I’ve done this call thing for a while.

Even before I was the night call nurse, I took a LOT of call.

Alotalot.

At the height, I was pulling something like 88 hours of call a week.

For those playing along with a calculator saying huh? That is every weekday night 2300-0700. Which is essentially 40 hours a week. Add in 48 hours on the weekend that is 88 hours.

I didn’t take EVERYONE’S call. Just 95%-100% of it. And if the nurse responsible for the day call on the weekends still wanted to keep their call, I still took laser call. Because, by policy, there has to be a dedicated person to run the laser.

Call exists so that the OR can be staffed, even during the night or on weekends.

Call exists so that the patient in need of surgery can have surgery at the hospital.

Call exists so the surgical team only has to be on stand-by in case there is a surgical need.

Call just is a function that we, as the OR team, fulfill.

It doesn’t have to be scary.

You just have to know how to get the answers that you need when a situation arises.

OR who to reach out to get the information.

But, I get it. Call isn’t for everyone.

Some people like to sleep all night without the possibility that they will be needed at the hospital. Some people like to have a glass of wine after their shift.

I can’t tell you how to get to a state of zen about taking call.

I can tell you that you need to relax.

Take a deep breath, unclench your fingers from the phone, put it down, and close your eyes.

In years, and years, and year, and hour upon hour of taking call (and they are legion), I slept through a phone call AND my pager exactly once.

Odds are good that it won’t happen to you.

As I tell new scrubs about calling in the scrub tech, if you don’t answer I try again, and then I try the secondary number, and then I start down the list searching for someone to come in and function as the call person.

There may be consequences. But again, has happened less than 15 times in all that time.

Don’t fear the call. It isn’t the monster under the bed.

I’d take it if I could.

The regularly scheduled Tuesday Top of Mind has been co-opted by the spooky!

Do not adjust your TV sets.

<spooky music!>

Where there are hospitals there are stories of odd things.

Things that go bump in the night.

Medicines that get moved or go missing.

Instrumentation that gets moved or goes missing.

There is a lot of suffering in hospitals. And if you ascribe the creation of ghosts to suffering, it makes sense.

If you believe in ghosts; you do you.

I’ve had my spooky share of weirdness in the hospital.

I’ve written about them before.

But This is Halloween and I want to share.

I worked evenings as a Med-Surg RN in this older hospital in California, and then I worked nights as a Med-Surg RN on the same floor when they conned us that 12-hour shifts were awesome! One night, late, either in the middle of the night or after 2230 waiting for the night shift to arrive, I was checking the medicine cart for something. I no longer remember what. I looked down the long. empty, dark hall. Empty because we were only half full at the time, and I saw her.

An elderly woman, bundled up in a pink robe, looking at the painting on the wall.

Not my patient.

I glanced over to ask one of the other nurses which of their patients was out of bed. This took seconds. When I looked back, she was gone.

Uneasy now, I went down the long, empty, dark hall to the painting, glancing into the rooms as I passed. Everyone was asleep in their bed.

I came up the other side of the hallway, think of the unit being like a racetrack. No one was out of bed, the rooms were dark.

I took the stairs to the ICU unit. No one was out of bed there.

I took the stairs to the Skilled Nursing unit on the first floor.

No one was out of bed there.

Still the eeriest experience I’ve ever had in the hospital.

And that includes the time that the elevator was open and waiting for me when I had to get an instrument up 3 flights of stairs to the obstetrics ward where the c-section room needed it.

And it was open again to go back down to get a different instrument.

And it was open again to go back up with the next instrument.

Hospitals can be creepy places.

Hi, yeah, Post-it Sunday is delayed.

Everything I write turns super dark.

Or would just hit wrong.

Must be the spooky season.

Or the full blue moon from two days ago.

I’ll try again tomorrow.

I know that the Fall Semester JUST FREAKING STARTED!

But, alas, at my school we are 12 weeks in already.

Time is funny that way. You are just getting into a routine, class, reading, studying, writing. And then, poof, the semester is nearly over.

Yeah, I know that I wrote about midterms a blink of an eye ago. Time is weird, okay?

Just a little bit longer. You’ve got this.

One of my instructors kindly reminds us every class which week we are in.

I know I need it. Very soon now will be the reminders to sign up for Spring Semester. If you haven’t already been getting them. Take that leap! Sign up for Spring Semester with the conviction that school will help you pass your classes in the right now.

Tests are getting harder. Papers are getting longer. And, in my case, preliminary exam, which is the door to the dissertation, is only nine months away!

It’s going to be okay.

Just focus on the remaining assignments, and study for the tests, and take a day off once in a while.

