There is a scene in Princess Bride where Count Rugen asks Westley a question after he’s used the “Torture Machine” on him for the first time. That is very, very applicable to time change Sunday.

The gown card reads “I’ve just sucked one year of your life away. I might one day go as high as five, but I don’t really know what that would do to you so let’s start with what we have. What did this do to you? Tell me. And remember this is for posterity so be honest.”

There is a lot to unpack here.

We’ve just lived through a once-in-a-lifetime pandemic. There are people, including myself, who exclaim that time has no meaning.

I know I’ve written that babies who were born in the first year of the pandemic are THREE this year, and may have a sibling by now.

As for me, in 2020 I was graduating with my MSN, took a year off of school, changed it to 2 years off of school, and now I am in a PhD program.

All of a sudden, I worked all the hours that were during a pandemic, taking care of patients, and supporting the hospital. Fearing bringing covid home.

All of a sudden, people were on lockdown. And the streets were empty.

All of a sudden, my niece is graduating from high school.

All of a sudden, my nephew is taller than my sister.

The point is that time feels disjointed.

I would like my hour back, please.

Enough of the recent time has already been taken away from us.

Perhaps this is compounded by Spring Break and being off school for a week.

Maybe a nap will help.

Before I dive back into the grind of research assisting work and papers and graded homework assignments and presentations and quizzes.

Oh, my.

Definitely a nap on this rainy, dreary day.

Before my week begins anew.

Midterms were just a week or so ago. And your student got rewarded with Spring Break. Unlike the spring breaks of their childhood, this has nothing to do with Easter.

The run-up to midterm is exhausting. All the papers, all the readings, all the tests.

All the presentations.

Makes me tired to write about it and I just lived it.

And now that we’ve had our fun and a break, back to the grindstone of the semester.

Your student may or may not have been assigned homework on the break.

Your student may or may not have DONE their assigned homework on the break.

Sounds familiar, right? Just like high school.

Now that the excitement and rest of spring break has passed, your student may turn their eyes to their calendar and realize there will be a test almost immediately upon returning.

Now that the panic doing of homework has set in, or maybe passed, the mid-semester doldrums can move in.

Many assignments and tests and presentations before the end of the semester. Oh, boy.

And, for me at least, the ennui of having to face it all.

Your student may be blah.

And that is okay.

Just remind them that 8 weeks separate them from summer break.

And they have a lot of work to do.

Maybe they should start with opening their calendar and making a plan. Or, at least, reviewing for the test that is sure to hit after the break.

The impetus for this entire Blast from the Past theme was a Facebook post of a Twix cookie I made way back in the start of Cookie Thursday is a Thing. In February 2015.

To my recollection, I have not made them again since.

This is a multi-step cookie, which is probably why I’ve not made them since.

Bake the shortbread. Let cool.

Make the topping and top cookies. Let cool.

Melt the chocolate and top the topping. Let cool.

I just finished the chocolate layer and I’ve been baking since 0800. And it is not 1220.

A labor-intensive cookie.

I’m on spring break this week from university,

And minimal meetings.

Perfect day to dust off the recipe.

The original Facebook post says that I need to work on my chocolate game.

Still do.

But I realize that the cookie does not have to be perfect.

A fact that some surgeons I work with need to internalize.

I’ve been on many cases that the surgeon wanted to make “perfect”. Only to have the repair fall apart and need to be done again. At the expense of the patient having to remain under anesthesia for that much longer. At the expense of the OR schedule.

Here’s the thing. We are never going to be able to put the patient back together to factory standard. They will still have been broken, or their abdomen entered into, or their uterus cut to deliver a baby. There is no way to unHumpty Dumpty them.

Repairs don’t have to be perfect. They just have to be good enough to work.

And that is the lesson for today.

Is my chocolate enrobing perfect?

Nope. But the cookie still tastes amazing. Which is my goal.

The sterile processing department is where instruments go to be cleaned, counted, put back in order, and sterilized.

But how do they know what instruments go in each set?

What if I wanted a minor tray?

There is a count sheet for that.

This is a standardized to the hospital form that lists all the instruments, in order, and lists how many there are of each instrument that can be expected.

Ideally, the catalog number of the instrument is listed, along with the manufacturer. This makes it easier to be reordered in case of accidental loss.

Not in a patient.

We covered that in Counting Basics #4.

Why do counts exist? It allows us to be relatively confident that what goes in comes out.

Barring emergency cases (the cut or die type) or patients with a large cavity.

The count sheet is begun in sterile processing during tray makeup.

