Bashir. Julian Bashir.

I follow our INR patients on coumadin on a weekly to monthly basis. There was one patient, Randy, who was never quite compliant, but was always cheerful and friendly. 

Randy liked his drinks, and would joke when his INR was too high or too low that it “must be the whiskey”. Randy was on warfarin because of a heart valve replacement about 10 years ago. In the beginning, I always chastised him - nicely - to not drink and to do better to have his INR taken when I told him to take it. But overall, he was not a difficult patient and I always looked forward to getting to talk with him.

On one of our monthly calls, he had a congested cough, and I heard his wife gasp in the background. He was saying, “No, no, don’t tell them.” and his wife took over. 

“Randy is coughing up blood off and on for weeks now! And he won’t tell the doctor because he doesn’t want to have to take time off work.” 

Rightfully concerned, we made an appointment to see him in the office that week. The doctor ordered an urgent CT scan, only to have it denied by Randy’s insurance. 

Really?! You’re going to deny a CT scan of a man with a mechanical heart valve who’s coughing up blood? Insurance drives me mad. 

After two weeks of appeals and peer-to-peer calls, the insurance finally let us move forward, and he got his CT. I came in the next morning to a flurry of messages in my EMR - radiology apparently hadn’t been able to get ahold of the physician, but there was a problem with the valve and the troubling signs of the beginning of an aortic dissection. The back up doctor called the patient at 5am and urged him and his wife into the ER. 

I checked the chart and saw, thankfully, Randy had followed advice and gone to the ED. Reading through the ED notes, it looked like there were no beds available in the hospital, so he was being held in the ED to await workup with the heart team. I felt anxious and checked his chart every couple hours for updates, along with our physician who called the ED docs for report a couple times that day. We both lamented that it was terrible he had to sit in the ED because of a lack of ICU beds - he should be in surgery already! My doc decided to ask them to transfer to another hospital, but got roadblocked at every turn.

And then…at 3pm that day, I went to check his chart again, and received the notification - “You are entering the chart of a deceased patient. Would you like to proceed?”. I instantly clicked “no” - I must have clicked the wrong Randy!

Typing in the info again, I again got the warning, and my heart sank. 

Randy’s pressure had been climbing, and despite repeated administrations of IV beta blockers, they couldn’t get his pressure down. He gasped, screamed, and began to code. The team knew he’d fully dissected. In less than two minutes, he went from v. fib to asystole, and in less than 15 minutes, they called time of death.

I was mad for days. I still am mad, and that’s part of why it took me months to write this. At every turn, if something had gone better, he’d likely still be alive. 

If he’d told us sooner. 

If his insurance hadn’t denied and fought us for the CT. 

If our CT availability hadn’t put him off two more days.

If the physician could’ve been reached immediately. 

If the hospital would’ve had available beds.

If they would’ve transferred him to a hospital that had availability.

If. If. If. 

So many of the ifs caused by a broken healthcare system in which people you’ve never met determine whether you can have the tests ordered by the physician who has known you for 15 years and went through years upon years of schooling. A system in which state hospitals are overrun with people who cannot afford primary care, often blocking access to people who need it most.

“bro, you look so cute right now. dude, you are so fucking adorable.”

“wanna watch this murder documentary with me?”

“i may act like i’m sassy but if you’re mean to me there’s a 900% chance i’ll cry.”

“i may act like I’m clueless but actually know what’s going on at al times.”

“attention: i need attention.”

“i don’t have a nervous system. i’m a nervous system.”

“drugs? no thanks, the only ‘high’ i need is the natural rush you get from commiting a murder.”

“i think i’m subconsciously trying to ruin my own life.”

“why fall in love when you can fall on the floor and never get up?”

“i try not to sound like an asshole but it’s really hard because i am an asshole.”

“i don’t want to look ‘pretty’, i want to look otherwordly and vaguely threatening.”

“i’m the nicest, sweetest, most rage-filled person i know.”

“girls are so soft and amazing and nice and beautiful and mysterious and complex and loving and caring. i don’t remember what i was going to say but i’m just gay.“

“i’d love to relax but that’s just not realistic.”

“contrary to popular belief i’m actually soft and have feelings.”

“this could be less hetero.”

“to be honest i just need a hug.”

“why can’t I be mentally chill instead of mentally ill?”

