Every OR nurse has a story…..

A story of some mistake they made from which they learned something that they will never forget…..let’s face it, things happen.   We are all human and bound for error at one point or another.  To err as an OR nurse is NEVER intentional and the lessons learned are meant to be shared and never forgotten.  I long for the confidance that only experience will give me, and slowly I am gaining little bits of confidance every day.

The experiences I have had in the 10 months that I have been in training have been nothing short of amazing.  Every day is a new adventure and it will be that way for me for a very long time.  Slowly, pieces are coming together and I am having “A ha” moments more often now as I see more and do more on a daily basis.

The tried and true Girl Scout adage “Be prepared” could not be more appropriate as an OR nurse.  But sometimes, it doesn’t matter how prepared you think you are, or how much you know, there will always be a challenge….   The OR is obviously a whole new world for me, and every day I am learning something new.  Even if I have seen or done a case before, every rerun teaches me something else, or I remember something else, or better yet – I actually anticipate the need before it arises !!!!  That is the most satisfying “A Ha” moment…. knowing what the surgeon needs before he has to ask.   Which leads me to one of my biggest challenges….  (names have been changed to protect the not so innocent)

Let me start by saying that I have been teaching young interns and residents for many years…. it’s pay back time !!  I get the frustration of working with some one who is inexperienced.  I get the irritation of having to wait for something.  I completely understand the gravity of a situation, and believe me, I am experienced enough to know when I should step back and let my expert preceptor step in.   But give me a break…I can do this, just let me show you.

Stage left,  Dr “Let’s make this as complicated as possible.”   Dr LMTACAP is a good physician and a skilled surgeon.  He is very passionate about his patients and does wind up with some of the most compromised patients imaginable.  But he can turn a simple toe amp in to what looks like open heart surgery by virtue of the instrumentation and/or equipment that he requests….  And he frequently changes his mind and is sometimes inconsistent in his approach.  This is all very frustrating for a scrub nurse in training.  Throw in sarcasm and at times, obvious impatience, well, it is not a recipe for success.  May I also add that he has his own names for instruments and things which, in a world where one instrument can go by 3 or 4 different names, just serves to be that much more confusing.  In addition,  I can truthfully say that, after one case in particular with him,  I questioned my decision to become an OR nurse and wondered just what had I gotten myself into for the long haul.  Not to say that he is the most difficult personality, there are MUCH worse – but I was thinking, if I cannot handle him, what am I doing in the OR ???  I spent a whole weekend agonizing after that bad day with him and was reduced to tears…  But then the rational me showed up and I thought through the case and realized that this is part of my learning curve and I needed to figure out how to deal with the Dr LMTACAP’s that I will encounter in the rest of my journey.

I actually like Dr LMTACAP and can truly appreciate his sarcasm.  He does come off a little rough though and is at times misinterpreted.  That being said… if he could just be a little more consistent, his life might be easier too.  After that particularly bad day with him, I actually wanted to avoid scrubbing with him but realized that is not the answer to the situation.  I have been fortunate enough to work with some truly wonderful preceptors, and with their support have gained a lot of confidance in my ability to scrub, even with Dr LMTACAP.

So yesterday,  I scrubbed with Dr LMTACAP but the difference was, I was prepared.  I tossed and turned the night before,  I agonized over the speed at which I knew I needed to perform. But the day before my assignment to scrub in two cases with Dr LMTACAP I received wonderful tips from the two experts on the vascular service and I wrote everything down and practically memorized it in order to prepare myself for all the possibilities.  I launched in to my day with every ounce of determination to succeed.  The first case went down really very well and much smoother than any one of us in the room could have anticipated.  It was technically fairly simple, but could have easily taken a turn – or Dr LMTACAP could have careened off in to a wild detour and turned it in to an all day event.  That did not happen.  I think he even surprised himself.  Dr LMTACAP was also in a good mood and not too annoyed by things that usually would cause a running sarcastic commentary.

