I know that I did a series before of what it is like to be on call and called in. These are my personal preferences for call procedures.

Number 1- I do not want to surgeon’s message to go through the nursing supervisor. I would prefer that the surgeon call me directly.

There are reasons for this. The supervisor is busy, they are running the entire hospital. The supervisors, although most of them have been nurses for years, do not understand the operating room. Not that we are delicate flowers but everything about the OR is complicated. There are a lot of moving parts to a surgery.

To this end, I give the surgeons blanket permission to call my phone directly. This is my preference. This also cuts down on the number of calls that I have to make because I always call the surgeon for any special requests for the case or I might have a question for the surgeon and this allows me to give the surgeon a realistic time for incision. Or, at the very least, call the pager that I still have if they don’t want me to have their phone number.

This is where the two way call trust comes in. I trust surgeons not to abuse my phone number and, in return, I do not abuse the surgeon’s phone number. This is key.

Number 2- I will call the scrub tech myself.

Again, there are reasons for this but mostly so I know that the scrub tech is awake and activated to come in. I started this when the nursing supervisor would call the scrub tech and not get an answer and call me back when I was driving that they couldn’t get ahold of the scrub tech.

This led to a delay of the start of case because I would have to phone tree to get a scrub tech. I would call the original scrub tech on call and get no answer but I would leave a message. I would call again. This is a promise that I made to them that I try to get ahold of them at least twice before escalating to the phone tree.

The phone tree is where I call all the scrub techs for the department, searching for someone who would come in to scrub this case. I have had to do this multiple multiple times. This is a less frequent occurrence with the dedicated call shift though.

If, after I’ve exhausted the scrub tech list and didn’t get a person, I would start calling RNs. Ideally it would be someone who could scrub but not a necessity. I can always scrub a case myself.

Like magic this would always work but I had an avenue if it did not. And that would be calling the managers.

I try not to bother them at night.

Number 3- I will pick the case myself.

I am always the first person in. Regardless of where the scrub tech lives. I only live 5 minutes from the hospital with middle of the night traffic.

I love picking cases and will happily put on my favorite get stuff done song. I try to complete the pick before the song loops back. I can mostly beat the song these days. The song is Down with the Sickness by Disturbed and is four minutes and thirty seven seconds long.

Picking and preparing a room for surgery is going to be a separate post.

Number 4- Ideally, I will get the patient myself.

This can be complicated if the patient is in a unit bed and not the Emergency Department. If they are in a unit bed, they are most likely in a physical bed and that is harder to do alone. Sometimes I wait for the CRNA to help me with a unit patient, or, if the surgeon is there, I make them go with me. Or I will ask the supervisor for help. Or I will put in for transport but they are skeletons crewed at night.

Transport is always my last resort.

Number 5- I will prep the patient myself if possible.

If there is a PACU nurse there because of another patient I will let them do the prep but I prefer not to. I generally have a feel for the urgency of a middle of the night call case and can expedite prepping. Anyways, the OR patient prep is 9 screens total instead of 36 of the ACU nurse.

In a nutshell my prep questions are 1) who are you, name and date of birth, 2) what are we doing for you today (I don’t ask if they know the surgeon’s name, the answer is no because they’ve just met them and the patient is shell shocked by the events unfolding), 3) any allergies to medications, 4) when was the last time you ate or drank (yes, this means everything), 5) have you ever had a sleep apnea study, 6) do you have any metal anywhere like a total joint or screws, 7) do you have any contacts, dentures or hearing aids, 8) do you have any positioning limitations, 9) when was the last time you peed, and 10) do you have any questions.

I will hold on asking 2, 5, 6,7, 8, and 9 and instead listen when anesthesia asks them the same questions. Patients sometimes get grumpy at the same questions multiple times. I will warn the patient that they may hear some of the same question a lot. And then I tell the story of the time I was the last person that a patient talked to and they confessed to me, the 6th person, that they had lied and had had chocolate cake for breakfast.

This always gets a chuckle.

90% of the time there is a family member accompanying them and they will probably chime in.

