25- Protest all the way home

When we see injustice it is our duty to speak up.

When we see terror it is our duty to protect those who cannot protect themselves.

When we see powerful people speaking out of their ass it is our duty to remark upon it.

Be like the little girl in the Emperor’s New Clothes By Hans Christian Anderson who points that the emperor is naked during the parade, we have to speak truth to power. This is, of course, after all of his fawning sycophants declared the cloth of gold outfit (that didn’t exist) to be the most handsomest cloth of gold outfit that they’d ever seen and truth the emperor was the most handsome man they had ever seen.

You may remember the emperor had spent so much money on himself that he neglected his subjects and his empire.

Get the point yet?

I hope current events learns from the story. And the emperor is reformed after humiliation but we all know that is unlikely.

Do you know why colleges and universities always have “hot head” students who are shouted down by those in power?

Because college is where you go to learn to think. Because college is where you go to learn to unthink the lies that have been taught to you. Because college is where you go to give a damn what happens to those who have less than you.

No wonder colleges and universities are under ceaseless attack by the administration.

A person who can reason and think clearly outside of propaganda is a person who won’t be fooled by a conman’s false cloth of gold.

This, of course, makes them a target. Because they do not accept cruelty for anyone.

There are massive protests today June 14th, 2025.

It is No Kings Day after all.

It is important to point out and remember that protests look different for everyone. Some protest with their bodies. Some protest by supporting those who are able to participate in marches. Some protest with their words. Some protest by giving to others.

It is important not to stay quiet and to protest in your own way.

FFS Friday 6/13/25-TNTC, aka too numerous to count

On a normal Friday I pick one top of mind issue that is not necessarily medical. And then I write a sweary post about it.

But this week…

This week the issues are literally TNTC.

For those not in the medical field, this means too numerous to count.

This is a lab value that indicates that there that the total number of bacterial colonies exceeds 200 on a 47 mm diameter membrane filter used for coliform detection. To translate, 47 mm is roughly 4 centimeters, or not quite 2 inches. And a coliform is a either a gram positive or gram negative bacillus. A bacillus is a rod shaped germ. These can only be seen under a microscope.

The point is that there are 200 bacterial colonies.

Damn. Let me sum up some more. A colony is a group of germs.

The point is there are at least 200 groups of germs in a less than 2 inch piece of membrane filter. This is literally too numerous to count. The germs are packed in so tightly because there are so many of them that they cannot be counted.

It can be guessed at. But the guess might be wrong.

This is like the “Guess the candy in a jar” party game. You can never really be certain how many germs there are.

Too many.

Too many is the correct answer.

I feel that way about politics these days.

There are too many fucking things to pay attention to.

Like an insane game of Whack-a-mole.

Here there is a plane crash in India that occurred shortly after take off. And someone survived the 600 foot drop and the fireball.

There is yet another bat-shit decision made by the DHHS secretary.

Oh, wait, there are more than one.

Over there is Israel bombing Iran.

Here there is a woman being dragged out of a police car by one ankle, the cop not seeming to care when her head is banged first against the car and then against the ground. Then the cop forces this woman’s head to the left while laying on her back and neck. And the second cop, hands hooked under the bullet proof vest, watching.

There is the deploying of the national guard to a state whose governor didn’t ask for them.

Over here is the deployment of Marines to the same city as the unasked for national guard.

Over there in Florida is the sheriff saying it is okay to kill protestors that are violent. And then he doesn’t define it. There are so many ways that shit can go wrong.

Over there is expansion of PEACEFUL protests across the country.

Over there is the video of a cop breaking their own windshield. Presumably to blame the peaceful protestors.

THERE a United States SENATOR was forced to the ground, while identifying himself and HANDCUFFED for asking an unwanted question about the thuggery going on in his state.

Add in various judicial orders that are gut churning on their own.

All of this since Sunday.

Google TNTC and look at the images. Especially if the image has the progression in a petri dish from no colonies to low colonies to medium colonies to high colonies to TNTC. The image I want to share is copyrighted so words will have to do. And use your imagination. Or Google.

Apparently I am able to share the picture. But not no picture here because I have yet to learn how but the picture will be used on Facebook and Instagram. Citation of the picture at the end of the post.

A petri dish is usually 2.4 inches in diameter. To put it into perspective.