The second case of the day was big – a carotid endarderectomy – somewhat complicated and very delicate !  ( simply put – cleaning out the carotid artery )  YOU DON’T WANT TO MAKE ANY MISTAKES IN THIS CASE – stroke, hemorrhage to name just a couple of things that could go wrong.  Me nervous ??????  Yes, I was but not a panic nervous – a healthy kind of nervous because I knew I needed to be at the top of my game.  I was prepared.  I had plenty of time to set up my back table and get everything organized.  I had everything I needed and a few more things that I probably didn’t, but they were all within an arm’s reach in the event Dr LMTACAP made a request (demand).  I owned this case and I was going to prove that I could not only keep up, but stay ahead.  AND I DID !!!!  My preceptor stood gowned and gloved behind my table, ready to step in if I needed help – but I managed.  I panicked only slightly when some one came in to relieve us for lunch… I didn’t want to step out for lunch.  I needed to be in this case from start to finish.  I did not know the nurse who relieved my preceptor, but my preceptor told her that I was doing fine and the relief nurse said she had worked with Dr LMTACAP before – my panic subsided.  So not only did I keep up, but I anticipated the needs before the requests.  I knew what I needed to have ready, and I was able to switch gears when there was a little trouble.  I faltered but once trying to load a tiny little prolene suture on a castro needle holder – it may have been because Dr LMTACAP asked for it no less than 3 times breathing down my neck – and I have practiced with these types of needle holders at home with tons of expired prolene – every castro feels different and some are more cooperative than others.  I did ask my preceptor once to load the needle but I managed every other time thereafter….. I DID IT !!!!  At the end of the case Dr LMTACAP actually told me that I did a good job…. I nearly dropped all the instruments.  My preceptor and I high fived and fist bumped.

I felt tremendous relief and I can tell you that I was so completely exhausted at the end of my day…. it was a victory for me.

 

 

 

 

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Never let them see you cry…..

It has been far too long since I have blogged….and I have so much catching up to do.  This certainly would have been much easier if I had kept at it on a weekly basis (daily would be better) but I will attempt to back fill that space of time since my first couple posts to the present…..

Pediatrics was never my first choice for nursing…. sick kids scare the hell out of me. Kids (espeically babies) cannot always tell you what is wrong and because they are so small, they have little reserve or ability to compensate.  My first pedi experience as a nursing student was at an academic medical center where you see the sickest of the sick kids.  My very first pedi patient was all of about 15 months old and was on a cardiac monitor.  My nursing instructor was spectacular.  She always chose a slightly more challenging patient assignment for me because I already had a few years of hospital experience as a nurses aid and unit secretary, which gave me a much greater understanding of patient care in the academic setting.  I was standing at the nurses station reading the little guy’s chart and had one eye on the cardiac monitors when suddenly the “rhythm of death” alarm went off and his monitor tracing had clearly gone horribly wrong.  I raced down the hall to his crib, my own heart in a “rhythm of death”, only to find him sitting up and chewing on one of the monitor leads.  He broke in to a smile upon my arrival, clearly happy that some one had stopped in to visit him…..after I stopped shaking and having my own heart attack, the rest of the day went smoothly.  He was an adorable little guy, who had a correctable heart defect and went on to have successful surgery.   If only all of the pedi stories could have happy endings !!!  It is just not right that kids can have things so horribly wrong.  As a student, you can spend so much time with your one assigned patient and really get drawn in to the case, the kid, and the family.  As a Real Nurse (the other meaning of RN) the reality is that you don’t have all that time to devote to just one patient….and sick kids scared me.  So I went on to work with adults but now as an OR nurse, my patients come in all ages…. enter a little 8 year old boy.

