Best Kept Secrets of the OR #28-Holiday weeks are feast or famine

Yeah, I know that Easter/Spring Break was over a week ago. But the next holiday for the operating room will be here in less than a month. Slightly different rules but much of the same vibe.

Eh, things have been happening.

Because holiday weeks are a feast or famine situation in the OR.

On Good Friday all the doctor’s offices are closed. That means there are less phone calls and probably less add ons. Since Easter is a family holiday, much of the staff want it off as well. This is a win-win.

Unless you are in the feast portion of the holiday.

My evening tech, with whom I worked for literal YEARS, and I would nod to each other, regardless of the burgeoning schedule or the echoing schedule and say holiday.

Easter stands alone because it is not one of the drink to excess holidays. Well, not usually. There are always the exceptions. Because it is a family holiday.

The rules also extend, to a lesser extent, to Mother’s Day and Father’s Day but it is less acute then. Those days we try to get people who don’t have children to cover. At least I used to when I ran the schedule.

Feast or famine is what the OR schedule looks like.

Another variable is what week of the month the expected feast or famine days fall upon. Because the 5th week of the month is outside of the block scheduling process and you get a weird bunch of cases.

Feast means that there are more cases than time in the week. Since these weeks the OR is run on a traditionally smaller number of staff, that means there are plenty of cases for everyone. This is particular to the family holidays like Easter or Christmas when everyone wants to be off to be with their family.

Famine means that there are less cases than normal. This is usually due to the surgeons scheduling time off to be with their own families. This can be a bonanza for the people who didn’t get the golden ticket of approved PTO but really still want to be with their families. Or just want to be off. There is usually a list that is kept at the desk and, to make it fair, done on a first come first served basis.

Don’t worry, all the rules will be different for our next holiday. This is Memorial Day, which is the last Monday of May. It isn’t meant to be a drinking holiday, but it is the opening holiday for grilling. Especially here in the South.

Tuesday Top of Mind 4/29/25- The U.S. is trying to control what kind of health research is published

I know, I know, there is too much bullshit out there to focus on one thing.

I get it.

The purpose of Tuesday Top of Mind is to write about what fresh horribleness is happening in the healthcare realm.

Today, I want to write about the fact that the U.S. government is trying to control what kind of health research is published.

It is done to control what information is out there and, by extension, the U.S. population.

You see, they want to keep us dumb and to not have any avenue to question what is published.

I know that I am fairly new to nursing research but I am not new to nursing.

It is shit like this that allows them to put their knee to the neck of publishers so that the publishers will cave.

It is the bully in the room who takes control of your arm, usually bruising it, and hits you with your own hand, all the while asking “Why are you hitting yourself?” Dude, you are puppeting me and making me hit myself.

It is the bully in the room that has no intellectual curiosity and hates those of us who do.

It is the bully in the room that wants to bend all of science and academia to their will to declare the sky is green with screaming red polka dots and they’re just trying to protect you, boo.

All that they are asking about, if there is room for competing viewpoints, or does the articles get reviewed by lay people, and are the researchers transparent about who is funding them, makes me roll my eyes so hard I can see into last week. The kicker is what if the researcher got it wrong, what then?

They are definitely giving off “i’ve never read a journal article except for once and in that journal article there were no pictures so I didn’t understand it and it made my head hurt” vibes.

Yes, there are seldom pictures.

Yes, the researchers are upfront about each funding source. It is mandatory.

If the researcher came to the wrong conclusion they print a retraction. Like the retraction that the Lancet made for Andrew Wakefield about his flawed, doubly flawed, study of 12 cherry picked children that he said proved a vaccine link to autism. Bitch it did not.

Too late, that damage had already been done. We in healthcare deal with it every day.

Yes, competing viewpoints based in reality are welcome.

Oh, it’s the based in reality that you have a problem with?

I feel sorry for you.

School Me Saturday 4/26/25- Funding changes, what do we do now?

