25- Bonus post- The First Department of Education

There I was, running an errand, Throughline on NPR when they started talking about creating the first department of education in the 1860s.

The title of the episode is The First Department of Education and it first ran on June 12, 2025.

The entire episode boils down to how educating people will decrease societal ills. One of the first points that I heard was education of all costs less than a jail.

Of course people who craved control were against it.

Just like today.

Quality episode, definitely worth your forty eight minute listen.

School Me Saturday 6/21/2025- Read ’em if you got ’em

Today is the summer solstice, that time of year that marks the longest days of the year. When the sunlight is so bright it can burn you in moments,

It is also projected to be as hot as balls here in North Carolina. Currently it is 84 degrees in my town. It is projected to go up to 91 degrees.

But it’s not the heat, it is the humidity. Currently it is 56% humidity. Yesterday was delightful with very low humidity (in the 40s) and a milder temperature in the low eighties.

The United States is currently under the threat of a heat dome and the temperatures are expected to go soaring, often over 100 degrees. This is from Las Vegas to Maine, which is admittedly most of the country.

Where I live today (Saturday) and Sunday are projected to be the coolest for a week. This just means that I have to get up extra early to bake on Thursday. I have also been taking measures inside the house to shield us from the worst of it. This includes double curtaining the window in the office that gets the bulk of the morning sun and in the master bathroom which gets the bulk of the afternoon sun and hanging curtains in other rooms. I even went so far as to put removable privacy film on the side light of the front door. This little four inch window blasts in the morning sun as well and I am considering putting the same on the screened door because you can feel the heat radiating from the black front door when you go down the stairs in the morning.

Another place the afternoon sun sneaks into is the screened porch and therefore the living room windows. I have put 6 feet by 6 feet bamboo shades in the screened porch to decrease the sun exposure.

I have also put out iced water for the wildlife because there are squirrels and chipmunks in the front yard and they look hot. Also for the free roaming felines that my neighbors let explore.

But, Kate, how does any of that relate to the today’s title?

Well, I’ll tell you.

For the next several days all outside work should be done early morning or late afternoon/evening. People who have to be outside during the heat of the day should make plans to wear appropriate clothing, sunscreen, and/or hats and be hydrated.

This means don’t mow the lawn at high noon, neighbor that lives 2 doors down. I saw you! I hope you drank all the water when you went in, red faced from the sun. Next time wear a hat!

A normal person, fresh off the semester, would look at this and say “I get to stay in and watch all my favorite shows?” Yes, but, screens are not the only way to pass the time.

Take a nap. Clean the pantry. Heck, make decorating plans for Halloween.

What am I going to be doing? I say it is a perfect time to dust off the TBR pile and dive into reading. After all, the summer reading isn’t going to read itself.

But I am sooooooooooooooooooo tired of mandatory reading for school. Yes, but the semester ended weeks ago and the Fall semester doesn’t start for weeks and weeks. Now you get to read whatever you want. Also known as the book recommendations you’ve been getting from family and friends that you’ve just put on the back burner because who has time to read with tests and papers, oh, my.

You, you have time in this exact moment of the summer to read while it is too hot.

You also have time to read while it is not too hot.

Just saying.

And if you don’t have any books besides textbooks the local library would be very happy to help you out. There is even an e-book option that isn’t Kindle. Not that there is anything wrong with Kindle. It is good to have options. Also do not discount the audio book if that is your jam.

I am reading The Life of Chuck by Stephen King. The movie was great and I wanted to go a little deeper into it.

I also am re-reading Lock In by John Scalzi. This is about a locked in syndrome that affected a percentage of the population and the extraordinary efforts science and politics made to get their consciousness movable in metal suits. This was a great book, I hope I still like it. This is before I get his newest book When the Moon Hits Your Eye for vacation in July.

Stay inside, drink lots of water/iced tea to keep yourself hydrated, avoid being out in the heat of the day. This makes my little introvert heart happy.

FFS Friday 6/20/25- Fed, fussy feline

This is a change from my normal FFS Friday content and is brought to you because I wanted to.

Also my husband suggested it. After suggesting the four horsemen of the apocalypse, War, Death, Famine, Pollution and Pestilence, all of which were well represented this past week in the past week, we had to stop talking because the cat was SCREAMING at me to get my attention. He laughed and said I needed to write about her.

