I am going to break this down for you. And bring you along with a normal case. For ease, I’m going to call it a lap appy, or a laparoscopic appendectomy. This is considered a bread and butter call case. By that I mean there are a lot of lap appys performed per week in my OR. At least 5. One memorable summer when we still doing sterrad for the scopes, we did 100 in a month.

The room is dark and all is still. Suddenly a beeping sound splits the quiet. A hand emerges from the covers and fumbles with the pager and presses a button to make it stop. Mindful of the other sleeper, the light is not switched on. Glasses are put on, phone is grabbed, and I take pager and phone into the office to start the cascade of the case.

Looking at the display on the pager, I answer the page. If it is a surgeon I will be logging at the same time I am calling back. If it is the nursing supervisor, I call them back.

Regardless of the number, I call them, identify myself and say, “I was paged.”

There is an appendix in the ER. The surgeon who called wants to cut skin in 30 minutes.

This is the first point of managing expectations. I am at home, I get a 30 minute response time. This is a lap appy and easy to pull. I tell surgeon that it usually takes an hour from point of contact but I will try for 45 minutes. Because I live the closest to the hospital and I’ll be there in 10 minutes.

All of this is happening as I get dressed. And put on shoes. I clip the pager to my shirt.

I grab keys and wallet, probably still talking, and unlock the car. I hang up with the surgeon and immediately call the scrub tech if I know who it is. This is because the nursing supervisor will have to make all the phone calls and the scrub tech is the last one they make.

After notifying the scrub tech, I tell them to drive carefully. Always. There have been 2 accidents on call here in NC and a close friend was killed driving home after a night shift in CA.

I am at the end of the street, and I call the nursing supervisor. I tell them that there is a lap appy and I give them the details: name, surgeon, and, most importantly, I tell them the projected time of the surgery.

I live 5 minutes from the hospital. Especially in the middle of the night with no traffic. And I arrive soon after hanging up with the nursing supervisor.

I badge in to the department, grab scrubs, and move to the locker room. I wear easily changed clothes. I have been known to wear my jammies in, especially if it is the middle of the night. I grab socks from my locker, and a hat. I get dressed.

On the way to the OR core, I grab a surgical mask and put it on.

Sometimes I run into the nursing supervisor here. Most often I do not.

I grab a department phone and log in. Concurrently, I am logging into the electronic health record. I double check I know which room and patient name I am calling for report from the ED.

I call the ED and ask for the nurse taking care of patient A, in bed 65.

Since most of the information is already in the chart I scan it while I wait. I check lab results, especially HCG (pregnancy test) if the patient is female and of child bearing age, which is 12-55 in my hospital system. I look at what medications they have been given. When I get the nurse on the phone I only have 2 questions- are they lucid, and do they have family with them.

What this boils down to is can they sign consent?

If they are not lucid, and there is no family at bedside, there are many steps I have to do to ensure proper consenting is done.

But this appy is a 45 year old male that is alert and oriented x 4 and none of that applies. But I have to be aware of it because sometimes it all applies.

After getting off the phone with the ED I go down to the basement where the instruments and supplies are kept. Long ago I memorized all the appy cards. I was not kidding when I said that this case is one of the most common.

I am still the only one in the department when I come back up, case picked and instruments acquired. This is not unusual as I live the closest.

I leave the table with the case on it in the surgical room and make sure the video tower is present and on before I leave the case to be opened by the tech while I am getting the patient.

Entering PACU, I turn on all of the lights. And get the supplies that I need for the patient: the consent for surgery, the consent for anesthesia, and the sequential stockings that will be used during surgery.

I walk down to the ER.

I wave and say hello to the nurses and techs at the desk as I pass by.

Entering ER room 65, I glance to ensure that there is a family member present. Introducing myself, I begin to unhook the patient from the IV, and monitors. I begin questions that are geared toward what I know is on the pre-surgical checklist that I will be completing when we get back to the PACU, which is where the patient is starting and finishing with OR today.

I begin with name and birthdate that I ensure matches my expectations and the armband. I ask about NPO status, implanted metal such as a total hip or knee, any screws, any allergies. i was mocked by my trainer in CA about taking more than a minute for immediate survey. This is the immediate survey. This is when I inform them that the lap appy is the most common surgery I do at night.

