For many of the students, the semester is winding down.

It seems like just yesterday we were starting, full of energy and enthusiasm.

Even for those of us who have been around for a few semesters, or years, this is an exciting time.

We make promises to check in with our assignments often.

To reach out to the instructor if we need help.

To carefully watch our assignment list.

To do the reading faithfully every week.

To look out for our classmates, offer to lend notes, or offer to study together.

It is so, so tiring.

And then suddenly it is mid-semester when it was just the beginning of the semester.

Time is funny that way.

The end of the semester is so close for most of us, glimmering in the distance.

Kind of like a mirage.

But unlike a mirage this place in time is real.

There is just a little more gas in the tank to get to the end of the semester.

It is okay.

I believe in you.

And in myself.

Remember the mantras…

the only way out is through

just keep swimming

Whatever works.

Continuing this month’s theme of Something from Nothing is baked French toast bites.

This theme is a cleverly worded message to myself to use the ingredients that I bought with cookies in mind.

The ingredient for the week is cinnamon brioche bread.

I love a brioche bread.

By itself with butter.

In a bread pudding.

It is all good.

But…

I realize that I am the only one in the house that an ingredient such as this is for.

I bought this cinnamon brioche bread thinking I would be able to eat it for breakfast.

Or a snack,

Spoiler alert, I did not.

Really, is anyone surprised?

I had a load of cinnamon brioche bread that needed to be used.

Voila!

Baked French toast bites.

I will definitely be making this again. Maybe for my coworkers, maybe for my husband and myself. We’ll see.

The experimentation part of the recipe is that one of the recipes I found encourages the use of creamer in place of milk.

Hmm, I thought. I’ve got some brown sugar oat milk creamer.

Perfect!

After I sliced the pieces up, I tossed the lot of them with cinnamon sugar to coat.

Okay, now it’s perfect.

Oops, here I go again with the series. This time will be discussing consents.

A patient’s signature on a surgical consent indicates that they agree with the surgery that is going to be performed. That they agree that Surgeon X is going to perform the surgery.

A nurse’s co-signature on a surgical consent indicates that the patient was witnessed signing the consent.

That’s it.

The conversation about what all the words in the procedure mean should have happened between the patient and the surgeon. That is what makes it informed consent.

The surgeon INFORMS the patient about the risks, benefits, and alternatives to the surgical procedure. The surgeon also has to note this in the history and physical of the patient.

Yes, sometimes the PA or NP fills out the H&P, or their partner if they have one. But someone has to have a conversation, detailed in the notes or the H&P, with the patient.

And the ONLY time there is no informed consent is the true life or death emergency.

For example, the patient will die without treatment.

To recap, the patient who is named at the top of the surgical consent form agrees with the procedure listed on the surgical consent form to be performed by the surgeon listed on the surgical consent form (or their practice partner). The nurse who watched as the patient signed the consent also signed as the witnessing nurse.

In the hospital where I work, all three signatures must be present for the consent to be considered complete. If one of the signatures is missing, the surgery cannot be started until all three signatures are present.

Consents are a big deal and we in the operating room spend a lot of time making sure they are correct. These are the three absolute signatures on the consent for surgery to proceed.

But, but, but…

What if the patient is not able to sign their own consent?

What if the patient is not alert and oriented enough to sign their own consent?

What if the patient is under 18 and not emancipated?

Those questions will be answered as the series continues.

Today is voting day.

Although you might not think it is important, decisions are being decided across the country that are important. Like very important.

Like a woman having bodily autonomy in Ohio important. As they seek to protect abortion rights in the state constitution.

I mean they are also voting to legalize marijuana in Ohio. They should get some people out to vote for that.

Or keeping extra taxes that exceed the monies expected to fund preschool education. Capital idea.

Or giving people whose rights have been disenfranchised illegally the ability to vote again. This is Maine where there is an already declared illegal state provision on the books that says some people who are under guardianship cannot vote. This was declared illegal in 2001 by a federal court. To this put in perspective, Britney Spears, if she had lived in Maine while under guardianship of her father, would not have been allowed to vote.

