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.

I have decided that doing RA work for 10 hours each Monday.

Plus an hour and half there and an hour and a half home.

Plus my actual, you know, work.

Yeah, I worked until 0400, slept until 0755, logged onto the computer because I was doing RA from home today as instructed by the PhD nurse in charge because the PhD nurse I am to work with is out and won’t be returning until Saturday. Did what was requested of me until 1800, took a nap, did not leave much time for writing.

This has been coming for a bit.

Choosing Mondays as my RA day has not been without its challenges.

Tuesday Top of Mind it is.

There will be a longer post tomorrow for the inaugural Tuesday Top of Mind.

The post-it reads “The value of silence, also the danger of silence.”

Silence can mean many things.

All dependent on context.

If you are in church, you are probably praying.

If you are in a hospital at the bedside of someone who is dying, you are probably praying and holding your breath.

If you are in a surgical room and the surgeon has just dropped the vital one-of-a-kind instrument, you are probably praying, holding your breath, and planning your exit strategy.

There is also remaining silent in the face of an injustice.

But that is more of a Monday Musing post kind of thing.

Going back to the text of the post-it, there is value in silence.

This can be after a surgeon or doctor says there is nothing left to be done.

This can be after a pathologist states that the margins are clean and there is no evidence of cancer.

Sometimes the silence means you have a moment to catch your breath.

Sometimes the silence is just the pause before all hell breaks loose.

Often I have turned the radio down or even off if there is a particularly difficult part in an operation. You learn how to read the room and how to decide when music is appreciated and when it should be cut off.

There is a reason that the eye of a hurricane is meant to be silent and still.

There is also danger in silence. Kind of like the Monday Musing post I have not even written but have alluded to above.

Silence can be ominous and, at those times, it is to be respected.

Never fear the silence.

Also never think you have to fill up the silence.

Sometimes silence is, in and of itself, okay.

I know, I know. I usually do my personal report on the first Saturday of the month where I write about my personal school journey and the trials and successes therein.

But.

Spring semester ended at the end of April for me. I did TA over the summer and supported students on their RN-BSN journey. I learned a lot, mostly about myself and how I should approach assignments.

No more Last Minute Lucy for me!

(I hope)

There aren’t enough assignments for that.

The first and only in-person class was yesterday. 97 miles roundtrip.

It was a very long day.

This semester I am taking three courses.

1. Advanced Health Policies and Ethics
2. Quantitative Research in Nursing
3. Health Disparities/Outcomes

The first two are synchronous. This means that class is held virtually, every week, and we the students are expected to attend and engage with the professor and the other students.

With this cohort, I don’t think that will be a problem.

The last class is asynchronous only. This means that we will be learning at our own speed, doing the readings and papers, watching the video lectures. In short, how I got through my BSN and MSN. This is very familiar to me. My hope is that knowing my classmates so well in the Health Disparities/Outcomes class will lead to robust debate and discussion in the Discussion assignments. There is nothing worse than writing a Discussion post and no one responds. I have hope with this group.

It is the usual fare for all three: presentations, discussion boards, and the like.

I am also doing the research assisting thing. I have a new PhD nurse that I will be assisting. I hope this year is more engaging than last year. I’ve already started this. I will be driving up every Monday to do the assisting thing.

Outside of university, I am forever doing CEU hours to maintain my CNOR. There was an opportunity that arose last week to do a multi-week CEU on Writing for Publication. This is specifically about nursing and the operating room and what I can see myself doing at the end of my PhD. I will be doing this as well. My justification is that I no longer have to drive the 97 mile round-trip to the university every other Friday. This is on the lowest priority rung. I will not be getting graded; I just hope to learn more about writing for publication.

The beginning of the semester is always full of hope. Let’s hope it continues!

No heat Thursday continues with healthy butterfingers.

In the spirit of the no heat month theme, I knew that I wanted a healthy cookie in there as well.

Well, I say cookie.

I saw this recipe for healthy butterfingers with 4 ingredients.

Today’s calendar was jam-packed with meetings. I knew this. I also knew that simple would be best.

You see, the sole in-person class of the semester is tomorrow. This will make my second 97-mile round-trip of the week. There is tons of reading for my three classes and I knew I wouldn’t have much brain space for a complicated make.

Enter the healthy butterfinger.

Mix together 3 c pulverized corn flakes, 1/3 c maple syrup. 1 c peanut butter.

Portion out onto a cookie sheet with parchment paper. In the recipe, they get all fancy with shapes. I definitely do not have the brain space for that, I used the smallest cookie scoop.

I scooped one and a half cookie sheets worth of small balls. Into the freezer to harden.

While this was happening, I was listening and engaging with not one but two meetings, one right after the other.

Oops, gotta leave to get the flowers for the awards ceremony.

Got the flowers, got to the awards ceremony, emceed the awards ceremony, gave out the four healthcare and nursing awards.

