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canesdukegirl

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  1. canesdukegirl

    Transplant Thanksgiving

    Bwaaahaahahaha! I can relate!
  2. canesdukegirl

    Transplant Thanksgiving

    Yes, I do. I am thankful every single stinking day that he is by my side. Oh, and I can't help but mention that I am also lucky to have a puppy that curls up next to me, smelly feet and all!
  3. canesdukegirl

    Transplant Thanksgiving

    Thankfully, my husband is also in medicine. He understands with one look. Broom closet affairs? Has he been watching too much TV?!? I wish your hubby knew that our fantasies entail a complete lunch break (where we can actually DIGEST our scarfed down meal), time to pee, and being able to chart without interruptions.
  4. canesdukegirl

    Transplant Thanksgiving

    It's my turn to work this Thanksgiving. Although I am disappointed that I will not be having dinner with my husband, I knew that we would only be doing emergency cases in the OR. Expecting a relatively light working day, I swipe my badge and enter the locker room to change into scrubs. My trauma pager beeps almost as soon as I clip it onto the waistband of my scrubs. Reading the small screen of the pager, I decipher the code: "Red tag 24yo m, GSW head, GCS 3, intubated, ETA 2 min air." Quickly, I throw my lab coat around my shoulders, shouting instructions to staff to set up an OR for an emergency craniotomy. I rush down the hall to the ER. Halfway down the hall, my pager beeps again. "Black tag." I retrace my steps and return to the OR. A 24 year old man shot himself in the head, his neurological responses all but absent. His wife was currently in conference with the trauma attending. Another page comes through from the trauma attending. I read the page and shake my head. With a heavy heart, I set up the OR to do the harvest. The doors of the OR open, a myriad of beeping monitors accompanying the patient into the room. Silently, I watch the anesthesiologist, the tech and the circulating nurse transfer the patient to the OR bed. While I prep the patient's abdomen with Betadine, I glance at his swaddled head, his face barely visible beneath layers of gauze. The surgeon and I step up to the OR table, and begin the meticulous task of recovering the liver, and both kidneys. The patient's lungs are covered with pebble sized black spots, evidence of his heavy smoking. Ten hours later, we complete the organ recovery. Sending the staff out of the room, I sit beside the OR bed and look at this young man, wondering what kind of tragedies he had experienced. Picking up his cold, lifeless hand, I close my eyes and say a prayer for him, hoping that his soul is at peace. Tears spring from my eyes, dripping onto his colorless hand. I worry about the young family he left behind. Rising from my sitting stool, I take my time as I gently clean blood and Betadine from his skin, using my shoulder sleeve to wipe away my tears. Composing myself, I walk out of the room and down the hall to the OR front desk. Stopping short, I see a soldier and his family in pre-op. Several soldiers in full uniform surround his bed, chattering happily, and laughing while ribbing each other with stories. The patient is smiling, holding his wife's hand. Their eyes are bright with hope; this brave soldier will receive the liver that I just helped recover. Tears cloud my eyes again. One life ended. Another is beginning. Exhaust overwhelms me as I walk into the door of my house. My dear husband has dinner re-heated for me, but I am not hungry. He looks into my eyes and understands. Silently, my husband places a steaming mug of cocoa in my hand. He opens the patio door for me and kisses my forehead. I stand at the baluster outside on the deck, processing the emotional roller coaster I experienced today. The silence of the night cloaks me in a dark, comfortable embrace. As I wipe the tears from my face, I hear the helicopter buzz over my house carrying my patient's kidneys to a pediatric patient, and another to a solider at the nearest Army base. I smile through my tears, knowing that my efforts helped not one, but three families today. Thanksgiving has just taken on a completely new definition for me. I trudge up the stairs and pour myself into the bed. My sweet husband pulls the comforter around my shoulders as my puppy jumps up beside me and quickly makes herself into a tight circle against my abdomen. Gently, he brushes my long hair away and kisses my tear streaked face. "Thank you, sweetheart, for all that you did today. I love you," my husband whispers into my ear. I drift off to sleep, thankful for every facet of my life.
  5. canesdukegirl

