24-the to do list condundrum

You know when you are making a to do list and sometimes you get excited and forget that things such as time and energy and concentration and so you overload the to do list? And the next thing you know there are 16 items on your to do list that take at least an hour each.

I know I am not the only one this happens to.

I know I am not the only student this happens to.

The ultimate key to being a student is to be aware of this tendency and not overload your to do list. This leads to decision paralysis and you putting off items from the to do list until tomorrow.

Or never.

The take away of today is to be careful of the to do list. They are useful to utilize for the future. Just be careful of how excited you are to do the things on the list. Because future you may not be as excited for the to do list.

On my current to do list until Tuesday is

hang up the poster I am presenting
go to as many sessions at AORN that I want (I currently have 15 on the list)
give the presentation about the poster on Monday morning
Peer review session on Monday afternoon
delegate responsibilities of first forum
delegate sessions
closing sessions.
Drive home
Reading and notes for Friday’s classes

After Tuesday

RA make up day on Wednesday
3 hour class on Thursday for work
Cookie Thursday is a Thing make for Thursday
Work on Homework #3 (due 3/17)

But this is a conference week. Of course I have lots to do for that. I kept the list short for the rest of the list. Because conferences are exhausting.

Monitor yourself when making a to do list. Ask yourself if this is something you want to do, have time to do, have the energy to do. But be careful of the very human tendency to max out your to do list and be exhausted about it and nothing gets done.

Strategies can include writing a a ranked to do list where the important things to the top of the list. Or gamifying it by assigning colors like the traffic light to the importance of the item on the list. Red means caution, be careful of your energy levels and your attention, yellow indicates lesser importance, and green indicates must work on. Or star the items on you to do list 1-5, depending on how important they are.

There are many other strategies. Like so many things, you just have to find the one that works for you.

Just be careful of how many items you put on your list.

Tell me when you find your to do list strategy.

Cookie Thursday 3/7/24-parmesan crispy wonton crackers

The theme for March is similar to the November 2023 theme of Something From Nothing. That was where I made cookies out of whatever odd ingredient was in my baking pantry. At the time there was a poll taken with the two choices being 1) Something From Nothing and 2) Well That Was Easy. I knew that I wanted to return to the Well That Was Easy Theme in 2024.

I have decidedly simple recipes in my stack of recipes. These will become the Well That Was Easy makes.

This week, to kick off March will be the Parmesan Crispy Wonton Crackers.

I had two choices again, use storebought egg roll wrappers or make my own. Out of expediency, I bought egg roll wrappers. The homemade ones will have to wait until I am not preparing to leave for a conference. I have to practice rolling out dough to very thin some other time.

This recipe is very easy, very fitting with the theme. Egg roll wrappers, cut into strips, olive oil to wrappers, top with parmesan cheese. The original recipe called for thyme and parsley. I decided against that for 2 reasons (always the 2), 1) I hate parsley and 2) the OR is skeptical of green stuff, jalapeno chocolate chip cookies notwithstanding.

Bake the doctored strips at 375 degrees Fahrenheit for 8-9 minutes. Keep careful watch, these brown super fast.

I did hold back about 15 that I thought had gotten too brown. I am going to crunch these for use as salad toppers. What salad isn’t improved by a little crunch?

Tuesday Top of Mind 3/5/24-Nex Benedict

Tuesday Top of Mind for 3/5/24 has been simmering at the top of my mind since I learned of their death. They died one day after a beatdown by three classmates in the bathroom. In which they lost consciousness due to their head being beaten on the floor.

No ambulances were despite that.

They were being made fun of by the three girls and they flicked water at them.

For that, they were beaten to unconsciousness, and not given timely care at the hospital.

Instead, the school called their grandmother, who took them to the hospital. They spoke to police officers who told them that they started the fight with the water.

Flicking water to a beat down. Doesn’t seem fair, does it.

After giving their statement at the hospital and being released into the care of their grandmother, they collapsed and died the next day.

Preliminary autopsy reports stated that they did not die of trauma. It took pressure from trans activist groups and allies to get the U.S. Department of Education to open an investigation into their death. If the school responded appropriately in this matter. There have been student walkouts regarding Nex’s death and the widespread bullying the students say goes unanswered and uninvestigated. Even University of Oklahoma students staged a walkout.

The state superintendent denies. He goes as far as to say that transgender and nonbinary people do not exist.

Well, I know some transgender and nonbinary people and they are not unicorns or dragons. They are people.

I want to write directly to those who think this beat down was justified, and Nex deserved whatever they got and ask of those who think this who hurt you? Why do you care that this is the way they lived their life? Does it impact you personally when someone identifies as that with which you don’t agree?

I can’t understand it for you.

According to the Human Rights Campaign, 35.1% of transgender youth live in a state that would spit on them if they were on fire. Okay, I added that last part. However, 35.1% of transgender youth live in a state that is actively trying to ban them. Think why that is.

