Supply chains.

They just aren’t for Christmas presents.

Or for cheap goods from overseas.

The supply chain is also vital to the operating room.

It takes a sheer amount of stuff to run a case.

Let alone an operating room.

Back orders are a way of life in the OR.

And have been for as long as I’ve been a nurse.

We haven’t had a consistent supply of Marcaine with Epinephrine since Hurricane Maria.

0.25% or 0.5%!

Many of the supplies are made in other countries.

And the shipping backlog that is threatening Christmas affects the OR too.

Every day another supply that is short.

Every day the OR rises to the occasion and finds a way around it.

But some things are so unique it is difficult to find a way through.

There is nothing like the look on a doc’s face when you tell them that a previously common item is on backorder.

And that they will have to use a different item.

Materials managers struggle with this constantly.

I know that the pharmacy manager and the procurement manager work very hard to get us the medication that the hospital needs.

I know that the materials workers are doing everything they can to keep us afloat.

So cut them a break.

Did you know that you can add a very tiny amount of epinephrine 1:1000 to marcaine to make marcaine with epi?

Yeah.

We’ve been doing it for years.

You just need a teeny-tiny syringe.

And another nurse to check it with you.

(I strongly suggested that rule)

(We have to check insulin and epinephrine is dangerous)

My running mantra is the ‘only way out is through’.

I never thought this mantra would be applicable to a pandemic.

And assorted problems arising from it.

I only give books, pajamas, and socks for Christmas.

I’m not looking too crazy right now, am I?

Did you know that when you put candy corn in cookies they melt and t?urn caramelly

They do!

Baking tip of the month.

I wonder if it also happens in scones.

Must investigate.

Spooky Cookie month continues.

Yesterday I told the hospital wide meeting I was in that I was interested in the call shift being bandied about in the OR.

And if that happened, I would be opening up Cookie Thursday to a different unit in the hospital for one week a month.

Because we all need a morale booster.

I also decided to do a spooky hospital story a week during Spooky Cookie month.

This one is at the hospital that I am currently working.

It really isn’t old enough to have spooky stories as it has only been open for 16 years and when this happened it had only been open for 6 years but it was spooky enough at the time.

This was when I was not the evening charge nurse.

I had an evening charge nurse and he was off for the evening.

The tech and I were pulling instruments and setting up rooms when I got a call from the OB suite.

The OB suite was where they did c-sections and was 2 floors away.

They were doing a section and were in dire need of a large deaver retractor.

And the baby’s heart rate was dropping so they needed it stat!

I said I would send them one.

I pulled one off the shelf and went to the tube system but it was much too big to send in the tube.

I grabbed the portable phone and took off for the elevator.

To find it waiting for me, the door open.

I looked around and no one was in sight.

Bear in mind this was 2224.

I nipped into the elevator and went to the OB floor.

I dashed off the elevator and handed off the deaver.

Only to be told that they needed a different retractor, not the deaver they had asked for.

I left the section suite and the elevator door was open again.

This is not getting eerie.

No, not at all.

I went back to the main OR, ran inside and grabbed the newly requested instrument.

Too big to fit in the tube.

I dashed back out to the elevator.

The door was open again.

These are very busy elevators.

You have to wait nearly every time.

I brought the new instrument to OB and handed it off.

I ascertained that nothing else was needed, as it was nearly the end of shift, and was waved off.

I returned to the elevator,

The door was not open this time and returned to the OR to finish tucking it in for the night.

I have been asked to come to the section suite on multiple occasions.

Never again have the doors been open for me.

At least not when I had to go to OB.

To the ICU?

That’s another spooky story.

Imagination is not something people think about when they think about the OR.

After all, the OR is black and white,

A case or not a case.

A patient or not a patient.

I propose that imagination is very much needed in the OR.

The OR nurse needs to be able to look at a situation not as it is.

But as it could be.

The surgeon dropped the instrument that he needs to finish the case.

