abscessing

dizzy had surgery today!!!! all went well. 3 of the 5 abscesses were removed with the capsules. 2 were left open bc the capsules were right over her jugular. stitches to be removed in two weeks, right after i get back from singapore. please keep us in your thoughts!!! hoping for a smooth and speedy recovery. stressed that i will be gone 9 days……

‘Learning Russian has given me a whole new life’ Mary Hobson: It took me about two years [to read War and Peace]. I read it like a poem, a sentence at a time. English writer and translator Mary Hobson decided to learn Russian at the age of 56, graduating in her sixties and completing a PhD aged 74. Now fluent in Russian, Hobson has translated “Eugene Onegin” and other poems by Pushkin, “Woe from Wit” by Griboyedov, and has won the Griboyedov Prize and Pushkin Medal for her work. RBTH visited Hobson at home in London to ask about her inspiring experience. 

RBTH: Learning Russian is difficult at any age, and you were 56. How did the idea first come to your mind? 

 Mary Hobson: I was having a foot operation, and I had to stay in bed for two weeks in hospital. My daughter Emma brought me a big fat translation of War and Peace. “Mum, you’ll never get a better chance to read it”, she said. I’d never read Russian literature before. I got absolutely hooked on it, I just got so absorbed! I read like a starving man eats. The paperback didn’t have maps of the battle of Borodino, I was making maps trying to understand what was happening. This was the best novel ever written. Tolstoy creates the whole world, and while you read it, you believe in it. I woke up in the hospital three days after I finished reading and suddenly realized: “I haven’t read it at all. I’ve read a translation. I would have to learn Russian.” 

RBTH: Did you read War and Peace in the original language eventually? 

M.H.: Yes, it was the first thing I read in Russian. I bought a fat Russian dictionary and off I went. It took me about two years. I read it like a poem, a sentence at a time. I learned such a lot, I still remember where I first found some words. “Between,” for instance. About a third of the way down the page. 

RBTH: Do you remember your first steps in learning Russian? 

 M.H.: I had a plan to study the Russian language in evening classes, but my Russian friend said: “Don’t do that, I’ll teach you.” We sat in the garden and she helped me to remember the Cyrillic script. I was 56 at this time, and I found it very tiring reading in Cyrillic. I couldn’t do it in the evening because I simply wouldn’t be able to sleep. And Russian grammar is fascinating. 

RBTH: You became an undergraduate for the first time in your sixties. How did you feel about studying with young students? 

M.H.: I need to explain first why I didn’t have any career before my fifties. My husband had a very serious illness, a cerebral abscess, and he became so disabled. I was just looking after him. And we had four children. After 28 years I could not do it any longer, I had break downs, depressions. I finally realized I would have to leave. Otherwise I would just go down with him. There was a life out there I hadn’t lived. It was time to go out and to live it. I left him. I’ve been on my own for three years in a limbo of quilt and depression. Then I picked up a phone and rang the number my friend had long since given me, that of the School of Slavonic and East European Studies, London University. “Do you accept mature students?” I asked. “Of sixty-two?” They did. When the first day of term arrived, I was absolutely terrified. I went twice around Russel square before daring to go in. The only thing that persuaded me to do it was that I got offered the place and if I didn’t do it, the children would be so ashamed of me. My group mates looked a little bit surprised at first but then we were very quickly writing the same essays, reading the same stuff, having to do the same translations. 

RBTH: You spent 10 months in Moscow as part of your course. How did you feel in Russia? 

 M.H.: I hardly dared open my mouth, because I thought I got it wrong. It lasted about a week like this, hardly daring to speak. Then I thought – I’m here only for 10 months. I shall die if I don’t communicate. I just have to risk it. Then I started bumbling stuff. I said things I didn’t at all mean. I just said anything. The most dangerous thing was to make jokes. People looked at me as I was mad. I hate to say it, but in 1991 the Russian ruble absolutely collapsed and for the first and last time in my life I was a wealthy woman. I bought over 200 books in Russian, 10 “Complete Collected Works” of my favorite 19th-century authors. Then it was a problem how to get them home. Seventy-five of them were brought to London by a visiting group of schoolchildren. They took three books each. 

RBTH: You’re celebrating your 90th birthday in July. What’s the secret of your longevity? 

