decels

8

A week or two ago, I came across this Sonic character guide for AoStH (drawn by Pierre DeCelles), and I just love how adorable Sonic looks in these illustrations! ^^

It’s too bad he wasn’t quite as expressive in the final cartoon.

Obstetrics and Gynecology Advice

So I finished my Ob/Gyn rotation last week, and here’s some take aways that I found valuable. Take this with a grain of salt. I’m just a wee third year medical student:

Before the Rotation:

1. I studied a few things beforehand, and several residents/attendings said that it showed during the first couple of weeks of the rotation. Know fetal heart tracing basics and why they happen (baseline HR, variability, accels, decels). Know what G’s and P’s are (TPAL!). Review pre-eclampsia. You’ll learn more about this on the rotation, but if you’re at a larger urban hospital like I am, you’ll see a lot of this.

2. Watch a video of a baby being born and a c-section if you have no idea what you’re getting yourself into. If you haven’t taken surgery yet, and really want to be prepared, watch a video of a subcuticular suture. I closed more skin on this rotation than I did on general surgery.

3. Sleep and grocery shop because lol who knows when you’ll get the chance later.

Labor and Delivery

1. Follow your residents EVERYWHERE. You will get left behind if you don’t.

2. Offer to get an H&P on as many triage patients as you can, especially if it’s a labor rule-out. At my hospital, we weren’t allowed to go into rooms of laboring patients we hadn’t met before. So try to meet as many as you can, so you can get more deliveries! Don’t just expect to be handed deliveries. You have to earn it.

3. Ask to do as much as you can. Whether it’s cervix checks or presentation ultrasounds, there’s lots of smaller hands-on stuff that the resident can do in a few seconds and will forget to include you on if you don’t ask.

4. Some people might not agree with me on this, but if you’re interested in Ob/Gyn and have to do night shifts, don’t sleep if you can help it. See above, if you are asleep, there are tons of small things the residents do throughout the night that they won’t wake you up for. Also, there were a couple of times people rolled in by ambulance at 10cm and pushed a baby out in a few minutes. You don’t want to miss this. Be included in as much as you can! Plus, you can always study during slower nights.

5. C-sections are so much fun! Wear the knee high boots, and grab that suction because you’re going to need it. Eat something beforehand and don’t forget to bend your knees.

6. You’ll see lots of body fluids. Practice your poker face and don’t scowl when things get weird.

Clinic

1. Don’t forget the OB and GYN histories. For OB, get the full G’s and P’s. Don’t forget to ask about miscarriages and abortions. Ask about any pregnancy complications (i.e. hypertension, diabetes, preterm delivery) and mode of delivery. For GYN, ask about last menstrual period, how heavy they are, how regular they are, and how long they last. Then, ask about birth control/condom usage, history of STI’s (list them off because sometimes people don’t know), and pap smears (any abnormal ones?). Finally, ask about sexual activity (men/women/both, multiple partners, etc.). This seems like a lot to ask, but if you don’t ask, many people won’t tell!

2. Be comfortable with speculum exams. For God’s sake, don’t tell patients to “spread your legs”. Ask them to let their knees fall to the sides. Tell them to expect your touch and downward pressure. Insert the speculum ALL the way and open, the cervix will 9 times out of 10 pop into view from there. Make sure you close the speculum while taking it out.

3. Know what tests need to be ordered when for each OB visit throughout pregnancy. Know the types of spontaneous abortions and what can be expectantly managed. Know the work up for infertility. Know when colposcopy and LEEP are generally indicated. Know when endometrial biopsies are indicated.

4. Talk to every patient about birth control if they aren’t already on it and aren’t trying to get pregnant! Maybe this is something I’m just passionate about, but no one is going to fault you if during your presentation for a patient with a vulvar lesion or vaginal discharge you say “…oh by the way, she’s interested in trying a Nexplanon”.

Gynecologic Surgery

1. I only had a week of this but know your anatomy. Know layers of the abdominal wall, parts of the fallopian tube, and uterine ligaments.

2. Fibroids and abnormal uterine bleeding. Learn this. Know the types of fibroids and when you treat abnormal uterine bleeding with surgery.

3. Sleeping patients are the best time to practice speculum and bimanual exams.

Shelf Exam

1. I don’t know my score yet, but I studied sooo much for this one. I read BluePrints, did all the UWise/UWorld questions x1, and all the questions I got wrong x1.

2. Honestly, I love the ACOG committee opinions and practice bulletins. Ask your resident to use their account if you don’t have one. If you only choose a couple to read, the hypertension/pre-eclampsia and gestational diabetes ones are great.

3. Just work hard, and it will all be ok! After taking the shelf, I realized that I saw so many of the clinical vignettes in real life, which was pretty cool.

4. Some things I wish I studied more were STI’s and antibiotics, breast disease, and stages of labor.

I probably have a lot more advice, so if you have questions, just ask! These are just some things that helped me along the way.

