Inspired

Well, what nurse has never gotten tangled up in wires, tubes, drains, etc? That would be the nurse that never worked at bedside. One time I tripped on a long IV tubing that had draped to the floor. Next moment, I was on the floor, and the IV was still intact. That wasn't even my patient. Another time, working over at the University, Dr. X, had just placed a temporary, transvenous pacemaker, via subclavian. As he turned away from the table, somehow his gown snagged that same wire, and whoopsy, the pacemaker wire went in reverse. It was an epic fail, that's for sure. At that time, Joe-Bob the patient was somewhat unstable, with a severe bradycardia, and the Doc's had to hustle placing pacemaker wire #2.

Yesterday, after being the most awesome recovery nurse, for our third TAVR of the day, Betty Lou, with me and the Transporter, were beginning to launch out of our Recovery bay. I was 100% certain, I had successfully cleared all the monitor wires, cables, no-longer-running IV bag and tubing, ditched the IV pump, secured the Foley, and eye-balled the pacer wire coming out of the Right IJ introducer sheath.
Ready, set, go........then Betty Lou shreiked. I hit the brakes, yelled for transport to STOP!
Oops, somehow the TV controller, which I had parked below the heart monitor, had the neck IV tubing tangled in it. Yikes.........epic fail on my part. Still, aside from a serious tug on her neck, no harm was done; no bleeding, pacer wire secure. Of course, Betty Lou gave me some serious evil eye and her daughter fussed a bunch too.

Pulled on her neck

Oh man, something got tangled,

After a great afternoon

Things took a different angle,

Where she got to thinking

Maybe I am a fraud,

And this sweet old lady

Is now, one angry broad.

No harm done

Other than that serious yank,

On the pacemaker sheath

Let’s be perfectly frank,

It shouldn’t have happened

But sometimes it do,

Regardless of preparation

Even you could do it too.

Luckily my rep

From the previous four hours,

Laid a balanced foundation

Despite bitters and sours,

And I’ll be more careful

To  clear the tubes and wires,

Nothing like a total screw up

Oh, how that inspires!

The End is Nigh

I have made the decision..........12/31/18........I step into Pension #2. Now that does not mean that I will completely stop working, but it will mean, I don't have to continue, buckled on a daily basis, with the current job. But you don't care, do you? Didn't expect you to.

The real problem is that I haven't written much lately.

An anti-glut with writing
Idea fish aren't biting,
The bait I use
It has no taste,
The pond I visit
Is in a state of waste.

Still, the fisherman
Is lazy,
Talks only to himself
That's crazy,
So this might be
The perfect time,
To pull the plug
On hospital slime.

If I'm not slimed
Can I write about it?
If I'm not employed
It might be safer to shout it,
Less chance of lawsuit
And public blushing,
Let go of my nightmares
With literary flushing.

Like all the Code Blues
That didn't end well,
Depends on opinion
Regarding heaven and hell,
Because many of us
Have seen the face of evil,
Some folks are lower
Than a New York weevil.

How about
All those EKG's,
Counted in thousands
And no one said "Cheese",
Just taking a picture
Of your rhythm, babe,
In the old days we did it
With an astrolabe.

All the bottoms wiped
And the dangles adjusted,
Reliable coworkers
And others not trusted,
Trying to figure it out
In a cluster disaster,
The only solution?
Just do it damn faster.

Ya, I think I'll keep writing
To cleanse my mind
So to speak,
Don't expect me to quit
I won't go out with a squeak,
Because others will follow
Down these same old trails,
Through the bloodiest splatters
And interrupted fails.

Squirrel

This is not remotely related to anything medical, or nursing, or what? However, as I was at work last evening with my pals, I received a text/photo from my daughter. The photo appeared to show a squirrel in a toilet, and quite frankly I was aghast, while assuming it a prank. Well, it turned out to be true, and I wish I had been there, or not.

Squirrel in the toilet
How did that happen?
Thank the Lord I wasn't sitting
And having a crappen,
That would have scared my pants off
But they already were,
A squirrel in the toilet
Crap! How did that occur?

Squirrel in the toilet
Doing the backstroke?
Diving for dollars?
Man, this is no joke,
Must have fallen from the ceiling
The H-VAC vent beckoned,
Took a swan dive in the toilet
That's what I reckoned.

Squirrel in the toilet
Is a crazy event,
A picture, not precious
Luckily, no scent,
Looked like a monster
Glaring up from the bottom,
Had he been sitting on the bed
I probly woulda shot him.

