25- No Kings is over, now what?

Yay, over 8 million people showed up to march. Well, 7-8 million, depending on who you believe.

Either way that is a LOT of people.

And there were even more who were unable to make it to an organized march.

It was a grand gesture.

Now what?

You may be feeling a bit down. From the adrenaline high, from the knowledge that the no kings protest was a show of no kings force but it was only that. A show.

The government is still shut down. Because the Democrats are holding firm on the ACA subsidy fight. So that everyday Americans, not illegals despite the lie they are trying to force down our throats, won’t see health care costs on the exchange skyrocket out of reach. I am proud of them.

The East Wing of the White House has been scarred. For one man’s ego and because no one ever told him no.

The House of Representatives is out for recess. Again. There have been 3 full weeks of work by them since July 1st. This is shameful and not what we voted for. Not only that, the deciding signature on the Resolution to release the Epstein files was elected in Arizona. Adelita Grijalva has yet to be sworn in by that coward, Mike Johnson. She was elected September 23 a full month ago. But Johnson would rather play ostrich with his head in the sand.

AI slop is being used for everything. I’ve seen many, many, many badly written headlines in the news with all sorts of errors- punctuation, spelling, word choice, and tense. I’ve seen badly shaped and colored memes that some people want use as a gotcha. Dream on.

It’s okay to feel a bit blue.

However, the pressure must be sustained. If there is anything I’ve learned as a nurse it is not to decrease pressure when the bleeding has slowed, that way leads to a hemorrhage.

Maintain that pressure.

Keep making the phone calls, even if you are talking to a machine.

Keep sending those emails.

Participate in Operation Mail Drop where scolding cards or postcards are sent to those in power. Yes, all of them. The object that you mail is up to you and your wallet. I’m not saying mail them something that might rot by the time it gets there, but I’m not not saying it either.

But, most importantly, VOTE.

There is a General Election this coming first Tuesday in November. Many states already have the early voting sites open.

It is your right to vote. Exercise it.

Send the next message to Washington that we see their depravity and their illegal acts.

And we won’t stand for it.

And we don’t care for it.

Keep the pressure on.

Keep the eyes on them.

We drown out the illiberal with protest

Millions have taken to the streets.

Frogs, unicorns, everyday Americans bearing placards.

Saying with one voice “No Kings!”

More are protesting in their own quiet way.

Because they can’t join a march. But protested with their pocketbooks.

Too bad there isn’t a way to quantify that.

This is a message from the American public who say no more.

This is a message from the America public for one man.

This is a message from the American public as one.

No Kings!

Remember we fought a whole Revolution for that.

FFS Friday 10/17/25- “No Food For You” to the nation’s hungry

This is in reference to the U.S. Department of Agriculture letter that advised state agencies to hold disbursements of the Supplemental Nutrition Assistance Program (SNAP) for November. T

Their game is unknowable but is probably a lever to pressure Senate Democrats to vote to take on the so called clean continuing resolution to open the federal government. And probably a pain point to get those who are hungry and in need of SNAP to reach out to their representatives and beg them to open the government by passing the CR.

Diabolical in’t it?

That’s what they want. A reason to rat out the democrats to the voters for not doing enough to help those who are hurting.

I hope that people see through this charade.

Especially the ones that this hurts.

Especially as we hear that the government is giving now $40 BILLION dollars to Argentina to prop up their collapsing currency. Perhaps the attention should be on the United States economy and declining dollar. Just a thought.

According to the letter, the money exists in the USDA but the states are not allowed to spend it. The states are not allowed to give it out to the people who are on SNAP.

Instead those affected have to go to food banks, which are already stretched so so thin because of the economy in this country.

It is giving holding out bread to a starving person and then snatching it away and grinding it into the mud. That they then shove the starving person into.

It is giving Old Mother Hubbard with the empty cupboard to give the dog a bone. But she knows full well there is a second, secret cupboard for her own use and she hoards the contents. Even if the dog is hungry.

And shades of the Soup Nazi.

Full disclosure, I have never ever ever seen Seinfeld. I worked evenings/nights through the 1990s after I graduated from high school. I have only heard of it as a bit.

I direct those who are using this moment to make people hungry to Les Misérables by Victor Hugo.

And remember the name Jean Valjean. His prisoner number was 24601.

His only crime was that he stole a loaf of bread to feed his sister’s child, who was close to death from starvation. He received 5 years hard labor for that crime and 14 additional years hard labor because he tried to run.

