Author: dispatchesfromtheeveningshift

I am a 2nd generation nurse. I received my MSN in May 2020 and am now a PhD student. I am the night call nurse and these are the stories from my nursing career.

Cookie Thursday 7/31/25- Peanut butter, chocolate, oat bites

It is the most dangerous time for me in the kitchen and Cookie Thursday is a Thing. It is hot, we’ve been enjoying a pretty brutal heat wave here in NC with temperatures above 95. Plus 88% humidity.

Makes me tired.

Makes me bored.

Makes me not want to bake and heat up the house.

And it is too close to No Heat August to concentrate on baked goods.

I could have done what I did last year and started No Heat August a week or, in 2025’s case, a day early.

My brain went nah.

Do you see what I mean?

It’s been like that all month. I normally have a plan with recipes made before the last day of the month.

Today was particularly busy. It is nursing awards day!

I procured the cinnamon rolls yesterday afternoon, like I usually do.

Our balloons failed to achieve lift and so my co-person asked me to procure balloons. Happily Michaels opens at 0900 and solved that problem.

And then I needed the flowers.

And then someone’s Mustang was parked in the shade, which I would normally admire but they were taking up 2 parking spots as they were straddling the line. Rude.

I loaded myself up with the CTIAT container, the flowers, the cinnamon rolls, and the balloons and staggered into the hospital. I really could’ve used two trips.

Good thing that the front desk staff know who I am.

I arrived at the awards with 20 minutes to spare.

Which, if you know me, is practically late.

I ran the CTIAT container down one floor to drop off the cookies.

But, Kate, what did you make? You haven’t written that yet.

Oh, boy, heat does not make my brains work too well.

I decided to make an oatmeal, chocolate, peanut butter bar that I’ve been meaning to make for a bit.

I started it last night when I got home from the hospital.

The recipe looked easy. Butter, sugar, brown sugar, 1 egg, vanilla, peanut butter for the wet. For the dries flour, baking soda, salt.

Pat into the bottom of a 9 x 13 pan and bake for 20 minutes.

While it is baking, make the peanut butter frosting.

When 20 minutes is up, sprinkle chocolate chips over the baked bottom immediately so that they melt. Swirl on the peanut butter frosting.

Quick and easy, took me 40 minutes.

That wasn’t the long part.

The long part was when I walked upstairs to shut the computer down for the night and I noticed that I had not finished Wednesday’s post or posted it to all the places.

That took a minute. Okay, it took 30 minutes.

Long story short, I am tired of this heat.

And I am ready for the promised break from the heat starting on Saturday.

Fingers crossed.

Call Secrets of the OR #2- The contact list in case of emergency

I’ve been at this call business for a long time.

Well, strike that because I swore to my big belly patient last week that I would stop saying that. I apparently told them that I had been a nurse for a very long time, not once but twice, and they called me out on it the second time. They just wanted me to be more specific.

Ahem.

I’ve been at this call business for nearly 25 years and in that time I’ve had my share of no shows or no answers or, on two occasions, the tech that I was waiting for was in a car accident.

It was odd enough the first time it happened but the second time? Eerie. Made me think of the night call unit secretary that I worked with in California. She trained me and was always there to answer questions, even after I became a nurse. She died driving home after a night shift.

This is why I always, always, always tell people when I have called them in to drive safe.

What do you, as the call nurse, do in event of a no answer/no show/accident?

If you are me, you grab the big red book of numbers. Everyone is in this book: surgeons, PAs, doctors’ offices, anesthesiologists, CRNAs, scrub techs, circulators, management, charge nurses, SPD, and the all of the department numbers for the hospital.

You know, in case you don’t have those memorized.

If you still haven’t gotten a call back or a response to the second call, you start in on the list.

Over time you will get a feel for who is friendly to a three am phone call and who might be interested. If it is a scrub tech you might even call nurses who you KNOW are capable of scrubbing the case.

That’s what I did when the first tech got into the car accident on the way in.

If you don’t get a response or all you get is no thank yous or hung up on, you call the nursing supervisor to keep trying.

If after the case is picked and there have been no nibbles you should consider more scorched earth options. You call management until THEY pick up. And dump the problem into their lap.