    Shockingly Humbled

    She made it out of the OR. When any of us asked Dr. Singh about her progress, he was polite, but vague, and just said that she was doing fine.
  6. Beth slammed her locker closed, and adjusted her green scrubs. She pulled a blue bouffant cap over her hair and stepped into the OR hallway. As she made her way to the front desk, her work clogs echoed in the deserted hallway. She picked up the posting slips labeled for her room, and flipped through them rapidly. Seven trauma cases! Beth thought. Why do I always get stuck doing all of the trauma cases every Monday? It was springtime, and it seemed that everyone had lost their minds. Intoxicated motorcyclists turned their shiny bikes into scrap metal, fights ended with gunshot wounds, and early morning joggers magically became invisible to early morning commuters. And let's not forget the college students on Spring Break, who think that a five story dive into the hotel pool amidst a cheering, drunken audience instantly labels them a hero. Beth thought. Beth shook her head and donned a mask before entering her assigned OR. As Beth and the scrub tech methodically prepared the room for the first case, the door swung open and banged against the wall. Beth jumped. "What the heck?" Beth asked, and turned to deliver a tongue lashing, but she stopped short. Dr. Davis strode into the room with a computer bag slung over his shoulder. His tall, lanky frame was bent slightly forward. His permanent scowl matched his nasty disposition. No one liked to work with Dr. Davis. "We have a lot to do today, so let's get cracking!" he announced. Carelessly, he tossed his computer bag onto Beth's desk. All of the supplies that she had carefully laid out on the desk fell to the floor, displaced by Dr. Davis' bag. What a total jerk, Beth thought as she bent down to pick up the mess. "What are you doing?" Dr. Davis asked. He put both hands on his hips and regarded Beth like a child. "Well, Dr. Davis, I had the room almost ready, but now I have to clean up and re-organize the supplies that you need," Beth said with thinly veiled sarcasm. "Didn't you hear me? Let's GO! I have seven cases today, and we need to get a move on!" His overly tanned forehead reminded Beth of worn leather as he raised his eyebrows with impatience. With a dramatic sigh, he walked out of the room. The scrub tech peeked over her mask at Beth and gave her a sympathetic look. Beth rolled her eyes and made an inappropriate gesture at the backside of the surgeon, eliciting a giggle from the tech. In the pre-op area, Beth scanned the whiteboard that neatly listed each patient name and holding room. Locating her patient, she walked to the room and whisked back the privacy curtain with her right arm. A slight, unkempt man in his 50s with stringy hair and few teeth opened his eyes wide and leered at her suggestively. The hospital gown draped loosely over his thin frame, and made him appear childlike. The smell of stale cigarette smoke permeated the close quarters of the pre-op room. A very overweight man had somehow stuffed himself in the small visitor's chair. Pockets of fat bulged under the armrests. An image of Buddha instantly sprang to Beth's mind as she stepped over the clear bag labeled 'Patient Belongings'. Beth introduced herself to the patient, and leaned forward to compare the patient's armband information with the paperwork from pre-op.. She fought a wave of nausea as her nose was assaulted by a revolting bouquet of alcohol, cigarette smoke and body odor. She cleared her throat and began the interview. "Mr. Walton--" "Sweetheart, Mr. Walton is my daddy. My name's Billy," the patient said in a thick country accent. He leaned to the side in his chair, and placed his elbow on the armrest. Beth pretended not to notice when his elbow comically slid off the armrest. "Alright, then. Billy, can you tell me in your own words what procedure you are having today?" Beth asked. "Ain't that in my chart, lady? Dang, I hate it that y'all don't know what in the heck you're plannin' on doin' to me! What kinda hospital is this anyway?" He snickered, and glanced at his friend. "We routinely ask every patient to verify with us that they know what procedure is being done. It's a safety check. Sort of like 'checks and balances,'" Beth replied. "Sorry lady, but any check you git from me ain't gonna balance. It'll prolly BOUNCE!" He broke up into laughter, showing off reddened gums and a few rotting teeth. Billy reached a hand out to his friend, and they slapped a high five. Beth tried not to show her irritation as she asked the question again. "I'm gittin' my leg fixed up. I busted it all to hell 'n back when I fell off the porch last night. Ain't that right, Jimmy?" Billy said, raising his chin. Chuckling, Jimmy answered. "Yep, that's right. I told you not to go shootin' that 'possum. They ain't no danger to you. You shoulda left it be!" Jimmy said, and shook his head. Billy slapped his thin hand on the armrest. He frowned at Jimmy and yelled, "But it was scarin' my ol' lady. I just meant to scram it away. What's so wrong with that, Jimmy?" His face turned red with anger, and the veins in his neck popped out like strings on a marionette. Awkwardly, Jimmy leaned over the girth of his rotund belly. "You was off yer keister drunk, Billy! Ain't no wonder you fell off the porch. I still cain't believe yer shotgun didn't make Swiss cheese outta the side of yer trailer. Then you'da REALLY been in a heap o' trouble with Jo Ellen!" Hoots of raucous laughter echoed in the small holding room. Beads of sweat popped out on Beth's forehead as she thought of Dr. Davis tapping his foot, wondering why