I’m Happy Avery Was A Bad Friend To Max. I’m Happy She Hurt The People Around Her.

“what’s it like?”

oikawa turns to you at the sound of your question, “what’s what like?”

“what’s it like being in love?”

the boy quirks a brow, “what do you mean?”

“i mean,” you pause, shuffling from your place on the couch to face him. “what’s it like to give your all to a person? to have someone that loves you with all their being? what’s it like to have a bond and a connection that seems as if it would never break? or to have a person who’s poured their heart and soul into you? who would do anything to see you happy and make you feel loved?” you pause, meeting the boy’s gaze realizing you’ve been basically asking him the same question for the past three minutes. “i mean if you know about it, i know you’ve had your fair share of relationships.”

he bit back a chuckle at how small your voice became, “that’s a tough question for me to answer.”

“but you’re more experienced than i am with it,” you reason.

“why because i’ve been in more relationships?” 

”no because of the fangirls.”

and he laughs, “that’s adoration,” he notes. “adoration and love, while easily confused, are two different things.”

”alright then,” you wave off. “then tell me,” his gaze softens as he shuffles to face you. “what’s love like?”

“it’s,” he pauses, “it’s a feeling that you can’t really find anywhere else.”

“what do you mean?”

there’s a hint of curiosity in your voice, something that makes oikawa smile. contrary to you, his long time best friend, oikawa’s been in his fair share of relationships. some were long, others short flings, some serious ones, and then others that left just as fast as they came. he had watched you for years pine over other people wishing like the hopeless romantic that you are that you’d finally get your chance in love. he pauses for a moment before looking back at you. “do you know that moment where you have a puzzle and there’s only one piece missing?”

“okay,” you nod.

“and it turns out the puzzle piece fell on the floor, so you pick it up and then complete the puzzle.”

your brows knit in confusion, “that’s an odd scenario to compare love to.”

Keep reading

“Umm it will actually be very difficult for universities to divest from israel and arms manufacturers without tuition skyrocketing 🤓☝🏼” why is the financial stability of a college (and the economy at large, especially in the us) so reliant on what amounts to war profiteering to begin with? Why is that an inevitability that we’re supposed to accept?

i do not have the strength to block all the bots. welcome ladies make yourselves at home i guess. im a feminist

more of ex husband gojo i beg

𝐆𝐎𝐉𝐎 𝐒𝐀𝐓𝐎𝐑𝐔 | 𝐇𝐀𝐋𝐅 𝐎𝐅 𝐌𝐄 𝐈𝐒 𝐘𝐎𝐔𝐑𝐒: 𝐏𝐀𝐑𝐓 𝐓𝐖𝐎

cw/ tw. modern au. their daughter is an oc, mild angst, pet names (ex. baby), more of Gojo fawning over his ex wife | wc. 600+

an. okay, this is just a blurb my sleepy brain conjured up <3

Ex-husband!Gojo who doesn’t understand that the moms at Mio’s soccer games talk whenever he decides to pull you into his lap—a few sideways glances cast your way at how cozy you both must look as you watch your daughter run across the field.

He doesn’t hear the things they talk about, like “aren’t they divorced?” and “I’ve never seen anyone divorced act like that.” Although maybe he’s heard every word and doesn’t give it the same amount of thought or care as you do. 

“Satoru,” you hiss, trying to move off his lap to no avail. “I have my own chair.”

“Shh,” he tells you, tugging you further against his chest. “You’re missing the game.”

“But everyone’s staring at us.”

“So? Let them stare.”

Just then, the crowd in the stands starts cheering, and you both watch Mio chase the ball down the field, her smaller frame ducking between the taller kids. 

“That’s my girl!” Gojo shouts over the other parents. 

And then Mio kicks the ball into—well.

The wrong goal.

“Maybe we should have let her join t-ball,” you whisper, though you both clap as your daughter jumps happily in the middle of the field.

You’re probably scrubbing the plate in your hands rougher than necessary, doing everything to stop from staring out into the yard where he’s mowing the lawn. But it’s difficult when his chest glistens with sweat from the early-summer heat and how those gray cotton shorts sit dangerously low on his hips— 

Ex-husband!Gojo who still does work around the house every Friday, and to your dismay, shirtless.

