Surgery

Brain Dump

/ Marjorie / Leave a comment

I woke up this morning with what I call “The Overwhelm;” the feeling of being trapped under the snow after an avalanche. I can’t dig myself out. I’m struggling to breathe. I can’t seem to find a way out. Outside the sun is shining and the birds are singing, a sign that Spring is around the corner. Yet, I am on the Struggle Bus.

I know this is temporary. The beacon inside me says, “Keeping digging.”

There is no rescue team. I must rescue myself…

Digging

Last October, I was optimistic about my new job. At this point, I am questioning my decision about staying in OR nursing and working for a large institution. Whatever I thought I learned during my two and half month sabbatical between jobs, I have quickly forgot. The Overwhelm has a way of taking over sometimes and I never know when it will hit.

The new gig has been challenging and frustrating, so much that I actually considered calling my old manager to see if I could do an agency stint down there. I left my last job because I no longer wanted to live in that city. I left because I didn’t want to see the parade of gun violence victims brought into our OR. Do I really want to go back to that even on a part time basis? I don’t know…

“Don’t it always seem to go, you don’t know what you’ve got ’til it’s gone.” ~ Joni Mitchell

I miss the relationships I had with people – my fellow staff members, physicians, ancillary staff, the trust that was built through difficult times. I miss having a supervisor who rolled up her sleeves and helped the people she led. I miss having a supervisor that encouraged my creativity and appreciated my contributions to the department. I miss having charge nurses that were on the same mission as the staff – not to just keep the schedule moving, but to put the right staff in the right rooms. I miss the resources we had that helped us focus on patient care: the equipment guys, the sterile processing runners, the supply chain techs that would fill our supply lockers in the rooms. I miss the layout of my last OR which was open and helped facilitate a relationship with the Command Center. After all, the people in charge should know the staff and their skills.

Reality

Yes, I’m mourning the Past and I am trying to accept my Present. BUT WHAT ABOUT MY FUTURE? I don’t believe that I need to accept my current situation as my future. I am actively searching and meditating on what is next for me. I don’t think it involves OR nursing. I don’t think it even involves nursing. After all the hard work I put into getting my nursing degree, the blood, sweat, and tears I poured into every OR nursing job I have ever had, I am ready to give this all up for a little less sorrow and a little more joy.

The Year 2023 has already been a hard one and it’s only the beginning of March. The Universe slapped me in the face with the deaths of three strong women – my aunt, my friend, and my partner’s mom. A question emerged from the heartbreak, “What do you want for YOUR LIFE?”

Search

I am looking for the courage to face what is and what could be. I know there is no easy way out. But what is harder is staying in a joyless situation. I have more questions than answers.

Has healthcare changed so much that I won’t be able to find happiness in my work? Or is it me? Have I been changed by what I have witnessed over 17 years of OR nursing that the passion and fire I once had is beyond revival? Is it selfish for me to want to take care of myself and relinquish the honor of taking care of patients? Do I still love nursing enough to find another role outside of a OR staff job? What has enabled long-time nurses to stay in this line of work for as long as they have? Do I really need to leave the OR, nursing in general, or do I just need a therapist?

Beyond

Sometimes work takes over my life. I have to remind myself about the things that bring me joy on the outside: my partner, my dog, my family and friends.

Why do I always forget about this? Why is my identity so tied to my work?

I am exploring a new venture: starting my own business. This is separate from me being an investor in my significant other’s business. This will actually be MINE. Well, technically “OURS” – my business partner (another nurse friend), and me. I am starting work on the business plan today. It’s going to be a secret for a while until we are, God-willing, ready and able to launch.

I need to stay in this job for now. I need to find a way to fend off The Overwhelm. I want more joy in my life. And I know that I need my family and friends more than ever.

The good news is they have always been there. I just have to ask for help.

Help!

Starting Over

/ Marjorie / Leave a comment

New city. New job. New life.

