24-cracker toffee with chocolate on top

To recap the theme of the month is Tracie’s Favorites. This is sadly the last Thursday that Tracie will be at the hospital and the fourth cookie on her favorite list is cracker toffee with chocolate on top. This is also called Christmas Crack, or Cracker Crack but I like Cracker Toffee with Chocolate on Top as a name.

Let me tell you a little about Tracie. She’s whip-smart and has seen some shit in her life and is one of the most caring nurses I know. And she’s leaving us. Insert sad face here.

She let me poach her from the pre-op staff. There was a patient with an injury and a surgeon who wanted to fix the patient but the patient had had pizza about 2 hours before. It is the same old story, surgeon didn’t want to wait, patient needed surgery but it wasn’t urgent enough to compel anesthesia, or the surgeon didn’t declare it an emergency. It’s been a long time, details are a bit fuzzy. It was decided that the patient could have surgery IF it was local anesthesia only.

Well, on call there is only the OR nurse as the only nurse in the department. A local only needs 2 nurses, a monitor nurse to monitor the patient’s vital signs and talk to them and keep them calm and a circulator to do all the OR things. I took a chance and called one of the recovery room nurses on the off chance she would want to be the monitor nurse so we could help this patient.

Tracie agreed to be the monitor nurse. I think it was the exposure to the OR, talking to the patient while keeping them calm, and watching the surgery over the drapes that hooked her into the OR. After that case, she talked to the manager about training her as an OR nurse. I am very glad she did. One summer there were 9 babies born to the OR staff over the course of 4 months. This meant that there were 9 people out on maternity leave, staggered over that time. She and I tag-teamed and did ALL the call for the summer. I took the night call and she took the day call. It was grueling but we got through it.

She has been my best cheerleader in my academic endeavors. I went back to school for my BSN, and she said what about getting your MSN and teaching. I had already been thinking about it and she helped me make the decision. When I said I was thinking of going back to school for my PhD she thought I was crazy at first and has been supporting me in this decision the entire time. Through the onerous PhD application process, the interviews, the recommendation letters, through it all.

I’ve heard about her life and her husband and her kids for years. Basically watched the kids grow up through her stories and pictures. Talked at length about her retirement plans in 2025. And we talked and supported each other through the freaking pandemic. She and I both worked the entire time, because someone has to be the OR staff in emergencies.

Tracie, there will never be another OR nurse like you. It is exciting for you that this is your last week in the OR at this hospital but also sad for us, no matter what certain people say. Let’s just say there is a reason that she is leaving the department and the hospital and I don’t blame her.

It’s raining men

It’s raining men and women. Because gravity is a thing and a real force to be reckoned with. Gravity doesn’t mean to hurt us, it is just doing what a force of nature does without caring what we pitiful humans think. Gravity, if it was sentient, would not spare a thought to making people fall.

However, as fragile humans, we have to think about it. How many times have you seen an edge of a sidewalk that has come up because of root action by the nearby tree and thought to yourself “Gee, someone better alert people about the uneven ground? I’d hate to see someone fall.”

Anyone? Just me, then. Cool.

The slip, trip, and falls were the largest percentage of staff injuries last year. Because gravity has it in for us. If it were sentient.

However, and I know I’ve written about this before, there are things that you can do to improve your chances of not getting hurt. Exercises to improve your balance will always be important. Maintaining muscle mass, not only as a cushion but as a way to foster reflexes will always be important. Because if your reflexes are fast enough, you can catch yourself before you fall. Knowing HOW to fall is paramount. I can’t tell you how many times we’ve had a patient with both wrists broken because they put their hands in front of them or behind them as they fell.

Gravity, much like time, is an immutable force. However, you can certainly take care of your vessel by maintaining balance, and reflexes, and learning the proper way to fall.

Maintaining your bone health is also very, very important. If you don’t have an adequate substructure, it doesn’t matter if you have great balance and great reflexes, an injury is more likely to lead to broken bones. Weight-bearing exercises and a good diet will help with maintaining the strength of your bones.

And women. Sigh. After menopause, women lose bone strength, because of estrogen loss. Estrogen plays a very important part in bone turnover.

My advice to you so you don’t end up on the operating room table.

protect your bones by eating a well-balanced diet.
Learn how to fall.
Ask your doctor if there is something that you can do to decrease bone loss.
Weight-bearing exercises are your friend to support the maintenance of your bones.
balance exercises are also very important to maintain your balance to decrease falls.

