April's Fool

Conservatives are suddenly angry that Green Day doesn't like Trump.

Some conservatives never really picked up on that subtle undertone.

Anyway, here's a link to an article.

It's very good, and was prescient for a lot of the early days of the covid pandemic. I found myself returning to it often in the first couple of years because of how steadfast it was in its hopefulness.

Last year she wrote a novelette, "The Year Without Sunshine," which attacks a similar problem in a similar way; instead of pandemic, this one is about the aftereffects of a distant nuke or a massive volcano explosion (it doesn't say), which has churned a great deal of dust into the air, causing massive damage to society and agriculture. The story covers one neighborhood, pulling together to keep each other alive--not through violence, but through lawn potatoes and message pinboards and bicycle-powered oxygen concentrators.

If you are a writer or work with documents in any way, STOP USING GOOGLE DOCUMENTS. Go and write in your PC and don't save it to your cloud, save it to your hard drive, that you have, in your house. If you have a tablet or mobile, install Collabora Office which is a version of Libreoffice that allows you to save locally, in the memory of your tablet.

Don't save your life inside Google Drive. Use it, if you must, to share work stuff, but save your personal files in your hard drive or flashdrives, away from any fucking "cloud".

If you have a Chromebook I don't fucking know, burn it.

i personally use Syncthing between my windows desktop, android phone, and linux laptop and have never had even a little issue. a jailbroken microsoft office copy lets me keep all my files locally and has more features than google's dogshit editing software, but libreoffice is probably better for most people.

if you don't have the wherewithal to set up syncthing (or the ios port fsync, but if you're using ios you have a whole parallel set of problems and should probably see above for chromebooks) Proton has its own whole ecosystem of secure sharing tools.

And then do it again, and again, and again.

in love is just choosing love

over and over.

‘The injury happened close to me. I kept playing at first because I didn’t think it was that serious,’ said Morena, whose Brazil side ended up beating Angola 30-19.

‘Albertina is a friend of mine for many years. We both play in Romania. There was no way I couldn’t help her, because I knew it would be very difficult for her to leave the court.’

Brazil’s Tamires Morena and Angola captain Albertina Kassoma play in the same league in Romania

‘I have a special affection for her. I respect her work a lot.’

Asked what was said in their brief exchange after the gesture, Morena said: ‘She said, ‘thank you very much, my friend. Only you could lift me up. I was very hurt’.

"“What have you done?” the king said, when at last the princess ran out of words. “Seven save us, what have you done? Have you given one of these boys your maidenhead? Tell me true.” “True?” said Saera. It was in that moment, with that word, that the contempt came out. “No. I gave it to all three. They all think they were the first. Boys are such silly fools.” Jaehaerys was so horrified he could not speak, but the queen kept her composure."

"Princess Saera might have been forgiven and restored to favor if she had done as she was told, if she had remained meekly in her chambers reflecting on her sins and praying for forgiveness. [...] The king was angry and unyielding, for his shame was deeply felt, and he could not forget Saera’s taunting words about his uncle’s wives. “She is no longer my daughter,” he said more than once."

"She [Saera] would never be a septa, much less a silent sister, but she required punishment, and it was thought that a few years of silent prayer, harsh discipline, and contemplation would be good for her, that it would set her on the path to redemption. [...] All this she suffered, for a year and a half...but when her chance came, in 85 AC, she seized it, fleeing from the motherhouse in the dead of night and making her way down to the docks. When word of her flight reached King’s Landing, it was assumed that Saera would be hiding somewhere in Oldtown, but Lord Hightower’s men combed the city door to door, and no trace was found of her. [...] The truth did not come out until a year later, when the former princess was seen in a Lysene pleasure garden, still clad as a novice. Queen Alysanne wept to hear it. “They have made our daughter into a whore,” she said. “She always was,” the king replied."

Everything I learn about RFK jr is

1) against my will

2) absolutely banana-pants bonkers

@irrellavant oops you activated my trap card of asking about something I care about, please enjoy this monologue. Also it’s not comprehensive, can’t stress that enough, this is a just a lil long tumblr post made by a just some nurse who isn’t a palliative care expert and is also writing this on her cell phone on break. Some of this stuff is gonna be pretty obvious! I just would feel remiss if I left it out. And also please anyone who has pain or addresses pain, please feel free to add on. I'm always looking for new ideas and new insights, especially from the patient side so please please do chime in if you like. Okay SO

For me, the biggest thing is conveying to the patient that you care that they are in pain and that you are trying to make it better. I remember I had a patient who was in horrible pain all night, we never got it down, we never got her comfortable, but at the end of the night she thanked me so sweetly for trying and she said that knowing I was taking her pain seriously helped her feel better even if it didn't make her hurt less. Just because someone is in pain, it doesn't mean they have to suffer, if that makes sense. I think one of the worst things about pain in the hospital is the feeling that you've been abandoned to experience it. Someone gives you a pill (or not even that) and says "okay bye" then you go back to writhing in agony. I make sure that before I leave the room of a patient who is still in a pain crisis, that I let them know what the plan is and what the next step is. "You just got 5 mg of oxycodone, which will take up to an hour to take full peak effect. If your pain doesn't get better after that hour, I can give you another dose" or "I'm going to go page your doctor to see if I can get you an additional dose" or "I need to step away right now, but I'll be back in 20 minutes to see how you're doing and if the heating pad is helping." I tell the patient "we're gonna try X, which should do Y, but if it doesn't, the next step is Z” and then I make sure to follow up with them.

