Too Young to Retire, Too Old to Change – A Day In Anesthesia

 

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From my trip to Guatemala in Feb 2013

“Relieve OR 108,” says the note written on the assignment board as I return from lunch on this scheduled day of surgery. Today is like any other day in my work life as a nurse anesthetist. I make a bathroom stop and then stride into OR 108 to relieve the anesthetist that was previously assigned there. The patient is already asleep and positioned, so all the physical work is pretty much done. The surgical staff is casually chatting as they wait for the surgeon to show up. I take report from my colleague and get settled in for what seems like it should be a rather routine anesthetic.

I now have two places to sign into when entering an operating room- into the charting system and into the drug dispensing system. In just the last couple of weeks, what is called Pyxis A has been installed in some of the rooms. Pyxis A is a drug dispensing system that is stocked with pharmaceuticals that we might need in caring for our patient during the course of an anesthetic. Most of these drugs used to be freely accessible without charging the patient or were gotten from a central drug dispensing system in the hallway or supply room. Now the patient will be charged for each drug used. Definitely, more cost effective for the institution, I would assume.

Change seems to be the order of every day in my workplace. In just one more month, we will be getting a whole new billion-dollar charting system throughout the hospitals. Change always has been a part of the Mayo system for whom I work but changes seem to be coming faster and faster in the last few years. Maybe it is just that I am getting older and no longer have the resilience and energy to quickly make the transitions. My brain is stressed by the continual changing of the rules and policies and systems. There are days when my head literally spins.

As preparation for any emergency that might occur, I make a quick survey of the setup of this room in order to establish in my brain where each supply or drug is located. This is necessary as all the general supplies for patient care have also been relocated to different cupboards and drawers in an effort to make way for the new drug machine and to “standardize.”

Soon the surgeon arrives, and we stop for our “pause” – it always reminds me of the practice of bowing our heads before digging into the food to thank our Heavenly Father. The “start” button is clicked, and we are off… I plunk into my chair to take the load off my feet. Ugh! I realize this is one of the chairs that I find causes my back to ache after about 30 minutes of sitting. I make a call to the anesthesia lead, “Can you bring me one of the chairs from the work room?” I am sure they are rolling their eyes at my request. I have come to realize that if I don’t want to be in agony for 10 hours and want to be able to work a few more years, I have to make some really strange adaptations to preserve my back. Five minutes go by and then a chair is pushed in the door at me with the comment, “Your funny!” Yes, I am.

As I monitor my patient, most of the time I don’t pay much attention to the chatter that goes on on the other side of the drapes, but today I begin to pick up snippets of conversation that grab at my attention.

“I just can’t get this in,” says the surgeon. And to the nurse, “Can you call interventional radiology and see if they can take this patient directly from here?”  OK, I need to be part of this conversation. THIS affects me. “Are you thinking of taking this patient to IR?” I question.

“Yes, and it would be in the best interest of the patient to go directly from here rather than waking him up and sedating him again later.”

I would agree with that, but this is not something I was planning on. I have not been to IR more than once in the last 2 years since it was moved downstairs to the main level of the hospital. I don’t usually work there, and I don’t even think I can find it. My anxiety level has shot up a few notches and heat begins to creep out of every pore. Off comes my scrub jacket. This is not how I foresaw my afternoon beginning. I make a phone call to the anesthesia lead and soon the transfer is coordinated and finalized. Now to have someone fetch a monitored transfer cart and get the patient ready.

I turn to find Sam, another nurse anesthetist, standing behind me. “I am supposed to help you take this patient to IR,” he informs me. That sounds like music to my ears. We move our patient to the cart, get him hooked up, tucked in, and I am ready to go once I switch over to the Ambu bag for ventilation on the trip. As we start down the hall, I am struggling to ventilate the patient with my right hand and to steer what seems like a semi with my left hand.

“Sam, can you help me guide the cart before I crash into the wall. I have this habit of paying attention to my patient and not paying much attention to where I am going.”

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Kinda like this, not quite this bad

“Why don’t you let me push and steer,” he responds, “And you run ahead and make sure the doors and elevators are open and ready?’

