Times have changed over my career. (30 years)

There was a day when one might work in a "pure" Cardiac unit, where one saw primarily persons with just Myocardial Infarcts, Heart Failure, etc., and their various treatments. Now, those places are few and far between. Sure, the patients had other problems, but most just dropped in for 2 or 3 days, to receive treatment, for just their heart problem. Thus, all the nurses in the unit became Cardiac experts over time. Fast forward to now, with people living longer, getting more health problems over the years, with a greater degree of complexity, and we critical-care nurses, must become near-experts in whole-body medicine.

Essentially, what I described above, undoubtedly represents the maturing of the nurse-individual over a long career. I guess I share that distinction, yet I remain highly interested in the diseases, therapies and arrhythmia's of the heart; that's what I bring to the table. Luckily, I work with many other highly educated and vastly experienced nurses, and together we form a powerful force of good, for the patients that we care for.

But still, I poke a finger at us and try to make it funny.............go figure?!?



The Battle Of The Brady's

'Twas the battle of the Brady's
Jousting in the corral,
Was it caused by poisoned water
Like the famous Love Canal?

Were they age-related impulses
Unclear just how to work it?
Or knotted myofibrils
In the conduction system circuit?

Was the SA node too sickly
Or the AV node too slow,
Were the atrial motor pathways
On the stop and not the go?

Well, I opened up a chart or two
And discovered other answers,
There was a Digitalis suicide
And the other, a heroin dancer.

He was a boyish seventy-fiver
She, an ancient forty-sixer,
She'd mix heroin, cocaine and crank
Thrown together in her KitchenAid mixer.

He was despondent and lonely
His investments had gone down the drain,
So, why not take thirty Digoxin
And say "Goodbye, bon voyage", to his pain?

Now parked in a critical-care place
Where cardiac experts are few,
It's ho-hum when the heart-rate hits thirty
Quite frankly it interferes with the view,
Of Bobby-Joe showing his photo's
On Facebook, Picasa and Flickr,
"Oh look now, there's Bobby-Sue's baby"
And the local chums, giggle and snicker.

But here in the 21st century
We juggle mysteries like the jesters of old,
Knowing that illusions are paramount
For selling the goods in the hold,
We manage such multitudes of misery
Looking like mavens of medicine,
Caffeinated nurses got it covered;
We'd be the envy of good Thomas Edison.

Hence, the battle of the Brady's and Boomers
Neck and neck, at the end of the night,
The Brady's were beating at twenty
While the Boomers were ready for flight.

Fibril_late;
2/21/10

Either we're getting really good, or some people don't die easily. This patient was a Type 1 Diabetic. For lack of insurance, she hasn't bought Insulin in 2 months. She was found down at home. Upon admission her pH was 6.8, a glucose over 700 and an unmeasurable bicarbonate. In any population, that is considered so near death, as to be considered as virtually waiting before the pearly gates. Now it's 24 hours later and she's talking about little Muffy her dog. Like I said, some folks just don't die easily.

Diabetic Curse

The diabetic patient, can
Be their own enemy, my man,
If they don't follow their diet orders
Their blood sugar will go beyond the borders.

Or say, they're on the Insulin shot
Two times a day, whether cold or hot,
But then they stop for a month or two
Surprise, surprise, their death comes due.

We try to save that unfortunate mate
Whose blood pH is 6.8,
And a glucose of one thousand two
Of the many we treat, we save but a few.

It's a foolish death, but survival may be worse
And that's the diabetic curse.

Fibril_late;
2/20/10

There is a job opening, and I figured, better to hire the local guy who knows the ropes. Too bad, I can't tie a decent knot.

Interview

I was interviewed
And it was good
Like any righteous grilling should,
Interrogated
By, just the Boss,
I had prepared myself
With mental floss.

It took place
In the hospital venue,
And followed the tried and true
Interview menu,
To pose ten questions
About this and that,
To find out where
My head is at.

To ascertain
My sanity,
Did I seek the position
For vanity?
Do I want to rule
With an iron hand?,
And will I do
What the boss has planned?

All in all
I think it went well,
Like a well cooked pot-roast
With that barbecue smell,
And now I must wait
On bended knee,
Wondering, "Who will be chosen
That other guy or me"?

Fibril_late;
2/16/10

Just a Waiter

Am I a Nurse or a Waiter / Waitress? Last night it seemed like I was a Waiter, but I sure didn't get any tips!

I'm A Waiter

Tonight, I'm a waiter
Tomorrow, I'm not,
What is the difference?
I won't be here in this spot,
Catering to
That man with a switch,
He makes an announcement
"Hey Buddy, I've got an itch".

But he's not really helpless
He worked 5 weeks ago,
He didn't break any bones
He had an earache, to show,
But it morphed and it broiled
And seeped into his neck,
Now he's landlocked and bedded
The train crashed, he's the wreck.

Twenty minutes times three
That's 3 calls an hour,
He's 27 years old
And he must have more power,
Than the strength of his thumbs
Dancing Salsa on the call-light,
"Yes sir, what do you need"?
It will be a long night.

Fibril_late;
2/12/10

The world is so weird, that I have an endless supply of ideas to tap into. Take the story I read that was posted in the newspaper, "Telegraph" from the U.K. The writer reported how in China, there are unscrupulous vendors who are marketing a diet pill, that actually contains viable eggs of the Ascaris Tapeworm. Well, hot damn! I guess that will cause you to lose weight......among other things, especially when one understands that they can produce 200,000 eggs per day. Yowza! That's gross.In fact, it makes me squirm.

It Makes Me Squirm

Because it's in China
It's the reason I believe,
I've heard they'll eat most anything
What an accomplishment to achieve

Yet, despite this foreknowledge
These things that I learned,
I'd think there'd be limitations
That even Chinese, would have spurned.

So imagine my surprise
That turned to horror
When I read it,
There's a brand new crazy supplement
You can buy with cash or credit,
To assist the overeater
Shed those pounds
They need some help,
After failing with the Exlax
The Colace and the Kelp,
The concept, the idea
It really makes me squirm,
What kind of crazy dieter
Would swallow a worm.

A tapeworm at that
The Ascaris parasite,
They lay a hundred thousand eggs
Every day and night,
But don't worry, it's safe
If it's on the Internet,
Guaranteed truth in advertising
Are you willing to take the bet?

The Ascaris tapeworm diet pill
Is a winner, there's no doubt,
Don't believe the medical experts
They don't carry any clout,
And don't worry about nasty side effects
The worms are always pure,
Infestation is the way to go
It's the latest obesity cure.

Fibri_late;
2/10/10

Young, large, seemingly getting along ok. He holds a job, still lives at home, drives a car. What could go wrong? It's not unusual to have Otitis Media, but an abscess in the neck, can cause swelling and compromise the airway of just about anyone. However, if one weighs close to 500 pounds, the potential sequelae of an invasive infection, well that's quite another story, indeed.

500 Pounds

500 pounds
With an infection in his neck,
It swelled his airway
And what the heck,
He couldn't breathe
And all hell broke loose,
Now he has a trach in his throat
And his bowels are loose.

500 pounds
27 years of age,
His weight is a shackle
In the obesity cage,
He thought a simple ear ache
Was just a bother, with some pain,
Now with respiratory failure
He might be easily slain.

500 pounds
His skin is wearing thin,
Septic emboli and toxic shock
He's rotting deep within,
His gut is sloughing out
Drained with a tube and bag,
His family hang by the bedside
Waving their hopeful flag.

500 pounds
It's a horror and a curse,
It's a premature invitation
For transport in a hearse,
Not a typical expectation
For one so young and in their prime,
Trapped by morbid obesity
Is the sentence, to the crime.

Fibril_late;
2/3/10

I was out of work for 3 weeks because of some alien organism that seems to have taken up residence in my right throat and ear canal. It's still there, but I've gone back to work. A lot happened at work during my missing weeks. Our "Cardiac Care Unit", has morphed into the Medical Cardiac ICU. Now I'm really more than glad that I work night shift, because most of those surgeries are recovered on Day-shift. That's right, and we stlll get paid more on the night shift. Talk about hidden benefits!

Anyway, going back to work after the unit has been broken-in a bit, has revealed new topics of business that I can write about, so I hope you enjoy this new journey.

Here again, I address a big topic; bariatrics. It's just a ruse. It's really about corporate spending on big projects, and the end-user impact.

Slalom Sleds

These hot new Bariatric beds
Are like super mondo slalom sleds,
We pull the patients up Q1 hour
They slide right down under gravity power.

The hydraulics seem a little weak
I'll explain it now, just let me speak,
When we lower the bed, head-down under feet
It's easy to reposition, all slick and neat,
But to return the head, upright beyond 30
We strain our backs, lifting down and dirty,
By physically hoisting the head of the bed
Another “safety” device, liable to make me dead.

These are new tech beds for the super heavies
Supposedly better than Sacramento levies,
Holding back the 100 year flood
But I'm not sure about Billybob's bud,
He weighed in at 225 kilo's
And we weren't even weighing the pillows,
On beds that are rated to 500 pounds
We're approaching that number in leaps and bounds.
Beds with all the bells and whistles
Not suitable for an ICBM missile.

The beds can rotate side to side
It's really quite a pleasant ride,
But here again, this weight thing irks
If you're really heavy, it barely jerks,
There's a tendency for big boy Jimmy
To get stuck on one side while the bed just shimmies,
Wiggles and strains, to pump air through the bellows
I wonder, “where is the lift team, I really need those fellows?”

There are lifts on the ceiling, with slings down below
When Jimmy's feeling better, we can swing him real slow,
Into the chair by the window to improve his outlook on life
Then the bed will be vacant, for his long suffering wife,
Her kilo's are many, her cankles are like stumps
I'm praying to Euphemia, “Dear Sister, bless these chumps”
Don't let either the one of them, have a cardiac arrest
Our defibrillators aren't prepared for that test.

