Hello.
This weekend I was on call and I worked both days. Then Friday--as I had written--Friday before that I was on the Code 19 Intubation call shift.
Yesterday reminded me of something. It is perhaps another topic, all in itself. When Anthony was little, we watched a lot of Thomas the Train videos. He had a wonderful set of wooden trains and tracks, and we played with that too. And in those videos, the absolute worst thing a train could do, was to cause Confusion and Delay. I included a four minute video there just so you can see the concept yourself if you aren't familiar with Thomas.
When Anthony first started traveling, it was so adorable. He had a suitcase that looked like Thomas, and a matching backpack. I used to pack his diapers in the suitcase. It was so long ago...
Watching the four minute video, I realized how the Thomas system sets children up with the expectation to be productive, and that Confusion and Delay aren't good things for production. Ironically, this morning at breakfast, Anthony was talking about how the feudal systems were replaced when the landowners kicked everyone off their land, fenced it off (the beginning of private property), and started growing things on a four year crop rotation, with bigger yields than before when peasants just made enough to support themselves on their lord's land. In the past, it was enough to farm for yourself, in exchange for going to fight with the lord when it was time for war. The people who ran things began to call the peasants 'lazy' for only working enough to support themselves. So the fences came. Many families couldn't afford to eat after they paid for their fencing to mark off their property. And others couldn't have land because they couldn't make fences. So then there were many who needed work and a place to live, and domestic work became the next thing, lots of it was making fabric of wool...
Then here is something else to write about. Someone I hadn't thought about in forty years. When I was in high school, the punk scene was very popular. I went to an affluent high school but we were by no means affluent whatsoever. Three girls and mom living on dad's schoolteacher salary. I sat next to a girl in my Intermediate Algebra class. Her name was Lisa. She was one year older than me. And she had a beautiful light green cashmere cardigan sweater she wore every day. Only she had taken an iron and melted brown crayon all over it, and done other things to it to 'punk it up'.
I used to cry inside when I saw her wearing it. I only had one nice sweater in my life, and it wasn't a cardigan. Every other sweater I had was cheap acrylic or scratchy wool--pullover sweaters, or those bulky seventies style cardigans from ivory yarn. I would have done anything to have a nice sweater without the destruction of it. Anything. Anything to wear something so soft and beautiful...that was all my own.
I don't know why I thought of it, or of her, but Spirit said to write about it. The concept is that for some people their need to 'make a statement' about 'themselves' and 'their beliefs' --in essence their Ego--is so great that beauty is overlooked, value is ignored, and treasures are destroyed. It's a form of insanity that only happens in modern times and in people who are otherwise well fed and housed. Even now Spirit says, 'remember this'.
Yesterday I noticed some flowers, a beautiful white bouquet, on the front desk in the ER's main nursing station. I read the card. It was from a sister hospital's ER to our ER with condolences and prayers.
Why?
Because we lost our first frontline doctor, and ER physician, to Covid on Friday. Remember how I had looked for the obituary?
I sensed it.
Here's something he wrote: https://www.researchgate.net/publication/224977533_Disaster_Metrics_A_Proposed_Quantitative_Model_for_Benchmarking_Prehospital_Medical_Response_in_Trauma-Related_Multiple_Casualty_Events
And here is someone who built upon this work: https://www.hsdl.org/?view&did=818118. The deceased is in the citations.
And neither the deceased or the PhD candidate, would have guessed that surge capacity is what is predominating our lives in the hospital now.
I can't put my finger on it, but I'm struck with two impressions from the hospital--nurses are 'losing it', their 'edge' and 'focus' pretty much all over the places I work (OR, and ER, pre-op, PACU, floor) but also 'we are lucky that they are showing up to work'. I don't know if it's the stress from the Covid surges, or an effect from the Maxines, or the older ones retiring early and leaving the newer ones, but it's been ROUGH. Hence the term, 'Confusion and Delay'.
A surgeon went last night to talk to the patient, and wrote the order for consent. He didn't physically get the consent himself. Surgeons can ask nurses to get it. But the nurse signed the consent form as a witness but forgot to have the patient sign it. Well, instead of taking the gallbladder out after the ERCP, which is our custom, we delayed the case until five o'clock the following day! Why? Because a patient who has had anesthesia can't consent. He even tried calling the family for their consent. But the patient had given us a wrong number! That one bed, with a hospital shortage of beds so critical--impacts others.
