25- all call cases are emergencies

All call cases are emergencies. I admit sometimes they are emergency adjacent but still the case must be done. There are the rare exceptions when the call team did a total knee in the middle of the night and then discharged the patient because the surgeon, who was 5 hours late, insisted. That’s for another time.

All call cases are emergencies. To that end, it is okay to tell another department who has their gurney waiting outside the room when you go to pick up a patient that their non-emergent test is just going to have to wait.

Yes, that happened.

Another nurse and I were up on the 4th floor picking up a patient. We packaged the patient up. This means that we removed all the monitors, and replaced them with our own, we cleared all the stuff from the bed that wasn’t the patient. We unplugged the bed and told the family to follow us to the elevators and opened the door.

To be confronted by a worker from another department, ready with a gurney, to take the patient to their department for a non-urgent test.

Um, no you may not have the patient for your non-urgent test.

No, I don’t care that this patient is next on your to do list.

No, I don’t care that it looks badly to your supervisor if you don’t get the test done in a timely manner.

This patient is ill, ill, ill and requires emergent surgery to fix what is wrong with them. Well, not fix, but to remove the offending body part that was making them so sick.

No, we have to rush down to the OR and start the surgery.

No, you will have to do your non-emergent test on them after surgery.

No, I don’t know how long the emergent surgery will take. Surgical cases take as long as they take for the surgery.

No, I don’t care that this is the last thing on your to do list and you get to go home after the non-emergent test.

Sometimes you just have to say no and mean it.

Even if it means blocking another department from getting their hands on the patient for a non-urgent test that could wait until morning. But they don’t want to tell the hospitalist the non-urgent test wasn’t done.

Sorry for delaying this non-emergent test for a real, honest to goodness emergency surgery without which the patient has a good chance of dying.

Nah, not sorry.

I’ll probably hear about this later from my manager.

Oh, well.

At least we saved that patient’s life.

FFS Friday 10/24/25- Fret not, the White House East Wing has gone to a better place

We should have expected this kind of reaction.

The reaction of an abuser when the abused stand up to them.

Also the reaction of a mob boss trying to shake down a business. I’m sure we’ve all seen the memes; “This is a real nice place, it would be a shame if something were to happen to it”.

This is a shakedown. Something we’ve already seen from this administration.

What happened to the East Wing of the White House this week went beyond that.

It was a message from an abuser to an abusee.

And absolutely was in response to the wildly successful No Kings Protest on 10/18/25.

He fumed all weekend and then went hard on “making the White House better”. In his image. After he “gilded” the Oval Office with tacky gold tchotchkes. After all, he wants a golden ballroom that none of us are ever going to step into.

He reacted by tearing out the East Wing of the White House. The image of our government as much as the Jefferson Memorial and the Vietnam Memorial Wall has been irretrievably broken apart.

Bit on the nose there, dude.

I saw a message from a trauma survivor that called this kind of over the top reaction that of a narcissist. Well, if the orange makeup is badly applied.

I was sickened and enraged by the pictures and video that were filmed and released by the Treasury.

If you haven’t seen them, google works just as well for you as for me. Watch them. Watch the gop try to soft pedal this desecration. Trigger warning, the pictures and video are obscene.

Also know that one of the talking points is that nothing ever happened in the East Wing anyway. And it wasn’t even original to the White House. As construction began in 1902 under Franklin D. Roosevelt and renovated several times. The idea of the East Wing goes back further. To Thomas Jefferson who

The East Wing was also the public entrance. Again, a bit on the nose. From the fascist who doesn’t like the American people and only cares about his image and his money. Not that any of his money will be spent building the ballroom.

That list is a who’s who of the billionaire elite and corporations.
Here is the list, sourced from the Time article released October 23, 2025 titled ‘Who is Paying for Trump’s $250 Million Dollar Ballroom- and What They Might Get in Return by Rebecca Schneid and Connor Greene.

