It's wonderful knowing everything, but don't be a fool, knowing isn't loving. What do I mean? Enjoying all the various tasks that one knows about, is the kicker. We all have favorite things that we enjoy doing, some of those that we excel at, and a few others that we suck at. If you're my manager, and you know I'm not so good at something, that I hate doing it, and it's very likely that I won't get through it, without screwing the pooch somewhere, why give me that assignment? The person following me is just going to get angry, that once again, I screwed up on this "not so difficult" task. Why throw me into that black hole in the first place?

Black Hole

Why I don't like
One particular job,
You must be neat and exacting
But I am a slob.

I can't seem to keep track
Of all the finicky parts,
The nuances and particulars
Where it ends and where it starts.

I become anxious and distraught
And I lose all control,
What should take two or three hours
Becomes a timeless black hole.

My chance of screwing up?
If you're a betting man, odds are good,
But that raises the question, dear Leader
Why not assign it to someone who could,
Just breeze through it dandy and efficient
There are several who work at our station,
I'm not trying to dodge, but rather support
No mistakes, for that big operation.

I'm accustomed to procedures, fast-paced situations
Quick assessment of resources and need,
I like doing different stuff, all the day long
If it's a hemorrhage, I'll help stop the bleed,
But give me a task, with a 50 step checklist
That must be done, an exact, certain way,
I guarantee, Boss, that will be your mistake
It will seem like it takes me all day.

From a management side, I get the point
Everyone should know everything,
But let's be honest, we all have our talents
I can chant, but I surely can't sing,
And they know damn well I will jump in the fire
When others are running for the door,
I'm willing to be here, any time, day, or hour
Just don't assign this particular chore.

Fibril_late;
12/31/11

Things were pretty slow the day after Christmas, a Monday, such that there were no procedures or "preps" on our roster. However, we still had a couple of people on call...........me and you. I received the dreaded phone call about 0835, right in the middle of a cool dream about the mini-mountains outside of Escondido, Cal, and the "hidden" Buddhist monk gathering at their amphitheater, that I discovered. What a dream to leap out of!

Anyway, no matter how I look at it.................'twas easy money.

Just a Wiffle and a Doodle

On-call Monday
The Christmas day, after,
Awakened at 8:30
By the phone, no, not laughter,
A 9:15 clock-in
Betty-Lou was in charge,
Oh, the dread in my heart..........
Just glad it wasn't Large Marge.

A couple of Echocardiograms
Were awaiting on my plate,
Scheduled two hours apart
One is bound to be late,
But then, the second one was cancelled
He was hypertensive and tachy,
Hyper-fluid dynamics
Results unclear and just wacky.

Three more hours of doodles
Help and assistance to share,
I got home about four
Easy work, completely fair;
Short hours, extra pay
Who could complain about that,
On-call is just a wiffle
When it's my turn at bat.

Fibril_late;
12/26/11

In the realm of post-Interventional Angiography, we see our fair share of predictable adverse events. We take all the steps that we can to avoid these happenings, but what can you do, when the universe is gunning against you?

This is the story about crazy Betty and the dancing Russian.

He Fainted, She Bled

She bled, she Bled
But she's not dead,
But I have to admit
She was out of her head;

He slept four hours
But when given the chance,
He passed out cold
After his little dance;

Predictable events
That I'd rather not see,
After a Cardiac Cath
But it happens to me,
When Billy Bob - Betty Lou
Get out of bed,
One of them fainted
And the other one bled.

Fibril_late;
12/20/11

Expensive Replacement

Double-time
But I was still screwed over,
Sending me to Neuro on Saturday
As the float-pool rover;

Look!: An extra nurse
To use, as they will do,
If you think that's cool
Just let it happen to you;

I'm an expensive replacement
I've already clocked, 43 hours,
But when they're desperate
They'll use all of their powers,
To coerce this unfortunate
And available nurse,
My buddies get 6 hours of call
And I earned the curse.

Fibril_late;
12/16/11

__ __ __ __ __ __ __ _

Dissent

Well, it wasn't too bad
But it just wasn't right,
Float-pool nurse on the weekends
Sleep well, nighty-night,
Time-and-a-half, that's ok
But it was a sentence
Not consent,
If they propose this again
I'll buy a boat and cement.

Fibril_late;
12/17/11

It's a fact......I'm aging. Sure, everybody knows it might come to be, but wait until it happens to you. One day, you're a happy-go-lucky 20-something and then BAM!, your back aches at 4am, your teeth are in cup, and all your body parts are drooping south. It's horrid. I didn't sign up for this.......apparently, this business was hidden and buried in the very small print, in those pages of the instruction manual, that were eaten by the rats.

Deaf, Dumb and Blind

When I was younger
I studied mind over matter,
But as I get older
It's about mind over bladder.

Back when I was twenty
I pondered psychic meditation,
Now I'm almost sixty
With atrial fibrillation.

As a young man
I practiced altered states,
Now I'm pushing sixty
I lost hair and gained some weight.

Life is such a laugh
My early endeavors
Were fantastic in my mind,
Now I'm approaching an age
Where I worry
That I'm deaf, dumb and blind.

Fibril_late;
12/5/11

In a previous post (Nov 1), I wrote about symptoms of all kinds........and I'm revisiting the theme conceptualized by the flier for our Vascular Department.

This time, I'm "inspired" by that particular patient, that we see, who ignores even the most obvious and blatant signs of their serious disease: for example, a black toe falling off, before they seek medical treatment. Frickin' crazy!

Just A Symptom: Revisited

Is your leg pain just a symptom
Of some serious disease?
Do your toes seem loose and wobbly
Every time you sneeze?
Do your black and shiny feet
Give you cause to worry?
If you're just a couch potato
What's the rush, no need to hurry.

If your foot pain feels a little
Like an atom bomb exploding,
If your toes smell kind of bad
And it seems like they're eroding,
Do you leave a crusty trail
As you limp across the room?
Don't worry, what's the bother
Get the dustpan and the broom.

If you wake up, Sunday morning
And you can't seem to find your toes,
Maybe you remember, that about 2 am
You had that tickle in your nose,
And then it felt like five little rockets
Blasting off, on both of your feet,
Take a look down there, brother
Two black appendages, looking neat.

Yes, that leg pain could be a symptom
A harbinger of bad circulation,
What the heck, go ask a Doctor
Before you suffer abbreviation.

Fibril-late;
11/30/11

I'm a veteran of bedside nursing; a survivor of the system, and well on my way towards retirement. Do you think I really want to spend extra hours at work, on a whim? Sure, when I was younger, I wanted to tally as many hours I could, all for the bucks. But no longer; my body needs as much rest as I can acquire...........after all, bedside/gurney nursing is labor intensive.

So why is it, week after week, when we tally in an extra 15 minutes (or whatever is NECESSARY) at the end of a busy shift, the "Uppers", reprimand the "lowers" about the "strain" on the budget. And yet on the other hand, they don't applaud us for going home early (not paid)?

It's no mystery, and I know why.....Corporate/Business mentality is at play here. Ball and chain, whips and sour carrots. It's all in the coaxing, right?

Oh ya, how could I forget about "Nurses' Week and Nurses' Month in May"; I guess this is just the waiting period.

Overtime

Instead of giving a reprimand,
How about a clapping hand?
I know it's radical, like any diet
But whuda-you say, we bother to try it?

We know that
Unexpected overtime,
Adds to cost
By nickel and dime,
It makes the bosses
Curse and cuss,
And they point fingers
Right at us.

Reprimanded overtime
Late discharge and departing,
'Tis just my patient-centered care
And the necessary charting,
The beds to clean, the charts to strip
The whiteboard, fill the blanks,
And tally up that billing, mate
Still we're scolded, never thanks.

But when we're saving money
By our unpaid, early, off-time,
No thanks are sent our way
And that feels like caustic lime,
I wasn't paid for H-C hours
'Tis my voluntary loss,
Let's prepare a balance sheet, my friend
And present it to the boss.

How much money do we save
Compared to what we lose,
We will only tally our nursing hours
To keep it simple how we choose,
No thoughts about productivity
That's a management realm, my friend,
I don't want a clap or reprimand
Until this tally-month shall end.

Plus or minus, that's so easy
Hours are dollars, and that makes sense,
Don't scold me for my overtime
Unless you can prove I caused expense.

Fibril_late;
11/24/11

Every nurse has had the experience of encountering an angry, out of control, irate, screaming, cussing, cursing family member, at one time or another. I was lucky this time, it was just a phone conversation, and not a face-to-face confrontation. I can't say that I enjoyed it, though.

