Updated 07/08/2006
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St. Elsewhere Theme

Just a regular OR - not mine

Hello, welcome to my little corner of the world I love to call Nursing. Lets see, where to start. Well, first of all, if you had asked me about being a nurse when I was younger I would have thought you were crazy! There was no way in this world that I was ever going to be a nurse. So, it has been a strange road to this place, but once I got here I fell in love with it. How many people do you that can say they truly love their line of work? Yes it is frustrating at time, what job isn't? But being an Orthopedic operating room nurse is for me!

OK, well back to my "strange road" to nursing! Let me explain what I mean by that - - As a young child in the 1950's I came to learn about my greatgrandfather who was a physician and surgeon in Cleveland at the turn of the century. Seems he liked to travel a lot, so I'm not quite sure exactly when he took care of his patients. From a young age I saw antique surgical/medical instruments. Grandma still had much stuff in the house, including the old glass medicine bottles. There was one long narrow closet behind the fireplace in the parlor that had some old stethoscopes and stuff hanging from hooks - creepy, but fun. One of my favorite book titles was "Obstetrics and Gynecology - and Other Disorders Peculiar to Women and Children". Now there's a topic for you - - peculiar??

Fast forward to the 1960's when I spent a summer as a candy striper. They started me out in admissions (boring), moved me to floor duty (even more boring), and then on to the lunch counter they had at the time. Let's just say that food service was not my forte! But I handled the cash register with ease (now remember folks, this is before electric or computerized registers, you hand pushed the amounts with number keys and had to figure out the sales tax in your head). I was bored!! Finally, they moved me to help in the emergency ward - now that was more my style. Having had over 300 stitches myself over the years, blood didn't bother me. I even got to help transport to the morgue and get a tour. I realized that nursing in the 60's didn't do any of the "fun" stuff I enjoyed, so I decided it was not for me.

A Nurse is God's Angel of Mercy!

Fast forward to the early 70's. I'd graduated from high school and was attending college studying business (marketing) and continuing with my music studies (vocal performance - had studied and trained for many, many years). Nursing students of the time had the no make-up or decent hairdo rules (I was into good grooming and proper fashionable attire). And, besides, nursing students had really lousy hours as "hospital slaves" while in school. That was definately not the route for me, so business remained my area. I graduated with a B.S. in Marketing and went out into the world of business.

A few of years go by and I somehow end up in the administrative end of an Otolaryngology research department at a medical school. I found that I had quite an interest in medicine - surgery fascinated me. My most favorite procedure to watch was the radical neck dissection. We also did cochlear implants and work with Meniere's Disease. I taught our department's introduction to Otolaryngology for Phase C medical students, and assisted in the adminstration of a temporal bone banking program. Some of the surgeons I worked with felt I should go to medical school (no way!), and somehow I decided to become a nurse (much to their dismay).

So, off I moved to Texas and entered a program for people with degrees to fast-track for a second one. 2-1/2 years later I had a B.S. in Nursing. During my time as a student my advisor was an old Orthopedic operating room nurse and somehow we clicked and found that Orthopedics was my "cup of tea" (after all, I made a name plaque with a router as a very young child). I interned in the operating room and then worked at a Level 1 trauma center. Years go by, I've done Orthopedic trauma, Orthopedic floor nursing and Orthopedic operating room nursing. Amazing huh?!

When I started working at my current hospital in 1989, I had been back in Ohio for about 10 months. Since there were no OR positions available at the time I started out on their Orthopedic division. Not long after returned to the world of the OR where I have remained an Orthopedic operating room nurse at "Cleveland's Premiere Medical Center". For those of you living in my area you will understand the commercial slogan - for those of you out of this area it is NOT the Cleveland Clinic!! There is nothing quite like working with dangerous power tools on the human body. If you've never worked with a Midas Rex drill, you've missed out! And, the 2 pound mallet is one of my mainstays!

