Best Kept Secrets of the OR #20- HIPAA still applies to immigrants

I cannot believe I have to write this.

The Health Insurance Portability and Accountability Act remains active for the immigrant population. You know the one that guides all of our interactions with patients? The one that if we breach it will lead to punitive action by your employer?

Yeah, that one.

Well, suppose the Immigration and Customs Enforcement comes to your hospital, and this has started. However, hospitals and churches were not overrun by ICE because there are reports of them coming to hospitals and asking about employees that may be illegal. In that case, HIPAA laws are still in effect.

What if they ask about patients?

HIPAA laws are still in effect.

Supposing the employee they are asking about is a patient of a doctor of the system, HIPAA laws are still in effect. And you can’t tell ICE anything without breaking the HIPAA law and policies.

This is a very scary time in this country. That should be acknowledged.

What should also be acknowledged is that this is a problem of their own making. Remember in 2024 there was a bipartisan law that passed one of the chambers and then was torpedoed by the other part of Congress? Because someone came out against it so he could run on immigration and border control? Remember that?

You might not. But look it up.

Misinformation is rampant and often used to their advantage. Don’t buy into their lies.

Make sure you take care of yourself.

And your patients.

Because that is why hospitals exist. To care for patients, no matter if they are from down the street or the next state or from somewhere else.

Hospitals and churches should be safe places. Schools, too, but we know what they think of that.

Tuesday Top of Mind 1/21/25- Limbering up the “NO, I don’t think so” muscle

Warning: this might be a VERY SWEARY and a VERY CAPS-LOCK post. Or not. Behave accordingly.

Somewhere not very far from where I am, about 390 miles give or take, is a man who has never heard the word no and not reacted like a spoiled, entitled brat.

To parody the meme, “Someone has never been told no and sent to bed without supper and it shows.”

Has anyone ever told this man no and slapped his hand while he was reaching for something that wasn’t his?

Strike that. I am sure that plenty of people have. He has the guilty verdicts to show for it.

Has this man ever had to face the consequences of his own actions? I would hazard a guess at that. And that guess would be no.

It helps to know that the crap that is going on in Washington D.C. amounts to nothing more than a tantrum.

A tantrum from a spoiled brat.

I just feel sorry for the people who will be hurt/killed/smeared out of existence by his very presence where he is. For the people who will lose their healthcare coverage, or their right to exist as they want to. The group that I am afraid will suffer the most are the women. I am lumping in ALL women, be they born female or not.

We are facing a very dark and dangerous future.

Because we as a nation told this spoiled man-child no.

How dare we?

And then we went and fought the pandemic that he mismanaged.

Inflation sucked, yes, but it sucked WAY harder in other countries who didn’t enjoy our “soft” landing.

Greed is the rot and the root of all the challenges that everyday Americans have lived with over the last four years. Corporate greed, individual greed, billionaire greed. Billionaires who are not content to have all the toys in the sandbox but instead demand the sand as well. Normies like you and me can play in the dirt. Until they want that too because we are surviving without them and that IS NOT in their business plan.

Today I am just going to breathe. I am not going to react, I am not going to rend my clothes or pull my hair, or do something rash.

What I am going to do is breathe and document. Just like a nurse in an emergency should.

I know I’ve written about my first ACLS teacher, the beginning of my first ACLS class, and her counseling us that the first thing to do in a code is to take our own pulse. This is to check in with ourselves and remind us that there is a patient who is dying in front of us, and we have to do something about it.

This is our code, Democracy and the America that I love is dying in front of us.

Take your pulse, check in with yourself, and get ready to resist.

Because he has been told no once, time for him to hear it a whole bunch of times. From every corner of the country. Together we can drown out the sycophants and cultists that, until now, have been shouting louder.

Bullies try to silence those who stand up to them. Have you ever considered why? If our voices didn’t have power, they wouldn’t try so hard to silence us.

As I tell my coworkers, if they are afraid to speak up call me and I will. I will absolutely yell back at the men in power, real or imagined. Tell me if you want me to be louder because you can’t. I don’t even need a reason to raise my voice.

See if I don’t.

I know how to use the word no and I am not afraid to use it.