Also in Maine, there is a measure to ban foreign spending on elections on candidates or ballot measures. This also is already illegal federally, locally, and state, but this expands direction to radio, television, or print to set up policies to prevent publication of communications bought with foreign money.

There is a county in Texas where the ballot measure is to disband the county treasurer. This is not the first, and the treasurer himself is telling people to vote for it. To me it is wiser to follow the money. But I don’t live in Texas. Heck, I won’t even visit Texas with its current political climate. That is just me being wise with my spending money and not willing to spend it on a state that doesn’t think I am a whole person.

Locally, the Democrats got burned last state legislative session by a Democrat suddenly deciding she was a Republican. This is awful because it tipped the balance in the state house of representatives to be a veto proof margin for Republicans. I am not sure if I have written about this before but I have some friends who voted for her and are PISSED! Apparently, the Republicans are trying this wolf in lamb’s clothing gambit again with 3 school board candidates whose money people are 1) the same person and 2) Republican based.

See, follow the money.

And if you cheat to win an election and no one notices, what does that say about the populace?

Or about you?

Yeah, it’s not the BIG election year where the country chooses a president. It doesn’t mean it isn’t as important.

If you haven’t voted early, take a few minutes and vote today.

Early voters in my county were more than 40,000.

You will need photo ID to vote.

Yeah, that disenfranchises people who can’t afford a photo ID.

But that is and has been the plan for “fraud” that doesn’t exist for years and years and years.

But that is another Top of Mind.

Polls close at 1930.

Time for a time change!

You see what I did there?

Time is and has been very fluid for years now. The pandemic just made it worse.

They say that time moves faster the older you are.

Or, at least, it appears so.

I enjoyed the extra hour’s worth of sleep last night.

My cat did not appreciate waiting to be fed tonight.

Who is right?

Aren’t we both?

I have fed the pager (new battery) and I will see what that brings me tonight.

There is an endeavor to get rid of daylight savings time. the time change that has been implemented in states across the US.

The daylight savings time started with the farmers needing their children to man the fields in 1966. Or when in Germany in 1916 to save energy during the First World War, followed by the US in 1916 to be repealed a year later. Or in Canada in 1908. Benjamin Franklin thought it would be a good idea to sync waking life to the outside sun hours. Of course, he only meant it in a satirical manner.

If you are on the pro side of more sleep, or the weepy side of where has the evening daylight gone, don’t fret. The world will continue to turn.

I hope.

Just keep on swimming.

If your school is anything like mine, the end is in sight.

For good or for ill the end of the semester is in site. 4 weeks, 5 weeks, 6 weeks away.

Time to buckle down to do the end-of-semester assignments. For me, I have 5 assignments before the end. Well, four with the 5th being a presentation of one of the 4.

The semester that started with so many assignments now has 5.

I bet the same is true for your student.

But don’t forget to remind them to take a breath, and take a moment to reflect on the semester.

This is not the time for self-recrimination. They’ve kept swimming. Through calm waters and through storms the only way out is through.

Grade chasing for that A need not apply. The focus right now is to finish the semester.

New month, new theme.

I have been workshopping the title of November’s theme for the last couple of days. Because I already knew what I wanted to do.

I want to do a pantry cleanout. Of all the odds and ends I’ve collected over the past year.

The theme for November is Something from Nothing

And what better place to start immediately after Halloween than the leftover Halloween candy.

Any kid who has been trick or treating in the last several decades knows that the best candy is to be eaten that night, or the next day. This is the best way to protect the haul from poachers, AKA siblings or parents.

Frankly, the dregs of the candy pumpkin are just sad.

And, of course, I saw a recipe.

I’ve made these in the past, with the standard Toll House recipe and chopped-up mini candy bars. This was exactly the recipe.

