Times have changed over my career. (30 years)

There was a day when one might work in a "pure" Cardiac unit, where one saw primarily persons with just Myocardial Infarcts, Heart Failure, etc., and their various treatments. Now, those places are few and far between. Sure, the patients had other problems, but most just dropped in for 2 or 3 days, to receive treatment, for just their heart problem. Thus, all the nurses in the unit became Cardiac experts over time. Fast forward to now, with people living longer, getting more health problems over the years, with a greater degree of complexity, and we critical-care nurses, must become near-experts in whole-body medicine.

Essentially, what I described above, undoubtedly represents the maturing of the nurse-individual over a long career. I guess I share that distinction, yet I remain highly interested in the diseases, therapies and arrhythmia's of the heart; that's what I bring to the table. Luckily, I work with many other highly educated and vastly experienced nurses, and together we form a powerful force of good, for the patients that we care for.

But still, I poke a finger at us and try to make it funny.............go figure?!?



The Battle Of The Brady's

'Twas the battle of the Brady's
Jousting in the corral,
Was it caused by poisoned water
Like the famous Love Canal?

Were they age-related impulses
Unclear just how to work it?
Or knotted myofibrils
In the conduction system circuit?

Was the SA node too sickly
Or the AV node too slow,
Were the atrial motor pathways
On the stop and not the go?

Well, I opened up a chart or two
And discovered other answers,
There was a Digitalis suicide
And the other, a heroin dancer.

He was a boyish seventy-fiver
She, an ancient forty-sixer,
She'd mix heroin, cocaine and crank
Thrown together in her KitchenAid mixer.

He was despondent and lonely
His investments had gone down the drain,
So, why not take thirty Digoxin
And say "Goodbye, bon voyage", to his pain?

Now parked in a critical-care place
Where cardiac experts are few,
It's ho-hum when the heart-rate hits thirty
Quite frankly it interferes with the view,
Of Bobby-Joe showing his photo's
On Facebook, Picasa and Flickr,
"Oh look now, there's Bobby-Sue's baby"
And the local chums, giggle and snicker.

But here in the 21st century
We juggle mysteries like the jesters of old,
Knowing that illusions are paramount
For selling the goods in the hold,
We manage such multitudes of misery
Looking like mavens of medicine,
Caffeinated nurses got it covered;
We'd be the envy of good Thomas Edison.

Hence, the battle of the Brady's and Boomers
Neck and neck, at the end of the night,
The Brady's were beating at twenty
While the Boomers were ready for flight.

Fibril_late;
2/21/10

Either we're getting really good, or some people don't die easily. This patient was a Type 1 Diabetic. For lack of insurance, she hasn't bought Insulin in 2 months. She was found down at home. Upon admission her pH was 6.8, a glucose over 700 and an unmeasurable bicarbonate. In any population, that is considered so near death, as to be considered as virtually waiting before the pearly gates. Now it's 24 hours later and she's talking about little Muffy her dog. Like I said, some folks just don't die easily.

Diabetic Curse

The diabetic patient, can
Be their own enemy, my man,
If they don't follow their diet orders
Their blood sugar will go beyond the borders.

Or say, they're on the Insulin shot
Two times a day, whether cold or hot,
But then they stop for a month or two
Surprise, surprise, their death comes due.

We try to save that unfortunate mate
Whose blood pH is 6.8,
And a glucose of one thousand two
Of the many we treat, we save but a few.

It's a foolish death, but survival may be worse
And that's the diabetic curse.

Fibril_late;
2/20/10

There is a job opening, and I figured, better to hire the local guy who knows the ropes. Too bad, I can't tie a decent knot.

Interview

I was interviewed
And it was good
Like any righteous grilling should,
Interrogated
By, just the Boss,
I had prepared myself
With mental floss.

It took place
In the hospital venue,
And followed the tried and true
Interview menu,
To pose ten questions
About this and that,
To find out where
My head is at.

To ascertain
My sanity,
Did I seek the position
For vanity?
Do I want to rule
With an iron hand?,
And will I do
What the boss has planned?

All in all
I think it went well,
Like a well cooked pot-roast
With that barbecue smell,
And now I must wait
On bended knee,
Wondering, "Who will be chosen
That other guy or me"?

Fibril_late;
2/16/10

Just a Waiter

Am I a Nurse or a Waiter / Waitress? Last night it seemed like I was a Waiter, but I sure didn't get any tips!

