Tuesday, December 30, 2014

Change is not Coming


Ever hear that old-timey platitude about change? One guy says, "Change comes from within". Another one says, "Become the change that you wish to see"......these are dudes who are not Nurses, working on the front lines of healthcare in the USA.............and you know what I'm talkin' about!

Fill out an A.D.O.
Oh, wouldn't that be grand,
If only I had the time
And maybe it was planned,
But when we are crushed
And fighting for our lives,
All we want is the end
And how soon it arrives.

Fill out an A.D.O.
It sounds great, when it's spoken,
And could it do any good?
Well, I think you're jokin',
Because this is a system wide
Decades long issue,
And Sister Euphemia
Just keeps handing out tissue.

Where can I find an A.D.O.?
It's on a shelf somewhere,
In the back of the break-room
Probably under a chair,
Will I fill it out?
There ain't a snowballs chance in Hell,
The facts will be ignored
Despite the stories we tell.

Because, this is more than local
It's health-care bureaucracy,
This is business, it's about money
A type of Theocracy,
With a God at the top
And she runs a tight ship,
Fill out an A.D.O.?
She'll give you a fat lip.

Fill out an A.D.O.
I can't hear you, La La La,
Union Reps claim they represent
And all that, sis-boom-bah,
No, I'd rather have the form
For an early retreat,
I need a mental health retirement
And everything sweet.

12/30/14



Saturday, December 20, 2014

Too tired to think

20 years ago, I worked too much and didn't sleep enough and at the end of a work shift, I might have an addled brain. Now, I'm twenty years older working just 38 hours a week, out of the ICU, but the level of job stress is of an equal comparison. Near the end of a typical insanely busy shift, I sometimes have too many details bouncing around in my brain, like the balls in the Lottery machine. 

Circadian Calamity 

I've been known to brag
That I am infallible,
Master genius at work
Always present, ever callable,
But in the waning minutes
Of my twelve hour shift,
I'm more prone to forget
And suffer memory drift.

But I'm not alone
With this egghead fault,
A Harvard brainiac
Suffering memory halt,
Other nurses I work with
Who are half of my age,
Remark, they, as well
Lose an occasional page.

Eminent researchers
Call it Shift Work Sleep Disorder,
Decreased mental acuity
After crossing the Circadian border,
Key details and facts
Have undergone cancellations,
Call a "Memory Alert"
Block the doors, man the stations!

12-Hour-shift workers
Includes many variants,
Rotating work assignments
You could forget your under-pants,
When your mind gets so befuddled
Sleep deprived and wasted,
You feel like rotten turkey
Unfit to be tasted. 

A paper was written
Let me read it to you,
Keen observations
And a theory or two,
To correct memory drift
A recurrent event,
A simple 5-step approach
Time well spent.

The best thing I found
When my brain feels like crap,
Stop what I'm doing
Take a break, have a nap,
Find some darkness
Or simply, close my eyes,
And even if I don't sleep
I watch the starry skies,
Behind my closed eyelids
With the ringing in my ears,
I relax in that environment
My mind shifts gears,
Producing relaxation
A restful transformation,
Feeling better, I'll be
When I return to the station.

Sounds like a treatise
Delivered at the N.T.I.,
Where's the documentation?
My competitors cry,
If I don't show some proof
My claims are just fluff,
If my brain remains addled
I'll be shunned, and that's enough.

But will I remember?
Let's not presume,
I suffer memory drift
When I walk across the room,
And forget what I wanted
To do for Mr. Jones,
This Circadian calamity
It rattles my bones.

12/17/14

Terrorist Snot

I don't like coughing, sneezing, and so on..........on the job. Patients have their own problems, and I don't need to contribute to that. Every year about this time, I get my first Respiratory infection, and endure a week of feeling rotten. This year, it was a 2 week attack by Terrorist Snot. I earned enough points to score an Albuterol inhaler and 2 days of "voice rest".

Sufferin' succotash
This ailment won't leave me,
If it goes on much longer
You might have to bereave me,
Because I think it might be
One of those new-age bacteriums,
Cooked up in a lab
By some government mysteriums.

Perhaps I was chosen
At random, to be tested,
If that is the case, then
Someone should be arrested,
Because I have been sick
More days than I can measure,
And fourteen gallons of snot
Is not something I treasure.

Five nights I have coughed
For hours at a time,
And I don't just say that
To make a good rhyme,
I used antihistamines
Antitussives, anti-pain,
Still, I've coughed till my back hurts
A frickin' hacking muscle strain.

I am starting to suspect
This is a terrorist plot,
Bugs tickling my lungs
And the buckets of snot,
I am under attack
From the inside of me,
And I'm telling you, brother
It's impossible to flee.

Was it the Axis of Evil?
It’s too hard to tell,
When I’m launching green golf balls
And I’m feeling like hell,
At this juncture, who cares?
About the source of the sickness,
If the Grim Reaper wants me
He'll be here with a quickness.

Oh, miserable me
Cough-master, I be
My outcome is shrouded in doubt,
I might need a new lung
Because my Left one just flung
Through the door,  'cuz I just coughed it out.

It flopped on the floor
And now I'm feeling quite sore
Losing a Lung isn't easy,
But one thing I'll say
Things might be going my way,
Because now I am one-half as wheezy.

12/15/14

Complicit


It does no good to act like an a**hole, when the option is gratitude and collaboration. You poke your patients with sharp, pointy things, and we are assigned the duty of making sure they don't bleed. Sometimes, spontaneous hemorrhage occurs, and there is no way to prevent it, aside from paralyzing the guy for 5 hours.

