25- Finally

Vaccine news has been exhausting this week. Good and terrible.

But first something I learned today. States manage their own vaccine programs and their programs are more powerful than the federal wants and wishes.

This is a Gordian knot of anti-vaccine bullshit. Of RFK Jr.’s making. He’s the one driving this train straight to widespread illness and death. Do not pass go, and, by the way, covid vaccines will be going up in price.

RFK Jr. testified before the Senate on Thursday. In part to answer for the CDC chaos that he fomented and lit a fire under, and in part to address his egregious anti-vaccine stance.

Some of the senators, especially Sen. Bill Cassidy (a doctor and a republican who voted RFK Jr. into his position), and Sen. John Barrasso (a doctor and a republican who voted RFK Jr. into his position) reminded RFK Jr. that he promised to uphold the highest standards for vaccines.

It was a contentious hearing and RFK Jr. was misrepresenting what was going on. Misrepresenting is another word for lying. We deserve better. We, as a society and as health care workers, are not surprised.

As an aside, we all know that he is shitting on the standards for vaccines. From his Advisory Committee on Immunization Practices (ACIP) firings and subsequent hiring and appointment of anti-vaccine bros and sycophants onto that same committee (an lying about it to the public that this unprecedented action would restore public trust in vaccine, a trust he’s violated for years), his canceling of mRNA vaccine grants, and his pressure on the directors to follow his tyrannic drivel on vaccines. Some of the directors have resigned in protest. There was even a letter from 1000 current and former HHS employees that called for RFK Jr.’s resignation on Wednesday (9/3) morning.

As an other aside, we all have heard stories, some first hand, of people being denied the covid vaccine. Including doctors and nurses and other front line staff. Even a grade 4 cancer patient who was under the 65 year age limit, the wife of conservative commentator Erick Erickson, was denied. Correct me if I am wrong but stage 4 cancer is the very definition of high risk.

By the way this is why I recommended a booster for EVERYONE that I know back in April when the shit started to roll downhill. Because this writing was on the wall.

In positive vaccine news, Washington, California, and Oregon have launched the West Coast Health Alliance. Its aim is to use scientific integrity in public health and the use of evidence based guidance for their states’ citizens. This was Wednesday (9/3/) as well. They cited the politicization of the CDC and HHS as primary drivers of this new alliance.

I believe that other blue states will join them. I wish them all the best of luck.

Somewhere a states’ rights believer’s (who also believes in federal mandates on abortion and vaccines head) is exploding. My body, my choice for me, not for thee.

You cannot pick and choose when states’ rights are allowed and when they are not.

Cookie Thursday 9/4/25- Pop-tart bites

In the scheme of things I could make my own pie crust and I do sometimes but sometimes it is easier to buy the ready made pie crust.

This is one of those sometimes.

The September theme for Cookie Thursday is a Thing is Cookies for Breakfast. Each week will be a different cookie based on breakfast.

Today is pop-tart

My favorite kind of pop-tart is the cinnamon brown sugar. Frosting is unnecessary. I hate making frosting, you may recall.

But somehow this frosting worked and got hard.

It is a simple recipe. Crust, mixture of brown sugar, 1 tsp flour, a bit of salt, and cinnamon. You spread it over the bottom crust and top with the top crust. You are supposed to seal the edges but I did not. A step I did not miss was spreading 1 tbs of butter over the whole thing. Before it goes in the oven.

If you do seal the edges you need to poke vents so that the steam can escape during baking. Let cool slightly and spread on the frosting.

I am not sure what made the frosting work this time. By work, I mean harden.

So I can cut and stack them, of course.

Very simple recipe but wow, what a result.

Buttery, flaky, cinnamon-y. Just enough frosting to make it interesting.

I will not kick these out of the cookie jar.

Call Secrets of the OR- What to do when there is a screw up with the call sheets that you tried to head off and a day shifter got called in when they shouldn’t’ve

Well, that’s a run on sentence.

This exact scenario actually happened less than a month ago.

