I train all the new nurses on how to do call. It’s been my thing for years and years and years. I was doing that way before I became the night call nurse.

I have a set spiel that I go through.

I help them optimize the electronic health record for ease in charting. Since I was one of the original subject matter experts (SMEs) that helped with deciding what the corporation’s Epic was going to look like I know my way around the EHR.

I definitely help them discover ways of where the heck the patient is in the hospital.

I set up their flowsheets to help capture hysteroscopy fluids and deficits.

I set up their flowsheets to help them do the appropriate charting for a miscarriage.

I show them how to perform and chart a pregnancy test because we test everyone who still has a uterus, age 10-55.

I show them how to use transport and how to find out how many patients are ahead of the requested transport.

I show them how to create a case and schedule the case that I just helped them create.

I show them how to put in blocks for requests that have to be blessed by day shift.

I show them how to find the ER patients. There is only ONE place to see the ER list. Even that took me about three years to figure out where it was.

The point is that there are a lot of things that I brain-dump on all the new nurses.

I made a call preserver book with frequently asked questions to use as a reference key.

But the very last thing we do, and I mean the very last thing, is talk through an emergency, such as a code blue.

Codes terrify the OR.

A friend of mine who is on the call team at the secondary trauma center said “Yeah, the OR is terrible at codes.”

But codes happen.

Sobering as that is.

I review where the crash carts with defibrillators are (PACU, ENDO, outside of Room 2, in the Cysto hallway, and ACU). I review the Broslow cart for those cases where the patient is a ped. I review where the MH cart is and the MH hotline number. I go through the silver anesthesia emergency binder that is in all the ORs (after we find it). I review where the critical care cart is in the OR core.

Frank talk of codes freak people out. But I am of the mind that familiarity brings comfort.

The last two things I show nurses are 1) where to chart the code in real-time in the EHR and 2) where the code button is in each and every OR.

I talk about what is the expectation after the code button is pulled about mass of people who will descend on the OR. Anesthesiologist, security, house supervision, ER, ICU, pharmacy.

The point is, they are not alone for long in the event of a code.

They just need to know how to activate one.

Because codes do happen in the OR.

In fact, one of my recent bootcamp attendees just had a code during a call shift. They did excellent. The patient survived. We had a debrief the next time I was at the hospital and they said they knew just what to do BECAUSE codes are the last topic in the bootcamp.

I think I will keep codes as the last topic of the bootcamp.

Because knowing there is a code button is half the battle.

There have been protests in India this month because of the rape and murder of a junior doctor. This occurred inside the HOSPITAL!

The violated body of a junior doctor was found in a seminar hall at the state-run hospital, RG Kar Medical College on August 9th. A suspect, who has declared himself innocent, has been arrested and arraigned and is standing trial.

The rape and murder of a junior doctor sparked nationwide protests and walkouts by other junior doctors.

Their response? “There is a lot of pressure on others because manpower is reduced.”

This is the shittiest most tone-deaf response I have ever heard.

Why is the manpower reduced?

Because other junior doctors staged a walkout in protest of the killing of one of their own.

India has had several high-profile rape/murders in recent years. It’s as if the men who are doing the crime think that 1) what they are doing is no big deal and 2) they will not be found out. And 3) I can do what I want.

You know what we call that? Emboldened.

You treat women badly enough for long enough, troglodytes such as these perpetrators feel they can do anything they want.

When you are a woman, nowhere is safe.

This is not an Alice in Wonderland School Me Saturday. Those should resume shortly.

No, this post is about how school is back in session.

It doesn’t matter the kind of school. Grade school, high school, junior college, college, university, trade school, it all counts.

There is something magical about the end of August and the beginning of the school year.

New clothes, new school supplies, sometimes new schools, new friends.

It is all part and parcel of the excitement of the late summer/early fall.

My advice is to embrace it.

And if you have to practice getting up on time to make it to class, do so. Also do a dry run of school lunches. And maybe the drive to school, if applicable.

Whatever you can do to ease the first days will be paid back.

If you want to hide so the school can’t find you, resist the temptation.

Don’t forget to read the syllabus.

You know who I am referring to.

After all, the end of the semester can only get closer if you take the first step.

Go ahead, the semester is fine.

Think about all the things you’ve learned over the summer, all the projects you did to make your semester the best ever.

Those still exist.

Just remind yourself, huh?

This is a good time for a mantra. Remember those?

The only way out is through.

And I don’t mean the shit, as in a good thing.

Yes, this post is tragically late. I have an excuse. I had the second stage of a dental surgery (root canal #2) today; I had the first root canal emergently last week. And my mind is limping along. Dentist terror flop sweat commenced.

Back to the issue at hand.

Pre-surgery workups are terrible.

They are either not done, or incomplete.

