New CPR

CPR, a lot of tries, very little advanced.

Evidenced Based New CPR

Over the years

There have been a lot of changes,

Regarding CPR

With many rearranges,

First, it was the drugs

That were tried and rejected,

When we discovered

Few were cardio-protective.

As a result we said

Back to the drawing board,

Accept one new drug

And leave the rest in accord,

So that meant Amiodarone

Epinephrine and Atropine,

Adenosine as a special

For a certain kind of tachyzine.

Next it was compressions

That slamming on the chest,

Who could be fast enough

And who did it best,

Carefully tested results

Regarding heart chamber pressure,

Without a steady MAP

Joe Bob isn't any fresher.

Lastly, respirations

Not so important any more,

It's all about the hemoglobin

Carrying out its chore,

We can all live without oxygen

Longer that we think,

Because our blood is carrying it

What was already in the sink.

Sure, it has some importance

But what we learned, was better,

Hyperventilation

Was far worse, to the letter,

And that was always a risk

When Barry was working the bag,

He would ventilate like a crazy man

Overcompensate, what a drag.

Labs would be drawn

And an A.B.G.

The p.H. would be 7.7

The Doc would say, "Oh, goodness me",

Knowing that now

We needed to halt all breaths,

Which doesn't look good in the records

When investigating the deaths.

Finally, a solution was discovered

In regards, to delivering breaths,

We could fake out any observers

The ones who are tracking the deaths,

By reverting to the mouth-to-mouth

By appearance, no breath shall it miss,

In reality, Jerry from Respiratory

Has the duty of Emergency Kiss.

Smacking away at those lips

Pretending to blow like a hoover,

Counting out the expected ratio

With the compressor; he's the prime mover,

Carrying on like he's important

An integral player in this event,

Just hoping this silly charade

Will earn him some points of intent.

I have watched the total endeavor

I had ACLS in 1984,

That's a whole bunch of time

I renew soon, it’s a regular chore,

There were a bunch of diversions

And many of them, that did miss,

But who would have ever guessed
It would be Epinephrine and just a kiss.

Wish List

I like making lists, no telling why, but it probably enhanced my critical decision making over the years. As a result, I'm the type to have my favorite list of Jazz artists, all the books I've read for the past 20 years, all the addresses I have lived at, and all the cars I've owned. My own private fixation.
And sure enough, I have an ever expanding list of the favorite nurses (and persons of other departments) that I worked with over the years. The A-Team, if you will. And that's what I miss, since I changed my work status.

Wish

I wish we could have worked together longer
With you, I felt so much stronger,
When there was some kind of task that made me feel queasy
Having you as my partner, made it seem easy.

Synergy, that is the name
The best kind of partnership
When playing the game,
Plus, a mesh of fine skills
Experience and know-how,
We could accomplish anything
In the here and now.

With our many years of ICU
Each one of us, knew what to do,
Under any condition, without hesitation
But to have a partner, is the best situation,
Sharing the tasks, in the most efficient way
To insure that Joe Bob would see the light of day,
To listen to our silly jokes and laughter
Tomorrow, and hopefully, the day after.

I don’t have any doubt
We saved quite a few lives,
Events I’d rather not remember
Stored in the archives,
But knowing, you and I
Had the power and moxy,
To overcome the toughest
With spirit and epoxy.

Yep, that’s what I miss the most
Finishing the game at the goalpost,
With the ideal team mates at my side
Agreeing; that was one heck of a ride.

Epilogue

I am now preparing a manuscript, to finally publish, a book that may sell or not. That's what writers always worry about, but I don't. Perhaps because my writings are the equivalent of my 40 year trip in healthcare. Every bit of writing, is tied to a memory. Today I have written the Epilogue

You might think I'm a horrible nurse
You might think I had the curse,
That I talked about, from day-one, Betty
Back when charcoal stools were hot and sweaty.

But you would be wrong, on that account
My freakish writings, held a measured amount,
Of the stress and anguish, that every hard-working nurse
Is forced to carry around, in their favorite purse.

Injection inspection

It isn't often one reads about medication errors offsite of the hospital, where the usual blame is forced upon a distracted nurse. Here is a recent event at a High School, where students were to receive a TB skin test, but sixteen of them, received SQ Insulin instead.

Lock, Stock and Peril

Oops, you got Insulin
For your TB skin test,
To the hospital you went
You must be impressed,
With our professional promise
Regarding safety and health,
Call it our Student Special
Injected with stealth.

Luckily, not one of you
Suffered anaphylaxis,
That would have looked bad
On next year's taxes,
We might have been sued
For every lock, stock and barrel,
Sixteen students got Insulin
With no warning of peril.


https://www.wishtv.com/news/local-news/students-hospitalized-after-receiving-insulin-during-tb-skin-test/

"Severe anaphylactic reaction to human insulin in a diabetic patient"
https://www.ncbi.nlm.nih.gov/pubmed/17331861

Future Charades

I still have plenty of words to share regarding what it's like to be the Nurse at the bedside; but my drive to expel those words, has diminished, now that I am freshly retired.
I continue to teach the science of EKG Interpretation, but that incurs no stress at all.
Still, I feel that I have an obligation to write, because my pals remain at the Western Front.


