falling out of love…
the clouds have lifted,
the truth is revealed.

the stars in your eyes have gone out;
you are no longer in control of me.

I mourn for the loss of what I once dreamed possible.
but now I know that I deserve someone
who loves me.

fuckyeahtattoos:

Supermoon

Savaş Doğan - Matkap Tattoo Istanbul Kadiköy

instagram.com/inktotalart

www.facebook.com/savas.dogan.5437

www.matkaptattoo.com

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dbd-jk:

cranquis:

sketchshoppe:

This patient isn’t usually mine, but today I’m covering for my partner in our family-practice office, so he has been slipped into my schedule.

Reading his chart, I have an ominous feeling that this visit won’t be simple.

A tall, lanky man with an air of quiet dignity, he is 88. His legs are swollen, and merely talking makes him short of breath.

He suffers from both congestive heart failure and renal failure. It’s a medical Catch-22: When one condition is treated and gets better, the other condition gets worse. His past year has been an endless cycle of medication adjustments carried out by dueling specialists and punctuated by emergency-room visits and hospitalizations.

Hemodialysis would break the medical stalemate, but my patient flatly refuses it. Given his frail health, and the discomfort and inconvenience involved, I can’t blame him.

Now his cardiologist has referred him back to us, his primary-care providers. Why send him here and not to the ER? I wonder fleetingly.

With us is his daughter, who has driven from Philadelphia, an hour away. She seems dutiful but wary, awaiting the clinical wisdom of yet another doctor.

After 30 years of practice, I know that I can’t possibly solve this man’s medical conundrum.

A cardiologist and a nephrologist haven’t been able to help him, I reflect,so how can I? I’m a family doctor, not a magician. I can send him back to the ER, and they’ll admit him to the hospital. But that will just continue the cycle… .

Still, my first instinct is to do something to improve the functioning of his heart and kidneys. I start mulling over the possibilities, knowing all the while that it’s useless to try.

Then I remember a visiting palliative-care physician’s words about caring for the fragile elderly: “We forget to ask patients what they want from their care. What are their goals?”

I pause, then look this frail, dignified man in the eye.

“What are your goals for your care?” I ask. “How can I help you?”

The patient’s desire

My intuition tells me that he, like many patients in their 80s, harbors a fund of hard-won wisdom.

He won’t ask me to fix his kidneys or his heart, I think. He’ll say something noble and poignant: “I’d like to see my great-granddaughter get married next spring,” or “Help me to live long enough so that my wife and I can celebrate our 60th wedding anniversary.”

His daughter, looking tense, also faces her father and waits.

“I would like to be able to walk without falling,” he says. “Falling is horrible.”

This catches me off guard.

That’s all?

But it makes perfect sense. With challenging medical conditions commanding his caregivers’ attention, something as simple as walking is easily overlooked.

A wonderful geriatric nurse practitioner’s words come to mind: “Our goal for younger people is to help them live long and healthy lives; our goal for older patients should be to maximize their function.”

Suddenly I feel that I may be able to help, after all.

“We can order physical therapy — and there’s no need to admit you to the hospital for that,” I suggest, unsure of how this will go over.

He smiles. His daughter sighs with relief.

“He really wants to stay at home,” she says matter-of-factly.

As new as our doctor-patient relationship is, I feel emboldened to tackle the big, unspoken question looming over us.

“I know that you’ve decided against dialysis, and I can understand your decision,” I say. “And with your heart failure getting worse, your health is unlikely to improve.”

He nods.

“We have services designed to help keep you comfortable for whatever time you have left,” I venture. “And you could stay at home.”

Again, his daughter looks relieved. And he seems … well … surprisingly fine with the plan.

I call our hospice service, arranging for a nurse to visit him later today to set up physical therapy and to begin plans to help him to stay comfortable — at home.

Back home

Although I never see him again, over the next few months I sign the order forms faxed by his hospice nurses. I speak once with his granddaughter. It’s somewhat hard on his wife to have him die at home, she says, but he’s adamant that he wants to stay there.

A faxed request for sublingual morphine (used in the terminal stages of dying) prompts me to call to check up on him.

The nurse confirms that he is near death.

I feel a twinge of misgiving: Is his family happy with the process that I set in place? Does our one brief encounter qualify me to be his primary-care provider? Should I visit them all at home?

Two days later, and two months after we first met, I fill out his death certificate.

Looking back, I reflect: He didn’t go back to the hospital, he had no more falls, and he died at home, which is what he wanted. But I wonder if his wife felt the same.

Several months later, a new name appears on my patient schedule: It’s his wife.

“My family all thought I should see you,” she explains.

She, too, is in her late 80s and frail, but independent and mentally sharp. Yes, she is grieving the loss of her husband, and she’s lost some weight. No, she isn’t depressed. Her husband died peacefully at home, and it felt like the right thing for everyone.

“He liked you,” she says.She’s suffering from fatigue and anemia. About a year ago, a hematologist diagnosed her with myelodysplasia (a bone marrow failure, often terminal). But six months back, she stopped going for medical care.

I ask why.

“They were just doing more and more tests,” she says. “And I wasn’t getting any better.”

Now I know what to do. I look her in the eye and ask:

“What are your goals for your care, and how can I help you?”

-Mitch Kaminski

Source

THE important question.

This.

(via void-birb)

(via cometinorbit38)

orzhov-fun-police:

today-ifuckedup:

This happened a few years ago and I was living in Zimbabwe at the time, and I was having a pretty bad day, I was going to see my auntie who lived about 400km away from me. If youre african you’ll understnad that this was no small journey. So I got in my car and set off and about 3 hours into the journey i came across a Dude by the side of the road who was going in the same direction, so out of the goodness of my heart i said jump in. we go to talking and he happened to be going to exact same village as me and he knew my auntie!.