I feel a relisten/rewatch of Les Mis is in order.

Cookie Thursday 10/16/25- E.T. phone home

Remember, the theme of the month is Something Spooky This Way Comes.

The cookie of the week I baked this week was a blond cookie with Reese’s Pieces.

Some of us remember that in 1982 an extra-terrestrial came to earth and crash landed near a house in Southern California. The E.T. was befriended by a boy named Elliot with troubles of his own. The boy’s little sister Gertie, played by Drew Barrymore, was initially scared and then thrilled to have a playmate that was just her size. And then mom comes home and the government is hot on the heels of E.T. to experiment on him. All Elliot and Gertie wanted was to help E.T. get home.

Because Gertie was so scared and screamed so loudly when she met E.T., the Reese’s Pieces I think that this cookie, which is a perennial October cookie, fits the theme.

Now, it took me a bit to find the Reese’s Pieces but I was able to locate them at CVS of all places.

And they were on sale. So bonus for me!

Stove update- my favorite burner is still giving very low flame. From what I have read, this means because the natural gas is constricted in the line. This makes sense because the stove and oven are 20 years old and it is my favorite burner. Because it is a favorite it is used 90% of the time and is the right lower burner. The rest of the time more than 1 burner is in use. But the favorite burner is used at the same time as the other burner. Think pasta sauce on the favorite burner, and water for pasta on the other burner.

First world problem is that I had to learn the other burners. The next most used burner is the bottom left. Which is the biggest burner with the biggest flame of all.

Let’s just say that there was a learning curve.

I do not think this is the right time to buy a new stove due to political atmosphere and the here again and gone again, just kidding tariffs. But I will remain open to replacement. If I find a stove that I think can be useful.

The oven though? That is holding strong, despite the nearly 11 years of Cookie Thursday is a Thing.

I’ve said it before and I’ll say it again, it has been a lot of cookies.

I’m off to rewatch E.T.

Secrets of the OR- Sterile processing, the unsung heroes of the OR

You think you know the OR? As if.

We know the usual cast of characters in the room.

The circulating nurse who bosses everyone around and ensures that the patient has everything they need. Including activating an emergency team.

The scrub tech who is in the sterile environment with the surgeon and assists who knows what the surgeon needs before they ask for it.

The CRNA who ensures that the patient is comfortably anesthetized and is prepared for any emergency.

The anesthesiologist who supervises the CRNA, up to 4 rooms at a time and who pinch hits for the CRNA at times.

The patient without who none of the cast of characters would be there.

But, do you recall the most famous reindeer of all?

Just kidding; it takes more that the usual cast of characters to safely see a patient through surgery.

There is the pre-op team that makes sure the patient is prepared for surgery. They know all about the patient and is a source of comfort for them as they wait for the surgery to begin.

There is the post-op team that makes sure the patient is comfortable waking up from surgery. In the hospital where I work the pre-op and post-op teams are comprised from the ACU/PACU team.

But the one you hear the least about? The ones who cleans the instruments, readies the trays, sterilizes the instruments, and puts the sets back where they live so that the OR can find them.

The sterile processing department. SPD in the hospital I work at.

They know everything there is to know about the trays. They should they put them together from the jumbled mess that the scrub tech might leave. Depends on the scrub tech. If asked about a certain instrument that was dropped they might be able to point the circulator in the correct direction for a replacement instrument.

The first thing they do is decontaminate the instruments that have just been used in a surgery. There are washing machines, similar to a dishwasher, that are used. But, just like in real life, the gross bioburden has to be washed off many of the instruments. By hand.

They inspect all instruments that they get out of the washers. They make sure that the tips of the instruments meet and are not out of alignment. They make sure that all the lumens of instruments are clean with air or a brush prior to set assembly. They make sure that all the very fine instrument tips are not broken off because of mistreatment. Then they string the instruments together in the order they appear on the count sheet.

They double check the count sheet to make sure that everything is accounted for in a set. If not, they mark the set as incomplete and put on a bright orange sticker that indicates what is missing. If too many things are missing the set it taken out of use and set aside until the missing pieces are located and the complete set can be sterilized.

How does an instrument get lost? This is out of their control. Sometimes the instrument is thrown away (I tried to get a research project off the ground to decrease inadvertently thrown away instruments by using a metal detector. I maintain it would have worked too, but covid shut that down). And sometimes the instrument is in another tray from the same case, just misplaced.

