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ysabetwordsmithThis story belongs to the series Love Is For Children which includes "Love Is for Children," "Hairpins," "Blended," "Am I Not," "Eggshells," "Dolls and Guys,""Saudades," "Querencia," "Turnabout Is Fair Play," "Touching Moments," "Splash," "Coming Around," "Birthday Girl," "No Winter Lasts Forever," "Hide and Seek," "Kernel Error," "Happy Hour," "Green Eggs and Hulk,""kintsukuroi," "Little and Broken, but Still Good," "Byzantine Perplexities," "Up the Water Spout," "The Life of the Dead," "If They Could Just Stay Little," "Anahata," "When the Wheels Come Off," "Against His Own Shield," "Coming in from the Cold: Saturday: Building Towers," "Coming in from the Cold: Sunday: Shaking Foundations," "Coming in from the Cold: Monday: Memorial Day," "Coming in from the Cold: Tuesday: Facing Fears," "What Little Boys Are Made Of," "Rotten Fruit," "Keep the Homefires Burning," and "Their Old Familiar Carols Play."
Fandom: The Avengers
Characters: Phil Coulson, Clint Barton, Bruce Banner, Bucky Barnes, Steve Rogers, Betty Ross, Natasha Romanova, Tony Stark, Maria Hill, Nick Fury, Sam Wilson, JARVIS, DUM-E, U, Butterfingers
Medium: Fiction
Warnings: Food issues, religion, past alcohol abuse, sparring, minor injury, insecurity, nonsexual ageplay, tactile issues, forgiveness, games, PTSD, boundary issues, HYDRA, teamwork, SHIELD, laboratory, messy medical details, facing the past, memory issues, frustration, interpersonal dynamics, emotional challenges, past abuse, and other angst.
Summary: Phil manages the household as Tony takes Steve and Bucky to a baseball game, and later spars with Betty and Bruce. Later that day, Bruce helps Bucky figure out some things about his body.
Notes: Team as family. Competence. Friendship. Comfort food. Emotional first aid. Nostalgia. Hot tub. Protectiveness. Hurt/comfort. Science. #coulsonlives.
Begin with Part 1, Part 2, Part 3, Part 4, Part 5, Part 6, Part 7, Part 8, Part 9. Skip to Part 12, Part 13.
Warning: This post involves messy medical details and some emotionally fraught issues for Bucky and Bruce. If this is touchy territory for you, please consider your tastes and headspace before reading onward.
"Coming in from the Cold: Thursday: Digging for Answers" Part 10
"It's fine, you've already seen the whole show anyway," Bucky said. He was a lot more relaxed now, growing accustomed to Bruce's touch and reassured by the fact that some of the issues were in fact easy to solve. Thoughtful fingers prodded Bucky's shoulder. "Um ... what are you doing?"
"Searching for a good spot," Bruce said. "This needs to go into muscle, and preferably not through a nerve on the way in." He marked a place with his thumb, then rubbed a swab over it. "As long as I do this right, you should feel no more than a pinch and a little cramp."
The needle sank in with no reaction from Bucky. It was over in a moment, Bruce pulling out and dabbing over the puncture again. "All done."
"Huh," Bucky said thoughtfully. He rolled his shoulder, then wiggled his fingers.
Testing the function, Phil realized. It made him wonder just how roughly HYDRA had handled their asset -- or how hard he fought them in the process.
A computer screen chimed. Bruce ambled over to look at it. "Good, good, hmm ... not much I can do with that section."
"Why not?" Bucky asked.
"Too much data missing still. These are readouts from the scanning booth," Bruce explained. He pointed out several large blank spots. "See, I'd need direct-contact scans to fill in these gaps, passive or active."
"Okay, so ... what does that actually mean?" Bucky said.
"Sticking leads on or under your skin to get more detailed information than JARVIS can pick up through the air. This too, preferably," Bruce said, tapping the metal arm. "I wasn't sure if you'd go for it."
"We could try?" Bucky said. "Maybe start with the least-worst thing on the list and see how far I get."
"Sure, let me just grab the gear." Bruce rummaged in a cabinet for fresh supplies, then waved to Bucky. "Come on over here, some of this stuff is stationary."
"Okay," said Bucky, trotting obediently across the lab.
Bruce got him seated on a chair next to a whole bank of equipment. "Shirt off, please."
Bucky shucked it off, and sat patiently while Bruce pressed sticky dots all over him to hold the wires in place. "So, what're we looking for here?"
"Nerve function," Bruce said. "Basically I can use most of your torso to establish a baseline, then figure out how much damage there is in your shoulder and how the signals work to and from your prosthetic arm. Hrm." He frowned over the metal, tracing the seam, then farther down, examining how the metal plates fitted together. "Bucky, move around a little, stretch this arm forward -- hah. Yes. Stay like that."
Phil could see where the plates had shifted slightly, tiny cracks opening and closing as Bucky moved.
Bucky watched Bruce carefully tucking bare tips of wire between the bands. "Will they stay there? I mean without all the stickum?"
"Move your arm back where it was," Bruce said, and Bucky did. The cracks closed right back up, pinching the wires neatly in place. "See, it's fine. I just didn't want to get adhesive on the metal, I'm not sure how to clean it safely."
The machines hummed quietly, but if Bucky felt anything, he didn't say. Phil suspected not, since Bruce was meticulous about giving due warning. It was just a long, quiet, boring time.
"I'm bored," Bucky announced. "Can I play another game?"
"I don't want you moving that much, because it could impact the readings," Bruce said. "How about reading something instead? JARVIS, pick something safe from Bucky's current reading list and display it somewhere he can see without moving."
The screen that shifted was in Bucky's direct line of sight, but it was yards away. "Gee, thanks!" Bucky said, brightening.
Phil took the opportunity to pull his phone out and catch up on messages, fortunately not finding anything urgent. He kept an eye on Bucky, but nothing untoward happened.
