Five more Shifts

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

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

Terminal Burnout

That was not enjoyable

I'm telling you,

Running around like crazy chickens

With too much to do,

And I came to the understanding

That I have finally breached,

Terminal burned-out status

The pinnacle I have reached.

I despise all alarms

And the computerized medical chart,

The former, because it's often so pointless

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

Some kind of crazy committee

Offsite in the middle of Texas,

Declares you must chart this one way

As convoluted as the mesenteric plexus.

Pharmacy calls me four times

Asking; what is the allergy of Betty,

Quite frankly I don't have a clue

She is snoozing and looks kind of sweaty,

Her daughter just left for tobacco

The son is on YouTube in the lobby,

And I don't have one frickin' minute

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

I'm the Charge Nurse with 5 patient's

On a 12 hour shift,

So many people ask for me

It's worse than the Tokyo drift,

And I do incredibly appreciate

How we work as a team and all,

But even working five more shifts?

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

Even five more days might be impossible

I might explode if pushed the wrong way,

One more migraine headache that needs Percocet

A forty-one year old gal, Sallie Mae,

Who can't lay supine just another four hours

After all babe, you might just bleed out,

If she keeps hopping around on that gurney

With her ten out of ten fussy pout.

Come on chick, you managed two babies

It had to be worse than an Ablation,

“Only Percocet works for me, Bub”

With an attitude, Oh consternation!

And meanwhile the Pharmacy pages me

Asking that allergy question,

Finally, I'm about to explode

With terminal indigestion.

And really, it wasn't enjoyable

Though we did have a lot of good laughs,

That's what nurses do in a typical crisis

Beat with bats and old rusty gaffs,

We gather around the dead campfire

Bemoaning our plight and our pay,

Knowing we'll sleep it all off

To be tortured another bright day.

12-15-18

Writer of Notes

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

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

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

Note Writer

I'm a nursing note writer

That's my declaration,

Like I'm writing to the Jury

Describing fact and causation,

Every single interaction

For the patient I observe,

In the final court of law

I didn't drive off the curve.

Go ahead, read my notes

You'll know what happened each time,

When Joe-Bob got up

And slipped on his slime,

And I called the Doctor

And the Doctor said:

For Gods sake, keep Joe Bob

Tied down in his bed!

Or something like that

Back in the day, when we could do it,

When Joe Bob broke his leathers

After all, he could chew it,

Whereas, you can be sure

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

You might try to sue me

But I won't take the fall.

In these EMR days

Half the Nurses, they don't write,

They check boxes and forms

And read their phones half the night,

But three years down the line

When Joe Bob's case comes up in court,

They won't remember a damn thing

They'll just shake, whimper and snort.

Yes, Nursing is very demanding

But I write, for each one,

My job is to tell their story

Everything that was done,

During my short contract

Their events, my responsibility,

And if I am questioned later

My notes are my utility.

12/4/18

A Waste of Energy

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

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

Planning

Things that I plan

They rarely turn out,

Whereas, things that I don't plan

Get a high-five and shout,

Because I reserve a place for

Change and spontaneity,

Unconventional outcomes?

I'm filled with gaiety.

Henceforth, I don't plan much

In fact, it produces anxiety,

I want to run to a waterway

To practice silence and piety,

I don't need that type of stress

I'm just a momentary guy, 

Right now, I'll do this thing

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

When big decisions come

I gather knowledge and ponder,

Consider multiple outcomes

That could occur down yonder,

But, don't presume that is planning

I'm just collecting information,

Until I whip out the knives

And delare: Captivation!

I work with all kinds of planners

They are good at what they do, 

I know it isn't me

But it just might be you,

I admire the energy

You throw at all situations,

I'm happy to stand to the side

While you collect your ovations.

I don't want any part of that

Yet, we share the same desire,

To reach the end of the road

Without pain or funeral pyres,

And I believe we can achieve that

In our own unique ways,

How about, I take the nights

And you take the days.

Germy makes me squirmy

When travelling, the good advice is to drink bottled or boiled water. Also cooked meals, and for us Westerners, remember to carry TP and hand-cleaner, wherever you go.

TP Tourist   

The modern world tourist
Expects toilet paper,
Unlike the locals
Who use their hand as a scraper,
Thus, why we avoid
Handshakes at all,
We wai, with respect
Because your skin
Does surely crawl,
With 17 million
Pathogenic germs,
And probably some eggs
Of your favorite worms.

If you are travelling
Don’t drink the water,
Especially if skinny dipping
With the shopkeeper's daughter,
Consider the potential
Of life-threatening danger,
Instead buy bottled water
From a reliable stranger.

Do peel all the vegetables
The fruit and the goats,
Boil when cooking
Even your steel cut oats,
Served every morning
With slices of Mango,
Remember, don’t eat that skin
It’s not fun, like the Tango.

Just because it is spicy
Doesn’t mean it is safe,
Montezuma’s revenge
May cause serious chafe,
Wiping down yonder
For 24 hours,
Next time, avoid the water
Drink only, whiskey-sours.

