25- Chasing Rabbits by Rodolfo Del Toro

I get discounted and free e-book lists daily. I never spend a lot of money, less than $5.00 per week. I was looking over the options this past Wednesday, like you do, when I saw this book. It is Chasing Rabbits by Rodolfo Del Toro and it is my favorite kind of medical non-fiction, a memoir.

And it was 99 cents.

I hit the buy now button and I was surprised that I already owned it. I was embarrassed when the site informed me that I had owned this book since February 2024.

I had never read it. School brain, you know. The book was part of my ginormous TBR pile that grows daily. But I can’t give up books entirely.

As medical memoirs go it is on the shorter side, only 220 pages. A quick read. I had time this weekend and so I decided to read it all in one go.

This story is in three parts. The beginning is what stands for present day, many years after the events of the 2nd part, and the third part picks the story back up from the first part. Rudy the doctor has an unexpectedly light afternoon before a three day weekend and his long-time secretary tells him he received an intriguing invitation from a butler.

This leads to the middle part of the book, which is the meatiest part of the book, and Rudy telling his secretary about this one rotation he had in his 4th year of medical school.

Cue the second part. The first part felt a little disjointed and rushed and I was prepared not to like the doctor. His secretary was great and is well written.

In the middle part, Rudy and his friend Mike are 4th year medical students and their planned clerkship for the last rotation of the year fell through. This was strongly hinted out because Mike’s family was rich and connected with an insurance company. This unexpected snafu was punishment for his father’s actions. I could see this but I wish that the book would have spend a little more time on this.

Because their real last rotation of the year was going to be together. In a children’s oncology ICU. With stable cast of characters, the doctor who oversees the unit, the fellow, a resident, and several nurses. And a pulmonology resident. All the nurses are named and have their own personalities. I love it when that happens. There is also Julia the supermodel who has been set up with Rudy by Mike.

There are three main children whose stories are centered in this section. Tim, the little boy with bone cancer, Megan, the little girl who has leukemia, and Maria, the ward of the state with a lost brother who has

Tim has had his lower leg amputated and a lump had been noted on his femur above his BKA. His parents were understandably concerned and he was in the hospital for a biopsy and treatment if necessary. He was waiting on biopsy results.

Megan is most concerned with being well enough for the trip to Disney land that was being planned for the children. When she is introduced, a nursing student has been assigned to restart her IV. Megan objects because the vein they want to use is unusable. Because she knows her body best she gives a tour of the most often used veins in the forearms. The nurse, not the nursing student, is successful in cannulating the vein that she indicates. This was one of my favorite passages. It is important that we give these kids who know they are sick, who know that it might not end the way everyone wants it to, agency over their body.

As Rudy and Mike leave the room, Dr. Betances is explaining to the nursing instructor that no nursing student will be starting this IV. His reasoning is that the kids have been through hell and do not need the pain from an unsuccessful needle stick. The nursing instructor just wants a body to have her students practice on and protests that the kids need new IVs so often it is a good practice place. I also liked this exchange. Dr. Betances standing up for his fragile patients. But I also disliked the nursing instructor who tantrumed off to tell on Dr. Betances. The nursing instructor does not come off looking good here.

Maria is in the isolation part of the ward because of her end-stage leukemia. She had a good attitude and a great smile. She also had a really good relationship with the main Dr. Betances. There is a back and forth about a business arrangement for having 1 medical student in her care, not 2. This was a great back and forth and you can really feel Maria here. The price of 2 medical students for the rotation is a 64 pack of crayons. As the group leaves to continue rounding, a nurse stays behind to talk to Maria.

In the next little bit, you learn about Billy, her foster brother, who was also at the farm where she was being fostered. But once the foster father died, she was sick and they were separated. He was adopted after that. Maria has been at the hospital for nearly a year. This is where it is explained that the staff takes care of all of Maria’s needs, including the non-medical ones. There are pink curtains, art supplies, and all the things to make a home for the dying little girl.