We've got negative airflow, isolation rooms
And those lifts on the ceiling, on super-strong booms,
But honestly, I'm wary about the safety of it all
Bad things happen, when big people fall,
Caregivers damaged, lawsuits are brewing
When the dust has all settled, corporate is screwing,
Around with the numbers, statistics and more
The science of big, is a titanic chore.

Please, don't misinterpret my harangue on what's big
It's really an expose on the bureaucratic jig,
Million-dollar decisions, from dubious advice
High cost vendor contracts at an unbelievable price,
End-users suffer, at the whim of corporate decisions
Are Workmans' Comp injuries, in the provision?

This light-hearted muse, ended heavy and dark
But the business of healthcare, is no walk in the park.

Fibril_late;
1/29/10

I worked in the new tower for 3 days and then I came down with some weird illness, where the right-side of my face feels like I got too much Novocaine at the Dentist office. Also, some of my taste buds quit, so food tastes really weird. Hey, maybe I could blame it on "sick-building syndrome"?

Anyway, I get a bunch of days off, and I figured I better prove that I can still pen nonsense.

Like Cancun

Any one of you with Addisons
Come on down to Auburn and Madison,
Check out our billboard
Take a look at our sign,
Glance at our fine menu and
How you will dine.


We have a shiny new tower
And a new Chef, to boot,
We welcome the gang-bangers
Who maim, stab and shoot,
We are non-prejudicial
Because everybody bleeds,
We're ready to serve
Our community's needs.


It's a fine looking billboard
Yes, it really caught my eye,
I'm thinking, that's where I want to be
When it's a good day to die,
And maybe Sister Euphemia
Will comfort my soul,
With her help I can avoid
That fire-belching hole,
Where I'm probably heading
After writing poems like this,
Poking fun at the nuns
Is like a sacrilegious kiss.


This is all about expansion
Up, sideways and down,
We're one hundred beds bigger
And in this hospital town,
It certainly is necessary
To appeal to the living,
As a non-profit joint
We depend on them giving,
Bundles of dollars
And cases of cash,
Or Sister Euphemia
Comes down with a rash.


It's a heck of a sign
On the outskirts of Carmichael,
If you're in a plane or a car
Or even on a bicycle,
It seems almost as big
As the real thing, I swear,
And if you look at it long enough
You'll crash and end up there,
As a bonafide patron
A victim, per se',
Where you had planned for a visit
And now you will stay.


New rooms and equipment
New Nurses and more,
Shiny, bold elevators
And locks on the door,
Beefed up security
And an incredible view,
You'll feel like you're in Cancun
With nothing to do.


Yes, our ambience was tested
By professional slackers,
Free drinks on the veranda
Toasted oyster on crackers,
And they gave us high-fives
Back-slapping and more,
The new McCauley tower
Got the highest darn score,
Way better than Sutter
UC Davis and Kaiser,
If you bring your business to us
You'll prove that you're wiser,
Than all the other folks
Who catered to our competition,
When they get their bills, they'll suffer
Extraordinary rendition,
Yes, buyers remorse
The equivalent or worse,
They know they should have chosen Mercy
And now they are cursed.


We have the coolest billboards
Plastered all over town,
If you give us a call
You'll get a free gown.


Fibril_late;
1-14-10

East Coast Steve, is at it again. A definite rival in crap poems, that's for sure. And so fitting here in the end-times.

Thar She Blows

What’s that smell coming from my floor.
Oh no, I think it’s from room sixty-four.
I wouldn’t mind it if I float today
To escape the smell of bowel decay.
 
C-diff, it could be, I don’t know
With blood mixed in, let me tell you bro’
Every time he poops, he fills the bed,
And I swear it smells like something’s dead.
 
I know nurses are supposed to take this in stride,
But when it smells like something died
My eyes, they water, my head will swirl,
And before too long, I start to hurl.
 
The pregnant nurses won’t go near
That smelly, leaking, dying rear,
The other two nurses are on the floor,
So Your’s Truly, gets room sixty four.
 
I have some Febreze, I spray like mad.
I have Glade for every plug, too bad.
I spread the Vicks beneath my nose,
I Scotch-guard everything from neck to toes.
 
I’m really thinking Flexi-Seal
Two fingers in, it’s no big deal.
Just hope that stool ain’t too thick.
If it is, I know that I’ll be sick.
 
So lube it up, and in it goes.
Holy Cow cause Thar She Blows.
He farts a big one, the shit, it flies.
I need a shower before it dries.
 
Why did I think this would cause no harm?
I now have poop all over my arm.
When I said “She Blows”, he really blew.
I’m going to cry, these scrubs were new. 
 
There’s doo on my glasses, and I swear
There’s something sticky in my hair.
And when my head begins to throb,
I know that I have done my job.

Steve (watch him heave)H.

The two first nights that I spent in the new tower (the unit opened 3 days ago), I was so-o-o-o- lucky to be Relief Charge nurse. Yikes! Both nights would have been considered crazy busy, even in the old unit, but now we're running around like Bob the chicken, who survived decapitated for 8 months.Naturally it got me thinking about the real state of affairs, that we're in. Easy enough: new tower, new equipment, same old jaded crew of over-experienced nurses. Oh, to top it all off, new stuff started breaking with "real" nursing care going on; Go figure!

Like A Lemming

Returning for one more night
Seems a little crazy, for sure,
But we are the answer people
Offering the cheap thrills cure;
A great deal of frustration and angst
Is just water beneath the bridge,
Although sometimes I feel like a Lemming
Being forced over the next plunging ridge.

Long hallways, new closets, and storage rooms
Yes, plenty of places to hide,
Maybe it's better, than it looked from the start
Like a husband reviewing a new bride.

Admissions, on top of admissions
Rapid response, Code Blue and the like,
If you do this for twenty-plus years
Why, it's just like riding a bike;
Careening down the side of Pike's Peak
On a single-track, dark and rainy night,
Survival means, bloodied and bruised
Rejoicing with the mornings first light.

Taking on the role of Relief-Charge-Nurse
I'm paid an extra one-buck-per-hour,
After just two nights this week
It felt like a slap on the cheek,
The smallest of sweeteners, turned sour.

Topping it off, the bosses decided
That Ward-Clerks are at best, obsolete,
For no-bucks-an-hour, the Registered Nurse
Can add all those tasks to their sheet,
Along with the endless new regulatory rules
"Just one more thing" added each week,
It's easy to predict, the next numbing edict
But quite frankly, we're ready to shriek.

Two hundred and twenty million dollars
Give or take a few clams in the mix,
Sister Euphemia is gambling on goodwill
To support all of her magical tricks,
Showing a good face to the community
With a shiny new chapel to boot,
Asking God for obedient employees
And extreme unction for the ones she can shoot.

Fibril_late;
12/29/09

Like the Christmas present I wasn't expecting, Steve RN in Virginia (we worked together, years ago, although we're brothers thrice removed), sent me his latest "typical" experience for a nurse.

Saving the Code

S.Huff RN

The I.V.’s running
The foley’s patent,
I smell infection,
But for now, it’s latent.
 
The code is done,
The heart still beats,
Most of the nurses
Are back in their seats.
 
He has a rhythm,
His pressure’s stable,
For now, we’ve kept him
Off the table.
 
But have we done him
Any favors?
This role we have
As, lifesavers.
 
He breathes for now
Due to a vent,
His infection held intact
By Vanc and Gent.
 
His pressure kept up
To perfuse his brain,
While the rest of him
Goes down the drain.
 
This poor man,
It’s such a pity,
I think its time for
The Ethics Committee.
 
So I call them in,
Just like I should,
They say they’d do something
If they could.

But the doctor had
To show his might,
And insisted he,
And he alone, was right.
 
And mighty doctor
Had his way,
He took me to
The family that day.
 
He proclaimed aloud
So all could hear,
This nurse thinks we
Shouldn’t treat your dear.
 
He’s convinced that
Granddad is already gone,
He thinks his soul
Should be moving on.
 
And the family looked
At me with eyes of red,
How dare you think
My dearest dead.
 
The doctor is God
For all we know,
And when Gramps is back
It’s you he’ll show.
 
So they took me off the case
As well they should,
Poor Gramps was given
To a nurse that “could”.
 
And, nigh, another night
Went by,
And down the hall
I heard them cry.
 
Poor Gramps had gone
In ALLLL his glory,
Despite the doctor’s
Convincing story.
 
What was I to do,
The family now was low,
Should I rub it in and
Say, I told you so? 
 
Or should I say “He was doing fine”
Just like the doctor said.
Or say the doctor was full of shit
And has mush inside his head.
 
Or should I approach the crying girl
The one that’s a real moaner,
And say if Gramps was in such good shape
Do you think he could be a donor? 
 
Nah, I sucked up all the insults
I took them all in stride,
I looked at each one earnestly
I said I’m sorry that he died.
 
I told them that the doc was young,
And often optimistic,
But in my mind I really thought,
Our actions were quite sadistic.

S. Huff, RN
Va.
12/19/09

*Thanks Bro, you're the bomb!
ph

I don't usually go 3 weeks without a writing, and especially at Christmas. A bunch of stuff was going on at home to arrange a big trip overseas, is what I will say was the cause. Anyway,

We're almost about to groove over into the "new tower". I expect it will supply me with an abundance of inspiration over the early part of year 2010, as we settle in. We will be taking on the Surgical Service ICU patients, so that will be interesting, as we have only had to do that "cut and sew" recovery stuff, only once in a while. So, apparently, you can still teach an old dog (and his extended family) some new tricks, after all.

Now, on the virtual cusp of the ribbon cutting, the final Health Dept. licensing and so on, here is my latest endeavor, regarding the new Tower:

A Whizz, Is What It Is

It's a brand-new tower
With carpeted floors,
A closet for the Nurses
And locks on the doors,
Spacious waiting rooms deluxe
For John Q. Public and his crew,
Who gape with wonder and amazement
'Cause all the furniture is new.

