Medicine-speak is impossible to understand if you don’t know.

And medical-type people can say an entire paragraph comprised completely in letters, vowels and consonants both. It is shorthand that brings all other medical-type people up to speed about a patient in less than 15 seconds.

It is kind of like Twin Speak that twins sometimes develop among themselves when they don’t want adults or other kids to know what they are saying. But more special because there are many many twins.

There can be different dialects, and different accents of sorts. The letters can be tinged by the type of medical-type person is speaking it. Because there are infinite combinations of medical-type people.

We can talk among ourselves, but it important to be able to speak to the non-medical type people. Common language is hard to come by in the medical profession. I can talk to another medical-type person and come to a complete understanding.

But non-medical type people don’t have the common language that most medical-type people do. And they are the ones that need to understand. And medicine people and lay people (those who are not medical) need a familiar language.

We need to slow down the language and allow non-medical type people to understand. And if they can’t, we need to come up with better words for what is happening.

I say this, as a representative of the medical-type people, tell us when you don’t understand and we can find the words together. Some of the concepts will be hard. There isn’t a guaranteed happy ending. Sometimes medicine and operations fail. I recognize it is so hard for patients and families to understand situations that we in the medical field have been training for for years, sometimes decades.

And it is hard on us too.

It is very hard to go to a family member and say that everything has been done. Families will tell you that their person is strong and a fighter. Absolutely, they are. But they are fighting against something that may not be winnable. With all of our technology, with all of our medical words, sometimes we don’t win. And it is hard to convey to families, and to ourselves, that sometimes the worse happens.

Believe me when I say that every death, and every set back, hurts. I just don’t have the words to convey it to you.

A common language will help us all.

Who wants language lessons?

The post-it says, ‘I LOVE teaching myself something new. New things learned- manipulating the snapboard to add new rooms and where patient education is at.’

I’ve been involved in the electronic health record since its inception at our hospital system. I a SME, or subject matter expert and I had input into parts of the build. I have been a Superuser for the surgeons since, able to answer their questions. I have been a Superuser for the staff since, able to help them optimize the program for their use.

I have been learning all the time. Especially when updates for the build comes out quarterly. I’m on the committee that reviews new parts of the build and I have input here as well. This group meets twice a month. This information learned here is taken to my department, and shared in the other committees that I am on.

Benjamin Franklin said it best “Tell me and I forget, teach me and I may remember, involve me and I learn.” Being involved definitely increase my learning. And when I teach others, I don’t do it for them, I explain the process, and have them perform the function under supervision.

The things that I learned that week that energized me? There are two new rooms for the OR; an operating room and a procedure room. The snapboard is a visual representation of the schedule for the OR. When we started there was 4 rooms on the snapboard. This is not the OR at a glance like I required for being evening charge. I added the c-section suite, and endoscopy rooms and this enabled me to keep track of where the CRNA may be. This also helped with creating addons. There is nothing more embarrassing then accepting an add on and, when the snapboard is opened, it is apparent that there is an endo or a section at the very time that you gave the surgeon and you have to call the surgeon back and tell them another time.

My snapboard currently has 6 ORs, 4 ENDOs, 2 C-section suites, and 4 ASC rooms. The two rooms that needed to be added are smack in the middle of all the rooms. Before I would have to reverse add the rooms, starting at the bottom of the now 17 room list. This was obnoxious. This time I decided to try something new. I highlighted OR 6 and clicked the add button on the right. Before the new room would be added at the end of all of the room. Because I told the program that I wanted the room added after OR 6, it added a blank room after OR 6. I added another room as well as there are 2 new rooms. And then I named them OR 7 and Procedure Room 8. And it worked. After I went to all the other nurses in the department and helped them add OR 7 and Procedure Room 8.

Is this new information? Maybe. Did it help me and all the nurses I helped add. Absolutely.

And to cap it off, I explored the pre-op tab while I was functioning as the 2nd PACU nurse. The OR has been missing a metric around pre-op patient education about foley catheter insertion. The nurse who runs our reports and I have been looking for an answer. This is the obnoxious part of the electronic health record; you must have the exact place to document an intervention. And I found it. Now to teach all the other nurses.

