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.

Continuing the theme of Baker’s Choice, today I chose to make a Rosh Hashana cake. Well, I have to feed a lot of people and I am adapting the recipe a little to make a very flat cake in a cookie sheet. Everything else is the same.

Rosh Hashana is also known as the Jewish New Year. And New Years are a time of new beginnings. It also marks the start of the High Holy Days in the Jewish calendar. It is marked with prayer, and the blowing of the traditional ram’s horn. And there are symbolic foods.

Being a diverse country, I think it is important to celebrate differences. I am not Jewish, but I know and work people who practice the Jewish faith. And I want to know more. Because I don’t want to make circumstances awkward for them. And they are free to celebrate their religious holidays, no matter what certain facets of our country say

It is important to celebrate these days of reflection and the 10 days of Awe.

And Jewish people are meant to reflect on where the past year has gone wrong, and how they might improve in the future. I think this is a practice that everyone needs to do, regardless of religion, regardless of time. For those of us who celebrate the New Years when the Grigorian calendar flips from December to January, this is absolutely something that we can do.

Today’s bake is a honey syrup soaked cake with cardamon and cloves for spices. And it is cooling in the kitchen on the stove before I take it to the hospital.

I had a friend celebrate her 10 year old son’s learning and maintenance of life skills that are not being taught in schools any longer. And the emphasis on this learning is not being done at home, either.

The life skill he learned and demonstrated was shoe tying.

Apparently, all shoes are slip on now.

Disappeared is the learning to read cursive, or write cursive

And driving a stick shift.

This loss of life skills is not happening only in real life.

Working life has also lost some skills.

Hospital life definitely has lost skills.

No one takes off handwritten orders anymore. No one else is squinting at a doctor’s appalling penmanship and guessing that this order is 200 micrograms of fentanyl, not milligrams. This is also why many systems have moved to pharmacy clearing medicine orders. 200 milligrams is lethal. Layers of eyes looking at orders isn’t a bad thing and might save a life.

Many of the improvements that have been made, looking at you electronic health record and especially computer-based orders, have been done for safety.

There are other skills that really shouldn’t be disappearing.

Analog clocks as the world moves to digital ones. And for that matter military time. Most hospitals run on military time to be able to quickly differentiate between day light hours and evening/night hours.

Calculating medicine drips. Yes, the IV pump will do it for you but what if there isn’t a pump? Or electricity for that matter.

What nurses have forgotten is there is a world out there that does not have the advantages that we enjoy in this country.

Teach children to tell time on an analog clock, to read and write cursive, to drive a stickshift. Someday they may be in a place where they are commonplace.

Teach new healthcare workers and nurses to calculate and hang drips, to take handwritten off and make sure they are followed. To take a verbal order and do the same.

This new technology driven world is exciting and wonderful and new advances are being made all the time.

But what if all of that stopped?

And the kid/nurse/society had to go back to the way it used to be?

Apparently the influenza, aka the flu, has been particularly vicious this summer season in the southern hemisphere.

I’ve been seeing article after article warning of an increased flu risk. Sometimes coupled with covid. We don’t know how covid is going to react this fall and winter. How could we? Many states have stopped tracking, and Johns-Hopkins’ Data in Motion dashboard has been rumored to be scaling back.

And the damage that has been done to willingness to get a vaccine will be here for a long time.

A look at the CDC flu vaccination coverage, shows a drop for age group 6 months to 17 years in the 2020-2021 flu cycle. And a slight increase for the 18-48. And a larger increase for the over 49, with the largest increase for 65+. The increases are good, although slight.

But the drop in 6 months to 17 years is alarming. The overall vaccination rate for all age groups encompassed in the larger range dropped from 63.7% to 58.6%. More than 5% points in a year.

Isn’t anyone else alarmed by this?

I find this scary. If parents aren’t vaccinating for the flu, what else aren’t they vaccinating for?

Another thing the articles are positing is the possibility of a twindemic. This means that there will be high levels of cases in both flu and covid.

Because reminder! Covid still kills Americans every day. Over 2,000 in the last 6 days alone.

Is the covid pandemic slowing?

Yes.

Should we still be absolutely concerned?

Also yes.

Does covid had the capacity to come back swinging? BF.7 anyone? Ba.5, which became the cause celebre in the late spring, as well as the most dominant Omicron variant causing most of the infections, is still around but ceding ground to the new variant.

I’m just waiting for the variant one that laugh at the vaccinations and the antibodies.

They’ve already found a coronavirus in bats that laughs at the vaccines.

And we start this entire mess over again.

Clock is ticking.

But for now, we have a new booster that is made specifically for the Omicron variants. And it was just released 3 weeks ago. Get it.

And get your flu shot too. Yes, you can get them both at the same time.

The life you save may be your own.

The folded paper state ‘Wizard of Oz. Winged monkeys leads to policy and procedure; signatures- winged pens; -paperwork’.

Um.

I write about the first paper/post-it/gown card I pluck from the stack.

And sometimes it doesn’t make a lot of sense.

This one was written in haste. I can tell because it is on a folded piece of paper.

Sometimes you have to be your own diviner of what you meant to write.

To me, this is about 2 separate issues.

That sometimes policy and procedure doesn’t make sense, brought to us by the winged monkeys from the Wicked Witch of the West. You know, the winged monkeys who did the bidding of the WWW? And terrorized Dorothy and crew.

You could assign an identity to the witch, or those who do her bidding. And relate it back to the hospital and it becomes even creepier.

The second part of the note is about signatures using winged pens. Again, this can be related back to the leadership of the hospital. Signing the aforementioned policy and procedure. The pen can be a stand in for the winged monkey. An update if you will.

Or if could be gobbly gook.

