Monday, July 30, 2018

Fainting, Heavy Lifting & Injury

Major Fall-out

Lets consider little Betty. Her silly antics, led to my last work related injury (I hope). She was old (older than 75), sedentary, obese, short and compact, playing at helpless, got an angio-procedure with dubious results, meaning she probably didn't really need it, had the usual bleeding that won't stop and needed the chastity belt (Femostop) on for a few hours, and a blood sugar of >450......and finally she did swoon/faint.
If that wasn't bad enough; we had to deal with Dr. I-don't-call-back, who ultimately told us to send her home. He finally gave in and told us to call Dr. Who-does-care, and the dude admitted Betty.

Spittle and Cuss

Little Betty fainted
With nary a squeak,
As her family stood by
In shock, cheek to cheek,
Till I did command
Young Junior, do help,
He had a good bark
For such a young whelp.

I call her little Betty
You might say, Betty Little,
She had spunk and complaints
And each utterance launched spittle,
So I stood to the side
When she shuddered and gasped,
And with my 3 buddies
We flung her, hands grasped.

Back onto the bed
With a lurching big launch,
Her biggest issue?
Was that massive paunch,
Describing a measurement
The same as her height,
Five by five, we do say
God speed and goodnight.

Twang, went a ligament
Or a muscle, who knows?
An electrical shock
Blasted down to my toes,
And the hamstrings did spasm
As I shuffled away,
While little Betty woke up
With a farting bouquet.

Now, little Miss Sunshine
Said, Thanks folks for coming,
I could have handled it myself
One hand tied, plus some humming,
But I wanted some pals
To come on the run,
Should little Betty faint
And torpedo my fun.

The mirth and the joy
Departed, each one of us,
Battered and broken
Full of mustard and cuss,
Behind on notations
That will never be read,
But some of us will document
Even when we're dead.
_ _ _ _ _ _ _ _ _

Addendum: How I was blamed (the usual Boss response) for my injury.
Let's just call it: Catch-22, hospital style.


Last week, I managed to get another work-related lower back strain, during another gotta save the patient incident. Bosses always try to blame us for getting injured when we put the patient first, and we get injured, because the hospital provided Lift-equipment, is 5-10 minutes away, because the tools are not on hand. Yes, the sentence did run on. This was not a solo act on my part, I had 3 other pals and a family member, helping Betty Lou (musta weighed 222), into a position where she could breathe, after passing out.

Bosses keep trying to say, we shoulda left her on the floor; but, the fact is, the patient wasn't on the floor. I told my story to Nursing Supervisor, Employee Health Nurse, Doctor at Occupational Med, my two bosses. Each of them started off with; Why didn't you use the patient-safety-Lift equipment that all Nursing Units have. See, blame first, concern for employee, somewhere down about 5 steps on the list.

Answer: We don't have that lift equipment in our Unit, and remember? Half of the hospital, doesn't even know where our Unit is. And frankly, our Recovery rooms are minuscule in size, the woman was not on the floor, really half on the bed, had fainted, could barely breath laying supine, and there were four nurses using the skillsday-instructed-patient lift technique with a pull sheet beneath the victim, where we all lifted and pulled in the time-tested method of 1-2-3.......SCOOT. Imagine a 240 pound bag of loose potatoes, with not an ounce of help from the patient, who was only partially conscious.

I guess we ought to have let her slide to the floor, pulled the bed/gurney out of the room, so there would have been ease of movement around her, while Joe Bob went running to the Emergency Department 5 minutes away (with a 5 minute return), essentially too late, as we probably would have already called Code Blue . Those responders would have run into the room, declare WTF, why is she on the floor, instead of on that gurney over there? I would announce, because the Boss says, don't ever try to move a fainted sick person, without getting the Lift equipment. Naturally, I would probably be excommunicated for that colossal FUBAR, but maybe I wouldn't have strained my back.



Thursday, June 28, 2018

Epic Details


Folks get impatient when the procedure starts late, and also, when we delay their departure to home. The latter, is usually, because recovery did not go smoothly; in fact, we care about outcomes and safety.

