you, preferring his contingency plans having contingency plans, all neatly laid out in his cute little spreadsheets. Which… you can appreciate. You love a good spreadsheet, but sometimes flying by the seat of your pants is just so much more… fun and exciting. Maybe this is why the two of you make such a good team, a bit of intense control and structure and, well, a lot of whatever it is you feel like doing in the moment.

You can tell the moment Dave decides to play along when he drops a chunk of his weight on you and you nearly stumble trying to keep the both of you upright. You keep up a rambling monologue at Brian as you settle Dave back into his bed while Brian shuffles awkwardly around the room, obviously trying to herd you out of the room. Your spidey senses tingle — something is about to happen. Before you leave the room, you surreptitiously slip the scalpel back to Dave and give him the most reassuring look you can manage. 

Just outside Dave’s room Brian finally spills the news that the feds got approval to transfer him later tonight. Perfect, you think. Just enough time for a bit more improvisation to break Dave out of this place. And get you out of here too. If you have to give another sponge bath or assist with another bowel evacuation you might start killing people.

“Turns out Killer is actually a killer,” Brian whispers, shaking his head. “I’ll be damned. Just make sure you don’t go into his room by yourself anymore.”

Boy, do you have news for your supervisor. 

During your next break, you comb the facility looking for something to create a distraction. A big one. As you pass by the PT room, the small row of treadmills call to you and a burst of inspiration hits you. Yorkie will be so pleased. He hates running.

The fire is a lot bigger than you expected. Apparently all the foam roller things in the PT room are also highly, highly flammable. Piled together by the treadmills you rigged to spark, you didn’t expect it to make quite the towering inferno it did. But you know what? Mission accomplished. 

In the chaos of the fire alarm and subsequent evacuation, you sneak Dave off in a wheelchair (and the plant you brought him, gotta save the little guy too!) and into a car you had borrowed before you started your very brief career in healthcare. Parked in an alleyway cleared of cameras, you almost giggle at the getaway going so well. The only person you had to kill was the fed left to watch Dave’s floor. Yorkie, on the other hand, is still tense with apprehension apparently.

“We’re not clear yet,” he growls as you flip on the radio and peel out of the alleyway.  

“Don’t make me tranq you,” you threaten with a smile. “Raining on my brilliant plan.”

He grumbles something unintelligible while pinching the bridge of his nose, but keeps quiet as he looks out the window as Tracy Chapman’s Fast Car comes on over the radio. As the miles roll by, it occurs to you that it’s the first time he’s been outside of a hospital or facility in almost a year and the uncertainty of the future, now on the run, sobers you up a bit for the rest of the drive. 

It takes a subway, a bus, and a boat, and another borrowed car, before you make it back to your place. You didn’t want to give the feds a chance at tracking either of you, so you took the extra long, long way home. You’re both quiet most of the journey, only communicating when necessary when switching modes of transportation. 

The only time he asks you anything is when it starts to rain, water streaming along the wide windows of the bus. He whole body jerks when he remembers something he wanted to ask you, “Mac. Was he the one who… Is he — is he alive? Or dead?” You can hear the absolute terror in his whispered confusion.

You slide a hand over his to calm him, “He was alive. He didn’t die all those years ago.” You can feel his entire body tense even more. “He’s gone now though, Yorkie. Can’t come after you anymore.”

He stares at you, stiff as a corpse.

“I took care of him for you, baby.” You pat his hand, willing him to take a breath and relax. 

He continues to look at you, wanting an explanation, but you’re not about to confess to murder and torture on a bus, even if it is mostly empty. 

“Later, Yorkie,” you murmur as you snuggle up next to him, hoping he will finally relax. There’s still a way to go before you both get home.

He crashes immediately after getting to your place. You can tell he’s overexerted himself and is likely in more pain than he’s letting on. Still too wired from being on high alert and making sure Dave was okay on the long trek home, you curl up in an armchair by the bed and just watch him sleep. Perhaps you’re afraid if you take your eyes off of him for a moment, he’ll vanish again. 

There’s a warm shaft of light emanating from the bathroom, casting soft shadows around the room, highlighting the outline of his form, those broad fucking shoulders and soft brown hair. He’s so still you’d rush to check for a pulse save for the slow steady rise and fall of his chest.  

Even with all the progress he’d made in physical therapy, he still has a ways to go. You push aside the concern and anxieties of tomorrow to appreciate that he’s warm and safe in your bed right now. Your eyes trace his face, those plush lips you’ve only gotten to kiss once since he remembered you. Following the arch of that nose you love to the two deep furrows between his brows. How does someone look so grumpy even in their sleep? It delights you.

When you can’t take the distance, however short, from Dave, you slide into bed as slowly as you can. He’s usually such a light sleeper, but he doesn’t move an inch. You gently smooth a thumb between his brows until you feel him melt. You close your eyes and allow his steady breathing to lull you to sleep.

“You’re going to cook? Breakfast?” you almost fall out of bed as you try and untangle yourself from the sheets, still half asleep. Who is this man and what has he done with Dave York?

He grumbles something before raising his voice, “I miss real eggs. That place only ever made the powdered shit.”

You shrug and gesture at him to knock himself out, while you busy yourself with making coffee. Coffee always first. Then food. This is the correct order of things. As you hear the fridge door swing open, you feel Dave freeze, standing stock still while letting all the cold air out. Ugh, Dave.

“Sunshine…” he seems to be at a loss for words. “Why the fuck do you have an eyeball in your fridge?”

“Oh, I forgot!” you exclaim. “It’s your welcome home present, Yorkie.” 

His head pokes out from behind the door and he frowns, “You know it can’t replace the eye I lost right?” 

“Oh, I know. It’s what’s left of Mac,” you explain as you slide by him to grab the oatmilk for your coffee. The eyeball stares down at you, suspended in formalin, from its clear jar on the top fridge shelf. “Eye for an eye right?” 

He just looks at you and then at the jarred eyeball in the fridge, and then back at you, speechless.

“Well, except he’s dead and you’re not.” You smile and shrug as you finish stirring the milk into your coffee and take the first blessed sip, extra pleased with yourself. “You’re welcome, Yorkie.”

“Fuck baby, sometimes you scare me you know that?” 

You just smile at him, looking so at home in your colorful kitchen with his tousled hair and grumpy expression before you go to sit on one of the kitchen island stools. “I think that’s exactly why you love me.”

He rounds the island counter and cages you in with his arms. You take in his handsome face, so handsome it’s sometimes hard to breathe, as he just takes you in. He finally rumbles, “Yeah, I guess that’s why I do.” 

“Yeah?” you look at the floor at the admission, swiveling back and forth on the stool, not quite ready to look at him again.

He tilts your chin up with one hand, “You really take care of Mac for me? All by yourself?”

You consider reminding him that you offered to help in the first place, but somehow an I told you so felt like it would ruin the moment. You just bite your lower lip instead.

“Mmh hmm.”

“Why, baby? I — I almost died,” he presses. “He coulda killed you! You didn’t know then if I was even going to make it or not.”

You frown at this. Did he not understand?

“And I’m still so — so broken. Never going to fully recover and be who I was. Not worth anything to anyone anymore.”

He definitely does not understand. And you haven’t had enough coffee for this conversation. You quell the urge to roll your eyes as you grasp the front of his shirt and pull his face down level with yours.

“Yorkie, that’s exactly why I killed him.” Your words are firm even if you feel yourself shaking at what you’re about to admit. “He doesn’t get to try to kill the person I love and get away with it.”

