Cookie Thursday 11-17-22- Pumpkin quickies

November theme of fall for Cookie Thursday is a Thing continues. Today’s bake is Pumpkin Quickies.

This was a recipe developed in the 1965, according to B. Dylan Hollis whose YouTube channel is where I found the recipe. I wanted something different than the normal pumpkin cookie recipe.

And these did not disappoint.

Except that y’all know that I do not like box mixes. Or you should. I don’t even have bisquik in the house. And spice cake mix is impossible to find. I went to 4 grocery stores. The selection of box mixes has dwindled dramatically in recent years.

I had a recipe of spice cake mix, and a can of pumpkin puree. That’s it.

Mix and bake at 350 degrees for 12 minutes. That is the entirety of the recipe. And the resulting cookies are cake-like, and springy and soft. Not too bad, will definitely make it onto next year’s fall recipes for Cookie Thursday is a Thing. Maybe with the addition of chocolate chips.

But you don’t want to get too fancy with such a simple recipe. Definitely not drown in out with other flavors, like caramel, or too much chocolate.

Sometimes simple is good.

Like many things in the OR, the recipe is deceptively simple: spice cake box mix and pumpkin puree. That’s it. There are cases in the OR that are that simple, but have a profound effect on patient’s lives. I’m looking at you, carpal tunnel release.

I call them the knife and fork cases. Simple enough cases (no case in the OR is ever simple), that ORs have been doing for years and years and years, with hardly any change in technique or instrumentation. Another that comes to mind is the slash and suck. That is what I call abscess drainage; basically you poke a hole in the big collection of purulent matter, and you suck out what is in there.

I deliberately left the case description to the end because some people might find it nauseating.

But I would argue a good slash and suck is sometimes the best outcome for the patients.

Nothing fancy. Because sometimes that is all you need.

Happy Perioperative Nurses’ Week 2022

Hello and welcome to the perioperative nurses’ week 2022!

There will be cake later.

But this is a check in with the state of our worklife.

How is your work life balance?

Do you get enough sleep?

Do you get enough exercise?

Do you drink enough water?

The answer is a resounding laugh, I am sure.

You can still hear it echoing in the ORs.

But, seriously, how is your staffing?

Is the nursing shortage brought on by other hospitals and travel agencies still on fire?

Health care is in a strange flux right now.

The pandemic is still going strong, especially with the diabolical twins influenza and RSV. I get strange looks everyday when I wear a mask into stores. Don’t care but there you have it. And the newest hilarious gambit is to pretend they can’t hear me.

Bitch, please.

I’ve been wearing a surgical mask in my workaday world for over 20 years. And if the operative field and the CRNA can hear me over the loud music, the suction noises, and the bovie drone, you absolutely can hear me. Stop. It makes you look foolish.

But it makes you feel good. Whatever.

Inflation is still going on. Not as hellacious as it was but still. Prices and life are expensive.

And there is the little matter of an unprovoked war in Ukraine dragging on food prices, and oil prices. That’s been a bundle of joy for the economy.

All we can do is hope it will get better. Life, prices, the war in Ukraine, the pandemic that people have forgot, even as it kills people, staffing. All of it.

Because as Jyn Urso says in Rogue One, a Star Wars story, “We have hope. Rebellions are built on hope.”

But this week is ours to celebrate us. Surgeries could not happen without the expertise of the OR nurse and we matter.

We impact patient care every time a surgeon picks up a scalpel and you call for the surgical pause before incision.

There will most likely be cake in your future. Even if you have to make it yourself.

Monday Musings 11/14/22-patients I carry cont.

I fell into a rabbit hole of my own writing this weekend. When I should have been working on my statistics homework. At the bottom of every blog post, there is a posts related to selection of previous posts.

These are not necessarily related to other posts.

I don’t know why the program thinks so.

I wended deeper and deeper into Dispatches from the Evening Shift archives.

And I say a post about the patients that I carry.

This was a small series I wrote in 2019 about patients who I remember. The first one I highlighted was my very first patient in clinical in 1994. I remember her well.

And that got me to thinking about a patient I had a few years ago, prior to the now customary alerts on the computer regarding gender, and sex, and name changes.

It was a patient who was in the computer system twice.

Same name, same birthday, same address, different genders.

Obviously they were in twice because they were transitioning and the system had not yet been updated.

The CRNA was breathing down my neck about choosing the one that the CRNA felt matched the birth certificate.