We did it. My partner P and I finally left Chicago and headed north to Wisconsin. It was bittersweet leaving the town I have loved all my life. So many great memories, yet that city is unrecognizable to me.

Is this what old people say?

I guess I am older now, but those memories feel like they were just a moment ago. Riding my bike along the lakefront path… Cruising down Lake Shore Drive… Playing touch football, beach volleyball, and floor hockey with the Chicago Sport and Social Club… Bars, music, dancing… All the activities of my youth! Then later, fine dining and culture… It all felt safe.

But then things got worse – the violence and cost of living… What the hell, Chicago???

I don’t know when the wheels started falling off. With the exception of my first year as an OR nurse, I have been an OR nurse at a Level I Trauma Center for 16 years. Trauma call was bad, but then it got WORSE. (Or maybe the PTSD was rearing its ugly head? The jury is still out on this one…) My last hospital was THE PLACE where ambulances brought victims of gun violence, stabbings, and motor vehicle accidents. In the last year especially it seemed like every day my department saw something catastrophic.

The decision to move was not made overnight. It fermented for months. How could we leave family and friends? And then we just could not take it anymore. For the sake of our mental health and our relationship, it was time to do it. Besides, we weren’t going far away and we had family and friends in Wisconsin.

One of the hardest things to do was resign from my job. It wasn’t perfect – no hospital is… But in the grand scheme of things, it was one of the best places I have ever worked. I felt respected, even loved, by my colleagues and friends. I was in my comfy, cozy, comfort zone. Deep down, I knew it was time for a change, a new challenge.

Hello, Wisco…

I asked the Universe for a challenge and I got one. Moving was stressful. Every day for the first month we discovered something that needed to be fixed in our rental home. My Wisconsin license was pending with no word of any progress. I had applied well in advance of the move. The plan was to take one month off between jobs. One month turned into two, which then turned into two and a half. It took a little political help to push it along. But I needed the break. Desperately. I’m still processing everything that bubbled up during my sabbatical. More on that topic later…

Getting an operating room nursing job was easy with 17 years of experience, including scrubbing, circulating, management, and exposure to all the surgical specialties, especially trauma. The hurdle I am facing now is orienting to a huge hospital with different processes, surgeons, staff, and all the personalities that come with that… Ah, the weirdness of an OR!!!

I’m three weeks into the job and so far so good (at least in my eyes). OR nurses are Type A, each in their own way. For me, I want to know everything about everything NOW. Enthusiasm is good, but I need to stop myself.

Slow your roll, girlfriend…

One of my nurse preceptors could not believe that “at [my] age” I am making this change, as if I am running the gauntlet.

Ummmm… What???

My mind is still sharp. My body is still strong. Comfort zones can be a death sentence. Sometime somewhere in my life I became fearful of stagnation. Even if I get comfortable at my new hospital, I know that I will always be looking for opportunities to learn something new. I’m even looking into how to make my own YouTube videos. Totally not kidding… But that’s for another post!

So many things I’m still processing, still mulling over, still figuring out. This is good. It means that I’m not done yet. Ah, Life!!!

Return To ME

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For eight months, I have been silent. It’s not that I don’t want to write… When I am just about to pull out my laptop, something gets in my way. It’s my To Do List, the telephone, the need to tidy my surroundings before I do something that requires sitting. More accurately, I get in my way. The excuses are really my tendency to procrastinate. I know that this will be good for me – to write and get everything off my chest.

I am so much better than before. Truly. Seriously. I promise I am.

What has helped me over the last several months, is that I finally put myself first. I leveled up my meditating game and have been making breakthroughs thanks to Dan Harris and crew at Ten Percent Happier. I have been doing MORE – more yoga, more listening to music, more cooking, more sitting down and doing NOTHING. It was a struggle not to feel like I should be doing more and being more “productive.” Thankfully, I came to the realization that, even if I was doing “nothing,” that that was actually SOMETHING for me and my mental health.

