25- Winter-freaking finally-break!

I know this semester has been, well, odd.

Hell this entire year has been odder.

So many changes on the federal level, including new intrusive FAFSA questions.

Including the grinch swiping away what little student loan relief that the Biden administration was allowed to do by the courts.

I mean, we all know who the grinch is, right?

Put that aside.

Things will still be bat-shit-crazy in the new year and the new semester.

Take a deep breath now, and count the good things.

Finals are done and your grades most likely in by your instructors.

Winter graduations and hoodings for graduate students have occurred. Including two of my cohort. Congratulations, guys, well done.

I’m not jealous at all. No, really I’m not. This is a process and I am just not as far along as them.

It is too early to plan for Spring Semester.

Christmas is over 10 days away.

Now is the time to breathe. And maybe nap. In fact, I hope your sleep is as good as Dot’s on her warming pad and window perch.

My winter hope for you is that you rest well over Winter Break.

Think about school only if you want to but don’t obsess about it.

Read that book you’ve been meaning to get to.

Watch that hot new movie in the theater before it is pulled.

As an aside, Hamnet was one of the best movies I’ve ever seen.

Watch that television show that you’ve been saving up for the end of the semester.

Wrap your presents (if you do them), ready your travel plans (if you are going anywhere), but be safe.

The crazy things will be there after the first of the year.

Take this time to re-center yourself and remember who you are and why you are on this journey.

And have a happy, safe, and restful holidays.

Spring Semester is just a breath away.

FFS Friday- FDA, blink twice if you are in trouble

Actually, don’t bother blinking.

We in healthcare KNOW that you are in trouble. As you have a bad case of the know nothings in charge of you and your vaccines and your medications.

Some of the Senators could have helped you out but they were too busy bending the knee to a wannabe fascist who is hell bent on wringing all the money they can out of their shitty decisions and actions.

You see, they are in their villain phase.

Where the only thing that matters is the green.

Of course, I write of money, moola, dough, loot, and bucks.

They are too busy stealing from us that they think that making us sick by not extending Affordable Care Act credits for those who need help with the astronomically skyrocketing costs of insurance, shields what they are doing by providing cover fire.

Forget bread and circuses, this administration is about social media lies and villainy.

Why? Because to be the lowest level they can be feels GOOD. To them at least. I would have sent myself to bed without dinner if I acted like they do. Lives are not their playthings. Did no one teach them manners as children? Or even ever told them no?

Today’s latest bullshit is a waving of a “possible” black box warning on the covid vaccine.

Yeah, that one.

The one that has saved millions and millions and millions of lives.

Worldwide.

This black box warning will be slapped on the life saving, lung saving, world saving vaccine by the end of the year, according to reports from CNBC and Reuters and CNN and other news sites.

I think this is a distraction. Of course all the news is covering it.

Of course all the healthcare workers, MDs, RNs, LPNs, CNAs, PAs, and the like are decrying it.

If true, this is big black coal letters the size of Mt. Everest BAD.

This kind of bullshit pulls the wool over the eyes of the people who don’t know any better.

And makes them doubt ALL the vaccines.

Makes them doubt healthcare.

Makes them doubt medicine.

Takes us back to when we were smashing rocks against other rocks and against each other.

I am not sure of their endgame, besides confusion, and lining their own pockets and those of their billionaire handlers.

Or are they spoiled brats who are gleefully pulling the stuffing out of America?

After all, weakening us makes us prey.

Well, I don’t feel like acting like prey. Wanna see my teeth?

We tried to warn you but you didn’t listen.

Tuesday Top of Mind 12/9/25- Empty stools in empty lab rooms

With apologies to Claude-Michel Schonberg, Herbert Kretzmer, and Cameron Mackintosh and the original singers of this adapted song.

I speak of course of Les Misérables.

All of the albums, the 1985 cast album, The 10th anniversary Dreamcast, and the 2012 movie soundtrack, have been on near repeat in my head and in my speakers since the first No Kings protests. I’ve written about it before but something about the failed revolution speaks to me in these WTF times.

