Spring has Sprung month continues. The sun is shining, it’s not too hot, too humid, sounds of lawnmowers in the distance. The pollening is over. More importantly, the rain has stopped. For now.

And the birds are singing.

I did not have the unique delightfulness that is hummingbird cake until I came to North Carolina. I’m not sure why, it may be specific to the South.

It has all sorts of yumminess- banana, pineapple bits, pecans. It is rather like souped-up banana bread.

It definitely brings to mind Spring.

I took the eggs out of the fridge and let them come to room temperature and took out the butter needed.

The recipe that I used was for a bundt cake. But I wanted to be fancy so I used 2 loaf pans, one ridged to make cutting slices easier, and the other a standard loaf pan.

And when I say the batter filled the entirety of the Pyrex bowl that is because it did.

The only experimental portion of today is the addition of coconut to the batter. Because pineapple and banana just scream tropical to me. And that needs to include coconut.

The cake smelled amazing while it was baking.

And I pulled them out when each pan when tested with a toothpick, the toothpick came out clean.

I left them to cool for about 10 minutes and then tried to turn them out on to the cutting surface.

Yeah, the cake said no.

Although I had greased both loaf pan, there was a portion that stuck to each pan.

Eye roll. Next time I will use an 8 x 8 or 9 x 13 pan. Or use the mini cupcake pan, which was my first inclination.

Kate, listen to yourself next time.

As always, when there is a barrier, overcome with frosting.

Y’all know I hate frosting and I will not be making it. I mean free cake is good enough, right, even if it looks a bit rough.

Congratulations!

Somewhere in the middle of a turbulent case, or not, something countable has gone missing.

The surgeon swears it isn’t in the cavity.

You’ve counted and re-counted and re-counted.

It has disappeared.

Oh, well, time to finish closing.

(obnoxious buzzer sound)

Wrong!

It is kind of like Special Ops or the Rangers. No man, woman, or thing is left behind.

Why would you have gone to all the trouble to counting in the first place if something was willingly left behind?

That’s what I thought.

If after counting AGAIN the item is still unaccounted for, it is time to call x-ray. Because it is time for an intra-op film. After the film is taken and shuttled off to be read by a radiologist, the surgeon can continue to close. The closure can’t be finished before the x-ray read is available. Do not put the dressing on. The anesthesia can’t be stopped before the radiologist has chimed in.

No matter the whining. From the surgeon, from the tech, from anesthesia.

Hold firm.

After an interminable time the phone will ring and it will be the radiologist. Put them on speaker and tell them to begin.

There are two ways this can go:

1. the x-ray is clean and there is no identifiable sponge, instrument, or suture needle (thingy, technical term you understand).
2. the missing thingy is visible at (here the radiologist names the area where the thingy can be seen). If this is the case, the surgeon re-opens and pulls out the thingy, sheepishly. Sometimes they will tell the room that they knew it was there. Do not let them fool you. The last conversation that was had with them about it was the impossibility of them leaving the thingy behind. And that was 20 minutes ago. Gaslighting. It’s not just for the normal population anymore.

If there is no thingy identified on the x-ray the surgeon can finish closing up, the dressing can be placed, the patient awakened.

All is good.

Except for the small matter of the missing thingy. But as long as it is not in the cavity the exact location of the thingy is not to something that the room has to be concerned with.

Sometimes it feels like a Bermuda triangle has opened in the room. Or IdaKnow from Family Circle is real. At least she’s a ghost and can’t impact the sterile field.

What is doom scrolling?

We all probably engage in the practice sometimes. Reading only the gotcha headlines. Reading only the doom and gloom headlines. Focusing tightly on the horrible at the expense of all else

And right now it feels like there is all sorts of horrible. Between women under attack, and nurses under attack, and the economy under attack. And some people actually being under attack going about their business, for example the bank shooting in Louisville, Kentucky from this morning. The children under attack at schools. Books are under attack. Or the war in Ukraine and the Russia saber rattling.

And the more you engage with it, the worse it gets?

Yeah, that is the algorithm talking to you.

Is it useful to know some of these things?

Yes.

Is is useful to be beaten over the head in repetition with these things?