Complicating factors or patient prep are dementia and inability to understand or sign consent, or interpreter needs. Both of these have their own challenges and therefore take longer.

Number 6- I will call PACU myself.

Timing when calling PACU is a must. Too soon and they are waiting for the surgery to end, and waiting. Too late and you are cooling your heels with the CRNA in PACU waiting for them and starting the recovery yourselves.

Getting the timing right is the most important thing and is the hardest thing to teach.

However, if I feel like I require a second set of hands I will call at least one of them in early. Some cases you just know are going to be busy and complicated and someone else would be so helpful.

These six things are my personal preferences, honed over thousands of call cases over 25 years. Other nurses will have different preferences and they can do what they want when they are on call. But this is the most efficient way that I have found.

I’ve been mulling this over all weekend.

Banned Books Week started on Sunday, October 4th.

I have read plenty of the widely banned books. And so have you.

Charlotte’s Web by E. B. White about a lonely pig who just wanted to live and the spider who helped with the advertising.

The Hunger Games by Suzanne Collins about a grotesque demand from an all powerful government that was still bent on punishing their people for a failed uprising by sacrificing 23 children per year., spread out from all the states (districts).

13 Reasons Why by Jay Asher about the reasons a girl has for committing suicide.

The Handmaid’s Tale By Margaret Atwood about totalitarianism/patriarchy and the rules for women and childbirth and the control over women and children in the religion’s name.

To Kill a Mockingbird by Harper Lee about racial injustice in the South.

Nineteen Minutes by Jodi Picoult about a school shooting.

These are all important stories to be told. Stories are told because the author is trying to get an idea across about a situation, to create understanding of a situation. Stories are not told because the author wants to be banned.

No author puts hundreds of hours into a book, sweats over it, fights with their editor over it to desire the banning of said book.

If a book is saying something that you don’t understand or you don’t want your kid exposed to, fine. Don’t buy the book for your child.

But I think you should read the book that you want banned. That should be the ground floor of all bans. Not because you want to be popular with the others. Not because you want clicks and likes.

No, it should be required that all book and wanna be book banners read the books they are objecting. Not only that, they should have to write a book report so that the library association can ascertain whether or not the book banner understood the book. And all book banners need to stand in front of the author and defend their book ban and explain where they got the money.

The Librarians, an Emmy winning documentary by Kim A. Snyder about a book ban that started in Texas is available to rent or purchase on streaming sites. The players, the books, the power behind the book bans.

I saw this last year at a library and I cannot recommend it enough. It shows the power behind the book ban movement and, spoiler, it is not concerned parents.

The October theme for Cookie Thursday is a Thing is Something Spooky This Way Comes.

I was torn between two names Spooky or Trick or Treat. And I asked some friends and they choose Something Spooky This Way Comes.

Maybe I should title the Halloween Candy Board, where I make homemade candies on the closest Thursday to Halloween, Trick or Treat.

Could be fun.

These would be candies that are in disguise, which would definitely fit the Trick or Treat theme. All the candies would be treats, of course.

For this Thursday I made candy corn cookies.

It’s almost a tradition how many years in a row I’ve made these cookies. At least 4, maybe 5.

Candy corn is a fabulous “chocolate chip” style add in. It melts in the oven and becomes almost caramel like.

Unless it is on the edge of a cookie. Then it becomes stained glass.

Cutting up the candy corn into smaller slices is a bit obnoxious and I’ve tried various ways. Using a knife was tedious. Using the smaller food processor resulted in a mushed up mash. Using a food chopper like the one my mom had when I was growing up? The blades weren’t sharp enough and either didn’t cut through or caused the candy to get caught in the blade.

This year, I wised up and cut each candy corn with scissors. This was also tedious but less so than the knife. I snipped the tip, cut through the orange middle and then flipped the candy and cut the bottom third into 2 with a vertical snip.

When I dropped them off, one of my coworkers said the candy corn cookies were their favorite of the October cookies.

Good enough for me.

Nothing to see here.

Just me in my house, idly refreshing the email that I sent in the presentation application to.

