24-Off with her head!

Reminder- this series is roughly based on Lewis Carroll’s Alice in Wonderland and Through the Looking Glass. In this series, Alice is the student and the other characters are actors in the student’s life.

Nope. It isn’t Alice’s head that needs to be lopped off. It is the Queen of Hearts.

In this post, we are going to pretend that the Queen of Hearts is the little whisper of self-doubt that all students have. Regardless of where they are in the college/university/degree journey.

ALL students have that little voice that whispers to them that they are not good enough.

That they are only in the program they are in because of pity.

That the next test/essay/research paper will be their last.

Because how can they last?

Do they really think they can finish?

Do they really think no one is laughing at them and their audacity for thinking they are on par with their classmates?

And, if they finish by the grace of the teachers, how do they think they will pass the next test? In nursing, this is the NCLEX, the national boards that assess a nurse’s readiness to practice safely.

It is insidious, that little voice in all students’ heads.

In the book, Alice draws the Vorpal sword, which allows her to defeat the Jabberwocky by cutting off its head and defeating the Jabberwocky allows her to defeat the Queen of Hearts.

The key to defeating the student’s Queen of Hearts little voice is to draw their own Vorpal sword.

This is gonna get a little metaphysical but bear with me.

The Queen of Hearts yells constant threats. Off with his head, off with her head. But no heads are actually lopped off except the Jabberwocky. She is all bluster and vim, but in the end, Alice proves her to be thin and unsubstantial. Because the Queen of Hearts is only a playing card. In naming her to be inconsequential Alice defeats her.

The little voice in students’ heads (and I am not immune) can be defeated in such a manner. It is about recognizing the voice and knowing that the voice is not telling the truth which allows the student to defeat the voice.

This is not an easy battle, (see me in my fourth degree program and still struggling at times with the voice), but naming the voice and recognizing that it is self-doubt at its heart allows us to ignore the voice. Ignoring the voice leads to its defeat, just like paying a lot of attention to the voice allows it to grow.

My best advice is to talk to other students and have conversations about defeating self-doubt. There is safety in numbers and when one student is having a bad day, the others can serve as a support system to buoy them up.

Above all, give yourself grace.

This is new. This is difficult. But there have been others before you.

Talk to them. Talk to your classmates. Find the voice and squash it like a little bug!

This is where I put in a mantra- the only way out is through.

Picking the surgical case is a personalized topic

I’ve been an OR nurse for over 20 years. My career has been in three hospitals, many different shifts, and many, many, many call shifts.

Call is my favorite, after all.

Call is my life now.

I’ve been picking cases, and this is getting case supplies together, for a long time. There have been thousands of cases that I’ve picked.

I like to pick cases and I think it is soothing.

Most people who I’ve talked to about picking cases have developed their own process.

This is mine.

I use the elevator to go to the case make-up area in the basement. This is where the supplies are kept. When we were designing the basement for case-picking I was adamant that the room had to be organized in terms of picking a case. This means you start in one corner of the room with the basics. These are the supplies that every case needs. A back table cover, drapes for the surgery (this is dependent on what kind of surgery you are picking for), gowns for the surgeon and scrub tech, and a basin set. This is the absolute bare minimum for a case.

I crank up Down with the Sickness by Disturbed and start in that corner.

These days or nights, I pick a LOT of general cases, a few ob-gyn cases, and very few orthopedic cases. But the process is the same.

Starting with the basics- back table cover, basin set that is appropriate for the surgery (there are 2 basin sets), gowns for the surgeon, and drapes for THIS surgery.

Next, I pick out gloves for the surgeon. This is the next area in the basement. This is also where I get the prep kit if this is an ob-gyn case.

And then it is time to select the bovie tips that are needed, if any, and the suction tips that are needed, if any. You see what I mean about being highly customizable? I refer to this section as the basic sharps- knife blades, syringes, extra sponges (raytex or lap), bovie tips, bovie grounding pad. These are all within 2 large shelving units. These are the end of the basics, the bare minimum for every case.

