24- Billionaire Bites

The highest week of April’s theme of the Taxman Cometh.

Taxes are due on Monday.

I know it.

My husband reminds me of it DAILY.

My email knows it because it reminds me of it DAILY.

Last week’s cookie was Millionaire Shortbread.

Are you picking up on the way the cookies are going?

This week’s cookie is the Billionaire Bites.

This is a no-bake recipe.

11 oz caramel, melted over low-medium heat with 1 tbs of water until smooth

1 c rice krispies

1 1/2 c pecans. The recipe didn’t call for toasting. I did that all on my own.

Mix all of these together and portion out by the teaspoonfuls. The mixture is very sticky.

I let them dry overnight before I covered them in chocolate. They were still very sticky. The humidity of days of rain did not help. I am not sure if it is the fact that it’s been raining for days but the melting of 2 c melting chocolate wafers did not go smoothly until I added about a tablespoonful of coconut oil.

Dip the bites into the chocolate.

Start running out of chocolate halfway through. Decide to call those ones half-naked billionaires.

Get mad at the existence of billionaires. These are people who have billions of dollars when there is suffering and do little to help. You know the ones.

Let chocolate dry and package them up in a container for the trip to the hospital.

I don’t think anyone is going to get the half-naked billionaire joke. Perhaps if I named them the emperor is half naked they would get it. Maybe not.

Back to taxes being due on Monday. I will do the groundwork of the taxes tonight and file them. I won’t pay until Monday. The government will get my money when it is due. And not before. Even if is is only four days before. It is the principle of the thing.

Dissertation topic

On Wednesdays we wear pink. Deliberate Mean Girls Reference.

On Wednesdays, I write about the operating room Not so weird, considering Dispatches from the Evening Shift started as an OR blog. And then it became an operating room/nursing/post-it notes to me discussion/Tuesday Top of Mind where I discuss politics and things that are top of my mind/Cookie Thursday is a Thing/School Me Saturday blog.

Yeah, I know that the topic of my dissertation might be more of a School Me Saturday post but this is very operating room-centric. I just felt like it fit here best. And I’m doing an Alice in Wonderland theme for School Me Saturday for a few weeks.

My idea for the dissertation project that will take me nine months to do and write the damned dissertation (name of a dissertation service I’ve seen) is solidly in the OR.

Not to go too deep into the details but the OR is consumed with turnover.

This is not when people leave and new people are hired. While that is also called turnover, this is not it.

Turnover refers to the Wheels Out to Wheels In time. This is the length of time that elapses when one patient leaves the room (Wheels Out), the room is cleaned, the equipment is brought in, the next case is opened and counted, and the next patient enters the room (Wheels In).

There are industry standards. There are goal times that the hospitals strive to meet. The industry average is 26 minutes.

And I am over here doing 10-12 minute turnovers. Often in the same room, always with the same team, and always without anyone but us to clean the room/get the equipment/open and count the room.

The question is why.

Why is the evening night team so efficient?

So efficient that several doctors remarked on it. One of them went so far as to suggest they were going to schedule all of their cases after 1500.

The thing is… I don’t know.

Being a circulator is a job in a solo. We don’t know what the other circulators are doing.

This leads me to the pilot observation study that I will be doing as soon as the IRB allows.

It is my hypothesis that there are tasks that can be done to potentiate a faster turnover.

These are simple tasks.

Make sure there is no trash on the floor.

Make sure all the linen is in the linen bag.

Make sure all equipment is away from the OR table.

Make sure that all extra supplies are either put away in the room or readied to be taken out of the room.

Make sure all the suction cannisters are prepped for removal.

Be thinking ahead to the next case and the equipment that might be needed.

Be thinking ahead to the positioning requirements of the next case.

In other words, prepare to room to be left.

I only know what I do. I don’t know what other circulators do.

Hence the pilot study.

The pilot study will be in one hospital during the day shift.

The big dissertation study will be controlling as many variables as I can and observing in other venues. Such as a bigger hospital. Such as an ambulatory surgery center. Such as the night shift. Such as the weekend shift.

