24- glazed ricotta cookies

This cookie doesn’t really fit with the Holiday theme but there is a story behind it that is very Christmassy.

Once upon a time, a long, long time ago, in a galaxy far, far away, I was working as a CNA on a skilled nursing unit of a local hospital. There were all sorts of patients, short-timers, post-total hip or knee patients who would be going home after physical therapy, and even a long, long-timer who had been there for 10 years.

This was a unit that some patients came to after extensive surgery, often from other hospitals. This story is about Gertrude, not her name and I don’t normally add names to my posts but I felt that she needed a name.

Gertrude was from Northern Italy and she had had major abdominal surgery in San Francisco. She had been admitted to our unit to gain additional strength before she went home to her little bungalow.

She needed a lot of assistance when she first came to us, walking to the bathroom, repositioning in bed, and having her drains emptied twice a day. This was a task that was delegated to me.

Gertrude was admitted to the unit in September, with an eye to go home before Christmas. Step by step she became stronger. Step by step her drain was putting less and less fluid. As the months passed, she got stronger and stronger.

In late November she was given a discharge date of December 6th.

As the CNA on the unit, I spent a lot of time with her. She was a very educated woman who delighted in talking literature or the college classes she used to teach. I really enjoyed talking to her.

She would regale me with stories of growing up in Northern Italy as I walked with her to the bathroom and to physical therapy and she talked about her favorite ricotta cookies. I can’t describe the accent she put on ricotta but she swallowed the o sound and made the t’s sharp. She informed me that when she got home she was going to make me her favorite Christmas cookies. I told her she didn’t need to but she insisted she would return.

She was discharged home with her friends on December 6th. Unit life after she left was a little flatter without our daily talks. It was December and December sucks in the hospital. It just does.

Right before Christmas, she made a triumphant return. Her drains had been removed, she was dressed in street clothing and she was all smiles. She was also bearing a box of the ricotta Christmas cookies for the unit nursing staff. With sprinkles. To make them festive.

Those were the most meaningful Christmas cookies that we received that year. But even better was to see her looking happy and healthy as she returned to life outside of the hospital.

That is why I made these glazed ricotta cookies for the December theme.

No sprinkles though. I was out.

Best Kept Secrets of the OR #18- Find Your Why

I know this sounds more like a navel gazing exercise than a secret of the operating room. I bet if you polled the long-timers in the OR, those who have been in the role for years, every single why would be different. And every single why probably has something to do with the patient.

Because when it works and all cylinders are rocking and rolling, and every potential catastrophe is dealt with it is beautiful.

Here is mine.

‘This.

This is why we do what we do. This is why we work the impossible hours, away from our own loved ones. This is why we cheerfully (mostly) smile at our patients and our doctors and do our very best for them.

Because sometimes, it is a awe inspiring ballet of anesthesia, nursing, scrub techs and surgeons all knowing our job and how to help others do their jobs. Ordering labs during the case on the in room computer, putting in lines, getting patients from the ICU ourselves when it is necessary getting blood products, keeping one step ahead of the sterile team.

This saving of a life can be a thing of outstanding grace and beauty.

Because you go home at the end of the day, exhausted, exhilarated. And that patient is alive because of you and the incredible tango you have all just performed, just for them, to the beat of their heart monitors and their breaths.’

According to my notes, I wrote this on December 16th, 2013. Do I remember the particulars of that case or that patient? No, but I would bet cash money that the patient hemorrhaged. When a patient hemorrhages, it is all hands on deck. Heck, if you can beg, borrow, or steal other hands do so. The hands don’t even have to be OR hands; I’ve pulled in PACU people before.

The saving of a life can be a thing of outstanding grace and beauty.

Still is, more than 10 years later. Which is why I will never leave the OR. As long as I am capable, I am there.

Tuesday Top of Mind 12/17/24- Your grandparents would be rolling over in their graves if they knew!

