#then ots completely okay to feel a bit messed up after a rejection

[kingofdandelions]

Advice is uh, make sure to actually go through with it and not give up halfways

Go all in, and also tell him up front and not with a text cus texts can be misinterpreted and screenshotted

Maybe practise to the mirror or a friend so you dont stutter and fuck up as much

And if you cry, then dont apologise for it, its okay to cry and its okay to be sad if you get rejected.

Afterwards make sure to get yourself something nice, a snack or a gift to yourself for being brave enough to confess.

If you're that certain that he'll reject you then think of it as a good thing, cus afterwards you wont have to worry about whether or not he likes you, since you'll know. So then it will be a "okay since that youre sure he doesnt like you back, now you dont have to worry about that anymore" thing

Tho tbf Im not an expert on this topic, so idk, but this is my guess as for what to do

hey uh

im going to tell him i like him in 2 weeks

and im so scared

and i have to prepare myself to not cry infort of him when he rejects me

so yeah

(i need advice if someone has)

[hangrypa]

s/p first year as a PA

I was hired as a hospitalist primarily for the transplant service. However, in the setting of the pandemic and staffing shortages, I am all over the place now and work in almost everything non-pediatric and non-surgical. 

In my first few months as a PA, I was incredibly overwhelmed. I went from being a learner who switches specialties every month to a fully-fledged provider making life-or-death decisions on an hourly basis. Oftentimes I’d find myself in the room of a patient actively crumping, surrounded by the patient’s family and multiple nurses awaiting instructions on what to do to save the patient. I thought that I faced a lot of pressure in school, but it was nothing compared to this. 

And just when I started to get a hang of it all, the pandemic hit. What a nightmare. As mentioned above, I was hired to work with with transplant patients. Prior to the pandemic, my transplant colleagues and I were masking and gowning for almost every patient: 1 surgical mask and 1 gown per patient and per patient encounter. But once COVID hit, we were rationing PPE. 1 N95, 1 pair of goggles, and 1 face shield for the pandemic. 1 surgical mask per week, and 1 gown only if a patient had Cdiff or a history of MDRO bacteremia.

What did the pandemic mean for our transplant patients? 

Our patients are on immunosuppressant medications to prevent transplant rejection. Unfortunately, this makes it difficult for them to fight infections. 

Our department did what it could to prevent COVID. We'd test patients on admission for COVID, regardless of symptoms or exposure history. If they were positive, they went to the COVID team and quarantined on their unit for a period of time and had to test negative before returning to our unit and being transplanted. We took many other measures to reduce COVID risk to the best of our ability. 

People still died. To see someone get transplanted successfully and then die of a virus is horrifying. Unfortunately, despite our admission tests, sometimes patients contracted COVID within the hospital. Patients would be happily FaceTiming their family one moment, telling them all of their plans for once they were discharged- then the next day they'd be intubated. We tried Remdesivir, Dexamethasone, prone positioning, etc. But the virus moved through them quickly, and these efforts often were too late. No amount of hoping and praying brought them back. 

As a first year PA, I learned to go to an empty conference room, close the door, and remove my mask before calling to the family of the deceased. This way, as they gathered around the phone in their homes, the family could hear me unmuffled as I delivered the news. Also, this way my tears didn't ruin my mask for the rest of the week. 

I learned a lot this year. It's been a mixture of crying and laughing. There are times that I question why I ever became a PA, and then there are times when this career feels like home. In addition to transplant, I’ve also been working in the  ED, IMC, ICU, inpatient hospice, clinic, and infusion center these past 6 months. I’ve learned quite a lot along the way.

Lessons learned as a first year PA:

1. Check your pager hourly: This is in addition to checking it whenever you get paged. Sometimes I’ll get paged while I’m rounding, read it, and then forget about it. Now I go through my pager at every hour to ensure that I already responded to all my pages and then answer ones that I missed/forgot.  On a semi-related note, a while back I wrote about good paging etiquette.

2. Let people know when you're out: I work a rotating schedule. As a result, it’s hard to predict when I’m in or out of the hospital. Sometimes I’ll come back on service and find urgent emails or texts that are a few days old. Now I leave an away message with my return date and my supervisor’s contact information on both email and hospital text. If someone really needs to get a hold of me, my supervisor has my personal cell phone number.

