This is the second week of this month’s theme of Gravestone Cookies.

That is recipes that are on tombstones, not in the shape of a gravestone.

This was the first recipe on a tombstone that I saw. I’m not much on candy making, I usually save it for October and the Halloween homemade candy that is the theme of the last Thursday of the month.

One thing that I do know about candy making is that humidity is a threat.

When I woke up this morning, of course it was raining!

I checked the humidity, 74%.

Therefore I waited as long as I could before I dared to start the fudge.

It is still cooking, but I THINK it is setting.

I put the batch into the fridge. We’ll see what that does.

If not, the batch will make fabulous hot chocolate.

Fingers crossed!

I hope Kay likes my reason for making the recipe.

Update from 6 hours later.

Unqualified fail.

I guess the humidity didn’t drop enough.

Hot chocolate anyone?

No, I don’t know where we would be without them.

Sterile processing is the department that takes the used instruments, that are no longer sterile because they’ve been in someone, processes them, puts them into sets, and sterilizes them. For use by the next surgery.

That is a very, very, very simplified discussion of what they actually do.

The instruments start in the decontam room. This is where the instruments are pre-washed for blood and pieces before they go into the big washer that washes them with detergent.

The sterile processing tech has to know the IFU or instructions for use on every single piece of instrumentation and also how to use the many pieces of equipment that are in the department to clean and prepare the instruments for sterilization. After their bath, of course.

The IFU is the sterilization manual for every piece of instrumentation. From the manufacturer.

How long does an arthroscopic shaver have to be cooked?

By cooked, I mean sterilized in the big sterilizer. It is a combination of pressure, and time, and steam.

Kind of like a big Instapot.

Each specialized instrumentation has its own sterilization instructions.

Milking has to do with oiling the hinges. So that the clamps can be open to clamp.

There are also ultrasound machines to get stuck stuff unstuck. And to shake off the bioburden.

There is the sharpener that comes to sharpen all the scissor blades.

There is the steam sterilizer that is run on steam, and pressure, and time to sterilize things.

There is the Sterrad that used to be to sterilize the cameras with a mild form of acid.

There is the plasma sterilizer. It’s not what you think, it is for the more delicate things like batteries that still need to be sterilized for use but can’t be cooked too long or they lose their charge.

There are the 5,621 types of instruments that the sterile processing techs have to be able to identify at a glance and know what kind of instrument tray the instrument belongs in.

This is probably a WAY undercount.

This piece went to ER.

This piece stayed in the OR.

This piece got milked.

This piece stayed dry.

And this piece went whee, whee, whee. All the way home.

You knew where I was going with that, right?

The point is, without the SPD and their specialized knowledge about sterilization the OR would be sunk.

To think that when I was starting in the OR we were still dipping instruments in Cidex. That smell will take you back.

I am not an SPD tech, all the errors are mine. Beyond Clean does that what can, you know?

Beyond Clean is an amazing SPD education hub. I have learned so much!

Words have meaning.

This has been shown over and over and over again.

Heck, Shakespeare’s Hamlet used the word in response to Polonius’ question about what he was reading.

He was reading words. He wasn’t going to tell Polonius what those words were.

In what he was reading, Hamlet knew that the very words were not important. Because words get carried on the wave of other words, in a never-ending maelstrom. By impermanence, I mean lasting for a very short period of time.

Not unlike social media these days and the impermanence of the videos on social media, or reactions to events in the real world. Or the thoughts and prayers that have been forgotten before the reverberation of the event has finished.

Knee-jerk reaction, those thoughts and prayers.

Do you mean them in the moment? Absolutely.

Does the moment fly away? Yes.

However, the meaning of the words can have lasting impacts, even in the far future.

For example, it irks me to no end to hear that everyone is present AND accounted for, instead of the appropriate phrase present OR accounted for. The first means that everyone is present. To say AND accounted for is saying the same thing twice and no one has time for that. The second means that there are some people who are not present but we know where they are.

There are some no-no words that have lasting impacts too. I will not be going into them. But you know what they are.

We will never know the true impact of the words we use until we ask the person. Even then, they may prevaricate or say it doesn’t matter.

But it does, doesn’t it?

Be careful of the words that you use, they may be in the moment and gone, but still have a lasting impact for as long as the person hearing them remembers.

And for some of us, that is a long time indeed.

Yes, I know that I covered thoracic incisions last week. And I was gonna cover head and neck incisions.

oops

However, I realized that I was remiss in covering plastic surgery incisions on the chest. Or breast cancer at all.

These are incisions that don’t go into the thoracic cavity. As they are only skin deep.

I know that they are more than skin deep, I am attempting a metaphor.

Moving on.

October is Breast Cancer Awareness Month here in the United States.

There is so much information out there about breast cancer. Most of it is viewed from a womanly lens.

Cancer doesn’t care if you are a man or a woman.

Breast cancer also doesn’t care. I’ve done mastectomies on men. Men can also be impacted by breast cancer. 1% of all breast cancers occur in men.

In the US, this is 2300 cases of male breast cancer per year. As a diagnosis, it is also becoming more common. Where it was 1in1,000, it is now 1 in 833, according to the website Go Beyond the Pink.

The CDC numbers are that for every 99 women who are diagnosed with breast cancer, 1 man is diagnosed with breast cancer.

Don’t think that because you are a man with a family history of breast cancers, of BRCA1 or BRCA2 family history, you are safe.

Cancer doesn’t care.

