Yesterday should have been day 1 but we were delayed by a crazy storm 3 hours into the day. Atlanta weather does not play.

This led to me missing the eChapter meet and greet from 1730-1830. We got into town at 1900.

And pickup stopped at 1700. Okay, I can pick up in the morning.

Today is a different day.

I was able to get my packet just in time for the session that I really wanted to go to. The session was about self-care. The importance of it and how you should engage in it. The best take home words from that session was ‘reconciliation takes two people but forgiveness only takes 1.’

This is a powerful sentiment.

And then a session on IRB. Institutional Review Board. Or the there is no risk to the participants of the study. Or there is risk and these are the steps taken to review and mitigate them. This is terrifying. This means that I must do it. I’ll look into joining the committee when I get back to work.

There is another session momentarily.

And then lunch.

And the welcome and keynote speaker at 1500

I wonder if I have time for a nap.

I am convinced there is a hive mind that directs our stomachs.

I read that every society on earth has done a fried food. And some sort of alcohol. Because if you take honey water and wait long enough, it ferments.

I am pretty sure that the same is with the cookie of the week.

I know them as fudgey cocoa no bakes.

They contain peanut butter and oatmeal and chocolate.

Other people tell me about eating them in the cafeteria in elementary school. A lunch lady special that she made if you were good.

My mother made them as well.

It is a simple no bake recipe.

Application of heat to butter, milk, sugar, cocoa and stirred to boiling. Let boil one minute, add peanut butter and oatmeal.

And portion out on waxed paper and wait impatiently for them to dry.

I’ve not tried them immediately after the no bake. (looks shiftily about). Why? What have you heard?

To many it is a good representation of our childhood.

I like to mess with a recipe. You all know this.

I’ve added unsweetened coconut to the mix. They were yummy, like a Mounds Bar.

But this month is all about comfort.

This recipe is easily in the top five of requested cookies.

Because nostalgia is real.

And if you never had them growing up, I’ll give you the recipe. Because this is a cookie that deserves to remembered kindly.

For edification purposes, Cassandra was cursed by the gods to always tell the truth. The kicker was that no one would believe her.

I recognize that the last two years have been difficult. No more so than for healthcare workers. And parents.

And the world at large.

But I am watching the new variant. In Germany, in China, in the UK.

And I am concerned.

I fear that the relief of freedom has blinded us to peril.

However, if I mention it, I am disparaged as a hysteric.

Don’t I know that covid is over? That we are safe now?

No to both of those questions.

Covid is very much out there. Replicating and morphing into yet another variant.

Which variant will be the one that morphs covid back into a killer? One that laughs at the vaccines. And infects and kills people indiscriminately.

We are not safe until everyone who is eligible is vaccinated

The vaccine works to decrease the incidence of hospitalization. Of death.

Of course, to mix Greek messages, the thing left in the box after Pandara opened it, was hope.

I am hopeful that there is a way out from Covid.

But I fear that we are moving too far. Too fast.

In case anyone is wondering, the new variate, BA.2 subvariant comprises 23.1% of cases from last week. This is according to the CDC.

AORN is in person this year.

In New Orleans!

I’d been to this one in March of 2005. My mom, two of my sisters, my niece, and I rented an 2 bedroom, 1 bath apartment for a week in the French Quarter.

There is no better way to do New Orleans.

Loud with frat boys.

But up close and personal in all of the action.

I was a new nurse.

I was a new OR nurse and keen to learn all the things.

This was before I decided to start my education journey.

Through BSN, MSN, and now staring down the barrel of a PhD.

I’ve put in to do some paid focus groups.

I always enjoy those.

I haven’t heard anything yet.

I will be on a panel though.

Speaking to the nurse educators special assembly about Shared Governance.

I think the slides are due in two days.

My husband, though, has not been present for a conference yet.

This will be interesting.

I’m afraid he will be bored.

Because I have lots of things to do and my days will be jam packed.

There is a welcome party by my chapter.

There is voting to be done via forums.

There is the panel.

There is the expo.

We are going to to the kick off party on Saturday. I bought him a ticket.

So much to do.

Not all fun.

We will be shoe horn in some sight seeing.

And restaurants.

Can’t forget the food.

And, despite gas prices, we are driving.

Because my husband is not yet ready to fly with people who will not be masked.

And two plane tickets is more than the 2 tanks of gas it will cost us to go.

It will be a raucous good time.

