The post-it reads “Actual conversation a charge nurse had with a nurse in the hospital in front of me. ‘You want to know if you should have a monitor on a patient who is going down for imaging tests who has a sky-high blood pressure and a headache?’ My response would have been is this a trick question?”

I was chatting with a charge nurse from another department in the cafeteria when they got a call from one of the nurses on the unit. One of the nurses in their unit called to ask if they needed to send this particular patient down for testing on a monitor. Bear in mind that the reason they were going down for testing was the headache they had developed because of their very high blood pressure.

Pause to let that sink in.

A patient, experiencing a sudden 10/10 headache from very high blood pressure is in danger of a cerebral vascular accident. In layman’s terms, a stroke.

My initial answer in my head would not have been helpful. And I have no idea how this charge nurse refrained from yelling out loud, “Have you forgotten everything since nursing school?”

Part of a charge nurse’s duty is not to make fun of an honest question. This can be a time for learning for the questioning nurse.

The charge nurse calmly said to the nurse, “Yes, that person needs to be on a monitor the entire time they are out of department. And you should accompany them for the test. I’ll be right up to take your other patients so you can go with them. I can finish my lunch later.” They smiled at me in apology and repacked their lunch box, and left, still talking on the phone.

There is a good reason that charge nurses exist.

There is a good reason that I rarely got a full lunch when I was charge.

There is a good reason that I do not miss being on the floor.

It is the end of the semester, or nearly. The last-minute scrambling to finish all the projects and papers and final exams will soon be upon us.

Deep breath.

In.

Hold.

Out.

It is going to be okay.

It is okay to ask for help. Sometimes sooner is better, but it is never too late to ask for help.

And the vast majority of schools have help aplenty.

Counselors.

Tutors.

Writing help.

And your instructor is only an email away.

Some things that I have found helpful in my various college experiences is to have a group of friends, not even in the same program as you, though that does help. I find it helpful to remember that we are not the first class in this program, and we won’t be the last. Every single problem has already been seen by the department and the instructors. It is their job to guide you.

Deep breath in again.

On this Saturday before the last week of school, I am going to be writing and reading, reading and writing for theory. I am going to finish the last assignments in the Informatics class that are due at the end of next week. I have already downloaded the Statistics final and I am letting that simmer.

I am also going to listen to my favorite pump it up song. Loudly. This is the song that has gotten me through every road race I’ve ever run, including the marathon. This is the song that has gotten me through every surgical case I’ve picked as the night call nurse. It never lets me down. Find yours.

Find yourself a song that makes you want to take on the world. And listen to it when you are feeling stressed.

It will help.

Ask for help when you need it.

Deep breath we will get through this.

Spring has sprung! theme continues.

And this recipe caught my eye.

Very basic. Self-rising flour, greek yogurt, shredded cheese, shredded carrots.

That’s it.

Little morsels of kinda cheesy flavor.

Zero carrot flavor, which is good because I abhor carrots.

I wish that the little biscuits tasted… more. Delicate, kind of bland, would make again.

I say would make again because this recipe is so easy.

The only thing that was fiddly was the rolling out of the dough but nothing horrible.

And, since it is a roll-out recipe, you can make the biscuits as big or as small as you want. I opted for a little quarter-sized star cut-out. Because I have a lot of people to feed.

I think this recipe is very adaptable, with the addition of salt for sure, or some kind of hot sauce.

I am definitely putting this into the adaptable toolbox.

What they really bring to mind are goldfish crackers. This could be a more economical recipe for knockoff goldfish crackers. That recipe is kind of spendy with butter and cheese. This one is just cheese that is more spendy.

And it hides the vegetable!

The next time I make the recipe, I will adapt it for pimiento cheese. I bet that would be good.

Or make the biscuit into a thumbprint.

In this series we have talked about the vital importance of counting, the timing of the counts, what is counted, and what happens if the count is wrong. Phew, it’s been a busy three months.

The last part of the series is arguably the most important, outside of the actual, you know, count.

And this is documenting.

Yes, nurses are very into documenting. And we should be as it is the record of the surgical case/patient’s day in the hospital/a record of interventions done. Very important.

There is an old phrase that was pounded into us as students.

