Call Secrets of the OR- Do not assume that the case will be less than posted

There is a universal truth for charge nurses. MDs might be less than truthful to get what they want.

A surgeon might whine and complain and complain some more that they absolutely need to be out by 1400. Never the six cases.

I’ve written about that before.

It is usually about flights.

Of fancy maybe.

The inverse is the surgeon who spies a very very very very minute gap in the schedule. And bluffs the charge nurse that they can absolutely do a 2 hour case in 20 minutes.

Balderdash.

It’s giving desperate. It’s giving Druzilla and Anastasia as they chop off bits of their feet to fit inside the glass slipper. Because their mother told them to to snare the prince.

The only prince around here is the sweet sweet spare time that I imagine all surgeons desire.

99% of these cases run over. And tee time is missed. And TEA time is missed. And flights that never existed are missed.

Mostly because the doctor doesn’t want to wait.

I say put them to work. Give them a mop or a wiping cloth for the room that the last patient vacated 30 seconds before. Show them how to bag trash. Show them where to put the trash.

And watch their head explode when you say that the products used have a 10 minute dry time.

Most importantly, remind them that the consent for the surgery that you both know very well will take longer than the 30 minutes promised. That consent must be signed. And the H&P written.

Or, you know, make them answer the phone that is ringing every 5 seconds. You could do.

We’ve had Epic for more than 10 years now. That is a lot of time for the computer to learn average case times and also be more truthful about how long a surgery will really take.

Surgeons don’t like being told no. But the downstream patients will appreciate you not letting them squeeze in a case that is going to take 10 minutes max.

Notice how the time goes down with each iteration.

Yeah, so do the charge nurses.

Tuesday Top of Mind 4/21/26- One hand gives and the other hand looks through your pockets looking for loose change

Yes, this is a Princess Bride allegory. When Miracle Max says the only thing to do for someone who is fully dead is to go through their clothes and look for loose change.

It reminded me of something.

It reminded me of Joann fabrics. This was an amazing craft store that was bought by private equity and liquidated and sold. RIP Joann’s. My friends bemoan the loss weekly.

It reminded me of Party City, which met a similar fate. Of course they did.

It reminded me of the trouble that Red Lobster is in. Because of private equity.

Talk about going through their pockets and looking for loose change.

It also reminded me that in 2025, RFK Jr. and the department of DHHS cancelled five hundred billion dollars in grants. Some of those grants were for cancers.

Because they thought private equity would be able to do it cheaper.

Have they ever met private equity?

Whatever gave them that idea?

I bring this up because a positive mRNA story is all over the main stream media. They are heralding the use of an mRNA vaccine for pancreatic cancer. This is one of the most deadly cancers. You can’t turn on a television without it playing somewhere.

Don’t get me wrong. This is a big win, one of the biggest.

However, with the short sightedness of the DHHS, what other wins are going lacking? What other possible wins are dying on the grant tree?

We may never know.

How many people could’ve been helped?

We will never know.

There is a phrase that I use to describe a lot of hospitals- penny wise and pound foolish. To me this describes the entire situation. Don’t be too quick to save a penny, to lose a pound for the want of the penny.

But then, private equity and pharmacy benefit managers and hospital CEOs are only out for the money. It isn’t about the little people who could’ve been helped by a new kind of drug therapy. It is all about the cost savings. The savings isn’t for the normal everyday people; it is for the rich who don’t understand the concept of having enough.

Hooray for the positive news about the pancreatic cancer mRNA vaccine that has helped a few people.

What about the others who died in agony?

Wasn’t cost effective, was it?

Cookie Thursday 4/16/26- Marmite cheddar cheese straws

Crushingly, the cookies last week were NOT popular. Half the batch was left in the drawer. Which is disappointing. Perhaps I need to scale back Cookie Thursday is a Thing in the operating room and expand to other departments the other weeks.

New week, new make.