I told you my day was jam-packed.

But, Kate, what about the 4th ingredient in the butterfingers?

While driving home to bathe the now-frozen butterfingers in chocolate, I listened to yet another meeting. This one was about the hospital and was exciting. When I got home, I hurried inside to continue listening to the meeting, while jotting down what I remembered during my 10-minute drive home and taking notes on the rest of the meeting.

It isn’t even noon!

After the meeting, I dug out my double boiler and started melting chocolate chips for the aforementioned enrobing of the butterfingers. It was going swimmingly until I ran out of chocolate and added additional chocolate chips.

The chocolate promptly seized on me. I dumped that chocolate and started over.

Now I am out of chocolate chips (how did that happen?) and 90% of the butterfingers are covered.

I just put the naked ones into the container with the others. I am sure that someone will want them without chocolate. If not, I will retrieve them from the hospital because I will eat them out of the freezer as a treat.

This make is very fragile and does not like being at room temperature. I quickly made an “In Fridge” sign for the drawer.

That was my day.

Lessons learned- use candiquik to coat the butterfingers. Standing over a double boiler is HOT.

The healthy butterfingers are good, though.

Yes, I know there should be an article like the word the, but then it wouldn’t match the cadence with The Night the Lights Went Out in Georgia by Reba McIntyre.

As discussed in the Monday Musing on 8/14/23 hot enough for you, it is high summer here in North Carolina. Hot days and afternoons often spawn late-afternoon thunderstorms. You’d think this would cool off the temperature and bring down the humidity but you’d be wrong.

The hospital is an electrical power hog.

Think about it- all those rooms, all those corridors, all those automatic doors, all those lights, all the air conditioning, and don’t forget about all the equipment in the specialty areas like the laboratory and the operating rooms. All of it takes electricity.

What happens when the thunderstorm is so intense that it knocks out the power to the hospital? It doesn’t even have to be a close storm. The incident that knocks out the power to the hospital can be a car hitting a transformer. Or a squirrel getting frisky with the power lines as has happened in, well, everywhere. If you Google squirrel and power lines there are many stories from around the country and around the world.

My point is it doesn’t take much.

Luckily hospitals have generator backup. This is the very large generator that backs up specific electrical systems in the event of an outage. These are things such as the life-sustaining ventilators, minimal temperature controls, half-lights in the corridors and rooms, and are usually indicated by a red outlet. No generator is big enough to power everything the hospital usually uses the power for. If it was it would be ginormous and require vast amounts of gasoline to power it.

The operating goes on stand-by during generator use. This does a couple of things. It decreases the drain on the generator, and it maintains the patient safety while in surgery because they are not being operated on under generator power.

Because what would happen to the patient if the generator failed during surgery because the surgery was allowed to continue despite the loss of power and working solely under generator?

The room would turn completely black with no lights. The ventilator and anesthesia machine would not work, which means the patient would stop being ventilated and the anesthesia gases would no longer flow. The pyxis machine would not work, which means the CRNA could not get medication out of it to give to the patient. The OR spotlights would not work, which means the surgeon could not see what they were doing. The video tower would not work, which means the surgeon can no longer see what is going on during a laparoscopic case. The electrocautery machine would not work, which means any bleeding the patient has must be controlled with the old clamp-clamp, tie-tie, cut method of controlling bleeding. The robot must have consistent CO2 insufflation so that the patient is not endangered by the working elements or the trocars, which means sudden loss of generator power can lead to important abdomen things being punctured because insufflation cannot be consistent.

In a word, the OR would be fucked.

I do not use that word lightly.

There could be tears.

In my 22 years, the complete and utter loss of power has happened to me twice while in a surgical case. Both times the generator kicked in after what felt like forever, but was, in reality, less than 30 seconds. You can imagine the chaos.

No, Virginia, the operations that were not yet underway when the power failed and the generator kicked in CANNOT be allowed to go forward.

But, but, the patient took time off work, arranged a ride, and has been NPO for all that time? What am I going to tell them?

The hospital is very sorry but surgery has to be cancelled to KEEP you safe. Yes, the generator is supplying power to some systems.

FOR NOW!!! But what if it failed?

It is the operating room nurse’s job to imagine the possibilities. And one of those possibilities is the generator failing, perchance by running out of gasoline. If that happened at the wrong time, the patient would be in dire straights. Or dead because of what transpired in the paragraph that describes/supposes what would happen if the generator failed whilst doing a case under generator power.

Yes, it sucks, but would you like to toss the dice and continue for a chance to die?

No, I didn’t think so.

It’s hot. Damned hot!

There is a scene in Airplane when McCroskey back at the airport asks how hot the plane is running. And Ted Striker replies, and Elaine the stewardess relays, “It’s hot, damned hot.”

