25- AI tattles

A tell is something during a game, usually of cards, that indicates what is in your hand. Good or bad. Physical change or behavioral change. It encompasses a lot.

The use of AI, especially in a education setting, has tells as well.

There is the direct copy and paste of the output of a prompt. Warts and all. This is a glaring red flag to the people grading the assignment.

Try a little and reword some of the output.

But this is also a trap. You really should understand what the output says before you throw yourself on the mercy of the thesaurus.

Above all, know the difference in usage between lie and lay and lied and lain. Can’t forget their, they’re, and there. These three little words have forever stymied English speakers, native or not.

And is a giant AI tattle.

3 years into this AI game, universities and colleges are learning how to recognize and grade you accordingly. The university I go to has announced that any AI usage has to be on the university site. I imagine this is so they can keep on eye on who is doing what with what AI generator.

Publishing has also gotten wise to the AI slop that is out there. I have seen the stamp they are putting on some books. It proclaims that the book is “Human Authored”. I think this is smart but also vulnerable to copycat. The seal does have a seal number on it. I am not sure but I bet the numbered seals are searchable on the Writers’ Guild site. Nope, I just checked. They are not easily searchable.

The point is that if you cheat, someone, somehow is going to figure it out. That beggars the question Why cheat? in the first place. It is only your reputation and your admission to the university/college that is at stake.

Darn, I guess you’re just gonna have to do the assignment. With your own brain and your own fingers typing on the keyboard.

Darn.

FFS 9/26/25- Fearmongering

According to the Cambridge Dictionary, fearmongering is the act of “intentionally trying to make people afraid of something when this is not necessary or reasonable”.

To me this is the default setting of much of the bullshit that is coming out of Washington these days. After all, a fearful public is one that cleaves to the familiar and allows atrocities to happen, thanking their stars that they are not the ones the atrocities are happening to.

Fearmongering was the word that immediately comes to mind when people who 1) are not research trained and 2) talk bout of their ass in hopes of convincing you that the sky is bright purple with screaming yellow spots.

This has trying to confuse women who are pregnant into NOT taking one of the only medications they can during pregnancy all over it.

It is not the Tylenol. It is not the acetaminophen. It is not the paramecatol.

Above all, it is not the women.

Autism has been around for generations.

These medications have been around for less than 80 years. Genetic rewiring has been around for as long as people have existed.

Blaming women for pretty much everything has been around for generations.

When is enough going to be enough?

We are so sorry that you as a male are unable to create life.

We are sorry that you as a male want to blame the women for something genetic that happens with a child. Did you forget that half of the genetics of the child are yours?

Stop the fearmongering.

Stop panicking because you feel the control over women slipping.

Just stop.

PS. the sky is not bright purple with yellow screaming spots. Please adjust your viewfinder.

Cookie Thursday 9/25/25- French Toast Cookies

This week concludes the Cookies for Breakfast September 2025 theme.

There have been a lot of hits. As in all of them.

The month started off strong with a cinnamon pop-tart, which some people missed and were sad about it.

The second week was the cornflake cookie. This one was surprising. Not only for the solid cookie but also for the scandalous past of the cornflake and breakfast cereal.

The third week was the not so surprising hit. This was a crescent roll topped with bacon and maple syrup. Everything is better with bacon, right?

This Thursday I made French toast cookies. Well, I say cookies. More like French toast baby muffins.

The best part of it was that I used stale hamburger buns. I read a couple of other recipes and decided to just wing it. I know how to make French toast but I have made toast sticks in the past and cut them up. I wanted something more special and more cohesive.

I decided to mash together two recipes that are well known to me. French toast and bread pudding. The modified bread pudding would give the little muffins more structure and the French toast basic recipe that I follow would give it the flavor.

Success!

And someone already asked me for the recipe!

October is always my favorite CTIAT month. Stay tuned for the spooky times.

