Literary month concludes with a recipe inspired by Roald Dahl’s Charlie and the Chocolate Factory.

The fizzy lifting drink that Grandpa Joe and Charlie surreptitiously drink and nearly die in the ceiling rotators?

Turns out there is not a lot of consensus about what the drink tastes like.

Or how to turn it in to a cookie.

I used miniature marshmallows in a standard cookie batter.

Tragically I was out of/couldn’t find my vanilla.

I used watermelon flavoring instead.

It added a certain sweetness, which, when coupled with the marshmallows, made the cookies light.

Almost lifting worthy.

The very first experimental cookie I ever made was to add miniature marshmallows to a cookie recipe.

I was in middle school.

It is awesome.

They turn all caramel-ly and chewy and disappeared because they melted.

But it is the substitution of the watermelon flavoring for vanilla flavoring that is my take-home lesson for today.

In baking, such as in the OR, sometimes substitutions need to be made.

The tray #1 is needed for a case and there are no more tray #1s on the rack.

A nurse with an imagination and a nimble mind would know that tray #8 is just a tray #1 with additional retractors.

Give the doc a tray #8 and keep mum about the substitution.

And they would never know.

Do you know what happens when you get a group of nurses together?

They come up with bright ideas.

Ideas about all sorts of things.

Things that need to be fixed.

And how to fix them.

Things that need to be retired.

And how to replace them.

Things that cheer others up.

And how to do them.

There is something relaxing and freeing when you get a group a nurses together and give them time to talk while they are waiting for the the speaker who is running late.

It’s like talking to my mom.

But multiplied by 20 other nurses.

Today I shared my crochet group of nurses during such a discussion.

The Random Acts of Crochet Kindness that is on Facebook.

This is a British group that advocates creating little makes to make people smile.

Sometimes they are butterflies, or flowers, or little angels, or even post box toppers.

But the ones that I am going to start with are the worry worms.

The idea is that you take these little makes.

Bag them and add a little note that says ‘I am not lost, if I made you smile, take me home’.

Or words to that effect.

Apparently there are tons of You Tube videos that show you how to make them, step by step.

I haven’t crocheted in about 5 years.

It is time to get my hooks out of retirement.

By some frankly weird coincidence it has been 9 months yesterday since I was considered fully vaccinated. (Edited because math)

My first shot was in December.

My second shot was January 12.

The date I was considered fully vaccinated was January 26.

I received the Pfizer vaccines.

And the CDC recommends booster shots after 6 months.

There is a lot of data behind the timing, and the idea of booster shots.

The CDC also recommended booster shots for those over 65, those medically fragile, and those who work in healthcare.

I work in healthcare.

I have been fully vaccinated for 8 months.

Greater than the 6 months talked about.

I work in a hospital.

One that has covid patients.

One that has never been covid free.

We’ve had covid patients since the testing began last year.

The lowest the hospital’s patient volume went was 3.

I work in the evenings.

None of my ED patients, the ones who are unvaccinated, are tested.

There simply isn’t the time for the PCR test because they need surgery in a timely manner.

However, on the flip side, I am young and healthy.

Well, young-ish.

I believe in vaccination.

I believe it is the only way we are getting through this.

I believe that the goal numbers for herd immunity keep changing and rising the longer this plays out.

I may be denied when I schedule my booster shot, although I am a nurse and work in a hospital that has patients, and may have asymptomatic patients who need surgery.

Because of my age and my general good health.

Let’s find out.

The post-it reads ‘Med-surg training has fallen on the way side to the detriment of new nurses.

When I fought tooth and nail to become an OR nurse, over the objections of my teachers, I first had to do some time on the medical surgical floor.

This taught me many things.

How to keep a clean room.

How to keep a clean patient.

How to take orders off.

How to stand up to a doctor when they would not call back and the patient was writhing in pain.

Or the flap that the nurses were supposed to be assessing for blood flow turned darker and darker and the MD would not call us back.

How to approach a doctor when the patient needed something.

This was over 20 years ago.

I did my time on med-surg and I learned a lot.

I have noticed there is a trend these past few years.

There is no time spent on the med-surg floor.

There is no time learning how to be a nurse.

Besides nursing school, which does not teach you how to be a nurse.

It just shows you how to keep a patient alive.

6 hours twice a week, during the school year, is not enough.

Now nurses go straight into specialty roles; be it OR, or OB, or ED, or special care nursery.

And they have to be taught on the specialty floor all the skills they should have learned on a med-surg floor.

In addition to the specialty floor details and skills.

I do not think that is a good thing.

And it is setting the new nurses up to feel worthless.

Or to feel like they know it all and the senior nurses know nothing.

I am not sure what is worse.

I am sure that there are studies that say it is a good thing to go straight into specialty.

But I could see the pendulum swinging back the other way.

Did I like being a med-surg nurse?

No.

Did I learn very valuable skills?

Yes.

Do I still use those skills today?

Double yes.

It appears that the site has eaten my post-it note for today 9/26/21.

And I saved it.

And tried to publish it several times.

And I saved it in draft.

Only not to be seen.

Hmm.

Maybe if I shut everything completely down I can get it back.

If not I will recreate it.

There are lots of ‘it’ that this could be referring to.

When to call the end of the pandemic.

When to call the sinking ship.

When to call the end of a code.

When to call the search for something that the doctor must, must have and then doesn’t use.

When to call the association with a hospital.

When to call a career.

Too many of the nurses that I know are tired.

Too many of the nurses that I know have come to me and expressed regret with their current working conditions.