Male breast cancers are more likely to be discovered later than women. Because they are discovered later, the disease is more advanced. And harder to treat. Leading to a higher death rate from breast cancer in men. The likelihood of surviving breast cancer in men is 77.6%, compared with 86.4% survival rate for women.

Risk factors include, from the CDC: age, genetic mutations such as the BRCA1 and BRCA2, estrogen-containing medication including estrogens that were used to treat prostate cancer in the past, or estrogens that are used in trans patients, weight, FAMILY HISTORY, liver disease, Klinefelter syndrome where there is an extra X chromosome, and certain conditions that affect the testes.

There are minimal guidelines out there for male breast self-examination. What to do, where to feel, when to do the self-exam.

Every little bit of education helps.

Every little bit of raising awareness helps.

Don’t be afraid of the pink.

Just like sands through an hourglass, this is the timeline of the semester.

Yeah, that is a reference to a soap opera.

But, depending on the start date of the semester, the time is really flying.

At the university I go to this is 8th week of the semester!

Or at the last university I went to for my masters this was the last week of the quarter.

Mind-boggling!

And true.

This is usually when the heat starts ratcheting up on students.

This is midterm week.

Tempers may be short, the caffeine money may be running shorter, and the to-do list per class may be just as long as the first day of class. Well, it might feel like that.

But learning has been going on in the past two months. Time to test that knowledge. Or time to write a paper or three. This depends on the curriculum of the school and the class.

There will probably be presentations though.

Take a deep breath.

In.

Out.

Maybe take a nap. Or have a mental break before hitting the books again.

Remind yourself that you have a family and you love them. Or remind yourself that you have friends and you love them. Remind yourself that you have pets and you love them.

Oh, and the last day to drop a class is right around here too.

That is always an option.

I cannot explain how long I’ve waited to reveal the theme for October.

Excited doesn’t even cut it.

The theme for October will be Gravestone Recipes.

I had been low-key aware of recipes on gravestones in the past but I didn’t see how I could use it as a theme as there weren’t enough recipes available. Until Rosie Grant, a librarian from LA, started making gravestone recipes and sharing them online.

Even my husband saw them and told me it would make a good theme. I know! I practically shouted, I’ve been waiting until October and spooky season to use it.

I have chosen 3 recipes to use for the month. The 4th CTIAT will be the annual homemade candy bash. I’ve been collecting recipes and ingredients for that and I have the CUTEST theme.

The thing about gravestone cookies is there isn’t a lot of room on a gravestone to write. These recipes will be rather simple.

Today’s recipe is a version of the cookies I’ve made many, many times before.

The recipe is titled “Chocolate Oatmeal Cookies (no bakes).

The recipe is practically identical to the fudgy cocoa no-bakes that I make.

I usually dole out the mixture on waxed paper and leave it to dry. But I had a brain wave and decided to use the cookie sheets with the silicone liners. Worked very well, but the metal of the cookie sheet got rather hot.

I will probably use the cookie sheets and silicone liners again. After the cookie sheet cooled off, the cookies dried as usual.

Every three years the joint commission, formerly and forever known at JCAHO (JAYCO) to those who have been around since before the rebradining, visits each hospital is is responsible for surveying. They just want to ensure that the hospitals are actually doing what they say they are doing.

And you have never witnessed a tizzy like a JCAHO tizzy.

The hospitals are buffed up and painted and cracks are repaired and ceiling tiles inspected.

Employee files are inspected for completeness.

For the OR, there are a couple of different things that can go on. A suveyor can follow a patient through admission to discharge. This can be done to make sure that all the pieces that the organization says it does is actually done in real time. This might take a lot of time and definitely makes the team in the room nervous. Or the surveyor can watch a time out to make sure it is done appropriately. This still makes people nervous, really nervous.

I tell people when they are face to face with a surveyor to always be truthful with their questions. If you don’t know the answer, you can find out. Or you know where to find out.

But most people just hide when the Joint Commission is at the hospital.

Covid gave the Joint Commission a bit of a bumpy time.

At my hospital (we were due in 2020), they had suspended in person visits because of the pandemic. This led to a delay in the survey of about a year, it might have been 18 months.

The Joint Commission is interested on restoring the normal calendar, even if that meant another visit 18 months-2 years after the last.

Same tizzy,

The surveyors will come. Like clockwork. It is to the hospitals advantage to keep key players in place to help guide departments in preparations. This way they will have a front facing person for the surveryors to question.

Speaking to a surveyor is not unlike meeting a wild animal in a dining room. Stay calm, be deliberate in your actions. To quote Phil Slott, an advertising man, “Never let them see you sweat.” Most imporantly, you don’t have to have all the answers, only a few people know and remember all that. It is better that you now where to find the answers and who to ask.

The extra most important thing is to conduct your life as if they can drop in at any time. Because they can. And will, for a sentinel event.

Keep up on damage repairs, always be on the lookout for issues such as stained ceiling tiles. An ounce of prevention will save the hospital hours and many dollars in repair later. My hospital does a really good job in maintaining the hospital plant (that is what it is called).

Also know that there will be a tizzy when surveyors come. A flurry of activity as the water bottles are hidden, as the visible expiration dates are checked, as people are coached, yes, again. As people scurry and hide or walk quickly with purpose if they come across a surveyor.

It’s going to be okay. Just take your mask off when you are done with it, alcohol in and out of rooms, and after an action where you touch a patient.

Take a deep breath.

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.