Being an LGBT+ ally is not convenient. Or easy. And yet it is not about me. I cannot stay silent over the miscarriage of justice that is happening right now with all the legislation being passed in states across the country banning gender-affirming care.

I’m going to let you in on a secret. Come closer.

GENDER-AFFIRMING CARE IS NOT SURGERY.

Do you even know what you are afraid of?

These are people who have been struggling for a long time to name the thing that makes their very existence shitty and you want to ban it?

Now you’ve done it. You’ve made an innocent, struggling, very small section of the trans population into the boogeyman.

And what’s worse, you’ve cajoled and dripped your poison into the ears of anyone who wants to “save the children”.

Well, you are the ones targeting the children that are suffering.

And not in a positive way.

We already knew that the LGBT+ population was at risk for mental health problems and suicide. And you’ve made it worse.

Are you proud of hating on a minority group?

Oh, who am I kidding?

Of course, you are.

And did you realize that gender-affirming care encompasses so much more than the vital care needed for people who are genuinely in pain?

Oh, it is a wide range of surgeries, and medication, and therapy.

It is also hair restoration.

And breast implants

And, hell, breast reduction could be and is considered top surgery.

States and governors and mayors are bleating about mental health in the next breath as they ban gender-affirming care.

Of course, they are.

But they don’t stop to think that their actions and the mob they have whipped up is a big cause of the mental health issues!

Of course you don’t.

Stop reacting the way they want you to in their quest for power and control.

And start thinking.

Maybe talk to a trans youth or a trans adult. Do you even know what you are squawking about?

But of course you can’t.

Because then you might empathize with them.

I’m sorry that you don’t have the empathy or sympathy to try to understand.

And that does nothing about ceding your brain to the people who want power and control.

I’m getting a very strong 1930s vibe here. So many of our grandparents and great-grandparents said, “Never again.”?

And we are letting it happen.

In real-time.

Again.

The post-it reads “Tacit approval for nurses watching old nurses go against policy.”

Can’t say it any plainer than that.

Tacit approval is accepting, without words, an action by another.

Even if the other is wrong.

Even if the action is wrong.

Even if no one is hurt.

Especially when the other is getting away with it.

As an elder nurse with 22 years of experience, I follow policy and procedure.

Even if I don’t agree with it.

Even if it would be easier to do something else.

For one, this keeps me out of trouble.

For another, this allows newer nurses to shadow the proper ways of nursing without telling them the correct ways of nursing. Because some of the new nurses close their ears to instruction. And then bleat “I didn’t know!” when caught.

This is why it is important to always walk the walk, not just talk the talk.

Talk is cheap.

And someone is ALWAYS watching.

Oh, boy.

Being a teaching assistant has given me all sorts of perspective on myself as a student.

And how I must have driven the teachers nuts in my last two degrees.

I’ve always been a last-minute Lucy kind of student.

And I mean ALWAYS.

For as long as I can remember.

But now that I get notifications from one of the classes that I am TAing when an assignment or quiz is submitted. I see the early bloomers, and the plod alongs and the other last minute Lucys.

And it kind of makes me anxious.

You see I read the assignment, think about the assignment, think about the assignment more, and then sit down and write the assignment. Full stop.

In the days when I was working all the hours that were and taking 88 hours of call a week this was a survival mechanism.

Those days are past. And I am still approaching classes this way.

But why?

In April when I had a ton of stuff due, I happened upon the post-it method. You remember from Post-it and gown card Sundays that I love to take notes.

In April I decided to expand my note-taking to post-it notes and I leave them in a prominent location so I don’t forget. I was using a whiteboard to track meetings and such and I still do for assignments.

And in my third class my assignments were going in two or three days before they were due. There is still some anxiety to this. What if I think of something better in the interim? Versus. What if I just submit and move on?

Overall the early turn-ins seem to be working better for me.

Ripping off the completed post-it off the stack is very satisfying.

I have been sharing this method with the students that I am counseling when they are worried about forgetting anything.

It has been so successful personally that I’ve started post-its on meetings that will be coming up

It seems to be working well.

I will also be taking this into Fall Semester.

I will also be taking the do assignments when they open up mindset.

We’ll see how it goes.

For this month’s theme things are going to progress a little differently.

The first cookie I ever made on my own was the chocolate chip cookie. I distinctly remember my friend Summer and I baking these in the summer after 8th-grade graduation.

That was also the summer she tried to get me to smoke pot, which I declined vehemently and it broke up our friendship. That is a story for another day.

