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Updated for a WI Writers' Association reading today.
In the middle of a quiet summer afternoon in the Operating Room, we received a call. A patient, a child, was en route to us from the Emergency Room. Immediately we heard voices and clanging equipment in our outer hall as the patient arrived. Three years old, had been hit by a car. Intubated, his breathing assisted by an anesthesiologist, he was transferred to the OR table as we rapidly got everything ready. Nurses and surgical techs worked together to scrub his torso with soap, open and set up instruments, and help surgeons and assistants into sterile gowns. Lots of people, lots of talking, lots of commotion. The surgeon was known for being particular about using specific instruments, and as he made the incision he yelled that he didn’t have his “special” goddamn suction tube. Our head nurse yelled back that he wasn’t much of a goddamn surgeon if he couldn’t manage this emergency without his special goddamn suction tube. I had never heard her raise her voice to a surgeon, or to anyone, before. The surgeon stopped yelling. It soon became apparent that the procedure was futile. The room quieted, extra people left and eventually the surgery concluded with the abdomen being quickly sutured closed and the anesthesia withdrawn. As the child lay dead on the table, we removed IV lines, tenderly washed blood and debris from his body, placed him in a clean gown and covered him to his chin with a soft blanket. He was so tiny. No one spoke. Tears were shed. Some of us had three-year olds at home. I did. I remember going home late that afternoon, wanting to talk about what had happened, but not finding words that could convey the story. That was a day in the OR, and in the OR, there was at least a story a day.
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There have been lots of changes since I worked in the operating room, but I’m pretty sure one thing hasn’t changed.
There is a major mission for every surgical procedure, and it’s achieving a safe and positive outcome for every surgical patient. A diverse group made up of surgeons and anesthesiologists, nurses, surgical technicians, nursing assistants and housekeeping aides are responsible for meeting that goal. It was my good fortune to work with talented people in every role. The surgeon will work closely with the surgical technician for the next few hours, so as they are scrubbing their hands before a procedure, he might strike up a friendly conversation. Maybe he’ll tell her about his tropical vacation, or mention the newly acquired Rolex he has tied to the drawstring of his surgical scrub pants. Both the vacation and the Rolex, which costs more than her annual salary, are out of reach for the technician. Later, during the procedure, the technician tactfully mentions something unusual she notices about the patient’s anatomy, preventing the surgeon from making a horrendous mistake. Mission accomplished. We all move on. A patient is softly crying as she goes under anesthesia, apologizing to the surgeon, to whom she has asked a question that he had already answered. He rebukes her for asking the question again. After working with this excellent surgeon for many years, I recognize his bad moods. Later, in private, I call him out for his treatment of his patient. His response is to ban me from working with him. This lasts less than a day, since we have to work together later that evening on an emergency case. We make our peace, and move on. Scrubbed in to a long orthopedic procedure, a surgeon stops briefly and asks everyone to gently put down what they are holding (in my case, a very large and heavy leg). We breathe and stretch out limbs and move shoulders and necks, and then we all go back to our places and begin again. I will always remember that surgeon as one of the kindest persons on earth. While a procedure I’m responsible for is ending, another nurse comes in to give me a break between cases. I leave, but while my patient is being moved from the operating table, she narrowly escapes injury when a quick-thinking housekeeping aide who is scrubbing the floor notices and then safely locks the cart she is being moved to. I find out and thank the aide profusely. Just doing my job, he says. Mission accomplished. We move on. Emergencies happen 24/7, and in the OR of the community hospital where I worked, we covered emergencies on off hours like evenings and weekends with an on call system. We had to be immediately available when needed, and when I was on call on weekends, that often meant from 6 a.m., Saturday, until 6 a.m., Monday.