I'm A Waiter

Tonight, I'm a waiter
Tomorrow, I'm not,
What is the difference?
I won't be here in this spot,
Catering to
That man with a switch,
He makes an announcement
"Hey Buddy, I've got an itch".

But he's not really helpless
He worked 5 weeks ago,
He didn't break any bones
He had an earache, to show,
But it morphed and it broiled
And seeped into his neck,
Now he's landlocked and bedded
The train crashed, he's the wreck.

Twenty minutes times three
That's 3 calls an hour,
He's 27 years old
And he must have more power,
Than the strength of his thumbs
Dancing Salsa on the call-light,
"Yes sir, what do you need"?
It will be a long night.

Fibril_late;
2/12/10

The world is so weird, that I have an endless supply of ideas to tap into. Take the story I read that was posted in the newspaper, "Telegraph" from the U.K. The writer reported how in China, there are unscrupulous vendors who are marketing a diet pill, that actually contains viable eggs of the Ascaris Tapeworm. Well, hot damn! I guess that will cause you to lose weight......among other things, especially when one understands that they can produce 200,000 eggs per day. Yowza! That's gross.In fact, it makes me squirm.

It Makes Me Squirm

Because it's in China
It's the reason I believe,
I've heard they'll eat most anything
What an accomplishment to achieve

Yet, despite this foreknowledge
These things that I learned,
I'd think there'd be limitations
That even Chinese, would have spurned.

So imagine my surprise
That turned to horror
When I read it,
There's a brand new crazy supplement
You can buy with cash or credit,
To assist the overeater
Shed those pounds
They need some help,
After failing with the Exlax
The Colace and the Kelp,
The concept, the idea
It really makes me squirm,
What kind of crazy dieter
Would swallow a worm.

A tapeworm at that
The Ascaris parasite,
They lay a hundred thousand eggs
Every day and night,
But don't worry, it's safe
If it's on the Internet,
Guaranteed truth in advertising
Are you willing to take the bet?

The Ascaris tapeworm diet pill
Is a winner, there's no doubt,
Don't believe the medical experts
They don't carry any clout,
And don't worry about nasty side effects
The worms are always pure,
Infestation is the way to go
It's the latest obesity cure.

Fibri_late;
2/10/10

Young, large, seemingly getting along ok. He holds a job, still lives at home, drives a car. What could go wrong? It's not unusual to have Otitis Media, but an abscess in the neck, can cause swelling and compromise the airway of just about anyone. However, if one weighs close to 500 pounds, the potential sequelae of an invasive infection, well that's quite another story, indeed.

500 Pounds

500 pounds
With an infection in his neck,
It swelled his airway
And what the heck,
He couldn't breathe
And all hell broke loose,
Now he has a trach in his throat
And his bowels are loose.

500 pounds
27 years of age,
His weight is a shackle
In the obesity cage,
He thought a simple ear ache
Was just a bother, with some pain,
Now with respiratory failure
He might be easily slain.

500 pounds
His skin is wearing thin,
Septic emboli and toxic shock
He's rotting deep within,
His gut is sloughing out
Drained with a tube and bag,
His family hang by the bedside
Waving their hopeful flag.

500 pounds
It's a horror and a curse,
It's a premature invitation
For transport in a hearse,
Not a typical expectation
For one so young and in their prime,
Trapped by morbid obesity
Is the sentence, to the crime.

Fibril_late;
2/3/10

I was out of work for 3 weeks because of some alien organism that seems to have taken up residence in my right throat and ear canal. It's still there, but I've gone back to work. A lot happened at work during my missing weeks. Our "Cardiac Care Unit", has morphed into the Medical Cardiac ICU. Now I'm really more than glad that I work night shift, because most of those surgeries are recovered on Day-shift. That's right, and we stlll get paid more on the night shift. Talk about hidden benefits!

Anyway, going back to work after the unit has been broken-in a bit, has revealed new topics of business that I can write about, so I hope you enjoy this new journey.

Here again, I address a big topic; bariatrics. It's just a ruse. It's really about corporate spending on big projects, and the end-user impact.

Slalom Sleds

These hot new Bariatric beds
Are like super mondo slalom sleds,
We pull the patients up Q1 hour
They slide right down under gravity power.

The hydraulics seem a little weak
I'll explain it now, just let me speak,
When we lower the bed, head-down under feet
It's easy to reposition, all slick and neat,
But to return the head, upright beyond 30
We strain our backs, lifting down and dirty,
By physically hoisting the head of the bed
Another “safety” device, liable to make me dead.