This is a FFS Friday on the lighter side. I believe we all need something on the lighter side today in the midst of all the chaos.

You can’t tell me that cats do not have a rudimentary grasp of time.

Ask me how I know? Dot knows roughly when I am due back from work. Dot knows roughly when the spare human is due back from work and also when he goes to work.

Before the other cat died last summer, Dot would wake me to make sure the other cat got fed at 0800. Even if I had just gotten to bed at 0700. Dot is free fed, which means there is always dry cat food in her dish.

Conversations I have with my cat every day include.

Yes, you’ve been fed.

Yes, I will touch your food.

No, I will not top off your dish. You get food added at 0800 and 2000.

No, you cannot have your wet cat food. You don’t get that at 1000 and 1600, you know that.

Cats also have a grasp on simple mathematics.

Dot, despite not having any sweet receptors on her tongue, long ago developed a taste for mini marshmallows. She knows I keep a bag in my desk for her. She knows that she gets TWO at 2000. I fear for my safety if I only have 1 to give her. Not really, but she will plant herself in front of the monitor and STARE until I give her the second one. Even if that means I have to go downstairs to the kitchen and pull out another bag. And if we are ever out of them? She pouts.

Did you know that it is possible to be too touched out by a cat? Again, ask me how I know.

Dot has to be within arms reach of me at all times. We’ve compromised to where she will sleep in her window perch if I am reading on the couch. If I get up to come upstairs to the computer she follows me. If she wants my attention she yells at me. If I am on a zoom meeting she wants in. In fact, I warn people that they will see a white cat, her name is Dot and she has zero Zoom or Teams manners.

If I am called in she is waiting for me, her little head visible in the sidelight, when I pull in.

She absolutely HATES thunder and will hide under the bed. Fireworks are somehow okay though.

Her latest cute-ism is demanding to be lifted to the lip of the bath where one of her water cups is while I am brushing my teeth. You know, so she can keep an eye on me while I am brushing.

She has perfected sitting between me and the keyboard but I can still reach the keyboard and type.

She’s perfect the way she is.

This is a PSA that most of the US will be under a heat dome Saturday-Wednesday. Maybe put out some water for outside animals to drink. Maybe provide shelter/shade if you can.

It’s gonna be hot, damned hot.

Yes, that is an Airplane! reference.

Cookie Thursday 6/19/25- Plus, plus, Funfetti cookies

I may be reaching a bit with this pun.

This is in honor of the For Good trailer that dropped this week. You know, the sequel to Wicked? Galinda always says “Toss, toss” right as she shakes her beautiful hair out and back. She also tells Elphaba that there is another version known as toss, toss, leg where she tosses her hair out and back and then sticks out her leg.

This is also the closest I am going to get to doing a Pride cookie this month.

I am a proud ally and I wore my Ally Cat tee shirt in to deliver the cookies.

The cookie of the week continues the Cake Mix cookie theme. The cake mix of the week is Funfetti.

This is a deeper richer vanilla cake with sprinkles in the batter.

Everything is better with sprinkles I think.

So much so that I used the rest of a bottle of sprinkles in the dough. I also added half a bag of white chocolate chips because the recipe says to add in a mix in.

And also to extend the dough just that little much farther.

These are some seriously pretty cookies. All the colors of the rainbow.

Best Kept Secrets of the OR #?- Like the Highlander, there can be only one

It’s okay if your Highlander point of reference is Henry Cavill reprising the role in 2026, Adrian Paul from the television show or Sean Connery from the 1986 movie. The only thing you need to know is that there can be only one.

But one what you ask?

In terms of the show and the movies, there can be only one immortal left after the “Gathering” and that immortal will be gifted all the powers of the other highlanders. You see the highlander can die, and often, but at the end there can be only one.

For a geek in the late 80s and 90s (hello, that’s me and countless others) there can be only one was a rallying cry.

But why only one immortal you ask?

I don’t make the rules.

This does handily shift the balance of favoritism in the operating room.

Favoritism in the operating room is where one person seems to be unable to do anything wrong. No matter what they do it, is explained away by management. No matter what they do in the operating room, it is explained away by the surgeons.

Kind of like rose colored glasses on the face of management. For one person.

They go home early every day? Well, duh, they have a family.

