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.

The post-it reads ‘when construction on the street in front of the hospital cuts the gas line, this gives new meaning to the term rock this house!’

Absolutely this is a true story.

No, no explosions.

I think I have shared that I call the hospital as a whole the house. Each unit is a different room to my head. This makes the hospital the house. No, as always, I don’t know where I picked that up.

Did we panic that there was a cut gas line near the hospital?

No.

BECAUSE WE DIDN’T KNOW ABOUT IT.

This happened when I was still the evening shift charge nurse and the evening was spooling out like it always did. Add on appy, rooms set up. The usual.

Until the nursing supervisor showed up on her rounds. And happened to mention that there was an emergency in front of the hospital as the construction crews had cut the gas lines. And, upon immediately recognizing the problem, capped the gas line.

No overhead page. No ring on the red emergency phone in the department. Nothing.

The house was not in danger anymore.

Well, it would have been nice to know that the hospital had been in danger, as brief as it was. We could have prepared to shelter in place. Secured the windows, moved people and patients away from the windows. Something.

But no.

And then I looked at the supervisor and asked if the boilers in the central sterile processing department were affected. Because that is the big user of gas in the department. And if the boilers were affected and they could no longer process and sterilize instrumentation, the department was going to have a bad day tomorrow.

They looked aghast. As if that had never occurred to them to check in with departments and

1) inform them of the potential for a cut gas line, IN FRONT OF THE HOSPITAL

2) ask if the departments had any specialized need for natural gas. Like the boiler and SPD.

3) and, once informed of the need for natural gas for the boilers and the sterilizing of instruments, check on the boilers to see if they were impacted. Because if they were the OR schedule for the next day would be impacted.

They hurried off.

I went to SPD to see if they had boiler pressure and the sterilizers were functioning within normal limits. They were.

This could have been bad. It wasn’t.

But what if…

This is the December wrap-up report of my personal school journey.

I’ve been a PhD student for four whole months now. I’ve learned so much.

I had to learn an entirely new program for calculating statistics. Hell, I had to learn an entire new school.

This is the biggest school that I’ve been to, including Creighton.

But the short of it is I passed all three of my courses.

Phew.

Statistics bedeviled me of course.

I am decidedly not math brained. And so it makes me all thumbs when I am writing up my homework. When I was solving and writing up the final test for the class, I completed 4 of the 6 questions. I decided to save my progress, go to bed, and hit the last two problems in the morning. That way I could submit the final before 1200, well before the cutoff time of 2000. I saved my progress and went to be at roughly 0100. I got up, intending to finish the last two questions and submit the test before noon.

And the file was GONE!

Poof.

As if it never existed.

The output worksheet remained as that had been saved separately.

But the homework write-up itself?

Gone.

And IT doesn’t work on the weekends.

But the worksheet was still saved.

No time to go down the rabbit hole of what happened. I opened another copy of the assignment, saved it again, and rewrote the damn thing, using the output that was saved separately.

Not the best Sunday of my life.

But, you know what?

I passed.

I survived to take the second half of the statistics course in the spring.

I developed some coping strategies over the course of this semester.

Make a clear calendar of what is due and when.

Make time for writing group.

Make time early in the week for required reading, ideally not the day before I am going to be expected to interact with class.

Most importantly, keep reminding myself that this is not a sprint. This is a marathon. And each class builds onto the next to utilize my time the best.

Second most important is to take time to relax and let my brain contemplate the classes. This helps immensely when writing papers.

But first semester is finished.

And next semester I have the second half of statistics, nursing informatics, and nursing theory. One math class and 2 paper classes.

But for now, I am going to take my own advice and relax.

After all, the start of Spring semester is five weeks away.

Plenty of time to think about my dissertation topic.

Continuing this month’s theme of Holiday the make of the week is Chex Mix.

I’ve made it before. Twice, I think, last December, plus once in late winter.

This is one of the most requested recipes from the department.

