Call Secrets of the OR- Keeping up with the Joneses, Dr. Jones that is

Call is my job and has been for nearly 4 years, since December 2021.

In that time, many surgeons have come and gone.

There have also been many different pieces of equipment that may be useful at night that have been introduced to the OR.

There have been many changes to the instrument sets.

There have been many changes to the type and style of suture that are kept on site.

There have been many misguided re-working of the OR core. The general cart specifically.

There’s even been a brand new robot introduced into my OR.

Guess what?

Even with all of these changes I am expected to still know everything.

When a surgeon asks for a certain piece of sterile supply, an AbThera, I am required to know where it is. And when I convince the surgeon that no such thing lives in this OR because it doesn’t match our negative pressure wound machine, I have to be able to trouble shoot Macgyvering or cobbling together a facsimile of available sterile supplies. While we are putting our Frankenstein dressing on, I am required to listen to the surgeon bitch about the department not having such a thing. After all downtown’s hospital has it. The why doesn’t this hospital is sometimes silent, most likely not.

Sigh.

The point of this post is that it takes a lot of time and effort to keep up with the various changes to the operating room. But also not look I’m struggling when I can’t find the exact thing the surgeon is asking for. Kind of like Ginger Rogers dancing all the dances with Fred Astaire; only backward in heels.

I just have to bear in mind that the surgeon and I are united in our desire to provide the best care for the patient currently on the table.

Sometimes that requires a little imagination. And a little homework.

In order to keep up with the Dr. Joneses, I tour the OR when I am there and make note of the changes. Because, you know, no one is going to loop me in.

I read my work email nearly every day, looking for policy changes.

I attend the staff meetings when I am able.

I ask questions.

Just keeping up with the Joneses (department changes) can be a full time job.

Good thing I am built for this position.

Call Secrets of the OR 10/29/25- all call cases are emergencies

All call cases are emergencies. I admit sometimes they are emergency adjacent but still the case must be done. There are the rare exceptions when the call team did a total knee in the middle of the night and then discharged the patient because the surgeon, who was 5 hours late, insisted. That’s for another time.

All call cases are emergencies. To that end, it is okay to tell another department who has their gurney waiting outside the room when you go to pick up a patient that their non-emergent test is just going to have to wait.

Yes, that happened.

Another nurse and I were up on the 4th floor picking up a patient. We packaged the patient up. This means that we removed all the monitors, and replaced them with our own, we cleared all the stuff from the bed that wasn’t the patient. We unplugged the bed and told the family to follow us to the elevators and opened the door.

To be confronted by a worker from another department, ready with a gurney, to take the patient to their department for a non-urgent test.

Um, no you may not have the patient for your non-urgent test.

No, I don’t care that this patient is next on your to do list.

No, I don’t care that it looks badly to your supervisor if you don’t get the test done in a timely manner.

This patient is ill, ill, ill and requires emergent surgery to fix what is wrong with them. Well, not fix, but to remove the offending body part that was making them so sick.

No, we have to rush down to the OR and start the surgery.

No, you will have to do your non-emergent test on them after surgery.

No, I don’t know how long the emergent surgery will take. Surgical cases take as long as they take for the surgery.

No, I don’t care that this is the last thing on your to do list and you get to go home after the non-emergent test.

Sometimes you just have to say no and mean it.

Even if it means blocking another department from getting their hands on the patient for a non-urgent test that could wait until morning. But they don’t want to tell the hospitalist the non-urgent test wasn’t done.

Sorry for delaying this non-emergent test for a real, honest to goodness emergency surgery without which the patient has a good chance of dying.

Nah, not sorry.

I’ll probably hear about this later from my manager.

Oh, well.

At least we saved that patient’s life.

Secrets of the OR- Sterile processing, the unsung heroes of the OR

You think you know the OR? As if.

We know the usual cast of characters in the room.

The circulating nurse who bosses everyone around and ensures that the patient has everything they need. Including activating an emergency team.

