Does this ever happen to you?

When you want to do something, something cool, and your mind peace’s out?

Nah, I didn’t think it was me alone.

You know what?

It is okay.

Our minds are busy, busy places.

There is so much to look at.

So much to do.

While you are at work, room 306 needs pre-op antibiotics, room 312 needs to be turned, room 316’s call light is on AGAIN. And the phone will not stop ringing!

Or at home:

Little Timmy has to be picked up from swim practice, Samantha has to be taken to somewhere else.

And you don’t know how you are going to fit it all in?!?

Dinner is late, no one has clean clothes for the week.

Arrghhh! It’s all too much.

Shhh.

It is okay to give yourself a break.

Even if it only a little one.

Relax.

Close your eyes.

And let your mind drift for a moment.

Only, don’t do it at a stoplight. Wait until you are off the road.

It will be okay.

After all, most of these “MUST DOS” are things that we get ourselves into. Thinking we have more time and more attention than we actually have.

It is okay.

Read a book. Take a nap.

Your mind can be blank once in a while.

The world will come crashing into focus sooner or later.

And things will get done. Timmy will be picked up, Samantha will be where she has to be.

Cut yourself some slack, okay?

The gown card reads ‘unauthorized water.’

I remember this, because it happens ALL the TIME.

NPO is not just a suggestion and up to the patient to follow or not follow.

I know it’s tough to have a long wait. Especially when you are thirsty.

I know.

Sometimes cases run over but when we ask re NPO, that means nothing per os, or nothing by mouth.

Nothing.

Not unauthorized water from an unknown source.

Although, as an aside, when you are thirsty and uninterested to going to get a glass of water from the kitchen, that water tastes the best. Like, ever.

We will know.

We always know.

Especially when your CRNA has to suck it from your lungs,

Because after you’ve been put under anesthesia, you are no longer able to protect your airway.

And what was in your stomach comes up.

It sucks. I know.

But it beats aspiration pneumonia.

Just imagine that you had a laryngeal mask airway (LMA) in which does not cut your lungs off from your stomach. We use these with people who are at low risk for aspiration. AND NPO for 8 hours.

Why? It is gentler on the throat and means that we can remove it sooner and still keep you asleep for your surgery.

If your stomach contents make a surprise visit after the LMA has been seated, the acid and contents can go into your lungs. Causing aspiration pneumonia. And a surprise intubation is no one’s idea of fun. The endotracheal tube has to stay in place until you are awake enough to protect your airway and protest the tube down your main bronchus.

Remember this next time you want to drink bathroom tap water because it has been SOOOOO long, and you’ve been thirsty for SOOOOO long.

Is it worth it?

Is it worth possibly dying?

I don’t think so.

I remember when I was at the university bookstore in Creigton in 1993. Stacks upon stacks of books broken down by discipline and then by class. You hunted until you found your discipline and then you looked for books for each class. Of course, you also needed the syllabus for each class.

A syllabus is a roadmap for the class. Expectations, due dates, grading rubrics were all in the syllabus. And instructors WANTED you to read the syllabus, if only to cut down on repeated questions.

Think of the syllavus as the FAQ of the class.

In 1993, they were printed and sold next to the book for the class.

When I was at Napa Valley College in 1998, they were printed and sold next to the book for the class.

I’m not sure when, in the heady days of the internet emerging to what it could be, not just cat pictures and insane rhetoric, the syllabus started to be put online and the colleges and universities stopped printing them. Definitely before I started an online only degree at Chamberlain in 2015.

Now they are all online. There is not a printed syllabus to be found.

Anywhere,

This is good in two ways.

• Being online means that the demand for trees for paper for printing goes away
• Since the printing costs are no longer there to justify the cost of the syllabus, they are just bundled in with class announcement

Every class begins the same way.

Read your syllabus. And if you have any additional questions, ask.

As a serious type of student, I have read the syllabus for all three of my classes. Twice.

And I refer to them often.

And sometimes my third reading shows me something I never noticed before. An often vital piece of information that made it all clear.

And you feel silly for an hour or so. After all, it is there in black and white.

And then you regroup and go back to writing the paper. Or studying for the exam.

It will be okay.

As befitting the cooler days and longer nights, the theme for November is fall.

Autumn, if you please.

This time evokes the coziness of the season, prior to the craziness that is December, and the exhaustion that is January.

After the Halloween rush, it is time to relax before the holidays.

Psych, just kidding!

