Monday’s Musings will be Tuesday Musings because I have to recreate my blog post after Dispatches ate it!

AAARRRGGGHHHH!

The post-it reads ‘what do you do when you cat has no zoom manners?’

Dot, my menace of a white cat, has zero Zoom chill.

None.

Nada.

Zilch.

If I am talking in a meeting she feels the need to parade across the keyboard. In complete view of the camera. Or she chimes in with a meow after I’ve finished making my point.

But at what point do you bring that up in the meeting?

I’ve been bringing it up at the beginning, either verbally, or in the chat function. I started doing this in my zoom classes. The professor welcomed her by name.

I wonder how long the welcome will last.

Because the Zoom platform will not be going away. It is too easy to connect across the globe using the meeting function. To have ideas and information free flowing.

Hell, even the AORN conference and expo had a zoom option for attendance. You don’t get the excitement of the conference. Or the networking. But some people don’t care for that part.

Classrooms demand being on camera so they can see if you are actually present or goofing off. That’s a stressor for the introverts among us, including myself.

It is extra stressful when the white cat pops up and moons everyone.

There is a lot of joy to be had for zoom classes, seminars, and conferences. You are at your own house, you have your own bed, you have your own kitchen. And you have your pets. And people on Zoom love to see pets. It breaks up the hours.

I hope Dot does not wear out her welcome.

This is meant to be a lighthearted post as I know nursing can be a bit heavy at times.

But Dot is still a brat.

Okay. I’ve been doing Sunday, Monday, off Tuesday, Wednesday, Thursday, Friday as the Dispatches from the Evening Shift blog dates.

I will be having class every Friday going forward. and every other Friday will be in-person at the university with an hour and a half commute on either side. I decided to change Friday blog day to Saturday.

Today in class we talked truth.

Truth is a hard concept to teach. Because your truth is not the same as mine. It’s all about perspective. And perspective is colored by personal filters, on both sides of the educational exchange.

I referenced the sacred cows in the OR. These are processes that are XYZ because they’ve always been done that way, even if YXZ makes more sense. It is the doing because it has always been done this way and heaven forbid there is a change in your perspective.

Yes, I am in a philosophy class. I’ve taken philosophy before, years ago, at Creighton.

And today’s class was about truth. And the different shifts in truth. There as a large section on fake news and how it is created and comes about and how it poisons society.

But, as the professor says, all viewpoints can have validity.

And, really, after all isn’t a viewpoint the same as a filter. That colors the information that comes through your own filter and changes it.

I think I’m going to like this class.

I am not sure what I expected when I went on vacation last week. Because it was the week of the 7th annual ice cream social that Cookie Thursday is a Thing hosts for back to school in August. This is a part of the no heat theme.

I had hoped that the department could pull it together without reminders from me.

Nope.

One of the other nurses said that although there were sign ups with the date clearly marked, people were confused about the date. And what to bring.

And it was rescheduled for today.

I mean, I get it. Cookie Thursday is a Thing is my creation. Of course the ice cream social would not go forward without my reminders, and prodding, and talking it up every day.

I’m not even mad at that.

I find that this is emblematic of the decrease in participation in ANYTHING. Especially as the pandemic drags on, and more diseases and disasters are popping up all the time. And people still don’t want to do the slightest thing to help another person.

On one hand, the entire department is burned out because of, well, everything going on in healthcare and in the world. This is why the department needs an ice cream social. This is the altruistic me having that though.

On the other hand, the entire department doesn’t want to do anything extra for anyone except themselves. And maybe their work besties.

As I was writing that I was struck that those two hands are part of the same whole. Life itself is a lot right now.

Even if it involves ice cream.

To look on the brighter side, I got to participate. Last night I made a no churn cinnamon flavored ice cream. I’ve made this before and traditional ice cream syrups go amazingly with it. Flavors like caramel and hot fudge, even at the same time, do wonderful things to the rather subtle flavor.