3. Be conscientious of what time you consult: I generally try to get all of my nonurgent consults done before 3pm. Many services have only 1 resident covering after 3pm, so I try not to page/call unless I have an emergency. 

4. Call the nurse if something needs to be done urgently: Being a nurse means being the ultimate multitasker. Room 5 is due for his IV Amphotericin, Room 2's Foley is supposed to come out prior to void trial with Urology, Room 1's infusion completed and is beeping, and Room 4 is a bit altered and yanked out her PICC. Now I’m placing an order for Room 3 to get IV Lasix due to concern for pulmonary edema. However, the nurse may be preoccupied with Room 4 and not see the order in the computer for some time. If I really need to the patient to get the Lasix right way, I’ll place the order through EMR and then call the nurse and see what their situation is. If they’re crazy busy with Room 4 and likely to be unable to get to the Lasix within the next 15min, I ask whether they’re okay with me asking another nurse to give the Lasix now. Usually the answer is yes.

5. Value your nurses: Nurses know the patient best. They’re the ones answering call bells, giving meds, doing dressing changes, etc. Unfortunately they oftentimes bear the brunt of everyone’s frustrations, from patients to patients’ families to attendings to managers. Not to mention, they’re the ones doing the dirty work. Bedside nurses are the heartbeat of healthcare, but they also are high risk for burnout. Always support your nurses, whether that’s volunteering to answer a patient’s family member’s 17th phone call of the day or responding to a patient’s call bell yourself. 

6. Know how to get a hold of someone quickly: It’s less than ideal to page someone repeatedly. At my hospital, if I need to talk to an attending urgently, I call the operator and ask them to connect me directly to the attending’s cell phone. If a patient is crashing and we’re not in the ICU, I dial the emergency number and call a rapid response, which sends people running into my patient’s room. 

7. Plan your discharge meds from Day 1: The goal of every admission is to treat the patient and then discharge them safely. Send medications early for prior auth and call the pharmacy to make sure that they have medications in stock. (One time a patient’s insurance didn’t cover Levofloxacin, of all things.) 

8. Keep social work and care coordination aware of all needs from the start: Does your patient looks unsteady? Place a PT/OT consult and let social work and care coordination know that the patient might require home therapy services and/or DME so that they can start looking at services and companies that may be covered by insurance. Does your patient have a central line? They’ll likely need a home health service to teach them how to care for it daily at home. Do they seem to require frequent transfusions? They’ll probably need labs on discharge. Is the patient’s living situation safe (no heat/AC, possible abuse at home, financial difficulties, etc)? They may need alternative housing.

9. The attending is not always right: Generally speaking, the attending has the last say on how the team manages a patient. However, I’ve come across situations in which an attending’s decision put a patient in more danger. Sometimes asking them about their decision can help steer the care plan toward better patient care. Other times you just have to stand your ground and be okay with being on the receiving end of an attending’s misdirected rant. Report these instances to your manager and to other higher-ups.

10. Always have gloves in your pocket: You never know when you’ll find a mess. Or which part of the body someone asks you to examine. Or how hygienic a person is (or is not).

11. Verify weird vitals: I was very new when I walked into work, opened a patient’s chart, and promptly bolted down the hallway when I saw a patient’s O2 sats recorded as 15-20s. I found the patient sitting up in bed, eating breakfast, and bewildered by me bursting into the room. Turns out that overnight someone mistakenly recorded his respirations as the O2 sats.

12. Remove whatever tubes you can: Anything entering the body is an infection risk. Does your patient still need that Foley placed by the surgery team? No? Yank it (don’t actually yank because ouch). Is your patient A&O and able to eat without aspirating? Remove the NG tube. Does your patient have good veins and require infrequent transfusions/labwork? Pull their central line.

13. Take a buddy with you to emergencies: Two heads are better than one. Even if you’re a seasoned provider and well-equipped to manage an emergency, you might need another body to help with performing CPR, making urgent calls, grabbing supplies, etc. 

