Yeah, that is a riff on Blue Oyster Cult’s Don’t Fear the Reapers. While researching the song I realized that it was released in 1975. I also learned that it is a song about not fearing death. And if that is not the perfect hospital song, I don’t know what is.

July 1st is the start of the intern year for all of the medical students that graduate in May. They may be nervous on their first foray into, you know, actual medicine. To what they have gone from at least 8 years of college for. June 30th is when the previous year’s crop of interns graduates in residency.

It is also feared among the staff of the hospital.

And there are memes aplenty.

In the United States it is known as the July Effect. And in the UK they call it the Killing Season. The idea that a patient will have sub-standard care because there is a new intern is not borne out by the literature. It is just that medical type people are alarmed by what could potentially happen, not what actually happens. (Hughes, 2017)

But why?

The July 1st start for the interns is not to be feared. If they are left alone on their first month, without supervising doctors who are supposed to be teaching them, that is the flaw of the system, not the intern.

This is how the medical system grows doctors in the United States. It is a stair step approach. They begin on the lowest run. Internship is the first rung, followed by residency, however many years is required and it changes by specialty, and then fellowship, and then further fellowship in a more pinpoint direction, and then full fledged doctor. It is the rung above that is responsible to teaching and guiding the interns, along with a supervising doctor that all the residents and interns report tp.

Hey, doc, act your internship, not your residency doesn’t have quite the same ring. Some interns are cocky, finally freed from the shackles of their medical school bounds. This does happen because interns are people too. And people think they are smarter and better trained than they actually are. It doesn’t last long, though. A new intern figures out pretty quickly that there is still more to be learned, and other former interns, known as residents, are there to help them along the path.

But the impact on patients, on human life? Is minimal.

And intern season, is here and then gone.

Only for the next intern crop to rise.

Hughes E. (2017) July Effect? Maybe not. CMAJ. 2017 Aug 14;189(32):E1050-E1051. doi: 10.1503/cmaj.1095466. PMID: 28808121; PMCID: PMC5555760.

The gown card reads ‘being addressed as nurse’.

Just nurse.

And a lower case ‘n’ at that.

As if that is your name.

Hey, if you are going to address me as nurse, I am at least an upper case ‘N’. I have my dignity. And more college degrees than you.

Probably.

I have 3. And I am working on #4. Because I’m that person that thinks that school is fun.

Before, it was understood that nurses would stand and give the doctor our seat in the nursing station. Thankfully, this kind of thinking has drifted away. Nurses today are not the handmaiden of the doctor. Our input regarding the patient’s condition is what drives many of the orders that the doctor writes.

For example, the Nurse calls the doctor with this report, “Your patient XYZ has a temperature of 104, Dr. Q. I have decreased the temperature of the room, had them take off the four sweaters they were wearing, and given them an tepid bath, but perhaps pharmacological intervention is necessary.”

Note the respectful address for the doctor. That’s another post.

I am more than my job class. Under the nurse umbrella. There are many types of registered nurses in the hospital.

Should we start addressing people as ‘Patient?’. As in Patient presents with… No, that would be ludicrous. There are many patients in an area such as the ER, they can’t all be addressed as Patient. How are you going to tell them apart?

Maybe by using their full name, AND an identifying feature that is mostly unique to them. Like their birthday? But that is what we do.

We would never say the patient in room 313 is presenting with… I am going to stop you right there. Nope, don’t care what they are presenting with, I need more information in order to identify and treat the patient.

Until people come standard with QR codes, we just fumble along. Using our names and birthdays as identifiers when we are in the healthcare system.

Patients are treated as whole individuals, perhaps we should do the same for the healthcare workers caring for them?

So we can tell Patient from Patient.

And Nurse from Nurse.

It is a fact of life that sometimes kids need surgery. Just like adults.

It is a fact of life that some of these kids will be scared out of their minds. Just like adults.

It is a fact of life that sometimes these kids will be wise asses. Just like adults.

For every kid that cries when you open the door, there will be the kid that asks all the questions.

For every kid that screams when an IV is started, there will be the kid that watches in fascination. Even when the parent that is with them pales and sits down.

For every kid that fights the monkey cologne (we breathe them down with anesthesia gases, especially when they don’t have an IV and it stinks), there will be the kid that just looks trustingly at you while they are breathing and while you are holding their hand before they go to sleep.

