Cath Lab Pulse

We got a call from one of our former travelers today.  He’s landed a job in the Midwest, I’m not sure specifically where.  But it’s so funny…he is working with one of our former traveler nurses.  And this is not the first time we’ve had travelers who’ve worked in our lab meeting up in other labs across the country.

Really, how often does this happen?  It seems to me that the travelers we’ve hired are always bumping into one another at different cath labs.  But really??  Are there so few travelers making the rounds that they cross paths all the time?  It seems inconceivable to me.  But apparently that’s what happens.

I’ll tell you, though, it’s a great way to catch up on gossip!

I am so sick of dealing with techs who want to tell me how to do my job.  Or worse, who think they need to tell me how to do my job “right”.  It’s so easy isn’t it to be scrubbed in at the table, focusing literally on the task “at hand”?  It must be easy if the tech has time to oversee the job of the nurse and make recommendations.

The tech is gowned, doesn’t have to do anything but prep equipment and hand it off, while the nurse runs around getting and giving meds, dropping supplies, keeping an eye on the monitor, all while attending to the patient on the table.  

How many times have I been rounding the corner of the table to reposition the monitors for the spider shot, when the scrub tech says “could you get the monitors?”  Well, duh…I swear they say it just to give the impression they’re running the show.  The same thing goes for refilling contrast.  I’ve literally had one hand on the bottle and the other on the spike when the tech says “I need some contrast here!”  Duh.

Why, why, why do they have to play these games?  So patronizing.  The thing is, I know I don’t know everything.  I don’t try to pretend that I do.  Nobody can know everything.  Well, except for these guys. 

I wonder…do other nurses have to deal with the same thing?  Or is this just the atmosphere in my lab?

The acutes we are getting seem to be younger and younger lately.   My last was in his early 50’s, with not a lot of risk factors, but a penchant for Nicorette gum.  And for awhile there it seemed that we had a run on 40-somethings.

What is going on??  I think it must be all of the McDonald’s, Burger Kings, Wendy’s, KFC’s, the list goes on and on, catching up with us.  Time will tell, I guess?  It’s a little scary, though, especially when I see how much my own kids love their fast food.  And don’t think I’m letting myself off the hook either.  I love my french fries dipped in my vanilla shake.  Ugh.  Sign me up for a stress test…here comes that chest pain.

With all due respect to you travelers out there…well, never mind.  I do have respect for you – most of you that I’ve met, anyway.   And I honestly don’t know how you do it.  I couldn’t uproot myself for 13 weeks and start working with a bunch of people I didn’t know, only to leave again when my contract was up.  It must be tough!  But, if I had to choose, I wouldn’t have travelers in my lab.

I feel bad even saying it, because most of the travelers I’ve known were good, if not excellent, practitioners.  And a few were  truly excellent.  But there were others….oh, were there others.  Arrogant…obnoxious…creepy.  Fortunately, none of them signed on for good with us.  Okay, I take it back, one of them did sign on with us.  He was a proficient tech, but not overly so.  And he had all of those qualities I mentioned.  BUT…he took up with a traveling nurse, left his fiancee, and headed for greener pastures.

I don’t know if I’m biased toward traveling nurses vs techs because of the “nurse-thing” or the “female-thing”.  I haven’t actually worked with a female tech, so perhaps time will tell.  But I find that the traveling nurses are not quite as obnoxious as the techs are.   For instance, one of our traveling techs swore like a sailor, but if one of the women in the department did (most of us being nurses who can drop an f-bomb with the best), he would respond with dismay that swearing is “not lady-like”.  Phht.  Who needs that? 

Oh, I have a lot of reasons for disliking travelers in the lab.   I would be going a little bit too far to say they’re a necessary evil.  Or maybe I wouldn’t!   

Stay tuned…

So, I’ve worked in the Cath Lab for about five years now.   It sounds like a long time, but there are days when it feels like I’ve been there for less than five weeks.

I consider myself pretty intelligent.  Well fairly intelligent, anyway.  And my Cath Lab training went pretty well, I think.  I prepared for the standard 3-to-6 month internship, and by the end of three months I was taking “buddy-call”.  Within six months, I could basically handle the requirements of the job whether it was a scheduled case or an acute mi.

