Happy New Year 2023!

I wrote 2022 review yesterday for School Me Saturday. And I’m not really the type for resolutions.

Instead, I’m going to give my wish list for 2023.

Last year my word for the year was hope. I hoped that the pandemic would end with a whimper. I hoped that 2022 was not as bad as 2021.

Well.

There are good things, past me, and bad things.

The pandemic is struggling on, and new variants are being discovered. But for the most part, the vaccines, if you got them, decreased the number of hospitalized and dead. Decreased mind you, not stopped.

This year my word for the year is wish.

There are different types of wishes. There is the one that you get after blowing out the birthday candles or wishing on a star. There is the type that you are hoping against hope against a diagnosis or a horrible situation. I see that one a lot as an operating room nurse.

According to the Merriam-Webster dictionary, a wish is to have a desire for something unattainable. And that is very appropriate for the pandemic. And for a world where there are active wars.

It is going to be hard to cap it off and transition to endemic disease. But I hope we can do it as healthcare workers. As society.

I wish, I wish, I wish.

happy new year.

Instead of School Me Saturday today I want to discuss the year that has just passed. More specifically, the year that has just passed with Dispatches from the Evening Shift as a focus.

In the past year, there have been 266 blog posts written by your truly.

TWO HUNDRED SIXTY-SIX. I think that is amazing.

In the past year, I wanted to redouble my efforts for the blog. And I think I have hit that goal.

There have been many things that have happened in the last year.

51 Cookie Thursdays is a Thing.

56 weeks in my new role as the call nurse.

Consistent themes for 3, sometimes 4 of the weekly blog posts.

Hell, let’s just break down the highlights, using the handy dandy schematic I made myself.

January

New year, new gig. The weekly themes of Post-it Sunday, Cookie Thursday is a Thing (CTIAT), and Monday Musings were all active. Covid was on my mind as we were in yet another surge. This is the month that the United States marked 850,000 dead on 1/15/22. And I was deep into applying for PhD programs.

The CTIAT theme of the month was Boozy cookies.

February

Covid continued to surge. Notably, there were 890,816 covid dead on 2/1/22. That is nearly 41,000 in two weeks. And Russia invaded Ukraine on February 24th. This was definitely a bleak month.

The CTIAT theme of the month was cheese.

March

This month I went to my first in-person conference, masked, in New Orleans. And in the car on the way home, my husband and I discussed the RaDonda Vaught case. And this was almost immediately after the J’Accuse blog post where the nurse is often the scapegoat of the medical profession.

The CTIAT theme of the month was Comfort. Didn’t we need it this month?

April

I wrote about Just Cause and what it means in a corporation and what it should mean for nursing. And my favorite post of the month was a breakdown of what the pandemic had stolen from me. Among others. Notably I chose a PhD program this month.

The CTIAT theme of the month was Coconut cookies.

May

Inflation reared its ugly little head. Not only in the hospital itself with continued supply chain issues but the pressure of the cost of the travel nurse.

Oh, the US marked the 1,000,000 covid death.

The CTIAT theme of the month was Inflation baking. I am the sole baker of CTIAT. It is my baby, and my baking supplies that are used. This was an effort to show my coworkers that yumminess can be had on a budget.

June

I started a many parted series about What it Means to be Called In. Here I broke down the steps, from the phone call to the ride home that the patient undergoes for a call surgery.

And there were physical assaults on healthcare providers in a variety of states. People died.

And then the Supreme Court overturned Roe with the Dobbs decision. Yes, I am still incensed at this.

The CTIAT theme of the month was Inflation Baking, which continued. The price of butter specifically was immense.

This was a crummy month.

July

Laughter has always made me feel better and I started a short-lived theme day of Friday Funsies. And I realized I am just not that funny. The Nursing Mantra was a post that I am particularly proud of.

The CTIAT theme of the month was If You Want a Woman to be in the Eighteenth Century so Badly… This month I made exclusively 18th-century recipes.

August

This was a month of many school posts. The PhD program started. We finally got to London.

The CTIAT theme of the month was No Heat.

