Best Kept Secrets of the OR #26- Sometimes you kill the CPR dummy

At the hospital system I work for it has been decided to have us go through the motions of a CPR class every quarter. No, I am not sure why. Someone probably observed someone with rusty skills.

CPR certification lasts for 2 years.

In this regime, there is an online portion. This is where you do the book learning of the old system. Different scenarios are given and you have to pass each scenario with 100%.

Don’t worry, the test helps you along.

The most common type is the adult scenario. Differing patients with differing problems allow the learner (that’s you) to learn and show that the material has been understood.

Ideally, this is knowledge that can be used in real world scenarios.

After all, in each code, there isn’t necessarily a code team steps away from the operating room. Your mission is to get the patient to survive the code until the cavalry arrives. By calvary I mean the ER nurses, the ER doctor, a pharmacist, the nursing supervisor, the chaplain on duty, and ICU nurses. Who shows up depends on what time of day it is and if there is anything horrible going on in their unit.

Concurrent codes do occur. Depending on your hospital size this would be rare but it can happen.

To facilitate quarterly skills testing, a wired up CPR adult dummy and a wired up CPR infant await you with laptops to test your skills. There are 2 stations.

The dummies are the first thing you see as you enter the employee entrance.

They are ready to take all comers.

But don’t be too rough. I’ve seen the baby dummy with no legs and they are never dressed afterward.

Give the dummies their dignity and redress them.

At the very very very least, don’t try to take off their head and break their neck with your aggressive C-clamp.

After all, you get another swing at the apple starting next quarter. Be gentle, would you?

These dummies have a lot of customers in the staff of the 150+ bed hospital. Think of everyone else who has to test. Don’t decapitate the dummy.

You might kill the dummy in the computerized scenario but we never said it was gonna be for reaslies.

If you kill the dummy in the computerized scenario you can try again. These dummies are a lot like computer games that way.

Unless you break their necks.

Tuesday Top of Mind 4/15/25- This is not a drill…we in danger

There is a scene from the movie Ghost when Oda Mae Brown (played to great comedic effect by Whoopie Goldberg) says to the grieving Molly Jensen (played by Demi Moore) where she says “Molly… you in danger, girl.” This is meant to be a communication from the titular character Sam Wheat (played by Patrick Swayze).

It is meant as a warning to Molly as she is being stalked by Carl Bruner (played by Tony Goldwyn). Sam is desperate to give Molly a warning before something terrible can happen to her at Carl’s hands and whims.

The scene has been meme’d many, many times. Just saying “you in danger, girl” is meant to evoke the danger that whoever it is being said to finds themself.

America…you in danger, girl.

I don’t say this lightly.

But the constitution is in danger.

Therefore our country is in danger.

The current WTF is about a man who is legally living in the country, is married to an American citizen, and is the father of an American citizen. I am writing, of course, of Kilmar Abrego Garcia.

If you don’t know his name you have not been paying attention. Kilmar Abrego Garcia was disappeared off the streets (which is terrifying enough), not given due process (which is the most terrifying of all), and spirited off to El Salvador to a concentration camp. There is no other name for it. The Supreme Court says that the White House has to “facilitate” bringing him back.

And the White House has not done so.

In fact the White House feted and presented and paraded the president of El Salvador, Nayib Bukele, who then said that there was no way to “smuggle a terrorist into the US”. Kilmar Abrego Garcia is not a terrorist. His entire story is of a boy threatened by thugs and gangs in El Salvador and he fled to the only place that he thought might take care of him.

Little did he know.

In fact, on a hot mic, the current president told Bukele to prepare for incarcerating “home growns”. These are American born citizens that might be spirited away without due process because we have displeased the current administration.

How much louder can we be?

How much danger is America in?

This is a test and we are failing.

This is a test of how far the current administration can go before there is mass protest.

This is a test of how the current administration can go in ignoring the courts, including the Supreme Court.

This is a test and we are failing.

America… we in danger.

School Me Saturday 4/12/25- College is for exploration

Maybe what you thought you wanted to be as a grownup no longer appeals. You might’ve thought about being a rocket scientist but were stymied by the sheer amount of math and papers you would have to write.

That might not have been your first choice. It certainly would not have been mind. All that math, the papers I am okay with. But math…urg.

University and college and junior college or even online classes are a chance to explore the you that could be. I am not forgetting trade schools but I feel there is less self-explanatory space there.

Of course, when I first started my college journey it was the early 1990s (shut up, I’m old and the age my mom was when she dropped me off at the plane for my trip to Nebraska) and there were no such things. Your choices were college, university, trade school or junior college. That’s it.