The scrub tech who is in the sterile environment with the surgeon and assists who knows what the surgeon needs before they ask for it.

The CRNA who ensures that the patient is comfortably anesthetized and is prepared for any emergency.

The anesthesiologist who supervises the CRNA, up to 4 rooms at a time and who pinch hits for the CRNA at times.

The patient without who none of the cast of characters would be there.

But, do you recall the most famous reindeer of all?

Just kidding; it takes more that the usual cast of characters to safely see a patient through surgery.

There is the pre-op team that makes sure the patient is prepared for surgery. They know all about the patient and is a source of comfort for them as they wait for the surgery to begin.

There is the post-op team that makes sure the patient is comfortable waking up from surgery. In the hospital where I work the pre-op and post-op teams are comprised from the ACU/PACU team.

But the one you hear the least about? The ones who cleans the instruments, readies the trays, sterilizes the instruments, and puts the sets back where they live so that the OR can find them.

The sterile processing department. SPD in the hospital I work at.

They know everything there is to know about the trays. They should they put them together from the jumbled mess that the scrub tech might leave. Depends on the scrub tech. If asked about a certain instrument that was dropped they might be able to point the circulator in the correct direction for a replacement instrument.

The first thing they do is decontaminate the instruments that have just been used in a surgery. There are washing machines, similar to a dishwasher, that are used. But, just like in real life, the gross bioburden has to be washed off many of the instruments. By hand.

They inspect all instruments that they get out of the washers. They make sure that the tips of the instruments meet and are not out of alignment. They make sure that all the lumens of instruments are clean with air or a brush prior to set assembly. They make sure that all the very fine instrument tips are not broken off because of mistreatment. Then they string the instruments together in the order they appear on the count sheet.

They double check the count sheet to make sure that everything is accounted for in a set. If not, they mark the set as incomplete and put on a bright orange sticker that indicates what is missing. If too many things are missing the set it taken out of use and set aside until the missing pieces are located and the complete set can be sterilized.

How does an instrument get lost? This is out of their control. Sometimes the instrument is thrown away (I tried to get a research project off the ground to decrease inadvertently thrown away instruments by using a metal detector. I maintain it would have worked too, but covid shut that down). And sometimes the instrument is in another tray from the same case, just misplaced.

They maintain a bin of lost instruments from the misplaced instruments that are retrieved after the sets are put back together. These instruments can be from the core, where there is an entire shelving unit full of sterilized single items. Sometimes it is a replacement for the scissor the surgeon just dropped, sometimes it is a replacement for the orange sticker. SPD puts these back up in single sterilizer packet. This is a down time occupation. The downtime of which there is very little because some of the sets are needed later in the day and the set from the 0700 first case has to be washed, inspected, put back together and sterilized in time for the case that starts at noon.

They know everything there is to know about the instructions for use of the sterilizers and the instruments that might go in the sterilizers. These are the IFUs. These indicate what is the best sterilization method for a given instrument, including parameters of time and exposure.

We’ve come a long way since the days of one set of instruments that was washed and flash sterilized for ALL the cases of the day. Or the care and maintenance of the Cidex, which is a semi-sterile instrument dip that was sometimes used the before times that would expire. Or the care and maintenance of the Steris machine, which used an acid bath to delicately clean scopes and cameras that could not be sterilized in the autoclave. Or the care and maintenance of the newer machines like the Sterrad that uses plasma to sterilize cameras and scopes.

They had to have all of that in their heads. Or at least readily accessible to look up on the spot. But in my experience, they kept it all in their heads.

SPD workers have to be efficient and know their stuff. And keep all the rest of it in mind as they do so.

No sterile instruments? No surgery can be done safely. There aren’t enough antibiotics in the world to cover that.

