#started adderall again and this is the result

[slitheringghost]

I do agree that people sometimes tend to minimize the Blacks abuse (I don't believe Sirius was crucio'd like so many fics seem to focus on, but I do believe strongly in psychological abuse that might’ve escalated to physical - this being what forced him to run away), but Snape being abused by his father is just... a logical conclusion of the narrative based on popular tropes and the things we're shown. First because of his father's background (poor muggle who hates magic and lives in the slums) and from everything we're told about Snape as a child - his severe social awkwardness, him being described as looking unloved, the brief glimpse we see of his father being Eileen and Severus cowering from him - I think it's pretty clear what we're meant to infer about his family life

No I mostly agree with you! Sorry I think my post was confusing. I don’t actually interpret the text that way, I think Snape is implied to be abused and it’s somewhat of a bad faith reading to claim he wasn’t. Like you CAN make that argument but it’s a reach, and that post was meant to be me doing weird mental gymnastics lol as a demonstration of how fans do that with Sirius. (I also forgot the description of Snape as unloved, thanks for pointing that out. That fits with how Kreacher says Walburga hated Sirius too).

That said, I have a major gripe with “Tobias was a poor muggle who lived in the slums” as evidence for Snape being abused.

This fandom constantly frames wealth and privilege as mutually exclusive with abuse and I’m so tired of it - i.e. I see takes framing the Black sisters being wealthy, privileged, spoilt, arrogant, raised as royalty, etc. as reasons why they couldn’t have been abused or have a tragic backstory. Same that Sirius was the brilliant eldest son and heir and therefore either wasn’t abused at all or only started being abused once he disagreed with his family’s politics, because Why Would His Parents Abuse Their Super Talented Beloved Heir otherwise? Or how “Sirius doesn’t act like an abuse victim, he acts like an heir who was raised to run an estate” as if those are, again, mutually exclusive. With the Blacks framed as being too much of “refined aristocrats” to resort to beating their children and seeing that as “beneath them” (also shown in the bizarre takes that the Blacks would think it’s “Muggle” to hit their kids. Like, WHAT? It’s magical society that is centuries behind the Muggle world in terms of social progress and therefore ideas of abuse… if anything what they’d view as “too Muggle” is the idea that torturing your children is abuse). ETA: I've also seen fandom compare the Blacks to the Roys from Succession, the Targaryens from ASOIAF, characters from the Crown, etc as part of evidence that they're not (severely or at all) abusive... AGAIN plainly linking abuse to wealth.

Rich privileged people do, in fact, experience (and commit!) domestic violence! Just as poor people do! Rich kids experience sexual abuse. Rich wives are murdered by their rich husbands. And so on. Denying this is absolutely fucking wild. And this is a dangerous mindset for several reasons, but particularly given that sometimes victims’ wealth is used as reasons to dismiss abuse in real life too - i.e. the Menendez brothers.

Yes, poverty certainly influences domestic violence in many ways - as @ashesandhackles says in this post, “Statistically, this is also seen more in low income households where economic instability and resulting domestic instability creates an unsafe environment for the kids to safely form ideas of their identity, or express emotions in healthy ways, modelling instead out of behaviour seen at home.” (I’m not sure of the exact statistics of how socioeconomic status affects rates of abuse, but even if it’s significantly higher in lower income families, it still wouldn’t make these takes less dismissive of privileged victims). We see this with the Gaunts too. This is an interesting post on Snape’s abuse and poverty (and, notice how literally no one denies that Snape was abused to the point of having bruises and scars and broken bones…).

But wealth does too - people who hold and abuse their power over their “inferiors” often bring that violence and abuse of power home. That’s not always true i.e. Lucius abuses Dobby and that doesn’t extend to his family. But on the other hand, Crouch Sr’s treatment of Winky directly parallels his treatment of his son, and his abuse of power in the MLE throwing others into prison without a trial also led to him not giving his son a proper trial before throwing him to the dementors. And certainly the Blacks’ murdering Muggles and house-elves relates to them disowning - and potentially honor killing- children for marrying Muggles/Muggleborns.

(There are spoilt wealthy characters for whom it makes no sense to give an abuse backstory, like Draco, but his privilege doesn’t have much to do with it - his portrayal as deeply loved by their parents does.)

This is a tangent, but re: Bellatrix’s behavior in particular, it’s canon that Bellatrix acts arrogant, calm, like a leader, like royalty (“sitting on her chair as if it was a throne”) in the middle of literal dementors during her trial, which means that, as this essay points out, putting on a front of arrogance is how Bellatrix copes with despair. This fits with how when she’s terrified Voldemort will kill her and her family in DH, she takes charge of the household. I think she’s also truly haughty, but it’s not always about her privileged upbringing, it’s also oftentimes a mask to hide her real terror and misery. Potentially this applies to Sirius’s arrogance too.

And like… it’s better than the people who completely deny Sirius was abused, but I also have a gripe with the emphasis on it being largely psychological and very occasionally physical (it’s not just you, it’s very standard nowadays to emphasize that Sirius’s abuse was only emotional).

I often see fandom cite fics portraying the Blacks’ Crucio-ing their children as a reason to go “well it was obviously not that extreme and actually only emotional abuse”, when… there’s a very wide spectrum of possibilities in between solely emotional abuse and “Crucio’s their children”. Not using the literal Cruciatus doesn’t mean they couldn’t still have been severely physically abusive in other ways. Or, if not physical abuse (though I think that’s clearly implied), then other forms of extreme trauma in addition to the verbal abuse - sexual abuse, long periods of imprisonment and starvation, continuous drugging, and idk you could probably come up with more creative/less standard spells and methods of magical abuse i.e. Crouch Sr. using the Imperius curse on his son for 13 years, which doesn’t really have a real life equivalent.

(And I’m not saying emotional/verbal abuse isn’t traumatizing! I’ve been traumatized by it myself. But degrees of abuse are a spectrum and vary greatly, and if the level of abuse Sirius experienced consisted only of Walburga cruelly screaming at him and very occasional physical abuse, mixed with love and affection as people say, then, well, all of Molly Weasley’s children would’ve been traumatized the way Sirius was. But they’re obviously not. More on this in another post).

Re: Sirius vs. Snape and how their abuse is interpreted - it’s nearly always taken as a given that Snape was (often severely) physically abused, fandom even citing the Pottermore article about him being whipped despite that being extracanon and not written by JKR, and there aren’t constant debates and disclaimers about how it was only emotional/psychological abuse and not physical, like there are for the Blacks, and I often even see explicit statements that Snape’s abuse was worse than Sirius’s. People also generally accept that Tobias just didn’t love Snape at all vs. takes about how Walburga and Orion actually deeply loved Sirius. I’ve even seen the headcanon multiple times that Tobias murdered Eileen in a rage! When you have the same fandom saying the Blacks coming close to killing their children is “exaggerated, cartoonishly evil” abuse. It again plays into the idea that only poor people do something as crass as commit physical violence on their family - the Blacks are simply above that kind of violence.

(I think there’s some amount of gender essentialism and messed up ideas about motherhood going on too, regarding Walburga vs. Tobias. And fandom not being able to comprehend the idea of even one single mother being portrayed as violently abusive and hating her children - the only mother in the series described as such. The fact that I’ve seen the headcanon several times over about how Orion is the more violent one and Walburga was trying to protect Sirius and Regulus from his abuse… makes me even more sure of this).

[stephaniedola]

so i (mostly) cut caffeine in an attempt to reduce my muscle spasms and you wont believe it but they're pretty much gone

[femmedesyeuxnoirs]

Ok i need to know if im being entitled and crazy or if my doctor is actually discriminating against me

I had my first appt after my intake w this lady and was able to get cymbalta and vyvanse again thank god. But anyways. she asked about my past drug use and this is where it starts getting ummmm

I only mentioned the alcohol and nicotine and that i used to be a stoner earlier in my 20s. Then out of nowhere she was like so how long were you on meth? And i was like…… ive never been on meth but i was prescribed adderall before? She asked as if it was already on my chart. I was kinda shocked tbh. Then she sent the meds whatever and before ending the appt she ordered labs for her to, in her words, “make sure” i was “legit”. That weirded me out a lil too but i just assumed it was protocol for prescribing stimulants. It was also in my chart that i was a stripper for a while and now im starting to think maybe that was a mistake

Anyways fast forward to almost 2 months later. I only got a month and a half of vyvanse in the initial appointment so ive been without it since like new years day. Barely got my labs done yesterday but in my defense i was so stressed from being fucking evicted and moving back to my parents so it waant really at the top of my mind. I had called last week to ask for a vyvanse refill right. Well I just got a call from the clinic and the lady told me that my doctor is refusing to send the vyvanse script until the lab results come back.

I didnt even know how to reply. I said ok… thanks… and hung up. Like bitch i need that to function!! I could barely string the words on this fucking post together!!! Now this is tge part where i might be crazy

I think shes withholding my meds for even longer i assume because she thinks im a secret meth user. Is it valid to think this. Considering the circumstances. I just wonder. if i hadnt disclosed my recent past as a stripper and hanging out at punk houses n shit, that maybe she wouldve taken me more seriously in the beginning and not immediately assumed my methhead status? Or am i overreacting. idk im really really really pissed. i fucking hate jumping thru all these hoops just to receive my meds for my condition that ive been diagnosed with for 7 years

I also feel stupid asf for not advocating for myself enough. I shouldve asked her why she assumed i was on meth and been more confrontational when asking for a refill but oh well

[cyclogenesis]

life update, sry for absence, you will literally not believe the breadth and depth of fuckery I have been facing down these last few weeks including the last insane 24 hours

Cannot overstate how obscenely ridiculous things have gotten for me. I thought I felt Seasonal Affective Disorder looming at the turn of September to October but I think now it was just a sense of general foreboding. 