I assure the family member that there are surgeons and the anesthesia team to meet and they will be accompanying the patient. I will take them to the surgical waiting room after the patient has gone back.

I chat the entire way back to the PACU. I don’t want the patient to feel self conscious in the gurney, being trailed by the family member.

Entering PACU with the gurney, I invite the family member to sit while I get a warmed blanket. I caution that all the stools have wheels and please be careful.

While I was getting the blanket, I glanced into the OR and made sure that the scrub tech was opening.

After putting the blanket on the patient, the OR is about 5 degrees cooler, at least, from the ED, I pull out my phone to alert anesthesia that the patient is in PACU. I send the text after changing lacy back to PACU.

My million dollar idea is a hospital specific auto-correct. Medical words are not in the auto-correct data base. In my head, I would never have to correct my text messages and names of staff would be entered into the data base. Too much time is lost correcting texts. Feel free to use my idea. I’ve not done anything with it in three years.

I digress.

I sit on the stool next to the patient’s gurney so I can do the pre-op checklist in the computer. By this I mean put in the answers to the questions I’ve already asked. While making small talk.

I can talk about lots of different things. I can talk about my husband waking me in the middle of the night once so excited that they’d announced the most likely cause of appendicitis. I can talk about how the symptoms probably started and the likely way their day unfolded. I can college sports. I can talk regular sports. Whatever the patient needs to feel comfortable.

Usually it is the cause of appendicitis.

By this time I have put down all my answers that I’ve already gotten. And we are at the sleep apnea portion of the checklist. I usually tell them the story of the cat snoring on my back and waking me up in the middle of the night. This always gets a laugh. I ask him if he’s had a sleep study or been diagnosed with sleep apnea. I ask about snoring, and sleepiness in the middle of the day, blood pressure medications. the reason this is so important is because this can have down the road impacts for anesthesia. EVERYONE gets screened.

I write out the consent, using the order that had been put in by the MD. Or hold it for them to fill out if it has not.

Anesthesia is here by this time and the ologist is speaking to the patient. I pass them the anesthesia consent and excuse myself to go count the instruments and soft goods with the tech. And probably alert the CRNA that anesthesia is with the patient as they are in the room getting ready.

By the time I get back to the PACU, the ologist is just finished their portion and is signing the anesthesia consent. I collect this from them as I will have the patient sign both at the same time after they are spoken to the surgeon.

And the double doors the PACU open. It has been 45 minutes since I was paged and the surgeon has arrived.

He greets the patient and family and begins.

Is the OR just a training ground for adrenaline junkies?

Who doesn’t like doing the adrenaline pumping, patient’s life on the line case?

Oh, is that just me. Okay.

But I bet it’s not. (said in a sing-song cadence)

Probably one of the reasons I enjoy call so much. You never know what is coming through the door. From the ER. When the pager will go off. Or the phone will ring.

As I settle into my new role as the call nurse, I find it interesting that the rest of my life is, well, boring. I have lived in both the call world and the evening charge nurse for so long it takes more to get my butt off the couch, or out of the computer chair.

Which got me thinking about the OR and the adrenaline that a case engenders. I have no problem doing the case. Moving fast, impossible odds. And if there is another case, better yet. My brain has to juxtapose the current case and the next case and what will be needed for the next case and which room should we go in? And on, and on.

But that is lacking in my current job role. I wonder if this is what all the other call team members are going through. I have to reach out and ask.

Yeah, I’ve had my break. Many books have been read. Goodness knows I’ve needed it after working like an idiot for many, many years. But the adrenaline needed for me to do anything is missing. I would rather read than just about anything in my house.

I think routine is needed. And definitely has gone by the wayside, especially under pandemic conditions.

Oh, the pandemic.

I legit just thought of this as I am typing. Those of you who thought this blog was stream of consciousness, here is your proof. Especially Monday’s Musings.

Every health care worker I know is experiencing something after this last 2 years.