Call Secrets of the OR- OR investigations

Once upon a time that really happened, the patient was not waking up the way they should. All the anesthesia gases were off, the reversal agent given at least 10 minutes, but they were not opening their eyes or making any effort to, you know, breathe. Time ticks by, first five minutes, and then 10, and then 15 minutes. The anesthesiologist has been called to the room.

While anesthesia is trying to wake the patient up, you drag the workstation on wheels to the patient’s bedside so you can be an active part of the extubation, but also able to read the chart looking for clues.

There are none.

Time for a group think.

You ask about family history that isn’t in the chart. You remember that there is an enzyme deficiency that delays the clearance of anesthesia. You remember because one of your med-surg patients had it and would call for a certain medication whenever she woke up from anesthesia. You remember her telling you that she had a liver problem in the beginning of this conversation. And not only did she have it but so did her youngest daughter. And the last time there was a very long delay in waking up from anesthesia on one of the cases you’ve worked, it was also an enzyme deficiency. The same one the med-surg patient had.

The anesthesiologist goes out to the surgical waiting room to ask about family history of slow wake ups. This was covered in the pre-op consultation at bedside but this is a check in that what the patient and family said pre-op is correct. This is where they remember that grandfather would talk about the time that it took so long for him to wake up after surgery that when he finally did it was the next day and he was in ICU. But no one else has had a long wake-up. Not that many of them had ever had surgery other than babies.

There is such an enzyme deficiency that causes this. It is called pseudocholinesterase deficiency. This is an enzyme that breaks down anesthetic medications, such as succinylcholine. This is the medication that is often used to paralyze the patient prior to intubation.

Unknown to any of us, and the patient, and the family, this patient had a pseudocholinesterase deficiency. Their liver wasn’t metabolizing the paralytic, which kept them unable to breath on their own.

This is a quandary. There are two paths. The first is to keep the patient intubated in the operating room until enough time has passed to allow them to breath on their own. This is costly as an OR minute is expensive and who knows how long it will take before the patient wakes up. And also it effectively ties up the anesthesia team and leaves OB especially vulnerable in case there is a stat section. The second path is to keep the patient intubated, call for a ventilator to be brought to the PACU, and admit them to the ICU. Not long, just long enough for them to start breathing on their own. This can be anywhere from 2 hours to 12 hours.

The decision is made to move the patient to PACU and the waiting ventilator. If they are not extubatable at 2 hours, then PACU would move the patient to the ICU. Because call back time for the PACU nurse is expensive.

The first thing to do as the OR call nurse is to check the hospital census. This is a picture of what rooms are available. The second thing is to call the supervisor and tell them about the situation and the steps that might need to happen going forward. They promise to save an ICU bed.

The patient is moved to PACU, and attached to the ventilator and the monitors.

The waiting begins.

After the patient is settled in PACU, on a ventilator, you call the surgeon, who has been long gone, to tell them of the situation. Regardless of the working theory it is pseudocholinesterase deficiency, the surgeon still needs to be informed of what is going on. You tell the surgeon of the plan to wait in PACU for 2 hours and then the admission to the ICU if the patient is not yet awake.

You check in the PACU nurses and tell them that you’ve called the surgeon and gotten them up to speed on the situation. If there is nothing else, you will be heading home because OR call back time is expensive and being in the PACU when there are 2 recovery room nurses is expensive.

You remind them that the nursing supervisor is aware, there is a bed being held and the surgeon is aware. They run through the plan again with you of 2 hours intubated in the PACU and then, if not awake enough to extubate, admission to the ICU. They tell you to go home.

On your way out of the PACU you pass the anesthesiologist who is writing a letter to the patient advising them to be tested for pseudocholinesterase deficiency and advising them of the importance of having the family tested to. Because this is a genetic deficiency and is passed down. Like the patient’s grandfather likely passed it down to the rest of the family.

Luckily there is a test for that.

You tell the anesthesiologist that the PACU nurses know the plan and ask if they’ve spoken to the family again. If they have, you are going home.

The anesthesiologist assures you that the family has been spoken to and are waiting to see which path is to be taken.