Hey, maybe next time I make it I can add Fireball Whiskey. That’ll liven up a depressed department and hospital that is full to bursting every damn day. The hospital being so full concerns me for fall and winter when there will be another congruence of the flu and covid. Sounds like great times, can’t wait.

Not that I would put out an alcoholic ice cream in an actual working department function, even if the amount of alcohol would be miniscule. But I think it would be a great addition to any party I go to.

To the kitchen!

A confused, 94 year old patient trying to get out of bed. We’ve all been there. Sometimes it is impossible to re-direct their energy and their determination to get out of bed. It happens. It certainly did in a Lexington, Kentucky hospital. I can understand the nurse’s frustration.

She reached out to the patient’s doctor, asking for something to help calm the patient down. The doctor said no. Did he explain the reasoning to this nurse? We have no way of knowing. I would hope so.

The nurse, unable to get an order for medication, took it upon herself to pull out the medication she wanted from a different patient’s supply. She then prepared a syringe and gave the patient the medication. That was intended for another patient. Without an order.

I’ll pause here why you pick up your jaw from the ground.

I was certainly taken aback when I heard of it.

This is operating outside her nursing scope of practice. And is a big NO-NO. And illegal as hell.

Oh, it gets worse.

Other nurses asked her what she was giving the patient via injection. They probably knew that the request for an order had been denied. Because nurses in that situation love to talk smack about what is going on. I can imagine that conversation ‘I asked for come calm down medication and the doctor said no. Can you believe him?’ They reported her.

Good for them. This is how the system is supposed to work.

And even worse.

The patient died!

Because of aspiration the patient suffered because they were fed under sedation. Which developed into aspiration pneumonia, which led to their death within the week. And having vital monitoring, including the pulse oximeter, turned off. The hospital was able to determine that the alarm parameters had been lowered, several times, before the unit was turned off.

Worst yet.

No rapid response was called when the patient started to de-sat because no one knew because of the monitoring equipment being disabled. I cannot fathom what was going through the nurse’s head. The patient suffered and nothing was done, except an amendment to the other patient’s chart that the ativan was not given, when it had been charted given at the time.

She has been charged with murder.

Why is this case different than that of RaDonda Vaught? Many reasons.

Because this nurse knowingly sought out and gave an unordered med. To give the patient ‘something special’ as she told her coworkers. Which was a sedative commonly used prior to surgery. She stepped out of the scope of practice lines, was unsatisfied with the no she received from the doctor, took medication from another patient, gave the unruly patient what she thought they needed. And the patient aspirated and died. And she tried to cover it up. Worlds apart from the swiss cheese mistake that RaDonda Vaught was involved in.

This nurse also has an immediate temporary suspension of her nursing license. I hope she loses it for good.

There are guardrails of the scope of practice for a reason! Stay in your lane, people!

Let’s not forget the real victim here. The patient who died, and the family who lost them.

I was ready to be outraged on the nurse’s behalf. Until I read more about it. It is so easy to blindly follow the mad.

Now I am outraged on the patient’s behalf. This was unconscionable.

I haven’t done a school update in awhile.

My school, that is.

After months of applications, and interviews, and prep work, starting day at university is finally here!

Well, not starting day. That was last week when I was finally in London celebrating my 2020 graduation with my MSN.

And not the first day on campus, that was 8/8/22 for PhD orientation.

And not the first day of my online class, that hasn’t happened yet.

After the first vacation we’ve had in three years. Because, you know, covid.

Jeeze, there’s been a lot of first days around here lately!

No, this is the first day of being a research assistant. I applied for this position right when I was accepted at the university. And I got a 10 hour position. This is one day a week, and in person. I will be leaving shortly to make the 70 minute drive to meet the doctor with whose research I will be assisting. I chose Mondays as my day to go up there. Because I have the least amount of meetings for the hospital on Mondays. I know, I know, still.

