This is Banned Book Week and the entire situation is very top of mind.

I am a reader.

Always have been.

Most days I definitely would rather read for pleasure than do, well, anything.

Book banning goes in and out of style.

It is intrinsically linked to the authoritarian rule that some people want us to be under.

Right now there is a LOT of book banning going around.

So much so that some libraries are declaring themselves to be Book Sanctuaries.

This started in Chicago.

Kids are going to find the books that are banned for the simple reason that these books have been forbidden.

The Fifty Shades of Grey series was devoured by many mothers when it came out. These same mothers want to ban their precious Timmy from maybe seeing something that they are not mature enough for and asking questions.

Instead of getting in front of it, reading the books the kids are reading themselves, having book discussions about content, they would rather whole sale ban whatever makes them uncomfortable.

But those Fifty Shades of Grey books go down real nice, don’t they, Karen?

You don’t want little Timmy to feel uncomfortable reading about slavery and how white people permitted it and done horrible things to those they deemed lesser than themselves?

Truth hurts.

Oscar Wilds wrote in the Picture of Dorian Gray that “the books that the world calls immoral are the books that show the world its own shame.”

There isn’t shame in books. There is shame in how people perceive them and cry out that the “children” must be saved.

This is censorship and a violation of the 1st Amendment.

You don’t want your child to read X book, don’t buy it for them, don’t let them download it. Follow them around the library and the bookshop and ensure that they only pick out books that are your approved list?

Don’t be surprised when they find a way to read it anyway. Because you told them not to read it and make such a big stink about it.

Funny that.

The only “points” this is getting you is the echo chamber approval of people who think like you.

Thank goodness not everyone in the world does.

There are terribly written books out there. I count the Help by Kathryn Stockett and the Fifty Shades of Grey series mostly because I think they are terrible books. Frankly, there is better erotica out there that you can probably find for free. That doesn’t mean that I don’t think you should read them. If you want to read terrible books, be my guest. But don’t tell me or my hypothetical children that they can’t read to Kill a Mockingbird, or about genders in Gender Queer because there might be questions that you don’t want to answer.

That is a YOU problem; don’t make it a societal problem.

The post-it states “Skin is a map of your history.”

*

Last week I accidentally started another series when I started to write about how skin is a map of your history. A memoir of you.

I wrote about abdominal incisions/scars and I decided to end the post there. Because the body is a LOT of territory to cover, and it is best broken down in zones.

The zone of the week is incisions of the thoracic, aka the chest.

Four things can be gotten to through an incision on the chest. The lungs, the heart, and the mediastinum, and the esophagus. Although it is more accurate to say that the esophagus is just passing through.

Ha!

I’m here five posts a week.

And I nearly forgot about the diaphragm, the floor of the thoracic cavity.

There is the median sternotomy incision. This is how they “crack” your chest for major heart surgery. It goes from the suprasternal notch (between your collarbones) to below the xiphoid (the end of the sternum). This incision takes two months to heal at a minimum and is very painful as well.

They crack your sternum to work on your beating heart.

To access the lungs or the pleural cavity there are the thoracotomy incisions. These are named for the approach. There is the posterior-lateral incision, the axillary incision, and the anterolateral incision.

The posterior-lateral incision actually starts on your back, under the scapula and around to the side. This is the gold standard incision for lungs. This incision is used to resect part of the lungs, surgery on the esophagus, and can be used to resect part of the chest wall.

The anterolateral incision is from the sternal border (the big bone running down the chest) to the mid-axillary line. This is used for some lung surgeries, some heart surgeries, such as valve replacement, and some esophageal surgeries.

The axillary incision is a straight incision underneath your armpit. This is a muscle-sparing incision used for some pneumothorax surgeries including pneumonectomy. This means that the muscles of the chest are not transected and the patient doesn’t have to heal them. But there are limitations to what can be reached with this approach.

There are other incisions and scars that can be found on the chest.

The pacemaker incision is for the insertion of a pacemaker to control the heartbeats. This is usually under the clavicle on the left side. Also of note is the pacemaker itself under the skin. Usually about 4 cm x 5 cm with a rounded upper edge.

Sometimes an implantable intravenous port is necessary. Often called a port or portacath, this is used for administration of chemotherapy medications. Sometimes it is used when long-term parenteral nutrition needs to be given because you are not able to eat for a variety of reasons.

There can also be an orthopedic incision on your chest. Specifically on the clavicle. This is an incision over the clavicle bone for open reduction, internal fixation of the clavicle for fracture.

Next week on this accidental series, I will be discussing head and neck incisions.

Classes come with assignments. Classes come with due dates. Classes come with all the readings your little brain can hold.

But mostly, classes come with due dates. There are 2 big due dates that happen in every class, spring or fall, the season break. I won’t talk about the big end-of-semester due date, which is the end of the semester. That will come later.