So I’m trying to truck along these last few weeks, sad as hell about my beloved cat, and then for the third time this year I have to find a new psychiatrist. I take Adderall for my ADHD, I have for six+ years, I see telehealth providers for monthly five minute appointments to be like yes I still need Adderall please send the prescription thanks. Walgreens causes a problem too fucking stupid to get into with psych #1 this year, I go out of my way to explicitly confirm this same problem won’t crop up with psych #2. No it’ll be fine he says. He was wrong, because he apparently didn’t know what he was talking about, and instead of looking into it for clarification he just said meaningless words to shut me up. 

The problem crops up again. We try three different pharmacies to try and get around it. Doesn’t work. I have to find a new psychiatrist. Again. Takes weeks. I finally find a place where god willing this dumb issue will not crop up again. I get an appointment for last Friday morning. Yay!!!! I decide to start seeing a new therapist too since one was on offer and I was feeling rough. (Last Thursday I said yes to the appointment. This is when I was already having a hard time.)

I see this new psych. He tells me that he’s going to hold the Adderall prescription hostage until I get an EKG and also a bunch of lab tests done. He watches me visibly wilt like a flower trapped in a bell jar. Fine. I go to Quest Diagnostics like he told me to. I get there at 10:30am and I’m #10 on the standby list. At 12:30pm I’m still #10 on the standby list and the nurse comes out and tells us all basically there’s no chance. I pay $6 for parking and leave having wasted two hours and six dollars. 

Fine. I make an appointment for Tuesday, the soonest I could get. (Great, that won’t already be a stressful day!) I find an urgent care place as suggested for the EKG. It’s a mile and a half away. I walk there. I wait an hour and forty minutes before a nurse comes to take my vitals. Because I didn’t expect to be waiting in the exam room for so long I’d taken my jacket off and then got too lazy to get back up and get it even though the AC had inexplicably kicked on. Because of this, and because anxiety makes my extremities go numb, my hands were so cold she had to take multiple pulse oximeter readings. “I’m a vampire,” I joked. “I’m actually dating a vampire,” the nurse said. She explained her boyfriend is Bela Lugosi’s grandson. Los Angeles: lmao. From outside as my eventual results are shared with the doctor I hear, “How is she awake??” 

I put my jacket back on as I wait for the doctor. I lie down. I stick my hands in my pockets. I try to think relaxing thoughts, going to my happy place: earlier this year, the beach at Cannes, walking ankle deep in the Mediterranean. I run through entire Sarah McLachlan songs in my head. By the time the doctor comes in for the EKG I’m feeling very chill. 

Too chill. The doctor has a ridiculously hard time getting a good reading. I’m lying there in an open front paper gown, topless, hooked up to this machine with wires coming off me like a desktop computer running Windows 96. She keeps having to move the little sticker things. We’ve been having a good time since she had to pull out the footrests and keep pulling. “I’m 5’11,” I told her. “I was always mad I didn’t hit six feet.”

“You should just lie,” she said, “How would they know?” I love her. Going forward I will lie. Doctor’s orders! 

I joke that given my previous case of corpse fingers with the pulse oximeter that I’m just a ghost and that’s the issue. She points out that it’s the Day of the Dead. I tell her I tried to haunt my family but their shrines sucked and nobody did the cool skull makeup so I decided to come fuck with some doctors. She laughs. I laugh. We continue to joke around. I love it. All I ever want to do is make people laugh. 

On the third try she finally gets a decent EKG reading though she’s iffy that she may need to do a fourth. Nope, this one is fine. I get to leave. I arrange to have the results faxed to my new psych. “Wait, is my heart okay? Haha,” I say to the receptionist. She passes me a copy of the results and tells me to talk to my doctor. 

It’s all fun and games until I’m walking out at 7:10pm on a Friday night into the cold dark evening with a 1.5 mile walk in front of me and abnormal EKG results that say “possible left atrial enlargement” and “abnormal right axis deviation” and “incomplete right bundle branch block” and “consistent with pulmonary disease”.

Oh. Um. Well. Okay. 

Googling all this leads to results that are scary and not in the “I googled my hangnail and WebMD says I have fingernail cancer” way, more in the there’s actually only so many things all of this together can mean and also the words “consistent with pulmonary disease” are in fact right there in black ink sort of way. Lots of stuff about the very increased likelihood of heart attacks. You hate to see that!!!!

In retrospect maybe it has been weird that I’ve been so aware of my heartbeat all the time lately. Maybe it hasn’t just been caffeine and stress. Well, I’ll call my GP first thing Monday and beg for an appointment ASAP, obviously. In the meantime I’ll try not to freak out. I’ll try to avoid additional stress. 

But, you know, I’ve been meaning to call my grandmother anyway. I still haven’t told her about Klaus. Our relationship has been shaky these last few years since I became estranged from my parents in 2021 after they went QAnon and decided that believing Facebook memes was more important than their relationship with their only child (me!!) and she got mad at me for standing up to them ever. Also she was diagnosed with stage 4 cancer in July so that’s been rough. But I figure she should be in the loop. 

I get ahold of her last night. I tell her there’s stuff going on with me, but she should tell me what’s up with her first. I await news of who triumphed in this week’s game of Yahtzee with her cousin and whether or not the Warriors or whatever sports team she’s keeping up with right now are winning. 

“Well, I wasn’t going to tell you because I know you don’t really care what’s going on with them, but your mom’s moved in with me because your parents are getting a divorce,” she says. 

First I explain, again, as she knows, because she was there, that they are the ones that rejected me. I remind her that my mom got in touch last Thanksgiving saying she missed me and wanted to see me and that I said I felt the same, we just needed to have a serious talk first. I remind her that my mom completely fucking ghosted me after that and has not tried to get in touch since. Even unfriended me on Facebook. Been almost a year now. My parents’ entire relationship with me is less important than their unwillingness to have even one single solitary fucking grown-up conversation. This is a fact. 

And then I’m like, also what???????????????

So apparently my dad (stepdad actually, but he married my mom when I was seven and he’s the only person I’ve ever called Dad) told my mom they should move back to the Central Valley. He said they should sell their house in Sacramento and she should quit her job up there and try to find a new one in Fresno. They sell their house and use the extra to pay off debts, because they are morons who have always lived paycheck to paycheck no matter how big or small those paychecks are. 

Mom asks Grammy if she can move in with her in Fresno while she looks for a new job. Grammy says no. Mom moves in her friend Diane, who was widowed after her idiot MAGA antivaxxer husband got Covid (which he didn’t believe in) and ended up getting an entire lung transplant and then dying anyway. Mom gets a job in Fresno but she doesn’t like it so she quits. 

My stepdad meanwhile has a one bedroom apartment in Sacramento and is still working at his job up there. He puts a bunch of their stuff in storage in Fresno in anticipation of the move. My mom goes up to visit and they celebrate their 34th wedding anniversary. Everything’s fine. 

A week later he calls and says he’s divorcing her. She can keep all the stuff that’s in storage in Fresno. This apparently comes out of nowhere, though not for him I guess (lol?). 

Diane’s landlord finds out my mom’s living there and threatens to evict them due to the unauthorized tenant. Mom has to move in with Grammy. 

And that’s what you missed on Glee!!!!!!!!!

With that out of the way, I tell Grammy my cat died and also I likely have some kind of lung disease and my heart’s maybe fucked. I tell her luckily lol I’m starting therapy again and she says she doesn’t understand that and that she gets depressed sometimes and then she gets over it. She tells me I should get a job because she knows I don’t make enough from my shop. I explain that I’m trying to avoid stress right now because it could very literally give me an actual genuine fucking heart attack. She continues to be a dick because instead of using any of her 85 years of life on this planet to try to become emotionally healthy she has chosen again and again to just lash out when she’s upset and never grow as a person in any capacity whatsoever. I am grateful again that I’m able to take her and my parents as examples of what I don’t want to be. I am far more patient with her than she deserves and we part on decent terms. 

I immediately proceed to storytime this bitch out with the besties. Everyone’s like “What?????” and I’m like “I know!!!!!”

The funniest part is that the parental estrangement was due largely to my mom just fully choosing my stepdad over me, her only child. Which like wasn’t even a surprise really, as she had told me once in a childish and unexpected outburst of anger that she didn’t have a choice but to have me. (Sure she did. She just buried her head in the sand until it was too late.) So it made sense that it would be my stepdad. He was the one she felt she got to choose. Also, she is an asshole.

Hope she feels great now about making that call, lmao!!! How’d that one work out queen?? No husband, no daughter, 62 years old moved back in with your mom who didn’t even want you there, huh? Yikes!!

So anyway, my GP’s office opens in twenty minutes, please cross your fingers for me that I’ll be able to schedule an appointment sometime before my heart bursts out of my chest like the alien in Alien and then dons a tophat and tapdances away from this clusterfuck, an action for which I would not blame it tbh. (Edit: They don't have any appointments until April [what?!] but they have walk-in hours thrice a week. I will get there at 10am Wednesday morning and hopefully they will see me.) New therapist appointment is at 12:30pm, best of luck to her with this goddamned Pandora’s box of bullshit that I’m about to unleash on her. 

Gonna try to relax in the meantime as I am at this moment very aware of the consistent thumping of the tell-tale thing inside my chest. Wish me luck!

[ordinarytalk]

Dopamine, migraines, and ADHD

Y'all.

I had a bad migraine today, pain 8/10, and I noticed I was yawning constantly all day. Out of curiosity, once I had recovered enough that I could take off the blindfold, I looked up "do migraines make you yawn."

Yeah. Migraines can make you yawn. They make you yawn because it's a dopaminergic symptom. Migraines involve fluctuations in dopamine, and people who have more of the dopaminergic symptoms (yawning, drowsiness, fatigue, nausea, mood swings, and increased urination) also tend to have migraines that are longer and worse.[1]

Not only that, it turns out that migraines are much more common in people with low dopamine.

"ADHD is caused by low dopamine," thought, so I looked up ADHD and migraine. Yeah! ADHD and migraine are correlated.[2] Low dopamine levels can increase the risk of ADHD, migraine, sleep disorders, and pain disorders. Dopamine-signaling cells are part of neural pathway for perceiving pain.