If you turn around, there are the dressings on another cart. These are highly case-specific.

Then you go to the particular section of the case make-up that is determined by the case you are picking for. Orthopedic stuff is with orthopedic stuff, laparoscopic stuff is with laparoscopic stuff, ob-gyn stuff is with ob-gyn stuff, and so on.

There is a section tacked on the end of the ob-gyn section that is the hot items. I don’t mean stolen, I mean electro-cautery items used for laparoscopic or open surgeries.

Here I pause to look at the exact card to see what I am missing. I do not go line by line with the card. There are many reasons, but mostly because what is on each line is not alphabetical like I told them would be good. Instead, supplies are listed by how where it is in the WAREHOUSE! Tell me, in what universe does that make sense?

But we adapt and move on.

It would surprise exactly no one when I say that surgeons have many opinions on the supplies. Some surgeons are really concerned with costs, some are not. Some surgeons, well, most surgeons, just want what they want. They will complain mightily if corporate does not want to buy them what they want and instead give them a comparable supply.

I head upstairs to the instrument room. It used to be next to the case make-up area but has since been moved back upstairs. I pull the instruments that are needed for the case.

End of story time.

Down with the Sickness is four minutes and thirty-nine seconds long. It never takes me the entire song, including elevator rides, to pick a call case. But I’ve done this a long time and I have most of the cards memorized.

I train a lot of people in my job, or, I did, and I offered to do a case-picking BootCamp, like the Call Bootcamp that I do. No go.

Everyone is going to develop their own style. But a grounding in the basics would have been useful to new people.

Tuesday Top of Mind 4/23/24-every week is a fresh bouquet of WTF

Every day brings a fresh WTF. No, this is not a positive thing.

I could explain what WTF means… but I won’t. Let’s just say it is nothing positive. It could mean where’s the flowers but sadly it does not.

Every week there is a new atrocity against women.

Every week there is a new idea from MEN about how to be cruel to women.

Why?

I think a large part of it is fear. They are afraid of the rights and privileges that we are demanding. Like the right of bodily autonomy, of making decisions about our body.

Like the right to a bank account.

Like the right not to fawn over them and make their world better at the expense of our own.

The newest case before the Supreme Court is a symptom.

In 1986 Ronald Reagan signed the EMTALA law.

This is a law that demands that hospitals treat patients in emergency situations. With or without the ability to pay.

And these yahoos in Idaho have decided that this means that women who are dying of a miscarriage don’t deserve emergency treatment. Because the emergency treatment for the treatment of a miscarriage is the removal of the doomed pregnancy. Before the woman, you know, dies or suffers irreparable harm to her fertility.

But no, these assholes would rather make a political point that they think allows them to stay in power.

In just the past week there have been many articles about women in Texas, and Idaho, and North Carolina and Florida who have been turned away from emergency rooms. Because they aren’t sick enough and their life isn’t in jeopardy enough.

Women are suffering. The potential child is suffering.

But, sure, make your political point with the blood of these women and see what happens.

Cruelty is the point indeed.

Another WTF in our current affair bouquet is the Illinois case where a nonverbal disabled woman was assaulted in a longterm care home. When? No one knows. But she was discovered to be pregnant. At THIRTY THREE weeks along. Trust me when I write that she had zero capacity to consent. The who attacked her and sexually assaulted her should be in jail.

Cruelty is the point.

Control of women is the point.

They won’t stop at Roe.

So many WTFs in the bouquet.

Oh, goodie, and tonight is a full moon.

Post-it Sunday 4/21/24-strength of character

The post-it reads “Doctors and nurses are many things. Dedicated, bright, and driven. But the piece of paper that confers the MD or the RN does not indicate strength of character.”

Well, I KNOW I’ve written about this before.

