Gash

Bleeding, makes me nervous
Not my own, silly goose,
Rather, your gushing artery
It's a heck of a deuce,
Most special is the instance
Where your artery was nicked,
And nobody knows it
Thus, I do feel tricked.

If the nick is on top
That's a singular thing,
Easier to deal
With the tools that I bring,
But a notch or a gash
On the side of that vessel,
Is like crushing a bowling ball
With a mortar and pestle.

In other words, foolish
To think we can squish,
Hard enough on your artery
To fix the crack in the dish,
And taking into account
Your anticoagulation,
It's like holding a locomotive
At the Brownsville station.

Two and a half hours
We finally achieved,
Another great save
Where nobody grieved,
And even the Irishman
Shook his head in wonder,
Stating, "I even used Ultrasound"
To avoid this blunder.

There is nothing to blame
We all do our best,
Though holding pressure that long
It was certainly a test.

What We Do

What happened this week
You might not believe,
And if we weren't so good
Then someone would grieve.

Monday, we worked late
There were not enough rooms,
There was a late anesthesia
For the bride and the groom,
And sure, that sounds just like
My usual rant,
But Tuesday blew the leaves
Off the Mulberry plant.

Three Rapid Responses
Meaning, we ask for help,
77 year old Clifford
Was drowning in kelp,
Flash Pulmonary Edema
After a PCI,
We got him out of our Unit
'Cuz he was too young to die.

And then there was Willard
97 years later,
He got the leadless pacemaker
But needed a breath locator,
Because he didn't wake up
And he wouldn't keep breathing,
I tell you, this is more work
Than a one year old teething.

The final Rapid Response
Well, it was the best,
Billy Bob Borko
Was taking the test,
His get up and go walk
After Cardiac Cath,
To get ready for home
A short walk on the path.

Off to the restroom
He was looking good,
Didn't lock the door
Just like he should,
The toilet did flush
Then the ground did shake,
Billy Bob passed out
Man, I think he will ache.

Prone on the floor
And face-down, he was,
Not moving at all
I don't know, just because,
Till I called his name
To assess, signs of life,
Hoping to reassure
The whimpering wife.

And I have to admit
I'd rather not call Code Blue,
We don't need 20 helpers
In a bathroom built for two,
So, once again we paged
Our RRT pals,
Got Billy Bob moving
Just one guy and two gals.

All's well that ends well
'Tis the moral of this week,
Surround yourself with good nurses
No matter young or antique,
Because we'll pull you back
From the envelope of doom,
Keep you comfy in your bed
To see the sunrise in your room.

Out-Patient ICU

Out-Patient ICU

Has a nice ring to it, ya.

A day in our hidey hole

Just another average, no crisis day.

Pool of Anxiety

What about today?
Half fussy, half cool,
I never know what attitude
Is floating in their pool,
Could be deep anxiety
Regarding the unknown,
Or they're simply ticked off
Without service on their phone.

I always admire
The visitor in the chair,
If they talk to patient Billy Bob
Instead of the vacant stare,
Focused on their smartphone
Although, how smart is that?
Creating no thoughts of their own
No sharper than fat.

Three admissions and departures
In the first three hours,
Thank goodness I'm endowed
With a couple super powers,
Then later on the same
Like a movie shown twice,
The evening ones are fussier
Demand to leave, not so nice.

We threaten with drama
"Well, you know, you might bleed,
Then, you would have to stay longer
Because safety is our creed,
So, just calm yourself down
And thank that lucky star,
Dude, we fixed your A.Fib
With nary a scar".

Over and over
Day in and day out,
This is what we do
Without a whimper or shout,
Sure, we do complain
Occasional and easy,
But we do the kind of stuff
That makes lots of folks queasy.

Turn, Turn, Turn

While perusing my medical reading / updates a couple of days ago, I came upon an article / advertisement for a sticky pad thing we can attach to patients, to monitor how adherent we are to Q2 hour turning. The website is all touchy-feely-good time stuff regarding HAPU, and reduction of pneumonia and so forth. The kind of stuff that gets healthcare systems to invest another gazillion bucks on hardware, software, equipment and more beeping monitors (and ways to punish Nurses). All of those bazillion dollar expenditures (and branding bucks too), would be much better spent on real live Nurses and support personnel. Of course we who read this stuff, know all that! Phooey; just look at this website. ........http://www.leafhealthcare.com/

 Turn, Turn, Turn

Staff nurses will hate this
A patient-turning alert,
Electronic surveillance
The reprimands will hurt,
Because no one has time
To do Q2 hour turns,
We don't have enough staff
But nobody learns.

HPPD tallies
In case you don't know,
Rule every damn thing
Over at the big show,
It accounts patient care
With a static measure,
As if nurses were dallying
All those moments they treasure.

Another monitor thingy
That we stick to Billy Bob,
He’s as hairy as a Yak
But don’t label him a slob,
He prides all of his fur
And dare not, you trim,
His hair is religious
According to him.

If I place that sensor
On his naked back,
Will the monitor think
It's a face-down hack,
And I will be reported
To the motionless committee?
Could I be fired? (Then I'll sue)
Oh, isn't that a pity.

