Lately, almost every week, there have been Regulators, Dignitaries, Law-Enforcers, and other wandering eyeballs, that we need to impress, over at yonder healthcare system. Every department wants to look as neat as a pin, and then to top it off, all those wonderful visitors get the best of all meals, and what budget does that come out of, I wonder?

These two poems touch upon financial impact and all of that.

Sisters Charm

Sure, I realize
There’s a tough crunch,
Matching dollars to nursing time
But what about that lunch?

Where visiting dignitaries
Chew the fat and shoot the bull,
Who pays for all of that?
Waiting till all those suckers are full,
With our special gourmet
We catered for you, kind of dinner,
Now please, if you all would score us
As your favorite winner,
In the lottery of favorable comments
On the Who’s-Who list of Hospitals Best,
Come on; just give us a good score
This is not a quiz, exam or a test.

And it’s not about our Surgeries
Or Cancer-Care, or Robotic Arm,
No, it’s all about the catering
And Sister Euphemia’s charm.

Fibril_late;
4/13/12

Like Sheep

Writings twenty years old
Do they still have some funny?
If I publish them, what are the odds
That I’ll make any money,
Pretty low, I estimate
But that’s not the point,
I wrote then, about issues
That I needed to anoint.

Human habits change very little
Despite our technological advances,
I wrote about missed opportunities
And precarious chances.

Since that time, not much has changed
With ethics, morals and actions,
Although I’m inclined to believe
That the Hospital-as-a-business-model
Has led to an impaction,
Where good care and cost-cutting
Have nearly reached a critical-mass,
Where a gentle mercy and kind dignity
Won’t be allowed to pass………..

No matter how many feel-good, call-back
Phone calls are made
Cost-cutting will surely, bury those deep,
Even while our leaders and administrators
Chase Medicare dollars in their slumber…………..
Like runaway proverbial sheep.

Fibril_late;
4/13/12

I'm currently compiling old writings into a cohesive shape, for publishing, and what not. Along the way, I have unearthed some gems. I like this one, because it summarizes the feeling a nurse has after a wild night in a University Trauma Emergency Department. Yes folks, even in sleepy Sacramento, we have blood, guns and gore. And heck, this was back in the bygone days, of the gay 90's.

Nightmare on Stockton Street

It was a nightmare on Stockton Street
I heard a thousand marching feet,
I saw the blood, the guns and gore
And it was only eight forty-four;

The patients came in groups of five
And half were barely still alive,
The remaining few were very brave
Though most had one foot in the grave,
They spilled their guts upon our floor
And it was only, ten forty-four.

The setting sun, it spelled our doom
It was a blood bath here, from room to room,
We began to feel the Lunar pull
'Twas no surprise, the moon was full,
Down on my knees, I prayed, “no more”
Because it was just, twelve forty-four.

Loose body parts were tossed aside
Later, we would have them fried,
My ears were ringing from the screams
This night was worse, than my worst dreams,
Please help me find the exit door
Yes, now it's almost ten-to-four.

This massacre, is finally through
I'm up to my elbows in bloody goo,
And management has the gall to say
Why don't you work a double today?

Fibril_late;
1995

I like to think that I'm pretty good about being able to simplify complexity, when I'm trying to explain treatments, procedures, therapies, medications and the like to our clientele. However, once in a while, that look of "uh, what did he mean", comes into their eyes. Well then, I guess I just have to start over.

Longer Short Life

A shorter half-life
What's that all about?
A longer short life
Do you want to jump and shout?

All of those ear-catching terms
Garner interest, that's a given,
It might mean something to a scientist
But surely not, to David Niven.

Fibril_late;
3/30/12

I do not recall in previous years, any hoopla revolving around "Doctor Day", but apparently, this is celebrated on March 30th. So, during my dinner meal break, I penned this little muse.

Doctor

Dedicated Doctors
Optimistic, with
Compassionate connections,
Terrific, talented teamwork
Offering
Repair, recovery and resurrections.

Fibril_late;
3/29/12

An oldy-but-goody. Not sure what year I wrote it, although I think it was when I was still an RT, maybe during nursing school.

