During the time that I was off for bone repair, I used up all of my banked sick-time, and most of my PTO. After 2 weeks of work, I finally caught up with the local flu-like viral syndrome and missed a day on the job (fortunately I reduced my hours to 24 hours per week)...but that's a day without pay, however I slice it.

Skid Row

I called in, sick
Just the other day,
When a few hours before
I felt OK,
But Saturday morning
When perchance, I coughed,
My oropharynx
Was no longer soft;

No, it felt as if
Those tissues were ripped,
Where sharpened blades
Had gouged and clipped,
My tonsils
In a rage of fury,
And when I almost cried
My eyes got blurry.

There's a packet of pus
At the back of the bus,
Ripping razors, whenever I cough,
My vocals were distorted
When my voice-box aborted
Communications quite clearly, are off.

I'm no good for work
And sick-time is a perk
But in my case, that perk can't be trusted,
I used those hours in December
I quite clearly remember,
When my ankle was damaged and busted.

I'm not working, it's a freebie
I'll have to suck on a BB
Counting my negative cash flow,
I will heal pretty soon
After I main-line the moon,
While resting down here, on skid row.

Fibril_late;
4/29/11

Is it just Nursing or has the whole world gone crazy for words that end with "ment"?
Nursing loves to describe how we all implement, supplement and so on. We don't see impediment too much, and no one likes to talk about excrement, but I managed to get the whole bunch into a short little essay/poem/comment.

Ment Well

We implement
Their supplement
To their detriment,
Blame it on their impediment
When it results in excrement
(aka: a movement);

I think we're in agreement
That's no compliment,
It's a measurement
Of mismanagement
Of an ailment;

Despite commitment-
Just another appointment
Of torment:

But we ment well.

Fibril_late;
4/29/11

Well, it happened. The bigwigs rule the day. Our 20 bed ICU has now been chosen to accept (allot) ten of our beds for acute Neuro patients. Look, this is a passion one is born into, not picked willy-nilly. I have spent 30 years doing my best to avoid acute Neuro. Now, it wants to jump on my back. Here are my thoughts about it:

C.M.N.P.P.S.*

We’re the C-M-N-P-P-S:……. ICU
We can fix you up
No matter what you do.

You can blow a vessel
In your brain,
Or have the heart-attack
With crushing pain,
A saddle-block
Pulmonary embolus,
Or a pelvic abscess
Filled with pus.

We have surgical clients
With a perforated colon,
Pancreatitis
And gall-bladder's swollen,
Drains out the yin-yang
And wound vacs that suck,
In for a dollar
And out for a buck

We admit psychotropic
Seizure manics,
When they come in
Everybody panics,
Like alcoholic
Bipolar Bobby,
Collecting personalities
Like a knick-knack hobby.

Let's remember Septic Suzy
Of nursing-home fame,
Seven organ-systems failing
And she's losing the game,
Her family wants everything
Because life has no price,
Suzies age is one hundred
And she's rolling loaded dice.

Now rumor has it
We have allotted ten beds,
For all of those people
With screwed up heads,
And when the dust settles
It’s anyone’s guess,
To see who’s left standing
At the bottom of this mess.

But we don’t care
If you have all those issues,
We have stem-cell soup
To repair your tissues,
And we’re paid by the organ
On an exponential scale,
Whatever the problem is
This plan can’t fail.

Fibril_late;
4/29/11

(*Cardiac-Medical-Neuro-Pulmonary-Psychiatric-Surgical ICU)

I was out of work for 4 months after stepping into-the-hole-that-should-have-been-covered. Yes, it's like some curse out of Harry Potter, I swear. But the upshot was, during the time away from the work arena, I had little to inspire my medical muse.

This week I returned to the fold and spent two days, getting reacquainted with my old time used-to-be. And kapow!, a virtual watershed of stuff to write about!

This one regarding, the frequent flyer.

Rankle My Ankle

Four months of renovation
Before I got back in the game,
But the patient population
Was nearly, still the same............

No, I never should have wagered
On the the size of that Anaconda,
And I was never, more surprised
To see my old friend, Wanda.

