Anonymous asked:

Can you tell me about benzodiazepine overdose and how to reverse it? I'm finding conflicting information on whether to use activated charcoal and whether to use the benzo overdose antidote, Flumazenil.

Also say the whumpee is coding from the overdose. Would that change the opinion of the doctors on whether to use activated charcoal or Flumazenil? I would assume it might change things to more of a "we have nothing to lose" opinion if the patient is already clinically dead.

Thanks! Your blog is one of the most valuable resources on the internet for whump research.

The reason you may have gotten conflicting information is because it really depends on a lot of factors.

First, activated charcoal generally only works if given within about an hour of ingestion of the toxic substance, in this case the benzidiazepine. It’s also a whole thing, where 50-100g of activated charcoal powder is mixed with about a liter of water or cola. The patient then either has to drink it (usually fairly quickly) or else get a tube going from their nose to their stomach and have it administered that way. So it’s not really a “code friendly” medication. Also, I was only able to find one study suggesting activated charcoal works on benzodiazepines (It doesn’t work on everything).

Flumazenil is a decent drug, but it works best on people who haven’t taken a benzodiazepine long-term. This is because, in people with a tolerance to benzodiazepines, it sends people from overdose to severe withdrawal in a matter of minutes, and benzodiazepine withdrawal is life-threatening due to the high risk of repeated seizures (flumazenil also causes seizures, so there are risks). Obviously it’s going to be given since it’s the only option, and there are ways to manage seizures without benzodiazepines, but still, if it weren’t for your character coding, there would be pause.

So basically, if he were at the point of coding, they’d give flumazenil, because it would probably be too late for the activated charcoal.

Pre-Appointment Planning Sheet

Here’s a pre-appointment planning sheet I made as part of my Community Health Worker training. It’s especially useful if you have trouble expressing everything you need during a short appointment. Use it to get your thoughts together or even just to hand to a clinician to facilitate the appointment:

Anonymous asked:

Does rescue breathing during CPR actually significantly improve survival chances vs. compression-only CPR? I keep seeing people (medical professionals) saying it's not worth it, but idk if that's just because they're assuming they'd be able to quickly access hospital treatment for the patient, so maybe it'd be different in a field medicine context?

No. And yes. It’s a little complicated.

The more people without pulses that get CPR, the better and the more lives are saved. Within the last about 15-20 years, research showed that the two main barriers to giving CPR were an inability to figure out whether someone had a pulse or not, and the panic-inducing concept of doing mouth-to-mouth on a stranger.

So we eliminated both of those problems. Today, if you take a community-level CPR class, you’ll find two differences from older classes. 1, you no longer have to feel for a pulse (just start CPR if there’s no breathing) and 2, call 911 and start pushing hard and fast in the center of the chest, no need for rescue breaths.

Just because of population density, in the majority of CPR cases help is less than 10 minutes away. Which means that right about the time that the circulating oxygen has dropped to the point that CPR is becoming less effective, help is there to give rescue breaths and replenish that oxygen.

At a population level, this saves lives, because it increases the number of people who are actually getting CPR. Greatest good for the greatest number of people, and all that.

But that leaves out 2 groups- children, and people who are greater than 10 minutes from care.

Children, because they often become unresponsive due to respiratory issues. This means they probably have very low levels of oxygen in their blood at the time they need CPR.

And people who are greater than about 10 minutes from care, because the oxygen in their blood would rapidly be being used up by that point.

So for these groups, if you know how and are comfortable providing CPR with rescue breaths, you really want to do so.

One important note for field settings: if someone’s heart has stopped because of drowning or a lightning strike, there is a chance they will regain a pulse even if they don’t get medications or defibrillation. In this case, doing CPR with rescue breaths is warranted even if there is no help coming.

However, if the person has not regained a pulse in 30 minutes, it is safe to stop CPR, as there is an exceedingly low chance of success after this point. Also note that one person alone doing CPR for 30 minutes is generally not possible. A group might be able to do it.

