I ran a poll in the OR lounge this week.

I wanted to give my teammates a choice.

Because I want to bake each theme of cookie.

I gave them the choice of literary cookie, that is cookies or described in books.

Or international cookies.

The poll was up all week.

And international had edged it out yesterday afternoon so I started making mental plans for international cookies.

And then, in a come from behind win, literary edged international out by 2 votes.

Who knew?

I scrapped my plans to make tiramisu cookies and started planning literary.

Sometimes that happens during surgery too.

The pre-op diagnosis that we all discuss and talk about during the pre-procedure time out proves to be wrong.

And that simple appendectomy for simple appendicitis turns into not appendicitis and a bigger colon resection.

In life, in the kitchen, in the OR, you have to learn how to roll with the punches.

To be nimble and not get your head caught up in the ‘this isn’t the way it was supposed to be’ trap.

Because Murphy lives in the OR.

And loves to fuck with OR people.

I’ll get to international cookie theme sometime or other.

Maybe in 2022.

The rest of the months of the year are planned already.

Or I could throw out the plans and do international.

Have to be nimble in this day and age.

Look, I get it.

We’re all tired.

Of the pandemic.

Of the variants that arise what seems like every other week.

Of the relentless news.

Of the masks.

Of the signs in grocery stores asking you to mask up.

Of the doom.

Of the gloom.

Of the 30% covid positive in the hospital.

Of the way there are no beds available.

Ever it feels like.

Of the 20+ inpatient holds in the ER.

Of the people living it up where the vaccination rate is higher,

Of the relentless bad news on the vaccine uptake front.

Of the lies.

Of the willful ignorance of some healthcare workers who will not, cannot, I ain’t gonna take the shot.

Of it all.

I get it.

We are all so very tired.

But this is not the time to let down our guard.

Children are getting sick because of the no-mask mandate rules in their states.

Children are dying.

Children not even born are dying inside their mothers, who have also died of covid.

This summer definitely feels like a step back toward last summer.

But that is no reason to engage in thoughtless behavior.

If I want to put up hearts that denote the vaccinated patients on the board, I will continue to do so.

Because other people remark on them.

Other people know how very far we have come.

Other people know how very far we have left to travel.

We have to stay the course not just for ourselves.

We have to stay the course for others who are ignorant, or afraid, or belligerent in the face of science.

We have to stay the course for them.

With my happy birthday dispatches post I set out goals for the year.

One of the big ones was applying for a grant.

AORN and Sigma have a grant application process specific for the OR.

I chose that one to get my feet wet in.

I read over the application form and thought about how to apply, how to get the information that they would need, how to get the paperwork in before the deadline of August 31, 2021 midnight.

You see, I had an opportunity to apply for a grant from AORN eChapter in July and I missed the deadline.

I was determined not to miss this one.

I gathered up all my information, put it in PDF form and sent it in.

I am not asking for much; just $400.

Enough to buy 2 more hand held metal detectors.

This project has had some massive delays.

Covid.

The ORAs, who will be involved, all quitting.

More Covid.

I finally feel like our ORA situation is stable.

In the timeline I had to fill out for the grant, I put education about the metal detecting to begin in September, with roll out in October.

The reviewers may feel this is a bit rushed.

And I may not get an answer before the end of the year.

That’s okay.

They don’t realize that this project has been on the back burner for nearly a year.

And other members of the research council keep asking me about outcomes.

I feel foolish that I don’t have an answer.

And that they have to stay tuned.

I really want this project to actually start.

Then I can turn my attention to the other items on the list.

I have to decide what to do next:

1. explore publication with AORN or another nursing journal
2. apply to PhD school, after I finish researching which ones I am interested in

Daylight’s burning on this year.

Have to get started.

No sooner had I clocked in today when I was stopped by a good ACU friend.

She asked, “Have you heard? About the new variant? We’re never getting to go back to normal.”

How do you reassure someone who is working so hard to keep people safe?

One of my favorite surgeons stopped by the desk to thank me for getting his case going so fast.

He also asked me about the new variant.

He said he and his wife had not been out to eat since January.

Of 2019.

They had gone out for an early Valentine’s Day dinner.

He and I spoke about the new variant.

And the New England Medical journal and the 800,000+ person study that had been done and reported on recently.

And we spoke of hope for the vaccine for children 5-12.

His child is more than 5, less than 12.

He and his wife are hopeful the vaccine for children will be released within 8 weeks.

October.

We smiled grimly at each other through our masks, our eyes hiding the same pain.

October.

What the post-it says, ‘day shift says can’t stay late.’

Dude!

