Um.

This is too many digits.

For America.

This is too many digits.

I could not even begin to parse this return number on my pager.

I believe 786 is Miami.

But this is 768.

The only thing to do is to hope they realize their mistake and page again.

Oh, listen.

They paged again.

And this time the return number is 768.

I will learn who this is when they call the nursing supervisor and complain that they didn’t get a call back.

And, when I go in to do the case, I will show them the botched page.

Both of them.

Every year I write this disclaimer.

I believe in protecting patient’s and staff privacy.

I do not include details that make it clear or easy to figure out which patient or staff member I am talking about.

I do not use names.

And if I do, they are changed.

I change ages.

I change gender.

I change details such as which limb is fractured.

I change details such as which surgery is performed.

I change a lot.

So that, if you knew where I worked, you could not figure out who I am talking about.

I discuss issues that impact healthcare broadly.

I do swear sometimes.

But mainly to make am emphatic point.

Sorry, mom.

The post-it reads ‘that phrase that makes you incandescent with rage.’

This is a phrase that is used sometimes as a catch all phrase that means don’t hurt me, I’m just relaying a message.

Yeah, and your message is crap.

This is a mealy mouthed expression that means nothing.

One of my least favorite trigger phrases is just making sure.

Usually said with a hand up or a shrug.

No, no you are not.

You are ensuring my continuing obedience to whatever crack pot idea you have.

That is the phrase you use when nothing else comes to mind.

When you know very well that there that the job has been done.

And done well.

But you need to make sure (air quotes).

Because you are controlling like that.

Nails on a chalkboard.

If I could I would consign the phrase to Mount Doom.

With the One Ring.

And if you don’t get that reference I weep.

According to several geek type movies in recent years, hope means different things.

In Justice League, Superman explains to Lois Lane that the stylized S on his breastplate stands for a Kryptonian word that means hope.

And we all know that Superman is from Krypton.

And in Rogue One, Jyn Erso states that rebellions are built on hope.

And everyone knows that the group standing up to the Evil Empire is the Rebel Alliance.

I mean, the name of Star Wars Episode III is a New Hope.

And in the vein of dispatches, which are communiques from the front line, and the name of this blog, there is a podcast called Hope from the Front Lines.

About caregivers of color and their stories of struggles, and strength.

I am so tired of the word resilience.

Yeah, yeah, there is a lot of resilience going around in healthcare.

We have little choice.

Instead of resilience, which is the ability to recover quickly from difficulties, according to the dictionary, I want to have hope.

Hope that this pandemic will end with a whimper.

Hope that those who are resistant to the vaccines, for whatever reasons floats their boat, fear, oppositional defiance, whatever, will embrace the vaccines as the way out.

Hope that 2022 will not be as bad as 2021.

We have no choice.

My personal mantra is the only way out is through.

Let’s get started.

This is the final Cookie Thursday is a Thing for 2021.

I had a poll on the board in the break room.

And people chose Chex mix over cheddar triple pepper thumbprints.

Okay.

It has been quite the year.

I made cookies for nearly every week.

Except for the week I was in CA.

Or one week I was on vacation.

Cookie Thursday is a Thing turns 7 next week.

I think, time is fluid.

I mean I just got married a couple of years ago.

Just kidding, it’s been 23 years.

Eek!

Seven years of nearly weekly cookies.

Hmm.

In the next year I will be expanding the Cookie Thursday is a Thing as a morale booster to other departments in the hospital.

Why and how?

Because I have 40+ hours to fill a week.

And after 7 years I think the department can share.

I think I will choose the emergency room as the first recipient of a Cookie Thursday is a Thing batch.

Since the beginning this was an afternoon/evening shift endeavor.

And so it will remain.

I hope to deliver the cookies by 1400 on Thursdays.

I probably should tell the managers what I am doing.

The theme months will continue.

And I began 2021 with a booze cookie month.