Absentee writer
That's me,
A lot of it was stress
Now I'm a retiree,
Am I any happier?
Not sure, just saying,
My thoughts are still professional
There's a balance shift playing.

I still keep up
With scientific curiosity,
Though, considering the old days
There was a degree of monstrosity,
Which changed its morphology
Over the years, and more decades,
What was believed back then
Was like a game of Charades.

If you're still a Clinician
Keep an open mind,
Best Practice isn't always
Give it a decade, and you'll find,
If all of the posturing
And big ideas in play,
Still hold any legitimacy
In that future day.

Joke Disorder

Not highly regarded for my social skills, nor ability to lead perky conversations, I did develop a keen ability to make puns, cynical/sarcastic innuendos , sharp observations, and conveniently, my thoughts frequently rhyme in patterns. There is probably some kind of Psychological disorder, to explain all of that. (no doubt, carefully delineated in the DSM-5)

So, without further ado; new words and definitions:

Alcohol Use, Disorder:

When you tell the Bartender, you don't really want this particular cocktail.

Vernacular Fibrillation:

Making vocal utterances, which make no sense. 

(somewhat like this definition)

Break-out sessions at the Acne Convention 

Diawheaties:  The latest breakfast cereal from Shaker Mills.

Improve your blood sugar management, while

enjoying your old favorite morning breakfast cereal.

Angiobran:

Part Anti-Coagulant, part Fiber supplement.

Prevent blood clots & prevent colonic (clots) obstructions.

Consider the similarities:

Q: A Creamcicle ice-cream treat, and the IV tubing used for hanging a piggyback medication.

A: The Creamsicle........you, suck on dairy;

      The IV tubing set is called, a Secondary.

High Expectations; Low Standards

I'm on the mailing list of various Nurse recruiters. Recently there was an ad placed looking for an RN, at a hospital I recently worked at. The qualifications were: High School diploma or equivalent (G.E.D.); plus satisfactory completion of a formal Registered Nurse program pursuant to the Division of Allied Health Professions or military training that is equivalent to an accredited Registered Nurse program. Wow, those qualifications are kind of weak...........so I got to thinking about Hospital X.

Easy Job at Hospital X

Good old Hospital X
Has a job for me,
Cuz all they ask for
Is a G.E.D.,
Along with a basic
License for Nursing,
You just memorize scripts
And practice rehearsing.

You don't need to know much
Just smile and wave,
Fluff the pillows
And be a good slave,
And if you're ever asked
About your education,
Mumble some credentials
With obfuscation.

At Orientation
They emphasize certain rules,
That are never enforced
I ask, what kind of fools?
Can run a business like that
A hospital, for goodness sake,
Where every employee is on the phone
During the hours they are awake.

In Recovery, after your procedure
You started bleeding,
Joe holds pressure on your artery
At the same time, he's reading,
About the the latest pistol
Using the phone, in his other hand,
Sure doesn't look smart to me
But we can't make him understand,
If the rules aren't enforced
Until a sentinel event,
That means, until it's too late
And there's no chance to repent.

Precious Flower
Works intensive care,
She charts with earplugs on
Watching Vanity Fair,
No attention on the monitor
For yonder patient, Jack,
Work-time hours watching YouTube;
Don't have a heart attack.

Nurse; can you read an EKG?
Not really, but I have a Monitor Tech,
Hope they are not using their cellphone
Wait a minute, let me check,
But aren't these all Heart patient's
Under your care?
There are some things you must know
As important as breathing air.

Sensible policies
Without enforcement,
Can you trust the care
With this kind of endorsement?
While the public is influenced
With colorful advertising,
Unsafe practices are the norm
Broken rules, not surprising.

Yep, good old hospital X
Will hire me soon,
No more Orientation
We’ll just chant and hum a tune,
Because it was clearly a waste
Training twelve turtles,
About best practices
When they couldn’t run hurdles.

Wide and Bizarre

Over the years I have written numerous times about SVT & TVS (or a similar iteration). Depending on the urgency, the disease process, or even the on-site knowledge base, wide complex tachycardia can present a conundrum, in terms of proper naming of the rhythm. In the event that the patient is critically unstable, cardioversion may be the best choice of therapy.

Wide and Bizarre

It's the middle of the night
And you are a newbie,
You're dead asleep
And dreaming about Ruby,
When your pager goes off
For the CCU,
It seems that Billy Bob Borko
Had some dying to do.

The nurse asks, Doc
Will you look at this for me?
Billy passed out
When he was taking a pee,
And you notice his rhythm
Looks wide and bizarre,
Enough room for a semi
And a Mini Cooper car.

Is it SVT or TVS
If you don't know
You won't impress,
The Attending physician
In the morning meeting,
You better talk to the nurse
Before you take a beating.

There's a guy at the desk
With arm raised and beckoning,
Don't bother to argue
Or there will be a reckoning,
A teacher of EKG
With 30 years of knowledge,
You're not even that old
After eight years of college.

Sure, he can't name a diagnosis
His license won't allow,
But his barrels of experience
Are available, like free chow,
And any self-realized
Brand new doctor,
Will understand free
Without asking a proctor.