Eventually Bruce unhooked everything. "Okay, that fills these gaps from here to here," he said, pointing to something on a screen that made Bucky nod. Then Bruce when back to coiling up the wires.
Bucky started to shrug his shirt on, then paused. He frowned, flexing his right arm, then reached around to rub it with his left hand. "Hey, Doc? My shoulder hurts."
Instantly Bruce shut the drawer he was using and came over. "Let me see that," he said. "What does it feel like?"
"Like a knot or a cramp," Bucky said.
"Where? Tell me when I get to it?" Bruce said, running his fingers over Bucky's skin.
"Lower, right about -- ow! There," Bucky said.
"No bruising, no sign of a bad reaction," Bruce said.
"It's like a fucking walnut right under my skin," Bucky whined.
"Now what could be -- oh, I know," Bruce said, his voice lilting up in satisfaction. "Sequestration error. Your body doesn't recognize what I put into it as useful yet, so tried to wall it off. That happens sometimes, and people get cramps from a supplement, but it usually comes up the day after. Nothing to worry about."
"Easy for you to say," Bucky grumbled, rolling his shoulder.
"I can probably fix it if you want," Bruce offered. "It'll be a little uncomfortable for a few minutes, then you should feel better."
"Yeah, give it a try, this is really bugging me," said Bucky.
"Okay, stretch your arms forward ... out to the sides ... now up," Bruce said. He caught both of Bucky's hands in his own, guiding him through a series of slow stretches. Then he smoothed his fingers over Bucky's skin, working from elbow to shoulder. After a few strokes, Bruce shifted to gentle kneading. "Really all we need to do is jostle that knot loose, help the nutrients spread out through your body so they don't just sit there in a lump. As fast as this came on, though, it should go away pretty quick."
"Yeah, it's starting to feel a little -- oh! Wow, just like untying a knot," Bucky said happily.
"Better now?" Bruce asked.
Bucky rolled his shoulder, and then nodded. "Bit sore, but it's back to what it was before it cramped up like that. I think it'll be fine now."
"Okay," Bruce said. "Let's switch down to something less aggravating for you to do while I'm setting up the equipment for the next test." He handed Bucky a Starkpad. "I found some worksheets on quality of life. Some of them are specific to health issues affecting arms. Then while I was looking up those, JARVIS suggested several others on mental health and general areas of activity. There's also a matched pair with a static form and one for after an intervention to see if anything got better or worse. If you fill these out, it will give us an impression of where you are now, and we can compare changes over time."
"I can do that," Bucky said. He started working on the forms.
Phil leaned over to see that Bucky had begun with one on Maslow's hierarchy of needs, and quickly moved on to a pie chart ranking different areas of life. After that came a much lengthier mental health questionnaire. Bucky frowned over that one.
"You're doing fine," Phil assured him. "Fill out as much as you can, and don't worry about it if some things don't fit perfectly. Whatever we get from this is more than we had before. Besides, if it turns out to be totally inappropriate for your situation, you and I can discuss what you really want to measure and I can just build a form from scratch for you."
"Now why didn't I think of that?" Bruce said. Something clinked quietly, and the doctor turned to give Phil a keen look.
"Probably because you're not used to having an in-house paperwork specialist," said Phil. He got the impression that he might get some requests to design forms for the care and feeding of more than one superhero after this. He also felt confident that Bruce would appreciate that a lot more than SHIELD did. Fury pretty much took Phil for granted these days. Hill was the only one who consistently thanked Phil for building a customized form for her.
When Bucky finished the questionnaire, he went to the arm checklists next. He looked increasingly glum as he went through them.
"What's wrong?" Phil asked.
"I guess I ... didn't realize how bad it was, until just now," Bucky said slowly. "I mean, I knew it wasn't like the arm I lost, but I thought it was a good replacement. It does way more than anyone else's fake arm, I've been reading up on those."
Bruce came back over. "What won't it do, or what gives you trouble?"
"I can't do up buttons. Well, sometimes I can, but tiny ones like shirt buttons are really hard. I can feel to pull a trigger, but I can't always tell where a buttonhole is. Steve's been helping me. I didn't even think of it because we've just always done stuff for each other," Bucky said. "I can whittle a pencil, and a lot of other things with knives. Some kitchen things are hard though, the really small motions, or anything that needs both hands like peeling and slicing. It's the limited feeling that gets me again -- I'm not always sure where my left hand is. And if I lift my left arm straight up overhead for more than a few minutes, the pain gets a lot worse."
"Show me the lift," Bruce said, and Bucky stretched his arm up. Bruce prodded along the line of the shoulder seam, then pulled the arm back down. "Hmm ... hard to tell for sure, but it's probably either pinching a nerve in that position, or else the extra weight is straining your muscles and bones. I'll make a note. We should try to pin this down before we replace that arm, to make sure we don't accidentally replicate the same problem."
"If you can fix it, that would be swell," Bucky said.
"Don't worry about dexterity and sensitivity," Bruce said. "Tony's been working on both the hardware and software. It won't be exactly like a flesh hand, but it should definitely work much better than what you have now."
"The second worksheet is worse, that's got more at the bottom beyond just activities that are hard," said Bucky. "Like how much the arm problem affects what I do with other people, which is a lot because it's toxic. It always hurts, some, and it flares up occasionally. Sometimes the scars bug me too. I think ... my pain scale is pretty skewed by now."
"Likely so," Bruce said. "You're not the only one, though. Where does it hurt? What does it feel like? Chronic pain can do some pretty bad things to you."
"Different places," Bucky said, pointing with his right hand. "There's a deep ache here, like around my shoulder socket." He traced a finger along the seam. "This is usually numb, but if anything rubs over it, then it gets irritated and burns." His hand shifted to rub the scars that fanned out over his chest. "This whole area is just fucked up. Some of it hurts, some is numb, and I get weird things like hot or cold spots." He shivered. "Sometimes I have these shooting pains all down my arm, even though it's not really there anymore, or the whole damn thing itches or tickles or worse."