In the ER, my patient had spent the last two days on a gurney in a hallway. There are no beds. The ER's non-covid part is now a holding place for patients who would otherwise go up to the floor but since the Covid patients are taking up seventy-five to eighty percent of the beds in the hospital--there's not enough beds. In the chart I saw that the workup had happened while he was sitting in the waiting room because they didn't have enough room inside the ER. He had been sitting in the waiting room with a hep lock i.v. and getting his CT scans.
Another patient needed dialysis. I know that hospital beds and ER beds are at a shortage, so I moved the case to give dialysis access up in line ahead of other cases, and brought in backup from home in order to free up a bed. That old lady had been in the ER bed for two days waiting for surgery. When we finished the case, we brought her back, and her old bed was filled and she had to take a spot on the Covid side so they could give her dialysis and send her home.
I did a Covid case, a real one, in the O.R. It had been scheduled for Saturday. We only have one OR where we do Covid cases. It can go to negative pressure ventilation. But on Saturday, an orthopedic surgeon wanted that room (It's normally an ortho room) for a case. And instead of putting it at the end of the day (our custom for Covid cases), they put it on to the next team the next day. When I tried to correct it, she had 'just eaten a meal'--you can't do anesthesia on a full stomach for an elective case. If they aspirate (choke on vomit) then it's a serious anesthesia complication. Actually, she hadn't eaten. She doesn't eat at all. That's why she was in the hospital.
Anyhow, I gowned up and protected my neck. If you see people posting pictures of themselves all protected, watch for how they cover their neck. I noticed many gaps in Covid protection. If you imagine a hazmat virologist all suited up--that's protection. I saw people with exposed ears, backs of necks, fronts of necks, hair...working in the room that was so contagious we have to use the ozone UV zapper for fifteen minutes to clean it afterwards. For me, I couldn't shower, but I changed everything, including my scrubs, and took off my shoe covers. The patient did well. There are many, many, many people who have damage post Covid who need surgery now. Tracheostomy. PEG (feeding tube). Dialysis access.
Even another of my cases was on someone who had recovered from Covid, had a positive test, but was in the non-covid side of the hospital because 'he wasn't contagious'. I had one exactly like him, for the same thing, who was still on the Covid side of the hospital!
Long story short--Covid is everywhere in the hospital, and the patients are mixed in with the regular ones, even if they are in some places separate wards. The ventilation system is the same. Yes there's more filters in the system, but it's everywhere.
People who have recovered and work there, or now who have the vaccine, aren't as careful.
And for my last case? Everyone needs a Covid test to go to the O.R. A fresh one within seventy-two hours. So for the second time yesterday, we needed to wait for the Covid result. The rapid test takes forty five minutes. Well, I found out that the lab never got the specimen even though it was 'collected' in the system.
The nurse had thought she had sent it but didn't send it. It took a nurse telling me, and my telling the surgeon, and my surgeon leaving his dinner and going to the ER to talk to the nurse, to get her to send it. And there was an extra hour delay. This is the same surgeon who had to cancel his case due to the lack of signature on the consent form.
I explained in the locker room, to my anesthesia colleague who had staffed the Code 19 shift for the day, that my team--my nurse and scrub tech--weren't 'on it' and lost their 'edge' and I felt like I was 'herding cats' all day on my shift. I even had to push the patient on the gurney to the O.R. by myself because my nurse had wandered off looking for denture cups. He couldn't find a lid. And I had to tell him where it was. (I know where everything is lol).
We are getting shortages too. There is no tubing for the fluid warmer. Our gloves are in short supply. surgical supplies are backordered. We are having to make do. Propofol is being used for sedation of intubated and proned (lying on their stomach) patients. There is critical short supply of injectable hydralazine (to control blood pressure).
I had seen a strange conversation in the ER. My nurse used to work there, but he switched to the O.R. a few years ago. But he ran into an old friend or two. One had taken to working as a temporary (locums) to make more money. He was back for six weeks. Another was working multiple hospitals --moonlighting back at ours--to make more money. Mine was sharing how he's learning to become a Nurse First Assist--to make more money.
In the hallway, at the ER, pushing a cart of phlebotomy supplies--was someone who used to be an orderly and clean the rooms in the O.R. He looked on top of the world, so delighted and happy, and he even gave me a fist bump! Why? Because he was part of the system--medical now--and making more money!
