#respiratory examination

[jellyjamoh]

07.05.2024

This one's from last year's International Book Fair held at SMEX Convention. There are like thousands of books there, and the crowd was unbelievable lol. The moment I stepped inside the hall, I was swept off my feet. Totally mesmerized by the huge collection of readings.

I jumped right into healthcare-related stalls because I really wanted to purchase the neurology pre-test guide.

It was so expensive (although given that all med books are pricey) and was out of my budget. It honestly felt like I wouldn't be able to go home with a healthcare book on my cart.

To my surprise, a cozy and tiny stall has this Pulmo-related reading.

I think they also sell UST merch stuff and it was just so random that it took my attention all of a sudden.

This serves as a guide for radiologists, students, practitioners, and alike. Twas written by Jose S.L. Valencia, MD, an Assistant Professor of Radiology in the Faculty of Medicine and Surgery of the University of Santo Tomas, and a hospital consultant in radiology at the same University.

If I'd give it a star rating, it would be 5/5. It was precise, and well-written. I actually bought it just so I could have an idea about my Premed course (Respiratory Therapy lol got no choice, it's the closest/most related book that I can get).

I was trying to understand what kind of world am I getting myself into.

I'd recommend it to dorks out there. Not too complicated to digest. Realization after reading it. Pulmo isn't so boring after all. Maybe it wasn't bad that I took RT. lol just because I was into the surgery side of Nursing.

The most interesting case for me was Lung Metastases from Choriocarcinoma. Choriocarcinoma is a germ cell tumour containing syncytiotrophoblastic cells and secreting human chorionic gonadotropin (hCG) hormone. Gestational choriocarcinoma originating in gonads frequently metastasizes to the lungs, but primary choriocarcinoma originating in the lung is a very rare entity.

I do not need to explain any further why it is appealing to me lol. I mean come on. I haven't heard anything like this before. I actually like the elevated diaphragm too. :>

Thank God after searching the whole place I got to purchase a few readings and many cute colorful pens too. I hope I could still make book reviews some other time. <3

[fanaticsnail]

Caught: Shachi & Penguin

Birthday Celebration Masterlist

Word Count: 4,200+

Themes: Shachi x afab!reader x Penguin, mdni, smut, 18+, NSFW, caught masturbating, sex pollen, first time together, throuple dynamic, preexisting flirtationship, fingering, oral, unprotected sex

Notes: Day 3 of my celebration event! I would like to dedicate this fic to @avogigi who's birthday is today! Happy birthday love! I hope you enjoy your silly boys infused with need and lust.

It all started with a flower. A small, innocent, little flower.

A flower gifted with well-met intentions by your redheaded crewmate, tucked behind your ear for safekeeping.

Venturing into an unknown destination with your crew, you all banded together and took in your surroundings. One by one, the Heart Pirates trudged beyond the threshold of the new village and respected your view of unexplored horizons. Shachi, yourself and Penguin marched toe to toe, every so often pointing out one thing or another to each other.

You had this unspoken thing with both Shachi and Penguin: the two misguided misfits of the Heart Pirates. They would never fight, nor ever engage physically in violence for your affections: but their little competition vying for your attention has begun to get out of hand in your captain's opinion

Trafalgar Law, your captain and doctor, had taken you aside to your office earlier in the month and barked at you to: “Just pick one already! They're both being unhinged idiots, and I can't stand any more of their peacocking.” It was true, both Shachi and Penguin had this peculiar way of taking their affections up a notch when the other was present. In private, they were both so shy and sweet to you, you felt called to usher them into your arms and indulge in their attention.

In lieu of following that former suggestion made by your captain, not an order to obey, you simply remained steadfast and strong in your politeness towards them. You could never choose between which of your friends to engage with romantically, and they both knew you were not going to make any decisions without a large event occuring between the three of you.

Stooping below a large trunk of an unknown tree, he easily pried a small flower from the base of the trunk by snapping it as close to the roots as he could get it. Gently and coyly floating his glasses-clad eyes over towards you, he lifted the pale petals up to his nose and took a lengthy inhale.

The pollen in the center smelled as sweet as you were to him, and he was immediately taken by the heady aroma. Slowly approaching your position by Penguin, he tapped you on the shoulder to gain your attention. Just as to turned your head, Shachi skillfully tucked the pale flower behind your ear with a mischievous smirk.

“A pretty flower for my pretty flower,” Shachi cooed down at you, moreso in a lower and more playful tone he knew Penguin would despise him for. You couldn't help but laugh at him, gently reaching for the object and untucking it from your ear to gaze down lovingly at.

“Thank you, Shachi. It's beautiful,” you nodded towards him. Gently raising it up to your nose, you inhaled from the center just as he did moments prior, “Do you know what type it is? I haven't seen anything like it before.” The fragrance felt thick, but not overall itchy or overwhelming in your respiratory system. There was something particularly intoxicating about it, but it could've just been the softness in Shachi’s expression when he gifted it to you.

Just as Shachi made to offer you an answer for your question, Penguin snatched the flower from your fingers and began to examine it. His brows knit with confusion, leering down at the center, and taking in the soft balayage fading from the base of the petals up to their unique, pointed tips.

“I've seen this in one of the captain’s medical books before,” Penguin stated softly, leaning forward and inhaling a little of the fragrance before withdrawing it from his face, “I just can't remember where it was.”

“Poisons?” you asked softly, taken aback a little by how intensely he was gawking at the stem and petals. Penguin shook his head and placed it back within the nook of your ear.

“Nah, nothing like that,” Penguin commented with a polite smile, “I have seen the description, pretty sure it was in the edible section of weeds or something,” he shrugged softly before backtracking and rephrasing his statement, “I wouldn't eat it, just in case.”

“Because that's my first thought when I'm gifted a pretty flower by an attractive guy,” you uttered sarcastically, reclaiming the flower and tucking it once more behind your ear, “‘Eat the damn thing’. Seriously, Penguin?”

Overlapping sentences of “Hey, I didn't mean it like that,” and “Wait, you think I'm attractive?” were both broken by the call of the three of your names by your captain. Surrounded by the remainder of your crew, Clione was holding a map of the area given to him by a local, and Law was assigning roles.

“Shachi, Penguin,” Law barked in an authoritarian tone, “You're on dinner. Organize it for the lot of us, and try to keep to the budget.” Next came your name, to which you smiled and stood a little taller.

“You're on ‘home duty’. The inn is there, organize with the front desk who's bunking where and unpack the essentials. We're in our own rooms for a bit while we resupply the Tang.” Law continued to delegate chores and orders, each of you listening intently to the directions before you were dismissed.

Just as he reached the last few members of the crew, your mind began to get a little more foggy, and your tongue felt heavier in your mouth. The air felt thicker, and your eyes began to sting a little at the corners as they glazed over with a foreign contemplation and sleepy haze. You attempted to shake it off by pinching the bridge of your nose and stimulating the corner of your waterline, which aided a little in drawing back your attention.

What you couldn't ignore was the neediness beginning to rise at your core. A tingling sensation started to gather at your slit as your clit quivered beneath the shroud of your boiler suit. You shook off the feeling, truly considering the fact that you had been at sea for too long, and the flirtations from both of the animal-hat wearing men may have worked a little better than anticipated.

Regardless of how the meeting went, you were thankful that Law placed you on ‘home duty’. Once the meeting was dismissed: you could set to your task: assign the rooms, gather the belongings, carefully dump them in their appropriate lodgings, and take care of your physical needs dripping currently in your underwear and sticking the garment to your skin, before the remainder of the crew got back.

What you didn't anticipate was the fact that after you did organize all of those chores, you physically couldn't cross that bridge into bliss with your hands alone. Laying on your back atop your allocated bed, traveling bag hastily thrown from the duvet, boiler suit and undergarments discarded, legs parted and slick falling freely from your quivering core, you found yourself unable to cum.

You tried everything: focussing solely on your clit with your fingertips, burying three fingers into your cunt and roughly fucking yourself with them, playing with your nipples while you attempted to move your hands more slowly, or bracing your abdomen with your forearm and hastily impaling yourself with your digits. Nothing worked.

“Hnnngh-! Fuck!” you cried out, sobbing as another high slipped through your fingers and smeared your arousal on the duvet below you. “Why-? What-?”

Closing your eyes, you began to softly sob while you plunged your fingers in and out of your needy core, bringing up your other hand to clap over your lips. All you could do was sob while waiting for your orgasm to finally grip you and crash from your core to spread through your body. Yet, every time, that swell would always sizzle and fade before it ever took root in your body.

Both Shachi and Penguin found themselves in a not so dissimilar predicament. Neither man had ever felt desire like this at any moment in their lives prior. Panting, sweating, heaving, groaning: Shachi and Penguin were consumed with the aggressive urge to claim and use their bodies to rutt and ravage.

“You started this shit,” Penguin barked at him, aggressively snatching his allocated key off the counter in the inn, “You think we're the only ones suffering for your stupidity?” The innkeeper backed away, assuming the similar uniform they were donning to yours meant they were a part of the same crew.

“I know, I know,” Shachi whined, the groceries in his arms weighing heavy and encumbering his ability to walk more hastily. “If you would've said something earlier, I wouldn't have fucking plucked the damn thing and gave it as a gift. For fucks sake.”

“Oh? So now it's my fault?” Penguin snapped back at him, stomping up the stairs towards the rooms where they were allocated, “Be thankful I was the one to tell Law about it. If not, we wouldn't have gotten the fucking antidote.” Penguin began to turn the key into the latch, letting out a groan as his painfully hard erection brushed against the front seam of his boiler suit.

Just as Penguin managed to twist the knob and push open the door, his ears pricked at the mention of his name. It only spilt in a voice below a choked whisper, but his heightened senses from the illumination of the pollen managed to decipher it amongst the white noise.

“Fuck,” Penguin whispered, stumbling in his room, “Throw the groceries on the counter, I don't think we've got much longer until the antidote won't be as effective.”

“Right,” Shachi said in response, immediately moving his body with each agonizing step towards the counter. As soon as he managed to place the contents on the marble surface, he used his palms to brace his weight against the surface.

Each part of his body felt alight with the flames of lust, each part screaming for a cure within the thralls of passion. Both Shachi and Penguin agreed, as soon as they learned what the flower was, you needed to be given the antidote before either of them could take it. They refused medical attention, much to Law's chagrin, and forced themselves to complete their chores first.

As Shachi took a moment to steady himself, his ears burned at a soft sound whimpering from the adjoining room.

“Did you hear-?”

“-We’ve gotta move.”

Both men sprung into action: Penguin with the vial from Law clutched firmly in his grasp, and Shachi who had been exposed far longer to the pollen as either of them.

Penguin tried to remain level headed. Get in, give the vial, sit and wait for it to come into effect, and apologize for his friend profusely for accidentally dousing you with a potent aphrodisiac. That was his plan.

Shachi’s was much the same. Go in, beg for your forgiveness, grovel at your feet and watch as Penguin administers the cure for what was plaguing the three of you.

As soon as they barged into your lodgings and their eyes found your body, their jaws grew slack and their chins tilted down to take you in. Fingers buried and curling deep within your pussy, brows furrowed and eyes scrunched shut, their names were spilling from your lips as you attempted to reach the cusps of your bliss - only to immediately sob when it flew away once more.

If your name was called, you could barely hear which one of the two called it. Too lost within your own ministrations to care, you reached your unoccupied hand out for the closest person near you. The only thing to break you out from your hypnotic stimulations was the door slamming tightly shut behind them.

“I-I can't s-stop,” you whimpered out, the crude squelching from your cunt continuing to ring throughout the room, “H-Help. Please?” You moved faster, spreading your legs and uncaringly began to put on a show for the intruders. You hoped they were the men you needed them to be, and not some poor maintenance crew coming in to change over the supplies within the fridge or refold the towels. “Penguin, Shachi-... I need you. Please, I need you.”

“Fuck-.”

“-Shit.”

The vial slipped from Penguins grip as he immediately pounced towards you. He knelt at the foot of the bed, slowly prying your hand away from your core and replacing it with his own. His stiff cock was propping up the waist of his boiler suit like a pole to erect a tent, but his mind still grasped the fact that you needed to understand what you were asking for while you could still speak.