Yes, I know I have written about this before. I don’t care. It is too important. Every day research that has been in the works for I can’t even tell you, research that has already been paid for, is shriveling in the petri dishes.

Research is expensive. Proper, well structured research is expensive. You have to pay for the researcher, you have to pay for the research assistant, you have to pay any adjunct helpers who are conducting the research, you have to pay for the computer you use to write up the reports, you have to pay for the electricity that run a lot of this, you have to pay for the IRB, you have to pay for the data analysis, you have to pay for the lab time, sometimes you even have to pay to get it published (those are the predatory publishers, don’t give in to them), and if you are offering an incentive to garner participation, you have to pay each participant the incentive.

It gets expensive. Capital red letter expensive.

Oh, not only do you sometime have to pay to publish, you have to pay to present at conferences. With all of those attendant costs as well. At AORN there were several international hospitals and countries and research presented. Each of them had to pay for the conference fee, the flight, the hotel, and the food while they were in Boston. Or Orlando, or Chicago, wherever the conference is held.

Many of these are covered in grant indirect costs. These indirect costs are not well understood and is more than a line item in the grant. Not being understood, like at all, means that people overact when they see the line item.

The hammer has fallen. Nascent grants are not being approved. Existing grants are being yanked, even as the research is underway. That is what I meant when I wrote that research is shriveling in the petri dishes.

Why?

This is a very good question. Because the researchers are daring to research something that isn’t white or male. It is being stripped because of the specter of DEI.

Another not well understood concept that is being used as a bludgeoning tool.

DEI doesn’t mean what they think it means. Inigo Montoya snuck in the chat.

This, of course, has started panic at the research universities. Especially the ones who don’t have billions of dollars in endowments. But even if you have that kind of money doesn’t mean it is just sitting around in coffers, or under a dragon like Smaug.

It has been a long time since the students (hello, that’s me and my cohort), had any guidance in the matter. Probably because those doing the reaping are being mum on the matter.

No DEI is all they know how to chant. Again, it doesn’t mean what they think it means.

Yesterday we had a rare in person day on campus where the second and third years who were interested, were given a ground level “this has happened and this is how we envision going forward” talk.

We had a group discussion about how to find and secure funding. Ideas about other funding sources were floated. It was a good conversation. Remember, all of us are nascent nurse researchers.

I know I left feeling a little more hopeful about this crappy situation we find ourselves in. I hope others did too.

I offered my notes to the rest of the cohort that were not there and I hope to have the notes to them tomorrow. I just want to reflect on it some more.

I wore my “Baking is Science” tee shirt with a baking cat on it. On my husband’s recommendation that I leave the political shirts at home. I think a stronger worded tee would have been better. There is always the August in person day.

Cookie Thursday 4/24/25- applesauce egg replacement

When I first started planning this month’s theme of “That’s a good egg…substitute!”, I began, as I always do with searching for suggested egg substitutes. I hoped I would find at least 4 to round out the month.

To my shock, I found so much more than four.

There are egg substitutes for different applications, too. Some for baking, some for cooking, and some that switch hit.

I was certainly not spoiled for choice.

To recap

April 3, 2025- flax egg. 1 tbs flax to 3 tbs water per egg. These cookies did not behave like I was expecting them too. They were almost too crisp with no give in the mouth feel. These cookies tasted stale, even right out of the oven. 4/10
April 10, 2025- chia egg. 1 tbs chia seed to 3 tbs water per egg. I felt that this second egg substitute had a lot going for it and I was prepared to wowed. I was not wowed. But this was a fresher tasting cookie, even right out of the oven. 5/10
April 17, 2025- banana and psyllium husk eggs. No idea what led me to combining the different egg substitutes but I am so glad I did. Definitely the star of the month. Soft, pliable cookie, even 4 days later when I retrieved the leftovers. 10/10
April 24, 2025- applesauce egg. This one came highly recommended by some bakers I know. I was underwhelmed, especially after last week. The applesauce led to quick browning yet not quite done cookies. I understand the ease of these because most kitchens, especially those with children, have applesauce in them. But eh. 5/10.