Is it because they dare to be different? That’s another good question.

Some states are going so far as to ban gender-affirming care until the age of TWENTY-SIX! You know, adults. If this doesn’t make you mad, I can’t explain it to you.

Did I know Nex Benedict? No. But I know others like them. The ones you want to shit upon for being different. The ones who are afraid today of what tomorrow will bring. Afraid to be themselves. May you never know that kind of fear.

I have some questions for you. Again, what does it matter to you? Could it be that the banning of all transgender and gender-affirming care led to this? The horrible rhetoric of the current State Superintendant of Schools Ryan Walters? The emboldening of people, like the girls who were involved in the altercation and were the ones who physically assaulted Nex? Could it be? Why do you care so much?

Please reflect upon that.

School Me Saturday 3/2/24- do not panic!

It is already March.

I said not to panic. It is going to be okay.

It is probably midterms or even Spring Break.

Time to give yourself some time to breathe. Maybe take a walk. Or out with friends. The work will still be waiting for you when you get back.

Me? What do I do to relax between homework assignments?

After I started feeling better after a truly awful week, I was very excited to actually get to go on the movie date with my sister. We had lunch out before the movie.

We saw Lisa Frankenstein and it was hilarious. Kind of the way Shaun of the Dead is. Macabre and dark and funny. Definitely a must-see.

And when the younger generations get their hands on it, as it was a blink and you miss it in the movie theaters, this has cult classic written ALL over it.

Afterward, I noticed that my phone had done a video for me about my two cats and I was showing her how to access one on her phone. Suddenly, in the middle of the pictures of her cats who died in 2019 and 2020, there was her picture. SUDDENLY.

I’ve not laughed like that in a long time, sputtering and wheezing, and coughing the entire time with tears. I needed that as much as the horror comedy we just watched.

Find time for the laughter. Your brain will be thankful.

Now that my brain is refreshed, I have a Measurement homework due tomorrow and my newly declared get homework in early to do. It was a good thing that I had this declaration as I had turned in my qualitative homework nearly 6 days early and then spent the next week recovering.

Cookie Thursday 2/29/24-jalapeno chocolate chip cookies

To cap off the month’s theme of favorites I made jalapeno chocolate chip cookies. This is the department’s hands-down favorite. I mean, I get the appeal. This is the cookie I was going to make last week before I got horribly sick on Thursday. I had already written the week’s selection on the board on Wednesday and then… I did not bake on Thursday. I barely got out of bed.

My stamina remains in the toilet and I have to be careful how much I do.

However, knowing that these are a crowd favorite, I did not want to disappoint a second time. My brain went off this morning at 0619. Again. I don’t think I’ve slept past 0700 since last week. There was also a hospital meeting at 0730 AND the 4th quarter awards at 1030. I did what any other workaholic would do, I got up and mixed the cookies. The first tray went into the oven at 0715. The meeting began and went on. Thank goodness for Zoom. I engaged when I was asked to engage and offered up ideas for the group. The meeting ended at 0815 and the last tray of cookies came out at 0832.

Neat.

However, I noticed that the cookies were not baking up to their usual cookie-ness. They were tender and flat. I think the baking soda is going bad, although I JUST BOUGHT IT in December. At least they tasted the same.

The jalapenos were not very hot at all. I had gotten them for free from a farmer I know back in September. I processed them to freeze them for use in cookies. I did have them come to room temperature before baking.

When I dropped the cookies today and rewrote what the make was on the board, one of the other nurses told me that some people were hot about no cookies last week. Especially, no jalapeno chocolate chip cookies last week.

Oh, well, that’s the way the cookie crumbles.

twilight time

No, not the book, or the movie. Not even the twilight sleep that is used during some surgeries and procedures.

Twilight time is when it is too early to call in the call person because their shift hasn’t even started, it is too late not to.

When I was the working evening charge nurse this time would drive me crazy.

Scenario 1-Surgeon A is swearing up and down the patient will be out of the room by 1845. Surgeon B is putting pressure on you to approve the add-on because the patient is very sick and needs surgery like an hour ago when Surgeon B was still at the office. Funny how add-ons come AFTER the office is closed. The anesthesiologist is just wishing you’d stop taking add-ons. The charge CRNA is just wanting to be off the floor and back to their call room.

You’ve got a bad feeling about this. Okay, Solo, you still have to make a decision. You choose to allow the emergency.

You feel like this is a bad decision but you put into motion the add-on case because sick patient. The add-on gets started in a timely manner and you are the circulator here, with the evening scrub tech as you scrub tech. But wait! Surgeon A is not going to be done at 1845 after all, maybe yes, maybe no. (shocking that)

But you have to relieve the team from Surgeon A’s room.