Because if you are not learning, you are dying. This is a paraphrase of a a quote by Robert T. Kiyosaki in which he said “The moment you stop learning, you’re dying.”

I completely agree. This is how we are different from automatons. We have to keep learning to live.

I am on vacation.

The same vacation we planned and paid for in 2020.

You know, the one that was my present for finishing my MSN. Yeah, that one.

And then a pandemic came and washed it all away.

And it was planned again. In September 2021. Uh, oh. Delta variant.

And planned again. In December 2021. Uh, oh, Omicron variant..

Well hell.

Planned for the 4th and final time as the time limits were running out. But there are still people dying! And cases are still surging due to BA.5. Universe says go now or lose the $15,000. Well, when you put it that way.

And to make it EXTRA difficult, school will start just as you are leaving. And you have to explain to the instructors why you are not in class.

But, at least you are in London.

Yeah, during the second heat wave of the summer. It is 95 degrees Fahrenheit today. It will get better on Monday, with temperatures in the high 70s. It can always be worse.

Go out in the beginning of the day and go back to the flat at noon before it gets too hot. And go out later, after 1800 when the sun begins to think about setting.

Greetings from vacation. Where it is just as hot here as at home, without air conditioning. Ah, well, vacation is meant to be an adventure.

Cookie Thursday is a Thing- No Heat Month continues…

Make for 8/11/22- Maza

I do not know the origin of this amazingness. But my mother corrected the spelling on the lounge board.

My parents would make this when we lived in California from the very ripe garden tomatoes. My dad liked to grow heirlooms.

They would serve it up with bread for dipping on sun dappled late afternoons in the Wine Country. We would sit on the deck, eating Maza, watching the fog roll in as the temperature dropped by as much as 50 degrees.

A fond food memory from CA. I find memory and the taste of food is intrinsically linked.

Maza

Very ripe tomatoes, almost to the point of being overripe-at least 4
Garlic- whatever you feel in your heart
1/4 c olive oil
Salt if desired
Stale bread for dipping

Chop tomatoes very fine and put in a bowl, including juice
Chop garlic very fine and add to tomatoes. We LOVE garlic and therefore I use at least a head, sometimes two. Add to bowl
Add olive oil and mix well

And you’re done!

Serve with cut up bread, sourdough if you can find it. Otherwise French bread is good

Like a lot of culinary awesomeness, Maza matures in flavor, so make in advance

Every time I make this for Cookie Thursday I have to explain what it is and urge people to just try it. I come back and the bowl is gone.

If there is any left over, a sacrilege really, it makes amazing tomato soup.

This is a perennial make for Cookie Thursday is a Thing. Nothing wrong with the classics.

Cookie Thursday exists as a breather for the department in the midst of sometimes chaos. And it is good to introduce new recipes to people who have not had it before. Kind of like introducing a new surgeon into the mix. (I know, a reach. But I have to relate it to OR somehow)

This is a good appetizer for lazy summer days, and it is best enjoyed in the summer, with tomatoes straight from the garden. If you add wine, that is your business. I assume you are an adult.

Back to school!

Not just for children anymore.

School begins in earnest this month for millions of school children.

And the hospital is doing a school supply drive.

I anticipate that this will be a smaller event than in years past. Inflation is high; a dollar just doesn’t stretch like it did before. Part of me just wants to donate the lot to a local school. This has happened before, recently. But I know that some of our team members are counting on the supplies. There just isn’t the drive to donate this year.

Like all of healthcare, our donating muscles are tired. What more can we be asked to do? We’ve been carrying this country through the pandemic, through the ones who value their personal freedom over the health of others. We are all tired of the mask.

Times are hard, I get it. Gas is expensive, and so is food. There just aren’t very good deals out there, not like in years past. I anticipated this. I think, as a double income no kids, it is our duty to donate to the school supply drives. My trunk is full of at least three people’s donations. I will add this to the supplies collected at the hospital and sort them out into extra-large ziploc bags. There have been zero, nada zilch backpack donations. The drive usually gets around 35. But I also don’t want to go out and panic buy, either.

