I have heard this many times.

So many times.

And there are different answers to the question. Depending on which month it is.

Is there a holiday this week or next? Just like in yesterday’s Tuesday Thought.

Is this week near a major school holiday such as Spring Break, or Summer vacation, or Christmas break?

Most of the surgeons have children still in school. And they want to spend as much time as possible with them.

Is there a major conference going on?

Such as Academy for orthopedic surgeons.

Is there a major golf tournament nearby? Or on the television.

This depends on if the surgeons play golf. Hint, most of them do.

Is there a major sporting event going on?

The Super Bowl, the World Series, the final race in the Nascar Cup Series, March Madness.

Are there any local Nascar races?

Same reason as the sports ones.

The biggest is the week of the month the weird week falls on.

Specifically the 5th week of the month.

Most ORs allocate case time using a block schedule.

Not all months have a 5th week and the block schedule cannot accommodate it.

This week happens to be the 5th week of May.

Therefore the OR schedule is rather light.

Don’t worry; it will rebound on Thursday. Which is the first Thursday of June. Or Friday, which is the first Friday of June.

The surgeons haven’t run out of patients yet.

Of course, politics may be exerting some influence. Such as the debt ceiling crisis that is currently embroiling Washington DC. Patients and surgeons may be feeling the pressure a bit.

The schedule may be light. But it will rebound soon enough.

And the staff will be wishing for the light days.

Yeah, I know yesterday was Monday.

Yesterday was also a holiday and I have something to tell you about holidays in the operating room.

For years and years and years, it was myself and a tech on the evening shift. The tech changed depending on what day it was but we had a pretty good rhythm going.

Case came in, we did it.

Case didn’t come in, we stocked and set up rooms for the next day.

Years and years and years, remember?

Holiday weeks just threw us off our game.

It didn’t matter what holiday, it impacted the schedule.

Mostly an increase in evening cases.

And also the people who sober up AFTER the holiday and realize they need medical intervention.

Surgeons were hot to get out of time trying to squeeze in just one more case. Because they didn’t want to dump on their partners and they had a plane to catch, naturally.

And if we were going on a personal holiday, you know, vacation? Bets were off and the evening shift was reliably chaotic.

Some of the worst cases I’ve ever done were on holiday weeks.

There was the time the bed malfunctioned on Labor Day night and went into such a steep Trendelenburg I worried that the CRNA was soon to have a lapful of patient. It took two of us, the tech and me to hold the patient up so that this wouldn’t happen. And I scrabbled for the phone and called the anesthesiologist who came in to help us get the patient on the table.

That was a close one.

Or the time we had to practically do a hemipelvectomy for necrotizing fasciitis. In late December. I’ll let you guess which holiday this was adjacent to.

Odd things happen during holiday weeks.

All we can do is work the schedule and try to finish before day shift arrives.

The gown card reads “addressing the wrong problems.”

This is actually a, well problem in healthcare.

There is something wrong. For example, there are red scrubs when there should only be blue scrubs.

Instead of thinking about where the red scrubs came from, addressing the wrong problem would be changing all the scrubs worn by staff to the red scrubs. Regardless of where they came from, who is washing them, and how do we get them back. And, most importantly, how much do they cost.

A lot of healthcare decisions seem to be made on the fly, to address the problem right in front of leadership.

Little thought is given to how this may impact the worker in a month’s time.

The problem is the red scrubs that are somehow in place of the normal blue scrubs.

The answer is not change to the red scrubs! The proper solution requires some investigation.

Instead of a blanket, knee-jerk reaction, it is better to be calm and thoughtful about making changes that will impact the entire organization.

If you are continually putting out fires, you never investigate where they come from or why they start.

And you never realize there is a dragon with a cold at the top of the hospital.

This is what I mean by investigating the source, and not just treating the problem right in front of you.

You see this in internal medicine as well.

There is a famous joke that starts, “Doc, doc, it hurts when I do this.”

The this might be any number of things.

Instead of investigating, the doctor says, “Well, don’t do that!”

If the doctor had just looked at the problem, they would realize that there is a bigger problem underneath the little problem. Such as the broken finger that hurts in a 21-year-old with no mechanism of injury.

In healthcare, we call that masking.

The little problem, which is the complaint, is hiding the bigger problem, which is the bone disease that led to the broken finger.

But guess which one gets addressed?

Depending on the course, there may be a teaching assistant attached to it.

Hi. That’s me.

I am functioning as summer short term TA for 6 weeks for a group of RN-BSN students.

I am working with another TA and we had to create sign-ups to show our availability to students to help them.

My summer gig, if you would.

Since this is a bridge program there are only three semesters. And this summer short term is the third semester.

As far as I can ascertain, we function to answer questions, to help with writing and editing of papers.

And as the cheerleader for these students.

Heck, yeah, I’ll be a cheerleader.

After all, it was only 7 years ago when I was in their shoes.

And I would tell them NOT to take economics and statistics in the same semester.

I have had lovely conversations with the students who have reached out.

