25- When Breath Becomes Air

This was another book I read pre-BSN. I was a working nurse and had been for 13 and a half years When Breath Becomes Air by Paul Karanthi was published January 12, 2016.

Admittedly this was mid-BSN course work but I just had to read it. I love neurosurgeon medical non-fiction, I always have. From the first one I read in 1997- When the Air Hits Your Brain: Tales from Neurosurgery by Frank Vertosick Jr., MD. This goes along with the ditty that I learned in nursing school- when the air hits your brain you are never the same.

This is the story of a neurosurgeon resident before and after he is diagnosed with lung cancer in the final years of his training.

Neurosurgeon training is a loooonnnnggggg haul. The google results vary. Some call it 15 years after high school (includes a bachelors of some sort and medical school, internship and residency) and other programs clock it at 7 years (which is minus the bachelors years). In a simpler format, it is seven years after the undergraduate degree and the medical degree. Of course, type-A personalities that 100% of them are, there may be additional fellowship after the end of residency.

In short, you have to REALLY like cutting into people’s heads.

Or the aforementioned type-A personality.

Or just want to care for people who are sick and have no where else to turn.

Sit down.

I’m going to hold your hands and gently explain that I didn’t enjoy this book.

Like, at all.

Take your fingers off your pearls. It isn’t personal.

I get that Dr. Paul Kalanithi wrote this while he was actively fighting lung cancer and actively dying. And that his wife, Dr. Lucy Kalanithi wrote the final chapter explaining his death.

I understand.

I just don’t think it is that great a book.

Seriously.

I re-read it this past week to make sure that I still felt that way. Also I re-read it with the knowledge that I had finished two whole nursing degrees and am most of the way through the third in the intervening years.

There are entire passages of brilliance. I marked 11 pages of them.

This book is this man’s journey to coming to grips with a fatal disease. I can understand that.

I can also appreciate how they let his voice drive most of the way through the book. It starts off strong when he was a boy and stronger when he is in medical school, before petering out over the course of his illness. If this was intentional this is masterful editing. If this is not, it is still masterful storytelling.

My biggest pet peeve with this book is that it is over-confident in its own brilliance and the author is a huge name dropper. Granted most of the names dropped were author’s names but nurses were not named. Not once. His surgical nurses were only mentioned a handful of times, including the conversation about his long hours at the hospital that apparently the nurse didn’t understand? I bet she did. Oh, and they were always women, nameless women who didn’t understand the pressures on a rising neurosurgeon resident. My feminist heart didn’t like this one bit.

I appreciated how he let his patient’s be fully realized people in his mind. I find that is the best way to approach a patient. As if they are people too, not just a problem for him to do surgery on. This I liked.

But I kept thinking how one note the nurses were. In fact the only named women are his co-resident, his wife, and his oncologist. Otherwise they were referred to as the relation to him and his wife and his family. No, thank you.

I stand by my first impression of the book as a memoir of residency. That there were better instances out there. Even as a memoir of his death I give it an 8/10.

Would I read it again? Yes, and I have.

Would I shelve it on my bookshelves? Yes, and I have.

Would I recommend it? Yes, as a book on dying.

Tuesday Top of Mind 5/13/25- Fluoride and why getting rid of it is a bad idea

There are a lot of dumb hills to pitch a fit over these days. My least favorite is the anti-fluoride movement.

Fluoride is important because it prevents cavities and strengthens teeth. As someone who has a complicated relationship to my dentist I am in favor of everything and anything that decreases my chances of additional tooth decay.

Fluoride has been shown in some shoddily done studies to “alter your gut microbiome and has suggested associations with thyroid disorders, weight gain and possibly decreased IQ”.

Note the important shoddily done study in question that indicates decreased IQ has been roundly criticized and recommended for retraction. Yes, it is that bad.

The measurements used to ascertain IQ decrease were 1) not validated, 2) used different testers, 3) done in multiple cities. It is the first point that is the most crucial. I can swear to you that the sky is pink, not blue. I can have other swear the same to you. But I won’t let you look at it to see for yourself that it is pink.

It is the same energy as the question that captivated the internet in 2015, is the dress blue or gold.

Bitch please, it depends on the lighting. True, sometimes the sky is pink, especially in the early morning as the sun is rising, or later in the day as it is setting.

For a sarcastic example: Yay, you proved that the sky was pink at 0635! Now prove it again and again and again. Also, prove it at noon.

I’ll wait.

Who are you going to believe? Me, or your lying eyes?