Retirement Security

If you have read anything I have posted over the past 10 years, you know I find bureaucracy to be a total mind-melter. Well, proof of this, is how difficult it is, to actually arrange to stop working and begin receiving any kind of future benefits. I almost wish I was an illegal, and then I could get some hot looking young social conscious do-gooder to help me navigate this quagmire of nonsense.
But instead, I am just an over-educated, short tempered, sarcastic retiring Nurse...........

Unplanned

Social Security office
Makes retirement look hard,
It might look like an inch
But it's really a yard,
To jump through the hoops
Without blowing your top,
I thought working was tough
But it's harder to stop.

Folks there were seeking
Their first SS Card,
Others getting payments going
So they can sit in their yard,
Watching the world go by
As they allocate each nickel,
Wondering why they didn't save
'Cuz now, they're in a pickle.

Grandma Moses
Had a five year old, for show,
She talked to him like he was two
In baby-talk, you know,
Telling him something about school
Study hard, and get a job,
But did she even bring a book for him?
Not a chance; the lazy slob.

In fact, no one had a book
Not even me,
Although I read my journal abstracts
On Medscape, for free,
Thus I know a lot more stuff
About cardiac innovations,
A new pacemaker, for the neonate
For those rhythm aberrations.

Does it really seem
That I am ready to retire?
No, it doesn't feel that way
My mind is still on fire,
To learn the most I want
In the time I still command,
Life will show me what to do;
The guy that never planned.

Train to be Violent

By now, I expect that every healthcare organization all the way out to Timbuktu, has offered free, workplace-violence response training, to all and everyone. At our mega-medical entity, this endeavor seems way over the top intensive, no doubt costs millions, but looks good on paper for the public to read about. But what do I really think?

All the excitement:

What is the latest, hot button topic
For all the people in our nation?
Active-shooter situations
Expounded via oration,
And our own organization
Is spending gobs of money,
Learning to defend ourselves
When some jerk calls you "Honey",
While pointing a weapon
Or threatening you harm,
Got his arm around your neck
His favorite method of charm,
And a blade at your throat
While you gouge, scratch and bite,
Crush his instep with your heel
And kiss him goodnight.

At the Class:

We all learned the blade-stance
Where it looks like you're praying,
Shuffle forward and backward
Keep focused, no swaying,
Yell, scream; don't beg
While showing power, no fear,
Startle that mofo
Then bust a cap in his rear.

Another option:

Or........just arm us with guns
With a weapon I.D.
I can hide it in my scrub pants
A Glock 43,
I'm ready for whatever.........
Oh shit, now he sees us!
But, I'm not really worried
He's about to meet Jesus.

Warm Blanket

Planting a Seed

I changed my mind
Withdrew my prior writing,
I had a good run
No need to be indicting,
We work in a tough business
Life, death and worse,
No need to be remembered
As the disgruntled Nurse.

Work is damn stressful
Till we rise above it all,
Do what we do best
And answer the call,
To comfort those in pain
Some are worried and more,
It might be their own loved one
Or their own, gruesome score.

Expertise is important
So also, is a warm blanket,
Like that Model T Ford
Won't run unless you crank it,
And so does our care
Meet the want where it is needed,
Should we all work together
Our best results are exceeded.

Sure, there are times
When we protest for change,
It is difficult for a system
To work outside a range,
That has been predetermined
Not in a democratic way,
Inhibiting improvement
It won't happen in a day.

In the meantime we care
For those with greater need,
Helping brother and sister;
Is but planting a seed.

Mini-moles

This is the fifth, post-symposia revelation; and I wonder, does anyone else doodle in words like I do?
likely not. It is amusement and part memory method. So here is the latest nonsense.

Mini-moles
Very small rodents
Seemingly important, they say,
Something regarding
Umbilical LDL
Not seeing the light of day,

Supposedly at birth
Your U-LDL
Resides at a measure below 50,
But that's kind of silly
You never have eaten
Ya, extraneous data is shifty.

The Cholesteral-HDL ratio
Is a predictor of some kind of risk,
Particular with folks of Diabetes
Don't ask me, but something is brisk,
That's just about where the after-lunch dude
Was guiding us all into sleep,
I suspect he has earned a favorable rating
As we awakened; man, that nap was so deep!

For Giving, that's who we are

End of days ponderings:

I feel kind of alone
Going to classes and such,
It's just one of those things
That I enjoyed very much,
Sharing moments of learning
Perhaps I'm just such a geek,
Feeling a need for expansion
If only just a peek.

Rubbing shoulders with colleagues
Over the years,
We all got a little older
And shed a few tears,
As we all are wont to do
On this human path of living,
And hopefully we have acquired
More capacity for giving.

The Best New Drugs

Every year at one conference or another, a presenter will regale us regarding the use of Wonder drug Z, and all the other great stuff in the cue. Some of those drugs disappear, never to be listed, because the side effects began to show up after 300,000 people had been tested against placebo. Maybe their toes began to fall off, or there were too many folks dying from long thumb disease, or whatnot.

The Best New Drugs

Death eliminates all risk
LDL reduction is very brisk,
Approaching zero, as the heart stops beating
After that, no worries about eating.

Sodium reduction has a lot of hype
Not sodium sensitive? you're not the type,
Regarding all that worry, about retaining fluids
No need to join the low sodium Druids.

