Apologies to any Dorothys.

I was sitting and talking with the ladies of the Monday morning grad school writing group when my back flared up again.

Odd, I thought. This was supposed to be over. With all the moving and the stress of the AC going out at the end of July, I pulled a muscle in my upper back. Ouchie. That was 36 hours of misery, no position was comfortable, neither lying nor sitting nor reclining. Every time I relaxed enough to sleep, my back would spasm.

I’ve been in nursing for a long time. I started as a CNA in 1998, became an RN in 2001 on the med surg floor, and moved to the operating room. The work and stressors are the same. Moving, and pulling, and pushing, and lifting heavy, and getting heavier by the minute, patients. Not to mention the stress of the last 5 years. Going back to grad school for my PhD AND the covid pandemic. But I’ve been managing to duck back pain this entire time. Apparently losing AC for 3 days and moving and removing furniture and equipment was enough.

It’s been 2 weeks. On a routine medication for inflammatory and a muscle relaxant that I only take on the weekends because of call.

Back to today. I was in the office, at the desk, when my back started twinging.
And then I remembered the first adage of operating room nursing, if your back hurts it’s the shoes.

What is equivalent to shoes in my new life as a night call nurse who is also a PhD student and spends a lot of time on research assistant Mondays in the car (14 hours with commute and work hours)?

My office chair.

We bought this office chair in 2020 and I’ve sat in it every day since.

I get up and move around but over time? Yeah, my ass has been in this chair many, many, many hours.

Light bulb moment.

I couldn’t get to Staples soon enough to buy a chair. And, with my current back situation, pay to have them assemble it.

If your back hurts, consider the simple things that may be contributing to it.

If you are an OR nurse or tech, make sure to purchase new shoes yearly. Or at least have 2 pairs and rotate them.

Your back will thank you.

There is a well-worn path that some politicians like to take.

They like to claim that Democrats want there to be abortion all the way to birth AND AFTER.

Yeah, these yokels want to hypnotize people, who may not be as educated as everyone else, into believing that some doctors and nurses are out there killing the newly born.

That is murder.

Completely different than what really goes on in late-term abortions.

To understand, we first have to define.

A pregnancy is divided into portions of three months. These are trimesters. First trimester (conception to 12 weeks), second trimester (13-27 weeks), third trimester (28-birth).

Conception is when the ova (woman’s egg) is fertilized by a spermatoza (sperm).

This is also when the cells start dividing and dividing and dividing.

At any part during the cell division or even the translation of the genes of the two parts that make up conception, there can be errors.

These errors result in birth defects.

Late-term abortion has been erroneously compared to being in the third trimester.

But let’s run some numbers. According to the CDC data, 91% of abortions take place in the first trimester. That is up to 12 weeks. Second-trimester abortions account for 7.7 percent. This can be for a variety of reasons.

It goes without saying these reasons are between a woman and her doctor.

It really isn’t anybody’s business.

Late-term is what medical people refer to as near birth. Later term abortion as defined by medical people account for 1.2% of abortions.

And it is always performed for a horrific reason.

Most often because the fetus has incompatible with life abnormalities.

A later term abortion is done with care and compassion for the fetus and the mother.

It is often done to prevent suffering of the fetus or mother and to preserve fertility of the mother.

This kind of care, and I’ve been in those surgeries, is always done with gravity and compassion to both parties.

And compassion for the surgeon and the surgical team as well.

And there is a debrief for the medical people after. If they want or need it.

A later term abortion is often an act of compassion for the fetus and the mother.

It is NOT murder.

It is not making the mother carry a doomed fetus to their death or to term.

That is the brutality and cruelty of the anti-abortion side. Those who doom these children that were not meant to live in the world and their makers to never-ending sadness and despair that they are not doing the best for the very often much wanted child.

Words matter.

I would rather be compassionate than brutal or cruel.

One of the most frequently requested cookie of Cookie Thursday is a Thing is the fudgy cocoa no bake cookies.

Hence, it is one of the most frequently made cookie.

And yes, I still need to look up the recipe every time.

But what if they were not chocolate?

What would that do?

Several years ago I made a speculous butter no bake cookie.

For those not in the know, speculoos butter is a magical elixer that is cinnamon and crunchy and amazing. As I understand it is made by blitzing speculous cookies into peanut butter.

No, I’ve not made it. Either the speculoos cookie or speculoos butter. The speculoos cookie is a Belgium cookie. And served as a snack item on some flights. Also known as the Biscoff cookie.

