Another hard-to-believe tale, that is filled with truth; really, just ask any Nurse!

Looking For Some Sturgeon

Now here's a strange phenomena
I've noticed o'er the years,
The gastroenterologist
Has stomach cancer fears,
And sure enough, before too long
He suffers bowel constriction,
Good golly gosh, I'm not surprised
He was a specialist of the affliction.

And then the neurosurgeon
Has a headache of grand proportion,
A nasty neuroblastoma
Has caused a brain distortion,
And the pain is so damned awful
Like a pterodactyl sting,
He takes a buzz-saw to his head
To eradicate that thing.

The saddest one most surely
Is the cardiology dude,
When the crushing pain and tombstone lines'
Begin to threaten his good mood,
He's inclined to pass the time away
Denying it's for real,
No Cardiologist worth his salt
Would accept such a lousy deal,
Alas, this can be fatal
Unless his family has some guts,
Accustomed to his attitude
They'll take no "ifs or buts",
And haul his sorry, dying ass
To the neighborhood cardiac surgeon,
He'll soon retire and buy a boat
And go looking for some sturgeon.

Fibril_late;
3/31/08

Many will tell you that it's hell getting old. It certainly is when ye olde hollow husk disintegrates slowly. Nary a nurse looks happily forward to that kind of existence.
Here are some quick thoughts about meeting the ancestors.

I'm Going to Meet My Ancestors

I am hoping to meet my ancestors
Perhaps they'll come and get me,
To join my ancient family
If only they would let me.

I'm old and feeble and misunderstood
And commonly feel alone,
But I have limited capacity
To make my wishes known.

I'm going to meet my ancestors
It's so painful being sick,
I've called my long dead family
To get me soon and quick,
They left so very long ago
But finally it's my chance,
I'm going to party with my relatives
And do the death-march dance.

Oh look, I see my ancestors
They are waiting at the door,
They've come to take me sailing
Yes, my boat is at the shore,
I don't need a life-preserver
Nor a compass for this trip,
I am ready for my maiden voyage
As the captain of my ship.

Fibril_late;
3/31/08

Deja Vu all over again. Yup, I'm reliving every flippin' nursing experience that I ever had, all over again, one-by-one. Last night it was the "Ketoacidosis, Bipolar, immature, positive drug history, non-compliant, adult-in-childs-clothing, whoops I didn't use my insulin for a week", individual.
I was a party to all of the emotions and behaviors associated with each disturbance. I really can't begin to tell you how much fun I had, (so I won't bother). However, let me share with you what it might feel like, if you were to be picked to be the nurse for that kind of patient, over and over again.

First, here is the cartoon: A wonderful quote from my favorite humorist, George Carlin:

In Rome, the emperor sat in a special part of the Coliseum known as the Cesarean section.
George Carlin, Brain Droppings (1997)

Thank you; and now for the main attraction:



One Nutcase, Too Many

Sometimes I feel like
There's a target on my butt,
It says, "Give him the patient
Who is whacked out of their nut",
Or maybe, I'm wearing
The hat with the logo,
It reads, "Welcome all zombies
From the Whisky a’ Go Go
Whatever the reason
The cause, or the blame,
What to me, is a conspiracy
To others, is a game.

There is probably a lottery
Going on behind my back,
To name the hours and minutes
Wagering when I will crack,
Where I go running and screaming
Yes, totally ballistic,
One nutcase, too many
And now I'm just a statistic.

Fibril_late;
3/28/09

Over the years I have written often about excrement. And here I am, less than two months into my reincarnated career and I find myself knee-deep in the slimy stuff again. Sheesh, nothing ever changes (at least in that territory). What has changed is the.....................

The Arc of Ejection

Bowel movements times four
And Urostomy leak,
Do I dare disturb the bedclothes
And venture a peek?
It's been a long night
Of cleaning up crap,
Patients lying on their sides
Try to launch it in my lap,
And I covered that topic
Must be 15 years past,
But nothing has changed
They have to crap, really fast.

