25- f’in cowards- part 2

Well that vote finally happened with the conclusion that they all wanted.

215- yea.

214- nay- including two republicans. Good for them and thank you.

There was also two that just didn’t vote and 1 who voted present. I guess so they can look themselves in the mirror tomorrow. Or brag to those they will BEG to reelect them, promising to do better next time. They are the real villains of this piece.

Except for those 2 the vote was on party lines. Too bad for the Democrat representative that died this week. Gerry Connolly of Virginia.

RIP. You should have retired. Did you learn nothing from the lesson of Ruth Bader Ginsburg? And why oh why does this keep happening. The last 8 congressional deaths were democrats. Maybe look to the younger candidates instead of wiping the assess and mouths of the gerontocracy.

But I digress.

This fucking bill- Why?

Because this is a fucking abomination of a bill.

It strips money from suffering people in so very many ways.

It strips healthcare away from struggling people. By ending Medicaid. Fun fact, Medicaid has many different names depending on the state. There are going to be a LOT of angry and desperate people when their medications suddenly quadruple or higher.

It takes food out of the mouths of babies and children. By nearly ending SNAP benefits. I have known people on SNAP and they were 1) struggling and 2) working. What now?

It kicks grandma out of the retirement home. Because of the decrease in Medicaid. Which we fucking told you was fucking coming. Better clear out the spare bedroom because she’s coming home.

It is a death knell to the declining hospitals in the rural South and everywhere because it ends Medicaid. The already high number of hospital closures is about to go to stratospheric numbers.

But don’t worry there is some good in it. For those who want to buy a tanning bed. The excise tax on it has been decreased. Of all fucking things, of course.

Here is the end of democracy, have to put a cherry on it for their corporate masters.

It is cruelty and project 2025 marked up pretty like. So that they could lie and make pretty speeches about while picking your pocket at the same time.

The end goal is to provide a multi-trillion dollar tax break to those who DO NOT NEED IT! The billionaire class that Nixon started and Reagan fostered and the current president has egged on. Because he is one?

Next it heads to the Senate.

Upon wake up to this piece of bullshittery, I immediately wrote the two senators in my state.

I told them to vote no on the senate bill.

I told them to find their balls.

I told them their grandparents and grandkids would be ashamed of them.

I told them that I, a citizen of their state, wanted them to vote no. This is to take care of people who are citizens in their state, who failing and will fail harder with a yes vote.

I also did a hand written series of cards with a lot less nice wording on it.

I lambasted the reps in my state.

Being the OR nurse that I am I have to wonder what is their end-game?

Slavish obedience to their one true god of a president.

Slavish obedience to the people whose money they will NEVER reach.

Or is the cruelty the point?

Cowards, the lot of them.

Grow a set, will you?

And also get a replacement rep in there ASAP.

The time for mourning will come but now is the time for action.

Write and call as much as you can.

Remind them that they work for us, not the billionaires.

Remind them that they have to be reelected in 18 short months.

Remind them that while some in their district won’t have the energy or the capacity to remember who is to blame for their new worse circumstances, some of us have fucking long memories and will be sure to remind them.

Over and over and over and over.

Your grandparents and grandkids are ashamed of you kicking the other old people and stealing food from the babies.

For shame!

Cookie Thursday 5/22/2025- Going back to where it all began

I am not sure if this is the first cookie I made for Cookie Thursday is a Thing but probably.

It is the cookie of a lot of our childhoods.

It is the fastest cook time, longest dry time of the cookies.

I am, of course, writing about the fudgey no bake cookies.

You know, the chocolate peanut butter haystacks.

If these were in our kitchen growing up, it was gonna be a great day.

Perfect for breakfast with milk. What? They have heart healthy oats AND peanut butter. Perfection.

Perfect for lunches because they travel well.

Perfect for keeping at room temperature because there is nothing in them that can go bad. I’m thinking of you eggs.

If I had to chose a cookie from my childhood to be my absolute ride or die cookie it would be this one.

And the crumbs aren’t so bad either.

