Worst week ever

I’ve been a nurse for eighteen years and change. That’s a long time.

And these last seven days?

WORST WEEK EVER!

It started last Saturday with an urgent call from the nurse on call.

She needed help at 1000 and I was at the grocery store.

I paid for my groceries and went in for a couple of hours.

And went back at 1500 for more. I left the hospital after 0300 the next morning.

Sunday, I got called in at 1900 until 2300 for a drawn out ORIF.

Monday, from the time I arrived at 1430 to 1445 there were 5 add-ons. Okay, this is usual. And we worked hard all evening until after 2300.

Tuesday, from the time I arrived at 1430 to 1445 there were 5 add-ons. This night, there was no way to finish all but one by 1900 so we got a CRNA to stay until 2000 to catch us up a bit. He finished his case at 1727 and did not go to get the next patient, that we had to have finished by 1900 until 1815.  Which meant we couldn’t go back with the late case until after 2000. And the late late case got pushed back to Wednesday evening.

Wednesday, from the time I arrived at 1430 to 1445 there were 5 add-ons.  The board still had 12 cases left to start. This night there was no friendly CRNA to stay late and help. I was so outraged that I was in tears (I do this when I am mad) and I was going to have to tell the surgeon who was doing the case that was delayed from Tuesday that his case would be going at 2300, or later. He was unhappy, I KNEW the patient would be unhappy, but I could not get any CRNA to stay. Finally one ponied up to the bar and agreed to stay for that surgeon. I offered to make him any cookie he wanted. A second surgeon agreed to delay his case until the next day due to time constraints. Finally, we finished at 2300 with all cases.

Thursday, from the time I arrived at 1430 to 1445 there were 5 add-ons (do you see the trend?). All the cases are running over. One of the day shift people told me that they didn’t receive their evening break. I looked her in the eye and told her that I hadn’t had a lunch or a break in at least a week and I would get her a break when I could. People. Finally finished the delayed case from Wednesday and the last case finished at 2200. And then an add-on. (apply head to desk here)

Friday, from the time I arrived at 1430 to 1445 there were 5 add-ons. And one was an emergency that was going to be bumping one of his partner’s cases. Oh, well. She was taken upstairs to the ICU immediately upon end of surgery. I ran from 1430-2200. We finished our last case at 2200 and made the conscious decision to not do anything with the core, that I would go in on Saturday to clean up after our disastrous week.

And so I did.

Quick note before work

Off to the hospital I go.

But, first, update on the gravity situation.

No more prednisone.

Yay!

It makes my mouth taste funny.

And no advil on prednisone.

Sneezing.

That most innocent of actions.

Makes me want to put a knife in my temporal mandibular joint.

You know, the jaw joint.

I had to describe today exactly what it feels like when I sneeze or make sudden jaw movements.

It feels like a 8/10 to the TMJ. With a tearing sensation and a flash of warmth.

Ouchie.

However, my lovely, lovely bruise is mostly healed. Now just the line that shows on my cheek the impact point with subsequent sliding on the trash can remains.  This is still tender to the touch.  So no touchie.

After I told the PA about the pain he ordered me a panoramic x-ray of my face and jaw, with special consideration shown to the left TMJ.

I had to miss 2 meetings to do this.

Bother.

I am awaiting results.

Reach out anytime, from anywhere

My hospital system has invested in a system wide phone system that works on cell phones. This is a private, secured system that allows us to call anyone at any of the 15 hospitals and work together to solve a problem.

This last Friday I was at lunch when my phone rang with a non-hospital number. Of course I answered it.

I clearly said, “Surgery, this is Kate, how can I help you?”

A voice launched into “Janet, I was your patient today and I think my take home packet is missing information.”

It was a young woman who had been discharged from a sister hospital that day with a new diagnosis of diabetes.

Now, I know there is a TON of education around a new diagnosis of diabetes. But I was curious as to how she happened upon my dedicated system number.

Her floor nurse had written a number on the white board, probably one number off from mine and she called it after she had a question once she got home.

She had tried to call the pharmacy but they couldn’t tell her anything.

She had tried to call her doctor’s office but all she got was an answering machine.

She had been forwarded to the wrong number three times before she remembered her nurse’s number.

And so she called it.

I reassured her that she was absolutely right to reach out and that I would do everything in my power to help her.

I returned to the front desk.

It was an important question and something that needed to be answered before a weekend could start.

I reached out to our house supervisor to see if he had any ideas. He did not.

Okay.

I took her name and number and birth date.  I assured her that either I or someone from the sister hospital would be calling her back with information but that I would need a few minutes to find out information and I didn’t want her to be on hold for that long. She said she understood and hung up.

I called the house supervisor for the sister hospital.

I quickly explained the situation.

The supervisor said absolutely she would take the girl’s name and number and get in touch with their on-site educator or one of the floor nurses to help the young woman out.