No colonies is a completely empty petri dish.
Low colonies is less than 20 in a petri dish.
Medium colonies are 20-100 in a petri dish.
High colonies is 100-500 in a petri dish.
TNTC is more than 500 in a petri dish.

You get the idea. If it feels like we are in a blender with all this information coming at us and more and more and more and more, that’s because we are. They want everyday Americans to feel terror.

Because that makes us easier to control.

And it fucking sucks.

If you need me tomorrow I will be pocket book protesting and doing things that bring me joy.

Because joy is the antidote to terror.

Citation
Kallam, Brianne & Pettitt-Schieber, Christie & Owen, Medge & Asante, Rebecca & Darko, Elizabeth & Ramaswamy, Rohit. (2018). Implementation science in low-resource settings: using the interactive systems framework to improve hand hygiene in a tertiary hospital in Ghana. International journal for quality in health care : journal of the International Society for Quality in Health Care. 30. 10.1093/intqhc/mzy111.

Cookie Thursday 6/12/25-Spice cake mix with caramel chips

Note to self, make sure that the cake mix has at least 15.25 oz of ingredients.

This week’s cookie was made with a spice cake mix and the mix ins were caramel chips.

I like these so much better than last week. They are reminiscent of gingerbread cookies but softer with more rise. The caramel chips also do some heavy lifting.

Same recipe as before. Box of cake mix, 3 eggs, 1/2 c melted butter, 1 tsp vanilla and the mix ins of choice. I thought caramel would go really well with the warm notes of the spice cake.

I just checked.

The cake mix that I used last week did have 15.25 oz of ingredients but when I poured it out of the box it seemed like very little and when I poured this week’s cake mix out of its box it seemed so much more. And these cookies raised more as well.

The output was the same. 4 full cookie sheets, 12 cookies per sheet. For a total of 48 cookies.

Hmm.

I guess my taste is more to the spicy side and less to the sweet side.

Good to know.

Best Kept Secrets of the OR #?- Happy 23rd birthday, surgical time out!

Once upon a time, when I was just a mere baby nurse, new to the ways of the OR, there was a wrong site surgery in the operating room. I was listening to my preceptor talk about the schedule when a more experienced nurse burst out of their room, nearly in tears, babbling about the video tower being on the wrong side of the room.

The video tower is just what it sounds like. Remember those AV carts in high school and middle school? The ones that the teacher would wheel into a room when they wanted to show a video. Do they still do that? I have no idea. It was a video monitor, a light source and a camera box. Sometimes a printer. That is so the surgeon can insert the arthroscopy camera and see what they need to see and, because of the video set up, so can the rest of the room. The early early scopes didn’t have the camera and a surgeon would hold up the scope to their naked eye and no one else could see. We’ve come a long way, baby.

Another detail that non OR people need to know is that the video tower is on the opposite side of the patient than the operative side. For example, a right knee arthroscopy requires that the video tower be on the left side of the patient.

Clear as mud, right? Just go with it.

The case left knee arthroscopy was the first case of the day in that room. The problem was that the last scope of the previous day had been a right knee arthroscopy and the video tower was pushed back to the wall to the left side of the room. The tower for a left knee scope should’ve been on the patient’s right side. And the nurse, not thinking, had just pulled the tower next to the bed and prepped what she assumed was the correct leg. She assumed that the knee arthroscopy that the patient needed was a right one because the tower was on the left side.

It wasn’t until the surgeon was in the knee, looking around and not seeing the anterior cruciate ligament defect that they even asked to see the consent. The operative consent was for the left knee and they were in the right knee.

Early morning, first case of the day. That was when we didn’t set up the rooms for the next day. It was just convenience that led to the video tower being on the incorrect side. It was just bad luck that the nurse and the surgeon and the scrub tech and the anesthesiologist didn’t recognize the error. This is the very definition of Swiss cheese error.

This is the kind of stuff that I came to understand, very quickly, was nightmare producing. It goes against everything healthcare is supposed to be and a patient was temporarily injured. And inconvenienced. The surgeon had to stop the surgery and, accompanied by the charge nurse, go out to speak to family and tell them what happened. And get permission to do the real surgery on the correct leg. I imagine while this was happening the surgery manager was on the phone with the hospital lawyer. But maybe not, it was a simpler time. The family agreed and the patient got the surgery on the correct leg, and three port sites in their other knee as well. As this was before bilateral orthopedic surgery became more commonplace.

