Tuesday, July 28, 2009

I suppose that some of you must have heard about the latest and greatest can-opener,that is circulating the country. It's called, "The Nursing Bundle". I'm sure all of you have experienced something like this before, where your hospital organization believed the need for greater efficiency, and dollars saved, carried a higher importance than what was happening directly at the bedside.

Sure, I know, the "new" ideas are always couched in cool new slogans, and psycho-babble business speak. Another way of recognizing these insidious trends, are all the catchy Acronyms that the trainers sling around, like cheap 19-cent hamburgers, and would you like some fries with that, Honey?

I'll tell you what........Sister Euphemia has always been a sucker for this stuff, and there's no pulling the blinders away from her eyes; but why worry when we all know, the pockets of her habit are deep and lined with green.

Let's get to the story, the way that only I can tell it, ok?

The Nursing Bundle

The Nursing Bundle
I'm glad I missed it,
But from what I've heard
I could have kissed it,
Though all in all
It makes me wonder,
Should I have gone?
Did I commit a blunder?

I too, could have tasted
The Acronym soup,
With it's endless supply of
Loopedy loop,
Those inspirational moments
When ideas start firing,
And I give up the idea
Of maybe retiring,
Because, where else could I go
To get ideas like this,
The Nursing Bundle Workshop
Was not one to miss.

I can merely report
Third person, quite respected,
Why heck, I'm so jealous
That I wasn't selected,
But they told me the following
Version of truth,
Quite probably embellished
With 3 glasses of Vermouth.

We came with our questions
They were answered and more,
We received a lovely binder
And a "high-five" at the door,
They said, "Thank you, for coming"
There's so much you can learn,
Quite frankly I wondered
Just how much did they earn,
For a gig such as this
It has to be sweet,
Driving all around the country
With an expense account to beat.

I guess that's what you do
After your bedside tour,
Go from hospital to hospital
Selling the marketing cure,
The ploy to bring dollars
And a shine to our reputation,
The bread and butter, of repeat customers
Earns a standing ovation.

Ask Nielsen and Johnson
Because they measure the stats,
If we score near one hundred
There will be bonuses for those cats,
Sitting high in their offices
Running the numbers for this quarter,
And, "By the way" they admonished
"Keep the overtime shorter".

Now those Bosses, who are nurses
Tap their feet and giggle,
Knowing that years behind the desk
Have only added to their wiggle,
While visions of floor nurses
Dance in their heads,
Imagining how their staff
Will chant slogans, while making beds,
For their clients every morning
To boost morale and good feeling,
Yes, that's what is most important
Second fiddle, comes the healing.

Nursing Bundle is our friend
That's the take-home message, I guess,
Sister Euphemia, likes the idea
If it will clean up this mess.


Monday, July 27, 2009

This is no particular complaint about a specific person, but rather, just inspiration from something Ms. B said today. It does seem at times, that the shift was 15 minutes long, after a grueling 12-hour report!

15 Minute Shift

It was a 15-minute shift
After that horrendous 12-hour report,
43,200 seconds
While I listened to him suck and snort,
About the complicated events
Between the beginning and the end,
It seems like the dude was on offense
And I was the one to defend.

It seemed like a long 15 minutes
While you gave your 12 hour rendition,
How those bastards in Pharmacy processing
Could care less about someone’s condition,
You ranted, and railed and you moaned
And you simply just ran out of time,
There’s no one who works, quite as hard as you do
You’re a savior amidst all of this crime.

It was a long 15 minute triathlon of pain
After the 12-hour report from south Hell,
We’re lucky that anyone is left standing
Your oration could crack a coconut shell,
I survived because I always wear earplugs
When I know that you’re headed my way,
But who did I piss off, I'd just like to know
To earn this kind of punishment today?


