24- A Cultured Kind of Surgery

The post-it reads “Hey doc, are you expecting a different result from a mm away?”

A culture is a lab test that tests for infection in a location where the culture is taken from.

This location can be anywhere in the body. I’ve done cultures on abscesses from the top of a patient’s head all the way down to their toes. Different patients, mind you.

The reason behind doing a culture is twofold. It lets the lab and the surgeon identify the particular pathogen that is causing the infection. It also allows the surgeon to order the correct antibiotics targeting the pathogen. A third possibility is that there is no infection that is causing the symptoms. However, even that is an answer. A negative result and lack of a pathogen is still an answer.

However, this post is about a surgeon who is culture happy. They culture everything. And I mean, everything. Oftentimes there are multiple cultures, within the same geographical area on the body.

My question to that surgeon is why run these expensive tests when the area that is cultured is essentially the same place. I do understand pre and post-lavage cultures. This is when the body part is cultured before irrigation and after to see if there are any lingering bits after being sprayed with the equivalent of a garden hose.

What I don’t understand is the multiple cultures after the incision and before the irrigation. Please help me understand why this is routine for the culture happy surgeon.

Is the pathogen just under incision different than the pathogen 1 mm in? I guess it could be. Especially when there is a verifiable pocket of pus that looks different. And I understand culturing separate body parts, such as the heel of the foot and the knee. But how often does that happen?

And at what a cost to the patient?

School Me Saturday 11/30/24- Push on through (to the other side)

The song starts with a short cymbal warm-up.

Then the guitar starts laying down a beat.

Then the vocals.

“You know the day destroys the night,

night divides the day.

Tried to run, tried to hide.

Break on through to the other side.”

I am, of course, writing about Jim Morrison and the Doors and one of their best-known songs. It was the opening track on their debut album.

It is nearing the end of the semester. Perhaps you listen to music while you are studying. Or not. Perhaps you listen to music to wind down. Or not. But think about this song with me.

“Made the scene,

week to week,

day to day,

hour to hour.

The gate is straight, deep and wide

Break on through to the other side.”

I can take you all back with me to Peg Garner’s Advanced Placement English class in my junior year of high school, where I learned about poetry. In 1992. And how to analyze poetry. Because music is poetry. Or maybe they are complementary arts. I will let the philosophers decide.

However, music can teach us about ourselves. How to study, the cadence of songs helps here. It also helps if you are so familiar with the song that it ceases to be new and amazing and just becomes like elevator music. But you notice when it is gone.

Then a song like Break on Through (to the Other Side) speaks to you about endings. Because the semester is ending. It is nearly time to put up the books, and to put away the paper and pens and pencils. It is too early to worry about next semester; it is too late to worry about this semester. All you have to do is break on through. Finish the final papers, take the final tests. Do what you have to do to get through. Whatever it is.

Reflection is helpful here at the ending of one thing and not yet beginning of another thing.

Reflect on the semester and what went well and what didn’t. You can promise yourself to do better next semester.

Because there will be a next semester until you are finished with the degree program. And maybe even after that.

You might not be able to quit school.

But that is a problem for future you, isn’t it?

Happy Thanksgiving- no cookies today, only ambrosia

Happy Thanksgiving.

Today I made ambrosia for the holiday feast.

Not cookies.

Ambrosia is a canned fruit salad, although it can be made with fresh.

There is a can of fruit cocktail, a can of pineapple tidbits, a can of Mandarin oranges, 1 bag of mini marshmallows, 1 c of sweetened coconut, and 1 c of walnuts, coarsely chopped. Mixed together in a big bowl with 2/3 c sour cream.

I also add an additional jar of stemless maraschino cherries because I know my audience and the two that you get in a can of fruit cocktail is NOT ENOUGH.

It is better the next day.

I made this early enough in the day that the fruit juices had enough time to work their magic in softening the mini marshmallows.

This makes a giant container or bowl of ambrosia.

I divided it and will bring along the bigger portion to Thanksgiving dinner.

Best Kept Secrets of the OR#16- we all deserve a break some times

A day in the OR can go one of three ways.

Number 1- add-ons galore. This is when there are more surgeries than time on the schedule and cases sometimes get tacked on at the end of a surgeon’s day. These add-ons can be emergent cases from the ER or the floor. Or Endo. If this was the fairy tale The Three Bears, this would be Papa Bear’s bed.

Number 2 – comme ci, comme ça. This is French. It means neither good or bad. Really it means so-so. This is when the OR schedule runs as designed. Neither early, nor late. Neither too many or too few cases. If this was the fairy tale, this would be Mama Bear’s bed.

Number 3- cancellations aplenty. This isn’t desirable all of the time. But occasionally having the schedule suddenly lighten is not a bad thing. This often leads to people being able to go home early. And who doesn’t like that? In this fairy tale, this would be Baby Bear’s bed.