Sodium-glucose Cotransporter-2 Inhibitors
If you can say that, you're clearly an exhibitor,
But they never talk about
Those incidental amputations,
Or how Fournier's gangrene
Can ruin a reputation.

Beware, dear public
About the newest, latest drugs,
Testing on rabbits, rats and pigs
May not eliminate all the bugs,
Lurking in the background
Glossed over by slick advertising,
If you should get Angioedema
Death may be very surprising.

10/30/18

Price versus Advice

More nuggets of information, from the symposium. If Joe Bob can drop a kilogram of weight (2.2 lb)
this may lower his Systolic BP, by an average of 5 mm of mercury. This alone, can be an organ saver.
But, there is the topic of compliance, isn't there?

If you drop your weight
By one kilogram,
2.2 pounds
It will be favorable, M'am,
To bring your systolic
Down five millimeters,
That might save you a kidney
Unless you're one of those cheaters,
That puts the weight back on
After you leave the Clinic,
You loved all that praise
But you're just a cynic,
Not believing a bit
About all that good advice,
You don't worry about pounds
You only ask about the price.

10/30/18

Syncope Slide

I went to our local Cardiology Electrophysiology Symposium two weeks ago, and learned some good stuff. Man, those physicians love to strut their stuff regarding favorite topics, but there are usually some good nuggets of information.

For example, about 50% of folks who take blood pressure meds for hypertension, still have lousy control, and as such, remain at high risk for deadly complications. We were informed, that better success is achieved if two different medications are working together, rather than just doubling the dose of a singular drug. However, the discussion did not address the added risk of additional side-effects that might come along with those secondary medications.

Anyway, life itself is risky...........and doctors are averse to blame.

Slide

Lowered your BP

But still you died,

When you busted your hip

Doing the Electric Slide,

Thanks to your doctor

Adding another medication;

The plaque on his door reads:

"Your health, is my dedication".

He’s a BP control freak

He studies all the trials,

And as a result

You should see all the vials,

Stacked on the counter

At Billy Bob’s house,

16 plastic bottles

Between him and his spouse.

Meanwhile, the doctor

Basks in recognition,

Writing books on medicine

The latest rendition,

On BP control

All the methods he has tried,

But nowhere will you find

Just how many have died.

He had no hand in that

Never takes any blame,

P-value significance

Is the name of the game,

Statistical variants

Like a bolt of lightning,

Impossible to predict

And that’s what’s so frightening.

Syncope

Is what happened to you,

Your blood pressure crashed

As its likely to do,

After that fourth medication

Was added to your list,

Now that you busted your head

You will be sorely missed.

We’ll get your pressure down

The doctor had reassured,

You’ll feel a whole lot better

The hypertension cured,

You can fulfill your dream

To learn the Electric Slide,

Yes, I fixed you, old man

But still you died.

Gunning for Retirement

Gunning for Retirement

Another great plan
For when I retire,
An alarming inspiration
Truly did inspire,
For me to think of a way
Where nurses can blow up their stress,
Come to Billy Bob's shooting gallery
It won't matter how you dress,
Because you get to choose
Your favorite cannon,
Please, let me explain
Just what I am plannin'.

I have endured enough
Of every kind of alarm,
My psyche is maimed
With significant harm,
My ears ring incessantly
I dream beeps and sirens,
That's not what I call peace
In any environs,
So, my plan is a shooting range
To vent your frustrations,
Blast those infernal machines
To hell and damnations.

I figure a five minute session
Ten shots in all,
Pick any weapon you like
It's absolutely your call,
The lockers are stuffed
With every kind of gun,
From small stinger missiles
Or some desert eagle fun,
It's all a part of stress relief
Cutting loose with a scream,
Blow up that IV Pump
Like you did in that dream.

The worse flippin' alarm
That I ever heard,
Is on that CRRT machine
Like a foghorn, my word,
So that is my target
With a shotgun to blast,
10 gauge for sure
Nice and slow, meant to last,
Ten shots in all
To damage and maim,
Twenty bucks admission
Come on, play this game!

Can't Remember

I was talking with one of those young nurses of the day, bright as an atomic bomb, and probably the type I'd want on hand if I was in the ICU. She noticed I kept a small note/list on my phone that covered some of the common IV drip mixes and calculations, and it prompted a discussion of this thing.

Hence, I wrote this:

It's the middle of the night
And you can't remember,
The drip calculation
You learned last September,
And it's really important
Because you're at the Code Blue,
It seems like everyone is staring
And waiting for you.

You reach for your phone
It's in one of your pockets,
In your deluxe cargo pants
That hold 42 sockets,
When you suddenly realize
The smartphone is gone,
When you were rushing to work
It fell on the lawn.

Joe Bob the victim gasps
"You can use mine",
Look up Cardiac Arrest
Dial 249,
Ask for Betty Lou Johnson
Also known as my wife,
First ask her opinion
If you should save my life.

The moral of the story?
Keep your tools close at hand,
Know those drug concentrations
For those moments on demand,
When you're on the spot
And Joe is circling the drain,
In those crazy, clutch moments
You gotta trust your old brain.

Prolonging life without consent

Dementia & Pacemaker

DNR
Do not resuscitate,
A reasonable approach
To a dead end fate,
And one might argue
We all will die someday,
But if you have severe dementia
How long would you choose to stay?