And signature?

Could be anything.

Sometimes the post-its don’t make any sense and you have to make sense of scribblings from years ago.

Nurses are always trying to learn more about how to care for patients.

And that looks different for each nurse.

Some want to learn more about how to run the unit, or the hospital.

Some want to learn more about how to run another department.

Some want to learn more about disease states.

Some want to learn more about new treatments and new modalities.

Some want to learn more about getting away from the bedside.

All of these are okay.

And there are different ways to learn about each one.

There are different degree paths for each one.

Some of them don’t even require a degree path.

And some nurses don’t want to get any more degrees than the one that got them their RN.

And that is perfectly fine.

But healthcare is always moving in an outward direction, toward education.

Because we are all here for the patients, whatever that may look like.

You don’t have to follow my path.

Because you are your own nurse.

I love to learn. I have spent the last 6 years on various degree paths.

But that is me.

No one said you had to do as I do. You’re not me after all.

Just to have the same endgame of safe, effective care for patients.

But you will find that you know more than you think you do.

And the patients will still need us.

No matter what form of nursing we take.

The theme for the month is baker’s choice. I was going to make a standard cookie this week, but something caught my eye earlier in the week.

Have you ever heard of a Butter Board?

It is similar to a charcuterie board. That is a selection of meats, crackers or breads, cheeses, and nuts, and sometimes jellies. All forming a pleasing to the eye and mouth collection of flavors that work well together. Especially in your mouth.

The world became enchanted with the charcuterie board, especially during the pandemic.

I mean, I’ve had a few at parties, and I’ve made a couple myself.

But all that specialty meat and cheeses are expensive. And sometimes hard to source.

I was reading on Monday when I read about a Butter Board. It was in a video made viral by Justine Dorian where she made a butter board, inspired by Josh McFadden’s cookbook titled the Six Seasons. I love cookbooks and I am on the waitlist for the local library for that one.

Justine Dorian begins with a half pound of softened butter that she spreads, in an artistic manner that I don’t have time or energy for. She went on to explain that anything can be added to the butter but her explanatory board had honey, red onions, flaky salt, among other things.

Well, most Cookie Thursday is a Thing bakes begin with a half cup of butter, softened.

I was intrigued. And determined to make a butter board as this week’s make.

It was the simplest and easiest thing I’ve ever done on a Cookie Thursday. And that includes the time I dipped fruit in chocolate.

I added lemon zest, a good balsamic, flaky salt, everything but the bagel seasoning, and Mike’s Hot Honey. You know, just things I had in the pantry.

And I sliced up most of a loaf of 3 cheese bread that I had in the fridge, arranged it prettily on a cutting board, put the cutting board on a cookie sheet and added the sliced bread around it.

And then panicked when I didn’t think there was going to be enough bread and bought a loaf of French bread at the store and added it to the table.

People were already starting to dive in when I left.

My intention was to made the butter myself because have you seen the price of butter these days, using my mixer and cream but I worked ALL last night and thought sleep was more important.

Next time, mixer, next time.

What is a pager?

For a very long time, it was the only way to get in touch with needed personnel, be they the call team, or doctors. Or, in the late 1980s into the 1990s, to get in touch with family, drug dealers and the like.

This is preemergence of the cell phone to dominate our lives.

The mobile pager allowed for doctors and nursing staff to live relatively normal lives, while on call. Or to allow one doctor to cover the hospital.

There are movies in which doctors are shown flashing their pagers, answering a page and leaving. Kind of like the bat symbol in Gotham.

It has been very useful. And convenient.

And lucrative for the people who run the pager companies.

I’ve had a pager in some capacity since 2002. I’ve had a cell phone since 2004.And that’s an entirely different post.

But pagers were created/invented to shortcut reaching out to someone for all sorts of reasons.

In my hospital, the reliance on pagers has been declining for years, matching the rise of cell phones. Heck, I have 90% of the cell numbers of the surgeons I work with. Allowing them to tell me about a surgical case, or me responding to their asks regarding future cases.

And texting. Most of the conversations to be had can be done over text.

Game changer.

But.

What if the surgeon trying to get ahold of you doesn’t have your number and is just on call for the ER that night? And is a courtesy member of surgical staff, solely for call purposes? This is where the pager absolutely comes in handy. Allowing the not our surgeon to reach out to the nurse on call, bypassing the often messy communication with the nursing supervisor. All they have to know is one pager number and it will page all pager numbers associated with that number. This is known as the group page.

Last night I got a call from the supervisor that a PA, who I know for a fact knows the process, called her to book an emergency case. Okay, not the process but I’m on my way.

Prior to the case, I gave the PA a gentle reminder to call the pager and I would answer. He said the number didn’t work. Hmmm. Regardless, I reminded him that I am the call nurse Sunday-Thursday 2100-0700. And to go ahead and call me directly and I would start the cascade of notifications of everyone else. Instead of playing phone tag.

And he told me he never knows who is on call.

Oh, my head.

Prior to this job change the odds were VERY good it was me. And now, the odds are very good that it is me. At least 72% of the nights of the week, and I will re-direct a call outside of those days.

Do I have to wear a tee shirt that says “On call most nights”? Or “FIVE nights a WEEK”!

Maybe.

Do they think it is conversation like Prince Phillip and Aurora? You know when he asks this damsel he meets in the forest “When will I see you again?” To which she replies, “Oh, never!, never!”

Pager, cell, home phone (that no longer exists); there a lot of ways to get in touch with me.

I would much rather not be stuck at home waiting for a page that may or may not come.

You are not going to bother me, promise. I would rather answer a misdirected phone call than a surgeon get frustrated with the back and forth communication, or a patient not receive the care they need in a timely fashion.