The thing I’ve learned about the dissertation during my program is to keep it simple.

There are many downstream effects that an efficient turnover can do. Keeping to the scheduled times. Getting people out of shift on time. Decreasing overtime costs.

The end goal is to create a checklist for pre-Wheels Out activities.

But that is NOT the dissertation goal. That’s for later.

Because creating a checklist and getting it validated can add 2 years to the dissertation time.

I don’t have time for that.

Remember. Keep it simple. This is not the best work I will ever do. This is not the most important work I will ever do.

The dissertation project is just enough. Because although there is a degree at the end, it is really about the journey.

Tuesday Top of Mind 4/9/24-bbbbrrrraaaaiiinnssss

I was going to write about something completely different for this Tuesday Top of Mind. I had it written and everything but posted.

And then Arizona’s Supreme Court upheld an 1864 anti-abortion law, making it the law of Arizona.

A near-total abortion ban.

Okay. I see what you did there.

They resurrected a zombie law. A law that is technically still on the books but hasn’t been enforced in DECADES.

This completely dismisses more than half of their population. Because in 1864 women couldn’t 1) vote 2) hold office 3) hold property 4) hold a job 5) have a bank account. No women voted for it. Because they couldn’t. Women didn’t gain the right to vote in Arizona until 1912.

I am so incandescent with rage about this further degradation of women’s bodily autonomy and rights.

This zombie law has lurched back to life, aided by those who seek to control women and is now going to be fed the blood of those who it tortures. The women who request abortions and the often doomed children they are seeking to protect. Just like Texas. Just like Tennessee. Just like Florida. Just like any other state that has passed anti-abortion bills since the overturning of Roe v Wade and the Dobbs decision.

This is what Justices Alito and Thomas were signaling when they brought up the Comstock law against mailing indecent and lewd things in the mail during arguments about the legality of mailing mifepristone through the mail. You know, the abortion pill. The Comstock law hasn’t been enforced since the 1930s. I remember when it was bandied about when Larry Flynt was on trial for distributing lewd magazines in the 1970s and 1980s. That magazine was Hustler, among others. If I remember correctly, that is why magazines such as these started to be shipped in brown paper wrapping. To protect the eyes, you know.

Eye roll.

Cruelty and control are their endgame.

They don’t care about the potential child. They just want to control women and bring them to heel because we dare to think that we are people in our own right. With our own rights. With our own ideas. With our own bodily autonomy.

Cruelty is the point.

Control is the endgame.

Also endgame is to have the hard-won rights of women rolled back to when we could be controlled. If that ever was a thing.

This is what the attack on no-fault divorce is about.

This is what the attack on abortion rights is about.

This is what the attack on women’s bodily autonomy is about.

This is what the upcoming attack on birth control is about.

I’ve been writing and marching about it for years.

Increasing the birth rate of WHITE women by WHITE men is the ultimate goal.

This is and always has been about control and cruelty.

This is where being a Cassandra really sucks. No one believes us.

Gah!!!

School Me Saturday 4/6/24-Down the rabbit hole

Being in school very often results in having to do research. This can be for a paper, or a discussion post, or for a class. Students are always doing research. You trot on down to the library, at the college or other, and you, hopefully, engage in conversation with a research librarian.

These magical creatures exist to aid students. Kind of like the kindly shopkeeper or the stray magical beast who gives you the answer to your quest.

Except being in college is not an adventure game. I mean, it is, but not that kind.

Let’s pretend it is the middle of the night and the library is CLOSED!

And the assignment is due tomorrow!

What then?

For a student in this situation, there is probably an online version of the school library.

There is also Google Scholar. Warning, many of the literature hits from Google Scholar is open source. Which may mean they paid to get their article published. It is still a good option though, and better than plain Google.

But the clock is ticking and the assignment is getting hot. You enter your search terms in Google Scholar or the library, and this results in 4,332,662 hits. Far, far too many. This is where you start refining your search question and publication date. Often, schools only want literature or research from the last 5 years.