But the Toll House chocolate chip cookie is engrained into my memory banks. I use the cookie without chocolate chips as a base cookie for many of the Cookie Thursday is a Thing bakes.

2 sticks butter, 2/4 c each brown sugar and white sugar, 1 tsp vanilla, 2 eggs, 2 1/4 c flour, 1 tsp baking soda, 1 tsp salt. Bake at 350 degrees until done.

Easy, right?

The theme for the month is Chocolate Chip cookie. I’ve done this theme before with different additives such as jalapeno, or sourdough, or sour cream, or peanut butter chips.

But what about the basic cookie recipe. How can I mess with that?

I have plans.

This first week will be the original cookie recipe. And I will change an ingredient in the recipe each subsequent week. Except for the 4th week, I will be out of reach of my oven on vacation.

This week will build the rest of the month. And the basic cookie will be the make.

I have heard this many times.

So many times.

And there are different answers to the question. Depending on which month it is.

Is there a holiday this week or next? Just like in yesterday’s Tuesday Thought.

Is this week near a major school holiday such as Spring Break, or Summer vacation, or Christmas break?

Most of the surgeons have children still in school. And they want to spend as much time as possible with them.

Is there a major conference going on?

Such as Academy for orthopedic surgeons.

Is there a major golf tournament nearby? Or on the television.

This depends on if the surgeons play golf. Hint, most of them do.

Is there a major sporting event going on?

The Super Bowl, the World Series, the final race in the Nascar Cup Series, March Madness.

Are there any local Nascar races?

Same reason as the sports ones.

The biggest is the week of the month the weird week falls on.

Specifically the 5th week of the month.

Most ORs allocate case time using a block schedule.

Not all months have a 5th week and the block schedule cannot accommodate it.

This week happens to be the 5th week of May.

Therefore the OR schedule is rather light.

Don’t worry; it will rebound on Thursday. Which is the first Thursday of June. Or Friday, which is the first Friday of June.

The surgeons haven’t run out of patients yet.

Of course, politics may be exerting some influence. Such as the debt ceiling crisis that is currently embroiling Washington DC. Patients and surgeons may be feeling the pressure a bit.

The schedule may be light. But it will rebound soon enough.

And the staff will be wishing for the light days.

Yeah, I know yesterday was Monday.

Yesterday was also a holiday and I have something to tell you about holidays in the operating room.

For years and years and years, it was myself and a tech on the evening shift. The tech changed depending on what day it was but we had a pretty good rhythm going.

Case came in, we did it.

Case didn’t come in, we stocked and set up rooms for the next day.

Years and years and years, remember?

Holiday weeks just threw us off our game.

It didn’t matter what holiday, it impacted the schedule.

Mostly an increase in evening cases.

And also the people who sober up AFTER the holiday and realize they need medical intervention.

Surgeons were hot to get out of time trying to squeeze in just one more case. Because they didn’t want to dump on their partners and they had a plane to catch, naturally.

And if we were going on a personal holiday, you know, vacation? Bets were off and the evening shift was reliably chaotic.

Some of the worst cases I’ve ever done were on holiday weeks.

There was the time the bed malfunctioned on Labor Day night and went into such a steep Trendelenburg I worried that the CRNA was soon to have a lapful of patient. It took two of us, the tech and me to hold the patient up so that this wouldn’t happen. And I scrabbled for the phone and called the anesthesiologist who came in to help us get the patient on the table.

That was a close one.

Or the time we had to practically do a hemipelvectomy for necrotizing fasciitis. In late December. I’ll let you guess which holiday this was adjacent to.

Odd things happen during holiday weeks.

All we can do is work the schedule and try to finish before day shift arrives.

The gown card reads “addressing the wrong problems.”

This is actually a, well problem in healthcare.

There is something wrong. For example, there are red scrubs when there should only be blue scrubs.

Instead of thinking about where the red scrubs came from, addressing the wrong problem would be changing all the scrubs worn by staff to the red scrubs. Regardless of where they came from, who is washing them, and how do we get them back. And, most importantly, how much do they cost.

A lot of healthcare decisions seem to be made on the fly, to address the problem right in front of leadership.

Little thought is given to how this may impact the worker in a month’s time.

The problem is the red scrubs that are somehow in place of the normal blue scrubs.

The answer is not change to the red scrubs! The proper solution requires some investigation.

Instead of a blanket, knee-jerk reaction, it is better to be calm and thoughtful about making changes that will impact the entire organization.