A term is used
The apt applier,
The client known as
The frequent flier,
But in Wanda's case
That term is too loose,
Try, analogically imagined
The big plane, the Spruce-Goose.

If you don't know her history
I'll gladly, share mine,
A visit from Wanda
Makes me whither and whine,
She stays for a month
Her claim, on the corner,
A victim of pie
Place the blame, on Jack Horner.

Enticed as a youngster
Nursery-rhymes about eating,
Later, as a teenager
Culinary competing,
It got out of hand
And quickly into her mouth,
Her size expanded westward
While her health, was going south.

Now her quarterly visitations
For roughly, a month at a time,
Have apparently coincided
With my recovery time,
And though I'm back on my feet
Anecdotally, for a busted ankle,
Facing this kind of patient assignment
Quite honestly, it doth rankle.

Fibril_late;
4/9/11

I know that some of you, and maybe all of you, have been force-fed with another silly nursing idea called "The Huddle". At my domicile, we're always a little late getting on the bandwagon, but rest assured, we eventually do get on board with the rest of America's Nursing Management, to right the wrongs, so to speak. Thus, I am now qualified to editorialize on the (who needs it?) Huddle.

The Cuddle Huddle

Critical care medicine
Can be complex and muddled,
Many disciplines and specialties
Are often befuddled,
But Nursing, as usual
Came up with an answer,
After consulting outside experts
From Studer and Prancer.

They claimed they had knowledge
From studies and such,
That nurses perform better
If they cuddle and touch,
So the latest directive
From the lofty environs,
Will have us cuddling each day
To the songs of the sirens.

To make it seem official
Like it's a recognized practice,
We'll hold hands and chant “Om”
Under the mistletoe cactus,
And if your day started poorly
Because you stepped in a puddle,
Don't worry, we'll fix it
In our feel-good, daily huddle.

Fibril_late;
4/7/11

A buddy of mine reminded me that I haven't posted anything in a while. It's true, but I haven't been to work in almost four months either. When I'm not there, inspiration lags without new experiences bombarding me right and left. I've had a few ideas here and there, but nothing really came of it. However, since I will be returning to work in about 2 weeks, just the mulling about it caused a writing.

Preparing My Return

I've barely said a word or two
In one month recent past,
The days turned over hours
That hardly went too fast,
And now I'm preparing my return
To stomping grounds of old,
Will my old and newer workmates
Accept me, back into the fold?

Something to look back upon
I missed the pneumonia season,
My advice if planning injuries
Pay attention to the reason,
Whether stumbling in the gaping hole
Or falling down the stairs,
Be careful how you do it
To avoid the worst repairs.

I broke a foot and leg bone
And yes, it hurt like hell,
But surgery was avoided
And the plaster cast as well,
Now walking isn't as easy
As it once was, yesteryear,
But I'm strong enough to face the beast
With my shield and trusty spear.

Another aging warrior
Returns to the blooding field,
Stumbling over sleeping pigs
In harmony, they squealed,
Awakening the enemy
A disturbance of the peace,
We'll hang him by his toenails
And fry him in the grease.

Hopefully my return
Will be anti-climactic, for a pause,
Hold back the circling heathens
Who are sharpening their claws,
Allow me a moment of preparation
To face the advancing hoards,
Then I can dive in with some gusto
And earn my just rewards.

Fibril_late;
3/22/11

I read recently that we actually have five layers of bacteria on our skin. Some of them are ok, I guess. Who knows? But even when we wash our hands, shower, exfoliate, etc.......just 24 hours later, all those critters just reproduce all over again. And to top it off, my bacteria are unique to me. Even if you should rub a few of your bacteria on me....hmmmm........they'll probably get the boot anyway from my bacteria......'cause they don't belong on my side of the tracks.

A Million Popes

Five layers of bacteria
Upon my skin,
More than I thought
And microscopically thin,
When washing my hands
I might only lose one level,
Twenty-four hours from now
I'll be the same old dirty devil.

