Tattling the OR out

I was heading to the emergency room one day.

To pick up a surgical patient.

Because, you know, I like to spoil ACU.

This was near the height of the latest covid surge in the hospital and gurneys and beds were lining the halls outside of the emergency room.

I passed an unmade stretcher.

Stopped.

And went back to the stretcher.

On gurneys there is a slot specifically made for an oxygen tank.

And this gurney had an O2 tank hanging out the side.

Most decidedly not in the O2 slot.

I took a picture to show the plant engineering people that we do know how to fix glaring problems.

And I put the O2 back in its slot.

And continued to the ED to pick up the patient.

I ran into the plant engineering head yesterday.

And I stopped him to show him the picture.

I told him that I had definitely fixed the problem.

He thanked me and asked if I had any other pictures of such examples.

Because he uses them as a what is wrong with this picture visual interest on his slides.

I laughed and said ‘do I!’

He may be sorry he asked for picture.

Which one should I send him next?

I’m thinking of the one where there is a step blocking the return grate of the air handler.

I have no problem tattling on the OR.

Not if it leads to solutions.

Cookie Thursday 10-21-21-chocolate raspberry oatmeal quinoa

Say the name of this week’s cookie 3 times fast.

It is quite the mouthful.

Spooky cookie month continues.

And I promised the department a surprise ingredient.

Shh, don’t tell them quinoa replaces some of the oats in the traditional fudgey cocoa no bake cookies.

Plus the addition of freeze dried raspberries.

An experimental cookie if you will.

To quote Dr. Frankenstein of what he called his abomination “It lives!”

That is a tad over-dramatic.

There is nothing living about this cookie.

The spooky story of the week is about my very first hospital.

Well, not a hospital, definitely a nursing home.

I was brand spanking new to any kind of nursing care as a job.

As my previous experience had only been as a nursing student.

I clutched my newly obtained certified nursing aide certification as I started night shift as a CNA.

This particular nursing home was set up as a wheel with 3 spokes.

There was the red wing.

There was the yellow wing.

And there was my wing, the blue wing.

I had 16 double rooms.

Which means I had 32 nursing home residents that I turned and cleaned and turned again and rounded on nightly.

We worked 4 nights on with 2 off.

My wing gave me the willies.

There was something about the shower room that I did not like.

I hated organizing the shower room so I did it when I first came on shift.

The residents were nice.

I like Amethyst.

She had a neuro degenerative disease that left her seriously disabled.

She was only in her late 50s but confined as a resident in the nursing home.

Her father was on the memory care wing.

They did NOT share a room.

She was the one that told me that the nursing home used to be a psych hospital.

And the blue wing was the lock down room.

And the shower room.

The one I hated.

Was the rubber room.

This was the 1990’s.

And she told me that this story was from the 1970’s.

When rubber room was a socially accepted word.

The rubber room means that it was where they put people to calm down.

She told me the shower room was the lockdown calm down room on the lockdown ward.

Creepy.

It wasn’t until a couple of years ago that I had the realization that she was pulling my leg.

And that was mean.

But at the time the shower room gave me the willies.

And I avoided the room when I was alone.

Less a spooky story, more a creepy story.

Like all of the best horror movies.

There’s a reason the shower scene in Psycho was so effective.

And now I’ve creeped myself out some more.

Remember vacations-part 2

In the continuation of the notes I took from our Disney World vacation from 8 years ago:

Day 2 (10/17/13)

Reading, in the hotel room because someone is sleeping in. Perfect.

What? Doesn’t everyone take 12 books with them on vacation, and 6 for Jeremy?

I feel like such a drug pusher. Jeremy finished the books that he wanted to read. I walk over to him, book in hand and say, “psst, you wanna try some John Steakley? Or I’ve got some Star Trek. Come on, first chapter is free.”

There are seven books waiting for me at the library when we get home. Hmm.

Seven-hour drive, library closes at 6 pm, leaving at 6 in the morning.

And that is the last of the book humor for today. Because I am now packing us up for a trip to Harry Potter.

We’ve been on vacation for seven days. (Yes, someone is at the house. Thanks, Dad!) but SEVEN days and today our bank decides that someone must be using up card fraudulently in Florida. No calls to my cell, no e-mails, no texts, just a robo call to the hospital I work at. Just…ooh, I’m too disgusted!

And of course, we were at the last theme park at that time, in line for a ride. Way to torpedo the day, bank.

No one ever wants to take our money at restaurants. We’ve been kept waiting 10-15 minutes at a time. Servers (8 or 9), including our own pass our table and will not take the bill folder that is strategically placed on the far corner of the table. I know we are a quiet group of two without crying or screaming but seriously?

Of course one wants to take our money at restaurants to this day.

2 middle aged adults sitting, talking quietly, playing a pass along game on a phone.

I’m still not very good at vacations.

Most of our vacations are usually spent at family functions.

We try to steal away to a hotel at least once a year and have at the very least a long weekend.

If you are DINKS (double income no kids) that is the expectation.

At least we did.

No vacation other than the house in the last year and a half.

We were very close to booking another vacation to London for December of this year.