Q2 turning is great
With caregivers aplenty,
But that concept was banned
Way back in 1920,
While working the most recent
Fifteen year gap,
Any bedside Nurse can tell you
It's been a spank and a slap.
_ _ _ _ _ _

My favorite contributor of hospital nonsense.........in Virginia, has this to say:

We have these thing called VisAlerts.  They hang on the outside of each room.  They have a green, yellow and red light on them, connected to a timer.  When you go into the room, you reset it.  The light turns green.  At approx 54 minutes, it turns yellow.  At 1 hour (that's what ours are set to), they turn red.  If they manager or director see too many red lights, the  nurse gets a "talking to".
We didn't even have a working EKG machine on the 3rd floor last week.  We called a Rapid Response.  Our EKG machine had a broken clip.  We ran to get Ortho's EKG; theirs didn't work.  Renal didn't have one.  We had to go to the 2nd floor to find one.  (Renal didn't even have a bladder scanner.  Renal??)  And then they invest in these VisAlerts.  What a joke.

Enough all ready

If we don't empty out our Unit by the 11pm closing time, we are on mandatory overtime. Now, I'm pretty sure the Nursing contract states something that opposes that concept. Well anyway, usually it has to do with a lack of patient beds on the floors that can accept our patients.
However, in the past couple of months the Master of the Universe is trying to double down on his number of procedures every day.........and dragging his procedural staff and our Recovery Unit right down the rabbit hole with him.
Stay tuned for updates on this one.

We are overwhelmed
With too many clients,
Excessive procedures
Without scheduling science,
Someone calls asking
Can you do it tomorrow?
They say, "Yes, come on down"
It's like Kilimanjaro.

A mountain too tall
To climb in one day,
So many procedures and
Recoveries, we say,
'Cuz we'll have to stay
Until the beds are vacated,
After 43 pacemakers and
Arrhythmia's ablated.

We know who to blame
And we're taking names,
Loading our weapons
We've had enough of these games,
Because we want a bonus
For our overtime care,
And we're charging the doctor
Because that's only fair.

Psychogical Manipulation

When I meet the patient, I address them as Mister or Missus & Last name, while stating my own First name. Sometimes I remember to ask them what name they like to be called. Most of the time going forward, I will then address them as "Sir" of M'am. Just call me old fashioned.

What bugs me, is when that person pulls the psycho-babble name-game on me, by making sure, they use my first-name whenever they talk to me. Supposedly, the intent is to: "Acknowledge my identity, massage my ego, and boost my self-esteem". Well I don't like it; we're not bosom buddies. You want to use my name in every sentence, is an assumption of intimacy, that quite frankly, we haven't yet established. I know you don't love my name, because back when we were kids, it was sometimes used to joke about a particular body part. If you wish to use my name in every sentence, you damn well better, ask for my permission! Just saying.

How about those patients
Who are so demanding,
Like a politician
Doing their glad-handing,
Using that technique
Of saying my first-name,
I know they read that in a book
A subtle psychology game.

I'd rather be generic
And dazzle you with my skills,
Bring you what you ask for
Like 14 pain pills,
But please do one thing
Stop saying my name,
I know you read that in a book
It's a smarmy little game.

Old Fool

The song remains the same. We three nurses, over the period of 11 hours, did recoveries on 2 Interventional Radiology patients; 5 Arrhythmia ablations and 2 pacemakers, where each one of those seven had some version of General Anesthesia; and 6 Cardiac Caths with PCI. Plus, we assumed coverage of 3 other patients who had not yet gone to their procedures. I pulled 4 four Femoral sheaths on one person, had to deal with bleeding groins on two others, had to transport with 5 patient's. The other two nurses did about the same. But heck, I'm just an old fool.

Well, I'm an old fool
I keep coming back,
Like a rusty old truck
On a beaten down track,
Where every hole and rut
Is a forgone conclusion,
After a 12 hour beating
I need a tonic infusion.

Today, for example
No vacancies in the Inn,
The Cath-Lab was stacked
And 6 ablations were a sin,
Because we bore the brunt
Recovering twenty,
With two point five nurses
That's double-down plenty.

One point five hours
Of double time pay,
Makes 13 plus hours
All work and no play,
I walked 13,000 steps
Which is more than enough.
But I'm an old fool
Pretty rusty, but tough.

[dedicated to another Old Fool]

Doctor Wife

It is not unusual for medical professionals to marry, and many doctors do that very thing. But when the kids enter the picture, how many of the house-wives are there, compared to house-husbands? How many of those husbands are willing to set aside thier 12 years of education, and 7 years of hotshot practice, to be the house-husband? Probably not a single one!

Doctor Wife

She's an E.P. doctor

In her own right,

Yet, she's alone with their kid

At the house every night,

While hubby plays Master

Of the Universe,

He denies complications

His ambition is a curse.

Courageous

Once again the insanity is full bore at work; we seem to have a perpetual 4 persons off on indefinite-leave, so their positions hang in limbo. Thus, we remain perpetually, unsafely understaffed. The only thing saving us and our fragile clients, is us. And we are the evening Recovery crew comprised of 2 or 3 nurses, barely hanging on from 1730 to 2300+.  So, crazy.

That 8 French arterial sheath
What a bloody nightmare,
What the hell was I thinking
Like I succumbed to double-dare,
Supposing, I can handle this
I'm a seasoned old horse,
But it was the wrong time to saddle
A huge mistake, of course.

