25- AI tattles

A tell is something during a game, usually of cards, that indicates what is in your hand. Good or bad. Physical change or behavioral change. It encompasses a lot.

The use of AI, especially in a education setting, has tells as well.

There is the direct copy and paste of the output of a prompt. Warts and all. This is a glaring red flag to the people grading the assignment.

Try a little and reword some of the output.

But this is also a trap. You really should understand what the output says before you throw yourself on the mercy of the thesaurus.

Above all, know the difference in usage between lie and lay and lied and lain. Can’t forget their, they’re, and there. These three little words have forever stymied English speakers, native or not.

And is a giant AI tattle.

3 years into this AI game, universities and colleges are learning how to recognize and grade you accordingly. The university I go to has announced that any AI usage has to be on the university site. I imagine this is so they can keep on eye on who is doing what with what AI generator.

Publishing has also gotten wise to the AI slop that is out there. I have seen the stamp they are putting on some books. It proclaims that the book is “Human Authored”. I think this is smart but also vulnerable to copycat. The seal does have a seal number on it. I am not sure but I bet the numbered seals are searchable on the Writers’ Guild site. Nope, I just checked. They are not easily searchable.

The point is that if you cheat, someone, somehow is going to figure it out. That beggars the question Why cheat? in the first place. It is only your reputation and your admission to the university/college that is at stake.

Darn, I guess you’re just gonna have to do the assignment. With your own brain and your own fingers typing on the keyboard.

Darn.

Medical non-fiction podcast review 9/7/25- Dr. Death Season 1- Dr. Duntsch

I would be remiss if I didn’t review the medical non-fiction podcasts as well. There are some really well made ones out there. My favorites are from the Wondery studio.

This was a podcast that was recommended to me in 2020 by a certified registered nurse anesthetist (CRNA) as something I might be interested in. The first season that I am going to talk about was released August 2018 and ran through October 2018.

I listened to the first season avidly, aghast that an MD would be so negligent. But then I never thought of it again. Why? There was a little pandemic that also happened in 2020. Does covid-19 ring a bell?

Not to mention I graduated with my MSN in May of 2020. I used to listen to the recast episodes on my way to teach in January and February before the world shut down in March. And then I got a little busy. And then I went back to school in Fall 2022 and moved on to listening to other medical podcasts on my trips to the university.

Dr. Death is a story about the arrogance and

Dr. Death is about an orthopedic spine surgeon who left a trail of broken backs, death, and broken dreams behind him. He graduated from the University of Tennessee and did his training at the Tennessee Health Science Center. He only completed 100 surgeries out of the 1000 surgeries in a standard neurosurgery residency. He was hired by Baylor Regional Medial Center in Plano, Texas where he began to leave broken bodies behind.

He is the epitome of fail up. He would be invited to leave by a hospital and would leave for another hospital and damage patients and be invited to leave the second hospital. Rinse, repeat. Death and paralysis trailed in his wake.

No one had the presence of mind to stop his slow moving rampage until two surgeons who were called to repair the damage that Dr. Duntsch had wrought compared notes. They were determined to have charges filed against him. The filing of charges against another doctor is not a done thing. It is easier to have them resign and not care about where they go. This disregard for life at another hospital is a failure of the medical system and carried on far too long.

Of interest is that he chose neurosurgery, one of the most technical and prestigious of all surgery types, because it was considered the most lucrative. Of the 38 patients profiled for Dr. Death, 31 were harmed or 2 died as a result of his arrogance.

He is in prison for life and is not eligible for parole until July 2045.

Kudos to the two surgeons who were able to work with the Dallas prosecutor to stop him. Really stop him, not just pass the buck to the next hospital. Not just pass the buck on the next patient that would be harmed or killed. .

This was a very easy to listen to podcast. It was broken down over 7 episodes, although there are several additional bonus episodes that attached at the end of the episodes, from his appeal that he filed to the introduction of the actors that were in the television show.

