25-LOL

The post-it reads “Alpha numeric spelling is just coding.”

This post-it got me thinking about coding in a couple of different ways. What is meant by coding? It is a communication style that seeks to with hold information that might be damaging or incomprehensible to the non speakers. For example the anesthesiologist can say that they need an ABG, CBC, BMP, PT/PTT, T&C and a lollipop, and I know that something bad is happening or has the potential to happen at the head of the table.

I was kidding about the lollipop.

This spate of orders makes me wonder if there is unanticipated bleeding and the patient is not doing well. In response, I would look at the suction canister to see if I can see what they are seeing, and I would offer to get the tube colors that they need as a way to confirm the colors that they need. I would also glance at the back table/mayo and offer the scrub tech additional lap sponges if I see they are down to one or two. I would nudge the red lined kick bucket to be more accessible for the scrub tech.

I would also ask if the patient needs a higher level of care. By that, I mean does the patient require ICU or a transfer to a tertiary hospital. This is code

My next step is to call the supervisor to request an additional set of hands or the ICU bed or to get the ball rolling on the EMTALA paperwork. Which is the Emergency Medical Treatment Act and Labor that allows the emergency treatment of patients.

All of that from the sudden request for lab tests. But, to be more specific, those lab tests. The 17 letters tell a story.

Yes, but… Talking in medical code, AKA the acronyms that you know are near and dear to the heart of all medical personnel, is also done to protect patients. After all, little pitchers have big ears. This means that there is always someone who is listening. And being human they often will take the worst inference of what was just said. AKA the patients will jump to conclusions that aren’t true. And panic.

Parents do this too. Parents can spell out a word that they know the child will react to. Such as B*A*T*H or I*C*E*C*R*E*A*M.

Pet owners do this as well. Such as spelling out the word R*I*D*E or V*E*T.

Both times it works until the kid or the pet can work out is being spelled.

Are we coding in these instances so that the kid or the pet doesn’t become too excited?

I am writing this post because I caught myself coding a social media post the other day. I didn’t care how other people perceived the post but I wanted to share the information for those who are also frustrated by the current atmosphere.

And there I go again! AARRGH!

I think I need a N*A*P.

Post-it Sunday 12/15/24-Napoleon who?

The post-it reads “The shortest surgeons are the biggest assholes.”

That could be the complete post right there. It is truth. If we have all decided that this is truth, we have to unpack it a bit.

The question remains what level of asshole.

Because, yes Virginia, there are levels to asshole. It is nearly Christmas and that IS a Christmas reference. It refers to the 1897 editorial where Virginia’s question is answered.

There is the instrument-throwing asshole. These are the ones who decide that the instruments are not up to snuff and they are tired of complaining about it. Hence, the throwing of the instruments. This is also one of the angrier assholes.

There is the globe-trotting asshole. These are the ones who absolutely, positively need to add on a case and the case has to be done as soon as possible because they have a plane to catch. Do they really? Or is that a handy excuse.

There is the gotta make dinner with the spouse asshole. These are the ones who swan up an hour late and try to get finished with surgery in time to meet their spouse at a restaurant. This is a close cousin to the globe-trotting asshole.

There is the deity’s gift to surgery. These are the ones who decided that the rules do not apply to them and they can absolutely jump the add-on line. After all, do you not know who they are?

There is the my father will hear about this asshole. These are the ones who followed in daddy’s footsteps and became a surgeon. They are a short step away from deity’s gift to surgery type but there are enough of them I decided they needed their own subcategory.

There is the operate on holidays because they are a miserable bastard asshole. Yes, I’ve worked with one of these. They were not religious and called us out on every, single holiday, especially Christmas. And 4th of July. And Memorial Day. And Labor Day. And President’s Day (this is a real holiday in California). And Thanksgiving. And New Year’s Eve. And New Year’s Day. Why they were on call every danged holiday, I don’t know. At least we were guaranteed call-back pay.

There is the too smart for this room asshole. These are the ones who are convinced that they are the smartest one in the room. We’ve all worked with this one. They delight in the “Well, actually” put down and mansplain or womansplain or theysplain the ENTIRE case.

Of course, there are exceptions to every one of these categories. Sometimes a short surgeon isn’t an asshole, sometimes a surgeon really does need to catch that flight, sometimes the spouse will leave them if they are late one more time because they have been taking care of patients, but sometimes they are just assholes. No matter their height.

School Me Saturday 11/2/24- minding your p’s and q’s and citations

As an adult learner, I have had to unlearn and re-learn so much.

I write unlearn because I picked up some bad habits when it came to writing essays as a high schooler. I would spend a lot of time thinking about the essay that was due. And then I would research what I had to do. I would finish the book if it was a book report. I spent a lot of time thinking about opening hooks and sentences and essay structure.

I still do a lot of my writing in my head. Even during my fourth degree. I am unsure why this is the way that I have worked, am working, and will continue to work.