Employee Survey: Anonymous?

I'm pretty sure that everyone working at a hospital in the USA, is presented on a yearly basis, the Employee Survey. At our system, we are told, that our responses are completely anonymous. Well, I don't believe that for a minute, nor do I care. Heck, I'm probably going to retire in a year, so what does it matter? Still, I thought I might share with you the final Q&A, 3 top questions (and my responses), at the end of the survey.

Please provide one suggestion on how to improve the Employee Experience here at XYZ Health.

Management in some Nursing areas, talk DAILY about budget, HPPD hours, and so on, to the staff nurses, as if those nurses have some influence over the patient census and procedural scheduling. We don't have any influence, on how many patients come on any single day, and thus, all of this kind of talk is petty and short-sighted. The nurse at the bedside, is working as hard and fast as possible, so, instead of being reprimanded by managers, those bedside nurses should be praised and thanked every single day for their diligence and hard work.


What do you like best about your Employee Experience at XYZ Health?

The opportunity to work with other highly competent and trusted work companions.


What is one thing XYZ Health could do to create a more inclusive culture?

Sure, it's great that our color and branding slogan, tells the world that we care about a Load of Kindness; heck, it's brilliant. After all, that's what healthcare workers the world over, have always been doing; putting others needs ahead of their own. So face it, this is not a new idea. Let's have XYZ cut the branding budget in half, and spend that other half exclusively and inclusively, inside of these hospitals in a direct way, that impacts employees. This will make workers happy; they will tell their friends to come work at XYZ and truly encourage people in the community, to seek medical care at our hospitals.......much more effectively than tv commercials about whales, lame deer, drowning dogs, and elderly women crossing the road.

The Old Guard

If you've worked anywhere, and found some way to survive your less-than-perfect work place, bravo to you. Why? Because we're all human and no job is perfect. We all have to put up with all kinds of convoluted nonsense in healthcare, and usually somewhere in your career, you will have worked at the best place for you.

And then, there is the "new" employee, with some kind of stupid crusader attitude. They come to the job, and think the place is super dysfunctional (and it might very well be), and figure all it needs is their insight, and "how we did it back home" and they begin to raise complaints, regarding all the stuff that the rest of us know, that are almost impossible to change. The outcome is very predictable......our place of work, spits out that irritating rotten little bit of noise (sooner than later).
The betting pool is warming up on how long that will take...............

Newly hired employees
Arriving at deeply entrenched places,
May try to change the old guard
Make big statements and hard faces,
While ruffling a lot of feathers
And raising up dander,
Eventually this mess
Will lift the hackles of the Commander.

With your prodding and complaining
How this place of work is busted,
Your turmoil is so toxic
That you can't be trusted,
Thus, the outcome is usually
New employee will implode,
Sonny, you can't beat the system
Get the message? Hit the road!

Unplanned Descent to Stupidity

Sometimes, I'm behind the times. Apparently back in 2009, some genius came up with the definition of a "Fall", as: An Unplanned Descent to the Floor".Yep, that was pure genius, and how did I miss such a gem as that. Things like that drive me to research, and I won't bore you with the details. But, here is my poetic rendition and assessment.

I am not sure how I missed
The definition of the year, in oh-nine,
Back when someone redefined "Fall"
They must have drank too much wine,
After all, who could possibly imagine
This would be the slogan at the door,
Nurses, be on the lookout for:
An; "Unplanned descent to the floor".

It must have been a Nursing Educator
That came up with that,
Any sensible staff nurse
Would keep it stuffed in their hat,
To utter something so stupid
When Billy Bob slipped on his pee,
"Hey, stop your unplanned descent to the floor
Weren't you listening to me?"

Now, Nurse Suzy has to call Risk Management
Fill out an IVOS, to explain the score,
Was the Unplanned descent to the floor
Truly unplanned, or was Bluto helping with the chores,
Trying to mop up his mess
As mentioned in stanza # two,
This was a "PLANNED descent to the floor
He was just trying to help you.

As usual uppity-mucks and big associations
Are driving up costs, and pushing down nurses,
They don't see it that way
Because it does line their purses,
To create all kind of surveys
Along with metrics and tools,
And when you call a Fall
An unplanned descent to the floor,
We nurses know, we are guided by fools.