Leftover because of course we overbought. Blame our horror of being caught without candy.

Oh, the neighborhood shame!

Has that ever happened?

No.

But it could!

I’ve done this call thing for a while.

Even before I was the night call nurse, I took a LOT of call.

Alotalot.

At the height, I was pulling something like 88 hours of call a week.

For those playing along with a calculator saying huh? That is every weekday night 2300-0700. Which is essentially 40 hours a week. Add in 48 hours on the weekend that is 88 hours.

I didn’t take EVERYONE’S call. Just 95%-100% of it. And if the nurse responsible for the day call on the weekends still wanted to keep their call, I still took laser call. Because, by policy, there has to be a dedicated person to run the laser.

Call exists so that the OR can be staffed, even during the night or on weekends.

Call exists so that the patient in need of surgery can have surgery at the hospital.

Call exists so the surgical team only has to be on stand-by in case there is a surgical need.

Call just is a function that we, as the OR team, fulfill.

It doesn’t have to be scary.

You just have to know how to get the answers that you need when a situation arises.

OR who to reach out to get the information.

But, I get it. Call isn’t for everyone.

Some people like to sleep all night without the possibility that they will be needed at the hospital. Some people like to have a glass of wine after their shift.

I can’t tell you how to get to a state of zen about taking call.

I can tell you that you need to relax.

Take a deep breath, unclench your fingers from the phone, put it down, and close your eyes.

In years, and years, and year, and hour upon hour of taking call (and they are legion), I slept through a phone call AND my pager exactly once.

Odds are good that it won’t happen to you.

As I tell new scrubs about calling in the scrub tech, if you don’t answer I try again, and then I try the secondary number, and then I start down the list searching for someone to come in and function as the call person.

There may be consequences. But again, has happened less than 15 times in all that time.

Don’t fear the call. It isn’t the monster under the bed.

I’d take it if I could.

The regularly scheduled Tuesday Top of Mind has been co-opted by the spooky!

Do not adjust your TV sets.

<spooky music!>

Where there are hospitals there are stories of odd things.

Things that go bump in the night.

Medicines that get moved or go missing.

Instrumentation that gets moved or goes missing.

There is a lot of suffering in hospitals. And if you ascribe the creation of ghosts to suffering, it makes sense.

If you believe in ghosts; you do you.

I’ve had my spooky share of weirdness in the hospital.

I’ve written about them before.

But This is Halloween and I want to share.

I worked evenings as a Med-Surg RN in this older hospital in California, and then I worked nights as a Med-Surg RN on the same floor when they conned us that 12-hour shifts were awesome! One night, late, either in the middle of the night or after 2230 waiting for the night shift to arrive, I was checking the medicine cart for something. I no longer remember what. I looked down the long. empty, dark hall. Empty because we were only half full at the time, and I saw her.

An elderly woman, bundled up in a pink robe, looking at the painting on the wall.

Not my patient.

I glanced over to ask one of the other nurses which of their patients was out of bed. This took seconds. When I looked back, she was gone.

Uneasy now, I went down the long, empty, dark hall to the painting, glancing into the rooms as I passed. Everyone was asleep in their bed.

I came up the other side of the hallway, think of the unit being like a racetrack. No one was out of bed, the rooms were dark.

I took the stairs to the ICU unit. No one was out of bed there.

I took the stairs to the Skilled Nursing unit on the first floor.

No one was out of bed there.

Still the eeriest experience I’ve ever had in the hospital.

And that includes the time that the elevator was open and waiting for me when I had to get an instrument up 3 flights of stairs to the obstetrics ward where the c-section room needed it.

And it was open again to go back down to get a different instrument.

And it was open again to go back up with the next instrument.

Hospitals can be creepy places.

Hi, yeah, Post-it Sunday is delayed.

Everything I write turns super dark.

Or would just hit wrong.

Must be the spooky season.

Or the full blue moon from two days ago.

I’ll try again tomorrow.