Pandemic + End of year deductible = increased volume

We had paused elective cases for seven weeks during March and April.

This means that we only did cases that were deemed urgent enough not to wait.

Not that many people wanted to come to the hospital.

Not that most people weren’t afraid of us.

For those 7 odd weeks that we only did the urgent stuff, all the others were placed on the backburner, so to say.

They would be rescheduled when the cases opened back up.

And they did.

But what about the people who were ill and deliberately did NOT seek care.

The odd appendixes that were painful but all of the sudden felt better.

For a month.

Or all the people who did not go to the doctor during lockdown.

Which meant that their ailments, be it cancer, or hernias, or joint issues, or all manner of things, were NOT diagnosed.

And that meant that they got sicker and sicker.

And are now showing up on my schedule.

Sick as a dog.

Ill, ill, ill.

This leads to a delay in diagnosis.

This leads to a delay in care.

This leads to the operating room, which is not staffed to run more than 1 room after 1900.

Is, at times, now drowning.

Stand up for patient safety

Today, well, last night was an odd one.

I got a page from a surgeon who needed to clear an abscess.

Not so unusual, we do a lot of abscesses.

But this patient had a tough airway.

Really tough.

Really they almost did not survive the last surgery tough airway.

I encouraged the surgeon to speak to the anesthesiologist as I was not sure they would be suitable for our community hospital.

Especially in the middle of the night.

With a skeleton crew of surgeon, anesthesia team, RN and scrub tech team.

I just didn’t feel it would be safe.

To quote Han Solo: ‘I’ve got a bad feeling about this.’

Sanity prevailed.

They did the case the next afternoon.

With loads of people around to help, if needed.

Phew.

Student loan final recap

Final student loan payment has been submitted.

sigh of relief, I guess.

I’m not sure how to feel about this.

I have worked hard.

I have given up 5 years of my life to school.

For the second time in my life I will have paid off my student loans.

Before, during, and after the pandemic, it was important to me to get this paid off by the end of the year.

And I have willed it so.

Using the combination of my clinical ladder bonus, my tuition reimbursement, and my personal money.

It is done.

So why does it feel so weird.

Where’s the sense of relief?

The sense of a burden put down forever.

I’m putting this feeling in the entire bucket of the world is hurting and getting back to work.

Bad handwriting? Bitch, please.

Let me address my handwriting.

Yes, it is horrible.

Yes, it is next to illegible.

Yes, I can read it.

Yes, increased exposure to my handwriting increases the legibility to people who read it often.

Sometimes my hand is trying to keep up with my brain.

And it loses.

Let me tell you that the there are many, many people with worse handwriting.

Trust me.

I used to be a unit secretary.

And I would take handwritten orders off and in the computer.

My handwriting, bad?

I’ll own that. I will be proud of it.

Yes, have you seen MD’s writing?

mansplainers

Mansplaining.

For those who do not know the term, and why don’t you know the term, it is when a man explains anything to a woman, who is usually qualified and in possession of said information.

Today an anesthesiologist, who is a mansplainer extraordinaire, explained to me why it is important to place an axillary pad when the patient is in a side-lying position.

Um, okay?

Of course you need to take pressure off the axilla while a patient is in a side lying position.

Because you know veins and arteries and nerves and such (I really do know the reason why, bear with me.)

He and I had positioned so many people on their sides, together.

The most recent was last week.

But today, this same anesthesiologist that I’ve positioned with for years, took it upon himself to explain the mechanics of why we were doing it.

I did not shake him, although I wanted to.

I did not snap back, although I wanted to.

I just kept going with the positioning.

We had a case to start.

But the mansplaining is getting REALLY deep in here.

And my willingness to put up with it is very, very thin.

Lots of Nevers this Year

There seems to be lots of never occasions this year.

From the never had to stay home so long

To the never going to get to go on vacation.

To the never going to get enough hours because the elective surgery cases have stopped.

To the never have I ever had to wear a mask every time I leave the house.

To the hmm, I’ve never done that.

This week the surgeon never got the hip back in place.

This means that the total hip the patient has WOULD NOT go back into the socket.

Say it with me.

This has never happened in a closed reduction case.

I’ve personally assisted on several a year.

Times 19 years.

NEVER.