The seasonal break, fall or spring is 2 days to a week off, usually in October or March which gives students a bit of a mental break.

Some students go home.

Some students get cracking on their assignments, like studying for midterms.

Some students just exist without the immediate pressure of this week’s due date.

Some students sleep the entire time.

All of that is valid.

Breaks are good.

Because sometimes you just need a break.

Take one.

Your brain will thank you.

Short post today.

I’m going to take a break.

This Thursday rounds out the sourdough waste theme for the month.

Did you know you can make pie crust out of sourdough?

The things I learn researching cookies!

The recipe I have is butter-based, not crisco-based. Which, as I learned watching Good Eats, is not necessarily the most stable crust there is.

The original recipe had me grating very cold butter into the flour, adding sugar and salt, and then mixing it all together until it was pea-sized. This is the same way I am used to making pie crust.

I know a better way of mixing the butter and the flour together that takes much less time. I pulled out my food processor and cut the butter into small pats and used the processor to mix it until it was pea-sized. After that, I added the 1/2 c of sourdough starter (cold) and 1 tsp of vinegar. And processed some more. After a minute I removed the bowl from the processor and dumped the contents into a bowl. As instructed by the recipe, I gathered all the dough fragments into a ball and then a disc, covered in cling wrap, and refrigerated for 2 hours.

Whole thing took me 4 minutes and most of that was cutting up the butter and forming it into a disc.

After the dough had rested in the fridge for 2 hours, I let it come to slightly below room temperature and rolled it out and transferred to a baking sheet. Using a pizza cutter, I lightly cut the dough into squares. I topped the squares with melted butter and cinnamon sugar. Into the 375 degrees Fahrenheit oven it went until browned, and the sugar had caramelized.

After pulling it out I thought that some of the squares were too big so I used a metal spatula to cut them into smaller pieces.

Next was the best part- the taste test.

To my surprise, of all the sourdough weeks of September, these had the strongest sourdough taste.

10/10, will absolutely do again.

Maybe next time I will experiment with crisco instead of butter. Or do like Alton Brown said on Good Eats, use both!

I am stupidly excited for the Spooky month of October. I can’t wait to write about what I have planned. (insert evil laugh here!)

The surgeons are never that polite about bumping.

This is not the bump into you in a crowded elevator.

Bumping is the act of doing an urgent case in front of another surgeon who has an elective case on the schedule.

When a surgeon determines that their patient can absolutely not wait for surgery time, they ask for a bump.

Psst- nurses don’t bump.

Never.

Nuh-uh.

Nope.

Don’t even ask. I will refer you to the surgeon whose case it is you want to bump.

I will even give you their number.

But I will not make the call for you and ask that if they don’t mind, can surgeon #2’s urgent case go ahead of surgeon #1’s elective case.

Pretty please.

No.

Surgeons only talk to surgeons. The bump conversations must be had on a peer-to-peer level.

When I give surgeon #2 the phone number of surgeon #1, often they are mystified that I am giving them a number. I’ve even been asked, “Aren’t you going to do it?”

Nope. Policy says I am not the one to make the ask. Surgeon # 2 is.

After I give the phone number, I request a call when permission has been granted. Or not.

Most surgeon #1s (the ones with the elective scheduled case) are pretty cool with a later time slot. After surgeon #2 explains their reasons for asking for a bump. Usually something to do with deteriorating a patient and no time to transfer to a higher level of care.

I will get a phone after that conversation has happened and surgeon #2 says that they got permission to bump. The cascade and shift to a different surgery and a different surgen than planned begins.

But, yes, I absolutely follow up with surgeon #1, not to see if surgeon #2 is telling the truth (although a little bit), but to ask who is going to inform their scheduled elective case. I also give them a new timeline of their case starting and reassure them that they will receive a phone call when it is time to head to the hospital.

Take away of the story is that

1. surgeons bump surgeons
2. keep in contact with surgeon #1 about the new timeline of their case
3. be aware that surgeon #1 will ask you to tell the elective patient that there is an emergency and their case is being delayed
4. communication is key to this working

Don’t be afraid to get your higher-ups involved if there is a conflict and surgeon #1 insists that their elective case MUST go at the proscribed time. You have a lot of phone calls to make about getting patient #2 to pre-op and don’t forget to inform anesthesia of the new plan.

In further Oh shit, we caught the car and the car is biting back abortion news, I’ve been watching as there is a movement to rebrand pro-life.

To make it slightly more palatable to those of us who object to our rights being taken away.

For years and years, as long as I can remember, there was pro-choice and pro-life.

Pro-choice wanted the woman to make up her mind about what was going on with her body and to be able to make a choice when it came time. To have autonomy over her bodily processes, no matter what men who sought to control them thought.

