I have begun and discarded this post so many times. I have many questions and many, many, many concerns after Dobbs was decided just over a year ago.

But what can I say about the hellscape that is maternal medicine in this country?

I have bookmarked 1080 articles from various news outlets about abortion. Who can no longer access it at all, who can access with severe restrictions, who is fleeing to another state for the healthcare that they can no longer get in their own state.

The exceptions to save a woman’s life are not worth the paper they are printed on. People are dying, have died, and will continue to die.

Doctors are afraid of prosecution if they stray from the very, very narrow ledge they are on.

Mothers are afraid of complications with their pregnancy.

Women are mad about losing control over our own bodies with good reason.

Again, I can’t make you understand about what this supreme court has done to us with the flick of a pen and a smug, oh, so smug, decision document that was written by the architect of this madness.

Many states are jumping on the bandwagon. Including North Carolina, where I live. They saw the backlash about the “heartbeat” bills. No, it’s not a heart beat, it is electrical activity in what will become the heart. And they decided in their patriarchal wisdom that if the time is DOUBLED to 12 weeks, what would women object to? After all they added SIX entire weeks to the decision process. Of course, they put up roadblocks such as how many visits a women, who may not be able to afford or take time off from her work, has to have with their doctor. I’ve written about it before. 12 weeks is an arbitrary number they made up in their heads. More important information can be gotten at the anatomy scan after 18 weeks such as fetal abnormalities, but sure, 12 weeks is more than enough time (sarcasm, dripping in condescension).

Slow clap.

You sure have shown women who is boss. Who is control of them. Who taught you to be afraid of the female?

What about the infants, inter-uretero or otherwise, who are doomed to be tortured until they die after birth?

I have not heard one peep from the legislatures who are rushing to judgement about the inhumane torture of these infants. Those who are born to die, horribly, gasping for breath, their heart struggling to keep up with its new demands when the infant was never meant to survive out of the uterus. What about those American citizens? Who speaks for them.

What is it? Are you anti-abortion and pro-torture?

Who takes care of these unwanted babies?

Who pays for their futile medical care?

Who pays for their funerals? Which some states have oh so helpfully put into laws.

The African-American maternal death rate has skyrocketed. Some of these are partner violence, and some are forcing a woman to carry a doomed child who is poisong to their host.

We should be ashamed.

And mad. We should be mad.

Vote like your life depends on it.

Because, if you are a woman, it does.

The phone note reads “hey buddy, I get it. You have big feelings about LGBTQ+. You don’t know why you are big mad, do you?”

I have thoughts about why you may be mad.

Control.

It is always down to control.

People want it over their own lives.

They want to make their own decisions.

They want to love who they love.

They want to be who they want to be.

And you can’t stand it.

Because it isn’t what YOU want for your own life.

That’s okay.

No one wants you to be gay, or want to marry someone who you deem to be socially unacceptable, or anything else really. Or to not wear white after Labor Day. Or to not take in your trash containers after the trash collectors come (except for your HOA).

Hell, wear the white.

Don’t take in your trash containers after trash collectors.

But the issue is still there in your mind. You can’t control them.

Make everyone automatons who think like you do, and act like you do, and work like you do. Have 2.1 children and a house in the suburbs. And retirement at age 60.

Can you?

You can make laws and rules and stack the Supreme Court with activist judges who align with your narrow way of perceiving the world.

The world is changing. There are those among us who do not want to be controlled and turned into a puppet so you’ll be more comfortable.

Don’t want to see gay marriage or trans people or people having bodily autonomy. The answer is very simple: Don’t look.

We will still fight.

We are not done fighting.

Happy Pride Month.

As my favorite hat that I bought after the Dobbs ruling says “Fuck your laws”.

I think the messaging needs to be stronger and nice.

“Fuck your laws, have a nice day.”

That’s better.

Remember, don’t look and judge people who are just trying to live their lives.

I can scarcely believe it is just over a month before the Fall semester begins. I have done so much and so little all at once.

In the absence of classes, I did continuing education units (CEUs) like I did last year. I attended a 7-hour research symposium. I did a 6-hour CEU conference based specifically on SPD. I attended three day, 7 hour a day writing group. Not once, not twice, but three times.