You head home.

In a rare follow-up, you learn that the patient was able to breath in the PACU after an hour. They were extubated and sent home with family. The entire family was aware that they had to be tested or tell the next hospital and operating room they found themselves at.

This was the best case scenario. If the patient hadn’t been a young, health individual with a possible family history of pseudocholinesterase deficiency, more steps would have been taken in case it was something else. A head CT would have been the next stop to check for a stroke, and labs would have been drawn.

But not this patient. They were able to be extubated and go home with their family. With a heck of a story to tell and homework to do.

Call Secrets of the OR 9/10/25- We all need a hand every now and again

Sometimes the middle of the night surgical case is because it truly can’t wait the handful of hours before day shift. In the OR world we call that a life or limb emergency and it trumps everything, including power outages.

The thing is that most of these life or limb cases require more hands than the anesthesia team, scrub tech, surgeon, and circulator. I’ve already talked about calling in the PACU nurses for that extra set of hands, but what do you do while you are waiting for them to show? It’s not like you can tell the patient and the surgeon to chill out while you get more help.

The first thing you do is call the nursing supervisor and ask for any nurse or CNA that is free to come help. This is a move that is highly irregular and you will hear about it in the daytime from your manager. But remind them that the patient on the table who is actively trying to die but not actively enough to call the code button.

Another option is to call and wake up the manager and put them to the task of finding you a second set of hands. Once upon a time I lived less than a block from the hospital and they all knew it. I was as open then as I am now about pitching in and lending a hand when needed. One night the phone rang and it was L&D. There was a mother in full arrest and they were running the code blue but they needed to get the baby out pronto. Of course I threw some clothes on and ran down the street. They were doing chest compressions as I entered the OR to prepare for the section. The mom and the baby both lived. Apgar 6 and 8 for the kid.

But what do you do when you have the person who is pitching in? You give them an abbreviated version of the nursing student in the OR talk.

Don’t touch anything blue
If you do, just tell me and we can make it right
If you feel faint sit down, don’t even try to make it out of the room because you will not be able to

With a few questions you can ascertain their comfort level with basic nursing care and you can assign them. Anesthesia probably needs a second set of hands too. Get them to assist anesthesia. There will probably be STAT blood tests to order and vials to run to the lab. There may also be the need to hang stat blood and that is another thing they can do. This will free you the circulator from having to serve two masters and you can focus on the operative field.

One night there was a patient with belly bleed and we had suddenly gone through an entire basin full of laps when the surgeon asked for a blood loss estimate. This was when I had the PACU nurse who had arrived by then pulling the bloody sponges out of the basin and weighing them and putting them into the counter. A quick and dirty blood loss estimate is the weight of the sponge minus 20 grams because that is how much the sponge weighs. And a cc of blood roughly is a gram. For instance, it the bloody sponge weighs 55 grams minus 20 grams for the sponge equals 35 grams equals 35 cc of blood for that sponge. It isn’t wholly accurate and off by a couple of ccs give or take but it is a good ballpark figure to give the surgeon.

Remember your extra person doesn’t know what you know, and doesn’t know where anything is in the OR. This is where you curse that the Vulcan Mind Meld isn’t real and you can’t just download the information to their brain. But they do know how to make phone calls and put labs in. There are things that are too complicated for them to do like count instrument if you have to open another tray. Also they should not write on the count board. Only one person, you, should do that to decrease the chance of a miscount.

You can also show the extra set of hands how to open a package sterilely. Start them with something easy like a pack of sponges and show them how to hold the package in your hand and open the inner package like a present while it is resting on your palm with you thumb stabilizing it. If this is delegated be sure to keep an eye on them as they open sponges.

Someone needs to keep the family in the loop while also managing their expectation. This phone call is best from you as you know what to say. If you are too busy, ask the surgeon what message to give the family and the extra set of hands can relay it to the family word for word.