How To Avoid a Broken Vagina in Labor

This week in Cosmo Australian blogger Zoe George graphically described how her vagina was ‘broken’ in labor.  This Mom of 2 experienced a difficult forceps birth during her first baby’s birth.  The words ‘broken’ and ‘vagina’ should never be in the same sentence but it’s a case of what you don’t know can hurt you and your vagina.

Pelvic floor injury and perineal injury is not a given in childbirth. There are things you can do to stack the odds in your favor of emerging from birth healthy and well and in most cases without a broken vagina.

Perineal trauma in modern childbirth has become so common place that women almost expect that they will need some ‘help’ in this last very important part of birth. Hollywood has us convinced that all that purple faced pushing is normal. The 2nd stage of labor becomes a frantic race to get the baby out as quickly as possible – suggesting to women that their own body is a danger to her baby. Your body has grown your baby from 2 cells to a perfect baby…knowing exactly where each fingernail should be placed….where your baby’s tiny ears should be placed….down the the perfect number of hair follicles on your baby’s head…with no conscious input from you…..no 'fetus growing’ classes…just the intelligence and wisdom of your body. Your body knows how to finish the process.

Most women who have experienced ongoing complications from a broken vagina have had traumatic births - in many cases it involves an assisted delivery with forceps or vacuum. As perineal injury becomes 'normalised’ we are losing sight of how physically and psychologically debilitating a damaged pelvic floor can be in day to day life and in a woman’s relationships with her partner.

In many maternity units the mom simply receives a referral to a physiotherapist to help her with the physical recovery but the emotional recovery and mental health issues (including depression) are not seen as being equally important. Day to day living can be a nightmare for these moms especially if they are experiencing fecal as well as urinary incontinence. These professional, healthy, young women have no control over their bowels and end up prisoners of their own homes and nobody is talking about it. 

 Sadly some women feel it was their fault because they couldn’t 'push’ properly or were too uptight and couldn’t 'let go’. So let me start off by stating that your body works. Your body knew exactly what to do. You weren’t too 'uptight’ or had issues with letting go. Your body did not fail you - but there’s a good chance that routine maternity practices most certainly did. 

Even the most skilled yoga moms and the most laid back relaxed hypnomums are faced with the most harmful intervention in current obstetrics - not the forceps - but the clock. What many moms don’t realise is that they are on a time limit from the moment they are 'diagnosed’ to be in labor until the placenta is delivered - the clock is ticking. There is no evidence to support these arbitrary time limits especially for the 2nd (pushing) stage.

Here’s a typical scenario that plays out in our hospitals every day. Mom is managing well - baby is healthy and coping well with labour. 

Mom has 2 hourly VE (vaginal exams) to ensure she is dilating with the hospitals guideline of 1cm per hour (there is no evidence to support 2 hour VEs) 

Around 7cm (sometimes even at 10cm) Mums labor slows down as her body rests and as her baby rotates into the optimal position… Mom is deemed to have inefficient uterine action and is prescribed the Pitocin drip and her are waters broken.  Mom is now on continuous monitoring due to the administration of Pitocin. Mom is finding it more difficult to cope with the chemically driven contractions that give her and her baby little or no rest between. Her baby finds it harder to recover from the intense, longer chemically driven contractions and is now showing late decels on the monitor. Mom is now 10cm and baby is showing signs of distress due to the Pitocin. 

Additional staff enter the room and Mom is instructed to lie on her back and pull her knees up to her chest as 2 nurses shout at her to hold her breath and push into her bum (whether she has any urge to push or not). Sometimes staff will tell a mom to 'get angry with her baby’. Prolonged breath holding further restricts oxygen to her baby which again shows baby in distress and a decision is made for an assisted delivery. An episiotomy is performed and vacuum applied - vacuum fails and forceps applied. Baby is born limp and has low APGARS due to hypoxia (lack of oxygen). Mom is in a state of shock but thankful that her baby was 'saved’ Mum’s notes read - 'FTP’ - failure to progress and reluctantly accepts that this was her fault.

Nobody told Mom that holding her breath for long periods of time might not be good for her baby. Nobody told her that 'purple pushing’ could damage not only her baby, but her bladder, her pelvic floor and perineum. In fact the birth classes encouraged it and other women told her to 'listen to your nurse - she’ll show you how to push’.  Nobody told her that if all is well that there is no hurry (even up to 3 hours is reasonable for a 1st time mom) when her body is doing most of the work.

Current evidence and international best practice would suggest that this was a case of 'failure to wait’ rather than failure to progress. In my experience there are several factors that increase the risk of perineal/pelvic floor damage  

1 - Arbitrary time limits (time limits mean more assisted deliveries) 

2 - Coached pushing 

3 - Overuse of episiotomies 

4 - Induction of labor

There are a number of studies comparing coached vs spontaneous pushing In 2003 the WHO recommended removing coached pushing from practice. Research from 1957 describes the damage to the muscles of the vagina and support ligaments after coached pushing so the new research is reaffirming what we already knew to be the case - that 'purple pushing’ is harmful for women and their babies and the more Moms can educate themselves about Irish maternity practices the better. I often hear Mums say not to focus on the birth as it’s 'just one day’…..but that’s not the case for those women who are living with incontinence for the rest of their lives. Information is power. My recommendations are the same to all women whether they have have had previous trauma to the pelvic floor or are first time Moms. It’s so important that women understand how the 2nd stage actually works.

