God - Yes, you know who I'm talking about. That omnipresent or never present being (depending on your point of view or level of desperation), has a lot of stuff on her plate. She's blamed or begged, sworn upon, or sworn at, prayed to, damned, and so on. As a nurse, I heard every convoluted opinion or belief imaginable, in some connection to God. In this poem we visit with some hapless soul, who has abused their body for decades, who now is pleading with God, to rescue them. Good luck, pal; God often looks the other way, when she has been ignored for so long.

Gray Shapes

Ominous gray shapes formed
On the horizon of his health,
Subtle elements of disharmony
Approached with painless stealth.

Clues of imminent disaster
Unseen by the untrained eye,
Told a tale of evil habits
But a muted voice can’t cry.

Too late for safe intervention
And desperately grasping at straws,
The dying man begs God for mercy
After violating all of his laws.

So God gives the second opinion
She laughs, saying, “You must be dreamin’”
I never buy back those old souls
That were long ago sold to the demon!

Fibril_late; 2/94

Today, a little longer entry, where I read a letter I received from my local nursing chapter of a well known professional nursing organization. The names will be blocked/changed, but the essence will be unaltered. It's just a glimpse into the world of, "The Underside of Nursing".

Igor, Editor Sept. 22, 1993
The Underside of Nursing
PO Box 371
Paradise, Ca 95969

Dear Igor:

I am writing on behalf of the Board of Directors for the Sacramento Area Chapter of the _WXYZ Critical-Care Nurses.

We have been on your mailing list for The Underside of Nursing for some time now. Discussion of your publication has been addressed at numerous meetings. As nurses, we feel that humor is an important part of life as well as healing. However, the mien of the humor in your publication is uncomplimentary to nursing, personally as well as professionally; unsavory toward the patients for whom we care; and fetid toward healthcare in general.

While we do not in any way wish to infringe on your right to free speech, we do not wish to support your humor, even passively. Therefore, we are hereby serving notice of our demand to have our address removed from your mailing list.

Thank you for your attention to this matter.

Sincerely,

Broomhilda , RN, XXXX
President Emeritus - wxyz organization.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
What the heck, they were getting a free subscription! I guess they wanted to make a "public" announcement, that our points of view were somewhat opposed.
Here is my editorial response:

9-29-93
To the President Emeritus, of the Local Chapter of wxyz.

Broomhilda,

Thank you for your letter. I will indeed remove you from my mailing list. However, I wonder why you are unable to understand that I am clearly a staunch patient advocate and definitely, a nursing advocate as well.

As a wxyz member and wxyz card holder, I recognize the need for professional attitude, research, etc., and "professional" humor too. I have read a number of other healthcare humor publications and they read like the "Readers Digest". Pleasant humor that barely touches the real pain that nurses and their patients are subjected to. I am just trying to fill those "grey areas" where few dare tread.

Sure, I sometimes display a "fetid" outlook on healthcare. I do when I see medicine intervening in peoples' lives when they clearly don't need treatment, when the discussion of life-threatening risks are minimized, when family members care less about their loved one than we do. I go home and cry, just like you would, when my acute MI patient in the process of an evolving septal injury has unrelieved crushing chest pain for 12 hours, and the attending physician won't come to the bedside at four in the morning to evaluate this patient. This is not something to be lightly humorous about. Nor is my suffering likely to be relieved by reading some research about doctor/nurse communication!

Broomhilda, I write about real life. It isn't always nice, courteous or professional. I write for nurses who daily must undergo incredible risks to their own health, in terms of exposure to deadly diseases, high level unrelenting work related stress, unexpected death and long term painful suffering of the patients they care for. I am sure it would be great to do critical stress debriefing every day, but that isn't practical. I am just doing my part.

Igor, Editor
The Underside of Nursing
* * * * * * * ** * * * * * * * *
There you have it dear reader, the way things were back in 1993; before the age of the blog.

Fibril_late; 9/93

One idea leads to another. I believe that nurses suffer "burnout" not from long shifts, or bad managers, or the burden of bureaucracy, but rather from being a recipient of "second-hand" pain. That is, being a partner with the endless suffering of humanity. This is what wears you down, in the long run. Post-traumatic stress............................
What the poem addresses, is a concept that people in severe, life-threatening pain, who require hellatious doses of narcotics, deserve to recieve those drugs. The idea that, "he might get addicted" should never even be considered. It is our moral and ethical duty to relieve suffering.


Unendurable Pain

I have an important question
To lay at the feet of my brother,
Where do we draw the line on suffering
That we inflict upon another.

Do we superimpose our own values
When the pain is not ours to endure,
Do we propagate horrible treatments
When there is slim hope for a cure.