Bruce followed the route that Bucky's hand had taken with his own light, clinical touch. "I feel what you mean," Bruce said. "Nerve damage is touchy stuff. I can't make promises, but given your healing factor, I think we can manage some improvements. That chronic pain is completely unacceptable."
"Yeah well, nobody took 'it hurts too much' for an answer until you," Bucky said. "I kind of learned how to turn my brain off and just ignore it. But then you started telling me to pay attention to my body, and I realized it's a mess. Some of my sleep trouble comes from this too." He patted his metal shoulder. "Not even just the pain, or the power source. It's uncomfortable and distracting simply because it's a big heavy hunk of metal."
"Is that why you were lying on Steve for a while?" Phil asked, remember how they used to sleep curled up like puppies.
Bucky nodded. "That made it easier, when I had some support."
"Try using pillows," Bruce suggested.
"They squash," Bucky said, shaking his head.
"We'll get you some that don't," Bruce said. "JARVIS, analyze Bucky's sleeping patterns and see if you can figure out what shape and density of pillow might provide useful support. I know we have an assortment of foam fill here."
"Focus on density," Phil said. "If lying on Steve works, we can just take a shirt and pants from his closet and stuff those with suitable foam. I'm sure he'd be happy to donate something in the interest of helping Bucky sleep better."
Bruce quirked a smile. "Good idea," he said. "Betty turned some of mine into a boyfriend pillow. See, Bucky, the paperwork is already paying off with new ideas."
* * *
Notes:
(These links are graphic.)
In The Winter Soldier, you can see the scars left by the appalling hack job on Bucky's left shoulder. There are a number of things going on in this picture. First, look at the thick circumannular ridge of scar tissue where the metal arm meets flesh. That kind of scar is often numb -- but any time there's an implant, the interface is prone to irritation. Look how bright of a red that line is. Old scar tissue usually fades to white. The vivid color indicates inflammation, which is logical given the armor. Second, the radial scars fan out from the arc of the juncture. Those show where the skin was opened up and then closed back together over the underpinnings of the prosthesis. Surgical scars should be neat. When they're ragged like that, it means either the initial injury was messy and/or the victim caught a raging infection later. This is what you'd expect from meatball surgery done by hacks who didn't care how much they hurt a possibly conscious victim. So that chopped up about half of Bucky's pectoral muscles and nerves. This kind of patchwork scar tissue tends to create erratic results as the fibers try to grow back together: numb in some places, painful in others, and it can even scatter random sensations around instead of reporting localized contact. Notice that the radial scars are also irritated, more so closer to the prosthesis, gradually fading farther out. Third, that's just what we can see on the surface in one picture; the scar tissue under the surface is probably even worse. The deep ache probably comes from the junction between implant and bone, a common source of trouble. Put all that together, and it explains why Bucky has a low level of chronic pain with occasional spikes if he moves wrong, plus episodes of phantom pain/sensations all down his harm. It doesn't show in combat due to adrenaline and probably whatever cocktail of drugs his captors had him on, but now that Bucky's off all those things, he can feel more of the damage. For an ordinary person, this would be only somewhat fixable with more adept surgery. But for a super-soldier, the prognosis is much better -- if they cut down to healthy tissue and then provide proper wound care, it should heal up to a clean edge.
(Graphic torture pastiche.)
Things like this are why the inside of Bucky's head is such a mess. You can see the violence, confusion, and terror -- and this is exactly where Bucky's head goes the moment he steps into a lab. Even though The Winter Soldier is not canon for LIFC, that's pretty much how people treated him.
Bucky uses a number of worksheets to measure his quality of life. Maslow's Hierarchy of Needs is a valid list of popular concerns, but it must be noted that this is merely a common order, not the universal order as claimed. Some people prioritize social needs above safety (e.g. staying with an abusive spouse) or self-actualization over physiological needs (e.g. running away from a slaver who provides food and shelter). For satisfaction, it is imperative to know one's own priorities and how they are or are not fulfilled. This scale measures how much pain (or other impairment) impacts a person's life. Bucky is around a 4 or 5 on this scale, which is not good. More of that is mental than physical, but he's not able to work yet and rarely leaves the shelter of Avengers Tower. This is a painful realization for someone who used to be healthy and vigorous. The Wheel of Life assessment measures the amount of satisfaction in different areas. Here is a mental health questionnaire that looks at various challenges people might have and offers a gauge for changes in quality. Not everyone has the same values, but at least this offers a starting point for discussion. This mental health continuum places experiences on a spectrum. If you do this kind of thing online, you get sliders that move back and forth. On the physical side, this questionnaire focuses on upper limb functionality. Bucky becomes upset when he realizes how much he can't do or struggles to do. This one also discusses unpleasant symptoms. The last two go together: a static assessment of satisfaction in various areas and after an intervention. These will be extremely useful moving forward, so that Bucky can see his progress.
Poorly designed paperwork wastes time, money, and energy; plus it means you don't have all the information you need in a readily accessible form. Studies reveal the qualities of bad and good paperwork. Know how to design good forms.
Disability comes in various types. Of those, acquired disability is prone to causing depression due to lowered quality of life. It typically requires a mourning process before positive growth can occur. In Bucky's case, HYDRA interrupted that process, so it's all bubbling up now that he's safe, and he has no idea how to handle it due to the clusterfuck of bad tape about disability that used to be considered a normal social attitude. Understand how to cope with disability and how to support a friend with a new disability. There are also ways to cope with depression and to help a depressed friend.
There are many variations on human-shaped pillows. These come in male and female versions. They are easy to make by stuffing clothes. Note that most such items are made with regular fiberfill, which is soft like a bed pillow. However, many people find that firmer support helps with a variety of physical complaints, as with Bucky's shoulder. Should you need this kind of support, choose stiffer materials. Furniture foam is one option. If you like beanbags, you can use filler beans or an organic filling such as rice.
[To be continued in Part 11 ...]
