The pork roast is in the crockpot.

The potatoes are prepped and ready to boil.

The brussel sprouts are ready to be smashed.

The ambrosia is mixed.

The corn pudding is ready for the oven.

The sweet potato souffle is ready for topping and baking.

The black and blue mac and cheese, with four types of cheese and pan-fried pancetta, is ready for the oven.

The presents have been opened and exclaimed over!

The cats are thoroughly confused.

And we are promised above-freezing temperatures later in the week, up from a low of 3 degrees. The furnace has been working nonstop for days.

The holidays are a marathon, not a sprint. And, like the pandemic, carry the same friendly reminders.

Be safe.

Wash your hands.

Get vaccinated for others.

And social distance as much as you can.

Odds are if you exchange gifts with people there is a calendar under your tree. Or wrapped. Or just handed to you.

The calendar is a very useful tool. For school, for work, for life. It all goes there.

I know that Google calendar exists, and the calendar on the iPhone, and I imagine a similar program on Android and Google phones.

And I do use my phone calendar to a certain extent.

And the one attached to my work email.

And the one attached to the school account.

But just like in Lord of the Rings and the One Ring, there must be a calendar to rule them all.

During my MSN program, I had two identical calendars that I used. One was for school, and one was for work. I tried the single calendar life and it never worked out, there was too much on every single day and I would find myself missing things. And I would invariably run out of room.

A couple of years ago I bought the Arc paper cutter from Staples. The Arc system is a notebook that you can add and rip out pages. Kind of like a binder. But cooler. And they stopped making the calendar inserts for the Arc system.

I have to improvise. I love that. I counted all the various calendars that I keep: work, school, house projects, blog posts, and exercise. I printed off a year’s worth of calendar pages that would fit into an Arc shell. And started organizing the things that I have to do.

I am gen x and having a physical copy of dates is important. Inputting all the different tasks into the online calendars is obnoxious and takes too long.

And now I have a custom for me calendar that I can flip through the tabs and see due dates and upcoming events.

Of course, I also have a dry-erase board mounted on the dining room wall, to highlight school assignment due dates.

This is a system that works for me. It may be trial and error but find a system that works for you. It will be different, but make it your own.

As is her wont, my mother starts making Christmas cookies on the day after Thanksgiving. It is tradition after all.

And I go over to help on Saturdays and random Wednesdays.

And the output is 16 types of cookies, candies, and barks.

It is a labor of love as apparently our love language is feeding people. Kind of explains Cookie Thursday is a Thing in a nutshell, doesn’t it? Why else would I make weekly cookies, for YEARS!, except as a way to show my appreciation. I also bake them as a morale builder.

On Wednesday I went over and we made up different cookie platters. They are gifts for people: their landlords, neighbors, and three enormous platters for the OR where we both work. And a special one for my friend that has a jar of blueberry jam.

Recipes upon request.

I’m going to having pretzel bark as dessert for my lunch of Chex Mix.

Tis the season.

Today, December 21, 2022, is the winter solstice.

This is important because it marks the longest night of the year.

After tonight, the nights begin to wane. That means they get shorter.

Unlike the summer solstice, which marks the longest day of the year, there is muted celebration. Mostly because it is too cold, and dark to party.

I think that is the wrong attitude to take.

Boo-hoo, it is so dark.

Boo hoo, it is so cold.-

Boo-hoo, there are so many add-ons. Nothing to be scared of there, we in the OR world expect it. It won’t be like this forever.

Just like being afraid of Monday is the wrong attitude to take. It is less about fearing what will happen on Mondays, or the longest night of the year, and more about celebrating that Monday or the longest night of the year won’t happen for 7 or 365 days.

It is rewriting the script the allow that yes, this is the longest night of the year, BUT it won’t happen again for an entire year. Celebrate that.

It is also Saturnalia, but I won’t get into that.

Pour yourself some cocoa, add a little alcohol if that is your thing, or make yourself a hot toddy. Bundle up warm and wear extra thick socks and some slippers. It is all right that it is the longest night of the year. After all, it won’t be the longest night of the year again for an entire year.

Since much of the United States is in a deep freeze this week, remember that you should not touch bare metal with wet fingers, or your tongue. You remember that scene from the Christmas Story. Right?

As part of the pre-op checklist, I have to ask patients what their current pain level is.

Some people need a translation.

You wouldn’t think so, but there it is.

Through careful questioning, I have to ascertain the type of pain, where the pain is, what makes the pain worse, and the quality of the pain. This means is it stabbing, or throbbing (yes, those are 2 different kinds), duration of the pain, and so forth. And then I ask about the number on a scale of 0-10, where 0 is no pain and 10 is the worst pain ever.

