I feel attacked.

No, not really.

Yesterday at school they had a seminar on preparing for the exam that is to be done prior to starting a dissertation. And how to avoid procrastination.

My nearest and dearest will tell you I am a procrastinator. I’ve been one for a long time. And no matter the strategies I’ve learned about, and programs I’ve tried to self-teach to not be a procrastinator, it has been to no avail.

To do lists.

Masterfully crafted schedules.

Pomodoro timer technique, where every hour is chopped up in to 25-minute segments. And you are supposed to go on to something different after the segment. Until the work is all done. This works okay.

Minutely written howler lists that I write myself. A howler is a yelling device that Harry Potter utilizes to have the parents long distance yell at their kids. I use these as a way to prioritize what needs to be done.

Bupkis.

No idea why.

No idea how to train myself NOT to be a procrastinator.

Not much helps.

For example, this week I had a 1-page paper due in the Financial Longevity class I picked up last week, a 45-minute philosopher presentation that I had to give on Friday that needed a PowerPoint made to help deliver the remarks, and a statistics midterm that is due on Sunday.

I spent the week doing the reading for the philosopher presentation and witing the pilosopher script and PowerPoint. And the reading for my new class, including an outline for the paper due yesterday. And the studying for my statistics midterm. And blog writing, and outlining the major papers I have beginning in a month. And the philosophy midterm just dropped, a 20-page paper on four different philosophers and what was learned in class due next Sunday.

I am learning something and working every day.

So why do I feel like I am not doing enough?

And writing it down shows me that I am not behind. It just feels like I am.

As I joked to one of the PhD professors living through a pandemic, well, working through a pandemic on the front lines wrecked my brain. After all, when every day is do or die at the hospital, what is the point of a 20-page paper?

Nevertheless, I soldier on. Even if my brain feels sluggish.

I wonder how much of that is the pandemic fatigue that all nurses I know have, how much is recovering workaholic fatigue, and how much is true procrastination.

Hmm. Must ponder that.

There is a Gaelic saying that I printed up for my desk translated into English it means ‘Don’t Lose Heart’. And I’ve offered a copy to those in my cohort. As I feel we are all in the same boat.

There is a post-it on my laptop in my dining room desk that I wrote the same saying on. Right next to the post-it with my favorite reminder from Elyse Meyers, “I Just Do Things Scared.”

To go along with this month’s theme of Spooky cookies, I chose to make Candy Corn Cookies. I make these every year. And every year, people are surprised by how good they taste.

Because candy corn undergoes an amazing transformation when heat is applied. It turns to caramel.

Transfiguration through application of heat sounds familiar to anyone in healthcare.

We are under a tremendous amount of pressure from all sides- covid, flu barreling down on us, the increase of the RSV or respiratory syncytial virus. This is a virus of the respiratory track and mostly affects children.

All of that is still dangerous though. Wear a mask, wash your hands.

It is the sudden increase in pressure that creates the heat for healthcare workers.

I mean, the hits do keep coming. All of the above respiratory viruses, over full hospitals, chock full and holding emergency rooms, increase in the OR schedule and need for more and more from the OR.

And since we are humans living in this society there are other pressures as well, including inflation.

It is no wonder that there is a nursing shortage, and an overall healthcare shortage, and a teacher shortage, and nursing school instructor shortage.

The list goes on.

Like candy corn, we have no choice but to transform.

There is a flow of admissions to the hospital. In, get better, or not, and leave.

Hospitals in winter are usually full. And less so in the summer.

Same with the operating room schedule. Here in North Carolina, most people have an insurance deductible to meet before insurance really kicks in. Once the deductible and out of pocket max has been reached, in theory the rest of hospitalizations, and surgeries, are not on the insured’s bill, but the insurer’s bill. In theory.

This means that many, many people have reached or will reach their out of pocket max toward the end of the year. And can suddenly afford their surgery. This stresses the surgery schedule.

Happens every year. Like a tide.

Of course, the tide doesn’t drop until March. I have a theory for that too. Getting the out of pocket max over with in the first of the year means that the rest of the year will be paid for. This is what I would do.

Some, but not all, admitted patients are surgery patients.

Even the non-surgical patients typically follow a pattern of admission. Up in winter due to flu season and colds. Down in the last spring and summer due to kids being out of school and away from passing the cold around amongst themselves.

In years past, summer admissions decline.

But not during covid times.

My hospital has not had a lighter census (admitted patients) since 2020.

At all!