Let’s say it all together now-

If you didn’t chart it, you didn’t do it.

If you didn’t document it, it wasn’t done.

No one who is at the hospital and is not you know what happened and didn’t happen during the course of a shift.

And even your memory may be incorrect, especially as time passes and our brains get busy with other patients, and other tasks.

The entire idea comes from a place of keeping the patients safe. And keeping the nurse safe. The if you didn’t document it, you didn’t do it refrain is to remind nurses that the chart is a record of the care given to the patient. And is of utmost importance when delivering care.

In the OR, it mostly revolves around counts. Our electronic health record has a handy, dandy space to document who performed which counts, and if they were correct or not. There is also a place to document the time the count was completed.

As discussed previously in this series, there are the absolute minimum counts that must be completed.

These are the beginning of the case and the end of the case counts, also known as skin-to-skin.

Absolute bare minimum.

There are other counts that need to occur. Such as cavity closure, or the beginning closing count. This is case-dependent and what and when these are counted may change.

There is also the relief count. If the circulator or the scrub tech is going on break or leaving for the day, the counts should be reviewed and, yes, documented that a relief count has been done.

Again, if you didn’t document it, which is what this is in the EHR, you didn’t do it. And will save yourself a phone call from the room after you’ve left as they frantically look for something missing. Or having to testify in a retained surgical item court case. Because despite our best efforts, things do happen.

The best advice I can give is to get into a routine of charting the counts, a rhythm to your charting.

But remember, as always, patient care comes before charting.

The current fire that is going on in statehouses across the country.

About books, and gender-affirming healthcare, and LGBTQIA+ rights, Climate change, and vaccinations, both covid and otherwise. And Drag Queens and their entertainment of others is apparently bad?

And I can’t forget about her Dodd decision last year that struck down a 50-year law that certain people have been railing against for just as long.

Oh, and racism is always a hot number. And guns and the literal children that are being shot and killed.

Because they don’t want to engage in the behavior, or the books, or the vaccinations, and abortion conversations, and taking away of women’s rights, in their minds, we shouldn’t have the change either.

It is enough to make you sick, listening to them.

It’s for the children, they bleat. Think of the children.

Bullshit.

More kids are going to die at their own hand because they can’t stand the crushing pressure of making them act like whatever gender you assigned them at birth.

It is about control and their fear of losing control over the populace. The ones who bear their children and wash their clothes and cook their food.

Whoever “they” are.

They don’t think people should be reading, or having bodily autonomy, or recycling, or driving more fuel-efficient cars, or taking a vaccination for a disease that can and will call you. Or that a person can be born in the wrong body, Or love someone that doesn’t make sense in their little lizard brains. And since they don’t think any of that should be happening, no one gets to do any of the things that THEY don’t like.

And that is a problem.

No, it is THE problem.

I don’t care if you think that the sky is purple with screaming yellow stripes. It only becomes a problem when your personal belief dictates my belief. And you won’t give up until you make me say it.

See, control.

Or your actions have the potential to harm many people, in the event of a catastrophic new disease that was sweeping, continues to sweep, and will be sweeping the world because you don’t care enough to get vaccinated for another person. Why should you, you don’t know them? Until that person is your grandmother.

Millions have died due to the pandemic, how many hundreds of thousands could have been saved if everyone had gotten vaccinated. According to a study by the University of Minnesota in June 2022, 20 million people survived because of the vaccines. No small number. How many more could have been saved if there wasn’t such a backlash against the vaccines and everyone had taken one when they were first available instead of whining? No way of knowing.

Again, it isn’t that there are other belief structures out there. It is when the beliefs actively actually harm others that pause has to be taken. And not in the “pretend in their heads” cause I made it up harm.

And if my daughter I don’t even have wanted to change her name and her pronouns, that would be fine. If a kid wants to read a book, let them, if they are too young for the book and don’t understand the themes, have a conversation with them. And if a woman wants to have bodily autonomy and not birth their rapist’s child, don’t stop her. Don’t control them.

Don’t control us.

I am a married woman with no children and an advanced degree and working on another one. And I am not falling for their bullshit.

And doesn’t that scare them to death?

The post-it reads “tacit approval gleaned from new nurses watching old nurses go against policy.”

