Thursday, June 28, 2018

Epic Details


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

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

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

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

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

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

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








Betty and Sue


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

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

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

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

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

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

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

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

Obesogenic


From the not-so-new word Department:

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

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

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

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


Listening Lost


This is the story:

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

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

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

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

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

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

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

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

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

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

Sunday, June 24, 2018

Hair Appointment


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

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

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

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

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

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

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


About the Underside


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

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

Shout It, Speak It

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

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


Tuesday, June 05, 2018

Inspired


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

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

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


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


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


Friday, June 01, 2018

The End is Nigh


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

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

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

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

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

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

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

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

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

Tuesday, May 15, 2018

Squirrel


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

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

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

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


Saturday, April 28, 2018

Employee Survey: Anonymous?


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

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

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


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

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


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

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


Saturday, April 14, 2018

The Old Guard


If you've worked anywhere, and found some way to survive your less-than-perfect work place, bravo to you. Why? Because we're all human and no job is perfect. We all have to put up with all kinds of convoluted nonsense in healthcare, and usually somewhere in your career, you will have worked at the best place for you.

And then, there is the "new" employee, with some kind of stupid crusader attitude. They come to the job, and think the place is super dysfunctional (and it might very well be), and figure all it needs is their insight, and "how we did it back home" and they begin to raise complaints, regarding all the stuff that the rest of us know, that are almost impossible to change. The outcome is very predictable......our place of work, spits out that irritating rotten little bit of noise (sooner than later).
The betting pool is warming up on how long that will take...............

Newly hired employees
Arriving at deeply entrenched places,
May try to change the old guard
Make big statements and hard faces,
While ruffling a lot of feathers
And raising up dander,
Eventually this mess
Will lift the hackles of the Commander.

With your prodding and complaining
How this place of work is busted,
Your turmoil is so toxic
That you can't be trusted,
Thus, the outcome is usually
New employee will implode,
Sonny, you can't beat the system
Get the message? Hit the road!


Saturday, March 31, 2018

Unplanned Descent to Stupidity


Sometimes, I'm behind the times. Apparently back in 2009, some genius came up with the definition of a "Fall", as: An Unplanned Descent to the Floor".Yep, that was pure genius, and how did I miss such a gem as that. Things like that drive me to research, and I won't bore you with the details. But, here is my poetic rendition and assessment.

I am not sure how I missed
The definition of the year, in oh-nine,
Back when someone redefined "Fall"
They must have drank too much wine,
After all, who could possibly imagine
This would be the slogan at the door,
Nurses, be on the lookout for:
An; "Unplanned descent to the floor".

It must have been a Nursing Educator
That came up with that,
Any sensible staff nurse
Would keep it stuffed in their hat,
To utter something so stupid
When Billy Bob slipped on his pee,
"Hey, stop your unplanned descent to the floor
Weren't you listening to me?"

Now, Nurse Suzy has to call Risk Management
Fill out an IVOS, to explain the score,
Was the Unplanned descent to the floor
Truly unplanned, or was Bluto helping with the chores,
Trying to mop up his mess
As mentioned in stanza # two,
This was a "PLANNED descent to the floor
He was just trying to help you.

As usual uppity-mucks and big associations
Are driving up costs, and pushing down nurses,
They don't see it that way
Because it does line their purses,
To create all kind of surveys
Along with metrics and tools,
And when you call a Fall
An unplanned descent to the floor,
We nurses know, we are guided by fools.

Friday, March 30, 2018

Titration Dedication


Historical background:

In my current job arena, I rarely encounter any kind of vasoactive "IV drip"; why would I, we're just a prep & recovery joint. Only rarely, a TAVR recovery might be on a Cardene drip, or maybe someone with acute bradycardia or heart block, might be on Isuprel or dopamine, but that's it.

I was thinking back to the old days (actually still the new days), and how drip-titration, in the setting of a profound state of shock, is a delicate and risky endeavor. I remember with my early forays into the ICU setting, titrating vasoactive solutions, was like some mysterious science only understood by the Gods. Well, after a lot of critical care classes (Thank you! Deborah Tuggle), countless hours reading medical journals, textbooks, going to symposia, on and on (still to this day) I'm pretty sure I got the hang of it.

