650,000.
Well.
I hope we are proud of ourselves.
Although vaccination rates are beginning to creep up.
From previously unwilling people.
It may be too little, too late.
The senselessness of it all is astounding
And pitying.
And makes me anxious for our future as a country.
And as a species.
However long that may be.
Stand down.
Two of the most beautiful words in the English language.
To me it means that the case is cancelled.
The patient is better.
Surgery is no longer required.
17 minutes ago the patient was dying and would certainly die without surgical intervention.
15 minutes ago I got a page.
15 minutes ago I was talking to the nursing supervisor about the urgent need for surgery.
15 minutes ago I was calling and waking the scrub tech up and saying there was an urgent case.
10 minutes ago I was changing into scrubs in the locker room.
9 minutes ago I was getting report from the emergency room while simultaneously putting the case into the computer.
9 minutes ago I was checking the surgeon’s credentials at this hospital.
7 minutes ago I was picking the case in the basement.
6 minutes ago I was taking the bed apart and putting the foot and head back on the bed.
5 minutes ago I was leaving the scrub tech opening and walking post haste down the hall to the ED.
5 minutes ago I was approaching the knot of people in blue scrubs standing outside the patient’s ED cubicle.
5 minutes ago the anesthesiologist was smiling at me with his eyes.
5 minutes ago the surgeon was apologizing to me about calling me in.
5 minutes ago I was asking if the operating room was being stood down.
4 minutes ago I received confirmation we were being stood down.
Being stood down can be a mixed bag.
It either means the patient is making marked improvement.
Or they are past the time when surgical intervention would save their life.
Thank goodness, this was the marked improvement one.
I walked back to the OR with the CRNA.
I confirmed with the scrub tech that we were being stood down.
The scrub tech and I broke down the room and took the set to SPD to be sterilized.
I confirmed that were was another emergency set that could be used.
Otherwise the SPD tech would be called in to sterilize the set.
I told the scrub tech I was impressed by their hustle in getting to the hospital so fast.
And then we left to go back to our houses.
To go back to bed.
I called the supervisor on my way out of the property.
To tell her we had been stood down and to call us if we were needed.
The post-it reads ‘it’s cool that day shift is now tracking and very, very worried, about having the correct amount of people after 1700. Don’t forget that I’ve been screaming about this for months. But cool, cool, you do you.’
This is a thing that is actually happening.
I’ve been screaming about not having the correct staffing mixture after 1700 for at least six months.
I cajole.
I cry.
I ask people to stay late.
crickets
But now that it is the new day shift’s job all of a sudden there is an influx of ideas and people.
And I am charge-splained how important it is to have the correct staffing mixture after 1700.
As if this hasn’t been something evenings has been struggling with for a long, long time.
As if the day charge woke up one day and realized there is a problem and had to fix it.
As if it were her idea.
Now they are paying attention to it, in advance, instead of day of.
Never mind that I have been making them lists of who to ask.
Never mind that I have been making charts of who to require to do it next, so that it is fair.
I am sure this is how Cassandra felt, especially after they took her ideas and her warnings and made them their own and suddenly there was a renewed attention on it.
But I don’t have enough say/sway to explain how fucked up this is.
And charge-splaining is when I am informed of something that they are working on that I
Sorry for the sweary post.
But sometimes only a four letter word will do.
Holiday weekend incoming.
Not only is it a holiday weekend that harkens the end of summer, it is also another chance to remain vigilant.
Authorities in my state are asking people not to engage in large gatherings, have large parties, or behave like fools.
This is also when the area hospitals are detailing exactly how many people are in their ICUs, IMCUs, Med-Surg units and how many of each are unvaccinated.
Our hospital has a 15 hour wait to be treated in the ED.
FIFTEEN HOURS.
sigh.
Please be safe this weekend.
I am off-ish.
Of course I am taking call all weekend, and all day Monday.
Got to make that money while I still can.
And, frankly, I don’t know how to say no.
I ran a poll in the OR lounge this week.
I wanted to give my teammates a choice.
Because I want to bake each theme of cookie.
I gave them the choice of literary cookie, that is cookies or described in books.
Or international cookies.
The poll was up all week.
And international had edged it out yesterday afternoon so I started making mental plans for international cookies.
And then, in a come from behind win, literary edged international out by 2 votes.
Who knew?
I scrapped my plans to make tiramisu cookies and started planning literary.
Sometimes that happens during surgery too.
The pre-op diagnosis that we all discuss and talk about during the pre-procedure time out proves to be wrong.
And that simple appendectomy for simple appendicitis turns into not appendicitis and a bigger colon resection.
In life, in the kitchen, in the OR, you have to learn how to roll with the punches.
To be nimble and not get your head caught up in the ‘this isn’t the way it was supposed to be’ trap.
Because Murphy lives in the OR.
And loves to fuck with OR people.
I’ll get to international cookie theme sometime or other.
Maybe in 2022.
The rest of the months of the year are planned already.
Or I could throw out the plans and do international.