You see, for my 49th birthday my sister had gifted me tickets to see Cary Elwes (the Dread Pirate Roberts aka Farmboy aka Wesley from The Princess Bride) for January of this year. That was when his house burned down in the Los Angeles fires. Understandably the show was cancelled and rescheduled for May. And then that show was cancelled and the money refunded to my sister.

She asked me to pick another show. We ended up going to the Postmodern Jukebox when it was here locally. It was awesome.

But the show was on a Thursday. I calculated how many hours of PTO I would have to use to cover the show and the driving home. Four hours. I asked for 4 hours off. On the calendar that everyone’s time off is posted I made a notation over my name on that day that I only needed coverage until 2300.

I fully intended to take 2300-0700. Like the good little call nurse that I am.

I called the OR in the afternoon to check on the call sheets reflected that I would be on call after 2300. They assured me it was correct and to have a nice time.

My conscience was clear and I went off to enjoy a dinner out at a new to us restaurant and a rollicking good show. Side note, if you are sleeping on these performers stop. Check them out on YouTube right now. My personal recommendation is the House of the Rising Sun.

I was home at 2300, as planned, and reading, also as planned, when the PACU call nurse texted me at 5 to midnight that the nursing supervisor couldn’t get ahold of the call nurse.

But…but I’m the call nurse.

I checked.

I texted the PACU nurse back.

I called the nursing supervisor and got the surgeon’s name and number.

I called the surgeon and arranged for surgery time to be at 0100.

I called the surg tech.

I called the nursing supervisor back and told them that I had spoken the surgeon and gave them the time and that I was on my way in.

I got in to the hospital, changed, and scheduled the case. Just like a normal night call case.

Suddenly the OR core door opened and it was a day shift nurse. Called in to do the same case I was setting up.

whomp, whomp

The best laid plans.

I told them to go home. And that I would handle it and also handle the necessary conversations with the evening nurse I had spoken to.

They went home.

I picked up the patient from the ER and delivered them to the PACU nurse who was there out of time because they had been called by the supervisor before they texted me. Which was the thing that started the cascade of unfortunate events.

We did the case.

I had a long conversation with the new to the job nursing supervisor. I gave them point blank instructions to call me with any problems in the future.

The next day I had a long conversation with the person who had assured me the call sheets were correct. They hadn’t even looked at the call sheets when I called them.

aaaarrrrrrrrghghghghgh!

Next time I want a half shift off, I will call the supervisor myself to check the call sheets.

But kerfuffle aside the patient needed the semi-urgent care and the OR was happy to provide.

Oh, and I also spoke to the new to me surgeon as well and gave them the sitch about call at this hospital. I also encouraged them to call me if they needed to do another night call case in the future.

Tuesday Top of Mind 9/2/25- Kudos to the pediatricians out there denying the DHHS over the covid boosters for children or why covid is still trying to kill you

I will be frank- Covid is still circulating and still killing people, including children. According to the Kaiser Family Foundation (KFF) 194 people died of covid weekly in August 2025. Of course this number is highly suspect as many states stopped reporting covid deaths. I suspect that the true number is higher.

To many people, covid is dead and none of the protections need to happen anymore.

Vaccine? Yeah, I got one three years ago and then I stopped getting them.

Yeah, I got covid four times last year but I’m okay.

Other people are not okay after getting covid-19.

To think that covid no longer affects the US or you is highly privileged. This means it hasn’t affected you personally YET.

I think that a lot of the conversations about covid are missing the qualifier “YET”.

I think you mean to say that covid hasn’t given you long covid symptoms YET. I think you mean to say that you got the first vaccine series and don’t think you can get covid YET. I think you mean to say that covid hasn’t impacted or killed your child YET.

See how easy that was?

The CDC finally came out with its covid recommendations in the beginning of June. The recommendations are for adults 18-65 to have an optional covid vaccine but for those over 65 it is highly recommended. They said that they were not recommending the covid vaccine to children or to pregnant women.