His eyebrows shoot up at your disclosure, that pesky L-word. Should it really be a surprise at this point though? After everything? Even if it terrifies you to admit out loud. You did all of this because you love him. Your Dave.

“After I — I saw you in the hospital, everything Mac did, there wasn’t another option,” you murmur. “You mean everything to me, Yorkie.”

Dave forgets about the stupid eggs as he drags you back to bed and reminds you exactly why you love his nose so much. Fuck, you missed this. 

You suppose from one assassin to another, there’s no declaration of love like getting all murder-y and revenge-y for them. It might as well have been a proposal of marriage. Even with so much uncertainty about your futures and how much rehab Dave still has to go, you figure as long as he doesn’t start trying to back seat assassinate, you’ll both be fine. You’ll take care of your Yorkie until he can be Murdah Daddy again.

[macgyvermedical]

Fun (recent) Medical Technology History Facts

The first EKG was taken in 1901, the machine looked like this:

CPR was invented about 10 years after the defibrillator came into use (1960s vs 1970s).

The first CT scans on humans were taken in 1973. They took 1-2 hours to scan 8-12 images, which printed out on Polaroid film. They looked like this:

The first MRI machine image was taken in 1980. It was of a bell pepper:

The first bioethics committee determined who got to use the first 6 dialysis machines for chronic use in 1960 (dialysis was invented in the 1940s but was only used for acute care, not long-term).

Metered Dose Inhalers didn't exist until the 1950s.

Heart transplants and oral contraception were invented in the same decade- the 1960s

Routine handwashing in hospitals and food service didn't start until the 1980s.

We didn't know what viruses looked like until the 1970s.

Human insulin didn't exist until the 1980s (prior to that we only had pork and bovine insulins).

[andhumanslovedstories]

hello this is kind of heavy and no pressure at all to answer. and apologies because im sure you must have answered this before. but do you go through like a pain management flow chart for your patients and if so what are some of the steps? my dad is having some medical issues and i want to be able to help him manage his pain as much as i can. thank you and enjoy wasteland!

I work in a hospital setting so my pain management care plan is part of an interdisciplinary team in that setting. It's relatively easy for me to get, say, IV pain meds for a patient with extreme breakthrough pain. I don't know how well my approach would translate outside of that setting, I'm not palliative care trained, and I don't personally deal with chronic or acute pain (which is why I'm answering this publicly so other people can chime in), but in broad strokes:

First: Define pain. What type of pain is it? Muscle pain? Indigestion? Neuropathy? Surgical site? Stiffness from lack of movement? Is part of the pain also the fear of the pain? Sometimes when pain has been bad for a long time, or even has been bad in a short-term but very notable way, the idea of hurting that bad again is traumatizing. That fear of pain can, unfortunately, make you focus more on the pain you're feeling because now it's not just the physical sensation of pain, it's also the psychological impact of it.

Then, how does the pain affect you? Is it stopping you from sleeping? Is it stopping you from eating? Is it making you short-tempered or depressed? Does it make it difficult to focus on things? Does it make you nauseated? Anxious? Isolated? Do you feel like you need to hide it from those who care about you?

Everything pain is and affects is a place where you can intervene. Some of these interventions will be very small and would, if they were the only intervention, feel completely inadequate. Pain relief is rarely "you do one thing and you're done." You're addressing pain on multiple fronts, and sometimes that doesn't mean your focus isn't just the reduction of pain but the restoration of what pain has taken away. It's possible the worst part of pain for you isn't the pain itself but, for example, the immobility it causes. Are there different ways you can learn to move? Can you get a grabber? Can you get a shower chair? Can you find physical therapy exercises that help you regain strength or stop you from deconditioning to the degree you're able? What mobility aids might restore movement to you?

And if returning mobility is not possible at this time or ever, how can you modify your environment to support you? Can you figure out what bothers you the most about that immobility and mitigate that? If it's annoying that not being able to leave bed makes you bored, what can be within arm's reach? If it's frustrating that being too painful to move means you feel isolated from other people, can you make wherever you are more central? If pain makes having your bed on the second floor unfeasible, can you move your bed to the first floor? How can you adapt the environment around you?

I'd encourage movement too, to the degree it is possible. Being in the same position HURTS. If it feels good to stretch but you can't do it by yourself, can someone help you with range of motion? (You can look up "passive range of motion" to get an idea of how to do that.) This doesn't need to be exercising, just exploring the joy of moving your body. Related to movement is physical touch. I love lotions and medicated creams for pain patients because you can turn them into massages. Just be careful with pressure and be open about what hurts and what feels good. At the most gentle end of the spectrum is something called the M Technique which isn't even massage, it's like guided gentle touch. Give the body something else to feel.

Different medications work better with different types of pain. This part is hard to talk about in general because of the specificity of some pain med regiments. Tylenol is great, but be cautious with how much you are taking (acetaminophen overdoses are no joke) and remember that there's a point where more tylenol doesn't mean more pain relief. Opioids are great, but they can be very dangerous and aren't well-indicated for a lot of types of chronic pain. Even if opioids work best, I'd encourage you to be working on pain reduction on multiple fronts, as opioids are so controlled, it is easy to lose access to them. If opioids give you enough pain relief to do physical therapy, then make sure to do that physical therapy. Medications are amazing and I love them and I give out PRNs like crazy, but similarly to how I can't just take my depression meds and stop being depressed, pain medication works best in conjunction with other strategies. Those other strategies though can literally be something like "tramadol takes away the pain enough I can focus on something, and what I want to do with that focus is to watch a movie I've been meaning to rewatch for a while now but haven't had the spoons for." Sometimes all you will want to do when you get pain meds is sleep because you can't when you're hurting. Sleep is wonderful; how can you arrange your sleeping place and habits to make sleeping even more of a delight?

And if you find a medication that works, use it consistently. It is always easy to keep pain level than it is to address a pain spike. Don't wait until symptoms are at their worst to address them. Figure out what it feels like when your symptoms are ramping up, and intervene early.

Sometimes medications that aren't explicitly for pain can still help. If anxiety makes pain worse, consider an anxiety medication. If coughing hurts, can you get a numbing spray from your throat to make it less sensitive so you cough less?

I don't know how useful this is to you and your family. Hopefully it's at least something to think about. Think about palliative care (which is about the management of symptoms of illnesses rather than the treatment of illnesses) as not just taking away bad sensations but restoring good ones. You can't always get someone to a place with no pain. But what can you do to enhance life in the presence of that pain? There is a psychological aspect to pain, it's a parasite that drains you and makes you feel like you are nothing but a body that hurts and won't stop hurting. I want to make clear, I'm not saying pain is only in your mind. Bone mets and nerve pain exist whether you're cheerful about it or not. But pain doesn't have to mean suffering, it doesn't have to take away the things that make you you. Address pain through medication and therapies, but also remember that protecting, promoting, and prioritizing the parts of yourself that you most value and give you the most joy will help give your life so much substance that pain can't rob it all. You aren't doing one big thing. You are doing a thousand small things that make life easier, better, more suited to yourself and your abilities, and more aligned with the parts of life that you that give your life meaning.

(And a note in particular for being the family member of someone in pain--ultimately, they are going through this alone. It is their body. What can you make smoother for them? How can you protect their dignity and their privacy without making them feel abandoned or alone? How can you make it so your reaction to their pain is not part of their burden? Like for the six hundred other hypothetical questions in this endless post, the answers will be highly personal and will take time to figure out. Be patient and calm.)

