Career Synopsis

Forty years went something like this:

Oh, what a relief
That last day became,
It was time to step back
From the working game,
After forty years
Of a healthcare endeavor,
Starting in ‘78
When I pulled the lucky lever.

Tired of getting laid off
Then signing in at Unemployment,
I took occasional benefits
Without much enjoyment,
As I searched for a solution
And found a Medical Career school,
It wasn’t free
But it was a workable tool.

I became a Respiratory Therapist
Working five years,
A couple guys inspired me
To conquer my fears,
Moving on to Nursing school
It’ll be a cinch, they said,
Despite working full time
And rarely sleeping in a bed.

I thought I would work E.R.
Or probably ICU,
I majored in Cardiac
With a medical view,
And in that first year
Obtained certification,
To play ICU nurse
At almost anybody’s station.

That’s the road I chose
The knowledge I pursued,
My focus on heart disease
With an occasional interlude,
Worked in clinical Ophthalmology
And Neuro ICU,
A Pulmonary Lab stint
And Legal Consultant too.

I sought variety
I worked all over the city,
Major medical centers
And little itty-bitty,
Hospitals, with maybe
Twenty to forty clients,
With a four bed ICU
Employing rocket science.

That stuff is what made me
The nurse that I am,
Life and death situations
Like cases of Spam,
Still the bulk of my study
Has been Cardiology,
Though sometimes I think
I had a minor in ghostology.

Last Shift is Finished

Yep, I survived my last official day of employment. It wasn't too rough, but again, as mentioned in the log of the final days, the last two weeks exposed me to some stuff I haven't done in quite some time.

1. Two weeks ago, was the night with 2 successive patients for Pacemaker Recovery, requiring a Code Blue and its equivalent Rapid Response, each getting airway intubation and heading to ICU emergently.

2. Two nights ago, the elderly really sick guy, being delivered to me for recovery, and he was purple, cold and barely conscious. A look in the Policy & Procedural manual, calls this Deep Sedation, which should be handled with an Anesthesiologist on standby; not in our unit. Heck, it was 9pm, we had 2 nurses, a total of 5 patients, and three had arrived in the past 2 hours!

3. Yesterday, (last shift), I get a guy who had a Diagnostic cardiac angio, with global arterial vascular disease............he had bilateral Femoral artery sheaths, plus a Left Femoral vein sheath. His BP was 187/88, and the the palpable femoral pulse, superior to each of those artery conduits, was hyperdynamic. Essentially, that means, stiff calcified blood vessels, not amenable to collagen plug therapy so me and my best buddy, do a tandem, Femoral artery sheath removal, where we both do the super-duper fist hold to the groin x 25 minutes, to obtain secure hemostasis. I was pretty sure the guy was going to "pop" one of those punctures, because he kept bending his legs, trying to sit up, roll over, and so on, but he managed to survive his non-compliance for 5 hours and not hemorrhage.

4. That same guy as described above was only 64 years old. His cath revealed that he needed CABG and Aortic Valve repair. He kept breaking into episodes of moaning / crying, having something to do with learning he needs surgery, pretty damn soon. Several times I go to the room, and he's sobbing, "I want to go to Paradise, I want to go to Paradise" over and over, the crying mantra. Oh I finally figured it out; he was beholden to one of those religious faiths so enamored with the Paradise theme.

5. I also had Betty Lou who needed 4 hours of bedrest after Atrial Flutter ablation, moaned and groaned about terrible back pain, which I medicated generously with Fentanyl and Dilaudid, hot-packs and towels. Both the Ablation doctor and Anesthesiologist came around later and asked "how has she been doing" and "Betty, do you want to go home?" I share that she has had a lot of back pain, probably from lying on the gurney for 5 hours. She practically yells out; "I don't have back pain!"

Her husband tells me several times about all of his herniated discs, and how sometime back, he was taking 280mg of Norco everyday, until he finally got Duragesic patches, and is doing much better. Actually, Betty Lou has been regularly dosing with (2) Norco 10mg's, every four hours at home, and some Oxycontin too. When I took her upstairs to her room, her new nurse asks, Betty, "How is your Pain". Her response; Well it's somewhat better, but it's not my back, its really because I have had more than 14 surgeries, and I have a chronic pain syndrome. Holey Moley.

