2025- S’mores treats

August is, as is traditional for Cookie Thursday is a Thing, No Heat Month.

Of course, you wouldn’t know that by the weather this past four days.

Rainy, humid, slightly cooler.

Slightly.

It is tradition, as I’ve said, for August to be the month where I do not turn on my oven.

Like, at all.

With the Thursday before the start of school for most of the schools around here on August 21 and the department has an ice cream social on that day, that leaves me only 3 CTIATs.

This week is a Rice Krispies knock off. Well, the same recipe with a different cereal.

What is more summer late night than s’mores?

Not much.

You know when the temperature is a bit cooler in the evenings but still dark enough to see the fireflies? Yeah, that.

And what goes best with summer late night around a campfire?

S’mores.

I happened upon a Malt-O-Meal bagged S’more cereal. Graham cracker cereal, mini marshmallows, and chocolate balls. Perfect for a Rice Krispies knock off.

But, me being me, I added chocolate chips as I was stirring in the cereal.

Because why not?

Call secrets of the OR #3- Positivity is a must

This is what I alluded to all the way back in call secrets of the OR #1 when I told the surgeon that I approach each case with optimism and I do not dwell on the possibilities.

Not a lot of people like call.

I get this.

However, I think it is because their attitude is wrong.

In case after case after case, the surgeon talks about what can go wrong during the surgery. Before the incision is even made.

I let them grouse and complain and say that they are missing sleep. They list off the complications that could happen. Not will, but could. Yes, yes, we all are missing sleep. I let them get it out of their system. There is a LOT of complaining.

And then I hit them with “But what if none of that happens?”

What if the appendix is sitting on top of their bowel, just ready to be plucked?

What if I have everything in the room for every eventuality and therefore you are not delayed?

What if I can get you back in bed in 90 minutes, 60 if it is an uncomplicated appendix?

Don’t get me wrong, sometimes the nights are very long and I don’t see my bed until after day shift starts. And my cat, who has boundary issues, demands that I get up and touch the food in her dish at 0800, even if I’ve just gotten into bed. Sometimes the case devolves into a messy one and I don’t have everything they need. Sometimes the case devolves into a real shit show and now I have to man the phones to arrange for a higher level of care bed in the intensive care unit.

Sometimes not cool stuff does happen. But not every time. And certainly, not every night.

What if by naming the bad outcome you are dreading makes it happen? What if by naming the bad outcome you are dreading makes it not happen.

Call is a craps shoot. With a 20 sided die. Sometimes you get a natural 1 and it all goes to hell. But there is an equal chance of a nat-20 and the incarcerated hernia reduces itself as the patient goes off to sleep.

Yes, this can happen.

Don’t you see? By steeling yourself that the bad thing will always happen, you cut yourself off from the possibility that it won’t.

I admit that sometimes I am aggressively positive. Which can irritate a surgeon or a coworker. I know this and I will not be working on it.

I just shrug and say, “Oh well. Better luck next time.”

Tuesday Top of Mind 8/5/25- Raw milk does NOT do a body good

Before the ubiquitous “got milk” complete with milk mustache campaign of the 1990s, there was the “Milk Does a Body Good” campaign of the 1980s. Both of these were to promote milk as a healthy drink that builds strong bones.

Don’t get me wrong, milk does have a lot going for it. It has protein, vitamins, and other nutrients that your body and your bones need to be strong and withstand life. The habits that promote bone density will have a pay off well into middle age and older adulthood.

Kind of like blood sugar, it is the cumulative high blood sugar that does the damage, it is the cumulative wear and tear and not giving the osteoclasts enough raw material to work with that can lead to troubles down the road.

Believe me, I’ve been in enough broken bone surgeries to identify, at a glance, who does not keep up with their diet and exercise.

Exercise also stresses bones, which makes them stronger.

It is the entire package. And is an investment in your future bone health.

I am, of course, speaking to the benefits of pasteurized milk. Never raw milk.

Pasteurized milk is milk that has been exposed to temperature and time. The milk is heated up to ensure that the bacteria and viruses are killed, for long enough. This has the added benefit of preventing spoilage because the same bacteria and viruses are what causes spoiled milk. Some of you have never gotten the milk out of the fridge and poured yourself a glass of spoiled milk that you promptly spat out in the sink and it shows.

The process was developed by Louis Pasteur who was a 19th French chemist and microbiologist. His pasteurization process (spot the name similarity) made milk safe to drink. It also made beer and wine safe to drink. In short, he saved France. Or the industries that made France famous.

Just think of how many lives he has saved.

In this current day, it is the fashion to ignore medical advice. Shocking!