These are new tech beds for the super heavies
Supposedly better than Sacramento levies,
Holding back the 100 year flood
But I'm not sure about Billybob's bud,
He weighed in at 225 kilo's
And we weren't even weighing the pillows,
On beds that are rated to 500 pounds
We're approaching that number in leaps and bounds.
Beds with all the bells and whistles
Not suitable for an ICBM missile.

The beds can rotate side to side
It's really quite a pleasant ride,
But here again, this weight thing irks
If you're really heavy, it barely jerks,
There's a tendency for big boy Jimmy
To get stuck on one side while the bed just shimmies,
Wiggles and strains, to pump air through the bellows
I wonder, “where is the lift team, I really need those fellows?”

There are lifts on the ceiling, with slings down below
When Jimmy's feeling better, we can swing him real slow,
Into the chair by the window to improve his outlook on life
Then the bed will be vacant, for his long suffering wife,
Her kilo's are many, her cankles are like stumps
I'm praying to Euphemia, “Dear Sister, bless these chumps”
Don't let either the one of them, have a cardiac arrest
Our defibrillators aren't prepared for that test.

We've got negative airflow, isolation rooms
And those lifts on the ceiling, on super-strong booms,
But honestly, I'm wary about the safety of it all
Bad things happen, when big people fall,
Caregivers damaged, lawsuits are brewing
When the dust has all settled, corporate is screwing,
Around with the numbers, statistics and more
The science of big, is a titanic chore.

Please, don't misinterpret my harangue on what's big
It's really an expose on the bureaucratic jig,
Million-dollar decisions, from dubious advice
High cost vendor contracts at an unbelievable price,
End-users suffer, at the whim of corporate decisions
Are Workmans' Comp injuries, in the provision?

This light-hearted muse, ended heavy and dark
But the business of healthcare, is no walk in the park.

Fibril_late;
1/29/10

I worked in the new tower for 3 days and then I came down with some weird illness, where the right-side of my face feels like I got too much Novocaine at the Dentist office. Also, some of my taste buds quit, so food tastes really weird. Hey, maybe I could blame it on "sick-building syndrome"?

Anyway, I get a bunch of days off, and I figured I better prove that I can still pen nonsense.

Like Cancun

Any one of you with Addisons
Come on down to Auburn and Madison,
Check out our billboard
Take a look at our sign,
Glance at our fine menu and
How you will dine.


We have a shiny new tower
And a new Chef, to boot,
We welcome the gang-bangers
Who maim, stab and shoot,
We are non-prejudicial
Because everybody bleeds,
We're ready to serve
Our community's needs.


It's a fine looking billboard
Yes, it really caught my eye,
I'm thinking, that's where I want to be
When it's a good day to die,
And maybe Sister Euphemia
Will comfort my soul,
With her help I can avoid
That fire-belching hole,
Where I'm probably heading
After writing poems like this,
Poking fun at the nuns
Is like a sacrilegious kiss.


This is all about expansion
Up, sideways and down,
We're one hundred beds bigger
And in this hospital town,
It certainly is necessary
To appeal to the living,
As a non-profit joint
We depend on them giving,
Bundles of dollars
And cases of cash,
Or Sister Euphemia
Comes down with a rash.


It's a heck of a sign
On the outskirts of Carmichael,
If you're in a plane or a car
Or even on a bicycle,
It seems almost as big
As the real thing, I swear,
And if you look at it long enough
You'll crash and end up there,
As a bonafide patron
A victim, per se',
Where you had planned for a visit
And now you will stay.


New rooms and equipment
New Nurses and more,
Shiny, bold elevators
And locks on the door,
Beefed up security
And an incredible view,
You'll feel like you're in Cancun
With nothing to do.


Yes, our ambience was tested
By professional slackers,
Free drinks on the veranda
Toasted oyster on crackers,
And they gave us high-fives
Back-slapping and more,
The new McCauley tower
Got the highest darn score,
Way better than Sutter
UC Davis and Kaiser,
If you bring your business to us
You'll prove that you're wiser,
Than all the other folks
Who catered to our competition,
When they get their bills, they'll suffer
Extraordinary rendition,
Yes, buyers remorse
The equivalent or worse,
They know they should have chosen Mercy
And now they are cursed.


We have the coolest billboards
Plastered all over town,
If you give us a call
You'll get a free gown.


Fibril_late;
1-14-10

East Coast Steve, is at it again. A definite rival in crap poems, that's for sure. And so fitting here in the end-times.