Communication Fail

I think I may have flunked
A call-back review,
After a screaming conversation
With a patient's daughter, Betty Lou,
I called her on her cell-phone
What time, to pick up Mother,
She angrily responded
Why, you ugly son-of-a-brother.

Perhaps it was my error
When we had that conversation,
Pick up Momma, at four, today
But that was faulty information,
Learning more, I phoned again
But encountered her cellphone-mail,
Yes be damned I was that moment
'Twas a communication fail.

At four-thirty I answered her call
And she was clearly on attack,
She said a Discharge Nurse had told her
It was time to bring her Momma back,
Saying, “What do you think you're doing
By jacking me around”,
I said, Betty Lou, it's not that way..........
Then she called me a son-of-a-hound

She was screaming, ranting, raving
Yelling and accusing,
I tried calming, caring logic
But that doesn't trump abusing,
From the mouth of an angry daughter
Venting at my expense,
Like a pitbull on a rampage
On the other side of the fence.

We didn't resolve our issues
And I don't care, I'll tell you why,
I'd rather walk on gilded splinters
And mate with a tsetse fly.

Fibril_late;
11/24/11

Sure, it has been about 3 months since I had to confront excrement drainage, but it's still a fresh topic, although not exactly. I saw a flier in the breakroom, advertising the latest edition of that wonder-tube the Flexiseal, and once again I was inspired.


Happy Camper

Flexiseal
Oh, Flexiseal,
It has a kind of
Sex appeal.

Just lubricate
And insert with a finger,
It’s up to you
How long you linger.

Inflate the bulb
With sterile N S,
If you warm it first
You’ll be sure to impress.

So,
For Billy Bob’s bottom
We soothe and pamper,
With the new Flexiseal
He’s a happy camper.

Fibril_late;
11/21/11
__ __ __ __ __

WD-40

Flexiseal
Oh, Flexiseal,
The thought of it
Just makes me squeal.....
When I see that tube
I get nervous and antsy,
A preemptive trigger
For diarrhea, Nancy.

It just won't stay solid
My excrement,
But if liquid is bad
What about cement?,
Try coaxing that down
My Flexiseal tube,
You'll need WD-40
And Astroglide lube.

A dilemma for sure
My excrement collection,
The stuff is caustic to my skin
And I clearly need protection,
Please hang that bag, over the edge of the bed
I don't want to view that part of me,
Although I own it, I don't need to see it
In this age of transparency.

Flexiseal
Oh, Flexiseal,
I'm willing to gamble
And make a deal,
Take away my drainage
And protect my skin,
And I promise to abstain
From original sin.

Fibril_late;
11/24/11

I was reading a History & Physical the other day, and the physician was describing the ongoing health problems. Under the topic of "Substance Abuse", he described this as, "None, other than cigarettes and food". I think he nailed it on the head.

Cigarettes and Food

I saw this in a chart today
Health habits; described this way:

“No substance abuse
Except cigarettes and food”,
Clearly bad enough themselves
To allow illness to intrude.

Many sorts of health issues
Go hand in hand, with hand to mouth,
And if good health is towards the north
These bad habits will lead you south.

Fibril_late;
11/07/11

Unfortunately, I had to have a root-canal done last week, after the onset of acute tooth pain. I was referred over to an Endodontist here in town, and bam-bam, he fixed it in 40 minutes. His office has one of those X-ray devices, where one can see the image instantly on a viewer.............definitely cool. So here you go, Dr. S........you rock!

Pitfalls of the Canal

Dr. S., over on 12th Street
Excavates a quick canal,
Take a photo, shoot some pain killer
There is nothing sloppy or banal,
Regarding his gun-slinger approach
And an office, skillfully staffed;
For Endodontal pitfalls
Visit a master, of this craft.

Fibril_late
11/9/11

Why do I enjoy hospital meetings, seminars and corporate pep rally's so much? Because there is always so much material to satirize.

Case in point:
Yesterday I finally attended the “must-go” Satisfaction class, at blah-blah hospital. For each table of hospital participants, we had one of those whopping big white paper flip charts to write our collective brilliant thoughts upon. I spent the 90 minutes drawing a cute little doodle-vignette, which included the what-where-when-why-how anagram Bear, the aidet-man super hero, and the nursing bundle dropping from the sky, like a giant turd, in the “no pass gas” zone.

I also keyed in on several hot phrases to turn into satirical poems, covering the hot topic of patient satisfaction. Have a look:



Bust or Boon

H-CAHPS, and Avatar scores
They’re shooting for the moon,
Blasting satisfaction surveys
Will it be, a bust or boon?

We’ll smile and wave to our customers
Hold hands and lookem’ in the eye,
Write two things that they want to do
On the white-board, before they die.

And if that ain’t satisfying
Oh surely, yes we’ve made it,
And thanks to all those trainers
Who taught us how to AIDET.

Fibril_late;
11/8/11
__ __ __ __ __ __ __ __ __ __ __ _

Peanuts and Candy

Always, usually, sometimes, never
Ambiguous terms, this primate lever,
Satisfaction scores, tell it all, aren’t they dandy?
Like training monkee’s in a cage, with peanuts and candy.

Fibril_late;
11/8/11
__ __ __ __ __ __ __ __ __ __ __ __

Satisfaction School

Sitting at the round table
At Satisfaction school,
Another Management exercise
Just who will they fool?

This time around.........
Same old stuff
Brand new wrapping,
Another AIDET revival
With all of that back-slapping.

Fibril_late;
11/8/11

America the beautiful; where even dogs and cats can have dialysis, race-horses are put away for a busted leg, and humans with severe dementia and a danger to themselves and their caregivers, can have a pacemaker to prolong their lives. I am not suggesting that I am self-appointed judge of ethics and morality, I am just a healthcare journalist and there are real-life stories that need to be reported.

What a Drama

She's confused and bipolar
She's a crazy holy Roller,
They give her Haldol
To make sure she stays happy,
She's a demented old lady
With severe Sinus brady,
And she's calling her doctor
My “chappie”.

Now, Dr. O'Heart
That dude's really smart,
And he knows how to charm
An old dame,
Whereas we minor nurses
Bear the brunt of her curses,
And Dr. “Chappie”
Collects all the fame.

The family finds relief
In the midst of their grief,
After all
They thought Momma was dying,
Now she's back in her room
Her dementia, in full bloom,
They're writing letters
“Thank you Doctor, for trying”.

We do our best to be kind
But family members are blind,
They think that we're
Torturing Momma,
Without restraints and a sitter
Watch out – she's a hitter,
Just maintaining her safety
What a drama!

Fibril_late;
11/2/11

At work, there is a flier on the wall, advertising the expertise of our Vascular Services. The question posed to the public is this: “Could Your Leg Pain Be The Symptom of Some Serious Disease?”

Now I suppose that is a worthy question to propose to society, but I noticed a nice rhythm and meter to that statement. Also, it caused me to ponder the proliferation of medical advertising that we are pummeled with, every day of our lives. I think just about every flippin' magazine, newspaper, website, radio, TV and even the movies with product placement, are carrying advertising to suck us into the idea that we are all sick, and we need a medicine or treatment.

So here's my take on it all:


Just a Symptom

Could your leg pain be a symptom
Of some serious disease,
Do you have Tuberculosis
Because you have a cough and sneeze,
Do you suffer from Meniere's
'Cause you're a dizzy, dipsy dame,
Do you practice hypochondria
Because you're seeking hospital fame?

Oh, first we had the word of mouth
And then the printing press,
The television and radio
And our digital age is a mess,
Of constant advertising
To your weakness and desires,
Drug companies and device makers
They love it, they need buyers.

Did your lifetime worldly savings
Disappear when you got sick,
Did you chase the cures and medicines
Hoping one of them would stick,
Did you follow healthy habits
Over the decades of your life,
Or did you hope for God's deliverance
When the surgeon cut you with a knife.

Could your life just be a symptom
Of a string of lousy choices,
Don't worry, our industry loves you
You are financing our Rolls-Royces.

Fibril_late;
11/01/11

Yesterday I attended a Cardiology conference in San Francisco, sponsored by UCSF. One of the topics addressed the equipment associated with non-implantable defibrillators, and for the sake of this discussion, the defibrillator vest. It is generally agreed that the device is currently cumbersome, weighing about 15 pounds, and about 20% of people get bothersome skin rashes from the materials. I figured, that if the manufacturer could team up with Men's Wearhouse, with a slogan like, "Look Your Best, When You Wear the Vest", these things would be selling like hotcakes. I shared my musings with that particular presenter, and got a laugh at least. And maybe, someday in the future, we'll have it that way.

