I just finished my shift, with helping prep a lap appy patient. Everything marched out as it should.

Surgeon calls to book a case.

I text the anesthesiologist and the anesthetist that there is an appy to do.

I call the night call team in.

I call and get report from the ED.

I go and get patient.

The night nurse arrives and I tell her to get the room ready, I’ll prep the patient.

The evening tech is opening the case. We both can’t leave until the night team is here.

I begin prepping patient.

Realize I hadn’t yet had a reply from anesthesia.

I call anesthesia, both of them. And inform them there is a lap appy for Dr. X.

I continue prepping the patient.

Surgeon has not yet arrived.

Anesthesiologist arrives to interview patient. He is perturbed that the surgeon is not yet on site.

I inform him I had spoken to the surgeon thirty five minutes before when he called to book the case.

I finish prepping the patient.

Surgeon has not yet arrived.

I walk over to the OR to inform them that the patient is prepped, consent has not been obtained because he hasn’t talked to her yet, and the surgeon is not yet here.

The night nurse and I walk out of the room and toward the patient.

The anesthesiologist confronts me about being called too soon, as his part only takes a couple of minutes and the patient seems healthy.

I change my posture to that of PARADE rest, hands clasped behind my back, legs slightly apart.

I acknowledge his feelings. And remind him that he has asked me in the past to contact him immediately upon notification of a case, even if it is the middle of the night and the case isn’t until morning.

He informs me that what I am talking about and this patient is apples and oranges. And that sleep is precious and he could’ve had 10-15 more minutes of sleep. Unsaid is the how dare I?

I refrain from reminding him forcefully that the previous case he’d fussed about not being called and woken at 0200 was also a lap appy on a very similar patient. Out loud I say nothing.

He leaves the substerile room the three of us had been in.

I shoot the night nurse a look.

We continue toward the prep area.

We are now in the hall outside of prep.

Anesthesiology reminds me again that sleep is precious and he has 26 more years of this unlike some of the other anesthesiologists who are closer to retirement and he would prefer to sleep as long as he can.

I say nothing.

Anesthesiology informs me that he doesn’t like group texts, because there will be an informative text and six acknowledgements. And he’s afraid an urgent text will be missed among the inconsequential responses.

Anesthesiology informs me that he does 2 call shifts a week and it’s a lot and he needs all the sleep he can get and he has 26 more years of call shifts.

I inform him the only group texting I do is to both members of the anesthesia team, him and the anesthetist, including myself in the number.

He says I don’t know what the answer is and goes to the dictation computer to sit down.

I turn to the poor night nurse who is witnessing this and tell her that I was surprised the surgeon wasn’t at the hospital yet, as I’d spoken to him over 35 minutes before.

She says that when she spoke to him, because she had answered his page, that the surgeon said he would see her in a minute before they hung up.

With my eyes I say sorry.

I bid them both goodnight. Hang up my work phone and go the long way to the locker room so I won’t be a visible target.

I’m alone in the locker room and I take a deep breath.

I am upset.

I change my clothes and get ready to go home.

What I don’t do is go back out to the anesthesiologist and inform him that he may have 2 call shifts a week, but I have to work with a different anesthesiologist every evening and I do this five fucking nights a week. So sorry about his two.

I don’t inform him that I do a group text of myself and the anesthesia team because if I had to text each separately it would double my work. And both the anesthesiologist and the anesthetist would ask if the other had been informed, which I would have to reply to separately again.

I don’t inform him that I didn’t have to call him myself, that I could’ve had the nursing supervisor do it and she would have called him when I called her, after talking to the surgeon, instead of when I had the patient in prep.

I don’t inform him that I also have 26 more years of this bullshit.

As I am in my warming car, I text the night nurse how awkward that was and I tell her to have a good case and I would see her on Monday.

I am still upset.

 

 

Murphy is an entity that lives in the operating room. Whatever can go wrong will.

Who know that Occam did as well?

Occam’s razor?

The entity that the simplest answer is usually the correct one?

Yeah, he lives in the OR too.

And the simplest answer is usually that there needs to be more work done and less people to do it.

Um, hi.

I have taken a wee hiatus because of reasons. Mostly because I have been working 60 hours a week, plus call for months and I am tired. But the huge project this is related to is FINISHED and I’ve now got some breathing room.

Also I got a C in a class and I’ve had to take a semester off.

This has never, ever happened to me.

Other things are happening in real life that are directly related to me being careless and I’ve been dealing with them.

I am going to restart the Friday, Sunday posting.

If it kills me.

I got a C in a class.

I’m not sure how to react.

This has never happened to me before.

The class was very hard, with a lot of moving parts that I frankly had no time for.

So, I deserved the C.

Which has never happened before.

But a C in masters land is not passing.

It kicked me out of the program.

The good news is I can go back on the next class cycle.

Which doesn’t start until January.

I’m still a bit overwhelmed.

And ashamed.

And not sure how to fill the four months off, one of which I’ve squandered on 55 hour work weeks.

 

I’m floundering a bit in school. It’s not that I am drowning in the work. It’s that I am drowning in my own apathy. I know that I should be doing homework before the day it’s due. But I can’t seem to care.

That is unfair to me.

It’s not that I don’t care.

It’s that I’ve only got so much energy a day and sometimes I want to relax and not think about work or school or call.

Saturday I worked 10 hours. The rest of the time I slept and did some much needed household chores.

Thankfully, next week I only have one meeting and that’s on Monday.

Of course, there is also the annual school drive to plan and I can’t get anyone else excited about it. And some of our coworkers depend on it.