“Sweetheart,” Penguin uttered softly, rubbing gentle and soothing circles on your aching clit, “You've been-... fuck you look so good-... You've been hit by a violent aphrodisiac. Can you understand what I'm saying?”

“I-I know-!” you whimpered, hips bucking up and trying to get more feeling of any part of him within you, “Y-You guys-?”

“-It was the flower,” Shachi shuddered, holding the wooden door frame to hold himself back from springing forward and prying Penguin away from your body to replace his with his own, “Are you still wearing-... look at how good you are, letting him play with you like that-... Are you still wearing it?”

Reaching up, you grabbed the flora from behind your ear and tossed it over the side of the bed. Shachi nodded, feeling choked by the amount of heat within his boiler suit. “To answer your earlier question, us too. Not as bad as you, but yes.”

“Wh-What do we do?” you sobbed, eyes opening and looking past Penguin at your pussy towards the redhead, “Shachi, what do I do? I-I’ve been at this for two hours now, and each time I try-... fuck-!” You arched your back, feeling on the edge of an orgasm by Penguin’s hands and expecting to fall away from it.

Only you don't.

Screaming out in relief, your world shatters like a stone through glass against Penguin’s fingers. Your body convulses around his motions, riding through the first waves of ecstasy in what felt like a painful lifetime. Penguin did nothing to hold you back from your bucking, only chasing you with his hands while he aided you through your high.

“Cumming?” Penguin asked coyly, his eyes dark with lust as he watched your pussy pulse and clench around absence, “Good, sweetheart. How do you feel?”

Taking a moment to steady your breaths, you nod while panting through your recovery. After gulping back some essential breaths, you felt the need once again rising in your abdomen, but manageable as opposed to the way you had been feeling for hours.

“Need more,” you nodded, reaching down and grabbing Penguin's wrist, “I need a cock in me, now.” Penguin groaned needily at your confession, his precum tinting his briefs beneath his boiler suit with pearls of viscous desire.

“Who's?” Penguin asked softly, again reaching for your sensitive bud and drawing soft and senseless patterns against it. You chose to angle yourself on the bed, prying yourself from Penguins hands and leaning with the edge of the mattress tucked firmly within your neck.

“I am going to close my eyes,” you utter firmly, doing as you suggested and clenching your eyes shut, “And in three seconds, I better have someone’s cock in my pussy and the other’s in my mouth or I feel like I'm going to die. One.”

A shuffle of motion occurred immediately, shifting materials pooling at ankles and casted aside with haste small choked words of “But,”, “Who?” and “Where?” we're quietened by the haste of your next word.

“Two.”

“Sweetheart, if you could just hold on a minute while we get situated-.”

“-Please see reason, sunshine. I can't thrive under these conditions.”

Shachi quickly found his drooling cock head against your entrance, his eyes rolling back in his skull as he carded it through your folds. Penguin tapped your cheek with his tip, indicating he was ready for you whenever you chose to part your lips to drink him in.

“Three,” you gasped, gently flicking out your tongue to tease Penguin’s cock gently, “Use me. I need to feel you cum in me, wherever you choose to fill me up.”

Where Penguin chose to halt his actions, Shachi was simply too far gone under the influence of the pollen. He was never this consumed with arousal, and he truly felt if he wasn't buried up to the hilt within you, he would keel over where he knelt.

His cock slipped in with an ease that held him speechless, your clit brushing with the small patch of red public hair he manicured at the base. Shachi shuddered as he rocked his hips from side to side, nestling completely within your pussy and holding onto your thighs for support.

“Shachi-... fuck, that's so good-!” you whined, opening your eyes and gazing lovingly at the cock presented in front of your lips. “Pen, what's stopping you from fucking my face? Need you!”

Penguin knelt down in front of you, piercing you with his icy eyes before pressing his forehead to yours.

“I do want to ravish you, don't get me wrong,” he confessed with a humorless laugh, “But neither of us have even kissed you yet.” Penguin leaned forward, his chin brushing with your nose while his lips hovered over your own, “Seeing as though Shachi gets to claim that beautiful pussy for himself before me, I should at least get to kiss you first.”

“Kiss me,” you whisper softly, your need once again swelling in your stomach as Shachi began to gently retract a small portion of his cock and steady himself before slamming it back in. As Shachi thrust forward, he shifted your body which made your lips collide with Penguin’s in a firm and lustful kiss.

Penguin adjusted his lips immediately, moving his hands to grasp the back of your neck and hold you steady. Shachi picked up his pace, rutting into you with an easy rhythm that forced your eyes to roll back into your skull. The kiss of the dark-haired man became intense and heavy, his tongue brushing and colliding messily with your own while the redhead’s pants began to pick up in intensity.

Pulling away from your face, your voice spilled out a whine that shot lightning directly to Penguin’s cock now presented to you.

“Be a good little thing and open your mouth for me, would you?” Penguin purred down at you, using his hands to find your forearms and wrap them around his ass, “C'mon. Easy does it now- Oh, fuck-!”

Penguin flung his head back the moment your lips parted to take him in. Shachi tried to ignore the whine that the other man made, but the twitch of interest in his cock raking against your walls was undeniable in feeling at home with his friend and himself taking you together.

Shachi rose your leg up to hook your knee over his shoulder, turning his head to huff and pant into it in a bid to silence his needy cries. Penguin’s own breath hitched when he peered up at Shachi lost while buried deep within you.

They had never really considered both enjoying you together, should their private courtship of you amount to anything. Their assumption was likely a one week on, one week off situation, never together. But as Penguin let out soft little whimpers at the feeling of his cock being taken by your lips, Shachi let out groans that were a little deeper to complete the pornographic symphony.

Your mouth and pussy was too stuffed full of both mens cock, all you could do was whimper out small cries in bliss at finally being met with exactly what your body was craving.

“Good job, j-just like that,” Penguin stumbled, gently rocking his hips against your face while you pawed at his ass to draw him closer, “Fuck, you feel so good like this.”

Shachi could barely articulate any thoughts of praise. His lips clashed against your thigh as he felt the coil in his abdomen wind tight as he teetered on the cusps of crashing into ecstasy. Sucking and biting at the flesh of your leg, he let out several intense whines as he drew closer to his edge.

Reaching down between your thighs, he thumbed at your clit while drawing his cock in languid and heavy thrusts deep within your pussy. With each in-thrust, his sighs and whines began getting louder and higher in frequency.

“N-Need you to cum, sunshine,” he whimpered against your leg, increasing the pressure against your sensitive bud with his thrusts becoming more urgent, “Can you do that for me? Cum for me? Wanna feel you when you do. Please?”

You could barely whisper out a yes, only humming through your confirmation and bobbing your head more desperately against Penguin's thick cock. Upon hearing Shachi beg to feel you cum for him, salty bursts of Penguin's release began to dart over your tongue in soft spurts.

“Sh-Shit-!” Penguin cried out, truly expecting he would have more time before he flooded your cheeks and throat with his release, “Oh fuck, I'm cumming-!!”

“Fuck-!” Shachi whined in a long drag, feeling you clench around him at Penguin’s confession. Penguin using your face so needily and messily caused your own orgasm to ricochet off his own like a chain of lightning. Your pussy clenched and pulsed around Shachi’s cock, which in turn sucked him in in hard contractions. Shachi immediately began to spill over in hot ropes of white, flooding your walls with his own accumulation of bliss.

The three of you rode out your highs, Penguin pulling out and dribbling the last of his spend on your chin and chest from his position above, while Shachi burried himself deep within you. You felt tears of relief begin to sting the corners of your eyes, finally feeling the joy that finally found its home with the three of you together.

Shachi dragged your body down the bed, messily peppering your shoulders and neck in a cluster of grateful and overwhelmed kisses. Penguin stepped away to the bathroom, your ears pricking up at the sound of running water from your personal ensuite. You felt your neck thank Shachi for drawing it to a more comfortable position, your throat now raw with the rate you chose to suck Penguin’s cock with.

Penguin returned with, hot, damp towels, and begun to rub your face affectionately to rid you of any of his remaining mess. Slowly moving his cock out of your core, Shachi swiped the towel from Shachi to romance you with soft drags against your pussy to clean you of his spend.

“How do you feel?” Penguin asked quietly, crawling on the bed beside you on all fours, and tilting his head to check you over. “Need more, or has it dissipated for now?”

“I-I think it's dissipated,” you nod slowly. Slowly examining his face while Shachi cleaned you up, you felt yourself become a little shy to his eyes beaming down at you with the softest expression of love. Shachi completed his small duty of cleaning you up before rising to his feet towards the doorway.

Stooping low, he picked up the oral antidote and returned to your side. Popping the cork top of the liquid, he slowly drew it to your mouth and tapped your bottom lip twice.

“Say ‘ah’, sunshine,” he smiled down at you, slowly offering you a few drops before offering the same to Penguin, and then to himself. Turning to the bedside table, he took note of the time beginning to draw close to the end of daylight.

“Penguin,” Shachi spoke slowly with a soft groan, “Cap said we're on dinner duty.” Penguin had yet to tear his eyes away from you, only doing so to lean towards you and press his forehead against your neck. “We gonna cook or-?”

“-I’ll call the front desk,” Penguin whispered against your neck, kissing your collarbone softly and covering over the small marks Shachi had peppered you with moments prior. “I'll take it out of my cut of loot.”

“There's a few of us, Pen,” you whispered, feeling need once again rise at the pit of your stomach that was entirely your own, “It's one hell of a expense.”

“If I get to stay right here,” Penguin whispered, drawing his hands to tickle at your stomach in soft, swirling patterns, “I'd say it's worth it. I'll be skint for a bit, but I'll make it.”

Feeling a little awkward, somber, and out of place, Shachi gulped back his defeat at earning your affections and began to shift the materials at the floor to redress himself. Locating his socks, he placed them in each of his boots while untucking his briefs from the legs of the boiler suit.

“Where you going, Shachi?” Penguin asked softly, “We can make the call from up here. No need to go down there if you don't want to.”

“No, no, it's fine.” Shachi confirmed with a smile, feining joy at your soft moment together, “You guys just sit and bask. I'll go organise the dinner, then I'll just go and read in my room before bed time. Yeah?”

“No,” both you and Penguin utter in unison, one of your arms and one of his extended out to invite him back. “Here, now,” you clicked your fingers and gestures to the mattress he was just laying on.

“You sure?” Shachi asked, his eyes rounded and pouting innocently, “I know I messed up with the flower, and I shouldn't interrupt what you guys have going on-.”

“-All of us,” Penguin uttered sharply, “Together, you hear? Always together.”

“Always together?” Shachi asked, his feet gently stepping closer to the bed. Shuffling his knees up on the mattress, he gently crawled beneath your other arm and nuzzled against your neck. His lips found your skin and pressed a soft kiss against it while making himself comfortable. You let out a content sigh, drawing your hands up to lace in locks of raven and auburn.

“Always together,” you whispered in confirmation.

Food will have to wait for your crewmates, the call to the front desk being at the back of your minds while the three of you began to navigate this new covenant forged between you. Three as one, and your hearts swelling enough to love each and every in their own way. You were their partner, and they were yours.

Always together.

Tag list: @mfreedomstuff @daydreamer-in-training @since-im-already-here @gingernut1314 @writingmysanity @i-am-vita @indydonuts @feral-artistry @the-light-of-star @empirenowmp3 @racfoam @sunflowersatori @carrotsunshine @skullfacedlady @jintaka-hane @thenotsofantasticlifestory @jadeddangel

🎶Happy Birthday to Me 🎶

If you would like to celebrate by indulging my caffeine and bubble tea addiction, my Kofi link is here.

[andhumanslovedstories]

A while ago at work, I had a patient whose condition rapidly deteriorated during my shift, which I believed at the time was due to me not monitoring certain therapies closely enough. Essentially patient had parameters that their oxygen saturations should be between 88-92%. The patient was on supplemental oxygen via a nasal cannula, and was having oxygen saturations of 95% or more. The patient later became lethargic, confused, and hard to rouse. The patient was in hypercapnic respiratory failure, where they essentially were not exhaling enough CO2, the waste product of respirations. Patients who have oxygen parameters of 88-92% tend to be COPD patients, and I'd been taught where giving them too much oxygen can result in CO2 retention.