It's almost like it's a ploy to torture you...and it's working.

He looks towards the kitchen window, a crooked smile stretching across his lips when he catches you staring, and suddenly the suds in the sink seem ten times more interesting.

Ex-husband!Gojo who strolls into your room while you’re folding laundry. And he’s still shirtless, you realize, as he presses his front against your back.

Your resolve slips at how familiar it feels (to be held like this), and you swallow the whimper working its way up your throat. “Satoru…”

“You know, these little shorts were always my favorite,” he tells you, his fingers playing with the elastic waistband around your waist.

Breathless, you ask, “where’s Mio?”

“Watching Paw Patrol.”

Ex-husband!Gojo who works your shorts and underwear off your legs before pulling you to the edge of the bed. 

“Satoru, we—we can’t keep doing this—”

Your words trail off into a lilted moan when he slaps your clit with his leaky tip.

“Yeah? Go on, baby,” he tells you, slowly splitting you open on his cock. “Tell me more about why we can’t keep doing this.” 

And you can’t, not with how he’s filling you up in the way only he knows how. Not when he wraps his long fingers around your throat because you’re getting too loud, pinning you against the bed, every sound choking into nothing.

You wriggle underneath him, fingers clawing at the comforter and your back arching.

“That’s it,” he growls, leaning over you, teeth bared. “Take it.”

Ex-husband!Gojo who pushes the sticky rivulets of cum back inside you after he pulls out, muttering something that sounds like, “can’t waste it.” 

Ex-husband!Gojo who stays for dinner for the fourth time that week, and none of the reasons have been because Mio asked if he could. It’s more about the fact that you’ve enjoyed how whole your family feels again, that you can pretend for a moment this is what you do every night. 

That your wedding ring doesn’t sit in the back of your sock drawer, and his isn’t tucked away in his wallet—

“Daddy, you gonna lose,” Mio tells Gojo as Mario Kart appears on the screen.

“We’ll see,” he laughs, ruffling her hair until she’s giggling and swatting his hand away.

You lean back against the couch, watching them with a small smile, content.

"You're taking fucking forever in there."

You ignore Levi's irritated comment as you fiddle with the buckles on your shoes, too tiny to clasp easily and at a part of your ankle that requires your legs to be both tilted and bent to access them. A lethal combination in opposition to your dexterity.

"Are you sewing that dress by hand or what?"

His voice is nearer to your bedroom door now, a little bit more difficult to tune out with only the thin wood between you.

"No, my little mice helpers are doing that for me while I sing to them," you call back, but your words are light and flippant where his were heavy with the weight of his impatience.

"It wouldn't surprise me if you did have your own army of vermin with the amount of junk you've got in this apartment." You can't see Levi's face but you know he's looking around your living room with his nose crinkled in the particular way he does when he finds something distasteful.

You scoff as you finally succeed in doing up your second buckle. You lift your head so you can snap your rebuttal directly towards your closed door.

"Sorry we can't all live like minimalist monks!"

Levi snorts in reply. "I'm hardly a minimalist, I just don't accumulate needless things."

"You only own one bowl, one plate, and one mug."

You've known Levi since college, and you're fairly certain he has the same amount of possessions filling the entirety of his one-bedroom apartment that he did in his one-room dorm a decade prior. Probably the same ones, too.

"That way no one ever tries to come over for meals, it's clever."

"It's spartan."

There's a light thump on the other side of your door, and you wonder what it may have been.

"Didn't you ever read those Marie Kondo books?" Levi's voice is impossibly close now, like he's got his forehead pressed to your door. The thump makes a little more sense.

You laugh a bit to yourself as you imagine the way he's slumped against the expanse of wood, long-dressed in his suit and ready to go where you've taken your time getting ready. It's not your fault Levi showed up thirty minutes earlier than he said he would to pick you up for the company party your shared workplace was throwing that evening--though you should have expected it, given he's never been tardy to anything in the entire time the two of you had been friends.

"Can't say I did," you reply as you cross your bedroom, leaning over in your mirror to get one last close-up look at your face. You run your thumbnail against the edge of your bottom lip where your gloss was slightly ill-applied. "Why do you ask?"

"S'all that," Levi sighs, "'spark joy' bullshit. Don't keep things in your space if they don't make you happy or whatever."