Kind of like ordering a BMP (basic metabolic panel) and expecting liver panel results. Like for a lap chole patient. And the surgeon shrugging it off or, worse, asking for the AST and the ALT and the bilirubin on an assay that doesn’t have them.

Patients are sicker. This is a fact of the OR.

Patients are also not tuned up for surgery in the most efficient way.

Sometimes I feel like Mrs. Weasley and the Howler she sends Ron after they’ve taken the flying car in the second book. “Car gone! No note!”. This is when I am looking at the patient’s chart prior to surgery, just perusing their blood levels and lab tests that were done. And finding nothing recent and the last labs they had were 4 years ago. Or longer.

You want to do a total hip revision of implants that are at least 10 years old, who refuses blood products, and the last hemoglobin on their file is from 5 years ago?

Make it make sense.

There are standards and I would like to assure myself that we are not going to kill this patient.

Sometimes I wonder if the surgeon just wants to cut and doesn’t want to look under that rock of the 93-year-old in multi-system failure. But we can fix them!

There is a fracture, I have to fix it.

You see, every case is a mini-mystery. There is a problem that needs a surgical intervention. Please give us all the tools to help the patient and to help you not kill the patient.

Slow golf clap for the CDC.

Extra slow golf clap for the medical establishment that has been downgrading women’s pain for hundreds of years.

Dunce cap for every medical professional who has lied and said “it’s just a pinch” while they yield very sharp instruments at one of the most sensitive parts of a woman’s anatomy.

The renewed attention to pain medication for painful medical procedures has been refreshing to witness.

And a long time in coming.

No matter than women have been thought to be small men in regarding medical research. No matter that the often men ob-gyn probably didn’t have the parts in question and were in no way qualified to judge how uncomfortable a procedure could be.

The new CDC guidelines call for some sort of personalized pain relief for painful in-office procedures. Like a paracervical block. Or lidocaine jelly or spray to the area. This gives the women some measure of control of what is going to be a not-very-enjoyable experience.

You know, like the lidocaine jelly that we have been using for male urinary catheter insertion for years and years and years. Because urinary catheters hurt. (sad, clown face here)

Mind-blowing, I know.

Who do we have to thank for this?

The increase in the chatter around pain medication for painful procedures a woman might go through at the ob-gyn?

Social media.

And the girls and women who know that this is wrong and are speaking up about it.

Like many things, older generations of women would just put up with it because that is the way things are done.

I personally had a rather invasive procedure in an ob-gyn office that was painful. To give the doc credit he did offer a cervical block. But he knew and I knew that it would be the same kind of pain as the procedure and I told him to just go ahead.

But I had the option.

Choice.

It’s a beautiful thing.

Now that there is more attention to the woeful state of women’s pain control during procedures, I can only applaud, with fervor, all of those who have spoken up about it. And continue to speak up about it.

It’s time I spoke up too.

Not bad for a bunch of “hysterical” women.

Let’s reclaim that term next.

Yes, there has been an echo.

Because of life, I’ve not been able to blog since last Wednesday!

Eek.

I shan’t bore you with the details.

Let’s just say I’ve had emergency dental surgery for a cracked tooth with abscess that spread to the next tooth.

Dental pain is miserable.

I am sure that everyone has had it.

I’m halfway through, okay, maybe a third of the way through treatment.

That’s gonna be a fun bill. Good thing I have a health reimbursement account through my insurance company. And a healthy balance there as they wouldn’t let me use it for LASIK.

However, I proved to be a badass because I went from the dental chair to the pharmacy to the online meeting I had for the IRB. I made my presentation with a lisp and a very swollen face.

We’ll see how the revisions go.

But now I am on stronger antibiotics and prescription ibuprofen (no, I don’t know why the one pill is different than the four pills but it is) and a prednisone taper. And a probiotic because that is a lot of medications that I am not used to taking.

But enough about me and my travails.

No Post-it Sunday today because, well, life.

I am going to focus on revising my IRB application.

Because the only way out is through.

Apologies to any Dorothys.

I was sitting and talking with the ladies of the Monday morning grad school writing group when my back flared up again.

Odd, I thought. This was supposed to be over. With all the moving and the stress of the AC going out at the end of July, I pulled a muscle in my upper back. Ouchie. That was 36 hours of misery, no position was comfortable, neither lying nor sitting nor reclining. Every time I relaxed enough to sleep, my back would spasm.

I’ve been in nursing for a long time. I started as a CNA in 1998, became an RN in 2001 on the med surg floor, and moved to the operating room. The work and stressors are the same. Moving, and pulling, and pushing, and lifting heavy, and getting heavier by the minute, patients. Not to mention the stress of the last 5 years. Going back to grad school for my PhD AND the covid pandemic. But I’ve been managing to duck back pain this entire time. Apparently losing AC for 3 days and moving and removing furniture and equipment was enough.