Once again Miss Courageous
Came to my aid,
She's a good one to work with
Though clearly underpaid,
And when my cavalier attitude
Gets me in trouble,
Thank goodness my companions
Coming running on the double.

Ben Gay

Over the counter; sometimes it actually works, but you'd better read the label.

A pain in the neck
That's what he felt,
A 3 day muscle spasm
After his tendons took the belt,
Now after he performs
Range of motion,
He goes running to the cabinet
For Ben Gay lotion.

Great stuff it is
Smells good too,
Not as dangerous
As super glue,
But, don't spread it all over
You just might not endure it,
Methemoglobinemia
It is difficult to cure it.

Because you can't carry 
Enough Oxygen to utilize,
Your hemoglobin is blocked
Oh, what a surprise,
And if you don't have on hand
A hyperbaric chamber, or Methylene Blue,
We'll shake our heads and gossip
When we say goodbye to you.

Bully

http://www.beckershospitalreview.com/human-capital-and-risk/8-things-to-know-about-nurse-bullying.html

Bullying / Hazing, is still happening in our industry. I was subject to it just last year, when I started another job. The other nurses at that place said stuff like, "Oh ya, Betty Lou is always rude like that". I thanked my lucky stars when that bully nurse left the department soon afterward. DISCLAIMER: This poem presents a radical, dark solution to the problem. In other words, my own cynical views.


I was subject to bullying
Numerous times,
As a youngster suffering
Those childhood crimes,
And a few distinct instances
In my Nursing career,
Why it persists to continue
Is not really clear.

The bully has a weakness
Somewhere deep inside,
They will never admit
That it's under their hide,
They might raise their voice in anger
They may threaten or yell,
Reprimand or ridicule
Till your job is a holy Hell.

You might want to quit
But that's giving in,
You can't escape the problem
This original sin,
It is better to stay
And get retaliation,
Become smarter and tougher
And then perform eradication.

There are various ways to do this
Yes, books have been written,
Subtle ways of harrassment
So the subject feels bitten,
A little this and that
To dismantle their career,
So, when they look in the mirror
They will see a face of fear.

Yes, life is a battle
From the day you were hatched,
It's time to show the bullies
They are hopelessly overmatched.

Our Mission

Some healthcare rumblings in my gut.

From the public perspective
It's about health and healing,
But at the political level
There's moaning and squealing,
Repeal Obamacare!
Get a Trumpian replacement,
While a lot of vulnerable folks
Expect authorized erasement.

I don't have the answer
I don't join the discussion,
I don't want to argue
I might suffer a concussion,
When Billy-Bob Teamster
Get's excited and mad,
Grabs the scalpel on the counter
And does something bad.

We display human kindness
Yep, that is our motto,
But there's a lot of money spent
On that self-driving auto,
While that guy at the top
Seeks our vote, that he's the Best!,
Human Kindness our mission
But what about the rest?

Strung Out

I work with some great nurses, of all ages. This particular one, seems to get quite a few challenging patient's. This one is about that.

A clean bill of health
After your angiogram,
I would think you would be celebrating
Hot damn!
But you began moaning,
Shaking and twitching,
As if you had undergone
Some kind of psychic bewitching.

Pains in your chest
Your arms and your legs,
We checked underneath you
To see if you'd laid any eggs,
But nothing made sense
And your doctor was tired,
He told us to do anything
Urging us to be inspired.

Even your saintly husband
Begged for us to intervene,
I think he was a bit embarrassed
By your emotional tragic scene;
Until finally at last
You were dressed to go out the door,
When you bothered to mention
Your chronic pain score,
And the Oxycontin at home
Waiting for you over the bathroom sink,
Oh ya, just another strung out housewife
That's what I think.

Three Days

Working 3 days in a row is tough (for me), here in my 6th decade of life,
4th decade in healthcare..............being on the feet, probably 11 out of the 12 hour shift.

Three day stretches?
Sure, I can do it,
However. by that 3rd day
I'm all damn it and screw it,
Because I am older
And beat to a pulp,
Way beyond
Just one big gulp.

I don't know
A single elder,
Who doesn't feel
Like a journeyman welder,
Flaming the trenches
Of Nursing, today,
We have all paid our dues
In the usual way.

So, why do I do
Three day stretches?
It provides exciting fodder
For my poetic etches,
Because, that's what I do
In the hours soon after,
When I hang by my toes
With the bats in the rafter.

A Bloody Memory

Well, several of my work pals will attest that this was one bloody week at work! Of course, that is the nature of our business, in the realm of Angiography. Aside from the method, many of our patient's are treated intentionally with anti-platelet agents and additionally, are commonly blasted with Heparin during their procedures. Our job as Recovery specialists, is to be the bloody guardians, so to speak.

After her Heart-Cath
She rested seven hours,
Enough time for margarita's
And two rounds of whiskey sours,
When she got up
She denied that anything was hurting,
But wouldn't you know it
Her Femoral artery started squirting.

Afterwards, the room looked a little like
That crazy chainsaw movie,
All the while, little Miss Fantastic
Took it in stride, stating, "totally groovie",
Just an ordinary day's work
Over at 35th and Emory,
To be added to her diary
She'll call it, "A Bloody Memory".

Meaningful Abuse

This story ties in a bit with the poem that follows, because it addresses subtle monetary pressures on our business of care and healing. However, it starts out initially, with some of the usual Nursing nonsense we must put up with.

