#they are otherwise 100% healthy so its hard to do

[sassyhazelowl]

Annoyed about being given birds with issues. Now that I've gotten the valleys separated out in pairs and they're less flighty, I've noticed that while the 3 roosters are in pretty good shape the 3 hens are less so. One has an overgrown beak, which is nbd, but it means how she was kept before didn't allow her to grind down her beak appropriately (she's been grinding it down since I got her, so thankfully it doesn't look like I have to do it - overgrown beaks get in the way of eating and they can break causing a nasty injury). Another one has a squinty eye, which indicates, most likely, a low grade infection on the eye itself or internally. It isn't too bad yet and appears to be improving already, but I may have to catch her and treat it. The third one is a mess; she has paralysis in her toes, which makes them curled and crooked. The way she walks tells me she has probably been like this since she was a chick. This indicates that either her parents or she or both were not feed appropriate food as this is most often caused by a vitamin deficiency.

I already know the guy wasn't feed them the greatest food because they reeked so bad when I got them I had to move them out of the box and throw it away b/c it was stinking up the room. They also don't seem to know what pellets/crumbles are and prefer to eat seeds/grass only. IDK why people can't be bothered to feed their animals appropriate diets. I see it in my chicken/quail groups all the time. Just stop being stingy and pay a few more bucks to invest in the health of your animals. Gamebird feed is not that much more expensive than chicken feed. Chickens need feed not just free ranging and scraps. Also, this is why you quarantine!!! I almost never take in adult animals for this exact reason. I almost exclusively get eggs from trusted sellers now - any chicks that hatch automatically get a 6 week quarantine via the brooder. New animals can bring in all kinds of nasties, especially if you don't know how they were kept before you got them and what precautions the previous owner took to mitigate risks.

[sangaverage]

1. Vampirism as a Condition

Its finally here folks, My long awaited and long Text attempt at writing up something I've promised for a little while

This will be based on more personal experience and the experience of a primarily sanguine Vampyre, there may be a few mentions of other feeding methods here and there

(as far as I know) There is a word limit so I shall try to cram as much in as possible here!

Lengthy and somewhat messy post under the divider (Credit: here!)

Feeding:

Yes we drink blood, or at least the Sanguinarians and Medsangs do, some feed on energy, some feed on both and much more.

There is a genuine Need when it comes to "IRL" vampirism, sure it won't kill us but it makes it incredibly hard to function properly sometimes and the symptoms can be intense.

Now the symptoms are different from vampyre to vampyre so I can't give an exact list...

Some symptoms however can be found Here!

How it may feel to feed Here!

(Thank you: as-others-were, and sauromatos )

What Causes Vampirism:

It has yet to be proven but the general agreed on consensus here is that for some unknown reason A vampyres body either fails to or cannot produce a specific thing it needs well on its own, for Sanguinarians my guess is Something in heme iron is what gives them what they need and as heme often equates to blood, its the most logical thing to consume and also gives us the most of this energy that we need, for psychic vampires it's theorised something in prana (aka a person's life force) is what gives them the energy they need.

Despite what some "Fluffier" sources may tell You, this is not parasitic behaviour, we are not to be shunned/feared/ to be constantly protected from! more often than not the Vampyre and Thier Feeding partners/ Donors can come to a symbiotic agreement! Though many who can detect our energy signature do have some form of stigma or are otherwise unnerved around us.

More in this type of feeding relationship sort of in This post.

See This post For more details as to possibly why.

See This post As to a funky theory that it's also possibly something to do with our eyes,

no it's not the scleric ring theory!

(Thank you to: fugamextenebrae and Confessionsofabloodfreak )

it is also theorised that vampires suffer a damaged solar plexus and thus cannot adequately hold on to or break down the energy they need well themselves due to this.

Vampirism is not thought to be genetic nor can someone be "turned" in the sense you may be thinking, there is however something known as the awakening.

The Awakening:

Despite what you may be thinking The Awakening is not a 100% sudden occurrence! Sometimes it takes the individual Vampyre several "mini awakenings" before the true realisation/ finally ignoring the doubt happens and the confirmation and learning process can begin proper.

The Awakening itself is hard to describe to non vampiric, but is often explained as some form of realisation or coming into ones own, generally around or just after puberty (some can be much earlier and some can be much much later) where the individual realises that they need said energy source to remain "fit and healthy" in a sense, an unawakened Vampyre or Vampyre coming into thier awakening is often called a "latent".

Usually, being around other vampyres is said to be the catalyst that leads to an awakening, however in some cases, be it lack of vampyres in an individuals area or other external factors, this is not entirely needed. And some vampyres can awaken solely on their own, this is said to be a slower process however...

Are Vampyres Spiritual:

Many of us are, yes but not all of us, first and foremost, Vampirism is not a religion!

Ones vampirism can be incorporated into spiritual practice or Those who are not vampyres but have weak energy systems, can still practice vampirism and are willing to do so spiritually!

Many but not all vampyres are attracted to Predatory spirituality at some point in there lives, vampyres are more instinctual, after all but not all vampyres do this, some are pagan or wiccan, some are Buddhist, etc etc some aren't even spiritual at all!

(more on predatory spirituality and how it equates, Here! And Here! Thank you: fugamextenebrae and Xerxeswitch )

Common misconceptions:

-We have reflections, can be filmed and have our pictures taken

-we do not set on fire or burn to ash in sunlight, hower some of us do suffer heatstroke more easily or are more prone to sunburn and eye strain in strong sunlight

-Stakes to the heart will kill us, but they'll kill pretty much anything

-Religious symbols and other holy items do not bother us, however there is a theory that faith can bother some of us, but that is just a theory, we do not spontaneously combust on church ground

-we can mostly wear silver and eat garlic, allergies do exist though

-we are not immortal and live and die as you do

-we can get sick, we are not living corpses despite the fact we may look "dead" sometimes (I am not a morning person lol)

-we do not have Supernatural superpowers, however some of us do have well developed clair senses

-we are chill with "werewolves"

-Animals do not hate us more than anyone else, however there is a theory some animals are sensitive to odd energy signatures so may behave a little strange in our presence (prolonged eye contact, overly friendly etc)

-we can cross running water (if it's shallow or we can swim lol)

-we can enter places uninvited but it's common courtesy and manners to be invited in anyway

-many of us do not "bite", let alone hard enough to puncture skin, we are still biologically human and bites can and often will cause infections, rather we use sterile tools should we need blood or substitutes

-we do not die without the ingestion of blood/ prana etc, we can also eat human food

-we don't all "get off" on blood, though some of us vamps can have a fetish for blood, fangs or biting, we're biologically human after all and there's no harm in it!

-we look just like any other human and no we don't sparkle (unless we use body glitter or something)

I think that's everything really!

For stuff I didnt cover, please check the "general living Vampirism" section of my Important posts as it may be there!

More posts like this possibly in the future!

☥

[aeon-borealis]

Dumb AleHeather Related Rambles

I play with the idea of "Dumbass is jealous of/has a goofy rivalry with their S/O's cat" for Serirei (Serizawa X Reigen), but I just can't do it with AleHeather. It'd be in-character for them. It'd be so petty and fall so perfectly in place with what kind of writing better Total Drama has. Hell, if I got to work on an older TD cast special, I'd sooo want to storyboard whatever Looney Tunes antics someone brewed up for Alejandro and Bruiser.

But I'm not strict canon compliant for AleHeather. I can, will, and have broken what's "in character" to get more sincere, fluffy moments than I'd get otherwise. That includes both Alejandro and Heather being cat persons. And Alejandro loves Bruiser as much as Heather does because that's wholesome as fuck to me.