Key Point:
Doctor, why not express a "Thank you", because we just saved the life of your patient. Take your nasty, grumpy attitude home and shoot it up with Vodka or something, Ok?

Doctor, dear doctor
Please, won't you calm down,
Blaming, shaming tactics
Make you look like a clown,
You're the leader of the pack
With this issue, you're complicit,
You lanced the artery
The cause of bleeding, more explicit.

I pulled out the catheter
And held pressure long enough,
Dressed the site, gave instruction
I did all the right stuff,
I checked the site often
Yes, everything was fine,
Two hours later, a leak!
Like gushing, bloody wine.

He came pretty close
To punching his ticket,
From our point of view
A bit of a sticky wicket,
A vasovagal episode
Blood pressure down to fifty,
Cut his heart rate in half
Fun to watch?; not so nifty.

Uncommon occurrence
Can happen any minute,
Billy-Jean blows an artery
Next, you're stepping in it,
With blood everywhere
On the bed, the wall
And the floor,
I said, "Holey moley!"
Grabbed a mop, what a chore.

Three nurses responded
Stopped the hemhorrhage, saved the dude,
And what did we get?
A grumpy-assed doctor, being rude,
Because he was complicit
In this bleeding event,
He should have thanked us profusely
Then gone home, to repent.

12/19/14


Monday, December 15, 2014

Way to Busy

Oh good grief! Another day of the same old sandwich.

Perhaps my perspective
Of imagined disaster,
Means I'm getting old
And no longer so much faster;

But still:

It seems like the funny stuff
Within the context of my job,
Has very little to do
With patient, Billy-Bob,
But more with situations
With my coworkers, and such,
Tired old nurses, that feel
Like a worn out clutch.

Unit Standard concepts
That don't make any frickin' sense,
We can't work as fast as they want
Even the highly trained dogs
Can't  jump that fence,
Yet, they will be the ones scrutinized
Held to the Policy intent,
And should we ever complain
They'll say we are exhibiting dissent.

I suffer intellectual overload
Some days I can barely function,
Quick; find me a Priest
Because I need Extreme Unction,
I am very nearly close
To the end of this frayed old rope,
Overwhelming nonsense
And I'm giving up hope,
In the course of this workday
Beneath this burden of need,
Oh, find me some Hemlock
To perform my final deed.

11/20/14

Thursday, December 04, 2014

Mirrors and Tissues


The kitchen sink, the cyclone, and Godzilla all get thrown at us after 5pm.......

Mirrors and Tissues

Forgo the trip to Tacoland
It wasn’t very clearly planned,
Three wrong turns
From misdirection,
Stuff like this
Won’t pass inspection.

Perpetual
Understaffing issues,
Can’t be fixed
With mirrors and tissues,
High-fives!
Missing four good fingers,
The boss goes home
Our animosity lingers.

The beating goes on
Every day after five,
Sometimes I wonder
If we’ll get out alive.

12/4/14

Charades

Historically speaking, our new hospital addition required about 12 years to achieve, from an idea, a donation, a break-the-ground ceremonial shovel, knock down a school, move houses, find a place to put a new school, batter heads with local leaders............until finally, doors were opened 8 months ago. And yesterday, as I stumbled and traipsed throughout a meandering path of new destruction (while I sipped my Latte') out come this minor missive:

First came the years
Of ballyhooed construction,
Celebrated with pomp
And parades,
Now we must undergo
Years of destruction,
Exposing our Brand
Of dignified charades.

**
According to the article in the Business News Journal, the whole kit and caboodle, costs $170 million dollars!


Thursday, November 27, 2014

Dramatic Duress

Do you ever work with the over dramatic player of work stress? Maybe it's you or Billy-Bob over there. Whatever, the at-work-temper-tantrum type, or the one who has to leave the Unit every hour for something (and claim it's always legitimate)........is a tough one to work with. They make a fuss about something, and baby, they are always very dramatic in the telling.

You know about PTSD
It's in our neighborhood,
Everyone in service to others
Would like to avoid it if they could,
But it comes with the service
And leaves us in pain,
PTSD grooves
Forever furrowed in our brain.

But, I'm all over that
I have my mind on another thing,
No one is talking about it
It's a little bit like a bee sting,
Once you have lived it
You won't forget,
You'll wish you avoided it
There's guaranteed regret.

Dramatic Duress syndrome
I see it every day,
Some persons that I work with
Really know how to play,
The Dramatic duress card
When they feel over-stressed,
They come to a standstill
They need a break, a snack, a rest.

It's a cross-gender malady
With an all-ages potential,
Some people never get it
It has a vague differential,
Men and women alike
The old and the young,
Exposed to Dramatic duress?
You'll feel like you've been stung.

Bystanders are disturbed
By the wailing and moaning,
Adult temper tantrums
Deserve immediate stoning,
Yet, the perpetrators prevail
Professionals, it's their right,
Practicing Dramatic duress
All day and all night.

Is there a cure for this?
Not that I've heard,
Birds of this feather
Will just give you GERD,
Try to ignore them
And turn a deaf ear,
Collective agreement says
"I wish they'd disappear!"

_ _ _ _ _ _ _

Dramatic Distress

Dramatic distress
Some people display,
When they are trying
To have things their way

Dramatic impress
Is their method and plan,
Get everyone's attention
Like an earthquake in Japan.