No beads though.

The post-it says “the other side of the coin with the need? For an abg right before incision and the crush that follows, including ologist handing off the specimen with NO label to someone in black scrubs.’

The universe saw the post-it from 2/27/22 and decided to up the ante.

The CRNA, the scrub tech, the surgeon, and the anesthesiologist needed something at the exact busiest time of the case.

The incision.

This one pushed my skills to the test.

The ologist and the surgeon agreed they needed a baseline ABG.

And decided that the time to request it was right then.

Immediately before incision.

There is much to do immediately before the incision.

The pre-incision pause has been done.

Lines including suction and bovie are being handed off.

The surgeon’s step is being put in place.

You remind the room at large that you are the only person in the room that is free and they will have to wait their turn.

The bovie and the suction are the immediate concerns.

Once the incision has been made, which is happening right now, the need for electrocautery and for suction is high.

Especially on a big belly case.

Where you don’t know exactly what you are getting into.

Of course there is no one in the department.

It’s a call case.

Why would there be?

The ologist bleats again, while you are tending to the possibility of bleeding, about the ABG.

You tell him to put the order in himself.

And you will print the sticker after the suction and the cautery are connected and starting to suck up blood and control the blood because the incision has been made.

And once the pressure of the skin is released the intestinal contents spill out like a trick can of snakes.

Which leads to more immediate requests from the table.

Once those are taken care of, you sign in, again, to the EHR.

While you are doing that you call the supervisor and ask for the respiratory therapist to come to the PACU to pick up the ABG.

You go in search of the blood tube for the ABG, which is not in the room.

Why?

This is the critical case room.

The ologist is sitting there frustrated.

You have no time to re-sign into the electronic health record and print the labels.

It has been 3 minutes.

Haven’t you finished getting the case started yet?

What are you doing?

The CRNA finds the blood tube and draws the ABG blood from the central line.

The phone alerts that the respiratory therapist is in PACU to get the blood sample.

The EHR has timed out AGAIN.

In a moment of calm, when the field and the CRNA are both content, you sign back into the EHR and try to print the labels.

Which do not populate to your to-do list.

You check the ologist’s work.

The order is not in correctly.

You correct that, and go get the printed label.

It has now been 5 minutes.

When you ask where the blood tube is, the ologist calmly tells you that he gave it to someone who knocked on the sub-sterile door.

Someone he didn’t know.

In black scrubs.

Wall, meet head.

The ologist allowed a specimen to go out of the room.

Hell, out of the department, without a specimen sticker.

There are so many ways that could go wrong.

You don’t have time to yell at the ologist.

Much.

But, wait, the sterile field needs you before you can cause bodily harm to the ologist.

Don’t tell me Murphy doesn’t live in the OR.

I know we are all tired of covid.

And we want our lives back.

“I just want to get back to normal!”

Is the refrain I hear over, and over, and over.

And over.

We should not go back to ‘normal’.

It is a fallacy anyways.

The last two years have changed us as a society.

As nurses.

As patients.

There is no going back.

There is only adjusting to what is now.

Many of the ideas need to come along.

Wash your hands.

Don’t touch your face.

Judge the person next to you for still wearing a mask.

Don’t do the last.

You never know what they are dealing with in their lives.

There is no return to normal.

As a society, America is 35,000 deaths away from 1,000,000.

One MILLION.

Should be shocking.

But is probably is a massive undercount.

Covid case numbers are declining.

For the first time since testing began, there is no patients in my hospital with active infection.

A few persons under investigation whose test results have not come in yet.

But no patient with active covid infection.

Don’t let your guard down too much.

Being from California they warn you about the undertow at the beach.

They warn less about the sneaker waves.

Both need to be on our radar.

This is the next normal.

As a society, we can not go back.

Only forward.

Comfort month continues.

I intended to bake Syrniki, a Ukranian cheese pancake.

And I could not find the farmer’s cheese that is integral to the recipe.

And this week has me on the ropes.

I’ve only slept 2 hours at a time, due to cases.

Two hours before and 2 hours during the day.

I’m tired.

I found a recipe to make farmer’s cheese but even that can’t hold my attention.

Cue double-cream cheese from Petaluma, CA, that my brothers-in-law sent us for Christmas.

I shredded the cheese that was part of their amazing gift.

And used it to make Syrniki inspired baked cheese cookies.

I had a cookie straight from the oven.

