A Not-So-Routine Routine

During the Monday through Friday work week, I work four ten-hour shifts.  On those work days, my alarm goes off at 5:00 AM.  And the routine starts…

5:00 AM – Jump out of bed and get ready for work.  Brush my teeth, blah, blah, blah.

5:30 AM – Feed the Doggie and take her out.

6:00 AM – Drive like a bat out of hell to the hospital.  [CUE:  Upbeat dance music.]

6:25 AM – Arrive at work, throw lunch box in one of the overstuffed refrigerators, get scrubs from the scrub machine, change into scrubs and OR-use-only Sanita clogs, put my hair up and put on one of my cute scrub caps.

6:40 AM – Grab a quick coffee in the lounge with my co-workers.

6:53 AM – Clock in and head down to the OR.

7:00 AM – Check for my assignment at the Command Center/Charge Desk.

And this is where the routine ends.

Operating Room Nurses are typically assigned to one room where there are several cases scheduled.  These are usually procedures that fall under their primary specialty (e.g., Orthopedics, General Surgery, Urology, etc.).  However, most operating room nurses are cross-trained in the other specialties, therefore, the assignment may not be in the primary specialty.  Or maybe it’s a room with a variety of procedures that fall under a variety of specialties.

Not only does the assignment vary in specialty, but it varies in role.  There are two staff members needed to set up for a procedure:  A Circulating Nurse and a Scrub Nurse/Surgical Technician (a.k.a. “Scrub Tech).  Operating Room Nurses can either be a Circulator or a Scrub.  A Surgical Technician can only perform in the scrub role due to their training and licensure.

Scrub Nurses/Scrub Techs are responsible for preparing the sterile field.  She or He performs a surgical scrub on both hands and arms at a scrub sink (just like on TV), then puts on a gown and gloves with proper aseptic technique.  The sterile field consists of a sterile drape covering a large table with a setup of items that are needed to perform the procedure (supplies and instrument). The Scrub sets it up so that instruments and supplies can be passed to the surgeons when they need it.  Knowing how to set up for a variety of procedures is a skill learned on the job – starting with an intense orientation.

In the role of Circulator, the nurse performs a patient assessment in the pre-op holding area.  It involves a checklist of questions that have also been asked by other providers.  It is our version of Checks and Balances.  Patients get an overview of what they can expect when they are brought to the OR.  Family and friends of the patient can also ask questions.  I call this, for my readers of a certain age, my “Julie McCoy, your Cruise Director” moment. In the OR, the Circulating Nurse’s work continues with helping the Scrub, sometimes the Anesthesiologist/CRNA, and works around the sterile field (circulator = circulate = circle = around) supporting the surgical team throughout the case.   Eyes and ears are always alert.  Circulating means helping coordinate and facilitate case progress, documentation, and whatever else is needed to provide safe patient care.

Anyway, back to getting my assignment…

Wait, what am I doing?

Every day, my assignment is a surprise to me. The Charge Nurse/Manager/Team Leaders put together the initial draft of the assignment sheet the day before, but it always seems to change the morning of, based on call-offs and schedule changes.  I have learned my lesson to avoid checking the day before because I don’t want to get myself unnecessarily upset or excited about the next day.  Pointless, really.

On the days I am in my specialty, I am in my comfort zone:  Orthopedic Surgery.    In the Main OR of my hospital, the procedures we perform the most are total hip or knee replacements, repairing broken bones, fixing someone’s spine, and even taking out cancerous bone and tissue.  I work with the surgeons and residents that I know well and my partner is usually someone from my specialty team (nurse or scrub tech).  When you have the “regular team” together, there is a flow that is like….a symphony.  I love that feeling.

Outside of my specialty, I am fine, but I am on extra alert for any nuances that are unfamiliar.  While this sounds scary to some people, the beautiful thing about working in surgery is the amazing teamwork we have with our staff.  My co-workers are excellent resources when I am in a bind or when I just want just-in-case information.  It is reassuring to know that someone has my back!

Today is my day off which means I return to work tomorrow.  What will I be doing?

I have absolutely no idea.

All I know is that there definitely will be coffee in the morning.

 

Healing

Since my last post, I have been on a search to find healing in this crazy messed up world. I knew I needed help when I found it difficult to talk about the trauma without my eyes welling up with tears. It was then that I decided to open myself up to different ways to recover from all the terrible things that I see on the job.