I did life admin: cleaning, yearly physical with my doctor, the establishment of a high-yield savings account to put scholarship money into. I packed and prepared the house for my mom who would be staying while we were out of town. I did the vacation, including getting very mad at the airline when they added a superfluous second layover that has us going north instead of east. This is NOT what we paid for and I tried to get it changed. A two-hour conversation with a rep trying to get it changed back. Four hours and three representatives later on the second day of getting it rectified only to be told that “Gee, it looks like you changed it yourself.” The fuck I did. They will be hearing from me when I get home; I have the original itinerary, plus screenshots from when I was online/hold/robot.

Oh, and I did teaching assistant for six weeks, twenty hours a week. This was invaluable to me as a continuing grad student. I’ve never had the opportunity to do that before. The report is due to my supervisor on Monday and I will get it off to them. I only wish I could have engaged more with the students, I think that would have been good for them, and for me.

Strangely I got invited to a curriculum-building two-day in-person class. I do not build classes as of yet. Or curriculum but it was interesting and information I will be needing in the future. I hope. Everywhere I read there is a deepening shortage of nursing instructors and to fulfill the grant that is paying the lion’s share of tuition, I have to secure a teaching position within 18 months of graduation and keep it for 4 years.

I have been assigned as a research assistant to a new doctor. They are more in line with what is my interest in improving processes and improving healthcare workers’ lives. I will email her on Monday and introduce myself and ask for guidelines. I hope this is a good fit; there is nothing I hate more than being paid for being useless.

The PhD cohort and I will be getting together in person before the beginning of classes. That will be a lot of fun and also a way to get my head back into the game. Since the university changed the curriculum in January, I ended up having to take one less class. In the original plan, there were three elective *** (word) classes that we got to choose what we wanted to take. The new curriculum drops that down to two, and I’ve already taken them in my first year.

When classes do resume, they will be online. Except for the first class of the semester, which is a meet and greet with the instructors, plus class. This is advantage me because it won’t matter if I’ve worked all night the night before, I can do class from home. This will be a huge help.

I want to write about the massive right swing the Supreme Court is currently doing, but this is not the space. Come back later for that!

No cookies today as I am far, far from the hospital. And enjoying the weather in the middle of the country.

Did I arrange a back up baker, like I’ve done in the past?

Nope.

I had enough to do with getting ready for the trip. And occupation of my house by my mom.

There is clean and tidy.

And then there is Mom clean.

Report from North Carolina is that it is smoky, and the cats are being vocal about food times. They must miss us because they are lurking about.

Apparently we did not bring the rain with us. Instead, we left a few raindrops behind.

Have you ever gone to the hospital and felt like you were just a number?

That the receptionist, doctor, nurse, medical assistant just wanted to get through the day and you were an impediment for them being able to finish their day and go on home?

This is not just a feeling that you get from the doctor’s office, the hospital, the emergency room, or the morgue. This has been brewing for a while now, since way before the pandemic. People feel as if they are infringing on the time of the other people who are supposed to be helping them.

This is not right.

Not in the doctor’s office. Not in the hospital. Not in the emergency room. Not in the morgue. People coming for help is the entire reason for those places and for the workers. No patients, no work. No work, no need for employees to staff those places.

No work.

No paycheck.

To reach out for help in these places, a person who will become a patient has to give out a lot.

They have to give up their control.

They have to acknowledge that they need help. This may be a big step. This is a big step for a lot of people.

They have given up so many things. The least we can do as healthcare workers is to strive to meet their needs.

After all, a nursing diagnosis is about meeting the needs of the patients. The patients coming to the hospital have more needs that can be reached.

One of the bigger needs is to not be seen as a burden, a speed bump on the nurse’s way home.

As the evening charge nurse who also took the majority of all the night call, there was no end to my shift. There was an end to my night, when I could go home, but no distinct someone is going to relieve me end to my night.

As the night call nurse there is no end to my shift. My entire responsibility and reason I am at the hospital is to care for the patient. It is the least I can do to be thorough and pleasant.

And never, ever make them feel like they are a number,

As a healthcare consumer I don’t like when I am made to feel like a number. I do not let my patients feel like they are an impediment to my night. Because I am certain they woke up in the morning and said to themselves “I’ve been a bit bored, I think I will try (insert thing that brought them to the hospital to seek care).”