Absolutely not.

Let’s stop for a bit, can’t we?

It is spring! The snow, where applicable is melting, the flowers are blooming, it’s nearly time to plant the garden.

Let’s just stop for a bit.

The horribleness will be there when our heads are clearer.

Trust me.

Shit like that never goes all the way away.

What prompted this musing is the news of a kitten rescuer that I follow in Washington state. Well, her demons proved to be too much for her and she killed herself last week in her late twenties.

And left a postumous scheduled post to go onto her Instagram page thanking her followers for the years of support and that her battle was over and she was at peace. Do I know her personally? No. Are there scads of other kitten people to follow? Definitely yes. Can I still be sad that she is gone? Yes. It just goes to show that for some their world is very different than yours.

The world doesn’t have to be absolutely light and dark.

Let’s let a little light into our dark spaces sometimes, huh?

And if the dark is just too dark to bear there are resources. Pick up a phone and reach out to someone. Call 988, the national crisis and suicide line. There is always someone to listen, you just have to reach out.

And stop doom scrolling! And filling your echo chamber with only the echoes of what YOU believe. You’ll probably be happier for it.

And with that, I am off to the bookstore.

The gown card reads “Squeaky wheel gets the flip.”

Sometimes there is a gap in the schedule.

And all the surgeons eye the gap and ask for one of their cases to be flipped into the gap.

Even if the case has ZERO chance of fitting into the space. And if the flipped case runs over, the scheduled case is delayed. This can set up a domino effect, leading to irate surgeon who got delayed by no fault of their own, more than irate and hungry patients, and a happy surgeon that got to slide into a space their case doesn’t really fit into.

It is kind of like Prince Charming accepting the Ugly Stepsisters who slice off part of their own feet to fit into the glass slipper. It never really works well and they’re gonna get found out by the visible blood on the glass slipper.

Even after explaining all of this to some surgeons they persist in asking if they can use the space as a flip room.

Over and over.

They send minions: the circulating nurse calls to the desk and asks, the scrub tech stops by on their way to lunch and asks, the anesthesiologist stops by and “casually” mentions that gee, Dr. Impatient really could use the empty space well.

You’ve already said no and the requests keep coming.

Drip, drip, drip.

It is the unpleasant task of the charge nurse to not give in to the badgering.

Because if they do give in, and the flipped case goes over, and the next surgeon is irate and wonders why there was suddenly a case in their room that wasn’t there an hour ago, and Dr. Impatient’s original room is already setting up for their next case, not a care in the world when Dr. Irate’s case could have gone in there and started on time. But no one ever thinks that far ahead.

And all Dr. Impatient has to say for themself is a giggle and an “Oh, well, I guess I was wrong.”

Yeah, no shit you were wrong. But the blowback is on the charge nurse who let the squeaky wheel get the flip unless they’ve already left for the day, early don’t you know.

The real blowback is on Dr. Irate’s patient and subsequent patients who have to wait for a room to be ready.

Because the squeaky wheel gets the flip.

Sometimes no is the best answer we can give.

It is officially the last month of the Spring semester. And the April PhD report.

I did not fail my mid-semester project. As always, my writing saved me. Don’t get me wrong, I could have done better. But I did not fail.

And for a program that feels like it is reprogramming me every day, I count that as a win. I joke to my cohort that I think that Lee Majored should be a verb for what we are all going through. You know, the 6 million dollar man. Every class, every assignment we are being rebuilt. They have the technology. I know that this is growing pains and everyone must go through it but it can suck in the moment, you know.

As I wrote last week, the end of the semester is so close I can taste it, and freak out about the amount of work. All at the same time.

In my Informatics of Healthcare course, the end is swiftly approaching. There is a quiz that is due tomorrow. And a PowerPoint presentation due next Sunday on a topic that I chose back in January. I am creating an 8-page PowerPoint and/or an 8-minute presentation on the Art of Caring in a Technically Laden Environment. I mean, have they ever seen an OR; high tech is what we do. But, after the pandemic, and even before, all the hospital units are technically laden. Especially since the EHR era began with the HITECH Act. My presentation is about how nursing caring can still be done in such a high-tech environment. And then I have to respond to someone else’s presentation. And a final discussion round at the end of the month and I will be done with that class. I have found it very enjoyable and recommend it to others in my cohort when they are looking for an elective.

