Welcome to the Operating Room. You are Somebody

“Hey, I need somebody to run this to the lab.”

“Hey, I need somebody to help us move in here.”

“Hey, I need somebody to open our next room, check our next case, get some instruments from downstairs, clean my room, find my surgeon, I need someone to give me a break…”

Honey, I hate to break it to you, but you are somebody.

These are quite frequent comments heard when a person not used to working evenings, ie a day person, works pms. Let me explain. The day shift is quite busy, yes, and they run four operating rooms from 0730 to 1700. We on evenings are also quite busy and run two operating rooms from 1700 to 1900 and run one room from 1900 to 2300. Day shift has roughly twelve people to run the four rooms, not including the charge nurse. This allows for free people to run things to the lab, move patients, open the next rooms, clean the rooms, get all the equipment needed, find the surgeons and give breaks. On evenings we do not have that luxury. We have four people until 1900 and two people after 1900, not including the charge nurse. Some nights the charge nurse is one of the two people. So there is no somebody to enlist to help. You are that somebody.

Welcome to evenings. You’ll like it here. You are somebody.

______________________________________________________________________________________________

This was the very first dispatch that I wrote. But I didn’t know it was for Dispatches from the Evening Shift at the time.

This was in reaction to the incessant calls out by day shift for SOMEBODY to get them something they needed.

Well, on the evening shift, we are all somebody.

On the evening shift, sometimes you have to help yourself.

More than that, you have to think 4 steps ahead.

Oh, and answer the phone.

It’s for you.

Happy Nurses Week to us all.

Call Secrets of the OR- You will dream of work

I spend a lot of time planning my sleep. And a lot of time counseling people about how to sleep on call. This is mostly a what to expect when you’re on call.

No, you will not miss a phone call from me. I call back.

Wait. You might miss a phone call. It is rare but it happens. When it does happen, I boot the repeated calls up to the supervisor as I get the room ready. If you still don’t answer the phone after 3 tries, I call the back up call. And if I can’t reach THAT person, I start calling all the techs that I know.

Someone usually says yes.

If not, I start to call management.

But, I cannot stress this enough, this rarely happens.

That is why there are layers of call people.

But I can’t lie and say that it never happens.

I get it, being on call at night might make for a stressful night. And uneasy dreams.

You might work at a “hospital” all night in your dreams, frantically looking for a lost patient, realizing at 1700 that you’ve had an unsupervised patient who has not gotten any of their meds since 0700. Or participating in your own surgery.

You are not alone in this.

At a meeting I was leading yesterday somehow the conversation turned to work dreams and 99% of us had had them.

So, yeah, it is okay to dream about work.

Just like it is okay to be so fucking relieved when you wake up and the nonsense you’ve been dreaming about all night, retained objects during surgery, lost patients, lost instruments has all been a dream.

But the super secret of my sleep on call is that the nights I am tossing and turning and turning and tossing and I cannot get my brain to shut up already, I do a bit of sleep self hypnosis.

I think I’ve written about this before.

I have a certain number that has been pre-selected (748,655) and I repeat it to myself.

And repeat it.

If after the 4th time I am still not asleep, I do tricks with the numbers. I multiple it by ten or 100. This does the trick.

I bore myself to sleep. Which I hope is a dreamless sleep.

yes, I yawned typing the number. And it is still daylight outside.

Call Secrets of the OR- With great power comes great responsibility

This is NOT a Marvel quote. It was attributed originally to the writer known as Voltaire. François-Marie Arouet adopted the pen name in 1718. This was after his incarceration in the Bastille. But before his smallpox infection. And before his exile into England. Among many other things.

His Wiki page is wild and worth the read.

In the Marvel Universe this saying is attributed to Peter Parker’s Uncle Ben. Who reminded the young Peter Parker that those who were given great power, much is demanded of them. And Peter ignored him and went to earn money by wrestling using his spider given powers so that they could keep their house.

Uncle Ben died being shot by Flint Marko or Dennis Carradine or any number of shadowy thugs.

No spoilers needed.

This is a well worn trope and has been explored over movies and comic books and books and television shows.