Fall is when deductibles are met and the OR schedule goes haywire. Everyone and their brother wants to have their surgery, any surgery, after their deductible has been met. Theoretically it is cheaper then, or less money out of pocket.

I could go on a tirade about the healthcare system in America and how crazy it is that people are forgoing needed care and surgeries because otherwise it would cost too much.

Mindboggling.

Personally, I would have surgery after the new year and max out deductible and out of pocket expenses. By the same logic, any additional necessary care would be free. For the rest of the year!

Of course, this only works if you can pay your deductible. I could go on about that.

Ahem.

I digress.

We were discussing fall as the theme for November.

I decided to start with sweet potato bread.

This bread was remarkably easy to put together and only utilizes a cup of mashed sweet potato. The recipe has instructions for cooking and mashing the sweet potato. You can used canned, I won’t tell. I will say that 1 can of sweet potato puree that I got at end of year markdown last December made 2 loaves.

I cubed up one and half of the loaves for Cookie Thursday is a Thing. I kept the other half for us. This household prefers sweet potato to pumpkin. We just do.

Toast up a piece of sweet potato bread, make yourself a cup of tea, and enjoy the sound of leaves falling.

For the OR, this will be the last calm moments before the end of year madness.

Or, rather, I’m doing a thing at 1500.

This is purely an about me post.

You see, I’ve worn glasses since I was in 1st grade.

For those following along at home, this is 40+ years.

40 years of paying for eye exams.

40 years of paying for glasses.

40 years of waking my husband up to find my glasses because I can’t find them and can’t see to find them. This happens more often that you’d think.

40 years of being afraid of traveling without an extra pair of glasses or, at the very least, my glass prescription.

In the back of my mind, I have been aware of LASIK. I always believed that my prescription was too extreme, especially my left eye.

But it has been a theory of mine. Get LASIK when I am in my 40s and then, as my eyes deteriorate as I age, start buying glasses again as I need them. Kind of like doubling the life of my eyes and doubling the correction that I can have before I am legally blind. Because isn’t that what everyone who is severely myopic fears? Being blind.

What prompted the desire now?

When I was getting my glass adjusted because they continued to slide down my nose right after I got them, the frame snapped. This rendered the glasses unwearable. And me unable to see for my drive home because those were the only glasses that I had with me. And no one to come bring me my spare pair.

Stranded, no correction for my vision, less than 2 miles from home.

My plan was leaving my car at the optometrist’s office, walking home, and retrieving my second pair, walking back and picking up my car. I’m pretty nearsighted and that would have been terrifying. I can see movement and color and shapes without my glasses but not much else, definitely not any sort of focus. They were able to put my lenses into a loaner pair of glasses and I could drive home. The mind-eye dissonance of fitting my lenses into the glasses they were not made for was headache inducing. I only wore the Frankenglasses long enough to get home to my spare pair.

And I started thinking about what a disaster this could have been.

And I started reading more seriously about LASIK.

And here we are.

The LASIK doctor pointed out that my glass prescription already made me somewhat disabled. And that had never freaking occurred to me. My glasses had just been a part of me for 40+ years after all.

Tests and appointments and eye drops. And talking to others who have had it done, about how life changing it was for them.

LASIK here I come.

Fingers crossed.

Happy Halloween!

For a good bit of the population, Halloween is the best day of the year.

These are your Halloween geeks that do cosplay, heavy on the costume, heavier on the play. And these just aren’t the kids.

Macbeth’s witches always loom large at this time of year, with the spell making. Thrice the tabby cat has mewed, thrice and one the hedgehog has…

You get the picture.

There are many interpretations as to when the witching hour is: when the darkness starts to gather, 0300, for parents early to late evening. For your circadian rhythm it is at the lowest: blood pressure, pulse, temperature. This is usually regarded at 0300.

Depending on the shift you work, this may be smack dab in the middle of your sleeping cycle. Shift work ruins everything.

If we are talking heart attacks, most happen in the morning after 0300. There is some evidence that these early morning heart attacks are the most sever types.

When I was working nights in a nursing home, this was when we would find residents dead in bed. Or in distress.

For parents it is the time of day when the day is slowing down, everyone is tired and crabby and the crying starts. Colic is also most prevalent from 1800-midnight.

To put it plainly, this is the time of day that is most dangerous: for health, for sanity, and for evil if you believe in that. To put in metaphysical terms, this is the time of day that the barrier between the worlds is thinnest. Which worlds is up to your personal belief patterns.