Altria Group, Inc.
Amazon
Apple
Booz Allen Hamilton
Caterpillar, Inc.
Coinbase
Comcast Corporation
J. Pepe and Emilia Fanjul
Hard Rock International
Google
HP Inc.
Lockheed Martin
Meta Platforms
Micron Technology
Microsoft
NextEra Energy, Inc.
Palantir Technologies Inc.
Ripple
Reynolds American
T-Mobile
Tether America
Union Pacific Railroad
Adelson Family Foundation
Stefan E. Brodie
Betty Wold Johnson Foundation
Charles and Marissa Cascarilla
Edward and Shari Glazer
Harold Hamm
Benjamin Leon Jr.
The Lutnick Family
The Laura & Isaac Perlmutter Foundation
Stephen A. Schwarzman
Konstantin Sokolov
Kelly Loeffler and Jeff Sprecher
Paolo Tiramani
Cameron Winklevoss
Tyler Winklevoss

What you do with the names on the list is up to you.

The final thought I had about the East Wing (RIP) is that it housed the First Lady’s office.

Of course, it did. It’s all about control and hurting the women.

Aren’t you tired of being abused?

Cookie Thursday 10/24/25- Cotton Candy Cookies

Step right up, step right up!

Get your snacks before entering the big top.

Step right up!

What is a good circus snack?

Cotton candy.

Are there good cotton candy cookie recipes on the interwebs?

No.

But there is some AI slop where the picture doesn’t match the recipe ingredients.

But there is some AI slop where the picture is too good to be true.

Scary right?

And that is why Cotton Candy Cookies is a fitting edition to the Something Spooky This Way Comes October theme.

But I still had no recipe. So I read them all.

I had cotton candy, which none of the crappy recipes included. It seemed a good fit and was on sale.

I had cotton candy flavoring, which only 1 of the crappy recipes included.

You see one of the main problems with the AI generated picture is that the cookies looked like clouds. Like cotton candy. They were all sorts of colors; the palest of pinks and the cheerful yellow and the baby blue.

None of the recipes included food dye.

“Fine. I’ll do it myself!” Growled Obadiah Stane, the bad guy in the first Iron Man Movie.

He wanted control over the trillion dollar Stark Industries.

I just want a cotton candy cookie.

This cookie has been one of the true experiment cookies that I have done for awhile. I mean, Inflation Baking 2022 was the last time I really let my hair down in the kitchen. Experimentally, that is. My hair is always tied back when I bake and all the surfaces are freshly cleaned.

How to get the cotton candy into the cookies, without melting it?

Truly, a question for the ages.

I made a sugar cookie base (the one from the animal crackers week, nice to see that I am continuing the circus theme) and folded in cotton candy hunks.

Would this work?

Probably not.

But it was pretty.

When I pulled the first batch out of the oven, the cotton candy had coalesced into a ball of sugar. Kind of like a chip.

Perhaps these should be called Cotton Candy Chip Cookies.

I think I might be onto something here.

Or I could melt white chocolate chips and add the cotton candy flavoring to make a true chip.

Or I could melt white chocolate chips and add the cotton candy flavoring and the cotton candy and put it into a mold to make cotton candy chips.

Why do I only have these ideas when I am writing up the experiment results?

Call Secrets of the OR- Flexibility is your secret power

To be on call is to do battle with the unknown.

Every day.

Well, every shift.

Each moment you are on call can bring a phone call from the nursing supervisor. Or a text or call from a surgeon.

To be on call is to be vigilant every day. To sleep when you can and to know the power of a nap.

Some nurses and techs are unable to grasp this and stay awake all night, just waiting for the phone to ring to summon them to the hospital. Or they wake in a panic and check their phone, frantic that they have missed a text or a phone call.

Shhh. Relax. I always call twice. And so does the nursing supervisor.

This is part of our flexibility. The ability to sleep through anything and everything. The ability to work all night, have a small sleep with maybe a nap later and emerge ready to do battle with the unknown again.

More than that it is our flexibility to be okay with the known and unknown.

Will there be a case? Maybe.

Will I sleep all night and awake refreshed in the morning because there was no case? Maybe.

It is being absolutely okay with either instance that makes you flexible.