Epic refusal
To grasp crucial details,
Your wailing in pain
Totally off the rails,
Flinging about
A threat of bleeding, for sure,
With 4 milligrams of morphine
We found us a cure.

But still, we asked why
What's the cause of all that pain,
Questions were posed
To the man with a brain,
So he ordered a STAT scan
Meaning, a bothersome trip,
Off to Radiology
That's a STAT reading, Skip!

Almost 4 hours later
No reading, on the scan,
Hell? What does STAT mean
Is your head in a can,
Then with three more calls
What say the diagnostic reading?
The guy had a small
Retroperitoneal bleeding!

How do you like them apples
Do they stick in your craw?
Doctor says, no go home
With a hem and a haw,
And the family says, Why
What's all of the fuss?
Well, you're bleeding inside
It's about you, not us.

Luckily, it stabilized
'Twas the thought at the end,
Joe Bob went home
Time to rest and mend,
But call 911
If your pain gets so bad,
If you pass out stone cold
You'll be a deadbeat Dad.

We haven't heard nuthin
Since Tuesday this week,
No shrieking sirens
About an aortic leak,
So we guess he's Ok
Ya, what was all that fuss?
Hope you had a good time
Thanks for riding our bus.








Betty and Sue


My writings are like little birdy flight of ideas, as I'm sure you know, if you follow this blog. Sure, there's some good, state of the art, evidence based facts peppered here and there, so don't be disappointed. It's the nonsense, that I love!

The Betty here, is the same Betty, two poems down.

Strained some ligaments
Over-stretched some muscle,
It was a pull-up in bed
Not a crazy man tustle,
But it's easier to do
In decade six plus,
I feel like I need
A total body-truss.

Day one, a little ache
Day two, I can barely bend,
Hard to ride the bike home
When the shift did end,
Just past the 12th hour
After Betty Lou bled,
I asked her to scoot over
Just let me lay on your bed.

Well, that didn't happen
She was already upset,
When her artery gushed
And got her all wet,
Even then, she was bothered
That she couldn't take her pee,
She asked to stay on the wheelchair
Rather than lay down with me.

But forget about Betty
Let me tell you about Sue,
She had a peripheral runoff
Leg arteries plugged with glue,
No, the doctor couldn't fix it
Despite, balloon, stents and TPA,
Next, a 3 hour recovery
At the end of our day.

She woke up hungry
I gave her what she asked for,
Shredded chicken taco
A soda, and more,
Intravenous meds
Better than on the street,
I fluffed her and buffed her
And gave her more to eat.

Near the end of her sentence
Three hours in our unit,
I got a guitar
And she asked me to tune it,
She sang Down By The River
By Neil and Crazy Horse,
Is that HumanKindness, folks?
By golly, of course!

Obesogenic


From the not-so-new word Department:

A new word today
That I never heard,
Obesogenic
And all that's conferred.

The environment
Which promotes that thing?
Obesity happens there
With a song and a fling.

Many different factors
Food choices and more,
Hand to mouth disease
And exercise? What a chore,
Alteration in composition
Of that which is called food,
Just musing on the weight I'm gaining
Puts me in a mood......
To eat larger portions
And walk a lot less,
Consume how many calories?
I can't bother to guess,
Because I'm too darn hungry
It's quite obvious, I need to eat,
In this obesogenic environment
That's what they call it on the street.

Now I'm 48 years late
Learning that new word,
Coined in 1970
Until today I never heard,
Despite the fact, I deal with
Obesity every day,
No one told me, that environment
Was obesogenic, as they say.


Listening Lost


This is the story:

Three heart-caths recovered
All those arteries OK,
Well, not exactly normal
But they'll fight another day,
And I like to know their story
Because report is often slim,
Is Billy Jean a woman
Or is Lindsay a him?

Was the puncture site at the Left groin
Or was it the Right wrist?
When I'm peeking under the covers
Was there something I missed?
And was the Nurse who gave report
Actually present during the test?
How much Heparin did they get
Catheter sizes, and the rest.

