Excellence

by Alexandra Skinner

The patient returned from the OR on three vasopressors, with no arterial line, no urinary catheter and no thoughts from the anesthesia team on accurate intake and output. I watched the looks of horror assail the faces of my ICU nurses. “We figured she has a blood pressure because we’re getting a good reading on the pulse oximeter,” quipped one of the OR nurses in response to questioning regarding absent reads from the manual BP cuff. Interesting logic, but in my ten years of practice I had been apart of hand-offs messier than this. We found out later that the arterial line we had inserted prior to the OR for accurate invasive blood pressure monitoring had become accidentally dislodged while transferring her from the stretcher to the OR table.

I inwardly smiled as my ICU charge nurse took the lead, in true ICU nursing fashion, and reassured the OR team that we would replace the arterial line and be able to get the urinary catheter in place, as the OR staff skulked out of the room. With a half joking wink and their good-natured, ever competitive laughter, my team reiterated to me that we would get the job done because we were the best in the hospital. “We are,” I said joking back, “but that’s not why we get the job done. We just try a little harder, work a little harder and are willing to do what other people won’t.”

These were concepts instilled in me at young age through watching the life of my mother - how she mothered and how she managed her patients and staff at her small animal veterinary medicine clinic. Concepts of excellence were impressed upon me by my coaches throughout high school and college, and by my physician mentors throughout medical training.

Excellence is figuring out how to prioritize the sleep I need to function safely and at a high level. It is wiping yogurt off of hands, mouths and walls twenty-five times a day. Excellence is the extra person to hold the pannus to get the urinary catheter in place. It is 100 penalty kicks on an empty soccer field late at night, with your music blaring, worried they will turn the lights off on you. In different walks of life, in different stages of life, excellence looks a little different, but her most arresting features remain the same.

A lot of excellence involves slowing down to do the little things - the mundane, the often overlooked. These are the things no one notices when you do them, but are suddenly glaringly obvious if you don’t. So, save yourself the time and stress and order the CT head on admission, enforce the boundary even when you know the toddler tantrum will ensue, and laugh along the way, giving grace abundantly, since excellence within these human shells is impossible one hundred percent of the time.