Gravity is a stone bitch.

Saturday there was a little boy with a both bone broken forearm.

This kid was much more composed than the one two days earlier.

He was invested in the process and interested in what we were going to do to him.

He had an IV which always makes it better.

Prep went smoothly.

I called PACU in as soon as I got him to prep area.

The booking sheet said it was the left arm.

So I brought the c-arm in to the room and prepared it on the left side.

Booking sheet was wrong.

That’s okay, we can roll with the punches.

We sort out all the fiddly stuff: correct consent, H&P, site marking, and head back to the room.

As the anesthesia team was hooking him up to the monitors, in preparation to go to sleep, and he was still behaving remarkably, I decide to step aside. To the phones to get x-ray into the room so we can set this kid’s arm and go home.

Less than 10 feet.

And, on my way to call radiology, the c-arm behind me.

I trip on the power cord.

Take a moment to savor the irony.

I trip over the c-arm on my way to call x-ray.

Down I went.

My knee hit the floor.

My face hit the trash can.

My glasses spun off and hit the floor.

I’m sure there was a loud crash.

In that moment after a fall, you think, this is gonna hurt.

But it doesn’t.

Not yet.

The orthopedic surgeon and the PA came over and hovered over me as I got my knees under me and snatched my glasses up and put them on.

I patted my face,

Numb.

I ran my tongue on my teeth.

Intact.

I stood up, despite being told to sit down.

I continued to the phone.

And called radiology.

And went back to the kid’s side.

Despite all the looks from the four men in the room.

We had a case to do.

The kid was depending on us.

During our 4 minute closed reduction, the anesthesiologist went to PACU and got me an ice pack. Bless him.

After the cast was on but before the kid woke up, the orthopedist mopped the blood off my cheek and put a bandaid on for me.  Bless him.

The kid woke up and we took him to PACU and he went home 40 minutes later. With his blue cobaned cast. And a wave at me.

Advil in my future.

Plus the incident report.

No biggie.

I just terrified a 6 year old.

Who had broken her wrist in gymnastics.

I got the call about the case and alerted anesthesia.

And then, as is my custom.

I walked over to the ED to collect her so we wouldn’t have to wait on transport.

I walked into the room, mom and dad hovering over the small, thin girl in the gurney, still dressed in her practice leotard, brother playing something on a hand held device.

I smile brightly and say, as I usually do, “Hi, my name is Kate and I am going to be your surgery nurse tonight.”

The little girl in the bed, looking at me with big. big brown eyes?

Promptly burst into tears and wailing “I don’t wanna have surgery. Why is she here?”

Dad looks at me, back straightening as I watched, as if I was a threat to his child, “Surgery? What surgery?”

Um, thinking fast, still smiling, warm blanket that I had just retrieved clutched to my chest, looking from mom to dad to mom and to brother and to dad again, “They didn’t tell you about surgery?”

Pigtails bobbing, she shook her head violently, tears streaming down her cheek. “Nononono!”

Me, trying to be soothing, “I spoke to the doctor who’s going to fix your arm so it doesn’t hurt.”

Dad, a bit belligerent now, “Which doctor, we’ve not talked to anyone about this.”

Me, “I got off the phone with the orthopedic surgeon not 5 minutes ago and then I came to get you to whisk you away on the magic gurney ride. So you can meet the anesthesia team and the doctor before we go to the operating room.”

Cue more wails from the 6 year old. “I don’t wanna go to the operating room.”

Mom, stroking her forehead, “It’s a procedure to make your arm better.”

Me, trying to chime in something soothing, “No sharp objects at all.”

Well, that was the wrong thing to say.

Wails.

I cover her with the blanket and bring up the side rails. And I say, briskly, “I am going to take you to the pre-procedure area so you can meet all the other funny people in blue. Mom and Dad and brother are coming with us.”

And away we went, wailing, and tears, and brother coming up from behind, the tinny music of the game a counterpoint to the tears.

You must have courage to be a healthcare worker in the OR.

You must have courage to tell a doc what no, he shouldn’t do that.

You must have courage to tell your coworkers that no, they shouldn’t do that.

You must have courage to say no when you really don’t want to but you are being pressured.

You must have courage to tell yourself no, that would not be wise.

You must have courage to tell your boss when things are going awry.

And, you must have courage, no matter who  you are, to write up a surgeon for using the device in a manner it was not meant to be used.

You must have courage to back up the rep when they are telling the surgeon they are doing it the wrong way.