Rudy offers to talk to his friend the lawyer to search for Billy. This irritates Dr. Betances, like no one had bothered to look for Billy in the past 10 months.

The middle part is concerned with these children and their care. The nurses are caring and competent, the head doctor, Dr. Betances, is caring and giving, and the fellow teaches all that he can to the medical students.

I won’t write anymore about what life and death and bad news and good news happens in the second act. Or the third.

The best I can say is that I cried. And sometimes that is the best recommendation a book can have.

Part 2 more than made up for my perceived rushed feeling from part 1. I can understand after reading the second part, he just wanted to get into the meat of the story. I am a little less forgiving of the super model side plot, but even that has a good payoff and explanation.

You’re going to have to take my word for it.

I will read this again. I might even come to like the first part. But the second part is where the heart of the story is.

Call Secrets of the OR- OR investigations

Once upon a time that really happened, the patient was not waking up the way they should. All the anesthesia gases were off, the reversal agent given at least 10 minutes, but they were not opening their eyes or making any effort to, you know, breathe. Time ticks by, first five minutes, and then 10, and then 15 minutes. The anesthesiologist has been called to the room.

While anesthesia is trying to wake the patient up, you drag the workstation on wheels to the patient’s bedside so you can be an active part of the extubation, but also able to read the chart looking for clues.

There are none.

Time for a group think.

You ask about family history that isn’t in the chart. You remember that there is an enzyme deficiency that delays the clearance of anesthesia. You remember because one of your med-surg patients had it and would call for a certain medication whenever she woke up from anesthesia. You remember her telling you that she had a liver problem in the beginning of this conversation. And not only did she have it but so did her youngest daughter. And the last time there was a very long delay in waking up from anesthesia on one of the cases you’ve worked, it was also an enzyme deficiency. The same one the med-surg patient had.

The anesthesiologist goes out to the surgical waiting room to ask about family history of slow wake ups. This was covered in the pre-op consultation at bedside but this is a check in that what the patient and family said pre-op is correct. This is where they remember that grandfather would talk about the time that it took so long for him to wake up after surgery that when he finally did it was the next day and he was in ICU. But no one else has had a long wake-up. Not that many of them had ever had surgery other than babies.

There is such an enzyme deficiency that causes this. It is called pseudocholinesterase deficiency. This is an enzyme that breaks down anesthetic medications, such as succinylcholine. This is the medication that is often used to paralyze the patient prior to intubation.

Unknown to any of us, and the patient, and the family, this patient had a pseudocholinesterase deficiency. Their liver wasn’t metabolizing the paralytic, which kept them unable to breath on their own.

This is a quandary. There are two paths. The first is to keep the patient intubated in the operating room until enough time has passed to allow them to breath on their own. This is costly as an OR minute is expensive and who knows how long it will take before the patient wakes up. And also it effectively ties up the anesthesia team and leaves OB especially vulnerable in case there is a stat section. The second path is to keep the patient intubated, call for a ventilator to be brought to the PACU, and admit them to the ICU. Not long, just long enough for them to start breathing on their own. This can be anywhere from 2 hours to 12 hours.

The decision is made to move the patient to PACU and the waiting ventilator. If they are not extubatable at 2 hours, then PACU would move the patient to the ICU. Because call back time for the PACU nurse is expensive.

The first thing to do as the OR call nurse is to check the hospital census. This is a picture of what rooms are available. The second thing is to call the supervisor and tell them about the situation and the steps that might need to happen going forward. They promise to save an ICU bed.

The patient is moved to PACU, and attached to the ventilator and the monitors.

The waiting begins.

After the patient is settled in PACU, on a ventilator, you call the surgeon, who has been long gone, to tell them of the situation. Regardless of the working theory it is pseudocholinesterase deficiency, the surgeon still needs to be informed of what is going on. You tell the surgeon of the plan to wait in PACU for 2 hours and then the admission to the ICU if the patient is not yet awake.