About that, I had heard that there was a television show made of the first season that premiered in the time of the world is trying to kill us still of 2021. It ran until 2023 and is currently streaming on Peacock plus or available for purchase from Prime Video. But I don’t watch television and then I finished the first season of the podcast I removed it from my list and I had no idea that three other seasons had released. I will be listening to these. Dr. Duntsch, Dr. Fata, Dr. Paola, and Dr. Gumrukcu. I have some listening to catch up on.

But as a surgery nurse I have to question where are the nurses at the hospitals that kept failing him up? Were they part of the complainants that got him fired but not prosecuted? Did they just blink at his behavior and say “Well, that’s just Dr. D for you.”? Where were the scrub techs who can also voice objections? Granted, as the surgical team we don’t know a lot about patient follow up, except when the patients return for a revision. But surely question were raised among the teams.

This is also a failure of the surgical team. It is our duty to point out problems and mistakes that the surgeon might otherwise try to brush off.

I recommend this podcast to anyone who is a scrub tech or a surgical nurse. It is up to us to recognize and stop these surgeons when they are harming patients.

School Me Saturday 8/30/25- Long weekends

Yes, I know that school JUST started. Like seriously, how long have you been back- a week?

However, for the rest of society it is the last hurrah of summer. Time to have one last barbecue, time to have one last dip in the community pool, time to sleep in (hopefully not the last one), and time to get your breath before the marathon that is coming. You know the one I mean. The Christmas decorations are starting to trickle in and the Halloween decorations have been dominating the stores since the beginning of July.

But you are a college student, you have no time for frivolity, you think to yourself as you pull up the chapter that is due in a week and start the outline for the paper you have to write about this module.

Wrong.

Take a breath.

Yes, the semester just started and there is so much work to do. Papers to outline, and tests to study for, weekly chapters and scholarly papers to read.

Yes, yes, you’re so busy.

It is okay to take a breath and go to that BBQ and take a swim in the pool.

Summers are fleeting and fall is knocking on all of our doors.

The paper outlines can wait. The reading can wait. The end of the semester will be here before you know it. The end of your college career will be here before you know it. Now is the time to enjoy the new friends you have made, to celebrate the joys that they have.

It is okay to take a breath and sink into the long weekend. Think of the two weeks you’ve had of school as the warm up lap and this is your mini break before the work really begins.

Your brain will thank you.

School Me Saturday 8/23/2025- You and the environment is what feeds AI

I know, I know. AI was exciting and the new shiny thing when it bowed into existence in November 2022.

But.

But have you ever wondered what AI gets out of this?

It can make you feel like an artist. It can make you feel like a writer. It can make you feel like the best singer/producer in the world. It can make you feel like the best director of a movie ever!

It can make your appointments and keep your calendar and give your reminders of things.

But it can also steal ideas and already published works. These are video, music, and writing. They call this training the AI and writers and performers and movie companies have no say.

What I want to write about today is the way that you, a regular joe or jane, feeds the AI.

The AI requires VAST amount of energy and water. Lots of water. Millions of gallons of it.

Your data is being compromised and stolen every time you interact with it.

All of it. Your identity.

Your brain (we talked about that last week).

Your ability to engage meaningfully in the world without the AI crutch.

All of this is fed into AI program and repackaged and sold back to you. At a higher cost.

There is definitely a reason for the existence of AI. To crunch the numbers and the existing data that we have on things like cancer rates, medication classes, and it can even see cancers before the human eye can.

AI is meant to serve us.

Instead, we are serving it.

Our attention.

Our time.

Our energy.

Our water.

And ourselves.

On a golden platter.

Because it is the new shiny and you can make a lady picture with 5 breasts.

This is a warning.

Also a reminder to go re-watch the Matrix. Or the Terminator series. But I like the Matrix.

AI is here and thriving.

Because we are its food.

Call Secrets of the OR #5- Designated Call Room

This is it. The big call secret.