In fact, I would hazard to say that the crumbs are the best part. They are certainly the most versatile and can be used in place of granola. Fight me on this one.

Best Kept Secrets of the OR- Frequently asked questions that new staff have part 1

Awhile ago I asked everyone I could in the OR to contribute questions that new nurses might have. And I was not disappointed.

During this limited series I am going by each person’s response.

The questions run the gamut from existential to practical.

For this first post in the series I asked myself what would be the questions I expect new nurses to have floating through their heads at least once.

I wrote down two questions that I know I had when I started in the OR.

The OR was different back then. At least for me.

It was a 3 room OR but we only had enough staff for two of the rooms. The big autoclave was only run once a day, maybe. The rest of the time we made do with flashing. That is the immediate use steam sterilization to those who don’t know. Being people who are keen to use acronyms where there has not been a call for one this is shortened to IUSS. Otherwise known as the flash.

Bear in mind that this was over 20 years ago and the policies that are in place now around flashing were not yet written.

It was 2001 and I had fought mightily to get my senior experience in nursing school in the operating room. The school really didn’t want me to do it, they wanted me to be a good little med-surg nurse. Little did they no. But I finally prevailed. And I showed up for my first experience day as an almost graduated ADN nurse. This was it, the final hurdle.

Only to find there were no scrubs in my size available.

As an aside, most ORs provide the scrubs to the workers. Because no one wants to take home dirty scrubs and wash them in your own washing machine. Also because no one wants to bring in home germs (AKA outside germs) into our as clean as possible rooms.

But there were no scrubs in my size available. I wore scrubs that were two sizes too big. I just shrugged and rolled up the sleeves and pants.

My preceptor for the day was a ditzy blond who took me through the admittedly small department and introduced me to the unit secretary, to the cleaner, to the PACU staff, to the boss, to the charge nurse and, finally, to the surgeon who was preparing to start a case.

The surgeon looked down their long nose at me from their superior height and sniffed. To the preceptor they murmured that perhaps I could hug the wall. Or watch from the hallway.

The preceptor just laughed and said that I wouldn’t cause any trouble.

They led me into the room, explaining all the lights and colors and sounds as the scrub tech opened supplies while watching me.

For those who do not know, the OR can be overwhelming at first. It is cold. It is bright. It is loud. I shrank back into my too big scrubs and just watched.

My preceptor positioned me next to the window. Yes, the OR had a window. Mind blowing to me all these years later. They left to interview the patient and check with the anesthesiologist and told me to just watch the scrub tech.

They left the room after warning me not to touch anything blue.

The scrub tech didn’t say one word to me.

My first question to myself, after I was finished being overwhelmed with the noise and the cold and the light, was “Where do I stand?”

After all, I didn’t want to interrupt the scrub tech or the surgeon or the anesthesiologist or the patient.

All these years later, knowing that where do I stand was my first question in the OR, I am careful to reassure any tourists I get in the OR (these are what I call the outsiders in the OR) that if they accidentally touch anything blue we could fix it as long as we know.

I have other rules for the newbies. But that is the first one. Stand where you aren’t going to touch anything blue.

Tuesday Top of Mind 5/20/25- Adriana Smith, a cautionary tale

Somewhere in a hospital in Georgia a woman lies dead. Her body is being illegally hijacked by the state’s abortion bill and is serving as a dead host to a parasite. Without her permission, against her family’s wishes and permission.

It does not matter that this parasite is a child to be.

It does not matter to the state that she was a nurse.

It does not matter to the state that she was a mother to a five year old little boy who is now confused and

It does not matter to the state that she was a daughter.

It does matter matter to the insurance company who will not pay this astronomical hospital bill because the policyholder has been declared brain dead 12 weeks ago.

It matters that her headaches were not treated appropriately.

It matters that her five year old son cannot conceive that his mother is dead and he thinks that she is sleeping.

It matters that the fetus has been without stimulation from the mother for 12 weeks. No one knows what that does to the fetus.

It matters to women everywhere because we knew this was coming and were unable to stop it.

This is medical experimentation of the worst kind. This smacks of Henrietta Lacks and her immortal cancer cells.

