All those damned credential abbreviations again, and I have to go off and invent a new one. Sheesh. But hey, it applies to me. I'm the aged nurse, heading back into the ICU, following a few years of retirement. So, for all of you like me, RN = Reincarnated Nurse!

Reincarnated Nurse

I'm just an aged RN returning
To the original scene of the crime,
The question that everyone's asking
How many years has it been, since his prime,
While the average age of a nurse
In California, is just forty-seven,
30% of us, clock over 50
You might say, we’re just closer to heaven.

But I suppose, we can’t take all for granted
When you pluck an old nurse from the crypt,
You’ll want to check the degree of senility
And how many discs have been slipped,
Are any critical devices required
For the operation of their bodily functions,
What are the odds, in the midst of their job
You’ll be required to perform extreme unction?

He has twenty long years, in critical-care
How much he retained is unknown,
You can’t train an old dog; can you train an old nurse?
Perhaps his brain has been turned into stone,
But this vacant position, has been unfilled forever
Our list of applicants amounted to two,
No young-nurses applied, perhaps they all died
When they learned how much work they would do.

Perhaps an old nurse, is better than none
All the tricks of the trade have been learned,
He may have lost a little speed, after 4000 shifts
His aches and his pains duly earned,
His competitive spirit, still fires his efforts
His good deeds have no need to be overstated,
A legend in his own time, if you ask those who know
An experienced nurse, reincarnated.

Fibril_late;
1/19/08

First post of the New Year is about becoming sensitive enough to be aware of death at a distance. With Nurses, that is an important tool to have on hand. Critical thinking is good, but Visual Mortality Acuity ranks higher.

Visual Mortality Acuity

Just how far away
Can you determine death,
Can you sense the subtle vibes
Of a beating heart or breath,
Can you see a vapor trail
At 27 meters,
Do you hear the failing heart
By the backfire of its beaters?

Can you hear the deathman's rattle
As you stand outside the door,
Or the whisper of the raven
Softly chanting, "Nevermore",
I like to think, it's just the tailwind
Of a guy who's heaven-bound,
Doing solo flying
With the wings that he just found.

Can you measure rigor mortis
With a telephoto scope,
Can you guarantee a suicide
By the tension on the rope,
Can you call a drive-by shooting
And the bullet riddled brains,
By the ashen colored skin
As the blood pours down the drains?

When you're driving in your car
And there's a guy down in the gutter,
Can you tell from half a block
If his heart beat has a flutter,
Is he a catatonic schizoid
With a blank and staring look;
If you've had the proper training
You could read him like a book.

When you've learned to spot a dead man
At any distance you inspect,
You must study proper timing
To be sure you are correct,
Because uniqueness is the key
When determining a stiff,
This application of your senses
May require just a whiff,
Because death is an olfactory
Experience indeed,
A body laying undisturbed
Begins to go to seed,
And the germination process
Is a documented science,
The timing quite predictable
Like a clockwork geared appliance.

What this boils down to, folks
Is a measurable skill,
It is used by law enforcement
At the scene of any kill,
It can guide the health-care workers
In the plan of their attack,
The odds are, death has not set in
If the body is warm and slack;
So if you'd like to earn your license
With a handsome annual annuity,
Train for certification
In visual mortality acuity.

Fibril_late;
1995

1997. We were using live-leeches for certain wounds, to protect the microvasculature. Leech saliva contains Hirudin, which is an anticoagulant. It got me thinking and that led to this:

Leech Spit

Leech spit for you
Hirudin for me,
With a torque wrench or hammer
Get your leech spit for free,
Fat bloody suckers
Latch onto your skin,
They suck up the pus
And keep your blood thin.

When those fat little suckers
Have appeased their appetite,
Apply the leech tweezers
To loosen their bite,
You can toss them in a salad
With garlic and oil,
Or throw them in the garden
To enrich the soil.

Leech spit is tasty
Just take it from me,
It's better than jelly
Or a fancy French Brie,
Spread on your cracker
While at brunch with the Queen,
And you don't have to floss
Because it keeps your teeth clean.

Fibril_late; 1997

As it turns out, you should read the previous entry ("So Very Clear"), before reading this one, (but that is not human nature), so I digress.
Together, these two poems, chronicle events that were happening in the same time frame. Thus, if you were to read the previous one, maybe it would all make some total sense.