Fandom: The Avengers
Characters: Phil Coulson, Clint Barton, Bruce Banner, Bucky Barnes, Steve Rogers, Betty Ross, Natasha Romanova, Tony Stark, Maria Hill, Nick Fury, Sam Wilson, JARVIS, DUM-E, U, Butterfingers
Medium: Fiction
Warnings: Food issues, religion, past alcohol abuse, sparring, minor injury, insecurity, nonsexual ageplay, tactile issues, forgiveness, games, PTSD, boundary issues, HYDRA, teamwork, SHIELD, laboratory, messy medical details, facing the past, memory issues, frustration, interpersonal dynamics, emotional challenges, past abuse, and other angst.
Summary: Phil manages the household as Tony takes Steve and Bucky to a baseball game, and later spars with Betty and Bruce. Later that day, Bruce helps Bucky figure out some things about his body.
Notes: Team as family. Competence. Friendship. Comfort food. Emotional first aid. Nostalgia. Hot tub. Protectiveness. Hurt/comfort. Science. #coulsonlives.
Begin with Part 1, Part 2, Part 3, Part 4, Part 5, Part 6, Part 7, Part 8, Part 9. Skip to Part 12, Part 13.
Warning: This post involves messy medical details and some emotionally fraught issues for Bucky and Bruce. If this is touchy territory for you, please consider your tastes and headspace before reading onward.
"Coming in from the Cold: Thursday: Digging for Answers" Part 10
"It's fine, you've already seen the whole show anyway," Bucky said. He was a lot more relaxed now, growing accustomed to Bruce's touch and reassured by the fact that some of the issues were in fact easy to solve. Thoughtful fingers prodded Bucky's shoulder. "Um ... what are you doing?"
"Searching for a good spot," Bruce said. "This needs to go into muscle, and preferably not through a nerve on the way in." He marked a place with his thumb, then rubbed a swab over it. "As long as I do this right, you should feel no more than a pinch and a little cramp."
The needle sank in with no reaction from Bucky. It was over in a moment, Bruce pulling out and dabbing over the puncture again. "All done."
"Huh," Bucky said thoughtfully. He rolled his shoulder, then wiggled his fingers.
Testing the function, Phil realized. It made him wonder just how roughly HYDRA had handled their asset -- or how hard he fought them in the process.
A computer screen chimed. Bruce ambled over to look at it. "Good, good, hmm ... not much I can do with that section."
"Why not?" Bucky asked.
"Too much data missing still. These are readouts from the scanning booth," Bruce explained. He pointed out several large blank spots. "See, I'd need direct-contact scans to fill in these gaps, passive or active."
"Okay, so ... what does that actually mean?" Bucky said.
"Sticking leads on or under your skin to get more detailed information than JARVIS can pick up through the air. This too, preferably," Bruce said, tapping the metal arm. "I wasn't sure if you'd go for it."
"We could try?" Bucky said. "Maybe start with the least-worst thing on the list and see how far I get."
"Sure, let me just grab the gear." Bruce rummaged in a cabinet for fresh supplies, then waved to Bucky. "Come on over here, some of this stuff is stationary."
"Okay," said Bucky, trotting obediently across the lab.
Bruce got him seated on a chair next to a whole bank of equipment. "Shirt off, please."
Bucky shucked it off, and sat patiently while Bruce pressed sticky dots all over him to hold the wires in place. "So, what're we looking for here?"
"Nerve function," Bruce said. "Basically I can use most of your torso to establish a baseline, then figure out how much damage there is in your shoulder and how the signals work to and from your prosthetic arm. Hrm." He frowned over the metal, tracing the seam, then farther down, examining how the metal plates fitted together. "Bucky, move around a little, stretch this arm forward -- hah. Yes. Stay like that."
Phil could see where the plates had shifted slightly, tiny cracks opening and closing as Bucky moved.
Bucky watched Bruce carefully tucking bare tips of wire between the bands. "Will they stay there? I mean without all the stickum?"
"Move your arm back where it was," Bruce said, and Bucky did. The cracks closed right back up, pinching the wires neatly in place. "See, it's fine. I just didn't want to get adhesive on the metal, I'm not sure how to clean it safely."
The machines hummed quietly, but if Bucky felt anything, he didn't say. Phil suspected not, since Bruce was meticulous about giving due warning. It was just a long, quiet, boring time.
"I'm bored," Bucky announced. "Can I play another game?"
"I don't want you moving that much, because it could impact the readings," Bruce said. "How about reading something instead? JARVIS, pick something safe from Bucky's current reading list and display it somewhere he can see without moving."
The screen that shifted was in Bucky's direct line of sight, but it was yards away. "Gee, thanks!" Bucky said, brightening.
Phil took the opportunity to pull his phone out and catch up on messages, fortunately not finding anything urgent. He kept an eye on Bucky, but nothing untoward happened.
Eventually Bruce unhooked everything. "Okay, that fills these gaps from here to here," he said, pointing to something on a screen that made Bucky nod. Then Bruce when back to coiling up the wires.
Bucky started to shrug his shirt on, then paused. He frowned, flexing his right arm, then reached around to rub it with his left hand. "Hey, Doc? My shoulder hurts."
Instantly Bruce shut the drawer he was using and came over. "Let me see that," he said. "What does it feel like?"
"Like a knot or a cramp," Bucky said.
"Where? Tell me when I get to it?" Bruce said, running his fingers over Bucky's skin.
"Lower, right about -- ow! There," Bucky said.
"No bruising, no sign of a bad reaction," Bruce said.
"It's like a fucking walnut right under my skin," Bucky whined.
"Now what could be -- oh, I know," Bruce said, his voice lilting up in satisfaction. "Sequestration error. Your body doesn't recognize what I put into it as useful yet, so tried to wall it off. That happens sometimes, and people get cramps from a supplement, but it usually comes up the day after. Nothing to worry about."
"Easy for you to say," Bucky grumbled, rolling his shoulder.