Meanwhile, things at work are interesting. COVID brought on different challenges, but then we all got used to the way we had to live our lives (N95 masks, all the PPE, negative pressure rooms, etc.). In the last six months, came another change – the loss of staff to lucrative agency contracts. My former co-workers have not been traveling out of state, just staying local. In fact, it feels like all the big hospitals in the city have just exchanged staff. We have been lucky to get some talented nurses who are very nice and fun to work with. Agency work isn’t for everyone, so we have added new staff as well. As a result, I have been teaching – A LOT. I actually enjoy it, but it doesn’t hurt that we get extra pay for precepting.

Watching my friends leave to pursue agency contracts has been hard. I completely understand why they are doing it, but still… It feels a little like breaking up.

Inevitably, I think that I will be going the agency route too. My boyfriend and I have been talking about moving to another state, so for now, I am putting agency opportunities on hold. Thoughts about leaving my current job make me sad, but things have changed so much that one way or another, it will never been what it once was.

Yes, change is inevitable. I have to accept this and be willing to let go of my comfort zone. The way I choose to look at the state of nursing and the uptick in agency staff is that I am increasing my network of nurse friends. Operating Room Nursing is such a small world. There aren’t many of us out there, so it stands to reason that I will eventually work with my friends again! And I’m good with that.

With all the changes in my personal life, professional life, and the world in general, it feels like I found my center and ready to ride whatever wave comes next.

Practicality Not Panic

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These are strange times…

As I was getting ready for work this morning, it dawned on me that I was one of the few residents that would actually leave this 40 unit low-rise condo building to go to WORK. This gave me a sense of purpose that I hadn’t felt in a long time. Or was it just a heavier weight on my shoulders?  Yeah, that’s probably it.  Since COVID-19 started making its way through my city, my neighbors, family, and friends have been working from home, even having to self-quarantine after an exposure to the virus.

Not me.  Not yet.  I’m a nurse.  This crazy pandemic is calling.

Hello, Nurse…  I’m waiting for you.

When I arrived at the hospital, it felt like I was in a new world.  The vibe was intense.  The normal glut of visitors at the security desk were missing.  No medical students rushing past me running late for rounds.  It was almost like a lockdown.  Almost.

As of today, our ambulatory surgery center was officially CLOSED.  All those nurses and surgical techs sent home until April 15th.  What the…..???  Our main operating room OR (where I work) cancelled all elective surgeries per the recommendation of the American College of Surgeons and our government (I’m assuming).  The monitor with our status board was depleted of its normally extensive list of cases.  Instead, a teeny tiny list.  It was so surreal.  We are talking a BIG surgery department that typically performs a lot of procedures now down to a select few.

Makes you want to rub your eyes to make sure you’re not seeing things…  But no…  Hands away from your face!

Because of the small number of cases, some nurses and techs had already been asked to stay home.  We called this “being low censused”.  Basically, this means that there isn’t enough work for them so they are being mandated to stay home, and use their vacation time if they want to get paid.  One day here and there isn’t bad…  But what if the hospital does the same thing to us as our ambulatory surgery colleagues who are off for a whole month?  I hate to even think about this…

I was assigned to circulate three orthopedic cases which kept me busy most of the day.  During slower moments, my mind kept spinning different scenarios on what would happen to me and my co-workers should the number of COVID-19 patients rise in our institution.  It is too soon to say.  Many nurses want answers as if this virus was planned or as if our administrators had been through this kind of crisis before.

NO ONE HAS EXPERIENCED THIS BEFORE.

What a scary thought.  We are looking for guidance, but sometimes those above us cannot figure out the best course of action fast enough.  I would like to believe that everyone is doing the best that they can.  The only thing any of us can do it take it one day at a time, be practical and not panic. 

I know in my heart, we will get through this…  We just need to hang on to hope and find a way to be kind to each other through this frightening time.

 

A Not-So-Routine Routine

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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.

 

I Want To Forget

/ Marjorie / Leave a comment

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

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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.