It’s not about how to make friends with people you wouldn’t talk to at a party. It isn’t about making nice with others of the opposite political divide. It isn’t about sleep deprivation or a cool, dark place to sleep. It isn’t about keeping all the procedures in your head so that you can pull out the appropriate one and get to work. It isn’t even about being on call.

It is about having a designated call room.

No, I don’t mean a room in the bowels of the hospital to chill in if your call is a twenty-four hour deal.

It is about having a designated operating room for call.

We like to think that all operating rooms are the same. We like to think that all operating rooms are a blank slate, just waiting for us to walk into and start the surgery.

We like to think about the call shifters as being separated from the rest of the OR crew. After all, we are a small cohesive unit. We work well together because we know the mission is to get in, do the case, and get out. No breaks, no water cooler moments, just case and be done.

In our perfect little world, every operating room would be the same. Each room would have exactly what it needs for the most common call cases. It would have a video tower, it would have an auxiliary monitor that shadow casts from the video tower. And it would be hooked up. It would have a full tank of carbon dioxide so that you can inflate the abdomen. It would have an irrigation module so that irrigation can be run into the abdomen. It would have a functional suction tree, with every “branch” that has a suction cannister. It would have the powered coagulator that you need to create access in the abdomen. It might have a tourniquet. The dilation and curettage machine would be in the designated spot. It would also be fully stocked. The irrigation would be warmed to the correct temperature of 104 degrees Fahrenheit and in the anteroom. The warmed blankets would be in the same warmer as the irrigation, steps away from the action.

The perfect little world call room is also close to help if you or the patient needs it.

But we don’t live in a perfect little world.

These operating rooms are workhorses. In the course of a day they can go from an OB-GYN case, to an orthopedic case, to a podiatry case, to a general case, and back again.

You will never be able to enact your will on every operating rooms. Don’t even try.

Because there are humans who inhabit the rooms during the other shifts. And their idea of a perfect operating room will differ from yours. The orthopedic rooms will have a tourniquet but will not have the power coagulator. The OB-GYN room will have most of what you need for a perfect little world call room, plus stirrups. The podiatry room will have a tourniquet and a bump for under the hip.

However, what is possible, is to have a dedicated call operating room that has all the equipment that the perfect little world operating room does. But you know that the dilation and curettage machine is fully stocked and where it should be.

This is imminently possible to have a conversation with your boss, or the boss before that one, or the boss before that one, about why having a dedicated call operating room is important.

Ideally invoking the wrath of a code blue in a surgery is not necessary. Remember what I said about close to help. Having a dedicated operating room allows those who would show descend on you if there was an actual code know where they are going.

I’ve done a code in the far flung cysto room. Now, do you understand why there are directional signs to that cysto room?

Having a dedicated call operating room will make your life so, so, so, much easier.

You won’t have to run around like a chicken, cursing day shift out loud as you search for the irrigation module, or the cord that connects the video tower to the auxiliary tower, or a video tower in the altogether. Or frantically searching operating room by operating room, in every store room, in the other store room, maybe it’s in the cysto room, looking for the dilation and curettage machine.

And that?

Is priceless.

And well worth the brow-beating you have to do to accomplish having a perfect dedicated call operating room.

School Me Saturday 8/16/25- AI is Making People Dumber

AI was thrust upon an unknowing public in late November 2022.

All of a sudden AI was EVERYWHERE!

In our search engines. You no longer could run a simple search without AI thrusting itself into the conversation. Uninvited or not. Frankly, it was giving Clippy vibes.

In our “art”. Yes, the quotes are important. Or should it be an asterisk? Also AI art is slop. By that I mean it is crap. Shoddily done, hallucinatory, and ubiquitous. Not to mention obvious.

In our daily planner. Some people began using AI immediately as an assistant. To keep track of their meetings, to bounce ideas off of, and to help write.

Students began using AI to cheat. They didn’t do the assignment. They asked a program, one that has known hallucinatory proclivities (they all do, no matter what people are saying), to write their assignments. And then they were just copy pasting the results into their papers.