Hell, we’ve been full 99 times out of 100 all year long. And when the hospital is full the emergency room has to hold patients who otherwise would have a bed on one of the floors. Recently, the ED in my hospital had a hold number of 17, more than half of their total beds. Even with a new unit on the floor, the number of hospital beds available cannot keep up with the demand of patients.

This means that the staff in the ED and on the floors have had no time to rest, relax, or rejuvenate for nearly 3 years now.

I fear for the state of the hospital during the winter months with the certain increase of bed needs due to flu.

Compounding this is even if there was a place and a bed to place them in, there may not be people available to care for them. This I put the blame squarely on the continued covid pandemic. Because it’s not over, not even close.

No matter what you want to believe.

The post-it reads ‘there are only 6 or so distinct personalities in the OR, or a combination of them. These comprise your coworkers).

This is actually something I’ve been developing, for years, either to write as an article, or to develop into a book of fairy tales. Or both.

These are the 6 observed personalities of the OR, in no particular order.

1) The Pretty Pretty Princess. This is the one whose makeup is always perfect, their nails are manicured against policy, and they know JUST how to speak to management/surgeons to get what they want. And they ALWAYS get what they want or gets away with behavior that would get you fired. For a fairy tale trope this is the spoiled (sometimes misunderstood) brat.

2) The Call Dog. Also called the call whore in not nice places. This is the one who scoops up unwanted call from all comers. This may be because they love to work, see also Workaholic, or is in need of the money. Caution, this can be dangerous to the department when they are reassigned or leaved. If they leave, no one in the department knows how to function on call. For a fairy tale trope this is the worker bee.

3) The Old Timer. This is the person who has been around the department the longest. And they REMEMBER when X (whatever type 4 is proposing) was tried and it didn’t work! What works is the way we’ve been doing it ever since I got here. This may also be the one who is resistant to new technology or the Electronic Health Record. They want to know why they can’t they just have a paper and pen, for goodness sakes? For a fairy tale trope this is the stuck in the past person who is impeding progress. That progress may be positive, or negative.

4) The IN MY LAST HOSPITAL We Did it so Much Better, We Should do it that Way. This personality type is exhausting to the listener. They are unwilling to learn the ways of their new department and instead always daydreams out loud about the way it used to be in their old place. This may go 2 ways. They are the slow drip against the department mores so that they get their way. They are acknowledged and it is explained to them that this is a different place, with different surgeons, and that what they have been talking about has been tried and failed miserably. The alternative is the If You Liked it So Much Better There, Why Are You Here conversation. For a fairy tale trope this is the one who can’t let their past go and so are doomed to repeat the in my last place we did it so much better script. See also high school jocks still reliving the big game where they caught the game winning touchdown well into their 30s.

5) The lecturer who knows everything about everything and they want to tell you. Or they think they do, and they want to tell you, or correct you. Don’t get me wrong. Sometimes this is how information is distributed to the rest of the team. If there is someone in the department who is knowledgeable, acknowledge and take their knowledge for yourself. But this can be taken to extremes. For a fairy tale trope this is the overly helpful blowhard that may not be more of a hindrance than a help.

6) The Hoarder. This is the coworker who knows very well where the instrument that the doctor requires is but keep that knowledge for themselves. Sometimes this is done so they can swoop in and find it so that they can be praised. Sometimes they don’t tell you or “find” the thing because they are mad at you or the surgeon. Sometimes it is because no one asked if they knew where the thing was. For a fairy tale trope this is the one who has valuable information to give for the quest, but no one thinks to ask them.

These generalizations are mean, a bit. And you will definitely recognize all of them. And if you don’t? Maybe you are that number.

There are definitely more, or combinations of the types. That will be another post, or maybe discover them for yourself. Definitely report back.

Or if you think you are all 6, relax. You are not all 6, and if you identify with a personality type that is okay. The OR is hard to learn and function in and everyone struggles sometimes. Just don’t let the personality type be your WHOLE personality.

Hi, and welcome to the October university update. I promised I would only update on my personal university journey once a month. Here it is.

Class has been in session for 7 weeks now and we are about halfway through the semester. That must mean it is time for midterms. And the third class that is an online paper class began yesterday, 10/7/22.

As a recap this semester I am taking a statistics applications class, a philosophy knowledge development in nursing class (the Ph in PhD), and the class I just picked up is Financial Longevity. Let me break them down one by one.

This is my third statistics course, and while I am not struggling per se, it is not my favorite class. Yesterday, yes, only yesterday, it dawned on me that I hardwired my brain against statistics when I naively took economics and statistics in the same 6-week session during my BSN.