What bothered me this week?
Now let me think,
When our EMR document
Went on the blink,
Charting froze up
Doctors orders went down,
The Gorilla in the corner 
Sat there with a frown.

Why does it bother me?
Well, it always seems to happen, 
When Billy Bob is bleeding
And then he is crappen,
Which he does with a wiggle
A grunt and a push,
And now the blood and the crap
Flow beneath his tush. 

This type of occurrence
Generates a lot of charting,
Describing the features
Of body fluids departing,
Old boy Billy Bob
Whose daughter, does state,
"When we go to the restaurant
He's a heckuva date".

Back to my story
Regarding the EMR crash,
'Tis a national dilemma
That comes on in a flash,
The system goes down
With no warning or threat,
And leaves us up to our elbows
In excrement and sweat.

Yet, we forge on
Relying on Cerner,
Epic and Allscripts
Athena Health and Turner,
Each worth a billion
Or two in the bank,
While Meaningful Use bucks
Are filling the tank.


https://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives


http://www.medsphere.com/resources/news/news-releases/3402-kern-medical-center-awarded-federal-funds-for-meaningful-use-of

CEO's Making Bank

According to Forbes, WSJ and other monetary reporting entities, if you want to be rich, be a hospital CEO. Here is a fun article that describes how our favorite CEO's are compensated, by each patient day in the hospital.

How much does your hospital CEO
Earn for each hospital client?
If everybody knew
Would you remain so compliant?
Knowing how much your daily cost
Goes directly into his pocket,
You might start to dream about
Hammers, nails and an electric socket.

Read this short article
Yes, why not be informed,
On cold winter nights
It is good to be warmed,
By wild crazy thoughts
and dreams of corrections,
Why dudes get paid so much
And all of their collections.

https://www.axios.com/stay-in-a-hospital-pay-the-ceo-56-a-night-2242870721.html

Weight a Minute

A two hour battle post-anesthesia, takes a lot out of me these days. Thirty years ago, no sweat; I was ready to take on Bluto, for 3 more rounds. Except, well there was the incident when Father Time kicked me in the head and caused a concussion.
Now, about last Friday............

When Bennie the Bruiser

Awoke from his surgery,

He immediately acted out

With assault and perjury,

Whereas, before

He was a mellow, young guy,

Post-anesthesia

He’s Godzilla, on the fly.

It wouldn't be so bad

But he's barely breathing,

Then suddenly gasping

Swearing and seething,

Plus, Bennie is big

Topping two-forty pounds,

If I was Mike Tyson

We might go seven rounds.

Oxygen saturation

Just seventy-five,

Gasping and wheezing

When his parents arrive,

To stand by the bedside

Try to settle him down,

Yep, Bennie the Bruiser

Is a meth-user clown.

Little by little

Maybe he's improving,

Gets some gas up his nose

He's resting, not moving,

Now, it's my turn to bother

Removing Femoral sheaths,

Oops, awakened the demon

Now I’m dodging his teeth.

Four people at the bedside

Trying to control,

As this monster of ceremonies

Takes us for a roll,

Bucking like a bronco

While I prevent bleeding,

Thinking dangerous thoughts

Regarding children and breeding.

At the hour marker

I was proclaimed the victor,

An epic battle it was

With a Boa Constrictor,

Yea, I expect a statue

To be erected in my name,

Constantine the Conqueror

Will just add to my fame

Vitamin Scarapy

Sometimes when the patient talks, I just stand there and wonder what the heck have they been smoking? Astounding stories of non-compliance, and the predictable outcomes, that prove a total lack of common sense.


I chose the vitamin cure
For my viral cardiomyopathy,
According to Betty Lou
Guaranteed by some expert of psychopathy.

See, those pills and potions
Prescribed by the Cardiologist back then,
Made me feel so lousy
I stopped taking them when,
I heard about the vitamins
Promoted by Chiropractor Jerry,
Plus, I read about it on the internet
Carnitine, and dust from a fairy.

Sure enough, I got better
My ejection fraction came up to fifty,
I rolled along on my merry way
Never saw another doctor, Tom Swifty,
Until just last week
I became short of breath,
Tried Flonase for a week
Until I began to feel like death,
Finally went to the hospital
Emergency room,
Ejection fraction 30 percent
3+  to 4+ Mitral Regurge
Vitamin therapy, badda-boom!

At age 64
She did luck out,
Normal coronary arteries,
That's worth a shout,
While husband/daddy/child
Sitting at the bedside with the Yorky dog,
Seemed to be in support of all this nonsense
Like a frog on a log.

She said, she likes the Cardiologist
(as long she approves what he's doing),
I wonder if he knows about the vitamins
And whatever she's smoking and chewing,
Because, I wouldn't cover any bets
On her likelihood, of compliance,
After all, she made up her own mind
In stubborn anti-medical defiance.

I asked about her career
She claimed she was a Nutritional Coach,
Good heavens, I wonder what she has been teaching?
Not likely, the scientific approach,
Yep, those vitamins for Cardiomyopathy
Read about them on WebMed dot tv,
Where you can trust a Hollywood star
To say what's best for you and me.

Someone Dies

Here's a pointer; know where your IV lines are going, know if that vein is functional and patent, and know exactly what drug is in your hand and in that line.............before you add anything new. When you have the time, I.D. those lines.

