Best Kept Secrets of the OR, part 2- Howling at the Moon T

This is the second part of the Best Kept Secrets of the OR.

This is not the post I was going to write. But I will keep that one half written and release it next week. I was just about done with it when I happened to look up and see the big bright nearly full moon.

I know a lot has already been written about full moons and healthcare. How we hate the full moon. How we fear the full moon.

True. All of them.

I know that Atul Gawande covered the statistical lack of the full moon craziness in his book Complications. Until he worked a full moon, he would have no idea.

The full moon brings out the crazies.

And it is not just the ER that feels the impact.

But I don’t think it gets enough attention.

Yes, the crazies howl at the moon.

There is more light available at the full moon that may lead people to do things they wouldn’t normally do because it feels kind of naughty. Until they step into a hole they can’t see fully and break an ankle.

There are also atmospheric pressure changes, kind of like a low-pressure front.

I mean the full moon also has an impact on labor and delivery. After all, the amniotic fluid is technically a body of water.

I mean I guess it isn’t only the OR’s best-kept secret.

But I hate working a full moon.

Not only are the patients feral, so are the surgeons.

Tuesday Top of Mind 7/16/24- Fifth verse, same as the first

Yes, the post title is meant to reference the song”I’m Henry the VIII, I Am” by Herman’s Hermits.

What the post title is referencing is that this is the FIFTH covid summer. 2020, 2021, 2022, 2023, 2024.

Not as bad, but still lethal. Masks have been legislated against or banned in many cities and states. You know, the masks that have kept some of us safe through this entire time.

It is illegal to wear a mask in some states if you are committing a crime.

Since when is the desire not to get covid a crime? Depends on who you ask. Are you asking the ones who don’t believe in covid, who think it’s a boogeyman dreamed up by those with public health in mind? To scare the stock market? To get people to buy into Big Pharma? To want to care for others, no matter their age, sex, religion, and orientation?

Yeah, those people. The ones who excuse the death of over one million Americans (the exact data is hard to come by). According to the CDC tracking database, there have been 1-9 covid deaths in North Carolina in the last week. However, the previous week’s numbers that allow comparison and percentages are not available. Ask yourself what they don’t want you to know or even acknowledge to themselves.

I am keeping a close eye on the infection rate at the hospital. We went from 1 admitted case to more than 5 times in a couple of weeks. ooh, five more patients? Yes, and these are just the ones that got admitted. Or came in. These are definitely the ones who are quarantining because they are in the hospital.

I have not resumed mask-wearing as a general rule. I have some in my car. However, I shop early or late or not at all. I don’t go places where there are a lot of people. On purpose, but then I’ve always kinda done that. Who knew being an introvert could help? Just every introvert known to man.

I have no idea how many covid posts this makes. My record-keeping has been spotty. And incomplete. And my mind has been busy with other things.

As always, it doesn’t matter if you don’t believe in covid; it believes in you.

Post-it Sunday 7/14/24-Details will save your ass

The gown card reads “Take credit for what you do. All documentation is important.”

This can be thought of in at least two ways.

Yes, write down everything you do during a surgical case. This is important. The OR documentation is a shell, it is up to you to fill in the details.

ALL the details.

This is to protect you when there is a complication.

All the positioning aids are important to note. It is also important to note what position the patient is in during the surgery. If you have to fudge the lithotomy a bit because of their body limitations, write that. Be as detailed as you can.

I don’t care if you’ve done this case 2000 times, document everything you’ve done.

All the medications are important to note. How will the pharmacy and nurses and doctors who take care of the patient AFTER they leave the OR know the details of what medication was given? Be detailed, not only in the medication dispensed to the field, but the total of the medication delivered to the patient. Don’t forget to include the route. Remember the 5 rules of giving medication to a patient from nursing school? Yeah, right patient, right time, right dose, right medication, right route. I would add another right; the right indication for use. If this medication is being used in a way that is unusual, write it down. Give justification as to why. If there are antibiotics added to bone cement, explain that.

All the dressing details are important, even if they can’t be seen without deconstructing the dressing. An addition of an antibiotic or non-adherent film is important to note. Because the nurse or doctor who will be taking down the dressing has to make sure they have all the pieces. Because some of that turns transparent against a wound.

All the people in the room are important. Not only is it up to the circulator to control the traffic in the room and keep the crowd down to necessary people only, but times are important. People I often see not listed on the chart as being present are the correct product representatives or x-ray techs. The times all the people in the room are present may be useful in the future. Not only for productivity tracking.

All the details of the equipment used are important. This is so we can track the equipment used and also aids in tracking down instrumentation if there is an issue with a later patient where the same equipment is used. It is often necessary to note when the equipment is used on patients.

All the supplies are important. In so many ways. This is important on the back end for ordering and correct billing.

Be as detailed as you want to be while charting. But remember, your charting might save your ass in a deposition during a lawsuit in 5 years, 18 if it involves an infant, or until age of maturity if it involves a child.

Tuesday Top of Mind 7/9/24-their plan, yes, that awful, horrible, no good plan

I took yesterday completely off after doing all the research into Project 2025 and Agenda 47. I did not want to sully the day with this filth.

