24- Cassandra calling

We warned you.

We warned you about the threat to Roe, despite assurances that there was nothing to be concerned about with settled law. Look what happened to Roe v Wade with the Dobbs decision. You know, the decision that knocked down fundamental, important rights of being a woman: the right to bodily autonomy, the right to privacy with discussions with their own doctor about their own body. That decision.

We warned you that medication abortion was next.

Along came Kacsmaryk and his ruling that called into question the FDA safety processes around mifepristone. The same ruling that was based on shoddy research that has since been recalled by the publisher? Yeah, and the case is now in front of the Supreme Court which has already shown willful disregard of laws and precedents in order to advance their religion on the United States. That one.

We warned you.

We warned you that in vitro fertilization was next.

After all the logical path says that if all abortion is murder, then in vitro embryos must be treated as people. The Alabama Supreme Court yesterday ruled that the embryos that were destroyed by accident by someone who wasn’t even allowed to be in the room but “wandered in” opened the freezer, took out embryos, and dropped them because the very cold temperatures required to gave them freezer burn to their hand. This broke the frozen clumps of cells. Yeah, and that temperature is -320 degrees Fahrenheit. The Alabama Supreme Court ruled that the embryos were to be considered children.

This was a terrible thing to happen to those cells. Terrible for the clinic that housed these cells, terrible for the family whose potential children were destroyed by someone “wandering around”. There should be charges.

However.

Respectfully an embryo is not a child. Embryos are potential children.

This ruling will send shockwaves through reproductive health. Again.

On a side note, the Mayo Clinic 10-20% of known pregnancies end in a miscarriage for a variety of reasons. That is not even counting the ones that are not yet realized and the woman may think nothing of a 1-2 day delay in her period or not even have a delay in her period.

Shall we take bets on what the courts will say about that? Are women going to be punished for having a miscarriage, a phenomenon that often has no answer and no causative agent? For being a woman. Bet me and you’ll be proven wrong when this slippery slope gets steeper and faster and men can act out their revenge fantasies on women. Because control.

I am sick of being Cassandra for reproductive health. Reminder, Cassandra was the daughter of the last king of Troy. Apollo bestowed the gift of prophecy on her in exchange for her doing his bidding. When she refused him, he said that no one would ever believe her prophecies. Sound familiar? Are you icked out yet?

Control has been the cudgel of powerful men for millennia. Even in fiction.

For now, in Alabama, frozen cells are to be conferred personhood.

We should all be frightened.

It’s raining men

It’s raining men and women. Because gravity is a thing and a real force to be reckoned with. Gravity doesn’t mean to hurt us, it is just doing what a force of nature does without caring what we pitiful humans think. Gravity, if it was sentient, would not spare a thought to making people fall.

However, as fragile humans, we have to think about it. How many times have you seen an edge of a sidewalk that has come up because of root action by the nearby tree and thought to yourself “Gee, someone better alert people about the uneven ground? I’d hate to see someone fall.”

Anyone? Just me, then. Cool.

The slip, trip, and falls were the largest percentage of staff injuries last year. Because gravity has it in for us. If it were sentient.

However, and I know I’ve written about this before, there are things that you can do to improve your chances of not getting hurt. Exercises to improve your balance will always be important. Maintaining muscle mass, not only as a cushion but as a way to foster reflexes will always be important. Because if your reflexes are fast enough, you can catch yourself before you fall. Knowing HOW to fall is paramount. I can’t tell you how many times we’ve had a patient with both wrists broken because they put their hands in front of them or behind them as they fell.

Gravity, much like time, is an immutable force. However, you can certainly take care of your vessel by maintaining balance, and reflexes, and learning the proper way to fall.

Maintaining your bone health is also very, very important. If you don’t have an adequate substructure, it doesn’t matter if you have great balance and great reflexes, an injury is more likely to lead to broken bones. Weight-bearing exercises and a good diet will help with maintaining the strength of your bones.

And women. Sigh. After menopause, women lose bone strength, because of estrogen loss. Estrogen plays a very important part in bone turnover.

My advice to you so you don’t end up on the operating room table.

protect your bones by eating a well-balanced diet.
Learn how to fall.
Ask your doctor if there is something that you can do to decrease bone loss.
Weight-bearing exercises are your friend to support the maintenance of your bones.
balance exercises are also very important to maintain your balance to decrease falls.

Bone density loss is a fact of aging. Protect yourself.

Because gravity doesn’t give a shit.

Tuesday Top of Mind 2/13/24-color me surprised, the articles about mifepristone were retracted by publisher

Shocked, I am shocked. This is heavy sarcasm.

Does anyone remember the debunked articles by Andrew Wakefield that began the most recent wave of anti-vaxers nonsense with a widely exposed fraudulent article in the Lancet conflating autism with childhood vaccines? And how every parent clutched their child to their breast and decided then and there that of course the man was telling the truth. With nothing underneath him but air? Yeah, him.

Healthcare workers, such as myself, have been educating parents about how safe vaccines are ever since. But the idea was like an earworm and refused to die. As a society, we are still dealing with the fallout and the consequences of this. Current measles outbreak numbers do not lie.

Herd immunity works very well. But the public has to be 1) vaccinated for it to work and 2) be protective of those who cannot get vaccinated, like the very young, the people who are anaphylactically allergic to the vaccines, or those who cannot otherwise take the vaccines.

Think of what the planet just went through with covid and you have a good idea of how damaging and heartless this was. People who didn’t get the widely available and FREE covid vaccines extended the pandemic.