Don’t get your knickers in a twist
If he knows more than you,
Regarding Torsades de pointes
And accessory pathways too,
Just sit down and listen
Maybe take a few notes,
On rounds, in the morning
You might get all the votes.

If the Attending should ask you
To cite an article or source,
Please do be honest
Don’t be the butt of the horse,
Embarrassed to admit
A nurse explained it last night,
Let’s have mutual respect
Because payback might bite.

SVT or TVS,
Beguiles folks
You must confess,
If you’re haven’t learned
The nuances and rules,
Your Attending will know
How to separate the fools.

Patty-Cake

I haven't written on this particular theme in quite sometime, but any bedside nurse will agree, this is a stinky subject. Frankly, I have penned an awful lot of crappy rhymes, over the years.

Poo Poo patty-cake
Practice your ability,
A simple test
Regarding GI motility,
The bane of all Nurses
Having to deal with all that crap,
And please listen to me
We don't want it in our lap.

Don't play the revenge game
When we turn you in bed,
Please don't bear down
And make your face turn red,
Because I'll flip you over
Back on your bottom,
Wink at my pal, saying
This time I got him.

Sure, it's kind of funny
When you rip a loud one,
Only if it's empty
Like an unloaded gun,
Because, if I get splattered
I won't be singing, "You're So Vain",
I'll be thinking Chernobyl
And acid rain.

Too much poo poo patty-cake?
We order a Flexiseal,
A miraculous invention
That's how we deal,
And it helps with the odor
Until emptying time,
Then it's the same old crap
Except, this stuff is slime.

Talk About Sex

Nurses; men or women, it doesn't matter. Somewhere in your career, and probably more than once, a patient will start speaking with sex based innuendo's or blatant, sexual harassment, and you need to shut that down, right at that moment! You might have to come right out and talk "Assault & Battery", where speech alone constitutes (threat) Assault, and laying on of hands / touching you, is Battery (causing harm or injury).  Hopefully a firm professional rebuke will halt this behavior in its tracks.

Anyway; here was my response last year when 64 year old Joe Bob just had to know how soon he and his partner could resume sexual activity.

Talk About Sex

Those patients
Who want to fluster their Nurse,
Talk about sex in some way
To embarrass, or worse,
Is it sexual harassment?
Do we snicker, smirk or wink,
It's usually a guy
And he's talking about his dink.

The dude had an Ablation
For his Atrial Fib,
He asked, "How soon for sex?"
Then I said, ad-lib,
Well, how about a week
That should be prime,
But if you just can't wait
Sex yourself, any time.

Common Sins

Not fake news, just old truth. Joe Bob, somewhere over sixty, had strained his back. He had Aspirin at home, and knew it was pretty good stuff for back pain. He remember it was OK to take two every four hours, but after a while he thought, this isn't really working, so he began to double up on the dosing. After about two weeks, he noticed he was feeling weak......................until he finally had Betty Lou take him to the Emergency Room.

Severe anemia
How was that begun?
One guy was popping Aspirin
When his knee had come undone,
Taking it every four hours
For the past two weeks,
His Hemoglobin was four
He had acquired many leaks.

Maybe you need platelets
Or clotting factors,
Though sometimes blood products
Have their detractors,
Perhaps you have a religious
Belief, where you'll refuse,
A standard life-saving therapy
Guess we'll watch you bleed and ooze.

We medical persons
Shake our heads in wonder,
What happened to common sense
Regarding your Aspirin blunder,
How could you think it was OK
To take it so often, for so long,
No Doctor told you that
You wrote your own song.

Over-the-counter medicines
Gotta be safe, right?
Millions of people use them
All day and all night,
If one or two don't work
Take a couple more,
But if you should overdose?
Please unlock your door.

Heinous Crimes

Beating, whipping, slapping, spanking, boiling hot water, running in the yard for 2 hours, locked in cages, closets, water-boarded, bottom of foot or lower leg, hit with a flexible rod or branch (switch), starving, hidden from society..........dare I go on? IT IS ALL WRONG. Particularly, against children.

I read about a man
He beat his child to death,
Momma, was at work
When Billy took his last breath,
When she came home after work
She saw him sleeping in his bed,
She claimed in the morning
That she didn't know he was dead.

Beatings for an hour
When homework wasn't complete,
Meals and water withheld
Children not allowed to eat,
Make them run in the yard
For two hours at a time,
In ninety-degree heat
These punishments are a crime.

Dad said, "Never in a million years
did I want this to occur",
I thought I was the best Dad
Loving and pure,
But my kids wouldn't listen
When I cussed, barked or yelled,
Never understanding
Kids just want to be held.

Parents or their surrogates
Most often perpetrate these crimes,
Children beaten and bitten
Hundreds of times,
Men claiming, their own father
Did the same thing, when they were young,
Getting a good whipping
When they stuck out their tongue.

Then going on to say
I leaned my lesson, don't you know?
That's why I do it to my kids
Because now I'm a pro,
I'll teach them a lesson
Beating harder than my old man,
Those kids need a whupping
I gotta do what I can.