Fifteen years later, and
What is the matter?
The crap is the same
But the clients are fatter,
The arc of ejection
Has increased in proportion,
The pattern of splatter
Is one of distortion,
And along with my age
And my weary old bones,
I don't leap, hop or scamper
Without a few groans,
As I seek to escape
The crap launched my way,
And I ponder again
About the terms of my pay,
But then I recall
My oath, Hippocratic,
You fool, you’re a nurse!
This crap is automatic.

Fibril_late;
3/24/08

It was as I thought; if I went back to work, I would be inundated with a review of topics that I probably wrote about in the past, but now I'm 10-15 years older, and I might possibly have a new perspective. Well, actually I have the same perspective, I just write a little different.

Suicidal

Nineteen years old
With suicidal ideation,
After seven years
Of self-induced degradation,
Popping pills and whatnot
In the name of “I hate me“,
Abusing all who care
I'll drag them down, just wait and see.

Nineteen years old
Whining, wailing, look at me,
Don't you know I was abused
And now my life is misery,
I'll keep trying to kill myself
Because, you know, I want to die,
As soon as I leave your care
I guarantee, another try.

Nineteen years old
What a waste, I say,
I'll care for you tonight
But tomorrow is another day,
Where you'll get the opportunity
To look your sorry self in the eye,
But tonight I'm going to tell you
You're just too weak to die.

Nineteen years old
And you've wasted seven years,
Nobody gives a crap
About your story of abuse and fears,
Your life is really easy
No working, school or tasks,
You just lay around and whistle
Through all of your phony masks.

Nineteen year old persons
I've seen paralyzed and more,
They didn't wallow in their misery
They were wheeling out the door,
With active minds and iron wills
They weren't whining, oh, poor me,
They weren't dreaming about their suicide
On Wednesday, at three-forty-three.

Nineteen years old
You need to begin the day and say,
Whatever happened to me before
Is ancient history and just the old way,
I have one choice, about moving forward
Each day is a fresh new start,
Those who care about me will do so
No matter if I depart,
But they are locking their doors
Watching to see where I will head,
Will I choose to be alive and live again
Or take the easy way out, and be dead.

Fibril_late;
3/16/08

I clearly missed out on a few "new" things in the past 7 years, away from the bedside. Maybe others did too.

Are you subject to the whole JCAHO "communication" directive regarding the SBAR acronym (Situation, Background, Assessment, Recommendation)? Everybody and their brother seems to have had to start reporting that way, or something similar, I guess. Well, it reminded me a heck of a lot of the old FUBAR acronym, which I'm sure many of you know to mean, Fu**ed Up Beyond All Repair. SBAR looks almost like that, right? Well, I sure thought so. And the following poem spells it out pretty clearly.

SBAR vs. FUBAR

I merely left the bedside
For seven short years,
But naturally I wondered
How I'd fit in with my peers,
I need worry not
They are stellar professionals,
But the workplace is different
Thanks to Jayco Congressionals.

Leave it to the Joint Commission
To give rules of communication,
They say it's all about patient safety
But it's more like approbation,
And another thing about it
Is the acronym, or name,
Just trying to pronounce SBAR
Those executives put us to shame.

Situation and Background
Assessment and Recommendation,
Up to five syllable words
Clearly testing my mentation,
Is this some kind of experiment
Are we rehearsing for the future?
If there is a threat of a lawsuit
Can we repair it with a suture?

But my greatest concern
Is with the choice of the acronym,
Having an Engineering background
It sounds like our marching hymn,
FUBAR was our mantra
It covered any possible disaster,
Fu**ed Up Beyond All Repair
Was our answer, to the master.

I know, that I possibly shocked you
But the world is a wretched place,
There are times at the hospital
When all Hell breaks loose
And the SBAR just flies in your face,
And I suspect that some members of Jayco
Were laughing while gasping for air,
Knowing the true meaning of SBAR;
Screwed Beyond All Repair.