The patient is most likely going to a higher level of care floor in the hospital or even to a higher level of care hospital. Making those phone calls is something that the extra set of hands can absolutely do.

Congratulations, you and the extra set of hands saved the patient’s life. Tuck the patient in to whatever unit they end up on, or help the nursing supervisor send them to a higher level of care hospital. Now go write a wow card for them or a glowing email to their boss. After you’ve finished your charting.

Medical non-fiction podcast review 9/7/25- Dr. Death Season 1- Dr. Duntsch

I would be remiss if I didn’t review the medical non-fiction podcasts as well. There are some really well made ones out there. My favorites are from the Wondery studio.

This was a podcast that was recommended to me in 2020 by a certified registered nurse anesthetist (CRNA) as something I might be interested in. The first season that I am going to talk about was released August 2018 and ran through October 2018.

I listened to the first season avidly, aghast that an MD would be so negligent. But then I never thought of it again. Why? There was a little pandemic that also happened in 2020. Does covid-19 ring a bell?

Not to mention I graduated with my MSN in May of 2020. I used to listen to the recast episodes on my way to teach in January and February before the world shut down in March. And then I got a little busy. And then I went back to school in Fall 2022 and moved on to listening to other medical podcasts on my trips to the university.

Dr. Death is a story about the arrogance and

Dr. Death is about an orthopedic spine surgeon who left a trail of broken backs, death, and broken dreams behind him. He graduated from the University of Tennessee and did his training at the Tennessee Health Science Center. He only completed 100 surgeries out of the 1000 surgeries in a standard neurosurgery residency. He was hired by Baylor Regional Medial Center in Plano, Texas where he began to leave broken bodies behind.

He is the epitome of fail up. He would be invited to leave by a hospital and would leave for another hospital and damage patients and be invited to leave the second hospital. Rinse, repeat. Death and paralysis trailed in his wake.

No one had the presence of mind to stop his slow moving rampage until two surgeons who were called to repair the damage that Dr. Duntsch had wrought compared notes. They were determined to have charges filed against him. The filing of charges against another doctor is not a done thing. It is easier to have them resign and not care about where they go. This disregard for life at another hospital is a failure of the medical system and carried on far too long.

Of interest is that he chose neurosurgery, one of the most technical and prestigious of all surgery types, because it was considered the most lucrative. Of the 38 patients profiled for Dr. Death, 31 were harmed or 2 died as a result of his arrogance.

He is in prison for life and is not eligible for parole until July 2045.

Kudos to the two surgeons who were able to work with the Dallas prosecutor to stop him. Really stop him, not just pass the buck to the next hospital. Not just pass the buck on the next patient that would be harmed or killed. .

This was a very easy to listen to podcast. It was broken down over 7 episodes, although there are several additional bonus episodes that attached at the end of the episodes, from his appeal that he filed to the introduction of the actors that were in the television show.

About that, I had heard that there was a television show made of the first season that premiered in the time of the world is trying to kill us still of 2021. It ran until 2023 and is currently streaming on Peacock plus or available for purchase from Prime Video. But I don’t watch television and then I finished the first season of the podcast I removed it from my list and I had no idea that three other seasons had released. I will be listening to these. Dr. Duntsch, Dr. Fata, Dr. Paola, and Dr. Gumrukcu. I have some listening to catch up on.

But as a surgery nurse I have to question where are the nurses at the hospitals that kept failing him up? Were they part of the complainants that got him fired but not prosecuted? Did they just blink at his behavior and say “Well, that’s just Dr. D for you.”? Where were the scrub techs who can also voice objections? Granted, as the surgical team we don’t know a lot about patient follow up, except when the patients return for a revision. But surely question were raised among the teams.

This is also a failure of the surgical team. It is our duty to point out problems and mistakes that the surgeon might otherwise try to brush off.

I recommend this podcast to anyone who is a scrub tech or a surgical nurse. It is up to us to recognize and stop these surgeons when they are harming patients.