Half an hour passes and we’re making polite chit chat and reminiscing about old times in zimbabwe, when all of a sudden he tell me to pull over, so I do. he runs out of the car and starts making wretching noises, so i assume he’s throwing up, its dark at this point so i cant really see much, so i go check on him ( first mistake). I get out and go to his side expecting him to be there but he’s not…..Then I here someone behind and me and before i know it im unconcious! so I wake up a couple hours later( iknow this becuase the sun was coming up at this point) without my car, clothes or wallet. so im thinking great. i look around and see im on some farmland wearing the giys clothes. SO i start walking in no particular direction and eventually come across a settlement.

I explain to them my situation and they tell me that the nearest main road is at least a good half a days walk from where I am and they dont get many cars coming through this part but they heard one last night ( which might be our thief). I start walking in the direction they point me in and after what felt like forever i come acroos a road, so I pitch up and start waiting, ( now i know most of you are thinking why not call someone, i had no phone with me and I dont have the best memory so I didnt know any numbers that would come in handy). after a couple of hours a car stops and lets me hitch I let him know the situaion and he says we’re in the complete opposite direction of my intended destination but he’s willing to drop me close enough to walk the rest of the way to which I thought great!

its takes a good two days to get there and he drops me off and i say my goodbyes to my driver, I take down his number so i can repay him later on. At this point im starting to recoginise my surroundings, I walk for a few miles and as im getting closer to my aunties i can here a lots of singing and what appears to be a large crowd which i though was strange. Im about 100 feet from the house and i see my Son which again i thought was strange because he was meant to be in school at this time, but instead of running to me and hugging me as he normally does…he runs away screaming to my complete bewilderment. I get to the the gate and all of a sudden the large crowd alerted by my sons scream has stopped singing and is stood silent. my wife appears and starts to run towards me hugging and kissing me like Ive been gone for months. My auntie appears and immediately faints when she sees me.

I still have no clue whats going on at this point and im exhausted, so we rush to get my auntie inside and I see my picture ontop of a large box that resembles a coffin sitting in the living room….

So it turns out that the guy who robbed me and made off with my car my wallet and all my clothes was in a car crash so bad that they couldnt identify the body and because the only things they could use to identify him was my wallet, they assumed it was me that had died in the crash. since there was no body of sorts they could arrange the funeral preety quickly and that is what I had stumbled upon. My son still has nightmares to this day and and my wife has told me never to pick up a hitch hiker ever again.

TL;DR Got carjacked, robber died and family thought it was me, they arrange my funeral and I somehow manage to stumble upon my own funeral.

If you only read one thing today, let it be this. Wild ride from start to finish.

(via void-birb)

yrbff:

(by elaina wahl)

(via yennyway)

polylove-girls-blog:

• Multiple people to do things with. Odds are that I’m not going to share all of my interests with a single person. With having multiple partners, however, the odds go up that I’ll share more of my interests with someone close to me and be able to further explore them. Also, I get exposed to more new interests with each of my sweeties, increasing my palette.  

• Extended support network. When someone in my intimate circle is having a bad day, or experiences a crisis - they have several people to lean on. And, conversely, no one person is taxed out on giving support, because that support is spread out. 

• Increased self-awareness. Intimate relationships act like mirrors we hold up to ourselves. And the reflection we see back in each relationship is slightly different, offering a new opportunity to discover something about ourselves. Having multiple intimate relationships gives us multiple perspectives to compare and contrast. 

• Learning new things about a loved one. The flip side to the above is that when your loved one is experiencing multiple partners, they are learning new things about themselves. In that process, you get a very unique opportunity to see your loved one through someone else’s eyes and perhaps realize new things about them. 

• Sexual Variety. Yes, I do admit it.. the opportunity to explore a variety of sexual interests is a really cool part of polyamory, even if that isn’t my drive for having multiple relationships.

• Increased Individuality. In a coupled relationship, it’s really easy to slip into a couplecentric identity - of always doing things together, having the same friends, and having a unit identification. When you’re involved in multiple relationships, you base more of your identity on who you are, not by your relationship(s).  It’s really hard for someone to identify me as part of ‘FritzandCherie’ when they know that I have other sweeties important in my life.  

• Personal Development. There’s nothing like having multiple partners to call you on your bullshit. In polyamory there’s a lot less room for personal insecurities and co-dependent communication patterns. When you have multiple people who you’re close with, who also communicate with each other in some form, you just simply can’t hide from your negative aspects and have to deal with them. 

Pretty interesting list, and I have to say I agree!

(via polylove-girls-blog)

(via lipstick-coveredmagnet)

hotladypants:

izmia:

Creative Art:  This Artist Takes Photographs of People On the Street, Then Doodles Over Them - Yaratıcı Sanat: Sanatçı sokakta insanların fotoğraflarını çeker ve onların üzerilerini boyalar. by Geeohsnap

This is unreal

(via 100-percent-morganic)

(via yesdarlingido)

(via mielparaoshun)

homogayhorse:

just-shower-thoughts:

“firefly” is the opposite of “waterfall”

what have you done

(via nbnightwing)

bruhless:

jangysprangus:

sanjanasart:

Wip of my very last parrot piece

So relaxing

Painting used to be my shit now im just slackin

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so-i-sailed-away:

yungp0ny:

Such an important vine

This is so peaceful and perfect can I please be wherever this is.

(via mielparaoshun)