When you’re reaching for the Lidocaine
The Epi or the Atropine,
The Propane or the Methane
Or maybe even Gasoline,
The Wheaties or the Captain Crunch
The chocolate cupcakes for your lunch.

Be sure you check your vital signs
And ensure the patency of lines,
Because in the midst of great surprise
If you’re not careful, someone dies.

Frisky Fireman

A cure for one kind of depression; or, where there's smoke, there might be a fireman to the rescue.

Just Call 9-1-1

I’m alive, I can’t believe it
I had given up to die,
I’d arranged to kick the frame today
No one cared to ask me why,
I have lived a long eventful life
But foresaw a painful death,
Then I was boldly interrupted
When I took my final breath.

A local family member
Discovered I was prone,
He heard me fall upon the floor
And thought he heard me moan,
In truth, I was rejoicing
It was time for me to run,
Well, then that sucker saved me
He dialed 9-1-1.

A gorgeous hunk of Fireman
Drove right up to my door,
Assessed the situation
And figured he could score,
Attached me to a monitor
Announcing an arrest,
Resuscitated me, Oh Lord
With massage upon my breast.

Aroused I was, and more alive
Than I had been in years,
I clutched that fellow to my chest
And nibbled on his ears,
He had a fancy uniform
That I quickly slashed and ripped,
It was barely thirty seconds
Till that Fireman was stripped.

My cardiac arrest
Was instantly converted,
When the fellow aimed his hose at me
Cut loose and really squirted,
I bounded to my feet
Feeling totally renewed,
I’m going to tell my aging lady friends
That they should all get screwed.

Well, I’ve changed my way of thinking
I’m no longer so depressed,
When I need a little excitement
At first, I get undressed,
Then, with a helpless cry
I dial 9-1-1,
My Fireman comes quickly
And boy, we have some fun.

Contagious

I just want a kiss, that's all. That's not asking too much.

You might say I’m isolationist
I have chickenpox and measles,
I keep bubonic squirrels as pets
And rabid wild weasels,
So why not snuggle up to me
And see if you’re courageous,
I just want a little kiss, please
I doubt if I’m contagious.

Literal

Sometimes I really take things literally.........

Smokefree vs. Free Smoke

Message on display
At the entrance of our Clinic,
Prompted reflection
(I'm a natural born cynic).

Firearms prohibited
Latex in use,
Smoke free environment;
Weird terms of abuse.

I mean, who can argue
About smoking, if it's free,
A heck of an invitation
At a hospital, whoopee!,
And regarding the latex
That's a turn-on for some folks,
A lot of smirking and giggling
With off-color jokes.

Firearms prohibited
That's easy to understand,
If your arm is on fire
I shouldn't shake your hand,
While considering the risk
Of spreading that fire,
In the presence of Oxygen
It could ruin my attire.

What kind of a hospital
Offers these kind of features?
I guess I'm truly blessed
To be a member of these creatures,
If you're possibly interested
Please submit an application,
Smoking is free, no burning arms
Latex in use.....it's a heckuva vacation!

A Mid Year Resolution

Ok, we just had the Summer Solstice, so why not an old resolution?


It is the week after Christmas
And not much has changed,
The patient’s are still alive
Though, the staff is deranged,
The Care Plans are filed
In the garbage, with care,
Because we finally realized
They work best in there,
The walls have been stripped
Of their bright coloration,
Returned to the original
Theme of sedation,
The nurses are groggy
Their hangovers linger,
The doctors all look
Like they’ve been through the ringer.

Now, the nurses get hungry
And search for nutrition,
Only to discover
Last weeks edition,
Of half eaten cookies
Green, white and red,
A few dared to eat them
And keeled over dead,
Too bad, said the clerk
Who handles our staffing,
You won’t get replacements
Then she hung up, still laughing.

All  of a sudden
There arose such a clatter,
As all of the dentures
Began to chatter,
Some silver, some gold
Some, even acrylic,
They chattered in harmony
A scene quite idyllic,
Because the ghost of this Christmas
Can’t exit our floor,
We all ate so much
He’s stuck in the door.

So what the Hell, we’ll be haunted
Till Easter, I’m sure,
Our floor will be famous
For a new kind of cure,
We’ll scare the old devil
Right out of their hearts,
And the ones we can’t cure
We’ll sell them new parts.

A New Year’s resolution
“Let Us Optimize Your Health”,
Be it cure or consumption
So we can maximize our wealth!

Tumbling Dominoes

One could keep reincarnating every 25 years as an ICU Nurse, and find the same old problems. We unleash new names for the same disorders, apply similar drugs, wring our hands, and have the same outcomes. Sepsis, Sudden Cardiac Death, 1st MI.........at least 50% mortality. Folks, when the Grim Reaper comes for you, we're not much help. But if YOU are willing to help....go for it.

She has been here several weeks

And had every kind of tube,

Can you believe, she was admitted

For just a Jiffy Lube,

Her heart was sort of sluggish

And her blood was quite anemic,

And so, like tumbling dominoes

Her brain became ischemic,

Combative and demonic

Obesity berserk,

She started busting up the place

And nearly killed the Clerk.