New Project

Hi All,

This is NOT an April Fool’s joke even though I’m posting it April 1st.

I have a new project I’m working on, probably the biggest I’ve ever attempted. It’s a book about writing low resource/field medicine.

I’m hoping to rough draft a chapter a month, and I want to be held accountable. The chapters are too big to fit into posts, so I’m posting them to a Google doc.

New chapters drop the first of the month. You can read them here:

macgyvermedical:

macgyvermedical:

Fun April Fool’s Prank- carefully remove all the furniture and belongings from your long estranged friend’s apartment in order to drag him into helping free your other friend from an imprisonment by heroin smugglers that was definitely not your fault.

Additional Fun April Fools Prank: find out about aforementioned prank and carefully remove all the furniture and belongings from your arch nemesis’s houseboat and maybe allege you could have totally killed that friend he definitely wishes was still estranged and then invite him to help you save your sister from your former assassin employer who wants their revenge on you for retiring.

macgyvermedical:

Attention Writers!

Have you ever had a quick medical question for your fiction works?

Do you ever wish you had a med pro you could text to hash out a scene?

I have experience working in inpatient, outpatient and education. I have extensive knowledge of wilderness and low resource medicine, and I have a small library of historical medical and nursing reference texts. And I’m taking my 10 years of experience answering medical questions on tumblr to discord.

$15 gets you lifetime access (not a subscription!) to a staffed (by me!) discord server where I answer your fictional medical questions, likely within 24 hours of you having them.

Email consultingwhumper@gmail.com to learn more or sign up!

Looking to liven the discord up if anyone new is possibly interested!

Anonymous asked:

Post-viral fatigue: When was it first officially recognized as A Thing? Was it unofficially observed much before then? What did the early documentation of it in medical literature/practice look like? How has our understanding of it evolved?

For this, since it is about history, I’m going to be talking mostly about our understanding of post-viral fatigue syndrome in a pre-covid context.

I have also decided to use sources describing what would later be termed ME/CFS. While viruses are only one trigger for ME/CFS, early reports tended to notice that ME/CFS clustered in outbreaks, which speaks to a viral, bacterial, or parasite trigger (for example, an outbreak of a viral illness happens, then just afterwards, an ME/CFS or post-viral syndrome outbreak does).

Finally, it is important to note that viruses are not the only infectious agent that can cause a fatigue syndrome. Bacteria (particularly strep) and even parasites (most notably giardia and malaria) have been known to cause it. As this is a history post, it generally will not be possible to differentiate the cause of any given outbreak, so I’m kind of lumping them in together.

————————

Let’s begin:

Between 1860 and 1880, a new disease arrived on the scene. It was called neurasthenia, and it was described:

Neurasthenia is a condition of nervous exhaustion,
characterised by undue fatigue on slightest exertion, both physical and mental, with which are associated symptoms of abnormal functioning, mainly referable to disorders of the vegetative nervous system. The chief symptoms are headache, gastrointestinal disturbances, and subjective sensations of all kinds.

It probably wasn’t actually new, but instead first recognized here due to the recent industrial revolution and change in work patterns. It was considered to strike upper-class men (as a consequence of their hard mental work) specifically, and thought not to strike the lower classes, women, or racial minorities (who surely never engaged in such work).

Between 1880 and 1900, in the UK, explanation after explanation was posited as the reason for the illness. It was due to overwork, or underwork. Due to a lack of electrical energy. Due to a physical insult like an infection or metabolic disturbance. Due to the law of thermodynamics playing out in the body. Basically, if the scientific community found a new cool theory, it was applied to explain neurasthenia. None of these, however, were able to be definitively proven with the technology of the time.

One thing, however, was consistent- the treatment. Like a number of other illnesses, it was sending someone to a retreat, rest home, or other place where they could experience physical and mental rest. This is also the first time “chronic fatigue” was used in the literature. Based on what we know today, this was probably a good option.

