#no kidneys required

[liveontelevision]

I beg of u pls more slowburn luci... I'm starved... No one writes him as well as you💔 I'll give you my kidneys 💔

THIS ONES FOR YOU BB

Did it Hurt? Lucifer x Reader

enjoy some quick fluff >:)

♡♡♡

Lucifer always had a habit of losing his temper. It wasn't often, usually when a specific document was giving him a hard time or when he would return from any meeting that took place at Heaven's Embassy. Or, with the relocation of his quarters, whenever a certain radio demon would push his buttons just a bit too much. You've seen it enough times to know when to leave him be and when to step in, but you hated to admit how familiar you became with him in this state.

It was a lot of work keeping up with the hotel after its renovation, and Lucifer did everything in his power to keep the hotel running behind the scenes, so Charlie could focus on her new residents. Being his assistant for so many years, even following him to work at the hotel, you were absolutely delighted to see him so passionate to work, obviously motivated by his rekindled relationship with his daughter. But with the whole redemption premise, it meant a lot more contact with Heaven, and that drained his battery more than anything you've seen.

You hated to compare, but it almost reminded you of his depressive episodes after Lillith disappeared. He walked the halls in a daze, putting on the brightest smile only around the other hotel staff, but you knew him too well to be fooled by his lovely grin.

Throw some drinks into the mix? You'd witness a truly gruesome sight.

It was almost evening when Lucifer realized he actually had caught up to his work and had the chance to enjoy his night. His first thought, no matter how much he'd deny it, was to find you. It was always easier to enjoy his rest and relaxation when you were around. Something about you just left that affect on him. It'd drive him crazy if he thought about it too long.

You found yourself in the newly renovated lobby, still decorated with a bar that exentuated both Lucifer's and Alastor's aesethetic. It was one of the few things they had compromised on.

Lucifer insisted you stop work for the night, but you only agreed after thoroughly skimming over his documents to see if there was anything that would keep him up too long. After finally being swayed, you give him a quick pat on his arm and wished him a good night, assuming he would take the oppurtunity to sleep through his newfound free time.

With a satisifed sigh, you slammed your empty cup on the bar's counter, shouting for another. There was a loud roar of cheers coming from everyone around you as Husk refilled your glass. You lost count after the first hour or so, your head beginning to spin before you could consider the consequences. Soft Jazz music was playing from a small radio, hidden from view, and the entire hotel staff was bustling and chatting as if it wasn't nearly midnight on an average night in Hell.

You had heard something particularly ridiculous from Angel that sent you into a laughing fit. Nearly falling from your barstool, you felt a sturdy hand brace the small of your back. Startled by the sensation, you whip your head around a little too quickly, leaving you dizzy and blinking before focusing in on Alastor keeping you upright.

"Careful, my dear! I enjoy the festivities as much as the next depraved sinner, but we can't have the king's secretary hurting themselves now, can we?" His words seemed rude, but he managed to say them with a charm that prevented you from truly questioning it. It didn't stop you from mumbling under your breath, "i'm not his secretary.. asshole deer demon - " You managed to say it quiet enough that he didn't react, but you did catch his ear twitching and turning torwards you for a second. You quickly resumed some random conversation with Charlie or Vaggie, you couldn't remember its contents if you were asked about it today, but it was better than dealing with the repercussions of insulting the radio demon.

It went back to being chummy and pleasant for a moment before you saw Charlie peering past your shoulder, an excited gasp escaping her lips.

"Dad! Come drink with us!" Charlie leaned back from her barstool, Vaggie bracing her drunken sweetheart from falling flat on her face. You quickly turn, dizzying yourself again, before seeing Lucifer making a hasty decent down the stairs. His hair was freshly quaffed, and he wore a clean white dress shirt, that smelled of a sweet cologne when he walked past you. He had that twinkle in his eyes that would appear whenever he was in Charlie's presence. You loved seeing his eyes that way. They'd shine no matter how heavy the bags under them were.

"Of course, kiddo! Your old man's got the night off if you'd believe it! Pour me a.. uh... something strong!" He puffed his chest out proudly, happy to spend some much needed time around demons in a casual setting. He propped himself against the counter between you and Charlie. When you finally caught up to his words, your eyes widened slightly, giving him a gentle tap on his shoulder. Lucifer turned to look at you, and you caught him speechless for a moment. Your cheeks were red and hot, your eyes dazed and a bit watery from laughing too hard, but still reading concerned for some reason. He's seen you in loungewear before, but you were barely put together in this state. Your hair was sprawled across your shoulders, a few strands blocking your eyes. You wore sweatpants that loosely hung from your waist, revealing your middrift that was visible from underneath your cropped t-shirt that bagged off your shoulders. After snapping back to reality, Lucifer let out a breath he hadn't realized he was holding in.

