The impetus for this entire Blast from the Past theme was a Facebook post of a Twix cookie I made way back in the start of Cookie Thursday is a Thing. In February 2015.

To my recollection, I have not made them again since.

This is a multi-step cookie, which is probably why I’ve not made them since.

Bake the shortbread. Let cool.

Make the topping and top cookies. Let cool.

Melt the chocolate and top the topping. Let cool.

I just finished the chocolate layer and I’ve been baking since 0800. And it is not 1220.

A labor-intensive cookie.

I’m on spring break this week from university,

And minimal meetings.

Perfect day to dust off the recipe.

The original Facebook post says that I need to work on my chocolate game.

Still do.

But I realize that the cookie does not have to be perfect.

A fact that some surgeons I work with need to internalize.

I’ve been on many cases that the surgeon wanted to make “perfect”. Only to have the repair fall apart and need to be done again. At the expense of the patient having to remain under anesthesia for that much longer. At the expense of the OR schedule.

Here’s the thing. We are never going to be able to put the patient back together to factory standard. They will still have been broken, or their abdomen entered into, or their uterus cut to deliver a baby. There is no way to unHumpty Dumpty them.

Repairs don’t have to be perfect. They just have to be good enough to work.

And that is the lesson for today.

Is my chocolate enrobing perfect?

Nope. But the cookie still tastes amazing. Which is my goal.

The sterile processing department is where instruments go to be cleaned, counted, put back in order, and sterilized.

But how do they know what instruments go in each set?

What if I wanted a minor tray?

There is a count sheet for that.

This is a standardized to the hospital form that lists all the instruments, in order, and lists how many there are of each instrument that can be expected.

Ideally, the catalog number of the instrument is listed, along with the manufacturer. This makes it easier to be reordered in case of accidental loss.

Not in a patient.

We covered that in Counting Basics #4.

Why do counts exist? It allows us to be relatively confident that what goes in comes out.

Barring emergency cases (the cut or die type) or patients with a large cavity.

The count sheet is begun in sterile processing during tray makeup.

All instruments in the tray are counted and noted on the sheet.

And the tray is sterilized.

But sometimes the count sheet and the tray do not match. What then?

Yeah, SPD techs are allowed to be human.

Just adjust the count sheet and continue with the count.

To you, the count is right in front of you.

To the SPD tech, the tray may have been one of several of the same kind that was assembled at that time. And it might have been days ago, depending on the frequency of use.

And that is why we count again. Comparing it with the count sheet.

Because all that matters is that somewhere, sometime there is an agreement before the patient is in the room.

And the count sheet is kept and maintained, added to if needed, and counted off again as the surgeon is closing.

Is this elementary? Yes.

Does anything better exist? No.

An option would be to x-ray every single person upon closure, exposing them to x-ray unnecessarily, costing them more.

Some places do this.

Of course, some places think that fewer counts are a good thing.

A retained surgical item can cost the hospital thousands and thousands of dollars for retrieval.

A retained surgical item can cost the patient another surgery and recovery period.

A retained surgical item can cost the hospital system big time due to lawsuits.

Follow the policy of your hospital. No matter what it takes. No matter the pressure from the surgeon to just get it done already.

You are not there to keep the surgeon on time or happy.

You are there to keep the patient safe.

Not much has been happening since the US decided that everything all at once could re-open and masks were optional.

All the time.

I mean ALL the time.

No matter the risk level of the community.

Cool.

You do you.

The covid death toll for the US is one million, one hundred twenty-two thousand, and sixty-four.

Yes.

I am still looking at the data.

No, they haven’t stopped the nonsense yet.

Yes, people are still dying.

On February 12th, the death toll was 1,114,377. The difference is a little under eight thousand, or 7800 for those doing the math. This was about three weeks ago. Divide by 3. The answer is 2629 dead a week.

Which, I’ll give it to you straight, is slightly better than the 2882 dead then.

And is 2629 US dead in a week worth not wearing a mask when going out? Or inconveniencing your life in any way.

Think on that a bit.

On the positive side, the hospitals in California have dropped the in-hospital mask mandate.

Why? Because the percentage of people who are fully vaccinated is 85.44.

By contrast, the percentage of people who are fully vaccinated in North Carolina is 66.8%. And we still have the in-hospital mask mandate.

I mean, the hospital where I work had a week, maybe two where there were no covid patient hospitalized.

It has been 3 years since I started doing this covid round-up. We’ve been through a lot.

The terror, the shutdowns, the masks, the vaccines, the refusal to wear masks, the refusal to get a vaccine.

Three years.

On one hand, this is what flattening the curve means; smaller curve, less deaths, longer time frame.

On the other, people are still dying. A lot.

As long as you are cool with that.

Carry on.

The post-it says “LOL being rolled out, the treatment is always good here.”

This has two meanings. Well, LOL does. The meaning in text speak is laugh out loud. To me and many people in the know it means little old lady. Guess which one predates text speak?