Preop for an acute issue, I can anticipate an answer along the entire gamut. Some people really have limited pain, some have a score of 10 while scrolling on their phone or laughing with their family member, and others have a score of 10 while clutching the body part and practically screaming. I record what is reported.

And then I ask about the anticipated pain AFTER surgery. And what they would like their pain level to be then. I get a lot more blank faces with this question.

I preface this conversation by informing them that they will hurt, in some capacity, after surgery. Zero pain is not obtainable, especially when sharp objects like knife blades or suture needles are used.

What I want to know is what is a goal pain level that will allow them to be comfortable, while recovering. A goal number that the pain medicine will try to get them to.

Remember zero is not obtainable.

And five times out of 7, after getting the there will be pain, what is a good pain goal to shoot for explanation, some will smile at me and still say zero.

ugh

And some of the 5 that answer zero will bluster and try to excuse their pain goal.

Look.

No one wants to be in pain.

I get that.

I definitely don’t want patients to be in pain.

But zero pain is not a good goal immediately post-operatively. A week, maybe. Tonight, after surgery? Nope, not gonna happen.

Shall we begin again and you can pick a number that is attainable?

Three.

I knew you could do it.

Post-it reads “what to do when a surgeon and an anesthesiologist have a pissing match over what room to put the case in?”

Background- a critically ill patient and a disagreement over which OR room to put the case in.

My reaction to this wannabe alpha male posturing that I did not say at the time but is very appropriate, would be to say”Whip them out boys. Let’s compare lengths. Yes, even the women.”

After they stared at me in disbelief, I would gently suggest the bigger room. Because if the case they are wrangling about is as bad as they think it is, we are gonna need the space.

No, this didn’t really happen.

But only because I was not the one who took the case information.

Would I have absolutely said this to a feuding surgeon and anesthesiologist? Yes. I have, and I would again. Because when they are lost in their arguing and their chest-thumping, a patient is getting sicker and sicker. The size of the room doesn’t matter; it is the readily available equipment needs of the case.

I think the anesthesiologist had it right. The room the surgeon wanted to use barely had enough room for the scrub and the nurse, and the anesthesia team, never mind the specialized equipment and supplies the anesthesiologist might need. And it was farther from the crash cart and the ICU that the patient invariably would end up in. This means that it was farther from help.

And, as we all know, distance equals time. This is time that can be useful to save the patient’s life. I absolutely backed up the room decision that they came to, with minimal prodding.

But this wasn’t my case or my monkeys. I was called in as a second set of hands. To help and get blood and send blood tubes for needed tests. And make phone calls to the ICU and the supervisor to smooth out the transition to ICU.

Depending on the type of school a student goes through it is the end of the fall semester. Time for a break!

Final papers and final tests have been turned in or taken. And grades have been posted.

Graduation may be this weekend for others whose journey is done.

After an entire semester, or quarter, full of work, it is good to put down the pens and pencils and let the mind wander a bit.

After all, the next semester or quarter will start after the first of the year.

But for now, it is important to pause and reflect.

Think about habits that did not suit the fall semester and how to fix them.

Think about what went well for the semester, and what is important to change.

Don’t dwell on it too much. That way lies madness. Or tears.

Just think about the semester that has just finished. And think about how to improve the next semester.

And when all the thoughts have been thought, put it away.

And take a break.

Time enough to pick up the pens and pencils for the spring semester.

After all, it will be here before too long.

Right now, relax, and enjoy the holidays that you celebrate. It doesn’t matter what grade was the result of the semester, just that it was a passing grade.

And breathe.

The make of the week is Toffee Grahams. This is similar to Christmas crack in that it is toffee poured over crackers. Only substitute the saltines for graham crackers. And top with pecans prior to pouring the toffee. And the chocolate chips are not necessary.

I hope they like them.

Months and months ago I put in an application for a podium presentation at AORN 2023. The middle or end of August, I believe. And I got monthly emails that the selection committee was still evaluating the proposals.

I am writing a presentation based on Cookie Thursday is a Thing and how such a program can have a positive effect on morale. And I wanted to present at AORN, in a half-hour presentation. Or write a book.

The tag line of the presentation/book/article will be, raising the morale of the department, one cookie at a time.

But no. My presentation abstract got denied.

I am not sure if it is too out there for the reviewers. Or deemed not OR specific enough.

That is okay; there are other conferences in the sea. Time to rework the proposal for OR Management Conference, or the North Carolina Nurses Association. Both of these conferences will be in the fall.

I also want to write a book about the history of Cookie Thursday is a Thing and how it came to be, and why the little engine that could is important. And how small things, such as a homemade cookie, can brighten the dourest of ORs.