C****  was a direct admit from the bone marrow transplant unit in to my operating room.  Normally we see kids in the pre-op hold area but his white blood cell count was too low for him to be hanging around in areas with all kinds of patient traffic.  He came rolling in via wheelchair and his big brown eyes revealed his entire emotional status in one glance.  Behind his little isolation mask was the face of one little boy trying to be so stoic in a situation much bigger than his little self.  Because he was now in a “sterile” environment, and the entire OR team was wearing masks we told him he could take his mask off….and he hopped up on the OR table with little help.  He lay there so small on the table, his eyes growing wider with each second.  He wasn’t saying much – you could tell he was just trying to hold it together.  He smiled ever so slightly when I asked if he felt like a race care in a pit stop, with the flurry of activity going on around him…. anesthesia setting him up with monitoring leads, the x-ray tech programming the machine, the scrub nurses setting up the instruments, and myself and the other circulating nurse standing on either side of him quietly reassuring him that “it was all okay.”  He only nodded in answer to questions and didn’t really want a hand to hold… and just before he started to drift in to his sleepy anesthetic haze, the big tears started to roll down from his deep brown eyes.  I will confess that I was quite welled up myself…as was my fellow circulator and the pediatric anesthesiologist too – this very brave little guy was facing a long and difficult battle ahead and our hearts were just breaking for him.

All in a days work I guess…. we didn’t let him see our tears and I hope he felt the compassion and strength we were all trying to envelope him with as he drifted off to sleep into the first of a series of life saving procedures, some of which will hurt, but all of which are meant to restore normalcy and health in to his young life.

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I am Joe’s Kidney……

My Mom subscribed to the Reader’s Digest when we were growing up…and I remember reading the articles every month that always started with the title “I am Joe’s……”   They were great little pieces that described one organ or another, one illness or another, and it was at once educational and terrifying.  I will confess to being a bit of a hypochondriac as a child and these articles would both amaze and frighten me to near death.  I was pretty sure I would have any or all of the symptoms of the prevailing ailment of the month and my poor mother spent a lot of time convincing me otherwise.  I think that may have been the first inkling that I would eventually become a nurse, my mom would totally deny that if she were alive today….and in fact, she was in complete shock when I called to tell her that I had decided to go to nursing school. It did take me a little longer to figure out that career path…. but here I am.

So I am loving everything OR but I have to tell you that there is something so very special about transplantation.  I have only been fortunate enough to be involved in 2 kidney transplants since my internship began….but my love of transplants started 25 years ago when I started nursing.  I have been caring for the liver and kidney transplant patients and their families since I started nursing and the surgeons and the patients are my favorite populations by far….and to know and work with the transplant surgeons is to love them too…

Both times I was able to scrub in – the first time I was there to just get the first hand view of the role of the scrub nurse and watch the procedure up close and personal.  But, I became a necessary set of hands when the surgeon needed me to hold the new kidney so that he and the resident could suture it in to place.  Honestly, when it came time to prep the new organ, it looked like a piece of chicken….it needed some trimming and it was pale and so very cold, as it had spent some time on ice.  I was a bit nervous….didn’t want to drop it, knew I would need to stand pretty damn still for quite some time, and I didn’t want to hold it too tight or the wrong way…. but I was so very excited and though it seemed like an eternity of suturing, once the they were finished the new kidney turned this miraculous shade of pink – taking on a new life and giving a new life to the patient on the table…. who by the way was not named Joe. (HIPA)

The second time I witnessed the miracle of transplantation I was an active participant as the scrub nurse for the first part of the transplant procedure for the recipient.  The very patient transplant surgeon taught through the entire process and my very wonderful scrub preceptor stood just on the other side of the mayo stand, ready to lend a hand if I looked like I was faltering…. She had a lot more confidence in me than I did in myself, but much to my surprise I was able to keep up and I didn’t falter.  Watching surgery is absolutely fascinating, dissecting the anatomy in real life, not just reading about it or looking at pictures – seeing the layers of tissue and muscle, identifying vessels and organs, fully understanding the process of the procedure first hand – it is all just so amazing.  But as a scrub in training, I was also very worried about passing the correct instruments, and passing the correct instruments correctly, and just trying to keep up with what was next…. I was concentrating on the process.  It is an art, let me tell you, passing instruments correctly.  Even now as a circulator, I love to watch the scrub person, how they organize their back table and the mayo and how they anticipate the need and pass the instruments with flare. It is both a skill and an art. When I grow up I want to be that graceful as a scrub nurse, when I get the chance.  Anyway, I was relieved to pass the first scrub role back to my preceptor so that I could take in the artistry of the entire surgery – watch her anticipate, prepare and pass instruments and watch as the surgeon planted this new life giving organ in to the recipient…. and quietly take in the sharp breath, behind my surgical mask, waiting for the new kidney to “pink” up and start it’s new work – it’s a truly amazing moment.  (this patient was not named Joe either)

