Saturday, August 12, 2017

Meaningful Abuse


This story ties in a bit with the poem that follows, because it addresses subtle monetary pressures on our business of care and healing. However, it starts out initially, with some of the usual Nursing nonsense we must put up with.

What bothered me this week?
Now let me think,
When our EMR document
Went on the blink,
Charting froze up
Doctors orders went down,
The Gorilla in the corner 
Sat there with a frown.

Why does it bother me?
Well, it always seems to happen, 
When Billy Bob is bleeding
And then he is crappen,
Which he does with a wiggle
A grunt and a push,
And now the blood and the crap
Flow beneath his tush. 

This type of occurrence
Generates a lot of charting,
Describing the features
Of body fluids departing,
Old boy Billy Bob
Whose daughter, does state,
"When we go to the restaurant
He's a heckuva date".

Back to my story
Regarding the EMR crash,
'Tis a national dilemma
That comes on in a flash,
The system goes down
With no warning or threat,
And leaves us up to our elbows
In excrement and sweat.

Yet, we forge on
Relying on Cerner,
Epic and Allscripts
Athena Health and Turner,
Each worth a billion
Or two in the bank,
While Meaningful Use bucks
Are filling the tank.


https://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives


http://www.medsphere.com/resources/news/news-releases/3402-kern-medical-center-awarded-federal-funds-for-meaningful-use-of

Friday, August 11, 2017

CEO's Making Bank


According to Forbes, WSJ and other monetary reporting entities, if you want to be rich, be a hospital CEO. Here is a fun article that describes how our favorite CEO's are compensated, by each patient day in the hospital.

How much does your hospital CEO
Earn for each hospital client?
If everybody knew
Would you remain so compliant?
Knowing how much your daily cost
Goes directly into his pocket,
You might start to dream about
Hammers, nails and an electric socket.

Read this short article
Yes, why not be informed,
On cold winter nights
It is good to be warmed,
By wild crazy thoughts
and dreams of corrections,
Why dudes get paid so much
And all of their collections.

https://www.axios.com/stay-in-a-hospital-pay-the-ceo-56-a-night-2242870721.html

Monday, July 24, 2017

Weight a Minute


A two hour battle post-anesthesia, takes a lot out of me these days. Thirty years ago, no sweat; I was ready to take on Bluto, for 3 more rounds. Except, well there was the incident when Father Time kicked me in the head and caused a concussion.
Now, about last Friday............



When Bennie the Bruiser
Awoke from his surgery,
He immediately acted out
With assault and perjury,
Whereas, before
He was a mellow, young guy,
Post-anesthesia
He’s Godzilla, on the fly.


It wouldn't be so bad
But he's barely breathing,
Then suddenly gasping
Swearing and seething,
Plus, Bennie is big
Topping two-forty pounds,
If I was Mike Tyson
We might go seven rounds.


Oxygen saturation
Just seventy-five,
Gasping and wheezing
When his parents arrive,
To stand by the bedside
Try to settle him down,
Yep, Bennie the Bruiser
Is a meth-user clown.


Little by little
Maybe he's improving,
Gets some gas up his nose
He's resting, not moving,
Now, it's my turn to bother
Removing Femoral sheaths,
Oops, awakened the demon
Now I’m dodging his teeth.


Four people at the bedside
Trying to control,
As this monster of ceremonies
Takes us for a roll,
Bucking like a bronco
While I prevent bleeding,
Thinking dangerous thoughts
Regarding children and breeding.


At the hour marker
I was proclaimed the victor,
An epic battle it was
With a Boa Constrictor,
Yea, I expect a statue
To be erected in my name,
Constantine the Conqueror
Will just add to my fame


Sunday, July 02, 2017

Vitamin Scarapy


Sometimes when the patient talks, I just stand there and wonder what the heck have they been smoking? Astounding stories of non-compliance, and the predictable outcomes, that prove a total lack of common sense.


I chose the vitamin cure
For my viral cardiomyopathy,
According to Betty Lou
Guaranteed by some expert of psychopathy.

See, those pills and potions
Prescribed by the Cardiologist back then,
Made me feel so lousy
I stopped taking them when,
I heard about the vitamins
Promoted by Chiropractor Jerry,
Plus, I read about it on the internet
Carnitine, and dust from a fairy.

Sure enough, I got better
My ejection fraction came up to fifty,
I rolled along on my merry way
Never saw another doctor, Tom Swifty,
Until just last week
I became short of breath,
Tried Flonase for a week
Until I began to feel like death,
Finally went to the hospital
Emergency room,
Ejection fraction 30 percent
3+  to 4+ Mitral Regurge
Vitamin therapy, badda-boom!

At age 64
She did luck out,
Normal coronary arteries,
That's worth a shout,
While husband/daddy/child
Sitting at the bedside with the Yorky dog,
Seemed to be in support of all this nonsense
Like a frog on a log.

She said, she likes the Cardiologist
(as long she approves what he's doing),
I wonder if he knows about the vitamins
And whatever she's smoking and chewing,
Because, I wouldn't cover any bets
On her likelihood, of compliance,
After all, she made up her own mind
In stubborn anti-medical defiance.

I asked about her career
She claimed she was a Nutritional Coach,
Good heavens, I wonder what she has been teaching?
Not likely, the scientific approach,
Yep, those vitamins for Cardiomyopathy
Read about them on WebMed dot tv,
Where you can trust a Hollywood star
To say what's best for you and me.