There are a couple more bathrooms
With a mirror for viewing,
As I stand there and pee
I can watch what I'm doing,
Now, if that ain't modern progress
Just tell me what is?
Could there be a hidden camera
To record what I whizz?

The kitchen is tiny
The Nurse's break room is small,
It's cleverly hidden
Somewhere down the hall,
The Doctors have two rooms
And larger, of course,
Though we do all the lifting
They have all the force.

It’s a wonderful new building
A new system to boot,
Sister Euphemia is dancing
In a her new tower suit,
Each time she clicks her heels
The cash register is ringing,
While the angels on high
Harmonize their singing;
Hosanna, hosanna
Let’s open this new banana,
Break out the new Chapel
And the rose garden cabana,
While the CEO, (that good boy)
Is serving up the tea,
Hosanna, on my new tower
Catherine McAuley, set us free!

Fibril_late;
12/20/09

Someone, roughly my age, noted a strange similarity, in respect to, the Dick & Jane books of childhood, with that common starting line.........."See Spot; see Spot run". It was something about a dog that was probably smarter than D & J. The similarity in question, was about the other "See" which we unfortunately are accustomed to............C Diff. Thus was born a new, sickening poem.

C Diff

C Diff
C Diff run,
Saturating linen
Its flow is never done.

C Diff
Is certainly the worst,
Use lots of soap and water
Or your hands are cursed.

C Diff
Its cloying sour smell,
Clinging to your uniform
Like a perfume from Hell.

C Diff
Odor atoms in the air,
You scrubbed per protocol
But what about your hair?

C Diff
Cleaning is a hopeless endeavor,
Just take a whiff
It stays in your nose forever.

C Diff
Oh, I'd rather not,
I'd rather wallow
In a bucket of snot.

C Diff
A room, by yourself,
Piles of linen
Fall off the shelf,
Friends and visitors
Wear protective gowns,
They smile and say, "How are you"
And leave with crappy frowns.

C Diff
Endless liquid stool,
Flexi-Seal stat
It's the perfect tool,
Make sure you change the bag
Before it bursts its seams,
Or you will surely suffer
C Diff nightmare dreams.

C Diff
Stays around for several weeks,
The smell is overwhelming
The atmosphere; it reeks,
No perfume eradicators
Will annihilate the odor,
You need an air-evacuator
With a mondo-turbo motor,
To suck the fumes away
Before they ever reach your nose,
And should C Diff ever splash on you
You better find a hose.


Fibril_late;
12/02/09

In the vicinity of our metropolitan area there are a number of prisons. Is this a curse, or a boon to business? I am not sure. However, I guess we can consider it a boon to Hospital revenue, because just a couple of the local hospitals, have the good fortune to having garnered the prison-care contract. That includes us at Sister Euphemia‘s joint.

Thus, I figured it was high time I took a look at the topic, and no better a time, than just having spent 3 nights administering to a bonafide felon from the notorious, Folsom Prison.

I Googled, “Folsom Prison Famous” and here is the following website, for those of you who are curious -
http://www.myfolsom.com/famousinmates.shtml

Made In The Shade

A prisoner from Folsom
San Quentin or Ione,
They love our soft beds
And their own custom phone,
The cable television
Music, movie, 50 channel,
The sheets from Bed & Bath
And the Ralph Lauren flannel.

Yes, a medical prisoner
Has it made in the shade,
Free, taxpayer paid insurance
And their own private maid,
To fluff up their pillows
And deliver their dinner,
Why, it makes it all worth it
To be a cold-blooded sinner.

Mr. I-Didn't-Do-It
Had a headache and blurred vision,
Apparently he had experienced
A head-floor collision,
After fighting with Bubba
For some contraband tobacco,
Not the best choice
Because, Bubba is a whacko.

The medical doctor
On site, at the slammer,
Had seen injuries like this
Like, head versus hammer,
And since the prison now out-sources
All their medical care,
We are the receivers
Of all the felons out there.

Most prisoners are cool
They know they've got it good,
Just smile, and say thank you
Like any locked up fool would,
When they know we have the power
To cause pleasure or pain,
Why even a rat understands
With his little rodent brain.

One or two ankles
Are shackled to the bed,
Two armed guards sit
Bored out of their heads,
It's a cush-job, always overtime
No part of it is hard,
Merry Christmas to all
Life is great, for a medical guard.

California prisoners
Fake an illness now and then,
To get a luxury bed in the hospital
Better than any, in the pen.

Fibril_late;
11/28/09

Yes, the talk of the town, and the rumblings of gossip all revolve around the building of the new tower/wing. When will it open? Who will work there? What version of ICU will occupy the new 22-bed critical-care floor? Of course, since we're nurses, the rumor-mill is hitting about 200 mph by now. Heck, even the rumors are spawning children. Anyway, I have some ideas about what's really happening, but as usual, it's just So Much Talk.

So Much Talk

It's a brand new tower
And there's so much talk,
About the circles and arrows
And colored chalk,
The fancy new beds
With the bariatric lifts,
Which Sister Euphemia claims
Are the most blessed gifts.

There are all kinds of new gizmo's
Both high-tech and low,
There are new communicators
That track where you go,
There's a lock on the doors
So the thieves don't get in,
And Sister Euphemia claims
It will protect us from sin.

There are mumblings and grumblings
Regarding which I-C-U,
Will stake claim to the veranda
With the most wonderful view,
While powerbrokers gamble
With buffalo chips and more,
The bookies in Vegas are
Handicapping the score.

Seniority claims
And back-slapping buyouts,
Brownie point redemptions
And cheerleader tryouts,
Ballot box stuffing
To influence their score,
Everyone bargaining
In the back of the store.

Sister Euphemia consoles
With a positive focus,
Casting prayers right and left
With a little hocus-pocus,
All will be well
As ends well, she states,
Now, just get back to work
And don't test the fates.

It's a brand new tower
But it's not open yet,
Who will win the right to work there?
Is anyone's bet.

Fibril_late;
11/21/09

Every,every day, the hottest topic is "the new building". As in, "when are we going to move in", and I wonder if we'll stay full, so we don't have to float.

I don't know, or particularly care, as I know it will be soon in dust-mite years. But, it's still the talk of the town!


Shiny New Building

It's a brand new tower

But we're the same old nurses,

It's the 21st century

And we still carry purses,

So don't be thinking something's different

It's the same old song and dance,

Draw the card, “Community Chest”

Or would you rather try at “Chance”?


If only life were fantasy

And imagination real,

All our fixtures made of the purest gold

Instead of stainless steel,

Our patients built of paper

Like the cut-out dolls of old,

We could cure their worst diseases;

Just cut the dotted line and fold.


We'll be doing all the same old stuff

Repackaged, new and shiny,

We'll be the happiest crew you could ever find

With no reason to be whiny,

The wonder-chip from IBM

Will be embedded in our brain,

And if we deviate from the master plan

Expect a ball and chain.


Oh, we're moving to a brand new building

The excitement grows every which way,

It's the hottest new trick since Trauma

Grabbed the headlines, 10 years ago today,

After the public is overwhelmed by our advertising

They'll be crashing Admitting for care,

We'll be praying to go back

To that old rickety shack,

And breathing that moldy old air.


Fibril_late;

11/13/09

Occasionally at work, there is a new Nursing Policy (or is that a new edict?), that seems so flippin' ridiculous. That means, any nurse that reads it over, stops, and emits a very loud, WTF? But then, when the boss says the cause of it was the "Joint Commission", we shake our collective heads and sigh. But after that, when the boss stumps that they wrote the flippin' edict, there's a distinctive head shake, eye squint and lip lift, and again, WTF-OMG!

The Joint Commission; band of brothers, or band of thieves? Who knows.

But, "National Patient Safety Goal 16", is something to do with making sure patients and families, have a method to "summon extra help". And so, at our hospital, this will be known forever as, the "Condition Help Policy". No, I'm not making this up.

Well actually, I did make up the poem you are about to read, in response to the latest flim-flam edict.

Condition Yelp

If you need urgent attention
Because you are concerned,
Your meatloaf was moldy
And the poached eggs were burned,
We now have a program
For help right away,
Condition Yelp is the answer
Any time night or day.

If there's a medical change
But we didn't notice,
Or you sent us a letter
But we ignored what you wrote us,
We now have a system
For hot buttered care,
Condition Yelp is always ready
Anytime, anywhere.

How do you do it?
Just listen and learn,
Dial "O" for the operator
And then wait your turn,
Because we are predicting
An onslaught of calls,
From every Tom, Dick and Harry
Out wandering the halls,
Complaining about the stupidest
Crap in the book;
Condition Yelp guarantees
The Charge Nurse will take a look.

I can hardly wait to be
A designated responder,
One more task to undertake
As the Charge-Nurse, over yonder,
Never knowing when the phone rings
If I have to leap into action,
It's a heavy responsiblity
This Condition Yelp distraction.

When the Satisfaction Surveys
Are tallied and scored,
It will all come up roses
So that we can afford,
To send the chief's on vacation
Or some high-end retreat,
While the minions of peons
Keep walking the beat.

Condition Yelp is the solution
To any problem that could be,
And the cost to the patient?
Hot damn! It's always free,
It's just a part of our
Hot, smoking package of care,
Dial "O", give a Yelp
And a Nurse, will be there!

Fibril_late;
11/02/09

Goin' South

Goin' South:

Last night I had two patients, one 55 and the other, 71. They both were "cardiovascular disasters". The younger one had just had his second MI in 6 months, and had the absolutely worst Left Ventricular Dilated Cardiomyopathy that I have ever encountered, and in essence, was in cardiogenic shock. His ejection fraction is 10-15%. He had Diabetes, an AICD with a biventricular pacemaker, and had a history of a cerebral bleed 5 years ago. What he needs is a heart transplant, but isn't on a list for some reason. Cardiogenic shock has roughly a 55%-80% in-hospital mortality (current estimates). He actually looked improved, compared to 16 hours back, when he was admitted.

