25- Flu increasing in NC, spreading like holiday music

This is your yearly December PSA. And a warning.

The best time to get your flu shot was 2 months ago in October.

The second best time to get your flu shot is today.

Come now, don’t tarry.

This is the warning part of the post.

If it seems that everyone is sick this holiday season, it is likely because they are.

The waste water monitoring data for North Carolina just increased. The NC level for the entire state is moderate. This is specific to flu A. But by the CDC map there are multiple areas of the state that are marked as very high and high levels of flu A in the wastewater.

This is well worn and timeless set of instructions.

Wash your hands.

Wear a mask

Cover your mouth when coughing.

Avoid crowded areas.

Avoid people who are actively coughing.

Drink your fluids.

Get plenty of rest.

And, for pete’s sake, get your flu vaccine!

If not, don’t come crying when you get the flu.

You are protecting not only yourself, but others in the community.

Just do it.

Cookie Thursday 12/18/25- 5 chips chocolate peanut clusters

The stove I ordered had to go back as it wasn’t the stove I thought I had ordered. I wanted dual fuel, gas on top, electric oven, and what was delivered was gas on top, gas oven.

I am not sure if you’ve ever baked with gas. Let’s just say it isn’t ideal.

Back to drawing board.

I picked out a new stove and they are supposed to keep the deliver/installation charge from the first stove.

Confused? Because the installation people are. I have a phone call in to them.

Guess what? The holidays are mucking up the timing.

New stove #2 will be delivered to my house on the Saturday after Christmas. It would be ideal if I could get the installation worked out before the end of the year.

Don’t worry, I will be calling them back.

So no new stove to try out for the last Cookie Thursday is a Thing of 2025. Instead I will hopefully be ringing in 2026 with a new oven.

Fingers crossed.

I mean, the airfryer is an airfryer/toaster oven combination so I am not totally in the weeds.

But still.

This left me cookieless on the last CTIAT of the year.

I pulled out a recipe that I’ve been wanting to do for No-Heat August for literal years.

It is 5 bags of chocolate chips, 2 containers of peanuts.

In hindsight, it makes entirely too much candy.

Like way too much.

Like who at the hospital can I give the excess to too much.

If I make this again, I will halve the recipe and use half bags of chips and 1 container of peanuts.

It is a good empty out the baking pantry recipe though.

The 5 bags were

caramel chips
semi-sweet chocolate chips
white chocolate chips
butterscotch chips
milk chocolate chips.

I used the crockpot to melt the chips, added the peanuts, heated it some more and used my cookie scoop to portion out the candy. And portion out the candy. And portion out the candy.

I placed the candy scoops as close as I could on 3 parchment paper lined cookie sheets and I still ended up with 3 full to the bursting sheets of 5 chip peanut clusters.

Did I mention it was a lot?

I took an entirely full cookie containment device to the hospital. And portioned out 2 full smaller containers for the other at the 0700 meeting.

I still have an entirely full sheet of peanut candy.

I will be handing these out to other units.

But I really should’ve realized I was in trouble when the chips and the peanuts filled up my entire crockpot.

Call Secrets of the OR- Call shift is great until something wakes you up

I still call my job the coolest shift I’ve ever had.

There are a LOT of positives. And I’ve written about them. As well as some instructions on how to deal with them. And how to sleep on call.

Now let’s talk negatives.

The first negative is that you now have a hair trigger sleep habit. Because when the call comes, you have to be awake, dressed, and at the hospital within 30 minutes.

I live stupid close to the hospital (less than 3 miles) and it still sometimes takes me 20 minutes to get there.

Because of this hair trigger sleep habit you are especially aware of every little noise the pager or your phone makes. Because it might be a case. Or it might be a pager in need of a battery.

Or it might be a stupid political text at 0400 (four in the morning).

Or it might be the university that is 90 miles away that you are attending virtually anyway with a new announcement regarding the snow day. Or the hurricane. Or once, memorably, a car fire in the parking garage.

Or it might be a text alerting you that the delivery drivers/installers will be there sometime in the next 12 hours with whatever you ordered.

Ask me how I know…

Or it might be your brain going off. For no apparent reason except to get you of bed at 0300.

Regardless of the time the hair trigger has been pulled. You are now awake and there will be no more sleep tonight.

You could toss and turn and read on the Kindle and check your email. Or try all the myriad of things that past insomniac you used to do to get to sleep. I mean counting sheep is an option. So is sleep hypnosis. I use repetition of one particular number, just that number, until I am asleep.

