To badly parody Pride and Prejudice by Jane Austen’s first line. “It is a truth universally acknowledged, that a person who has been made NPO, will subsequently develop a mighty thirst.”

Yeah, yeah.

I know.

However, in my experience, the instant you tell someone that they cannot have any liquids the more they will argue and bargain with you.

Just a sip, they beg.

My mouth is so dry.

My tongue is sticking to the roof of my mouth.

Can’t I just wet my whistle?

No, can I have a wet washcloth to suck? And then swallow that fluid.

Can I chew gum?

No, no, a thousand times no.

It is not that we want to torture you, or your family, it is more about the mechanics of having fluid in your/their stomach that may be regurgitated and sucked into your/their lungs. This makes everyone have a bad day; anesthesia, patient, circulator.

When prepping a patient it is the most frequently asked question.

Sorry, the answer is no water, no gum, no washcloth. Your life is worth more than the temporary discomfort of being told no.

And we will find out if you cheat.

And you could die by cheating. Because of pneumonia after the fluid is sucked into your lungs. So there’s that.

Just listen to us. And don’t drink water from the sink. We will find out.

This is Tuesday Top of Mind where I write about anything that is top of mind.

This is a heavy lift after Monday, which used to be Monday Musing with the same premise. Mondays are the longest day of my week. I am on call 2100-0700 Sunday night, and I leave the house at 0615 to drive 90 minutes to the university, work 10 hours as a research assistant, and drive 90 minutes home. To go back on call shift at 2100. It is a LOOOOONNNNNGGGGGG day. If there are no cases I go to bed early.

As a result, my mind is pretty empty on Tuesday mornings. I take the morning to get my head back into the school game and read all the news I missed on Monday. On the first three Tuesdays of the month, I have 0700 meetings. Not today! Today I slept in until 0815 and it was great!

Then I get to reading and engaging with all sorts of news outlets. I am continually looking for things to send to my classmates in their dissertation area, reading the policy news for one of my classes, reading health disparity news for another class, and just reading the rest of the news for me. This fills my brain back up.

Long explanation short, this Tuesday morning I ran across a news item about the changes to the Scholastic Book Fair and how they are self-censoring in a bow to book ban pressure.

I have many complicated feelings about this.

I love the Scholastic Book Fair.

Books were my steady and constant companion while I was growing up.

No one told me what to read or not read as a child. I would not have listened anyway.

But in today’s society, it is different.

Instead of policing what their children read and leaving the rest of us out of it, some parents want to not let ANY BOOK they find objectionable into schools, libraries, and what have you. I find some of the reasons for the objections laughable.

Granted, I’m not a parent.

But I am an aunt who gives books out for Christmas, along with pajamas and socks.

Yes, I’m that aunt.

When I am choosing the books to give at Christmas I don’t ask my siblings what books they object to. I ask about the current interests of the kid and make my own selections based on that.

For some kids, the Scholastic Book Fair was the only place they could see and read books about other kids that looked like them. Or it was a place to explore topics that the kids wanted to learn about but was too afraid to ask the librarian.

Books are important.

Ideas are important.

And the Scholastic Book Fair self-censoring itself because a small minority, granted a very loud minority, wants to be the book police for EVERYONE. Well, I find that shameful and embarrassing for them.

Have they never looked at the internet that most of the rest of the world has?

Again, it is not about the children. It never is.

It is about control over what we learn and how we think and how we live.

That is the scandalous part of this entire debacle.

The post-it that started this theme reads “Skin is a map of your history.”

Throat incisions and neck incisions.

The premise of this series started as a medically trained professional could “read” your skin. By doing that we have a pretty good picture of your health history.

I still think this is true.

This Sunday I am going to focus on the throat and neck scars.

For such a small amount of space, the scars can tell us a lot.

If there is a horizontal incision over the middle of the throat, you may have had thyroid surgery. Surgeons tried to hide this in one of the creases of your neck.