Here's how low dopamine makes migraines worse:

If you naturally have a low level of dopamine in your body, your body will try to adjust by increasing the amount or sensitivity of your dopamine receptors.

Dopamine levels rise during the migraine prodrome (the part before the pain hits).

The dopamine receptors will start firing at a lower dopamine level than normal, because they're all super-sensitive to deal with chronic low dopamine.

Now everything hurts for no damn reason.

Outside of me realizing that the low dopamine is, yet again, my personal villain, I also learned something else kind of cool: Dopamine antagonists (meds that lower dopamine activity) can help stop a migraine once it's started, but dopamine agonists (meds that increase dopamine activity) can prevent migraines from happening.[3]

That makes sense, if you think about it. If you're already mid-migraine, you need the dopamine turned off so your pain receptors can reset. And if you don't have chronic low dopamine to start with, your body won't make your dopamine receptors super sensitive.

My point for this entire post: There's evidence that taking ADHD meds can help prevent migraines.[4]

All I could find was one single preliminary study looking at this, but the results were very promising. I know that I personally have noticed less frequent migraines since I got on Adderall.

The fact that no one is studying this is driving me bonkers. I might actually try to email some college professors out of the blue to look at this. Hey! If you're in neuroscience and you're reading this, maybe study dopamine agonists as a method of preventing migraine!

(sources below cut)

[1] Barbanti et al. (2020). Dopaminergic symptoms in migraine: A cross-sectional study on 1148 consecutive patients. International Headache Society. https://journals.sagepub.com/doi/10.1177/0333102420929023

[2] Hansen et al. (2018). Comorbidity of migraine with ADHD in adults. BMC Neurology. https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-018-1149-6

[3] Gelfand, A.A., Goadsby, P.J. (2012) A Neurologists's Guide to Acute Migraine Therapy in the Emergency Room. Neurohospitalist. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3737484/

[4] Haas, D., Sheehe, P. (2004) Dextroamphetamine pilot crossover trials and n of 1 trials in patients with chronic tension-type and migraine headache. Headache. https://headachejournal.onlinelibrary.wiley.com/doi/10.1111/j.1526-4610.2004.04199.x

[baelpenrose]

Nihilus Rex 37: King's Bishop

Nils deals with the aftermath of what he and Lash have just done. He speaks to Bishop, and comes to a decision. Me and @canyouhearthelight went back and forth a lot on this moment - see if you can realize the role Bishop plays in this story.

Nils

What had I done? I’d killed kids. Sure, yeah whatever, no tracing it back to me, no one would know, except, oh yes, I’D KNOW. It wasn’t even like it wasn’t a predictable result of my actions - hell, Lash and I had discussed the possibility ahead of time. I’d tried to ignore the possibility, had ignored it when it was brought up. But now, too late, as always, I forced myself to stop being a coward and looked at myself.

There had been a part of me, when Gray had first brought up the ‘advantages’ of creating child martyrs against the deep state, that had buzzed with the possibilities - no, not even buzzed. Clicked, whirred, mechanically. Like a machine. Calculated the data available; compared it to other, similar datasets; concluded that yes, our skull-collecting psychopath was correct; and filed it away somewhere. 

And now it had happened, and fuck, it had even worked! Everything was going perfectly to plan! Bishop and Gray were raising hell and gun nuts were openly planning fights with even Trump’s law enforcement. I’d gotten everything I wanted out of it. 

I had planned out, in cold, detached hatred, that I wanted a bunch of hateful evangelicals dead and that their deaths would serve my purpose - double benefit. Remove one problem, use their deaths to create momentum and solve another. And it wasn’t like the world would miss a bunch of sadistic bigots who taught their daughters that girls only had value as wives or breeding stock. The world wouldn’t miss a bunch of hypocrites who cast their children out on the streets for being gay, taught them that they had to tremble in fear of a god that hated them and wanted any excuse to damn them. 

And I had just slaughtered a bunch of those children because it was tactically convenient.

I took a breath. I didn’t know how long I’d been standing outside my shitty little apartment. I was supposed to be working on the angle to frame Weasel, but I couldn’t focus, and dropping the Adderall wasn’t helping - my tolerance had gone down, now it was just making me jumpy again. 

Couldn’t call Lash. She was already wound up from this, and dealing with it her own way. Confession, maybe, but I had a feeling that even Father Rivera would turn up his eyes in disgust at what I’d done. Per the definition we agreed made me a murderer last time, I’d spilled the lifeblood of children in a church. Depending on whether Rivera counted Protestant churches, that was either four or five cardinal sins. And besides, openly confessing to ongoing terrorism was outside what he could keep secret. 

Did I want it to be ongoing?  Was it worth it?

I considered calling my mother and telling her I’d gotten in way too deep with a project and was afraid I was crossing lines I couldn’t come back from, but she’d look at it like a lawyer and in final analysis, I couldn’t have her asking those kinds of questions either. 

I didn’t consider talking to my father.

Bishop, maybe? He was older than Lash or me, and thought both of us were flakey. Still, he’d given us plenty of good advice over the years. I took a breath, and texted Bishop. 

‘We need to talk.’

I didn’t have to wait more than five minutes for a reply.  ‘Oh merciful fuck I’m on my way.’

There were benefits to him assuming I was unstable as all fuck. 

When he arrived and I buzzed him in, he plunked himself down on my couch and looked at me, up and down. “Based on the look in your eye, guessing you started your pills again. Not the ones you’re supposed to be on, either.”

I winced. “First time in a while. Right now, I have a bigger problem. Can’t focus, supposed to be laying tracks to get rid of Winston, can’t…”

“What’s on your mind instead?” His voice was leading, but he seemed ready to push.

I let out a slight, half-hysterical laugh. “What we did. I…Bishop, we…I. Killed a bunch of kids. It was obvious that was what was going to happen, and I did it anyway. Hell, I calculated the benefits once Gray brought them up. I knew it was going to happen and I did it.” 

Bishop gave me a flat look, almost like he was appraising me. Like there was something there there hadn’t been. “You played it off so calm back there. So, Nils. I have to ask. You knew what was going to happen, and you went ahead and did it. If this was going to freak you out so bad, why?” 

I took a breath. “I thought it would be worth it? I hated Evangelicals? I don’t know, man. I thought I was going to do something worth it but Bishop. Every path forward I see has this but a thousand times worse. There’s no way to win without making what we just did look like a picnic, a hundred times all over the world.” 

His eyes fixed on me, like they were piercing my soul. “Win what?”

“Everything! I did it because I wanted to win, Bishop. I wanted to take on the whole world, the whole system. Did…did you think Lash and I were kidding? I did this because I really thought we could do it. That this was a step on the road to taking down the banks, the government, the IMF, to building that world that Lash and I always talked about, to taking a wrecking ball to everything I hate about this one, but I…I’m scared that what I just did…If I have to do it again…”

“You two were serious!?” he practically shouted, incredulous. “The whole world. Everything. That’s why you risked those kids, even after Lash probably begged you not to?”

“Lash didn’t beg me not to. She begged Gray to try to make sure everyone would fire at adult head height - he laughed, because he thinks she understands nothing about firefights, which…yeah, maybe, if she thought that was an order that would or could be given ahead of time.” 

Bishop looked conflicted. After a minute, he carefully started to speak. “She wasn’t exactly wrong, although I can see why Gray would have laughed it out. Is it reasonable to try to ask that people shoot at the shoulder height of an adult? Yes. But the plan is the first casualty in any conflict. So you didn’t make the wrong call, per se.”

“It doesn’t matter. It wasn’t that me or Lash gave the go ahead, Bishop. I knew what could happen and I still…this was still my plan. I went ahead and came up with a plan that would do that. And I’m still making more. In the back of my brain, for how to keep going. I don’t know how to stop it - I can make sure Gray gets put down, but like. We can’t win without him. Hell, I’m not certain we can win WITH him.”

“So… what’s the plan if that’s the situation?” he asked. “Don’t get me wrong, I believe in what you and Lash are doing, I just don’t understand the plan.”

I took a breath. “I am trying to figure it out. Truth is, we have two choices. Choice one is that Lash and I can bail. Get Gray put down, call it off, try to repair some of the damage we’ve done, maybe do something less bold, like rigging elections. Option two is that we have to double down.” I shuddered. “I can see the argument for that one. The world system kills, every year -  by famine, exposure, thirst, disease, or lack of medicine - at least a tithe of the deaths that a revolution will cause. Yeah, it’s bloody, and it’s horrible, but is it worse than letting this horrible machine chug on and on forever, grinding people between the gears? And that’s before you get to climate change and the fact that we only have so many years to stop the machine entirely before it kills everyone. I don’t know if we can stop it faster any other way. But at the same time…I don’t know if this way will work. If it doesn’t, we’re going to have killed hundreds if not thousands of innocent people for nothing, and made the lives of just about everyone worse while we wait for the end. Can I justify doing that? Signing up not just me but the entire human race for that kind of gamble?” 

Bishop grunted and stroked his beard. “I. I think that you have to take into consideration how many are going to die if you don’t do this.”  He took a deep breath and puffed for a second. “And how many die if you do.  If three thousand - hell, thirty - kids are saved by losing those nine.  Is that worth it?” He clearly wasn’t sure of the answer, stroking his facial hair and combing it with his fingers in deep thought.

“Is it?” I took a breath. “Are we the ones to make that call?” I paused, then shook my head. “Wrong question. No one has ever been saved - or, yeah, admittedly, damned - by people who stopped to ask if they had the right to change history. Caesar crosses the Rubicon. Che Guevarra opposes the American Empire. A thousand activists picked their moments to march, to give speeches. If not us, someone else will step into this role in history. Maybe Gray or one of his ilk, or worse. Maybe someone better. Or maybe someone else who will wait too long to matter.” 