You smile at your own reflection, eyes flickering to the image of your bedroom door you can see in the glass.

"And what if all my 'junk' makes me happy?"

There's some shuffling, and a moment later Levi mutters: "How can an issue of a magazine from 2010 make you happy?"

You suspect he's plucked an old copy of some fashion magazine off the stack resting on the bookshelf beside your door. You've actually been meaning to throw those away for a while, but you don't tell him that.

"How can you manage to not find happiness in anything?"

"That's not true," he argues.

"Oh yeah?" you counter, adjusting the way your necklace is resting against your collarbones. "Name something that you keep around just because it makes you happy."

"My kettle."

"Nope," you answer immediately, grabbing your purse off the end of your bed and heading towards the door, "that serves a practical, utilitarian purpose. I mean something useless that you just like. Just something you think is pretty."

You grasp the handle and pull it open, and you take Levi by surprise--he barely catches himself with a hand on either side of the door frame to keep from crashing into you.

There's a little pink mark at the centre of his brow where he'd been leaning against the door, and his eyes are wide.

"You ready to go?" you ask him, tucking your bag under your arm.

He's frozen, his expression still a little taken aback.

"What?" you ask him, suddenly self conscious. Your hands tug at the material of your dress nervously. "Should I change?"

"No," he says, soft but sure. "You look... fine."

Your face pinches.

"Fine?"

"Nice," Levi corrects himself, finally looking away. He fiddles with the stack of magazines he'd been complaining about moments prior. "You look nice."

"Wow, Ackerman, with compliments like that it's shocking that you have to take your best friend as your date to the company party and not one of the countless women I'm sure are knocking at your door."

Levi narrows his eyes, tossing you a withering look.

"You're the one who said we should go together."

"That's because I want to blackout at the open bar, and you're the only person I know who turns down a drink on the corporate dollar," you say with a bright smile.

Levi tuts in annoyance, crossing his arms over his chest, his eyes wandering away from you again. "Charming."

A beat of silence passes.

Levi sucks in a little breath.

"You."

"Pardon?" you ask, and not even because he said it so quietly you barely understood him, but because it doesn't quite make sense.

"Something I keep around just because I like it," Levi says, his eyes fixed so intently on the outdated magazine stack that you're surprised the pages don't burst into flames. "Just because it makes me happy..."

Your heart stutters in its rhythm, a sudden weakness in your knees you can't chalk up to the height of your heels as easily as you may have liked to.

"...Just because it's pretty."

You swallow thickly.

His eyes meet yours.

The time and space between the two of you is thick and sweet like honey, and you wade through it slowly as you fight to find your words. You swear you can almost taste it as your tongue peeks out to moisten your already glossy lips.

"We should probably go," you say quietly, reaching out to adjust the lapel of Levi's suit. If your touch lingers a moment longer than it ought to, if your fingers brush against him in a way that friends' shouldn't, neither of you says anything about it.

Levi nods and clears his throat, taking the slightest step away from you towards your front door. "We gotta get you back before midnight after all, Cinderella."

You blink, a little confused, a little dazed, a little bit of a head rush still clouding your thoughts.

"The mice, remember?" Levi offers when he sees your curious look, stuffing his hands into his pockets.

"Oh," you laugh, letting your head hang as you nod slightly. "Right."

The two of you make your way down to the parking lot outside of your apartment building towards Levi's car, and you watch as the lights flash when he unlocks it.

"I've got two mugs, by the way," Levi says as he pulls the driver's side door open, and you pause with your hand on the handle of your own. He looks at you over the roof of his car, his eyes suddenly firmer than you'd seen them all night. More insistent. More sure.

You tilt your head, confused.

He ducks down to slide into his seat, but not before calling back to you one last time:

"The other one is yours."

International team of astronomers discovers two rare binary star systems

An international team of astronomers has identified only the second and third examples of a rare type of star system comprising two central stars orbiting each other, encompassed by a remarkable disk of gas and dust.

“If there were a planet in one of these systems, it would be like the planet Tatooine from Star Wars,” says Michael Poon, a Ph.D. student in the Faculty of Arts & Science’s David A. Dunlap Department of Astronomy & Astrophysics and one of two University of Toronto researchers involved in the discovery.