Mr. 71, was recovering from a GI Bleed (accidental Coumdadin overdose, when his prescription was delivered in error, to read 12mg daily, prior to admission). He suffered an MI, secondary to volume depletion; Heart-failure secondary to volume resuscitation, which lead to respiratory failure, and a few days on a respirator.
He has cardiomyopathy with an ejection fraction of 20%. He had prior revascularization of both carotids, and an Aorto-bifem bypass. A left femoral graft repair with subsequent graft infection, with need to replace graft, and at that go-around, he developed a Pulmonary Embolus, and had an IVC filter placed.

Today, he was hoping to go home. That went south at about 6am, when he said his right foot was painful and cold. At the start of the night, he had weak, but palpable pulses. The cold foot didn't even have a doppler pulse.
I paged and notified, those-who-must-know, but frankly, I felt pretty bad about the whole thing, knowing that his departure from the hospital, had just hit a major pothole on the road of his recovery.

Ready To Go Home

Ready to go home
What could possibly go wrong?
Don't ask me to sing it
It's a treacherous song.

First, you survived Sepsis
Cardiac Failure and more,
Diabetes Insipidus
And a high APACHE Score.

Your liver shut down
With your kidneys soon after,
We were preparing the pine box
Stored above on the rafter.

But like a cat with 9 lives
And the horse with no name,
You were the grand finale winner
In your survival game.

Then this morning at six
After you awoke from your slumber,
Your right foot was painful
And colder than a cucumber.

Bad tidings indeed
On that double bypassed leg,
If the gods had a solution
I'd be the first one to beg,
For some blessed reperfusion
And a miracle cure,
The vascular surgeon told me
We can't operate, that's for sure.

Because the man is a vascular
Disaster in person,
We repaired the graft in June
And in July it did worsen,
Infected it was, we had to pull it
And replace it,
I'm the surgeon who fixed it
And now I'd rather not face it.

Mr. Ready-For-Home
Poses a problem and a riddle,
We need to open that leg
But he's not fit as a fiddle,
His morbidity and mortality
Are at an all time high,
No matter what we do or don't
It's quite likely he will die.

I felt like an accomplice
But it was nothing like that,
I checked on him often
Every two hours for a chat,
And not till this morning
Till he moved to the chair,
Was there a hint of a problem
Of disaster in the air.

It's my day off, as I write
And I won't be there tomorrow,
I'm worried and concerned
For his pain and his sorrow.

Fibril_late;
10/12/09

Ready To Go Home II

Ready to go home
What could possibly transpire?
Let me first warn you
My predictions are dire.

Mr. Cardiomyopathy
Didn't stand a chance,
His 900-cc ventricle
Had done it's last dance,
After waxing and waning
A couple of days or two,
He kicked the bucket quietly
There was nothing we could do.

His wife and kids looked on
To the future, without the man,
His lifestyle choices
Take some of the blame,
They helped him kick the can.

Mr. Pulse-less foot
Had a rough couple days,
Vascular surgery attempted
Several, last ditch effort plays,
But the end result was removal
Of his leg below the knee,
Sometimes there are no winners
In the game of life, you see.

He went home a crippled man
But he's still alive for some good tomorrows,
Prosthetic engineering can help him
To waylay his endless sorrows.

Ready to go home
At the end of the night, I am,
Sometimes this healthcare business
Seems like, nothing but a scam.

Fibril_late;
11/7/09

Even in the workplace, or perhaps that is the only place where this topic arises, there might be a discussion whether what is best, to leave the toilet seat up, or down, following it's use. Let's examine that once again:

A Fair Compromise

Toilet seat up
Or toilet seat down?
There are different opinions
In hospital town.

Like an open-faced sandwich
Or a pan that's too hot,
Some like the lid up
On their chamber pot.

While others will argue
The lid should be seated,
And hey, while we're at it
Why not have it heated?

It's a quandary and conundrum
All rolled into one,
And no agreement or bargain
Shall likely be done.

I propose, year by year
We choose one or the other,
A fair compromise
For sister and brother,
But on that off year
When it's lifted again,
Be careful, in a hurry
That you don't fall in.

Fibril_late;
10/11/09

Don't get me wrong; I like the Day-shift. The crux of the problem? I don't belong there. Why? The 3-meals, the numerous Discharges, the numerous Doctors, Imaging tests to travel to and more. It ain't my gig, and everybody knows it.
So, when I have to hang out longer than my usual 12 hours to Chart, well, I get to write a poem too. So please don't take any of this as a personal slight, ok? After-all, I named it after my least favorite president.

George Bush

Charting, charting, charting
Q-four-hours, it's a bitch,
My arthritic joints are aching
And my butt begins to itch,
'Tis the same old stuff I chart each time
It's really such a chore,
But they told us George Bush wanted it
No wonder, it's a bore.

Charting, charting, charting
It's oh-eight hundred, I'm still here,
My friends have all gone home
There were laughing, in good cheer,
It seems I had to trouble-shoot
The IV pumps and charting,
Now I'm surrounded by those day-shift freaks
My defense? I sit here farting.

They stay away from me, they do
Afraid, they'll make me linger,
As I pluck away at the keyboard keys
I offer them the finger,
Their fault, it is not mine to blame
I'm old and thus, too slow,
But the best of them, will always wish
That they could buy, all that I know.

Fibril_late;
10/1/09

Who doesn't love the idea of walking up to a dispensing machine, and being able to withdraw, whatever drug sparks your fancy? It's a thing of genius; almost.

Drug Dispenser

The computerized drug
Dispensing machine,
It's a thing to behold
And must be seen,
Just enter your password
And a special code,
Open the door
And collect your load.

Choose the drug
That fits your mood,
Like a restaurant
With your favorite food,
Come back for seconds
If you need some more,
There is an endless supply
At the drug-dispenser store.

If there is a queue at the machine
Take a number and wait,
Come back in a while
For a drug selection date,
You won't be disappointed
It's like the candy shop,
Get some extra samples
Your friends might want to swap.

There are many clever features
Like keeping track of your transactions,
Though I suspect the obvious
Big Brother, knows our actions.

But there are always ways to cheat
Though I can't reveal them here,
Meet me after work, with a case of Bud
And I'll gladly bend your ear.

Fibril_late;
9/38/09

Sometimes I'll write nonsense (or something close), just for the fun of it. There might be some fact, but this is more for the sake of the rhyme.

Don't Like

I don't like wounds
And I don't like youth,
I don't like severe pain
And that's the truth.

I don't like big
And I don't like fat,
I have likes and dislikes
And that is that.

I don't mind pee
But I don't like poop,
Whether teaspoon size
Or one large scoop
And I don't like snot
Nor boogers, nor phlegm,
I'll gladly leave it
For the rest of them.

I don't like anything
That ends with ostomy,
Because I always find
It has to much cost to me,
I'll like your language
If you know what's common
Pain, money and toilet
Water and Top Ramen.

I don't like opinions
Other than mine,
I don't like disagreements
Or if you whine,
I don't like arguments
Unless I win,
And please don't tell me
What you think is a sin.

I don't like religion
Unless you keep it in your blouse,
If you would like to reveal it
Just come over to my house.

I don't like this poem
But it was fun to write,
I don't want your feedback
That's my undivided right.

Fibril_late; 9/28/09

So memorable are the times, where Mr. Patient, uses the call-bell at least every 15 minutes, for the littlest thing, even though each time before I leave his room (again!), I ask him, "Is there anything else I can do for you?". No, he says, and "thank you so much". Just minutes later, after disrobing the isolation garb, scrubbing my hands with hand cleanser, and I'm trying to sit down for a teensy bit of charting,
ding-a-ling, I hear his call bell again, he wants his pillows adjusted. I redress, enter the room, and there is his brain-dead brother at the bedside, asking me to fluff the pillow. Two pods from the same pea, I guess.


Polite

How polite you claim to be
But polite, you're really not,
You're on your call light every minute
For a drink, a wipe, and a shot,
You told me how your parents
They raised you properly,
But for a guy who's 62 years old
There's no evidence to see.

You say that you're so thankful
For every bit of our care,
But you claim you're too damned weak
To even part your hair,
You can't even hold the urinal
So you pee into the bed,
But you can find the call bell 50 times
And cry, "I'm almost dead".

I just left your room 2 minutes ago
And before I left, I queried,
If you needed any pillows, food, or
Medications carried,
No, you thanked me from the bottom of your heart
While I shed my isolation gown,
Then you nailed that call-bell 15 times
Before I made it back to town.

Your sibling came to visit
He treated you like the royal brother,
He even used the call-bell
For a pillow, a blanket and another,
"Cup of ice, please, can't you bring it
When you come back to the room",
Then he nailed me with a nasty attitude
When I failed to bring a broom.

I should thank your blessed parents
That you were raised the proper way,
Because, after visiting your room those 50 times.......
It really made my day!

Fibril_late;
9/27/09

These days, we're constantly bombarded with "celebrity" news. Even if you're not the slightest bit interested, you just can't avoid knowing about all the idiotic antics of the temporarily rich and famous. Take Peter Pan for example...........

Like Peter Pan

When I'm irritable, aching and tired
And feeling down like a double-deuce,
I know exactly what I need
Some of that celebrity MJ juice;
Some prefer to call it Propofol
And others Diprivan,
Just please inject it into my vein, right now
And I'll sleep like Peter Pan.

When my little ones were babies
It helped them when they were teething,
Despite the fact, that I had heard
It might affect their breathing,
Then I began to use it
When I couldn't get to sleep,
My private doctor delivers it
And frankly he ain't cheap,
Which proves that he has ethics
At least one or two, I'm sure,
For a one hundred thousand bucks a month
He guarantees a cure.