Call Secrets of the OR- What to do when there is a screw up with the call sheets that you tried to head off and a day shifter got called in when they shouldn’t’ve

Well, that’s a run on sentence.

This exact scenario actually happened less than a month ago.

You see, for my 49th birthday my sister had gifted me tickets to see Cary Elwes (the Dread Pirate Roberts aka Farmboy aka Wesley from The Princess Bride) for January of this year. That was when his house burned down in the Los Angeles fires. Understandably the show was cancelled and rescheduled for May. And then that show was cancelled and the money refunded to my sister.

She asked me to pick another show. We ended up going to the Postmodern Jukebox when it was here locally. It was awesome.

But the show was on a Thursday. I calculated how many hours of PTO I would have to use to cover the show and the driving home. Four hours. I asked for 4 hours off. On the calendar that everyone’s time off is posted I made a notation over my name on that day that I only needed coverage until 2300.

I fully intended to take 2300-0700. Like the good little call nurse that I am.

I called the OR in the afternoon to check on the call sheets reflected that I would be on call after 2300. They assured me it was correct and to have a nice time.

My conscience was clear and I went off to enjoy a dinner out at a new to us restaurant and a rollicking good show. Side note, if you are sleeping on these performers stop. Check them out on YouTube right now. My personal recommendation is the House of the Rising Sun.

I was home at 2300, as planned, and reading, also as planned, when the PACU call nurse texted me at 5 to midnight that the nursing supervisor couldn’t get ahold of the call nurse.

But…but I’m the call nurse.

I checked.

I texted the PACU nurse back.

I called the nursing supervisor and got the surgeon’s name and number.

I called the surgeon and arranged for surgery time to be at 0100.

I called the surg tech.

I called the nursing supervisor back and told them that I had spoken the surgeon and gave them the time and that I was on my way in.

I got in to the hospital, changed, and scheduled the case. Just like a normal night call case.

Suddenly the OR core door opened and it was a day shift nurse. Called in to do the same case I was setting up.

whomp, whomp

The best laid plans.

I told them to go home. And that I would handle it and also handle the necessary conversations with the evening nurse I had spoken to.

They went home.

I picked up the patient from the ER and delivered them to the PACU nurse who was there out of time because they had been called by the supervisor before they texted me. Which was the thing that started the cascade of unfortunate events.

We did the case.

I had a long conversation with the new to the job nursing supervisor. I gave them point blank instructions to call me with any problems in the future.

The next day I had a long conversation with the person who had assured me the call sheets were correct. They hadn’t even looked at the call sheets when I called them.

aaaarrrrrrrrghghghghgh!

Next time I want a half shift off, I will call the supervisor myself to check the call sheets.

But kerfuffle aside the patient needed the semi-urgent care and the OR was happy to provide.

Oh, and I also spoke to the new to me surgeon as well and gave them the sitch about call at this hospital. I also encouraged them to call me if they needed to do another night call case in the future.

Call Secrets of the OR #6- Sometimes you get beaten by the buzzer

Look, we are in the business of solving the case, of being the kiss on a boo-boo, of the patient having a problem and we need to fix it, of being the buzzer beater every damned time.

Sometimes that doesn’t happen.

And it sucks.

I had a difficult case a few weeks ago.

The kind of case where the patient is going to sleep and I am holding their hand, telling them that their son told me to tell the patient “I love you from your Danny.” He told me this while I was getting a phone consent with another nurse because the son was frantically waiting for his flight to get to the area and the patient, who was struggling to breathe, smiled.

The kind of case where you are listening to the pulse ox beeping get lower and lower and, without letting go of their hand you turn your head and tell the scrub tech to please let the first arrivers to the pre-op area (0530) to be on stand-by because the patient might need them.

The kind of case where the abdominal blocks are on hold because if the patient goes straight to the unit what’s the point of them?

The kind of case where you call the anesthesiologist back to the pre-op area that is also PACU at 0400 to tell them of the patient’s desired code status.

