Step away from the angry charge nurse

Yeah.

This will be a sweary post.

So I completely lost my shit at the charge CNRA last week.

It was deserved, no worries there.

I had taken over at 1500 from the day charge nurse. The cases were moving along.

And then the phone started to ring.

With emergencies.

The singular case that was going was going to be on the table until at least 2300.

That meant we had an hour and a half to do the 2 emergencies: a septic person, and an appy.

There is always an appy.

Phone was ringing, tempers were short.

Thank goodness the charge CRNA did not send any of his people home because ‘there is just one case going.’

That never works in our favor.

He did not send the people home.

I was called in to the appy room and asked to print the case picture.

Through some corporation magic all the pictures were to be saved, via this clunky system, to the medical record.

And to print them, you have to go to the OR desk and print to one of the manager’s printers, one of the only color printers in the department.

Awkward and takes time.

Apparently, the fact that I was sitting behind the desk, printing this picture for this surgeon who suspected cancer meant that I was not working.

The CRNA asked where the last case was going.

I told him room 4 was okay, it just needed to be cleaned.

This printing of pictures is a new process and takes concentration.

He asked again which room.

I said room 4, but could you help mop?

I have printed the picture and am going to the office to retrieve it.

He says something that made my blood boil.

He said, “Patient care comes first.”

I let the door swing most of the way shut, until it registered what he said.

I whirled around, slammed the door back open. And told him that was an asshole comment.

Why did he assume that I was not actively doing patient care from behind the desk?

This has been known to happen.

I asked him how often he saw me on my ass behind the desk, manning the computer, texting and calling about other cases.

I told him it was absolutely wrong to assume I did not care about patients. Which is what he implied.

I was blazingly angry.

There were tears. I cry when I am angry. Why?

The two nurses who had been at the desk, while I was showing them the new process of printing pictures, scattered.

I proceeded to yell at him, for at least five minutes.

I am not proud of yelling at him.

Or scaring the other nurses.

But when an asshole decides you are nor working because he can’t see you doing work.

That shit needs to be called out.

Be kind to yourself

This last week was hard.

It might be the pandemic.

It might be the restraint from hit people over the head with masks, yelling wear your masks.

Not unlike Faye Dunaway’s character in Mommy Dearest, beating her daughter bellowing no more wire hangers.

It might be the increased number of cases in the OR, as happens every year as people reach their deductibles and feel compelled to have surgery so that it is free.

It might be the new window installation at the house and let me tell you that is a LOT of work.

It might be letdown from being done with my MSN, yet not yet ready to start my PhD.

It might be the election.

It might be the increasing financial strain of the economy struggling to aid those who need aid.

It might be that I disappointed myself and didn’t finish a task before this morning’s meeting.

It might be all of the above.

It probably is all of the above.

But, if this year has taught me anything, it is that people are stupid and sheep-like.

Naw, it is that you have to be kind to yourself.

Give yourself a break.

Covid-19 is still happening

Back in the spring.

When we were in the lockdown.

Another nurse who I like and respect and trust told me bitterly that the covid pandemic would disappear after the 2020 election.

They believed that the covid pandemic was a Democratic hoax.

Just like the president said.

And so they maintained all through the summer and what was thought to be the second wave.

And so they maintained all through the early fall as we were staring down the third and most devastating wave.

They may still maintain that it will disappear.

I am not sure.

I have not spoken to them in weeks.

Coping with the impossible

We are roughly 10 months into this pandemic.

I firmly believe that it has been thoroughly mismanaged in the US.

We could have done better.

Instead the burden is on the states, and, depending on your state, this can be going badly or very badly.

I have instituted a coping mechanism.

A coping mechanism that is not the norm.

Others bake bread, purge their houses, fight online.

Others are or have been at home through the bulk of this.

I have not.

I work every day. And I mean EVERY day.

Instead, I cope with this impossible mess by going home after my shift, having a snack, and then killing the undead.

That is, I play a computer game that allows my character to wade into the undead of demons and demon lords.

And I kill them.

I play less than a half an hour at a time most nights.

But it helps.

However you cope with this mess, I hope it is helping.

And now the weekly funny

There isn’t much to laugh about these days.

Covid.

Over 240,000 deaths since this all began.

People who won’t take the mask thing seriously.

Whatever the hell is going on in Washington.

Laundry.

However, on Tuesday night.

While we were doing the safety pause prior to incision, I read aloud the patient’s name, date of birth, consented surgery, and her allergies.

On the board was written, Demerol, latex, and Meperidine.

I skipped the Meperidine.

The surgeon called me out on that.

For saying the Demerol and skipping the Meperidine.

I turned and looked at him, trying to see if he was being funny.

Nope.

I bit my lip behind my N-95 and surgical mask and peered at him behind my goggles.

And I told him Meperidine and Demerol were the same thing.

He was flabbergasted.

Coronavirus is still simmering, coming to a boil

I’m not sure how to track how many months this pandemic has been.

From the first American death in Washington in January.

From the first time I heard of a new virus in China, in December. I remember thinking to myself, this is interesting.

From the first lockdown talks.

From the time we started closing our borders in America.