his patient wasn't in the OR yet. The sooner I can finish this interview, the sooner we get back into the OR, and the sooner I can get finished with Dr. Personality. Beth thought. "OK, Billy. Let's finish up here. Have you had anything to eat or drink since midnight?" Beth asked. "Nope, no ma'am. I ain't had NUTHIN!" Billy cut his eyes over to Jimmy, who barely contained a laugh. Suspicion vibrated in every bone of Beth's body. Beth raised her eyebrows and asked, "So you didn't take a swig of juice, water, or coffee? Just a little one?" Billy hesitated, and Beth softened her voice. "Billy, this is important," she said. "No, no ma'am. No way." He fidgeted uncomfortably in his chair, and didn't meet Beth's eyes. A young anesthesia resident waited just outside the curtain for Beth to finish the interview. Becoming impatient, she elbowed past Beth and took over the interview. "I think it's clear that the patient hasn't had anything to drink," she said to Beth with disdain. The resident turned her back on Beth, effectively ending further conversation between Beth and Billy. "Now, Mr. Walton, have you had any problems with your heart, lungs, breathing..." Her high pitched voice delivered questions in a rapid fire mannerism. Angrily, Beth stalked out of the room and searched for the attending anesthesiologist, Dr. McKenna. Dr. McKenna was a large African-American man, weighing in at 265 and topping out at 6'6". He had an imposing nature about him that would turn the most combative man into a docile sheep with one steely glare. "Hey Big Mac, I have a problem," Beth said as she approached him. Dr. McKenna was writing notes in a chart, and looked up at Beth with heavy lidded dark eyes. Even though Beth had known him for many years, his direct gaze still intimidated her. "What's the problem?" he asked. He sat back in his chair and crossed his trunk like arms. Immediately, he took on the role of mentor, and offered Beth a rare smile. "When I interviewed our patient, he stated that he hadn't had anything to eat or drink, but I don't believe him. He didn't meet my eyes when he responded to the question, and his friend was snickering. Your resident took his answer at face value and all but dismissed me when she took over the interview," Beth said. With effort, the giant man raised himself from the chair and sighed. "I know, I know. You want me to scare the truth out of him, because your malarkey-o-meter is alarming, right?" "I just want to make sure the patient is safe for--" "I got this," Dr. McKenna said, and waved a hand at Beth. Dr. McKenna ambled into the room and introduced himself as he encompassed the patient's slight hand in his giant brown paw. He pulled a chair close to the patient, and sent the resident scurrying out of the room with one look. "Mr. Walton, I understand that you haven't had anything to eat or drink this morning, right?" He leaned forward and balanced his elbows on his massive legs as he sat in the chair. "Uh, no sir. I ain't had nothin', promise," Billy said, and held a tattooed arm up as if taking an oath. "Well that's some good news. I was just about to tell you about this guy who told me that he hadn't had anything to eat or drink for two days! Can you imagine?" he said as he crinkled his brow and widened his eyes. Billy shook his head rapidly and unconsciously scooted back in his chair. "Turns out he had a whole two liter of Sprite on his way to the hospital because he was so thirsty." Dr. McKenna tilted his head as he stared at Billy. Dr. McKenna chuckled, and Billy laughed nervously. "You see, when we put you under general anesthesia, we put a tube down your trachea-your windpipe, so you can breathe. The trachea and the esophagus-the tube that goes from your mouth to your stomach, are right next to each other, kind of like neighbors. They have to live next to each other, but they don't necessarily get along. If there is anything in your stomach when I put the tube down your trachea, the contents of your stomach will come up in an impolite kind of way, creeping into your neighbor's lawn and causing all kinds of fuss. So now you can understand that it's actually quite dangerous to put a tube down your trachea if your stomach is full, because whatever is in your stomach can go right into your lungs," Dr, McKenna said. Leaning toward Billy, he continued in a conspirative stage whisper. "We had quite a time with this cat, having to resuscitate him and all. He just about died," Dr. McKenna said. Just outside of the privacy curtain, Beth and the anesthesia resident were completing paperwork. Beth barely contained her laughter as she processed Dr. McKenna's newfound dialect and his artful way of educating patients. As Beth succumbed to a chuckle, the resident locked eyes with her. A slow grin spread across the resident's face. Beth and the resident stopped what they were doing to listen. They heard feet shuffling, and then a big sigh. "ALRIGHT! Ooo-KAY! Jimmy here told me that I was gittin' on his nerves cause I was bein' jittery and all while we was in the car comin' up here. He was cussin' me and sayin', 'Dang you, Billy! We got a ways to drive yet, and I ain't about to put up with your moanin' and groanin'! I had to take offa work today cause Jo Ellen cain't drive your dumb butt to the hospital!'" Billy said. He looked over at Jimmy, who stared sheepishly at the floor. Jerking his thumb at Jimmy, Billy continued. "He pulled into the Citgo off the highway 'bout 60 miles from here and bought me a 40. He said it was ok cause when he was readin' the directions I got from the doc, it said that I could have me anything CLEAR. Well, ain't beer a clear?"
  7. canesdukegirl

