Wednesday, November 14, 2018

Train to be Violent


By now, I expect that every healthcare organization all the way out to Timbuktu, has offered free, workplace-violence response training, to all and everyone. At our mega-medical entity, this endeavor seems way over the top intensive, no doubt costs millions, but looks good on paper for the public to read about. But what do I really think?

All the excitement:

What is the latest, hot button topic
For all the people in our nation?
Active-shooter situations
Expounded via oration,
And our own organization
Is spending gobs of money,
Learning to defend ourselves
When some jerk calls you "Honey",
While pointing a weapon
Or threatening you harm,
Got his arm around your neck
His favorite method of charm,
And a blade at your throat
While you gouge, scratch and bite,
Crush his instep with your heel
And kiss him goodnight.

At the Class:

We all learned the blade-stance
Where it looks like you're praying,
Shuffle forward and backward
Keep focused, no swaying,
Yell, scream; don't beg
While showing power, no fear,
Startle that mofo
Then bust a cap in his rear.

Another option:

Or........just arm us with guns
With a weapon I.D.
I can hide it in my scrub pants
A Glock 43,
I'm ready for whatever.........
Oh shit, now he sees us!
But, I'm not really worried
He's about to meet Jesus.







Monday, November 05, 2018

Warm Blanket


Planting a Seed

I changed my mind
Withdrew my prior writing,
I had a good run
No need to be indicting,
We work in a tough business
Life, death and worse,
No need to be remembered
As the disgruntled Nurse.

Work is damn stressful
Till we rise above it all,
Do what we do best
And answer the call,
To comfort those in pain
Some are worried and more,
It might be their own loved one
Or their own, gruesome score.

Expertise is important
So also, is a warm blanket,
Like that Model T Ford
Won't run unless you crank it,
And so does our care
Meet the want where it is needed,
Should we all work together
Our best results are exceeded.

Sure, there are times
When we protest for change,
It is difficult for a system
To work outside a range,
That has been predetermined
Not in a democratic way,
Inhibiting improvement
It won't happen in a day.

In the meantime we care
For those with greater need,
Helping brother and sister;
Is but planting a seed.







Tuesday, October 30, 2018

Mini-moles


This is the fifth, post-symposia revelation; and I wonder, does anyone else doodle in words like I do?
likely not. It is amusement and part memory method. So here is the latest nonsense.

Mini-moles
Very small rodents
Seemingly important, they say,
Something regarding
Umbilical LDL
Not seeing the light of day,

Supposedly at birth
Your U-LDL
Resides at a measure below 50,
But that's kind of silly
You never have eaten
Ya, extraneous data is shifty.

The Cholesteral-HDL ratio
Is a predictor of some kind of risk,
Particular with folks of Diabetes
Don't ask me, but something is brisk,
That's just about where the after-lunch dude
Was guiding us all into sleep,
I suspect he has earned a favorable rating
As we awakened; man, that nap was so deep!

For Giving, that's who we are


End of days ponderings:

I feel kind of alone
Going to classes and such,
It's just one of those things
That I enjoyed very much,
Sharing moments of learning
Perhaps I'm just such a geek,
Feeling a need for expansion
If only just a peek.

Rubbing shoulders with colleagues
Over the years,
We all got a little older
And shed a few tears,
As we all are wont to do
On this human path of living,
And hopefully we have acquired
More capacity for giving.

The Best New Drugs


Every year at one conference or another, a presenter will regale us regarding the use of Wonder drug Q, and all the great stuff, which is in the cue. Some of those drugs disappear, never to be listed, because the side effects began to show up after 300,000 people had been tested against placebo. Maybe their toes began to fall off, or there were too many folks dying from long thumb disease, or whatnot.

The Best New Drugs

Death eliminates all risk
LDL reduction is very brisk,
Approaching zero, as the heart stops beating
After that, no worries about eating.

Sodium reduction has a lot of hype
Not sodium sensitive? you're not the type,
Regarding all that worry, about retaining fluids
No need to join the low sodium Druids.

Sodium-glucose Cotransporter-2 Inhibitors
If you can say that, you're clearly an exhibitor,
But they never talk about
Those incidental amputations,
Or how Fournier's gangrene
Can ruin a reputation.

Beware, dear public
About the newest, latest drugs,
Testing on rabbits, rats and pigs
May not eliminate all the bugs,
Lurking in the background
Glossed over by slick advertising,
If you should get Angioedema
Death may be very surprising.