Dude, don’t ever do that. I have counseled against taking them together ever since. Did I pass? Yes. Were there tears? Oh yes.

Ever since my brain has rebelled against statistics. Well, this is statistical applications, which is different you say. Yes. And I have to learn an entirely new program, in addition to learning an entirely new email system, class platform, and new job as a graduate assistant. Don’t do that. It’s been a bit chaotic.

The midterm dropped this morning and I have to do the problems and turn it in NEXT Sunday. Who wants to use the cattle prod on my sense of urgency? I’m trying, I really am, I work on readings and practice problems almost every day.

Thank goodness I took the call job when I did and got my brain used to THAT before introducing this new chaos level madness. I’ll get by, I always do.

The philosophy course is similar to the one I had to take at Creighton. Except there is a presentation next Friday that I am working on my PowerPoint for now. I really enjoy this class; the teacher is awesome and fosters intellectual stimulation among myself and the cohort.

There are two papers due in this class. One about the Ways of Knowing, a 5-page exploration of the different ways there are to know things due in November. And a 20-page behemoth on Concept Application. What concept? And how do I apply it? I think that was discussed in the first class, which I missed because I was over the Atlantic Ocean on a plane returning home. i have emailed the instructor seeking guidance.

The new class on Financial Longevity may seem out of place. I chose it specifically. It had to a graduate level class, and maybe applicable to the thesis. I chose it because I am interested in the topic. Everyone should be, really. It behooves us to prepare for the future, even if retirement is not our scene (is it mine? probably not). This is the only class that I am taking that is online only, back to discussion posts and weekly papers. All right, something I am familiar with. Did you know that they call this asynchronous, where you don’t meet regularly for actual classes, doing all the work by yourself. Finally, a class that gets me.

Since this is a quarter class, not a semester, I anticipate the work will be truncated into the 7 weeks. Again, something I am familiar with. I’ve already done the task for yesterday, which was an introduction of who I am and why I am taking the class. I explained that my first hospital seemed to always be on the verge of closing. And since this was the only hospital in a “retirement” town it was important to be mindful of costs. This is a lesson I took to heart.

Outfitting the “office”, AKA enriching the office supply websites and stores.

1) Because I was spending entirely too much time in a chair, I bought a standing desk. The desk sits on top of the dining room table, and I can move it up and down at will. Yesterday was my first day of all day classes where I used it. I am already a fan.

2) A laptop stand. I do the bulk of my schoolwork in the dining room, because the husband was complaining about me being in the office when he was and I had a laptop, why was I using the desktop too? Short answer, because I can. But this way I can work and move to minimize distractions of him on the computer or watching television.

3) As I have been spending more time on the laptop in meetings and such, I was wanting more light. But not from the fixture in the room, although that is on a rheostat. And I anticipate having to do short videos for school. And maybe YouTube. IDK. Jokes on me, the glare from the ring light that I bought works great for brightness but makes a terrible glare on my glasses. On the positive side, the glare obliterates my fear of people seeing what websites I am on.

4) Shelving unit for the dining room. Future purchase as I am still deciding. In the dining room there are EIGHT chairs! Eight! And we are a house of 2 people, although I sometimes have family over for dinner and holidays. Right now, the extra chairs are horizontal places for school things. This will help that.

I have to get going, I have a midterm to continue to study for and a computer program to use for the midterm that I am still not proficient at.

Welcome to October!

The month of Halloween and the pause before the world plunges into the insanity that is the holiday season. The temperature is cooler, the leaves are turning colors and falling. It is time to tuck the garden into bed for the cold season.

Fall is my favorite season.

In years past I would go all out making homemade candy for the Thursday before Halloween. Only to have it rain that week and ruin my plans because some candies? Remain sticky when it is humid outside. And some things, like frosting, don’t work too well when it is 100% humidity. And water pilling on frosting is the WORST! Have I seen it? Absolutely and it sucks.

The Cookie Thursday is a Thing theme for this month is Spooky Cookie.

But basically, it is candies and treats I want to try. Sometimes because they are spooky. And sometimes because it a candy I have wanted to try my wooden spoon at.

Pumpkin spice has been derided as basic. A very low bar for fall cuisine. And have you been shopping? The stores are FULL of pumpkin spice this, and pumpkin flavored that.

This week’s make is a pumpkin spiced rice krispy treat. Was it something the world needed? No. Did I have fun and does it taste amazing? Yes.

But first I have to whip up some pumpkin pie spice. Instead of buying it, because sometimes it hard to find. And I have all the ingredients. Of course I do.