Defibrillator Flirting

Defibrillator clothing
Don't leave home, without the best,
Beneath your tux and tails
Do make sure, you wear the vest,
Sure, it's cumbersome and awkward
But sudden death might ruin your night,
When you're flirting with the hat-check girl
And things are looking tight,
And the wife is somewhere shopping
Down at Saks 5th Avenue and the Gap,
Your defibrillator accessory
Is what makes you a charming chap.

It is better than a vibrator
The whips and chains, and more,
It is better than Viagra
No matter how much you score,
Electric stimulation
It surely trumps them all,
Just flip the switch.....defibrillate!
Yessirree, you'll have a ball;
It's better than anything
That you've ever tried,
A little sex and sudden death
Why it's almost like you died.

Amidst amorous activity
My electric vest is standing by,
In the event of fibrillation
It assures me, that I won't die,
And I tell you, with all certainty
There's nothing quite like this,
When it seems like I am dying
I deny the reapers kiss.

I'm not afraid, it's figured out
From the minute to the second,
The Grim Reaper is by the doorway
And with his hand, I have been beckoned,
But with this vest, I am protected
When death is knocking at my door,
With my girlfriend I can have the best of times
And always ask for more,
And it's certainly a major selling point
In the Cardiomyopathy bunch,
When you wine and dine your secretary
You can have that dessert after lunch.

Fibril_late;
10/30/11

Health-care over the past 33 years............that's quite a memory to carry. We have had such an evolution of change in science and technology, but we humans haven't changed much; we take millions of years, to only change, perhaps one bit of our DNA. As a result, any talk of change in human dynamics, is just that - talk.

Same Old

We're doing the same old things
But with a brand-new name,
Like taking a damaged portrait
And rebuilding the frame;

The oils have hardened
The pastels are faded,
The painter is long-dead
And his relatives are jaded;

So, any efforts to revive
Some of the previous glory,
Will produce the same old results
And that's the point of my story.

Odarepsed;
10/27/11

No matter where you go, if you start a new job, you must endure something called "orientation". I just experienced that a couple of weeks ago, even though I am still, technically, in the same hospital system.

Orientation

Hospital orientation
No matter where you attend,
It always seems to last too long
And you just wish it would end,

After all the many introductions
The Avatar values, right and left,
No one in the audience seems interested
A classical, time-management theft.

Names and departments, and who's the who
And what they are doing, I just don't know,
But the dude from Human Resources
Loves his stories, and it's his show.

So you better look sort of interested
Because, sleepy new employees don't impress,
He has all of the Managers on speed-dial
And I hope he's open to bribery, I confess.

Fibril_late
10/22/11
__ __ __ __ __ __ __ __ __ __

Orientation propaganda always bugs me. I hope it only works on "the first-time" healthcare worker, because for the rest of us, it's old news.

Ancillary Propaganda

They're still selling us “A.I.D.E.T.”
So I guess we haven't made it,
Nursing Bundles and Rounding
….........Discharge phone calls.........
Tell me, how's that sounding?

And now an Ancillary Bundle
For all of you non-nurses,
And lastly the “No Pass Zone”
Oh Lordy, now that's a bundle of curses.

And to think, I've figured this out
Without having yet, gone to the inservice,
This is a well disguised pile of propaganda
And quite frankly, I'm paranoid and nervous.

The trends of Health-Care mismanagement
Have little to do with outcomes and healing,
Rather, patient satisfaction surveys and reimbursement
Keep the managers busy, bargaining and dealing.

Oh, shades of many different colors
Like an old time stage, with shifting scenery and a big curtain,
This is the present day arena we're working in
And like a low budget moving picture show......
The outcome is always uncertain.

Fibril_late;
10/22/11

Why do Pharmacy companies make up similar names of medications, or shape identical bottles of different drugs?

Why do Laboratories put names on lab-tests that sound almost exactly like something else, but the test is completely different?

And according to Nat-Pat-Sfty-Goals, we are supposedly trying to reduce medical errors?
Ya, right!

Naming Game

Sound alike, look alike, drugs
Also known as S.A.L.A.D,
Down in Pharmacy central
That's the name of their favorite ballad.

But what about those lab tests
Too many, sound the same,
Look alike and sound alike
Is the Lab-test naming game.

The latest silly example
Of Lab-test naming confusion,
“Anti-X-A Heparin”
Is focused on the infusion,
Of the Heparin drip we know so well
To be measured a different way,
Not to be confounded by that other test
The one known as, “Anti X-A”.

How many times do I predict
The test will be ordered incorrectly?
No one is willing to take that bet
In hindsight, circumspectly.

Fibril_late;
10/20/11

A Fabulous Excuse

I'll take a request now and then, to write a poem for someone, for some kind of special occasion. This is for you-know-who, getting a knee replacement. I wish him the best, and expect him to stop limping around; enough with the sympathy ploy, ok?

Actually, the fact that he lasted this long is astounding. Anyway, what every one wants is a good excuse, to get out of stuff..............perhaps this is his.

A Fabulous Excuse

Just another great reason
Oh, what a fabulous excuse,
How to get out of working
After years of abuse.........

I'll just blame it on my employment
Nursing is tough, and everybody knows,
It had nothing to do with motorcycles
Water skiing, or winter snows,
It wasn't rugby or football
Or jumping out of planes,
No, it had to be Nursing
That was the cause of my pains.

Although I limped around for years
And fought the righteous fight,
I had pain with each step
And I moaned every night,
Of course, I thought that was sexy
Laying in bed, next to Suzy,
Until my wife caught the two of us
And shot my knees, with her Uzi.

Well, I couldn't really broadcast
That I'd been cheating on my wife,
Heck, if word like that got out
She'd come after me with her knife,
So, what am I left with
But a damned good excuse,
My old knees are worn out
After years of abuse.

10/16/11

After just completing my on-line "Skills Test", I realized I had just been blasted with Nursing jargon. My recourse was to write about it.

Klitchy Jargon


It never ceases to amaze me
Just how jargon defines ones identity,
Each group creates a klitchy language
When we speak together, ahhhh, such serenity,
And exclusive it is...........
You don't fit, if you're left scratching your head,
“Nursing implements purposeful rounding”
Which means we came to your bed.

Pain, Potty, Position incorporates intentional rounding behaviors
You can see, I don't need to fabricate great words to rhyme,
When the care team embraces Patient-Family-Centered Care
Because Nursing writers and researchers, do it all the time.


Fibril_late;
10/5/11

I don't know about you, but to me, the idea that we are using "Satisfaction Surveys" to guide our reimburesments, seems absolutely ludicrous. I mean, how easy would it be to manipulate the results? Just take a little money out of the purse (or some other attractive trinket, like a free Heart-Cath), offer it to the patient or family, and have the best surveys coming in by the dozens. This will become a boondoggle for corruption, mark my words!

But you know, "corporate" and "big government" love the idea.........Politically Correct Care!

Sadist Faction Scores

Satisfacton surveys
For reimbusement compensation,
Are we the first country to do this
This united nation?
I'm not much of a historian
I only study the here and now,
But apparently Uncle Sam
Is threatening our cash cow.

So, of course your medical repair
Is our ultimate intent,
But does it offer real certainty
Regarding money well spent?,
If your satisfaction-survey
Is returned as a D-minus?
We might be forced to offer prayers
To Saint Thomas Aquinus.

Sister Euphemia
Would never throw those dice,
For patient-satisfaction
She's willing to pay any price,
Which is why this particular nurse
Always offers special care,
Sister Euphemia states
It's time for truth or dare.

By demanding satisfaction scores
That achieve one hundred percent,
If we don't reach those ideal numbers, baby
Rest assured, we will repent,
Because a reprimand from Sister
Is a frightening thing, indeed,
Satisfaction scores, be damned, my child
Get ready for your bleed.

Sadist Faction scores
Correctly named, to be sure,
Whenever Sister threatens
She guarantees her cure.

Fibril_late;
10/5/11

Out here on the left coast, reform of many sorts, seems to come about ten years after the new ideas originated somewhere else, like the East Coast. So here we are, year 2011, and finally, the Circus known as, "Patient Centered Care", has come to town. Here come the meetings, the training, the new jargon, the evaluations, and potentially the remediation (when I continue to screw up). Yes, these are exciting and heady times!

So naturally, I had to research the whole PCC movement, and write about it. To me, it just looks like a new version of an old game..................