Dramatic finesse
Self-trained, she's a master,
Oh, what would I give for
My Stokes-Adams blaster,
Holstered on my hip
For situations such as this,
A dramatic departure

With flame and a hiss.

Saturday, November 22, 2014

Missile


There were many times working in the ICU, when I thought, whew! that was a heckuva night, how did we possibly make it through? But here in good old Caleefornia, our staffing ratio's only allow us a maximum of two patients per nurse (ICU). Sure, there were countless nights where I never had a break, and two crashing Septic patients can seem a daunting task to face, but still...........only two patient's. Oh, I know, they could both transfer out and you get two more, and that isn't fun.

Now, in our Out-Patient Pre &  Post Procedure Unit,  after 5:30pm, when 5 day shift nurses split, our "Closer Crew" of two or three nurses might have 9 Recoveries, and more on the way. So, when an Atrial Fib Ablation, General Anesthesia shows up, and the dude had an 11 & 14 French holes in his Right Femoral vein, a 9, 11 & 14 in the Left Fem vein, an arterial line somewhere, and he is squirming, moaning, thrashing, vomiting.........that's what we call a 1:1. The Doc killed the arrhythmia, now it's my turn to save the patient (from themself).

So, that means my counterpart nurses, have to watch over my 3,4-5 other patient's plus their own....and some of those folks might bleed at any given moment (usually a Femoral artery).
Good old Head Nurse, also split at 5:30, telling me that there is absolutely no way, that any of the Day shift nurses could stay over and accrue overtime, because our "billing hours" are barely enough for the day. Thus, the Day Shift nurse who was not yet done with her Surgical Pre-op Workup patient.....one of us would have to assume that little task. Oh ya, and the guy that came in 8 hours ago to have an Echocardiogram and was found to have a Hemaglobin of 6.........we can have him also, for the 2nd round of blood transfusion. That leaves two nurses watching 6 patients, but one of them is the ICU player, who just arrived (emergently) from another hospital. He is in a 2nd degree heart block, with a Heart Rate of 40, whilst being on a Dopamine drip. Since I am the "ICU" nurse of the Unit, this guy is supposed to be a 1:1, because our Unit is a simple Out-Patient Recovery room.

Night after night, we feel like Gepetto and Pinochio, having just been swallowed by that whale.
So, for some reason, after I got home and had a glass of wine at midnight, I started to think of missiles, and what they are best used for.

Missile

Another usual week
We all were abused,
By the usual players
They stand accused,
Promoting unsafe conditions
Every day, post--5:30,
When the pedal hits the metal
We roll our sleeves up
And get dirty.

Mutiny mumbles
Beneath our daily dialogue,
How much longer can we take this
Perpetual flog,
Pushed to the curb
And thrown under the bus,
That's what it feels like
In the evening, to us.

It is stressful I'm telling you
I really don't enjoy it,
If I had a SCUD missile
I most certainly might deploy it,
Aimed at the perpetrators
Those who claim to be in charge,
Point that sucker, light the fuse
Everything improves, by and large.

These are just nightmares of a dreamer
He remembers better times,
Although, adversarial encounters
Create wonderful rhymes.


11/22/14




Thursday, November 20, 2014

Writing 4 Ever


Did I miss something somewhere?

Sometimes, it seems like I've written
Everything, I possibly can,
All of the medical situations
Included in the plan,
I don't possess all there is to know
But within the specialty I am employed?
I've covered most of the medical conditions
And the rest, are for Sigmund Freud.

11/20/14

Wednesday, November 19, 2014

Dental Dana 36

"Inspired by the true-life story"....any movie labeled as such, I absolutely refuse to watch. I work in a hospital, and as such, I know all about true-life; it's a mess. So, why call a movie that ahead of time?........more than likely the thing will be a sloppy mess.

Anyway, this was inspired by the over-perfuming of detergents used for the cleansing of your clothes. Folks, you need to buy non-perfumed clothing soaps, because you're all off-gassing excessively to those persons who are odor-sensitive. Sometimes a group of family members show up to see Auntie Mame, and I can barely enter the room or cubicle, because your clothing perfume is nearly toxic to me. You think you're an ethnic minority?, but I'm the minority guy who is being assaulted.........just the same as if you were pointing a loaded weapon at me.

So, that got me thinking about Dental Dana and her dangerous, musky body odor.....talk about a weapon!

Dental Dana
Has a special odor,
And when she's near me
I get to, racing my motor,
Like being exposed to
A nitro-octane booster,
She's the finest of hens
And I am a rooster.

Mixing up metaphors?
I do admit,
But sweet Dental Dana
Is hotter than spit,
Which I have a mouthful of
Requiring high-powered suction,
She has warned me about that
And threatened destruction.

Dental Dana
Is a flower in the rough,
Adversity, she surmounts
It makes her so tough,
But her clients adore her
She's a hard-boiled dame,
Dental Dana, mouth-master
Is at the top of her game.

11/19/14



Wednesday, November 12, 2014

Dental Dana 34

At the Dentist's office there is a Hygienist named Dana. She cleaned my teeth 2 years ago, but I haven't seen her in a long time, due to scheduling conflicts. But that doesn't stop me from writing about the fictitious DD, who is a bombshell, knockout hotty. I just can't stop thinking about that dame.