These days our domestic animals
Are often better treated,
They are provided a "forever home"
Identification and shots completed,
A soft comfy bed, toys, snacks
And rawhide bones,
Meanwhile little Billy is locked in the basement
Dreaming about ice-cream cones.

Heinous crimes perpetrated
Domestic violence and child abuse,
It is never OK
There's not a single excuse,
To allow for this behavior
It is abhorrent and evil,
A parent, such as described
Is lower than a Boll weevil.*


* Boll weevil: the most destructive cotton pest in North America. Best eradicated via pesticide, or crushing beneath one's heel.


https://americanspcc.org/child-abuse-statistics/

Remember, all we healthcare workers are Mandatory Reporters.

The mysterious domain of the gut

The science of the gut. Most of take our digestion for granted, yet it's like a wild and unexplored jungle, massively influencing our homeostasis.

The GI Tract
Is a mysterious place,
Trillions of organisms
All in a race,
It contains the Microbiome
'Tis a considerable size,
How it influences
That's the surprise;
Overall well-being
And auto-immune,
Far more complicated
Than a trip to the moon,
Influences our thoughts
And can be damaged by emotion,
There are as many moving parts
As the Atlantic ocean;
Teaming with bacteria
And viruses too,
Fungi and spores
And prions, to name a few,
And the multiple constituents
Of the hematological domain,
It could be argued, it is more complex
Than the average human brain.

Not so Basic EKG

Since 2002, I have been teaching Basic Cardiac Monitoring, which is essentially basic EKG. Since some of our students might go on to acquire a Monitor Tech position, we differentiate the actions for the RN and the Monitor Tech. Essentially, we take into account only 2-Leads, of the standard EKG.
There are a couple more advanced classes in our curriculum, but unfortunately, they are not well attended. Perhaps the Critical Care Educators at the hospitals, offer classes of this sort; I don't know.

I'm not on the job
But I am teaching,
Basic EKG
That's what we're preaching,
Laying a strong foundation
Of the standard beginners stuff,
Although, for some of our students
Even the basics are tough.

Our class is comprised
Of new nurses and old,
Echo techs and Sleep Lab
Housekeepers who are bold,
Because they want to change jobs
And Monitor Tech sure looks fun,
Understand, this is a new language
And it will feel like a hit-and-run.

Most of the students
Do pass the exam,
It's comprehensive and detailed
Without a hint of spam,
Phones are not allowed
And calipers are advised,
And the ones that fail
We are sometimes surprised.

They get a second chance
To do it over,
This class was all RN's
A new Tele Unit, fresh as clover,
Enthusiastic students
For most, a review,
They have to be certified
To be a part of the crew.

Almost a Trauma Victim

Retirement: more time for biking; that was what I was thinking. But wait, although the city leaders here claim they are trying to help make biking safe, their traffic calming measures are anything but calming. Anyway, just like my almost terrible accident of three years ago, when I was biking to work, an almost identical event happened yesterday. Yup, a driver staring directly at me, yet not seeing me. Look, I wasn't wearing my Zebra suit this time, OK? Time seemed to slow down, unlike that driver gunning the engine. I ditched and chose the pavement and although I get to grow new skin, I didn't become a Trauma patient with multiple broken bones. Whoopee!


Uncle Razmus

I've really been a slug today
I freely admit it,
Because I crashed my bike yesterday
And that’s what did it.

Uncle Razmus, and his wife
Sure, they looked both ways,
Then he gunned the engine
And I saw the end of my days,
I slammed on my brakes
Because they did not,
I took a header to the pavement
And I’m glad it wasn’t hot

I landed on my left side
In the usual fashion,
That’s my modus operandi
Whenever I’m crashin’,
It’s like I’m on a three year cycle
Where I end up on the street,
Lose some skin and bruise some muscles
Wait another three years; then repeat.

Isn't there some section in the grocery store for nuts?

Well, I'm not certain regarding the inspiration on this one (25 years back), but lots of nutty people do just fine in general society, and then they come to the hospital. I don't remember for sure, but I do know I had fun writing it. It has a pretty good 3-line rhyme.

A Special Kind of Ism

She went into the clinic
For elective surgery
To regulate the flow of her ureters,
It was a simple operation
That had never been performed
To implant some tiny microscopic meters,
See, she had a fascination
You might call it an obsession
For the inner workings of her organism,
She had made it her career
More precisely her crusade
Yes, specifically her special kind of ism,
She calls herself a mystic
Her return, a tidy profit
As she leads a modest crowd of imbeciles,
As a faithful testimonial
They visit doctors frequently
And take a million different kind of pills.

Upon awakening from surgery
She had a bold new vision
It involved uniting people on this planet,
So she called a special meeting
With a couple close advisers
Two old friends, whose names are Sven and Janet,
Now, the couple I just mentioned
Were consultants in brave ventures
Their reputation went before them, broadly speaking,
They had recently returned
From a trip out in the ozone
To discover why the atmosphere was leaking,
But that’s another story
That deserves a later telling
Let’s review the facts before us on the table,
It would be easy to identify
This woman as a nutcase
But as professionals, it’s best if we don’t label.