She was dosed with Midazolam

MS and Ativan,

Enough to kill an elephant

It knocked her on her can,

But side effects are side effects

And some can lead to death,

We finally had to silence her

But we took away her breath,

She earned the ventilator

The prize behind, Door Number Three,

It includes a year of tubing

And a Therapist for free.

Her respiratory failure

Brought on Shock and R-D-S,

Why, in just a couple hours

She became a total mess,

Reversible?, it’s possible

But, that’s not the likely course,

We can treat her up the yin yang

But can’t replace her life force,

The woman was a time-bomb

Just waiting to explode,

She had multi-system plug up

From a life on lipid road,

Her triglycerides set records

That will stand for many moons,

She had a steady diet

Of booze and macaroons,

Her husband was no better

He paid the grocery bill,

You couldn’t make them understand

This method of life would kill.

Now, lying here before us

Is a body, life supported,

And we’re rushing around like maniacs

Because her heart beat just aborted,

Thus, it seems a little pointless

To apply our super science,

To a person who spent years

In stubborn, health defiance!

Let the dying die

I wrote this, at least 25 years ago; and the issues and dilemma's of dying are still the same. We do make progress, but death must happen.

Time to Give In

What more can we do for this man
Despite all of our science, he’s dying,
We have done all that we possibly can
His family, so anxious and crying,
But alas, the time comes
When it’s time to give in,
To continue the treatment
Would be a merciless sin,
Prolonging the suffering
With no hope of reprieve;
Let the dead go their ways
So the living can grieve.

The Virtues of Floating

Here is a classic from 20+ years ago. Look, must nurses don't want to float off to another unit. They suffer anxiety regarding their skill set, and feel out of place, and worry about what the folks in that other unit might say about them.

Fortunately, since 2012, I have not been required to float.

I like my job now, well enough
But mind you I’m not gloating,
It has a dirty side to it
The multi-unit floating,
By and large the frequency
Is few and far between
But when it’s time to do your stint
It can be a messy thing.

Now, consider this my friend
You’re floated to Emergency,
The last place that you want to be
If suffering from urgency,
The place is non-stop madness
All bloody night and day,
Those nurses must be crazy
Because they don’t get combat pay.

Or maybe you’re more fortunate
And floated down to Burn,
You’ve got some guy with roasted flesh
And you’re afraid to turn,
Him over in the bed, in case
His skin grafts crack or flake,
Because you know that you’ll be crucified
Then roasted at a fiery stake.

Neuro ICU is like
A foreign land to me,
A lot of spinal action
And labile ICP,
The unsedated wild men
Are screaming out in pain,
They were motorcycle maniacs
And now have scrambled brains.

Is floating any better
In the Medical ICU?
Where microorganisms
Stick to you like glue,
Where charcoal spewing overdoses
Ruin all your clothes,
And G.I. bleeding alters
The function of your nose.

The Surgical Intensive Care
Is different in some respect,
The doctors are fanatics
About the drainage you collect,
Specific gravitation
And countless pus filled drains,
Provides ample entertainment
For all their busy brains.

In CCU it’s different
You must take a vow of silence,
The nurses aren’t restrained
But barely stoop to violence,
The patient are well mannered
But sometimes give you crap,
Just charge the paddles to 100
Then, defibrillate their lap.

All in all, the general feeling
To float, I’d rather not,
To save a lot of misery
Why not have me shot,
Or hang me by my fingernails
And whip me with barbed wire,
You’d better find another fool
I’d prefer to walk on fire.

An Apple a Day

I have unearthed a trove of ancient writings..........

An apple a day
Keeps the Doctor away,
But if you’re always pissed
Just see a Psychiatrist,
If your insides hurt in earnest
I suggest a good Internist,
And if your ankle had a twist
Go question a Podiatrist.

If you see your brain emergin’
Find a capable Neurosurgeon,
If your birth control was in omission
You’ll need to find an Obstetrician,
Should your bladder leak, oh, golly gee
You ought to see Urology,
If your busted femur needs a rod
You’ll need to visit an Orthopod,
And if you suffer from seismology
You better go to Radiology.
_ _ _ _ _ _ _

To Buy a Cure

I drank a lot of alcohol
And blew a lot of smoke,
My liver said, the hell with this
And my lungs began to choke,
My heart is doing double time
And my renal function is poor,
Oh, if I had a billion bucks
I would try to buy a cure.

My bones look like Swiss cheese
That I used to eat on rye,
The ultraviolet rays I worshiped
Wrecked my one good eye,
My libido was revoked
And my sex drive was recalled,
Because, when I raced my engine
It overheated, then it stalled.

The flukes in my intestine
Are thirty meters long,
While a host of other viruses
All sing a little song,
Hail, hail the bugs are here
Crawling in my belly
Coming out my ear,
Hail, hail this guy is dead
What the Hell do we care
As long as we’ve been fed.

And thus, my body fails me
I can feel the hangman’s noose,
I wonder if there is a connection
To this lifetime of abuse.
_ _ _ _ _ _ _ _

Jamming on the Joules

She died, she died
There’s no denying it
We tried,
To save her broken body
And fix her busted heart,
We tried a lot of crazy things
But couldn’t make it start.

We gave her Digitalis
Some Quinidine and more,
Dobutamine and Dopamine
And even Inocor,
A trial run of Nipride
To reduce her afterload,
But she bottomed out her pressure
On the rollercoaster road.