Titration of chemicals
Is a fine and delicate art,
As a critical care nurse
It requires education
and practice, in part,
To learn the subtle nuances
Regarding properties of drugs,
Factor in the complexity of illness
For now; leave out the hugs.

Only dedicated clinicians
Willing to study, practice, and improve,
Should be allowed into this realm
It requires more than moxy and groove,
Where vitality of life shifts delicately
'Tis a risky balancing act,
And if I'm your Boss, and see you on the cell-phone
Billy Bob, your bags are packed.



Wednesday, March 28, 2018

Hack Attack


Fooey, I finally have to admit that the Big Bad Wolf from Influenzia, stomped on my house with me in it. My mate thinks I'm a wimp, as she wonders every hour, if she should just call 911, and get it over with.

My thermoregulation
Broke down at the station,
After double daily fevers
I am now an unbeliever,
Hot and cold without control
Shivers, then I sweat,
Now five days running, I'm worn out
And it isn't over yet.

Calloo, calay, this ain't the day
To be playing at the park,
For every minute that I work
I need four more in the dark,
To overcome exhaustion
It's too crazy, but it's fact,
Good thing I took the week off
'Cuz my homeostasis was hacked.

Monday, March 26, 2018

Health Insurance Dropkick


About 20 years ago in our region, there came to be an HMO carrier, set up by local hospitals, to better control costs. (Mercy Medical Group, North Bay Healthcare, and UC Davis Medical Group). Now, starting this year, WHA and the UC Davis Medical Group, have parted ways, in respect to health insurance reimbursements. I'm not really sure how many subscribers are effected, but I am one of them.

5000 Customers

I can't see my Doctors
WHA won't let me,
I had a great team
But I think they'll forget me,
The University told WHA
They don't reimburse enough,
So they dropped 5000 customers
Said, "you don't like it - tough!"


l miss my skin doctor
We had a lot of fun,
She instructed, "wear a hat"
When you're out in the sun,
And at every appointment
Froze some of my skin,
And when the students took part
I felt like Huck Finn.


I Got the Fever


Three days of misery now, and my mate doesn't seem so happy; neither are my alveoli.


There is nothing cute
About acute bronchitis,
My alveoli are screaming
Something did bite us,
And we're drowning in goo blobs
Thicker than snot,
Well, we have a solution
We're going to cook this stuff hot.

Fever
For three days running,
Worse than a tanning booth
Or Riviera sunning,
Cooked right crisp
My wife said, you're a hottie,
You're making the bed too warm
And you smell like a chapati.


Saturday, March 24, 2018

Flu or Flew


In context to the next poem.

Juicy Blob

I haven't coughed up yellow loogies
For at least seven years,
Quite frankly, I didn't miss it
I'm telling you dears,
It is not recommended
If your pain threshold is low,
I am a wimp
I just thought you should know.

Of course, this is a pain
That can not be circumvented,
And as a healthcare worker
I do my best, that it's prevented,
But I shoulda got that shot
For pneumoniac elders,
Now it feels like my lungs
Are being scorched by welders.

I am in favor
Vaccinations for all,
Don't bother to argue
I just wait for you to fall,
Because your ninety year old granny
And three month old Bootsie.
If they catch your infection
Kiss them goodbye, tootsie.

And sure, I did hear
That your best friend Susan,
Got Guillain-Barre
And did some ventilator cruisin',
Which is really unfortunate
Bur your odds are nil,
Without your vaccinations
How many will you kill?

Every year I get my Flu shot
And what I have, isn't Flue,
Just a local little virus
That was long overdue,
Which normally I dodge
On a yearly basis, Rob,
Oops, excuse me I'm leaving
To launch a juicy blob.



Bronchitis


Yikes; I hate being sick. When it's really real, then getting off of work is a necessity, but not so much fun. I am not the type that works sick, to me that is morally unethical. Well, there is the fact, that I have enough PTO to be off for 6 months, so, what me worry?

Wailing Like a Monkey

Acute bronchitis
Haven't had if for a while,
Now I feel like
I'm at the bottom of the pile,
Any deep breath
Will precipitate cough,
The pain would be so bad
I would have to back off.