No wonder Goldilocks took a nap.

Of course, the vast majority of the days go between 1 and 2.

Sometimes it seems as if there is an emergency case pipeline. You hit the floor running as soon as you walk into the OR and it never stops. Sometimes you miss lunch or a break.

The vast majority of the days are Number 2. This is just a regular shmegular day.

But those Baby Bear days can hit just right. And you get that nap after working a few hours.

Good thing you can backfill those hours with your PTO bank.

Tuesday top of mind 11/26/24-it will be okay for THOSE voters

Have you been told that 2025 will actually be okay?

And did that raise your blood pressure?

Like, a lot. You actually saw red.

How can we make people understand that it will be okay FOR THEM?

But, and it is a big but, it will not be okay for millions of Americans.

Women will continue to have our rights degraded.

The LGBTQ+ will be forced back into the closet.

Children will continue to be preyed upon by those they should be able to trust. You know, teachers, preachers, and politicians.

DEI (diversity, equity, and inclusion) initiatives will continue to be deleted. Just today, Walmart announced that it will be dissolving the DEI policies. And it will be stepping back from the strides it made after 2020 and the killing of George Floyd. Even though it promised to have a race equity philanthropic initiative through 2025, it will not renew the initiative that examined the root causes of the gaps that African Americans experience in education, and housing, and banking and criminal justice forums. Sweeping it under the rug, nothing to see here, folks. It will also not use gender and race as a guide to improve diversity in the contracting processes. This means that they won’t have to consider a woman or an African American-owned company. And it will stop participating in the LGBTQ+ annual benchmarking through the Human Rights Campaign.

But they hurried to reassure that they want to have a place for everyone and foster belonging.

Excuse me while I choke on the hypocrisy. Because they never will.

My personal pocketbook protesting remains in place for Walmart and its ilk. They will continue to receive no money from us.

Nothing will change for Walmart, or Lowes, or any of the other companies that have been retracting their DEI statements. But a lot will change for the everyday Americans that shop there because of the prices they can charge because of their shitty policies.

That is the entire point of this post.

Heck, there will be minimal changes in this household. For the husband. Because he is a white, married man.

But for me? I am angry at the prospect of all the rights that people have fought and bled and died for since the Civil Rights movement started disappearing.

You know that somewhere in hell the architects of this abomination are smiling.

Post-it Sunday 11/24/24- Bbbbiiiiiggggg stretch/cough

The gown card reads, “Sometimes anesthesia reminds me of doting pet parents every time a cat stretches its entire length out, but instead of saying big stretch, the commentary is big cough.”

If you have a cat, or some dogs, you’ve given this commentary.

The cat stretches out their back legs or their front legs in an elongating stretch that makes you comment, every time, “big stretch”. The human extends the i sound to mimic the satisfying stretch the cat has just done. This comment is definitely a reflex on the human’s part.

When a patient is breathing on their own after anesthesia and is extubated by the anesthesia provider there is often a reflective cough after the tube is removed. Without fail, anesthesia will comment “big cough”. Extending the same i sound to encourage the patient to cough again.

I have a cat. I know how this goes.

The cat stretches for a variety of reasons. To say hi, to loosen up their muscles after a nap, and even to invite their owners to play. These are all positive affirmations by the cat that the human is a good human. A good stretch is also an indication that the cat is content and feels safe in the human’s company.

A good cough after extubation and the accompanying praise can also be a good indication that the patient is safe with the OR staff.

After all, a good couch stirs up the juices (for lack of a better, less icky word) that have been stagnating in the lungs during the duration of anesthesia and surgery. This improves lung exchange and can have a positive effect on the pulse oximeter reading.

The intonation and the elongated i in big is the same.

Both instances are hilarious.

School Me Saturday 11/23/24-punctuation poisoning

With the increased use of AI and the increased reliance of newsrooms to get a story out faster so that eyeballs can look at the story, there has been an increase in stray punctuation marks. Mostly quotations.

For example, I just pulled up a news clearance site. This particular site is the MSN home screen which is the first thing I see when I open the internet. There is a news crawl of stories that are supposedly curated to my interest. I like to bake and my computer has probably figured that out. Or, at least, the algorithm has.

The very first article that was in the news crawl was an article on pecan pie. The gotcha headline was “Pecan Pie Brownies” Are the Cozy Boxed Mix Hack I Make Every Thanksgiving.

There is so much wrong with this headline. Why is the phrase pecan pie brownies quoted? Why does the news crawl assume that I am looking for a baking hack? But mostly, why is the phrase pecan pie brownies in quotations.

It is kind of like seeing a red balloon after reading about a red balloon. And you see it EVERYWHERE. This can be attributed to the Baader-Meinhof phenomenon. This is a cognitive bias, also known as the illusion bias.

Me, I just call it lazy editing.

