24-yearly disclaimer, edited for 2024

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.

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.

I change a lot.

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

I discuss issues that impact healthcare broadly.

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

And covid. Can’t get away from covid. JN.1 is the newest variant and it is currently causing 44% of the cases. People continue to die.

I do swear sometimes.

But mainly to make an emphatic point.

School Me Saturday 12/30/23-looking ahead by looking behind

This is the last School Me Saturday post for 2023. And it will be a 2023 personal report post.

There is something about the end of the year that promotes introspection, of looking inside yourself to count your accomplishments. Do not count the failures. These are just learning opportunities.

This past year I survived TWO PhD semesters! In a six-semester program that is 2/3 of the way through. I almost called my chair a liar when she told me that I only had 4 classes to go, the rest of the time will be project and dissertation. Mind-blowing.

I learned about so much as well. Nursing Theory, more statistics, types of research. This past semester had a bit of a different feel with 2 of the three classes being mandatory classes in Policies and Ethics, and Health Disparities. I dare say I learned a lot in the two.

I continued to function as a research assistant and was assigned to a PhD nurse who was just starting a project. I got to design and create the survey that she will be using. I got to learn more programs, including Canva and Qualtrics which is the survey program. I love to learn stuff. This next semester will have more things to learn in data cleaning, and using my nascent skills in statistical modeling. But that is next year me’s problem. This post is about 2023 and all that I have learned.

The Tuesday night Writing Group has kept me in good stead to stay on target. This is a group I joined at the very beginning of this endeavor, and I use the three hours weekly to focus my attention and my thoughts. I know I am the only 2nd year who engages with the writing groups but they are very instrumental to my process.

I worked as a graduate assistant over the summer for a group of RN to BSN nurses who were in their last classes. We explored writing and citation, and I spent a lot of time reassuring them. Anyone who knows me in real life knows I am not that person, but I allowed myself to be that person for them. Well, I say I am not that person, but I am relentlessly cheerful and see the bright side. Not for nothing was my MedSurg nickname of Pollyanna Puke.

I survived the busy season in the operating room. To recap, many people have met their deductible and therefore MUST HAVE SURGERY NOW!!! This makes the end of the year, and the beginning of the year very busy in the OR. I still haven’t learned how to say no, and I’ve been doing a bit of evening shift charge during the week.

2023 was a busy year; I’m still on the bridge toward graduation.

Mantras always help. My favorite is “The only way out is through.”

Next week on School Me Saturday I will explore looking forward for adult learners.

Cookie Thursday 12/28/23-the last cookie of the year, toffee crackers

This is the last Thursday of 2023. That means it is the last Cookie Thursday is a Thing or 2023.

It was also a very big day for my mom. She was going to have surgery. And I was going to be her helper in the OR, and, more importantly, her driver.

Okay.

So I make cookies on Wednesday.

But what holiday cookie to make to keep up with the theme?

I went to my baking pantry to find inspiration.

What I didn’t find was the club crackers that I had. I must have put them somewhere else.

But I did find tea cookies. That’s what it said on the package. These were similar to naked hobnobs. See also, biscuits in Britain.

After finding them in the pantry, I decided to make toffee crackers with chocolate on top. This also goes by the name Christmas Crack.

Oven 350-degree Fahrenheit

1 c butter melted

1 c brown sugar

cook together until boiling and boil for 5 minutes

The entire package of tea cookies on a cookie sheet, laid out in a single layer.

It is best to do this while the butter and brown sugar are doing their thing.

Top the cookies with the toffee, making sure to cover all the corners.

Bake for 5 minutes.

Pull from oven and top with chocolate chips, about 1 cup. Wait until the chocolate starts to get glassy before spreading the now melty chocolate over the toffee-covered cookies.

This recipe also works with saltines, club crackers, Ritz crackers, graham crackers, matzoh crackers, and pretzels.

Hopefully the last worst case of the year

I have made no secret of my worst case. Ectopics are a pain in the butt. The surgeons always try to save the tube, which I understand trying to save someone’s fertility, but it rarely works. In the hundreds of these I’ve been the circulator for trying to save the tube just prolongs the surgery. Even with a perfectly executed hydro dissection of the ectopic from the tube, the tube is going to bleed. And bleed. And bleed. Which the surgeon will try to stop, throwing everything but the kitchen sink at it.

Admitting defeat, they take the tube.

Cool, we could’ve done that like an hour ago.

I took over the room from the day shift nurse right after patient positioning but before the start of the surgical case.

Wasn’t that fun?

No, no it was not.

Nothing is worse than inheriting a room.

As I was getting report, I flat out told the nurse I was relieving that ectopics were my least favorite case. I would go even so far as to say they are the worst.

The surgeon heard me and asked me why these were the worst cases.

I am not sure if they were looking for a political answer or an ode to saving the patient’s life.

To their surprise, I said that ectopic cases were the saddest cases I’ve ever done.