You check in the PACU nurses and tell them that you’ve called the surgeon and gotten them up to speed on the situation. If there is nothing else, you will be heading home because OR call back time is expensive and being in the PACU when there are 2 recovery room nurses is expensive.

You remind them that the nursing supervisor is aware, there is a bed being held and the surgeon is aware. They run through the plan again with you of 2 hours intubated in the PACU and then, if not awake enough to extubate, admission to the ICU. They tell you to go home.

On your way out of the PACU you pass the anesthesiologist who is writing a letter to the patient advising them to be tested for pseudocholinesterase deficiency and advising them of the importance of having the family tested to. Because this is a genetic deficiency and is passed down. Like the patient’s grandfather likely passed it down to the rest of the family.

Luckily there is a test for that.

You tell the anesthesiologist that the PACU nurses know the plan and ask if they’ve spoken to the family again. If they have, you are going home.

The anesthesiologist assures you that the family has been spoken to and are waiting to see which path is to be taken.

You head home.

In a rare follow-up, you learn that the patient was able to breath in the PACU after an hour. They were extubated and sent home with family. The entire family was aware that they had to be tested or tell the next hospital and operating room they found themselves at.

This was the best case scenario. If the patient hadn’t been a young, health individual with a possible family history of pseudocholinesterase deficiency, more steps would have been taken in case it was something else. A head CT would have been the next stop to check for a stroke, and labs would have been drawn.

But not this patient. They were able to be extubated and go home with their family. With a heck of a story to tell and homework to do.

FFS Friday 9/5/25- Finally

Vaccine news has been exhausting this week. Good and terrible.

But first something I learned today. States manage their own vaccine programs and their programs are more powerful than the federal wants and wishes.

This is a Gordian knot of anti-vaccine bullshit. Of RFK Jr.’s making. He’s the one driving this train straight to widespread illness and death. Do not pass go, and, by the way, covid vaccines will be going up in price.

RFK Jr. testified before the Senate on Thursday. In part to answer for the CDC chaos that he fomented and lit a fire under, and in part to address his egregious anti-vaccine stance.

Some of the senators, especially Sen. Bill Cassidy (a doctor and a republican who voted RFK Jr. into his position), and Sen. John Barrasso (a doctor and a republican who voted RFK Jr. into his position) reminded RFK Jr. that he promised to uphold the highest standards for vaccines.

It was a contentious hearing and RFK Jr. was misrepresenting what was going on. Misrepresenting is another word for lying. We deserve better. We, as a society and as health care workers, are not surprised.

As an aside, we all know that he is shitting on the standards for vaccines. From his Advisory Committee on Immunization Practices (ACIP) firings and subsequent hiring and appointment of anti-vaccine bros and sycophants onto that same committee (an lying about it to the public that this unprecedented action would restore public trust in vaccine, a trust he’s violated for years), his canceling of mRNA vaccine grants, and his pressure on the directors to follow his tyrannic drivel on vaccines. Some of the directors have resigned in protest. There was even a letter from 1000 current and former HHS employees that called for RFK Jr.’s resignation on Wednesday (9/3) morning.

As an other aside, we all have heard stories, some first hand, of people being denied the covid vaccine. Including doctors and nurses and other front line staff. Even a grade 4 cancer patient who was under the 65 year age limit, the wife of conservative commentator Erick Erickson, was denied. Correct me if I am wrong but stage 4 cancer is the very definition of high risk.

By the way this is why I recommended a booster for EVERYONE that I know back in April when the shit started to roll downhill. Because this writing was on the wall.

In positive vaccine news, Washington, California, and Oregon have launched the West Coast Health Alliance. Its aim is to use scientific integrity in public health and the use of evidence based guidance for their states’ citizens. This was Wednesday (9/3/) as well. They cited the politicization of the CDC and HHS as primary drivers of this new alliance.

I believe that other blue states will join them. I wish them all the best of luck.

Somewhere a states’ rights believer’s (who also believes in federal mandates on abortion and vaccines head) is exploding. My body, my choice for me, not for thee.

