24- doing things the hard way

The gown card reads “So long people/nurses have done hard things the hard way because that’s the way it’s always been done.”

In the OR this is known as a sacred cow.

This means that this is the way things are done, not sure why, but it is important that we still do everything the same. Forever and ever and ever and ever.

And ever!

Um.

Simple question-why?

Think about that. Why do anything the same way because that is the way it has always been done? Do we not have brains to think of perhaps a better way?

Or is doing things the hard way a comfort moment? You know how to do a specific thing a certain way and you KNOW how to do it this way. Nothing anyone can say will change your mind. This is the way and this is the way it has to be.

Forever.

That’s circular thinking. And it is a trap.

I’ve been thinking about my parent’s generation. If they didn’t adapt to changing technology as it happened, they got left behind. And, boy howdy, has technology changed a lot! And the changes are coming faster and faster. In just my lifetime we’ve gone from tapes to CDs to streaming. Not to mention how the computers have changed; from large room-sized computers to palm-sized ones that we routinely carry in our pocket.

Imagine if any of the creators of technology had decided not to push out and dream about what is possible, instead focusing only on how it has been done forever.

What is next for medicine and healthcare? I know people would say artificial intelligence. Well, that is here and already disrupting the pond. And some people don’t like it. Let’s be real, some people are using it to cheat. I’ll be writing about that on School Me Saturday soon.

How are you going to disrupt the pond? How will you challenge those who say it can only be done one way? Granted, they might have a point and other ways have been tried and tried and put aside. They might know the things that have been tried. Maybe listen to them too.

Both things can be true at the same time.

But doing things the same way because that is the way it has always been done is not a good answer.

When you are doing rote tasks at work, ask yourself why are these tasks done this way? That might be the question you need to disrupt the pond.

School Me Saturday 6/1/24- destination unknown

Before I started this post, lyrics flashed into my brain. Something, something, something, destination unknown. I quickly searched for those lyrics to no avail. I texted my friend who has an encyclopedic knowledge of songs and asked for their help. They returned with an answer Golden Earring by the band Twilight Zone. Instead of being satisfied, I queued up the song, and listening to it jarred my memory loose. The song does contain the destination unknown lyrics but it is not the exact song my brain wanted me to remember.

You see, my brain has a military bent when it comes to writing this blog. I know it, you know it, the blog knows it. When I used to exercise in the early mornings with the Army while I was at Creighton, cadence was discussed as a motivational partner. Cadence is the military song that is often used during running to keep the runners on beat. I am sure that readers will have seen this in movies or TV shows. The military cadence memory that was jarred loose during the conversation with my friend was C-130 Rolling Down the Strip. The lyrics I couldn’t remember were “Mission uncertain, Destination unknown.”

Long story short, this satisfied the question in my brain, even if it did set me up for a cadence earworm. I will let you know when it finally leaves me.

After this rabbit hole, I was ready to write. Remember, this is very appropriate because School Me Saturday is doing an Alice in Wonderland and the adult learner theme.

Here’s the thing about starting education as an adult learner, it is important to at least have an idea of where you are going. To have an end goal in mind. It might change. That is okay, but it is better to know something about what you want to do.

Not to mention that it is the best use of your resources to have a goal in mind. But at the very beginning, it is all general education that everyone has to take. This is why some people start adult learning at community colleges. For the bang for your buck.

It is absolutely okay not to have an end goal in mind at the beginning of your education. That might come later. And your end goal might change a bunch of times as you settle into the degree that you want.

After all, the Chesire Cat said “If you don’t know where you are going, any road can take you there.”

Any road will take you to the end. The question is how much you are willing to do and how many classes you are willing to take before you have the answer to what is your end game. Exploring is good and healthy.

But, be warned, don’t get lost. As I’ve discussed, it is okay not to have an end game in mind. For a while but eventually, you will have to settle onto something. If only for your wallet.

To make a big circle back to the destination unknown lyrics, your mission in college is to end up with some sort of degree. Hopefully, one that can be used in your career, but that is not necessary. Even as you step onto campus the roads open up to you.

Choose a good one. One that will serve you best. And if you decide that the road you’re on isn’t the right one, pick another. But there will be consequences to changing in the middle of the stream. Time, money, and adulthood tasks that you feel are important.