Titration Dedication

Historical background:

In my current job arena, I rarely encounter any kind of vasoactive "IV drip"; why would I, we're just a prep & recovery joint. Only rarely, a TAVR recovery might be on a Cardene drip, or maybe someone with acute bradycardia or heart block, might be on Isuprel or dopamine, but that's it.

I was thinking back to the old days (actually still the new days), and how drip-titration, in the setting of a profound state of shock, is a delicate and risky endeavor. I remember with my early forays into the ICU setting, titrating vasoactive solutions, was like some mysterious science only understood by the Gods. Well, after a lot of critical care classes (Thank you! Deborah Tuggle), countless hours reading medical journals, textbooks, going to symposia, on and on (still to this day) I'm pretty sure I got the hang of it.

Titration of chemicals
Is a fine and delicate art,
As a critical care nurse
It requires education
and practice, in part,
To learn the subtle nuances
Regarding properties of drugs,
Factor in the complexity of illness
For now; leave out the hugs.

Only dedicated clinicians
Willing to study, practice, and improve,
Should be allowed into this realm
It requires more than moxy and groove,
Where vitality of life shifts delicately
'Tis a risky balancing act,
And if I'm your Boss, and see you on the cell-phone
Billy Bob, your bags are packed.

Hack Attack

Fooey, I finally have to admit that the Big Bad Wolf from Influenzia, stomped on my house with me in it. My mate thinks I'm a wimp, as she wonders every hour, if she should just call 911, and get it over with.

My thermoregulation
Broke down at the station,
After double daily fevers
I am now an unbeliever,
Hot and cold without control
Shivers, then I sweat,
Now five days running, I'm worn out
And it isn't over yet.

Calloo, calay, this ain't the day
To be playing at the park,
For every minute that I work
I need four more in the dark,
To overcome exhaustion
It's too crazy, but it's fact,
Good thing I took the week off
'Cuz my homeostasis was hacked.

Health Insurance Dropkick

About 20 years ago in our region, there came to be an HMO carrier, set up by local hospitals, to better control costs. (Mercy Medical Group, North Bay Healthcare, and UC Davis Medical Group). Now, starting this year, WHA and the UC Davis Medical Group, have parted ways, in respect to health insurance reimbursements. I'm not really sure how many subscribers are effected, but I am one of them.

5000 Customers

I can't see my Doctors

WHA won't let me,

I had a great team

But I think they'll forget me,

The University told WHA

They don't reimburse enough,

So they dropped 5000 customers

Said, "you don't like it - tough!"

l miss my skin doctor

We had a lot of fun,

She instructed, "wear a hat"

When you're out in the sun,

And at every appointment

Froze some of my skin,

And when the students took part

I felt like Huck Finn.

I Got the Fever

Three days of misery now, and my mate doesn't seem so happy; neither are my alveoli.


There is nothing cute
About acute bronchitis,
My alveoli are screaming
Something did bite us,
And we're drowning in goo blobs
Thicker than snot,
Well, we have a solution
We're going to cook this stuff hot.

Fever
For three days running,
Worse than a tanning booth
Or Riviera sunning,
Cooked right crisp
My wife said, you're a hottie,
You're making the bed too warm
And you smell like a chapati.

Flu or Flew

In context to the next poem.

Juicy Blob

I haven't coughed up yellow loogies
For at least seven years,
Quite frankly, I didn't miss it
I'm telling you dears,
It is not recommended
If your pain threshold is low,
I am a wimp
I just thought you should know.

Of course, this is a pain
That can not be circumvented,
And as a healthcare worker
I do my best, that it's prevented,
But I shoulda got that shot
For pneumoniac elders,
Now it feels like my lungs
Are being scorched by welders.

I am in favor
Vaccinations for all,
Don't bother to argue
I just wait for you to fall,
Because your ninety year old granny
And three month old Bootsie.
If they catch your infection
Kiss them goodbye, tootsie.

And sure, I did hear
That your best friend Susan,
Got Guillain-Barre
And did some ventilator cruisin',
Which is really unfortunate
Bur your odds are nil,
Without your vaccinations
How many will you kill?

Every year I get my Flu shot
And what I have, isn't Flue,
Just a local little virus
That was long overdue,
Which normally I dodge
On a yearly basis, Rob,
Oops, excuse me I'm leaving
To launch a juicy blob.