I've also been sold on Alejandro and Heather both being HUGE fans of puppetry and that being the nerdy interest they both sync on. I want to do more research because if there's a scene with more of Alejandro's room, there's gonna be more than just the Jim Henson poster or references to The Muppets.

I vaguely remember establishing Alejandro as a Star Wars fan in a fan fic too. I'm not 100% sold on that one any more. It's more because I've never been that into it and I'd have trouble selling a character's enthusiasm on it.

I made some fanart with a hypothetical AleHeather fankid back in high school. She never had a concrete design or personality. The only given was that her name was Alejandra Heather Burromuerto.

By this point, I'm not keen on revising this character or doing anything further because it's important to me to have solid, meaningful childfree rep. I'm on the fence myself, but I feel like deliberately childfree characters with rich, interesting lives outside of kids is woefully under-explored in media at large. To me, its very believable that Alejandro and Heather could be childfree by choice as adults. I definitely want to write/draw content for late 20's-early 30's AleHeather. I don't have any solid ideas or directions other than that drabble I posted a couple months ago about depressed Alejandro.

Writing for them at that phase of life hits a bit too close to home. That's why it's so hard for me. By the reboot standards, they're the same age as me! It was one thing to write for them as a teenager. Hell, a few people told me my writing for Alejandro was spot-on ten years ago. By now, though, I don't want just the angst-fest and I don't have patience for the soap opera theatrics with no real payoff. I honestly want to flesh out and do more with them figuring out a healthy, meaningful dynamic. That's more of what I'm aiming for with my in-progress fan comic (once I actually get back to it. Going through some shit right now and its been hard to drum up motivation again).

[rodismancave]

A reminder to new folks because I feel I need to say this. It's a few specific rules and more of a 'this is how i roleplay' thing. It kinda got away from me fast but alas, I don't want to make anyone uncomfortable for any reason so I just said what I feel i need to say to make that happen.

My muse is mean. It's usually nothing personal but he is Mean if provoked. There is a line and it is Thin.

This extends to his friends, mostly as a show of ease around them and as jokes, its just how he is. a little jokey joke. he says things without thinking and sometimes that leads to misunderstanding or an otherwise "cruel" comment. He normally doesnt mean it like that (unless he does)

this account is like 80% crack. i am here to have fun and be silly. if you take me seriously and get offended by it then I'm sorry but frankly, I have stated this many, many times. I do roleplay serious stuff, I do focus on a little bit of storytelling every once in a while, but for the most part I am silly and quirky. My portrayal won't always be 100% ic, sometimes a little ooc is healthy, for the bit. I stay committed to the bit, always.

Of course. if he's mean to your muse and you don't like it then you can let me know and I'll tone it down. I'll never be an asshole to people I dont know are 100% down to it or who aren't familiar with how my muse acts. However, sometimes being mean is in character with my muse and theres no other way around it. But the more intense, "i want to cause psychic damage" convos I will always ask if its okay for my muse to go hard on yours.

Rodimus is aware of the multiverse. This does not mean he's aware of the history of each multiverse. He may be aware of them, briefly, but he is really not going to dwell on it much and if you expect him to know it he just. wont. He doesn't really care all that much. This is also to say that he may confuse your muse for someone in his crew because of looking alike, and will treat you as such unless proven otherwise.

There are no people who are "canon" to Rodimus' crew, not at the moment. The only ones who I can say with confidence who are in his crew are @weavingmemoir and @stealthfeline, who are also my muses. This is for practicality. If your muse is part of the Lost Light crew in general, though (brainstorm, whirl, megatron, etc) you can respond to my lost light posts as if you were a member of his crew, I dont really mind. Like I said: commitment to the bit, always. The bit is always funnier when more people join.

Don't pretend like your muse knows mine and vice versa without talking to me first. This is mostly about muses outside G1 and IDW, or even people in IDW that Rodimus never really met, as well as OCs. It isn't really towards muses who HAVE interacted with Rodimus at least a few times. It is Awkward having to figure that out, and I'm not particularly a fan of having to dig around for people's relationships to understand what's going on between your muse and mine.

I don't really care if your muse is banging another Rodimus, or anyone else from his crew. Like I genuinely do not care, and neither does he.

I'll always make adjustments if you ask me to. I'll create new verses to fit with your muse, but that requires communication first and foremost. This also goes for events, if you want in on an event just talk to me and we'll see about it together. My events are never 100% thought out because I like leaving space for other participants to have a say in what happens. I just think its fun, like a group project (but less stressful)

When interacting with me I ask to lay off on the quirky colors and varying different fonts in one single reply. I have a lot of difficulty reading things like that and it strains my vision and it gives me a headache. Just, always have the same font throughout, and if there are different fonts, please let them be at least readable. The standard tumblr fonts are fine, except 'lucille', and the small font tends to me specially frustrating sometimes.

This is a g1/idw based blog. I take stuff i like from g1 and stuff i like from idw and i slam it together until I have something I like. Rodimus does not like the prime title, he does not miss being a prime, and he absolutely does not appreciate being called one, unless its doing things for his ego or to make himself look greater than he is. He is an Ass.

[journeyintofiction]

hey can u do another shuri x reader where the reader has an ed and shuri doesn't notice it at first because of being in the lab so much but finally does when it gets really bad. its okay if you're not okay with writing about this topic I've just been struggling with mine rn.

TRIGGER WARNING: this fic will discuss an eating disorder, not in depth but still can be very hard to read, so if this is triggering please, please, please do not read! Your mental health comes first so feel free to pass on this one :) I am writing this purely from my own experiences and everyone's experience is different and valid. 

To the anon: I am so sorry you have been struggling recently :( just know that you, your thoughts, and your feelings are 100% valid!

Word count: 0.8k

Happy reading :)

It's been 13 days.

Shuri has been in the lab consistently for 19 hours a day for 13 days in a row. I know realistically this is her way of coping with grief and coming to terms with her brothers and mothers death. But I can’t help but feel forgotten and cast aside during her mourning period.

“Will you be joining us for breakfast Ms.Y/N?”

I turn to the door of my room and see Aneka and Ayo looking in my direction with curiosity and thinly veiled concern.

I shake my head and give them a brittle smile, “No not this morning, I went on a walk earlier and got some fruits afterward.”

They look at me for a second then nod and say, “As you wish.”

I knew they were concerned, to be honest, everyone was worried about me and it was obvious in the way they looked at me. I knew that I was restricting myself again even though I consciously knew I shouldn't. Shuri was a big help in getting me to recover from my eating disorder, she made sure I ate, got the right balance in food, and always fostered a positive environment around food. Since she was in the lab 24/7 now, I started to relapse and go back to my way of thinking. Between the stress of everything I just started to eat less and less partly because I didn’t think I deserved to eat without her.

I sigh and get up to tidy my room a bit before I decide to try and go to the lab, which she locked me out of earlier in the week. I think that's what triggered me into a downward spiral, the denial of my presence hurt deeply. It may not have been done with malice, but it was excruciatingly painful nonetheless. As I fold up some clothes I look at myself in the mirror and I’m genuinely taken aback by the person staring back at me. I didn’t realize that not eating consistently and in good quantities would take effect so fast but it was scary. My face looked thinner, I looked paler than usual, and I had dark circles under my eyes that seemed pronounced.

I move from the mirror on the verge of tears because I can’t stand to see myself so I quickly finish tidying up and move to the door and open it. I see two Doras stationed outside my door who look at me with concern and I just muster up my best smile and say hello before moving down the hallway.

I reach the lab doors and attempt to open them to no avail and with a huff, I call out, “Griot?”

“Yes Ms.Y/N?”