And things can happen.

Spooky things can happen.

I’ve written before about the “ghosts” I witnessed in Sonoma. I put it in quotes because you can believe what you want to believe. But was the woman that I saw with my own eyes admitted to the hospital? Nope and I checked every room and every floor.

In the emergency room it is a time of stress because people get drunk and do stupid things, just like any other perceived party time in the world.

The practical among us, myself included, would be wary of what the other people are doing.

Perhaps that is what the witching hour is. And who we should be afraid of.

Other people. Or our own minds. It all depends.

Or know that there can be change afoot, because that is what we all fear the most.

The gown card begins ‘2 word phrases- what is wrong in the OR’.

A 2 word phrase can be useful in establishing urgency in the OR. Think Suction Here. This indicates that suction is needed, right now, in this specific location. It is specific and to the point. No extra words are wasted to get the point across.

A 2 word phrase can be irritating as well. The rest of the gown card is filled with itty bitty writing giving 2 word couplets that can be rage-inducing. I’ll list them as written. And give background when I can.

A) Suction Cannisters. Whose job is it to fill the cannister tree? Everyone’s. Who does it? Hardly a soul. Nothing is more rage inducing than going into a room with an emergency with a single suction cannister in the 4 cannister tree. When I was the evening charge nurse I filled the trees as part of the set-up I did on every room, every night.

B) Warm Blankets. Sometimes the patients can hardly move they under so many blankets. It is an answer to every situation for some people. You’re bleeding uncontrollably? More warm blankets! Yeah, not the answer that will save a patient’s life. Rage inducing when the person giving them all the blankets is the same one who tears them off in a rage because there are too many blankets.

C) Pagers Phones. Prior to scrubbing in the PA or the surgeon will dump their phone or pager on the desk. Not give you the code to get into it, just drop it off and act like you should know the code. After all they gave it to you six months ago.

D) Bat Phone. This is the charge phone and will go off when your hands are dripping, or there is a request from the field. Take care of the field first. And if you answer the phone and it is the next doctor yelling about getting their case started, feel free to tell them that they are slowing down the case ahead with their non-stop calling. You will call them with updates as you have them.

E) Cold Room/Warm Room. No matter the room temperature, someone is always unhappy. AORN has parameters for optimal room temperature and humidity. We are not making this up and sorry if you are hot/cold. This is the temperature that is best for the patient. Got it?

F) Extra Instruments. Some surgeons are unable to work unless every instrument they could conceivably use, but will not, is readily available to the scrub tech, open and counted. Never mind that this practice slows down set-up and breakdown. God forbid the doctor wait a couple of minutes for the instrument that they haven’t used in years but is exactly what they want at this exact time. What? You didn’t look into the future and prepare for every eventuality.

G) Yes, Doctor. This is in reference to the expectation by some surgeons that the OR team is subservient to them and will put up with their nonsense. Instead of a team who is working together for the patient. I’ll use this when I think that the doctor is being irritating. Just imagine the sarcasm dripping. You get it. Sometimes they do not realize that it is an insult.

H. I Need. This is shouted out the door for someone else to get. This is only useful if there is anyone else there.

I) Can Somebody. This is similar to H but not exactly the same. The very first Dispatch I ever wrote was a screed on Somebody that points out that Somebody is sometimes just the person hollering for something. A long winded answer that says sometimes the only one you can depend on is you, because there is no one else.

J) Latex Free. By itself is not rage-inducing. However, when people hoard this knowledge and does not share until it is too late, the room has been set up with latex gloves and therefore must be broken down before the patient enters the room. And re-picked and re-set up. Oh, and the CRNA is coming down the hallway with the patient and the surgeon is pacing, ready to start. Yeah, been there a few times. Thankfully, the incidence of this is down due to the electronic health record flagging of allergies.

K) Sterile Conscience. Really the lack of it and lack of proper sterile technique. There is a reason that all the mothers and babies died in the 19th century when medical students used to go from autopsy to delivery without washing their hands. This was the beginning of the idea that there may be an infectious organism ready to ruin your day. This is a history lesson. Look up Semmelweis and learn why the hospital and especially the OR is so keen on handwashing.

L) It Hurts. Trust me, patient, we are aware that it hurts. This is why you are in the OR. But continually screaming that it hurts will not make us stop what we are doing, which is fixing what hurts. It only serves to distract us. And there is only so much medication that the CRNA can give to you.