We did all of our paper research in the LIBRARY and copied articles that we wanted to cite. I mean, Google as a search engine wasn’t established until 1998. Yes, I started my school journey pre-internet. Good times.

Instead, you explored due to class selection. If you wanted to learn how to macrame, there was a class for that. If you wanted to learn how to bake masterpieces, there was class for that. If you wanted to write the great American novel, there was a class for that. As in high school, if you needed an easy A, there were classes for that. Students were expected to take at least one-5 electives for their degree.

It was during these elective classes that you got to explore. I took Fencing. Not the yard creation, the exercise. We learned the strict footwork and the styles of fencing and spent some time in the sweaty masks that were used for years. We used the same fencing jackets that had been in use for years, unless we bought our own. We used the electrified lamé, which would indicate that the the electrical circuit had been created when it was touched by metal, such as an epeé. Which was the usual fencing sword.

It was awesome. It remains one of my favorite classes. Ever.

But it wasn’t something to build a career out of as I wasn’t the best in the class. Just one of the more annoying at beating the boys. Nursing was going to be that.

But chemistry for nurses followed by organic chemistry. I was the group tutor for both. That was where I almost chucked it all in and changed my major the chemistry and became a pharmacist. Because the chemical equations and the work in the chemistry lab with the smells and the acids and the Bunsen burner made sense.

But for the fact that my scholarship from the Air Force was for nursing, I might’ve had a very different career.

And the math.

The point is that I got to explore these things. Fun things, different things.

Could I still pick up an epeé and salute an opponent? Yep.

Does it come up often in daily life? Not often enough; the nearest salle is at least an hour away.

Sigh.

Cookie Thursday 4/10/25- Chia seed egg replacement chocolate chip cookies

The “That’s a good egg…substitute” month continues. Reminder, all four weeks will be the same recipe and the only difference will be the egg substitute that I use.

The egg substitute that was used was the chia seed egg replacement. This is an easy egg replacement. But sourcing the chia seeds was annoying. It started when I opened the chia seed bag and there was less than 2 tbs left. This is not enough. It took me 2 stores because the first store was sold out.

The recipe for the chia egg substitute is 1 tbs chia seeds to 1/3 c water. Warm or hot water would be best. Let the mixture rest at least 5 minutes depending on the temperature of the water. I let the mixture sit while I went to an Employee Health appointment about my leg. When I got back there was a gelatinous mass in the bowl. This is what it should look like, an amorphous mass that gives when you poke it and pours out easily, leaving the bowl mostly clean.

I made the cookies as usual, substituting the chia seed egg replacement for the 2 eggs I would normally use. The dough was a little stiffer than normal and it took longer that I anticipated to incorporate the flour.

The best thing about these cookies is that they bake up wonderfully and are gorgeous. If you looked up cookie in a photo dictionary, these cookies would be the picture.

The resulting cookies are less chewy but more “snappy”, if you know what I mean. There are hints of chewiness in them. I found them delightful.

Another thing I found delightful is that, for the second week in a row, the bowl that I used had zero dough residue on it. Normally, there would be dough scraps clinging to the bowl but these past two weeks were clean.

Interesting.

Best Kept Secrets of the OR #25- Conference edition

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

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

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

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

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

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

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

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

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

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

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

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

Tuesday Top of Mind 4/8/25- The little boy judge in NC who doesn’t like being told no

This is happening in my state.

There was a race for the state Supreme Court. And there were two people running Allison Briggs, a Democrat, and Jefferson Griffin, the aforementioned little boy that doesn’t like being told no.

All the votes of the November 5th election were counted. And recounted. And recounted again. Each time Allison Briggs was the winner by 700+ votes. And each time Jefferson Briggs raised his hand and said I object.

And he pressed all the pedals of the judiciary that he could. Appeal after appeal, defeat after defeat.

This has been going on since the November election.

He finally hit on what he believes is a winning strategy.

To disenfranchise 60,000+ votes of voters who voted according the laws at the time of the election. He wants to take their votes and declare himself the winner. This would shift the balance of the NC state Supreme Court in the Republicans’ favor.

Make no mistake, this is a test case for how to steal elections by stamping feet and shouting NO as loudly as can be. It is akin to a tantrum by a snot nosed, streaming eyes toddler who is red in the face about NOT getting what they want, regardless of how fair it is.

This is a test case for how the heavily Republican state legislature can change the rules in December and have it count for an election that took place more than a month prior.

How else to put their thumbs on the levels of power and swing what should have not been contested into the “appropriate to them” direction?

This is disgusting. And unworthy of a grown man.

How much louder can we be?