    Shockingly Humbled

    Unfortunately, yes. This really happened. Shocker of my career!
  8. canesdukegirl

    Shockingly Humbled

    Writing is my outlet. When I experience an unusually tough day, I write about it. "Creative non-fiction" is definitely my niche, as I like to write about my experiences in such a way as to engage readers (kudos to you, IEDave!). Most of the articles I write are about experiences that you guys can relate to. We have all had those days where we want to just throw in the towel, where we can't take one more demand, and don't want to hear our name called one more time. Every single one of you knows how it feels to run your butt off all day, come home exhausted, blisters on your feet, and can barely slog through dinner before pouring yourself into bed. You can also identify with having shining moments that stick with you forever, like a patient that pulls through despite the overwhelming odds, or an idea that you developed, implemented, and has now become practice, or seeing a former patient walking down the sidewalk after months of PT from a traumatic injury. Thanks for the compliments, guys! I enjoy writing and sharing these articles with you.
  9. canesdukegirl

    Shockingly Humbled

    "She's crashing!" yells the second year anesthesiology resident. His high pitched voice slices through the alarms that pierce the green tiled operating room. His forehead creases, and his eyes are wild as he rapidly glances from his patient to the monitor. His meaty hands awkwardly search for the phone. Fumbling, he can't dial the numbers in his haste. He throws it down to the floor, yelling expletives and breaking the cheap plastic into pieces. The monitor continues to alarm, and everyone hears the rapid staccato beeping of the heart monitor. Frantically, the resident turns to me. "Overhead page anesthesia to OR 15 STAT!" he commands. I reach for the phone next to my computer to overhead page. "Anesthesia staff to OR 15 stat. Anesthesia staff to OR 15 stat." Striding to the head of the bed, I say, "It's ok, John, we got this." "I've never had a patient crash during surgery," John says quietly, fear dancing in his light brown eyes. Sweat soaks through his light blue surgical cap. "I'll help you through it, ok?" I say, locking eyes with him. John and I work in silence as he adjusts the Isoflurane and increases the O2. Ripping off the cap to a 20 ml syringe with my masked covered teeth, I use both hands to draw up emergency medications as I watch the monitor. I point to the Propofol pump and gesture to him to stop the infusion. I quickly hand off the drawn up meds to John, calling out the dosage of each medication. Softly, I remind him to push the meds slowly and to watch the monitor as he pushes the medication. I notice that his eyes are glued to the monitor after he delivered the medication through the IV. I give him a gentle nudge, and nod toward the patient. "Don't forget to watch your patient. The monitor only shows a chapter of the story. Your patient shows you the novel," I whisper to John. Echoes from the monitor permeate the cavernous operating room. The surgeons, with their masked faces and blood drenched gowns, work feverishly in the open abdomen. Smoke from the electrocautery fills the room, and the sound of liquid pouring into the suction canister sends shivers of ice up and down my spine. A young man whom I have never seen rushes into the OR, breathless and sweating. "What do you need?" he announces to the room, his eyes scanning the bloody floor. John, dutifully focused on his patient, adjusts the rate of the IV. He does not hear the young man's request. I look at the young man and inwardly groan. Now is not the time to explain in detail what I need. I mentally brace myself for the lack of comprehension that was sure to come. His skin reminds me of my morning coffee, light brown and creamy. He is barely my height, and his scrubs drape across his slight frame, making him look like a child dressed in Daddy's clothes. "Who are you?" I ask, spitting out the needle cover from my masked mouth. "I am the new anesthesia tech. My name is Ben. What do you need, lady?" he asks again, face full of irritation. "Get two units of FFP and 6 units of blood," I demand. I sigh in relief when Ben nods his head. "I'm on it!" he yells over his shoulder as he turns and runs out of the room. "Stay two ahead, Sam?" I ask the surgeon. She pushes a lap pad into the abdomen to staunch the bleeding. Without raising her steel blue eyes from the surgical field, she nods her head. "And Canes, find Dr. Singh. He needs to get his butt in here. He turfed this patient to me at the last minute, the