Speculoos is a word that is just more fun to say but not type.

What makes today’s make unique is that it is a double experiment. When I attempted these cookies back then, the resulting cookie was nauseatingly sweet. I thought the answer would be in the balance of regular peanut butter to speculoos butter. So I throttled back the amount of speculoos butter to 1/3 speculoos to 2/3 smooth peanut butter. And commenced with the recipe.

The two experimental portions of this cookie are the 1) no chocolate and 2) addition of speculoos in the peanut butter.

These are not bad cookies. Very buttery tasting, very unique. However, not the flavor profile that I was going for because the speculoos is barely noticeable.

Next time I will do a 1/2 peanut butter to 1/2 speculoos and see if that lets the speculoos flavor shine through.

But today’s make is not a cookie I would kick out of the kitchen.

I made them yesterday because today Hurricane Debby’s remnants would come calling on Thursday and these cookies do NOT dry well in anything above 85% humidity. I also stealthily delivered them yesterday. I wonder how long it took for people to realize the cookies were there.

You see I know that people test the drawer before delivery because it is opened slightly when I go in to deliver the cookies on Thursday afternoon.

Tomorrow the remnants of Hurricane Debby will pass through the Carolinas. It has already started in some places. Much rain, much flooding. We are expected to get up to 7 inches of rain.

On top of the good soaking, we got over the past two weeks.

I mean we were in a drought in July, But we got a couple of hundred percentage of normal rain fall in the last 30 days. This is roughly 4 inches of rain. Or more.

Meteorology is not exactly an exact science.

The microclimates around here are fascinating. Because some parts of the county are considered dry.

Go figure.

But back to the best kept secrets of the OR.

PATIENTS ALWAYS SHOW UP FOR THEIR SURGERY DATE!

No matter the weather conditions.

Rain.

Hail.

Snow.

Hurricane.

Flood.

They always show up.

Which means you are expected to show up too.

Sometimes hospitals will send a car. But don’t get used to that.

There are no snow days in the OR.

Or hurricane days.

But be safe out there.

We need some basic definitions.

Ob-Gyn- obstetrics and gynecology. This is the branch of medicine that deals with female-type things. This may be pregnancy and babies, this may be cancer care, this may be menopause care. Basically from puberty until death, ob-gyn has it covered. This is where the babies are born. True, there are some very stressful parts because body parts develop cancer. But, on the whole, everyone loves babies, even if there is an issue with a birth that impacts the child, they are on the hot seat for lawsuits for 18 years. And sometimes more than that.

Desert- The Merriam-Webster definition is arid land usually with sparse vegetation; especially land that is very warm climate, which receives less than 25 centimeters of rainfall per year. I’ll do the math, 25 cm is roughly 10 inches. Of precipitation. In a year.

However, the Oxford Languages dictionary defines abandon (a person, cause, or organization) in a way considered disloyal or treacherous. “we feel our public representatives have deserted us”. Huh, hold that thought.

What is an Ob-Gyn desert? This is where the ob-gyns have voluntarily left. Yes, all of them. They have gone for a variety of reasons, the biggest one being laws that do not let them practice to the best of their abilities, at the top of their license.

You know the ones I mean.

It’s like these doctors don’t want to torture the unborn or their parents.

Strange, I know.

But let’s return to the Oxford Languages definition. Perhaps the growing ob-gyn desert is because they have been betrayed by the political parties (mostly on the right) at every level of government.

I mean, they can take a hint.

And so they are leaving the states that want to prosecute them for providing needed care to patients at very vulnerable times in their lives.

It’s not like are slaves and can be FORCED to stay.

They are simply exerting their freedom not to be in a place where they can’t give care to patients who desperately need it. This is a big country, after all.

Maybe don’t make the ob-gyns torture the unborn and the females they have put in 4 years of undergraduate college, 4 years of medical school, 4 years of residency, and passing their board specialty exam.

Because they have options of where to live and where to practice.

You probably should’ve thought of that.

The post-it reads “Prior authorization has negative impact for patients.”

Yeah, I got this from one of the OR newsletters I read.

And also, no shit, Sherlock!

Prior authorization is when you have to go before the insurance board, the insurance that you pay for, and ask for a test, physical therapy, imaging studies, surgery for your appendix, and what have you, you have to seek permission. You have to seek permission for the care that you need.

It’s like we are all back in grade school, asking the mean old nun for a pass to go to the bathroom. The kicker is that, just like then, what you seek, and what you really, really need, can be denied at their whim.