14. Ask your patients about premeds for procedures: We all have different levels of pain tolerance. A procedure goes far more smoothly if your patient is comfortable. Note: if you’re going to premed with Ativan or an opiate in the outpatient setting, make sure they have a driver.

15. Be good to your charge nurse and unit secretary: I don’t know how they do it. If I had to manage the unit’s signout, patient complaints, calls from other floor, being yelled at by providers, verifying paper orders, and finding beds for incoming patients- all at the same time - I’d lose my mind. 

16. If your patient is mad, just shut up and listen: There are many things that you can’t control: the time it takes for a patient to get a room, the temperature of hospital food, the dismissive attitude of your attending, etc. And oftentimes the patient knows this. My reflex is to want to apologize for things and overexplain why different things are happening. But sometimes the patient just needs to rant. Take a step back and just listen. That can make all the difference.

17. Fact check your notes: The framework for your progress note often is the note from the day prior. It sounds obvious, but make sure that you go through the note and make updates and changes accordingly. If today is 01/15, there’s a good chance that the Fungitell from 12/31 is not still pending. 

18. Try to learn some nursing skills: This is one of the areas in which I most envy my NP colleagues. If a patient’s IV pump is beeping or their central line need to be flushed, I oftentimes awkwardly step out of the room and look vacantly into the distance for a nurse. I’ve finally figured out how to spike a bag (albeit I do so very slowly, and it certainly makes the RNs giggle some). I talked to our unit’s nurse manager, and she’s willing for me to learn some nursing skills from the staff during a slow day- we’ll see when thing slow down!

19. Be kind: Generally speaking, being in a hospital is stressful. Patients are feeling out of sorts, and staff are working with constant dinging in the background. I rant plenty on this website, but I’m kind to everyone at work (with few exceptions) because it makes things more comfortable for everyone. Additionally, if you are always kind to your patients and colleagues, your reputation will speak for itself. One time I was walking down a hall with poor reception while on my ASCOM with a notoriously standoffish nurse from another unit. My phone cut out. She called my unit’s nurse manager to complain, and the nurse manager told her that I would never hang up on purpose. My interactions with the nurse going forward were always more pleasant in nature.

20. Support your team: The best colleagues are not the smartest colleagues; the best coworkers are the ones who have your back. Whether it’s a medical emergency or just a strange situation, it’s important to be supported and to give support.

I know that I’ve learned a lot more than this, so I’ll likely be adding to this throughout the year. Happy Snow Day, all!

[2old4this8]

The problem with Rise of Skywalker

It's been more than a week now so I feel like I can safely put some spoilers out there.

Let me begin by saying that overall I enjoyed the movie and found it to be thoroughly entertaining. It surprised me that they actually went and made Reylo canon and those last few moments Rey and Ben share were powerful and emotional to me. But I wasn't surprised that Ben died: I always felt his destiny was pretty much set the moment he killed his father, he would reject Kylo Ren and die. The fact that we got to have a glimpse of Ben Solo and canon Reylo before that was an added bonus.

There was a lot I didn't like though.

I didn't like the return of Palpatine (let the dead die, ffs) and what it meant for Rey. It gave a different tone to her anger and her search for purpose that I think cheapened them both. And I didn't like that she started her journey alone on a sand planet and ends it the same way (it doesn't matter if that's a pit stop on her way back to... what exactly? The resistance, I suppose, Finn and Poe? It doesn't matter, she still ends the movie on a sand planet, a bare planet).

I didn't like the way Rose was forgot. She only got one minute of being despondent and angry, the complete opposite to the Rose Tico in TLJ we all loved.

I did like Finn but it also felt like they were done with his character development long ago and kinda went on autopilot from there. And I didn't much like Poe but I always had a problem with his character, in that he always felt more like an Han Solo stand in than a character with his own agency to me and this movie didn't convince me of the contrary.

None of this, however dimmed my enjoyment of the movie as a whole at the time of watching it because as a movie on its own TROS isn't that bad.