Why do I ask? I'll tell you
I just met Betty Jane,
About the only thing she understands
Is to localize her pain,
No kind of simple words
Can appeal to any reason,
Betty's brain is at survival mode
And it's a long and pointless season.

She lives her life in a nursing home
Her cognition is unaware,
She can not form a memory
Nor have a thought to share,
She truly lives in the moment
Each minute is unique,
Though she can't recall the one before
Nor anything last week.

She doesn't know her children
Where she lives, or anything,
No purpose of existence
But she can walk and sometimes swing,
So a DNR is sensible
Yes, she requires a caretaker,
But honestly I think
It's a crime to give her a pacemaker.

She didn't request or pay for it
Just who made this choice?
And why would they do it
When Betty has no active voice,
Regarding her life
Without cognitive awareness,
I'm guessing it was family
Well meaning, without fairness.

Yep, a pacemaker just a month ago
Her heart was slowing down,
She had a bout of syncope
Where she lived in memory town,
A doctor intervened
Made a referral out beyond,
The care-center demanded it
"She might pass out at the pond!"

Naturally her son
Didn't want to miss his momma,
Despite the fact she doesn't know
A period from a comma,
So they shipped her out
Said, don't come back
Until your heart is stronger,
We'll await with open arms
To help you live a little longer.

Betty doesn't understand
Why her chest is sore and tender,
She scratches, picks and plucks
Till the incision doth surrender,
Where infection did ensue
Promoting gross and smelly pus,
Whereby the folks at memory town
Stated; you can't stay with us.

Another long trip to the hospital
A hundred-fifty miles away,
While everyone at memory town
Said, Betty we will pray,
For another speedy recovery
For a long and fruitful life,
When you come back, see Bobby
He is looking for a wife.

Halloweenish

Well, I'm in a bloody good mood lately, feeling like I should bite someones neck, and it is the Halloween season after all. Thus, I'm inspired by vampires and blood donations.

Blood Supply

I have read a lot
Of vampire books,
Depends on the author
Just how vampires look,
But there's a general consensus
Regarding aging, and such?
You'll be frozen at the age
Of your vampiric touch.

The rumor is
That they bite your neck,
A lot more vigorous
Than the little peck,
That you got from Eunice
Back in the fourth grade,
Ya, her mother was a vampire
And that's why you're afraid.

Historically vampires
Get a bad rap,
You may have heard about silver
Crosses and crap,
Designed to repel
Your friendly neck biter,
Every vampire I've met
Was a heck of an inviter.

Well, I suppose that is necessary
To maintain the blood supply,
It has a short shelf life
Because even blood will die,
And they don't bite the dead
So, your chances are good,
How best to avoid a bite?
Wear a chain-mail hood.

Blood Donation

I donated blood yesterday and here is what happened.
(In the event that you may be following this blog, my encounter with the blood chick, turned into something like when I visit with Dental Dana).
Who would ever think that donating blood could be so.....................delicious!

Rachel
That woman, she took my blood,
When I swooned
I fell with a thud,
Awoke light-headed
Like a spinning jenny,
Not only my blood
But the blood of many.

Rachel
Caught my eye at first,
Before I understood her thirst,
No, I won't argue
She was really cute,
I needed to see her....
I was resolute.

Rachel
Looks so young, that kid,
When I came to donate
She had the highest bid,
And now I'm drained
I guess; good to the last drop,
Rachel, I begged
Oh please, don't stop.

Rachel
So caring, she held my hand,
After I swooned
I could no longer stand,
I was laid on the gurney
And they lowered my head,
I was too weak to grasp
To pull her onto my bed.

Rachel
She stood to the side,
I caught a little smirk
Plus a wink, and I sighed,
Knowing, she tried to drain me
I guess I have a good taste,
She whispered in my ear:
"To the last drop; I mustn't waste".

Don't try to sue me

Gotta do something when I retire.

Don't Try to Sue Me

Here's a plan
When I retire,
Publish those books
And set the world on fire,
With all my funnies
And juvenile humor,
Silly as vomit
And bold as a tumor.

Amazing insights
Regarding amputations,
Ridiculous rhymes
And ambiguations,
Touching stories
Regarding life and death,
Spirits in the closet
And the Grim Reaper's breath.

There is a lot to cover
And I think I did,
I worked like a man
And thought like a kid,
Did my best to respect
Joe Bob and his cousins,
See, they looked kind of inbred
With children by the dozens.

There was Billy Bob Borko
And sweet Betty Lou,
Sister Euphemia
To name just a few,
Of the colorful characters
Whose paths I have crossed,
Most of them winners
Although a few of them lost.

I followed most guidelines
But stretched a few rules,
Some protocols, dear reader
Have been written by fools,
Who rarely endeavored
Into the milieu of reality,
Where the evidence of poor science
Might lead to fatality.

Am I an expert?
I don't claim to be,
But I do write with clarity
Regarding things that I see,
Armed with continuous
Ongoing education,
Regarding areas of interest
To support my reputation.

If I can be an inspiration
Let it be known, that I cared,
Regarding expertise
And the knowledge that I shared,
And always willing to work hard
In any kind of conditions,
Admirable traits
Outside of personal ambitions.