6. The real highlight of my day, was the woman who showed up for a Cardioversion, because she was in Atrial Fib 2 days ago at the doctor office. I put on the Cardiac monitor and.............she is in Sinus Rhythm. Thus, no need for an IV, Propofol, shock or anything. She did get a new prescription for Amiodarone. We had a pretty good time talking about all the books we like to read, and I gave her husband an author recommendation.

7. Best of all, we had a little Retirement Celebration with an awesome cake from the best bakery in town, my pals gave me a very funny card, (all signed with nice stuff) and photo's were made.
Last week I had bought a major pile of Starbucks coffee cards for Xmas presents, and I finished handing those out. Then, one of the Cardiologist, bought us all lunch, so a good time was had by all.
At the end.............we only got out of work 15 minutes early (on a 12 hour shift). C'est la vie.

Retro Future Spect

If you have been following, or visiting this odd spot, (thanks, by the way), it is obvious, my career is approaching a sharp left turn; aka: retirement. I just checked the blog stats, and see I have over a thousand separate postings. I think the first year the blog was up, I tried to post the original Underside of Nursing chapters, from the early printed pamphlets, that were sent out into the mail. Those poems were primarily written between 1988 and 1996.

Now lets consider, that for every published poem, there are probably 3 that were not published, and that means, this blog can go on for years, with fake new material. I know factually, that I will maintain my Nursing license for years to come, keep up with our nursing and medical industries, and keep on writing.

Hopefully within the coming year, there will be a publishing of my favorite gross-out poems, so get your Zofran ready!

And now Ladies and Gentlemen, stay tuned, because this 28th day of December, in the year of our Ford, 2018...............is my last scheduled shift!

The poem will come soon.

One more shift

Finally, one more work shift tomorrow, Dec 28. I hope I survive it.

Here is what happened just yesterday evening. Another patient, post-Pacemaker implant, late seventies, major comorbidities, had only Procedural Sedation, with a chaser of Benadryl, and he's deeply sedate, purple, and cold. Procedure guys kept him an extra 50 minutes, because they were trying to wake him up and get his blood pressure improved. Luckily, now he has a pacemaker, so pretty good guarantee, he won't go asystole soon. Anyway, we all survived again, although his family was kind of freaked out.

A couple of brothers
In the E.P. Lab,
Bring recoveries to us
Ice-cold, blue dudes
Like they're ready for the slab.

You call this sedation?
This is deeper than deep,
Guess I look like a miracle worker
Hope this doesn't turn into a tear-jerker,
Gotta keep Joe-Bob out of eternal sleep.

I ask the wife
Does your husband always look so dusky?
Well, he has a dark tan,
Because he's such a manly man,
While I'm thinking
I hope he doesn't join Edmund Muskie.

Old is just as good

I stumbled on this old poem today, a relic from 1997. I imagine there are quite a few readers who know nothing about Jack Kevorkian, MD, a proponent for assisted suicide.  (https://en.wikipedia.org/wiki/Jack_Kevorkian).

Having worked in the ICU as recent as two years ago, I witnessed very little change in the use of intensive therapies, (with similar poor outcomes), little changed since 1997. But of course, we have to keep trying. Fortunately, major strides have been made in other areas of medicine.

Still, I admire Jack Kervorkian, he was a pioneer bringing attention to end of life issues.

When I Retire

When I retire I plan to become

A member of the KKK,

Askance you look

You gasp and fret

But let me have my say;

Kevorkian’s Killer Kadets

He’s a pioneer on a mission,

At the forefront of liberation

I won’t have time for fishin’,

I’m joining the KKK.

After twenty years in critical care

I’ve seen my share of death,

Too many people kept alive

Because we control the breath,

But plenty of folks would make the decision

To cross to the other side,

If the final trip down the River Styx

Were like the ultimate limousine ride.

In the modern world we’ve cloaked our death

In shrouds of pain and fear,

Burying the steel-lined casket

We mourn the bones each year,

But as the 21st century approaches

It’s time to look death in the eye,

Let’s make a date with the afterlife

“Whoopee, it’s time to die!”

This is where the KKK

Can help you plan your trip,

Pick your favorite poison

And remember to leave a tip,

Before your third round of chemotherapy

Or your fourth amputation this year,

Demand to take control of your life

We’ll help overcome your fear.

If you live in relentless pain

The KKK is waiting,

No point in going on until

You’re fit for carbon dating,

The theory, that your suffering

Is God’s will, as some would claim,

Is just another fallacy

In the religious con-man’s game,

Cry for mercy, tithe me

He just might intercede,

Your suffering is a special moment

Just go ahead and bleed.