“Can you tell Shuri I would like to see her as it is urgent?”

I wait expecting a reply from Griot, but to my surprise, Shuri herself opens the doors to the lab. She waves me in and I take a moment to examine her, she looks sad and tired but otherwise healthy. When I get into her area of the lab and sit down she turns to fully look at me and she frowns deeply. I see Okoye and Nakia are one room over and the only thing separating us is the soundproof glass. They smile and nod to me before turning their backs to give us privacy, at least the glass was soundproof so they wouldn’t hear the extent of our conversation.

I look back at Shuri and she looks upset but before I can speak she says, “Have I done this to you?”

I take note of the pained expression she wears and the sadness in her voice as if it physically pains her to see my slowly relapsing. I bite my lip and say, “I’m not going to lie, you are partly the reason but the majority of the fault lies with me.”

She looks pained and just nods then asks, “do you…eat enough?”

I know this is her way of asking if I eat three times a day and snack in between while also trying to not trigger me. I decide to be honest and shake my head and hear her sharply inhale before gently taking my hands in hers.

She pulls me into a hug, “I’m sorry my love.”

I shake my head, “Don’t be sorry, you were grieving and you still are.”

She stops me and looks dumbfounded for a moment, “That doesn’t mean I have an excuse to stop caring for those I love.”

I just nod, “Please, just don’t shut me out of the beautiful head of your Shuri.”

She takes a deep breath and looks into my eyes, “ We will get better together, right?”

I smile and nod, “Yes, together.”

A/N: Hello wonderful people! If you made it to the end, thank you as I know this is an exceptionally heavy topic to discuss and write about. Again this was written from my own personal experience and I wasn’t super explicit because I don’t want to trigger anyone! As always my requests are open :) 

[tumblingxelian]

Hey, have you seen the recent post from STRQYR about the closest to Yang's deflect with humor we've seen is Summer? (Ozpin keeping secrets) Initial post is focused on how that behavior isn't inherited from Tai.

But the whole pointing out that Yang picked up a kinda major coping mechanism brings two things into a bit more focus.

Yang's laughter reaction to Taiyang's lost some brain cells with that arm was always dubious with Oobleck and Port telling the obvious that wasn't a normal for Remnant joke (and only relaxed when Yang laughed) But the fact it's a deflection mechanism as Ren pointed out (and it was always noted that laughing/smiling when ever super uncomfortable is a thing people do to not have big fights) and that Summer did so as well ... Did Tai never notice with either?

Tai seeing so much of Raven in Yang when the show started telling us that she was aping Summer back with Gold in the first Season. We admittedly haven't ever seen a happy healthy Raven.

But Tai in that scene was never a particularly accurate informant of information. Raven after all left the team but it survived until Summer never came back home.

I have not as far as I know STRQYR blocked me at some point which is admittedly odd as I don't recall interacting with them in aaaages outside of reblogging their art but maybe I said something annoying in a note or they just disliked my stuff and decided I wasn't on their enrichment team. As a result though I don't really see their stuff much.

As a result of this I cannot find the post or otherwise access it via searching and so its hard to comment on directly. The idea she got it from Summer is interesting, though I am surprised by the claim if only cos of how little we've seen of her.

1: I agree with you specifically tat Yang's laughter always felt super weird in that scene and that in one way or another the writers agree. Given Oobleck dropping the mug, Oobleck & Port only calming down when Yang laughed it off & them being the one's to actually give her serviceable advice rather than insults or demanding expectations in place of help.

As it is I doubt Tai noticed given his method of coping is to just ignore stuff or ash out when reminded of it and cos he projects Raven onto Yang so hard he might as well be a movie projector.

2: This too, the music, what we do see of Summer, Yang's actual reference point for motherhood and even elements of her body language like the shoulder check are all 100% Summer. Plus while we didn't see a strictly happy Raven we did get a playfully snarky one for a few moments and she has a bit of a different vibe to Yang, at least compared to Summer I feel.

[mountain-lion-gremlin]

i'm just wondering how real p-shifting is. i really want to be able to do it, but i don't know if it's something that's real, feasible and worth my time working towards, or if it's not.

i guess something that would help is some sort of proof that it's been done before. if it genuinely has, i absolutely want to get going on my own journey.

and i'm not saying it's impossible, but i just want to learn how possible it is and if current methods lead to genuine results. thanks!

OH OKAY, let me help you a bit fellow anon.

Honestly im not sure how exactly to affirm if it's real or not. I've had evidence such as growing fur strands, half shifting in my sleep, and even learning recently that when I was very little I had p-shifted before. That's just me, I've been a shifter for a long time and eventually came to this through WAY TOO MUCH exploring and asking myself hard questions.

Usually though, the best thing I can tell any curious individual is to just... go through the very first step of being a shifter. Its incredibly helpful, and will answer the majority of present questions at the beginning stage. If you want more details on this I will gladly do a follow-up, but currently I still have to collect and get my facts straight about this first step. More developed guides (such as phenexus weyr and even blaze's guide to shifting) will be much more helpful then what i have to say. Perhaps I'll have a guide to give one day too after all of this 💀

I can tell you though to just go for it. Not start p-shifting i mean, you wont be able to do so for a long time if you eventually figure out you are a p-shifter. Its better to know by exploring instead of just never trying because you are afraid of it not being real.

P-shifting is only a tiny part of being a shifter (as I've said over and over again lol) but similar to theirans our identities live on within us our whole lives. It's just keeping a healthy balance of understanding where you are at and that, usually, you might not be a p-shifter at all and that's OKAY.

Sorry I like talking. Perhaps that could help you a bit if you decide to begin your journey.

REGARDLESS.

i would honestly also love good evidence (images, videos, etc.) of p-shifting actually happening because of the methods that exist. (Disclaimer methods aren't "rituals" that are 100% guaranteed to give you results, they are only building blocks to help you develop your own style when you decide to voluntarily shift)

Ive had to realize that 1.) There is a whole community around it, from all walks of life and information, which gathered to give us the information we have today because they all experienced similar things too. 2.) time and time again there have been stories, from history all the way to now, where people have shifted into creatures and animals constantly. 3.) In truth you find your own evidence eventually, within yourself weirdly enough.

I can't speak for everyone (hell naw) but for me I eventually came to a point where i no longer needed to see from others that p-shifting was real, I knew it was real through my own evidence and experiences. Shifting involves a lot about connecting the dots tbh, sometimes it can take a hot minute to make the right dots connect.

If there is physical evidence out there, nowadays it's so incredibly targeted and never given a chance to believe. Like, honestly, tech is so good nowadays there is no way actual physical evidence could exist within the community anymore.

What im basically trying to say is that although physical evidence can help, at the end of the day you have to find it within yourself to see as true. Nobody can really convince you to believe otherwise 🤷

Thank you for sending the anon, and if you read this and want any more help or expansion on anything, please let me know and I'll be happy to expand. I'll probably stick around for a little longer to answer anything else anyone may want to ask.

[mbti-notes]

Anon wrote: Hi! INFJ. Thanks for this very useful blog. I wanted to ask, as I am considering to what extent I will make sacrifices to attempt to go into academia - what was your personal reasoning about an academic career?

I could be misremembering but I believe in saw in your prior posts that you studied at the graduate level in philosophy or psychology, and then held roles in education and finance.

On one hand, I love the freedom academics seemingly have to keep learning and work on projects with no obvious near term financial payoff. On the other hand, the faculty workload and financial opportunity cost (depending on the field) seem high, and I value a healthy lifestyle above everything else. And it's obviously very hard to get an academic job.