Now, with surgery behind her
More specifically below her
She relished the attention she was getting,
Her followers convinced
That their leader was a Goddess
Divine rapture and ascension, they were betting,
In cases such as this
When we cater to the weirdo’s
We don’t treat them any differently than others,
Because we follow a basic tenet
That our bottom line is care
We treat everyone as though they were our Mother,
And, so spirited was she
That she blessed in groups of three
And cast a good vibration in the air,
Now all who come in through our doors
Will walk upon our blessed floors
And will bear witness to a special kind of care.

Critical Awareness

In Nursing School, and then in practice, we hear a lot about Critical Thinking. It is a tool that develops over time, as the practitioner gains experience, and acquires a deeper knowledge base.
Furthermore, the more experienced Nurse, will eventually attain Critical Awareness, whereby, very subtle cues exhibited by a patient, or even a situation, alerts that Nurse, about impending trouble.

I used to work at night
I have a great respect for the dark,
Getting homeostasis balanced
Is not a walk in the park,
We night-time nurses needed to be watchful
Apprehending subtle cues,
Explosions take time to develop
Better keep an eye out for the fuse.

Accidental Doctor

An Emergency Room draws in the most unusual players; each one must be viewed with a cautious eye.

I had an accident today
I cut my hand while in the yard,
I was taken to Emergency
Down on Stockton Boulevard,
I saw bloody people everywhere
Children screaming in the halls,
Quite an experience, that’s for sure
So different from the shopping malls.

I lost quite a bit of blood
And forgot who I was,
I hit a doctor on the head
Why I did it?, just because,
I put his body in a closet
And placed his name-tag on my collar,
Just a simple street thug
Looking for an easy dollar.

With such an air of dignity
I drew everyone's respect,
I basked in all the glory
When I saw them bow and genuflect,
So involved with saving lives
I didn’t hear the sirens wail,
Till they took me away to raise the dead
Down at the county jail.

Nursing Collaboration

What greater example of genius can be found, than a group of nurses brainstorming ideas, to solve an apparently insurmountable situation. No names mentioned, but factually true; and I remember who my comrades were, what room the patient was in, which hospital............my poems are memory keepers.

Ring Around The Collar

She attacked my poor olfactory nerves

When I checked beneath the covers,

She had colonized a host of creatures

Left by thirty lovers,

In the dark, warm, damp environment

Those bacteria and yeasts

Synergized and incubated

Awesome, unknown beasts.

The Epidemiologist

Was unsure, what to do,

He ordered standard culture sets

On the exudative goo,

And quite frankly, like the rest of us

He was grossed out to the max,

So he didn't even notice

When the slime jumped on his slacks.

A fomite under power

This sad fellow was a dupe,

He should have tossed his clothes right then

Inside the linen hoop,

Instead he took that colony

On rounds with him, that day,

Contaminating everything

In an epidemic way.

Within the fortress of the unit

The nurses launched their fight,

They wrote a mighty care-plan

It was an awe inspiring sight,

The list of interventions

Would win a Nobel prize,

As sure as fresh made cow chips

Will attract three dozen flies.

But none the less, they knew the tricks

To eradicate this beast,

They called the local chaplaincy

To get a Catholic priest,

We need an exorcism

Before we gather by that bed,

Please come and do your demon dance

Or I'm sure we'll be dead.

The Catholic guy, said, my, oh my

Of course, I'll help those nurses,

I'll get a chance to practice

All of my anti-demon curses,

Because it isn't very often

Within the confines of my role,

That I have the opportunity

To really save a soul.

With the exorcism finished

Their job took on some meaning,

It was just another nasty site

Of excretory cleaning,

Engarbed in isolation robes

They were covered head to toe,

And if you turned the lights down

You would see those nurses glow.

Together they approached

Their formation, it was tight,

They stripped back all the bedclothes

And assaulted her with light,

They attacked with four point suction

To vacuum up the slime,

While taking notes in narrative

About the scenery of the crime.

In the background several nurses

Were at work in preparation,

To concoct some deadly mixture

For slime eradication,

And they finally reached consensus

About exactly what to do,

They would mix a triple portion

Of the hospital coffee brew.

It was well known information

That the stuff was nearly toxic,

It could revitalize a Resident

Who by appearance, seemed anoxic,

And the triple dose delivery

Would cause culture overdrive,

This seeping, weeping monster

Would no longer be alive.

The smell was overpowering

When they sprayed the caffeine flux,

It didn't touch the linen

Because they padded her with Chux,

And when the treatment was successful

You could hear those nurses holler,

I wonder if this stuff will work

On ring around the collar.

1994

Personal Space in the Community Place

The President of the hospital where I most recently worked, is very much a touchy-feely kind of guy. It's probably a cultural thing, or maybe some psychological personal space nonsense, but he makes a habit of reaching out & touching, without permission. One time, I was concentrating on a computer screen (charting); he came up behind me and placed his hand on my shoulder without warning. I was startled and spun around, only to find his leering face, asking me, how I was, and could he do anything for me. "Ya dude, keep yer paws offa me, Ok?"

Hug & Touch

What's up with those people

Who feel they need to hug and touch,

With complete strangers

They don't know very much.

And maybe they want

To look me straight in the eye,

And other things

I wish they wouldn't try,

If you engage my eyes

You don't know what I'm thinking,

Are you a body language reader?