Someone Dies


Here's a pointer; know where your IV lines are going, know if that vein is functional and patent, and know exactly what drug is in your hand and in that line.............before you add anything new. When you have the time, I.D. those lines.

When you’re reaching for the Lidocaine
The Epi or the Atropine,
The Propane or the Methane
Or maybe even Gasoline,
The Wheaties or the Captain Crunch
The chocolate cupcakes for your lunch.

Be sure you check your vital signs
And ensure the patency of lines,
Because in the midst of great surprise
If you’re not careful, someone dies.

Frisky Fireman


A cure for one kind of depression; or, where there's smoke, there might be a fireman to the rescue.

Just Call 9-1-1

I’m alive, I can’t believe it
I had given up to die,
I’d arranged to kick the frame today
No one cared to ask me why,
I have lived a long eventful life
But foresaw a painful death,
Then I was boldly interrupted
When I took my final breath.

A local family member
Discovered I was prone,
He heard me fall upon the floor
And thought he heard me moan,
In truth, I was rejoicing
It was time for me to run,
Well, then that sucker saved me
He dialed 9-1-1.

A gorgeous hunk of Fireman
Drove right up to my door,
Assessed the situation
And figured he could score,
Attached me to a monitor
Announcing an arrest,
Resuscitated me, Oh Lord
With massage upon my breast.

Aroused I was, and more alive
Than I had been in years,
I clutched that fellow to my chest
And nibbled on his ears,
He had a fancy uniform
That I quickly slashed and ripped,
It was barely thirty seconds
Till that Fireman was stripped.

My cardiac arrest
Was instantly converted,
When the fellow aimed his hose at me
Cut loose and really squirted,
I bounded to my feet
Feeling totally renewed,
I’m going to tell my aging lady friends
That they should all get screwed.

Well, I’ve changed my way of thinking
I’m no longer so depressed,
When I need a little excitement
At first, I get undressed,
Then, with a helpless cry
I dial 9-1-1,
My Fireman comes quickly
And boy, we have some fun.

Contagious


I just want a kiss, that's all. That's not asking too much.

You might say I’m isolationist
I have chickenpox and measles,
I keep bubonic squirrels as pets
And rabid wild weasels,
So why not snuggle up to me
And see if you’re courageous,
I just want a little kiss, please
I doubt if I’m contagious.

Thursday, June 29, 2017

Literal


Sometimes I really take things literally.........

Smokefree vs. Free Smoke

Message on display
At the entrance of our Clinic,
Prompted reflection
(I'm a natural born cynic).

Firearms prohibited
Latex in use,
Smoke free environment;
Weird terms of abuse.

I mean, who can argue
About smoking, if it's free,
A heck of an invitation
At a hospital, whoopee!,
And regarding the latex
That's a turn-on for some folks,
A lot of smirking and giggling
With off-color jokes.

Firearms prohibited
That's easy to understand,
If your arm is on fire
I shouldn't shake your hand,
While considering the risk
Of spreading that fire,
In the presence of Oxygen
It could ruin my attire.

What kind of a hospital
Offers these kind of features?
I guess I'm truly blessed
To be a member of these creatures,
If you're possibly interested
Please submit an application,
Smoking is free, no burning arms
Latex in use.....it's a heckuva vacation!



Sunday, June 25, 2017

A Mid Year Resolution


Ok, we just had the Summer Solstice, so why not an old resolution?


It is the week after Christmas
And not much has changed,
The patient’s are still alive
Though, the staff is deranged,
The Care Plans are filed
In the garbage, with care,
Because we finally realized
They work best in there,
The walls have been stripped
Of their bright coloration,
Returned to the original
Theme of sedation,
The nurses are groggy
Their hangovers linger,
The doctors all look
Like they’ve been through the ringer.

Now, the nurses get hungry
And search for nutrition,
Only to discover
Last weeks edition,
Of half eaten cookies
Green, white and red,
A few dared to eat them
And keeled over dead,
Too bad, said the clerk
Who handles our staffing,
You won’t get replacements
Then she hung up, still laughing.

All  of a sudden
There arose such a clatter,
As all of the dentures
Began to chatter,
Some silver, some gold
Some, even acrylic,
They chattered in harmony
A scene quite idyllic,
Because the ghost of this Christmas
Can’t exit our floor,
We all ate so much
He’s stuck in the door.

So what the Hell, we’ll be haunted
Till Easter, I’m sure,
Our floor will be famous
For a new kind of cure,
We’ll scare the old devil
Right out of their hearts,
And the ones we can’t cure
We’ll sell them new parts.

A New Year’s resolution
“Let Us Optimize Your Health”,
Be it cure or consumption
So we can maximize our wealth!

Tumbling Dominoes


One could keep reincarnating every 25 years as an ICU Nurse, and find the same old problems. We unleash new names for the same disorders, apply similar drugs, wring our hands, and have the same outcomes. Sepsis, Sudden Cardiac Death, 1st MI.........at least 50% mortality. Folks, when the Grim Reaper comes for you, we're not much help. But if YOU are willing to help....go for it.

She has been here several weeks
And had every kind of tube,
Can you believe, she was admitted
For just a Jiffy Lube,
Her heart was sort of sluggish
And her blood was quite anemic,
And so, like tumbling dominoes
Her brain became ischemic,
Combative and demonic
Obesity berserk,
She started busting up the place
And nearly killed the Clerk.

