This has been heavy on my head as I have read article, after article, after article, and watch video after video, after video of women being denied care as they stumble over the trigger laws that states put up as law to deny abortion to women.

I have read about the denial of care for a miscarriage which is losing a fetus before 20 weeks, and denial of care for an abortion, which is losing a fetus after 20 weeks. Or there is a miscarriage in process but the heart hasn’t stopped yet and nothing can be done to relieve women of carrying a doomed pregnancy. I mean the mental dissonance alone makes your head hurt.

Women are getting ill. There are infections that are sequelae (that means consequences) to carrying a dead baby that they are denied proper medical care for because doctors and hospitals are afraid of running afoul of the laws. And they should be, especially the laws that state that a layperson can sue for even the idea that a doctor helped a woman end a pregnancy and these laypeople are incentivized to do so by the $10,000 bounty on the doctors, or the driver who took a woman who was in pain and losing a pregnancy. This was a bad idea when Texas started it in September 2021 and other states have jumped on the bandwagon. Someone is making money off of someone else’s misery.

Got it.

Women are bleeding. I heard from another nurse that their patient had a hemoglobin of 6 and she was bleeding heavily and passing clots. And they were still denied treatment. Normal hemoglobin numbers for women are 12-15. At least half of the oxygen carrying cells of the woman’s blood were gone. These are cells that carry oxygen, which is something your organs cannot live without, to the organs and tissues of the body, and carry carbon dioxide from the organs and tissues of the bodies back to the lungs were it is exhaled. A hemoglobin of 6 is is a medical emergency, verging on the number that is not recoverable from for the woman.

Still others are being told that while there is a miscarriage in process after no cardiac activity is found during an ultrasound that nothing can be done without a second ultrasound to confirm there is no cardiac function, and a third to confirm again. And the women are left with this burden of a failed pregnancy, and have to go through a degrading ultrasound twice to confirm what it already known. This woman has to be told three times that the baby is dead before any action can be taken.

I mean, what the actual fuck?

And the infections can lead to a woman being unable to get pregnant, or carry a pregnancy. Where is the outrage about that? It is bad enough that we, as women, are told that our bodies are not our own and we can have no say over what happens to them. But women who very much want to get pregnant can have a miscarriage. And if they are in certain states they are not medically treated in a timely manner and this can lead to them being unable to every have a child.

And you are okay with that?

Women who have gone through this kangaroo court that we are all living in are suffering. And some of them are deciding not to have more children, or children at all, rather that go through this catastrophe again. And that is a compounding tragedy.

Next up on their docket of what they want not bound by laws will be gay marriage. Or maybe birth control so that they can have utter control over women. Because it is always and has always been about control. Someone, somewhere is doing something that a section of society doesn’t agree with and THEY MUST BE STOPPED!

I’m frightened and I am a married, white women in my late 40s.

It is unfathomable what others are going through.

Because a section of society doesn’t understand.

Can’t understand.

Won’t try to understand.

f you are not frightened, you should be.

The gown card reads ‘Treating the paperwork instead of the patient.’

Picture this: an OR that has all the lights on because this is an open case. The back table is full of instrumentation such as scissors, and pens, even replacement pages. There are electronic components carefully laid out. The “patient” on the table is a charting computer with its guts hanging out and a screen that has been blanked out. The surgeon snaps out ‘We’re losing it!’ as she frantically tries to stuff the electronics back into the computer.

You, the circulator, is sitting at the back of the room with the real patient and paying attention to their needs and wants.

I know I have written about this before, and it remains a serious judgement issue.

Some nurses are hell bent on getting their charting done and not paying attention to the field. They are chart first and let the field take care of itself. Um, they can’t, because they are sterile.

I find this especially true in nurses who have gone straight to the OR from college. For them, charting is the holy grail. After all, if you didn’t chart it, you didn’t do it has been bashed into their brains forever. I know. I had it bashed into my brain too and then I worked the floor for a year prior to being an OR nurse. And as a floor nurse, you have tasks to undertake and charting to do, but the tasks come first.

But which floor wants to train a nurse just to lose them to a specialty? It is expensive to train a nurse.

I have a radical thought. In order to chart, a nurse actually has to engage with the patient and DO something.

Charting can wait. Especially when the field needs something.

Your phone can wait. I’ve been an OR nurse a long time, pre-smartphone supremacy (that means before 2007) and I will tell you that the biggest distractor in the room is not the charting, it is the smart phone.

Phone, charting. They both mean the same.

It means that the patient, who is the sole reason that the circulator is in the room and charting to begin with, is the loser in the attention wars.