The real problem I have with TROS and by extension now the whole new trilogy is the way it develops and concludes the overall story, what for better or for worse has been the Skywalker saga. And let me premise this by saying, a Rey Nobody felt like a breath of fresh air after TFA, it made it okay to put the Skywalkers in the sidelines in favour of a new Trio because this was a new story. A Rey Palpatine brings the story back to centre, and Rey taking the name Skywalker at the end (not to mention the movie freaking title!) shifts the new saga on its own axis making this the concluding chapter of the Skywalkers saga (new Trio, 404 not found here).

So now if I look back at the whole saga I have to wonder why they made the choices they made with the characters they inherited from the OT.

As much as I loved the drama queen who was Kylo Ren and the duality of Ben Solo (not to mention my love for Reylo), I also hate how vague and fuzzy his origin story is. And what doesn't help is that all the hints and references we get don't really paint a favorable picture for the original Trio who, at best, were neglectful and scared by something Ben wouldn't have much control on anyway. And while this might feel real to a point (lots of parents who do their best still end up with troubled adult children) it also ruins their overall arc at least a little bit.

All is made worse by the fact that we don't have any real reconciliation to patch up this family drama. The only conclusion we have is Han appearing to Ben, sent, I guess, by Leia. As lovely as that scene was, though, it doesn't feel like it's enough, at least to me, and at the time it was more a visual reminder of why Ben had to die than an end to Kylo Ren's conflict both within himself and with his family. Hell, I am still not sure why Kylo Ren was so devoted to his grandfather's memory anyway, how could he look up to him to rid himself of the call of light when Vader's journey literally ends with him accepting and dying in the light.

There is a review out there titled "TROS has Ben Solo problem" and that title is big mood for me now but in relation to the whole new trilogy.

So, all in all, I didn't hate TROS in itself but I do feel like it made a mess of the whole story, and I'm not sure why exactly does that because I don't feel like it achieves anything in doing so.

Any thoughts? My inbox and my DMs are open!

[nothesc]

Please make prompt of noora and Elias. Instead of noora going with William in Eva party, she rejects him and just hangs out with sana. And Elias somehow is there, surprise me with ur story 😂

Hiii! 

I wrote this really quickly and it’s not very long but I hope you like it!!!

WARNING: Noorhelm shippers don’t read this, you won’t like it. This is a Noora x Elias fic.

———————————x———————————–

“Thanks for the email”

“What email?” Noora asked confused

“Noora…”Sana who was standing by her side said “Remember that thing I wanted to tell you?”

“Tell me you didn’t…” Noora said fearing the worst

“I’m sorry” Sana said biting her lip

“What is going on?” William asked

“I didn’t send you any email William” Noora said

“What?”

“So yeah, you can go back now”

“Are you saying that I’ve fucking come here for nothing?” William said angry

“Apparently” Noora said shrugging

“Oh no, you and I we’re going to talk, now”

“I don’t want to talk to you William”

“Yes you do and you are” he said taking Noora’s hand

“Hey, hey, hey man, the girl doesn’t want to talk to you. Easy there” Elias who had been watching thescene said approaching them

“It’s fine Elias” Noora said looking at the floor “Okay William, let’s talk”

Eliaswatched as Noora and William entered Chris’ house to talk and couldn’t help butfeeling disgusted at it. Noora clearly seemed like she didn’t want to be aroundthe guy and he felt frustrated ‘cause he couldn’t do anything about it.

“Who was that guy?” Elias asked Sana

“Noora’s exboyfriend”

“I don’t like him”

 -x-

 Eliaskept looking at the door of Chris’ house anxiously waiting for Noora to leavethe house. After what seemed like an eternity she finally came out. William wasright behind her but he just walked to his car, opened the door and slammed itbehind him only to start the engine and leave the house as fast as he hadarrived. Elias looked at Noora then as they approached the bench where Sana wasstill sitting and noticed that her eyes were red. He wanted to go there andtalk to her but he knew that she needed some time with her friends.

 -x-

Noorasat by Sana’s side on the bench without saying a word.

“Noora, I’m so sorry. I’m a horrible person. I thought you were withYousef and I was…I was jealous and I didn’t even think that he would actuallycome and…”

Noorainterrupted Sana with a hug. She buried her face on Sana’s neck and allowed herto cry a little more.

“Oh Noora…”

“No, it’s fine…it’s fine” Noora said as she pulled away “I’mnot mad at you”

“You’re not?”

