Menial tasks that are oddly satisfying

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norski

norski

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Yesterday, I came in to help out my colleague with an extubation after a four hour surgery. All is well, tube's out, patient is exclaiming she has to pee. Less than a litre of ringer infused, so guess she just hadn't had a wee before surgery. Bladder decompression by way of foley is decided.

Round one: sterile OR nurse goes in, fails after two attempts.
Round two: coordinating nurse gloves up, tries and fails. This urethra's becoming interesting.
Round three: surgeon gathers their balls, goes in, fails.
Round four: I say "glove me up, OR nurse", spread labia, find all the regular holes, insert catheter, urin spraying like a fire hose, which I expertly stop before it hits my nikes.

Walked out of the room with a full 1500cc bottle of urine, head held high, air fist bumping my colleague. Sad to say that was the single most fulfilling moment professionally from the last six months.

Any of you do any oddly satisfying stuff on the regular?
 
Had a similar thing happen a few months ago. In the dreaded cath lab doing a general anesthetic. Case requires a central line For some temporary pacing. Cardiologist typically puts it in.

cardiologist (do you even call these guys surgeons?) doing a blind RIJ stick. It is taking forever. After about 20 mins I am getting curious what is going on. I look over the drapes and he is now trying fluoro. At least 100 passes of the needle in the neck, not a single one successful. No joke. I’m surprised there isn’t a massive neck hematoma by this point.

He calls for an ultrasound. He prays to god. Still can’t get it. The nurses are getting antsy in the room and he is uttering some words under his breath. Maybe he is now trying to make a deal with the devil to get this RIJ. I don’t know.

After legit 1 hour and still unsuccessful, he announces that he is giving up and going to try for a subclavian. He looks completely defeated. Literally no ounce of joy or smugness that these cardiologists typically swell with. I have been a fly on the wall up to this point, but I ask if I can give it a shot before he undrapes and starts over.

“Size 8 orange and a large gown” I announce to the room. I leave my lead Shield stronghold and position next to the patients head. Ultrasound onto neck, needle immediately into jug vein. Thread wire, sheath. Rip gown off in the most flamboyant and dramatic fashion possible. Whole thing in approximately 15 seconds.

As I walk back to my fort, queen’s “we are the champions” softly plays overhead. The circulator has tears streaming from her eyes as she me a standing ovation. The device rep grabs the closest marker and asks me for an autograph. Fairly sure the patient is mouthing “thank you” over the endotracheal tube.

The cardiologist has been giving me a blank stare this whole time. He starts to go about the procedure but doesn’t say a word. After a few minutes, he looks over in my direction and says “how did you do that?” No thanks, no accolades, no “gee thanks for bailing me out of that one”. I literally winked at him without saying a word.

I placed one central line. That’s it. I normally place 2-3 central lines a week. But damn that one felt good.

He still hasn’t spoken to me since that day.
 
Some of my favorite mundane (but immensely satisfying and “ASMR”-ish) moments in anesthesia that have little to do with actual clinical expertise:

When, after you spike a unit of blood, the first dark maroon drops start to swirl around in your hot line tubing drip reservoir. Mesmerizing.

Same with the frothy bubbles that are left behind in an empty glass albumin bottle.

When your OG tube goes in like butter on the first pass without coiling up anywhere.

When drawing up propofol I like to have the syringe half-full of air that I inject into the vial so the back pressure then effortlessly and rapidly fills the syringe.

When doing ultrasound-guided blocks and the LA completely dissects around and envelopes the nerve bundle perfectly… orgasmic!

Similarly, sometimes if I have an PIV I’m not so sure about (especially in little babies) I’ll put the US probe on the heart (sub-xiphoid 4 chamber) and inject agitated saline… watching the RA light is super satisfying.

A nice “boring” case with train track vitals.

When I blindly get the PIV on a chubby toddler (blind saphenous or between 3rd/4th knuckles are the go-to spots).

When I can get the anesthesia machine’s gas blender to display flow rates in exact multiple of 0.5, like “Air 0.5, O2 0.5” instead of “Air 0.53, O2 0.48”

When doing an epidural and the mom-to-be anxiously says “Did you start yet?” as I'm taping up the catheter.
 
Last edited:
Morzh said:
When I can get the anesthesia machine’s gas blender to display flow rates in exact multiple of 0.5, like “Air 0.5, O2 0.5” instead of “Air 0.53, O2 0.48”
Click to expand...

That’s just the ocd part of your brain speaking....
 
Morzh said:
Some of my favorite mundane (but immensely satisfying and “ASMR”-ish) moments in anesthesia that have little to do with actual clinical expertise:

When, after you spike a unit of blood, the first dark maroon drops start to swirl around in your hot line tubing drip reservoir. Mesmerizing.

Same with the frothy bubbles that are left behind in an empty glass albumin bottle.