[covid-safer-hotties]

Also preserved on our archive

By Hugo Francisco de Souza

New research shows that COVID-19 survivors, especially older adults and non-hospitalized patients, are at an increased risk for chronic fatigue syndrome—underscoring the need for comprehensive care for vulnerable populations.

In a recent study published in the Journal of Infection and Public Health, researchers carried out a retrospective cohort study comprising 3,227,281 pairs of patients with and without COVID-19 from a larger dataset of over 115 million patients to investigate the associations between severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) infections and chronic fatigue syndrome (CFS) risk, particularly in the presence of comorbidities.

Cox proportional hazard models revealed that patients with prior SARS‑CoV‑2 infections were at increased risk of contracting CFS (HR = 1.59), with adults above the age of 65, Asians (HR = 1.75), females, and those with comorbidities including diabetes, obesity, hypertensive disease, and hyperlipidemia being identified as the highest risk populations. The omicron variant was associated with slightly higher CFS risk (HR = 1.40) than older SARS‑CoV‑2 strains (alpha HR = 1.33, delta HR = 1.40), with risk levels for Omicron similar to Delta, despite Omicron typically causing milder acute illness.

Furthermore, contrary to previous studies, this research found that non-hospitalized patients had a higher risk of developing CFS (HR = 1.64) compared to those who were hospitalized (HR = 1.22), challenging assumptions that more severe initial infections increase long-term fatigue risk.

Background

The coronavirus disease 2019 (COVID-19) pandemic remains one of the worst in human history, infecting more than 700 million humans and claiming more than 7 million lives in only four years. While social distancing measures and vaccination campaigns have substantially curbed disease spread and dampened infection severity, many COVID-19 survivors report persistent or novel symptoms that cause debilitation for months or years following initial infection recovery.

Alarmingly, these conditions, collectively termed “long COVID,” are estimated to plague up to 78% of survivors, leaving them with chronic chest pain, lung diseases, muscle aches, and chronic fatigue syndrome (CFS). While studies aimed at establishing the association between SARS‑CoV‑2 infection and CFS risk have been carried out, none have evaluated the effects of covariates, particularly comorbidities and other preexisting medical conditions.

A growing body of evidence suggests the positive feedback loop between long COVID and other chronic conditions, observing that the presence of one increases the risk and severity of the other. Furthermore, long COVID is a multi-organ condition, highlighting the need for comprehensive, extensive cohort investigations into the associations between CFS and long COVID risk factors.

The present study uses an extensive cohort (COVID-19 cases; n = 3,227,281 pairs) across a spectrum of infection severity, age, sex, race/ethnicity, vaccination status, and comorbidities to establish the risk associations between prior COVID-19 infections and CFS risk. Study data was obtained from the United States (US) TriNetX database, a collaborative network comprising electronic health records of more than 115 million patients, between January 2020 and December 2023. Participant selection was carried out by first identifying CFS patients from the database (n = 3,227,281) and then 1:1 propensity score-matching (PSM) matching them with CFS-free patients (non-COVID-19 controls).

Relevant data included demographics, infection and comorbidity diagnoses, ongoing medications, procedures, and laboratory test results. Covariates under investigation included age, sex, COVID-19 vaccination status and disease severity, hypertensive diseases, race, ischemic heart diseases, hyperlipidemia, cerebrovascular diseases, chronic kidney disease, chronic obstructive pulmonary disease, and depression. Patients were further divided into subcohorts based on the wave (alpha, delta, or omicron) of initial SARS-CoV-2 infection. The outcome of interest was medically confirmed CFS diagnoses.

Standardized Mean Differences (SMD) were used to compare covariates across COVID-19 and non-COVID-19 participants, with Kaplan–Meier analysis computing CFS incidence rates and univariate Cox proportional hazard models computing hazard ratios (HRs; CFS risk) in case and control cohorts.

Study findings

Of the 115,675,909 patients represented in the TriNetX database, 3,227,281 were confirmed to have experienced a prior COVID-19 infection and were included as cases. All cases were 1:1 PSM to COVID-free controls, doubling the size of the study dataset. Cases were predominantly female (54.4%), White (58.7%), and had a history of hypertensive disease (17%). Furthermore, obesity (8.1%), type 2 diabetes mellitus (7.8%), hyperlipidemia (14.2%), and depression (5.5%) were frequently observed as COVID-19-associated comorbidities.

SMD analysis and HRs revealed that COVID-19 patients presented both higher incidence (~0.6%) and risk (~59%, HR = 1.59) of CFS compared to non-COVID-19 ones. Notably, significant variable-associated differences in CFS risk were observed, with patients aged 65 and older (HR = 1.74), female sex (HR = 1.62), and Asian (HR = 1.75) patients revealed to be at highest CFS risk. Unvaccinated patients (HR = 1.62) were found to be more likely to contract CFS than vaccinated (HR = 1.25) ones. Contrary to previous research, non-hospitalized patients had a significantly higher risk of developing CFS (HR = 1.64) than those hospitalized (HR = 1.22), which may suggest that early medical care during acute infection mitigates long-term fatigue risk. This is one of the first reports of race/ethnicity altering post-COVID-19 CFS risk.

Omicron and delta variant patients were found to be at slightly higher CFS risk (HR = 1.40, respectively) compared to alpha variant patients (HR = 1.33), with Omicron showing similar risk levels to Delta despite typically causing less severe acute illness. Infection severity outcomes on HR ranged from 1.22 (the most severe infection requiring immediate hospitalization) to 1.64 (no hospitalization required).

Conclusions

The present study uses a cohort of more than 6 million patients to elucidate the risk associations between COVID-19 and its comorbidities and subsequent CFS risk. Supporting previous research, the study established a higher CFS risk (HR = 1.59) in COVID-19 patients compared to their COVID-19-free counterparts. Unlike earlier studies, this research highlighted the significant influence of race, with Asian patients showing the highest CFS risk (HR = 1.75), and emphasized the importance of comorbidities, with chronic obstructive pulmonary disease (COPD) also contributing to increased risk (HR = 1.43), in addition to the known comorbidities of obesity, diabetes, and hypertension.

The findings on hospitalization severity were unexpected, as non-hospitalized patients had a significantly higher risk of developing CFS (HR = 1.64) compared to those hospitalized on the same day (HR = 1.22), suggesting that prompt medical care during acute infection may mitigate long-term fatigue risk.

Together, these findings provide a comprehensive evaluation of the landscape of CFS risk, helping clinicians better understand the needs of COVID-19 patients and potentially improving their quality of life.

Study Link: www.sciencedirect.com/science/article/pii/S1876034124002934

[paintedscales]

FFXIV Write 2024 :: Day Eleven

Prompt: Surrogate Characters: Nomin tal Kheeriin, Y'shtola Rhul Word Count: 1,134 Notes + Warnings: Digimon AU (I'm stuck here, I guess); Leukemia stuff

Master List

Prev: Glass

The door to the room opened with a loud and audible ‘ka-chunk,’ and Nomin jumped, rousing Teiamon from her slumber. The person that walked in was a woman. Her hair was a striking platinum blonde in color, visible even in the dark of the room; a long white coat was draped over her body, marking her as a doctor, a black blouse underneath with an equally black pair of dress pants. A stethoscope hung around her neck, its silvery parts glinting in what light bounced off of it.

“You're awake,” the woman spoke, her voice carrying a rather authoritative tone to it. Pacing over, the doctor took up a stool and rolled it over, sitting next to the bed. “How are you feeling?”

“... Hungry…” Nomin quietly replied. She looked around the room again, the absence of both Bayarmaa and Esenaij feeling like a gaping emptiness. Even with Teiamon at her side, the unfamiliarity of the hospital and her situation made everything that much more apparent. “Where are my siblings?”

