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.

I have lost count of how many covid posts I have done.

I do know it has been a hot minute since I did one.

The next covid booster, which targets the Flirt variant, is out. Reminder the Flirt variant is an offshoot of the Omicron strain. The Flirt variant, or KP.2, was one of the fast-moving variants of the spring and will probably give the healthcare system headaches in the winter.

It got approved by the FDA on August 22 and the doses were rushed to stores.

I received the latest booster on 8/30/24 because it had been 10 months since the previous one.

Yes, my arm hurt.

No, I didn’t have any other symptoms. No fever, no chills, no malaise.

Nothing.

Schedule the booster, take the weekend off, and get it.

Better safer than sorry.

Or do I have to remind you that it is still a lethal disease? Or that some states do not track the deaths from covid? Or the case amount? Or that people are still being admitted and dying?

Gee, I hope not.

Get the covid booster. The more people who do, the less likely the virus will mutate again.

We might not be so lucky next time.

I would lay a bet that everyone who is currently in school right now has fears.

When I wrote this prompt to myself, the fear I was facing had nothing to do with school.

Nope.

That fear was the dentist.

Why generations have a fear of the dentist I don’t know.

But we do. Maybe I can unpack that some other time.

However, a different fear came to the surface just after the start of the semester.

That is the fear of your advisor emailing you.

I am sure that others have had this fear as well.

Because the advisors are not scary but in my head, and maybe yours, they can bounce you from the program.

All the advisors I’ve had, save one, would never! In fact, they would be aghast that I even felt this way.

Try telling that to my amygdala.

The scary advisor? That was the one who questioned me about my high score on the standardized test at the end of the ADN program. They hinted around but did not come out and say outright, that I cheated.

Scarred for life, I am sure of it.

However, that was three schools and 2 degrees ago.

Just like the captain who told me I was not a natural runner and to give it up, I have something to prove to that advisor. I ran a marathon out of spite for the captain. I will get my PhD despite the ADN advisor.

As a student, there are valuable things in the emails. Set yourself a reminder and make a pledge to check and respond to emails daily.

That way the advisor is not frustrated and you are not frozen in fear.

While you’re at it check the feedback on school assignments and learn from the comments.

It will help, I promise.

In the latest class I am in, the final class of the PhD before the Big Write, the professor came out and said boldly that we would have the opportunity on assignments to respond to the feedback and resubmit.

This is scary for me.

But I will attack it like I’ve planned for advisor emails. I will give myself a deadline of 1 day for each feedback.

After all, there will be lots of feedback during the Big Write, I’ve got to get used to it.

The teachers and advisors are there to help you learn.

Let them.

This week I saw a recipe that I had to try.

Like immediately.

Let me back up.

Puppy chow goes by a lot of different names such as that thing with the peanut butter and chocolate and cereal, or muddy buddies. However, the basics remain the same.

The original recipe calls for Chex mix, peanut butter, melted chocolate chips, and powdered sugar as a topper.

The recipe I saw asks why Chex mix, why not other kinds of cereal.

Mind blown.

Sometimes the simplest things, such as a cereal swap, yield the most amazing results.

The three cereals I chose to go with were Golden Grahams, Cinnamon Toast Crunch, and a random chocolate cereal.

I didn’t just use peanut butter. I also used hazelnut chocolate butter.

And three types of chocolate chips.

Covered in powdered sugar.

This make was amazing and the perfect way to close out No Heat August.

I am so excited for September’s theme and I am glad I got to end August on a high note.

I train all the new nurses on how to do call. It’s been my thing for years and years and years. I was doing that way before I became the night call nurse.

I have a set spiel that I go through.

I help them optimize the electronic health record for ease in charting. Since I was one of the original subject matter experts (SMEs) that helped with deciding what the corporation’s Epic was going to look like I know my way around the EHR.

I definitely help them discover ways of where the heck the patient is in the hospital.

I set up their flowsheets to help capture hysteroscopy fluids and deficits.

I set up their flowsheets to help them do the appropriate charting for a miscarriage.

I show them how to perform and chart a pregnancy test because we test everyone who still has a uterus, age 10-55.

I show them how to use transport and how to find out how many patients are ahead of the requested transport.

I show them how to create a case and schedule the case that I just helped them create.

I show them how to put in blocks for requests that have to be blessed by day shift.

I show them how to find the ER patients. There is only ONE place to see the ER list. Even that took me about three years to figure out where it was.

The point is that there are a lot of things that I brain-dump on all the new nurses.

I made a call preserver book with frequently asked questions to use as a reference key.

But the very last thing we do, and I mean the very last thing, is talk through an emergency, such as a code blue.

Codes terrify the OR.

A friend of mine who is on the call team at the secondary trauma center said “Yeah, the OR is terrible at codes.”

But codes happen.

Sobering as that is.

I review where the crash carts with defibrillators are (PACU, ENDO, outside of Room 2, in the Cysto hallway, and ACU). I review the Broslow cart for those cases where the patient is a ped. I review where the MH cart is and the MH hotline number. I go through the silver anesthesia emergency binder that is in all the ORs (after we find it). I review where the critical care cart is in the OR core.

Frank talk of codes freak people out. But I am of the mind that familiarity brings comfort.

The last two things I show nurses are 1) where to chart the code in real-time in the EHR and 2) where the code button is in each and every OR.

I talk about what is the expectation after the code button is pulled about mass of people who will descend on the OR. Anesthesiologist, security, house supervision, ER, ICU, pharmacy.

The point is, they are not alone for long in the event of a code.

They just need to know how to activate one.

