Wednesday, June 13, 2012

Healing in real life and in game - a Navi rant

It's not often I feel terrified.  But that doesn't mean I don't feel it.  As a healer, sometimes you feel like you can make the difference between who lives and who dies.  Holding someone's life in your hands.  If only real life was as simple as Battle Rez or a Resurrect.  People trust you with their lives, and you have a responsibility to them - it is no small thing to hand your life over to someone else's care.  Today I was reminded of the responsibility one holds and the consequences of those responsibilities.


I watched today as someone who was only minutes ago breathing and alive, turned into a blood bath in front of my face.  It all seems like a blur now - one minute I was telling the nurse about the patient, the next I was trying to clean up blood that was pooling in side her oxygen mask, then the next I was ripping her mask off and putting a resuscitation mask on her face with a resuscitator bag to try and breathe for my patient who had suddenly stopped breathing.  And blood was going everywhere.

Hand on the neck, no pulse.  Someone has jumped on the chest and started doing chest compressions.  I'm struggling to breathe for this patient, and I've hit the emergency button and suddenly there is a massive crowd of people around me, asking me what I need.  Others are trying to give orders.  I only have one thought on my mind - I need to get her to breathe again, get this breathing tube back in and get some oxygen in and get this f***ing bleeding under control because it is all over my hands, and spraying everywhere each time I'm trying to force a breath of air into her lungs.   Damn I can't even open her mouth, she's biting down, S***, how am I going to get all the blood out of her mouth, she's drowning in it.

Do you want adrenaline doc? - "Yes but only 0.1mg."
I can't feel a pulse! - "continue chest compressions!"

People materialise around meI can't even see who they are.  All I can see is my patient, her face, her blood, all over my hands, my clothes, the bed, while I'm trying to get her to breathe and getting someone else to do CPR while I also try to feel for a pulse.  I wish I had 3 hands.

My mind is racing.  F*** f*** f*** don't die.  You handed your life over to me, you were my responsibility.

OK, now I need to get this bloody tube in.  I slip the cold metal into her mouth to open it and finally I can suck out all this blood.  Tube... in.  Connect.  Press the bag.  Chest is going up and down.  Keep squeezing the bag, colour is coming back.  

"Stop CPR!"  I put my hand on her carotid.  OMG there is a pulse.  "Got an output!"  I look up at the blood pressure... it's high now after all that adrenaline... crap, that's just going to make the nose bleed more.  What was a trickle was now a goddamn stream.    OK, we're out of the woods.  Now... wake up.  God, why won't you wake up...

A colleague puts their hand on my arm.  "I can take over here, why don't you go clean up."

"No," I said, "I'm OK.  I just need to make sure everything is done first."  I ask for an electrocardiogram and a blood sugar, to rule out everything else, but I know what went wrong.  She didn't have a hypo or a heart attack.  Her oxygen went low and her heart stopped.  That was it.

"No, really," my colleague said, "Go wash your hands."

I look at my hands.  They are covered in blood, it's up to my arms.  I didn't even have time to get gloves on.  Way to go for taking care of yourself, you moron.  A nurse hands me a tissue.
"It's dry already," I said.  "I'll just go wash it off."

As I step away, the reality of it hits me.  She nearly died.  No, wait.  She DID die.  What did I do wrong?  What could I have done to prevent it?  What was I supposed to tell her family if she didn't wake up or didn't pull through?  I turn on the tap and my eyes start to sting.  Oh my god, don't start crying in front of all these people.

The head of department comes up to me.  "You did a great job, really slick, calm and cool."

One of the nurses hugs me.  "OMG, I'm glad it was you.  That was my first arrest, and I am glad it was you who ran it.  You were so calm and directed and focussed which is what a good leader should be....If it was anyone else..."  I hug her back, and dry my hands on her shirt, laughing at her squealing at me.

Yeah, well if it was so good, then why do I feel so bloody crap and awful and full of self beration?

My surgeon comes back with a hot chocolate and puts it in my hand.  "Here, I think you need this."

I smiled back, weakly.  "Thanks," and took a big slug, before I went and continued the battle of making sure my patient woke up ok and get this goddamn bleeding under control.  Thank goodness, she's now waking up and trying to take this tube out, such a good sign.  I talk to her, reassure her, but she's still confused, waking up from her operation and obviously struggling coz there is blood all over her face, pouring out her nose, and she feels weird.  After a few minutes, she's calm, and we've cleaned her up, changed her sheets and gown, and she looks as good as new, like nothing was wrong.  Just don't look in the bin.