They put in the incorrect blood order on a hemorrhage patient? Well, the patient was getting other products and the bleeding stopped eventually.

They take extra long luxurious lunches, mostly off the clock? Well, duh, a body has to eat.

They have a posse that hangs on their every word and covers for their every against the rules action? Well, duh, a leader needs followers.

We all know or have known of the previous favorite.

We have picked up their slack, caught their mistakes, covered for their hour and half lunch.

The secret of the OR is that the role of the favorite changes over time.

Someone new and fun comes into the OR and all the favors transfer to them. The old favorite is dog meat now and is in the manager’s office for a “talk” about their lunches or a “talk” about their habit of going home early every day.

It is unpleasant to watch the tantrums of the old favorite that result.

But whatev.

Have you met the new favorite? They’re awesome and want to remake the entire OR to reflect where they came from? Sure says management, sure says the posse that has sucked up to the new favorite.

And the old favorite is left in the cold.

Because there can be only one.

My favorite Highlander? Sean Connery, of course.

Duh.

Tuesday Top of Mind 6/17/25- Death from a thousand cuts

Piggybacking on FFS Fridays post from last week titled TNTC, AKA too numerous to count, I want to be clear on what happened to women in the past who did not have access to safe abortion care.

THEY DIED.

I want to be clear about what happened to children who did not received vaccines (they hadn’t been developed yet).

THEY DIED.

I want to be clear about what happened to everyday people who didn’t have access to quality healthcare.

THEY DIED.

I want to be clear about what happened to diabetics who did not receive insulin. This was in the before times when insulin resistance was not a thing.

THEY DIED.

Or they ate a horribly restricted diet under the guidance of a doctor. This was begun in 1915 and lasted until insulin was developed in 1922. The patients “lived” on 500 calories a day, with one fasting day per week. This was to keep their glucose in check. Or, knowing that this horrible disease was due to the patient not being to metabolize carbohydrates (they thought), there was also an animal diet where the patient only ate meat and fats. But in the post WWI world, who had that kind of money. Otherwise…

THEY DIED.

I want to be clear about what happened to babies who were born before 35 weeks. This was before the isolette which was developed in the 1880s to keep premature babies warm by Stephane Tarnier, a French physician.

THEY DIED.

I want to be clear about what happened to patients who developed gangrene from wounds before penicillin was discovered in 1928.

THEY DIED.

I want to be clear about what happened to women and children who were widowed and orphaned, respectively, and were sent to poorhouses because there was no longer anyone working.

SOME DIED.

I want to be clear about what was a major cause of death of women before the mid 20th century. Childbirth, many, many women DIED in childbirth.

I want to be clear about what happened to babies with congenital heart malformations such as Tetralogy of Fallot or a patent ductus arteriosus (which is the failure of the pathway between the two major arteries of the heart) or a transposition of the great arteries (the switching of the pulmonary artery and the aorta).

THEY DIED.

In agony.

I want to be clear about what happened to the babies who were born different and twisted.

They got sent away to an institution and THEY DIED EARLY.

All of the advancements brought to you by medical pioneers and researchers and you want to throw it away?

Worse, the government wants to throw it away. And toss money after it because of the cancelled trials.

Shame.

School Me Saturday 6/14/25- Protest all the way home

When we see injustice it is our duty to speak up.

When we see terror it is our duty to protect those who cannot protect themselves.

When we see powerful people speaking out of their ass it is our duty to remark upon it.

Be like the little girl in the Emperor’s New Clothes By Hans Christian Anderson who points that the emperor is naked during the parade, we have to speak truth to power. This is, of course, after all of his fawning sycophants declared the cloth of gold outfit (that didn’t exist) to be the most handsomest cloth of gold outfit that they’d ever seen and truth the emperor was the most handsome man they had ever seen.

You may remember the emperor had spent so much money on himself that he neglected his subjects and his empire.

Get the point yet?

I hope current events learns from the story. And the emperor is reformed after humiliation but we all know that is unlikely.

Do you know why colleges and universities always have “hot head” students who are shouted down by those in power?

Because college is where you go to learn to think. Because college is where you go to learn to unthink the lies that have been taught to you. Because college is where you go to give a damn what happens to those who have less than you.

No wonder colleges and universities are under ceaseless attack by the administration.