jerk," Sam says. Bending her masked face over the open abdomen, she pulls out a blood soaked lap pad. A spray of blood arcs onto her gown, and she quickly reaches for another lap pad. "Dang it! This was my best gown! Now what am I going to wear to the prom?" she says without looking up. The young intern begins to lose focus, her head bobbing as she looks up at the monitor and then back to the blood filled abdomen. "Watch the field! Never look up!" Sam barks at the intern. "If you look away from the field, you then have to re-acclimate yourself. Trust your team, and trust that your assistant will dissect and clear the field for you. " "I will guide you, but you must never take your eyes from the field," Sam instructs, handing the intern the suction. "Here, you suction for me, and I will find the tear," Sam says, calmly. With a shaky hand, the intern grasps the Yankauer suction. I hear Sam's calm directions to the intern as they isolate the bleeder. "Two-oh Vicryl!" Sam shouts. I hear the slap of the needle driver hit her open palm. Leaving John's side, I text page Dr. Singh from my computer, my fingers flying across the keyboard. "I need more laps!" the surgical tech shouts. Swiftly, I move from my computer to the glass cabinet doors, and find a pack of laps. I rip the package open and toss it onto the sterile field. The tech and I quickly count the sponges as she places one into Sam's open palm. I pull the cap off of the dry erase marker to add the laps to our surgical count, displayed on the whiteboard. "Ten laps added to the field," I announce. "Canes, I need Surgicel now!" Sam demands. I rush to the drug box and find the small strip of Surgicel. It is encased in foil wrapper, and I open it onto the sterile field like one would open a Band-Aid. Ben slams through the OR door, carrying the cooler of blood. He places the cooler on the floor next to John. "Yo, Canes. I need you to check this blood with me," John says as he pulls the first unit out of the cooler. John and I repeat to each other the patient's name, medical record number, date of birth, blood type, unit number and expiration date. The phone rings just as I sign the blood slip. Picking up the phone, Dr. Singh's smooth, melodic voice greets me. "So what's the problem?" he asks. Dr. Singh has always been an enigma to me. He is engaging, yet fiercely private. I imagine him sitting in his ornately decorated office, his feet perched on a rich mahogany desk, leaning back in a tufted leather chair while staring out the window. For some reason, his calm manner sends a rush of fury through me. "You know the 'simple' ex-lap that you didn't want to do? The one that you gifted to Sam?" I ask, my voice barely containing contempt. I didn't wait for his response, adrenalin coursing through me. "Turns out that it isn't quite so simple. This lady has adhesions out the wazoo, and when the surgeons were dissecting adhesions off the mesentery, the superior mesenteric artery tore. You should probably cancel the rest of your day and get your butt in here." John lifts the second unit of blood from the cooler and motions to me, drawing a check mark in the air. "Hang on, I have to check blood," I say into the phone. John and I quickly run through the routine of checking blood, and I pick up the receiver again. "Singh, we are going through blood quickly. This woman is bleeding out." I say, cradling the phone between by head and shoulder while scrawling my signature on the transfusion slip. Dr. Singh is slow to respond, as if he is distracted. "I cannot--" Cutting him off, my anger rears its ugly head, and I am surprised at the forceful words that come out of my mouth. "No, you can't get out of this one. We need you right now!" I spat. I hear John shouting for the surgeons to stop, as the monitor's green lines display a nasty show of atrial fibrillation. "Canes, uh...I must tell you this," he says softly. I need to get off the phone already and help this patient, I thought. My anxiety mounts as I see the young anesthesia tech push the crash cart into the OR. "You must tell me what? You're on the way, right?" I ask, as I watch Ben and John deftly place gel pads on the patient's chest. Silence greets me. "Charge to 200!" John commands. "Doc, you there?" I ask, impatiently. I am milliseconds away from just hanging up. "I am here," he responds. I hear him take a deep breath. "Canes, I am so sorry. I cannot come. This patient is my mother."
  10. canesdukegirl

    Silver Lining

    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.
  11. canesdukegirl

    Underwater

    EXCELLENT article, Soldier! You truly have a gift for writing.
  12. canesdukegirl

