Tomorrow the remnants of Hurricane Debby will pass through the Carolinas. It has already started in some places. Much rain, much flooding. We are expected to get up to 7 inches of rain.

On top of the good soaking, we got over the past two weeks.

I mean we were in a drought in July, But we got a couple of hundred percentage of normal rain fall in the last 30 days. This is roughly 4 inches of rain. Or more.

Meteorology is not exactly an exact science.

The microclimates around here are fascinating. Because some parts of the county are considered dry.

Go figure.

But back to the best kept secrets of the OR.

PATIENTS ALWAYS SHOW UP FOR THEIR SURGERY DATE!

No matter the weather conditions.

Rain.

Hail.

Snow.

Hurricane.

Flood.

They always show up.

Which means you are expected to show up too.

Sometimes hospitals will send a car. But don’t get used to that.

There are no snow days in the OR.

Or hurricane days.

But be safe out there.

We need some basic definitions.

Ob-Gyn- obstetrics and gynecology. This is the branch of medicine that deals with female-type things. This may be pregnancy and babies, this may be cancer care, this may be menopause care. Basically from puberty until death, ob-gyn has it covered. This is where the babies are born. True, there are some very stressful parts because body parts develop cancer. But, on the whole, everyone loves babies, even if there is an issue with a birth that impacts the child, they are on the hot seat for lawsuits for 18 years. And sometimes more than that.

Desert- The Merriam-Webster definition is arid land usually with sparse vegetation; especially land that is very warm climate, which receives less than 25 centimeters of rainfall per year. I’ll do the math, 25 cm is roughly 10 inches. Of precipitation. In a year.

However, the Oxford Languages dictionary defines abandon (a person, cause, or organization) in a way considered disloyal or treacherous. “we feel our public representatives have deserted us”. Huh, hold that thought.

What is an Ob-Gyn desert? This is where the ob-gyns have voluntarily left. Yes, all of them. They have gone for a variety of reasons, the biggest one being laws that do not let them practice to the best of their abilities, at the top of their license.

You know the ones I mean.

It’s like these doctors don’t want to torture the unborn or their parents.

Strange, I know.

But let’s return to the Oxford Languages definition. Perhaps the growing ob-gyn desert is because they have been betrayed by the political parties (mostly on the right) at every level of government.

I mean, they can take a hint.

And so they are leaving the states that want to prosecute them for providing needed care to patients at very vulnerable times in their lives.

It’s not like are slaves and can be FORCED to stay.

They are simply exerting their freedom not to be in a place where they can’t give care to patients who desperately need it. This is a big country, after all.

Maybe don’t make the ob-gyns torture the unborn and the females they have put in 4 years of undergraduate college, 4 years of medical school, 4 years of residency, and passing their board specialty exam.

Because they have options of where to live and where to practice.

You probably should’ve thought of that.

The post-it reads “Prior authorization has negative impact for patients.”

Yeah, I got this from one of the OR newsletters I read.

And also, no shit, Sherlock!

Prior authorization is when you have to go before the insurance board, the insurance that you pay for, and ask for a test, physical therapy, imaging studies, surgery for your appendix, and what have you, you have to seek permission. You have to seek permission for the care that you need.

It’s like we are all back in grade school, asking the mean old nun for a pass to go to the bathroom. The kicker is that, just like then, what you seek, and what you really, really need, can be denied at their whim.

This is from an article about a physician survey that illustrates how negative the impact can be of prior authorization.

The biggest no-duh is that necessary care is delayed, as relayed by 940/1000 survey respondents.

19% cited serious adverse events suffered by patients because of denial of prior authorization.

Serious adverse events leading to life-threatening events and needed intervention to prevent permanent impairment happened 13% of the time, according to these doctors.

Even more serious adverse events, including disability, permanent harm, birth defects, and DEATH happened 7% of the time due to denial of prior authorization.

Yeah, I like it when my insurance company is not actively seeking to kill me.

Often with no explanation; just to save a buck.

This has to do with the allocation of resources, I get it. I understand that not everyone can be saved.

But, the article goes on to say that it is not other peer-to-peer medical type people making these seemingly off-the-cuff decisions.

Seeking prior authorization, often more than once, and not being able to have a doctor to doctor conversation where they speak the same language? How much does that cost the medical practice?

Sounds like being penny wise and pound foolish.

Has prior authorization outgrown its banks?

Absolutely!

I’m open to suggestions about how to fix the dumpster fire.

Or do we continue to let it burn? And continue to hurt, disable, and kill patients?

Where is that lawsuit?

Oops, I said the L word.

Well, it’s been a minute since I did a personal PhD update. I’ve been having so much fun with the Alice in Wonderland theme.

Since we go back at the end of August for the fall semester, I felt this would be a good time for a personal PhD program update. Of interest only to me and my family but I don’t care.

I have spent 2 years working as a research assistant. I’ve learned so much about conducting research, synthesizing the research that I found for the professor, finding different articles for the professor, writing reports, creating and editing tables in Word, proofreading, and creating surveys Qualtrics. I’ve even done data cleaning for statistical analysis.

