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leviathanlazarus · 4 months ago

Text

In Your Fantasy

Pairing: Jake Kiszka x (F) Reader

Word Count: ~5300

Warnings: semi-public sex (like...very low-key), oral sex (F receiving), unprotected PIV sex. 18+ only ~

This took me forever to finish because I started it before my stupid tonsillectomy and I was totally useless throughout most of the recovery. Also, it's been absolutely ages since I wrote a Jake x Reader fic so I'm not sure how I feel about it...I really enjoyed writing this regardless of my trepidation though. I loved the idea of falling in love with him at work and him being so cheeky...hope you enjoy it too <3

P.S. also ages ago, I wrote a Josh x Reader fic that also took place in a library which you can read here. Links on my desktop masterlist aren't active for some reason...but I found it using a certain tag lmao. If you know, you know.

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You were finishing up fixing the order of some art books in the back of the library when you felt Jake come up behind you. “Wanna hear something kind of crazy?” he whispered in your ear, his chin nearly on your shoulder, his hair brushing against yours. Without even seeing him, the closeness and warmth of his body and the low, husky whisper sent a tingle up your spine–he certainly added a level of intrigue to working in a library.

“Always,” you said, slipping the last book into the correct spot. It was a quiet Thursday afternoon–you’d thought it’d actually be busier given the rain that kept bucketing down outside, creating an even cozier atmosphere, but maybe people just wanted to stay home with their books instead. That was fine by you. You liked it when it was nearly dead silent throughout the building and Jake was there to occasionally break through, his voice a river through your thoughts and his subtle touches all shockwaves to your heart.

When you turned around to face him, Jake looked like he was holding back a hilarious joke or something, eyes all eager and a grin tight on his lips like he was bursting at the seams. “So I just went to the bathroom and guess what I heard?” he went on, raising his eyebrows.

You scrunched up your nose, already worried. This wasn’t what you were expecting when he’d said ‘something crazy.’ What sort of craziness happened in libraries anyway? “There are a lot of things I can think of. Is this a gross story?”

Jake chuckled. “It depends on your definition of ‘gross.’ Okay,” he said, looking around to make sure you two were still alone in the section. Then he looked into your eyes again and lowered his voice even more to tell you, “There were people fucking in there.”

You scoffed, offended on behalf of the library–the sacred, beautiful space where people went to relax and read, not deal with lewd conduct. That wasn’t crazy, that was just offensive! “What, like two guys?” you questioned, tilting your head, a little irked at Jake finding this all so funny.

“No, a guy and a girl.”

“Ugh. That’s even worse. Women shouldn’t have to deal with getting laid in a men’s bathroom,” you said, then were momentarily distracting yourself with yet another out of place book on the shelf. “I’d never do that. I can’t believe someone else is. I mean, kids go here.”

“Yeah, that’s true,” Jake said slowly. He leaned against the bookshelf and looked at you pointedly, his dark eyes even darker in the dim light. “Then again–”

Before he could finish, you had another thought. “Wait, Jake–did you say anything to them?”

“No. What could I say? I just high-tailed it out of there as soon as I heard.”

You sighed. The whole thing would be far more redeemable if your boyfriend had at least tried to throw out some warning words to the perpetrators. “You should have told them to stop. I would have.”

“I’m sure they finished soon after I left.” He smirked. “It sounded like they were pretty close.”

You groaned quietly and turned away, preferring to find another thing to busy yourself with now. “Gross. They should be banned.”

Jake followed along right at your side as you whisked through the rest of the art section and back to the cart you needed to empty. “I didn’t see who they were, so no chance of that.” At the cart, he put his hands on it, keeping it in place. “I actually thought you’d find it sort of amusing, Y/N.”

You leaned over, almost close enough to touch your noses together. “You’re such a guy. Only a guy would think it’s amusing and not disgusting.”

“I don’t know about that. Maybe you’re just a little stuffy,” Jake replied, tilting his head up as if he were challenging you. “Although maybe I shouldn’t be surprised, considering we’ve never done anything like that.”

You scoffed again and leaned back, surprised and still a little irritated, but also genuinely curious. “Oh, so you want to fuck around in a public place? That’s something I didn’t know about you.”

Jake’s challenging stance turned crestfallen, and he lifted one of your hands to press a kiss to. “Forget I said anything about it. I mean, I suppose you’re right–it is kind of gross.” He kept your hand clasped in his for a few seconds as he said, “But I’d never make love to you in a public bathroom. I’d hope you know me better than that.”