In JUNE!

Yeah, yeah, it wasn’t due until July 19th but I was antsy before vacation.

This was the presentation application about building a Call Bootcamp for my hospital after I stepped down as the primary call taker. When I mean primary, I mean PRIMARY. Where I took other people’s call and wound up with nearly all the call for the week. All 88 hours of it. In addition to working my full time 1430-2300, plus 5-6 hours of meeting for various councils/committees per week.

It was a treadmill, and I was glad to step off it.

The number of hours I pulled, willingly, was the reason I have cheerfully called myself a workaholic.

If the work shoe fits…

Back to the presentation application.

Stepping into the call position and being unable to take others calls had to have been a slap in the face with a cold fish to my coworkers. Good thing they had a month to work through it while I was serving my month of notice of shift change.

No, I’m not sure why this is a thing either.

Suddenly there was a huge gap in people willing to take the call and the call dog has stepped away.

I did modified Call Bootcamps and beefed up the Call Preserver notebook.

And I willed the entire Call Bootcamp into being.

That is the story that I want to tell at AORN EXPO 2027.

Where call started at the hospital, my workaholic self, the sudden drop of call shifts being picked up by yours truly, training the new nurses during the pandemic, training my replacement on the evening shift. It’s all in there.

Back to the email haunting. I’ve been waiting for anything other than a “hey, we got it” email ever since July 19th. I realize that it has only been 2 months but I’m nervous, okay?

The other times I’ve put in presentations applications they were rejected out of hand.

But the one I got at the beginning of the week is more hopeful.

It talks of schedules being built and next steps.

No, it isn’t a blanket yes. I’m thinking it as more of a Watch This Space and Please Stand By email. Or, if I was asking a Magic 8 Ball the answer is a more positive “Most Likely” or, at the very least, not another immediate rejection.

But fingers remain crossed.

That reminds me, I should put in an application to present the Call Bootcamp story to the hospital system’s research council as is expected for all people who present at conferences.

I’ll work on that while I am waiting for the final yes.

Trigger warning: sexual assault of a drugged woman.

A former Cornell student, who had to leave due to a frat house 7 hour sexual assault ordeal she had to endure, has filed suit against the university and the fraternity house where the assault occurred.

She was drugged, kept under, and raped. Repeatedly violated.

FOUR SEVEN HOURS!

Two ringleaders of the group drugged her, raped her, and then sent out an all call in a group chat to invite other monsters to come do the same. I have heard a story that one of them even put ketamine on his penis to drug her extra hard but I haven’t found a separate report on that.

The two men who started this horrific crime drugged her, raped her, and put the group chat notification that there was free pussy at the frat house. I am repeating this to give others a scale of the depravity that went on here.

Before the “not all men” and the “why did she wait so long” weenies and apologists can come out of the woodwork and use their what aboutisms to defend this monstrous act, I will say that this reaction and behavior is why women are hesitant/afraid to speak up. And she spoke up. She reported the entire ordeal, the rape, the rape, the rape, the rape, the rape, the rape, the drugging, the sex trafficking, all of it, to the university police department. She reported after 2 or 3 weeks, the timeline is not clear.

Nothing was reported to the Ithaca Police Department. No one was arrested and no criminal charges were sought. The district attorney weighed in and said that there was insufficient evidence to proceed with criminal charges because the office had reviewed the Cornell Police Department’s investigation and concluded there wasn’t enough evidence.

There was an internal university investigation using the Title 9 office. There were reportedly 12 members of this separate body that ruled what was to be the punishment for the crime for the seven perpetrators.

The fraternity was dissolved and banned from campus.

The university expelled the two ring-leaders.

The university gave the other 5 lesser sanctions, such as writing an essay.

An essay.

You might as well have them write, in cursive, longhand, “I will not commit sexual assault” one hundred/thousand/million times.

Creators on social media apps are running with the story. One person, who had been student body president at their university (not Cornell), broke it down and explained every level of investigation and research that had been done. They suggested writing the Board of Trustees Office about your disgust with this matter.

