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.

Going with the something from nothing theme of using up odd things in my baking pantry or regular pantry, I saw a recipe for caramel oyster crackers with cinnamon sugar.

I have only previously used oyster crackers with a savory topping: dill, summer savory, and thyme. Not ranch, I loathe ranch dressing in all its forms. Yes, I understand this makes me unSouthernlike. They do love to drown their stuff in ranch dressing, don’t they?

Getting back to the reason for caramel oyster crackers with cinnamon sugar. I have oyster crackers.

Goodness knows I have butter.

And sugar.

And vanilla.

And cinnamon.

It’s a recipe date.

This recipe also has the advantage of being 1) an experiment and 2) quick.

Because school, ya know. The old noggin is full.

As I am reading this recipe, I am reminded of the cracker crack with caramel and chocolate and crackers. These seem to caramel coated oyster crackers, topped with cinnamon sugar.

Oven to 350 degrees Fahrenheit.

Cover a cookie sheet with aluminum foil.

2 sticks butter, 1 c brown sugar in a saucepan.
cook over medium-high heat until it is bubbling. Cook about 2 minutes more, stirring constantly.
add 1 tsp vanilla and stir, still over heat.
add 1 tsp cinnamon per recipe or 2 tsp if you are me, and stir.

Take off heat.
add in the bag of oyster crackers.

And stir.

Remember why the recipe says to use a big saucepan.

Immediately regret not remembering sooner.

Stir until all the oyster crackers are coated.

Spread the coated oyster crackers on the prepared cookie sheet. Don’t be too nitpicky about how spread out they are, or how clumped together they are.

Bake in the prepared oven for 15 minutes.

Duriing baking, the toffee/caramel/whatever you want to call it, will melt and the oyster crackers will settle into an even spread. Science is neat.

While it is baking, add 2-3 tsp cinnamon and 1 tsp salt to 3/4 c sugar until the uniform color of cinnamon sugar that you desire. I like it on the more cinnamony side.

Take the now neatly arranged oyster crackers out of the oven. Again, science is neat. And cool for 5 minutes.

In a large bowl add the cinnamon sugar and the oyster crackers and stir until the crackers are evenly coated with cinnamon sugar.

Resist more than a taste test.

If you know you don’t have any willpower, forgo the test taste.

It’s sugar and cinnamon and butter. What could go wrong?

A lot, I know, but if you don’t burn the brown sugar butter mix, it’ll be fine.

This is the week that celebrates us in the healthcare world.

It is November 12-18.

We are the ones who sometimes aren’t even at the hospital while we are still on shift.

We are the ones who are dismissed as not a real nurse because “your patients are asleep”. Okay, floor nurse, you memorize the 500+ different instruments, the oodles of equipment, the scads of positioning aids, hold in our heads the many different tables, how to use them and their weight limits, know how to position for hundreds of different surgeries, and can think 10 steps ahead of the surgeon and have what they need ready to give to the field if they ask for it. AND remember what instrument trays there are in the department AND where that specific instrument is. And how to break it to the surgeon that that instrument know longer exists. But you have to have an alternative plan in mind for the instrument.

Not so cushy now, huh?

We are the ones who troubleshoot our own equipment because the rep is in a surgery downtown, or, you know, it’s a regional rep and that region is vast.

We are able to spot a surgeon tantrum and know how to head it off.

We are the keepers of the scores, regardless of sport, and able to talk knowledgeably about soccer, football, baseball, hockey, basketball, regardless of the season. I’d even give a go at discussing cricket. Especially if it gives the surgeon something to complain about besides turnover times.

We are the ones who have to monitor the OR field and their needs, AND keep an eye on the anesthesia and how the patient is doing, AND know when and who to call when the patient is not doing well, AND think about the next case and the positioning and instrument needs, AND be able to get the blood tubes off to the lab in a timely manner, AND know how to label and collect and send off all manner of specimens. Don’t forget to let the family know how the patient is doing.

We are the cool ones.

That is all.

I was going to write about abortion and Ohio’s stunning victory. And raise a little hell about the Republican legislature in the state trying to take away the win.