Do I know what it all entails? Nope. Stepping off into a chasm here.

Why I chose this? For the experience. I think it dovetails in my future future plans.

And I am unaccountably nervous. I mean, come on. It’s been two and a half years since I did anything like this. Look, ma, I’m in real clothes! It’s like I’m an adult or something.

I packed my lunch because I will have a lunch break. In a neat, brown paper bag. I don’t feel like I can leave the house yet, even if it is nearly time, because what if I get a case? This has happened before. I took a nap, just in case there was a surgery overnight. And then I went to bed a bit early just so I could get up early and I was, frankly, driving myself crazy with nerves.

I have an awesome new school bag. I am wearing mostly adult clothes. I have an emotional support animal in my car. This is a stuffed hedgehog, he lives there now. No, he doesn’t have a name, I’m not a child. I have a pin that says socially awkward that I will wear because I want people to be aware. Not that we are not all socially awkward in this after covid lockdown world.

I have to be at the university at 0800. I know I’m cutting it a bit close by leaving at 0630, but I have to be within 30 minutes in case I get called in. Yes, the OR starts at 0630, but the end of my shift is 0700.

Time to grab my lunch and my bag.

Let’s get started.

The gown card reads, ‘Being in charge is just like being the oldest: set an example, don’t pick on your younger sibling, watching as the baby gets all the support.’

Looking at the note I would add dealing with all the shit because parents (management) isn’t around. And having to deal with tattle tales that didn’t get their way (request) and so they went straight to parent (management) to lie.

And you, as the charge nurse and the older sibling surrogate, being told that the parent (management) is disappointed in you.

Any one else get a shiver of recognition?

No?

Just me?

Do you not have siblings?

It is important as the charge nurse to set an example for the rest of the staff. In some places that includes following all the policies, and not complaining that they don’t make sense, even if they don’t. And believing in the company line. At all costs. Following the dress code, when it would be more weather appropriate to wear lighter clothing. There are many things that a charge nurse has to do to set an example.

My favorite part of the gown card is don’t pick on your younger sibling. This is absolutely true. It’s not fair to pick on someone who doesn’t know as much as you do. But I will absolutely tell a toddler don’t touch that because its hot and you’ll get hurt. I will also tell a coworker don’t flash that, the patient might get hurt. Shades of distinction, maybe. But both are truth. To be in charge you have to protect the patient. No matter what the doctor or the staff is demanding.

I’ve written about tattle tales in other posts. Just know that they are out there and will tell on you in a hot minute if they don’t get their way. This may lead to you being told to play nice, and let the baby have its bottle. While you don’t get to tell your side of the story, about the lead in the pain in the milk. (yeah, stretching that simile rather far)

But management not having your back in disputes, that undermines the charge’s authority to run a safe, productive OR. And that can lead to unsafe situations. But what do we know? We’re just charge, not management. We just love being told that at my last hospital, this is how it ran. Well, why did you leave your last hospital? This will be a later post.

What I’m going to write about next is watching the baby get all the support. Because, like it or not, sometimes all nurses and techs need support. It is damaging to existing staff to watch the new kids get all the attention and new toys. While we work without complaint, and having worked through exactly that the new ones are complaining about for years.

Sometimes because I told you so is a valid response.

But, maybe, stop damaging what little authority we have? Pretty please with sugar on top?

Jane Austen opened Pride and Prejudice with the lines “It is a truth universally acknowledged, that a single man in possession of a good fortune, must be in want of a wife.” She wrote these much adapted words in 1813. In Regency England, this meant that mothers wanted to marry off their daughters to a good match. Whether or not they loved each other was beside the point. Man with money, girl who needed to get married as she had no prospects alone, having no rights= match made in Mama’s head and in the ton.

It is much the same with hospitals and restaurants. I’ve never met a hospital that wasn’t surrounded by places for food. Nowhere; San Francisco, Sonoma, Sacramento, VA in Martinez, CA, Denver, CO, and the two hospitals that I have worked in here in the South, and several of their sister hospitals. All are surrounded by restaurants and with the expansion of food for delivery, the circle is getting wider.