Bronchitis

Yikes; I hate being sick. When it's really real, then getting off of work is a necessity, but not so much fun. I am not the type that works sick, to me that is morally unethical. Well, there is the fact, that I have enough PTO to be off for 6 months, so, what me worry?

Wailing Like a Monkey

Acute bronchitis
Haven't had if for a while,
Now I feel like
I'm at the bottom of the pile,
Any deep breath
Will precipitate cough,
The pain would be so bad
I would have to back off.

I might cry or shriek
Or wail like a monkey,
Until I expectorate
Something dark and chunky,
Whereby, my mate would go running
For her hazmat suit,
But, I told her to get the gun
Get close, and just shoot.

That's the way it is
With my acute bronchitis,
Now I must take your leave
And say, good nightis.

For everyone that works short-staffed

Paralyzed Toads

The six letter word
That managers hate,
UNSAFE is that word
That one can not placate,
Oh, they work up a lather
Gushing and spitting,
Just say the word UNSAFE
And soon you'll be quitting.

Somehow forced to depart
After a good sitting down,
With manager and two helpers
Angry faces with frown,
Claiming all sorts of avenues
That we should have tried then,
When seventeen patients
Had to wait in our pen.

UNSAFE is a value
A predictor of doom,
Where that one single straw
Busts the camel with a boom,
Where all hell breaks loose
Anarchy and disaster,
And our overtime hours
Are tallied much faster.

Yes, that six letter word
We're not supposed to speak,
Because Manager Betty
Says her knees get weak,
Applying that word
Might trigger an audit,
They're so fearful of that
While we would applaud it.

Salaries are at risk
When the powers that be,
Learn our clients aren't safe
Down in Unit 4 C,
Because corporate leaders
Try to hide all that stuff,
With Reimbursements at risk
They gotta play rough.

Whales are praising our efforts
Along with deer crossing roads,
Dogs flounder in the ocean
Along with paralyzed toads,
Advertisements at the ball-games
And billboards galore,
While there are not enough nurses
Back at the store.

Unwind the Action

When I come home

How do I unwind?

It started with the bike ride

The best of its kind,

The distance is short

The time is relief,

To unload all the garbage

The joy and the grief.

When I get home

Sometimes I must write,

With a short glass, a beverage

At the end of the night,

Although the bike ride unloaded

The terror and tension,

There is more that needs venting

Not all honorable mention.

Those things that are stewing

Beneath my facade,

Details and actions that

Might be outlawed,

If anyone cared

More than the corporate hoot,

That's what I'm carrying

On the bottom of my boot.

Do my words have power?

I'm not certain and don't be tricked,

But should I remain silent
I consider myself derelict.

Reputation Vacation

This here is an addendum to a poem a few days back, regarding the physician that wanted to send a patient home, with a blood sugar around 1000.

Doctor in his office
Puts up a good appearance,
In the clinical setting
Not much adherence,
Operates slowly
Doesn't return calls,
Fails to place orders
His behavior appalls.

Downplays our efforts
That make him look good,
We order the stuff
That really he should,
Because patients require
More than an operation,
A plumber he is
On a responsibility vacation.

Emesis Emeritus

Had a patient a couple days ago, for an Ablation recovery. She was totally schnockered for about 2 hours, and then for the next two hours, she complained of being dizzy and nauseated. The probable cause? Age of 75, weight 57 kg, and was given, Midazolam 10mg and Fentanyl 150mcg.
She eventually told me she was previously dizzy 3 days after having a Colonoscopy.

After 2 rounds of Zofran, and 3 empty emesii, along with moaning and whimpering, "what will I do at home if I can't eat for 3 days", I called her physician. Doctor says, let's keep her overnight in hospital. I return to the room, tell the patient (currently in fetal position in the bed, grimacing and fussing) the "stay-overnight" news...............where suddenly she sits up and with a straight face states, "Why did the Doctor order that? Why do I need to stay? I'm feeling better now".

I replied, "Good Lord, you are the one who has been slinging the story of 3 day nausea, misery and not eating! No way am I letting you out of this!"

A few minutes later, after Betty Lou goes to the restroom, she returns and immediately vomits.

Thus concludes the looney-tune story of the day.

Don't Be Offended

Writing about the business of my business (healthcare), I certainly do write about us, or you. If you think you are Billy Bob or Betty Lou, go see a shrink already!

Reflection Correction

Try not to disparage
Members of your clan,
I tell that to myself
The man without a plan,
So, I write in generalities
Class action, so to speak,
You think I'm pointing your way?
You must be some kind of freak.

