Guess Who Called

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

Guess Who Called

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

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

Doing Nothing, May be Harmful to His Health

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

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

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

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

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

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

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

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

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

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

Bloody Mess (again)

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

Bloody Mess 

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

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

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

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

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

Insensitive

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

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

Brain Salad Speech

Near the end of 12 hours

And 40 million thoughts,

My words become garbled

And I begin to see dots,

Speech dyslexia

And sentence destruction,

Like a garbage disposal

Applying suction.

So, who could blame me?

A spousal wife,

When she misunderstood me

And pulled out a knife,

Figuratively speaking

Claiming, I was so rude,

When I asked her, "Now, what?"

I'm an insensitive dude!

"Now what can we do for you"

Had a couple words missing,

She immediately looked daggers

Sputtering and hissing,

I had no way out

Not even an apology,

It was her misunderstanding

And abnormal psychology.

For the next two hours

I avoided that room,

After she took the time to tell me

All dire and doom,

That folks where she works

Over at Hospital X,

Would have tossed me out the door

With a doubled-down Hex.

At 12 hours plus

I have a disability,

This ancient nurse brain

Has lost some agility,

Manufacturing speech

At the drop of a hat,

“Now what (do you need)”

Is not more than just that.

2/3/18

In the Details

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

Parasystole

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

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

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

Candidly Speaking

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

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

Hip Hop Nurses

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

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

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

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

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

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

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

Kind of Crazy

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

Dental Dana #65

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

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

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

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

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

Crazy Wombats

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

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

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

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

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

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

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

Undisputed

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


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

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

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

It's a New Year Editorial

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

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

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

Gash

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

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

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

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

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

What We Do

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

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

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

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

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

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

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

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

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

Out-Patient ICU

Out-Patient ICU

Has a nice ring to it, ya.

A day in our hidey hole

Just another average, no crisis day.

Pool of Anxiety

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

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

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

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

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

Turn, Turn, Turn

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

 Turn, Turn, Turn

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

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

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

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

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

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

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

Enough all ready

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

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

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

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

Psychogical Manipulation

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

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

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

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

Old Fool

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

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

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

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

[dedicated to another Old Fool]