Short-taped in the OR

As a routine precaution during cataract surgery, we normally tape the patient’s head to the operating bed.  Our patients are sedated (wouldn’t you want to be sedated if someone was working on your eye?) but sometimes they wake up at unpredictable times.  Everyone metabolizes drugs differently.  So to prevent them from suddenly sitting up like the Cowardly Lion and quipping, “Unusual weather we’re having, ain’t it?” we gently but firmly run tape across the forehead and under the head rest.

May be a bit low tech, but IT WORKS.

In the past, we had this big ass roll of tape to make a couple of passes around the head (or more if the patient seemed likely to be a problem child.)  A typical roll might last for eight cases.

More than enough tape to get the job done!

Enter UPMC (the acronym for “U People Must Comply.”)  Someone, somewhere, in the vast corporate mind of the beast decided or calculated that  “single use” rolls of tape were more economical.  Or maybe they ordered 10 million rolls of the wrong tape.  Whatever, the reason, this is what we have to work with now.

The picture can be deceiving.  One roll of this single-use roll just barely makes one circuit over the head, so on most cases, we are now using TWO rolls of single-use tape to protect our cataract patients from their own involuntary movements.

Never mind the insanity of making rules to govern every situation as if every situation is identical, but isn’t this terribly wasteful?  At two rolls per case, we’re using about 8 rolls for every one of the larger multi-use rolls.  Is that environmentally conscious?

Rather disgusted, I told the nurse to just order the old rolls for us to use.

I was informed that we can’t do that.  This is what we are required to use.  Silly me.  This isn’t the United States of America.  I can’t be allowed to do what I think is in the best interest of my patients.

I’m going to go off on a rant right now (and several run-on and poorly structured sentences) so you might want to grab a Snickers and an English teacher.  Okay.  Do not grab an English teacher.  Unless you are Donald Trump.  Or you are married to said English teacher.

I am getting rather tired of people telling me, the surgeon, how to do my job.  I am told that I have to mark the patient’s eye.  (That is a good idea.  We always did it before, but . . . )  I am told where I have to mark it (in the holding room instead of the operating room where my chart is and with the patient in the proper position for the surgery–I know that sounds weird but when I operate I sit behind the patient’s head so his right eye is my right and his left my left, but when I face them in the holding area, my right is his left and vice versa–for someone who had operated for years the other way, it took some getting used to and I tried carrying my charts around, but now I have two charts, the previous patient and the next patient and of course I wrote on the wrong chart shortly into this new experiment which quite frankly made a simple but important safety act more cumbersome and difficult with no definable benefit), and how I am supposed to mark it (on the cheek below the correct eye, marker that won’t rub off easily (patients have to scrub, often with alcohol, to remove my initials tattooed on their face), and I have to include THREE initials, because I might forget who the fuck I am after following all these god-damned insane regulations.)  I am basically told what medications we can use because if it’s not in the hospital formulary, it ain’t happening.  I am supposed to date and time my orders–this is an outpatient procedure that takes 10-20 minutes in most cases.  How is dating, and worse yet timing, my signature of any benefit to patient care???  Anything I sign in the chart has to be on that date and within a fairly definable time frame.  I’m not supposed to wear a watch in the OR, yet I am supposed to time everything.  What the hell did I go to medical school and residency for?  I could have saved EIGHT years of my life and just had the federal government (The Joint Commission) and UPMC tell me what to do.  Maybe Trump will wipe out the Joint Commission after he’s done erasing the EPA.  And I am done digressing.

But I heard this single use tape experiment has been so wildly successful at improving patient care and cost-efficiency that UPMC is going to roll out their next great idea:  single-use toilet paper rolls.

Because you shouldn’t be pooping on company time anyway!!!!

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Phone Repair: Not What It’s Cracked Up To Be

I was dragged kicking and screaming into the new millennium about a year ago.  I finally gave up my cherished flip phone for a smart phone.

And while I haven’t had many regrets–it is a lot easier to text and having access to the Internet is very convenient–it did present me with some new problems.  For one thing, smart phones are not as durable as flip phones.  Within six months, the screen was cracked.  Fractured.  I managed to drop it several times. Threw it once.  After I got a call for a “routine” consult at 10:30 PM on a Sunday night.  Are you freaking kidding me?!?  If it’s routine, couldn’t it wait til business hours on Monday when someone else was on call?  But I digress.