“You would see two suns in the sky orbiting each other. In addition, there’s a disk around the stars. Picture Saturn’s rings but much, much larger—with the stars in the middle.”

Such disks are referred to as protoplanetary disks because they eventually form into families of planets like our solar system. The newly discovered systems are rare because their disks lie at an angle to the orbits of their central stars.

“The discovery of objects like these is important for our understanding of planet formation,” says J.J. Zanazzi, a postdoctoral fellow in the faculty’s Canadian Institute for Theoretical Astrophysics (CITA). “Planets are born from them so the existence of disks around binary stars shows it’s likely we will find more planets orbiting binaries.

"They’ll also help us understand whether life can exist on a planet that orbits a binary star at an angle because of how that orientation affects temperature and other conditions.”

The discovery of the new objects, designated Bernhard-1 and Bernhard–2, is described in a paper being published July 4 in The Astrophysical Journal Letters.

The lead author is Wei Zhu from Tsinghua University, Beijing, formerly a postdoctoral fellow with the Faculty of Arts & Science’s Canadian Institute for Theoretical Astrophysics (CITA). Zanazzi and Poon are U of T co-authors.

Bernhard-1 and Bernhard-2 are so distant, we can’t see their two central stars individually (such pairs of stars are known as binary stars). Instead, we only see a single point of light and measure the total brightness of the binary.

The researchers identified the new objects by analyzing the complex and distinctive variations in brightness caused by their unusual geometry. A graph of those variations over time is referred to as a light curve and the light curves of the new systems match that of the first such system ever discovered—an object referred to as Kearns Herbst 15D (KH 15D).

The light curves of Bernhard-1 and Bernhard-2 dip to a fraction of their peak brightness—the former for 112 days every 192 days; the latter for 20 days every 62 days. These dips are the sign that one of the stars in each binary is moving behind the disk as seen from Earth. When the star re-emerges, the brightness of the system returns to normal.

Also, when the co-authors compared recent observations with archival data going back decades, they found that both objects varied in brightness over much longer periods. Previous analysis of KH 15D by Poon, Zhu and Zanazzi, along with the work of other researchers, concluded that this long-term pattern revealed that the disk and stars were at an angle to each other.

Because binary stars and their protoplanetary disks condense from the same vast, spinning cloud of material, the disk typically lies in the same plane as the orbits of the stars—just as the orbits of most of the planets and moons in our solar system lie on the same plane. Imagine two figure skaters, holding hands, twirling around each other while other skaters circle the pair; all are skating on the same plane of the surface of the ice.

But KH 15D, Bernhard-1 and Bernhard-2 are rare in that their circumbinary disks are at an angle to the planes of the orbiting stars. Because of this tilt, the disks wobble like a spinning top, a motion referred to as precession, as they move between us and the stars, causing the light of the central stars to dim. For KH 15D, that cycle of dimming could take anywhere from 60 to 6,000 years.

The two types of variations in brightness combine to create the signature light curve of KH 15D-like objects.

The discovery of Bernhard-1 and Bernhard-2 was made when Klaus Bernhard, an amateur astronomer and member of the Bundesdeutsche Arbeitsgemeinschaft für Veränderliche Sterne, analyzed data from the Zwicky Transient Facility. The ZTF’s instrument surveys the entire northern sky every two days, providing data for countless objects over long stretches of time.

Combing through the data, Bernhard uncovered KH 15D-like candidates. He then shared his findings with Poon, Zanazzi and Zhu whose further analysis revealed Bernhard-1 and Bernhard–2.

Now that the researchers have found two more of these rare celestial objects, they are optimistic more discoveries will follow.

“Just this month, Gaia released its most recent data,” says Zanazzi of the space mission that has been observing a billion stars in the Milky Way Galaxy since its launch in 2013. “And now that we have this model for these objects, we’re hopeful we can use it to find more objects to add to the list.”

“We’re also hopeful more observers will look at Bernhard-1 and Bernhard–2 for longer periods,” says Poon. “We’re lucky that KH 15D has been observed at a special time where its orientation causes the light of the central stars to dim. We’re confident that Bernhard-1 and Bernhard-2 also exist in this favorable orientation, so having more observations will increase our understanding of these rare objects.”