I am not going to ask how we got here. It’s bad enough that we are here.

By that I mean the rampant feeling by some LOUD segment of the population that vaccines aren’t important. So unimportant that they don’t want them and, furthermore, their children don’t want them. Yes, I know that is grammatically incorrect.

They feel that the diseases that are currently being vaccinated against are a thing of the past. After all, THEY never heard of anyone getting whooping cough, or tetanus, or measles. And THEY certainly never had it themselves.

Now the anti-vaccinator himself, RFK Jr., has ingratiated himself into an essential job at the government level. He will be handed control of the Health and Human Services. This is a man who caused a fatal outbreak of measles in Samoa tby peddling his snake oil and misinformation about vaccines.

This man is not a doctor.

Like the yummy mummies on social media who are anti-vaxers and never expose their precious offspring to “chemicals” like di-hydrogen monoxide, that’s water, by the way. Until one of their children comes out with a PREVENTABLE disease, like influenza or measles, and dies. Then comes the rending of the clothes and the gnashing of the teeth and the wailing and fake tears. And the claims that no one told them that precious little Timmy-kins could die. After all, they just wanted to fit in with Tiffiny and Karin.

Spare me.

I’ve only read examples of death by tetanus. This is where your muscles lock up so tightly because of the toxin. The muscles are so rigid that bones break. Sounds horrible and not something I’d wish on my worst enemy. If I had any enemies, that is.

My great, great-aunt died of pertussis in the 1930s, even though a vaccine had been developed in 1914. The vaccine wasn’t widely used until the 1940s.

The DTP (diphtheria, pertussis, and tetanus) vaccine is a 3 vaccine for 1 shot deal. The caveat is that it only lasts for 10 years.

The flu shot is widely available, beginning in the fall. This is a yearly vaccine that everyone should get. After all, 28,000 people died of the flu in 2023 and the young, the old, and the immunocompromised are at risk, even with a vaccine.

Is this ringing a bell?

Same things we said about the covid vaccine and there were still millions of people who died worldwide. How many? We don’t know because they STOPPED collecting/reporting the data.

Your grandparents and great-grandparents lost children to what we can now prevent and would look at you in disappointment when you decide to listen to disgraced doctor Andrew Wakefield and his many, many, many, many times disproven paper that linked vaccines and autism.

Double spare me.

Better yet, spare your kids.

Post-it Sunday 12/15/24-Napoleon who?

The post-it reads “The shortest surgeons are the biggest assholes.”

That could be the complete post right there. It is truth. If we have all decided that this is truth, we have to unpack it a bit.

The question remains what level of asshole.

Because, yes Virginia, there are levels to asshole. It is nearly Christmas and that IS a Christmas reference. It refers to the 1897 editorial where Virginia’s question is answered.

There is the instrument-throwing asshole. These are the ones who decide that the instruments are not up to snuff and they are tired of complaining about it. Hence, the throwing of the instruments. This is also one of the angrier assholes.

There is the globe-trotting asshole. These are the ones who absolutely, positively need to add on a case and the case has to be done as soon as possible because they have a plane to catch. Do they really? Or is that a handy excuse.

There is the gotta make dinner with the spouse asshole. These are the ones who swan up an hour late and try to get finished with surgery in time to meet their spouse at a restaurant. This is a close cousin to the globe-trotting asshole.

There is the deity’s gift to surgery. These are the ones who decided that the rules do not apply to them and they can absolutely jump the add-on line. After all, do you not know who they are?

There is the my father will hear about this asshole. These are the ones who followed in daddy’s footsteps and became a surgeon. They are a short step away from deity’s gift to surgery type but there are enough of them I decided they needed their own subcategory.

There is the operate on holidays because they are a miserable bastard asshole. Yes, I’ve worked with one of these. They were not religious and called us out on every, single holiday, especially Christmas. And 4th of July. And Memorial Day. And Labor Day. And President’s Day (this is a real holiday in California). And Thanksgiving. And New Year’s Eve. And New Year’s Day. Why they were on call every danged holiday, I don’t know. At least we were guaranteed call-back pay.