That's why I pick on Billy-Bob
Betty Lou and Sadie,
Generic nonsense names
To keep the story shady,
But if you take offense
Go talk to your reflection,
I can't be held responsible
Nor forced to make correction.

Guess Who Called

Sure, we do recoveries, it's in our Charter, I guess. Probably why all kinds of folks try to take advantage of us.

Guess Who Called

Guess who called?
Just after you departed,
Angio; with a patient
Whose breath hadn't started,
Over sedated
Given way too many drugs,
Yep, those Angio nurses
All smiles and hugs.

But I turned them down
Stating, "not this time, Sister",
We are done for the day
We're recovery resistors,
A couple of mutts
Unchained from the leash,
And if you thought we would stay
You must be smoking hashish.

Doing Nothing, May be Harmful to His Health

When you hear my story
Will you sing?,
Probably not
When you hear what I bring

The patient was having
A cardiac discovery,
To determine his worthiness
For Renal recovery,
Clearance for a transplant
Good news on his vessels,
No significant disease
Bless his pestles

But lo and behold.
He was a sweet old guy
Blood sugar one thousand
My, oh my,
Did the doctor care?
Not one, hot wit,
He said, "Well, he came in that way"
What of it?

No orders at all
We had to scramble and fuss,
This was not a patient
Not for us,
Because he would require
An insulin drip,
Was he HHNK
Or a DKA crip?

Well, you just can't beat it
The Doc said, "just send him home",
After groin recovery
And magical foam,
Because this is how he came
To the hospital today,
So, that's how it is
Good luck, be on your way.

By good fortune, we pushed
By complaint and demand,
Admit this sweet patient
Because we don't understand,
How the Doctor could sing
Such a lameass song,
Send Joe-Bob home
Back where he belongs.

Embarrassing it is
And negligent too,
Clearly unethical
Old, you-know-who,
Won't get our referrals
Nor a slap on the wrist,
He brings in good revenue
And that's why we're pissed.

He won't be reprimanded
He'll just roll with the punches,
No one wants to work with him
Not a minute, or in bunches,
His peripheral interventions
Run for hours and hours,
While other doctors, get it done
And head to the showers.

He is certainly a legend
In his own mind,
But we hate those recoveries
They bleed till we're blind,
Overdosed on IV heparin
And Brilinta, super power,
Where prolonged hemostasis
Ain't achieved for an hour.

Today, we saved a life
A severe Diabetic,
The fact his doctor did nothing
Well, that is pathetic.

Bloody Mess (again)

Oh Nurse, never ever think that your work environment or work load could never be worse, because that is the equivalent of inviting hellish demons to prove otherwise!

Bloody Mess 

A colossal mess
In our complexity of care,
Vascular complications
That would give you a scare,
To make doctors throw tantrums
When they were the doers,
Poking hundred pound patients
With 14 French skewers.

Back in my days
At good old university,
There were Interns and Residents
To help buffer adversity,
Extra doctors on deck
When blood began to fly,
Now our current situation
Is enough to make one cry.

Don't imagine I'm blaming
Only the doctor,
Our corporate entity
Is a beast of a proctor,
Forcing tight budgets
Upon a short-handed nurses,
Thus, we bear the brunt
Of discontent and curses.

Few nurses are willing
To do what we do,
Ya, we get all the glory
The brave and the few,
But the conditions are abysmal
Unsafe, for Public Joe,
And when Boss counts only numbers
It's a pyroclastic flow.

A dense, destructive mass
Hot lava and gasses,
Exploding and gushing
And burning our asses,
Yes, that is how it feels
In Cardiac Support,
It never changes, my friend
And that's my report.

Insensitive

Yesterday was cur-r-r-r-r-azy. Patient's behaving abnormally gruff, a couple major bleeding problems, cars breaking down, people waiting hours and hours for scheduled procedures and so on. Unfortunately, this is turning into a regular, daily occurrence. Even a couple doctors were short tempered, but amazingly, we actually had enough nurses for once. Sure, that probably won't happen again, but I guess it is notable.

Anyway, I managed to ruffle some feathers on a doting family member, and let me tell you why:

Brain Salad Speech

Near the end of 12 hours

And 40 million thoughts,

My words become garbled

And I begin to see dots,

Speech dyslexia

And sentence destruction,

Like a garbage disposal

Applying suction.

