1,000,000 American Dead

Well, we’ve crossed the one million dead mark.

That is one MILLION.

That is just under the 2020 population for San Jose, California.

To write that I am appalled on behalf of people I don’t even know would be too pale an example.

This is what we in the healthcare field were afraid of. Why we pounded and continue to pound the idea of simple measures to keep the population safe; wear a mask in crowded areas, maintain social distancing, wash your damned hands.

But no.

That appears to be too simple for some people. They would rather see the world burn that to do something simple to help another person.

This is all over the media. And before you poo-poo the media I mean it is all over the media, in all the trusted places that I’ve been reading from for years. Not the echo chambers that are ignoring the numbers, and have been all along.

The media exists to hold up a mirror to society. And this society is looking pretty sad right now. Oh, you’re tired of covid and want to live life as if it doesn’t exist? The one million dead do not have that choice. Society has taken it away from them.

I read a report yesterday about how many unnecessary dead there are. NPR reported on the Brown Public Health Report that was recently released about the number of unnecessary dead in each state. To put it another way, this is the number of people that would have survived if complete vaccination had taken place. If everyone had rolled up their sleeves and accepted the vaccine.

That number that would have survived if there had been more complete acceptance of vaccination? Nearly 319,000.

Would there have been some losses? Yes, because we know that covid is a killer. But nearly a third less.

And the death rate, that had been stable for a number of weeks, is beginning to rise again.

There are no more words.

Reference: Of 1 million COVID deaths, how many could have been averted with vaccines? : Shots – Health News : NPR

Cookie Thursday 05/12/22- nursing awards and intentions

This Cookie Thursday is a Thing I intended to make impossible carrot cake. To go along with my theme for the month of Inflation baking.

I did not.

This morning was the quarter 1 awards for my hospital.

Normally the shared governance council votes on all of the award nominations in the next month after the quarter’s end. And we hold the celebration near the end of the month. We hold quarter 1 specifically in May. During Nurses week, and Hospital Week.

No, they are not the same week on the calendar. But they are similar, off by one day. Aggravating. But we Nurses can share our week. Sure,

In my head this is the big awards celebration for the year. I know I have it conflated but yes, yes it is.

We celebrate nurses through the Daisy Award, and the Professional Practice Model Award.

But healthcare is not just about the nurses. There are CNAs and techs. The award we have for them is the Rose award.

And the ancillary staff, who are not nurses or nursing related, such as dietary, admins, radiology, environmental and more, deserve their own award. The award is the Sunshine Award because they bring sunshine to our professional lives.

For a treat we had had nominations and winners from all four awards. This has not been the case for several years. The Professional Practice Model award has gone un-nominated before. Not that there are no nurses who embody the nursing theory the hospital follows, but that the nomination form is complex, and the sections to write on are so small, only 4 lines.

Shared governance has been working for years to get the nominations online. And the Daisy ones are kind of online but it is difficult to get people to fill them out.

And then there is the current staffing difficulties of healthcare. I began the awards ceremony today by telling the crowd that there had been 30 nominations for the quarter. And that this was half of the nominations we had had in the past but more on that in a bit. And of the 30 nominations, 14 had to be discarded because they no longer work for the hospital, or even the system. This is almost half.

How many of those nurses would have remained at the hospital if given a bit of encouragement?

I told the council that we were going to start something new.

After I gather all the nominations, and decipher the handwriting, I am going to email the managers monthly that they had a nomination. And the person would be celebrated at the next awards celebration in the month after the end of the quarter. With instructions to tell the person that they are amazing. And the nominators and the council sees them.

I reminded all the people at the celebration, all socially distanced, to nominate, nominate, nominate. All the staff at the hospital deserve to know that they are seen. That someone knows they are doing an amazing job and nominated them for an award.

I hope this helps.

Traditionally, the Daisy celebration always has Cinnabons. The nearest Cinnabon is in the next town over and I picked them up yesterday. When I was told that the only ones available were 6 pack of large ones, I told the counter girls that I wanted 2.