You looked over your shoulder at the sound of a man clearing his throat, settling down into a chair with a newspaper. He wasn’t paying any attention to you or Jake, but you gave the cart a push anyway, cajoling Jake off it so you could navigate to where you needed to go next.

“It’s really the fact that it’s the bathroom that makes it so gross,” you whispered as Jake kept following you. You couldn’t deny you’d had some secret fantasies about getting it on in the library–after all, it was where you and Jake had met and where you continued to spend the most time together. But none of your fantasies included the restrooms in the hall, or the utility closet or that little corridor tucked away across from the restrooms where the vending machines were. Too grody, too cramped, too obvious.

“At least our bathrooms are clean.” Jake parked himself right next to you once you were in the biography section, and when you stepped away from the cart, he wrapped his arms around your waist and held you in place. “But if I’m being really honest, I have thought about us, well, fooling around here. I think it’s quite surprising we never have.”

“Jake,” you said in an attempt to protest, but his sweet, pretty face and ticklish touch on your waist made you giggle, and his confession that echoed your own secret thoughts lit a little spark. “We work here!”

“So? All the more reason. It’s always been our special place.” Jake smiled as he got even closer to kiss you; you kissed him back, looping your arms over his shoulders. He was smiling even bigger when you both broke away and he said, “You know, it’s just me closing tonight. You should stay after with me.”

“God, and do what?” you replied, but, despite yourself, you were growing more intrigued.

“Well, don’t you think the study rooms here are nice and cozy?” Jake questioned, still latching himself to your side as you started to put more books away. “There aren’t any cameras in any of them either. No one would know.”

You looked up at him from your crouched position, sliding a book into place. “Someone would know. Someone would find out somehow.” You were quickly finding even more perfectly good reasons in your mind not to do this, to not even really toy with the idea, but the more you thought about it, the more you thought, why not? Could the risk make it more fun? Even just the new, ill-fitting, sort of scandalous environment?

Besides, Jake really did look hot today. He looked hot every day, but the second you’d seen him after he’d come into work earlier, he’d lit a fire in your belly that was more intense than usual. His hair had the perfect level of slight messiness and the relaxed black button-down shirt was perhaps one or two buttons shy of being overtly inappropriate for work; the smooth tan skin of his chest exposed and acting as a lovely backdrop to the long silver chain dangling, the pendant hitting his sternum. You could imagine tugging on that chain, grasping the pendant in your palm, to pull him closer while he pressed you against one of those thick wooden tables. You’d run your fingers through his hair and kiss him in the frozen silence, and maybe no one would ever know after all.

“I can practically hear the wheels turning,” Jake remarked, tapping your forehead once you were standing again. “You know you want to.”

You let out an inadvertent nervous giggle and rolled your eyes. “Yes, I’m thinking about it.”

Jake stepped closer, pressing you back against the cart of books. “I’d love to hear some of those thoughts,” he said, putting his hands on your waist.

“You’re lucky it’s dead here today,” you said, keeping your voice a whisper despite the, indeed, dead library around you. You rested your arms over his shoulders, twisting a strand of his hair between your fingers; Jake just kept looking at you with that sweet, silently begging gaze until you giggled, relenting. “Okay. I was, um…thinking about you pushing me down on one of those big tables.”

Jake’s eyebrows rose. “What else?”

“Well…” you began, looking down at his dark jeans rubbing against your skirt. “You’re giving me some more ideas now.” You lifted one foot off the floor to rub your calf over his, the delicate material of your tights creating subtle but scintillating friction against his denim.

Jake ran the tip of his nose up your cheek and whispered in your ear, “Same here.”

Just as you were closing your eyes and allowing yourself to let your environment fall away around you, to forget about all the risk of being caught right there, and just as Jake’s hand was sliding down between your legs, a person’s incredibly soft–thanks to the clever carpeting job–footsteps headed your way yanked you right out of the moment.

Jake, too. He shot back and cleared his throat, ran a hand through his hair and looked in the direction of the footsteps; you did too, and soon enough an older woman with her nose already in an open book trotted past the shelves.

“See?” you whispered, gesturing at the passer-by who was already out of view. “It’s so easy to get caught.”

“Please, that lady didn’t notice a thing. Alright,” Jake said before he stole one last hurried kiss. “I should let you keep doing your job and I should carry on with mine. But will you stay after with me tonight?”