They maintain a bin of lost instruments from the misplaced instruments that are retrieved after the sets are put back together. These instruments can be from the core, where there is an entire shelving unit full of sterilized single items. Sometimes it is a replacement for the scissor the surgeon just dropped, sometimes it is a replacement for the orange sticker. SPD puts these back up in single sterilizer packet. This is a down time occupation. The downtime of which there is very little because some of the sets are needed later in the day and the set from the 0700 first case has to be washed, inspected, put back together and sterilized in time for the case that starts at noon.

They know everything there is to know about the instructions for use of the sterilizers and the instruments that might go in the sterilizers. These are the IFUs. These indicate what is the best sterilization method for a given instrument, including parameters of time and exposure.

We’ve come a long way since the days of one set of instruments that was washed and flash sterilized for ALL the cases of the day. Or the care and maintenance of the Cidex, which is a semi-sterile instrument dip that was sometimes used the before times that would expire. Or the care and maintenance of the Steris machine, which used an acid bath to delicately clean scopes and cameras that could not be sterilized in the autoclave. Or the care and maintenance of the newer machines like the Sterrad that uses plasma to sterilize cameras and scopes.

They had to have all of that in their heads. Or at least readily accessible to look up on the spot. But in my experience, they kept it all in their heads.

SPD workers have to be efficient and know their stuff. And keep all the rest of it in mind as they do so.

No sterile instruments? No surgery can be done safely. There aren’t enough antibiotics in the world to cover that.

Tuesday Top of Mind 10/14/25- There is too much to focus on and that is the ENTIRE POINT

Every minute of every day there is additional ghastly moments perpetrated by our own government on their own born here people.

It is meant to be exhausting.

It is meant to draw your minds’ eye away from what really matters.

Someone has to keep watch.

I learned a new phrase today that sums up the frog costumes in Portland, OR-Tactical Frivolity.

I shared said phrase and the video is was on to a certain social media site.

And they took it down.

Quietly.

It is no longer on my feed.

But that’s okay, I know how to use google. And how to double check my sources. And which sources to even use. Thanks, PhD program.

Tactical frivolity is also used to exhibit peaceful non-compliance to those who would put their boot on your neck.

To bring it back to something else I’ve written about a story by Hans Christian Anderson, a character that exhibits Tactical Frivolity is the tailor in the Emperor’s Has No Clothes. His peaceful protest of the emperor’s spending is to “use” expensive fine fabric that only the best people can “see”. The emperor pretends to perceive the expensive fine fabric so as to not be thought a best person. To his chagrin, a young child calls him out on it and everyone can see what a fraud he is.

Ta da, Tactical Frivolity.

Also why the costumed frogs in Portland, OR have had such a fun impact.

Kind of like sticking your tongue out and razzing those who want you to comply.

Tactical Frivolity is not complying.

And I think the protests in Portland are better for it.

After all, the costumed frog has been joined by many, many others.

Other frogs.

Dinosaurs

Unicorns.

And more.

The costumes are sold out everywhere.

Tactical Frivolity is useful in these times. It reminds those who would have us comply with their bullshit that we very much will not.

Now where can I get a Peep Costume. I think that would be fun.

School Me Saturday 10/11/2025- El Presidente shakedown of Universities

In the so-called OBBB, aka the “big beautiful bill”, where the conservative right laid out most of their demands from Project 2025 that hadn’t yet been begun by the draconian Department of Education policies, the student loans were capped. Yup, at the undergraduate AND the graduate level. This means that the Parent PLUS loans are capped at $20,000 per year, with a lifetime cap of $65,000 per student. For the graduate unsubsidized direct loan limits are $50,000 per year, with a lifetime cap of $200,000.

At first glance, like so much of what this administration does, this is positive. This means that student loan amounts will be limited. That student loans can’t hamstrung young adults and their families long after the principal amount has been paid, often many times over.

But, like so much of what this administration does, this is a poison pill.

You either have to be rich to attend undergraduate and graduate schools, or you have to be able to take out subsidized loans, often from predatory lenders, or you have to have a very robust 529 savings.

Yeah, right, you have to be rich. This decreases the student “talent” pool available for universities and colleges. If you have an unlimited checkbook, you’ll be fine. Otherwise you are fucked.