My favorite are the kids who ask impossible questions. You can tell they are just trying to get one up on the adults by the glimmer in their eye and the cheeky smile. This is also a substrate of the ones that all the questions.

When I was the service line leader in charge of pediatric trauma at an orthopedic hospital I got to know about kids and the different reactions to anesthesia, to being in an unfamiliar environment, and away from their parents.

Some of the impossible questions that they ask, trying to trip up the adults.

Why is the sky blue? This was a frequent question. I remember why the sky is blue from my high school physics class. And I tell them it has to do with the refraction of the sunlight through the atmosphere and particles in the atmosphere and which wavelengths of colors get scattered the most. You can see them thinking about the answer hard.

The follow up question will always be why the sky is different colors at sunrise or sunset. I tell them it has to do with the curvature of the earth and how the different wavelengths of colors are more prevalent due to that curve.

Do you think there are aliens? I see you, little science fiction geek, kudos to your parents.

It shocks the kids when the adult in the room has a ready answer.

Some kids were chill, just like adults.

Some kids were not, just like adults.

Pediatric surgery is not working on small adults. But there are some similarities.

The second month of Inflation Baking concludes with crust cookies.

What are crust cookies?

I have been asking all sorts of people if they know what crust cookies are.

And the answer is a resounding deer in the headlights look.

Must be a midwestern thing.

What do you do with the extra dough that is left over from a pie crust?

You add butter and a cinnamon sugar topping. And bake until golden brown. Voila! Crust cookies.

In all honesty, I thought everyone did this.

Apparently not.

Of course, Cookie Thursday is a Thing was started because a coworker had never had a home made cookie. I mean, the idea is not entirely foreign.

And it being Inflation Baking I was sifting through recipes from the Great Depression and War World II, and I ran across this recipe that called for a oil pastry crust.

I had rarely head of such a thing. According to Alton Brown of Good Eats, the best pastry is a combination of Crisco or something similar and butter. And an oil pastry would fit in nicely with the Inflation Baking theme.

Inflation. The big bad this is currently plaguing the world. Along with all the other things plaguing us. Including an actual, you know, plague called covid.

This is due to a bunch of factors, most related to covid. There was an increase in buying because people were bored at home during lockdown that continued as the world started to get its feet again. There were manufacturing problems in Asia, due to covid. There was a shipping crisis because there were limited people to off load the ships, due to covid. There is a trucking crisis due to covid and desire for increased wages from the truckers. There is a gas price jump that is decades in the making and, in my opinion, fueled by corporate greed. The corporations seeking to increase profits do not come off well in this nightmare of a tale.

Inflation bites into people’s wallets that had barely had time to recover from the pandemic. Yes, a section of society is making more due to the Great Resignation, but cost of living has gone up dramatically.

And Cookie Thursday is a Thing is a one woman show, and she foots the bill. This is what started me on the path of Inflation Baking. It’s been 2 months since I used butter in Cookie Thursday is a Thing.

I would continue the Inflation Baking theme, but I have already chosen a new theme for July. And you’ll just have to wait until next week to find out what it is.

Next time you make a pie crust, reserve a little to make crust cookies. Or, heck, make a pie crust specifically for crust cookies. And I made a batch, using the vintage oil pastry recipe. Tastes good but structural integrity is lacking. I wonder if adding cheese to the pie dough would make that better. But that is an experiment for another month. The memory of these is an integral part of my childhood.

You won’t regret it.

I know, such a news flash.

The world is tired, lady.

There is war.

There are fires.

There are ever increasing in strength hurricanes.

There are ever increasing temperatures that are rendering some places all but uninhabitable.

There is a supreme court in the US that has decided that a woman has no control over her own body. For an idea of a child. It isn’t a child; it is a clump of cells with potential.

Next up is the war on birth control. Because why not?

There is climate change that is quite handily the fault of humans. Same humans who don’t believe in it look to the sky when there is a disaster and shriek why? Um, because we are poisoning the planet and you can’t get your head around the whole sacrifice just a little bit of comfort for the greater good idea.

Inflation I’ll cover tomorrow.

It is a scary time to be a human.

It definitely is a scary time to be a woman.

There is so much that needs to be top of mind and top of wallet it is exhausting.

Yeah, but healthcare workers have borne the brunt of the world’s health for two and a half years now. And it is getting heavy.

And since covid can’t go away until everyone takes it seriously and I guess we are in a holding pattern there too.