“They had no idea when you'd be up; they've since left after we informed them of your condition. But…don't worry, they'll be back soon,” the woman informed Nomin.

“My condition…?” The fear from before tickled at Nomin’s mind, though she was able to keep it much more subdued now that she was, from the look and feel of things, stabilized.

The doctor nodded in response and then said, “we took some blood to have a look at what's going on with you. Now, we don't have the most definitive answers right now, but we do know that you're dealing with leukemia.”

Nomin’s brow twitched with some confusion. She had never heard this term before.

“... Will…Will it kill me? What is it?” Nomin asked.

“Luckily for you, leukemia is an easily treatable cancer,” the doctor said with a small smile. “But we do need to know what kind of leukemia we're dealing with. We hope that it's type ALL versus type AML. Acute lymphoblastic leukemia versus acute myelogenous leukemia.”

To say that Nomin was stunned to hear this revelation would have been an understatement. She stared at the doctor, mouth slightly agape, and clear disbelief in her eyes.

She had cancer?

“I know it's a lot to take in,” the doctor said, filling the silence. “But so long as we can keep you taken care of, you'll make a recovery into remission in a couple years.”

“‘Years’?” Nomin gawped. In the back of her mind, she knew that cancer -- any type of cancer -- was bad. Simply, she was far too in a state of disbelief that she had it that even the most basic of information escaped her.

“That's the best case scenario, yes,” the doctor confirmed. She then stood up from the stool, taking her stethoscope from around her neck and wearing it to use. Motioning toward Nomin, she asked, “can you lean forward for me? I want to take a listen to your lungs.”

Nomin slowly nodded, inching forward and then leaning as much as she could manage. When the doctor reached back behind Nomin and she felt the cold pressure of the diaphragm upon her skin, she only just realized then that she had been changed into a hospital gown.

‘When did that happen…?’

“Deep breaths for me,” came the doctor's instruction, and Nomin did as asked. The diaphragm moved, and Nomin took another breath. 

Again.

‘What’s this doctor's name? Did she say at all?’

Again…

‘No… Or if she did, it was when I was having trouble hearing anything… I don't even remember meeting her.’

It was finally removed, and the doctor smiled. “Everything sounds good with your breathing so far.”

“... You didn't introduce yourself…” Nomin finally commented.

“Oh…” A look of realization fell over the doctor's face. “I'm your oncologist, Dr. Shtola Rhul. You can just call me Dr. Rhul.”

‘Dr. Rule…??’

“But, now that that's out of the way,” Dr. Rhul sighed, taking up a clipboard next to the computer in the room. She stood close to where the light was coming in from the door. “Maybe you can answer some questions for me that your siblings couldn't?”

Nomin shrugged. “I can try…”

“Do you know if your parents had a medical history regarding cancer, or any other ailments?” Dr. Rhul asked. Nomin shook her head.

“No one knows anything about my biological parents… At least, that's what I've always been told…” Nomin replied. “My siblings are my only family now since my foster parents died.”

“I see… That is rather unfortunate. But,” Dr. Rhul wrote down a couple things before tucking the clipboard away under her arm. “We'll take as good of care of you as we can. Is it only your siblings you live with?”

Nomin nodded.

“Hm… In cases such as these, it wouldn't be entirely uncommon to have…” Dr. Rhul rolled her wrist as she thought of the term. “A…surrogate parent that is assigned to you.”

“I don't want a parent.” Nomin’s tone was flat, and Dr. Rhul chuckled softly.

“They won't be a parent parent… If the circumstances are that your older brother is your legal guardian, but you are not necessarily in his legal custody, this surrogate parent will be here to help make medical decisions with you -- or, should worse come to worse -- for you.”

Nomin frowned in response, not really liking the implications. She almost forgot Teiamon was there, but once she felt the weight of her partner Digimon pressing against her, Nomin placed a hand on her head. Of course, that also made another question spring forth.

“What about Teiamon? You won’t make her stay with my siblings the entire time, will you?” Nomin asked. “She’s…she’s my partner Digimon. You can’t separate us…” ‘Not again…’

Dr. Rhul’s expression was hard to read in the dark. Her features seemed to be…sympathetic as she looked down at Teiamon. “You don’t need to worry. I wouldn’t dare try to separate you two. In fact, I had a discussion advocating for letting you keep your partner Digimon close to you. After all, following laws and regulations for those that do have partner Digimon, it would be remiss of us to go against separating you when it is very much against the law to be as such.”

For a moment, Nomin pursed her lips. It seemed Dr. Rhul was pretty knowledgeable about that. Nomin herself was aware of the laws in place for partner Digimon to stay with their Digidestined humans. But then again, it was and always will be something that affects her directly.

“Well!” Dr. Rhul started. “It’s a bit late for our hospital’s kitchen to get you anything, but I’ll see if I can’t get a nurse to bring you a drink and a snack. The options are quite limited, though.”

“That’s fine…”

[cannabiscomrade]

Expanding on that post that talks about how disabled/chronically ill people are not a burden on the medical system

Simultaneously, the system is also not built to accommodate our needs when they become chronic and long term. There is an inability for us to create a burden when the system cannot even make room for us.

Speciality care is behind bureaucratic paywalls and insurance restrictions and prior authorizations and referrals and other administrative bullshit that draws out the very critical need for acute care for diagnosis and intervention in the disease process. And it’s intended to be that way to deter people from seeking out these resources.

This is what burdens the system. Limited access to prompt speciality care puts further strain on emergency rooms and hospitals.

People in need of complex care shouldn’t be seen as a burden because of the cost of our care. The cost of our care is often prohibitive and is designed to “thin out the crowd”. It’s eugenics and capitalism is what helps it prosper. If the idea wasn’t to profit off of essential healthcare needs, then the priority would be on helping people who have higher care needs.

[burninglights]

seeing some of you getting snotty about people not having first aid kits & first aid training without advising people on what they should have/what they should know is doing my nut in. without further ado:

First Aid Kits (what should be in yours)

If you’re going to uni/moving out of home, you really ought to have a first aid kit. Small first aid kits are fairly inexpensive and come with basic first aid supplies.

Included in my first aid kit is:

1 card of paracetamol tablets

1 card of ibuprofen tablets

A length of gauze bandage

1 tube of topical antiseptic (I use Savlon or Germolene)

1 tube arnica/bruise cream

30x plasters, assorted sizes

5x long strip plasters

10x antiseptic wipes

3x individually sealed small sterile gauze pads (7cm x 7.5cm)

4 sterile small adhesive dressings (7cm x 5.3cm)

it’s a good idea to also have an emergency card in your first aid kit, with the contact details for your next of kin and any health conditions written on it. They usually come as part of first aid kits anyway, and have a little clear plastic pocket to keep them in.

Also, remember to replenish whatever you use from your kit, and to keep an eye on expiration dates of medications/ointments.

Medication management

If you’re on medication long term (antipsychotics, antidepressants, statins, anticonvulsants, immunosuppressants, insulin etc.) you should have a two week overlap period; where possible, you should order a refill of your medication two weeks before your current supply runs out, so that if there are supply issues, you’re not going to be left hanging.

I’m aware this might not be possible for Americans owing to insurance and reassessment (I’m UK based, and just have to refill by filling out a form available in my GP’s office) and for those on controlled medications (opiates, methadone treatment for addiction, ADHD meds etc).