Check in on your classmates frequently. Check in with yourself frequently.

It’s going to be okay.

This is just a moment to focus in on the semester.

It’ll be over, for good or for ill, sooner than you think.

I cannot tell you how excited I’ve been for this Thursday.

As excited as I was for the secret theme of the month- the Gravestone recipes.

But times a hundred. Easy.

Traditionally on the closest Thursday before Halloween I’ve made homemade candy.

I’ve done sour patch candy.

I’ve done red hots.

I’ve done seafoam. That one was a trip.

And then it started to rain on the closest Thursday to Halloween. For like 4 years running.

Just like frosting, candy doesn’t really like humidity.

I’ve decided to take it back a notch this Thursday before Halloween.

I’ve done more classic candies.

I made butterscotch haystacks that have not yet solidified.

Rude.

I did caramel popcorn balls.

I did clodhopper candy. Which was created/discovered by a candy company in Canada. This is crushed graham crackers, roasted and salted cashews, and melted white chocolate chips. This one dried well, I’m not sure what is up with the haystacks.

The one I am most excited for is the brownie cauldrons. I made brownies in a mini muffin tin and, just after I pulled them out, made a well in each with a measuring spoon. I will fill this well with green frosting in the morning, it doesn’t look like rain, with green candy “bubbles”.

Also on deck for tomorrow is the sweet and spicy bacon cracker bites. This is new and I can’t wait to try it.

Plus decor.

I had so much fun deciding on the candies, and making the candies, and deciding on the decor. I can’t wait!

To badly parody Pride and Prejudice by Jane Austen’s first line. “It is a truth universally acknowledged, that a person who has been made NPO, will subsequently develop a mighty thirst.”

Yeah, yeah.

I know.

However, in my experience, the instant you tell someone that they cannot have any liquids the more they will argue and bargain with you.

Just a sip, they beg.

My mouth is so dry.

My tongue is sticking to the roof of my mouth.

Can’t I just wet my whistle?

No, can I have a wet washcloth to suck? And then swallow that fluid.

Can I chew gum?

No, no, a thousand times no.

It is not that we want to torture you, or your family, it is more about the mechanics of having fluid in your/their stomach that may be regurgitated and sucked into your/their lungs. This makes everyone have a bad day; anesthesia, patient, circulator.

When prepping a patient it is the most frequently asked question.

Sorry, the answer is no water, no gum, no washcloth. Your life is worth more than the temporary discomfort of being told no.

And we will find out if you cheat.

And you could die by cheating. Because of pneumonia after the fluid is sucked into your lungs. So there’s that.

Just listen to us. And don’t drink water from the sink. We will find out.

This is Tuesday Top of Mind where I write about anything that is top of mind.

This is a heavy lift after Monday, which used to be Monday Musing with the same premise. Mondays are the longest day of my week. I am on call 2100-0700 Sunday night, and I leave the house at 0615 to drive 90 minutes to the university, work 10 hours as a research assistant, and drive 90 minutes home. To go back on call shift at 2100. It is a LOOOOONNNNNGGGGGG day. If there are no cases I go to bed early.

As a result, my mind is pretty empty on Tuesday mornings. I take the morning to get my head back into the school game and read all the news I missed on Monday. On the first three Tuesdays of the month, I have 0700 meetings. Not today! Today I slept in until 0815 and it was great!

Then I get to reading and engaging with all sorts of news outlets. I am continually looking for things to send to my classmates in their dissertation area, reading the policy news for one of my classes, reading health disparity news for another class, and just reading the rest of the news for me. This fills my brain back up.

Long explanation short, this Tuesday morning I ran across a news item about the changes to the Scholastic Book Fair and how they are self-censoring in a bow to book ban pressure.

I have many complicated feelings about this.

I love the Scholastic Book Fair.

Books were my steady and constant companion while I was growing up.

No one told me what to read or not read as a child. I would not have listened anyway.

But in today’s society, it is different.

Instead of policing what their children read and leaving the rest of us out of it, some parents want to not let ANY BOOK they find objectionable into schools, libraries, and what have you. I find some of the reasons for the objections laughable.

Granted, I’m not a parent.

But I am an aunt who gives books out for Christmas, along with pajamas and socks.

Yes, I’m that aunt.

When I am choosing the books to give at Christmas I don’t ask my siblings what books they object to. I ask about the current interests of the kid and make my own selections based on that.

For some kids, the Scholastic Book Fair was the only place they could see and read books about other kids that looked like them. Or it was a place to explore topics that the kids wanted to learn about but was too afraid to ask the librarian.

Books are important.

Ideas are important.