While this is going on you also keep preparing for the case. Because the show must go on.

In my twenty years of doing this I have never had outright nos from every single person I have called. Knock on wood. Mostly because I have garnered 17 years of brownie points at my current hospital.

Because they’ve all been there and can commiserate with you.

A very last resort would be transferring the patient to another hospital. This is the very last option because there are going to be delays getting the receiving hospital to accept the patient. There might not be room in their overnight schedule. And surgeons would definitely not appreciate this kind of maneuver.

And you’ll never hear the end of it.

If you are going to be new to call and are scared that this might happen, start gathering your brownie points now. Be nice, consistently nice, and people will have a harder time saying no to you.

There is also the mandatory call list but that is more to cover people during the day. I’ve never used it at night. But it is an option.

Know your friendlies and also know who is more likely to say yes.

That will save you, the patient, and the surgeon a big headache just trying to get the case off the board.

Being nice never cost you anything.

Think of it as banking brownie points for use in an emergency.

Tuesday Top of Mind 7/29/25- Initial cost of childbirth

Children, I’ve been told, are expensive.

This is an observation from a childless woman.

There is the constant need for diapers and wipes and creams on one end and the other end requires food. Like, every day, many times every day.

Sometimes the food (formula) requires bottles and nipples. As well as the cost of the formula and the water to mix it with and the sterilization of the bottles so that the infant doesn’t get sick. Sometimes (always) the food (breast milk) requires that the woman supplying the breast milk be fed as well. I am unsure how to write you have to feed the cow in a non-judgmental gentle way. Perhaps a better way of putting it is that you can’t get milk from a stone.

There is always going to be an opportunity cost. (I learned that one from Economics class).

Another thing that feeding a baby, no matter how (breast or bottle), requires is time.

Time to sterilize the bottles.

Time to feed at the breast.

Time.

Then you have to clothe the baby. It is high summer right now here in North Carolina and I know that baby would be most comfortable in just a diaper. In the shade. But it is not always high summer. This means that there are costs for clothes for the baby.

You know what else happens? Babies grow because you’ve been feeding them. That is their job after all, to grow and learn and explore.

Humans are astonishingly unable to care for themselves after they are born. A foal stands minutes after birth, even kittens’ learning period is vastly truncated from the years it takes a human to be self sufficient. Someone needs to mind the baby. But most Americans’ work so that they can afford a roof over baby’s head or food for baby or clothes for baby. Since we know that baby’s self sufficiency is non-existent, someone has to mind the baby and often mothers and fathers pay for someone else to mind the baby when they are at work to earn the money to house, feed, and clothe the baby. This means childcare, which is extremely expensive.

Babies are expensive.

But this entire post is about the initial cost of a baby.

According to Fair Health, a healthcare data company, the costs can vary widely across the U.S.

I am going to write about North Carolina and South Carolina, since they are the closest geographically.

These costs are inclusive of pharmacy costs, nursery while in the hospital costs, the labor and delivery room cost, the medical supplies, the room and board for mother. Also included in the cost estimate is anesthesia costs for delivery, feral non-stress tests in the weeks before delivery, ultrasounds, and the laboratory tests that may be needed.

And a breast pump.

You know, to feed baby.

I think that is a pretty inclusive list for delivery. But what do I know? I’m just a childless woman.

I am going to break it down by the two types of delivery- vaginal and cesarean section.

For vaginal births, NC is near the bottom of the middle of the pack. According to their numbers it costs $14,250 to delivery vaginally. Reminder this includes the costs that are listed above. The South Carolina cost of a vaginal delivery is $13,865.

For section births, NC is again near the bottom of the middle of the pack at $18,490. It surprised me when South Carolina was at $19,654.

Again these are the costs inclusive of the above list.

But, Kate, where did you get this list?

From Becker’s Hospital Review. This is a clearinghouse newsletter of new and notable data and information in the healthcare realm.

Oh, and the data? From 2024. When I googled the cost of a vaginal birth in North Carolina, Fair Health was the second result.