But he inspired Peter Parker with his words reminding Peter that with great power, comes great responsibility.

But that isn’t why I bring up the quote.

I had a doctor’s appointment yesterday. A doctor who sometimes does surgeries in the operating room at night. As I was leaving they said if I had any issues to call the office.

Like a silly goose I said, pleased with the good appointment, that I had access to their personal cell number because they had called me to create a surgery in the dark one night.

The fear in their eyes.

I rushed to reassure them that I had multiple doctor phone numbers in my phone as a function of my work as a call nurse. And that I never abused the numbers.

Ever.

This is part of personal code of ethics.

If I need a surgeon for details of a case I will text them or call them. They are aware of this.

If not, the numbers stay locked in my phone.

I never ever ever ever give them out.

Just like I never give out staff numbers without clearing it with the staff first. I’ve been told this is an uneccessary step but I continue it.

That pesky personal code of ethics that I have.

If I need to call a doctor that is not work related, I use the same avenue that everyone else does. I call the doctor on call or I leave a message with the office and patiently wait for the callback.

Having these numbers is a great power. It eases communication about middle of the night cases, or cases for the day shift that I arrange at night. it is my great responsibility to have a personal code of ethics that doesn’t allow me to abuse the numbers.

Ever.

I don’t care who thinks they need the number, too bad. (shrugs)

They can call the office and go through the call system just as I do when it is not work/case related.

FFS Friday 4/10/26- Forest service fuckery

First they start with firing. Just in time for fire season. 3400 federal employees across every level of the forest agency. T

Then they rescind the roadless rule. This is the rule that prohibits road construction, road reconstruction and TIMBER harvest on 60 million acres of national forests and grasslands. You know, so that someone can make a buck harvesting the timber and laying waste to our national parks.

Then they rape our lands and its national resources in the name of profit. Of course they do.

Animals.

This was also a step in their complete trashing of the United States and all that we used to hold dear. Up to auction to the highest bidder.

Or, you know, the average Friday.

This restructuring of the US Forest Service was announced on March 30. They were going to move the agency headquarters to Salt Lake City. This kind of implies that everything east of the Rockies is trash.

Research was trashed. Of course it was. There is a lot of research done on the forests and, you know, in actual fucking nature that this destroys.

Don’t worry, the propaganda machine is working on spinning this disastrous move. The bots are already hard at work denying, denying and, oh yes, denying.

Of course they are.

We need people to look up from their phones and their computers and their tablets to PAY FUCKING ATTENTION when the administration does shady shit like this.

It’s illegal. Because of course it is. This move was explicitly prohibited by the fiscal year 2026 appropriations.

Congress can stop it. but they won’t. Because they have their heads so far up the administration’s ass as to lead one to wonder how they breathe. Perhaps they have developed gills that can do oxygen exchange through shit. And there’s a lot of shit that everyone should be paying attention to.

The Alt National Parks page on the socials is leading the charge in getting the word out and in advertising which big outdoor companies to petition and what to say. Find them, pick a company and get to the phones.

Smokey the Bear needs us right now. Time to write and call and call and write. Ad nauseum.

Still.

Cookie Thursday that wasn’t 1/22/26

For the first time since January 2024 I have burnt the cookies.

Well, not cookies, peanut brittle.

I was making chardonnay peanut brittle. This was inspired by a peanut brittle I had out of California. It was so good.

This is tied to the malfunctioning stove/oven saga.

Everything was going well, the candy was candying and the peanuts were in. I was just waiting for the mixture to get up to 300 degrees so I could add the vanilla and the baking soda.

The thermometer was getting close and the candy was turning a nice pale tan, like all good peanut brittles must be. I picked up the baking soda to add it when all of a sudden the candy was dark brown and started to smell burnt.

I took the pot off the burner and added the baking soda and vanilla and the candy turned nearly black.

And then the fire alarm started going off.

I carried the pot to the front porch and left it on the cement.

I returned to a smoky house.

I opened the screened porch door and turned on the microwave vent. I turned on the overhead fan. I fanned the house using the front door and the back door and the alarm stopped.

