monday stress

i had a stressful day. it all started with toilet paper. apparently the city hospital does not have toilet paper. there is a doctor bathroom, locked with a key that hangs out in the call room. bathroom is nice and clean, has a shower. but i walked in and desperately looked for toilet paper, nothing, not even a toilet paper hanger...so i walked out, bladder full. and since i continued to forget to bring disposable pack of tissues, i suffered all of last week, full bladder despite large quantities of consumed coffee. finally, this morning, i remembered, so i walked into a store to buy some tissues. i found an entire row of shelves, with wet tissues. imagine, something like 7 shelves all filled with wet-ones, different brands, different flavors, smells, strengths...all wet. i literally stared at the shelf for like 20min. maybe i missed it, maybe i'm not reading it right, maybe i'm just totally crazy... nothing. some lady comes by and starts carefully staring at the shelves. we are now staring together, looking. i walk around the corner, maybe there is a whole shelf-full of dry tissues just around the corner..nothing. i come back: "ummm...there are no dry ones" "i know!!" finally, she breaks down and asks someone about the dry tissues: apparently, they are in an entirely different store section, at least they exist. at work, i am allowed to place leeches. this is additionally stressful. the little mo-fo's are squirmy and wet. they are different to grab with ring forceps, i'm afraid i am going to squish them, i'm afraid they're going to escape. the little 'resident' behind me is encouraging, but is always whispering something about the gauze being not entirely over the entire cervical surface, fearing the little criters with climb inside the uterus. mind you, i'm operating in one glove only, without a light. little buggers do not want to attach, i cant tell what's head and what's tail. in the end, it worked. but i was not a fan of this procedure. then, the head attending created a neo vagina. the scrubbing procedure is very interesting: you scrub your hands, then, you are given 2 4x4s which you use to dry your hands. then, you are handed another 2 4x4's soaked in ethanol...for disinfection. then you are dressed. the robe doesnt tie in the front, just the back. every time you touch something in the sterile field, which is maybe not exactly the sterile field (like the steril-y draped portion of the leg), you are handed a gauze soaked in ethanol, for disinfection. needles are not counted, in fact, there is such thing as disposable needles, and vicryl is threaded as if sewing thread. sponges and laps are not counted. i asked the scrub tech if they are counted, no bt she knows how many she has...so they are counted?? the anesthesia machine is old...there is no blood pressure cuff, the anesthesia intern (resident? nurse? i'm not actually sure who she is) takes blood persssure by hand, intermittently. they use monopolar--these prehistoric coag forceps. the attending who is assisting by holding the vagina, or what is going to be the vagina, at some point, removes her sandals, and stands there barefoot, on a step. the patient has no foley, she is intermittently straight cathed, despite the fact that we are operating by the bladder and the urethra, with a high risk of getting in to the bladder or accidentally injuring the urethra. . the foley is inserted after surgery, when patient goes back to teh room. returning to the call room, all the attendings are watching the elections. but more on that later.