The pushing stage is a reflex..when your baby’s head triggers Fergusons reflex your body automatically starts to nudge your baby down. The top of the uterus gets thicker and thicker and moves down around your baby - like a tube of toothpaste. When you think of how our body works when we feel sick and vomit. Your body throws up….so in labor it’s like your body is throwing 'down’. You’d never say ‘oh I had a dodgy curry last night and was pushing up vomit all night’….you’d say you were throwing up….it’s the same with the 2nd stage….your body does all the work for you but it feels sooo good to go with it.

It’s an irresistible urge that you can’t ignore. Think of how the bowel works - pushing when you don’t have the urge to push is like me instructing you now to go and have a bowel movement immediately when you don’t feel the need to go! Think of a time when you really really needed to go….did you need someone to coach you? Did you need to do anything else other than sit down and relax? Whether you sit on the toilet and push for gold or bring a book (men are great at this) the poop still comes out!!! When you think of it how did humans get out of the uterus for the thousands of years before Midwives and Doctors came on the scene? Who is coaching the cows and sheep in the fields or the women who have accidental homebirths or give birth in the car?  I guarantee you those women pushing in the car are sucking their baby in to try to keep the baby there until they get to the hospital.

Mother led pushing is protective for your baby. When you hold your breath for sustained periods of time the oxygen to your baby is turned off (as well as oxygen to the uterus, pelvic floor and perineum.

What can you do to avoid a ‘broken’ vagina?

  • Avoid induction unless medically necessary.
  • Practice perineal massage in the 3rd trimester
  • Write your birth preferences down and discuss antenatally e.g. “I prefer not to have coached pushing but will push with my own urges”
  • Have your birth partner advocate for you in labor if a staff member starts instructing you to hold you breath.
  • Ask for more time if you and baby are well.
  • Choose an upright birth position even with an epidural
  • Focus on slow comfortable breathing - let your body do the work.
  • If you have an epidural request additional time for 'passive descent’ especially if you and baby are well.
  • Labor in water if possible.

Consider a homebirth or giving birth with a Community Midwives scheme (in 2008 a Swedish study showed a lower frequency of perineal injury associated with homebirths between 1992 & 2004). The risk of perineal/pelvic floor damage was 5 times higher in hospital. Or if possible choose a maternity unit or careprovider with a low rate of episiotomies and assisted deliveries to stack the odds in your favor. 

Midwife Penny Armstrong describes her experience of episiotomy.

One becomes accustomed to routines - including cutting of the flesh - and can get in the habit of not questioning their necessity. But if you are not accustomed to it, it is shocking to see vibrant muscle cut. I think of muscles as being strung out on our bones like strings on a cello - vibrating with potential, as if for an extended concert. I dream about a baseball player with his shirt off and the graceful cresting of power that curves up from the small of his back, across his shoulders and down his arms. to interrupt that progression of movement is an esthetic crime, and I feel sure we wouldn’t do it if it were avoidable. If a professional athlete was on a table in the operating room and if there was no other remedy but surgery, the prospect of cutting his muscles would still be sobering…seeing him prepped and draped, we would know that everything possible had been done….physical therapy, massages, slings…Only then would they resort to the knife. Maybe we don’t think of these women’s muscles with the same regard because of where they are located. We don’t see them crossing and gliding as they make our hips swing; we don’t watch them spreading into broad ribbony bands when we squat down. Because we can’t see them, maybe we think of them as a static crude vessel fit only for containing entrails, bowels and other oozy organs. Maybe that’s what makes them easier to cut… But I have seen the muscles in women. In the delivery room, when the cut was made across three or four major muscle groups, and I’ve seen them retreat and lie there, shrunk back into themselves, and I felt the same way I would if the athlete’s muscles had been cut. The same way I feel when a cellist’s string snaps during a concert. The music of the body, the resonance and the potential for rapture are interrupted

lucys-imaginarium  asked:

What are some of your favourite med school mnemonics? (5 weeks out from finals haha)

I was a big fan of the shortcut way to draw the brachial plexus, though I don’t remember it perfectly now. Unfortunately I remember more mnemonics than what they’re supposed to stand for. 