The most expensive state to have either a vaginal birth or a section birth is Alaska ($29,152/$39,532). This makes sense as everything has to be shipped state side and hospitals are in the bigger cities, which costs travel. The least expensive in both kinds of delivery is Mississippi ($9,847/$11,110). According the KFF (Kaiser Family Foundation) the maternal mortality rate for Mississippi is 39 per 100,000 live births. The maternal mortality rate for Alaska has been suppressed due to reliability and confidentiality restrictions.

But my take away is that babies are expensive straight out of the gate. (Sorry, I couldn’t resist)

This is not something to be taken lightly and should absolutely factor into a woman’s desire to have children.

I can hear it now “But, Kate, what do you know about it?” Well, nothing but I have friends and family who have recently given birth. That also doesn’t mean that I can’t add to the conversation.

School Me Saturday 7/26/25-students and AI part 3- spellcheck AI, a cautionary tale

Your spell check is lying to you.

In the before times, you know before 2022, spell check used to be of the actual world. A list that was carefully maintained by the company that ran the spell check program. Programs like the spell check embedded in Microsoft Word or Google Docs.

Well I say used to be of the actual world.

Now it is a computer program that has been trained using AI in pattern recognition. The patterns that they recognize is the correctly spelled world. And the myriad ways that a word can be misspelled. And there are so many ways a word can be misspelled.

Think they’re, their, and there. They’re is a contraction of they are. Their indicates ownership. There indicates place.

Which usage is correct? The spellchecker now uses pattern recognition to recognize if the usage of that particular word is the correct one.

Are you with me so far?

But when enough people misspell and misuse a word or a phrase enough time the program now lets the wrong word and the wrong usage to be accepted as truth.

Where it gets tricky is that the sentence “They’re over there” meaning they are over there can confuse the program. What someone meant to mean is place (there) over place (there). Which doesn’t make sense. Or the third person meant to mean Their (possessive) over there (place).

And the computer program which is not an actual person and therefore cannot think, allows it.

Because enough people have made that mistake. This tricks the program to thinking it is correct when it could not be further from the truth.

This is, and I can’t stress this enough, dumbing us down tremendously.

Kind of like evil auto-correct.

This is also a self perpetuating problem. People can’t spell, can’t write, and fuck it up either way and depend on a machine that is not a person to sort it out for them. And so on and so on and so on.

Until we are left scratching letters into the dirt again.

A duck is never a duck when you mean fuck.

The AI is patting us on the back and saying “their, their, their.”

Cookie Thursday 7/24/25- Cookie Inception

Inception was the 2010 mind heist movie that starred Leonardo DiCaprio, Joseph Gordon Levitt, Tom Brady, Elliot Page, and Cillian Murphy. It was about mind criminals that used dreams to steal corporate secrets, other secrets that you don’t want anyone to know.

Also known as one of my favorite movies.

The reason it is called Inception is a major plot point revolves inserting an idea or secret into a subconscious, not retrieving it. This secret can be anything. Such as convincing you to break up your newly dead father’s energy conglomeration.

10/10. Would definitely recommend.

The reason this week’s cookie has been dubbed Cookie Inception is that a cookie is inserted into another cookie and baked, thereby creating an entirely new cookie. Inception.

Neat huh?

Okay, if that is too much for you, I had a package of Oreos in my pantry. No idea when they were bought/how they came to be in the pantry/who brought them over for me to put in the pantry. I was going to use them in the ice cream for the department ice cream social in August but then I thought about crushing them, putting them into a cookie base and baking them.

Cookie within a cookie.

You see where I am going with this, right?

Cookie Inception.

Or Cookie-ception.

Call secrets of the OR #1- Know call time is not your own

Instead of Best Kept Secrets of the OR I thought instead to start a new subset of Wednesday. This is going to be Call Sets of the OR.

I got the idea last night when I had a surgeon, a CRNA, and the surgical tech all tell me that the case we were about to start would horribly. I reminded them that we could not know that and I believed in the power of positive thinking. That thinking and speaking negatively might just create the very negative reality for us and the patient.

No wonder they called me Pollyanna Puke on the floor.

But that is another call topic for another time.

The very first call secret is one that I know that a lot of my fellow operating room people fail at.