But you know that it is useless and your brain is now engaged and awake.

So you get out of bed.

This makes the cat happy.

You brush your teeth and get dressed to start the day.

Who cares that the sun isn’t even up?

There’s a new crossword puzzle to do and emails to catch up on and a cat to feed and a sunrise to watch.

Don’t worry, there will be a nap in your future.

I hope that for you.

Now this negative doesn’t happen every night. No.

It is just often enough to be obnoxious.

I still wouldn’t change a thing and this remains the coolest shift I’ve ever done.

School Me Saturday 12/13/25- Winter-freaking finally-break!

I know this semester has been, well, odd.

Hell this entire year has been odder.

So many changes on the federal level, including new intrusive FAFSA questions.

Including the grinch swiping away what little student loan relief that the Biden administration was allowed to do by the courts.

I mean, we all know who the grinch is, right?

Put that aside.

Things will still be bat-shit-crazy in the new year and the new semester.

Take a deep breath now, and count the good things.

Finals are done and your grades most likely in by your instructors.

Winter graduations and hoodings for graduate students have occurred. Including two of my cohort. Congratulations, guys, well done.

I’m not jealous at all. No, really I’m not. This is a process and I am just not as far along as them.

It is too early to plan for Spring Semester.

Christmas is over 10 days away.

Now is the time to breathe. And maybe nap. In fact, I hope your sleep is as good as Dot’s on her warming pad and window perch.

My winter hope for you is that you rest well over Winter Break.

Think about school only if you want to but don’t obsess about it.

Read that book you’ve been meaning to get to.

Watch that hot new movie in the theater before it is pulled.

As an aside, Hamnet was one of the best movies I’ve ever seen.

Watch that television show that you’ve been saving up for the end of the semester.

Wrap your presents (if you do them), ready your travel plans (if you are going anywhere), but be safe.

The crazy things will be there after the first of the year.

Take this time to re-center yourself and remember who you are and why you are on this journey.

And have a happy, safe, and restful holidays.

Spring Semester is just a breath away.

FFS Friday- FDA, blink twice if you are in trouble

Actually, don’t bother blinking.

We in healthcare KNOW that you are in trouble. As you have a bad case of the know nothings in charge of you and your vaccines and your medications.

Some of the Senators could have helped you out but they were too busy bending the knee to a wannabe fascist who is hell bent on wringing all the money they can out of their shitty decisions and actions.

You see, they are in their villain phase.

Where the only thing that matters is the green.

Of course, I write of money, moola, dough, loot, and bucks.

They are too busy stealing from us that they think that making us sick by not extending Affordable Care Act credits for those who need help with the astronomically skyrocketing costs of insurance, shields what they are doing by providing cover fire.

Forget bread and circuses, this administration is about social media lies and villainy.

Why? Because to be the lowest level they can be feels GOOD. To them at least. I would have sent myself to bed without dinner if I acted like they do. Lives are not their playthings. Did no one teach them manners as children? Or even ever told them no?

Today’s latest bullshit is a waving of a “possible” black box warning on the covid vaccine.

Yeah, that one.

The one that has saved millions and millions and millions of lives.

Worldwide.

This black box warning will be slapped on the life saving, lung saving, world saving vaccine by the end of the year, according to reports from CNBC and Reuters and CNN and other news sites.

I think this is a distraction. Of course all the news is covering it.

Of course all the healthcare workers, MDs, RNs, LPNs, CNAs, PAs, and the like are decrying it.

If true, this is big black coal letters the size of Mt. Everest BAD.

This kind of bullshit pulls the wool over the eyes of the people who don’t know any better.

And makes them doubt ALL the vaccines.

Makes them doubt healthcare.

Makes them doubt medicine.

Takes us back to when we were smashing rocks against other rocks and against each other.

I am not sure of their endgame, besides confusion, and lining their own pockets and those of their billionaire handlers.

Or are they spoiled brats who are gleefully pulling the stuffing out of America?

After all, weakening us makes us prey.

Well, I don’t feel like acting like prey. Wanna see my teeth?

We tried to warn you but you didn’t listen.

Cookie Thursday 12/11/25- Triple mint chip cookies

So my oven must’ve heard us talking about replacing it. Because this was the worst performance by my oven in the nearly 12 years I’ve done Cookie Thursday is a Thing.

Each batch as they came out of the oven, was a bit different. Even with the same parameters of temperature, dough, and time.

The first batch was too done and so has not been included in the hospital’s box.

The next batch was crispy on the edges but the centers were cooked but not brown.