    Drawing the Line: Shutting Down Verbal Abuse

    You are right. I should have ended the conversation earlier. I knew that this fellow was new, and likely didn't understand block times. Part of my job is to explain the whys and hows of processes in the OR. That's why I was explaining it to her. I expected that she would be angry, because most surgeons are angry when their cases are delayed. I didn't expect that she would turn the conversation into a personal insult, and that's where I drew the line. Snarkiness is something that I deal with every single day. When staff/surgeons/anesthesiologist approach the charge desk, it's usually because they are angry about something, need to vent, need to lodge a complaint, or need clarification on something. One of the things that I love about my job is that it's challenging. Ninety percent of the time, the snarkiness comes from a misunderstanding or some kind of miscommunication. I like to be able to resolve issues in real time, as they occur. In this situation, I felt that I needed to explain the decision making process. I could have routed her to the Medical Director, but I wanted to try to resolve the issue first. The emergencies occurred almost simultaneously. I handled one, while my secretary was posting the other, and calling staff to get an OR ready (yeah, she's da bomb!). Here's the bottom line: I knew that Dr. D personally spoke to this fellow about holding her case. She didn't speak to him the same way she spoke to me. If she had, then it would have been dealt with in his office. Since Dr. D and I agreed on this plan, why is it that she had no compunction to be disrespectful to me? Because she thinks that she can bully a nurse. I thought it prudent to stand up for myself, and send a very clear message that rudeness and bullying will not be tolerated.
  13. It's 3 p.m. The witching hour for any operating room. As our medical director makes rounds, he tallies up how many late rooms are running, and compares that to how many surgical and anesthesia staff we have available to run the late rooms. If the numbers don't add up, then cases are put on hold. While our director speaks frankly and with tact to the surgeons whose cases are being held, it never fails that the surgeons immediately call me and try to barter, beg and plead. End run at its finest. I am the charge nurse for a busy OR. My job is to facilitate case movement, troubleshoot delayed cases, help staff to overcome challenges, tend to red traumas, make staff assignments, and put out fires. Many, many fires. I am busy assigning relief staff, and delegating duties to nurses and scrub techs that I have not assigned as relief. A new anesthesiologist takes over the anesthesia charge duties, and he has lots of questions. I answer them as best as I can while being constantly interrupted. Our medical director is waving his hands at me, trying to get my attention through the crowd of staff. Shouldering through the crowd, he approaches my desk. "Canes, we have too many late rooms. I've moved Dr. Y to OR 5 so he can get started with his last case. He told me it was a doozy and may need cell saver. I also held Dr. R and Dr. L. I told them that their cases will start when some of these rooms come down." "Canes, line one!" my unit secretary shouts over the group of OR and anesthesia staff gathered near the charge desk. For some, the day has come to an end. They are sharing stories, venting, and socializing. I can hardly hear my secretary as a loud burst of laughter rises from the group. I pick up the phone and cradle it between my ear and shoulder while writing out the answers to the anesthesiologist's questions and nodding to the medical director. "This is Canes," I answer. The laughter and rising voices of the group near the desk makes it difficult to hear. "I'm the fellow for Dr. K, and I just want to know why you chose to move another case into our room," the fellow demands in a clipped tone. "We have an add on case, you know," she continued. I didn't catch her name. I began to explain my decision. "Block times are by service, not by attending. Your colleague, Dr. Y is behind in his schedule. Our Medical Director, Dr. D decided--" "There is an empty OR. We are ready, our patient is ready, and I don't understand why you made this decision," the fellow said. Her tone was singsong-that of an adult explaining something to a child. "If you would let me explain--" "This is totally nuts. I mean, here we are-all of us are ready to go, and you put another case in OUR room?!? It makes no sense at all!" she exclaims. I take a deep breath and start over. "Scheduled cases should always be done before add on cases. Dr. Y ran into some problems in his first case, which delayed the rest of his cases. His following case is a very difficult one. We made the decision to get him started in the empty OR so that our staff could have everything in place, anesthesia staff could place lines, and the room would be set up and ready to go when he comes out of the case he is working on," I said. "But that is OUR OR!" the fellow shouts. "I understand your frustration, which is why I asked you to let me explain. You are reading a paragraph, while I am reading the entire chapter. Of course the paragraph won't make sense unless you read the chapter," I explain