Just because the healthcare worker is an MD, or a DO, or a CRNA, or a PA, or an RN, or an LVN, or a CNA, that doesn’t mean they are necessarily good people.

Some people are drawn to the field because of wanting to do good and take care of people.

But some people are drawn to the field because of the perception of money that healthcare workers make. Also known as in it for the paycheck. Yes, we get paid to care for those who cannot care for themselves. We also get paid to work long hours and not attend to bodily functions, such as emptying our bladders or eating.

The bottom line is that healthcare workers of all stripes are people too.

Maybe they should be people first.

It is how we care for others that indicates the strength of our character. Not in the act of caring for a paycheck.

Because those who care for a paycheck often are distracted by the next shiny thing and leave.

Don’t be that person. No, wait, do. Because I don’t want to be alongside others who jump at every new moneymaking prospect that comes along. The people we care for deserve better.

School Me Saturday 4/20/24- personal end of semester update

On this palindrome Saturday I am going to be digressing from the Alice in Wonderland school series I have been writing and will be writing about myself and my program.

Why?

Because it is nearly the end of the Spring semester and it’s been a hot minute since I did an update.

Two weeks remain in the semester.

That is 2 more times driving to the university for my research assistant job. I did decline to work this summer for the department as I anticipate life is going to get very interesting and busy over the summer.

That is 2 more assignments. One in the qualitative research class and 1 in the measurement class.

As the qualitative, I should have seen the writing on the wall. I do not care for math. Especially the kind of math that is required for quantitative research. Statistics makes me itch a bit. You know? I am leaning into the qualitative sphere. And this is shocking to me.

Talking? To other people? Not really a strength of mine. But here we are.

For the third class, the directed research class, I was thrown off a bit by being sick for 2 months starting in February. I just feel like I got a slow start. But that’s okay. I am chipping away at it. Next week I will be presenting my directed research project, an observation project, to the corporate research council. After that, and after the blessing of the school IRB and the hospital IRB, I will dive into the observations and finish the class.

Thankfully, I am not the first person to have a slow start and there is a process for this.

For the rest of the summer, I will be preparing for and taking my preliminary exams. These are exams that separate the PhD student you from the PhD candidate you. These are also the threshold that must be crossed to begin dissertation work.

The exams are timed, kind of, and meant to be written over two weeks from home, or 3 days at the university. I will stay home, thank you, and write them from here.

After I pass the preliminary exams (I hope) I will start work in earnest on my dissertation project and my dissertation itself. As I understand I will need to have it completed and defended by March if I want to graduate in May. The directed research informs the dissertation project research.

I have had so much support from the university in this journey. And a journey it is. And support from family and friends.

I need a better answer to what are you going to do after graduation?

For the longest time, the answer has been write for publication. I might throw in some teaching in there too.

After the end of this semester, I will be a 3rd year PhD student. If you had told my younger self that I would someday be looking at and surviving a dissertation she would have laughed.

Oh, boy.

Let’s get started.

Cookie Thursday 4/18/24-Crust cookies

This is where the joke of the April theme of the Taxman Cometh really comes into its own.

Mind the pun.

Monday was April 15th. This means that all the taxes owed had to be paid or postmarked Monday April 15.

Yeah, I did the taxes. Unsurprisingly we owed. A not unsubstantial amount. We’re double income no kids (Dinks) of course we owed.

The amount I am putting down to the discrepancy in our take homes and the RA job that is paying for school. The RA job does withhold taxes but not enough. I will see if I can change that to withhold 75% of the money there.

The make of the week is crust cookies.

The joke/pun is that after paying for taxes we have to live on crumbs.

Badum-tss.

My coworker got it. Especially after I told him that we’d been living large the first two weeks of the month with the Millionaires Shortbread and the Billionaire bites we had to pay the taxes.

He laughed and laughed.

But crust cookies are awesome no matter what time of year.