You pursed your lips as you looked at him, considering, but it wasn’t long before you said, “Alright, Jake. I’ll stay after and we can play out your little fantasy.”

“It’s your fantasy too, baby doll,” Jake said with a wink before he half-turned, beginning to step away. “I think we’ve established that.”

There wasn’t a whole lot to keep your mind occupied as the afternoon carried on. The rain kept coming down, hammering hard against the roof and windows, and the sky outside was pure gray, all flat and blank. It reminded you of your first day working here, as a matter of fact–that morning in the previous late October, when autumn’s chill was officially in the air. A fine layer of frost had even been on the ground that morning; your shoes had crunched over it on the short walk to your car and you’d had to use your defroster once you turned the key, your anxiety peaking as you had to wait even longer to start the new job.

How could such a quiet, peaceful place encite so much anxiety anyway? You remembered wondering that very question as you walked over the sidewalk to the library entrance for the first time since being hired, the concrete slick with that morning frost and the beginnings of a gentle rainfall. And just when you’d been settling in and getting comfortable, Jake had showed up and introduced himself, all casual and easy like he didn’t know he was the most beautiful man you’d ever seen.

Thankfully, Jake was also the sweetest man you’d ever met. It didn’t take long before his beauty and charm stopped intimidating you and instead just made you feel all light and full of joy–you were simply happy to chat with him whenever you both could spare a few minutes. Those few minutes steadily turned into shared breaks; then, shared lunches where you’d sit out back on the one picnic table when the weather permitted. Then he started bringing you special treats sometimes, things he knew you liked because he actually listened about what you liked, and then after that he started bringing you whole lunches packed with love and care that you’d never experienced before.

So, after all that, was it really such a big deal to make love inside the place in which you fell in love?

None of your other coworkers even seemed to notice that you were staying later than planned this evening. But, just to be safe, you also made a point to hide out in the kid’s section when closing time crept up, busying yourself with cleaning up stray crayons and markers and then browsing through some of the newer picture book additions when you were done with that.

When you were sliding one picture book back onto the shelf and reaching for another, you noticed the part of the library beyond the kid’s section dim; you stood up and walked out into the main area, and there Jake was behind the checkout counters flipping switches.

“Despite almost always being the one to close,” he said, flipping another switch. “I still sometimes forget which lights actually get turned off and which ones stay on.”

A path of yellow light led the way past the checkout and reception, past the few rows of public use desktop computers. Jake held your hand as you both stepped through the library, your heartbeat speeding up a bit with nervous yet delightful anticipation; a few more steps and you were further into the very back of the library, just about there. Four study rooms were staggered just beyond the teen reading section, two on the left and two on the right with a wall of windows in between.

Jake opened the door to the last study room on the right. A large window was in there too, soaking in the deep sunset that was resting beyond the grass outside and the trees, and the mostly-bare branches of all the trees were throwing shadows across the library grounds. Then Jake flipped the light on, making it all disappear.

“Oh no,” you said, reaching behind him to flip it off again. “It’s sort of magical with the light off. Look at that sunset.”

Jake followed your gaze out the window to the wash of deep blue painted across the sky, nighttime so early in autumn that only a slight sliver of golden-orange remained just on the horizon. The rain had stopped a few minutes ago and had left a lingering mist on the ground, its faint haze trailing along just outside the windows–the whole scene was so much more peaceful than what was going on inside your head. You couldn’t shake the possibility of getting caught even though Jake was right about there being no cameras back here, and there was no one else around, not even any of the custodial staff, and not a soul out there in the fog. Just you and Jake in the little dark study room, his hand still warm around your own.

Your thoughts started to drift away, making space for your mind to comprehend the shadowed image of Jake before you as he gently turned you to face him. He smiled with the slightest bit of white teeth gleaming between his full lips, and you instinctively smiled back, pulled under his charm again. So, now effortlessly charmed and put at ease, you wrapped him in your arms and pulled him close, caressing his shoulder blade with one hand and the slight curve of his waist with the other as both of your smiles disappeared into a kiss.

“You were making me crazy all day,” he remarked between the kisses that accelerated with both of your lips parted and the wet meeting of tongues.

“Really? You kept it well-hidden.” Of course Jake did–you never doubted his affection and passion for you, but he kept everything so private. It was one of the many things you liked about him. You cupped the back of his head, sinking your fingers into his hair, scratching his scalp with your nails just the way he liked it, and kissed him again.