"Yes, yes, dear, here I am. Hope you've been having fun - but not too much! Fun.. Aha... what-what is it, what do you need..?" He stumbled over his words, attempting to be charming but failing miserably. A staticky chuckle responded to his words before you could get out what you wanted to say. "Poetry, your highness. True poetry~" Lucifer hated to look away from you but did so anyway to send a red eyed glare to Alastor, who sat across the bar. He scoffed before scooping his freshly poured drink into his clawed hand and taking a quick swig, slamming it back down. He coughed for a moment, hitting his chest with a balled up fist before sending Husk a teary-eyed thumbs up. "Smooth.. Another..!" He squeaked out. You resorted to taking a soft grip on his forearm after he got too distracted to hear you out before.

"Sir, be careful! We both know you can't hold your liquor.. just - be careful." You spoke in a hushed tone, far closer to his ear than you intended to be, but personal space became foggy in your drunken state. He shivered, feeling your breath against the side of his face, then quickly turned his head up to hide the red creeping across his cheeks. Clearing his throat and picking up his refilled glass, he let out a pompous laugh.

"Thanks for worrying about me, but i'm fine! I'm the king of Hell! I can handle my.. whiskey?" He turned to Husk with a confused look on his face, only to get a confirmation on his drink. He sent a charasmatic smirk in your direction after getting a thumbs up from the bartender. You couldn't help but giggle, covering your mouth to not embarrass him or yourself. He always eased your nerves like this.

What a dork.

You smiled to yourself for a moment before feeling a hand brush the hair that laid across your eyeline out of the way and tucking it away behind your ear. You looked up, fluttering your eyelashes as your eyes focused in on the figure. You turned red seeing Alastor brushing his claws across your hair to keep it away from your face. Without proper judgement, you cringed at the suddenly intimate interaction and jolted away from his clawed hands.

"Now, now, I'm only trying to help! You look an absolute mess, darling." You shrunk at Alastor's words. He still spoke charmingly, but it was clear he had a few drinks as well. You let out a nervous chuckle, running your hands through your own hair and crossing your arms over your exposed middrift.

Lucifer's seen you stick up for yourself before. You were as passionate as he was in that sense. So seeing you almost curled up into a ball at Alastor's words, that were spoken closer to your face than he'd ever want to see, made him growl. "Keep your distant, buddy, maybe you should call it night. If you know what's good for you, that is." Lucifer's confidence only grew with the alcohol finally hitting him. He laid his arm across your shoulder, slightly leaning you away from the demon that towered over the two of you. Alastor found a weakspot and knew exactly what to do with it.

The chatting went on for another hour or two. After Lucifer was calmed down by Charlie and yourself, you all managed to have a decent time until demons started heading back to their rooms one by one. Lucifer was going on a rant about some bullshit documents that Heaven sent and how he'll have to set an appointment to go to the embassy soon, while you propped your head on your hand and only half listened. It wasn't because you were disinterested, you were just coming off your high. You still weren't sober enough to warn Lucifer that he probably had one drink too many, but that was a problem for later.

"Why not send your little servant to deal with Heaven, hmm? I've seem them dealing with plenty of your problems, i'm sure another burden won't hurt, wouldn't you agree?" A wave of radio static washed over your body as you felt large hands fully encase your shoulders. Alastor's claws were cold against your skin, your shoulders exposed by the drooping of the oversized shirt you wore. When he was drunk, his little quips seemed much more personal.

You let out a sarcastic laugh, carefully pulling your torso away from his grip." Ha ha ha. I'm fine, Alastor. I can handle myself, even against Heaven. If i have to, I could totally deal with an angel!" You bragged, maybe the confidence of alcohol made you respond, maybe something else.

"How about you? Think you can handle an angel, Al?" Lucifer added to your words, his arms across his chest. Alastor's eye twitched, his clawed fingers digging into his dress shirt where he was nearly killed this past extermination. The static in the air crackled louder for a moment, before Alastor spun you around to face him. His hands were planted firmly on either side of the chair, caging you in uncomfortably.

"Oh rest assured, sweetheart, I'm fully capable. If you ever need.. protection.. on one of your little errands, do let me know, hm? Maybe you'll need a gentleman to accompany - " He slowly moved in closer to you, until your could barely hold yourself up, your breath hitching as you lost the strength to handle his exessive teasing. Lucifer ripped on of Alastor's hands away, before pulling you from your seat and holding onto your arms to brace you from the quick movement.

"Back the fuck off, bitch." Lucifer's eyes were glowing a familiar red, his teeth snarling at Alastor, who was standing with a playful glint in his eyes.

"Oh dear, did I make a mistake? Is someone a bit protective? Best not lose this one, your higness!"

Damn, that's cruel, you thought, wincing at his words.

You hadn't even confessed any feelings, not that they were clear to you. You considered being in some sort of romantic relationship with Lucifer as your still not entirely sober mind wandered from the frightening moment.