Digging My Hole

I'm bound to get in more trouble
Digging my hole deep and wide,
But after our "attitude" meeting
Our morale, just rolled over and died.

Theoretically, as professional persons
We can communicate by "Doyles book of Rules",
But we're all emotional cretins
And few of us have all the tools.

I've commented before in my ramblings
About the ways in which real people talk,
The mirroring/rephrasing proponents
Make me cover my ears and squawk,
To me, it's too stilted and phony
Lacking empathy and a sense of connection,
I believe that it alienates people
And personally, I want some protection.

I'm bound to get in more trouble
For spreading my thoughts in the press,
But I'm merely recording my insights
As a participant in this morale building mess.

Fibril_late; 1995

It was 13 years ago. There were some heavy emotions and discord, curdling among our night shift crew. The Unit Manager had us all sit down together, in an attempt to attain an accord of understanding, and presumption of harmonious relations. It wasn't easy, it didn't flow smoothly, but in the end, compromise was reached and our journey together resumed on a fresh course.

So Very Clear

It's all, so very clear
But I question our success,
Ten people trying to communicate
To clarify a mess.

With our new found understanding
Will we share a common oath?
Or did we polarize our differences
And shatter hopes of growth.

Surely, we won't walk away
As though we are starting anew,
The memories of our discord
Are ingredients in the brew,
It just depends on how we stir it
And the elements we add to the pot,
Will it be a culinary masterpiece
Or just a soup, that's too damn hot?

Fibril_late; 1995

A.I.C.D. to those of us who know,.....refers to an Implantable Cardiac Defibrillator. I wrote this at least ten years ago, and revised it today. Not just to bring it up to date, but I know I'm a little better at writing too. Don't expect miracles, OK?

A.I.C.D.

The automatic implantable
Defibrillator,
Draws comparison
To something like
An angry alligator.

It's a guardian of the heart
And it has some discrimination,
But once the threshold is crossed
There's no possibility of evasion.

Imagine, deep inside of you
A reptile in repose,
Just waiting for your ventricle
To forget the things it knows,
The reptilian response
Is intriguing to explore,
That cold blooded, sleeping 'gator
Is just a hungry carnivore.

The device is touted broadly
As the answer to your needs,
Although placement has gotten easier
Everybody bleeds,
And the shock of the employment
When the device might save your life,
Might be that night of nooky
With your happy, smiling wife.

To utilize this gadget
You must understand its' name,
It requires a prescription
In the medical-lingo game,
Thus, discussing ye olde acronym
A. I. C. D. and all,
The medical establishment
Will rally at the call.

The "A" is for automatic
How it determines, when to fire,
It considers heart rate and morphology
And the odds if you will expire,
Taking into consideration
Last will, Trust and all bequeathments,
Calculating death expenses
And subsequent bereavements.

It is commonly felt that "Implantable"
Is the word, best attached to the "I",
But contrary to that opinion
It's a concept I boldly deny,
I contend that it's a part of the
Medical-miracle always a cure over-rate-able,
In an endless array
If you got bucks to pay
For the price that is always inflatable.

The "C" could stand in for anything
But here, it corresponds to your heart,
If your Doctor believes that you need it
You'd better be playing your part,
Doing research on all of the avenues
Acquiring a second opinion, too,
Be your own consumer advocate
Before committing to saying, "I do".

The "D", is up for discussion
Though it's translated, to imply defibrillator,
If you ask me, a better description
Would define it as, de-liberator,
When you think of the dead guys we are saving
Who otherwise would have departed,
When their heart started flippin' and floppin'
And their A.I.C.D. got it started.

If they had reserved a heavenly timeshare
Some years in the far distant past,
There might be a statute of limitation
Because that heavenly place fills up fast,
Thus, you might lose your priority status
And survive, to commit mortal sin,
Losing your passport to Heaven
When St. Peter, won't let you come in.

I'm hoping you take into consideration
The facts I have carefully spelled out,
Debarking on the path of the A.I.C.D.
You must choose, when you have no more doubt,
Remember to visualize the image
An alligator awaits your instruction,
His bite might surprise you during dinner
While his goal is to prevent your destruction.

Fibril_late;
1996 / 2007

Just a simple birthday wish.

Mika

If Mika is just like her mother
The world is a better place,
If Mika looks like her mother
Then surely, she has a beautiful face;
And if Mika learns from her mother
Perhaps she'll live in a state of grace.