Well, I will keep writing
About the usual baloney,
The whackified truth
Not fake and not phony,
And yes, I hide names
So don't try to sue me,
Take your business elsewhere
And stop acting gloomy.

Nurse Centered Care

Patient-Centric Care. By golly, that sure does sound good, and I bet there are hundreds of papers and studies all wrapped around that feel-good concept. But let's talk reality! In the ICU and Recovery Room, we are talking Nurse-Centric Care. As in: The Nurse runs the show, knows what is best, and don't screw with us, if you want to see Joe Bob walking down the healing road to recovery.

Maybe that's how we old gunslingers see the world. We anachronisms of the old west, firing our pistols off, just to hear the big bang, and to smell the gunpowder. Who cares; I'm unplugging soon.
Just don't get it into your heads, that I'll stop writing about this, ok?

Not To Speak

After general anesthesia
Short term memory rules,
As you begin to wake up
You'll be missing some tools,
And may ask the same question
Over and over again,
We'll repeat the same answer
Like a stuttering hen.

In respect to the family
There are three things, not to speak,
Don't ask Jerry if he has pain
Or if he has to take a leak,
And most of all, never
Ask if he is nauseated,
His short term memory will cling
To the idea you perpetrated.

The Anesthesiologist
Gives meds for dizzy indigestion,
No one wants it to happen
Please don't give Jerry an auto-suggestion,
Because his brain will latch on
To that five letter word,
His circus memory will focus on VOMIT
He may start retching, undeterred.

Sure, I care about his history
Of his sensitive tummy,
You probably run to his side
Like the very best Mummy,
Each time he has a burp
And spits up a little rice,
But do be aware;
Encouraging vomit, is like rolling the dice.

Vomit............

Vomit never loses its gross-out feature, that's for sure. And folks, new nurses or any sentient beings, DO NOT ask Joe Bob repeatedly, if he is nauseated! The very word, triggers that person, to feel the sensation of nausea. It is a visceral memory.

Three vomits?
That's too much,
A slimy smelly
I didn't want to touch,
Yet, apparently
It wasn't an option,
Vomit #2
Was up for adoption.

What was for dinner?
I'm not too sure,
But there was some lettuce
All pretty and pure,
On my forearm
With an olive and a carrot,
Look; I like salad
But I don't want to wear it!

Many Nights Like This

There were many shifts like this, repeated over and again..........any nurse who has worked at the bedside, can attest to the most irritating of all things; the relentless demanding patient.

99 Requests

After 99 requests
In the course of twelve hours,
You have thoroughly diminished
All of my powers,
Just saying, if you suffer
A cardiac arrest,
I can not guarantee
The outcome will be the best.

Your water requisition
Ten times, just like this,
No more than five ounces
On the hour, don't miss,
Because I am your patient
And you are my slave,
Each time I pass the room
She gives a beckoning wave.

I offered the four P's
But it really seemed like twenty,
Pain, potty, and position
And many more a'plenty,
And of course I offered AIDET
(I've had it shoved down my throat).
Management loves that crap
It certainly fills up their boat.

At the end of my shift
I’m supposed to say, Thanks,
For allowing me to serve you
(The worst of old cranks),
No, instead I have pity
For your family and friends,
You treat them just as poorly
And never make amends.

Moan and Rattle

His smile is infectious..........yep, that's what people say about the kid.


It's a nasty infection
And I blame it on the kid,
He's not a pharmacist yet
Doesn't know what he did,
Coming home, with a
Class-A infection,
Hit up the old man
He wasn't wearing protection.

This otherworldly beast
Has cut me at my core,
Approaching day seven
I have Hades at my door,
Proposing special offers
To relieve me of this disease,
I have rejected each one
Though I bargained on the sneeze.

See, the cough is bad enough
But the sneeze is hell on wheels,
Each time it rips my throat
With razor blades, it feels,
I have learned from prior suffering
It's a decent bargaining chip,
Succumb to 17 lashes
From the elder Abaddon's whip.

Ah, don't worry it's just mythical
I wasn't whipped by Loki,
Although a trade was made
To clean the Okefenokee,
And I'll get to that later
If I survive this epic battle,
Why, even the cats are howling
As my lungs doth moan and rattle.

Deaf and Kind

An attentive daughter is a wonderful thing.

90 years old
Deaf and nearly blind,
A daughter named Donna
She is so kind,
Helping to navigate
Time with her father,
Clearly she knows
He's a bit of a bother.

Just waking up from
Conscious sedation,
He has all the right questions
With mixed up equations,
He simply can't grasp
Complexity now,
I answer over and over
The most basic how.

In time he will grasp
As the drugs disappear,
All those things he most know
With the help of us here,
And his surrounding family
Which decision might be best,
To solve his heart problem
Defined by this test.

Aim is the Game

Old guys...........I'm kind of one.

They talk about their junk
I wish they would not,
How lying supine
They can't make a shot,
Into a plastic urinal
I say, aren't you a guy?,
Did you never pee in your garden
They say, No; I ask why?

What the heck? are you kidding?
Man, that's what we do,
We must mark our boundaries
Why didn't you?
And this is the moment
I show that rubber tube,
Where Joe Bob imagines
He'll need a psychedelic lube.