Call secrets of the OR- Wanna trade? Or how to get last minute days off

Unfortunately we are bound by the schedule guidelines when it comes time to take a day off.

I have been with the company for 19 years, 11 months, 3 days. With longevity comes a healthy PTO accrual. I make an embarrassing amount each pay period, 52 pay checks a year. Fine. It can ride. Until they put a cap on that that works out to about 3 months of PTO.

I work, or don’t work, to keep myself under the cap. Because if you are over the cap you no longer accrue PTO and I am not working for free. I will take my benefits please.

But what if the schedule just started and you need to take a little day off. This might be because of a sudden doctor’s appointment, or a pageant day at the little one’s school, or just needing a mental day, No judgement here.

Because you are within the bound of the schedule, you have to trade days with someone to get the day that you need off. Or call in sick. Again, no judgement but that also comes with a trade-off that counts against you, somehow.

You trade.

It is very much Khajit has wares if you have coin. This is a reference to The Entertainment System. AKA TES. AKA Nintendo platform. It is very much a gaming in-joke that has been used by a lot of people. Even people who don’t play computer games.

If you need a giggle google the phrase and look at images. All those cats hard at work.

However, you suddenly need next Thursday off and you’ve been told it is within the current schedule.

You start asking people to trade.

You start begging people to trade.

Sometimes it works, sometimes it doesn’t.

It works best if there is a workaholic in the department. Or someone who wants to work extra to buy something, or save for vacation, or all sorts of things. I used to pick up shifts to earn race money. Running races, that is.

Not every department has a workaholic.

This is when you can turn in the favor coins you have earned. You earn these by doing favors for your coworkers.

In the rare occasion, you can even trade with your boss. If they need coverage on the Friday and no one has agreed to work it, you can offer to work the Friday, if you get Tuesday off.

This is a not very well known rule of healthcare. Someone will have your back and trade with you. They might complain. But it magically happens.

Medical non-fiction books review 9/21/25- Chasing Rabbits by Rodolfo Del Toro

I get discounted and free e-book lists daily. I never spend a lot of money, less than $5.00 per week. I was looking over the options this past Wednesday, like you do, when I saw this book. It is Chasing Rabbits by Rodolfo Del Toro and it is my favorite kind of medical non-fiction, a memoir.

And it was 99 cents.

I hit the buy now button and I was surprised that I already owned it. I was embarrassed when the site informed me that I had owned this book since February 2024.

I had never read it. School brain, you know. The book was part of my ginormous TBR pile that grows daily. But I can’t give up books entirely.

As medical memoirs go it is on the shorter side, only 220 pages. A quick read. I had time this weekend and so I decided to read it all in one go.

This story is in three parts. The beginning is what stands for present day, many years after the events of the 2nd part, and the third part picks the story back up from the first part. Rudy the doctor has an unexpectedly light afternoon before a three day weekend and his long-time secretary tells him he received an intriguing invitation from a butler.

This leads to the middle part of the book, which is the meatiest part of the book, and Rudy telling his secretary about this one rotation he had in his 4th year of medical school.

Cue the second part. The first part felt a little disjointed and rushed and I was prepared not to like the doctor. His secretary was great and is well written.

In the middle part, Rudy and his friend Mike are 4th year medical students and their planned clerkship for the last rotation of the year fell through. This was strongly hinted out because Mike’s family was rich and connected with an insurance company. This unexpected snafu was punishment for his father’s actions. I could see this but I wish that the book would have spend a little more time on this.

Because their real last rotation of the year was going to be together. In a children’s oncology ICU. With stable cast of characters, the doctor who oversees the unit, the fellow, a resident, and several nurses. And a pulmonology resident. All the nurses are named and have their own personalities. I love it when that happens. There is also Julia the supermodel who has been set up with Rudy by Mike.

