And now the weekly funny

There isn’t much to laugh about these days.

Covid.

Over 240,000 deaths since this all began.

People who won’t take the mask thing seriously.

Whatever the hell is going on in Washington.

Laundry.

However, on Tuesday night.

While we were doing the safety pause prior to incision, I read aloud the patient’s name, date of birth, consented surgery, and her allergies.

On the board was written, Demerol, latex, and Meperidine.

I skipped the Meperidine.

The surgeon called me out on that.

For saying the Demerol and skipping the Meperidine.

I turned and looked at him, trying to see if he was being funny.

Nope.

I bit my lip behind my N-95 and surgical mask and peered at him behind my goggles.

And I told him Meperidine and Demerol were the same thing.

He was flabbergasted.

Coronavirus is still simmering, coming to a boil

I’m not sure how to track how many months this pandemic has been.

From the first American death in Washington in January.

From the first time I heard of a new virus in China, in December. I remember thinking to myself, this is interesting.

From the first lockdown talks.

From the time we started closing our borders in America.

From the time I started preparing for elective cases to cease.

From the time it was declared a pandemic.

From the time it started to seriously impact my schooling.

From the time it started to be heavily in rotation on the news.

From the time I first wore a mask in public, self conscious as always.

From the time the lockdown began. Although I continued to go into the hospital for my shift every day.

From the time the governor of my state declared the first lockdown rules.

From the time the schools started to close.

Any way you cut it, it has been a hell of a year.

And there were things that could have been done differently that would put us in a much better place. So many things could have been done on a national level.

So many things we’ve all lost.

So many memories we won’t get back.

However.

As healthcare workers, we remain, mask and goggles on.

I propose a study

We have a new process in the operating room.

It is a hepa filter that is very powerful.

It will be used next to the patient’s head during aerolizating procedures such as intubation and extubation.

IT IS VERY LOUD.

AND NEXT TO THE PATIENT’S HEAD AS THEY ARE EMERGING FROM ANESTHESIA.

It is to be used on all patients who do not have a covid test prior to surgery.

Um, that’s like 80% of the evening patients.

We are still to use N-95 masks.

On the evening shift we’ve been doing this for nearly seven months.

In the beginning none of our patient’s were tested. Everyone was thought to be a person of interest or potentially infected and treated accordingly.

The number has slowly gotten better over time with access to testing and testing prior to elective surgery becoming more common.

However, no one know when they are coming to the hospital to get emergency or urgent surgery.

And the pre-op tests are for 96 hours before surgery.

Again, not an evening shift type of thing.

But apparently this new hepa filter is.

My theory, which I will propose as a PICOT if I have to, is that the loud hepa filter next to their head, as they are waking up from anesthesia, will activate their flight or flight instincts. Leading patients either to try to get away or try to fight us off.

Either way they will be struggling or fighting the staff.

When they wake up.

Because IT IS VERY LOUD!

I have seen this with my own eyes.

I have held down a waking patient up as they panicked.

So, I propose a study.

Now to get the research council’s backing.

Drowning? A bit.

I have talked about how I have been anticipating staff changes due to the pandemic.

I thought that there would be staffing gaps as people left for various reasons.

And I was correct.

Our tech numbers, which had been very low, are rebounding.

We are nearly fully stocked with techs.

The nurse numbers.

Those are a different story.

This nurse had a baby, this nurse had surgery, this nurse left to pursue other things such as administration. This other nurse left because.

We have new nurses coming on. But they are still in orientation.

I do not approve of rushing orientation, especially for surgeons who are as spoiled as ours.

I also do not approve of rushing tech orientation, although I lost that battle. And they rushed 2 techs through orientation. Not ideal.

I do not approve of throwing the orientee nurse into an “easy” room and telling them to go at it and we would be by to check on them.

And now another nurse has gone out due to surgery.

I told them I would be available on mornings to help out.

They have yet to call for my help.

Be kind

“Be kind.” I whispered to the doc as I gowned and gloved him.

To facilitate the closing of his enormous case I was going to scrub while he was closing, leaving the real scrub tech to count all ten trays.

“Be kind.” I whispered to the resident as I gowned and gloved him.

This was a new resident for us and I wanted to alert him that I was not the regularly scheduled scrub tech and he would have to be patient with me as I scrubbed the closing with him and the surgeon.

“Be kind.” I told the ambulatory care unit as I was handing them yet another add on sheet.

Each add on sheet represented a patient who was in need of care. And it was our job to render that care.

“Be kind.” I told the x-ray department while I was trying to get them to the room to do the surprise closed reduction.

I say surprise closed reduction because the message was not passed on to them for the need of x-ray.

“Be kind.” I told the endo nurse I had to call in to finish the case with us.

The message for the need of endo at the end of the case had gone awry. I had not seen any endo nurses since the end of their shift and I was making sure that there was someone available to do the endo part of the case so that the patient would no have to wait.

“Be kind.” I told my orientee as I walked her through the proper way to put formalin on specimens that don’t fit in the pre-filled container.

It has not escaped my notice that some circulators fill the specimen container with the contents of many pre-filled containers to the detriment of their health. This drives me crazy.

“Be kind.” I told the lab department when I called and asked about how to set up uncross-matched blood and if they still had a pink top tube and could cross-match the patient.

Because both arms were tucked tight to the body under the drapes, and the legs were in stirrups under the drapes and we’d had an unexpected 1500ml blood loss in five minutes.

“Be kind.” I told the recovery room nurses as I handed off the patient.

I explained the need for the conversion of the robot case to an open case. I cautioned them about the blood loss and the need for blood collection to check blood counts.

“Be kind.” I whispered to myself.

Still not pan(dem)icking

Play on words.

No, we in health care are not panicking.

We are not running round like chickens with our heads cut off.

We are just trying to keep our patients, the families safe.

We are just trying to keep our own families safe.

Wear your mask.

Wash your hands.

Do not panic.

It’s been a long nine months, almost long enough to have a baby.

Who knows how many more due to the mishandling of this crisis in this country.

We are not panicking.

We are living in this new normal until we have a vaccine, or the social distancing mores have starved the virus into submission.

I’ll wait.

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?