The American Academy of Pediatrics said “Bet” and did not change their vaccine recommendations to reflect what the CDC says. The AAP recommends the covid vaccine to children over the age of 6 months. In order to decrease the likelihood of serious illness and covid complications.

Because, and I cannot shout this enough, covid is still out there and still killing.

The most current FDA recommendation is that adults greater than 65 years of age continue to get the vaccine. The vaccine is not recommended for anyone under the age of 65 unless you have one medical condition that puts them at higher risk of a serious covid complication.

But, Kate, that is awfully vague, what kind of medical conditions?

The list I pulled from the FDA website was cancer, obesity defined as BMI greater than or equal to 20, or greater than the 95th percentile in children, diabetes I and diabetes II, asthma, cerebral vascular disease, chronic kidney disease, chronic lung disease, chronic liver disease, cystic fibrosis, Down syndrome, mental health conditions, dementia and Parkinson’s, physical inactivity, pregnancy, smokers current and former, TB, those who have had a solid organ or stem cell transplant, use of corticosteroids such as prednisone, and being unvaccinated or not up to date on your vaccinations (interesting). This is not an exhaustive list.

The point is you are going to have to fight and justify your need for the covid vaccine if you under 65. If you can find one, if you can afford it. But that’s an issue for another day.

I think they are playing Russian roulette with people’s lives. Especially children who are still growing and don’t have the mature respiratory system.

Medical fiction book review 8/31/25-Hospital Sketches

I have been a huge reader ALL of my life. The first book I ever read to myself was Ferdinand the Bull about the bull who would rather smell flowers under his favorite cock tree than fight in the arena. The first book I ever stayed up all night to read was Magic’s Pawn by Mercedes Lackey when I was a sophomore in high school (shhh, don’t tell my parents). The first chapter book that I ever read by myself was Little Women by Louisa May Alcott.

We’ve all seen the various movie adaptations where various actresses spanning generations played Jo, the headstrong March daughter. These actresses vary from Katharine Hepburn to Saoirse Ronan, seven in all from 1918-2019. Her story remains the same. So does the story of the doomed March sister, Beth March, the gentle soul that contracted scarlet fever while providing care for a poor family in their town.

But as a child and teenager I read all the Louisa May Alcott books I could get my hands on. Little Women, Good Wives, Little Men, Jo’s Boys. I own a very old copy of Aunt Jo’s Scrap Bag that I got in an antique store in Wyoming. These are the books that dealt with the March sisters. There are also more like the Eight Cousins or the Aunt-Hill, Rose in Bloom, Under the Lilacs and Jack & Jill. This last book was written in 1880 and the Jill of the title was a poor girl who had a friendship with Jack of the title while they were young. Through childhood misadventures she tumbled down and broke her back, like the nursery rhyme while Jack got a bump on the noggin.

Louisa May Alcott desperately wanted to go to war and wanted to enlist but she was denied because she was a woman. She volunteered as a nurse during the Civil War in 1962 and was confronted by the dirty, nasty, medical mess that accompanies war. She served only 6 weeks of her 3 month assignment, becoming seriously ill herself. She sent home stories that were compiled into Hospital Sketches in 1863.

I had no idea this novella existed until I heard about it on an NPR program about Louisa May Alcott. The library didn’t have it but Amazon did and I purchased it immediately. It is a little book, only 99 pages. I am glad that I didn’t read this book until I was an adult and a working nurse. Because my 24 years in the hospital trenches allowed me to understand Tribulation and to empathize with her.

It is about a woman in the 1862 who is bored. This is Tribulation Periwinkle. She doesn’t want to teach, or write, or get married, or act. Her little brother suggests that she go to war. And she does.

Although not without difficulties or barriers in her way. The battlefields were a long way from New York.

While nursing the desperately wounded, Tribulation has conversations with the dying soldiers. One dismisses his injury as just being shot in the stomach and wishes for a drink of water. But there was no water to be had as the water pails were being filled. Tribulation took the first mug and hurried back to her patient patient, who was dead. There is something about the description of the patient patient who is patiently waiting for water that never comes.