Other faves include:

  • Learn one. The other one’s the other one. - Goljan’s wise advice on learning the difference between 2 things. This is how I distinguish pemphigus and pemphigoid. 
  • the R-rated version of the cranial nerves. I’ll just abbreviate OOOTTAFVGVAH. I still run through that one. 
  • Some Say Marry Money But My Brother Says Big Boobs Matter More (remembering which cranial nerves are sensory, motor, or both)
  • I remember on renal drawing Hydrogen and potassium ions on a seesaw to remember how they moved in relationship to each other
  • There was definitely a weird one to remember the glycogen storage diseases, but I’ve never had to use that one so I’ve forgotten.
  • SpIN and SnOUT - for specificity and sensitivity, which rules in and which rules out
  • SIG E CAPS - symptoms of depression - Sleep disturbance, loss of Interest, Guilt, loss of Energy, poor Concentration, Anhedonia, Psychomotor retardation, Suicidality
  • MUDPILES - things that cause anion gap metabolic acidosis
  • DUMBBELS - cholinergic overdose symptoms - Diarrhea, Urination, Miosis, Bronchorrhea, Bradycardia, Emesis, Lacrimation, Sweating/Salivation
  • DIAPPERS - causes of urinary incontinence - Delirium, Infection, Atrophic Vaginitis, Pharmaceuticals, Psych, Excessive urine output, Reduced mobility, Stool impaction
  • Dry as a bone, hot as hades, blind as a bat, red as a beet, mad as a hatter - effects of anticholinergic drugs
  • wet, wacky, wobbly - symptoms of normal pressure hydrocephalus
  • bones, groans, stones, and psychic moans- symptoms of hypercalcemia
  • VEAL CHOP - fetal monitoring (put the words on top of each other)- Variable = Cord compression; Early Decel = Head compression; Acceleration = O2; Late Decel = Placental insufficiency
  • social history on kids and teenagers: HEADDSSS - Home, Education, Activities, Drugs, Depression, Safety, Sex, Suicide

kimbureh replied to your post “Toss me a prompt? Been feeling really blue lately and the writing just…”

my first thought is luke with a kitten! space kitten if u will ;) doesn’t matter if its tattooine Luke or old reclused brooding Luke who has a cute kitty or two to keep him company on that green rock

@kimbureh! You were right, there is indeed a kitten. Thank you for the prompt!


X-wings make their own gravity.

Pilots can’t be getting thrown around the cockpit with the accels and decels of battle. The G’s would knock them out if the whiplash didn’t get them first.

It took Luke by surprise the first time, when he stayed snug in his seat through the battle above the Death Star. Now, he takes the artificial gravity for granted as he flips his starfighter through hairpin turns and 360 degree rolls.

He knows just when it’ll give out, too. This roll he’s about to execute–it’s going to strain the engines, the grav sensors don’t have a chance. Luke mashes a control button and eyes the accelerometer as the ship tucks into a dive. The safety straps snap taut, hard against his collarbones. Then he forces the stick sharp left and braces for impact. This time the straps cut into the tops of his shoulders as the starfighter flips a sudden 180 and the TIE that’s been chasing him soars overhead.

The TIE comes around in a tight U-turn, lasers already blasting. Luke, still upside-down, takes it out on his second shot.

He peers through the claristeel of the canopy. Space is empty around him. The gravity’s back on, straps loose around his shoulders again. He doesn’t bother righting the ship because what direction’s “up” in the middle of space, anyhow?

Luke rubs at his neck. As the sharp pain of wrenched muscles subsides, he’s aware of a different pain now. A line of heat across his face. He reaches up and his hand comes away streaked with blood.

Whoops. Luke pats the chest pocket of his flight suit and, sure enough, it’s empty.

“Where are you?” he says out loud. An answering whistle comes through the comm. “Sorry, Artoo, not you. I’m glad you’re still back there, though.”

Artoo offers a series of beeps in reply.

Luke, bent down now to try to feel under the seat, cranes his neck up to read the droid’s words on the monitor. “Yes, I’m bleeding.”

Boop-beep?

“Yes, you were right.” It’s empty beneath the seat, at least as far as he can feel. Luke reaches up, now, back over his shoulder to the space behind his headrest. His fingers brush soft fur for a moment, then encounter air.

Boop-boop-beep?

Eyes still on the monitor–”No, I’m not telling you where it scratched me. I don’t need you laughing all the way to the Remembrance”–Luke reaches back with the other hand.

Careful, careful…

He works his fingers under the soft little body, other hand blocking its escape, and gently lifts the kitten down into his lap.

It wriggles, trying to get away. Luke cradles it against his chest, both hands around it now, and gradually the tiny creature calms.

“That’s better,” he says. The kitten is barely larger than his palm. He uses one finger to stroke its head, smoothing the fur between its ears. The tiny eyes drift closed.

A moment later Artoo whistles, concerned.

Luke laughs. “That’s not the engines, Artoo. It’s just a noise these creatures make.” The soft purring does sound a little like a rough engine. Luke wonders if Han’s ever seen a kitten–and if not, how long he can make his friend think the Falcon’s subspace drives are out of whack again.

Luke shifts the kitten in his hands, petting its back now, and the purring gets louder. Beneath that sound, the starfighter’s engines hum smoothly. All around them, the stars are bright, and the space between them is empty and silent.

