We live in interesting times, my friend

According the John F. Kennedy, there is a Chinese curse that reads ‘May he live in interesting times’.

Never was it more true that it is today.

Now.

In this moment.

A novel Coronavirus, a pandemic, hoarding of goods and supplies, school closings, people working from home, people being told to maintain social distancing, which they don’t.

These are very interesting times.

I am 10 weeks into my last MSN semester. This is the big one, the 150 hour residency.

And on Friday, my preceptor informed me that the organization is cancelling all non-mandatory education. And moving most education to video instructor led training.

I’m at 102 out of 150 hours.

And until the end of April to do them in.

I’m not sure what to do.

I’m not sure what to say

I am not sure what to say.

This past Tuesday night we had a true life or limb surgery in the OR.

It involved a patient bleeding.

The surgeon was super freaked out.

She paged me at 2227.

I arrived at the hospital 2241 (I had to put clothes on).

I got dressed, scheduled the case at 2241.

She paged me again at 2252 to tell me the patient was bleeding and time was of the essence.

I told her I would be able to do more things faster if she would get off the phone and let me work.

The patient was in pre-op at 2314.

Anesthesiologist was upstairs in OB, starting an epidural.

I pulled out the anesthesia consent, took a set of vitals with a BP of 90/60, and noted down her answers from the conversation we’d had on the way to pre-op.

The surgeon was pacing around, completely freaked, wondering why we weren’t moving fast.

The anesthesiologist came down and pre-oped the patient.

I had her sign the anesthesia consent and I cosigned it.

The CRNA did the safety time out and she was in the OR at 2226.

We did what we had to do.

We saved her life.

And today, a full five days later, my boss pulls me aside to tell me that the surgeon’s perception was that I was not moving fast enough.

That I had no sense of urgency.

I was taken aback.

Excuse me?

Who else in this department could’ve been paged, driven to the hospital, picked the case, threw together the positioning aids, retrieved the patient personally, prepped the patient, waited for anesthesia, finished prepping the patient, walked the loved one to the waiting room and still managed to make it back into the OR within two minutes? All within 59 minutes of the page.

Of course I don’t act like I’m in a tizzy.

That does NOTHING to reassure the patient.

But apparently I should’ve been ranting that the patient had to go back to the room.

Immediately.

Because she was bleeding to death.

With a BP of 90/60, pink cheeks, and a normal heart rate.

Right.

Weekender update

I’m trying to keep an open mind. Really, I am.

BUT…

Of the 8 weeks this thingy has been active, I’ve been on call after the weekender leaves at 1900. Okay, normal.

What is not normal is the 15 weekend days I’ve been there after 1900. Sometimes the surgeon waits until after 1900 to page me, sometimes I am summoned earlier.

For instance, Saturday I was texted, called and paged within a minute.

Okay.

I answered the page at 1835. The weekender told me that Dr. X had an open fracture that he wanted to put an ex-fix on.

Okay.

She told me it would start at 1900.

I asked if the patient was prepped.

No patient, no exact surgery planned.

Just there is an ex-fix and doctor wants to start at 1900.

I gently told her she had no patient, no clear plan of what was going to be happening and there was no way on God’s green earth all of that would happen in 30 minutes and that I was on my way.

Next she told me she could not get a hold of the tech.

Okay, I’ve got that.

I had the nursing supervisor call the tech while I was driving as I was not exactly clear who was on call.

When I got there 10 minutes later (don’t hate me because I live so close), the two weekenders were milling around, I guess.

I asked if the case had been picked since they knew about this case in advance.

No.

Resounding thud of an answer.

I held my tongue, I smiled and nodded and went downstairs to get case picked.

And then I prepped the patient.

And then we started the case at 1935.

 

Mercury in Retrograde

Mercury is in retrograde.

This spells trouble.

Not unlike a full moon.

Yes, I mostly grew up in Northern California so my outlook is moderately crunchy.

My zodiac sign is Cancer. I prefer the moniker Moon Child.

I am a water sign.

I believe in the power of the full moon, especially on the crazies, and the pregnant women.

I wasn’t paying too close attention to Mercury being in retrograde until recently. Mostly because I don’t really ascribe to it.

Mercury went into retrograde on Monday, February 17.

The OR worked until 0100. I didn’t get to sleep until 0130. As you do after a busy shift.

And I had an 0630 meeting. Of course.

Rinse and repeat ALL WEEK LONG.

Mercury is in retrograde, please make the increased evening cases stop. We had just gotten over the late fall early winter rush.

0300 Scaries

All of a sudden I’ve lost my number one asset.

That of being able to sleep through anything.

Anytime.

Anywhere.

I am awake most nights at 0300.

Why?

The symposium I have poured so, so much of my brain power into over the last four months.

The mountains I’ve had to scale to make it an actuality.

The minutiae I’ve had to pay attention to.

It’s exhausting.

And nearly done.

And, God, I hope it goes off without a hitch.

Off to  make my punch lists for the week for this Friday.

I hope I survive.

Worst case EVER

Ick.

That would be the worst case I’ve ever personally done.

Necrotizing fasciitis.

This is often caused by a group A streptococcus.

It attacks the muscles, fat, tissue and liquefies it into a rank gray brown ooze.

And it moves quickly, very quickly.

People die.

To get ahead of such a monster there is an incision and debridement.

There is an incision and the surgeon scrapes out the gray brown ooze until there is healthy muscle and tissue.

I’ve been in on lots of these cases.

Nothing to do but put peppermint on the mask, double mask if needed, and dive in.

This poor person had one of the worst cases I’ve ever seen.

The entire limb was affected. The surgeon kept cutting more and more and more.

Peppermint was not adequate for smell containment.

This smell required benzoin.

After hour 2 I informed the surgeon that I would be putting in a foley catheter at the end of the case as the limb was now half flayed open and I thought they would need it to be able to watch the I&Os carefully.

This was when I quietly began making arrangements for a higher level of care than Med-Surg. Not that they aren’t capable but this was rapidly becoming beyond their capacity.

After hour 3 I informed the surgeon that I had saved an ICU bed for the patient. This was when we were at a major joint and headed south.

He agreed absently, intent on getting all the dead tissue out.

After hour 4 he began to do the final irrigation of what had been this limb and asked me to block off time 24 hours in the future for a bring back. To do more debridement.

I met the PA’s eyes over our masks. We didn’t think the patient would survive that long.

 

Why, oh why

Today, at 1615, a private tech left the room and indicated the room was closing.

Okay.

At this time two other rooms were going full blast.

If room 1 was going to be done by 1700, I could green light the 1700 add on, which would leave room for the 1800 add on.

The rep also indicated that they were done.

The ambulatory care unit called and said that the 1700 doctor had just arrived.

Okay then.

I green lit them to go back.

Guess what?

The tech and the rep were WRONG!!!

I know better than to listen to the tech. He’s usually on my personal shit list.

I definitely know better than to listen to the rep. He has an unflattering nickname in the department.

Even giving them twenty minute padding they should be done WELL before 1700.

Guess what?

They were not.

And then I had to listen to the CRNA bitch about being let go 5 minutes late.

I had to scrub out the scrub so she could go home.

I had to slightly delay the hip fracture.

I had to listen to the call CRNA Monday morning quarterback the decision to continue on.

And go on and on and on about whether the 1800 add on could go.

I knew that the 1800 would be done by 1800.

So I green lit that too.

Recap, there is a hip fracture and a foot I&D, both going to be done by 1900.

And the CRNA is giving me crap about it.

Yes, they were both done by 1900.

Yes, I might have gloated a little bit.