In the Statistical Interpretation class, there are two homework assignments and a final to go until the end. One of the homework assignments is due Tuesday at midnight. I understand what we are doing. I still have no math brain. I will be spending time revising (a British term that I adore, means studying) the contents of the entire semester in preparation for the final. Which is due on 4/30/23.

In Nursing Theory I have a presentation and a paper from the presentation, or vice versa, due on 4/28/23. I have to do a deep dive into a selected nursing theory that goes along with my phenomenon of interest for my dissertation. I have been reading books, and articles on the theory.

But my personal White Whale lately is my brain block on looking at my grades.

Yes, still.

I think I will set a deadline of Tuesday to look at the past Theory papers. And apparently use some of the feedback in the presentation and paper.

Lots to do.

And only ONE more in-person class for Theory and Statistics on 4/21. The others on 4/14 and 4/28 will be virtual.

I still show up at the university every Monday to be a research assistant and I am learning so much there too. Experience is a good teacher.

Don’t mind me I am just being re-built every class. They have the technology.

The April theme for Cookie Thursday is a Thing is Spring has Sprung!

April is wonderful in North Carolina after you get past the pollening. It isn’t as cold, it is not yet humid and gross. The trees are budding out, the weeds have just started, and are not yet overwhelming. The birds are chirping.

Peeps have a checkered appreciation. People either love them or hate them.

I love them. I get gifted a LOT of Peeps.

Did you know you can microwave Peeps for 10 seconds and it turns amazingly caramelly? True story. Try it.

And everyone knows what goes into a s’more: graham cracker, chocolate, toasted marshmallow.

I’ve made s’more cookies before, adding marshmallows to a standard chocolate chip cookie. And when I was deciding the theme for April I decided to see if Peeps could be used instead of miniature marshmallows.

I took four strips of Peeps, 2 yellow, one pink, and one purple. I opened them and left them to dry out a bit. As I had never cut Peeps and I thought it would be best if they were a little stiffer.

In case you are wondering, the best way to cut up a Peep is by using a pizza cutter. Works great. I cut the Peeps into roughly the size of a miniature marshmallow and threw them into a standard chocolate chip cookie recipe.

The Peeps might melt a bit, but that just gives them more of a caramel taste.

Just like surgery isn’t every nurse’s passion, Peeps have their fans. It takes all types.

The case is winding down and you and the scrub tech start the closing count.

dun, dun, dun!!!

A sponge is missing.

This can be for a variety of reasons. It’s on the floor, it’s held in place against the patient by someone’s abdomen, it’s under the mayo stand, it’s in the mess of the back table because someone, looking at you surgeon, has been impatient and rummaging through the carefully set up table.

Or it’s in the abdomen/cavity/joint where someone, again looking at you surgeon, tucked it to control bleeding, or to get it out of the way, or used it to sop up fluids of some kind and forgot about it.

There are steps to follow

1. check the floor
2. check the kick bucket
3. count again
4. if you find it, count again

But you are still missing a sponge. Tell the surgeon to stop closing and announce that a sponge is missing.

9 times out of 10 a surgeon will say immediately when told the count is incorrect, “Well, it’s not in the wound.”

Often without looking.

Stare at them and if they continue to close, ask nicely for them to examine the wound for the missing sponge. If they continue to close, ask not so nicely.

Get anesthesia involved if you have to.

The scrub tech can also be useful here by declining to hand them requested items.

In a huff, the surgeon will search the cavity/incision/abdomen and find the sponge, tucked away safe.

Sheepishly they will announce, “Found it!” And they will continue on closing.

Feel free to raise an eyebrow in disbelief.

And return to counting. Beginning with sponges.

Counting is a process, after all.

Next week I’ll write about if the sponge is truly missing, what then?

This musing may seem a bit… unhinged.

What the hell is up to my husband’s uncanny calling of surgical cases, especially call cases?