My weekend on call plan was to first meet my own basic needs. Thus, I would get up early, brush my teeth, drink a cup of coffee and read the morning newspaper before the phone had a chance to ring. I had nearly reached those goals on a particular Saturday morning, just finishing an article by a favorite columnist, when I received a call and rushed to the OR for a patient who had suffered a ruptured abdominal aortic aneurysm, a critical emergency. The aorta is the large, main artery that carries blood from the heart to the entire body. When an area of the aorta ruptures, every moment counts. Depending on the area of rupture, some patients can bleed out fast, and don’t make it to the OR. Adrenaline high, the surgical technician, surgical assistant and I rapidly opened packs of sterile supplies and instruments, while the anesthesiologist and her assistant readied machines and medications. When the patient was transported to the OR, in my role as the circulating nurse, my focus switched from setting up the room to taking care of him. Amid the chaos of any grave emergency, I tried as much as possible to be the person who stopped for a moment to support and reassure the patient, staying at their side until they were under anesthesia. Wheeling him into the room, I introduced myself and began a brief assessment process, determining his name, doctor, level of consciousness and understanding of what was happening. As I identified the patient, I was stunned to realize that he was the favorite columnist, the author of the newspaper article I was reading when my phone rang that morning. Coincidence, yes, of course, but connection too. I cared about all of my patients, but this connection, to this face, this person, caused me to bond a little more tightly to this one. Although unlucky to have had a ruptured aortic aneurysm that day, he was lucky in the end. So happy to tell you that that his aorta was successfully repaired during surgery, that he survived, and that when he did pass away, years later, his death seemed to be part of a much more peaceful event. A nurse educator in the late 1980’s, I had the opportunity to become part of a new standard in patient documentation.
Everything nurses do and observe in regard to patients - condition, pain level, vital sign readings, interventions like medications and treatments - must be documented. Our hospital was the first in the Milwaukee area to develop electronic documentation that would be accomplished on touch screens at the patient’s bedside. Rather than a generic product, information technology (IT) chose software and, together with nursing, built screens with information personalized to our hospital protocols. My colleagues and I developed education for nurses, nursing assistants and unit secretaries based on the information they would be accessing and entering. Training classes were presented day and night in the computer lab to accommodate the needs of every staff member. The new technology represented a huge change. Excitement was running high, along with anxiety. That anxiety came along to the classroom with the staff, of course, because, really, who enjoys being pushed out of their comfort zone into the free fall blackness of the unknown abyss? At least, that's how some staff members seemed to feel at first. While many were positive and happy to learn, others came to class angry and threatening to resign if they had to incorporate this change into their daily work. Some did actually resign, only to move to hospitals that eventually used similar systems. Others felt care would be fragmented if they had to talk to patients and document patient responses at the same time. Nursing assistants began to realize they were going to log on to a computer, read screens and type words. Some could not read well, and most had never used a typewriter, much less a touchscreen keyboard. Some feared they couldn’t learn the new technology and would lose their jobs. I remember a nurse in class one night who had difficulty using the tip of her finger to make selections on the touch screen. She instead stabbed at the screen with the tip of a nail file, and, in her anger and fear, punctured the thin, delicate screen. As educators, we conveyed technical information, but also tried to injected humor, compassion and lots of reassurance into the classes. IT was surprised when we asked for computer solitaire to be installed on the training computers, but solitaire was invaluable in teaching mouse skills. A computer scavenger hunt helped staff find information on various screens. We engaged in role play to encourage nurses to find ways to talk to patients and make eye contact while accessing the documentation screens smoothly and without distress or interruption. The refrain I heard most at the start of a class was “I’ve never touched a computer in my life” a statement I enjoyed pointing out was no longer true by the end of class. When training was complete and the system went “live”, we supported staff on the units around the clock, helping to solve problems and ease the transition, and, mostly, all went well. I found that I loved every moment of teaching those classes and supporting staff on the units, even in the middle of the night, even when anger and fear bubbled over. I loved conveying information in a way that allowed staff members to gain confidence, let go of fear and move forward with new and better processes. What we did then seems primitive and naive now, but that’s ok. We were, after all, pioneers, and we did our best with what was available. And, except for that punctured screen, we all survived. My first computer wasn’t actually mine, but was the first computer I ever saw in person. While touring a surgical unit at Milwaukee County General Hospital in the late 1960’s, our instructor opened a door that was labeled “Computer Room” and we peered in.