September

A new theme day was added. This was School Me Saturday where I wrote about school-type matters. I also began limiting myself to writing about my personal school story one time a month.

There were rumblings and the beginning of discussions on a Twindemic, flu and covid.

The CTIAT theme of the month was Baker’s Choice. I had recipes I wanted to try that didn’t fit any theme.

October

The themes from the year continued: covid, and attacks on healthcare. There was a shooting at a maternity ward in Texas where 2 nurses died.

The CTIAT theme of the month was Spooky Cookies.

November

Oh, and now there is a third disease that is weighing down the hospitals. Flu, covid, and RSV.

But seriously, the hospitals have barely had a break in nearly 3 years.

The CTIAT theme of the month was Fall cookies.

December

What to say about this month? I asked if you were happy, I invited a surgeon and an anesthesiologist to whip em out and compare lengths while they were fighting over room choice. Oh, and the holidays, everyone’s favorite. With a full hospital and an over-full OR schedule.

The CTIAT theme of the month was Holiday cookies.

But it wasn’t all bad. We got through.

I survived my first year as a call-only nurse. AND my first year as a PhD student.

My hope for the new year is that there is a marked decline in the number of covid deaths. Currently, the US stands at 1,092,670.

My hope for the new year is a decrease in inflation or a decrease of the impacts of inflation on the costs of goods.

My hope for myself is to continue to be a PhD student. And a writer for this blog.

Let’s raise a glass to next year, and sage smudge this year to get rid of bad juju.

This is the last Cookie Thursday is a Thing of 2022.

And CTIAT is always about experimentation. I was given a pomegranate and I wondered what to do with it. The first thing I did was de-seed it, wearing gloves, and set them aside.

And in my pantry, I had melting wafers, vanilla and chocolate. Except I couldn’t find the chocolate ones (I blame my husband and the desire for sweets he knows he should not have. I used my double boiler and melted some chocolate chips to use instead.

I laid the white chocolate melting wafers onto a cookie sheet and stuck them into a 250-degree Fahrenheit oven for a few minutes.

I took the melted chocolate chips in the double boiler and dolloped quarter-size circles onto another cookie sheet.

Moving quickly, I pressed a couple of pomegranate seeds into the melted chocolate. By the time I had finished with the chocolate, the white chocolate was ready to come out of the oven. And I repeated the process.

Once pomegranate seeds were pressed into each chocolate wafer or dollop, I set the trays on the front porch to cool.

We’ll see if this works.

If not, I have another batch of Chex mix in the oven.

This Cookie Thursday is about using what is available and not going out to buy different chocolate wafers to fulfill the vision. And this is something that is needed in all hospital settings.

It is not about not having what the surgeon thinks they want in any given situation. It is about being mentally flexible enough to give the surgeon what they need in a particular instance and within what you have.

Last week an ENT surgeon wanted a certain clip that he has used at other hospitals to stop bleeding. The hospital where he was doing a hemorrhage case doesn’t have what he requested as they rarely perform ENT surgery. Okay. Let’s think about what else can be used in the hospital you are now, instead of pining for what we don’t have.

Boom, we came up with another solution and used it. The bleeding stopped, and the patient was safe. Even not having exactly what the surgeon wanted.

What else can be asked for?

Let us take a random body part of which there is only one in the body.

Such as the appendix.

The removal of the appendix is called an appendectomy.

I talk about appendixes a lot because they are the largest percentage of afternoon and night cases.

The goal is to remove the appendix.

It is up to your body type and makeup and the surgeon’s skill level to determine which way to remove it.

There are lots of ways; or rather, there are two ways with lots of approaches.

The decision tree looks like

APPENDICITIS

REMOVE?

YES NO

OPEN LAPAROSCOPIC ANTIBIOTICS

If open is chosen, you make an incision, tie off the appendix and cut it out and close.

If laparoscopic is chosen, there are many other options. Which scope? Which stapler? Which trocars? Which sizes of trocars? Which suture? Which electrocautery device?