“God, your ass in this skirt,” Jake said, voice a little rough, and he reached down to grab you there. “The way your hips move.” He licked his bottom lip as he took a moment to just look at you, his eyes scanning your face. “So unbelievably pretty.”

You held the side of his face. “You are too, Jakey.” He really was, and even in the dark–perhaps especially in the dark, actually. The shadows enveloped him in even more mystery than normal, but you could still so plainly see the angles of his face and the smoothness of his skin in the faint, distant glow of the lingering sunset. Jake smiled at the sound of that little nickname coming from you, then disappeared as he pressed his lips to yours again and pushed you back against the table just like in your little fantasy.

You felt the warmth of his hand travel around your hip then slide down over your skirt; you kissed him harder and spread your legs a little wider when his fingers skated effortlessly up your thigh over your tights. Jake purred against your mouth as he traced the seam of those tights, and subsequently the crotch of your panties beneath, with one fingertip, and your own hands hurried down his body with much less grace to squeeze his ass and feel the hardness between his legs as reciprocity.

Before you could do much more than that, he was pushing your skirt up all the way with one hand and continuing to use the other to tease you. Your breath caught in your throat as you were finding yourself trying to stay silent despite the library being completely empty; Jake carried on with longer, deeper touches over the crotch of your panties and tights. The steady back and forth of his fingers over the two thin layers of fabric sent a delightful tingle of pleasure up your spine but you couldn’t forget his either–you kept that one hand of your own on his crotch too, gently squeezing his erection through his pants.

Jake huffed softly and kissed you again; you clutched his arm with your other hand, squeezing his bicep. Maybe other people didn’t mind getting caught–maybe there really was some sort of thrill to it. Maybe other people actually sometimes wanted others to witness their most intimate moments but you didn’t. You couldn’t imagine doing this with the lights on in the middle of the day, with the soft noises of people beyond the walls and the risk of someone catching a glimpse from opening the door or from outside the windows. You were perfectly happy with having Jake all to yourself in the shadowed little square study room, his skin so perfectly warm, his kiss so perfectly molded to yours.

“Was this part of your fantasy?” Jake questioned as he slowly sank to his knees, keeping your skirt bunched up over your hips with both hands now. But it was obvious what he was doing, so you took their place to keep it out of the way while his hands squeezed your thighs as he pressed his face between your legs.

The scant sharpness of his teeth over your crotch made you gasp. “Maybe,” you answered, thighs quivering against the table behind you.

“Oh, come on,” Jake beckoned, looking up at you with a sweet but slightly mischievous gaze, his eyebrows raised just enough to display teasing curiosity.

“Seems like you already know,” you replied, stifling a giggle at him struggling to get your tights down from beneath your skirt.

“I don’t know how you wear these things,” he remarked, which made you actually let out a laugh.

“Just rip them for fuck’s sake,” you instructed, eager now, already wet for him. “They’re not expensive.”

Jake didn’t hesitate. “If you insist,” he said as he grabbed a fistful of black nylon in each hand and ripped the tights right open, then quickly pulled your panties to the side next, giving you no time to think at all anymore. Whatever words your mind may have found merely turned to shaky breaths as you watched Jake’s face disappear between your legs again.

He gave a little hum just as he went straight in, the bridge of his nose rubbing up against your clit while he dove his tongue into your center like he really did want to eat up all the arousal that had been conjured up just for him. Your fingers found his hair again, knuckles curling to tug the long strands while your nails scratched his scalp again and he let out a little pleased sound, almost like a gratified laugh, and dug his own blunt nails into your inner thigh as he kept you spread open.

One word finally emerged from your lips–Jake’s name, simply spoken in a soft tone as the ministration of his tongue and lips had you squirming and quivering even harder, your heels digging into the carpet below as you slightly struggled to stay upright. The repeated flicks of tongue over your clit disappeared for a brief moment, then slowed to one long drag of his tongue over your center just to start that quick pace again. Sighs and whimpers were dragged out of you with each lick; when Jake slipped two fingers in, the slow but easy stretch made you tremble and clench your fingers into his hair even harder.

“You’re so tight,” he commented when he pulled back just enough for you to look down again and see your own wetness glistening on his lips and chin. You could feel it too, how much tighter you were clenching around his fingers as he gently thrust them and teased, curling them and now rubbing your clit with his thumb.