Life is a trade-off, the roads are not always clearly marked. But don’t get lost.

Cookie Thursday 5/30/24- war on women’s bodily autonomy

I mean would I be writing about the healthcare battlefield without touching on the war on women’s bodily autonomy during War Cookie Month? I mean, who am I if I don’t?

The Cookie Thursday is a Thing theme for May is War Cookies. Appropriately this is also the month of Memorial Day and was completely unplanned when I decided to do this theme. Apparently, my brain is smarter than my fingers.

This is the 5th Thursday of the month and I am making basic chocolate chipless cookies for the week. This is chocolate chip cookies without the chocolate chips. Kind of a vanilla sugar cookie vibe.

Since this is War Cookie Month I would be remiss if I missed a chance to beat on the drum of women’s rights. Yes, again. They keep attacking us, keep whittling away at the rights they do deign to “gift” us. Since the Dobbs decision that overturned Roe v Wade, there has been a slow drip of rights being taken away. And then they realized that they could get away with more and the ripping away of women’s rights became faster and faster.

My tee shirt of the day is “They Won’t Stop at Roe.”

They aren’t even hiding the end game anymore.

Am I still mad as hell about the Dobbs decision? Fuck yes.

Will I still write about it in an unceasing drumbeat? Again, yes.

Am I alone in this? Absolutely not.

Are people not paying attention because it doesn’t affect them? Absolutely.

Vote in November. Remember what has been taken from women. And those who will be women when they grow up. And those who would be women because it is the best fit for them and that is truly who they are under the skin.

All of us are under attack.

Man the battle stations!

My next tee shirt will be a Ruth Bader Ginsberg one that says I am Tired of Listening to Old White Men.

Counting Basics #16- stray sponges and instruments

I’ve discussed 15 other types of counting basics. From what is counted, sponges, needles, and others to what happens if there is a miscount. Today I am going to write about the stray sponges and instruments.

One would hope that when a room is opened and prepared for a surgery that there are no stray sponges and instruments. In fact, the patient is depending on the counts being an accurate snapshot of all the countables.

A stray instrument is a not counted instrument. A stray instrument is also an instrument that is just hanging out on the computer desk, or in the marker tray under the white board. Or even used to hang the irrigation fluids. Or in the computer desk drawer.

This instrument is NOT included in the count.

Some of my coworkers call them the bonus instruments.

I call them a liability.

This goes for the sponges that are not included in the count but are just hanging out on the equipment boom, or on the shelves above the computer desk.

Some of this is to be saved for the worker in the room. I know I am of the thrifty sort and put aside sponges that have been passed off and not included in the count. For use at home.

But…

These stray sponges are not to be left in the room for the next surgery.

I’ll type it slowly. This is a liability!

Last week, after I took over for the day shift nurse and completed the surgery, and did the RF wanding (remember that?) prior to the closing of the incision. Like I’m supposed to. Well, when we were taking down the drapes, a raytec was taped over the foley catheter. Why? I don’t know!

But the scrub tech and I both looked at it, knowing full well I had RF wanded the patient not fifteen minutes before. I don’t know how they felt, but I felt sick.

This raytec was definitely not included in the count. We had done a relief count, and a closing count and a skin incision count and all 10 of the raytecs were accountable then.

Mystery sponge.

I will be discussing this with the nurse I relieved. And the manager.

My brain goes straight to the possibilities. None of them good. I cannot be alone in this.

These are new RF machines and apparently they are not as sensitive as the previous ones. I will be testing them this evening when I go into work.

No matter how you describe it, this is scary. And thoughtless. And leaves the previous nurse and tech as open to a lawsuit as myself and the evening tech.

Word to the wise, DON’T DO THIS!

And take the stray sponges and instruments out of the room prior to the surgery. Or count them. I don’t care which. But they have to accounted for. Our patients are vulnerable and they are depending on us to do the right thing.

Being accepting of stray instruments is not the right thing.

Ever.

Tuesday Top of Mind 5/28/24- incoming- misoprostol and mifepristone are now same schedule as opioids

Every day the right murmurs hold my beer when anything new comes out about the control of women. They are trying to one-up the other states in a massive race to the bottom.

I’ve discussed this at length.

They want to control WOMEN.