It is pie crust, leftover or otherwise, melted butter, and cinnamon sugar.

Sublime.

Even after paying taxes.

Yes, I did make a special batch for the night folks who had never heard of such a thing.

Boy, are they in for a treat.

Counting Basics #15- opening trays during surgery and refusing to count

There is so much that is done incorrectly in the title sentence. This is from a friend of mine. There was a large, involved open case and the scrub tech was searching for just the right instrument, neither too short, nor too long, nor too stout, nor too fine. Look at Goldilocks over here.

They had the circulator open at least 6 trays searching for this one instrument.

The circulator, who was fairly new, would ask to count all the new trays. The scrub tech refused and said that the instrument was the only thing they were going to take and to just add the instrument to the existing count sheet. They then instructed the circulator to take the tray out of the room.

Facepalm.

Never take a tray out of the room.

Always count the entire tray. Even if you don’t take the tray out of the room, I have caught scrub techs, and even surgeons and PAs rooting through the open tray. The open, uncounted tray.

Of course, they needed an instrument from the tray the scrub tech had dismissed from the room. With no additional trays that had the needed instruments. This led to even more trays being opened and dismissed.

Of course, the count was off and they needed to take a pre-wake-up x-ray to make sure that there were no instruments in the incision site. This leads to a prolonged wake-up from anesthesia because the scrub tech can’t break down the table (this means keep it sterile), or the patient awakened from anesthesia in case there is an instrument or a sponge or a needle that the surgeon needs to go back in for.

Always count the tray.

Never take a tray out of the room.

Never listen to someone who is telling you to do the wrong thing. The wrong thing that you know in your gut is the not correct thing.

It’s okay to call for backup.

Heck, call me and I will yell at them.

Post-it Sunday 4/14/24-one minute

The gown card reads “What can happen in a minute?”

This is an undated gown card so I am unsure what I was getting at as I didn’t clean up my documentation act until later.

However…

One minute is 60 seconds.

A proper dry time for surgical prep can be 3 minutes, depending on what has been prepped and what prep is used.

In a minute, your heart can beat anywhere from 30-200+ times. This is depending on your heart and what is impacting it.

In a minute, the world can change.

I think a better question to ask is what can happen in a second. A second can be the threshold from one world into another. A second can be the threshold between being alive and being dead. A second can be how long your attention is diverted and catastrophe can strike in that second.

Anyone with cats or kids can tell you that.

Just like silence in an empty house can be peaceful, silence in a house with toddlers or cats can be suspicious.

In a second, the world can change.

It depends on your perspective.

School Me Saturday 4/13/24- Goodbye, hello…I’m late, I’m late, I’m late

It happens to everyone.

And I mean EVERYONE. Including the White Rabbit from Alice in Wonderland. Well, it seems to happen to him a LOT.

An assignment slips your mind or, worse, doesn’t make it onto the calendar. The calendar of assignments that you live and breathe by.

What do you do?

This advice is compliments of my first ACLS teacher. The first thing you do is take your own pulse.

In this instance, taking your own pulse helps you to not panic.

I know wild things are going through your head.

This assignment is going to be late. I’m doomed.

This assignment is going to be SOOOO late. I’m gonna fail.

This assignment is going to be so late that I will have to wail in the afterlife with calendars shackled to my wrists. A la Morley in the Christmas Carol.

Yes, a little book mixing that you didn’t know was possible.

Take a deep breath.

It will be okay.

First things first, email your instructor.

They are people too and they know that life happens. Life definitely makes a habit of getting in the way of adult learning because you probably have a job and responsibilities. Maybe even children.

Now that you’ve emailed your instructor, read the assignment and make a plan to get it done.

Often points will be deducted because it was late. But it is late and this is the way to minimize the fallout. You could just not do the assignment. But then you won’t learn the Student Learning Objective that is often a building block to the next SLO.

Email your instructor and get to work on the assignment. Because points are points.

Do not panic.