Doctor, maybe?

This is more nerve wracking than I thought.

I have narrowed down the field for PhD schools to two.

Sinclair College of Nursing- part of the Mizzou family, with a personal history, online only.

University of North Carolina Greensboro- local, online and in person classes.

I started the UNCG application today.

It has a LOT of moving parts.

And I have to prove that I live in this state, and have since 2005.

I already submitted that information.

I get it, there’s a big difference between in state and out of state tuition costs.

I am undecided but I have to think about it, make charts.

You know, be me about the process.

Let me tell you, so much as changed in the world since I first started baby steps about applying for college in the mid-1990s.

Not sure if the fact that everything is findable online in an instance is an improvement or not.

Regardless, I am making my inquiries, checking my facts, etc.

So Doctor, well, PhD.

Maybe?

Post-it note 9/19/21-OR timing

The post-it reads ‘timing is not a science. MD’s don’t follow a proscribed march to finishing cases. In short, shit happens. Please do not count your chickens before they hatch and rob me of a third CRNA and hobble the evening.’

Timing.

That elusive, misunderstood, much maligned view of how long cases are going to take to finish.

I could fill books with what I know about timing.

It is specific to both case, and surgeon

One surgeon may be 33 minutes on a lap appy.

Another may be 90.

It is all dependent on what the abdomen looks like when the scope is first inserted.

It is all dependent on skill level of the surgeon; the meticulousness of the surgeon, the poor, or not, protoplasm of the patient.

It can be dependent on the availability of the anesthesiologist; are they in another unit intubating, or on OB inserting an epidural.

It can be dependent on the OR team and their cohesiveness as a working group; do they have everything they need, including reloads of the stapler?

It can be dependent on the likelihood of the lap appy becoming an open laparotomy; CTs are only as good as who reads them, and sometimes there are surprises.

It can be dependent one who in pre-op is prepping the patient; we all know that one nurse who takes FOREVER!

There are many, many factors that need to be considered and tabulated regarding timing.

Times the number of surgeons, times the kind of cases, times the X factor.

It all goes into the OR charge nurse’s tabulation of time.

Mostly I get it right.

But I’ve been doing this for years.

This is a skill that is hard to teach.

This is a skill that is hard to learn.

However, the charge nurse and the head CRNA need to be in constant communication about needs of the department.

They should not send their third CRNA home at 1600 because no cases have been added.

And the phone rings at 1605 for an emergent case.

And the OR has been hobbled.

There are three teams available.

With 2 CRNAs.

And the emergency will have to wait.

Why am I ashamed to claim that I am a veteran?

As I was filling out the call shift application I came across a section that I answered in the negative 16 years ago when I applied for the hospital system when we moved to the South.

Of course, it was pen and paper then.

The section asked about military history and if I was active, retired, disabled.

The answer is none of the above.

And that may be why I have been hesitant to claim that I am a veteran after nearly 30 years.

I was in the Air Force Reserve Officer Training Corps while I was in college.

In fact, I had an immense scholarship from the Air Force for a private Jesuit university in the Midwest.

I was a year and a half in, with full intentions of going the distance in my Air Force career.

I was going to be a BSN.

I was going to graduate a lieutenant.

I was in the dorms, enjoying classes, including clinical.

When I fell.

The stairs were ripped up.

I can see how this happened.

Who takes the stairs?

The ROTC people do.

Any chance to exercise, including getting up at 0600 to work out with the Army ROTC.

I did a lot of damage to my labrum on my left shoulder because I was holding onto the railing as I was going down the stairs to the communal television on the first floor.

I had the first of two reconstructive surgeries over Spring break, three weeks later.

I could no longer do push-ups.

And sprinting hurt a hell of a lot.

And I was medically DQ’ed that summer.

This was before 9/11.

This was after Desert Storm.

This was before Afghanistan.

They decided I was too much trouble, I guess.

I was shown the door, stripped of my scholarship, and given a bill for all that had been spent on me.

It took me 10 years to pay off.

I graduated from a community college 5 years later, with my ADN.

After 9/11, when I went to a college fair at the community college I went by the Air Force booth.

They assured me I would be welcomed back.

But that I would have to get my BSN.

And they would not forgive the scholarship repayment monies that I still owed and was chipping away at.

I declined, as I would essentially be enlisting.

And I would not become a lieutenant until I graduated with my BSN.

This was before bridge programs made it so easy.

I didn’t get my BSN for an additional 15 years.

I feel ashamed to claim that I was a veteran.

Was I?

Today is the Air Force’s birthday.

Happy birthday.

I would have made a great officer.

Two million, nine hundred eighty thousand, three hundred seventy six minutes

2, 980, 376 minutes.

That is five years and eight months without an immediate use steam sterilization for total joints.

5 years and 8 months saying no to surgeons.

Until this week.

Because the surgeon didn’t want to wait.

A flash takes 13 minutes.

A pre-vac takes 25 minutes.

For an impatient surgeon that didn’t want to wait the additional 12 minutes for a pre-vac cycle, the no flash streak in the OR was broken.

For a surgeon that no one had the balls to say no to, the patient is at increased risk of infection.

For a surgeon that just had to have his way, the patient has to be monitored by infection control for 5 years.

Flashing should solely be done in life or limb situations.

I have been working on decreasing the IUSS in the OR for 7 years.

