Can’t sleep again.

It hasn’t been this bad since last spring.

Case in point, last night I got to bed around 0113.

I woke up from a very strange dream at 0420.

The dream was so strange I had to get up and note down the details.

Because writer, you know.

I got back in bed at about 0440.

And slept until the pager went off at 0700.

I go off of call at 0700.

I texted the day nurse about the page and went back to sleep until 0715 when she texted me back.

Whelp.

That’s another night’s sleep ruined.

According to my sleep log that I keep, because data is power, I haven’t had any night’s sleep over 5.5-6 hours in about two weeks.

All I want to do is sleep.

Pager, be good.

Please.

Last week I got an email that the poster I had submitted to AORN this year was accepted.

I had two accepted last year.

And then COVID.

This year I knocked together a proposal for the long-term flashing project that I have been running in the OR.

Long-term meaning 6+ years.

Flashing is the immediate use steam sterilization of instruments or implants.

This usually means that something has dropped to the floor, or there is a to follow case, but more than likely it has hit the floor.

Flashing is bad.

It has taken 6-plus years to get a 12 month span with no flashing.

Many things had to happen in order for this to be successful.

In 2014, there were at least 25 flashes in the OR.

in 2020, there was 1.

In January.

Fingers crossed, spit, knock on wood, whatever you have to do.

The poster proposal was titled Flash this! How 1 OR systematically decreased IUSS to near 0.

I am going to keep it at near 0.

For the Murphy.

Because Murphy loves the OR.

Best laid plans and all that.

Whatever can go wrong will.

This poster got accepted.

Yay!

I have to design, get it printed and submitted for judging by July 12th.

And go to Orlando in August to the AORN conference.

I’m gonna melt!

Another thing I was kicking around as a better use of my MSN is establishing a writing career.

As a side gig.

I am reading and writing and learning about this.

I was thinking the AORN conference might be an opportunity to connect with other writers.

And one of the best ways for that used to be the business card.

I designed a card and submitted it for printing.

Double sided:

1. the one side is my real name with credentials and email address against a light OR green background
2. the other side is this blog, with my nom de plum, email address, and blog address, with a blog caption at the bottom. The background is clouds. whatever

Regardless, I ordered them to have with me at the conference.

Will it work?

Who knows.

But I will be ready.

I was going to search for the perfect post-it note to encapsulate the entire experience of evening shift.

But then there was a stack of post-its and gown cards next to the computer and I picked the first one off the top.

At the top of the post-it are the words “don’t ask to be celebrated for doing your job”.

And this is very, very true.

Sometimes people come up to me and tell me this is their 5th call shift in a week.

And I pause and reflect and absolutely do not say the first thing that comes in my head.

Which would be “Child, please, I routinely do 9 a week, every weeknight and both weekend days”.

But I don’t.

That would be counterproductive.

So I don’t say the second thing that comes in my head.

Which would be “But you are the one who signed yourself up for this”.

Again, that would garner nothing but a huff from the person “confessing” to me.

And a talking to by management.

And I prefer to avoid those.

I usually say “Good for you. I bet the people you took call from are thankful”.

Don’t complain when you give yourself extra work and then have to work extra.

That is, in fact, how call functions.

This week was the last Cookie Thursday is a Thing for May.

10 days ago I began a starter for sourdough.

I’ve made these before.

Then: they were cakey and dense and overall one of my favorite cookies.

Now: The day was very warm so I decided to bring the butter up to room temperature in the sun, on the porch, in my favorite Pyrex bowl.

Coming back inside, I took 1 egg out of the refrigerator and placed it to the side so it, too, could come to room temperature.

I gathered the rest of the ingredients and went to get the now softened butter.

The butter on the porch worked BEAUTIFULLY.

I proceeded to make the cookies and had the first batch out of the oven when I turned around and noticed that I had not put the egg that I’d carefully placed out of harm’s way into the batter.

I have no excuse.

Other that I am tired.

Surprisingly the cookies baked up great.

I was afraid that the cookies would not be cohesive because the egg is a binder.

Nope.

Now I have a starter that I will continue to nurture and use the discards off every other day.

At least until I get tired of it.

But the softening the butter on the porch in the sun.

Definitely going to keep that one.

I have decided the word stupid as a descriptor is, well, stupid.

It doesn’t sound right.

And my managers are no longer listening when I say something is stupid.

See the new day shift “charge” layer that overlaps with my shift by 2 hours.

But that is a story for another day.

I am transitioning to using the word silly instead.

And it means the same as when I use the word stupid.

It means the idea is laughable.

It means the idea is absurd.

In fact if the word silly doesn’t make my point, I will start to use the word absurd.

Yes, I know it is only Tuesday but I had an idea.

I love post-it notes.

Love them.

I stick them on the back of my badge to make myself notes.

Sometimes it is a post idea.

Sometimes it is add on information.

Sometimes it is both.

I have easily a box full of these.

Because I am incapable of throwing away paper.