And that made me very uncomfortable. Not because they are in the middle of transition. Because this was a person who had made a deliberate and, I’m sure agonizing, choice to present as something else.

But because the CRNA would not fathom that this might be a thing. Their mind was so small that to suggest that it could be a thing enraged them.

And made for a very long case, with them fuming, after the case started and the patient was asleep about how the patient obviously was confused and needed to be taught the ways of the world. The ways that the CRNA felt it should be done.

This patient had to withstand snide comments prior to the case, with the CRNA losing their mind over the possibility that this was the patient’s choice and not the CRNA’s choice.

This was several years ago and the me of today would never have stood for it. I would have used my polite words to tell the CRNA that the patient needed to be cared for in the moment, regardless of how the CRNA thought about it. Definitely not in front of the patient, like the CRNA was doing. And I would have reported the CRNA at the end of the case.

Because people are different. And it is not any of my business what they do with their own lives. All we can do, as health care workers, is honor their choice. Their burden is hard enough without me weighing it down more with judgement.

I think this is a timely musing, as the country is currently embroiled in a witch hunt against people who are different.

Because people are different and that’s okay.

I’ll say it louder if I have to, so the ones with their heads in the sand or fingers in their ears can hear.

I think about that patient now and again, especially when I see another patient alert in the computer system that a patient is non-binary, or prefers different pronouns. The healthcare systems are slowly changing to accommodate them.

I hope the patient from years ago is okay. And I hope they remember not the CRNA who othered them because they dared to be outside of what that CRNA felt was appropriate, but they remember that the care that they got when they needed it was compassionate.

At least, from the circulating nurse.

Post-it Sunday 11/13/22-Cholelithiasis and the 4 Fs no longer apply?

The post-it reads “Lap Chole patients when I was a new nurse, 40, fat, female, flatulent… certainly has changed”.

Before I graduated from nursing school in 2001, what was taught to the nursing students about the four Fs was that the usual gall bladder patient was over 40, was female, was fat, and suffered from flatulence. I distinctly remember this being a topic for a lecture day. And me, being 25, was sure I would never get there.

Um, honey?

Time happens to us all.

And that is not at all the case anymore.

If, indeed, it ever was.

Now that I have been working the OR for 21 years and have done many, many, many gallbladder removals, I can say that this is not the case.

The youngest gall bladder surgery I’ve been involved in was an 18 year old female. And the oldest was a 92 year old man.

This brings to mind so many research questions. Where did the mnemonic come from? Does age have anything to do with it? Does gender have anything to do with it? Is the increasing incidence of other patients that do not fit the mnemonic have anything to do with the now standard laparoscopic approach?

I know that cholelithiasis is a real health problem, impacting many people of all ages, and genders. I’ve seen necrotic gallbladders, and gallbladders with gallstones the size AND color of a robin’s egg. I’ve seen perfectly normal appearing gallbladders that were removed because we were there and the surgeon had thought that it was causing the patient’s symptoms. I’ve seen malignant gallbladders, this is sad and a serious cancer. I’ve casually suggested to a pregnant coworker that the pain under her ribs on the right side might be caused by a sluggish gallbladder (I was right). I’ve prodded my husband to get his gallbladder checked out at age 36 when he would not stop complaining about right sided shoulder pain after eating fast food.

But what I think bothers me about the mnemonic is the casual misogyny of it.

It reeks of there there little lady smugness. And the paternal surgeon who will fix this female.

Ugh.

In a published study from 2013, the group recognized that the age of 40 was no longer relevant. And they posit that the F word for family history be substituted. Published in a journal I had never heard of, but published all the same.

In a what came first the chicken or the egg thought, maybe more women are diagnosed because they are the ones who have the most contact with medicine type people. We all know men who would rather reattach their own thumb with a stapler than see a doctor. I know I certainly do. I also know women like this but women have been told it is better to see doctors more frequently for girly things. And women who are of childbearing age and internal parts are more likely to engage with healthcare providers because of pap smears and other gynecological care that is needed, including pregnancy.

Huh.

I will have to put that thought to bed until I have enough education to fully deal with it.

Take 2 tums and see be in three years when I am done with school.

School Me Saturday 11/12/22-deadlines

There are many deadlines surrounding school.

There is the application deadline.

There is the FAFSA deadline. This is important if you are needing student loans to pay for going back to school.

There is the registration deadline for classes.