The New Bingo

The latest catch-phrase
In health-care bingo,
Patient Centered Care
Is the hot new lingo,
It describes what we do
In this modern age,
In case you didn't know
It's written on the last page,
Of the thirteenth chapter
In the book of new thought;
At the meeting in the auditorium
Come and see what Sister bought.

Sister Euphemia, is crafty
That's for sure,
Regarding the issue of non-profit, profits
She has the remedy and the cure,
Change the name of the business model
Every couple of years, at least,
The dodge and weave manifesto
Is the nature of the beast.

Ten years in the making
This Patient Centered Care,
Proposed in academia
And now it's everywhere,
Heavy handed implications
To manipulate behavior,
Couched in terms of common good
It's the latest health-care savior.

Coming to a neighborhood near you
Meetings, memo's and more,
Roughly, every new decade
They retrain us, what a chore,
We learn bright new terminology
Describing the same old tasks,
Underneath, it looks the same
If you bother to remove the masks.

Just wear your smiley face
Nod your head, and say, “Yes”,
Before long, we'll be wearing hats
And bring back that white dress,
Because apparently our patients
Liked us better back then,
In those horse and buggy days
Good old fashioned, way back when.

Patient Centered Care
Yes, it's the latest new lingo,
Just say all the right stuff
And you'll win the Bingo.

Fibril_late;
10/6/11

Regarding our EMR (again).

When we started this thing 3 years ago, there were several layers of experts, trainers and learners. I took a week of training, and became a "Super-User", because I have a bit of computer aptitude. But the guru's of training were called "Red Shirts". Most of them were cool, professionally sharing their expertise, but there was/is a rare bird, that has the obnoxious, "red-shirt egotism", that persists even to this day, now 3+ year in practice. I bumped into one of those birds today, and quite frankly, after her little bit of "teaching", my feathers were ruffled.

O.C.* Agent Three

A dressing down
By Agent Three,
She said, “I’m a red-shirt
So, do like me,
You must chart exactly
The way that I teach,
Because this is is my ocean
And I own the beach.

OK, there’s your way to teach
But seven ways to record,
All of your obsessive details
That eventually get stored,
Into this medical record
In our digital age,
But I won’t guarantee
That it’s on your favorite page.

You want Stepford nurses
Charting perfectly, O.C.?
Go looking somewhere else
Because that surely isn’t me

*O.C. = Obsessive Compulsive

Fibril_ate;
9/30/11

Back in July I wrote about a friend who had a back surgery, and 48 hours of dismal nursing care. Today, I think I wrote the last poem about the debacle. Check it out.

Condolences

They sent me condolences
Addressed to a different name,
So, was the letter truly for me?
Oh, it's such a guessing game.

After all, I was owed an apology
For some two-month old transgression,
A mismatched name to my address
Doesn't leave a good impression.

But perhaps, it's an appropriate ending
Case closed; such a messy ordeal,
I'll never step foot in that place again
And I'll tell all my friends how I feel.

Fibril_late;
9/29/11

Most of us working at big hospitals are now using some sort of EMR (electronic medical record). I am only familiar with one of them, a product from the company, Cerner.
The complexity, layers upon layers of charting, and often, processes that don't make a whole lot of sense to the end-users, are actually setting the stage for more medical errors. Of course, the buyers of such products, and the sellers of the same, would like the public to think, that every step we take in the digital world, somehow makes their precious lives safer. Not so, and you know it.

Let's take a look at one of the biggest boondoggles, "medication reconciliation".

Reconcile Redundancy

The greater the complexity
The number of steps in an equation,
The more likely a random chance
To make a mistake on any occasion.

It's an engineering problem
Mathematical in a sense,
The more steps it takes to accomplish a thing
A greater opportunity for an offense.

And that is our state of art
In the realm of medication reporting,
The repetitive steps to reconcile
Redundant, reiterative, resorting.

Take a look at our typical patient
Age 62, Diabetic and over-weight,
He has high cholesterol and gout
And he's here, to learn his cardiac fate.

He has three doctors on tap
Primary, secondary and another,
Fourteen medications and 32 pills
All organized by his dear old mother,
Maybe I'm lucky and open the chart
Finding a medication recording,
Although, just how reliable that might be
Nonetheless, it is somewhat rewarding.

Hopefully, the guy is carrying a list
Otherwise, we're totally screwed,
Because I am supposed to record all the details
From this stressed-out, forgetful dude,
When did you take it last, what day, what time
How many milligrams, sir?
Muddled he looks, then he points at his mother
Saying, “I think you better ask her”.

But here comes the crux of the problem
And it really doesn't make any sense,
His home meds will be merged with his hospital drugs
Then we toss them all, over the fence,
Each time he goes to a procedure
Every time he comes back to recover,
We have to perform another reconcile
Like trying to save an old lover.

His fourteen meds, and today's seven drugs
Keep shifting around in the bag,
What are the odds that I'll make a mistake
And select the improper tag,
Pretty damn likely, I'm telling you
When a system is built, in this way,
How many times will I reconcile
Three times, and that's just today.

With all of the hype about Patient Safety Goals
We're battered and bludgeoned with these themes,
If a problem is “solved” with a complex solution
I tell you these are only pipe-dreams,
More problems created, more mistakes out there waiting
Software written and then sold, as the best,
But the engineers writing this nonsense
Are not the ones putting it to test.

So if they come after me, because I made a mistake
I'll point an accusing finger at Cerner,
And ultimately, the exemption that I will claim
Excuse me, I'm just a slow learner.

Fibril_late;
9/28/11

We have all seen the “Companion” animals in the hospital; usually a cat or a dog. And it is becoming ever more common, to see people carrying or walking dogs, in almost any store in town. I suspect that business owners are afraid to speak up against it, because the next thing they know, the SPCA or PETA will be protesting outside their store, trumping animal rights. Fine! If it's all right for your cat or dog, it better be hotsy-totsy for my hamster.

Three Bites

Too many frickin' dogs
Wherever I go,
I've seen them at the pharmacy
And the motion-picture show,
Teacup-poodles at Costco
Handbag-bassets at Taco-Bell,
To, us cat aficionado’s
It feels like canine hell.

I plan to protest
I propose to fight back,
We cat and rat-lovers
Have to take up the slack,
And each and every one of us
Who prefer rabbits and hares,
Need to get out in public
And show that somebody cares.

If I'm ever in the hospital
I'll send my wife
To “Rent-a-Rabbit”,
Because too many dogs
Have become society's bad habit,
I'll need my helper-hare
And I want my comfort-cat,
And he wants his ever playful
Laboratory rat.

I want equality
For the animals that visit,
No more chance for discrimination
When people say, “what is it?”,
A biped, a quadruped
A uniped, who cares?
Because there once was a time
When even dogs, would bring stares,
So the future is bright
And those dogs will take a lickin',
Because after my rabbit
I'm bringing a chicken.

Canine-companion
Ain't got nothing on me,
Just wait till they see
My helper-wasp and my bee,
The Cockatoo speaks Spanish
And my Coyotes that howl,
Whenever the nurse
Brings some soap and a towel.

Some say I'm like Doolittle
But in fact, I do a lot,
Equality of animals
Is hotter than snot,
And according to the Baboons
From Animal rights,
They fully support my stance
And give it, “Three Bites”.

Fibril_late;
9/26/11

People are patients and just like all the rest of us. Sure, going to the hospital is stressful, and maybe you really are totally fubar..........but why treat your doctors, nurses and everyone who want to help you, like crap.........why cuss and swear at us? Because you are evil. It's that simple. Inside hiding, is your nasty little self.

Foul Air

I see the wholeness of people
In their most vulnerable position,
No matter how they arrived
They have a medical condition,
They are stressed, they're in pain
And sometimes angry, to boot,
Some of them will abuse their caregivers
Like hunting animals to shoot.

And the real nature of who they are
Will be revealed without blindness,
Most rise above their afflictions
With beauty and kindness,
But if they are petty and nasty inside
And lived life with a bad attitude,
No amount of pain-killer
Can make you feel better, dude.

Why take it out on us
Those persons assigned to give you care,
Why disturb the atmosphere
With your cussing, cursing air,
Why address me with foul language
Essentially I'm there, at your behest;
Your evil Karma
Is just my daily test.

The sordid nature of your soul
Beneath your beat-up bod,
The true nature of your personality
Like dirty, worn out sod,
Striking out at your caregivers
And calling them foul names,
If this is your idea of control
It is the stupidest of games.

Perhaps you always felt inferior
And now you're the superior witch,
Perhaps you always felt downtrodden
And now, you're just an angry bitch,
Perhaps you might think my language
To be foul and uncouth,
Yet, you use those same names
Toward your caregivers
Those fresh young angels of youth.