Fibril_late;
11/30/07

oops, I went into a fugue of emptiness, or something. Here is my latest, current poem. I need to dig into some boxes to get to the Nursing stuff, which I will return with in a few days.

What Matters

You may start with something
And it never finishes
But you started, and that is what matters;
Think of things you started and lost
And everything
Ended in tatters,
The journey is life
And life is the journey
It's all about learning and attention,
Insignificant now
Or so it may seem
At the end, may be an honorable mention.

What I have learned
In the course of my years
Has left me open, to the all of potential,
All that may seem
Unconnected and divided
Is but the seed, of the utmost sequential,
Every step of the way
Every motion of breath
Has a purpose to the end of all action,
But we know from our physics
Motion never finds rest
There is always some kind of distraction.

Fibril_late;
11/24/07

It's really quite simple how the pseudo-life we attempt to recreate in the average hospital admission, reflects life in the real world. All you have to do is imagine.................

Everybody Feeds

Good taste and good value
A basic human desire,
From the day that you are born
Until the moment you expire.

So with that in mind
We tailor health-care to your needs,
Two sheets and a pillowcase
And everybody feeds.

Fibril_late; 1995

Once in a while, in our CCU, we would have in our care someone who would be waiting for a heart transplant. That person would be high on the waiting list to receive a donor heart, perhaps "hoping" for some unfortunate motor vehicle accident victim to visit our Emergency Room.

No Longer at the Top

It's lonely here
No longer at the top,
As my cardiac function
Grinds to a stop.

I'm just waiting and waiting
For a suitable donor,
It's a serious commitment
I need a permanent loaner,
But someone must die
So I can survive,
Each day I deteriorate
Wondering when they'll arrive.

As the days turn to weeks
And the weeks into months
My room starts to feel like a jail,
My veins are sclerosed
I'm catecholamine dosed
And my kidneys are starting to fail.

My future is grim
But I'm not without hope,
I'm becoming an expert
At trying to cope,
And I'm thankful the nurses
And doctor's are trying,
Their utmost endeavors
To keep me from dying.

Fibril_late; 1998

I must have been thinking about what a gang member would want for Christmas, and what would be the absolutely, most important #1 thing. Yep, a free-admission pass to the Emergency room!

My Christmas List

It's the Christmas season once again
And I've been good all year,
My wishing list ain't very long
So why not lend your ear?
A case of liquor and some wine
And a couple other trifles,
A tear gas mask, some throwing knives
Plus automatic rifles,
A kilo of Columbian
A water-pipe from Seoul,
A pound of methamphetamines
And an ornate hashish bowl,
A vehicle that's nondescript
But advertised as fun,
It should have a lot of gadgets
Like a loaded drive-by gun,
For those fickle freeway freakouts
And the turf related games,
The hassles with the homeboys
And someone else's dames,
A worn and tattered trenchcoat
For flashing Lois Lane,
Some mescaline and LSD
To fry my little brain,
But if you find my list too long
I have one priority,
A year long E.R. admission pass
To UCDMC.

Fibril_late; 1995

Nursing is hazardous work. Every year, you hear from someone, "Did you hear that so and so died. Yup, got shot by a patient." One time I was kicked in the head by a berserker, and suffered a concussion. Patients get sick, and then crazy, and you never know what will happen next. Back in the day, it wasn't like that.

In Days Long Gone

In days long gone
Of innocent youth,
You could go to a Doctor
To get at the truth,
Because disease back then
Was fairly simple,
Unwanted babies
Or maybe a pimple,
A week in the hospital
Would do the trick,
If you didn't die
You weren't really sick,
Because medicine men
Didn't have many drugs,
No antibiotics
For bacterial bugs,
Just common sense
Like fluid and rest,
Surgical wounds
Were debrided and dressed,
Life support measures
Not yet invented,
Many more sinners
Took stock and repented.

But today, man, it's different
This hospital scene,
Each organ system
Has a machine;
Any mechanic can tell you
This carries a price,
It's Russian roulette
With a medical device.

Central line catheters
A bacterial threat,
Ground fault dysrhythmias
If a pacer gets wet,
Gastric perforation
From sump pumping hoses,
After long-term use
They'll have a nasal necrosis,
Tracheal malacia
And traumatic intubation,
Will lead to a permanent
Horse voiced oration,
Tympanic rupture
From a doppler detonation,
Uremic poisoning
From bladder ablation,
And that's just the patients
But, what about the nurse,
Each day at the job
Is surely a curse.