And some of us are going back to colleges of all sorts: community college, trade schools, 4-year university, grad school. All sorts of degrees to be had!

There is an awful lot of learning going on around here.

If you need me this evening, I will have dragooned two volunteers into sorting with me.

But be nice to those going back to school. Some of us are deer in the headlights, at least for awhile.

(cough, cough, I’m talking about me)

Bump goes bogeyman.

Clutch goes the fingers around the pearls.

Shame, shame, chants the sheep. Only when it is convenient and nothing they think they need to be concerned about.

Hey, in case you’ve forgotten. Covid is still a killer. As of this morning ONE MILLION THIRTY THREE THOUSAND SIX HUNDRED SIXTY EIGHT Americans have died.

Poo, poo go the people who are bored with the pandemic and just want to go back to their lives. Can’t we just go back to our lives?

There is no back to pre-pandemic carefree society. Well, only carefree if you were wealthy enough and lived in a developed country to provide food and medical care. Or, you know, a white man. Then you had it pretty good. Hell, you still have it pretty good. What is happening with woman’s healthcare is the subject of a different post.

People are still getting sick at a high rate. How high? Well. we don’t know because like all of us, the US Congress is bored and sick of talking about that which still kills over a thousand people a week. They’d much rather get back to how to control women even more. Limited people are reporting their at home tests, positive or negative. Some cities are monitoring wastewater but even that does not give us the entire picture. The answer is we don’t know how many people have covid, how fast and wide it is spreading because people, Congress, your school, the community you live in, the state you live in, can’t be bothered anymore. They are bored of covid. It is like Jan chanting in the Brady Bunch when she is sick of her sister, “Covid, covid, covid.”

The ONLY positive is that hospitalizations are down, kind of. I’ve been monitoring hospitalizations in my hospital the entire pandemic, and while we HAD a few days with zero covid patients, the number has been sneaking up since June.

But to many, covid is old news. What is the new sexy disease that wants to hurt us?

Monkeypox.

Terrible name, really. Needs to be renamed. I’m looking at you WHO where it was announced that would be happening in short order. On June 15th.

Monkeypox is not a killer. Yet. There have been 5 deaths associated with Monkeypox in the world in 2022. Zero Americans have died of it.

What makes this a pearl clutching disease that allows people to shame the people who get infected is that this round, because this has been a disease of concern before, most of the infected are those men who have sex with other men.

I can hear the chins wagging from here.

I was a very young child when the AIDS epidemic started. But by the time I was in middle school, the shaming was in full force. There have been great books and plays about it, check it out for yourself. But the shaming energy feels very much the same.

As if those infected DESERVE it.

This is very much bullshit, of course.

Recap:

1. covid is still killing people
2. people should still be wearing their mask if the infection rate is high in their area
3. how do they know the infection rate is high in their area?
4. they don’t
5. Monkeypox is becoming a real concern
6. the US has reported more than 6,000 cases since the beginning of May
7. sound familiar yet?
8. don’t worry about not being able to find a vaccine
9. the US is and has been bungling the response to monkeypox
10. much like they bungled the response to covid
11. does anyone else feel a sense of doom?
12. as if there is something just waiting out there to emerge?
13. no, just me?
14. Okay, then, have a good day
15. wear your mask if your community has a high level of covid, or you know, just wear the mask
16. wash your hands
17. stop shaming monkeypox victims
18. what are you? 5?

But don’t let us stop your cookouts and vacations. Sure.

If something that is trying to kill you could have a bit more of your attention, that would be great!

The gown card reads ‘I am not PACU’s bitch’.

Simple.

Declarative.

Tells the entire story in 5 words.

I was definitely frustrated when I wrote this gown card. I could also probably tell you who I was frustrated by. And why.

But I wrote the card to remind myself to stand up to this person. And their unreasonable demands.

The feeling within the department is I work with PACU for the better of the department.

Yes, individuals may frustrate me and make me want to scream. At the end it is their misfunction that is at play here. Something tells them that I am an easy mark for bullying by yelling at me for not doing their job in addition to my own. Something is wrong.

I remember this. Or, at least, I remember the setup for why I wrote this card. Someone was trying to bully me into doing their job as well for reasons that made sense in their head. I simply chose not to entertain them.

