The operating room is always pushed to move faster.

Faster turn overs.

From patient to patient.

Faster in room to incision times.

Faster finish times to out of room times.

Faster instrument turn over times.

Bad luck, this one is mostly static.

Faster.

Faster.

Faster.

…

Yes, OR time is money.

But so is patient safety.

And safety of patients is paramount.

And safety of staff is paramount.

Sometimes I hear of staff who are nudged to go faster when it is not in the patient’s interest to go faster.

Mistakes happen in faster.

The wrong implant is opened and charged to the patient because they did not follow the implant pass off procedure.

An entirely different surgery than planned happened because they did not follow the pause procedure.

That is where EVERYONE in the room stops and agrees that the patient, the procedure, the consent, the laterality, the antibiotic, and the availability of all needed instruments and supplies are correct.

These intentional pauses are there for a reason.

That is because yup, someone fucked up.

The wrong body part was operated on.

The wrong patient was operated on.

The wrong antibiotic was given.

The wrong procedure was performed.

The very needed this was not available and so there was a wait under anesthesia.

These all have one thing in common.

Faster.

Faster isn’t necessarily better.

The post-it reads ‘Don’t use JCAHO as the boogie man to introduce change.’

The Joint Commission, formerly known as JCAHO, is a triennial review of hospital quality and safety.

The Joint Commission wants to make sure that you, as a hospital system, are really doing what you said you are doing.

That’s it.

Not so scary.

I mean, they do have the power to yank Medicare payments, thereby effectively closing the hospital.

However, as long as you are doing what you said you are doing, it really shouldn’t be that bad.

But it sure gets the higher ups’ panties into a bunch.

Tightens some sphincters.

This can goad management to make changes, “because joint commission will be here soon.”

Sometimes these changes are good changes.

Made to make the survey easier.

But sometimes they are bad changes.

Used to make changes in the name of Joint Commission that will make hospital life easier for those people enacting them.

Or to justify a job for someone who has failed up.

Every healthcare worker knows at least two people that I am referring to.

The threat of a Joint Commission survey is not bad.

It just means that the hospital has to tighten up its game a little.

And actually do what we say we are doing.

Do not use the Joint Commission as the boogie man who hides under the bed.

This is just a step to ensure that the hospitals are providing good, quality care.

No more, no less.

Shame on you if you use the boogie man to effect changes that do not make sense in the realm of quality and safety.

Of course, there is always THAT surveyor who makes it their mission in life to nitpick over every, single, little thing.

If that is what you celebrate.

And to all a good night.

And a good rest to the pager.

Short and sweet post for this Thursday before Christmas.

My mom got into the act with her annual cookie platter today.

Two of them.

One for day shift and one for evening shift.

I decided to add coal.

For those naughty healthcare workers.

By coal I mean dark chocolate fudgy cocoa no-bake cookies.

By using a dark cocoa they turn very dark.

Almost like coal.

But yum.

I don’t find them as cloyingly sweet as regular no-bake cookies.

Just kidding on the naughty healthcare workers.

Mostly.

One year ago.

December 22, 2020.

I received my first vaccination shot.

I remember working until 0700 the morning of.

My appointment was at 0925.

I decided to take a small nap before I had to drive to the city and get the vaccination shot at the big hospital downtown.

I very nearly overslept!

I was driving hellbent for leather on the way down.

Thank goodness traffic wasn’t yet recovered.

I stood in line for 23 minutes.

Got my shot from a friend of mine.

And went back home to go back to bed.

I was home and back in bed by 1100.

Because I had to be back on shift at 1430.

But I was so very grateful that the vaccines had been developed,

And I was able to get mine within two weeks of them being released.

I was even more grateful when the vaccines opened up to the regular population.

Slight sore arm.

No fever.

No chills.

Got up and went back to work.

Like the good soldier I am.

All of a sudden I have 40+ hours of “free time”.

In my working life I have NEVER had such a thing.

I am certain I am not alone in wishing for more free time.

Time has been moving oddly during the pandemic.

Or I may just be more aware of it.

Healthcare workers do not have enough time to do all the care that is needed for our patients.

We often feel the lack.

A busy shift can go by in the blink of an eye.

A slow shift can dddrrrraaaagggg.

It is the same amount of time but our perception is different.

Often I feel like the white rabbit from Alice in Wonderland.

No time to say goodbye, hello, I’m late, I’m late, I’m late, I’m late.

I’m late for things I haven’t even thought of.

By contrast people who are impatiently waiting for the pandemic to end are bogged down by ennui.

That means boredom.

According to the Oxford dictionary ennui really means ‘a feeling of listlessness and dissatisfaction due to lack of occupation or excitement.’

I took this to mean that minds are not occupied.

Healthcare workers have concept of the lack of occupation or excitement.

Every minute of the shift is scheduled.

And when we are done, we crave doing nothing.

This is the much vaunted ‘free time’.