By the early 20th century, unable to find an explanation that stuck, however, physicians threw their hands up. It was all just a weird form of melancholia, they said. It is important to note here that psychiatry and neurology would not become distinct fields until after WWII. So it was mostly neurologists saying “hey, we can’t figure out what causes this, so we’re going to lump it in with another thing we can’t figure out the cause of that also makes people stay in bed all the time.”

This was followed very swiftly by other physicians, several of whom had neurasthenia themselves, advocating for it to continue to be considered it’s own separate neurological condition. Unfortunately, the melancholia label stuck, and the view of it as an upper class disease that only affected men quickly flipped to one that was only experienced by the lower classes and women.

Whether understood as physical, mental, or a combination, however, the early 1900s brought with it another explanation for the problem- febrile illness. It was noted that chronic fatigue syndromes frequently followed malaria, flu, and other illnesses that caused fever. This was not the first time this had been postulated, but it was the first time it attained widespread acceptance. The lack of persistence of the culprit (at the time bacteria or parasite), however, only lent more credibility to the idea that it was mental in nature, and it was largely forgotten about.

In 1934, a series of outbreaks of what was thought to be an abnormal form of polio struck around the world. Once it was differentiated, it would be named epidemic neuromyasthenia. This was seen as a brand new illness, not connected to neurasthenia.

By the 1950s, the term had changed to “benign myalgic encephalomyelitis”, which was chosen due to

the absent mortality, the severe muscular pains, the evidence of parenchymal damage to the nervous system, and the presumed inflammatory nature of the disorder,

as described in a 1959 paper on the subject. It was recognized that the disease came in both epidemic and sporadic cases, but the scientific community wasn’t entirely sure what caused it. Still, the number of papers about it suggested they were looking (unfortunately, most of these papers are not available, even in abstract form).

The next problem happened in 1970. Two psychiatrists named McEvedy and Beard wrote a paper that analyzed an outbreak that occurred in 1955, proclaimed it a case of mass hysteria without talking to any of the patients, and retroactively concluded that all previous outbreaks dating back to 1934 had also been mass hysteria. Over the next 8 years, there were many papers vehemently refuting this claim, by at least 5 different authors that I could find.

Unfortunately, instead of the rebuttals cementing McEvedy and Beard as not knowing what they were talking about, it created a deep rift in the scientific community: did the disease belong to psychiatrists, neurologists, both, or someone else entirely?

People working on the physical end in the 1980s pointed to high rates of viral titers for specific viruses, circulating immune complexes, muscle biopsies showing necrosis, abnormal jitter potentials, and abnormally early acid production during exercise, among other things. Basically, there’s something wrong with how the immune system is working, and also something very wrong with the physiology of the muscles.

People working on the mental end pointed to mass hysteria and high rates of anxiety, depression, and emotional liability in people with myalgic encephalomyelitis, combined with a then relatively new understanding that mental illness sometimes does wonky things with the immune system.

Note that, for the mental end of things, some of the sources cited in these papers are exceptionally old for scientific papers, like, going back to neurasthenia days and the original 1900s explanations of neurasthenia as melancholia.

Because the two camps couldn’t get along (I have no proof, but I know neurology and psychiatry fought like cats and dogs for long swaths of the 20th century, so it honestly might have been a professional scrap that made this illness so fraught), “post-viral syndrome”, and later “post-infectious fatigue syndrome” were coined because they didn’t specifically point to physical or mental being the primary reason for the syndrome.

And this argument continued into the 2020s, and in some cases until today. The COVID-19 pandemic did finally settle it largely into a physical illness with some psychological features (rather than a psychological illness with some physical features). But it can still be exceptionally difficult to get diagnosed and correctly treated depending on where a person is and what doctor they have.

In conclusion, the history of post-infectious fatigue syndrome has gone through many names and many phases, and there was a lot to the story I wish I could have covered in this post, but it was already really long. Hopefully this gives you some understanding of the social and scientific history of this syndrome.

happinessisntfun asked:

why is a steroid like prednisone (or prednisolone for cats!) so useful systemically?

in the last six months, I have taken steroids for migraine treatment, ear infection remnants, and a frustratingly long-lived chest infection. My orange cat takes prednisolone to treat his asthma and stomatitis flares.