There is the too smart for this room asshole. These are the ones who are convinced that they are the smartest one in the room. We’ve all worked with this one. They delight in the “Well, actually” put down and mansplain or womansplain or theysplain the ENTIRE case.

Of course, there are exceptions to every one of these categories. Sometimes a short surgeon isn’t an asshole, sometimes a surgeon really does need to catch that flight, sometimes the spouse will leave them if they are late one more time because they have been taking care of patients, but sometimes they are just assholes. No matter their height.

School Me Saturday 12/14/24- CV reminder

A CV is a curriculum vitae. It is beyond a resume, which may cover a portion of your working and school life. The CV covers all the amazing things that you got to do, not only in your working life, but in your schooling life.

Writing your CV is important. It shows the ways you’ve changed in your working or schooling life and it also shows ALL the things that you’ve done in those lives. These can be awards, committees that you are on, or organizations and certifications that you have.

If you are still at school ask the writing center for help crafting your CV. Do not raw dog it like I did.

Just like you have a current and up-to-date resume ready to go at all times just in case, you should also be looking at your CV and adding things that you’ve done.

I recommend doing this yearly. Or when someone asks for it. I have several saved on the cloud, each named with my name and the year. But, Kate, why keep the old ones? Sometimes you want to reminisce who you were before all the work.

Personally, I update both the resume and the CV every year after I submit and receive confirmation of the clinical ladder. Seven years I’ve been a level 5 at my hospital. That is an accomplishment that makes me proud.

I was polishing my CV for a project not related to school or work when I realized there is a big chunk missing. I was a subject matter expert when the hospital system I work for was building out their EPIC. This means that I gathered with a bunch of other OR people and we hashed out the bare bones of what the EPIC should look like. I went back to the training computers when the build was complete and EPIC ready to release the system’s version to us so I could train other nurses and be the superuser for the surgeons.

The surgeons have never forgotten that I am the point person in the department with EPIC issues. It’s been 13 years and I still field questions regularly.

This was no where on my CV. Of course I had to add it. I also added the part about the subject matter expert and I also updated the non Dispatches from the Evening Shift writing that I do.

The moral of today’s story is when you get invited to do amazing things don’t forget to put it on your CV. Doing so shows that you are willing to take risks and also be involved in the hospital’s affairs.

Today’s homework is to bring up your resume and read it for completeness. Also get started on your CV. Be aware that this may take several passes. But it is so worth it.

Even if the only person you amaze is yourself.

FFS 12/12/24-FINE

News flash women are not fine. We haven’t been for a long time. But we just shove whatever we are feeling under the rug and promise to get to it later. News flash, later never comes.

When I had just graduated from middle school, in 1989, Aerosmith put out a record Pumped with the song F.I.N.E. as the second track. To Steven Tyler and Joe Perry, FINE stood for fucked up, insecure, neurotic, and emotional. The song doesn’t reference fine, but the liner notes mentioned that it stood for Fucked up, Insecure, Neurotic, and Emotional. He was referring to himself.

By the time I was in high school, someone, probably teenage boys, had taken those initials and decided it was about women. With that, they branded all women Fucked up, Insecure, Needy, and Emotional. Teenage girls and women are none of those things. It does not escape my attention that all of these are adjectives that they want to use to tar and feather us, to make women, no matter the way she got that way, feel lesser.

But they didn’t care and they made that acronym the center of all their interactions with women.

It is time to take back the acronym, especially in light of how some men and some boys reacted to the election, by becoming grosser. I didn’t think that was possible.

Women are under real threat in the next four years. I don’t want to start down that slippery slope that the Dobbs decision put us on.

Instead of Fucked Up, women need to be Fired Up.

