Thursday, October 30, 2008

In Nursing, when you go to work somewhere new, sooner or later you will be expected to be "Relief Charge Nurse" for your particular day/night of work. It's a dirty job, but somebody has to do it. Usually the established format is that you will receive some sort of "orientation", most likely with one of the other "experienced" charge-nurse persons. Once in a while, an error occurs in the "usual plan" and you might be thrust into the "first night as Charge-Nurse" quite unexpectedly.

In my case, everyone I worked with that fateful night, just refused to believe that I was not supposed to be assigned to Charge, yet. So I figured, "what the hey", they might have a different opinion when the dust settles. Naturally, 3 quiet hours passed and then all hell broke loose. The survivors will talk of this night for years to come.............


That was interesting
To say the least,
I entered as a lamb
And departed as a beast.

Once again
I was saved by my peers,
With them by my side
I didn't age years,
And surely, any other nurse
Would have been reduced to shrieking,
Gone catatonic
Never again speaking,
But with the help of my comrades
I limped through a disaster,
With their mighty efforts
The night passed much faster.

It was a classic example
Of a courtesy appointment,
And the word on the street is.......
I've had my anointment.

Don't take offense when I humor religion, ok? Let me shoulder the entire karmic debt. If you get angry, that isn't my fault.

Now let's just consider for a moment: Doesn't Jehovah deserve to have a week off now and then, to recharge his batteries (or whatever it is that he runs on)? Well, I think so. The big boss in the sky, has a heck of a lot on his plate, and deserves every little bit of peace and quiet that he can sneak in. So, I authorize at least a week off. Just call it a "prior-auth".

Jehovah On Vacation

Jesus is so frickin ' busy
Doing good works, far away,
And of course, he has the power of creation
At his fingertips, they generally say,
But surely this man of the robe
Needs to rest, like that Saturday in the cave,
He may be the ultimate healer
But frankly, he isn't our slave.

And I know for a fact he was here just last week
Saving Popeye, after a bad fight with Bluto,
Olive-Oil was there at his bedside
With her seeing-eye dog, he's named Pluto,
Mr. Whimpy came around with his hamburgers
Flirting with the Nurses; (that Casanova),
And who should he bump into in the hallway
None other, than our good Lord, Jehovah!
He'd dropped in, to have a parlay with Popeye
Bringing a case of special spinach from his garden,
He'd responded to some prayers within our chapel
Figuring someone was in need of a pardon,
And the housekeeper overheard (as he dusted)
That Jehovah planned vacation next week,
So if you should die in the next 7 days
You'll take off from this planet in a streak.

No lingering around on a respirator
No response to a shock to your heart,
When Jesus is off on vacation
It's pretty damn easy to depart,
Slicker than a whistle, slippery as an eel
Faster than you say whoops-a-daisy,
And if you're thinking, that Jesus is watching
"Good Lord", he'd exclaim, "you are crazy"!

If you would look at previous posts around October 7, 8 & 9, I was writing about death and families, and Aunt Mary. There was some religion thrown in also, and this piece is just a little bit of unfinished business, inspired by that previous happening.

The Crux of Departure

CPR times 90 minutes
A heartbeat, but desperately slow,
In reality, it was the end of her life
And it was time for Aunt Mary to go,
And I'm telling you, Jesus was there that day
Hell, you could hear the dude coming,
He responded to a summons by his Angels
Off-key, with their death-march humming.

As she peered down that long empty tunnel
His light illuminating, all she could see,
She had long heard his voice in a whisper
"Aunt Mary, come along with me",
But the family at bedside thought otherwise
Claiming, "We have a contract, to grieve"
Halting the process of her departure
Like a magician with tricks up his sleeve.

Yes, the crux of departure, most often
Is prolonged by a family in distress,
The patient in question is dying
While the kin are an emotional mess,
Some want to revel in each torturous breath
As if bystander suffering should be scored,
While the long endured agony of the victim
Is conveniently denied and ignored.

"God will save her", they say, "It is written"
To have faith in the Lord, our belief,
They previously disallowed any medicines
And now they are reveling in grief,
Harboring the idea that Aunt Mary is alive
As proof of her stalwart independence,
Proclaiming each blink of an eyelid
Is proof that the Lord, is in attendance.

After 30 long years of experience
I have opinions derived from observations,
I've seen hundreds of people pass on
From so many different congregations,
And those people who experience the most difficulty
Accepting the end days of life,
Are the most basic of Fundamental Christians
Who take the bible as their mistress and wife.