A couple of years ago, I heard rumblings about the “conservative game plan” for after the 2024 election. You know, the one that is November 5, 2024.Call it Project 2025, the 900-page conservative wishlist. Call it Agenda 47, which is what Trump wants to do if he is reelected. And he’s got a whole lot of hurt planned for those he perceives who have wronged him.

I call it bullshit.

All of their horrible, misogynistic, misanthropist, nightmare wishing, end of the rainbow, white christian nationalist ideas. All of it is bunk.

Call a spade a spade.

They wouldn’t because a spade is a black card.

This is how far they have slid down the white christian nationalist shit pile.

Did you see the masked, khaki pant wearing, beige baseball hat wearing, blue polo shirted assholes that came pouring out of rented U-haul trucks to stalk the streets of Nashville, waving their upside down flags, and their confederate flags, and their 13 starred flags? Yeah these are a what I can surmise is an offshoot of the Proud Boy movement that call themselves the Patriot Front. They look like all the brotastic podcast boys, put the women in their place wannabes. Riding in the back of the probably sweltering U-haul trucks in disregard to ANY safety laws.

Ugh. I need a shower after digging through that muck.

I’ve done a pretty deep dive into the mess. The 900 pages of the Project 2025, the hate speech of Agenda 47 which, again, calls patriots traitors for daring to stand up to the great one. I’ve listened to podcasts, and I’ve watched videos, and I’ve read article after article after article about it.

Kevin Roberts, the head of the Heritage Foundation, believes that we are in the middle of another civil war and you know what side he is on. He also believes that this can be bloodless if the left allows it to be. Yeah, no. I don’t think so. Who gave him the covenant to declare that? Himself.

But I have a pretty good bead on what it all means.

There is a part of the introduction that says that they want to “live well”. Well, that’s up to interpretation. My well is to have dominion over my own body and voting rights for those who are citizens. To some of these people, living well is holding their feet/knees/weapon against the neck of others they deem less than themselves.

It all boils down to three things. All 900 pages of the vitriol. Of all the weaponizing of our own tools against us with the takeover of the DOJ and the firing of all the civil servants who are there as a constant. The Agenda 47 on 45’s own website.

$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
I don’t like it because it is not like me, therefore no one should have it. Doesn’t matter what it is, gender affirming care (but Cialis and Viagra are still okay), rights of people to have dominion over their own body, rights of people to love who they love, regardless of gender, to be who they are at the core regardless of gender
We fear women

That’s it, that’s their entire platform.

Why would you believe a known liar? They are telegraphing who they are and straight out telling us who they are and then lying about it when they claim that they are not. Why should we believe the known liars? I will not pretty up their actions and words by calling it “Falsely accused without evidence.” It is lies.

Call them for what they are- liars and wanna be big men.

I call them creepy and gross who see bogeymen in the shadows that look and act a lot like their secret desires.

These are beyond scary times. This election isn’t about red v blue, Trump v Biden; it is about not allowing the very bones of Democracy be picked over by the corporate ghouls who want you to live as they DEEM you should. Personal freedom goes out with the bathwater. As I just wrote, money, fear of women, and fear of the unknown is at the root of it.

We should be alert but resolved.

I am.

Both as a woman and a patriot. Just not their definition of the word. Because of the whole woman thing.

I am going to take another shower now, just writing this. And set fire to my browsing history.

Post-it Sunday 7/7/24- I’m not that kind of nurse

The gown card reads “Mocking MDs to their faces is funny.”

Yeah, on its surface this gown card is kind of mean.

But MDs are people too. They should be people first.

I remember when I wrote this gown card. The companion note says that “the squeaky wheel gets the flip.” And I wrote the Post-it Sunday dispatch last year on 4/9/23. And you thought I was just picking post-it notes from the cloud.

Nope. I still have a container full of them.

But I should really have left these two together.

I have laughed in a surgeon’s face when they requested a flip. Only to have them go behind my back and TEXT my manager. Who told them of course they could have the flip room. No matter that we didn’t have staff for another room. Or that another room wasn’t even cleaned. No matter that they were at home with their wine and their kids. The squeaky wheel got the flip.

But I got to laugh at a surgeon. So that’s good.

The title of this dispatch is that I am not that kind of nurse.

I was thinking of John Travolta and the movie Michael, where he played the titular angel who leans over to Andie McDowell as she was protesting that he was an angel and he couldn’t do what he was doing. His next line was my favorite in the movie, “I’m not that kind of angel.”

Still cracks me up.

I am not that kind of nurse. I will take under advisement any requests for a flip room.

But the surgeon may not get it.

So don’t go and tattle to someone who isn’t even at the hospital.

Or I’ve got a mop you can sling.

School Me Saturday 7/6/24- beyond the rabbit

Happy conception day to Alice in Wonderland! On July 4, 1862, Lewis Carroll was on a river trip with friends, including the three daughters of a friend. Through the journey, Carroll told the girls the story of Alice in the Underground. This, of course, became Alice in Wonderland.

Alice is beset by curiosity. That is what prompts her to follow the White Rabbit, who is the representation of time. Or rather time slipping away.

