24-Fudgy Cocoa No-Bakes.

New month, new theme. The theme for February 2024 was going to be favorites. And then my favorite nurse in the department put in her resignation. 😦

I mean, I know why she put in her resignation. She isn’t treated very well by management. Sound familiar? But she’s an amazing nurse and an amazing circulator. She always has the patient’s best interest in mind, no matter if that goes against the OR culture. Frankly, the department will be diminished without her.

The theme for February will be Tracie’s Favorites.

As I’ve written before, there were a few bakers at the beginning of Cookie Thursday is a Thing, and one by one they all dropped. Tracie has been involved with much of my planning and discussing of the monthly themes.

Although she never got behind the most popular CTIAT cookie, the Jalapeño Chocolate Chip Cookie. She has always seen it as vegetables in the cookies.

I am starting this month’s theme of Tracie’s Favorites with one of her most requested cookies- the fudgy cocoa no-bake. These go by a bunch of different names. Peanut butter oatmeal stacks, school lunch special but I call them fudgy cocoa no-bakes.

This is one of the recipes that is a good repeat. Quick and easy to make and they last forever. If they last that long.

This is the cookie that I made to bring to the in-person day at school. Speaking of school, Tracie has always been my number 1 cheerleader for school. That isn’t going away, but conversations at the hospital are.

Counting basics #14- yes, the specimen must be counted

I finished the counting basics series in September but I missed one. This past week, I was at the hospital for a call case when I, as a routine part of the evening shift charge nurse duties, checked the cart where specimens stay until they are picked up by the lab.

I know that this was on the list that I left behind for the next evening shift charge nurse. Oh, wait, they have lost four of the five that have been hired to replace me in the last two years. To other hospitals mostly. Because being the evening shift charge nurse is hard!

The list I left behind got lost somewhere. I have to reprint it. But on the list was to check the specimen cart to make sure that all the specimens had been transported to the lab for processing.

There were 9 cases worth of specimens in the cart when I checked it before taking the case specimen that I had to the lab. NINE!

My sister the pathologist was crying and didn’t know why. There were specimens that didn’t even have formalin on them for over 12 hours. Thankfully there were no cultures. Makes my blood boil; you bet I wrote an email to the manager explaining how checking the cart is an expectation of the evening shift charge nurse.

But, Kate, if they didn’t know… Bah! The specimen cart is not magic, drop off the specimen and never think of it again. Specimens have to be treated carefully. Which is why it is the 14th counting basic.

Care and handling of the specimen was also the subject of my master’s thesis and project, the standardization of specimen hand-off.

Imagine if you are that patient whose specimen goes missing but there isn’t any more tissue left in your body to test. Imagine if you are that patient whose specimen is not handled correctly, with formalin, or put in the specimen refrigerator promptly if there is no formalin and the specimen is unusable for testing. Heck, imagine the nurse who failed to collect the specimen correctly and caused all this furor.

Think of how badly you would or should feel.

This is why the correct specimen hand-off is the counting basic # 14. The surgeon has to name what the specimen is, the nurse prints the label, puts the label on the container, shows the label to the scrub tech and they both agree that this is the specimen that is going into the labeled container for this patient that is currently on the OR table.

In fact, the corporation changed its policy to reflect what I had done in my master’s project. Don’t think I didn’t notice!

Specimen hand-off is of utmost importance to the patient. Second is the handling of the specimen after the case. Whether or not it needs formalin, or is a frozen section, or needs to go fresh.

Know the rules of your particular OR for how the specimen gets to the lab, and who takes it, and the hours that the lab collects the specimen. Because they don’t have the manpower to be collecting at all hours of the day and night.

Tuesday Top of Mind 1/30/24-1460 days of covid

On my Facebook memories from 2023, the Dispatches from the Evening Shift post was a Monday musing from 1/30/23 was 1095 days of covid. I thought, well, it’s been a minute since I wrote about covid.

Let me take the local temperature of covid.

Yes, there was a winter surge. As predicted. The hospitals were full; the hospital I work at seems to be always full. There was flu, and RSV, and covid. Just like last year.