Grieve if we must. I certainly understand the impulse but we also have to be ready to counter moves by the administration. Bought as it was.

Post-it Sunday- Tomorrow is gonna suck

There isn’t a post-it from today. Just a free-floating malaise and sense of doom that has been hanging over me since the general election.

The fact that it is the WORST time to be a hospital-based nurse with the 15 hip fractures this week alone, or the overfull emergency room, to the overfull hospital. But you’ve heard that from me before.

Two things have stood out to me in this general morass of gloom.

The first is that kindness still exists, even from the perceived other side. Last week, I was at Aldi to go grocery shopping. As I was walking in, I passed a woman who was just finishing unloading her cart. I held out my quarter and said, “Save you the trip?” She smiled, no, she beamed, and said take it. I tried to give her my quarter and she said no, just pass it on. And then she remarked that she couldn’t wait for the 20th. At my befuddled look, she added, you know when things can get back to normal.

It took me aback and I didn’t quite know what to say to her. I smiled, awkwardly, and said, with all the energy I could muster “I hope you get what you wanted.” I did not harangue, refuse the cart, or interrogate her as to why she felt that a day was gonna make all the difference in the world. I didn’t because I knew what kind of claptrap she was going to spew. The kind found on extreme right media or, worse, hate speech from Fox. Or the kind from the echo chamber she probably lives in. There is no changing her mind until she lives through the consequences of her action. Too bad she has to drag the rest of us down.

But I was nice. Through gently gritted teeth. I promised my dentist; that three broken teeth in the last six months is enough.

The second is that I am leaning into the little things that bring me joy. And I am leaning HARD.

I read a book in the last 24 hours that didn’t have anything to do with my dissertation and I started another one too.

I got up when the white whiskery wonder wanted me to, even if it was 0630.

The extra vehicle that I’ve been holding onto with clenched fists has been donated. I loved that car but it was time. The relief I felt after the flatbed picked it up. Well, after I cried a little I felt relief.

But the thing that has brought me the most joy this week?

A partial set of Corelle Lazy Daisy bowls and plates. This was a pattern that they released in conjunction with PYREX. I wasn’t looking for it, specifically, but it fell in my lap. 7 large plates, 6 salad plates, 3 saucers, and 5 bowls. For less than $20.

Yes, please.

For no other reason than it made me smile.

Of course, the Pollyanna Puke is attempting to pop her little misguided head up and reminds me that tomorrow starts the clock. Because the president-elect cannot run for office again.

This also makes me smile.

School Me Satuday 1/18/25- Under pressure

This is from a note I made last September. I wrote to myself that Under Pressure by David Bowie and Queen just hits different as a student. To quote Darth Vader “Search your feelings and know it to be true”.

Starts with a riff we all know in our bones. At least those of us of a certain age.

Dotdotdot didi da

This, like life as an adult student, was a group project.

Dotdotdot didi da

I hate group projects. I find they have no redeeming quality. Except for this song. This song is the quality we should hold ourselves to. After we teach the other generations about the song.

Dotdotdot didi da

Pressure pushin’ down on me. This can be pressure from teachers, the syllabus, the exam dates, and even ourselves. I have heard that college is like a pressure cooker. There are demands on us from all sides and we just have to tread water.

“Terror of knowing what this world is about, watching some good friends scream let me out!”

As an adult learner, one of the first lessons is that not everyone makes it. This goes for classmates who have to drop out for one reason or another. Or teachers who quit in the middle of the semester. However, we have to soldier on if we want to hit our goals/targets/graduate.

“Chippin around, kick my brains round the floor. These are the days it never rains but it pours.”

This is another absolutely true sentence. Most college students have more than 1 class and they have to juggle their notes, and their reading time, and the tests and papers. There will be nothing but reading/lectures for weeks and then BOOM tests/papers in three classes all due in the same week. This teaches the adult student about time management and pressure management.

“Can’t we give ourselves one more chance?”

The feeling of “I wanna quit” is known to all students. Being an adult learner is hard. But we can absolutely do it. One lecture, one set of readings, one test, one paper at a time.

“Caring about ourselves is the last dance.”