I panicked, and I overbought. One usually feeds the awards ceremony. I am not sure why I said 2 boxes. I brought the remaining box of 6, cut up small, to the OR for Cookie Thursday.

Happy Hospital Week.

Happy Nurses Week.

What does it mean to be called in? Part 3-prepping and draping

When we last left the patient, and the call team, the patient had just gone under anesthesia.

This is when I call the PACU nurse in.

Some might say that it is too soon, I would not. Depending on the surgeon, the case might only be 20 minutes long, plus wake-up time, equals 30 minute response time. For this particular surgeon, call PACU in sooner than later, otherwise you will be chilling in PACU, not knowing the next steps, until they get there.

As I am calling the PACU nurse in, I am pulling back the top blanket to expose the abdomen and preparing to tuck the left arm. As part of my preparations, I have pulled out 1 egg crate ulnar pad, and the clipper and clipper head, plus tape.

After I hang up with the PACU nurse, I tuck the left arm snuggly against his side, placing the egg crate under the elbow, and tucking the overhang of the draw sheet, thereby securing it. I pull off the armboard at this time.

I nearly forgot the electrode grounding pad. I grab it from my desk and go back to the patient’s side.

Depending on who it is, the surgeon may clip the abdomen and remove the hair with the tape. Again, depending on the surgeon, this may be all on me.

With the patient’s abdomen freshly clipped and the hair removed with the tape, I open the chloraprep stick in a sterile manner. Chloraprep is to antiseptically prepare the skin. It is a combination of alcohol and chlorahexadine. And it is bright orange, so that it stands out against pale skin and you can see what area has been prepped. . I have read of a blue chloraprep but that is not available in my system. I leave the stick’s packaging open, making it easy to grab.

I pull on sterile gloves and open and activate the stick. I am waiting for the solution to saturate the sponge on the end of the stick. Once it has, I scrub the abdomen at the umbilicus, or belly button for 10 seconds in a back and forth manner. I “paint” the abdomen with the rest of the solution. From nipples to pubic bone to bed on both sides. You always want to prep more area than you think you need. After all, in the OR, exposure is everything.

But, you may ask, why am I prepping without putting on the grounding pad? Because the chloroprep has alcohol in it and needs to dry, thoroughly, prior to draping. Three minutes total is dry time. It is part of our documentation.

But, Kate, you didn’t put on the grounding pad that you pulled out a little while ago. While waiting for the chloroprep to dry, I apply the grounding pad. As long as I am seen to be doing something, surgeons don’t try to hurry me up, as if I can make time move faster. At least, they don’t try much.

I am known to be strict about this. Alcohol is part of the fire triad as fuel and is very flammable. I do not want any drape fires in my OR, thank you.

As a delaying tactic I often do not tie the surgeon’s gown until the grounding pad has been applied.

I tie the surgeon’s gown at his neck and his waist. And then he will “dance” with either me or the scrub tech to completely surround him sterilely with the gown. Fun fact, anyone who is gowned and gloved for the OR is only considered sterile from two inches above the elbow to the stockinette cuff, which is covered by the gloves. And on the front to the level of the bed.

Finally, the seconds drag on and it has been 3 minutes, despite my ignoring the visual whining/pleading from the surgeon. Often I use this time to talk movies, or sports, or books; whatever I know the surgeon enjoys. This often takes up the entire time.

Draping can begin. It begins with blue towels delineating the operative field. The squaring off. Sometimes the corners of the towels are secured with penetrating towel clips, it is why the instruments are named that.

Direct communication that would feel coded happens between the surgeon and the scrub tech. Stickies or sticker on indicates to the scrub tech if the surgeon wants the stickers left on the fenestrated drape. The scrub tech complies, on or off, and places the window of the drape squarely on the operative field. Once this is placed it is not to be moved. The drape is unfolded, like a flower, to cover the patient entirely. There should be a decent hang off of drape on the sides and end of the bed and enough drape to create a wall by their head. Anesthesia does that bit, securing the wall with their non sterile clips.