If you have medication that only requires use in emergent circumstances (ie. an EpiPen or an asthma inhaler), keep track of the expiration dates, and order a refill of your medication ahead of time. Better to have an extra inhaler knocking about for a couple of weeks than to really need one and not have it.

First Aid for Dummies & How to Get First Aid Training

Aif you’re ‘fresh out the womb’ new to first aid, or live somewhere where medical care is inaccessible, I highly recommend Where There Is No Doctor by David Werner and Carol Thuman, which gives step by step guides from scratches, scrapes and rashes up to emergent wound care. It’s not an exaggeration to say that that book kept me and my siblings alive for the first few years of our existencewhen we lived on the edge of the Kalahari 120 miles from the nearest hospital.

few bits and pieces of first aid I’ve picked up, both from training and being the world’s clumsiest son of a bitch:

Z-wrapping for wrists and ankles, especially if you’re prone to sprains. I don’t know how to explain this in a coherent way, so I’ve linked a video of how to do it.

For deep cuts or wounds that bleed a lot, you need to apply pressure and elevate the injury above the heart. It takes a nearly comically small amount of blood loss to become life threatening (blood loss equivalent to half a coke can is considered life threatening in adults) - if the blood is bright red, spurting/gushing, and the blood loss is uncontrolled, or if you have a clotting condition like haemophilia, you need to get to an urgent care centre yesterday. Call 999/911, maintain hard pressure over the wound, and keep the person calm and talking.

If someone has been stabbed an the knife is still in situ, for the love of God do not pull out the knife, or let them pull out the knife. It’s impossible to know what’s been hit without imaging, the knife acts as a seal in the wound; haemorrhage or massive internal injury are not situations you want to be dealing with outside of an acute trauma care setting. Call 999/911 immediately, and keep the injured person calm.

Learn how to recognise the signs of overdose. I went to a Midlands uni that had a reputation as a party uni, and hearing through the grapevine about ODs on nights out wasn’t uncommon. Narcan/Naloxone is a controlled substance in the UK so can’t be bought OTC, but I know it’s available to buy OTC in some parts of America and Canada. If you can, please consider carrying naloxone. If you witness an OD, call 999/911 immediately, and try to keep the person alert. If you have it, administer Narcan.

Don’t fuck with sepsis or meningitis. These diseases move fast, and can turn you into a past participle in as little as 12 hours. Get your MenACWY vaccine, know the symptoms, and call 999/911 immediately if you have the symptoms, especially if there’s been an outbreak in your area or you’ve had close contact with someone who is infected.

If you get bitten by a wild animal, (fox, bat, dog, raccoon…whatever) flushing the wound with water and then getting to A&E needs to become your number one priority. Tetanus, rabies and capnocytophaga infection are no joke: you need boosters/antibodies and antibiotics as a matter of urgency.

Finally, don’t be a hero. You are not John Wick. If someone is injured in an actively dangerous location or situation, the only thing you ought to do is call 999.

You really and truly don’t need to be able to pull a Hawkeye Pierce; the whole point of first aid is that it’s the first line of aid, and gets you to A&E or Minor Injuries so that you can receive professional medical attention.

That said, having a first aid training is incredibly valuable, both because you never know when some fuck shit is about to happen, and because by law most workplaces are supposed to have at least one first aider on staff, so it gives your CV an edge.

In the UK, the St. John Ambulance Trust offers workplace first aid certification, annual refreshers, sports first aid training, AED use & CPR certification and mental health first aid training.

You can also get personal first aid training for adults, children and babies with the British Red Cross for the cost of £37.50, as well as certified workplace first aid certification from £165.

The British Heart Foundation offer CPR training for free via their RevivR program; it takes 15 minutes, and can be used for workplace certification.

[lifewithchronicpain]

Dr. Charles LeBaron is a medical epidemiologist who worked for 28 years at the Centers for Disease Control and Prevention. LeBaron was not directly involved in the development of the CDC’s 2016 opioid prescribing guideline, but knew colleagues who were and largely supported their efforts.

Then LeBaron developed crippling pain from a meningitis infection and learned firsthand how the CDC guideline was harming patients. While hospitalized, he screamed into his pillow at night because a nurse -- following the CDC’s recommendations -- gave him inadequate doses of oxycodone. The pain relief only lasted a couple of hours, and then he had to wait in misery for the next dose.

“I hadn't experienced the pain so that many patients feel, so I hadn't had the level of sensitivity to the issue that would have benefited me. It took full personal experience to straighten me out,” said LeBaron. “You'd rather be dead than in pain. In that bubble of pain, it really is life changing.

“Once you experience that, you tend to view things very differently through a very different lens. At least that was my experience. There was nothing like being in acute pain.”

LeBaron eventually recovered from the infection and no longer needed oxycodone. But his experience made him wonder if the CDC -- his longtime employer – made mistakes in developing the opioid guideline. That’s when he saw the CDC’s push to limit opioid doses was based on weak evidence and the false presumption that many patients quickly become addicted.

Most of all, he was shocked at how quickly the CDC’s guideline was adopted throughout the healthcare system. He’d never seen anything like it, in all his years at the agency.

“Most of the recommendations we come out with, that people should eat right, exercise or whatever, no one ever bothers doing. We have a tough time getting people to do things. This recommendation? They just had remarkably fast implementation,” LeBaron told PNN…

…“The problem here was not the motivation, the notion that if you can kind of reduce prescription opioids, maybe you'll reduce subsequent addiction. The problem was not looking at the thing sufficiently quantitatively and then not checking the consequences, or at least responding to the consequences when they're brought to your attention.”

People working in public health are normally careful about tracking the outcomes of their policies. But before and after the CDC guideline, the agency turned a deaf ear to a chorus of complaints that it was forcing patients on long-term opioids into rapid tapers that resulted in uncontrolled pain, withdrawal and even suicide.

Worst of all, the number of fatal opioid overdoses doubled to over 80,000 annually after the guideline’s release, an outcome that demonstrated CDC had gone after the wrong target at the wrong time and with the wrong solution.

“The typical person who's having an overdose is a 30-year-old male taking illicit medication. The most typical person who's getting chronic opioids for pain would be a 60-year-old woman with a variety of rheumatological conditions. So you're aiming at a completely off-center target,” LeBaron explained.

“Then subsequently the data started coming in that, in effect, you are worsening the situation. If you take people who really need pain control off their meds, in a sense, it normalizes illegal acquisition. (Read full article at link)

I don’t generally wish chronic pain on other people. But I tell you what, if doctors having an experience with under treated chronic pain is what it takes to give them some fucking perspective and empathy on the opioid crisis, then so be it. I hope they all do.

[laurellynnleake]

🚨 COVID19 WEATHER REPORT: HOLIDAY SPIKE RAGES ACROSS USA 🚨

1/1/2024: Okay! Things are bad! We're JUST beginning to see how many people caught COVID-19 during the holidays. Right now it's moving through the USA causing AT LEAST 2 million infections per day (and that's the under-counted government numbers alone).

During this surge, ~100 million people total (~1 in 3 people in the US) will likely get COVID. Different areas will peak at different times, so keep an eye on your local numbers.

Reminder: All our viral data (recorded infections, deaths, wastewater viral count, etc) works on a 2 week delay - the length of COVID-19's initial acute phase where people are contagious and shedding viruses.

We want to slow the current spike down as much as we can by using respiratory masks like N95s, air filtration, and isolating and testing for COVID-19 multiple times after exposure. Hopefully we'll hit the peak soon (and not get hit as hard as Omicron in 2022).