My main area of practice is Total Joint Replacement of which I am the RN, ACN (Advanced Clinical Nurse) Service Manager for that area. For hospitals in our consortium level we rank second in the number of total joints done per year. Primarily we do total hip and total knee procedures (primary and revisions). We also do total and hemi shoulder replacements and hip hemiarthroplasty procedures on a regular basis. We briefly did total ankles, but that surgeon has left the hospital and no-one else is doing them at this time. On occasion we also do total elbow replacements, but not too often.

I keep track of about 4,000 various implants at any given time which we keep in stock. Unlike many hospitals, we have a consignment of a variety of items rather than having them brought in on a per case basis. The paper-work alone to maintain this stock is enough to make you want to pull your hair out. But, I devised a tracking system which drastically cut down the number of unaccounted for implants and lets us know immediately what we have and were it is.

 
A Nurses Prayer

As I care for my patients today.
Be there with me O Lord I pray.

Make my words kind, it means so much.
And in my hands place Your healing touch.

Let Your love shine through all that I do.
So those in need may hear and feel you.

The "new thing" is the MIS Hip procedures, both mini-incision and two-incision cases. The two incision doesn't disrupt the tendons and ligaments so the patients can walk on them almost immediately and home quickly. Right now it is really only healthy, young patients with little to no deformity that are eligible for this type of procedure. Not easy putting those big implant pieces through those small holes.

The other "new thing" is actually a return to an old concept - the unicompartmental knee. For patients that are younger, who have only single compartment disease (lateral or medial) and no patellar-femoral disease, this can buy them years before having to undergo a complete total knee replacement. The incision is smaller, the patellar tendon is left intact and we only remove a small surface of the involved femoral condyle and tibial condyle. The implants are so small and "cute".

Another "new thing" is again, actually a return to an old concept. We have been part of a study for hip resurfacing replacements. For these cases the patients femoral head is left intact, but cut down in size with cylindrical reamers. A replacement "cap" with a small stem is them cemented on to the patients femoral head. This is the old part. The new part is adding a small acetabular surface which this new cap slides against. Patients for this type of procedure need to have good vascular flow to the hip and little to no acetabular disease. We have done around 35 in the past 1-1/2 years.

 
"IF" For Nurses

If you can bring a special understanding
To all of those entrusted to your care,
And meet their needs, no matter how demanding,
With patience and with energy to spare;
If you can lend each task your full devotion,
And always try to listen and to cheer;
If you can learn to understand emotion,
And comfort others just by being near;
If you look forward with anticipation
To meeting special challenges each day,
If you can keep your faith and dedication
Whenever disappointment comes your way;
If you take pride in giving your profession
The finest skills and talents you possess,
Then all your dreams and goals will find expression
And, as a Nurse, you'll be a great success.

We work in laminar flow rooms wearing the battery powered helmets for that "spacesuit" look. We have frequently been referred to as "hemlet heads" by those unfortunate people who work in non-Orthopedic rooms! I've gotten rather fond of wearing my helmet, and find wearing the basic face mask a real pain. Besides, the suits make the patients feel like they're "going to the moon" or some such thing. I rarely leave the world of orthopedics (joints, scopes, fractures, spines, hand, and such) - which is fine with me. If I have to I've been known to do Neurosurgery, General Surgery, Plastic Surgery, and Oral Surgery - but note I say "if I have to"!

For those of you just dying to know - these are some of the parts of the body I work on daily. The pictures on the left are of a normal hip and knee joint, and the ones on the right shows you the arthritic changes that cause us to have to replace them.

Normal hip joint Arthritic
hip joint

Normal knee joint Arthritic
knee joint

Perioperative nursing is an absolute joy. Oh yea, like any job, it is frustrating also. Budgetary constraints get in the way of patient care all the time. We as nurses have to stand up for what is right and necessary for proper patient care. Healthcare is a business, but there are times when you have "to spend money to make money". It is often hard to make the "bean counters" understand that, but we have to keep on trying. As nurses, we have to keep an eye on the cost, but the total patient outcome should be our main concern. Often, as specialty nurses we loose sight of the total patient. Try not to do that in your daily patient care, no matter what your area, OK?!!