We ended up having to call a rapid response on that patient who needed to go on the bipap (non-invasive ventilator) to help them breathe effectively, and I went home from that shift feeling certain that I killed this person. That I had triggered a terminal decline that the patient would never recover from.

(Perhaps some context here: my grandfather went into hypercapnic respiratory failure and then died within a few days. Maybe he would have passed either way, I think probably he would have, but the respiratory failure was the moment his decline started accelerating. After he went hypercapnic, he was non-responsive from that point on.)

I called in sick to my next shift because I couldn't face going in. I spent the day thinking about what I'd done, what my moral obligations were, how do you atone for something when you cannot reverse the effects of the original error, and how paralyzed by shame I felt. What did I owe the patient? What did I owe the family? What did I owe myself? How many times had this happened before and I just didn't know because the decline happened after my shift ended?

It was a productive if unpleasant day of trying to sincerely examine myself and the things I'd done wrong without flagellating myself. It'd be almost easily to complete condemn myself and to stop nursing because I'm a Bad Nurse than it would have been to acknowledge the many steps that led to this patient outcome, only some of which I had a hand in. But this was my patient. They were my responsibility. What was the right reaction to have? What should I be feeling? In the course of doing my job, I caused harm to someone I swore to take care of. I still think that I am a thoughtful, hardworking, and compassionate nurse. I don't think the hospital would be better off if I quit. But I hurt someone.

I thought a lot about how this outcome happened, came up with steps to prevent it in the future, and found a new commitment within myself for continued learning. (If you've got a timeline of my particular fixations, this is about when my determination to go to grad school began.) I also thought about how much shame was making me sick. When my patient started declining and I realized the effects of my actions and inactions, one of my first thoughts was genuinely, "Everyone's going to know what I did." It was thought with absolute horror. I'd hurt someone and everyone was going to know it. They were going to know I was bad at my job and bad as a person.

And I was struck by what an unhelpful emotion that was. How much it made me, if only for a moment, tell NO ONE what was going on and what I believed to be the root cause. That it'd be better to let the decline continue rather than intervene because if I intervened that'd be admitting that I'd done something wrong. I didn't listen to that voice that told me to hide what I'd done, but I instantly understood the power of it.

There's this thing called the Compass of Shame which is about the different ways people handle their own feelings of shame--they avoid the shame, they withdraw from themselves and others, they attack others, they attack themselves. I know my own reactions to shame and try therefore not to go with my gut instincts, which are always to say I'm an irredeemably bad person and no one can know about this and if anyone does not about what I've done wrong, I deserve literally whatever punishment they could give me. I've had to learn I can both have failed to complete my responsibilities and still not deserve to lose my job or my flunk this class or give up on college or lose all my friends. But there is something appealing about masochistic shame. Like you can prevent others from judging and punishing you if you sufficiently judge and punish yourself. You'll still be a wretched monster, but no one else needs to know that.

That's actively dangerous for patients, who are the victims of healthcare errors, and it doesn't help prevent future mistakes if we are too ashamed to talk about what happened and why. We'll just keep fucking up in the exact same ways because no one else told us how they'd fucked up that way in the past and here's how we've changed the process because of that. I therefore have an ethical obligation to not internalize shame when I make mistakes at my job. I have tried to remember that while also trying my best to not make the same mistakes twice.

And then a week later, I was sent back to the same floor with the patient who'd declined on my watch. Because I'm a float RN and therefore don't have an assigned unit, I go to different floors every night (occasionally multiple floors on the same night). I see patients for 12 hours and then almost never see them again. Since I was back on the floor, I girded myself and went to go visit the patient, who to my surprise was alert and upright and about the same as I'd seen her at the beginning of my shift before they'd gotten bad. I said hi and asked how the patient was doing, and the answer was that patient was doing about the same as they'd been doing for the last month.

This was not good news for the patient, who was still medically complex, still dealing with an extremely difficult to address condition, but they were also not in the ICU, dying, or dead which is what I'd feared. And with the new knowledge that the patient was, if not okay, than at least stable as ever despite my actions, I could look back on that shift and see it differently, namely that this patient kept continuing to go into hypercapnic respiratory failure with or without oxygen. And then I looked into what I thought I'd been negligent about before and found that the scholarship on it was more complicated and divided than I'd thought. That the mechanism of action that I thought was driving the hypercapnic respiratory failure was in fact waaaaaaaaaaay more complicated than just over oxygenation, particularly in this patient who had a number of muscular abnormalities that made much more of an impact on ventilation than the oxygen would have. And while I still had to improve my practice, upon more reflection I could no longer say there was a direct one to one of my actions and the patient's decline.

I felt simultaneously forgiven, absolved, and humbled. I cannot describe to you the almost sheepish relief that rushed over me. Nothing that bad had happened. What did happen was only ambiguously my fault.

There's a power fantasy to shame sometimes, that you are uniquely bad and that your actions have monumental consequences. My actions on the job can have monumental consequences, but usually they are little things, little cares, little turns, little med doses, little therapies, little steps, little tasks, little jobs, little kindnesses or little cruelties that help a patient move forward or which hold a patient back. I'm there for 12 hours and never again. I can do a lot in that time, but I'm not gonna cure them and I'm probably not going to kill them. It's a relief, and it's a strange disappointment. We want to be important, even in bad ways.

While I can certainly fuck things up for patients, while I can certainly kill patients or traumatize them or withhold care or misuse my position, while I can do all those things, I don't actually have that much power over life and death. Everything that goes wrong isn't my fault. And sometimes something is your fault and nothing really happens except a few people have a bad night and you try not to do it again. I think that last bit is the most important part. I still should have titrated her oxygen down. I'm more careful about that now. I'm trying not to fuck up in the exact same way. I'll find exciting new ways to fuck up, and then I'll learn from those too.

[covid-safer-hotties]

Also preserved on our archive

Whenever you hear someone trying to blame kid's poor test scores "post pandemic" on "lockdowns," show them this.

By Dr. Sushama R. Chaphalkar, PhD.

New research shows that mild COVID-19 alters brain structure and connectivity in key areas responsible for memory and cognition, emphasizing the lasting effects on young people’s brain health.

In a case-control study published in the journal Translational Psychiatry, researchers used magnetic resonance imaging (MRI) and cognitive tests to examine brain structure, function, and cognition in adolescents and young adults with mild coronavirus disease 2019 (COVID-19) compared to healthy controls in a pandemic hotspot in Italy. They identified significant changes in brain regions related to olfaction and cognition, with decreased brain volume and reduced functional connectivity in areas like the left hippocampus and amygdala, which were linked to impaired spatial working memory. Notably, no significant differences were observed in whole-brain connectivity, suggesting that these changes were localized rather than widespread.

Background COVID-19, primarily known for respiratory symptoms, also affects the central nervous system, leading to neurological issues like headaches, anosmia, and cognitive changes. MRI-based studies reveal anatomical brain changes in COVID-19 patients, such as reduced gray matter and decreased volume in regions like the hippocampus and amygdala, often linked to cognitive deficits.

While research mostly focuses on severe cases and older adults, a majority of infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19, occur in adolescents and young adults who also experience long-lasting cognitive symptoms.

This age group, undergoing key brain development, is impacted by changes in spatial working memory and brain structure, which are crucial for cognitive functions shaped by social interactions, significantly disrupted by the pandemic.

Given that this is the largest and most understudied population affected by COVID-19, understanding the brain and cognitive impacts in adolescents and young adults is vital.

Therefore, researchers in the present study compared anatomical, functional, and cognitive outcomes, utilizing a longitudinal design that allowed them to assess both pre- and post-infection differences, in COVID-19-positive and negative adolescents and young adults from Lombardy, Italy, a global hotspot during the pandemic.

About the study The present study involved participants from the Public Health Impact of Metal Exposure (PHIME) cohort, a longitudinal investigation of adolescents and young adults in northern Italy. Between 2016 and 2021, 207 participants, aged 13 to 25 years, were included in a sub-study with MRI scans and cognitive tests. After COVID-19 restrictions were lifted, 40 participants (13 COVID+ and 27 COVID−) participated in a follow-up study, which replicated the MRI and cognitive assessments.

The mean age of participants was 20.44 years and 65% were female. COVID+ status was confirmed through positive reverse transcription polymerase chain reaction (RT-PCR) tests within 12 months of follow-up. Neuropsychological assessments used the Cambridge Neuropsychological Test Automated Battery (CANTAB) to evaluate spatial working memory.

MRI and functional MRI data were acquired using a 3-Tesla scanner, processed, and analyzed for structural and local functional connectivity using eigenvector centrality mapping (ECM) and functional connectivity (FC) metrics. Whole-brain functional connectivity metrics showed no significant differences between COVID+ and control groups, indicating that the observed changes were specific to key brain regions rather than generalized across the entire brain.

Statistical analysis involved the use of pairwise Student's t-tests, Kolmogorov–Smirnov test, linear regression, two-waves mediation analysis, negative binomial regression, and linear regression, all adjusted for covariates.

Results and discussion Significant differences were observed in the two groups regarding the time between assessments, COVID-19 symptoms, and vaccine status. The research identified five localized functional connectivity hubs with significant differences between the two groups, including the right intracalcarine cortex, right lingual gyrus, left frontal orbital cortex, left hippocampus and left amygdala, which is vital for cognitive functions. Only the left hippocampal volume showed a significant reduction in COVID+ participants (p = 0.034), while whole-brain connectivity remained unchanged, reinforcing the localized nature of the brain changes.

The left amygdala mediated the relationship between COVID-19 and spatial working memory "between errors" (p = 0.028), a critical finding that highlights the indirect effect of amygdala connectivity on cognitive function in COVID+ individuals. This mediation analysis underscores the role of specific brain regions in influencing cognitive deficits, as only the indirect effect was statistically significant for spatial working memory errors. The orbitofrontal cortex, involved in sensory integration and cognitive functions, also showed decreased connectivity in COVID+ individuals, supporting previous findings of structural and functional changes in this region during COVID-19.

The study is limited by small sample size, lack of diversity, potential confounding factors due to the long interval between MRI scans, treatment of certain subjects as COVID-negative based on antibody testing beyond the 12-month threshold, and the possibility of non-significant findings in mediation analysis due to these factors.

Conclusion In conclusion, the findings indicate persistent structural and functional alterations in specific brain regions of COVID-19-positive adolescents and young adults, including changes in gray matter volume and localized functional connectivity, which correlate with diminished cognitive function, particularly in working memory.

Further research is necessary to evaluate the longevity and potential reversibility of these brain and cognitive changes post-infection, enhancing our understanding of post-COVID outcomes and informing future interventions and treatments. The longitudinal design of this study, with pre- and post-COVID data, strengthens these findings by allowing direct comparisons over time, offering robust insights into the impact of COVID-19 on adolescent brain development.

Journal reference: COVID-19 related cognitive, structural and functional brain changes among Italian adolescents and young adults: a multimodal longitudinal case-control study. Invernizzi, A. et al., Translational Psychiatry, 14, 402 (2024), DOI: 10.1038/s41398-024-03108-2, www.nature.com/articles/s41398-024-03108-2

[evidence-based-activism]

IOC Study on Transgender Athletes Severely Flawed

So, to a certain extent, the question of "should transwomen be able to compete female sports?" is an ideological question (i.e., "should identity supersede reality?").

That being said, there's a recent report [1], funded by the IOC, that is being used to "prove" that transwomen do not have a biological advantage over non-trans women. This report is severely flawed and does not actually lend support to the idea that transwomen have no biological advantage in sports over female people.

(I will mimic the language used in the report (e.g., using "ciswomen").)

Significant differences noted by the report that do NOT support transwomen's inclusion in women's sports:

Transwomen were substantially taller than ciswomen

Transwomen had more lean/fat-free mass than ciswomen

Transwomen had better lung function than ciswomen, as measured by forced vital capacity, forced expiratory volume in one second, and peak expiratory flow. (See the next section for a discussion on the ratio.)