She had total akinesis
With a low ejection fraction,
And to complicate these matters
Had arrhythmia distractions,
At first we gave some Lido
Then Pronestyl and the joules,
She was jamming on 360
As if to say, You fools,
For every problem that you treat
I present another three,
Because the Reaper is standing at the door
He has come to set me free.
_ _ _ _ _ _ _

Humble Student

Talking about conduction
Regarding the upper and the lower,
The former is the faster
And the latter is the slower,
See, sometimes there is a stimulus
Lost in its own travels,
And before you get a chance to breathe
That impulse just unravels.

It can follow any pathway
If the guidance system is shot,
If you fail to snare that sucker
The rhythm will be naught,
So be sure, oh, humble student
To heed the wise instructor,
Because a heart without a rhythm
Is like a train with no conductor.
_ _ _ _ _ _ _ _ _ _ _

Serious Impactions

Oh, Mr. Jones you fail to see
The error of your actions,
A diet low in fiber leads
To serious impactions,
On top of that I’ve noticed
You don’t drink enough to spit,
Now you find you can’t eliminate
You’re so full of it.

There is but one consensus
Your innards must be reamed,
We’ve got a new technique
We’re gonna have you steamed,
It involves a high tech nozzle
Inserted in your gut,
Then we tape a hefty garbage bag
Securely to your butt,
The countdown then commences
As we hoof it down the road,
We have to go some distance
Just in case you might explode.

You know, we’re not to sure
About your chances of survival,
But the competition is fierce
With a scientific rival,
Who is working on a similar
Device to clear the crap,
It’s a vibratory mechanism
Placed upon your lap,
It bombards the microvilli
With microsonic hits,
It has a lifetime warranty
And guarantees the shits.

We apologize, posthumously
We didn’t clear your load,
Unfortunately, Mr. Jones
Indeed, you did explode,
Rest assured, you are remembered
For serving all mankind,
And all of those that follow you
Who find they’re in a bind.

_ _ _ _ _ _ _ _ _ _ _ __ ___

Phaht

Phaht, is but a word
That conjures up many visions,
It confronts a lot of people
With everyday decisions,
Phaht, a simple concept
That shares a lot of weight,
It can generate emotions
That stretch from love to hate.

Phaht, an easy word
That requires little breath,
Yet is powerful enough
To influence life or death.

Phaht, a weighty subject
No matter what your view,
Be cautious when you speak of it
Some day it might be you.
__ __ __ __ _ _ _ _ _ _ _

Niacinamide

Did you ever take
Too much niacinamide,
In minutes you discover
You are scratching off your hide,
It somehow makes you itch
On a scale that's microscopic,
It gets around quite quickly
In the system circulopic,
Blessedly its half-life
Is fifteen minutes short,
If not, I would worry
That the flesh would just abort.
_ _ _ _ _ _ _

The Toughest Break

My hot job is apparently being phased out. In some respects, it did look too good to be true, but I did the best that I could while I was there. I think some thought mavens have deduced, that there are some limitations to my position (I'm not supposed to take a patient assignment; just do breaks). Anyway, once I heard about it, I had to jump on the bandwagon and find something else. The tough part, is leaving the crew I have been working with, for the past 14 months. I enjoyed being a part of the team (and can only hope they will muse about the "good old days" when they had a dedicated Break-Relief Nurse).

Here is my farewell:

I enjoyed every minute
Except, just one,
It was back at the beginning
But all the rest was fun,
And do understand
I'm not leaving for that reason,
Nor was it excommunication
Or treacherous treason.

Whether rumor or fact
The position is phasing out,
I couldn't wait
Till I heard the last shout,
Nor could I accept
A return to the bedside,
In ICU; just one step
From the dead-side.

Don't take it personal
It's not about you,
But rather, the clients
The drug-addled few,
The revolving door return
Of non-fixable folks,
I think I might go postal
Attending to those blokes.

My injury risk
As a bedside punching bag,
Dead in the sights
Of some murderous nag,
Who is on the steep downslope
Of Delirium Tremens,
Like gargling with razor blades
With a chaser of lemons.

Proning and flipping
On a whim for mankind,
CRRT and ECMO
You must be outta your mind,
Level-1 transfusions
And fourteen vasopressors,
On a DNR Grandma
'Twould be better just to bless her.

Sure, it's not all that
No, sometimes it's more,
ICU nursing these days
Is a death defying chore,
In for a penny
And ten diseases for a pound,
A lot of dubious solutions
And endless problems all around.

What I will miss?
All of that stuff,
Imagining 12 hours of it
I'm not tough enough,
To maintain my poise
And my youthful good looks,
Thus, I return to the Mother ship
To drink coffee and read books.

The saving grace?
One's comrades at arms,
You are a powerful group
Defying numerous harms,
With synergy and camaraderie
Good fellowship and fun,
Working together
Like a well oiled gun.

And so on, henceforth and furthermore
Gotta go, slipping out the back door,
Fourteen months, didn’t seem like a chore
And God forbid, hope I didn’t catch a spore!

Dutch Jones Disease

Poor old Mr. Jones, always coming down, or happening to, some kind of horrid ailment. I caught up with him back in the gay old nineties. Let me tell you about it:

Mr. Jones, I gotta tell you

You have a strange disease,

You’re the first man to succumb 

To a virus that kills trees,

Your symptoms are unusual

But our data is pretty thin,

As a tree would shed its bark

We note your flaking skin.