Maybe what is the matter is I’ve been living under a pandemic cloud for so long, and this has tripled what I had been doing with working so much.

I’m a bit of an adrenaline junkie. I like to push the limits, the time needed for anything. I’ve always been like this. There has always been the next deadline, the next thing, etc. Rinse, repeat.

I think all OR people are a bit of an adrenaline junkie. We get to help people, yes, but we get to exist and thrive in an atmosphere that demands more, faster.

And now all I have is time. And it is messing with my head a bit.

Time to do all the house things. School starts in 10 weeks, you know.

The post-it reads ‘surgeon singing along with Poison- Talk Dirty to Me.’

Music in the OR can take many forms.

Depending on the surgeon.

Depending on the surgical type and specialty.

It can be so loud you can’t hear yourself think. Forget communicating with the field. This is where OR sign language comes in handy. An entire conversation can be had with the scrub tech with no words being spoken. You can’t hear them anyway. But you can get them what they need.

It can be so quiet you can hear the music, but not the words. This is best for the surgeons who get distracted by the song. And insist on singing along, with choreography for their favorite songs. And every song is their favorite. And the desk wonders why we get behind.

There can be no music. This is in defense because you can’t understand the surgeon, regardless of the volume.

A shoot off of that is when to turn the music off completely. Surgery and surgeon can be bopping along to a hit when a different kind of hit takes place. This is usually when the surgeon gets into unexpected bleeding. The best thing to do is to turn down, or better yet off, the music. This is a drastic move that can yield big time effects. It lets the surgeon know you are serious, that you understand the case is going badly, and signals to the anesthesia team as well. If they aren’t paying attention, or are busy.

Type of music is key. Some surgeons bring their own, complete with speakers. Some like different music. Some have the preferred XM station on their cards. Where I worked in California, the eye doctors all listened to classical. I thought this was across the board until I moved to the South. An eye doctor was listening to rap. Whatever lets you focus, dude.

And some prefer the quiet.

All of that is okay.

If the surgeon likes music, I ask the patient what kind of music they prefer for going to sleep. Some patients have definite ideas, down to song, who performs it, even the album it comes from, not that version, dearie, I prefer the 1967 version.

I can completely relate. My favorite version of Falco’s Rock Me, Amadeus is on their album 3. The one that they used for the video. The Salieri version. Be right back. This requires a deep dive on YouTube.

Okay. Found the Salieri version but not the ones with facts. This still eludes me.

Where was I before the deep dive into my favorite music? What? I was a weird kid.

Music and the OR. These two things go together quite well. Until they don’t. And administration needs to get involved and tell the OR and surgeons that explicit lyrics are not allowed.

You know that normies do not get OR anything. What we listen to. The temperature in the room. Our humor. Especially our humor.

Music and the OR go together like peanut butter and jelly.

But some don’t like peanut butter. Or are allergic. That’s okay.

No music, low music, loud music. It’s all okay. Until you keep the other room up.

And then it’s too loud.

I imagine these posts are pretty boring. I will continue them once a month as a grand wrap up of my progress toward PhD.

Yesterday, my husband finally asked the why question. To be fair I was asking this myself. What will a PhD do for me in my current job, healthcare system? Not much is the answer. All the degrees I’ve gotten have been a defensive move toward not being able to function as an OR nurse anymore.

He was surprised by the I want to write textbooks answer. I mean, have you met me?

Class does not start in September like I thought. The school year starts August 9. The reason I know this is I looked it up as part of the research assistant grant follow up. I was chosen. This means I am indebted to 10 hours of work for a professor per week. I hope the call job continues to enable me to say yes. I have to give them an answer by the end of week.

Being a research assistant will look good on my resume. It will also enable me to teach some classes, I think, and grade. I get to finally use my MSN in a constructive manner.

But what about the great white whale of a trip? For London. If school starts this is gonna be awkward? The short answer is that yes we are still going. I immediately emailed my advisor when I realized. She said I would be fine for the first in-person day of class. It is my online elective that I have not yet chosen or signed up for. I will have access in London, and I can make-up my first day of class. It will make a hell of a story to tell my classmates.