calmly. A vascular resident rushes up to the desk, posting sheet in hand. Breathlessly, she said, "Canes, this is an emergency fasciotomy. We need to go back within the next 20 minutes." I tell the fellow that I would like to discuss block time rules with her later in the day, but I was needed for an emergency case that was just posted. Surprisingly, she continues to rant about how irrational it is to put her colleague's case in HER room, and how unfair it is to punish HER just because her colleague is lagging behind. I am half-listening. All of the phone lines ring at once. "Canes, there's a code in OR 9!" my secretary shouts. I put the fellow on hold while I deploy necessary staff to attend the code. I pick up the phone again and apologize for the interruption. "OR block times aren't based on the SURGEON, they are based on the SERVICE," I repeat for the third time. "I would be glad to discuss this with you some other time, but I have two emergencies that I must attend to now," I said. "So you mean you don't have the time to explain why we can't follow ourselves in an empty OR? the fellow asks, her voice taking on a saucy tone. "Correct. I don't have the time right now. An emergency case has been posted and another patient is coding. I need to coordinate many things right now," I said. I feel my anxiety level increase. I need to get off the phone and help my staff with these emergencies. "You don't seem to have a grasp on continuity of care, do you?" the fellow asks sarcastically. "I guess the saying is true: management doesn't understand how to take care of patients," she spat. I refuse to take the bait and engage in verbal warfare. I replied, "I will not tolerate being insulted. If you continue to be disrespectful, I will end this conversation. As I said before--" For the third time, she interrupted me. She spoke directly into the phone while talking to her attending, "Dr. S., I'm sorry, but I can't give you an answer as to why we can't follow ourselves in an empty OR, despite the fact that our patient is ready and we are ready. I am just as frustrated as you are....I agree...it seems like the charge nurse doesn't have a clue what's going on...I know...she must have no sense of logic." CLICK. I hung up on her. This might seem like a very unprofessional thing to do, and it is. However, the fellow not only disregarded my rationale and explanation, but also personally insulted me. She didn't take me up on my offer to explain block times, but continued to speak to me in a condescending tone. The most troubling factor with the above scenario is that she did not acknowledge that there were two ongoing emergencies. This is classic bullying behavior, and we as nurses have every right to refuse to be bullied. Recently, I lectured new OR residents on bullying in the workplace. While researching this topic, the message really struck home was that it didn't matter WHO was bullying WHOM, or what kind of alphabet soup followed their name. Nobody deserves to be spoken to in a disrespectful manner. According to the ANA, a whopping 48% of nurses reported experiences involving strong verbal abuse (ANA, 2001). The impact of workplace bullying is often insipidus. Like a cancer, it grows slowly, silently, and has devastating effects. Low staff morale, increased absenteeism, attrition of staff and the deterioration of quality patient care are some of the results of bullying (Hughes 2008). To combat bullying, you must adopt a "zero tolerance" mindset. No one, no matter who they are or what their relationship is to you, has the right to be disrespectful to you. Helpful Guidelines As soon as you recognize bullying behavior, speak up and set boundaries. Point out that you are willing to listen to the content of the discussion, but you will not tolerate disrespectful behavior. Do not reduce yourself to engaging in a verbal tete-a-tete. Speak calmly and resist the urge to raise your voice; it will only escalate the situation. Clearly state the consequences of continued verbal abuse. Make eye contact and speak with confidence, not with anger. Follow through on your stated consequences. Privately seek out the advice of nurses whom you respect and admire about your experience. Avoid "bashing" behavior, and don't tell everyone within earshot about the exchange. Keep a journal and write down what you felt during the experience. Don't include names, but write what your initial reaction was, and how you felt you handled yourself. Did you lash out? Did you freeze up? Did you speak calmly? As you gain more experience, you can look back on how much you have grown by reading your old passages. Keeping a journal is also very cathartic. Nursing is a tough profession, no doubt. We are constantly on the move, we multi-task while triaging priorities, and we are constantly troubleshooting. It's no wonder that at the end of the day, we are both mentally and physically exhausted. When we are faced with bullying behavior, tension and negativity can become distracting elements in our daily lives. By setting boundaries and adhering to stated consequences, we have the power to diminish bullying behavior. References American Nurses Association. (2001). Health and Safety Survey. Hughes, N. (2009). Bullies in healthcare beware. American Nurse Today, 3(6), 35.
  14. canesdukegirl

