The post-it reads “Sometimes I think that a patient thinks that medical imaging is like a window into their body. It is, but it is frosted over.”

Patients are always keen to look at their films. They don’t know what they are looking at and want us to interpret for them, but they are excited.

Medical imaging- CT scan, mammography, MRI, even x-ray, can be confusing for an untrained eye to look at them and diagnose themselves. Doctors train for years and years to be able to interpret faint images that result from these tests. To tell the good, crisp scan, which they aren’t, from the blurry blob.

Each of the medical imaging type is used in the diagnosis of different things. A CT of your abdomen when you have belly pain will tell the doctor different things than an ultrasound of your abdomen.

An MRI is more specific but prohibitively expensive, which is why the cheaper tests are done first.

There is an art to medical imaging reading that, again, takes years to learn.

And even then the picture can be fuzzy.

I was going to write kind of like tea leaves and augury (mucking about in entrails) to tell the future but medical imaging is hard science, not telling the future.

I will absolutely bring up your pictures, but unless there is a helpful arrow drawn on by the radiologist, I have very limited experience to draw upon.

I am better with x-rays of bone.

I haven’t written yet today for the simple reason that all the papers have been turned in. I’ve written 56,271 words for November. And my brain is completely empty after turning in two 20+ page papers in the last two days.

This word count is for lecture notes, notes from readings, rough drafts, actual papers, and blog posts.

I know this because I kept track because November is National Novel Writing Month, where writers try to write 50,000 words.

I’ve participated in NaNo, as it is colloquially called, for years with original fiction. I wrote Calling in Dead, which is about a road trip with a scientist who is becoming a zombie who is trying to get to the cure while trying to outrun the hunters who want to kill the partial zombie. I wrote Gabriel’s Gate, which is about a politically connected detective agency in Maryland. I worked on Occupational Hazard, which is about a serial killer in the OR.

I have to say, after being a working nurse during a pandemic, about a virus, makes me kinda reconsider the zombie virus. It just hits differently.

The overall point of this blog post is that it is okay to admit your brain is empty after the end of the semester.

Just look at what you’ve done over the semester.

Books that have been read.

Papers that have been written.

Tests that have been taken.

Be proud of yourself for all that you’ve accomplished.

After finals put away the schoolbooks.

Enjoy the holidays if you participate.

Enjoy the time off if you don’t.

Spring semester will be here before you know it.

Yes, the title is clunky.

It is meant to convey that there are crispy fried jalapenos in the cookie dough.

The fan favorite of the OR. 95% of OR approved.

There is always going to be a few outliers. Statistics has taught me that.

This is the final Thursday of the Something from Nothing November theme. Where I use random ingredients from my pantry.

Today is the container of fried jalapenos that I bought from Trader Joe’s.

I was wondering if they could cookie. And they can.

It is a more subtle taste than fresh or dried jalapenos.

Let’s see if they like them.

This is a short post because this is four days into my own hiatus.

Off to work on the final paper!

Have you heard from nursing lately? How do we, as one of the largest labor forces, lose our voice?

You haven’t heard much from us as a group. Not much has been said. Because the loud makes right crowd are shouting us down and taking all the oxygen in the room.

But we have to realize as a group, we are bigger than them. And what we have to say matters just as much as what the loud makes right group has to say.

The different people in the group have different voices, true. But speaking together we can drown out the anti-science noise that is going on.

Or the anti-woman noise.

Or the anti- this is confusing to me and therefore I am scared so I shout louder noise.

Or the anti-I don’t like this choice so you can’t have this choice noise.

Or the anti-I don’t like this book so you can’t read this book noise.

Definitely the anti-abortion noise.

But people are beginning to understand the effects of all this noise has on people.

Women are dying.

LGBTQ+ people are dying.

People who just want to live life the way they choose are being impacted.

Books are not dying but personal choice to read what you want is being impacted.

Again, women are dying. Especially black women who are just trying to give birth and survive to raise their children.

Babies who cannot survive out of the womb are being tortured and then dying.

Shhhh.

Stop the noise.

Let people live.

It is the end of the semester, and Dispatches from the Evening Shift is going on a brief hiatus. Until December 2 because I have 2 big final papers to finish and submit for class.

Because I would rather write Dispatches than some of the school stuff.

I could write ahead and stockpile posts.

But I have never done that.

I do have draft posts that never made it into the world for a variety of reasons. I felt that a few are too mean, or too topical, or not time-separated from the actual event I am writing about.

I will be posting some of those instead.

Starting for Tuesday Top of Mind.

So, really, It is only three regularly scheduled posts that are going to be affected.

Four including this one.

I know that I have been struggling with Post-it Sundays for the past couple of months. I have been taking Sundays to prepare for my long, long, long Mondays, but tomorrow is the last Monday! The Skin, a memoir by you, series that I’ve been posting on Sundays will be continuing soon.

Hello, and welcome to the end of your semester.

This upcoming week may be finals week. It might be the week after.

This upcoming week may be when all the final papers are due in your classes. It might be the week after.

However, it is important to have a strategy in mind for these events.

Yes, I know that Christmas and the holiday season are exploding everywhere.

Stay focused!

Be prepared.

Write those papers!

Study that syllabus as to what is going to be on the final exams.

Getting ready now will save you some late, late, late, late nights later.

Ask me how I know?

I have 2 papers due on December 1st. One at 1700 and one at midnight.

I have been working on them for about 10 days now.

Do what you have to do to keep your head in the game.

I could drag out a tired sports metaphor here but use your imagination and make it relevant to a sport you enjoy.