(orange cat attached)

Prednisone is an old drug (it came out in 1955), and like a lot of old drugs, we’ve found a lot of uses for it. Prednisolone is a metabolite of prednisone, meaning it is created as prednisone breaks down in the liver. The active drug is actually prednisolone no matter which form it’s taken in.

Prednisone is used to to replace the hormone cortisol, suppress the immune system, decrease swelling, and fight cancer. We know how some of this works, (for example, we know that it decreases the amount of certain chemicals (cytokines, thus decreasing swelling) and the number of circulating white blood cells (thus suppressing the immune system)). It’s also really similar to cortisol, so it can replace it in people who don’t make enough cortisol themselves.

Generally, it’s used for either it’s swelling-reducing properties (like for your ear infection and chest infection) or the immune-suppressing properties (your cat’s asthma and stomatitis). When looking at why it works for migraines, I got 3 wildly different answers, so I think the reason is we don’t fully know.

hempseeeeds asked:

Thing to maybe research If you Like: What does a receptionist or general assistant in a rural/small-town doctor's Office (as in general/family Medicine) do? What are the minimal qualifications to be legally allowed to do that Work, and what are the typical qualifications to be likely to get hired? What was that like in the 1980s and 1990s? (How plausible is the situation of Marilyn as the doctor's assistant, in Northern Exposure?)

I have never seen Northern Exposure so I’m not totally sure who Marilyn is and what her background is.

Today, a receptionist at a medical office (sometimes called a “medical office assistant/associate” or MOA) is someone who makes appointments, answers the phones, faxes/calls in referrals, and checks patients in for their appointments. They may or may not be Medical Assistants (MA- which is an approximately 10 month certification program) depending on the needs of the clinic.

Keep in mind that “checking in” is just the process of taking insurance information/payment and making sure the patient is marked as “here” in the electronic medical record. Taking vital signs and updating medication lists (called “rooming”), giving medications/vaccines and drawing blood are jobs done by either an LPN or MA.

A small, rural office with one or two providers might only have one person doing everything, or splitting the work with a provider (for example, the provider might do their own rooming/everything clinical, while the MOA does the making of appointments, answering the phones, etc…).

MAs have been around since the 1950s, but didn’t really take hold in a big way until the 1970s or 1980s. Prior to that, there was no real official training that went in to working at a medical office, especially not a small, rural one. A lot of times the providers did their own training of staff. Without a specific license, there was a wider range of tasks an assistant could do.

So really, if the clinic in question was run by one doctor and it was in a rural area that maybe didn’t have a population of official MAs to pull from, the doctor could hire whoever they wanted. That is actually still true today in Alaska, though other states have laws requiring an MA credential.

sanguinarysanguinity:

When I was in my twenties, before the internet was very useful as a reference tool, I painstakingly built myself a collection of how-to reference books: car engine and house repair, knitting techniques, knot-tying, basic cookery… An assortment of topics that I found useful to have at hand.

By the time I got into my forties, that reference shelf was looking rather obsolete. Even foolish! Why had I sunk all that energy into building it? Not that the knowledge on it was outdated, per se, but all information was on the internet nowadays, and often easier to find there, or in more detail, than I could get from one of my reference books. Why, when I was living paycheck to paycheck, had I spent all that money on reference books?

But now I find myself turning to my reference shelf again. Because suddenly the internet is drowning in AI-generated gibberish, and it’s no longer easy to find basic how-to information anymore. I wade through webpages and webpages of unreliable AI-crap trying to find a solid answer to a simple question, and finally, in frustration, go consult my reference shelf. Because maybe my books only have a bare-bones and twenty-year-old answer to my question, but by god, it’s on-point and accurate.