A person who can reason and think clearly outside of propaganda is a person who won’t be fooled by a conman’s false cloth of gold.

This, of course, makes them a target. Because they do not accept cruelty for anyone.

There are massive protests today June 14th, 2025.

It is No Kings Day after all.

It is important to point out and remember that protests look different for everyone. Some protest with their bodies. Some protest by supporting those who are able to participate in marches. Some protest with their words. Some protest by giving to others.

It is important not to stay quiet and to protest in your own way.

FFS Friday 6/13/25-TNTC, aka too numerous to count

On a normal Friday I pick one top of mind issue that is not necessarily medical. And then I write a sweary post about it.

But this week…

This week the issues are literally TNTC.

For those not in the medical field, this means too numerous to count.

This is a lab value that indicates that there that the total number of bacterial colonies exceeds 200 on a 47 mm diameter membrane filter used for coliform detection. To translate, 47 mm is roughly 4 centimeters, or not quite 2 inches. And a coliform is a either a gram positive or gram negative bacillus. A bacillus is a rod shaped germ. These can only be seen under a microscope.

The point is that there are 200 bacterial colonies.

Damn. Let me sum up some more. A colony is a group of germs.

The point is there are at least 200 groups of germs in a less than 2 inch piece of membrane filter. This is literally too numerous to count. The germs are packed in so tightly because there are so many of them that they cannot be counted.

It can be guessed at. But the guess might be wrong.

This is like the “Guess the candy in a jar” party game. You can never really be certain how many germs there are.

Too many.

Too many is the correct answer.

I feel that way about politics these days.

There are too many fucking things to pay attention to.

Like an insane game of Whack-a-mole.

Here there is a plane crash in India that occurred shortly after take off. And someone survived the 600 foot drop and the fireball.

There is yet another bat-shit decision made by the DHHS secretary.

Oh, wait, there are more than one.

Over there is Israel bombing Iran.

Here there is a woman being dragged out of a police car by one ankle, the cop not seeming to care when her head is banged first against the car and then against the ground. Then the cop forces this woman’s head to the left while laying on her back and neck. And the second cop, hands hooked under the bullet proof vest, watching.

There is the deploying of the national guard to a state whose governor didn’t ask for them.

Over here is the deployment of Marines to the same city as the unasked for national guard.

Over there in Florida is the sheriff saying it is okay to kill protestors that are violent. And then he doesn’t define it. There are so many ways that shit can go wrong.

Over there is expansion of PEACEFUL protests across the country.

Over there is the video of a cop breaking their own windshield. Presumably to blame the peaceful protestors.

THERE a United States SENATOR was forced to the ground, while identifying himself and HANDCUFFED for asking an unwanted question about the thuggery going on in his state.

Add in various judicial orders that are gut churning on their own.

All of this since Sunday.

Google TNTC and look at the images. Especially if the image has the progression in a petri dish from no colonies to low colonies to medium colonies to high colonies to TNTC. The image I want to share is copyrighted so words will have to do. And use your imagination. Or Google.

Apparently I am able to share the picture. But not no picture here because I have yet to learn how but the picture will be used on Facebook and Instagram. Citation of the picture at the end of the post.

A petri dish is usually 2.4 inches in diameter. To put it into perspective.

No colonies is a completely empty petri dish.
Low colonies is less than 20 in a petri dish.
Medium colonies are 20-100 in a petri dish.
High colonies is 100-500 in a petri dish.
TNTC is more than 500 in a petri dish.

You get the idea. If it feels like we are in a blender with all this information coming at us and more and more and more and more, that’s because we are. They want everyday Americans to feel terror.

Because that makes us easier to control.

And it fucking sucks.

If you need me tomorrow I will be pocket book protesting and doing things that bring me joy.

Because joy is the antidote to terror.

Citation
Kallam, Brianne & Pettitt-Schieber, Christie & Owen, Medge & Asante, Rebecca & Darko, Elizabeth & Ramaswamy, Rohit. (2018). Implementation science in low-resource settings: using the interactive systems framework to improve hand hygiene in a tertiary hospital in Ghana. International journal for quality in health care : journal of the International Society for Quality in Health Care. 30. 10.1093/intqhc/mzy111.

Cookie Thursday 6/12/25-Spice cake mix with caramel chips

Note to self, make sure that the cake mix has at least 15.25 oz of ingredients.