Fibril_late;
3/10/08

Back in the gay old '90's, I wrote frequently about a local hospital system that was suffering through the throes of "redesign". They had adopted some sort of chest-thumping, corporate blah-blah, best-practice BS, that was going to save money, garner applause and launch them fiscally solid, into the 21st century. I think it went hand-in-hand with all the excitement of Managed Care. Fade to the future:

Now, they are heralding a "communication tool", with the acronym of AIDET - Acknowledge, Introduce, Duration, Explanation and Thank You.
I have since learned it is the brainchild of one, Quint Studer (www.studergroup.com), who at his own website claims, he is one of the "Top 100 Most Powerful People" identified by Modern Healthcare. Apparently, he's also famous for his "Five Pillar" approach to achieving operational excellence, goal setting and measuring progress under service, people, quality, finance, and growth.

It's all a smoking pile of feel-good, smiley-face, top-a-the-mornin'-to-ya, remember my good name on your patient satisfaction form, best hospital in town, front and back door advertising. For Nurses, who have already racked up 20+ years of loyal, back-breaking service to humanity, it all seems a little like heavy-duty glad-handing.

Therefore, I was assigned by my society to speak for all of us.

At the End of the Day

Until you've learned your AIDET
You haven't really made it,
Acknowledge their name
At the threshold door,
Introduce yourself
(Try not to bore),
Define the time
Of the things you'll do,
Explain, entertain
Educate them too,
At the end of the day
When you're on your way,
Say, thanks for the fun
Now, what about my pay?

Fibril-late;
3/10/08

I was thinking about how so many "professional caregivers", such as Nurses, Doctors and many others in the broad spectrum of those who attend to the health-care needs of humanity, commonly overwork themselves way beyond what might be expected of them.

My impression, both as one who has led the life, and also observed many of my colleagues, is that most of the time, we are doing it for others. Sure, once in a while, we're chasing the $ because we want the new car, or the Costa Rica vacation and so on, but really, it's almost always because we are the caregivers in our own personal sphere of influence.

We can earn some major cash, working overtime. If our spouse is just an average wage-earner, heck, we might be pulling down $1000 a day, for a little extra work. So naturally, all eyes look to us and open palms extend our way, and since it is our very nature to care, we just knock down a few more hours. Well, it's a slippery slope into oblivion, substance abuse, auto accidents, suicide and other similar miseries.

I call it:

Our Fountain of Giving

Regarding professional caregivers
Overworked, burned-out, and dedicated,
Performing with such depth of compassion
Commonly coping, self-medicated,
Amidst an over-capacity workload
They perform at the peak of their prime,
Look closely, it's not selfish fulfillment
It's for somebody else, every time.

Each one of us dedicated professionals
Came to our path, perhaps fated,
Like genetics, or family predisposition
A long history, to be traced, carbon-dated,
We often suffer, from a primitive condition
Where we overlook our own precious needs,
Eventually we crash, torn asunder and maimed
And suddenly everyone bleeds.

Because, attached to each one of these professional caregivers
There's a long line of benefited receivers,
They depend on our fountain of giving
We’re their God, and they’re the believers,
But even a God needs to rest
And that is the sober reality,
The ongoing demands of those persons
Deplete our very essence of vitality.

Premature retirement, disabled or dead
Is often the path that we follow,
Many caregivers are completely depleted
Their mortal remains are but hollow,
Left by the wayside of existence
Empty shells, that once held a precious light,
A dedicated professional, drifting off in the mist
Succumbs to the quiet of night.

Fibril_late;
3/5/08

For a friend undergoing a terrifying health dilemma; kind of a review of old times.

Back In The Day

Certainly,
There were times we had
Some were good and
Some were bad,
Plenty of laughter
Back in the day,
Hanging out with
Uncle Jay,
Taking trips
On a wing and a dollar,
Years of study
From High School to scholar,
Then somewhere, someday
Fragments coalesce,
The chaos of life
Is no longer a mess,
The answer seems startling
Why, it took so long to know,
That all the pieces were important
In this emotion picture show.

Fibril_late;
2/25/08

I started working again. In a hospital at that. In a busy ICU. Still on orientation (scraping the rust off, as my stellar preceptor says) and just a couple days into it, I have my first poem. It's an updated view on the thrills and chills of Kaexalate therapy. I don't know what stinks worse; the treatment, or my rhyming.