When your OG tube goes in like butter on the first pass without coiling up anywhere.

When drawing up propofol I like to have the syringe half-full of air that I inject into the vial so the back pressure then effortlessly and rapidly fills the syringe.

When doing ultrasound-guided blocks and the LA completely dissects around and envelopes the nerve bundle perfectly… orgasmic!

Similarly, sometimes if I have an PIV I’m not so sure about (especially in little babies) I’ll put the US probe on the heart (sub-xiphoid 4 chamber) and inject agitated saline… watching the RA light is super satisfying.

A nice “boring” case with train track vitals.

When I blindly get the PIV on a chubby toddler (blind saphenous or between 3rd/4th knuckles are the go-to spots).

When I can get the anesthesia machine’s gas blender to display flow rates in exact multiple of 0.5, like “Air 0.5, O2 0.5” instead of “Air 0.53, O2 0.48”

When doing an epidural and the mom-to-be anxiously says “Did you start yet?” as I'm taping up the catheter.
Click to expand...

IMGASMD said:
That’s just the ocd part of your brain speaking....
Click to expand...

I like when all 4 tires match on TPMS.
 
Also, doing mid lines in cubital veins, getting needle thread catheter in less than 2 minutes, I'm happy. I do hate picc lines, though. Really love mini mid lines (8-12cm).for some reason, they just want to be threaded.
 
I like it when I get the spinal without a single redirection of the needle.

Get warm and fuzzy when I get the chubby kid PIV in one stick.

Also nice to pop the art line in and have it hooked up and taped in place after induction but before the tube goes in while the anesthetist is waiting for the muscle relaxant to kick in.
 
During lap hernias, getting the art line in blind with my left hand. We have slow surgeons who really like to block my nibp tubing with their hips.

Agree with whoever posted placing blind OG tubes without curling.

Managing a _no_ deflection-of-vitals ett induction in vasculopaths with only propofol and fent plus roc, no pressors.

I'll add a guilty pleasure or two; adding ketamine near the end of surgery, watching the entropy/bis rise. Pulling out the miller blade in a country where these are unheard of, hear reactions from whoever's with me (yes, still just a mil3, not getting any others,despite the other thread from some time back).
 
I like bridling NG tubes. The magnet system is genius.

E8ED97B2-2EEE-4B42-A598-FAEB33B3B245.jpeg
 
Last edited:
If you’re using a micro dropper, seeing the small spheres of saline float on the surface of the saline liquid in the Drip chamber...always looks cool.

perfect set of vitals...hr100, sat100, bp 120/80 temp 37.0. Pretty rare one though.

Aline before ett is secure is good I like that one.

bridling is also satisfying when you get that nice magnet “click” in the back of the nose as already stated.

Getting called to place an IV in the nicu that nobody can get after 30tries, and getting it first stick. Tell them your colleagues name when they ask for your info on the way off the unit.

a flawless FOI with no coughing or reaction from the patient
 
Letting the A-line spray all over the floor for a few seconds while I hunt for the tubing.

Exclaiming "Well I hope that tube went in the right place!" As I pull the laryngoscope out of the mouth.

Dropping my fentanyl vial and watching it shatter all over the floor.

Knocking a whole epidural tray over and having to open another one while laboring mom can barely breathe during her contractions.

And my personal favorite:

In the middle of telling an awesome joke, instead of pushing a blunt needle through the vial stopper I miss and impale the needle into my finger.
 
Doing a machine check and getting a 350+ ml leak 3 minutes before your case start

Logging onto the computer and seeing "change password now", knowing you'll forget it for the next two weeks

Running a propofol infusion when your center is out of 50 and 100ml vials

Controlled drug count is incorrect at 1600 on a Friday afternoon

Patient hasn't brushed their teeth or bathed this century, and during laryngoscopy is a grade 3 view

Pre-op sends you a patient with an empty LR bag

The hospital comes up with a new policy banning surgeon caps because of new cutting edge AORN "research"

The patient says they have a "high pain tolerance" and takes 500mcg fent for their lap chole
 
Stealthy silent deep(ish) extubation under the drapes, so that when the drapes come down and the patient is breathing spontaneously with a face mask and opens their eyes to voice- telling the surgeons “we're ready for the stretcher” and watching their eyes bug out (I currently work at an academic institution where residents and CRNAs typically have long and ugly wake ups)
 
The continuous stream of fluid in the drip chamber when a 14g IV is absolutely rolling.

DLTs placed anatomically and when you go down the tracheal to look the bronchial lumen is perfectly in position.

Pts with more than one IV having their respective tubing de-spaghettified and push ports/roller clamps for each line color-coded with different stickers.

A 180 turn or prone flip going absolutely perfectly with no tangling of anything.