The familiarity of Chex Mix is like wrapping yourself in a warm cardigan, sipping on some tea. It is a big part of my Christmas baking, and a big mover in celebrations, or sitting at home in the afternoon and evenings, in the light of the Christmas tree, reading a book.

It is also non-denominational. And non-partisan.

I find it comforting and therefore I make it every year, only around the holidays. When the evening darkness comes early and the outside temperature is dropping.

And there might be the precipitation of your choice outside.

I prefer rain.

Because people around here can’t deal with the white stuff.

We’ve already had a run on hips from people falling on slick leaves.

No need to add ice and such into the mix.

There has been a marked increase in book bans across America recently. One group doesn’t like a book, feels their child should not exposed to it.

Simple solution- Don’t buy your kid that book.

Oh, but what if they get access to it at a library or a school?

What if they get access to it at a friend’s house or a book store?

Do you think that dealers in forbidden knowledge are just standing on a street corner, their trench coat full of things that YOU don’t think your kids should have access to?

Fine.

Don’t buy them the book.

I’m not sure if they told you that you cannot control everything. Information is like water, it finds its way out.

And although YOU don’t want YOUR kids to read a certain book, maybe others do not care if their kid has access to a certain book. Whatever sins you think the book has done.

But what if my kid learns to do X, when I don’t believe in it.

Okay.

You do realize that the kid is not a perfect carbon copy of you. And has thoughts and feelings about what they would like to read.

No?

Okay then.

Knowledge is, of itself, dangerous. And free knowledge even more so.

Have you heard that libraries are free? Anyone can go in and pick up a book, take it home. No questions asked. The only limits is how many books you can check out.

Of course they want you to return the book.

That means the next person can read it.

And so on.

Of course there are books being banned. And pearl clutching.

Think of little Timmy.

Those of us not in the book banning business are thinking of little Timmy. And of broadening his worldview so that when he encounters something unfamiliar to him his first instinct is to wonder what the new thing is, not to kill the new thing.

Ah, I get it.

Information is freedom.

And you would rather their mind not be free? To not question?

The mass banning of books only serves to make the information exciting and exceptional. Not all information is exciting and exception. Until you ban the knowledge.

You are not protecting others, you are forcing them into the little box that you grew up in. That you still reside in, judging others about how big their boxes are.

I can hear the complaining now. “Well, if you had kids you would understand.”

No, I don’t have kids. But I was a kid. Books were never banned in my house. Ever. I could read whatever I want. And I wanted. If something made me confused, I would ask an adult to explain. Or I’d read another book to explain what I just read.

Ah.

And of course hoarding of information is power.

Boy, do I have bad news for you.

The post-it reads “You are entering the twilight zone, where everything you can think of has been tried. Tried and failed. But sure, maybe this time it will work.”

New people always have ideas on how to make things work better.

There isn’t anything wrong with the way their new department does things.

New people are just not used to it.

It makes them uncomfortable.

Their new department doesn’t quite fit right. Needs to be taken in, or let out, or something. A new color perhaps?

‘Eureka!’ they think. ‘I’ll let these people know how we used to do it in my old hospital. Where it worked SOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO much better!’

And they do.

Non-stop for days/weeks/months talking about how great their old hospitals were.

The surgeons were nicer.

The staff was more helpful.

The food in the cafeteria was better.

There was no snow/rain/frost/hurricanes/earthquakes/tornados. The list goes on.

It was nothing but kitten kisses and chocolate every day. And they got out early when they wanted, or made overtime when they wanted, or worked with their favorite surgeon when they wanted.

Life had been good in the old place. Or so they remember.

This lasts about two months. You know, through orientation. And then they realize that hey, their new place isn’t so bad. It just needs a bit of tweaking. And some new equipment. Dr. W would LOVE this particular instrument for Z surgery.

When they get over their impulse, their next impulse is to come up with a bright idea for their new department to buy to make X surgery for Y surgeon easier.

Never does it cross their mind that the department in question, their new department, has tried their new idea.