It reminds me of my mothers milk
As a baby, I drank it often,
Now, please don't bother me, I need to sleep
In my hyperbaric coffin.

Fibril_late;
9/27/09

I went to a well-attended meeting a couple of days ago, and when I left, I felt like I was the only guy going home with a sunburn. And that's tough to accomplish, in a room with no windows, in the evening, just past 8pm. I'll take my parasol next time, along with my bug spray.

Ponder the Consequences

I went to a staff meeting
Dominated by a speech,
Regarding a new fangled program
Someone wanted to teach,
And I guess my body language
Conveyed my doubts and concern,
Thus, that lecturing nurse
Figured I had something to learn.

She halted her dissertation
To bring attention to me,
Directing every one
To take a look and see,
Recognize that his body language
Signals objection and disbelief,
So succinctly laid out
In front of our Commander-in-Chief.

How fortunate she was
That I forgot to bring my pack,
With my favorite weapons
For an unexpected attack,
My cat-of-nine-tails
And the latest new Taser,
The brass knuckles, and sap
And my straight-edged razor,
Typical tools
For streetwise protection,
If you're going to call someone out
Be cautious with your selection.

On my way out the door
She loudly asked for my suggestions,
If I were a fly, I’d set her up
For enzymatic digestion.

Fibril_late;
9/25/09

Gordy, Lordy! WTF?!?

We, (all nurses, in this singularly broad arena of a particular organization) must assimilate, into our already, highly-demanding and the-plate-seems-too-full-and-I'm-stuffed-with-27-things-that-should-never-happen-in-the-hospital events, faced with but another way, that we the bedside nurses, are supposed to increase the odds, that Mr./Mrs./Ms. patient, will be happier than a pig in shit, to recommend our hospital to others, and bother to come back here again.

Look folks, our town is at the "ground-zero" of Managed Care and Capitation. Our clients/patients don't really get a choice regarding where they get care. Who are the powers-to-be, trying to fool. In this community, we have about 5 predominant Health-care insurance providers in place, and if you belong to them, you essentially have been assigned to Hospital A, B, C, or D, whereupon, you will be delivered, to get your infected Gall Bladder removed. This is not about satisfaction and choice.

But perhaps it is all about reportable statistics? Hmmmm, that has a nice sound to it, n'est pas? Oui!

But, because of the way the "business" model works best, there is a filtering down of ideas, to the basic level of care. Thus, the collective we, are faced with, "The Nursing Bungle". Sure, I know that seems a bit odd for a name, but.......well, in fact, that is truly my derivation of what is being passed off as the greatest thing since french-bread with snails, "The Nursing Bundle".

I know this was along harangue, but I'm just letting you know, there will be a bunch of poems to follow, that will address this topic.

Stay Tuned

I’ve got a slew of poems
About the Nursing Bungle,
Stay tuned for the latest
Coming out of the jungle,
The morass of misfired management
It goes all the way to the top,
The hot topic this year?
Patient satisfaction slop.

Fibril_late;
9/22/09

The Nursing Bungle

The Nursing Bungle....
We heard it first,
From the very mouths of babes
Man, it made me really thirst,
The refreshments were okay.
Crackers, cookies, and cheese,
I kept going back to the chef
And begging, “Mister, please”,
Do invite me again
To the next festive event,
I swear, in the meantime
I'll do my best to repent,
For my overt body language
Silently screaming, without a sound,
As I sat pondering all that information
Joe Studer discovered and found.

Look, it's the same old data
Repackaged and pretty,
Shiny mylar balloons
And a parade in the city,
With new benchmarks and measures
Lengthy checklists and more,
Observations by the charge-nurse
Who will stand by the door,
Observing our behaviors
And making check-marks on a paper,
Yes, these are the hallmarks
Of another questionable caper.

The Nursing Bungle it is
The name is so apropos,
Educate ye olde bedside nurse
As if they don't know,
About care and collaboration
Critical illness and more,
Now, it's all about “satisfaction”
When Mr. Patient leaves our floor.

Let's recognize the fact
It's just old stuff renewed,
And management has emphasized
Follow orders, or you're screwed,
Because we have to be compliant
And take on new behaviors,
Avoid 27 new bad things
Then all is well, proclaim our saviors.

It's old and it's new
And we get tired of this,
Every five years, or so
We're told something's amiss,
But the problem really isn't
On the street of our action,
It's just a management perspective
And I call it, distraction.

Someone way at the top
Looks around at the horizon,
Some study results tell him
You're losing money, it's not surprizin',
The economy is down
But you must blame it on people,
Find the guy at the bottom
And impale him on a steeple.

The dollars float up
To the top of the pond,
Mr. ground-cover boss
Wants to wave his magic wand,
And ensure that the fiscal
Prosperity of his being,
Remains all omnipresent
Instead of his salary fleeing.

So the shit slides down hill
To finally find the plateau,
We're inserviced, “The Nursing Bungle”
It's the same old stuff, don't you know?

Fibril_late;
9/23/09

Doubtful Old Man

Call me a conspiracy theorist
Call me a fool with a pen,
Whenever there is a new fangled program
I want to know why, where and when.

Call me disruptive and cynical
Call me a doubtful old man,
Laugh when I'm doing the research
Following the trail of the plan.

I want to know the cause for new action
When management demands our compliance,
When rules and directives are jammed down our throats
Under the guise of some evidence based science.

Fibril_late;
9/23/09

Scathing Words

Oops, I stumbled on some toes, and underwent some body blows.............

Scathing Words

What an experience that was
The power that sits, sat down with me because,
I had ruffled some feathers
Last evening by phone,
I called, old Doctor what's-his-name
And struck a funny bone,
He rattled his saber
About missed communication,
So this morning, I got an earful
In the middle of the nursing station.

I apologized to yonder doctor
And I acknowledged my error,
There was no intimidation
Not a shred or whiff of terror,
Just an agreement of sorts
That our computer documentation,
Leaves a lot of buried orders
An unintended complication.

Last night he was so busy
Over-stressed by demands,
I sought simple clarification
And bought a reprimand,
Uninvited scathing words
Where a simple sentence would suffice,
On-call, is a professional obligation
A pleasant deportment, is my advice.

A couple of salient points
Were hammered home to me,
Be careful whom I call at night
And keep the blaster, on setting #3.

Fibril_late;
9/19/09

Another stab at our digital medical record. Why? Because there are some screwy new terms, that seem like they originated in some foreign country. "Bedfast / Chairfast"...what in the heck does that mean??

Flatus Findings

I've already told the story
Of our new charting ways,
A preponderance of data
Absorbing our days,
Removing us from the bedside
Although our patient's need us more,
The boss of the bosses
Demands adherence to the chore.

There are new terms to contend with
That I don't understand,
Bedfast and chairfast
Initiated and planned,
And other strange items
That demand some rewinding,
Just what is the meaning
Of a Genital Finding.

Am I supposed to chart, "Yes"
I found the appropriate organ,
Or maybe, Miss Betty
Is endowed more like Morgan,
I can't seem to find the answer
And I'm embarassed to ask,
I didn't think that my charting
Would be a sexual task.

Perhaps I'm too old
For this digital charting,
Because, I also noticed
There's a query on farting,
A delicate subject
Regarding flatus of the gut,
In summary, I tell you
It's a pain in the butt.

Fibril_late;
9/17/09

Someone was telling me about the latest diet, and then we had a laugh about the "obesity chain letter" that you would have to send to 3 other people so the secret magic worked. I enjoy silly ideas like that; they stimulate my writing.

The Diobesity Chain Letter

When the letter first came to me
It almost made me cry,
It said, "You better lose weight
Or you will surely die",
Your cholesterol (Oh, lordy)
Is so high it can't be counted,
Your HDL is puny
And your LDL has mounted,
To a level never seen before
In the annals of Cardiac medicine,
"Beyond a chance of survival"
Said (the famous), Dr. Edison.

I was on the verge of tears
Because I didn't know what to do,
So I grabbed a tasty side of beef
For a 14 hour chew,
While my triglyceride's kept leaking
From every available pore,
(They help me slide out sideways
Out my Winnebago door.)

After reading all of that letter
Every chapter, page and verse,
I felt that I was doomed
By my genetic family curse,
Those generations on the prairie
Raising cattle, sheep and swine,
With deep subliminal messages
That said, "Baby, you must dine".

Genetic memory eaters
Can't be blamed for their bad habits,
When we consume a couple calories
They multiply like rabbits,
Pretty soon we've grown some haunches
That have no rivals anywhere,
One day we balance upon a stool
And tomorrow we bust the chair.

After several rounds of reading
I knew the message was a beast,
My health was heading south
While I continued driving east,
To get as far away as possible
From the evidence in that note
I was convinced that "fat and happy"
Was baby, "All she wrote".

I crumpled up that paper
And headed for the shredder,
But I slipped upon my lard
And nearly took a header,
Finally noticing a post-script
That offered me some hope,
Would it be enough to save me
Here, at the end of my rope?

The instructions were so simple
"At least that's the way it sounds",
What have I got to lose
Other than 150 pounds,
And one more thing, it mentioned
I must forward the letter to others,
Similar folks, of similar means
Diobesity sisters and brothers.

I'd be cutting back on eating
All my favorite types of food,
The thought of that, was so heavy
I had a 17 hour brood,
But the alternative, yea the options
Stared me boldly in the eye,
Remember what I told you, chick
"You could surely die".

My family had already been down this road
Sisters, brothers, and cousins too,
An inch would come off, then add an extra pound
Just stand in the mirror, and there's more of you,
It's a vicious cycle and around the bend
Diseases are waiting to pounce,
In for a penny and out for a pound
Over the years gaining ounce by ounce.