Friday, July 24, 2009

There are times when a simple 12-hour shift can seem to last 24 hours in duration. Last night was one such night. I had to transport the blob (1950's Horror movie), to Nuclear medicine for a WBC scan. The blob had an anxiety attack during the procedure, and if you've ever seen the movie, you already know it is difficult to communicate with water. It just isn't like those Timothy Leary moments from the sixties, where I floated on a lotus flower, talked to the colored orbs in the sky, and chanted "Om" in reverse, which came out as "Moo". Oops, maybe you missed the 60's!?!

Anyways, luckily the reader never knows if I'm actually relating something from real life, or if I'm still on some kind of acid trip.

Regardless, if you've worked with many horrid conditions, you certainly have met up with Ms. Anna Sarca. She hangs around and makes your life miserable.

Criminal Edema

He has criminal edema
It's coming out his ears,
Even Anna Sarca
Almost came to tears,

It's a crime against his passion
Perpetrated on his life,
A transgression of such proportion
That he wished he had a knife,

An insidious attack
That caused him such rancor,
It weighed upon his body
Like a 300 pound anchor,

He's a blob in the bed
A jellyfish on the shore,
Like a gasping guppy monster
That I dream of when I snore.

Because he suffers, oh he does
From edema on the run,
Escaped from Alcatraz
He'll tell you it's no fun,
To have your skin weep wonky water
You can't drink it, that's for sure,
And although it's the 21st century
Ask a doctor, there's no cure.

He has criminal edema
America's Most Wanted?
It's not him,
Though he has a proper future
Filling swimming pools;
To swim.


Tuesday, July 21, 2009

Someday, in the far reaches of your career, you will look back and recognize that one special person, was your nursing soul-mate. I know who mine is, although we no longer work together. However, I know that if we were to be reunited in the work setting, incredible things could, and no doubt, would happpen. Our assessment and technical skills were complimentary, we were always looking out for each other and most importantly, mutually focused on the most advantageous outcome for the patient.
Sometimes I go to work, look around, and long for just one more shared work day, with my old friend.


Sixteen years now
And I've figured it out,
You were my Nursing soul-mate
Without a doubt,

No one since
Has had your tools,
You were my balance
When we were surrounded by fools.
My sounding board
Whether wrong or right,
We could face any disaster
In the darkest of night.

'Tis a rare opportunity
To work with someone like you,
Nothing could stop us
When there was a job to do,
Under the circumstances given
The best outcome was guaranteed,
What might have been a hemorrage
Became a small bleed.

Now all these years later
When I scan the scene before me,
Searching for a comrade
Whom I can always trust,
I wish that you were there
To share the vision that I see,
With your fine tuned assessment skills
We can both decide, success or bust.

If ever we are reunited
I'm sure the years will melt away,
I know you're still working the circuit
As I do, to this day,
We'll talk about the old times
And share our aches and pain,
I'll check you out, for the kinds of injuries
That leave a permanent stain.

And when we part, I'll feel whole again
Like those years so long ago,
Reminded that your spirit is with me
In every episode of this show.


Thursday, July 09, 2009

We have this new computer charting and it comes with about 50 tiny, (font 8) icons, that look like little bugs crawling across the screen. Thus, I had to write the iconic poem.


Icon not understand
Nor fathom what they mean,
All those silly little symbols
Running circles on my screen,
The experts call it my PAL
But it ain’t no friend of mine,
A pal is strong and helpful
And this one has no spine.

Icon not discern the meaning
Icon not discover a solution,
Too many icons running around
That deserve an execution,
Icon hardly wait the day
When we finish up this caper,
There will be a mass revolt
And we will welcome back the paper.

_ _ _ _ _ _ _ _ _ _ _ _

I wrote "Icon"; then I slept. I woke up and wrote "Yukon"..........................must have been the Boss invading my sleep.


"Yukon", she repeated
"Yukon, do what I say",
Treat these icons with respect
All night and all day,
Because that's our new language
Our lexicon, our lingo,
Get on the boat and behave
You, pestilent gringo.

Whether she said that exactly
I can not be sure,
But if I want to get paid
I better find me a cure,
To my symbolic sepsis
This agonizing irritation,
Or yukon bet my next boat trip
Might be a smoldering cremation.


