Just do it.

This is a bit of a rant.

I work weekends, hence the title of the blog. I have to be able to do just about any case that comes along. I understand that the wimps fine scrubs who work during the week are stuck in their specialties and don't have a lot of exposure to other specialties. I don't care though. There are certain cases spread through all of the specialties that every scrub working in a large hospital must be able to do. (I may make a list of these someday.) If you can't do them, go work out an outpatient surgery center, or L &D, or specialty hospital and let your position be filled by a competent scrub. Even if you don't see them every day, you gotta be able to day a crani for subdural, a thoracoscopy, an ORIF and other procedures in the "scary" specialties of ortho, CV and neuro, even if you a GYN, or Plastics or General scrub. You just have to be able to do them, or get the hell out of here.

There, I feel better.

Bad scrub.

So I've been following this story and giving it some thought.

Short synopsis: A hep C positive scrub in Denver was caught exchanging her dirty syringes filled with saline for fentanyl syringes, which she then shot up with. Thousands of people may have been exposed. After being fired from the Denver hospital she went to work at a one day surgery center where she worked until she was arrested. Hundreds of more potential exposures.

Some interesting tidbits: the hospital knew she was Hepatitis C positive, it showed up on her blood work when she was hired. They counseled her on a ways to avoid avoid exposing patients. A few news stories have made statements that she did not have patient contact. That can't be true, if she was in fact working as a scrub, unless reaching into a patient's abdomen and holding their intestines doesn't count as patient contact.

Also the news stories say that she was caught after being found in an OR which she was not assigned to. This is interesting, as, at every hospital I have worked at, people go into other rooms all the time to steal supplies or say hello to friends. The hospital must have had serious suspicions about her, or she was found messing with the anesthesia stuff. Some of the articles mention a previous drug test which came back negative, so the hospital was probably suspicious.

The fact that she was going into other ORs explains those high numbers of potential exposures. She only worked at the hospital for about six months, so that's about 130 working days. She would have had to have been stealing dozens of syringes a day to actually expose thousands of people. In fact the hospital is testing every one who had surgery at the hospital when she was at work. Of those "only" a hundred or so will be at serious risk of exposure. Pretty horrific, but not quite as scary as the headlines.

I'm still flabbergasted at the substitution of her dirty syringes. Why? Stealing drugs I can understand, that's what addicts do. But exposing people? Surgery departments are awash with syringes. Finding sterile syringes would be quick and easy. Sterile saline is likewise easy to find. I can think of only three reasons why she reuse her dirty syringes: She was paranoid that the extra syringes would be missed; second, she didn't have access to the proper labels for the syringes, or the original labels could not be removed from the original syringe. Not having a proper label on her replacement syringe would expose her quickly. Finally she may have been an evil bitch who wanted to infect other people.

My final thought is that, without taking away any of her responsibility, there are others who have seriously screwed up here. There is no way that she should have been able to go get Fentanyl syringes. Narcotics are suppose to be strictly controlled. Ideally, an anesthesia provider should never draw up a narcotic until he or she is ready to give it. What was obviously happening was that anesthesia was pulling up drugs, setting them down, and leaving the room. Stupid. Especially, as seems likely, there was a staff person about whom the hospital had suspicions of drug abuse.

General badness all around.

How in the hell?

Working in surgery can lead to interesting questions.

Today's question is: How in the hell is it possible that someone can shoot themself in the leg with a bow and arrow?

HIPAA and me

So there is this law, HIPAA, that says that we medical folk can't divulge patient's medical information without a good reason. We also can't act on it for any reason other than to treat or aid the treatment of the patient. The rules are so strict that if I saw my mother's name on the surgery schedule, I couldn't go and see her after surgery unless I also got the information from a non-hospital source. HIPAA can cause some problems for bloggers, as the best stories involve patient information. I feel that on this blog I am abiding by these rules in the following ways.

I, of course, never use patient names. I don't use my name or the name of my hospital. I don't even explicitly name the city where my hospital is located, although it probably isn't difficult to figure out. However given my other interests, as seen on my other blogs, anyone who knows me would recognize me here. I am the only scrub in my town, who works the weekend shift, with my set of interests. I have a limited set of patients, so it theoretically may be possible to figure out which patient I am talking about. I doubt anyone will actually go to the trouble to figure out which town I work in, then who I am, and therefore which hospital I work at, and then connect my patients with a blog post. It could be done, but only by someone who has access to my hospital's records, and who knows me. Still I protect myself further by lying. When I say "this weekend", I mean, "sometime in the last 19 years". I can and will change the nature of a patient's injuries, disease or treatment in ways that don't change the core of the story. If I can, I might even change the patient's gender. In other words, this isn't the patient you're looking for. Go away.

Cases that suck, and their causes.

I made passing reference to the something that made a case suck over here, but I thought that the causes of surgery sucking could be further expanded upon. Note that some of this list is subjective. It is also viewed from the scrub staff's point of view, rather than the surgeon's, patient's, anesthesia's or circulator's point of view. I suppose that ophthalmologists actually like eye surgery. Some circulators like long cases because they get to sit. Anesthesia has a completely different set of priorities from the rest of us. They seem to think that just because the patient’s blood pressure stays in the 50s it is a bad case. There are even some scrubs who might some theses cases.

First and foremost, harvests suck. Nothing sucks worse.

Second, eyes suck, but not as much as harvests. Retina and vitreous surgery sucks more than other eyes.

Third, any case with certain doctors suck, because the doctor is an asshat. Luckily, this is actually a small set of surgeons.

Any case involving more that one surgical specialty sucks. The suck factor goes up exponentially. A case with two specialties sucks 4 times as much as a similar case with 1. Three specialties sucks 27 times as much. Four specialties sucks 256 times as much. If we get to five specialties, just put a central line in me and hook it to wall suction.

Any case which departs from its script sucks. Some departures suck more than others. This includes, for example, the unscheduled opening of an endoscopic case. Note that just because we don’t know what we are doing going in doesn’t mean that there isn’t a script. For example, an exploratory laparotomy for bowel obstruction has departed from the script if we find a huge diaphragmatic hernia. It hasn’t if we find a tumor or adhesions.

Dead bowel sucks. Smells too. That’s why it sucks.

Any case scheduled to last more that 150% of what a normal version of that case would last sucks. First it's going to last twice as long as it's scheduled for, and second the surgeon knows something, and it's not good.

Any case scheduled for longer than two hours sucks. (Corollary, heart scrubs are crazy.)

Any case that requires re-draping sucks.

Any case with broken bones in more than one limb sucks.

Any case in which the circulator has to leave the room for anesthesia more than twice sucks. The circulator is there to get me things, not them.

Aneurisms suck. All of them.

Holding retractors on vaginal cases sucks.

Interesting cases suck. After 19 years, if I haven’t seen it, I probably don’t won’t to. OK there’s one exception. Years ago, when I was a baby scrub, a case down the hall has a removal of a cyst. When the surgeon cut into the area an insect stuck its head out of the wound. The patient had been in the tropics recently. I didn’t see that case, but I’ve always wanted to see another one. Otherwise interesting is out.

So there it is, an incomplete list of ways that cases can suck. I leave out that there are certain case and doctor combinations that suck and that certain staff have people that they can't get along with, which sucks. I, of course, can get along with anyone.