The Case of the Missing Sponge

Learning to scrub in the OR was a major task for me.

For those of you that are not familiar with the roles in the OR, I have attached these links for your reference. At the end of this document.

There are things I call OR Games that reflect some of the relational issues that occur in the surgical setting. There can be long standing competitive relationships between the RN's and the technicians. the basis for this is unknown to me.

I had not been in the OR for very long but because we were a small facility RN's needed to be able to scrub to meet the staffing requirements.

the ORT assigned to orient me was not happy with teaching a "new" person but as things were then, one did what the supervisor told you to do.

The basics were mastered and I finally got to pass instruments, I didn't perform too badly the first time. It was a basic hernia repair and really quite a simple procedure. When we were finishing as you do in all surgeries we counted. counting involves all sharps (knife blades, needles etc) and sponges. There was a missing sponge, We looked everywhere, the circulator went through the trash, the surgeon true to form informed us we needed to get our act together because there was no way there was a sponge left in the patient.

I was absolutely beside myself, we did one last count and lo and behold LaCretia (my preceptor) found it. I was elated. I did puzzle for some hours about what had happened, but went on to other cases without event,

This scenario repeated itself again and again ( only when LaCretia was present) and I began to doubt my skills, the big clue came one morning when we were setting up our table and I realized I needed an extra instrument on my mayo tray. For some reason I picked up the tray and lo and behold there was a clean folded sponge under the tray.

we did the case and of course at the end there was a missing sponge. We looked in the usual manner and then LaCretia declared, to all present," Chris will never get this right, she can't even keep her sponges straight. " I had been embarrassed over and over for this but this time I looked up at the surgeon and smiled. "I know where the sponge is, it is right here under the tray, where it was put. No doubt to be used at the end of the case, isn't that right LaCretia"

The room was quiet and LaCretia replied "my goodness, yes it is to clean up the patient, I plumb forgot that I put it there"

This game was over, it is only one of many and hopefully I will be more entertaining with future entries. I am hoping that I will have help from other OR people and more of their stories to share.





http://www.aorn.org/docs/assets/2092D890-1871-EBA3-88A5F41706EECF5E/RN%20Circulator%202008-2009%20Brochure.pdf

http://www.aorn.org/docs/assets/1CB4985E-1F29-E23E-B8EDD74AFF172420/FAQs.pdf

Basically the breakdown is that the RN circulator(circulator must be an RN) is in charge of the surgical suite operations. This RN is the controller if you want a simple definition.

The scrub role can be performed by an RN, Surgical Technician or several other trained roles. This position is the person that sets up the instruments that are required to perform the surgery. They then hand (pass the instruments to the surgeon to perform the surgery), this requires concentration, knowledge of the surgery and instruments.

Vacation is over, OR stuff defined

The nagging Blackberry started before I even got up. Since my alarm was set for 0500 it was early. Census alert, which to the OR person means that this may be another day of challenges without enough post op beds when they are needed. This is probably only meaningful to an OR person. Most people believe that when you have surgery there is automatically a bed waiting for you. This may or may not be true, like hotels hospital beds are assigned as they become avaialble (or in the hotel business as they are cleaned). Unlike the hotel business not all customers move along according to plan. People may remain sick, get sicker, or in the case of a Trauma center more new patients arrive before beds are cleared.

On days like this the OR desk person becomes an orchestra conductor, directing the patients to PACU and Out Patient recovery timing the comings and goings like the blending of the sounds in a symphony.

The instruments consist of nurses, surgical techinicans, operating room assistants, anesthesia providers, surgeons, residents, medical students, radiology technicians, pathology staff, perfusionionists and a myraid of others that are needed to make the world of surgery sing.

The challenges are met, the patients are recovered and the OR prepares for another day.

In the coming editions of the blog, there will be more descriptives on the OR world before i really begin the story telling, because for myself and my own sense of logic the definitions and boundaries need to at least be discussed.