Wednesday, July 08, 2009

This shouldn't be an issue, in our line of work, but believe me, it is. Trust. Who can I trust, when the rubber hits the road. When the Sht hits the fan, or when I am away from the bedside. It isn't always about being untrustworthy, but rather, someone who may lack common sense, or has yet to develop their critical-thinking skills. The danger in this case, lies in the fact, that the person in question, doesn't realize they "have a problem". After all, when you don't know what you don't know, by golly, you don't know Jack!

And Jack is dangerous!!!

Thick and Thin

Who can you trust
When your IV bag runs dry,
Let's just say you're out to lunch
And your patient could possibly die,
You surely expect to hope
That fellow nurses on your crew,
Will walk into that room
And know exactly what to do.

Who can you trust
When the ventilator tubing comes apart,
You're on a trip to the pharmacy
And your patient isn't smart,
He dislodged the vital tubing
And now his lungs no longer inflate,
Can you trust the members of your crew
Before it is too late?

Who do you trust
When you need a vital favor,
You're so busy with one patient
And cherry is the flavor,
Do you query anybody
Or single out, one or two,
The ones you know, through thick and thin
Would do the same as you.

Who do you trust at work
It should be any person,
In this critical-care arena
If we don't cooperate, patient's worsen,
But after all is said
And most of all, is done,
Who I trust, is selective
It isn't everyone.

"Bless you": this line is uttered so often, you'd think there were a bunch of Gods running around. Or agents of a God, dressed in the clothing of the day. Hmph. It sure makes me wonder.


I wonder sometimes
What stories I'll tell,
When I have left Heaven
And I'm not in Hell,
Some might think I'm crazy
The things that I'm saying,
But if you are religious
I know that you're praying.

At work the other night
I performed some good feat,
The nurse that I helped said
God bless you, Pete,
And it caused me to wonder
If she somehow had the power,
Bestowed on her, by God
To bless me for an hour.

I didn't notice any difference
That a blessing could have made,
Perhaps the blessing is in storage
To be sometime, later played,
To my better advantage
In a time of greater need,
Like when I stick myself with a needle
Causing me to bleed.

What makes people think
They can randomly send a blessing,
As personal agents of God
It's almost depressing,
Because that's what the whacko's say
Before they poison their flock,
It fills me with trepidation
As I prepare for the blessing shock.

Who knows what it means
When you're blessed for a sneeze,
Though I've always preferred
"Gesundheit", if you please,
That kind, German wish
To offer me good health,
But I'd really prefer ten dollars
And wish me good wealth.


Monday, July 06, 2009

I woke up from my "first day off sleep" and immediately wrote this poem. All I had was the line, "At risk for skin integrity", which had earlier struck me as an odd way to describe skin that had the potential of being damaged.

Where did I get that line, you ask? From a memo, of course. Furthermore, a "bathroom memo", with its accompanying flowchart format. I'm telling you, that this organization I work for is a veritable writers dreamland; a germinating pit of poem seeds, if you will. I suppose that might be going overboard, but to me, it is constantly entertaining.


At risk for skin integrity,
It could happen to you
It might happen to me.

Your skin was ragged
And worn, at each seam,
We tried to repair it
'Twas a heck of a scheme;
But you wouldn't have it
You scratched and you picked,
The carefully placed Duoderm
With your fingers, you flicked,
It littered your bed
And fell to the floor,
The housekeeper bitched
At one more, extra chore.

They came with their science
Those Hyperbaric nurses,
You flailed and you spit
And heaped them with curses,
And thus, you were blessed
By the most basic of karmic laws,
You reap what you sow
The effect is your cause.

Your skin wouldn't heal
You moaned as it wept,
Perpetually, you were awake
While everyone else slept,
With your circadian rhythm
Totally, fu-barred,
Even if you survived
You'd be horribly scarred.