Tuesday, October 21, 2008

It's happening to a lot of us Nurse baby-boomers; we're providing care to a lot of 50 year-olds with horrendous health problems (and counting our blessings). And then in one short week, I provide care for a couple of really-looking-healthy guys younger than me, and I realize once again, that life is just a crap-shoot. We don't have a clue what is lurking around the next curve in the road!


A glioblastoma and a dermoid cyst
I'm telling you, brother
I would rather have missed,
These cerebral events
Inside of my head,
It's anybody's guess
How soon I'll be dead.

He was fifty-one
And the other fifty-two,
No other health problems
And I'm telling you,
As an older senior nurse
I was measuring my well-being,
Against these two guys
I couldn't believe what I was seeing.

Twenty-five years ago
When I left nursing school,
I was just about thirty
And no longer a fool,
And I think that's about average
From later observations,
Rattlebrained for 3 decades
In many derivations.

The next twenty years
Are to establish your brand,
By fifty you'll be good
And carefully planned,
So that the next half of life
Will unfold, as you thought,
After all you invested
You can see what you bought.

While I'm looking at these guys
I'm thinking, "Holy crap!",
They look healthier than me
And I realize the trap,
That all of us fall into
Sooner or later,
If you haven't met Fate
Watch out; you might date her.


Friday, October 17, 2008

A life is saved, the victim "comes around" and..............voila', you discover they are a classic p.i.a.
Being in the hospital, is just Part "A" of their daily drama performance. One moment they're on the phone, bragging about how they almost died (with a dramatic sob thrown in), the next moment, they're complaining that a favorite TV show isn't on, "here in this place I got moved to, and can't ya page somebody to fixit". And then there is that central line the Surgeon placed an hour ago, when the systolic blood pressure was 47/22, and this Drama Maven, will probably dislodge it in the midst of some hissy-fit!

Sometimes a 12-hour shift can seem like 3 frickin' days.

Harp and Moan

I've talked about this type before
How caring for them, is such a chore,
Drama mavens, in their own right
Their passion play is out of sight.

How they harp and moan
With a waxing whimper,
Bring attention to their cause
With a preen and simper,
Boast or cry
Whatever suits them best,
It's your compassionate attention
They like to test.

At the limit of your tolerance
They will claim offense,
Accusing you of insult
With a phony pretense,
They might demand to see your boss
Or spit at you and curse,
And like a self-fulfilling prophecy
You hate to be their nurse.

Big Problems

The bigger they are
The wimpier they seem,
When they’re 5’2’’
And wide of beam,
Wailing and fussing
Way out of proportion,
Maximizing complaints
Beyond all distortion.

The tiniest problems
Will initiate a grumble,
Magnanimous moaners
They hardly are humble,
Boiling over with an outburst
Of evil dispensation,
Accusing their nurse
Of prejudicial intonation.

They want a Supervisor
To reprimand that horrid nurse,
Claiming insults were flung
And her caregiver cursed,
They’ll say, “My nurse had no compassion
And I’ll write it in a letter,
I know the CEO…………….
I guarantee, that he’ll get her”.

Oh, the biggest of problems
Have little to do with sickness,
With personality disorders
They manifest with a quickness,
Irritating as hell
Some people vex and annoy,
Virtual walking inflictions
Always ready to deploy.


Tuesday, October 14, 2008

Being sleepy has nothing to do with getting old. Just ask a veteran worker of the night-shift. This morning, after working a 12 hour easy shift, I could barely stay awake to drive my sort-of-short 15 mile trip home. OK, it is tough to deal with the customary morning freeway slowdown and the blazing sun at eye level, but come on, why can't I stay awake?

Let's do the instrument checklist:
Radio blasting, window rolled down, moon-roof open, slap my face briskly, scream, bite my, that's not working..............what I really need is a 100th second mind drift, didn't notice the abrupt slowdown, brake-slamming-almost-rear-ended the guy in front of me, holy-crap!!! moment, to blast 17 micrograms of adrenaline, mainlined into my sinus-node, precipitating a burst of atrial tachycardia and HOOYAH, I'm AWAKE!
A half a minute later, I'm drowsy again. Go figure!

Can't Stay Awake

It's amazing how sleepy I am
Like I've been snacking on drug-enhanced Spam,
At some point in its creation
There was chloral hydrate migration,
And voila', I'm the stuporous man.

I'm astounded that I can't stay awake
Even during a California earthquake,
Heck, I noticed when I'm driving
It seems that sleep is arriving,
Perhaps being on the road is a mistake.