M.H.: If I had not gone to university, if I had given up and stopped learning Russian, I don’t think I’d have lived this long. It keeps your mind active, it keeps you physically active. It affects everything. Learning Russian has given me a whole new life. A whole circle of friends, a whole new way of living. For me it was the most enormous opening out to a new life.

There are some smells… unique to working in healthcare. Smells that you don’t (or really shouldn’t) smell elsewhere. Once you learn what they smell like, you never truly forget.

Deal with one of them, and even when you’re home and showered, you might get the feeling you can smell it still. Even thinking about them is enough to conjure a vivid sensory memory.

I admit, I had way more fun with this series than I initially intended to. I personally have a relatively poor sense of smell, so if even I can smell something, then it must be pretty bad. Sometimes it’s a blessing. But there are some smells even I can’t escape….

Aztec burial of a sacrificed child at Tlatelolco. The exact ideologies behind child sacrifice in different pre-Columbian cultures are unknown but it is often thought to have been performed in order to placate certain gods.

The Aztecs believed that, if sacrifices were not given to Tlaloc (a rain god), the rain would not come and their crops would not grow. Archaeologists have found the remains of 42 children sacrificed to Tlaloc. In every case, the 42 children, mostly males aged around six, were suffering from serious cavities, abscesses or bone infections that would have been painful enough to make them cry continually. Tlaloc required the tears of the young so their tears would wet the earth. As a result, if children did not cry, the priests would sometimes tear off the children’s nails before the ritual sacrifice. (Source)

Dear Trump Administration

Hello Mr Ryan, Mr Trump, and whomever else this may concern.

(And, if you are an American of any stripe, then as it turns out it also concerns you.)

I am a family physician. I interact with your constituents all day, every day. I hear about their problems, their struggles, and often the limitations they face regarding healthcare. I try to help them when I can. That’s my job in a nutshell.

So let me tell you about one of your constituents who also happened to become my patient. Let’s call him Bob.

Bob is a middle aged man who worked full time at an entry level manual labor type job. The kind of job you spend 40 hrs/wk working but still hover around the poverty line. The kind of job with no benefits. He didn’t go to the doctor and had no health insurance but as far as he knew he also didn’t have any health problems. Until one day he started feeling unwell. This persisted for a few days and he refused to let his wife take him to the doctor. He was worried about the cost and figured he’d get better in a few days anyway. Only he didn’t. He got worse and his wife called an ambulance.

Enter the healthcare system.

Actually, let’s skip ahead to the final diagnosis. Bob has type 2 diabetes. Newly diagnosed. Easy. Boring. Right? Except Bob clearly had diabetes for some time, unbeknownst to him. When he arrived in the Emergency Department he was in septic shock. He was riddled with large abscesses in his internal organs and soft tissues. Both his lower limbs were necrotic. He had osteomyelitis in multiple locations. What’s really amazing though is that he lived. He had both his legs amputated below the knees and was hospitalized for weeks. All told he had 8 or 9 surgeries. He required weeks of additional IV antibiotics. But he ultimately got better. And his diabetes is well controlled now on pretty minimal medication.

During his hospital stay he was enrolled in Medicaid which, fortunately, will pay for all this medical expense. So let’s look at this from an economic perspective for a quick minute. This is a man who very quickly racked up hundreds of thousands of dollars of medical bills for which the government will pay. He is wheelchair bound now and on disability, again on the government’s tab. He will certainly have additional complications during his lifetime including pressure ulcers, infections, chronic kidney disease, etc. All told this one individual is costing/will cost the government millions of taxpayer dollars.

For want of a couple hundred bucks of prevention.

A routine visit to any PCP would have certainly identified his diabetes earlier and, as it turns out, he only needs like $30/month of medication to control it.

This is the tragedy of healthcare in America. That few hundred bucks of prevention is the ‘entitlement’ you and your fellow Republicans want to remove. This is of course saying nothing of the great personal cost to Bob in terms of his quality of life, physical, and psychological well being. Your bill that was withdrawn on Friday was nothing short of an abomination. Now, you might say I have chosen an extreme example to make a political point. Only I haven’t. I have multiple Bob like patients. Ask any PCP, especially in rural and urban underserved America. I promise you they will all know Bob. They will all have multiple Bobs on their panel.