Don’t let your patient become a casualty to not paying attention to the field.

988 is a new national number, similar to 911 which was implemented in 1968.

This has been such a great need for so long. Hopefully this will decrease the number to 911 for mental health crises that today lead to deaths because sometimes in crisis people can’t listen to directions. Cops are not trained to handle a mental crisis. When I was a volunteer for the local crisis line when I was in college, I had to undergo 180 hours of training in transactional analysis before I was allowed to take a call.

This was before the advent of cell phones as an everyday item. Some people had car phones but it was too expensive to talk to a person in crisis on them. Everyone I knew who worked on the volunteer line took their shift from their house. The people in need could call the number that was advertised, and the call would ring through to whoever was on call. Our personal numbers were never advertised.

Our local crisis line was staffed entirely volunteers who would take a shift to be available for calls to speak to whoever reached out. Mostly it was people who were lonely, I’m looking at you person who shan’t be named who just called in every shift to tie up the line for 4 hours at a time. But other people called with genuine need.

One day, in the middle of summer in the mid 1990s, I got a call from a suicidal person. They didn’t want to die but there was no other way to stop the pain. They had a knife and they called the crisis line instead of using it to harm themselves.

I remember telling them that I was so glad they called the crisis line and I would be happy to talk to them for as long as they needed. They just sobbed on the phone saying the mental pain had to stop and could I help them please. Leaning on my training, I ascertained whether or not they were alone, which they were. I asked if there was someone that could be contacted to come be with them. They panicked, thinking I was going to hang up the phone. I soothed, explaining that I had a neighbor who could call for them. I would just need a number. They mumbled a number, I wrote it down, along with a note that I needed them to call this number and alert who answered that they were needed at home because someone in their house could not be alone.

Still talking on my portable phone, I walked over to my neighbor’s apartment and banged on the door. He opened it and I thrust the note to him. As if we had practiced it, he read the note quickly, held up his hand in a call gesture and I nodded, mouthing please. It took less than a minute to convey the message. I went back across the hall, continuing to talk and listen. My neighbor gave me a thumbs up through the screen door. I smiled at him and mouthed thanks. And told the caller that their person was on the way to them.

The caller and I spent about an hour on the phone together, as they became more and more calm. We talked about whatever topic they wanted to talk about. I knew that the immediate crisis was ending but I didn’t want to hang up until someone else was with them. We talked about their plans for college in the fall, and which city had the better baseball team, about their job. We talked movies and television shows.

Every minute away from the acute crisis calmed them even more.

Finally, I could hear the doorbell through the phone. Their person was there.

Haltingly, they thanked me for my time and that they were feeling much better. I could tell they were becoming embarrassed about causing a scene and I rushed to remind them that is why I volunteered for the crisis line.

I did not give them any recommendations for treatment, that was not my role. My sole job was to listen and make gentle suggestions such as the have another person present and diffuse the acute crisis by being a listening ear when they needed one.

I am not sure that the crisis line still exists or if it has been enveloped by the mental health services for the county. But I was there when that person needed me, and that is all that matters.

The If You Want Women to be in the 18th Century so Badly… theme for July continues.

The bake of the week is pound cake.

Quick check in on my feelings. Yup. Still pissed.

Someone in the department asked what the theme written on the board meant. I had to adjust the board to add an appendix (Yes, this is a SCOTUS protest). No, not that kind of appendix.

In 1796 the first American cookbook was penned by Amelia Simmons. In a very literal title, it is called American Cookery. and it is fascinating.

It is a simple cookbook, with recipes that made use of what the people had. It is also written in the style of the time. The library copy of the cookbook that I read had the original recipe on the right page, and a modern translation on the left page. This meant that the modern translation of the words, not written in the script of the time was word for word with the original work. I found this fascinating.

The original recipe for pound cake calls for 1 pound of sugar, 1 pound of butter, 1 pound of flour, 1 pound of eggs. Hence the name.

There are many other recipes that I found interesting. Carrot pudding. I hate carrots but this has potential. Game, or the meat source of the time, had several pages of recipes. It wasn’t as if you could pop out to the nearest supermarket when you have a hankering for chicken. And all parts of the animal are discussed in recipes. And variations are given for different recipes. There is a variation of the pound cake recipe with is the one I used. And there is also a brief explanation of what ingredients to add to make the pound cake into cookies in case you don’t have small tins to bake in.

The coolest thing was the last page, which was the corrections page. This means that the cookbook had been re-printed. I know that, but it is still very cool.