That Diobesity chain letter?
I sent it to three people, in a hurry,
I guess it really comes down to me
Cut back on the calories and curry,
But what have I got to lose
Other than one hundred fifty pounds,
Get buried before death is due to me?
Or lose all my heaps and mounds.

Fibril_late;
9/15/09

Go Home Now

I'll be hitting 60 in quattro years. Thanks to the almighty Pixie, I'm way healthier than all of the clients who roll through the doors. Take the 39 year old guy who was in for Acute MI #3. The deal was, that 10 days ago, he had an elective Cardiac Cath with Stent placement to his Right Coronary Artery. After his free-7 day supply of Plavix ran out, he didn't order anymore. Somehow that pack-per-day cigarette habit, seemed more important. This time he returned with full blown acute Stent closure MI with cardiac arrest, Intra-aortic balloon pump, Hypothermia protocol, etc.
When he finally got extubated 4 days later, he seemed to have lost a few brain cells in the flux, but did finally discharge home, with the S/O he now wants to marry. She's the one that deserves a medal for sticking by his lame and lazy side. Anyway, I'm healthier than he is.

Still, even old warriors get punked out a little. To go to work, feeling like maybe I've got a touch of the piggy flu or maybe I'm suffering from California wild-fire smoke pollution, I wore out fast during the two nights I spent at work. We have a running joke in the ICU where I hang my proverbial hat. If there are any whacked out, crazy, on the call-bell every 15 minutes, or totally psycho nutcase patients, you can bet that either Jerry or I, will automatically have that assignment, if one of us is working. That's how it was last night.

Hello Shanna, I'm your Nurse for the night. Shanna responds, "Why do you want to kill me?". She says this over and over, for the next 15 minutes. It only got better when she started yelling obscenities. And that was just the first hour. The Morphine and Ativan sort of helped, but then again, maybe not. Ms. L. was as usual, somehow helpful with her calming presence. Thanks, K.

The night ended with my following thoughts around the theme of Going Home:

Go Home Now

I have to go home
When I'm tired of the bull,
All the idiotic innuendo
I eventually get full,
All the Care-plan duplications
And the unrelenting charting,
I have to go home now
Goodbye, I'm departing.

I have to go home
When my inertia is lost,
It was stolen by someone
Or maybe it was tossed,
Into the trash by mistake
By the legally blind,
I have to go home now
I hope you don't mind.

I can't stay any longer
Unless you're willing to pay,
Double-time for my troubles
There's just no other way,
That I can put up with this garbage
That I shoveled all night,
Don't threaten to keep me
I'll put up a fight.

I'm home now, and happy
Just typing this note,
A glass of wine in my hand
While my thoughts drift and float,
On the stream of contentment
Amidst bubbles and foam,
I'm so glad I left work
Because now I am home.

Fibril_late;
09/09/09

Some doctors seem older than dirt, still keep practicing, and have great results, regardless of how archaic they may seem.

He Cuts and Slices

The olde-time surgeon
He's the one,
He cuts and slices
Until he's done,
He might even dabble
In ways of the occult,
Whatever it takes
To get the best result.

He'll follow-up every morning
To see the result of his work,
He had a personalityectomy
So he's kind of a jerk,
But you just can't argue
With the results he gets,
If you need something cut out
He wins all bets.

Fibril_late;
9/6/09

Maybe you know someone who gets a "bee in their bonnet" regarding some affront to them, whereupon the offended one has to "share" their misery, with anyone within earshot.
I say, get over it dude, or prepare to meet Mr. Hammer.

Mr. Hammer

When she gets a bee in her bonnet
She won’t take off her hat,
I just stand back and watch,
And wonder, what’s up with that?
She starts to holler and screech
With moaning, all about,
"Just remove the damn hat"
I am tempted to shout!

It’s some ownership thing
This pain that she earned,
I can’t take it away
Or I will get burned,
By the heat of her anger
Regarding the bee in her bonnet,
But I have a solution
I’ll slam my hammer upon it.

Fibril_late;
8/28/09

People are admitted to the ICU for many reasons. Usually their first questions will not be regarding their length of stay or treatment, but rather, they want food and and they want to to know how to turn on the TV. Let's take a look at that:

On Admission

The most important thing
That we explain,
It's not the heart
It's not the brain,
It's not the
End of life decision,
It's the wired remote
To the television.

What's more important
Than our Nursing role?
The channel-choosing
Volume control,
But heed my warning
You better listen, right now,
That Nurse-call button?
Don't teach them how!

Fibril_late;
8/27/09

One Night Only

Over and over again, I repeat, I WANT A DIFFERENT ASSIGNMENT, every night that I work.

Apparently, nobody gives a rats ass about what my theory is regarding the "care-experience". Heck, it's probably because they don't follow the writings of "The Underside of Nursing".

One Night

We're not family
And we're not friends,
Particularly if
I have to clean your bottom end,
More than 5 times
In the course of 12 hours,
Super-nurse that I may be
I lack certain powers.

I don't want to know you
Longer than one night,
Some relationships are short
And ours just ain't right,
There's no need to prolong
An association such as this,
When I return tomorrow night
You're not the one that I will miss.

I'm a natural born mercenary
I want to choose my own battle,
Continuity, is a concept
That works well with cattle,
But these patients have personalities
With excretions, you can't envision,
Every day a new assignment
Is my career decision.

It's so easy to become enemies
When you're fighting hand to hand,
With a sick and twisted adversary
In the jungles of hospital land,
So, if I had my druthers
I'd fight a different one each night,
They're not my family, friend or neighbor
If I want to treat them right.

Fibril_late;
8/19/09
__________________________________

And then it came to this:

Transfer To The Floor

Last night my patient
Took her life in her hands,
Wrote notes by the thousands
And made her demands,
Let me walk to the toilet
Let me walk in the hall,
No, I replied
I believe you will fall

Her Doctor had written
That she could transfer to the floor,
Though the time had not arrived
For her exit out the door,
He postponed her departure
Because she acted a bit strange,
He felt she wasn't quite ready
To roam on the range.

She had a previous history
Of alcohol and drugs,
And in my esteemed opinion
Her brain was full of bugs,
Clearly she was infected
With a disordered personality,
I thought, if she gets out of bed
She'll be the next fatality.

Be as that may, she decided
To ante up her score,
In the middle of the night
She transferred to the floor,
Climbing out of bed
Without notifying her nurse,
Was she going to the bathroom
Or looking for her purse,
I'm sure I'll never know
And it doesn't really matter,
On the floor or in the bed
She was as mad as a hatter.

No injuries were apparent
When we hauled her back to bed,
Her escape had been aborted
And she wasn't even dead,
Perhaps a Posey-Vest would hold her
Until my shift was over,
After that I will not care
If she falls from the Cliffs of Dover.

Fibril_late;
8/19/09

It's my biannual rant regarding restraints. The regulations regarding what to chart, how often, and what must be addressed are ridiculous for those of us who work in Critical Care areas. So let's roll............and then one follow-up, Coup de Grace.

Extremity Management

By now it's the 21st century
And clearly time to revise an old term,
Regarding a particular topic
That causes some people to squirm
If you're a nurse in the hospital arena
You will know what I'm talking about,
Regarding, the rambunctious patient
Whose mental acuity is in doubt.

For the safety of the patient in question
There are times we must secure foot or hand,
Perhaps they are climbing out of bed
Without a lick of a chance that they can stand,
They may not remember the surgery
The amputation, of five necrotic toes,
They'll leap out of bed like a revived Fred Astaire
And go crashing to the floor; so it goes.

Such an outlandish occurrence as identified
Demands mountains of details in writing,
Old Gimpy, on the floor, has just busted his hip
And his family and I, are now fighting,
They were the ones, in the first place
Who were outraged, when we tied Poppa down,
When we complied with their wishes, and released him
He just figured he’d go dancing downtown.

We’re sued when we do, and screwed when we don’t
Any injuries will be blamed on the Nurse,
Thus I believe, it’s time to toss out the word
The terminology, “restraint” is a curse,
I’ve researched for hours and interviewed for more
And I think I have found the solution,
We need to obscure, the description of our actions
And resolve it with a binding resolution.

I recognize the value of convoluted terms
That were popularized in the business domain,
With an acumen for language, I believe I found the answer
“Extremity Management”, will be the name of the game,
An umbrella of sorts, for a variety of methods
To achieve the best outcome, over time,
Securing, old rambunctious Roberto in bed
And never to be sued for a dime.

We won’t be required to document
The same, silly details each hour,
I’m telling you, that’s such a waste of our time
A guaranteed drain of Nursing power,
We’ll Implement “Extremity Management”
The latest, hot care-plan in town,
With a protocol like that, I can chart in nothing flat
Forcing the Joint Commission to back down.

Fibril_late;
8/11/09
_ _ _ _ _ _ _ _ _ _ _ _ _

Coup de Grace

Extremity Management is my coup de grace
In the face of excessive regulation,
The protocols in practice, regarding Restraints
Are a conglomerate of nonsensical information ,
Foisted upon us by unreasonable voices
Claiming human, and animal rights,
They don’t have a clue to what happens
When Billy-Bob goes bonkers each night;

His Nurse won’t be found at his bedside
With continuous attention for hours,
She has to attend to her other 9 patients
For their meals, dressing changes and showers,
Upper management won’t find us a “Sitter”
A lowly-paid person to watch Billy,
After all, they would have to pay benefits
And for minimum wage, that is silly.

Now sealing our fate, like a 500 pound weight
Are the regulations regarding restraint,
And the all-seeing eyes, of the management guys
Want a guarantee, there's no legal complaint,
While the Nurse on the street
Spends 12 hours on her feet
Walking miles to appease every master,
When old Billy gets loose
He is one wild goose,
And his condition deteriorates that much faster.

I chart every two-hours
So much that it sours
I mark the same boxes each time,
On my 12 hour night
Billy remains snug and tight
In the morning, he's still alive
Is that a crime?

