Covid is not gone.

Despite what politicians will tell you.

Despite what the man on the street will tell you.

Despite what your cousin’s mother’s auntie’s next door neighbor will tell you.

People are still dying. No one is writing it down. No one is keeping track of current infections. No one cares!

I get it.

A giant, broadway in lights covid is over… in neon.

Yeah, keep telling yourself that.

I get it.

It has been a long, hard two years. Because it has been over 2 years of this nonsense. Healthcare is tired. Nurses are tired. I am tired.

But wishful thinking doesn’t make it so.

And don’t wear a mask on an airplane if you don’t want to.

The air is only circulated with every exhalation for however many hours you are on the plane. But what if?

I will be continuing mask wearing when I see fit. No matter what people may say.

You think I care about what people say?

Or think?

Or talk about the crazy behind my back?

Don’t know me very well do you?

I don’t wear a mask for myself.

I wear it to protect others. And those people who cannot be vaccinated. Or the people whose vaccinations didn’t work. Or are too young for vaccination. This is who I chose to protect.

You do you.

I’ll be over here wearing a mask to protect others.

No matter who is against it. Because it is the right thing to do.

Can’t argue with the right thing to do. And if I get to fly to London in August. I will be wearing a mask during the flight.

Let us be honest. Sometimes a surgical case is not our cup of tea. Heck, the entire service is not our cup of tea. Every nurse I know has a case or body function they HATE.

Despise.

Abhor.

Nails on chalkboard would be more soothing.

Please don’t make me go in there; I’ll do anything.

For the most part this can be accommodated. Kind of. If you have the staff.

And the case aversion can be as varied as the human body. This nurse hates teeth. This tech hates feet. My own mother hates vomit, explains a lot about my childhood.

Me? I can’t stand phlegm. Lung butter. Ew. This has roots in training. My patient had a full beard, a raging upper respiratory infection, and green noxious phlegm everywhere. And the patient, not sound of mind, reveled in it. Makes my skin crawl just writing about it. Nightmares tonight.

Do you want to know WHY I did not pursue a CRNA, which means certified RN of anesthesia? For this alone.

Case aversions exist.

However, the body part/function in question is attached to a patient. Someone who needs our help. And we soldier on. This is what we are best at.

Through something we hate, despise, abhor, makes us want to run and hide.

Because someone needs us.

I have and I will continue to care for patients who exhibit my case aversion.

But I will wear gloves.

The post-it reads ‘don’t be married to the plans.’

This is something that the OR does particularly well. Plans change. Diagnoses change. Patient anatomy is not clear cut and pretty like it is in text books.

There can be a tentative plan. A structure in place, a general idea of how something will go. An over all plan.

Beware that overall plans can change. And do.

A does not lead to B cleanly. Sometimes there is a needed jaunt to Z. Don’t be surprised by it. Be flexible in plan changes.

You might surprise yourself.

This is hard lesson in nursing. Despite all of our preparations, plans can change.

And have contingency ideas in the back of your head for how this is going to go. For example, the anatomy is plain weird and there is no safe way to finish the planned procedure. E.g. a lap appy.

Okay. You will need larger sponges, even maybe some appy tapes (long, thin sponges that are x-ray detectable), different suture, and a few instruments.

I guess the lesson for today is not to be married to the plans, but have an alternate in mind for when the plan changes.

The what has become the yearly screed against Home Owners Associations and the associations that tell me how to live my house.

Last year they sent an email to everyone reminding us to make our houses pretty for the inspectors.

Yawn.

There would be inspectors to look at the houses, like they don’t weekly.

And send out nasty letters reminding you to put away the trash can that had been left out for 4 seconds while you opened the garage door. Or mow the lawn that was 1 inch longer than agreed.

Who agreed and who has a ruler?

Everyone I have spoken to gets these letters. And we pay them. Living in the South, where they are prevalent, is so much fun. They love to judge the other down here.

We did the yearly mop up of the front beds. And, as I do every other year, I ran into something. Not poison ivy, not poison oak, poison sumac I think. And instead of suffering the itch in silence, like I usually do, this year I reported to my doctor. With pictures.

And got put on a Prednisone dose pack.

I don’t recall having a taper pack before. It stinks. It chalky, and tastes bad and is generally not much fun. It makes my legs ache. Fun. The cream that they gave me for the rash does much better. I think I will ask for lesser guns next time.

Now that I have three days left of the taper I have thoughts. Is this more symptom management? I’ve gotten through before. Is this something better left in the doctor’s quiver? And could this post be more 1st world problem if I tried?

Time to think of the positives.

I have shelter. I have a house. One that even has new siding, that I paid for with the money we had saved up for two years by not going out or vacationing. To the dismay of my in-laws.

I have my health. I have a short term rash and itches. So many people have it worse.