A horizontal incision to either side of the middle of your throat could indicate a cervical spine surgery. Such as an anterior cervical discectomy and fusion. As an OR nurse, I would be concerned with proper body alignment during the surgery and I might ask the patient to put themselves in a position of comfort prior to surgery.

If there is a round scar at the base of the neck, near where the clavicles come together, or slighly higher, I would ask about your past tracheostomy history. This is a sign of a surgical airway and isn’t done just because. This can indicate long-term use of the ventilator or injury to the throat that made the doctors concerned there may be airway involvement.

Some patients have had what is called a neck dissection. This is usually for cancer treatment or lymph node removal. This kind of incision usually indicates something about your past medical history and current medical issues.

A past incision, or scar, over the carotid arteries may indicate a carotid endarterectomy, or the rotor rootering of a major vessel of the brain. This is usually done for plaque removal. It isn’t just your heart that develops this fatty material lining the vessels.

Sometimes you need IV access and none of your smaller veins in your arms and legs are good enough, or big enough to support the kind of IV you need. At times like these, an internal jugular IV is used. This could also have been an invasive heart monitor known as a Swann-Ganz catheter. The tip of this catheter sits in your right atrium and feeds back intel about your pulmonary function and your cardiac output.

For such a small amount of total area, incisions and scars on the neck and throat can tell us a lot about your past surgical and medical history.

Next week, the scars of the head and face.

References are the bane of many, many, many, many students.

And I mean many.

I count myself among them.

It would be one thing if there were the same rules for everyone.

But no, there are many. If you are in English Literature, they have their own.

If you are in legal, they have their own.

If you are in health sciences, we have our own.

To name a brief few, there are Chicago, and MLA, and APA.

Health Sciences, including nursing, uses the APA. This stands for the American Psychological Association. There have been hundreds of books on the proper usage of the APA. This is including the OG publication manual from the American Psychological Association. There are websites dedicated to helping you figure out the correct citation. And how to use it.

I know the most about the APA and even then I have only scratched the surface. It didn’t help that the APA was updated just after I finished my MSN.

My suggestion find a book that is easy for you to use to find out the nuances of the particular reference style that is necessary for your schoolwork. Websites are also useful in whatever style you have to use.

Also make friends with the librarians. They are always good in a pinch. Some university libraries will offer to make the citation for you when looking up articles in databases.

Always, always, check the citations when you are given them. Often they are wrong. There is either a misspelling, or the wrong word is capitalized, or the wrong words are italicized.

The coolest thing I’ve learned about citations is that Google Scholar will do them for you. When you look up articles in Google Scholar, part of the results has cite built into it. This is end quotations cite, after the star save on the bottom line of a result. I could have used that information a LONG time ago.

This is APA style, though. Edit- I was just using Google Scholar to find a Discussion post answer and it also has MLA, Chicago, Harvard, Vancouver as well as APA. So I was wrong and I was thankful that I was so I can update this blog post!

Yay for the health sciences!

To be clear, not my mom’s Christmas cookies.

This is another in the gravestone recipe theme for October.

After last week’s Cookie Thursday is a Thing fail of Kay’s fudge I wanted a sure-win cookie this week.

I mean, technically the dough could’ve been chilled and rolled out and treated like regular cut-out cookies.

Technically that would be boring.

I did drop cookies using my medium-sized cookie scoop instead.

A basic sugar cookie.

This recipe surprised me a bit, though. There is only about a 2-foot x 1-foot area to write these recipes on. Don’t forget the name and dates of birth and death also need to go on the tombstone. Unless you utilize the backside of the tombstone, which many of these recipes did. But there just isn’t a lot of room for long, in-depth recipes. Unless you go the QR code route for the newly dead.

I would like to see those recipes.

This week’s cookie is simple.

Sometimes that is good enough.

If I had a dollar for every time I pulled out and opened a suture packet, say a 3-0 vicryl SH, and it wasn’t. Instead, the suture that was in the wrong box was a 2-0 vicryl CT-1. Not even remotely the same. One is a cutting needle, the other is a taper needle and the suture, although the same type of suture, also isn’t the same size. Well, I would be wealthy.

