No post today.

I am not sure if you’ve heard but there is a critical election here in the United States on November 5, 2024.

So much is riding on this election I would hazard to say that it is the most important election of my life. And yours.

No, that is not hyperbolic. Or an exaggeration.

On one hand, you have women’s bodily autonomy.

On the other hand, you have the slide toward fascism. And I do not write that word lightly.

Choose wisely.

Today is National Voter Registration Day.

If you are not registered, please register.

If you are registered, please check your registration.

There are some foul shenanigans afoot that want to strip you of your constitutionally recognized and protected right to vote.

Let us say no.

No to fascism.

No to the odd idea that men know best about a woman’s body. Weird, right?

No to making the rich richer and leaving the less rich hanging out to dry.

Just no.

This post is not part of the Best Kept Secrets of the OR series. This is a remembrance of the day the world stood still.

September 11, 2001.

The day that the world stood still. If only for a moment in time.

It is strange to think that an event that changed our world has no reference for the latest generations.

Last year’s post for 9/11 was talking through it for the generation that watched the JFK assassination on television.

This year’s 9/11 post will be trying to explain what it was like for the younger generations.

The one’s who didn’t live through it.

Who have only learned of it through textbooks. And that is if their state hasn’t banned history textbooks.

But September 11, 2001 was a day that took us outside of ourselves.

It was a date that allowed us to come together as a society. Even if only for a moment.

The parallels are there for today as well.

9/11 was less than 10 months after George W. Bush took up residence in the White House as the 43rd president after a nail biter of an election.

Our elections haven’t gotten any easier. Or easier on the nails.

But for the moment and for months after 9/11 America spoke with one voice.

And that voice said “No.”

We would not disappear.

We would not bow to the pain of the the 2,977 dead.

2,753 people died at the World Trade Center Twin Towers collapse.

40 people died on a plane outside Shanksville, Pennsylvania.

343 people died at the Pentagon.

Many valuable lessons were learned that day.

We would learn that not everyone is a friend.

We would learn that not eveyrone is a foe.

We would learn the value of helping others through the darkness.

We would learn fear.

Many lessons were learned after the events that this attack unfolded. I won’t get into them here becasue this shouldn’t be political. It should be a remembrance of what and who we lost.

However…

We learned that we would endure.

The gown card reads “I’ll say it again and again, overstocking leads to compromised sterility.”

I’m not sure if you’ve gotten the memo yet but the OR is all about keeping the field, the instruments, and the back table as sterile as possible. I’m sure that nugget of truth has filtered down.

Where does the sterile stuff come from, Kate?

It comes from packages. All of our sterile bits and bobs come from packages. Packages that we then open in a sterile manner and place on the back table. The scrub tech then uses sterile technique to cleanse their hands, put on a sterile gown and gloves, and then prepare the back table and mayo stand.

However, the bits and bobs come from packages, as discussed.

Some people dislike being away from the OR room and proceed to overstuff their cabinets with the packages. These can be packages of gloves, dressing supply packages, sterilely packaged drains, sutures, syringes, and needles.

There are a lot of things that are needed for surgery.

And people overstuff their cabinets with everything they can think of and then the kitchen sink.

This leads to compromised packaging.

Which leads to a break in sterility if not recognized.

Because a micro tear is still just as big a break in sterility as a big tear.

Or licking your hand and touching everything on the back table without wearing gloves as the scrub tech stares at you in disbelief.

The easiest and best way to prevent this is to STOP OVERSTOCKING!

Maybe if we anthropomorphize the packaging and make the OR team care about them like kittens we can put an end to the overstocking.

After all, you don’t want to suffocate a cute little kitten or puppy.

Right?

There are 5 other operating rooms within 100 yards of the OR. The odds are very good one of them will have the 75th size 8 1/2 glove.

Maybe stop the overstocking and use your resources?

I promise your sterile packages will breathe a sigh of relief.

This will also decrease the breaking of sterile technique.

Win-win.

University/college has been underway for a few weeks, if not longer. Students are settling into their classes, doing their reading, and looking at the assignments that aren’t due yet.

Some of us are waiting for the internal processes to work through the delays and allow the long-awaited project to proceed.

Waiting is terrible.

As is the amount of work that awaits on the other side of the decision.

I have found that academia is like that.