But that is for another day.

I will crack the presentation abstract at some point. I just need to right spin on things.

Are you happy?

Are the nurses in your unit happy?

What would make you happier?

I know!

Engaging in professional development is a good way to start.

Yeah, bitching and moaning is a good way to pass the time.

But it doesn’t DO anything to address the problems. If you complain to the car that is stuck in the mud, the car does not suddenly move. The stuck car does not realize its mistake and fixes itself and gets back onto the road.

In this way complaining about hospital management does nothing to fix the problems. But we love to complain, don’t we?

Stop your complaining and find a way to engage with the hospital as a whole, and the other nursing professionals in the hospital.

Why, yes, this is an ad for shared governance.

I’ve been involved in shared governance since 2015. And there have been a LOT of changes in healthcare since then. States are slowly coming around to the idea that expanding Medicaid is actually a good idea to help citizens in their states, instead of the black mark against themselves by some conservatives. We’ve been staffing and providing care through a pandemic, the likes of which have not been seen in 100 years. I’ve been involved at every level of shared governance, from the unit level to the corporate level. And involved in all the meetings to restructure it in light of all of the current challenges.

How else is the bedside nurse going to speak the truth to the powers that run the hospital?

A quick google search for what makes a nurse happy will result in at least a page of nurses who are happiest when engaging with their professional development and nursing practice.

Which is, drum roll please, shared governance.

This morning I sat with a small group from the hospital shared governance at a restaurant, including the chief nursing officer of the hospital, and we ate breakfast and talked about what shared governance could do for the hospital. And how to engage other nurses.

A question I did not ask is am I happy?

And the answer is yes, I am happy. I also know I am happiest when I am working. Call, shared governance duties, it is the same. I view it as taking care of people, which is my duty as a nurse. These could be patients, they could be fellow nurses at the hospital, this is my way of taking care of them.

Find your happiness factor.

You might be surprised at what it is.

It isn’t money. It is never money.

Okay. It’s been a minute since I did one of these.

Not that Covid is gone. Oh, no, not in the slightest.

Not that Covid is not still killing people, including Americans. Oh, no, not in the slightest.

Not that there are other viruses that are killing and sickening everyone. Oh, no, not in the slightest.

This should be old hat to us. Get vaccinated, the life you save may be your own. Get boosted, the life you save will probably not be your own but someone who is unable or unwilling to get vaccinated. Like, at all, not even one shot.

I was walking a family member back from the surgical waiting room, explaining that most people want to go home, especially after laparoscopic surgery, because of the hospital’s high patient count. Especially high with the three viruses that are trying to kill us. Yes, THREE. Covid, influenza, and RSV. And honestly after a non-complicated surgery, in an otherwise healthy patient, it might be safer outside the hospital than in.

The family member stopped me and said something that I had no response to, “Oh, we don’t believe in Covid. Or vaccines. I’ll kiss someone who is infected on the mouth and prove it.”

Um.

Ew.

I continued my spiel, “Well, anyway, there is not a lot of rest to be had in the hospital. The patient will sleep better at home in their own bed.”

It took everything in me not to shake the person and tell them and that is why we are still in this mess. But I didn’t. And that is all I have to write about that.

Three things of note.

Zero Covid has ceased in China. This was a policy that stated that the goal for China was zero incidence of covid transmission. Many things happened when that did not come to pass. There were riots, multi-city, many thousands of people, against the policy. And they scrapped it and allowed life to go on as before the pandemic. But it isn’t before the pandemic. Life needs to be different now.

Why is that so hard to understand?

In New Zealand, parents would not consent for life-saving surgery for their four-month old infant. Unless the hospital could ensure that no blood from a covid vaccinated donor was used for the surgery. The baby would have needed blood due to the nature of the surgery. The blood pipeline is not set up like that and there would be no way of ascertaining with donated blood was from a person who had been vaccinated. The father said that he was aware of the potential impact of not allowing the surgery to happen. Was he though? Or would he have been the first to yell lawsuit when the baby died. Because the baby would have died without the surgery. New Zealand took emergency custody and ensured the surgery could take place.

I cannot even imagine what misinformation poisoned their minds. No, wait, yes I could.

And sometimes I get random ‘on this date, you posted this’ memories. And yesterday, 12/11/2021, I wrote about it being the day that America marked 800,000 dead. And, just now when I looked, the death toll in America is one million, eighty-four thousand, five hundred twenty-six.

Yeah.

That is an additional 284,521.

American dead.

Of Covid.

In three hundred and sixty-six days.

Of something we have the tools, like vaccination, to fight.

But no, people want to live their lives as they used to back in 2019.

People.

Yes, I am using it as a swear word.