I. A. M. O.

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…

You are your own delay

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!)

Rumors…

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.

oops, I did it again.

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.

We are all distracted

After the events of 1968, the author Joan Didion was flummoxed by the tumultuous events of that year.

So many things happened then

Kind of like now.

She had a hard time concentrating and writing was hard.

She said, “We tell ourselves stories in order to live.”

I imagine she found herself floundering a bit.

Kind of like we are today.

Historic things were happening.

Kind of like today.

She wrote the book “White Album” in that year. I imagine the title inspired by the Beatles’ White Album. It is about race and tumultuous times that threatened to rip our nation asunder.

However, she did not have a deadly pandemic at the same time.

Lucky us.

I have been floundering a bit these past few weeks.

All I seem to do it work, be on call, write my blog, occasionally feed my husband.

When I am not doing those things, I doom scroll, watching for news.

I stare into the middle distance when I am not even doing that.

This is not me.

I am a go-getter, someone with a thousand things to do and a hundred things always going on

All of my meetings, which is one way I engage with other nurses, have been cancelled because this nation is in the grips of another surge.

I feel we are on the brink of another quarantine.

I feel as if elective cases may be paused soon.

I feel tired watching all the people running around without masks and hugging and going out to dinner and going to birthday parties.

And I want to scream.

Mostly I feel tired.

This past year has been very grinding on the healthcare system as a whole.

I hope we get a grip on it before we are ground away to nothing.

As we, as a nation, are on the brink of 400,000 dead, it is hard to grasp it.

I find her words comforting.

We are all just stories after all.

Can the newbies even get through the door?

I heard something profoundly disturbing this week.

Our tech population is down.

This means we are short on techs.

But the newbie isn’t even a tech.

Isn’t a nurse.

The newbie is an orderly.

Someone who cleans and stocks the ORs.

I love our orderlies.

They work very, very hard.

We as so much of them.

And of the three we have on staff one left and one had surgery.

Leaving only one.

And that one took the day shift spot.

Leaving evenings with no one.

I did not think that was very fair and I lambasted the managers.

We run too may rooms and too many cases after 1500 to be cleaner-less.

As it stood I was the acting orderly, going from room to room, turning over rooms, opening rooms while still doing my evening shift charge duties of answering the phone, adding on cases and getting people out on time.

And sometimes I was in a room myself.

It made for some endless, endless days,

We have a brand new orderly.

Evening shift welcomed her.

Day shift couldn’t wait to tell her to watch out for one of the evening shift techs.

Dudes, can she not even get in the door?

This is going to be hard enough on her, to learn a new department and new duties, without terrifying her because of the tech that works the hardest in the department.

Sure, she’s a bit outspoken, but so am I.

And quick to point out inconsistencies in policies and how other staff are treated, but so am I.

This may be why we get along so well.

She is also the only one who will come in when there is a crisis, to help out.

She is also the one who makes sure we have certain supplies, cough, suture.

When I heard this, I was so mad. I’m not sure what I am going to ask management about this, but I will.

This is not right, to throw a fellow coworker under the bus.

And. Don’t frighten the newbie they are just arriving.

Vaccine shot 2 accomplished

I have had a week, let me tell you.

Not the 2nd vaccine shot, despite rumors to the opposite.

Sunday night I got called in at 0400 and worked until 0700.

My 2nd vaccine shot was at 0945.

Yeah, I could take a bit of a nap before I had to drive in rush hour traffic, or at least what amounted to rush hour traffic during a pandemic.

I overslept. I was going to wake up at 0830, shower and head to the main hospital.

I woke up at 0911. With a twenty minute drive.

I got up, brushed my teeth and drove down to the appointment, getting there in the nick of time.

I received my second Pfizer shot and I am very grateful that I did.

I was home by 1115.

I was back in bed by 1130 and up at 1345.

I caffeined it up and went to my normal shift.

Temperature normal, no pain, no nausea, no dizziness.