Tried it once. It failed, walked off, was too expensive.

Tried again with the next new staff. It failed, walked off, was too expensive.

Rinse. Repeat. With every new staff member.

And beware if their is a long-timer in their new place.

A long-timer with a good memory.

Always pointing out that whatever it is has, in fact, been tried before.

And failed for a variety of reasons.

Does this mean that new people can’t try?

No, absolutely not.

But don’t take it too badly when your idea has been tried and failed. Your precious idea that no one in the history of surgery has ever conceived of.

We can try again.

It might work this time.

What if it doesn’t?

What if it is too expensive? Or actually causes patient or staff harm? Or walks off to another department never to be seen again?

What then?

I was today years old when I found out that any extra scholarship money, above costs, is refunded to you as cash. At the end of the semester.

My mind is blown.

All my life I have wondered about why people are so excited when they get scholarship money over and above their free ride scholarship. Because they get the money as a pay out at the end of the semester.

I checked in with a student billing officer at a university. And she says this is legit.

Well, hell.

I’ve just been satisfied with my scholarship money, the little I’ve received, and my tuition reimbursement from the hospital. I thought that any scholarship money that was unused just went back to the company that runs the scholarship. I find this very sad that I am just learning about it. I’m on my FIFTH nursing school program, and my sixth college.

Holy cow!

However, this does explain the $995 check I got in September. I thought that was a sinking fund for books. Apparently in my new reality as a Nursing Faculty Loan Forgiveness Program student (they will pay 85% of the tuition cost for school after I teach at the college level after graduation for 4 years), I get $1000/year for books.

The money is on the fridge because I was afraid that they would ask for it back. Tomorrow, I will put it into a high yield savings account.

Of course, the true test will be if I get the $2,000 scholarship that is to be paid out at the end of the semester from AORN. Which would also go into the high yield savings account.

Because I will be holding this money to pay back the NFLFP in case I am unable to fulfill the terms of the contract.

Off to apply for more scholarships. Including the high dollar one from the hospital ($5,000-10,000).

And to finish the statistics final and the 20 page concept application paper for Philosophy.

Because it is finals week!

But if you are looking to go back to school, or have a kid in school, don’t be like me and be ignorant of what the scholarship can do for you, above what school costs.

And there are videos (?) on YouTube that explain more.

I am still flabbergasted.

The December theme is holiday cookies.

But that is not the story of today.

I was going to make cranberry meringues and peppermint meringues. Two types. Not cranberry-peppermint meringue, I can’t even imagine the horror.

I was going to make them on Wednesday because I knew Thursday would be a rush because of the quarterly awards ceremony at the hospital. These are awards that the shared governance proctors and gives out. The Daisy Award for nurses. The Sunshine Award for auxiliary staff such as pharmacy, or environmental, or dietary. The Rose Award for CNAs.

But there was a banger of a storm on Wednesday. And I knew that the meringues would not dry in such an environment. And I didn’t bake them on Wednesday.

I made the cinnamon rolls for the awards ceremony instead. Patrick Barnes, whose death prompted his family to start an international nurse celebration award program, loved Cinnabon. And before he died, he would ask his family to bring some in for the nurses, especially after he became unable to eat. The tradition was born and added to the Daisy ceremony. Well, the local Cinnabon has been closed for months. When I was searching for another one close by, I learned that there were only 16 Cinnabon stores left in the entire state. I didn’t particularly relish driving to the nearest one, the one at the biggest mall in my area, during Christmas shopping season. This led me to make the cinnamon rolls for the ceremony.

Well, I used canned cinnamon rolls from the grocery store, jazzed them up a bit with additions, and made home made cream cheese icing to top them.

They were a hit.

And then we worked all night on Wednesday night.

All part of the gig. You know?

I got home at 0500 and went straight to bed, knowing that I had to be up at 0830 at the latest to buy the flowers that all nominees received, and drive to the hospital to emcee the awards ceremony. It is part of my duties as the chair of the hospital shared governance.