Ugh.

Nothing that the troglodytes and mouth breathers have brought up, none of the studies have been replicable. That means no one else has been able to do the same study, as outlined in the study, and gotten the same results. This is the major finding. This is the flaw in the study.

Trust me, I’ve taken many graduate level courses to make sure that the studies that I will create are able to be replicated. This is why what these people who are playing with fire drive me so insane with anger. They don’t know enough not to touch the hot stove. But they will blame the resulting burn on vaccines, don’t worry.

This is more bluster and nonsense coming from non-science believers.

There is a big story going around now that the Secretary that is pushing for this swam in feces contaminated water. Worse, he let his grandchildren swim in the same water. Gross.

Also, double ugh.

As someone who has spent thousands of dollars at the dentist in the last year, I will keep my fluoride toothpaste and my fluoridated water. Or is someone going to tell me that the hole in our bank account is a figment of my imagination or the pain that I’ve suffered through is in my head or is because I am overweight?

Triple ugh.

School Me Saturday 4/26/25- Funding changes, what do we do now?

Yes, I know I have written about this before. I don’t care. It is too important. Every day research that has been in the works for I can’t even tell you, research that has already been paid for, is shriveling in the petri dishes.

Research is expensive. Proper, well structured research is expensive. You have to pay for the researcher, you have to pay for the research assistant, you have to pay any adjunct helpers who are conducting the research, you have to pay for the computer you use to write up the reports, you have to pay for the electricity that run a lot of this, you have to pay for the IRB, you have to pay for the data analysis, you have to pay for the lab time, sometimes you even have to pay to get it published (those are the predatory publishers, don’t give in to them), and if you are offering an incentive to garner participation, you have to pay each participant the incentive.

It gets expensive. Capital red letter expensive.

Oh, not only do you sometime have to pay to publish, you have to pay to present at conferences. With all of those attendant costs as well. At AORN there were several international hospitals and countries and research presented. Each of them had to pay for the conference fee, the flight, the hotel, and the food while they were in Boston. Or Orlando, or Chicago, wherever the conference is held.

Many of these are covered in grant indirect costs. These indirect costs are not well understood and is more than a line item in the grant. Not being understood, like at all, means that people overact when they see the line item.

The hammer has fallen. Nascent grants are not being approved. Existing grants are being yanked, even as the research is underway. That is what I meant when I wrote that research is shriveling in the petri dishes.

Why?

This is a very good question. Because the researchers are daring to research something that isn’t white or male. It is being stripped because of the specter of DEI.

Another not well understood concept that is being used as a bludgeoning tool.

DEI doesn’t mean what they think it means. Inigo Montoya snuck in the chat.

This, of course, has started panic at the research universities. Especially the ones who don’t have billions of dollars in endowments. But even if you have that kind of money doesn’t mean it is just sitting around in coffers, or under a dragon like Smaug.

It has been a long time since the students (hello, that’s me and my cohort), had any guidance in the matter. Probably because those doing the reaping are being mum on the matter.

No DEI is all they know how to chant. Again, it doesn’t mean what they think it means.

Yesterday we had a rare in person day on campus where the second and third years who were interested, were given a ground level “this has happened and this is how we envision going forward” talk.

We had a group discussion about how to find and secure funding. Ideas about other funding sources were floated. It was a good conversation. Remember, all of us are nascent nurse researchers.

I know I left feeling a little more hopeful about this crappy situation we find ourselves in. I hope others did too.

I offered my notes to the rest of the cohort that were not there and I hope to have the notes to them tomorrow. I just want to reflect on it some more.

I wore my “Baking is Science” tee shirt with a baking cat on it. On my husband’s recommendation that I leave the political shirts at home. I think a stronger worded tee would have been better. There is always the August in person day.

Best Kept Secrets of the OR #25- Conference edition

I am an introvert who is also quite shy. That is a double whammy when it comes to being engaging in large groups. Especially people I don’t know. Even people I probably will never see again in my life.

That being said conferences are particularly hard. It is best that I am rested. Not well rested, this is a hotel that I am most likely staying in with its vagaries in bed comfort and light levels. The hotel that I just stayed in had a night light in the bathroom with no door to the bedroom. Low levels of light all the nights. Which isn’t exactly conducive to sleeping.

The operating room encompasses so much space in nursing. Goodness knows that the department encompasses a pretty big majority of the operating revenue. Goodness knows that running an OR is a very very very very costless enterprise. Never mind the human capital, the outlay for supplies and equipment is immense.