Thar She Blows

What’s that smell coming from my floor.
Oh no, I think it’s from room sixty-four.
I wouldn’t mind it if I float today
To escape the smell of bowel decay.
 
C-diff, it could be, I don’t know
With blood mixed in, let me tell you bro’
Every time he poops, he fills the bed,
And I swear it smells like something’s dead.
 
I know nurses are supposed to take this in stride,
But when it smells like something died
My eyes, they water, my head will swirl,
And before too long, I start to hurl.
 
The pregnant nurses won’t go near
That smelly, leaking, dying rear,
The other two nurses are on the floor,
So Your’s Truly, gets room sixty four.
 
I have some Febreze, I spray like mad.
I have Glade for every plug, too bad.
I spread the Vicks beneath my nose,
I Scotch-guard everything from neck to toes.
 
I’m really thinking Flexi-Seal
Two fingers in, it’s no big deal.
Just hope that stool ain’t too thick.
If it is, I know that I’ll be sick.
 
So lube it up, and in it goes.
Holy Cow cause Thar She Blows.
He farts a big one, the shit, it flies.
I need a shower before it dries.
 
Why did I think this would cause no harm?
I now have poop all over my arm.
When I said “She Blows”, he really blew.
I’m going to cry, these scrubs were new. 
 
There’s doo on my glasses, and I swear
There’s something sticky in my hair.
And when my head begins to throb,
I know that I have done my job.

Steve (watch him heave)H.

The two first nights that I spent in the new tower (the unit opened 3 days ago), I was so-o-o-o- lucky to be Relief Charge nurse. Yikes! Both nights would have been considered crazy busy, even in the old unit, but now we're running around like Bob the chicken, who survived decapitated for 8 months.Naturally it got me thinking about the real state of affairs, that we're in. Easy enough: new tower, new equipment, same old jaded crew of over-experienced nurses. Oh, to top it all off, new stuff started breaking with "real" nursing care going on; Go figure!

Like A Lemming

Returning for one more night
Seems a little crazy, for sure,
But we are the answer people
Offering the cheap thrills cure;
A great deal of frustration and angst
Is just water beneath the bridge,
Although sometimes I feel like a Lemming
Being forced over the next plunging ridge.

Long hallways, new closets, and storage rooms
Yes, plenty of places to hide,
Maybe it's better, than it looked from the start
Like a husband reviewing a new bride.

Admissions, on top of admissions
Rapid response, Code Blue and the like,
If you do this for twenty-plus years
Why, it's just like riding a bike;
Careening down the side of Pike's Peak
On a single-track, dark and rainy night,
Survival means, bloodied and bruised
Rejoicing with the mornings first light.

Taking on the role of Relief-Charge-Nurse
I'm paid an extra one-buck-per-hour,
After just two nights this week
It felt like a slap on the cheek,
The smallest of sweeteners, turned sour.

Topping it off, the bosses decided
That Ward-Clerks are at best, obsolete,
For no-bucks-an-hour, the Registered Nurse
Can add all those tasks to their sheet,
Along with the endless new regulatory rules
"Just one more thing" added each week,
It's easy to predict, the next numbing edict
But quite frankly, we're ready to shriek.

Two hundred and twenty million dollars
Give or take a few clams in the mix,
Sister Euphemia is gambling on goodwill
To support all of her magical tricks,
Showing a good face to the community
With a shiny new chapel to boot,
Asking God for obedient employees
And extreme unction for the ones she can shoot.

Fibril_late;
12/29/09

Like the Christmas present I wasn't expecting, Steve RN in Virginia (we worked together, years ago, although we're brothers thrice removed), sent me his latest "typical" experience for a nurse.

Saving the Code

S.Huff RN

The I.V.’s running
The foley’s patent,
I smell infection,
But for now, it’s latent.
 
The code is done,
The heart still beats,
Most of the nurses
Are back in their seats.
 
He has a rhythm,
His pressure’s stable,
For now, we’ve kept him
Off the table.
 
But have we done him
Any favors?
This role we have
As, lifesavers.
 
He breathes for now
Due to a vent,
His infection held intact
By Vanc and Gent.
 
His pressure kept up
To perfuse his brain,
While the rest of him
Goes down the drain.
 
This poor man,
It’s such a pity,
I think its time for
The Ethics Committee.
 
So I call them in,
Just like I should,
They say they’d do something
If they could.

But the doctor had
To show his might,
And insisted he,
And he alone, was right.
 