Obamacare is not perfect, but it is progress. You must understand that prevention is cheap and to continue to make progress Obamacare must be augmented and refined, not ‘repealed and replaced’. Anything else is a complete affront to the American people. So please, cut your political BS and draft some useful legislation with input from actual physicians and other folks who understand that yes, healthcare is complicated. Perhaps you could ask Mr. Obama for some tips.

Memento mori,

Hostile Shrubbery

2

PLEASE make sure to regularly check your pet’s toenails! This dog’s owner had not realized that the dewclaw was curling around and growing into the paw pad. It embedded a full centimeter into the pad, causing an abscess and severe pain in the area. It would have taken weeks to get to that point. Antibiotics and pain medication are the mainstays of therapy.

Nail trims are especially important in any dog with dewclaws, cats with extra toes, and senior pets whose nails do not get worn down as quickly anymore. I see this problem most often in ancient cats.

4

Getting to help stitch up a cheetah @ethicaltaxidermy is mounting for the Booth Museum! This cheetah died of abscess in her spine and jaw back in 1980, and has been sitting in a barrel in the museum ever since. Her skin is tough and brittle, as she is been in formaldehyde for 30 years - but she is looking good. So very soft too.

Temporary abdominal closure with zipper-mesh device for management of intra-abdominal sepsis. Intra-abdominal sepsis is an inflammation of the peritoneum caused by pathogenic microorganisms and their products. The inflammatory process may be localized (abscess) or diffuse in nature.

Emergency Medicine Advice

Alright, I made an advice post for Obstetrics & Gynecology that people liked, and I got requests to make more. So, here’s some of my EM advice. As always, I’m not an expert by any means and have my own problems, but these are just my reflections while on clerkships. There’s always a learning curve, so if I can alleviate some of that for others, that’s great! Let me know if these are helpful, because if so, I might go back and reflect on other rotations I’ve done and make more. Now, I rotated at a metropolitan level one trauma center for EM. So, here’s some of my advice:

1. At the start of each shift, be enthusiastic and eager. This goes a long way, and residents/attendings will be more likely to include you on cool things even if it’s not one of your own patients.

2. Let your residents/attendings know that you want to do/assist with any and all procedures. Be enthusiastic about the opportunity to do all of them! Because of this, I got to suture countless lacerations, irrigate and debride abscesses, do vaginal speculum exams, ultrasound heart/lungs/abdomen/pelvis/joints, do a paracentesis, help reduce joints, splint extremities, etc.

3. The ED is fast-paced. Your residents and attendings will be signing up for and seeing patients constantly. When you see a new patient on the board, let someone know immediately that you are going to see that patient, and jump into it! Don’t be forgotten.

4. I liked to pend labs/imaging before presenting my patient to my resident. Even if it was completely wrong, it showed that I actually thought about my plan rather than rambling things off. Also, it provided for great learning opportunities. For the times that my work-ups were correct, my residents liked that the orders were already there. Of course, if your residents/attendings don’t like this, don’t do it.

5. Also related to above, know your assessment and plan before presenting! This is the most important part of the ED. It frustrated me at first, but really you have to consider the big and bad things at all times even if it’s unlikely. For example, for chest pain, always consider ACS, dissection, pneumothorax, PE, etc. For back pain, consider spinal stenosis, cancer, aortic dissection, etc. For headache, consider meningitis, SAH, mass, etc. Even just last night, I had a patient with leg pain and chalked it up to an arthralgia… Nope, it was subtle septic arthritis. Never let your guard down, and have thorough work-ups even if you aren’t convinced by a history. Also, have an idea of what the dispo will be from the first time you see the patient. This may change as labs and imaging return, but keep it in mind.

6. Take ownership of your patients. Read their chart, and know their labs and imaging results before the resident/attending does. Update the team and keep your notes up to date with the latest plan.

7. Don’t be afraid to get on the phone for your patients. Call the lab. Call radiology. Call social work. Sign out the patients to the medicine team for admits. Your resident may do this without you, so ask to be involved if you want to practice.

8. Don’t overwhelm yourself with too many patients at first. Making quality plans for a few patients is better than making mediocre plans for many of them.

9. Check in with your patients multiple times during their stay. Did you give them pain medications? Don’t forget to follow-up if it helped. Ask if the zofran helped their nausea. Are they breathing better after a duoneb? Do they need another? Don’t forget to keep checking on vitals as well.