Bishop kept fussing with his beard. “MLK and Malcom X didn’t ask anyone what they thought of the revolution either, did they? So it tracks.  I get it.”

I looked at him. “You always said Lash and I were flakes. Why follow us into something this insane?”

He looked at me as though re-evaluating what he’d thought of me. “I think you make each other more serious. I haven’t decided yet if I think it’s a good thing. But there’s no way I can ever underestimate either of you again. I never would have imagined both of you being behind the same cause, and clearly the fact that you are is something to pay attention to.” 

I took a long moment, thoughts swirling in my head. “Then. We go all the way. Instead of bleeding the world to death a little at a time while the people at the top get away with it, we wade through all of it at once and drag them out of their penthouses and build a new world once the flood recedes. Because that’s the only way out they’ve left us. Glad you’re in.”

“Sure, Creampuff. Now, before you spin yourself out, because I’m not going to follow a tweaker. Go do what Lash does when her conscience starts freaking out. Help someone, then get back to scheming.”

[vraska-theunseen]

did you guys know when you take drugs meant to have an effect on your cognitive function they have an effect on your cognitive function. adderall was crazy it was like i could think. i always think of my mind as like, a really foggy swamp and every time i have to write or think of a thought that isn't like a mindless generic response it's like i'm reaching into the muck to wrestle out each word and there's so much going on that i forget what i'm thinking of but earlier today it felt like. clear. or when im walking into rooms or doing a task i often walk out of the room multiple times or pick something else up because i completely forget what it is i came there for during the journey but like. earlier today i went to grab my mouse and it was in a bag multiple floors and rooms away and i think i'd normally have gotten distracted or preventatively had to keep repeating what it is im on a path for while i walked so i remembered it but today it was like hm i need to get my mouse. goes all the way downstairs grabs it comes all the way back up plugs it into my computer and continues the task i was doing. it's entirely possible im heaping too much praise on the adderall im only at a 10mg dose it's possible i just had a good day it's not like i had to do any real tasks or focus on doing schoolwork or anything but like. i think it did help. guys did you know that what i've been struggling with for years and years and years and years and has cost me credits and tears and sleepless nights and self worth actually had a fix. there was a magic pill to let me think the whole time. did you guys know that. my mom irreparably thinks i'm lazy when we were meeting with the doctor she interjected when i said i struggled doing my homework in high school to say "yeah but did you try to do your homework? my impression was that you just didn't do it not that you tried but couldn't" and then said to the doctor "she's very focused on the effects of the pill but am i correct that it will also require some behavioral changes?" and both times i couldn't think of what to say remember my brain is like a swamp it's so hard to think sometimes i was so flummoxed that i just like laughed (today doing tasks was like i could just do them i could just start them. again granted i didn't really have to do anything but it's just. what am i saying i don't have to explain you get it) and this isn't about my results on adderall today anymore i just want her to die a little bit. can she experience some light suffering at my behest. can she get her liver pecked out by eagles once in a while but be okay the next day

[vvatchword]

Kansas City Highways: Of God or Entropy? (Wrong Question)

I have been on a road trip for the past two days across the entire country. I hated it. It was so hard to say goodbye to everyone. I felt so totally accepted and loved and supported. Having to leave felt very much like dying. I closed my eyes as I hugged my friend and I felt like: the door is closing, and it cannot be reentered. It must be this way but I feel great grief.

The trip would take 20 hours. I had once driven for 15 in a straight shot which we determined was a mistake and should not happen again. I have a problem with "decision paralysis" specifically, so sometimes if I start moving it is very hard for me to stop.

I decided to stop in Kansas City for the night. The hotel would have to be pet friendly because I was traveling with my bird, a green-cheek conure named Indy.

This is Indy (as well as a story in four parts):

This is Cosmo the absurd hound animal.

"why u take picture of bird. Cosmo wants to know"

Indy was not a fan of this

Anyway.

I did not stop in Kansas City.

Let me explain something to you about roads.

Roads express the needs and histories of their residents. In Kyoto, Japan, roads are extremely narrow because for centuries they were only really used for foot traffic, and new technology had to be built around the pre-existing structures. In Lubbock, Texas, USA, the city was set on a strict grid system by utilitarian farmers, who named the streets by numbers and alphabetical order to make them extremely simple. Even streets with "real" names are in alphabetical order. As a result, it's a very easy city to traverse.

Kansas City's roads were designed by fifth-dimensional clowns for fifth-dimensional clown purposes.

I do not know when, why, or how these roads were formed. Kansas City started life as a Western town clustered around the Missouri River after kicking a bunch of native tribes out in an insufferable expression of moral and cultural superiority, as is the American way. I suppose a curse isn't out of the question.

The first problem was that it was night. The second problem is that I have ADHD, and night tends to enhance all of my problems, like:

Extreme contrast drawing attention to all the wrong things, like lights in businesses and lamps 15 miles away. I would see a person in a restaurant before I'd see the SUV in the other lane

All colors are washed out, which means that intense color (neon signs, billboards, car modifications) yank my eye toward them immediately

Dazzling headlights jerking my attention everywhere

AAAaaaAAaaAAaaaaaaaaAoughhGhGggH

I can't accurately judge how fast cars are going because my spatial sense is borked

Weird reflections sweeping past me in metal and wet pavement and glass (is it a car? a pedestrian?? A wall??? A ghost????)

Also, at that point I had taken my previous dose of Adderall XR about 12 hours prior. My perception had returned to "everything is equally interesting and important," which may be true while on a nature walk but is not true about driving a two-ton death machine with other multi-ton death machines at speeds of 30-120 mph.

Also. It had snowed.

In a normal city, one can kinda tell which exits to take to get to a business. Just exit a little ahead of the sign and whallah. But in Kansas City, the highway was elevated, and I felt like a camera panning along an establishing shot. Here is the city, an ocean of signage and plate glass and reflective rooftops. Where do you want to go? Because it's an amorphous mass. good luck I don't think it's real

But this was fine on the whole. I mean, I was just driving through, and I meant to stop on the outskirts somewhere anyway.

And then I got into the heart of the city.

Have you ever watched someone play Rollercoaster Tycoon badly on purpose? You know, like building a rollercoaster that launches all its passengers into a deep well? Well if there were a Highway Simulator, this was the road system they would build. With absolutely no warning, the road stopped being straight. It started leaping up in tight hairpin turns and diving into corkscrews. Five major highways converged, then split apart again, all in less than a mile. Multiple exits branched off one after the other, less than a hundred feet from each other in most cases, and usually after tight blind turns. Signs tried to alert you that they were there, but I'd feel this frantic panic upon zipping around Dark Corner Z only to behold three dark and shining exits dipping and diving on every side to destinations unknowable. Also, because it had snowed, there would be sudden and unforeseen patches of ice in unexpected sheltered spots beneath miniature overpasses.

If you require a summary, take this: there is an exit 2W. Why one needs 23 exits inside a single mile of real estate is a question only philosophers can answer.

Naturally I started thinking about cowboys driving cattle into a Kansas City designed by MC Escher. It couldn't have been designed by cowboys because cowboys didn't understand non-Euclidean geometry.

Obviously, someone in Kansas City said, "This is ridiculous! Who let the fifth-dimensional clowns design our transportation system?" So they decided to fix it.

And so you exit the labyrinthine guts of Kansas City only to enter miles and miles and miles of labyrinthine roadwork, with no sense of where any businesses are anywhere, nor where exits might take you.

I drove until I suddenly popped out of Kansas City entirely. All that lay before me was black farmland spotted with the sulfur lamps of farm buildings. Macroblank's album dungeon of lust started playing and suddenly I was in the middle of every creepypasta with a sapient man-eating building.

I had cut off three different cars and taken two wrong turns. I had missed every hotel in the city. I was in the country, where black vegetation jutted through glassy snow over endless fields stretching to a glowing horizon. Moody grungy pop--one notable track of staccato beats framing samples of someone howling, "Fuck you!"--growled and pulsed from my speaker.

I did not sleep in Kansas City. I slept at Fort Scott. A wonderful mistake. I got to choose a wonderful historical hotel and eat a bagel and look at this thing.

What in the ever-loving Mussolini is that thing

Whatever it is you can eat there

[anon420journal]

12/30/24

Ok LOL i definitely haven’t journaled consistently at all but it’s ok. I lowkey wish I had prompts for each day so maybe I should identify what personal stuff I want to track daily? I’m going to try to reflect on the week now. I remember feeling like shit and being cranky ash the 25th and then decided to start taking adderall again so I feel like im rotting less and it definitely helped because I started my hobbies (painting) agsin. I’m lowkey a shit painter but it’s relaxing to do the painting strokes while I watch smth bc it feels like at least im creating something; I do want to get better at painting. I also want to get better at identifying and expressing my emotions. It has reignited my Stucky obsession though which is really cooked because I found one of my all time favorite series again and read like literally 300k words over like 8 hours over night and it fucked up my already fucked up sleep schedule. I love fanfic but I literally consume it so much constantly it just fills some kind of emotional gratification instantly (or it’s my go to emotional validation thing idk) like idk maybe I should look into that but idgaf. I’ve been rot maxing this winterbreak a lot and it reminds me of the behavior/self(even?) from a year ago.