Ode To Gomer

What do you see nurses, what do you see
What are you thinking when I take a pee?
Did you notice my bladder distended and firm
And that thing in my stool, it looked just like a worm;

Did you notice my sputum was crawling and green
Can't you see I need treatments, on my Bird machine,
I'm nauseous and nasty, whoops, up came my brunch
Please save it for me, I'll have it for lunch;

That IV solution is really poison, you know
And you're trying to kill me, but I won't let go,
So, I'm calling my Lawyer, to represent me
I'll have you all jailed, and I'll be set free;

Oh, my God, my heart's pounding, like it's hitting my ribs
And I hear a great voice announce, “Look, it's V-Fib”,
Someone's battering my chest, as ribs crack one by one
Why is everyone smiling, like this is all fun?

Now, I'm just an old body, lying limp on the bed
The crowd sighs with relief, 'cause this old Gomer is dead!

Fibril_late;
1980

The current, no longer so new job (6 months) is one where we are essentially a prep-go-and-recover-you procedure unit, where we close at 11pm, and any patient left over, spends the night somewhere else. We don't typically cater to ICU patients, because that's what an ICU is designed for; places full of experts and equipment to support all that fancy stuff. But we do occasionally have a patient designated "like ICU" (by MD orders as "critical) and then technically, I need to be around, or Ms. LL. Currently, we are the only available "certified ICU" players in our arena. Use your imagination and you can see that this might cause some staffing problems, right?

God Knows What

At work
Time passes so quickly,
But things are a bit different now
The patients I encounter, are not so sickly,
Although occasionally, there is that ICU type
Multi-system problems that are getting sort of ripe,
And for same strange reason
Dr. X, at such-and-such facility,
Decides that just when BillyBob is drifting
This is the time for us to exercise our ability,
To fix, some god-knows-what rhythm trouble
Do it now, and on the double,
Despite the fact, that BillyBob is slipping
Towards Nirvana, he's definitely tripping,
On a low blood pressure, with no Septic restraint,
Doing his best to become
Somebody's patron saint..............

Well, that's one thing
And then here is another,
We're not really an ICU
Even if it's for your best-friends mother,
Two of us, have the designation
ICU nurses, ready and willing to jump,
Just please don't tell me
You need a frickin' Aortic Balloon pump.

Fibril_late;
3/14/12 

Bobcat Bite

Over the years, many jobs, and there is one certain thing in common; sooner or later, the new guy or gal, gets jumped in some nasty way. Technically, I'm talking about some sort of verbal assault, but anything counts here, as I am sure many others would attest. It is sort of a “Welcome Wagon” in reverse. I wouldn't say that it's always the playground bully, but certainly, there is that common thread of uncalled-for anger, pressure, coercion, pettiness, which leads to an unexpected attack of some sort.

I'm going to use the Bobcat, as a euphemism, for this kind of unruly behavior

Bobcat

A Bobcat bit me
Late last night,
It was so unexpected
I had quite a fright,
And the fact, that it occurred
On hospital grounds,
Well, that's the kicker
Because the way that it sounds,
Why, no one would believe me
They'd say, “C'mon, you must be kidding,
You must have paid your witness
To support what you're bidding”,
So, for now I'm keeping quiet
But, I'm prepared for the next attack,
And if I spot that Bobcat first
I'll just shoot him in the back.

Don't Need It

Workplace violence
A verbal assault,
I don't need it
For my gestalt,
Because an attack of this nature
Unexpected, unannounced,
Is like a Bobcat attack
I've been pummeled and pounced.

I've seen a Bobcat
When I lived up on the hill,
Carnivorous, I suspect
They eat, what they kill,
So next time, I'll shoot first
And ask questions, later,
There will be Bobcat for dinner
After a pass through the grater.


2/24/11

Two entries in one day; now that is really productive, and there does seem to be an undercurrent of commonality.

Syndrome and Disease

Mary has a syndrome
And Bob has a disease,
While Mortimer Snoot
Just had a little sneeze,

Bill has a disorder
A derangement of function,
Betty is almost dead
And requires extreme unction.

All these classical terms
A fancy way to say, “you're sick”,
It sounds like a conspiracy
Let's try and bury you, quick;
Before you figure out
What our medical lingo means,
We want you unconscious
When we pull the wallet from your jeans.

Fibril_late;
2/21/11

I'm not really picking on anyone in particular, but our success in health-care, does rely on a steady stream of sick and diseased people. And many of us are a part of that screwy, socioeconomic moniker, currently identified as the “1%”. In fact, I would wager that for the most part, when one of the “99%” finds themselves in the hospital, it's a “1% - er” saving their butt. How ironic is that?