There are three main children whose stories are centered in this section. Tim, the little boy with bone cancer, Megan, the little girl who has leukemia, and Maria, the ward of the state with a lost brother who has

Tim has had his lower leg amputated and a lump had been noted on his femur above his BKA. His parents were understandably concerned and he was in the hospital for a biopsy and treatment if necessary. He was waiting on biopsy results.

Megan is most concerned with being well enough for the trip to Disney land that was being planned for the children. When she is introduced, a nursing student has been assigned to restart her IV. Megan objects because the vein they want to use is unusable. Because she knows her body best she gives a tour of the most often used veins in the forearms. The nurse, not the nursing student, is successful in cannulating the vein that she indicates. This was one of my favorite passages. It is important that we give these kids who know they are sick, who know that it might not end the way everyone wants it to, agency over their body.

As Rudy and Mike leave the room, Dr. Betances is explaining to the nursing instructor that no nursing student will be starting this IV. His reasoning is that the kids have been through hell and do not need the pain from an unsuccessful needle stick. The nursing instructor just wants a body to have her students practice on and protests that the kids need new IVs so often it is a good practice place. I also liked this exchange. Dr. Betances standing up for his fragile patients. But I also disliked the nursing instructor who tantrumed off to tell on Dr. Betances. The nursing instructor does not come off looking good here.

Maria is in the isolation part of the ward because of her end-stage leukemia. She had a good attitude and a great smile. She also had a really good relationship with the main Dr. Betances. There is a back and forth about a business arrangement for having 1 medical student in her care, not 2. This was a great back and forth and you can really feel Maria here. The price of 2 medical students for the rotation is a 64 pack of crayons. As the group leaves to continue rounding, a nurse stays behind to talk to Maria.

In the next little bit, you learn about Billy, her foster brother, who was also at the farm where she was being fostered. But once the foster father died, she was sick and they were separated. He was adopted after that. Maria has been at the hospital for nearly a year. This is where it is explained that the staff takes care of all of Maria’s needs, including the non-medical ones. There are pink curtains, art supplies, and all the things to make a home for the dying little girl.

Rudy offers to talk to his friend the lawyer to search for Billy. This irritates Dr. Betances, like no one had bothered to look for Billy in the past 10 months.

The middle part is concerned with these children and their care. The nurses are caring and competent, the head doctor, Dr. Betances, is caring and giving, and the fellow teaches all that he can to the medical students.

I won’t write anymore about what life and death and bad news and good news happens in the second act. Or the third.

The best I can say is that I cried. And sometimes that is the best recommendation a book can have.

Part 2 more than made up for my perceived rushed feeling from part 1. I can understand after reading the second part, he just wanted to get into the meat of the story. I am a little less forgiving of the super model side plot, but even that has a good payoff and explanation.

You’re going to have to take my word for it.

I will read this again. I might even come to like the first part. But the second part is where the heart of the story is.

FFS Friday 9/19/25- Find Joy!

Man, I struggled with what to write today.

There’s just so much to swear about. Attacks on free speech, attacks on the free press, attacks on homeless people who a certain asshole of a fox anchor think need to be put to death, the smugness of certain individuals as they continue to survive the fall out.

I kind of feel like the Grandson in The Princess Bride as his Grandfather reads to him that Humperdinck survives. He is aghast and troubled about the continued existence of such a rotten antagonist. The one who has killed, and lied, and lied, and lied, and continues to survive. And survive and lie and kill.

Same, kid, same.

My advisor chair knows that I have been struggling with this nonstop shitshow. It is sapping my concentration. Concentration that I desperately need to finish my PhD program.

I have concentration but it is fragile. Because I feel like someone, anyone, needs to be documenting this shit show. Witnessing is a form of protest. Because those who go bump in the night would rather not be seen, thank you. It is very much go away, there is nothing to see here.

It is time to look past the shadows. It is time to find Joy. This will depend on the eye of the beholder. My joy is not the same as yours. Because we are different, you see.