You cannot pick and choose when states’ rights are allowed and when they are not.

FFS Friday 8/29/25- Free the CDC

Additional furor over the CDC.

This time it’s personal.

The CDC director was asked to step down after refusing to support the administration’s agenda. Newly confirmed Susan Monarez refused. So they fired her for refusing to toe their line of bullshit and refusing to listen to RFK Jr.’s nonsense.

Basically they fired her for choosing public health over politics.

Good for her.

Also good for the wave of resignations that followed of an additional four high level department heads including the head of the National Center for Emerging and Zoonotic Infectious diseases. The others who resigned in protest were the deputy director and the heads of the National Center for Immunization and Respiratory Diseases, and the head of the office of Public Health Data, Surveillance, and Technology. Like that’s not going to shoot us in the foot. Or, rather, in the public health.

For those who are not aware of what public health is, the definition that the American Public Health Association goes by is that “Public health promotes and protects the health of all people and their communities.” The association goes further to explain that their solutions are science-based, and evidence-backed that strives to give everyone a safe environment to live, work and play in.

For those who are not aware what science-based means broadly that there has been use of “rigorous, systematic, and objective methodologies to obtain reliable and valid knowledge.” This definition is by the American Education Research Association and is used as a framework to members of Congress. As someone who has spent the last three years learning how to do research I can assure it is not “vibes” only.

For those who are not aware what evidence backed means it is another way to phrase evidence-based. This means that the information used to back up the care or the data as been found through credible, reliable science. It is important to understand that there is a hierarchy of evidence that is used to rank research. The strongest is systematic reviews. This is a systematic investigation of the meta- analyses of research. There are nine steps to the pyramid of hierarchy of evidence pyramid with the last, lowest step being expert opinion. There are many hierarchy of evidence lists from the NIH, from the Canadian Task Force on the Periodic Health Examination’s Level of Evidence, and many other. Not one of the progenitors say “vibes” only.

Former HHS Secretary Xavier Becerra was understandably concerned with this development. He said, “Politicians don’t do science well. It is dangerous to put politics over public health.”

It is my opinion that is also costly to put politics over public health. Not just in lives of the people that will die but also fiscally. It is expensive to care for those who are caught up in the web of deceit that now descends on the agency.

Unless of course you don’t care about scientific inquiry and base your entire secretary-ship on the lies you tell yourself. And other people. That is cold comfort to those who have to bury the dead from the misinformation.

Don’t forget that over 80 people died when RFK Jr’s lies led them not to trust the Mumps, Measles, Rubella vaccination. They decided that he knew what he was talking about and didn’t vaccinate and a cluster soon followed. A deadly choice on their part. This information is in part from Senator Brian Schatz (D, HI) at the circus of confirmation of RFK.

This information is also widely known and you’d think it would be enough to sink his ego.

But that’s not a bad enough vibe for these people.

Call Secrets of the OR #6- Sometimes you get beaten by the buzzer

Look, we are in the business of solving the case, of being the kiss on a boo-boo, of the patient having a problem and we need to fix it, of being the buzzer beater every damned time.

Sometimes that doesn’t happen.

And it sucks.

I had a difficult case a few weeks ago.

The kind of case where the patient is going to sleep and I am holding their hand, telling them that their son told me to tell the patient “I love you from your Danny.” He told me this while I was getting a phone consent with another nurse because the son was frantically waiting for his flight to get to the area and the patient, who was struggling to breathe, smiled.

The kind of case where you are listening to the pulse ox beeping get lower and lower and, without letting go of their hand you turn your head and tell the scrub tech to please let the first arrivers to the pre-op area (0530) to be on stand-by because the patient might need them.

The kind of case where the abdominal blocks are on hold because if the patient goes straight to the unit what’s the point of them?

The kind of case where you call the anesthesiologist back to the pre-op area that is also PACU at 0400 to tell them of the patient’s desired code status.

