Hey, February, who or what gave you permission to act like December?

Knock it off!

We have a new doctor.

She is efficient.

As the nurse who has worked with her the most, I recognize that she has been gifted the black cloud for the group.

This is something that gets passed around to ALL the new docs.

Her cases are harder, her patients sicker, the diagnoses are odder.

Guys, we go through this every time with a new doc in that group.

Remember how horribly the last new doc got beaten up by cases.

Oh, that’s right, you can’t.

You weren’t here then.

To date she has done 3 impossibly hard cases in the middle of the night, one retrocecal appy in the evening.

And 2 horrible gall bladders on a weekend shift.

And she and I have started building her preference cards; so far we have an appy, a gallbladder, an open belly case, and the start of an ex lap card.

Okay, it takes time, depends on the case.

When I got to work yesterday to do a diagnostic lap with her I got an earful from the CRNA, telling me she was reserving judgement on this doctor based on the two horrible gallbladders.

And a corrected preference card at the desk.

I reminded the CRNA to please have an open mind, see the above black cloud she has been gifted.

The diagnostic lap, although strange and odd diagnosis, went well. The CRNA said she was pleased it had gone so well.

I looked at the preference card corrections.

Every single, blessed thing that was written down to be added WAS ALREADY ON THE CARD!

Sigh.

There I was, minding my own business, in a very long case that had converted to open, making it longer still, when I thought to myself, “I’ll do one of my favorite long case distraction techniques.”

Not my phone.

Checking for outdates.

After the counting and conversion was done, I went to the cabinets and began going through them, looking for outdates.

I found the outdates, many of them, up to $500 worth.

What I also found was the cabinets stuffed with supplies.

I had to closed my eyes and breathe deeply.

The thing that really frosts my button, besides inefficiency, is waste.

So may things were stuffed into these poor cabinets, often in two places.

I pulled out an entire bin of overstock, always leaving 2-5 of a supply, depending on the kind.

Bovie tips, and dressing supplies, and more bovie tips, and extra chloraprep (hello, it comes in the packs, you do not need 15 in a room). Gelfoam of all sizes, and surgicel of all sizes. Excuse me the most common sizes are 4×8 and 2×14, why do you need fifteen 0.5×2?

When I was done, there was entire bin of extra supplies, the cabinets still looked full, and I had removed 30+ pieces of expired things.

The oldest expired item was from December.

Of 2019.

As this is 2021, I think that is excessive!

And I also think I need to retrain my coworkers on stocking and expiration date hunting.

Monday, I think I will do room 5.

I was talking to my nursing supervisor this evening and in doing so I struck upon the perfect metaphor for the Covid winter, autumn, summer, spring, winter we are stuck in.

I know I have written before about Covid being the grindstone and healthcare workers being ground down and we have to be careful that we are not ground down into nothing.

But this metaphor is even more perfect.

I wish, I wish I could draw.

I wish, I wish I could protect my idea.

I wish I knew an artist.

Here is the metaphor:

Have you heard of Sisyphus?

The Greek king who was sentenced by Zeus to forever roll a large rock uphill in Hades.

The king could never get the rock up the hill.

For healthcare workers the rock is our patients and society at large and the hill is Covid.

And we are forever rolling and supporting the rock up the hill.

And never getting anywhere.

I could expand the metaphor and say there are obstacles in our way.

The obstacles of denial, of mask refusal, of anti-vaxxers.

The obstacles of the economy and the political climate that makes the obstacles even harder.

I think that is the perfect metaphor for healthcare workers.

We are supporting the rock, who may not want to be rolled up the hill, against the hill that is the Pandemic.

And the hill seems like it will never end.

And the rock never gets any lighter.

Look, I’ve been a nurse for nearly 20 years. And an OR nurse for 19 of them.

I’ve had my share of gross, how are you still alive cases.

I keep a ranked list in my head.

The guy who lost his buttocks, and rectum to necrotizing fasciitis.

The woman who lost her leg and nearly her life to necrotizing fasciitis.

The men who’ve made me believe the 90% fatality rate that happen with scrotal abscesses.

The men and women who have had plastic surgery cheaper abroad.

Hint, it’s never cheaper when you come home and nearly die of sepsis.