Through judicious refining, you only have 15 articles to read. You start reading the titles and find that they have little to do with your original search. But they are interesting and you keep reading.

And reading.

And finding.

And reading.

And finding.

Suddenly it is dawn and you can use absolutely none of the articles that you’ve found. You wanted to find articles about prohibition and suddenly you are reading about they made wine in 500 A.D.

This is the research rabbit hole.

You just keep digging yourself deeper in search of good stuff and all you are finding is not usable for this paper/assignment.

Research is a skill.

But even the research librarian has gone down the rabbit hole. Just ask them.

You are still going to go down rabbit holes. Being aware of the possibility of a fruitless search lets you make decisions about what to read and boundaries to put on your search.

Seriously though, reach out to the research librarian at the school. Or at the actual library in your town. They will have strategies to help.

Cookie Thursday 4/4/24- millionaire shortbread

Welcome to April in Cookie Thursday is a Thing. The theme for the month is the Taxman Cometh. Appropriate for April, no?

No, our taxes are not done. I wanted to get through the two assignments due this week. And then I’ll do the taxes. I have all the documents.

We always pay and with the 2017 tax breaks sunsetting for normal Americans who are not rich, I am anticipating a big bill. Even though I am in school that should theoretically offset some of that.

Some of my coworkers who have children are finding out they have to pay federal taxes for the first time. I remind them that since we are not the wealthy ones that Congress is so concerned about they put an end date to the 2017 tax breaks. A reminder that the corporate tax breaks do not have an end date. Makes you wonder about your worth as an American, doesn’t it?

This week’s make is the millionaire shortbread. This is a triple-layer cookie. There is a shortbread base, a caramel center, and a chocolate topping.

As always, I have thoughts. I should have scored the chocolate when it was half-set. I think then the caramel layer wouldn’t squish out as much. Because the caramel layer didn’t set appropriately.

The cookies are still delicious. Messy, but delicious.

Let’s talk sterile consciousness-what it is and what it is not

Sterile consciousness is defined as being acutely aware of potential or actual contamination of the sterile field or object and taking steps to remedy the break.

You want surgeries to be as sterile as possible; as a patient, and as a surgical team member. There is a LOT of work done to keep it so.

A break in sterility happens when there is an inadvertant introduction of something non sterile into the sterile field. This can be a tear in the drapes, this can be a puncture from a blade being opened in the wrong area, this can be stray hair in the sterile instrument tray, or when people where their surgical cap in a messy manner with hair hanging out everywhere.

Many things can break the sterile field.

Today, I want to write about the sterile caskets. These are the hard metal containers that the instrument tray is sterilized and stored in. Some of these caskets have single-use filters that must be replaced in the bottom and the top. This is so steam can penetrate the instruments during the steam sterilization process.

You with me so far?

The filters themselves can be inserted incorrectly. There can be missing filters. There can be punctures in the filters from incorrect storage or from loose instruments in the casket. There can be folds in the filters. All of these instances render them unsterile.

If in doubt, sterility has been compromised and another tray must be opened. Hard and fast rule in any of the ORs I’ve worked in.

During the case opening process, the scrub tech does not continue set up and will stand there holding the instrument tray until the filters in the bottom of the casket can be checked for holes. Don’t wander off during this time, your scrub tech will not appreciate it as they are literally left holding the bag.

This next break in sterility has been reported to me. The scrub tech was holding the instrument tray, waiting impatiently for the circulator to reach into the casket, pull out and inspect the filters. Normal right? Yeah, the scrub tech placed the sterile instrument set BACK INTO THE NO LONGER STERILE CASKET and was picking instruments that they wanted out of the tray. No recognition that the entire instrument tray had been contaminated and must be taken away to be re-processed and protesting when the circulator told them it was now contaminated.

That is what I mean about breaks in sterile consciousness.

Don’t do this.

The OR is complicated.

