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.

 

December, you suck!

Egad, I hate December.

the people

the constant crappy music

the case after case after case

the people (yes, this deserves to be here too)

the time sucking, life draining operating room schedule

all of it

One of my coworkers is making me a tee shirt that I feel epitomizes December.

Fuck you, December!

With a snowman flashing the double birdies (middle fingers).

Now if only our case volumes lighten up a bit in January.

I am not holding my breath.

1.5 classes left

It is with a sigh of profound relief that I submit my last discussion post reactions.

Three weeks off!

And then 4 months to complete the 175 hours of clinical education I need to graduate.

The math is that I have three mornings off a week.

I don’t have to work until 1430.

0800-1400 is 6 hours, times three mornings a week equals 18 hours a week.

This should get me to the finish line for this part of my class withing 10  weeks.

Time off for good behavior.

The 0.5 is the writing of my master’s thesis.

Which we have been cleverly working on the ENTIRE time we’ve been in school.

I think it’s supposed to be 50 pages, or 75.

No matter, I’ll just weave the papers I have been writing into a cohesive whole.

And submit and I’ll be done.

Two things remain:

I have yet to submit for graduation. Gotta shoehorn a call into them about that.

And I have yet to find a preceptor for the 175 hours.

Wish me luck.