No one wants to see you
And no one wants to talk,
No one wants to hear
Your foul, angry squawk,
No one wants to care for you
But we do, because that's our job,
And really all I can say is
I feel sorry for your husband Bob.

Fibril_late;
9/22/11

Ok, so maybe I need to proceed cautiously, now that I'm in new territory; at least until they understand that I am super-nurse..............

Good Advice

Sometimes the trouble
With so much experience and knowledge,
When one feels like a post-graduate
From the autonomy college,
Perhaps I was acting too loose
When the blood pressure was dropping,
“You should have called me”, said Doctor
After all, I wasn't out shopping.

I'll take that good advice
And be more careful next time,
To avoid future antagonism
And perform a little more sublime.

But ultimately
No harm was done,
The patient went home
Feeling, the happy one,
She thought that her care
Was exemplary and super,
Looking as fit as a fiddle
For a low-ejection-fraction trooper.

One might ask, were my actions
Too happenstance and loose,
Was some evil done
Or some kind of abuse?
No, none of those things
In fact, all ended well,
But I'll call the doctor in the future
So I won't catch hell.

Fibril_late;
9/16/11

Last Night

Here's what happened on the last night of work, over at the previous job.

My patient had undergone a VAT (video assisted thoracotomy), and had previously been using Oxycontin frequently at home. Post-op she had a Q-pump with a local anesthetic infusing into the rib area, she was on a basal-rate Dilaudid PCA, and popping an Oxycontin every four hours.

Apparently she was on Klonopin for an anxiety disorder; and quite obviously, this woman was on a lot of drugs at home. So I'm thinking, that when I told her she was getting her Klonopin, but really it was a Pepcid, the placebo effect was fully operational. She went right to sleep; later telling her daughter that the Klonopin really helped. Go figure!

Last Night

My last night at work
Was kind of funny,
But I'll wait a year
Before I tell you, sonny,
About the little mistake
I made with one med,
It caused no harm
And no one is dead.

In fact, I might have actually
Saved a life,
Someone's mother
Someone's wife,
When I administered Pepcid
And not Klonopin,
Was anyone hurt
By this omission, this sin?

In retrospect,
I think it was better
II didn't follow the med-profile
Exactly to the letter,
What with frequent Oxycontin
And the Q-pump for pain,
That Klonopin might have
Gone straight to her brain.

Respiratory depression
When that breathing stops,
The rhythms get whacky
And everybody hops,
To the tune of the wild rabbit
Can you think of a better name?
If she ends up on the ventilator
Tongues will wag and fingers blame.

So a Klonopin omitted
I have no sense of guilt,
She got a Pepcid swap instead
And her comfy, hand-made quilt.

8/26/11

When I interviewed, I said that I had probably seen or experienced, every possible Heart-cath disaster/dilemma that one could imagine. Although some of those events were truly scary, they were all learning experiences. I've just returned from my 7th day of new job, and here was the dreaded retro-peritoneal bleed crisis. Sure that happens now and then, but 'tis all the more dreadful when the patient is completely disoriented, suffering from severe dementia and fighting like a trapped wild animal.

Just another terrifying, true story.

Shouldn't Be Done

It wasn't criminal or negligent
But it shouldn't have been done,
Although diagnostically wonderful
Heart-caths aren't for everyone.

Fairly youngish, only sixty
But fate had struck her, many blows,
A brain tumor and severe dementia
There is nothing that she knows.

Pre-cath she wandered frequently
Amidst our busy staging scene,
Frequent searches, where did she go?
She was the rambling queen.

After her cath and clean coronaries
It was our job to pull sheaths fast,
With the application of heavy pressure
On her groin, like a bomb-blast,
She started screaming and writhing
Fighting, kicking and trying to sit,
I'm telling you, it wasn't pretty
And all hell broke loose, I admit.

Two nurses pinning her down
One giving drugs to relax,
Blood pressure dropping to sixty
Pale and diaphoretic, those are the facts,
I saw the hallmarks of bleeding
Internally, that was my thinking,
Because I've taken this boat down the river
And I know the signs when they're sinking.

IV fluids wide open for volume
A little drug to quiet this poor lady,
Tachycardia was soon our companion
Her skin was so pale and too shady,
A Rapid Response was called overhead
What the heck, have some friends drop in too,
Get a couple of other, hot opinions
We better do something, before she's blue.

An emergency call to the Cath-Lab
Where her doctor is working on some other guy,
Ya, sure, take her down for a CAT-scan
That sounds like a good thing to try,
With the nurses running out the door
Racing that gurney down the hall,
Sure enough, she was sure bleeding
She won the ICU bed after all.

It wasn't criminal or negligent
But it shouldn't have been done,
Heart-caths are clearly, quite dangerous
Not frivolous exercises for fun.

Fibril_late;
9/9/11

There's nothing wrong with busy...........it keeps nurses off their phones, off Facebook, and makes the time fly. But sometimes if you look in on it, chaos will be your impression. The new job is a bit of all that

The Wild Magician

It's a dance, it's the rhumba
It's some crazy samba, my friend,
In the middle of the day
It's seems like there is no end,
At five in the morning
You might think you know these folks,
But they're just passing through
With all of their nervous jokes.

Let's take a moment to examine
To summarize the outpatient condition,
They are told to arrive two hours early
So we can prepare their admission,
Hopefully, they arrive promptly
To give us time to do their prep,
In theory, we're a well oiled machine
With everything going step-by-step.

Unfortunately, in real time
We dance to the tune of the wild magician,
From the doorway, it looks more like chaos
Combustible and approaching ignition,
Patients are waiting beyond the time
There were informed regarding appointment,
Because of an emergency with Billy Bob Borko
Extreme Unction, consecration and anointment.

But eventually this day shall pass
The most that need be done is achieved,
And as long as they continue to pay us
No one shall be aggrieved.

Fibril_late;
9/4/11

Why My Care is Better

Many people know this, but here is a reminder of how ridiculous health-care has become.

"Tying Medicare and Medicaid reimbursements to patient satisfaction was a component of the Patient Protection and Affordable Care Act, and will go into effect in October 2012."

That leaves us nurses with but one choice; time to start bribing our patients and families.

Better

I bribed my patient
To write a thank-you letter,
To describe my patient-care as great
Like yours, but mine is better.

But why, all the fuss
About these letters of thanks?,
Because these notes are like money
Into the hospital banks.

Don't call me cynical
When I know this is true,
Uncle Sam will pay us more
If patient-satisfaction grew,
Greater than our last tally
In the previous fiscal quarter,
Because these satisfaction quotients
Are the brick and the mortar,
Of the second-tier reimbursements
When private-insurance halts,
My patient's love me, baby
Because I bring them chocolate malts.

I pose to them a question
“If you could have anything tonight,
What is your desire
Just name it, in lights”
Because I have the power
To the kingdom, (and the keys),
To make your night easier
And surely, everyone agrees,
That a happy, satisfied patient
Writes the best, post-hospital letter,
And although, your care is good
That's why mine is better.

Fibril_late;
8/26/11

What the Hell?

This is a long one, but is my last opportunity to comment on a local memo, before I head down the road.

Nursing - What the Hell

I’m thinking of instituting a new Blog / Forum titled:
“Nursing – What The Hell?”

Don’t get me wrong, we nurses keep the world turning, but golly-gee, our leaders have the craziest ideas.

For example, the hot topic on the Staff-bathroom wall is the memo that includes the following paragraphs, outlining the latest “What the hell” idea; read along, and see if you agree. I have made special comments, as denoted by the asterisks.

Quote: “As we continue to provide the best care for our patients, we must improve our documentation accordingly. (In regard of Patient Turning Protocol)  H, D and L reviewed what was taught to the nursing staff regarding documentation of patient turns. We feel that documenting every shift that the patient was turned every two hours is inadequate. We would like for all of you to begin documenting the individual turns that are being made. For instance, if at 8am, you turn the patient to the right, you will need to document in the I-view, that the patient was turned to the right and so on…..

”We appreciate the care that you give our patients every day.(*1) We want to be able to acknowledge that care, by having you document it in the medical record.(**2) The nursing department managers will be auditing your charting and coaching you as needed.(***3) The data gathered in these audits will be reported back to you, as well as being presented to the hospital leadership team.(****4) It is our desire to see the documentation of patient turns to reach the 100% goal."(*****5) Closed-Quote.

This Author responds:

1* This is the sweet, feel-good stroke, before we’re slammed with the message

2** How exactly do they “acknowledge” our care, when we are documenting something? That doesn’t make a lick of sense.

