Tuesday, September 6, 2016

Scrub Nurses Flying High

Give me enough of these and a
place to stack them and you will
need a pilot's license AND a nursing
license the next time you are scrubbed
.
Beethoven had the fifth symphony, Sousa had the Washington Post March, and  Oldfoolrn had  the distinction of being a surgical elevation platform builder extraordinaire. I'm on the taller side and developed an early appreciation of having the scrub nurse on a level above the operative field. It is so much easier to properly deliver an instrument to the surgeon when working from above. It also gives you the best seat in the house when visualizing the technical aspects of the surgery. I think just about everything works better when going downhill except perhaps a patient's vitals. Sorry for the momentary lapse into foolishness.

For the  height compromised scrub nurse I could construct an elevated platform extending from her Mayo stand all the way to the back table using standard, readily available platforms which were supplied  in every room. If more than the alloted 6 platforms were required, I would be off on  a scouting mission to an adjoining OR to steal borrow a couple of extra platforms. It was considered bad form to aggressively yank a stool out from under an observing medical student. The best strategy to use here was distraction,  " There is an interesting aneurysm clipping in the next room, why don't you check it out?"  The med student quickly vamoosed leaving behind the coveted platform. Just remember to act dumb (it was easy for me) when the angry medical student returns and replies, "I thought you said they were doing an aneurysm clipping. That I&D of an abcess made me sick to my stomach. It was disgusting." Meanwhile the scrub nurse is regally perched on the medical student's platform enjoying her lofty perspective and happily passing instruments from above to the surgeons in the lowlands.

For the really short scrub nurses I devised a custom built platform that got pint sized nurses high in the sky. I removed the horizontal metal pan from a non functioning litter. This piece of steel was the perfect length reaching from the midget scrub nurse's  Mayo stand all the way to the back table. From either end I elevated the litter bed on ordinary platforms. This Rube Goldberg  height enhancer even had a built in safety feature. I left one of the siderails functioning and it served as a safety fence to prevent the miniature scrub nurse from falling backwards off the platform. It worked like a charm and my short colleagues just loved it.

For a couple of weeks all went well with my jury rigged scrub nurse elevation platform. Short nurses were clamoring to climb aboard and they even claimed the surgeons were better behaved and yelled less when they towered above them. It's much more difficult to badger and berate someone who is taller than you. When my ever present supervisor, Alice, learned about my custom elevation device, she went ballistic, "What's this ridiculous hodge-podge of components? Dismantle that abomination immediately." That was the end of that. It was fun  while it lasted and gave the vertically challenged nurse a new perspective. Alice always got her way.

If you think my litter elevation contraption was unsafe, note the photo on the left. Using anesthesia stools as the person on the far left is doing invites mishaps. Anesthesia stools are height adjustable by rotating the seating platform. Spinning round and round while sitting might be fun, but not while standing. These anesthesia stools used as elevation devices are tuntables of death or serious bodily harm. Stay off of them.

Circus trapeze artists have safety nets, baseball players have warning tracks and elevated scrub nurses need a safety net too, especially while they are elevation novices. In time nurses learn they can only shuffle from side to side on elevation platforms. It usually takes one good fall to learn this valuable lesson. Here is an interim safety tip for platform elevation beginners. Strip the padded mattress from a litter and carefully place this behind your meticulously  constructed platforms. We used to have bright red foam litter pads that worked perfectly. The bright red mat functioned just like the ball player's warning track and the foam silenced and cushioned a fall. I do not know any scrub nurse that fell off a platform more than once. To paraphrase Neil Armstong, "That's one small back step off the platform and one giant crash when you fall to the floor holding a heavy surgical instrument." Be careful out there when you are working high in the sky. That unpadded terrazzo floor is an unforgiving surface.

There was one type of neuro case that called for elevation for even the tallest of scrub nurses. Any craniotomy with the patient in a seated position called for special elevation tricks. In the early days we had a heavy duty Mayo stand that could be positioned about 5 1/2 feet in the air. Even the tall nurses needed platforms to work from this dizzying height. At about the time I was nearing retirement a specialty neuro instrument table was introduced.

This table was one piece and eliminated the separate back table and Mayo stand set up that I knew and loved. I always had to imagine a corner of this monster Phelan Neuro  table as the Mayo stand to keep things orderly. If we were working with Methylene blue which was one of Dr. Oddo's favorite marking agents, I was in business. I physically drew a Mayo stand top outline  on the oversize single table drape. It worked like a charm for me, but some of my co workers thought it was really a silly thing to do.

Another one of my signature tricks was to take my straight Mayo scissors and cut an intricate filigree design into the top of the wax paper bag that we tossed used suture scraps into. Dr. Oddo always said that it was going to be a tough case if he noticed a plain trash bag on my Mayo stand. "Uh Oh, somethings up.. oldfoolrn did not have time to decorate the suture bag," was his ususal reply. I never felt the artistic urge when dealing with late night or trauma cases so I just went with the plain old suture trash bag.

I'm starting to get off track again, so it must be time to wrap this up. I really do appreciate all of you who indulge in my foolishness and it amazes me how many of you read this in the middle of the night. Sometimes I fantasize about that phone ringing in the middle of the night to jump out of bed and scramble over to the hospital for a  trauma case with Dr. Slambow. It really sounds like fun now that I cannot clearly recall scrambling to set up instruments or feeling totally beat up by the late hour and gruesome trauma.

4 comments:

  1. Wow!
    I am always amazed by the latest, burdensome safety requirements when compared to the "anything goes" standard of the past.

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  2. I most definitely lived most of my nursing life in the anything goes standard. If the patient benefitted or was made comfortable that was what I tried to do. We used to describe questionable, but best for the patient interventions as "not exactly according to Hoyle."

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  3. I really enjoyed working the floors in an 'anything goes' environment. I always said 'if it's stupid and it works, it's not stupid'. The real issue is that unless people feel free to innovate, innovation never happens. In a profession as hidebound and tradition heavy as nursing, nothing ever changes. People go on learning the same old way to do procedures, and keep doing them that way their whole career, because the old way is the best way. I hear so much lip service these days for evidence based practice, but in the end, it's still old nurses teaching young nurses, and passing on the old ways.

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  4. There seems to be too much oversight in nursing by people that have never worn our a pair of Clinics (Danskos today??) There are so many nurse sages today that are not involved with direct patient care. I hate to go Dean Wormer on all those computer nurses and utilization nurses, but for God's sake find a patient to suction or a chest tube to milk. Get out there and smell the Bovi smoke, dress that draining wound, or clean up that foul smelling effluent from that GI bleeder. Do something to directly help a sick person. Enough said.

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