That means the new nurses are watching experienced nurses go against procedure, or outside of their scope of practice, or go against policy and getting away with it.

And the new nurse goes against procedure, outside their scope of practice, or against policy.

There are two ways this can end.

1. they get away with it
2. they get caught and can’t understand why everyone including the experienced nurse is mad at them and not mad at the experienced nurse

Sigh.

Do we need a primer on why that stuff exists?

Policies and procedures do not exist to make a nurse’s job harder. They exist, in part, to lay out steps for a procedure the nurse might need to do. They also exist, in part, to protect the patient and the nurse both.

There is a reason that the nurse somewhere in the Midwest got in major trouble when they cut off a necrotic foot of a patient, instead of the proper channels. Remember that? I think that is one of the most extreme cases. And what it that nurse had gotten away with it. All of a sudden the patient has no foot to assess. All’s good, right? I would hazard a guess that the nurse had seen someone else get away with something more minor and thought to themselves, oh, I guess I can do what I want to patients.

At least that is how it goes in my head.

Fact number 1- just because someone else gets away with bad behavior there is no reason to believe that yourself will get away with bad behavior.

Fact number 2- sometimes healthcare is monkey see, monkey do. Actually, that is how we teach how to do procedures with the famous see one, do one, teach one mantra of medical school. But if you are doing something against policy, scope of practice, or procedure and think that no one is paying attention, this is me telling you that absolutely people are paying attention. And we don’t want to give the wrong message to be perpetuated.

Just follow policy and procedure. And stay within your scope of practice. The license you save may be your own, or your new trainee who doesn’t know any better.

The end of the semester is approaching at warp speed.

Before we know it, school will be out for the semester. And all students can look forward to a nice long break.

However.

Here in the United States, the 4-year bachelor’s degree is something of a myth. The student can take 18 credit hours and study like anything and be done in 4 years. So much for the much-talked-about college experience. And what if the student would like to eat and is no longer in the dorms on a meal plan.

Or supplement their scholarship money with work-study.

Or does plain old work.

Or is solely responsible for their college bill and would like to be done in 4, please.

Or is an adult learner, with a family, and is also responsible for the college bill.

Sometimes to hit that 4-year mark, summer school is a must. Or the instructor only teaches summer session.

What then?

Summer school is where some curricula add classes to ensure that the student is out in 4 years. Or is where the makeup sessions are.

There are lots of reasons for summer school.

Odds are, you or your student knows someone who is taking summer school. It might even be you.

There is probably a week off between the end of classes and the beginning of summer session.

And a bit of time at the end of summer session. Plenty of time to live it up a bit without the demands of homework assignments and tests. And to sleep in.

Ah, sleep. Perchance to dream.

Wrote a famous writer.

At the end of the college experience and the degree is in hand, I promise, it is worth it.

It can be difficult in the meantime to keep going. Especially when everyone else is out having fun. But they probably will have to take a 5th year or at least part of one.

As I heard from one of my grandmothers, sooner begun is sooner done. These summer sessions might seem hard but if it gets you graduated sooner, with degree in hand, it will be worth it.

Spring has Sprung month continues. The sun is shining, it’s not too hot, too humid, sounds of lawnmowers in the distance. The pollening is over. More importantly, the rain has stopped. For now.

And the birds are singing.

I did not have the unique delightfulness that is hummingbird cake until I came to North Carolina. I’m not sure why, it may be specific to the South.

It has all sorts of yumminess- banana, pineapple bits, pecans. It is rather like souped-up banana bread.

It definitely brings to mind Spring.

I took the eggs out of the fridge and let them come to room temperature and took out the butter needed.

The recipe that I used was for a bundt cake. But I wanted to be fancy so I used 2 loaf pans, one ridged to make cutting slices easier, and the other a standard loaf pan.

And when I say the batter filled the entirety of the Pyrex bowl that is because it did.

The only experimental portion of today is the addition of coconut to the batter. Because pineapple and banana just scream tropical to me. And that needs to include coconut.

The cake smelled amazing while it was baking.

And I pulled them out when each pan when tested with a toothpick, the toothpick came out clean.

I left them to cool for about 10 minutes and then tried to turn them out on to the cutting surface.