It’s been 2 weeks. On a routine medication for inflammatory and a muscle relaxant that I only take on the weekends because of call.

Back to today. I was in the office, at the desk, when my back started twinging.
And then I remembered the first adage of operating room nursing, if your back hurts it’s the shoes.

What is equivalent to shoes in my new life as a night call nurse who is also a PhD student and spends a lot of time on research assistant Mondays in the car (14 hours with commute and work hours)?

My office chair.

We bought this office chair in 2020 and I’ve sat in it every day since.

I get up and move around but over time? Yeah, my ass has been in this chair many, many, many hours.

Light bulb moment.

I couldn’t get to Staples soon enough to buy a chair. And, with my current back situation, pay to have them assemble it.

If your back hurts, consider the simple things that may be contributing to it.

If you are an OR nurse or tech, make sure to purchase new shoes yearly. Or at least have 2 pairs and rotate them.

Your back will thank you.

There is a well-worn path that some politicians like to take.

They like to claim that Democrats want there to be abortion all the way to birth AND AFTER.

Yeah, these yokels want to hypnotize people, who may not be as educated as everyone else, into believing that some doctors and nurses are out there killing the newly born.

That is murder.

Completely different than what really goes on in late-term abortions.

To understand, we first have to define.

A pregnancy is divided into portions of three months. These are trimesters. First trimester (conception to 12 weeks), second trimester (13-27 weeks), third trimester (28-birth).

Conception is when the ova (woman’s egg) is fertilized by a spermatoza (sperm).

This is also when the cells start dividing and dividing and dividing.

At any part during the cell division or even the translation of the genes of the two parts that make up conception, there can be errors.

These errors result in birth defects.

Late-term abortion has been erroneously compared to being in the third trimester.

But let’s run some numbers. According to the CDC data, 91% of abortions take place in the first trimester. That is up to 12 weeks. Second-trimester abortions account for 7.7 percent. This can be for a variety of reasons.

It goes without saying these reasons are between a woman and her doctor.

It really isn’t anybody’s business.

Late-term is what medical people refer to as near birth. Later term abortion as defined by medical people account for 1.2% of abortions.

And it is always performed for a horrific reason.

Most often because the fetus has incompatible with life abnormalities.

A later term abortion is done with care and compassion for the fetus and the mother.

It is often done to prevent suffering of the fetus or mother and to preserve fertility of the mother.

This kind of care, and I’ve been in those surgeries, is always done with gravity and compassion to both parties.

And compassion for the surgeon and the surgical team as well.

And there is a debrief for the medical people after. If they want or need it.

A later term abortion is often an act of compassion for the fetus and the mother.

It is NOT murder.

It is not making the mother carry a doomed fetus to their death or to term.

That is the brutality and cruelty of the anti-abortion side. Those who doom these children that were not meant to live in the world and their makers to never-ending sadness and despair that they are not doing the best for the very often much wanted child.

Words matter.

I would rather be compassionate than brutal or cruel.

One of the most frequently requested cookie of Cookie Thursday is a Thing is the fudgy cocoa no bake cookies.

Hence, it is one of the most frequently made cookie.

And yes, I still need to look up the recipe every time.

But what if they were not chocolate?

What would that do?

Several years ago I made a speculous butter no bake cookie.

For those not in the know, speculoos butter is a magical elixer that is cinnamon and crunchy and amazing. As I understand it is made by blitzing speculous cookies into peanut butter.

No, I’ve not made it. Either the speculoos cookie or speculoos butter. The speculoos cookie is a Belgium cookie. And served as a snack item on some flights. Also known as the Biscoff cookie.

Speculoos is a word that is just more fun to say but not type.

What makes today’s make unique is that it is a double experiment. When I attempted these cookies back then, the resulting cookie was nauseatingly sweet. I thought the answer would be in the balance of regular peanut butter to speculoos butter. So I throttled back the amount of speculoos butter to 1/3 speculoos to 2/3 smooth peanut butter. And commenced with the recipe.

The two experimental portions of this cookie are the 1) no chocolate and 2) addition of speculoos in the peanut butter.

These are not bad cookies. Very buttery tasting, very unique. However, not the flavor profile that I was going for because the speculoos is barely noticeable.

Next time I will do a 1/2 peanut butter to 1/2 speculoos and see if that lets the speculoos flavor shine through.

But today’s make is not a cookie I would kick out of the kitchen.

I made them yesterday because today Hurricane Debby’s remnants would come calling on Thursday and these cookies do NOT dry well in anything above 85% humidity. I also stealthily delivered them yesterday. I wonder how long it took for people to realize the cookies were there.

You see I know that people test the drawer before delivery because it is opened slightly when I go in to deliver the cookies on Thursday afternoon.