August, 2007 Archive

August 24, 2007, 10:31 am

Pearls of Wisdom for Perioperative Purveyors

muppets

This was my favorite skit on the old “Muppet Show”.

Usually the “patient” would sit up and make some wisecrack to the OR team.

Can’t say much for their technique, though!

No one is wearing a mask and Miss Piggy’s hair would easily all into the surgical field.

Oh well, no one is perfect.

******************************

We all expect our surgeons to be perfect.

Perfect in technique, perfect in personality, perfect in demeanor.

Eternally patient, never exhausted, always in a good mood.

Hate to break this to ya, folks but surgeons are human!

*****

It’s no secret that surgeons have a reputation for being egotistical, overbearing and intolerant.

We’ve all heard the horror stories of instrument tossed across the OR in anger.

I once saw a surgeon throw a chest tube full of contaminated blood across a trauma room in an ER.

And let us not forget the infamous Dr. Prissy Pants who intimated that no one in my ER was working because the patient did not have his consent signed by the time the Dr. walked in to see him!

*****

Surgeon stories.

We nurses have a million of them.

But how many of us have ever looked at the situation from the side of the surgeon?

Instead of dreading the idea of having to work with one, what can a nurse do pro actively to make the preoperative experience a smooth one for themselves, the patient and the surgeon?

Having dealt with surgeons as a nurse, a patient and a family member, I have a few ideas born out of my experiences. Your mileage may vary.

  • If you work with inpatients, for pete’s sake make sure the patient is NPO! Nothing will make a surgeon blow up faster than finding out the patient can’t go to OR because they have eaten! I know of one incident that caused a six hour delay in the removal of what turned out to be a gangrenous gall bladder.
  • Make it a priority to have the patient ready for surgery. Paperwork can come later. The surgeon is not operating on the chart.
  • Having said that, the more paperwork you have done, the more efficient the process. Have alert patients fill out their own anesthesia questionnaire if they can.
  • After hours, follow up and make sure the supervisor has called in the OR team and make sure you know the ETA. Hell hath no fury like a surgeon who walks in ready to take the patient to OR only to discover the team wasn’t called in.
  • If pre-op antibiotics/medications are ordered get them in - they are ordered for a reason.
  • Every nurse knows the surgeon must speak to the patient about the risks/benefits of surgery before the consent is signed. Every surgeon knows it too, but that doesn’t stop them from telling you to have the consent done before they get there. Fill it out so it is ready to go after the surgeon is done explaining.
  • Post-op: when you call a surgeon, be concise. Tell them what you want. Is more pain medication needed? Are you seeing signs of infection at the incision site? Is the patient now febrile? Don’t beat around the bush with a long-winded story.

Those are just a few of the ideas that come to mind when working with pre-op patients and their surgeons that contribute to a smooth peri-operative experience for everyone involved.

*****

It helps to remember that surgeons are just like us. They get tired with long hours, they have no control over their workload if they are on-call. Yes, they get paid well and yes, they chose their specialty and yes, being called in is part of the deal they signed up for but that doesn’t mean it is easy. Even though you work a night shift and are chipper at 0400 (raising hand here) the surgeon who is coming in early to fit your appy in before his full day in the OR might not be so upbeat.

There is always room for understanding and for cutting each other a little slack.

That is why I can count the number of think-they-are-God surgeons on less than one hand.

Mutual respect goes a long way.

*****

(Epilogue: to all surgeons reading, please understand that nothing undermines the care of your patient worse than an arrogant, insulting attitude. If you are lucky, the nurse will call you on it. Worst case scenario, the nurse is afraid/unwilling to interact with you and that is never in the best interest of your patients.)

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August 23, 2007, 8:17 am

Change of Shift: Number Two, Volume 5

cos

…is up over at Nurse Ratched’s Place!

Mother Jones takes us out west this week as she hosts this edition!

droopy

Many thanks to Ma Jones fer hostin’ this here carnival!

Mosey on over and get a load of the babe who introduces it!

She reminds me of someone in an old Tex Avery “Droopy” cartoon.

There was always a girl who would make the wolf’s eyes pop out of his head.

I love Droopy. He’s the coolest!

Got him on DVD, I did!

******************************

As I noted in the previous post, I’ve been going over my blogroll. Please contact me if:

  • I’ve removed your blog and it is still active. I removed the links of blogs with no posts in 2007. If you are just on an extended hiatus, let me know and I’ll put your link back up.
  • You have a blog that is not listed that you would like to see listed.
  • You would like to be placed on (or taken off) the Change of Shift address book. I send out reminders to almost everyone on the blogroll and to the Grand Rounds discussion group. If you are on both lists, let me know and I’ll take you off of one. If you’d like a reminder every two weeks that CoS is up, let me know and I’ll add you to the roster.
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12:07 am

A Tale of Two Seniors

becca

Ah motherhood!

Totally embarrass your children whenever and wherever you choose, often by just being yourself!

No worries, though.

This is my youngest daughter’s senior portrait.