Pro-life wanted the political power of being the ones that wanted control over a woman’s body through the possibility she might carry a child.

For years, a subset of the population who wanted to “save the babies”* sent money to the political side that was pro-life. This political side got used to the cash flow.

*but then not have anything to do with them or support them after they were born but that is another post.

I think there are a lot of things going on here.

This subset of the population ceded their entire political power to the ones who proclaimed themselves to be “pro-life”. You know, the ones who secretly paid for their mistress’ abortions.

A simple Google of politicians who have paid for their mistress’ abortions will tell you that and who.

But it is always about the money. If you scare people that the “children” are going to die, they will vote en bloc for you and your whims, thereby giving you control and power and money. But I imagine that this dependable 50-year source of revenue is drying up.

The pro-life crowd caught the car and overturned Roe v Wade, giving individual states the right to ban abortion.

They were genuinely surprised when they stopping winning elections. Turns out women do care about control over their own body. Shocking.

And then they started to say no, you can’t go to another state for an abortion, we don’t allow it, all but stamping their feet. Forgetting that those are American citizens who have freedom to move around the country for their own purposes and no you can’t ask why they are going to Illinois. Or California. Or New Jersey. Or Colorado. Or Minnesota. Or Washington state. Or Alaska. Or Hawaii.

And then they started with the you can’t drive through our town on the way to get vital medical care. Oh, that wasn’t such a good idea because who is going to support the gas stations and other businesses.

And then they started with medication abortions are not good and here is a little-known process to stop them. Because we are old white men who are clinging to power.

And then they started with the hmm if there was no birth control, then we could force all the women to carry babies thereby ensuring that there will be a good, steady supply of white babies to shore up the birth rate and help them maintain the majority white country.

I’ve said it before, it is NEVER about the children.

Abortion remains a way to control the women.

It is and has always been about control.

And people who didn’t care one way or the other are getting wise to them.

Pro-life is now seeking a new slogan to get the money into their coffers.

Especially when it hits their pocketbooks.

Money, power, and control.

And the foundation of them is eroding.

And that scares them to death.

The post-it states “Skin is a map of your history.”

***

Incisions

Injuries

Wrinkles

Stretch marks

The well-trained medical professional can tell.

Incisions are surgery scars that tell us what kind of surgery you’ve had in the past. Whenever I have abdominal pain patient on the table that is less than forthcoming with their history.

Why a cesarean section where they cut the baby out through SEVEN tissue layers is considered MINOR SURGERY and not worth mentioning, I will never know.

Even before the surgeon makes incision into your abdomen, we can read it like a book and even make suppositions about why there is an incision scar there. There is a scar on the right lower quadrant, with a history of appendectomy is most likely a McBurney incision. There is a scar on the right upper quadrant, just below the ribs is for the removal of your gallbladder, also known as a Kocher incision.

The smiley-faced incision just above the pubis is called the Pfannenstiel incision and the cesarean section incision. You know, the one that NO ONE ever remembers to include in their surgical history. Someone should do a study. Wait, that’s me.

The smiley-faced incision that that goes from hip to hip low on the abdomen so you can still wear a swimsuit (!) is an abdominoplasty incision scar. This means that a plastic surgeon removed excess fat and skin from the abdomen, pulled the remaining skin taut, and created a new hole for the belly button. In my head, I call in my head the why-so-serious incision (IYKYK). Joker approved.

The midline incision scar is smack in the center of your abdomen. This can be of differing lengths and they all say something different. A short incision that went toward your ribs could have been used for esophageal or stomach surgery, especially a bleeding ulcer. A longer incision that starts above the belly button and ends below the belly button can be used for the small intestines, or to get the specimen out after laparoscopic colon surgery. I use the midline incision to describe to the PACU nurse the extent of the abdominal surgery. I tell them if it is an upper incision, a middle incision, or a lower incision. Sometimes the incision has to be from xiphoid to pubis, or from where the ribs join, to the end point of the abdomen. When I am reporting off to the PACU nurse I call this the full monty, meaning that it is the ENTIRE abdomen that has been flayed open and, yeah, the patient is going to hurt. This xiphoid to pubis incision might mean that the surgeon was searching for the point of bleeding, or had to remove the entire colon. It is a big deal type of incision.

There may be small 1/2 inch incision scars that indicate previous laparoscopic surgeries. They may be only 1 inch away from another lap incision scar but that indicates different kinds of laparoscopic incisions. Surgeons try to use previous incisions for surgical sites, but sometimes they can’t because of placement, and you, the patient, end up with similar but not the same spot scars.

There may be an abdominal incision scar that indicates that a hernia was repaired.

There may be an abdominal incision scar that indicates a kidney transplant.

There are a lot of surgical scars.

