2, 980, 376 minutes.

That is five years and eight months without an immediate use steam sterilization for total joints.

5 years and 8 months saying no to surgeons.

Until this week.

Because the surgeon didn’t want to wait.

A flash takes 13 minutes.

A pre-vac takes 25 minutes.

For an impatient surgeon that didn’t want to wait the additional 12 minutes for a pre-vac cycle, the no flash streak in the OR was broken.

For a surgeon that no one had the balls to say no to, the patient is at increased risk of infection.

For a surgeon that just had to have his way, the patient has to be monitored by infection control for 5 years.

Flashing should solely be done in life or limb situations.

I have been working on decreasing the IUSS in the OR for 7 years.

And they fuck it up in one fail swoop because the precious surgeon didn’t want to wait.

I am so disgusted.

And defeated.

And tired.

But, mostly, I am angry.

(the title is an homage to Seasons of Love from Rent: the musical)

For Cookie Thursday is a Thing this week, I decided to use Harry Potter as inspiration.

Which fits in with the literary month.

If you ask anyone who has read Harry Potter, a child, a teen, or an adult, what would they like to try in that fictional world, the answer is butterbeer.

I have had butterbeer at Universal Studios and it is butterscotch adjacent.

We’ll see what the cookies turn out like.

My normal meeting for the third Thursday of the month was cancelled by the CNO of the market.

Because of the Delta surge, you know.

It is not looking too promising to have a symposium in 7 weeks.

Especially if I have two slots left to fill with speakers.

Yeah, not looking too likely.

Even if it is virtual.

The memo/welcome letter to new doctors worked!

Yesssss!!!

It was toward the end of the shift and I was walking a piece of equipment over to the other OR when the phone rang.

It was a new doctor.

The one I had helped get scrubs the other day.

When he was here I gave him a copy of the welcome letter.

And today he followed the hints.

(happy dance)

I knew it would work!

I cannot stop looking at the death toll.

I look at it daily.

At night.

After I get home from work.

I knew that the death toll was nearly to 660,000 on Sunday.

As in 659,931.

But with the expected weekend lag with reporting I knew that the number would be reached on Monday the 13th.

And it was.

I looked back at other posts to see what had transpired.

The post I did about 650,000 was on September 8th.

5 days, 10,000 dead.

Of course.

However, I think the hospitalizations are lessening at my hospital.

And the hospital system.

You know, just in time for the Labor Day surge we all know is coming is here.

Please practice social distancing.

Please wear a mask.

Although the case volume is down our ICU and IMCU are still full of covid patients.

Be safe.

My sister and I grabbed out KN95 masks and went to the theater.

That was different.

The last musical we saw was in 2019, when we saw Hamilton in San Francisco.

We had major plans for our theater group in 2020.

We were going to get season tickets.

And see 8-9 of the 12 shows on offer for the year.

And we all know how that went.

For my birthday I received tickets to Wicked.

They were for September when the shows would re-open in our town.

This was back in the halcyon days of early July.

When we might’ve, could’ve had a chance.

But no.

Delta came roaring into our lives.

And people were entrenched in their mask and covid denial.

And those of us who are fully vaccinated tsked and shook our heads.

And got mad.

Today was the day of the show.

My husband bowed out and offered his ticket to my sister.

She graciously accepted.

The date was on.

And then I worked the majority of last night.

All I could think when I clocked in at 0300, knowing full well that my mom and sister were coming over for brunch at 0930, was that my mom was going to be so mad at me.

I got home at 0800.

And collapsed into bed.

My sister came by and picked me up at 1200.

The theater is 15 minutes away.

We made plans to don our KN95 masks before we left the car, because we are responsible for ourselves.

There was a strict mask policy at the show.

No one asked to see my vaccination card, although I had brought it along because of course I did.

There were many announcements about leaving the masks on during the performances.

Because everyone.

And I mean everyone in the seats, including the ASL interpreters were masked.

And there were roving spot checks for people who had removed their masks.

All in all I felt safe-ish.

Delta is still raging in this town.

Across the Southeast, really.

But it was different to be in a theater, surrounded by people I hope were taking it safe.

My sister and I scooched down into the 2 empty seats in our row.

You know, to increase the distance between us and others.

It was different.

It was nerve-wracking.

It was scary.

I was sleep deprived.

But the show.

It was great!

Would I do this again?

Maybe.

Especially if I am guaranteed empty seats to distance myself with.

The post-it reads ‘stop with the everywhere I’ve ever worked does it like this– whataboutism regarding the last place.’

Sit down, buckle up.

I do not care how your previous hospital did something.

If it was so good, then why did you leave?

Of the hundreds of these old hospital whataboutisms that I hear about a year probably 4 are useful.