I helped one with starting with PowerPoint. And another with setting up and understanding their discussion question.

I also offered a lot of support.

Because they CAN do it.

I also remind them how far they have come.

And the end of the program is in sight.

They just have to press forward a little more.

And I’ll be here if they need it. Or the other TA will. As we are very careful not to overlap the availability schedules.

Absolutely reach out to whomever you can for support. Because we all need it.

Last Cookie Thursday is a Thing of May 2023.

Of course the last movie make will be the gray stuff from Beauty and the Beast.

It is from the song Be Our Guest. When the cutlery and plates and furniture are dancing around Belle telling her to relax and be their guest.

It is very similar to the operating room experience.

We invite people in.

We dance around giving them everything that we can to make them comfortable.

We dance around giving them a good OR experience.

We dance around making sure the room is ready and prepared.

Give them nourishment in the form of an IV. Nothing by mouth, please.

Give them warm blankets.

Fix their physical problems.

Make sure they are comfortable before they go up to their room/are discharged.

We get treated like furniture.

I’m telling you it all fits.

The make this week is the gray stuff.

Watching the movie, I really thought it would be savory. Like goose liver pate.

But no.

The recipe I found is a Disney copy-cat recipe.

Gray Stuff

3.4 oz package of vanilla instant pudding

1/2 c milk

15 oreos

6 oz container of cool whip

Make the pudding with the package and the milk. Set aside to set. Add in crushed oreos and fold in the cool whip.

Voila!

Gray stuff.

This is going to be a hot take.

The circulator’s role during induction of anesthesia is to be standing at the side of the OR table, ready to assist anesthesia.

End of story.

Yes, cases can be routine. Patient in the room, patient on the table, patient intubated, surgery, patient extubated, patient put on gurney, patient taken to recovery.

Being blind to anything but routine is where mistakes happen.

Where the circulator should not be:

1. charting at the computer.
2. discussing weekend plans with the surgeon and scrub tech.
3. looking at hotels for their next getaway.

The circulator should be at the side of the patient, offering comfort to the patient.

Who is probably scared out of their wits. Many are.

This should be an expected role of the circulator.

To offer a hand to the patient as they go under anesthesia.

And to offer a hand to the anesthesia team as they intubate.

Because sometimes there is difficulty in securing the airway.

The endotracheal tube goes into the esophagus.

The patient has a very short jaw and the anesthetist is unable to see anything. And they do not intubate blind. Well, they shouldn’t.

And if the circulator is across the room, attention on anywhere but the field, this can lead to disaster. By the time the inattentive circulator realizes that there is a problem the O2 sat has dropped and this can have outside-of-surgery complications.

During the very beginning of the pandemic, circulators were forbidden from being directly at the side of the bed. Because covid was known to be respiratory and the team wasn’t supposed to be more exposed than necessary.

Some circulators adopted this habit of not being at the OR table during induction. Worse, some are teaching this bad behavior to new people.

Don’t do it.

Stay at the bedside during induction.

Your patient’s life may depend on it.

Okay. There has been fervent pushback on the 6-week abortion bans. The “heartbeat” bills. The heart doesn’t exist yet, it is just electrical activity but go on with your delusions. This led to political challenges for the republicans, and rightly so. They only won a little when they expected to win big in 2022. The protests are ongoing from women who believe that they should have bodily autonomy and the men who support them. Doctors are leaving states where they are sorely needed. It’s like they should have listened to the 63% of Americans who believe that abortion should be legal and not the 37% who believe that it is wrong.

Uh, oh… time to recalculate.

This is obviously a losing message. And there is a very important presidential race in 2 years. Can’t fuck that one up.

They are frantic for a new message. The state of North Carolina gave them one. If 6 weeks is too stringent, they believe that doubling the amount of time will buy them back their seats. The legislature in NC, as discussed last week, passed a very rigorous, no woman can do all the things that this bill says, law that was promptly rejected by the governor, and a vote was taken in the middle of the night to overturn the veto. Remember that? I talked about it last week.

Now 12 weeks bans are the bills that are passing.

What are women so upset for?

Still?

We gave you what you wanted.

No. You gave us what you think we want.

Different story.

Women want to have control back.

Control over their bodies.

Control over their healthcare.

Control over the ability to end a very much hoped-for pregnancy that will only end in tears and torture for the child who cannot survive. This past weekend there was an article in the Washington Post about Baby M, who would not be able to live outside the womb. His parents had the poor fortune to live in Florida and the pregnancy was forced to continue. The story concluded as you anticipate. He suffocated trying to survive in a world that he could not. He tried and lived 99 minutes after birth.

There was no miracle. (a part of the article that made me see red!)

There are many babies like this.

This is what I have been railing on for MONTHS, nearly a year.

Babies will be tortured. Mothers will be guilt-ridden for all their days because their bodies failed this baby.

Women will die trying to hit the high bar monstrosity that has been foisted upon us.

By men.

12 weeks is an arbitrary number.

12 weeks is the end of the first trimester. Not arbitrary.

18-10 weeks is the anatomy scan where catastrophic problems are detected.