I didn’t ask you.

And you have three hours left on your shift.

Do I expect you to work your entire shift?

Yep.

Nothing irritates me more that someone stopping the conversation I wasn’t even having with them.

I don’t want you to stay late.

That means I am not doing my job well.

That means I have not judged the board well enough to allow later cases to start on time, rather than pushing them out so that the OR can be down to the requisite 3 rooms at 1700.

Or 1 room at 1900.

Of course, since I am no longer making those decision until after 1700 due to the asinine new rule that the days shift charge makes ALL the assignments, talk to them.

Yes, I’m still a little salty over the entire situation.

Don’t worry, I will still be blamed for running rooms late.

As I have been looking at different doctoral tracks I have been thinking of how best to use the resulting degree.

A DNP would be useful if I had any desire to be a nurse practitioner.

Which I don’t.

There is a DNP on a leadership track.

Also, no go.

I have turned down opportunities to advance.

I have turned them all down.

A PhD in nursing is about research.

I love research.

I love seeing if the changes made have had any impact and what that impact is.

Call it straight research.

Or quality improvement project.

I love them all.

When the organization started talking about hiring a salaried night time call staff it got me to thinking.

1. can I do that job-there’s an entire decision tree I am working on with that one
2. what kind of impact would that have on the regular staff whose call is now limited (I can’t be the only call dog out there, can I?)
3. what kind of impact would that have on the staff who chose to take that role

I want to find out.

I reached out to our nurse scientist to ascertain if anyone was doing such a study.

She said no.

And gave me the green light.

Tomorrow I will look at all that entails.

I also have to think about making this a mixed method study.

With a qualitative and a quantitative arm.

I’ve never qualitative.

To the library.

Online of course as the biggest organization library is 65+ miles away.

But I have access online.

I have research to do.

Evenings IS magic.

Or, it has the potential to be so.

It all depends on how the stars align.

And which surgeons are on call.

And it takes a lot of mental energy.

Because I firmly believe that the OR can make certain things go well.

If you will it hard enough.

This is a skill that is hard to learn.

The day charge calls it my zen.

Not quite.

It is me exerting my energy and my stamina against the world.

If I believe that two rooms will be done by 1700, I have to believe it hard.

It is a little bit of faith, and a lot of experience.

And the ability to read the board.

And experience to know the most likely outcome of a case.

And how long it will take.

I’ve done this for 7 years as the evening charge nurse.

I’ve been a nurse for 20 years.

It doesn’t always work.

But when it works, it is magical.

Last week of No Heat August and I’ve not turned my oven on once this month.

It is hot here in the South.

And humid.

This cookie is one of the most requested cookie and easily the most nostalgic.

The fudgey cocoa no bake cookie.

Several of my department have declared to be their all time best, after the jalapeno chocolate chip cookie.

For me it invokes Summertime as a child.

It is a cookie that is frequently used or adapted for Cookie Thursday.

The first adaption, not used today, is to replace 1 cup of oatmeal with 1 cup of unsweetened coconut.

And its taste is evocative of an Almond Joy.

For this Thursday I wanted to do a throw-back.

And they also come very quickly together and take less than 15 minutes, excluding drying time.

And I have hit a rough call patch and I wanted to take a nap instead of baking for 3 hours.

630,000 is so close you can feel the singe.

Never mind.

I thought I should check my math again.

Not only is the US past 630,000.

It is nearly 1000 past.

At some point it ceases to be funny.

At some point it ceases to be sad.

We are at the point that it is pathetic.

Early, early on a morning, think 0200, I put in for a transport request for a patient who needed emergent surgery.

A patient who happened to be on the floor.

Next I picked the case, spread the case.

No patient.

Consents and other paperwork were pulled.

No patient.

The scrub tech arrived.

No patient.

I didn’t think there was that much competition for transport at 0200.

I was wrong.

I called the transport center.

The patient was 4th in line.

That’s not what the computer says, but whatever.

And the first in line, the transporter had been delayed on the floor by 20 minutes for an unknown reason.

I flattened my lips and interrupted the transport center to tell the to cancel the transport.

That I would be going up to get the patient myself.

I waved over the surgeon, who had peeked his head in to see if the patient had arrived.

Using short, pithy phrases I told him that he and I would be going to get the patient.

Because transport takes too long and the patient was 4th in line with an unknown 20 minute delay.

We went up to the floor to get the patient and brought them down to prep them.

So they could have the emergent surgery they needed to save their life.

The guiding principle of the evening shift is needs must.

This means if an action is needed, it will be done, within the boundaries of my license.

Not within the boundaries of my job description.