And now monkeypox (to be renamed by the WHO) has gotten a foothold and infections are increasing. Oh, boy.

Breathe.

Just breathe.

And then pull up your big girl or boy panties and get to work.

The environment needs us.

Humans need us.

Women who are in danger every day need us.

The world needs us.

Let’s get to work.

Yes, this is in reference to the Supreme Court overturning Roe vs Wade. And this is notes that I’ve been collecting all weekend and may be disjointed.

As a person with XX chromosomes they’ve stripped me away of rights. The right of bodily autonomy, to decide what happens to their body.

This decision tells me that as a woman my only value is my uterus and what it may or may not contain. My thoughts, fears, concerns no longer have any bearing on my life and my personhood once I become pregnant. This is bullshit.

In the leaked opinion, Alito referenced the number of women nearly “1 million women were seeking to adopt children in 2002, whereas the domestic supply of infants relinquished at birth or within the first month of life and available to be adopted had become virtually nonexistent”. I mean, what the actual fuck? I presume these women are unable to have pregnancies and babies of their own and the answer that he stumbled upon is to have other women who don’t want their children carry the child, pay for pregnancy and birth and then give up the baby for adoption? Double what the actual fuck. There is a lot to unpack even there.

The Court seems to be grabbing for a tarnished ring that gives them a win for the 20% of Americans who want abortion overturned. Because it has never happened to them. Or because they have money and access to care for themselves and their children. Or because they can support themselves and the child they already have. Or because they’ve never been told that the wanted baby they are carrying is desperate ill and will not survive continued pregnancy or birth. Or because they have access to childcare while they work to earn money to support the child. Or because they haven’t been told another pregnancy will kill them.

So, you say that all laws have to be grounded in the constitution and that abortion is not mentioned. I’m sorry, what about how during the 18th century and the founding of this country abortion was legal until the quickening (roughly 15-20 weeks). I mean women are barely mentioned in the constitution, why would this have been mentioned? Like, at all. We know the men of the Court are not going to think about that and the woman who voted to overturn only sees the fractured truth that she thinks her god demands.

There will be more death. America already has the highest mortality during pregnancy and the post-partum. 23.8 dead in 100,000 births. This will only serve to heighten it. And the racial disparity is stunning and not in a good way.

There will be far flung reverberations to the economy, to healthcare, to having even OB-GYNs available, as abortion goes underground again. And don’t point that there are TWENTY-TWO states that do not have laws on the books that make abortion illegal. Out of fifty or less than 50%. That is 56,000,000 women of childbearing age. How are women supposed to get to these states? How are these states going to handle the influx of patients? And the word I think you are searching for is that is not illegal YET.

And this decision opens up other rights that are held dear by the majority of the population that are grounded in the 14th Amendment. This includes gay marriage, biracial marriage, and birth control. Some people who have the megaphone right now don’t believe in those things. They will be next on the chopping block. The ability to prescribe and take birth control will be on the docket soon.

I fear for the young women of this country. I truly do. Doesn’t impact me, but will impact my nieces and nephews. Because this absolutely impacts boys.

I am sorry that the world has moved beyond what you think is familiar and comfortable. I am sorry that the world has left you behind and grasping at ideals from a time past that are no longer relevant. I am sorry that you perceive this as a weakening of your power and control over women.

Speaking to women, this shows that we are viewed as a vessel only, as chattel, and stripped of our own self-determination, which is antithetical to the Constitution. Our value has been sunk to that of a broodmare, and our only value is in the children that we can bear.

This is forced birth. Where are the people who have been chanting my body, my rights about masks and vaccinations? Or, are they the same people behind this abomination?

As a gender we are less free today then we were a week ago. Aren’t you tired of men telling you you can do with your body? I am.

The overall message being broadcast to me, my sisters, my nieces, all persons with XX genes is that as woman, there is no greater contribution to society than the ability to reproduce.

Are there such things as “convenience abortions”? I am sure there are. But all the D&Cs and D&Es that I’ve circulated have been for wanted pregnancies. I know that this is a talking point of the anti-choice.

Let’s discuss why some women seek abortion for wanted children. It is because they have been told that their child will not survive continued pregnancy and will have limited survivable outside of the womb. We are to carry these doomed children, birth them, and watch them die, or live in agony for less than a year. Makes complete sense to no one.

This is not an argument about the child, or potential child. This is vicious misogyny.