The focus of my training at first was “in the room”, learning the procedures, the meds, the equipment, and, of course, what not to say to certain docs.  It was fine, and I was pretty comfortable.  Until I reached the last hurdle.  Oh, and what a hurdle.

 Monitoring didn’t look so bad, I thought.  Right.  There are  days that I still think that.  But five years later, there are days when I just want to sink under the desk rather than continue monitoring a case I’ve started.  And, really, it all comes down to that dreaded word.  Hemodynamics.

“Why?”, I ask myself, “Why do I get so freaked out about hemodynamics?”  I wish I had the answer.  But I don’t.  And every single time I’m signed up to monitor a right heart cath, I might as well be on the table myself, having my own palpitations evaluated.  It doesn’t help that the newer nurses in the lab just sit right down and start measuring and recording like they were born to it.  Damn kids, I tell myself.  Computers come so much easier to them! 

Not me.  I sweat.  I fidget.  I hyperventilate.  I hover over the keyboard, silently reviewing the quick-keys so that I won’t miss a step.  I pray to myself that the doctor will follow the “normal” routine, so I can just follow along with the macro.  And how often does that happen?  Never. 

What’s worse is knowing that, with every misstep I make, everytime I have to say “one moment, please” to the doc, I’m one step closer to having to deal with a really pissed off MD, who’s ready to share with me every potential complication of my ineptitude. 

Although it’s been a good year or so since I’ve heard the phrase, “get someone in here who knows what they’re doing”, it seems like just yesterday.  And the thing is, I really do know what I’m doing.  I know the anatomy.  I understand the physiology.  I understand the wave forms.  But…I can’t memorize.  I can’t memorize the pressures, and I can’t memorize the wave labels.  This is my secret shame!

So, here I am, in the New Year.  I’ve resolved that I will study more.  I’ve picked up the Kern book a few times already, hoping that the numbers and waves will finally sink into my brain and stay there.  But my eyes glaze, my mind wanders…and I close the book.  I’ve searched the Internet for sites to review.  I read a little…and shut it down. 

So if my patient bradys down during the case?  No sweat.  V-fib arrests on the table?  I’m all over it.  But ask me to change my scale or sweep speed?  I’m all thumbs and stuttering. 

I guess there are worse things.

You know the drill.  The pager goes off, probably at 4am or so, you swear aloud, climb out of your warm bed and throw on your clothes.  If you’re smart, you’ve left clean scrubs out so you don’t have to find anything else to wear.  On your way out, you trip over the dog, who’s thinking “awesome, it’s time to go out and smell stuff!!”, and maybe, just maybe, you have time to grab a coffee (and I have one word for you…Keurig).

You get into your cold car, turn on the defrost, and hope the windshield washer fluid doesn’t make the icing worse (another tip…Deicer in a can…don’t know who invented it, but they should be up for a Nobel prize).  Now, on the road…is there rain?  Snow?  Ice?  Been there, my friend, and it sucks.  Royally.  But you have someplace to be…and a limited amount of time to get there.

Welcome to the world of D2B.  Door-to-balloon time to you and me.  So how much time do you have to get to the lab?  30 minutes?  Average.  Do you live close or far?  I happen to live 10 minutes from my lab, a fact that pisses off my coworkers to no end.  But, hey…they chose to live 28 and a half minutes away.  Sucks to be them!

You get to the hospital, set up your table, call the ER, and run.  If you’re lucky, you don’t have the cardiologist breathing down your neck.  Either way, you know what you have to do.  And you do it. 

Door-to-balloon is about more than just meeting a 90 minute goal.  We all know that.  The goal is a good thing.  But it isn’t the only thing.  “Time is muscle”…and time can make the difference between life and death.

Congratulations!  You’ve made it to the debut of Cath Lab Pulse, a site designed for cath lab professionals.   During our construction phase, we’ll be looking to you for ideas…general information, education, burning issues…you name it.  We depend on you, the people on the front lines,  for our content, so let us know what you think is important.  Thanks for visiting, and come back often!