The kind of case where the anesthesiologist came right back and spoke to the patient and the son on the phone about what needed to happen about the code status during surgery.

The kind of case where there are a thousand different needs from the field, from the anesthesia team, from the front desk calling you for some reason because they want to tell you not to call in the PACU nurse.

The kind of case where before you even are in the room with the patient you look to see where the open beds are, hoping that there is an intensive care bed.

The kind of case where you text the nursing supervisor that you will need an ICU bed as you are on the phone with pharmacy looking for the coumadin antagonist that has been ordered. STAT.

The kind of case where the surgeon asks for an impossible item that does not live in the hospital, despite you mentioning it several times that it has been requested. The surgeon didn’t want to use the off-brand disposable.

The kind of case that when day shift workers, who have shown up by now, are in the room for the sixth time asking how they can help you send them to get gloves and to try to find the piece of equipment that the surgeon is demanding that you know doesn’t live in the hospital.

The kind of case where the surgery is cut short and the surgeon says that the patient will have to come back to the OR in the next day for completion of the surgery after the patient was worked up a bit more (we call that resuscitation). Because the surgeon knew that the patient was too ill to continue surgery, after the offending part had been excised.

The kind of case where you’d love to go home and get back into bed but you’ve a full day planned between meetings for the hospital and a long delayed birthday lunch.

The kind of case where you leave the patient open because of the need for a further surgery shortly. Open but with a wound-vac.

The kind of case where you call and ask the pre-op area to please get the ICU bed from ICU and a transport monitor and the bed that is left for the patient is a regular patient bed. And the transport monitor? It is dead.

The kind of case where it takes so long to pack the patient and their various lines up and get ready to bag the patient all the way to the ICU the ICU bed and monitor make it downstairs. And you help put the patient on it, making sure that all the lines and the foley is untangled and not caught.

The kind of case where you clock out at 0830, an hour and a half after your end of shift.

The kind of case where you tell the front desk, the unit admin, the charge nurse that the ice cream you’d made for the ice cream social that afternoon was in the freezer and every damned person in the lounge and at the desk freezes and says they forgot that it was today. You collect money and go to the grocery store across the street and buy 4 gallons of ice cream, ice cream bars, 3 different types of syrup, canned whipped cream, sprinkles, spoons and bowls for the exact amount that you collected from the guilty coworkers who forgot about the 11th annual ice cream social. It isn’t like this happens every year.

The kind of case where you go home and stare at the wall for awhile. But you have meetings to attend! So you get up and join the meeting.

The kind of case where you never know the outcome because the patient was transferred to a higher acuity hospital and it is against policy to open up charts willy-nilly because you are curious.

Ugly calls will exist.

What matters most is that you were able to comfort the patient as they went to sleep and you were able to pass on the message from their loved one. What matters most is that you were able to manage all of the calls and push and pulls of day shift and the call shift in that moment.

And that there was ice cream.

Call Secrets of the OR #4- Every call shift will end… Tomorrow!

The shift will end
Tomorrow
Bet your bottom dollar
That tomorrow
There’ll be sleep!

Just thinkin’ about shift end
Clears away the cobwebs
And the sorrow
’til there’s none!

When I’m stuck in a shift
That’s long
And forever
I just stick out my chin
And grin,
And say,
Oh.

The call will end
Tomorrow
So I’ve got to hang on ’til tomorrow
Come what may!

Tomorrow!
Tomorrow!
I will sleep
Tomorrow!
Sleep’s only a shift away!

Apologies to Martin Shaman and Charles Strouse for co-opting and re-writing their hit “Tomorrow” from the Broadway musical Annie.

As a night shifter, I know that sleep is very important. And some nights we don’t get a lot of it. But that is the nature of the call shift. Sometimes there isn’t a lot of sleep, and sometimes it is a full night of it. You have to be able to roll with the schedule.

The first thing my university advisor asks when she sees me is “How’s the sleep? Are you getting enough of it?” Yes, Dr. Advisor, I am getting enough sleep. I have data points to share if you are interested. Maybe I should make it into a graph for show and tell purposes.