This should definitely scare me because it’s honestly been a recurring TM issue like my passiveness or my lack of ambition core or like idk lacking executive function core. It’s lowkey a lot to explain at least from my perspective as the writer idk. But I’ll try because maybe it will help unpack it (though im certain I have done this before). But to keep it brief because it feels like so much work to explain but it’s my procrastination. I have been using a physical planner for all the schoolwork/job stuff I need to get done but it fails with my personal goals. For example I’ve been meaning to get into exercising for like months now and I know a lot of ppl have troubles w that but it’s trusting for me especially because im aware of just how much it would help my physical health and as a result my mental health. I feel like I’m exhausted all the time and it’s deffo bc of my eating and my mental health but even thinking abt walking around campus fills me w dread. Right now im lucky because I stay with my parents and commute and it’s more sedentary. My life has been a lot easier living with my parents but I hate it at the same time because I want to be able to function more independently and I want to get the fuck out of my midwest ass state and meet more people who are like me and not just white neurotypical losers and not to be a hater but lowkey the loser yt NDs ive had so many of u guyd as bffs and i need to branch out. Sorry loser yt NDs im one of u guys on the inside. I wanna meet more cool fashionable poc who are also nerds and have their little homebody hobbies but also are ambitious career-wise. And I think being more active would help me with the drive/motivation I want to have to live the way I want to when I move out. I think 2 major roadblocks for my exercising have been not getting the right equipment and this is some real shit not bs yoga mat or like home gym equipment shit I mean like I literally don’t have tennis shoes and comfy moveable but body safe gym clothes. And also going to the gym alone. My college has a gym but im scared of the equipment and all the exercises you can do. But lowkey none of my friends have the time or want to go to the gym. I’ve already gone through these realizations for working out already so I decided maybe stretching in the morning would be better but if I have to be honest I need to give myself like an hour and a half for my morning routine for my optimal health idk and I’ve always struggled with waking up. In fact waking up has always been really fucking hard for me and im sure it’s related to all my nighttime media consuming but whatever. Also I noticed that my planner hasn’t always been the most useful for true deep learning that I need to get done as a college student but that’s kinda beside the point bc usually if I lock in w my adderall for my lectures im pretty well off. Ok im tired of journaling this shit took like an hr to write. I have vented in my notes app before when im actually literally tweaking and I can’t just text my friends abt it and it’s been useful but idk abt this daily shit. Oh I need to leave off w this realization because I feel like it’s significant and new to me: most of the problems people will have with you will stem from you not taking care of yourself. Realized this while reading my stucky fanfic ngl.

[ramblingvents]

Therapy ramble (discussion of suicidal ideation and aborted suicide attempt but ends with me talking about how I'm feeling more safe in treatment)

Man so I have the worst seasonal depression - it always starts in like September and goes on till roughly February. And I always have dissociation and suicidal ideation every single year so bad I genuinely don't remember a lot of it unless I read my journals from that time.

This has been happening since I was 10 and this year when I started therapy I decided that I was going to find someone trained in DBT (since that's one of the therapies that works for suicidal thoughts) and not lie or omit anything as much as possible.

And I've actually stuck to that pretty well. I have told my therapist when I feel suicidal, how much it escalates, any plans my brain comes up with, etc, when last year I was unwilling to even talk about it enough to make a safety plan.

It literally got to the point where I made an AITA for making a safety plan (in February) and telling my friends I'm suicidal (which I did tell one friend as a result even though I largely ignored the 99% of people telling me expressly to tell people).

I aborted an attempt last April when I was in a particularly dark place due to grief and life stuff.

I didn't tell anyone for 4 months and lied about any evidence of it and everyone close to me believed me. It was giving me serious PTSD flashbacks, especially when I was pretty isolated this summer, and also especially with my living arrangement as I'm in the same on-campus apartment, in the same room.

I forced myself to ask my therapist if it was something she could treat in the first session. Tried to make progress with ADHD, it didn't work out super well because the combo of meds making it so I couldn't sleep and lack of good habits. I missed assignments and got so overwhelmed I couldn't focus on them. So it got to mid-semester and ideation started again. And I contacted the crisis line and told my therapist. And I answered in detail when she asked what plans I had considered. So I've been talking to her about things that can help and letting her know when it's been worsening these past couple weeks. Wednesday I told her all I can remember of the previous aborted attempt.

Also this week, I talked to my doctor and she suggested starting Wellbutrin for ADHD because Adderall does help me focus but I have insomnia and the mood swings are pretty bad. Unfortunately one of the side effects of Wellbutrin is also suicidal thoughts (primarily because it gives you energy before giving you an elevated mood). So I tell my therapist this and she's like "okay you can give it a shot but I will do regular checkups for the next week". So that's what I've been doing now, while also trying to get energy to catch up on assignments and talking to both my academic affairs person and accomodations person.

And it's just really weird?!? I'm not used to being honest about it, I've spent half of my life finding ways to self-soothe and avoid telling my friends or parents. But I feel like talking about it and just reporting everything I feel with honesty is helping a lot. And having her be like "okay so here's stuff you should do, and you know this is situational/you've been through this before and gotten out of it" is also very helpful because it feels less like death is an objective truth I'm trying to deny and more like I'm trying to treat a chronic illness.

It's not "I'm suicidal and I'm awful for feeling that way and if I say anything I'll get hospitalized and worry people unnecessarily and I'm gonna feel like this for the rest of my life, so I need to either cope better or die right now" like it has been in the past it's more like "my brain very much wants to escape the current situation and I'm having a hard time finding a way through it/conceptualizing next steps. I haven't slept a lot and I've spent a lot of time alone this semester because my friends graduated and are now in another city which has worsened my mental health/ability to focus and emotionally regulate. There are things I can try that might help me feel better and improve the situation. I might not be able to do all of them and they may not all help but there are actions I can take and there are people I can go to for help, and trying to do that matters even if I don't end up liking the outcome."

I'm just really grateful to be able to be honest about it and actually get help. It feels like the first time I haven't been trying to deal with it alone.

[trilledrambles]

Greeeeat..... just looked up my new medication and found a lot of people experience psychotic hallucinations on it. I've only been on it for a full day wtf. I'm already schizoaffective which probably just made it easier to hallucinate. Luckily, no voices yet, and i still seem to be able to hold a conversation. I've only ever had auditory ones while on Lexapro and Adderall. Yes, at the same time.

All I wanted was to feel more emotionally stable. What's worse is the drug sheet they give you, didn't mention hallucinations once. First result on Google? Call an ambulance or doctor ASAP. Not doing either until doctors' offices start opening for the day. And the ambulance? This the US what do you think will happen? They get here freak the entire neighbor hood out, I get in, we get to the hospital wait 6 hours (would be 10 if i walked in), be scene by doctor, they think I'm lying, given a benadryl and an ibuprofen, drugs make me sleep, I wake up, they tell me I'm all better, despite feeling worse and looking like a corpse I'm discharged, get billed $50,000.

I don't understand why anyone would willingly choose to immigrate here. This place is a gold plated shit.

Ah once again living up to the blog name

[briamichellewrites]

74

Phoenix surprised Brad by being the first one in the conference room. He was rested but craving another pill. Brad said nothing except a thank you. Where’s Rob? He was around somewhere. Joe… Mike… Chester. Rob was two minutes late. He had to use the bathroom. Brad determined that was a good excuse. They all got comfortable. Mike gave Phoenix a look before saying good morning. Before they started, they all said good morning to Phoenix to get it out of their systems.

They were all watching him. It would be hard to sneak a pill in the bathroom. Three hours. That was how long the meeting was. He was half paying attention. The other half wanted to get high. Brad was going on and on. He had to go over every minute detail. The sound they wanted, the producers they wanted to work with… it just went on and on.

Finally, he was back at home with Kyle, who he texted to come over. They both went into his bedroom and closed the door. After getting high on cocaine, they hooked up on his bed. Why did they break up? His family and friends were pushing him to get treatment for his alcoholism. Kyle was his enabler because he gave him drugs and alcohol. He didn’t love him, but he needed him. Just like the Adderall and cocaine he was addicted to.

Mike got a call from the police. Phoenix was in the hospital for an overdose. He dropped what he was doing and grabbed his car keys. Misty whined. You’re leaving again, human? He crouched down and petted her. I’m sorry. I’ll be home soon. Okay, human. She walked sadly to her toys. He made sure she had food and water before leaving.

On his way, he called Brad. He was angry because he had lied to them. I’ll meet you at the hospital. When he got there, he went to the emergency department to check-in. He asked for David Farrell or Phoenix Farrell. The nurse looked at the clipboard before telling him which room he was in. Thank you. Police were there outside of his room. He had been arrested for possession of drugs and was handcuffed to the bed. When he saw him coming into his room, he didn’t say anything.

Not until he asked what happened. He was worried while also being angry he had lied to them about his drug addiction.

“Where’s Kyle?”

“Who the hell is… that’s where you’ve been getting the drugs from? And you dragged Chester into this? Your ex-boyfriend, Kyle. I thought you broke up with him.”

When Brad got to the hospital, he was brought up to speed by Mike. He was as angry as he was. Phoenix covered his face with his hands. The two officers came in after giving them privacy. They heard raised voices, so they wanted to make sure everything was okay. Mike and Brad introduced themselves. They found out that he was found unconscious after an anonymous caller reported an overdose.

What did he overdose on? Phoenix reported it was a combination of drugs. His blood was taken to be tested. They were waiting for the results. When they came in, he tested positive for cocaine, heroin, and Adderall. Brad excused himself because he needed to walk away before he lost his temper and got arrested. He went out the double doors and sat down on a bench. After getting his phone out, he texted Chester, Rob, and Joe.

Once he was discharged, he would be arrested and charged for possession of illegal drugs. That meant he would go to court. He would likely be discharged the following morning because he was stable. When Brad came back in, he asked for Mike. They went out the double doors to talk privately. He just got off the phone with Chester. What did he say?

He was feeling very guilty because he knew about Phoenix’s drug use. The reason why he didn’t say anything was because he slipped up. He stopped because he had to stay sober to get tested for drugs. But, he saw him using pills and cocaine. He didn’t want to be implicated by guilt by association. The five of them needed to talk about the situation. Mike asked him not to go too harshly on Chester. Yes, he slipped up but he deserved to be heard.

“We’re not going to help Phoenix by throwing Chester under the bus. The more he tells us, the better we can help both of them.”

He nodded and said okay. Thank you. The following morning, Brad took his advice. He started the conversation by telling Joe, Rob, and Chester what happened with Phoenix. Currently, he is in jail waiting for his arraignment hearing after being arrested for possession of drugs.

“Chester, I promised Mike I would allow you to talk. I promise to listen without judgment. We want to help both of you.”