Yesterday, when I was preparing for my Sunday afternoon nap that I take in case I get called into the OR in the middle of the night and still have to show up for my research assistant gig at the university on Mondays, he mentioned that he felt like there was a big belly case in the wind. Or an ectopic. Or both.

And there was a big belly case at 2100. Just when I started my call shift.

Of course, there was.

I got home and in bed at 0115. Never mind that I have to get up at 0545 in order to pack my lunch and his lunch, shower, and get myself on the road to the university by 0630.

And, of course, my brain went off at 0300. For no other reason than to remind me that I had to get up in two hours.

There is much to unpack here. I’m not sure if he is jealous that am no longer “working hard”, AKA all the hours that are, and wants to be an asshole about it. Or if he knows I love work and am a workaholic (recovering) and he just wants me to have something I enjoy. For example, a case.

But there is definitely something woo-woo about his ability to divine the cases out there and pull one of them down for me to do on call.

He does frequently mention that I am beloved by the surgeons because I get shit done. And he does acknowledge that sometimes they wait for me to be on call so they don’t have to wait forever on an emergent case while someone else does the pre-op checklist. This does happen. Or the glee with which a surgeon approaches me and is visibly pleased that I am, in fact, on call that night.

Once would be a coincidence, two would be odd, but this happens every damned month. Ectopics, lap appies, big bellies, bleeders of all sorts, the surgeon he doesn’t care for because I don’t care for them, called them all at one time or another.

In fact as we were just about to make incision on last night’s big belly, after the pause, and while I was doing the plugging of things, and as I was pouring the irrigation fluid I mentioned it to the team. And the surgeon and the tech turned to me and asked “Again!?!” Because they had heard me complain about this in the past. And the surgeon remarked, matter of factly, “Tell your husband to shut up”

Oh, Dr. Blank, I have. And I will.

The gown card reads “Don’t you hate following someone else’s setup. I do things deliberately.”

Nothing will throw me out of the flow of the case faster than taking over a room immediately before the beginning of a case. Nothing!

It is like when a record skips a beat. What happens to the beats that are skipped?

In the OR these beats are probably steps that are necessary for a smooth case. Things like grounding pads, or even turning on the machines. If I am dropped in a case, even one I know very well, ahem lap appy, I am probably going to forgo a needed step.

Nothing like a surgeon needing to use the bovie and nothing happens but a rude noise when the button is pressed.

And the stopping the entire case to pick that step back up? And put that grounding pad on, or attaching the grounding pad to the machine?

Excruciating.

Call it what you will: being caught with the pants down, being caught flat-footed, dropping a stitch, missing a dance step. It feels terrible.

Once upon a time, during a crash cesarean section, back when I used to circulate those, I could see that the grounding pad was plugged in, and all the lights were green. But same thing, rude noise, no electricity for the doctor. For the life of me, I could not figure out why the bovie was not working. There was a pad plugged into the machine, the bovie pencil was plugged into the machine,

However, a silver lining is that once a step has been discovered to have been dropped I would bet money that I won’t forget again. However, there are many, many steps in combination to starting a case. Drop one and all the balls come crashing down.

Yes, I am mixing metaphors.

As an illustration of what missing a well-trod step in the beginning of a case feels like.

Horrible, isn’t it?

I try to keep the ball dropping to a minimum. Being aware that this can happen is the first step to controlling the chaos.

This is not an April Fool’s post.

This is a post about how the student in your life might be going through the Semester Doldrums, interspersed with the Semester Terrors.

You see, this is the time of the semester where the end of the semester (where the break is) is too far away and too close all at the same time.

It is an icky, tricky time of the semester.

Your student may be concerned with grades. This is where the terror comes in. The all-consuming will I pass question may be top of mind. All students have that question in their heads, even the ones who are carrying a 95 in the class and there are only 2 assignments and a final left to the end of semester. And they could turn in none of that and STILL pass the class.

Before the end of the semester craziness with tests, and papers, and presentations, oh, my, give your student unconditional support.

They may be acting crazy as they try to fit the rest of the semester into a month and a half. They may be acting depressed. They may be doing none of this at all.

Just know that they are stressed. And let them know that you are there for them.

And remind them, gently, this is for the future. Growing pains have to happen now so that the future might be better.