The sweet lady on the floor who the surgeons were waiting to see demarcation of the necrotic limb before amputation who died of sepsis before the amputation could take place.

And there is a new contender for not the grossest case ever but high on the list.

This past week we had diffuse necrotizing fasciitis through an entire segment of a person’s body.

As the surgeon kept doing sharp debridement and continuing to find the black/gray tendrils and liquifying sub-q, the patient kept losing more and more area.

It is now 2nd on the list of the amount of tissue taken off a patient.

But they clearly needed it.

Because necrotizing fasciitis can kill.

I hope they do okay.

It has been a full year since I paid for college courses.

I paid for my last 2 classes just after New Year’s last year.

In this past year I have paid more for membership in various nursing groups.

I joined my state nursing association and do education through there.

I paid for an education membership to a group that does continuing education.

I paid for my Sigma Theta Tau membership.

I paid for a nursing membership to a group that is going to be important to a project I am working on with another nurse.

I paid to go to a virtual conference through my state nursing association.

I take free classes when I can, especially those surrounding the Coronavirus and the response therein.

I take free classes through AORN.

But my AORN membership allows for monthly free CEUs through their journal.

It is part of my New Year’s resolutions to fully engage with the AORN CEUs.

And read all of my nursing education.

Because I have 3 years to earn 125 hours to retain my CNOR.

All the while, in the back of my head, I think PhD, Maybe?

You’ve heard of FOMO?

Fear of Missing Out.

Over the last several months looking at what other people have done on quarantine, I have coined a new phrase.

I.

A.

M.

O.

I am missing out.

As a working nurse who works between 40-50 hours a week, plus 98 hours of call, I cannot help but fear I am missing something.

I have not baked bread.

I have not decluttered my closet.

I have not read more.

I have not participated in a Zoom happy hour.

I have not had my groceries delivered.

However, looking at that list I realize I sound a little whiny.

I will be reframing my thoughts to the best of my ability.

I have worked my regularly scheduled shifts.

I have received both vaccine shots.

I have not gotten sick due to strict masking and handwashing.

My husband has the ability to work from home.

I would like to read more but I find myself doing the same things when I am not at work.

And let’s face it, I would not participate in a Zoom happy hour.

But, still…

This has happened many times in the past. And yesterday.

A surgeon calls and books a case.

An unusual case for the evening shift, but okay.

I personally think the patient could use a little more scrutiny from other docs before getting her fracture fixed.

But, I’m not the surgeon. I tell him that this kind of fracture is highly unusual the SAME DAY of the accident.

Most of these patients have co-morbidities and could stand to be buffed up a bit.

Surgeon persists. He wants to go today.

Okay, we’re there to work.

I tell ACU to get the patient from ED and prep the patient.

Normally, I would get the patient myself. But the case the surgeon wants to do?

Requires a complete reset of one of the rooms.

New bed. Heavy bed.

New technology.

All the equipment and furniture moved.

New equipment.

After I spend 20 minutes preparing the room, I walk to ACU to interview the patient.

No patient.

She is in x-ray. As the surgeon has decided that he wants 1 more x-ray.

Never mind the patient is gonna be on the table in less than a half an hour.

IF THE PATIENT HAD BEEN BROUGHT TO ACU.

And the surgeon is in x-ray with the patient.

Finally, we have a patient.

As my room is set up and open with the tech setting up the table, I continue with the evening chores.

As I am putting up the board and the assignments, the surgeon came in to ask what was taking so long.

I looked at him and said because of the delay from taking the patient BACK to x-ray. This set up a trickle down delay.

The new x-ray order had to be put in.

The transport had to show up to take them to x-ray.

The patient had to endure another x-ray.

The patient had to go back to ED.

The patient had to come to ACU.

The delay was 45 minutes.

And then and only then they were brought to ACU to be prepped for surgery.

The patient is elderly and has a lot of medical history to go through.

If the patient isn’t brought to prep when sent for it delays everything else.

He scoffed a bit and said he couldn’t even get the reduction he wanted because the patient was in too much pain to stand the x-ray.

That’s because she is BROKEN.

(I apologize for the excessive use of the caps lock, but come on!)

We have new people in the department.

Both techs and nurses.

And the rumors have been UNREAL.

There are rumors around Covid.

There are rumors around who is sleeping with who.