Before you could realize, you were tossed to the side, stumbling onto the carpetted floor with a light thud. Your vision returned to see a fully demonized Lucifer, gripping Alastor's collar as he yelled out some profanities, puffs of flames leaving his mouth as he spoke. You were completely shocked to see how Alastor stood there with a grin on his face. Like he was enjoying it. You quickly stood to your feet, the adrenaline coursing through your veins being more than enojgh to sober you up.

"Sir! Stop!" You reached out and grabbed Lucifer's sleeve, only to be nudged off a bit forcefully. He definitely wasn't using his full strength to keep you away. This was one of the moments you would step out, Lucifer was always impossible to calm down in this state and the alcohol surely made it worse. He lifted his flame engulfed fist, ready to drive it directly into Alastor's shit eating grin.

"Lucifer!" You finally shouted. He paused, slowly releasing Alastor's shirt and stepping away. He scoffed and didn't even snap his fingers, yet a portal appeared behind him. You could see from the outside that it led to his office.

"You're not worth the trouble anyway, fucker." A final puff of fire left his lips as he stepped through his portal that instantly vanished. It left you alone with Alastor in the lobby, the collar of his shirt and a few of his hairs lightly cinched.

"What the fuck is your problem?? Stay away from me! And him? Leave him alone! Damnit, he doesn't deserve this..!" You huffed, making your way up the stairs. Alastor stood alone, his stature still unphased. His eyes shook and he finally let out a shakey breath once you were out of view.

●○●○●

You recognized where to find him and quickly made your way up to his tower. Sure, it stung that he would just leave you after causing such a scene, but that still didn't stop you from worrying about him.

You opened the office door slowly, peaking in to see an empty office. You stepped in and scanned the area, no sign of the king of Hell. You noticed a soft flicker of light coming from the window and went towards that direction. The large windows of the office opened up, one in particular leading to a small balcony that displayed the Pride Ring as a bustling landscape of city lights.

You let out a soft breath, taking in the view before finally seeing Lucifer sitting on the railing, his hands holding him up. The flickering that led you towards him was the flame that sat at the crown of his head, his demon form still intact. You knew it took him awhile to calm down, but you rarely got the chance to see his powerful features this close. His tail was hung over the railing, swaying like how a cats' would. His wings were fully sprawled out, only moving with his breath and his horns, a vivid red at the tips, tore through his scalp, breaking up the purity of his white flesh. The flame that sat between them was much smaller than before and his eyes were still red, but you could see his yellow irises looking down at the city. His shirt had torn from the back, you assumed with how fast the situation at the bar escalated he didnt properly consider the physical damage he'd cause. In this vision of raw power, just the sight of the back of his neck and shoulder blades peaking from his torn shirt was what made your blush.

He turned his eyes towards you, then looked back to the city, adjusting his wings so you could have some space to stand near him. At least he was welcoming you in. You carefully stepped over the ledge, bracing yourself on the railing as you got a full view of the city. The wind left a much needed cool touch to your face, making you let out a soft sigh. You propped yourself up on your elbows, bending at the hips slightly.

"You know, considering how terrible the people are down there, the city really is beautiful. From a distance." You spoke softly, testing the waters; seeing if he simply needed a distraction from the outburst." Actually, it looks pretty similar to a city on Earth. Not as busy and a lot less bloodshed, but still similar. I've never been, but this is pretty close to the pictures i've seen." You described. Sometimes the mention of Earth was good for him to hear too, so you gave that a shot as well.

"They used to be white. Sometimes in the sunlight, you could even see some gold flecks in there." He finally spoke, his voice hoarse. He stretched out his wings slightly, motioning that those were what he was referring to. You twisted around to fully face his wing that had outstretched in your direction. "They were really beautiful."

"I'n sure they were, sir. Do you like flying? I saw you doing it when you were fighting Adam, you seemed really fast." You spoke softly, deciding not to argue the fact that they were still beautiful in this state. He didn't need to debate right now. "May I?" You let your hand hover just above his feathers, the wind occasionally blowing them into your touch. He nodded, even if he was exhuasted, he still seemed anxious at the idea. You carefully trailed your fingers in the direction of the feathers, now a blood red. They were still unbelievably soft and they essentailly leaned into your touch, as you traced the spine of each feather mindlessly.

Clearing his throat and letting himself calm down from the touch, he did his best to respond." I-I used to. In Eden, I would.. mm... I had to patrol and catalog Adam and - well... any progress or changes.." he stammered out his words, occasionally stopping to let out a quiet hum." I just don't see the point anymore. Plus, it's probably not the safest bet." He let his head fall back for a moment, his wings slowly but surely pulling you towards him.

"What about your tail? And.. your horns? Those only appeared after you.. erm... after you arrived in Hell, right?" You moved on to the lower wing that was closest to you. There were some loose feathers that were sticking in all sorts of direction, so you carefully wiggled those out and continued to comb through the large span of feathers, running your nails along the very top with slight pressure. "Hng.. right, yeah. Those are newer." Was the only response he managed to get out.