And that is knowing that the hours you are on call is not your own. By that I mean that the hours are not yours to do with as you wish and you might get called in during that time. But if you are called in, you are unpleasant and drag your feet on everything.

That is no way to create a positive experience for the patient.

Look, having to undergo semi-urgent or emergency surgery, because that is what the call case make-up should be, is no walk in the park for them. The patient has to be NPO, dressed in tissue paper, have an IV, and have anesthesia. This might be run of the mill for us but maybe they’ve never had surgery before and they are scared out of their wits.

Or maybe they’ve had surgery before but it was years ago when they were a kid and all they remember is being cold and dressed in tissue paper and surrounded by people in funny blue clothes that are not their mommy or daddy and being held down and having to breath in a yucky gas and then nothing until they wake up in a too bright room with yet more strangers and their wrist or their ears or their tummy hurts. And so they are scared out of their wits.

It is rare to have a patient who is laissez-faire about having surgery.

The patients are who the call nurse needs to be thinking about while they are on call. And how to make their experience smooth and efficient.

It is a mind shift for sure.

Make it less I HAVE to go in and more I GET to go in.

Do I know how to make the mind shift? No. The only thing that I know is that the brain is kind of like a muscle. You have to work on changing your own mindset.

Frankly, it can take some time, and repeated calls.

Ultimately we don’t take call for ourselves. Some of us might take call for the extra pay, or to pay back a favor to a coworker, or so that a coworker will owe you a favor. A lot of people take call because it is mandatory. Those are the calls that I took, back when I was the evening charge nurse and scooping up all the calls. Because the person whose call it was didn’t want it.

So don’t make plans. Your call hours are not your own. At the very most make vague plans. And realize that a call from the supervisor can and will change them in an instant.

Tuesday Top of Mind 7/22/25- Here’s Johnny!

All work and no play makes Jack a dull boy
All work and no play makes Jack a dull boy

Interior-
Stairs with yellow flower patterned wallpaper, white French double doors to the left at the top of the stairs, open white French doors to the right.
Man limps up the stairs, he is balding, wearing a maroon zip up jacket over a majority dark blue with yellow and green plaid shirt. He is caring an axe in his left hand. He seems to be intent on the open French doors at the top of the stairs. He is grimacing, bottom lip tucked under.
He glances into the room.

Exterior-
Half opened small window, a woman in a blue bathrobe with long dark hair is waving her arms as she frantically tries to squeeze through the very small opening onto the snow covered roof.
She struggles for a moment more and, realizing that she can’t squeeze through, slides back into the room.
A small boy, snow on his sweater gasps and watches as she disappears from the window
The frantic music is coming to a crescendo.

Interior-
Older style refrigerator on the left of the passageway leading past a bed toward a yellowish lit door. There is a small table and chair to the right and a small radiator to the right of the passageway.
Same man, still holding the axe now near the head, seen from behind,
“Come out, come out, wherever you are.”

Interior-
Tiled bathroom, woman from before seen from behind frantically trying to get the window open wider. She glances back, mouth ajar, seemingly frightened and tries to squeeze through the window again.
The music (strings) gets louder

Exterior-
Same window as before, same woman trying frantically to get through the window.

Interior-
Same lighted door as the previous interior shot
Man is now seen in profile. He tries the door knob. It is locked.
He lifts his head, as if in thought, as if listening.
Man turns, tongue between teeth, and knocks on the door.

Exterior-
Woman reacts to hearing the knocking by gasping.

Exterior-
The bathroom window is on the slope of a large snow pile that is against the house. She is in the window, the boy is on the ground.
She whisper shouts to the boy on the ground “I can’t get out. Run! Run and hide!”
The boy turns to run.

Interior-
Same interior as before.
Man in ¾ profile is listening. He smiles and says “Little pigs, little pigs, let me in.”

Interior-
Woman in blue bathroom, long dark hair framing her face is now inside the bathroom. She looks around frantically and picks up a long 9“ knife from the sink. Holding the knife she goes to the door. She collapses to the wall next to the door.

Interior-
Man now turned fully toward the camera.
He says “Not by the hair on your chinny-chin-chin.”
The music is still frantic, still strings.
Man looks at the door, frowning, and turns slightly toward the door. “Then I’ll huff.”
He turns toward the door “And I’ll puff.”