Is unendurable pain
Treated with compassion and kindness,
Or do we succumb to narcotic hysteria
In our tunnel vision blindness.

These are questions that demand our attention
Beyond the simplicity of denying,
We must comfort our brothers and sisters
To ease the course of their dying.

Fibril-late; 2/94

Here I take a look at the tragedy of unwanted, preventable pregnancy, in the setting of premature delivery of an infant with enormous developmental deformities. I don't seek an argument with "pro-lifers", but merely report my observations of tragic suffering, that might have been avoided with some kind of birth control.

Some Moral Attention

How many unwanted infants
Born to unprepared mothers,
Arriving on earth, often early
They may never compare with the others.

So often crippled, I wonder
About the mercy, of an all loving God,
Was he so busy; he released this young soul
With hardly a wink or a nod.

And now with our ever increasing
Methods of medical technology,
We can prolong their suffering forever
It surpasses any sense of theology.

In the midst of this profound dilemma
We must acquire, some moral attention,
It's unethical to allow all this suffering
When there are so many means of prevention.

FIbril_late; 2/94

About strength of spirit and respectful care for those whose steps we follow.

I Won't Surrender

She lay so silent
A hidden strength radiating
From her pale, fragile frame,
Who was this person
This nameless soul
Who at one time, must have been "some dame",
Her body, weakened
Ravaged by some evil force
We call a cancer,
Her spirit raging
"I won't surrender"
She used to be a famous dancer,
With admiration
I go to her
She needs to be respected,
This light that shows us
How to live
Deserves to be protected,
When death shall come
To take this mighty
Woman to her rest,
Her memory lives
Within our hearts
She did her very best.

Fibril_late; 12/93

There is a "look" in the patient's eyes, maybe it's the "deer in the headlights" appearance. And those of us who have worked side by side with the sick, maimed and dying, we acquire the "1000 yard stare" - the look of those who have seen too much.

Hospital Eyes

The sick, the maimed, the indigent
I hear their mournful cries,
They look to us in anguish
With their soulful, hospital eyes.

They come from every walk of life
The gunshot wound, the carving knife,
For every one that lives, one dies
We close their hospital eyes.

Some give up hope, some buy the farm
They take their magic and their charm,
They'll ride the bus to paradise
We'll see them off, with our hospital eyes.

Fibril_late; 12/93

Healthcare delivery in the good old USA is grossly unfair and this poem gets to the heart of the matter. It isn't pretty and it often places medical persons into an ethical quagmire. This rejuvenated memory still causes me distress.

Did The World Default

What kind of message
Was derived from work today,
Did the world improve or default
It's just too hard to say.

Here's one guy
A treatable epileptic,
The other fellow there
Is dying, because he's septic,
And at last, there is the prisoner
The man is really nasty,
He'll enjoy his life long sentence
After obtaining angioplasty

How can we justify
The incredible cost,
When homeless mothers and babies
And children are lost,
On the street every day
While this murderer is treated,
Oh, the money is funneled
Where the high-tech god is seated.

Thirty thousand dollars
Is the minimum at least,
That we spent for just a couple days
To treat this awful beast,
Just imagine all the blankets
And winter coats that you could buy,
But instead we're saving murderers
While homeless people die.

To maintain a healthy outlook
And to keep from going crazy,
I must forget about reality
And let the facts get hazy,
Then look upon each man
As he lays there in the bed,
As just another brother
Who could very soon be dead.

Fibril_late; 12/93

I have some distinct and well founded opinions about the futility of life-saving methods and machines in the setting of almost certain, albeit prolonged, painful death. But sometimes the fighters are not easily recognizable.

This Old Boy From The Hood

He made it and who could
Believe that he would,
Defy all the odds
This old boy from the hood,
A cat with nine lives
Would wish for his luck,
A bookie from Las Vegas
Would wager a buck,
That no human being
On this side of hell,
Could survive this disaster
And come out so well.

His kidneys had failed
His heart wasn't beating,
This hulk of a man
Went a month without eating,
Then came respiratory failure
Pneumonia and P.E.,
A bowel busting ileus and
Hepatic encephalopathy,
Chills of unknown origin
Fevers of unknown disease,
Layers upon layers of treatment
In a setting of life threatening fees.

Who are we, to think we can predict
The survival of those likely to die,
No matter, the stack of their cards
As their caretakers, we have to try.

Fibril_late; 12/93

There was a time when most people died at home, so the average person was well acquainted with this normal and expected, piece of living. Nowadays, the process of entering the world and leaving the world, usually happen in the hospital. Thus, very few people, and this includes doctors, are on speaking terms with death. This poem, takes a look at the situation through the eyes of a dying person.