That being said, conferences are important. Not only to meet the people who are like minded and that you have loads in common with, but also to share experiences across the board.

Did I have fun at the conference? Sure. For a value of fun.

Was the conference exhausting? You bet. I suffered a fall at work just over two weeks ago and my left lower leg, knee to toes, is such pretty colors and shades of purple. The hotel was half a mile from the convention center and I walked it every day. Well, I limped it.

Except the morning it was raining too hard to contemplate it. This was also the day I was to do a poster presentation of my pilot study that I completed last year. The one about the pre-Wheels out behaviors of the operating room. So I had makeup on.

Every night I peeled off the compression socks and elevated my foot/leg. But the pain was worth it for the opportunity to present my own research and talk with the chapter that I belong to in the organization.

I made sure that my carry-on was mostly empty. Because conferences give out a lot of swag. By that I mean that conferences give away paperwork and pamphlets about their products. There is also a certain amount of toys and soft things that are given out. I don’t collect a lot of the pens that these companies give out but I pick up a few to give away to my coworkers.

The majority of what I bring back is education that I learned. I get to impart to my coworkers the latest and the greatest of nursing knowledge.

I also collected many colleges so that I can curate a binder for shared governance and to share it with, again, my coworkers.

The thing about conferences is that you are at the mercy of the weather in the host city. We were in Boston and it rained every danged day except for the day we arrived. That day was beautiful and showed off the city well.

School Me Saturday 3/29/25-Suddenly, all at once

Spring Break is over. I hope you had fun because now is when the real work begins.

But, Kate, I’ve been working hard all semester, in all of my classes with readings and lectures and papers and quizzes and tests.

Oh my.

I know. Trust me, I know. But think of Spring Break as the 7th inning stretch.

Yes, I know that I am mixing my metaphors here. Or I will be very shortly.

The end of the semester is barreling down upon us. Which means the projects that most classes have been working toward for weeks will be due soon.

This makes students panic. Knowing that there is a large amount of work to be done and a suddenly, all at once, finite amount of time to cram the work into.

Don’t panic.

Of the several universal truths from The Hitchhiker’s Guide to the Galaxy by Douglas Adams, the most important is DON’T PANIC.

You see if you had read the book, you’d be at least smiling now..

Another universal or, in this case galaxial truth, cheating is not the answer. Just ask Zaphod Beeblebox, the hapless leader and President of the Galaxy. Because 2 heads are not better than 1.

The biggest takeaway from the book is that it is not the answer that matters. Anyone can give you an answer, especially since AI has entered the chat. Anyone and anything can give you AN answer.

It is knowing that the answer is not the right answer is where the true learning begins.

Deep Thought spent several millennia thinking on the meaning of life. Their answer was 42. And it did not expound on what is the meaning of 42. To be clear, the meaning of life and the semester is not to get a 42. By any measure that is a failing grade.

True learning is not knowing the answer to the random question but WHERE and HOW to find the answer. Because that will survive the memory reset that so many students do at the end of the semester.

That is what the professors want you to know.

FFS Friday 3/2/25- Fra-gee-lay

If you grew up at any point past the 1980s you are familiar with this pronunciation.

In A Christmas Story, the dad, AKA Old Man Parker, is unboxing a prize that he had won filling out punny word puzzles from the newspaper. The clues all resolved around a play on words around a lady’s knee. The prize, as we all know, is a woman’s leg, in fishnet stocking and garter, with a gold satin lamp shade.

This is the big prize that he has won.

Some prize. He was expecting a bowling alley to be the prize and get the leg lamp instead.

Anyone else feel bait and switched by the events after January 20th?

Like a bomb has gone off in our administration and we are shaking apart at the seams. And the gleeful spoiled brats are shaking the tree to see what will fall out?

We know they are uncaring about the chaos they have wrought. As long as they get their tax break it will be worth it. No matter that those of us will get less than nothing.

Beats a poke in the eye with a sharp stick, we will console ourselves.

As a society we are on edge, unable to concentrate? Near tears at most times? Unsure which executive order will be the one that will bring us to our knees. Or fully rend the fabric of society, leaving the worker bees to pick up the pieces and bear the entire weight of the now changed world while the lords are in their counting house, counting out their money.

Yeah, that is by design. And part of the entire plan that we told you was the plan but so many of you believed it when they denied it. How is that working for you now?

As a society we are feeling fragile. At least some of us are. The ones with empathy. Is that word even allowed anymore? It is one of the No-No words for research or public institutions because it hurts a white man’s feelings of superiority.