Be mad for her.

But be mad at the crazy politician who wrote the abortion ban in such a way that allows for the state to deny this woman a peaceful passing.

Be mad at the mad scientist who just wants to see what they can do with the bill and how far they can push medical knowledge.

Be sorrowful for Adriana Smith’s family, especially the 5-year old, and the mother who has to watch her child be experimented on with no consent granted.

But be mad at the political machinery that has been put in place to prey upon this woman and her family and the child who may never be.

Most importantly, when this fails and this fetus dies a horrible death, stay mad.

Most importantly, when this fails and this fetus survives into a family that is shocked and appalled at this science fiction bullshit, stay mad.

I have written it before and often. This kind of chicanery is about control.

Only now they have added medical experimentation on top of it.

But stay mad.

Stay vocal.

Tell the mad scientists that there will be no more experimentation without consent. Tell the mad scientists that we are ashamed of them and their ancestors are ashamed of them.

Call this what it is, Handmaid’s Tale bullshit.

A nugget of information that I learned very recently is that Margaret Atwood was intentional about the scenes that she wrote. Nothing that happened to any of the women, to any of the Handmaids, was plucked from history.

Be careful out there.

School Me Saturday 5/17/25-Preparing for a fall college fair

It’s been a minute since shared governance put on a college fair at the hospital.

There are a myriad of reasons so go ahead and pick one.

The pandemic. The four bulwark members were on zoom meeting for over a year.
Lack of interest by hospital members. We were too tired, too demoralized by watching the public ignore common sense protections. See reason 1.
The Great Resignation. This hurt the hospital in so many ways as people sought to make more and go to travel nursing or people left the profession all together because of, you guessed it, reason 1.

But now the units are bulking up their shared governance presence and interest. Even though some departments are still hurting for staffing they survive.

Seems like the perfect time to stage a comeback for the hospital college fair.

At one of the last college fairs we did, there was an overarching theme of “What if healthcare isn’t what I want to do for the rest of my life?” There were a few requests for colleges and trade schools that were not healthcare related.

Fair enough. Because not only do we have nurses and techs and CNAs who want to further their education, they also might have husbands and wives and children who want to do so as well.

I want to make this fall’s college fair at the hospital the most inclusive one yet.

Nursing schools will be represented.

But so will schools that have something other than nursing.

I have to start calling and emailing places soon.

Just as soon as we have a firm date. You know, other than “fall”.

Ideally it would be just before or in the of tuition reimbursement application window. Those dates I know.

Wish me luck. I already informed the president of the hospital that this was something shared governance was hoping to host in the fall. I also laid out the reasons for inviting not healthcare related school. They were fine with it although they would prefer that the team members stay at the hospital.

Again, fair. But we have to allow those team members who want to fly to fly.

You know?

Cookie Thursday 5/15/25- Too much of a good thing

I can sense that after 2 weeks of the non-stop treats and massages and food gifts there is little appetite for CTIAT. So I shall stay home and my oven will stay cold.

I must remember this for next year.

No need in carrying coals to Newcastle. This is a charming English idiom that points out a pointless action.

The cookie drawer will be empty today.

Don’t worry, there’s lots of treats in the hospitals.

Best kept secrets of the hospital #1- the explosion in patient armbands is giving the 80s and 90s Swatch trend

Yeah, so this is expanding to the entire hospital. Because what is involved happens to the entire hospital.

Once upon a time, at least 30 years ago, the Swatch watch was trending. Only we didn’t call it trending then, we called it cool.

The Swatch watch were colorful plastic watches that kids collected like hotcakes. Well, the cool kids with disposable income collected them. And then they wore ALL of them at once.

Like the stacking bangle trend of the 2010s.

Except they were watches. Some kids I went to high school with wore as many as 6, marching up their arm.

Of course the times were not synced. The extra cool kids synced the times to different major cities around the globe. So they would always know what time it was in New Delhi. Or London. Or Tokyo.

When I was a new nurse, the patients only wore one armband. The one with their name and their medical record number and their birthday on it. These were stamped using their patient admission card that every patient got at admission.