Pumpkin Pie Spice

2 tbs cinnamon

2 tsp ground ginger

2 tsp nutmeg

1 1/2 tsp all spice

1 1/2 tsp cloves

As with many spice recipes I wasn’t very strict on measuring. And although the phrase measure with your heart hasn’t been around for that long, I really like it. It feels Southern, but is it? Is it one of those backstabby comments that have two meanings like Bless Your Heart? I couldn’t find it in my readings. I infer it to mean whatever measurement that makes your heart happy. While still staying within the recipe’s lines.

I doubled the recipe as I anticipate putting this on everything- sweet potatoes, butternut squash, and I bet it would be great on coffee froth.

Recently the CDC came out with a new masking guidance.

And that is to wear a mask if you are unvaccinated. Or in an area with a high covid transmission rate. Or, as most of the population of the US, never, never, never. Except for some of us. And then they doubled down and said that hospitals don’t have to wear masks.

And a lot of hospital type folk are not happy about this. Especially as covid is still killing thousands a week.

And others are throwing a ticker tape parade. And think that this is yet another sign that we are getting back to “normal”.

uh, huh.

And if you think that the world is going back to what you considered normal nearly three years ago, there is some lovely ocean front property in Arizona. George Strait says so.

Of course, the way the seas are rising, it shan’t be long until that song is deemed prophetic.

But the Golden Gate Bridge is not for sale.

We are facing what has been deemed to be a very rough flu season. Australia is often seen as the canary in the coal mine around flu, as their flu season starts nearly 6 months ahead of ours. Not to mention the sheer amount of people dying of covid monthly.

Or the hospitals that still have covid patients. Including nearly every hospital in the system I work for. Admitted numbers are down, true. But everyone I know on Med-Surg, or the ED, or the ICU is bracing for flu season. Our admitted for other reasons number never has gone down. The hospital is holding in the ED more often than not. The ACU is holding post op patients weekly. Traditionally in the summer the numbers moderate a bit. But not this year.

Do I still mask up when I go places? Yes.

Am I vaccinated? Yep. Twice, and boosted twice, including the bivalent vaccine that just came out. But the life I save may be someone else’s.

As of noon today, there have been one million, sixty thousand, four hundred seventy-eight deaths.

Tell me again, grandpa, how covid is gone away. I like fairy tales as bedtime stories.

It is important to take your Zen moments, those ahh relaxation moments where you can. When you can.

During the height of the lockdowns and the existential panic of Spring and Summer 2020, I revived an old past time. Along with this blog it kept me sane. And continues to keep me sane. Nothing like coming home from a long day/evening at the hospital and booting up the computer to kill things. In an online first-person shooter of course.

First-person refers to the type of video game where the player (me) controls the character and guides the destruction and the shooting. Not necessarily guns. Can be a bow and arrow. Or magic missiles. Or magic, period.

I’ve been playing Diablo for years. We played Diablo I on a console back when we were young in our marriage, and I was new to nursing. I was a CNA back then. I played through nursing school. And Diablo II came out for PC in 2000. I played less then because I was actively in nursing school, and we only had 1 computer and my husband was busy making an interstellar empire on Eve. I don’t believe I had my first computer until 2005. And I played Diablo II then. And worked in the operating room.

In late 2005, we moved cross country; the lot of us, to North Carolina. And I worked as a nurse. And I played Diablo more sporadically. After the game is beat, where is the fun?

in 2012, Diablo III came out for PC and consoles. Again, my husband and I played together or separately. Over the internet; in the same room. And there were more characters to explore, new dungeons to conquer. I beat the game, several times. And I put it away.

Until…

The pressures of working like mad life, coupled with the MSN program began to weigh on me. And I rebooted Diabo on my new computer and played again. Nothing like slaughtering the evil undead to put the mind at ease. Every month of so I would play a bit, beat the game, put it away again.

Until…

I noticed that Diablo had expanded. There was a patch that gave the gaming community a new area to explore- Westmarch. This was 2015. New big bad. New rewards. Of course I played that.

Diablo added seasons to their game in 2014. No idea why that slipped past me. Except that I was deep into my workaholic self and had picked up shared governance in the hospital. What’s a season? A short playing time to accomplish certain tasks. Same game, same characters, same big bad. Different rewards. And a pause, and another season starts.

I started playing Diablo seasons at Season 19. And I am currently playing Season 27. My husband asks me how I can keep playing Diablo 3 after all this time. I assure him that the game is different every time. And, no, I don’t need to explore more of the player classes. I’ve played the necromancer and the crusader in previous seasons. The demon hunter is my favorite, and my current character that I am playing. Yes, husband, again! Diablo 3 allows me to rest my brain a bit. And let out a little aggression at the same time. Win-Win. I don’t play long; a half an hour at most. But I play consistently. Especially since the pandemic began.