I have reasonably well-developed industry plan, but I may eventually hit a wall with my learning in industry. I'm curious to hear your thoughts on the academic lifestyle and alternative ways to still pursue lifelong learning, which you clearly have done.

----------------------

You said you value healthy lifestyle above all else, so use that as your guide. But then you talk about other things you also value. In real life, with its practical limitations, you can't value everything equally. You have to make trade-offs, otherwise, you'll get stuck in indecision or bite off more than you can chew.

Experiences of working in academia vary widely based on factors such as: field of study, faculty support, school expectations, and personal factors. Some fields of study are much more competitive than others, which might demand more sacrifice from you. Being part of a faculty means dealing with office politics, so faculty leadership makes a big difference for handling difficult environments. Some schools are certainly better than others, which can determine what constraints are put upon you.

What about personal factors? Are you an overthinker? If so, it might mean you doubt your capacity for handling adversity. Are you an overplanner? If so, does it mean you have a general mistrust in the world? Are you the kind of person who can only ever see one path ahead? If so, it might indicate lack of adaptability. Every job has its downsides to deal with. Life is going to keep throwing challenges at you. If you spend your life always trying to get ahead of every single negative possibility you can imagine, you'll live a very harried life.

Why not simply trust the process, enjoy the journey, and be open to changing course as needed? That's how I roll. My feelings guide me through life and I trust them 100%. If I don't feel like something's for me, then it's not for me and I'm not going to do it. I've never been married to any job or any career path. It's not my priority. You ask me for my "reasoning" but I have nothing to offer you except the feelings that guide my preferences.

If you don't trust your feelings, then I'm not the right person to ask. Perhaps the people you should ask are the ones already working the jobs you are considering. For instance, talk to all of your professors, especially the ones who have worked in more than one institution. Ask them about the pros and cons and work-life balance, etc.

[purlturtle]

In case you were wondering if you're imagining things:

No, I don't think you do. Or if you are, I am too.

I think the population of (at the very least) the United States, and with them many of those countries that are culturally linked (for example because they watch a lot of US media), are being lied to, gaslighted, and traumatized, both intentionally and un- (or semi-) intentionally.

I think there is a concerted effort of conservative, ultra-conservative, evangelical, etc., forces to gain power at any cost. Those efforts go into politics, but also finance, education, media (both news and entertainment), judges/courts, medical institutions and so on. Everywhere that institutional power lies, basically.

(i don't wanna leave out other power hungry individuals and groups from, for example, ultra-capitalist and other areas, but i do think the main thrust comes from the unholy mix of right/conservative/evangelical quagmires.)

It's not just that their efforts lead to grotesque and evil laws and court decisions. It's also that they undermine worker protection, social safety measures, safety regulations for work, food, health, etc etc. It leads to a news cycle that is so toxic, skewed, and fear-mongering that it can't rightly be called "news" anymore. (Social media plays a part here too, firing up the "fastest wins, don't care if it's 100% factually true and reliably sources" carousel to dizzying speeds.)

All of this creates a climate of fear. People fear for their jobs, health, livelihood, actual lives, where the next meal will come from, whether their living situation is stable for the foreseeable future, etc. etc.

This fear directly leads to a loss of empathy (it's hard to feel for someone else when you're worried that you'll lose your job and your apartment if you miss your next shift.) and to physiological and psychological stress that, by its sheer duration and scope, is one of the definitions of trauma - even in otherwise completely healthy (including mental health) people.

This attack is widespread, concerted and relentless, and that is bad enough by itself. But if you're like me, the worst aspect of it is:

There are people out there who honestly think this is the correct, good, right way to behave.

Be that because they're openly and unashamedly power hungry, or because they're evangelical Christians who think this is the path to heaven, there are people, in actual positions of power, who see all of the above as the way to go.

It boggles my mind, and it's been the single most disturbing thing for me to see and watch and accept.

I'm not here to speak to what can be done.

I'm here to say, i see you, fellow person who is equally appalled at this. Yes, this is happening, yes, this is traumatizing, and yes, you might be traumatized by it as well, even if your life situation is relatively stable and/or not directly impacted by all this shit.

And that means that giving others grace and understanding for reactions caused by all that relentless trauma is important - but it also means giving yourself time and space (and understanding and grace) to process this as well. Because you, too, are part of this traumatized society. And if you're a highly empathetic and/or compassionate person, like me, this will burn you out if you don't take preventative measures. Take care not to pile onto others' trauma - but take even more care not to compound your own. Feed your soul with good things, and don't be ashamed of that "when so many others are suffering" - adding your own suffering will not help those others one bit. On the contrary, you'll be able to help them better if you're calm, have slept enough, have nourished your body and soul with good things, and help only to the degree that is sustainable for you. Not "doable", but sustainable. This is a marathon not a sprint.

This is a concerted, deliberate attack on solidarity and union of the people against the 1%, the "ruling elites", whatever you want to call them. This is a concerted, deliberate attack on our collective, society-wide ability to be empathetic, compassionate, helpful and united with others against a common foe. "You are amongst the walking wounded" has never been so true, and so important to keep in mind: fight against those who wound, not those who are wounded.

[ty-bayonet-betteridge]

okay as a vegan who tries to be openminded let me take these one at a time

honey: OP you're 100% correct about the destructive impact of the agave industry. i have no intention of supporting that shitshow. youre also right about the honey industry not being cruel if good beekeepers are in charge (sidenote: honeybee/beekeeper partnerships are so cute!!! did you know that bees kept in good conditions will start to set aside a specific part of the hive to deposit honey where bees never go otherwise so that beekeepers can retrieve it with minimal disturbance??? they have a lil dropoff site it's so cute!!!) the problem is i don't trust major honey producers to be good beekeepers. i could buy from locally-kept honey farms that i was able to visit and verify the good conditions of, but as alyana pointed out the European honeybee is an invasive species in North America and does deep damage to the ecosystem as it edges out local pollinators. so until i can move to a place where the European honeybee is native, I've stopped eating honey or its alternatives. it's a flavor i miss but not one worth the ecological damage it causes.

wool: IT IS CORRECT that the modern domestic sheep grows an excess coat and if not regularly shorn will suffer symptoms of heat stroke and dehydration leading to death. HOWEVER most wool used for textiles comes from factory farms which are also unspeakably cruel to the sheep in their care. i simply can't support wool that i have not seen with my own eyes is sourced in a way that loves and respects the sheep involved, which means i can't buy wool fabrics from any large or even medium-scale distributor. if i knew a local shepherd and saw how they kept their flock, i would be happy to buy from them, but that's not feasible for me since i do not live in an area that's big for livestock agriculture. so i buy cotton fabrics. i know they're also destructive to the environment with current farming techniques, but i decided they're the least impactful of the options since factory-farmed wool is both cruel and destructive, whereas synthetic fabrics are both destructive AND fast fashion bullshit I'll need to replace in eight months.

eggs: almost entirely with you on this one!!! only thing I'll add is that modern domestic fowl have been bred to lay eggs at an unhealthy rate, which can lead some of them to have vitamin and mineral deficiencies (especially of calcium.) it's nothing that proper attentive care can't resolve but make sure whoever is providing you with eggs is giving their birds a nice well-rounded diet and that the birds seem healthy and in good spirits.

tl;dr I'm not against animal agriculture when it views the animals in question as equal partners and is respectful of the environment. unfortunately, it's so difficult to find animal agriculture that fulfills both those criteria. it's hard (dare i say impossible) to live without harming parts of the world around me, especially under capitalism, but i find that veganism is frequently the less impactful option. i also recognize that veganism does not exempt me from needing to be aware of the effect my consumption has on the world, and try to stay away from any consumption that is deeply, actively harmful.