To be blunt, autism is NOT caused by vaccines. To mislead the public into believing that was a gross malpractice on the former Dr. Wakefield’s part.

Well.

The 2021 paper that the Texas judge used in a ruling against the use of mifepristone has been yanked. By the publisher. Retracted by the publisher. What the judge did was bend the facts to make his ruling that mifepristone was dangerous and should be stopped. And his ruling was appealed and stayed and overturned. Which is what was the intention.

The case that is in front of the U.S. Supreme Court right this very second.

I’ve said it before, over and over again. This lunacy is a war against women and is about trying to control more than half of the population. Control is at the root of this.

Will they care that the original ruling was based on a retracted by the publisher paper?

It remains to be seen. I have an idea about what will happen. Don’t you?

I hope I am wrong.

Tuesday Top of Mind 1/30/24-1460 days of covid

On my Facebook memories from 2023, the Dispatches from the Evening Shift post was a Monday musing from 1/30/23 was 1095 days of covid. I thought, well, it’s been a minute since I wrote about covid.

Let me take the local temperature of covid.

Yes, there was a winter surge. As predicted. The hospitals were full; the hospital I work at seems to be always full. There was flu, and RSV, and covid. Just like last year.

According to the CDC Covid Data Tracker, there have been 26,607 hospitalizations for covid in the US in the week of January 20, 2024. This is down from 28,323 hospitalizations for covid in the US in the week of January 22, 2023. The weekly death rate has been averaging 1800 American dead each week. That is still a substantial number, for all that the public is bored hearing about covid. The most current number of dead, as reported, which is suspect because of the patchwork reporting done by some states, is one million, one hundred seventy-two thousand, two hundred two.

The CDC Codiv Data Tracker has improved its reporting and ease of information finding. This was always my second choice for covid data. RIP Johns Hopkins Covid Dashboard.

Covid is still here. People are still dying.

The best way to protect yourself and your family members is to make sure you’ve had the most current booster. Get tested if you are sick. Stay home if you are sick. If you feel the need to go to the hospital because of difficulty breathing, or low oxygen saturation, go to the hospital. According to my county’s tracker, 12.8% of those who presented to the hospital were admitted.

Not very exciting, I know. But important to keep yourself and your loved ones safe.

No, I can’t believe I am still writing about this shit nearly 4 years after the first recognition that this might be bad. It’s not as bad as it was, but it is still not good.

Post-it Sunday 1/21/24-Make it bigger!

The gown card reads “Dear Doctors, JUST MAKE THE INCISION BIGGER!!!”

Mic drop.

I don’t know who needs to hear this but, yeah, struggling for 20 minutes because you made the incision a quarter inch smaller than normal.

What do you get out of it? Bragging rights in the doctor’s lounge? A free all-expense paid golf trip at the next conference? The love and devotion of your patients?

The push in the OR is toward smaller and smaller. Smaller incisions, smaller case times, smaller.

Just smaller.

And, yeah, that should be shorter case times but it didn’t fit the theme, you know?

I see you struggling with the smaller incisions that you make.

Yeah, patients may like a smaller incision, but how much smaller can you go? And still have the proper exposure to have to do what you are operating to do? Patients probably will be happier with a regular-sized incision and a smaller hospital bill. Because you ramp up their time under anesthesia and therefore the cost of the procedure while you struggle with exposure

I know that you know the incision is smaller. But the patient is not going to know. The incision can only stretch so much.

We were doing a case in the middle of the night. Of course, it was the middle of the night, you work nights, Kate! But the surgeon was struggling with taking out the specimen from the incision size and I mean, struggling! Thirty minutes they struggled and sweated and fought to get the specimen out, me watching from the sidelines, the sterile scrub tech helping them. Finally, they gave up and started pulling the specimen out in pieces. I asked gently if a slightly bigger incision would’ve been helpful. They sighed and said it would’ve been easier. I asked if the patient was going to notice that their incision was mm longer if they had gone for the bigger incision. They said no.

I said nothing else. I think the point had been made.

Two weeks later we had a nearly identical case, same team, same surgeon. When they had localized the specimen they asked for the knife and said to me “See, I can learn.” They made the incision slightly bigger and were able to only work on getting the specimen out for 6 minutes.

Sometimes you just need to make the incision bigger.

It isn’t a slight on the surgeon; just the facts.

Tuesday Top of Mind 12/5/23-Gap in the data

My brain is right now about finding data gaps in the nursing research. This is to aid me in my doctoral classes and I think I’ve found one. Both in the doctoral classes.

And in the current covid pandemic numbers.

What covid pandemic numbers?

You say you haven’t seen any covid pandemic numbers in months. You even didn’t know it was still a thing. Mostly because you don’t care. It has killed as many as it is going to kill and other things are more important to you.

I get it, I do. But that’s just it; we don’t know about current numbers. All we get are dribs and drabs of numbers, sometimes, if the wind is right. Otherwise, no one is reporting numbers right now.

At a glance at the current numbers here in my town, the data is lagging a bit. The last numbers are from November 3-November 16 and apparently, the covid risk is low. 11% of those who presented to the hospital with covid like symptoms got admitted, but the covid risk is low.

79% of the covid samples are from 2 dominant strains-Omicron XBB and Omicron XE. The most current variant that is in the news is BA.2.6, according to the CDC. Even that update is from 11/27/23.

That is the point.

The data are weak. When we get it at all.

There certainly is a lot more to capture our attention. Is covid a victim of the news cycle because there is something sexier to talk about that gets attention?

Yep.

Inflation, the holidays, and wars.

Lions, tigers, and bears indeed.

Oh my.