Dispatches from the Evening Shift Disclaimer Sunday 1/11/25

I usually do this on the first day of the year so I am a little tardy this year.

Happy New Year!

Let’s get down to business.

Every year I write this disclaimer. And add to it. And tweak it. And if I knew how to pin it to the blog start page, I would.

I began writing the yearly disclaimer to be able to point to my posts and say, see nothing to give away the patient here. You know, HIPAA. In case the corporation, that I work for and discuss my blog openly in meetings etc., tries to tell me I cannot write this. Not that they have, but I can believe they would.

I believe in protecting patients’ and staff’s privacy.

I do not include details that make it clear or easy to figure out which patient or staff member I am talking about. If I am talking about any.

I do not use names. And if I do, they are changed.

I change ages. I change gender.

I change details such as which limb is fractured. I change details such as which surgery is performed.

And the cases that I do talk about obliquely are changed in how time is perceived as well. The cases/people/staff may not be the same at the time of the surgery.

I definitely change aspects of time. By that I mean there is no relationship between the moment I write the post and the actual events that prompted it.

Some of the stories aren’t even mine, but even they are changed so as to be unrecognizable.

That being said, I change a lot.

So that, if you knew where I worked, you could not figure out who I was writing about or when.

I discuss issues that impact healthcare broadly.

And, after the events of the two past years, issues that impact women’s health. There has been a LOT to unpack here.

And covid. Can’t get away from covid. XEC is the newest variant and it is currently causing over 50% of the cases. People continue to die; not that we know it because they stopped keeping track years ago. And there is a new game in town, or should I write games. The bird flu that has made the jump to infecting and killing humans, and the human metapneumovirus which isn’t new but is making noise in China.

I do swear sometimes. But mainly to make an emphatic point.

I write themed days. Post-it Sundays which are from notes to myself, usually on a Post-it or a gown card. Monday I take off. Tuesday Top of Mind is the most political day of the week where I write what is weighing heavily on my brain. Wednesdays had been a free day that I wrote exclusively about OR things. This has morphed into the Best Kept Secrets of the OR where I divulge the secrets of the OR. Cookie Thursday is a Thing is where I write about the cookies I make for the department. This is a long-running morale project in the OR of homemade cookies or candies are brought in around 1400. This started as an evening shift things and remains so. FFS Fridays is the newest day that I write about things that begin with F, F, or S. This is the day that has the most swearing and I started it as a reaction to the 2024 general election. Buckle up, it’s gonna get weird. On Saturdays, I write about being an adult learner.

Phew.

I may miss a day here or there because 6 days is a LOT, even if the blog posts are shortish.

This month marks 10 years of Cookie Thursday is a Thing! I had no intention of baking cookies for so long, but it gives me a handy bookmark for my week. I also theme the months and this month’s theme is Favorites. Along with the departmental favorites, I also tell a story about CTIAT.

School Me Saturday 1/11/2025- new semester, who dis?

Yes, it hurt a bit to be ungrammatical in the title.

I know it feels like winter break started a second ago. December and the first part of January is a marathon and a whirlwind. You blink and, next thing you know, Spring Semester is due to start. Like tomorrow.

Relax. Deep breath.

Remember when you chose your classes in the fall? Or remember when your advisor told you what classes to take? And you signed up for them and everything? And you and your spouse or you and your parents or just you filled out your FAFSA when they released it in December?

I know that the beginning of the semester is scary. But breath. You’ve got this. Every class is one step closer to being done.

Now that you’ve remembered what classes you are taking this semester, get yourself to the Canvas site and see if the syllabi have been released. Or Moodle or Google Classroom. Or whatever platform your college or university uses.

Read the syllabus. Yes, in its entirety.

Make a plan for due dates or exam dates. But also make sure to note when the breaks are.

The syllabi will have the books needed for the class. Buy them, rent them, borrow them. It doesn’t matter how you get them, just get them.

Now all you can do is relax and get back into school mode.

But take heart. Spring break and Summer break will be here before you know it.

Don’t forget to eat right, drink your water, brush your teeth, and exercise. You know, the things that your parents told you to do. Do all of them.

And enjoy the semester.

FFS Friday 1/10/2025- Freaking Snow

Everyone I know is glued to their radar as they anticipate or dread the coming storm. It was less than a week ago that we were anticipating, or not, snow, in North Carolina. Turns out it was just cold then.

And it has been cold ever since.