“You’re so good,” you told him breathlessly, closing your eyes again when the sensations had you arching your back. You hissed and bit your lip when Jake’s mouth found you again, his tongue teasing your clit more while he slid his fingers in deeper.

You had thought it would take more of a conscious effort to relax in this space and just let go, but it was easy, so easy–you just let your body respond to Jake with each tremble and moan and gasp and tug at his hair until your legs were outright shaking. Panting, the peak rising deep inside, you pulled him closer and he obliged, sucking on your clit as his fingers curled and gently tugged deep inside you too as if he was literally trying to pull you right to the edge you were already rapidly careening to.

His name from your lips once more wasn’t a soft little sigh; it was a sharp, long whine that seemed to boom in the little study room. Your ferocity surprised you even more when the overstimulation came on so soon and you yanked his head back with one hand and shoved him away with the other, your hand gripping his shoulder. Panting, eyes still shut, you could feel how much wetter you were with his saliva and the rush of your orgasm, the fluid soaking your panties that were pulled to the side and even the very inside of your thighs.

Jake pressing a kiss to your thigh made you look down but he was getting up on his feet now; your gaze followed the steady movement of his rise and then you were whisked away into blissful darkness again when he closed in and kissed you–close-lipped because he was so polite. But you parted yours and slid your tongue over his and gripped his waist tight for a moment before hastily getting those buttons on his shirt undone, fingers trailing all the way down to get his pants undone next.

He tentatively pushed you back onto the table a bit more so your feet were off the floor, legs still spread wide around him and dangling when he pulled his pants and underwear down just enough to reveal that heated hardness. His cock leaked just a bit as he stroked it once, looking at you, and a blip of that old insecurity born from adoration and fascination stroked your brain, because Jake was just so beautiful and his beauty was so much more stark in contrast to the plain white walls behind him.

“That was intense,” Jake said with a chuckle, leaning in to kiss you. You sighed against his lips as he slid the head of his cock all through your wet center, making a point to rub longer and harder over your clit. As he slid in, taking your breath away entirely, he sighed too and you watched his shoulders drop and his chest flush and he asked, so casually, “Is your fantasy being fulfilled?”

Even with the impact of Jake’s cock filling you so perfectly, you had to laugh. “You're a fantasy, Jake,” you told him, wrapping your arms around his shoulders to bring him closer, to make the head of his cock hit so deep inside you that you gasped again as if you weren’t expecting the feeling. “What about–” You had to pause when Jake gave his first thrust. “What about your fantasy? This was all your idea.”

“It was a shared idea,” he reminded you with the cutest little smile. How could anyone be so sexy and adorable at the same time, especially during the actual act of sex, especially when that sex was taking place inside a public library? But he was, and you kept your eyes on him as he steadily sped up with his hips and his hands explored your body over your clothes, one squeezing your breast through your shirt and the other smoothing down your waist, your hip, traveling around your thigh.

“Oh god,” you chirped when Jake’s fingers made contact with your still-sensitive clit; but he was gentle, clearly deliberately being slow with the little circles he was making. With your arms still a loop around his shoulders, you sank your fingers into the hair at the nape of his neck and held him there for a minute before the soft pink of his chest became too tempting not to touch.

“Fuck yeah, that feels amazing,” Jake said in that deliciously hazy, husky voice after you slipped your hands past his open shirt to toy with his nipples. Bringing more attention to him put your lingering overstimulation in the background–you continued to tease with one hand while the other skated over the other side of his chest, feeling his warm, soft skin, up to his neck. You caressed him there, your fingers lightly touching the tender skin along his throat and then up to his ear, and Jake moaned softly and tilted his head to try and get more contact.

That was fine by you. You lightly scratched behind his ear like he was a cat and he sort of purred like one anyway, making you giggle; Jake giggled too and surged forward, picking up his pace as he whisked you away with another series of kisses that were deep but just sloppy enough for your mutual moans to be voiced.

But, also to your surprise, Jake began to voice more thoughts between increasingly ragged breaths: “Remember when we first met?” he asked, his fingers over your clit sliding down to get slick again from your own arousal. “That was–fuck, that was such a good day.”

“It was,” you agreed, playing with one of his earrings as your other hand squeezed his pec. “I’m lucky I even got the job here. For a lot of reasons.” You stole another lingering kiss before adding, “You’re the biggest reason.”

Jake smiled. The sunset that had been just barely clinging to life when you’d both began was gone now–the only illumination was coming from a parking lot light that was too far away from the windows to see, but the pale yellow glow was scant enough to see that alluring, mystical beauty that your boyfriend possessed. Just looking at his face was enough to make you come again.