So, who could blame me?

A spousal wife,

When she misunderstood me

And pulled out a knife,

Figuratively speaking

Claiming, I was so rude,

When I asked her, "Now, what?"

I'm an insensitive dude!

"Now what can we do for you"

Had a couple words missing,

She immediately looked daggers

Sputtering and hissing,

I had no way out

Not even an apology,

It was her misunderstanding

And abnormal psychology.

For the next two hours

I avoided that room,

After she took the time to tell me

All dire and doom,

That folks where she works

Over at Hospital X,

Would have tossed me out the door

With a doubled-down Hex.

At 12 hours plus

I have a disability,

This ancient nurse brain

Has lost some agility,

Manufacturing speech

At the drop of a hat,

“Now what (do you need)”

Is not more than just that.

2/3/18

In the Details

I am an avid student of the EKG and what is now called the science of Electrophysiology.

Parasystole

I spotted a parasystole
As obvious as a cyst,
No one else had heard of it
The reason it was missed,
Benign it was, in general
The anomoly fit the condition,
While I enjoyed the discovery
Everyone else had suspicion.

Effectually, they cared not
With glazed look in the eye,
A ho-hum sort of response
I felt that I might cry,
That's how it is sometimes
For the guy who holds the loot,
Getting excited about a mystery
And nobody gives a hoot.

https://www.sciencedirect.com/topics/neuroscience/parasystole

Candidly Speaking

In my current job position, death does not occur in our unit. We rarely ever call the "Code Blue". Occasionally, we call a "Rapid Response", primarily to get a little help, for the problem that is already known to us. But, the discussion of death, never comes up in our outpatient conversations. My past tours of employment included a heck of a lot of death, so I have played on both teams.

Candid?
I try to be, often,
But in my line of work
I don't talk about the coffin,
Down the hall in the closet
It is ready for you,
If I can be perfectly candid
Your time is almost due.

Hip Hop Nurses

After seeing an advertisement for the upcoming Grammy awards, naturally I thought "what would a Hip Hop nurse do"? Just use your imagination.

If Nurses were Hip Hop stars
We would take it up a notch,
I could give you your Norco
While grabbing my crotch,
Other nurses are my homey's
Just working in this crib,
We talk with hand gestures
Hip Hop lingo, ad lib.

Vacation, Staycation..........Flucation

Newsflash! If you are harboring any ideas of visiting California about now, DON'T!
We're all infected with the big, bad Flu. That includes all hospital workers too. This year, it surely doesn't matter if you had a Flu shot or not, you will still get sick, albeit less likely to die, if you did accept the needle. Don't get me wrong, I am a staunch supporter of vaccinations, in effect, believing it to be a moral imperative that health-care workers be required to be vaccinated. However, that's for the ACLU to sort out, I guess.

Anyway
Let me tell you how it was,
Everyone I know was sick
And the research says, because,
Just breathing is enough
To share the evil virus,
And what you get is worse than any
Song by Miley Cyrus.

In my case, I suffered
24 hours of severe pain,
In every joint and ligament
From my ankles to my brain,
One simple short term fever
That was it, and I am happy,
Everyone else I know
Was in a crisis feeling crappy.

The death rate climbs each week
Healthy people dropping like flies,
Don't even visit the hospital
Death is in the air, oh, surprise!
It will catch you unawares
And tomorrow you'll be sick,
Call the mortuary now, my friend
You'll be heading there, right quick.

Kind of Crazy

I went to the Dentist for a cleaning, and had the good fortune to be worked upon by Dental Dana (my favorite). Once again, it was another appointment that went south, very fast.

Dental Dana #65

Dental Dana
Might be crazy,
But that chick
Is never lazy,
Her tool control
Is so efficient,
In the Dental suite
She appears omnsicient.

I always get
A tingly rush,
When she uses
That laser scaling brush,
Abrading plaque
In my nether regions,
Annihilating
Bacterial legions.

How she knows
I don't understand,
But I follow each
And every command,
"Turn your head
Now, clench a little,
And do control
Your slimy spittle".

With words like that
I can't resist,
A subtle nudge
Upon her wrist,
Unnoticed, I think
Oh, not a chance,
She dropped that laser
Onto my pants.

That's her usual
Time to quit,
Stating, "We're done here
And do not spit"
But I'll come back
When she says it's okay,
For another round
Of hygienic play.