10. At my hospital, there were 2 rooms we used for codes/traumas. If you have a few minutes, go in there and study where things are. There were times I was asked for a stat OG tube, bougie for an airway, 4x4 gauze, scissors, etc. and it was helpful knowing where things were in stressful situations without being frazzled.

11. For the first couple of codes and traumas you see, get to know how things are done at your hospital. Once you’re more comfortable, ask your resident/attending how you can be helpful. Of course as a student, you won’t be doing anything too crazy, but you can help roll patients, hold a cervical spine stabilization, manage basic airways with supervision, and do CPR if you put yourself out there as willing to help.

12. If you walk into a patient’s room and someone looks sick-sick, tell someone immediately! Don’t take your chances, and it’s better to be on the safer side. If they look like they’re in bad shape, don’t stall the process of getting an attending to lay eyes on them and put in orders.

13. You’ll see a lot of psych crisis evaluations, social issues, and drug abuse. Check your judgement at the door, and don’t be surprised at what comes through the door. If you feel unsafe at any time, tell someone. Take threats seriously.

That’s all I can think of right now. EM is an exciting rotation, and every shift is truly different. Get as much out of it as you can, and have fun getting involved and doing hands-on things! Let me know if you have other advice as well. I’d love to hear.

Is Anyone Else-

Okay with bodily fluids but finds soggy dishes/food DISGUSTING? Plucking maggots out of a crusty wounds? No problem. Lancing a juicy pus-filled abscess? Sure! Cleaning up diarrhea or vomit with worms in it? I can do that. Getting splattered with blood during surgery? Not an issue. But touching soggy food in my kitchen sink? Noooooooooo no no no no. EWWWWWWWWW


Am I a complete weirdo or what?

Here’s a weird thing I’ve learned since I started working with the homeless:

If you want to know if someone grew up rich or poor, take a look at their teeth. 

It seems so stupid now, but before I got this job, I didn’t really think about teeth. I went to the dentist every six months. I was bucktoothed and gap-toothed as a child, so I got braces. That’s just how life worked. Almost everyone I knew had braces. By my final year of high school, my graduating class was a sea of perfect smiles. It never once dawned on me that other families might not have thousands of dollars to spend on cosmetic dentistry. In my world, if you needed braces and cleanings, you got braces and cleanings. 

In the real world, thousands of children go without those things. People who live on food stamps can’t afford fresh food every day; when you grow up poor, you often grow up with sugary snacks and beverages, which decay your teeth over time.If your tooth gets chipped, broken or rotten, it gets pulled or it stays that way, because you can’t afford to fix it. And at the end of the day, you end up as an adult with dental issues. 

If you have nice teeth, you probably don’t realize this, but we live in a world that is fucking obsessed with teeth. Celebrities have nice teeth. Politicians have nice teeth. When you picture a rich person, a successful person, an educated person, they have a full set of gleaming pearly whites. 

In our culture, we use “bad teeth” as a signal of poverty. They are shorthand for low education, for “hillbillies” with a lower quality of life. Bad teeth are not welcome at job interviews. They are not wanted in the dating scene. If you are trying to be taken seriously - at the bank, at the lawyer’s office, at your child’s school, at the doctor’s office - bad teeth will hold you back.

And the consequences go far beyond the social issues. Tooth problems are painful. When you go to the dentist every six months, cavities and issues get caught early. When you go years between visits, abscesses, infections, exposed nerves and irreversible damage have time to take root. It’s an extremely painful thing to live with, it can make eating unpleasant, and tooth infections can get into your blood steam and kill you. Teeth are a health problem, and yet we price dental care like a luxury commodity. 

So if you meet someone with crooked teeth, or broken teeth, or tooth decay, don’t stare. Don’t make fun of them. Don’t fixate on it. That person may not have grown up with the money or nutrition that you did. Take the person for who they are, not for the teeth in their mouth. 

Dental care should be a human right, just like healthcare. Let’s fight for that.

Just some friendly tips for future vet techs.....