And don’t you forget it.

Battle stations.

Tuesday Top of Mind 10/21/25- No Kings is over, now what?

Yay, over 8 million people showed up to march. Well, 7-8 million, depending on who you believe.

Either way that is a LOT of people.

And there were even more who were unable to make it to an organized march.

It was a grand gesture.

Now what?

You may be feeling a bit down. From the adrenaline high, from the knowledge that the no kings protest was a show of no kings force but it was only that. A show.

The government is still shut down. Because the Democrats are holding firm on the ACA subsidy fight. So that everyday Americans, not illegals despite the lie they are trying to force down our throats, won’t see health care costs on the exchange skyrocket out of reach. I am proud of them.

The East Wing of the White House has been scarred. For one man’s ego and because no one ever told him no.

The House of Representatives is out for recess. Again. There have been 3 full weeks of work by them since July 1st. This is shameful and not what we voted for. Not only that, the deciding signature on the Resolution to release the Epstein files was elected in Arizona. Adelita Grijalva has yet to be sworn in by that coward, Mike Johnson. She was elected September 23 a full month ago. But Johnson would rather play ostrich with his head in the sand.

AI slop is being used for everything. I’ve seen many, many, many badly written headlines in the news with all sorts of errors- punctuation, spelling, word choice, and tense. I’ve seen badly shaped and colored memes that some people want use as a gotcha. Dream on.

It’s okay to feel a bit blue.

However, the pressure must be sustained. If there is anything I’ve learned as a nurse it is not to decrease pressure when the bleeding has slowed, that way leads to a hemorrhage.

Maintain that pressure.

Keep making the phone calls, even if you are talking to a machine.

Keep sending those emails.

Participate in Operation Mail Drop where scolding cards or postcards are sent to those in power. Yes, all of them. The object that you mail is up to you and your wallet. I’m not saying mail them something that might rot by the time it gets there, but I’m not not saying it either.

But, most importantly, VOTE.

There is a General Election this coming first Tuesday in November. Many states already have the early voting sites open.

It is your right to vote. Exercise it.

Send the next message to Washington that we see their depravity and their illegal acts.

And we won’t stand for it.

And we don’t care for it.

Keep the pressure on.

Keep the eyes on them.

We drown out the illiberal with protest

Millions have taken to the streets.

Frogs, unicorns, everyday Americans bearing placards.

Saying with one voice “No Kings!”

More are protesting in their own quiet way.

Because they can’t join a march. But protested with their pocketbooks.

Too bad there isn’t a way to quantify that.

This is a message from the American public who say no more.

This is a message from the America public for one man.

This is a message from the American public as one.

No Kings!

Remember we fought a whole Revolution for that.

FFS Friday 10/17/25- “No Food For You” to the nation’s hungry

This is in reference to the U.S. Department of Agriculture letter that advised state agencies to hold disbursements of the Supplemental Nutrition Assistance Program (SNAP) for November. T

Their game is unknowable but is probably a lever to pressure Senate Democrats to vote to take on the so called clean continuing resolution to open the federal government. And probably a pain point to get those who are hungry and in need of SNAP to reach out to their representatives and beg them to open the government by passing the CR.

Diabolical in’t it?

That’s what they want. A reason to rat out the democrats to the voters for not doing enough to help those who are hurting.

I hope that people see through this charade.

Especially the ones that this hurts.

Especially as we hear that the government is giving now $40 BILLION dollars to Argentina to prop up their collapsing currency. Perhaps the attention should be on the United States economy and declining dollar. Just a thought.

According to the letter, the money exists in the USDA but the states are not allowed to spend it. The states are not allowed to give it out to the people who are on SNAP.

Instead those affected have to go to food banks, which are already stretched so so thin because of the economy in this country.

It is giving holding out bread to a starving person and then snatching it away and grinding it into the mud. That they then shove the starving person into.

It is giving Old Mother Hubbard with the empty cupboard to give the dog a bone. But she knows full well there is a second, secret cupboard for her own use and she hoards the contents. Even if the dog is hungry.