IMAGE….Original illustration of protoplanetary disc by Sahl Rowther, et al with binary stars added by Poon, et al. Credit: Poon, Zhu, Zanazzi, U of T; Sahl Rowther, et al, Warwick University

small amnesia drabble ft osamu based on this 9yr old video that still makes me giggle. cw: little violence mention but that’s it.

The hell’s that beeping coming from…

There’s a noticeable restriction in his movement when he slowly begins to stir, lethargy sitting heavy on his limbs as his eyelids pull with visible tension.

Osamu immediately winces. “…Fuckin’ bright…”

Someone gasps at the foot of his bed.

It’s an effort to crane his neck and peek over the footing of his bed, more of an uncomfortable strain than the headache he should expect but what he finds there might just be worth it.

There’s… a cottony to the woman standing before his bed unreserved for anybody else in that typical stark hospital lighting. A fuzzy glow, unburdened by the mussed hairs that stick out of your done up hair or that blue tinge of worry that melts into relief the moment you realize he’s returning eye contact. There’s a few vending machine snacks in your hand that he watches you discard as you step closer to him, and he’s not too shy to blatantly ogle as you take a comfortable seat at his bedside.

That beeping’s gotten a little faster. “You’re up. How do you feel?”

“Dunno…” Though charmed would’a been his second answer.

“Dunno’ s a good answer.” You reply. “Better than what the other guy’s probably saying.”

“The other guy?” There’s not a lot he remembers aside the basic stuff, and you’re definitely not one of ‘em.

“The blow job that tried to hold up your shop last night. Came in swinging this big ass metal bat like you wouldn’t knock his lights out a moment later.” Your smile sparkles as you hum fondly. “Although he did knick you a few times before you could actually get at him.”

Which would explain the thick casting on his arm and the way your fingers softly graze the wrapped gauze on the side of his face. Which in turn makes him blush a little like an overgrown schoolboy.

Although the way your thumb starts to rub circles in his cheek has him breaking out in a sweat. “You saved a lot of people, ‘Samu, me including,” You coo. “But more than anything I’m just glad you’re okay.”

‘S-Samu…?

Your eyes quickly flicker to the quickening heart monitor.

Though when you glance down his face is neutral as ever. “Are you feeling okay?”

“Yeah, just…” Osamu swallows. “Just havin’ a hard time connectin’ the dots.”

“Hm? Oh, has the anesthesia not worn off completely yet?”

“Don’t seem like it.”

You nod a little understandingly, straightening your back until you’re fastening your hand in his. “Hmm, that makes sense. I mean, I can’t imagine what they’re pumping you up with after a broken elbow and a few fractured knuckles. - For your sake, they don’t stop too soon,”

Osamu watches you pull his good arm into your lap and hold it there like it belongs to you, and he’s definitely not gonna tell you otherwise. “Although, the quicker we get home the better. At the very least, for some proper rest-“

“Home?”

You tilt your head a bit. “Yeah home? You know, our cozy little shoebox apartment? The one your brother’s definitely not raiding for snacks while you’re gone?”

“Wait, are - we’re…?”

“Baby?”

“Baby.” Ohhkay,” Osamu blows out a disbelieving breath. “Oh, wow. I’m definitely missin’ some important information.”

You furrow as he tilts his head to scan you over a little more. “I hope I’m not misreadin’ this. An’ I hope to god I’m not. - But are we…?”

“Do you not… remember me?”

“I’m pretty beat up about it too, angel.”

“Oh.” You glance at the I.V. still hooked in his wrist. “Yeeaah, that anesthesia has not worn off yet.”

“I’m not misreadin this, right?”

“No. No, you’re not, honey. You’re not.”

“Aye so,” He lifts himself more properly on the hospital bed. “What… the hell does a scrub like me gotta pull off to bag a dime like you, angel? Askin’ that honestly.”

And it looks like an effort not to full out laugh at the genuine confusion on his face. “Straight to the point, huh?”

“I mean, when a guy wakes up to a girlfriend like-“

“Wife.”

“Wi-“ The way he all but gasps to himself has you full out giggling before you can stop yourself. “Yer lyin! Ma wife?!”

The little (see: not little) rock you wave on your ring finger is enough to turn him all but blue, especially when you reach forward to gingerly unveil the matching wedding band hanging from a chain under his hospital gown. “Your wife, baby. Made me a Miya not even a year ago.”

