I am not sure what I expected when I went on vacation last week. Because it was the week of the 7th annual ice cream social that Cookie Thursday is a Thing hosts for back to school in August. This is a part of the no heat theme.

I had hoped that the department could pull it together without reminders from me.

Nope.

One of the other nurses said that although there were sign ups with the date clearly marked, people were confused about the date. And what to bring.

And it was rescheduled for today.

I mean, I get it. Cookie Thursday is a Thing is my creation. Of course the ice cream social would not go forward without my reminders, and prodding, and talking it up every day.

I’m not even mad at that.

I find that this is emblematic of the decrease in participation in ANYTHING. Especially as the pandemic drags on, and more diseases and disasters are popping up all the time. And people still don’t want to do the slightest thing to help another person.

On one hand, the entire department is burned out because of, well, everything going on in healthcare and in the world. This is why the department needs an ice cream social. This is the altruistic me having that though.

On the other hand, the entire department doesn’t want to do anything extra for anyone except themselves. And maybe their work besties.

As I was writing that I was struck that those two hands are part of the same whole. Life itself is a lot right now.

Even if it involves ice cream.

To look on the brighter side, I got to participate. Last night I made a no churn cinnamon flavored ice cream. I’ve made this before and traditional ice cream syrups go amazingly with it. Flavors like caramel and hot fudge, even at the same time, do wonderful things to the rather subtle flavor.

Hey, maybe next time I make it I can add Fireball Whiskey. That’ll liven up a depressed department and hospital that is full to bursting every damn day. The hospital being so full concerns me for fall and winter when there will be another congruence of the flu and covid. Sounds like great times, can’t wait.

Not that I would put out an alcoholic ice cream in an actual working department function, even if the amount of alcohol would be miniscule. But I think it would be a great addition to any party I go to.

To the kitchen!

A confused, 94 year old patient trying to get out of bed. We’ve all been there. Sometimes it is impossible to re-direct their energy and their determination to get out of bed. It happens. It certainly did in a Lexington, Kentucky hospital. I can understand the nurse’s frustration.

She reached out to the patient’s doctor, asking for something to help calm the patient down. The doctor said no. Did he explain the reasoning to this nurse? We have no way of knowing. I would hope so.

The nurse, unable to get an order for medication, took it upon herself to pull out the medication she wanted from a different patient’s supply. She then prepared a syringe and gave the patient the medication. That was intended for another patient. Without an order.

I’ll pause here why you pick up your jaw from the ground.

I was certainly taken aback when I heard of it.

This is operating outside her nursing scope of practice. And is a big NO-NO. And illegal as hell.

Oh, it gets worse.

Other nurses asked her what she was giving the patient via injection. They probably knew that the request for an order had been denied. Because nurses in that situation love to talk smack about what is going on. I can imagine that conversation ‘I asked for come calm down medication and the doctor said no. Can you believe him?’ They reported her.

Good for them. This is how the system is supposed to work.

And even worse.

The patient died!

Because of aspiration the patient suffered because they were fed under sedation. Which developed into aspiration pneumonia, which led to their death within the week. And having vital monitoring, including the pulse oximeter, turned off. The hospital was able to determine that the alarm parameters had been lowered, several times, before the unit was turned off.

Worst yet.

No rapid response was called when the patient started to de-sat because no one knew because of the monitoring equipment being disabled. I cannot fathom what was going through the nurse’s head. The patient suffered and nothing was done, except an amendment to the other patient’s chart that the ativan was not given, when it had been charted given at the time.

She has been charged with murder.

Why is this case different than that of RaDonda Vaught? Many reasons.

Because this nurse knowingly sought out and gave an unordered med. To give the patient ‘something special’ as she told her coworkers. Which was a sedative commonly used prior to surgery. She stepped out of the scope of practice lines, was unsatisfied with the no she received from the doctor, took medication from another patient, gave the unruly patient what she thought they needed. And the patient aspirated and died. And she tried to cover it up. Worlds apart from the swiss cheese mistake that RaDonda Vaught was involved in.

This nurse also has an immediate temporary suspension of her nursing license. I hope she loses it for good.

There are guardrails of the scope of practice for a reason! Stay in your lane, people!

Let’s not forget the real victim here. The patient who died, and the family who lost them.

I was ready to be outraged on the nurse’s behalf. Until I read more about it. It is so easy to blindly follow the mad.

Now I am outraged on the patient’s behalf. This was unconscionable.

I haven’t done a school update in awhile.

My school, that is.

After months of applications, and interviews, and prep work, starting day at university is finally here!

Well, not starting day. That was last week when I was finally in London celebrating my 2020 graduation with my MSN.