Ar-15s are not in the constitution but they have more rights than us and are allowed to exist. Why?

You bet I’m pissed.

And afraid for those who do not access to get to a state with legalized abortion.

And afraid for those who enjoy the marriage rights, even in they are gay.

And afraid for those who enjoy the marriage rights, even if one is a black and the other white.

And afraid for those who want to access and take birth control to have what little say they have left over their bodies.

I’m sick of having a man tell me what I can and cannot do with my body. Who makes him right? Because he has a penis?

Hell, yes, I’m mad and willing to work for others.

The gown card reads ‘stickerectomy.’

That’s it.

One word.

-ecomy is the removal of.

Stickerectomy is the removal of stickers.

In this instance, it refers to the removal of the excessive amount of EKG stickers on a chest. These stickers are usually placed in the ER for monitoring.

And sometimes the ER uses the EKG monitor in the room in place of a 12-lead EKG machine. This gives the treating physician information about the electrical activity of the heart. And this information tells the physician, and the nurse who has gained knowledge about EKG, about how the heart is doing.

I’m not sure if you know this but the heart is integral to the human condition.

Of course, in my quest to know all the things I have done classes and extensive reading on the EKG squiggles. And this was useful when I was an EKG tech while I was in nursing school.

But once the test is done, or the results have been interpreted by the doc, the stickers are left on.

Sometimes this is useful. Especially if there needs to be another read later after an intervention such as medication has been given. But that’s it.

And sometimes the EKG stickers are ones that the ambulance uses. You can always tell those at my hospital as they are different color and shape than the ones that are routinely used in the hospital. Even if the patient has outside of ER stickers they are not usually in the correct place and so extra stickers are placed on.

And the stickers remain on. They pull a bit when being removed and patients may object to it, especially if they have been placed over chest hair.

Once a patient is under anesthesia in the OR I make a point of removing all the extra stickers. Of doing a stickerectomy. The most I have removed prior to a surgery was 26. It was a combination of ambulance and hospital stickers.

Remove the extra stickers. They are probably going to be in the way, especially for a belly case. And the patient definitely doesn’t need to go home with them.

I’ve been noticing a trend in my posts. They sometimes can be a downer, with an odd funny one thrown in. I’ve decided to be more intentional with the funny ones. Yes, the world is a bit of a scary place but there is humor to be found, even in healthcare and nursing. This is the first Friday Funsies post.

Of course, my humor isn’t for everyone. It is dark and can be self-deprecating.

Oh, well.

In an effort to learn all the things that I am doing during the run-up to school starting in August, and also learning things I think I need to know prior to school, I’ve been doing classes and webinars. What about? All manner of things.

The use of UV disinfection for hospital rooms. The cleaning of the instrumentation and the special cleaning methods used for high level disinfection things that can’t be sterilized. More about blogging and WordPress. More about writing in general. The funniest one I’ve done is You’re Not a Shitty Writer series. This one is about the self-doubt that all writers have. I finished up the AORN Expo education that I did not get to do in person because of conflicting times. I did investing for dummies (not it’s actual title), and a how to not freak out when the market is webinar.

The point is I do 3-4 hours of education a week. Because if not me, then who?

This last week I was in an Excel class put on by the local library. There are many classes that my library put on; this is the third class I’ve been to. And I know I need a refreshed on using Excel as I will be using it extensively during university.

It was meant to be a class of 5, but just myself and another showed up. A 12-year-old whose father had signed them up and accompanied them to class for half of it.

The instructor was showing us the various bells and whistles of setting up a basic Excel workbook page. And the 12-year-old and I were following along, doing the exercised in tandem with the instructor on the library computers. Until it came time to save.

In Excel there are multiple ways to do pretty much everything. This holds true with saving. There is the menu button, there is the save icon at the top, there is Control S.

The instructor told us to use the save icon at the top left of the screen. This looks like a floppy disc. The 12-year-old couldn’t find it. Said they didn’t know what a floppy disc was.

The instructor and I shared a look. Of course, the kid had never been exposed to a floppy disc as the only world they knew was cloud based.

We did not laugh. It was not the kid’s fault that technology had changed since we’ve learned about technology.

How to get Microsoft to change their save icon? Letter writing campaign? Or a TikTok?

The juxtaposition between generations in using the computer. But I think it is emblematic of all generational push and pull. And this is why the next education I seek out will be about teaching different generations. Because if i am serious about teaching college I must learn how to speak their language.