Tuesday Top of Mind 4/2/24-what fresh hell is there now?

The questionis what fresh hell is there now?

Well.

So much.

Republicans are still bitter that it is no longer the 1950s and women have rights and bank accounts and our own money. Therefore they are enacting laws to get us back there. When they mattered because money is power and women had none.

Apparently some women want to get back there. There is even a small movement around it. The Trad Wife. Or Stay At Home Girlfriend.

But do they really? Do they want to do all the chores without modern conveniences such as vacuum cleaners? Or dishwashers? And bake the bread from scratch. All the bread. And make all the dinners from scratch. And not have any other their own money in case the man in question no longer wants a stay at home wife/girlfriend because maybe a new little cutie has caught their eye. Maybe the new one would like to be a stay at home whatever.

No. I would hazard a guess that they want to be taken care of by a rich person. Where they don’t have to think about the money that is spent. Where they don’t have to pay X bill this month and hope that Y company does not cut off service for non-payment. Where they don’t have to wonder how to stretch the grocery budget this week for all the demands that the sugar person had. Where their only job is to look good.

Kind of hollow that life. It is kind of like the food that looks so appetizing in the store and tastes like sawdust.

Be careful what you wish for.

Don’t give up what control you have. Don’t let them take it away from you, no matter what they promise.

Instead of the gold ring, you might end up with a green finger.

Post-it Sunday 3/31/23-milestone post

This is from a message from WordPress, which is the platform this blog is on, specifically from the Jetpack, which is where I get messages and can write and share posts.

The message was Dispatches from the Evening Shift (that’s this blog) has had ONE THOUSAND POSTS.

One thousand posts like Post-it Sundays.

One thousand posts like Tuesday Top of Mind, previously Monday Musings.

One thousand posts like Cookie Thursday is a Thing.

One thousand posts like School Me Saturday.

One thousand posts like Wednesdays, which don’t have a name, but each is about the OR or hospital life.

This blog has been active since 2017. Through my MSN, through my PhD program.

Through being a working nurse during the fucking pandemic!

I just wanted to share that.

Thanks, as always, for reading.

School Me Saturday 3/30/24-Twas brillig, and the slithy toves…

I’ve decided to start a small series for School Me Saturday.

The title is taken From the Jabberwocky if that is any hint.

This series will be based on Lewis Carroll’s Alice in Wonderland and Through the Looking Glass.

It is spring and I think this is a good time to highlight the strange, wonderful world of higher education. Through Lewis Carroll and his zany books.

We will meet creatures such as the Dormouse, the Mad Hatter, the White Rabbit, and, of course, Alice herself. Delilah might have a cameo as well.

Who’s Delilah? Watch the movie. Spoiler, she was the kitten that Alice followed at the beginning.

Of course, we can’t forget the Cheshire cat.

Next week, I will be writing about the danger of rabbit holes and how not to fall down them, or at least how to get yourself out of them. A la Alice.

If you know, you know.

But don’t drink or eat anything strange. Even if they are labeled eat me and drink me.

Cookie Thursday 3/28/24-the ApocaPEEP

This is the final week of Well, That Was Easy March. And the week before Easter.

At this time the surgical schedule is kind of hit and miss. It all depends on where the doctors’ kids go to school and where their spring break falls.

This is also the fourth day of my new antibiotic (third one!) and I needed an easy make.

Enter the PEEPS.

For those who don’t know, the peep candy is a marshmallow body that is covered in sugar crystal, with two itty bitty wax eyes.

You either love them or hate them.

Me, I love them. I am enabled in my love for them too.

I long wondered if I could use the peep in a rice crispy treat. And you totally can!

But as I learned in the execution, you have to choose your peep colors carefully. I used what I had; pink, yellow, and blue. Eh, it was all I had. I kind of expected the end result to be gray.

Nope!

Very much in keeping with Dispatches from the Evening Shift and its war tone, where healthcare is a war and we are all on the frontline, the peeps turned out camo? Blotches of pink, yellow, and blue.

Very cool.