If you are continually putting out fires, you never investigate where they come from or why they start.

And you never realize there is a dragon with a cold at the top of the hospital.

This is what I mean by investigating the source, and not just treating the problem right in front of you.

You see this in internal medicine as well.

There is a famous joke that starts, “Doc, doc, it hurts when I do this.”

The this might be any number of things.

Instead of investigating, the doctor says, “Well, don’t do that!”

If the doctor had just looked at the problem, they would realize that there is a bigger problem underneath the little problem. Such as the broken finger that hurts in a 21-year-old with no mechanism of injury.

In healthcare, we call that masking.

The little problem, which is the complaint, is hiding the bigger problem, which is the bone disease that led to the broken finger.

But guess which one gets addressed?

Depending on the course, there may be a teaching assistant attached to it.

Hi. That’s me.

I am functioning as summer short term TA for 6 weeks for a group of RN-BSN students.

I am working with another TA and we had to create sign-ups to show our availability to students to help them.

My summer gig, if you would.

Since this is a bridge program there are only three semesters. And this summer short term is the third semester.

As far as I can ascertain, we function to answer questions, to help with writing and editing of papers.

And as the cheerleader for these students.

Heck, yeah, I’ll be a cheerleader.

After all, it was only 7 years ago when I was in their shoes.

And I would tell them NOT to take economics and statistics in the same semester.

I have had lovely conversations with the students who have reached out.

I helped one with starting with PowerPoint. And another with setting up and understanding their discussion question.

I also offered a lot of support.

Because they CAN do it.

I also remind them how far they have come.

And the end of the program is in sight.

They just have to press forward a little more.

And I’ll be here if they need it. Or the other TA will. As we are very careful not to overlap the availability schedules.

Absolutely reach out to whomever you can for support. Because we all need it.

Last Cookie Thursday is a Thing of May 2023.

Of course the last movie make will be the gray stuff from Beauty and the Beast.

It is from the song Be Our Guest. When the cutlery and plates and furniture are dancing around Belle telling her to relax and be their guest.

It is very similar to the operating room experience.

We invite people in.

We dance around giving them everything that we can to make them comfortable.

We dance around giving them a good OR experience.

We dance around making sure the room is ready and prepared.

Give them nourishment in the form of an IV. Nothing by mouth, please.

Give them warm blankets.

Fix their physical problems.

Make sure they are comfortable before they go up to their room/are discharged.

We get treated like furniture.

I’m telling you it all fits.

The make this week is the gray stuff.

Watching the movie, I really thought it would be savory. Like goose liver pate.

But no.

The recipe I found is a Disney copy-cat recipe.

Gray Stuff

3.4 oz package of vanilla instant pudding

1/2 c milk

15 oreos

6 oz container of cool whip

Make the pudding with the package and the milk. Set aside to set. Add in crushed oreos and fold in the cool whip.

Voila!

Gray stuff.

This is going to be a hot take.

The circulator’s role during induction of anesthesia is to be standing at the side of the OR table, ready to assist anesthesia.

End of story.

Yes, cases can be routine. Patient in the room, patient on the table, patient intubated, surgery, patient extubated, patient put on gurney, patient taken to recovery.

Being blind to anything but routine is where mistakes happen.

Where the circulator should not be:

1. charting at the computer.
2. discussing weekend plans with the surgeon and scrub tech.
3. looking at hotels for their next getaway.

The circulator should be at the side of the patient, offering comfort to the patient.

Who is probably scared out of their wits. Many are.

This should be an expected role of the circulator.

To offer a hand to the patient as they go under anesthesia.

And to offer a hand to the anesthesia team as they intubate.

Because sometimes there is difficulty in securing the airway.

The endotracheal tube goes into the esophagus.

The patient has a very short jaw and the anesthetist is unable to see anything. And they do not intubate blind. Well, they shouldn’t.

And if the circulator is across the room, attention on anywhere but the field, this can lead to disaster. By the time the inattentive circulator realizes that there is a problem the O2 sat has dropped and this can have outside-of-surgery complications.

During the very beginning of the pandemic, circulators were forbidden from being directly at the side of the bed. Because covid was known to be respiratory and the team wasn’t supposed to be more exposed than necessary.

Some circulators adopted this habit of not being at the OR table during induction. Worse, some are teaching this bad behavior to new people.

Don’t do it.

Stay at the bedside during induction.

Your patient’s life may depend on it.