Instead of Insecure, women need to be Incensed. Irate is also a word choice for the I.

Instead of neurotic, women are Not Having It. This means we are done with coddling men and doing all the things. It is time we women demand equal participation of men in the domestic life. They are not “babysitting” their own children, they are being a dad. They are not “helping” around the house, they are participating in the running of the household. This should be the bare minimum of the ask.

Instead of Emotional, women are Equal. We should start acting like it.

There you have it. F.I.N.E. rewritten for the world of 2024.

Cookie Thursday 12/12/24-rosemary thumbprint cookies with white chocolate ganache

In Hamlet Ophelia gave Laertes Rosemary, reminding him that it was for remembrance.

I think that is a striking part of the play when she moves around the stage giving flowers to people. Rosemary for remembrance, pansies for thoughts, and fennel, and columbines, and rue. She ends with the daisies and violets that withered when her father died.

Today rosemary is for remembrance. And because the bush is loosely associated with the holidays as it is evergreen, even in the depths of winter.

I saw this recipe and immediately knew that I wanted to make it. I informed the recipe’s creator that I was going to make it for Cookie Thursday is a Thing and she encouraged me and told me to report back.

A dispatch I can do.

Reading the recipe I was concerned that there were not enough wet stuff for all the dry stuff. The recipe only calls for 14 tablespoons of butter (about 1 and 3/4 sticks) and 2 3/4 cups of dry stuff. The dry ingredients are cornstarch, flour, and sugar. This ratio seemed way off. The other recipes that I use for shortbread have a bit more wet stuff. The recipe also calls for 5 tablespoons of rosemary, chopped fine.

This is a very dry dough, crumbly even. The recipe says to use your fingers to mold it into a cohesive dough. And then rest it for 20 minutes.

I used smaller dough balls than called for. My dough balls were about 1 to 1 1/2 inch thick. I formed the thumbprints prior to baking. I did use a spoon to re-thumbprint them after baking.

I did not use white chocolate and heavy cream to make the ganache. I used straight up candiquik. Not sorry. These baked up easily and cooled quickly, which is good because I was on deadline for cookie delivery and I worked last night.

The delicateness of the rosemary shortbread with just a touch of white chocolate to smooth the taste out is divine.

I will 100% make these again. Perhaps, next time, with a savory thumbprint. I am wondering what goes well with rosemary. .

I wonder what else is in my spice cabinet that can be made using this recipe as a base.

Best Kept Secrets of the OR # 17- December blows

I know I have written about this before but it bears repeating.

When you are working in healthcare, December sucks for a variety of reasons:

Labor and Delivery has all the babies due that were conceived in the coldest month of the year. We know what some people do to keep warm and entertained during the long winter’s night.

Emergency Room has all the people who did not get any of their vaccinations and NOW want the ER to save their asses. This department also has all the slip-on wet leaves and fall patients. Add a soupcon of all the patients who don’t care what they are eating because it is the “Holidays!” and have probably gone off their prescribed diets.

Med-Surg has all the post-op and post-procedure patients and the emergency room patients who have been admitted.

Cath Lab/Endovascular- similar to the operating room. Also a consequence of all the rich eating that takes place during the holidays.

Operating Room has all the patients who have met their deductible and require surgery before the end of the year. After all, that is when the deductible ticker will click back to zero and the paying of the deductible starts again.

Oh, and everyone would like to 1) have their babies, 2) get that rash looked at, 3) go home after recovering in the hospital, and 4/5) have their procedures done while they have maxed out their deductible before Christmas. So they can be home to celebrate with the family. And eat all the things they couldn’t have in the hospital, which lands some of them back in the hospital, to be admitted, to be discharged, to eat all the things they couldn’t have in the hospital… Etc.

A vicious cycle.

Isn’t American healthcare fun?

Tuesday Top of Mind 12/10/24- Sympathy for the devil?

