Itchy

Coronavirus vs. Aromavirus:
Sounds similar doesn't it? Well, listen up and I'll explain it all.
Also, this poem is not about me being itchy, but all about the play on words.

Sometimes at home
I have an attack,
I get itchy and red
On my hands and my back,
It seems to happen most often
When my wife does her cooking,
I wonder what could it be?
So now I am looking.

Is it a simple allergy?
A bush, bug, or tree,
Did I eat the wrong thing?
And now it's inside of me,
Was I bitten by a snake
Or some other kind of predator?
I’m searching the Journal of Medicine
And letters to the Editor.

Little raised red bumps
Itchier than heck,
It started on my torso
And now it’s on my neck,
Traveling down my legs
To the bottom of my feet,
I can’t possibly go to work
Until I’ve got this thing beat.

It’s springtime in our region
Could it possibly be a flower?
As a child it was grasses
That held the itchy power,
I was tested for Allergy
Revealing dander and Iris,
The doctor said, sonny
You have Aromavirus.

He told me, “Kid, wear a mask”
Not the Halloween type,
Beware of new plants
And more of that hype,
Plus, I was introduced
To some magical beans,
The first generation
Of Antihistamines.

In High School I discovered
The drugs had more potential,
If I took four or five of them
I felt existential,
If I added something more
I could channel Miley Cyrus,
Then I knew I had conquered
The dreaded Aromavirus.

That doctor was a trailblazer
Naming my condition,
Now it seems once again
There is a similar rendition,
So I’m filing a lawsuit
A play on words, this something new,
Corona sounds too similar
And compensation is due.

Oh, Pharmacist

This is a gathering of several Pharmacy themes, coming together into one poem. Naturally, ideas pooled from real experiences.

The Pharmacist is a special player
A fount of knowledge, not a soothsayer,
Can be sweeter than a Tasmanian devil
When conversations are on the level,
If discussing matters
Regarding toxic ingestions,
The Pharmacist poses
His list of questions,
What’s the body-mass index
Their age and gender,
Was this a single shot of heroin
Or an overnight bender.

There once was a Pharmacist named Maury
All caught up with his power and glory,
He sold dubious potions
And age reversal lotions
From the back of a busted down lorry,

At his job on San Juan Avenue
In the middle of the city,
Pharmacist Maury
Was sitting pretty,
He was controlling and ornery
If you know what I’m saying,
If I needed something STAT
He might start delaying,
Telling me fourteen other people
Are ahead of me in line,
“ But Maury, if we wait
This guy will be dead on the vine.”

I think working at night
He felt like King of the pile,
With the power to delay
Making us wait for a while,
And I could never figure out
How to play to his good graces,
Never saw the dude smile
Only his control-freak faces.

Other places that I worked
Pharmacists went on rounds,
To be part of the discussion group
Dicing kilograms and pounds,
And the best time to have a Pharmacist
Right at my side,
During a Code Blue situation
Before somebody died,
With that dude on hand
To dispense all those drugs,
Handling the conversions
And refilling our mugs.

Ya, those chaotic scenes
In the University setting,
Sounded like Billy-Bobs club
With everyone betting;
“Hey, pass me a lidocaine
No wait, make that two,
Plus three epinephrines
And an epidural screw.

But there were the times
At other hospital places,
No Doctor or Pharmacist
Arrived to show their faces,
Until the very last minute
A chance to do some billing,
Yep, someone gets paid
Even when there’s a killing.

A Pharmacist in the family
Well that would be handy,
He will know what I mean
When I ask for some candy,
Plus he can probably get it
For pennies on the dollar,
Or sneak them out of the shop
Under a starched linen collar.

Pharmacists are the second
Most trusted professionals,
Good Catholics each one of them
With a guaranteed confessional,
To absolve them of sin
Should they waver from their path,
Like bringing home candy
And cheating on their math.

Monkey Smart

At my previous healthcare organization, we were unionized and that truly is a good thing. However, the downside is, that the pay was divied out based on how many years of experience a nurse had worked. 0-5, 6-10, 11-15, 16-20 and beyond. That was the basis; not talent, motivation, effort, productivity, or even showing up. Regarding that last feature, I probably averaged 3 sick days per year and took a short vacation once a year. Bobby-Joe would call in sick three days a month, take four vacations, beg to be sent home when the daily hours dipped, refuse to keep up with medical knowledge and skills.........and still, if his years of service matched mine (and like me, hadn't killed anybody) then our evaluations were equal. Essentially, even a monkey could do this job.