Joy can be found in a baby’s laugh, or a perfectly made dinner just to make someone smile. It can be found in the soft fur of our beloved cat or dog. It can also be found in a movie that makes you laugh. This weekend I am determined to watch the Cornetto Trilogy by Edgar Wright, Simon Pegg, and Nick Frost. Simply because I find joy in laughter.

The shitshow will go on. But there is joy in protesting for some.

Does the administration not realize that certain someones can seek out other platforms after they’ve been attacked and denigrated and next to fired by the administration’s yes men? If one platform is threatened, find another. The internet will be their playground. If anything they’ve been constrained and shackled to an industry that seeks to profit above all else. If the last five years has taught us anything there is gold in the internet.

Remember that someone has to pay witness to this continued insanity. Someone has to be able to explain to the next generation that most of society fucked it up and we lost the most precious prize of the last 249 years. Our freedom.

But find the joy in the everyday.

This will ease the pain of the witnessing.

It goes back to the thought experiment that was going around as I was growing up. If the tree falls in a forest, does it make a sound? My answer was always yes. The tree doesn’t care if there is anyone to perceive it. Sound happens in the absence of someone to hear it. It is arrogant of us to consider the tree as an extension of our consciousness when it should be the other way around. The tree doesn’t care or need us but Democracy needs us to be able to bear witness when/if it falls. And to help if we can.

After all, in the Lord of the Rings when Théoden asked “Who was there “Where was Gondor when the gates of Westfall fell?” This really was a question of Théoden’s son, Theodred, falling in the battle and the grief that paralyzed a nation that followed.

Maybe I will watch the LOTR trilogy next weekend. Just to remind myself that this has happened before and good has triumphed over evil. We see you, Sauron, and we do not care for it.

Cookie Thursday 9/18/25- Jalapeño bacon crescent roll bites

This week continues the month theme of Cookies for Breakfast.

Of course, I am taking the definition of cookie with an extreme grain of salt. Like huge, the size of Gibraltar.

This is more classified as a make. As in it has breakfast type items in it. I would almost call them a biscuit but then that’s not correct, either.

It started when I say these packages of cooked jalapeño bacon at Aldi when I was grocery shopping. They were on steep discount but still within expiration date. I believe they were less than $1.50/each. So I bought 3, with this exact make in mind. Aldi also has a knock off of Pillsbury Crescent Rolls, which were $1.29. I bought 3.

Not having to cook the bacon? Priceless. But the entire make cost me less than $9.00.

I became aware of this recipe through a video series called “Dead Greg’s Recipes”. A relative of the cook had died and had left their cousin a ziploc bag full of recipes. The cousin gave the cook the bag of recipes and said let’s try them. There’s a whole schtick where the cook has labeled each bag onto a spinny wheel and they spin the wheel and the pointer lands on a category.

Kind of fun.

I should’ve checked the fridge before beginning the recipe though. I had less than 1/4 c of maple syrup and I could not find the bottle I had bought to replace it. Oops. But this recipe didn’t exactly have measurements for the ingredients. Beside the bacon, it called for 1 pound of bacon. The rest of the recipe was Crescent Roll tube, maple syrup, and brown sugar. No details on any of them.

I persevered on.

You open the Crescent roll tube by peeling the paper to reveal the fault line. It’s supposed to open itself from that point. Guess what didn’t happen! I used a spoon along the fault line, as directed. I opened and spread out 2 on a parchment lined cookie sheet, pinching the perforations together. I layered in what maple syrup I had, and then the bacon, and then 3/4 c brown sugar. I topped the entire thing with another Crescent Roll tube.

The entire make baked at 350 degree Fahrenheit. Again, no time limit was given so I just baked until browned. This was about 15 minutes.

Interesting result. I cut the entire structure with a pizza cutter after it had cooled. I have thoughts. The result was not very structurally sound. I think it needs a bit more on the bottom layer.