It is kind of like translating between the generations in the OR, just not as literal. Kind of like telling a millennial or a generation z that the reference number is pound sign123 and them looking at you like you are crazy. Until you remember that they have a different representation of that and you correct yourself hashtag123. Things get lost in translation. My favorite factoid is explaining where the word and came to be. From the ampersand, or the @ symbol on the keyboard. Blows people’s minds.

The recipe that I chose for this week is also very simple. There wasn’t a lot of different ingredients as we understand them available. There was no leavening agent to make the cake rise, instead it depends on adding the eggs to the creamed butter and sugar. There is no vanilla to flavor the cake, it depends on rosewater. Which I found really interesting, and I am going to explore this more in future Cookie Thursday is a Thing.

Experimentation is so much fun! And at the heart of Cookie Thursday is a Thing.

And here we are again.

Again.

There is a new alarming covid variant that is spreading rapidly.

Again.

For a very brief moment this spring my hospital’s covid cases dropped to zero. For less than a week. Something to be celebrated, yes, but it didn’t last long. I’ve been monitoring the covid hospitalization rate for what seems like forever, at least since testing and reporting became a thing.

The OG covid is Alpha, and then Beta didn’t do much of anything and certainly did not become the most widespread. I don’t remember Gamma at all. Must have been a flash in the pan. And then came delta in Summer/Fall 2021, followed by Omicron fast on its heels in November/December. And then the offspring variants of Omicron started showing up. Omicron BA.2, Omicron BA.4 were each more infectious than the last as the virus learned. Now we have Omicron BA.5. It is now the prevalent covid variant in the country, as 65% of all cases are sequenced as it.

Covid evolves quickly. That is 3 subvariants that are making inroads into the population in less than 7 months.

And then there another. BA.2.75. Arising from India. Some dude on Twitter named it Centaurus. And the name stuck. Naming your enemies is supposed to help them be defeated. Um, guys, I don’t think it is working like that.

These variants are all more and more infectious as they learn to step around immune response, either from prior infection or vaccination. This is known as immune escape and that was a phrase I never wanted to learn.

Some people are going to work sick with covid. I get it, you have to earn a living, but although you will likely survive, others you come in contact with may not be as lucky. At least you will save money on gas. (weak joke)

I read several articles that if you get sick, you should assume that it is covid. That is how widespread it is. Not that we’ll know for certain, unless you get tested. Because testing, has fallen out of vogue. I’m not sure if this like when my cat reaches for my pizza with her eyes closed, I think she is reasoning that if she can’t see me, I can’t see her. Or, to use a fable, the emperor has no clothes.

We are all sick of this merry go round. Trust me when I say that healthcare workers are the most disgusted of it of everyone.

It is like a round, why, why is this happening? Because of low vaccination rates, giving the virus plenty of time to evolve into something even more deadly. Just get the vaccination already. I can’t believe I am still writing about this.

The refrain: wear your mask, stay home if you are sick, get vaccinated and boosted if you have not. A 2nd booster is available to those over 50. If you of that population, get the second booster. You might still get sick, but it will not be as severe or deadly. And you might survive.

Wear your mask when you are out. I have read articles that the outside air may not be as noninfectious as last year. Reasons? Please see last two paragraphs.

The WHO came out with a warning that covid is nowhere near over. Despite the rosy misguided thinking of most people, but Americans most of all.

This has been heavy on my head as I watch the calendar slip away toward August.

The first day of orientation for the PhD program is August 5. Orientation for the research assistant job is August 8. We leave for London, a trip long promised, and many times delayed, on August 11. The timing is not ideal but is not to be helped.

I will be taking 3 courses this fall semester of 16 weeks. I am used to taking 2 in a condensed session of 6 weeks. If I remember correctly, all it takes is organization.

And last week I got an email from the university inviting me to apply for faculty loan repayment plan. This is a plan that will pay the student loans of the program, if I teach at an accredited college after for 4 years after graduation. As this is what I was planning on, I would be silly not to apply for it. And utilize it. There is a book allowance attached to it. The application is due July 31. I think that there would be value beyond the money for the program. I will be making contacts that may be useful after school. And I know I can continue with clinical work at the same time, lots of people continue their day jobs. It isn’t as if I have been working the equivalent of 2 jobs for 20 years, minus the idyll of the last 7 months.

Less than 4 weeks to go.

I believe I have to go to the actual university, 73 miles away, once a week, sometimes twice. That is not so bad, especially now that gas prices are dropping. I’ve just been spoiled by living 3 miles from work. My mom used to commute 50 miles to San Francisco and other have it worse. Especially when I take into account they drive that distance every day. I will be going against traffic, on a three lane interstate the entire way. I haven’t been to a brick and mortar school in 20+ years. That reminds me, I need to buy a parking pass.