And mighty doctor
Had his way,
He took me to
The family that day.
 
He proclaimed aloud
So all could hear,
This nurse thinks we
Shouldn’t treat your dear.
 
He’s convinced that
Granddad is already gone,
He thinks his soul
Should be moving on.
 
And the family looked
At me with eyes of red,
How dare you think
My dearest dead.
 
The doctor is God
For all we know,
And when Gramps is back
It’s you he’ll show.
 
So they took me off the case
As well they should,
Poor Gramps was given
To a nurse that “could”.
 
And, nigh, another night
Went by,
And down the hall
I heard them cry.
 
Poor Gramps had gone
In ALLLL his glory,
Despite the doctor’s
Convincing story.
 
What was I to do,
The family now was low,
Should I rub it in and
Say, I told you so? 
 
Or should I say “He was doing fine”
Just like the doctor said.
Or say the doctor was full of shit
And has mush inside his head.
 
Or should I approach the crying girl
The one that’s a real moaner,
And say if Gramps was in such good shape
Do you think he could be a donor? 
 
Nah, I sucked up all the insults
I took them all in stride,
I looked at each one earnestly
I said I’m sorry that he died.
 
I told them that the doc was young,
And often optimistic,
But in my mind I really thought,
Our actions were quite sadistic.

S. Huff, RN
Va.
12/19/09

*Thanks Bro, you're the bomb!
ph

I don't usually go 3 weeks without a writing, and especially at Christmas. A bunch of stuff was going on at home to arrange a big trip overseas, is what I will say was the cause. Anyway,

We're almost about to groove over into the "new tower". I expect it will supply me with an abundance of inspiration over the early part of year 2010, as we settle in. We will be taking on the Surgical Service ICU patients, so that will be interesting, as we have only had to do that "cut and sew" recovery stuff, only once in a while. So, apparently, you can still teach an old dog (and his extended family) some new tricks, after all.

Now, on the virtual cusp of the ribbon cutting, the final Health Dept. licensing and so on, here is my latest endeavor, regarding the new Tower:

A Whizz, Is What It Is

It's a brand-new tower
With carpeted floors,
A closet for the Nurses
And locks on the doors,
Spacious waiting rooms deluxe
For John Q. Public and his crew,
Who gape with wonder and amazement
'Cause all the furniture is new.

There are a couple more bathrooms
With a mirror for viewing,
As I stand there and pee
I can watch what I'm doing,
Now, if that ain't modern progress
Just tell me what is?
Could there be a hidden camera
To record what I whizz?

The kitchen is tiny
The Nurse's break room is small,
It's cleverly hidden
Somewhere down the hall,
The Doctors have two rooms
And larger, of course,
Though we do all the lifting
They have all the force.

It’s a wonderful new building
A new system to boot,
Sister Euphemia is dancing
In a her new tower suit,
Each time she clicks her heels
The cash register is ringing,
While the angels on high
Harmonize their singing;
Hosanna, hosanna
Let’s open this new banana,
Break out the new Chapel
And the rose garden cabana,
While the CEO, (that good boy)
Is serving up the tea,
Hosanna, on my new tower
Catherine McAuley, set us free!

Fibril_late;
12/20/09

Someone, roughly my age, noted a strange similarity, in respect to, the Dick & Jane books of childhood, with that common starting line.........."See Spot; see Spot run". It was something about a dog that was probably smarter than D & J. The similarity in question, was about the other "See" which we unfortunately are accustomed to............C Diff. Thus was born a new, sickening poem.

C Diff

C Diff
C Diff run,
Saturating linen
Its flow is never done.

C Diff
Is certainly the worst,
Use lots of soap and water
Or your hands are cursed.

C Diff
Its cloying sour smell,
Clinging to your uniform
Like a perfume from Hell.

C Diff
Odor atoms in the air,
You scrubbed per protocol
But what about your hair?

C Diff
Cleaning is a hopeless endeavor,
Just take a whiff
It stays in your nose forever.

C Diff
Oh, I'd rather not,
I'd rather wallow
In a bucket of snot.

C Diff
A room, by yourself,
Piles of linen
Fall off the shelf,
Friends and visitors
Wear protective gowns,
They smile and say, "How are you"
And leave with crappy frowns.

C Diff
Endless liquid stool,
Flexi-Seal stat
It's the perfect tool,
Make sure you change the bag
Before it bursts its seams,
Or you will surely suffer
C Diff nightmare dreams.