It's where the rubber meets the road
He will give it a try,
A urinal supine
Is better than some guy,
Shoving a hose
Up his special junk,
What he thought was a capillary
Was a mighty redwood trunk,
Spewing gallons of pee
Into yonder container,
Good Lord, it's so easy
Really, a no-brainer,
And factually, I have trained
A 90 year old man,
Reminded him, what to do;
Just aim for the can.

Leaving, mostly

Due to misinformation shared with me by an office, now I have to declare my retirement date as January 1st, 2019. It's all right, it helps with my taxes, not to get the whopping PTO payout added on my 2018 income.

Anyways, I haven't written much, so now here are a couple ones regarding those aspects of life and death that are so hard to see.

Spirit and Ghosts

I felt ghosts
I heard spooky whispers,
Haunted hallways
With psychic lispers,
Working forty years in hospitals
With too much history,
Spirits lurking
In realms of mystery.

Stories are told
Not everyone approves,
Especially the religious
Who lack certain moves,
Regarding acceptance
About that other world,
They ought to loosen up
And get their mindset uncurled.

Empathic persons
Or the psychic type,
Can tune to the vibe
Beyond all the hype,
Regarding near death
Little changes; not the same,
Subtle muted signs
Near the end of this game.

Why talk about it?
Well, I'm about to head out,
I want other believers
To cast aside all doubt,
Regarding assessment
Of the person, and the spirit,
Listen closely my friends
You want to be near it.


Neither Blessing nor Curse

Gently fading
Upon the bed,
Until the angels visit
You're not dead,
But when they depart
I will feel the breeze,
Escorting your soul
O'er the grass and trees.

I will miss those moments
When I felt such things,
At the bedside
As we cut the strings,
Letting them go
No matter what age,
Just a transition
To another page.

Believe what you will
Religion or not,
Your time on earth
Is like a pistol shot,
Some kind of energy
In this vast universe,
Neither a blessing
And never a curse.

I'm Busted Again

Major Fall-out

Lets consider little Betty. Her silly antics, led to my last work related injury (I hope). She was old (older than 75), sedentary, obese, short and compact, playing at helpless, got an angio-procedure with dubious results, meaning she probably didn't really need it, had the usual bleeding that won't stop and needed the chastity belt (Femostop) on for a few hours, and a blood sugar higher than 450......and finally she did swoon/faint.

If that wasn't bad enough; we had to deal with Dr. I-don't-call-back, who ultimately told us to send her home. He finally gave in and told us to call Dr. Who-does-care, and the dude admitted Betty.

Spittle and Cuss

Little Betty fainted
With nary a squeak,
As her family stood by
In shock, cheek to cheek,
Till I did command
Young Junior, do help,
He had a good bark
For such a young whelp.

I call her little Betty
You might say, Betty Little,
She had spunk and complaints
And each utterance launched spittle,
So I stood to the side
When she shuddered and gasped,
And with my 3 buddies
We flung her, hands grasped.

Back onto the bed
With a lurching big launch,
Her biggest issue?
Was that massive paunch,
Describing a measurement
The same as her height,
Five by five, we do say
God speed and goodnight.

Twang, went a ligament
Or a muscle, who knows?
An electrical shock
Blasted down to my toes,
And the hamstrings did spasm
As I shuffled away,
While little Betty woke up
With a farting bouquet.

Now, little Miss Sunshine
Said, Thanks folks for coming,
I could have handled it myself
One hand tied, plus some humming,
But I wanted some pals
To come on the run,
Should little Betty faint
And torpedo my fun.

The mirth and the joy
Departed, each one of us,
Battered and broken
Full of mustard and cuss,
Behind on notations
That will never be read,
But some of us will document
Even when we are dead.
_ _ _ _ _ _ _ _ _

Addendum: How I was blamed (the usual Boss response) for my injury.
Let's just call it: Catch-22, hospital style.


Last week, I managed to get another work-related lower back strain, during another gotta save the patient incident. Bosses always try to blame us for getting injured when we put the patient first, and we get injured, because the hospital provided Lift-equipment, is 5-10 minutes away, because the tools are not on hand. Yes, the sentence did run on. This was not a solo act on my part, I had 3 other pals and a family member, helping Betty Lou (musta weighed 222), into a position where she could breathe, after passing out.

Bosses keep trying to say, we shoulda left her on the floor; but, the fact is, the patient wasn't on the floor. I told my story to Nursing Supervisor, Employee Health Nurse, Doctor at Occupational Med, and my two bosses. Each of them started off with; Why didn't you use the patient-safety-Lift equipment that all Nursing Units have. See, blame first, concern for employee, somewhere down about 5 steps on the list.

Answer: We don't have that lift equipment in our Unit, and remember? Half of the hospital, doesn't even know where our Unit is. And frankly, our Recovery rooms are minuscule in size, the woman was not on the floor, really half on the bed, had fainted, could barely breath laying supine, and there were four nurses using the skillsday-instructed-patient lift technique with a pull sheet beneath the victim, where we all lifted and pulled in the time-tested method of 1-2-3.......SCOOT. Imagine a 240 pound bag of loose potatoes, with not an ounce of help from the patient, who was only partially conscious.