According to the CDC Covid Data Tracker, there have been 26,607 hospitalizations for covid in the US in the week of January 20, 2024. This is down from 28,323 hospitalizations for covid in the US in the week of January 22, 2023. The weekly death rate has been averaging 1800 American dead each week. That is still a substantial number, for all that the public is bored hearing about covid. The most current number of dead, as reported, which is suspect because of the patchwork reporting done by some states, is one million, one hundred seventy-two thousand, two hundred two.

The CDC Codiv Data Tracker has improved its reporting and ease of information finding. This was always my second choice for covid data. RIP Johns Hopkins Covid Dashboard.

Covid is still here. People are still dying.

The best way to protect yourself and your family members is to make sure you’ve had the most current booster. Get tested if you are sick. Stay home if you are sick. If you feel the need to go to the hospital because of difficulty breathing, or low oxygen saturation, go to the hospital. According to my county’s tracker, 12.8% of those who presented to the hospital were admitted.

Not very exciting, I know. But important to keep yourself and your loved ones safe.

No, I can’t believe I am still writing about this shit nearly 4 years after the first recognition that this might be bad. It’s not as bad as it was, but it is still not good.

School Me Saturday 1/27/24-Procrastination, part 1 the mental load

According to the Oxford English dictionary, procrastination is the action of delaying or postponing something.

It will surprise no one that I have often been accused of procrastinatory tendencies. I freely admit it. What some people see as me just putting something off is the action of me in my creative process. While I am not doing the assignment/cleaning/item on the to-do list, my brain is thinking about the assignment.

I would caution against this. It can cause a lot of anxiety.

And students don’t need to be adding to their anxiety about school.

I have had many thoughts and plans and “fixes” to being a procrastinator. These have either been given to me, or I was told about them, or I found them on my own.

Because no one likes to be a procrastinator. No one wakes up one day and says to themselves well, that paper/assignment/dissertation isn’t due for 10 days, I’ve got plenty of time. Only to wake up the day before it is due thinking “oh no!” and pulling an all-nighter to get it submitted on time.

For example, I have a 5-page paper due next Friday night. At 2359.

I know what it is to be about. I have been considering it since I learned about the paper. I have started the mental process of thinking about it. Thinking through each of the asks. Thinking how I am going to keep it to ONLY 6 pages.

Yes, I am in a PhD program and still struggling with this. I KNOW I am not alone. I’ve been like this since I first started writing my papers on the family computer and printing them in the late 1980s/early 1990s.

I have 2 things due in the next two weeks. My goal is to finish the paper and submit by Wednesday 1/31. My second goal is to finish and submit the Measurement homework assignment that is due on 2/8 by Tuesday 2/7.

You do what works for your schedule and your brain. My goal for the semester is to submit assignments 2 days before they are due. Wish me luck!

When I do a 2nd procrastination post, I will bring up some of the common fixes.

Let’s work on this together.

Cookie Thursday is a Thing 1/25/24-white cheddar shortbread

It is the last Thursday of the Why is There So MUCH Cheese? January theme. I added the caps on much because there is still so much cheese. But… I can see the bottom of the cheese drawer so that is something.

This was a very simple recipe. 2 c flour, 2 sticks butter, 2 c cheese. Spices. Bake at 375.

The original recipe called this a shortbread and also wanted the dough mixed in a stand mixer. I can see why this is called a shortbread but I didn’t think the mixer would work. So I used the food processor.

I had to add water to make the ingredients bind together because they would not. All I had after 30 seconds of food processing was fluffy white powder. After I added the water, the dough came together. I pinched off small pieces of it and rolled the balls. The recipe also calls for pressing the balls with the bottom of a glass. I hate to do that because the dough balls will stick to the glass and it just gets messy. I used my fingers.

To bring it back to the OR, why are there still so many appendixes out there? Yeah, statistically not everyone has their appendix removed. I have mine, and so does my sister, and husband, and mother. Not my brother though, he’s the only one in the family that has had it removed. And in the same thought, why are there still so many gallbladders out there. Watch what you eat, people!

How to delicately say things to patients and to not give away too much information

How, and what, to say hard things to patients should be a graduate-level class. You know the things I mean.

There is potentially life-altering information that you have that you may be asked point blank your opinion of.

Knowing what is a conversation that should be at a doctor or surgeon level AND also knowing how to get out of giving too much information without the proper context and freaking out the patient would be the final exam.

Practice the following “The specimen for the surgical case is in the lab for testing. Dr. X will know more. They are speaking to your family right now.” Or there is always the cop-out “Dr. Y will be in to speak with you shortly.”