Or at least that is how I remember it. I remember the instrument panel and Striker relaying to Elaine, who then relays to the tower about the plane’s overall situation. I remember Striker saying that the plane was running hot, and the controls were a little sluggish.

There is a scene from Good Morning, Vietnam when Adrian Cronaur riffs that “It is hot! Damn hot!” when talking about the weather in Vietnam. There is more to the quote, but that is just Robin Williams (RIP) riffing on the heat

I always think of that quote at the tail end of summer here in North Carolina. Middle to tail end of summer.

It is hot!

Damn hot!

And humid!

I don’t dare make anything with frosting because it breaks for Cookie Thursday is a Thing. Frosting does that, you know.

It is hot! Currently, the ambient humidity in the state ranges from 63% in Asheville to 58% in Greensboro and 63% in Huntersville.

And 88 degrees Fahrenheit but only because the sun is going down.

I don’t think I should mow today.

Even in the shade and the cooling temperatures. I am going to practice common sense and not mow.

The western US is going through, and what the world is really going through, a heat crisis. There was an unconfirmed temperature in China of 126 degrees Fahrenheit in July. The Badwater Basin in Death’s Valley peaked at 128.6 degrees, cooling to 120 degrees overnight.

This is not sustainable and we may have already tipped over the precipice.

It’s only going to get worse. The saddest comment I’ve heard over and over again is that this may be the coolest summer of the rest of our lives.

I am very glad that opted for a lighter roof.

I am also very glad that we have done so much to make our home energy efficient. New windows. Completely new siding plus poly wrap where it did not exist. New vent covers that can be closed in the winter to keep the house warmer, or open in the summer to keep the house cooler in the summer. New doors as applicable, back door, including the insulated garage door. Caulking and new weather stripping where applicable. Energy-efficient curtains throughout. Attic fan to blow out hot air when the attic starts to heat up I am selective when I run the big appliances such as the dishwasher, the washer, and the dryer.

My next thing is to hang an energy-efficient curtain in our bathroom which gets blinding sun in the afternoon and heats up our bathroom about 15 degrees.

The kicker is that the house is only cooled to 76 degrees. That’s it, it goes no lower than that. There is an overhead fan on each level of the house. And a couple of stand-along fans too. Especially blowing straight onto the bed.

There is much that living in California taught me about surviving the heat. Too bad there weren’t any lessons about surviving the humidity.

If we are to survive this, we must change our ways.

Climate change is a problem of our own making and our own hubris. Our wings are melting.

The post-it reads “I’ve been an OR nurse long enough that the issues that we solved years ago are popping up again.”

Sigh.

I’ve been a nurse for 22 years, an OR nurse for 21 of them. Let me tell you, I’ve seen some shit.

I’ve also been on committees that solved the issues.

Do I know why I keep getting invited to committees? No, no I do not.

Probably because I am consistent in my support, and am focused when working on problems.

I am also less likely to go off on personality tangents and to work to settle old feuds.

For me, it is about the work and the best care we can provide.

I don’t care about the personalities, I only care how they can impact the care that we give.

I must be frustrating when I decline to engage in shenanigans that some people find life-changing and worthy of their attention. I am that nurse who just wants to work.

Period.

End of story.

However, I have noticed a decided upswing in the issues that we solved years ago and someone new deciding they were an issue again.

Much sturm and drang commences.

The department is in an uproar.

Things are switched and switched back again.

There is nothing wrong with confirmatory projects.

However, there is something wrong with causing the destruction of thousands and thousands of dollars in supplies because someone decided the old way must be wrong.

AND PROCEEDED TO MARK ON STERILE SUPPLIES WITH A BALLPOINT PEN!

This renders them unsterile and unsafe for patient use. A ballpoint pen can cause microtears in paper, and ink is a liquid that can seep into the previously sterile supply.

There are small stickers at the desk that have been used to track supplies.

Maybe ask next time. And don’t decide because a process is before your time it is useless.

Thank you.

The school year is barrelling down upon us.

I know at the university I go to this is move-in weekend. Classes start for the fall semester on Monday.

Your university may have a different schedule but the motions and the feelings are the same.

This time next week, many of the freshmen will be moved into the dorms.

Many tearful goodbyes will be had.

Many parents will leave their children behind to become adults as the parents drive away.

This can be a sad time for parents and students alike.

But…

The students are on the cusp of something new and exciting and adulthood.

The parents are also on the cusp of something new and exciting. They will be rediscovering who they are when they are not so and so’s mom or dad.

Be careful of the new student as they leave the chrysalis and try out the new adult wings.

But be careful of the parents who perceive that something is different as they drive home alone.

Change is good. It is time to acknowledge that change is hard as well.

My fall wish is that all the students will be able to adapt to their changed reality. An additional fall wish is the flip side of that coin. That all parents will be able to adapt to their changed reality.

It’s going to be okay.

If it is not, you have the tools to survive. So do the students, you’ve made sure of that.