The gown card reads “Opportunity is a dirty word.”

The thing about opportunity is that it is nonsense.

Oh, it looks good. The dictionary definition is that it is a set of circumstances that makes it possible to do something.

The set of circumstances and the definition of something is deliberately undefined.

But people love to talk about opportunity as if the playing field is the same for everyone. That every one of us can go out there and invent the next big thing. Or write the Great American Novel. Or go to bed with a full stomach.

It is not.

Which is why it is a dirty word.

In my fourth class as a PhD student, there was a lot of class discussion on what a paradigm is. And how to shift the paradigm in nursing. Also discussed were the meta paradigms of nursing.

Patterns.

A paradigm is a pattern.

There are 4 meta paradigms in nursing, that filter down into the patterns. Person, Nursing, Environment, and Health. Nursing looks at the meta paradigms and breaks them down into the paradigms or patterns. We use these patterns to guide how we care for patients.

When I walked into that class, the last thing I had read about paradigm was a Dilbert comic making fun of management speak. I was definitely confused for a moment.

Another buzzword that gets thrown around too often is spearhead.

I’m rather a literal minded person. To me, a spear head is a sharpened stone, used to hunt.

In management buzzspeak, it refers to the person being the boss of a project. Or being the point person, but might be TOO literal. You get it, right? Sharp stone, point?

The buzzwords are used to obfuscate (confuse) the true meaning. They can be useful speaking shorthand, but can also be used as a blunt instrument against the subordinates.

Hands up.

Nothing in your hands.

Put your phone in your pocket.

Or your bra.

Your hands should be empty as they are to the sky.

Don’t have anything in your hands.

Don’t.

Watch for the gunman.

Don’t try to be a hero.

Don’t approach the gunman.

Don’t.

Follow directions if you meet a responding officer.

Don’t ask questions; you will get your questions asked in a timely manner.

Don’t distract the officer.

Don’t.

*

I was on my way home after working as a research assistant on Monday. This was after a 10-hour shift in the research assistant workroom.

It was a standard day, some filing, some working on assignment from the PhD nurse I am assigned to. Some light Excel work.

I was released a little early.

You see, the head of the department knew I had worked half the night the night before. I wanted a nap before my shift started at 2100.

I was 60 minutes into my 90-minute drive home when I heard about the shooting at UNC-Chapel Hill. Details on NPR were kind of scarce and then on to the next story.

I read all about it before my nap after I arrived home.

Shooting at a lab. One person dead, shooter in custody.

In the immediate aftermath, the campus had been locked down.

Wednesday morning, the front page of the UNC’s student newspaper, the Daily Tar Heel was entirely text messages that had been sent during the lockdown.

Simple.

Stark.

From friends and family members reaching out to their loved ones on campus.

From students reaching out to each other, desperate for a connection.

To make sure loved ones were safe.

But are we safe?

If you haven’t seen it, Google the Daily Tar Heel.

Read the fear in the tweets.

And assure yourself that gun control is just someone else’s issue.

This week concludes the no heat month, where I don’t turn on my oven because have you heard July was the hottest month on record? EVER?

No bakes, ice cream, and edible cookie dough.

I don’t think I turned on my oven at all this month.

According to Google, a dessert called slice from Great Britain can either be a single mixture such as the cookie I made, or a combination of a base, such as shortbread, and a topping layer.

In my head, it means a dessert that can be cut and portioned.

A small voice pipes up, “Like cake.”

Shh, small voice in my head, no one asked you.

I can see how the recipe I chose might have started out with a base layer and a topper but that was decidedly not the cookie I got.

For this recipe, 500 grams digestive cookies, crushed, 395g or 14 oz sweetened condensed milk, 250 g butter or 1 c, softened butter, 1 tsp of vanilla, and an entire package of marshmallows cut small. If using mini marshmallows, you can omit cutting them.

*

Oh! Oh dear.

*

I skipped an entire ingredient. I was supposed to add 4 tbs of cocoa powder. No wonder mine looked different than the reference picture. Besides the fact that I didn’t have pink marshmallows.

Oh, well.

This is a happy accident that made me think of another no-bake recipe, based on this one, for s’mores slice, on the fly. You see, if I substitute graham crackers for the digestive cookies, and continue not to add the cocoa powder, and add chocolate chips instead…

S’mores slice!

That is how to be an experimental baker; turn issues into opportunities.

This has a lot to do with the OR as well. You have to be able to keep your mind flexible and offer alternatives to problems.

For example: A surgeon has dropped the instrument for the second time and that was the remaining sterile one, because he, you recall, dropped the other one. You sent the original down for processing but it won’t be ready for another 45 minutes.