Bone density loss is a fact of aging. Protect yourself.

Because gravity doesn’t give a shit.

Tuesday Top of Mind 2/13/24-color me surprised, the articles about mifepristone were retracted by publisher

Shocked, I am shocked. This is heavy sarcasm.

Does anyone remember the debunked articles by Andrew Wakefield that began the most recent wave of anti-vaxers nonsense with a widely exposed fraudulent article in the Lancet conflating autism with childhood vaccines? And how every parent clutched their child to their breast and decided then and there that of course the man was telling the truth. With nothing underneath him but air? Yeah, him.

Healthcare workers, such as myself, have been educating parents about how safe vaccines are ever since. But the idea was like an earworm and refused to die. As a society, we are still dealing with the fallout and the consequences of this. Current measles outbreak numbers do not lie.

Herd immunity works very well. But the public has to be 1) vaccinated for it to work and 2) be protective of those who cannot get vaccinated, like the very young, the people who are anaphylactically allergic to the vaccines, or those who cannot otherwise take the vaccines.

Think of what the planet just went through with covid and you have a good idea of how damaging and heartless this was. People who didn’t get the widely available and FREE covid vaccines extended the pandemic.

To be blunt, autism is NOT caused by vaccines. To mislead the public into believing that was a gross malpractice on the former Dr. Wakefield’s part.

Well.

The 2021 paper that the Texas judge used in a ruling against the use of mifepristone has been yanked. By the publisher. Retracted by the publisher. What the judge did was bend the facts to make his ruling that mifepristone was dangerous and should be stopped. And his ruling was appealed and stayed and overturned. Which is what was the intention.

The case that is in front of the U.S. Supreme Court right this very second.

I’ve said it before, over and over again. This lunacy is a war against women and is about trying to control more than half of the population. Control is at the root of this.

Will they care that the original ruling was based on a retracted by the publisher paper?

It remains to be seen. I have an idea about what will happen. Don’t you?

I hope I am wrong.

Post-it Sunday 2/11/24-Sorry, the universe says no

The post-it reads “Sometimes the answer from the universe is no.”

I’ll just let that sink in.

What does sometimes the answer from the universe is no even mean? Can it apply to all things? Can it be applicable as an answer that I can give people who are asking the impossible of me?

I know that when I wrote the post-it it referred to the sometimes crushing inability of health care to solve all physical ills. That sometimes the damage is too great for even surgery to surmount. That sometimes medicine and medication and surgery won’t have the answer that people are asking. Or the answer that the universe gives back is a resounding no.

Heck, even money isn’t the answer in some cases. Well, in most cases. No matter the rich rich rich seeking to live forever.

Wow, this got dark fast. Well, I’m doing a PhD assignment. (shrugs)

But sometimes the answer from the universe is no and remains no. All the pleading, tears, and money in the world cannot make that answer a yes.

To get RREEEEAAALLYYY philosophical, maybe the no is the answer that you need to hear in that moment.

What about that?

School Me Saturday 2/10/23-Fear of failure

The fear of failure is very real for students.

What if I fail a test? Does mean I fail the class? What if I get an F on a paper? Does this mean I fail the class?

What if my alarm(s) fails to go off?

What if I fail to get into the homework study group that I really want into? What if I fail my parents, my significant other, myself?

What if I fail the class? What if I fail myself? What if I fail the class? What if I fail the test? What happens if I fail? Will I have to leave the program?

Calm down. Take a deep breath. Breathe in, breathe out.

Calm.

You can work yourself into a big tizzy thinking about all the things that could happen if you fail. Your mind can go faster, faster in circles. Like a dog chasing its tail.

Failure happens. I am quite certain that all of academia has seen every iteration of failure. All the ways that people fail.

Some people will tell you that failure is not an option. Obviously, it is or we would not be so scared of it. But what to do about it?

Reams and reams of articles have been written on the subject. All I can tell you, with any certainty, is how I deal with academic fear. Because I’ve been afraid as a student. Many times. it is how to meet the fear head-on that allows you to gain the courage to go on. And go to the next class.

I sit with the fear and play the what-if game. What if I fail this class? What if I fail this paper? There are conversations you can have with your instructors about make-ups, or extra credits, or even if the grades will be on the bell curve.

The movie Dune tells us, through Paul Atreides (the main character, AKA Paul Muad’Dib) that fear is the mind killer. This is very true. Fear can be a paralytic.