But not every scar is surgical.

There are the tattoo removal scars.

There are the gunshot scars.

There are the belly button piercing scars that looked so badass in your teens and 20s and now are just a reminder of your past self.

There might even be fell out of the tree at 9 scars. Or the car accident or bike accident scars.

We can tell.

And that is only the abdominal scars.

This is apparently a new series I’ve begun for Sundays.

Come back next week for chest scars.

Students of all backgrounds have to find their preferred way of studying. Some are Last Minute Lucy and Larry, who wait until the last possible second to read the assignment or write their paper. Some are Get it Done Sooner Sally or Steve who get from home and immediately do the reading or assignment. Some just dabble until they find the routine that works for them.

This past week the Pomodoro focus technique really came into, well, focus for me.

I’d heard about it. Read about it. Half-assed my way through it. And still I struggled with it.

The Pomodoro technique is a minutes on-minutes off routine. This means that you study or read for X minutes and take Y minutes off between study “sessions”. In everything I had ever read before, it was 30 minutes studying, 5 minutes off. Rinse, repeat.

It didn’t work for me; I still have no idea why. Often I would get distracted in the 5 minutes off, or want to continue working in the 30 minutes on. The result was frustration. With myself, with the technique, and with my schoolwork.

However, I listened to a short blurb-ette about the Pomodoro technique this week. Something the presenter said struck me as different but also achievable. I had been approaching it as a zero-sum proposition. 30 minutes on, 5 minutes off. Regimented. Kind of like the operating room that way.

Wrong.

Well, the way it had been explained to me was wrong.

The Pomodoro technique is more forgiving than that.

In this new recording that I heard, you are allowed to keep working in the long segments if you are on a good roll and can push the length of the short segments.

In short, make the technique work for you.

My mind was blown.

Tentatively I decided to try it out. I experimented with the length of time for segment a, or the working portion, and also the length of time for segment b, or the rest portion.

I struck upon what I think will be my new, very favorite way to approach assignments.

30 minutes active working time, with the option of continuing to work, with 1 song length attention to something else.

This week I weeded. In between 30-90 minutes of hyperfocus on writing or reading.

It worked! I was flabbergasted, and eager to continue this next week as well.

I hope that your student finds the best way for them and that I can continue this as well. I will report back in a couple of weeks.

Continuing the theme of the month of Sourdough Wastes, I found a cookie that encompasses sourdough AND fall. Pumpkin is one of my favorite fall flavors.

Not pumpkin spice from the coffee shop. I have never tasted it.

I am talking about simple pumpkin flavor.

It just screams fall to me. Cooler weather, decreased humidity, sleeping with the windows open with extra blankets on the bed. Everything that I love about fall, in a flavor.

When I was in college my mother made this awesome pumpkin cookie with a hard brown sugar glaze. I’ve no time for the glaze but I remember it fondly.

The cookies I will be delivering are simple pumpkin cookies, made soft with sourdough. There may be a tinge of sourdough, if you eat enough of them.

Simple isn’t always wrong, you know.

Especially working as a nurse. Simple can be good.

Simple can be taking off your shoes at the end of the day.

Simple can be getting all the things right on a complex case.

To me, it is the same feeling.

Now, I caution about slapping pumpkin in EVERYTHING! This will be the only pumpkin cookie of the year.

I think it is a good representation of how the simple things can be the best things.

Probably would’ve been better with frosting, but I took the simple way out.

Now will everyone tell the new people there are cookies in the lounge on Thursdays? At about 1400?

Staffing, even for surgeons, has been in deep flux during the pandemic and has only intensified after. The Great Resignation, and flocking to traveling, you know?

When I go to the hospital to drop off Cookie Thursday is a Thing weekly, I see unfamiliar faces. Everywhere.

I try to introduce myself to all new faces.

Today I am going to write about surgeons. New surgeons specifically.

There is also a new surgeon in practically every service line.

A couple of years ago I wrote a memo that I thought was going to be given to every new surgeon. It was all about call hours, and how to get in touch with the call nurse, and how to schedule cases, and what expectations could be had. I updated it when they started the call position.

Yeah, I was wrong.

I have no idea what is the distribution of the memo. Do the doctors’ offices get it and they are responsible for handing it out to new surgeons? Does it get distributed by the medical staff office? I’m going to answer my own question and say no, there are too many hospitals for them to keep up with it.

What usually happens, is that it is word of mouth by their partners, with me batting cleanup as I hand out the pager number to new surgeons who don’t know the process. I also explain how the process works at this hospital. I cover any expectations they can have, and manage the ones that are not realistic.

Like expecting the team to be at the hospital and ready in 10 minutes, no matter how far they live. Not going to happen, doc, the team has 30 minutes to be at the hospital. We will try, but miracles are not accomplished every day.