To use up the money that we had spent in January of 2020 on plane tickets to London.

That otherwise will revert back to the bank at the end of 2021.

Um, there’s a pandemic on.

Still.

And some of us work in healthcare.

But events happened that made me want to stay state side for this vacation.

And the new variant is increasing in Britain.

Now we are planning a small get away to a mask friendly area.

In the beginning of December.

Maybe Washington DC.

But Washington DC hates us.

Long story short: shingles on one trip, Hurricane Sandy on another.

But if we can’t go to museums in London, we can go to museums in DC.

With masks on.

728,192 American dead

That is roughly 28,000 more than the last time I posted a death stat.

Which was on October 2.

The death rate is slowing, somewhat.

But people are still dying every day.

From Covid.

A largely now preventable death.

Cases are slowing where I live.

I know that this is not the same in all the states.

I do know that my hospital has a fifth of the cases that we had just a month ago.

We know how to stop this.

How to slow it down.

I know that myself and several of my coworkers, MD and RN and CST alike, are tired of saying it.

Wear a mask.

Wash your hands.

Get a vaccine, any vaccine.

If you are sick quarantine.

Especially sliding toward the winter.

I hope I don’t have another milestone post before Thanksgiving.

Especially with the hopefully soon FDA blessing of boosters for Moderna and J&J vaccines.

There some hope.

Just don’t be stupid.

Post-it post 10/17/21-cloudy cysto fluids

The post-it reads ‘cysto field on the screen suddenly gets cloudy. Surgeon and I both look at the hanging fluids to see if the bags have run out of fluids’.

It was almost a choreographed spot in a movie.

On the screen, the view suddenly gets bloodier.

There are only 2 reasons why:

  1. the hanging fluids have run dry
  2. the surgeon has hit something and made it bleed

The first thing to look at, and the easiest to fix, is the hanging fluids.

If they are dry then you hang more.

If they are not empty, the surgeon has to find the bleeding vessel and cauterize it.

The response to both is the same.

Fix the problem:

  1. hang more fluids
  2. get further equipment to control the bleeding

It just struck me as funny that both the surgeon and I had the same response to the bloody field.

An information seeking move.

Remember vacations?

In the way back machine that is Facebook memories, there were several posts about the vacation we took 8 years ago to Disney World.

I remember vacations.

I am good on vacation for about 5 days.

My husband loves going places.

For about 3 days.

And then he wants his own bed.

But these posts show that you can take the nurse out of the OR but you can’t make her less sarcastic.

Or knowledgeable about vacation hazards.

These are 13 posts that I did in one 3 hour swoop about the thoughts I had driving down there and being at the theme parks.

  1. Almost everyone who knows me understands that I am a bit of an introvert. I’m a personable person but not necessarily a people person, especially large amounts of people person. So for the next several hours there will be a steam of thoughts about the last seven days
  2. Husband’s biggest problem down here. People who stop in the middle of the thoroughfare for whatever reason. Drives him nuts..
  3. The lazy river just off our balcony? I floated that and I only went around five times because I was just waiting for the kid in front of me, or the one behind me to do something stupid and need medical assistance.
  4. Of course your feet hurt. You wore dollar store flip flops to a theme park.
  5. Yes, you are going to hurt later. Although it is October, it is also Florida and the sun is strong. That sunburn? Will blister. Sunscreen, not just a suggestion.
  6. And don’t get me started on the whole baking in the sun thing, covered in oil. Yeah, I saw you pretend to put on sunscreen but in reality used baby oil. Melanoma much?
  7. The flu shot you neglected to get? Yeah, welcome to Influenza Alley. You will be surrounded by people who are sneezing and coughing and to whom personal hygiene is just a suggestion.
  8. From husband, older women in scary revealing clothing and their young daughters who could be dressed like adorable Disney princesses like 90% of the little girls. But no, the girls are rocking the slutty princess look.
  9. Every state of undress except naked.
  10. Screaming babies who will never, ever remember this trip except in pictures that yeah, you cut off Mom’s head in. Screaming because it’s hot, damned hot and you are bottle feeding them in direct sunlight, my God, they are less than a month old and you have them in direct sunlight. You moron.
  11. When while walking to the entrance, you watch a man drop a water bottle and a kid from behinds runs past you and picks it up for the oblivious man. Who thanks him.
  12. Yes, your kids’ voices are that piercing. Dogs in the next county are crying.
  13. Yes, those pink pajamas make your ass look flat.

I presume that all of these vacations hazards still ring true.

Take the second one about the people who stop in the middle of thoroughfare and substitute wearing masks and that is still painfully accurate.

There were always be screaming kids, there will always be people dressed in inappropriate clothing.

I will always be on the look out for hazards and people who are in trouble.

Maybe someday we will get to take our fully paid for trip to London, England.

Here’s hoping the case volume continue to drop.

And vaccination efforts continue.

And the vaccine is approved for ages 5-11.

Here’s hoping.

Supply, supply, supply!!!

Supply chains.

They just aren’t for Christmas presents.

Or for cheap goods from overseas.

The supply chain is also vital to the operating room.