When artists and writers objected to their works being used to “train” these large language models, the programmers started to feed the models crap. And the hallucinatory problem got even worse.

And the models started spouting the nonsense it was being fed and some people took that as truth.

I have been invited to use AI to write my thesis. No thank you. The Big Write will be by my own hands and out of my own brain. No large language models needed here.

AI output is only as good as the material that is used to create it. And so much of that is terrible. I would hazard a guess that it is all terrible.

Ooh, you can give a pretend sex doll a third breast. Why not go whole hog and give the bytes four breasts. Or is that too bestiality coded for you?

There is even a name for the phenomenon of the human brain on AI. The phenomenon is split into what the researchers explain are the three main problems.

There is the cognitive offloading. This is when you ask AI to do so many tasks for you, you forget how to do them for yourself. Instead of engaging in the multiple decisions that everyday tasks demand of us, you cede this power over to the machine
There is skill erosion. Simply put this the decreased ability to do the skills that you rely on the program to do for you. Alexa started this cascade. In this the ability to critically evaluate information and come to conclusions is missing.
There are generational gaps. Much like introducing the computer in the 1980s, and the cell phone in the 1990s, and the smart phone in the 2010s, earlier generations who are not born into the AI generation don’t depend on it as much. I have seen this in the subsequent nursing generations. And it is scary how they depend on their AI assisted searches.

All of this results in a population and a generation who is unable to reason, unable to perform simple tasks, and can’t evaluate the results they do get for clarity and for correctness (truth) of the information given.

The best day of the last 6 months was when I found out how to disable the AI search. I taught Chrome how to disengage from AI searching. And I think my searches are better and more complete this way.

This information is from a study as reported by the Forbes Magazine.

Call secrets of the OR #3- Positivity is a must

This is what I alluded to all the way back in call secrets of the OR #1 when I told the surgeon that I approach each case with optimism and I do not dwell on the possibilities.

Not a lot of people like call.

I get this.

However, I think it is because their attitude is wrong.

In case after case after case, the surgeon talks about what can go wrong during the surgery. Before the incision is even made.

I let them grouse and complain and say that they are missing sleep. They list off the complications that could happen. Not will, but could. Yes, yes, we all are missing sleep. I let them get it out of their system. There is a LOT of complaining.

And then I hit them with “But what if none of that happens?”

What if the appendix is sitting on top of their bowel, just ready to be plucked?

What if I have everything in the room for every eventuality and therefore you are not delayed?

What if I can get you back in bed in 90 minutes, 60 if it is an uncomplicated appendix?

Don’t get me wrong, sometimes the nights are very long and I don’t see my bed until after day shift starts. And my cat, who has boundary issues, demands that I get up and touch the food in her dish at 0800, even if I’ve just gotten into bed. Sometimes the case devolves into a messy one and I don’t have everything they need. Sometimes the case devolves into a real shit show and now I have to man the phones to arrange for a higher level of care bed in the intensive care unit.

Sometimes not cool stuff does happen. But not every time. And certainly, not every night.

What if by naming the bad outcome you are dreading makes it happen? What if by naming the bad outcome you are dreading makes it not happen.

Call is a craps shoot. With a 20 sided die. Sometimes you get a natural 1 and it all goes to hell. But there is an equal chance of a nat-20 and the incarcerated hernia reduces itself as the patient goes off to sleep.

Yes, this can happen.

Don’t you see? By steeling yourself that the bad thing will always happen, you cut yourself off from the possibility that it won’t.

I admit that sometimes I am aggressively positive. Which can irritate a surgeon or a coworker. I know this and I will not be working on it.

I just shrug and say, “Oh well. Better luck next time.”

Medical fiction and non-fiction book report 8/3/25- Little Miss Diagnosed by Dr. Erin Nance

Something happened during the pandemic.

People got bored.

A lot.

Even healthcare professionals.