This was before the surgical time was developed and introduced. But wrong site surgery was such a bad thing that the National Quality Forum included it in their never events. These are medical error events that should never be. The surgical time out was the solution developed by AORN.

All members of the OR team must stop what they are doing, agree that this is the correct patient, correct laterality, correct equipment, correct surgeon, correct surgery set up, and correct surgery.

The surgical time out is kind of like the 5 rights of medication administration that they taught us in school. Scratch that, the surgical time out IS the 5 rights of operation.

I still remember when the manager gathered us around not too terribly much later and explained that there was a new WHO tool that had to be done on every surgery. Also why it is called the WHO surgical time out in some hospitals that cling very tightly to their traditions.

Whatever it is called, the surgical time out or “pause” has been integral for stopping surgical mistakes. Thousands, if not millions of them, in the 23 years since its adoption.

Taking the time to pause or stop and agree on all the things is the very best we can do for the patient.

Tuesday Top of Mind 6/10/25- It’s okay to lie to the Senate under oath, I guess. Noted.

This headline can mean so many, many things and so many, many lies. <Cough cough> Brett Cavanaugh, Amy Coney Barrett Neil Gorsuch and the settled law of Roe v Wade. <Cough cough> Michael Cohen and the plans to build a Trump tower in Moscow. <Cough cough> W. Samuel Patten and the little matter of being a foreign agent.

Man, I should really see someone about that cough.

But I will not see RFK Jr. as he is the latest one to outright lie in order to get confirmation.

He told the Senate that he would leave in place the vaccine advisory panel at DHHS. This is a board made up of outside experts on illnesses that can be mitigated by vaccines. You know, people who have been working for literal YEARS in the fight against illnesses that we have a vaccine for.

By this firing and attempting to ram in the anti vaccine zealots and toadies in their place, RFK has come out soundly against science.

Well, we knew that.

He says that to re-establish faith in vaccines this is a step that must be taken. Collectively the entire research community rolled their eyes so hard they could see their very big brains.

Um, dude, the person who broke the faith in vaccines was you. Just you. Also anyone who professed anti vaccine rhetoric for the ‘gram and for the views. And for the money that thrown at them.

It is always the money. The money and the power.

The call is coming from inside the house. And we should all be afraid.

The kicker is we warned you. And warned you. And warned you. We did everything except sky writing. But since we aren’t pretty blond trad wives we were ignored.

People are gonna die. I feel like I say that all the time. Let me check real fast the last several months/years of Tuesday Top of Mind.

Yes, I say it all the time and no one is listening.

Are you paying attention yet?

Medical fiction review 6/8/25- The Surgeon By Tess Gerritsen

The medical fiction book The Surgeon by Tess Gerritsen.

This is another reread. I read it for the first time shortly after its publication in 2001.

I was deep in a murder mystery kick.

Here was an amazing, kick ass, take no shit heroine, Jane Rizzoli. She is on the hunt of a copy-cat serial killer in Boston.

This book series, 13 in all, that introduced Jane Rizzoli police detective to Maura Isles coroner.

They solve crimes together. And were the headliners in a cop and medicine show, a la CSI, NCIS, Crossing Jordan, and a slew of others. This aired from 2010-2016 and had seven seasons in total. I severely curtailed my television viewing in 2010 and I missed this one entirely.

But this is the book that spawned all of that.

I remember at the time that I enjoyed it. Nothing like a good mystery with high stakes and bodies all around. The serial killer this copycat was well copy-catting is a trauma surgeon (Dr. Catherine Cordell) in a Boston hospital who killed the original serial killer. Who happened to be a fellow surgical resident in Georgia.

It sounds more convoluted than it is.

Dr. Cordell is the pre-Isles, I guess. She is traumatized by surviving the original serial killer and had to have the mental fortitude to help find the copy-cat.

Jane is a good all around detective with a chip on her shoulder. She is the only girl in a rough and tumble Boston family. Her fellow detectives treated her poorly, beside her fellow detective Frost. One of them left a tampon in a bottle of water on her desk, hoping for a rise out of her. There is another detective who will be instrumental to the case. And to healing Dr. Cordell.

Misogyny aside this was a solid book.

I thought it would be a stand alone book. I was wrong. Maura Isles is introduced in the next book, The Apprentice. And she and Rizzoli unite against the haters.