Some officials might claim
I have doctored the game
To tie down the patient, for convenience,
If Billy falls out of bed
Busting a hip and his head
I am sure a court of law, will show no lenience.

So, I tie when I can
If escape is his plan
Don't look to me
For psycho-social recommending,
Patient safety is my mission
And I'll hook him like I'm fishin'
I've got 12-hours to keep him alive
And that's my ending.

Fibril_late;
8/16/09

Floating (working in an unintended area) can be a nightmare. Not always, but it's a good set-up for a bad shift. Anyway, it was my turn, and off I went to Trauma ICU.

Cut Out

I'm not cut out for Trauma
It just isn't my gift,
Too many busted young guns
Too heavy to lift,
Now, don't get me wrong
This ain't about knowledge,
Why everyone knows
I spent a few years in college.

I'm not cut in the mold
Of the great Trauma nurse,
Masters of bone breaking
And they know how to curse,
Now me, I'm content with
The cardiac arrest,
Stent an artery or seven
Why, it brings out my best,
And let me play Sherlock Holmes
For that complicated EKG,
Just please keep your busted femur
Far away from me.

A visit to Trauma
Once a year, is enough,
C-collar practice and log rolling
Just to prove I am tough,
And then a visit to ICU
To catch the latest in slicing,
Oh, the secret is out
Floating: is so enticing.

Take it from me
I'd rather see Trauma,
Than Neuro ICU
Stuck with Godzilla's Momma,
Fresh off a stroke
In her right hemisphere,
Now that is a nightmare
Where I'd rather keep clear.

All in all, I am jealous
The news-clipping is in my purse,
Down at the big house
There's no floating a nurse,
Or so, the smiley one claimed
But why shouldn't I believe,
UC gets hot benefits
While the rest of us grieve.

I'm not cut out for Trauma
I had a Cardiac birth,
This is no war of worlds
To determine our worth,
We all have our talents
Our specialties and more,
And the patients don't care
When they roll through the door.

Fibril_late;
8/5/09
___ ________ ___

Slice of Life

A Trauma nurse
No, I am not,
But I love to learn
Why Bob got shot,
And how about Mary?
She paid the price,
When her boyfriend Billy
Gave her neck a slice.

The morbid details
Are fascinating,
The monsters mayhem
Is not abating,
Such an endless scope
Of injuries,
I want to know
So tell me, please.

Hour by hour
In the dead of night,
Visions of trauma
Are always in sight,
And even though
I'm not that kind of nurse,
I keep a police scanner
In my purse.

Fibril_late;
8/5/09
__ __ __ __ __ __ __

12 Hours

A Trauma nurse?
Oh that, I'm not,
I'd rather have my
Left foot shot,
From a careless moment
Cleaning the gun,
A buckshot foot
Is surely more fun.

Bariatrics
Isn't my gig,
The patient's are
Just too damn big,
But like it or not
It's part of the job,
When you buy the corn
You get the cob.

Obstetrics would never
Be my career option,
I just wouldn't fit in
Like a bad adoption,
With lochea's and placenta's
Flinging right and left and center,
Now that is one arena
I have no right to enter.

I considered Neonatal
I heard the babes were really small,
That piqued my curiosity
Call me kinky, that is all,
One kilo is so tiny
I can hold her in my hand,
But to wait for 20 years of growth?
Is more than I can stand.

To be a Nurse Anesthetist
Looked pretty slick indeed,
Passing gas for hours
While I watch somebody bleed,
But I'm a little claustrophobic
Stuck in the operating suite,
I'd rather be more mobile
On my bloody buckshot feet.

I'm settled in with Cardiac
In the middle of medical mysteries,
Instead of just dealing with body parts
I get to know the whole sordid histories,
Dwelling on complex disorders
Fills me with ideas and drama,
And having stuck with this job, for all of these years,
I play the role of the old and wise Lama.

I'm not a trauma-pedi-bari-neo
O-b kind of guy,
But when forced to float, I'll do my best
To make 12 hours fly.

Fibril_late;
8/6/09

I suppose that some of you must have heard about the latest and greatest can-opener,that is circulating the country. It's called, "The Nursing Bundle". I'm sure all of you have experienced something like this before, where your hospital organization believed the need for greater efficiency, and dollars saved, carried a higher importance than what was happening directly at the bedside.

Sure, I know, the "new" ideas are always couched in cool new slogans, and psycho-babble business speak. Another way of recognizing these insidious trends, are all the catchy Acronyms that the trainers sling around, like cheap 19-cent hamburgers, and would you like some fries with that, Honey?

I'll tell you what........Sister Euphemia has always been a sucker for this stuff, and there's no pulling the blinders away from her eyes; but why worry when we all know, the pockets of her habit are deep and lined with green.

Let's get to the story, the way that only I can tell it, ok?

The Nursing Bundle

The Nursing Bundle
I'm glad I missed it,
But from what I've heard
I could have kissed it,
Though all in all
It makes me wonder,
Should I have gone?
Did I commit a blunder?

I too, could have tasted
The Acronym soup,
With it's endless supply of
Loopedy loop,
Those inspirational moments
When ideas start firing,
And I give up the idea
Of maybe retiring,
Because, where else could I go
To get ideas like this,
The Nursing Bundle Workshop
Was not one to miss.

I can merely report
Third person, quite respected,
Why heck, I'm so jealous
That I wasn't selected,
But they told me the following
Version of truth,
Quite probably embellished
With 3 glasses of Vermouth.

We came with our questions
They were answered and more,
We received a lovely binder
And a "high-five" at the door,
They said, "Thank you, for coming"
There's so much you can learn,
Quite frankly I wondered
Just how much did they earn,
For a gig such as this
It has to be sweet,
Driving all around the country
With an expense account to beat.

I guess that's what you do
After your bedside tour,
Go from hospital to hospital
Selling the marketing cure,
The ploy to bring dollars
And a shine to our reputation,
The bread and butter, of repeat customers
Earns a standing ovation.

Ask Nielsen and Johnson
Because they measure the stats,
If we score near one hundred
There will be bonuses for those cats,
Sitting high in their offices
Running the numbers for this quarter,
And, "By the way" they admonished
"Keep the overtime shorter".

Now those Bosses, who are nurses
Tap their feet and giggle,
Knowing that years behind the desk
Have only added to their wiggle,
While visions of floor nurses
Dance in their heads,
Imagining how their staff
Will chant slogans, while making beds,
For their clients every morning
To boost morale and good feeling,
Yes, that's what is most important
Second fiddle, comes the healing.

Nursing Bundle is our friend
That's the take-home message, I guess,
Sister Euphemia, likes the idea
If it will clean up this mess.

Fibril_late;
7/28/09

This is no particular complaint about a specific person, but rather, just inspiration from something Ms. B said today. It does seem at times, that the shift was 15 minutes long, after a grueling 12-hour report!

15 Minute Shift

It was a 15-minute shift
After that horrendous 12-hour report,
43,200 seconds
While I listened to him suck and snort,
About the complicated events
Between the beginning and the end,
It seems like the dude was on offense
And I was the one to defend.

It seemed like a long 15 minutes
While you gave your 12 hour rendition,
How those bastards in Pharmacy processing
Could care less about someone’s condition,
You ranted, and railed and you moaned
And you simply just ran out of time,
There’s no one who works, quite as hard as you do
You’re a savior amidst all of this crime.

It was a long 15 minute triathlon of pain
After the 12-hour report from south Hell,
We’re lucky that anyone is left standing
Your oration could crack a coconut shell,
I survived because I always wear earplugs
When I know that you’re headed my way,
But who did I piss off, I'd just like to know
To earn this kind of punishment today?

Fibril_late;
7/27/04

Criminal Edema

There are times when a simple 12-hour shift can seem to last 24 hours in duration. Last night was one such night. I had to transport the blob (1950's Horror movie), to Nuclear medicine for a WBC scan. The blob had an anxiety attack during the procedure, and if you've ever seen the movie, you already know it is difficult to communicate with water. It just isn't like those Timothy Leary moments from the sixties, where I floated on a lotus flower, talked to the colored orbs in the sky, and chanted "Om" in reverse, which came out as "Moo". Oops, maybe you missed the 60's!?!

Anyways, luckily the reader never knows if I'm actually relating something from real life, or if I'm still on some kind of acid trip.

Regardless, if you've worked with many horrid conditions, you certainly have met up with Ms. Anna Sarca. She hangs around and makes your life miserable.

Criminal Edema

He has criminal edema
It's coming out his ears,
Even Anna Sarca
Almost came to tears,

It's a crime against his passion
Perpetrated on his life,
A transgression of such proportion
That he wished he had a knife,

An insidious attack
That caused him such rancor,
It weighed upon his body
Like a 300 pound anchor,

He's a blob in the bed
A jellyfish on the shore,
Like a gasping guppy monster
That I dream of when I snore.

Because he suffers, oh he does
From edema on the run,
Escaped from Alcatraz
He'll tell you it's no fun,
To have your skin weep wonky water
You can't drink it, that's for sure,
And although it's the 21st century
Ask a doctor, there's no cure.

He has criminal edema
America's Most Wanted?
It's not him,
Though he has a proper future
Filling swimming pools;
To swim.

Fibril_late;
7/24/09

Someday, in the far reaches of your career, you will look back and recognize that one special person, was your nursing soul-mate. I know who mine is, although we no longer work together. However, I know that if we were to be reunited in the work setting, incredible things could, and no doubt, would happpen. Our assessment and technical skills were complimentary, we were always looking out for each other and most importantly, mutually focused on the most advantageous outcome for the patient.
Sometimes I go to work, look around, and long for just one more shared work day, with my old friend.

Soul-Mate

Sixteen years now
And I've figured it out,
You were my Nursing soul-mate
Without a doubt,

No one since
Has had your tools,
You were my balance
When we were surrounded by fools.
My sounding board
Whether wrong or right,
We could face any disaster
In the darkest of night.