Today I spent an hour
Shredding old papers,
Those yearly evaluations
The most worthless of capers,
Where the best of employees
Just get a pat on the back,
"Keep up the good work, Bob
You got everything on track".

The stupidity of it all
Is that even the flunkies,
Get paid the same level
Like we're a gaggle of monkey's,
Vying for sweet treats
Plush toys and balls,
Yep, every year is the same
As we bounce off the walls.

You Want Me to Do What?

At Med-school training hospitals, new cycle Interns-Residents are quite often nervous or anxious about doing new things. Sometimes that new Doctor will be bossy, arrogant and argumentative with the new-found sense of power they can wield over others to do a task they themselves, are unfamiliar with. This kind of surly behavior is not welcome to the great society of ICU nurses who know it is their sworn duty, to iron out the creases so readily apparent on the surface of the newly manufactured doctor.

You Want Me to Do What?
No, Doc; you can do that,
A typical Nurse response
To Resident Brat,
Who boldly suggests
Some outlandish proposal;
Dude, if this doesn’t work
You’ll be destined for disposal.

That day Joe Bob had a fever
The 900 pound man,
Laying on two attached beds
Plus a ventilator and a fan,
I needed that Resident
The night guy on call,
He said, you know where to stick it
The suppository Tylenol.

I’m not doing that
Not this nurse, not me,
That’s clearly an experience
For the new Doc on the tree,
To explore the heart of darkness
The depths of the unknown,
Just wear a mask, and 3-foot gloves
I’ll stand by and chaperone.

Rabbits

I am sure every Nurse has discovered something very unusual about a patient, that had been not been communicated during report, or wasn't in the patient history document. The overlooked amputation, the hand with seven fingers, a third breast, or a ginormous schlong; true eyebrow raising discoveries or phenomena.

Rabbits

There was a really big thing
One time, that I saw,
When I lifted the covers
And there ought to be a law,
Where patient's inform us
About their physical anomalies,
Pastor Bob, said
It helps with my homilies.

Every Sunday morning
Delivering the sermon,
He gestures like a hip-hop star
Grabbing his herman,
To emphasize points
In the body of the teaching,
Well, I wish I had known that
Before I went reaching.

At the pre-op appointment
Complete an intake form,
Discover the anomalies
Compared to the norm,
Ask about his medicines
Diseases and habits,
Become well informed
And watch out for the rabbits.

Nostalgia not

Anytime I feel a teensy-weensy bit nostalgic for working with my old pals; all I have to do is go to my blog and read writings from the seven years I spent in the Diagnostic Cardiology unit. There were so many times that we were understaffed, where we truly worried about the safety of our patients, and our unit managers refused to create solutions. Sure, there were instances where the day shift was helped, but there were no evening shift solutions. From what I've heard (since my departure), Recovery area staffing has been improved, because the workload increased upward a couple notches. Cardiac Surgery is doing more catheter based valve repairs and the EP Lab added another performer. Additionally, the outside vendor, added their own EP practitioner too.

My favorite tasks to do were recoveries and special procedures such as TEE, Bronchoscopy, Cardioversions, because those duties were closest to what my years in ICU had been like; highly technical one-on-one care. For nurses that work beyond age 60, I think the most of them have to come to terms with the physical demands of the job, and the potential for more injuries. Also, I had reached my limit on patients bleeding and sequelae of those events; I was bloody well done with it.

Hospital; I'm done. 

I'm not nostalgic
Regarding all that stuff,
For forty long years
I was tough enough,
Responding to emergencies
With expertise,
Now I would rather visit
Mountains, rivers and trees.

Insulin for All

What are the odds regarding a medical mistake?
To happen twice in two months; news that isn't fake,
Regarding Insulin injection not on hospital grounds
The community at large is not out of bounds.

Insulin is dangerous, if it isn't needed
Blood sugar dropping completely unheeded,
Brain cells die fast, but it's just teenagers, right?
Maybe no one will notice at the end of the night.