C Diff
Stays around for several weeks,
The smell is overwhelming
The atmosphere; it reeks,
No perfume eradicators
Will annihilate the odor,
You need an air-evacuator
With a mondo-turbo motor,
To suck the fumes away
Before they ever reach your nose,
And should C Diff ever splash on you
You better find a hose.


Fibril_late;
12/02/09

In the vicinity of our metropolitan area there are a number of prisons. Is this a curse, or a boon to business? I am not sure. However, I guess we can consider it a boon to Hospital revenue, because just a couple of the local hospitals, have the good fortune to having garnered the prison-care contract. That includes us at Sister Euphemia‘s joint.

Thus, I figured it was high time I took a look at the topic, and no better a time, than just having spent 3 nights administering to a bonafide felon from the notorious, Folsom Prison.

I Googled, “Folsom Prison Famous” and here is the following website, for those of you who are curious -
http://www.myfolsom.com/famousinmates.shtml

Made In The Shade

A prisoner from Folsom
San Quentin or Ione,
They love our soft beds
And their own custom phone,
The cable television
Music, movie, 50 channel,
The sheets from Bed & Bath
And the Ralph Lauren flannel.

Yes, a medical prisoner
Has it made in the shade,
Free, taxpayer paid insurance
And their own private maid,
To fluff up their pillows
And deliver their dinner,
Why, it makes it all worth it
To be a cold-blooded sinner.

Mr. I-Didn't-Do-It
Had a headache and blurred vision,
Apparently he had experienced
A head-floor collision,
After fighting with Bubba
For some contraband tobacco,
Not the best choice
Because, Bubba is a whacko.

The medical doctor
On site, at the slammer,
Had seen injuries like this
Like, head versus hammer,
And since the prison now out-sources
All their medical care,
We are the receivers
Of all the felons out there.

Most prisoners are cool
They know they've got it good,
Just smile, and say thank you
Like any locked up fool would,
When they know we have the power
To cause pleasure or pain,
Why even a rat understands
With his little rodent brain.

One or two ankles
Are shackled to the bed,
Two armed guards sit
Bored out of their heads,
It's a cush-job, always overtime
No part of it is hard,
Merry Christmas to all
Life is great, for a medical guard.

California prisoners
Fake an illness now and then,
To get a luxury bed in the hospital
Better than any, in the pen.

Fibril_late;
11/28/09

Yes, the talk of the town, and the rumblings of gossip all revolve around the building of the new tower/wing. When will it open? Who will work there? What version of ICU will occupy the new 22-bed critical-care floor? Of course, since we're nurses, the rumor-mill is hitting about 200 mph by now. Heck, even the rumors are spawning children. Anyway, I have some ideas about what's really happening, but as usual, it's just So Much Talk.

So Much Talk

It's a brand new tower
And there's so much talk,
About the circles and arrows
And colored chalk,
The fancy new beds
With the bariatric lifts,
Which Sister Euphemia claims
Are the most blessed gifts.

There are all kinds of new gizmo's
Both high-tech and low,
There are new communicators
That track where you go,
There's a lock on the doors
So the thieves don't get in,
And Sister Euphemia claims
It will protect us from sin.

There are mumblings and grumblings
Regarding which I-C-U,
Will stake claim to the veranda
With the most wonderful view,
While powerbrokers gamble
With buffalo chips and more,
The bookies in Vegas are
Handicapping the score.

Seniority claims
And back-slapping buyouts,
Brownie point redemptions
And cheerleader tryouts,
Ballot box stuffing
To influence their score,
Everyone bargaining
In the back of the store.

Sister Euphemia consoles
With a positive focus,
Casting prayers right and left
With a little hocus-pocus,
All will be well
As ends well, she states,
Now, just get back to work
And don't test the fates.

It's a brand new tower
But it's not open yet,
Who will win the right to work there?
Is anyone's bet.

Fibril_late;
11/21/09

Every,every day, the hottest topic is "the new building". As in, "when are we going to move in", and I wonder if we'll stay full, so we don't have to float.

I don't know, or particularly care, as I know it will be soon in dust-mite years. But, it's still the talk of the town!


Shiny New Building

It's a brand new tower

But we're the same old nurses,

It's the 21st century

And we still carry purses,

So don't be thinking something's different

It's the same old song and dance,

Draw the card, “Community Chest”

Or would you rather try at “Chance”?


