Time Out - I Contaminated my Gown

President Trump now seems to be buddies with his old North Korean nemesis and  most likely has surrendered his "dotard" title. So.... I've been thinking about changing my handle from OldfoolRN to OlddotardRN because there  is just so much about modern operating rooms that fall beyond my level of comprehension.

What happened to the sacred tiled temples that were once ORs?  Modern ORs have sacrificed  their penthouse location to practically anywhere in the hospital and worse yet resemble a waiting room at the Greyhound station. Valued work areas have been converted to electronic warehouses with enough computerized  doo dads to land a 747 in a whiteout.

The above illustration is the latest  iteration in a long line of befuddling situations. When I initially laid eyes on this young, scrubbed  whippersnappern I had that weird feeling that totally smacked my gob, (see, I can talk like a youngster if I try real hard.) She just contaminated her right hand by elevating it well out of the accepted zone of sterility. Everyone knows that the sterile part of a gown is restricted to below the armpits and above the waist tie-NO EXCEPTIONS.  If Alice, my favorite OR supervisor were on the scene she would be swinging her sponge stick like a baseball bat at this poor nurse's knuckles. Breaks in sterile technique earned the most severe knuckle bashing and I can almost see  Alice winding up like Mickey Mantle at the plate.

I educated myself about the situation and learned this nurse is calling for a "time out," which probably means she recognized the error in her ways and wants a sleeve and a new glove from the circulator. Asking for a sleeve to cover the contaminated section of a gown was a humbling experience because it required the assistance from a sterile member of the surgical team.  A surgeon helping a scrub nurse provided ample fodder for endless jokes. Dr. Slambow, my general surgeon hero usually made the nurse step away from her Mayo stand and assist with the surgery while he assumed scrub nurse duties to demonstrate the correct way of doing things.

There are a couple of other issues with the way this nurse is conducting her duties, but I think I'll let my esteemed readers point them out.

A Remembrance of Nursing Pins Past

The land of the free and the home of the brave was once home to 4,000 diploma schools of nursing  each with their own unique nursing pin. These pins were typically designed by committee and the final version was often a hodge-podge collection of sometimes divergent elements. It was tough for a committee to come up with a consensus for a coherent design.  At my alma matter the pins were the responsibility of the Admissions and Promotions committee and it required weeks of heated discussion to decide if one letter on the pin should be changed to reflect the conversion of our hospital to a "medical center." After much heated debate it was decided to change the "H" which was for hospital to "MC." Nursing pins were sacred symbols and change did not come easily.

Implant something in an adolescent brain while it's developing and it sticks forever. We were brainwashed  conditioned  into believing our pin was the ultimate reward for 3 years of soul crushing labor while  subjected to near constant badgering and belittling by down right mean instructors like Miss Bruiser. That beloved pin had a transcendant element to it that required a compulsory level of reverence. It was the alpha and omega to any 3 year diploma student. The  radiant pin glowing against a pure white background was the first thing your eye settled on when a nurse appeared on the scene and it told the story of a nurse's experience. If only nursing pins could talk.

I spent many hours staring at the cover of RN magazine when their annual nursing pin edition was published. A cover adorned with 30+ pins in glowing color was a feast for any diploma grad's  eye. The most common pin design was a Maltese cross with the schools initials plastered one on top of another over the center. I just loved pins with a singular sculpted design like the  Ravenswood Hospital School of Nursing in Chicago. The pin featured a beautiful version of the Good Samaritan that seemingly glowed in the dark. Wow.. that was one heck of a pin.

Speaking of good samaritanns this unusual pin featuring a beaver really got my attention. Simple, straightforward design at it's best. Beaver's are like nurses; hard working and they have the ability to modify their environment for unexpected needs. Beavers are also continually growing just like me after too much hospital cafeteria food. I really cherish this pin and think it has much better aesthetics than mine which resembles a policeman's badge. While working in psych, I found that it was prudent to remove my pin lest I be confused with an undercover cop.

Another animal themed nursing pin with a serene looking moose in the foreground framed by the hospital's name. I wonder why the moose is gazing in the opposite direction from the beaver. I think it looks better from a nurse's view looking down to have the animal facing the nurse.   The cross in the background forms a lovely backdrop. It takes a moose 3 years to attain adulthood and 3 years for a diploma nurse to graduate; an interesting fact that ties it all together. A moose also has muscular shoulders and nurses acquire the same qualities  after a stint on the orthopedic ward. I admire these two pins because they are straightforward and very pleasing to the eye.

So many pins contain multiple symbolic features that are difficult to decipher. I was admiring the floral design on a friend's pin and was quickly informed they were no ordinary flowers. "That's the Papaverum somniferum plant that is the source for opium," I was told. Her pin was symbolic of the nurse's duty to relieve pain.

It really bothers me when I hear that present day nurses must pay money for their nursing pins. A nursing pin was no ordinary commodity that could be purchased with money. Blood, sweat and tears were how we paid for our pins. The symbolic meaning of a diploma nurse's pin stays with a person forever. I sneak little glances at my pin all the time just to remind myself of who I was am.