My favorite song has always been Empty Chairs at Empty Tables when the survivor of the barricade, Marius, sings to the phantoms of his friends. It is hard to be a survivor of atrocities. I imagine it is harder yet to be among the survivors desperately trying to salvage what they can at the CDC. Because of the grant pulling and the firings and the August 20, 2025 attack on the CDC itself where a police officer died.

I was driving home from baking Christmas cookies with my mom when I started humming this song. I started changing the lyrics right then. I tried to stay true to the original cadence of the song and I changed some words.

Empty Stools in Empty Lab Rooms
There’s a rage that can’t be spoken
There’s a fear goes on and on
Empty stools in empty lab rooms
Now my friends are fired and gone

Here they talked of exploration
Of possibilities
Here they talked about diagnoses
And the diagnoses never came

From the laboratory in the hallway
They could see a germ defeated
And they rose crying Eureka
And I can see them now
The very science that they had worked
In the lonely lab at dawn

Oh, my friends, my friends, forgive me
That I work and you are gone
There’s a rage that can’t be spoken
There’s a fear that goes on and on

The lonely faces on the screen
Phantom shadows on the Zoom
Empty stools in empty lab rooms
Where my friends will work no more

Oh, my friends, my friends, forgive me
That I work and you are gone
There’s a rage that can’t be spoken
There’s a fear that goes on and on

What scientific advances won’t be made? What cancers will grow out of control because there is no one to stop them?

How people have to die because this is happening?

Call Secrets of the OR- FOUR years I’ve been doing this gig

It was the beginning of December in 2021 when I started the night call nurse position.

Let me back up. In the spring of that year my manager pulled me aside. She knew that I picked up the vast majority of the call and she wanted to warn me that the corporation was doing a pilot call team position at a sister hospital. If the call team was successful, the idea would roll out to all the hospitals in the market and then the corporation. If that happened, all my call hours would go away. The pilot was successful and they were going to roll it out to the market hospitals.

When the position opened I took a deep breath and applied.

There were various reasons for this. It was mid pandemic and the dark scary 2020 was over and people were surviving and the schedule was open to all surgeries again. Vaccinations were in full swing in the population. It felt like time to breathe.

More than that, it felt like time to step back from being so involved in the hospital.

I could have stepped away from call and only done my 1430-2300 Monday-Friday shifts. Without every night and all weekend call I would gain 88 hours back. 40 of night call hours, and 48 of all weekend call.

That would have been good. I would get my nights and weekends back.

But the call that I enjoy so much would have been wildly reduced.

Call is my favorite. Have I mentioned that?

I had been working so hard for so long that I felt that I needed to step away from my workaholic tendencies.

I interviewed and received an offer. After a counter offer to keep the ability to maintain my clinical ladder, I accepted.

My new journey as the night call nurse would commence in 30 days.

It was time and this was a good stopping point.

I had been the evening charge nurse for 10 years.

I had been leading shared governance in most of its levels for 6 years. I had been on four hospital committees with their attendant meetings which was about 2 hours per week. I stepped back to 1 committee and from the corporate shared governance levels.

It was time for this workaholic to try to remember who she was without the hospital.

I have maintained the Cookie Thursday is a Thing and I am proud that there hasn’t been any store bought cookies for 3 years. Its popularity is waning and I have to consider what that is going to mean for the future CTIAT. But more on that in the new year.

Carving out a 50 hour workweek out of 128+ hours I had been scheduled was going to take some time to get used to.

But first a nap.

And then maybe I will look around and see what I can do with my new free time.

Since this all happened in the past I can tell you that I spent the next six months applying to a PhD program and I’ve been doing that for the past three years. But that is a story for School Me Saturday.

Being a recovering workaholic is hard. Especially one who jumped straight into another long term commitment.

I assure you that this is slowing down for me.

I regularly tell other operating room nurses that I encounter at conventions or online that I have the coolest job in the world.

And I still feel that way.

Call Secrets of the OR 10/29/25- all call cases are emergencies

All call cases are emergencies. I admit sometimes they are emergency adjacent but still the case must be done. There are the rare exceptions when the call team did a total knee in the middle of the night and then discharged the patient because the surgeon, who was 5 hours late, insisted. That’s for another time.

All call cases are emergencies. To that end, it is okay to tell another department who has their gurney waiting outside the room when you go to pick up a patient that their non-emergent test is just going to have to wait.