I worked my normal shift and went home.

After killing undead for twenty minutes I though it best that I go to bed so I did.

I was in bed by 0010.

My injection site had begun to ache a bit.

My pager went off at 0150.

Ugh.

Incarcerated ventral hernia, new doc.

Here we go.

I was at the OR until 0708.

Temperature still normal, some pain at injection site, slight dizziness that could be put to sleep deprivation.

I drove home and was in bed by 0745.

I woke up at 1130.

It confuses the cats when I am in bed after 1000.

No fever, minimal pain at injection site, no dizziness. I am tired but nothing else.

Some people at work who have been getting their second shots and suffering I am sorry.

For those still to get their second shots I have two pieces of advice.

  1. power of positive thinking. If you put it out to the universe that it is going to be hell you have just invited in the bad juju.
  2. peasant bloodline for the win!

It’s the stress dreaming, I swear

Anyone else not in my household having sleeping problems?

Okay, just us then.

Likely not.

Last night I had a doozy of a work dream.

I remember I woke up a little at 0755 and my husband said it was too early, go back to sleep.

So I did.

Right into a dream about doing a laparoscopic cholecystectomy (gallbladder removal) in OR 2.

The woman was generously large. It took me 2 chloraprep sticks to prep her abdomen.

I secured her to the bed with a safety strap and foot boards.

As we were doing the pause before incision the consent, that I had looked at before, now read laparoscopic cholecystectomy and intra-operative cholangiogram. I looked at AB the surgeon and he said that it had been added because there was something hinky with her common bile duct.

I spent the rest of the dream fetching the c-arm and the supplies needed for the IOC.

I also called the radiology tech where the phone rang and rang and rang. Although, this is what happens every day.

Some of the supplies were in the basement which was the same basement as my CA hospital.

Some of the supplies were on the roof, where they were giving out vaccines.

I finally made it back to my patient and my case in time for the surgeon to say he didn’t need all that stuff and her anatomy wasn’t as bad as all that and he was done anyway.

He does not talk like this.

We woke the patient up and were taking her to the recovery room, which had been chopped into 2500 different rooms.

Because of the flood, you know.

Flood? What flood?

I woke up right after giving report to the PACU nurse.

Odd, odd, odd dream.

And it was 0845.

What a year this week has been

I saw that somewhere and I completely agree and feel the sentiment.

This has been the longest week.

Warning: contains political talk.

First we had the elections in Georgia.

Nail biter, that one.

My husband woke up very early, for him, on Tuesday and was doom scrolling his phone. He said he couldn’t sleep.

I asked him if it was because of the existential dread of the elections.

He paused and said, ‘Maybe.’

And both democrats pulled it out. Thank goodness. This wasn’t decided or announced until Wednesday, around lunch time.

Wednesday was the day the Senate and House were to certify Biden’s win.

Already there had been several senators and house members who were going to object.

It is your right to object if it is what you need to do.

Please do not object to get face time with future voters, say 2024 voters.

Please do not object to kowtow to strange political bases.

Okay, good. Time to go to work.

Off I went to work and about an hour in people came rushing to the desk, talking about the mob in DC and the presence of armed so called protestors in the capital.

The rest of the night I admit I spent doom scrolling, unable to look away.

And now we have fall out from that.

Tiptoeing toward no elective cases

This is not good.

Our covid patient per bed capacity is not good.

By my calculations, we are 33% covid patient to hospital bed.

The ICU has been averaging 90% covid for over a week.

The step down unit has been averaging 75% covid for over a week.

And, I still firmly believe, this has all been fallout from Thanksgiving.

God help us when Christmas and New Year’s cases hit.

I figure we will be decreasing our elective cases soon.

Or, at the very least, going to outpatient only cases.

But then there are the cancer cases, who by the very nature of their surgery, must be admitted.

To a hospital where 1/3 beds has a covid patient in it, and that is not even counting the ED overflow hold patients.

Please wear your mask.

Please wash your hands.