It seems that people come down on one of two sides of snow anticipation or snow dread. You either love everything about snow, or you don’t. You either love all the little touches that snow brings such as hot cocoa, closed schools, or holing up in your warm house in your warmest clothes. Or you hate all the little touches that snow brings such as ice dams on the roof, or icy roads, or icy cars that won’t start because it is too cold.

Yes, I am on the anti-side when it comes to snow. I mean it’s pretty to look at but I don’t like to be out in it. I especially don’t like how other drivers react to snow. The thing about North Carolina is that less than 2% of drivers know how to drive in the snow. Others go too fast or drive down the center of the street because they can’t see the markings on the road.

On the healthcare side, patients ALWAYS make it in when there is snow or ice. I have spent more nights at the hospital because of the threat of inclement weather than I care to.

It all comes down to having good processes around snow. I prep my car with a sheet over the windshield and prop up the windshield wipers so that they don’t freeze to the windshield. When we get snow/ice that makes getting out of our neighborhood difficult (we have a steep hill) I park at the park and ride just outside of the neighborhood entrance. I haven’t had to for a couple of years as there has been minimal snow and ice and I also don’t work every day like I used to. I make sure that the cold winter gear is out of the coat closet and ready to use.

And, as always when I drive in the snow, I take it slow and don’t make any sudden movements or sudden braking. I am always watching other drivers and am prepared for evasive action at all times.

Driving in snow and on ice is a lot like handling a wild animal. Slow deliberate movements, don’t make any sudden movements in case you end up in a ditch. When I was at Creighton University we used to make fun of the drivers that ended up in ditches or the ones that we knew were going too fast and got themselves into trouble.

If you need me, I’ll be at home because I am off during these snow days.

Snow. It looks pretty but I don’t like to drive in it because of other drivers.

Cookie Thursday 1/9/25- enduring happy accidents

This is the second week of the Cookie Thursday is a Thing 10th-anniversary baking frenzy. Not really, it is just a highlight reel of the department favorite cookies from the past 10 years. It is a good thing that this month has 5 Thursdays.

The cookie that I made today was a perennial favorite and is always at the top of the cookie wishlists.

I, of course, am making the jalapeño chocolate chip cookies.

As always, I am shocked and tickled pink by the enduring love for this cookie from my department. Many people put it at the top of their list. Of course, there are always the naysayers who say vegetables don’t belong in cookies.

Nay, I say. Cookies are only bound by your imagination.

The jalapeño chocolate chip cookies were begun after my dad planted my garden for me. And included three jalapeño plants.

No one in the house would eat them and I needed to dispose of them somehow.

Looking at the pile of peppers on my countertop and the supplies of Cookie Thursday is a Thing started me wondering what if.

What if I put the jalapeños in the cookies?

This started the experimental phase of CTIAT. A phase I am proud to continue as I am always down to experiment on willing participants.

Since it is January and peppers are getting weaker and weaker I use dried jalapeños. I reconstitute them in water for several hours and use the entire ramekin of peppers and water in the batch. I do increase the amount of flour to compensate for the increased fluid.

So really the jalapeño chocolate chip cookies were an accident. A happy accident but an accident nonetheless.

Best Kept Secrets of the OR #19- Knowing how to get help is the best way to help yourself

Once upon a time, at Christmas, I was startled awake by the phone ringing unexpectedly. I had been sleeping the sleep of the one who was medicated and not on call. I was off and had taken a muscle relaxant because I had tweaked my back.

There arose such a clatter from my bedside table. I glanced at the number and knew immediately it was the hospital. I answered.

A new nurse who had not taken the call bootcamp was given Christmas night call.

Rude of them to give a brand new nurse Christmas night call.

No, I have no idea how they slipped the call bootcamp net but there are so many new people it is hard to keep track of who has and has not had the class. Or who has had the class and subsequently left.

There are those as well.

In a fog, I answered their question of how to schedule a case in the specific OR. I hope I made some sort of sense. I must have because they didn’t hang up until the case was scheduled.

Someone had told them that I was the go-to person to reach out to with all questions.

It was probably someone I told to reach out to me when they were on call.

Because I do that.

Knowing how to get help when you are drowning on call is important.

I would say it is the most important call piece I give the new ones.

They finally got to take the call bootcamp this past two weeks.

I answered their questions and I also reassured them that they could reach out to me at any time to get the information.

In fact, I would rather they reach out to me than be yelled at by a doctor. Or, you know, they can call me when they are yelled at by a doctor. I yell back.

And the doctors all know it.

Tuesday Top of Mind 1/7/25-of course babies are being thrown away in TX

SIX babies have been found abandoned in dumpsters in this last year in Houston, TX, alone. According to reporting by Fox News 26 in Houston, this is a 500 increase since 2022. In that year ONE baby was abandoned.