I went with my surgeon to look for her husband, he wasn't there.  So I called him to let him know his wife was fine, there was a complication, but now she's fine, and I would see him when he got here.  He was only 10 minutes away.

I went to do something and came back to her room and he was there.  I shook his hand, he was concerned of course, I told him everything that happened, but reassured him that she was fine now and that I was taking blood tests to confirm things were ok, but the heart tracing looked good.  He asked what caused it and I told him the truth - I didn't know exactly, but she did stop breathing right in front of me, it could have been from the nosebleeding, or drugs, I wasn't sure, but we got on top of it as soon as we noticed it.  My patient was listening as well.  And I was stunned and embarrassed when they both thanked me for being there and for never leaving her side and for saving her life.  I certainly didn't feel anything like a hero or anything, I felt more like... well, I felt like crap!

She could have died today.  But she didn't.  People pat you on the back and tell you what a great job you did, you saved her life, but you don't feel like that at all. You berate yourself, thinking about what you could have done better, what can you do to prevent this happening again, what did I do wrong that made this happen.  Even now, hours after the event, I still have that leaden hearted, sinking feeling of dread.  But it's easing.

So how does THIS relate to World of Warcraft?

I play a healer in World of Warcraft.  I LOVE healing. Raid healing, is where the highest points of this game come, for me.  Keeping people alive, fighting your own battle with players health bars whilst the tanks and DPS fight with the bosses' health bars. Bringing back people from the dead. Here it's all a game, and the best thing is you can have a second, third... 1000th chance at life. In this fantasy world you can afford to make mistakes.  It's fun because you can be a doctor without the consequences of failure.  I mean sure, there is failure, because when healers fail, people die and the raid wipes.  But when you win, there is a massive feeling of elation, of success... that WINNING feeling, and you feel absolutely legendary that you were there to make it a success.  It's so different from real life, well it is for me.  Life in the game is such a trivial thing, it comes back without many consequences.  Life in real life, is not.

People wonder why I never get angry, or cry with raid wipes or with failing at a boss.  Because, though it is frustrating to not get something done, it really is, just a game.  I come here to the game to be a hero medic.  And when you win you feel like such a hero.  Even when I win in real life, sometimes you don't feel like that much of a hero.  Though, gifts and thanks and chocolates do help :)

I guess the other thing is, someone went from the well state to the unwell state because I put them at risk to start with.  Giving an anaesthetic is so easy these days, it's easy to forget that it's an unnatural state, and frought with danger.  Look at Michael Jackson.  That is what you get when you have an anaesthetic without an anaesthetist there.  Who is going to snatch you back from the jaws of death then?  Luckily for my patient, I was there.  Not so lucky for MJ.

That's why there is no feeling of heroism here.  It's different when you get someone from a car wreck who is bleeding to death and I am resuscitating them and bringing them back and we whisk them off to surgery to stem the bleeding and I'm battling to keep them alive with blood transfusions, drugs and tubes and drips being shoved into the poor person just to keep their heart going.  When that patient pulls through, THEN you get that feeling of heroism and success.  Because it wasn't a risk I put them into in the first place.  But you know, I still wouldn't change my job for anything, I still love it.  Yes it has its scary times, but now that I've had some time to reflect, THIS is what I trained for.  THIS is why anaesthetists are paid.  Because we have the skills to administer anaesthetics and deal with its consequences.  It is how we deal with the consequences that makes or breaks us.

Thanks for reading!  I wrote this post mainly to destress about my day, and getting it out does help.  Whether to hit publish or not, is another question.  I'll go sleep on it.

52 comments:

  1. I hope the post helped you destress and be able to get a good night's sleep. I was happy to see in spite of what you went through you were still Navi!

    "I hug her back, and dry my hands on her shirt, laughing at her squealing at me."

    That sounds like Navi!

    I've had so many bad medical experiences that I now avoid doctors unless something's broken and hanging at an odd angle. I wish the one's I'd gone to cared as much as you do.