Kaexalate, Revisited

Kaexalate is rarely
Shared upon a date,
Kaexalate commonly
Will seal your fate.

Kaexalate, is best taken
Like a shot of nasty medicine,
Make reservations with a restroom
Your shit will soon jettison.

You can always tell your visitors
That your afternoon will be busy,
You can say you're writing a thesis
On the lyrics of Thin Lizzy,
They may look at you strangely
But probably won't query,
The very idea of that endeavor
To the novice, sounds scary.

Kaexalate is best taken
Shaken, or even stirred,
The smoother it goes down
The more slippery the turd,
It's better than Ex-lax
Or cod liver oil,
It eliminates work
And fertilizes soil.

The user will discover
The need for ventilation,
Because Kaexalate promotes
Rapid evacuation,
Of the immediate area
Of all personnel,
A Kaexalate dump
Carries a frightening smell.

And finally, heed my warning
It's best taken in the morning;
'Cause if you wait till lunch
Or afternoon,
You'll be on the toilet
With the rising moon.

Fibril_late;
2/20/08

Getting old; some people feel as though every year brings about the loss of another freedom. One of the most difficult to let go, is the freedom to drive a car.

Old Driver Blues

When I do my shopping
I drive into town,
The people in the streets
Look at me and frown,
The other drivers are terrible
They get in my way,
Why, the streets were much safer
Back in my day.

I've been driving
For something like 70 years,
Now it makes me so nervous
Unless I've had a few beers,
Because everyone else
Drives so gosh darn fast,
Like they're racing to the future
While I dwell in the past.

These new-fangled cars
Have so many dang buttons,
I think the kids of today
Are technological gluttons,
And by the time I have learned
What all of them are,
Ten years have gone by
And I need a new car.

I know some day I'll have to
Get someone else to drive,
But I swear to you now
Not while I'm alive,
I'm an independent man
And I'll have no drivin' slave,
I'll be behind the wheel
Till they drop me in my grave.

Fibril_late;
1997

Now that Obesity has been declared an epidemic, I guess I can cast all caution to the wind, and spell it like I see it.

Fat and Shortening

Something needs to be written
But dare I be the one to do it,
There's a backlash in society
For those who like to chew it,
There are over-eaters clubs
And natural shape coaches,
Big and husky clothing shops
And a hundred other approaches,
To address the significant fact
That many of us are overweight,
But if you don't do something about it
You're making a heart attack date.

There are a hundred easy reasons
Why we add the extra fat,
To insulate insecurity
Ninety-nine more than that,
But whatever your excuse
You better look it in the eye,
Twenty percent over your ideal body weight
And you're shortening your time to die.

In these days of over-sensitivity
Politically correcting any sort of verbal affront,
You can barely talk about the human condition
Without becoming the victim of a witch hunt,
Just look at the language we have formulated
To talk about what we are thinking,
Weight challenged with adolescent appetites
While the ground under us is sinking.

Now I know, I'll be attacked for my stance
An inflammatory response is just around the bend,
My teeth are crooked and my hair is falling out
But I don't think it will kill me in the end,
I'm thinking I ought to throw this away
But obesity is fat and we know it,
It's one of those challenges that stands right out
If you're as big as a house, you will show it.

I agree that all of the media hype
About biceps, abs and buns,
May cause the hopeless fatty's to commit suicide
Or seek murder, mayhem and guns,
But it isn't OK to condone it
In the context of feelings and disposition,
There are far reaching medical consequences
For the rampant, obesity condition.

Geneticists spearhead a campaign
To discover the causative gene,
That triggers the body to fill fat cells
It will be a lucrative, capitalist scheme,
The pharmaceuticals will jump into the foray
Bulging bank account sharks that they are,
To charge you an arm and a leg, sir
So you can fit into your car,
But if it's a magical pill that you want
The future can't guarantee that,
It comes back to good health habits and will power
The secrets, to not getting fat.

Fibril_late;
1997

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