Dental Dana 35

Dental Dana
She knows a thing about jaws,
How to ratchet them open
To reveal all the flaws,
In your careful narrative
Regarding how you brush and floss,
Nothing, escapes her purview
She let's you know who's the Boss.

Dental Dana instructs
We commoners, should listen,
Be patient, she'll do her best
To make your enamel glisten,
She knows the best way to tell you
What you already should know,
Had you been paying attention
Instead of eating that jelly roll.

Dental Dana, I must admit
Looks so hot, I get distracted,
When I do that she raps my incisor
And says,"Whoops, I think it's impacted",
Thereby threatening to remove it
With a pair of rusty tweezers,
DD, I get the point!
Knowing, I better please her.

Dental Dana
Won't put up with too much,
Apparently, I didn't listen
I just wanted a touch,
Now I'm missing a tooth
Well she warned me, I guess,
It hurt for an hour
But now it's a caress;
Nothing she says
Will ever scare me away,
Dental Dana is so fine
And yes, I'm willing to pay.

11/12/14

Dental Dana 34

Dental Dana
I apologize,
The other Hygienists
Have gotten wise,
Regarding my silly
Behaviors, and such,
Now they are all jealous
That I like you so much.

I really can't help it
'Cause I'm in a trance,
Your coquettish demeanor
And pink Go-go pants,
Are more powerful than Novacaine
Dilaudid and Ver-sed,
Without our Dental dalliance?
I'd rather be dead.

Harsh reality, it is
I'm smitten beyond reason,
You can scrape or Taze my plaque
Any month, in any season,
Vacuum my tonsils
And floss with barbed wire,
Whatever you do, DD
I am filled with desire.

But, do watch your back
(As I watch your front),
Those other chicks in the office
Might be planning some stunt,
To vie for my attention
Because I only want you,
Jealousy, being what it is
They might think their time is due.

But I swear, I won't waver
Because you have no compare,
Dear Dana, your presence
Is like Nitrous infused air,
Making me tingle and numb
In a pleasant kind of way,
Can I have another appointment
Later in the day?

11/11/14

Dental Dana 33

Dental Dana
(I've decided to propose),
Although I'm worried
She'll punch me on the nose,
After all of the trouble
I've caused her at work,
She knows I do love her
And still, she calls me a jerk.

Dental Dana
I admire her courage,
Despite my frisky advances
She has been one to discourage,
Yet, every time she blocks me
I'm more determined than ever,
She's a treasure to me
And worth any endeavor.

Dental Dana said "No!"
When I advanced my proposal,
She chased me out of the office
While threatening disposal,
She said something like, "Never,
Don't ever say that again",
I think she really meant, Yes
But I'm left wondering, when?.

Oh, I can abide
By the rules she has written,
Because, “Dental Dana, Darling
I am hopelessly smitten”,
And gladly will submit to
Dental torture for a fee,
'Cause I'll never stop thinking
That she's the girl for me,

11/9/14

Thursday, October 30, 2014

A Lotta Fun

Just trying to survive and continue having fun.

Thirty years from now
I could be Ninety-one,
If I can stay healthy
It oughta be a lotta fun.

I need to avoid
Getting hit by a truck,
Keep away from large snakes
And horses that buck,
Jellyfish stingers
And terrorist captors,
Giant wooly mammoths
And prehistoric raptors.

I shouldn't roller-skate
No sense in sky-diving,
Why hurry death?
When it's always conniving,
To remove just one more person
From the planet, each minute,
An out-of-control dragster?
I don't want to be in it.

Deep sea diving in a Bathysphere?
That's a possibility,
Although, I might just wait
Till I have reached senility,
Because, if a brain injury might happen
I'd rather not rush it,
And if I go down too deep;
The ocean might crush it.

Sword fighting with a Samurai?
I wouldn't know how,
I'd probably end up
Being sliced like a cow,
Not too much sirloin
I'm lean, not plump,
Barbecued, or Jerky?
And stay away from my rump.

Let's appreciate SPIKE.com
"A 1000 Ways to Die",
They pretty much cover
All the things I shouldn't try,
If my intent is to survive
To the ripe old age of 91,
Stupidity is often fatal
A not a whole lotta fun.

10/30/14

Sunday, October 26, 2014

Leader Fail

Thanks to an occasional outside contributor, I present this gem of a story:

I witnessed the stupidest
Thing today,
A Charge Nurse
Had the gall to say,
That paperwork trumped
A failing heart,
Charting, had to be completed
Before the procedure could start,
To place a life-saving pacemaker
The man was going into shock,
Charge Nurse said, "You can't take him"
She's such a cuckoo clock.

The Surgical nurse
Was forced to stand by,
A witness of this stupidity
Despite my rallying cry,
That this was an emergency
A life-threatening event,
But Charge Nurse stomped her foot
And blocked all circumvent.

I split the scene
Frustrated and fuming,
Charge Nurse is a paper pusher
A number counter, I'm assuming,
With assessment skills
That have no compare,
How can there be?
When they never were there.

Crap rises to the top
Never more true,
I wish she would stay away from the bedside
And completely out of view.

Anony-mouse

Wednesday, October 22, 2014

Soldiers of the Myocardium

The overtired theme of understaffing. My workplace, health system, corporation, conglomerate, you name it organization, will always try to run their nurses ragged, all in the hope of shifting more dollars to the top of the pyramid. 30+ years ago, hospitals stopped doing healthcare and healing, and became ordinary cutthroat businesses. Luckily, Nurses have tried to ignore all that and just do what needs to be done, for the sick and maimed.