Nurse's Cap Folding - An Ancient Tutorial

You are in for a heap of demerits if this nursing cap  winds up off center or not parallel to your face. Do not get caught wearing this outside of the hospital. It is to be removed on the ward after your shift and carried in that especially designed cap case. I still have my cap carrier today and use it to tote around my Yorkie. You whippersnapperRN's aren't the only ones that know how to repurpose an item.

Before getting to the folding stage, the cap had to be cleaned and starched. The traditional method to launder caps at our school was to fill a bathtub about 1/2 full with water add 1 cup Borax detergent and agitate with a toilet plunger that was dedicated solely to this purpose. A rinse cycle and another toilet plunger agitation and the caps were ready for starching. Cups were starched with the Niagra brand  in a hospital bath basin and plastered to our metal headboards to dry. About 20 caps could be processed at a time using this method. I am not sure how this practice originated, but maybe it evolved out of necessity. The school laundered our uniforms, but we were responsible for our own caps.

Caps were really something special in that they were a tangible symbol of  your accomplishment. Patients could readily identify a nurse by the cap and it seemed to generate a special sort of respect. Every nurse seemed to stand taller with her cap. They really were a unique symbol in nursing history and I don't think there has been a meaningful replacement.

That black band which had to be exactly 5/8 inch across was added at a banding ceremony after completion of our junior year. It was a big deal because it meant you were almost a nurse. The bands were known to be measured at uniform inspections to insure size compliance. I have heard that the black band was added to nurses cap as a remembrance and way to mourn Florence Nightingale.

This is a scan of a mimeograph, made by an old fashioned duplicating method that used a stencil created on a ribbon-less typewriter. The stencil was rotated on a hand cranked drum to create the copy.  Careless mimeograph operators could be readily identified by their blue fingers. I didn't realize that mimeographs had archival qualities - this one is nearly 50 years old and looks like it just rolled off the machine. 

The following little ditty nicely summarizes the meaning of a nurse's cap.


        The Cap
We are the "Probies"
Our piece must be said
Of our envy for the nurse
With the cap on her head.

Like an angel in heaven,
With a halo 'bout her head.
Her cap symbolizes mercy
For all sick abed.

Her duties are many,
Of  knowledge well learned
That cap upon her head?...
Yes, it's been well earned.

"Big Sisters," we're so proud
Of  your cap of white.
May we be as worthy
When we've earned that right.
                         -Dorothy Benner 

Your Cap is Off-Center, You Just Earned a Demerit!

Excerpts from my Diploma School handbook.

Rules  within this handbook are enforced and supported by the issuing of demerits.  Members of the faculty and the student health nurse issue demerits.

If one demerit is received, the student will serve two, four hour work periods to be served on two consecutive weeknights within one week of the issue of the demerit.  Work shall be performed on a ward as needed.

If three (3) or more demerits are issued or accumulated punishment shall be determined by the judiciary committee. One punishment was to lay in bed for an extended time without turning or moving to experience the hazards of immobility first hand. Another was being assigned to a cleaning detail. (this could be really bad. There lots of unpleasant things to clean)

                                                               ATTIRE
Uniform should always be worn in hospital public areas, faculty  areas and the library. No slacks, shorts, or hair curlers are allowed in public areas. In the student rooms care should be taken in keeping the shades drawn when dressing and undressing.

                                                                MEALS
Students receive free meals in the hospital cafeteria by presenting their meal tickets. After eating the table is to be cleared, and the dishes, silver, and glasses carried to the dishwashing room. No food may be removed  from the cafeteria. No food may be kept in the dorm.

                                                               LINEN
At the beginning of each September students will receive  2 bath towels, 2 washcloths, 2 hand towels and one pillow and blanket. The student is responsible for the care of these items.
                                                                    
                                                              TELEPHONE
No telephone calls received  after 10:00PM.  Outgoing calls are limited to 15 minutes.  (There was 1 pay phone on each dorm floor and  about 30 girls lived on each floor)  This caused much name calling and hair pulling

                                                        VALUBLES/MONEY
Students are advised not to keep valuables or money.  There is no need to keep sums of money in the dorm. The school supplies all needs.

                                                          SEWING MACHINES
Sewing machine are available from the house mother. A deposit of 15 cents, which is returned is required for bobbins and needles.  (I thought we were not allowed to possess money)

                                                         RESTICTED AREAS
Men's residence quarters are out of bounds for female students. Doctors lounge and dining room are also out of bounds. Please refrain from using public bathrooms in the hospital lobby.

                                                              SMOKING
Smoking is permitted in the auditorium and classrooms as per the instructors discretion. Neatness in smoking is the responsibility of the individual. Disposal of the ashes and cigarettes in a safe and hygienic manner is expected. Ashtrays are provided

The remainder of the handbook is devoted to wearing and maintain of the uniform right down to the color of underwear that must be worn     Uniform regulations were  aggressively enforced at weekly uniform inspections and the most common reason for demerits. When there were few effective treatments for illness, Instructors tried to gain a sense of control  by enforcing rigid authoritarian rules that governed every minutiae of daily life.