Thank you. Joe, Rob, and Mike also promised to keep an open mind. That helped him open up, instead of shutting down. He had gone home the previous evening with Rob. Phoenix invited him over, but he had to get ready to go to court. Rob confirmed he spent the night at his place. How many times did he slip up? Just once. After finding out that Talinda wanted him tested for drugs and alcohol, he quit.

He knew about Phoenix using drugs because he gave him everything he had. What was that? Pills and cocaine. He didn’t want them in his house because he couldn’t resist the temptation. Instead, he taught him how to snort cocaine. He acknowledged that he enabled him by not stopping him.

They could see the guilt on his face. Why did he do it? It sounded stupid but he thought he was his friend. He thought it was better to be there in case anything happened. I’m sorry. Phoenix was in a jail cell after being processed. He had his fingerprints and mugshot taken. The bed was hard. All he had was a toilet and a sink. He laid down and covered himself with a blanket. This was jail.

He was able to call his father, which was very difficult. As much as he was disappointed with him, he promised to hire a lawyer for him. Thank you. It was the first time he had been arrested for anything. He did have problems with alcohol, but he obeyed the law.

All he had were minor traffic violations. The lawyer advised him not to talk to the police without him present. Together, they talked about what happened before talking about what would happen when he went to court. He would plead not guilty, which would mean they would go to trial. While he waited to go to court, he would likely have to agree to drug testing, home detention, ankle monitoring, and a drug treatment program. What about his kids? He would have to figure that out himself.

“I adopted them. Their mother was a drug addict. I fucked up so bad!”

“The only person you can save from this is yourself. That’s all the advice I can give you.”

“Thank you. Maybe this is the kick in the ass I need.”

The next morning, he appeared before a judge after waiting through other people’s hearings. When it was his turn, he remained polite. He was given a day to stand trial. Until then, he was sentenced to home detention and an ankle monitor would be placed around his ankle.

He was only allowed to go to and from a rehab program assigned to him; meeting with his attorney and court. By violating the terms, he would be looking at jail time. Did he understand? Yes, your honor. He signed paperwork before the ankle monitor was placed around his ankle. After completing everything, he was given privacy to change into his street clothes. He then got his stuff back before following his father out to the parking lot.

@zoeykaytesmom @feelingsofaithless @alina-dixon @fiickle-nia

[pinkydragon01]

So, I've finally started drawing again after a long break. This is the first time I've attempted art since starting Adderall and... I think it helps a lot!

On the downside, I'm WAY slower and it takes me much longer to make progress. However, I feel much more focused and I think the longer time is a result of being more critical. Cuz so far, I like how this com is coming along already and I've only sketched the skeleton and the upper body.

I'm doing so much drawing and erasing but it's way better than leaving something "okay" because I got frustrated. Now I don't move on until I'm 100% satisfied.

Rip my back tho cuz 5+ hours just whipped past my head and I barely noticed

[sugar-and-spite]

apparently there's a limit of 30 tags and a character limit per tag so tumblr won't let me share this in the tags :)

anyway: by far, worst experience ever was with a psychiatrist. technically two different psychiatrists, but both from the same practice, so i'm counting them both as one.

to set the scene: it's 2017, and i've just returned home from living in various other places for the past couple years. i decide to see a psychiatrist with the primary goal of getting adhd meds, so i can focus on getting a job and getting my life together. i was diagnosed with adhd when i was 11 (10 years ago at this point), was on medication for it for most of middle school, and had an IEP and was in special education courses when i was in high school. because of my diagnosed adhd. so i figured it should be easy to get medicated again, right?

I Could Not Have Been More Wrong.

my psychiatrist (who is actually good) tells me that according to their practice's rules, i need to get re-diagnosed with adhd in order to be prescribed medication. i tell her that's bullshit, but fine. like, i clearly have adhd. this won't be an issue, and i can get an autism assessment at the same time, since i think i'm probably autistic. it'll be fine.

i walk in to get the test done. the tester lady walks in. i tell her i'm there for a diagnostic test and an autism assessment. she scoffs at me and tells me i can't be autistic (remember: at this point she's known me for all of 20 seconds) because "autistic people aren't self-aware enough to know that" (?????). fine, whatever. i don't need the autism assessment. just validate my adhd diagnosis that i've had for 10 years and i'll go.

i go through all the tests, including a test where i have to sit in a silent room with noise canceling headphones on and focus only on a computer screen, which makes me want to DIE because, as i've said by this point, i have adhd. but i suffer through it, and then the results are in.

according to the tester lady, i apparently don't have adhd anymore. she has undiagnosed me.

i complain nonstop about this to my psychiatrist, who sympathizes with me, but there's nothing we can do because that lady is apparently the only tester at the practice. so for two years we focus on my depression and anxiety and forget about getting adhd meds. then, the lady leaves the practice and a new tester is brought in. my psychiatrist sends them my test results - i want to clarify i did not take any new tests or give any additional information - and the new tester is like "uh, yeah, you clearly have adhd. you can get meds now." TWO YEARS LATER!! i was unmedicated for TWO YEARS because this one lady didn't like me because i thought i might be autistic!!!

anyway, so i start taking adhd meds, try a few different things, eventually settle on adderall. i take it more or less uninterrupted for 3 years (took a few months break at the start of the covid lockdown, because it was the only one of my medications that couldn't be delivered to me, and as an asthmatic i'd rather just lose the adderall for a few months than risk going in public in april 2020).

then, mid-2022, my psychiatrist (who has been good and is the one who prescribed the adderall) tells me she's leaving the practice. she personally assigns me to another doctor in the same practice and assures me that i'll like them and everything will be fine.

Everything Was Not Fine.

the new doctor questions all of my prescriptions and makes me jump through hoops just to keep what i'm on, even my antidepressant (which i've literally been on this exact one since i was 18, and i'm 25 at this point). i grumble and bitch about it but i jump through every hoop, and all of my medications are renewed - though she refused to give me half of my adderall. i was taking an extended release dose in the mornings, and a smaller, immediate release dose in the afternoons. again, been taking both for almost 3 years at this point. she flat out refuses to prescribe me the second, smaller dose. so i'm just taking one dose in the mornings, which does not last the entire day, but at least i'm getting something, so i don't try to fight it.

in august of 2022, i get the news that my grandmother has cancer, again. she survived rectal cancer and was cancer-free for several years, before a completely new, unrelated cancer appeared in her bladder. due to her weak health and the previous surgeries, radiation, and chemo from the other cancer, this one is inoperable, and she likely has less than two years to live. i'm the only member of the family who is able to be with her to care for her, so i start making preparations to move 500 miles out to stay with her and my grandfather to keep them company and help with grandma's care.

it's at this point that my new psychiatrist brings out another hoop for me to jump through. i have to fill out a bunch of forms, and attend a class telling me what adhd is and how to handle it, before i can be prescribed my medication that i've been taking for 3 years. because, you know, having been diagnosed since i was 11 and had 5 different psychiatrists for it AND special classes in school specifically for it, i clearly don't know any of what they're going to tell me in this class. i tell my psychiatrist, "my grandmother has cancer and she's not going to make it. i'm the only one who can care for her. i'm going to be out of state for at least the next 3 months, probably longer, and i know from the last time i was out of state that i legally can't receive medical care in this state while i'm somewhere else, even video appointments. i will not be able to take this class, but i will need my medication that i've been taking for 3 years. i can take the class when i'm back in state." my psychiatrist tells me not to worry about it, that i will get my refills, and we will schedule the class when i'm back.

so i go to live with my grandparents. about a month later, i'm running out - since adderall is a controlled substance, i'm only allowed a refill when i have two pills left. so at that time, i call my pharmacy and ask them to refill it.

10 points if you can guess what they told me.

so now i have 2 pills left, no refill, and i'm 500 miles from home. i call my psychiatrist and ask her what gives. she tells me again about the class, and i remind her that we agreed i would take it when i'm back. she says it has to be scheduled or i can't get the refill, so i should just schedule it for when i'm going to be back. if you've been paying attention, you know that i don't know when i'm going to be back. i say fine, whatever, schedule it for december (it's october at this point). she schedules it and promises i'll get my medicine. it's too late to call the pharmacy at this point, so i call them again the next day. and guess what they tell me. again.

so i call my psychiatrist. again. and i tell her i don't have any refills. again. and she says she needs my pulse and blood pressure to prescribe the medication. as a side note here, as part of the hoops i went through for my OTHER medications, i went to my primary care doctor near the end of september and had all my vitals taken, as well as blood tests done, all of which were sent to my psychiatrist. she says those are not valid since it has to be recent, within 30 days. the only reason it's been more than 30 days now is because she keeps denying me my medication.

i also want to remind you, again, that i'm 500 miles from home. i legally can't have even a video visit with any of my normal providers, and i can't go into the office, which would be required for getting my vitals. my only option would be to go to an urgent care center near where i'm staying, which would cost upwards of $70 per visit, even with my insurance.

to make a long story short, it's now been more than 7 months since i last had my adderall, as i'm still trying to find another psychiatrist. i had to spend two months caring for my sick grandmother without an essential medication for staying awake and focused, which my psychiatrist promised me multiple times that she'd prescribe. all of this after having to wait two extra years to even get it in the first place because one unpleasant woman with a phd didn't like me personally.

yeah, this was the worst medical nightmare of my life, and i'm honestly wondering if it's even worth trying to find a new psychiatrist just for adderall. i'm terrified that the same or worse is going to happen with any other provider.

Disabled/chronically ill people, ND people, and people who interact with medical providers often:

Just testing my own theories. Personally the worst care I've received was from a PA in the ER, and PA's consistently give me terrible gastric care.

For sake of the poll, a specialist is any doctor that specializes in a disease or body system. Example: rheumatologist, psychiatrist, gastroenterologist, OBGYN, etc.

Bonus if you're willing to share if your care was received in the ER or another place. You don't have to share the context of your care if you don't want to.

