When I interviewed, I said that I had probably seen or experienced, every possible Heart-cath disaster/dilemma that one could imagine. Although some of those events were truly scary, they were all learning experiences. I've just returned from my 7th day of new job, and here was the dreaded retro-peritoneal bleed crisis. Sure that happens now and then, but 'tis all the more dreadful when the patient is completely disoriented, suffering from severe dementia and fighting like a trapped wild animal.

Just another terrifying, true story.

Shouldn't Be Done

It wasn't criminal or negligent
But it shouldn't have been done,
Although diagnostically wonderful
Heart-caths aren't for everyone.

Fairly youngish, only sixty
But fate had struck her, many blows,
A brain tumor and severe dementia
There is nothing that she knows.

Pre-cath she wandered frequently
Amidst our busy staging scene,
Frequent searches, where did she go?
She was the rambling queen.

After her cath and clean coronaries
It was our job to pull sheaths fast,
With the application of heavy pressure
On her groin, like a bomb-blast,
She started screaming and writhing
Fighting, kicking and trying to sit,
I'm telling you, it wasn't pretty
And all hell broke loose, I admit.

Two nurses pinning her down
One giving drugs to relax,
Blood pressure dropping to sixty
Pale and diaphoretic, those are the facts,
I saw the hallmarks of bleeding
Internally, that was my thinking,
Because I've taken this boat down the river
And I know the signs when they're sinking.

IV fluids wide open for volume
A little drug to quiet this poor lady,
Tachycardia was soon our companion
Her skin was so pale and too shady,
A Rapid Response was called overhead
What the heck, have some friends drop in too,
Get a couple of other, hot opinions
We better do something, before she's blue.

An emergency call to the Cath-Lab
Where her doctor is working on some other guy,
Ya, sure, take her down for a CAT-scan
That sounds like a good thing to try,
With the nurses running out the door
Racing that gurney down the hall,
Sure enough, she was sure bleeding
She won the ICU bed after all.

It wasn't criminal or negligent
But it shouldn't have been done,
Heart-caths are clearly, quite dangerous
Not frivolous exercises for fun.

Fibril_late;
9/9/11

There's nothing wrong with busy...........it keeps nurses off their phones, off Facebook, and makes the time fly. But sometimes if you look in on it, chaos will be your impression. The new job is a bit of all that

The Wild Magician

It's a dance, it's the rhumba
It's some crazy samba, my friend,
In the middle of the day
It's seems like there is no end,
At five in the morning
You might think you know these folks,
But they're just passing through
With all of their nervous jokes.

Let's take a moment to examine
To summarize the outpatient condition,
They are told to arrive two hours early
So we can prepare their admission,
Hopefully, they arrive promptly
To give us time to do their prep,
In theory, we're a well oiled machine
With everything going step-by-step.

Unfortunately, in real time
We dance to the tune of the wild magician,
From the doorway, it looks more like chaos
Combustible and approaching ignition,
Patients are waiting beyond the time
There were informed regarding appointment,
Because of an emergency with Billy Bob Borko
Extreme Unction, consecration and anointment.

But eventually this day shall pass
The most that need be done is achieved,
And as long as they continue to pay us
No one shall be aggrieved.

Fibril_late;
9/4/11

Why My Care is Better

Many people know this, but here is a reminder of how ridiculous health-care has become.

"Tying Medicare and Medicaid reimbursements to patient satisfaction was a component of the Patient Protection and Affordable Care Act, and will go into effect in October 2012."

That leaves us nurses with but one choice; time to start bribing our patients and families.

Better

I bribed my patient
To write a thank-you letter,
To describe my patient-care as great
Like yours, but mine is better.

But why, all the fuss
About these letters of thanks?,
Because these notes are like money
Into the hospital banks.

Don't call me cynical
When I know this is true,
Uncle Sam will pay us more
If patient-satisfaction grew,
Greater than our last tally
In the previous fiscal quarter,
Because these satisfaction quotients
Are the brick and the mortar,
Of the second-tier reimbursements
When private-insurance halts,
My patient's love me, baby
Because I bring them chocolate malts.

I pose to them a question
“If you could have anything tonight,
What is your desire
Just name it, in lights”
Because I have the power
To the kingdom, (and the keys),
To make your night easier
And surely, everyone agrees,
That a happy, satisfied patient
Writes the best, post-hospital letter,
And although, your care is good
That's why mine is better.