Yes; skin integrity
Oh, my,
We fixed your skin
But still, you died.,
You fought all of our efforts
So valiant; with vigor!
But it matters not
With your mortis and rigor.


Sunday, July 05, 2009

Picture this scenario: The patient, a young mother dying with cancer, a family in crisis, a husband going ballistic, a teenage son overwhelmed with the burden he is shouldered with, a grandmother newly arrived from the old country, without a lick of spoken English. Then, the patient has a respiratory arrest: the outcome.........chaos!

Letter To Sergei

In my letter to Sergei:
There's so much I want to say,
I recognize your anger
But don't aim it our way,
We care for your wife
Much like you do,
Just a different perspective
Than the loving husband view.

We want the best for her
And we're doing what we can,
Please hold back your anger -
Be strong; be her man,
Her protective custodian
Her pillar of stone,
If we can all share this space
She won't be alone.

We suffer your loss
We're included in your pain,
Love is a journey
It is never in vain;
I see the strength of your love
And recognize your power,
Please set aside your anger
And love her, one more hour.


Friday, July 03, 2009

I've been an EKG fanatic for years. It's the topic I study the most. When I see some arrhythmia scoot by on the monitor, I want to capture it, and analyze it as if I'm Sherlock Holmes. I've never been successful in learning other spoken languages, (as my mate will attest to), but the EKG, that's a different story.


Is it SVT
Sometimes I get
Confused, and guess,
My idiot factor
Increases by doubles,
With an exponential
Rise in my troubles.

Let's examine a scenario
You've got the night-shift blues,
It's your fourth night in a row
And this one's an easy cruise,
When abruptly, you're assaulted
By alarms and lights galore,
Awakened from your reverie
You fall upon the floor.

The rhythm is wide and ugly
And it's totally bizarre,
The short trip to your patient's room
Suddenly seems quite far,
You fumble for the Lidocaine
Then stagger in the room,
Your tunnel vision activates
The flashing light, spells doom.

Is he conscious, is he dead
Is he even in the bed?
Is he watching television
Can you make a quick decision?
Should you stop a moment, and clock him
Or just go ahead and shock him?

Well, there isn't always time
To plan a course of action,
You will always get opinions
From many other factions.

Now you zap him with the macrovolts
And raise a head of steam,
He jerks up off the bed
And summons a frightful scream,
“Holy Mother of my ancestors
Deliver me from Hell,
If this is getting better
I'd rather not be well,
Because I have no recollection
No, I never have agreed,
To allow electrocution
It's just not a thing I need”.

Despite his pain and suffering
His rhythm has reversed,
He is mad as hell that you saved him
And announces, you've been cursed,
By the mother of his ancestors
The mark is on your head,
(Lord, another thing to think about
When it's time to go to bed).

Did you get a few good strips
Before you shocked that creep tonight?,
Was it SVT or TVS
Or Parkinson, Wolfe and White,
Does a delta-wave announce itself
Or remain concealed and silent,
Was it SVT aberrancy
Or something else more violent?

Is the phenomena reentry
Are the P-waves retrograde,
Does the AV-node dissociate
Or the P-waves simply fade,
Is the antegrade conduction
A sign of CMT,
Is it Atrial Fibrillation
With ventricular ectopy?

Is the axis indeterminate
Is it normal, left or right?
Is the complex wide or narrow
Or the R-wave broad or tight?
Does the QRS morphology
Have a well defined polarity?
Is it positive or negative
Are the fusion beats a rarity?
Do you notice a concordancy
In the horizontal plane?
Is there evidence of R-wave loss
Or just too-little gain?

Beware of helpful hints
That are often unreliable,
Choice of drugs is crucial
For the patient to be viable,
Like compensatory pauses
Gross appearance and the rate,
Commonly unsubstantiated
Clues of someone's fate.

The outcome, is all that matters
Did you fix it, did you not?
Could you halt decompensation
Or do you feel, your nerves are shot?
Did you conquer SVT
Or succumb to TVS,
Terrifying Ventricular Syndrome
And its' consummate distress.