M) Hey, nurse. Oh, my favorite. Some doctors don’t even learn our names, preferring to use the word nurse to describe everyone who comes in contact with them. Also what patients call everyone who is not a man involved in their care, even if they are the doctor. It is beyond some people’s awareness that some doctors are women.

N) Work Smarter. There is only one way to work in the operating room, sometimes smart has nothing to do with it. This is a productivity prompt. What they don’t tell you is that sometimes there is no way to increase productivity, not without doing some unsafe practices. Which isn’t smart.

O) Sacred Cows. I’ve written about this before. These are the things that continue to be done in a certain way, not because it is the best way, but that other ways have not been explored because we’ve always done it this way. It is a circular argument. And hard to convince others to explore other ways, because why break what works. But does it though?

The longer I work in nursing, the more the rage inducing 2 word phrases multiply.

ROI. Otherwise known as Return On Investment.

One of the questions that you have to ask yourself is if the outlay for school will be worth what you get out of it.

And that is a very personal question.

It depends.

That is not a cop out.

This university PhD jaunt is my 5th (!) nursing school.

Let’s talk nitty gritty detail and money.

Creighton 1993-1995. This was paid for by student loan, scholarship from Marshalls, and an Air Force Reserve Officer Training Corps (AFROTC) scholarship that covered some of my second year at Creighton.

After I hurt my shoulder and lost my scholarship, I did not return to school after my sophomore year. This was because I had lost my scholarship and I just gave up? I’m not sure. I do know I needed two separate surgeries to repair the labral damage.

The total cost to me for this was $4500 in student loans that I paid back by 1998. And a $10,000 AFROTC bill that I got after I left Creighton. It took me ten years of monthly payments to pay that off. I began paying it back in 1997, and finished in 2007. And I have the letter from the government to prove it.

Considering I didn’t finish, and owed $14,500 was this a good ROI? I would say no. I was not a nurse and had to pay off those student loans. The classes that I did complete did come in handy later and decreased the outlay for Chamberlain. Like many things in life, this was a wash, I guess.

Napa Valley College 1998-2001. My parents bought my books, I paid cash for the classes. At the end of this I was a nurse. An ADN nurse, but a nurse. This was definitely worth the ROI.

However, working as a CNA Thursday-Monday evenings 1500-2300, and class every day of the week but Thursday was a tough road. And probably helped set up my workaholic habits. And I maintained those for YEARS.

Chamberlain College 2015-2016. I had a wild notion to go back to school for my BSN. Things were happening in the hospital system. And I started to think what would I do if I got hurt? The OR is a dangerous place. I needed a fall back position and a BSN would help. I paid for Chamberlain with student loans and $3,000 when the billing cycle and the student loan disbursement did not meet. $19,000 in student loans, which I immediately rolled over into my MSN.

Knowing what I know now, there are cheaper ADN-BSN bridge options out there. I advertise these to my coworkers monthly. And offer tutoring.

Queens University of Charlotte 2017-2020. I went here for the MSN program. It was touted to be affordable and less than $15,000 for everything. I paid with a combination of student loans, and out of pocket expenses. I haven’t used the MSN as of yet, because covid. But I did use it as a steeping stool for my last university. We paid off all $29,000 in student loans from Chamberlain and Queens in September 2021. I was able to accomplish this with clinical ladder money, tuition reimbursement, and picking up extra shifts/extra call. So many extra shifts.

University of North Carolina Greensboro is hopefully my final school. It is $500/credit hour and the PhD program is 57 credit hours to graduate. By my calculation this will be roughly $29,000 for class and another $3,000 for fees. I am paying for this through a loan that will be reimbursed 85% if I teach nursing after I graduate. As this has always been an end game goal of mine, I don’t think I will find that too onerous. If I do the math and I fulfill the faculty part of the loan, I will have to pay about $6,000. That brings the grand total to roughly $55,000 in education over 30+ years.

I am saving all extra money gained from clinical ladder, tuition reimbursement, and hospital bonuses in a separate savings account to pay back the PhD loan if I am unable to fulfill the contract I signed.

My goal in continuing my education is to have a fall back if I get too old or too injured to work as an OR nurse. And to further nursing science in the operating room. The BSN, the MSN would open doors for me to step outside of the OR.

But who wants to do that? Not me. Not yet.

What does this mean for my personal ROI?

If and when I finish my PhD?