Too many of the nurses that I know have come to me and expressed anger at their manager.

Or their manager’s manager.

Too many of the nurses that I know are starting to look for other jobs.

Too many of the nurses that I know have left to go to other jobs.

A good friend of mine told me last week that her manager told her that she was delivering not good care.

And this on a floor.

During a patient boom brought on by the surge.

During a pandemic.

The nurse that has won awards for being a top nurse in the state.

No wonder she is contemplating her future with nursing, with the hospital, with the company.

This makes me so sad.

Nurses who have been there delivering care to the best of our delivery in circumstances that no nurse alive and working have ever seen in the US.

And we have kept people alive.

People who would spit on us.

People who have yelled at us.

People who do not believe in the science of vaccines but are still reaching out for help when they get ill with the same disease that the vaccine is designed to alleviate or prevent.

But, of course, they didn’t take the vaccine.

And now they are sick unto dying.

That is a deliberate reference.

But my fellow nurses and I keep showing up for work.

Keep working through surge after surge.

Keep taking care of people; be they patients, or family, or co-workers, or people on the street.

Because that is what we do.

And we are tired.

The state nursing association is holding their annual convention in a nearby town. .

I am a member of this association.

Last month, when they were debating whether or not to call the convention and put it completely online there was a poll.

I love polls, so I did it.

And the results were that 89% of the potential attendees are vaccinated.

And that the majority of them had indicated they would feel comfortable at a convention where safety protocols are in place.

Including me.

So I am here at the convention center for as long as I can be, masked.

You know, because I worked last night and I have to work again at 1430.

And I would LOVE a nap.

This is a hybrid convention with some sessions live and some sessions recorded.

Before this, with the AORN and Lippincott conventions I have already participated in, I had 54.8 continuing education hours.

And I should earn 18.5 hours for these two days, including the on-long portion.

Meaning 73.3 hours for the three conventions.

And I need 135 every five years for my CNOR.

Not too shabby.

And I’ve learned a TON.

Learning is the battle.

So what if I cried when they asked for anyone who had served in the armed forces to stand up and be acknowledged.

Apparently the blog post of the past week remains heavy on my head and heart.

Normally I would have remained in my seat.

But I stood.

Happy Friday.

Yesterday was the autumnal equinox.

Where we begin the long, slow slide to winter.

And more Covid and flu cases/.

What better than a bit of fall flavor in gingerbread,

This is not ginger cookies.

This is gingerbread.

With clotted cream befitting a truly English book.

One of the scenes in Mary Poppins they have gingerbread.

I find gingerbread comforting.

Especially with clotted cream.

Or whipped cream.

I’m not picky,

And you know what is best?

Gingerbread trifle

Because we need all the comforting we can get as we start the slow march toward winter.

One of the guiding principles of scheduling cases in the evening is fairness.

First one to call is first case scheduled.

I schedule by this.

I live by this.

I have received a lot of negative feedback from doctors about this.

I don’t care.

Last night was rough.

There was an obstetrical emergency that involved bleeding.

There was an already ruptured appendix.

There was a person whose potassium level was 6 due to kidney failure.

The first call was the OB patient.

And bleeding trumps most everything.

The second call was the already ruptured appendix.

The third call was the kidney patient.

The OB caller acted as if I had a team on standby at all times, ready to spring into action.

I don’t.

They were quite put out when I would not grant them an immediate OR and begrudgingly took the soonest time slot.

Which was an hour away.

After one of the rooms dropped.

It takes roughly an hour to get a patient ready.

It takes less time in an emergency.

You know, depending on who is the prepping nurse.

Next the appy doc called.

I gave them a time that was three hours later.

I still had 3 rooms going, and now an OB emergency.

They took the time without a whimper, or a complaint.

After I picked the OB emergency case I had to relieve as the robot scrub.

Because the tech was adamant on getting out bang on time.

No matter the fires going on in the OR core.

When another scrub was available after their case, she came and got me out.

Immediately the phone rang with ANOTHER emergency.

The PA was a little taken aback that they were the 3rd emergency in line.

I looked at the cases continuing to drop.

I looked at the likelihood of the OB case finishing by 1900 (they did).

I looked at the 2030 appy time.

And, although the kidney emergency was the third call, I made the executive decision to jump the appy and schedule the kidney for 1930.

And of course the kidney case was difficult.

What should have been a 15 minute case turned into 75 minutes.

But sometimes you have to rank the cases on how sick the patient is.

The appy patient was sick.

But he was already ruptured.

The kidney patient was not ruptured but his labs were far worse.

So I let the kidney patient go second.

And, even though the appy started 45 minutes late and I didn’t get home until 0200, I am at peace with that decision.

Because taking cases as they come in is the guideline, sometimes you have to look at the kinds of patients they are.

And plan accordingly.

676,059 American Covid dead.

According to the CDC the 1918 Pandemic claimed about 675,000.

Well, we’ve beaten that number!

The deadliest pandemic on record.

Yay us!

I do not have a lot of words about this.

Just that it did not have to be this way.

Yes, the US population was smaller then, so the percentages work in our favor.

No, no one knows exactly how many people died, as records were spotty.

But 1918 did not have our current technological advances.

Also I think it is a no to knowing exactly many current era people have died from covid.

With the lack of communication, the fear about being labeled a covid death.

Sheer obstinancy.

676,000+ people are still 676,000+ who do not get tomorrow.

With the newest estimates that 100,000 more can die by the beginning of 2022.

😦

😢