I did not yell. I did not curse. As those would have been counterproductive.

Instead I worked with this person to get the patient to their room. I understood that this person was frustrated by a lot of things outside of work and things they had no control over. I also had no control over these things.

The proverb of you catch more flies with honey than with vinegar is true. And very useful for a harmonious department. Did this person and I have a later conversation as to why what they were demanding was not appropriate for the workplace and that I would appreciate not being bullied? Yes. Simply and without emotion I explained their demands were not going to be met with me jumping to their bark. And they haven’t barked at me since.

The proverb goes both ways. If you want something, don’t tell me I need to do it or make demands. Simply ask.

Having this conversation about tone and timing has gone a long way to calming the waters between that person and myself. They now know I can’t be bullied and I don’t get mad enough to yell. But I will help if asked. And all subsequent times that I was asked to do something for the PACU department I can see the change in the words when they actively think about what they are asking.

Don’t get mad, and curse, and stomp. For pete’s sake don’t run to the bosses and tattle. We are all adults. Ask for a frank and genuine conversation after the current situation has cooled. It will be amazing what can happen.

The OR being a clean environment full of clean edges, and sterile surfaces during a case, is a dearth of places to write. There just isn’t a lot of paper to write anything. Stacks of paper are frowned upon because they can be dust catchers. And blood can go flying, especially during a total hip.

You could theoretically write on the back of the schedule or the preference card. Those pieces of paper are handy. And since the schedule or the preference card is only printed on one side, the entire back side of the page is empty. Plenty of room to make notes.

The whiteboard is also a place to write. On the bottom, under the patient’s name, birthday, procedure, surgeon and allergies, there can be 18 inches of space. I use the whiteboard to write down things all the time; I note down times, and results from the pathologist if doing a frozen, I write down information while I am on the surgeon’s phone answering a page, I write down the name of the specimens, especially if the surgeon is rattling them off too fast for me to input the orders. If the case is over too quickly and I have not finished charting, I will take a picture of my notes and refer back to the picture when I am finishing charting. I very carefully do not take a picture of the patient’s name or detail and I delete the picture after I am done.

That’s why I don’t like to make important notes that I have to address and complete on the back of a schedule or preference card, there is the potential for too many HIPAA violations. And I’d rather not lose my job for a violation. And it is not appropriate for the patients to have their information bandied about.

Best not.

I am not talking about notes that are about the patient.

I am talking about notes to yourself about future self things.

The to do lists, the next case notes, the reminders about picking up little Timmy from afterschool event. All the things.

There is a dearth of writing materials in the OR. In a pinch, I have been known to write on my scrubs, or on my hand. I routinely keep a post-it on the back of my badge for when I need to take notes.

Another widely used writing paper that all the OR nurses and techs know about is the gown card. This is a 2.5 in x 4.5 in card that is attached to the gowns to allow the wearer to turn in a sterile manner.

These gown cards are useful as hell.

And I cannot keep from collecting them. They are that useful. I have about 10 in my locker at all times, and about 500 at my house because invariably they go home with me.

Things that I have on the gown cards on my desk:

1. to do list for home
2. to do list for work
3. to do list for school
4. Dispatches from the Evening Shift notes. This comes in handy on Sundays
5. Cookie Thursday is a Thing themes
6. Cookie Thursday is a Thing recipes
7. Christmas list
8. A reminder for the free library classes I have signed up for

The point is that the gown cards are really useful. And a recyclable resource that is self propagating. This is because there are at least 2 gowns opened per case, more if there is a break relief, or a PA.

I could make notes on my phone but I don’t like to be seen by the surgeon “playing” with my phone. It’s just not a good look.

This makes me analog in a digital world. And that is okay.

August.

Much has been written about August. According to the Farmers’ Almanac, July 3-August 11 are some of the hottest days of the year. The dog days, where colloquial wisdom explains that is because the dogs are panting in the shade because it’s so hot.

I mean, yes, but wrong.

Yes, these are the hottest days of summer.