And also! I’ve found that the older the reference text the more complete the answers to common questions. The book assumes you don’t have another source of information, so readily explains everything you’d need to know to understand an answer, whereas even before AI garbage you might need to search 3-5 websites to get the same understanding.

(via dxmedstudent)

Anonymous asked:

heyy idk if tumblr ate it or something but just in case i'm sending it again. say patient gets shot with an arrow somewhere in the non-fatal meat between heart and shoulder. they pull it out clean and stitch it up quickly. after some hours of rest, can patient ride a horse at a moderate pace? would that pop the stitches? worsen the wound? or just be terribly painful?

First, assume that everything fiction has told you about this situation is a lie. I’m always blown away by how accurate older movies and television are as compared to modern versions. I have no proof of this, but it seems like instead of subsequent shows hiring medical consultants, they kind of…. just copied older television and movies? But they didn’t know what was important and what wasn’t, leading to a game of telephone where injuries got milder and milder (because who wants their character to die, or need surgery) until we got to today.

NOTE: A key exception to this is (some) novels, or movies and television based on a novel where the author did the research or hired a consultant. I assume this is because authors have longer timelines on which to do research.

Back to the ask, the bow and arrow is a lethal weapon, and its wounds mirror gunshot wounds in a lot of ways. We have evidence that as early as the 1400s fighting arrows could pierce bone and go clear through the human body, including through the skull. Also assume that even if a group only uses bows to hunt and not for warfare, those arrows have to pierce the hides of some pretty large and thick animals. So assume this arrow went through the shoulder and scapula (the shoulder blade).

There is also no place in the shoulder (except the very outside- through the trapezius or deltoid muscle or if maybe it lodged in the ball of the humerus (probably the only place in the shoulder that could stop it, but then you’d be looking at bone infection, which isn’t pretty)) that wouldn’t be deadly, even if you didn’t count infection.

The reason for the deadliness is that between the heart and shoulder, you still have lung. Lungs work because the diaphragm pulls them downward, making space in the chest cavity, which causes air to rush in through the nose and mouth. If there’s a hole in the chest, air rushes in there instead, collapsing the lungs and killing the person. This is called a sucking chest wound.

Imagine if, in this demonstration, there was a hole in the side of the chamber- the lungs wouldn’t be able to inflate properly.

As soon as you pulled that arrow out the lungs would start to deflate, which you could patch with sturdy tape and a firmly placed hand (on both entry and exit wound), but that ultimately would need surgery to adequately close.

Could the patient ride a horse in that condition? Probably not, unless that horse was the only way to an operating room and someone was sitting behind them keeping pressure on both entry and exit wounds to prevent air from entering and escaping.

I love to research things. Send me things to research. Would love to tell you about things. But mostly things you want to be told about.

creekfiend:

About ten years ago I decided that the next step I needed to take in my life was to accept and explore what it meant to be a failure and to have failed. This infuriated almost everybody in my life and clearly terrified a lot of people. People do not want you to accept failure. They dont want you to like… Sit with and think about it and pick it up and turn it arpund in your hands and really examine it. They want you to keep throwing yourself against the impossible walls until your body explodes! They do not want you to say “alright then, I’ve failed. What does that mean for me? Im still here. What does the life of someone who has failed look like?”

This makes people very angry and panicky.

My mental health improved in ways it had not in the previous DECADE once I stopped. And. Sat. With failure. And thought about what my failure … Was. And looked at the structures that produced it and examined them critically.

It is so taboo to fail and admit it openly and talk about it. It is so taboo to talk about or think about failure in an accepting way rather than hiding it shamefully until you experience a degree of success in some area which allows you to present the past failure as “a stepping stone” to your current situation. Fuck that. We are put in positions of guaranteed failure by society every day and then punished and shamed for it. Lets fucking talk about failure

(via happinessisntfun)

macgyvermedical:

macgyvermedical:

It’s MacGyver’s birthday and I’m once again thinking about how March 23rd 1952 was a birthday selected by the Vietnam draft. There was a moment on August 5th 1971 where the world crashed down around 19 year old Mac. Where the number “89” rang out like a gunshot. He went from being a student at Western Tech to being a soldier: no longer having any agency except refusing to carry a weapon, and being brave enough to exercise that agency.