This is from an article about a physician survey that illustrates how negative the impact can be of prior authorization.

The biggest no-duh is that necessary care is delayed, as relayed by 940/1000 survey respondents.

19% cited serious adverse events suffered by patients because of denial of prior authorization.

Serious adverse events leading to life-threatening events and needed intervention to prevent permanent impairment happened 13% of the time, according to these doctors.

Even more serious adverse events, including disability, permanent harm, birth defects, and DEATH happened 7% of the time due to denial of prior authorization.

Yeah, I like it when my insurance company is not actively seeking to kill me.

Often with no explanation; just to save a buck.

This has to do with the allocation of resources, I get it. I understand that not everyone can be saved.

But, the article goes on to say that it is not other peer-to-peer medical type people making these seemingly off-the-cuff decisions.

Seeking prior authorization, often more than once, and not being able to have a doctor to doctor conversation where they speak the same language? How much does that cost the medical practice?

Sounds like being penny wise and pound foolish.

Has prior authorization outgrown its banks?

Absolutely!

I’m open to suggestions about how to fix the dumpster fire.

Or do we continue to let it burn? And continue to hurt, disable, and kill patients?

Where is that lawsuit?

Oops, I said the L word.

Well, it’s been a minute since I did a personal PhD update. I’ve been having so much fun with the Alice in Wonderland theme.

Since we go back at the end of August for the fall semester, I felt this would be a good time for a personal PhD program update. Of interest only to me and my family but I don’t care.

I have spent 2 years working as a research assistant. I’ve learned so much about conducting research, synthesizing the research that I found for the professor, finding different articles for the professor, writing reports, creating and editing tables in Word, proofreading, and creating surveys Qualtrics. I’ve even done data cleaning for statistical analysis.

I have been hemming and hawing and turning over in my mind NOT continuing for RA in my last year. Yes, there would be an extra sticker on my diploma for being an RA all three years but the commute was draining me. You might remember, that Mondays are RA days during the semester. This is 15 weeks of being on call Sunday night (hoping beyond hope there is no case), getting up at 0500, leaving at 0600, getting to the university at 0730, starting work at 0800, doing tasks until 1800, and then driving home, to be on call at 2100. Very long day. So long I often took Tuesday off in recuperation. Rinse and repeat the next week.

Well, I have scholarship money that needs to be used. After many conversations with my husband, with my mom (my mentor), my friends (who have been so supportive in this whole endeavor), and with myself, I decided not to work as an RA this last year. Because it is nearly time for the Big Write. I emailed the professor and the department RA handler of my decision last week.

I am at peace with that decision.

In preparation for the Big Write, and to get my head back in the class space, I took a summer session class about professional writing. This was an English class. I struck me as I was taking the class that it is the first English class of any sort that I have taken in my 4 other programs. This is because I have always tested out of any English requirement and I took AP English my senior year in high school. Considering I was the only health studies/nursing student, I really enjoyed the class and I would suggest it to anyone who needs encouragement and writing practice. It was all about creating a writing schedule and STICKING to it. I will definitely be taking what I learned forward into fall.

I hope to finalize plans to take my preliminary exam this month, again in preparation for the Big Write.

And then the fall semester starts in earnest on August 23.

New month, new theme.

It has been hot, hot, hot here in North Carolina.

About six years ago I declared that August was going to be no-heat month. The reason for this theme was a coworker whose oven died and she had cookie dough that she needed to bake. With my eye ever on the experimentation of my coworkers idea, I suggested baking on the grill. After all, the gas grills these days have a temperature gauge.

Then I thought to myself Cookie Thursday is a Thing needs a no-heat month.

Voila.

No-heat month was born.

Or created.

Or thought into being.

Whatever.

No baked-in-the-ovens cookies will be had this month.

This week my attention was grabbed by a pan de eclair recipe. An eclair cake. But fake.

This recipe has no choux pastry or baking. Which one of my coworkers pointed out when I took the make to the hospital. I know! The making of eclair shells requires baking. Which requires the oven.

No heat! (written in my best Edna Mode)

This recipe is made with already baked, out of the package I had in the pantry of plenty from the grocery store graham crackers

I did make homemade pudding though. Because I didn’t want to go to the store.

Did you know that homemade pudding is dead simple?

Huh, the things I learn from CTIAT. I certainly won’t be buying pudding mixes from the store anymore!

Except for pistachio. But I bet there is a DIY recipe for that too.

Why, yes, I’ve certainly had enough caffeine for the day! Why do you ask?