Multiple choice time:

Do you throw yourself on the mercy of the team in Surgeon A’s room and ask them to pretty please stay late?
Do you want to roll back time and not accept the add-on?
Do you call in the night tech and beg for them to come in?
Do you call the evening tech and tell them to come in?
All of the above
None of the above
1, 2, 5 only

What would you do? Oh, never mind, Surgeon A will be finished at 1855. Crisis averted. Yeah, except for your cortisol levels.

Scenario 2- The evening scrub tech gets ill very quickly and has to excuse themselves to go throw up. It is 2010. It is too late to call in the evening tech who would take the full thirty minutes to get to the hospital. It is too early to call in the night tech (who starts at 2100).

Multiple choice time:

Which one do you call?

the evening call tech who will surely yell at you and take their sweet time getting to the hospital
the night call tech who will surely yell at you and take their sweet time getting to the hospital
the surprise third choice, the night call nurse who lives the closest and will be glad to come in.
the even more of a surprise 4th choice, call for help from the ACU staff to see if they can spare someone who can be directed by you because you are scrubbed in until the called in tech can arrive.

What would you do?

Unsurprisingly, this is a dilemma that I faced weekly, if not daily, as the evening charge nurse.

Be kind to your charge nurse, there are forces and pressures that you cannot understand until you are in the role yourself.

Sometimes you just have to call in sick, you know?

I am ill. I can count on one hand the number of times I’ve been ill in the last 19 years. I had vertigo in 2005 and was flat on my back for 2 weeks because I couldn’t stand up. I think it was 2005, it might have been 2004. I had a cold in 2013. I had a persistent bladder infection/kidney infection in 2018. I know because it was so bad I basically gave up in class for my masters and I had to repeat it after taking 6 months off. I got food poisoning in May of 2022 that was so bad it put me off fast food and I haven’t had it since. I had a cold in July 2023. My body doesn’t like to rehash things, I guess?

Until today. Well, Monday. I won’t talk about symptoms, just know they were intense. Fever, pain… you get the picture. Hello, bladder infection.

I am on antibiotics.

I had the worst sick day on Thursday I’ve had since I had vertigo. I THINK my fever topped 103 but I’m not sure because I was shaking so hard from chills. The shaking made my muscles hurt. Or I have a concurrent viral thing going on.

NOT COVID.

I know, I tested Thursday AND Friday.

This week has been a bust.

No cookies.

No blogging.

But sometimes you just have to call in sick.

And I did, on Thursday. And if I still have a low-grade fever, yes, STILL, on Sunday. I will be calling in sick to the research assistant job.

I feel 60% better, but I’ve been having a low-grade fever since Monday. 99-101.6, with a high of 103. Not well enough to focus on my homework assignment that is due on Thursday, or reading for next week. I do have something VERY VERY IMPORTANT to finish for my third class.

I will have to focus on that tomorrow.

Let me run to the thermometer and recheck real fast.

I’m back; 100.8. Joy.

I will check back in with the doctor on Monday.

The work-around, what is it and why can it be dangerous?

Picture that you are an operating room nurse going about your day, doing cases, preparing for the next case, taking patients through the entire process of the case, induction of anesthesia, case, emergence from anesthesia, and taking patients to the recovery room. The entire gamut.

Suddenly management appears with what seems to you to be a new nonsensical rule.

Let’s use the example of not having bottles of saline in the warmer above 104 degrees Fahrenheit.

They leave you to your own devices.

You continue on with your shift, cases, lunch, more cases. The usual, you know.

When suddenly a surgeon says out of the blue that they wish the saline that was being used to wash out this patient’s abdomen were a little warmer. They don’t think that 104 degrees Fahrenheit is warm enough. After all, the saline doesn’t feel warm to their gloved fingers. Everyone knows it cools off during pouring and as it sits in the pitcher on the back table. Can’t they just have a little warmer saline? For the patient.

The work-around is used to circumvent the rules. Because the rules don’t make sense to you or to your coworkers. You think to yourself, why should the saline only be at 104, the blankets are heated to 130. I can just stick the bottle of saline in the blanket warmer. The patient will be warmer, the surgeon will get off my case, and everyone wins.

You continue to put the saline bottles in the blanket warmer. The surgeon is happier. Because what is the harm?

That’s the lure of the work-around. Standing up against the nonsensical new rule. Or finding a way to do a task a little faster than the last time. It can feel good to find a useable work-around, kind of like a dopamine hit.

But…

You have to consider why the rules exist. In the litigious realm of healthcare, it usually is because someone fucked up. Somewhere else. And the powers that be overreacted and made a new rule. But the rule is impacting you now. However, consider the possibility that there is danger behind the rule and that management and leadership are trying to protect you and the patient.