Luke jumps when Artoo whistles again. The kitten jumps too, leaving gouges on his palms when it leaps down to his knee and then disappears at his feet. “What?!”

The text on the screen is plain and emotionless, but Artoo’s scolding comes through loud and clear. This is still Imperial space.

Yeah it is, Luke thinks, as he twists his body to get his head under the control panel. “Where did you go?” he mutters, aware that Artoo can hear every word.

We still need to set a hyperspace course.

Luke whacks his head on the panel as he tries to look up at the monitor again. “Right, could you get on that please?”

If you’ll tell me where we’re going.

Artoo knows where they’re supposed to be going. “We’re still going home to the Remembrance,” Luke says, his back to the monitor now as he stretches around to look behind him. “Stop being jealous, it’s just a kitten.”

And what the hell are you doing petting a kitten when the Empire is probably coming back any minute to kill us?

“I’m not petting the kitten.”

You lost it again, didn’t you.

Luke feels something moving against his lower back. He extracts the kitten, carefully avoiding the tiny claws, before he tells Artoo, “No.”

Just put it back in your pocket and let’s get going. You’re supposed to be driving, not me.

Artoo can fly the X-wing just fine. He’s programmed to do so, in case Luke’s badly injured, or knocked out cold, or dead. But Luke’s none of those things, and he supposes Artoo’s programming doesn’t cover the rescue of tiny cats from abandoned Imperial outposts.

Luke slips the kitten back into his pocket. The kitten squirms and begins to claw its way up his chest. “Stay there, ok?” he tells it in whisper, stroking its back until it begins to purr again.

It’s not easy to fly an X-wing one-handed, but once they’re in hyperspace he can let the autocontrols take over for a while.

The comm pings with Artoo’s hyperspace coordinates. Luke accepts the course and engages the hyperdrive, and the stars stretch out and shift to a multicolored swirl. A few minutes later, the young pilot and the tiny kitten are both sound asleep, cradled in the artificial gravity, while Artoo mutters quietly to himself about Skywalkers, common sense, and rescuing things.

New Guy

I don’t own shit. Not even one of the shits.  

28

================

“Do you have one in particular picked out?”  The way to nice sales associate asked.

“No.” Gajeel growled in reply.  He was almost to town and he really should’ve stopped earlier but it was nice seeing that that Levy cared enough to call him.  It was selfish and mean but it wasn’t like he would ever see her again anyway so she couldn’t be that mad.  “Just whatever all I need is a phone.

The bubbly asshat brought him a phone that looked about  10 years old and activated it in no time.  When he got back out to the car he saw that Levy had called 2 more time while he was inside.  “Sorry Shrimp.”  He muttered as he took the sim card out.  

+++++++++++++++++

Lucy handed Levy her car keys and smiled at her.  “Are you sure you an survive that right now?”  Levy asked Lucy who was getting on Natsu motorcycle with him.  

“No but it doesn’t matter.  You don’t have a car and public transport is a good as walking.  So you take my car. Remember what I told you about getting pulled over though.”

“Just smile and be cute?  Yeah that doesn’t work for me but okay.”

“Good luck my little strategist!”  Natsu and rode off leaving Levy and Wendy behind.  

“You sure you want to do this?”  Levy asked Wendy who was still weepy.

“You sure YOU want to do this?” She smugly replied.  “I gotta hit him a few times before you make out with him again.  I don’t need him thinking running away like a dumbass gets the girl.”

“I do not want to kiss him!”

“Sure thing.”  

They got into Lucy’s car.  It had been quite awhile since Levy had drove and Wendy didn’t have a license so either way this was going to be a terrifying drive.  She glanced at the fancy touch screen and controls it bore.  Bleh!  All she needed was to know was the windows, steering and acceleration.  Oh yeah decel too!  She slowly backed out of the spot getting her bearings.

“You sure you know how to drive?” Wendy joked.

“Nope!”  Levy fearfully replied.  And with that they were off.  GPS was set for Oak town and they had quite the drive ahead of them.  

About 2 hours in Wendy woke up from a short nap.  “How far are we?”

“Getting to the mountain ranges about now.  We are going around though, don’t worry.”

“Cool.”  She yawned sitting up and pulling her seat back up with her.  

“Wendy can I ask you a question.”  Levy asked, keeping her eyes on the road.

“Yeah what is it?”

“Gajeel.  What did he do that was so bad for Gray to freak on him like that?”

“I don’t entirely know to be honest.  I wasn’t there.  I know what he told me, he was recruited to a group of really bad people after his dad disappeared and he was stuck.  At Least that is what I think.”

“What do other people think?”

“He did it for kicks.”

“It?  If you don’t mind me prying so much.”

“It’s fine, he loves you so you have the right to know.  And he would have told you at some point.”  She laughed.  “In simplistic terms they were a mercenary group of sorts. Some guy was pulling off the street rats that had nasty cred and offering them peace.  Obviously that isn’t what he got.”