The refrigerated room was aptly named, since it was almost completely filled by a computer. Blue, green and red lights blinked from every surface. It looked like something NASA could use to launch a spaceship. Cool. Nothing to do with me, though. I slowly began to be aware of computers being used in business and industry, and in the mid-1980’s, personal computers (Macintosh, Commodore 64), along with video games (Atari!), began to show up in homes. Even our home had an Amiga computer. It had no color, no graphics and no practical use that I could imagine. So, nothing to do with me. In 1989 I accepted a position at a large community hospital as a nurse educator in orientation and staff development for the department of surgical services. As part of my job, I began developing lesson plans, lectures, multi-part presentations and posters. Our department of 12 educators had little secretarial support and one beat-up electric typewriter that was in constant demand. It was heavy and hard to move and I usually typed standing at a counter in the room where it was stored, white-out nearby for the errors I inevitably made. It was tedious. One day, in a quiet area of the hospital, passing a room labeled “Computer Room”, I stopped and peered in. A woman was working at a desktop computer, her eyes on a screen, no white-out in sight. This was Pam, a kind and generous person I’ll never forget, who offered to help me learn something called word processing in a program called Word Perfect. I sat down in front of a computer near her desk and began to work. I would type, get stuck, and then Pam would help me get unstuck. This was repeated over days, then weeks. I had limited time to get to the computer room, but Pam was there, ready to help, when I did. I eventually, and gloriously, used that computer for all of my typing needs. After conquering word processing, something even bigger was around the corner and down the hall. Our Surgical Services director asked me to contact our professional organization with a question about surgical protocol. My usual process was to make a phone call regarding my question and eventually get a response from the organization in the form of a journal article, on paper, by mail, a week or two later. On that day (how I wish I could remember the date), I instead marched to the hospital library, to the only computer I knew of in the building that had something called internet access. With the librarian’s help, I logged on and found the organization’s primitive website. I searched, I printed. An hour after her request, I handed the pertinent article to our director. She was startled, then horrified. She questioned me. This came from the internet? Yes. Can we trust this information? Yes, I assured her. And that’s how life changes. In an hour or a moment. On an anonymous day. Via something called the internet. Or the information highway. Or the web. I didn’t understand it all, but I did understand that I really liked it, and that it would have a lot to do with me. At Milwaukee County General Hospital School of Nursing, in late 1968, my classmates and I were thrilled to be invited to a presentation in the hospital auditorium.
We entered along with doctors, nurses and other students from all areas of the hospital. The room was absolutely buzzing with anticipation as we waited for the event to begin. During my time at County, many exciting things were happening in medicine. One of the most exciting, I think, was the transplantation of human hearts, something that had been hoped for but seemed almost unimaginable just a few years earlier. In 1967, the first human heart transplant was performed by a South African doctor, Christiaan Barnard. Just 10 months later, a successful heart transplant was performed in Milwaukee at St. Luke’s Hospital by Dr. Derward Lepley, Jr. In the auditorium, our excitement built as Dr. Lepley and his surgical team appeared and narrated a film of the heart transplant. We watched in awe, fascinated to hear Dr. Lepley describe what was happening during the procedure and see the inert, transplanted heart begin to beat after it was placed in the patient’s chest. The film ended, and we began to applaud as the lights came up. It was then that Dr. Lepley introduced his patient. The 49-year old woman with the new heart stepped onto the stage. An incredible, uplifting wave of emotion swept through the auditorium as every person rose to give Dr. Lepley and Betty Anick an ovation. At that moment, in my 18 year-old heart, I felt I was in a world where anything and everything was entirely possible. Although Betty lived for 9 years after her transplant, most transplants were not as successful until the 1980’s when immunosuppressant drugs were developed. Today, heart transplants are fairly routine procedures with optimal results. Not too long ago, a local museum had a display supporting organ transplant on a day I happened to visit, and several transplant patients were there to talk about their experiences. I spoke to a man who had recently received a heart, and tried to express to him how it felt to see Betty Anick on that long ago day. He got it. We shared a spontaneous hug at the end of our conversation, as I wished him well. Not long after I graduated from nursing school and married, my husband and I moved to his new assignment at Glynco Naval Air Station in Brunswick, Georgia.