Prima Donna and Loving It

We preach preventive medicine
And good life-style choice,
But, surgeries and disease
Bought my Ferrari
And your Rolls-Royce.

You see, after years of study
Toil and sweat,
I welcome your diseases
It helps pay off my debt.

But don't be thinking that I'm greedy
Why, I deserve every perk,
I've worked harder and longer
Than your average jerk,
Showcasing all the facets of
Of my prima-donna existence,
So, bring your diseases to me
And we'll both go the distance.

Fibril_late;
2/21/12

I went to ACLS today. There were a few new protocols, and it just seems to get simpler and easier. The drugs have been reduced to Amiodarone, Atropine, Lidocaine, and Epinephrine, for almost all scenarios. I got to thinking about how the approximate 5 year period of change, is probably a really good manufacturing cycle to achieve, and how certain companies are very likely benefiting in the dollar department.

Gin and Tonic

Four decades spent
In a healthcare setting,
Algorithmic procedures
Are just predictable betting,
That change, every few years
After the latest new fangled,
Ideas and data
Are sorted and untangled.

We believe our new techniques
Are better than the old,
We get new machines
And the prior ones are sold,
To that big third world market
Across oceans and borders,
While the medical device makers
Are raking in new orders.

It's sort of a racket
One must question each new way,
I'm betting, obsolete
In two years and one day,
And then Pfifzer and Ballard
St. Jude and Medtronic,
Will be counting their millions
On the beach with Gin and Tonic.

Fibril_late;
2/19/12

Back in the day, when I was working in various units, either ICU or on the "floor", I remember taking report from the Recovery Nurse. When the conversation finished, I never called back to the Recovery room, once I had received the patient. Why? Because now, it's my duty, job, and expertise, to determine what needs to be done, and move forward. Why would I hassle the Recovery nurse, now that it is 3 hours post-op, and there is mysterious swelling over a dressing where the new pacemaker is? My response? Betty, take the dressing off, look at the incision, and call the doctor if you think there is a problem.

If you're confused about this, take a visit to a typical Recovery arena; the newly repaired patient arrives, and for the next hour or two, the focus is on the old standard ABC's, equipment, incisions, consciousness and other nuances. If the patient is hypertensive, we're giving Hydralazine, not Lisinopril. If there is tachycardia, it might be IV Lopressor, not oral Metoprolol. So, no, I'm not responsible for giving the patient, their standard daily medications, all right?!?  Criminy!

She's Throwing a Slider

As a Recovery Nurse
There is a particular focus,
A-B-C's and equipment
And some other hocus-pocus,
Perhaps, some particular points
From the Anesthesia provider,
Like, “Don't expect a fastball
Because she's throwing a slider”.

When it's time to report
To the next, receiving nurse,
It can be collegiate and collaborative
But at times it makes me curse,
When questions are asked of me
As I'm poised on your doormat,
Posing irrelevant queries
From some predetermined format.

“What were the closing pressures?”
Nurse B, wants to know,
It's unclear what she's talking about
As this was a Pacemaker show,
Where they cut a pocket in the skin
Put in a pacer and connected wires,
Closing pressures don't apply
Unless you're focused on the tires.

Later on, I get a call
Did I give the afternoon meds?
No, I told you, the patient had nausea
And vomited while in bed,
Then 15 minutes more
You're on the phone again,
Looking for some answers
That were charted, way back when,
That's why we have computers
In this digital, modern age,
Did this patient have their X-ray?
Look at the Radiology page!!!

Recovery takes an hour
Sometimes, a little more,
Wake and shake and breathing
To get them ready for the floor,
So, if daily medications
Were not administered, it's your duty,
Please stop calling me, do your job
And don't complain, that I am snooty.

Fibril_late;
2/17/12

Mr. Anxiety (age 57) came in yesterday, for a Tilt-Table test and then to follow, an EP study trying to induce an arrhythmia. This fellow had experienced one solid episode of passing out while on a treadmill at his gym, with a trip to the ED, and then another “near miss” of pre-syncope. Unfortunately, there was no documented or recorded proof that he had an arrhythmia.