The past few years or so have been a challenge for me as a nurse. I have had to be a patient for not one, not two, but a total of four surgeries, rehab, treatments and radiation therapy. I can't decide whether it is better to have the knowledge of what is wrong and what is being done, or to know nothing more than the average lay person. At least my doctors tell me I have a wonderful outlook for all I have gone through. Hey, what more can I do?

First I had my left total knee done on 8/28/02 and Jennifer and Patty were there to take care of me. I had epidural without sedation so I was awake through the whole thing. Just listened to my cd player and answered the occasional question. Jen was a doll, came in to work at 7am just to circulate for my 8am case (of course they had her scheduled to come in 11am-8pm that day!) and Patty was my fantastic scrub tech. Everything went well in surgery and was good until I got the Dilaudid PCA in PACU. No matter what medication they gave, I kept on vomiting with each successive push of the button. Hmmm, decrease pain or puke - what a choice! The hospital stay was OK (fortunately only 3 days) and then I was transferred to rehab under the care of my primary physician at another of the system hospitals. The left quad shut down and went into severe spasm. Now that was a "thrill", didn't work for almost 5-1/2 weeks so I spent a lot of hours in the CPM daily both in rehab and once I was home. The joint didn't have much pain, but the ineffective quad surly did! I spent 12 weeks in outpatient rehab before I was ready for the right total knee. The left one has done great and I have a range-of-motion of -5 degrees extension to 127 degrees flexion when I work it. Not bad for someone with an implant.

Then on December 4, 2002 I underwent my right total knee replacement. Again they managed to have Jennifer on the 11am shift that day so she came in the 4 hours early again to do my 8am case. This time she circulated with Frances being the scrub nurse. Again, an epidural without sedation and listened to the cd player. Surgery went well, but gosh all mighty did I have bruises on the leg. The right one has had numerous surgeries in the past so the retraction and old adheasions popping did a very colorful number on my leg. Joint did well, the quad shut down again, but this time there was no spasming and pain so I was much happier. Quad started responding within 2 weeks and by 4 weeks post op I already had a range-of-motion of 6 to 95 degrees. My surgeon was very pleased with himself! When all was said and done I had 0 to 125 on that knee.

I'm "young" for total joints - but my knees were "old". I am so pleased that I did it. I was off work for 7-1/2 months and have done great with the knees upon return to work. I can stand to scrub cases, walk around the OR, everything (well, as long as I remember to take my 1pm 800mg Motrin that is). They get stiff and a little sore when I do a lot, but no severe, stabbing, debilitating pain - so I am more than happy!

Was only back to work about 2 weeks when I had to be off again for a few days for biopsy surgery on 4/26/03 for the breast cancer that was found on my annual physical mammogram. Three weeks later on 5/14/03 I was off again for 5 weeks after having re-excision of the biopsy area and removal and study of axillary nodes. I am lucky that UH has the Ireland Cancer Center which has designation by the National Cancer Institute, does all sorts of clinical trials and is on the cutting edge of cancer detection and treatment.

Then, ended up being out again from mid December '03 to mid January '04 due to an infection that occurred in the old seroma sac which had collected some of the radiation necrosis fluid. Since it couldn't be absorbed by the body and was basically in a "balloon", it festered until it swelled up and had to be aspirated. First day had over 50cc of thick tan pus. Next day was another 50cc, but since I had started on antibiotics it was not as thick. The next day it was incised open, packed and left to drain and close on its own. Has healed OK, but the nice tiny scar is now a wide thick one since it had to granulate in.

I have been through whole body bone scans, liver scans with and w/o contrast, MRI (with and w/o contrast) from top of my head through mid femur. I have been poked, prodded examined over and over. After the second breast surgery I went through 5 months of the "seroma from hell" that just love to fill-up. I have never spent so much time taking off my tops to have people examine me over and over. Had to have the seroma aspirated about every 10 days until it finally collapsed and then I got to start radiation therapy. Was originally scheduled for 28 whole breast treatments and 7 boosts. I developed 2nd degree burns with "lovely" tissue sloughing around 20 whole breast treatments in. The radiation oncologist decided to decrease the boosts down to 5 thank goodness. The boost area was where there was no intact skin left. Very painful, but is healing nicely. Surgeon, medical oncologist and radiation oncologist are all pleased with things so far. I have infiltrating ductal ca so this is something that we have to continually watch out for metastatic disease.