Next I drove over to a local grocery store and bought cookies. I took them to the staff lounge in the hospital and dropped them off.

There was no way I could get home and nap and make the meringues.

And I didn’t.

For the second time this year, Cookie Thursday is a Thing was store bought cookies. And that is okay.

Because sleep.

This was prompted by an article/news story that I heard listening to NPR while cleaning the kitchen.

In the story, the patient had received a small abrasion on his forehead during a cataract procedure. After napping at home post procedure, he woke up to a bloody pillow case as his forehead was bleeding. His surgeon did not mention the abrasion at his post-op appointment. Upon further investigation, he discovered that was no mention of the abrasion in his chart. Not under the post-op documentation, not under anesthesia notes.

He did not appreciate that much. The entire episode was thought by him to be a reaction to the anesthesia medication.

Wait, let me back up.

This patient was undergoing cataract surgery at a cataract center. While in the procedure, the CRNA asked if he was in pain. He wasn’t, just felt some pressure to the side of the head. They increased his sedation.

The next thing the patient recalled was a bit of a commotion, and the surgeon yelling at him to stay still. In a later appointment the surgeon told him that he had a “adverse impact from the anesthesia.”

He thought to ask for a rebate in recompense for the injury.

The article uses phrases like the jig was up, in ascribing guilt to the surgeon for not mentioning it before. But the surgeon should absolutely have mentioned it when talking to the wife at the end of the procedure.

Oh, this makes me so mad.

Yes, adverse reactions to anesthesia happen. They do. And can run the gamut from allergic reactions to the anesthesia to death. That is quite the range of possibilities.

What I think is that he got a little frisky under deeper sedation.

I see it happen ALL the time in my role as an operating room nurse.

Especially the surgeon shouting at him to keep still while attached to the eye equipment. If the surgeon hadn’t shouted at him, he could very well have been blinded.

And the surgeon should have told the wife immediately. And the circulating nurse should have filled out an internal quality assurance form. That he would not have access to as the patient.

I tell patients after the case when they get belligerent under sedation and their family member. I also warn teenagers, especially boys to age 25, not to wake up like a brat (not the actual word I use). Because teenagers do.

I’ve been slugged, and scratched, and kicked more times than I can count. While patients are emerging from anesthesia. Oh, can’t forget the pinching. That also happens.

Do I think it was a medication reaction like they are purporting it to be? Nope. I bet he got belligerent under deeper sedation. This happens. But this is not an allergy. This is a reaction, probably a one time one..

This makes me wonder if he bothered to ask for and read the nurse’s notes as well. Instead of relying on the doctor’s notes.

The circulator should have note the abrasion on the operative record.

Do you think he even looked there?

I don’t think that this is the whole story. But enough of a story that an article was written and a news story broadcast.

There has been such an upswing in the number of broken hips that surgeons in other specialties not orthopedic are starting to notice. Mostly because repairing broken hips clogs up the schedule, but yeah.

One of them asked me during a night case what was up with all the fractured hips.

Two words- FALLEN LEAVES.

Lookit all the colors on the leaves!

Isn’t it bootiful?

Yes. Fall foliage is pretty.

The chlorophyll production that the trees live on in the spring and summer is slowing down, preparing the tree for the colder months. This produces the color change, and the leaves dropping as they are no longer useful to the tree.

And fallen leaves are slick. Especially when they have built up into layers.

It’s kind of like being on a sudden ice skating rink.

And gravity wins. Every time.

If it isn’t your hands out to catch you and the wrist breaking, it is the hip hitting the unforgiving ground and breaking.

All the seasons have their own trip and fall hazards. Spring has people newly released from their homes and the yardwork that needs to be done, Summer has garden hoses and gardening mishaps. Winter is what is traditionally thought of as broken hip season.

Not true.

Hazards abound year round. Just do all the ORs a favor and review how to fall. Maybe practice a little in a safe, cushioned environment.

Just wait until the ice comes.

Timber!