This was not ideal as my husband was still asleep and it was before 0800.

I took the prepared pans out to the porch and stirred the morass.

The candy turned lighter and I held my breath as I poured it into the prepared pans. Still dark and smelling burned.

I took my pot inside to soak it, hoping that I hadn’t just ruined one of my favorite deep pans and left the cookie sheets with what I was sure was ruined candy on the porch to cool.

I had received a phone call on Tuesday about my new stove. It was due to arrive at the store on Monday and the installers would expedite me on their schedule so I could put this nearly 2 month saga to bed.

I’ve been functioning and baking and cooking with 1 burner, an unreliable oven, and a crockpot. I am ready for my new beautiful stove.

Fingers crossed. That it does get here on Monday and the installers can slot us in next week.

I really hope the coming winter storm doesn’t delay things. Fingers and toes crossed.

BTW, the pot was fine. It washed up beautifully.

Not the candy, I pitched that.

Normally I would buy cookies for the department as I have in the past on the rare occasions I couldn’t get anything baked. But there’s a storm coming. North Carolina doesn’t do well with snow and ice. And everyone is at the grocery store buying milk, toilet paper, bread, and eggs.

I gave myself permission to miss this Thursday.

I’ll think about what to make next Thursday.

Maybe I will have my new oven by then.

Call Secrets of the OR- Full moon chart 2026

Medical personnel are, as a whole, superstitious.

I’ve worked with orthopedic surgeons who had to do hammer strikes in multitudes of 7. If they accidentally did 8, they had to do 14. Every damned time.

I’ve worked with nurses and techs who give away their Friday the 13th. Yes, every Friday the 13th. Or they would just call in sick. Even if it left their department short.

One year for the Christmas tree contest the department tree was the Lucky Tree. We had shamrocks, and fortune cookies, and horseshoes, and wishbones, and Hamsa hands, and rabbit’s feet, and gold balls signifying the gold at the end of a rainbow. This was in 2020 and I decided we needed all the luck we could get in healthcare. In fact, that was the name of the tree. The Good Luck Tree, and the caption on the sign was that we needed the luck we could get. I believe this was the last Christmas tree contest tree that I helmed.

I’ve worked with nurses and techs who swear at the sight of a full moon.

That’s me.

I have been surprised more times that I can count when I am driving up the out for our neighborhood and I see a bright, juicy full moon.

I always swear. And cross my fingers for good luck.

When I get home, I remind the pager to be good.

I wanted to be a little more practical about it. So I pinned a full calendar to my Facebook page. According to my calculations March, April, June, July, October, November, and December will be on my normal work week of Monday-Thursday. 7/13 ain’t too shabby.

I do get to miss the double barreled month of May.

By the way, there are 3 Friday the 13ths in 2026. These are in February and March and November. There are 13 full moons in 2026. Lucky May gets 2.

Plan your schedule accordingly.

And be mindful of the request windows.

And February’s is the first. And it’s a Sunday!

Call Secrets of the OR- Call shift is great until you can’t find a supply at 0200

Job is still cool.

There are still a lot of positives. This is a post about the second negative- when day shift makes a massive floor move, ignoring why the rooms are set up nearly identically, and gets rid of half the shit that isn’t used every day but when you need it you need it.

Yes, the rooms are set up nearly identically. I am referring to the supplies in the supply cabinet.

But, but, we never do general surgery in room 1, it is an ORTHO room.

Wrong.

You have never done a general surgery case in room 1.

Lots of us have.

In the before times, long before you were a nurse/tech/surgeon at this hospital, room 1 housed the robot. And even then the cabinet was identical to room 2, room 3, and room 4.

This is the before times when the hospital only had 4 operating rooms. You wouldn’t’ve recognized it.

The cabinets were all set up to be identical.

And that was so that any case could be done in any room by anyone.

This is to decrease the amount of out of room time a nurse might spend during a case. Any case but especially a call case or an evening case when we don’t have the wherewithal to scream out the door for “somebody” to get us something.

By wherewithal I mean other people.

In the daytime there are lots of people rushing about cleaning rooms, turning over instruments, opening rooms, giving breaks, giving lunches, helping out.