The Unexpected Ingredient theme continues. Today, I put marmite in sharp cheddar puff pastry cheese straws.

Marmite, the fermented yeast you either love or hate or hate on principle.

These were unexpectedly yummy.

Marmite isn’t as bad as they would have you believe.

Is it strong tasting? Yes.

Does it smell strong? Yes.

Is it worth it? Yes.

Do I want to explore more taste sensations with marmite?

Yep. Next I will do a butter and marmite on toast.

After I pick up the CTIAT leftovers at the hospital later this evening.

By the way, marmite is an excellent source of B vitamins. But it is also very high in salt and should be eaten sparingly.

Call Secrets of the OR- With great power comes great responsibility

This is NOT a Marvel quote. It was attributed originally to the writer known as Voltaire. François-Marie Arouet adopted the pen name in 1718. This was after his incarceration in the Bastille. But before his smallpox infection. And before his exile into England. Among many other things.

His Wiki page is wild and worth the read.

In the Marvel Universe this saying is attributed to Peter Parker’s Uncle Ben. Who reminded the young Peter Parker that those who were given great power, much is demanded of them. And Peter ignored him and went to earn money by wrestling using his spider given powers so that they could keep their house.

Uncle Ben died being shot by Flint Marko or Dennis Carradine or any number of shadowy thugs.

No spoilers needed.

This is a well worn trope and has been explored over movies and comic books and books and television shows.

But he inspired Peter Parker with his words reminding Peter that with great power, comes great responsibility.

But that isn’t why I bring up the quote.

I had a doctor’s appointment yesterday. A doctor who sometimes does surgeries in the operating room at night. As I was leaving they said if I had any issues to call the office.

Like a silly goose I said, pleased with the good appointment, that I had access to their personal cell number because they had called me to create a surgery in the dark one night.

The fear in their eyes.

I rushed to reassure them that I had multiple doctor phone numbers in my phone as a function of my work as a call nurse. And that I never abused the numbers.

Ever.

This is part of personal code of ethics.

If I need a surgeon for details of a case I will text them or call them. They are aware of this.

If not, the numbers stay locked in my phone.

I never ever ever ever give them out.

Just like I never give out staff numbers without clearing it with the staff first. I’ve been told this is an uneccessary step but I continue it.

That pesky personal code of ethics that I have.

If I need to call a doctor that is not work related, I use the same avenue that everyone else does. I call the doctor on call or I leave a message with the office and patiently wait for the callback.

Having these numbers is a great power. It eases communication about middle of the night cases, or cases for the day shift that I arrange at night. it is my great responsibility to have a personal code of ethics that doesn’t allow me to abuse the numbers.

Ever.

I don’t care who thinks they need the number, too bad. (shrugs)

They can call the office and go through the call system just as I do when it is not work/case related.

Tuesday Top of Mind 4/15/26- Great, now there are known gender disparities for those who receive life giving care (CPR/defibrillation) in the field

I do not watch the Pitt. Many, many, many people have told me that I need to watch the most groundbreaking show that illustrates what hospital life is like on a crazy shift.

No thank you, I live it enough.

I mean, ER started my sophomore year at Creighton. It aired on Thursday nights and all the nursing students would critique it in class on Fridays. That is the goal post that I have in my head and nothing has measured up to it.

But in the latest episode of the second season of the Pitt that aired April 10th, a woman came in with chest pain and coded and nearly died because her paramedics (sad pouty face) didn’t want to disturb her bra.

I personally can handle exposed breasts/titties if it saves my life.

Just saying.

In the clips that I have seen of this scene, Robby (the head MD) asks the women in the room “Hey, ladies in the room, show of hands. Death with modesty or life with brief nudity? Death or Life? Look at that. Turns out women want to live”. He says this to what I presume is the head paramedic.

No bra, no matter what the cost, is worth a life.