However.

I have no room in my mind for that. Top or otherwise.

The change from Daylight Standard Time (DST) to Eastern Standard Time (EST) has made Dot lose what little mind she has.

Stop laughing.

I’m serious.

Dot is our 11-year-old cat. She’s a menace.

You know the comics when the cat knocks over the full glass staring you in the face?

That’s Dot.

Cat people are going to know the mrowing cry when no one is paying attention to her.

Usually in the stairwell for extra emphasis with the echoes.

I just took her picture and she’s sulking on the corner of the desk, waiting for me to say sorry.

Nope.

She wakes me early, early at 0500 to remind me that the other cat needs to be fed. (Dot gets food all the time in her bowl that Pickles can’t get to. Pickles can’t free feed, she already resembles a football.)

The first Monday after the time change she woke me up at 0430 to remind me that I had to get up to go to the university for research assisting.

How does she know what day it is? Asking for me.

I worked quite late on Sunday night/Monday morning and the professor I do the research assisting for said we could change the day to Tuesday and I could do it from home.

You’d think WIN! Not driving to the university saves me gas money, parking money, and about 3 hours of time.

Dot isn’t sure what’s wrong but something obviously is because I’m on the computer all day, when I prefer to work later in the day.

Up on the desk, down to the distraction chair, up on the desk and sit in front of the monitor, down to the distraction chair, up to the desk to stare lovingly at me, down to the distraction chair, up to the desk to sit on the keyboard and act like she’s gonna eat my headset. All the while, purring hard enough to shake the desk.

Since 0630 she’s been in my business; be it on the phone, or the computer, or the other computer. I balanced the keyboard and sat down with my legs up, thinking she would settle if she had access to a lap.

Nope.

I opened the back door to the screened porch.

Nope.

I made sure she had fresh water, in all three locations there is water for the cats.

Nope.

I policed the litter boxes at 0600.

Nope. Back on the desk.

I need a feline-to-human interpreter, please.

Don’t worry, it’s almost time for her 4-hour nap.

Maybe I will get some work done then.

She just mrowed from the door and dropped one of her toys at my feet.

Awww.

Maybe she’s okay.

But she still needs to calm down.

For many of the students, the semester is winding down.

It seems like just yesterday we were starting, full of energy and enthusiasm.

Even for those of us who have been around for a few semesters, or years, this is an exciting time.

We make promises to check in with our assignments often.

To reach out to the instructor if we need help.

To carefully watch our assignment list.

To do the reading faithfully every week.

To look out for our classmates, offer to lend notes, or offer to study together.

It is so, so tiring.

And then suddenly it is mid-semester when it was just the beginning of the semester.

Time is funny that way.

The end of the semester is so close for most of us, glimmering in the distance.

Kind of like a mirage.

But unlike a mirage this place in time is real.

There is just a little more gas in the tank to get to the end of the semester.

It is okay.

I believe in you.

And in myself.

Remember the mantras…

the only way out is through

just keep swimming

Whatever works.

Continuing this month’s theme of Something from Nothing is baked French toast bites.

This theme is a cleverly worded message to myself to use the ingredients that I bought with cookies in mind.

The ingredient for the week is cinnamon brioche bread.

I love a brioche bread.

By itself with butter.

In a bread pudding.

It is all good.

But…

I realize that I am the only one in the house that an ingredient such as this is for.

I bought this cinnamon brioche bread thinking I would be able to eat it for breakfast.

Or a snack,

Spoiler alert, I did not.

Really, is anyone surprised?

I had a load of cinnamon brioche bread that needed to be used.

Voila!

Baked French toast bites.

I will definitely be making this again. Maybe for my coworkers, maybe for my husband and myself. We’ll see.

The experimentation part of the recipe is that one of the recipes I found encourages the use of creamer in place of milk.

Hmm, I thought. I’ve got some brown sugar oat milk creamer.

Perfect!

After I sliced the pieces up, I tossed the lot of them with cinnamon sugar to coat.

Okay, now it’s perfect.