She was dosed with Midazolam
MS and Ativan,
Enough to kill an elephant
It knocked her on her can,
But side effects are side effects
And some can lead to death,
We finally had to silence her
But we took away her breath,
She earned the ventilator
The prize behind, Door Number Three,
It includes a year of tubing
And a Therapist for free.

Her respiratory failure
Brought on Shock and R-D-S,
Why, in just a couple hours
She became a total mess,
Reversible?, it’s possible
But, that’s not the likely course,
We can treat her up the yin yang
But can’t replace her life force,

The woman was a time-bomb
Just waiting to explode,
She had multi-system plug up
From a life on lipid road,
Her triglycerides set records
That will stand for many moons,
She had a steady diet
Of booze and macaroons,
Her husband was no better
He paid the grocery bill,
You couldn’t make them understand
This method of life would kill.

Now, lying here before us
Is a body, life supported,
And we’re rushing around like maniacs
Because her heart beat just aborted,
Thus, it seems a little pointless
To apply our super science,
To a person who spent years
In stubborn, health defiance!

Let the dying die


I wrote this, at least 25 years ago; and the issues and dilemma's of dying are still the same. We do make progress, but death must happen.

Time to Give In

What more can we do for this man
Despite all of our science, he’s dying,
We have done all that we possibly can
His family, so anxious and crying,
But alas, the time comes
When it’s time to give in,
To continue the treatment
Would be a merciless sin,
Prolonging the suffering
With no hope of reprieve;
Let the dead go their ways
So the living can grieve.

Monday, June 19, 2017

The Virtues of Floating


Here is a classic from 20+ years ago. Look, must nurses don't want to float off to another unit. They suffer anxiety regarding their skill set, and feel out of place, and worry about what the folks in that other unit might say about them.

Fortunately, since 2012, I have not been required to float.

I like my job now, well enough
But mind you I’m not gloating,
It has a dirty side to it
The multi-unit floating,
By and large the frequency
Is few and far between
But when it’s time to do your stint
It can be a messy thing.

Now, consider this my friend
You’re floated to Emergency,
The last place that you want to be
If suffering from urgency,
The place is non-stop madness
All bloody night and day,
Those nurses must be crazy
Because they don’t get combat pay.

Or maybe you’re more fortunate
And floated down to Burn,
You’ve got some guy with roasted flesh
And you’re afraid to turn,
Him over in the bed, in case
His skin grafts crack or flake,
Because you know that you’ll be crucified
Then roasted at a fiery stake.

Neuro ICU is like
A foreign land to me,
A lot of spinal action
And labile ICP,
The unsedated wild men
Are screaming out in pain,
They were motorcycle maniacs
And now have scrambled brains.

Is floating any better
In the Medical ICU?
Where microorganisms
Stick to you like glue,
Where charcoal spewing overdoses
Ruin all your clothes,
And G.I. bleeding alters
The function of your nose.

The Surgical Intensive Care
Is different in some respect,
The doctors are fanatics
About the drainage you collect,
Specific gravitation
And countless pus filled drains,
Provides ample entertainment
For all their busy brains.

In CCU it’s different
You must take a vow of silence,
The nurses aren’t restrained
But barely stoop to violence,
The patient are well mannered
But sometimes give you crap,
Just charge the paddles to 100
Then, defibrillate their lap.

All in all, the general feeling
To float, I’d rather not,
To save a lot of misery
Why not have me shot,
Or hang me by my fingernails
And whip me with barbed wire,
You’d better find another fool
I’d prefer to walk on fire.

An Apple a Day


I have unearthed a trove of ancient writings..........

An apple a day
Keeps the Doctor away,
But if you’re always pissed
Just see a Psychiatrist,
If your insides hurt in earnest
I suggest a good Internist,
And if your ankle had a twist
Go question a Podiatrist.

If you see your brain emergin’
Find a capable Neurosurgeon,
If your birth control was in omission
You’ll need to find an Obstetrician,
Should your bladder leak, oh, golly gee
You ought to see Urology,
If your busted femur needs a rod
You’ll need to visit an Orthopod,
And if you suffer from seismology
You better go to Radiology.
_ _ _ _ _ _ _

To Buy a Cure

I drank a lot of alcohol
And blew a lot of smoke,
My liver said, the hell with this
And my lungs began to choke,
My heart is doing double time
And my renal function is poor,
Oh, if I had a billion bucks
I would try to buy a cure.

My bones look like Swiss cheese
That I used to eat on rye,
The ultraviolet rays I worshiped
Wrecked my one good eye,
My libido was revoked
And my sex drive was recalled,
Because, when I raced my engine
It overheated, then it stalled.

The flukes in my intestine
Are thirty meters long,
While a host of other viruses
All sing a little song,
Hail, hail the bugs are here
Crawling in my belly
Coming out my ear,
Hail, hail this guy is dead
What the Hell do we care
As long as we’ve been fed.

And thus, my body fails me
I can feel the hangman’s noose,
I wonder if there is a connection
To this lifetime of abuse.
_ _ _ _ _ _ _ _

Jamming on the Joules

She died, she died
There’s no denying it
We tried,
To save her broken body
And fix her busted heart,
We tried a lot of crazy things
But couldn’t make it start.

We gave her Digitalis
Some Quinidine and more,
Dobutamine and Dopamine
And even Inocor,
A trial run of Nipride
To reduce her afterload,
But she bottomed out her pressure
On the rollercoaster road.