[notanettelmao]

Wolf Moon pt. 3

Also on AO3

(A Teen Wolf rewrite)

Fandoms: Teen Wolf, Supernatural Warnings: usual teen wolf stuff, blood, werewolves... Pairings: Stiles Stilinski x reader Words: 2,5k

Pt.1 Pt.2

Y/N went to watch the boys practice the next day again. She sat on the bleachers with her dad’s journal on her lap and her phone in her hand. She was going through the emails Bobby sent her yesterday and slowly adding to the journal, not really paying attention to the field where Scott was currently being told he made first line.

“This is not going to end well,” Y/N almost screamed when Stiles appeared next to her, freshly showered in the changing room and back in his normal clothes.

“You want me to have a heart attack or something?” She squealed and hit his shoulder with her fist lightly. Stiles laughed and rolled his eyes.

“Not really, what I want is you helping me with research.” The boy grinned as he saw her face light up. She nodded quickly and packed her stuff before following him to his car.

***

Stiles led Y/N to his room. He sat on the chair next to his desk and let Y/N make herself comfortable on his bed.

“So, where do we start?” She asked as if she hasn’t told him most of the information needed yesterday.

“You can go through the journal and I’ll google.” He smiled at her and then turned to the laptop on the desk. He quickly typed something in the search bar and started reading through the google results. Y/N opened the journal on the werewolf pages. Then she pulled out her phone and quickly texted Sam to send her all the info they had about werewolves. When he asked what she needed it for, she simply answered her new friend was into supernatural stuff and she wanted to impress him. Which, to be honest, wasn’t that far from the truth. She wanted to impress Stiles. She didn’t know why, but since she met the boy, she had a soft spot for him. Y/N got up from the bed and walked to stand behind Stiles’ chair so she could look over his shoulder as he was reading. She noticed multiple tabs open with words she recognized. Stiles was currently reading about wolfsbane.

“You’re really good at research.” Y/N smiled. Stiles looked up at her and grinned. Then he opened one of the books he found in the school’s library this morning and started reading. Y/N sat back down on the bed, making notes on a piece of paper from the stuff Sam sent her.

Sometime later Stiles printed out an old sketch of a hunter aiming a crossbow at a transformed wolf. Y/N raised her eyebrows when she noticed the crossbow, trying not to giggle. A sudden knocking on the door scared both of them, their papers flying around the room.

“Son of a-” Y/N mumbled and quickly pushed all the papers under the bed, not knowing who was behind the door. Stiles, who nearly fell out of his chair, thought about what to do next for a few seconds. He quickly closed his laptop, then he walked over to open the door revealing Scott. Both Stiles and Y/N sighed in relief. Scott entered the room, shooting weird looks at both of them. He noticed all the papers on the floor, his eyes widening.

“How much Adderall have you had today?” Scott asked Stiles.

“A lot,” Stiles answered and shot a look at Y/N, who just shrugged.

“Doesn’t matter, okay? Just listen.” Stiles watched Stott as he sat down next to Y/N.

“Is this about the body? Did they find out who did it?” Scott asked looking down at all the papers under his feet.

“No, they’re still questioning people. Even Derek Hale.” Stiles waved his hand.

“The guy in the woods we met the other day,” Y/N explained when she saw Scott thinking about why Derek’s name sounds familiar. Stiles just pointed at her, agreeing.

“Yes, but that’s not it, okay?” Stiles continued. Scott frowned in confusion.

“What then?”

“Remember the joke from the other day?” Stiles suddenly got nervous, Y/N could see it on him. It only got worse when Scott just shook his head. Stiles shot a look at Y/N. She smiled at him and nodded, silently assuring him she’s there if he’ll need help.

“Not a joke anymore. The wolf, the bite in the woods.. I- We started doing all this reading.” Stiles gestured to Y/N as he said we.

“Do you even know why a wolf howls?”

“Should I?”

“It's a signal. When a wolf's alone, it howls to signal its location to the rest of the pack. So if you heard a wolf howling, that means others could have been nearby. Maybe even a whole pack of them.” Y/N explains from Scott’s side, pretending like she’s reading through her journal.

“A whole pack of wolves?” Scott asked, still confused. Y/N rolled her eyes.

“No- Werewolves,” Stiles finally got to the point. Y/N slowly put down the journal, getting ready to step in if something was about to go wrong. Scott stood on his feet, looking irritated.

“Are you two seriously wasting my time with this? You know I'm picking up Allison in an hour.” He picked up his backpack and was getting ready to leave, but Stiles grabbed him by his arm, pressing his other against Scott’s chest, trying to keep him in place while convincing him he’s telling the truth.

“I saw you on the field today, Scott, okay? What you did wasn't just amazing, all right? It was impossible.” Scott shrugged off Stiles’ accusation, trying to leave once again.

“Yeah, so I made a good shot.”

“No, you made an incredible shot! I mean, the way you moved, your speed, your reflexes? Y'know, people can't just suddenly do that overnight. And there's the vision and the senses, and don't even think I don't notice that you don't need your inhaler anymore.” Stiles was trying to get his friend to believe him.

“Okay! Dude, I can't think about this now. We'll talk tomorrow.” Scott stated. Both Stiles and Y/N panicked.

“Tomorrow? No! The full moon’s tonight!” Y/N said and shot up from the bed, quickly walking to stand in front of the door so Scott couldn’t escape. Scott looked at both of them, sighing.

“What are you trying to do? I-I just made first line. I-I got a date with a girl who I can't believe wants to go out with me, and everything in my life is somehow perfect. Why are you trying to ruin it?”

“We are trying to help!” Y/N yelled at the same time as Stiles.

“You're cursed, Scott. You know, and it's not just the moon causing you to physically change. It also just so happens to be when your bloodlust will be at its peak.” Stiles continued.

“Bloodlust?” Scott asked.

“The urge to kill,” Y/N said, unimpressed, leaning against the door.

“I'm already starting to feel an urge to kill, guys.” Scott rolled his eyes. Stiles grabbed the book he was reading and found the page he wanted.

“You gotta hear this-- "The change can be caused by anger or anything that raises your pulse." All right? I haven't seen anyone raise your pulse like Allison does. You gotta cancel this date.” Stiles started going through Scott’s backpack.

“I’m gonna call her right now.” He mumbled.

“What are you doing?” Scott yelped, watching his friend going through his phone.

“I’m canceling the date,” Stiles said.

“No, give it to me!” Scott grabbed the phone out of Stiles’ hand, before dropping it on the floor. He shoved Stiles against a wall, raising his fist and preparing to punch him in the face. Y/N quickly ran over, trying to help, not realizing Scott turned around reaching for the desk chair. She opened her mouth in a silent scream, as she felt Scott’s claws scratching her side as he pushed her out of the way.

“I’m sorry. I- I gotta go get ready for the party.” Scott picked up all his things.

“I’m sorry,” he gave Stiles and Y/N one last apologetic look before he went. After Scott has gone, Stiles let out a long breath of relief. Still clearly upset, he sat down in his chair. Just then he noticed Y/N wasn’t getting up from the ground.

“Y/N?” He asked, worried. She looked up at him with tears in her eyes, holding her side.

“We have a problem,” she whispered, pain evident in her voice, as she moved her hands to the side, showing him the blood-stained t-shirt.

***

“So you’re saying you found her like this in the preserve? What were you doing there alone?” Sheriff Stilinski asked his son as they both helped Y/N with the scratches.

“I was walking around.. Walking.” Stiles shrugged. Y/N bit her lip to stop herself from laughing. After Scott left, Stiles wanted to take her to the hospital, but Y/N protested. They moved to the living room and that’s where Stiles’ dad found them. You can imagine the horror he went through when he saw the blood. They quickly came up with a cover story.

“And you took her here instead of a hospital why exactly?” The sheriff raised an eyebrow. Stiles nervously scratched his head.

“I’m sorry Mr Stilinski. I hate hospitals, it just makes me feel anxious and I may have said I would hit him with a rock if he tried to take me there.” She smiled at the older Stilinski. Stiles looked at his father nodding. The sheriff sighed and rolled his eyes.

“Teenagers,” he mumbled under his breath.

“What did you say happened to you?” He asked again, sitting on the couch next to the girl. Stiles carefully taped a bandage over the scratches, listening to the conversation.

“I don’t remember exactly. I was walking and then all I remember is Stiles talking to me.” She frowned. Stiles was shocked by how believable she sounded. If he didn’t know what really happened, he would believe her.

“There’s a killer running in these woods. Don’t go in there again, please.” The sheriff looked at both of the teenagers. Then he noticed the clock.

“I have to go. Stiles, take Y/N home.” And with that, he was gone. Y/N blinked, staring at the door.

“Welp, that’s that.” She stood up. Stiles was immediately next to her, ready to help if she needed it.

“I don’t need help Stiles, I’ve had worse than werewolf scratches.” Y/N waved her hand.

“Let’s go find Scott.” She gestured to the door.

“No, you can’t go, you’re hurt!” Stiles protested.

“What part of a ‘hunter’ did you not understand, Stiles?” Stiles only rolled his eyes and went to change. After that they both got into the jeep.

***

They parked in front of the Martin house. Y/N took her shirt off and pulled out a dress from her backpack.

“Oh- Whoa, what the-” Stiles quickly covered his eyes. Y/N giggled.

“Shush Stilinski,” Y/N mumbled and put on the dress. She pulled down her pants and put them and the bloody shirt into her backpack.

“Okay, let’s go.” They walked in, separating when Stiles wanted to talk to someone. Y/N slowly waked around in between the partying students, trying to find Scott. She spotted him when he walked in from the backyard, quickly walking through the crowd out. Y/N ran after him, noticing Allison also going after Scott. She watched from the front door as Allison watched Scott drive away and then get into Derek Hale’s car, driving away with him.

“Stiles!” Y/N yelled, trying to find her friend who appeared right next to her.

“Yeah?”