Patient’s families have to eat. Especially if it is in the middle of the night and they are trying not to be frightened.

Hospital employees have to eat. Especially if it is in the middle of the night and they are trying to stay awake.

I have likened the OR as a battlefield. This just broadens the metaphor. Soldiers need to eat, entire wars have been lost because of supply line disruptions. The supply line is disrupted, the soldiers run out of bullets, but more importantly they run out of food.

Hospital administration knows this. It is why every opportunity for celebration in the hospital is met with food. It is also why Cookie Thursday is a Thing exists, not the sole reason but a big part of it.

Music hath charms to soothe the savage breast, said William Congreve in the 17th century. The quote has been bastardized to music tames the savage beast. Same difference. But food keeps the soldiers happy.

And a well timed cookie makes the surgeon calmer.

No cookies today. As I am currently miles, and miles from home. 3977 to be exact. I thought it was farther, seems farther.

I will definitely be having a cookie today, in honor of Cookie Thursday is a Thing.

Traditionally, on the Thursday closest to the start of school, I throw an ice cream social with the assistance of the department. Some people bring ice cream, others toppings, others bowls and spoons. There is enough slots on the sign up for everyone who wants to participate.

But I cannot direct that so far from home. I hope the signs got put up last week when I sent them to the administrative assistant for the OR. I hope that people decided to participate when I was not there to direct things.

I worry about that, you know. About getting people to participate in things when I am not there everyday to remind people.

The idea of the department ice cream social is to celebrate the start of school. The hospital is smack dab in the middle of 1, 2, 3, 4, 5 counties. And they all have their own school calendars and the start of school is staggered.

I know that some schools have started, and I know that some schools start next week. This week is the middle ground.

The start of school was always my favorite. I know there are some kids who enjoy it too.

And definitely some parents.

There is a covid memorial wall in London, along the south bank of the Thames, facing Parliament and Big Ben. Fittingly, it is right outside of St. Thomas Hospital, where the Florence Nightingale Museum is.

This was a top item on my to-do list in London.

And it took us two different tube lines to get here.

Originally we were going to take the Central line to the Jubilee line. But there was a fire at Southwark and the Jubilee line was closed. We had to reroute and take a different line. But the beauty of the Tube system is that there is always more than 1 way to get somewhere.

My husband was not sure that this was somewhere we had to go. His exact words were “I don’t want to go to a memorial to people whose genetics failed them.”

Um, no.

I quickly disabused him of that notion. These were people who had died of covid in the UK. This was through no fault of their own. Blame should not be assigned for their deaths. The UK was locked hard and fast. And their rules were more stringent than the US.

I felt it important to go to the covid wall and bear witness as a nurse who has lived and worked through it.

There are pink and red hearts all along the wall and people are invited to write in them. Many people wrote names of loved ones who died. There were 150,000 hearts originally. As of today, 8/17/22, the death toll of the UK is 186,798.

So many hearts.

The wall extends over 500 meters, or over a third of a mile. And was begun in March 2021.

It was awe inspiring. This is not an authorized memorial. This was campaigned for and done by the group ‘Led by Donkeys’.

I hope that the incoming Prime Minister, when one is chosen, will allow this memorial wall to stay.

It was peaceful. Facing the water. People coming up and reading the hearts. The only thing that I can compare it to is the Vietnam Memorial in Washington D.C. For reference, there were 57,939 inscribed on that wall at the time it was dedicated.

The covid wall was sobering. All those lives lost. All those families changed forever.

It was defeating. It feels as if we could have done better.

Of course, I passed an anti-vaxxer protesting in Whitehall on the way to the covid wall.

How are we going to explain this to future generations?

What will be the final memorial? Not just here in the UK, but in the US, and around the world as well.