3*** Now we’re going to be audited (to make sure we behave) and coach us if necessary. Oh boy, I love coaching! Perhaps it will be like my High School PE teacher screaming four-letter words during football practice. “Turn the G-D patient, you f**khead, or else I'm going to give you a jalapeno enema!”

4**** Oh boy #2, audit us and then tell the hospital leadership team; maybe they can coach us also.

5***** Look, if you want 100% compliance, we can all continue to lie about it in our charting (as usual).

6****** H, D & L = Huey, Duey and Luey.

It makes me laugh, how our whole frickin' management society in this country, want “100%” compliance. Nothing in nature will ever achieve 100% compliance. How about that cardiogenic-shock patient that will die if we turn him; the morbidly obese patient that fills the bed, and can not be turned; the need for three or four nurses to be available to turn a patient, when there are no nursing assistants; the patient that wiggles out of position within five minutes of just turning them; and so on. This directive is ludicrous.

There is a severe nursing shortage in America (if one believes the media) and for some reason management doesn't get a clue: we, your valuable, and supposedly appreciated assets, do not feel happy when we are threatened with “audits and coaching, to achieve compliance”.

It all comes down to one thing, you know you are truly valued and appreciated, when the Capo di tutti capi are threatening you. Booyah!

Fibril_late;
8/22/11
* * * * * * * *

When I posted my pseudo-flier on the wall in the Staff-bathroom (see flier below), some persons actually thought it was true, until they noticed the silly poem at the bottom. Ain't that something? We are so inured (hardened, accustomed) by these types of directives, as to be accepting anything (no matter how ludicrous) that comes our way. That must be the sign of a "true" professional.

Breaking News! Breaking News!

From the

Breaking News Department
Beginning September 1st:

Q2 Turns will require a Witness

And,

Coming soon!!!

XOXO Hospital, is opening a new RN position

Finally, at last;

Witness Nurse

Now, let’s all sing together:

Turn them to the left
Turn them to the right,
Turn ’em supine,
And say, nighty-night.

Turn them around
Forward and back,
Get a witness while you’re at it
It’s the Q2-turn attack,

(Repeat)

Turn to the left
Turn to the right,
Stand up, sit down
Fight, fight, fight,
Turn them on their side
Thirty degrees, on the angle,
Have a witness to prove it
It’s the latest fandangle.

Fibril_late;
8/22/11

_________________        __________________

I'm sorry to say but the Management did finally demand that we have a 2nd nurse as witness, to the actual turning of the patient. PATHETIC.

Hunt and Hess

Attached to our computer monitors where we chart, are a variety of laminated "prompts" to help us know stuff. I spotted this one last night, because we're a Neuro Unit now. One more reason I'm glad I'm moving on. But, the name of the thing caught my eye, because it had a nice rhythm to it. "Hunt and Hess Assessment Tool".

Hunt and Hess

If you really
Want to impress,
Use the scale
From Hunt and Hess,
For non-traumatic
Sub-arachnoid bleed,
Know your hemispheres
And who they feed.

Fibril_late;
8/22/11

The term, "evidence-based" always bugs me. It is supposed to be so cutting-edge. But that's this year; what about 5 years from now, when we debunk the whole thing? When there is new evidence, that we were just running around in circles (as usual)? I guess after we implement, nobody will give a rat's ass anyways. Well, out in the hayfield, there is always room for just one more.................

Sacred Cow

I could have written more
And maybe I will,
Could you get me some water
To swallow that pill?

You see, I'm feeling kind of dry
Parched mind, and not enough to think,
Just get me a glass of water
And give me some time to drink.

There is a lot to be said
And in time, I will say it,
I'll write the usual words
Like a dragon, I will slay it.

Retrospective analysis
Why, that's our bread and butter,
You know, I get all excited
Evidence-based, set's my heart a'flutter,
Then we can all run around
Thumping our chests, stomping our feet,
When we proclaim, we're “evidenced-based”
Why, good golly, that's so neat.

But don't inquire too much
About what we did before,
Why in the hell we did things, that way
How come, we chose the crooked door,
And then again, ten years in the future
When again, we look back to now,
What we think is evidence-based
Will be just another sacred cow.

By golly, I did write more
As if I was appointed, yay, it was my duty,
Now, if you love that evidenced-based stuff
Come on down, and shake your booty.

Fibril_late;
8/16/11

Goodbye; I'm leaving Timbuktu.

Timbuktu

Goodbye to all
Farewell, to thee,
I’m heading off
To Mercy-G,
It’s been a helluva
Wild ride,
But I’m crossing over
To the other side.

‘Tis like a family
Here at McAuley,
Just hanging out
With Mabel and Wally,
Their cousins and nephews
And grandchildren too,
Like a relative revival
In Timbuktu.

You know I won’t miss
All the crap that we do,
I’ll only miss
Mabel, Wally and you.

Fibril_late;
8/12/11

Feel The Ouch

I haven't written much about Diabetes
The old, the young, the grumpy, the sweeties,
A collection of persons
Everyday, on my path,
They have one thing in common............
At night, they get a bath.

Blood sugar samples
Every six hours
Or more often,
If the crisis is acute
Fingertips scar
They don't soften,
And if blood pressure is low
Maybe a repeat poke
A couple of times,
Even I, feel the ouch
In the midst of my rhymes.

Fibril_late;
8/5/11

It's official: I applied for a different hospital position, interviewed, was offered the job on the spot (seniority/experience) and accepted. I'll be moving across town to another subsidiary of this same system, and I'll be able to walk the one-mile to work. But what will I miss from my old job, when I switch over?

Won’t Miss

Nightly bath’s
And cranial drains,
Insulin drips
And hemorrhaged brains,
Delirium tremens
And the overdosed,
The suicides
That meet the holy ghost.

Respiratory failure
And the bundled VAP,
GI Bleeds
With smelly crap,
Gaping wounds
That just won’t heal
Because none of this
Has sex appeal.

Oral-care, and
Q-2 rules,
Turn and baste
And lifting tools,
High-tech equipment
Not ergonomic,
Break-room size?
Sub-atomic.

HAPU-this and
John Hopkins, that,
Acronym’s for everything
Like, who fell flat,
When the family demanded
Elmer, should ambulate,
After 3 months in bed
It’s too damn late.

Patient satisfaction
Driven,
Screw that up
You’re not forgiven,
Then top-end bosses
Will stomp and snort,
About that juicy
Government support.

Thoracot
Colectomies,
Post-op surgicals
Delivered free,
Into this
Convoluted place,
We cover all specialties
Of the human race.

The flier was on the wall
But I had to squint,
The matches were missing
And I had to use flint,
But when I lit up that paper
And followed the ink,
I found a position
That caused me to think,
And ponder the option
A most excellent adventure,
Could I apply in time?
That was the clencher.

I’m moving on
And heading back,
To Billybob
With his heart-attack,
The heart-failure group
And the E-P ablations,
Pacemaker placements
And aberrations,
Bypass and valvular
Heart repairs,
I’ll advise them on diet
And climbing stairs,
Take all of your Plavix
Your Aspirin and Statin,
And if you want to live
You better unfatten.

Can this old dog
Learn a few new tricks?,
I'm betting yes
In a couple of clicks,
And the walk to work
Is one heck of a bonus,
And surely, I won't miss
That pseudomas!

Fibril_late;
7/30/11

Back on April 19, I wrote about how our ICU was to be designated as the "go-to" Acute Neuro Unit. I know these things are decided up in lofty offices, and the community at large will benefit, but this addition of yet one more service under our belt, has caused a lot of anxiety and discontent amongst the nursing staff. There have been a number of classes and on-line educations available, and the "official" starting date, was August 1st. I've gone to those classes, and here is my take-away:

Neuro Class

Locked-in State
That's how I feel,
Becoming a Neuro-nurse
Makes me want to squeal;

My reticular activation
Is clearly in doubt,
Psychogenic unresponsiveness
Is my way out.

Nuchal rigidity
That's Viagra of the neck,
Who took the fun out of fundoscopy
Oh my, I'm a nervous wreck,
Then, there is “gaze preference”
Like when I'm lunching at O'Grady's,
My eyes are roaming the room
Looking at all of the ladies,
While Uncle Herniation, snickers in the corner
I'm checking his accomodation,
He has pathological reflexes
And a sociopathic fixation.

They're giving Imhotep
A dose of Nimotop,
Buried alive and resurrected two times
His headache, just won't stop,
It's a neurological emergency
Mummification, just didn't suit him,
Probably the only recourse we have
Is to take him out back, and just shoot him.