Vegans of tumblr, listen up. Harvesting agave in the quantities required so you dont have to eat honey is killing mexican long-nosed bats. They feed off the nectar and pollinate the plants. They need the agave. You want to help the environment? Go back to honey. Your liver and thyroid will thank you, as well. Agave is 90% fructose, which can cause a host of issues. Bye.

[system-of-a-feather]

Also also x2

The Riku and XIV brain do chronically - both as a fused whole and as individual parts - have a "this is a negative emotion and its getting in the way of my ability to have an optimistic and healthy vision on how to make it better" and "this is a pathetic emotion and its useless when I can just find the piece of shit - living or not - that caused us to be in this situation and destroy it" relationship that synergizes both extremely well or really poorly depending on how its moderated

The Riku part of the brain doesn't really process negative emotions and rejects them in favor of "practical and productive solutions that is good for the whole" and the ability to "bring a sense of hope and optimism for the future so that we can endure an otherwise shitty present"

The XIV part of the brain doesn't feel vulnerable emotions and / or pain and doesn't ever really take an L ever. If there is an L to be taken, its not a matter of him having "lost" but rather the battle isn't over and for him the battle isn't over until he's "won" and thus, "XIV never looses" because he just doesn't accept it as over until he feels hes on top. So any time theres a vulnerable emotion, its actually the fact that there is something making us feel vulnerable and weak thats causing it and thats an offense and target to take down so that we can go back to living our lives

Both parts end up creating a MEAN and really powerful unstoppable train that honestly can really carve through any shitty situation and so a lot of the time I - as a fused whole - when I feel stuck or lost, really want to bank into that synergy of those two that lets basically any sense of uncertainty or vulnerability get washed away cause like... its honestly REALLY works and hasn't really failed us ever. It got us where we are in our healing

The thing is, vulnerability is a valuable emotion and feeling to learn to deal with and the synergy makes it very hard to ever have time, space, and the mental and emotional presence to actually process or experience vulnerability. And without properly experiencing and processing vulnerability, its very had to obtain the full breath of joy that comes from relationships and life in general.

And the truth of the matter is, we already have the sheer focus, vision, optimism, action, and aggression / dedication to overcome our obstacles that both an independently functioning Riku and XIV would bring to the table and we've already used it to make sure that our life moving forward will not be stuck like this. The only thing that would come from doing that (reinstalling the full dissociative-duo to full capacity only possible with dissociative barriers) would be emotional unawareness to the vulnerable feelings that we are having and honestly... that's not healthy with our current recovery goals and where we want to go with our healing and relationship with ourselves / others.

A thing I think about our system is that we don't feel vulnerable ever because we have one another to take care of eachother always, and thats great and awesome and important. But I think lately, I think we are good on our self confidence and sense of self agency and faith and belief in ourselves. I think what we really need to create opportunities to improve is our trust in others, ability to take help from others, and the ability to feel vulnerable even when we know we can do it.

And we honestly can't really practice any of those three when we are having our social and internal support needs met by 100% internal interactions that are only equally fulfilling because of dissociative barriers.

It's not to say that its bad or anything to be reliant on your parts. It's great honestly. It's just I think at the moment we are past that point in our healing journey where its providing as much benefit and rewards as it is getting in the way of growth. And I think thats why - for the past few months - we've been actually just a fused whole for the most part (albeit, at any point anyone could really talk to one part in specific and our fiance does it regularly when a topic is specifically best talked to a specific part). It's currently what we need in our healing and so we rock it like that

Man am I incredibly depressed I think. At least in the spectrum of which our brain is capable of experiencing and doing depression. I think its a lot of build up from how hard the past year or so has been now that my fiance is getting back on his feet but... its a lot and I'm feeling like shit

Actively kinda thinking of seeing if I can just build up an actual dissociative barrier and bring back proper dissociative barriers between the Riku and XIV brains so their extremes can "solve it" but Im pretty sure thats more so me trying to brute force and "solve" an issue that just needs time and processing

[stephanielynn117]

NEDA Week is Coming Up and Already I've Had At Least One Convo That Resembles This

Me: I survived an eating disorder and I'm only saying that so you know that I'm not trying to speak for people with eating disorders without any knowledge on the topic because that is dehumanizing and super condescending.

Person: You say "survived" like you actually did something. You don't hate yourself 100% of the time so you must be snobby.

Me: I'm just mimicking others because I hear the word "survived" a lot. The word means nothing like that to me. In fact, I don't even really like a lot of survivor culture that blames eating disorders exclusively on the media/body image and ignores trauma as a cause.

Person: *overdramatically sighs.*

Me: Wait...are you testing me? Then I should probably indicate that I know that eating disorders manifest from other problems and that people can recover from the disorders but not necessarily the problems/mentalities that fuel them. Thought I mentioned it. Is that the answer you wanted? I'm genuinely confused....

Person: Still, you must think you're some kind of an expert. Because contrary to what you believe, being a stakeholder does not in anyway mean you know anything and first-hand experience is also totally meaningless. Which I will say despite only having that type of experience and still thinking I'm an expert.

Me: I mean I disagree that stakeholders don't know anything but if you're looking for more.....I still wouldn't go as far as to call myself an expert, but I have a degree in psychology from a top psych school, I wrote a thesis, I founded a club about mental illness in cooperation with an organization that has state, local, and national chapters, I give lectures about this formally, speak with senators, and I regularly work around the concept of eating disorders and a variety of people who have them.

Person: *Gives blank stare*

Me: Look.......While I know it does not mean I know everything because there are a variety of experiences out there that aren't mine, I assumed that counted for something. Is that what you were looking for? Again, genuinely confused....

Person: God, you're so pretentious.

Me: But.....

Person: You stated your qualifications as a fact in order to jump through my hoops and not a way to brag, but that still makes you pretentious.

Me: When did I...

Person: Pretentious.

[theglitchywriterboi]

Some of y'all are so fukcing disgusting omg.

FOR THE LOVE OF GOD, REAL PEOPLE CAN'T "QUEERBAIT" !!!!

Like this is so depressing, I feel so sorry that people practically forced him to come out because MAYBE he MIGHT'VE been straight ??? The fuck is wrong w/ some of y'all ???? [I'm pretty sure he also I.D.ed as unlabeled at some point, but even if he didn't, this is still disgusting]

Someone's sexuality or gender identity IS NONE OF YOUR FUCKING BUSINESS & the fact some of y'all feel entitled to that information is terrible. I've seen so many people say [both regarding Kit & other unlabeled celebs] "If you're unlabeled but date the opposite gender, you're just straight trying to get queer points" & shit like that. AND NO !!! IF THEYRE UNLABELED THAT MEANS THEY DON'T USE A LABEL !!! People shouldn't have to tell you "I'm unlabeled, & to me that means I like guys & girls & other genders, idrc !! But I just don't resonate w/ bisexual or pansexual, or any other label at the moment" because YOU feel entitled to their identity. Maybe they're unlabeled because they simply don't like other labels. Maybe they're unlabeled BECAUSE THEY'RE STILL FIGURING THEMSELVES OUT !!! Maybe they know a label they like, but they don't wanna tell hundreds->millions of strangers ???

"Bu-bu- but what if a stinky cishet is playing a queer character I like/making songs about liking the same gender or questioning your gender 😨😨" WHO FUCKING CARES ?? Just hope that 1: they aren't a bigot & 2: The creator sought out queer people to play queer roles & if they didn't, sure that sucks, but it's never that deep.

I personally would rather the most cishet person ever play a queer character than to forcibly out ANYONE, let alone someone who's not even twenty yet.

Log off & go outside. Needing to know a strangers identity & harrassing them isn't normal or healthy.