And the Scholastic Book Fair self-censoring itself because a small minority, granted a very loud minority, wants to be the book police for EVERYONE. Well, I find that shameful and embarrassing for them.

Have they never looked at the internet that most of the rest of the world has?

Again, it is not about the children. It never is.

It is about control over what we learn and how we think and how we live.

That is the scandalous part of this entire debacle.

The post-it that started this theme reads “Skin is a map of your history.”

Throat incisions and neck incisions.

The premise of this series started as a medically trained professional could “read” your skin. By doing that we have a pretty good picture of your health history.

I still think this is true.

This Sunday I am going to focus on the throat and neck scars.

For such a small amount of space, the scars can tell us a lot.

If there is a horizontal incision over the middle of the throat, you may have had thyroid surgery. Surgeons tried to hide this in one of the creases of your neck.

A horizontal incision to either side of the middle of your throat could indicate a cervical spine surgery. Such as an anterior cervical discectomy and fusion. As an OR nurse, I would be concerned with proper body alignment during the surgery and I might ask the patient to put themselves in a position of comfort prior to surgery.

If there is a round scar at the base of the neck, near where the clavicles come together, or slighly higher, I would ask about your past tracheostomy history. This is a sign of a surgical airway and isn’t done just because. This can indicate long-term use of the ventilator or injury to the throat that made the doctors concerned there may be airway involvement.

Some patients have had what is called a neck dissection. This is usually for cancer treatment or lymph node removal. This kind of incision usually indicates something about your past medical history and current medical issues.

A past incision, or scar, over the carotid arteries may indicate a carotid endarterectomy, or the rotor rootering of a major vessel of the brain. This is usually done for plaque removal. It isn’t just your heart that develops this fatty material lining the vessels.

Sometimes you need IV access and none of your smaller veins in your arms and legs are good enough, or big enough to support the kind of IV you need. At times like these, an internal jugular IV is used. This could also have been an invasive heart monitor known as a Swann-Ganz catheter. The tip of this catheter sits in your right atrium and feeds back intel about your pulmonary function and your cardiac output.

For such a small amount of total area, incisions and scars on the neck and throat can tell us a lot about your past surgical and medical history.

Next week, the scars of the head and face.

References are the bane of many, many, many, many students.

And I mean many.

I count myself among them.

It would be one thing if there were the same rules for everyone.

But no, there are many. If you are in English Literature, they have their own.

If you are in legal, they have their own.

If you are in health sciences, we have our own.

To name a brief few, there are Chicago, and MLA, and APA.

Health Sciences, including nursing, uses the APA. This stands for the American Psychological Association. There have been hundreds of books on the proper usage of the APA. This is including the OG publication manual from the American Psychological Association. There are websites dedicated to helping you figure out the correct citation. And how to use it.

I know the most about the APA and even then I have only scratched the surface. It didn’t help that the APA was updated just after I finished my MSN.

My suggestion find a book that is easy for you to use to find out the nuances of the particular reference style that is necessary for your schoolwork. Websites are also useful in whatever style you have to use.

Also make friends with the librarians. They are always good in a pinch. Some university libraries will offer to make the citation for you when looking up articles in databases.

Always, always, check the citations when you are given them. Often they are wrong. There is either a misspelling, or the wrong word is capitalized, or the wrong words are italicized.

The coolest thing I’ve learned about citations is that Google Scholar will do them for you. When you look up articles in Google Scholar, part of the results has cite built into it. This is end quotations cite, after the star save on the bottom line of a result. I could have used that information a LONG time ago.

This is APA style, though. Edit- I was just using Google Scholar to find a Discussion post answer and it also has MLA, Chicago, Harvard, Vancouver as well as APA. So I was wrong and I was thankful that I was so I can update this blog post!

Yay for the health sciences!

To be clear, not my mom’s Christmas cookies.

This is another in the gravestone recipe theme for October.

After last week’s Cookie Thursday is a Thing fail of Kay’s fudge I wanted a sure-win cookie this week.

I mean, technically the dough could’ve been chilled and rolled out and treated like regular cut-out cookies.

Technically that would be boring.

I did drop cookies using my medium-sized cookie scoop instead.

A basic sugar cookie.

This recipe surprised me a bit, though. There is only about a 2-foot x 1-foot area to write these recipes on. Don’t forget the name and dates of birth and death also need to go on the tombstone. Unless you utilize the backside of the tombstone, which many of these recipes did. But there just isn’t a lot of room for long, in-depth recipes. Unless you go the QR code route for the newly dead.

I would like to see those recipes.

This week’s cookie is simple.

Sometimes that is good enough.