Worse yet are the ones who are gleefully watching the destruction, the fires that they set dancing in their eyes, unaware that the conflagration that they have started will consume everything, including themselves. It’ll be worth it to them, owning the libs.

It begs the question, what kind of fragile?

Fragile like a man’s ego?

Paper thin, will punch down at anyone or anything that displeases the ego?

Or…

Fragile like a bomb.

Thick outer shell, maybe filled with pieces that are intended to hurt whatever has triggered it.

Yeah, we’re all feeling a little fragile these days.

We must chose; fragile like a man’s ego or fragile like a bomb?

FFS Friday 3/21/25 Futile

The famous quote from Star Trek the Next Generation, AKA the Star Trek I grew up watching, is “Resistance is Futile”. Specifically from the movie First Contact.

The Borg Queen says it.

The Borg are the race who are tearing through the galaxy/universe in search of unique beings/species that it can add to its collective. Any species or being that is not or who is not assimilated is destroyed.

The Borg Queen famously responds when challenged that “We are the Borg. You will be assimilated, your biological and technological distinctiveness will be added to our own; your culture will adapt to serve us. Resistance is futile.”

That’s a bit on the nose, Star Trek Next Generation.

Jean Luc Picard and the rest of the Next Generation starship do not take kindly to this message or this directive. They resist.

And prevail.

I love looking to older sci-fi to explain modern events.

Resistance is futile is the message that is being broadcast during these days of shock and awe. If they drown us in bad messaging, we can be overwhelmed and while we are distracted the bad actors (you know who they are) can sneak around and do very real damage to our country.

Fuck that shit.

It is vital that these state and country ending actions be witnessed and called out for the vile plots that they are.

It is when they want us to look away that we have to refocus our attention. I realize that I am writing this from a position of privilege. Mostly because I am discounted because I am a woman. Or, to use the Ferengi slur “FE-male”.

Yes, still a Star Trek reference, but from Deep Space Nine referencing the Ferengi. The alien race whose entire world view can be split into two camps. 1) women are not to be trusted and must be kept naked and down trodden,and 2) the pursuit of profit is above everything. Even if you have to lie and steal and cheat. But that is an F for another Friday.

Resist this abomination of a regime. Ignore the ones who tell you resistance is Futile. They don’t know anything and are banking on your sleep walking to our destruction.

Make sure you are reading and listening to trusted sources. But always question and have a second source on news that seems like rage bait.

Do not engage with bots online.

Do not engage with scam accounts online. These may not be the same.

Do not freely give your attention and your likes away. This is their currency.

Currently I am tripling down on my pocketbook protesting. Is there a more impactful phrasing than that? I mean that I am spending as little as possible and from a carefully curated list of establishments.

I am not responding to people I know don’t have my best interests in mind and have voted accordingly.

Would it be easier to just go with the flow and let them do whatever they want?

Yes.

But, again, fuck that shit.

Post-it Sunday 3/9/25- 29 ways

The post-it reads “29 ways to make it to the hospital”.

This is, of course, in the reference to the Marc Cohn song 29 Ways to Make it to My Baby’s Door. Yes, the same Marc Cohn who sang Walking in Memphis. Both songs are from his debut album in 1991.

Marc Cohn was the first bar concert I ever saw. I want to say it was in 1996 and in a small bar in the college town near where I grew up. Between 1993-1996

In the song, the protagonist lists off the ways he can make it to his baby’s door. Near the end of the song he sings that if she needs him real bad, he can find two or three more.

I know that people already think that I have an unnatural attachment to the hospital. I don’t, I swear. I do have an unnatural attachment to work, though I am trying my best to overcome it.

But I was thinking of mass casualty events when I wrote this post-it. Probably after one of the hospital shootings we’ve had nationally for a lot of years. Or being the second runner up to Oklahoma City when I was at Creighton. If that is even true, we talked about it in clinical just after it happened.

However, if the hospital needed me in a hurry, and they have, I could get to it, at night, in less than 5 minutes. This depends on hitting the lights right and no traffic.

However, I thought about it and counted the many ways I know how to get to the hospital during the day. I counted at least 10. And I only live 3 miles from the hospital.

Those are the 10 that I have found. There is probably more.

It just depends on how badly they need me.

And the traffic lights.

Tuesday Top of Mind 3/4/2025- The real tragedy of modern times is being afraid of the light

The proper quote, attributed to Plato, can be summarized by “The real tragedy of life is when people are afraid of the light.”