You know, I've been an orthopedic patient for years, but this has been a whole new experience for me. I would have treatment at 9:15am and be at work from 11am - 7:45pm daily. Didn't miss a single day due to the treatments. I was lucky, Heather (a PRN nurse) was always looking for extra hours so many of the weeks she worked on Wednesday for me so I got to rest a bit more. I'm a couple years out of radiation now and on Taxoxifen twice daily for a full 5 years. All scans remain negative and my oncologist is happy, so I am too.

The total knees are doing great. It was odd, but at over 3 years out I gained lots of strength, range of motion and ability to do things I hadn't done in years. Don't know why it took so long, but I'm happy with the results. No pain - just occasional stiffness at the end of a long day. I'm back to doing remodeling around my house by myself - something I love to do and missed doing for so long.

I've added some links below. OrthoWorld has a site developed for surgeons, patients and companies can search stuff out. The patient site map has links to all sorts of things like - what is Orthopedics, anatomy, surgical and non-surgical therapies and stuff. I've also added a link to the American Academy of Orthopedic Surgeons - you can search a variety of educational topics that have been presented at various annual conferences. Very informative.. a different perspective from the nursing end of Orthopedics. Of course, one of my favorites is still the Antique Surgery site - it's fun. Unfortunately for the patient I've killed them more than once!

Hope you like my Operating Room cartoons. I got the "Totally Lost" one from Mary, a nurse who used to work with us in the operating room. She left us to become a Nurse Practitioner at another institution (see what happens when you have someone go on to further their education - way to go Mary!), although she did stay on PRN, occasionally working on the weekends. A year later she returned to our hospital as a NP so we do get to see her a bit more often. She even took care of me in PAT for the first surgery. The other cartoons I came across in one of my print programs.

I got tired of the music from Quincy so I have gone back to the "sentimental" theme from St. Elsewhere (used it in our pinning ceremony many years ago). I tried using the theme from E.R., but it just irritated me. And, Chicago Hope's was too dull. Anyway, I hope you like it.

Here are two interesting photographs I found. The one on the left
is an old-time picture of nurses. Geesh, I sure am glad that we don't
dress that way any more!! The one one the right is a portrait of Florence Nightengale and her sister.

Old Style Nurses     Florence Nightengale and her sister

Sign Our Guestbook     View Our Guestbook

I thought these rather appropriate given nurses service
to their country through the years!

Doc's Patriotic & Military Graphics - Angels of War    Doc's Patriotic & Military Graphics - She to was a Hero

Interesting Nursing Links

National Association of Orthopedic Nurses
Association of Operating Room Nurses
OrthoWorld
American Academy of Orthopedic Surgeons
World Ortho Online Electronic Textbook
Online Atlas of Surgery
Tribute to Clara Barton
The Changing Faces of Nursing


My Hospital and some of the Adult Orthopedic Surgeons
that I work with at UHC:

University Hospitals Health System Home Page
Henry H. Bohlman, M.D. (Spine)
Patrick J. Getty, M.D. (Ortho Oncology)
Victor M. Goldberg, M.D (Total Joint)
Donald B. Goodfellow, M.D. (Sports Medicine)
Matthew J. Kraay, M.D. (Total Joint)
Randall E. Marcus, M.D. (Total Joint/Foot & Ankle)
William J. Petersilge, M.D. (Total Joint)
Brian N. Victoroff, M.D. (Sports Medicine)
John H. Wilber, M.D. (Trauma/Fractures)
Roger G. Wilber, M.D. (Trauma/Reconstuction)

Comprehensive Cancer Center Designated
by the National Cancer Institute

University Hospital's Ireland Cancer Center

If you have a nursing site link that you would like to have
added to my page E-Mail Me and let me know about it.

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