I certainly will be writing the Board members.

It took a lot of courage, and probably counseling, to prompt the filing of the lawsuit by the victim. Nothing will make it better for her.

Now the names of the monsters who repeatedly raped her are freely available on the web, with pictures.

The University needs to do some soul searching for when this happens again.

Because it will happen again and that victim might not be strong enough to come forward and face recriminations and shame for what amounts to a slap on the wrist for the rapists.

Many, many years ago, when I was a high school senior, I had to make a decision. I had been Copy Editor of the high school newspaper, The Dragon’s Tale, my junior year and I was Editor in my senior year. Writing was in my blood and reporting came second nature. As did archiving information and disseminating it through op-eds.

Being the editor taught me so much about lay-out, of negative and positive white space on a page. It allowed me to experiment with pictures and with assignments to the reporters who wrote for the paper. This was the 1992-1993 school year and I became editor right when the 1992 general election was heating up. We wrote about it, of course we did. I fought for inclusion of student art as part of the layout. I asked a very talented cartoonist in my class to draw me a couple of comics of the presidential nominees. He did and it was everything I was looking for.

Were we old enough to vote? Some of us. I wouldn’t turn 18 until the following July but I wanted my classmates who were old enough to realize the importance of voting and of making their voices heard. It was a pivotal election year.

Just like this year.

I used the high school paper to try to get the older students excited about the election. Same as today. It might look a bit different but same.

My choice when I was a high school senior was to continue my education through the two things that were interesting to me. Journalism and science.

We all know which one I picked.

I picked the science.

However, I kept up with the news, preferably printed, ever since. From multiple source, like a good little editor.

Right now the first amendment of the US Constitution is under attack by the administration.

The first amendment secures the freedom of the press. This means that the press can publish anything they want to report on, regardless of how the president and congress feels about it. The reporting is often done on the actions of the government and is not to be controlled, stopped, censored, or censured by the government.

At all. .

It is a foundational constitution given right. It is enshrined in the very first amendment of the Bill of Rights. Remember those?

This week the government expelled three separate news organizations because the president felt they said mean things. The three were CNN, MSNow and Politico.

They tried to fancy up the language but that is what it is at its core.

Censorship.

And a veiled threat.

I would say that I am sorry that the president’s feelings got hurt and he lashed out. But I am not. The news organizations exist to report on the news, not to make nice and say nice things about the administration. Well, at least most of them. But you can’t throw out the baby with the bathwater.

Everything that has happened since, the lawsuit filings, the court siding with the press organizations, the administration failing to heed the courts, has been breathtakingly dangerous.

We are teetering on a very unstable branch.

And the president and cabinet and all the yes men and women are gleefully shaking the branch.

Talk about a dark night in the soul of our country.

If only there were news organizations who could shine light through the night.

Oh wait, there are.

Because the Constitution said so.

Happy Scrub Tech Week, everyone!

There was a lot of competition for the stomachs of the operating room this week. Every day there was a different kind of treat. Cheesecake on Monday, donuts practically every day, lunch brought in on another day, capped off with homemade chicken and noodles today.

I should have finished the Good Morning, Starshine, the Earth Says Hello September theme with the espresso shortbread.

Instead I plowed ahead with my plan. This week’s make was a version of the McDonald’s McGriddle in mini muffin form.

I am not sure which of the week’s is my favorite. The Grape-Nuts cookies were phenomenal but these McGriddle mini muffins were amazing.

Since I went to the dark side in January by turning lacto-ovo vegetarian (eggs and cheese are fine), I have been exploring meat free options. And there are a lot of options.

Today’s McGriddle mini muffins were made with just one of the many sausage options. Which made the over all muffin lower in fat and cholesterol and calories.

As with using a new ingredient, practice does make perfect here.

Did I practice? Heck no. Did it turn out amazing. Heck, yeah.

Would I do a better job oiling the pan before introducing the vegetarian sausages? Yeah. There is always next time. Cooking is about learning how to adapt to the different ingredients you have. Cookie Thursday is a Thing is about learning how to use different ingredients in the weekly makes.