“Were?”

“I’ll get to that.  Stuff went down and long story short Gajeel got paid to hurt people for some rich guys personal gain.  Alot of innocent people.  There were four people who were known as the elemental 4.  Well Gajeel wasn’t classified as one of the elemental 4 but he was above them, in a way.  Like I said, wasn’t there.  The rich guy, Jose, pinned all crimes committed on these four even ones done by lesser members.  You know one of them by the way.”

“Well I’m guessing Natsu.” Levy shrugged.  Sure he was sweet but he had something going on.

“Hahaha!  No way!  Natsu can’t hurt a fly! Surprisingly enough Juvia.”

“What!”  Levy almost flew off the side of the road.  “Juvia!  Like sweet foreigner Juvia?”

“Yeah.  That is probably why she was so upset when Gray blew up on him.”

“Jesus.  What about Sweden”

“Oh she is lives there,now.  Well the other three all disappeared the same time Juvia and Gajeel did.  They disappeared because Jose took a bribe from the government to give up the elemental 4 and ‘black steels’ location.  Black steel is such a stupid name to call someone right!”  Levy nodded in confusion.  “The five of them ended up destroying Jose and all of his mercany bull shit as soon as they heard and all parted ways Juvia oversees, Gajeel to the mountains and who knows where the rest of them went.  The end.”  

Levy and Wendy sat in silence for the next few quickly covered miles.  Sun was setting and the evening chill had set in.  “Look don’t hate him for it, please.”  Levy looked over to the girl who was as scared as Levy was.  “I promise you that he isn’t like that.  I think you already know that but I get that you would be mad I was for a while.  Just don’t hate him.  He always talked about disappearing but it seemed more like a pain than a goal lately and for him to get up and leave like that is just crazy.”

“Maybe we shouldn’t be doing this.” Levy sighed and looked at the GPS 40 more minutes.  That is 40 opportunities to turn around and make it in time for class.  

“What!  No way we have been driving for like 5 hours and-  what are you doing!”

“We need gas either which way so that is what I am doing.”  Levy took the small exit and headed towards the gas station sign that was visible from the interstate.  

“Sorry I just don’t want him to disappear.” Wendy sighed

“Ditto.”

+++++++++++++++

“It is the next exit up.”  Levy replied to Wendy’s question on far they were.  Wendy nodded in understanding and went back to her game.  Levy grabbed her phone out of the cup holder as it began to ring.  “Hello?”

“Hello Levy.” Juvia mumbled into the phone.

“Oh hi Juvia, how are you?” Levy tried not to sound awkward or concerned but she just learned a great deal about the ‘innocent’ Juvia, that wasn’t so innocent.

“Juvia is fine thank you.  Juvia just wanted to call you to tell you that she would take notes for you tomorrow in class so you don’t have to rush and Natsu has filled out a family emergency form for Wendy so she is okay to stay at a hotel too.”

“Oh no it is fine, don’t worry about us.”  

“Juvia is asking Levy as a friend to stay the night.  If you get hurt on the way back home Juvia would feel responsible.”

“Juvia, this has nothing to do with you don’t worry about it.   But if it really worries you so much we will stay.  Only if you take really good notes.”

“EEEP!  Juvia promises!  Thank you Levy!  Juvia will take amazing notes for Levy!”

“Alright Juvia.  I’ll see you soon.”

“Yes!  Okay Goodbye.”

She hung up as she pulled up the exit.  “Now where?”  Wendy asked.

“For now?  A hotel.  We need to get some rest,  Juvia’s orders.”  She shrugged.

===============

“How long will you be staying?” The hotels apparent assistant manager asked.

“One night.  No breakfast and no pool extras either.” Gajeel growled quickly in reply.

“Are you sure?  We have  lovely complimentary brea-”

“I’m sure.”  He snatched his room key and walked to the stairs nearest to him.  He hated this part of it all.  Such a pain dealing with these people.   He just wanted to take care of everything on his own.

++++++++++++++++

Levy and Wendy rolled up to one of the very few hotels and gave the valet the key.  As they walked in the smells of lavender and vanilla filled the air. Levy let out a sigh of relief. Levy loved Lucy’s perfume but 6 hours later, she was sick of it.

“Hello ladies!  What can I do you all tonight?” The assistant manager behind the desk asked.

“We need a room for one night.” Wendy quickly said.  “Preferably with two beds.”

“Of course.  Would you like to include breakfast and poolside amenities?”

“No we are fine without, thankyou.”  Levy said.  Wendy moaned in the background as they got the key and headed to the elevator.

“We can’t even have complimentary breakfast?” Wendy whined in the elevator

“Nope, got things to do.” She laughed.  “Anyway since when do you eat breakfast?  I was told all you have for breakfast is tea.”

“That is breakfast!  Well sort of breakfast.  Anyway, I just want waffles!”