What's it mean if I'm blinking.

If I cross my arms on my chest

Is it a sign of strength or fear,

Whatever it is

I don't need you near,

If your circle of influence

Crosses my personal space,

You’re way too close to me

If I feel your breath on my face,

If you want to touch my shoulder

My arm or my hand,

You better ask for permission

Why don't you understand?,

Don't sneak up behind me

And put your hand on my shoulder,

There's no telling how I'll react

And as such, you might not grow older.

4/8/19

The Monkey's Paw

At a number of hospitals (over the years), I encountered situations where it seemed like some kind of patient disaster, was bound to happen, just around the corner. My take on it, is that the hospital corporate structure, was more focused on public perception, image, branding, and so on, and not taking the time to be focused on best practices, inside the building. 

Anyway, maybe I'm totally off course..............but give it some thought.

Don’t Ask Why

Without the usual

Irritating factors,

Overloaded circuits

And persnickety actors,

My poetic Muse

Has been unusually silent,

I have not been provoked

Nor caused to be violent.

I visited my pals

Last Thursday night,

It was an easy-going interlude

Not the usual fright,

But the stories they told

Occurring after my exit,

My Gawd it sounded horrible

Way worse than Brexit.

I wonder:

Does anyone care

About sentinel events,

When disasters are lurking

Near the picket fence?

This is like the King’s fresh clothing

Every single day,

It looks good on the surface

But there is Hell to pay.

When one is dealing with sick people

Sometimes they die,

Intervening on 3-vessel disease

We might not ask why,

Sure, we’ll do a risk analysis

As is required, by the law,

Then move on to lunch

Down at The Monkey’s Paw*.

I recommend, that if you haven't read The Monkey’s Paw, a famous little horror story published in 1902, ( you should read it)
authored by W.W. Jacobs. 

CCU

When I worked at the University hospital 88 - 2001, our Cardiac Unit was named CCU (Coronary Care Unit). The 1990's were the years, when the liquid diarrhea's that we now associate with C. Difficele, began to proliferate. The ICU's were becoming a stinky mess, and historically clean Cardiac Units, were not spared.

The Writing on the Wall

I'm really getting tired
Of all this crap I'm cleaning,
It's really not an issue
That the task is so demeaning,
It's more, the risk of splashes
When I clean those potty pans,
While my nostrils scream in agony
And I beg for scented fans.

I'm getting the impression
That something bad occurred,
I've read the writing on the wall
While no one speaks a word,
A change in nomenclature
A shitty point of view,
Chronic Crap, not Cardiac Care
A new meaning for C.C.U.

1993

What is Known

How we write, to avoid HIPPA, and still, explain our stories and yours.

If you gotta talk about your hospital gig; talk to a professional peer.Otherwise, the best person is your ESTL (English as a third language)  spouse. 

I realize, that what I write
May not be clearly understood,
Because I am processing an experience
The could have, should'a, would,
We all go through this method
As we analyze our actions,
I think talking about it has some value
To avoid terminal impactions.

To have a sympathetic listener
Another nurse, for example,
With experiences similar
Not so likely to trample,
Upon feelings and senses
Where we both know the stage,
Don't talk to a Child Psychologist
Regarding abused children, with our rage.

Henceforth, are the times
Where the writing wanders about,
When I rage at the perpetrators
I want to scream and shout,
But instead, I follow the protocols
What agencies to page and connect,
While in my dreams, I call the assassins
Phone numbers, address, and where to intersect.

Every individual person
Faced with outrage and mayhem,
Wonders, why we do pause
And not immediately slay them,
Where we name them as "alleged"
Although we hold the information,
And if they get the best Lawyers
They might earn a nice vacation.

So you see, I do ramble
As the words lead me on,
Exposing my experiences
What is known and beyond.

Fontius Pilate

Like Pontius Pilate (some kind of Testament of recognition), I am a persecutist of Font. Just so you know; my font and text handling is atrocious. I write in a consistent matter and don't murder the English language (unless it suits me), but my Font management is a failSorry

Let them go

No lead in here..........I lost another font war.

Why go on? When your body has failed, Why send a letter? That never is mailed, Why own a comb? If you've lost all your hair, You can't hold your breath If there isn't any air, Why go on reading? If it isn't making sense, Can you say you have a farm? If it doesn't have a fence. Why prolong the suffering? Of the one you love the most, Are your grief and loss so great? You are clinging to her ghost, Sit beside her, hold her hand Feel her pain and you will know, That love is giving and receiving; And love is letting go. _ _ _ _ _ _ _ _ _ _ _ _

While on the same topic of dying; here was the opposite approach, as shown by this loving and attentive family.

Humbled

"This Lady is fun" Her daughter said to me, The portrait on the wall Displayed her lovingly. She held her mother's hand And gently stroked her hair, It felt like I was standing In a sanctuary there. Her husband gazed into her eyes And only saw her beauty, He'd gladly suffer all her pain In love, and not for duty. The part I played seemed minor In the drama on this stage, I felt just like a footnote At the bottom of the page. "My Mother is the strong one" Her daughter said to me, And in a moments silence I was humbled by the three. 1994

Continuity vs Chaos

This is about that darn dream again; yet, it is relevant in one aspect. In the course of my career, I wanted different patient's every day. I believed I was more attentive that way, because the situation was new and different. I discovered, that if I had the same patient more than two days, I was likely to start making some assumptions based on prior information, and I might under assess the patient.