DON'T GIVE UP HOPE! RESPIRATOR MASKS STILL PROTECT US

Respirator masks like N95s and KN95s use electrostatic filters that block at least 95% of dangerous virus-carrying respiratory aerosols, and can be adjusted to fit snugly around your nose and mouth. The few viruses get in, the less "sick" you'll get during the acute phase, and the less long-term damage they'll cause to your vascular and immune system (aka Long COVID).

If you are sick, please stay home and REST for as long as you can - the goal is 14 DAYS even if the surface symptoms seem "mild". People physically need rest to prevent worse damage to our organs. We need immediate emergency aid from our local and federal government to keep people staying HOME and fed and with medicine like Paxlovid.

If you are forced to work while sick, please wear a well-fitted N95/KN95 respirator mask to prevent further outbreak (but surgical/cloth masks are better than none). Avoid CROWDED PLACES, COVERED SPACES, and CLOSE CONVERSATIONS. Stay hydrated and eat easy, bland food, keep cleansing your sinuses and throat with nasal sprays/CPC mouthwash, and take ibuprofen/aspirin instead of tylenol for pain. If you keep struggling to breathe and you can't get enough oxygen, you need emergency hospitalization (look for blue/purple/grey tips to fingers, tongue, lips).

Please take care of yourself and each other! We will get through this.

[savrenim]

not to be another donations post but you may remember how over the summer we had massive amounts of plumbing problems and other unexpected moving costs? well. after proceeding to work every single hour available to me for six months, take no holidays whatsoever, and budget the hell out of every aspect of my life, I was actually on track to pay everything back and maybe have a little bit of wiggle room by the time summer came around!

and then we got a call from the vet about routine labs saying that if we didn't take Suzy in to an emergency specialty hospital immediately, she would die within in a week, she might die anyways if we took her there, but it was our only chance to have a few more months with her. after an extremely difficult household discussion, we decided that we needed to do as much as we could for her. she's been a beloved member of the family for 18 years. we were not going to abandon her in her hour of need.

with two days at the specialty hospital, the prognosis was better than we could have possibly hoped! the most important thing is she does not have heart problems at all, which means that we can treat her chronic kidney disease with normal IV fluids and with careful treatment she could easily be with us for years to come. the timely intervention also may or may not have saved her from acute kidney failure too, we'll know when we go back to the vet on Wednesday to get her blood checked where her levels have stabilized at.

two days at the specialty hospital means we are also down $3652 , and no longer are on track to pay back everything by July when it comes due unless a couple of uncertain things going forward Go Right, I do not trust everything to Go Right, and we're also still uncertain about what long-term treatment going forward is going to cost.

I still have my ko-fi and my patreon, but honestly, I'm aware that everything is tight for everyone always and there are also a lot of causes that need money right now and in the face of that "hey my family went super out on a limb to try to save our cat and would love some help not falling off" feels kind of shallow. but like. not to sound dumb or like a youtuber or podcaster, but, like. honestly I think the Most Helpful Thing that anyone could do for me right now is take a fucking HelloFresh link that will send you a "free" box for cost-of-shipping ($7ish?) if you Sign Up For An Account that you can then cancel Immediately After The Box Has Shipped and Never Give Them Any More Money Than That and get Six To Ten Meals Out Of It, and for getting someone to "sign up", they will give me a free box too. like. if 13 people are willing to take a link then I don't need to worry about food for the next three months. which would be. HUGE.

so I guess.... dm me if you want a link? otherwise expect to see a lot of promotion of my writing/ patreon as I scramble the hell to try to make this money up

[theculturedmarxist]

Although many Canadians act as though the pandemic has ended, the airborne virus that causes COVID-19 continues to evolve at an amazing pace with devastating consequences for both individuals and the public at large.

The pandemic may no longer be a major conflagration but it still kills about 140 Canadians a week while morphing into a steady viral blaze sustained by dirty air, waning immunity and overt political indifference.

What was once a giant wave of acute illness has become a series of often unpredictable wavelets driven by ever-changing variants that can cause chronic illness. Long COVID, a disabling health event that can affect multiple organs and destabilize the immune system, now affects millions and continues to claim new victims.

A 2023 Danish study recently confirmed that about 50 per cent of those diagnosed with long COVID fail to improve 18 months after infection regardless of the variant.

Long COVID has taken a huge toll among health-care workers. Anywhere from six to 10 per cent of Quebec’s health-care workforce, for example, has been derailed by long COVID.

Seventy-one per cent of health-care workers impaired by long COVID reported that their state of health now interferes with their ability to function. Another 16 per cent said that they are often unable to work. Multiply this data across the country and then ask: How sustainable is this trend?

The cost of living in a ‘viral soup’

While the media focus concern on the potential next big nasty viral wave, evolutionary biologist T. Ryan Gregory says that threat seems less likely than before, but the current reality is nothing like normal.

“We are not dealing with Omicron-like waves but a viral soup,” Gregory told The Tyee. “We are seeing a near-constant high level of hospitalizations that falls just below overwhelming them but is nonetheless unsustainable. More health-care workers are getting sick and that just adds to the strain on the whole system.”

What worries Gregory, an expert on the evolution of COVID variants at the University of Guelph, “are the long-term effects of multiple infections and the sustained pressure on the health-care system and well-being.”

Yet the current impact of COVID — measurably higher than at some previous points during the pandemic — remains largely ignored or poorly reported.

Tara Moriarty, a University of Toronto infectious disease expert and co-founder of COVID 19 Resources Canada, recently tallied the imperfect data, and it is bracing. She calculates that about one in every 23 Canadians is now infected with COVID. We are not at the low point of the pandemic in Canada. To the contrary, compared with a previous time during the pandemic, infections are 25 times higher and the rate of long COVID is 19 times higher. Meanwhile the hospitalization rate is 13 times higher and deaths are 25 times higher.

In the middle of October, Moriarty calculated that COVID patients occupied about nine per cent of intensive care beds and 21 per cent of hospital beds across the country. (The average hospitalization rate during the pandemic has been seven per cent.) The estimated cost of this sustained viral assault is $274 million a week.

Governments peddling denial

Most governments seem intent on diminishing or hiding these realities. They avoid any talk about the effectiveness of masking in public places or the value of improved ventilation and filtration in schools and workplaces. It’s a demonstrated fact that the virus travels through the air in tiny smoke-like aerosols that can infect people at much greater distances than six feet, but the natural responses to this reality are not encouraged by our leaders.

Alberta, for example, now pretends that COVID is just another mild respiratory disease and reports its doings along with influenza and RSV activity.

Despite this push for “normalization,” only one disease stands out as a routine killer and dominant occupant of hospital beds on the province’s “respiratory virus dashboard.” And that’s COVID. COVID also dominates outbreaks in Alberta’s hospitals and long-term care facilities where masking and attention to ventilation have become haphazard practices.

Lumping COVID in with other respiratory diseases is also patently misleading. A recent Swiss study compared hospitalized patients infected with COVID and those infected with the flu. Those with COVID had a 1.5-fold higher risk of dying in hospital up to 30 days after infection than patients infected by influenza A. The death rate was even higher for unvaccinated people.

A 2023 Swedish study also found the death rate from Omicron greatly surpassed that of influenza patients.

And next comes the increased risk of cardiovascular problems. Medical researchers have long observed strokes and acute myocardial infarctions in patients after respiratory infections, such as influenza. But COVID breaks the mould here. Compared with patients with the flu, the risk of stroke is more than sevenfold higher in COVID-19 patients.

This is likely tied to the fact that COVID can inflame the vascular system through which the body’s blood travels. New non-peer-reviewed evidence suggests that even a mild infection can temporarily damage endothelial cells that line the interior of blood vessels.