My very first ACLS (advanced cardiac life support) told us on the very first class, on the very first day that the first thing you do in a code is take your own pulse. This shocked many of us into laughter because my pulse in a code is the least of my concerns. It is the patient who is dead. What she meant is that you have to check in with yourself, and take a split second to calm yourself. This is taking your own pulse.

When you get the test booklet, the first thing to do is to answer the very first question. It will be your name. And you certainly know your name. First question down. On to the next.

When you get your first F, the first thing to do is take a deep breath and calm down. After your panic has subsided, look at the answers that were missed and read the questions. Square in your head why the question was missed. In the days of the scantron answer sheets, I accidentally skipped a page, which made all the questions after that wrong. Plead your case.

Find your study group, talk to your instructor, talk to your classmates.

Take your own pulse. And breathe.

Cookie Thursday 2/8/24-cheese straw cookies

Continuing on February’s theme of Tracie’s Favorites, cheese straw cookies.

I know, I just did a cheese month in January. Yes, there is still that much cheese.

I don’t care. This is what Tracie asked for.

I did ask qualifying questions. Whether what she had in mind was pepper jelly thumbprints, cheese straws, or pimento cheese straws. She chose straight-up cheese straw cookies.

Okay then.

All of these three cookies have the same base. Flour, butter, and shredded cheese.

It is the application of how much and what to do with it that is a bit different.

These are not a roll-out cookie. So there will be no chilling of the dough. As always, I am going to be doubling down on the spices. The recipe I am using asks for 1/8 tsp garlic powder. Um, no. I don’t think so.

Since I will not be rolling these out, I will use my smallest cookie scoop to portion out the dough balls. And bake at 350 degrees Fahrenheit oven.

There is also the question of how crispy do I want to make these bakes? The longer the cookies are in the oven, the crispier they get of course. But I want a bit of chewiness to them.

The cheddar cheese should not be bagged cheese. There are anti-clumping ingredients added to the cheese when it is packaged. I will be grating my own.

Also, my grater was last seen while making Christmas dinner. I have looked everywhere. Either it got thrown out by mistake, or broken and then thrown out, no one knows. Moment of silence for one of the OG wedding gifts. It served me well for over 25 years.

I bought a new one. Did you know that they are not dishwasher-safe? Probably explains why it broke/got thrown away/ran away.

Nursing is tops again for being trustworthy. But…

According to the 2023 Gallup Honesty and Ethics Poll, nurses remain the most trustworthy profession for Americans. Yay, us! I mean, I’m not surprised, are you? This is the 22nd year as the top dog out of the 23 professions ranked.

Nurses are the hardest working, patient facing group of professionals out there. We are at the hospital, at the bedside, 24/7/52. This means 24 hours a day, seven days a week, and 52 weeks a year there is a nurse at a bedside. There are also certified nurse assistants to assist in the work, environmental services to keep everything clean and hygienic, plant engineering to keep all systems like HVAC running, IT professionals on standby to help with software problems in the electronic health record, admission and records people to keep the records straight and admit as needed, dietary people to keep the kitchen running and the patients fed, and pharmacists and pharmacy techs to keep the medications correct and flowing.

Honestly, healthcare takes a village. We all worked together to get the world through a pandemic!

I am not surprised that nursing is at the top again when rated on honestly and ethics.

But…

Here it comes.

But… the ratings, although nursing is at the top, have drifted from their peak. Yes, the peak was in 2020. We all know what happened in 2020.

All the ratings are lower, except for those at the other end of the spectrum, their ratings either worsened or were the same. These are the members of Congress, senators, car salespeople and advertisers and they were all viewed by Americans as the least ethical. I mean, when you at the bottom, is there anywhere to fall?

Surprisingly, yes.

I am sure there will be additional research as to WHY there is an almost across the board decrease in perception of trustworthiniess and ethics. I have a pretty good idea. Don’t you?

Anyway, nurses are on top again as the most trustworthy and ethical profession, members of congress and senators are at the bottom. Fascinating read.

Reference

Brenan, M. & Jones, J.M. (2024, January 22). The ethics ratings of nearly all professions down in U.S. Gallup. DOI.Ethics Ratings of Nearly All Professions Down in U.S. (gallup.com)

Tuesday Top of Mind 2/6/24-quote unquote suggestions

On this Tuesday Top of Mind, I want to write about (quote) suggestions (unquote).

You know the ones that people, especially women, get blasted with about clothes, and shoes, and hairstyles. A headline I just saw said ‘no woman over 50 needs this haircut.’ Bold statement.

But who says?