No one likes the second one, not the patient, not the family member, not the surgeon. Not even me when I give that line. Because the patient or the family member knows that I know something and I AM NOT TELLING! And I know that I can’t tell because I give the proper context to tell anything.

Last week I had a patient ask me directly how the surgery had gone when they were in the recovery room. I was not about to give any details that were better off coming from the surgeon. Instead I leaned forward and said earnestly, “We were glad that you decided to seek care today.” They closed their eyes and nodded, content with the explanation.

We were, the surgery would have been much harder if the patient had waited, suffering at home. Instead they decided to come in and seek care. If they had waited, the outcome might not have been favorable.

Sometimes I do pass on information during the intra-operative phone call that we make to inform the family how things are progressing. However I always ask what the surgeon wants me to tell the family.

Saying the wrong thing can absolutely be bad. The family, who is not medical, can take things out of context or misunderstand what is being said. This can lead to repurcussions when the surgeon is yelled at by the family, or goes to the waiting room to find ALL the family, all crying, when the message was interpreted incorrectly.

It is best to be simple with explanations of the surgical kind, or, really, the medical kind. You have training to understand the words and the context. The patient and the family does not.

Tuesday Top of Mind 1/23/24-light a candle for Roe

Yesterday marked 51 years since Roe versus Wade. The ruling protected a woman’s constitutional right to choose their own path, including the right to choose an abortion.

Well, thought men everywhere, we’ll see about that.

After all, if a woman as the right to her own body just think of what else she will decide to have the rights for.

She may decide that she has the right to end a terrible marriage. Not terrible because of abuse, or because of infidelity, but because they just don’t suit after all. There has been a rumbling, deep in the men’s groups, about the downfall of society was the no-fault divorce. This means that the woman (or man) can just decide that they don’t want to be married anymore.

Gasp, the audacity!

Yes, this is heavy on the sarcasm. The no-fault divorce will be the focus soon enough. And is what will be the focus of some groups next as I’ve heard the rumblings.

However, the Roe v Wade decision guaranteed a woman’s privacy in health care matters, including abortion.

Apparently we women don’t know our own mind.

But we do; and that scares people to death.

As I’ve written before, it is not about the child. If it was there would be affordable daycare, rent, healthcare. You know, the things that are required to raise the infant to adulthood. Where they can be a tax paying entity.

Money and power and control.

I’ve written about it many times because it is heavy on the mind. Especially 51 years after Roe v Wade was decided by the Supreme Court 7-2.

The Dobbs decision was June 24, 2022. Notwithstanding the outright lies to get three of the justices on the court during their confirmation hearings, this kicked back the decision to the states.

According to the Guttmacher Institute and their work on reproductive health, the state laws run the gamut of total ban, without exclusions for rape or incest or health of woman, to 6 weeks (the so-called heartbeat bills), 8 weeks after last menstrual period (essentially a 6 week ban), 12 weeks (end of first trimester, and also before the anatomy scans for sex of the baby are even done), 15 weeks after last menstrual period (essentially a 12 week ban), viability (which is nebulous and being pushed by medical science all the time), 24 weeks after last menstrual period, and one 3rd trimester. A couple of states don’t have any abortion ban laws at all. Confusing, right?

Raise a glass to the Roe v Wade decision, light a candle, not matter what you feel you have to do to mourn the rights that were stripped from ALL women in this country in June 2022.

Because some men said so. Okay, there was a woman too.

How dare they?

Taking away the power and the control and the patriarchical overtones, it is, and always has been, about cold hard cash. Taxes, I mean. The taxes that the baby could have paid as an adult. Or, in some states, as child laborers.

Not to mention to torturing of unborn babies who are incompatible with life, or the women who die because their state said no. Even though the pregnancy is killing them.

Mourn them too.

Then put the steel in your spine and fight to get our rights back.

Post-it Sunday 1/21/24-Make it bigger!

The gown card reads “Dear Doctors, JUST MAKE THE INCISION BIGGER!!!”

Mic drop.

I don’t know who needs to hear this but, yeah, struggling for 20 minutes because you made the incision a quarter inch smaller than normal.

What do you get out of it? Bragging rights in the doctor’s lounge? A free all-expense paid golf trip at the next conference? The love and devotion of your patients?