I might cry or shriek
Or wail like a monkey,
Until I expectorate
Something dark and chunky,
Whereby, my mate would go running
For her hazmat suit,
But, I told her to get the gun
Get close, and just shoot.

That's the way it is
With my acute bronchitis,
Now I must take your leave
And say, good nightis.


Thursday, March 08, 2018

For everyone that works short-staffed


Paralyzed Toads

The six letter word
That managers hate,
UNSAFE is that word
That one can not placate,
Oh, they work up a lather
Gushing and spitting,
Just say the word UNSAFE
And soon you'll be quitting.

Somehow forced to depart
After a good sitting down,
With manager and two helpers
Angry faces with frown,
Claiming all sorts of avenues
That we should have tried then,
When seventeen patients
Had to wait in our pen.

UNSAFE is a value
A predictor of doom,
Where that one single straw
Busts the camel with a boom,
Where all hell breaks loose
Anarchy and disaster,
And our overtime hours
Are tallied much faster.

Yes, that six letter word
We're not supposed to speak,
Because Manager Betty
Says her knees get weak,
Applying that word
Might trigger an audit,
They're so fearful of that
While we would applaud it.

Salaries are at risk
When the powers that be,
Learn our clients aren't safe
Down in Unit 4 C,
Because corporate leaders
Try to hide all that stuff,
With Reimbursements at risk
They gotta play rough.

Whales are praising our efforts
Along with deer crossing roads,
Dogs flounder in the ocean
Along with paralyzed toads,
Advertisements at the ball-games
And billboards galore,
While there are not enough nurses
Back at the store.

Wednesday, March 07, 2018

Unwind the Action


When I come home
How do I unwind?
It started with the bike ride
The best of its kind,
The distance is short
The time is relief,
To unload all the garbage
The joy and the grief.


When I get home
Sometimes I must write,
With a short glass, a beverage
At the end of the night,
Although the bike ride unloaded
The terror and tension,
There is more that needs venting
Not all honorable mention.


Those things that are stewing
Beneath my facade,
Details and actions that
Might be outlawed,
If anyone cared
More than the corporate hoot,
That's what I'm carrying
On the bottom of my boot.


Do my words have power?
I'm not certain and don't be tricked,
But should I remain silent
I consider myself derelict.



Reputation Vacation


This here is an addendum to a poem a few days back, regarding the physician that wanted to send a patient home, with a blood sugar around 1000.

Doctor in his office
Puts up a good appearance,
In the clinical setting
Not much adherence,
Operates slowly
Doesn't return calls,
Fails to place orders
His behavior appalls.

Downplays our efforts
That make him look good,
We order the stuff
That really he should,
Because patients require
More than an operation,
A plumber he is
On a responsibility vacation.

Tuesday, March 06, 2018

Emesis Emeritus


Had a patient a couple days ago, for an Ablation recovery. She was totally schnockered for about 2 hours, and then for the next two hours, she complained of being dizzy and nauseated. The probable cause? Age of 75, weight 57 kg, and was given, Midazolam 10mg and Fentanyl 150mcg.
She eventually told me she was previously dizzy 3 days after having a Colonoscopy.

After 2 rounds of Zofran, and 3 empty emesii, along with moaning and whimpering, "what will I do at home if I can't eat for 3 days", I called her physician. Doctor says, let's keep her overnight in hospital. I return to the room, tell the patient (currently in fetal position in the bed, grimacing and fussing) the "stay-overnight" news...............where suddenly she sits up and with a straight face states, "Why did the Doctor order that? Why do I need to stay? I'm feeling better now".

I replied, "Good Lord, you are the one who has been slinging the story of 3 day nausea, misery and not eating! No way am I letting you out of this!"

A few minutes later, after Betty Lou goes to the restroom, she returns and immediately vomits.

Thus concludes the looney-tune story of the day.

Don't Be Offended


Writing about the business of my business (healthcare), I certainly do write about us, or you. If you think you are Billy Bob or Betty Lou, go see a shrink already!