I almost said cool kid language, but I’ve never been cool.

And I know that learning about generational education styles will let me educate other healthcare workers in the hospital.

Yeah, this was only mildly funny. I’ll try harder next week.

Inflation baking continues.

I ONLY make chex mix in December. Seriously, this is a hard and fast rule in my kitchen. Much to the dismay of my coworkers and friends who enjoy my recipe.

But it is now 6 months to the holidays. And I think we need a little encouragement/fun with the inflation, and price of gas, and pandemic, and war in Ukraine, and… Well, it’s a lot. And I know that out of season chex mix will make my coworkers smile. And none of us are guaranteed another December.

And it has been 95-100 degrees Fahrenheit here in the American South and it is too hot to run the oven during the day. My chex mix recipe bakes low and slow because everything contained in it is already cooked. The oven is set to 225 and I bake it for 2 hours, sometimes less, with frequent stirring. It smells amazing though.

What makes this recipe an inflation baking is the usage of ingredients already in the house. I overbought Chex cereal when it was on sale and I have been storing the excess for this upcoming baking season and they weren’t going to expire until January 2023. Why not use it now?

Also what makes this recipe an inflation bake is the utilization of plantain chips in place of pretzels instead of going out and buying pretzels. I had the plantain chips and I needed to use them so into the mix they went. These are garlic plantain chips. I have no idea how people are going to react. And as this is an experimentation, that is half of the fun.

When I was writing on the board what would be the inflation baking cookie of the week I added a note to remind people that the holidays are just 6 months away. And have they started shopping? Or started saving, although that would be a high bar what with the aforementioned worldly ills.

One thing the slow moving organization frenzy that I am in has been good for is finding presents that I bought and neglected to give to people. Sometimes because I found something better, sometimes I because I forgot where I hid it from myself. Now I have a small pile of presents ready to be gifted at the holiday season. It’s a start. Every little bit helps.

The use of inflation baking as a theme these last two months is to encourage the use of ingredients that already are existing in my house. My baking pantry was stuffed to the gills with Cookie Thursday is a Thing ingredients; it is less stuffed now.

Hospitals and healthcare professionals also suffer from this scarcity mindset or mentality. We are always saving in case a thing can be useful in the future. The sticker is that you have to utilize the thing that you’ve saved, not just buy the newest, shiny sexy thing.

As I wait for August because all the exciting things happen or begin in August, I have been doing a lot of continuing education. I mean I have to keep the learning muscles up and ready for school. I get different CEUs from different sources. Or. sometimes, I don’t get CEUs but they are important talks to attend.

Including different avenues from the hospital. This past month I did a research symposium where I learned a lot. And my advisor for university was the key note speaker. And at the end of last month I did a class on the Pause. This was not the surgical time out. This refers to the moment of silence among the healthcare workers after an unsuccessful code blue and the patient dies.

Because we are not going to win them all.

This is an intentional pause.

It is done to acknowledge the patient who has just died. Because they were a person with hopes and dreams and desires in life. And they had every expectation of going forward with that life.

Until they couldn’t.

It is also done to acknowledge the healthcare team who were working to save them. And all their individual effort during the code.

And couldn’t.

The Pause is an international practice. And was started in 2009 by Johnathan Bartels, an emergency room nurse. And has spread since, even to television shows. I think this is something that has always been done, to some extent, but now it has a name. And naming things is influential.

This is a way to acknowledge that with all of our medications, and tools, and machines, this person who had value was unable to be saved. It is a moment to recognize that something momentous has happened. And while momentous things happen every shift, especially in the ER, this was the patient’s momentous thing. And it was also a thing that happened to the healthcare workers.

To me, the pause is a moment to recognize that this has happened, to realize that there will be changes in the survivors lives, and to realize that were will be a change in my own life. Because every death impacts the healthcare worker. The pause allows healthcare workers to realize that something has happened, to acknowledge that it happened, and to set it aside to help the next patient.

This 1 hour webinar was powerful. And made me think about the times I have pronounced a patient dead while working in med surg. And all the times that perhaps went unacknowledged in the last two years as patients died alone in their beds. Except for the healthcare workers who were there. And they just kept giving care to their next patient after pausing to reflect, very briefly, on the one who just died.

I hope that understanding that someone was there when they couldn’t be gives comfort to the families.