She had total akinesis
With a low ejection fraction,
And to complicate these matters
Had arrhythmia distractions,
At first we gave some Lido
Then Pronestyl and the joules,
She was jamming on 360
As if to say, You fools,
For every problem that you treat
I present another three,
Because the Reaper is standing at the door
He has come to set me free.
_ _ _ _ _ _ _

Humble Student

Talking about conduction
Regarding the upper and the lower,
The former is the faster
And the latter is the slower,
See, sometimes there is a stimulus
Lost in its own travels,
And before you get a chance to breathe
That impulse just unravels.

It can follow any pathway
If the guidance system is shot,
If you fail to snare that sucker
The rhythm will be naught,
So be sure, oh, humble student
To heed the wise instructor,
Because a heart without a rhythm
Is like a train with no conductor.
_ _ _ _ _ _ _ _ _ _ _

Serious Impactions

Oh, Mr. Jones you fail to see
The error of your actions,
A diet low in fiber leads
To serious impactions,
On top of that I’ve noticed
You don’t drink enough to spit,
Now you find you can’t eliminate
You’re so full of it.

There is but one consensus
Your innards must be reamed,
We’ve got a new technique
We’re gonna have you steamed,
It involves a high tech nozzle
Inserted in your gut,
Then we tape a hefty garbage bag
Securely to your butt,
The countdown then commences
As we hoof it down the road,
We have to go some distance
Just in case you might explode.

You know, we’re not to sure
About your chances of survival,
But the competition is fierce
With a scientific rival,
Who is working on a similar
Device to clear the crap,
It’s a vibratory mechanism
Placed upon your lap,
It bombards the microvilli
With microsonic hits,
It has a lifetime warranty
And guarantees the shits.

We apologize, posthumously
We didn’t clear your load,
Unfortunately, Mr. Jones
Indeed, you did explode,
Rest assured, you are remembered
For serving all mankind,
And all of those that follow you
Who find they’re in a bind.
_ _ _ _ _ _ _ _ _ _ _ __ ___

Phaht

Phaht, is but a word
That conjures up many visions,
It confronts a lot of people
With everyday decisions,
Phaht, a simple concept
That shares a lot of weight,
It can generate emotions
That stretch from love to hate.

Phaht, an easy word
That requires little breath,
Yet is powerful enough
To influence life or death.

Phaht, a weighty subject
No matter what your view,
Be cautious when you speak of it
Some day it might be you.
__ __ __ __ _ _ _ _ _ _ _

Niacinamide

Did you ever take
Too much niacinamide,
In minutes you discover
You are scratching off your hide,
It somehow makes you itch
On a scale that's microscopic,
It gets around quite quickly
In the system circulopic,
Blessedly its half-life
Is fifteen minutes short,
If not, I would worry
That the flesh would just abort.
_ _ _ _ _ _ _



Tuesday, June 06, 2017

The Toughest Break


My hot job is apparently being phased out. In some respects, it did look too good to be true, but I did the best that I could while I was there. I think some thought mavens have deduced, that there are some limitations to my position (I'm not supposed to take a patient assignment; just do breaks). Anyway, once I heard about it, I had to jump on the bandwagon and find something else. The tough part, is leaving the crew I have been working with, for the past 14 months. I enjoyed being a part of the team (and can only hope they will muse about the "good old days" when they had a dedicated Break-Relief Nurse).

Here is my farewell:

I enjoyed every minute
Except, just one,
It was back at the beginning
But all the rest was fun,
And do understand
I'm not leaving for that reason,
Nor was it excommunication
Or treacherous treason.

Whether rumor or fact
The position is phasing out,
I couldn't wait
Till I heard the last shout,
Nor could I accept
A return to the bedside,
In ICU; just one step
From the dead-side.

Don't take it personal
It's not about you,
But rather, the clients
The drug-addled few,
The revolving door return
Of non-fixable folks,
I think I might go postal
Attending to those blokes.

My injury risk
As a bedside punching bag,
Dead in the sights
Of some murderous nag,
Who is on the steep downslope
Of Delirium Tremens,
Like gargling with razor blades
With a chaser of lemons.

Proning and flipping
On a whim for mankind,
CRRT and ECMO
You must be outta your mind,
Level-1 transfusions
And fourteen vasopressors,
On a DNR Grandma
'Twould be better just to bless her.

Sure, it's not all that
No, sometimes it's more,
ICU nursing these days
Is a death defying chore,
In for a penny
And ten diseases for a pound,
A lot of dubious solutions
And endless problems all around.

What I will miss?
All of that stuff,
Imagining 12 hours of it
I'm not tough enough,
To maintain my poise
And my youthful good looks,
Thus, I return to the Mother ship
To drink coffee and read books.

The saving grace?
One's comrades at arms,
You are a powerful group
Defying numerous harms,
With synergy and camaraderie
Good fellowship and fun,
Working together
Like a well oiled gun.

And so on, henceforth and furthermore
Gotta go, slipping out the back door,
Fourteen months, didn’t seem like a chore
And God forbid, hope I didn’t catch a spore!


Monday, June 05, 2017

Dutch Jones Disease


Poor old Mr. Jones, always coming down, or happening to, some kind of horrid ailment. I caught up with him back in the gay old nineties. Let me tell you about it:


Mr. Jones, I gotta tell you
You have a strange disease,
You’re the first man to succumb 
To a virus that kills trees,
Your symptoms are unusual
But our data is pretty thin,
As a tree would shed its bark
We note your flaking skin.