And they fuck it up in one fail swoop because the precious surgeon didn’t want to wait.

I am so disgusted.

And defeated.

And tired.

But, mostly, I am angry.

(the title is an homage to Seasons of Love from Rent: the musical)

Cookie Thursday is a Thing- 9/16/21- Butterbeer cookies

For Cookie Thursday is a Thing this week, I decided to use Harry Potter as inspiration.

Which fits in with the literary month.

If you ask anyone who has read Harry Potter, a child, a teen, or an adult, what would they like to try in that fictional world, the answer is butterbeer.

I have had butterbeer at Universal Studios and it is butterscotch adjacent.

We’ll see what the cookies turn out like.

My normal meeting for the third Thursday of the month was cancelled by the CNO of the market.

Because of the Delta surge, you know.

It is not looking too promising to have a symposium in 7 weeks.

Especially if I have two slots left to fill with speakers.

Yeah, not looking too likely.

Even if it is virtual.

It freakin’ worked!

The memo/welcome letter to new doctors worked!

Yesssss!!!

It was toward the end of the shift and I was walking a piece of equipment over to the other OR when the phone rang.

It was a new doctor.

The one I had helped get scrubs the other day.

When he was here I gave him a copy of the welcome letter.

And today he followed the hints.

(happy dance)

I knew it would work!

660,000

I cannot stop looking at the death toll.

I look at it daily.

At night.

After I get home from work.

I knew that the death toll was nearly to 660,000 on Sunday.

As in 659,931.

But with the expected weekend lag with reporting I knew that the number would be reached on Monday the 13th.

And it was.

I looked back at other posts to see what had transpired.

The post I did about 650,000 was on September 8th.

5 days, 10,000 dead.

Of course.

However, I think the hospitalizations are lessening at my hospital.

And the hospital system.

You know, just in time for the Labor Day surge we all know is coming is here.

Please practice social distancing.

Please wear a mask.

Although the case volume is down our ICU and IMCU are still full of covid patients.

Be safe.

Well, that was different

My sister and I grabbed out KN95 masks and went to the theater.

That was different.

The last musical we saw was in 2019, when we saw Hamilton in San Francisco.

We had major plans for our theater group in 2020.

We were going to get season tickets.

And see 8-9 of the 12 shows on offer for the year.

And we all know how that went.

For my birthday I received tickets to Wicked.

They were for September when the shows would re-open in our town.

This was back in the halcyon days of early July.

When we might’ve, could’ve had a chance.

But no.

Delta came roaring into our lives.

And people were entrenched in their mask and covid denial.

And those of us who are fully vaccinated tsked and shook our heads.

And got mad.

Today was the day of the show.

My husband bowed out and offered his ticket to my sister.

She graciously accepted.

The date was on.

And then I worked the majority of last night.

All I could think when I clocked in at 0300, knowing full well that my mom and sister were coming over for brunch at 0930, was that my mom was going to be so mad at me.

I got home at 0800.

And collapsed into bed.

My sister came by and picked me up at 1200.

The theater is 15 minutes away.

We made plans to don our KN95 masks before we left the car, because we are responsible for ourselves.

There was a strict mask policy at the show.

No one asked to see my vaccination card, although I had brought it along because of course I did.

There were many announcements about leaving the masks on during the performances.

Because everyone.

And I mean everyone in the seats, including the ASL interpreters were masked.

And there were roving spot checks for people who had removed their masks.

All in all I felt safe-ish.

Delta is still raging in this town.

Across the Southeast, really.

But it was different to be in a theater, surrounded by people I hope were taking it safe.

My sister and I scooched down into the 2 empty seats in our row.

You know, to increase the distance between us and others.

It was different.

It was nerve-wracking.

It was scary.

I was sleep deprived.

But the show.

It was great!

Would I do this again?

Maybe.

Especially if I am guaranteed empty seats to distance myself with.

Post- it note 9/12/21- old hospital whataboutism

The post-it reads ‘stop with the everywhere I’ve ever worked does it like this– whataboutism regarding the last place.’

Sit down, buckle up.

I do not care how your previous hospital did something.

If it was so good, then why did you leave?

Of the hundreds of these old hospital whataboutisms that I hear about a year probably 4 are useful.

Maybe 5.

This is not your old hospital.

This is a different hospital.

With a different culture.

Different people.

Different surgeons.

Different instruments.

Different total joint sets.

Different fracture sets.

Different computer system.

Different call requirements.

Different shift requirements.

Enough with the well, at my old hospital we…

Shut it.

No one cares.

new surgeon, who dis?

Remember I wrote that welcome letter to the new doctors?

The one to be given to new surgeons when they start taking call here?

Yeah, the one with the OR numbers, hours of operation.

And the OR pager number for after hours?

The one that is titled “Welcome to call at (hospital)?

Yeah, that one.

I wrote it, proofed it, and gave it to my boss.

Who was supposed to take it to surgical committee.

And the doctors on the surgical committee was supposed to approve it.

And send it out to all the doctor’s offices.

Who was supposed to give it to all of their on call doctors.

Massive fail.

I am not sure where the chain broke.

But I will find out.

Three surgeons I talked to this week without the number.

1 had an emergent case.

1 was looking for scrubs.

1 was trying to schedule for tomorrow.

NONE of them had the pager number or any idea how call works at (hospital).

Do I re-double my efforts?

Or do I let the information slide through the cracks?