Going back to the saline bottle that has been warmed, routinely, 26 degrees more than the rule says. Ever consider that the rule change wasn’t arbitrary? That warming the bottles to 130 degrees had the potential to cause real and considerable negative impacts on the patient. Maybe it was discovered that the plastic of the bottle leached into the saline and therefore into the patient at temperatures above 120 degrees. Maybe there had been a reformulation of the bottle’s chemical formula that let this happen and the company found out about it and was just trying to protect the patient.

Is this scenario unlikely? No, more than likely.

Are the kudos and the dopamine you get from the surgeon enough to risk the patient?

That is why work-arounds, although sometimes useful and needed, are dangerous. Rarely do they give up all the facts when making a change, they may not even think about it because they, as leadership and management, know the reason behind the change. I’ve only met a few management-type people who offer up the reasons behind the change, instead of taking the hard line of “because I said so.”

Even before I went back to school I was always the one who needed the data behind the decision. Nothing has changed.

After all, the patient on the OR table is the reason for our job.

Tuesday top of mind 2/20/24- Cassandra calling

We warned you.

We warned you about the threat to Roe, despite assurances that there was nothing to be concerned about with settled law. Look what happened to Roe v Wade with the Dobbs decision. You know, the decision that knocked down fundamental, important rights of being a woman: the right to bodily autonomy, the right to privacy with discussions with their own doctor about their own body. That decision.

We warned you that medication abortion was next.

Along came Kacsmaryk and his ruling that called into question the FDA safety processes around mifepristone. The same ruling that was based on shoddy research that has since been recalled by the publisher? Yeah, and the case is now in front of the Supreme Court which has already shown willful disregard of laws and precedents in order to advance their religion on the United States. That one.

We warned you.

We warned you that in vitro fertilization was next.

After all the logical path says that if all abortion is murder, then in vitro embryos must be treated as people. The Alabama Supreme Court yesterday ruled that the embryos that were destroyed by accident by someone who wasn’t even allowed to be in the room but “wandered in” opened the freezer, took out embryos, and dropped them because the very cold temperatures required to gave them freezer burn to their hand. This broke the frozen clumps of cells. Yeah, and that temperature is -320 degrees Fahrenheit. The Alabama Supreme Court ruled that the embryos were to be considered children.

This was a terrible thing to happen to those cells. Terrible for the clinic that housed these cells, terrible for the family whose potential children were destroyed by someone “wandering around”. There should be charges.

However.

Respectfully an embryo is not a child. Embryos are potential children.

This ruling will send shockwaves through reproductive health. Again.

On a side note, the Mayo Clinic 10-20% of known pregnancies end in a miscarriage for a variety of reasons. That is not even counting the ones that are not yet realized and the woman may think nothing of a 1-2 day delay in her period or not even have a delay in her period.

Shall we take bets on what the courts will say about that? Are women going to be punished for having a miscarriage, a phenomenon that often has no answer and no causative agent? For being a woman. Bet me and you’ll be proven wrong when this slippery slope gets steeper and faster and men can act out their revenge fantasies on women. Because control.

I am sick of being Cassandra for reproductive health. Reminder, Cassandra was the daughter of the last king of Troy. Apollo bestowed the gift of prophecy on her in exchange for her doing his bidding. When she refused him, he said that no one would ever believe her prophecies. Sound familiar? Are you icked out yet?

Control has been the cudgel of powerful men for millennia. Even in fiction.

For now, in Alabama, frozen cells are to be conferred personhood.

We should all be frightened.

School Me Saturday 2/17/24-the more we learn, the less we know

The more we learn, the less we know.

This is a stark statement and it can also feel a bit disheartening.

What do you mean I have more to learn? When can I be done?

We can break down the phrase. The more we learn. Yes, there is always something to learn. It is impossible to know everything about everything. Learning is a privilege, some people do not have that luxury. We’re not going to unpack that; that’s a Tuesday top-of-mind topic.

If you have the opportunity to learn, absolutely do it! No matter how you learn, what you learn. It is always important to stretch those brain muscles.

The second part of the saying is no less important than the first part. The less we know, to me this means there is an opportunity to examine what we know and what there is still to learn in whatever realm you want to learn.

If you are a current adult learner you are already engaging with learning more. The key is always to be learning more and expanding your knowledge. You have to be content with the learning because it is not about learning all the things. Because that is impossible because no one has the time to learn all the things, not in a human’s life span. Even AI doesn’t know everything. Because there is always knowledge being generated in every minute, in every day.

Albert Einstein said that the brain is a muscle. In growing older the idiom if you don’t use it, you lose it really becomes clear. Your brain, your muscles, the foreign language you took in high school. All of it has to be augmented; there is always something to learn.

That fact that there is always something to learn is the takeaway from today. As is the idea of additional education in whatever realm that you want to learn.

Learning will never be done.

There is always something new. Being willing to learn is half the battle.