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.

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.


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.