Life caring for people is a gift and delivering the gift in the OR world is not always easy. When I was a staff nurse and simple participated in the surgeries life was easier. I had one room, one surgeon and one team to deal with a patient. Now I am in management and I have many times that number of rooms, teams and patients per day. Life has become more complex, more like a 1000 piece puzzle where the picture rotates so the pieces continually changes places. Or perhaps an old fashioned kaleidoscope where the center is constant and the edges change on a whim.

The patient is the center of all, and that DOES not change.

The challenges of this chosen life are many, the rewards great, and the days where the difference between them is hard to discern. This will become a later discussion

Nurse - Wikipedia, the free encyclopedia

Nurse - Wikipedia, the free encyclopedia

Kyak Adventure, the inner child returns

When my friend Ben suggested a kyak trip today, I had images of drifing lazily down the "Cusa River" meandering slowly and paddling gently. It was a beautiful day, light breeze, Alabama August, and the clouds were beautiful. There were big fluffy clouds, thin wispy clouds and the layer that scurried accross the horizon like commuters hurryign to beat the traffic. The win rustled the dying leaves and grasses along the bank and herons called out to each other. Tranquility reigned.

Ben did not mention rapids, however I will generally try anything at least once. When we approached the first set I could feel my heart speed up a little, I gripped the paddle a little tighter and the water began to splash in my face, the beginning of panic was arrpoaching and then the boat swirrled, twisted and turned and I was back in calm water. The laugh that erupted from my throat was pure child. It was FUN! I loved it, and I wanted more.

this is a great deal like real life, you meet the challenges head on, prepare for the worst, go with the flow(TRUST) and you will emerge on the other side, safe and sound and perhaps with a laugh.

we paddled and paddled did more rapids and then swam with our Kyaks for the last quarter mile. The day was perfect, harmony with the river, peace and time with a trusted friend.

Change is challenging, Change is good, Change is Growth

I am not afraid to change, a fact of which I am quite proud. I have had some very difficult challenges recently and they are related to truth, transparency in communication and change.

It is a trememdous shock to learn that your perceptions of you are not quite as you might like them to be. In fact it is quite painful to learn that people you deal with on a daily basis do not see you as you see yourself.

I found this message on Renassiance Unity today and it totally hit home

I am not afraid to ask myself tough questions and I am not afraid to change.
Today's Meditation
Dear God,
Some questions are hard to live with it seems, because the answers are elusive or require a change of heart or mind.It seems easier not to think about those kinds of questions.I have been wondering when You might plant an idea in my mind that would lead me to write this prayer and send it out.An idea or a series of them have come, ideas that have become questions
.Questions that are hard to think about.
Questions about greed and the reality that this nation is becoming a land of those who have a lot and those who are just getting by.
Questions about life.
Questions about huge corporations who make incredible billions of dollars in profit and simultaneously reduce wages and benefits for millions of workers in the name of being competitive.
Questions about the few in our land who are rich beyond imagination and the millions of people who are barely getting by and who cannot afford health care.Questions about the constant spin that lulls so many of us to sleep.
Questions about why some who publicly proclaim to be in relationship with You do not seem to live
Your simple message of loving one another and caring for the oppressed and poor.God, am I way off track here?
Either I am missing something, or things seem very out of balance.If I am off base, help me understand.If I am seeing things as You want me to, help me to know what I can do.It seems to me that the real threat to our democracy and way of life is greed.Help me to ask myself the tough questions.
Help me live a life of honesty and integrity.Grant me the courage to live the answers to the tough questions.Open my eyes to Your truth and my heart to Your ways.
This is simply said and very difficutl to live.

the First Blog

It is 3 AM and my phone just rang to let me know there is something that I need to know. I just love these announcements. It at least has quit snowing and I am enjoying the soft glow of the lights on the white world outside.

It is a wonder, the night is transformed into a different place with the snow. The night sky is a soft muted grey looking like is surprised at the white reflection from below. the calm and peaceful glow is relaxing, and gives the impression of a fluffy white blanket keeping the world warm and safe.

This is a world free from the the blemishes of daily life, waiting to be lived in and loved.