Transwomen had greater hand grip strength (a proxy for overall strength measurement)

Transwomen had higher absolute peak power (lower extremity) compared to ciswomen. (See next section for a discussion on the relative measure.)

Transwomen had the same "absolute strength" as cismen

The data showing no significant difference between transwomen and ciswomen has substantial flaws:

The sample size was too small to reliably determine differences in bone mineral density

For lung function only the FEV1:FVC ratio was lower for transwomen, but the values are generally within the normal range for both groups. The impact of this difference is therefore questionable, as the transwomen have greater absolute values on each measurement and the ratio is not showing any abnormalities. In addition, the effect size (size of the difference) is much smaller than the effect size of the absolute differences described above. The conclusion here is simply that the participants do not have any obstructive respiratory diseases, and the transwomen have greater absolute lung function. (Although there are better tests for this.) There is also one outlier in the transwomen group that is likely driving this relationship in the ratio; unfortunately they do not perform the expected control analyses to demonstrate the retention of results without the outlier. [2]

The researchers decided to examine power in the lower extremities relative to lean/fat-free mass, which yielded a lower result for transwomen compared to ciswomen. However, this methodology make absolutely no sense. We have already established that transwomen have significantly greater lean/fat-free mass, and this paper is interested in determining equitably in sport performance. In general, sports aren't divided out by mass (and certainly not by lean mass), therefore we are interested in absolute differences, not in differences adjusted by some other factor. (Particularly not when that factor is established to be significantly different between transwomen and ciswomen!)

The same criticism applies to their analysis of cardiac function. But even more importantly, "the most crucial variable influencing VO2_max was not assessed in the present study" which is a significant oversight given the stated goals of this paper.

There are numerous other limitation and issues with this report:

This study is of "cross-sectional design, making it challenging to establish causation or examine if the performance of athletes changes as a result of undergoing GAHT"

"The athlete training intensity was self-reported. Therefore, the results may suffer from selection and recall bias." [emphasis mine] -> In other words, these results may be "comparing apples and oranges" with varying rates of fitness impacting the results.

"The athletes participating in the present study represented a variety of different sports, and this would have undoubtedly impacted the results of the study as different sports stress different training and sports modalities." [emphasis mine] -> This is a significant limitation, as comparing the strength of a ciswoman weight lifter to a transwomen distance runner (or vice versa) is meaningless. It's true that measures of fitness tend to correlate, but comparing across sport disciplines for highly competitive sports (where they are focusing on improving specific characteristics) distorts the results. (They explicitly note this: "Exercise type, intensity and duration all have an impact on physiological responses and overall laboratory performance metrics.")

"Social media recruitment leaves this study open to sample bias"

"The gender-affirming treatment of the transgender athletes was not controlled"

"The participants were not screened by a clinician before participation, and any medical conditions were self-reported"

The transwomen in this study all suppressed testosterone to ciswomen's levels and increased oestradiol above ciswomen's levels. This is a limitation because this degree of success in hormone suppression is uncommon, meaning that even these these poorly-supportive results are likely inapplicable to the majority of transwomen. [3]

There is a significant conflict of interest: this study was funded by the IOC after they had already changed the rules to remove the "hormone suppression" requirement [4]

All in all, this study is a classic case of researchers misrepresenting their data in the study's abstract. The data they actually collected shows that transwomen on hormone suppression maintain significant advantages over ciswomen. Further, the flaws in the study limit the applicability of their results.

---

In addition, there are other studies that contradict this result:

This review [3] discusses numerous sources describing "the inherent male physiological advantages that lead to superior athletic performance and then addresses how estrogen therapy fails to create a female-like physiology in the male"

This review [5] found "the performance gap between males and females becomes significant at puberty and often amounts to 10–50% depending on sport" and that "longitudinal studies examining the effects of testosterone suppression on muscle mass and strength in transgender women consistently show very modest changes, where the loss of lean body mass, muscle area and strength typically amounts to approximately 5% after 12 months of treatment. Thus, the muscular advantage enjoyed by transgender women is only minimally reduced when testosterone is suppressed."

This study [6] found that transwomen "generally maintained their strength level" during "gender-affirming therapy".

This study [7] found that all physical advantages were present after one year and that some are retained even after years on hormone suppression. They also specifically hypothesized that "gender dysphoria could stimulate the opposite behaviour [differences in exercise habits] in transwomen, decreasing push-up performance and explaining why transwomen performed fewer push-ups than [cismen] prior to starting oestrogen." This motivation difference likely won't apply to elite athletes, which further supports the idea that transwomen athletes should not be competing with female athletes.

As this position statement [8] indicates we know that there are substantial differences in athletic performance for male and female people.* However, there is little high-quality, definitive evidence concerning the effects of hormone suppression/replacement on people's athletic performance. The current state of evidence suggests that hormone suppression/replacement fails to bridge the physiological gap between male and female people, but we need further higher-quality evidence to definitively prove this.

(That being said, the burden of proof here is on the people attempting to initiate a change; that is equitably between transwomen and female people should be (have been) established prior to eliminating biological sex-separation.)

*Before anyone jumps on this: this is not a moral difference. There is absolutely no reason why running faster or lifting heavier things would make someone "better". The biological difference in performance exists, but it does not in anyway suggest superiority of men over women. Beyond that, it is unsurprising that men outperform women on traditional sports given that sports were designed by and for men. In sports that cater to women's physiological advantages (e.g., endurance, flexibility), women outperform men. [9]

---

So, given all this, what would we actually need to make determine transwomen's relative advantage over female people?

The "perfect" study would involve (at least) these elements:

Random selection from the desired population(s) of transwomen (e.g., top-ranked athletes in a specific sport, non-athletic, etc.) with matched (for population) non-trans female and non-trans male controls

Observation (not self-report) of activity level prior to, during, and following a standardized treatment (hormone suppression/replacement) initiation

Continual measurement of various physical and athletic performance, preferably with a range of laboratory (e.g., spirometry, body measurements) and naturalistic (e.g., actual sports competitions) tasks along with monitoring the treatment and clinical/health issues in all participants (again, not via self-report)

Large enough sample sizes to allow for sufficiently powered tests of all groups/differences of interest

A double-blinded assessment approach (or "placebo" controlled) such that both the researcher assessing the participants and the participants do not know what is being evaluated until the study is complete. For example, you may tell one half the transwomen participants that you are tracking the long term health effects of the intervention (hormone therapy), while you tell the other half that you are assessing differences in athletic performance as a result of the intervention. This will allow for the evaluation of demand characteristics like the ones impacting [7].

There are likely even more factors I have not currently thought of. Of course, completing the "perfect" study would likely be almost impossible. It would certainly be impossible to do for every population of interest (e.g., Olympic weight-lifters, adolescent track and field athletes, sedentary office workers) at the same time.

That being said, a study that fails to include all of these factors (particularly the blinded approach, matching of control participants, and sample size) is not going to meet the standard of evidence needed to make decisions of this magnitude (i.e., choosing to change the priority from biological categorization to ideological categorization). In reality, we would likely need many studies that individually evaluate each group of interest (e.g., transwomen olympic-level weight-lifters vs female olympic-level weight-lifters), each applying as many of the ideal study characteristics as possible.

In conclusion, the IOC has failed to perform their stated duty to regulate and ensure fair competition in sports. There is no current evidence suggesting that transwomen have lost their male-advantage in sports, much less any evidence suggesting they are at a disadvantage.

References below the cut:

Hamilton, B., Brown, A., Montagner-Moraes, S., Comeras-Chueca, C., Bush, P. G., Guppy, F. M., & Pitsiladis, Y. P. (2024). Strength, power and aerobic capacity of transgender athletes: a cross-sectional study. British Journal of Sports Medicine, 58(11), 586-597.

Al-Ashkar, F., Mehra, R., & Mazzone, P. J. (2003). Interpreting pulmonary function tests: recognize the pattern, and the diagnosis will follow. Cleveland Clinic journal of medicine, 70(10), 866-881.

Heather, A. K. (2022). Transwoman elite athletes: their extra percentage relative to female physiology. International Journal of Environmental Research and Public Health, 19(15), 9103.

“International Olympic Committee Issues New Guidelines on Transgender Athletes.” NBC News, 3 Jan. 2024, https://www.nbcnews.com/nbc-out/out-news/international-olympic-committee-issues-new-guidelines-transgender-athl-rcna5775.

Hilton, E. N., & Lundberg, T. R. (2021). Transgender women in the female category of sport: perspectives on testosterone suppression and performance advantage. Sports Medicine, 51, 199-214.

Wiik, A., Lundberg, T. R., Rullman, E., Andersson, D. P., Holmberg, M., Mandić, M., ... & Gustafsson, T. (2020). Muscle strength, size, and composition following 12 months of gender-affirming treatment in transgender individuals. The Journal of Clinical Endocrinology & Metabolism, 105(3), e805-e813.

Roberts, T. A., Smalley, J., & Ahrendt, D. (2021). Effect of gender affirming hormones on athletic performance in transwomen and transmen: implications for sporting organisations and legislators. British journal of sports medicine, 55(11), 577-583.

Pitsiladis, Yannis MMedSci, PhD, FACSM; Harper, Joanna MS; Betancurt, Jonathan Ospina; Martinez-Patino, Maria-Jose; Parisi, Attilio MD; Wang, Guan; Pigozzi, Fabio MD, PhD. Beyond Fairness: The Biology of Inclusion for Transgender and Intersex Athletes. Current Sports Medicine Reports 15(6):p 386-388, 11/12 2016. | DOI: 10.1249/JSR.0000000000000314

Ro, Christine. The sports where women outperform men. (2024). From https://www.bbc.com/future/article/20240731-the-sports-where-women-outperform-men

[icu-fetish]

Cassie in coma

Cassie, fragile and defenseless, fights for her life in a hospital bed. Her consciousness is obscured by a coma, and her breathing is supported by artificial ventilation. A long plastic tube, like a thread, woven into her body, becomes the key to her recovery, giving hope that one day she will be able to breathe on her own again.

She lay motionless as the nurses carefully placed a smooth, blue plastic retainer over her face. This device, made of a strong but flexible material, was supposed to fix the breathing tube, giving it stability and comfort.

Surrounded by a web of tubes and wires, Cassie lies motionless, connected to life support machines. Droppers, like saving arteries, carry the necessary medicines and nutrients to her. Special catheters inserted into her body ensure the delivery of this fluid and the removal of waste products. There are monitors by her bed, recording the slightest changes in her condition.

After a long period of uncertainty, the doctors decided on the next step. The surgery, which involves a tracheostomy, will be Cassie's chance of survival, but at the same time, it carries certain risks and uncertainty about the further development of events. The creation of a tracheostomy will provide her with direct access to the respiratory tract, which will allow artificial ventilation of the lungs and support life.

A ventilator, placed on a standby Cassie's bed, supports her life-giving breaths. Two tubes, like an artificial airway, connect the machine to a tracheostomy tube, delivering oxygen to her lungs and removing carbon dioxide.

In view of the data obtained during constant monitoring and comprehensive examination, the doctors made a reasoned decision to stop artificial ventilation of the lungs, which for a considerable period ensured the patient's vital activity.

In one of the tense moments, when it seemed that all chances were lost, Cassie suddenly showed signs of life. Her eyelids, which had remained motionless for days, twitched slightly, and a shadow of a smile flashed across her pale face. This barely perceptible movement became a signal for the doctors, who with a sinking heart were waiting for the patient's first independent breath. And then, after a few anxious seconds, Cassie's chest rose and then fell, filled with air without the aid of a machine.

Cassie finally woke up. Cassie slowly opened her eyes, returning from the depths of sleep to harsh reality. Looking around, Cassie tried to figure out where she was. Her gaze wandered around the unfamiliar room, stopping at the multitude of tubes, catheters, and wires entwined around her body. Despite her fear and weakness, Cassie believed she would recover.

Tiny Pretty Things (2020)

[getphysicalexam]

oxBk_PglA84

[prinzrupprecht]

His healer

For some reason I just love writing about Okita a lot. This is a one shot this time. Okita x reader again..