Patients waiting for surgery are vulnerable and may strike out verbally for delays. We must never let them think they are taking up time they do not deserve.

Patients and families are the reason we have jobs, after all.

Polls are strange.

They ask 1000 people their opinion on something and that is supposed to be representative of the ENTIRE country.

I’m sure there are behind the scenes math magic.

After all, you could find a statistic the support just about any viewpoint.

If we have learned anything from 2016 and 2020 polling and the 2022 expectations that fell flat, it is that people know their own minds.

And polls are easily misrepresented, depending on which ideologue you want to push. It is in the telling of the story behind the poll that is becomes relevant.

There was a new poll out last week. The NBC one that said thee majority of the people of the United States thinks the country is going in the wrong direction.

In times past, that may be a reflection of the economic era, and I believe that it is, with inflation finally starting to edge down but not so the average American feels it.

In times past, that may be a reflection of the president who is the captain of our ship. And that may be but…

What has changed the most in the last year?

Could it be the unrelenting attack on ordinary people’s rights, starting with the misbegotten Dobbs decision? Don’t worry, I will get back to this. I am reading articles from a wide variety of sources and that post isn’t ready yet. But the cheapening of women’s bodies has been very much top of mind for the last year.

What I think may be an answer is the unending attacks on “woke”. Not that anyone can define it. But definitely the ceaseless attacks on the LGBTQ+. States with super majorities are passing anti this or anti that bills left and right and center.

It is no wonder that the average American feels like the rug has been pulled out from under us.

First the initial weak ass response that tried to sweep the pandemic under the rug. Over 1.135 million dead. That leaves a mark on a psyche.

And the feckless wonder that tried to discount it and led his followers to do the same, to their deaths, is running again to be in charge. The unrelenting coverage there cannot be good for us.

There is still a war on in Europe. Because someone thought to take something (land and a country) that didn’t belong to him. Because in the past, it used to belong to the country he has an iron grip on.

The point is there is much to feel badly about. And the President is not a fairy godfather and can’t wave his wand and poof it back to 2015.

Not to be a Pollyanna Puke but look at your blessings. And trust in the process. Even if that process is being pushed back HARD by those who want women in the kitchen, stripped of ALL their rights, who want kids who are trying to tell their truth in the graveyard and out of their sight. Because their policies will kill children, and has.

The gown card reads “degrees of separation in how we talk among health care workers-how we talk to patients”.

Medspeak can be brutal.

This is our black humor that being used as a coping mechanism for as long as there have been healthcare workers talking.

You remember Hawkeye and Trapper used to talk over the wounded on the M*A*S*H television show. They would joke and tell tall tales and try to solve the war’s problems over the open cavity of a wounded soldier. But when they were actually talking to the patients the tone was different? Yeah, like that.

In the unit lounges the conversation about a situation can be salty and a little, okay, definitely not safe for work.

In the lounge the conversation can be about the full moon. “How shitty do you think tonight is gonna be?”

Someone else answers “Well, Dr. Doom is on call.”

To which the original speaker replies “Oh, fuck. There goes the shift.”

On the phone to the waiting room, the conversation can go like this- HCW to patient’s family member, “Dr. Doom wanted me to call and update you. Unfortunately there was a complication during surgery. Your loved one is fine but recovery/surgery/time in hospital may be extended. Dr. Doom is doing everything he can to make sure the surgery is a success. But right now your loved one is stable and doing okay.”

You know in the operating room, the same HCW turned to the others in the room and used some very nice language when the stapler misfired. Or the surgical site was so packed in with scar tissue, the field looked like the Gordian Knot and no Alexander the Great was available to solve it. But the knot has to be unpicked carefully.

The two are not even the same.

Use your words, people. Be kind, but factual.

There is a time and a place for medspeak. And an audience.

Choose the time carefully.

When speaking to family, choose your words carefully.

Do not offer hope, instead speak carefully of complications but assure them that everything is being done to assist their family member. Speak about how good the surgeon is, no matter how you feel about them.

Do not tell family members details when there is a complication. Use broad language that reassures.

Do not overwhelm them with medspeak words they don’t understand.

Because, regardless of the outcome, the family will remember how they were updated.

Citation.

The word to strike fear into the heart of any student.