Looking back at my prepared list of egg substitutes it appears that the month isn’t quite over yet. And so I will be continuing the theme for next month.

I mean, I shouldn’t be surprised at the breadth of choice for egg substitutes. You have the people with allergies and you have the vegans.

Everyone deserves a cookie sometimes.

Best Kept Secrets of the OR #27- Always be reading

The best kept secret of this Wednesday is that the book learning never ends with us.

Appropriate to World Book Day, no? Double that for William Shakespeare’s birthday.

Some of us go back to school.

Some of us read for pleasure.

Some of us read to keep current on new surgical advances or approaches for the surgeries we do.

Some of us read to keep current on current events.

Some of us read to justify the journal price.

Some of us read to keep up our certifications.

Some of us read ourselves to sleep.

Hi, it’s me. I’m one of the us.

I know, you’re so shocked.

But it is not only me. I, along with others, do read for all of those reasons.

And more.

One of my favorite tee shirts says it best “A day without reading is like… never mind, I have no idea.”

Keep reading.

Keep being intellectual curious.

Even if it is just the back of a box of cereal.

The books are counting on us.

After all, “All the world’s a stage, and all the men and women are merely players.”
As You Like It by William Shakespeare

Tuesday Top of Mind 4/22/25- Sure, nothing bad has ever happened from collecting data on what is deemed as “other”

Every damned day I hesitate to open the news. It is not unlike the meme where a serious faced Captain Picard, seated behind a desk, requests “Damage Report”.

Every damned day it is something different. I understand that this is the strategy of dragging us down with overwhelming bullshit every day. After all the numbing of the population (us), is the expected result.

I know, I know, I’ve written about this before. And this is nothing that you are not aware of. Just making sure that I write it down makes me feel a little more ready to deal with the BS. This also ensures that nothing falls through the cracks because people aren’t paying attention to this nonsense because something else is on fire over there.

To explain the headline, the Health and Human Services Department secretary (like Voldemort he will not be named) wants to start a database of the Americans with autism. To curate this list, he will be using public and private insurers data bases, plus the VA and Indian Affairs, pharmacies, genomics data (DNA anyone?), and maybe even the wearable sports devices (Fitbit/Apple Watch). All this data to find the underlying cause of autism. Um, sir, that is not how you create a study.

Add in the fact that he thinks the analysis is going to take less than 5 months.

This gives me the ick.

Not only are they using databases of our private information, but there is no consent. Not only are there no consent procedures, there are no CITI procedures. CITI is the protection of human subjects in research. This is problematic. How did they get this past IRB?

As a nascent real world researcher, I can identify many, many, many problems with their proposal. And I’ve only been at this for less than 3 years.

According to the CBS News report and the Guardian article, 10-20 NIH researchers (unnamed) will be able to piece together everyone’s health records.

There are so many problems with this approach.

It sees all people with autism as the same.
This is a massive database of all American’s private medical records.
As described this is too broad of a research question.
There will be possibilities of using the data in a bad way, not described in the original research question. It is like throwing out a big net and seeing what you catch.
There are no inclusion and exclusion criteria listed.
We all know that they want the answer to be. This is no way to do research.

Why every American should be concerned.

We’ve been here before. In 1942, Japanese Americans were put into internment camps.
It starts with flawed logic that there has to be an external trigger for autism.
They are looking to blame vaccination, which would put us all at risk.

I knew that the current secretary was going to be bad for America’s health. At least, as long as he is tilting at this windmill.

After all, proper research is not done by shaking a Magic 8 ball because you didn’t like the first fifty answers obtained using real research.