Fibril_late;
8/26/11

What the Hell?

This is a long one, but is my last opportunity to comment on a local memo, before I head down the road.

Nursing - What the Hell

I’m thinking of instituting a new Blog / Forum titled:
“Nursing – What The Hell?”

Don’t get me wrong, we nurses keep the world turning, but golly-gee, our leaders have the craziest ideas.

For example, the hot topic on the Staff-bathroom wall is the memo that includes the following paragraphs, outlining the latest “What the hell” idea; read along, and see if you agree. I have made special comments, as denoted by the asterisks.

Quote: “As we continue to provide the best care for our patients, we must improve our documentation accordingly. (In regard of Patient Turning Protocol)  H, D and L reviewed what was taught to the nursing staff regarding documentation of patient turns. We feel that documenting every shift that the patient was turned every two hours is inadequate. We would like for all of you to begin documenting the individual turns that are being made. For instance, if at 8am, you turn the patient to the right, you will need to document in the I-view, that the patient was turned to the right and so on…..

”We appreciate the care that you give our patients every day.(*1) We want to be able to acknowledge that care, by having you document it in the medical record.(**2) The nursing department managers will be auditing your charting and coaching you as needed.(***3) The data gathered in these audits will be reported back to you, as well as being presented to the hospital leadership team.(****4) It is our desire to see the documentation of patient turns to reach the 100% goal."(*****5) Closed-Quote.

This Author responds:

1* This is the sweet, feel-good stroke, before we’re slammed with the message

2** How exactly do they “acknowledge” our care, when we are documenting something? That doesn’t make a lick of sense.

3*** Now we’re going to be audited (to make sure we behave) and coach us if necessary. Oh boy, I love coaching! Perhaps it will be like my High School PE teacher screaming four-letter words during football practice. “Turn the G-D patient, you f**khead, or else I'm going to give you a jalapeno enema!”

4**** Oh boy #2, audit us and then tell the hospital leadership team; maybe they can coach us also.

5***** Look, if you want 100% compliance, we can all continue to lie about it in our charting (as usual).

6****** H, D & L = Huey, Duey and Luey.

It makes me laugh, how our whole frickin' management society in this country, want “100%” compliance. Nothing in nature will ever achieve 100% compliance. How about that cardiogenic-shock patient that will die if we turn him; the morbidly obese patient that fills the bed, and can not be turned; the need for three or four nurses to be available to turn a patient, when there are no nursing assistants; the patient that wiggles out of position within five minutes of just turning them; and so on. This directive is ludicrous.

There is a severe nursing shortage in America (if one believes the media) and for some reason management doesn't get a clue: we, your valuable, and supposedly appreciated assets, do not feel happy when we are threatened with “audits and coaching, to achieve compliance”.

It all comes down to one thing, you know you are truly valued and appreciated, when the Capo di tutti capi are threatening you. Booyah!

Fibril_late;
8/22/11
* * * * * * * *

When I posted my pseudo-flier on the wall in the Staff-bathroom (see flier below), some persons actually thought it was true, until they noticed the silly poem at the bottom. Ain't that something? We are so inured (hardened, accustomed) by these types of directives, as to be accepting anything (no matter how ludicrous) that comes our way. That must be the sign of a "true" professional.

Breaking News! Breaking News!

From the

Breaking News Department
Beginning September 1st:

Q2 Turns will require a Witness

And,

Coming soon!!!

XOXO Hospital, is opening a new RN position

Finally, at last;

Witness Nurse

Now, let’s all sing together:

Turn them to the left
Turn them to the right,
Turn ’em supine,
And say, nighty-night.

Turn them around
Forward and back,
Get a witness while you’re at it
It’s the Q2-turn attack,

(Repeat)

Turn to the left
Turn to the right,
Stand up, sit down
Fight, fight, fight,
Turn them on their side
Thirty degrees, on the angle,
Have a witness to prove it
It’s the latest fandangle.

Fibril_late;
8/22/11

_________________        __________________

I'm sorry to say but the Management did finally demand that we have a 2nd nurse as witness, to the actual turning of the patient. PATHETIC.