And not the first day on campus, that was 8/8/22 for PhD orientation.

And not the first day of my online class, that hasn’t happened yet.

After the first vacation we’ve had in three years. Because, you know, covid.

Jeeze, there’s been a lot of first days around here lately!

No, this is the first day of being a research assistant. I applied for this position right when I was accepted at the university. And I got a 10 hour position. This is one day a week, and in person. I will be leaving shortly to make the 70 minute drive to meet the doctor with whose research I will be assisting. I chose Mondays as my day to go up there. Because I have the least amount of meetings for the hospital on Mondays. I know, I know, still.

Do I know what it all entails? Nope. Stepping off into a chasm here.

Why I chose this? For the experience. I think it dovetails in my future future plans.

And I am unaccountably nervous. I mean, come on. It’s been two and a half years since I did anything like this. Look, ma, I’m in real clothes! It’s like I’m an adult or something.

I packed my lunch because I will have a lunch break. In a neat, brown paper bag. I don’t feel like I can leave the house yet, even if it is nearly time, because what if I get a case? This has happened before. I took a nap, just in case there was a surgery overnight. And then I went to bed a bit early just so I could get up early and I was, frankly, driving myself crazy with nerves.

I have an awesome new school bag. I am wearing mostly adult clothes. I have an emotional support animal in my car. This is a stuffed hedgehog, he lives there now. No, he doesn’t have a name, I’m not a child. I have a pin that says socially awkward that I will wear because I want people to be aware. Not that we are not all socially awkward in this after covid lockdown world.

I have to be at the university at 0800. I know I’m cutting it a bit close by leaving at 0630, but I have to be within 30 minutes in case I get called in. Yes, the OR starts at 0630, but the end of my shift is 0700.

Time to grab my lunch and my bag.

Let’s get started.

The gown card reads, ‘Being in charge is just like being the oldest: set an example, don’t pick on your younger sibling, watching as the baby gets all the support.’

Looking at the note I would add dealing with all the shit because parents (management) isn’t around. And having to deal with tattle tales that didn’t get their way (request) and so they went straight to parent (management) to lie.

And you, as the charge nurse and the older sibling surrogate, being told that the parent (management) is disappointed in you.

Any one else get a shiver of recognition?

No?

Just me?

Do you not have siblings?

It is important as the charge nurse to set an example for the rest of the staff. In some places that includes following all the policies, and not complaining that they don’t make sense, even if they don’t. And believing in the company line. At all costs. Following the dress code, when it would be more weather appropriate to wear lighter clothing. There are many things that a charge nurse has to do to set an example.

My favorite part of the gown card is don’t pick on your younger sibling. This is absolutely true. It’s not fair to pick on someone who doesn’t know as much as you do. But I will absolutely tell a toddler don’t touch that because its hot and you’ll get hurt. I will also tell a coworker don’t flash that, the patient might get hurt. Shades of distinction, maybe. But both are truth. To be in charge you have to protect the patient. No matter what the doctor or the staff is demanding.

I’ve written about tattle tales in other posts. Just know that they are out there and will tell on you in a hot minute if they don’t get their way. This may lead to you being told to play nice, and let the baby have its bottle. While you don’t get to tell your side of the story, about the lead in the pain in the milk. (yeah, stretching that simile rather far)

But management not having your back in disputes, that undermines the charge’s authority to run a safe, productive OR. And that can lead to unsafe situations. But what do we know? We’re just charge, not management. We just love being told that at my last hospital, this is how it ran. Well, why did you leave your last hospital? This will be a later post.

What I’m going to write about next is watching the baby get all the support. Because, like it or not, sometimes all nurses and techs need support. It is damaging to existing staff to watch the new kids get all the attention and new toys. While we work without complaint, and having worked through exactly that the new ones are complaining about for years.

Sometimes because I told you so is a valid response.

But, maybe, stop damaging what little authority we have? Pretty please with sugar on top?

Jane Austen opened Pride and Prejudice with the lines “It is a truth universally acknowledged, that a single man in possession of a good fortune, must be in want of a wife.” She wrote these much adapted words in 1813. In Regency England, this meant that mothers wanted to marry off their daughters to a good match. Whether or not they loved each other was beside the point. Man with money, girl who needed to get married as she had no prospects alone, having no rights= match made in Mama’s head and in the ton.

It is much the same with hospitals and restaurants. I’ve never met a hospital that wasn’t surrounded by places for food. Nowhere; San Francisco, Sonoma, Sacramento, VA in Martinez, CA, Denver, CO, and the two hospitals that I have worked in here in the South, and several of their sister hospitals. All are surrounded by restaurants and with the expansion of food for delivery, the circle is getting wider.