I have food. Although there is inflation I am careful with our money so it is not impactful on us. I have water. I am thinking of starting a summer vegetable garden. You know, now that I have time.

Covid is doing what covid does. It waxes and wanes and people die. Or have long term side effects. But I, for the grace of vaccination and booster, masks and social distancing, have not gotten it (knock on wood).

On measure I am doing pretty good. I think I will give myself a break and go read.

And spread out the 10 cubic feet of mulch for the front beds. I don’t want a letter. Although I did pick up glow in the dark spray paint for some of my cement animals in the front that need a touch up. I’m still me after all.

Coconut month continues.

Why coconut month?

Because I have a ton of coconut in my baking pantry.

And lots of recipes.

And coconut flour that I don’t care for that I will gladly feed to other people.

For this week, I used the basic fudgy cocoa no bake recipe of 1 stick of butter, 2 c sugar, 1/3 c of cocoa, 1/2 c milk, 3/4 crunchy peanut butter, 3 c of oatmeal. I had plans of using 1 1/2 c coconut and 1 1/2 c oatmeal.

But horrors! No crunchy peanut butter. There are 2 of us in this house and I’m the only one who eats it. Curious.

I did have a multiple nut butter in the pantry. One of those hmm, I wonder how this tastes. And it languished. Not crunchy though. It is a blend of Brazilian nuts, hazelnuts, almonds. All the nuts.

I used that instead of crunchy peanut butter. And 2 cups coconut, 1 cup quick cook oatmeal.

The cookies were softer than usual but still tasted amazing.

I was expecting a stronger coconut flavor.

To the baking pantry!

On nursing side this week, yet another nurse was charged for stopping a med error before it reached the patient. In their mind this is elder abuse. In my mind this is getting scary.

Because we don’t always get the effect that we want from treatment. People get sicker. People die.

It is not the nurse’s fault.

Today was our monthly shared governance meeting for the hospital.

And it was in person!

You think I would be leery of in person after the AORN cluster that did not infect me. Because I was wearing a mask.

But I’m trying. Okay?

There were only 4 of us at the meeting, properly spaced out. Three more were on the phone. And one of the 4 was several people dropping in and saying their piece and leaving. And staying 6 feet away from the rest of us.

Sort of a zoom hybrid.

With snacks.

Will do lots for free breakfast apparently.

I wore a mask into the hospital. And took it off in the conference room, after the door was shut. And also masked up for the restroom and to walk to my car.

I have much to do regarding shared governance.

The corporation is realizing that this pandemic has been very hard on staff and many of our staff have left. For travelling, or other reasons. There will now be conversations about what we all know has happened.

The infection rate is stable and low where I live. Hospitalizations are less than 7 patients per day, with several days (6) in the last month that had zero patients.

I hope this continues.

I live in a high vaccinated area. Next to a low vaccinated area and I will leave my mask on for the foreseeable future when I go out. Grocery store, Target, the bookstore, and the library are always on my radar.

Give me funny looks when I go about masked.;

Don’t care.

But not among people who are socially distanced and vaccinated.

I thoroughly enjoyed by cinnamon Danish and fruit. And the free water.

I was driving home when there was a librarian on the radio, the head of the School Librarian Society, and she was talking about the rush to ban books. And its logical, in some people’s minds, legislation in some states.

Have y’all lost your minds? I mean, what the actual fuck?

This has been weighing heavy on my mind in the last few months. This absolutely is about censorship.

This is about a very vocal, very minority deciding what ALL the kids need to read.

Or not read, as the case may be.

For some of live an all censorship is bad.

Regardless of content.

They are saying that they can only be the parent.

Of ALL children.

And the child that needs to learn about kids that think like them, act like them, have questions like them are not to be thought of, or talked about.

It is in the conversation that these books spark that we are telling these children about the wider world. And there is more in the world than is dreamt of your philosophy, Horatio.

Yes, a bastardization of Hamlet by Shakespeare.

Uncomfortable as that may be for some parents.

Think about what this is doing to your children. Putting your head in the sand like an ostrich is not helping. Also not helping is stopping up your ears and saying na, na, I can’t hear you.

And administrations and politicians are pandering to this very vocal, very minority. Because it is easier to listen to the loud voices who are demanding that we return to when they had the power and, by God, won’t someone listen to the white man?!

Don’t tell me that I do not have a dog in this fight because I am not a parent. Some of you are thinking of it.

I just don’t understand, you are thinking.

Because I don’t have children.

No, I don’t. But we have had many conversations about how we would raise a child, if we had one. And censorship is not on the table. Not for my hypothetical child, and not for another other child.

My favorite quote from that interview was when the librarian said that it is the parent’s prerogative to decide what their child could read. It only slips into censorship when the parent says that ALL children cannot read this book.

You know what else shows nudity, adult situations?

Core curriculum books of nursing school, medical school, dictionaries, encyclopedias.