ALSO

Stop making jokes about someone else's identity ???? "Well they haven't said they're queer [& maybe even said they're cishet] so they shouldn't care, in fact - if they do, they're bigoted !!" [Real take I've seen] W H A T ?? For one, cishet people are ALLOWED to feel uncomfortable w/ strangers jokingly calling them slurs, saying how gay they are, making jokes about their mannerisms, etc ??? Like y'all are just rebranding homophobia & transphobia. "But I'M gay/bi/trans/a lesbian" that's crazy, you can still spread bigotry while being in that group. Which is what you're doing. But also, THEY MIGHT BE IN THE CLOSET !!! I'm not saying "Everyone is queer, even if they've said otherwise" cause no, but a lot of queer people [including queer celebs] have said "Oh I'm cis/straight" before either later realize "Oh shit, I'm not !!!" Or before feeling comfortable w/ coming out.

"Oh well I wouldn't make those jokes if I KNEW they were queer" THAT DOESN'T HELP YOUR CASE YOU WEIRDO, ITS NOT OKAY PERIOD & SAYING YOU'LL STOP MAKING DEROGATORY JOKES ABOUT THEM ONLY IF THEY PUBLICLY SAY THEY'RE QUEER IS A TERRIBLE STANCE & NOT OKAY !!

They're strangers, not your mutual who thinks those jokes are funny. You're just harassing a stranger & brushing it off because you think just because you're queer you have the right to behave this way when you don't. Grow up. You're not doing any woke LGBTQ+ progressive win, you're just making life harder for other queer people.

Real people can't queerbait & trying to say they can HURTS people

Idc if someone who insists they're 100% cishet constantly plays roles where they're kissing the same gender or makes music videos where they're kissing the same gender. They're not queerbaiting cause real humans can't queerbait.

Sorry if this makes no sense, I'm sick & also really mad at this so it's hard to articulate everything well-

[an-aussie-button-masher]

The Real Heroes - Five Gaming Sidekicks that Carried the Protagonist

   From combat and platforming to sneaking and puzzles, the hero in any video game can do it all - most of it, anyway. When the game is over and the protagonist is getting all the praise and glory, it’s easy to forget that they often had help. It’s rare that the main character can accomplish every single task in the game all by themselves, which results in the thankless job of the sidekick. They’re usually non-playable, rarely acknowledged, and almost always completely necessary for game progression. They’re not just there to help in combat; the player literally cannot complete the game without their aid. The companion’s help is indispensable in almost every game they’re in - activating mechanics, discovering hidden items, or simply acting like walking keys for otherwise-insurmountable obstacles. After all their hard work, it’s time to shine a spotlight on some of the best companions in gaming - give them a hand!

Sparx the Dragonfly (Spyro the Dragon, 1998)    He might not have the star power of Clank or Daxter, but Spyro’s tiny dragonfly friend Sparx is one of the most important characters in the Spyro the Dragon saga. This diminutive little bug actually serves as Spyro’s health bar, changing colours each time Spyro is hit until he vanishes after the third strike - implying that Sparx is constantly taking all the hits meant for Spyro! Once Sparx is out for the count, Spyro will go down in a single hit, so you’d better keep that dragonfly healthy. Sparx’s other main ability is automatically collecting any nearby gems for Spyro, allowing the player to keep their momentum through each level without needing to carefully tip-toe around and manually grab each individual gem. Additionally, Sparx can point the player in the direction of any missing gems in the level, an invaluable mechanic in a game where gems can be easily missed in tall grass or around corners. On top of all that, Sparx also happens to be generally adorable with his little buzzing and zapping sounds, and his idle animations where he’ll even fly right up to the camera and wave at the player. Without Sparx, trying to 100% any Spyro game would be insanely difficult and tedious - it’s no wonder Sparx is Spyro’s best friend. He may as well be the player’s best friend too!

Trico (The Last Guardian, 2016)    Escort missions: usually the bane of anyone playing them. The NPC you’re charged with protecting is often painfully slow, and seems to have a deathwish considering how often they end up walking into enemies for you to jump to their rescue. Thus, an entire game that is effectively one long escort mission sounds like hell, right? Not when the character you’re leading is a gigantic apex predator about fifty times your size. For most of The Last Guardian, your massive feathered friend Trico tends to be the one protecting the player, rather than the other way around. Trico is the only thing standing between the defenceless player and the armoured sentries trying to capture them, and climbing up onto its back is the only way you can clear pretty much any area in the game as Trico leaps from platform to platform across the giant ruins the two of you find yourselves in. Besides being plain badass, Trico is also the most realistic and impressive example of animalistic AI I’ve ever seen in a game. Trico really feels like an actual creature - it gets easily distracted by food and will paw at any treats out of its reach, it will splash around in water for fun, and it is very careful not to accidentally step on the player if they happen to be hanging around its giant feet. The bond that the young boy you play as forms with Trico throughout the game feels just as real as the bond the player will form with it, and soon you’ll be treating the huge beast as though it were your own pet. An adorable, unstoppably powerful pet.

Six (Little Nightmares 2, 2021)    After spending the first game in the playable spotlight, Six takes a step back into a supporting role in the prequel game Little Nightmares 2 with some of the most impressive AI I’ve ever seen. Hand-in-hand with Mono, the player character, Six quickly proves to be the most helpful companion you could ask for in the warped and dreary Pale City. She helps out throughout the game completely unprompted, grabbing items and keys for two-person puzzles and running ahead to demonstrate how to clear certain platforming segments. Six even treats stealth sections as though she were a real player, ducking and dashing about when it’s clear, unlike certain other game companions that just blindly barge through like there’s nothing to fear. Other moments in the game add to the lifelike feel of Six, reminding you that she’s just a little girl under that hood; she’ll grab random toys just for fun, amuse herself in empty playgrounds if the player hangs around long enough, warm her hands on fires, and so on. Of course, Six isn’t exactly what you’d call an “innocent child” - that fire she warms herself on? It’s the burning corpse of a monster you trap in an incinerator. She’ll snap fingers off the sentient hand enemies for fun, ambush and rip apart enemies that are set up to be avoided, and generally remind players that she was a bit of a psychotic little monster in the first Little Nightmares. Players of that game will know to be wary of Six - after all, Six doesn’t play second fiddle for long, and the second game’s lead character Mono is nowhere to be seen…

B12 (Stray, 2022)    Have you ever wondered what your cat could be capable of if it could just talk? As it turns out, the answer is “save a whole city of robots”, all thanks to a tiny little translator drone. In Stray, the playable cat wouldn’t be able to do much of anything if it hadn’t encountered B12, a small flying drone that acts as a translator and item-grabber for the heroic feline. B12 has completely lost all their memories after being stuck as an AI in a massive software system for millennia, and it’s due to the actions of a small ordinary cat - that is, stepping all over a random keyboard and batting various objects off shelves - that B12 begins to accompany it and help the cat escape. B12 offers most, if not all, of the game’s overall lore and backstory to the player, hidden in various “memories” that the cat can discover around the underground city to help restore B12’s mind. In return for this, B12 helps the cat (and the player) by collecting useful items, hacking certain electronics, talking to the resident robots and guiding you ever higher towards the city’s upper levels. As such, despite being the cat’s “sidekick” for the duration of the game, B12 is technically the one doing all the heavy lifting - the cat is effectively B12’s ride. As more and more of B12’s past and the larger plot surrounding the game’s setting is revealed, the more engaging and intriguing the game becomes beyond the general “play as a cat” gimmick. If not for this glitchy little bot, Stray would be over within minutes, and we’d be missing out on a massive, fascinating world to explore from the eyes of its tiny tabby hero. 