Too many crazy days
Understaffed,
Luckily, some of our clients
For hours, they laughed,
Knowing;  waiting is a moment
Best savored alive,
One doesn't hurry a procedure
In the busiest hive.

We're the most productive bees
In the strongest of hives,
There's just no way to measure
Just how many lives,
Have been saved by our actions
Our good teachings and good deeds;
You can't hurry excellence
Or somebody bleeds.

Joe Bob in the corner
Gets anxious and belligerent,
He's missing his Nicotine
The room's too hot
He needs refrigerant,
Along with some Ativan
Let's mellow him down,
His wife leaves for coffee
With an apology and a frown.

We race around wondering
Just how can we do it?
Process so many patients
Before we totally screw it,
Or it screws us
When we refuse, for safety reasons,
12 patients, 3 Nurses?
Not in the best of any seasons.

Assuredly; we represent
Three of the best,
Throw anything at us
And you will attest,
Hot-selling, predictable
Solutions on demand,
Is it safe, my good brother?
Hell No! And be damned!

Yet, we struggle on
We are warriors of the heart,
From the very beginning
Till the end of your chart,
You command our best intentions
We will do the most we can,
As Soldiers of the Myocardium
That's our duty and our plan.

10/20/14

Wednesday, October 08, 2014

Never In Time


We're short staffed, so my time slot pulled back 1.5 hours, in the (ridiculous) theory, that we could close the shop at 2130. But it never, ever works....often, with disastrous results.


Oh, what a ridiculous
Night it was,
You ask why
Because, becuz,
Of all the silly
Things we does;

Like coming in early
When we shouldn't,
Never leaving on time
Because we couldn't,
A hematoma
On a TR-band wrist,
And late recoveries
That we shoulda missed,
But you don't keep normal
In the hospital overnight,
That won't fly
On Medicare oversight.

10/7/14

Tuesday, October 07, 2014

Research


I went to that Cardiac Symposium last week, and learned some new stuff, and here are my results.

This latest Heart Failure topic
"LCD-696",
Is the hottest new stuff
Promoted to fix,
The agony's of heart failure
Comorbidities and death,
But now my G.F.R. is dropping
And I'm completely out of breath.

High-falutin research
During experimental stages,
Where theories and data
Fill up hundreds of pages,
On 500 laptops
In 42 Labs,
Result in 3000 white rats
Dissected on slabs.

Evolutionary
Quantum theory,
Found the white rat
As the perfect model, dearie,
To experiement upon
They're much cheaper than dogs,
Although, if you need a heart valve
Set your eyes on the hog.

Dogs, these days
Have achieved a reprieve,
Owners, view them as family
Experimental death?, now we grieve,
But cut up a rat, no one cares
'Twas their fate,
Remove emotion from research
And have a heckuva date.

Fibril_late;
10/6/14

Saturday, October 04, 2014

Nursing; now it's relative


It's hard to believe that the "Nursing Diagnosis" and its companion, "Care Plan" has survived into the 21st century. I thought they were absolute effin B.S. back in 1981, but apparenly the force of evil (Darth NANDA), was more powerful than I could ever imagine. A close relative of mine, now in Nursing School, is suffering through all of that nonsense, just as I did, and millions of other suckers. I just couldn't help but write about it again.

Darth Nanda

I've been studying so much
My brain seems to hurt,
My eyes are so dry
My tear ducts can't squirt,
There's a crick in my neck
From some postural twist,
If I had a Care Plan punching bag
I'd slug it with my fist.

"Critical Analysis of NANDA
Nursing Diagnosis Taxonomy",
This gobbledygook nonsense
Might ruin our economy,
When Nursing students realize
They can't swallow that crap,
They should have studied something else
Instead of wearing the fools cap.

Is it any wonder
That a Nursing Educator,
Isn't paid as much
As your average head waiter,
So, to bury their misery
They'll write scholarly junk,
To force on nursing students
Like a bullying punk.

Just find me a nurse
Who thinks care-plans are hot,
Those are the ones
Whose skills are but naught,
Because the genuine experts
Who deal with bullets and knives,
Have no time to score care-plans
When they're out saving lives.

Fibril_late;
10/4/14

http://en.wikipedia.org/wiki/NANDA

Thursday, October 02, 2014

Seats Belts...who needs'em


Driving way too fast
For my own good,
The tree leaped in front of me
Who would think that it could?

Fortunately, for the alcohol
I didn't feel a thing,
Face first, swan-dive
And it didn't even sting.

I couldn't recommend
A better pain remover,
As they vacuumed my face
Off the pavement, with a Hoover.

1993

Hocus Pocus


Memory sure is a strange thing. Currently, I see patient's on a daily basis having Atrial Fib, Flutter, PVC, Vtach ablations, and what not. My memory does not recall, that I was writing about this topic 21 years ago (and studying it as well). But here is the proof.

Hocus Pocus

In this day of modern medicine
There's a topic and a focus,
Preventing sudden death
With a lot of hocus-pocus.

Take a heart, that's sick or injured
With a recent big M.I.,
You want to try to minimize
The risk of ectopie.

You might load them with some Lidocaine
Procainamide, Bretyllium,
Dietary fiber with
Colace and some psyllium,
To regulate conduction
In the bowels and the heart,
It's a basic fact of life
You have to
Let the poor guy fart.

You might try a new religion
If he's blocking without capture,
And if you convert just one more heathen
You will earn angelic rapture,
If you could get one hundred heart attacks
At a summertime revival,
Just think about the impact
On the sudden death survival.