Yeah, no such luck at night or even during the evenings.

I count that as a positive for evenings or nights. It makes you think on your feet and prepare your room better for the case at hand.

When I train people for the evening charge role, this is big selling point that I make. No managers, no charge nurse besides yourself, nobody is around.

When I train people for the call nurse role, this is a big selling point. No one is immediately around to help. There are people you can reach out to in a pinch and I’ve written about that before.

Day shift is just too… Too busy, too loud, too many people. All wanting to go home unless they want to ride out the clock.

Nights/evenings get it. It is mano a mano with the OR team. Except it isn’t a competition with the OR team, it is a competition with the reason the patient needs surgery in the middle of the night.

But I digress.

Day shift has all the time in the world to make changes to make the OR in the image of their last hospital.

Things get moved. A lot.

Things get deleted from stock. Things that are rarely used but are used all the same and is the only thing to work for scenario X. A lot.

The now 9 rooms are siloed into specialties.

But not every case is that specialty and not every case “fits” in that room. I do except the robot room. The robot room is highly specific to the specialty and the robot. I agree with this. But the rest causes me to run at night.

And don’t get me started on the dismantling of the identical suture carts that had been in every room. The suture on these carts are basic suture that every specialty might need. And an emergency sutures like 3-0 silk for a stitch to stop bleeding.

This entire post boils down to “If you move it/delete it/there has been a change in supply” tell the night shift call team. Because how else would they know except for when a surgeon asks for it in the middle of the night?

The operating room recently changed out some of the GI staplers. And didn’t tell us. Which led to me running around like a chicken. In an emergency.

I am not asking for much. A friendly “hey they got rid of X and replaced it with Y” would’ve sufficed. Instead of making the call team look like idiots at 0200.

Yes, yes, there are communication papers everywhere. In the elevator, at the desk, in the year binder. But did you write it down? So that the call team could read it and be prepared?

No?

That’s what I thought.

Pretty, pretty please stop making changes to the OR supplies and not cc-ing the call team with the information.

With sugar on top.

That would really help us give better care to the patients. They deserve a circulator that is present for the surgery, not off fetching and carrying because you couldn’t be bothered to inform us of changes.

TTYM.

I come to bury 25, not to praise it

Friends, Romans, countrymen, lend me your ears;
I come to bury 25, not to praise him.
The evil that years do lives after them;
The good is oft interred in their days;
So let it be with 25.

This is, of course, a knock off of Marc Antony’s speech from the Shakespeare play Julius Caesar.

Normally it starts ‘Friends, Romans, country men, lend me your ears. I come to bury Caesar, not to praise him.’

This after the Roman Senators, led by Marcus Junius Brutus, assassinated Julius Caesar by stabbing him. Having so many assassins makes it difficult to know who dealt the killing blow.

This was after Caesar had proclaimed himself the dictator of the Roman Republic.

And that is where I am going to leave it.

Draw your own conclusions.

The terrible, horrible, no good, very bad year of 2025 has died.
(apologies to Judith Viorst)

It lived for what seemed like more than the 365 days it was allotted and dragged on and on and on. Each day was seemingly more horrible than the last.

I broke down much of 2025’s crimes against the world in yesterday’s post. Yes, I know that the crimes were done by actual real live people but the year bears some culpability.

Today I want to celebrate 2026 and tell you how I bid good riddance to 25.

I threw 25 a wake.

A wake, according to Wikipedia, is a part of death ritual in many cultures. The rite allows for last interaction with the dead (25), and allows for thoughts and feelings to be expressed to the body. 25 left no corporeal body and so this all had to be done in absentia. Or the absence of a body.

To be fair, I waited until the year was well and truly dead before I celebrated its ending. I didn’t want to leave it any loop holes, you see.

I made all the lucky foods I could think of. I had grapes, I had mandarin (round food). I made collard greens and black-eyed peas. I had Lucky Charms. Sushi of the vegetarian type also felt right to me so I bought some of that too.

