Thanks for rolling with me over the past few days.
I know it’s been a little intense.
That’s kind of where life has been.
Wasteland Update (Because Of Course There Is One)
Fallout continues to do what Fallout does best—move forward at a pace only Bethesda understands.
Two weeks ago: update breaks the servers.
This week: maintenance “fixes” them back to their usual buggy state.
Balance, I suppose.
And yet—I’m still there.
Because it’s not just escapism. It’s connection.
It’s socialization in a world that, lately, hasn’t exactly been lining up to do that with me.
I’ve made some peace with that.
The last three years have made something very clear:
not all friendships are meant to survive who you become.
New ones are forming—but slowly.
Trust isn’t gone. It’s just… cautious now.
Earned, not assumed.
The Wrist (Or: Consequences, Ownership, and Reality)
This week I had surgery to complete the repair of my left wrist.
The original injury?
An abscess tied to my substance use.
That part is mine. Fully.
I should have sought care sooner. I didn’t.
Fear of consequences has a way of overriding logic.
The initial care was solid. A resident handled it with professionalism and basic human decency. Surgery the next morning. Two weeks in a splint. Standard course.
Then came the follow-up.
That’s where things shifted.
I was accused of being non-compliant with occupational therapy—
a service I had not yet even seen.
I was told, bluntly, that I had “brought this on myself.”
No documentation.
Just words.
Words that stick.
And in that moment, I made a decision:
function mattered more than arguing.
So I did the work.
I showed up.
I complied.
I pushed recovery as far as I could.
Not because of what was said to me—
but in spite of it.
The Part That Still Sits Wrong
At one month follow-up, I expected a conversation about the second surgery.
Instead, I got refusal.
Same reasoning. Same tone.
“You did this to yourself.”
And just like that, the door closed.
No referral.
No alternative plan.
Just judgment, dressed up as clinical decision-making.
So I adapted. Again.
Because that’s what patients do when the system stops meeting them halfway.
Fast Forward Through the Wreckage
Then came 2024.
Strokes.
Survival mode.
Everything narrowed down to “get through today.”
By the time I could revisit the wrist in 2025, it was part of a larger picture—both shoulders now involved.
The difference?
This time, I was met with professionalism.
And something rarer: understanding.
The orthopedic teams were direct, honest, and collaborative.
My left shoulder? A success.
Function restored faster than expected.
To the point where—strangely enough—I’m actually looking forward to fixing the right.
That’s what good care does.
It rebuilds trust.
What Should Have Happened
The ortho hand team reviewed everything.
Their take?
A revision should have been done 6–8 months after the initial surgery.
Not optional. Not controversial. Standard.
And not doing it—or referring it—was fundamentally wrong.
No theatrics. No judgment.
Just facts and a plan.
That’s medicine.
Redemption (Or the Lack Thereof)
Here’s the part that lingers.
Yes—I caused the initial problem.
Yes—I changed.
Yes—I did the work.
And still… for some people, that will never be enough.
Some providers don’t treat patients.
They judge timelines.
They decide, quietly and without documentation, who is worth effort.
Who deserves another chance.
Who doesn’t.
From the Other Side of the Bed
Here’s the irony.
I used to be on the other side of that interaction.
Thirty years in healthcare.
Did I ever get frustrated with patients?
Of course.
Did I ever stop trying?
No.
Did I ever tell someone they “did it to themselves” and leave it at that?
Absolutely not.
Because that’s not care.
That’s commentary.
Harm Reduction (The Part We Keep Ignoring)
This is where harm reduction comes in.
Not as a buzzword.
Not as a political talking point.
As actual medicine.
Harm reduction is about minimizing damage while people are still human.
Not waiting for perfection before offering care.
We already do this everywhere else.
- The diabetic patient who wants Cheetos?
Fine. Adjust the carbs elsewhere. - The smoker who isn’t ready to quit?
Reduce. Support. Revisit. - The patient struggling with substance use?
Keep them alive long enough to choose differently.
That’s the goal.
Not moral victory.
Actual outcomes.
What Happens Without It
When providers default to judgment instead of harm reduction:
- Patients stop coming back
- Conditions worsen
- Trust erodes
- Outcomes decline
And eventually?
Everything comes crashing back in crisis.
We even have a phrase for it.
“When the fertilizer hits the spinning ventilator.”
The Point (Because There Is One)
This isn’t about one bad interaction.
It’s about a mindset.
A failure to recognize that change is not instant.
That recovery is not linear.
That people are not static.
If you’re in healthcare:
Be better.
If you don’t know how—
ask someone who practices patience every day.
My dog would be a good start.
My mom too.
They’ve never once required perfection to show up.