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    1. @TotA - A good sleep was what I needed! When you keep it all inside, it seems to just burn and churn and self doubt eats you all up, and writing it out always helps me destress. LOL, yes that line is very me! It is nice to see I was still inside that horrible mess somewhere. /hugs

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  2. WoW, Navi, awesome post. I would have thought that trying to heal the virtual troops after the RL stuff would have pushed you to something nice and easy like a pure DPS class :)

    The difference between staying calm under virtual stress and being able to do the same when the stakes are real and ultimate and the people around you are taking their cues from you ... It is an awesome talent and you couldn't ask for more in a health-care professional.

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    1. @Saunder - Ty Saund :) I think that I do like a bit of control and DPS seems a bit out of control to me - at least with healing you feel like there is something to focus on! Ty for the kind words :)

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  3. Holy hell, that post hits hard. I don't really know what to say. I know you said you don't feel like a hero, but to that person you saved, you are. Heroism is not and should never be the perception of the hero, in my opinion. It doesn't matter if YOU feel heroic. What matters is that your actions saved someone's life. To that person, and their family, you are a hero. This is one of those rare occasions where you own opinion of yourself means very little.

    I think you're a hero just for doing the job. Many others, I think, would agree.

    Thank you.

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    1. Also, I never knew doctors actually cared so much. I always thought they were supposed to be completely detached emotionally. It's nice to know that misconception isn't entirely accurate.

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    2. @Hyperious - Aww thank you so much! Sometimes the job is thankless, but sometimes you get those people who are grateful for what you do and it makes up for all that. This post is a bit "glorifying" in that the usual day is not like that at all. Doing what I do is more like flying a plane - it's only risky at the take off and landing, and it's usually smooth sailing and cruisy in between. About the detached emotionally - you can see why they are, when you care too much, the emotional stress is overwhelming and can lead to burnout. That's why most doctors are detached - it's a coping mechanism.

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  4. Navi, that is amazing. YOU are amazing. I think even if you may not consider yourself heroic, you training, calm focus, and true care for the patient is what matters. You were there for her, giving your all to save her. And you did. I agree with Hyperious above that you were indeed the hero for doing your job and for caring so much. If only everyone in the medical field were like you!

    I think it's incredible you can keep so cool about the game also. A lot of times we forget exactly how trivial it is since it's just a game, in comparison to reality! Thank you for posting this, Navi! I hope you're feeling better after a night's sleep.

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    1. @Ninevi - TY Ninevi for the kind sentiments and for reading my rant! I do feel a lot better after a sleep (and lots of chocolate). In my profession, I think most people are like me - it's surgeons who are typically very cold and impersonal, I find.

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  5. Wow Navi, I don't know what to say except that I totally agree with all the other reply's. You truely are amazing!

    Souglyy

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    1. @Souglyy - TY Baha :) I certainly don't FEEL amazing, but I think... relieved? is the closest positive emotion that I feel about that whole thing now.

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  6. Oh, Navi, I can feel your fright and horror just reading this! (and it's making light-headed, because I'm sensitive to blood) I'm so glad you were able to bring your patient to a successful recovery. ((hug))

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    1. @Kamalia - Oh my I'm sorry for the gory descriptions! TY /bear hugs back.

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  7. navi your my hero :D and look at you casting rebirth IRL!!!!

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  8. @Biship - LOL I was thinking it was more like Revive, but I was still in combat, technically, so it must have been a rebirth :P

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    1. @imageheavy - /hugs TY (still not feeling the amazing! Maybe after more chocolate!) :)

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  10. First of all, I'm glad you wrote it all down. I know how cathartic it can be when you just need to work something out in your head or just have the need to let it all out. Whether people read/respond or not.

    Knowing you for so long (geez it's getting closer to 20 years now) I am not surprised that you performed so well under pressure and that you would be beating yourself up that this happened at all.

    But you did have a good outcome from this and you remained calm when it was needed most. I'm also glad you had such great support staff during and after the ordeal.

    You sounded a lot better when I spoke to you earlier :)

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  11. @Cymre - Thx for the supportive call :) It is so much better out than in (like a fart... TMI!!! LOL!!)

    I am just glad major work dramas like this only happens once or twice a year. If it happened every week I'd be an emotional wreck!

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  12. After reading your post, I commend you on your patience and handling of that moment of your working life. And yes I see you recognized that you were trained for that reality.

    secretly I think WoW is continuing training for you. The hustle and bustle of keeping a LARGE group of colourful characters alive, keeping the real life people behind these characters not too insane. To keep calm and order, a large task. And so I commend you, I pat you on the back for your bravery, because it is brave. Brave to step up, take control and maintain what you striven to do in the first place, keeping your patient your first priority. Keeping the raiders you are assigned to keep alive or rebirthing.