"The horns.. did it hurt?" You were almost scared to ask, the idea of horns sprouting through your head and breaking your skin on multiple occasions made you shiver.

You continued to groom his wings as he responded. "T-The first time, yeah. But now, not so much. Or maybe i'm just.. I'm just used to it.. Mmh!" He winced mid sentence, his wings curling in with a jolt. You felt his tail rope itself around your wrist and hold it in place. "Oookay! That was n-nice.. thank you, but- yeahh.. Ahha.. that's enough of that." He chuckled nervously, and you looked over at him after not doing so for awhile. His face was flushed red and his chest was heaving. You couldnt tell if he was hurting or.. "Oh! Sorry! I didn't mean to.. Sorry..." you weren't exactly sure what you were apolgizing for, but considering the possiblities made you turn red.

"Nono, it's fine. It was nice, I promise." He managed to compose himself, but left his tail around your arm loosly. "But, uh, yeah! Yup! Horns are new, Tails' new. The fire's definitely an interesting choice, can't get rid of that even if i tried. And trust me, I tried." He went on, leaning back on the railing and letting his wings tuck in, but still left them in view. You let your head fall to your shoulder, cocking your eyebrow. "Get rid of it? Why? Doesn't it go away on its own?"

"After awhile yeah. But here I am, in a situation where I definitely don't need to use any of this shit - I-I don't know what it's for other than intimidation, but I still can't get it to go away on command. After all this time.. The vodka probably doesn't help either." He huffed, clearly frustrated at his physical appearance. You had taken to fiddling with the tip of his tail as he spoke. You did it much more softly, and it didn't seem as sensitive, so he didn't comment on it. But he still had a red hue across his cheeks and his tail twitched every now and then at certain touches.

You let out a quiet giggle, "It was Whiskey, but yeah i'm sure that didn't help either." You clarified in a teasing sense, then fell comfortably into a silence for a moment. You could just barely hear cars honking, gunshots and music when neither of you spoke.

"Well, if it makes you feel any better, it definitely does the job. You left Alastor shaking in his boots back there." You said with a smile, turning your head to meet his eyes. They were still mostly red, but you could see them softening just at the sight of you.

"Good! He deserves it. Sweetheart, if that prick ever does anything - "

"Don't worry, he won't. You know he only picks on me to get under your skin." You walked your fingers up his arm before seeing his fist clench at the sensation.

"I-I suppose.. I- Uhm... What are you doing..?" He started to sound nervous, but didnt pull away from you. You stopped what you were doing, realizing one hand was sitting on his thigh and the other was making its way up his arm. You yelped and pulled your hands back, placing them on your cheeks just to gauge the heat immiting from your skin.

"I-I don't know! Sorry! M-maybe i'm still drunk..! Yeah, that has to be it.." you stammered, a blushing mess. The sound of his soft chuckle was quick to ease your nerves." Maybe.. it's curiousity... Do you- not to sound weird, say no if i'm wrong - but.. you can- ahh.. touch my horns, too.. if you want - " He wasn't trying to be crude, you could tell he really just wanted to calm you down. Or maybe he just wanted to be touched. You nod your head slowly, keeping your eyes locked on his.

He shifts his positioning to face you, and leans his head down a bit. Taking each of your hands into his own, which were a bit shaky , he pulls them up to meet his intimidatingly tall horns. You basically shut your eyes in anticipation, only opening them back up when you get a good feel. They were smooth, like the surface of a violin, but they felt heavy. You wondered if they felt heavy to him. You carefully menuvered your hands around the fire that was nearly the size of a matches flame at this point, sliding up to the tips. They were ridiculously sharp. It made you more anxious than anything else, they couldve pricked your finger if you werent being careful enough.

"Remind me to remind you how sharp these are. You'll poke someones eye out if you're not careful. Unless that's what you're aiming for, then go for it." You tried speaking to him as you did this to break the intimate silence of the moment.

He let out a nervous laugh. From his view, he could see most of your stomach, more visible than before due to your reach. You actually felt a particularly heavy breath reach your middrift, making you tense up for a moment. Still, lucifer was careful to keep still after the comment on his sharp horns.

You made your way down to where they met his temples, hesitating for a moment before feeling the skin that was stretched over the bone-like features. It felt like scarred flesh. Your felt your heart drop in your chest at the sensation. When he said it hurt the first time.. the horns must've physically ripped through his skin. Without thinking, your hands trailed down to cup his cheeks, making him lift up his head with a questionable expression." So? Did you get your fill?" He asked, a stupid smirk dancing across his face. You scoffed, taking the moment to look into his red eyes. They almost hid the tiredness of his usual colors.