What else happened in 2022? The Supreme Court overturned Roe v Wade, dooming more than half of their constituents to fear and the possibility of death if pregnancy doesn’t go 100% right.

This sounds like the natural consequences to their actions. To be clear, the government and the legislature are not the ones facing the consequences or death.

The worst part of this story is that 2 of the babies were found dead.

The other worst part of this story is that it is not just Houston.

The other other worst part of this story is that sometimes it is a ditch.

Reminder, Texas has one of the strictest abortion laws in the US.

And they are surprised? No, of course not, this is just expected fallout of their control issues. Acceptable casualties such as these have probably already been calculated and their concern level has not been breached.

There is another way. There are safe haven laws on the books in Texas. It just comes with an eensy, teensy catch. The mothers (it is always the only the mothers, have you noticed?) might not even know about them as the powers that be in TX certainly don’t advertise the laws. To do so would burst their happy little bubble that this is fine, everything’s on fire, but it is fine.

Dead women if you do (abysmal women’s maternal mortality rate, worst in the nation according to the state rankings), dead infants if you don’t (allow abortion rights, fund women’s healthcare, give a damn about your constituents, allow ).

And the women who have the money and the support to go out of state to seek their very much needed healthcare? Texas and Indiana and possibly Idaho would very much like to know where women go when they flee the state for needed healthcare.

A law called HIPAA prevents them. But that doesn’t stop them from trying. From battering down the walls that are protecting women from creeps like them.

Are you paying attention yet?

Or are you pleased this is happening and the dead children and dead women are acceptable losses?

Post-it Sunday 1/5/24- You get more flies with honey than vinegar

The post-it reads “Killing the coworkers with carbs/kindness.”

This made me laugh when I re-read it.

This is another Cookie Thursday is a Thing story.

I did not start the behemoth that is Cookie Thursday is a Thing to kill my coworkers. We started it because a coworker had told us in the lounge that they’d never had a homemade cookie. Many pearls were clutched as we all inhaled in indignation.

However, not everyone is privileged enough to have someone who can bake or money to buy ingredients. This is a fact that was not lost on us. However, righting this wrong absolutely could happen. And did, every week for 10 years.

I had this brand new pretty kitchen that I was itching to use. Why not make homemade cookies, weekly for 10 years.

The new kitchen was put in during the entire year of 2014 and the countertops, which were back ordered for a month were installed in November. But that is a story all on its own.

I am not sure that my coworkers know the hows of CTIAT, yes that is the acronym I use. It has to fit in with all the other acronyms in the OR and there are many.

The entire thing is done on my and my husband’s dime. We earn the money to buy the ingredients that I use. We earn the money to buy the utilities that I use. That’s it.

Well, that isn’t entirely accurate. I have had a couple of pinch hitters when I was away or sick. I also have received $55 and a bag of flour over the course of those 10 years.

My sister would ask why I don’t charge a fee. She made me charge a drive-the-detachment fee for gas when I was in university and the only person in the detachment with access to a big enough car. We had to go between 2 universities for Air Force training. Funnily enough, they stopped asking me for rides when she did that. And the relationships cooled mightily.

I don’t want to charge a fee for people to eat the CTIAT cookies. It is not in the spirit of the thing. I have seen surgeons ask for repeats of certain cookies. I have also had people ask for specific cookies for their birthdays or last days. I happily made them all.

Kindness begets kindness, no matter how or why or who.

Being self-funded makes me feel better about experimenting on my coworkers with new cookies. I have had some real success. And a couple of duds. If I asked for money, I fear that I would lose some of the control. I set the schedule and decide on the monthly themes.

Imagine what it would be like if that had to happen by committee?

School Me Saturday 1/4/2025- The to do list is yesterday’s productivity hack

I was tooling around on the internet like you do when a post caught my eye.

It claimed that the to-do list was dead. I love a good to-do list. Nothing more satisfying than making a list and crossing things off.

Yeah, I can see it. Especially for today’s young adults and teenagers. Heck, even the older adults.

It introduced the concept of a bingo card instead of a to-do list. The idea is that you populate the card with what needs to be done and you cross the squares off as you do them.

Genius.

That can be an exciting adjunct to a student’s portfolio of items to encourage productivity.

I used Canva to make the Spring semester 2025 bingo card and it was easy and free. Both of these things are important to a student’s life. I would make a bingo card for each class, filling in the squares with the details of the class. This includes reading, tests, quizzes, and papers.

The beauty of this is that it can be whatever you want it to be. Each row can be a type of thing for the class, or it can be staggered.