Even the start of school is a deadline. Of your spare time.

There are deadlines for papers.

There are deadlines for homework assignments.

There are deadlines for projects.

There are deadlines galore.

Welcome to the world of deadlines.

But each deadline you meet will bring you closer to the end of

  • the quarter
  • the semester
  • the class
  • most importantly, GRADUATION!

Deadlines are not meant to be feared. They are guideposts that are meant to keep you on track.

Hopefully you have a teacher that gives you a lot of warning when things are due. And, if not, your syllabus should have them all listed out for you. And a class calendar should be somewhere.

And doesn’t, you know, completely change the expected order of things.

Apparently, I’m a week ahead of the third class.

oops

Well, at least I only have three things left to do in that class.

And 2 homework assignments due tomorrow in Statistics.

And a giant paper due in the beginning of December for Philosophy.

And a final due in Statistics in the beginning of December.

My advice is to keep track of your deadlines the way it makes sense to you.

I’m a list person myself. And, as an offshoot, a calendar person.

Right foot left foot.

You will get through this.

If not, you tried your best.

Now get out there and show the deadlines that you’ve got this!

Cookie Thursday 11/10/22-Cinnamon cookies

The theme for November remains fall.

I know it is downright chilly in some states, and heaters have been switched on. But here, the Cleveland Pear in my front yard still has leaves. It won’t after tomorrow’s expected downpour, but it still does.

Leaf eradication is in full swing in my neighborhood. That’s not really something I do. I will mulch the leaves, or rak,them into the island in the grass. Do my neighbors care for this? Don’t care. Caterpillars, ground bees, and other insects can winter in it. It is better for the environment that the leaves are not snatched off the ground, bundled into plastic sacks and otherwise hidden away from judgmental eyes.

Fall flavors continue this month. This week the make is cinnamon cookies. This is another wholly original recipe. Before the pandemic Coca Cola released cinnamon coke, a seasonal flavor. If you didn’t try it and don’t care to, that’s okay. More for me. It was awesome and I bought it when it came out in November. As it is seasonal. stock was limited and when it was gone, it was gone. Which led me to decide to make my own. I tried to make cinnamon syrup, and then I realized that there was a cinnamon syrup to flavor coffee. During the horrible days in 2020, I thought it would be a good use of my time that I wasn’t at the hospital to recreate the cinnamon coke. My experiments were so-so and I still had most of the flavoring bottle left.

You know where I am going with this.

That’s right!

I looked at the bottle and though “I wonder if I can cookie this.”

And you can!

The resulting cookies are thin, kind of like a gingersnap but with a wonderful cinnamon flavor. I doubled down and used ground cinnamon in addition.

Because of course I did.

What is Cookie Thursday is a Thing that is not about experimentation? Not much.

That’s it. A cinnamon flavored cookie. Very simple.

Great with tea.

Or coffee.

Or warmed apple cider.

Anything that you use to warm up these days that are getting chilly.

Because baking, like in life, or the OR. Sometimes simplicity is best.

Just because there is a new, very expensive instrument or machine that does the same thing as the old equipment doesn’t mean that it is better. The OR can get caught up in the newest thing must be better. Sometimes yes, sometimes no.

Except Cinnamon Coke.

That stuff is amazing!

RSV, covid, and flu…oh, my

And in the center ring, weighing in at full hospitals, and full Emergency rooms everywhere, that darling of the winter, here for an early engagement, INFLUENZA!!!

In the left ring, just in case the world left it behind, and how could it when it is killing 13,000 Americans a month, COVID!!!

And entering the ring, a new darling of the infectious sort, sickening kids and now adults leading to hospitalizations and full emergency rooms. R. S. V!!!

Let’s get ready to RUMBLE!!!

Now get out there and stir some shit up.

Kill some people.

Sicken some more.

Kids!

Babies!

Grandma!

We’ve got something for everyone.

Long Covid would be ideal.

Let’s throw our weight around and show them we have not disappeared.

We will not be ignored.

It really would have been better if they had kept to mask wearing.

And handwashing.

And vaccinations.

(whispers) But I’ll let you in on a little secret.

Come close.

Closer.

Closer!

6 feet social distance would have helped too.

But humans are stupid.

And their attention span is little, and their distractions many.

Now, go wreck some havoc.

.

oh, and wash your face. I got a little virus on you.

See how easy that was?

Yes, vaccinations could have helped.