Louisa May Alcott touches on the senselessness of war and the unceasing dying of the soldiers. She writes of families that are holding vigil at bedside for those who were dying. She writes of sitting vigil herself and the conversations that she had with the wounded.

Tribulation Periwinkle goes home and writes about the surgeons and the patients and the other nurses. The last paragraph in the book is about her wish to volunteer at a hospital for “colored regiments” because she knows that society owes them a great debt.

A little book, yes, and a bit disjointed, but it really gives a snapshot of what it was like serving in the Civil War battlefield hospitals. Some good, a lot of bad.

Rather like today. Even with all of our pharmacological advancements and surgical advancements and technological advancements we sometimes don’t in. And Louisa May Alcott knew that.

School Me Saturday 8/30/25- Long weekends

Yes, I know that school JUST started. Like seriously, how long have you been back- a week?

However, for the rest of society it is the last hurrah of summer. Time to have one last barbecue, time to have one last dip in the community pool, time to sleep in (hopefully not the last one), and time to get your breath before the marathon that is coming. You know the one I mean. The Christmas decorations are starting to trickle in and the Halloween decorations have been dominating the stores since the beginning of July.

But you are a college student, you have no time for frivolity, you think to yourself as you pull up the chapter that is due in a week and start the outline for the paper you have to write about this module.

Wrong.

Take a breath.

Yes, the semester just started and there is so much work to do. Papers to outline, and tests to study for, weekly chapters and scholarly papers to read.

Yes, yes, you’re so busy.

It is okay to take a breath and go to that BBQ and take a swim in the pool.

Summers are fleeting and fall is knocking on all of our doors.

The paper outlines can wait. The reading can wait. The end of the semester will be here before you know it. The end of your college career will be here before you know it. Now is the time to enjoy the new friends you have made, to celebrate the joys that they have.

It is okay to take a breath and sink into the long weekend. Think of the two weeks you’ve had of school as the warm up lap and this is your mini break before the work really begins.

Your brain will thank you.

FFS Friday 8/29/25- Free the CDC

Additional furor over the CDC.

This time it’s personal.

The CDC director was asked to step down after refusing to support the administration’s agenda. Newly confirmed Susan Monarez refused. So they fired her for refusing to toe their line of bullshit and refusing to listen to RFK Jr.’s nonsense.

Basically they fired her for choosing public health over politics.

Good for her.

Also good for the wave of resignations that followed of an additional four high level department heads including the head of the National Center for Emerging and Zoonotic Infectious diseases. The others who resigned in protest were the deputy director and the heads of the National Center for Immunization and Respiratory Diseases, and the head of the office of Public Health Data, Surveillance, and Technology. Like that’s not going to shoot us in the foot. Or, rather, in the public health.

For those who are not aware of what public health is, the definition that the American Public Health Association goes by is that “Public health promotes and protects the health of all people and their communities.” The association goes further to explain that their solutions are science-based, and evidence-backed that strives to give everyone a safe environment to live, work and play in.

For those who are not aware what science-based means broadly that there has been use of “rigorous, systematic, and objective methodologies to obtain reliable and valid knowledge.” This definition is by the American Education Research Association and is used as a framework to members of Congress. As someone who has spent the last three years learning how to do research I can assure it is not “vibes” only.

For those who are not aware what evidence backed means it is another way to phrase evidence-based. This means that the information used to back up the care or the data as been found through credible, reliable science. It is important to understand that there is a hierarchy of evidence that is used to rank research. The strongest is systematic reviews. This is a systematic investigation of the meta- analyses of research. There are nine steps to the pyramid of hierarchy of evidence pyramid with the last, lowest step being expert opinion. There are many hierarchy of evidence lists from the NIH, from the Canadian Task Force on the Periodic Health Examination’s Level of Evidence, and many other. Not one of the progenitors say “vibes” only.