And shades of the Soup Nazi.

Full disclosure, I have never ever ever seen Seinfeld. I worked evenings/nights through the 1990s after I graduated from high school. I have only heard of it as a bit.

I direct those who are using this moment to make people hungry to Les Misérables by Victor Hugo.

And remember the name Jean Valjean. His prisoner number was 24601.

His only crime was that he stole a loaf of bread to feed his sister’s child, who was close to death from starvation. He received 5 years hard labor for that crime and 14 additional years hard labor because he tried to run.

I feel a relisten/rewatch of Les Mis is in order.

Cookie Thursday 10/16/25- E.T. phone home

Remember, the theme of the month is Something Spooky This Way Comes.

The cookie of the week I baked this week was a blond cookie with Reese’s Pieces.

Some of us remember that in 1982 an extra-terrestrial came to earth and crash landed near a house in Southern California. The E.T. was befriended by a boy named Elliot with troubles of his own. The boy’s little sister Gertie, played by Drew Barrymore, was initially scared and then thrilled to have a playmate that was just her size. And then mom comes home and the government is hot on the heels of E.T. to experiment on him. All Elliot and Gertie wanted was to help E.T. get home.

Because Gertie was so scared and screamed so loudly when she met E.T., the Reese’s Pieces I think that this cookie, which is a perennial October cookie, fits the theme.

Now, it took me a bit to find the Reese’s Pieces but I was able to locate them at CVS of all places.

And they were on sale. So bonus for me!

Stove update- my favorite burner is still giving very low flame. From what I have read, this means because the natural gas is constricted in the line. This makes sense because the stove and oven are 20 years old and it is my favorite burner. Because it is a favorite it is used 90% of the time and is the right lower burner. The rest of the time more than 1 burner is in use. But the favorite burner is used at the same time as the other burner. Think pasta sauce on the favorite burner, and water for pasta on the other burner.

First world problem is that I had to learn the other burners. The next most used burner is the bottom left. Which is the biggest burner with the biggest flame of all.

Let’s just say that there was a learning curve.

I do not think this is the right time to buy a new stove due to political atmosphere and the here again and gone again, just kidding tariffs. But I will remain open to replacement. If I find a stove that I think can be useful.

The oven though? That is holding strong, despite the nearly 11 years of Cookie Thursday is a Thing.

I’ve said it before and I’ll say it again, it has been a lot of cookies.

I’m off to rewatch E.T.

Secrets of the OR- Sterile processing, the unsung heroes of the OR

You think you know the OR? As if.

We know the usual cast of characters in the room.

The circulating nurse who bosses everyone around and ensures that the patient has everything they need. Including activating an emergency team.

The scrub tech who is in the sterile environment with the surgeon and assists who knows what the surgeon needs before they ask for it.

The CRNA who ensures that the patient is comfortably anesthetized and is prepared for any emergency.

The anesthesiologist who supervises the CRNA, up to 4 rooms at a time and who pinch hits for the CRNA at times.

The patient without who none of the cast of characters would be there.

But, do you recall the most famous reindeer of all?

Just kidding; it takes more that the usual cast of characters to safely see a patient through surgery.

There is the pre-op team that makes sure the patient is prepared for surgery. They know all about the patient and is a source of comfort for them as they wait for the surgery to begin.

There is the post-op team that makes sure the patient is comfortable waking up from surgery. In the hospital where I work the pre-op and post-op teams are comprised from the ACU/PACU team.

But the one you hear the least about? The ones who cleans the instruments, readies the trays, sterilizes the instruments, and puts the sets back where they live so that the OR can find them.

The sterile processing department. SPD in the hospital I work at.

They know everything there is to know about the trays. They should they put them together from the jumbled mess that the scrub tech might leave. Depends on the scrub tech. If asked about a certain instrument that was dropped they might be able to point the circulator in the correct direction for a replacement instrument.

The first thing they do is decontaminate the instruments that have just been used in a surgery. There are washing machines, similar to a dishwasher, that are used. But, just like in real life, the gross bioburden has to be washed off many of the instruments. By hand.