But Jake’s skilled fingers and the heat, weight and stretch of his cock still thrusting into you certainly helped. You buried your face against his neck now that you had access to all of him; a thick sob was muffled as you tightened and spasmed around him, and you heard him let out a quiet “wow” as the second orgasm rolled through you.

His fingers on your clit, thankfully, moved away. He gripped your thigh again instead; his pace was now messy and fierce, and you had to fight to stay in place not only from the harsh movements and how the table you were sitting on was skidding a bit across the floor, but also from that second round of intense bodily excitement.

“God,” you huffed, stifling another laugh. Apparently it didn't matter where you were–if you were with Jake, he just gave you the giggles. “You’re really going for it.”

Jake cradled the back of your head, messing with your hair a bit. “And I’m–hmm–almost there.”

You kissed him softly and sweetly, from his collarbone and up his neck to his ear. “Good boy,” you whispered there, giving his ear a nibble. Jake moaned wordlessly in response and gave one last deep, solid thrust that jostled you backwards and made the table creak, then he went slack over you, his whole upper body all loose and so hot that warmth was radiating through his shirt.

When Jake lifted his head, you leaned back and waved the back of your hand over your forehead with a silly “whew” motion; Jake laughed and nodded, then slowly pulled out. He collapsed forward again, resting his head on your chest, and you wrapped your arms around him once more.

“Well, we’ve done it once. Do we ever need to do it again?” you asked, petting his back.

“Like, um, sex?” Jake asked, mumbling against your chest. “Or sex in the library?”

“In the library, duh,” you said with a chuckle, and kissed him when he lifted himself up and looked at you.

“Where else should we do it?” Jake replied, his tone and little smile making it obvious he was kidding–finally. You were glad to have played out this little fantasy and do something new and a little risky, but you’d be even more glad to just go back to the way things were. Nothing wrong with a classic.

“Our bed, definitely,” you said, and Jake smiled and nodded again; you began working on buttoning up his shirt. “Our couch. The floor. Maybe the shower.”

“Maybe?”

“Last time we tried the shower, you nearly cracked your head open,” you reminded him, lifting a hand to cup his jaw. “And nearly broke your perfect teeth.”

Jake’s smile grew wider. “That would be terrible, wouldn’t it?”

“I’d never forgive that stupid shower.”

Jake patted his hands from your shoulders down the length of your body, stopping at your ankles. “Well, babe, we’re both in one piece now, aren’t we? Time to close up?”

“Definitely. The custodians are probably going to be here any minute.”

“Oh my.” Jake held your hand to bring you off the table. “That would have been quite the show for them.”

“No more shows,” you said as you both put the finishing touches on getting yourselves decent before Jake opened the door. “I should be the only one looking at you when we fuck.”

---

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Tagging: @kissingsun @starbuggie @lightsofthe-living-gvf @sanguinebats @gvfrry @milojames16 @mindastreamofcolours @wetkleenex-gvf @itsafullmoon @heckingfrick @peaceloveunitygvf @musicspeaks @clairesjointshurt @bizzielisteningtogreta

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186 notes · View notes

cripplecharacters · 16 days ago

Note

Do people with contracture scars from burns that severely limit movement and function of a limb but pose no other immediate health risk ever choose to get the limb amputated so a prosthetic can be fitted in its place? Or are there other easily accessible options with more minor surgery or treatments?

Hello,

It's possible, but very few doctors wouldn't try to talk them out of it, so the procedure would be against medical advice (AMA.) An amputation is a major procedure and though it's relatively straightforward, a lot can go wrong and even if everything goes right, it is going to be permanently life-changing. Most surgeons aren't going to do a major procedure like that electively, the character is going to be hard-pressed to find someone to do it. Plus, because it's a major procedure, it's going to be expensive. Insurance often doesn't cover elective procedures and almost certainly won't cover an AMA procedure, so the character is going to be paying for the procedure out of pocket. And then there the weeks in the hospital, months of medical treatment, monitoring, and physical therapy, and then thousands of dollars for the temporary prosthetic and thousands more for the permanent prosthetic. People who had medically-necessary amputations have a hard enough time getting insurance to cover even part of all of this, your character will need to pay for all of it on their own and it's going to be, at minimum, tens of thousands of dollars.