Hunt and Hess

Attached to our computer monitors where we chart, are a variety of laminated "prompts" to help us know stuff. I spotted this one last night, because we're a Neuro Unit now. One more reason I'm glad I'm moving on. But, the name of the thing caught my eye, because it had a nice rhythm to it. "Hunt and Hess Assessment Tool".

Hunt and Hess

If you really
Want to impress,
Use the scale
From Hunt and Hess,
For non-traumatic
Sub-arachnoid bleed,
Know your hemispheres
And who they feed.

Fibril_late;
8/22/11

The term, "evidence-based" always bugs me. It is supposed to be so cutting-edge. But that's this year; what about 5 years from now, when we debunk the whole thing? When there is new evidence, that we were just running around in circles (as usual)? I guess after we implement, nobody will give a rat's ass anyways. Well, out in the hayfield, there is always room for just one more.................

Sacred Cow

I could have written more
And maybe I will,
Could you get me some water
To swallow that pill?

You see, I'm feeling kind of dry
Parched mind, and not enough to think,
Just get me a glass of water
And give me some time to drink.

There is a lot to be said
And in time, I will say it,
I'll write the usual words
Like a dragon, I will slay it.

Retrospective analysis
Why, that's our bread and butter,
You know, I get all excited
Evidence-based, set's my heart a'flutter,
Then we can all run around
Thumping our chests, stomping our feet,
When we proclaim, we're “evidenced-based”
Why, good golly, that's so neat.

But don't inquire too much
About what we did before,
Why in the hell we did things, that way
How come, we chose the crooked door,
And then again, ten years in the future
When again, we look back to now,
What we think is evidence-based
Will be just another sacred cow.

By golly, I did write more
As if I was appointed, yay, it was my duty,
Now, if you love that evidenced-based stuff
Come on down, and shake your booty.

Fibril_late;
8/16/11

Goodbye; I'm leaving Timbuktu.

Timbuktu

Goodbye to all
Farewell, to thee,
I’m heading off
To Mercy-G,
It’s been a helluva
Wild ride,
But I’m crossing over
To the other side.

‘Tis like a family
Here at McAuley,
Just hanging out
With Mabel and Wally,
Their cousins and nephews
And grandchildren too,
Like a relative revival
In Timbuktu.

You know I won’t miss
All the crap that we do,
I’ll only miss
Mabel, Wally and you.

Fibril_late;
8/12/11

Feel The Ouch

I haven't written much about Diabetes
The old, the young, the grumpy, the sweeties,
A collection of persons
Everyday, on my path,
They have one thing in common............
At night, they get a bath.

Blood sugar samples
Every six hours
Or more often,
If the crisis is acute
Fingertips scar
They don't soften,
And if blood pressure is low
Maybe a repeat poke
A couple of times,
Even I, feel the ouch
In the midst of my rhymes.

Fibril_late;
8/5/11

It's official: I applied for a different hospital position, interviewed, was offered the job on the spot (seniority/experience) and accepted. I'll be moving across town to another subsidiary of this same system, and I'll be able to walk the one-mile to work. But what will I miss from my old job, when I switch over?

Won’t Miss

Nightly bath’s
And cranial drains,
Insulin drips
And hemorrhaged brains,
Delirium tremens
And the overdosed,
The suicides
That meet the holy ghost.

Respiratory failure
And the bundled VAP,
GI Bleeds
With smelly crap,
Gaping wounds
That just won’t heal
Because none of this
Has sex appeal.

Oral-care, and
Q-2 rules,
Turn and baste
And lifting tools,
High-tech equipment
Not ergonomic,
Break-room size?
Sub-atomic.

HAPU-this and
John Hopkins, that,
Acronym’s for everything
Like, who fell flat,
When the family demanded
Elmer, should ambulate,
After 3 months in bed
It’s too damn late.

Patient satisfaction
Driven,
Screw that up
You’re not forgiven,
Then top-end bosses
Will stomp and snort,
About that juicy
Government support.

Thoracot
Colectomies,
Post-op surgicals
Delivered free,
Into this
Convoluted place,
We cover all specialties
Of the human race.

The flier was on the wall
But I had to squint,
The matches were missing
And I had to use flint,
But when I lit up that paper
And followed the ink,
I found a position
That caused me to think,
And ponder the option
A most excellent adventure,
Could I apply in time?
That was the clencher.

