24- Fifth verse, same as the first

Yes, the post title is meant to reference the song”I’m Henry the VIII, I Am” by Herman’s Hermits.

What the post title is referencing is that this is the FIFTH covid summer. 2020, 2021, 2022, 2023, 2024.

Not as bad, but still lethal. Masks have been legislated against or banned in many cities and states. You know, the masks that have kept some of us safe through this entire time.

It is illegal to wear a mask in some states if you are committing a crime.

Since when is the desire not to get covid a crime? Depends on who you ask. Are you asking the ones who don’t believe in covid, who think it’s a boogeyman dreamed up by those with public health in mind? To scare the stock market? To get people to buy into Big Pharma? To want to care for others, no matter their age, sex, religion, and orientation?

Yeah, those people. The ones who excuse the death of over one million Americans (the exact data is hard to come by). According to the CDC tracking database, there have been 1-9 covid deaths in North Carolina in the last week. However, the previous week’s numbers that allow comparison and percentages are not available. Ask yourself what they don’t want you to know or even acknowledge to themselves.

I am keeping a close eye on the infection rate at the hospital. We went from 1 admitted case to more than 5 times in a couple of weeks. ooh, five more patients? Yes, and these are just the ones that got admitted. Or came in. These are definitely the ones who are quarantining because they are in the hospital.

I have not resumed mask-wearing as a general rule. I have some in my car. However, I shop early or late or not at all. I don’t go places where there are a lot of people. On purpose, but then I’ve always kinda done that. Who knew being an introvert could help? Just every introvert known to man.

I have no idea how many covid posts this makes. My record-keeping has been spotty. And incomplete. And my mind has been busy with other things.

As always, it doesn’t matter if you don’t believe in covid; it believes in you.

Post-it Sunday 5-26-27- Outlook not so good, ask again later

The gown card reads “Surgery is not without its risks.”

My favorite thing is when people assume that surgery will solve everything.

Or should I say least favorite thing?

I get it. People want surgery to be an answer. Strike that. People want surgery to be THE answer.

My second least favorite OR thing is when people discount the c-section as not surgery.

Bitch, we opened up your belly like a can opener to get the baby out.

Understand?

I mean, we put it back together and stitched it up real nice. But the point is that someone was inside your abdomen, rooting around. There are all sorts of risks in this.

And people just answer no, no surgeries when asked in pre-op about previous surgeries. Only to casually drop that all four of their babies were born via section.

Um. That is major abdominal surgery. With a great prize at the end. But major abdominal surgery nonetheless.

But back to the least favorite thing with patients assuming that surgery is the answer to all their problems. Nope, not even a little.

There will be the risk of anesthesia. The risk of death. The risk of infection. The risk that the surgery might not even solve the problem that the patient is having. The risk that surgery itself will lead to another list of problems because of the risk of anesthesia, the risk of infection, or even the risk of it not being the appropriate surgery for their problem.

Why?

Because often to cut (do surgery) is to definitively find out what the problem is. Even if the problem was not the one that the patient and the surgeon thought they had.

Because your skin and insides are not transparent and until the surgeon gets a direct view of the problem, there is always the possibility of a missed diagnosis. Because although surgeons are excellent at their job (ahem, for the most part), they are not prognosticators.

This means they don’t have a crystal ball.

All they can do is their best.

And all the OR team can do is support them.

This is how you get the best outcomes for patients.

There is no magic 8-ball in surgery.

Imagine if there was.

Tuesday Top of Mind 5/21/24- anti public mask law proposed in NC

Um.

Are they trying to kill people?

Or is this a desperate cry to their base and the millions of people who HATED to wear a mask in the worst public health emergency in 100 years?

Masks save lives.

Full stop. End of story. Masking to save lives was true in the Middle Ages and the Black Death. It was true in 1918 during the Spanish Flu Epidemic and it is true today.

But, but what about the masked fiends who are protesting? Or who are breaking laws? What about them?

Increasing penalties for committing a crime while wearing a mask I can kind of understand.

But protesting is not breaking the law.

And neither is going out masked because someone is medically vulnerable.

This bill would make it illegal to wear a mask out if the wearer were medically fragile.

Consigning them to house arrest.

That is not a good look for the NC legislature but they don’t care. Doctors and other health professionals (hello, I’m right here) have spoken out against this proposed legislation.

Make no mistake, this is mostly about the protesters who wear masks.

And control. It is ALWAYS about control.

But what about the white supremacists who are trying to hide their identity.

What about them?

Tuesday Top of Mind 3/26/24-old song, new verse

On this Tuesday I am struck by the US measles rate. In the last three months, there have been 64 suspected cases in the US. According to the CDC, this is in 17 states and surpasses the total number of cases in 2023, which was 58. FOR THE ENTIRE YEAR! And there have been 64 in 85 days. How high can the number go in the next 280 days?