Look at them, singing about self-care before it was cool. Know that being an adult learner is hard. No one is making us do this, unlike high school. Keeping our eyes on the proverbial pie helps immensely. Remember, school can’t last forever.

Dotdotdot didi da

FFS Friday 1/17/25- Frugality

Frugality is defined as “being economical with money or food”.

Word to the wise, you can also be frugal with time.

Times have been difficult for a lot of people for a lot of years. Pandemic, inflation, inflation, inflation, and more inflation.

You get the drift.

I have always been low-key frugal. See also cheapskate. See also, tightwad. “But aren’t you rich? the uninformed might ask. After all, we don’t have children and we have 2 incomes.

This is both correct and incorrect. I am a nurse but I gave away the ability to make overtime when I transitioned to my new call-only role.

I like the security of knowing that there is money in our bank account, husband!

I like the thrill of the hunt at the grocery store.

I like a bargain. I do thrift, on occasion, but there are other people there.

I like participating in my local Buy Nothing group for my town. I’ve gotten some nice stuff and also given away some nice stuff. Beats the landfill or the donation place that may or may not be able to sell it. Again, beats the landfill.

Frugality is not a dirty word.

You may get some looks from your family. Or your friends. Or your spouse. But they’ll get used to it.

I leaned harder into frugality when I needed to reside the back of the house and a video I found encouraged me to do so myself, instead of hiring it out. This was 2018, I think? All I remember was that it was bitterly cold and I had a section of siding off that was 4 feet x 6 feet because it was essentially rotten and letting in tons of cold air. I learned two things: 1) there wasn’t any barrier underneath the siding into the house, which is against the building code which explained a LOT and 2) a hand warmer against your neck will keep your whole body warm.

I started reading a lot of the Frugalwoods blog. Which led to the Facebook page they hosted. I am not into the F.I.R.E. movement. This is financial independence retire early. I don’t want that. But frugality for frugality’s sake is right up my alley.

There are many tips and tricks to frugality. All you have to do is seek it out.

Stop eating out so much! Make your food at home! Make your coffee/tea at home! Seek out the best price on everything. I understand that some people don’t have the free time that I enjoy but bargain shopping, especially at the grocery store, pays off. No one is judging you for bargain hunting. After the last few years, they may ask you for tips.

It will be worth it.

I hope.

I am very nervous about the new administration coming in in THREE days.

Ugh.

I’ll just be over here, looking for deals.

Cookie Thursday 1/16/25-Twix Cookies

I did a very unscientific poll on which flavor of Twix Cookies I would do. Are you team caramel? Or team peanut butter?

Out of the 10 people I asked, nine said caramel.

Sorry, peanut butter person.

This is the 3rd Thursday in the 10th-anniversary celebration of Cookie Thursday is a Thing, and the cookie that was voted on as one of the top 5 cookies of CTIAT was the Twix Cookie.

You see, there is a bit of science to my madness. I chose this cookie to be the third on the list because that way there is a break between the jalapeno chocolate chip and the pepper jelly cheddar thumbprints. And the last cookie has the longest preparation time.

The Twix Cookie was one of the original cookies of CTIAT. In fact, I don’t think it was called CTIAT yet.

It started, as CTIAT so often does, with me seeing a cookie recipe. It is seeing a cookie recipe and wondering if I could do that. Often I can but sometimes I recognize that I have limits on my time. Especially in the early days when I was driving to Charlotte or Winston-Salem for meetings.

Thank goodness for Skype and Zoom. The learning curve was steep in the early days, though.

Today’s secret of CTIAT is that I often lean into the experimentation phase but I have to be mindful of people’s favorites. I try to institute a favorites month into the year’s calendar. This cuts down on surgeons asking when I am going to make the jalapeno chocolate chip again.

I don’t want people to be so complacent that they are gonna get cookies but also not bore them. I wouldn’t want to be bored.

The Twix Cookie takes a fair amount of time. There is the baking of the base cookie, waiting for it to cool, melting and adding the caramel and waiting for it to cool, and melting and adding the chocolate layer. All those steps take time.