I’m moving on
And heading back,
To Billybob
With his heart-attack,
The heart-failure group
And the E-P ablations,
Pacemaker placements
And aberrations,
Bypass and valvular
Heart repairs,
I’ll advise them on diet
And climbing stairs,
Take all of your Plavix
Your Aspirin and Statin,
And if you want to live
You better unfatten.

Can this old dog
Learn a few new tricks?,
I'm betting yes
In a couple of clicks,
And the walk to work
Is one heck of a bonus,
And surely, I won't miss
That pseudomas!

Fibril_late;
7/30/11

Back on April 19, I wrote about how our ICU was to be designated as the "go-to" Acute Neuro Unit. I know these things are decided up in lofty offices, and the community at large will benefit, but this addition of yet one more service under our belt, has caused a lot of anxiety and discontent amongst the nursing staff. There have been a number of classes and on-line educations available, and the "official" starting date, was August 1st. I've gone to those classes, and here is my take-away:

Neuro Class

Locked-in State
That's how I feel,
Becoming a Neuro-nurse
Makes me want to squeal;

My reticular activation
Is clearly in doubt,
Psychogenic unresponsiveness
Is my way out.

Nuchal rigidity
That's Viagra of the neck,
Who took the fun out of fundoscopy
Oh my, I'm a nervous wreck,
Then, there is “gaze preference”
Like when I'm lunching at O'Grady's,
My eyes are roaming the room
Looking at all of the ladies,
While Uncle Herniation, snickers in the corner
I'm checking his accomodation,
He has pathological reflexes
And a sociopathic fixation.

They're giving Imhotep
A dose of Nimotop,
Buried alive and resurrected two times
His headache, just won't stop,
It's a neurological emergency
Mummification, just didn't suit him,
Probably the only recourse we have
Is to take him out back, and just shoot him.

GPS vs. GCS
What the two of those are
I don't know, I'm under duress,
Global position system, and
Glascow coma scale,
Search and seizure, I'd rather avoid
The thrill of it is beginning to pale

So, Monster Jobs
Is calling to me,
My motor activity
Will set me free,
Jump in my car
Put my foot to the floor,
Take a look at my “run sheet”
As I'm racing out the door.

Fibril_late;
8/3/11

My best of all friends had a “global” spinal fusion a couple of days ago. The surgery was perfect and the care sucked. It's true, and if you could know all of the transgressions, you too, would be shocked.

My friend is a highly experienced critical-care nurse, like myself. Nine out of ten of her visitors were from the same crowd. Did that make a difference? Not really, but we were there as her witnesses, journal-persons, and safety-net. She went home a day earlier than expected. Why? Because every hour longer that she stayed in that hospital, was one more hour that somebody could screw up.

To an outsider, that may seem harsh. But, in truth, it was reality. I know, because I was there to witness the debacle. I'm sorry to say, that I work for the same employer, across town at a different facility.

There was an old saying, like a kind of prayer, that went like this: “Lord, have mercy on us/me”. Unfortunately, my best friend was a recipient of that mercy-style care. Ouch!

Un-Care

Diagnosed you were, indeed
With a surgery, to boot,
Unintentionally, under-medicated
You were primed, and ready to shoot,
Just name the perpetrators
The participants in this crime,
More focused on a policy
Than patient-advocate time.

Just forty-eight hours duration
Is more than enough, when care is lacking,
When you want to run home, screaming
And send those care-givers packing,
To be ignored, and accused, and betrayed
By fellow nurses, who treat you like dirt,
Unwilling to accept that their errors
Are at least half of your feelings of hurt.

Who is to blame, and what is the problem
I'm embarrassed, because this is my employer,
Where mercy should be doled out to everyone
But now we're looking for one good lawyer,
To right the wrongs that were experienced
To prevent future scenario's like this,
So that persons who follow beyond us
Might be protected from this careless abyss.

Fibril_late:
7/22/11
_ _ _ _ _ _ _ _ _

A Guiding Principle

A common surgery
With the best doctor,
Turned out to be a gamble
In the absence of a proctor,
A guiding principle
Of good care and compassion,
Instead, you were abused
In the worst fashion.

The surgical intent?
To alleviate pain,
In the post-op period
It was a ball and chain,
Dragging you under
While caregivers watched,
Their morals and ethics
Completely debauched.