Reflection Correction

Try not to disparage
Members of your clan,
I tell that to myself
The man without a plan,
So, I write in generalities
Class action, so to speak,
You think I'm pointing your way?
You must be some kind of freak.

That's why I pick on Billy-Bob
Betty Lou and Sadie,
Generic nonsense names
To keep the story shady,
But if you take offense
Go talk to your reflection,
I can't be held responsible
Nor forced to make correction.

Friday, March 02, 2018

Guess Who Called


Sure, we do recoveries, it's in our Charter, I guess. Probably why all kinds of folks try to take advantage of us.

Guess Who Called

Guess who called?
Just after you departed,
Angio; with a patient
Whose breath hadn't started,
Over sedated
Given way too many drugs,
Yep, those Angio nurses
All smiles and hugs.

But I turned them down
Stating, "not this time, Sister",
We are done for the day
We're recovery resistors,
A couple of mutts
Unchained from the leash,
And if you thought we would stay
You must be smoking hashish.




Thursday, March 01, 2018

Doing Nothing, May be Harmful to His Health



When you hear my story
Will you sing?,
Probably not
When you hear what I bring

The patient was having
A cardiac discovery,
To determine his worthiness
For Renal recovery,
Clearance for a transplant
Good news on his vessels,
No significant disease
Bless his pestles

But lo and behold.
He was a sweet old guy
Blood sugar one thousand
My, oh my,
Did the doctor care?
Not one, hot wit,
He said, "Well, he came in that way"
What of it?

No orders at all
We had to scramble and fuss,
This was not a patient
Not for us,
Because he would require
An insulin drip,
Was he HHNK
Or a DKA crip?

Well, you just can't beat it
The Doc said, "just send him home",
After groin recovery
And magical foam,
Because this is how he came
To the hospital today,
So, that's how it is
Good luck, be on your way.

By good fortune, we pushed
By complaint and demand,
Admit this sweet patient
Because we don't understand,
How the Doctor could sing
Such a lameass song,
Send Joe-Bob home
Back where he belongs.

Embarrassing it is
And negligent too,
Clearly unethical
Old, you-know-who,
Won't get our referrals
Nor a slap on the wrist,
He brings in good revenue
And that's why we're pissed.

He won't be reprimanded
He'll just roll with the punches,
No one wants to work with him
Not a minute, or in bunches,
His peripheral interventions
Run for hours and hours,
While other doctors, get it done
And head to the showers.

He is certainly a legend
In his own mind,
But we hate those recoveries
They bleed till we're blind,
Overdosed on IV heparin
And Brilinta, super power,
Where prolonged hemostasis
Ain't achieved for an hour.

Today, we saved a life
A severe Diabetic,
The fact his doctor did nothing
Well, that is pathetic.

Saturday, February 24, 2018

Bloody Mess (again)


Oh Nurse, never ever think that your work environment or work load could never be worse, because that is the equivalent of inviting hellish demons to prove otherwise!

Bloody Mess 

A colossal mess
In our complexity of care,
Vascular complications
That would give you a scare,
To make doctors throw tantrums
When they were the doers,
Poking hundred pound patients
With 14 French skewers.

Back in my days
At good old university,
There were Interns and Residents
To help buffer adversity,
Extra doctors on deck
When blood began to fly,
Now our current situation
Is enough to make one cry.

Don't imagine I'm blaming
Only the doctor,
Our corporate entity
Is a beast of a proctor,
Forcing tight budgets
Upon a short-handed nurses,
Thus, we bear the brunt
Of discontent and curses.

Few nurses are willing
To do what we do,
Ya, we get all the glory
The brave and the few,
But the conditions are abysmal
Unsafe, for Public Joe,
And when Boss counts only numbers
It's a pyroclastic flow.

A dense, destructive mass
Hot lava and gasses,
Exploding and gushing
And burning our asses,
Yes, that is how it feels
In Cardiac Support,
It never changes, my friend
And that's my report.





Saturday, February 03, 2018

Insensitive


Yesterday was cur-r-r-r-r-azy. Patient's behaving abnormally gruff, a couple major bleeding problems, cars breaking down, people waiting hours and hours for scheduled procedures and so on. Unfortunately, this is turning into a regular, daily occurrence. Even a couple doctors were short tempered, but amazingly, we actually had enough nurses for once. Sure, that probably won't happen again, but I guess it is notable.