[insert extreme eye roll here]

The ingestion of raw milk for its nonexistent “powers” has been gaining in popularity.

To be clear, raw milk can be sold to feed livestock.

But *wink, wink, nudge, nudge* people have been lying to get their hands on the white stuff. And all the bacteria and viruses it contains.

Why?

Because they’ve been lied to and told it was the healthier way.

To be clear, pasteurization does nothing to the nutritional value of milk. Raw milk has been linked to miscarriage, stillbirths, kidney failure and death since 1987. Definitely before that as well.

Someone is making money off the sale of raw milk and telling gullible people that it is the healthier way. Consider who profits from the sale of raw milk.

That is a round about way of informing you that there is a current raw milk crisis in Florida. At least 21 people, including 6 children, people have been sickened from ingesting raw milk. Probably because of contamination at the farm. Raw milk has to be handled in an extremely professional manner, as does the farm that it is from.

Those who drink raw milk are you sure you know all of the inherent dangers? Were you told?

Those who have been sickened, often to the point of hospitalization, was raw milk worth it? Just so you could stick it to “Big Dairy”?

Medical fiction and non-fiction book report 8/3/25- Little Miss Diagnosed by Dr. Erin Nance

Something happened during the pandemic.

People got bored.

A lot.

Even healthcare professionals.

And they turned to YouTube and Instagram and TikTok to make reels as a way to release the pandemic pressure and to make us smile.

Dr. Erin Nance was one of these.

She is a double board certified orthopedic hand surgeon. This is her story.

She is also big into treating the undiagnosed and unheralded medical problems of women. Because, you see, she was also dismissed because of her gender in her internship selection. And she knows that many women are dismissed because of their gender when they seek medical care.

I like and admire that.

We all know that surgery is my favorite. But my especial favorite is hand surgery. I have stared down other orthopedic surgeons who wanted to bump a finger amputation because to them it is just a hand. Yeah, that is like calling brain surgery easy.

Shortly after starting at the regional orthopedic hospitals after we moved across the country I was offered and subsequently took on the hand service line. This means that I was responsible to knowing everything about the hand surgeons and the hand surgeries. I also ordered specialized sutures for the hand surgeons. Healthcare being healthcare I was also handed the trauma service line and the pediatric service line. This means that I had to know all of the fixation types to fix a broken bone or to fix a tendon.

It was a lot.

Hands hold and sculpt and cook and soothe and comfort. Hell, the opposable thumb is what allows for much of what the hand is capable. Opposable thumb means that you are able to bend, twist and touch the tip of your thumb to all of your other fingers. This allows us to hold a pen, or a paintbrush and create art or books. When they talk of fine motor skills, this is what they mean.

Put your hand out and take a look at it. Spread your fingers wide and note which muscles of your forearm control which finger. There are 23 bones in your hand. The bones of your fingers, we call these phalanges, each have a tendon attached to them that enables their movement.

I waited and waited and waited to get this book from the library. I have seen a few of her videos on Facebook and I found her to be warm and genuine and have really great stories. I was very excited to read her book.

I received and read her book in one sitting. Not hard because it is less than 250 pages.

As much as I was looking forward to this book, I didn’t like it as much as I was expecting.

There isn’t much of a narrative throughline. There is her brother Kevin who suffered a devastating spinal injury with spinal cord fracture on her very first day of her internship. The scenes written with him were warm and just on the side of Pollyanna puke that I live on. He pops up periodically as Dr. Nance celebrates his wins.

The stories are not told in a chronological order. This kind of bugged me and some of the stories I am familiar with through her stories were missing. Ones that I think would’ve made compelling reading.

Her very short chapter on the other denizens of the operating room left much to be desired. According to her explanation I, as an OR nurse, comfort patients and fetch them warm blankets and are a soothing presence as anesthesia is started. And my mood sets the mood for the entire room.

Yes, but.

She could have definitely gone deeper here.

The book was less surgery details focused and more her process focus through internship, residency and hanging out her shingle immediately after residency. This means that she opened her own practice because she couldn’t find a niche.

I can respect that.

But I didn’t like this book as much as I expected because it was so shallow. There isn’t a lot of detail that screams real life. This is a good book for those who are not in the know. There isn’t a lot of gore or death or broken bones.

I picked up the book expecting some of that and it did not deliver. That is what I meant by shallow. There are depths that I wish had been plumbed.

School Me Saturday 8/2/25- It’s AUGUST, you know what that means?

The summer is winding down.

To the college student that means that the Fall semester is just around the corner.