It takes a sheer amount of stuff to run a case.

Let alone an operating room.

Back orders are a way of life in the OR.

And have been for as long as I’ve been a nurse.

We haven’t had a consistent supply of Marcaine with Epinephrine since Hurricane Maria.

0.25% or 0.5%!

Many of the supplies are made in other countries.

And the shipping backlog that is threatening Christmas affects the OR too.

Every day another supply that is short.

Every day the OR rises to the occasion and finds a way around it.

But some things are so unique it is difficult to find a way through.

There is nothing like the look on a doc’s face when you tell them that a previously common item is on backorder.

And that they will have to use a different item.

Materials managers struggle with this constantly.

I know that the pharmacy manager and the procurement manager work very hard to get us the medication that the hospital needs.

I know that the materials workers are doing everything they can to keep us afloat.

So cut them a break.

Did you know that you can add a very tiny amount of epinephrine 1:1000 to marcaine to make marcaine with epi?

Yeah.

We’ve been doing it for years.

You just need a teeny-tiny syringe.

And another nurse to check it with you.

(I strongly suggested that rule)

(We have to check insulin and epinephrine is dangerous)

My running mantra is the ‘only way out is through’.

I never thought this mantra would be applicable to a pandemic.

And assorted problems arising from it.

I only give books, pajamas, and socks for Christmas.

I’m not looking too crazy right now, am I?

Cookie Thursday is a Thing 10/14/21- Candy Corn Cookies

Did you know that when you put candy corn in cookies they melt and t?urn caramelly

They do!

Baking tip of the month.

I wonder if it also happens in scones.

Must investigate.

Spooky Cookie month continues.

Yesterday I told the hospital wide meeting I was in that I was interested in the call shift being bandied about in the OR.

And if that happened, I would be opening up Cookie Thursday to a different unit in the hospital for one week a month.

Because we all need a morale booster.

I also decided to do a spooky hospital story a week during Spooky Cookie month.

This one is at the hospital that I am currently working.

It really isn’t old enough to have spooky stories as it has only been open for 16 years and when this happened it had only been open for 6 years but it was spooky enough at the time.

This was when I was not the evening charge nurse.

I had an evening charge nurse and he was off for the evening.

The tech and I were pulling instruments and setting up rooms when I got a call from the OB suite.

The OB suite was where they did c-sections and was 2 floors away.

They were doing a section and were in dire need of a large deaver retractor.

And the baby’s heart rate was dropping so they needed it stat!

I said I would send them one.

I pulled one off the shelf and went to the tube system but it was much too big to send in the tube.

I grabbed the portable phone and took off for the elevator.

To find it waiting for me, the door open.

I looked around and no one was in sight.

Bear in mind this was 2224.

I nipped into the elevator and went to the OB floor.

I dashed off the elevator and handed off the deaver.

Only to be told that they needed a different retractor, not the deaver they had asked for.

I left the section suite and the elevator door was open again.

This is not getting eerie.

No, not at all.

I went back to the main OR, ran inside and grabbed the newly requested instrument.

Too big to fit in the tube.

I dashed back out to the elevator.

The door was open again.

These are very busy elevators.

You have to wait nearly every time.

I brought the new instrument to OB and handed it off.

I ascertained that nothing else was needed, as it was nearly the end of shift, and was waved off.

I returned to the elevator,

The door was not open this time and returned to the OR to finish tucking it in for the night.

I have been asked to come to the section suite on multiple occasions.

Never again have the doors been open for me.

At least not when I had to go to OB.

To the ICU?

That’s another spooky story.

A seldom used or talked about OR skill- imagination

Imagination is not something people think about when they think about the OR.

After all, the OR is black and white,

A case or not a case.

A patient or not a patient.

I propose that imagination is very much needed in the OR.

The OR nurse needs to be able to look at a situation not as it is.

But as it could be.

The surgeon dropped the instrument that he needs to finish the case.

The answer is not to flash the instrument, but to think about alternatives for the instrument.

Because rarely is there a truly single job performer in the instrumentation world.

The OR is out of supply A.

Supply B is almost the same.

Could it work?

The suture that has been requested is on backorder, will this other suture suffice?

This is something that is coming up more and more as the supply chain is squeezed, but that will be another post.

OR 2 is in need of the specialized equipment that is in use in OR 9, what else can be used?

Or, if it truly is that specialized, how can the cases be moved around to accommodate the need?

The previous robot case is running so very late, can the next case be done laparoscopically? In order to be respectful of the surgeon’s time and the patient’s wishes.

There are only 2 scrub techs for 1700 but the rooms need 3 and there are 4 nurses can one of the nurses work in the scrub role?

This scenario depends upon the ability of one of the 4 nurses’ willingness and ability to perform in the scrub role.

Many things have to be balanced, but imagination does play a role in the OR.

To function completely as an OR nurse you have to have enough imagination to see the possibilities.

And the ability to weed through the possibilities and choose the one that will work for the particular pickle you find yourself in.

While keeping the patient safe.

And the surgeon somewhat happy (not my personal end-goal for the shift but you do you).