Yeah, the cake said no.

Although I had greased both loaf pan, there was a portion that stuck to each pan.

Eye roll. Next time I will use an 8 x 8 or 9 x 13 pan. Or use the mini cupcake pan, which was my first inclination.

Kate, listen to yourself next time.

As always, when there is a barrier, overcome with frosting.

Y’all know I hate frosting and I will not be making it. I mean free cake is good enough, right, even if it looks a bit rough.

Congratulations!

Somewhere in the middle of a turbulent case, or not, something countable has gone missing.

The surgeon swears it isn’t in the cavity.

You’ve counted and re-counted and re-counted.

It has disappeared.

Oh, well, time to finish closing.

(obnoxious buzzer sound)

Wrong!

It is kind of like Special Ops or the Rangers. No man, woman, or thing is left behind.

Why would you have gone to all the trouble to counting in the first place if something was willingly left behind?

That’s what I thought.

If after counting AGAIN the item is still unaccounted for, it is time to call x-ray. Because it is time for an intra-op film. After the film is taken and shuttled off to be read by a radiologist, the surgeon can continue to close. The closure can’t be finished before the x-ray read is available. Do not put the dressing on. The anesthesia can’t be stopped before the radiologist has chimed in.

No matter the whining. From the surgeon, from the tech, from anesthesia.

Hold firm.

After an interminable time the phone will ring and it will be the radiologist. Put them on speaker and tell them to begin.

There are two ways this can go:

1. the x-ray is clean and there is no identifiable sponge, instrument, or suture needle (thingy, technical term you understand).
2. the missing thingy is visible at (here the radiologist names the area where the thingy can be seen). If this is the case, the surgeon re-opens and pulls out the thingy, sheepishly. Sometimes they will tell the room that they knew it was there. Do not let them fool you. The last conversation that was had with them about it was the impossibility of them leaving the thingy behind. And that was 20 minutes ago. Gaslighting. It’s not just for the normal population anymore.

If there is no thingy identified on the x-ray the surgeon can finish closing up, the dressing can be placed, the patient awakened.

All is good.

Except for the small matter of the missing thingy. But as long as it is not in the cavity the exact location of the thingy is not to something that the room has to be concerned with.

Sometimes it feels like a Bermuda triangle has opened in the room. Or IdaKnow from Family Circle is real. At least she’s a ghost and can’t impact the sterile field.

What is doom scrolling?

We all probably engage in the practice sometimes. Reading only the gotcha headlines. Reading only the doom and gloom headlines. Focusing tightly on the horrible at the expense of all else

And right now it feels like there is all sorts of horrible. Between women under attack, and nurses under attack, and the economy under attack. And some people actually being under attack going about their business, for example the bank shooting in Louisville, Kentucky from this morning. The children under attack at schools. Books are under attack. Or the war in Ukraine and the Russia saber rattling.

And the more you engage with it, the worse it gets?

Yeah, that is the algorithm talking to you.

Is it useful to know some of these things?

Yes.

Is is useful to be beaten over the head in repetition with these things?

Absolutely not.

Let’s stop for a bit, can’t we?

It is spring! The snow, where applicable is melting, the flowers are blooming, it’s nearly time to plant the garden.

Let’s just stop for a bit.

The horribleness will be there when our heads are clearer.

Trust me.

Shit like that never goes all the way away.

What prompted this musing is the news of a kitten rescuer that I follow in Washington state. Well, her demons proved to be too much for her and she killed herself last week in her late twenties.

And left a postumous scheduled post to go onto her Instagram page thanking her followers for the years of support and that her battle was over and she was at peace. Do I know her personally? No. Are there scads of other kitten people to follow? Definitely yes. Can I still be sad that she is gone? Yes. It just goes to show that for some their world is very different than yours.

The world doesn’t have to be absolutely light and dark.

Let’s let a little light into our dark spaces sometimes, huh?

And if the dark is just too dark to bear there are resources. Pick up a phone and reach out to someone. Call 988, the national crisis and suicide line. There is always someone to listen, you just have to reach out.

And stop doom scrolling! And filling your echo chamber with only the echoes of what YOU believe. You’ll probably be happier for it.

And with that, I am off to the bookstore.