Dr. Cordell is off having her happily ever after with Detective Moore.

I give this book a solid B. My first reading was an A. But points off for misogyny that the detectives display and the in poor taste practical jokes they pull on one of their own. It isn’t her fault that she is more observant than them and has a set of breasts. This was before the backlash to the “boys will be boys” pervasive attitude that we’ve been trying to kill for YEARS.

I still have The Surgeon and the second book The Apprentice on my bookshelves.

FFS Friday 6/6/25- Lest We Forget

Today, June 6th, 2025 marks the 81st anniversary of the Allies storming the beaches of Normandy. This is also called the Normandy invasion. The beaches of Normandy ran red with blood that day.

In the largest joint operating the world had ever or has ever seen, the Allies led a combined naval, air and land assault on Nazi occupied France. On Omaha beach, twenty four hundred American soldiers died. That was the deadliest day so far in WWII for Americans.

The British author Rudyard Kipling wrote the Recessional in 1897. The words ‘Lest We Forget’ is the repeated refrain.

We will not forget.

We shall not forget.

Until we do.

The United States of America is in the process of forgetting the hard won battles that brought us to global dominance after World War II. The United States of America is in the process of being led to forget about Allied blood that was spilled during WWII.

Because of attacks on education there are a shocking amount of people who no longer have the capacity to understand just what had happened in WWII. Or understand that Americans bled and died fighting against the very idea of fascism that they now embrace.

They only know what has been spoon fed to them by the algorithm. And their precious Fox news. And their elected officials who prefer when Americans are dumb.

Here is another frighteningly frank F for FFS Friday, Four hundred seven thousand Americans died in WW2.

How many will die in WW3?

Are you paying attention yet?

In other words, stop believing what they want you to believe and pick up a damned history book before they rewrite them.

Cookie Thursday 6/5/25- Cake mix cookies

You know how it goes, late night surgical case, you are shooting the breeze with the CRNA, they start telling you about the cookies they baked with their kids that were so easy and so fun. You say interesting. And they text you the recipe.

No?

Just me then. Okay.

For those who might be worried, the entire exchange took less then three minutes as they were just bursting to tell the department cookie lady about the cookies that they made.

But that got my brain thinking. After the initial ew, no reaction.

When I got home one of my friends had sent me an email of a baker making nearly the exact same cookie. Their recipe allowed for more creativity.

I decided to theme June as cake mix cookie month.

Baking is often seen as elitist. Because baking is very demanding of attention to detail. And precise measurements.

Unless you want to experiment.

I do like an experiment. See also the entire reason that Cookie Thursday still exists and has been going strong for over ten years.

The email from my friend laid out how to be experimental. Within the strict bounds of baking.

I started making lists of combinations of cake mix flavors and mix-ins I could do. A pairing, if you would.

It didn’t hurt that the cake mixes were on sale that week.

I did a quick math in my head. Each recipe takes 1 stick of butter and 2 eggs, plus the mix. Normally in a month I would use 2 pounds of butter as a recipe usually takes 2 sticks. There are 4 sticks in a pound of butter which means I normally go through 2 pounds per month. Butter is still egregiously expensive and is running around $5 a pound. This makes the butter cost of each CTIAT $2.50. The butter cost of these cookies will be cheaper IF I keep the cake mixes under $1.25.

The buy one get one free cake mix deal was looking pretty good. Even better was the coupon I had. AND the place where I bought them doubles coupons with a face value of $1.

The cost of the eggs is the same as a normal batch of cookies takes 2 eggs, just like this recipe.

Not only that but in the scratch and dent produce section, where they sell soon to be expired food stuffs, there was an entire bag of pink chocolate shavings, like you use on cake frosting for decoration. For $1.00. You cannot get chocolate chips for anything near the price.

I used half of the bag in the cookies.

My first thought as I was mixing these up is that there isn’t enough liquid for the amount of solid.

Spoiler alert- there was. Also the 1 tsp of vanilla was helpful.

I will delay judgement on what I really think of the cookies until week 4.

Tuesday Top of Mind 6/3/25- News flash- We are going to die!

The title is referring, of course, to Joni Ernst, an erstwhile senator from Iowa, and her reaction to a concerned constituent at a Town Hall event.

The concerned constituent yelled “Someone is gonna die”.