I’m going to start addressing the post ideas on the back of the post-it notes.

Ha, do you see what I did there?

I think Sunday would be a good day to start.

I will have to find a real juicy one to start with.

Why do I do this to myself?

A surgeon paged me last night with a request.

He wanted to go at 0700.

I told him I was told that I could no longer give out 0700 time slots, even if there is nothing in that room until later.

He asked for 0630.

I said yes.

I am going to go to work, clock in as call back, pick the case, open the case, get the patient, prep the patient, call the anesthesia team, think about calling the scrub tech, realize that someone will be here at 0600, probably the scrub tech on call.

Start the case.

Be relieved.

Come back home and go back to bed.

I will probably be asked about why I let this happen.

I will tell them I think their rules for not adding on early morning cases are silly and a surgeon disatisfier.

In March the hospital leadership were casting around for socially distanced ideas for nurse’s week/hospital week.

Curses on whoever decided those weeks should overlap.

I had heard about a covid pinata at an educational seminar and found the idea hilarious.

I brought that up to the meeting.

And the OR administration assistant was riffing ideas with us and together we came up with beating up a derelict car.

This was also hilarious.

But there were a LOT of hurdles to overcome.

The hospital had to find the car.

Had to get permission from the corporation.

Had to get an insurance rider.

Had to assemble the implements of mass destruction.

Had to make the car safe for destruction.

Had to arrange for delivery of the de-fluided/de-engined/de-glassed car to the hospital.

The stars aligned and it all happened.

We had TWO covid pinatas.

We had one car that we got to beat up on.

We had to arrange a five hour time during hospital week to beat up on the car, so that all who wanted to could beat up on the car.

IT WAS AMAZING!

Very cathartic.

Implements of destruction included the three different sizes of sledge hammers, two aluminum bats, one wooden bat, a crowbar, a crowhammer, and an bed IV pole that had been bent out of usefulness.

Participants got to choose their weapon.

I used the medium sized sledge hammer and took several might thwacks to the poor beat up car.

Someone had attached covid decals to the paint job: some sneering, some with an expression of horror.

I wanted a piece of the car to take home and frame but I did not get my wish.

I have pictures though.

As I was parking, I had a thought.

Some people hadn’t wanted to beat up on the car because they didn’t want to get hurt.

Water balloons would have been wonderful.

I wonder if we can incorporate them into next year?

This is the third week of the chocolate chip cookie month.

This is by far the most requested cookie of all the cookie Thursdays.

The OG jalapeno chocolate chip cookie.

Apparently making last week’s cookie made a doc forget about his “no sugar” month.

And this week was his favorite.

Oops.

I also started the sour dough for next week’s cookie.

Apparently I need to start to use the extra starter that I’m supposed to throw out.

I am collecting recipes.

Here we go again.

Last night, while some of the staff were writing the board (yes, this is a daily task) an emergency case came in.

There are very few true emergencies.

Bleeding.

Blocked ureters leading to urosepsis.

Fournier’s gangrene (if you’ve smelt it you know).

Compartment syndrome.

Volvulus of all sorts that are threatening the integrity of the bowel.

All of these cases are life threatening.

Last night’s was the volvulus.

It is 1810, people are starting to think about going home.

One of the CRNAs certainly was.

Dr. C called about a cecal volvulus, a true emergency.

I had a case due to come off the table in 45 minutes.

And a spare team.

And what I thought was a spare CRNA.

I stopped the CRNA on their way out the door and told them there was an emergency and I would need them to stay and start said emergency while the charge CRNA was finishing up the case.

They went to the room and asked how much longer that first case was going to take and then proceeded to come tell me they would be off the table in 30 minutes (lie) and they were going home.

I could not stop them.

eye roll and a heavy sigh (internal, of course)

Next I turned to the two staff members at the desk and asked them to please pick the case that had just been added on.

The case card was on the printer.

I turned back to the phone and called the pre-op and told them there would be an incoming case and they needed to be prepped with all due haste.

I went back to scheduling the case.

The staff I had asked to pick the case said they needed a preference card, because the one that had printed was blank.

I stared dumbfounded at them and repeated “You need a card to pick an ex lap?”

One of the knife and fork cases that EVERYONE needs to know how to pick.

The reply I got was “well, yeah. this card is blank.”

They were not kidding me.

Deep cleansing breath.

I quickly attached a card and reprinted the case before they got on the elevator to go pick the case.

I scheduled the case, got off the computer and went to fetch the patient.

Because this is an emergency, damn it!

I wanted to scream that they needed to stop being so married to the cards that they can’t make a step without them.

But I did not.

I went to get the patient.

I fully expect to be called to the office about this.

To be told that other nurses are not me and I should not expect them to be.

Um, I don’t.

I do expect them to be able to pick a basic case without a card.

I will be creating an education around this for the staff.

I will take them down to the case make up area, tell them they have 3 minutes to pick an ex lap.

On your mark, get set, go.