Synopsis: AU universe where you treated Okita’s illness as one of the best doctor’s in Kyoto and slowly grew attached to him.

TW: kind of angst but mostly fluff.

WC: 943

The moment you were summoned by the leader of the Shinsengumi to check on someone’s condition, you knew you couldn’t decline the man known as Kondo Isami. He was well respected and so were his men. All you were known for was being one of the best doctors in Kyoto. You studied all sorts of medicine and healing practices.

A few days after the ikedaya incident, a young boy in his early twenties laid in his bed panting heavily. Upon finding out what his name was: Okita Souji. He was the first division captain and former chief assistant of the mibu rishigumi. You heard of the incident that lead many dead from Chousou and Tosa clans. The political chaos between the factions broke out leading many ronin began assassinating each other.

As you made your way to the Shinsegumi base holding your supplies in your bag. Many of the members were already gone on their patrols. “Oh you must be the doctor,” Kondo greeted you at the entrance as you smiled and nodded. Truth be told, you were young and talented in your field. You were quite surprised your name travelled through most of Kyoto reaching the ears of the Shinsengumi to summon you.

Okita at first was very reluctant with your help. He kept telling you that he was fine and to go away. You noticed that when he coughs and struggled to sit up, you had requested to examine his chest area with your stethoscope with a soft smile. He couldn’t figure out why someone like you kept persisting on helping him.

Overtime you kept checking on him and started to give him the necessities to treat the bacteria in his lungs. Okita started to open up to you about his life and how he became a samurai with his friends which put a smile on your face. He was very kind to you when he slowly starts to trust you’re not trying to kill him or anything. You were feeling sorry for him and his condition since you knew he wanted to help protect those close to him, but was stuck in bed for months. He talked about Kondo-san a lot so you had an idea that was his closest person to him.

“It seems that you’re recovering faster than I thought. I guess the fresh mint has been working well with your lungs. Your respiratory tract seems to be almost clear.” You had sat next to him while wondering what he was going to do next. You only had known him for about a month which didn’t feel long.

Okita was smiling and was going to say something before Kondo walked in with free tea. “You’re looking a lot better,” he noticed Souji was moving more freely thanks to your help. You couldn’t help but giggle at their interaction. The young boy was happy to be able to get back and fight for Kyoto. It was risky trying to get involved with any ronin or samurai since the risk of dying is high. You couldn’t help but feel slight attachment grow but you pushed the thought away. Kondo noticed your mind was in a different world and asked if you were alright.

“Oh yes! I’m fine. I’m thinking I should be getting back soon.” You stood up but you couldn’t help but noticed the slight frown on Okita’s features. You saw a few other Shinsengumi members in the hallway spying in on the conversation and wanted to celebrate with Souji for his recovery. You quickly slip through the door as they all seemed busy and left their base.

You had wondered what it was like being a samurai and feeling respected by the townsmen. There was a lot of trouble with Chousou domain and their affiliation with Satsuma domain as well. Maybe it was best to forget about it all and move along like you’re used to; going into peoples homes and treating civilians was mostly your job. You got some money but mostly you prefer their hospitality over the money since your family was already wealthy.

As you almost made it back to your house near the Kamo river which was relatively close to Yagitei where the Shinsegumi’s headquarters were located. You heard someone behind yell for you to wait up. You were confused hearing your name being called out, till you saw it was Okita catching up to you. “You didn’t say you were leaving for good,” Okita stopped in front of you giving you a rather sad look.

“Kondo-san said you weren’t coming back,” Okita fell silent leaving you to feel solemn.

“Okita-san, you don’t need me anymore, it seems that my job is done and I’m happy that you’re all better. So, please, don’t push yourself hard and I’ll be ready to help you or anyone else that needs me again.” You gave him a gleeful smile but it wasn’t enough for him to whine and to see you again.

“Awww, how about I come see you when we’re both free? I don’t like the idea of never seeing you again.” The last phrase had him puffing his cheeks a bit making him look cute how stubborn he was. He didn’t want to let you go? You thought over it but nodded, you would love to get to know him better even if there’s risks in getting close to him.

“Okay, than it’s settled. I’ll see you around, Okita-san.” Little did you know this was just the beginning of your new profound friendship that would blossom to something anew and future with him.

Note: sorry I promised more Anubis but I really been dying to do this piece for a long time. I’ll get back on Anubby soon~

[transmutationisms]

I turn into a miasma theorist when I have to use the fucking hand blower in the public bathroom. Putrid and no amount of data will convince me otherwise.

ive been saying for years now that it's pretty common to hear people espouse variations on what is essentially miasmatic thinking in lots of everyday situations, it's not even a terrible heuristic (lots of things that smell bad have harmful effects on human health, even though the smells themselves are not the cause of disease) and this isn't even a particularly hot take among historians of epidemiology and pasteurianism: david barnes coined the 'sanitary-bacteriological synthesis' to describe the process whereby germ theory did not replace sanitarian theories of disease, but provided scientific language for beliefs about filth and disease to be 'translated' into; michael osborne has written about the persistence of hippocratism incl. miasmatic and sanitarian theories of disease in colonial military medicine of the french empire throughout the nineteenth century and well into the twentieth; the status of pasteurian germ theories was so contested and bacteriology so hybridised with sanitarianism that this was thee face case bruno latour examined in 'the pasteurization of france' to study the ideological and political reasons why scientific theories are disseminated, and how that happens. it's actually very strange, historically speaking, how hostile public health institutions had become to the notion of airborne respiratory diseases by 2020, that wasn't like something that just happened as part of the inexorable progress of knowledge, it's a pretty outlying case in the history of medicine and one that we are arguably still paying dearly for insofar as institutional scleroticism and expert wagon-circling fuelled anti-mask sentiment well into the covid pandemic

[oneshotnewbie]

If you come back soon could I pretty please request an Amelia (greys) one shot where the reader is her girlfriend and is brought to the ER in critical condition as Jane Doe but as soon as Amelia sees her she’s hysterical and all she wants to is reasure and hold the readers hand! YOU WOULD MAKE MY QUARANTINE SO MUCH BETTER I LOVE YOUR WORKS SM

Authors note: So... um... I know I waited so long to post this request but... I HAVE MISSED IT IN MY INBOX FOR SO LONG AND WHEN I FOUND IT TWO DAYS AGO, I WROTE IT IMMEDIATELY! I am so sorry. I hope you're still out there somewhere recognizing your request and reading it ♥

ᕚ---ᕘ

The hustle and bustle of the emergency room echoed through the cold hallways as the double doors were pushed apart to make way for the ambulance crew and their critical patient. The vehicle's red and blue lights cast flickering shadows on the walls, while the howling sound of the approaching accident conveyed to hospital staff the urgency of the situation.

The paramedics, with serious faces and rustling uniforms, wheeled the gurney into the emergency room. An unknown woman lay on the stretcher, pale and motionless, only the shallow rise and fall of her chest showed any life. A white sheet covered her completely, and her blood-stained hair stuck damply to her forehead. The slow, monotonous beep of the portable monitor accompanied every breath.

Dr. Hunt, the emergency physician in charge, immediately rushed to the bed. His expression was professional, but the depth of his gaze betrayed some concern. The nurses and also Dr. Keppner rushed to help the team take over.

"What do we have?" Owen asked as he looked over the medical file one of the paramedics handed him. "Unknown female person, middle-aged, found unconscious in a park, presumably after an attack. Stabbed in the chest and abdomen. We cannot say any more. No identification and no indication of possible previous illnesses."

The paramedics quickly explained the course of events, how they found the patient and what first aid measures they had taken. The information was relayed with the precision of a well-trained team, but uncertainty about who the woman was and what had happened to her hung in the air.

While Hunt and Keppner began checking vital signs, the unknown woman was wheeled into an examination room. The nurses exchanged hand signals and quietly instructed each other on the next steps. The background noise is a chaotic orchestra of clanging instruments, murmuring conversations and the beeping of medical equipment.

April Keppner leaned over the patient and began a thorough examination. She checked the pupillary reaction, palpated the pulse and analyzed the respiratory rate. The monitors showed unstable readings and the two doctors' facial expressions hardened. A quick look between the two revealed that they were worried.

"We need a CT scan immediately," Owen said, turning to the nurses present. "I also want blood samples for a comprehensive analysis. Let the lab know it's urgent."

While preparations for further examinations were underway, the nurses and doctors tried to keep the unknown woman stable. An intravenous line was placed and fluids began flowing through her derm. The monitors continued to show jittery signals and the tension in the room increased.

"Call Dr. Shephard and Dr. Altmann. I want them here as quickly as possible!" He ordered as he continued to analyze the data on the screen. "And someone should inform the police. We have to find out who she is and what happened in order to prevent further damage."

The exam room was now in a coordinated state of emergency and in a room that was normally a place of rescue, the medical team battled uncertainty and a race against time to save a woman's life. He was abuzz as the neurosurgeon and cardiologist burst through the door almost simultaneously with quick steps. Their eyes were focused, the rubber of their Crocs squeaking in unison with the machines.

"Shephard, the patient is exhibiting unstable neurological signs. The CT scan and blood results are pending," she informed Hunt as he cleared the way for her to the bed.

Amelia nodded curtly and fully entered the room, closing the door behind her. A glance at the monitor and the papers on the tablet caused her eyes to flash briefly before she focused back on the patient. However, as she leaned over the lounger, she froze.

Her features slipped away, the slight smile on her lips fading as she realized who was in front of her. The woman on the lounger was none other than you. Hunt and Keppner stared at her as she noticed her reaction, not understanding why she didn't move forward with her work. "Amelia, we have a critical situation here. The patient's identity is unknown and her values are concerning. We urgently need your expertise!"

Amelia shook her head slightly, as if she could push reality away. Her heart raced as she double-checked that her eyes weren't playing tricks on her. "This is y/n. Y/n y/l/n. She's my girlfriend. Find her family, get them here!" A strangled sound escaped her throat and the world around her seemed to stand still for a moment as she processed the shock.

The emotional rollercoaster went through all the ups and downs, from worrying about you to the overwhelming need to stay in control. Her hands shook slightly as she reached for your lifeless and bloody hand.

"Y/n," Amelia whispered with a strangled sound in her voice and the two doctors and friends of the neurosurgeon were also dumbfounded, their breath catching in their throats. "What happened to you?"

Owen Hunt moved closer and tried to reassure her, while also conveying the urgency and explaining the neurological details. But Amelia only heard fragments. Her gaze was lost in your eyes, which were closed as if you were in a deep sleep.

"Amelia, I know it's hard. But we have to act immediately. The CT results are crucial and we have to find out what happened to her to prevent something worse. She could die!" April urged, concerned about her colleague's professionalism.

But Amelia couldn't let go. She ignored the two of them, her focus solely on you. The world outside the exam room seemed to fade as she held your hand tightly. "Y/n, you have to hold on. You can do this," she whispered in your ear, tears of despair welling up in her eyes. "You're strong, you know? We'll get through this together."

In her emotional despair, an internal struggle unfolded within Amelia. Her professional self fought against her personal connection to you. The shouts of other doctors and nurses became a muffled background noise as she refused to loosen her grip on your cold hand.

"Amelia," Owen Hunt spoke in a calm but firm voice. "We need you now. She needs you now. Let's find out what happened to her together.

A conflict between duty and personal pain raged within Amelia. Finally, she reluctantly gave in and removed her hand from yours. However, her gaze remained focused on you, and concern for you was reflected deep in her eyes. She struggled with fear for you as she prepared to resume her professional role as a neurosurgeon.

A deep breath flowed through her body and with a firm resolve she wiped the tears from her cheeks and turned her gaze to the surroundings. "Dr. Hunt, take her to the CT immediately. She's probably having a brain bleed." she spoke, her voice firm. The neurosurgical focus returned fully, analyzing the medical indicators.

The trauma surgeon nodded in agreement and began giving the necessary instructions, getting you up to the CT scanner. Amelia stayed at your side, letting go of your hand for a moment to oversee the diagnostic process.