10/30/18

Price versus Advice


More nuggets of information, from the symposium. If Joe Bob can drop a kilogram of weight (2.2 lb)
this may lower his Systolic BP, by an average of 5 mm of mercury. This alone, can be an organ saver.
But, there is the topic of compliance, isn't there?

If you drop your weight
By one kilogram,
2.2 pounds
It will be favorable, M'am,
To bring your systolic
Down five millimeters,
That might save you a kidney
Unless you're one of those cheaters,
That puts the weight back on
After you leave the Clinic,
You loved all that praise
But you're just a cynic,
Not believing a bit
About all that good advice,
You don't worry about pounds
You only ask about the price.

10/30/18

Syncope Slide


I went to our local Cardiology Electrophysiology Symposium two weeks ago, and learned some good stuff. Man, those physicians love to strut their stuff regarding favorite topics, but there are usually some good nuggets of information.

For example, about 50% of folks who take blood pressure meds for hypertension, still have lousy control, and as such, remain at high risk for deadly complications. We were informed, that better success is achieved if two different medications are working together, rather than just doubling the dose of a singular drug. However, the discussion did not address the added risk of additional side-effects that might come along with those secondary medications.

Anyway, life itself is risky...........and doctors are averse to blame.

Slide


Lowered your BP
But still you died,
When you busted your hip
Doing the Electric Slide,
Thanks to your doctor
Adding another medication;
The plaque on his door reads:
"Your health, is my dedication".


He’s a BP control freak
He studies all the trials,
And as a result
You should see all the vials,
Stacked on the counter
At Billy Bob’s house,
16 plastic bottles
Between him and his spouse.


Meanwhile, the doctor
Basks in recognition,
Writing books on medicine
The latest rendition,
On BP control
All the methods he has tried,
But nowhere will you find
Just how many have died.


He had no hand in that
Never takes any blame,
P-value significance
Is the name of the game,
Statistical variants
Like a bolt of lightning,
Impossible to predict
And that’s what’s so frightening.


Syncope
Is what happened to you,
Your blood pressure crashed
As its likely to do,
After that fourth medication
Was added to your list,
Now that you busted your head
You will be sorely missed.


We’ll get your pressure down
The doctor had reassured,
You’ll feel a whole lot better
The hypertension cured,
You can fulfill your dream
To learn the Electric Slide,
Yes, I fixed you, old man
But still you died.



Sunday, October 28, 2018

Gunning for Retirement


Gunning for Retirement

Another great plan
For when I retire,
An alarming inspiration
Truly did inspire,
For me to think of a way
Where nurses can blow up their stress,
Come to Billy Bob's shooting gallery
It won't matter how you dress,
Because you get to choose
Your favorite cannon,
Please, let me explain
Just what I am plannin'.

I have endured enough
Of every kind of alarm,
My psyche is maimed
With significant harm,
My ears ring incessantly
I dream beeps and sirens,
That's not what I call peace
In any environs,
So, my plan is a shooting range
To vent your frustrations,
Blast those infernal machines
To hell and damnations.

I figure a five minute session
Ten shots in all,
Pick any weapon you like
It's absolutely your call,
The lockers are stuffed
With every kind of gun,
From small stinger missiles
Or some desert eagle fun,
It's all a part of stress relief
Cutting loose with a scream,
Blow up that IV Pump
Like you did in that dream.

The worse flippin' alarm
That I ever heard,
Is on that CRRT machine
Like a foghorn, my word,
So that is my target
With a shotgun to blast,
10 gauge for sure
Nice and slow, meant to last,
Ten shots in all
To damage and maim,
Twenty bucks admission
Come on, play this game!

Can't Remember


I was talking with one of those young nurses of the day, bright as an atomic bomb, and probably the type I'd want on hand if I was in the ICU. She noticed I kept a small note/list on my phone that covered some of the common IV drip mixes and calculations, and it prompted a discussion of this thing.

Hence, I wrote this:

It's the middle of the night
And you can't remember,
The drip calculation
You learned last September,
And it's really important
Because you're at the Code Blue,
It seems like everyone is staring
And waiting for you.

You reach for your phone
It's in one of your pockets,
In your deluxe cargo pants
That hold 42 sockets,
When you suddenly realize
The smartphone is gone,
When you were rushing to work
It fell on the lawn.