“We have to go.” She let out and they both ran back to the jeep. Stiles started the car, speeding to Scott’s house. Y/N was sitting in the passenger seat, trying not to cry from the sudden pain under the bandage.

***

Y/N and Stiles ran into the house. Stiles led her up the stairs to Scott’s bedroom. They stopped in front of his door and knocked.

“Go away,” Scott called from inside. Y/N sighed and knocked again.

“Scott, it’s us,” Stiles said. Y/N awkwardly stood there, thinking about how she literally came into this town just a few days ago and she’s acting like she’s known these guys since she was born. She blinked when she realized the only thing she knew was Scott’s definitely a werewolf.

“Scott let us in. We can help.” Y/N noticed the door was now open a bit.

“No, listen. You gotta find Allison.”

“She’s fine, all right? I saw her get a ride from the party,” Y/N said.

“No, I think I know who it is-”

“Dude just let us in! We can try-”

“- It’s Derek. Derek Hale is the werewolf. He’s the one that bit me, he’s the one that killed the girl in the woods.” Scott said. Wait, we didn’t know Derek was a werewolf? Y/N thought to herself, then she realized who she saw Allison leave with.

“Guys… Derek’s the one who drove Allison from the party…” Just as she finished the sentence, the door was slammed shut and locked again. Stiles tried to get in, he rattled the doorknob and even pounded on it with his fist trying to be let in.

“Stiles. STILES!” Y/N got the boy's attention.

“It’s too quiet in there. He had to get out of his window.” She pulled him by his arm out of the house.

“We have to check on Allison.” The boy panicked.

“It’s a good thing I live with her. Now drive.” She quickly got in the jeep. Stiles followed her, quickly driving to the Argent house.

When they got there, Y/N quickly found her keys and let herself in, holding the door for Stiles. They both ran inside, almost running into Allison’s mom. Y/N let out a squeal of surprise and Stiles just cursed, almost faceplanting next to the both of them.

“Hi, um, Mrs Argent. I- eh, I am a friend of Y/N’s.. and of your daughter’s, I- this is gonna sound crazy but I- we-” Stiles tries to explain, earning weird looks from the mom Argent.

“Is Allison home? She left the party without letting anyone know and we saw the suspect of the murder near the place so we got worried-” Y/N explained instead, placing a hand on Stiles’s back.

“Yeah, she’s okay, she just got into her room.” Y/N sighed out of relief at that.

“Okay,” She mumbled, watching the creepy lady walk away.

“I’m gonna go try to find Scott. You should change the bandage,” Stiles said, looking at Y/N. She nodded, smiling.

“Be careful. See you at school,” she awkwardly waved at him. He rolled his eyes and hugged her, then he ran out of the house and drove away. Y/N stood there, eyes wide, looking out of the still opened door.

“Y/N? You okay?” Allison’s voice sounded from the top of the stairs. Y/N closed the door and looked up.

“Yeah. Yeah I think so. I just- ehm.. Nothing. Everything is fine.” She shook her head. Allison smiled and gestured for her to follow her. Y/N did, walking up the stairs and then into Allison’s room. They talked about their day while getting out of the party clothes, eating candy.

[themedicalstate]

He Thought It Was the Flu, but He Had Never Been So Sick

Was there a clue in the dark color of his urine?

The 22-year-old man struggled to get out of bed. The E.M.T.s were just outside his door, if he could only get there. The previous day he felt that he was coming down with something. Normally he never took naps, but that afternoon, he returned from class feeling completely wiped out and slept long and hard. Yet when he awoke, he felt even worse. Every muscle was sore. He felt feverish. This must be the flu, he told himself. He had the flu shot before starting school that year, but of course no vaccine is 100 percent effective.

He spent the rest of that afternoon in bed, too tired and in too much pain to even get up to join his partner for dinner. When he awoke in the middle of the night to go to the bathroom, he was so weak and sore he could hardly sit up. He maneuvered to the edge of the bed and, using the headboard, pulled himself to his feet, but his partner had to help him get to the bathroom. Once he was there, the urine he produced was startlingly dark — the color of Coca-Cola.

The next day he felt no better. His partner wanted to stay home with him, but he hurried her off to work. It’s just the flu, he assured her. But as the morning wore on, he started to worry. He called his parents, who were both nurses. They were worried too; influenza can be bad. When he got the same message from a doctor back home in New York, he started wondering if he should go to the hospital. He’d never been this sick before.

It was late morning when fear overcame embarrassment and the young man called 911. And now that the E.M.T.s were here, he was worried that he couldn’t get to them. Just standing had every fiber in his legs on fire. He supported himself by leaning on furniture and slowly made his way to the front door. He was grateful that they had pulled the stretcher to the bottom of the steps leading to his porch.

An Off-the-Charts Test Result

He wasn’t in the emergency department of C.H.A. Cambridge Hospital in Massachusetts for long before the decision to admit him was made. The test for the flu was negative, but the blood tests done were dangerously abnormal. His kidneys were failing, and it looked as if his liver was damaged, too. His white-blood-cell count was twice the normal level, suggesting a severe infection.

The patient told the doctor that he had been working out a few days before he got sick, so the doctor sent a blood sample to look for the presence of creatine kinase (C.K.), an enzyme that goes up when muscle tissue is injured. Extreme bouts of exercise can cause this kind of injury, and when C.K. and other muscle components leak into the bloodstream, they can cause all kinds of damage — a condition called rhabdomyolysis. A normal level of creatine kinase is in the 100 to 200 range. This patient’s C.K. was over 40,000. Just how much over was unknown because that was as high as this initial test could measure.

Dr. Frances Ue was the third-year resident assigned to care for the young man. He hadn’t been working out that hard, he told her, after she explained the possible link between his exercise and his current pain. He went to the gym three times a week to help him manage the stress of grad school. He had added a couple of new exercises to his regimen, but nothing extreme. The doctor asked if he was using any drugs or supplements to help him build muscle. Absolutely not. Was he using any drugs like cocaine or Adderall, either recreationally or as study aids? These can increase the risk of developing rhabdomyolysis. Again, his answer was no.

She asked if anything like this had ever happened to him before. Never. Later he recalled an episode of really dark urine when he was sick as a child. But he never had this kind of muscle pain before.

The doctors in the emergency room thought exercise-induced rhabdomyolysis was the most likely cause of his symptoms and lab abnormalities, but not the only possibility. They had already sent off tests to look for infections known to affect the liver and kidneys: hepatitis A, B and C, Epstein-Barr virus, cytomegalovirus. They also ordered a blood test to look for Wilson’s disease, an inherited inability to eliminate copper from the body, which can cause sudden liver failure in young adults. What else? Ue wasn’t sure.

Flushing Out the Kidneys

Whatever the cause, she told the anxious young man, his muscles would recover. But his kidneys were in danger. His urine was dark because the oxygen-carrying parts of the muscle known as myoglobin were collecting in the kidneys. Myoglobin is a dark red color; it’s why muscle is red. The most important thing the medical team was doing for him right then was giving him fluids to help his kidneys flush out myoglobin and other components released by the damaged muscle.

Ue ordered additional tests to track the patient’s creatine kinase. On admission, his total C.K., initially reported at over 40,000, had actually been 189,000. It peaked the next day at nearly twice that: 364,000. Ue kept the IV fluids going and looked for a reason for the worst case of rhabdo she had ever seen. It wasn’t hepatitis or any of the common viruses they tested for. It wasn’t Wilson’s disease. It wasn’t any of the drugs she checked for.

A Fuel Problem?

What else? In search of an answer, she turned to the medical literature and found a paper describing two young people who, like her patient, developed severe rhabdo after a moderate workout. The writers listed factors that could predispose a patient to having this kind of muscle injury, and Ue found what she was looking for. There are people born with abnormalities in how their bodies use the fuel provided by the foods they eat. Because of this abnormality, when stressed or working hard these people could quite literally run out of fuel. Could he have one of these rare inherited diseases? To answer that question, after the patient recovered enough to leave the hospital, Ue referred him to a neurologist who specializes in neuromuscular diseases.

It was months later when the patient had enough of a break in his schedule to make an appointment to see Dr. Courtney McIlduff, a neurologist at Beth Israel Deaconess Medical Center in Boston. Since his week in the hospital, the man reported, he had two more episodes — though neither as severe as the first. Both happened after he took an easy walk. Hearing that, McIlduff, like Ue, began considering an inherited problem in turning food into fuel. These so-called metabolic myopathies sometimes didn’t reveal themselves until adolescence or even adulthood.

McIlduff examined the man carefully, looking for muscle weakness. Many forms of muscle disease can permanently alter how muscles look or work, but most metabolic myopathies don’t. The patient’s muscle exam was completely normal. She sent him to get genetic testing, to look for one of the several inborn errors of metabolism.

And indeed, he had one: He was born without the ability to make an enzyme called carnitine palmitoyltransferase type 2. Patients with CPT2 deficiency are missing the necessary biological equipment to turn some dietary fats into energy. Normally the body runs on a type of sugar made from carbohydrates and stored in the liver. When that sugar is used up, the body switches to fat for fuel. Patients with CPT2 deficiency can’t do that, or at least not well. Without the proper fuel, the muscle cells are injured and release their contents, causing the pain and dark urine. Neither of the man’s parents have this disorder, but they both have one copy of the erroneous gene for this enzyme. It takes two copies to get the disease, and so their son got one copy from each of them.

There is no cure for CPT2 deficiency. It’s managed with diet and lifestyle changes, as well as a supplement that provides fats that these bodies can break down. It has been a year and a half since this young man’s condition was diagnosed. To learn how to live with it, he has turned to others who have it, too. An online community called What Can You Do Despite CPT Type 2 has provided real-time tips and tales from those who, like him, live with this genetic abnormality. He has figured out how to eat, how to rest and how to exercise with this disorder. He is, he says, determined to learn how to take care of the only body he’ll ever have.

By Lisa Sanders, M.D. (The New York Times). Illustrations by Ina Jang.