Relax Babe

Critical Observation Critical observation is problem the biggest part of your job that is very difficult to teach. When I precept and my student is pretty confident in their skills, I’ll sit and think out loud. The issue with OR precepting, is that we are always thinking about the entire room, and it gets exhausting talking through all of it. And we don’t know where the student is, in terms of how much information is too much. When my student asks more questions or looks at their phone, it indicates to me that they’re ready for scaffolding to the next phase. So challenge them. What do you notice? What can we do to make the next step easier? What do we need for the second case? Is there anything we need for the second patient? Streamline the process, be grateful for the time to reflect on what you’ve done – could you have done anything differently or better? How is the room looking right now? How much blood is in the bucket? Are the surgeons joking? Is ...

Problem Solving There are so many times wherein you are the gate keeper of the peace. Peace for the interpersonal relationships as much as you keep the peace while looking for something you know won’t be there. I’ll give you a few examples of how I’ve used creativity, clinical reasoning, and innovation in my daily flow. It’s something I take pride in, even if I don’t come up with the answer, at least we have a few to work with to get the best situation for the room. Usually using SBAR or some version of the perfect problem solving communication tool. Do not come at me with a problem without a recommendation – that just means you’re looking for a cop out. One time, I was leaving work and my friend was holding the door open. I love this woman, she’s the mother of my cousin’s husband, but I very rarely see her. So I stopped next to her, only to find out that she was holding the door open because the other side of the double-doors was locked, and it was th...

Adaptability I would say more often than not, surgery does not go the way it’s intended. Especially with a sicker clientele base, there are more moving parts that can get cogged. You must be able to adapt and move with the flow, all while maintaining your integrity and holding the space for the room. This is your room. It will only get as chaotic as you let it. Sometimes you get into an abdomen and there is an upset not caught by imaging. Isn’t it cool that we work with surgeons who are capable of recognizing all issues, not just the ones the monkey computer spit out at them? I think it’s rad anyways. It’s even cooler that our society has specialized, and we have the capability of calling in other experts. My Emergency General Surgeons are good, we recognize that a patient’s ovary does not look normal while searching for her appendix. But they’re not the experts. They know that. So we adapt, we call in the experts, the GYN staff, and ask fo...

Teamwork One of the most intense feeling in the OR world is when STAT is called overhead. I always ran in, a soldier ready for battle. It was easier as a resident, knowing that there were very few things I would be asked to do, if anything. I even messed up the first time I witnessed a code blue, before I knew what was happening my preceptor was yelling for me to call the front desk, but the blood rushing to my ears, the fear of the anesthesia resident’s eyes, I couldn’t hear. I wasn’t there. But when you’re alone, everyone else is in a case, you have to prioritize and make the best decision at the time for your patient. You can delegate, but there’s no one to delegate to, they’re all doing their own tasks. That fear either paralyzes you, or ignites a fire. After a few situations, the fear usually takes a sidestep and allows you to focus, laser-in on what needs to be done. That’s when you know you’re ready. But sometimes, you get the summative report b...

Communication I work weekends, so I never know what service or procedure I’m going into. I love that, there’s no anxiety about working with unpleasant people or fear about being good enough. That happened during residency, a lot of people were shifted around, and often times I was placed in more difficult cases to protect less-skilled nurses. I took as a badge of honor and moved on. As soon as I could get on weekends, I transitioned. It was a femoral nail, which I’ve done a few times more than when I started weekends and didn’t even know what the Hana table was. I gathered my supplies, more than happy to know what I needed to position to decrease my patient’s time under anesthesia (I had just learned how terrible the effects of anesthesia were on temperature, circulation, and pain management, much less the increase in cost per minute in the OR - $62!). I got the patient in the room and called the surgeons in. The residents came, helped me move the pati...