Now, when it's time for teaching
I need background information,
Without it, I look stupid
Maybe provoke a confrontation,
Because knowing that they underwent
Heart surgery, just last year,
Will help me tune my message
In respect to Momma dear.

When I am giving report
To the nurse on yonder floor,
I will have mined the chart for details
To overwhelm them with my score,
Though, I'm a little lackadaisical
Giving dubious medications,
Not needed in the immediate
Throes of recovery, my explanation.

Last evening, for example
Betty Lou, was supposed to go home,
After her Radial artery sealed
With pressure and crazy foam,
But no, that didn't happen
She started bleeding at the 4th hour,
With her daughter at her side
Good lord, a bloody shower.

Dr. Terban, first suggested
Just keep her till eleven,
I told him he was crazy
(He sometimes acts, like he is seven)
No, Betty Lou should spend the night
Upstairs, with experts plenty,
You can see her in the morning
(And please pretend you're twenty).

A new nurse named Ginny
Took report from me,
I told her the bloody story
With extra points for free,
Telling her I'd fix the orders
So Betty's medications,
Would be available tonight
It's called reconciliation.

Just 5 minutes later
Ginny calls, excited!
Did I give the evening meds?
Why weren't they expedited?
Well no I didn't, Ginny
Betty Lou, was dressed for home,
I did not give those medications
(Is your brain, just crazy foam?)
Were you listening when I gave report
Just precious minutes past?,
The woman was gushing blood
And now I feel harassed,
By your idiotic questions
Regarding the N-Acetylcysteine,
Dr. Terban loves that stuff
A dubious medicine, is what I mean.

Then Ginny, quizzed my partner
Upon delivery of Betty Lou,
Did Bonzo, give the medications?
Probably not, but who knows who,
Because Bettty was destined for home
Till she changed her mind and bled,
So, why don't you mind your business
Attend to your patient in that bed!

Well, this is the greatest
Reality show!
We're recruiting all the time
Folks are retiring, don't you know?
Like me for example
Time to hit the road soon,
I can't take much more of this
It's time to shoot the moon.

Sunday, June 24, 2018

Hair Appointment


I haven't worked in a same-day surgery center, but I would imagine that those places probably stay relatively on-time; they don't have to deal with emergency things much. In contrast, where I work, almost every day there is some kind of major delay for one or more of several services. For those folks who get antsy, fussy, keep asking why is it taking so long, cuz the doctor said the procedure would only take 90 minutes (and as usual he forgot to tell them about the pre-op 2 hours and the post-op 4 hours, oops).............I will tell them; Ya know, this isn't like having your hair done. No actually, you might recall that it involves putting 6 wires up inside of your heart, freezing and burning tissue, and then we carefully watch over you for a few hours to make sure it's safe for you to go home. I mean, does your Hair dresser do that for you?

Waiting for a hair appointment
Fifteen minutes over,
You might feel like jumping
Off the Cliffs of Dover,
Or waiting for your Latte'
To get its signature foam,
As your stomach starts to rumble
Inside the silver dome.

Now compare that to waiting
For the procedure on your heart,
We all want the best for you
We're all a team, please play your part,
As a gracious consumer
With good fortune, to have this day,
Imagine just fifty years ago
We couldn't fix you, no way.

Truly, this is science
To repair major heart issues,
Heck, even in this moment
Researchers are growing heart tissues,
So please take a moment
Or maybe two hours more,
To get a grip, Joe Bob
Your complaining is a chore.

I told you that Mary
Had an acute M.I.
She had to go to the Cath Lab
Or she was going to die,
And that's why you're waiting
Longer than expected,
But if you keep yelling
We'll have you ejected.

Go ahead and write that letter
To the head honcho that you know,
Send a letter to your Congressman
And the Jerry Springer show,
Frankly, we don't really care
Because we do what is best,
Serve each client fairly
Like a member of our nest.