Smallfry (Splatoon 3, 2022)    While plenty of other video game companions are helpful in their own right, it’s not often that you get to weaponize your little buddy. In Splatoon 3, the story campaign features a tiny, friendly Smallfry salmonid accompanying the player like a pet, acting like a throwable bomb in some levels to distract enemies, activate platforms, and even stun otherwise-invincible foes. Certain levels will also strip the player of all their gear save for Smallfry, meaning you’ll have to rely on his help to reach the goal. Outside of the main story levels, Smallfry’s job is clearing out all of the deadly “Fuzzy Ooze” covering most of the overworld and blocking your progress. Touching the Fuzzy Ooze even slightly will instantly kill the player, spitting out a hairy corpse, but not Smallfry - he just gobbles it all up, eating a path from level to level. Besides his amazing appetite, Smallfry will also sniff out hidden collectables in the overworld all on his own, hopping out of your backpack and scurrying madly to the invisible treasure. When it comes to the grand finale of the campaign and it’s just you and Smallfry against the final boss, Smallfry really proves his worth - from eating the Fuzzy Ooze protecting the boss, to powering up at the last stretch to really even the odds as Hugefry. It’s truly a sight to behold. Finally, as per the norm in Splatoon, Smallfry is just plain adorable. Just look at those derpy little bug eyes! 

   There’s all too many of these unsung supportive heroes out there, so if there’s any other sidekicks that deserve the spotlight, feel free to let me know! Reblogs and likes are appreciated, and thanks for reading!

[anthropologist-on-the-loose]

Mild objections and some clarifying points

Hi Em. Long time follower, first time caller here. Its okay if you don’t want to post this, but I just wanted to clarify some thoughts I had about the most recent post about doctors and the medical system (in the U.S., I assume) from the view point of a doctor (if you were interested). If not, feel free to scrap this. I am sorry it got so long.

1. Doctors should be put through an extremely extensive relicensing process every 10 years

Agreed. That was the board exams are for. I am not certain why doctors without board certification are allowed to practice at all to be honest, but it is easy enough to find out if your doctor has re-upped their credentials or not. We usually have additional initials after the MD which stand for “Fellow of your-specialty-here.” If not, there are plenty of ways to check online. Certificationmatters.org is a decent starting point.

In addition to recertification board exams, most healthcare employers in the U.S. require us to have a certain number of CME (continued medical education) credits that are obtained through conferences and other educational events/activities meant to keep us up to date. If you don’t have these, you likely won’t be hired. I think the only people who get away without these might be some doctors doing solo private practices. At the very least, if you work for a hospital, hospital affiliated practice, or university, there is no way to get hired unless you do a certain amount each year.

2. Doctors should have their knowledge scrutinized against current medical research…

Agreed. To the maximum extent possible, we doctors should be practicing evidence based medicine. It drives me nuts when some of my older colleagues just say, “I don’t believe in X.” That shouldn’t be a thing. It’s like thinking the sun will go away just because you decide it doesn’t exist.

3. …and be de-barred at even the tiniest discrepancy

This wouldn’t really be possible, not really. Medicine has come a long way, even in the last 50 years, but we still don’t have all the answers. As much as medicine is touted as a science, the reality is much more wishy washy. The truth of the matter is that we don’t 100% understand how the body, mind, or disease works. Hell, we still don’t even know how some of the most commonly used medications work (example: Tylenol). Some things we understand better than others. Some we don’t understand at all and are still basically guessing. One of the most poignant pieces of advice one of my mentors gave me in medical school is a reminder that about half of what I know about medicine now will be proven as fallacy in 10 years.

So yes, I would love to stick and practice only what has been studied and proven. But the reality is there is so much that has not been studies and human bodies are so diverse, I am often flung into managing people and conditions for where there is no evidence based treatment or testing or algorithm for me to fall back on. I don’t get the option of cherry picking my patients and I don’t want that option. If someone is hurting and coming to me for help, I am going to dang well try to help them, to whatever ability I can.

To that point, when a patient comes to see me, sometime all I have is a really good hypothesis. Most of the time, it is a pretty good hypothesis based on my own exam and the patient’s description of what they have noticed, but it is still a guess and I could still be wrong. It is incredibly hard to prove or disprove a diagnosis definitively. Frankly, a lot of the things required to “definitively prove” a diagnosis are painful and invasive, if they exist at all, and are unlikely to change management (treatments overlap). Why put my otherwise healthy 30 year old patient through a colonoscopy and risk an intestinal puncture (which is a horrifying and incredibly deadly) to prove that their constipation isn’t a result of cancer in the absence of any other symptoms indicating cancer (weight loss, blood in the stool, fever, chills, etc.)? Decisions regarding treatment or testing outside the scope of what has been studied is a combination of medical gestalt (which takes years to develop, hence why we are one of the few professions left with an apprenticeship system) and weighing benefits versus risks.

When I don’t know the straight answer, I am upfront about this with my patients. I explain what I think it is and what I think we should do, but I am also clear that there is not straight right or wrong option. I often leave it up to the patient to make the final decision. I hate how some doctors make patient’s feel cornered like they don’t have a choice or option. It is one of the chief reasons I myself hate being a patient. Medical schools are trying to push away some of that paternalistic training, but it is still a work in progress.

4. Too many people are told their problems are nothing and come back in a year or more

Agreed, this is a problem. The medical system in the U.S. is not set up to facilitate appropriate follow up correctly. It can take my patient months to get an appointment with me and it frustrates me so much, because a lot of these things need to be followed up sooner. I would not want that 30 year old patient from my earlier example to follow up in a year, because if after a month of treatment, their constipation hasn’t gone away that necessitates further evaluation. But visits are stupidly expensive even with insurance and there are so many patients that finding a slot is a nightmare. As of now, I am booked out for 3 months. The dermatologists in my city are booked out for 8 months. The gastroenterologists (the ones who do colonoscopies such as for my poor constipated patient) are booked out until mid 2023.

I would love it if I had the ability to call everyone of my patients back after an appointment to follow up but there is no time. I work close to 70-80 hours a week between seeing patients, paperwork, and answering virtual patient messages. If I go home and do more patient work, I will crumble. I would burn out and be utterly useless to anyone in that state. I need to sleep and eat and play and be well if I am to take care of anyone. Nurses and auxiliary providers help with some of this burden, but frankly there just isn’t enough of us to go around.

5. Doctors are just like “lol everyone makes mistakes”

No. Just no. I don’t like using absolutes, but I have never met a physician who was blasé about a patient dying, regardless of how they may appeared to the patient family. I remember the name of every patient who has died in my hands. I remember the look on their family’s faces when I had to tell them their loved one passed or is going to pass. I have grieved for every single one and pored over the events that led to it over and over in my mind. Even when no mistakes were made, sometimes patients still die and I have never walked away from that unaffected. 

That said, I can’t always show or process that in front of a patient or their family. I don’t get the luxury of asking for time off. I still have to turn around and take care of the other patients under my care. Sometimes that means in the moment, I have to lock down my emotions and reactions and act as it if didn’t bother me until later. It’s not a great thing to do and likely actively damaging to the psyche, but I am not given any other choices - we are almost always short staffed and asking for time off to grieve isn’t usually an option (other than a nominal one). Most hospitals have gotten better about doing debriefings and root cause analysis after a catastrophic event, but they are still business and a lot of this is oriented towards legal liability things.

6. Quite frankly, the problem is bad doctors. A person can have all the right information and fill out a test perfectly but that doesn’t mean shit if they aren’t willing to apply that information in practice.

Preach, sibling of unknown gender. Fun fact: A patient recently informed me that the gender neutral term for child of you sibling is called a “nibling” - isn’t that adorable?

