Silver Lining

canesdukegirl, BSN, RN

I stare at the four LED panels in front of me, each displaying cases for every OR, listed by room. I groan inwardly, bracing myself for a busy day.

"Canes, you ready?" asks the Medical Director. Every morning, the Medical Director and the Anesthesia Coordinator and I meet to discuss add on cases, and the movement of scheduled cases to ensure the completion of the day's schedule.

We collaborate on which cases to move, which order add on cases should go, and discuss any unusual circumstances, such as time constraints for surgeons, specialty staff availability for difficult cases, and special requests.

Today is conference day, which means that surgical staff and anesthesia staff meet for the first hour of the morning prior to starting cases. Because I am the charge nurse, I can't attend the surgical staff meeting. Someone has to man the ship, right?

"Ok then, Canes. I'm off to conference. Page me if you need anything," the anesthesia coordinator sings over her shoulder as her wooden clogs click on the tile floor.

I glance up to acknowledge her, but only see the tail of her white coat as she throws it around her shoulders like a cape.

Ahhh...a few minutes of peace. I can get so much done now!

No sooner had I turned my back to the glaring LED panels than a resident appears out of nowhere, tugging on the sleeve of my lab coat.

"How's your day going?" she asks, traces of a smile dancing on her lips. She blinks rapidly and raises her eyebrows.

"Depends on what you are holding in your hand," I reply. There is no smile dancing on my lips.

She sighs. "Sorry to be the bearer of bad news, but I have a 65 year old woman in the ED with an incarcerated hernia. We need to get her to the OR now."

I glance at the LED panel and search for the trauma room. Several cases had already been posted.

Her gaze follows mine, and she reads the board with me. As if she could hear my thoughts, she turned to me and said, "It can't wait. We have to go right now. We will bump ourselves."

"Of course," I reply. "I'll page Dr. Thomas and let her know that we need to open the room right now."

"Thanks, Canes," she said. "I'll go ahead and bring her to the holding area, ok?"

"Yep, that's fine," I reply.

Running my finger down the list of staff for each room, I found the staff assigned to that room. Today, conferences were broken up by committee teams, and I didn't know which committee the staff members were on. I paged each manager, asking if Nurse X and Nurse Y were on their committee, because I needed them to start an emergency case.

"Hey Canes. Nope, Nurse X isn't on my committee."

"Canes, I don't have Nurse Y with me."

"An emergency already? Sorry, Canes. Nurse X isn't here."

My anxiety started to mount. My options were becoming more and more scant. When the phone rang, I jerked the receiver up.

"Canes, I have Nurse X with me. But she's in a meeting," the manager says.

"Yes, I know that. An emergency case was just posted, and I need her to start the case," I said.

"But she's in a MEETING. She's the recorder for the meeting. Can't you find someone else?"

I am incredulous with this response.

"Last time I checked, patient care trumped committee meetings," I reply, with barely contained sarcas

Nurse X checks in with me, and I fill her in on the details of the case. She is a trauma fiend, and loves the fast paced environment of a good trauma case.

"Did you find Nurse Y?" she asks.

"I still can't locate her," I said.

I paged Nurse Y's manager again. Ten minutes later, the manager calls me.

"We're in a meeting, Canes. What's up?" she said with a clipped tone.

"I have an emergency case, and I need Nurse Y. Nurse X is already preparing the room," I said.

"Oh. Nurse Y isn't scheduled to work today," she said in a matter-of-fact way.

"But you listed her in the trauma room," I said.

"My mistake. Sorry about that," she said, and hung up.

"Canes, our patient is in holding. Can we roll back now?" the resident asks me.

"Not quite yet. I'm still looking for another staff member," I said.

Luckily, one of the committee meetings broke early, and staff were milling around the desk looking for their assignments.

"What's with the frown?" one of the staff asks me.

I explain my dilemma, and bless her soul; she volunteers to start the case.

One fire put out.

As the morning progresses, I find that I am without a secretary. The phones are ringing off the hook. I page my manager.

"You rang?" she said.

"Did you give our secretary the day off?" I asked.

"Oh, yeah. I meant to tell you that. She had to attend her son's graduation this morning," she said.

"Did you have a replacement for her?" I asked, my voice reedy.

"Well, originally I had planned to come to the desk to answer phones for you, but I forgot that I have back to back meetings and won't be available until two. Do you need help?"

Softly, I close my eyes. What was I supposed to say? That she couldn't attend her meetings because she had to play secretary for me?

"It's ok. I can get through it," I said, eyes still closed.

The next few hours felt like a war zone. As I was assigning lunch reliefs, I posted one emergency case after another, took care of students/observers/reps asking for scrubs, contacted surgeons for availability for cases that could be moved up due to cancellations, kept Dr. Thomas in the loop with every change, handled a registration problem, fixed a computer interface problem, contacted staff/sterile supply/managers to room changes, changed staff in 3 different rooms to ensure competent matches for cases, and guided med students to rooms...the phone would NOT stop ringing.

A surgical attending was arguing with me about his case placement, and I couldn't get a word in edgewise. I let the phone continue to ring, adamant that I would get my point across to the surgeon.

Looking down at the phone with his face creased into an angry frown, the surgeon said, "You gonna get that?"

Seething, I picked up the phone.

"OR, this is Canes."

"Uh, somebody called me from this number."

"I'm sorry, what did you say your name was?" I asked, trying to keep the irritation out of my voice.

"Dean. Somebody called me from this number," he said again.

"Hey, Dean. Are you a patient?" Somewhere in the cobwebs of my mind, the name 'Dean' stuck out.

"Yeah. I was there last month. Somebody called me. I just hit *69. Who called me?"

We have about 500 staff members in the surgical services department. Needless to say, I had no idea who called this patient. But he was a PATIENT. He deserved my undivided attention.

"OK, Dean, let's you and I try to figure out who might have called you."

The surgical attending slapped the counter in front of me in frustration. Two staff members were waiting to get their assignments. Three phone lines were ringing. The pre-op nurse was gesturing to me. An anesthesiologist was talking to me as if I wasn't on the phone.

I spent twenty minutes on the phone with Dean, only to realize that he wasn't a surgical patient. He was a dialysis patient, and wanted to know when his next appointment was booked. I knew how frustrating it must have been for Dean to be transferred to one department after the next, and I wasn't going to transfer him again. I put him on hold as I contacted the dialysis unit, and got the information he wanted. As I relayed the information to Dean, his response caught me off guard.

"Hey, thanks, lady. Ya' know, I think the call might have come from the transplant surgeon, Dr. A. He called me yesterday and said there might be a match for me, and that I should come to the ED. What do you think? Should I call him, or do you think I should go to the dialysis unit?"

In spite of me, tears welled up in my eyes. I looked to my right and focused on the transplant information sheet tacked onto the corkboard. Sure enough, Dean's name and information were clearly written out.

"Yes, Dean. I see that you are booked for a kidney transplant. Come on in to the ED. We'll see you in a couple of hours," I said.

Gently, I replaced the receiver. I stepped away from the melee at the desk and gathered myself, encouraged that I would meet Dean personally, and help him through his life changing transplant surgery.

I'm so glad I picked up the phone.

Silver Lining

About canesdukegirl, BSN, RN

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