I started meditating and practicing yoga. I also started planning more gatherings with family and friends. Improvements in diet and sleep have helped, although this is more challenging to do. If I focus on why I am doing this, it becomes an easier task. Baby steps…

Months later I am not completely “fixed”, but it’s not like I will ever be. Life is messy. I have acknowledged this fact for a long time, but yet it is still a difficult pill to swallow. Our experiences make a lifelong impact. The only thing I can control is how I choose to handle it.

So here I am. Still trying to balance work life and personal life. The messiness continues. At work the traumas keep coming in and so do the really sick people. At home, I am supporting my significant other as he tries to find his way in a new industry at a startup company. In the last week, my dad just had open heart surgery. He is doing great, but it’s a long road to recovery. On top of this, my aunt is in kidney failure and is receiving hospice care. And now, one of my childhood friends is facing the fact that her mom might not survive after a bad fall.

It’s a lot. But I know things could be worse.

I could drown in negative thoughts, but what always brings me back to the surface is gratitude. The first thing that comes to mind is how lucky I am to have so much love in my life. I truly mean this. When shit is hitting the fan, the reinforcements appear – my family and friends! Even though I am so independent, they allow me….no, they remind me….to lean on them. I don’t have to hold back tears, force a cheerful hello, or hide my feelings. How lucky can one person be?

My experiences over the last year have reminded me that healing is an ongoing job. I am reminded by something an old boss said to me when I was feeling overwhelmed:

“How do you eat an elephant?

One bite at a time.”

Bon appétit!!!

I Want To Forget

I am a Trauma Nurse and I think something is wrong with me.

Lately, I wake up in the middle of the night, sometimes to go to the bathroom, but mostly just because I can’t sleep.  Tears flow very easily these days when I hear a touching story on a podcast, witness tender moments on television, or expose myself to the world tragedies broadcast on the evening news.  Eventually, it stops.  Eventually.

I don’t know when I got to be so sensitive.  Or perhaps I have been sensitive this whole time.

Other things in my life seem normal like eating, drinking, and socializing with friends and family.  I find ways to have fun and connect with the people I love.  It makes me feel almost normal.

But then the sadness strikes when I am alone, or even just feeling alone around other people.

Can it be that my return to working in surgical trauma has reminded me of how heartbreaking this world can be?

I have been in operating room nursing for 13 years with over half of those spent at a Level I Trauma Center.  I can’t remember feeling this way.  I can’t remember crying like this.  There is a distinct possibility that I have done what I usually do:  compartmentalize my feelings until I am ready to confront them.

And so here I am.  Dealing with This.  Now.

The emotions emerged after caring for a trauma patient.  He was a gunshot wound victim.  Just a kid barely in his teens.  The entire surgical team worked together to save his life.  We really tried.  We did everything humanly possible that we could do.  Everything.  We tried everything.  He didn’t make it.

His life ended in front of our eyes.

And he was just a kid.

I have been an operating room nurse for 13 years with over half spent in trauma and that was the first time I ever had a patient pass away on my watch.

It was the first time I had to clean the body of my patient, a victim of gun violence, and make him presentable so that his family could view him.  My friend, another trauma nurse, had to show me how to do it.  With tenderness and compassion, the two of us wiped away blood and betadine prep solution from his torso.  She gently cleaned his baby face, covered him in a fresh green gown and blankets, then positioned his hands so he looked like he was sleeping. The learning continued as she walked me through the finer points of hiding the body bag under his body with some bedsheets because how terrible would it be for his family to see that.

How terrible it felt to do all this…

We waited and hoped his family was somewhere in the hospital.  We hoped that they would get to see him before his body was sent to the morgue.

But they weren’t there.

And so, for the first time, I closed the body bag of a teenage boy who died of a gunshot wound.  And, with my friends, helped move him onto the unpadded, cold, steel-framed morgue cart.

This night…  I want to forget.

 

 

On Call

Working at a Level I Trauma Center means that I have to take call.  My colleagues and I sign up for at least one slot per week over a six week period of time right after our new schedule comes out.  Sometimes we pick up our friends’ call slots or take on extra call which is a nice option if you’re trying to pay off student loans, credit card debt, or that new hardwood floor you installed.

One night I was on call from 11:00 PM to 7:00 AM in the morning.  Something told me to go to bed early that night so that I had at least a few hours of sleep after working a 10 hour shift from 7:00 AM – 5:30 PM.  As usual, my gut instinct was right.  It was summer in Big City after all.  My phone rang at 12:09 AM

“We need you to come in.”

I mumbled, “OK be right there.”

In a matter of 30 minutes, I was at the hospital, dressed, and ready to work.  I was part of the team that was “on deck” just hitters are in baseball.  One team already started working on a patient with a gunshot wound to the abdomen, so we were available for the next trauma.  While we waited, my coworkers and I prepared the empty ORs for the next day’s cases.