It takes me back to my very first ACLS (Adult cardiac life support) instructor (before they got fancy and called it ALS [advanced life support]). She stood at the front of the class and told us that the first thing you do in a code is take your own pulse for a brief second. Now that you have ascertained that YOU are not dead you can help the patient who is.

I use similar phrasing when I run the Call Bootcamp for the hospital. I was asked if the responders from the hospital, from the ER and the ICU, need to put on bunny suits to enter the OR. I said no, the patient isn’t getting more dead. So there wasn’t any risk of infection.

This made me curious so I did a quick Google search. My search terms were are women less likely to receive defibrillation.

Spoiler alert.

Yeah, women are less likely to get bystander CPR and defibrillation.

Of course we are.

There are hits from the Duke University School of Medicine from 2024, from the National Institutes of Health in 2023. From Science Direct in 2026.

From the American Heart Association itself in 2024.

The list goes on and on and on.

Save a life, expose a breast.

That is the very very very very first thing I leaned when I took CPR in high school.

Expose the chest, make sure there are no barriers, or standing water.

It’s like a demented Little Red Riding Hood parody.

But grandmama, what pretty bra you are wearing.

FFS Friday 4/10/26- Forest service fuckery

First they start with firing. Just in time for fire season. 3400 federal employees across every level of the forest agency. T

Then they rescind the roadless rule. This is the rule that prohibits road construction, road reconstruction and TIMBER harvest on 60 million acres of national forests and grasslands. You know, so that someone can make a buck harvesting the timber and laying waste to our national parks.

Then they rape our lands and its national resources in the name of profit. Of course they do.

Animals.

This was also a step in their complete trashing of the United States and all that we used to hold dear. Up to auction to the highest bidder.

Or, you know, the average Friday.

This restructuring of the US Forest Service was announced on March 30. They were going to move the agency headquarters to Salt Lake City. This kind of implies that everything east of the Rockies is trash.

Research was trashed. Of course it was. There is a lot of research done on the forests and, you know, in actual fucking nature that this destroys.

Don’t worry, the propaganda machine is working on spinning this disastrous move. The bots are already hard at work denying, denying and, oh yes, denying.

Of course they are.

We need people to look up from their phones and their computers and their tablets to PAY FUCKING ATTENTION when the administration does shady shit like this.

It’s illegal. Because of course it is. This move was explicitly prohibited by the fiscal year 2026 appropriations.

Congress can stop it. but they won’t. Because they have their heads so far up the administration’s ass as to lead one to wonder how they breathe. Perhaps they have developed gills that can do oxygen exchange through shit. And there’s a lot of shit that everyone should be paying attention to.

The Alt National Parks page on the socials is leading the charge in getting the word out and in advertising which big outdoor companies to petition and what to say. Find them, pick a company and get to the phones.

Smokey the Bear needs us right now. Time to write and call and call and write. Ad nauseum.

Still.

Cookie Thursday 4/6/26- Fudgy cocoa no bakes with potato chip swap

Unexpected ingredient month continues.

I was wondering if I could modify the fudgy cocoa no bake recipe beyond what I already had. I’ve swapped out of the cups of oats for unsweetened coconut before. In fact, I’ve done that several times. But what else can be swapped out for that 1 c of oats?

Potato chips.

You know, sweet/salty combo.

Perfect.

I bought a bag of potato chips and crushed most of the bag to make the 1 c of potato chip crumbs that I needed. I let a few bigger pieces through to see what would happen. And then I proceeded to make the fudgy cocoa no bakes as described.

I discovered several things.

The first thing I noticed was that the color was a much paler brown than when I have made these in the past.

The second thing that I noticed is that the cookies themselves were much more crumbly in texture compared to the standard no bakes.

The last thing that I noticed was the salty sweet interplay when I sampled the cookie.

Exactly what I was going for.

Someone at work suggested that I use kettle cooked potato chips. For better structural integrity. I will definitely do that next time.

But not a bad cookie for something I made up out of my own head.