=================

Thank god for hot water!  He stood in the hot shower water letting his muscles relax from being tense in the same position for 6 hours in the car.  Suddenly flinching when the water got ice cold.  “Damn.” He turned off the water not wanting to deal with it.  He grabbed a towel and went back out to the room.  Some sort of giggling racket started the next room over as he got into bed.  He scratched at the fabric waiting a few seconds.  There ya go.  Lily jumped up onto Gajeel’s chest and dozed off almost instantaneously.  

+++++++++++++++++

“Hey Levy.”  Wendy called in the dark of the hotel room.  They both went straight to bed after showers and Levy just got out of hers.

“Yeah?” She replied as she dried her hair in a towel

“You didn’t deny it earlier.”  Wendy giggled.  She dropped her phone onto the pillow beside her and sat up to look at Levy.  

“Deny what?”  Levy pondered.  Still so dumb.

“Well do you remember why I told you that you deserve to know about his past?”  She giggled again.  This time a bit louder.  

“Uhm.  Not really.”  She really didn’t.  She was focused on how Juvia and Gajeel both were in the same boat.  She knew they were close for good reason, apparently there was a lot more behind that than it looked.  No wonder they are both so tight lipped.

“Well, I said that you deserve to know because he loves you.”

“Oh well that is your opinion I guess.”

“You didn’t deny it!  AGAIN!”  She shot up in her bed laughing and jumping about.  “AHH!  YOU LOVE HIM! OH YES YOU DOOOO!”  She sang while jumping on her bed.  

“I do not!  How would you saying he loves me would prove that I love him?  Which I don’t!”  Levy stammered.  She didn’t love someone that would leave without even saying goodbye.  

“Yes you doooooo!  I know you do cause you can’t say it.  You don’t want to think about him not loving you too, that is adorable!” She laughed

“What?  I don’t lo-”

Then there was a knock on the door.  They were becoming unreasonably loud.  Wendy jumped off her bed ran to the door.

“What can I do ya for?”  She asked as she pulled open the door.  “Oh you!  You-”

“Don’t say it.”  A man replied.

Levy recognized that voice.  Were her calculations correct?  Even though she was only wearing an oversized t shirt she ran to peek around the corner to see tall, angry, brutish, shirtless Gajeel. What were the odds.  Lucy would flip.  He was looking at Wendy then his gaze fell to the floor.

“You ass!”  Wendy yelled.  She grabbed his arm and dragged him inside.  He didn’t really resist though.  She pushed him into one of the cheap chairs and ran back to lock the door.

“I told ya not to say it.”  he grumbled under his breath.  Levy leaned against the wall just taking in the scenery, no one ever said she couldn’t.

“What is wrong with you!?” Wendy yelled as she began to pace back and forth in front of him.

Levy was still mesmerized by his abs.  He still looked to the ground not raising his gaze the whole time Wendy screamed at him for breaking her heart.  

“-and you owe an apology to Levy too!  You know that she broke the law to find you, ntha-”

“Okay, I can speak for myself.”  His face shot upwards bearing the most genuine smile that quickly turned back into a frown realizing the circumstances they met under.   Levy looked at him with pity.  She knew he hated it but oh well, he deserved it.  He was still running from his past mistakes even though he had whole heartedly changed, that’s unfair.  

Also he didn’t like pity and she really didn’t want him happy at the moment.  Safe and at home yes, but, not necessarily happy.  “Well say something!  Strong and silent won’t help you now.” Wendy sighed as she started to calm down but Levy knew what came next so she pulled her into her shoulder to let her cry.  And just as she thought; the sobs began, Levy running her finger through her hair just as before.  

Levy and Gajeel had locked eye contact at some point and she didn’t want to look away in fear that her would be gone.  

“It’s okay.  You see, I promised didn’t I?” Wendy just nodded and kept lightly sobbing.  

“He is coming home.”  She could bore holes though his skull the look she gave him.  He just swallowed as if he was going to say some snarky remark, but for once Gajeel Redfox said nothing.  

Wendy pulled back and wiped her tears. She looked to Gajeel who just tried to avoid her gaze.  “Really?”

“Yup.  Hes got a semester to finish.”  Levy nodded

“You promise?”  She didn’t think it was directed towards her.  Gajeel sighed and pushed his hair back.  

“Look I can’t whe-”  From ‘look’ to ‘can’t’ Levy waltzed right over to him and slapped him clear across the face.  

“I think you should reconsider.”  Levy hissed.  Control was about to be lost and she was only a few seconds before breaking down.  She had to break at sometime.

“Look. I’m sorry okay?  I just can’t be around him.  You wouldn’t understand.”  He groaned.

“Yes I do.  Wendy does, Lucy does, Natsu does and I know that Juvia does!  Gray is stubborn and overprotective and I am sorry for that, but can you blame him?  No!”

“If he was so good and honest and precise then why are you here?  Why waste your time looking for someone that you know won’t come back?”