The reason this is Monday’s Musings post is because all of my game play has not gone unnoticed. I don’t play cooperatively, although you can, with anyone except the husband. I don’t engage much with the online community or chat. I just play. And I got invited to participate in the Diablo IV End Game Beta.

Diablo IV has been on the horizon for a while now. It was going to be released in fall of 2020. The pandemic kiboshed that. And then fall of 2022. Same. All along the game makers have been fine tuning it. And putting different beta test times together. A beta test is a pre-release game test for gamers. To play and give feedback on. I’ve played a few beta test times in the past.

I am going to participate in this beta. Sometime over December, I think. Perfect. Just in time for end of semester break.

Because a nurse has to have their mind breaks, or they will break. And it looks different for every nurse. For this introverted nurse, killing the undead is perfect.

The post-it reads ‘struggle for OR space, a tremendous fight with anesthesia.’

Or space is finite. It is extreme limited supply. After all, the rooms don’t get any bigger just because you wish it so.

In all the hospital I’ve worked in the struggle has been real.

The OR rooms themselves have been all sizes. From I can hear my echo big, to reaching the walls from opposite sides of the OR table small. The last was a converted closet. There was just enough width to fit a gurney beside the OR table. All the equipment, like the bovie and the suction had to be plugged in by the anesthesia team as there was no way to get to the head of the bed after the patient was prepped and draped. But needs must.

In this itty bitty room there was no room for anesthesia to expand.

And the CRNAs HATED that room. They could not stretch or kick their feet up. What? You know you’ve seen it in an OR before.

Because it is the natural inclination of the anesthesia team to take up as much room as possible. No, I don’t know why. I guess the CRNA and their TWO pieces of equipment (pyxis and anesthesia machine) just expands to fit the space, like rising dough. And however much room they have, they want more.

Back when I was the evening charge nurse, I did a nightly reset of the rooms.

Invariably, during the day the bed would be moved, giving the CRNA more and more footage to do their thing. This would cramp up the rest of the room. Sometimes it would make it impossible for the circulator to go behind the sterile table to accomplish tasks on the far side of the room.

Leading to the nightly reset.

Every night I would move the anesthesia machine and the pyxis toward the back wall. I would move booms and video towers, suction machines and tourniquets. Just to get a little breathing room for the team. And the next night the anesthesia machine and the pyxis would have encroached on the working space of the patient and the sterile team.

I may have ceded the battle bit by not being the evening charge nurse anymore. But I will not lose this tug of war. Every night I am called in I move the machine and the pyxis and the bed.

Trying to give the OR team a bit of needed room.

I used to tell the anesthesiologist that I worked with in California that he had enough room for an easy chair, feet up, and a cup of coffee. And could he share a bit? Hmmm? And he would grumble and move the anesthesia machine an inch, maybe two. And every night I would reset the room to give more room to the actual working sterile team.

21 years I’ve been doing this tug of war. And I imagine I will do it 21 years more.

You may know already that there a hurricane around these parts this week.

Hurricane Ian came to town. Or came to the state. It had a lot of destructive fun in Florida, left to get stronger in the Atlantic again, made a left turn and made a second US landfall in South Carolina.

The university was monitoring the situation. Class was going to be on site this Friday. And then it was moved virtual. And then classes were cancelled altogether for Friday. This was done out of an abundance of caution in case there was power outages across the state.

I thought this was very responsible of them. The PhD cohort I am part of it scattered across much of the midstate, from the South Carolina border to Raleigh and the state capital. Any one of these areas, but especially the Charlotte region, could have been impacted by the hurricane. Due to the power outage and wind and rain.

This was the best decision they could have made. To protect the teachers and the students.

Of course, now there is the evasive maneuvers to add the classes that would have occurred on Friday into the class calendar for the rest of the semester.

This is a very busy time for the university. We’ve been in school for nearly 2 months, and are looking down the barrel at midterm exam.s

The university and the professors have been emailing us all about the plan that will be the plan going forward. Syllabi have been adjusted, exam schedules and presentation have been adjusted. And life will go on through the semester.

The lessons from the pandemic have been well learned. Be nimble. be able to adjust and protect the students and the faculty members.

And be prepared to take evasive maneuvers to do all of the above.

How did I spend my unexpectedly free Friday? Not doing homework, that’s for sure.