That being said, and knowing that not everyone tracks your own sleep patterns, there are some things that can be done in your sleep environment to prepare yourself for good sleep.

Is the room cool enough? A University of Texas sleep specialist, Dr. Okeanis Vauu, reported that sleeping in a cool dark room is recommended. After all, our brain wants a cooler temperature while we sleep. This information is from a UT article on sleep after the spring forward time change.

But it is definitely appropriate for sleeping after a call shift.

The dark room during the day may be harder to accomplish. I have purchased black out curtains until I am blue in the face but they are never dark enough. Next I found and purchased black out blinds that you cut to size. I cut and installed these after the first month I was on call.

Instant bliss. Not to mention cooler.

In the summer, I also put up heavy curtains in the adjoining bath because of the afternoon sun that 1) heats up the small room, and 2) is blindingly bright.

My husband works afternoons/nights and is glad for the additional window coverings.

We don’t have children to get off to school or children at home. Unless you count the cat, who insists that I get out of bed by 0800 every morning, whether or not I’ve worked the night before. But I have heard that can be a barrier for some.

Sleep when you can. Some people can go right to bed when they get home and this is a good habit to get into.

Because you never know when the next case will pop up. There have been times that I’ve been home and in bed for 15 minutes and the darned pager went off again. And I head back to the hospital for another case.

Thankfully those kind of nights are hopefully far apart. And if it is a string of late nights just remember that day shift will be in a 0700 to relieve you so you can go home and sleep.

No bad pattern lasts forever. Some last longer than most but that’s call life.

I find it best not to focus on the sleep you’re missing but instead focus on the good sleep you will get the next day because you won’t be responsible for day cases. And the hospital won’t be ringing you up with add ons.

Remember, there is always a shift end. There is also a finite amount of time that the case volume can hurt you and stop you from sleeping.

These tips are coming from a call afficionado: make your room as dark as you can, and make your room as cool as you can. Fans are a good help here.

And take the afternoon nap when you are able to. Especially if the house is still and silent because everyone else is away at school or work.

Pay attention to your sleep hygiene and practices while on call. Well, any night really, but especially on call.

Call is only a sleep debt if you want it to be.

Tuesday Top of Mind 8/12/2025- Vaccine lies lead to deadly shooting at the CDC

The original title of this post was Panic at the CDC, with a subtitle of no, this ain’t no disco.

Then I thought better. Time to call the vaccine lies what they are, lies. According to the Merriam Webster dictionary the definition of a lie is to “make an untrue statement with the intent to deceive”.

We need to start naming the lies.

None of this namby-pamby “mistruths”, “states without evidence”, “mislead”, “false”, and “fabrications”. All of those words mean the same thing. That someone is not being honest with you *cough, cough, RFK Jr., Fox News* for their own benefit.

Use the word lie(s). Tell it like it is.

It is a good rule of thumb to interrogate your feelings about what you are being told. And also consider the motive behind the one telling you these “truths”. Is it to make you mad? Is it to make you do something that you would not normally do? Such as shoot up the very place that works, and has worked since 1946, to keep the public safe.

This is about a man who was poisoned by the media he was ingesting, not the vaccine that he receive. He thought, probably because that is what he was told, that the vaccine was making him depressed and suicidal.

So, emboldened by the lies that were being told to him at the highest levels and the news, the shooter gathered up his guns and went to kill the very thing he blamed for how his life had gone off the rails.

Never mind that the CDC had been actively working to keep him alive and in good health.

No.

He went to the CDC campus in Atlanta, Georgia and fired 180 rounds into the buildings. He broke 150 windows by firing indiscriminately at four buildings. He was not on the CDC campus, instead firing from the second floor of a CVS across the street.

He also killed a first responder, a Dekalb police officer by the name of David Rose. This was a man who will be missed by his wife and children. He was shot responding to the shooting.

This is an ongoing story and investigation. However, it is also a moment of reflection.