Yes, that happened.

Another nurse and I were up on the 4th floor picking up a patient. We packaged the patient up. This means that we removed all the monitors, and replaced them with our own, we cleared all the stuff from the bed that wasn’t the patient. We unplugged the bed and told the family to follow us to the elevators and opened the door.

To be confronted by a worker from another department, ready with a gurney, to take the patient to their department for a non-urgent test.

Um, no you may not have the patient for your non-urgent test.

No, I don’t care that this patient is next on your to do list.

No, I don’t care that it looks badly to your supervisor if you don’t get the test done in a timely manner.

This patient is ill, ill, ill and requires emergent surgery to fix what is wrong with them. Well, not fix, but to remove the offending body part that was making them so sick.

No, we have to rush down to the OR and start the surgery.

No, you will have to do your non-emergent test on them after surgery.

No, I don’t know how long the emergent surgery will take. Surgical cases take as long as they take for the surgery.

No, I don’t care that this is the last thing on your to do list and you get to go home after the non-emergent test.

Sometimes you just have to say no and mean it.

Even if it means blocking another department from getting their hands on the patient for a non-urgent test that could wait until morning. But they don’t want to tell the hospitalist the non-urgent test wasn’t done.

Sorry for delaying this non-emergent test for a real, honest to goodness emergency surgery without which the patient has a good chance of dying.

Nah, not sorry.

I’ll probably hear about this later from my manager.

Oh, well.

At least we saved that patient’s life.

School Me Saturday 9/27/25- AI tattles

A tell is something during a game, usually of cards, that indicates what is in your hand. Good or bad. Physical change or behavioral change. It encompasses a lot.

The use of AI, especially in a education setting, has tells as well.

There is the direct copy and paste of the output of a prompt. Warts and all. This is a glaring red flag to the people grading the assignment.

Try a little and reword some of the output.

But this is also a trap. You really should understand what the output says before you throw yourself on the mercy of the thesaurus.

Above all, know the difference in usage between lie and lay and lied and lain. Can’t forget their, they’re, and there. These three little words have forever stymied English speakers, native or not.

And is a giant AI tattle.

3 years into this AI game, universities and colleges are learning how to recognize and grade you accordingly. The university I go to has announced that any AI usage has to be on the university site. I imagine this is so they can keep on eye on who is doing what with what AI generator.

Publishing has also gotten wise to the AI slop that is out there. I have seen the stamp they are putting on some books. It proclaims that the book is “Human Authored”. I think this is smart but also vulnerable to copycat. The seal does have a seal number on it. I am not sure but I bet the numbered seals are searchable on the Writers’ Guild site. Nope, I just checked. They are not easily searchable.

The point is that if you cheat, someone, somehow is going to figure it out. That beggars the question Why cheat? in the first place. It is only your reputation and your admission to the university/college that is at stake.

Darn, I guess you’re just gonna have to do the assignment. With your own brain and your own fingers typing on the keyboard.

Darn.

Medical non-fiction podcast review 9/7/25- Dr. Death Season 1- Dr. Duntsch

I would be remiss if I didn’t review the medical non-fiction podcasts as well. There are some really well made ones out there. My favorites are from the Wondery studio.

This was a podcast that was recommended to me in 2020 by a certified registered nurse anesthetist (CRNA) as something I might be interested in. The first season that I am going to talk about was released August 2018 and ran through October 2018.

I listened to the first season avidly, aghast that an MD would be so negligent. But then I never thought of it again. Why? There was a little pandemic that also happened in 2020. Does covid-19 ring a bell?

Not to mention I graduated with my MSN in May of 2020. I used to listen to the recast episodes on my way to teach in January and February before the world shut down in March. And then I got a little busy. And then I went back to school in Fall 2022 and moved on to listening to other medical podcasts on my trips to the university.

Dr. Death is a story about the arrogance and

Dr. Death is about an orthopedic spine surgeon who left a trail of broken backs, death, and broken dreams behind him. He graduated from the University of Tennessee and did his training at the Tennessee Health Science Center. He only completed 100 surgeries out of the 1000 surgeries in a standard neurosurgery residency. He was hired by Baylor Regional Medial Center in Plano, Texas where he began to leave broken bodies behind.