1. Lunch will become a distant memory.
2. Your vet will throw you under the bus with clients…deal with it.
3. You will stab yourself with a needle. (Bonus points if it has lidocaine in it)
4. You will accidentally skin glue yourself to at least one animal.
5. Don’t lock your knees.
6. Keep your mouth closed when helping with an abscess.
7. Rubbing alcohol gets ink out of scrubs, hydrogen peroxide gets blood out.
8. Wear comfortable shoes.
9. Have a sense of humor…if you can’t laugh about it you will get an ulcer from it.
10. Clients are crazy…resist the urge to roll your eyes when taking history.
11. Your receptionists can make your day…or make your day hell.
12. Christmas is a magical time filled with sugary gifts from clients.
13. Those sugary gifts will disappear in ten seconds flat so get yours fast.
14. Never say the Q word (quiet) or slow.
15. Guard your pen like your life depends upon it.
16. People will ask for vet advice at the grocery store, the restaurant, Walmart…if you run into a client outside of work they will ask you vet advice.
17. Take responsibility for your mistakes.
18. There is the very real possibility your mistake will kill at least one animal during your career…learn from it and never do it again.
19. Wash your hands, wash your hands, wash your hands.
20. Become friends with the clinic cat.
21. You will have days when you can’t hit a vein, intibate a cat or place a catheter. We have all had those days. All of us.
22. Try to not cry during every euthanasia, it’s hard and sometimes certain ones hit us harder than others. But, your pain is not as acute as the owner. Sometimes they appreciate the tears…sometimes they don’t.
23. Have fun. Laugh. Tell dirty jokes (not around clients), get drunk (after work), vent, cry, and make memories.

Do you even know what time it is right now? // SHAWN MENDES

Once again I turned on my side and stared at the dark walls of our shared bedroom. We had gone to bed hours ago yet sleep just didn’t seem to succumb to me. I hated not being able to fall asleep and the hours that would be wasted by just laying there unable to get a wink of shut eye. Peeling one eye open, I checked the alarm clock. Bright green numbers of 3.12 stared right back at me. 

Flipping onto my other side I stared at the exposed back of my boyfriend. I couldn’t help but admire the flat planes of his shoulder muscles and how it dipped and curved. Lifting a hand, I gently traced a track down his spine, watching as tiny goosebumps appeared in its wake. Can’t help but to smile, I found joy in being able to produce such a reaction out of him. 

Sliding closer to him, I wrapped one arm around his waist while nuzzling my face softly into his back. I felt him move softly and for a second I thought he had woken up but when he didn’t move again, I let the thought go. I didn’t know whether it was not being able to sleep that was making me so emotional but tears sprung into my eyes and leaked down my cheeks. When I felt Shawn move again I knew I had finally woken him up. 

 "Baby,“ I heard his rough voice murmur as he turned around to face me. 

“Yeah?” I returned quietly, wishing that my voice didn’t sound as weak as I thought it did. 

 "Do you even know what time it is right now?“ Shawn drawled out to me.

 "Its 3.12,” I said quietly. He chuckled, draping an arm around my waist and pulling me closer. There was a faint light coming through the windows, illuminating Shawn’s face and I rose my hand again to rest on his jawline. Rubbing his jaw softly, i could feel the tiny hint of stubble which would be gone after his shower. Then he noticed my tears. 

 "Whats wrong y/n?“ Shawn asked immediately. 

"Nothin’. Just tired” I mumble. 

“Why were you crying then?” He asked, pressing his forehead to mine as I wrapped one leg around his legs pulling him impossibly closer. 

“Just stressed ‘cos I couldn’t fall asleep” I whisper into the crook of his neck where my head currently laid. His hand was running through my hair, whether he noticed he was doing it or not. 

 "Want me to stay up until you fall asleep?“ Shawn murmurs softly. 

"You have to go to the studio in about-” I look at the clock, “4 hours" 

"I don’t mind baby, I want to make sure you get some rest” our gaze meets in the dim lighting. 

“Will you sing to me?” I ask shyly tucking my head in his chest again. 

 "What song?“ Shawn asks, his fingers still tugging my hair gently. 

"Bad reputation” I answer immediately and Shawn chuckles at my immediate response. 

“Anything for you” he says and I feel myself fall into the black abscess of sleep as his voice softly fills the room. “She’s got a bad reputation..”

Originally posted by mercyshawns

So last night I was working and one of my patients (who’d come in to have an abscess on her back surgically drained) had an order for nursing to do her PM dressing change.

That’s a fairly normal order, and the resident who placed it even left me some instructions- something to the effect of: “Remove and replace kerlix dampened with normal saline BID.” And I’m thinking “score!” cause usually when there’s a dressing change order its something nice and vague, like “nursing to do PM dressing change,” meaning the nurse needs to just go ahead and reverse engineer whatever creative wound filling/covering the medical student came up with that morning.