Next time I will definitely have more maple syrup, probably 1/2 c for the size I made. I would also mix that with 1/4 softened butter because this is the bottom layer and I feel it needs to be more substantial. Next is the chopped up bacon. I would increase the brown sugar to 1 c, dependent on the size of the dough. I would also add a spice into the brown sugar. Of course I might feel that way because it is nearly fall and pumpkin spice is EVERYWHERE. I would brush the top with butter and maybe a bit of cinnamon sugar.

Not a bad make with the scant details of the recipe. But sometimes that is fun.

I will not kick this out of the cookie jar, I’ll just tweak it a bit.

Call Secrets of the OR- OR investigations

Once upon a time that really happened, the patient was not waking up the way they should. All the anesthesia gases were off, the reversal agent given at least 10 minutes, but they were not opening their eyes or making any effort to, you know, breathe. Time ticks by, first five minutes, and then 10, and then 15 minutes. The anesthesiologist has been called to the room.

While anesthesia is trying to wake the patient up, you drag the workstation on wheels to the patient’s bedside so you can be an active part of the extubation, but also able to read the chart looking for clues.

There are none.

Time for a group think.

You ask about family history that isn’t in the chart. You remember that there is an enzyme deficiency that delays the clearance of anesthesia. You remember because one of your med-surg patients had it and would call for a certain medication whenever she woke up from anesthesia. You remember her telling you that she had a liver problem in the beginning of this conversation. And not only did she have it but so did her youngest daughter. And the last time there was a very long delay in waking up from anesthesia on one of the cases you’ve worked, it was also an enzyme deficiency. The same one the med-surg patient had.

The anesthesiologist goes out to the surgical waiting room to ask about family history of slow wake ups. This was covered in the pre-op consultation at bedside but this is a check in that what the patient and family said pre-op is correct. This is where they remember that grandfather would talk about the time that it took so long for him to wake up after surgery that when he finally did it was the next day and he was in ICU. But no one else has had a long wake-up. Not that many of them had ever had surgery other than babies.

There is such an enzyme deficiency that causes this. It is called pseudocholinesterase deficiency. This is an enzyme that breaks down anesthetic medications, such as succinylcholine. This is the medication that is often used to paralyze the patient prior to intubation.

Unknown to any of us, and the patient, and the family, this patient had a pseudocholinesterase deficiency. Their liver wasn’t metabolizing the paralytic, which kept them unable to breath on their own.

This is a quandary. There are two paths. The first is to keep the patient intubated in the operating room until enough time has passed to allow them to breath on their own. This is costly as an OR minute is expensive and who knows how long it will take before the patient wakes up. And also it effectively ties up the anesthesia team and leaves OB especially vulnerable in case there is a stat section. The second path is to keep the patient intubated, call for a ventilator to be brought to the PACU, and admit them to the ICU. Not long, just long enough for them to start breathing on their own. This can be anywhere from 2 hours to 12 hours.

The decision is made to move the patient to PACU and the waiting ventilator. If they are not extubatable at 2 hours, then PACU would move the patient to the ICU. Because call back time for the PACU nurse is expensive.

The first thing to do as the OR call nurse is to check the hospital census. This is a picture of what rooms are available. The second thing is to call the supervisor and tell them about the situation and the steps that might need to happen going forward. They promise to save an ICU bed.

The patient is moved to PACU, and attached to the ventilator and the monitors.

The waiting begins.

After the patient is settled in PACU, on a ventilator, you call the surgeon, who has been long gone, to tell them of the situation. Regardless of the working theory it is pseudocholinesterase deficiency, the surgeon still needs to be informed of what is going on. You tell the surgeon of the plan to wait in PACU for 2 hours and then the admission to the ICU if the patient is not yet awake.

You check in the PACU nurses and tell them that you’ve called the surgeon and gotten them up to speed on the situation. If there is nothing else, you will be heading home because OR call back time is expensive and being in the PACU when there are 2 recovery room nurses is expensive.