Anyway, I managed to ruffle some feathers on a doting family member, and let me tell you why:


Brain Salad Speech

Near the end of 12 hours
And 40 million thoughts,
My words become garbled
And I begin to see dots,
Speech dyslexia
And sentence destruction,
Like a garbage disposal
Applying suction.

So, who could blame me?
A spousal wife,
When she misunderstood me
And pulled out a knife,
Figuratively speaking
Claiming, I was so rude,
When I asked her, "Now, what?"
I'm an insensitive dude!

"Now what can we do for you"
Had a couple words missing,
She immediately looked daggers
Sputtering and hissing,
I had no way out
Not even an apology,
It was her misunderstanding
And abnormal psychology.

For the next two hours
I avoided that room,
After she took the time to tell me
All dire and doom,
That folks where she works
Over at Hospital X,
Would have tossed me out the door
With a doubled-down Hex.

At 12 hours plus
I have a disability,
This ancient nurse brain
Has lost some agility,
Manufacturing speech
At the drop of a hat,
“Now what (do you need)”
Is not more than just that.

2/3/18

Thursday, February 01, 2018

In the Details


I am an avid student of the EKG and what is now called the science of Electrophysiology.

Parasystole

I spotted a parasystole
As obvious as a cyst,
No one else had heard of it
The reason it was missed,
Benign it was, in general
The anomoly fit the condition,
While I enjoyed the discovery
Everyone else had suspicion.

Effectually, they cared not
With glazed look in the eye,
A ho-hum sort of response
I felt that I might cry,
That's how it is sometimes
For the guy who holds the loot,
Getting excited about a mystery
And nobody gives a hoot.

https://www.sciencedirect.com/topics/neuroscience/parasystole

Saturday, January 27, 2018

Candidly Speaking


In my current job position, death does not occur in our unit. We rarely ever call the "Code Blue". Occasionally, we call a "Rapid Response", primarily to get a little help, for the problem that is already known to us. But, the discussion of death, never comes up in our outpatient conversations. My past tours of employment included a heck of a lot of death, so I have played on both teams.

Candid?
I try to be, often,
But in my line of work
I don't talk about the coffin,
Down the hall in the closet
It is ready for you,
If I can be perfectly candid
Your time is almost due.


Thursday, January 25, 2018

Hip Hop Nurses


After seeing an advertisement for the upcoming Grammy awards, naturally I thought "what would a Hip Hop nurse do"? Just use your imagination.

If Nurses were Hip Hop stars
We would take it up a notch,
I could give you your Norco
While grabbing my crotch,
Other nurses are my homey's
Just working in this crib,
We talk with hand gestures
Hip Hop lingo, ad lib.

Wednesday, January 24, 2018

Vacation, Staycation..........Flucation


Newsflash! If you are harboring any ideas of visiting California about now, DON'T!
We're all infected with the big, bad Flu. That includes all hospital workers too. This year, it surely doesn't matter if you had a Flu shot or not, you will still get sick, albeit less likely to die, if you did accept the needle. Don't get me wrong, I am a staunch supporter of vaccinations, in effect, believing it to be a moral imperative that health-care workers be required to be vaccinated. However, that's for the ACLU to sort out, I guess.

Anyway
Let me tell you how it was,
Everyone I know was sick
And the research says, because,
Just breathing is enough
To share the evil virus,
And what you get is worse than any
Song by Miley Cyrus.

In my case, I suffered
24 hours of severe pain,
In every joint and ligament
From my ankles to my brain,
One simple short term fever
That was it, and I am happy,
Everyone else I know
Was in a crisis feeling crappy.

The death rate climbs each week
Healthy people dropping like flies,
Don't even visit the hospital
Death is in the air, oh, surprise!
It will catch you unawares
And tomorrow you'll be sick,
Call the mortuary now, my friend
You'll be heading there, right quick.


Sunday, January 21, 2018

Kind of Crazy


I went to the Dentist for a cleaning, and had the good fortune to be worked upon by Dental Dana (my favorite). Once again, it was another appointment that went south, very fast.