Back to school things have been the stores for a minute. Yesterday I heard a mom frantically looking for extra long twin sheets and I thought to myself, “Someone is sending their first kid off for their first colleges days.”

The Fall semester will start before you know it.

Make a list of necessary dorm things. Extra long twin sheets, a caddy for the shower, some rudimentary kitchen stuff, and probably a mini fridge. Definitely a microwave.

Make a second list of necessary school things. In my day, this was notebooks and pens and paper and my very first computer.

Don’t forget clothes for the changing temperatures.

Don’t forget quarters for the washing machines. If they even do that anymore that is.

Don’t forget your chargers.

Don’t forget notebooks and pens. You know, just in case.

Don’t forget to download your syllabus when available.

Don’t forget to make a schedule of your classes.

Don’t forget to check out the nearby restaurants or, if you are eating on the meal plan, the hours of the cafeteria.

Don’t forget to be excited about this new chapter in your life. It is okay to be a little scared too.

Above all, don’t forget to reach out for help when you need it.

But these last few days before the hustle and bustle truly starts give yourself permission to finish that book you’ve been reading. Give yourself permission to enjoy this time.

It will be over before you know it and you will be an old hand a the dorm thing. Or at the off campus house thing.

Before the Fall semester starts take a moment and remember yourself just as you are because you will be a different person when you next are home. Also remember to give your parents grace as they learn to understand and accept the new you.

After all, to them, you were just in diapers.

FFS Friday 8/1/25-F-in Cowards #4

Oh, my god, they pulled up the corpse of Elmo and shot him again.

Shield your eyes, children.

And just like that the path in childhood has been closed to CHILDREN. No more education programs that are not ads for toys or ads for movies or just plain ads.

The Corporation for Public Broadcasting announced today that it has begun shut down procedures. People are being laid off, with the corporation shuttering in January 2026.

The CPB was authorized by Congress in the 1967 Public Broadcasting Act to ensure that everyone, and I mean everyone, has access to non-commercial, high-quality content and telecommunications. They used 70% of their own funding to support more than 1500 locally owned radio and television stations.

This means that the shows and the broadcasts are not trying to sell you anything.

Unlike the rest of the world.

Every minute of every day.

But, alas, this is no more because congress yanked its funding in order to give money to millionaires and billionaires in the form of tax credits.

“But, but you will get a tax credit too!”

pffft, I’ll believe it when I see it.

We certainly did not receive any money during the pandemic and those 2017 “tax cuts”? Our taxes went up. By a lot. Many thousands of dollars a lot.

No, I don’t believe you when you tell me that it was worth it.

Fucking cowards.

Mr. Rogers is very disappointed in you.

I believe Horatio in Hamlet said it best “Now cracks a noble heart. Good night, sweet prince/and flights of angels sing thee to thy rest.”

Or maybe Inigo Montoya when he is advancing on Count Rugen, “Hello, my name is Inigo Montoyo, you killed my father, prepare to die.” Count Rugen pleads for his life in the final duel, offering Inigo all that he wants, money, power jewels anything Inigo wants.

And Inigo, stabbed, bleeding, facing down the man who murdered his father twenty years before, tells him “I want my father back, you son of a bitch.”

Let me tell you, we are all Inigo.

We want our PBS and NPR.

Again, Mr. Rogers is very disappointed in all who voted for this.

Cookie Thursday 7/31/25- Peanut butter, chocolate, oat bites

It is the most dangerous time for me in the kitchen and Cookie Thursday is a Thing. It is hot, we’ve been enjoying a pretty brutal heat wave here in NC with temperatures above 95. Plus 88% humidity.

Makes me tired.

Makes me bored.

Makes me not want to bake and heat up the house.

And it is too close to No Heat August to concentrate on baked goods.

I could have done what I did last year and started No Heat August a week or, in 2025’s case, a day early.

My brain went nah.

Do you see what I mean?

It’s been like that all month. I normally have a plan with recipes made before the last day of the month.

Today was particularly busy. It is nursing awards day!

I procured the cinnamon rolls yesterday afternoon, like I usually do.

Our balloons failed to achieve lift and so my co-person asked me to procure balloons. Happily Michaels opens at 0900 and solved that problem.

And then I needed the flowers.

And then someone’s Mustang was parked in the shade, which I would normally admire but they were taking up 2 parking spots as they were straddling the line. Rude.

I loaded myself up with the CTIAT container, the flowers, the cinnamon rolls, and the balloons and staggered into the hospital. I really could’ve used two trips.

Good thing that the front desk staff know who I am.

I arrived at the awards with 20 minutes to spare.

Which, if you know me, is practically late.