I have to begin thinking about a thesis and what I will be using my classes to build toward. I want to do something operating room based. I also would like to do something budget based. And to that end my first elective that I have chosen is about aging with money, where to get it and how to

I have to remind myself to enjoy the next 4 weeks and relax some. Because after August 5th, the real work begins.

Nope, I shan’t be nervous. I love school. And I have been doing online seminars and classes the entire time I’ve been the call nurse. Just to keep my hand in.

On to the next challenge.

The post-it reads ‘practice makes perfect regarding practicing for emergencies.’

I was driving to work, listening to Fresh Air on NPR, and there was a pediatric neurosurgeon as a guest. He was describing intra-uterine surgery on a fetus. In this case, it was a surgery to ameliorate the effects of spina bifida. This is a birth defect where the skin doesn’t completely cover the spinal column. There are all sorts of developmental, some lifelong, related to this condition.

He was talking about a case where they had opened the uterus and were in the process of beginning the surgery when all of a sudden there was an obstetric emergency. Of course it was all of a sudden, that is what emergencies are. But in this case, the mother’s life and the fetus’s life were in immediate danger. And all he could do was watch as the anesthesia and the OB teams took over and saved their lives. I can imagine that it was a thing of beauty to another healthcare worker and a thing of chaos to an layperson. Organized chaos. Each team danced around each other, each knew exactly what they needed to do to stop the bleeding, deliver the baby, and save the baby, keep them both alive.

And he said something that struck me as both routine and profound. He said that practice makes perfect and this is why healthcare workers practice and drill for emergencies.

And there are many, many drills that hospitals and healthcare workers engage in every month and every year. These are all ‘codes’ that the healthcare organization teaches their employees not only to recognize the codes and know what is going on, but how to respond. The codes are all named different things in different places.

Fire codes. Fire drill in case there is a fire and we have to abandon the floor, or the hospital but still keep the patients safe.

Inclement weather code. This is to alert employees that there is a weather event happening nearby that is capable to impacting the hospital. I’ve had two alerts on my phone from the hospital this week about possible tornados. As a tornado has struck a sister hospital in the last couple of years, this can be a big one.

Active shooter code. This is to alert employees that there is a gunman on site and to follow the protocols that have been drilled into us to decrease the possibility of being shot. This has also been used in the last two years by the organization I work for.

Missing person code. This is to alert employees that there is a missing infant/child/adult on premises. During this code, all available employees are to go to an outside door and keep their eyes open for someone acting suspicious or fits the description of the person. During one of these drills, I was in a stairwell near an outside door. I always take that stairwell for the drills. A leader from another department was walking down, cool as could be, with an oversized bag over their shoulder. I stopped them and asked to see inside the bag. They admitted that I had caught them, showed me the doll they had in the bag, and told my boss what a good job I had done during the drill.

This is why we drill. When something tragic happens we, as healthcare workers, can respond appropriately and quickly. And save a life. Sometimes, it is even our own.

There are many codes and drills that we have to be aware of. They run the gamut of bomb threats, active shooter, code blue where someone is dying, missing person.

We run them over and over and over. We are practicing for when the time comes that it is real. Because practice, and muscle memory, can make the difference in a life.

All nurses and techs are storytellers.

It is how we relate to others who do the same work. Because normal people do not relate to our humor and our capacity to talk about gross things. Or do gross things. But not all gross things, every healthcare worker has a Kryptonite that makes them gag. It is different for everyone.

Get a group of OR nurses or techs together and the stories come out.

They can range from do you know what Dr. So and So did this week? Story.

Have you heard about Nurse C? Yeah, this is what happened.

What is the grossest thing ever? Pull up a chair, I have pictures (sometimes true).

The OR team as a whole love to talk about something in the past.

We do it to spread knowledge about certain cases and certain doctors who may not be the best. But sometimes they are, and this story tells you why.

We are also competitive and love to tell a grosser story, or a time a surgeon or a leader made you so mad you couldn’t think straight.

Or the past coworker, who moved on years ago, and how they were the worst, and this is some of the shit they pulled.

Or the story about the patient that lives in our hearts and in our minds.

A bit like Barry Manilow, but instead of writing the songs, we tell the stories.

OR is kind of like Vegas, what happens here stays here. In the stories of the workers who may or may not have been in the room. We are bound by HIPAA, our stories do not have identifying names, or addresses, or churches. But we know the facts, we just don’t share them.