This was WAY pre-EHR.

And then it was thought that we needed to be able to recognize the patients who were DNR more readily. DNR means do not resuscitate. This is usually a personal decision by the patient not to seek CPR, or by the family. I imagine that somewhere a patient who desired to be DNR was not readily identified as a DNR and coded when their heart stopped. Because no one knew they were DNR.

They started putting DNR bracelets on the patients who were DNR and no CPR would be given to them. This is so you can tell at a glance that a patient is a DNR and CPR is not desired. For whatever reason.

And then it was thought that we needed to be able to recognize the patients who were a fall risk. This is so we could take measures to keep them safe. The patients who were labeled a fall risk had certain conditions that precluded them to a fall. These include orthopedic problem, stroke, and, believe it or not, post surgical.

Another bracelet was added to the stack of DNR, patient bracelet, and fall risk.

Again, this was so we could tell at a glance who didn’t want CPR, and who needed to be watched carefully to prevent a fall. As well as who the patient was.

And then some patients should not have an IV or a blood pressure taken on a certain arm. Or their leg had a DVT, which makes the SCD sleeve a contraindication. You guessed it, a bracelet was developed for that. This bracelet was to be worn on the affected side.

This makes 4 possible bracelets- patient identification, fall risk, DNR, and restricted limb.

Are you seeing the trend here?

In the last 4 months, there have been 2 additional possible arm bands added to the possibilities.

The first is for patients who use an insulin pump for administration of insulin. The armband is to alert the staff that this patient doesn’t need insulin and is used to decrease the chances of a hypoglycemic event.

The second is a timing armband for a specific medication that we use in the operating room. This is a long acting local medication. The idea is that no additional local medication should be given to a patient who already has this long acting local medication on board. Once you have seen a local medication toxicity seizure or reaction, you never want to see them again.

This makes 6 possible bracelets. On one arm.

I means it is possible to have the restricted limb bracelet on the other arm and the rest on the arm.

But it is giving the Swatch watch trend from the 80s and 90s.

Did I mention that all the bracelets are different colors to make them easy to identify a patient?

Yeah, you see it now, don’t you.

Google image search what I am talking about and you will never unsee it.

I am sure that there are still additional armbands out there at other facilities. And the information conveyed by the bracelets is good quality information that us healthcare workers need.

But it just seems a bit excessive.

Tuesday Top of Mind 5/13/25- Fluoride and why getting rid of it is a bad idea

There are a lot of dumb hills to pitch a fit over these days. My least favorite is the anti-fluoride movement.

Fluoride is important because it prevents cavities and strengthens teeth. As someone who has a complicated relationship to my dentist I am in favor of everything and anything that decreases my chances of additional tooth decay.

Fluoride has been shown in some shoddily done studies to “alter your gut microbiome and has suggested associations with thyroid disorders, weight gain and possibly decreased IQ”.

Note the important shoddily done study in question that indicates decreased IQ has been roundly criticized and recommended for retraction. Yes, it is that bad.

The measurements used to ascertain IQ decrease were 1) not validated, 2) used different testers, 3) done in multiple cities. It is the first point that is the most crucial. I can swear to you that the sky is pink, not blue. I can have other swear the same to you. But I won’t let you look at it to see for yourself that it is pink.

It is the same energy as the question that captivated the internet in 2015, is the dress blue or gold.

Bitch please, it depends on the lighting. True, sometimes the sky is pink, especially in the early morning as the sun is rising, or later in the day as it is setting.

For a sarcastic example: Yay, you proved that the sky was pink at 0635! Now prove it again and again and again. Also, prove it at noon.

I’ll wait.

Who are you going to believe? Me, or your lying eyes?

Ugh.

Nothing that the troglodytes and mouth breathers have brought up, none of the studies have been replicable. That means no one else has been able to do the same study, as outlined in the study, and gotten the same results. This is the major finding. This is the flaw in the study.

Trust me, I’ve taken many graduate level courses to make sure that the studies that I will create are able to be replicated. This is why what these people who are playing with fire drive me so insane with anger. They don’t know enough not to touch the hot stove. But they will blame the resulting burn on vaccines, don’t worry.