You noticed his eyelids begin to droop and before you knew it, your lips had brushed together in a tender kiss. You pulled him in closer, your hands still planted on his cheeks. He wrapped his arms around your waist and lifted you up to sit on the railings beside him, never breaking contact during the process. He was careful with you, even as you parted your lips to invite a heavier kiss, he held his shut. You pulled away for a moment, moving your hand to his lower lip and just lightly brushing your thumb across it. His breath became heavy at the delicate touch, his grip around your waist falling onto your hips. You left your thumb on his lip and took the opportunity to slide your tongue slowly into his mouth. He yelped, his eyes suddenly shot open at the boldness of your actions. His suddenly limp hands, almost clawing at your hips. His forked tongue eventually made his way into your mouth, still with caution. You felt the fork in his tongue and smiled into his lips, enjoying this new discovery a little too much. He melted into your touch and followed your movements, barely having the strength to keep his head up on his own. You reveled in the moment, before feeling a sharp prick on the tip of your tongue. You pulled away, giving you both a much needed break to breathe.

You run your tongue across the top of your mouth, the smallest taste of blood hitting you."Oh! Fangs!" You quickly exclaimed, the realization hitting you before you could form a real sentence. He stared at you almost dumbfounded, not sure how to respond.

Once you had both composed yourself enough, you noticed that all of his demonics features had retreated, leaving just his wings sprawled out. He let out a satsified hum as you looked into regularly colored yellow and red eyes. You ran your hair through his hair, that had become messy from the horns, and pulled him into another kiss. Lingering for just a moment, you pulled back and smiled, letting your eyes dart across all he features." You're beautiful, Lucifer~" you hummed, your thumb caressing his cheek. You almost couldn't tell, but he did his best to keep any tears from welling in his eyes.

♡♡♡

I wanna work on my multi-part series after all my exams as a heads to you lovely lil people

[bicarb-of-soda]

I'm on holiday rn but I'll post it soon dw

okay but kayne in jessica rabbit's dress

[inga-don-studio]

A few close-ups of some of the Halloween Cultural Preservation Museum displays that particularly spoke to me and frankly are just? Fantastic art? That I figure others might like to see for art inspo or just because they're cool?

"Totem pole" Halloween die-cuts, with art I've never seen and am now hopelessly in love with:

And a soft-bodied doll with a small vintage trick-or-treat bucket for a head?! I need to make one! Look at how cute this little guy is!!!

[salemoleander]

btw in case anyone is like 'wow Salem you've been weirdly offline, esp considering there's a new Life series':

Starting last Thursday night one of my teeth became excruciatingly painful, and the earliest I can get in anywhere for a root canal is Wednesday afternoon. Been alternating high doses of ibuprofen and acetaminophen and sleeping 16+ hours a day.

Will be very excited about this series/gaming with friends/etc once this is resolved, until then I'm online very intermittently

[fitnessadvicethatfitsinyourlife]

Not to be a conspiracy theorist about it, but I'm thinking about how the only two macronutrients our body can use to create ATP (the "currency" of our cells) are: Carbs & Fats

And how the two macronutrients most villainized by the diet industry are: Carbs & Fats

And how the diet/fitness industry is constantly pushing supplements to "increase energy."

And how it kinda feels like they're manipulating you into forgoing essential nutrient sources, just so they can sell you "solutions" to the problems created by those nutritional deficits.

[ace-dodo]

Do you ever have a comfort character who you love and would do anything to talk to but in reality you would want to kys if you actually interacted with them????

[green-lights-33]

Hi! I noticed your profile says you don't do commissions, and I was wondering if you accepted humble drawing suggestions for your consideration?

Love LOVE your art (genuinely makes me smile so much and giggle and kick my feet!)🖤 and there's a scene in my fic with Sirius & Reg that I would give a kidney to see drawn, but I am unfortunately so embarrasingly bad at it even stick men look wobbly when I attempt them 🫠

Not sure if it's OK to suggest it / if you'd consider drawing it - totally understand if it's not, but I thought I'd at least ask :) Thank you for sharing your talent with the world🖤

I guess i do have requests open? so by all means, shoot through an ask with whatever you’d like to see drawn!! i adore anything black brothers so i’d very much like to read the scene 😋

(i can’t guarantee that it’ll get done just cause i’m busy and i sometimes become incapable to doing something as soon as i have to do that thing.)

[mycological-mariner]

Im going to jettison my seizure alarm into the sea. Set it off painting and I immediately got 2 different people calling me repeatedly begging me to answer them, what was wrong, for god’s sake pick up or I’m calling emergency services

[kasumingo]

So I ended up reading about type 2 diabetes in case there is something I'm missing that my doctors are also missing and there are some sources saying there's no link to sugar intake and the disorder but at the same these sources talk about "high carbohydrate intake" which are... essentially sugars

But just as insulin resistance, diabetes type 2's origins are not fully known yet but can be linked not only with diet but also stress, trauma, genetics and so on and so forth

My general take is stopping giving a fuck what strangers are eating because you are not entitled nor will know everyone's disorders but also spreading information about good habits and improving your diet - not to lose weight, but to feel better.