I think it is like a pendulum.

And, personally, when there is free time, such as the vast amount I now have, I feel nothing.

All I want to do is read.

And write.

But mostly read.

I can’t help the feeling that this is not healthy.

But this is what the pandemic has gifted to me.

The concept of free time is seductive.

And a liar.

I promised a career coach that I would work on my LinkedIn page.

Using her ideas, adding my own, as another avenue to get Dispatches from the Evening Shift noticed.

I will be giving myself a deadline of the end of the month.

December 31st.

I just have to ignore the siren’s call of my books.

Maybe a new scheduled day theme?

I’m trying it out.

I appreciate alliteration.

Today’s musings as I stare at the email confirmation for the tickets to London we just bought.

Knowing that there is another variant out there.

We had to use the money by the end of December.

Or forfeit it to the airline?

I think?

Regardless they would not give us our $11,000 back.

We bought tickets for August.

I really hope we get to go.

I have many plans if we get to go.

Including a train ride to Wales.

But let me slow my horses.

There is a lot of pandemic muck to wade through before then.

But, fingers crossed.

Another musing is that my first salary paycheck will be here on Friday.

I’m agog in suspense.

I knew going into this lark that I was going to be making less money.

Due to the no call or call back hours.

And I had a lot of those.

I soothe those fears by reminding myself that all the call and call back hours would be decreasing anyway when the shift got hired into.

Am I lying to myself when I say I’ve got this?

We’ll see.

As my mother-in law says now I am not working extra for the tax man.

It would be nice not to owe 4 digit tax bill every year.

Another musing is do I re-take the GRE?

I truly did not give it my best shot.

And I am 3 points away from the minimum that one of the colleges asks for.

I have an email to them regarding the acceptance of a lower score than desired.

After all, I already have a graduate degree.

Applications open for a couple of the schools that I am looking at January 1st.

I have to get cranking on those.

Apparently I need an idea of what I want to focus my research on prior to getting in.

I have no idea.

Surgery?

Enough musings, I’m making myself anxious over here.

I may have to re-think this theme.

The post-it says ‘Nursing is battle weary.’

According to Merriam-Webster Dictionary, battle weary is ‘1 : affected by war-weariness : tired of or depressed by war. 2 : of, relating to, or being a combat plane so worn or damaged as to be beyond repair and consigned to be scrapped, cannibalized, or used for target practice

Absolutely.

Nurses ARE battle weary.

In both senses of the word.

Since well before the beginning of the pandemic we have toiled in the trenches.

Patients are getting sicker.

Productivity demands are making people go home and get off the floor just so the numbers look right.

Never mind that those healthcare workers can be doing things are not “productive” in the eyes of the hospital balance books.

Such as cleaning med rooms.

Cleaning and replacing damaged equipment.

Organizing non-sterile supplies, in the case of the operating room.

Taking a freaking break from the grind.

Before we plaster on our smiles while we greet the next patient.

That was before the pandemic.

The pandemic has made it immeasurably worse.

Except now we use our eyes to smile.

Over our masks.

OR has been doing that for as long as the surgical team has worn masks.

According to my Google-fu, surgical masks came into vogue in the 1920s.

But was started much before that.

Right after Dr. Carl Flugge (there needs to be an umlaut but I can’t make that happen) developed droplet theory of infection in 1897.

Nursing is tired.

Of the coronavirus battle.

Did you think that was just you?

Nurses and other healthcare workers show signs of the second definition of battle-weariness.

Our fuselages are damaged.

And we are constantly being used for target practice.

By the continuing pandemic.

That has mitigation strategies that some people just don’t feel like doing.

umm, okay

By the family members who can’t believe this is happening that grandpa is dying.

Somehow that is nursing’s fault.

Under this constant barrage of fire, nurses and other healthcare workers take up their stethoscopes, put on their masks and greet the next patient.

This is what we do.

Even while being fired upon by science deniers and pandemic deniers.

okay

I am not only a blog writer, I write OR parodies.

I’ve written 8.

These are most likely to be parodies of children’s books.

Auntie Allis Doesn’t Live Here Anymore- about an ill fated romance between a clamp and a retractor.

The 2,410 Things I Pick Up Off the Floor- a counting book.

Dr. Alexander and the No Good, Horrible, Very Bad Day- about a doctor who gets to work and his team is on vacation, his normal room has been usurped and he’s operating out of the janitor’s closet, his instruments have been replaced with safety scissors, and on and on.

The OR Sign Language book- about how outside the room communicates with the team in the room through the window in the door, or how the scrub tech and the circulator communicate without a word.

And more.

There was a store near me that you could go and make little books.

You could choose the cover, the font, everything.

These were best suited for pictures and therefore the parodies became picture books.

Taking all the pictures for all the various pages was hilarious and an evening shift project.

The make a book store closed and I have not found a reliable replacement.