Crazy Wombats

The public, the client, the patient; come in all kinds of nice or crazy. Sure, they gotta be nervous about dire unknown outcomes and the like, but still, why not be friendly, pleasant and appreciative? After all, we're just trying to help.

They said over and over
"Now, please don't forget,
If you remember this thing
We will be in your debt".

And each time after that
They said it again,
It would have been better
On occasion, now and then.

If you will, tell the doctor
The nurses and the tech,
Uncle Bob has a problem
His kidneys are a wreck,
Please measure the contrast
As careful as can be;
I said, yes I will do that
It's important, I can see.

When Hector from Transport
Came into the room,
Aunt Mary looked at him
All dire and doom,
And once again launched
The tale of the kidney,
Like a crazy old wombat
Down Under, from Sidney.

Later on, after
Man, they wanted to book,
Uncle Bob and Mary
They just had that look,
Like coming down here
Was all a mistake,
A couple Wombats from Sidney
That stepped on a snake.

We bend over backwards
Primp and placate,
Give them sausage and capers
On porcelain plate,
But some of them leave
Good behavior at home,
Instead of proper manners
They spray crazy foam.

Undisputed

December came and went without a blog entry; despicable! I really was distracted. Even I am shocked with my laziness. I woke up 3 days ago and took stock of things at work, and I was once again impressed with the way some things have not changed from the day I started working there, 10 years ago.
Many of those items I have already written about, and surely, I will do again.
This poem shall launch another year of the Chronicles of the Underside of Nursing.


Another lapse in writing son?
From drudgery, or too much fun?
I suspect the former, not the latter
Because drudgery, is no mad hatter.

New Year arrives, how does it feel?
Exactly like the same old deal,
The usual drama, changes not
With the same ingredients in the pot.

We're not unique
I know that, sure,
There are toxic behaviors
That have no cure,
Unless radical surgery
Is executed,
Nothing will change;
'Tis Undisputed.

It's a New Year Editorial

Something new under the sun! Ok, I know, we're probably behind the times a bit, but the usual suspects have been bitten by the "Unit Practice Committee" bug. After all, we belong to a big healthcare entity that wants to be a highly recognized player on a national level, and by golly, let's pretend that we care about the professionalism of our Nurses. And with our big BRAND advertising expense account, apparently they’re willing to pay overtime for industrious nurses, to join a committee and try to make changes. Of course, we will always implement  evidence-based-care and all the ideas we come up with, will be facilitated, acquisitioned, elucidated  and so on.
But seriously folks, there were two prime targets for runnin’ this thing, and #1 said “no” and pointed at #2………….ya, that’s me. Well, I figured what the heck, as long as #1 agrees to be my sidekick.

See, I do have a streak of idealism in me; there are a few things I that believe should be standards of practice in the unit that I work in. We look like an ordinary same-day-procedure unit, but we’re doing preparation and recoveries on highly complex patients, mostly Cardiac. Only half of our staff seem aware of that, but all of those future applicants, must understand the lay of the land when they arrive.

Well, I guess some folks think I have some leadership traits, and I talk like I know a couple things, so I been appointed and anointed as the committee Boss. There it is; in the autumn days of my career, I will pull the sword out of the stone, and look for a suitable target to aim that pointy thing at. Watch out!

Gash

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

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

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

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

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

What We Do

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

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

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

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

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

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

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

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

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

Out-Patient ICU

Out-Patient ICU

Has a nice ring to it, ya.

A day in our hidey hole

Just another average, no crisis day.

Pool of Anxiety

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

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

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

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

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

Turn, Turn, Turn

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

 Turn, Turn, Turn

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

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

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

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

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

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

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

Enough all ready

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

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

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

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

Psychogical Manipulation

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

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

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

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

Old Fool

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

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

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

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

[dedicated to another Old Fool]

Doctor Wife

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

Doctor Wife

She's an E.P. doctor

In her own right,

Yet, she's alone with their kid

At the house every night,

While hubby plays Master

Of the Universe,

He denies complications

His ambition is a curse.

Courageous

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

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

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

Ben Gay

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

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

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

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

Bully

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

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


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

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

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

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

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

Our Mission

Some healthcare rumblings in my gut.

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

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

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

Strung Out

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

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

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

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

Three Days

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

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

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

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

A Bloody Memory

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

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

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

Meaningful Abuse

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

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

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

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

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

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


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


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

CEO's Making Bank

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

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

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

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