Even with the $10k stipend, I am still applying to scholarships like mad. I joined a clearinghouse of sorts, with my professional email address. I have not gotten any, but it has only been 2 days since I started applying there. I also am applying to all the other usual suspects: AORN, NCNA, the company that credentials my CNOR, the American Nurse’s Association. I imagine I will have to also do the FAFSA.

I am also in the process of upgrading my clothes for this new reality. Many of my clothes are tired after working on my body during the pandemic. Many of my clothes are not appropriate or professional. My husband is thrilled.

I did order a professional type bag off of Kickstarter. The pandemic weighing on shipping and manufacturing I have not yet received it. Maybe by school start. I know that the boxes of bags has left the port and is on their way because I get frequent updates.

I hope the progress in May will be the completion of two more rooms in the house. I would say 3 but I am stuck for progress. I would rather read, especially since part of the letter was a book suggestion before school even starts. I am waiting on availability at the library.

I had ever intention of making these myself. I had the coconut, I always have the flour, I always have the sweetened condensed milk, and I always have the flavorings. I even got up early to make the macaroons.

But real life intervened. As it so often does.

My husband fell down the steps last year. He did not seek out help from an orthopedist surgeon, despite me telling him to, for several months. Preferring to complain about it to me instead. He was diagnosed with a frozen shoulder in December, after FINALLY seeking care. An MRI on last year’s deductible, thank you, later and surgery was not indicated. Thankful for that. Physical therapy was.

The thing about shoulders is you have to be diligent about stretches, regardless of surgery. Spoiler alert, he was not. He is a grown man and I cannot, will not ‘make’ him do things. He was diligent about going to physical therapy though. But he was unhappy about his progress. Because he did not do his daily stretches. He wanted a quick fix, and there is nothing quick about rehabbing a shoulder. I know, I’ve had shoulder surgery twice, plus a rotator cuff strain from a car accident. There is no shirking your stretches.

Compounding this he fell after making fun of me when I tripped in New Orleans. And he fell hard. And declined x-rays at the hospital that I offered. He finally went back to the orthopedist after three weeks. And was diagnosed with a non-displaced hairline fracture of the proximal ulna. Which is already healing. That’s good.

His physical therapist told him of a new treatment for frozen shoulder. One that involved breaking the scar capsule after local injection, and lubricating the joint with steroid. They do this through a saline injection that will ‘pop’ the frozen shoulder capsule and stretches. All of this is done at the doctor’s office. He was told he could drive home today from his appointment. Traffic being what it is around here this is a 45 minute drive, at minimum. The appointment was carefully made to coincide with his Thursday physical therapy appointment.

I did not think driving himself would be useful or safe. I used my baking time to take him to both appointments.

I was browsing at the grocery store near the office. This is a new one on me, one that I had heard of. I saw they had bite-size coconut macaroons on offer. I grabbed two boxes and bought them.

This kind of goes against the home-made portion of Cookie Thursday is a Thing.

But it allowed me to be present and available for my husband today.

And it afforded me a nap when I got home from these errands because I had dropped off the bought cookies earlier at the hospital. I left them in keeping with my manager.

It will have to do.

During our 10 hour drive back from AORN in New Orleans, I started thinking about what the pandemic has stolen from all of us. Now that it is waning, and deaths are going down, although it is to be determined regarding hospitalizations.

The biggest thing that the pandemic has stolen from us is time. This is multi-layered because time itself has different meanings. I read an article this week about how the pandemic has skewed our sense of time. I feel this acutely. Two summers have come and gone and we are looking at our third summer under covid. I would have thought you lying if you said we would be here now. Two Christmases, two birthdays; the list is unending.

The following is a list of what the pandemic stole from me, personally. Everyone else’s list is different, but we should still be able to grieve over it.