It was a little… lacking.

Inspiration struck in my pantry.

I brought toppings for the little cheese cookies.

A sour cherry jam, a triple pepper jam, and raspberry jam.

I had a triple pepper jam topped cookie as I was dropping them off.

Transcendent.

I wanted to do my little part, because my husband won’t let me go volunteer in Ukraine.

Making these gave me comfort during a hideous week.

Comfort cookie #2 of the month.

Ukranian Syniki inspired cheese cookies.

A humble little cookie.

Made of cheese, egg, and a little flour.

With toppings.

Good wishes and best thoughts to those fighting in Ukraine.

There are no words.

After two years on-line AORN Expo starts next week in New Orleans.

The conference runs from Saturday 3-19 through Wednesday 3-23.

As ever, when a group of nurses get together we are going to make some noise.

Is it okay to be suddenly nervous?

I know these people.

Many of them anyway.

But in-person after two years on screen can be daunting.

We will be driving down on Saturday.

It is a 10 hour drive.

Even with gas prices that is cheaper than flying for the two of us.

I anticipate 2 tanks down and 2 tanks back.

A lot like driving to Nashville, TN, for the last in-person Expo.

Only this time, I am taking my driver.

He’s gonna drive.

I’m going to sleep.

And jamming in a lot of things for the Expo.

In addition to the in-person sessions, I am going as a funded delegate.

This means I have responsibilities.

Voting type responsibilities.

And there will be a party.

I already bought us tickets.

And, today, I get an email that matched me up with 2 Expo newbies.

Oh, boy.

How caffeinated was I when I made this plan?

I get to be the mentor to show them the ropes.

Oh, boy.

Every so often something happens to remind you that you are an elder nurse.

With 21 years of experience.

Like this.

That’s okay.

My introvert heart can take it.

I think.

I’m off to email my mentees about myself and my arrival details.

My plan is to make enough CEUs to complete my 135 needed to renew my CNOR.

Which is due December 31, 2023.

Right now, I have 175.

Oops.

I have lots of time for CEUs.

Okay?

After I prepare the house for my mom to move in an take care of the spoiled cats.

I have a list of things I do for the department.

Outside of my new shift of Sunday-Thursday 2100-0700.

Because someone has to get this stuff done.

First on the list is checking the instrument tracking numbers.

To ensure that people are still doing what is set forth in policy.

And tracking the instruments.

Not so funny story about that.

Something about an infectious disease and the immense need to be able to quarantine instruments.

In order for them to be destroyed and limit other patient’s exposure to the horrible disease.

Because we are in the business of helping, not harming people.

I check each day for complete documentation of instruments.

I make a report for people who are not quite doing what we know is right.

I am the OR representative on the Joint Commission team for total joint replacements.

I continue to be the laser safety officer for the hospital.

At least, until I’m not.

I represent surgical services at the hospital wide shared governance.

Because if we don’t speak to power, who will?

I continue to listen to complaints.

I may have less responsibility than I did, but I will still listen.

I track the IUSS.

Again, someone has to.

This department needs a mom, I swear.

For everything I still do for the department, I have dropped one or two things.

Balance, you know.

And I have to keep my Clinical Ladder Five somehow.

The post-it reads ‘upright and above ground.’

Being a woman of a certain age (above 16), everyone was interested in me procreating.

Well, sometimes it doesn’t happen.

And that is okay.

It sucks a bit.

But is okay.

I used to say when asked how I was, as they LOVE to do in the South, “Present or accounted for.”

This was a call back to parade practice while in ROTC.

It meant that all soldiers were present.

Or otherwise accounted for do to vacation or illness.

Many, many, many people think it means present AND accounted for.

Meaning you are double counting soldiers.

Don’t do that.

And as I matured people would mishear present for pregnant.

Also, don’t do that.

A woman’s reproductive life is not up for discussion.

When I hit my 40s, after 10 years of trying for a child with bupkis, I changed my answer.

My answer to how are you?

Upright and above ground.

It either startles people into a laugh or a commiseratory yeah, me too.

And the further we go along this pandemic path the more I mean it.

How am I?

I’m a working nurse in a hospital who has worked too many hours in the past, and taken ALL the call.

I’m a working nurse in pandemic times who has, so far, remained healthy.

So yeah, upright and above ground.

All present or accounted for means I am ready for service.

So does upright and above ground.

Ready to be deployed in healthcare.