He steps back and slides his right hand up the shaft of the axe to where he is holding it in both hands, he steps back, readying to strike. “And I’ll blow your house in!”

Action shot of man, striking the door with the axe.
A woman’s voice cries out “NO!”
The man strikes at the door again, as the woman screams.

The music is quieter now, nearly silent.

Interior-
The woman who is now clutching the knife is screaming as the door is battered by the axe.
The door splinters and she screams. She brandishes the knife toward where the axe is tearing at the door.
The axe blade is now visible.
Woman screams “Jack! Please!” as she slides down the wall slightly.
The axe hits the door again.
Woman screams “No!”
The axe hits the door again.
Woman screams “No!”
The axe head is driven completely through the door.

Woman looks at it in terror and screams.

The axe head twists and turns are the man tries to free it.
Woman screams.
The axe finally is pulled through the door.
Woman hides her face with her left hand, still clutching the knife with her right. A wedding ring is visible on her left hand.
Woman turns to where the door is still being battered, flexing as it is. She clutches the knife in her right hand and screams “No!”
The attack on the door continues.

The woman screams “Please”

The axe head is visible again.

Interior-
Shredded door.
Man on other side of door, readies the axe again to swing.
He swings again.
Woman shrieks.
His entire head is now visible. He swings again to make the hole bigger.

Interior-
Bedroom side of the door.
Man swings again to make the hole bigger.
Man drops the axe.
Man sticks his head in the opening in the door he has made.

Man “Here’s Johnny!”

All work and no play makes Jack a dull boy
All work and no play makes Jack a dull boy

______________________________________________

This is, of course, the “Here’s Johnny” scene from Stanly Kubrick’s amazingly terrifying movie The Shining. The woman is played by Shelly Duvall and the madman is played by Jack Nicholson.

I didn’t think of this movie as a parable for the ongoing (yeah fucking still!) covid pandemic.

But it fits so well.

We are being stalked by the covid virus. It is rising across the country.

Did you hear, there is a sneaker covid wave happening right now? Did you get boosted in the Spring when that crackpot RFK Jr. took control of DHHS? It might not be too late.

The states that it is definitely growing in are Texas, Florida, Iowa, Illinois, Ohio, Kentucky, Pennsylvania, Virginia, North Carolina, and Arkansas. The states that are likely increasing their number of cases are California, Oklahoma, Mississippi, Wisconsin, Michigan, Indiana, New York, Maine, New Jersey, Delaware and Maryland. That we know of. This information is from the news report on CBS news on July 21, 2025.

It hasn’t gone away. We can’t wish it away. We can’t hide our eyes under the covers and pretend like it isn’t happening.

No one at the switch means that more Americans are going to die. Currently the American Death Toll from covid is 1,225,181. This information is from the Kaiser Family Foundation and is current and easier to find.

This why the scene fits so well.

BTW, we are Shelly Duvall screaming.

Wear a fucking mask, wash your hands, don’t gather with a large group of people.

If you are sick STAY HOME!

Medical fiction and non fiction book report 7/20/25- Re-reading in a different political climate is surreal

An ode to re-reading everything.

And I mean everything.

Do you mean every book you’ve ever read, Kate?

Yes, every book you’ve ever read.

It is amazing how a re-read shows that the story has changed. I have heard this from a lot of different readers. The books they loved as children, the books they loved as adolescents, the books they’ve loved as young-adults, the books of their early adulthood? All different because you’ve changed.

Well, you’re not the person who originally read the book anymore.

Things have changed. You may have gone back to school. You may have gotten married, or had a child. The country might’ve been taken over by a despot whose only concern is himself and how much money he can bilk out of his followers. You might have changed jobs.

I didn’t start this series out in a bid to change my mind about the classics that I’ve read, or about books that I enjoyed in the past.

But it has happened.

You’ve heard the Star Trek joke about not liking Shakespeare until you’ve heard it in the original Klingon?

I am not the person I was when I originally read these books. Fiction AND non-fiction. That means the lens through which I see them is different now. And my interpretation will be different now.