But I still would encourage others to include less processed foods, fruit, vegetables and information how to spot better quality meals in general - not choosing cheap supermarket food if you can help it, buy high quality meat, fresh veggies and do eat comfort foods but in moderation. Not only to improve mood but also to let your body rest, because dieting of any kind can exhaust your body and the effect might be opposite to what you want to achieve.

[cherrychapati]

insisting that you need a macbook to do your work is called macademia. you're a nut.

[hehosts-moved]

.

[healixhospitals24]

Discover the importance of hydration for urinary health and find out how much water you really need. Expert tips on maintaining optimal urinary health.

Do Visit: https://www.healixhospitals.com/blogs/the-importance-of-hydration-for-urinary-health:-how-much-water-do-you-really-need

[reasonsforhope]

Article | Paywall-Free

"The Environmental Protection Agency finalized a rule Tuesday [October 8, 2024] requiring water utilities to replace all lead pipes within a decade, a move aimed at eliminating a toxic threat that continues to affect tens of thousands of American children each year.

The move, which also tightens the amount of lead allowed in the nation’s drinking water, comes nearly 40 years after Congress determined that lead pipes posed a serious risk to public health and banned them in new construction.

Research has shown that lead, a toxic contaminant that seeps from pipes into the drinking water supply, can cause irreversible developmental delays, difficulty learning and behavioral problems among children. In adults, according to the Centers for Disease Control and Prevention, lead exposure can cause increased blood pressure, heart disease, decreased kidney function and cancer.

But replacing the lead pipes that deliver water to millions of U.S. homes will cost tens of billions of dollars, and the push to eradicate them only gathered momentum after a water crisis in Flint, Mich., a decade ago exposed the extent to which children remain vulnerable to lead poisoning through tap water...

The groundbreaking regulation, called the Lead and Copper Rule Improvements, will establish a national inventory of lead service lines and require that utilities take more aggressive action to remove lead pipes on homeowners’ private property. It also lowers the level of lead contamination that will trigger government enforcement from 15 parts per billion (ppb) to 10 ppb.

The rule also establishes the first-ever national requirement to test for lead in schools that rely on water from public utilities. It mandates thatwater systems screen all elementary and child-care facilities, where those who are the most vulnerable to lead’s effects — young children — are enrolled, and that they offer testing to middle and high schools.

The White House estimates that more than 9 million homes across the country are still supplied by lead pipelines, which are the leading source of lead contamination through drinking water. The EPA has projected that replacing all of them could cost at least $45 billion.

Lead pipes were initially installed in cities decades ago because they were cheaper and more malleable, but the heavy metal can wear down and corrode over time. President Joe Biden has made replacing them one of his top environmental priorities, securing $15 billion to give states over five years through the bipartisan infrastructure law and vowing to rid the country of lead pipes by 2031. The administration has spent $9 billion so far — enough to replace up to 1.7 million lead pipes, the administration said.

On Tuesday, the administration said it was providing an additional $2.6 billion in funding for pipe replacement. Over 367,000 lead pipes have been replaced nationwide since Biden took office, according to White House officials, affecting nearly 1 million people...

Environmental advocates said that former president Donald Trump, who issued much more modest revisions to the lead and copper rule just days before Biden took office, would have a hard time reversing the new standards.

Erik Olson, the senior strategic director for health at the Natural Resources Defense Council, said that the Safe Drinking Water Act has provisions prohibiting weakening the health protections of existing standards...

Olson added that the rule “represents a major victory for public health” and will protect millions of people “whose health is threatened every time they fill a glass from the kitchen sink contaminated by lead.”

“While the rule is imperfect and we still have more to do, this is by far the biggest step towards eliminating lead in tap water in over three decades,” he said."

-via The Washington Post, October 8, 2024

[dead-ghouls]

Hello. I’m sorry for begging again but my situation is pretty dire.

Recently, I’ve been diagnosed with chronic kidney disease, stage 4. It came out of nowhere and was caught by sheer luck on an unrelated test. Stage four means my kidneys are shriveled up and almost dead - currently at only 17% working condition. When it drops to 10%, which is stage 5 (prognosis is within a year) I will require a kidney transplant and/or dialysis. You can not live without it, and prognosis for dialysis/kidney transplant patients are 10 to 20 years. I’m very young and I really would like to continue having a peaceful life and work on my art. I’ve had many hardships before - I’ve fundraised to get money for rent because of a homophobic attack I’ve suffered, I’ve fundraised to escape my country, all within 2-3 years. I’m really grateful for all the help I’ve gotten and I believe in people’s kindness.

Please, if you’re able, share or pitch in to my gfm campaign made by my fiancé. Link in the reblog.

My comms are also still open if you’d like to help in that way and get some art.