"I can probably fix it if you want," Bruce offered. "It'll be a little uncomfortable for a few minutes, then you should feel better."
"Yeah, give it a try, this is really bugging me," said Bucky.
"Okay, stretch your arms forward ... out to the sides ... now up," Bruce said. He caught both of Bucky's hands in his own, guiding him through a series of slow stretches. Then he smoothed his fingers over Bucky's skin, working from elbow to shoulder. After a few strokes, Bruce shifted to gentle kneading. "Really all we need to do is jostle that knot loose, help the nutrients spread out through your body so they don't just sit there in a lump. As fast as this came on, though, it should go away pretty quick."
"Yeah, it's starting to feel a little -- oh! Wow, just like untying a knot," Bucky said happily.
"Better now?" Bruce asked.
Bucky rolled his shoulder, and then nodded. "Bit sore, but it's back to what it was before it cramped up like that. I think it'll be fine now."
"Okay," Bruce said. "Let's switch down to something less aggravating for you to do while I'm setting up the equipment for the next test." He handed Bucky a Starkpad. "I found some worksheets on quality of life. Some of them are specific to health issues affecting arms. Then while I was looking up those, JARVIS suggested several others on mental health and general areas of activity. There's also a matched pair with a static form and one for after an intervention to see if anything got better or worse. If you fill these out, it will give us an impression of where you are now, and we can compare changes over time."
"I can do that," Bucky said. He started working on the forms.
Phil leaned over to see that Bucky had begun with one on Maslow's hierarchy of needs, and quickly moved on to a pie chart ranking different areas of life. After that came a much lengthier mental health questionnaire. Bucky frowned over that one.
"You're doing fine," Phil assured him. "Fill out as much as you can, and don't worry about it if some things don't fit perfectly. Whatever we get from this is more than we had before. Besides, if it turns out to be totally inappropriate for your situation, you and I can discuss what you really want to measure and I can just build a form from scratch for you."
"Now why didn't I think of that?" Bruce said. Something clinked quietly, and the doctor turned to give Phil a keen look.
"Probably because you're not used to having an in-house paperwork specialist," said Phil. He got the impression that he might get some requests to design forms for the care and feeding of more than one superhero after this. He also felt confident that Bruce would appreciate that a lot more than SHIELD did. Fury pretty much took Phil for granted these days. Hill was the only one who consistently thanked Phil for building a customized form for her.
When Bucky finished the questionnaire, he went to the arm checklists next. He looked increasingly glum as he went through them.
"What's wrong?" Phil asked.
"I guess I ... didn't realize how bad it was, until just now," Bucky said slowly. "I mean, I knew it wasn't like the arm I lost, but I thought it was a good replacement. It does way more than anyone else's fake arm, I've been reading up on those."
Bruce came back over. "What won't it do, or what gives you trouble?"
"I can't do up buttons. Well, sometimes I can, but tiny ones like shirt buttons are really hard. I can feel to pull a trigger, but I can't always tell where a buttonhole is. Steve's been helping me. I didn't even think of it because we've just always done stuff for each other," Bucky said. "I can whittle a pencil, and a lot of other things with knives. Some kitchen things are hard though, the really small motions, or anything that needs both hands like peeling and slicing. It's the limited feeling that gets me again -- I'm not always sure where my left hand is. And if I lift my left arm straight up overhead for more than a few minutes, the pain gets a lot worse."
"Show me the lift," Bruce said, and Bucky stretched his arm up. Bruce prodded along the line of the shoulder seam, then pulled the arm back down. "Hmm ... hard to tell for sure, but it's probably either pinching a nerve in that position, or else the extra weight is straining your muscles and bones. I'll make a note. We should try to pin this down before we replace that arm, to make sure we don't accidentally replicate the same problem."
"If you can fix it, that would be swell," Bucky said.
"Don't worry about dexterity and sensitivity," Bruce said. "Tony's been working on both the hardware and software. It won't be exactly like a flesh hand, but it should definitely work much better than what you have now."
"The second worksheet is worse, that's got more at the bottom beyond just activities that are hard," said Bucky. "Like how much the arm problem affects what I do with other people, which is a lot because it's toxic. It always hurts, some, and it flares up occasionally. Sometimes the scars bug me too. I think ... my pain scale is pretty skewed by now."
"Likely so," Bruce said. "You're not the only one, though. Where does it hurt? What does it feel like? Chronic pain can do some pretty bad things to you."
"Different places," Bucky said, pointing with his right hand. "There's a deep ache here, like around my shoulder socket." He traced a finger along the seam. "This is usually numb, but if anything rubs over it, then it gets irritated and burns." His hand shifted to rub the scars that fanned out over his chest. "This whole area is just fucked up. Some of it hurts, some is numb, and I get weird things like hot or cold spots." He shivered. "Sometimes I have these shooting pains all down my arm, even though it's not really there anymore, or the whole damn thing itches or tickles or worse."
Bruce followed the route that Bucky's hand had taken with his own light, clinical touch. "I feel what you mean," Bruce said. "Nerve damage is touchy stuff. I can't make promises, but given your healing factor, I think we can manage some improvements. That chronic pain is completely unacceptable."
"Yeah well, nobody took 'it hurts too much' for an answer until you," Bucky said. "I kind of learned how to turn my brain off and just ignore it. But then you started telling me to pay attention to my body, and I realized it's a mess. Some of my sleep trouble comes from this too." He patted his metal shoulder. "Not even just the pain, or the power source. It's uncomfortable and distracting simply because it's a big heavy hunk of metal."
"Is that why you were lying on Steve for a while?" Phil asked, remember how they used to sleep curled up like puppies.
Bucky nodded. "That made it easier, when I had some support."
"Try using pillows," Bruce suggested.
"They squash," Bucky said, shaking his head.
"We'll get you some that don't," Bruce said. "JARVIS, analyze Bucky's sleeping patterns and see if you can figure out what shape and density of pillow might provide useful support. I know we have an assortment of foam fill here."