Many nurses want the same patient's day in and day out; plus, there is some institutional hype regarding "Continuity of Care", that is often touted to the public at large.

I awoke from that same old dream
A nursing unit drop-in,
It could have been a lot more fun
If Betty took me shoppin',
When I arrived, they made me Charge
So I chose the fractured leg,
Everyone gave me the stink-eye
While one of them even begged.

He said:
I wanted the patients that Peggy had
Like our hand-off from night till this morning,
He almost incited a riot
So I glared, as if sending a warning,
And as usual, I was so busy
I ignored my own patient, again,
This is my hospital nightmare
Last count, at one hundred and ten.

Mental Misdirection

I rarely write about mental health, other than commenting on patients with crazy, disruptive behavior.

Across the Border

When you're driving home
And it seems like it's the same old way
But suddenly you're lost, and across the border,
To me it appears, it must be something like
The fellow with the Mental disorder.

Derailed thoughts
Like a telegraph line
With its wires crossed.

It doesn't matter if you remember
Where your home is,
You're still going to get lost.

So what can you do?
Find an alternate route
Or maybe get a new map,
Or get a mobile home,
Then you'll always be there.

10/12/82

In Training

Written in 1994; never posted. I worked for a University Medical Hospital for 20 years and don't regret a moment of it. The educational / training going on, with a variety of disciplines and specialties, was invaluable. Anyway, in the midst of that is a daily reality; Doctors in training, under enormous pressure.

Training the Scholars

Cirrhosis caused by too many years
Of IV drugs and a million beers,
Disabled with his Liver disease
He wants a medical miracle please.

On public assistance, he has no job
No health insurance plan to rob,
Sister Euphemia said, “you're in a pickle”
“Don't come to us, if you don't have a nickel”.

So, off to the University joint
We charge triple, that's the point,
All in the name of research and knowledge
You have to remember that this is college.

Last year in Biology, frogs in the Lab
This year an Intern, people on a slab,
Poking around for landmarks  unseen
Unlicensed drivers on every machine.

You chose the lifestyle of abuse and addiction
Now you're begging for help, to reverse the affliction,
You agree to proceed, did you pause to repent?
There's a chance you will die, but you gave us consent.

Your family is angry, they threaten to sue
But you know the truth, the blame is on you,
And it seems like a waste of our healthcare dollars
But then I remember, we're training the scholars.

1994

PTSD

Many nurses do report they have work nightmares, or what I call, Hospital Dreams. Invariably, mine would usually highlight a situation where it would be near the end of my shift, when I become aware that I have a patient that I have not visited during the entire night.

There were other really scary themes; for example, uncontrollable bleeding. Those are factually PTSD, from numerous real-time situations I took part in, working in the areas I spent most of my career in.

Anyway, last night I had two hospital dreams; surely inspired from real history.

Two hospital dreams
In one retirement night,
The usual thing;
Too busy, and making something right.

The first dream:
I was called back to work
To document a Death,
No neuro-responses
No heart beat or breath,
But when I looked under the covers
I discovered a central line,
Sure, there might be a reason
Still secured with some twine.

Although my wisdom is limited
My foolishness knows no bounds,
When I loosened that silly string
There were immediate whistling sounds,
Then some yucky liquid slime
Did gush from that central IV,
On the bedclothes and onto the floor
And a plentiful bit upon me.

Luckily, the clerk at the desk
Had stepped out for moment or two,
I grabbed a clean sheet for mopping the mess
Then shrouded the body, to hide any goo,
I looked for a camera, and found one above me
Thankfully pointing away,
When the Attendant returned, I submitted my notes
And cheerfully announced; Good Day!

Dream second:
I was working in that recent place
Though it looked like an ICU,
There were 38 patients to process
Our staffing was FUBAR too,
One of the patient's required 3 nurses
While over my way, a respiratory arrest,
Thank goodness I thought, K.D. is here
When the worst day happens; we're saved by the Best.
__ __ __ __ __ __ __ _

If you know K.D............you know what I'm talking about; she always saves the day!

Healing Methods

Make room for healing, as long as it is sanitary.

There is something else
Needs saying,
In many hospitals
There's a lot of praying,
Staff members idly
Belching, God Bless,
It usually involves Jesus
But I digress.

Little did they consider
Other ways of healing,
Wu Ji Gong methods
And Reiki, by the feeling,
Ascertained when I paused
Sensing the need,
Feeling the spirit
'Tis possible to read.

No matter what the method
It's hard to measure,
Each person has inside
An inner treasure,
To be treated properly
Be it drugs, prayer
Energy or touch,
Combination therapy
Is recognized as such.