You remind them that the nursing supervisor is aware, there is a bed being held and the surgeon is aware. They run through the plan again with you of 2 hours intubated in the PACU and then, if not awake enough to extubate, admission to the ICU. They tell you to go home.

On your way out of the PACU you pass the anesthesiologist who is writing a letter to the patient advising them to be tested for pseudocholinesterase deficiency and advising them of the importance of having the family tested to. Because this is a genetic deficiency and is passed down. Like the patient’s grandfather likely passed it down to the rest of the family.

Luckily there is a test for that.

You tell the anesthesiologist that the PACU nurses know the plan and ask if they’ve spoken to the family again. If they have, you are going home.

The anesthesiologist assures you that the family has been spoken to and are waiting to see which path is to be taken.

You head home.

In a rare follow-up, you learn that the patient was able to breath in the PACU after an hour. They were extubated and sent home with family. The entire family was aware that they had to be tested or tell the next hospital and operating room they found themselves at.

This was the best case scenario. If the patient hadn’t been a young, health individual with a possible family history of pseudocholinesterase deficiency, more steps would have been taken in case it was something else. A head CT would have been the next stop to check for a stroke, and labs would have been drawn.

But not this patient. They were able to be extubated and go home with their family. With a heck of a story to tell and homework to do.

Tuesday Top of Mind 9/16/25- Thank you, Governor Stein, for not kotowing to the CDC

Did you get your covid booster shot in May like I told you? You know after RFK Jr. started his bs at the department? When the department first announced that boosters were only for those 65 years and older or those with preconditions but had not yet enacted it?

My husband immediately got an appointment and the booster. I immediately got an appointment and the booster. We both got boosters on May 21 of this year.

Do I remember exactly what spooked me about this entire situation? Apparently the FDA came out on May 20 with an article that I saw in Stat News.

The shenanigans are afoot again. Always, forever…

Now that the CDC has approved the new booster shot for the flu/covid season 2025 there is a discrepancy of which states will give you a vaccine/booster without a prescription. Or even with a prescription.

It is a hot icky mess.

Just as was designed by HHS.

Some states have come out as needing a prescription. If the pharmacy even has it.

Some states have not.

Nine states require individual prescriptions for a vaccine. At least at the writing of my source article from PBS dated September 12, 2025. In the four days since this article was written 3 other states have issued orders to make the covid vaccine available to their citizens. These are Arizona, Maine, and North Carolina. Hence the reason I am thanking Josh Stein in the post title.

To look on the bright side 41 do not. Soon to be 44. Six states that still require a prescription for even those eligible for the vaccine are Florida, Georgia, Louisiana, Oregon, Utah, and West Virginia, plus D.C.

That’s even if the pharmacies are stocking the vaccine.

Rather a game of three card monte. Here a vaccine for the prescribed, there a vaccine for anyone who meets the threshold. Everywhere a vaccine. Confusing right?

Trust me, that is the entire fucking point. It’s as if the CDC wants to make it so confusing that people will throw up their hands and give up.

Too bad, CDC and HHS, those of us who’ve lived and survived since March 2020 know better. We know that this virus is a killer. We know that this virus disables through Long Covid. And we do not wish that on our worst enemy.

We are tired of the dead and the double speak and the ghoul in charge of it all.

My cat won’t let me write today

I know this is supposed to be a School Me Saturday post but I can’t write today.

Dot forbids it.

Dot is well known to my classmates and people I meet with on the regular from the hospital.

She’s quite popular. In fact, one of the monthly meetings has turned into an on the road meeting. Where we go to all the different hospitals and have the meeting with the different people from the hospital and the rest of the meeting attendees on Teams.

The same group of people that she mooned during a meeting two months ago when I was leading the meeting. She has no zoom chill.

Someone suggested that I have her be a traveling kitty.

She says no.