I also try to be honest. I never promise that they'll be pain-free, just that we'll keep trying. We aim for small but achievable goals. If it's acute pain, like you just had a surgery or something, I try to contextualize it for the patient. "We're not gonna get you pain-free ten hours post surgery, but we can get you more comfortable than you are right now." Patients are usually fine with being a six outta ten pain if they’ve been otherwise sitting at a nine. Since I’m night shift, I often tell them my goal is for them to get at least a couple hours of sleep and ask them how that sounds.

Then pharmacologically, I look at the meds I do and don't got. If a patient is having incisional pain, lidocaine patches on either side can be great for just numbing the area up. If the patient can get oxy every 6 hours but routinely gets very painful again just three hours after taking the med, then maybe the dose or the timing is not right. Maybe under prns we've got so many opioids and not a single NSAID, and there's not a contraindication. Maybe their pain is caused by muscle spasms, in which case a muscle relaxer could be a great addition. Maybe the pain is nerve pain that would respond much better to gabapentin instead. Or maybe you need IV dilaudid to quickly get the breakthrough pain down to a manageable level so that the other meds have a fighting chance to do anything. If meds aren’t available, these are things you can page the doc about and discuss with them.

I'm also a big fan of around the clock medications for patients that have had poor pain control. Ask patients if they want to be woken up for pain meds (again, patients that have been that painful usually say yes). Explain how it's easier to keep the pain low than it is to play catch up after pain spikes. Pain control works best when you avoid the spikes in the first place. There's no point getting someone out of a pain crisis if you then withdraw all your cares until they're in a pain crisis again.

I also try plenty of non-pharmacological methods of lowering pain or enhancing comfort. (Sometimes you can't lower pain! Sometimes all you can do is enhance comfort!) Does the patient have a topical cream that helps with pain? Could it be applied while gently stretching the muscles and really going to town with a foot massage? Has the patient just thrown up and would like a bed bath to feel clean again? Would they benefit from heat? Or ice? Or warm blanket? Ice and then on top of that a warm blanket? Do they want some pudding? Do they need a little candy from the nurse station candy drawer? If their lower back hurts from being in bed so long, can we get them out of bed? Even if it's three am and we need to lift them with a Hoyer to their recliner, that might still be the best intervention. I had a patient where the only thing that helped her hip pain was going on walks so over the night we went on a bunch of walks. Worked better than any meds.

What about conversation? Do they need someone to cry with? Do they want to talk about pets or their diagnosis or the bizarre TLC show that's playing on the TV? A lot of this is feeling out conversation, and I don't have great advice for that besides if you make yourself obviously available and interested in people, they tend to open up to you.

Also I’m a big fan of asking if there’s anything I can do while we wait for the meds to kick in. That’s usually when I do a bunch of those non-pharm interventions, because it’s efficient (we are in fact waiting for the meds to kick in) and it makes the waiting less miserable. I think it also makes the waiting feel less helpless. We aren’t just waiting an hour for the dilaudid to do something, we’re also tucking you in with a warm blanket and giving you the finest jello I could scrounge up.

And obviously, I ask the patient if the pain they're currently feeling is uncommon for them, either in the type of pain or the intensity. This is good for general assessment stuff and to figure out if the pain itself is the problem to be managed or if there's something new causing the pain. If the cause of the pain can be managed, that's my priority with pain medication as a supportive therapy because like if you're a paraplegic and suddenly you're complaining of an intense pounding miserable headache, giving tylenol isn't the right intervention when what I should be doing is assessing for autonomic dysreflexia.

And I ask them about the type of pain they're having and if they know what works for them to manage it. Plenty of chronic pain patients can tell you what is and isn't effective. Maybe at home they're on 50 mg of oxycodone a day, but right now in the hospital they're only prescribed 40 mg. Or hell, they're still getting 50 mg but they're here because they’re sick so their baseline level of opioids isn't gonna be enough because that's to manage their every day pain and not their new super hell hospital pain. Or they know aspercreme works like a dream on their legs but not on their back. Or patients know that ibuprofen works better for them for this type of pain than a fentanyl patch does, or they don't want to take dilaudid because it makes them nauseated, in which case you can try premedicating them with an antiemetic.

Also when your shift is done, write down all the stuff that worked to control pain in your nursing note so there’s a record of it in case someone needs to do it again.