Patient’s families have to eat. Especially if it is in the middle of the night and they are trying not to be frightened.

Hospital employees have to eat. Especially if it is in the middle of the night and they are trying to stay awake.

I have likened the OR as a battlefield. This just broadens the metaphor. Soldiers need to eat, entire wars have been lost because of supply line disruptions. The supply line is disrupted, the soldiers run out of bullets, but more importantly they run out of food.

Hospital administration knows this. It is why every opportunity for celebration in the hospital is met with food. It is also why Cookie Thursday is a Thing exists, not the sole reason but a big part of it.

Music hath charms to soothe the savage breast, said William Congreve in the 17th century. The quote has been bastardized to music tames the savage beast. Same difference. But food keeps the soldiers happy.

And a well timed cookie makes the surgeon calmer.

No cookies today. As I am currently miles, and miles from home. 3977 to be exact. I thought it was farther, seems farther.

I will definitely be having a cookie today, in honor of Cookie Thursday is a Thing.

Traditionally, on the Thursday closest to the start of school, I throw an ice cream social with the assistance of the department. Some people bring ice cream, others toppings, others bowls and spoons. There is enough slots on the sign up for everyone who wants to participate.

But I cannot direct that so far from home. I hope the signs got put up last week when I sent them to the administrative assistant for the OR. I hope that people decided to participate when I was not there to direct things.

I worry about that, you know. About getting people to participate in things when I am not there everyday to remind people.

The idea of the department ice cream social is to celebrate the start of school. The hospital is smack dab in the middle of 1, 2, 3, 4, 5 counties. And they all have their own school calendars and the start of school is staggered.

I know that some schools have started, and I know that some schools start next week. This week is the middle ground.

The start of school was always my favorite. I know there are some kids who enjoy it too.

And definitely some parents.

There is a covid memorial wall in London, along the south bank of the Thames, facing Parliament and Big Ben. Fittingly, it is right outside of St. Thomas Hospital, where the Florence Nightingale Museum is.

This was a top item on my to-do list in London.

And it took us two different tube lines to get here.

Originally we were going to take the Central line to the Jubilee line. But there was a fire at Southwark and the Jubilee line was closed. We had to reroute and take a different line. But the beauty of the Tube system is that there is always more than 1 way to get somewhere.

My husband was not sure that this was somewhere we had to go. His exact words were “I don’t want to go to a memorial to people whose genetics failed them.”

Um, no.

I quickly disabused him of that notion. These were people who had died of covid in the UK. This was through no fault of their own. Blame should not be assigned for their deaths. The UK was locked hard and fast. And their rules were more stringent than the US.

I felt it important to go to the covid wall and bear witness as a nurse who has lived and worked through it.

There are pink and red hearts all along the wall and people are invited to write in them. Many people wrote names of loved ones who died. There were 150,000 hearts originally. As of today, 8/17/22, the death toll of the UK is 186,798.

So many hearts.

The wall extends over 500 meters, or over a third of a mile. And was begun in March 2021.

It was awe inspiring. This is not an authorized memorial. This was campaigned for and done by the group ‘Led by Donkeys’.

I hope that the incoming Prime Minister, when one is chosen, will allow this memorial wall to stay.

It was peaceful. Facing the water. People coming up and reading the hearts. The only thing that I can compare it to is the Vietnam Memorial in Washington D.C. For reference, there were 57,939 inscribed on that wall at the time it was dedicated.

The covid wall was sobering. All those lives lost. All those families changed forever.

It was defeating. It feels as if we could have done better.

Of course, I passed an anti-vaxxer protesting in Whitehall on the way to the covid wall.

How are we going to explain this to future generations?

What will be the final memorial? Not just here in the UK, but in the US, and around the world as well.

Medicine-speak is impossible to understand if you don’t know.

And medical-type people can say an entire paragraph comprised completely in letters, vowels and consonants both. It is shorthand that brings all other medical-type people up to speed about a patient in less than 15 seconds.

It is kind of like Twin Speak that twins sometimes develop among themselves when they don’t want adults or other kids to know what they are saying. But more special because there are many many twins.

There can be different dialects, and different accents of sorts. The letters can be tinged by the type of medical-type person is speaking it. Because there are infinite combinations of medical-type people.

We can talk among ourselves, but it important to be able to speak to the non-medical type people. Common language is hard to come by in the medical profession. I can talk to another medical-type person and come to a complete understanding.

But non-medical type people don’t have the common language that most medical-type people do. And they are the ones that need to understand. And medicine people and lay people (those who are not medical) need a familiar language.