Joe Bob the victim gasps
"You can use mine",
Look up Cardiac Arrest
Dial 249,
Ask for Betty Lou Johnson
Also known as my wife,
First ask her opinion
If you should save my life.

The moral of the story?
Keep your tools close at hand,
Know those drug concentrations
For those moments on demand,
When you're on the spot
And Joe is circling the drain,
In those crazy, clutch moments
You gotta trust your old brain.

Tuesday, October 23, 2018

Prolonging life without consent


Dementia & Pacemaker

DNR
Do not resuscitate,
A reasonable approach
To a dead end fate,
And one might argue
We all will die someday,
But if you have severe dementia
How long would you choose to stay?

Why do I ask? I'll tell you
I just met Betty Jane,
About the only thing she understands
Is to localize her pain,
No kind of simple words
Can appeal to any reason,
Betty's brain is at survival mode
And it's a long and pointless season.

She lives her life in a nursing home
Her cognition is unaware,
She can not form a memory
Nor have a thought to share,
She truly lives in the moment
Each minute is unique,
Though she can't recall the one before
Nor anything last week.

She doesn't know her children
Where she lives, or anything,
No purpose of existence
But she can walk and sometimes swing,
So a DNR is sensible
Yes, she requires a caretaker,
But honestly I think
It's a crime to give her a pacemaker.

She didn't request or pay for it
Just who made this choice?
And why would they do it
When Betty has no active voice,
Regarding her life
Without cognitive awareness,
I'm guessing it was family
Well meaning, without fairness.

Yep, a pacemaker just a month ago
Her heart was slowing down,
She had a bout of syncope
Where she lived in memory town,
A doctor intervened
Made a referral out beyond,
The care-center demanded it
"She might pass out at the pond!"

Naturally her son
Didn't want to miss his momma,
Despite the fact she doesn't know
A period from a comma,
So they shipped her out
Said, don't come back
Until your heart is stronger,
We'll await with open arms
To help you live a little longer.

Betty doesn't understand
Why her chest is sore and tender,
She scratches, picks and plucks
Till the incision doth surrender,
Where infection did ensue
Promoting gross and smelly pus,
Whereby the folks at memory town
Stated; you can't stay with us.

Another long trip to the hospital
A hundred-fifty miles away,
While everyone at memory town
Said, Betty we will pray,
For another speedy recovery
For a long and fruitful life,
When you come back, see Bobby
He is looking for a wife.

Friday, October 19, 2018

Halloweenish


Well, I'm in a bloody good mood lately, feeling like I should bite someones neck, and it is the Halloween season after all. Thus, I'm inspired by vampires and blood donations.

Blood Supply

I have read a lot
Of vampire books,
Depends on the author
Just how vampires look,
But there's a general consensus
Regarding aging, and such?
You'll be frozen at the age
Of your vampiric touch.

The rumor is
That they bite your neck,
A lot more vigorous
Than the little peck,
That you got from Eunice
Back in the fourth grade,
Ya, her mother was a vampire
And that's why you're afraid.

Historically vampires
Get a bad rap,
You may have heard about silver
Crosses and crap,
Designed to repel
Your friendly neck biter,
Every vampire I've met
Was a heck of an inviter.

Well, I suppose that is necessary
To maintain the blood supply,
It has a short shelf life
Because even blood will die,
And they don't bite the dead
So, your chances are good,
How best to avoid a bite?
Wear a chain-mail hood.

Wednesday, October 17, 2018

Blood Donation


I donated blood yesterday and here is what happened.
(In the event that you may be following this blog, my encounter with the blood chick, turned into something like when I visit with Dental Dana).
Who would ever think that donating blood could be so.....................delicious!

Rachel
That woman, she took my blood,
When I swooned
I fell with a thud,
Awoke light-headed
Like a spinning jenny,
Not only my blood
But the blood of many.

Rachel
Caught my eye at first,
Before I understood her thirst,
No, I won't argue
She was really cute,
I needed to see her....
I was resolute.

Rachel
Looks so young, that kid,
When I came to donate
She had the highest bid,
And now I'm drained
I guess; good to the last drop,
Rachel, I begged
Oh please, don't stop.

Rachel
So caring, she held my hand,
After I swooned
I could no longer stand,
I was laid on the gurney
And they lowered my head,
I was too weak to grasp
To pull her onto my bed.

