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.

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.