This frail little old lady, bundled up to the ears, with a hat on, was chatting to the volunteer wheeling her out to the car. Remarking how her hospitalization had gone, how glad she was to be going home, and the kindness of the staff.

I was behind them as I was walking to a meeting and decided to get a drink in the cafeteria prior to it. Just walking, not really paying attention to what they were saying. Thinking about the meeting to come and the needed caffeine I was about to buy.

But what she said about the treatment being good at this hospital caused me pause, and to watch as they continued down the hallway.

In shared governance we can look at monthly patient satisfaction scores all we want. But those are from people who WANT to talk to the company who handles the satisfaction surveys. And that is a knife edge, some want to talk about what good care they received at the hospital, and many want to complain.

And guess who listens to the complainers most in creating and changing policies. That’s right. The hospital powers that be.

It was refreshing, knowing that I was heading into a shared governance meeting where we would be discussing complaints about hospitalizations, to hear something good about the hospital.

And, apparently, this patient had been admitted to a few places, enough to be able to talk about how the care was at our hospital. It is always important to hear the well dones! As well as the complaints.

They are both equally important.

I hope she gets a survey and I hope she fills it out.

February report.

My grade, which I expect to be dismal, is not in for statistics midterm project/presentation.

Why do I think it will be dismal?

Because in my estimation I bombed it.

My math was poorly conceived, my presentation was poorly written and presented.

Ugh. The less said about that the better. Did I cry walking to the car? Absolutely.

And I have a 98% in the class going into the grade. I asked the professor if I should drop the course, and he told me not yet as there are still 3 homework assignments and a final to get through. The drip torture continues. Which makes sense but no sense because I am understanding the current lectures.

Time will tell.

My concept evaluation paper came back at 94% for nursing theory. No, I have not yet looked at the comments. I will, I will.

Next up for this class is a theory compare and contrast paper that is due on Friday 3/17/23. Loads of time to button down with 2 theories I will be comparing and contrasting. Next week I will be reading about theories and the week it’s due I will write the 20-page paper.

This blows people’s minds until I remind them that the paper has to be double-spaced and formatted correctly, which takes up many pages. Theoretically, I am looking at 10 pages of actual content.

Eminently doable.

And in the third class, there was the start of a group project. We, as a group of three, had to pick a hospital, decide on variables to report on, run the graphs, and discuss conclusions from the graph. And my group mates actually did work. I am so proud! And grateful I didn’t have to do it all myself. The next step is formatting the small paper we turned in on the variables into a PowerPoint, as if we were presenting it to hospital administrators.

Quite a mixed bag to report for February.

Takeaways:

1. Trust the group project, especially on a grad school level
2. just keep on swimming, keep on swimming, keep on swimming
3. It is Spring Break, take a nap for goodness’ sake!

This month’s theme is Blast from the Past.

Cookies and Makes that I don’t make very often and haven’t made in ages. Sometimes years.

It has been nearly 6 months since I made the perennial favorite if 90% of the OR: the jalapeno chocolate chip cookie.

This month I had to make do with diced jalapenos.

I put 3 tbs of diced jalapeno in a quarter cup of water and let sit overnight to rehydrate the bits.

It isn’t ideal but it is what I am working with.

The fluid is then added with the eggs during the making of the batter.

Make as usual.

Standard Toll House chocolate chip cookie recipe.

I’ve done it this way a bunch of times.

And the cookies spread out very thin, making for a thin, crispy cookie.

Odd.

New baking soda. Room temperature butter, room temperature egg.

It just goes to show you that you can’t control for every variable.

But I think there is something going on with my oven. The cookies baked very unevenly, one side baking faster than the other. I am familiar with the back of the oven being hotter than the front and I can correct for that with size of the dough balls. But the side versus side unevenness. I have to read more about this.

I love my little oven. It is 16 years old at least. And I get a LOT of use out of it.

Next week I will use the standard-sized oven and see if that makes a difference in even baking of the cookie sheets.

If it isn’t one thing, it is another.

This is the 5th post about Counting Basics.

Rarely.

And, I mean rarely, there is a case that is completed without additional instruments being added.

These can be small: a forcep.

These can be bigger: a retractor.

These can even be bigger: an entire extra tray.

Sometimes a surgeon does not want to pause when an instrument set that they asked for is added.

But take the time when a new set is added to do the count.

Anytime something new is added to the field, it must be counted.

ANYTHING!

ANYTIME!

If the surgeon pushes back, inform them that this will save time in the end because the OR room will not need to take an x-ray because the count was not correct.

I mean, sometimes there is literally zero time to count additions.

That is a very rare case and most likely an emergency. This case we are doing of a lipoma removal is not that case.

Trust us, doc. It is better and safer if we take 30 seconds to count off an additional tray. Especially if the patient isn’t actively dying. Okay? Glad we had this talk, now suction something or bovie something to keep your hands active.

Any additional single instruments need to be added to the count sheet. Or multiple instruments.

Just let us get on with it. I will have your scrub tech back to you momentarily.