The kind of case where the anesthesiologist came right back and spoke to the patient and the son on the phone about what needed to happen about the code status during surgery.

The kind of case where there are a thousand different needs from the field, from the anesthesia team, from the front desk calling you for some reason because they want to tell you not to call in the PACU nurse.

The kind of case where before you even are in the room with the patient you look to see where the open beds are, hoping that there is an intensive care bed.

The kind of case where you text the nursing supervisor that you will need an ICU bed as you are on the phone with pharmacy looking for the coumadin antagonist that has been ordered. STAT.

The kind of case where the surgeon asks for an impossible item that does not live in the hospital, despite you mentioning it several times that it has been requested. The surgeon didn’t want to use the off-brand disposable.

The kind of case that when day shift workers, who have shown up by now, are in the room for the sixth time asking how they can help you send them to get gloves and to try to find the piece of equipment that the surgeon is demanding that you know doesn’t live in the hospital.

The kind of case where the surgery is cut short and the surgeon says that the patient will have to come back to the OR in the next day for completion of the surgery after the patient was worked up a bit more (we call that resuscitation). Because the surgeon knew that the patient was too ill to continue surgery, after the offending part had been excised.

The kind of case where you’d love to go home and get back into bed but you’ve a full day planned between meetings for the hospital and a long delayed birthday lunch.

The kind of case where you leave the patient open because of the need for a further surgery shortly. Open but with a wound-vac.

The kind of case where you call and ask the pre-op area to please get the ICU bed from ICU and a transport monitor and the bed that is left for the patient is a regular patient bed. And the transport monitor? It is dead.

The kind of case where it takes so long to pack the patient and their various lines up and get ready to bag the patient all the way to the ICU the ICU bed and monitor make it downstairs. And you help put the patient on it, making sure that all the lines and the foley is untangled and not caught.

The kind of case where you clock out at 0830, an hour and a half after your end of shift.

The kind of case where you tell the front desk, the unit admin, the charge nurse that the ice cream you’d made for the ice cream social that afternoon was in the freezer and every damned person in the lounge and at the desk freezes and says they forgot that it was today. You collect money and go to the grocery store across the street and buy 4 gallons of ice cream, ice cream bars, 3 different types of syrup, canned whipped cream, sprinkles, spoons and bowls for the exact amount that you collected from the guilty coworkers who forgot about the 11th annual ice cream social. It isn’t like this happens every year.

The kind of case where you go home and stare at the wall for awhile. But you have meetings to attend! So you get up and join the meeting.

The kind of case where you never know the outcome because the patient was transferred to a higher acuity hospital and it is against policy to open up charts willy-nilly because you are curious.

Ugly calls will exist.

What matters most is that you were able to comfort the patient as they went to sleep and you were able to pass on the message from their loved one. What matters most is that you were able to manage all of the calls and push and pulls of day shift and the call shift in that moment.

And that there was ice cream.

Call Secrets of the OR #2- The contact list in case of emergency

I’ve been at this call business for a long time.

Well, strike that because I swore to my big belly patient last week that I would stop saying that. I apparently told them that I had been a nurse for a very long time, not once but twice, and they called me out on it the second time. They just wanted me to be more specific.

Ahem.

I’ve been at this call business for nearly 25 years and in that time I’ve had my share of no shows or no answers or, on two occasions, the tech that I was waiting for was in a car accident.

It was odd enough the first time it happened but the second time? Eerie. Made me think of the night call unit secretary that I worked with in California. She trained me and was always there to answer questions, even after I became a nurse. She died driving home after a night shift.

This is why I always, always, always tell people when I have called them in to drive safe.

What do you, as the call nurse, do in event of a no answer/no show/accident?

If you are me, you grab the big red book of numbers. Everyone is in this book: surgeons, PAs, doctors’ offices, anesthesiologists, CRNAs, scrub techs, circulators, management, charge nurses, SPD, and the all of the department numbers for the hospital.