The minutes that passed felt like hours. The results of the CT scan appeared on the screen, and Amelia scanned the images with a trained eye. She analyzed each region of the brain, looking for signs of bleeding, injury or other abnormalities. The intensity of her concentration was palpable, and the medical staff eagerly awaited her assessment.

"We have severe damage to the frontal lobe," Amelia explained, swallowing hard as she continued to study the images. "It looks like a severe traumatic brain injury. We need to operate immediately to relieve the pressure and prevent further damage."

The team immediately began preparing for the operation. The sterile atmosphere of the operating room seemed to embrace Amelia as her professional role took over. In her surgical uniform, surrounded by a team of experienced professionals, she struck her familiar Superman pose and focused on the procedure ahead.

During the operation, which lasted several hours, your girlfriend showed an impressive mix of calm and precision. Her hands worked in sync with the instruments as she gently treated the damaged tissue. Monitors in the operating room recorded progress, and the medical team closely followed their experienced leader's every move.

After what seemed like endless hours, but which passed like seconds, she finally closed the last stitches and the atmosphere relaxed slightly, but the uncertainty about the outcome of the operation weighed heavily on her.

Amelia let out a frustrated gasp before exiting the operating room, tearing off her gloves and hood. She immediately went to the waiting area to inform your siblings and parents. The tension in her chest eased as she saw the expectant looks of the people who were now her family and your sister immediately threw her arms around her.

"The operation is complete," Amelia began, trying to keep her voice steady as she also clung to your sister to keep her emotions at bay. "It was a complex brain injury for reasons still unknown, but I did everything I could. The next step now is to wait and hope she remains stable."

Your family breathed a sigh of relief as Amelia explained more details about the condition and cooperation with the police. Her words were reassuring to your sister, but she still felt the knot in her stomach. The outcome of the operation was uncertain, and there was no way of knowing whether you would ever wake up and be your old self again.

In the silence of the hospital hallway, as she left the waiting people behind, a moment of exhaustion overcame her. Her eyes wandered back to the exam room where she found you in. The image of you on the lounger didn't fade, but Amelia found comfort in the fact that she had saved you. Now things could only go uphill and she couldn't wait to look into your beautiful eyes again.

[covid-safer-hotties]

Listing archived on our website

Summary Background Patient-reported outcomes and cross-sectional evidence show an association between COVID-19 and persistent cognitive problems. The causal basis, longevity and domain specificity of this association is unclear due to population variability in baseline cognitive abilities, vulnerabilities, virus variants, vaccination status and treatment.

Methods Thirty-four young, healthy, seronegative volunteers were inoculated with Wildtype SARS-CoV-2 under prospectively controlled conditions. Volunteers completed daily physiological measurements and computerised cognitive tasks during quarantine and follow-up at 30, 90, 180, 270, and 360 days. Linear modelling examined differences between ‘infected’ and ‘inoculated but uninfected’ individuals. The main cognitive endpoint was the baseline corrected global cognitive composite score across the battery of tasks administered to the volunteers. Exploratory cognitive endpoints included baseline corrected scores from individual tasks. The study was registered on ClinicalTrials.gov with the identifier NCT04865237 and took place between March 2021 and July 2022.

Findings Eighteen volunteers developed infection by qPCR criteria of sustained viral load, one without symptoms and the remainder with mild illness. Infected volunteers showed statistically lower baseline-corrected global composite cognitive scores than uninfected volunteers, both acutely and during follow up (mean difference over all time points = −0.8631, 95% CI = −1.3613, −0.3766) with significant main effect of group in repeated measures ANOVA (F (1,34) = 7.58, p = 0.009). Sensitivity analysis replicated this cross-group difference after controlling for community upper respiratory tract infection, task-learning, remdesivir treatment, baseline reference and model structure. Memory and executive function tasks showed the largest between-group differences. No volunteers reported persistent subjective cognitive symptoms.

Interpretation These results support larger cross sectional findings indicating that mild Wildtype SARS-CoV-2 infection can be followed by small changes in cognition and memory that persist for at least a year. The mechanistic basis and clinical implications of these small changes remain unclear.

[a-d-nox]

web of wyrd: the heart charkra

the numbers we are focusing on today are based on the green bubbled numbers in the web then the sum of the two equal your emotional number - ex: as you see above and in previous charts, my energetic number is 22 and my physical number 21. so to get the emotional number i have to sum the two: 22 + 21 → 43. recall that numbers must be summed a second time if they total 43 (i.e. 4 + 3 → 7) and above.

but what does this number mean?

the chakra set we are examining is the heart chakra (anahata); it signifies our love, feelings, sincerity, compassion, altruism, patriotism, duty, ability to feel, awareness, acceptance, and spiritual values. bodily it governs our heart, circulatory system, breasts, respiratory system, lungs, and ribs.

so let's talk about some examples:

7 - the chariot

physically 7s are hardy people. this arcana is ruled by cancer so naturally these people have tough ribs, like a crab shell, and it is likely that they have bigger and/or denser breast tissue due to cancer being ruled by moon. however, they might have very delicate lungs and a fragile circulatory system. these people aren't made for running because of this - it is just too hard on their bodies. try to aim for a lighter aerobic exercise like water aerobics, wall sits, swimming, tennis, etc.

energetically 7s are often very altruistic - they rally when getting things done for the greater good. they tend to be very selfless - they know what it is to be in charge and have people looking up to them and trusting them to do what is best for them. they don't do anything lightly; they like to have a plan and reason - but when they are out of balance, they can be very impulsive or too hesitant. mainly they have a strong sense of duty - they are one hundred percent the people who will serve their country because it is "their duty to protect their country". they are very patriotic in that regard. they value forward movement and intention - they feel it is important to continually progress for the betterment of the future.

7s emotionally are very guarded. they don't easily share their feelings. they have a lot of love to give, but they can easily frighten people with their defensiveness and emotional remoteness. cancer's, and thus charioteer's, have a hard exterior but a soft interior. they are guarded and defensive for a reason - they are protecting themselves. these people tend to have large emotional wounds that originate in childhood - from that moment on, they dress for war when dealing with emotional situations and situations where they can potentially get hurt emotionally. they are very aware of others emotions which is why they tend to make their intentions incredibly clear.

21 - the world

21s physically have great breasts - it is like the card itself; they enjoy being braless. it is something about this card though - it sort of reminds me of cancer awareness ribbons. maybe it is a cause they support - heart, breast, or lung cancer research - or maybe someone close to them struggled with the disease. this is a card of celebration after a long fight/journey, so maybe they themselves have experienced some form of chest cancer. in time all wounds heal given the card. something else i noticed with this placement is that these people really consider chest surgery - i wouldn't be surprised to find this arcana on this charka for people who had breast augmentation or removed a set of ribs.

energetically 21s want to see the world flourish and improve. they are often very involved in the realm of politics and search for candidates that are willing to get things done in their country. they want people in charge who are mature and responsible. they want someone like themselves in other words. other then that, they empower others and generally want to see others rise up - they are the best cheerleaders a person could ask for. frankly, this is a great leader in general because they want what is best for the people who look up to them.

emotionally 21s experience a very wide range of emotions. emotionally they are extremely vulnerable and don't fear what the world sees from them emotionally. they have been through a lot and fear nothing when it comes to expression and sharing. in fact, they enjoy letting others know how they feel because it sets them free in a way. they are very emotionally mature and tend to take into account how others react to their reactions and how they can best articulate to others how they feel.

22 - the fool

22s physically remind me of either good or poor circulatory flow. uranus is the ruler of this arcana and has the tendency to mix things up. these people could have a rare blood disorder, a lack of an rh factor, need to take medication for rh factor when pregnant, etc. you can never predict what is going to happen where this person's blood is involved. they also have a tendency to get stitches in their side or feel like there is a sharp pain when breathing. and not to be extreme but i have seen these people break a rib (especially, the floating one) and/or have a sudden heart issue, like a cardiac arrest.

energetically 22s are willing to try anything once. altruism is something they do once, but if they see that they are being used for their generosity, they are quick to cut ties. they are easily blind to being used at first, but as soon as they see it, they will leave and aren't afraid to go ghost. they aren't the most patriotic person - often they will dream about leaving their home country. these are not the type of people to be relied on in terms of duty; they can either be extremely flighty or they will do what is expected of them before it is asked.

love is blind - emotionally 22s are the type of people who take a chance when it comes to romances. they have a tendency to let people back into their lives because they believe that change is possible and that it is never too late to start again. they listen to their heart more than their intuition at times; which can be a dangerous game because they often associate the two together then they wonder why they can't trust their intuition.

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[plastictoyphone]

Attachment Will Bring Me To My Doom

(The long awaited Black backstory)

Peeps the time has come: @kijimha @city-of-c0rpses @joanbarrie @fedya-the-rat-god @myluckymoon @respiratory-kristem

"Our baby boy..... We will love you forever." Those were the first words I ever remember my mother saying to me. I was barely a few months old yet that loving memory is still faint in the back of my mind. Slowly fading away from my subconscious.

I would have been lucky. A loving mother, a proud father, excited and supportive brothers. Yet I was unlucky. For I was stuck with this curse that has taken everything away from me.

It was all an accident too.....

Most parents would be excited and proud when their baby says their first word. Mine was mommy. It was easy to roll off the tongue and that's who I wanted most when it came to attention. Mommy, I wanted mommy to hold me. To feed me, to love me, to speak to me, I wanted her.

"Mommy." I wailed in my crib. I can't remember how old I was or the memory so well. The only thing I can remember was waking up that night in a cold sweat and a bad cough. A poor sick little child wanting his mother to comfort him.

Make it stop.

"Mommy." 96. I cried again when she didn't come.

Make it stop.

"Mommy!" 97

Stop it!

"Mommy!!!" 98

STOP THIS! JUST STOP TALKING! KEEP SILENT!

"MOMMY!!!" 99

I don't remember much, other than the faint sounds of her slippers tapping the floor and the warmth of her arms as she scooped me up. Her soft voice comforting me. "You okay my baby boy?"

I shivered in her arms before closing my eyes. "Cold....." 100.

I never saw my mother from that day forward ever again.

In fact I never saw the rest of my family from that day forward ever again as well. All I know is these 4 white walls and complete utter isolation with no contact from the outside world. I had no name as well. I used to have one before I was taken away by a facility, but I was given a new one. Or multiple I should say.

Rey was the common one. So was child 89, Mute, silent killer, "that kid", and most of all Black. To the facility I wasn't a child to them. In all reality I was some uncontrolled weapon of a monster who would kill anyone by a single touch if I spoke too much.

They tried to "cure me" at this facility. Testing to see if I can be stable enough for the outside world. Yet those moments were nothing but pain.

I would kick and scream every time the "doctors" tried to take me to a examining room. I was scared, I didn't care if my screaming for help or to be let go was going to get someone killed. I didn't want to go through another experiment or examination. I'm tired of the needles, the pills, the electro shocks, or anything that would keep me quiet.

Worst of all the doctors would lock a iron muzzle on my face, locking my jaw shut so I couldn't speak. Those were the worst moments because I felt so powerless in those moments. All I could do is sit in my cell, sitting in a straitjacket with no freedom to move around more utter a single sound.

These 4 walls became my life. And so did that man. The head of the facility. I didn't bother to remember his name or face. Why should I when all he repeated to me was, "Try not to get attached to people, 89. It's for your own good and for the rest of the world as well. Everything that you will love will die by your hand. It's best to keep your distance and stay far away. So no one can ever get hurt."

So I obey those orders.

Because in the end someone did end up getting hurt because of me. For once in my life the facility let me out of my so called home and out into the real world for just a month. To test the waters if I was stable enough.

At the time I was 17, they put me into a high school, yet I was barely given any schooling about the real world or how people act. All I knew to do was to keep quiet and count how many times I spoke a single word. In order to communicate I would pass notes and lie that I was a mute. This would keep most people away from me so no one got hurt. If they ignore me because I'm a mute then they won't get hurt or killed by me.

Yet it still happened. Even when I tried to keep my distance someone had to die by my hand. All because I wanted to help.