As a woman, I continue this continued bullshit as a warning.

What will they come after next?

We know that mifepristone and misoprostol are endangered.

As is free travel across some state lines.

The big question is why?

Control.

The I don’t like it, therefore no one should do it crowd.

Hell, yes, I’m still pissed.

The post-it reads “Dressing a pillow.”

That’s it.

That’s the sum of the note.

But I know what it is referring to.

Basic nursing care that I was taught in nursing school included how to change a bed, occupied or unoccupied.

That is with or without a patient. I didn’t see fitted sheets on a hospital bed until I moved to the American South.

How do you dress a pillow?

This was covered in the first semester at my first nursing school.

This was 1993.

I even learned how to sharpen needles and re-sterilize them.

Old School, you know.

Old Nursing School. Established in 1928 in Omaha, Nebraska.

At 18, giving bed baths to my classmates was embarrassing. At least we got to keep our underwear on. Everything else? Off. And we used warm soapy water. And finished the bed bath with a back rub.

We learned how to do hospital corners on the bedsheets, top and bottom. Did I mention there were no fitted sheets?

But the pillow dressing. That threw some of my classmates for a loop.

You see, I had already known about the hospital corners and the proper dressing of a pillow. Daughter of a nurse.

Most people grab a pillow and put it against their chest as they put on the pillowcase. Or slip as we called it.

Naughty.

That means all the germs on the front of your scrubs get transferred to the pillow. Where the patient was expected to lay their head.

The proper way to dress a pillow is to grasp the bottom of the pillowcase in the center. And keeping it in your grasp, turn the pillowcase over your arm so that the outside of the pillowcase is along your forearm. This means that the clean side of the pillowcase is against the clean pillow. Next, you grab the middle seam of the bottom of the pillow and ease the pillowcase over the pillow.

Now the pillow is dressed. The germs on your scrubs have not come in contact with where they will be putting their head.

Apparently, no one teaches it this way anymore. Even if it makes sense. That is okay; I’ll keep doing it.

No germs on the outside of my pillows.

At work.

Or at home.

Nothing like it being nearly June to have thoughts of the finish line dance in your head.

Not unlike sugarplums dancing in your head as you drift off to sleep on Christmas Eve night in Clement Clark Moore’s “Twas the Night Before Christmas” poem.

The finish line I am referring to here is graduation.

The grand culmination of all of the sweat, and tears, and late nights, and papers, and tests. It is all leading to the moment of graduation.

Of the 4 graduations I’ve had, high school, ADN, BSN, and MSN, I have only attended 2. These were high school, and the ADN. The BSN graduation was in Illinois in December, and the MSN graduation was in Charlotte, in May 2020. Right smack in the beginning of the pandemic. Graduation was delayed two times until 2021 and I elected not to go because I was not doing large gatherings. Even masked.

As evidenced graduation does not have to be the end. There is always more to learn. More ways to grow.

Or not.

It is up to you and your wallet.

And where you want to go in your career.

But graduation is an ending and a beginning.

The formal education of the college degree has ended. Depending on what degree you receive there may be ongoing education credits required. I know there is for nursing. In my state, 15 continuing education units (CEUs) are required every 2 years for licensure if you are a registered nurse.

Or you could decide that a more advanced degree is desirable. It may be necessary for your career goals. You may be bored. You may, like me, be focused on what happens if I get hurt and am no longer able to be a functioning operating room nurse and want a backup plan. Or you may decide that retirement is may not be the only path you want to take and you need an alternative for retirement. You know, to keep your hand in.

Or your formal education may culminate in graduation. It is all okay.

Take a deep breath and happy job hunting.

Movie Magic continues.

In another nod to my childhood and adolescence, the movie chosen this week is ‘Earth Girls Are Easy’.

This is a 1988 movie starring Geena Davis, Jeff Goldblum, Jim Carrey, Damon Wayans, and Downtown Julie Brown.

A spaceship crashlands into a Southern California pool of a nail artist (Davis). The aliens in the spaceship are covered in colored fur. A hair stylist (Brown) helps the nail artist hide them.

With a lot of Nair.

The quote from the movie is “I gave them pop tarts and a makeover!”.

Instead of making pop tarts with crust, I wondered if cut-up, already prepared pop tarts can go into a cookie.

And of course, it can.

This may be one of my new favorite doughs. It is purported to be a sugar cookie dough but I bet I can change the mix-ins and change the cookie.

The only thing is that the original recipe has cream of tartar listed as an ingredient. And baking soda.

Cream of tartar is useful in stabilizing meringue, and prevents crystallization of sugar in candies, and is part of baking powder. This was useless as far as I was concerned. There was no rise, and there was no spread. Both of these ingredients are less than three months old. Next time I will use the full tsp of baking soda and not cut it with the cream of tartar.

Maybe cornstarch as an addition.

After the cookies finished baking, again with no spread and no rise, I flattened them slightly with the bottom of a glass. We’ll see how that goes over.

Remember, experimentation is the name of the Cookie Thursday is a Thing game.