Your gait is quite unsteady
As you stumble in your boots,
There’s a striking similarity
To a tree with rotting roots,
And like autumn leaves that change
Drifting through the air,
We notice the alarming rate
You’re losing all your hair.

Though the cause is not determined
There is but one straw that we clutch,
You share a common ancestry
The tree and you are Dutch.


Sunday, May 28, 2017

Come Pliants


Apparently our metrics regarding Customer Satisfaction were abysmal again. So naturally, blame the Nurses. Everywhere in the good old USA, Nurses have to put up with this corporate BS. Essentially, management would love it if we girls would just remain easy and compliant, and always do what daddy says. I say, fuggedaboutit !!!

Come Pliants

I missed an appointment
Two times already,
The Nursing Bungle
That's the name of it, Freddy,
I guess the powers that be
Think we all need retraining,
If our profits keep dropping
They'll start again, with the caning.

Flogging us daily
A customer service reminder,
Do your hourly rounding
And always be kinder,
Remember the 4-P's
No Pass Zone and AIDET,
If I was sure there were refreshments
I probably would have made it.

I've been told I'll be paid
For this mandatory class,
But that doesn't mean
It's not a pain in the ass,
I just think we'd do better
Without our billion dollar advertising,
Invest in the employees?
The results might be surprising.

Instead, they hammer away at us
Regarding the metrics they measure,
Reports of satisfaction
Give executives pleasure,
They throw a big box of money
Focusing attention on our image,
While kicking around the employees
Like a sandlot scrimmage.

Well, I'm not so compliant
Though I am persistent,
I balk at coercion
With intent to be resistant,
When workers are badgered
Threatened and harassed,
Perhaps, that's why I forget
Until the appointment has passed.

I don't want to participate
In this customary nonsense,
Nurses are not to blame
For the usual offense,
Better to focus attention
On the business design,
Management, listen to our voices
Collectively, we decline!



Thursday, May 25, 2017

Just Another Fad


Here is a FAD you ought not to bother with.

FAD

Familial Aortic Dissection
If you don't know you have it
You have no protection,
Just when it will strike
No one really knows,
So you better be careful
What you put up your nose.

Familial ascending
Aortic dissection,
A genetic mishap
Of cosmic selection,
You better have a good surgeon
One who knows what he's doing,
It's a little more complicated
Than light bulb screwing.

Wednesday, May 24, 2017

After the tissues, monetary issues


Pass the Gate

It was a quick death
When he lost his breath,
A short goodbye
Because he had to die,
He hitched a ride
To the other side,
And waved his palm frond
To the great beyond,
And took a key lime pie
To that place in the sky.

St. Peter said,
Did you bring the bread?
You mean Heaven, ain't free
You gotta be kidding me,
He said, just because you died
You don't get a free ride,
If you want to pass through my gate
You better fill the collection plate.

Terminology Murder


I do break-relief in two ICU's. I read the charts of all those patients that I interact with, because I need to know what I'm dealing with for that one hour. This knowledge also allows me to contribute pertinent assessments, to assist the staff member I'm working with.

Bottom line; I read a lot of charts. I have decided to place some attention to the use of home-made Medical Terminology, those abbreviations that are not included on the standardized lists. Essentially, these are unique notations, understood by only that person who is doing the documentation. No nurse wants to end up in a court, arguing about what they were charting on that dark and stormy night; especially, when they were using unauthorized charting terminology.

Medical terminology?
We must agree,
To use the same terms
One, two, three,
To share information
Promotes understanding,
Or we’ll see you in court
And be more demanding.

GUOP, what is it?
Is it something you ate?
Might be GUacamole
On an Outdoor Plate,
And why chart it twice
How much urine amounted,
When it was entered on I & O
The running tally accounted?

Prop for sedation
Now what does that mean?,
A couple large pillows
In a stage-play scene?
When you charted it already
In the IV Drip roster,
In terms of documentation
You are an imposter.

S/W, makes me wonder
Did you mean Smith & Wesson?
What kind of a shot?
Please don’t keep us guessin’,
Because the family wants to know
How Billy-Bob died,
MDR completed, coninue poc
That’s what they cried.

Bld clt
Might have been talking
About me,
I belong to the bald cult
Check Facebook
You will see,
Might have meant
Blood culture
But it’s not our terminology,
Once again, your charting
Approaches pathology.

*  *  *  *  *  *  *  *  *  *  *

GUOP…………..good urine output
Prop…………….Propofol
S/W..................... spoke with
MDR completed, coninue poc…………(What did this convey?)
bld clt...................blood culture

One Ideal Leads to Another


Nice and proper, litigation averse charting; that's what we are taught.

Pretty Nice Terms

All of us are coached
In Nursing school class,
To say anal discomfort
Not a pain in the ass,
We say, you are combative
Not a son of a bitch,
Your wife is unruly
Not a low class witch.

Yes, we pamper our language
In pretty nice terms,
You are infected with Ascaris
Better known as worms,
You ate uncooked pork
With your fermented grain,
Acquiring Cysticercosis
Larvae in the brain.

We leave it to you
To tell your wonderful story,
Hello, Social Media
For your fame and glory,
You don’t need good looks
Just take a picture of your worm,
You’ll get millions of likes
And make everyone squirm.

Tuesday, May 02, 2017

Valve Job


Another moral tale: The Valves of Meth.

He was twenty nine
When he ruined his valve
And had it fixed in our garage,
Now eighteen months later
He did it again
With another
Drug fueled barrage.