Writing is my favorite, after all.

Much better than math. Or statistics. So many statistics classes. I am not sure if I’ve shared this before but I decidedly do not have a math brain. At least not a higher-level math brain. I mean, simple math, algebra, and even geometry are doable. But beyond that? Anxiety city.

This was supposed to be a post about spelling and citation errors.

Apparently, I am not in the mood.

Spelling errors and citation errors will tank your grade because at the collegiate level, they include that in your grade and absolutely will take points off for errors.

There are many different kinds of citations. Find out the citation style that your program uses and embrace it. Embrace it hard-core. This will only help you.

Also embraceable is the spell check. I cannot stress this enough. Nothing impacts a grade more than using the incorrect tense/spelling/contraction/conjunction in a sentence. It makes your essays hard to read.

As a former editor and a current reader, I can tell you that nothing knocks me out of a written article or paper than a spelling error. Or badly used punctuation.

But nothing gives me more glee than noticing an error in a school document, such as the syllabus.

Typos happen, acknowledge that this will happen to you and go on and write the danged essay.

Just be aware of spelling mishaps, and the stray badly written sentence. Your writing will be better for it.

Post-it Sunday 10/20/14-hoarding

The gown card reads “Hoarding is not a good look and leads to panic.”

Yes, this is an operating room topic that I’ve written about before.

Yes, this is something that is happening in the real world right now because of hurricanes.

Yes, I am a bit late covering this for the hurricanes. Gee, Kate, Helene, and Milton were like TEN days ago. What? I live in North Carolina and I’ve been busy.

To be explicit, I’ve been busy with school, not with horrific water damage.

Hoarding is what happens when the OR fears that there won’t be a piece of equipment, a surgical supply, or a certain instrument(s) available for their case.

Instead of considering the entire picture of the surgery schedule and the fact that the case that needs X isn’t until late afternoon, with plenty of time to turn it over, they take X and hide it.

I am talking about any number of things in the operating room. An irrigation machine, a video tower, everyone’s FAVORITE C-arm, a battery, it can be any number of things. Most egregious is when the room doesn’t even need it for any of their cases but squirrels it away so 1) no one else can have it or 2) they can look like a hero to their doctor who might (emphasis on might) need it.

This is problematic for a variety of reasons.

It breaks trust in the department.

It makes it look like the department urgently needs a supply. It doesn’t, the supply is in a drawer in a room, location known only to the person who put it there. And maybe their work bestie. You now, for days they are not there.

The team members in question are greedy and desperate to be the hero when THEIR surgeon needs X and they abra cadabra produce it.

This is just as big of a problem as it is in the real world.

In the real world, I am talking about toilet paper.

Of course, I am.

The same reasons apply.

People are afraid that they won’t have it in case of emergency. Or what they think is an emergency or because Debbie Down the Street has it and I need it. ‘ll buy it ALL up and I will have it all. I will corner the market in tissue paper.

Just don’t. You have enough toilet paper, water, canned goods, etc. Leave some for people who really need it.

Did covid hoarding teach us nothing?

Cookie Thursday 2/15/24-cracker toffee with chocolate on top

To recap the theme of the month is Tracie’s Favorites. This is sadly the last Thursday that Tracie will be at the hospital and the fourth cookie on her favorite list is cracker toffee with chocolate on top. This is also called Christmas Crack, or Cracker Crack but I like Cracker Toffee with Chocolate on Top as a name.

Let me tell you a little about Tracie. She’s whip-smart and has seen some shit in her life and is one of the most caring nurses I know. And she’s leaving us. Insert sad face here.

She let me poach her from the pre-op staff. There was a patient with an injury and a surgeon who wanted to fix the patient but the patient had had pizza about 2 hours before. It is the same old story, surgeon didn’t want to wait, patient needed surgery but it wasn’t urgent enough to compel anesthesia, or the surgeon didn’t declare it an emergency. It’s been a long time, details are a bit fuzzy. It was decided that the patient could have surgery IF it was local anesthesia only.

Well, on call there is only the OR nurse as the only nurse in the department. A local only needs 2 nurses, a monitor nurse to monitor the patient’s vital signs and talk to them and keep them calm and a circulator to do all the OR things. I took a chance and called one of the recovery room nurses on the off chance she would want to be the monitor nurse so we could help this patient.

Tracie agreed to be the monitor nurse. I think it was the exposure to the OR, talking to the patient while keeping them calm, and watching the surgery over the drapes that hooked her into the OR. After that case, she talked to the manager about training her as an OR nurse. I am very glad she did. One summer there were 9 babies born to the OR staff over the course of 4 months. This meant that there were 9 people out on maternity leave, staggered over that time. She and I tag-teamed and did ALL the call for the summer. I took the night call and she took the day call. It was grueling but we got through it.

