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.

Post-it reads “what to do when a surgeon and an anesthesiologist have a pissing match over what room to put the case in?”

Background- a critically ill patient and a disagreement over which OR room to put the case in.

My reaction to this wannabe alpha male posturing that I did not say at the time but is very appropriate, would be to say”Whip them out boys. Let’s compare lengths. Yes, even the women.”

After they stared at me in disbelief, I would gently suggest the bigger room. Because if the case they are wrangling about is as bad as they think it is, we are gonna need the space.

No, this didn’t really happen.

But only because I was not the one who took the case information.

Would I have absolutely said this to a feuding surgeon and anesthesiologist? Yes. I have, and I would again. Because when they are lost in their arguing and their chest-thumping, a patient is getting sicker and sicker. The size of the room doesn’t matter; it is the readily available equipment needs of the case.

I think the anesthesiologist had it right. The room the surgeon wanted to use barely had enough room for the scrub and the nurse, and the anesthesia team, never mind the specialized equipment and supplies the anesthesiologist might need. And it was farther from the crash cart and the ICU that the patient invariably would end up in. This means that it was farther from help.

And, as we all know, distance equals time. This is time that can be useful to save the patient’s life. I absolutely backed up the room decision that they came to, with minimal prodding.

But this wasn’t my case or my monkeys. I was called in as a second set of hands. To help and get blood and send blood tubes for needed tests. And make phone calls to the ICU and the supervisor to smooth out the transition to ICU.

Depending on the type of school a student goes through it is the end of the fall semester. Time for a break!

Final papers and final tests have been turned in or taken. And grades have been posted.

Graduation may be this weekend for others whose journey is done.

After an entire semester, or quarter, full of work, it is good to put down the pens and pencils and let the mind wander a bit.

After all, the next semester or quarter will start after the first of the year.

But for now, it is important to pause and reflect.

Think about habits that did not suit the fall semester and how to fix them.

Think about what went well for the semester, and what is important to change.

Don’t dwell on it too much. That way lies madness. Or tears.

Just think about the semester that has just finished. And think about how to improve the next semester.

And when all the thoughts have been thought, put it away.

And take a break.

Time enough to pick up the pens and pencils for the spring semester.

After all, it will be here before too long.

Right now, relax, and enjoy the holidays that you celebrate. It doesn’t matter what grade was the result of the semester, just that it was a passing grade.

And breathe.

The make of the week is Toffee Grahams. This is similar to Christmas crack in that it is toffee poured over crackers. Only substitute the saltines for graham crackers. And top with pecans prior to pouring the toffee. And the chocolate chips are not necessary.

I hope they like them.

Months and months ago I put in an application for a podium presentation at AORN 2023. The middle or end of August, I believe. And I got monthly emails that the selection committee was still evaluating the proposals.

I am writing a presentation based on Cookie Thursday is a Thing and how such a program can have a positive effect on morale. And I wanted to present at AORN, in a half-hour presentation. Or write a book.

The tag line of the presentation/book/article will be, raising the morale of the department, one cookie at a time.

But no. My presentation abstract got denied.

I am not sure if it is too out there for the reviewers. Or deemed not OR specific enough.

That is okay; there are other conferences in the sea. Time to rework the proposal for OR Management Conference, or the North Carolina Nurses Association. Both of these conferences will be in the fall.

I also want to write a book about the history of Cookie Thursday is a Thing and how it came to be, and why the little engine that could is important. And how small things, such as a homemade cookie, can brighten the dourest of ORs.

But that is for another day.

I will crack the presentation abstract at some point. I just need to right spin on things.

Are you happy?

Are the nurses in your unit happy?

What would make you happier?

I know!

Engaging in professional development is a good way to start.

Yeah, bitching and moaning is a good way to pass the time.

But it doesn’t DO anything to address the problems. If you complain to the car that is stuck in the mud, the car does not suddenly move. The stuck car does not realize its mistake and fixes itself and gets back onto the road.

In this way complaining about hospital management does nothing to fix the problems. But we love to complain, don’t we?

Stop your complaining and find a way to engage with the hospital as a whole, and the other nursing professionals in the hospital.

Why, yes, this is an ad for shared governance.

I’ve been involved in shared governance since 2015. And there have been a LOT of changes in healthcare since then. States are slowly coming around to the idea that expanding Medicaid is actually a good idea to help citizens in their states, instead of the black mark against themselves by some conservatives. We’ve been staffing and providing care through a pandemic, the likes of which have not been seen in 100 years. I’ve been involved at every level of shared governance, from the unit level to the corporate level. And involved in all the meetings to restructure it in light of all of the current challenges.

How else is the bedside nurse going to speak the truth to the powers that run the hospital?

A quick google search for what makes a nurse happy will result in at least a page of nurses who are happiest when engaging with their professional development and nursing practice.

Which is, drum roll please, shared governance.