COVID may begin with the symptoms of a cold or flu for most people, but it often ends as thrombotic or vascular disease in a small percentage for reasons researchers don’t clearly understand. The virus can therefore infect multiple organs from the brain to the kidneys.

Immune systems and long COVID

COVID can also unsettle the immune system by damaging T-cell response, as recent studies have illustrated.

These findings make all the more illogical the current, widespread blasé attitude towards the ever-evolving virus.

Let’s begin with diabetes, which itself stresses the immune system and makes it less effective.

Early in the pandemic, researchers suspected there might be a connection between having COVID and later developing diabetes. Now it’s confirmed. Earlier this year the Smidt Heart Institute at Cedars-Sinai organization in Los Angeles found that a COVID infection dramatically increases the risk for developing Type 2 diabetes and that this risk continues with Omicron variants.

“The trends and patterns that we see in the data suggest that COVID-19 infection could be acting in certain settings like a disease accelerator, amplifying risk for a diagnosis that individuals might have otherwise received later in life,” noted Susan Cheng, a senior author of the study and a professor of cardiology.

Another study found that the incidence of diabetes in Black and Hispanic youth has increased by 62 per cent since the pandemic. The authors noted that COVID can bind to receptors in the pancreas, resulting in damaged cells.

A Canadian study also found steep increases in diabetes after COVID infections. University of British Columbia researchers examined a large population of British Columbians (more than 600,000) and discovered that people infected with COVID had a 17 to 22 per cent higher risk of developing diabetes within a year compared with uninfected people.

Concluded the researchers: “SARS-CoV-2 infection was associated with a higher risk of diabetes and may have contributed to a three per cent to five per cent excess burden of diabetes at a population level.”

Related research has also demonstrated that COVID infection can trigger or lead to a variety of autoimmune disorders.

One recent Lancet study that looked at nearly a million people who were unvaccinated between 2020 and 2021 found that COVID cases experienced much higher incidence of autoimmune disease than non-infected people.

These autoimmune conditions included rheumatoid arthritis, systemic lupus erythematosus, vasculitis (inflamed and swollen blood vessels), inflammatory bowel disease and Type 1 diabetes mellitus.

A similar German study, which has not yet been peer reviewed, evaluated a cohort of 640,701 unvaccinated individuals with PCR-confirmed COVID infection during 2020 for the risk of autoimmune conditions. The researchers identified “a 42.6 per cent higher likelihood of acquiring an autoimmune condition three to 15 months after infection” compared with a group of 1,560,357 individuals who weren’t infected.

The researchers also found that a COVID infection “increased the risk of developing another autoimmune disease by 23 per cent” in individuals with pre-existing immune conditions.

The autoimmune studies confirm that COVID can be a significant immune deregulator. The Yale University immunologist Akiko Iwasaki, who has dedicated her lab to studying long COVID, notes that “there's misfiring of the immune response happening in the severe COVID patients that lead to pathology and lethality.” Even a mild infection can lead to this misfiring and long COVID, and this group tends to be women between the ages of 30 and 50.

Reinfection is no trifle

The autoimmune studies, of course, don’t tell us anything about the current crop of variants and what autoimmune or cardiovascular diseases they might trigger in the future. But the precautionary principle would suggest avoiding infection.

The highly regarded U.S. epidemiologist Ziyad Al-Aly, who also studies long COVID, has been very clear about the hazardous consequences of reinfection in terms of chronic disease such as diabetes, brain inflammation and heart disease: “Two infections are worse than one and three are worse than two.”

His most recent research shows that people with mild infections are still at risk for chronic disease two years after the fact. Patients who were hospitalized with COVID were at even greater risk for chronic complications.

“The concern here is that this pandemic will generate a wave of chronic disease that we did not have before the pandemic,” Al-Aly, chief of research and development at Veterans Affairs St. Louis Health Care System, recently told Euronews Next.

“Even when the pandemic abates and is in the rear-view mirror, we will be left with it after the fact in the form of a chronic disease that for some people may last for a long time or even a lifetime,” added Al-Aly.

The Tyee has repeatedly reported evidence that immunity to COVID from natural infection or vaccination is not long-lasting because of the nature of the virus.

The research now confirms that infections can even leave some people more vulnerable to reinfection. A startling Canadian study published this year looked at 750 vaccinated elders at long-term care facilities where COVID deaths continue to be high. They found infection with Omicron in its first wave actually made these inmates more susceptible to reinfection in subsequent waves. Counterintuitively, these people were more prone to reinfection than patients who had never experienced COVID.

“Our current vaccine schedules are based on the assumption that having had an infection provides some level of protection to future infections, but our study shows that may not be true for all variants in all people,” noted Dawn Bowdish, an immunologist and one of the study’s authors.

What our health leaders should be saying

The implications of these findings are plain enough. The pandemic has a long tail, and it can be found in a growing population of people experiencing chronic disease. Therefore, limiting transmission is still the most important public health goal.

We know how to do that but are reluctant to employ the tools. Masking in crowded public spaces or poorly ventilated buildings during periods of high infection is a proven viral risk reducer. Cleaning dirty air in workplaces and schools removes the virus and other pollutants such as wildfire smoke and should be an urgent public health crusade.

We might all take inspiration from what happened at one Australian school. Concerned parents studied airflow and then installed HEPA filters with the result that improved air circulation stopped COVID transmission dead.

Rigorous surveillance testing is also essential to inform citizens of the advancing or retreating COVID risks.

Vaccinations play a role because they can significantly reduce the risk of hospitalization, death and long COVID. But current vaccines will not stop transmission. Or end the pandemic.

In a recent study a group of U.S. researchers modelled a variety of paths that COVID might take in the future.

If repeat infections and vaccinations actually work to improve immunity and dent the pandemic over time, then models suggest infections and the incidence of long COVID should decline too.

But as Omicron demonstrated, community immunity is unlikely to be achieved via existing vaccines and especially at a time when vaccine hesitancy is rising.

In one pessimistic scenario the researchers posited that “a first infection may provide partial protection against a second infection” but the combination of new variants and complexities surrounding immune responses “could then increase the susceptibility to tertiary and quaternary infections.”

That means a good proportion of the population could end up with long COVID in the absence of effective public health measures and the development of a durable, transmission-blocking vaccine.

“More pessimistic assumptions on host adaptive immune responses illustrate that the longer-term burden of COVID-19 may be elevated for years to come,” added the researchers.

[skaylanphear]

The Marauders

Summary: Heading to Hogwarts for the first time, Remus tries not to let his worries get him down. He has a lot on his plate—truths he can’t share with anyone—and none of it is helped by the bullies constantly casting jinxes and calling him nasty names. Despite it all, though, he has his three best friends—the first friends he’s ever made, in fact.

Yet, it doesn’t take long for Sirius to start getting suspicious, questioning what strange sickness could be keeping Remus in the hospital wing for days at a time. Ever nosy, Sirius takes it upon himself to unravel the mystery that is Remus Lupin, unaware of the tortured consequences that come with knowing such an intimate secret.

A story about the Marauders as they navigate their school years and set off into adulthood.

Year One: The Marauders and the Shrieking Shack - Chapters 1-25 Summer 1972 - Chapters 26 - 34 Year Two: The Marauders and the Counting Curse - Chapters 35 - 68

Start Reading Here

Chapter 21

Coming back from Easter Holiday really hammered home how irritating the change in attitude was to each of the boys. Despite being in the best part of the month, Remus was still exceedingly annoyed with coming back only to be treated like he was made of glass by all the older students in their house. They'd apparently decided to double-down on trying to be nice to the first years, which only reminded Remus acutely of his days in the hospital wing right after full moons—when everyone was always so careful and needlessly kind. He appreciated it during those specific times—especially from his friends—but it was maddening otherwise.