    4th Nursing Caption Contest - Win $100

    C'mon! All I asked is why you didn't become a doctor instead of just a nurse! I thought it was a compliment!
  15. canesdukegirl

    Precepting new staff members in the OR

    I was excited to start my first day in the OR. Full of optimism and nervous energy, I found my way to the staff locker room, looked through the lockers to find my name and started to change from street clothes into fresh new scrubs. "Um, can you please move your stuff over so that I can get dressed?" asked the nurse next to me. Nurses were chatting, some were laughing and others were complaining about the previous day's cases. Although there were at least 30 women crammed into the locker room, not one staff member met my eyes, and no one asked me who I was, if I was a new, if I was an observer or if I was a student. The only indication that my presence was even acknowledged was the comment that the nurse next to me made as I hastily gathered my shucked clothes from the tiny bench that we shared. I gathered with the rest of the staff in the hallway for the daily briefing. I looked around for my preceptor, and found her chatting with her co-workers. I stood with the other 3 new staff members during the briefing. I expected the NM to give a brief acknowledgment to the new staff members so that we could introduce ourselves, but it didn't happen. The rest of the day was met with more of the same; no introductions by my preceptor, no greeting of 'welcome to our unit', no sense from the staff that they were even curious about their new teammates. Being from the South, manners mean a great deal to me. Making a new person feel welcome has always been a priority for me, no matter if it was in school, a new job, or moving into a new neighborhood. Although I found it odd that the NM nor the preceptor of our small group made a gesture to even introduce us to the rest of the staff, it didn't bother me a great deal. This was work. I figured a 'get down to business' mindset was the norm in the OR. I figured correctly! The OR is a different beast. You almost need a passport to enter this foreign place. Expediency, efficiency, protocol and keeping in mind the ever present time crunch are the main priorities in many ORs. A new staff member, a new grad or even a medical student oftentimes find themselves overwhelmed by the seemingly hundreds of little unspoken rules: don't speak unless you are spoken to, don't sit down, don't address the docs until you become involved in the case, don't ask questions when your preceptor is busy, don't ask what is going on during the case, and DON'T TOUCH anything! New members are relegated to standing in the corner without much guidance, and constantly worry if they are in the way. It is an awkward time. How many of you guys remember feeling this way when you first started your OR career? I am raising my hand while jumping up and down, sounding like a monkey, "Oooo, oooo, ooooo! ME!" I swore that I would NEVER make someone feel as uncomfortable as I did when I first started. As many seasoned nurses do, I lapsed into a comfort zone at work. When I had a student with me, I went about my duties (mindful of the time crunch) and didn't explain to my student what I was doing, or the rationale of my implementations. I just wanted to get the job done. The day I found myself saying, "Stand right here and watch. DON'T TOUCH anything!" was the day that I knew I needed to re-focus. I sought out the Nurse Educator and confessed. I told her that I felt so badly for brushing off my student and shared my vow that I would never do that to a new staff member. I told her that I loved to teach, but because I am so OCD, I didn't think that I would make a wonderful preceptor. I asked for some guidance. She laughed at me and said that she wondered when I would finally realize that I loved to teach. She gave me some great pointers that I want to share with you all Communicate with the NE so that you know to expect to teach during your shift. The NE will usually let you know, but there is nothing worse than finding yourself scrambling to get your case set up and the NE interrupts you in mid-stride to tell you that you will be precepting a brand new staff member. With no experience. While the anesthesia staff tell you that they are rolling back with the patient. And you haven't counted yet. If you are OCD like me, get to work early to plan your day. Get all of the little stuff done to allow more time for teaching. Ask your orientee what they know, what they feel comfortable doing, and what they would like to focus on. Introduce your orientee to the surgeon and the rest of the team. Explain what you are doing. Offer a brief description of the surgery and instruct your student to read about the procedure when they get home. USE the resources that the NE has to offer; that is what they get paid for. Never forget what it feels like to be new. It is never comfortable. If you offer a kind word, a new member will never forget it. If you ignore them or treat them like a second class citizen, they will take longer to feel as if they are part of the team, longer to feel confident, and longer to be a productive staff member. Don't assume that they know the etiquette of the OR; give them a quick and dirty run down of what to expect. If we KNOW what to expect, we can conduct ourselves accordingly. Take time at the end of the day for a "hot wash". Ask your orientee what their challenges were, what tasks they felt comfortable doing, and develop a the plan for the next day. LISTEN to your orientee. If they say that they feel comfortable doing XYZ, then LET them do it. Stand back, or step out of the room and observe from the door if you must. Encourage your orientee to write down the events of the day when they are in a quiet place. A journal is helpful. Go over the journal with them and offer guidance with the most challenging experiences. Always encourage. Never berate. Most adults respond to positive reinforcement. Sometimes we get caught up in the tasks at hand, and don't give priority to the students or new staff members that rely upon us to learn the expectations of the OR. A well thought out plan in conjunction with our Nurse Educators fosters an effective learning experience that preceptors and orientees feel good about. Guidance and compassion are the tools that we can use to develop confidence in our new staff members. Watching them become assertive and effective is a wonderful reward for the preceptor.
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