How can that be
In this day and age,
We have been counseled
That pain, is front-page,
And nurses stand by
As guardian's at your side,
Instead, you were assigned to
Beelzebub's* bride.

How could they, not act
To alleviate your pain,
Stand up for your needs
Isn't this their domain?
To act as an advocate
For those persons in their care,
Instead, you were trapped
Within the dragon's lair.

We sat there and witnessed
And I have written, what I know,
Guiding principles were lacking
Nursing was absent at your show.

Fibril_late;
7/24/11

Beelzebub* = Satan
__ __ __ __ __ __ __ __ __ __

A Transgression – No Compassion

A transgression, a crime
Perpetrated upon you,
Oh, where was your error
Just what did you do,
You chose to have surgery
In a well known place of healing,
But the care you received
Was absent of feeling.

Is that a crime in the courts?
Probably not, but I suggest,
That nurses, who choose this profession
Should be offered a test,
Where they imagine their child in bed
Suffering life-threatening pain,
Will they stand around and argue policy
Or get on the phone with Dr. Humane?

We test Nurses on experience
And we test them for knowledge,
We check their credentials
And we applaud them for college,
We welcome them readily
When they come from afar,
But we don't test them for compassion
And that would reveal who they are.

This “calling” of Nursing
Is legitimate and true,
We're seeking a few good souls
Who'll take the best care of you,
And hopefully, we'll be watching
For the weeds, yes, pluck them out,
Because Caring is an advocacy*
That's what Nursing is all about.

Fibril_late:
7/26/11

*Advocate: Noun: person who pleads for a cause or propounds an idea
Verb: speak, plead, or argue in favor of

On The Bottom

Over many years, I've seen a metamorphosis and evolution of skin dressings, protective barriers, wound packing’s, etc. These are used to either promote healing, protect skin, and now days, prevent the formation of bedsores. Sure, those breakdowns have some fancy name like HAPU, but it's the same old story, as usual. Ya gotta see the humor; one of our computer charting Plan of Care selections reads, “At Risk For Skin Integrity”. I'm not kidding. How about that for a typo? Whoa there, I better be careful, my patient might develop integrity of his skin; I better leave him on the bedpan for a few hours.

The latest new product we are using is a dressing for the sacrum, to be used on all patients who are on a ventilator, and any one else who might get a HAPU. Last night one of the patients had his Mepilex dressing changed four times, because he had a CRAPU! By golly, we really got to the bottom of that problem, right away.

On The Bottom

Mepilex, oh Mepilex
Advertised as
“Butt Protects”,
Use it on
Your infant too,
A cover-up
For baby poo.

Mepilex, oh Mepilex
For the kitchen floor
And redwood decks,
Water proof
And rot resistant,
Placed properly
With one assistant.

Mepilex, oh Mepilex
We employ it often
Like a hex,
To ward off bedsores
On the bottom,
We don't care
If you already got'em.

Mepilex, oh Mepilex
For on-line dating
And couples connects,
Way better
Than those churchy meetings,
Though I don't know
About Twitter tweetings.

Mepilex, oh Mepilex
There are special versions
For rated, “X”,
Check our website
Adults section,
Then left-click right
For that selection.

Mepilex, oh Mepilex
The best protection
For having sex,
Self adhesive
And hydrophylic,
Try it out
'Tis life idyllic.

Fibril_late;
7/12/11

Sure, we always do a Skin Assessment when we admit someone, (and of course 2 nurses sign on it), but now, Sister Euphemia wants us to do a Sin Assessment!?! Can you believe it?

Sin Assessment

Down at Sister Euphemia's place
Everyone working has a happy face;

You might think it's natural
But the water is tainted,
One day I drank so much
I almost fainted,
Swooned, I did
With ever-expanding joy,
I gotta be thankful
Because they do employ,
All sorts of us heathens
That follow a different path,
Sister Euphemia states;
Just give a good bath.

When a new patient arrives
We assess them head to toe,
Using all of our five senses
And technology for the show,
Charting hundreds of check-marks
On many drop-down lists,
If something is wrong
We have to see if it exists.

Now, since this is a Holy
Hospital place,
We evaluate the sins
Of the human race,
And then we'll formulate a care-plan
To wipe clean your dirty deeds,
Medicare demands it
Stating, “address all of their needs”.

Who can argue with that?
And Sister is paying,
We always do what she says
If we want to be staying,
At this heavenly job
Hell, it's Paradise, after all,
If you need to be employed
Why, just give us a call.