Absolutely worth it. Would do again.

Finding if going back to school is an ROI for you is a personal decision. Let’s talk about it. And we’ll see if we can figure out a good program, tuition reimbursement, and scholarship opportunities. Because every nurse can be who they want to be, and have as much education to get there. But if you want to go further, I can help.

Spooky cookie theme continues with the last Thursday of October.

Oh boy! This year, like all years, is going by too fast. Hell, this is the 9th week of the semester for the PhD program. Time flies.

This Cookie Thursday is a Thing is a double biller thriller- the trick and treat cookies.

In years past when I had more time I would make handmade candies for the closest Thursday before Halloween.

I made some doozies in the day-redhots, gummie bears, honeycomb candies, Halloween colored butter mints, Halloween crack candy (crackers, toffee, and chocolate), bacon crack, home made sour patch kids, candied orange and lemon peel, black licorice. The list goes on.

Invariably it rains the day I want to make candy. Which ruins the candy because it is too humid.

This year, to keep it simple, and weather minded and time constraint minded, I decided on a trick and treat theme.

S’mores cookies made with dark chocolate chips and mini marshmallows. In a basic Toll House Cookie Recipe. Did you know that marshmallows essentially melt during baking creating pockets where there should be something. I have seen these called Hocus Pocus cookies recently. Because poof! The marshmallow is gone.

Now for the trick. I ran across a pickle cookie recipe not too long ago and I was intrigued. It is sharp cheddar, pickle chips, and seasoning, if desired. I made these in both a mini muffin tin and a regular sized muffin tin, depending on the size of the pickle slices.

I was explaining the cookie types to my friend and she said these are keto cookies that her sister makes all the time (she’s a brittle diabetic and there is no sugar).

I call these the trick cookies because a pickle in cheese baked is a surprise! And I mixed up the two types of pickles and there are both dill and bread and butter pickles. Surprise!

Pickle Cookies

To make pickle chips, put a small amount of cheese in the bottom of the muffin tin that is chosen. Top with the pickle slice, add a little bit more cheese. Bake at 400 degrees for about 10 minutes. Let cool and enjoy.

The recipe calls for spraying the tins with muffin tins. I find this makes them pretty greasy and I will be omitting that step next time I make these.

I used both dill and bread and butter pickle slices. And the cheese was very sharp cheddar.

I wouldn’t kick either of these cookies out of the cookie jar. Both have their charms.

Halloween can be one of the craziest days of the year in the Emergency Room, topped only by the full moon.

What is that you say? Studies have proven that there is no such thing as the full moon affect. Tell that to the ER patient who acted out of character and stuck something where he shouldn’t. Or the one who has alcohol poisoning.

Stay tuned for a new theme coming in November.

It’ll be a howlingly good time!

At the hospital level healthcare workers are very concerned about patient falls.

We dissect each fall as they occur and look to see if the guardrails have been in place around the patient.

Things like bed alarms on to remind the patient not to get out of bed. And to alert the healthcare workers on the unit that there are shenanigans afoot. Some places have the bed alarms wired into the call bell system as an additional alert.

There are chair alarms that function as a reminder to the patient, and an alert to the healthcare team. Much the same as the bed alarm.

There are emergency pulls in the bathrooms that someone can pull to alert others that they overjudged their stamina and endurance and are in trouble while in the bathroom.

There are safety attendants who sit with patients to remind them not to get out of bed. There are cameras that can also serve as watchers when there are not enough safety attendants available.

There is paperwork that is filled out on every fall, documenting the presence of these fail safes or absence. In some places they do a debrief after every fall.

There are special fall bracelets that serve as a visual reminder that the patient is at risk for a fall. In some places this is a conclusion for a patient after the nurse fills out a fall risk assessment.

It is understood that the patient is assessed and given a score about their likelihood of falling in the hospital. Which starts the cascade of fall precautions: the alarms, the bells, the pull station, the armbands.

But sometimes all of that is not necessary. Because sometimes a fall is an accident.

And all of the precautions in the world could have prevented it.

And sometimes it is the verbiage of a fall that starts the cascade.

I had a patient once who had all the fall precautions, even though they were under 20 with no balance issues. I was perplexed and investigated more.

Their “fall” was using a bike that someone had left on the side of the road. Did they know how to ride a bike? No. But it still counted as a fall.

Sometimes a fall is due to the very human condition of foolishness.

And that is hard to guard against.