This is a follow-up from last Wednesday’s post when there were 2 separate healthcare related breaking news items. The United Healthcare CEO who was shot and the Anthem Blue Cross Blue Shield only paying for X amount of anesthesia for any given case. And the insurance company solves for X.

The entire US was on edge and reacting to both these news items ALL WEEK LONG.

On Friday, December 6th, Anthem came out and rescinded the suddenly toxic policy. You know what dispells gloom in a fairy tale? Or what gets rid of mold in the house? Light. If you shine light on an issue the rats will run. Yes, I am aware that I am mixing my metaphors. The sentiment is true. If we pay enough attention to the shitty things that corporations do, we might be able to stop some of their worst impulses as they chase profit.

I have additional thoughts.

The reaction to the shooting and subsequent death has been fascinating. It has been the man is dead, yes, his wife widowed, yes, and his children half-orphaned yes. But people are flipping the script and talking about how many people have died because of the policies that enriched the insurance companies. Some people are even sharing what happened to them or a loved one. The stories of denial of care are heartbreaking.

Can we have compassion for his family? Yes. Can we hate what he worked and stood for? Another yes. Does the American public who has had their care nickeled and dimed for years have sympathy? Not many, and more would sooner have sympathy for the devil.

No American, not even a rich, conservative Ivy graduate like the accused, hasn’t been harmed or denied by the privatized healthcare in this country.

Note- he has only been charged, there has been no trial, and he is fighting extradition back to New York.

The First Rule of Acquisition is once you have their money, you never give it back. Sounds a lot like healthcare in the US does it not?

I am referring, of course, to the 285 Rules of Acquisition that were set out and explored on Star Trek: Deep Space Nine.

If they can deny and delay and deny and delay and outlast you, the insurance companies don’t have to pay and they get to keep the money. For whatever it is you want them to pay for, all they have to do is make up arcane rules that the consumer unknowingly violates. Oh, they don’t tell you what the rules are. That would be cheating.

Kind of reminds me of “ignorance of the law is no excuse”; which is a legal principle.

The question remains- which one is the devil?

Post-it Sunday 12/8/24- Circuses every where

The gown card reads “Sometimes I feel like running away to join the circus but, really, how much different would that be?”

Dat-dat-dadadaditda
dat da dah
dat-dat-dadadaditda.

You tried it in your head and recognized it immediately, right?

So starts the screamer theme song for many circuses. Because that is what they are called- screamers. These are the marches that the circus is most well-known for. That’s something I learned today.

But this post is about another kind of circus.

The shift circus or the unit circus. It’s all the same.

This person is new and says it was better at their old place and this new place should change so that they are not uncomfortable learning new things anymore.

That person wants to go home early. Again.

That person wants to ride the clock but does not want to actually do work.

This person is riding the clock, waiting to complain that they are being sent home early.

This person has too much education and will not be going home early but will also not do any additional work. Even when asked by the charge nurse.

That person disappears after being sent home and the charge nurse thinks they have left. Only for them to pop up after several hours to inform the charge nurse that it is time for them to go home.

This surgeon is three hours late and wonders why they got bumped. Doesn’t the OR know they are very important? The charge nurse points to the policy that states the next case can begin if a surgeon is more than 1 hour late.

This surgeon wants to add on a surgery, what do you mean there are several cases ahead of me, don’t you know who I am? And they have a tee time/flight/dinner with the family to get to. And they simply cannot be late.

This policy has been changed because the laws in your state are stripping the bodily autonomy away from women. But don’t worry, it isn’t as bad as those other states.

This patient is crashing because no one did a complete history and physical on them. They are crashing because there was no lab work. If a simple CBC or H&H was done, the low blood count would have been picked up on, or the extremely high white count indicating infection somewhere would have been caught and a new total joint would NOT have been put in.

Boy, do I have bad news for myself.

Every hospital/operating room is a circus.

Sometimes in running away from one circus you go from the frying pan into the fire with the next hospital circus.