Not to mention, in this time of high grocery prices, the vegetarian sausage was much cheaper than pork sausage. Cookie Thursday is a Thing is self-funded after all.

This month had 2 winners.

The espressos shortbread was kind of lost on me because I don’t drink coffee and I missed adding marmalade to the orange muffins. Bear in mind, the orange marmalade was not an ingredient. I just wanted to see what would happen.

I plan to incorporate the Grape-Nuts cookies and the McGriddle mini muffins into my own breakfast rotation. They were that good.

The McGriddle mini muffins can be made gluten free by using a gluten free pancake mix. I am still trying out recipes for gluten free Grape-Nuts so I can make that one gluten free as well.

This caps off September!

On to my very favorite month of the year, Something Spooky This Way Comes.

Of course I over-scheduled myself this past week. This job was supposed to counter-vent that but you can only do what you can.

I covered for the evening shift Thursday and Friday from 1900-2300.

I had agreed to cover the weekend call shift for the weekender months ago.

It was just my dumb luck that the two occasions collided.

Add in a soupçon of very late/early cases and add a dash of very long surgeries by Sunday I was hurting and had the entire week of my own shifts to do. I did a series of 5 things to make it a bit easier on myself.

The first thing that I did to be kind to myself was that I allowed my husband to take care of the house and the cat during the weekend. He also fed me and would have stepped in to feed the OR if asked.

I slept when I could and took naps as needed. This was number two.

It wasn’t a hard weekend, just a long one that was bookended with long surgeries on either end.

The third thing I did was take Monday off from working out by giving myself a rest day.

A book I had on hold at the library was ready to picked up and I did that on Thursday. I read in snatches through the past six days and returned it early. You know, for the next person. This was number four.

The last thing that I did was order new work shoes because I had been stepping out of my clogs.

And they came today!

Happy dance.

None of the things that I allowed myself to do were difficult but it can be hard to get out of the “I am responsible for the universe” mindset.

This is me giving myself and you permission to be kind to yourself during long stretches.

Even if you did it to yourself.

Especially if you did it to yourself.

Also, Merrell is finally making shoes that are not brown or black or navy.

Happy Day!

Early voting has started in Virginia for the 2026 Midterms. And the resulting number of people who have voted already has outpaced the 2022 Midterms early voting.

Early voting won’t begin in North Carolina until October 15th.

I submitted an application to be a poll worker in August.

Crickets.

I re-submitted in the beginning of September. I changed the answer to being able to work in a precinct that was not my own.

Louder crickets.

It’s not like I’ve heard nothing. Just the email that acknowledges that I submitted the form. Both times.

That’s less than nothing.

I may have to re-tool my being a poll worker plan.

But one part of my brain is wondering if the inaction on their part has been linked to my voting record. Which they have.

I would hate to speculate.

I’ll just have to be louder.

If you are planning to vote, good for you.

What is your plan?

Are you going to show up on the day of and vote?

Okay.

Do you know what your precinct is?

Double check because, here in NC, they were monkeying with the districts in order to squeeze that much more red winners. In a state that is remarkably split and not the red bastion they want you to believe.

Are you registered to vote?

Okay.

Have you checked recently?

Check again.

And DO NOT use Elon Musk’s sham of a website vote.com, use vote.gov instead.

Check weekly until you vote.

Read up on the issues. All of them.

Make a plan of who you are voting for.

This is a friendly reminder that a passport can be used as voting identification.

You know, in case you lose your other government ID.

There are 44 days until Election Day.

I’m not going to lie and say it’s going to be smooth sailing.

After all, a badger is at its most dangerous when it is cornered. So too are the politicos that feel the election heat drawing ever closer.

Don’t be distracted by the cost of living. The cost of gas. The cost of food. The cost of healthcare.

Make a plan and stick to it.

Remember that all the really icky stuff in the bullshit big beautiful bill will come due AFTER the election. Because they depend on your faulty memory and blaming whoever is in power.

A poison pill of a bill. Who’d of thunk.