Maybe 5.

This is not your old hospital.

This is a different hospital.

With a different culture.

Different people.

Different surgeons.

Different instruments.

Different total joint sets.

Different fracture sets.

Different computer system.

Different call requirements.

Different shift requirements.

Enough with the well, at my old hospital we…

Shut it.

No one cares.

Remember I wrote that welcome letter to the new doctors?

The one to be given to new surgeons when they start taking call here?

Yeah, the one with the OR numbers, hours of operation.

And the OR pager number for after hours?

The one that is titled “Welcome to call at (hospital)?

Yeah, that one.

I wrote it, proofed it, and gave it to my boss.

Who was supposed to take it to surgical committee.

And the doctors on the surgical committee was supposed to approve it.

And send it out to all the doctor’s offices.

Who was supposed to give it to all of their on call doctors.

Massive fail.

I am not sure where the chain broke.

But I will find out.

Three surgeons I talked to this week without the number.

1 had an emergent case.

1 was looking for scrubs.

1 was trying to schedule for tomorrow.

NONE of them had the pager number or any idea how call works at (hospital).

Do I re-double my efforts?

Or do I let the information slide through the cracks?

There is a new mandate in town.

After my hospital system blinked and said that as long as employees have started the vaccine process by the middle of September they can keep their jobs, the president of the US came out and said that all companies with a minimum of 100 employees must vaccinate or test weekly.

I am relieved.

This is what should have happened months ago.

Instead of relying on people to do the right thing.

There was always going to be people who stamp their feet and say not in my body.

There is always going to be those people who nay-say the vaccine.

Fine.

You have a choice.

Vaccinate.

Or weekly tests.

I think that weekly tests are going to be so onerous and expensive that people will get the vaccine so they don’t have to get weekly, monitored tests.

Because someone is going to watch you take the test.

Good.

There is an alarming story out of the South.

There is an upswing in fetal demise and miscarriages for those who have had Covid or are unvaccinated.

And reports of devastatingly early birth with these same mothers.

The point is no one knows how Covid impacts people.

But there is a vaccine that teaches the body to be on alert for the virus and defeat it before the host becomes ill.

Take the vaccine.

Where we are now is what people in the healthcare industry were so afraid of last spring and summer.

However, we have an effective vaccine and, if people had rolled up their sleeves, we should be in a vastly different space right now.

Literary month continues.

Some people are excited for literary month because they get Harry Potter Butterbeer something or other.

This is not that week.

This week’s cookies are inspired by J. R. R. Tolkien.

And Merry Took, one of the mischievous hobbits from Lord of the Rings.

This carrot scone is perfect for second breakfast.

The sign in the lounge states it is from the Hobbit, with the name of a Lord of the Rings’ character.

Only one person stopped me and told me I noted down the wrong book.

Everyone else just ate the cookies.

I was sure this one was going to be too far out there for people.

I guess not.

Over and over and over this last couple of months I have heard the word consistency.

Just looking for a consistency, they say.

Look people, I don’t think that word means what you think it means.

Consistency is showing up and doing the same job in the same way.

Consistency is doing the job even though it is not what you want.

I heard it again yesterday, ‘this person is looking for a little consistency.’

Um.

That person is valuable because she lets me shift her schedule to suit the needs of the department.

And she wants the schedule to be in her favor for Christmas.

Okay.

That week I will schedule her Monday-Wednesday.

I only shift her by a day or two with her permission.

Otherwise she is ALWAYS Monday-Wednesday.

It is only if the schedule is so bad as to require another nurse on Thursday or Friday because of vacations.

This is what I already do.

It is what I have always done.

Do not bleat at me that the staff want a little consistency.

What about what is going on is not consistent?

Or, to put it another way, what can be changed to make it more consistent?

in your eyes?

Or is consistency the new word of the year in the management?

That can be morphed to cover all incidences that make you uncomfortable?

You know what should be consistently communicated to me, the evening crew?

What has come, what is needed, what needs to go.

Case in point, there was a disposable that needed to be sterilized dropped off yesterday.

It was sterilized and placed on the rack.

At no time did ANYONE tell me there was a disposable to be sterilized for a case today.

This has always been daily communicated to me in the past.

And it is retrieved and placed with the case before the end of my shift.

Therefore why is it my fault that they mislaid the piece, actually put it away where it lives, and no one can find it today?

Because no one told me that it had 1) come, 2) was sterilized, and 3) needed to be put with the case.

Instead the blame and the finger pointing begins.

And there is me, with a confused look on my face, unaware of everything that had happened yesterday.

Is that the consistency you want?

Because if blaming me is part of your consistent plan I may need to change my plan.