Former HHS Secretary Xavier Becerra was understandably concerned with this development. He said, “Politicians don’t do science well. It is dangerous to put politics over public health.”

It is my opinion that is also costly to put politics over public health. Not just in lives of the people that will die but also fiscally. It is expensive to care for those who are caught up in the web of deceit that now descends on the agency.

Unless of course you don’t care about scientific inquiry and base your entire secretary-ship on the lies you tell yourself. And other people. That is cold comfort to those who have to bury the dead from the misinformation.

Don’t forget that over 80 people died when RFK Jr’s lies led them not to trust the Mumps, Measles, Rubella vaccination. They decided that he knew what he was talking about and didn’t vaccinate and a cluster soon followed. A deadly choice on their part. This information is in part from Senator Brian Schatz (D, HI) at the circus of confirmation of RFK.

This information is also widely known and you’d think it would be enough to sink his ego.

But that’s not a bad enough vibe for these people.

Cookie Thursday 8/28/25- no cookies today

No cookies today.

This is a medical appointment pause. Not mine, the husband’s.

It has taken up too much of my brain capacity. No, it’s not my appointment but there are a lot of questions that I am fielding and answering. Not to mention the nutritional consults that are unending.

We could have stopped by the hospital and picked up cookies at the store. After all, what is more no heat than other people’s kitchens heating up because of baking.

But I didn’t want to.

So I didn’t.

I have been having a bit of a thought about the viability and persistence of Cookie Thursday is a Thing.

People are either uninformed or forget when the cookies arrive. I get that new people aren’t informed and that is okay. The information trickles down, eventually. But dumping out a half full container of cookies and taking the empty container home gets old.

There isn’t a rhyme or reason as to how many cookies are eaten.

Even the experiment cookies are popular and the fudgy cocoa no bakes are not popular. It goes week by week.

So I find myself at a bit of a crossroads with CTIAT.

Until we were driving home from the appointment when I brought up the possibility of downgrading Cookie Thursday is a Thing. I said point blank to my husband that was I making cookies to comfort myself or to comfort the department. His response, while high as a kite and doped up, was “It is both. The people who need morale boosting changes every week. And don’t forget the doctors also need morale boosting.”

Huh.

Out of the mouth of someone fresh-ish out of anesthesia.

I’ve long known that the act of weekly cookie making is helpful to me, not only as a weekly appointment with my kitchen to zen out. But I believe, firmly, that is also helpful to those who just need a sweet little something. No strings, no expectations.

Other than someone eats the cookies.

I am also super excited about next month’s theme.

What is September’s theme? Shh, spoilers.

Call Secrets of the OR #6- Sometimes you get beaten by the buzzer

Look, we are in the business of solving the case, of being the kiss on a boo-boo, of the patient having a problem and we need to fix it, of being the buzzer beater every damned time.

Sometimes that doesn’t happen.

And it sucks.

I had a difficult case a few weeks ago.

The kind of case where the patient is going to sleep and I am holding their hand, telling them that their son told me to tell the patient “I love you from your Danny.” He told me this while I was getting a phone consent with another nurse because the son was frantically waiting for his flight to get to the area and the patient, who was struggling to breathe, smiled.

The kind of case where you are listening to the pulse ox beeping get lower and lower and, without letting go of their hand you turn your head and tell the scrub tech to please let the first arrivers to the pre-op area (0530) to be on stand-by because the patient might need them.

The kind of case where the abdominal blocks are on hold because if the patient goes straight to the unit what’s the point of them?

The kind of case where you call the anesthesiologist back to the pre-op area that is also PACU at 0400 to tell them of the patient’s desired code status.

The kind of case where the anesthesiologist came right back and spoke to the patient and the son on the phone about what needed to happen about the code status during surgery.

The kind of case where there are a thousand different needs from the field, from the anesthesia team, from the front desk calling you for some reason because they want to tell you not to call in the PACU nurse.

The kind of case where before you even are in the room with the patient you look to see where the open beds are, hoping that there is an intensive care bed.