Osamu quietly repeats the admission under his breath as he takes a moment to digest that.

And then he’s turning to you fast enough to break the sound barrier. “Can I kiss ya’?”

You chortle as you lean in, gentle mint pervading his nose. “You’ve been kissing me, baby.”

Osamu’s putty when your lips meet.

Yeah, there’s no way he didn’t die and go to heaven.

reblog for a warm bowl of soup 🍲

How to Go To a U.S. Hospital in 2022

Welcome to the hospital. You may have heard that we're understaffed. We are. We are no longer in a position to live up to the hospital experience you had back in 2019.

This post is about how to get the best possible care despite these trying times. Much of it is also applicable to long term care facilities and other institutions who are running on empty.

The Emergency Department

Consider: Do you have to go to an emergency department to get the care you need? If you need a prescription or a covid test or an inhaler or an x-ray or a STI test or basic diagnosis and otherwise you're probably fine, go to your doctor, a quick clinic, or an urgent care. You will not get care faster in the emergency room. I promise. Go to the ED if you are reasonably sure you would die or lose a limb if you didn't.

The ED is not first come first served. People who are going to die if they are not seen get seen first. If you are stable, even if you are in pain, be prepared to wait. At the height of covid we had stable people waiting for over 24 hours in the waiting area. We also cannot legally tell you to go somewhere else, even if we're pretty sure you're not sick enough to get seen anytime soon.

Bring your home meds. You are going to be there a while and you might not get in a bed in time to get your next dose. Even when you do, it takes a long time for a doctor to order your home meds. We never intended you to stay here for 4 days, so the infrastructure isn't there. Also, bringing your home meds is going to save you money.

RE: the above- tell us what you're taking, when you're taking it. We do want to know that so we don't give you anything that would interact with it. We also really want you to keep taking your home meds so you don't get worse.

Bring a charging cord for your phone, a change of clothes, a book, and if the visitation rules allow, a friend. You're going to be here a while.

The Emergency Department is designed to figure out what's wrong with you and do things that will save your life or help you leave the ED without having to get admitted. Sometimes the ED will treat pain, but each pain medication dose is ordered separately, so it's probably not going to be on the time scale you want or need. I hate to say this, but do keep asking. We have been really conditioned to assume if you stop asking, you're not in pain anymore.

If they tell you not to eat, or not to take a certain med, follow that advice. I know you've probably been there for a while and no one's told you why you can't do these things. That's not great. Ask why if you can, but assume the request is legit.

In order for you to be admitted, you need to be sick enough that they can't just kick you out with a cab voucher, a prescription, and a turkey sandwich. That's pretty dang sick these days. Pretty much, you have to be in danger of dying or losing a limb if you don't get admitted. And also, a bed in the hospital has to become available that can accommodate your needs. This usually means someone else has to get discharged or die. That might take a while, because they were just as sick as you when they came in.

The Hospital Floor

So they decided to admit you, a bed became available, and transport finally showed up to take you to your new bed.

Bring the following: A charger for your phone (I know you'd think we have these, but I swear we don't- they've all been stolen). If you smoke, bring nicotine lozenges or gum (you can't smoke or vape here. We have patches, but if you wait until you need a cig, it's too late for a patch to work, and if you try to sneak out most places will not let you back on the floor and you'll have to go back to the ED). If you have heartburn regularly, bring tums (we can order you tums, but you'll only be able to take like 1 every other hour, and let's be honest, if you use tums you usually need more than that). If you take a weird med, bring it (especially HIV drugs, chemo drugs, and meds for autoimmune conditions, because it takes forever to get some of these because we don't always have them on site). If you have severe allergies, consider bringing your own food. Seriously.

RE the above: Tell us what you're taking, when you're taking it.

Do not bring narcotics. There's too much liability on our end. Both because we cannot control how much you take if they are in your possession and if we find them we have to call security to watch us count them and store them in a locked drawer and which will be destroyed in 30 days if you forget to ask for them on the way out. It's just a hassle and someone is always in danger of getting sued over it.

If you drink more than 4 drinks a day, or use street drugs, tell us. Tell us please please tell us. We will not tell the cops. If we know, we will then be able to ask you questions about your withdrawal symptoms and can give you meds to control them. If you wait until you start swinging at us and having seizures we will not be happy.