No, that is not why they are considered the dog days of summer. The ancient Greeks noticed that the hottest days of summer coincided with the rising of Sirius, the dog star. Hence, these are the dog days of summer. Am I Sirius? You bet, and don’t call me Sirius. (Any Airplane! fans reading? just me, okay)

In my house the cats do not lie panting in the shade. They do, however, lie on the floor, eschewing the cat beds and furniture.

Yes, I don’t want to turn on my oven to bake cookies. It is too hot to add more heat to our house.

That is the origin story of No Heat August, a Cookie Thursday is a Thing exclusive. (I mean, I think)

Every week will be a different no bake make. Today’s cookie is the fudgy cocoa no bakes. I know I had these growing up, did you?

Of course, since Cookie Thursday is a Thing is about experimentation, I wondered a couple of years ago if I could add unsweetened coconut to the cookies. Would they firm up as much? Would there be any substantive change to the cookie? The answer is yes, they firm up just fine, just a little softer, and no there is no real change to the texture of the taste. There is a very slight coconut flavor to them.

There is another meaning to the word august. It doesn’t mean the 8th month of the Gregorian calendar. It also means marked by majestic dignity or grandeur according to Merriam-Webster. For men I think it is a double-edged insult. It sounds majestic, I mean that is in the definition, but I think it is as much an insult as calling a woman’s features handsome. This is done in many 19th century books and if you read between the lines the woman is to be pitied for not being pretty. Saying a man has an august bearing belittles them for not being handsome. At least it does to me.

Okay, tangent city.

The bake of the week is no bake cookies with peanut butter, oatmeal, cocoa. No flour or eggs required. Or oven, which is the point of no heat theme for August.

Before I start back up in school I’ve been reading and watching videos, I came across and I watched a video where a nurse was denied a continued discount being offered to nurses from a store. She got the discount at the time but was warned that she was not eligible for it in the future. She had her license pulled up from the stateon her phone, and her badge and these were both showed as proof that she is a nurse. Her takeaway, and mine really, is that because she is an LPN, and licensed by the state, she is a nurse. This is absolutely true. And enraging that she is second classed because she is an LPN, not an RN.

The definition of nurse, according to Merriam-Webster, is a ‘licensed health-care professional who practices independently or is supervised by a physician, or dentist and who is skilled in promoting and maintaining health’. The Licensed Practical Nurse (LPN) is a person who has undergone training and obtained a license (as from a state) conferring authorization to provide routine care for the sick. The Registered Nurse (RN) is a graduate trained nurse who has been licensed by a state authority after qualifying for registration.

This is a very dry way of saying that both are real nurses. Both take state licensure exams, both care for the sick and injured. From what I read when researching this topic, the LVN requires less education; an RN can have a diploma of nursing, an associate’s degree in nursing, a bachelor’s degree in nurse, or higher. For some people the education to be an LVN can be less daunting. Of course, others view it as a stepping stone before they continue their education.

Organizations also have to watch for classism, or othering of the LVN. In the hospitals that I’ve worked in, some in leadership look down on the LVN because they “don’t have the degree”. So what? They are caring for those who need help. There will be some things they are not qualified to do, and that’s okay. Trust me when I say every hand on deck is a release of the pressure on the unit. Clear roles and responsibilities go a long way for this. Just because the nurse is an LVN does not mean that they are not smart enough.

I’ve heard jokes that being an LVN means that they are not smart enough for an RN program.

Egad! Do you hear yourself?

Being an LVN does not mean that! It means that this is what they wanted, maybe because the nurse in question didn’t have the opportunity to do an RN course, which can be longer than an LVN course. I know lots of nurses who started as LVNs, went back to school for their RN while working as an LVN.

This is not a Pinocchio moment. The LVN is not waiting for a visit from the Blue Fairy for an enchantment so they can be a real nurse. They are a real nurse.

So sorry your narrow-mindedness and ignorance has got in the way of your recognizing an LVN is a real nurse.

The woman in the video seemed genuinely distressed over this encounter. And I hurt for her, and am mad for her and other LVN that are confronted with this every day.

Say it with me, everyone, PEOPLE!

(reminder that people IS a swear word that can mean many things, but most commonly it is a derogatory term when used in the correct context)