"Focus on density," Phil said. "If lying on Steve works, we can just take a shirt and pants from his closet and stuff those with suitable foam. I'm sure he'd be happy to donate something in the interest of helping Bucky sleep better."
Bruce quirked a smile. "Good idea," he said. "Betty turned some of mine into a boyfriend pillow. See, Bucky, the paperwork is already paying off with new ideas."
* * *
Notes:
(These links are graphic.)
In The Winter Soldier, you can see the scars left by the appalling hack job on Bucky's left shoulder. There are a number of things going on in this picture. First, look at the thick circumannular ridge of scar tissue where the metal arm meets flesh. That kind of scar is often numb -- but any time there's an implant, the interface is prone to irritation. Look how bright of a red that line is. Old scar tissue usually fades to white. The vivid color indicates inflammation, which is logical given the armor. Second, the radial scars fan out from the arc of the juncture. Those show where the skin was opened up and then closed back together over the underpinnings of the prosthesis. Surgical scars should be neat. When they're ragged like that, it means either the initial injury was messy and/or the victim caught a raging infection later. This is what you'd expect from meatball surgery done by hacks who didn't care how much they hurt a possibly conscious victim. So that chopped up about half of Bucky's pectoral muscles and nerves. This kind of patchwork scar tissue tends to create erratic results as the fibers try to grow back together: numb in some places, painful in others, and it can even scatter random sensations around instead of reporting localized contact. Notice that the radial scars are also irritated, more so closer to the prosthesis, gradually fading farther out. Third, that's just what we can see on the surface in one picture; the scar tissue under the surface is probably even worse. The deep ache probably comes from the junction between implant and bone, a common source of trouble. Put all that together, and it explains why Bucky has a low level of chronic pain with occasional spikes if he moves wrong, plus episodes of phantom pain/sensations all down his harm. It doesn't show in combat due to adrenaline and probably whatever cocktail of drugs his captors had him on, but now that Bucky's off all those things, he can feel more of the damage. For an ordinary person, this would be only somewhat fixable with more adept surgery. But for a super-soldier, the prognosis is much better -- if they cut down to healthy tissue and then provide proper wound care, it should heal up to a clean edge.
(Graphic torture pastiche.)
Things like this are why the inside of Bucky's head is such a mess. You can see the violence, confusion, and terror -- and this is exactly where Bucky's head goes the moment he steps into a lab. Even though The Winter Soldier is not canon for LIFC, that's pretty much how people treated him.
Bucky uses a number of worksheets to measure his quality of life. Maslow's Hierarchy of Needs is a valid list of popular concerns, but it must be noted that this is merely a common order, not the universal order as claimed. Some people prioritize social needs above safety (e.g. staying with an abusive spouse) or self-actualization over physiological needs (e.g. running away from a slaver who provides food and shelter). For satisfaction, it is imperative to know one's own priorities and how they are or are not fulfilled. This scale measures how much pain (or other impairment) impacts a person's life. Bucky is around a 4 or 5 on this scale, which is not good. More of that is mental than physical, but he's not able to work yet and rarely leaves the shelter of Avengers Tower. This is a painful realization for someone who used to be healthy and vigorous. The Wheel of Life assessment measures the amount of satisfaction in different areas. Here is a mental health questionnaire that looks at various challenges people might have and offers a gauge for changes in quality. Not everyone has the same values, but at least this offers a starting point for discussion. This mental health continuum places experiences on a spectrum. If you do this kind of thing online, you get sliders that move back and forth. On the physical side, this questionnaire focuses on upper limb functionality. Bucky becomes upset when he realizes how much he can't do or struggles to do. This one also discusses unpleasant symptoms. The last two go together: a static assessment of satisfaction in various areas and after an intervention. These will be extremely useful moving forward, so that Bucky can see his progress.
Poorly designed paperwork wastes time, money, and energy; plus it means you don't have all the information you need in a readily accessible form. Studies reveal the qualities of bad and good paperwork. Know how to design good forms.
Disability comes in various types. Of those, acquired disability is prone to causing depression due to lowered quality of life. It typically requires a mourning process before positive growth can occur. In Bucky's case, HYDRA interrupted that process, so it's all bubbling up now that he's safe, and he has no idea how to handle it due to the clusterfuck of bad tape about disability that used to be considered a normal social attitude. Understand how to cope with disability and how to support a friend with a new disability. There are also ways to cope with depression and to help a depressed friend.
There are many variations on human-shaped pillows. These come in male and female versions. They are easy to make by stuffing clothes. Note that most such items are made with regular fiberfill, which is soft like a bed pillow. However, many people find that firmer support helps with a variety of physical complaints, as with Bucky's shoulder. Should you need this kind of support, choose stiffer materials. Furniture foam is one option. If you like beanbags, you can use filler beans or an organic filling such as rice.
[To be continued in Part 11 ...]
(no subject)
Date: 2017-12-01 12:12 pm (UTC)Nice explanations of what Bucky can and cannot do, and how his arm and body feel.
I wonder why Betty would need a boyfriend pillow with Bruce's clothes. I wouldn't think he left the Tower all that often except on missions, and most of those wouldn't be overnight.
Zelofheda
Thoughts
Date: 2017-12-01 09:10 pm (UTC)I couldn't find a technical term for it, so that's how I described it. The body has a number of ways to handle challenges. If you put a lot of fluid in one place, it presses on the nerves, which is uncomfortable. The surrounding tissue normally pulls the excess away and distributes it. But if the body interprets the addition as a threat then it tries to wall off the problem to contain the damage in a smaller area. One version of that happens with foreign materials in flesh, and another with lung infections, but they're really just different iterations of the same thing. The fast version in muscle manifests as a small hard knot that is damn aggravating. Gentle motion and massage will often work it loose.