On to next week. I am very excited about next week’s unexpected ingredient.

Cookie Thursday is a Thing 4/2/26- Devil’d eggs cakes

New month, new theme.

I am not a fan of April Fools’ Day. Most often it is seized upon as a reason to be a jerk. I am also not a fan of pranks. No, thank you. But I am a fan of the mild unexpected. I’m complex, okay?

The April theme is going to be the Unexpected Ingredient.

Take today. I saw a recipe for deviled brownies and I knew I could re-create that using white cake and golden frosting. I considered using blondies for the cake but I didn’t think the contrast was going to be enough. Consider the devil’d egg. White egg, creamy golden goodness made up of egg yolk and mustard piped vacancy left from the egg yolk. I wanted that kind of contrast.

And did I mention I was doing a gluten free version too? With a brand spanking new recipe?

Well, I did.

I also made plain chocolate chip cookies for our new manager. Yes, an entire batch. As a welcome to the department gesture.

For those playing along that is white eggs, gluten free white eggs, gold frosting, and chocolate chip cookies.

Oven #3 got a workout.

After I delivered the make, several of my coworkers expressed amazement that they weren’t actually devil’d eggs. Which was exactly the point of the theme.

These little cakes were tender and the frosting was creamy and luscious. They were the perfect make to kick off April. In a nice way.

Because April Fools’ doesn’t have to be mean.

But frosting still isn’t my favorite thing to make.

The gluten free devil’d egg cakes were saved by the frosting. I found them a bit dry, as a lot of gluten free makes are. Next time I make the recipe I am going to sub in 1/2 -1 cup almond flour. To see if that would give it more moisture.

Call Secrets of the OR- When on call you have 30 minutes to get to the hospital

When you are on call, it is the expectation of the department that you arrive to the hospital, ready to work, within 30 minutes.

Not 45.

Not 35.

Thirty.

I know that it is part of the onboarding at my current hospital and also at past hospitals.

But the recovery room in particular has been pushing it and pushing it.

That is not a Salt-N-Pepa reference.

They leave messages to give them 45 minutes in when calling them in at the end of a case.

I have to keep all surgeons and their preferences for all cases in my head. At all times. For all cases.

And you are telling me that I now have to keep a mental map of all the locations of the recovery room nurses on call? And do the mental gymnastics of making sure I call them at the exact right time during the surgery that I am actively participating in? Because if they are called too early, they complain to management. If they come in after the surgery is completed, the CRNA and I have been functioning effectively as the PACU team.

Wow, this is a much angrier post than I intended.

I do my utmost to honor the requests for a little extra time for call back.

But that is not always possible.

I will end up cooling my heels in PACU until they come in. But when is it too much and merits a talk with management?

Age old question I guess.

Tuesday Top of Mind 3/31/33- It’s still HERE!!!

Yeah, the title is meant to be a call back to Poltergeist.

I am, of course, referencing covid. Always referencing covid. It is exhausting.

The variant this time is tricksy. Wicked, tricksy variant.

Yeah, that was a Hobbit movie reference.

The newest out to kill variant is called the Cicada variant. So called because it waits and emerges to cause chaos when you least expect it. This variant is called the cicada because after emerging in 2024 it laid in wait. And is now the fastest growing variant in the United States. It has been found in the waste water of at least 25 states.

Oh, joy.

Of course there are mutations to the spike protein that allows it to elude immune systems that have been vaccinated. Or previously infected.

Double oh, joy.

The symptoms that are prevalent are the run of the mill respiratory symptoms. Long gone are the tell tale no taste no smell symptoms.

Ever time we are growing closer to the one variant that knocks aside the vaccines and we have to start ALL OVER.

Make sure your vaccinations are up to date. Make sure you wash your hands. Make sure to avoid crowded spaces. And, for the love of pete, stay home if you are sick and test.

We’ve done this since 2020, get a clue people!