[mostlysignssomeportents]

Epic Systems, a lethal health record monopolist

Epic Systems makes the dominant electronic health record (EHR) system in America; if you're a doctor, chances are you are required to use it, and for every hour a doctor spends with a patient, they have to spend two hours doing clinically useless bureaucratic data-entry on an Epic EHR.

How could a product so manifestly unfit for purpose be the absolute market leader? Simple: as Robert Kuttner describes in an excellent feature in The American Prospect, Epic may be a clinical disaster, but it's a profit-generating miracle:

https://prospect.org/health/2024-10-01-epic-dystopia/

At the core of Epic's value proposition is "upcoding," a form of billing fraud that is beloved of hospital administrators, including the "nonprofit" hospitals that generate vast fortunes that are somehow not characterized as profits. Here's a particularly egregious form of upcoding: back in 2020, the Poudre Valley Hospital in Ft Collins, CO locked all its doors except the ER entrance. Every patient entering the hospital, including those receiving absolutely routine care, was therefore processed as an "emergency."

In April 2020, Caitlin Wells Salerno – a pregnant biologist – drove to Poudre Valley with normal labor pains. She walked herself up to obstetrics, declining the offer of a wheelchair, stopping only to snap a cheeky selfie. Nevertheless, the hospital recorded her normal, uncomplicated birth as a Level 5 emergency – comparable to a major heart-attack – and whacked her with a $2755 bill for emergency care:

https://pluralistic.net/2021/10/27/crossing-a-line/#zero-fucks-given

Upcoding has its origins in the Reagan revolution, when the market-worshipping cultists he'd put in charge of health care created the "Prospective Payment System," which paid a lump sum for care. The idea was to incentivize hospitals to provide efficient care, since they could keep the difference between whatever they spent getting you better and the set PPS amount that Medicare would reimburse them. Hospitals responded by inventing upcoding: a patient with controlled, long-term coronary disease who showed up with a broken leg would get coded for the coronary condition and the cast, and the hospital would pocket both lump sums:

https://pluralistic.net/2024/06/13/a-punch-in-the-guts/#hayek-pilled

The reason hospital administrators love Epic, and pay gigantic sums for systemwide software licenses, is directly connected to the two hours that doctors spent filling in Epic forms for every hour they spend treating patients. Epic collects all that extra information in order to identify potential sources of plausible upcodes, which allows hospitals to bill patients, insurers, and Medicare through the nose for routine care. Epic can automatically recode "diabetes with no complications" from a Hierarchical Condition Category code 19 (worth $894.40) as "diabetes with kidney failure," code 18 and 136, which gooses the reimbursement to $1273.60.

Epic snitches on doctors to their bosses, giving them a dashboard to track doctors' compliance with upcoding suggestions. One of Kuttner's doctor sources says her supervisor contacts her with questions like, "That appointment was a 2. Don’t you think it might be a 3?"

Robert Kuttner is the perfect journalist to unravel the Epic scam. As a journalist who wrote for The New England Journal of Medicine, he's got an insider's knowledge of the health industry, and plenty of sources among health professionals. As he tells it, Epic is a cultlike, insular company that employs 12.500 people in its hometown of Verona, WI.

The EHR industry's origins start with a GW Bush-era law called the HITECH Act, which was later folded into Obama's Recovery Act in 2009. Obama provided $27b to hospitals that installed EHR systems. These systems had to more than track patient outcomes – they also provided the data for pay-for-performance incentives. EHRs were already trying to do something very complicated – track health outcomes – but now they were also meant to underpin a cockamamie "incentives" program that was supposed to provide a carrot to the health industry so it would stop killing people and ripping off Medicare. EHRs devolved into obscenely complex spaghetti systems that doctors and nurses loathed on sight.

But there was one group that loved EHRs: hospital administrators and the private companies offering Medicare Advantage plans (which also benefited from upcoding patients in order to soak Uncle Sucker):

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8649706/

The spread of EHRs neatly tracks with a spike in upcharging: "from 2014 through 2019, the number of hospital stays billed at the highest severity level increased almost 20 percent…the number of stays billed at each of the other severity levels decreased":

https://oig.hhs.gov/oei/reports/OEI-02-18-00380.pdf

The purpose of a system is what it does. Epic's industry-dominating EHR is great at price-gouging, but it sucks as a clinical tool – it takes 18 keystrokes just to enter a prescription:

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2729481

Doctors need to see patients, but their bosses demand that they satisfy Epic's endless red tape. Doctors now routinely stay late after work and show up hours early, just to do paperwork. It's not enough. According to another one of Kuttner's sources, doctors routinely copy-and-paste earlier entries into the current one, a practice that generates rampant errors. Some just make up random numbers to fulfill Epic's nonsensical requirements: the same source told Kuttner that when prompted to enter a pain score for his TB patients, he just enters "zero."