He is the epitome of fail up. He would be invited to leave by a hospital and would leave for another hospital and damage patients and be invited to leave the second hospital. Rinse, repeat. Death and paralysis trailed in his wake.

No one had the presence of mind to stop his slow moving rampage until two surgeons who were called to repair the damage that Dr. Duntsch had wrought compared notes. They were determined to have charges filed against him. The filing of charges against another doctor is not a done thing. It is easier to have them resign and not care about where they go. This disregard for life at another hospital is a failure of the medical system and carried on far too long.

Of interest is that he chose neurosurgery, one of the most technical and prestigious of all surgery types, because it was considered the most lucrative. Of the 38 patients profiled for Dr. Death, 31 were harmed or 2 died as a result of his arrogance.

He is in prison for life and is not eligible for parole until July 2045.

Kudos to the two surgeons who were able to work with the Dallas prosecutor to stop him. Really stop him, not just pass the buck to the next hospital. Not just pass the buck on the next patient that would be harmed or killed. .

This was a very easy to listen to podcast. It was broken down over 7 episodes, although there are several additional bonus episodes that attached at the end of the episodes, from his appeal that he filed to the introduction of the actors that were in the television show.

About that, I had heard that there was a television show made of the first season that premiered in the time of the world is trying to kill us still of 2021. It ran until 2023 and is currently streaming on Peacock plus or available for purchase from Prime Video. But I don’t watch television and then I finished the first season of the podcast I removed it from my list and I had no idea that three other seasons had released. I will be listening to these. Dr. Duntsch, Dr. Fata, Dr. Paola, and Dr. Gumrukcu. I have some listening to catch up on.

But as a surgery nurse I have to question where are the nurses at the hospitals that kept failing him up? Were they part of the complainants that got him fired but not prosecuted? Did they just blink at his behavior and say “Well, that’s just Dr. D for you.”? Where were the scrub techs who can also voice objections? Granted, as the surgical team we don’t know a lot about patient follow up, except when the patients return for a revision. But surely question were raised among the teams.

This is also a failure of the surgical team. It is our duty to point out problems and mistakes that the surgeon might otherwise try to brush off.

I recommend this podcast to anyone who is a scrub tech or a surgical nurse. It is up to us to recognize and stop these surgeons when they are harming patients.

School Me Saturday 8/30/25- Long weekends

Yes, I know that school JUST started. Like seriously, how long have you been back- a week?

However, for the rest of society it is the last hurrah of summer. Time to have one last barbecue, time to have one last dip in the community pool, time to sleep in (hopefully not the last one), and time to get your breath before the marathon that is coming. You know the one I mean. The Christmas decorations are starting to trickle in and the Halloween decorations have been dominating the stores since the beginning of July.

But you are a college student, you have no time for frivolity, you think to yourself as you pull up the chapter that is due in a week and start the outline for the paper you have to write about this module.

Wrong.

Take a breath.

Yes, the semester just started and there is so much work to do. Papers to outline, and tests to study for, weekly chapters and scholarly papers to read.

Yes, yes, you’re so busy.

It is okay to take a breath and go to that BBQ and take a swim in the pool.

Summers are fleeting and fall is knocking on all of our doors.

The paper outlines can wait. The reading can wait. The end of the semester will be here before you know it. The end of your college career will be here before you know it. Now is the time to enjoy the new friends you have made, to celebrate the joys that they have.

It is okay to take a breath and sink into the long weekend. Think of the two weeks you’ve had of school as the warm up lap and this is your mini break before the work really begins.

Your brain will thank you.

School Me Saturday 8/23/2025- You and the environment is what feeds AI

I know, I know. AI was exciting and the new shiny thing when it bowed into existence in November 2022.

But.

But have you ever wondered what AI gets out of this?

It can make you feel like an artist. It can make you feel like a writer. It can make you feel like the best singer/producer in the world. It can make you feel like the best director of a movie ever!

It can make your appointments and keep your calendar and give your reminders of things.

But it can also steal ideas and already published works. These are video, music, and writing. They call this training the AI and writers and performers and movie companies have no say.

