See the Angels

 

The demands of our job, the knowledge we must acquire drive us to achieve something known as "Critical Thinking". This is defined as the mental process of active and skillful perception, analysis, synthesis and evaluation of collected information through observation, experience and communication that leads to a decision for action. One does not graduate from Nursing school with this tool fully formed; experience in the workplace, further knowledge obtained and a solid degree of personal confidence will move the new nurse towards that goal.

But what of critical Feeling skills? That is another thing altogether. I know that I do not have the words to lay out the recommended steps required to become an empathetic caring individual but I will say that when the tears started falling, the sobs and wails cried out, I headed for the door and called upon someone else to handle that. 
But there is another type of feeling - perception that is not taught or is little discussed in the realm of Nursing education. Perhaps when cultural topics are addressed there may be discussions regarding different spiritual practices, "pagan" beliefs, a use of amulets or items of power (the Catholic crucifix for example). To add to that, a belief of spirits, angels, demons and what have you very near to us while remaining unseen. Could all of this be possible?

Now consider that the first telephonic spoken word was transmitted electrically in 1876 by Alexander Graham Bell. Certainly, the engineering was complex but millions of people were not believers. Some would say that now in 2023 our understanding of the universe is “light-years” ahead of 1876, but that was only 150 years ago. Quantum science has demonstrated that two elemental particles can and do communicate with each other across vast regions of space, so why is it so difficult to accept the possibility that there is a spirit realm? I propose that is because science has not yet developed instruments to measure these kinds of things and as such, I will keep an open mind about it all.

Nurses and Doctors are right to keep some of their observations “unknown” in respect to things of a paranormal nature. We don’t want to be labeled as quacks or fools; however, over the past four decades of my career hundreds of patients, family members, elder relatives and friends have admitted their belief of a spirit world. In fact, most modern religions are steeped in spiritualistic unprovable phenomena. When we interview our patients & families, we are advised to keep an open mind and not to judge. Let us all agree that is a good idea and open our own minds to vast possibilities that are not yet measurable.

For the record, I witnessed a person (DNR status) come back to life after thirty minutes while being flat-line, pulseless, not breathing and declared dead by an MD. This was in an ICU in a regional medical center in southern California. That man was later discharged home in an improved state. I suspect he had some help getting back his heartbeat. Incidentally, he suffered no neurological deficit. I felt rooms become icy cold for no apparent reason and sometimes associated with the death of a patient. And also at times, where the patient expressed there were demons terrorizing them

I witnessed patients who indicated they were talking to dead relatives that were present in the room. I did not argue with that because it was obvious I had not been granted that privilege. A case in point: In our Coronary Care Unit we had a patient that had end-stage heart and organ failure and was designated as DNR. She knew her life would soon end and she stated that her Uncle and other dead relatives were in the room and telling her it was time to go. Some current family members would visit and tell the patient to stop with her crazy talk and all the while tell the patient that she was going to get better and soon come home. (now, that was truly crazy talk). At some point, the dayshift nurse encouraged the family to go to lunch so that “Mom could get some rest”. About five minutes after the family stepped out, the patient went “flatline”.  Now this was a kind of thing that I observed a number of times too, where the family effectively prevented their loved one from moving on to the next realm of life. Afterall, billions of people do believe in an Afterlife and I can accept that as a possibility.

All of this has been a lead up to a patient experience I had in May of 2008. The patient I was assigned to had developed rather suddenly a cancer that affected her heart. There was no cure, therapy or surgery that was going to interrupt this end-stage condition and she chose to die when it would come. I knew her just 12 hours and when she departed, with family at her bedside and me at the door, I felt a sensation like a cool breeze puff past me the moment she died.

See the Angels

"If only we could see the angels taking her away"
I heard those very words, when I was present the other day,
When that good woman died at the end of her shortened life
She'd been a loving mother, she had been a wonderful wife.

I can't say that I knew her
We had the briefest of introductions,
I can say that I cared for her
Because those were my instructions,
And during those few hours of care
Her spirit, I came to know,
Such that I can tell you truthfully
I felt her spirit go.

If only we could see the angels
Taking her away,
I didn't see them but they were present
When she departed yesterday.

5/7/08

1st Debris Belt

 
In the Charlie Brown Cartoon stories there is a character named Pig Pen who seems to leave a wake of dust and mess behind him wherever he goes. Let's just say that I was not a total neat-freak (like some dayshift nurses that followed me) because my main focus was getting my patient's through the night alive. The next morning an occasional muttering was heard as that day nurse fussed around the patients room making it look pretty, to their standards.