We do the kinds of things
Never done before,
To help you have more of life
How do you rate that, what's the score?
Even if we're delayed
Why not show us your best side,
But if you can't do that
I'll call Uber for your ride.


About the Underside


I was a shy kid, read a lot of books, loved the writings of Dr. Seuss, Ogden Nash, and Edgar Allen Poe. Those guys knew how to put together interesting rhymes that expressed ideas very clearly. To express my views of the world, I began rhyming in the 6th grade. At the time, I didn't really write for anyone other than myself. I did know, that it was good practice, and I tried to be very selective with the words that I used. I wrote the usual idiotic teenage stuff, love and loss, all about that uncomfortable experience. The years went by, as I made an attempt to write every day, but the time for sharing finally started with Nursing. I guess that's when I realized I had joined a select tribe, and I had a duty to share my experience with others.

My blog, "The Underside of Nursing" actually began in 1992 (before the internet) as a "Zine", and I sent it through the mail, to a handful of readers, mostly in this country. I enjoyed making fun out of the usual stuff that goes on in hospitals, and also wrote a lot about the uncomfortable things too; death, disparity, questionable ethical issues, mistakes and all kinds of gross stuff, which has always been my favorite. 99% of persons who bothered to read what I write, have responded favorably, so that beats all, in my book. If I ever get around to publishing any anthologies, I'll let you know.

Shout It, Speak It

If it was funny
I wrote about it,
If it was unethical
I attempted to shout it,
To announce to the world
This must be spoken,
Not to be hidden
As a meaningless token.

Hundreds of stories
Repeated over and over,
Destined to repeat
Like a new batch of clover,
For the students and practitioners
Who are fresh to the fold,
Do take the time to listen
To the voices of the old.


Tuesday, June 05, 2018

Inspired


Well, what nurse has never gotten tangled up in wires, tubes, drains, etc? That would be the nurse that never worked at bedside. One time I tripped on a long IV tubing that had draped to the floor. Next moment, I was on the floor, and the IV was still intact. That wasn't even my patient. Another time, working over at the University, Dr. X, had just placed a temporary, transvenous pacemaker, via subclavian. As he turned away from the table, somehow his gown snagged that same wire, and whoopsy, the pacemaker wire went in reverse. It was an epic fail, that's for sure. At that time, Joe-Bob the patient was somewhat unstable, with a severe bradycardia, and the Doc's had to hustle placing pacemaker wire #2.

Yesterday, after being the most awesome recovery nurse, for our third TAVR of the day, Betty Lou, with me and the Transporter, were beginning to launch out of our Recovery bay. I was 100% certain, I had successfully cleared all the monitor wires, cables, no-longer-running IV bag and tubing, ditched the IV pump, secured the Foley, and eye-balled the pacer wire coming out of the Right IJ introducer sheath.
Ready, set, go........then Betty Lou shreiked. I hit the brakes, yelled for transport to STOP!
Oops, somehow the TV controller, which I had parked below the heart monitor, had the neck IV tubing tangled in it. Yikes.........epic fail on my part. Still, aside from a serious tug on her neck, no harm was done; no bleeding, pacer wire secure. Of course, Betty Lou gave me some serious evil eye and her daughter fussed a bunch too.

Pulled on her neck
Oh man, something got tangled,
After a great afternoon
Things took a different angle,
Where she got to thinking
Maybe I am a fraud,
And this sweet old lady
Is now, one angry broad.


No harm done
Other than that serious yank,
On the pacemaker sheath
Let’s be perfectly frank,
It shouldn’t have happened
But sometimes it do,
Regardless of preparation
Even you could do it too.


Luckily my rep
From the previous four hours,
Laid a balanced foundation
Despite bitters and sours,
And I’ll be more careful
To  clear the tubes and wires,
Nothing like a total screw up
Oh, how that inspires!


Friday, June 01, 2018

The End is Nigh


I have made the decision..........12/31/18........I step into Pension #2. Now that does not mean that I will completely stop working, but it will mean, I don't have to continue, buckled on a daily basis, with the current job. But you don't care, do you? Didn't expect you to.