It wasn't supposed to be like this. Some girl at school invited me to her house party, it's what you would normally expect from any drama show or movie. Lots of people, underage drinking, smoking, drinking games, a couple making out in the back. I only went because I didn't know how to say no.

Though I wish I didn't go. Because that night the girl who invited me was getting harassed by some guys. I wanted to step in, after all she was nice to me. Yet I lost count of how many words I have spoken. And by the graze of her hand on my shoulder, everything fell apart.....

I never saw that girl or that house ever again.

The facility immediately took me back after the incident. After that it was back to every day life within these 4 walls. That was until one night I was sleeping peacefully in my bed, unaware that someone was out for my blood.

There was a hand tight against my neck and I jolt awake to see a guy older than me with a knife, ready to kill me. I panicked of course, how could I not? I seen this guy before. He was the older brother of that girl who invited me to the party. From the piercing look in his eyes, I can tell he was out to get me for the incident.

I don't know how but after a bunch of struggle and bashing our heads against walls and glass, we ended up outside in the deep woods. I was trying to run but he was chasing up behind me. When I got near a river I attempted to leap over it but he tackled me and dunked me underwater, his hands around my throat as I struggle and kick to no avail. I was power less underwater and I was losing air.

This was the end of me.....

That was until the man's hand let go of my throat and somebody else yanked me out of the water when I fell unconscious. Soon before I knew it I was coughing up water and leaning against a tree. Stood before me was a tan guy with glasses and yellow eyes.

His name was Nicholas. I called him my brother once he took me in thay day. Now I'm with this Mafia organization called XY for a couple of years now. It's quite nice. The people here are a little weird but it's my kind of weird.

For once it feels like I have a family to call my own.

Yet I'm scared. I still keep my distance away from everyone else. Standing in the dark shadows while everyone else has fun in the light. Because if I step into the light then I'll get attached. And attachment will bring me to my doom. Keep my distance and no one gets hurt.

That's how it will always be.

[pearldog30]

Eyes on me.

All right my nasty Gremlins y'all are getting fed today. y'all are getting the spicy ghost fic, That I've had in the works. That took way too long because your girl got an upper respiratory infection and is slowly dying but we don't let that stop us. (Also @simonsdoll that slut heard this idea and forced me into writing it so thank her, for feeding y'all's nastiness.) This is also going to be a very long one so buckle up.

Simon ghost Riley x F reader

18+

Other works 👉Master list

Warnings| fingering, masturbation, bruising, praising, degrading, deepthroating, alcohol, P&V SEX.

(mahaha my lil thirsty hoes y'all are welcome for that. Pinterest came in clutch)

walking out of the steamy shower, grabbing a towel and wrapping it around your dripping body. lightly dabbing yourself dry, wiping your wat feet off on the rug beneath, you. pulling the wet strands of hair out of your face, back up into the messy bun. walking out of your master bathroom, and entering your lightly dim master bedroom. huffing out a relief sigh to yourself, happy you're finally clean, and your body's relaxed from the rough day you had. Simon really knew how to help you unwind, and relax from those days. a nice cozy dinner, a bottle of wine is just what you needed.

Softly walking next to your nightstand. turning your head to your part of the bed, looking down at the clothes Simon had laid out for you, while you were in the shower. most of the time you didn't even ask him to do it, he just did it himself when he was home. knowing you like to curl up in bed as soon as possible. taking a closer look examining at the clothes Simon had chose for you that night, noticing it's one of his big t-shirts, looking around confused on why you didn't have underwear there. he always grabbed underwear with it, so why wasn't there any there now? Instead of stressing too much about it. you just figured he must have forgot, or something, unwrapping the towel from your body, drying yourself off the rest of the way. tossing the towel somewhere on the floor, grabbing his way overly sized t-shirt, for you putting it on your much smaller frame. relaxing your body once again at the way his scent covers you, from his T-shirt. you always loved when he picked out your clothes after shower. it was always one of his t-shirts that smelled like him, that smelled comforting, relaxing, safe, like home. because well truth of the matter is, he is your home.

Turning away from your bed. making your way over to your dresser, to pull out a fresh pair of underwear. catching the door softly open in the corner of your eye, turning your head to be met with none other than Simon Riley himself. leaning heavily, yet softly, against the door frame. in nothing but gray sweatpants, while his dog tags jingle from his neck, resting on his broad chest. And then resting in his left hand a glass of bourbon, his favorite classic alcohol beverage, in such an inexpensive glass that you bought him for his birthday. his brown eyes catching yours. but there's something off about the look in his eyes. it screams dominance, passion, hunger. Looking you up and down like you're pray waiting to be turned into a meal.

Resting more of his body weight, on the door frame making it crack a little sound. watching you intently, as you turn back to your dresser drawer pulling out a fresh pair of clean underwear, out of your shared dresser. You hear him clear his throat "ah what do you think you're doing" confused. turning your gaze, back to his. "uhh grabbing underwear" standing back up to his full intimidating height. "darling there's a reason why there wasn't. put them back" he says. demanding in a Stern, yet gentle, voice. Obeying, you do as you're told closing the drawer. humming happily to himself that you obeyed him. he walks up to you letting his free hand meet the palm of your back.

Guiding you to follow him, you do. and he brings you to his side of the bad. Bringing his hand from your back down to your ass, giving it one good squeeze. Before gesturing you up, to your king size bed. you have to do a little jump to sit on the edge of it. watching you, he can't help but think how God damn cute and "innocent" you are. he points his finger at you gesturing you to stay, as he turns his back to you, to sit on the little loveseat. that y'all have in the corner of the room, facing towards the bed. directly towards you! feeling your cheeks heat up, knowing his gaze is heavily on you, watching your every move, watching your chest rise, and fall. he sits in the chair leaning back, groaning to himself. relax, man spreading as much as possible in the small chair, making him look even bigger. You look down to where his hands both come to meet in his lap. still holding his bourbon, but now with both hands cupping the cup, making it look child size.

Clearing his throat, maintaining eye contact. his eyes burning through your soul. "Spread them" he says, in a serious tone. You knew what that meant. Adjusting yourself on the bed a bit, you move your legs wide for him. Seeing your wet, throbbing, cnut. As his oversized shirt lightly dangles over his view. Making his mouth water, and you can tell the bulge in his pants is getting bigger, tightening the fabric around him. Licking his lips hungrily at the site, adjusting himself properly on the chair. resting his elbow and his drink on the side arm of it.

"fuck" he huffs under his breath scratching his chin with his other hand "rub that perfect little clit for me" cheeks heating up even more at that statement. Slowly moving your arm down to your soaking cunt. As you have your other behind you, keeping you sitting up, To keep your eyes on him. Your fingers finding their way to your slit, rubbing the wetness from your hole, all around. before slowly making your way up to your clit, rubbing small circles around the throbbing sensitive nub. Tilting your head at the small pleasure, that was introduced, moaning as you continue your slow, gentle, rubs around your throbbing area.

"AY come on, eyes on me darling" rough, husky, voice. snaps you out of your own thoughts. Staring into his eyes, pleading to let you introduce a finger, or speed up the process needing more pressure, speed, instead of keeping you at this edging slow, he has you. "Come on doll rub that clit, like how it was meant to be rubbed" he says. knowing you need more speed, friction, to really get to that high. And you eagerly jump to that opportunity, more than happy that you're allowed to chase your orgasm a lot quicker. "Fu- fuck Simon" you moan out, Slowly becoming lost again in your own thoughts. "I know you wish it was me, right now between your legs" he says with a chuckle in his voice, knowing full well what his voice alone, does to you. "I-.. I do" you respond. still keeping your eyes on him. afraid if your eyes leave, he'll make the pleasure stop. "Well too damn bad slut. it needs to be earned" turning his head to take a sip of his bourbon. watching you intently, as you slowly come apart with just your fingers, and his voice.

Before you could get too close he stops you. "Fuck yourself" and with that, your other arm you had behind you leaning yourself up with. now you're back fully laying against the mattress, legs still spread wide for him to see. As you now take your free hand, slowly moving it down to your soaking wet entrance. the other still rubbing circles on your clit. Your fingers slowly find their way to your entrance spreading the wetness around, before you insert a finger. "Ah you better take that hand away from your clit. I just want to see that pretty little soaking hole of yours being fucked!" your hesitant, to stop the motion, and Pace, you had going. afraid to lose the high you've been chasing. but you contemplated it, too long before his voice snaps you back. "you heard what I said, quit being a needy whore." whimpering, you slowly move your hand away from your clit, your hand finding its way to the sheets gripping hard. As your other hand inserts 2 fingers going in and out of you so smoothly, picking up the pace fuckin yourself quickly, to get back to that high.

Arching your back, whimpering, and moaning. Happy that your high is finally coming back. You hear Simon, "atta girl, just like that" (me casually staring at doll in the corner 👀)

"Sh- shit Simon I... 'm sooo closeee pleasess let mmm- me cummm-" you moan out loudly "aww fuckk baby cum for me, keep on fuckin that tight little hole for me." he moans out in pleasure. Turning your head a bit. you get a view of his lap, and it brings you even closer, making your mouth water at the site. The bulge is even bigger than before, and you can see a little dark wet spot on his pants, clearly where his tip is bulging the most. begging for freedom, to be touched. Not even realizing, you're somehow fuckin yourself even faster than before, eyes still locked on his Major bulge. "Damn you fuckin needy ass slut, looking at my lap are you? wishing it was my cock fuckin you, don't you" he says knowing what he's doing to you. and that's what broke you, arching your back off the bed, getting the familiar feeling of your stomach tightening. "fu- fu fuck I.. I'm cu. Cuminnnn" you cry out. as you can feel your cum dripping down your fingers, soaking the sheet beneath you. Simon watching you intently, as you come apart. Moving your hand up to your mouth, sucking your cum off your fingers teasing Simon. Making him grunt in response. While he takes yet another sip of his bourbon, trying to quenches his thirst, that seems to never leave.

Quickly moving both your arms behind you to keep you up. breathing heavily, slowly coming down from your high. You turned to Simon looking at him with euphoria, heavy eyes, catching his gaze he looks down. he slowly lifts his hips up, pushing down his sweatpants, to his knees. revealing he's massive erect, throbbing, cock. hitting his stomach the second it's free, making a little slap sound. And you can see the absurd amount of precum, dripping down from his bright red tip and onto his stomach. you can see that his entire length, as well is covered in precum. He really is a messy boy. Looking back up at you, moving his hand gesturing you to come to him. And you do so jumping off the bed slowly, wobbling towards him. Standing between his spread legs looking down at him, WHAT A FUCKIN A SITE TO TAKE IN, and you do so for a few seconds photographing the image to memory.

"get on your fuckin knees" He commands. and you do so without hesitation. Adjusting himself forward catching his lips with yours, you can feel from that kiss how hungry he really is. Shoving his tongue down your throat, you can taste the strong bourbon of his tongue. While he's hungerly trying to get the taste of your arousal in his mouth. Pulling away for air, he pushes you back down near his lap. As he sits back in his seat. Looking at you intently, as you take his big cock in your hands, jacking him slowly. before you, take your tongue from the bottom of his shaft, licking all the way up to his throbbing messy tip. licking his slit that's covered in precum, before you slowly put your soft lips around him, sucking him. then pulling away to savor his taste, licking your lips, to make sure you get all of it. he softly moans at the site, turning him on even more. at the way there's a long string of precum connecting your tongue to his tip. "Fuck pet! you have no idea how good you look, at the way you take my cock. fuck you'll look even better when I ruin you....!" he moans out. And his words send a shiver up your spine. knowing at any given moment, he could stop your light teases, and fuck you senseless.

Continuing your light teases, dragging your tongue back at the base of his dick, dragging your tongue up across the thick, long, vein he has. from his shaft all the way up to near the tip. moaning softly at the way he taste. feeling how lubricated his cock is from the mix of his precum, and your saliva, sending you into a trance from the taste. "Fuckin hell" he moans out. Knowing he's starting to grow tired of your teasing, but you ignore his warning sign continuing your painfully slow pace.