Plan for the week ahead

Sunday: rest and relax and finish bookclub book. Do reading for this week. done with this

Monday: up at 0600- work on homework for this week, 0830 leave for my four hour meeting 1 hour away, 1430 or whenever I get done work my usual shift. Work on homework.

Tuesday: up at 0800, library for books that I don’t have time to read, homework until time to work. Set up parameters for school drive. Work at 1430. Turn in half of homework.

Wednesday: up at 0600, turn in homework by noon, nap before work at 1430

Thursday: response to discussion post from my classmate. Work and bookclub.

Friday: begin work on next week’s homework. Work.

Saturday/Sunday: no call. yay.

The only way out is through. The only way out is through. The only way out is through.

I had a surgeon become absolutely unglued yesterday. Not at me, or not just at me.

The problem, as he perceived it: the transporter was late bringing down his patient.

His solution: not offer to go get the patient with me, no, never that. But instead to call the supervisor up and browbeat and threaten to call the VP of the hospital.

The Situation:

Arrived at hospital at 0901 for 1000 case.

0907: Called to the floor for report, was given the report. Nurse said she was going to ask anesthesia about giving him some medication.

I gave her the number, and went to pick case.

0915: put in for transport.

Went to open case and prepare room.

0940: am standing in pre-op waiting for patient. Surgeon shows up and blows his stack that the patient wasn’t yet down from the floor.

0941: surgeon calls supervisor and threatens and blames and generally raises hell.

0947: patient arrives in pre-op. I then get him ready.

0955: we roll back with the patient to do case.

As I find out later when I called the supervisor to explain. She is my hero: go ahead and call the VP.

How many guesses do I get that I will be asked to explain on Monday?

Sorry for the 2 week hiatus, clinicals and work and opening a new OR means 16 hour days for me.

Lesson learned the last eight weeks.

Hard lesson.

Upon the opening of a new OR planned for June, life is a little like “If you give a mouse a cookie.” If you plan to open an OR, you have to make sure you have all the furniture ordered early, and once the furniture is in the small details have to be worked out, glove boxes, desk placement, etc. And once the small details have been worked out the OR is opened for business. But there are still a hundred and one details to work out.

The requirements on my time went through the roof. And I wasn’t super involved in the planning or the buying of things. But the organization of the room and the cabinets? That has me written all over it. And then the reorganization of the equipment pieces in lines that I know aren’t going to last a day. And then the reorganization of the former occupants of the supply room that was currently the new OR.

And the 75 hours of self scheduled clinical to be done over fourteen days. Essentially I worked from 0530-2300 for two weeks straight. Ugh.

But self care is important and I’ve had myself a massage, and a pedicure and dinner out.

But next new OR we have to open. I will be taking the quarter off of school.

How does your hospital deal with annual education that leads to the verification of you skills?

At my hospital, they do a massive education push with touch stone stations on a three day stretch where we practice the skills. Which is useful. Practice makes perfect.

But nursing isn’t perfect.

And neither is healthcare.

Nursing is doing the best care, at the best of your ability, at the top of your license so that the patient gets better, if possible. And if they can’t get better, the patient is kept as comfortable as possible until the end.

Is that too much to ask?

Whilst keeping everything sterile and clean as possible.

Because if you’ve contaminate the field at the outset, anything you then touch is contaminated, the germs don’t go away.

So, yes, it is useful to keep all the skills sharp, including sterile technique.

Which can’t be taught quickly, it’s has to become ingrained.

This is when a word can change the vernacular of a place and can be embraced by both shifts. And the second evening shift phrase. If you can call a single word a phrase.

People.

People is perfect.

It is a safe for work swear word.

Like fuck it can be many things. A noun, an expletive, an adverb, and a verb.

It is useful when you want to swear but you can’t.

It can be used to express disdain, anger, disgust. PEOPLE

Don’t like what someone did. PEOPLE

Can’t believe that your boss is asking you to do that again. PEOPLE

Express too many reps/surgeons/tech/that strange hanger one. PEOPLE

“People!”

You have to pop the ‘p’s though.

Okay, enough of the gloom and doom and hatefulness that is my life the last month.

Evening shift sayings of the OR.

Oh, yes, this is a thing.

Did you know it is possible to add words to the common vernacular in an enclosed space?

Oh, yes, this is possible.

The first one I coined was after I noticed a uni knee tray in the basement on a table. I had just come on shift and I was pulling cases for the next day. I finished pulling all fifteen of the cases and went upstairs to find something else to do, because evening work is never done. And the manager, assistant manager, sterile processing manager, and day shift charge nurse were all in a tizzy. Multiple trays were open, the rep was pacing around, the assistant manager was on the phone. I casually asked what was up, as you do, feeling my way gently through the emotional crowd.

Elle, the assistant manager, snapped, “We’ve lost a tray, can’t find it, not in SPD, not on the shelf, it’s nowhere and it was will thousands of dollars to replace it.”

Me, wondering if it was the tray I’d seen plain as day on a table in the basement, “Which tray?”

Elle, “A medium uni tray.” She then went back to her conversation.

Me, nonchalantly taking the elevator downstairs and retrieving the tray from the table they would’ve had to pass umpteen times in the day during their franticness and hysteria. I brought it upstairs, handed it to Elle, and asked, “this one?”

You would’ve thought I had paraded naked in the core.

Elle grabbed it, “Yes!!! Where did you find it?”

Me, “On a table in the case makeup section, near the SPD door.”

Elle, clutching the tray to her bosom like a tragic heroine, “How did you find it?”

Me, shrugging, resisting telling them that they could have found it at any time, “Evenings is Magic.”

And, like that, the phrase was born.