It moves at a slow deliberate pace until a decision is made. Often this period of waiting has the student on tenterhooks as they await the decision. This feeling is agonizing.

And then the decision is made.

Then it’s off to the races. Have to get the project done in time to start the waiting game anew.

It’s a little exhausting.

Okay, a lot exhausting.

Playing the waiting game with yourself as you, well, wait.

There is nothing else to do but wait.

And, often, wait some more.

This is the time to make plans and also to make headway into the other projects.

The projects for other classes that are waiting on you.

The decision will be made, for good or ill.

Sometimes the decision events in chucking the entire project as planned and going in another direction.

Good thing academia is also patient.

They have to be.

They also know that academia processes move slowly.

Until it doesn’t.

It is now September. When I was growing up Labor Day was the beginning of the school year. Now, for the most part, the official start of summer is in August, and getting earlier all the time. Cookie Thursday is a Thing that ended the last school year in June with a month of after-school treats. In full circle, September’s theme will be the lunch lady cookie. These are meant to evoke fond memories of the treat that was included in many school lunches.

The first cookie is based on a 5-cup cookie recipe. This recipe is simple and all the ingredients are mostly measured by the cup. You get it?

There is peanut butter, oatmeal a cookie base, and FIVE separate chip flavors. These can be standardized OR customized. Guess which one I chose?

Always experimentation. And I was out of butterscotch chips. The five chips that I chose were dark chocolate, milk chocolate, semi-sweet chocolate, white chocolate, and caramel.

I was very pleasantly surprised by this cookie. It is crumbly and chewy and peanut-buttery. And chippy.

Again, a cookie that I would not kick out of the cookie jar.

Maybe that should be my new rating system. How likely to make and keep the cookies around. For general purposes, you know.

The opportunities to change this cookie are epic. I could see an addition of bacon to make it a sweet and savory cookie. You can also change the chip composition. If you want to be chaotic, I would add a mint chip. I didn’t want to be chaotic today.

But the possibility is always there.

Call a spade a spade. Sometimes the surgeons are just assholes.

Full stop.

A best-kept secret of the OR is that sometimes we don’t like the surgeon.

Like at all.

Because we are people too. People with our own likes and dislikes.

These can be cases we don’t like. Ahem, OB-GYN for me. Yes, ALL of them. I definitely didn’t like my OB rotation in nursing school. Birth blood is just icky.

These can be coworkers so unpleasant that working with them is like nails on a chalkboard.

These can definitely be surgeons we don’t care for. This can be because of their political views, how they live, or how they treat their patient when the patient is under anesthesia. Or how they treat their significant other. Or how they treat their room staff. Or how they treat the charge nurse.

Make my charge nurse/circulator/scrub tech cry? You are on my shit list, doctor!

However, at the heart of it, we are there for the patient. And the finite amount of time we spend in unpleasantness is okay because it will end.

But sometimes we as the OR staff know that a surgeon just shouldn’t be operating. They may have the textbook knowledge but they are dangerous in the OR. To the patient, to the staff, and to themselves.

That is when you put on your adult hat and call them on it. Get reinforcements if you have to. Call the manager at home. Call in the nursing supervisor. Whatever you have to do.

My husband once needed emergent gallbladder surgery. On a holiday weekend. On a Sunday on a holiday weekend. I did not care for the on-call surgeon. I didn’t like their technique or their personality or their closing and dressing habits. Staples on everything! Including laparoscopic sites. Um, that’s gonna scar. You bet I called in a favor. I just happened to have the other doctor’s personal phone number in my cell because of answering a page. I called them quickly and had my husband transferred to their service instead.

My husband spent the night in the hospital, on very strong antibiotics, and good pain medicine. He got the best care that I could ensure. It is all in who you know. This is a rare instance.

But, you ask, what about the patients who are not related to someone in the know? How do you deal when they ask point blank if the surgeon is a good surgeon or not?

Tell the truth.

This is where you put your patient advocate hat on. Because sometimes, in an on-call situation, they don’t get to choose. But you can give them numbers of other surgeons, or make a call on their behalf. This is risky and has the potential of getting you reprimanded. But it is the right thing for the patient.

My favorite response that I give to the question is if I would let the surgeon operate on me?

I would let the surgeon in question operate on a family member.