In my world, that’s a bold faced lie

The Big Guy is my friend,

He wouldn’t have me suffer

For the duration or the end,

So, I’ll dedicate my energy

The KKK has defined my role,

To alleviate the suffering

Of any interested soul.

1997

Write a little later

Look, I'm not a journalist, writing about now. I write in generalities, that can be applied to many situations that occur over and over. I always hope to learn something every time.

Sometimes I write about
Too close to home,
Gotta wait a few months
Before I post that old tome,
By then, most of memory
Has gone to the ditch,
Where the sad, sorry episode
No longer doth itch.

By then, it is legend
And perhaps we have learned,
The ways and direction
Said worm, stopped and turned,
We have that kind of a feeling
"Something just like this?"
A few months ago
When we avoided the abyss.

Those are special moments
Where threat and danger no longer exist,
Problem solving is so easy
With no threat of heavy fist.

3 more shifts

Really winding down now. Today, I went in at 7am, which I haven't done in about 10 years. As a result, I worked the front end, get folks ready for procedures (3) and then do a Cardioversion, plus a TEE. I probably hadn't started an IV in a month in a half, but nailed it first-time on the four outpatients. That last one was tough, on a person vastly fluid overloaded, and just a very tiny under-wrist vein. It worked out well (luckily), because this was needed for the push of Propofol for the cardioversion.
Later, because of the Eliquis (blood thinner) that she takes, that thing wouldn't stop bleeding when I removed it, so she went home with a beautiful bruise and a small hematoma.

Gosh, no poem this time.

Last Days

The previous poem (down the page) I herald that I only have 5 shifts of scheduled work left.
Well today was that 5th shift (before the end) and it was a doozy!

Last Days

On my 5th day before the end
Listen to what went down,
A couple post-op sedation patients
Crumped in Recovery town,
They arrived, and went south quickly
At the moment of delivery, not later,
Therefore, I can't be blamed
All focus on the operator.

First it was the aging Ivan
At 91 years, he got a pacer,
Severly hypotensive and then he stopped breathing
We moved fast to avoid the eraser,
Called Code Blue, which brought a huge crowd
The room was a mess when it finally ended,
We saved Ivan, like the pro's that we are
Off to ICU he went, categorically ascended.

It was time to take a breather
Sweep the floors, assemble papers,
Visit the other patients
And replenish my vapors,
Until I got another report
To expect Betty Lou,
Another simple sedation
Hardly anything to do.

Round two disaster
How could I possibly know,
Betty arrived gasping for air
This time, a Rapid Response show,
With stat breathing treatments
And assisted ventilation,
Betty Lou, she turned blue
After AV Node ablation.

Two patients in a row
Surviving Code Blue,
The first with a cardiac tamponade
Then pulmonary edema, for number two,
We all responded quickly
In a fairly organized fashion,
Yes, humankindness was right there
With a spoonful of compassion.

Five more Shifts

Almost there; that thing called retirement. Of course many folks are pretty sure they might be able to entice me back sometime in the future, and I don't discount that, because I have done my best to stay at the forefront of certain areas of interest. That learning switch is not being flipped off.

However, the most recent Friday, two days ago, the wall hit me........even if I wasn't retiring, it would be time for me to bail out again. Over the course of the past 11 years, I have flipped back and forth between two hospitals in the system, where I worked for A and then B, and then A and then B.
So, that's how it is; I jump ship when I can.................and I'm about to do that, after 5 more shifts.

Terminal Burnout

That was not enjoyable

I'm telling you,

Running around like crazy chickens

With too much to do,

And I came to the understanding

That I have finally breached,

Terminal burned-out status

The pinnacle I have reached.

I despise all alarms

And the computerized medical chart,

The former, because it's often so pointless

The latter, because it's not a la carte,

Some kind of crazy committee

Offsite in the middle of Texas,

Declares you must chart this one way

As convoluted as the mesenteric plexus.

Pharmacy calls me four times

Asking; what is the allergy of Betty,

Quite frankly I don't have a clue

She is snoozing and looks kind of sweaty,

Her daughter just left for tobacco

The son is on YouTube in the lobby,

And I don't have one frickin' minute

It's not like I'm engaged in a hobby.

