It is with a sigh of profound relief that I submit my last discussion post reactions.

Three weeks off!

And then 4 months to complete the 175 hours of clinical education I need to graduate.

The math is that I have three mornings off a week.

I don’t have to work until 1430.

0800-1400 is 6 hours, times three mornings a week equals 18 hours a week.

This should get me to the finish line for this part of my class withing 10  weeks.

Time off for good behavior.

The 0.5 is the writing of my master’s thesis.

Which we have been cleverly working on the ENTIRE time we’ve been in school.

I think it’s supposed to be 50 pages, or 75.

No matter, I’ll just weave the papers I have been writing into a cohesive whole.

And submit and I’ll be done.

Two things remain:

I have yet to submit for graduation. Gotta shoehorn a call into them about that.

And I have yet to find a preceptor for the 175 hours.

Wish me luck.

 

December bites.

That is all.

 

Lately I have been struggling with the different generations at work.

Or, to be more specific.

The different work ethics at work.

Because work ethic knows no generation.

I am sorry that I expect you to do your job.

I am sorry that you have to work for a living.

I am sorry that you cannot be on your phone 24/7. (This is across generations).

I am sorry that I find you when you are trying to hide.

I work like I do so that no one can come to me and complain about my work ethic.

Hell, I don’t even expect you to work like me.

I do expect you to do your job.

I have not said this before.

But is bears repeating.

Surgeons!

Yes, you, even the ones in the back.

When the desk gives you a surgical time.

IT IS OUR BEST GUESS!

No, we are not trying to make you late for your plane.

(I’m tired of that excuse, please find another)

Or your romantic dinner with your wife.

(Slightly better, especially if we know your wife)

Or miss homework with the kids.

(Best yet)

But still, we are not working against your schedule.

It is your partners and your compatriots who are doing that.

Not us.

When I call you to tell you’ve been delayed from your surgical time.

It is often due to circumstances beyond our control.

Especially in the evenings.

So, again;

YOUR SURGICAL TIME IS OUR BEST GUESS!!!

So please stop calling me every 15 minutes to see if the time has changed.

I will call you when I have a better guess.

My assistant manager asked me this week about the no-lunch days I have been having lately. Hello, it is November. I assured her when I had time I made every effort to go to lunch. It just hardly ever happens.

She urged me to go to lunch then. It was 1545.

I agreed.

And then four of the 6 ORs, three of which had to follow cases, indicated the current case was done.

And the phone started ringing.

And decisions had to be made about 1700 when we drop from 6 rooms to 3.

And it became clear that we would be at 4.

And then the conversations with the surgeon that we were delaying had to be had.

And he pouted.

She said, what about using the call nurse to come give you lunch.

Okay, I said. I’m not going to do that.

1. that’s a horrible use of the call nurse
2. After my 30 minute lunch, the department would be on the hook for the 1.5 hour call back guarantee.
3. It is not fair to call them in just to give me a lunch.

She frowned at me and then conceded my points.

And I grabbed my glove box and went to the first room that called out for turnover.

And I turned them over.

Little OR stories I am writing for a book for my mother for Christmas.

I write OR parodies.

I’ve written:

Dr. Alexander and the Very Bad Day

The 7468 things I pick up off the floor, an OR counting book.

Tiny Heinie is Appalled.

OR Sign Language

Auntie Allis Doesn’t Live Here Anymore, a cautionary tale.

The 13 Days of the OR Christmas.

The one I am working on for this Christmas is an homage to Aesop’s Fables.

There will be Hansel and Gretel.

The Ant and the Grasshopper.

The Princess and the Pea.

Goldilocks and the 3 Bears.

The Hare and the Tortoise.

And the Boy Who Cried Wolf.

I’ve got to get to work writing and then taking pictures and then having it bound.

Of course I have time.

Is it too much to ask for people to pull their own weight?

I took minutes for the meeting today.

One of the round table items: having a prepared bin ready for an exploratory laparotomy.

People thought this was great.

I objected.

Everyone should know how to pull an ex lap from the supplies kept in the OR core.

EVERYONE.

This is a knife and butter case.

This is the most basic of the larger cases.

And you should very well be able to pull it from the stock in the core.

I was told to think of the children.

No, not really.

I was told to think of the inexperienced nurse.

I held my eye roll, just barely.

I said, I was thinking of the inexperienced nurse.

You know how you get experience, asked Bacall of Bogart?

You get in there and do it.

An ex lap case: a set up pack, a double basin, a laparotomy drape, a 3/4 drape, gowns and gloves for the doctor(s), a grounding pad, 0 silk ties, 2-0 silk ties, 3-0 silk on an SH needle, towels, a foley kit (that’s for  you), a major instrument tray , a major retractor tray.

That’s it.

The rest is just dressing and closing suture.

I had questions after I received my list.

I wanted to know who I had to call to find a preceptor.

The answer: the education department and beg.

I added the beg.

But it seemed appropriate.

I am considering it part of my journey. An extra step I have to take before I graduate next spring.

And then, who knows?

I am definitely taking a little time off.

And reading all the books.

And writing all the books.

This has been a long slog.

Oooh, here we go.

I just got the list of approved sites for our clinical rotation that lasts 4 four months.

My advisor also exhorted us to stretch beyond what we think possible and not go with places we know and understand.

I’ve decided to stretch to other sites, not my hospital or a sister hospital.

Should I choose the community college?

Should I choose the competitor?

Should I go in a completely different direction?

So much to think about.

As I understand we are still responsible for finding our own preceptors.

I will do my best to get this squared away before the beginning of December.

Because I’ve got a LOT to do before Spring Semester starts in January.

If only I knew how…

Informed consent is a very big safety issue.

It came up recently when two doctors, a surgeon and an anesthesiologist consented a family member over the phone for surgery on a patient, who could not consent for himself.

It is a good thing that I was listening in to the call, unbeknownst to the doctors.

Because telephone consent cannot be obtained by the surgeon of record.

BECAUSE of potential bias on the surgeon’s part.

After I reamed them out, the anesthesiologist had more questions.

Can two doctor’s ever sign consent for surgery?

Yes, in a truly dire emergency where if the family was consulted/asked/found it would lead to the patient’s death from waiting. The signer cannot be the surgeon of record.

Why does not have to be a nurse who consents over the phone?

Um, because the bias issue.

What exactly is the nurse co-signing?

The nurse, that would be me, is signing acknowledgement the patient’s signature, of the fact that the surgeon and the patient have discussed the surgical procedure, all risks and benefits and alternatives. There is a lot of other language in a consent, such as who is allowed in the room, whether or not to give blood products, whether there can be photography. Not the actual informing part of the consent, just the acknowledgement of it.

He had further questions. I wonder if he was testing my own knowledge.

I referred him to the state statute that explains the consent laws in our state, such as who can sign consent.

Prat.