There are rumors around which MD has the highest mortality rate.

There are rumors that we will be not doing elective cases soon.

There are rumors that a kind of popular nurse will be coming back and in a management position.

There are rumors that the sky is green.

Just kidding on that last one, just wanted to make sure you were paying attention.

There are rumors about another political insurrection around the inauguration.

I am not sure how to quash all of these rumors.

If asked directly, because people know I won’t lie to them, I tell them the truth.

No, I don’t know who has Covid in the department.

Yes, I took my second shot just fine, no symptoms.

No, I don’t know if we will be stopping elective cases soon.

No, I don’t know about any of this.

Meetings have largely been cancelled because of the surge.

If I knew, I would tell you.

You always get the truth from me, no matter how unpleasant you might find it.

Friday night was hard. (I feel there needs to be a yo here but whatever)

Friday night was never ending.

Except for the 2 hours in the beginning where I was just trying to herd all my day to evening staff into being productive.

As we waited for the surgeon of the hour to arrive.

And then, BAM another case.

I had misgivings about giving this surgeon a time.

Many misgivings.

He is not known for his speed.

Or his timeliness.

But it was 1645, loads of time.

So I said yes to the case.

IF he started at 1730 and was finished by 1900.

Because there were cases still to go.

I went and picked up the patient in the ED.

I delivered her to pre-op.

I returned to the OR, asked the nurse resident to scrub, as I wanted to hold my night tech in reserved because it thought it was gonna be a long night.

And we waited.

Our 1600 surgeon showed up at 1740.

Our 1730 surgeon showed up at 1740 (early for him, I may say.)

Both cases were heading back at the same time.

It was to be a race to 1900 when I have to go down to 1 case.

Our fracture case was in the room and asleep before the 1730 case.

It was definitely going to be a race to the finish.

I have to make relieving decisions by 1830.

Neither case was done.

Both were going to be kissing 1900.

I called in my on call tech as I could get no one to agree to stay for 10 minutes over. (this frustrates me so much! I mean, the CRNA had agreed to stay to finish. AARGH!)

Fracture case was done and out of the room by 1855.

Phew.

Except not I have this call tech who has arrived.

I assigned her to finish the 1730 case while I worked on getting the second fracture case started.

And then the anesthesiologist had to go upstairs to do an epidural.

OB, always harshing my buzz.

My night tech and I finished getting the room prepared for the second fracture.

That case was finished and in PACU by 2215.

I was working on the evening chores when the on call general surgeon called to set up a case.

I told him 2300.

And I called in the night on call nurse. She had hinted she wanted me to cover her call earlier but I declined.

The night on call tech was my night tech. She was overjoyed.

I walked to PACU to tell them there was another case. They told me I had to get and prep the patient myself because, I don’t know, reasons?

I went and picked up the patient from the ED and prepped them.

Waiting again.

For my call nurse to relieve me, for the surgeon.

Finally, all the ducks were in a row. The patient prepped, the team in place.

It was after midnight when I left.

I was mentally exhausted and physically on edge.

And starving as I had worked through lunch. AGAIN.

I stopped by and got Wendy’s, my late night after crap shift food.

Upon arriving home, I ate and stayed up for a bit, killing undead in my game.

I think I went to bed at 0300.

At 0730 my phone indicated a text.

There had been a case I re-scheduled during last night’s craziness.

The surgeon was reaching out because on Epic his case was listed at 1230.

We had agreed on 0930.

I confirmed the vendor of fracture fixation that he wanted and I told him I would tell the weekend nurse to call him and confirm his time.

Next, I texted the vendor that he requested and told him the new time.

I texted the weekend nurse.

And then when I was beginning to get responses from my texts, I silenced my phone and went back to sleep.

And missed phone calls wanting me to come in an do an “emergency” case that had been posted day before.

They just didn’t want to wait for the 3rd emergency belly case to be done. And called it “bleeding” to jump the line. (OB, you strike again)

They got another nurse to come in and to the OB case, thank goodness.

I called back and would have been there within the 30 minute response time.

The pinch hitter nurse said she would do the case, and go back to bed.

Great, I can’t wait to see what the fall out from this is gonna be. This makes 2 times in 10 years.

My poor night tech worked 19 hours. Oof.