And they turned to YouTube and Instagram and TikTok to make reels as a way to release the pandemic pressure and to make us smile.

Dr. Erin Nance was one of these.

She is a double board certified orthopedic hand surgeon. This is her story.

She is also big into treating the undiagnosed and unheralded medical problems of women. Because, you see, she was also dismissed because of her gender in her internship selection. And she knows that many women are dismissed because of their gender when they seek medical care.

I like and admire that.

We all know that surgery is my favorite. But my especial favorite is hand surgery. I have stared down other orthopedic surgeons who wanted to bump a finger amputation because to them it is just a hand. Yeah, that is like calling brain surgery easy.

Shortly after starting at the regional orthopedic hospitals after we moved across the country I was offered and subsequently took on the hand service line. This means that I was responsible to knowing everything about the hand surgeons and the hand surgeries. I also ordered specialized sutures for the hand surgeons. Healthcare being healthcare I was also handed the trauma service line and the pediatric service line. This means that I had to know all of the fixation types to fix a broken bone or to fix a tendon.

It was a lot.

Hands hold and sculpt and cook and soothe and comfort. Hell, the opposable thumb is what allows for much of what the hand is capable. Opposable thumb means that you are able to bend, twist and touch the tip of your thumb to all of your other fingers. This allows us to hold a pen, or a paintbrush and create art or books. When they talk of fine motor skills, this is what they mean.

Put your hand out and take a look at it. Spread your fingers wide and note which muscles of your forearm control which finger. There are 23 bones in your hand. The bones of your fingers, we call these phalanges, each have a tendon attached to them that enables their movement.

I waited and waited and waited to get this book from the library. I have seen a few of her videos on Facebook and I found her to be warm and genuine and have really great stories. I was very excited to read her book.

I received and read her book in one sitting. Not hard because it is less than 250 pages.

As much as I was looking forward to this book, I didn’t like it as much as I was expecting.

There isn’t much of a narrative throughline. There is her brother Kevin who suffered a devastating spinal injury with spinal cord fracture on her very first day of her internship. The scenes written with him were warm and just on the side of Pollyanna puke that I live on. He pops up periodically as Dr. Nance celebrates his wins.

The stories are not told in a chronological order. This kind of bugged me and some of the stories I am familiar with through her stories were missing. Ones that I think would’ve made compelling reading.

Her very short chapter on the other denizens of the operating room left much to be desired. According to her explanation I, as an OR nurse, comfort patients and fetch them warm blankets and are a soothing presence as anesthesia is started. And my mood sets the mood for the entire room.

Yes, but.

She could have definitely gone deeper here.

The book was less surgery details focused and more her process focus through internship, residency and hanging out her shingle immediately after residency. This means that she opened her own practice because she couldn’t find a niche.

I can respect that.

But I didn’t like this book as much as I expected because it was so shallow. There isn’t a lot of detail that screams real life. This is a good book for those who are not in the know. There isn’t a lot of gore or death or broken bones.

I picked up the book expecting some of that and it did not deliver. That is what I meant by shallow. There are depths that I wish had been plumbed.

FFS Friday 8/1/25-F-in Cowards #4

Oh, my god, they pulled up the corpse of Elmo and shot him again.

Shield your eyes, children.

And just like that the path in childhood has been closed to CHILDREN. No more education programs that are not ads for toys or ads for movies or just plain ads.

The Corporation for Public Broadcasting announced today that it has begun shut down procedures. People are being laid off, with the corporation shuttering in January 2026.

The CPB was authorized by Congress in the 1967 Public Broadcasting Act to ensure that everyone, and I mean everyone, has access to non-commercial, high-quality content and telecommunications. They used 70% of their own funding to support more than 1500 locally owned radio and television stations.

This means that the shows and the broadcasts are not trying to sell you anything.

Unlike the rest of the world.

Every minute of every day.

But, alas, this is no more because congress yanked its funding in order to give money to millionaires and billionaires in the form of tax credits.