A 400lb pt who still has enough force of will and residual muscle mass to position themselves on the bed instead of making us do it

A crani or carotid deep extubation and emergence with absolutely no coughing or bucking where they report no pain and then move all 4 extremities

The moment when you finally slip under the clavicle after walking down it for a subclavian CVC and you immediately hit venous blood
 
Last edited:
Hork Bajir said:
Stealthy silent deep(ish) extubation under the drapes, so that when the drapes come down and the patient is breathing spontaneously with a face mask and opens their eyes to voice- telling the surgeons “we're ready for the stretcher” and watching their eyes bug out (I currently work at an academic institution where residents and CRNAs typically have long and ugly wake ups)
Click to expand...

This is it for me. I mentally high five myself every time the drapes can come down and the patient is looking back at them. "Did you guys do a spinal?" "No, general..."
 
secretasianman said:
Uncapping the 14g iv and seeing people’s eyes bug out. Watching the swirly laminar flow of propofol by the iv port.
Click to expand...

When you have a great IV that passively bleeds back a little into the tubing, and mixes with a few leftover CC's of propofol... mmm strawberry milkshake
 
The progression of the 5 stages of grief visible in the CT surgeon's eyes when I turn the TEE monitor toward him after a repair that made the mitral valve worse. Some need to talk it out ...

Denial - no way, are you using that thing right?
Anger - $&*@#!
Bargaining - show me the 3D, maybe it's not that bad
Depression - why did I do this case?
Acceptance - OK let's go back on
 
norski said:
Yesterday, I came in to help out my colleague with an extubation after a four hour surgery. All is well, tube's out, patient is exclaiming she has to pee. Less than a litre of ringer infused, so guess she just hadn't had a wee before surgery. Bladder decompression by way of foley is decided.

Round one: sterile OR nurse goes in, fails after two attempts.
Round two: coordinating nurse gloves up, tries and fails. This urethra's becoming interesting.
Round three: surgeon gathers their balls, goes in, fails.
Round four: I say "glove me up, OR nurse", spread labia, find all the regular holes, insert catheter, urin spraying like a fire hose, which I expertly stop before it hits my nikes.

Walked out of the room with a full 1500cc bottle of urine, head held high, air fist bumping my colleague. Sad to say that was the single most fulfilling moment professionally from the last six months.

Any of you do any oddly satisfying stuff on the regular?
Click to expand...
while holding the arm with the other hand, removing an armboard and placing it on the floor with one hand as the stretcher comes into the room at the end of the case
 
Mman said:
I like it when I get the spinal without a single redirection of the needle.

Get warm and fuzzy when I get the chubby kid PIV in one stick.

Also nice to pop the art line in and have it hooked up and taped in place after induction but before the tube goes in while the anesthetist is waiting for the muscle relaxant to kick in.
Click to expand...
Yes- I love the aline one!
 
(1) Placing an epidural on a hysterically screaming OB patient. Go back to check on her 10 minutes later and RN is gone, lights are off and patient is sleeping.

(2) Easy spinal/epidural/nerve block on morbidly obese patients is always satisfying.

(3) Getting an IV after others have failed

(4) 100% agree with propofol and blood “strawberry milkshake” mixing is oddly beautiful. Same with first drops of pRBCs.

(5) Redoing a failed block in PACU and having patient go from severe pain to no pain.

(6) halothane showing up on monitor after Albuterol. Call me crazy, but I like it.
 
Especially with two OR nurses at our hospital; hearing them make gagging noises on extubation.

Also a big fan of the stealthy extubation,but the or nurse gagging is worth it.
 
pgg said:
The progression of the 5 stages of grief visible in the CT surgeon's eyes when I turn the TEE monitor toward him after a repair that made the mitral valve worse. Some need to talk it out ...

Denial - no way, are you using that thing right?
Anger - $&*@#!
Bargaining - show me the 3D, maybe it's not that bad
Depression - why did I do this case?
Acceptance - OK let's go back on
Click to expand...

I am so lucky i work with excellent CT surgeons. I went back on CPB exactly 1 time in the last year...

There are some good ones in this thread. One hasn't been mentioned yet:

- Deep extubating a pt after sternotomy and have them open their eyes like it's been a foot case.

I haven't done this one, but hopefully one day for me:
- Awake off pump CABG with thoracic epidural.
 
Getting clear CSF on a single pass with a spinal is probably the most satisfying.

I’ll add a good MAC case where the patient behaves, no moving, no airway manipulation needed after positioning, just a mild snore for the whole case.
 
Anybody else think that cell saver blood is the absolute perfect shade of crimson red?

Another one for me is that final release on ultrasound of fascial layer or arterial wall on nerve blocks and guided lines.
 
The Duck Knows said:
Anybody else think that cell saver blood is the absolute perfect shade of crimson red?

Another one for me is that final release on ultrasound of fascial layer or arterial wall on nerve blocks and guided lines.
Click to expand...
I think that "final release" is always super satisfying no matter what you're doing in life.

Amirite @SaltyDog ?
 
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