Our elections that is a founding tenet of this country of ours are under attack (but not from the fictitious illegal voter) and our duly cast votes are in danger.

Are you paying attention yet?

There are so many hateful shenanigans afoot I feel that we Democrats and the people who are non-political but still paying attention are going crazy trying to plug all the itty bitty holes. Not unlike Hans Brinker in the 1865 novel The Silver Skates where he plugged up the hole in the dike with his finger and sent his brother to get help.

It is just as easy to die from a thousand cuts as it is to die from a slashed neck. Blood loss is blood loss and eventually the loss of blood will cause the heart of the republic to stop.

For North Carolina voters, please check the The Jefferson Griffin’s List site at https://thegriffinlist.com/.

Make sure that your vote is not stolen by a spoiled brat who can’t hear the word no.

Gee, I wonder who he learned that from?

Post-it Sunday Medical non-fiction edition 4/6/25- Year of the Nurse by Cassandra Alexander

This is the first book in the newly minted Post-it Sunday Medical non-fiction edition or Post-it Sunday Medical fiction edition.

Year of the Nurse by Cassandra Alexander was published July 19, 2021. I pre-purchased the book May 25, 2021 on Kindle. I did not read this book until the past week.

By any measure that is a fast turnaround for a book. On an evolving and delicate subject like covid.

There are reasons for that. I had just lived through the damned pandemic and am living through the damned thing and I didn’t want to delve too much into it.

But I wanted to be aware of the others who were being our chroniclers. I was doing my chronicling on Dispatches from the Evening Shift and reading the news. All the news, good and bad.

Remember that in spring 2021 the vaccination efforts were in full swing. I have my own notes from working my normal shift from 1430-2300, being on call 2300-0700, and having to get up, hoping that there would be no case called, at 0600 to get ready to drive to the vaccination site in the next county. I worked there from 0800-1300 and returned to the hospital for my normal 1430-2300 shift. Rinse, repeat for at least a week. And then again as my hospital schedule allowed for it.

But reading her book now I realize that she is my people. She is foul mouthed, quick to volunteer, ready to take on anything and sick of the measly mouthed response to PPE in 2020. And also disgusted by the lack of testing.

She acknowledges that the U.S. response was poor. That we were told to reuse masks and PPE. That family members were not allowed at bedside. But she and I both watched as other countries were better outfitted with PPE.

This book is part tweet recall, part diary, and part April 2021 thoughts. It pulls no punches about how bad it was in the early days of the pandemic.

Included, at no extra charge, is the idiot brother in Texas who denigrates the author even as she is sharing information to keep their parents well. Her, not me.

At the end of the book, she writes about when the Great Resignation came for hospital nurses and she volunteered to work extra shifts because if not her, then who. She also touches upon the insanity of the anti-vaxxers and their holier than thou bad attitude. As if their shit doesn’t stink too.

I know that this book ends in April 2021 and the author has zero idea how bad the anti-vaxxers get with their truth twisting bullshit. But I remember.

It is important to realize and remember that we were flying blind. No one, not the NIH, not the CDC, no one had all the answers.

Fabulous book. 10/10 would recommend. If only people who need to read it would.

School Me Saturday 4/5/25-A conferencing we will go, hi ho the merry oh

Now that the weather has thoughts of spring, conference centers are creaking to life.

It is conference season.

Read this and heed some of the advice.

The first point is that conferences are exhausting. This is a marathon, not only for the planners who have been working since last year’s conference to present an exciting program. It is also a marathon for participants. There may be little to no time between events and the rooms that the sessions are in might be a conference center mile away. If you don’t know how far that is… it’s a lot. Most conference centers span multiple city blocks.

At the end of a conference day, which run from 0700-1800 you have to make a choice. Do you go back to the hotel room and think about what you’ve learned? Kind of a brain dump to prepare for the next day’s learning and go to sleep early in an unfamiliar bed. Or do you go out with old friends and new friends that you just met and catch up. There is a bar out there somewhere. Probably very close because a conference loves the booze. And what happens at conference, stays at conference.

Caffeine will be your friend. And whatever sleep you can snatch between partying with your friends and the conference itself, embrace it.

The second point is that conferences are exciting. You get to see people you haven’t seen in, well, a year. Ideas and gossip will be exchanged in equal measure. There is always a new to you session to explore and, in the case of the AORN expo, there will be product demos galore. As well as schools and universities vying for your attention and your tuition dollar.

The third point is that conferences are a marathon. This goes hand in hand with the point that conferences are exhausting. There are multiple educations sessions every hour. Be aware that the 2 sessions that you are most excited about will happen at the same time. Bring a coin to flip. And hope that the conference organizers put the content of the other online so you can live vicariously through PowerPoint slides.