Some people think that as long as the suture is replaced in a box, any box will do.

Deep breath to center myself.

No, no, no. Not any box will do. The box that matches what the suture is best.

If things are hopping, and the surgeon is waiting for me to open the requested suture to control bleeding, grabbing what you thought was the right one and having to go again out for the actual right one is so dangerous and can be detrimental to the patient. As a species, circulators don’t need to add to their steps that badly.

Could I look at the package that I pull out of the box?

Sure. I glance a the package to ensure that it is still in date. That’s what I do. But taking the time when I am running back to the room with suture in hand, not gonna happen. Therefore the wrong suture gets opened. A lot. Not only is that a waste of product, it is also a waste of time.

Just put the suture in the box it came out of. That’s all we are asking.

Also, the orthopedic supply that is one of a kind. I’ve heard about this happening too. At a glance, it looks like there is a very needed supply, but in actuality, someone returned the supply to the wrong box.

Years ago the OR was besides themselves because it appeared as if they had misplaced an entire instrument set.

Many, many people were on the hunt for this set. The department was set to be charge beaucoup bucks for the set if it was not produced by the end of day.

I walked onto the floor to start my shift, go to get something from the basement, and pick up the very set they are looking for. On a go back instrument table in plain sight.

No idea who put it there. Much panic to the day shift crew.

Don’t be that person who puts things in the wrong place.

If you don’t know where the proper place is, ask.

If you don’t care where the proper place is, ask yourself if healthcare is right for you.

I said it, well, I wrote it.

On this Tuesday Top of Mind is voting.

Do it before it is taken away from you.

Kind of like bodily autonomy.

Just ask all the women who are fighting to get it back from the scaley old white men and women in power.

Voting and abortion rights have a lot in common.

Some people want to take away the right to vote. To make it fair?

Do you mean so you can win?

Okay, got it.

Well, if it is the only way you can win…

NO!

2020 was a fair and free election.

As was 2016, 2012, 2008, 2004…

You get my point, right?

If your policies aren’t getting you the results that you want, maybe try to be less of an ass. And stop trying to take away rights.

It isn’t the 1950s. Women deserve more rights than we had in that era.

For that matter, so do trans women. They are women just as much as I am a woman.

Has your head exploded yet?

Darn.

Do you hear that?

That high-pitched whistling followed by the thud and an ewww?

Yeah, that is the sound of all the TERFS heads exploding.

Maybe try to act like you like other people that are not like you.

You know?

And stop trying to take everyone’s rights that you don’t believe in away from them.

M’kay?

Everyone else, vote in November. Yeah, it isn’t a very exciting election that will sway the balance of power in America. It still is vitally important.

Here in North Carolina early voting starts on Thursday and I and my husband will be there. Because if no one votes, the ones who got their supporters to vote using hatred as fuel win.

The only things on the ballot locally are the School Board, a bond measure to fund schools, the mayor of the town, and the board of commissioners.

I don’t care how little or how much there is to vote on, I will be there.

This is the week in which I discuss my personal PhD journey.

All of a sudden, we are on the cusp of week 10.

Didn’t school start like a week ago?

I have one assignment due this week coming up on Thursday night. I’ve already started writing it.

That assignment is in the Health Disparities and Outcomes class. This class also has a fairly big assignment due Monday, October 26. I’ve started that one as well and I hope to finish it and turn it in next Saturday.

The Quantitative Research class has a big assignment due at the end of the month as well. This is a draft of the research proposal the class has been building towards all semester. I have an idea of the research topic at hand, I just need to be able to discuss tools to get the hard data, and the group I am going to survey to get the data. This, unsurprisingly, has been the hardest class for me this semester. I mean, it’s statistics adjacent.