Full stop.

In Louisiana, the GOP legislature passed and the GOP governor signed into law that reclassifies mifepristone and misoprostol as the same schedule as opioids. Punishable with up to 5 years in prison.

This means that anyone caught possessing or using without a prescription. Or those who aid in the pregnant person obtaining the medication.

However, the law does say that the medications can be used for other applications besides abortion. In my experience, the drug mifepristone has been used to control bleeding after delivery. How kind and generous! (this is heavy sarcasm). Also kind is that women who are pregnant and possess the medications will not be charged.

Is the yet heavily implied? Or is that just me?

More like with every iteration of this insanity, they learn from each other and the mistakes that trip others up.

Are they screaming and scheming loud enough for you yet?

It is not about the fetus or the child to be.

It is, and has always been, about controlling women. If it were about the child there would be comprehensive health care both before and after birth, and subsidized childcare since women have to work to feed the child.

There goes Louisiana from the list of states I will currently travel to.

Pocketbook protesting.

If you know, you know.

Post-it Sunday 5-26-27- Outlook not so good, ask again later

The gown card reads “Surgery is not without its risks.”

My favorite thing is when people assume that surgery will solve everything.

Or should I say least favorite thing?

I get it. People want surgery to be an answer. Strike that. People want surgery to be THE answer.

My second least favorite OR thing is when people discount the c-section as not surgery.

Bitch, we opened up your belly like a can opener to get the baby out.

Understand?

I mean, we put it back together and stitched it up real nice. But the point is that someone was inside your abdomen, rooting around. There are all sorts of risks in this.

And people just answer no, no surgeries when asked in pre-op about previous surgeries. Only to casually drop that all four of their babies were born via section.

Um. That is major abdominal surgery. With a great prize at the end. But major abdominal surgery nonetheless.

But back to the least favorite thing with patients assuming that surgery is the answer to all their problems. Nope, not even a little.

There will be the risk of anesthesia. The risk of death. The risk of infection. The risk that the surgery might not even solve the problem that the patient is having. The risk that surgery itself will lead to another list of problems because of the risk of anesthesia, the risk of infection, or even the risk of it not being the appropriate surgery for their problem.

Why?

Because often to cut (do surgery) is to definitively find out what the problem is. Even if the problem was not the one that the patient and the surgeon thought they had.

Because your skin and insides are not transparent and until the surgeon gets a direct view of the problem, there is always the possibility of a missed diagnosis. Because although surgeons are excellent at their job (ahem, for the most part), they are not prognosticators.

This means they don’t have a crystal ball.

All they can do is their best.

And all the OR team can do is support them.

This is how you get the best outcomes for patients.

There is no magic 8-ball in surgery.

Imagine if there was.

School Me Saturday 5/25/24- the hookah-smoking caterpillar in the corner

In this continuing Alice in Wonderland/college/adult learner exploration, I would be remiss if I didn’t address the caterpillar in the room.

I am, of course, referring to the Blue Caterpillar who is first introduced to Alice by challenging her existence.

OOO….RRR…UUU spells the smoke as the Blue Caterpillar looks at Alice and placidly sucks on the hookah.

This is a very important question. WHO ARE YOU.

This is an answer that college will definitely challenge. After all, being in college usually means working toward a degree or a certificate that will redefine you. It is important to begin the journey with a sense of self.

During Alice’s time in Wonderland, the Blue Caterpillar is important, beginning with the first question. Her answer is that she doesn’t know, or, rather, that the answer had changed from that morning. Being aware of the changes in perception of self that college brings is also a very important nugget of information to have. Of equal importance is the acceptance that Alice has changed as a person, even since she woke up in the morning.

In my myriad of college experiences, I feel that I’ve remained the same person, even though that cannot possibly be the case. It is how others perceive me that has changed. I was a teenager in my first experience and I grew up. As one does. I was a CNA when I re-started nursing school after an injury. Through that journey, I became a telemetry tech and a uni secretary who just happened to do CNA tasks as well. After nursing school, I was a nurse. Going back to school for my BSN, MSN and now, I remain a nurse first, and a student second.

Every college experience is a journey. Hopefully, you or your Alice has a Blue Caterpillar to offer up things to eat for growth. Kind of like how students have to go through classes, learning and writing all the way, to get out the other side.