Final push and then a month-long break.

Breathe.

Remember the mantra that you’ve set up.

I’m using one from the original post on nursing mantras way back in July 2022-the only way out is through.

Happy Thanksgiving 2023.

I worked until 0630 and I slept until noon.

With the OR being closed except for urgent cases, I did not bake Cookie Thursday is a Thing cookies for this week.

I made ambrosia for Thanksgiving dinner instead.

I made it on Wednesday because it is always best next day.

Ambrosia is one of those festive foods that you either love or hate.

I love it.

In the strictest sense, it is not really a salad.

It is made with canned fruit cocktail, mandarin oranges, pineapple chunks, sour cream, marshmallows, and maraschino cherries.

If you are fancy, walnuts or pecans.

We’re fancy.

I made it Wednesday, as I’ve written, and let it marinate in its own juices. This breaks the marshmallows down. Just a litle.

Yum.

This is part 2 of the short exploration into what a consent is. Last time I discussed the signatures of the patient, of the surgeon, and of the witnessing nurse.

This time I will be discussing parts of the actual form itself.

At the top of every consent I’ve seen is the patient’s name line. This is where the patient who is going to be the surgery is written.

Underneath are two or three lines where the pre-op nurse writes down what the surgeon says the surgery is.

The nurse doesn’t write down what is their interpretation of what the surgery is. They might be wrong.

Either there is an order to obtain consent where the surgeon or PA fills out EXACTLY what is to be put on these lines. Or the surgeon writes it themselves.

As the witnessing nurse who is doing pre-op on this patient I either read what they’ve written to make sure it is what the patient is expecting or I make sure that there are no unauthorized contractions of words.

You know, and I know, that R often means right. But it might not. Laterality words must be spelled out. Other frequently contracted words are ORIF, this means open redution internal fixation. Or TAH, this means total abdominal hysterectomy. Or TKA, whic means total knee arthroplasty.

It doesn’t matter that the OR team knows what all those words mean. Because we can have complete conversations that are comprised mainly of words like LOLNAD, LOL, CHF, V-TACH, V-FIB, DNR. To me this is a bad day for the little old lady with no apparent distress who devolved into just a little old lady with congestive heart failure which devolved into ventricular tachycardia, which devolved into ventricular fibrillation, and someone reminded the team that she is do not rescuscitate. Lots of words to describe a sequence of events.

Yeah, we speak our own language.

To be legal, the patient has to understand what the words mean.

Therefore no abbreviations allowed on the procedure description lines. None.

Because if the outcome of the surgery is not what the patient expected and they sue an abbreviation can sink your defense.

Also it allows the team in the OR to be on the same page as the surgeon, the patient, the witnessing nurse.

Once upon a time before I knew better, a surgeon wrote umb. hern. They meant umbilical hernia, but the handwriting was so bad (this was before EHRs) that the tech, the charge nurse, the patient all understood it to mean right inguinal hernia. Not even remotely the same. This was caught before the patient even went back to the OR, but what if it wasn’t?

Be smart, don’t use abbreviations on your consents.

And please print! Or put the order in and someone with nice handwriting will write it out.

I am unsure if this should be a Tuesday Top of Mind post or a School Me Saturday post.

Then I thought of all the adults that are not in school.

Heck, I might do both.

But the best advice I can give to anyone is it is okay to give yourself permission for a break.

There is no set number of chores that have to be done before you take a moment to yourself.

There is no set of unwritten rules that says all work must be done before you take a break.

There is no taskmaster standing over us with a whip in one hand and an ugly sneer on their face barking at us to get back to work.

The only taskmaster that we have as adults is our own brains.

Granted, some people’s taskmaster is very lenient and allows them to do nothing but relax. That’s for another time.

Remember recess?

That period of time that school kids are allowed to blow off some steam on the playground.

There should be adult recess.

No chores allowed.

This will take self-control to stop recess and continue with your chores, tasks, or work.

I believe I can do it. I believe you can do it too.

Go ahead.

Take 10 minutes away from the chores, and the tasks, and the work.

Your mind will thank you.

It’s official.

No more classes for the Fall Semester.

Last classes were yesterday. Since class is on Friday and next week is Thanksgiving week and the next week is finals week.

This semester was surreal. It was simultaneously too short and so long at the same time.

I have things due in each of my three classes by December 1st.

In Health Disparities, I have an 8-page paper, 15-minute presentation combo due on Monday. The topic is a singular health inequity. After having done a deep dive into health disparities over the course of the semester, the things I have to choose from are vast. I think I will write about either climate change as a health inequity or food insecurity.

In Advanced Health Policies and Ethics, I have a max 25-page paper on a Health Policy Impact. I have to think what are the implications of the selected health policy, how it can impact health care, and the sociocultural, economic, legal, and ethical factors that are influencing the policy. I have to discuss why this focuses on my own lens of the OR. And evaluate whether present or pending policies impact the quality of care. This one is due on December 1st. I am unsure of the policy I am going to be addressing. I can follow up with the surgical smoke-free OR, or I can let my typing fingers free on abortion care in my state. I’ve been so good during the semester not riling up the rest of my classmates.

In my third class of Quantitative Research, I need to finalize the study proposal. I think this is in demonstration of the entire semester’s work we’ve done in this class. I’ve learned so much about how to do a literature review, synthesize the literature and all. I’ve learned what are the different kinds of surveys and proposals. Yesterday, in our last class, I learned about how to use big data sets in research. There is so much to learn and internalize.

Less than 2 weeks before the end of the semester. Let’s do this.