At the beginning of the pandemic, when details were kind of light on the ground and the world seemed to be on fire, I began a daily practice of reading newspapers and news sites. I’ve kept it up. I have the sites that I think have proven accurate and fact-based and I rely on those. Of course, like any former high school journalist, I know that the best information comes from a variety of sources. Some of these sources I use when I am writing the Tuesday Top of Mind posts. I read about the coronavirus and all its updates, I read about abortion and the cluster fire the Dobbs decision has enabled states to become. I read about climate disasters and the sequelae of climate change. I read about LGBTQ+ issues, including the war on trans people. I read about healthcare because I’m in the industry. The point is, I read a lot of different things. I think it behooves us as citizens to engage with the world.

This brings me to my third class, Advanced Health Policies and Ethics. This is, by far, my favorite class of the semester. Not only because being informed makes for better discussions within the group, but better discussions outside of the group. I find myself wanting to know and understand more. This does lend itself to being more politically involved. During our class discussion on Friday about political activism as nurses, I vowed to email my representatives monthly about what I see as the major political issues. I have thoughts on this versus the money from the lobbyists and special interest groups but I have to start somewhere, right?

This class, too, has a major project due just at the beginning of November. With PowerPoint presentation. I must start on the research for that.

That’s what I do, read research, and plan assignments.

And stack books I would otherwise be reading on the towering to-be-read pile.

Someday.

This is the second week of this month’s theme of Gravestone Cookies.

That is recipes that are on tombstones, not in the shape of a gravestone.

This was the first recipe on a tombstone that I saw. I’m not much on candy making, I usually save it for October and the Halloween homemade candy that is the theme of the last Thursday of the month.

One thing that I do know about candy making is that humidity is a threat.

When I woke up this morning, of course it was raining!

I checked the humidity, 74%.

Therefore I waited as long as I could before I dared to start the fudge.

It is still cooking, but I THINK it is setting.

I put the batch into the fridge. We’ll see what that does.

If not, the batch will make fabulous hot chocolate.

Fingers crossed!

I hope Kay likes my reason for making the recipe.

Update from 6 hours later.

Unqualified fail.

I guess the humidity didn’t drop enough.

Hot chocolate anyone?

No, I don’t know where we would be without them.

Sterile processing is the department that takes the used instruments, that are no longer sterile because they’ve been in someone, processes them, puts them into sets, and sterilizes them. For use by the next surgery.

That is a very, very, very simplified discussion of what they actually do.

The instruments start in the decontam room. This is where the instruments are pre-washed for blood and pieces before they go into the big washer that washes them with detergent.

The sterile processing tech has to know the IFU or instructions for use on every single piece of instrumentation and also how to use the many pieces of equipment that are in the department to clean and prepare the instruments for sterilization. After their bath, of course.

The IFU is the sterilization manual for every piece of instrumentation. From the manufacturer.

How long does an arthroscopic shaver have to be cooked?

By cooked, I mean sterilized in the big sterilizer. It is a combination of pressure, and time, and steam.

Kind of like a big Instapot.

Each specialized instrumentation has its own sterilization instructions.

Milking has to do with oiling the hinges. So that the clamps can be open to clamp.

There are also ultrasound machines to get stuck stuff unstuck. And to shake off the bioburden.

There is the sharpener that comes to sharpen all the scissor blades.

There is the steam sterilizer that is run on steam, and pressure, and time to sterilize things.

There is the Sterrad that used to be to sterilize the cameras with a mild form of acid.

There is the plasma sterilizer. It’s not what you think, it is for the more delicate things like batteries that still need to be sterilized for use but can’t be cooked too long or they lose their charge.

There are the 5,621 types of instruments that the sterile processing techs have to be able to identify at a glance and know what kind of instrument tray the instrument belongs in.

This is probably a WAY undercount.

This piece went to ER.

This piece stayed in the OR.

This piece got milked.

This piece stayed dry.

And this piece went whee, whee, whee. All the way home.

You knew where I was going with that, right?

The point is, without the SPD and their specialized knowledge about sterilization the OR would be sunk.

To think that when I was starting in the OR we were still dipping instruments in Cidex. That smell will take you back.

I am not an SPD tech, all the errors are mine. Beyond Clean does that what can, you know?

Beyond Clean is an amazing SPD education hub. I have learned so much!