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A Surgical Conscience

As I close out week 7 of the internship program, I am finally starting to feel like an OR nurse;  not some one caught in a foreign land without any understanding of the language and no interpreter service.  Still so much to know but learning the lingo and totally feeling like I am getting a grasp.

The highlight thus far, on a very personal level, was participating in a kidney transplant.  I got to scrub in and working along side the transplant surgeon, I actually held the newly transplanted kidney in place while it was being sewn in to the recipient.  Holding that kidney was an experience that is hard to describe….feeling I guess, like I have finally found the place I am supposed to be.  Sounds rather dramatic but there is so much satisfaction in being a part of a team that makes such a difference in the live of a patient.  Being a part of the transplant team that day was truly a dream come true….

Okay, dream sequence over !!!  In reality, I still feel cognitively impaired when putting on the gloves…. my personal joke is the surgery will be over by the time I am gloved.  It is definitely getting easier and slightly faster.  And, altering the glove size has helped tremendously – both in donning the gloves and the improved circulation, sensation, and motion to my hands after hours of wearing them.  Keeping a sense of humor ultimately makes life easier.

There have been some light bulb moments….. finally getting the anatomy in the laparoscopic sleeve gastrectomy cases;  holding the camera during some of the lap cases;  appreciating the plastic surgeon who said “let’s get you in this game and taught me how to retract and how to ‘buzz’ ” ;  and just expanding the the scope of my radar on a daily basis.

I have also learned just how very expressive eyes can be – so much can be said without actual words…. I’m just sayin’……..

 

 

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Can an old dog learn new tricks?????

My journey began almost one month ago…..after 25 years as a bedside staff nurse on a very busy surgical unit, I decided I needed a change.  At 53 years old, I did question myself and the director of Surgical Services …. “Am I too old?”  “Can I do this?”  “WTF am I thinking?”   But I was selected out of a number of candidates applying for the position…all younger than myself…so that gave me the confidence I was looking for to support a decision that I have been mulling about for quite some time.  The world of OR nursing takes a very special personality – a group that is not necessarily easy to break in to…. who I am kidding….Nurses tend to eat their young…  This is a very sad, but very true statement.   The fact of the matter is, if you cannot survive the stress of being a new nurse you won’t survive happily as an experienced nurse.  The job never gets easier.  You are put to the ultimate test on a daily basis.  You need tough skin and to be able to think fast on your feet.  Your decisions can be life altering to your patients.  You will experience things no one outside the profession would ever believe.  You will cry.  You will question yourself daily.  But, you will make a difference in every life you touch, in some way.  You will be amazed and amused.  You will learn to love cold coffee.  You will develop a bladder the size of the Titanic.  You may start swearing like a sailor.  Your colleagues will become family.  You learn to treasure life because you see so much tragedy….and you learn to celebrate the little things.  So, it is with some trepidation I depart (on a permanent full time basis) the world of bedside nursing and catapult myself in to the land of over 1000 instruments, masks, gowns, and gloves, and a whole new book of nursing that I am embracing with gusto!  I so appreciate the opportunity that I have been given as a paid peri-operative nurse in training.  I love all the learning and have already had some great laughs with my partner in crime….another “older” nurse switching it up at age 46.  We have been welcomed by many…. questioned by a few ….. overwhelmed by it all, but taking it all in, and just one day at a time.  

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