This morning I sat with a small group from the hospital shared governance at a restaurant, including the chief nursing officer of the hospital, and we ate breakfast and talked about what shared governance could do for the hospital. And how to engage other nurses.

A question I did not ask is am I happy?

And the answer is yes, I am happy. I also know I am happiest when I am working. Call, shared governance duties, it is the same. I view it as taking care of people, which is my duty as a nurse. These could be patients, they could be fellow nurses at the hospital, this is my way of taking care of them.

Find your happiness factor.

You might be surprised at what it is.

It isn’t money. It is never money.

Okay. It’s been a minute since I did one of these.

Not that Covid is gone. Oh, no, not in the slightest.

Not that Covid is not still killing people, including Americans. Oh, no, not in the slightest.

Not that there are other viruses that are killing and sickening everyone. Oh, no, not in the slightest.

This should be old hat to us. Get vaccinated, the life you save may be your own. Get boosted, the life you save will probably not be your own but someone who is unable or unwilling to get vaccinated. Like, at all, not even one shot.

I was walking a family member back from the surgical waiting room, explaining that most people want to go home, especially after laparoscopic surgery, because of the hospital’s high patient count. Especially high with the three viruses that are trying to kill us. Yes, THREE. Covid, influenza, and RSV. And honestly after a non-complicated surgery, in an otherwise healthy patient, it might be safer outside the hospital than in.

The family member stopped me and said something that I had no response to, “Oh, we don’t believe in Covid. Or vaccines. I’ll kiss someone who is infected on the mouth and prove it.”

Um.

Ew.

I continued my spiel, “Well, anyway, there is not a lot of rest to be had in the hospital. The patient will sleep better at home in their own bed.”

It took everything in me not to shake the person and tell them and that is why we are still in this mess. But I didn’t. And that is all I have to write about that.

Three things of note.

Zero Covid has ceased in China. This was a policy that stated that the goal for China was zero incidence of covid transmission. Many things happened when that did not come to pass. There were riots, multi-city, many thousands of people, against the policy. And they scrapped it and allowed life to go on as before the pandemic. But it isn’t before the pandemic. Life needs to be different now.

Why is that so hard to understand?

In New Zealand, parents would not consent for life-saving surgery for their four-month old infant. Unless the hospital could ensure that no blood from a covid vaccinated donor was used for the surgery. The baby would have needed blood due to the nature of the surgery. The blood pipeline is not set up like that and there would be no way of ascertaining with donated blood was from a person who had been vaccinated. The father said that he was aware of the potential impact of not allowing the surgery to happen. Was he though? Or would he have been the first to yell lawsuit when the baby died. Because the baby would have died without the surgery. New Zealand took emergency custody and ensured the surgery could take place.

I cannot even imagine what misinformation poisoned their minds. No, wait, yes I could.

And sometimes I get random ‘on this date, you posted this’ memories. And yesterday, 12/11/2021, I wrote about it being the day that America marked 800,000 dead. And, just now when I looked, the death toll in America is one million, eighty-four thousand, five hundred twenty-six.

Yeah.

That is an additional 284,521.

American dead.

Of Covid.

In three hundred and sixty-six days.

Of something we have the tools, like vaccination, to fight.

But no, people want to live their lives as they used to back in 2019.

People.

Yes, I am using it as a swear word.

The post-it reads ‘when construction on the street in front of the hospital cuts the gas line, this gives new meaning to the term rock this house!’

Absolutely this is a true story.

No, no explosions.

I think I have shared that I call the hospital as a whole the house. Each unit is a different room to my head. This makes the hospital the house. No, as always, I don’t know where I picked that up.

Did we panic that there was a cut gas line near the hospital?

No.

BECAUSE WE DIDN’T KNOW ABOUT IT.

This happened when I was still the evening shift charge nurse and the evening was spooling out like it always did. Add on appy, rooms set up. The usual.

Until the nursing supervisor showed up on her rounds. And happened to mention that there was an emergency in front of the hospital as the construction crews had cut the gas lines. And, upon immediately recognizing the problem, capped the gas line.

No overhead page. No ring on the red emergency phone in the department. Nothing.

The house was not in danger anymore.

Well, it would have been nice to know that the hospital had been in danger, as brief as it was. We could have prepared to shelter in place. Secured the windows, moved people and patients away from the windows. Something.

But no.

And then I looked at the supervisor and asked if the boilers in the central sterile processing department were affected. Because that is the big user of gas in the department. And if the boilers were affected and they could no longer process and sterilize instrumentation, the department was going to have a bad day tomorrow.

They looked aghast. As if that had never occurred to them to check in with departments and

1) inform them of the potential for a cut gas line, IN FRONT OF THE HOSPITAL

2) ask if the departments had any specialized need for natural gas. Like the boiler and SPD.

3) and, once informed of the need for natural gas for the boilers and the sterilizing of instruments, check on the boilers to see if they were impacted. Because if they were the OR schedule for the next day would be impacted.