I was 21 and he was 22. We were newly wed, living in an unfamiliar part of the country with new jobs and excited to be experiencing many new things. While my husband settled into his job in the radar tower on base, I found a job at Brunswick Memorial Hospital in Labor and Delivery (L&D). Other than during nursing school, I had never worked in that area, but I thought L&D would be interesting and fun, what with all those cute babies and happy parents. As it turned out, as is so common in life, I was kind of right and kind of clueless. It was interesting and fun and also frantic and heartbreaking. Brunswick Memorial was a busy little hospital with a very busy obstetrical department. Some women arrived in early labor, having had regular prenatal care. Others arrived in active labor with no prenatal care and no doctor assigned to deliver their baby. Women suffering from toxemia of pregnancy arrived with blood pressure so high that we feared for their lives and the lives of their babies. For those mothers, we instituted special precautions to lower their blood pressure and help them avoid one of the worst effects of toxemia, which was convulsions. Some evenings we ran from one labor room to another in our overly full department, checking the progress of mothers who might be having their first or fifth baby or even their tenth. Admitting new patients, phoning doctors, getting orders and injecting the pain medication they wanted given every few hours. We called doctors in, timing our calls to when we anticipated the birth to occur, and hoping they made it in on time, because sometimes they didn’t, especially at night. We didn’t have birthing rooms, so we transferred women in late stage labor from their rooms to the narrow delivery beds, attaching their wrists to leather straps so they couldn’t interfere with the doctor’s work during delivery. Many of the mothers were very medicated, and unaware that birth was imminent. They were unable to push, and I learned to place my arm strategically across the upper abdomen so I could exert pressure across and down during contractions, pushing the baby out. Some of the medicated mothers were confused and fought and scratched and tried to bite us during contractions. My arms sometimes bore the scars. Others simply slept through the entire event. Most mothers and babies, even those with little or no prenatal care, did surprising well, had few complications and went home a day or two later, healthy mother and healthy baby. A few mothers left without their babies, who were too premature to live or were stillborn, never having taken even a first breath. You might be wondering where the fathers were during all of this. They were not allowed to participate, and instead were installed in the Father’s Room, far from L&D, for the duration. Family-centered care had not yet arrived in Brunswick, Georgia, in 1970. I met her in the Emergency Room. It was late on a Saturday night, maybe even Sunday morning, and I’d been called in for an auto crash victim who needed surgery. I talked to her as we wheeled her to the OR. She was conscious, crying and asking me not to tell her parents that she had been drinking. She was 15. After we transferred her to the OR table, I stood at her side, assisting the anesthesiologist while holding her hand and telling her that her parents loved her and that everything was going to be all right. She would see her parents soon, right after surgery, and they would be overjoyed to see her. We kept her alive during surgery, but her internal injuries weren’t able to be fully repaired and weren’t compatible with life and she bled out and died in the ICU shortly after surgery. I know she never woke up. That’s all I will ever know. 40 years later, I think of her from time to time, and keep her in my heart. My final position in Nursing was at a long term care and rehabilitation facility, as a Nurse Educator. I was responsible for the educational needs of the Nursing Department as well as the mandatory educational requirements for all departments.
I was accustomed to being busy and having lots of interaction with about 200 employees and department heads. In addition, I was responsible for the annual influenza (flu) vaccine campaign. As a huge supporter of the vaccine, I was always eager to get started. The flu is dangerous for everyone, but especially for the population of long term care and rehab facilities. Patients who have compromised health need extra protection even if they themselves are vaccinated against the flu. That extra protection comes from surrounding patients with health care workers who are also vaccinated. Each year in August I started education. I discussed the flu vaccine at leadership meetings, staff meetings, new employee orientation classes and, probably, in my sleep. I created and distributed posters on the importance of the flu vaccine and how to avoid getting and spreading the flu. I stocked the vaccine and related supplies and scheduled mass vaccine events where employees could come to a central place in our building to receive their vaccine. I also created a portable vaccine kit that could bring the vaccine directly to staff members anywhere in the building at a moment’s notice. Receiving the flu vaccine at work was at first optional but encouraged. A few years later, my organization decided that receiving the flu vaccine would no longer be a gentle suggestion. It would be mandatory for all employees. Our goal: 100% compliance. While the majority received the vaccine, employees who wished to opt out took up a considerable amount of time over many, many weeks. I found myself tracking down employees on all three shifts and using my powers of persuasion and scientific facts to convince them to get the vaccine. They didn’t want the vaccine, but did want to talk about why they didn't want it. Reasons ranged from “I just don’t believe in it”, to, “I think it will give me the flu”, and “I’m pretty sure I’m allergic”. Also, “the vaccine is a scam by pharmaceutical companies”. Sometimes religious reasons were cited. I helped refusers fill out refusal forms, submitted the forms and waited for a response to each employee. Most were told their refusal was not accepted. Others were told they could opt out of the vaccine, but would need to wear a paper mask at work during influenza season (roughly October through April). A couple of people left our employ over their refusal to be vaccinated. A few wore masks for months. They included people in every department, and some department leaders as well. Even as a supporter of vaccine efforts, each year, near the end of summer, I began to dread the start of flu season. I knew that instead of working on projects and offering needed educational programs, a lot of my time was going to be directed towards the mandatory influenza vaccine campaign. I’m retired now, and last week my husband and I stopped in at a local pharmacy to get our flu shots. The pharmacy was quiet and calm, the pharmacist was congenial and soon we were on our way with matching tiny bandaids on our left arms. I spent about 10 minutes thinking about the flu vaccine this year. Yes, life is good. |