I certainly hope those who are spewing anti-vaccine lies and rhetoric do not sleep easy knowing that their reckless lies and breathless new reports caused this.

According to the CDC website, and the various vaccine makers such as Pfizer and Moderna, depression and suicidal ideation is not a side effect of the vaccines.

And no, I will not be naming the coward who thought it was a good idea to listen to the lies and act upon them. That is readily available.

As always when you are confronted with a news report, Facebook post, text from a friend, consider who your anger benefits.

For fuck’s sake, stop calling it misinformation and use the word lie!

Call secrets of the OR #1- Know call time is not your own

Instead of Best Kept Secrets of the OR I thought instead to start a new subset of Wednesday. This is going to be Call Sets of the OR.

I got the idea last night when I had a surgeon, a CRNA, and the surgical tech all tell me that the case we were about to start would horribly. I reminded them that we could not know that and I believed in the power of positive thinking. That thinking and speaking negatively might just create the very negative reality for us and the patient.

No wonder they called me Pollyanna Puke on the floor.

But that is another call topic for another time.

The very first call secret is one that I know that a lot of my fellow operating room people fail at.

And that is knowing that the hours you are on call is not your own. By that I mean that the hours are not yours to do with as you wish and you might get called in during that time. But if you are called in, you are unpleasant and drag your feet on everything.

That is no way to create a positive experience for the patient.

Look, having to undergo semi-urgent or emergency surgery, because that is what the call case make-up should be, is no walk in the park for them. The patient has to be NPO, dressed in tissue paper, have an IV, and have anesthesia. This might be run of the mill for us but maybe they’ve never had surgery before and they are scared out of their wits.

Or maybe they’ve had surgery before but it was years ago when they were a kid and all they remember is being cold and dressed in tissue paper and surrounded by people in funny blue clothes that are not their mommy or daddy and being held down and having to breath in a yucky gas and then nothing until they wake up in a too bright room with yet more strangers and their wrist or their ears or their tummy hurts. And so they are scared out of their wits.

It is rare to have a patient who is laissez-faire about having surgery.

The patients are who the call nurse needs to be thinking about while they are on call. And how to make their experience smooth and efficient.

It is a mind shift for sure.

Make it less I HAVE to go in and more I GET to go in.

Do I know how to make the mind shift? No. The only thing that I know is that the brain is kind of like a muscle. You have to work on changing your own mindset.

Frankly, it can take some time, and repeated calls.

Ultimately we don’t take call for ourselves. Some of us might take call for the extra pay, or to pay back a favor to a coworker, or so that a coworker will owe you a favor. A lot of people take call because it is mandatory. Those are the calls that I took, back when I was the evening charge nurse and scooping up all the calls. Because the person whose call it was didn’t want it.

So don’t make plans. Your call hours are not your own. At the very most make vague plans. And realize that a call from the supervisor can and will change them in an instant.

North Carolina is going Surgical Smoke FREE

dun-dun-DUN–dun-dun-DUNan–dun-dun-DUN-dun dun

This is the opening guitar riff of Smoke on the Water by Deep Purple. Go to YouTube and check me. You know that I am right.

It was 8 years ago that I recognized that other people, often with less years in the OR, would react to the shall we say unsightly odors of some surgeries. Smells would hit me later in a case than others. A surgeon and a tech would react to the smell of an appendix or open abdomen and it wasn’t until it was closer to me such as when I was collecting the specimen that the smell would make it to my scent receptors, and I would become aware of what they were talking about.

This was a very gradual awareness, brought on by what I assumed was a very gradual over- exposure to the bovie smoke.

Let’s talk about the effects of surgical smoke. It has been compared to smoking 30 unfiltered cigarettes per day. Surgical smoke also contains arsenic, smoke particles, people particles (live tissue fragments), e-coli, SARS-Cov-2 (aka covid), toxic gases, benzene and hydrogen cyanide. It can cause a decreased sense of smell, asthma, allergies, chronic bronchitis, chronic sore throat, and even chronic lung diseases.