Because codes do happen in the OR.

In fact, one of my recent bootcamp attendees just had a code during a call shift. They did excellent. The patient survived. We had a debrief the next time I was at the hospital and they said they knew just what to do BECAUSE codes are the last topic in the bootcamp.

I think I will keep codes as the last topic of the bootcamp.

Because knowing there is a code button is half the battle.

There have been protests in India this month because of the rape and murder of a junior doctor. This occurred inside the HOSPITAL!

The violated body of a junior doctor was found in a seminar hall at the state-run hospital, RG Kar Medical College on August 9th. A suspect, who has declared himself innocent, has been arrested and arraigned and is standing trial.

The rape and murder of a junior doctor sparked nationwide protests and walkouts by other junior doctors.

Their response? “There is a lot of pressure on others because manpower is reduced.”

This is the shittiest most tone-deaf response I have ever heard.

Why is the manpower reduced?

Because other junior doctors staged a walkout in protest of the killing of one of their own.

India has had several high-profile rape/murders in recent years. It’s as if the men who are doing the crime think that 1) what they are doing is no big deal and 2) they will not be found out. And 3) I can do what I want.

You know what we call that? Emboldened.

You treat women badly enough for long enough, troglodytes such as these perpetrators feel they can do anything they want.

When you are a woman, nowhere is safe.

This is not an Alice in Wonderland School Me Saturday. Those should resume shortly.

No, this post is about how school is back in session.

It doesn’t matter the kind of school. Grade school, high school, junior college, college, university, trade school, it all counts.

There is something magical about the end of August and the beginning of the school year.

New clothes, new school supplies, sometimes new schools, new friends.

It is all part and parcel of the excitement of the late summer/early fall.

My advice is to embrace it.

And if you have to practice getting up on time to make it to class, do so. Also do a dry run of school lunches. And maybe the drive to school, if applicable.

Whatever you can do to ease the first days will be paid back.

If you want to hide so the school can’t find you, resist the temptation.

Don’t forget to read the syllabus.

You know who I am referring to.

After all, the end of the semester can only get closer if you take the first step.

Go ahead, the semester is fine.

Think about all the things you’ve learned over the summer, all the projects you did to make your semester the best ever.

Those still exist.

Just remind yourself, huh?

This is a good time for a mantra. Remember those?

The only way out is through.

And I don’t mean the shit, as in a good thing.

Yes, this post is tragically late. I have an excuse. I had the second stage of a dental surgery (root canal #2) today; I had the first root canal emergently last week. And my mind is limping along. Dentist terror flop sweat commenced.

Back to the issue at hand.

Pre-surgery workups are terrible.

They are either not done, or incomplete.

Kind of like ordering a BMP (basic metabolic panel) and expecting liver panel results. Like for a lap chole patient. And the surgeon shrugging it off or, worse, asking for the AST and the ALT and the bilirubin on an assay that doesn’t have them.

Patients are sicker. This is a fact of the OR.

Patients are also not tuned up for surgery in the most efficient way.

Sometimes I feel like Mrs. Weasley and the Howler she sends Ron after they’ve taken the flying car in the second book. “Car gone! No note!”. This is when I am looking at the patient’s chart prior to surgery, just perusing their blood levels and lab tests that were done. And finding nothing recent and the last labs they had were 4 years ago. Or longer.

You want to do a total hip revision of implants that are at least 10 years old, who refuses blood products, and the last hemoglobin on their file is from 5 years ago?

Make it make sense.

There are standards and I would like to assure myself that we are not going to kill this patient.

Sometimes I wonder if the surgeon just wants to cut and doesn’t want to look under that rock of the 93-year-old in multi-system failure. But we can fix them!

There is a fracture, I have to fix it.

You see, every case is a mini-mystery. There is a problem that needs a surgical intervention. Please give us all the tools to help the patient and to help you not kill the patient.

Slow golf clap for the CDC.

Extra slow golf clap for the medical establishment that has been downgrading women’s pain for hundreds of years.

Dunce cap for every medical professional who has lied and said “it’s just a pinch” while they yield very sharp instruments at one of the most sensitive parts of a woman’s anatomy.

The renewed attention to pain medication for painful medical procedures has been refreshing to witness.

And a long time in coming.

No matter than women have been thought to be small men in regarding medical research. No matter that the often men ob-gyn probably didn’t have the parts in question and were in no way qualified to judge how uncomfortable a procedure could be.

The new CDC guidelines call for some sort of personalized pain relief for painful in-office procedures. Like a paracervical block. Or lidocaine jelly or spray to the area. This gives the women some measure of control of what is going to be a not-very-enjoyable experience.

You know, like the lidocaine jelly that we have been using for male urinary catheter insertion for years and years and years. Because urinary catheters hurt. (sad, clown face here)

Mind-blowing, I know.

Who do we have to thank for this?

The increase in the chatter around pain medication for painful procedures a woman might go through at the ob-gyn?

Social media.

And the girls and women who know that this is wrong and are speaking up about it.

Like many things, older generations of women would just put up with it because that is the way things are done.

I personally had a rather invasive procedure in an ob-gyn office that was painful. To give the doc credit he did offer a cervical block. But he knew and I knew that it would be the same kind of pain as the procedure and I told him to just go ahead.

But I had the option.

Choice.

It’s a beautiful thing.

Now that there is more attention to the woeful state of women’s pain control during procedures, I can only applaud, with fervor, all of those who have spoken up about it. And continue to speak up about it.

It’s time I spoke up too.

Not bad for a bunch of “hysterical” women.

Let’s reclaim that term next.