Have you studied early bloomers
Or simple delayed potentials,
Be they premature or missing
And other fine essentials,
Does the corrected Q-T interval
Increase, despite your scrutiny,
Do you double up your bets
When you think their heart may mutiny,
With increasing T-wave ectopy
And ischemic irritation,
It may warrant intervention
Like bedside HIS ablation.

It's really very simple
Though it takes a steady stroke,
It requires a lengthy needle
Then just eyeball where to poke,
Drive the needle to its hub
And shake it all about,
If you do this hocus pocus
The ectopy comes out.

1993

Wednesday, October 01, 2014

Forensic Files

What with all of the television shows about CSI, Forensic Files, Law and Disorder, and so on, I feel like the Nostradamus of Nursing. In 1993, I posted a poem that addressed that fascinating field regarding the determination of death.

Visual Mortality Acuity

How far away
Can you determine death?,
Can you sense the subtle vibes
Of a beating heart or breath?,
Can you spot a vapor trail
At twenty-seven meters?,
Do you hear the failing heart
By the backfire of its beaters?

Can you hear the death-mans rattle
As you stand outside the door?,
Or is it like the conch shell
With the oceans distant roar?,
I suspect it's just the tailwind
Of a guy who's heaven bound,
Doing solo flying
With the wings that he just found.

Can you measure Rigor Mortis
With a telephoto scope?,
Can you guarantee a suicide
By the tension on the rope?,
Can you call a drive-by shooting
And the bullet riddled brains?,
By the ashen colored skin
As the blood pours down the drains.

When you're driving in your car
And there's a fellow in the gutter,
Can you tell from half a block
If his heart beat has a flutter?
Is he a catatonic Schizo
With a blank and staring look?,
If you've had the proper training
You could read him like a book.

When you've learned to spot a dead man
At any distance you inspect,
You must study proper timing
To be sure you are correct,
Because uniqueness is the key
When determining a stiff,
This application of your senses
May require just a whiff,
Because death is an olfactory
Experience indeed,
A body laying undisturbed
Begins to go to seed,
And the germination process
Is a documented science,
The timing quite predictable
Like a clockwork geared appliance.

What this boils down to, folks
Is a measurable skill,
It's used by Law Enforcement
At the scene of any kill,
So, if you'd like to earn your license
With a handsome annual annuity,
Train for certification
In Visual Mortality Acuity.

1993



Dental Dana 32


The older I get, the prettier things are.

Dental Dana
Got me thinking,
Every time I see her
I get rapid eye blinking,
She's so damned radiant
A pleasure to behold,
Except for one little thing;
She says I'm too old.

But I can't help it
When she peers at my teeth,
Doing a critique of my brushing
And the plaque underneath,
Amidst the environs
In my oral cavity,
Meanwhile, I'm pondering
Immoral depravity.

Oh, Dental Dana
You're the bomb, Baby Blue,
But now, I have to run
Because she's coming with the glue.

Fibril_late;
10/1/14

Rolling the Dice


The latter half of my workshift revolves around the Discharge event; having patient's walk after their period of bedrest. Their Recovery period had been anywhere from one to six hours, and usually they are impatient to get going. But we wise old veterans know, this is not a hurry-up event. Perhaps 10% of them will have some bleeding, and maybe 1% might get light-headed and bradycardic. So, I'm extremely cautious about the whole thing.

Six hours of bed-rest
An average time to wait,
Before they have
Their walking date;
So, this young fellow had
His appointed walk,
All was awesome good
When he stood upon the dock.

He was on his way out
Wife and Nurse at his side,
And there he was bragging
About his beautiful ride;
That '67 Mustang
With Holly-Carbs and Lifters,
That he was a member of
The California Drifters,
When all of a sudden
He touched his pants and said;
"I think I might be bleeding
Look, my hand is all red".

Nurse Emma brought him back
Administered Epi and Lido,
Walked him again in one hour
And he bled just like Fido,
So, we laid him again
Held pressure
And invoked the Gods;
Sandbags and D-stat
And pondered the odds.

I bet on Emma
After hearing her stories,
Simple nights of debauchery
And serendipitous glories,
In Reno or Vegas
Or maybe Burning Man,
At that point, last night
I was open to her plan.

Well, third time's the charm
When you're rolling the dice,
And sometimes when you're bleeding
You need more than twice,
When the ultimate goal
Is to send you home safe and sound,
In the future I'll feel luckier
When Emma is around.

Fibril_late;
9/29/14

Fist


The National Institute for Occupational Safety and Health (NIOSH) defines workplace violence as any physical assault, threatening behavior or verbal abuse occurring in the workplace.


You tried to punch me with your fist
To do me harm,
With your Mike Tyson grip
You bruised her arm,
And sure, you "got better"
We can blame the anesthesia,
Conveniently, you won't remember
Claiming, you seem to have amnesia.

But I know better
After thirty years of Nursing,
The drugs tear down the curtains
That hide the violence and cursing,
The evil one inside of you
That you rarely let out,
People who live with you, they know
It's not something they talk about.

Your faithful wife, stands up for you
Asking me, "Sir, are you having a bad day",
Implying, that I am the aggressive one
In the midst of this violent parlay,
Where our whole intent is his safety
In this setting, of saving his life,
But we're dealing with his hidden demons
And his ever-supportive wife.