The push in the OR is toward smaller and smaller. Smaller incisions, smaller case times, smaller.

Just smaller.

And, yeah, that should be shorter case times but it didn’t fit the theme, you know?

I see you struggling with the smaller incisions that you make.

Yeah, patients may like a smaller incision, but how much smaller can you go? And still have the proper exposure to have to do what you are operating to do? Patients probably will be happier with a regular-sized incision and a smaller hospital bill. Because you ramp up their time under anesthesia and therefore the cost of the procedure while you struggle with exposure

I know that you know the incision is smaller. But the patient is not going to know. The incision can only stretch so much.

We were doing a case in the middle of the night. Of course, it was the middle of the night, you work nights, Kate! But the surgeon was struggling with taking out the specimen from the incision size and I mean, struggling! Thirty minutes they struggled and sweated and fought to get the specimen out, me watching from the sidelines, the sterile scrub tech helping them. Finally, they gave up and started pulling the specimen out in pieces. I asked gently if a slightly bigger incision would’ve been helpful. They sighed and said it would’ve been easier. I asked if the patient was going to notice that their incision was mm longer if they had gone for the bigger incision. They said no.

I said nothing else. I think the point had been made.

Two weeks later we had a nearly identical case, same team, same surgeon. When they had localized the specimen they asked for the knife and said to me “See, I can learn.” They made the incision slightly bigger and were able to only work on getting the specimen out for 6 minutes.

Sometimes you just need to make the incision bigger.

It isn’t a slight on the surgeon; just the facts.

School Me Saturday 1/20/23-Keep your eyes on the prize

Keep your eyes on the prize. The reasons and motivations for going back to school will vary person to person. They can range from just wanting to learn to have to have a degree to get a job to have to get a more advanced degree to keep a job. The same applies to certification.

The idea of the prize is the same for all of these. The attainment of a degree. Or a certification. The degree or the certification IS the prize.

I’ve written about degree creep before. Of always having to have a higher and higher degree. You follow that path and you end up in the terminal degree program. The end degree.

The final countdown, if you were.

Yes, that is a terrible joke.

What makes us want to strive for more, to push ourselves higher, further, faster.

Yes, that is another joke using the Marvels tagline. Which was a good Marvel movie, even if the boys deny it.

What makes us want to do that? To have deadlines, and lectures, and assignments, and the like?

Everyone’s answer to that is different. Some want the promotion, some want to learn, some can’t think of anything better to do. Some, like me, are on the bucking back of the degree as long as they can hold on.

We all have our eyes on the prize.

It is just that the prize has a different outcome for all of us.

I was questioned, quite thoroughly, by my coworkers about what I was going to do after I got the degree. They couldn’t believe that I was going to continue to work as the call nurse. That any work that sprang from my PhD (which I don’t have yet!) will be my side gig.

Operating room for life! Or as long as I can manage it. There is much to research in the OR.

I finally was able to put a meaning to this feeling of education for the sake of education.

I called it an intellectual exploration and an intellectual exercise.

Isn’t that what all education is? An exploration of how high, how far, and how fast we can get there?

Cookie Thursday 1/18/24- Cheddar dill pickle bites

This week continues the Why is There So Much Cheese? January theme. Because there is STILL SO MUCH CHEESE!

This week’s make is one I saw the video on about a year ago. Cheddar cheese dill pickle bites that are baked until they are delicious.

The umami factor on this alone is off the charts. Except that none of the ingredients is actually MSG. But it is salty and bitter and sour and sweet. All the words that describe umami.

The definition of umami is the essence of deliciousness and these deliver.

All that is needed is shredded cheese, either out of a bag, or freshly shredded and pickle chips small enough to fit in the well of a muffin tin. You also need a muffin tin. I used a mini muffin tin.

Oven to 375 degrees Fahrenheit.

Place some shredded cheese in the bottom of the well. Top with a pickle slice and more cheese.

Bake until slightly browned. About 12-15 minutes.

The original video called for blotting the pickles kind of dry with a paper towel.

I am anti-paper towel in this house. I skipped that step although I could’ve used a recycled lap sponge or blue towel.

It will surprise no one that I wanted to see what would happen.

This is definitely a trust the process Cookie Thursday is a Thing make.

And definitely one of the most surprising makes.