If only life were fantasy

And imagination real,

All our fixtures made of the purest gold

Instead of stainless steel,

Our patients built of paper

Like the cut-out dolls of old,

We could cure their worst diseases;

Just cut the dotted line and fold.


We'll be doing all the same old stuff

Repackaged, new and shiny,

We'll be the happiest crew you could ever find

With no reason to be whiny,

The wonder-chip from IBM

Will be embedded in our brain,

And if we deviate from the master plan

Expect a ball and chain.


Oh, we're moving to a brand new building

The excitement grows every which way,

It's the hottest new trick since Trauma

Grabbed the headlines, 10 years ago today,

After the public is overwhelmed by our advertising

They'll be crashing Admitting for care,

We'll be praying to go back

To that old rickety shack,

And breathing that moldy old air.


Fibril_late;

11/13/09

Occasionally at work, there is a new Nursing Policy (or is that a new edict?), that seems so flippin' ridiculous. That means, any nurse that reads it over, stops, and emits a very loud, WTF? But then, when the boss says the cause of it was the "Joint Commission", we shake our collective heads and sigh. But after that, when the boss stumps that they wrote the flippin' edict, there's a distinctive head shake, eye squint and lip lift, and again, WTF-OMG!

The Joint Commission; band of brothers, or band of thieves? Who knows.

But, "National Patient Safety Goal 16", is something to do with making sure patients and families, have a method to "summon extra help". And so, at our hospital, this will be known forever as, the "Condition Help Policy". No, I'm not making this up.

Well actually, I did make up the poem you are about to read, in response to the latest flim-flam edict.

Condition Yelp

If you need urgent attention
Because you are concerned,
Your meatloaf was moldy
And the poached eggs were burned,
We now have a program
For help right away,
Condition Yelp is the answer
Any time night or day.

If there's a medical change
But we didn't notice,
Or you sent us a letter
But we ignored what you wrote us,
We now have a system
For hot buttered care,
Condition Yelp is always ready
Anytime, anywhere.

How do you do it?
Just listen and learn,
Dial "O" for the operator
And then wait your turn,
Because we are predicting
An onslaught of calls,
From every Tom, Dick and Harry
Out wandering the halls,
Complaining about the stupidest
Crap in the book;
Condition Yelp guarantees
The Charge Nurse will take a look.

I can hardly wait to be
A designated responder,
One more task to undertake
As the Charge-Nurse, over yonder,
Never knowing when the phone rings
If I have to leap into action,
It's a heavy responsiblity
This Condition Yelp distraction.

When the Satisfaction Surveys
Are tallied and scored,
It will all come up roses
So that we can afford,
To send the chief's on vacation
Or some high-end retreat,
While the minions of peons
Keep walking the beat.

Condition Yelp is the solution
To any problem that could be,
And the cost to the patient?
Hot damn! It's always free,
It's just a part of our
Hot, smoking package of care,
Dial "O", give a Yelp
And a Nurse, will be there!

Fibril_late;
11/02/09

Goin' South

Goin' South:

Last night I had two patients, one 55 and the other, 71. They both were "cardiovascular disasters". The younger one had just had his second MI in 6 months, and had the absolutely worst Left Ventricular Dilated Cardiomyopathy that I have ever encountered, and in essence, was in cardiogenic shock. His ejection fraction is 10-15%. He had Diabetes, an AICD with a biventricular pacemaker, and had a history of a cerebral bleed 5 years ago. What he needs is a heart transplant, but isn't on a list for some reason. Cardiogenic shock has roughly a 55%-80% in-hospital mortality (current estimates). He actually looked improved, compared to 16 hours back, when he was admitted.

Mr. 71, was recovering from a GI Bleed (accidental Coumdadin overdose, when his prescription was delivered in error, to read 12mg daily, prior to admission). He suffered an MI, secondary to volume depletion; Heart-failure secondary to volume resuscitation, which lead to respiratory failure, and a few days on a respirator.
He has cardiomyopathy with an ejection fraction of 20%. He had prior revascularization of both carotids, and an Aorto-bifem bypass. A left femoral graft repair with subsequent graft infection, with need to replace graft, and at that go-around, he developed a Pulmonary Embolus, and had an IVC filter placed.

Today, he was hoping to go home. That went south at about 6am, when he said his right foot was painful and cold. At the start of the night, he had weak, but palpable pulses. The cold foot didn't even have a doppler pulse.
I paged and notified, those-who-must-know, but frankly, I felt pretty bad about the whole thing, knowing that his departure from the hospital, had just hit a major pothole on the road of his recovery.