There is no reason to wait, twiddling your thumbs and staring at each other, while the patient remains under anesthesia.

There is no reason to flash the instrument because you remember that a very similar instrument is in another pan that is not in use. The very similar instrument is half an inch longer than the original two but should be used interchangeably.

The OR could have had an IUSS except for you.

Or the patient could have been under anesthesia at a considerable premium except for you.

A nimble mind can help in situations such as these.

On an OR Facebook page I follow because it is funny, someone asked a question about where some people go during lunch and breaks.

They aren’t in the lounge.

Not in the department.

As I see it there are three answers to this mystery.

The first answer is probably the most likely. Some people just don’t want to sit with other people. This can because of a variety of reasons.

People, some people, suck.

There is a television ALWAYS going and silence is never appreciated.

There are too many voices going on, competing with the TV and each other.

Chaos in a break room is not loved by everyone.

Have you never noticed the seating area that people have created outside the lounge. Or is that just my hospital.

The second answer is that not everyone goes to lunch at the same time.

This is an operating room! Cases do not start at 0630, 0830, 1030, [PAUSE FOR EVERYONE TO GO TO LUNCH], 1230, 1430, etc.

This is not how the OR schedule in a hospital works, or any OR schedule in anywhere I’ve ever worked.

This also isn’t high school where we all have to eat the same things, drink the same things to be popular. We’re all adults, most of us do not care.

If the OR schedule stopped so everyone could go to lunch at the same time, the lounge would have to be ginourmous to accommodate all the employees in the department.

The third answer, and the one that I gave, was that they are busy working.

My answer verbatim “Aww, you think I take a break?

When I was the evening charge nurse there was ALWAYS something to do and only me to do it.

I always look a little askance at the ones who are always in the break room. You know who you are.”

My evenings were spent doing the cases on the board or preparing for the next day, I don’t watch television, I don’t require an audience while I eat.

Everyone is on their phone anyway. No one is watching the television but protests when it is turned off.

If you are in the lounge often enough to notice abscence of certain people, you might be in the lounge too often. And we have noticed. Management probably hasn’t, but your coworkers have.

You are the lounge lizard.

Sleep deprivation is a HOT topic in nursing circles. I’ve read several articles on its detrimental effects on your heart and your mind and this was just in the last two weeks.

Last week was a tough one. I worked nearly every damned day of my week. Considering that work consists of doing call cases, i.e. cases that come in the middle of the night, or hang on after the end of the day, that is a long week.

Back at it again at the beginning of this week. Sunday AND Monday.

Except for Thursday, those surgeons have had a hell of a time.

It was all one group too!

I told the last one of the set when I saw them on Sunday night that they must have had my bed monitored because I kept getting paged, or called just when I was putting my head on the pillow. I also referenced Pokemon and asked if, since I had the whole set, I had definitely caught them all.

I cannot stress how odd this is. A group of 8 and I’ve seen 6 of them, at night, in the last eight days. Weird.

But today the topic top of mind is sleep deprivation.

My sleep deprivation and how I handle it and processes that I’ve started to minimize it when I do sleep.

Mondays can be tough as discussed in last week’s Monday Musing 8/21/23, especially if I work all Sunday night. I have, believe me.

The first thing I do to combat Monday sleep deprivation starts on Sunday and it is simply a nap. I know that you can’t pre-save sleep in case you have a rough night and can’t sleep but I can try.

I nap on Sunday afternoon and go to bed at 2130 Sunday night. I do this with the intent of sleeping as much as I can, hopefully until the alarm goes off at 0515 to get up and get ready to drive the 90 minutes to the university. If I work, as I did this past Sunday, I go straight to bed as soon as I get back, again to sleep as much as I can until the alarm goes off. This past Sunday, I took the planned nap, and got into bed at 2130, after prepping my breakfast and my lunch for Monday.

There was a case and a page as soon as I pulled up the covers. That’s okay, I had gotten some sleep during the nap.

I was back in bed, case finished, by 0215.

After I checked the alarm was set to a slightly later time.

I slept from 0220 until my husband woke up to ask if I was going to the university that morning. He woke me up at 0527. My alarm was set to go off at 0540.

That is 13 minutes I’ll never get back.

Everyone knows the best sleep is right before the alarm.

Right?

I brushed my teeth, got dressed, grabbed my school satchel and my lunch, and left.

Spent a busy day doing research assisting stuff; editing an abstract, table edits, meeting with my new PhD nurse that I will be working for, doing budget-type things for another grant, and getting off an hour and a half early because I had finished everything asked of me.

Yay! Just in time to beat the 1700 traffic.

Got home 90 minutes later, diving straight into bed for another nap.

Because I go on shift at 2100 and I had a meeting at 1930 that I didn’t want to miss.