What I found to be more telling, was that he had experienced a major heart-attack at age 48, requiring a 5-vessel CABG, he was at least 70 pounds overweight, taking meds for Lipids, Hypertension and Metformin (while denying he was a Diabetic), had a major anxiety disorder and a job in Sales, which he and the wife claimed was “highly stressful”. And all that he talked about over the course of his ten hour stay, were the symptoms associated with his pre-hospital syncope and the Tilt Table test; over and over and over again.

Both tests were negative; I think he started worrying ten years ago, and instead of embracing life, he just worries about death.  


Shadow of Fright

Since his heart attack
At age forty-eight,
He has been a fearful man
Regarding his fate,

He takes Valium and Ativan
Bupropion and Xanax,
His wife calls him her baby
As he relives all of his panics,

He denies that he has Diabetes
Though he's a Metformin user,
Seventy pounds, overweight
He's a lifestyle abuser;

Quite frankly, it was crazy
Listening to his tale,
Regarding the Tilt-table test
And the EP-study fail,
He casts blame on the doctor
But he is blind to his plight,
For ten years he has been living
In a shadow of fright.

Fibril_late;
2/17/12

The years of your career, the many experiences and books of knowledge you assemble that is you...........allow your work day to be a journey of excellence. But what is it that makes any single day stand out, the event that cuts a little groove in your memory blank?; I find it to be the Uncommon Interaction.

Uncommon Interaction

All in one day
The uncommon interaction,
My neighbor's daughter had a Cath
Was the first distraction;

Then retired nurse Betty
Her husband, on the table,
Had been my patient last summer
At my previous stable;

Encounter number three
Caught me completely off guard,
A person I used to work with
In the University yard,
We both exclaimed the same
“What are you doing here,
Man, I'm so surprised to see you
It seems it must be at least ten year”.

Amidst the stress and all the drama
That surrounds me every day,
It's the uncommon interaction
Like an afternoon parfait.

Fibril_late;
2/12/12

Sure, I'm a bit disorganized, and I spread out my papers, all over the place. The deal is, that I like to see it all, and not have to dig through a pile of stuff to find what I'm looking for. If you're a neatnik, then I'm going to drive you crazy.

1st Debris Belt

I have a 1st Debris Belt in Messiness
But Lana, she's got me beat,
Just trying to start an IV
There are throw-away wrappers
Covering her feet.

I have a 2nd Debris belt in Organization
I couldn't follow a list if you paid me,
That's why it's not a good idea
To try to coerce or persuade me.

Then there's my 3rd Debris belt in Entanglement
I can conjure a knot in any shoelace or cord,
Why untie, when I can more easily break it
I'm one of those employees, you can't afford.

Fibril_late;
1/31/12

Pill-bottle safety caps have been around for years. When my kids were young, I could see the value, although, as a good parent, I kept a locked cabinet in the garage for all poisonous substances of that nature. Now that I'm an older person, safety caps, knobs on devices that I must unleash, and other similar designs, are a painful threat to me on a daily basis. Quite frankly, I think it's a conspiracy against all of us with cranky hands.

Pill Bottle

Narcotic security
It's a no-brainer,
Until I need the medication
And can't open the container;
Sure, I understand
There's a crime problem, dude,
But, this bottle is so hard to open
It might as well be glued.

Then take into account
My arthritic right-hand,
If you're asking me
This mechanism should be banned,
Because, just trying to remove
The top, to get a pill,
My hand hurts, I get so angry:
There's an inventor I want to kill.

Press down, hard
Turn counter-clockwise, and lift,
Feel the bones in my hand
Torque sideways and drift,
As a thousand nociceptors
Are activated, and I scream,
Dammit, whose idea was this?
Now I need a surgical team.

I have real pain
And I need some relief,
But all I get from this safety-bottle
Is a world of grief,
So, once again
An engineering braniac,
Has turned a civil citizen
Into a raging maniac.

Fibril_late;
1/29/12

I don't like getting sick. Sure, paid sick-time is good, but it does put a burden on the crew at work, and I should be able to stay healthy, right? But the viral community / army, thinks otherwise. It seems like I'm nailed each year, with some atomic-sized particle, that my immune system doesn't recognize, and about one hour later, I've been ambushed, and then spend the next 7 days, in abject misery. Hows that for the easiest downfall of the most advanced species? Pathetic.