The kind of case where you text the nursing supervisor that you will need an ICU bed as you are on the phone with pharmacy looking for the coumadin antagonist that has been ordered. STAT.

The kind of case where the surgeon asks for an impossible item that does not live in the hospital, despite you mentioning it several times that it has been requested. The surgeon didn’t want to use the off-brand disposable.

The kind of case that when day shift workers, who have shown up by now, are in the room for the sixth time asking how they can help you send them to get gloves and to try to find the piece of equipment that the surgeon is demanding that you know doesn’t live in the hospital.

The kind of case where the surgery is cut short and the surgeon says that the patient will have to come back to the OR in the next day for completion of the surgery after the patient was worked up a bit more (we call that resuscitation). Because the surgeon knew that the patient was too ill to continue surgery, after the offending part had been excised.

The kind of case where you’d love to go home and get back into bed but you’ve a full day planned between meetings for the hospital and a long delayed birthday lunch.

The kind of case where you leave the patient open because of the need for a further surgery shortly. Open but with a wound-vac.

The kind of case where you call and ask the pre-op area to please get the ICU bed from ICU and a transport monitor and the bed that is left for the patient is a regular patient bed. And the transport monitor? It is dead.

The kind of case where it takes so long to pack the patient and their various lines up and get ready to bag the patient all the way to the ICU the ICU bed and monitor make it downstairs. And you help put the patient on it, making sure that all the lines and the foley is untangled and not caught.

The kind of case where you clock out at 0830, an hour and a half after your end of shift.

The kind of case where you tell the front desk, the unit admin, the charge nurse that the ice cream you’d made for the ice cream social that afternoon was in the freezer and every damned person in the lounge and at the desk freezes and says they forgot that it was today. You collect money and go to the grocery store across the street and buy 4 gallons of ice cream, ice cream bars, 3 different types of syrup, canned whipped cream, sprinkles, spoons and bowls for the exact amount that you collected from the guilty coworkers who forgot about the 11th annual ice cream social. It isn’t like this happens every year.

The kind of case where you go home and stare at the wall for awhile. But you have meetings to attend! So you get up and join the meeting.

The kind of case where you never know the outcome because the patient was transferred to a higher acuity hospital and it is against policy to open up charts willy-nilly because you are curious.

Ugly calls will exist.

What matters most is that you were able to comfort the patient as they went to sleep and you were able to pass on the message from their loved one. What matters most is that you were able to manage all of the calls and push and pulls of day shift and the call shift in that moment.

And that there was ice cream.

School Me Saturday 8/23/2025- You and the environment is what feeds AI

I know, I know. AI was exciting and the new shiny thing when it bowed into existence in November 2022.

But.

But have you ever wondered what AI gets out of this?

It can make you feel like an artist. It can make you feel like a writer. It can make you feel like the best singer/producer in the world. It can make you feel like the best director of a movie ever!

It can make your appointments and keep your calendar and give your reminders of things.

But it can also steal ideas and already published works. These are video, music, and writing. They call this training the AI and writers and performers and movie companies have no say.

What I want to write about today is the way that you, a regular joe or jane, feeds the AI.

The AI requires VAST amount of energy and water. Lots of water. Millions of gallons of it.

Your data is being compromised and stolen every time you interact with it.

All of it. Your identity.

Your brain (we talked about that last week).

Your ability to engage meaningfully in the world without the AI crutch.

All of this is fed into AI program and repackaged and sold back to you. At a higher cost.

There is definitely a reason for the existence of AI. To crunch the numbers and the existing data that we have on things like cancer rates, medication classes, and it can even see cancers before the human eye can.

AI is meant to serve us.

Instead, we are serving it.

Our attention.

Our time.

Our energy.

Our water.

And ourselves.

On a golden platter.

Because it is the new shiny and you can make a lady picture with 5 breasts.

This is a warning.

Also a reminder to go re-watch the Matrix. Or the Terminator series. But I like the Matrix.

AI is here and thriving.

Because we are its food.