All instruments in the tray are counted and noted on the sheet.

And the tray is sterilized.

But sometimes the count sheet and the tray do not match. What then?

Yeah, SPD techs are allowed to be human.

Just adjust the count sheet and continue with the count.

To you, the count is right in front of you.

To the SPD tech, the tray may have been one of several of the same kind that was assembled at that time. And it might have been days ago, depending on the frequency of use.

And that is why we count again. Comparing it with the count sheet.

Because all that matters is that somewhere, sometime there is an agreement before the patient is in the room.

And the count sheet is kept and maintained, added to if needed, and counted off again as the surgeon is closing.

Is this elementary? Yes.

Does anything better exist? No.

An option would be to x-ray every single person upon closure, exposing them to x-ray unnecessarily, costing them more.

Some places do this.

Of course, some places think that fewer counts are a good thing.

A retained surgical item can cost the hospital thousands and thousands of dollars for retrieval.

A retained surgical item can cost the patient another surgery and recovery period.

A retained surgical item can cost the hospital system big time due to lawsuits.

Follow the policy of your hospital. No matter what it takes. No matter the pressure from the surgeon to just get it done already.

You are not there to keep the surgeon on time or happy.

You are there to keep the patient safe.

Not much has been happening since the US decided that everything all at once could re-open and masks were optional.

All the time.

I mean ALL the time.

No matter the risk level of the community.

Cool.

You do you.

The covid death toll for the US is one million, one hundred twenty-two thousand, and sixty-four.

Yes.

I am still looking at the data.

No, they haven’t stopped the nonsense yet.

Yes, people are still dying.

On February 12th, the death toll was 1,114,377. The difference is a little under eight thousand, or 7800 for those doing the math. This was about three weeks ago. Divide by 3. The answer is 2629 dead a week.

Which, I’ll give it to you straight, is slightly better than the 2882 dead then.

And is 2629 US dead in a week worth not wearing a mask when going out? Or inconveniencing your life in any way.

Think on that a bit.

On the positive side, the hospitals in California have dropped the in-hospital mask mandate.

Why? Because the percentage of people who are fully vaccinated is 85.44.

By contrast, the percentage of people who are fully vaccinated in North Carolina is 66.8%. And we still have the in-hospital mask mandate.

I mean, the hospital where I work had a week, maybe two where there were no covid patient hospitalized.

It has been 3 years since I started doing this covid round-up. We’ve been through a lot.

The terror, the shutdowns, the masks, the vaccines, the refusal to wear masks, the refusal to get a vaccine.

Three years.

On one hand, this is what flattening the curve means; smaller curve, less deaths, longer time frame.

On the other, people are still dying. A lot.

As long as you are cool with that.

Carry on.

The post-it says “LOL being rolled out, the treatment is always good here.”

This has two meanings. Well, LOL does. The meaning in text speak is laugh out loud. To me and many people in the know it means little old lady. Guess which one predates text speak?

This frail little old lady, bundled up to the ears, with a hat on, was chatting to the volunteer wheeling her out to the car. Remarking how her hospitalization had gone, how glad she was to be going home, and the kindness of the staff.

I was behind them as I was walking to a meeting and decided to get a drink in the cafeteria prior to it. Just walking, not really paying attention to what they were saying. Thinking about the meeting to come and the needed caffeine I was about to buy.

But what she said about the treatment being good at this hospital caused me pause, and to watch as they continued down the hallway.

In shared governance we can look at monthly patient satisfaction scores all we want. But those are from people who WANT to talk to the company who handles the satisfaction surveys. And that is a knife edge, some want to talk about what good care they received at the hospital, and many want to complain.

And guess who listens to the complainers most in creating and changing policies. That’s right. The hospital powers that be.

It was refreshing, knowing that I was heading into a shared governance meeting where we would be discussing complaints about hospitalizations, to hear something good about the hospital.

And, apparently, this patient had been admitted to a few places, enough to be able to talk about how the care was at our hospital. It is always important to hear the well dones! As well as the complaints.

They are both equally important.

I hope she gets a survey and I hope she fills it out.

February report.

My grade, which I expect to be dismal, is not in for statistics midterm project/presentation.

Why do I think it will be dismal?

Because in my estimation I bombed it.

My math was poorly conceived, my presentation was poorly written and presented.

Ugh. The less said about that the better. Did I cry walking to the car? Absolutely.

And I have a 98% in the class going into the grade. I asked the professor if I should drop the course, and he told me not yet as there are still 3 homework assignments and a final to get through. The drip torture continues. Which makes sense but no sense because I am understanding the current lectures.