Death Sits In The Corner

Just waiting and waiting
For my doctor to come,
The clock ticking quietly
Like a perpetual drum,
Louder and louder
It seems to me;
Death sits in the corner
Inconspicuously.

I just want acknowledgement
Though I know the replies,
There's no rhyme or reason
When somebody dies,
Yet, even the dying
Deserve some respect;
Death sits in the corner
He's here to collect.

Before my doctor arrived
To say good day,
Death stretched out his hand
And took me away:
I know why, my physician
Wouldn't come near;
Death sat in the corner
And challenged his fear.

Fibril_late; 10/93

This is one my "weekend filler" poems. A recent addition, that has nothing to do with nursing or medicine, but more to do with my personality.

Outspoken Man

There are those who might doubt
That I’m an out-spoken man,
But I harness golden thoughts
And insert them where I can.

I attempt to avoid arguments
The emotion drives me to ruin,
My fight or flight goes overdrive
And I wonder what I’m doin’
When my heart goes pitter-patter
And not on little cat’s feet,
Arguments and tension
Are my physiological defeat.

I’m an outspoken interloper
Sneaking into conversations,
You get it going
And I provide the commentations,
I heard everything that was said
And I have my opinion,
If I’m in range to hear your story
I’m a part of your dominion.

Fibril_late; 8/25/06

"Oops!" Now that is the four letter word you never want to hear a Doctor say, when he's rewiring/replacing a Central-IV line, in your ICU patient. This is the tale of a real John Doe, who fortunately survived one of those really big "Oops" moments.

The Missing IV Caper

It's not that I'm complaining
I won't say my care was shoddy,
But there's an IV catheter
Lost, somewhere in my body.

I've had several consultations
The doctors shrug and wonder,
They scramble for some research
For solutions to this blunder.

I've been CT- scanned and echoed
They even split my arm,
I thought the basic tenet was
Physician, do no harm.

So when they came this morning
With the fiber optic pliers,
I screamed, "Not another inch, boys"
Let's call Jacoby and Myers.

It's a litigation nightmare
As the accusations fly,
The defense will try to drag it out
In the hopes that I will die.

Then they'll probably pay the coroner
To falsify the paper,
To exonerate the guilty
In this missing IV caper.

Fibril_late; 10/93

I worked in a number of Cardiac ICU's over the years and saw a lot of people getting coromary bypass surgery. It certainly can be a life-saving procedure, but not always, and some poor souls will have their grafts reocclude in a short time and may opt for a repeat surgery. I recall a few men who had it done 3 separate times; I guess they had generous insurance providers.

A Fish Lovers Dream

Chest crushing pain
And diaphoresis,
A flash on her life
And a vision of Jesus,
It must be a heart attack
Claiming another,
A lot of things hurt
But this one's a mother.

It blasted away
At her cardiac tissue,
Now here come the surgeons
With their government issue,
Rebuilt and sanitized
Almost new heart,
Guaranteed to deliver
A fresh, wholesome start.

Oh, isn't technology
A fish lovers dream,
If something is busted
There is always a scheme,
To promise results
So remotely obscure,
The public believes
They are buying a cure.

Saphenous vein grafts
To restore circulation,
The business is booming
In this heart attack nation,
With repeat offenders
Lining up at the door,
Expecting their doctors
To do it some more.

Fibril_late; 10/93

I would rage against the machine of medicine at times, when promises and cures were offered, yet our technology was still in its' infancy. Too much suffering was prolonged, further crises were created, personal choices were stomped beneath the feet of modern science.


His Last Precious Breath

The pain and the suffering
He had to endure,
In light of his age
And slim hopes for a cure,
Was out of proportion
To the health he retrieved,
It is quite clear to me
The man was deceived.

If his primary problem
Was only his heart,
If he wasn't getting senile
Then he might have had a start,
A few good years left
To enjoy like a man,
With dignity and respect
But it wasn't the plan.

Near syncopal episodes
But never passed out,
He had a one room apartment
And short mailbox route,
He finally called the doctor
Because his kids said, "Dad, we care",
Now he's dying in the hospital
And at his bedside; no one's there.

Feeling too damned guilty
To come visit each day,
Knowing full well
That they said ok,
"Say yes to the doctor, Dad
Because he knows what's best",
He's an expert in his field
And believes he is blessed.

Indeed, he's an expert
In the parlay of words,
He could romance the feathers
From a large flock of birds,
And he told this old man
He had an appliance,
That would solve all his problems
A gift of great science.