They were, of course, talking about the long standing plan to cut Medicaid. The bill that has us all on tenterhooks and reacting to how awful it is has passed the House and is at the Senate.

Her reaction, which launched what seems like a million articles, was to say “We are all going to die.” I’m not lying when I say it is giving “let them eat cake” energy.

Her probably supposed to be a joke (maybe) landed with a thud heard around the country. I say probably because that is the type of person she appears to be. Laughing at someone else’s pain. Voting consistently to harm others.

Her response to the backlash was to release a video and continue to joke about how she didn’t know she was telling grown adults a truth. The video was in a cemetery.

She also outed the tooth fairy as not being real. As always she completely misses the point.

Yes, everyone dies. It is a fact of life. There is a finite number of days that each person is granted. You can try not to die by wearing your seatbelt. Or, I don’t know, getting vaccinated against known killer viruses. You can exercise and eat right but that does not forestall death. None of us made a deal with the devil.

Everyone dies.

It is in the manner of death that is important.

The concerned constituent’s point was less o, save me, great and powerful senator, and more people are going to die badly.

Because they will.

Without Medicaid people no longer will have access to even the bare minimum of healthcare. Things like A1c checks for diabetic control would be too expensive for people. Women will no longer get cancer checks such as a pap smear or mammogram. Why? Because they can’t afford it. Cancer will no longer be caught in a treatable phase.

People will die in agony.

Entire towns and cities will suffer as hospitals close. This has already started happening. Becker’s Hospital Review, something I read myself, states that there have been 16 hospital closures in 2025. This rate is up from 25 in all of 2024, and overclocks the 14 cited by OR Manager as closing in 2023. To do the math that is just over 3 a month since January 1st.

People will die.

From neglect, from delayed diagnoses, and from Congress not giving a fuck.

Yes, we know, senator, that everyone will die. But do you have to add fuel to the fire as we all burn to death? Yes, even you.

I know I would prefer not to be tortured to death. Because none of us are getting out of here alive.

What’s in my bag?

I have a confession to make. Not something deep and dark but something a little more fun than that.

I do not carry a purse. I never ever ever have. Don’t get me wrong, a purse is a useful thing. To some people.

I am not that kind of people. I just never got into the habit of carrying anything other than my backpack when I was high school or college. Any of the colleges.

I just done see why I should carry a school bag and a purse. This seems counterintuitive to me. Why carry 2 things when one would do?

To carry the thought further, why carry 1 thing when nothing will work as well.

What about your wallet? I carry it.

What about your phone. I carry it.

What about your keys? I tuck them into the back of the pants/shorts/skirts that I am wearing. The larger key fob keys has made this possible.

There is also this new-fangled thing that men have enjoyed for centuries. It is a small pouch that is sewn into the seam of the pants they are wearing.

I think they call them pockets.

There are a couple of reasons why pockets for women disappeared.

Fashion is one of them. Of course it is. Dresses were cut closer to the body and there was no room for pockets. It would spoil the line, you see.

Apparently there wasn’t any call for women to carry money or to have access to money. After all, the men had pockets. It is the attitude akin to the why teach women to read. Reading and thinking is suspicious.

Eye roll.

Another more sinister reason is that women with pockets were suddenly especially suspicious.

Who knew what she was harboring in her skirts!

A puppy or kitten. Money she had saved from the shopping in order to run away from her abusive husband. Or political tracts/articles that she had no reason to read because she wouldn’t understand them anyway.

This is sarcasm. But what isn’t sarcasm is that it was yet another way to financially control women. Why would a woman need to have money if she could charge anything at the shop with the bills to be sent to her husband. Or her father. Or her brother.

Ahem.

Pockets and access to pockets is not the reason that I’ve never carried anything but a backpack for school or a work bag for the hospital. I have just never cared to.

It just always seemed like something to lose. Not to mention that you have to have one for day and one for going out. You have to match the purse of the day to your outfit.

Frankly, no thank you. I’m a simple soul and I don’t need a purse. But I would like pockets.

To that end all the clothes that I have bought in the last several years must have pockets. Yes, even pajamas. And dresses. And skirts.

The overall secret to this freedom?

Small wallet and minimal keychains. Too many keychains is bad on your ignition anyway.

But what if you need X, Y, Z?

We’ll look at what’s in the wallet next time. But it isn’t much. Simplicity is the keyword, after all.