Especially immediately before or after a major holiday.

I informed them that the worst of the worst was several years ago when I was the circulator on 10 ectopics in 7 days. Right after Christmas.

That was the worst worst.

Not only are you breaking the patient’s heart but these are not easy cases.

No matter how prepared the room is.

No matter how much was missing from the room preparation.

Not to mention the surgeon’s demands for things that are not on the preference card like a certain needle or the physically impossible contradicting orders from them and their assistant. No, I cannot turn on the light source and the CO₂ and dim the room lights and the spotlights at the same time I am also setting up their suction. The gas and the light source are on the same tower but the room light switches and the spotlights are in an entirely different place in the OR, as is the suction. And then they express displeasure that I can’t do all four things at the same time.

Rude.

A friendly word to the CRNA, if there are calls from the field about changing suction and I am across the room attending to something else, please change the damned suction. That’s why there are 4 suction canisters on that suction tree. And don’t watch me in an avuncular manner as I scurry to change the suction out. That you are sitting RIGHT next to. Okay?

Hopefully, that will be the last worse case of the year. I mean the year has 7 more days in it. Anything could happen and will.

Just ask Murphy.

Tuesday Top of Mind 12/23/23-the melancholy of Christmas, AKA the after

Christmas is exciting!

Presents, food, more food, games, wrapping paper, excited children running through the house screaming, excited pets who know something is happening but have not copped on to what yet, more food, Christmas cookies (25 types, Mom is an overachiever!), awake too late, up too early, no time to sleep, all the ovens baking, feasts, pies, presents.

All of this boils down to the wonder of Christmas.

For some people, Christmas is anything but wonderful.

There are many different reasons for this.

An estrangement.

Last of the family.

An argument.

A death.

Even as we are wrapped up in our fun and our joy and our food and our presents, it is important that we remember the struggles of others.

Some of these people you can invite in to the party.

Some of these people will not come to the party.

Some people we have to support from afar. Silently. Because naming them and expressing support is not to be done out loud.

It is also okay to be sad after the glitz and glamour of the holiday season is over. When the present has been drunk, or put away. When the last of the Christmas cookies have been eaten.

And the whole of society is left with the aftermath.

The mess, the decorations that have to be taken down and put away, and the leftover food that no one wants.

It is okay to be tired and sad.

Even at Christmas.

Especially at Christmas.

Post-it Sunday 12/24/23- holiday call

The post-it reads “holiday call can be the pits, depending on where you fall in the seniority list.”

Call is what the department makes of it through policy. Holiday call is also what the department makes of it through policy.

I’ve heard good things and not-so-good things from my friends at other hospitals.

Some places choose holiday calls by seniority. Like the hospital I work at.

Reminder, the department that I work in has 9 ORs, one of which is a procedure room. There are currently 25 nurses in the department, of different hours and different levels. These levels can be PRN. If the nurse who works PRN was working this before 2015, then they are grandfathered into no call. Otherwise, everyone takes call.

PRN means pro re nata. You may have seen it on a medication label. This means as needed.

I’m only going to be talking about the RNs here. The rules are the same for the scrub techs.

Unlike the banking or government sector, the holidays that count are dependent on the state. I believe here in North Carolina, there are 8 holidays that the surgical department is closed. These are the standard holidays like New Year’s, Christmas, Memorial Day, Labor Day, and Thanksgiving.

In the surgical services department where I work, each holiday is split into 12-hour shifts, a day shift 0700-1900 and a night shift 1900-0700. The department also voted that Christmas Eve after 1900 and New Year’s Eve after 1900 are considered holidays. This puts them into the mix.

Going back to our numbers, if there are 8 holidays, including eves, split into 12-hour shifts, effectively doubling the days that need coverage. This means 16 shifts need to be covered. By 25 nurses. This is where seniority comes into play. This is seniority in the department, not in the corporation.

I’ve been there so long (15 and a half years) that I have the most seniority of the OR RNs. Which means I don’t have to take holiday call.

Signing up for holiday call, even by seniority, can be a challenging thing for management to handle. To ensure that no one gets a “hot” holiday, such as Christmas or New Year’s, more than once every two years. There are even lists of the holidays and an A team and a B team who chooses.

Because the OR must be staffed in case of an emergency. Even if it is taking call from home.

This year Christmas Eve, that’s today!, is on a Sunday, which added an extra day to the holiday call rotation.

I’m still senior to everyone else and I didn’t have to take any holiday call this year.

If you are on call this weekend or next, or not, have a Merry Christmas! And a Happy New Year.

Don’t forget to think good thoughts for 2024.

We are going to need them.

School Me Saturday 12/23/23-where I’ve been and new tool for school

Good morning!

I know, I know. I’ve been very light on posts this week. I blame the December schedule and the hours I picked up to help out. I also blame my old computer which had been limping since I received it in November 2022. It was bought new then to replace the older computer that saw me through the MSN. The computer I used for my BSN had completely fried one day, after the BSN but before I started the MSN. My husband says that although the PhD computer had had good reviews when he bought it there were files that were missing in its programming and after about December there were a lot of bad reviews.