@tramontane-fire some extremely good questions there. So the first part, Mac was a conscientious objector, but not in the way a lot of people think of conscientious objectors. He would have been part of a group of people classified as “I-A-0”. This meant he qualified for military service, but his very documented refusal to carry a weapon meant he would only be assigned non-combatant tasks. Ultimately he ended up on a bomb disposal team (not sure whether this counts, but he did not carry a weapon canonically).

And yes! There were lots of conscientious objectors in the Vietnam war. They ranged from “non-combatant-only” objectors like Mac, to “I would rather die than serve in the military”. Most of the latter “I-0” classification could choose to serve another way, such as civilian national service or work in a field like healthcare for a certain number of years. If they refused this, they faced jail time.

Check out my post about Project Whitecoat as well!

1971

MacGyver wandered slowly down the sidewalk as the last of the sun slipped below the horizon and the streetlights clicked on. It was late summer in Minnesota, and he could feel the last of the warmth of the dry dirt road on his bare feet. Crickets chirped. The air was warm too and after a long day at the lake, he smelled of sunscreen and bug spray.

He approached the back door to his grandfather’s house carefully. Lights were on inside, giving the house a hazy glow. As far as he could tell Harry was asleep in the living room with the TV on. His mother would still be at work. As quietly as he could manage, Mac opened the screen door, slipped inside, and closed it behind him. The dusty storage-smell of the porch came over him. The door to the inside of the house was fortunately open, letting the evening breeze into the kitchen.

He tiptoed past the formica kitchen table and across the hall to the stairs, precariously traversing the several of them that he knew creaked.

“You missed the news tonight, Bud.” Mac stopped just short of the top stair. Harry.

He turned around, very slowly.

“I… didn’t expect you to still be up.” Mac said carefully, scanning his grandfather’s face for any change of expression.

“I happened to catch it.”

Mac closed his eyes, suddenly regretting every decision he’d ever made. He swallowed. He knew what Harry had to say, and he knew he wouldn’t like it. He knew he should have been there so they would have been able to get the news together. Harry seemed to take this as an invitation to continue.

“It was the lottery tonight.” Harry gently reminded him.

“I know…” Mac said, dropping the pretense that he had simply forgotten. He knew what tonight was. The 3rd draft lottery. “I know.”

Harry’s face softened. “Come downstairs, Bud, we have some things to talk about.”

They sat together at the kitchen table, the light above them swinging slightly as a few mosquitoes danced around the bulb. Mac could tell by the look on his grandfather’s face how the lottery had gone, but waited quietly for him to speak.

“Bud…” Harry reached out and touched Mac’s hand, struggling to come up with the words.

“They called my number, didn’t they?” Mac asked. “They called 89?”

Harry nodded slowly. “I’m so sorry, Bud.”

“What about Jack’s?” He asked. “What about 250?”

Harry shook his head. Not only, Mac realized, in a moment of dawning shock, was he going to Vietnam, but he was going without Jack Dalton.

——————-

The 10 days it took for the letter to arrive were some of the longest of Mac’s life. Knowing he was going to Vietnam, maybe to die, maybe to kill, was solidly the most devastating feeling he had ever felt.

“Are you opposed to war?” The man asked. He sounded bored, impatient. The question came after he’d given Mac a cursory physical exam and a barrage of other questions. The question sounded too simple.

“I’m against… using a gun?” MacGyver answered. He was actually surprised that the words had come out of his mouth. It had been six years since he’d held one, and a few times in that time he’d toyed around with never touching one again. But then it just… hadn’t come up. Or he’d dodged the question by refusing a hunting trip here and there.

But now, standing in front of this man who worked for the draft board, he was actually saying it out loud.

“Is that a yes, or a no?” The man asked. “Are you against war?”

