Post-it 1/9/22-Can we talk about what the word dying means?

The post-it reads ‘on call doc who wouldn’t let us leave, wanted there just in case. Yeah, that case never developed, and we went home after 6 hours of no case’.

But the next call night I got paged for an ectopic.

With the same doctor.

I loathe ectopics.

Especially with a doctor who I don’t know anything about.

And who told me the patient was dying.

Actively dying.

There was a lot of blood in the belly after we put a scope in her belly, I’ll give her that.

Pre-surgery, her heart rate and blood pressure were stable.

Her color was pink and she was in good spirits.

Nope, that is not how an actively dying patient presents.

If you know, you know.

The MD tells me again that the patient is dying as I was prepping the patient for surgery.

Um, I don’t think you know what that means.

I am sure you do.

But not.

While I agree this case is urgent, this patient is in no way actively dying.

But I’m not the surgeon.

Guess what?

Maybe the doctor should’ve made sure the patient was type and crossed.

In the ER.

Where they have more people.

Not in the OR where there is 4 people.

3 with active computer permissions and skills.

But no.

I had to do it while I am doing all 500,000 things I have to do to get the ’emergency’ case going.

Can we agree what dying is?

If not, can we agree what is or is not an emergency.

And just like that- introvert interruptus

I am an introvert.

This is one of the reasons that I thrive in the operating room.

Limited people in the room.

Patient is asleep.

I’m not very good in big groups of people.

But little groups are okay.

One on one is even better.

In my new call job, I have a surgical tech that will be my partner in crime.

And I know she is an introvert.

The CRNA and anesthesiologist will change daily.

But I’m okay with most of them.

Except the one who told me I was throwing away my vote when I didn’t vote the way this MD wanted.

And then didn’t speak to me for four years when it turned out badly.

Not them.

Thankfully I hardly ever see them.

I am okay with a limited team in the OR at night.

And I was enjoying my alone time in the house while my husband was in the office.

And then they closed the office.

Only for one week.

There’s a new surge, you know.

Let us clean the office and we’ll get all the vaccinated people back in the office next week.

Next week has come and gone and he is still working from home.

What that tells me is that someone who is vaccinated, because everyone who has returned to the office is, got covid.

I get mildly reprimanded for noise when I am in our home office with him.

Now I write in the dining room on my laptop.

But in typical introvert fashion I want to throw a tantrum.

But frankly, I don’t know how.

And, yes, the title is borrowed, a little, from the Sex and the City limited series.

No, I’ve never watched it.

No, I’m not watching it now.

But it fit.

Does everyone you know have covid?

I know people with covid.

I take care of people who might have covid.

The operating room has had patients in the last week who were positive for covid.

The hospital, while not as full as last winter, has a lot of covid.

This is a January covid update.

I am still not going to places during the middle of the day if I can help it.

I go early in the morning.

Or later at night.

My husband’s office closed for this week only.

They promised.

oops, they are closed for next week too.

I’ve had to cancel our hospital shared governance coordinating council because of the same reason I will be cancelling the symposium.

I have to cancel another symposium because I am afraid of not having any attendees.

Because they are working in the hospitals.

Better luck next summer.

Now people are testing positive on airplanes.

Or when they get to their destination.

And I fear for the AORN conference that is to be in New Orleans in March.

Canceled for the third year?

We’ll see.

Masks work.

Vaccines work.

Handwashing works.

Social distancing works.

I can not stress this enough.

I also cannot stress enough that we could be so much further along in this pandemic.

We could be approaching endemic status.

Life could be approaching somewhat normal.

But no.

Cookie Thursday 1/6/22- Any Port in a Storm

Happy 1st Cookie Thursday is a Thing of 2022.

The theme for this year, again, will be booze.

Because 2021 was only slightly better then 2020.

And Cookie Thursday is a Thing is turning 7 years old.

That’s a lot of cookies.

Cookie Thursday was started as a moral booster for the department.

And because I had a shiny new kitchen.

And someone once told me that they had never had a homemade cookie.

That cannot stand.

A small group of us started making cookies, weekly.

This became Cookie Thursday is a Thing, because it is not yet Friday and we are sad.