Also, if you're on MAT, tell us. We don't automatically re-order suboxone or vivitrol like we do other meds. Addiction med has to be consulted, come see you, and work miracles to get that ordered for you while you're in the hospital.

If you see pain management, tell us as early as you can. Pain management has to be consulted and then work absolute miracles to get the admitting providers to order your home regimen, because anything more than 10mg of oxycodone every 4 hours is terrifying to them, even if you take 160mg of methodone everyday at home without a problem. The sooner they know you're here, the less likely you'll be miserable for a week before those things can be re-ordered.

Also, bring a friend. Seriously. I'm not kidding please bring a friend who is willing to help take care of you- things like turn you, help you dress, feed you, hold your hair back when you puke, and change your sheets when you pee the bed. And please bring someone you feel will follow the rules and ask before getting you something. You don't want to stay longer just because your friend brought you food you weren't supposed to eat because they felt bad for you.

A scheduled event is not really scheduled. Yes, you might have been told that your surgery is scheduled for 8am. You might have been told your dialysis was going to be "this afternoon". These things are not set in stone, and unless you are literally and currently dying, nothing is happening "right now". I have watched people wait days for appendectomies, gallbladder removals, displaced fractures, and other urgent-but-not-immediately-life-threatening problems. All a late intervention means is that someone else would have died if they did it as scheduled.

MOVE. Barring an unstable pelvic fracture or two broken femurs, if you can get out of bed and walk around, walk (ask your nurse if they want you to ask for assistance when you get out of bed to prevent falls). If you can't, sit up in a chair for part of the day. If you can't do that, move around in bed- roll back and forth, bend your knees, point your toes, do anything to keep you moving. If you're in pain, take pain medication strategically and move when it's most effective.

6:30 to 9:30, day or night, is the worst time period to put your call light on. Report time is 7 o'clock, meaning we have about a half hour to learn about our patients and set up our day, after which we have about 15 mins allotted per patient to assess the person, discuss goals for the day, find and pass daily medications, get vitals and blood sugar if applicable, and do anything the patient needs to get them set up for the day (water, pain meds, set up tray/feed, toilet, etc...). Put it on if you need to, but know that it will take a lot longer to be answered during these time periods than any other time of day.

You can refuse anything you want to refuse. You just can't sue us about it later. You can even say "I know you told me to do this thing, I am not doing it, please document accordingly". We will probably try to explain the consequences of not doing the thing. I recommend you listen, but the choice is certainly and always up to you.

You can leave against medical advice. It is also a thing you can do. As long as you let us tell you the risks, you can leave with prescriptions, education, and a wheelchair ride to the front door if you care to stick around for an hour or so after you declare you would like to leave. Some insurance companies have rules about this, which you can find by calling them. Just call and ask "what are the consequences of leaving against medical advice?" Some insurances don't have any consequences, some will completely refuse to pay for the stay, and some will refuse to pay for a second ED trip or admission within 30 days for the same problem.

Our prioritization system is: Critical (CPR, evaluating changes in status, dealing with changes in vital signs) Urgent (bed change for incontinent patient, pain/nausea/time-sensitive meds, drawing stat labs, answering phone calls from doctors, etc..) Routine (scheduled meds, scheduled assessments, calling family members, basic comfort things, ambulating patients, education, etc..) and Extra (everything else that has to do with comfort but isn't necessarily going to change outcomes).

I have had whole shifts where I don't do anything that isn't critical or urgent (with one routine med pass that was really late). I've rarely had a shift in the last 3 years where I've been able to do anything extra.

We're doing our best. Seriously. Nearly every shift I've worked has been absolutely flat out for 12 hours, and it takes a solid 2 days actually to recover from 2 days in a row of work. I would say I rarely get a full lunch break. Our patients are more and more complicated, and the decisions higher and higher stakes. Please understand. If you or a loved one hasn't been seen by the nurse in a few hours, it just means we're not as worried about you as the person down the hall who keeps trying to die.

We wish we could give you 2019 care. We really, really do. We don't have the resources for that anymore. We are triaging. The hotel vibe they were trying to present in 2019 is in the facility design only. You have to bring your own bells and whistles. You have to help us help you now.