He came back to the same old Surgeon
Who offered a second dance,
Declaring, you stupid young punk
After this, you get no third chance,
He is polite and innocent looking
Appearing younger than stated age,
But the drugs
Have ravaged his organs,
He is now at the 99th page.

Clearly, his Mom
Wants the best for her punk,
She thinks he is retrievable
Although he's strung out on junk,
She drove him from one hospital
And brought him to us,
We're the best Cardiac
Says the sign on the bus.

A sad, sorry story
Of a Methamphetamine user,
A slow kind of suicide
For the drug abuser,
Ingesting powerful stuff
Unknown ingredients, the issue,
Whatever strange concoction        
Wrecks your organs and tissue.

What is the likelihood
That he will get clean?
Stop snorting dirt
If you know what I mean,
The odds are not favorable
But we'll repair him just the same,
We taxpayers got it covered
Because billing is the game.

Friday, April 21, 2017

Trust Someone

Trust that my awareness is on my patient's on the job

Who is the first
To get up from their chair,
When alarms are ringing
Anywhere,
This is the one
I can probably trust,
They are listening
Because we must.

To be your Nurse
Means that my awareness,
Should be totally focused
On you, in all fairness,
Because we are here
To attend to your needs,
If my attention wanders
Maybe somebody bleeds.

We are duty driven
And morally inspired,
To perform at our best
Until retired.

Thus....
Turn off your devices
When you come to work,
Check later for updates
Don't be a jerk,
Secretly viewing
When you know you shouldn't,
We could fire you
Don't think that we wouldn't,
You reviewed the policy
On your hire date,
Electronic entertainment
Is tantalizing bait,
That could lead you to
The unemployment line,
When Billy Bob is calling
In room ninety-nine.

Thursday, April 20, 2017

Seatbelt

Pretty much, auto seat belts have been a safety requirement on our American cars since 1966.
Now it is 2017, and if you choose not to wear a seat belt, and drive your car and crash, you are the fault of your injury. Don't try to pin it (to get money) on anybody else. You are the fool.


I didn't wear a seat-belt
Because I'm young and pretty,
Till I rammed that metal pole
Now, I'm one dead kitty.

I didn't wear a seat-belt
Because, what could go wrong?
Now I'm singing soprano
An angel's song.

I didn't wear a seat-belt
Because I was too busy,
Now I'm floating up in the clouds
And feeling kind of dizzy.

I didn't wear a seat-belt
Because it pushed on my breast,
And because of my stupidity
I earned eternal rest.

I didn't wear a seat-belt
Because I'm a good driver,
Now I'm up in heaven
An early arriver.


Monday, April 10, 2017

My (hopeless) Journey


MyJourney is the name of the software application that delivers the bulk of our required yearly hospital education. It is nothing like a journey, it is not a vacation, and we certainly don't get to choose the island. I discovered today, I can do it all in the safety of my home........and they better pay me for it, too.

Oh, I'm such a happy
Old fool,
Lying here
Next to the pool,
Spending the day
On MyJourney,
Wishing instead
I was an attorney.

I could bill for
Hundreds of dollars an hour,
While sipping away
On whiskey sours,
Dreaming of sugarplums
Dancing at the bank,
Instead I'm on MyJourney
In a blitzkrieg tank.

Firing away
At educational objectives,
I don't have much choice
To be very selective,
If I don't show effort
Or participation,
I'll be, persona non grata
At my nursing station.

Friday, April 07, 2017

Another Bungle


Uh, oh, rumor has it another Nursing Bundle is about to be jammed down our throats. I heard one of the ANS crew talking about it last night, and the religious fervor she exhibited while sharing the "good news" (and dismal statistics) had me running to my creative writing space, to contemplate, Nursing Bungle #2.

The Nursing Bungle requires a testament of belief
Give all of the appropriate answers to avoid any grief,
It's not an annual Revival, but they would do it if they could
Gather around the campfire boys, because the bungle is good.

This latest Nursing Bungle contains all the new thinking
Grandiose ideas to keep this ship from sinking,
And with new management in Washington you better hang on to your seat
Next time the Nursing Bungle will be delivered by tweet.

Excitement is high, at the place that I work
Unveiling the new Bungle with a wink and a smirk,
Promising wonderful top-notch Avatar Scores
Whiz-bang H-CAHPS, and C.Diff. s'mores.

Oh, I can hardly wait to travel on My Journey
After 8 hours of study, they'll transport me on a gurney,
Down to Radiology, for the implants in my brain
I'll be a Nursing Bungle Cyborg, with a built-in ball and chain.




Thursday, April 06, 2017

Out of Rhythm


Well, I caught another Rhythm interpretation screw-up and it's a doozy. From what I can see, nobody really cares, but I have fun doing the research and exposing the fraud.
.

Here's my report:

It bothers me
When I do see,
A misinterpreted
EKG,
I can give a pass
To untrained Docs,
Who specialize
In Chicken Pox,
But Cardiac nurses
And their monitor crew,
Should nail every rhythm
In their purview,
Because that is a skill
Required of them,
And when they blow the rhythm
I say, "Ahem"!

How could you call that strip
Atrial Flutter,
When there is a "P"
"T" and "U" wave
You're some kind of nutter,
A rhythm so slow
With a triplicate block,
'Twas not even A. Fib
You got your head in a sock.

Ah, woe is me
And Auntie Em,
Under the watchful eyes
Of the likes of them.