“But, but you will get a tax credit too!”

pffft, I’ll believe it when I see it.

We certainly did not receive any money during the pandemic and those 2017 “tax cuts”? Our taxes went up. By a lot. Many thousands of dollars a lot.

No, I don’t believe you when you tell me that it was worth it.

Fucking cowards.

Mr. Rogers is very disappointed in you.

I believe Horatio in Hamlet said it best “Now cracks a noble heart. Good night, sweet prince/and flights of angels sing thee to thy rest.”

Or maybe Inigo Montoya when he is advancing on Count Rugen, “Hello, my name is Inigo Montoyo, you killed my father, prepare to die.” Count Rugen pleads for his life in the final duel, offering Inigo all that he wants, money, power jewels anything Inigo wants.

And Inigo, stabbed, bleeding, facing down the man who murdered his father twenty years before, tells him “I want my father back, you son of a bitch.”

Let me tell you, we are all Inigo.

We want our PBS and NPR.

Again, Mr. Rogers is very disappointed in all who voted for this.

North Carolina is going Surgical Smoke FREE

dun-dun-DUN–dun-dun-DUNan–dun-dun-DUN-dun dun

This is the opening guitar riff of Smoke on the Water by Deep Purple. Go to YouTube and check me. You know that I am right.

It was 8 years ago that I recognized that other people, often with less years in the OR, would react to the shall we say unsightly odors of some surgeries. Smells would hit me later in a case than others. A surgeon and a tech would react to the smell of an appendix or open abdomen and it wasn’t until it was closer to me such as when I was collecting the specimen that the smell would make it to my scent receptors, and I would become aware of what they were talking about.

This was a very gradual awareness, brought on by what I assumed was a very gradual over- exposure to the bovie smoke.

Let’s talk about the effects of surgical smoke. It has been compared to smoking 30 unfiltered cigarettes per day. Surgical smoke also contains arsenic, smoke particles, people particles (live tissue fragments), e-coli, SARS-Cov-2 (aka covid), toxic gases, benzene and hydrogen cyanide. It can cause a decreased sense of smell, asthma, allergies, chronic bronchitis, chronic sore throat, and even chronic lung diseases.

Forthwith I became aware that my sense of smell had been altered by 23 years in the operating room. Many of those years were in heavy surgical smoke plume cases- total joints, plastic surgery, and open abdomens.

Surgical smoke is created by use of an electro-cautery device, most often a bovie. This piece of electrical cautery equipment was named after the Dr. William T. Bovie who developed the electrical cautery machine in 1926. This was used to stem the bleeding cause by incisions and surgery.

In 2018, Rhode Island became the first state to enact legislation to ensure that all hospitals and free-standing ambulatory centers used a smoke evacuator in the OR. Many other states joined them- Arizona, Colorado, Connecticut, California, Georgia, Illinois, Kentucky, Louisiana, Missouri, New Jersey, New York, Ohio, Oregon, Minnesota, West Virginia, and Washington.

AND NORTH CAROLINA!!!

We make the 19th state that has elected to protect their nurses, scrub techs, surgeons, and patients.

Smoke free is a misnomer. It is a short hand way of saying that the surgical smoke plume is contained at the site of surgery with smoke evacuation.

However, Governor Josh Stein just signed it into law. To go into effect January 1, 2026.

The hospital system I work for started mandating surgical smoke evacuation during covid. Because, as you may have noticed above, covid is carried by surgical smoke.

Did I write this legislation? No.

However, I have written, and spoke to surgeons, and written legislators, and called legislators, and signed petitions. Basically, we kept up pressure. I even used surgical smoke legislation in the Health Care Policy and Ethics class that I took fall semester 2023. This was when the NC legislature was waffling about it. I did presentations and wrote papers about the dangers of surgical smoke and the importance of going smoke free. I shared the papers and presentations with anyone who asked.

I needed this win today.

Oh, happy day!