Consider the dangerous
Equipment itself,
Monitor boxes
That fall off the shelf,
Land on your head
Bruising your brain,
There's no medication
For this kind of pain,
Suspended televisions
That swing in an arc,
Causing serious damage
At night, in the dark,
Colonic disasters
From overfilled pans,
Body fluid exposure
On your clothes and your hands,
Broken thermometers
With mercurial spills,
Inhaling poisonous dust
From all those crushed pills,
Exposure to X-rays
That zoom through the walls,
Effectively neutering
Ovaries and balls.

Good god, it's a nightmare
There is nowhere to hide,
But who keeps statistics
On the nurses that died,
In the course of their work
By their choice of career,
They silently vanish
Year after year,
As their spirits race homeward
At the crack of each dawn,
The days of their innocent youth
Are long gone.

Fibril_late; 1997

In most hospitals, there is rivalry between different ICU's, where each arena, likes to believe they know the most, have the most critical patient's to care for, and therefore, are the "best" critical-care nurses. Working in what is known as the Coronary Care Unit (medical) meant that you took care of people with CHF, acute MI's, Unstable Angina, pacemaker's, etc. You didn't have to deal with many wounds, virtually no post-op surgical patient's and rarely any infections. In other words, a pretty clean place. So when one of "our" nurses, decided to transfer to the Surgical Intensive Care Unit, I was forced to put my disbelief into words.

Oh, Marge

Oh, Marge
I have to tell the truth,
S.I.C.U.
Will steal your youth,
We'll miss your
Always wonderful self,
Like empty bookends
On a shelf.

Trauma surgeons
There's not doubt,
Really love to
Shake and shout,
Measure outputs
Like fanatics,
And drink the juice
Of drained lymphatics.

So sure, the place
Is great for learnin',
Q-2 hour
Crash and burnin',
Busted faces
Legs and brains,
Fifty thousand
Sucking drains.

But you'll be back
To plead your case,
And fool us with
A happy face,
Nostalgic for
The pretty view,
At sunrise
In the C.C.U.

Fibril_late; 1994

The word Obtunded is not used in everyday conversation. Its meaning is; mentally dulled. A person may be obtunded due to head trauma. Yet, you can understand why it might be commonly used, among certain medical persons.
Even less used is obtundation, which means, a dulled or reduced level of alertness or consciousness. One might report, that "Mr. X is in a profound state of obtundation." One of the ways to determine if the person is arousable, is to rub their sternum briskly and firmly, with your knuckles. Yes, it cause a noxious pain. Early in my career I worked with a nurse named Jan, whose sternal rub was legendary. Numerous obtunded persons, came to wakefulness under her forceful rub.

The Obtundation Rap

The shift was OK
Until he tried to spoil it,
Circling the
Obtundation toilet.

I lit up his pupils
And screamed, "Look here, Bub",
I'm known far and wide
For my killer sternal-rub,
You might think you can fool me
But as your nurse, I get first dibs,
To rap out the death-march
On your skinny little ribs.

Your brand of behavior
Will not be endured,
One way or another
Your obtundation will be cured.

Fibril_late; 1992

WARNING: This poem is totally gross.
Unfortunately, it was inspired by my own, real-life experience, getting involved in some TID dressing change, on a stage-4, infected decubitus. The only way I could deal with the demolition of "Universal Precautions", was to write about it.


Pseudomonas Stew

When the wound begins to fester
Oozing yellow goo,
When the pungency develops
Into a powerful pee-yoo,
When the macerated tissue
Melts into a slurry,
It's time to plan for dinner
Though there isn't any hurry.

When, necrosing blisters burst
And splatter you with blood,
When the stage-four lumbar crater
Starts leaking thick green crud,
It's time to think of dinner
Invite a friend or two,
The main course is a favorite
That pseudomonas stew.

FIbril_late; 1995

It seems like every big city has a Trauma Center, smack dab in the center of all the action. It's so convenient for the gangs and what not. When you get shot or stabbed, your friendly neighborhood Emergency department is just down the street looking for new business. Hey, we groove on it too; after all, there is nothing more boring than twiddling your thumbs all night in the E.R.