My best pal Nurse was the type that needed about 5 feet of desktop space to spread out papers, files and charts (before the EMR) leaving very little space for even one more nurse to chart. It was a bit of a joke between us and did not cause discord. Besides, she was a veritable encyclopedia of Cardiology and a great teacher as well. Anyways, a great team of nurses we were and that is the key to success wherever you work.

I have a 1st Debris Belt in Messiness
But Lana, she's got me beat,
Just trying to start an IV
There are throw-away wrappers
Covering her feet.

I have a 2nd Debris belt in Organization
I couldn't follow a list if you paid me,
That's why it's not a good idea
To try to coerce or persuade me.

Then there's my 3rd Debris belt in Entanglement
I can conjure a knot in any shoelace or cord,
Why untie, when I can more easily break it
I'm one of those employees you can not afford.

2010

Nurse: Things To Look Forward To

 

I posted this in 1997, when this Underside was a self-published endeavor. Here I am 26 years later, no longer working at the bedside but still performing some education duties. Look, Nursing isn't easy (not then and not now) but it is extremely fulfilling helping others in their time of need.

In Days Long Gone

In days long gone
Of innocent youth,
You could go to a Doctor
To get at the truth,
Because disease back then
Was fairly simple,
Unwanted babies
Or maybe a pimple,
A week in the hospital
Would do the trick,
If you didn't die
You weren't really sick,
Because medicine men
Didn't have many drugs,
No antibiotics
For bacterial bugs,
Just common sense
Like fluid and rest,
Surgical wounds
Were debrided and dressed,
Life support measures
Not yet invented,
Many more sinners
Took stock and repented.

But today, man, it's different
This hospital scene,
Each organ system
Has a machine;
Any mechanic can tell you
This carries a price,
It's Russian roulette
With a medical device.

Central line catheters
A bacterial threat,
Ground fault dysrhythmias
If a pacer gets wet,
Gastric perforation
From sump pumping hoses,
After long-term use
They'll have a nasal necrosis,
Tracheomalacia
And traumatic intubation,
Will lead to a permanent
Hoarse voiced oration,
Tympanic rupture
From a doppler detonation,
Uremic poisoning
From bladder ablation,
And that's just the patients
But what about the nurse,
Each day at the job
Is surely a curse.

Consider the dangerous
Equipment itself,
Monitor boxes
That fall off the shelf,
Land on your head
Bruising your brain,
There's no medication
For this kind of pain,
Suspended televisions
That swing in an arc,
Causing serious damage
At night, in the dark,
Colonic disasters
From overfilled pans,
Body fluid exposure
On your clothes and your hands,
Broken thermometers
With mercurial spills,
Inhaling poisonous dust
From all those crushed pills,
Exposure to X-rays
That zoom through the walls,
Effectively neutering
Ovaries and balls.

Good god, it's a nightmare
There is nowhere to hide,
But who keeps statistics
On the nurses that died,
In the course of their work
By their choice of career,
They silently vanish
Year after year,
As their spirits race homeward
At the crack of each dawn,
The days of their innocent youth
Are long gone.

Things Hospitals Don't Want the Public To Know

I was viewing the news and spotted a ridiculous reveal regarding multiple hospital entities sharing (what should be) private patient information with META (owner of Facebook). You and I both know, that is off limits.........I think we had our souls hammered with threats regarding HIPPA. 

Anyway, here is one of the links:

https://abcnews.go.com/Health/lawsuit-accuses-cedars-sinai-hospitals-website-sharing-patient/story?id=97080170

and, in Louisiana (same problem)

https://www.nola.com/news/healthcare_hospitals/lawsuit-facebook-meta-louisiana-hospitals/article_39c948ee-ac98-11ed-9da3-9bc8d9299fc5.html

I guess we didn't understand the HIPPA  acronym, after all. We were told it was:
Health Insurance Portability and Accountability Act

Instead, it must really mean: 

Health Insurance Portability and Advertising Act

Sheesh, I'm finally catching on.

Unaverage

 

Unaverge: What does that mean? 

According to Merriam-Webster dictionary, it allows for "uncommon, unusual and not ordinary". I like to think that it is a good description of my own self. After all, I certainly know I am not a great writer, but not so many "writer-poets" diligently pursue rhyming as their chosen medium. Therefore, I'll settle for "unaverage".

Was I the best ICU Nurse to walk the hallways of  Tinseltown? Assuredly not, but I did attempt to be one of the best, wheresoever I worked. So again, I like the identification of "Unaverage". And now that I ponder that, I believe it is a reasonable description of the multitudes of Doctors and Nurses (and others) I worked with, who made a point of staying current in skills and knowledge in their field of expertise.