The combinations are endless. In my hospital, there are 2 and a half trocar types. Of which there are at least 6 sizes from which to choose. There are 3 types of scopes and 2 types of degrees of bend to the scope, and three sizes of scopes. There is an upteen number of suture combinations. There are 2 types of staplers, but the second type has at least 2 different sizes of staplers and about 8 stapler heads. There are three different types of electrocautery devices, with the third with 4 different options in this hospital.

The point is, there are lots of decisions to be made.

And the circulator in the room is required to remember the surgeon’s on call’s preferences.

Higher math for OR nerds.

Or the surgeons are spoiled for choice.

But woe betides the circulator who does not remember what the particular call surgeon uses.

And please believe us when we tell you that something is on backorder.

And just imagine all the options in all the surgery specialties we have.

Mindboggling, isn’t it?

It is all over the internet, the time between Christmas and New Year’s has been declared the liminal time.

But what does that mean?

A liminal space is a transitory space, think about a foyer or a mudroom. These are spaces that exist to be transitory, from outside to inside.

Not unlike the mediastinum, the space between the lungs and the ribs. One of the most distinctly odd cases I’ve been in was a mediastinoscopy. This is where a camera is introduced into this vanishingly small space, most likely for the purpose of a biopsy because something is wrong. It always struck me as a liminal space.

Liminal time is a transitory time, a threshold, if you would, between two distinct eras of time. There is the excitement and the rush of Christmas. We are busy, busy, busy during that time; partying, eating, drinking. And, in the case of the OR, cases, cases, and more cases. And then the big day happens. And everyone, including children, feels a bit hungover after, from candy, from food, from liquor. Until the next big day, only a week hence.

New Year’s Eve and New Year’s Day.

The time between Christmas Day and New Year’s Day is short.

There isn’t enough time to start a project.

There isn’t enough willpower not to snack on the Christmas leftovers.

The thought of shopping makes some of us tired.

And it is cold and miserable outside.

And people just want to burrow into the warmth of their family.

Or their pets.

Or alone.

But, most decidedly, they don’t want to go outside.

Some want to do as little as possible before New Year’s.

And that is okay.

But there is a time to recognize that this is NOT the case for the healthcare worker, or the hospital worker.

We are just as tired as everyone else.

But there is no time to sleep.

Someone has to take care of the hospitalized patients, of the surgical patients, of the emergency room patients.

And this is the capper of yet another Pandemic Year.

And we are exhausted.

The pork roast is in the crockpot.

The potatoes are prepped and ready to boil.

The brussel sprouts are ready to be smashed.

The ambrosia is mixed.

The corn pudding is ready for the oven.

The sweet potato souffle is ready for topping and baking.

The black and blue mac and cheese, with four types of cheese and pan-fried pancetta, is ready for the oven.

The presents have been opened and exclaimed over!

The cats are thoroughly confused.

And we are promised above-freezing temperatures later in the week, up from a low of 3 degrees. The furnace has been working nonstop for days.

The holidays are a marathon, not a sprint. And, like the pandemic, carry the same friendly reminders.

Be safe.

Wash your hands.

Get vaccinated for others.

And social distance as much as you can.

Odds are if you exchange gifts with people there is a calendar under your tree. Or wrapped. Or just handed to you.

The calendar is a very useful tool. For school, for work, for life. It all goes there.

I know that Google calendar exists, and the calendar on the iPhone, and I imagine a similar program on Android and Google phones.

And I do use my phone calendar to a certain extent.

And the one attached to my work email.

And the one attached to the school account.

But just like in Lord of the Rings and the One Ring, there must be a calendar to rule them all.

During my MSN program, I had two identical calendars that I used. One was for school, and one was for work. I tried the single calendar life and it never worked out, there was too much on every single day and I would find myself missing things. And I would invariably run out of room.

A couple of years ago I bought the Arc paper cutter from Staples. The Arc system is a notebook that you can add and rip out pages. Kind of like a binder. But cooler. And they stopped making the calendar inserts for the Arc system.

I have to improvise. I love that. I counted all the various calendars that I keep: work, school, house projects, blog posts, and exercise. I printed off a year’s worth of calendar pages that would fit into an Arc shell. And started organizing the things that I have to do.