What else takes time is realizing that you are out of caramel. To the store in the middle of baking! Maybe all the pauses make sense.

I also utilized the Midwest Refrigerator and cooled the cookies outside on the front porch. This definitely sped up the cookies.

Tuesday Top of Mind 1/4/25- free- floating dread

Free-floating dread

Inauguration day is less than a week away.

Excuse me, coronation day.

At least in the minds of many MAGA followers.

Bear in mind that this is a four-year jaunt that may leave many of our democratic processes in ruin. All at the whim of a man-child who has never been told no in his very life. Or at least never told no and listened to it.

The free-floating dread is REAL.

Ruby Red states are feeling their oats/lack of self-control and are trying to shove very unpopular policies onto the rest of us. Like further eroding of women’s bodily rights, their nonsense about trans rights, and, this just in from passing the House, banning trans women from playing women’s sports. It should be pointed out that none of these bills and laws have anything to say about a trans man who plays men’s sports.

Not to mention the other things like the Texas babies who are being abandoned in dumpsters or in ditches. Consequences of their own actions but they will deny it and babies and women will continue to die. Or the newly resurrected bill that would send women in SC to death row for getting an abortion. Or the new crap out of Mississippi that has a life-in-prison penalty for even giving money to a teenager seeking an abortion.

I, for one, have no problem with using the same bathroom as a trans woman. In fact, it won’t even cross my mind to ask what is in their pants/skirt. Because it is none of my business and she is just trying to live her life.

I, for one, would rather be in a forest with a bear. This is in reference to a conversation I had with my husband last week about man v bear in the woods and he was shocked when I chose the bear. I cannot get it through to him that at least the bear doesn’t want to kill me/hurt me at all times.

No, it isn’t all men. But it is enough of them. Just as the 70,000-member strong Telegram group that were sharing pointers about how to get away with rape was discovered at the end of December.

This is really scary stuff and I, for one, am dreading next week. And all of his DAY ONE promises. I am not concerned about myself but for others.

Project 2025 shit is bearing down on us really quickly.

Mercy on our hearts and brains.

May our mothers and daughters, sisters and aunts, be safe.

Dispatches from the Evening Shift Disclaimer Sunday 1/11/25

I usually do this on the first day of the year so I am a little tardy this year.

Happy New Year!

Let’s get down to business.

Every year I write this disclaimer. And add to it. And tweak it. And if I knew how to pin it to the blog start page, I would.

I began writing the yearly disclaimer to be able to point to my posts and say, see nothing to give away the patient here. You know, HIPAA. In case the corporation, that I work for and discuss my blog openly in meetings etc., tries to tell me I cannot write this. Not that they have, but I can believe they would.

I believe in protecting patients’ and staff’s privacy.

I do not include details that make it clear or easy to figure out which patient or staff member I am talking about. If I am talking about any.

I do not use names. And if I do, they are changed.

I change ages. I change gender.

I change details such as which limb is fractured. I change details such as which surgery is performed.

And the cases that I do talk about obliquely are changed in how time is perceived as well. The cases/people/staff may not be the same at the time of the surgery.

I definitely change aspects of time. By that I mean there is no relationship between the moment I write the post and the actual events that prompted it.

Some of the stories aren’t even mine, but even they are changed so as to be unrecognizable.

That being said, I change a lot.

So that, if you knew where I worked, you could not figure out who I was writing about or when.

I discuss issues that impact healthcare broadly.

And, after the events of the two past years, issues that impact women’s health. There has been a LOT to unpack here.

And covid. Can’t get away from covid. XEC is the newest variant and it is currently causing over 50% of the cases. People continue to die; not that we know it because they stopped keeping track years ago. And there is a new game in town, or should I write games. The bird flu that has made the jump to infecting and killing humans, and the human metapneumovirus which isn’t new but is making noise in China.

I do swear sometimes. But mainly to make an emphatic point.