Already having enough of your shit. He swiftly grabs fistfuls of your hair without warning, or hesitation, shoving his cock down your throat. making you gag in response, tears forming at the corner of your eyes. Chuckling to himself, It didn't matter how many times you took his cock down your throat. it was a challenge every. Single. time. just like how he fucked you. And he found a sense of pride in it. knowing he could be the only one that you could never get used to no matter how many times you took him. Pulling you off his cock by your hair, looking down at you, as if to pity you. eyes darker than usual. Seeing that there's a mix of precum/saliva rolling down your chin, dripping onto your chest. making little dark spots on the fabric of his shirt, that is still on your body. Groaning lowly to himself.

Freeing his one hand from your hair, moving it up to where his bourbon was resting on the side arm of the chair. taking a quick swing of it before forcing your mouth open, spitting it into your mouth. forcing you to swallow, Burning your throat from The unexpected alcohol taste. Before forcing you back down onto his cock. The taste of alcohol, and precum, filling your taste buds. You hear him moaning again from the pleasure that was reintroduced. "I bet you love the way my dick taste" as he Swiftly face fuckeds you, catching his own high. "Ye...ah j- just like thattt hmm.. f-uckkk sooo gooood" he moans out, tightening your hair in his fists. bucking his hips into you, your nose meeting the very base of his dick. Making you gag, and cry out. From the fast, forcefully, Pace he has going shoving his entire cock down your throat over, and over, and over, again. Struggling to catch your breath, while you have a mouthful of him. You feel his cock starting to twitch, his thrust becoming sloppier, moaning, and grunting, getting louder.

He forces you down on his cock one more time. Before you feel his release feeling your throat, practically drowning you in his cum. "Fuckkkkkk m- I'm cum-in go good girl... ta-..ke mme take Allll.. o f of me" you can feel his seed running down your chin, struggling to swallow all of it. He sloppily pulls you off of him. Catching his breath, while you lick your lips trying to make sure his seed doesn't go to waste. Looking up at him with teary eyes, he catches your glance and you can tell this isn't over yet.

He pushes you back, to stand up from the chair making you fall backwards. Reaching his hand down to help you up. as he pulls his sweatpants off the rest of the way, Leaving him completely bare. Pulling you up, with one good motion pulling you into his chest. as his other hand comes down to meet your ass giving it one good slap, making you jump. "Come on baby" he says lowly. Before picking you up, with ease. Catching his starved lips with yours, while he walks over to the bed throwing you down on it. Making you squeal, as his hands find their way under your shirt, roaming your body. No matter how many times he seen it, has his hands over it. he is still mesmerized by it, making him fall a little more each time.

Lingering his hands up your body, finding your tits giving them a good squeeze before. His thumb rubs over your nipple making them hard, playing with them gently. Muttering to himself "s- so per.. perfect" you can feel him getting hard again against your inner thigh. As his lips find their way to yours, your taste buds being met with his bourbon breath. Growing impatient. he breaks the kiss, ripping his shirt off of you, pulling back, from the sloppy kiss. meeting his gaze with a surprise expression on your face. "Sorry love, you can't enjoy art if it's being covered." he says cocky. before he moves his head down, his lips meeting with your hard nipple. circling his tongue around it, soaking it, in his saliva. Making You moan out in pleasure. " Fuck Simon, please just fuck me" you say growing impatient. feeling him rock hard against you, teasing your slit. as he goes down on your breast licking, and sucking, them. "What was that didn't hear you" he says between licks. licking, and sucking, your nipple. as his other hand squeezes your breasts tightly. You cry out again "fu-ck pleaseess just fuck m. Me" begging, wanting to relieve the pressure that's growing between your thighs.

He then flips you on your stomach. head buried in the sheets, ass up. "Fuckkk such a perfect view" he whispersed. before he gives one good stinging slap to your ass, making you gasp. Seeing how wet you are, dripping down your thighs. taking his hand and spreading it around your heated, sensitive, cunt for lubrication. Making you whimper at his touch, where you need him the most. "fu-ck si your handsss feel s soo go-od" you moan trying to enjoy his hands rubbing up and down your slit, "and my cock will feel even better" he teases. Pushing his tip in making you gasp, at the unexpected stretch. A little painful, but pleasurable, each time. He goes inch by inch in your tight soaking walls. grunting from the tightness, and the pleasure, it breaks him. Grabbing your hips tight, almost enough to draw blood, with both his hands. Where you know there will be dark purple bruises in the morning, but you didn't care you loved it, every second of it, even the aftermath.

After easing you on him. he then unexpectedly pulls out all the way pounding into you with such Force, jolting you forward a bit. but bringing you back to him with his such strong grip. Making you cry out"aww si Sim-on" shushing you. before you could carry on. "I know baby I feel so damn good. Don't lie, come on you can take me, can't you?" Knowing you're slowly drowning in your thoughts, getting drunk on his cock" YE..SS SIRR" you scream out loud. from him picking up the pace even more. "Good girl call me that, that's what I like to hear"

Panting, grunting, moaning, skin slapping together, bouncing off the walls filling your ears. You both didn't realize how much you loved these moments, after him being gone for months at a time. Then removing his hand from your hip, and giving your ass another slap. putting it back where it was. You could sense he was getting close from how eager he is, and the way his grip on you tightened. Removing his hand again trailing up your back, sending shippers throughout your entire body. His hand reaching your hair pulling you back up against him. his chest right up against your back. Feeling his hot breath, on your neck slowly itching up to your ear "fuck you don't know how fuckin tight you feel on my cock, almost like you were made for me. Well fuck you were made for me, and only me." He says deeply, and possessively. His teeth coming to make contact, with your shoulder biting down making you yelp. Happy with himself knowing your helpless, your in his grasp, at his mercy.

removes his other hand from your hip, moving it down to your clip, rubbing small circles. making you shake from the overstimulation he's bringing on you. "Plea..ssseee.. I need it" struggling to get the words out. knowing he's messing with you, " I know love I know but do you think you can take me a little deeper" before he adjusts himself so he's all the way in, you feeling him poke out at your stomach. Making you gas, and moan. Removing his hand from your hair, slowly dragging it across your body, down to your stomach. so he can feel himself pounding into you, lightly pressing his hand down where is cock is bulging at your stomach. so you can get to your high quicker.

Feeling his thrust getting sloppy. knowing he's getting closer to his high, as he rubs your clit faster so you can cum at the same time. "Si I..m soo so close" you say, trying to gather your thoughts as he keeps on pounding so desperately. "Meee t o.. lo-ve I- I knowww, he says panting. Trying to keep up the pace, feeling him twitch in you, hitting the right spot, that made that string in your stomach snap. "FU- FUCK SIM-ONNN I'..M CUMINGGGG" screaming out. leaning into his chest more, than you thought you had. Feeling him, come undone at the same time, feeling your walls be painted a beautiful white. "A..www Good da-mn it f-ck just likeee th--at... you fe..ell s so good"

As he pushes the both of you forward, hand quickly coming down to catch the both of you before he crushes you beneath him. Adjusting himself upward, slowly pulling out of you, seeing his beautiful artwork smiling to himself. Then locking his arms around you, slamming himself on the bed, with you close to his chest. as he pulls a blanket over both of you "that was so good" you say sleepishly eyes closed. Him giving you an agreeing hum, before watching you drift off to sleep.

And that's going to be the end for this filth, I hope you all enjoyed it this took me way too long. As always I hope you are having a good/night day wherever You are. reblogs and comments are always appreciated 🖤(sideblog @pearldog)

[13lunarstar]

Kala Purusha

Kala Purusha, also known as the "Cosmic Man" is a concept in Vedic astrology that represents the universal form of the human being, correlating the Cosmos with the human body. This symbolic representation is used to understand how the various Zodiac elements influence different parts of the human body and aspects of life.

Kala Purusha is depicted as a giant cosmic being whose body parts correspond to the signs of the zodiac (sansk. Rashi) and a horoscope's twelve houses (sansk. Bhava). This concept is a framework to link the microcosm (an individual human being) with the macrocosm (universe). By examining the houses and the signs in a natal chart, it is possible to predict potential health issues and overall physical constitution. The Kala Purusha concept helps to understand the interconnectedness between celestial movements and bodily functions.

ZODIAC SIGNS AND BODY PARTS

Each zodiac sign, from Aries to Pisces, governs specific parts of the body in the Kala Purusha:

The first house of a horoscope - Aries (sansk. Mesha):

Body Part: Head

Characteristics: Represents the brain, brain activity, forehead, and overall upper head area.

The natural ruler: Mars (Mangal)

Health Concerns: General health, brain disorders, appearance, vitality, and overall physical constitution.

The second house - Taurus (sansk. Vrishabha)

Body Part: Facial middle and bottom parts, right eye, throat, neck

Characteristics: Associated with the throat, vocal cords, and lower face including the mouth and teeth. (Hint: benefic planets in the second house, as well as benefics' aspects, influence voice and appearance, making them appealing. At the same time, the ruler of the 2nd house in so-called dusthanas (6,8,12 houses) can give problems with vision and teeth).

The natural ruler: Venus (Shukra)

Health Concerns: Dental issues, speech problems, vision problems, and eating disorders.

The third house - Gemini (sansk. Mithuna)

Body Part: Shoulders, arms, and hands.

Characteristics: Controls the shoulders, arms, hands, and respiratory system.

The natural ruler: Mercury (Budha)

Health Concerns: Respiratory issues, shoulder pain, arm injuries, and ear problems.

The fourth house - Cancer (sansk. Karka)

Body Part: Chest area, lungs and heart

Characteristics: Governs the chest, including the breasts and upper stomach area (hint: benefics, such as Jupiter and Venus located in the 4th house or aspecting it, can give women big beautiful breasts)

The natural ruler: Moon (Chandra)

Health Concerns: Cardiac conditions, lung issues, breast health, and emotional well-being.

The fifth house - Leo (sansk. Simha)

Body Part: solar plexus, upper abdomen, stomach

Characteristics: Corresponds to stomach, digestive organs, spine, and upper back

The natural ruler: Sun (Surya)

Health Concerns: Digestive disorders, issues related to the stomach and intestines, and emotional stress.

The sixth house - Virgo (sansk. Kanya)

Body Part: Lower abdomen and digestive system

Characteristics: Influences the digestive organs, intestines, and lower abdomen.

The natural ruler: Mercury (Budha)

Health Concerns: Digestive problems, diseases, illnesses, and overall physical fitness.

The seventh house - Libra (sansk. Tula)

Body Part: Kidneys, lower back

Characteristics: Linked to the kidneys, lower abdomen, and lumbar region.

The natural ruler: Venus (Shukra)

Health Concerns: Kidney issues, lower back pain, sexual health

The eighth house - Scorpio (sansk. Vrishchika)

Body Part: Reproductive organs and pelvis.

Characteristics: Controls the reproductive organs, pelvis, and excretory system.

The natural ruler: Mars (Mangal)

Health Concerns: Chronic diseases, inflammations, surgeries, reproductive health issues, and problems related to the excretory system.

The ninth house - Sagittarius (sansk. Dhanu)

Body Part: Hips and thighs.

Characteristics: Governs the hips, thighs, and sciatic nerve.

The natural ruler: Jupiter (Guru)

Health Concerns: Hip problems, thigh injuries, and conditions affecting the sacral area.

The tenth house - Capricorn (sansk. Makara)

Body Part: Knees and skeletal system.

Characteristics: Associated with the knees, bones, and joints.

The natural ruler: Saturn (Shani)

Health Concerns: Bone issues, knee problems, arthritis, and joint disorders.

The eleventh house - Aquarius (sansk. Kumbha)

Body Part: Ankles and circulatory system.

Characteristics: Influences the ankles, calves, and circulatory system.

The natural ruler: Saturn (Shani)

Health Concerns: Circulatory issues, ankle problems, calf muscle issues, and blood disorders.

The twelfth house - Pisces (sansk. Meena)

Body Parts: Feet, toes, left eye.

Characteristics: Corresponds to the feet and toes.

The natural ruler: Jupiter (Guru)

Health Concerns: Foot ailments, eye problems (especially the left eye), and sleep and mental health issues.

[getphysicalexam]

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