Rachel
She stood to the side,
I caught a little smirk
Plus a wink, and I sighed,
Knowing, she tried to drain me
I guess I have a good taste,
She whispered in my ear:
"To the last drop; I mustn't waste".



Thursday, October 04, 2018

Don't try to sue me


Gotta do something when I retire.

Don't Try to Sue Me

Here's a plan
When I retire,
Publish those books
And set the world on fire,
With all my funnies
And juvenile humor,
Silly as vomit
And bold as a tumor.

Amazing insights
Regarding amputations,
Ridiculous rhymes
And ambiguations,
Touching stories
Regarding life and death,
Spirits in the closet
And the Grim Reaper's breath.

There is a lot to cover
And I think I did,
I worked like a man
And thought like a kid,
Did my best to respect
Joe Bob and his cousins,
See, they looked kind of inbred
With children by the dozens.

There was Billy Bob Borko
And sweet Betty Lou,
Sister Euphemia
To name just a few,
Of the colorful characters
Whose paths I have crossed,
Most of them winners
Although a few of them lost.

I followed most guidelines
But stretched a few rules,
Some protocols, dear reader
Have been written by fools,
Who rarely endeavored
Into the milieu of reality,
Where the evidence of poor science
Might lead to fatality.

Am I an expert?
I don't claim to be,
But I do write with clarity
Regarding things that I see,
Armed with continuous
Ongoing education,
Regarding areas of interest
To support my reputation.

If I can be an inspiration
Let it be known, that I cared,
Regarding expertise
And the knowledge that I shared,
And always willing to work hard
In any kind of conditions,
Admirable traits
Outside of personal ambitions.

Well, I will keep writing
About the usual baloney,
The whackified truth
Not fake and not phony,
And yes, I hide names
So don't try to sue me,
Take your business elsewhere
And stop acting gloomy.

Tuesday, October 02, 2018

Nurse Centered Care


Patient-Centric Care. By golly, that sure does sound good, and I bet there are hundreds of papers and studies all wrapped around that feel-good concept. But let's talk reality! In the ICU and Recovery Room, we are talking Nurse-Centric Care. As in: The Nurse runs the show, knows what is best, and don't screw with us, if you want to see Joe Bob walking down the healing road to recovery.

Maybe that's how we old gunslingers see the world. We anachronisms of the old west, firing our pistols off, just to hear the big bang, and to smell the gunpowder. Who cares; I'm unplugging soon.
Just don't get it into your heads, that I'll stop writing about this, ok?

Not To Speak

After general anesthesia
Short term memory rules,
As you begin to wake up
You'll be missing some tools,
And may ask the same question
Over and over again,
We'll repeat the same answer
Like a stuttering hen.

In respect to the family
There are three things, not to speak,
Don't ask Jerry if he has pain
Or if he has to take a leak,
And most of all, never
Ask if he is nauseated,
His short term memory will cling
To the idea you perpetrated.

The Anesthesiologist
Gives meds for dizzy indigestion,
No one wants it to happen
Please don't give Jerry an auto-suggestion,
Because his brain will latch on
To that five letter word,
His circus memory will focus on VOMIT
He may start retching, undeterred.

Sure, I care about his history
Of his sensitive tummy,
You probably run to his side
Like the very best Mummy,
Each time he has a burp
And spits up a little rice,
But do be aware;
Encouraging vomit, is like rolling the dice.





Saturday, September 29, 2018

Vomit............


After being horridly ill last week, I came to work. As an aside; here we are in 2/3 northern California, and starting about two weeks ago, doth arrive, the killer baby Flue #1 of the year. Nurses, patients, family members sniffling, coughing, missing work (not the usual lame reasons), with real Flu-like symptoms. UCK!

I came back to work this week, feeling very underenergetic, and got slammed on Day #2.
The worst part was the dude that upchucked dinner, and every prior meal I think, three times in ninety minutes!

Three vomits?
That's too much,
A slimy smelly
I didn't want to touch,
Yet, apparently
It wasn't an option,
Vomit #2
Was up for adoption.

What was for dinner?
I'm not too sure,
But there was some lettuce
All pretty and pure,
On my forearm
With an olive and a carrot,
Look; I like salad
But I don't want to wear it!

Monday, September 24, 2018

Many Nights Like This


There were many shifts like this, repeated over and again..........any nurse who has worked at the bedside, can attest to the most irritating of all things; the relentless demanding patient.