'Tis a rare opportunity
To work with someone like you,
Nothing could stop us
When there was a job to do,
Under the circumstances given
The best outcome was guaranteed,
What might have been a hemorrage
Became a small bleed.

Now all these years later
When I scan the scene before me,
Searching for a comrade
Whom I can always trust,
I wish that you were there
To share the vision that I see,
With your fine tuned assessment skills
We can both decide, success or bust.

If ever we are reunited
I'm sure the years will melt away,
I know you're still working the circuit
As I do, to this day,
We'll talk about the old times
And share our aches and pain,
I'll check you out, for the kinds of injuries
That leave a permanent stain.

And when we part, I'll feel whole again
Like those years so long ago,
Reminded that your spirit is with me
In every episode of this show.


Fibril_late,
7/21/09

We have this new computer charting and it comes with about 50 tiny, (font 8) icons, that look like little bugs crawling across the screen. Thus, I had to write the iconic poem.

Icon

Icon not understand
Nor fathom what they mean,
All those silly little symbols
Running circles on my screen,
The experts call it my PAL
But it ain’t no friend of mine,
A pal is strong and helpful
And this one has no spine.

Icon not discern the meaning
Icon not discover a solution,
Too many icons running around
That deserve an execution,
Icon hardly wait the day
When we finish up this caper,
There will be a mass revolt
And we will welcome back the paper.

fibril_late
7/9/09
_ _ _ _ _ _ _ _ _ _ _ _

I wrote "Icon"; then I slept. I woke up and wrote "Yukon"..........................must have been the Boss invading my sleep.

Yukon

"Yukon", she repeated
"Yukon, do what I say",
Treat these icons with respect
All night and all day,
Because that's our new language
Our lexicon, our lingo,
Get on the boat and behave
You, pestilent gringo.

Whether she said that exactly
I can not be sure,
But if I want to get paid
I better find me a cure,
To my symbolic sepsis
This agonizing irritation,
Or yukon bet my next boat trip
Might be a smoldering cremation.

Fibril_late;
7/9/09

This shouldn't be an issue, in our line of work, but believe me, it is. Trust. Who can I trust, when the rubber hits the road. When the Sht hits the fan, or when I am away from the bedside. It isn't always about being untrustworthy, but rather, someone who may lack common sense, or has yet to develop their critical-thinking skills. The danger in this case, lies in the fact, that the person in question, doesn't realize they "have a problem". After all, when you don't know what you don't know, by golly, you don't know Jack!

And Jack is dangerous!!!

Thick and Thin

Who can you trust
When your IV bag runs dry,
Let's just say you're out to lunch
And your patient could possibly die,
You surely expect to hope
That fellow nurses on your crew,
Will walk into that room
And know exactly what to do.

Who can you trust
When the ventilator tubing comes apart,
You're on a trip to the pharmacy
And your patient isn't smart,
He dislodged the vital tubing
And now his lungs no longer inflate,
Can you trust the members of your crew
Before it is too late?

Who do you trust
When you need a vital favor,
You're so busy with one patient
And cherry is the flavor,
Do you query anybody
Or single out, one or two,
The ones you know, through thick and thin
Would do the same as you.

Who do you trust at work
It should be any person,
In this critical-care arena
If we don't cooperate, patient's worsen,
But after all is said
And most of all, is done,
Who I trust, is selective
It isn't everyone.

Fibril_late;
7/8/09

"Bless you": this line is uttered so often, you'd think there were a bunch of Gods running around. Or agents of a God, dressed in the clothing of the day. Hmph. It sure makes me wonder.

Gesundheit

I wonder sometimes
What stories I'll tell,
When I have left Heaven
And I'm not in Hell,
Some might think I'm crazy
The things that I'm saying,
But if you are religious
I know that you're praying.

At work the other night
I performed some good feat,
The nurse that I helped said
God bless you, Pete,
And it caused me to wonder
If she somehow had the power,
Bestowed on her, by God
To bless me for an hour.

I didn't notice any difference
That a blessing could have made,
Perhaps the blessing is in storage
To be sometime, later played,
To my better advantage
In a time of greater need,
Like when I stick myself with a needle
Causing me to bleed.

What makes people think
They can randomly send a blessing,
As personal agents of God
It's almost depressing,
Because that's what the whacko's say
Before they poison their flock,
It fills me with trepidation
As I prepare for the blessing shock.

Who knows what it means
When you're blessed for a sneeze,
Though I've always preferred
"Gesundheit", if you please,
That kind, German wish
To offer me good health,
But I'd really prefer ten dollars
And wish me good wealth.

Fibril_late;
7/8/09

I woke up from my "first day off sleep" and immediately wrote this poem. All I had was the line, "At risk for skin integrity", which had earlier struck me as an odd way to describe skin that had the potential of being damaged.

Where did I get that line, you ask? From a memo, of course. Furthermore, a "bathroom memo", with its accompanying flowchart format. I'm telling you, that this organization I work for is a veritable writers dreamland; a germinating pit of poem seeds, if you will. I suppose that might be going overboard, but to me, it is constantly entertaining.

Skin

At risk for skin integrity,
It could happen to you
It might happen to me.

Your skin was ragged
And worn, at each seam,
We tried to repair it
'Twas a heck of a scheme;
But you wouldn't have it
You scratched and you picked,
The carefully placed Duoderm
With your fingers, you flicked,
It littered your bed
And fell to the floor,
The housekeeper bitched
At one more, extra chore.

They came with their science
Those Hyperbaric nurses,
You flailed and you spit
And heaped them with curses,
And thus, you were blessed
By the most basic of karmic laws,
You reap what you sow
The effect is your cause.

Your skin wouldn't heal
You moaned as it wept,
Perpetually, you were awake
While everyone else slept,
With your circadian rhythm
Totally, fu-barred,
Even if you survived
You'd be horribly scarred.

Yes; skin integrity
Oh, my,
We fixed your skin
But still, you died.,
You fought all of our efforts
So valiant; with vigor!
But it matters not
With your mortis and rigor.


Fibril_late
7/6/09

Picture this scenario: The patient, a young mother dying with cancer, a family in crisis, a husband going ballistic, a teenage son overwhelmed with the burden he is shouldered with, a grandmother newly arrived from the old country, without a lick of spoken English. Then, the patient has a respiratory arrest: the outcome.........chaos!

Letter To Sergei

In my letter to Sergei:
There's so much I want to say,
I recognize your anger
But don't aim it our way,
We care for your wife
Much like you do,
Just a different perspective
Than the loving husband view.

We want the best for her
And we're doing what we can,
Please hold back your anger -
Be strong; be her man,
Her protective custodian
Her pillar of stone,
If we can all share this space
She won't be alone.

We suffer your loss
We're included in your pain,
Love is a journey
It is never in vain;
I see the strength of your love
And recognize your power,
Please set aside your anger
And love her, one more hour.

Fibril_late;
6/30/08

I've been an EKG fanatic for years. It's the topic I study the most. When I see some arrhythmia scoot by on the monitor, I want to capture it, and analyze it as if I'm Sherlock Holmes. I've never been successful in learning other spoken languages, (as my mate will attest to), but the EKG, that's a different story.

SVT vs. TVS

Is it SVT
Or TVS,
Sometimes I get
Confused, and guess,
My idiot factor
Increases by doubles,
With an exponential
Rise in my troubles.

Let's examine a scenario
You've got the night-shift blues,
It's your fourth night in a row
And this one's an easy cruise,
When abruptly, you're assaulted
By alarms and lights galore,
Awakened from your reverie
You fall upon the floor.

The rhythm is wide and ugly
And it's totally bizarre,
The short trip to your patient's room
Suddenly seems quite far,
You fumble for the Lidocaine
Then stagger in the room,
Your tunnel vision activates
The flashing light, spells doom.

Is he conscious, is he dead
Is he even in the bed?
Is he watching television
Can you make a quick decision?
Should you stop a moment, and clock him
Or just go ahead and shock him?

Well, there isn't always time
To plan a course of action,
You will always get opinions
From many other factions.

Now you zap him with the macrovolts
And raise a head of steam,
He jerks up off the bed
And summons a frightful scream,
“Holy Mother of my ancestors
Deliver me from Hell,
If this is getting better
I'd rather not be well,
Because I have no recollection
No, I never have agreed,
To allow electrocution
It's just not a thing I need”.

Despite his pain and suffering
His rhythm has reversed,
He is mad as hell that you saved him
And announces, you've been cursed,
By the mother of his ancestors
The mark is on your head,
(Lord, another thing to think about
When it's time to go to bed).

Did you get a few good strips
Before you shocked that creep tonight?,
Was it SVT or TVS
Or Parkinson, Wolfe and White,
Does a delta-wave announce itself
Or remain concealed and silent,
Was it SVT aberrancy
Or something else more violent?

Is the phenomena reentry
Are the P-waves retrograde,
Does the AV-node dissociate
Or the P-waves simply fade,
Is the antegrade conduction
A sign of CMT,
Is it Atrial Fibrillation
With ventricular ectopy?

Is the axis indeterminate
Is it normal, left or right?
Is the complex wide or narrow
Or the R-wave broad or tight?
Does the QRS morphology
Have a well defined polarity?
Is it positive or negative
Are the fusion beats a rarity?
Do you notice a concordancy
In the horizontal plane?
Is there evidence of R-wave loss
Or just too-little gain?

Beware of helpful hints
That are often unreliable,
Choice of drugs is crucial
For the patient to be viable,
Like compensatory pauses
Gross appearance and the rate,
Commonly unsubstantiated
Clues of someone's fate.

The outcome, is all that matters
Did you fix it, did you not?
Could you halt decompensation
Or do you feel, your nerves are shot?
Did you conquer SVT
Or succumb to TVS,
Terrifying Ventricular Syndrome
And its' consummate distress.


Fibril_late;

1995