Women in medicine don't do that. LOL. But it is what it is.
My colleague suggested that perhaps it's because my nurse and scrub tech had been working in other parts of the hospital that they 'lost their focus and edge'. I think she's right. Many are giving vaccine doses. And many are doing totally random things, some right in the middle of the Covid units. One, a highly-skilled nurse first assistant--is working as a pharmacy tech (being paid nurses' wages) because the hospital 'reassigned him'.
Apparently, if you refuse to 'float' where 'you are assigned' then the hospital will not pay for your unemployment. That's the threat. I'm not sure if it's legal. But many in the Covid units are there kind of against their will due to that policy.
Is it real?
It's effecting my daily work. A lot. Enough that I'm super happy to have the week off. The stress is so much more--thanks to the Confusion and Delay. I realize the Covid patients could be anyone--it's not their fault. Wrong place, wrong time.
Do I wish I had Maxine?
A little.
It would be nice to have the peace of mind because I am at the front of the frontline doing intubations.
But I don't trust anything that is pushed so aggressively. There is no free lunch. You have to pay somewhere, somehow, there's always a trick.
I am only one of two I know in the hospital who aren't getting it, but apparently, the word on the street is there were a lot of front liners who declined it. More than they expected.
I forgot to write the most important part of the story! Ross reminded me. I had a seven a.m. start on my call day. But unlike old times where I could bring Anthony with me until I could register at the hotel, he's not allowed inside the hospital. Nobody is.
So I booked not one but two nights.
When we checked in, it was a ghost town. I had wondered why when I asked the front desk if they had availability for the night, on that day, she said, 'we have LOTS of availability!'. You see, the website will let you book a night. But the state of California has rules for hotels. If it's not for business, you can't stay. Fortunately, the hospital and the hotel and my need for it--it's an old established story so we got in. But for others who book for pleasure? They are turned away at the door and their money refunded.
It's that bad, the lockdown.
There is no service, no maid service either. And no little restaurant and bar.
My friend who checked us in said that people who come here from out of state stay in their rooms and don't leave for two solid weeks--and the staff doesn't go in for anything except at the end to clean it.
Then there's one last little part. Anthony used a food delivery service to get his breakfast yesterday. He found a cheap deal, a breakfast burrito for seven dollars and pancakes for four dollars. He was so excited to save me money!
It cost me over twenty dollars for the food!
Why? A delivery fee, a three dollar 'low food cost' penalty, tax, plus tip, and a one dollar random fee to the state of California for delivery 'luxury' for lack of a better word! They are charging double for food! And it takes an hour to get it!!! It's so evil!
Everything else?
All the politics?
My lips are sealed. So are Ross'.
We will still be here as long as we are blessed to remain. After that, perhaps Reikidoc.com.
My own sister got taken down from Insta. She did nothing. No warning, too. It was her favorite.
ROSS:
Everything I have, know I am with you. For all incarnations, for all time, and for everything that happens inside of this one, as well.
I am ALWAYS HERE.
I am ALWAYS ALWAYS ALWAYS here for you. And so is Carla.
Soon it is time for her lunch. Carla tell them what you will be having?
The Vietnamese restaurant where he have breakfast, well, there were three other restaurants in the strip mall that closed. So we helped by ordering our usual breakfast, and then, taking trays of Vietnamese lunch. Bun. Pronounced Boon. They are cold noodles, lettuce, and pork and shrimp. You pour a vinegar sweet thin fish sauce over everything. There's ground peanuts on top too. They give you one egg roll as well. You eat it with chopsticks. We are going to eat outside and get some sun.
(he puts his fingers interlaced in front of his face so you can see this). We are all in this together. Everything affects everything else. We are like a web from a spider--everything is working together as a whole. So when someone in your community is struggling, offer them your business. Assist them with food or money, or even toilet paper. This simple act of caring is good for the morale. Both for you and the other.
(he puts his right hand over his eyes like a visor, and scans looking from his left to his right) I want you to be on the lookout, looking for such need.
In this you are both a hope and a blessing, as well as an anchor of calm in the maelstrom of Confusion and Delay!
clap! clap!
Aloha and Mahalos,
Namaste,
Peace,
Ross and Carla
The Couple