The count sheet will be Counting Basics 6.

Yes, the world is on fire.

Earthquakes.

Death.

Destruction.

Snow at the Hollywood Sign.

Unprovoked war justified in a megalomaniac’s mind as getting the old band back together. And by old band I mean the glory days of the empire. You know what I am referring to.

Governors and state governments deciding about women’s bodies.

Not a lot that I personally can do.

I can decrease my carbon footprint. We can be good stewards of our energy consumption and overall commodity consumption. No fast fashion, not that do fashion. Interacting with the neighborhood Buy Nothing group. Reuse, recycle, reduce.

What I do have power over is not participating monetarily in conferences in states that have been egregious about a women’s right to bodily autonomy, and hatred of what they don’t understand, including books.

I am looking at you Texas and Florida. I just won’t engage in conferences at either place. And what’s more I inform the groups holding the conferences why.

In detail.

This I have a small modicum of control over.

Will it do anything?

Probably not.

But I can tell people the reasons I have for not engaging in conferences in these states that do not value women. Admittedly this is made easier by attending the conferences virtually. That way the organization gets the money, not the states.

And maybe I will start something.

The post-it reads “I’d say we’re too smart for this shift, but maybe that is why we’re on this shift.”

Nothing against day shift but evening shift has to be smarter. We have to move faster. We have to be able to make quick decisions, not be told what to do.

It is an entirely different mindset.

Day shift does the bulk of the cases. They have the bulk of the staff.

Evening shift does a fair amount of cases, less than day shift, with two people. Evening shift is also responsible for setting up rooms.

After we’ve cleaned up day shift’s detritus.

I’ll spare you the looking up what that means.

It means debris.

In fact, that is a much better word choice.

Evening shift cleans up day shift’s debris.

Many rooms are left in dishabille (messy) at the conclusion of the case or the day. At least the conclusion of the day shifter’s case.

My pet peeve is relieving someone and THEN spending 15 minutes picking up trash off the floor, and putting away supplies, all the while tending to the surgical team who are continuing to work on the patient.

I get that everyone has their own level of chaos they are comfortable working. My level of chaos that I am comfortable working in is shallow. After all, evening shift doesn’t have orderlies to clean the room prior to the terminal clean by EVS. There may be another case after this one finishes and the more orderly I keep the room, the faster it can be cleaned and the next case opened. Guess what? Evening shift doesn’t have people to do that either.

I think it all boils down to day shift and evening shift’s differing end games.

Day shift’s end game is to either finish the cases and do little toward the evening shift chores, regardless of how many cases remain on the board. Or ask to go home.

Evening shift’s endgame is to finish the day, so they can start on the evening shift chores and go home. Or hand off a case to the call shift.

There are different ends to the shifts. And I think that is where the struggle lies.

But, pretty, pretty, pretty please, with sugar on top prepare your room for the end of shift. No matter if there is a case ongoing, or the day has wrapped up in that room.

The best advice I can give is that your mother doesn’t work here, act like it. Pick up your crap!

Of course, my mother does work in the same department that I do. And I would never leave a mess for the next person. Because the next person for me is day shift.

Just be kind to your teammates coming after you.

Nothing strikes more fear into a student’s heart except for the three little words of the group project.

See, shudders.

I’d rather not, thank you.

There is always one of three archetypes

1. the overachiever who is in fear for their grade and does the entire project themselves
2. the slacker that might or might not come to the group meetings
3. the bubbly one who presents the group presentation

You can be all of these at the same time.

I know I can.

I just finished a midsemester project for statistics.

And by just finished I mean I turned it in at 1209, it was due at 1330.

And then we will have the PowerPoint presentations on the group project.

I will begin the way I always begin, by informing the group that I am not a natural speaker and to give me grace.

Back to the group make-up.

There is always the three; sometimes there can be more, but at least the 3.

For the group project in statistics, we were able to pair off to work on the project. There are 11 people in the group and before the first class had ended people were already pairing off.

I can do math. I know how this works.

Someone has to be the odd person out. I just assumed it was me.

Nope.

There are 2 groups and 7 singletons.

This is where I say that I wish I had had a partner to share the load.

To keep me on track.

To keep me from procrastinating, or showing my lack of knowledge to the professor. Because you bet I have already done that. And had to rework all the statistics overnight for the paper and the presentation.

Because all of this is self-inflicted.

I guess there re some good points about group projects.

I could have shared the misery.

And probably had a good night’s sleep last night, instead of the 3 hours I did get.

Pity party of one, in 7 separate locations because we all thought that all the pairs had been taken.

Or didn’t want to impose.

I will know better next time.

After the presentation-

well

I misunderstood that assignment

Clearly I would have benefited from a partner.

It was embarrassing to get up and present some half-done shit.

All the others were polished and pretty and got the math right.

Yeah.

That happened.

And now I wait to hear what the professor thinks.

The last day to drop the class is next Friday.

Stay tuned.

It might get bumpy from here.

Isn’t hubris fun? Asked no one ever.