The mayo stand, which has been prepared and draped out by the scrub tech, is brought into position at the patient’s side or over the patient. Some of this depends on the surgeon’s preference.

Once the mayo is situated, the surgeon and the scrub tech begin throwing off lines. There are several: the light cord, the camera cord, the CO2 cord, the bovie cord, the smoke evacuator cord, because bovie use creates smoke and smoke is bad, and the secondary electrical unit cord for the ligasure or the harmonic. Both of these machines are made to cut tissue or burn it to control bleeding or to ensure the surgeon can see what he is doing.

I plug all of these cords in. Three on the bovie side, 3 on the tower side. As these are on opposite sides of the patient I need to move quickly, but safely. As I go by the spots, or the overheads, I turn them on. These will allow the surgeon to see what he is doing and it is focused light.

The surgeon asks for the knife. I stop them and remind them of the pause. This will be talked about in the next section. We pause, everyone in the room stopping what they are doing and confirming the surgery, the supplies are sterile and accounted for, the antibiotic has been given. So many things.

You’ll see in What Does it Mean to be Called in Part 4.

The scrub tech hands the surgeon the knife and incision is made.

Monday’s Musings 05/09/22-Happy Nurses Week

Happy nurses week for 2022

The American Nurses Association theme for this week is Nurses Make a Difference. This is to celebrate the impact of all nurses on healthcare and patients; no matter they work in a hospital, or a doctor’s office, or are practicing on their own as a nurse practitioner.

As a group we have lived through some dark times in the last two years.

In 2020, the ANA theme was Year of the Nurse.

And with nurses that I know this hit with a resounding thud.

What we do is very important. We strive for hospital change. We care for patients and ourselves, all at the same time. And, as a group, we are tired and sick of being the scapegoat for systemic problems that arrive that we have tried to fix. In short, we are tired of being the squeaky wheel, of trying to bring up issues and being told to stay in our lane.

Now insurance companies are trying to charge back on premiums to account for rising nursing wages. This is just like when the powers that be, such as Congress, tried to indict travel nursing, and nursing in general, for wage hikes. This is because nurses were leaving the bedside and becoming travel nurses. Remember that?

This was in February.

A nurse is being sentenced on Thursday, 5/12/22. On Florence Nightingale’s birthday. If that is not an attack on nursing, I don’t know what is. She was found guilty in March of criminally negligent homicide for a medication error that led to a patient’s death. She was found liable in the systemic problems of a new medication machine relay with the electronic health record. She was found liable for a medication that should never have been in the area she was in.

Much has been written about the Versed, a sedative, versus the Vecuronium, a paralytic, mistake. And mistakes were made on her part. Oh, yeah. And the policy was stupid to not mandate her monitoring the patient after administration. But to elevate this to a criminal matter with conviction is to chill the reporting structure of the entire medical field. Nurses that I know have told me that they will no longer report errors, even errors as minor as a near miss that did not reach the patient. Because they fear reprisal and prosecution. Surgeons I work with have brought up their concerns about the reporting that they know is not going on. And they have referenced the tragedy happening at Vanderbilt Hospital for nurses.

A patient died. There was medical error that may have contributed to her death. The science, including the medical examiner, has thrown doubt on this. The nurse has been convicted of criminally negligent homicide.

Nurses are mad and quitting in waves over this, as we feel the system that we work in no longer has our back. And those who are left have to keep it together. For the patients.

There is a Nurses March in Washington DC on Thursday, May 12. There is another march happening in Nashville, Tennessee, on behalf of RaDonda Vaught on Friday, May 13.

Happy Nurses Week, everyone. Now get back to work.

This is the feeling that I am getting. You?

Post-it Sundays 05/07/22-charting

The post-it reads ‘charting is a secondary job.’