Fibril_late;
6/9/11

Gee, it seems like every other week, there's another protocol dropping in our lap. Half of the time, it's a new one, just like the old one, but a little bit different. They want to sell it as new, but it's just a revision. It's "evidence based", but wasn't the other one too, and if so, does that make us just a bunch of liars, in retrospect? If so, I'm going to confession, asap, before Sister Euphemia finds out.


Protocol Prognosticator

Protocols to the left
Protocols to the right,
A protocol for Sepsis
And Neurological blight,
As it was in the beginning
Is now, and never ending,
Protocols are the lifeblood
That experts are recommending.

Protocols are guidance systems
Armed and ready to fire,
Like everything in life, my friend
The circumstance is dire,
Poised upon the precipice
Of critical mass and disaster,
Just fire up that protocol
And you will be the master.

Large-group studies do propose
That if we read statistics right,
Some protocol will save us
In the middle of the night,
Despite apparent random selection
And other wild-cards of duress,
I propose a simple toss of a coin
As a worthy prognosticator, of success.

Fibril_late;
6/8/11

Little Miss Last Century

Wonders never cease. She's one hundred and four; Alzheimers, dementia, blind, living in the nursing home. A GI bleed brought her to the hospital and a visit to Interventional Radiology, where she had a cardiac arrest on the table. Well yes, of course she is a full-code, because her adult kids want everything done. Now she's on the ventilator in our unit, with the family expecting a "full" recovery!?!

One Hundred and Four

One hundred and four years of age
As if that’s not too old,
To perform goddamned heroics
And still the family will scold,
The doctors and nurses,
During that long CPR,
Because Momma is busted
Like a broken down car.

Suffering forty years of old
She went bad, after sixty-five,
It’s a wonder, this woman
Can even claim to be alive,
She has a spongiform brain
And Alzheimers too,
Her children are convinced
That she can still count to 2.

She’s on the ventilator
She had a GI bleed,
Her skin is like tissue
Where the bacteria feed,
Her heart beats a rhythm
Unclassified in the books,
This is not rocket science
Despite how it looks.

She's just an old, worn out woman
She can't tell day from night,
But her family wants everything
And they're willing to fight.

Fibril_late;
5/25/11
__ __ __ __ __ __ __

Grandson

Grandson takes care of her
He's on the county dole,
He's hoping she'll make it to 105
Before he puts her in the hole,
Then he can put all of his attention
On his sadly, stroked-out Mother,
He hasn't been employed in ten years
So he'll be looking for another.

Impaired relatives are his specialty
They can name him in their wills,
Who would ever suspect this caregiver
Who is handing out the pills,
Yes, this grandson, is a piece of work
He's found his niche in life,
Taking care of family members
Instead of taking a wife.

I'd be careful if I went visiting
To the house of his holy endeavors,
Expecting trap-doors in the floors
Controlled by hidden levers,
Incapacitating me in the process
To become, his next bedridden fool,
Suffering to the very end of my days
As his financial-freedom tool.

Fibril_late;
6/2/11
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Little Miss Last Century

Extubated at last
Comfort measures, and a no-code,
Maybe Miss Last-Century
Can finally retire to her abode,
An impending celestial discharge
To be carried gently to her Heaven,
Her grandson stepped out
He's down at the 7-11.

Pain and suffering
And unsavory medical measures,
Are finished at last
She's done with earthly treasures,
She may appear unconscious to us
But she's in direct communication,
As the Divine beckons to her
Her spirit reaches out, with anticipation.

Grandson raises a ruckus
When little Miss Last-Century dies,
Five minutes after her transfer
He's full of anger, that's no surprise,
He lost all precious control
When Grandma finally checked out,
His true nature clearly exposed
Absolutely, there's no doubt.

Sweet, little Miss Last-Century
We suffered too, there by your side,
Administering your care so gently
Until the day that you died,
Rejoicing in our own ways
That you cast away the shackles of Earth,
A little piece of advice to you
Take a long rest, before your rebirth!

Fibril_late;
6/3/11

On the theme of old nurses again..........I'm one of them.

Diagnosis: Aging

It's a strange world I live in
As nurses, we're getting older and aging,
Body parts moving around
And other battles are waging.