Buffalo Clover

Finally, I acquired my first infection
At my latest job,
What can I say, it's the season
For the free flying, viral blob,
It's so difficult to dodge
An invisible and tasteless microbe,
Thus, it is freely distributed
Around our city and the globe.

Was I careless
With my hand-washing habits,
Hard to say with a virus
That multiplies like rabbits,
I wash several times a day
And several times hourly with the wipes,
And who knows, maybe it was airborne
So hard to avoid that; holy cripes!

Was it a coworker or patient
The Echo-tech or coffee-server,
Was it the computer mouse
Or just a casual observer,
Dropping by
For laughs and diversion,
Whatever it was
I suffered viral conversion.

It surely wasn't spiritual
I didn't see the light,
But there were four days
When I nearly coughed all night,
A seven day trip of misery
I suppose I escaped unharmed,
Not like I was blessed
But rather, just charmed.

Infection number one
I'm glad it's over,
I did score some tasty cough syrup
It's better than buffalo clover.

Fibril_late;
1/26/12

Today, reading old writings from years past. The big hiedy-ho moment? When I realized nothing is changing in Nursing. Way back in the training period of '81-83, having to write by hand, those silly care-plans.....knowing at that moment, that P.O.C. really stood for piece of crap.............About every 10 years, I check the landscape, and we're still dragging around that POC anchor. You find me a nurse, who thinks these POC things really have value (not just something that gets audited, so that's why we do it), and I'll show you a nurse who wants to join management, because they groove on these concepts.

On that cynical note, here are my words from around 1993:

The Care-Plan Stomp

As nurses of these modern times

We're guided by the rules,

The policies and procedures

Designed by greater fools,

And every working moment

We must document our actions,

Despite the ever present risk

Of paperwork impaction.

The bedside nurse's duties

Are defined by job-description,

A lengthy boring manual

That's written in Egyptian,

There's a universal format

We call the P.O.C.,

Officially named the Plan of Care

It's a Piece of Crap, to me.

There isn't any doubt

There was once a worthwhile goal,

But in the interpretation process

It's been lost in some black hole,

Burying the spirit

By the wording of the plan,

It astounds the simple logic

Of any thinking man.

In the unit that I work

The P.O.C. is simple,

We're training adolescents

How to cultivate a pimple,

So all we have to document

Is how they wash and eat,

We write, “Alteration in Nutrition”

And right there, I claim defeat

Each and every problem

We address by intervention,

If we documented properly

We'd be forced to place attention,

On the paperwork itself

Instead of sick old Joe,

Who'd be swirling down the drain

With a documented glow.

I've worked in many hospitals

I'm care-plan oriented,

But the way this thing is going

I'll soon become demented,

And the hospital will be forced

To pay me Workmans Comp.,

Because I suffered mental injury

Performing the care-plan stomp.

Fibril_late;

circa: 1993

Almost every day, there will be a period of several hours, where all hell breaks loose. There will be too many patients, that need to be prepared for procedures, and we will be temporarily short on staff members. It is a stressful part of the job, because we are trying to make this journey-in-a-day, as comfortable as we can, for those people we are serving. It is the nature of our business, and it involves crucial resources.

Crucial Resources

This is a real-time journal
Written soon after,
The raccoons and the bats
Took residence in the rafters,
At least, that's how it seems
Some days in this church,
When we're short on crucial resources
Way out here on our perch.

Ours is not a job
Of bright lights and glitter,
I prefer a shotgun
To get rid of those critters.

Fibril_late;
1/18/12

I am thrilled when I learn something new, and when it happens at work, perhaps I'll perform at a higher level tomorrow; at least that sounds good, right? But when that "teaching moment" is delivered by Dr. X, and he is renowned for his arrogant persona of superiority, well, it feels more like the sting of a wasp. And even moreso, because I didn't learn anything; it was old news.


Good Learnin'

Unexpected outcomes
Do arise,
Awarded to me
Like a secret surprise,
Not because of carelessness
Or lack of attention,
No, it's like a betting game
At a gamblers convention.

Dr. S said
A teaching moment, this is,
Perhaps he'll come back later
And hit me up with a quiz,
But I was thinking, honestly
He was prob'ly still in prep school,
When I pulled that first sheath
Twenty years ago, fool.

Well, yes sir, I'm open
To good learnin', if you will,
But cut me some slack
And don't send me a bill.

Fibril_late;
1/18/12