1. MSN graduation in 2020. I was looking forward to this, it is why I chose a hyperlocal school. And I did not get to do any of it. The only graduation I went to was for my ADN, way back in 2001.
2. In-person work with my preceptor. In person education experiences had been cancelled. I was not allowed to teach for the end of MSN project. I had to finish the rest of 150 hours as a student online doing education. Not teaching, learning. And my preceptor left the organization during the last two years and I don’t know why or where she went.
3. Many, many hours of sleep. Again, this is not solely about me. I know that many people lost sleep during the very beginning of the pandemic due to fear.
4. There was a Sherlock Holmes traveling museum in South Carolina. I had tickets and plans to go. In March of 2020. No idea if this is still a thing, or even where it has landed.
5. There was a Sherlock Holmes convention in London. This was the original planned trip to London. It was going to be great to meet other fans. This was going to be in September 2020.
6. There was a Sherlock Holmes convention in Pennsylvania. This was a consolation prize because I could not get to the other two. Surely, the acute case of the pandemic would be over. No. This was going to be in November of 2020.
7. Poster presentation in March of 2020 and again in August of 2021 for AORN. These were different posters and although there was a poster portion of the online conference it is not the same.
8. I was going to take a year off and continue to pursue my PhD. This was going to be in September of 2021. As my husband says, the pandemic year did not count.
9. To finish my PhD by age 50, I had to start when I was 46. All of a sudden I will be 47 at the beginning of this program. I will probably be 51. I will be 51 regardless, but it is still a goal I had set in my brain.
10. In 2020, I was the chair of the professional nurse council for my organization. I was chair during 2020 but over Zoom, does this count? I didn’t have to travel to a far away hospital to be chair, that’s a win right?
11. Peace of mind regarding the leadership changes they rammed through. All of a sudden any autonomy I had was gone until 1700. And how is that working out for you?
12. My goal has always been to write. I was going to take the year off from school to polish up my fiction writing. And start sending query letters out. Instead, I worked insane hours at the hospital and training to do med-surg nursing so I could offer up hours to people who did not have a lot of hours because the elective cases had gone. Unsurprisingly no one took me up on the offer. Why would they want to work evening shift, if I was working all the hours? And taking all the call because they didn’t want to.
13. My over reaching goal for school has always been to write professionally. Articles, textbooks, I’ll do it all. Again, not a lot of movement there because I had been so overwhelmed being a working nurse during the pandemic.
14. I lost money on the London trip. This absolutely deserves its own line. It was completely planned and paid for. I had no hope of recouping everything. With the airline credit, I rebought us tickets for August. And they were $2000 less. I theoretically had a credit that carried over but had to be used by March 2022.
15. My sister was going to go with us to London for her 40th birthday present. I am sad that I don’t get to share London with her, as we are both anglophiles. I put that money toward a trip to San Francisco, including hotel. We will go to Twinings in her honor. And bring her back some tea to try.

This last one is a biggie and I felt deserved to come out of the queue. I have lost good faith in my fellow man. Whoever made the response to a pandemic political should be sentenced to serve hard time in the ICU watching people die. Instead of sensibly all striving to end the pandemic and get back to our new normal, some people decided to be assholes and whine about their freedoms and embrace other people’s deaths as just a cost of doing business for living their lives as they wanted. I still struggle with this, with rage and disbelief, and I also struggle to forgive.

The United States is over the acute phase of the pandemic for the most part. This is a list of what I personally lost. I think the biggest thing is the warping of time. but I know the biggest thing is knowing that some people don’t care about the dying that is still happening. That vulnerable people are at risk. That is hard to fathom and believe.

D. E. A. D.

This has been hanging on my mind for awhile. And our inability as a society to say it. To acknowledge it even.

According to the Merriam Webster dictionary it is someone who is no longer alive. That they have ceased to exist as the person you knew. It is a noun. It is an adjective, a description at times.

As a society we dress up the word in euphemisms. Passed is one. That person has passed. To some it may be a polite way of saying dead. To me it is stark reminder that as a society we do not deal well with death.

Oh, the patient in that room had a code blue. The patient coded. Also a euphemism for health care workers. That means the patient had a cessation of heartbeat and breathing. And we snatched them back from the maws of death. Or we didn’t, but we tried.

Even the famed M&M, or morbidity and mortality, conference that hospitals do to discuss less than ideal outcomes dresses up the word. Hell, at least they address it and how to make the system better.

Are we so afraid of death that we are unable to face the realities of it head on?