The Stockton Boulevard Shuffle

At night we go out cruisin'
For something fun to do,
We pack the glove compartment
With rock cocaine and glue,
We inventory weapons
And check our ammunition,
Then analyze the dress code
To prepare for demolition,
We'll boogie on the boulevard
Until the moon has set,
We're hunting for our rivals
It's a turf related debt.

We're doin' the Stockton Shuffle
It's our favorite expedition,
We'll keep our zip guns loaded
And ready for attrition.

The happy hombre' hideaway
Is actively recruiting,
Respect is guaranteed
If you've done a drive by shooting,
Because our leader, Jesus Wannabee
Got blown away last week,
He took a double shotgun blast
Directly on his beak,
Thus splattering his sacred essence
Upon the dashboard fur,
Now, when we take a low ride cruise
The windshield is a blur.

It's a party, it's a shuffle, on the promenade
We're kickin' up our heels out in the street,
We're paying our respects to Jesus Wannabee
While jamming to our favorite gangland beat.

Fibril_late; 1993

Who wants to get old and remain happy and productive? Most everyone would agree to that plan. But how about getting old and suffer dementia? Not a very desirable scenario, right? Well, here is one possible avenue of escape.

Demented Blues

Getting old
Don't look too fun,
I'm gonna get
A suicide gun,
Fill it full of bullets
Then hide it in my bed,
When I get demented
I'll ventilate my head.

I want a one way ticket
On the euthanasia bus,
Just let me die in peace
If I get delirious.

Fibril_late; 1993

Oh, my gosh; back to the topic of sputum once again. Since you're just reading the latest poem, you must become aware that I was once a Respiratory Therapist. Yes, many long years ago, prior to my exalted career as a Nurse. So yes, I know the ins and outs of sputum. After a while, one gets an attitude about it all...............

Cauterized

If you spit your sputum
On the floor,
Don't expect me
At your door,
Because the house-rule states
And, I'll be brief,
You have to use
Your handkerchief.

So heed my word
Don't be a fool,
It's easy enough
To follow my rule,
But if you continue
Don't be surprised,
When you find your lips
Are cauterized.

Fibril_late; 1994

In the presence of people with advanced stages of disease, you (Nurse) become sensitive to certain expressions of speech, or how they describe how they are feeling at the moment. Some of those expressions, portend impending doom and disaster.
For example, when the patient who has had a major Myocardial Infarction, suddenly states, "I don't feel so good" , yet all the while, everything has been looking peachy-keen. Don't ask questions, just call out the door, and say something like, "Would someone please bring the crash-cart to room-17, ASAP!!!". Yes, that is a clear example of your critical-thinking skills kicking in (aka, "intuition"). If you overlook it...................

Cruisin' Heaven

A mysterious event
Happened just today,
The man said, "I don't feel so good"
Then his heart-beat went away.

I told him not to do that
But he didn't seem to care,
His heart rate slowed dramatically
Until it wasn't there.

With bells and buzzers ringing
We wailed upon that man,
His color went from purple
To a lovely desert tan.

He received a hit of atropine
Some calcium and epi,
He replied with tachy-rhythms
But his pump just wasn't peppy.

With the force of seven doctors
And the strength of twenty nurses,
Collectively their aura
Dispelled the evil curses,
That had bound him to his destiny
In a room without a view,
Now he's cruisin' heavens highways
With an angel friend or two.

Fibril_late; 1997

A short story about a dying heart..............as told to me by (name withheld by request).

Ectopated

He had some pain
But then, he waited,
Because he didn't know
What it implicated,
Then he got real sick
Or so he stated,
When he became dizzy
And nauseated,
Because it's uglier than pain
When you vomit unabated,
Its the worst, God-awful feeling
That you ever have hated.

So he came into the hospital
To be evaluated,
He was worried that his body
Would soon become outdated,
He had never been a patient
And thought health was overrated,
He had never had a cause
Until death seemed almost fated.

His breathing was tachypneic
His neck veins were inflated,
His rhythm Sinus tach
And very ectopated,
His ischemic myocardium
Gave up and fibrillated,
We zapped him with the stunners
Till his heart electroplated.

Unconsciousness ensued
When his brain waves were ablated,
His astral body floated
To the ceiling elevated,
Then the angel guys arrived
And he participated,
There was no turning back
Because his life force dissipated.

Fibril_lated; 1995