I guess we ought to have let her slide to the floor, pulled the bed/gurney out of the room, so there would have been ease of movement around her, while Joe Bob went running to the Emergency Department 5 minutes away (with a 5 minute return), essentially too late, as we probably would have already called Code Blue . Those responders would have run into the room, declare WTF, why is she on the floor, instead of on that gurney over there? I would announce, because the Boss says, don't ever try to move a fainted sick person, without getting the Lift equipment. Naturally, I would probably be excommunicated for that colossal FUBAR, but maybe I wouldn't have strained my back.

2020 Update:
WooHoo, 
Dr. I-Don't-Care-or-Call-Back.............finally got fired!

Epic Details

Folks get impatient when the procedure starts late, and also, when we delay their departure to home. The latter, is usually, because recovery did not go smoothly; in fact, we care about outcomes and safety.

Epic refusal
To grasp crucial details,
Your wailing in pain
Totally off the rails,
Flinging about
A threat of bleeding, for sure,
With 4 milligrams of morphine
We found us a cure.

But still, we asked why
What's the cause of all that pain,
Questions were posed
To the man with a brain,
So he ordered a STAT scan
Meaning, a bothersome trip,
Off to Radiology
That's a STAT reading, Skip!

Almost 4 hours later
No reading, on the scan,
Hell? What does STAT mean
Is your head in a can,
Then with three more calls
What say the diagnostic reading?
The guy had a small
Retroperitoneal bleeding!

How do you like them apples
Do they stick in your craw?
Doctor says, no go home
With a hem and a haw,
And the family says, Why
What's all of the fuss?
Well, you're bleeding inside
It's about you, not us.

Luckily, it stabilized
'Twas the thought at the end,
Joe Bob went home
Time to rest and mend,
But call 911
If your pain gets so bad,
If you pass out stone cold
You'll be a deadbeat Dad.

We haven't heard nuthin
Since Tuesday this week,
No shrieking sirens
About an aortic leak,
So we guess he's Ok
Ya, what was all that fuss?
Hope you had a good time
Thanks for riding our bus.

Betty and Sue

My writings are like little birdy flight of ideas, as I'm sure you know, if you follow this blog. Sure, there's some good, state of the art, evidence based facts peppered here and there, so don't be disappointed. It's the nonsense, that I love!

The Betty here, is the same Betty, two poems down.

Strained some ligaments
Over-stretched some muscle,
It was a pull-up in bed
Not a crazy man tustle,
But it's easier to do
In decade six plus,
I feel like I need
A total body-truss.

Day one, a little ache
Day two, I can barely bend,
Hard to ride the bike home
When the shift did end,
Just past the 12th hour
After Betty Lou bled,
I asked her to scoot over
Just let me lay on your bed.

Well, that didn't happen
She was already upset,
When her artery gushed
And got her all wet,
Even then, she was bothered
That she couldn't take her pee,
She asked to stay on the wheelchair
Rather than lay down with me.

But forget about Betty
Let me tell you about Sue,
She had a peripheral runoff
Leg arteries plugged with glue,
No, the doctor couldn't fix it
Despite, balloon, stents and TPA,
Next, a 3 hour recovery
At the end of our day.

She woke up hungry
I gave her what she asked for,
Shredded chicken taco
A soda, and more,
Intravenous meds
Better than on the street,
I fluffed her and buffed her
And gave her more to eat.

Near the end of her sentence
Three hours in our unit,
I got a guitar
And she asked me to tune it,
She sang Down By The River
By Neil and Crazy Horse,
Is that HumanKindness, folks?
By golly, of course!

Obesogenic

From the not-so-new word Department:

A new word today
That I never heard,
Obesogenic
And all that's conferred.

The environment
Which promotes that thing?
Obesity happens there
With a song and a fling.

Many different factors
Food choices and more,
Hand to mouth disease
And exercise? What a chore,
Alteration in composition
Of that which is called food,
Just musing on the weight I'm gaining
Puts me in a mood......
To eat larger portions
And walk a lot less,
Consume how many calories?
I can't bother to guess,
Because I'm too darn hungry
It's quite obvious, I need to eat,
In this obesogenic environment
That's what they call it on the street.

Now I'm 48 years late
Learning that new word,
Coined in 1970
Until today I never heard,
Despite the fact, I deal with
Obesity every day,
No one told me, that environment
Was obesogenic, as they say.

Listening Lost

This is the story:

Three heart-caths recovered
All those arteries OK,
Well, not exactly normal
But they'll fight another day,
And I like to know their story
Because report is often slim,
Is Billy Jean a woman
Or is Lindsay a him?

Was the puncture site at the Left groin
Or was it the Right wrist?
When I'm peeking under the covers
Was there something I missed?
And was the Nurse who gave report
Actually present during the test?
How much Heparin did they get
Catheter sizes, and the rest.

Now, when it's time for teaching
I need background information,
Without it, I look stupid
Maybe provoke a confrontation,
Because knowing that they underwent
Heart surgery, just last year,
Will help me tune my message
In respect to Momma dear.

When I am giving report
To the nurse on yonder floor,
I will have mined the chart for details
To overwhelm them with my score,
Though, I'm a little lackadaisical
Giving dubious medications,
Not needed in the immediate
Throes of recovery, my explanation.