Anesthesia in General

I'm sure everyone has experienced this kind of thing; a solution is derived, to solve a problem, but no research was done. Over time, as the complexity of the "problem" develops, further work around's are devised. When leadership chooses to make do with the process as it has developed, they smile and wave, beaming about their home-made solution. And when outsiders, look at the process, all they care about is...........can you process 38 procedural patients with prep, do-the-deed, and recover, tomorrow?
The outsider doesn't care how it's done (and neither does the Overseer), they only care, that it's accomplished. This is not a good and safe way to solve challenges in a hospital.


A systematic malfunction
Without a doubt,
It never matters
How loud ya shout,
When the powers that be
Refuse to budge,
Is this Anesthesia Recovery?
You be the judge.

Patients return from
From a Procedural lab,
They were intubated
On a padded slab,
Given Etomidate
And Propofol,
Fentanyl and midazolam
But that's not all.

But don't let me bore you
With persnickety details,
We pat ourselves on the back
Rescuing the fails,
When Pulmonary Edema
Happened in a flash,
A Code Blue call
Made everyone dash.

Take Joe Bob with bad kidneys
And a failing heart,
Slip in a pacemaker
So he can't depart,
But that's a misnomer
Breath is essential,
The surgical sedatives
Inhibit the potential.

Deep sedation
Is akin to anesthesia,
An LMA or oral airway
May look like paraplegia,
Demanding a nurse
Stands guard, no leaving,
Inviting aspiration
With imminent bereaving.

But, ask the Great Wizard
Do we recover Anesthesia?
Heck, delivering Yak twins
That would be easy-ya,
Than getting a straight answer...
How about a shake of the head,
Perhaps there will be a moratorium
When someone ends up dead.

Unearthing an old favorite

Here's one from 1992; nothing has changed. Actually, in my most recent job, I was no longer in a position to be administering paralytics like Pavulon or Rocuronium. It's just as well; having to do the hourly TOF's (train of four) was a bit tedious.

Mortal Irritation

Your mortal irritation
Is making me insane,
This pathological nightmare
Is curdling my brain,
If you continue this behavior
I'll be driven to extremes,
When pushed beyond my breaking point
I make up tortuous schemes.

The paralytic agents
Are the drugs I like the best,
If you irritate me one more time
I'll put them to the test,
And whether I sedate you
Depends upon my mood,
The more you irritate me
The more likely, you'll be screwed.

There are periodic rumors
That I'm approaching burnout,
But every time I work
There's a special nut-case turnout,
So for mortal irritation
I will paralyze for free,
And if anyone needs sedation
Why surely, that is me!

Cancer Cardiology

As has been my custom for many years, I attend a community Medical CME, get inspired and write some rhymer silliness. Well, I need to keep my own CE's up, and I attended a half day Oncology Update conference just yesterday. Here's what happened; 3 minor moments in time.

Slap a tumor

Is what he said,

Spank a tumor

To make it dead.

Profiling mutations

Sequencing genes,

'Tis incredibly confusing

What it all means.

_ _ _ _ _ _ _ _

Precision Medicine

Who came up with that?

Sounds like "evidence based medicine"

Already in the hat,

Every ten years

We need new terminology,

Describing the same old ideas

It's a type of psychology,

Revered by intellectuals

Providing fodder for conversation,

While statistically the outcomes

Undergo inflation.

__ __ ___ _ __ _

He's a big word man

Multi-syllabilic,

The words roll off his tongue

Convolutedly idyllic,

Loves to hear himself talk

Hoarding the time,

Thank god I found a way

To make it all rhyme.

_ _ _ _ _ _ 

Stretcher Bearer

These two first lines came to me in the period of lucid dreaming, just before I awakened.

Trial and error
Vials and terror,
Just the kinds of actions
That employ a stretcher-bearer.

Fractional Shortening

That title has nothing to do with my cooking skills, alright? One thing I often kept on the fringes of my situational awareness, was the possibility and influence of silent ischemia, under physiological stress. Often, this is a sequelae of low ejection fraction; commonly, one begets the other. Anyway,
I do know, that this concept was not a part of everyone's patient assessment skills.

Your Ejection Fraction
Can rule the day,
Do let me explain
It's worth it, I say.

What is the E.F?
It has to do with your heart,
How much blood gets squeezed out
The contractional part,
At the maximum push
On the arterial side,
The Left Ventricle, I mean
How much blood takes a ride.

This cardiac output
How much ejects, every time,
Doesn't empty that chamber
A paradox crime,
Where one might assume
A full on ejection,
But that isn't the case
'Tis a means of protection.

I could describe
A hundred different factors,
With 99 arguments
And other detractors,
Opinions and guesses
Expertise and understanding,
Massive strata of data
Some weak, some commanding.

Still, we measure indices
We compare and predict,
EF influences outcomes
How the heart doth constrict,
The workload, the demand
Regarding MVO2,
Myocardial oxygenation
Just between me and you.

50 to 70 percent
Is the rule,
The range considered normal
As a comparison tool,
The lower it drifts
We wonder what disease,
Caused damage to the heart
Let’s discover it, please.

The lesser the measure
The greater the risk,
Cardiac performance
No longer is brisk,
A threat of sudden death
With a failing pump,
Silent ischemia
A Troponin bump.

Keep a wary eye
When low EF is known,
If you detect subtle changes
Get on the phone,
Have a word with the Doctor
Share your concerns,
Save a life today
And everyone learns.