Who packed the supplies before they were used?
The vials look different, how could they be confused?
Who was giving those shots, was it a regular assignment?
Or some dubious cause; the stars were not in alignment.

In the hospital we are advised
Perform two-person verification,
On many dangerous drugs
For self preservation,
Because if you screw up
And somebody dies,
You won’t be saved by your
Tears and your lies.

I’m pretty sure all nurses have medication errors
And some drugs can give you the willies and terrors,
Imagining the outcome with Nipride or Isuprel?
Take it from me, things don’t go so well.

Even a simple vaccination or TB skin test
Deserves the highest of caution, to perform at your best,
For the safety of the customer, as well as your career
Also, turn off your cell-phone, when the public is near.

Sept. 30, 2019: https://www.wishtv.com/news/local-news/students-hospitalized-after-receiving-insulin-during-tb-skin-test/

November 7, 2019:
https://www.kjrh.com/news/local-news/insulin-shots-given-by-mistake-instead-of-flu-shots

QRS Measuring

Basic EKG / ECG monitoring skills and certification, are now standard requirements in many hospitals and clinics. It certainly helps to have some prior exposure to the concepts, but in our class, it is not demanded as a prerequisite.

One of the most difficult skills to acquire, is the accurate measuring of the width of the QRS complex. We haven't been talking about the J-Point all this time, but now I have proposed that it become a part of our curriculum; this is currently under review.

Measuring Q

QRS measuring
It is tough to get it right,
Without proper instruction
Or low light at night,
One needs to understand the process
Of electrical action,
Dynamic to passive
To complete the transaction.

Does the monitor display
Just one line or six?
Are the QRS segments
Where they belong in the mix?
Because sometimes a Q-wave
Doesn’t show in the picture,
Or the R-wave went south
Like an esophageal stricture.

And what about that S-wave?
New students pass it over,
Measuring to the far side of the R
Like a hostile takeover,
Staking a claim
That the QRS is point-oh-four,
On an adult with heart disease
You need to double that score.

An important understanding
Regarding ionic flow,
Depolarizing is fast
And Repo is slow,
Thus, the QRS vectors
Show as quick straight lines,
Whereas repolarization
Has sloppier designs.

Is the ST-segment elevated
Or below the Iso-line?
Both will skew the measuring
So you must carefully assign,
The ending of the QRS
The crux of the problem at hand,
It is time to meet the J-Point
To fully understand.

The J-Point is found
At the S-wave end,
There is a shifting in direction
Like at a corner, then a bend,
It may be subtle or bold
The transition in the flux,
Study carefully the waves
Before you shoot your ducks.

Out of Alignment

After my previous post, where I covered why I'm still writing............to be a voice, that tells the stories; a loyal reader pitched in with a wonderful tale, which in fact, I was a witness to. It was fun writing about it (circa 1991)

Out of Alignment

Oral cavity cleaning
Turns out, is a really good endeavor,
When you are an ICU patient
And you don't want to be there forever,
If we keep your mouth clean
Your bacterial burden will be reduced,
Less chance of acquiring an infection
Where you might be double deuced.

But don't assume it is without risk
What if you have a loosie juicy jaw?
Your Nurse is armed with a toothbrush
Your jaw goes sideways, oops, was there a flaw?
You say," You know, that happens sometimes
And I have to go to the Dentist to get it fixed",
"Honey, we can't do that, but we've got drugs
That can get anything unmixed".

It was not an easy maneuver
To get her jaw in alignment,
It took Morphine and Valium
And group consensus refinement,
Ultimately, the ENT resident
Straddled the patient
Right there on the bed,
Pulled out his Home Depot vice-grips
And rearranged her head.

Betty woke up and her jaw was working
The ENT resident was gamely twerking,
And sweet little Vanessa, the toothbrush dame
Knew that someday this episode would earn her some fame.

Tell Your Story

People keep posing; "Dude, you're retired, why are you still doing stuff". Well, I did finish at Hospital X, and I am of the age, but my brain and passion hasn't turned off at all. Therefore, I keep writing new material because it is needed.

I needed to keep writing
Because that is what I do,
In the setting of duress
Whether around me, or you.