Wake me up Dot crawled into bed and cuddled because she hadn’t seen me all day. And purred herself to sleep.

If I am wrong about the quality of sleep with cat cuddles all I have to say is that YOU are wrong. I slept great for 70 minutes to wake up before my meeting.

All joking aside, sleep deprivation kills.

But I have a carefully constructed process to counteract it.

Including caffeine!

Tea and a Celsius drink and half a cold brew. I poured the rest out. I can’t stand coffee!

The post-it reads “nothing makes me madder than being reminded/texted at/informed by carrier pigeon 4 hours before the start of my call shift that the OR is a mess and “Don’t hold your breath to stay home tonight.” I never plan to stay home on any night except for Friday and Saturday nights, which are my nights off.”

It is statements like that that make me realize that call is more misunderstood than I thought. And also how I was able to take other people’s call to the tune of paying off my BSN student loans.

The big secret about call is to never expect not to be called in.

The universe loves a sucker.

There should be no expectations.

At all.

None.

Being on call means that if there is a surgical case out there, you’re gonna get called in.

There is nothing magical about it.

However, going back to the meat of the reminder I got that day, four hours before my shift started.

I KNOW!

I NEVER THINK I AM GOING TO BE AT HOME ON CALL!

If I am at home on call, that is a lucky night.

I know I am more sangfroid about being on call than 98% of the nurses that I see online whining about call,

That’s okay.

I like call.

I’ve always liked call.

If they let me I would probably take call on my nights off.

But they don’t.

Spelling is not so natural for some people.

That is okay.

Setting up papers is not so natural for some people.

That is okay.

Grammar is definitely not so natural for some people.

That is okay.

The arcane rules of the APA, MLA, and Chicago/Turabian, etc., are not so natural for all people. Especially when they keep changing the rules!

That is okay.

That is what the writing center at the college is for.

The library, which often houses the writing center, is not just for books.

Inside, there will be helpful people who want to help you learn these things.

After all, none of us are gifted at ALL of it.

English is weird.

The rules of English are even weirder.

If you need help, ask.

Even if you don’t need help it is important to create and maintain a relationship with a librarian and a writing center expert at the school.

They will come in handy sometimes.

Although the points for mastery of the citation style are small, they do add up. Depending on your particular degree and program, they might even get more punitive with every incidence of not paying attention to the required citation style.

Go ahead.

Ask me how I know.

Sometimes you have to get through to yourself that help is necessary.

And that is okay to ask for it.

For the last eight years, the closest Thursday before school starts is the ice cream social.

This event depends on audience participation to bring in toppings and ice cream.

Today there were at most 6 participants.

Yesterday someone texted me to ask if ice cream was still needed. I replied yes, and they asked if they should bring two.

I replied please do. Knowing that there would be at least 2 ice cream containers that I did not purchase made my night. .

There 4 half gallon ice creams, 3 bought and 1 homemade.

A tupperware container of homemade whipped cream.

A package of gummy bears.

1 container of freeze dried marshmallows. I honestly thought these were taken off the market because I’ve been looking for them for years.

1 container of sprinkles.

A jar of fudge topping.

A jar of caramel topping.

2 packages of bowls.

And 2 boxes of spoons.

That is it.

Missing was the fruit and the fake whipped cream. And the nuts.

And no ice cream scoops. I stopped supplying these after the third one was liberated and not by me.

There were sign up sheets two weeks ago at the OR core desk, the lounge board, the ambulatory care desk, and the endoscopy desk. I mentioned it at this month’s staff meeting.

A reminder sign was put up on Monday in the same places, including the door to the lounge.

And this was the input of audience participation. I brought the homemade ice cream and the sprinkles.

In contrast, in 2017 there were 7 different half gallons of ice cream, from different stores, 8 different syrups, 2 containers of sprinkles, two packages of different ice cream cones, marshino cherries, chopped nuts, wet walnuts, a container of canned whipped cream.

And 5 ice cream scoops.

To say I am upset is not quite right.

I am more disappointed in those who ate bowls of ice cream and who always eat the cookies with maybe a thanks, in those who can’t be bothered to engage in a department wide social event.

“I didn’t know” will be the response if asked. After ignoring the signs and the repeated reminders.

Never mind that this is the eight year of the ice cream social.

I think this has a lot more to say about staff engagement. Especially after the pandemic and with the influx of new team members.

How do you rally the troops when no one cares enough to be rallied, or to put their phones down long enough to pay attention?

Efficiency.

Efficiency is the hallmark of a well-run surgical case, a well-run OR room, and a well-run OR.

Efficiency is the way I try to run my life as well, results will not be the same for everyone.