And then there is me, who knows stories, and facts, and definitely does not share details. At all. When telling stories of the OR, I have to be careful to not reference anything that makes the patient or the doc or even the hospital recognizable. Broad strokes is what gets the story told, and details can be changed. Who cares if it was a right arm or a left? The person whose arm it was.

Keep on telling the stories but be careful of what details are shared and who is listening.

This month’s theme is If You Want Women to be in the 18th Century so Badly…

Yes, this is a direct response to the Supreme Court deciding that since women’s rights to bodily autonomy are not spelled out in the constitution, women are not entitled to any.

Am I still pissed about it?

Hell yes!

To that end I have decided this month’s Cookie Thursday is a Theme is going to be well, if you want women to be in the 18th century so badly… This is going to be an exploration of what cookies and things were created in the 18th century. I am inveterate researcher (this means I particularly enjoy research), and I am not afraid to use the skills.

This leads to the cookie of the week. Of course, I use the term cookie loosely. Cookie Thursday is a Thing is about experimentation after all.

French toast bread was ostensibly created in 1724 in Albany, New York by an innkeeper. Or so the legend goes. It was created by an innkeeper named French who forgot his possessive. You see the conflict. A recipe of the same type was discovered in a 1430 cookbook, named pain perdu, or forgotten bread.

1724, 1430, women were still considered second class citizens. To be chattel of someone else, meaning possession. I taught some of my coworkers this word last week when I used it in a sentence, “I am no man’s chattel!” And I am not, not even the property of the government. I am my own woman, despite what the Supreme Court has to say about it.

This recipe is the best use of stale bread, except for croutons, that I know.

I started by taking 10 pieces of brioche bread out of their bag and letting them sit in room temperature for a couple of hours. I then sliced them into small, bite size pieces and let them sit again.

I took 6 eggs out of the refrigerator and let them come to room temperature, combining the beaten eggs with 1/4 cup of milk and 2 tbs of sugar. I made the bites in two batches, adding cinnamon to the egg/milk/sugar mix.

I baked these in a 350-degree oven until crispy and took them tout suite (quickly) to the hospital where I dropped them off.

At the moment that healthcare is in, the tide is pushing travelers back to the hospital and to the units. I say tide because this has happened before, and the situation is cyclical. Just never on this scale. The hospitals are never going to recoup everyone that left during the covid craziness. Some people won’t come back because they have lost faith in the mission. And, after seeing that some sections of the public have branded the health and societal disaster that we all lived through as fake news, it is no wonder. Some healthcare workers found different jobs that they aspired to, and they are content. Some healthcare workers are still at home with their children because the childcare industry is going through its own seismic reverberations.

But hospitals need nurses and other healthcare workers. And so does the OR.

Welcome to this particular OR. Yeah, you’ve been through orientation, both from the hospital and the organization (because most hospitals belong to one). And you have gotten a tour of this OR and where things are.

Let me tell you where things really are.

Because the two, although related as this is the same space, are definitely worlds apart in actuality.

Get yourself a tour guide to the OR as it really is. This person can tell you where all the things really live, what to expect from different personalities that work there, what to expect from different personalities of the surgeons and physician assistants. Help you optimize the charting, help you set up the electronic health record so that it makes sense to you. Where to find all the hiding places that people use for themselves, and the clamps that are used in bed assembly.

Also, very important, tell you about the cliques that exist. Because this is still high school, despite all involved having been out of school and college graduated for years. And who is lazy and only wants to do their room’s work, never mind about the mountain of work that exists outside of the rooms.

And, as suggested by one of my coworkers, tell you where to poop during the shift. Because the bathroom is just stalls. Apparently, this is a thing that exists, and the knowledge may prove valuable.

And of utmost importance, who is a good sounding board to bounce ideas off of and who is a megaphone who will broadcast what is said in confidence to the entire department. And who is a vault, a black hole with empathy who won’t reveal what you told them but will offer support and guidance when needed.

And, in this particular OR, there is a chocolate locker where people bring chocolate in for everyone to share. Of course, it has a lock, some people weren’t donating to the locker but still helping themselves. This is the person with the combinations, they will give it to you with the understanding that sometimes you will kick in a bag of chocolates. The chocolates don’t have to be fancy; the OR will eat anything because the OR marches on its stomach. Also in the chocolate locker are over the counter medications; tylenol, ibuprofen, midol, naprosyn, migraine medications, aspirin, tums, lomitil, feminine products such as pads and tampons. And a Dammit Doll that you can use to vent frustration and anger on the walls and not use your fists.

Back to the clamps. You might think what if they put the clamps all in one place so that everyone can find them? Yeah, tried. People just like to have secret stashes.