She has been my best cheerleader in my academic endeavors. I went back to school for my BSN, and she said what about getting your MSN and teaching. I had already been thinking about it and she helped me make the decision. When I said I was thinking of going back to school for my PhD she thought I was crazy at first and has been supporting me in this decision the entire time. Through the onerous PhD application process, the interviews, the recommendation letters, through it all.

I’ve heard about her life and her husband and her kids for years. Basically watched the kids grow up through her stories and pictures. Talked at length about her retirement plans in 2025. And we talked and supported each other through the freaking pandemic. She and I both worked the entire time, because someone has to be the OR staff in emergencies.

Tracie, there will never be another OR nurse like you. It is exciting for you that this is your last week in the OR at this hospital but also sad for us, no matter what certain people say. Let’s just say there is a reason that she is leaving the department and the hospital and I don’t blame her.

Post-it Sunday 1/21/24-Make it bigger!

The gown card reads “Dear Doctors, JUST MAKE THE INCISION BIGGER!!!”

Mic drop.

I don’t know who needs to hear this but, yeah, struggling for 20 minutes because you made the incision a quarter inch smaller than normal.

What do you get out of it? Bragging rights in the doctor’s lounge? A free all-expense paid golf trip at the next conference? The love and devotion of your patients?

The push in the OR is toward smaller and smaller. Smaller incisions, smaller case times, smaller.

Just smaller.

And, yeah, that should be shorter case times but it didn’t fit the theme, you know?

I see you struggling with the smaller incisions that you make.

Yeah, patients may like a smaller incision, but how much smaller can you go? And still have the proper exposure to have to do what you are operating to do? Patients probably will be happier with a regular-sized incision and a smaller hospital bill. Because you ramp up their time under anesthesia and therefore the cost of the procedure while you struggle with exposure

I know that you know the incision is smaller. But the patient is not going to know. The incision can only stretch so much.

We were doing a case in the middle of the night. Of course, it was the middle of the night, you work nights, Kate! But the surgeon was struggling with taking out the specimen from the incision size and I mean, struggling! Thirty minutes they struggled and sweated and fought to get the specimen out, me watching from the sidelines, the sterile scrub tech helping them. Finally, they gave up and started pulling the specimen out in pieces. I asked gently if a slightly bigger incision would’ve been helpful. They sighed and said it would’ve been easier. I asked if the patient was going to notice that their incision was mm longer if they had gone for the bigger incision. They said no.

I said nothing else. I think the point had been made.

Two weeks later we had a nearly identical case, same team, same surgeon. When they had localized the specimen they asked for the knife and said to me “See, I can learn.” They made the incision slightly bigger and were able to only work on getting the specimen out for 6 minutes.

Sometimes you just need to make the incision bigger.

It isn’t a slight on the surgeon; just the facts.

Post-it Sunday 12/24/23- holiday call

The post-it reads “holiday call can be the pits, depending on where you fall in the seniority list.”

Call is what the department makes of it through policy. Holiday call is also what the department makes of it through policy.

I’ve heard good things and not-so-good things from my friends at other hospitals.

Some places choose holiday calls by seniority. Like the hospital I work at.

Reminder, the department that I work in has 9 ORs, one of which is a procedure room. There are currently 25 nurses in the department, of different hours and different levels. These levels can be PRN. If the nurse who works PRN was working this before 2015, then they are grandfathered into no call. Otherwise, everyone takes call.

PRN means pro re nata. You may have seen it on a medication label. This means as needed.

I’m only going to be talking about the RNs here. The rules are the same for the scrub techs.

Unlike the banking or government sector, the holidays that count are dependent on the state. I believe here in North Carolina, there are 8 holidays that the surgical department is closed. These are the standard holidays like New Year’s, Christmas, Memorial Day, Labor Day, and Thanksgiving.

In the surgical services department where I work, each holiday is split into 12-hour shifts, a day shift 0700-1900 and a night shift 1900-0700. The department also voted that Christmas Eve after 1900 and New Year’s Eve after 1900 are considered holidays. This puts them into the mix.

Going back to our numbers, if there are 8 holidays, including eves, split into 12-hour shifts, effectively doubling the days that need coverage. This means 16 shifts need to be covered. By 25 nurses. This is where seniority comes into play. This is seniority in the department, not in the corporation.

I’ve been there so long (15 and a half years) that I have the most seniority of the OR RNs. Which means I don’t have to take holiday call.

Signing up for holiday call, even by seniority, can be a challenging thing for management to handle. To ensure that no one gets a “hot” holiday, such as Christmas or New Year’s, more than once every two years. There are even lists of the holidays and an A team and a B team who chooses.

Because the OR must be staffed in case of an emergency. Even if it is taking call from home.

This year Christmas Eve, that’s today!, is on a Sunday, which added an extra day to the holiday call rotation.

I’m still senior to everyone else and I didn’t have to take any holiday call this year.

If you are on call this weekend or next, or not, have a Merry Christmas! And a Happy New Year.

Don’t forget to think good thoughts for 2024.

We are going to need them.