“No, I mean, it wasn’t cool of you but…I really needed thatconversation. I needed closure on that relationship…even if it hurts” Noora said wiping away the tearsfrom her face

“So…William and you?”

“We’re over” Noora said “Forever”

“Are you sure that’s what you want?”

“All I know is that no one has ever made me feel the way William has andthat goes both ways. I was really happy with him when things were good but assoon as things went bad he would completely shut me out and made me feel like Iwas the problem. These past few months I just…I’ve realized that I can livewithout him so I’m going to do just that”

“I’m proud of you” Sana said “And I’m really sorry for sending that email”

“It’s okay…you helped me in a way I guess, if you hadn’t sent that emailI would still be wondering what could’ve happened. At least now I know it’sover and I can move on” Noora said shrugging

“And you’ll be so happy from now on” Sana said hugging her friend

“Uh…Sana?”

Thegirls pulled apart and saw Yousef standing in front of them

“Can I…can I talk to you?” he asked shyly

“Um…”Sana looked at Noora, she didn’t want to leave her alone

“It’s fine, I’m fine. Seriously go, go!” Noora urged her

“Okay”Sana said smiling and stood up leaving with Yousef.

Noora watchedthem leaving with a smile on her face, at least someone was going to be happy.

“Can I sit?”

Shelooked up and saw Elias smiling at her

“Of course”

Eliassat down next to her and for a moment they both stayed in silence.

“Are you okay?” he finally asked

“Yeah…a little bit emotional”

“That was your boyfriend?”

“Ex boyfriend. We’re over, forever” she said biting her lip

“Well, I don’t know him but if he made you cry he clearly doesn’tdeserve you”Elias said smiling

“Thank you Elias, you’re such a nice guy”

Nooralooked at him tenderly, he truly was a good guy. Sana had told her a lot abouther brother, only good things. And well, there was no denying that he was goodlooking. Maybe that was what she needed, a good and respectful guy, she wasdone with bad boys.

She lickedher lips and leaned in for a kiss but Elias stopped her before their lips couldmeet.

“Wow, wait”

“Oh my god I’m so sorry” Noora said covering her face with her hands “I’ma mess and you’re fasting and…”

“Noora, Noora is not that, is not that.” Elias said taking her hands in his so shecould look at him “It’s just…you’re vulnerable right now and I wouldn’t take advantage ofyou. I would never kiss you while you’re crying”

“Uh…I know, I know, I’m sorry. I know you’re not interested in me thatway, you’re just being nice and…”

“No, you’re wrong there” Elias interrupted her “I wouldn’t kiss you while you’revulnerable…but that, Noora, doesn’t mean I wouldn’t kiss you under othercircumstances”

Nooralooked at him taken aback from his comment. She wasn’t sure what to say andfelt her cheeks blushing. Elias chuckled at her reaction.

Right inthat moment the song that had been playing ended and Oss to started to sound.

“Want to dance?” he said standing up and offering his hand “You can’t say no to this song”

Noora smiled widely at him and took his hand. Heled her to the improvised dance floor they had made at Chris’ yard and startedto dance. Everyone was dancing at that point. Noora looked around and saw Isakand Even dancing while hugging, Mikael and Adam just singing the lyrics whilethey looked at each other and sway to the rhythm of the music, the rest of theboys and the girls all dancing forming a circle, even Yousef and Sana weredancing, well Yousef was dancing Sana was laughing at him looking genuinelyhappy.

She then looked at the boy in front of her,still holding his hand. Elias smiled at her and started to make dorky faces tomake her laugh. She shook her head and let him twirl her around to the rhythmof the music. It was such an innocent and short moment, but she felt happy,happier than she had been in months.

———————-x———————–

This is it!

It’s the first time I write for Noora and Elias so I don’t know if I did it good

I hope you’ve liked it

Thanks to @stressedoutteenager for showing me that wonderful song and to all of you who haven’t listened ot it yet…WHAT ARE YOU WAITING FOR? (Oss to - Jonas benyoub)

Thanks for reading!!!

And YES I’m still hinting at Mikael x Adam and I won’t be stopping anytime soon