Supplements are notorious for causing cramps. The carrier fluid is easier to move than the "grainier" minerals. Usually the problem kicks in hours or a day later, and has to do with shifting the balance of trace nutrients within a muscle group, resulting in overall stiffness or small spasms. Again, massage helps by spreading out the new material, although the effect is less dramatic.
The fast version is more likely in bodies that are very alert to foreign substances and/or already have issues with imbalances. So obviously with the latter, people who need the supplements in the first place are in a state more susceptible to shift-related cramps. Not fun, but usually worth the tradeoff because a dose or two of supplements tends to kill off the gnawing, bone-itching feel of a serious nutrient shortage. Bucky's probably never been fed well enough to know what it's like not to have that craving in the back of his mind.
>> You know, for somebody who claims he's "not that kind of doctor," Bruce seems to be much better than that kind of doctor. :D <<
That's because he thinks like a scientist, not like a technician. Huh, probably why I get people telling me I'm more use than their paid expert -- if they say they have a problem, I take it at face value and look for a range of possible solutions, which can be in any field I've touched. Bruce does it because he's picked up every lesson he could get his hands on while globetrotting, and when you cram that much diverse detail into a genius brain, you get someone who can fix unique super issues while flying by the seat of his pants.
>> Nice explanations of what Bucky can and cannot do, and how his arm and body feel. <<
There is a more detailed description of what and why in the next chapter, too.
>> I wonder why Betty would need a boyfriend pillow with Bruce's clothes. I wouldn't think he left the Tower all that often except on missions, and most of those wouldn't be overnight. <<
I think she started the habit in college. Like most abuse survivors, Bruce turtles up sometimes and wants to be left alone. That's one reason Betty has her own little suite on Bruce's floor instead of always having to share his space.
(no subject)
Date: 2017-12-01 03:28 pm (UTC)Including the explain-y bedside manner. ;)
Yay!
Date: 2017-12-01 08:12 pm (UTC)I'm glad it works for you.
>> Including the explain-y bedside manner. ;) <<
Ideally, caregivers need a range from silent through clinical to explaining to chatty. Different people need different things. Since Bucky is freaking out over not knowing things, that narrative soothes a big part of the anxiety -- enough to extend his tolerance in the lab way beyond what anyone expected.
Re: Yay!
Date: 2017-12-01 08:19 pm (UTC)N is like Bruce, usually, unless something is being recalcitrant, then she talks *directly to the muscle*... but then she's not energy-sensitive, so the verbal feedback is a must.
Re: Yay!
Date: 2017-12-02 10:44 am (UTC)Agreed.
>> My first regular LMP was quite energy-sensitive. I remember some of our early sessions, getting some issues dealt with... as most LMPs do, she used background music... but she'd have me in so deep I couldn't hear the music, just the roar of the HVAC and whatever she'd say... <<
Fascinating.
One of the things I'd like to write is Shiv discovering the prison's Healthy Touch program after overstraining his wrists.
>> N is like Bruce, usually, unless something is being recalcitrant, then she talks *directly to the muscle*... but then she's not energy-sensitive, so the verbal feedback is a must.<<
That makes sense.
(no subject)
Date: 2017-12-02 01:05 am (UTC)experts who unpack ... are awesome
Date: 2017-12-02 05:45 pm (UTC)Re: experts who unpack ... are awesome
Date: 2017-12-02 07:36 pm (UTC)Oh, me too. It's like pulling three cherries and then quarters spew everywhere. Not only does it show respect and awareness, which greatly improve the working relationship, it's takehome. It's information I can use and reuse, not just in the moment, but to solve future problems of mine or someone else's. So that's why I do it when I'm problem-solving or writing directions. I've had people squee over it in cookbooks, because if they know why something in written a certain way, they know not to change it.
Another thing, which I've only found a few glimpses of this and seen once in its full glory, is when I ask someone to justify his proposal and skills, says "Okay" and explains all of it in detail. Finally! Someone who speaks English! (Usually they act like I said they have a tiny penis.) So that is the biggest green flag, if I ever see that again I'll know to check for unicorns.
Re: experts who unpack ... are awesome
Date: 2017-12-03 02:43 am (UTC)I can top that; the orthopedic surgeon in Portland (Dr. Jay B.V. Butler at the Orthopedic and Fracture Clinic at St. Vincent Hospital in Beaverton) who did both of my knee surgeries, and the discussion we had prior to scheduling the second one. Remind me to tell you all about it sometime. Am busy with other writing and fundraising at the moment...
Thanks
Date: 2017-12-01 04:04 pm (UTC)Nerve regeneration FEELS like a sudden swift stab of a needle, quickly pulled out again.
Also, I develop keloids. I don't know if Bruce can suggest anything besides vitamin E oil or scar cream, but massaging the scar tissue with anything is supposed to help.
Might be issues that Tony has also via his chest wound, but has ignored. Also another reason to abuse the alcohol, the chronic pain AND the unexpected sudden sharp pains. Comfortably numb is REALLY tempting, sometimes.
Re: Thanks
Date: 2017-12-02 11:27 am (UTC)That sucks. :(
>> and even though I won't click through the links right now, the fiction and non-fiction restatements help emotionally. <<
I'm glad I could help, then. There are things that can be done to help scars heal better, but it's a longish list, and spread out -- some only work on relatively fresh injuries while others you have to wait a long time before starting. If it's really bugging you, and you have a caregiver who seems competent, consider raising the topic. There are also specialists who just do scar management.
>> Nerve regeneration FEELS like a sudden swift stab of a needle, quickly pulled out again. <<
It can. For some people, it's fuzzy-staticky like an image slowly coming clear, or pins-and-needles like a foot falling asleep and waking up, or electric like licking a battery. Nerves can ghost anything they can feel, and that can be maddening.
>> Also, I develop keloids. <<
That really sucks. It makes management much more complicated because some of the options for fair-skinned people are riskier or contraindicated.
>> I don't know if Bruce can suggest anything besides vitamin E oil or scar cream, but massaging the scar tissue with anything is supposed to help. <<
Bruce has a variety of oils and creams developed for different purposes, and you'll see him pull out one for scars eventually.