I'm the Charge Nurse with 5 patient's

On a 12 hour shift,

So many people ask for me

It's worse than the Tokyo drift,

And I do incredibly appreciate

How we work as a team and all,

But even working five more shifts?

I'm like a plane, gone into a stall.

Even five more days might be impossible

I might explode if pushed the wrong way,

One more migraine headache that needs Percocet

A forty-one year old gal, Sallie Mae,

Who can't lay supine just another four hours

After all babe, you might just bleed out,

If she keeps hopping around on that gurney

With her ten out of ten fussy pout.

Come on chick, you managed two babies

It had to be worse than an Ablation,

“Only Percocet works for me, Bub”

With an attitude, Oh consternation!

And meanwhile the Pharmacy pages me

Asking that allergy question,

Finally, I'm about to explode

With terminal indigestion.

And really, it wasn't enjoyable

Though we did have a lot of good laughs,

That's what nurses do in a typical crisis

Beat with bats and old rusty gaffs,

We gather around the dead campfire

Bemoaning our plight and our pay,

Knowing we'll sleep it all off

To be tortured another bright day.

12-15-18

Writer of Notes

I am crazy about writing nursing note narratives. It's not really a lost art, but rather a form of communication / documentation that has been cast to the wayside, because our Over-Lords have fashioned an easy out  (Computer charting). Nurse got lazy! That's all it is.

I write, as if I am going to find myself in court, about 3 years from now. Those who read my notes, would agree to my statement. I write a narrative journal in a sense, on each patient I have that day. I have done that from the beginning of my career, until now, 35 years later.

Anybody who wants to know what happened on Tuesday, at 5pm, when Oscar (me) was that nurse, only needs to go to "Notes and Transcriptions"...........Nursing Progress Notes...........and you will find out, what procedural sheath of 22 French, was in what Femoral artery, and if it bled and how long, and what Doctor was called,  and who the Echo Tech was and so on.........................that's how it still needs to be done!

Note Writer

I'm a nursing note writer

That's my declaration,

Like I'm writing to the Jury

Describing fact and causation,

Every single interaction

For the patient I observe,

In the final court of law

I didn't drive off the curve.

Go ahead, read my notes

You'll know what happened each time,

When Joe-Bob got up

And slipped on his slime,

And I called the Doctor

And the Doctor said:

For Gods sake, keep Joe Bob

Tied down in his bed!

Or something like that

Back in the day, when we could do it,

When Joe Bob broke his leathers

After all, he could chew it,

Whereas, you can be sure

I documented it all.........

You might try to sue me

But I won't take the fall.

In these EMR days

Half the Nurses, they don't write,

They check boxes and forms

And read their phones half the night,

But three years down the line

When Joe Bob's case comes up in court,

They won't remember a damn thing

They'll just shake, whimper and snort.

Yes, Nursing is very demanding

But I write, for each one,

My job is to tell their story

Everything that was done,

During my short contract

Their events, my responsibility,

And if I am questioned later

My notes are my utility.

12/4/18

A Waste of Energy

As a Charge Nurse, I don't prognosticate. I don't call the ER to see if they are expecting to send us people; I don't harass the Nurse Supervisor, to see if we are getting any possible patients. What I do, is keep an eye on my show, keep apprised of what all our patient's need, or what the next two hours of care might look like, and I try to make sure, that patients get out exactly, at their appointed time. That's what drives patient satisfaction.

This poem is about my philosophy in life, and at this chosen career:

Planning

Things that I plan

They rarely turn out,

Whereas, things that I don't plan

Get a high-five and shout,

Because I reserve a place for

Change and spontaneity,

Unconventional outcomes?

I'm filled with gaiety.

Henceforth, I don't plan much

In fact, it produces anxiety,

I want to run to a waterway

To practice silence and piety,

I don't need that type of stress

I'm just a momentary guy, 

Right now, I'll do this thing

And when I do it, you'll know why.

When big decisions come

I gather knowledge and ponder,

Consider multiple outcomes

That could occur down yonder,

But, don't presume that is planning

I'm just collecting information,

Until I whip out the knives

And delare: Captivation!

I work with all kinds of planners

They are good at what they do, 

I know it isn't me

But it just might be you,

I admire the energy

You throw at all situations,

I'm happy to stand to the side

While you collect your ovations.

I don't want any part of that

Yet, we share the same desire,

To reach the end of the road

Without pain or funeral pyres,

And I believe we can achieve that

In our own unique ways,

How about, I take the nights

And you take the days.