James was starting to get miffed about it too. While he certainly wasn't a people pleaser in the vein that he wanted everyone to like him, he did want people to like him for who he was, not because they thought he was a pity case. Getting attention from the other Gryffindors every time they walked into their common room or into the great hall only rubbed him the wrong way. Especially after two whole weeks at home with his parents, who knew exactly the kind of person he was, good and bad alike.

Sirius was surprisingly short-tempered about it. "It's like this big fake front!" he said. "They're all pretending! It's just like with my whole family! We know they don't actually like us!" After being locked up in the Black House for two weeks, this frustration was relatively reasonable.

Peter was mostly upset because it was continually making his friends upset. Besides, they were still getting harassed and jinxed by the Slytherins (though less than before) which, to him, meant the change wasn't drastic enough to warrant attachment. He'd rather his friends went back to normal than have other students being overly nice.

"So how are we gonna do it?" James asked near the end of April. "Spill the beans, I mean."

"I was thinking we should do it at the end-of-term feast," Remus replied, the four of them sitting around in their dormitory. They did that more and more often these days. But going out by the lake or into the courtyard had long since ceased being safe, no matter the warmth of the weather. "Announce it so everyone hears."

"And then run away," Peter added meekly.

"Oh, I have an idea," Sirius said, grinning. And so they got to planning. Thankfully, such an announcement didn't take nearly the effort their other endeavors did, so once planned, all they had to do was wait. This meant their focus returned again to their swiftly approaching exams.

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[covid-safer-hotties]

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Another great reason to keep masking: We don't even have a good treatment for long covid yet, and many doctors know simply nothing about the condition.

Global efforts to understand and manage long Covid post-pandemic, with varied symptoms and limited treatment guidelines worldwide

Doctors in India are grappling to diagnose and treat unexplained and persistent symptoms of long Covid patients due to limited guidelines, whereas researchers have flagged inadequate studies on the condition.

With the World Health Organization declaring an end to COVID-19 as a global health emergency in May last year, focused efforts are underway around the world to estimate the burden of long Covid among the population.

The condition refers to the set of lingering symptoms affecting varied body parts and persisting well beyond the acute Covid infection period, including cough, muscle and joint pain, fatigue, brain fog and difficulty in focusing. The viral disease is caused by the SARS-CoV-2 virus.

While studies have suggested that about a third of those moderately or severely infected are likely to suffer from long Covid, region-wise though, incidence could vary.

A study by researchers, including those from Harvard Medical School, U.S., estimated that 31% of the once-infected people in North America, 44% in Europe, and 51% in Asia, have long Covid, which is “challenging the healthcare system, but there are limited guidelines for its treatment”. It was published in the International Journal of Infectious Diseases in September.

In India, however, studies on long Covid are few and far between.

One such study by Maulana Azad Medical College in New Delhi, conducted from May 2022 to March 2023 on 553 patients who had recovered from Covid, found that about 45% had lingering symptoms, persistent fatigue and dry cough being the most common.

“There is limited exploratory research on the long Covid syndrome with scarce data on long-term outcomes,” the authors wrote in the study published in the journal Cureus in May this year.

Understanding the long-term effects of the virus is important for developing management strategies, optimising healthcare delivery, and providing support to recovered Covid patients in the community, they said.

Dr Rajesh Sagar, Professor of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, said, “Looking at the current state of long Covid studies in India, it is too premature to say that we understand the condition well enough to know how to diagnose or treat it.”

Animesh Samanta, assistant professor at School of Natural Sciences in Shiv Nadar University, Greater Noida, said, “While studies in India highlight the growing recognition of neurological complications in long Covid patients, more focused research on neuroinflammation is needed.”

Doctors, too, have reported a rise in patients complaining of symptoms that they did not have pre-Covid. “People who never had asthma in the past, post-Covid, with every viral infection, they get a long cough, shortness of breath and wheezing, which require the use of inhalers or nebuliser,” senior consultant Dr. Neetu Jain, who runs a post-Covid care clinic at Pushpawati Singhania Hospital and Research Institute, New Delhi, said.

Dr. Arun Garg, chairman, Neurology and Neurosciences, Medanta-The Medicity, Gurugram, said that he was noticing a spike in stroke cases among young patients not suffering from known risk factors such as diabetes, hypertension and obesity.

“Similarly, we are seeing more cases of encephalopathy (swelling of the brain) without reason and having a confused state of mind following one or two days of fever. Their MRI scans show no changes. These patients have increased significantly after Covid,” he said.

In the absence of medical guidelines to diagnose long Covid, doctors are having to resort to broad, non-specific tests and questionnaires to gauge a patient’s ‘quality of life’.

Studies have shown that the fatigue experienced in long Covid is similar to that in cancer patients, with a quality of life similar to patients of Parkinson’s disease.

“We really do not have any test to diagnose long Covid, even though it is definitely a clinical diagnosis. We diagnose long Covid for people who had at least moderate to severe infection, following which they could never regain the quality-of-life pre-Covid. Checking for inflammatory markers like C-reactive proteins (CRP) can support the diagnosis,” Dr. Jain said.

“Other than routine blood tests that measure inflammation, we do antibody tests to look for direct markers. In many of these patients, we are finding rare antibodies which are very new to us and were not there pre-Covid,” Dr. Garg said.

Inflammation persisting despite recovery from acute Covid infection is thought to lie at the heart of long Covid. However, tests to measure this specific immune response are lacking, even as researchers have been working in this direction worldwide.

One such effort comes from Shiv Nadar University, where a team led by Mr. Samanta has developed a fluorescent probe capable of detecting inflammation in brain cells that can arise due to Covid infection.

The probe measures nitric oxide levels in brain cells, especially in human microglia cells, where increased NO levels are linked to the SARS-CoV-2 infection. Microglia are immune cells in the brain that fight disease and help maintain brain health.

Lysosomes within microglia, which help clear foreign disease-causing agents like the SARS-CoV-2 virus, produce nitric oxide as part of an immune response to infection. The probe detects nitric oxide produced in lysosomes in response to infection and thereby allows for a measurement of inflammation levels.

This examination method can provide “qualitative information on infection status”, said Mr. Samanta, corresponding author on the study published in the journal Analytical Chemistry in American Chemical Society.

He explained that patients with pre-existing conditions such as Alzheimer’s disease, Parkinson’s disease or multiple sclerosis (an autoimmune disorder) could exhibit prolonged neuroinflammation and loss of brain cells following Covid infection.

While the probe has shown efficacy in cell cultures, animal studies would need to be done, before testing it in humans, Mr. Samanta said.

Looking at the World Health Organization International Clinical Trials Registry Platform, the study by Harvard Medical School had found that 587 clinical studies were conducted on long Covid, of which about 53% (312) were testing potential treatments.

Most of these were found to be conducted in the U.S. (58), followed by India (55) and Spain (20). The trials looked at interventions including physical exercise, psychotherapy, and pharmacological ones such as paxlovid and fluvoxamine.

However, “to date, only 11 of these 312 studies have published their results that were not confirmative,” the researchers wrote.

The team called for studies to look into sleep disorders which were rarely included in the registered clinical studies. Further, interventions targeting the biological processes responsible for long Covid are needed but currently lacking, they said.