“this is it, this is how i die: lack of attention.”

“are we just friends or is this flirting serious?”

“i have this problem where i isolate myself from civilization and then get upset because i’m lonely.”

“i may be ugly but at least i have an ugly personality too. consistency is key.”

“i don’t wanna get involved in drama i just wanna know 103% of the information on what happened.”

“i am bysexual as in i’m not interested, goodbye.”

“i could win an olympic gold medal in being ignored.”

“fill your heart with bees. if someone breaks your heart then they have to deal with the bees.”

“i’m so tired of not being a multimillionaire.”

“i panic a lot of other places besides the disco.”

“which layer of hell do you think you’re going to?”

“my kink is being right.”

“my kink is being home alone.”

“you’re really sensitive for a selfish asshole.”

“i can tell myself to be heartless but in all reality, i have a big heart and can’t treat people badly, that’s just not me.”

“what about netflix and kill?”

“no offense but why does everyone hate me?”

“i’m a strong independent introvert who don’t need no social life.”

“why do i get struggles instead of snuggles?”

“if a conversation goes on too long without being about me, i’m out.”

“i’m small, queer and something to fear.”

“all this sadness is bad for my skin.”

“i’m cute and perfect but also unstable, violent and self-destructive”

“i’m beautiful and underappreciated.”

“she’s beauty, she’s grace, she’s me.”

“sorry for being awesome, loser.”

“I’m sorry Iyelled at you…” Garak says. They’ve been laying together inJulian’s quarters, Julian reading in silence while Garak lays onJulian’s abdomen.

Julian runs fingersthrough Garak’s hair. “You were dealing with a lot. The implantmade you not yourself.”

Garak leans into thetouches, making a low purr. “You have an excellent bedsidemanner.”

“I like tothink I can handle difficult patients.” He cups Garak’s cheek.“How are you feeling now?”

“Better,”Garak admits. “Those lights are still too bright.”

“And I expectthe station is too cold.”

“Mhm. Thoughyou, dear doctor, are enticingly warm. I find myself unable to move.”

Julian sighs andscratches at the nape of Garak’s neck. “You’re a flirt, Garak.”

“I didn’t meanto sound so flirtatious,” Garak says. “But where you’rescratching is just as much an act of seduction.”

“Would you likeme to stop?”

“Not at all,”Garak says.

He could have purred at that moment, but he instead curled in closer with his thin knees, at once so tall and yet so small.

“Hm…”

Julian wasn’t convinced, not fully, at least not for himself personally. Kids were cute and all, but…

He’d mess them up, somehow.

Besides, who knows how his edited genome would spread.

But then there was the awful loneliness, even when his bed was warmed by another.

“It does seem a tad scary…” Julian breathed.

“I suppose you’re right...” he sighed, “It takes a village, after all.”

The station seemed to be one hell of a village.

It was better to allow vomiting in this case, especially since he’d just fixed up a bit of internal bleeding, and it was all good and well to get whatever remaining blood out of his system.

Bashir wiped off Miles’s face once again, taking particular care around the lips, which he had to disinfect once again…

“This may sting…” he warned, getting into the crevices of the injury with extreme care, wiping the vomit from open wounds. God, this man was in a sorry state!

The doctor signaled for a simple electrolytic solution to be made, and quickly offered the pale yellowish fluid to the poor man.

“Here, if you can manage to swallow this, it’ll stop the shaking,” Bashir informed, “I’ll have to mend your lips and fingers before I can let you lay down for a while.”

He was a strong man, he could hold out for a little longer.

He was quick to fix the other man’s fingers at last, the procedure perhaps even more delicate than the nose. They were shattered almost completely.

This is a really good article about how quickly people actually die from cuts and punctures inflicted by swords and knives.  However, it’s really really long and I figured that since I was summarizing for my own benefit I’d share it for anyone else who is writing fiction that involves hacking and slashing your villain(s) to death.  If you want the nitty gritty of the hows and whys of this, you can find it at the original source.

…even in the case of mortal wounds, pain may not reach levels of magnitude sufficient to incapacitate a determined swordsman.

Causes of death from stabs and cuts:

massive bleeding (exsanguination) - most common

air in the bloodstream (air embolism)

suffocation (asphyxia)

air in the chest cavity (pneumothorax)

infection

Stabbing vs cutting:

Stabbing someone actually takes very little force if you don’t hit bone or hard cartilage.