I ran the CTIAT container down one floor to drop off the cookies.

But, Kate, what did you make? You haven’t written that yet.

Oh, boy, heat does not make my brains work too well.

I decided to make an oatmeal, chocolate, peanut butter bar that I’ve been meaning to make for a bit.

I started it last night when I got home from the hospital.

The recipe looked easy. Butter, sugar, brown sugar, 1 egg, vanilla, peanut butter for the wet. For the dries flour, baking soda, salt.

Pat into the bottom of a 9 x 13 pan and bake for 20 minutes.

While it is baking, make the peanut butter frosting.

When 20 minutes is up, sprinkle chocolate chips over the baked bottom immediately so that they melt. Swirl on the peanut butter frosting.

Quick and easy, took me 40 minutes.

That wasn’t the long part.

The long part was when I walked upstairs to shut the computer down for the night and I noticed that I had not finished Wednesday’s post or posted it to all the places.

That took a minute. Okay, it took 30 minutes.

Long story short, I am tired of this heat.

And I am ready for the promised break from the heat starting on Saturday.

Fingers crossed.

Call Secrets of the OR #2- The contact list in case of emergency

I’ve been at this call business for a long time.

Well, strike that because I swore to my big belly patient last week that I would stop saying that. I apparently told them that I had been a nurse for a very long time, not once but twice, and they called me out on it the second time. They just wanted me to be more specific.

Ahem.

I’ve been at this call business for nearly 25 years and in that time I’ve had my share of no shows or no answers or, on two occasions, the tech that I was waiting for was in a car accident.

It was odd enough the first time it happened but the second time? Eerie. Made me think of the night call unit secretary that I worked with in California. She trained me and was always there to answer questions, even after I became a nurse. She died driving home after a night shift.

This is why I always, always, always tell people when I have called them in to drive safe.

What do you, as the call nurse, do in event of a no answer/no show/accident?

If you are me, you grab the big red book of numbers. Everyone is in this book: surgeons, PAs, doctors’ offices, anesthesiologists, CRNAs, scrub techs, circulators, management, charge nurses, SPD, and the all of the department numbers for the hospital.

You know, in case you don’t have those memorized.

If you still haven’t gotten a call back or a response to the second call, you start in on the list.

Over time you will get a feel for who is friendly to a three am phone call and who might be interested. If it is a scrub tech you might even call nurses who you KNOW are capable of scrubbing the case.

That’s what I did when the first tech got into the car accident on the way in.

If you don’t get a response or all you get is no thank yous or hung up on, you call the nursing supervisor to keep trying.

If after the case is picked and there have been no nibbles you should consider more scorched earth options. You call management until THEY pick up. And dump the problem into their lap.

While this is going on you also keep preparing for the case. Because the show must go on.

In my twenty years of doing this I have never had outright nos from every single person I have called. Knock on wood. Mostly because I have garnered 17 years of brownie points at my current hospital.

Because they’ve all been there and can commiserate with you.

A very last resort would be transferring the patient to another hospital. This is the very last option because there are going to be delays getting the receiving hospital to accept the patient. There might not be room in their overnight schedule. And surgeons would definitely not appreciate this kind of maneuver.

And you’ll never hear the end of it.

If you are going to be new to call and are scared that this might happen, start gathering your brownie points now. Be nice, consistently nice, and people will have a harder time saying no to you.

There is also the mandatory call list but that is more to cover people during the day. I’ve never used it at night. But it is an option.

Know your friendlies and also know who is more likely to say yes.

That will save you, the patient, and the surgeon a big headache just trying to get the case off the board.

Being nice never cost you anything.

Think of it as banking brownie points for use in an emergency.

Tuesday Top of Mind 7/29/25- Initial cost of childbirth

Children, I’ve been told, are expensive.

This is an observation from a childless woman.

There is the constant need for diapers and wipes and creams on one end and the other end requires food. Like, every day, many times every day.

Sometimes the food (formula) requires bottles and nipples. As well as the cost of the formula and the water to mix it with and the sterilization of the bottles so that the infant doesn’t get sick. Sometimes (always) the food (breast milk) requires that the woman supplying the breast milk be fed as well. I am unsure how to write you have to feed the cow in a non-judgmental gentle way. Perhaps a better way of putting it is that you can’t get milk from a stone.

There is always going to be an opportunity cost. (I learned that one from Economics class).

Another thing that feeding a baby, no matter how (breast or bottle), requires is time.

Time to sterilize the bottles.

Time to feed at the breast.

Time.