In all transparency, Creighton cost me about $5,000 a semester when I went there for a total of 4 semesters, or $20,000. Reminder, this was 1993. I had a scholarship from the pharmaceutical company that owned Marshalls at the time for $4,000. I also had an Air Force reserve officer training corps (ROTC) scholarship that began in my second year. I live off campus for the first year and in the dorm for the second year. After I hurt my shoulder (on campus, mind you), I had to leave Creighton and I lost my ROTC scholarship. Don’t worry, the Air Force got their money back in painful $200 amounts over the next TEN YEARS. My next nursing school I paid out of pocket for. This was a community college in California and I don’t recall the per hour tuition from 1998. I had three classes that I took before I was accepted into the program, microbiology lab as I was missing a credit hour from Creighton and CA requires 5 credit hours, algebra, and an English class. Let’s call Napa Valley cost was about $3,000 for the program. My BSN was $24,000 in 2015 that I exclusively used student loans for, and my MSN was $12,000 which I used $5,000 in student loans and paid the rest cash. This was because the student loan disbursement did not jibe with the 8 week quarters. 20,000 + 24,000 + 12,000 + whatever the PhD is costing me= way over the $65,000 lifetime max. Okay, fine, under the $65,000 max for undergraduate and under the $200,000 max for graduate.

Trust me, it was painful to type that out. Imagine students and their families now. I always worked full time except for working part time that first year at Creighton.

But the real meat of today’s post is the shakedown request by the administration to 9 universities to sign a pledge that they (the universities) will uphold the administration’s higher education priorities. Of course, this wouldn’t be a shakedown without the poison pill. If the universities don’t sign this bullshit pledge which is, in effect, a blank IOU to the administration to cleave to whatever subsequent bullshit the administration pleases.

You know, a shakedown.

This is a commitment by the universities to not talk smack about the conservative ideas. I’ve been at five different colleges and universities and I have NEVER heard that there was a concerted effort to silence conservatives.

This is a fever dream, dreamt up by an administration that is so thin skinned that any talk that is not boot licking or ass kissing is seen as an assault.

It isn’t always about you, assholes.

The 9 universities who were tasked with signing this “pledge” were University of Arizona, Brown University, Dartmouth University, Massachusetts Institute of Technology, University of Pennsylvania, University of Southern California, University of Texas, University of Virginia, and Vanderbilt University. The universities would also have to cap foreign student enrollment and give American students an edge in applying.

This is American exceptionalism? Putting the thumb on the scale?

Odd spread, don’t you think? A mix of blue and red and purple states and a mix of Ivies and state universities.

MIT told them to pound salt.

The faculty of the University of Virginia voted overwhelmingly (97%) to say no thank you. But the university itself has not rebuffed the idea.

This is a shakedown at some of the best universities that America has. But it begs the question, why these universities? What can be accomplished by squashing original ideas and original thought in these nine? What about the oldest universities in America? What about them?

The universities have to realize that this is a poison pill. I imagine that the administration thinks this is an iron fist in a velvet glove but no. Excuse me, your iron fist is rusting and your emperor has no clothes.

Citation

Cunningham, M. (2025, October 2). White House asks 9 universities to sign agreement to ensure access to grants and other federal benefits. Cbsnews.com. https://www.cbsnews.com/news/white-house-nine-universities-compact-federal-funds/

Moody, J. (2025, October 10). MIT rejects Proposed Federal Compact. Inside Higher Ed. https://www.highereddive.com/news/trumps-higher-ed-compact-draws-condemnation-from-faculty-and-college-union/802425

Spitalniak, L. (2025, October 8). Trump’s higher ed compact draws condemnation from faculty and college unions. Higher Ed Dive. ttps://www.highereddive.com/news/trumps-higher-ed-compact-draws-condemnation-from-faculty-and-college-union/802425

No FFS Friday 10/10/25- It’s World Mental Health Day

Boy, do we need a day to stop.

Stop doom scrolling on your phone.

Stop yelling at the kids on your lawn.

Just stop.

For a moment just be.

Go for a walk.

Touch some grass.

Pet a puppy.

Hug your kids.

Remember what Annie taught us “Just thinking about tomorrow, blows away the cobwebs and the sorrow. Tomorrow there’ll be sun.”

We have to hold on to that knowledge, but also acknowledge that it is going to take a LOT of work to get to the tomorrow (Star Trek) that we want instead of the current (Star Wars) that we are in.

But today realize that this shit is hard and we are doing the best we can with the protesting and the speaking up and the witnessing their acts of cruelty.

Have a cookie.

Today of days I embrace the notion and the knowledge that these dark days cannot last forever.

Every time I open an app, I see thousands of people exercising their first amendment rights to peacefully protest.

And I see the Portland Frog Troup and I smile.