The next batch was perfect.

The last batch was back to crispy on the edges and the centers cooked but not brown.

I think my oven is trying to tell me something.

Three of the five burners do not work.

The top oven bleeds heat.

The bottom oven is rarely used an still functional.

I am saddened because this is the best stove I’ve ever had.

I get it, its tired. There have been thousands of cookies and hundreds of meals over its 20 year life.

It is time.

This is the last Cookie Thursday is a Thing that it will ever have to do.

I used the three half bags of mint in this week’s cookies.

Bailey’s Irish cream chips, Andes Mints chips, and peppermint bark chips.

They taste very good. Minty and crispy and chewy.

All at the same time.

Call secrets of the OR- Advocacy

The gown card that sparked this post is “you are the patient’s advocate. Yes, even in the middle of the night.”

Oooh, return of the gown card.

I wrote myself this gown card in the middle of a difficult middle of the night case.

The surgeon had been pushing to get the patient on the table, had been pushing to go home, had been pushing to start the next case.

It doesn’t matter why they were pushing, just that they were pushing you as the circulator to do something you weren’t okay with.

It is important to listen to your gut.

After all the patient can’t speak for themselves.

The family can’t speak for themselves or the patient.

It is up to you to speak for the patient.

Yes, even in the middle of the night when the surgeon is huffing and puffing and threatening.

Be like the Little Pig in the Brick House of Three Little Pig fame and stand firm.

You know what can and cannot be done. You know all the steps to make a surgery safe for the patient.

Know that you know and speak up for them.

They would do it for you, if they knew.

Tuesday Top of Mind 12/9/25- Empty stools in empty lab rooms

With apologies to Claude-Michel Schonberg, Herbert Kretzmer, and Cameron Mackintosh and the original singers of this adapted song.

I speak of course of Les Misérables.

All of the albums, the 1985 cast album, The 10th anniversary Dreamcast, and the 2012 movie soundtrack, have been on near repeat in my head and in my speakers since the first No Kings protests. I’ve written about it before but something about the failed revolution speaks to me in these WTF times.

My favorite song has always been Empty Chairs at Empty Tables when the survivor of the barricade, Marius, sings to the phantoms of his friends. It is hard to be a survivor of atrocities. I imagine it is harder yet to be among the survivors desperately trying to salvage what they can at the CDC. Because of the grant pulling and the firings and the August 20, 2025 attack on the CDC itself where a police officer died.

I was driving home from baking Christmas cookies with my mom when I started humming this song. I started changing the lyrics right then. I tried to stay true to the original cadence of the song and I changed some words.

Empty Stools in Empty Lab Rooms
There’s a rage that can’t be spoken
There’s a fear goes on and on
Empty stools in empty lab rooms
Now my friends are fired and gone

Here they talked of exploration
Of possibilities
Here they talked about diagnoses
And the diagnoses never came

From the laboratory in the hallway
They could see a germ defeated
And they rose crying Eureka
And I can see them now
The very science that they had worked
In the lonely lab at dawn

Oh, my friends, my friends, forgive me
That I work and you are gone
There’s a rage that can’t be spoken
There’s a fear that goes on and on

The lonely faces on the screen
Phantom shadows on the Zoom
Empty stools in empty lab rooms
Where my friends will work no more

Oh, my friends, my friends, forgive me
That I work and you are gone
There’s a rage that can’t be spoken
There’s a fear that goes on and on

What scientific advances won’t be made? What cancers will grow out of control because there is no one to stop them?

How people have to die because this is happening?

FFS Friday 12/5/25- Fox in the henhouse

Could you hear me screaming at the radio on the way to pick up my friend from the airport when I heard the vaccine shenanigans.

I write, of course, of the Advisory Committee on Immunization Practices (ACIP) who voted today to recommend NOT giving newborn babies a hepatitis B vaccine. Routine hep B immunization for newborns has been on the vaccination schedule for THIRTY years.

Instead they recommend that only babies born to women who test positive for hep B get the vaccination. But what about the women who are so newly infected with hep B that it doesn’t show up on a blood test, a la HIV. What about their babies?

This is not the final vote, this is just a recommendation.

This recommended change was strongly objected to by the actual medical experts in the room, many of whom were not allowed to speak or give evidence. The medical community points out that this 30 year recommendation has VASTLY decreased hep B rates in children. Hepatitis B can lead to chronic liver problems, liver cancer, and even premature death.