“I won’t use a gun.” Mac said, more decisively this time. The man took a deep breath. He handed Mac a slip of paper.

“You won’t get your answer today. You’re probably still 1-A so don’t get your hopes up. But go to the address on this card, 9:15am on Tuesday. Bring a friend who can vouch for you, ah, not using guns.”

——————-

It was 9:10 on Tuesday when he entered the elementary school wearing his cleanest shirt and the only pair of long pants that still fit him. The hot summer air was already stifling. There was a growing group outside the gymnasium where the draft board was hearing the cases for deferments and alternative service.

Half of the people there were holding files of papers, or had two or three people along with them. Mac looked at Jack, who looked uncomfortable.

It had been hard talking to Jack after the lottery. Jack seemed distant and nervous. Mac told him he didn’t care- was happy, even- that Jack’s number hadn’t been called. But the elephant was, metaphorically, still in the room.

“MacGyver, A.” A voice called. “Is there a MacGyver here?”

“Here!” Mac called, pushing forward to get to the door. Inside, Mac and Jack approached a single wooden table with three people sitting behind it. One of them was the doctor who had examined him the previous week.

Mac wasn’t sure what he expected. Certainly men in military dress and

“State your name.” An older man said. Mac slid his driver’s license across the table. The man closest to him glanced at it.

“Very well, Mr. MacGyver. State your case.”

“I am not against serving my country in wartime.” Mac said. The words were rehearsed, but not wholly incorrect. If anything, he was being generous to the board. “But I will not use a gun.” He continued. “When I was 13, I saw one of my best friends die when I pushed a gun out of my other friend’s hand. Ever since then, I swore I would never touch a gun again.” The man in the middle of the table raised an eyebrow. He looked at Jack.

“State your name.”

“Jack Dalton, sir.”

“And how long have you known Mr. MacGyver?”

“4 years, sir.”

“In those 4 years, have you been made aware of Mr. MacGyver’s aversion to using firearms?”

“Yes, sir.”

“Have you ever seen Mr. MacGyver hold or use a firearm?”

“No, sir.”

Two of the men whispered to each other briefly.

“1-A-0. Non-combatant.” He handed Macgyver a piece of paper. “You’ll receive a letter in the mail. It will tell you where to report. Next, please.”

Just want to plug Clubhouse International a little more than I already have. They’re something that’s helping me a lot recently and they don’t get a ton of press, even in areas where they’re common.

(Red= accredited, grey= not accredited, green= training sites)

I’ve talked about CI in the context of supported employment but it’s more than that and I feel it should be talked about more. It’s a work-ordered day and community-building program for people with mental illness. Not just severe mental illness. Mental illness in general. If you’re having trouble finding community that understands your mental illness or help finding/keeping a job you can tolerate there’s a place for you at clubhouse.

What that means is that you go there and you work on things that keep the clubhouse running. I’m sure it’s different at different Clubhouses, but the one I go to has three “units”- a business unit, a hospitality unit, and a career development unit. The business unit does things like filing, advertising, doing the paperwork, and developing flyers for different events. The hospitality unit prepares meals, coordinates donations and purchasing, and develops/presents health and wellness programming. The career development unit runs a little shop, does the landscaping, and performs janitorial tasks.

What’s special about it is that, unlike traditional day programs, at Clubhouse there is a very fine line between Member and paid staff. That means if you just walked in, you’d probably have no idea who was a Member and who was getting paid to be there. Many people come every day, and Members and staff do (or assist with) a lot of the same tasks. Technically things are led by staff, and staff do some of the admin like making notes on members and billing insurance.

Meetings are held every day to discuss tasks each member will complete on a given day. They are held weekly or monthly to discuss programming and menu options (there is a kitchen onsite where breakfast, lunch, and sometimes dinner are prepared for members, by members). There is also a weekly staff-and-member meeting where more pressing issues and their solutions are discussed.

All this to say, if you live near a city, especially in Europe or the US, there’s probably a Clubhouse near you.