Then you have to clothe the baby. It is high summer right now here in North Carolina and I know that baby would be most comfortable in just a diaper. In the shade. But it is not always high summer. This means that there are costs for clothes for the baby.

You know what else happens? Babies grow because you’ve been feeding them. That is their job after all, to grow and learn and explore.

Humans are astonishingly unable to care for themselves after they are born. A foal stands minutes after birth, even kittens’ learning period is vastly truncated from the years it takes a human to be self sufficient. Someone needs to mind the baby. But most Americans’ work so that they can afford a roof over baby’s head or food for baby or clothes for baby. Since we know that baby’s self sufficiency is non-existent, someone has to mind the baby and often mothers and fathers pay for someone else to mind the baby when they are at work to earn the money to house, feed, and clothe the baby. This means childcare, which is extremely expensive.

Babies are expensive.

But this entire post is about the initial cost of a baby.

According to Fair Health, a healthcare data company, the costs can vary widely across the U.S.

I am going to write about North Carolina and South Carolina, since they are the closest geographically.

These costs are inclusive of pharmacy costs, nursery while in the hospital costs, the labor and delivery room cost, the medical supplies, the room and board for mother. Also included in the cost estimate is anesthesia costs for delivery, feral non-stress tests in the weeks before delivery, ultrasounds, and the laboratory tests that may be needed.

And a breast pump.

You know, to feed baby.

I think that is a pretty inclusive list for delivery. But what do I know? I’m just a childless woman.

I am going to break it down by the two types of delivery- vaginal and cesarean section.

For vaginal births, NC is near the bottom of the middle of the pack. According to their numbers it costs $14,250 to delivery vaginally. Reminder this includes the costs that are listed above. The South Carolina cost of a vaginal delivery is $13,865.

For section births, NC is again near the bottom of the middle of the pack at $18,490. It surprised me when South Carolina was at $19,654.

Again these are the costs inclusive of the above list.

But, Kate, where did you get this list?

From Becker’s Hospital Review. This is a clearinghouse newsletter of new and notable data and information in the healthcare realm.

Oh, and the data? From 2024. When I googled the cost of a vaginal birth in North Carolina, Fair Health was the second result.

The most expensive state to have either a vaginal birth or a section birth is Alaska ($29,152/$39,532). This makes sense as everything has to be shipped state side and hospitals are in the bigger cities, which costs travel. The least expensive in both kinds of delivery is Mississippi ($9,847/$11,110). According the KFF (Kaiser Family Foundation) the maternal mortality rate for Mississippi is 39 per 100,000 live births. The maternal mortality rate for Alaska has been suppressed due to reliability and confidentiality restrictions.

But my take away is that babies are expensive straight out of the gate. (Sorry, I couldn’t resist)

This is not something to be taken lightly and should absolutely factor into a woman’s desire to have children.

I can hear it now “But, Kate, what do you know about it?” Well, nothing but I have friends and family who have recently given birth. That also doesn’t mean that I can’t add to the conversation.

School Me Saturday 7/26/25-students and AI part 3- spellcheck AI, a cautionary tale

Your spell check is lying to you.

In the before times, you know before 2022, spell check used to be of the actual world. A list that was carefully maintained by the company that ran the spell check program. Programs like the spell check embedded in Microsoft Word or Google Docs.

Well I say used to be of the actual world.

Now it is a computer program that has been trained using AI in pattern recognition. The patterns that they recognize is the correctly spelled world. And the myriad ways that a word can be misspelled. And there are so many ways a word can be misspelled.

Think they’re, their, and there. They’re is a contraction of they are. Their indicates ownership. There indicates place.

Which usage is correct? The spellchecker now uses pattern recognition to recognize if the usage of that particular word is the correct one.

Are you with me so far?

But when enough people misspell and misuse a word or a phrase enough time the program now lets the wrong word and the wrong usage to be accepted as truth.

Where it gets tricky is that the sentence “They’re over there” meaning they are over there can confuse the program. What someone meant to mean is place (there) over place (there). Which doesn’t make sense. Or the third person meant to mean Their (possessive) over there (place).

And the computer program which is not an actual person and therefore cannot think, allows it.

Because enough people have made that mistake. This tricks the program to thinking it is correct when it could not be further from the truth.

This is, and I can’t stress this enough, dumbing us down tremendously.

Kind of like evil auto-correct.

This is also a self perpetuating problem. People can’t spell, can’t write, and fuck it up either way and depend on a machine that is not a person to sort it out for them. And so on and so on and so on.

Until we are left scratching letters into the dirt again.

A duck is never a duck when you mean fuck.

The AI is patting us on the back and saying “their, their, their.”