Friday, March 31, 2017

Infusion Pump Apocalypse


From the "New Brilliant Stuff" Department: (jokes and more)

Consider the similarities:
Q: A Creamcicle ice-cream treat and the IV tubing used for hanging a piggyback medication.
A: The Creamsicle........you suck on dairy;
      The IV tubing set is called a Secondary.

Admission Database question:
Q: Have you ever had an infectious disease?
A: No I haven't, but some people say that I have an infectious laugh.

- - - - -

Here is a retirement business (or hobby) that I am considering:
I will have a sideshow / shooting range or even a mobile unit, perhaps a repurposed mobile home. At this location, Nurses will be able to shoot the weapon of their choice (Sig Sauer, Desert Eagle, Mossberg shotgun, you name it) at old, retired IV Pumps. Heck, I'd be more than willing to pay $20 for a chance to do that. Just think of the satisfaction you could have, sending one of those infernal beeping monsters, to it's bloody grave.

Stay tuned for the Infusion Pump Apocalypse!



Incompetent


Incompetent employees exist to make all of the rest of us look really good? Now that, is an interesting theory.

The truth of the matter, is that incompetence should not be rewarded, by allowing that individual to remain in their job. Some folks never improve, and as any industry changes and moves forward, Joe Bob the Incompetent, becomes a dangerous liability. Employers should have a contract clause that states, “JB, if you don’t learn the new stuff that is expected of all employees in your department……...YOU ARE FIRED!

The Headmaster
Turns a blind eye,
Intentionally ignoring
The incompetent guy,
The one who hasn’t kept up
With the changes in Nursing,
Every day that he works
The experts are cursing.

The Assistant boss
Ponders other things instead,
Ignoring the possibility
A patient might be dead,
Under the care of
Incompetent Billie,
Boss holds the thought
Oh, that’s just too silly,
Figuring the other nurses
Will keep an eye on that punk,
But, everyone else
Would like to throw him in a trunk.

Incompetent Billie
Types with a single digit,
If you’re standing nearby
Oh surely, you will fidget,
Watching with frustration
As he searches for each letter,
He skipped typing class in High School
He never gets any better.

Perhaps Billie believed
It’s all rumor and hype,
Someday I won’t be writing
That I will have to type,
So, why should I bother
To learn any new stuff,
Patients are just people
And I know enough.

For eight years now
Billie has restated,
I don’t have enough time
And it’s so complicated,
I can’t take another patient
Because I’m too far behind,
Floundering on the keyboard
He appears to be blind.

Your career in Nursing
Exceeds twenty years,
But watching you work
Doth bring me to tears,
You don’t know jack
And you ask me every day,
“How do I chart this
They didn’t teach me, no way”.
            _  _  _  _

When I ran to the break-room
Stating, “Oh, I think I saw my son”,
I was really going to my locker
To retrieve the loaded gun,
That I keep there for emergencies
And that time has come today,
Goodbye, Billie
Let me assist you, on your way.


Saturday, March 18, 2017

No snacks.............worth eating


The graham crackers are gone from our Patient Nutrition Snack drawer. In our two ICU's and also over at Trauma and SICU where I visited last week. What's up with that? In my opinion, and I am sure, many other Nurses would agree, Graham crackers and Peanut butter have been a regular option in our Patient Nutrition area, in our "pantry"for nigh, 40 years. Now these items are gone. There was no warning and no explanation from the Dietary Dept, so I'm thinking it was a result of the "higher-ups" slashing costs, just like our knuckle-head in Chief. It's the equivalent of pulling the funding for Elderly Meals on Wheels! If I am ever in the hospital, I won't eat any darn thing on that menu. My mate (or support group) will be responsible for providing me all of my nutritional needs. I'd rather have TPN than any of that hospital garbage (meals). Only the Graham crackers would be acceptable.

Folks know that I never, ever eat anything from the cafeteria. I did it once, about 8 years ago........and very likely had food poisoning. That's 38 years of passing up hospital food.

Graham crackers are gone
What's up with that?
It's not like anyone
Was getting fat,
From a couple little packages
Maybe a one ounce portion,
Human kindness in action
Oh, what a distortion.

No graham crackers
No peanut butter too?,
The whole world is not allergic
Probably not even you,
Plus, the sorbet is missing
Along with ice cream,
Our human kindness menu
Will make you want to scream.

Yep, we're going out of our way
To satisfy your appetite,
When you want a little snack
In the middle of the night,
And all we have to offer
Is pudding and jello.
Plus, an old turkey sandwich
Its color, chrome yellow.



More Items Branded


Our Big Brother agency, is still placing their colors, branding, kindness logo's on everything, except.............the vomit bags. Everybody in the worker force now has their own special color and we are "given" a number of outfits (uniforms) per year, so at least that might be a perk. But wait, there's more; I bet you haven't heard about the Human Kindness Underwear !!!!...........Look for them soon at Ross.

Magical Frog

Diggity branding messages
Even on the soap,
Back when we were CHW
We had soapy Pope-on-a-rope;

But the Pope was excommunicated
And now the suds are alcohol,
With gentle soft emollients
But friends, that isn't all......
Now, you can get two more
With a nail brush, that's no jive,
Six dollars shipping and handling
For nineteen ninety-five.

And if you call right away
You're one lucky dog,
Within sixty minutes
You'll get a magical frog,
But that's not all
We have more to share,
Are you ready for the latest?
Human kindness underwear.

Tuesday, March 14, 2017

Gourmet Thrombus


Do remember, when travelling in planes, trains or automobiles, to stop now and then for a simple walk. Wear support hose, and maybe even take a baby aspirin
(ask your Dr., of course).