The answer is not to flash the instrument, but to think about alternatives for the instrument.

Because rarely is there a truly single job performer in the instrumentation world.

The OR is out of supply A.

Supply B is almost the same.

Could it work?

The suture that has been requested is on backorder, will this other suture suffice?

This is something that is coming up more and more as the supply chain is squeezed, but that will be another post.

OR 2 is in need of the specialized equipment that is in use in OR 9, what else can be used?

Or, if it truly is that specialized, how can the cases be moved around to accommodate the need?

The previous robot case is running so very late, can the next case be done laparoscopically? In order to be respectful of the surgeon’s time and the patient’s wishes.

There are only 2 scrub techs for 1700 but the rooms need 3 and there are 4 nurses can one of the nurses work in the scrub role?

This scenario depends upon the ability of one of the 4 nurses’ willingness and ability to perform in the scrub role.

Many things have to be balanced, but imagination does play a role in the OR.

To function completely as an OR nurse you have to have enough imagination to see the possibilities.

And the ability to weed through the possibilities and choose the one that will work for the particular pickle you find yourself in.

While keeping the patient safe.

And the surgeon somewhat happy (not my personal end-goal for the shift but you do you).

This past weekend was rough.

Again.

Middle of the night cases Saturday and Sunday.

Hard cases.

And I was only able to sleep in 3 hour segments.

It has happened before.

If I work too many call cases at night.

If I stay up too late doing something fun.

And I finally get a chance to sleep more than 3 hours.

My brain will go off at about the 3 hour mark.

Last night, earlier tonight.

I was awakened after 3 hours by my husband to tell me my text alert was going off.

It was “amanda from an email address and she is home alone… wink, nudge…”

block.

delete.

And now my brain is going off.

Telling me that I have a meeting in two hours.

Telling me that maybe I should be getting up.

Telling me that I still needed to get the trash together, before my meeting.

Because it is trash day.

Informing me that I am too hot in the covers.

And now I am too hot in the sheet.

And now I am too hot in the sheet with a leg out.

And now I am too cold in the sheet with a leg out.

And now I am too cold in the sheet completely covered.

And now I am just right in the sheet and the cover.

Until my husband rolls over.

Or takes a too deep breath.

And did I really finish my grad school application?

And don’t you know the trash has to go out.

And, look!

It is now 1 hour and 50 minutes until the morning meeting.

Just get out of bed already.

You can sleep on the couch later.

After the meeting you don’t have ANYTHING for nearly 8 hours.

Go on, get up.

You know you want to.

The post-it reads ‘It’s too hard. It’s too soft. It’s just right. 3 bears and a penis.’

When a urologist said the goal of every man is to work on their penis if they either of the first two problem, this struck me as funny.

If is is too hard, and has been for too long, it needs intervention.

If it is too soft, and has been for what is perceived by the man to be too long, it needs intervention.

If it is just right that is the sweet spot, pun intended.

Yesterday’s post was a stark reminder of the cost of this pandemic.

I wanted to go a lot lighter today.

And the first post-it I pulled out was this one.

It made me giggle.

At the time I was collecting OR fairy tales or OR fables for a different project.

I still am.

This one will be fleshed out (pun still intended) and added to the list.

Spoiler alert, I have no children.

My siblings have 14 among them.

I have 4 great nephews and 3 great nieces.

I was a nanny while in college.

I have also participated in the birth of many, many babies.

At my first hospital, the OR staffed the OB c-section suite.

And then, like now I took a tremendous amount of call.

Any time, any day, any shift there were babies.

And, since I lived across the street from the hospital and they knew it, I was called when the mom or baby was in trouble and the baby had to be born stat.

Last week I got an covid update email from my hospital system that reminded everyone that the CDC recommends that all pregnant people should get the covid vaccination.

No matter how little or how much they are pregnant.

It is a matter of life and death.

The mother.

The baby.