Are they to be next?

The information contained there may be disturbing for some readers.

Yep.

It should also begin a conversation about why you think it is disturbing and why your children should not be exposed to it.

Because it makes YOU feel squicky?

My parents never monitored what I read, in my memory. If I read something disturbing I could take it to them and this would start a conversation.

But no one ever took a book out of my hands because someone deemed it not for me.

I would like to see them try.

The post-it reads “running to HR every time you are given feedback.”

And this doesn’t have to be feedback about your job performance, a la the yearly performance review. Although I have heard of it happening then too.

This is gentle correction of a dangerous situation.

Let us pretend the patient, who is on the table, is left unattended.

This is a recipe for disaster. A patient and a CRNA should never be left unattended. At the beginning of the case, at the end of the case, those are the times when it is crucial that at least three people are in the room. The CRNA, the patient, and the scrub tech. Or the circulating nurse. Never just the CRNA and the patient.

What if there is an emergency with the patient that the CRNA has to attend to? There is no one else in the room to summon help. A third person needs to be in the room at all times. The circulator needs a last minute supply that the surgeon has asked, again at the last moment. He wanders off to scrub his hands. The scrub tech also has to leave the room to answer nature’s call before being chained to the table for the duration. And the anesthesiologist, although notified that the patient is in the room, has not yet made an appearance.

This is an unwritten rule. Especially on the evening or night shift when there is only the team in the room. And emergencies do happen.

It happened in this instance. Again, the set-up is the CRNA is attaching leads and other things, the anesthesiologist has not yet made an appearance, the scrub tech needs to go the bathroom. But the circulator is getting a last minute requested supply.

The patient starts to de-sat, or has an allergic reaction to the pre-med. The what does not matter for this story. What matters is the CRNA has been alone with a patient in extremis.

After the patient has been stabilized and the surgery performed, both the circulator and scrub tech get a coaching about not leaving the CRNA alone with the patient. One of them goes to HR because they feel that the coaching was unwarranted. The other makes a mental note to never do that again. For the example set either role can be filled by either team member.

The point is that instead of internalizing the issue, and seeing the problem that could have arisen, one of the two went to HR because they were corrected. Do you see the problem?

This not the first time this team member has been corrected. And not the first time to HR. Too often what should have happened, the delaying of the quick bathroom trip because the circulator was out of the room, was not. Communication tools might have helped here to. The scrub tech could have told the circulator that they would get the item, whatever it was, on the way back from the bathroom. Instead of deciding to go at the same time, knowing that the circulator was not in the room.

Two take homes today.

1) be aware of why the other team member has to leave the room

2) don’t go to HR for every little thing

We are nearly to the next very exciting surge here in the US.

The covid roller coaster is climbing the next hill.

The covid roller coaster is ticking our way up to the next surge.

Tick.

Tick.

The roller coaster car seems to lose momentum as we near the crest to the next free fall and the coaster car is overcoming gravity more slowly. But it will overcome the pull of gravity and send us careening over the top. Some of us acting all cool like it is no big deal, some of us hanging on for dear life, some of us working to protect others who can’t or won’t protect themselves.

Is that not the pandemic in a nutshell?

Will this surge and this variant be the one that tip over the usefulness of the vaccines?

Is this where the virus has learned enough to overcome the vaccines?

And take us all the way back to pandemic square one?

Well, to be fair we learned a tremendous amount about this particular virus; how it is passed, how infectious each subsequent wave is.

Okay, not back to pandemic square one.

But it the virus learns how to circumvent the vaccines… Definitely back to square 3, before the vaccines.

Look, people cry out, look at the declining number of cases. The declining number of dead.

Yeah.

That ceased to be of consequence when states decided to pull back on reporting every day. Some still report every day, some weekly, a few monthly. All this does is decrease the usefulness of the data. And, don’t you know, there is more shiny things to think about and to react to.

Tick.

Tick.

Tick.

The theme for April is coconut cookies. Why? I have four coconut cookie recipes. Why else?

Coconut does not get enough love. Especially in a cookie.

I was going to kick off April Cookie Thursday is a Thing with washboard cookies. I had never heard of these cookies. They are a shortbread, with coconut milk replacing some of the butter, too much flour, at least in the recipe I am using. And a frosting, which I hate, with coconut “bubbles”. The cookie is meant to be striated, like a washboard.

I had my doubts for this cookie, based solely on the amount of flour in the recipe. I’ve been doing weekly cookies for a LONG time now and I know when the proportions are off. The results are edible but bland. Freshly baked but oddly stale tasting.

There is a new grocery store near the hospital. Time to see if there is a bought coconut cookie to be had. Because I am not sure I can serve up the cookies I made.

Nurses don’t get enough love. Especially in court these days.

The backlash against nursing has begun. I wish I wasn’t right about this.