This was my idea and is my baby.

And I am the chief baker.

Others take over when I am on vacation.

But mostly it’s me.

For SEVEN years.

Hello.

I bake cookies according to the month’s theme.

That I also come up with.

Staff, including surgeons, stop me early in the week to inquire what will be that week’s cookie.

2021 was hard on everyone, it especially on healthcare workers.

The theme of January 2021, after that horribly scary 2020, was booze.

For a household that doesn’t drink there is an awful lot of liquor around.

I decided January 2022 was also going to be a booze theme.

And I also decided to extend the cookies to other departments.

Today’s cookie is made with Port as the alcohol.

An entirely new cookie, recipe by me.

I’ve made enough cookies to make up a recipe.

I will be calling this cookie Any Port in Storm

This is why my baking pantry is full to the bursting.

This is why I have 10 different kinds of chips.

This is why I buy flour, butter, and sugar in bulk.

There is a way to make this frugal as well.

The alcohol used this year will come from our disused liquor cabinet.

I buy my ingredients in bulk.

I have several different sizes of cookie scoops.

I make one batch and it feeds the department, usually around 60 cookies.

Here’s to another year of cookie baking.

Even in this strange time and place.

The baking must go on!

To answer the page at 7684843201600

Um.

This is too many digits.

For America.

This is too many digits.

I could not even begin to parse this return number on my pager.

I believe 786 is Miami.

But this is 768.

The only thing to do is to hope they realize their mistake and page again.

Oh, listen.

They paged again.

And this time the return number is 768.

I will learn who this is when they call the nursing supervisor and complain that they didn’t get a call back.

And, when I go in to do the case, I will show them the botched page.

Both of them.

Yearly disclaimer

Every year I write this disclaimer.

I believe in protecting patient’s and staff privacy.

I do not include details that make it clear or easy to figure out which patient or staff member I am talking about.

I do not use names.

And if I do, they are changed.

I change ages.

I change gender.

I change details such as which limb is fractured.

I change details such as which surgery is performed.

I change a lot.

So that, if you knew where I worked, you could not figure out who I am talking about.

I discuss issues that impact healthcare broadly.

I do swear sometimes.

But mainly to make am emphatic point.

Sorry, mom.

Post-it 1/2/22- Trigger phrases

The post-it reads ‘that phrase that makes you incandescent with rage.’

This is a phrase that is used sometimes as a catch all phrase that means don’t hurt me, I’m just relaying a message.

Yeah, and your message is crap.

This is a mealy mouthed expression that means nothing.

One of my least favorite trigger phrases is just making sure.

Usually said with a hand up or a shrug.

No, no you are not.

You are ensuring my continuing obedience to whatever crack pot idea you have.

That is the phrase you use when nothing else comes to mind.

When you know very well that there that the job has been done.

And done well.

But you need to make sure (air quotes).

Because you are controlling like that.

Nails on a chalkboard.

If I could I would consign the phrase to Mount Doom.

With the One Ring.

And if you don’t get that reference I weep.

Hope for 2022

According to several geek type movies in recent years, hope means different things.

In Justice League, Superman explains to Lois Lane that the stylized S on his breastplate stands for a Kryptonian word that means hope.

And we all know that Superman is from Krypton.

And in Rogue One, Jyn Erso states that rebellions are built on hope.

And everyone knows that the group standing up to the Evil Empire is the Rebel Alliance.

I mean, the name of Star Wars Episode III is a New Hope.

And in the vein of dispatches, which are communiques from the front line, and the name of this blog, there is a podcast called Hope from the Front Lines.

About caregivers of color and their stories of struggles, and strength.

I am so tired of the word resilience.

Yeah, yeah, there is a lot of resilience going around in healthcare.

We have little choice.

Instead of resilience, which is the ability to recover quickly from difficulties, according to the dictionary, I want to have hope.

Hope that this pandemic will end with a whimper.

Hope that those who are resistant to the vaccines, for whatever reasons floats their boat, fear, oppositional defiance, whatever, will embrace the vaccines as the way out.

Hope that 2022 will not be as bad as 2021.

We have no choice.