Why shouldn’t I buzz-cut my hair if I want to? Or dye it a screaming yellow with magenta stripes and purple spikes. I mean, that’s not my jam but it is someone’s. Why can’t I have long pretty hair when I am in my 50s?

Well, besides genetics. And my hair follicles.

Yes, we do change as we age. Who cares? Age will happen to all of us at one point. The goal is, and always has been, to be yourself.

I am a huge proponent of being yourself.

If you feel the above hairstyle, knock yourself out.

If you want to wear jammies to the grocery store, go ahead. Or go without a bra under your sweatshirt, no one is stopping you.

Be yourself. There is no one else around to be you. You might as well get comfortable.

That means different things to different people. That is okay.

For me being comfortable with myself is wearing rubber duck pajamas to the grocery store. I also got complimented on them while at the grocery store.

Another thing that takes up way too much space in people’s minds, especially women but a surprising amount of men, is wrinkles. Aging in general, I think.

I know that there are people throwing millions and millions of dollars to solve a problem that exists in their own heads.

Make-up, don’t need it. Wrinkles? So what.

The latest television show that EVERYONE is talking about? I don’t watch television.

Have I heard about the latest rumbles in the music industry? So and so is mad at this and that. Nope, I don’t listen to current music. I like NPR, it is always changing.

Am I boring? With my lack of television watching, especially reality, and lack of knowledge of current music knowledge?

Yes.

But I would wager I know a ton about current events from NPR and the newspaper reading I do daily.

In my jammies, with my undyed hair, and my lack of make-up.

I’m okay with that.

Post-it Sunday 2/4/24-Don’t tell me that I can’t call you back in, I don’t control that

The post-it reads “smug person sitting in the lounge wrapped in a blanket as I came in at 1430 telling me not to call them back in tonight at 1900. Bitch please, I can’t control that!”

Ah, a post-it from before my current role as the night call nurse.

Goodness, I do not miss those days.

I do not miss the sighs when I have to call someone back because it is 2230 and I want to go home at 2300. Or the bargaining of whether or not they ACTUALLY have to come in. Or the anger I received when I wouldn’t stay just an eensie 45 minutes past my shift.

Once someone answered their phone and said that they couldn’t come in because they were drunk. I appreciate your honesty but my shift ends at 2300. What are they going to do about getting coverage? I’m not going to call around and find them coverage for a shift that they just assumed I would stay or or assumed that there would not be a case.

Thankfully, this only happened once.

And once when the person on call was in another STATE!

No, I do not miss those days at all.

Let’s go back to the post-it and this person who was 1) in the lounge on company time 2) in a warmed blanket that would have to be rewashed again on the company dollar and 3) ordering me about as if I was a peasant. Thankfully, that person no longer works for the department.

But, Kate, isn’t that a little harsh?

No. No, I don’t think it is.

The evening charge nurse has no way of knowing which surgical cases are coming in after hours, or if there is even going to be a case. Some doctors troll the ER on the way out of the hospital, looking for cases. Most do not, but some do.

Cut the charge nurse some slack, huh?

School Me Saturday 2/3/24-first assignments of the semester

It is hard to go fully into the semester. I know. All the reading, all the getting to know the professor. All the getting to know the other students. It is hard.

Especially if you are not socially gifted.

Believe me, I know.

However, the first month of the spring semester should be just about over. This is about the time that the first assignments are due. This can be a variety of assignments, a paper, a discussion post, a test. School does it all.

The only thing I can tell you is to have a plan for the assignments. Make a schedule if you are gifted like that. Or, if you are like me and write a schedule only to ignore it, write down the assignments everywhere. As discussed, part of my process is largely mental and I do a lot of thinking about structuring assignments. I have heard over and over to use an outline for written assignments. Yesterday I did and I wrote down what each section of the paper was to cover, and the broad strokes of the beginning and conclusion. Where has that nugget of wisdom been all my life?

We’ll see how far that gets me in the next three months.

It wouldn’t be the start of the semester assignment season without technical difficulties.

You are not alone in this. My computer got replaced for the second time over winter break. All the software had to be re-installed. Including the specialized software for statistics.

Oh, boy!

Take a deep breath and make a plan to conquer your first assignments. The first one, I find, is often the hardest to get started. After all, students, like us, are coming off a break where we did little to nothing to prepare for school. It might take a minute to get our brains in gear.

Start your assignments! The checkered flag has been raised!

Yeah, that is a veiled attempt at a NASCAR joke.

Humor me.