Instead, the doctors are going to recommend a number of more mild treatments for the contracture. There are massages to get the scar to loosen up that'll probably start early in recovery, medicated ointments and steriod solutions that can be applied or injected to help, and more tame procedures like skin or tissue grafts or a z-shaped incision to help add more surface area to the skin. Of course, most of the treatment for a contracture scar is going to be preventative, treatment that takes place while the skin is healing and scarring that aims to prevent or lessen contractures. And if all else fails, the character can use mobility aids, most often a rollator or a wheelchair, to get around easier with the contractures.

An amputation is the most extreme option and probably the worst possible option, worse than just letting the scar be and trying to walk around without any mobility aids (possible depending on the severity of the contracture and the location but painful nonetheless.) If the character were to even pitch this idea to their doctor, any doctor worth their salt would immediately point out why they shouldn't do this and tell them about the more accessible options, partially due to ethics and partially because if they let them do this and recommend the unnecessary surgery and the surgeon goes through with it, there's a massive risk they'll be sued and/or investigated and they could end up in jail and lose their ability to practice medicine. In the modern day, this is probably not something that would happen (you might be able to get away with doing it if your setting is back in the times of tonsillectomies and appendectomies over mild swelling before we realized we should treat the inflammation with medication before removing internal organs, but an elective procedure like this is probably not going to happen in modern times.) Plus, getting the entire limb amputated is the opposite of common sense. I don't know one person who would say "These contractures suck, I'm just going to get my entire leg chopped off" unless they're joking. And if they did seriously pitch this idea to their doctor or a surgeon or even to the receptionist or janitor at the hospital, I can't imagine any one of those people wouldn't shoot that idea down as fast as humanly possible.

I'm sure it's something they could probably do if dedicated enough, but it's extremely impractical and very difficult. I'd recommend looking into more mild contracture treatment options.

Mod Aaron

Hi,

I personally don't know anyone who would get an amputation for this reason, which doesn't mean no one does it, but rather that it's pretty damn rare. Most amputations related to burns are either because limb salvage is impossible due to the damage, or infection setting in.

The most basic possible treatment is simply stretching and massaging the contracted joints. The goal is to stretch and soften the skin gradually, and this will be started extremely early in rehabilitation. Moisturizing helps with this process too.

Next step would be splints designed to keep the joint uncontracted. This is especially helpful if muscles are ligaments are involved rather than just the skin. Over time splints will improve range of motion (not necessarily make it good; two different concepts) to support the person's quality of life and allow them to do more activities of daily living (ADL). If the person wears a compression garment then the splint goes on top of it.

If the issue is solely in the skin, then skin release surgery is an option. It's exactly what it sounds and requires skin grafts to give the person better mobility in the joint. However, muscles that were initially unaffected will shorten with time if the contracture persists, so if your character would be getting this surgery 10 years after the initial burn, their muscles would be affected now even if they weren't before.

There are also many other kinds of treatments like tissue expanders that help with growing more skin, z-plasties, rotation flaps, and a bunch of other ones that I'm not too familiar with.

A more possible (though still really rare) reason for an elective amputation after a burn would be for the most common reason elective amputations are performed: severe pain. Severe burns cause nerve damage, muscle damage, skin damage, all things that could potentially result in something like Complex Regional Pain Syndrome. This could be a possible reason for an amputation if, let's say, six years after the initial burn the pain has largely lowered except for the person's ankle that is still at the same level as it was on day one. There amputation could potentially improve the person's quality of life. It could also not do that, but they'd find that after the fact either way. This is a very last resort scenario where everything (!) else has failed, most people will go through tens of surgeries before seriously considering an elective amputation.

Prosthetic wear however is a completely separate thing. Burns are, despite the general perception, sensitive to many things. Temperature, touch, pressure... all things you get from putting something in a prosthetic socket. Burned skin is dry; it cracks easily. It'd be painful to walk on, as you can imagine. Maybe if they only burned their lower half, they could use crutches and get by this way (which is the same thing they'd probably be doing if they had a severe contraction in a leg). After all it's not like prosthetic wear is an easy thing that every amputee can do. Many can't reliably walk in prosthetics, even if their stump is in better condition than of someone with severe scarring on it.

There's simply too many options available for contractures before an amputation, and even more before prosthetic wear. I'd probably reconsider this idea unless you'd be working with someone who actually had this kind of experience.

mod Sasza

#mod sasza #mod aaron #anonymous #amputee representation #burn survivor representation

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