Another big story
About a very large man,
How truck driver Bob
Just sits on his can,
Hundreds of hours
Week after week,
He eats far too much
He's an overweight freak.

A heavy tobacco user
He breathes his own second-hand smoke,
Driving the long haul
It's a wonder he doesn't choke,
With the windows rolled up
Like he's afraid of fresh air,
He has nicotine stained fingers
And tar in his hair.

Science has taught us
That long periods of sitting,
Are about as physically demanding
As a knitter at knitting,
In that sit down position
On an airline or a bus,
You have a high risk to develop
A Pulmonary embolus.

One thirty five kilos
Driver Bob, is pretty big.
He stops at the trucker diners
And eats like a pig,
These are not gourmet restaurants
They use the cheapest ingredients,
Lard, salt and sugar
Because it's expedient.

For sure, it satisfies cravings
Big men in 18-wheelers,
I'm not saying their work is easy
But these are heart attack dealers,
Stopping at Cafe' Cholesterol
Fill up their bellies, and refuel the truck,
And if they happen to get sick?
Just call it dumb luck.

Truck driver Bob, had pain
Man, he was aching,
In his legs and his loins
He was practically shaking,
Like that place on his flank
When he had that kidney stone,
But then he waited two weeks
Before he picked up the phone.

He went to Emergency
The man was in dire straits,
His thinking was all messed up
Couldn't remember any dates,
About what exactly happened
And when did it start,
All he knows, he kept on driving
He was in denial; not very smart.

The Cat scan did show
A massive venous clot,
From Inferior Vena Cava
To the Femoral shot,
His legs and his scrotum
Swelled up like balloons,
Plus, he was already built
Like a giant pontoon.

Did I mention that he weighs
One hundred thirty five K,
That's three hundred pounds
In the middle of the day,
About the size of three
Asian, new Grad nurses,
Who are mumbling
Into their iPhone's,
Obesity Curses.

TPA and Heparin drips
In bilateral Femoral lines,
Trying to dissolve big thrombus
Without infarcting his spine,
Absolute bed-rest
Be observant for emboli,
If they migrate to his lungs
Trucker Bob, could easily die.

That would be a memorable
CPR,
Like doing chest compressions
On a Mini-Cooper car,
Rarely successful
Even in the ICU setting,
Odds makers in Jersey
Are already betting.






Thursday, March 09, 2017

Fake News


Fake news, Part 2. Sure, we in the public have been beat to a pulp with this non-news story of fake news. It has always been around, but now, the concept is being used as a tool for harm.

Consider this "news" that isn't:
I graduated from an accredited California Nursing school, in 1983. The school diploma did not specify that it was in Nursing, but rather just an AA degree.

Imagine my surprise, when some dweeb from Corporate, the one who looks at Point of Care device authorization, apparently caught sight of my nondenominational AA degree, and said to himself, "Hmm, this guy didn't go to Nursing school". After a couple more dull moments, he must have thought, "I gotta inform someone". He fires an alarming email off to HR, my ICU Manager, and a couple others who might care. And finally, a copy came to me, but not from the Dweeb himself. I mean, why bother to ask me in the first place, when I might be the guy who has qualifiable supporting documentation that I am really an RN, that went to a real Nursing school.

Here is a story
Of epic distortion,
How the facts of the tale
Were bent out of proportion,
To present a version of truth
With no hint that it is factual,
We call this false news
And present it as actual.
_ - -

I'm not letting this one slide.

Signed,

Faked out in Fargo



Saturday, March 04, 2017

Clean Out


GoLytely, is not lyte! They should have called it, "Drink Soap and Crapalot"
Well, times have changed, and for the better.


Clean Out

There will come a day
When you need to empty out,
Well, I discovered a remedy
I could publish and shout,
But, if I were to do that
I would certainly lose my edge,
And the next thing you know
I could be hiding under a hedge.


Hedge fund managers
Would be chasing after me,
They want to tap into my secret
Regarding this intestinal evacuee,
It's a multi-million dollar
Investment cycle milieu,
There is a lot of shit to spread around
And it all begins with YOU.


Some things are very sensitive
One can't inform the general population,
After all, I could really profit
From bowel medicine exploitation,
No more Golytely preps
With that vague citrus taste,
Whereby, most prescribed users
Will lie about, how much they waste.


It might seem drastic
Regarding what you do,
When you need to promote
Digestive doo-doo,
It's a method and a madness
And it really works, you'll see,
If you want to know about it
Step right up, and pay the fee.


Switch back and forth
A cup of tea, a cup of beer,
After four rounds of that
The toilet you will fear,
And after seven sit-downs
Take a glass of purple wine,
Your day will be complete
When you're flowing loose and fine.


There is one more ingredient
It can not be mentioned here,
It may foment religious commotion
And rile folks, with fear,
So, if you want the complete remedy
Just send me twenty dollars,
You will receive the secret Mojo
Known to very few scholars.


We take all major credit cards
Anything debit, that’s for sure,
Food stamps, cash, aluminum cans
Any questions?, read the brochure,
Anything recyclable
Goes to a local buyer,
Together we're custodians
Our Environment, Doth Inspire!


Your G.I. Doc, will recommend
GoLYTELY, for purification,
Please think of us, consumer
For a clean-out kind of vacation,
It won't seem as crazy stupid
As drinking a gallon of soap, 
Plus, you'll get a little buzz
Along with a pleasant sense of hope.