And since 2021 has been so awful I will begin 2022 the same way.

Hopefully a reset.

Because, according to my coworkers who are confused by the fact I don’t drink, booze makes it better.

And there are still so many alcohols to explore.

I want to do a rose wine cookie.

I hear the millenials loves rose.

I want to do a vodka cookie.

This one’s plan is secret.

I want to do a port cookie.

I should check the bar.

In September 2019 I fell in the OR.

I tripped over the c-arm cord.

I face-planted into a trash can.

This was a call case.

The only people present in the OR was the surgeon, the anesthesiologist, the CRNA and PACU was on their way in.

The patient was under 6.

I was not going to let a little fall stop me from giving care to this child.

Although all the others, all men, urged to me to sit down and take a break.

I looked at them, pointed at the child we had JUST put under general anesthesia and said there was no time.

Everyone turned to the patient and the case began after we all did the pre-incision pause.

The anesthesiologist went and got me an ice bag.

After the case the surgeon steri-stripped the small wound on my cheek.

Huh, apparently I was bleeding.

The take-aways were

1. I did not hit my head on the corner of the desk. This would have been infinitely worse and likely fatal.
2. I did not break my glasses
3. we were able to give this child a safe surgery, circulator injury not-withstanding.

After the case, the bruising was already evident on my cheek and on my neck.

Blood complies with gravity rules, after all.

Over the next 6 hours I developed a black, black bruise from my cheek where I had impacted the trash can to my clavicle.

It hurt.

Duh.

The cut that had been steri-stripped was a vertical slash just distal to the cheekbone.

See, I could have hit there and broken my face.

After the pain and the swelling and the employee health visits and the x-rays I was left with a stabbing pain in the left temporomandibular joint, an urge to scream when I sneezed, and a new dimple.

Exactly where the cut had been.

There was a palpable knot of tissue near my chin.

It’s still there.

I went back to employee health in December 2019 and asked them about the new dimple.

The employee health nurse said it was swelling and would go down.

I intended to follow up in three more months.

But we all know what started happening in January 2020 and February 2020 and so on.

I was not going to go back to employee health.

I am quite sure they had their hands full.

At my latest dental appointment I was informed that three fillings were breaking down, as they were old, and they would need to be replaced.

They were all on the left.

I decided to get all three done in a fail swoop.

Why wait?

In a marathon appointment that took 2 and a half hours the fillings were removed and replaced.

I was warned there may be some pain.

I can handle pain.

But two weeks later there is still pain.

My teeth don’t hurt.

The new fillings are fine.

My temporomandibular joint on that side is killing me.

Just like it did after I fell in September 2019.

It took months for that pain to go away.

And I had to be careful chewing.

Same.

I felt dismissed by employee health two years ago.

And I am sure the pandemic made it worse.

And we are in the Omicron wave now.

I am still going to email employee health and ask for guidance.

I’ll probably be told that the file has been open too long and they closed it.

What then?

It has been three weeks since I upended my life to start this call lark.

During the busiest month of the year.

Is it any wonder that I do not know what day is it?

I missed one of the meetings I am keeping.

Why?

Because I thought it was Monday.

Nope.

It’s Tuesday.

Sigh.

It has also been the run-up to Christmas.

And Christmas itself.

And my baby sister’s birthday.

In a three day span.

I am feasted out.

I am peopled out.

I am surrounded by all the work I wanted to have begun in this new call lark.

Yeah, no.

I have seen the week between Christmas and New Year described as a liminal week.

This truly is a transitional time.

I am bound to get my feet underneath me.

Sometime.

Right?

New plan.

Break down the big projects into littler ones.

Wednesday, 12/29 I will start my application to one of the schools am considering for my PhD.

Wednesday, 12/29 I will work on my LinkedIn page for this blog.

I am so used to shoe horning projects in around my work schedule, never mind call shifts.

No wonder I think I am floundering a bit.

So much free time.

Time to get serious.

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.