The council sounded very paternalistic when saying that parents need to carefully consider whether to vaccinate their newly born child. To me this puts the blame on whatever happens to the infant squarely on the parents. And the verbal poison the parents are being exposed to on social media via “mommy groups”.

How did we get here?

Oh, so many reasons. MAHA, the influencers who want to see the world burn, those who want to control women and babies.

It is a tale as old as time. Control the babies, control the women. But at the black heart of it is control the women because, they, as CIS men, know best. But the 6 men and women on the committee that voted for this monstrosity of a recommendation will be dead when the first babies, who will be born shortly, starts showing the liver damage.

There was a paper written on the “Economic evaluation of delaying the infant hepatitis B vaccination schedule”. The paper was written by Eric W. Hall, Prabhu Gounder, Heather Bradly, and Noele P. Nelson and published in medRxiv on November 25, 2025. Citation at the end of the post.

Each of the delayed vaccination scenarios were modeled on a Markov model to simulate lifetime health outcomes for babies who have the vaccine, those who have a delayed vaccine, and those who have no vaccine, among others. The costs of the attendant liver problems skyrocketed, as did the infections and possible/probably early death.

The conclusion of this paper is that even brief delays in hep B vaccine initiation exacts a wide cost to the person (baby) being vaccinated. The cost cited is hep B infections, chronic liver problems, including cirrhosis, and cancer, decrease in life years (meaning the possibility of early death), and the list goes on. This points a number to what will happen if the hep B vaccination schedule is disrupted.

I found this brief paper very stark and it tells a devastating tale of possible disease and possible death for babies that aren’t vaccinated at birth.

My personal feelings on this are the same as when RFK Jr. came in and cleaned house. This means he fired all the responsible medical type people who were previously on ACIP. It is like when you let the fox in the henhouse and they fire all the roosters who protect the hens and the fox hires other foxes to protect the hens, why are we surprised when the hens all end up dead?

This will end badly and all the culprits will be dead by the time the damage is assessed.

Hall, E. W., Gounder, P., Bradley, H., Nelson, N. P., Hall, E. W., Gounder, P., Bradley, H., & Nelson, N. P. (2025). Economic evaluation of delaying the infant hepatitis B vaccination schedule. bioRxiv (Cold Spring Harbor Laboratory). https://doi.org/10.1101/2025.11.24.25340907

Cookie Thursday 12/4/25- It’s beginning to look a lot like Chex-mas!

I think the Chex that I make is more popular than the Jalapeño Chocolate Chip Cookies.

I wonder if the fact that I only make it during December adds to its popularity.

I mean, if I made it monthly I think people would get tired of it.

As the department knows that I make cookies on Thursdays and Chex mix only in December some start asking for it in October.

When I was at the hospital on Tuesday for a half shift I erased the board in the lounge and added 12/4/25 CHEX MIX to it. To hype it up a little.

And it delivered.

Three people asked me when I was there for the nursing awards this morning about it.

Another stopped me and asked for the recipe.

Yay.

I use a turkey roasting pan

1 box each of the Family sized corn Chex and rice Chex
1-2 cups mixed nuts (I don’t like brazil nuts so I don’t get that one)
a decent amount of gluten free pretzels, I eyeball this
2 and half sticks of butter
new this year, 1/2 c oil (I wanted to see what this would do. Thumbs up)
Worcestershire sauce 4 good shakes

But the secret sauce is the spice mix.

2 tbs garlic powder
2 tbs onion powder
2 TSP seasoning salt
2 tbs Worcestershire powder (yes this exists and can be used in other things)

Melt the butter in a small pan. While it is melting, put all the dry ingredients into the turkey roasting pan and mix well. After the butter is melted, add the oil. I add the dry powders first and stir well. Once it is incorporated I add the Worcestershire sauce to the mix. Yes, 2 kinds of Worcestershire.

I use less seasoning salt because, well, salt. But the rest you can go ham on and add as much or as little as you want.

Pour the butter/spice mixture over the cereal etc. and stir well to combine.

I stir carefully because the cereal etc. completely fill my roasting pan.

Bake at 250 degrees Fahrenheit, stirring every 20 minutes, for 2 hours.

Let cool. If you taste test before cool the cereal will be bendy and not taste done. Once cool, the cereal will be crisp.

I used to take it in the roasting pan to the hospital but now I use the giant Tupperware covered bowl that I have. Because I would rather replace the Tupperware than the roasting pan if it happens to walk off.

This is the most vibes centered recipe that I make. If you want more pretzels, add more. If you want less nuts, add less. But the double down on the spice mixture stays.