This week’s cookie was made with a spice cake mix and the mix ins were caramel chips.

I like these so much better than last week. They are reminiscent of gingerbread cookies but softer with more rise. The caramel chips also do some heavy lifting.

Same recipe as before. Box of cake mix, 3 eggs, 1/2 c melted butter, 1 tsp vanilla and the mix ins of choice. I thought caramel would go really well with the warm notes of the spice cake.

I just checked.

The cake mix that I used last week did have 15.25 oz of ingredients but when I poured it out of the box it seemed like very little and when I poured this week’s cake mix out of its box it seemed so much more. And these cookies raised more as well.

The output was the same. 4 full cookie sheets, 12 cookies per sheet. For a total of 48 cookies.

Hmm.

I guess my taste is more to the spicy side and less to the sweet side.

Good to know.

Best Kept Secrets of the OR #?- Happy 23rd birthday, surgical time out!

Once upon a time, when I was just a mere baby nurse, new to the ways of the OR, there was a wrong site surgery in the operating room. I was listening to my preceptor talk about the schedule when a more experienced nurse burst out of their room, nearly in tears, babbling about the video tower being on the wrong side of the room.

The video tower is just what it sounds like. Remember those AV carts in high school and middle school? The ones that the teacher would wheel into a room when they wanted to show a video. Do they still do that? I have no idea. It was a video monitor, a light source and a camera box. Sometimes a printer. That is so the surgeon can insert the arthroscopy camera and see what they need to see and, because of the video set up, so can the rest of the room. The early early scopes didn’t have the camera and a surgeon would hold up the scope to their naked eye and no one else could see. We’ve come a long way, baby.

Another detail that non OR people need to know is that the video tower is on the opposite side of the patient than the operative side. For example, a right knee arthroscopy requires that the video tower be on the left side of the patient.

Clear as mud, right? Just go with it.

The case left knee arthroscopy was the first case of the day in that room. The problem was that the last scope of the previous day had been a right knee arthroscopy and the video tower was pushed back to the wall to the left side of the room. The tower for a left knee scope should’ve been on the patient’s right side. And the nurse, not thinking, had just pulled the tower next to the bed and prepped what she assumed was the correct leg. She assumed that the knee arthroscopy that the patient needed was a right one because the tower was on the left side.

It wasn’t until the surgeon was in the knee, looking around and not seeing the anterior cruciate ligament defect that they even asked to see the consent. The operative consent was for the left knee and they were in the right knee.

Early morning, first case of the day. That was when we didn’t set up the rooms for the next day. It was just convenience that led to the video tower being on the incorrect side. It was just bad luck that the nurse and the surgeon and the scrub tech and the anesthesiologist didn’t recognize the error. This is the very definition of Swiss cheese error.

This is the kind of stuff that I came to understand, very quickly, was nightmare producing. It goes against everything healthcare is supposed to be and a patient was temporarily injured. And inconvenienced. The surgeon had to stop the surgery and, accompanied by the charge nurse, go out to speak to family and tell them what happened. And get permission to do the real surgery on the correct leg. I imagine while this was happening the surgery manager was on the phone with the hospital lawyer. But maybe not, it was a simpler time. The family agreed and the patient got the surgery on the correct leg, and three port sites in their other knee as well. As this was before bilateral orthopedic surgery became more commonplace.

This was before the surgical time was developed and introduced. But wrong site surgery was such a bad thing that the National Quality Forum included it in their never events. These are medical error events that should never be. The surgical time out was the solution developed by AORN.

All members of the OR team must stop what they are doing, agree that this is the correct patient, correct laterality, correct equipment, correct surgeon, correct surgery set up, and correct surgery.

The surgical time out is kind of like the 5 rights of medication administration that they taught us in school. Scratch that, the surgical time out IS the 5 rights of operation.

I still remember when the manager gathered us around not too terribly much later and explained that there was a new WHO tool that had to be done on every surgery. Also why it is called the WHO surgical time out in some hospitals that cling very tightly to their traditions.

Whatever it is called, the surgical time out or “pause” has been integral for stopping surgical mistakes. Thousands, if not millions of them, in the 23 years since its adoption.

Taking the time to pause or stop and agree on all the things is the very best we can do for the patient.