Not the ticket you get from law enforcement.

A citation is properly acknowledging where the information that is in the paper/dissertation/article is from.

I do think the world could use a little more proper citation.

But the act of creating a citation is confusing.

The first thing you need to know is which one.

Will it be MLA? Which is from the Modern Language Association.

Will it be APA? Which is from the American Psychological Association.

Will it be CT? Which is the Chicago/Turabian style.

These are the three most common. And they all serve a different need.

The APA is used for Education. This is at the university level. Unless your particular university/college uses something else.

The MLA is used for the humanities.

The CR is used for business. history and the fine arts.

Confused yet?

Which one to use is determined by the program you are in.

And the styles are vastly different.

So it is important to know why one to use.

Not only is the citation style different, each one dictates how the paper etc is to look.

And they change and update!

When I was doing my BSN and my MSN, it was the APA 6th edition. For my PhD, only 2 years later, it is APA 7th edition.

There are books.

There are YouTube videos.

There are websites dedicated to helping you make the citation from an article or scientific paper.

But be careful.

A basic grounding of the rules is important.

This means you can catch the errors that the citation machine makes.

The proper citation of material can be as much as 10-25% of a grade on a paper. That can mean the difference between passing or not.

It is important to learn the basics or to know who to ask if you run into trouble.

Is it obnoxious? Sure.

But at the heart, it is standardization of language. And as an OR nurse whose surgeons sometimes call for the stabby thing or the hooky thing, I know this is important.

Painful.

But important.

No, that is not a typo.

I made chocolate chocolate chip cookies.

I hate making chocolate cookies.

It is too hard to gauge when they are baked.

They are too easy to burn.

I rely on the color of a cookie to gauge when they are done. When the batch first goes in, the dough is a pale cream color. And when they are done they are almost a light nut brown.

If you know, you know.

But in my experiment for this month of changing an ingredient in the standard Toll House recipe, I knew it would be the most impactful change.

Even if I dislike it.

You just can’t add cocoa powder to a chocolate chip cookie and call it good.

There are factors to keep in mind; the balancing of the butterfat and the chocolate.

Look. I don’t make the rules. I just know that it should not be done that way.

If you added solids to a cookie dough, you run the risk of drying it out the cookie.

And no one wants to eat dust.

As I am unused to making chocolate cookies, a new recipe had to be located.

This recipe was a bit different. A bit stiff. And required a minimum 3-hour rest in the refrigerator. This meant I made the dough up last night. And let it rest in the fridge. And after my 0700 hip and knee meeting, I pulled out the dough and let it rest at room temperature for nearly 30 minutes.

The dough was still a bit stiff, even after it warmed up. But I was able to use my cookie scoop to get cookies. The recipe calls for cookie scoop and hands to shape the cookies.

Ew.

I don’t like things on my hands. Cookie scoop it was to be.

The batches baked up relatively good, with me keeping a close watch on the timer.

This is unlike anything I’ve ever made before. A worthy addition to the CTIAT recipes to use.

And not a cookie was burned!

This is a win.

Time.

There is a lot of talk about time in the OR.

How long until my break?

How long until the room is turned over?

How long to count at the cavity closure?

How long as (the desired) circulator been on break?

How long to get the patient back to the room?

How long to go to sleep/get the spinal?

How long to properly process the instrument I just dropped?

How long if we just flash it?

But the biggest is how much longer after prep before I can drape?

Same as the last four hundred sixty five thousand thirty two times you asked.

Chloraprep takes 3 minutes to dry.

There will be no draping before then.

Yeah, I know it feels like it takes forever.

I could have a rude joke here. But I don’t do that. You’re just going to have to imagine it.

If I, as the circulator, were to allow you to drape prior to the chloraprep being dry, what would be the consequences.

Fire.

Burns.

You see, it all comes down to patient safety.

I prefer to keep the patient safe, no matter what time your flight takes off, no matter your tee time, no matter that your significant other is holding dinner.

Patient safety is my paramount concern.

And it should be yours.

The tech will only give you the drapes/square off towels after the 3 minutes are up. And arguing only kind of makes the time go faster and most likely serves to irritate you and me.

Oh, look.

We’ve used up 90 seconds already.

You seen any good movies lately, doc?