Your gait is quite unsteady

As you stumble in your boots,

There’s a striking similarity

To a tree with rotting roots,

And like autumn leaves that change

Drifting through the air,

We notice the alarming rate

You’re losing all your hair.

Though the cause is not determined

There is but one straw that we clutch,

You share a common ancestry

The tree and you are Dutch.

Come Pliants

Apparently our metrics regarding Customer Satisfaction were abysmal again. So naturally, blame the Nurses. Everywhere in the good old USA, Nurses have to put up with this corporate BS. Essentially, management would love it if we girls would just remain easy and compliant, and always do what daddy says. I say, fuggedaboutit !!!

Come Pliants

I missed an appointment
Two times already,
The Nursing Bungle
That's the name of it, Freddy,
I guess the powers that be
Think we all need retraining,
If our profits keep dropping
They'll start again, with the caning.

Flogging us daily
A customer service reminder,
Do your hourly rounding
And always be kinder,
Remember the 4-P's
No Pass Zone and AIDET,
If I was sure there were refreshments
I probably would have made it.

I've been told I'll be paid
For this mandatory class,
But that doesn't mean
It's not a pain in the ass,
I just think we'd do better
Without our billion dollar advertising,
Invest in the employees?
The results might be surprising.

Instead, they hammer away at us
Regarding the metrics they measure,
Reports of satisfaction
Give executives pleasure,
They throw a big box of money
Focusing attention on our image,
While kicking around the employees
Like a sandlot scrimmage.

Well, I'm not so compliant
Though I am persistent,
I balk at coercion
With intent to be resistant,
When workers are badgered
Threatened and harassed,
Perhaps, that's why I forget
Until the appointment has passed.

I don't want to participate
In this customary nonsense,
Nurses are not to blame
For the usual offense,
Better to focus attention
On the business design,
Management, listen to our voices
Collectively, we decline!

Just Another Fad

Here is a FAD you ought not to bother with.

FAD

Familial Aortic Dissection
If you don't know you have it
You have no protection,
Just when it will strike
No one really knows,
So you better be careful
What you put up your nose.

Familial ascending
Aortic dissection,
A genetic mishap
Of cosmic selection,
You better have a good surgeon
One who knows what he's doing,
It's a little more complicated
Than light bulb screwing.

After the tissues, monetary issues

Pass the Gate

It was a quick death
When he lost his breath,
A short goodbye
Because he had to die,
He hitched a ride
To the other side,
And waved his palm frond
To the great beyond,
And took a key lime pie
To that place in the sky.

St. Peter said,
Did you bring the bread?
You mean Heaven, ain't free
You gotta be kidding me,
He said, just because you died
You don't get a free ride,
If you want to pass through my gate
You better fill the collection plate.

Terminology Murder

I do break-relief in two ICU's. I read the charts of all those patients that I interact with, because I need to know what I'm dealing with for that one hour. This knowledge also allows me to contribute pertinent assessments, to assist the staff member I'm working with.

Bottom line; I read a lot of charts. I have decided to place some attention to the use of home-made Medical Terminology, those abbreviations that are not included on the standardized lists. Essentially, these are unique notations, understood by only that person who is doing the documentation. No nurse wants to end up in a court, arguing about what they were charting on that dark and stormy night; especially, when they were using unauthorized charting terminology.

Medical terminology?
We must agree,
To use the same terms
One, two, three,
To share information
Promotes understanding,
Or we’ll see you in court
And be more demanding.

GUOP, what is it?
Is it something you ate?
Might be GUacamole
On an Outdoor Plate,
And why chart it twice
How much urine amounted,
When it was entered on I & O
The running tally accounted?

Prop for sedation
Now what does that mean?,
A couple large pillows
In a stage-play scene?
When you charted it already
In the IV Drip roster,
In terms of documentation
You are an imposter.

S/W, makes me wonder
Did you mean Smith & Wesson?
What kind of a shot?
Please don’t keep us guessin’,
Because the family wants to know
How Billy-Bob died,
MDR completed, coninue poc
That’s what they cried.

Bld clt
Might have been talking
About me,
I belong to the bald cult
Check Facebook
You will see,
Might have meant
Blood culture
But it’s not our terminology,
Once again, your charting
Approaches pathology.

*  *  *  *  *  *  *  *  *  *  *

GUOP…………..good urine output
Prop…………….Propofol
S/W..................... spoke with
MDR completed, coninue poc…………(What did this convey?)
bld clt...................blood culture

One Ideal Leads to Another

Nice and proper, litigation averse charting; that's what we are taught.

Pretty Nice Terms

All of us are coached
In Nursing school class,
To say anal discomfort
Not a pain in the ass,
We say, you are combative
Not a son of a bitch,
Your wife is unruly
Not a low class witch.

Yes, we pamper our language
In pretty nice terms,
You are infected with Ascaris
Better known as worms,
You ate uncooked pork
With your fermented grain,
Acquiring Cysticercosis
Larvae in the brain.

We leave it to you
To tell your wonderful story,
Hello, Social Media
For your fame and glory,
You don’t need good looks
Just take a picture of your worm,
You’ll get millions of likes
And make everyone squirm.