    In all things virtual I give you a /hug. In all things RL I'd still give a hug and say what a truly wonderful person you are Navi!

    De-stressing is healthy, even if it is through the internets. Judging by the responses so far, you have a warm welcoming amount of supporting friends =)

    Keep up with the good work ingame and out

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  13. @Faithy - so formal faithy! Thank you for the kind and encouraging words :) /hugs to you and gosh, I'm not sure if my work skills are improved from keeping all the guildies and raids in order, but my PARENTING skills have improved /grin

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  14. WTB Innervate for Navie

    Perhaps we can get blizz to change Innervate to replenish your mug of hot chocolate instead of mana ;)

    PS: I won't embarass you in public, you got my private msg :P /hug

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  15. @Tout - mmmm Chocervate FTW!

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  16. I hope sharing this Helped you. I Know it was something I can't explain in Reading But yes at the end of the day WoW is just a game and if only Life was as perfect as WoW is.

    What I do wanna say is You are alike many other medical care each of us have in this world and What is teh sad thing is not many Realize what you and your fellow workers experience day after day. If I could Thank each and every one I would However I have thanked doctors nurses each time myself or family are put in to ones care.

    But from a Utter stanger to a another person Who cloud do everything possible.. Who does everything possible and is human Alike the rest of us, I thank you <3 I respect and appreciate everything people like yourself do for teh rest of us Who may need you at some point. Bravo.

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  17. @Vyx - Ty for visiting my blog, Vyx, and for your kind words. Every now and then, if only one person shows appreciation, it makes up for the other 100 who didn't or were, even worse, nasty and rude. Your words are a great encouragement :)

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  18. Navi, everybody before me has said what I would say, so I'm only going to say your the one person I would have in my corner when the shit hits the fan.

    Ayelena

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    1. @Ayelena - Thanks Ayel :) though you know what I'd say? Move the fan to the other corner :)

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  19. epic story

    -Hwired

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  20. I admire people like yourself who are able to work under such unpredictable and stressful situations but are able to remain calm under pressure and continue to show leadership to those around you. I know I'm not cut out to handle life and death situations, which is why I stuck to research. But strangely I had a very similar day to your own harrowing day today, although the scope is no where near as significant as yours. One of my jobs is to process and prepare samples submitted by various researchers for microarray analysis (gene expression analysis). These experiments can be quite time consuming, samples can be unique such as patient samples and hence very precious and the reagents that are used to perform these experiments can be very expensive (sometimes more than $5000 for one experiment). Today, after 2 weeks of preparing the samples, was the day where we actually see the results. I scanned the chip which had the loaded samples and... blank. Usually I see a bunch of fluorescent green spots, but never have I seen a blank scan. My heart sank, and to make it worse, the researcher who's samples I was running was standing there next to me. I was struggling to come up with an explanation, thinking all the things I did that could have gone wrong and like yourself, trying to stay calm in the midst of panic. It takes about 2 hours to scan the entire chip so it was the longest 2 hours ever. In the end, I managed to salvage the chip and the data though. I rescanned it and for some unexplainable reason, it worked much to my relief. The scanner just decided to have a conniption.

    Anyway, I thought I'd share my story too because when I read your post I got a sense of dejavu. Glad you feel better now :) I think I need some chocolate too...

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    1. @Shab - That feeling of dread is terrible. Though 2 hours of dread that you had to endure sounds worse than my 5 minutes of terror. Glad you didn't stuff up those samples!!! Woulda been expensive and some very upset people!!! Here have some of my chocolate :)

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  21. Glad you feel better now Nav. ;)

    It sounds like everyone who was there thinks you did a great job (but I can't fairly comment - I always think you're an awesome healer! :p).

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    1. @Sevrus - /hug that's because you're stuck with me healing you for 2s! :)

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  22. Bloody Hellfire Nav. You save real lives.

    You have no idea how much respect I have for you right now. You're an utter star :D

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    1. @Godmother - TY my friend for the HUGE compliment. I definitely don't feel like a star, but I would happily settle for competent and safe :)

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  23. Really great read. My wife is currently a med-peds hospitalist and just finished her residency last year. The stuff that goes down is just unbelievable. The stories she has, the stress, sometimes its a wonder that she functions at all.