I write themed days. Post-it Sundays which are from notes to myself, usually on a Post-it or a gown card. Monday I take off. Tuesday Top of Mind is the most political day of the week where I write what is weighing heavily on my brain. Wednesdays had been a free day that I wrote exclusively about OR things. This has morphed into the Best Kept Secrets of the OR where I divulge the secrets of the OR. Cookie Thursday is a Thing is where I write about the cookies I make for the department. This is a long-running morale project in the OR of homemade cookies or candies are brought in around 1400. This started as an evening shift things and remains so. FFS Fridays is the newest day that I write about things that begin with F, F, or S. This is the day that has the most swearing and I started it as a reaction to the 2024 general election. Buckle up, it’s gonna get weird. On Saturdays, I write about being an adult learner.

Phew.

I may miss a day here or there because 6 days is a LOT, even if the blog posts are shortish.

This month marks 10 years of Cookie Thursday is a Thing! I had no intention of baking cookies for so long, but it gives me a handy bookmark for my week. I also theme the months and this month’s theme is Favorites. Along with the departmental favorites, I also tell a story about CTIAT.

School Me Saturday 1/11/2025- new semester, who dis?

Yes, it hurt a bit to be ungrammatical in the title.

I know it feels like winter break started a second ago. December and the first part of January is a marathon and a whirlwind. You blink and, next thing you know, Spring Semester is due to start. Like tomorrow.

Relax. Deep breath.

Remember when you chose your classes in the fall? Or remember when your advisor told you what classes to take? And you signed up for them and everything? And you and your spouse or you and your parents or just you filled out your FAFSA when they released it in December?

I know that the beginning of the semester is scary. But breath. You’ve got this. Every class is one step closer to being done.

Now that you’ve remembered what classes you are taking this semester, get yourself to the Canvas site and see if the syllabi have been released. Or Moodle or Google Classroom. Or whatever platform your college or university uses.

Read the syllabus. Yes, in its entirety.

Make a plan for due dates or exam dates. But also make sure to note when the breaks are.

The syllabi will have the books needed for the class. Buy them, rent them, borrow them. It doesn’t matter how you get them, just get them.

Now all you can do is relax and get back into school mode.

But take heart. Spring break and Summer break will be here before you know it.

Don’t forget to eat right, drink your water, brush your teeth, and exercise. You know, the things that your parents told you to do. Do all of them.

And enjoy the semester.

FFS Friday 1/10/2025- Freaking Snow

Everyone I know is glued to their radar as they anticipate or dread the coming storm. It was less than a week ago that we were anticipating, or not, snow, in North Carolina. Turns out it was just cold then.

And it has been cold ever since.

It seems that people come down on one of two sides of snow anticipation or snow dread. You either love everything about snow, or you don’t. You either love all the little touches that snow brings such as hot cocoa, closed schools, or holing up in your warm house in your warmest clothes. Or you hate all the little touches that snow brings such as ice dams on the roof, or icy roads, or icy cars that won’t start because it is too cold.

Yes, I am on the anti-side when it comes to snow. I mean it’s pretty to look at but I don’t like to be out in it. I especially don’t like how other drivers react to snow. The thing about North Carolina is that less than 2% of drivers know how to drive in the snow. Others go too fast or drive down the center of the street because they can’t see the markings on the road.

On the healthcare side, patients ALWAYS make it in when there is snow or ice. I have spent more nights at the hospital because of the threat of inclement weather than I care to.

It all comes down to having good processes around snow. I prep my car with a sheet over the windshield and prop up the windshield wipers so that they don’t freeze to the windshield. When we get snow/ice that makes getting out of our neighborhood difficult (we have a steep hill) I park at the park and ride just outside of the neighborhood entrance. I haven’t had to for a couple of years as there has been minimal snow and ice and I also don’t work every day like I used to. I make sure that the cold winter gear is out of the coat closet and ready to use.

And, as always when I drive in the snow, I take it slow and don’t make any sudden movements or sudden braking. I am always watching other drivers and am prepared for evasive action at all times.

Driving in snow and on ice is a lot like handling a wild animal. Slow deliberate movements, don’t make any sudden movements in case you end up in a ditch. When I was at Creighton University we used to make fun of the drivers that ended up in ditches or the ones that we knew were going too fast and got themselves into trouble.

If you need me, I’ll be at home because I am off during these snow days.

Snow. It looks pretty but I don’t like to drive in it because of other drivers.