GPS vs. GCS
What the two of those are
I don't know, I'm under duress,
Global position system, and
Glascow coma scale,
Search and seizure, I'd rather avoid
The thrill of it is beginning to pale

So, Monster Jobs
Is calling to me,
My motor activity
Will set me free,
Jump in my car
Put my foot to the floor,
Take a look at my “run sheet”
As I'm racing out the door.

Fibril_late;
8/3/11

My best of all friends had a “global” spinal fusion a couple of days ago. The surgery was perfect and the care sucked. It's true, and if you could know all of the transgressions, you too, would be shocked.

My friend is a highly experienced critical-care nurse, like myself. Nine out of ten of her visitors were from the same crowd. Did that make a difference? Not really, but we were there as her witnesses, journal-persons, and safety-net. She went home a day earlier than expected. Why? Because every hour longer that she stayed in that hospital, was one more hour that somebody could screw up.

To an outsider, that may seem harsh. But, in truth, it was reality. I know, because I was there to witness the debacle. I'm sorry to say, that I work for the same employer, across town at a different facility.

There was an old saying, like a kind of prayer, that went like this: “Lord, have mercy on us/me”. Unfortunately, my best friend was a recipient of that mercy-style care. Ouch!

Un-Care

Diagnosed you were, indeed
With a surgery, to boot,
Unintentionally, under-medicated
You were primed, and ready to shoot,
Just name the perpetrators
The participants in this crime,
More focused on a policy
Than patient-advocate time.

Just forty-eight hours duration
Is more than enough, when care is lacking,
When you want to run home, screaming
And send those care-givers packing,
To be ignored, and accused, and betrayed
By fellow nurses, who treat you like dirt,
Unwilling to accept that their errors
Are at least half of your feelings of hurt.

Who is to blame, and what is the problem
I'm embarrassed, because this is my employer,
Where mercy should be doled out to everyone
But now we're looking for one good lawyer,
To right the wrongs that were experienced
To prevent future scenario's like this,
So that persons who follow beyond us
Might be protected from this careless abyss.

Fibril_late:
7/22/11
_ _ _ _ _ _ _ _ _

A Guiding Principle

A common surgery
With the best doctor,
Turned out to be a gamble
In the absence of a proctor,
A guiding principle
Of good care and compassion,
Instead, you were abused
In the worst fashion.

The surgical intent?
To alleviate pain,
In the post-op period
It was a ball and chain,
Dragging you under
While caregivers watched,
Their morals and ethics
Completely debauched.

How can that be
In this day and age,
We have been counseled
That pain, is front-page,
And nurses stand by
As guardian's at your side,
Instead, you were assigned to
Beelzebub's* bride.

How could they, not act
To alleviate your pain,
Stand up for your needs
Isn't this their domain?
To act as an advocate
For those persons in their care,
Instead, you were trapped
Within the dragon's lair.

We sat there and witnessed
And I have written, what I know,
Guiding principles were lacking
Nursing was absent at your show.

Fibril_late;
7/24/11

Beelzebub* = Satan
__ __ __ __ __ __ __ __ __ __

A Transgression – No Compassion

A transgression, a crime
Perpetrated upon you,
Oh, where was your error
Just what did you do,
You chose to have surgery
In a well known place of healing,
But the care you received
Was absent of feeling.

Is that a crime in the courts?
Probably not, but I suggest,
That nurses, who choose this profession
Should be offered a test,
Where they imagine their child in bed
Suffering life-threatening pain,
Will they stand around and argue policy
Or get on the phone with Dr. Humane?

We test Nurses on experience
And we test them for knowledge,
We check their credentials
And we applaud them for college,
We welcome them readily
When they come from afar,
But we don't test them for compassion
And that would reveal who they are.

This “calling” of Nursing
Is legitimate and true,
We're seeking a few good souls
Who'll take the best care of you,
And hopefully, we'll be watching
For the weeds, yes, pluck them out,
Because Caring is an advocacy*
That's what Nursing is all about.

Fibril_late:
7/26/11

*Advocate: Noun: person who pleads for a cause or propounds an idea
Verb: speak, plead, or argue in favor of

On The Bottom

Over many years, I've seen a metamorphosis and evolution of skin dressings, protective barriers, wound packing’s, etc. These are used to either promote healing, protect skin, and now days, prevent the formation of bedsores. Sure, those breakdowns have some fancy name like HAPU, but it's the same old story, as usual. Ya gotta see the humor; one of our computer charting Plan of Care selections reads, “At Risk For Skin Integrity”. I'm not kidding. How about that for a typo? Whoa there, I better be careful, my patient might develop integrity of his skin; I better leave him on the bedpan for a few hours.

The latest new product we are using is a dressing for the sacrum, to be used on all patients who are on a ventilator, and any one else who might get a HAPU. Last night one of the patients had his Mepilex dressing changed four times, because he had a CRAPU! By golly, we really got to the bottom of that problem, right away.

On The Bottom

Mepilex, oh Mepilex
Advertised as
“Butt Protects”,
Use it on
Your infant too,
A cover-up
For baby poo.

Mepilex, oh Mepilex
For the kitchen floor
And redwood decks,
Water proof
And rot resistant,
Placed properly
With one assistant.

Mepilex, oh Mepilex
We employ it often
Like a hex,
To ward off bedsores
On the bottom,
We don't care
If you already got'em.

Mepilex, oh Mepilex
For on-line dating
And couples connects,
Way better
Than those churchy meetings,
Though I don't know
About Twitter tweetings.

Mepilex, oh Mepilex
There are special versions
For rated, “X”,
Check our website
Adults section,
Then left-click right
For that selection.

Mepilex, oh Mepilex
The best protection
For having sex,
Self adhesive
And hydrophylic,
Try it out
'Tis life idyllic.

Fibril_late;
7/12/11

Sure, we always do a Skin Assessment when we admit someone, (and of course 2 nurses sign on it), but now, Sister Euphemia wants us to do a Sin Assessment!?! Can you believe it?

Sin Assessment

Down at Sister Euphemia's place
Everyone working has a happy face;

You might think it's natural
But the water is tainted,
One day I drank so much
I almost fainted,
Swooned, I did
With ever-expanding joy,
I gotta be thankful
Because they do employ,
All sorts of us heathens
That follow a different path,
Sister Euphemia states;
Just give a good bath.

When a new patient arrives
We assess them head to toe,
Using all of our five senses
And technology for the show,
Charting hundreds of check-marks
On many drop-down lists,
If something is wrong
We have to see if it exists.

Now, since this is a Holy
Hospital place,
We evaluate the sins
Of the human race,
And then we'll formulate a care-plan
To wipe clean your dirty deeds,
Medicare demands it
Stating, “address all of their needs”.

Who can argue with that?
And Sister is paying,
We always do what she says
If we want to be staying,
At this heavenly job
Hell, it's Paradise, after all,
If you need to be employed
Why, just give us a call.

Fibril_late;
6/9/11

Gee, it seems like every other week, there's another protocol dropping in our lap. Half of the time, it's a new one, just like the old one, but a little bit different. They want to sell it as new, but it's just a revision. It's "evidence based", but wasn't the other one too, and if so, does that make us just a bunch of liars, in retrospect? If so, I'm going to confession, asap, before Sister Euphemia finds out.


Protocol Prognosticator

Protocols to the left
Protocols to the right,
A protocol for Sepsis
And Neurological blight,
As it was in the beginning
Is now, and never ending,
Protocols are the lifeblood
That experts are recommending.

Protocols are guidance systems
Armed and ready to fire,
Like everything in life, my friend
The circumstance is dire,
Poised upon the precipice
Of critical mass and disaster,
Just fire up that protocol
And you will be the master.

Large-group studies do propose
That if we read statistics right,
Some protocol will save us
In the middle of the night,
Despite apparent random selection
And other wild-cards of duress,
I propose a simple toss of a coin
As a worthy prognosticator, of success.

Fibril_late;
6/8/11

Little Miss Last Century

Wonders never cease. She's one hundred and four; Alzheimers, dementia, blind, living in the nursing home. A GI bleed brought her to the hospital and a visit to Interventional Radiology, where she had a cardiac arrest on the table. Well yes, of course she is a full-code, because her adult kids want everything done. Now she's on the ventilator in our unit, with the family expecting a "full" recovery!?!

One Hundred and Four

One hundred and four years of age
As if that’s not too old,
To perform goddamned heroics
And still the family will scold,
The doctors and nurses,
During that long CPR,
Because Momma is busted
Like a broken down car.