Yet when I get home, I awaken
It might be the smell of the bacon,
And when I finally lie down
I'm an insomniac clown,
I need a potion for sleep, I'm not fakin'!

No one believes me, I'm sure,
Otherwise, I might find a cure,
There is a lot here, at stake
To prove my drowsy is no fake,
And my reputation is truthful and pure.

I called upon an expert of sleep
But then I fired him, that dude was a creep,
He charged by the hour
To some exponential power,
He dug a hole in my bank account, deep.

Now I'm panhandling, at the corner of Ambien and 3rd
Can you spare me a dollar, I wonder if you heard,
My old friends run the gap
Because I look like crap,
And I'm snoring before I chance to hear a word.


Thursday, October 09, 2008

I shudder to consider the ramifications of this; in fact, if I had not been there as a witness, thus being one of several witnesses, I would doubt the veracity of the story.

Picture this:

A busy hospital in a busy city. Beds are at a premium; patients are stacking up in the ED, like planes at O'Hare in Chicago, in the midst of a "Nor'wester" blizzard. The call from "Admitting" comes in at 0500, regarding patient in critical-care bed #A, that they may transfer to Floor bed #D. The patient in bed #A is a female, isolated for MRSA. The available bed #D, is in a room with a male patient and he is colonized / isolated for a strain of klebsiella.

Lordy be! What in the tarnation is goin' on?!? (This is where we collectively said, "Duh, why can't they see what is wrong with this picture?") The most shocking thing is this: This is Sister Euphemia's place!

Luckily, the nurse for Ms. MRSA, put her feet down, chomped the bit, blew a gasket, raised hell, and said, NO!
So the transfer fell out of favor........

Naturally to me, the whole thing had a humorous side to it:

Euphemia's Clinic

We're totally integrated
No longer segregated,
Men and women united
And finally cohabitated,
Where even infections
From different families,
Can bed to bed comingle
Like pear and apple trees.

Regarding the songs of death.

Singing Harmony

You were right
But I wasn't wrong,
We two, were humming harmony
In the death-prediction song.

The lyrics of this song
Are expressed in many ways,
Sometimes shreiked like a bloody banshee
Or whispered a fortnights day.

Hundreds of different cultures
With rituals and such,
Many convoluted expressions
I don't understand very much,
That's why I like to hide in the corner
Mumbling and humming a tune,
Praying the shreiking and wailing
From that family will end pretty soon.

Being present at the time of many deaths, one acquires a sense of the impending moment of departure..............

Death is Coming

The qualified, competent, experienced Nurse
Knows when death is approaching the bend,
We can feel the subtle vibrations
We sense where the cord will end.

It comes after thousands of hours
With practice, then mastery of skill,
Hanging around in the shadows
Close to the edge of Boot Hill.

Gleaned from years of observation
Clues of impending death,
Delicate variations
Of the heart beat and the breath;
Changes of demeanor
At times, a peaceful calm,
After weeks of fretful anxiety
Now a measurement of balm.

Rarely, are we caught off guard
It takes significant subterfuge and guile,
Though occasionally the suicide player
Goes out with a bang and a smile,
Otherwise we are the experts
Judgment Day deliverers of care,
Worry not, patrons of pathos
Upon departure, a Nurse will be there.


Monday, October 06, 2008

I was inspired to some degree by one of those end-of-life for "Aunt Mary" dilemma's, that cross our threshold frequently.

If only John Q. Public would get a clue: Look, when you're over 50, you have the "big-three" of CAD, Diabetes and HTN, and you're in piss-poor every-day health, and then you drop over dead, CPR x 1 hour, portends no more than a 1% likely-hood of survival. And even then, that's probably a very generous outlook. But, during that aggressive hour of resuscitation (and just why?!? did it last that long?) you do receive a boatload of powerful chemicals that just might.........initiate some last-ditch electrical activity in your heart. Well, it's tough for a physician to stand around and wait for the heart to stop (again). So, put Aunt Mary on a respirator and treat her as though she has more than a snowballs chance in Hell to survive. Believe me, even the all-powerful Sister Euphemia can't intercede at this point.

The only hope is that JESUS, will intercede, and raise the dead.

Frankly, I feel kind of sorry for that dude. There he was, hanging around in the ER, with his arms outspread to hug and welcome Aunt Mary, into his heavenly fold. And then, damn, there is that freakin' strong epinephrine stuff coursing in her nearly dead veins, and there is nothin' he can do about it! This is a moral dilemma for Jesus. He and Aunt Mary had this pact, that if she were to ever have a cardiac arrest, he would be there at a moments notice, to usher her to the other side. Now, it's as though she is being held back by some puny little humans, and it is outside of his job description to kill her, to be able to keep her, so to speak!?!