“Because I like to think that people whether in their power or not sometimes have bad pasts and you can’t completely judge a person off that, like a second chance.  You shouldn’t be running and hiding from it either.”

Levy pulled back from him and sat against the wall beside them.  She pulled her hair in front of her face and tried to get her breathing back on track.  The six hour drive was catching up to her and she could already feel her eyes becoming heavy.  This was not time to sleep though.  By the grace of God they were granted with the greatest coincidence on the planet.  She laid down to stretch out to her phone.  “Come here damnit.”  She muttered as she fumbled for it.  She pulled it up to her noticing that Gajeel eyes kept darting from her and Wendy, who was sitting on the edge of her bed.  She looked even more tired than Levy.  

11:24pm

Lucy: I swear if he doesn’t pull a Lloyd Dobler I might flip.

Levy: I highly doubt that will happen.  I am no Diane Court!

Lucy: But come on it is perfect!  Your the valedictorian Diane and he is the less than perfect Lloyd!!  It’s like the part of the movie when she asks why he is shaking “I don’t know.  I think I’m happy”  LEVY!  GET YOUR BRAIN STRAIGHT, YOU’RE IN A MOVIE!  

Levy pressed her forehead to her phone regretting this whole trip.  What did she gain?  A moppy Gajeel and a overly emotional teenager, lovely.  Maybe they were blood related  

Gajeel got up from the chair and walked towards the door.  “Please don’t.”  Wendy begged from the safety of the blankets.  He sighed and walked over to her avoiding Levy’s sector of the wall.  

“Goodnight Wendy, I’m goin’ to bed.”

“No you’re not.”  She yawned.  “You are going to re pack and go someone else.  Well guess what.” She said still slightly weepy.  It was kind of adorable, to be honest.

“What?” He groaned while lightly scratching her back.

“I got her” She pointed to Levy who was more focused on the conversation than the both of them.   “and she is a super genius that can come up with any place you would ever go and we’ll find you and drag you home every time.”

Gajeel looked at Levy who was so hyper focused on not falling asleep and paying attention  that her eyes were about to pop out of her head.  

“I ain’t goin’.”  he gruffly said, rolling his eyes.  

“Good.  now get Lily and come over here.  Levy.”  She sat up straight hitting her head on the wall

“Ow.  Yeah?”

“Follow him.  If he runs kill him for me?”

“I’ll be back, kid.” He said walking out the door without Levy.

============

“Damn women.”  He grumbled grabbing his bag and Lily “Come on cat, we might be stayin’ for a bit.”

He walked back over to the open hotel room dropped his things and closed the door.  Levy was asleep on the floor and Wendy on the bed.  He put Lily on the window-sill and went back over to Levy.  “Damn women.”  He cursed under his breath again with a grin.  Thinking now maybe it was okay that they came to find him.  If Levy wasn’t lying, he didn’t think she was, he could stay until graduation and go from there.  She was so light it was almost ridiculous.  He picked her up and rested her down in the second bed.  “Night Shorty.”  He tossed and blanket over her and went to lay on the couch.  

“Gajeel?”  She lightly groaned, reaching towards him.  “Don’t be stupid.”

“Shrimp, go to bed.”  He walked over and pulled the blankets back over her.  

“Come here” she patted on the mattress.

“What Shrimp?”  he said after approaching her again.  She rolled over and tugged at his arm.

“You’re comfy.”  she purred pulling him towards the mattress.

“Night, Shrimp.” He turned around when she hooked her two fingers in his belt loop and pulled him onto the bed.  Her sudden strength didn’t stop there.  She had a near death grip on his arm as she held him like a stuffed animal.  “Shrrriimp.”

“Shhh.  It’s bed time.”  

Well atleast she really initiated it this time.

“Night”  He dozed off with her arms halfway wrapped around him. 

Scientists Are One Step Closer To Growing Replacement Limbs

by: Daniel Cooper

If the goal in medicine is to be able to repair people as if they were made out of Legos, then we just took a big stride towards that future. A team at Massachusetts General Hospital has managed to grow a rat’s forearm that, theoretically, could open the door to whole-limb transplants. The team, led by organ regeneration expert Harold Ott used a technique called decel/recel, which has already been used to grow hearts, lungs and kidneys within the confines of a petri dish.

Rather than building a fresh arm, the decel/recel process requires scientists to decellularize organs from deceased donors. As New Scientist describes it, that means washing a forearm from a previously expired rodent until just the “scaffold” remains. It’s a clumsy metaphor, but imagine that you could rinse off the mushy stuff until the biological equivalent of an ice cube tray remains. This empty receptacle retains the structure of the component with none of the icky bits.

After that, this “scaffold” is seeded with cells from the eventual recipient and nourished so that the cells grow themselves into a new body part. In this case, the team used the forearm of a deceased rat, washed it down, added some fresh cells and wired it up to a machine that kept its tissue alive. In under three weeks, blood vessels and muscles had built themselves across the structure, and the team just had to graft on some skin to complete the project.

[Read full article]