99 Requests

After 99 requests
In the course of twelve hours,
You have thoroughly diminished
All of my powers,
Just saying, if you suffer
A cardiac arrest,
I can not guarantee
The outcome will be the best.

Your water requisition
Ten times, just like this,
No more than five ounces
On the hour, don't miss,
Because I am your patient
And you are my slave,
Each time I pass the room
She gives a beckoning wave.

I offered the four P's
But it really seemed like twenty,
Pain, potty, and position
And many more a'plenty,
And of course I offered AIDET
(I've had it shoved down my throat).
Management loves that crap
It certainly fills up their boat.

At the end of my shift
I’m supposed to say, Thanks,
For allowing me to serve you
(The worst of old cranks),
No, instead I have pity
For your family and friends,
You treat them just as poorly
And never make amends.

Sunday, September 23, 2018

Moan and Rattle


His smile is infectious..........yep, that's what people say about the kid.


It's a nasty infection
And I blame it on the kid,
He's not a pharmacist yet
Doesn't know what he did,
Coming home, with a
Class-A infection,
Hit up the old man
He wasn't wearing protection.

This otherworldly beast
Has cut me at my core,
Approaching day seven
I have Hades at my door,
Proposing special offers
To relieve me of this disease,
I have rejected each one
Though I bargained on the sneeze.

See, the cough is bad enough
But the sneeze is hell on wheels,
Each time it rips my throat
With razor blades, it feels,
I have learned from prior suffering
It's a decent bargaining chip,
Succumb to 17 lashes
From the elder Abaddon's whip.

Ah, don't worry it's just mythical
I wasn't whipped by Loki,
Although a trade was made
To clean the Okefenokee,
And I'll get to that later
If I survive this epic battle,
Why, even the cats are howling
As my lungs doth moan and rattle.


Deaf and Kind



An attentive daughter is a wonderful thing.

90 years old
Deaf and nearly blind,
A daughter named Donna
She is so kind,
Helping to navigate
Time with her father,
Clearly she knows
He's a bit of a bother.

Just waking up from
Conscious sedation,
He has all the right questions
With mixed up equations,
He simply can't grasp
Complexity now,
I answer over and over
The most basic how.

In time he will grasp
As the drugs disappear,
All those things he most know
With the help of us here,
And his surrounding family
Which decision might be best,
To solve his heart problem
Defined by this test.



Wednesday, September 19, 2018

Aim is the Game


Old guys...........I'm kind of one.

They talk about their junk
I wish they would not,
How lying supine
They can't make a shot,
Into a plastic urinal
I say, aren't you a guy?,
Did you never pee in your garden
They say, No; I ask why?

What the heck? are you kidding?
Man, that's what we do,
We must mark our boundaries
Why didn't you?
And this is the moment
I show that rubber tube,
Where Joe Bob imagines
He'll need a psychedelic lube.

It's where the rubber meets the road
He will give it a try,
A urinal supine
Is better than some guy,
Shoving a hose
Up his special junk,
What he thought was a capillary
Was a mighty redwood trunk,
Spewing gallons of pee
Into yonder container,
Good Lord, it's so easy
Really, a no-brainer,
And factually, I have trained
A 90 year old man,
Reminded him, what to do;
Just aim for the can.


Thursday, September 13, 2018

Leaving, mostly


Due to misinformation shared with me by an office, now I have to declare my retirement date as January 1st, 2019. It's all right, it helps with my taxes, not to get the whopping PTO payout added on my 2018 income.

Anyways, I haven't written much, so now here are a couple ones regarding those aspects of life and death that are so hard to see.

Spirit and Ghosts

I felt ghosts
I heard spooky whispers,
Haunted hallways
With psychic lispers,
Working forty years in hospitals
With too much history,
Spirits lurking
In realms of mystery.

Stories are told
Not everyone approves,
Especially the religious
Who lack certain moves,
Regarding acceptance
About that other world,
They ought to loosen up
And get their mindset uncurled.

Empathic persons
Or the psychic type,
Can tune to the vibe
Beyond all the hype,
Regarding near death
Little changes; not the same,
Subtle muted signs
Near the end of this game.

Why talk about it?
Well, I'm about to head out,
I want other believers
To cast aside all doubt,
Regarding assessment
Of the person, and the spirit,
Listen closely my friends
You want to be near it.