We need to slow down the language and allow non-medical type people to understand. And if they can’t, we need to come up with better words for what is happening.

I say this, as a representative of the medical-type people, tell us when you don’t understand and we can find the words together. Some of the concepts will be hard. There isn’t a guaranteed happy ending. Sometimes medicine and operations fail. I recognize it is so hard for patients and families to understand situations that we in the medical field have been training for for years, sometimes decades.

And it is hard on us too.

It is very hard to go to a family member and say that everything has been done. Families will tell you that their person is strong and a fighter. Absolutely, they are. But they are fighting against something that may not be winnable. With all of our technology, with all of our medical words, sometimes we don’t win. And it is hard to convey to families, and to ourselves, that sometimes the worse happens.

Believe me when I say that every death, and every set back, hurts. I just don’t have the words to convey it to you.

A common language will help us all.

Who wants language lessons?

The post-it says, ‘I LOVE teaching myself something new. New things learned- manipulating the snapboard to add new rooms and where patient education is at.’

I’ve been involved in the electronic health record since its inception at our hospital system. I a SME, or subject matter expert and I had input into parts of the build. I have been a Superuser for the surgeons since, able to answer their questions. I have been a Superuser for the staff since, able to help them optimize the program for their use.

I have been learning all the time. Especially when updates for the build comes out quarterly. I’m on the committee that reviews new parts of the build and I have input here as well. This group meets twice a month. This information learned here is taken to my department, and shared in the other committees that I am on.

Benjamin Franklin said it best “Tell me and I forget, teach me and I may remember, involve me and I learn.” Being involved definitely increase my learning. And when I teach others, I don’t do it for them, I explain the process, and have them perform the function under supervision.

The things that I learned that week that energized me? There are two new rooms for the OR; an operating room and a procedure room. The snapboard is a visual representation of the schedule for the OR. When we started there was 4 rooms on the snapboard. This is not the OR at a glance like I required for being evening charge. I added the c-section suite, and endoscopy rooms and this enabled me to keep track of where the CRNA may be. This also helped with creating addons. There is nothing more embarrassing then accepting an add on and, when the snapboard is opened, it is apparent that there is an endo or a section at the very time that you gave the surgeon and you have to call the surgeon back and tell them another time.

My snapboard currently has 6 ORs, 4 ENDOs, 2 C-section suites, and 4 ASC rooms. The two rooms that needed to be added are smack in the middle of all the rooms. Before I would have to reverse add the rooms, starting at the bottom of the now 17 room list. This was obnoxious. This time I decided to try something new. I highlighted OR 6 and clicked the add button on the right. Before the new room would be added at the end of all of the room. Because I told the program that I wanted the room added after OR 6, it added a blank room after OR 6. I added another room as well as there are 2 new rooms. And then I named them OR 7 and Procedure Room 8. And it worked. After I went to all the other nurses in the department and helped them add OR 7 and Procedure Room 8.

Is this new information? Maybe. Did it help me and all the nurses I helped add. Absolutely.

And to cap it off, I explored the pre-op tab while I was functioning as the 2nd PACU nurse. The OR has been missing a metric around pre-op patient education about foley catheter insertion. The nurse who runs our reports and I have been looking for an answer. This is the obnoxious part of the electronic health record; you must have the exact place to document an intervention. And I found it. Now to teach all the other nurses.

Because if you are not learning, you are dying. This is a paraphrase of a a quote by Robert T. Kiyosaki in which he said “The moment you stop learning, you’re dying.”

I completely agree. This is how we are different from automatons. We have to keep learning to live.

I am on vacation.

The same vacation we planned and paid for in 2020.

You know, the one that was my present for finishing my MSN. Yeah, that one.

And then a pandemic came and washed it all away.

And it was planned again. In September 2021. Uh, oh. Delta variant.

And planned again. In December 2021. Uh, oh, Omicron variant..

Well hell.

Planned for the 4th and final time as the time limits were running out. But there are still people dying! And cases are still surging due to BA.5. Universe says go now or lose the $15,000. Well, when you put it that way.

And to make it EXTRA difficult, school will start just as you are leaving. And you have to explain to the instructors why you are not in class.

But, at least you are in London.

Yeah, during the second heat wave of the summer. It is 95 degrees Fahrenheit today. It will get better on Monday, with temperatures in the high 70s. It can always be worse.

Go out in the beginning of the day and go back to the flat at noon before it gets too hot. And go out later, after 1800 when the sun begins to think about setting.

Greetings from vacation. Where it is just as hot here as at home, without air conditioning. Ah, well, vacation is meant to be an adventure.