The most important factor in the ease of stabbing is the velocity of the blade at impact with the skin, followed by the sharpness of the blade.

Stabbing wounds tend to close after the weapon is withdrawn.

Stabbing wounds to muscles are not typically very damaging.  Damage increases with the width of the blade.

Cutting wounds are typically deepest at the site of initial impact and get shallower as force is transferred from the initial swing to pushing and pressing.

Cutting wounds have a huge number of factors that dictate how deep they are and how easily they damage someone: skill, radial velocity, mass of the blade, and the size of the initial impact.

Cutting wounds along the grain of musculature are not typically very damaging but cutting wounds across the grain can incapacitate.

Arteries vs veins:

Severed veins have almost zero blood pressure and sometimes even negative pressure.  They do not spurt but major veins can suck air in causing an air embolism.

Cutting or puncturing a vein is usually not fatal.

Severed arteries have high blood pressure.  The larger arteries do spurt and can often cause death due to exsanguination.

Body parts as targets:

Severing a jugular vein in the neck causes an air embolism and will make the victim collapse after one or two gasps for air.

Severing a carotid artery in the neck cuts off the blood supply to the brain but the victim may be conscious for up to thirty seconds.

Stabbing or cutting the neck also causes the victim to aspirate blood that causes asphyxiation and death.

Severing a major abdominal artery or vein would cause immediate collapse, but this takes a fairly heavy blade and a significant amount of effort because they are situated near the spine.

Abdominal wounds that only impact the organs can cause death but they do not immediately incapacitate.

Severing an artery in the interior of the upper arm causes exsanguination and death but does not immediately incapacitate.

Severing an artery in the palm side of the forearm causes exsanguination and death but does not immediately incapacitate.

Severing the femoral artery at a point just above and behind the knee is the best location.  Higher up the leg it is too well protected to easily hit.  This disables and will eventually kill the victim but does not immediately incapacitate.

Cutting across the muscles of the forearm can immediately end the opponent’s ability to hold their weapon.

Cutting across the palm side of the wrist causes immediate loss of ability to hold a weapon.

Stab wounds to the arm do not significantly impact the ability to wield a weapon or use it.

Cuts and stab wounds to the front and back of the legs generally do not do enough muscle damage to cause total loss of use of that leg.

Bone anywhere in the body can bend or otherwise disfigure a blade.

The brain can be stabbed fairly easily through the eyes, the temples, and the sinuses.  

Stabs to the brain are more often not incapacitating.

The lungs as targets:

Slicing into the lung stops that lung from functioning, but the other lung continues to function normally.  This also requires either luck to get between the ribs or a great deal of force to penetrate the ribs.

Stabbing the lung stops that lung from functioning, but the other lung continues to function normally.  It is significantly easier to stab between ribs than to slice.

It is possible to stab the victim from the side and pass through both lungs with an adequate length blade.  It is very unlikely that this will happen with a slicing hit.

“Death caused solely by pneumothorax is generally a slow process, occurring as much as several hours after the wound is inflicted.”

Lung punctures also typically involve the lung filling with blood, but this is a slow process.

The heart as a target:

I’m just going to quote this paragraph outright with a few omissions and formatting changes for clarity because it’s chock-full of good info:

…[stabbing] wounds to the heart the location, depth of penetration, blade width, and the presence or absence of cutting edges are important factors influencing a wounded duelist’s ability to continue a combat.

Large cuts that transect the heart may be expected to result in swift incapacitation…

…stab wounds, similar to those that might be inflicted by a thrust with a sword with a narrow, pointed blade may leave a mortally wounded victim capable of surprisingly athletic endeavors. 

nsfw meme | Accepting | @mydeardoctorbashir​

Of course, like intimate relations with Bolians, their medication also did result in some nausea...

He quickly took to fiddling with the insides of his pockets.

Julian rolled his eyes for emphasis, his hands fluttering out to remark upon how lovely that mouth felt around him...

“But he had a few...guests with him...and let me tell you about the company Morn keeps--I had no idea he was so popular!” 

He quickly took to fiddling with the insides of his pockets.

He quickly took to fiddling with the insides of his pockets.