This is very true.

Although the old saw that says if you didn’t chart it, you didn’t do it, you have nothing to chart without doing.

Too often people are enthralled with charting.

Charting must be done.

Charting must be done right now.

They are missing the forest. They are so focused on the trees that make up charting.

The charting should be the last step in your care for the patient.

The patient is in need of care. You provide it, then you chart it.

This is what charting as a nurse is; there is an action we have to document it.

The electronic health record has made it better and worse. The EHR boils down the entire encounter to check boxes and a narrative comment section that allows for observations that don’t fit in the check boxes. Because patients are individuals and are not all going to be check boxable.

Too often, the nurse wants to chart. Above all else. And the OR field or anesthesia is left wanting because the nurse is so bent on finishing the charting, regardless of attempts to sway them from the chart.

There is time enough to do both care for the patient and the field, and chart. But charting should not be a nurse’s primary concern.

The patient is.

What does it mean to be called in? Part 2- the surgeon has arrived, getting the patient back to the OR and under anesthesia

In our previous episode I was called in, and I prepped a patient for surgery.

Almost.

There are no consents signed.

Because the surgeon has not met the patient.

The double doors to PACU swing open and the surgeon, dressed in street clothes, walks in.

I am using he as a descriptor because that’s how I described the surgeon in the previous post. Nothing is meant by this. I’ve worked with many fine FEMALE surgeons.

He makes a bee-line for the patient and introduces himself.

With a half an ear I listen in while I am getting a clipboard for the signing of the consents.

Pro-tip: It is better to sign against something. And, as an ER patient, there is no hard chart. All I have are patient stickers.

After meeting the patient, the surgeon wanders off to do the history and physical. This is a must have for surgery. He has to attest in the H&P that he has gone over all risks and benefits of the surgery with the patient. This is where the informed part of informed consent comes from. The surgeon has informed the patient of the risks and benefits and alternatives the surgery. All I am doing when I co-sign a consent is that the patient signed it.

I review the consents with the patient. The anesthesia consent, and the surgical consent. I always encourage people to read the consents. I have read the consents, every line, to patients. The part I highlight, always, is that any tissue removed, in this case the appendix, has to go to lab for testing. I usually make a joke here that the patient cannot take it home for experiments.

The patient laughs and they sign the consent.

I follow up with a story of a patient that wanted to take a substantial body part home and smoke it.

Ew.

Other people are avid fishermen.

Double ew.

Regardless this appendix that we are about to take out has to go to the lab.

The patient signs both consents. I co-sign both consents.

I ask if there is any last minute questions. I’ll answer anything. One time a kid asked me why the sky was blue. And was shocked when I had an answer.

I nod at the CRNA and show them both signed consents.

Logging back into the EHR, because you know it has timed out, I go to the part of the chart that deals with the timeouts.

A timeout is a pause that ensures that we have everything prior to surgery. Patient identifiers (name and birthdate), H&P, pregnancy test if applicable, antibiotic, it is all discussed here between myself and the CRNA and the patient. We both take another look at the consents that I just signed with the patient and it is time to go back.

I encourage signs of affection between the family member and the patient. This is the last time they will see each other before surgery is completed. The family member is always stressed. The patient has had a mickey from the CRNA. By that I mean the CRNA has given the patient sedation for the trip back. After consents, because legal reasons. But they are stressed too.

I wave at the double doors leading to the OR hallway and indicate that the OR itself is beyond those doors and visible from where the family member and I are standing.

As the CRNA and the patient go through the double doors to the OR, I indicate that the family member should follow me and I will take them to the waiting room. They follow me out of PACU.

As we are walking down this long corridor toward the surgical waiting room, I reassure the family member. Remember, they are stressed. I discuss, again, how they will be in the waiting room and if the phone that I am about to show them rings, they are to answer it. It will be me, for them.