Dental Dana #65

Dental Dana
Might be crazy,
But that chick
Is never lazy,
Her tool control
Is so efficient,
In the Dental suite
She appears omnsicient.

I always get
A tingly rush,
When she uses
That laser scaling brush,
Abrading plaque
In my nether regions,
Annihilating
Bacterial legions.

How she knows
I don't understand,
But I follow each
And every command,
"Turn your head
Now, clench a little,
And do control
Your slimy spittle".

With words like that
I can't resist,
A subtle nudge
Upon her wrist,
Unnoticed, I think
Oh, not a chance,
She dropped that laser
Onto my pants.

That's her usual
Time to quit,
Stating, "We're done here
And do not spit"
But I'll come back
When she says it's okay,
For another round
Of hygienic play.

Monday, January 08, 2018

Crazy Wombats


The public, the client, the patient; come in all kinds of nice or crazy. Sure, they gotta be nervous about dire unknown outcomes and the like, but still, why not be friendly, pleasant and appreciative? After all, we're just trying to help.

They said over and over
"Now, please don't forget,
If you remember this thing
We will be in your debt".

And each time after that
They said it again,
It would have been better
On occasion, now and then.

If you will, tell the doctor
The nurses and the tech,
Uncle Bob has a problem
His kidneys are a wreck,
Please measure the contrast
As careful as can be;
I said, yes I will do that
It's important, I can see.

When Hector from Transport
Came into the room,
Aunt Mary looked at him
All dire and doom,
And once again launched
The tale of the kidney,
Like a crazy old wombat
Down Under, from Sidney.

Later on, after
Man, they wanted to book,
Uncle Bob and Mary
They just had that look,
Like coming down here
Was all a mistake,
A couple Wombats from Sidney
That stepped on a snake.

We bend over backwards
Primp and placate,
Give them sausage and capers
On porcelain plate,
But some of them leave
Good behavior at home,
Instead of proper manners
They spray crazy foam.


Sunday, January 07, 2018

Undisputed


December came and went without a blog entry; despicable! I really was distracted. Even I am shocked with my laziness. I woke up 3 days ago and took stock of things at work, and I was once again impressed with the way some things have not changed from the day I started working there, 10 years ago.
Many of those items I have already written about, and surely, I will do again.
This poem shall launch another year of the Chronicles of the Underside of Nursing.


Another lapse in writing son?
From drudgery, or too much fun?
I suspect the former, not the latter
Because drudgery, is no mad hatter.

New Year arrives, how does it feel?
Exactly like the same old deal,
The usual drama, changes not
With the same ingredients in the pot.

We're not unique
I know that, sure,
There are toxic behaviors
That have no cure,
Unless radical surgery
Is executed,
Nothing will change;
'Tis Undisputed.


It's a New Year Editorial


Something new under the sun! Ok, I know, we're probably behind the times a bit, but the usual suspects have been bitten by the "Unit Practice Committee" bug. After all, we belong to a big healthcare entity that wants to be a highly recognized player on a national level, and by golly, let's pretend that we care about the professionalism of our Nurses. And with our big BRAND advertising expense account, apparently they’re willing to pay overtime for industrious nurses, to join a committee and try to make changes. Of course, we will always implement  evidence-based-care and all the ideas we come up with, will be facilitated, acquisitioned, elucidated  and so on.
But seriously folks, there were two prime targets for runnin’ this thing, and #1 said “no” and pointed at #2………….ya, that’s me. Well, I figured what the heck, as long as #1 agrees to be my sidekick.

See, I do have a streak of idealism in me; there are a few things I that believe should be standards of practice in the unit that I work in. We look like an ordinary same-day-procedure unit, but we’re doing preparation and recoveries on highly complex patients, mostly Cardiac. Only half of our staff seem aware of that, but all of those future applicants, must understand the lay of the land when they arrive.

Well, I guess some folks think I have some leadership traits, and I talk like I know a couple things, so I been appointed and anointed as the committee Boss. There it is; in the autumn days of my career, I will pull the sword out of the stone, and look for a suitable target to aim that pointy thing at. Watch out!