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.

Pandemic + End of year deductible = increased volume

We had paused elective cases for seven weeks during March and April.

This means that we only did cases that were deemed urgent enough not to wait.

Not that many people wanted to come to the hospital.

Not that most people weren’t afraid of us.

For those 7 odd weeks that we only did the urgent stuff, all the others were placed on the backburner, so to say.

They would be rescheduled when the cases opened back up.

And they did.

But what about the people who were ill and deliberately did NOT seek care.

The odd appendixes that were painful but all of the sudden felt better.

For a month.

Or all the people who did not go to the doctor during lockdown.

Which meant that their ailments, be it cancer, or hernias, or joint issues, or all manner of things, were NOT diagnosed.

And that meant that they got sicker and sicker.

And are now showing up on my schedule.

Sick as a dog.

Ill, ill, ill.

This leads to a delay in diagnosis.

This leads to a delay in care.

This leads to the operating room, which is not staffed to run more than 1 room after 1900.

Is, at times, now drowning.

Stand up for patient safety

Today, well, last night was an odd one.

I got a page from a surgeon who needed to clear an abscess.

Not so unusual, we do a lot of abscesses.

But this patient had a tough airway.

Really tough.

Really they almost did not survive the last surgery tough airway.

I encouraged the surgeon to speak to the anesthesiologist as I was not sure they would be suitable for our community hospital.

Especially in the middle of the night.

With a skeleton crew of surgeon, anesthesia team, RN and scrub tech team.

I just didn’t feel it would be safe.

To quote Han Solo: ‘I’ve got a bad feeling about this.’

Sanity prevailed.

They did the case the next afternoon.

With loads of people around to help, if needed.

Phew.

Student loan final recap

Final student loan payment has been submitted.

sigh of relief, I guess.

I’m not sure how to feel about this.

I have worked hard.

I have given up 5 years of my life to school.

For the second time in my life I will have paid off my student loans.

Before, during, and after the pandemic, it was important to me to get this paid off by the end of the year.

And I have willed it so.

Using the combination of my clinical ladder bonus, my tuition reimbursement, and my personal money.

It is done.

So why does it feel so weird.

Where’s the sense of relief?

The sense of a burden put down forever.

I’m putting this feeling in the entire bucket of the world is hurting and getting back to work.

Bad handwriting? Bitch, please.

Let me address my handwriting.

Yes, it is horrible.

Yes, it is next to illegible.

Yes, I can read it.

Yes, increased exposure to my handwriting increases the legibility to people who read it often.

Sometimes my hand is trying to keep up with my brain.

And it loses.

Let me tell you that the there are many, many people with worse handwriting.

Trust me.

I used to be a unit secretary.

And I would take handwritten orders off and in the computer.

My handwriting, bad?

I’ll own that. I will be proud of it.

Yes, have you seen MD’s writing?

mansplainers

Mansplaining.

For those who do not know the term, and why don’t you know the term, it is when a man explains anything to a woman, who is usually qualified and in possession of said information.

Today an anesthesiologist, who is a mansplainer extraordinaire, explained to me why it is important to place an axillary pad when the patient is in a side-lying position.

Um, okay?

Of course you need to take pressure off the axilla while a patient is in a side lying position.

Because you know veins and arteries and nerves and such (I really do know the reason why, bear with me.)

He and I had positioned so many people on their sides, together.

The most recent was last week.

But today, this same anesthesiologist that I’ve positioned with for years, took it upon himself to explain the mechanics of why we were doing it.

I did not shake him, although I wanted to.

I did not snap back, although I wanted to.

I just kept going with the positioning.

We had a case to start.

But the mansplaining is getting REALLY deep in here.

And my willingness to put up with it is very, very thin.

Lots of Nevers this Year

There seems to be lots of never occasions this year.

From the never had to stay home so long

To the never going to get to go on vacation.

To the never going to get enough hours because the elective surgery cases have stopped.

To the never have I ever had to wear a mask every time I leave the house.

To the hmm, I’ve never done that.

This week the surgeon never got the hip back in place.

This means that the total hip the patient has WOULD NOT go back into the socket.

Say it with me.

This has never happened in a closed reduction case.

I’ve personally assisted on several a year.

Times 19 years.

NEVER.

But this week we had to open a hip because we could not get it back in place.

Of course there were two more urgent cases waiting and I decided to allow the hip reduction to go first, foolishly thinking it would take the usual 15 minutes.

I was wrong.

Two hours later we were finally done.

The waiting surgeon was like a jack in the box, popping up to ask me if I was going to call in the other team.

Like Schroedinger’s Cat there is and is not another team.

Tired

I’m tired of this.

Aren’t you?

Tired of the battles over wearing masks.

Yes, you absolutely should, no, it does not infringe on your rights.

Tired over the nightly conversation with surgeons about no, the ED patient who is having surgery in the next hour cannot be quickly tested for COVID. Newsflash, we don’t have enough tests.

Tired over never being home alone now that my husband is working from the next room.

Tired of the constant news.

Tired of the constant science naysayers.

Tired of the fact that my backyard has not been mowed in a month.

Tired of the fact that I am tired.

I am tired.