Last evening, for example
Betty Lou, was supposed to go home,
After her Radial artery sealed
With pressure and crazy foam,
But no, that didn't happen
She started bleeding at the 4th hour,
With her daughter at her side
Good lord, a bloody shower.

Dr. Terban, first suggested
Just keep her till eleven,
I told him he was crazy
(He sometimes acts, like he is seven)
No, Betty Lou should spend the night
Upstairs, with experts plenty,
You can see her in the morning
(And please pretend you're twenty).

A new nurse named Ginny
Took report from me,
I told her the bloody story
With extra points for free,
Telling her I'd fix the orders
So Betty's medications,
Would be available tonight
It's called reconciliation.

Just 5 minutes later
Ginny calls, excited!
Did I give the evening meds?
Why weren't they expedited?
Well no I didn't, Ginny
Betty Lou, was dressed for home,
I did not give those medications
(Is your brain, just crazy foam?)
Were you listening when I gave report
Just precious minutes past?,
The woman was gushing blood
And now I feel harassed,
By your idiotic questions
Regarding the N-Acetylcysteine,
Dr. Terban loves that stuff
A dubious medicine, is what I mean.

Then Ginny, quizzed my partner
Upon delivery of Betty Lou,
Did Bonzo, give the medications?
Probably not, but who knows who,
Because Bettty was destined for home
Till she changed her mind and bled,
So, why don't you mind your business
Attend to your patient in that bed!

Well, this is the greatest
Reality show!
We're recruiting all the time
Folks are retiring, don't you know?
Like me for example
Time to hit the road soon,
I can't take much more of this
It's time to shoot the moon.

Hair Appointment

I haven't worked in a same-day surgery center, but I would imagine that those places probably stay relatively on-time; they don't have to deal with emergency things much. In contrast, where I work, almost every day there is some kind of major delay for one or more of several services. For those folks who get antsy, fussy, keep asking why is it taking so long, cuz the doctor said the procedure would only take 90 minutes (and as usual he forgot to tell them about the pre-op 2 hours and the post-op 4 hours, oops).............I will tell them; Ya know, this isn't like having your hair done. No actually, you might recall that it involves putting 6 wires up inside of your heart, freezing and burning tissue, and then we carefully watch over you for a few hours to make sure it's safe for you to go home. I mean, does your Hair dresser do that for you?

Waiting for a hair appointment
Fifteen minutes over,
You might feel like jumping
Off the Cliffs of Dover,
Or waiting for your Latte'
To get its signature foam,
As your stomach starts to rumble
Inside the silver dome.

Now compare that to waiting
For the procedure on your heart,
We all want the best for you
We're all a team, please play your part,
As a gracious consumer
With good fortune, to have this day,
Imagine just fifty years ago
We couldn't fix you, no way.

Truly, this is science
To repair major heart issues,
Heck, even in this moment
Researchers are growing heart tissues,
So please take a moment
Or maybe two hours more,
To get a grip, Joe Bob
Your complaining is a chore.

I told you that Mary
Had an acute M.I.
She had to go to the Cath Lab
Or she was going to die,
And that's why you're waiting
Longer than expected,
But if you keep yelling
We'll have you ejected.

Go ahead and write that letter
To the head honcho that you know,
Send a letter to your Congressman
And the Jerry Springer show,
Frankly, we don't really care
Because we do what is best,
Serve each client fairly
Like a member of our nest.

We do the kinds of things
Never done before,
To help you have more of life
How do you rate that, what's the score?
Even if we're delayed
Why not show us your best side,
But if you can't do that
I'll call Uber for your ride.

About the Underside

I was a shy kid, read a lot of books, loved the writings of Dr. Seuss, Ogden Nash, and Edgar Allen Poe. Those guys knew how to put together interesting rhymes that expressed ideas very clearly. To express my views of the world, I began rhyming in the 6th grade. At the time, I didn't really write for anyone other than myself. I did know, that it was good practice, and I tried to be very selective with the words that I used. I wrote the usual idiotic teenage stuff, love and loss, all about that uncomfortable experience. The years went by, as I made an attempt to write every day, but the time for sharing finally started with Nursing. I guess that's when I realized I had joined a select tribe, and I had a duty to share my experience with others.

My blog, "The Underside of Nursing" actually began in 1992 (before the internet) as a "Zine", and I sent it through the mail, to a handful of readers, mostly in this country. I enjoyed making fun out of the usual stuff that goes on in hospitals, and also wrote a lot about the uncomfortable things too; death, disparity, questionable ethical issues, mistakes and all kinds of gross stuff, which has always been my favorite. 99% of persons who bothered to read what I write, have responded favorably, so that beats all, in my book. If I ever get around to publishing any anthologies, I'll let you know.

Shout It, Speak It

If it was funny
I wrote about it,
If it was unethical
I attempted to shout it,
To announce to the world
This must be spoken,
Not to be hidden
As a meaningless token.

Hundreds of stories
Repeated over and over,
Destined to repeat
Like a new batch of clover,
For the students and practitioners
Who are fresh to the fold,

Do take the time to listen

To the voices of the old.