I have been hemming and hawing and turning over in my mind NOT continuing for RA in my last year. Yes, there would be an extra sticker on my diploma for being an RA all three years but the commute was draining me. You might remember, that Mondays are RA days during the semester. This is 15 weeks of being on call Sunday night (hoping beyond hope there is no case), getting up at 0500, leaving at 0600, getting to the university at 0730, starting work at 0800, doing tasks until 1800, and then driving home, to be on call at 2100. Very long day. So long I often took Tuesday off in recuperation. Rinse and repeat the next week.

Well, I have scholarship money that needs to be used. After many conversations with my husband, with my mom (my mentor), my friends (who have been so supportive in this whole endeavor), and with myself, I decided not to work as an RA this last year. Because it is nearly time for the Big Write. I emailed the professor and the department RA handler of my decision last week.

I am at peace with that decision.

In preparation for the Big Write, and to get my head back in the class space, I took a summer session class about professional writing. This was an English class. I struck me as I was taking the class that it is the first English class of any sort that I have taken in my 4 other programs. This is because I have always tested out of any English requirement and I took AP English my senior year in high school. Considering I was the only health studies/nursing student, I really enjoyed the class and I would suggest it to anyone who needs encouragement and writing practice. It was all about creating a writing schedule and STICKING to it. I will definitely be taking what I learned forward into fall.

I hope to finalize plans to take my preliminary exam this month, again in preparation for the Big Write.

And then the fall semester starts in earnest on August 23.

New month, new theme.

It has been hot, hot, hot here in North Carolina.

About six years ago I declared that August was going to be no-heat month. The reason for this theme was a coworker whose oven died and she had cookie dough that she needed to bake. With my eye ever on the experimentation of my coworkers idea, I suggested baking on the grill. After all, the gas grills these days have a temperature gauge.

Then I thought to myself Cookie Thursday is a Thing needs a no-heat month.

Voila.

No-heat month was born.

Or created.

Or thought into being.

Whatever.

No baked-in-the-ovens cookies will be had this month.

This week my attention was grabbed by a pan de eclair recipe. An eclair cake. But fake.

This recipe has no choux pastry or baking. Which one of my coworkers pointed out when I took the make to the hospital. I know! The making of eclair shells requires baking. Which requires the oven.

No heat! (written in my best Edna Mode)

This recipe is made with already baked, out of the package I had in the pantry of plenty from the grocery store graham crackers

I did make homemade pudding though. Because I didn’t want to go to the store.

Did you know that homemade pudding is dead simple?

Huh, the things I learn from CTIAT. I certainly won’t be buying pudding mixes from the store anymore!

Except for pistachio. But I bet there is a DIY recipe for that too.

Why, yes, I’ve certainly had enough caffeine for the day! Why do you ask?

If by wild ride you mean hot, humid, and expensive. Then, yes, yes it has.

Our air conditioner died on Tuesday night. In North Carolina. In high summer.

This week has not been fun, easy, or cheap.

I specifically took two days off to relieve the pressure on my PTO balance, which was closer to the max than I was comfortable with. My summer class was over and I was just going to read and relax.

The universe said nope, no you’re not.

I had been building a new bookcase in the living room, listening to music when my husband came home from work and asked why it was so hot in the house?

By hot, he meant 80.

Huh.

I guess I was the proverbial frog in a cooking pot, blithely working away while I was being boiled.

Cue an awful night. But I was not going to call the emergency number to have someone out there to look at the unit in the middle of the night.

Long story short, we replaced the HVAC unit, and, as a bonus, updated the electrical panel.

With the electrical panel, the electricity had to be turned off for about 6 hours; no electricity, no fans, which was how we were keeping sane.

We spent the night at a hotel.

The crew worked through some hellacious conditions: up in a summer attic, through some of the wettest weather we’ve seen all summer, and with the quirks of this house. Seriously, no room in this house is a square box, they all have interesting cut-out windows, or extra walls, or, suddenly, a column!

They are getting the best review!

Yeah, so that’s where I’ve been since Wednesday. Spending money like it’s my job.

Oh, and since I am incapable of having workers at the house and not working myself, I’ve been keeping myself busy with mindless tasks. I reorganized the pantry, worked on the garage, kept the kitchen clean.

It’s been exhausting.

What if you don’t want a degree?

What then?

I believe it is everyone’s right to decide whether or not to continue their education post high school graduation. If they don’t want to have more education, no one is forcing them.

Except maybe the job market. But even that is getting a little thin to demand a degree. I’m sure we’ve all seen the meme of a company asking for 10 years of experience in a new field, with a master’s degree and only paying $25K a year.

And the goods market. How are they going to pay for the lifestyle they grew up accustomed to?

This is not knocking trade school. Trade schools are very important and teach valuable skills that can be used to get a high-paying job. For example, plumbing. There may be colleges to teach plumbing. However, it is often learned on the job through an apprenticeship program.

Then, the student also has to know enough not to get scammed. Or how to do their taxes.

Yes, they are adults.

But this is the price of living in our society.

The economy is a crucible that heats you up and spits you out.

Post-high school college and trade schools are a kind of armor to protect people.

Goodness knows no one is lining up to protect anyone.

It is a way to protect yourself and maybe learn what you really want to do.