I guess it had been a busy evening because the overnight staff had not eaten or taken any breaks.  I was asked by the charge nurse to take over for the circulating nurse who was working the case in progress.  When I walked in, she let out a big sigh of relief.

“What’s going on?” I asked.

I recognized an Orthopedic resident with whom I worked with regularly.  Apparently, my friend was taking on the details from the young doctor for what was to be the second procedure performed on this patient.

OR Nurses are crossed trained over several surgical specialties, but we all have one or two which we are the most comfortable and confident.  Part II was not my co-worker’s expertise; it was mine.  Immediately, I started rattling off a list of what we were going to need for repositioning, instrumentation, and supplies.  As I took over care of this patient, my co-worker collected the items I needed and left them outside the door to my room while I worked out a plan for the transition.  The surgeon and the Ortho residents also provided input on other supplies.

One more staff member on call came in — a teammate of mine from Ortho.  Halleluiah! We could not believe our luck!  We had everyone we needed in place.  The transition from one complex surgery to another could not have been smoother.

In retrospect, the success of this surgery depended on three factors:

  1. Expertise – knowledge of the procedure and the items needed for it
  2. Teamwork – sharing the knowledge and then acting as a unit to prepare and execute
  3. Communication – a constant exchange of information that helps the team operate in sync

These three elements are crucial to the success of delivering the best patient care in surgery whether during a regular work day or while on call.  This is not a guarantee that the outcome will be positive; however, ultimately, we can truly say we did everything we could do for our patient.

 

Timeout

In surgery we do something known as a “timeout.”  We verify identity of the patient, the procedure that will be performed (and later, has been performed), and all pertinent information. This occurs three times while a patient is under our care in the operating room.  It happens when the patient enters the room (a “sign in”), before incision (“pre-incision”), and at the end of the procedure (“debrief”).  It allows the surgical team to ensure a patient’s safety as well as review any issues that might have been encountered.

At the end of my work day and my work week, I do my own timeout.  It helps me answer these questions:

  • What challenged me today/this week?
  • How did I handle it?
  • What did I learn about myself?
  • What did I learn about others?
  • How can I improve?

Maybe this sounds too touchy feely or too deep, but I honestly love my job.  When I stop taking it seriously, it’s time for me to find something new.  Taking care of my patients is a big deal to me and I just want to be the best that I can be.

Asking myself these questions also allows me to take better care of me.  It prevents the onset of nurse burnout.  One of my fears is that I go back to the person I was in my last job as an assistant nurse manager in surgery at a busy Level I Trauma Center.  The stress from that role made me a different person.  The job wasn’t fun and neither was I.  My family and friends can attest to that!  When a friend bluntly told me that she “will pull [my] hair out if [I took] another management job,” I knew it was bad.  I didn’t realize the extent until I left to go back to being a staff nurse.  What a difference!  I show up, work hard, and then at the end of the day I go home and can leave the work at work.

But anyway…

In my Personal Timeout, items tend to fall in these categories:

  • Moments That Made Me Laugh
  • Times When I Wanted To Quit
  • Reminders of Why I Do This Crazy Job

Today is the end of my work week.  I worked four ten-hour shifts and it’s time to call it DONE.  So here is my Debrief…

Moments That Made Me Laugh

  • My ornery nurse friend who would not take crap from a resident when he tried to do things his way versus the way the attending surgeon usually does it.  Sometimes you have to remind them that they are not the attending!
  • The CRNA who sang along to a Spotify Throwback Thursday playlist and didn’t realize she was doing it until the surgeon mentioned it.  He was entertained and she was embarrassed!
  • A coworker who announced that she is trying to be more positive by forcing an unconvincing smile.  It looked painful…  We told her to “just do you.”  No point in looking constipated!
  • The 80 year-old woman who was trying to get up on the operating room table while waking up from anesthesia.  She told a resident to “shut up” several times as he was trying to calm her down.  Feisty little lady!

Times When I Wanted To Quit

  • The combination of having a new employee to teach, a surgeon who was in a hurry, and an annoying sales rep made my head pound.

Reminder of Why I do This Crazy Job

  • My patients and their families and their appreciation of my care
  • Being able to share knowledge AND learn from my colleagues
  • Working with people who know the meaning of TEAM

 

I really do love being an Operating Room Nurse.  It is hard to think about finding satisfaction in doing something else.  At this point, I am not actively searching for a new position.  Surgical nursing is a very physical job and I know that I need to figure out where I want to be in the future.  Hopefully, I can figure that out before my body starts protesting!