They inspect all instruments that they get out of the washers. They make sure that the tips of the instruments meet and are not out of alignment. They make sure that all the lumens of instruments are clean with air or a brush prior to set assembly. They make sure that all the very fine instrument tips are not broken off because of mistreatment. Then they string the instruments together in the order they appear on the count sheet.

They double check the count sheet to make sure that everything is accounted for in a set. If not, they mark the set as incomplete and put on a bright orange sticker that indicates what is missing. If too many things are missing the set it taken out of use and set aside until the missing pieces are located and the complete set can be sterilized.

How does an instrument get lost? This is out of their control. Sometimes the instrument is thrown away (I tried to get a research project off the ground to decrease inadvertently thrown away instruments by using a metal detector. I maintain it would have worked too, but covid shut that down). And sometimes the instrument is in another tray from the same case, just misplaced.

They maintain a bin of lost instruments from the misplaced instruments that are retrieved after the sets are put back together. These instruments can be from the core, where there is an entire shelving unit full of sterilized single items. Sometimes it is a replacement for the scissor the surgeon just dropped, sometimes it is a replacement for the orange sticker. SPD puts these back up in single sterilizer packet. This is a down time occupation. The downtime of which there is very little because some of the sets are needed later in the day and the set from the 0700 first case has to be washed, inspected, put back together and sterilized in time for the case that starts at noon.

They know everything there is to know about the instructions for use of the sterilizers and the instruments that might go in the sterilizers. These are the IFUs. These indicate what is the best sterilization method for a given instrument, including parameters of time and exposure.

We’ve come a long way since the days of one set of instruments that was washed and flash sterilized for ALL the cases of the day. Or the care and maintenance of the Cidex, which is a semi-sterile instrument dip that was sometimes used the before times that would expire. Or the care and maintenance of the Steris machine, which used an acid bath to delicately clean scopes and cameras that could not be sterilized in the autoclave. Or the care and maintenance of the newer machines like the Sterrad that uses plasma to sterilize cameras and scopes.

They had to have all of that in their heads. Or at least readily accessible to look up on the spot. But in my experience, they kept it all in their heads.

SPD workers have to be efficient and know their stuff. And keep all the rest of it in mind as they do so.

No sterile instruments? No surgery can be done safely. There aren’t enough antibiotics in the world to cover that.

Tuesday Top of Mind 10/14/25- There is too much to focus on and that is the ENTIRE POINT

Every minute of every day there is additional ghastly moments perpetrated by our own government on their own born here people.

It is meant to be exhausting.

It is meant to draw your minds’ eye away from what really matters.

Someone has to keep watch.

I learned a new phrase today that sums up the frog costumes in Portland, OR-Tactical Frivolity.

I shared said phrase and the video is was on to a certain social media site.

And they took it down.

Quietly.

It is no longer on my feed.

But that’s okay, I know how to use google. And how to double check my sources. And which sources to even use. Thanks, PhD program.

Tactical frivolity is also used to exhibit peaceful non-compliance to those who would put their boot on your neck.

To bring it back to something else I’ve written about a story by Hans Christian Anderson, a character that exhibits Tactical Frivolity is the tailor in the Emperor’s Has No Clothes. His peaceful protest of the emperor’s spending is to “use” expensive fine fabric that only the best people can “see”. The emperor pretends to perceive the expensive fine fabric so as to not be thought a best person. To his chagrin, a young child calls him out on it and everyone can see what a fraud he is.

Ta da, Tactical Frivolity.

Also why the costumed frogs in Portland, OR have had such a fun impact.

Kind of like sticking your tongue out and razzing those who want you to comply.

Tactical Frivolity is not complying.

And I think the protests in Portland are better for it.

After all, the costumed frog has been joined by many, many others.

Other frogs.

Dinosaurs

Unicorns.

And more.

The costumes are sold out everywhere.

Tactical Frivolity is useful in these times. It reminds those who would have us comply with their bullshit that we very much will not.

Now where can I get a Peep Costume. I think that would be fun.