Like Covid, the answer is the same. Vaccination. The MMR, measles, mumps, and rubella vaccine that has been given to millions of people. If not billions. The same titer that I have had to have drawn at every level of schooling: ADN, BSN, MSN, and PhD. To make sure that I was not a danger to my classmates and that I was not in danger from the very random person who has those diseases. I also got the booster in the 1990s.

If another booster was deemed appropriate today I would roll up my sleeves. Right now.

Like Covid, the reason is the same. People who are against vaccines. For a variety of reasons. I don’t really care what your reasons are. I have heard them all.

You know what I read that was jaw-droppingly stupid? That the Florida surgeon general, whose state is enduring part of the measles wave, said it was okay to send your children to school even if they have measles. Oh, and the vaccinations? Not necessary.

Wall, meet head.

As the magazine Scientific American put it, this is a direct effect of the peddling of covid-era pattern of medical misinformation.

I will say it again, if you are against vaccination and part of the tide of cases that is threatening our herd immunity, your great-grandparents are spinning in their grave. They watched their children die and fought for vaccines. The same vaccines that have allowed us to build up the herd immunity that everyone enjoys. Even those assholes who think that they are not part of the herd but are enjoying the effects of our rolling up our sleeves and taking it for the good of humanity. Or allowing our children to be vaccinated so they are not in danger.

You might have been lucky and continue to be lucky, but what happens when your luck runs out?

Post-it Sunday 3/17/24-Recognition can be paralyzing

The post-it reads “Being recognized is hard.”

I didn’t add anything else to the post-it so I can only guess at the meaning.

Being recognized when you aren’t prepared for it is hard. It is paralyzing.

Years ago a patient approached me at the bookstore. I remembered them as being a patient several weeks back. They asked me if I was a nurse. I said that I am. They asked if I was their nurse.

This is where it is paralyzing. At least for this OR nurse.

Most of our patients are asleep. Even if I do the pre-op check-in and check-list with them I am not expecting to be remembered. There is a reason that the only Daisy nominations for the OR people are us recognizing our own.

I remember this patient. I remember that the outcome was not necessarily positive. But I couldn’t come out and say that.

Instead, I said, “Yes. I remember you. How are you doing?”

Taking the pressure off of me as an OR nurse and them as a patient. And recognizing them in return was a good thing. Perhaps they didn’t feel alone after their surgery and especially during. They had a hand to hold and a calming voice as they went to sleep and as they woke up.

I don’t think all OR people are awkward. But enough of us are. I definitely count myself in that number.

Because being recognized out of context can be weird. And paralyzing.

I hope that the patient is continuing to do well. I haven’t seen them in the bookstore in a while.

The OR patients are vulnerable

All OR patients are vulnerable.

Think about it. We take their clothes, their electronics, their glasses, their hearing aids, their family members, their dignity (at times). They are left with warm blankets, an electronic signature on an electronic consent, and a gown that doesn’t fasten in the back. And non-skid socks.

Sometimes there’s even a pillow!

There is always an IV.

Of course, the OR patient feels vulnerable. Some react by lashing out and being unpleasant. Some react by being meek. It takes all kinds of patients. The trick is knowing when they are acting out because they feel vulnerable and when they are in actual fear. A soothing hand and a soothing voice go a long way to defusing the situation.

The reason I write about this is because I was defending my dissertation interest of the OR during an assignment. The assignment was to write about a measurement tool that is being given to a vulnerable population and how it is translated into another language. There are MANY steps to the translation of a measurement tool. The professor looked surprised when I claimed that OR patients are vulnerable. I think I will incorporate the first paragraph explaining why the OR patient is vulnerable into the assignment paper. I just have to de first-person it.

I can do that.

During a session at AORN, the presenter echoed my thoughts that the OR patient is a member of a vulnerable population. I felt very smug because she was making all the points that I did.

Often when other nurses consider the vulnerable patient, they think of mothers, and children, and prisoners, and the mentally unwell, and they don’t even consider the OR patient. They are vulnerable as well.

And we should consider them. Imagine if I took away your glasses, your hearing aids, your clothes and your family. Think how you would feel.

We also speak another language that not many people know or understand. There is another vulnerability there.

Covid 4 years later

March 11, 2020, was the date that the WHO declared covid-19 a pandemic. I remember where I was; do you?

It was Wednesday and I was on shift. The lockdowns were not to start for over 2 weeks, the operating room schedule was normal. Little did we know what was to come.

I could not let this day go unrecognized.

So much has happened in the past 4 years. People have died and continue to die of covid. Long covid is the boogieman underneath the bed for many people. Symptoms can last for years. We are continuing to learn how dangerous long covid is and, really, how dangerous covid is. The virus attacks many systems: heart, lung, liver, brain. It can also cause extreme fatigue. I mean the kind of fatigue that makes life unbearable and very hard to survive. There are reports of long covid around the world.