But the one I wrote about the 12 days of Christmas has always been one of my favorites.

I had to keep in mind the original song and make sure the beats matched exactly.

And add in the asides after each verse that are mostly about what the OR experienced in each day.

I had to write about the 13th day and the aftermath of the abuse.

Just know that the name of the charge is Jack, Jack Ashe.

The Thirteen Days of the OR Christmas

Once there was a snowy Christmas , cold and snowy, snowy and cold. Nothing would be better than staying home under the covers with a good book and a cup of tea. But, of couse the patients made it to the hospital for their surgeries. J. Ashe, my charge nurse, assigned me to a different room each day. These are the my thirteen days of the OR Christmas.

Bah Humbug.

On the first day of Christmas, my charge nurse gave to me: a surgeon in a good mood. (Dr. Good Mood declined to be pictured for this book or even named as he doesn’t want to ruin his reputation among the other surgeons)

On the second day of Christmas, my charge nurse gave to me: two should scopes, and a surgeon in a good mood. (get out the hip waders)

On the third day of Christmas, my charge nurse gave to me : three appys, two shoulder scopes and a surgeon in a good mood. (this is not looking good)

On the fourth day of Christmas, my charge nurse gave to me: four cataracts, three appys, two shoulder scopes and a surgeon in a good mood. (at least the eyes are quick)

On the fifth day of Chrismas, my charge nurse gave to me: Five C-Sections, four cataracts, three appys, two shoulder scopes and a surgeon in a good mood. (babies, hurray!)

On the sixth day of Chirstmas, my charge nurse gave to me: Six bowel resections, 5 C-Sections, four cataracts, three appys, two shoulder scopes and a surgeon in a good mood. (this is not trending well)

On the seventh day of Christmas, my charge nurse gave to me: Seven hip revisions, 6 bowel resections, 5 C-Sections,  4 cataracts, 3 appys, two shoulder scopes and a surgeon in a good mood. (well, at least the surgeon is in a good mood)

On the eighth day of Christmas, my charge nurse gave to me: Eight Septoplasties, 7 hip revisions, 6 bowel resections,   5 C-Sections, 4 cataracts, 3 appys, 2 shoulder scopes and a surgeon in a good mood. (I must’ve been bad this year)

On the ninth day of Christmas, my charge nurse gave to me: Nine bladder tumors, 8 septoplasties, 7 hip revisions, 6 bowel resections, 5 C-Sections, 4 cataracts, 3 appys, 2 shoulder scopes and a surgeon in a good mood. (Santa, am I getting coal?)

On the tenth day of Christmas, my charge nurse gave to me: ten fractured ankles, 9 bladder tumors, 8 septoplasties, 7 hip revisions, 5 C-Sections, 4 cataracts, 3 appys, 2 shoulder scopes and a surgeon in a good mood. (Okay, who told Santa about that time at the holiday party?)

On the eleventh day of Christmas, my charge nurse gave to me: Eleven breast reductions, 10 fractured ankles, 9 bladder tumors, 8 septoplasties, 7 hip revisions, 6 bowel resections, 5 C-sections, 4 cataracts, 3 appys, 2 shoulder scopes and a surgeon in a good mood. (Or the time at the 4th of July picnic?)

On the twelfth day of Christmas, my charge nurse gave to me: Twelve carpal tunnels, 11 breast reductions, 10 fractured ankles, 9 bladder tumors, 8 septoplasties, 7 hip revisions, 6 bowel resections, 5 C-Sections, 4 cataracts, 3 appys, 2 shoulder scopes and a surgeon in a good mood. (Make it stop!)

On the thirteenth day of Christmas, my charge nurse gave to me: the day off. 

Yeah, right.

On the thirteenth day of Christmas, my charge nurse got from me: my resignation and a California birdie.

Is there anything prettier than a red and white meringue cookie?

Well, I made them this morning and they are very pretty.

The theme for the month is holiday.

And I will be adding these to my holiday rotation.

And maybe exploring other flavorings.

ooh, I wonder if I can do a jalapeno meringue.

I’m kidding.

Mostly.

I’d never made meringues before.

Not even sure why.

Apparently they are very easy to make.

And they are.

Have you ever been faced with an unfamiliar task and you’ve put it off and put it off and put it off and then you do it and it was one of the easiest tasks you’ve ever done?

The task had grown in complexity in your head until it consumed your waking thoughts and filled you with dread?

Those are meringues for me.

I had heard they were easy.

I was just afraid of having a sticky batch.

Will they turn out sticky because it’s too humid?

Will they turn out flat?

Will the swirl be pretty?

No, no and yes.

Not sticky at all, only as flat as I made them, and the swirl is very pretty.

What else can I meringue?

Once I have overcome this task that has been on my head all week long and I was dreading it and it wasn’t even that bad, what else can I accomplish from my to-do list?

I think we give ourselves mind blocks.

We are our own worst enemy, after all.