All the things have an expiration date

Time has a funny way of affecting a budget.

Not only return on investment.

Not only asset capture.

Not only surgical time versus man hours.

But the expiration of surgical supplies.

These can be many things.

Sponges.

Mesh implants.

All the implants.

Dressings.

Staplers.

Suture.

The list is as long as the supplies for the OR.

99.9% of our supplies/implants have an expiration date.

If the department doesn’t use them within the time frame, the department eats the cost.

I am sure some of the depreciation is calculated into the cost of surgery.

But.

I train people to always look at expiration dates when opening supplies.

Most especially for implants.

And if there are two of an item in their hand, they should open the one that will expire first.

It just makes sense.

 

I’m not always the best judge of character

When I was living less than a block from the hospital, my husband and I explored buying the townhouse duplex we lived in. Someone scooped it out from under us. No matter. I still lived less than a block from the hospital.

We lived in the bigger half of the duplex. A three bedroom, two bathroom open concept place. I loved it there. I was a new nurse, working evening shift on a Med-Surg floor.

The people in the other half had moved out and a woman and her daughter moved in. I soon saw her orienting on my floor. She was a fellow nurse!

She was fun.

Always laughing.

Always open to doing things out of work.

She had been a nurse for ten years, and she’d been working at several hospitals before she moved to our little town.

I was none of these things.

I have been called severe, too serious.

I laughed but usually at myself.

I had been a working nurse for three months and my only experience was a CNA in a nursing home and several different jobs at the hospital.

I thought she could teach me a lot of things, like time management, and how to address scary situations.

And then I noticed some things.

She was always behind on her evening med pass.

That some of her patients had fallen.

That she always worked later than me finishing her charting.

That she always was laughing, sometimes at the patients.

She was always flirting with the doctors.

I did learn from her.

I learned when to keep my mouth shut.

I learned  how to time my evening med pass so none of the medications were late.

I learned when to pay extra attention to symptoms the patient was having.

I learned to be succinct in my narrative charting.

I learned how to talk to doctors.

I learned how to be respectful to patients, because they were in our care.

She didn’t last long at our little hospital. She and her daughter moved away after six months.

 

Nuclear Edition

There is a newish tech at the hospital.

And he’s scooping up all the tech weekend call.

And he’s obnoxious.

He’s a know it all and not in a good way.

He won’t answer his phone.

He won’t answer his pager.

I am disgusted.

I have two options as I see it.

  1. grin and bear it until the weekend tech is ready to go live on her shift
  2. stop taking all the weekend call from the nurses

The second is the nuclear option.

I enjoy call.

I’m good at it.

I do not enjoy shepherding a know it all through his paces.

Every weekend.

I’m leaning toward 1. However, I heard about him telling the new weekend tech that she’s going to get tired of working every weekend, inferring that she should not.

As I did not hear this myself I can’t report off to my boss.

However, I can tell her to pay no attention to him.

 

What a week

Ugh.

This week has been particularly hateful.

I believe the best way to synopsize the last three days is a little story.

We are about to start a 3 hour jaw revision.

At 1900.

Hark, the phone rings and it is OB telling me there’s an ectopic in the ED.

Well, an ectopic is an emergency.

I told the OB to see the patient in the ED and get back to me, because we would hold the jaw fracture.

He hemmed and hawed and said he’d go the ED after he finished the delivery he was on.

I went to tell the team and the surgeon who was being delayed about the ectopic and that I anticipated hearing something soon.

Cue me and the CRNA checking on the rooms.

Each of us not wanting to go past the surgeon at the desk with no news.

FINALLY, after 45 minutes I sent a query text to the OB doc. ???

A little sheepishly I got a reply to start the revision.

Because the patient wasn’t even in our ED.

They were at another hospital.

You made me delay a case for 1 hour and you’d been consulted on the wrong ED.

Sheesh.

Incoming!

The new six week schedule is complete.

It has to be published two weeks before the start date.

So, essentially, it’s been done for three days.

And here comes the bomb to blow up the carefully prepared schedule.

I don’t know what it is.

I don’t know when it will come.

But it will.

I am waiting.

Budgeting time

There are many, many things to account for in the operating room.

A seldom thought of one is time.

There are lots of packets of time to budget.

The time it takes to drive to work. Or take transit. Or walk.

The time it takes to walk in to work, especially if the car/bus stop is far away from the OR.

The time it takes to walk to the lounge, use the facilities, have your break, and walk back to your room. All within 15 minutes.

The same for lunch. Except you get 30 minutes.

The time waiting for the surgeon to arrive.

The time waiting for the patient to wake up.

The endless time it takes the elevator to come up from the basement. And you’re on the 1st floor. Why, oh, why didn’t they build stairs next to the OR.

The time waiting for your relief to show up so you can go home.

And get ready to do it all again tomorrow.

Sunday’s Theme: past patients and coworkers

This will have to be quick.

I am working at 0630 in the morning.

For the third morning in the row.

Argh.

One of my favorite anesthesiologists was waked on Saturday.

Well, it was his funeral day.

But his family ordered people who went to wear brightly colored shirts.

In his memory.

And, hearing that, I laughed and laughed.

Because, of course.

Dr. C was an amazing man.

He was gifted as an anesthesiologist.

He put everyone at ease, including the staff AND the patient.

He handled emergencies with compassion and the right word after the crisis had passed.

I will miss him.