The PhD student in me knows that this is a reference to Allegory of the Cave. Also by Plato.

In the cave the only perspective is that of what is projected on the walls. What you see projected on the walls is entirely left up to your own experiences.

For example, if a republican was attracted to a drag queen they would question their manliness and therefore be afraid of drag queens exposing their secrets. But they can’t be afraid of something so silly, so they hate it. Worse, they teach others to hate the shadows on the wall of the drag queen as well.

Oh. This argument got a bit away from me. I don’t mean to point fingers, but if the pattern on the wall fits…

The Allegory of the Cave is also about truth. It is a warning not to take the easy path and believe everything your eyes tell you.

Or believe what the voice on the television or podcast tells you.

Critical thinking is a must, especially in these times when the wrong voices and the wrong actions are vying for our attention and our belief.

In simpler terms and the phrase I remember hearing or reading as a child, that what you hate is something that frightened you as a child. Instead of another person just trying to live their life, they are hated as other.

Well, going back to the cave, who decides the other.

And, more importantly, why do we listen and sometimes blindly follow the hatred that is spoon fed to us in increasing amounts? Perhaps in the hopes that we will drown in filth and be reborn hating the things that caused us to be drowned. Instead of real fear of those who drowned us.

To make light of it, perhaps they were frightened by a drag queen as a child.

As Master Yoda says, “Fear is the path to the dark side. Fear leads to anger, anger leads to hate. Hate leads to suffering.”

Don’t walk the dark path.

And don’t believe what other people are telling you about the shadows on the wall.

They may get something out of frightening you.

Tuesday Top of Mind 1/21/25- Limbering up the “NO, I don’t think so” muscle

Warning: this might be a VERY SWEARY and a VERY CAPS-LOCK post. Or not. Behave accordingly.

Somewhere not very far from where I am, about 390 miles give or take, is a man who has never heard the word no and not reacted like a spoiled, entitled brat.

To parody the meme, “Someone has never been told no and sent to bed without supper and it shows.”

Has anyone ever told this man no and slapped his hand while he was reaching for something that wasn’t his?

Strike that. I am sure that plenty of people have. He has the guilty verdicts to show for it.

Has this man ever had to face the consequences of his own actions? I would hazard a guess at that. And that guess would be no.

It helps to know that the crap that is going on in Washington D.C. amounts to nothing more than a tantrum.

A tantrum from a spoiled brat.

I just feel sorry for the people who will be hurt/killed/smeared out of existence by his very presence where he is. For the people who will lose their healthcare coverage, or their right to exist as they want to. The group that I am afraid will suffer the most are the women. I am lumping in ALL women, be they born female or not.

We are facing a very dark and dangerous future.

Because we as a nation told this spoiled man-child no.

How dare we?

And then we went and fought the pandemic that he mismanaged.

Inflation sucked, yes, but it sucked WAY harder in other countries who didn’t enjoy our “soft” landing.

Greed is the rot and the root of all the challenges that everyday Americans have lived with over the last four years. Corporate greed, individual greed, billionaire greed. Billionaires who are not content to have all the toys in the sandbox but instead demand the sand as well. Normies like you and me can play in the dirt. Until they want that too because we are surviving without them and that IS NOT in their business plan.

Today I am just going to breathe. I am not going to react, I am not going to rend my clothes or pull my hair, or do something rash.

What I am going to do is breathe and document. Just like a nurse in an emergency should.

I know I’ve written about my first ACLS teacher, the beginning of my first ACLS class, and her counseling us that the first thing to do in a code is to take our own pulse. This is to check in with ourselves and remind us that there is a patient who is dying in front of us, and we have to do something about it.

This is our code, Democracy and the America that I love is dying in front of us.

Take your pulse, check in with yourself, and get ready to resist.

Because he has been told no once, time for him to hear it a whole bunch of times. From every corner of the country. Together we can drown out the sycophants and cultists that, until now, have been shouting louder.

Bullies try to silence those who stand up to them. Have you ever considered why? If our voices didn’t have power, they wouldn’t try so hard to silence us.

As I tell my coworkers, if they are afraid to speak up call me and I will. I will absolutely yell back at the men in power, real or imagined. Tell me if you want me to be louder because you can’t. I don’t even need a reason to raise my voice.

See if I don’t.

I know how to use the word no and I am not afraid to use it.

Grieve if we must. I certainly understand the impulse but we also have to be ready to counter moves by the administration. Bought as it was.