For those who can get them.

But humanity isn’t that considerate.

Monday Musings 11/7/22- my mind is blank

Does this ever happen to you?

When you want to do something, something cool, and your mind peace’s out?

Nah, I didn’t think it was me alone.

You know what?

It is okay.

Our minds are busy, busy places.

There is so much to look at.

So much to do.

While you are at work, room 306 needs pre-op antibiotics, room 312 needs to be turned, room 316’s call light is on AGAIN. And the phone will not stop ringing!

Or at home:

Little Timmy has to be picked up from swim practice, Samantha has to be taken to somewhere else.

And you don’t know how you are going to fit it all in?!?

Dinner is late, no one has clean clothes for the week.

Arrghhh! It’s all too much.

Shhh.

It is okay to give yourself a break.

Even if it only a little one.

Relax.

Close your eyes.

And let your mind drift for a moment.

Only, don’t do it at a stoplight. Wait until you are off the road.

It will be okay.

After all, most of these “MUST DOS” are things that we get ourselves into. Thinking we have more time and more attention than we actually have.

It is okay.

Read a book. Take a nap.

Your mind can be blank once in a while.

The world will come crashing into focus sooner or later.

And things will get done. Timmy will be picked up, Samantha will be where she has to be.

Cut yourself some slack, okay?

Post-it Sunday 11/6/22-NPO is not just a suggestion

The gown card reads ‘unauthorized water.’

I remember this, because it happens ALL the TIME.

NPO is not just a suggestion and up to the patient to follow or not follow.

I know it’s tough to have a long wait. Especially when you are thirsty.

I know.

Sometimes cases run over but when we ask re NPO, that means nothing per os, or nothing by mouth.

Nothing.

Not unauthorized water from an unknown source.

Although, as an aside, when you are thirsty and uninterested to going to get a glass of water from the kitchen, that water tastes the best. Like, ever.

We will know.

We always know.

Especially when your CRNA has to suck it from your lungs,

Because after you’ve been put under anesthesia, you are no longer able to protect your airway.

And what was in your stomach comes up.

It sucks. I know.

But it beats aspiration pneumonia.

Just imagine that you had a laryngeal mask airway (LMA) in which does not cut your lungs off from your stomach. We use these with people who are at low risk for aspiration. AND NPO for 8 hours.

Why? It is gentler on the throat and means that we can remove it sooner and still keep you asleep for your surgery.

If your stomach contents make a surprise visit after the LMA has been seated, the acid and contents can go into your lungs. Causing aspiration pneumonia. And a surprise intubation is no one’s idea of fun. The endotracheal tube has to stay in place until you are awake enough to protect your airway and protest the tube down your main bronchus.

Remember this next time you want to drink bathroom tap water because it has been SOOOOO long, and you’ve been thirsty for SOOOOO long.

Is it worth it?

Is it worth possibly dying?

I don’t think so.

School Me Saturdays 11/5/22-Syllabus

I remember when I was at the university bookstore in Creigton in 1993. Stacks upon stacks of books broken down by discipline and then by class. You hunted until you found your discipline and then you looked for books for each class. Of course, you also needed the syllabus for each class.

A syllabus is a roadmap for the class. Expectations, due dates, grading rubrics were all in the syllabus. And instructors WANTED you to read the syllabus, if only to cut down on repeated questions.

Think of the syllavus as the FAQ of the class.

In 1993, they were printed and sold next to the book for the class.

When I was at Napa Valley College in 1998, they were printed and sold next to the book for the class.

I’m not sure when, in the heady days of the internet emerging to what it could be, not just cat pictures and insane rhetoric, the syllabus started to be put online and the colleges and universities stopped printing them. Definitely before I started an online only degree at Chamberlain in 2015.

Now they are all online. There is not a printed syllabus to be found.

Anywhere,

This is good in two ways.

  • Being online means that the demand for trees for paper for printing goes away
  • Since the printing costs are no longer there to justify the cost of the syllabus, they are just bundled in with class announcement

Every class begins the same way.

Read your syllabus. And if you have any additional questions, ask.

As a serious type of student, I have read the syllabus for all three of my classes. Twice.

And I refer to them often.

And sometimes my third reading shows me something I never noticed before. An often vital piece of information that made it all clear.

And you feel silly for an hour or so. After all, it is there in black and white.

And then you regroup and go back to writing the paper. Or studying for the exam.

It will be okay.