Efficiency can also turn around and bite the hand that feeds it.

You can have all the cases teed up for the rest of the day in your room. All the instruments, all the supplies, the organization is just stunning. And then there is an emergency case and all of your original cases and painstaking organization are going to SOMEONE ELSE. You are given the emergency case and you need a certain instrument that you’ve already pulled for what was going to be your last case of the day.

What do you do?

Which case do you feed first?

The first thing to do is to mourn the fruits of your efficiency going to another room and another nurse.

It will be okay.

Next is to tell the nurse who is the benefactor of your largess that you need the instrument that is currently teed up for the 1600 case. It is only a maybe for the 1600 case but it is a definite need for your 0730 emergency.

If you are the new nurse who has been gifted this magnificently organized day, you do not hide the instrument in question out of spite. You give up the instrument and ask that it be sent down to be sterilized as soon as the emergency is over so that you may have this maybe instrument for the 1600 case.

If you are the original nurse do not snap that of course you will send down the instrument for reprocessing and don’t hold it hours after the emergency case before sending it down to be reprocessed. Out of spite because your beautifully efficient day has just gone down the tubes.

Again, it will be okay.

The best case scenario is that the emergency does not take too long, and uses the maybe instrument that you promptly send down to be reprocessed in time for the 1600 case. After the emergency, your room is now clear and no other cases are moved into it.

You have the rest of your shift to be the float nurse and move around helping rooms.

If you start thinking about tomorrow’s line up of cases in your room, that’s okay.

Efficiency can be efficient tomorrow.

Today is for taking care of today’s patients and also your coworkers.

Welcome to a new themed day of the week. This is Tuesday Top of Mind.

Tuesday replaces Monday Musing for reasons discussed in yesterday’s post.

My mind is a busy-busy place these days. No, seriously, it is like Grand Central Station up in there.

I meant to write this first thing this morning, as an effort to getting out posts in a more timely fashion. But, alas, I worked until 0530 again. This is the breaks of the call job.

Sometimes there are patients who need care in the middle of the night.

Hence the call job.

Zero complaints here.

Hey, even Wake Me Up Dot left me alone to sleep in relative peace until noon. After I woke up to put clothes in the wash and fed the cats at 0830.

The point is my mind has many, many things that are top of mind.

There is the continuing war on women’s bodily autonomy. Idaho is certainly feeling the effects of their war on women and bodily autonomy couched in being anti-abortion.

There is the continuing war in Ukraine and the many people impacted there for this WTAF war on one nation’s autonomy and cultural identity.

There is the continuing war on books and the people who want to have control over ALL the reading material.

There is the continuing war on trans individuals, again by people who want to have control over ALL the people.

There is the continuing war on LGBTQ+ individuals for the same reason.

There is the war on information that is rife in this country, brought on and egged on by the 24 hour news cycle.

There is the Kansas newspaper that was raided by a small-town sheriff with what seems to be a grudge and a judge that was not the town’s judge who rubberstamped the warrant. This is a small-town newspaper that was hard-hitting and so vital to the community in a time when small-town newspapers are being bought out by conglomerates. The publisher of the newspaper died the next day. No wonder proper journalists, not just people who flap their mouth and say what their sycophants want to hear, are in danger.

There is the war on nurse’s rights to practice without a medical doctor in places where the medical doctors are hard to find. This does nothing about the conversation that not all Drs have the same education. There are several DO (doctors of osteopathy, another path to being a Dr) who are not part of this conversation, taking care of patients and quietly doing surgery in the background.

There is the continued fear of women mostly who are sick of being marginalized and told our only worth is the contents of our uterus and what we can do for you.

There is a theme here, you get it, right?

However, I will not be silent on these matters because they are important to bring to the surface and have a serious discussion about. One that does not devolve into the keyboard “warriors” who skulk in the shadows with their keyboards typing things they would never say to my face.

What I was going to write about today before this post got co-opted by the insanity that is modern life was the nurse who killed 8 babies in a neonatal ward in the UK, and seriously harmed 8 more where only a few will have normal lives. Yeah, she was just sentenced to life in prison, no possibility of parole.

She didn’t even come to the court in the impact statement portion of the proceedings. This is where the victims can lay out the impact on their lives from the killings and poisonings. Really, their parents because some of these children are non-verbal because of what has been done to them and the survivors are less than 10 years old. No. She stayed in her cell while the statements were read aloud by lawyers or the judge. In doing this, she denied them what little closure they could have had.

Yeah.

There is a lot top of mind these days.

And that isn’t even including the university stuff.

Tuesday Top of Mind will continue with more cohesive posts next week. Probably on one of the above “wars”. Maybe not.

I’ll see what is top of mind then.