Forthwith I became aware that my sense of smell had been altered by 23 years in the operating room. Many of those years were in heavy surgical smoke plume cases- total joints, plastic surgery, and open abdomens.

Surgical smoke is created by use of an electro-cautery device, most often a bovie. This piece of electrical cautery equipment was named after the Dr. William T. Bovie who developed the electrical cautery machine in 1926. This was used to stem the bleeding cause by incisions and surgery.

In 2018, Rhode Island became the first state to enact legislation to ensure that all hospitals and free-standing ambulatory centers used a smoke evacuator in the OR. Many other states joined them- Arizona, Colorado, Connecticut, California, Georgia, Illinois, Kentucky, Louisiana, Missouri, New Jersey, New York, Ohio, Oregon, Minnesota, West Virginia, and Washington.

AND NORTH CAROLINA!!!

We make the 19th state that has elected to protect their nurses, scrub techs, surgeons, and patients.

Smoke free is a misnomer. It is a short hand way of saying that the surgical smoke plume is contained at the site of surgery with smoke evacuation.

However, Governor Josh Stein just signed it into law. To go into effect January 1, 2026.

The hospital system I work for started mandating surgical smoke evacuation during covid. Because, as you may have noticed above, covid is carried by surgical smoke.

Did I write this legislation? No.

However, I have written, and spoke to surgeons, and written legislators, and called legislators, and signed petitions. Basically, we kept up pressure. I even used surgical smoke legislation in the Health Care Policy and Ethics class that I took fall semester 2023. This was when the NC legislature was waffling about it. I did presentations and wrote papers about the dangers of surgical smoke and the importance of going smoke free. I shared the papers and presentations with anyone who asked.

I needed this win today.

Oh, happy day!

Tuesday Top of Mind 6/17/25- Death from a thousand cuts

Piggybacking on FFS Fridays post from last week titled TNTC, AKA too numerous to count, I want to be clear on what happened to women in the past who did not have access to safe abortion care.

THEY DIED.

I want to be clear about what happened to children who did not received vaccines (they hadn’t been developed yet).

THEY DIED.

I want to be clear about what happened to everyday people who didn’t have access to quality healthcare.

THEY DIED.

I want to be clear about what happened to diabetics who did not receive insulin. This was in the before times when insulin resistance was not a thing.

THEY DIED.

Or they ate a horribly restricted diet under the guidance of a doctor. This was begun in 1915 and lasted until insulin was developed in 1922. The patients “lived” on 500 calories a day, with one fasting day per week. This was to keep their glucose in check. Or, knowing that this horrible disease was due to the patient not being to metabolize carbohydrates (they thought), there was also an animal diet where the patient only ate meat and fats. But in the post WWI world, who had that kind of money. Otherwise…

THEY DIED.

I want to be clear about what happened to babies who were born before 35 weeks. This was before the isolette which was developed in the 1880s to keep premature babies warm by Stephane Tarnier, a French physician.

THEY DIED.

I want to be clear about what happened to patients who developed gangrene from wounds before penicillin was discovered in 1928.

THEY DIED.

I want to be clear about what happened to women and children who were widowed and orphaned, respectively, and were sent to poorhouses because there was no longer anyone working.

SOME DIED.

I want to be clear about what was a major cause of death of women before the mid 20th century. Childbirth, many, many women DIED in childbirth.

I want to be clear about what happened to babies with congenital heart malformations such as Tetralogy of Fallot or a patent ductus arteriosus (which is the failure of the pathway between the two major arteries of the heart) or a transposition of the great arteries (the switching of the pulmonary artery and the aorta).

THEY DIED.

In agony.

I want to be clear about what happened to the babies who were born different and twisted.

They got sent away to an institution and THEY DIED EARLY.

All of the advancements brought to you by medical pioneers and researchers and you want to throw it away?

Worse, the government wants to throw it away. And toss money after it because of the cancelled trials.

Shame.