They hurried off.

I went to SPD to see if they had boiler pressure and the sterilizers were functioning within normal limits. They were.

This could have been bad. It wasn’t.

But what if…

This is the December wrap-up report of my personal school journey.

I’ve been a PhD student for four whole months now. I’ve learned so much.

I had to learn an entirely new program for calculating statistics. Hell, I had to learn an entire new school.

This is the biggest school that I’ve been to, including Creighton.

But the short of it is I passed all three of my courses.

Phew.

Statistics bedeviled me of course.

I am decidedly not math brained. And so it makes me all thumbs when I am writing up my homework. When I was solving and writing up the final test for the class, I completed 4 of the 6 questions. I decided to save my progress, go to bed, and hit the last two problems in the morning. That way I could submit the final before 1200, well before the cutoff time of 2000. I saved my progress and went to be at roughly 0100. I got up, intending to finish the last two questions and submit the test before noon.

And the file was GONE!

Poof.

As if it never existed.

The output worksheet remained as that had been saved separately.

But the homework write-up itself?

Gone.

And IT doesn’t work on the weekends.

But the worksheet was still saved.

No time to go down the rabbit hole of what happened. I opened another copy of the assignment, saved it again, and rewrote the damn thing, using the output that was saved separately.

Not the best Sunday of my life.

But, you know what?

I passed.

I survived to take the second half of the statistics course in the spring.

I developed some coping strategies over the course of this semester.

Make a clear calendar of what is due and when.

Make time for writing group.

Make time early in the week for required reading, ideally not the day before I am going to be expected to interact with class.

Most importantly, keep reminding myself that this is not a sprint. This is a marathon. And each class builds onto the next to utilize my time the best.

Second most important is to take time to relax and let my brain contemplate the classes. This helps immensely when writing papers.

But first semester is finished.

And next semester I have the second half of statistics, nursing informatics, and nursing theory. One math class and 2 paper classes.

But for now, I am going to take my own advice and relax.

After all, the start of Spring semester is five weeks away.

Plenty of time to think about my dissertation topic.

Continuing this month’s theme of Holiday the make of the week is Chex Mix.

I’ve made it before. Twice, I think, last December, plus once in late winter.

This is one of the most requested recipes from the department.

The familiarity of Chex Mix is like wrapping yourself in a warm cardigan, sipping on some tea. It is a big part of my Christmas baking, and a big mover in celebrations, or sitting at home in the afternoon and evenings, in the light of the Christmas tree, reading a book.

It is also non-denominational. And non-partisan.

I find it comforting and therefore I make it every year, only around the holidays. When the evening darkness comes early and the outside temperature is dropping.

And there might be the precipitation of your choice outside.

I prefer rain.

Because people around here can’t deal with the white stuff.

We’ve already had a run on hips from people falling on slick leaves.

No need to add ice and such into the mix.

There has been a marked increase in book bans across America recently. One group doesn’t like a book, feels their child should not exposed to it.

Simple solution- Don’t buy your kid that book.

Oh, but what if they get access to it at a library or a school?

What if they get access to it at a friend’s house or a book store?

Do you think that dealers in forbidden knowledge are just standing on a street corner, their trench coat full of things that YOU don’t think your kids should have access to?

Fine.

Don’t buy them the book.

I’m not sure if they told you that you cannot control everything. Information is like water, it finds its way out.

And although YOU don’t want YOUR kids to read a certain book, maybe others do not care if their kid has access to a certain book. Whatever sins you think the book has done.

But what if my kid learns to do X, when I don’t believe in it.

Okay.

You do realize that the kid is not a perfect carbon copy of you. And has thoughts and feelings about what they would like to read.

No?

Okay then.

Knowledge is, of itself, dangerous. And free knowledge even more so.

Have you heard that libraries are free? Anyone can go in and pick up a book, take it home. No questions asked. The only limits is how many books you can check out.

Of course they want you to return the book.

That means the next person can read it.

And so on.

Of course there are books being banned. And pearl clutching.

Think of little Timmy.

Those of us not in the book banning business are thinking of little Timmy. And of broadening his worldview so that when he encounters something unfamiliar to him his first instinct is to wonder what the new thing is, not to kill the new thing.

Ah, I get it.

Information is freedom.

And you would rather their mind not be free? To not question?

The mass banning of books only serves to make the information exciting and exceptional. Not all information is exciting and exception. Until you ban the knowledge.

You are not protecting others, you are forcing them into the little box that you grew up in. That you still reside in, judging others about how big their boxes are.

I can hear the complaining now. “Well, if you had kids you would understand.”

No, I don’t have kids. But I was a kid. Books were never banned in my house. Ever. I could read whatever I want. And I wanted. If something made me confused, I would ask an adult to explain. Or I’d read another book to explain what I just read.

Ah.

And of course hoarding of information is power.

Boy, do I have bad news for you.