What I want to write about today is the way that you, a regular joe or jane, feeds the AI.

The AI requires VAST amount of energy and water. Lots of water. Millions of gallons of it.

Your data is being compromised and stolen every time you interact with it.

All of it. Your identity.

Your brain (we talked about that last week).

Your ability to engage meaningfully in the world without the AI crutch.

All of this is fed into AI program and repackaged and sold back to you. At a higher cost.

There is definitely a reason for the existence of AI. To crunch the numbers and the existing data that we have on things like cancer rates, medication classes, and it can even see cancers before the human eye can.

AI is meant to serve us.

Instead, we are serving it.

Our attention.

Our time.

Our energy.

Our water.

And ourselves.

On a golden platter.

Because it is the new shiny and you can make a lady picture with 5 breasts.

This is a warning.

Also a reminder to go re-watch the Matrix. Or the Terminator series. But I like the Matrix.

AI is here and thriving.

Because we are its food.

Call Secrets of the OR #5- Designated Call Room

This is it. The big call secret.

It’s not about how to make friends with people you wouldn’t talk to at a party. It isn’t about making nice with others of the opposite political divide. It isn’t about sleep deprivation or a cool, dark place to sleep. It isn’t about keeping all the procedures in your head so that you can pull out the appropriate one and get to work. It isn’t even about being on call.

It is about having a designated call room.

No, I don’t mean a room in the bowels of the hospital to chill in if your call is a twenty-four hour deal.

It is about having a designated operating room for call.

We like to think that all operating rooms are the same. We like to think that all operating rooms are a blank slate, just waiting for us to walk into and start the surgery.

We like to think about the call shifters as being separated from the rest of the OR crew. After all, we are a small cohesive unit. We work well together because we know the mission is to get in, do the case, and get out. No breaks, no water cooler moments, just case and be done.

In our perfect little world, every operating room would be the same. Each room would have exactly what it needs for the most common call cases. It would have a video tower, it would have an auxiliary monitor that shadow casts from the video tower. And it would be hooked up. It would have a full tank of carbon dioxide so that you can inflate the abdomen. It would have an irrigation module so that irrigation can be run into the abdomen. It would have a functional suction tree, with every “branch” that has a suction cannister. It would have the powered coagulator that you need to create access in the abdomen. It might have a tourniquet. The dilation and curettage machine would be in the designated spot. It would also be fully stocked. The irrigation would be warmed to the correct temperature of 104 degrees Fahrenheit and in the anteroom. The warmed blankets would be in the same warmer as the irrigation, steps away from the action.

The perfect little world call room is also close to help if you or the patient needs it.

But we don’t live in a perfect little world.

These operating rooms are workhorses. In the course of a day they can go from an OB-GYN case, to an orthopedic case, to a podiatry case, to a general case, and back again.

You will never be able to enact your will on every operating rooms. Don’t even try.

Because there are humans who inhabit the rooms during the other shifts. And their idea of a perfect operating room will differ from yours. The orthopedic rooms will have a tourniquet but will not have the power coagulator. The OB-GYN room will have most of what you need for a perfect little world call room, plus stirrups. The podiatry room will have a tourniquet and a bump for under the hip.

However, what is possible, is to have a dedicated call operating room that has all the equipment that the perfect little world operating room does. But you know that the dilation and curettage machine is fully stocked and where it should be.

This is imminently possible to have a conversation with your boss, or the boss before that one, or the boss before that one, about why having a dedicated call operating room is important.

Ideally invoking the wrath of a code blue in a surgery is not necessary. Remember what I said about close to help. Having a dedicated operating room allows those who would show descend on you if there was an actual code know where they are going.

I’ve done a code in the far flung cysto room. Now, do you understand why there are directional signs to that cysto room?

Having a dedicated call operating room will make your life so, so, so, much easier.

You won’t have to run around like a chicken, cursing day shift out loud as you search for the irrigation module, or the cord that connects the video tower to the auxiliary tower, or a video tower in the altogether. Or frantically searching operating room by operating room, in every store room, in the other store room, maybe it’s in the cysto room, looking for the dilation and curettage machine.

And that?

Is priceless.

And well worth the brow-beating you have to do to accomplish having a perfect dedicated call operating room.