Violence in the workplace
This is it folks, it isn't fun,
Potential career-ending injuries
Are the proverbial loaded gun,
Whether intentional or not
It hardly matters, when harm is done,
And defensive family members
Probably helped to load that gun.

9/30/14

Monday, September 29, 2014

Just Stay Home

On the recent Saturday, I attended a Cardiology conference. There must have been at least 200 attendees, mostly physicians and a handful of nurses. Sitting behind us, and to the Right about 5 chairs, was a gentleman with a bothersome cough and clearing of the throat. This occured continuously, minute by minute, the entire day long. We professionals are polite endurers of bothersome personal habits and discomforts, so I suspect the majority of us where silently praying the dude would either buy a cough-drop at the commissary, suck on ice cubes, get a beverage at the hotel bar, or just go home. Evidence suggests he did none of these things, much to the displeasure of many.

Sir Coughalot

Sir Coughalot
Should have stayed away,
Coughing continuously
All night and all day,
With little consideration
For others nearby,
Is that cough contagious?
If so, we'll ask why,
Did he bother to attend
And potentially expose,
200 colleagues
With debris from his nose,
Plus, flying projectiles
With each coughing hack,
I think his choice to attend
Looks like a terrorist attack.

Sir Coughalot
Didn't listen to his marm,
She admonished him often
"Remember, do no harm"
But he's here today
Sharing his coughing disease,
Sir Coughalot
"Why don't you go home, please?"

Fibril_late;
9/27/14

Tuesday, September 16, 2014

Exposed Iceberg



I know about harrassment
And all about assault,
I've delved into my psyche
And considered Gestalt,
But here is a topic
Upon which, I have never written,
And if I dare say the word
I will surely be bitten.

As a writer of medical mayhem
I thought,
That no topic was sacred
Where anything could be bought,
But a situation is present
With Danger supreme,
The iceberg is exposed
Oh, it makes me want to scream.

I'm skirting the swamp
As I don't wish to be beaten,
There is a threat of a lawsuit
And I don't want to be eaten,
The core of the issue
Power and culture,
The best and worst of that
Thrown into a mulcher.

Now, Sister Euphemia
Is at her wits-end,
She's got a bagfull of troubles
That she wishes she could send,
To a secret incinerator
The proverbial compost-bin,
But all she knows is crucifixion
For Original sin.

This is a Tequila Sunrise
Running for too many hours,
While the Pina Colada's
Have become Whiskey Sours,
Whoever mixed those ingredients
Well, that Bartender is long gone,
I ran into her 2 months ago
And she's singing a new song.

"I am totally happy with
Something new, really fun,
Bartending was Ok
But I needed a gun,
To keep the help-staff and patrons
Under control and out of trouble,
When I had the chance to jump ship
I got out of there on the double."

Then she went across town
Another, bartending gig,
It was like going to the Hilton
On a ship just as big,
Run by regimented officers
Steeped in duty and decorum,
Every decision she had to make
Needed to be reviewed by a forum.

Two years were enough
On that formulaic farm,
Where policy's and procedures
Come first, before harm,
Where one must toe the line
Or be keel-hauled by the boat,
A grand salary isn't enough
When crap is shoved down your throat.

And at the Heavenly Hilton
The Pina Colada's suck,
They are subsidized heavily
And only cost a buck,
Mixed with probiotics
This contaminated culture,
Isn't fit for consumption
Not even by a vulture.

So, one must tread carefully
Speak in code, and watch your back,
At any given moment
We might come under attack,
There's a culture war in town
This is a dangerous place,
A Pinot Noir of mystery
That I'd rather not embrace.

Fibril_late;
9/15/14

My Latest Rant


Recently I noticed a "new" paper form in my workplace, named the "Just Culture Event Investigation".......(something like that). Apparently it is used when some type of Audit has been done, and an error was identified. What bothers me, is that since it is a new idea, why was I not made aware of this tool?

Frankly, I think the naming of the process is stupid. "Just Culture Event"? 

1.) At first, I thought it was some kind of notice for a concert, or something like that; a Cultural Event. Perhaps a time to celebrate that dubious thing called, "Adversity". Well, adversity might be truthful, because if my Boss person, lays this form on me, I feel like I am in a situation of adversity, as in, bad luck, trouble, suffering, and misery.  

2.) Second bothersome thing to me:
I don't know who the Auditor was. So, as I showed proof that my audited error, was incorrectly identified, why don't I have the opportunity to educate that person (the Auditor) and show them the error of their auditing method. In other words, that Auditor person should be served with their own "Just Culture Event Investigation" form.

What my Boss person said, when I pointed out the true error of the Audit: "Oh, then I'll just tear this one up". But I think that it is very likely, that there is an accounting somewhere, that shows I made an "error of omission" in my charting. That won't be corrected, because the Auditor won't be aware of their own error. 

Because of all of this, I decided it was prudent and necessary that I perform some research on "The Just Culture". I am not surprised that big business has jumped on this and turned it into a money making scheme, with similarities to, "The Seven Pillars", "Project Redesign" and other nonsense. 

It dates back to around the year 2001.  

Patient Safety and the "Just Culture": A Primer for Health Care Executives.
Marx D. New York, NY: Columbia University; 2001.

Review Excerpt:
Written prior to the acceptance of open disclosure or general policy support of it, the primer thoughtfully outlines the complex nature of deciding how best to hold individuals accountable for mistakes. Four key behavior concepts serve as the structure for the paper: human error, negligence, reckless conduct, and knowing violations. How they are applied to various situations in health care and how the individuals involved should be disciplined provide thoughtful reading.