I tell every single family member about the phone call that they are going to get. I tell them I have a 65% answer rate. I reassure them if they can’t get to the phone before it rings over to the answering machine I will call back.

By this time I have badged us into the waiting room. I talk up the charging station and invite them to charge their phone as it has all the cords. Years ago when cell phones were become popular, I kept charge cords at the desk to lend to families. Finally, administration listened when I told them that it was imperative that a charging station be installed. Yay for them listening.

I briefly show them around the rest of the room and am specific which phone will ring. I lift the phone up and make sure the ring is audible. I reiterate that this will be the phone that will ring. After I go back to their loved one, it may take me a few minutes to call but I will call.

I hand them the remote for the television and tell them that the restrooms are down the hall on the right.

Last reassurance that we will take very good care of the patient is given. I walk back to proper pre-op area, pulling my phone out of my pocket. I need to call the on call PACU nurse before the patient goes to sleep. That way they will be in the hospital when the patient comes out of the OR.

I walk back into the OR. By this time, the patient is on the OR table and the gurney is in the hallway.

After reassuring the patient their family member is tucked back in the waiting room and I will be giving them updates, and the surgeon will see them after the surgery, I do a visual survey that all is in readiness.

I chat with the patient as the CRNA and anesthesiologist prepare to put him under anesthesia. During this, I and the tech are doing many things.

Mr. A gets sequential stockings on his legs to help the blood return to his heart while he is in our care, the SCD machine is turned on, the seatbelt is applied, the armboards are put on the bed, the patient’s arms extended and secured. Warm blankets are refreshed. The temperature in the room has dropped 5 degrees again.

Sometimes during the whirlwind that is the preparation to go to sleep, I tell the patient that we used to ask people to count backwards from 10. And often they nod, familiar with the concept. They are shocked when I tell that this will not be happening. They look perplexed, and I inform them instead that they will be counting backwards from 100 by 7. I don’t always do this, but patient sometimes do better with a task. This is a task.

And it is time to start induction of anesthesia. The anesthesiologist and I take up posts at the opposite sides of the bed and prepare to assist as we can.

And the medication is started. I remind them to count backwards from 100 by 7. Often they only get to 86.

Lidocaine first. Because propofol is an irritate. Then the propofol, the so called milk of anesthesia, the Michael Jackson medication. Jokes are sometimes made. And then the paralytic.

Medication always wins.

Cooking Thursday 05/05/2022- Inflation baking, spice cakelets edition

The theme for the month is going to be inflation baking. I was going to call it inflation cookies, but what I am baking is based on recipes from the Great Depression and WWII.

Because inflation is real. It is not caused by our government, it is caused by the US coming out of a pandemic. In my core I think this was always going to happen. It is happening world wide. And the war in Ukraine is not helping matters; in fact it is harming matters because much of the world depends on food from Ukraine.

These recipes that I will be doing for the next month have no butter. Which is the most expensive ingredient in Cookie Thursday. There are no eggs. And now that there has been an ongoing outbreak of bird flu that has been impacting eggs and egg production, this recipe double fits into the theme.

I am aware that today is Cinco de Mayo. Which is mostly a made up holiday in the US. To that end I made spice mine cakes. People ask why I didn’t make flan; some things are best left to the masters and that is not me in the department.

The recipe calls for frosting. Well, the recipes call for an 8 inch cake pan, and I needed to make small servings of the cake, enough for the department. I will be serving the frosting on the side. I hate working with frosting anyways.

When I pulled out the mini muffin pans to bake the cookies, I was surprised, not surprised that I have 3!

The filled mini muffin pans when into a 350 degree oven and I decreased the baking time. Because decreased mass = less baking time.

People the world over are being impacted by inflation, myself included. I hope this theme resonates with my coworkers and impacts and sparks giving.

What does it mean to be called in? Part 1- all that happens prior to surgeon arrival

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.

Monday’s Musings- 5/2/22 OR as adrenaline junkies

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.

Post-it 5/1/22-Music in the OR

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.