Case in point- I am re-reading the book Lock In by John Scalvi. Yes, that same John Scalvi. I started three books when I was on vacation. Lock In by John Scalvi, All Systems Red by Martha Wells (this is the books the Netflix show Murderbot was based on), and The Soul’s Guide to the AfterDeath by Gwenna Laithland. Lock In was the only book that was a re-read.

Back to the analogy-

I originally read this book when it first came out in 2015. And I remember liking it. It is a near future story about people who have had a disease (Haden) and are locked in. There has been a flurry of these books over the years, think The Butterfly and the Diving Bell, but this was the first one that I read that was was fictionalized. This book has robots that can be piloted by those who are locked in.

The United States has just passed a law that will seriously impact those who are locked in. By taking away their subsidies. These are everyday Americans who have been struck down by an illness that they didn’t want and didn’t ask for because it is expensive, baby. To care for all of those 5 million Americans who are locked in. And the government would rather you take the cure that no one has yet, than be on the dole.

Not that most of the Haden sufferers don’t have a job. From coding, to the FBI agent main character. But caring for a body is expensive and having a second life piloting the robots is expensive. The robots are also expensive. You have to care and feed for the body that you are not using and you have to maintain the robot and make sure it is charged. That is why most of them have jobs. And still the funding for their survival and medical care has been cut.

Sound familiar?

This was definitely not how I interpreted it when I first read it.

It is funny how times and circumstances and bullshit that those in power and those in power desperate to stay in power are pulling on us changes our perception. Isn’t it?

Re-reading this book about a pandemic that locked in 5 million Americans and 20 million people around the world? Well, those the Haden virus didn’t outright kill. That has been a mindfuck to this operating room nurse who worked in a hospital nearly every day through the real 2020 pandemic.

Of course the government tires of taking care of these disabled Americans. Have we learned nothing?

Eye roll.

FFS 7/18/25- F’in Cowards #3

Oh, my God, they killed Elmo.

Say it along with me and Kyle “You Bastards!”

Or they are doing their damnedest too. Kill Elmo that is.

This is, of course, a riff on the long standing killing of Kenny on South Park. This is a not quite children’s show on Comedy Central.

It isn’t just Elmo. It is also Wait, Wait Don’t Tell Me. It is also Fresh Air with Terry Gross. It is also Sesame Street, writ large. It is also Masterpiece Theater. It is also PBS Newshour. It is also Antiques Roadshow. It is also Ken Burns’ myriad historically important history programs. It is also Morning Edition. It is also may podcasts that go beyond the story. Hey, that is a good point, it was also Paul Harvey.

This is when the big bad budget that was passed in March, with Chuck Schumer’s reluctant support, was deemed by some people to be too “woke” and so their leader decided that there needed to be a claw-back to money that has already been approved for things like NPR, PBS, and foreign aid.

As always, the more poor people are punished for being poor by the richest congress that lobby money can buy, the better for the richest congress that lobby money can buy.

For why?

Because we as a society don’t deserve nice things, apparently.

After all, if children watch PBS and see everyone being kind to the Muppets or learn something, they will be tainted. And infected with the so called “woke mind” virus.

Many people who voted for this stupid, stupid, stupid, stupid (did I write stupid yet?) bills in the last two weeks have come out to their outraged constituents as being unhappy with the bill. Cough, cough, Josh Hawley, Lisa Murkowski. Look at you trying desperately to save your jobs from your rightly outraged constituents.

Um, if the congressperson or senator doesn’t like a bill, there is a REALLY simple and EASY solution. Don’t vote for the fucking thing!!!!!!!!!!!

Grow a back bone or develop a set of balls or ovaries and stand up for your constituents! Stop listening to the minority who have the megaphone at the moment and start listening to the everyday Americans who have been calling your offices and standing up to you at town halls.

Stand up for the people who sent you there!

Stand up for your children and your grandchildren, for the god you profess to believe in’s sake!

Stand up to the wannabe tyrant at 1600 Pennsylvania Ave.

For fuck’s sake, the Founding Fathers would be so disappointed in your lack of care for those you wouldn’t piss on if they were on fire.

Fucking cowards, the whole lot of you!