Another headline on the news crawl “Messy Thanksgiving travel” because of the Thanksgiving Week forecast. Why they felt the need for quotations there I don’t know. To draw the eye? To make the headline stand out?

Just watch out for how many badly placed punctuation marks there are, especially the quotation marks. They are misused everywhere. And take care not to fall into this trap yourself. If school has taught me anything, it is that a proper citation is worth learning. A citation in a headline without attribution is just lazy.

Because it is apparently a hard habit to break.

So sorry if you start seeing horribly written headlines everywhere. But if we don’t demand better editing in our headlines we descend into chaos. And we don’t need the additional stress in this environment.

Also, I would never use a boxed mix. Especially not a brownie mix.

FFS 11/22/24-I’m thinking of a certain word that starts with “C”

Fridays will be the new political day here at Dispatches from the Evening Shift. I may not make or keep friends. The direction will be from a feminist lens. Most of the time I will write about topics that are health care related.

But not today.

I have been thinking about the general election that was 19 days ago and the surprising/not surprising results.

A singular word keeps flashing in my mind.

It begins with a C but it is not the word you are thinking of.

The word is coward. Too many of the voters were cowards. They were too wrapped up in their misogyny and their disordered thinking to even conceive of voting for a woman. Much less a blank woman.

Too often they were caught up in the pretend world where a nearly 60-year-old woman is held hostage by her hormones.

Too often they were caught up in the pretend world of strong men world leaders who would make the poor little old woman cry. Insert eye roll here. As if Harris didn’t make the mortgage lenders and others that she prosecuted cry herself.

That or they were bamboozled by propaganda from foreign agents.

Oh, look an F word.

The F words of the day are feminist, friend, and foreign.

The S word of the day is sigh.

I require a tee shirt with the word coward on it.

Hell yes, I am still mad as hell.

Just wait until I write about what I consider a good holiday gift for those who voted with their wallets and their misogyny and their online “friends”.

No, it is not just that I am mad, it is that I am disappointed in us.

I have decided my tee shirt should read “Cowards! All of you.”

Cookie Thursday 11/21/24- sweet potato cookies

Yeah, this is the same recipe that I used two weeks ago for the pumpkin cookies.

Cookie Thursday is a Thing is nothing but exploratory. That means I experiment on my coworkers. They get cookies, I get to experiment in the kitchen. It’s all good fun.

I’m not a huge fan of pumpkin, I like the milder sweet potato.

The pumpkin cookies that I made two weeks ago were very popular. And since this month’s theme is Fall (so original, I know) I wanted to make two of the popular Fall “vegetables” into cookies.

The pumpkin ones went great, although the recipe was a snickerdoodle in disguise.

I just used the same technique on sweet potato, without the fiddly sugar dip in cinnamon sugar step. I was going to use ginger and sugar but I had a meeting that was starting in 15 minutes and the sugar dipping took so long and was so messy last time I just skipped that step. I think ginger sugar dipping would be delightful and I will stow that idea away for use in an upcoming Cookie Thursday is a Thing.

Without the sugar dip these cookies still turned out. They were soft and cakey (in a good way) and delicious.

This is one experiment that I wil have no problem replicating. Unless I change another variable.

Experiments for life.

Edit to add that I added the chocolate chips that I felt were lacking in the pumpkin cookies to half of the batch. Yep, the pumpkin cookies definitely needed chocolate chips.

Best Kept Secrets of the OR #15- What you ignore or suggest is treated as normal

This isn’t a positive best-kept secret. In fact, it makes me mad and is probably making some of your charge nurses mad too. But not the one who is trying to be your friend and suggested that you call in sick, in front of another charge nurse, because you couldn’t get that day off.

However, this is directed at the other charge nurses who permit this behavior.

Apparently, in today’s working operating room, all you have to do to get the day off that was denied is call in sick. No thought was given to the rest of the OR team that now has to work short. No thought is given to the patients who are going to be worked on that day when the rest of the OR is working short. No thought was given to the person who makes the schedule that you just took a giant dump on.

This is because you didn’t get your way and you are making it everyone else’s problem.

Number one- there are rules for a reason. Only one person per staffing level (scrub tech, registered nurse, orderly) can be off at the same time, on the same day. Writing as a previous staff scheduler whose OR was run a lot leaner than the one you enjoy, there are reasons for that rule. You are damning someone else to work extra. The rules are different in each unit. In this unit, one person per staffing level is allowed off for a specific day.

Number two- this is for the charge nurse who suggested that a team member call in sick to accommodate their desire to have a certain day off. To that charge nurse I say don’t do this. Don’t make the rest of your team work extra so that you can be buddy-buddy with another team member. It reflects badly on you.

Number three- what you permit becomes the new standard. And will most likely come around to bite you in the ass.

Just no.

Don’t do this.

You are UNDERMINING your authority.

Consider that.

Or you might want to be friends with all of your subordinates and wonder why they don’t respect you.

You choose.