From the time I started preparing for elective cases to cease.

From the time it was declared a pandemic.

From the time it started to seriously impact my schooling.

From the time it started to be heavily in rotation on the news.

From the time I first wore a mask in public, self conscious as always.

From the time the lockdown began. Although I continued to go into the hospital for my shift every day.

From the time the governor of my state declared the first lockdown rules.

From the time the schools started to close.

Any way you cut it, it has been a hell of a year.

And there were things that could have been done differently that would put us in a much better place. So many things could have been done on a national level.

So many things we’ve all lost.

So many memories we won’t get back.

However.

As healthcare workers, we remain, mask and goggles on.

I propose a study

We have a new process in the operating room.

It is a hepa filter that is very powerful.

It will be used next to the patient’s head during aerolizating procedures such as intubation and extubation.

IT IS VERY LOUD.

AND NEXT TO THE PATIENT’S HEAD AS THEY ARE EMERGING FROM ANESTHESIA.

It is to be used on all patients who do not have a covid test prior to surgery.

Um, that’s like 80% of the evening patients.

We are still to use N-95 masks.

On the evening shift we’ve been doing this for nearly seven months.

In the beginning none of our patient’s were tested. Everyone was thought to be a person of interest or potentially infected and treated accordingly.

The number has slowly gotten better over time with access to testing and testing prior to elective surgery becoming more common.

However, no one know when they are coming to the hospital to get emergency or urgent surgery.

And the pre-op tests are for 96 hours before surgery.

Again, not an evening shift type of thing.

But apparently this new hepa filter is.

My theory, which I will propose as a PICOT if I have to, is that the loud hepa filter next to their head, as they are waking up from anesthesia, will activate their flight or flight instincts. Leading patients either to try to get away or try to fight us off.

Either way they will be struggling or fighting the staff.

When they wake up.

Because IT IS VERY LOUD!

I have seen this with my own eyes.

I have held down a waking patient up as they panicked.

So, I propose a study.

Now to get the research council’s backing.

Drowning? A bit.

I have talked about how I have been anticipating staff changes due to the pandemic.

I thought that there would be staffing gaps as people left for various reasons.

And I was correct.

Our tech numbers, which had been very low, are rebounding.

We are nearly fully stocked with techs.

The nurse numbers.

Those are a different story.

This nurse had a baby, this nurse had surgery, this nurse left to pursue other things such as administration. This other nurse left because.

We have new nurses coming on. But they are still in orientation.

I do not approve of rushing orientation, especially for surgeons who are as spoiled as ours.

I also do not approve of rushing tech orientation, although I lost that battle. And they rushed 2 techs through orientation. Not ideal.

I do not approve of throwing the orientee nurse into an “easy” room and telling them to go at it and we would be by to check on them.

And now another nurse has gone out due to surgery.

I told them I would be available on mornings to help out.

They have yet to call for my help.

Be kind

“Be kind.” I whispered to the doc as I gowned and gloved him.

To facilitate the closing of his enormous case I was going to scrub while he was closing, leaving the real scrub tech to count all ten trays.

“Be kind.” I whispered to the resident as I gowned and gloved him.

This was a new resident for us and I wanted to alert him that I was not the regularly scheduled scrub tech and he would have to be patient with me as I scrubbed the closing with him and the surgeon.

“Be kind.” I told the ambulatory care unit as I was handing them yet another add on sheet.

Each add on sheet represented a patient who was in need of care. And it was our job to render that care.

“Be kind.” I told the x-ray department while I was trying to get them to the room to do the surprise closed reduction.

I say surprise closed reduction because the message was not passed on to them for the need of x-ray.

“Be kind.” I told the endo nurse I had to call in to finish the case with us.

The message for the need of endo at the end of the case had gone awry. I had not seen any endo nurses since the end of their shift and I was making sure that there was someone available to do the endo part of the case so that the patient would no have to wait.

“Be kind.” I told my orientee as I walked her through the proper way to put formalin on specimens that don’t fit in the pre-filled container.

It has not escaped my notice that some circulators fill the specimen container with the contents of many pre-filled containers to the detriment of their health. This drives me crazy.

“Be kind.” I told the lab department when I called and asked about how to set up uncross-matched blood and if they still had a pink top tube and could cross-match the patient.

Because both arms were tucked tight to the body under the drapes, and the legs were in stirrups under the drapes and we’d had an unexpected 1500ml blood loss in five minutes.

“Be kind.” I told the recovery room nurses as I handed off the patient.

I explained the need for the conversion of the robot case to an open case. I cautioned them about the blood loss and the need for blood collection to check blood counts.

“Be kind.” I whispered to myself.

Still not pan(dem)icking

Play on words.

No, we in health care are not panicking.

We are not running round like chickens with our heads cut off.

We are just trying to keep our patients, the families safe.

We are just trying to keep our own families safe.

Wear your mask.

Wash your hands.

Do not panic.

It’s been a long nine months, almost long enough to have a baby.

Who knows how many more due to the mishandling of this crisis in this country.

We are not panicking.

We are living in this new normal until we have a vaccine, or the social distancing mores have starved the virus into submission.

I’ll wait.