24- It’s beginning to look a lot like Chex-mas

New month, new theme. This December’s theme is Holiday, just like it has been so many years.

I always start December off by making Chex mix and I only make Chex mix in December. I start buying the ingredients when there is a good buy or a BOGO.

The ingredients that I buy are

garlic powder
onion powder
I use the same Lawry’s seasoning salt because I use much less than the recipe calls for. Too much sodium
family sized Chex mix- Corn and Rice
1 box of wheat chex
pretzel rods
containers of deluxe mixed nuts. I find I don’t care for peanuts so I don’t make it with them
And the most important ingredient of all- butter
Worcestershire sauce/I also use powdered. I find that it makes a big difference

Each batch is made in my turkey roaster. 1 box each of rice and corn Chex and 1/2 box of Wheat Chex. 3 melted sticks of butter, 2-3 tbs each of garlic and onion powder, 2 tsp seasoning salt, 3-4 tbs Worcestershire sauce or 3 tbs powder, 1/4 bag pretzels, 1/2 large container of nuts.

I make the seasoning liquid all together in a small pan, over low heat. The butter is melted first, almost browned butter, add the rest of the seasoning and cook until simmering, stirring occasionally as you mix the rest of the dry ingredients.

Low and slow at 350 degrees Fahrenheit, stirring every 20 minutes for 2 hours.

The first two batches I make have gluten in it and the rest are gluten free.

I probably make 4-5 batches as it is a crowd favorite for Cookie Thursday and a family and friend must have.

The nuts and pretzels can be measured with your heart and any additional addins are allowed and encouraged.

Funny story, today I was dropping off the leftover cinnamon rolls from the nursing awards ceremony at around 1130 to the OR lounge. Someone asked me what was going to be the make this week.

Everyone else had their heads bent to their phone or their food or both. I mentioned that I would be bringing in Chex mix. Everyone stopped moving and raised their heads.

Like I said, department favorite.

Breaking news 12/4/24

It is rare that I get to write about kind of breaking news.

Today there were two separate reports about insurance companies.

12/4/24- United Healthcare CEO Andrew Witty was fatally shot by an unknown assailant outside of a hotel in New York City, and the killing was captured on hotel surveillance. The victim was due to host an investor day in a Hilton hotel. The suspect has not been located. United Healthcare is the largest private health insurer in the U.S.

I don’t have a lot to add except that United Health Care had the largest denial of care rate of all the major insurers.

11/14/24- (not sure why this is just gaining traction today)- Anthem Blue Cross Blue Shield announced that it would not be paying anesthesia costs for the entire duration of a surgery in 3 states. The states are Connecticut, New York, and Missouri. Instead, it would only pay for a certain amount of hours of surgery. Presumably, the patients or the hospital, or the anesthesiologist would have to eat the remaining cost of the anesthesia.

Wow.

No idea where this idea came from. Greed, probably. The insurance parent company reported a 24% year-over-year profit increase in June 2024.

No idea how the decisions were made for how long each surgery will be covered. Presumably not by surgeons.

Because a surgeon would know and understand that there are unforeseen things that can happen during surgery that would make it longer. Does the insurance brain trust that came up with this think that surgeons are just making surgeries longer for the hell of it?

To me, 2 1/2 years into a research degree, this smacks of pilot study.

To be expanded to other states when they can.

You know, for the money. Certainly not for the patients.

Tuesday Top of Mind 12/3/24-Bullying on the Silver Screen

This afternoon I took myself out for a movie date. Just me. My husband doesn’t want to see the movie and there was no reason not to go this afternoon.

I saw Wicked.

Disclosure- the Wicked phenomenon happened WAY after I was out of my Broadway phase. In 2003, when it premiered, I was already deep into my workaholic phase. The term is musical awakening, when you get really into a Broadway show or Broadway musical and it can be defined as listening to the music on repeat. Well, I never had that. There were musicals that I watched many, many, many, many times as a child but they were movies. And only one was based on a Broadway show. Fun fact- I STILL listen to Little Shop of Horrors while doing yard work.

The point is that I missed being obsessed with the musical when it came out. Or any of the hot musicals of the 2000s, 2010s until Hamilton.

Second disclosure- I read the Wicked books years ago. Before I knew it had been turned into a musical. I also read the sequels. Gregory Maguire does some quality work and I highly recommend him.

There will be no spoilers because most of those are out already.

It is a very pretty movie. The music was great and the two leading ladies knocked it out of the park. The sets were great. The pacing was phenomenal and it certainly didn’t feel like we’d been sitting there for nearly 3 hours.

However, at its core, Wicked is about bullying.

Elphaba is different and she is at turns bullied, rejected, and ostracized. Her own father treats her like dirt and rejected her immediately at birth because she is outwardly different than the rest of society. He left her to be raised by the animal nanny bear. She is vulnerable but comes to understand that she will always be the scapegoat, even after scaring away other children who were making her sister cry.

The definition of bullying in the Oxford Dictionary is to “seek to harm, intimidate, or coerce (someone who is perceived as vulnerable).” Elphaba is plenty vulnerable.

I enjoyed the movie but I couldn’t help but overlay today’s political climate over it.

Like the Wizard of Oz says to Elphaba and Glinda, “The best way to bring folks together is to give them a real good enemy.”

That line disquieted me.

That line explains what is happening with the illegal immigrant rhetoric and is at the base of all the trans laws. Basically pitting the “everyday Americans” against the “other”.

I want to shake people and shout “These people are not your enemy! Stop othering them.”

Othering, or giving people a common enemy, is just another word for bullying.

That line, in this political climate, was chilling and a bit enraging.

How many of the people in the theater understood the correlation? Or were they just watching the pretty movie with the pretty music?

Post-it Sunday 12/1/24- 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.