Post-it Sunday Medical fiction series 4/20/25- Call the Midwife- in the Shadows of the Workhouse by Jennifer Worth

I am not sure if you are aware of a wonderful BBC show about midwives in the late 1950s. It is called Call the Midwife and is about women and Anglican nuns and the midwives who attended them. Through the post WWII population boom in East London and the attendant struggles of women and midwives with overcrowding and money struggles that they had. It is in its 14th season and has been renewed for a 15th season.

The episodes also aired on PBS, on delay.

I loved this show when I was still watching television.

Melodramatic? Yes.

Melancholic? Yes, mothers and children die from what is now preventable diseases.

There isn’t a so called woman’s issue they won’t touch. Often with great delicacy, sometimes with a mallet to the head.

I am not alone in adoring this series.

But first it was a series of books. I have them in various forms.

The one I want to write about today is the third in the series about the workhouses that the indigent were sent to. Each were ruled by a man who didn’t take any pushback and certainly didn’t spare the child. If you know that I mean.

I chose this book out of my stack of medical fiction or non-fiction books at random and re-read it.

I had forgotten that the first part of the book is about three people who were brought up by the workhouses and their different troubles.

What struck me most at this re-reading was the chapter where one of the three is dying. He doesn’t want his sister to be told of how sick he is.

But the home nurse knows and goes on to expand on how in hospitals, where she trained, no one died alone. No one died in the dark.

I had to stop reading for a moment. Because that is how I feel.

When I was a med surg nurse, I would have patients who were expected to die. Of course I did. I would get such push back on keeping a dim light on, even the one over the sink. Those who pushed back on me about having the light on when the person dying in the bed wasn’t even conscious enough to be aware of it never understood my feeling that people should not die in the dark.

Jennifer Worth, the author gets it. She write that unconsciousness might not be a state of unknowing. How are we to know what they are experiencing? The light might be comforting to the dying. A reminder that they are not unnoticed and unwatched and unloved.

I recommend the series wholeheartedly.

I can recommend reading the books at least once. There are nuances that come across on the page that are sensationalized and or missed on the screen.

However, re-reading the books after 24 years in the trenches, I would rather watch the show.

School Me Saturday 4/19/26- Fight Fiercely Harvard!

Yeah, I know that Fight Fiercely Harvard isn’t Harvard’s real fight song. But I don’t think 10,000 Men of Harvard sets exactly the right tone.

It’s sexist for one thing and since Harvard is fighting for independence for all of its students, not just the men, I thought Fight Fiercely Harvard was a better fit.

Fight Fiercely Harvard is a satirical song written by an alum, Tom Lehrer. Another song of his that you may be familiar with is The Elements. It is a lilting song with the elements from the periodic table. It is only clocked at 1 minute 26 seconds.

This week Harvard said no, thank you to pressure from the president of the United States. He would not bend the knee and bow to extreme pressure.

Of course, the president whined and threatened (typical). He even went so far as to threaten Harvard’s tax exempt status. This is a “punishment” meant to be punitive for violating tax law. There is no evidence that Harvard has violated tax law.

Side question, if it can be done so quickly, why can’t we do the same to churches and political organizations? I digress.

Apparently there are now pacts between schools where there were rivalries both in the classroom and on the playing field.

According to the Guardian newspaper at least 18 universities have united to defend academic freedom in the fact of these attacks and threats. The universities include 8 universities that comprise part of the Big 10 academic alliance include the University of Illinois, Indiana University, University of Iowa, University of Maryland, University of Michigan, Michigan State University, University of Minnesota, University of Nebraska-Lincoln, Northwestern University, Ohio State University, University of Oregon, Pennsylvania State University, Purdue University, Rutgers University-New Brunswick, University of California Los Angeles, University of Southern California, University of Washington and the University of Wisconsin-Madison. Some of these schools are in red states and some are in blue. To me this is indicative that academic freedoms are cherished, no matter the political leaning.

It also indicates that academic freedoms are to be protected.

Good for them. I hope other universities join and I hope they keep their courage.

I hope that this message is heard loud and clear.