Ready To Go Home

Ready to go home
What could possibly go wrong?
Don't ask me to sing it
It's a treacherous song.

First, you survived Sepsis
Cardiac Failure and more,
Diabetes Insipidus
And a high APACHE Score.

Your liver shut down
With your kidneys soon after,
We were preparing the pine box
Stored above on the rafter.

But like a cat with 9 lives
And the horse with no name,
You were the grand finale winner
In your survival game.

Then this morning at six
After you awoke from your slumber,
Your right foot was painful
And colder than a cucumber.

Bad tidings indeed
On that double bypassed leg,
If the gods had a solution
I'd be the first one to beg,
For some blessed reperfusion
And a miracle cure,
The vascular surgeon told me
We can't operate, that's for sure.

Because the man is a vascular
Disaster in person,
We repaired the graft in June
And in July it did worsen,
Infected it was, we had to pull it
And replace it,
I'm the surgeon who fixed it
And now I'd rather not face it.

Mr. Ready-For-Home
Poses a problem and a riddle,
We need to open that leg
But he's not fit as a fiddle,
His morbidity and mortality
Are at an all time high,
No matter what we do or don't
It's quite likely he will die.

I felt like an accomplice
But it was nothing like that,
I checked on him often
Every two hours for a chat,
And not till this morning
Till he moved to the chair,
Was there a hint of a problem
Of disaster in the air.

It's my day off, as I write
And I won't be there tomorrow,
I'm worried and concerned
For his pain and his sorrow.

Fibril_late;
10/12/09

Ready To Go Home II

Ready to go home
What could possibly transpire?
Let me first warn you
My predictions are dire.

Mr. Cardiomyopathy
Didn't stand a chance,
His 900-cc ventricle
Had done it's last dance,
After waxing and waning
A couple of days or two,
He kicked the bucket quietly
There was nothing we could do.

His wife and kids looked on
To the future, without the man,
His lifestyle choices
Take some of the blame,
They helped him kick the can.

Mr. Pulse-less foot
Had a rough couple days,
Vascular surgery attempted
Several, last ditch effort plays,
But the end result was removal
Of his leg below the knee,
Sometimes there are no winners
In the game of life, you see.

He went home a crippled man
But he's still alive for some good tomorrows,
Prosthetic engineering can help him
To waylay his endless sorrows.

Ready to go home
At the end of the night, I am,
Sometimes this healthcare business
Seems like, nothing but a scam.

Fibril_late;
11/7/09

Even in the workplace, or perhaps that is the only place where this topic arises, there might be a discussion whether what is best, to leave the toilet seat up, or down, following it's use. Let's examine that once again:

A Fair Compromise

Toilet seat up
Or toilet seat down?
There are different opinions
In hospital town.

Like an open-faced sandwich
Or a pan that's too hot,
Some like the lid up
On their chamber pot.

While others will argue
The lid should be seated,
And hey, while we're at it
Why not have it heated?

It's a quandary and conundrum
All rolled into one,
And no agreement or bargain
Shall likely be done.

I propose, year by year
We choose one or the other,
A fair compromise
For sister and brother,
But on that off year
When it's lifted again,
Be careful, in a hurry
That you don't fall in.

Fibril_late;
10/11/09

Don't get me wrong; I like the Day-shift. The crux of the problem? I don't belong there. Why? The 3-meals, the numerous Discharges, the numerous Doctors, Imaging tests to travel to and more. It ain't my gig, and everybody knows it.
So, when I have to hang out longer than my usual 12 hours to Chart, well, I get to write a poem too. So please don't take any of this as a personal slight, ok? After-all, I named it after my least favorite president.

George Bush

Charting, charting, charting
Q-four-hours, it's a bitch,
My arthritic joints are aching
And my butt begins to itch,
'Tis the same old stuff I chart each time
It's really such a chore,
But they told us George Bush wanted it
No wonder, it's a bore.

Charting, charting, charting
It's oh-eight hundred, I'm still here,
My friends have all gone home
There were laughing, in good cheer,
It seems I had to trouble-shoot
The IV pumps and charting,
Now I'm surrounded by those day-shift freaks
My defense? I sit here farting.

They stay away from me, they do
Afraid, they'll make me linger,
As I pluck away at the keyboard keys
I offer them the finger,
Their fault, it is not mine to blame
I'm old and thus, too slow,
But the best of them, will always wish
That they could buy, all that I know.

Fibril_late;
10/1/09