I made 2025 a casket, stickered with gold numbers. I had a voodoo doll, I had a Dammit Doll, I had a sage candle. I had a stuffed crocheted dumpster fire. Dot decided that it was hers and batted it off the table.

I arranged several of these around the little stickered casket and took a picture (of course). Did I write that I cut out flames to further bedazzle the casket? That part was a lot of fun.

The little casket only came in a pack of two so I of course had to make a 2026 one. I collected many good luck symbols to herald 2026. I had a Lucky Cat charm. I had an academic success sachet as I am still working on my dissertation and finishing my PhD. Too bad, the last year kinda derailed me as I thought, and still do, that my attention and writing skills would be better used in resistance.

I kept the voodoo doll and put it in the 2026 casket.

Only time will show if any of these had any impact on the world and the new year. But I had a lot of fun thinking about what to use to wake 2025, and also what to have on hand to prompt 2026 to be on its best behavior.

It gave me some sense of closure to list all the things that it had done wrong and it gave me a sense of hope to show 2026 the mistakes of 25 and a roadmap of what I would like to accomplish this year.

2025 was well and truly waked.

And 2026 has been given its marching orders.

Fingers crossed.

Tuesday Top of Mind 12/30/25- Nursing homes to no longer require nurses on site 24/7

Fun fact I bet you maybe knew, I started as a CNA in a nursing home.

I worked nights in a small 4 wing nursing home. There was the acute wing, for people who had just had surgery and were getting better or who just needed a little more time to recover from their injury/illness. And then there were 3 other wings that had 12 rooms each, with only 1 room being private. The other rooms either had 2 patients or 4.

That’s a lot of patients.

I worked nights and it was the four CNAs, one for each wing, a registered nurse for the acute side and a registered nurse for the rest of the hospital. Yep, that is over 100 patients for the sub acute registered nurse to chart and to medicate and to declare death and to call doctors’ offices if there was an emergency overnight.

This is per shift.

I worked 4 nights on with 2 off at the end of the stint.

Not good for the bank account as there were some paychecks that always ended up a bit short.

But the point is that there were at least TWO registered nurses onsite per shift. I believe day shift had more because of med pass.

There has now been a federal staffing rule change from the 2024 federal staffing rule that Biden’s administration put into place.

The Biden’s staffing rule for nursing homes was that
1) there were at least 3.48 hours of nursing care per resident, per day, with 0.55 hours from registered nurses
2) at least 1 registered nurse had to be onsite 24 hours per day, 7 days a week
3) these were the minimum standards for Medicare and Medicaid certified nursing homes. Nationwide.

In late 2025, HHS and the Centers for Medicare and Medicaid Services issues an interim final rule rescinding these mandated staffing levels. Including the hours per resident per day and the 24/7 nursing requirement. But wait, there’s more, they left the assessment and planning expectations in place

This was touted as a savior to the rural and tribal nursing homes due to the, you guessed it, nursing shortage. Folks, there has been a nursing shortage for as long as I can remember. But HHS ran the numbers and realized that 100,000 additional caregivers, CNAs, LPNs, and RNs, would be needed to fulfill the 2024 staffing rules.

There was pearl clutching I am sure.

By the owners, who didn’t and don’t want to hire additional workers to fulfill the 2024 staffing rules.

This is a gift to the nursing home owners.

Registered nurses are expensive. Because they are the front line between their patients, numerous as they are, and HHS. They recognize medication errors and mistakes. They recognize when a patient is not acting as expected and may be having a heart attack or a stroke or sepsis because of a UTI. They do the daily dressing changes and are expected to assess the wounds to ensure healing

Who cares about the disabled person, or the elderly person who will no longer be expecting the minimal level of care? This is a roll back of safety standards. The RNs will be replaced with cheaper staff. No shade to the LPNs but they are different job classes with different job roles. And assessment? Is in the registered nurses’ toolbox.

And if an elderly person dies because of the lack of supervision? Not the nursing home’s fault, they cry.

More savings to HHS and an increase to the profit margin for owners.

It isn’t about the people who have lived entire life times in the beds, it is about the bucks in their pockets.

School Me Saturday 12/13/25- 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.