The Who Are You answer may fundamentally change.

Or it might not.

But growth is the way through college.

No matter how it is defined.

Cookie Thursday 5/23/24- Vietnam care package cookies

I called in sick last week.

No cookies were made. I’m telling you, I want off this ride that I’ve been on for 2 and a half months.

Today, I made the cookies I was going to make LAST week.

Soldiers rely on care packages. And what is Cookie Thursday is a Thing except a weekly care package to my coworkers in the OR? I keep coming back to healthcare is a war footing and healthcare workers as soldiers who are fighting the healthcare war.

This recipe I found when I was looking up war cookies. It is from Pinterest and the title of the pin is Action Vietnam Cookies. The blog this cookie recipe is from is Cookie Madness. The recipe was originally from a book called Food Writer’s Favorite Cookies.

Apparently, these cookies ship well and age well. The cookies themselves are made with no butter, instead with lard which helps with the shelf stability. I used Crisco.

They are an amalgam of bananas. oats, chopped walnuts, chocolate chips, cranberries, and coconut. They are seasoned with nutmeg and cinnamon.

When I dropped them off, several people were waiting. Because, you know, I missed last week.

I hope my coworkers feel taken care of with these weekly care packages.

I know that I feel more involved for having made them.

Tuesday Top of Mind 5/21/24- anti public mask law proposed in NC

Um.

Are they trying to kill people?

Or is this a desperate cry to their base and the millions of people who HATED to wear a mask in the worst public health emergency in 100 years?

Masks save lives.

Full stop. End of story. Masking to save lives was true in the Middle Ages and the Black Death. It was true in 1918 during the Spanish Flu Epidemic and it is true today.

But, but what about the masked fiends who are protesting? Or who are breaking laws? What about them?

Increasing penalties for committing a crime while wearing a mask I can kind of understand.

But protesting is not breaking the law.

And neither is going out masked because someone is medically vulnerable.

This bill would make it illegal to wear a mask out if the wearer were medically fragile.

Consigning them to house arrest.

That is not a good look for the NC legislature but they don’t care. Doctors and other health professionals (hello, I’m right here) have spoken out against this proposed legislation.

Make no mistake, this is mostly about the protesters who wear masks.

And control. It is ALWAYS about control.

But what about the white supremacists who are trying to hide their identity.

What about them?

Post-it Sunday 5/19/24- Easily amused

The gown card reads “I need a tee shirt that says Easily Amused.”

Yes, please. I would like that tee shirt.

I have lots of tee shirts. Because I find them amusing. They run the gamut of “save the bees…or else” to “Be Prepared.” This last is a Lion King reference with Scar on the front of the shirt, surrounded by green wafts of smoke.

I have pandemic tee shirts. I have vaccination tee shirts, I have two “Practice Safe Science” tee shirts.

Recently I bought a bunch of Star Wars tee shirts. What? They were on mega sale because of May 4th.

Most recently I bought several so-called women’s issues tee shirts. I have a “Roe, Roe, Roe, Your Vote” one, and a “They Won’t Stop at Roe” one. The ones that kicked off the protest tee shirts were an Alan Turing one I bought in 2020 and two different Ally tee shirts that I bought to volunteer last May for Pride. My current favorite is one that proclaims “He Who Hath Not a Uterus Should Fucketh the Hell Up”, attributed to Fallopians 19:73. I have 2 of that one, one a tee shirt and one a tank top.

The newest one is one with a rooster on it that says “Regulate Your Cock”.

I’m going to wear these for Tuesday Top of Mind posts. Or maybe, all week long. Until the November election.

To get me in the correct mind space.

So much about life in these United States these days is not amusing.

Far from it.

From the culture wars around LGBTQ+ and the rot of women’s reproductive health, and the book bans. These issues are ALL helped along with jerry-rigging of the states by the Republicans to ensure that they and they alone control the state houses and the governorships. All the while making it harder for people who are citizens to actually get out and vote.

So, yes, I will take several of those “Easily Amused” tee shirts. My sense of humor needs all the help it can get.

If you want to know how I am feeling, just read my shirt.

Or my head. My mowing hat says “Fuck These Laws” with reproductive health pins all over it.

But mostly read my shirt.