I hesitate for just a second and then I willingly turn it over to this strong young man. It is time to stop trying to be the macho woman I have always been and let the younger generation help me. Soon we arrive at our destination. Many hands are waiting to help flip our patient prone onto the Interventional Radiology table and he is soon comfortably repositioned. Sam helps me with all the tasks of getting the patient in the computer and settled. Before he leaves to go home, he takes the extra time to point out where all the items I might need are stored. My stress level has settled back to a comfortable hum. I can do this. As I think about this whole situation, I realize how just one person has made what seemed like an overwhelming situation into a manageable and even fun one. My co-workers are the best. I think I will nominate Sam for a “Best at Helping Old Ladies” award.

Another Day of Dealing with Winter – It Has Arrived!

MaySnowstorm2013 020What does one write on a zero temperature January day? I hear the wind howling around the corners of the house. At least it is cozy and warm in my chair, especially since I am leaning on a nice warm heating pad.

The last few days have been a struggle. On Saturday, as I scurried about my usual life’s activities, I bent over to move a piece of clothing from one wash pile to another. I felt a separation in my lower back followed by a stabbing pain. Oh, no! Now is not the time to have my back go out. I have an appointment with my daughter to go wedding dress shopping in the afternoon and my hubby and I will be leaving for Florida on Wednesday. But backs do not ask what our plans are before giving up on us. And so for three days, I have been wearing a back brace and walking bent over like an old lady. Every step is a painful struggle.

Today, I knew I needed to get some things done as we are leaving tomorrow. But how am I going to do that. My back is stiff and painful, though less so. I still cannot pick anything up off the floor. How am I going to plow the drive, sand the drive, and shovel the sidewalk? I am overwhelmed just by the thought. But at 9 a.m. as the thermometer still displays -6 degrees F, I ever so slowly pull on my boots and bundle up. As I trundle through the cutting wind to the unattached garage, I hope that the plow truck will start. I don’t even have the strength to push the garage door up. This is just dandy. The truck stares at me open mouthed. The open hood reveals the battery charger in place. Maybe, there is hope. I turn the key, but only a half a turn of the engine breaks the stillness followed by a click. Well, there is nothing to do but to trundle back to the attached garage for the car and some jumper cables. I want to sit in the truck and cry. On a good day, jumping the truck would not be my first plan of the day but with the cold, cutting wind, and aching back, this is the last thing I want to do.Snow2014 008

I am soon parked facing the truck and with fumbling gloved up fingers, have the jumper cables attached. A turn of the key and my ears are rewarded with the welcome sound of a rumbling truck engine. Goal one completed. Back to the garage with the car and I am ready to plow. Now to get the plowing done without getting stuck or stalling the truck. I am convinced that if I stall it, it will not restart without another jump. As proof of this, each time that I try to raise the plow, it empties the battery of power and all the warning lights on the dashboard say “hello.” Twenty minutes later, I decide to call it “good enough” before I have pushed my luck to far. As I am backing into the garage, the inevitable happens. I stall it. A click is the only response I receive from turning the key. I sigh. I almost made it. Ten more feet and it would have been back in its designated place. So off to the house I go again for the car and jumper cables. One more jump and the truck is parked. Goal two completed.

MaySnowstorm2013 062Now, I just have to sand the hill and the drive will be good again for a few days anyway. I don’t think my back will allow me to lift the heavy buckets of sand and salt that I have stored in the garage for this task but I am determined to get this task done too. But as I eye the 5 gallon bucket and the distance between the ground and the car trunk, I know that I can’t lift it in my current shape. Suddenly, it hits me. I can be resourceful. I will take 1/2 of the sand out of the full bucket and put it in an empty one. Then I can lift them. I am proud of myself for thinking of this. As I back down the drive with my precious cargo, I meet the Grainger truck slowly backing down after a failed attempt to make it up our hill. At least, he didn’t put himself in the ditch. Soon the drive is sanded and ready for the next attempt by unsuspecting visitors.

And that plow truck has made ANOTHER trip to the repairman to determine what ails it. Maybe by spring we will have a functional plow truck.