    It really makes sense and informs your thoughts on WoW healing and the escape from reality that it gives you (E! THS is my wife's activity of choice). I personally use WoW to unwind from my day, but sometimes I feel like I'm in the minority with the seriousness that it elicits from some players.

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    1. @dreadblade - Ty for visiting Dreadblade! I was just looking at the comment I left on your blog during NBI and I have NO IDEA what I was talking about in that comment... P(a)eds is one of those areas that can be pretty horrible and sad, and I salute your wife for taking on that challenging role. I hate seeing sick kids with cancers and stuff, or dying kids. I can imagine it would be hard for her sometimes when kids the same age as your own kids are sick and dying...
      I also use WoW to unwind, and I think most people do, but I don't want the game to make me stressed out, so I just don't let it, if you kinda know what I mean. I had to go look up E! THS (is it E! True Hollywood Story?) because I had no idea what that was. Thank god for google :)

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    2. Yes, that's the one :)

      Its not the sick and dying kids (although they are sad) that stresses her the most, its the abuse cases. She was on service for 18 hours one day dealing with a serious abuse case where the family tried to blame OI (brittle bone disease) on all the broken bones on their infant.

      Stuff like that really makes you want to turn your brain off for a few hours you know?

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    3. @dreadblade - Omg yes, that is horrible... That stuff makes me cry :*(

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  24. I just wanted to say that I really loved this post. Actually I've been enjoying your blog since I've found it via the WoW Factor Show. :) But yeah, this one was particularly moving and awesome, I think. A healer that heals in real life, too! All my WoW friends who are doctors play mages, haha.

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    1. @Quelynn - TY so much for visiting and reading! The positive sentiments are really appreciated :) And interestingly, both of my guildies who are doctors as well play mages.... interesting (though I forced one to go heals for me LOL)

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    2. lol yeah... I found it a bit odd. But my god, the stories! One of them was still "on their way" to being a doctor and always had some interesting stories. He's a mage who has tailoring as his profession. One day he bursts into guild chat and starts talking about how he had to sew up 2 women that gave birth that day. Uh, hehe.

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  25. Navimie,

    This is a such a great post! That is definitely one of those times when it all works out and makes you be thankful. I'm not a physician, but I am in healthcare.

    We had a 84 year old woman who was diabetic not to badly on her A1c with 6.8 and no complications other than developing TA. Steriods to bring sed rate down but then blood glucose went through the roof. Admitted her to get sugars under control. Within 1 day a DVT formed and then after getting that under control she contracts MRSA. We lost her less than 48 hours later.

    It was a damned if you do and damned if you don't scenario - that still haunts me. Always know you did your best no matter what the outcome...whether it's a small victory or sadly in some cases a reminder of our mortality.

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    1. @Amijade - TY for the compliment :) It's so sad how there are so many untold stories out there, of things like this. Some people are just so unlucky :( and it's true, it's a damned if you do or damned if you don't, and we should be grateful for every positive outcome because... health and disease are funny like that, they can swing from one to the other in the drop of a hat. I think working in healthcare reminds us more than others just how fragile a thing life can be.

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  26. That was quite an amazing read. It felt like I was watching one of those medical drama shows! I agree with everyone that you are a hero and it's awesome what you did for that family!

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    1. @ManaM - TY for dropping by to read it and for visiting my blog! I am just very happy that everything turned out alright and my patient went home the next day. I know, it felt like one of those medical drama shows! It was a horrible thing to happen, but it was the best outcome one could hope for so I should be proud of that.

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  27. Great job Navi. Great write up too, edge of the seat stuff :) Glad it helped. Having known you for so long (I beat Cymre, we're up to over 21 years) I'm not really surprised how well you managed the emergency, but you never realise how well you're doing at the time.

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  28. @mabaho - thanks mab (LOL and thanks for hinting about my age!) for reading my rant. It was good to let it out. I still feel anxious but it is all good now so I should just put it behind me.

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  29. Oh man, that's really intense. You are such a rock star in your day job! I'm surprised you like to keep healing in game instead of checking out and doing massive DPS. Thanks for doing what you do :)

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    1. @Akabeko - Aww thanks Aka-chan :) Rock star is definitely not what I would describe myself in my day job - that kind of thing is uncommon and even more uncommon is when it happens to yourself... but we spend 5 years training so we can deal with those things, so I felt like I earned my money that day. I am just glad it worked out alright in the end :)

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