I dedicate this to those of you who might identify as Unaverage:

I'm just an Unaverage MD
Don't tell anyone
I got through Med-school for free,
While attending an Ivy League Residency
I found myself in play for the Presidency,
I had to turn it down, of course,
Because I might have suffered Med School remorse.

I'm just an Unaverage RN;
If they knew my history
I might be locked in the pen,
But I learned early 
To keep a low profile,
Plus, have all the answers 
On speed-dial.

Yes, the two of us together
Would have been a heck of a team,
Our ingenuity and brilliance
Could capture a dream.

Golden Retriever, RN

 I retired from the hospital almost four years ago, but I keep in contact with my old crew via an occasional visit to their battlefield. 

The latest news included a couple recent retirements, an EP doctor departed without a replacement, the work flow has not changed at all (still supremely understaffed at times) and the arrival of two new staff members with purported ICU experience. Oh ya, one of them came from an ICU but did not complete the three months in training (never had gone solo). The other hiree came from an outpatient surgery setting, where the day ends at 5:30pm. Now, being assigned to a shift that is 11a-11p, this person wants to leave early every day. What the fooey??

Here is my solution:

Last year, the hospital advertised
“Hiring experienced nurses”,
This year they hired the uneducated
Because they tightened the purses,
How is it working out?
Not too well, it was a lousy solution,
I think a Golden Retriever
Would be a better substitution.

Trainable
And energetic, 
Honesty
That is not cosmetic,
Never tiring
Until they are told to rest,
Enthusiastic
About any test.

Not prone to fail
With standard training,
Reliable
With no complaining, 
They won’t pretend
To do things well,
Hire a Golden Retriever?
What the Hell!

Everyone knows
I’m no fan of the canine,
But where I work
I think they’ll be just fine.

New Hospital Equipment

In 2010 at our Level I trauma center there was a new wing of the hospital and the opening of a 20-bed ICU for Neuro, Cardiac, Thoracic and Medical acute care. What a combo! There were four large rooms designed to accommodate Bariatric patients and in general, people weighing 400 pounds and more. Lift tools and devices hanging from the ceiling on movable tracks were part of the standard room setup. Plus, there were new air beds designed for really big clients. The Administration had their fill of hype on all of this stuff, but we nurse discovered things were not so rosy when working with the equipment.

These hot new Bariatric beds

Are super mondo slalom sleds,

We position patients every hour

They slide right down under gravity power.

The bed hydraulics are definitely weak

I'll explain it now, just let me speak,

When we lower the head below the feet

It’s easy to move the patient, slick and neat,

But to bring the head up beyond a 30 degree angle

The hydraulics are too feeble, oh what a fandangle!

The nurse at the bedside must help raise the head 

Another “safety” device, liable to make me dead.

These new tech beds are for the super-heavies

Supposedly stronger than Sacramento levies,

Holding back the 100 year flood

But I'm not too sure about this BillyBob stud,

He weighed in at two hundred and twenty kilo's

And we weren't even weighing the pillows,

On beds that are rated to 500 pounds

We're approaching that number in leaps and bounds.

Beds with all the bells and whistles

Not suitable for an ICBM missile.

The beds can rotate side to side

It's really quite a pleasant ride,

But here again this weight thing irks

If you're really heavy it barely jerks,

There's a tendency for big boy Jimmy

To get stuck on one side while the bed just shimmies,

It wiggles and strains to pump air through the bellows

I wonder, “Where is the lift team, I really need those fellows?”

There are lifts on the ceiling with slings down below

When Jimmy's feeling better we can swing him real slow,

Into the chair by the window to improve his outlook on life

Then the bed will be vacant for his long suffering wife,

Her kilo's are many, her cankles are like stumps

I'm praying to Euphemia, “Dear Sister, bless these chumps”

Don't let either of them have a cardiac arrest

Our defibrillators aren't prepared for that test.

We have negative airflow isolation rooms

With lifts on the ceiling on super-strong booms,

But honestly, I'm wary about the safety of it all

Bad things happen when big people fall,

Caregivers damaged, lawsuits are brewing

When the dust has all settled, corporate will be screwing,

Around with the numbers, statistics and more

The science of big is a titanic chore.

Please, don't misinterpret my harangue on what's big

It's really an expose on the bureaucratic jig,

Million-dollar decisions from dubious advice

High cost vendor contracts at an unbelievable price,

End-users suffer at the whim of corporate decisions

Are Workers Comp injuries in the provision?

This light-hearted muse ended somber and dark

But the business of healthcare is no walk in the park.

2010