So I get me some kerlix and dampen it with saline and start removing this lady’s packing. It goes pretty deep- like the incision is only a few inches long, but I’m pulling half a roll of kerlix out and there’s still some in there. So I keep pulling it, and finally its all out and I’m ready to inspect it and re-pack.

Imagine my surprise when, upon looking at the base of the wound, I find not fat or granular tissue, but a kidney.

I was literally, with no warning, in a lady’s abdominal cavity. No evidence of dehiscence, no note saying “Early April Fool’s!”, no heads up from the docs or offgoing nurse. Just a kidney.

Ya don’t see that every day.

Grey Fox Skull, from an old individual. Most of his teeth were worn down to the very jawline, and the rest still intact are very worn and/or rotten. Some of his back molars have cracks and holes in them. 

One of my local friends trapped this fella and when he was caught we assumed he was stung by a lot of bees as his muzzle and face were all swollen. The swellings were actually his abscessed teeth. When I got his head to process, he had a lot of puss laden swellings along his gum line. I’m surprised it didn’t harm the bone beyond the teeth as much, although it is more thinned out along there. 

Don’t know how he managed to survive so long with such painful teeth and barely even having them in place. 

He needs to be cleaned better, as he’s got some of that waxy stuff in crevices, I just have not got around to it yet. 

professionaltrash101  asked:

Hi! First, I want you to know I absolutely love this blog. It's super helpful! Anyway, I wrote an ask in November, but I'm assuming tumblr ate it. So here is it: I have a character who has burning hot pokers/nails purposely thrust into his eyes to blind him. I was wondering what this would entail. Would the skin around the eyes be burned? What would his eyes look like afterwards (is it possible any of the eye is left)? Could this cause brain/nerve damage other than rendering him blind?

Content warnings: Burns, eyeball injuries, infections, precious bodily fluids

Oh my gods. I’m so, so sorry for your delay! And I feel even guiltier because Oscar the Grouch is my absolute favorite character and I let him down. Seriously, I love your avatar.

Okay, enough fangirling! THE BUSINESS BEGINS NOW!

I’m EXTREMELY GRATEFUL for the fact that my image search came up with 0 actual images of eyes burned with hot pokers (the things we do for love!) and my PubMed search came up with no case reports or publications of any kind, so we’re in kind of open territory: do what feels right and what feels real.

The skin around the eyes would definitely be burned, because I don’t know of anyone cruel enough to poke someone’s eyes out with a hot poker and yet “kind” enough to try to spare the surrounding tissue, so as the victim struggles, the poker will likely sear the surrounding flesh.

I don’t exactly have a data set on “individuals with eyes burned out by a hot iron”, but I would imagine that the eye itself is mostly gone. They can melt and rupture, and whether that’s “true” or not, it’s believable. Also understand that the rest of the orbital cavity (eye socket) will likely sear from the heat, so at first there may be swollen tissue that almost… fills the void where the eye used to be?

Also, this person is going to have either no, or severely damaged, eyelids, because of the obvious NO DON’T ENUCLEATE ME WITH A HOT POKER PLEASE reaction is to clamp your eyes shut like there are monsters in the bedroom.

As for nerve or brain damage… my gut instinct says that it’s possible but not probable. But again… no case reports. If you need your character to be brain damaged it’s not impossible that some of the brain cooked a bit, but otherwise, from a storytelling perspective, I’d leave it.

Oh, one other thing… infection. We need to talk about infection, and pus, and eyeballs weeping pus, because infections after burns are very very common (was it a clean and sterile hot poker, we ask ourselves?). Likely not. So the tissue that remains in either eyesocket is massively inflamed, and it will probably get infected. And that infection will likely involve pus, and it will hurt, and they will likely try to rub their eye or do SOMETHING for the pain, and then we have a sad panda day where they rupture an abscess, and there’s just…. all the pus running down their cheeks. They’re crying pus, is what I’m saying. Pustulent tears.

I think that about wraps it all up on the negative eyeball/poker interaction -slas- thermal enucleation front. I’m sorry that you waited so long for this jiggery-pokery.

Yeah, I went there. You knew I had to go there.

Anyway, I hope the wait was worth it.

xoxo, Aunt Scripty

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