Maybe I could have written blues songs
And sang my heart out in seedy bars,
No, I went to college
Instead of renovating old cars,
And got an education in medicine
On a caregivers level,
Partly because my name wasn't BB
Or a brother named Neville.

Still, I heard all of the songs 
That humanity could sing,
Amidst life and suffering
And the other thing,
Where a transition is made
For the dearly loved one they miss,
The saddest thing of all
When there is no one to offer the last kiss.

That is why I keep writing
There is a heck of a lot more to say,
If you have some kind of experience
Let me know; I'll write about it today.

Questionable Emotions

Just like the poem X-Tensive and Zanzibar, just below this one, I discovered I had not written a Q poem. I am astounded, that in 40 years of healthcare related poems,  somehow I missed on Q, X & Z. 
Well Q had an answer to that.

All of us bedside nurses know about patients who don't communicate their needs well, but by golly, they sure know how to express emotions. Unfortunately, that does not guarantee we understand what the heck they are so excited about.

Questionable Emotions

Quietly suffering

The stoic fellow,

The gruff and manly

Everything a bellow,

Whimper or cry

At the drop of a hat,

Or the expressionless

Psychologically flat.

Trying to analyze the meaning

With or without words,

Is akin to interrogating

Exotic birds,

Unfamiliar, without context

Like pain, potty or position,

Grasping for meaning

Before I call the physician.

X-Tensive

Hypertension should never go untreated. Sure, we all know that, but many folks out there treat high blood pressure with the same respect as use of seat belts. They figure, "well, I feel all right now, I'm safe, so what's the big deal". How about death, dummy?

You have heard about Hypertension
It's a killer that's for sure,
Be careful what you read sir
No herb can promise a cure;
Unless that plant should kill you
Then your hypertension is gone,
You'll be sleeping six feet under
Over at Forest Lawn.

What you need is a decent doctor
One of modern medicine,
Preferably a well trained scholar
As bright as Thomas Edison,
Don't go to that guy on Craigslist
Offering chelation care,
The only thing cured will be his wallet
While you suffer a stroke, getting there.

Hypertension therapy
Usually requires medication,
You might need to lose weight and quit smoking
With commitment and motivation,
But if you consider no treatment
You better learn what your risks are Pop,
Get a couple million dollars of life insurance
For your family when you blow your top.

Flat Line

I realized I had not even a single "Z" poem, to round out an alphabetical collection I'm putting together. Here it is:

Zanzibar

Zanzibar;
I never wrote about that,
Could have been a great code word
As the vital signs went flat,
When Betty Sue checked out
Without any warning,
The family looked shell-shocked
In unexpected mourning.

It was a memorable transfer
From a hospital nearby,
Famous for screw-ups
Sending sick folks to die,
To save their reputation
Although, how could it be worse?
A death sentence hospital
The place had a curse.

Betty Sue landed
In cardiogenic shock,
There weren't many hours
Left on her clock,
And sadly, she didn't make it
To the end of our shift,
Zanzibar showed up
If you catch my drift.

Upon arrival we noticed
IV's, two weeks old,
Central-line insertion sites
Growing with mold,
It was truly disgusting
The level of substandard care,
She barely lasted six hours
It was a Zanzibar affair.

Zanzibar
Has acquired a definition,
Unexpected flat-line
Completing the mission.

Truths and Tweets

This isn't one of those blogs that hauls in a seven figure influencer income; not a chance. I'm thrilled when I can see that five to ten people take a look at anything I post. That's my style; subterfuge and secrecy.


Only a few folks check in
I examine those details,
In no way does it sway me
I don't consider wins or fails,
No, it's all about camaraderie
Maybe someone is reading my writing,
In my way, I am sharing community
Don't give up, it might just be the lighting.

I have read about, the nurses that quit
Realizing the first year, this job is tough,
Without support and analysis
Hazing perhaps, old crews can be rough,
I experienced some of that nonsense myself
I conquered it, I made sure that I knew more,
Than anyone that I might encounter
Trying to force me out of the door.

Whatever the reason
Thanks for reading my words,
Ideas fly over to me
Like wisecracking birds,
If I take the time to feed them
Sugar water and various treats,
They might sing to me in truths
Telling stories with short little tweets.

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.