And finally it slithers down to my workplace, thirteen years later. 

https://www.justculture.org/the-role-of-event-investigation/

http://www.health.ny.gov/professionals/patients/patient_safety/conference/2007/docs/patient_safety_and_the_just_culture.pdf

http://en.wikipedia.org/wiki/Blame

Same old sh*t slathered on white bread

Fibril_late;
9/15/14



Dental Dana 31


Dental Dana
Oh, what else can I say?
That I'm too frisky
But she never wants to play,
How she's so professional
With her knowledgeable smile,
How she twitches an eyebrow
It's her own particular style.

Other Hygeinists
They're good, so don't get me wrong,
But they aren't humming
The Dental Dana song,
Her mysterious aura
Well, it just vibrates in the room,
And when she supines me in the chair
My heart skips a beat, badda boom.

Dental Dana
What a chick, what a queen,
She's infused with something special
If you know what I mean.

Fibril_late;
9/15/14

Monday, September 15, 2014

Demise


Always here
Our ultimate demise,
Although medical science
Seeks more tries,
To prolong our natural life
And I can’t argue with that,
I’m just beyond sixty
And I want 30 more, in nothing flat.


I feel pretty good for my age
My weight is Ok, just a little more than I intend,
More exercise is needed
It’s not something I can pretend,
To make it dematerialize instantly
After all, work is required and such,
My pretty baby is in favor of it
But she’s not willing to hand me a crutch.


Demise, my bad habits
Although, I’m not so sure what they are,
I have a pretty good diet
Forty years, an anti-meat Czar,
That’s gotta have some value
In the , “It’s good for ya”, category,
I like raw vegetables
Not so much cooked, that’s the story.


I don’t smoke anything
Nor snort, mainline or whoof,
I don’t eat fish or fowl
Or anything on hoof,
Fermented grapes and hops
Oh, surely I do,
Probably just about as much
As the rest of all of you.


So, if Scientists find ways to prolong
The quality of life, in its length,
I’d like to sign up for that
While I work on my strength.


Fibril_late;
9/15/14

Sunday, September 14, 2014

Medical Assistants

Responding to a recent "letter to the Editor".........sort of..........here is my take on the necessity of Medical Assistants.

Medical Assistants

Medical Assistants
Without them, the system would come to a stop!
A necessary cog in the gears of countless Clinics
They are the lubricant
That runs a slick shop,
Vital signs and medical records
Everything operating smoothly or not,
Honor, your Medical Assistants
Or brother, your Clinical Practice is shot. 

Fibril_late;
9/14//14
 Stagnation

East Coast steve
Is really right,
My creative words
Are missing their bite,
Stagnation
That's the word for me,
No excuses count
Stagnated, I be.

Ashlee, blog-comment
Helped show me second sight,
Of course, I had to respond
She put me in a favorable light,
So, Quid Pro Quo
And do unto others,
A Medical Assistant Hi-ho
As if written by their Mothers.


Fibril_late;
9/14/14

Thursday, August 07, 2014

Gravestone

It seems like the most common reason for suicide, or "ending it all", has to do with an emotional disturbance. Sure, persons with intractible pain from some sort of horrid acquired disease fit in the category, but they represent the smallest fraction of life-enders. No, it's those emotions that are the culprit........they lead us astray and into, complicated thinking conundrums.


She had stress
And definitely sorrow, 
So much, she wondered
Will I know a tomorrow, 
That isn't a repeat
Of my miserable day to day,
If my life is like that
I don't think I want to play.

She had a lot of pain
And too many goodbyes,
It's kind of overwhelming
When everyone dies,
Those that mattered so much
At the same time, oh, it hurts,
No Emergency Broadcast System
Has those kind of alerts. 

But wait a minute.....Living
Sure beats being dead,
No matter what kind of nonsense
You have placed in your head,
Because I have met old ones
With seven major diseases,
They don't want to leave
Even the worst of the sneezes. 

Waking up in the morning
On the top side of dirt,
Sure, that seems kind of morbid
But, no matter how you hurt,
You could still make someone happy
And perhaps, alleviate THEIR pain,
Wake up under the gravestone?
Baby, you missed the plane!

8/6/14

Saturday, July 19, 2014

Crashed

Would you believe it? The older we get, the more a bicycle crash hurts! Ouch, I say.

Crashed my bike
And now I'm hurtin',
It wasn't fun
Of that, I'm certain,
Worked the next day
Should have not,
My aches and pains
Need Icy-Hot.

Crashed my two wheeled
Transportation,
Just before
I made the station,
Made a left turn
Should have gone right,
Now I can barely walk
Or ride tonight.

Severely hampered
Range of motion,
I need Left leg
Hip, and shoulder lotion,
With Vicodin and
A cold Blue Moon,
I might be feeling
Better soon.

My Vastus Lateralis
Hurts,
Damaged
Capillary spurts,
Creating one big
Hematoma,
While my gut spits out
A foul aroma.

Did I contuse
My G.I. tract?
I'll get worried
If my stools are blacked,
That happened before
In two-thousand-six,
When I crashed because
Of those Asian chicks.

Crashed my bike
And my body too,
Every biker accepts
It happens out of the blue,
So hard to predict
This fickle finger of fate,
First crash of the year
Worse than a blind date.

Fibril_late;
7/18/14