Courage.

It sometimes takes many voices to make a change but it should start with you.

I got a text today from the college.

Even though I had set up a payment plan so that I would not be in arrears before the scholarship money was dispersed and I had already paid $800.

I did not do it properly.

Today’s text was that I would be dropped from my classes for the semester unless I ponied up the entire amount.

I have scholarship money but it is hard to access.

I do not want any further delays in my MSN.

So I paid.

I asked my contact at the college what was up.

She’s the one who told me that I didn’t do it properly.

She had nothing to say about the scholarship money.

Or about the $2000 from a student loan that went missing after I tried to apply it to Spring semester tuition bill.

Um, why is it difficult.

Do you like torturing students?

Ugh,

Again with the weekend cases with the tech that I don’t care for.

To amuse myself, and to keep a civil tongue in my head, I began listing, also in my head, all the adjectives that embody this guy.

For no apparent reason I started with O.

Obstinate.

Obstructive.

Only out for his own sake.

Obstreperous.

I could go on.

This amused me and let me finish the case without blowing my top.

Especially after he put his dirty specimen cups and culture swabs on the metal table next to the “chart”. Without waiting for stickers, without care for the hand-off process that keeps the patient safe.

Obdurate *swear word*.

 

TedX is coming to my city.

This is a branch of the TED talk.

Today was the last day for submissions.

To challenge myself I submitted an application about shared governance and engaging nursing.

I have not told my employer.

I have not told the others on the council.

This may not work.

But what if it does

Today a nurse came to me and told me, proudly, that he’d built the flat top table with the help of the day charge. Because his doctor would need it for his tibial plateau fracture, his last case.

I had already written the instrument list and I knew that there was a case that required the fracture table that he’d just taken apart. And it was the case before his tibial plateau case.

The nurse’s face fell a bit when I told him the fracture table would have to be rebuilt. Because the hip pinning required it.

Then his face cleared.

“That way you can watch me build the fracture table to make sure I did it right.”

He didn’t want any prompting.

I told him I was there to lend a hand.

He did great.

That tech that drives me crazy?

Pretty much drives everyone crazy.

Good to know that I am not alone.

I know that he is actively working on the new weekend call tech.

Telling her that they can absolutely switch shifts.

That she can work Wed, Thur.

And he will work Fri, Sat, Sun.

Only one thing wrong with that, sunshine.

Those are two different shifts.

Which I told  you when you asked.

There is no guarantee you would get a third day during the week.

Because the weekend tech has to ask for extra shifts.

And the surgeons whose rooms you’ve been kicked out of?

They are on call those weekends too.

How is that going to work?

And don’t tell me you will call the call tech to cover those cases.

No.

Just no.

You cannot arrange the whole universe to suit you.

And, there would be no one to make sure that you were doing your job on the weekend.

I’ll make a case against this.

I will make it succinct and persuasive.

I just hope it works.

 

Care before Computers in my new mantra.

They updated the electronic health record for the system this week.

Sunday went fine.

Monday and today, not so much.

They are still finding things that are broken.

Today endo was in a tizzy because they couldn’t pull the patient in to their prep room and they wasted ninety minutes trying to figure it out.

I told them to just do the case on downtime.

Because what was important was the patient getting the care they needed.

The charting could be done at a later date.

The case needed to be done now.

And then I spent ninety more minutes on the phone with support trying to get them back to being able to chart in real time.

I did this so they could do the case and make the patient feel better.

Would do it again.

As I alluded to yesterday I have two rules.

These are rules that I abide by.

These are rules that I would like my coworkers to abide by.

These are rules that I would like my bosses to abide by.

The first is be fair.

This was a rule that was given to me by the leader who gave me the job of the staff schedule.

I was to be fair.

I added that rule to my internal rule book.

And I adapted it as a leader myself.

Be fair.

You’d think the second rule would be a no brainer, I certainly did.

I was wrong.

Don’t lie.

Always tell the truth.

Sometimes the truth hurts.

If  you get found out in a lie it will rebound on you so fast.

And, also, lying makes you untrustworthy.

There is a meme I have on my Pinterest account. On my this is me board.

The meme says “Expect blunt, honest answers. If you don’t want the truth, don’t ask”.

This is so, so, so very true.

If you ask I will tell the truth.

And I expect you to as well.

Now I will e-mail my boss about what transpired yesterday, now that I’ve blogged about it and calmed down some.