You know, in case you don’t have those memorized.

If you still haven’t gotten a call back or a response to the second call, you start in on the list.

Over time you will get a feel for who is friendly to a three am phone call and who might be interested. If it is a scrub tech you might even call nurses who you KNOW are capable of scrubbing the case.

That’s what I did when the first tech got into the car accident on the way in.

If you don’t get a response or all you get is no thank yous or hung up on, you call the nursing supervisor to keep trying.

If after the case is picked and there have been no nibbles you should consider more scorched earth options. You call management until THEY pick up. And dump the problem into their lap.

While this is going on you also keep preparing for the case. Because the show must go on.

In my twenty years of doing this I have never had outright nos from every single person I have called. Knock on wood. Mostly because I have garnered 17 years of brownie points at my current hospital.

Because they’ve all been there and can commiserate with you.

A very last resort would be transferring the patient to another hospital. This is the very last option because there are going to be delays getting the receiving hospital to accept the patient. There might not be room in their overnight schedule. And surgeons would definitely not appreciate this kind of maneuver.

And you’ll never hear the end of it.

If you are going to be new to call and are scared that this might happen, start gathering your brownie points now. Be nice, consistently nice, and people will have a harder time saying no to you.

There is also the mandatory call list but that is more to cover people during the day. I’ve never used it at night. But it is an option.

Know your friendlies and also know who is more likely to say yes.

That will save you, the patient, and the surgeon a big headache just trying to get the case off the board.

Being nice never cost you anything.

Think of it as banking brownie points for use in an emergency.

Call secrets of the OR #1- Know call time is not your own

Instead of Best Kept Secrets of the OR I thought instead to start a new subset of Wednesday. This is going to be Call Sets of the OR.

I got the idea last night when I had a surgeon, a CRNA, and the surgical tech all tell me that the case we were about to start would horribly. I reminded them that we could not know that and I believed in the power of positive thinking. That thinking and speaking negatively might just create the very negative reality for us and the patient.

No wonder they called me Pollyanna Puke on the floor.

But that is another call topic for another time.

The very first call secret is one that I know that a lot of my fellow operating room people fail at.

And that is knowing that the hours you are on call is not your own. By that I mean that the hours are not yours to do with as you wish and you might get called in during that time. But if you are called in, you are unpleasant and drag your feet on everything.

That is no way to create a positive experience for the patient.

Look, having to undergo semi-urgent or emergency surgery, because that is what the call case make-up should be, is no walk in the park for them. The patient has to be NPO, dressed in tissue paper, have an IV, and have anesthesia. This might be run of the mill for us but maybe they’ve never had surgery before and they are scared out of their wits.

Or maybe they’ve had surgery before but it was years ago when they were a kid and all they remember is being cold and dressed in tissue paper and surrounded by people in funny blue clothes that are not their mommy or daddy and being held down and having to breath in a yucky gas and then nothing until they wake up in a too bright room with yet more strangers and their wrist or their ears or their tummy hurts. And so they are scared out of their wits.

It is rare to have a patient who is laissez-faire about having surgery.

The patients are who the call nurse needs to be thinking about while they are on call. And how to make their experience smooth and efficient.

It is a mind shift for sure.

Make it less I HAVE to go in and more I GET to go in.

Do I know how to make the mind shift? No. The only thing that I know is that the brain is kind of like a muscle. You have to work on changing your own mindset.

Frankly, it can take some time, and repeated calls.

Ultimately we don’t take call for ourselves. Some of us might take call for the extra pay, or to pay back a favor to a coworker, or so that a coworker will owe you a favor. A lot of people take call because it is mandatory. Those are the calls that I took, back when I was the evening charge nurse and scooping up all the calls. Because the person whose call it was didn’t want it.

So don’t make plans. Your call hours are not your own. At the very most make vague plans. And realize that a call from the supervisor can and will change them in an instant.