Neither Blessing nor Curse

Gently fading
Upon the bed,
Until the angels visit
You're not dead,
But when they depart
I will feel the breeze,
Escorting your soul
O'er the grass and trees.

I will miss those moments
When I felt such things,
At the bedside
As we cut the strings,
Letting them go
No matter what age,
Just a transition
To another page.

Believe what you will
Religion or not,
Your time on earth
Is like a pistol shot,
Some kind of energy
In this vast universe,
Neither a blessing
And never a curse.


Monday, July 30, 2018

Fainting, Heavy Lifting & Injury

Major Fall-out

Lets consider little Betty. Her silly antics, led to my last work related injury (I hope). She was old (older than 75), sedentary, obese, short and compact, playing at helpless, got an angio-procedure with dubious results, meaning she probably didn't really need it, had the usual bleeding that won't stop and needed the chastity belt (Femostop) on for a few hours, and a blood sugar of >450......and finally she did swoon/faint.

If that wasn't bad enough; we had to deal with Dr. I-don't-call-back, who ultimately told us to send her home. He finally gave in and told us to call Dr. Who-does-care, and the dude admitted Betty.

Spittle and Cuss

Little Betty fainted
With nary a squeak,
As her family stood by
In shock, cheek to cheek,
Till I did command
Young Junior, do help,
He had a good bark
For such a young whelp.

I call her little Betty
You might say, Betty Little,
She had spunk and complaints
And each utterance launched spittle,
So I stood to the side
When she shuddered and gasped,
And with my 3 buddies
We flung her, hands grasped.

Back onto the bed
With a lurching big launch,
Her biggest issue?
Was that massive paunch,
Describing a measurement
The same as her height,
Five by five, we do say
God speed and goodnight.

Twang, went a ligament
Or a muscle, who knows?
An electrical shock
Blasted down to my toes,
And the hamstrings did spasm
As I shuffled away,
While little Betty woke up
With a farting bouquet.

Now, little Miss Sunshine
Said, Thanks folks for coming,
I could have handled it myself
One hand tied, plus some humming,
But I wanted some pals
To come on the run,
Should little Betty faint
And torpedo my fun.

The mirth and the joy
Departed, each one of us,
Battered and broken
Full of mustard and cuss,
Behind on notations
That will never be read,
But some of us will document
Even when we're dead.
_ _ _ _ _ _ _ _ _

Addendum: How I was blamed (the usual Boss response) for my injury.
Let's just call it: Catch-22, hospital style.


Last week, I managed to get another work-related lower back strain, during another gotta save the patient incident. Bosses always try to blame us for getting injured when we put the patient first, and we get injured, because the hospital provided Lift-equipment, is 5-10 minutes away, because the tools are not on hand. Yes, the sentence did run on. This was not a solo act on my part, I had 3 other pals and a family member, helping Betty Lou (musta weighed 222), into a position where she could breathe, after passing out.

Bosses keep trying to say, we shoulda left her on the floor; but, the fact is, the patient wasn't on the floor. I told my story to Nursing Supervisor, Employee Health Nurse, Doctor at Occupational Med, my two bosses. Each of them started off with; Why didn't you use the patient-safety-Lift equipment that all Nursing Units have. See, blame first, concern for employee, somewhere down about 5 steps on the list.

Answer: We don't have that lift equipment in our Unit, and remember? Half of the hospital, doesn't even know where our Unit is. And frankly, our Recovery rooms are minuscule in size, the woman was not on the floor, really half on the bed, had fainted, could barely breath laying supine, and there were four nurses using the skillsday-instructed-patient lift technique with a pull sheet beneath the victim, where we all lifted and pulled in the time-tested method of 1-2-3.......SCOOT. Imagine a 240 pound bag of loose potatoes, with not an ounce of help from the patient, who was only partially conscious.

I guess we ought to have let her slide to the floor, pulled the bed/gurney out of the room, so there would have been ease of movement around her, while Joe Bob went running to the Emergency Department 5 minutes away (with a 5 minute return), essentially too late, as we probably would have already called Code Blue . Those responders would have run into the room, declare WTF, why is she on the floor, instead of on that gurney over there? I would announce, because the Boss says, don't ever try to move a fainted sick person, without getting the Lift equipment. Naturally, I would probably be excommunicated for that colossal FUBAR, but maybe I wouldn't have strained my back.



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.