I had read of very premature births happening with pregnant people all over the world.

This is not a good trend.

A quick Google of covid complications and pregnancy brings up a thumbnail that the pregnant people who are infected with covid have an increased risk of pre-term labor and other poor pregnancy outcomes.

Poor pregnancy outcomes.

It bears repeating.

It is scary, I get it.

And heart-breaking.

And frightening.

But so is coming home from the hospital without the baby.

Because the baby is still in intensive care or worse.

Or the mother is still in intensive care or worse.

My friends and I have been talking about this.

In our respective hospitals there have been several fetal demises.

They run the gamut of miscarriages at any time before 20 weeks and all the way up to near term.

It is heart-breaking.

And my heart hurts for all those babies and mothers.

Please get vaccinated.

It hasn’t been just about you this entire time.

I am certain that someone is keeping track but not wishing to alarm the public.

Perhaps it is time to alarm the public.

I applied for a PhD program.

This was off my self-imposed to-do list for dispatches.

I applied for a program in my state.

Save on the in-state tuition.

At the nursing conference I went to (in person!) last week, I found more that I am interested in.

I’ve got a lot of read about and consider.

However, there are two, maybe three more I will be applying to before applications close for them at the end of January 2022.

I have an end goal.

I want to write textbooks.

My husband just wants to be married to Dr. Kate.

The theme for October is going to be spooky.

That can mean a lot of things to a lot of different people.

I think of dark cookies, spiders, ghosts and beasties.

We’ll see what I decide.

But today was inspired by a Pinterest cookie.

The picture showed a dark chocolate cookie with orange M&Ms.

That would have been okay.

But I instantly thought ‘Reese’s Pieces’.

And that made me think of E.T. the extraterrestrial.

And Drew Barrymore’s character Gertie trying to coax ET from hiding.

It took a minute to find Reese’s Pieces.

The last thing I saw them in was Reese’s Peanut Butter cups.

But a CRNA at the hospital said to try a gas station.

I finally found small boxes of them at a pharmacy.

These cookies were definitely a hit.

A friend of mine said that the group in the lounge voted and they were voted the best ever.

I will definitely be making these again.

Yes, another self indulgent post.

This time is about gravity.

You know, the thing that keeps us all grounded.

Facebook reminded me that it has been 2 years since I fell in the OR, during induction on a peds case.

I tripped over the c-arm on the way to the phone to call x-ray.

The irony just avalanches some days.

My left knee and tibia bones finally stopped hurting about 6 months ago and I can kneel without pain.

The newly formed dimple in my left cheek is here to stay.

I have not gone back to employee health.

They have their hands full right now.

And told me the dimple was in my head anyway.

Sure, Jan.

It still pulls when I smile too broadly.

The horrible TMJ pain is gone.

Small victories, I know.

What I remember most of that day is:

1. the anesthesiologist getting me an ice pack
2. the surgeon getting me a bandaid
3. the surprise on the team’s faces when I would not call anyone else in, um, this is a ten minute case, there is no one to call, and you’ll be done before they get here
4. the black bruising to my collar bone the next day

The OR is a dangerous place.

Sometimes for the workers there.

Last night was rough.

Again.

I know, I sound like a broken record.

I went home at my normal time.

Puttered around.

Played a little computer.

Killed a few thousand undead.

Headed to bed at a not unreasonable hour.

I have meetings on Tuesday mornings, after all.

And at 0130 I get a call from an MD.

Who wants to put a case on at 0500.

Okay.

Case for 0500.

Have to be at the hospital at 0400 to prep the room and prep the patient.

Called the surgeon at 0430 at their request as a wake up call.

Start the case.

Help the patient.

Finish case in time for the day shift to start.

Drive home.

I want a bagel but it is too late to get a bagel and make my meeting.

I was in my zoom meeting 2 minutes early.

Finish meeting.

Off to bed I go.

4.5 hours is an okay night of sleep, right?