I am gen x and having a physical copy of dates is important. Inputting all the different tasks into the online calendars is obnoxious and takes too long.

And now I have a custom for me calendar that I can flip through the tabs and see due dates and upcoming events.

Of course, I also have a dry-erase board mounted on the dining room wall, to highlight school assignment due dates.

This is a system that works for me. It may be trial and error but find a system that works for you. It will be different, but make it your own.

As is her wont, my mother starts making Christmas cookies on the day after Thanksgiving. It is tradition after all.

And I go over to help on Saturdays and random Wednesdays.

And the output is 16 types of cookies, candies, and barks.

It is a labor of love as apparently our love language is feeding people. Kind of explains Cookie Thursday is a Thing in a nutshell, doesn’t it? Why else would I make weekly cookies, for YEARS!, except as a way to show my appreciation. I also bake them as a morale builder.

On Wednesday I went over and we made up different cookie platters. They are gifts for people: their landlords, neighbors, and three enormous platters for the OR where we both work. And a special one for my friend that has a jar of blueberry jam.

Recipes upon request.

I’m going to having pretzel bark as dessert for my lunch of Chex Mix.

Tis the season.

Today, December 21, 2022, is the winter solstice.

This is important because it marks the longest night of the year.

After tonight, the nights begin to wane. That means they get shorter.

Unlike the summer solstice, which marks the longest day of the year, there is muted celebration. Mostly because it is too cold, and dark to party.

I think that is the wrong attitude to take.

Boo-hoo, it is so dark.

Boo hoo, it is so cold.-

Boo-hoo, there are so many add-ons. Nothing to be scared of there, we in the OR world expect it. It won’t be like this forever.

Just like being afraid of Monday is the wrong attitude to take. It is less about fearing what will happen on Mondays, or the longest night of the year, and more about celebrating that Monday or the longest night of the year won’t happen for 7 or 365 days.

It is rewriting the script the allow that yes, this is the longest night of the year, BUT it won’t happen again for an entire year. Celebrate that.

It is also Saturnalia, but I won’t get into that.

Pour yourself some cocoa, add a little alcohol if that is your thing, or make yourself a hot toddy. Bundle up warm and wear extra thick socks and some slippers. It is all right that it is the longest night of the year. After all, it won’t be the longest night of the year again for an entire year.

Since much of the United States is in a deep freeze this week, remember that you should not touch bare metal with wet fingers, or your tongue. You remember that scene from the Christmas Story. Right?

As part of the pre-op checklist, I have to ask patients what their current pain level is.

Some people need a translation.

You wouldn’t think so, but there it is.

Through careful questioning, I have to ascertain the type of pain, where the pain is, what makes the pain worse, and the quality of the pain. This means is it stabbing, or throbbing (yes, those are 2 different kinds), duration of the pain, and so forth. And then I ask about the number on a scale of 0-10, where 0 is no pain and 10 is the worst pain ever.

Preop for an acute issue, I can anticipate an answer along the entire gamut. Some people really have limited pain, some have a score of 10 while scrolling on their phone or laughing with their family member, and others have a score of 10 while clutching the body part and practically screaming. I record what is reported.

And then I ask about the anticipated pain AFTER surgery. And what they would like their pain level to be then. I get a lot more blank faces with this question.

I preface this conversation by informing them that they will hurt, in some capacity, after surgery. Zero pain is not obtainable, especially when sharp objects like knife blades or suture needles are used.

What I want to know is what is a goal pain level that will allow them to be comfortable, while recovering. A goal number that the pain medicine will try to get them to.

Remember zero is not obtainable.

And five times out of 7, after getting the there will be pain, what is a good pain goal to shoot for explanation, some will smile at me and still say zero.

ugh

And some of the 5 that answer zero will bluster and try to excuse their pain goal.

Look.

No one wants to be in pain.

I get that.

I definitely don’t want patients to be in pain.

But zero pain is not a good goal immediately post-operatively. A week, maybe. Tonight, after surgery? Nope, not gonna happen.

Shall we begin again and you can pick a number that is attainable?

Three.

I knew you could do it.