Have to be nimble in this day and age.
Look, I get it.
We’re all tired.
Of the pandemic.
Of the variants that arise what seems like every other week.
Of the relentless news.
Of the masks.
Of the signs in grocery stores asking you to mask up.
Of the doom.
Of the gloom.
Of the 30% covid positive in the hospital.
Of the way there are no beds available.
Ever it feels like.
Of the 20+ inpatient holds in the ER.
Of the people living it up where the vaccination rate is higher,
Of the relentless bad news on the vaccine uptake front.
Of the lies.
Of the willful ignorance of some healthcare workers who will not, cannot, I ain’t gonna take the shot.
Of it all.
I get it.
We are all so very tired.
But this is not the time to let down our guard.
Children are getting sick because of the no-mask mandate rules in their states.
Children are dying.
Children not even born are dying inside their mothers, who have also died of covid.
This summer definitely feels like a step back toward last summer.
But that is no reason to engage in thoughtless behavior.
If I want to put up hearts that denote the vaccinated patients on the board, I will continue to do so.
Because other people remark on them.
Other people know how very far we have come.
Other people know how very far we have left to travel.
We have to stay the course not just for ourselves.
We have to stay the course for others who are ignorant, or afraid, or belligerent in the face of science.
We have to stay the course for them.
With my happy birthday dispatches post I set out goals for the year.
One of the big ones was applying for a grant.
AORN and Sigma have a grant application process specific for the OR.
I chose that one to get my feet wet in.
I read over the application form and thought about how to apply, how to get the information that they would need, how to get the paperwork in before the deadline of August 31, 2021 midnight.
You see, I had an opportunity to apply for a grant from AORN eChapter in July and I missed the deadline.
I was determined not to miss this one.
I gathered up all my information, put it in PDF form and sent it in.
I am not asking for much; just $400.
Enough to buy 2 more hand held metal detectors.
This project has had some massive delays.
Covid.
The ORAs, who will be involved, all quitting.
More Covid.
I finally feel like our ORA situation is stable.
In the timeline I had to fill out for the grant, I put education about the metal detecting to begin in September, with roll out in October.
The reviewers may feel this is a bit rushed.
And I may not get an answer before the end of the year.
That’s okay.
They don’t realize that this project has been on the back burner for nearly a year.
And other members of the research council keep asking me about outcomes.
I feel foolish that I don’t have an answer.
And that they have to stay tuned.
I really want this project to actually start.
Then I can turn my attention to the other items on the list.
I have to decide what to do next:
Daylight’s burning on this year.
Have to get started.
No sooner had I clocked in today when I was stopped by a good ACU friend.
She asked, “Have you heard? About the new variant? We’re never getting to go back to normal.”
How do you reassure someone who is working so hard to keep people safe?
One of my favorite surgeons stopped by the desk to thank me for getting his case going so fast.
He also asked me about the new variant.
He said he and his wife had not been out to eat since January.
Of 2019.
They had gone out for an early Valentine’s Day dinner.
He and I spoke about the new variant.
And the New England Medical journal and the 800,000+ person study that had been done and reported on recently.
And we spoke of hope for the vaccine for children 5-12.
His child is more than 5, less than 12.
He and his wife are hopeful the vaccine for children will be released within 8 weeks.
October.
We smiled grimly at each other through our masks, our eyes hiding the same pain.
October.
What the post-it says, ‘day shift says can’t stay late.’
Dude!
I didn’t ask you.
And you have three hours left on your shift.
Do I expect you to work your entire shift?
Yep.
Nothing irritates me more that someone stopping the conversation I wasn’t even having with them.
I don’t want you to stay late.
That means I am not doing my job well.
That means I have not judged the board well enough to allow later cases to start on time, rather than pushing them out so that the OR can be down to the requisite 3 rooms at 1700.
Or 1 room at 1900.
Of course, since I am no longer making those decision until after 1700 due to the asinine new rule that the days shift charge makes ALL the assignments, talk to them.
Yes, I’m still a little salty over the entire situation.
Don’t worry, I will still be blamed for running rooms late.
As I have been looking at different doctoral tracks I have been thinking of how best to use the resulting degree.
A DNP would be useful if I had any desire to be a nurse practitioner.
Which I don’t.
There is a DNP on a leadership track.
Also, no go.
I have turned down opportunities to advance.
I have turned them all down.
A PhD in nursing is about research.
I love research.
I love seeing if the changes made have had any impact and what that impact is.
Call it straight research.
Or quality improvement project.
I love them all.
When the organization started talking about hiring a salaried night time call staff it got me to thinking.
I want to find out.
I reached out to our nurse scientist to ascertain if anyone was doing such a study.
She said no.
And gave me the green light.
Tomorrow I will look at all that entails.
I also have to think about making this a mixed method study.
With a qualitative and a quantitative arm.
I’ve never qualitative.
To the library.
Online of course as the biggest organization library is 65+ miles away.
But I have access online.
I have research to do.
Dispatches from the Evening Shift 