In the bingo card that I mocked up as an example, I staggered all 14 weeks of reading, added the 3 tests, the quiz, and the midterm and final. I left a line to be filled in for exact dates.

I also added a second free square, just because.

My personal Spring Semester 2025 bingo card looks a bit different as I have finished with classes and now all I have left are tasks. I have already mapped out my spring semester, including all the tasks that need to be done for the dissertation.

As with many things, I wish I or someone else had thought of this when I was actively in classes.

Because this could be a game-changer. Gamification is exciting.

I am going for a blackout on my bingo card.

FFS Friday 1/3/24- Un-Fancy

Life in the hospital continues to be a struggle with the increase of covid patients and the increase of flu patients and the increase of RSV patients and, unsurprisingly, the increase of whooping cough patients.

The holidays, the gift that keeps on giving to the hospital.

Also a gift/burden to the hospitals? The anti-vaccination movement. That someone made up because it made them feel powerful and popular and the political right seized upon the idea and started preaching anti-vaccination propaganda to their followers. The man who would be president in 17 days said it best in 2016, “I love the poorly educated.” And that was before the 2016 election.

If you are going to be on the side of anti-vaccination that does increase the supply of sick patients in the hospitals. If they can afford it. Otherwise, they are out there spewing germs and viruses everywhere. Because no one can afford to call off sick.

It can go back further all the way to Christopher Marlow and his 1604 work Doctor Faustus. This is where the man sells his soul for pleasure and knowledge. Being excessively educated leads to his eternal damnation. So the war on education started back when books were horribly expensive because the printing press had only been invented less than 150 years before. And printing presses were banned by the sultan of the Ottoman Empire upon pain of death.

Wow.

This post took a marked turn. From the trials of the hospital during the holidays to anti-vaxxers, to the war on education, to keeping people stupid is the point. This post was a wild ride.

I write this so often, this was not the post I wanted to write. But I do free write a lot.

I wanted to write about how un-fancy the hospital culture is during the holidays when it feels like it is every healthcare worker for themselves. We are surrounded by glitz and glamour of the holidays, and hospital-based providers are holding the burlap sack, begging for some more.

To bring it back to the Friday theme of FFS, this has definitely been an un-fancy post.

I just don’t have the energy to make it fancy.

Cookie Thursday 1/2/25- CTIAT Turns TEN!

When Cookie Thursday is a Thing began in our operating room in 2015, I was not the only baker. There were a group of us, committed to making and bringing in cookies on Thursdays.

One by one the others dropped out.

Along the way there were a lot of discussions on what to name the cookie day.

A couple of people wanted simplicity and said Cookie Thursday.

This didn’t feel complete enough to me. Thursdays happen every week.

In those days Thursdays were the heaviest day of the week. Both case wise and difficult case wise. There was a lot of heavy ortho on Thursdays. By that I mean total joint replacements galore. And the hospital had just gotten its first robot with its steep learning curve.

No, the name had to be distinct and special.

The evening tech and I were discussing in the hallway, just outside of the lounge. They were one of the ones that wanted Cookie Thursday. I interrupted them and said emphatically, “No, because cookie Thursdays are a thing.”

And the name was created.

The word thing is deliberate.

A thing can be many, well, things.

It can be making coworkers feel special by having specific treats in the afternoons when it is so often day shift that is celebrated.

It can be making coworkers feel seen by making what they suggest. This was in the early days, when the themed days hadn’t been settled on.

It can be sharing the load. Yeah, this one didn’t last.

For me, it can be a way of marking the days.

It can be an acknowledgement that yeah, Thursdays are bad but at least there are cookies.

In fact, that was also almost the name- It’s Thursday but at least there are cookies.

I think that one is too long. It can be shortened to At Least There are Cookies but that didn’t acknowledge that Thursdays were the bear of the week and we just had to get through Thursdays to get to Friday.

The cookies were meant to be special because it was Thursday and special for the evening shift because the hospital did not go out of its way to make evening shift feel special and special for the morale boost that having home made cookies can give a department.

This 10th anniversary month I will be making favorites. I asked a bunch of people to choose their least favorite out of a list of 6. There are 5 Thursdays in January 2025.

Stay tuned to find out the top five cookies.

I am starting with an easy one because yesterday was hard. Out of the 12 hours I was on call yesterday (0700-1900) we worked 12.

We did 2 lap choles, 2 hip fractures, an open belly, and a D&C. I kind of felt like I was in my 12 Days of the OR Christmas song.

The cookie of the week is the crust cookie.