And open 5 calls and write my next letter and make my next call.

Call Secrets of the OR 10/8/25- Call bootcamp

There’s this thing I do with new to the OR nurses or new to our OR nurses. It is called Call Bootcamp and I am the guru.

I’ve been taking all the call for so many years it has become my favorite.

And so I teach the new ones about how not to fear the call.

I call it Call Bootcamp. This is where the new nurse and I meet for about 60-90 minutes and talk about call. I also optimize their Epic situation to make it work better for them everyday. Not just on call.

I’ve done this well before the call shift. I used to buddy call with the new nurses and get them comfortable with call. I’ve done this for at least 10 years.

But I have never been able to justify the little call bootcamp on my clinical ladder. There isn’t a space for education items that are not posters or ANCC credited in person experience. That is my next step but it is a helluva lot of work and I have never dedicated weeks of my life to getting ANCC credits for the work.

The following is an attempt to get credit for the call bootcamps that I run. These are not part of my job description but rather are born from wanting to get a new nurse the best shot at a successful call shift.

1) How did you determine the date, location, and time frames for in-service? How did you communicate information to promote attendance?
This is a rolling in-service for new hires to the OR. These are one on one sessions that are not part of my role. When a nurse is deemed ready to take call for the department, the session is set though the assistant nurse manager. This is not expected in my role.

2) How was the need identified for this educational offering?
Surgery call is specific to the types of cases that you might encounter on call. Each time you are called in follows a pattern. This need was identified in new employees, many who had not taken call before. I was the natural answer to this need as the week call nurse.

3) Resources utilized?
None as I was available because of the call hours. The new nurses are paid for their time. Each call bootcamp takes 60-90 minutes, depending on their experience with call.

4) What is the objective of educating the team member?
The program objective is to familiarize new nurses to the call process at this particular hospital. This is done by a mock run through of a call case. From initial contact with the nursing supervisor, scheduling the case, picking up the patient/arranging for transport, picking the case supplies, doing the pre-op checklist through the Quick Prep tab of the operating room navigator, signing consents, doing the actual call case, when and how to call the recovery room team.

The new nurse and I walk through surgical services and talk specific to the OR things and specific to call things. Highlighted is the overhead call system, and the code button location in the OR. Specifics of code situations in the OR are discussed as well as where to find the department code carts. The silver anesthesia emergency binder is located and gone through with the nurse. In the PACU, the highlights include the Broselow cart, the Malignant Hyperthermia cart, the supply room and what might be needed from there. In the ACU, explanation of the pregnancy testing on all patients per policy and where the kits are, the supply room in the ACU is explained. The availability of the test tubes is discussed and demonstrated. The location of general ACU supplies are demonstrated. Matching Broselow band location is demonstrated, specific to pediatric patients, along with a discussion of how important it is for the responsible parent to have a band on as well. Tips and tricks specific to the call routine are discussed. I want them to be at least familiar with emergency procedures in the OR that can happen on call when there is a skeleton crew.

The Epic platform for each new nurse is optimized for the operating room. Specific to the OR flowsheets are added to the flowsheets (perinatal demise, and hysteroscopic use). Location of the code button hyperlink is explained but not demonstrated.

The Call Preserver notebook is highlighted. This is a step-by-step FAQ of specific OR things- including blood administration, how to schedule a case, how to put in a culture, what information is necessary to book a case, what specific orthopedic instrument sets are on site, how to use the iPads to do the surgical and anesthesia consents, how to run a code, and more. With a section of the supervisor has called me and I’m on call, now what?

The tour ends with the location of the call sheets. These are the pages that list who is on call for the day. In this hospital there is a call sheet for OR, PACU and Endoscopy.

5) Describe the benefits of the education to the unit/department?
Being on call is a scary proposition for new nurses. It is basically a mini shift, alone in the department with only the other call people and surgeon to rely on. This Call Bootcamp sets them up for success by answering their questions in a controlled environment when there isn’t a patient on the table, or a surgeon staring at you. I continue to offer support after the bootcamp by encouraging them to call me with any call question when they are in the middle of a call case if necessary. In the last week, I have received phone calls about specific supply locations, scheduling a case, and where the tonsillar bleed bovie was located.

By making myself available I alleviate their fears. Sometimes I do their first call with them. It is one thing if you are lectured about what to expect, it is another thing to actually do the thing. I iterate and re-iterate that I am always available for questions, should the need arise.

All of this stuff and there still isn’t a place to take credit for it. Shame.