I don’t think I am too hard on my computers. If I were, the computers would die from the same ailments, not different ones each time.

I think it is more that they fail me.

The one this computer replaced, the one I had had barely 12 months, started forgetting all my settings and would routinely dump all my information. This meant I was starting from scratch, with a computer that had to be retaught who I was and how to work best for me.

I admit, it was frustrating.

But having lived through my BSN computer dying and losing aaaaaaallllllllllllllll that work on the hard drive I was more strategic about where I saved my work. Once Microsoft 365 came along and made it easier to save on the cloud, and the computers began to be able to sync to others, recreating my school life, and my work life, and my writing life became a lot easier. This meant that I stopped losing school assignments, personal writing projects, and work writing projects each time the computer either died or had a seizure that made it forget me.

Which is the lesson for this School Me Saturday.

Starting over from scratch on a weekly basis is eminently frustrating. And, frankly, a waste of my time.

The lesson for this week is to have to right tools for the job at hand.

This will look different, depending on the job.

Right now this is a computer that can handle my hours and hours that I spend each week reading and making notes on the class readings. Or the hours and hours I spend each week on assignments.

This new computer is trial. Let us see if it will last through my dissertation.

I hope, I hope it does.

Although everything is in the cloud it is still annoying to bring the computer up to speed every time it decides to dump any knowledge I’ve gathered.

Fingers crossed.

Tuesday Top of Mind 12/19/23-December is a drag

I said it.

I mean it.

December in the operating room is a drag.

It is not for the faint of heart. Cases, cases, cases, cases, cases, cases.

Cases.

Everyone and their family member has hit their out of pocket deductible for the year and MUST HAVE SURGERY by the end of year!!!

Honey, there isn’t enough operating room hours to accommodate this. Even if you were more pleasant about it.

Do you want to know where my holiday spirit went?

Yeah, it’s under the avalanche of surigical cases.

I saw a tee shirt that said error 404, holiday spirit not found. You bet I bought it immediately. In green. The red lettering really pops.

Hell, for healthcare as a whole December is a drag.

The hospital wards are full, full, full. There are patients stacked in the ER like kindling, waiting for a bed to open up. They have cordoned off areas of the HALLWAY as “ER cubicles” where they see patients. And the patients wait until they are well enough to go home, or a proper room opens up and the hallway patient can become a room patient. To wait again for a unit bed to open up.

Plus covid, rsv, and the flu have decided to make this year a triple threat. Again with a new variant that is rising fast in the charts.

There are also the usual big bellies, gynecological emergencies, fractures. This month has it all.

Stay safe out there. But be especially careful of wet leaves.

The OR will still be doing cases until the bitter end of the year. And into next year, trying to clear the backlog.

I’m going to have a little eggnog and put on my favorite Christmas song and try to get into the swing of things as I check my list to make sure I have all the makings for Christmas dinner. And wrap presents.

The only acceptable Christmas movie will be either Die Hard or Gremlins.

Post-it Sunday 12/17/23-put a sock in it

The gown card reads “put a sock in it!”.

Yeah, that’s an idiom. It means be quiet!

That is not the context of this post.

This post is about socks and how important they are to the OR patient.

The operating room is cold.

Well, not really; the patients are cold. It is cold to the patient who is in a gown and stripped of their underwear and their own clothes. The patients are wearing thin cotton sheaths. They are cold. We give them socks to wear and hats. These socks serve two purposes, they are non-slip and they serve to keep their feet covered.

Socks are non-slip because we don’t want patients to fall. Because the ground is hard and they might get hurt. The floor is also often gross because of the shoes that all of the healthcare workers wear. Just think of all the things that people walk through before walking on the floor of the patient room. Especially the operating room floors.

I know I have written about how I cringe every time I see a child on the floor and being picked up, without washing the child’s hands.

The socks help with both of these problems.

Okay, it’s a little bit be quiet. But I won’t tell a patient to be quiet. I will tell a surgeon to be quiet in the right context. But that is another story.

School Me Saturday 12/16/23-breaks

The end of the Fall Semester was 2 weeks and 1 day ago. Spring Semester won’t convene until January 8th.

It is time to relax.

Maybe put up some holiday decorations or meet some friends for a holiday drink.

But mostly it is time to relax.

After all, it won’t be Christmas and all of that craziness for an entire week!

Pick up a book, go for a movie.

Re-introduce yourself to yourself.

I know that returning to school as an adult carries with it import. And money, don’t forget that we are paying for this privilege. We shouldn’t let that take full advantage of the breaks.

But don’t forget the you that has grand plans for after graduation.

This slog will end. Even if it doesn’t come with a graduation, there will be an end.

I’m going to go read another book that’s been waiting for the end of the semester.

What should I choose?