This is more bluster and nonsense coming from non-science believers.

There is a big story going around now that the Secretary that is pushing for this swam in feces contaminated water. Worse, he let his grandchildren swim in the same water. Gross.

Also, double ugh.

As someone who has spent thousands of dollars at the dentist in the last year, I will keep my fluoride toothpaste and my fluoridated water. Or is someone going to tell me that the hole in our bank account is a figment of my imagination or the pain that I’ve suffered through is in my head or is because I am overweight?

Triple ugh.

Post-it Sunday medical non-fiction series 5/11/2025- Happy Mother’s Day to the mother of most of modern science, The Immortal Life of Henrietta Lacks

Yes, yes, Happy Mother’s Day to all mothers, be your children human or not.

The non-fiction medical book for today is The Immortal Life of Henrietta Lacks by Rebecca Skloot. Henrietta Lacks (and the cells that were taken from her cervical cancer) is the mother of most of modern medicine. Until her, the cells that were to be used to medical research died. But hers did not.

And have not. Still.

Her cells have been to outer space, ridden on airplanes, or in cars, and even in the breast pockets of pilots as the cells were flown to additional hospitals/laboratories.

I first read this book shortly after it had been published in February of 2010. The cover is striking, a beaming black woman, hands on hips takes up the left side of the cover. The right side is the title “The Immortal Life of Henrietta Lacks” and the subtitle of ‘Doctors took her cells without asking. Those cells never died. They launched a medical revolution and a multimillion-dollar industry. More than twenty years later, her children found out. And their lives would never be the same.’ It is a striking cover with the background being, well, cells. Yellows and pinks against a red background with Henrietta Lacks in black and white with the colors bleeding over half of her.

Frankly, one of the reasons I probably picked up the book was the cover.

This is a tale of medical misadventure in the beginning of the medical marvels of the 1950s and on. Cancer treatments were developed using her cells, medication treatments were developed using her cells, the ability to keep other so called immortal cells alive was developed using her cells.

This book is the story of Henrietta Lacks. Her life was a quiet one, albeit a hard one. She was married at twenty to the father of her 2 children. He was her cousin. They went on to have three more children, moved away from their hometown to have a better life for them and the children.

Henrietta knew that something was wrong with her insides shortly after the birth of their fifth child, Joe.

This book is also the story of the explosive growth of medical innovation after the survival of Henrietta Lack’s immortal cells. It is the story of the man who first cultured the cells, of the callous way medicine used her cells but didn’t tell her family. It is the story of her family and how they survived after she died.

I don’t want to give away too much of the story but for me this is an absolute must read.

Every time I read it I notice different things. I re-read this recently and from what I know and understand now about HIPAA and medical consent as a PhD student I was struck anew of how important the story of Henrietta Lacks’ immortal cells are.

I will continue to recommend this book to all who want to learn more and those who want to know the wrong way to go about medical research. Because this book is a warning about getting it right. Not only for the family of the woman who died but for us all.

School Me Saturday 5/10/25- Teacher Appreciation Week

It is no wonder that 2 of the most influential professions, both mostly staffed by women, have their respective appreciation week right before Mother’s Day.

I am, of course, referring to nurses. And TEACHERS.

Women vastly outnumber the men in each of the professions. Teachers are 77% female to 23% male and nurses 88% female to 12% male.

Gender really doesn’t matter in either profession.

It is the quality of instructor. Even in the higher grades.

Looking back on my 40+ years of being a student I can count on one hand the number of male teachers that I’ve had, and 2 of those in the graduate school level.

No matter how you define it women are important to these very important gateways for students/patients.

It is time to celebrate them. It is time to thank them. And not with yet another coffee cup, although the caffeine does come in handy.

If you have had a teacher you really enjoyed in school, no matter the level, take some time to think fondly on them during this week. Thank them, even if it is silently. Better yet, if it is in the form of a handwritten note or card.

Because they don’t get appreciated enough.

Especially for all they do for us and the children in their classrooms.