Some stuff that I know:
* There are many different topical things for scar tissue. People respond to them differently. Some folks love silicone. Others go for heavy oils like cocoa butter or Vitamin E, even though other people say that makes it worse -- if you have very dry skin, they're a good bet. Some people want the herbal regenerators or adaptogens.
* Pressure stockings can really help, and are one of the few things that can discourage keloids from getting too big. Ideally, discuss this with a doctor, but if that's not feasible the wraps can be found on your own. People say it makes their scars feel better too -- but for some folks the wrap itself is bothersome.
* Massage and stretching reduce the risk of adhesions, a major concern in people prone to heavy scarring. The idea is to encourage the fibers to align themselves logically instead of in a mess, and not to stick to anything they shouldn't be. This is something to do several times a day for months on end, and is worth discussing with a physical therapist who understands scar development.
* If you're after nerve regeneration and positive healing, don't overlook visualization. Sometimes you can get the body to do things a little better with mindful guidance than without it. Results are erratic, but if it doesn't work it does no harm, and what do you have to lose?
* Drybrushing can reduce scars and help them mature. I have no idea if it's safe for keloids, though.
* For keloids, if at all possible, talk to a black doctor and/or someone who explicitly lists expertise with that problem. White people usually haven't seen it and don't understand it, and training in America doesn't cover it much if at all. But a black doctor is almost always familiar with it or will know where to refer you.
>> Might be issues that Tony has also via his chest wound, but has ignored. <<
Absolutely. The nerves and scars in his chest are a fucked-up mess, and he's too paranoid to let anyone near it to try and fix it. Also his responses are quirked in a different way -- not much helps, but he tends to do better with synthetics than natural ingredients. He's a super-gizmologist, it happens.
>> Also another reason to abuse the alcohol, the chronic pain AND the unexpected sudden sharp pains. Comfortably numb is REALLY tempting, sometimes. <<
Nailed it. Tony has been self-medicating for decades over all kinds of things. So of course that's how he handled most of the post-Afghanistan crap too. He has experimented with prescription drugs, and illegal ones, and shit he cooked up at home and thought might work. Some things help some of the time. Nothing works all the time. But he can get blind drunk and stop caring how much he hurts. This has drawbacks, but canon indicates that drunk Tony is more functional than wallowing in pain Tony, and that's all he cares about. He hasn't fully registered the fact that Bruce is actually smart enough to fix things -- but can't fix what he doesn't know about.
Bucky now, it only took him a couple of hard crashes to decide that minding Bruce is greatly preferable to wrecking his body, and not much longer than that to start asking for help. It's a glimpse of his innate personality showing through the trauma, paralleling Steve's deep appreciation for health care now that he can actually have it.
what it feels like
Date: 2017-12-02 05:46 pm (UTC)OH REALLY??? This has some very, very interesting implications for a set of symptoms I've only recently begun to encounter.
Re: what it feels like
Date: 2017-12-02 07:44 pm (UTC)This usually dies down to normal levels in reasonably short time, but a failure of this process is one of the common causes of chronic pain -- the nerves don't heal quite right and never shut up. For temporary breakthrough pain while healing, switch up the pain control dosage and/or methods for a little while. If you're good enough at body awareness, sometimes you can actually make it stop by pinging back, "Yes, thank you, I'm aware that's reconnected now, you don't need to keep testing the signal." Some of the visualizations for pain control are essentially based on that premise. Believe it or not, there's a fully detailed example complete with explanation of why it works in the novelization of Enemy Mine.
Re: what it feels like
Date: 2017-12-03 02:44 am (UTC)Noted, and added to the list of things to check out from the awesome local library. Thanks!
(no subject)
Date: 2017-12-01 07:39 pm (UTC)Aw. Also, that is something my grandfather would say, and entirely appropriate to the character. Well played.
>>The screen that shifted was in Bucky's direct line of sight, but it was yards away.<<
Distance reading is a fun trick. I can do it on a good day, but I sure can't read printed-page sized text at yards even at my best.
>>"Yeah well, nobody took 'it hurts too much' for an answer until you,"<<
Oh ow. Yeah, that's a big problem all over the place. I'm glad of that To Be Continued tag, and that Bruce is taking this seriously.
Thoughts
Date: 2017-12-01 08:49 pm (UTC):D My grandparents did about as much work of raising me as my parents did, which means I'm double-stamped in chronology on top of my fey nature not being firmly anchored in the consensus timespace continuum. It's a tremendous advantage in writing Steve and Bucky.
>> Oh ow. Yeah, that's a big problem all over the place. <<
Yep. Chronic pain undermines anyone's mood, and the spikes contribute to Bucky lashing out or moping.
>> I'm glad of that To Be Continued tag, and that Bruce is taking this seriously. <<
Very seriously. There are some more things that Bruce wants to do right now to map the problem. It's not something that can be fixed immediately, although there are things he can do to make Bucky more comfortable now that they know this is an issue. Mostly the goal is to identify what's going wrong with this prosthesis so they can fix as much as possible with the replacement. What they're learning today will be a tremendous help in that.
(no subject)
Date: 2017-12-01 08:09 pm (UTC)Yes ...
Date: 2017-12-01 08:40 pm (UTC)(no subject)
Date: 2017-12-02 03:36 am (UTC)Well ...
Date: 2017-12-02 09:08 am (UTC)At least you know what to look for. Who knows, you may get lucky.
Re: Well ...
Date: 2017-12-06 06:53 am (UTC)a good medico is hard to find
Date: 2017-12-02 05:58 pm (UTC)Besides being a brilliant diagnostician, she's simply a lovely person, kind and caring and with good boundaries. I feel incredibly blessed to know her and be in a position to learn from her. Good friends are treasures; good friends who are subject matter experts willing to share their skills freely, are pearls beyond price!
(no subject)
Date: 2024-01-08 12:50 am (UTC)