University, or college, or classes above or even in high school, represent time. This is the time that the student has to devote to learning a new skill, or learning about themselves (as discussed in a previous dispatch), or finding a new profession. Or just exploring for exploring’s sake.

All of this takes time.

For me, I first started nursing school in 1993, after I graduated college, got hurt, and rehabbed myself back into a different nursing school in 1998. This was the time that I lost because I was injured. After graduating in 2001, I did not return to another nursing school until 2015. That doesn’t mean I had stopped learning. It just means that my learning was in a different realm. I learned how the OR and how to be an OR nurse. Fifteen years ago, long before I considered returning to school, I studied and tested for my CNOR. I passed 15 years ago today.

However, this time was not wasted even though I wasn’t actively participating in formal education.

Adult learners should never stop learning; it keeps the mind sharp and nimble.

To keep my CNOR I need to do 135 hours of continuing education over 5 years, 100 in the OR. Nurses especially have to continually be learning. To be licensed in their state requires some form of continuing education. The number of hours depends on the state.

Not everyone wants to go back to school, and go back to school, and go back to school. However, every adult needs to keep learning.

What form that takes is up to you.

Learning is never time wasted.

Dispatch July 4, 2024-not so happy here on the front lines

I know many other people, liberals and conservatives alike, who have a pit in their stomach like me when it comes to celebrating the fourth. One of my favorite authors who I KNOW is a Republican because she has talked about it and is also sounding the alarm.

Some of us are actively sitting out on celebrations.

Because we don’t feel so merry.

Some would call us out as non-patriotic.

The United States we are living in is and always has been a grand experiment. It always has been. It is meant to be a living, breathing thing, not mired in the past as some would have us be.

We are patriotic enough to be fearful of the overreach by the Supreme Court, egged on by the dark money and not-so-dark money that has been flowing their way. Easier now that they ruled that bribes can happen AFTER verdicts. Handy, that.

We are patriotic enough to embrace change.

We are patriotic enough to cheer on those who are scrabbling, desperate for that change.

What we have to ask those who cleave so hard to the past what they are afraid of?

Because this smacks of fear to me. Afraid of the not like us, afraid of the other religions, even though this country was founded on religious freedoms. Afraid of the different. Afraid of things they don’t understand.

What they don’t know is that we would teach them not to be afraid.

Because they are hurting us with every law declaring the president can basically rule as a king as long as he is acting within official presidential duties. And what are official duties? Whatever they tell us or the president regards them. No matter if it is to deny a free and fair election and try to subvert the will of the people. Apparently, insurrection is within official duties.

Walt Kelly and his comic strip “Pogo” said it best.

We have met the enemy and he is us. I know it was a strip about littering and pollution and I could write about that too.

Speak up when they are against you and making it harder for you to vote.

Call out instances of cheating and stacking the courts.

Call a lie a lie.

Call an insurrection an attempted coup.

Fight like hell against those who want to drag the country back, kicking and screaming to a time they deem to be original.

Original to who?

The white men who owned other people and called them slaves.

Or the white men who fought to free themselves from tyranny just to foist it on the slaves.

Or the white men who left the faraway country and came to America to escape religious persecution.

By their court, women have been stripped of dominion over their own bodies.

By their court, what is feared can be ruled and legislated against. Even if it is the torture of babies who are not meant to live outside the womb. Ask a parent who has had to watch the minutes-long “life” their child endured before nature took over. Was that a peaceful death? Or did it look tortuous? More to the point, did their child die in pain?

By their court, the president has the powers of a king.

Please vote.

I am a patriot. Not only because I signed and swore my oath as an Air Force Reserve cadet at age 18.

I believe in this country and its people.

Even if it is hard at this particular moment.

This has been a dispatch from the healthcare front,

Kate

The best kept secret of the OR-part 1

Oh, boy.

Another series.

This one will be the secrets of the OR that your preceptor hasn’t told you.

The OR is many things. It is demanding, and fast-paced, and a steep learning curve, and demanding.

Yes, I know demanding is there twice.

And it is, in fact, the first secret.

The OR demands excellence from all of its workers. From the orderly to the circulator to the scrub nurse to the anesthesia team to the surgeon.

Why?

For the patient who is under anesthesia and has put their trust in us, the OR team.

Is the OR for everyone?

No.

No shame to the ones who are unable to work in the OR.

It isn’t for everyone.

Not everyone can rise to the level of excellence that the OR demands of us.

See, demanding.

The first thought in an OR person’s brain is not when is lunch/break/home time or I don’t want that case, or I had the hard room yesterday, make my coworker do it. It is and it should be how can we take care of this patient.

You have to park your stomach in your lunch box and keep going until you are relieved. You have to not whine when the hours are hard and Becky got to go home early yesterday and Joe never does any work, ever! You have to be aware of the steps of everyone else’s job and can step in if the circumstances demand it, within the scope of your license.

The hours are long, the floor is hard and your back WILL hurt. If you ask others, there is never enough help, and the doctors are demanding, and the charge nurse plays favorites.

None of that matters. Only seeing the patient safely through the steps of surgery matters.

And is our mission.

The OR is demanding. This is the first secret of the OR.