Now I have to learn all of their fight songs too.

But, but, Kate, what about their billion dollar endowments? Why do they need support?

Those endowments are the emergency fund and the funding for programs that allow the universities to continue to admit students from the lower-economic echelons. And to create scholarships to fund these students. And to create labs that make the discoveries that are why these universities have earned the world class reputation that they have.

Maybe, just maybe, they don’t like being told what to do, or who to listen to, or what to teach, or what to read.

It all goes back to book banning, doesn’t it?

Fight Fiercely Harvard! You are not alone.

FFS Friday 4/18/25- Four years

I know that people have been consoling themselves by chanting the number. It will be 4 years of the monster under the bed. Only 4 years.

4 years.

Well, less now that it has been 8 weeks.

8 weeks of nonsense and him smashing and cash grabbing all that he can get his grubby hands on. Like a child who has been let loose in a candy shop while the adults are distracted on their phone. Like the menace who doesn’t like the word no and ignores the adult when they finally notice the havoc that has been going on.

I, for one of many, am so tired of it.

How do you measure a year?

If five hundred twenty five thousand six hundred minutes make up a year this can lead to math.

You could multiply each minute by 60 to determine the number of seconds in a year (thirty one million, five hundred thirty six thousand seconds).

You could multiple 525,600 by four to determine the number of minutes we have left in this abomination of a presidential term (two million, one hundred two thousand, and four hundred minutes).

I could talk disheartening numbers all day long.

It all starts with the supposed fact that they will not gerrymander rig elections to keep themselves in power. Why would they hand the reins back at the end of 4 years? Just because that it is what expected of us?

Spoiler alert, it is already happening. I point out and have written about the Republican Jefferson Griffin and his grinding, unceasing, probably very expensive (where is the money coming from) tilting at windmills attempt to pry Alison Griggs out of the spot she rightfully won. In November. People aren’t paying enough attention to his scammy scammerton efforts to throw out the ballots that he doesn’t agree with that cause him to lose.

I have written at how this is a test case of how elections can be stolen with money. And sleight of hand. And bluster.

This definitely sounds familiar doesn’t it?

Back to the four years thing. If so much can be dismantled in 2 months, including destruction of any words that the administration doesn’t like, imagine how much the next three years and 10 months are going to cost us.

They can only hurt me for 4 years sounds comforting. Until you realize you are speaking like an abused wife. Cowering in the corner while the abuser takes off their belt.

Next thing will be the “gifts” and the promises never to do it again. Also included are the promises to be around after the 4 years, no matter how that is accomplished.

But it will happen again and the four years thing is not a guarantee.

It is a scary time to be an American who is paying attention.

Cookie Thursday 4/17/25-Psyllium husk and banana

I’ve got a wild hair this week. By that I mean I will be doing 2 different fake eggs in the batch this week.

I will be using a psyllium husk egg and a banana.

The reason I am using both is that I am afeared that the banana taste will be too strong.

I figured, hey, best of both worlds here.

It is now truly Thursday and I have baked and delivered the cookies.

And I have only one word- Wow!

No wonder that psyllium husk is used to create gluten like structure in gluten free goods.

Even 6 hours after I finished baking them, the cookies were soft and pliable. It even changed the structure of the chocolate chips and they too were soft. As if they had just come out of the oven.

I have rarely been so impressed by a recipe substitution.

Was it the banana?

Or was it the psyllium husk?

I think I know which one.

And now I want to make these again and add jalapenos. That is how cooking, er, baking science is made, right?

Throw a bunch of ideas in a bowl and see what sticks.

I think my instincts of combining the two types of egg substitute was the correct one.

Because wowza.

Just don’t eat the entire batch by yourself. Because psyllium husk is also known as metamucil.

Of course I warned my coworkers. After I explained the science to them.

Lessons were realized, the chief among these to crush the banana before adding it to the butter and sugar. It took forever to get all the lumps out.