Time will tell.

My concept evaluation paper came back at 94% for nursing theory. No, I have not yet looked at the comments. I will, I will.

Next up for this class is a theory compare and contrast paper that is due on Friday 3/17/23. Loads of time to button down with 2 theories I will be comparing and contrasting. Next week I will be reading about theories and the week it’s due I will write the 20-page paper.

This blows people’s minds until I remind them that the paper has to be double-spaced and formatted correctly, which takes up many pages. Theoretically, I am looking at 10 pages of actual content.

Eminently doable.

And in the third class, there was the start of a group project. We, as a group of three, had to pick a hospital, decide on variables to report on, run the graphs, and discuss conclusions from the graph. And my group mates actually did work. I am so proud! And grateful I didn’t have to do it all myself. The next step is formatting the small paper we turned in on the variables into a PowerPoint, as if we were presenting it to hospital administrators.

Quite a mixed bag to report for February.

Takeaways:

1. Trust the group project, especially on a grad school level
2. just keep on swimming, keep on swimming, keep on swimming
3. It is Spring Break, take a nap for goodness’ sake!

This month’s theme is Blast from the Past.

Cookies and Makes that I don’t make very often and haven’t made in ages. Sometimes years.

It has been nearly 6 months since I made the perennial favorite if 90% of the OR: the jalapeno chocolate chip cookie.

This month I had to make do with diced jalapenos.

I put 3 tbs of diced jalapeno in a quarter cup of water and let sit overnight to rehydrate the bits.

It isn’t ideal but it is what I am working with.

The fluid is then added with the eggs during the making of the batter.

Make as usual.

Standard Toll House chocolate chip cookie recipe.

I’ve done it this way a bunch of times.

And the cookies spread out very thin, making for a thin, crispy cookie.

Odd.

New baking soda. Room temperature butter, room temperature egg.

It just goes to show you that you can’t control for every variable.

But I think there is something going on with my oven. The cookies baked very unevenly, one side baking faster than the other. I am familiar with the back of the oven being hotter than the front and I can correct for that with size of the dough balls. But the side versus side unevenness. I have to read more about this.

I love my little oven. It is 16 years old at least. And I get a LOT of use out of it.

Next week I will use the standard-sized oven and see if that makes a difference in even baking of the cookie sheets.

If it isn’t one thing, it is another.

This is the 5th post about Counting Basics.

Rarely.

And, I mean rarely, there is a case that is completed without additional instruments being added.

These can be small: a forcep.

These can be bigger: a retractor.

These can even be bigger: an entire extra tray.

Sometimes a surgeon does not want to pause when an instrument set that they asked for is added.

But take the time when a new set is added to do the count.

Anytime something new is added to the field, it must be counted.

ANYTHING!

ANYTIME!

If the surgeon pushes back, inform them that this will save time in the end because the OR room will not need to take an x-ray because the count was not correct.

I mean, sometimes there is literally zero time to count additions.

That is a very rare case and most likely an emergency. This case we are doing of a lipoma removal is not that case.

Trust us, doc. It is better and safer if we take 30 seconds to count off an additional tray. Especially if the patient isn’t actively dying. Okay? Glad we had this talk, now suction something or bovie something to keep your hands active.

Any additional single instruments need to be added to the count sheet. Or multiple instruments.

Just let us get on with it. I will have your scrub tech back to you momentarily.

The count sheet will be Counting Basics 6.

Yes, the world is on fire.

Earthquakes.

Death.

Destruction.

Snow at the Hollywood Sign.

Unprovoked war justified in a megalomaniac’s mind as getting the old band back together. And by old band I mean the glory days of the empire. You know what I am referring to.

Governors and state governments deciding about women’s bodies.

Not a lot that I personally can do.

I can decrease my carbon footprint. We can be good stewards of our energy consumption and overall commodity consumption. No fast fashion, not that do fashion. Interacting with the neighborhood Buy Nothing group. Reuse, recycle, reduce.

What I do have power over is not participating monetarily in conferences in states that have been egregious about a women’s right to bodily autonomy, and hatred of what they don’t understand, including books.

I am looking at you Texas and Florida. I just won’t engage in conferences at either place. And what’s more I inform the groups holding the conferences why.

In detail.

This I have a small modicum of control over.

Will it do anything?

Probably not.

But I can tell people the reasons I have for not engaging in conferences in these states that do not value women. Admittedly this is made easier by attending the conferences virtually. That way the organization gets the money, not the states.

And maybe I will start something.