Suffering forty years of old
She went bad, after sixty-five,
It’s a wonder, this woman
Can even claim to be alive,
She has a spongiform brain
And Alzheimers too,
Her children are convinced
That she can still count to 2.

She’s on the ventilator
She had a GI bleed,
Her skin is like tissue
Where the bacteria feed,
Her heart beats a rhythm
Unclassified in the books,
This is not rocket science
Despite how it looks.

She's just an old, worn out woman
She can't tell day from night,
But her family wants everything
And they're willing to fight.

Fibril_late;
5/25/11
__ __ __ __ __ __ __

Grandson

Grandson takes care of her
He's on the county dole,
He's hoping she'll make it to 105
Before he puts her in the hole,
Then he can put all of his attention
On his sadly, stroked-out Mother,
He hasn't been employed in ten years
So he'll be looking for another.

Impaired relatives are his specialty
They can name him in their wills,
Who would ever suspect this caregiver
Who is handing out the pills,
Yes, this grandson, is a piece of work
He's found his niche in life,
Taking care of family members
Instead of taking a wife.

I'd be careful if I went visiting
To the house of his holy endeavors,
Expecting trap-doors in the floors
Controlled by hidden levers,
Incapacitating me in the process
To become, his next bedridden fool,
Suffering to the very end of my days
As his financial-freedom tool.

Fibril_late;
6/2/11
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Little Miss Last Century

Extubated at last
Comfort measures, and a no-code,
Maybe Miss Last-Century
Can finally retire to her abode,
An impending celestial discharge
To be carried gently to her Heaven,
Her grandson stepped out
He's down at the 7-11.

Pain and suffering
And unsavory medical measures,
Are finished at last
She's done with earthly treasures,
She may appear unconscious to us
But she's in direct communication,
As the Divine beckons to her
Her spirit reaches out, with anticipation.

Grandson raises a ruckus
When little Miss Last-Century dies,
Five minutes after her transfer
He's full of anger, that's no surprise,
He lost all precious control
When Grandma finally checked out,
His true nature clearly exposed
Absolutely, there's no doubt.

Sweet, little Miss Last-Century
We suffered too, there by your side,
Administering your care so gently
Until the day that you died,
Rejoicing in our own ways
That you cast away the shackles of Earth,
A little piece of advice to you
Take a long rest, before your rebirth!

Fibril_late;
6/3/11

On the theme of old nurses again..........I'm one of them.

Diagnosis: Aging

It's a strange world I live in
As nurses, we're getting older and aging,
Body parts moving around
And other battles are waging.

High blood pressures
And gall-bladders perturbed,
Crazy habits that we had when we were younger
Now just leave us disturbed.

Quite a few things we used to eat
That we no longer can do,
Most of us have gotten fatter
And a few of us can't chew.

And now we stand around the water cooler
Chewing the fat,
Talking about our body image
Because that's where it's at.

Like some kind of one-upmanship
My disease is worse than yours, Mabel,
Then she talks about her high blood
Diabetes and psoriasis
And man, I don't want to be at her table

We compare our doctors
Our therapies and our medicine,
You think yours is better than Einstein
And mine is better than Edison.

Some talk about their family's
And their irritating habits,
Others exaggerate their problems
Like reproducing rabbits.

This is life after 50
We’re all drifting downhill,
The diagnosis of Aging
Is one bitter pill.

Fibril_late;
5/15/11

I heard the term, "hostile abdomen", while attending a seminar yesterday. I immediately recognized it as the perfect line to a new poem; have a look.

Hostile

He had a hostile abdomen
An angry bowel,
A devilish duodenum
And a gall-bladder scowl,
His kidneys were complaining
His pancreas perturbed,
His liver was livid
And his spleen was disturbed.

All in all, his hostile gut
Was threatening to rebel,
His appendix was the renegade
Leading them all to Hell.

Fibril_late;
5/15/11

By and large (sometimes, very large) here in the nation of California, we are generally, a baby-boomer nurse constituency. So what happens around the proverbial water cooler? Yes of course, we talk about our own aches, pains, disorders, changing shapes and so on. And just like our patient population, we would all benefit if we could only improve our choices of food. Anyway, that's my diagnosis.

Diagnitis

When Diverticulosis
Becomes Diverticulitis,
You'll know your diagnosis
Has become a diagnitis.

Your doctor advises
Take no nut,
Because they won't exit
Out your butt,
Instead they'll fester
In your gut.

Sage advice
One would think,
That's nuts and bolts
And the kitchen sink,
Don't be chewing
On that chunky stuff,
Your gut will protest
And scream, “Enough!”

Pain will ensue
And you'll visit your doctor,
He'll advise colonoscopy
With a GI proctor,
Inviting all sorts of
Differential diagnoses,
Scaring the crap out of you
With your diverticuloses.

Get a clue now
And change your diet,
But if you don't want to
Please keep quiet.

Fibril_late;
5/13/11

The PoGlobin Index

It speaks for itself:

PoGlobin Index

An anomaly last night
Caught my ever-sharp attention,
There were laboratory values
That deserved a special mention,
The potassium was high
And the hemoglobin low,
In fact, their numbers matched
I saw the light, and it did glow!

A new prognostic indicator
Struck me on the head,
When the “K” and Hemoglobin match
You might soon be dead,
In the telling, what the value read
Was a gentle seven-point-two,
But those of us, who know the stuff
See the Reaper, coming for you.

Values incompatible
Organ systems halt,
Prognostic probes and platitudes
Propose a deep gestalt,
Code-status lurks beneath the waves
With nurses standing by,
Will we flail another suffering horse
Or wave a fond goodbye?

The new PoGlobin Index
Could revolutionize our field,
Retrospective analyticals
Would have a tool, that they could wield,
In the ever growing science
Of hindsight recognition,
PoGlobin Index data
Would be like gold to statisticians.

I am sure my future practice
Critical-this, and that beyond,
Whether here in good old USA
Or there, across the pond,
Will build upon this moment
Of genius in the rough,
PoGlobin Index was my baby
Building my fortune and that's enough.

Fibril_late;
5/3/11

Nightmare*

My nightmare came true
During that 12-hour shift,
I had a one-to-one patient
Plus two others, get my drift?

My dream came to life
On that 12-hour trip,
I was a desperate crewman
On my own sinking ship.

No, I couldn't do the things
That needed to be done,
I couldn't load the bullets
Into my gun.

I couldn't shoot the captain
Of this crazy ship of fools,
Because our leader was missing
Having broken all the rules.

I couldn't do my duties
That needed to be done,
But nobody died
So I guess, somebody won.

Fibril_late;
5/3/11

(* It's a recurring nightmare that I've had for years, where I've “forgotten” a patient for an entire shift.I'm sure it is a symptom of work-related PTSD, but still, to act it out in reality, is disconcerting).

During the time that I was off for bone repair, I used up all of my banked sick-time, and most of my PTO. After 2 weeks of work, I finally caught up with the local flu-like viral syndrome and missed a day on the job (fortunately I reduced my hours to 24 hours per week)...but that's a day without pay, however I slice it.

Skid Row

I called in, sick
Just the other day,
When a few hours before
I felt OK,
But Saturday morning
When perchance, I coughed,
My oropharynx
Was no longer soft;

No, it felt as if
Those tissues were ripped,
Where sharpened blades
Had gouged and clipped,
My tonsils
In a rage of fury,
And when I almost cried
My eyes got blurry.

There's a packet of pus
At the back of the bus,
Ripping razors, whenever I cough,
My vocals were distorted
When my voice-box aborted
Communications quite clearly, are off.

I'm no good for work
And sick-time is a perk
But in my case, that perk can't be trusted,
I used those hours in December
I quite clearly remember,
When my ankle was damaged and busted.

I'm not working, it's a freebie
I'll have to suck on a BB
Counting my negative cash flow,
I will heal pretty soon
After I main-line the moon,
While resting down here, on skid row.

Fibril_late;
4/29/11

Is it just Nursing or has the whole world gone crazy for words that end with "ment"?
Nursing loves to describe how we all implement, supplement and so on. We don't see impediment too much, and no one likes to talk about excrement, but I managed to get the whole bunch into a short little essay/poem/comment.

Ment Well

We implement
Their supplement
To their detriment,
Blame it on their impediment
When it results in excrement
(aka: a movement);

I think we're in agreement
That's no compliment,
It's a measurement
Of mismanagement
Of an ailment;

Despite commitment-
Just another appointment
Of torment:

But we ment well.

Fibril_late;
4/29/11