I got her permission to use it.

I think it is stunning, she thinks it is gross.

I’m a pretty proud mom.

Gee, two kids married and now my youngest is a senior.

My babies are growing up…

Time for tears?

No freakin’ way!!!!!

Can you say freedom???? I knew that you could!

Woo Hoo!

******************************

I have five days off, so I’ve been indulging myself and catching up on all the blogs on my blogroll, leaving behind a trail of comments as I go.

I’ve also been messing around with some other internet activities and and I am happy to report that:

  • My world is orange
  • Emergiblog is rated “G” for General Audiences (gonna have to spice it up a notch)
  • Dead or Alive, Emergiblog is worth $1800 cash
  • My dead body is worth $4340
  • I have a 30% chance of surviving a zombie apocalypse
  • I’m 71% addicted to coffee (seems a tad low)
  • I’m 82% addicted to blogging

These internet tests are stupid. It should be obvious that most of my blogging is done at Starbucks so if I’m 82% addicted to blogs, my coffee addiction should match!

******************************

When I was little, I used to read the old Reader’s Digests in my great-grandmother’s room. My favorite feature was called “My Most Unforgettable Character”. Throughout my nursing career, I’ve met a few patients who would meet the criteria. Here is the story of one of them.

*****

Ninety-seven years old and he was actually going to be discharged from the ER.

Nothing a few Tums wouldn’t cure.

I had just started my shift and the nurse who started at 1900 was going on her break. Would I be so kind as to discharge the patient in 4A?

Sure! Show me an ER nurse who isn’t all about discharging patients!

I took a quick glance at the chart to see what had gone on with the patient and what discharge instructions I would be giving.

I expected the discharge to take a bit longer than usual. As I printed up the instructions I realized that at the age of 97 he was probably frail, hard of hearing and I’d have to speak slowly and clearly to be understood. There might be a bit of dementia. He’d need help dressing and help out to the car.

*****

He wasn’t in the bed. He was holding court in a reclining chair, attached to the cardiac monitor.

He was anything but frail; he was borderline stout! Far from hard of hearing, he picked up the slightest sound and responded to normal conversation.

Actually, he did not respond to normal conversation, he directed it! He reminded me of Sam the Snowman from “Rudolf,the Red-Nosed Reindeer”. He didn’t look like Burl Ives but he sounded like him. Animated, jolly and full of life.

I had gotten out one sentence after introducing myself, something to the effect of “You get to go home!”.

And Mr. Sam was off!

*****

He was ecstatic that he did not have pneumonia and proceeded to explain to me that he was able to cure people, that he had the gift of healing from God and had treatments and cures for just about anything. Most of them had to do with poultices and iodine.

Pneumonia is cured by placing iodine on the chest. Within 24 hours, you cough up all the phlegm in your lungs and the pneumonia is cured.

I did not know that.

Oh, and by the way…no dementia!

This guy was fascinating. He took my hand as I passed by and had me sit down to tell me more about his gift. Luckily, the department was not busy so I had a chance to listen.

*****

Mr. Sam knew he had “the gift” from birth. The midwife told his mother that he was born with a “double veil”. This meant he was given the “gift” of healing. He had healed many people in his lifetime. People with pancreas trouble and heart trouble and back trouble.

I laughed and told him that he would have a line of nurses out his front door if he had the cure for back pain! He had me turn around so he could show me how he could cure back pain. He showed me some neck exercises. His neck was supple and moved easily.

Mine cracked six times.

He assured me he did have the power to heal and that there were 150 angels working with him. He was quite specific about the number. His friend, female and somewhat younger nodded as he spoke.

He did not just heal. He would do “readings”. He didn’t say tarot cards or palms, he “read” people. Eventually he had to stop because he often became emotional from what he saw in the future of the people who asked him for insight. It was hard to tell someone things were not looking good.

*****

Lest you think Mr. Sam was all spiritual and ethereal in demeanor , let me give you an example of one of his “readings”, as told to me.

A man, 75-years-old, came to Mr. Sam with a problem. Mr. Seventy-Five was in love with a twenty-something woman and was sure she felt the same towards him. He had spent much money on his sweetheart and was considering buying her a new Mercedes. Mr. Seventy-Five wanted validation that the woman young enough to be his grand-daughter really did love him.

Mr. Sam’s response? “YOU’RE STUPID!” he described himself as saying. “She wants you for your money! How much more stupid can you be? Don’t buy her the car and watch how fast she runs the other direction! YOU’RE STUPID! And you’ll be dead of a heart attack in six months.”

Now that’s a reading with a ton o’ common sense attached!

Guess what? Mr. Seventy-Five did not buy the car, the young woman dumped him and he died of a heart attack within six months.

*****

It took forty-five minutes to discharge Mr. Sam, who dressed himself faster than I can take a blood pressure and walked out of the department under his own steam.

He said if I ever wanted a reading to come and see him and he made me write down his number.

I could have sat there and listened to him for hours.

Something tells me he would have obliged.

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About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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