And the world shrugs.

Conflating covid with the flu is dangerous. One is more virulent than the other.

And the world shrugs.

Vaccines and updates to vaccines are ready and willing to go into arms. According to a March 8, 2024 report from the CDC, the population reporting having the updated 2023-2024 vaccine is THIRTEEN POINT FIVE.

And the world shrugs.

Sometimes you just have to call in sick, you know?

I am ill. I can count on one hand the number of times I’ve been ill in the last 19 years. I had vertigo in 2005 and was flat on my back for 2 weeks because I couldn’t stand up. I think it was 2005, it might have been 2004. I had a cold in 2013. I had a persistent bladder infection/kidney infection in 2018. I know because it was so bad I basically gave up in class for my masters and I had to repeat it after taking 6 months off. I got food poisoning in May of 2022 that was so bad it put me off fast food and I haven’t had it since. I had a cold in July 2023. My body doesn’t like to rehash things, I guess?

Until today. Well, Monday. I won’t talk about symptoms, just know they were intense. Fever, pain… you get the picture. Hello, bladder infection.

I am on antibiotics.

I had the worst sick day on Thursday I’ve had since I had vertigo. I THINK my fever topped 103 but I’m not sure because I was shaking so hard from chills. The shaking made my muscles hurt. Or I have a concurrent viral thing going on.

NOT COVID.

I know, I tested Thursday AND Friday.

This week has been a bust.

No cookies.

No blogging.

But sometimes you just have to call in sick.

And I did, on Thursday. And if I still have a low-grade fever, yes, STILL, on Sunday. I will be calling in sick to the research assistant job.

I feel 60% better, but I’ve been having a low-grade fever since Monday. 99-101.6, with a high of 103. Not well enough to focus on my homework assignment that is due on Thursday, or reading for next week. I do have something VERY VERY IMPORTANT to finish for my third class.

I will have to focus on that tomorrow.

Let me run to the thermometer and recheck real fast.

I’m back; 100.8. Joy.

I will check back in with the doctor on Monday.

Tuesday top of mind 2/20/24- Cassandra calling

We warned you.

We warned you about the threat to Roe, despite assurances that there was nothing to be concerned about with settled law. Look what happened to Roe v Wade with the Dobbs decision. You know, the decision that knocked down fundamental, important rights of being a woman: the right to bodily autonomy, the right to privacy with discussions with their own doctor about their own body. That decision.

We warned you that medication abortion was next.

Along came Kacsmaryk and his ruling that called into question the FDA safety processes around mifepristone. The same ruling that was based on shoddy research that has since been recalled by the publisher? Yeah, and the case is now in front of the Supreme Court which has already shown willful disregard of laws and precedents in order to advance their religion on the United States. That one.

We warned you.

We warned you that in vitro fertilization was next.

After all the logical path says that if all abortion is murder, then in vitro embryos must be treated as people. The Alabama Supreme Court yesterday ruled that the embryos that were destroyed by accident by someone who wasn’t even allowed to be in the room but “wandered in” opened the freezer, took out embryos, and dropped them because the very cold temperatures required to gave them freezer burn to their hand. This broke the frozen clumps of cells. Yeah, and that temperature is -320 degrees Fahrenheit. The Alabama Supreme Court ruled that the embryos were to be considered children.

This was a terrible thing to happen to those cells. Terrible for the clinic that housed these cells, terrible for the family whose potential children were destroyed by someone “wandering around”. There should be charges.

However.

Respectfully an embryo is not a child. Embryos are potential children.

This ruling will send shockwaves through reproductive health. Again.

On a side note, the Mayo Clinic 10-20% of known pregnancies end in a miscarriage for a variety of reasons. That is not even counting the ones that are not yet realized and the woman may think nothing of a 1-2 day delay in her period or not even have a delay in her period.

Shall we take bets on what the courts will say about that? Are women going to be punished for having a miscarriage, a phenomenon that often has no answer and no causative agent? For being a woman. Bet me and you’ll be proven wrong when this slippery slope gets steeper and faster and men can act out their revenge fantasies on women. Because control.

I am sick of being Cassandra for reproductive health. Reminder, Cassandra was the daughter of the last king of Troy. Apollo bestowed the gift of prophecy on her in exchange for her doing his bidding. When she refused him, he said that no one would ever believe her prophecies. Sound familiar? Are you icked out yet?

Control has been the cudgel of powerful men for millennia. Even in fiction.

For now, in Alabama, frozen cells are to be conferred personhood.

We should all be frightened.

It’s raining men

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

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

Anyone? Just me, then. Cool.

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

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

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

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

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

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

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

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

Because gravity doesn’t give a shit.