When he signed the consent
The doctor outlined his risk,
He minimized problems
His delivery was brisk,
"Do you have any questions"
The old man replied, "No",
Just a sharecroppers son
He was illiterate and slow.

But he'd lived a good life
And deserved a good death,
Until this conscience-less doctor
Stole his last precious breath,
Now he's destined to die
With a long muted scream,
Another high tech victim
Of the American dream.

Fibril_late; 10/93

I had to fit sex into a poem somehow and I was pondering how just maybe, this most common human experience could be harnessed for the good of the practice of medicine. After all, there are some Cardiology stress tests that require chemical administrations, such as Dobutamine, to induce tachycardia and the sympathetic response. Why not simplify matters and just have the patient open up a Penthouse magazine or watch a sexy movie? So I propose the:

Provocative Resting Test : (S.EX. - Stimulated Exercise)

There's a promising procedure
That we have now, in the lab,
It may prevent your stable patient
From landing on the slab,
It works for men and women
It isn't age-specific,
In multi-center trials
The results have been terrific.

Not everyone is suited
To test this brand new science,
It's completely non-invasive
And requires no appliance,
You just need an open mind
And a good imagination,
To achieve the best results
Exceeding threshold excitation.

Be ye literate or not
It's an adjustable modality,
Conforming to your needs
And your type of personality,
We perform it in a setting
Of privacy and trust,
Should you realize your potential
Of experiencing lust.

It's so simple to perform
It's a wonder why we've waited,
When a number of our tests
Are simply too outdated,
A resting and continuous
12 lead EKG,
With non-invasive pressures
Are the keys, to what you'll see.

Position is not important
Unless deformity demands,
Comfortable fitting clothing
That readily expands,
To accommodate prodromal
Characteristics of reflex,
Because the objective of the treatment
Is to have the client think of sex.

A library of literature
With a thousand paperbacks,
Cheap pulp novels
And folio's of facts,
Adult rated video's
And romantic, loving works,
Twisted, murky monographs
To accommodate all quirks.

Unlike pharmacology
The side effects are nil,
No FDA approval
To regulate a pill,
It's an absolutely normal
Response of excitation,
And so easy to elicit
With an active imagination.

The specialist stands by
To monitor events,
Record the vital data
In this scene of present tense,
Ischemic abnormalities
Or a dysrhythmia display,
Will guide the future treatment
In the usual kind of way.

So you see, it’s fairly easy
After a minor evaluation,
To identify specifically
A target population,
And in the acute hospital setting
We should offer them the best,
So familiarize yourself
With the provocative resting test.

Fibril_late; 9/93

Hand washing! Gee, I think it was in the news when Florence Nightingale was teaching 100+ years ago. Probably the single most effective means of disease prevention.

Until They Squeak

Oh, doctor
All I ask, is please,
Go wash your hands
Each time you sneeze,
And every time
You spit or cough,
Make sure you wash
The germs all off.

Because studies show
That very often,
Doctors pick
Their patients coffin,
So listen up
In layman's speak,
Please wash your hands
Until they squeak.

Fibril_late; 9/93

If your blood pressure should become dangerously low, say at your arm, just imagine what's happening in your brain. Maybe this is what they mean by heintz-sight?

Ketchup Brain

In a state of no perfusion
You'll see ketchup brain ensue,
As the viscosity of blood flow
Becomes a sludge like glue,
And the lubricated bearings of your thoughts
Begin to smoke,
While you gain the realization
It's some crazy, cosmic joke.

As your window of perception
Is reduced by each degree,
You'll begin to beg for mercy
Asking God, why pick on me,
And a league of minor angels
Sing in harmony this refrain,
"We're conducting an experiment
To study ketchup brain".

Fibril_late; 9/93

When you visit the Dentist, place yourself in that chair of torture, you are virtually a prisoner at your own bidding! Crazy but true..........

In Her Grip

That diabolical dentist
Has me in her grip,
I dare not moan or wiggle
She might accidentally slip,
And perforate my palate
With her light speed laser drill,
In the winking of an eye
She could make an easy kill.

Her happy smiling
Look-alike attendant at her side,
Will help insure I won't forget
This agonizing ride,
She keeps the Novocain placebo's
In plentiful supply,
And with malevolent amusement
She laughs each time I cry.

Fibril_late;
8/93

A little more in the Dental vein; all about pain and pleasure

She Turned Me On

She turned me on to pleasure
She turned me on to pain,
With those Novocain injections
Mainlined straight into my brain.

With an endless bag of tricks
And the tools of her profession,
I never leave her office
With regrets about our session.

I recommend her name
To everyone I meet,
In her field she has no equal
This dentist can't be beat.

Fibril_late;
8/93