7. But there would be so many fewer mistakes if more doctors would actually fucking listen to their patients. What we truly need is more doctors to acknowledge that all of their expert medical knowledge doesn’t change the fact that the patient is the expert on their own body.

I fully believe in this. Patient are experts of their own body and when they something is wrong, something is wrong. Of course, they may not always be accurate about what in specific is wrong, which is where we come in to help them figure it out. For example, I had a patient last week who came in because she though she was having kidney trouble. She then proceeded to point to her left thigh and tell me this was where her “kidney” was and that it was hurting. I explained the kidney does not exist there in the human body and we (the patient and I) are still working together on figuring out what is going on in her leg.

8.  We also very much fucking need insurance companies to stop practicing medicine without a license.

OH MY GOD - THIS! Aetna recently purchased or took over some smaller insurance companies and has been suddenly refusing to pay for any of the (very cheap to manufacture, by the way) medications my patients have been stably on for years! I am ready to strangle the bastards on the board or whoever makes their stupid decisions (those terrible spawn of Wall Street Bankers and Orcs).

~~~~~~

In reference to this post

I’m really glad you sent this in!! I’m always happy to hear first-hand perspectives. And thank you for clarifying all the points that I didn’t in my original comment - you’ve explained it all way better than I could.

[mostlysignssomeportents]

Machine learning sucks at covid

The worst part of machine learning snake-oil isn’t that it’s useless or harmful — it’s that ML-based statistical conclusions have the veneer of mathematics, the empirical facewash that makes otherwise suspect conclusions seem neutral, factual and scientific.

Think of “predictive policing,” in which police arrest data is fed to a statistical model that tells the police where crime is to be found. Put in those terms, it’s obvious that predictive policing doesn’t predict what criminals will do; it predicts what police will do.

Cops only find crime where they look for it. If the local law only performs stop-and-frisks and pretextual traffic stops on Black drivers, they will only find drugs, weapons and outstanding warrants among Black people, in Black neighborhoods.

That’s not because Black people have more contraband or outstanding warrants, but because the cops are only checking for their presence among Black people. Again, put that way, it’s obvious that policing has a systemic racial bias.

But when that policing data is fed to an algorithm, the algorithm dutifully treats it as the ground truth, and predicts accordingly. And then a mix of naive people and bad-faith “experts” declare the predictions to be mathematical and hence empirical and hence neutral.

Which is why AOC got her face gnawed off by rabid dingbats when she stated, correctly, that algorithms can be racist. The dingbat rebuttal goes, “Racism is an opinion. Math can’t have opinions. Therefore math can’t be racist.”

https://arstechnica.com/tech-policy/2019/01/yes-algorithms-can-be-biased-heres-why/

You don’t have to be an ML specialist to understand why bad data makes bad predictions. “Garbage In, Garbage Out” (GIGO) may have been coined in 1957, but it’s been a conceptual iron law of computing since “computers” were human beings who tabulated data by hand.

But good data is hard to find, and “when all you’ve got is a hammer, everything looks like a nail” is an iron law of human scientific malpractice that’s even older than GIGO. When “data scientists” can’t find data, they sometimes just wing it.

This can be lethal. I published a Snowden leak that detailed the statistical modeling the NSA used to figure out whom to kill with drones. In subsequent analysis, Patrick Ball demonstrated that NSA statisticians’ methods were “completely bullshit.”

https://s3.documentcloud.org/documents/2702948/Problem-Book-Redacted.pdf

Their gravest statistical sin was recycling their training data to validate their model. Whenever you create a statistical model, you hold back some of the “training data” (data the algorithm analyzes to find commonalities) for later testing.

https://arstechnica.com/information-technology/2016/02/the-nsas-skynet-program-may-be-killing-thousands-of-innocent-people/

So you might show an algorithm 10,000 faces, but hold back another 1,000, and then ask the algorithm to express its confidence that items in this withheld data-set were also faces.

However, if you are short on data (or just sloppy, or both), you might try a shortcut: training and testing on the same data.

There is a fundamental difference from evaluating a classifier by showing it new data and by showing it data it’s already ingested and modeled.

It’s the difference between asking “Is this like something you’ve already seen?” and “Is this something you’ve already seen?” The former tests whether the system can recall its training data; the latter tests whether the system can generalize based on that data.

ML models are pretty good recall engines! The NSA was training it terrorism detector with data from the tiny number of known terrorists it held. That data was so sparse that it was then evaluating the model’s accuracy by feeding it back some of its training data.

When the model recognized its own training data (“I have 100% confidence this data is from a terrorist”) they concluded that it was accurate. But the NSA was only demonstrating the model’s ability to recognize known terrorists — not accurately identify unknown terrorists.

And then they killed people with drones based on the algorithm’s conclusions.

Bad data kills.

Which brings me to the covid models raced into production during the height of the pandemic, hundreds of which have since been analyzed.

There’s a pair of new, damning reports on these ML covid models. The first, “Data science and AI in the age of COVID-19” comes from the UK’s Alan Turing Institute:

https://www.turing.ac.uk/sites/default/files/2021-06/data-science-and-ai-in-the-age-of-covid_full-report_2.pdf

The second, “Common pitfalls and recommendations for using machine learning to detect and prognosticate for COVID-19 using chest radiographs and CT scans,” comes from a team at Cambridge.

https://www.nature.com/articles/s42256-021-00307-0

Both are summarized in an excellent MIT Tech Review article by Will Douglas Heaven, who discusses the role GIGO played in the universal failure of any of these models to produce useful results.

https://www.technologyreview.com/2021/07/30/1030329/machine-learning-ai-failed-covid-hospital-diagnosis-pandemic/

Fundamentally, the early days of covid were chaotic and produced bad and fragmentary data. The ML teams “solved” that problem by committing a series of grave statistical sins so they could produce models, and the models, trained on garbage, produced garbage. GIGO.

The datasets used for the models were “Frankenstein data,” stitched together from multiple sources. The specifics of how that went wrong are a kind of grim tour through ML’s greatest methodological misses.

Some Frankenstein sets had duplicate data, leading to models being tested on the same data they were trained on

A data-set of health children’s chest X-rays was used to train a model to spot healthy chests — instead it learned to spot children’s chests

One set mixed X-rays of supine and erect patients, without noting that only the sickest patients were X-rayed while lying down. The model learned to predict that people were sick if they were on their backs

A hospital in a hot-spot used a different font from other hospitals to label X-rays. The model learned to predict that people whose X-rays used that font were sick

Hospitals that didn’t have access to PCR tests or couldn’t integrate them with radiology data labeled X-rays based on a radiologist’s conclusions, not test data, incorporating radiologist’s idiosyncratic judgements into a “ground truth” about what covid looked like

All of this was compounded by secrecy: the data and methods were often covered by nondisclosure agreements with medical “AI” companies. This foreclosed on the kind of independent scrutiny that might have caught these errors.

It also pitted research teams against one another, rather than setting them up for collaboration, a phenomenon exacerbated by scientific career advancement, which structurally preferences independent work.

Making mistakes is human. The scientific method doesn’t deny this — it compensates for it, with disclosure, peer-review and replication as a check against the fallibility of all of us.

The combination of bad incentives, bad practices, and bad data made bad models.

The researchers involved likely had the purest intentions, but without the discipline of good science, they produced flawed outcomes — outcomes that were pressed into service in the field, to no benefit, and possibly to patients’ detriment.

There are statistical techniques for compensating for fragmentary and heterogeneous data — they are difficult and labor-intensive, and work best through collaboration and disclosure, not secrecy and competition.

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