Now he is definitely between a pillar of salt and the dead sea. We caregivers are just following directions. We and the doctors have that Hippocratic Oath to "do no harm". So, we forge ahead and follow the family wishes (no matter how bizarre), because Aunt Mary, no longer can speak for herself. By this time, Jesus has split, and just maybe, he has told one of his groupies to hang around the hospital room, and keep him posted with daily updates. However, once Jesus takes off for other more pressing demands, that is when the Grim Reaper starts hanging around. Who knows what his intentions are?

And that's how I got here:

The Work of Jesus

I'm ever more astonished
At the work, Jesus is expected to do,
Forecasting that he will heal
When really, death is due.

Take this patient in the corner
As example number one,
Her heart, her lungs and kidneys
Were very nearly done,
When a cardiac arrest
Knocked her to the floor,
Giving her tired soul a chance
To slip right out the door.

She had CPR
For well beyond an hour,
Where the medical team performed
Everything within their power,
But they finally reached consensus
That there was nothing more to do,
When lo and behold, her heartbeat
Went from straight-line to forty-two.

Now she’s grazing in our unit
Life-supported to the nines,
Seven vasopressors
And thirteen central lines,
An ET tube, an NG sump
And the Foley-Temp-Deluxe,
And while it seems we're doing everything
She's a DNR, oh shucks.

We finally get to Jesus
His role in this whole caper,
The family expects a miracle
According to the paper,
Written by some disciple
Two centuries post-resurrection,
How Jesus will raise the dead again
Like some cosmic lottery selection.

There are just too many people
Who need that Lazarus link,
Jesus can't heal every one
So do not even think,
That your sweet old Aunt Jemima
Is on the Jesus list today,
She tried to depart a week ago
Till epinephrine, made her stay.

The truth regarding dear old auntie
Is that she'll never get restarted,
Her body is here, and her brain is dead
While her soul has already departed,
The resident of this ICU bed
Could be likened to an empty shell,
Auntie is firmly ensconced in heaven
While her body remains here in Hell.


Sunday, October 05, 2008

The level of professionalism is daunting where I work, and how I suffer through it, I do not know.
And now enjoy Part - 2, "Tear Drop Tissues".


She's a professional practice
Committee nurse,
She keeps all the bylaws
In her purse,
When it's time to practice
She's the go-to lady,
She knows what's right
And what is shady.

Don't even try to pull
The wool upon her eyes,
Others have attempted
Perhaps you heard their plaintive cries,
Because the PPC nurse
Surely, never wavers,
Sticking to the rules
Is the sum-total of her flavors.

She's a pillar of our community
The lightbulb of our lamp,
Like that famous Disney movie
She's the lady and I'm the tramp,
I get a biscuit now and then
If I properly fetch and heel,
Of course, she's happier than snot
If I also bow and kneel.

_ _ _ _ _ _ _ _ _

Tear-Drop Tissues

When I grow up
I want to be,
A Confessional Practice
Nurse, you see;
Everyone will tell me
About their "issues",
And I'll make a buck
Selling tear-drop tissues.

As Nursing is predominantly
A female career,
(Men, don't be insulted -
Remember, I'm a peer),
And I'm covering the topic
Of the female outlook,
It reads like the typical
Romance book;
You know, "she said, blah"
And, "she, responded",
And before you knew
The two had bonded,
Taking down Mary
With a tattletale rumor,
Giggling whispers
Like schoolyard humor.

That's where the Confessional
Practice Nurse,
Pulls the teardrop tissues
From her purse,
Because, Mary the wronged
Is seeking restitution,
She's jumping up and down
Regarding workplace persecution,
And if she's not heard
She'll take the quitters route,
Find a lawyer and file
A whistle-blower suit.

As the Confessional Practice
Purveyor of truth,
It's my responsibility
To rectify the uncouth,
Behaviors and insults
And the backyard rumors,
Pluck those suckers out
Like a malignant tumor,
Then I'll offer a penance
To the goddess of nursing,
To reverse the ill effects
Of 14 females cursing,
Each other, for the petty
Day to day imperfections,
As the Confessional Practice Nurse
I'll define new directions,
For all persons and peons
Who populate this plane,
And if you don't like that
You can hop the next train.