The fourth point is that conferences are not fashion shows. You can always spot the participants who are first timers. They are wearing wildly inappropriate clothing for the sessions and the weather. And you feel for them tottering back to the hotel in the kitten heels that made way more sense at 0700 and less at 1800. The more experienced conference participant knows that, like the OR, comfortable shoes are a must.

Point number 5- Conferences are hard on your feet. There is standing, and walking, and standing, and walking. Your next session of interest might be at the other end of the convention center (see point 1). After standing and working on concrete floors that are covered with convention center carpet with no padding, your feet will likely be swollen and hurt far before the end of the day (see point 4). Hopefully you brought along your significant other for a foot rub at the end of the conference day. Or, at the very least, packed some pain medicine.

The last point is that is not your job to hoard the knowledge that you gained from the conference. Use the information to spark conversations with your coworkers, bring product ideas to your boss. Don’t forget to plan with your hospital nurse scientist any research that you want to do. This also goes for Process Improvement (PI) projects.

Who knows… maybe you can present a podium presentation or explain your poster at the next conference.

Because all the energy you have gained from being with like minded nurses who UNDERSTAND you when you speak has to go somewhere.

FFS Friday 4/4/25- Fall… off a steep cliff

When I left the state at 1000 am I was going to write about a different F. In fact I worked on it during the flight.

And then my plane landed and I was able to catch up on news of interest, including the latest stock market numbers.

Free fall.

Yesterday the Dow Jones lost 1600 points

Today the Dow Jones lost a jaw dropping TWO THOUSAND TWO HUNDRED AND THIRTY ONE POINTS. And the S & P 500 fell TEN PERCENT!

Collectively, between the two days, the Dow lost roughly 3,800 points.

Ahem. Sorry for yelling.

Swear words deleted here. Many, many swear words.

My husband who has stock share in a bank because of a bonus structure says that his shares went from $44/share to $33/share today. And that was the last that he looked. A 25% reduction in value. In two days.

I will not be looking at my 403B from California or North Carolina. I am not on a secured network and I am not that stupid.

However, I will be looking upon our return next week.

Perhaps with a stiff drink. And my cat nearby. And probably a teddy bear.

Mark Cuban, the entrepreneur and, apparently, television personality, has come out today and advised the purchasing of consumables before the stores have to restock and the prices go up. Way up.

Mark, honey, some of us have been doing that since the election. Because I, for one, expected something like this was going to happen. Hell, he told us.

I had been feeling foolish that the supplies had overrun our dining room but now I look very far-seeing.

Because we bought shampoo, and razors, and dish soap, and dishwasher soap, and hand soap, and toilet paper. And canned goods, and dry goods like lentils and rice and chickpeas and pasta. It felt very 2020 as I was buying these things and stocking them in the dining room.

I had hoped that I could slowly use the supplies and they would be an addition to our usual grocery shopping, not the lifeline I fear they will become.

Kind of puts a pall on the nursing conference I am at. Definitely explains the funk I’ve been in since November.

Fuck this shit!

Cat pictures make everything better, right? Right?!?

Cookie Thursday 4/3/25-That’s a good egg…substitute

Let’s talk about a different kind of flu. The bird flu that is still having a devastating impact on birds across the US. The best that can be said about it is that only one person has died. Also positive is that there has been ZERO person to person transfer.

Believe me, that’s a good thing. Remember, measles, the hot virus on the block that is attacking humans, is 90% infectious. If there are 10 unvaccinated people in a group and all are exposed to a person who has the measles, 9 will get the measles.

There has been bird to other animal transfer. To cows and even pet cats. Even bird to human transfer. Which is a stepping stone on the way to infect human to human. This is stepping stone we don’t want.

Ever.

This uncertainty and lack of supply impacts egg prices. Which leads to limits on how many cartons you can buy at stores and your wallet can limit how many cartons you buy a week.

To run a weekly morale project such as Cookie Thursday is a Thing means that sometimes the box must be thought outside of.

The theme this month will be “That’s a good egg… substitute”.

I have done a ton of reading on what other people are doing to substitute eggs in cooking or in baking. I mean the vegans have been doing it forever.

I am going to bake the same recipe and the same cookie each week for this month. The only change will be the egg substitution method.

First up is the flax egg.

One flax egg is 1 tbs ground flax and 3tbs of water. You let it sit for a few minutes to gel and then add to a recipe and bake.

I am going to use the most familiar of the cookie recipes in my repertoire- the Toll House chocolate chip cookie. The recipe normally calls for 2 eggs so I will be doubling the flax egg recipe.

Wish me luck.