My personal mantra is the only way out is through.

Let’s get started.

Final Cookie Thursday is a Thing of 2021- Chex mix redux 12/30/21

This is the final Cookie Thursday is a Thing for 2021.

I had a poll on the board in the break room.

And people chose Chex mix over cheddar triple pepper thumbprints.

Okay.

It has been quite the year.

I made cookies for nearly every week.

Except for the week I was in CA.

Or one week I was on vacation.

Cookie Thursday is a Thing turns 7 next week.

I think, time is fluid.

I mean I just got married a couple of years ago.

Just kidding, it’s been 23 years.

Eek!

Seven years of nearly weekly cookies.

Hmm.

In the next year I will be expanding the Cookie Thursday is a Thing as a morale booster to other departments in the hospital.

Why and how?

Because I have 40+ hours to fill a week.

And after 7 years I think the department can share.

I think I will choose the emergency room as the first recipient of a Cookie Thursday is a Thing batch.

Since the beginning this was an afternoon/evening shift endeavor.

And so it will remain.

I hope to deliver the cookies by 1400 on Thursdays.

I probably should tell the managers what I am doing.

The theme months will continue.

And I began 2021 with a booze cookie month.

And since 2021 has been so awful I will begin 2022 the same way.

Hopefully a reset.

Because, according to my coworkers who are confused by the fact I don’t drink, booze makes it better.

And there are still so many alcohols to explore.

I want to do a rose wine cookie.

I hear the millenials loves rose.

I want to do a vodka cookie.

This one’s plan is secret.

I want to do a port cookie.

I should check the bar.

Dimple update

In September 2019 I fell in the OR.

I tripped over the c-arm cord.

I face-planted into a trash can.

This was a call case.

The only people present in the OR was the surgeon, the anesthesiologist, the CRNA and PACU was on their way in.

The patient was under 6.

I was not going to let a little fall stop me from giving care to this child.

Although all the others, all men, urged to me to sit down and take a break.

I looked at them, pointed at the child we had JUST put under general anesthesia and said there was no time.

Everyone turned to the patient and the case began after we all did the pre-incision pause.

The anesthesiologist went and got me an ice bag.

After the case the surgeon steri-stripped the small wound on my cheek.

Huh, apparently I was bleeding.

The take-aways were

  1. I did not hit my head on the corner of the desk. This would have been infinitely worse and likely fatal.
  2. I did not break my glasses
  3. we were able to give this child a safe surgery, circulator injury not-withstanding.

After the case, the bruising was already evident on my cheek and on my neck.

Blood complies with gravity rules, after all.

Over the next 6 hours I developed a black, black bruise from my cheek where I had impacted the trash can to my clavicle.

It hurt.

Duh.

The cut that had been steri-stripped was a vertical slash just distal to the cheekbone.

See, I could have hit there and broken my face.

After the pain and the swelling and the employee health visits and the x-rays I was left with a stabbing pain in the left temporomandibular joint, an urge to scream when I sneezed, and a new dimple.

Exactly where the cut had been.

There was a palpable knot of tissue near my chin.

It’s still there.

I went back to employee health in December 2019 and asked them about the new dimple.

The employee health nurse said it was swelling and would go down.

I intended to follow up in three more months.

But we all know what started happening in January 2020 and February 2020 and so on.

I was not going to go back to employee health.

I am quite sure they had their hands full.

At my latest dental appointment I was informed that three fillings were breaking down, as they were old, and they would need to be replaced.

They were all on the left.

I decided to get all three done in a fail swoop.

Why wait?

In a marathon appointment that took 2 and a half hours the fillings were removed and replaced.

I was warned there may be some pain.

I can handle pain.

But two weeks later there is still pain.

My teeth don’t hurt.

The new fillings are fine.

My temporomandibular joint on that side is killing me.

Just like it did after I fell in September 2019.

It took months for that pain to go away.

And I had to be careful chewing.

Same.

I felt dismissed by employee health two years ago.

And I am sure the pandemic made it worse.

And we are in the Omicron wave now.

I am still going to email employee health and ask for guidance.

I’ll probably be told that the file has been open too long and they closed it.

What then?