High blood pressures
And gall-bladders perturbed,
Crazy habits that we had when we were younger
Now just leave us disturbed.

Quite a few things we used to eat
That we no longer can do,
Most of us have gotten fatter
And a few of us can't chew.

And now we stand around the water cooler
Chewing the fat,
Talking about our body image
Because that's where it's at.

Like some kind of one-upmanship
My disease is worse than yours, Mabel,
Then she talks about her high blood
Diabetes and psoriasis
And man, I don't want to be at her table

We compare our doctors
Our therapies and our medicine,
You think yours is better than Einstein
And mine is better than Edison.

Some talk about their family's
And their irritating habits,
Others exaggerate their problems
Like reproducing rabbits.

This is life after 50
We’re all drifting downhill,
The diagnosis of Aging
Is one bitter pill.

Fibril_late;
5/15/11

I heard the term, "hostile abdomen", while attending a seminar yesterday. I immediately recognized it as the perfect line to a new poem; have a look.

Hostile

He had a hostile abdomen
An angry bowel,
A devilish duodenum
And a gall-bladder scowl,
His kidneys were complaining
His pancreas perturbed,
His liver was livid
And his spleen was disturbed.

All in all, his hostile gut
Was threatening to rebel,
His appendix was the renegade
Leading them all to Hell.

Fibril_late;
5/15/11

By and large (sometimes, very large) here in the nation of California, we are generally, a baby-boomer nurse constituency. So what happens around the proverbial water cooler? Yes of course, we talk about our own aches, pains, disorders, changing shapes and so on. And just like our patient population, we would all benefit if we could only improve our choices of food. Anyway, that's my diagnosis.

Diagnitis

When Diverticulosis
Becomes Diverticulitis,
You'll know your diagnosis
Has become a diagnitis.

Your doctor advises
Take no nut,
Because they won't exit
Out your butt,
Instead they'll fester
In your gut.

Sage advice
One would think,
That's nuts and bolts
And the kitchen sink,
Don't be chewing
On that chunky stuff,
Your gut will protest
And scream, “Enough!”

Pain will ensue
And you'll visit your doctor,
He'll advise colonoscopy
With a GI proctor,
Inviting all sorts of
Differential diagnoses,
Scaring the crap out of you
With your diverticuloses.

Get a clue now
And change your diet,
But if you don't want to
Please keep quiet.

Fibril_late;
5/13/11

The PoGlobin Index

It speaks for itself:

PoGlobin Index

An anomaly last night
Caught my ever-sharp attention,
There were laboratory values
That deserved a special mention,
The potassium was high
And the hemoglobin low,
In fact, their numbers matched
I saw the light, and it did glow!

A new prognostic indicator
Struck me on the head,
When the “K” and Hemoglobin match
You might soon be dead,
In the telling, what the value read
Was a gentle seven-point-two,
But those of us, who know the stuff
See the Reaper, coming for you.

Values incompatible
Organ systems halt,
Prognostic probes and platitudes
Propose a deep gestalt,
Code-status lurks beneath the waves
With nurses standing by,
Will we flail another suffering horse
Or wave a fond goodbye?

The new PoGlobin Index
Could revolutionize our field,
Retrospective analyticals
Would have a tool, that they could wield,
In the ever growing science
Of hindsight recognition,
PoGlobin Index data
Would be like gold to statisticians.

I am sure my future practice
Critical-this, and that beyond,
Whether here in good old USA
Or there, across the pond,
Will build upon this moment
Of genius in the rough,
PoGlobin Index was my baby
Building my fortune and that's enough.

Fibril_late;
5/3/11

Nightmare*

My nightmare came true
During that 12-hour shift,
I had a one-to-one patient
Plus two others, get my drift?

My dream came to life
On that 12-hour trip,
I was a desperate crewman
On my own sinking ship.

No, I couldn't do the things
That needed to be done,
I couldn't load the bullets
Into my gun.

I couldn't shoot the captain
Of this crazy ship of fools,
Because our leader was missing
Having broken all the rules.

I couldn't do my duties
That needed to be done,
But nobody died
So I guess, somebody won.

Fibril_late;
5/3/11

(* It's a recurring nightmare that I've had for years, where I've “forgotten” a patient for an entire shift.I'm sure it is a symptom of work-related PTSD, but still, to act it out in reality, is disconcerting).