The real problem is that I haven't written much lately.

An anti-glut with writing
Idea fish aren't biting,
The bait I use
It has no taste,
The pond I visit
Is in a state of waste.

Still, the fisherman
Is lazy,
Talks only to himself
That's crazy,
So this might be
The perfect time,
To pull the plug
On hospital slime.

If I'm not slimed
Can I write about it?
If I'm not employed
It might be safer to shout it,
Less chance of lawsuit
And public blushing,
Let go of my nightmares
With literary flushing.

Like all the Code Blues
That didn't end well,
Depends on opinion
Regarding heaven and hell,
Because many of us
Have seen the face of evil,
Some folks are lower
Than a New York weevil.

How about
All those EKG's,
Counted in thousands
And no one said "Cheese",
Just taking a picture
Of your rhythm, babe,
In the old days we did it
With an astrolabe.

All the bottoms wiped
And the dangles adjusted,
Reliable coworkers
And others not trusted,
Trying to figure it out
In a cluster disaster,
The only solution?
Just do it damn faster.

Ya, I think I'll keep writing
To cleanse my mind
So to speak,
Don't expect me to quit
I won't go out with a squeak,
Because others will follow
Down these same old trails,
Through the bloodiest splatters
And interrupted fails.

Tuesday, May 15, 2018

Squirrel


This is not remotely related to anything medical, or nursing, or what? However, as I was at work last evening with my pals, I received a text/photo from my daughter. The photo appeared to show a squirrel in a toilet, and quite frankly I was aghast, while assuming it a prank. Well, it turned out to be true, and I wish I had been there, or not.

Squirrel in the toilet
How did that happen?
Thank the Lord I wasn't sitting
And having a crappen,
That would have scared my pants off
But they already were,
A squirrel in the toilet
Crap! How did that occur?

Squirrel in the toilet
Doing the backstroke?
Diving for dollars?
Man, this is no joke,
Must have fallen from the ceiling
The H-VAC vent beckoned,
Took a swan dive in the toilet
That's what I reckoned.

Squirrel in the toilet
Is a crazy event,
A picture, not precious
Luckily, no scent,
Looked like a monster
Glaring up from the bottom,
Had he been sitting on the bed
I probly woulda shot him.


Saturday, April 28, 2018

Employee Survey: Anonymous?


I'm pretty sure that everyone working at a hospital in the USA, is presented on a yearly basis, the Employee Survey. At our system, we are told, that our responses are completely anonymous. Well, I don't believe that for a minute, nor do I care. Heck, I'm probably going to retire in a year, so what does it matter? Still, I thought I might share with you the final Q&A, 3 top questions (and my responses), at the end of the survey.

Please provide one suggestion on how to improve the Employee Experience here at XYZ Health.

Management in some Nursing areas, talk DAILY about budget, HPPD hours, and so on, to the staff nurses, as if those nurses have some influence over the patient census and procedural scheduling. We don't have any influence, on how many patients come on any single day, and thus, all of this kind of talk is petty and short-sighted. The nurse at the bedside, is working as hard and fast as possible, so, instead of being reprimanded by managers, those bedside nurses should be praised and thanked every single day for their diligence and hard work.


What do you like best about your Employee Experience at XYZ Health?

The opportunity to work with other highly competent and trusted work companions.


What is one thing XYZ Health could do to create a more inclusive culture?

Sure, it's great that our color and branding slogan, tells the world that we care about a Load of Kindness; heck, it's brilliant. After all, that's what healthcare workers the world over, have always been doing; putting others needs ahead of their own. So face it, this is not a new idea. Let's have XYZ cut the branding budget in half, and spend that other half exclusively and inclusively, inside of these hospitals in a direct way, that impacts employees. This will make workers happy; they will tell their friends to come work at XYZ and truly encourage people in the community, to seek medical care at our hospitals.......much more effectively than tv commercials about whales, lame deer, drowning dogs, and elderly women crossing the road.