Don't worry, Epic has a solution: AI. They've rolled out an "ambient listening" tool that attempts to transcribe everything the doctor and patient say during an exam and then bash it into a visit report. Not only is this prone to the customary mistakes that make AI unsuited to high-stakes, error-sensitive applications, it also represents a profound misunderstanding of the purpose of clinical notes.

The very exercise of organizing your thoughts and reflections about an event – such as a medical exam – into a coherent report makes you apply rigor and perspective to events that otherwise arrive as a series of fleeting impressions and reactions. That's why blogging is such an effective practice:

https://pluralistic.net/2021/05/09/the-memex-method/

The answer to doctors not having time to reflect and organize good notes is to give them more time – not more AI. As another doctor told Kuttner: "Ambient listening is a solution to a self-created problem of requiring too much data entry by clinicians."

EHRs are one of those especially hellish public-private partnerships. Health care doctrine from Reagan to Obama insisted that the system just needed to be exposed to market forces and incentives. EHRs are designed to allow hospitals to win as many of these incentives as possible. Epic's clinical care modules do this by bombarding doctors with low-quality diagnostic suggestions with "little to do with a patient’s actual condition and risks," leading to "alert fatigue," so doctors miss the important alerts in the storm of nonsense elbow-jostling:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5058605/

Clinicians who actually want to improve the quality of care in their facilities end up recording data manually and keying it into spreadsheets, because they can't get Epic to give them the data they need. Meanwhile, an army of high-priced consultants stand ready to give clinicians advise on getting Epic to do what they need, but can't seem to deliver.

Ironically, one of the benefits that Epic touts is its interoperability: hospitals that buy Epic systems can interconnect those with other Epic systems, and there's a large ecosystem of aftermarket add-ons that work with Epic. But Epic is a product, not a protocol, so its much-touted interop exists entirely on its terms, and at its sufferance. If Epic chooses, a doctor using its products can send files to a doctor using a rival product. But Epic can also veto that activity – and its veto extends to deciding whether a hospital can export their patient records to a competing service and get off Epic altogether.

One major selling point for Epic is its capacity to export "anonymized" data for medical research. Very large patient data-sets like Epic's are reasonably believed to contain many potential medical insights, so medical researchers are very excited at the prospect of interrogating that data.

But Epic's approach – anonymizing files containing the most sensitive information imaginable, about millions of people, and then releasing them to third parties – is a nightmare. "De-identified" data-sets are notoriously vulnerable to "re-identification" and the threat of re-identification only increases every time there's another release or breach, which can used to reveal the identities of people in anonymized records. For example, if you have a database of all the prescribing at a given hospital – a numeric identifier representing the patient, and the time and date when they saw a doctor and got a scrip. At any time in the future, a big location-data breach – say, from Uber or a transit system – can show you which people went back and forth to the hospital at the times that line up with those doctor's appointments, unmasking the person who got abortion meds, cancer meds, psychiatric meds or other sensitive prescriptions.

The fact that anonymized data can – will! – be re-identified doesn't mean we have to give up on the prospect of gleaning insight from medical records. In the UK, the eminent doctor Ben Goldacre and colleagues built an incredible effective, privacy-preserving "trusted research environment" (TRE) to operate on millions of NHS records across a decentralized system of hospitals and trusts without ever moving the data off their own servers:

https://pluralistic.net/2024/03/08/the-fire-of-orodruin/#are-we-the-baddies

The TRE is an open source, transparent server that accepts complex research questions in the form of database queries. These queries are posted to a public server for peer-review and revision, and when they're ready, the TRE sends them to each of the databases where the records are held. Those databases transmit responses to the TRE, which then publishes them. This has been unimaginably successful: the prototype of the TRE launched during the lockdown generated sixty papers in Nature in a matter of months.

Monopolies are inefficient, and Epic's outmoded and dangerous approach to research, along with the roadblocks it puts in the way of clinical excellence, epitomizes the problems with monopoly. America's health care industry is a dumpster fire from top to bottom – from Medicare Advantage to hospital cartels – and allowing Epic to dominate the EHR market has somehow, incredibly, made that system even worse.

Naturally, Kuttner finishes out his article with some antitrust analysis, sketching out how the Sherman Act could be brought to bear on Epic. Something has to be done. Epic's software is one of the many reasons that MDs are leaving the medical profession in droves.

Epic epitomizes the long-standing class war between doctors who want to take care of their patients and hospital executives who want to make a buck off of those patients.

Tor Books as just published two new, free LITTLE BROTHER stories: VIGILANT, about creepy surveillance in distance education; and SPILL, about oil pipelines and indigenous landback.

If you'd like an essay-formatted version of this post to read or share, here's a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:

https://pluralistic.net/2024/10/02/upcoded-to-death/#thanks-obama

Image: Flying Logos (modified) https://commons.wikimedia.org/wiki/File:Over_$1,000,000_dollars_in_USD_$100_bill_stacks.png

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