Death is not polite. It rarely comes knocking and you never know when it is your turn.

In hiding the word, society makes ourselves feel better. If we don’t say it, it is not happening. But it is. No need to dress up the word that happens to everybody. To quote Benjamin Franklin “nothing is certain except death and taxes.” None of us are getting out of this alive.

It is time to have more open conversations around the word dead. Because sometimes the used euphemism is misconstrued and misunderstanding takes place. And I cannot think of anything worse.

The post-it says ‘2 super I charge nurse memories this week. 1) telling an irate CRNA to calm down 2) chasing everyone away from the desk because I can’t hear on the phone with 5 conversations going on at once.’

Yeah, this was evening shift in a nut shell.

I had an irate CRNA, who is named in the post-it note, no I will not name them. They were going on and on and on and on. About an imagined slight from the surgeon. There was no time for hand-holding and there there-ing the CRNA. There was a case to begin. I took 5 minutes and sequestered the surgeon and the CRNA as the tech and I counted and told them to hash it out. There was a patient that needed our help and I was not interested in a blow by blow conversation discussing the issue. They would have to be adults and handle it like adults. There was no other choice.

Sometimes you have to be the kindergarten monitor. I stopped short of sending them to their rooms without supper. Because patient was waiting.

Within four minutes they had the conversation they needed to have. And we could get on with the business of helping the patient.

No time was lost on this interaction and the patient was able to have their surgery.

I swear the OR desk has magnets in it. Kind of like a kitchen in a home, everyone congregates at the OR desk. Some are goofing off, some are awaiting the elevator, some are trying to work. hi, yeah, that’s me.

The phone rings and it is someone that I need to talk too.

But I can’t hear them. Because of the 5 different cross conversations going on.

In this instance I have no compunction with excusing myself a moment, muting the phone, and getting everyone at the desk away. I quick assign evening tasks that they know already need to be done and go back to the conversation on hold. With a silent desk area.

Sometimes you have to assign tasks that need to be done and, again, all adults here.

Yeah, shift work is often about being the adult in the room and facilitating talking. Or not talking as the case may be.

Or, everything I learned about how to treat people at work came from kindergarten.

I was aghast, appalled, angry at what was revealed to us at the latest shared governance meeting. People are misleading travel nurses, or any nurse or tech they feel is infringing on THEIR department. This can even be a nurse or tech from the float pool.

They are withholding vital patient information, such as report, from people who are just there to help.

It was a tale of two hospitals as explained by one of the participants in our group.

At hospital A, the flagship hospital, report was withheld from the oncoming nurse. No one was there to greet the nurse when they arrived to, again, help by taking an assignment and patient load. It was as petty as not giving needed information such as parking, or cafeteria hours, or even how to get into the department. How do you think that nurse felt?

By contrast, at hospital B the same nurse had a vastly different experience. They were helped to find parking, that their badge worked to gain access to the department, where they were greeted by the charge nurse, who facilitated them getting report and generally helped them get their feet. Same nurse, different greeting. I can tell you the nurse felt way better about hospital B.

I said that what was described to us made me want to shake hospital A.

And shake the hand of hospital B.

Are we 5? Or toddlers? When has it become acceptable to gaslight, and mislead people who are just there to help us?

sigh

Don’t make me take it back to the golden rule. Treat others like you want to be treated.

No, scratch that. The platinum rule. This is a rule that states that people are to be treated the way they would treat others. This involves having a little empathy.

These techs and nurses are just there to help. And we should let them. Healthcare has been taking it in the shorts since before the start of the pandemic.

We should all be ashamed of treating helpers this way.

Mr. Rogers would be ashamed at some of you.

This is a brief side-step in coconut month. This week is Passover, and I found a recipe that sparked my interest.

The recipe is for matzo crack. I have made it before several times using different crackers. I have used Ritz crackers, saltines, but this is the first time that I used matzo crackers. I am not sure I had never had matzo crackers.

Being welcoming to other faiths is important. This is a skill and a mindset that needs to be ingrained.

And the other recipes I found were above my skill set.

Therefore, chocolate topped matzo toffee.

Because the world is better with butter.

And chocolate.