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.

When I get a green light, especially if I’ve been sitting at the red light and I am the first to go, I pause, very briefly, and look both ways.

You know, the way we were taught to cross a street as a pedestrian.

As children!

I do this because I have noticed a distinct increase in red light runners.

Those who cannot be bothered to be stopped by a bit of red plastic.

I mean, who does the light think it is?

Doesn’t the light know that you in the little sportscar, or the big truck, or the minivan, or the sedan are important and have places to go!

Time is a-wasting, after all.

This habit of pausing has saved my life many times.

I mean it, MANY times.

Because someone is too impatient to follow the rules of the road or the laws in their state.

Because, they have places to go, man!

I am important.

Yeah, so is the stroller that you hit, or the pedestrian that you creamed with the several thousand-pound machine.

Why is your life and desires and needs more important than theirs?

On my way to the hospital last night, I saw three red-light runners. During a three-mile trip, that is impressive. And dangerous.

Not only to you who is piloting the car but to the others that you might impact by pursuing this dangerous habit.

Is there a scare-them video for this like the ones we had to watch to get our driver’s license in the 1990s? A Blood on the Highway type video?

Maybe it can be called Red is the Blood. Or something to that effect.

Maybe Red Death, Green Insurance Money to the Victims.

I’ll keep thinking about it.

Until the dangerous drivers get their collective heads out of their collective orifices, take a second to pause at each red light.

You might save yourself and anyone else in the car.

Apparently, last month I started doing the monthly personal reports on the first day of school. Which led to September’s report being today.

I’m okay with that.

We just finished the 5th week of school. The professor in my policy and ethics class pointed that out.

And I’ve already done so much.

In my first class, which is a quantitative research class, I gave a presentation yesterday on Quasi-Experimental Non-Equivalent Control Group. Every time I said the entirety of what I was discussing I cringed a bit. That is a lot of words. Of course, I broke down the discussion by defining all the words and then bringing the definition of each word into the presentation before I explained the entire thing.

I am not a good presenter. But I keep plugging at it in hopes of improvement.

In this class, there have been 5 weeks of reading the textbook, 11 articles to critically read, one presentation given, and a discussion post where we dissected an article. Next in this class is a literature synthesis exercise due at the end of the month.

Behind door number 2, there is a health disparities class. This class is completely asynchronous, which means there isn’t a face-to-face online class every week. It is read and learn on your own. This class is the only one of the three like this.

So far in this class, there have been 5 weeks of reading parts of the 2 textbooks, watching of many videos and a few Ted Talks, the reading of 22 articles, and more taped lectures. So much reading! My presentation in this class isn’t until the end of the month, with a discussion question due at the end of next week.

Last, but not least, is the advanced health policies and ethics. The students in this class, myself included, are not shy when it comes to discussing the importance of the 6-9 articles we’ve read. There are also weekly textbook readings and videos to watch. The next assignment I have in this class is a policy presentation around a policy of our choosing, but hopefully around our area of interest. This is due at the end of the month, and I already have an idea, and I’ve started researching it.

There are less assignments in grad school which ratchets up the pressure to perform well on them.

The research assisting that I am doing is going well. I met with the PhD nurse and she has been giving me assignments. I am learning a lot, which is what I wanted.

Of interest to my cohort is the qualitative class we have to take during spring semester, and also the comprehensive exam. This is the multi-paper written exam that shows what we have learned in our time in the PhD program. It is also the mark that separates us as PhD students and, with the addition of an approved dissertation project, after which we can call ourselves PhD candidates.

I’ll just keep plugging away at my reading.

I dislike peanut butter cookies. I don’t seek them out as a matter of fact. The last time I baked a peanut butter cookie there was frosting involved because I made a Nutter Butter knockoff. You know, the peanut butter sandwich cookies with frosting in the middle.

Frosting makes everything better.

But as the theme of the September is Sourdough Wastes I was looking at recipes for using the sourdough waste that I generate every time I feed the sourdough. Most of the recipes are bread-based. But bread can’t be scaled up to feed upwards of 60 people.

Then I saw the sourdough peanut butter cookies recipe. I thought I could do that.

And I did.

Is the resultant cookie a bit sourdough-tasting? Yes, and I think it complements the peanut butter well.

Is the resulting cookie not very sweet? Yes, which I would see as a detractor for this cookie although I often bake not very sweet cookies.

Instead of white sugar, brown sugar was an ingredient. Otherwise, the recipe was very familiar. With the additions of peanut butter and sourdough waste.

I found them a little bland with not as much peanut butter flavor, more fragile than I expected, and not as sweet as I expected. But I am biased against PB cookies. To me, peanut butter cookies would be best augmented with chocolate.

When I experiment with this cookie, and you know I will, I think I will add more peanut butter and change the sugar to half white sugar and half powdered sugar.

But probably frosting would be great.

Today I presented Cookie Thursday is a Thing in poster form to the North Carolina Nurse Association annual conference. Many people dropped by the poster and expressed interest in doing such a program at their units. Of course, I had business cards to hand out and told everyone to reach out to me with any questions or ideas for recipes. It would have been way cooler if the venue had allowed me to bring in a few dozen cookies.

But it was a Cookie Thursday is a Thing poster presentation on Thursday which was very neat of the universe. At least 10 nurses asked me what about today, where were the cookies for the department on this Thursday? I reassured them all this week’s cookies were brought to the hospital early this morning and put away in an office with instruction to put them out at 1430. At least 50 nurses also expressed dismay that someone had never had a homemade cookie before.

Questions that I will have to address the next time I give this presentation- cost per Cookie Thursday. I was asked this several times. To me, this is a conversation about themes and why this theme and not another. It led to me telling the participants that there were 2 months of inflation bakes last spring and summer when ingredient prices were out of control. This led to a discussion about the most controversial theme of them all: If You Want a Women in the 18th Century So Badly… Reminder this was post Dobbs decision.

I am pleased with the interest and genuinely good questions about Cookie Thursday is a Thing.

For the really fun, today I got an email accepting Cookie Thursday is a Thing at the AORN Expo 2024.

For the really, really fun, I’ve been taking a short 5-week class on Writing for Publication and the subject I am writing about is Cookie Thursday is a Thing.

Maybe this little project of mind has some wings. Morale is important. Small steps to improving morale are also very important. I can’t wait to see how far this goes.