I can’t imagine how scared she was, reaching out into the void, knowing she needed information to keep her healthy and that it could absolutely not wait until Monday.

I was glad that I had the number that she called and that I was able to help.

Gravity, it’s a bitch

Gravity is a stone bitch.

Saturday there was a little boy with a both bone broken forearm.

This kid was much more composed than the one two days earlier.

He was invested in the process and interested in what we were going to do to him.

He had an IV which always makes it better.

Prep went smoothly.

I called PACU in as soon as I got him to prep area.

The booking sheet said it was the left arm.

So I brought the c-arm in to the room and prepared it on the left side.

Booking sheet was wrong.

That’s okay, we can roll with the punches.

We sort out all the fiddly stuff: correct consent, H&P, site marking, and head back to the room.

As the anesthesia team was hooking him up to the monitors, in preparation to go to sleep, and he was still behaving remarkably, I decide to step aside. To the phones to get x-ray into the room so we can set this kid’s arm and go home.

Less than 10 feet.

And, on my way to call radiology, the c-arm behind me.

I trip on the power cord.

Take a moment to savor the irony.

I trip over the c-arm on my way to call x-ray.

Down I went.

My knee hit the floor.

My face hit the trash can.

My glasses spun off and hit the floor.

I’m sure there was a loud crash.

In that moment after a fall, you think, this is gonna hurt.

But it doesn’t.

Not yet.

The orthopedic surgeon and the PA came over and hovered over me as I got my knees under me and snatched my glasses up and put them on.

I patted my face,

Numb.

I ran my tongue on my teeth.

Intact.

I stood up, despite being told to sit down.

I continued to the phone.

And called radiology.

And went back to the kid’s side.

Despite all the looks from the four men in the room.

We had a case to do.

The kid was depending on us.

During our 4 minute closed reduction, the anesthesiologist went to PACU and got me an ice pack. Bless him.

After the cast was on but before the kid woke up, the orthopedist mopped the blood off my cheek and put a bandaid on for me.  Bless him.

The kid woke up and we took him to PACU and he went home 40 minutes later. With his blue cobaned cast. And a wave at me.

Advil in my future.

Plus the incident report.

Oh, I just terrified a 6 year old

No biggie.

I just terrified a 6 year old.

Who had broken her wrist in gymnastics.

I got the call about the case and alerted anesthesia.

And then, as is my custom.

I walked over to the ED to collect her so we wouldn’t have to wait on transport.

I walked into the room, mom and dad hovering over the small, thin girl in the gurney, still dressed in her practice leotard, brother playing something on a hand held device.

I smile brightly and say, as I usually do, “Hi, my name is Kate and I am going to be your surgery nurse tonight.”

The little girl in the bed, looking at me with big. big brown eyes?

Promptly burst into tears and wailing “I don’t wanna have surgery. Why is she here?”

Dad looks at me, back straightening as I watched, as if I was a threat to his child, “Surgery? What surgery?”

Um, thinking fast, still smiling, warm blanket that I had just retrieved clutched to my chest, looking from mom to dad to mom and to brother and to dad again, “They didn’t tell you about surgery?”

Pigtails bobbing, she shook her head violently, tears streaming down her cheek. “Nononono!”

Me, trying to be soothing, “I spoke to the doctor who’s going to fix your arm so it doesn’t hurt.”

Dad, a bit belligerent now, “Which doctor, we’ve not talked to anyone about this.”

Me, “I got off the phone with the orthopedic surgeon not 5 minutes ago and then I came to get you to whisk you away on the magic gurney ride. So you can meet the anesthesia team and the doctor before we go to the operating room.”

Cue more wails from the 6 year old. “I don’t wanna go to the operating room.”

Mom, stroking her forehead, “It’s a procedure to make your arm better.”

Me, trying to chime in something soothing, “No sharp objects at all.”

Well, that was the wrong thing to say.

Wails.

I cover her with the blanket and bring up the side rails. And I say, briskly, “I am going to take you to the pre-procedure area so you can meet all the other funny people in blue. Mom and Dad and brother are coming with us.”

And away we went, wailing, and tears, and brother coming up from behind, the tinny music of the game a counterpoint to the tears.

Courage

You must have courage to be a healthcare worker in the OR.

You must have courage to tell a doc what no, he shouldn’t do that.

You must have courage to tell your coworkers that no, they shouldn’t do that.

You must have courage to say no when you really don’t want to but you are being pressured.

You must have courage to tell yourself no, that would not be wise.

You must have courage to tell your boss when things are going awry.

And, you must have courage, no matter who  you are, to write up a surgeon for using the device in a manner it was not meant to be used.

You must have courage to back up the rep when they are telling the surgeon they are doing it the wrong way.

Courage.

It sometimes takes many voices to make a change but it should start with you.