But this week we had to open a hip because we could not get it back in place.

Of course there were two more urgent cases waiting and I decided to allow the hip reduction to go first, foolishly thinking it would take the usual 15 minutes.

I was wrong.

Two hours later we were finally done.

The waiting surgeon was like a jack in the box, popping up to ask me if I was going to call in the other team.

Like Schroedinger’s Cat there is and is not another team.

Tired

I’m tired of this.

Aren’t you?

Tired of the battles over wearing masks.

Yes, you absolutely should, no, it does not infringe on your rights.

Tired over the nightly conversation with surgeons about no, the ED patient who is having surgery in the next hour cannot be quickly tested for COVID. Newsflash, we don’t have enough tests.

Tired over never being home alone now that my husband is working from the next room.

Tired of the constant news.

Tired of the constant science naysayers.

Tired of the fact that my backyard has not been mowed in a month.

Tired of the fact that I am tired.

I am tired.

What’s wrong with these people

Friday night I had a tech who told me she was not on call and she would call me back with the person who was, because she just knew they had signed a change sheet.

Spoiler alert, they had not and she did not call me back.

In fact she ducked my calls for the rest of the night.

I sicced my assistant manager on the task to man the phones and get me a replacement call tech.

Because I was too busy converting a laparoscopic case to an open belly case.

I called her at 2230.

At 0015, while we were getting ready to close, she informed me she could not find anyone willing to come in.

And the original call tech had taken her sleepy medicine so she could not come in.

I had to keep my tech, who had been working hard all day and evening long, against her will.

I will be escalating this if nothing happens.

This is unacceptable.

Keeping on keeping on

I have had limited outside exposure outside of work.

I go to the grocery store once a week.

I go to the comic book store (small, local business) once a month.

I go to the bookstore (books!) once a month.

I go to Target once a month for those things I can’t get from my grocery store.

I go to all of these places as soon as they open, hoping to avoid crowds.

I go to work every day.

All of my meetings have been switched to Zoom.

I wash my hands, wear a mask, use hand sanitizer when I can’t wash my hands.

This is all the new normal for me.

I would like it to be the new normal for everyone.

You don’t have to go to the same places I go to.

You don’t have to go at the same times I go.

You don’t have to go anywhere at all.

But please wear a mask and cleanse your hands.

Please.

If not for yourselves than for your loved ones.

 

The saddest OR case

I’m not going to lie.

It’s been a rough week in the OR.

This is outside of the Covid-19, mask tumult, Black Lives Matter.

Something you never want to hear a surgeon say is “hmm, that doesn’t look good.”

Especially when he is talking about the suspicious appearance of the abdominal tissue discovered while doing a lap chole.

Especially when he says “gosh, that looks like CA.”

The patient is going to have to wait for the pathology report.

Or, while doing an upper endoscopy, looking for bleeding, and small bowel tumors let them selves be seen.

Or the peek and shriek.

What is the peek and shriek?

It is where the belly is opened emergently through a long midline incision and the surgeon gets to the bowel, quickly buzzing bleeders and cutting through the fascia to discover the bowel is completely dark purple and necrotic.

This has happened while anesthesia is still doing their thing and putting in lines to monitor the patient.

There is nothing to do but close them  up and take them to the PACU.

There is no life without the bowel.

Emergency laparotomy case with terrible labs, acidotic as hell, a very worrisome CT, and the beep that comes in the middle of a Saturday morning to summon you to it.

Other things that are not reassuring is the anesthesiologist remarking that the patient’s vital signs are trending toward a code.

Now, quickly, have to get the patient off the table and to the ICU so they don’t die on the OR table.

Taking care to get the ICU bed and the travel monitor so we can keep an eye on their vitals and react to his blood pressure and saturation readings.

Taking care to count as the surgeon is frantically closing.

Taking care to secure the foley to the leg so that the catheter is not pulled on.

Taking care to have a travel monitor available, plus a full tank of oxygen to make the trek to the ICU.

Taking care to take the seven extras EKG leads off the abdomen.

Taking care to put a gown on them.

Taking care to put a new pillow under the patient’s head, with a chux pad on top of it.

Taking care to send someone to call for the elevator and hold it until we get there.

We pass the surgeon in the hall, talking to the family, somewhere in the midwest.