The phone worked fine, but now the surface looked like a cobweb (and a few fragments and one corner were missing) and I was concerned I was one more phone rage call away from it not working anymore.  Or, since I like to take it running in case I fall or do something stupid, I was one drop of sweat or an unexpected rain shower away from water getting in my smart phone’s head.

So I stopped by a place that advertised fixing iPhone screens.  It was a paintball store, but that did not deter me.  They must go together.  Shooting paintballs probably results in some broken phone screens.  But Mr. PaintBall wanted $120.00 to fix my iPhone 5 screen.  Apple already is up to #7, so it seemed like a lot of paint to pay for an outdated phone.  (I didn’t want to enter modern civilization too quickly.)

But my good old flip phone never gave me trouble like this.  It bounced off walls better.  Makes you wonder which one is the smarter phone.

So I went to Google.  Low and behold, you can purchase new screens and replace them yourself.  There are multiple videos on You Tube.  It looked so easy.  And I could buy one for around $25.  Take that Mr. $120 Paintball shyster.

I waited for my salvation to come in the mail.  I had two weeks before I was on call again, and I would need my phone.  And one more pitch against the wall might be too much.  It finally came.  I rushed home, loaded up the You Tube videos and prepared to save myself, um, like almost $100 bucks.  A lot more if you factor in the unreasonable cost of a new iPhone.  $700?!!!!

I managed to get the cracked screen off, fracturing it even more.  Nothing to worry about.  I was going to fix this cracked phone with a brand new screen.

Okay.  What was underneath doesn’t look like the video.  Maybe it was the wrong video.  Nope.  None of them looked like my broken mess.  I can’t start sweating now–the perspiration will drip inside and fry the smart phone’s stupid brain.

I’m pretty sure I had more parts than this.  If I walked away, they would start replicating.  It was like a sci-fi horror flick.  Low budget.  Very low.

After some praying and swearing (I might even have swore while I was praying, God help me) I figured out that my phone was more broken than I had imagined.  There is a frame that should have come out with the screen and did not.  I was able to get that out.

But I realized that the videos were all replacing screens that had home buttons and cameras already in them.  What I had bought, was just a screen.  No home button.  No camera.  WTF?!

Just an empty shell of a real phone.

I did consider stopping at this point, but I couldn’t get my old screen to work anymore.  I had to press onward.  But no matter how hard I tried, I could no longer get the phone to work.  With either screen.

So I made a decision.  I would purchase the proper screen with home button and camera.  I still had a week before I was on call.  I could live without a phone until then.  Cavemen lived without phones for years.

I found the proper part and ordered it.  I paid extra for 1-5 day delivery.  Unfortunately, it was President’s Day Weekend.  I still hoped it would be delivered to my office by Friday.  It did not come.  I did get three emails asking me to rate their product and offering me on-line instructions on how to use it even though they have failed to actually deliver said product to me.

I finally got a tracking email that it was being delivered Saturday.  My partner was going to be working Saturday morning, so I thought I’d stop by later in the day and get my salvation.  Apparently, even though the office was actually open (one Saturday out of every five) the post office doesn’t bother to deliver mail, assuming we are closed.  I had to wait until MONDAY.

Monday came.  The mail came.  But the screen was the same one I had already ordered.  No home button.  No camera.  No working phone!

I called and complained, but was told that that was what I ordered, regardless of the photo of the product.

Now I’m down $60 and still no working phone.  It’s like a series of Two Broke Girls episodes with the total changing after each episode.  I have a pager, but no way to call back.

On  my way home, I stopped by the paint ball store in desperation.  This time I talked to someone different.  I was afraid since I had already tried and failed to fix the phone that they might not want to get involved at all.  To my surprise, the guy said he could fix it and it would cost me $50.00.

I wasn’t going to argue with him.  At $110 so far, I was still ahead of the paint ball shyster who wanted to charge me $120!

And my phone works.

I put the money I saved toward an otter box that so far has kept my new screen without a scratch.

I will consider this DIY project a victory.

 

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