Most bacteria are my friends
Though some are deadly foes,
Others are just plain ugly
Just take a look at my toes,
But possibly those are fungi
But not like Joey at the bar,
Knocking down three Heineken
And crashing in his car.

Five layers deep
Bacteria on my skin,
There's a microscopic ocean
That we're all swimming in,
Forget those sterile wipes
And all those silly soaps,
They're no better than the blessings
From a million Popes.

Fibril_late;
2/8/11

Just a little thing about the whole "scripting and rounding" concept, again.

Nurse Clone

After twelve hours
Of scripting and rounding,
Good golly, Miss Molly
I've taken a pounding;

After the four P's
And everyone's Aidet,
Yesiree, Bob
I know I've surely made it;

With scripting and rounding
We're of a similar tone,
Just like Stepford Wives
I'm your favorite nurse clone;

And at the end of my shift
I'll up-sell the next nurse,
Even when I know
His reputation is a curse.

Fibril_late;
1/17/11

Just a little reminder; don't eat the hospital food and don't drink the water.

Average

The average hospital sink
Is not an ideal place to drink,
All the germs and the fungus
Are shared there among us,
So the thought of a drink there, doth stink.

The average hospital meal
Is rarely an appetizing good deal,
The meat is long dead
And there's mold on the bread,
Even if I were a pig, I would squeal.

Fibril_late;
1/14/11

A couple of weeks ago, I wrote about a guy who was fixated on his bowel function, and how crazy he was regarding that problem. This is just a short sequel.

What A Bother

I don’t need to know about
Your bowel habits, sir,
I don’t need the circumstance
The when, the why, the were,
And no one else, includes
Your children, wife and father,
No one wants to hear about
Your bowels, what a bother.

When you were working your career
An executive, is what I heard,
You must have been the Type-A kind
An obsessive-compulsive bird,
Controlling all of the company crap
And snooping in personal files,
You're retired now, to constipation
With painful, itchy piles.

Now top it off, you’re infected
We call it “contact isolation”,
Every trip into your room, sir
Is like a third-world destination,
Please roll over now, it’s time
For your daily disimpaction,
With smiles around we cater-up
To earn your patient satisfaction.

Fibril_late;
1/13/11

I am quite impressed with two articles in the October and November issues of "National Nurse" the Voice of National Nurses United. The two articles addressed that ridiculous "Scripting and Rounding" that has been shoved down the throats of nurses nationwide, by hospital administrators. If you are uncertain what I am talking about go to the following link:

http://www.nationalnursesunited.org/publications/entry/national-nurse-magazine/

I have been writing about this crap for a couple of years lately, but I am only becoming further incensed with this nonsense. So I'm starting off the New Year with my latest rant:

Violated

We're threatened with HIPPA violations
We're laden with boatloads of rules,
I'm the nurse for two 500 pound patients, and
Administration is stealing our tools.

They disbanded the guys on the lift-teams
A cost effective measure they claim,
Now daily they're stealing our break-nurse
High-census, low-staffing they blame.

Administrators attacking any overtime
That occurs daily in every ICU,
I'd wager, that not one of those bosses
Could accomplish, even half, that we do.

Don't write any incriminating emails
Don't post on any internet sites,
If you do you'll be sued and delicensed
And denied every one of your rights.

With scripting and rounding we're programmed
By the little tin soldiers upstairs,
The hell with our critical thinking
It's driven by money, who cares?,
The Medicare-Medicaid gorilla
Threatens hospitals with financial extortion,
No longer are outcomes important
The scales shift to the satisfaction proportion.

Pushed to the edge of the precipice
Perhaps it's time for the young to step in,
They are faster than me on the computer
And not tainted as I am with sin,
Their bullshit intolerance capacitors
Are so new, they're just out of the box,
We old veterans should hang up our gloves
And send the bosses our sweaty old socks.

Fibril_late;
1/7/11

Here it is December 31 and this is the last poem of the year. Because this is such an auspicious occasion, I am delivering an opus of intrigue and mystery. It’s all hush-hush, wink-wink, in-between the lines stuff. Although I share my writings with my colleagues when it is on the up and up, occasionally I address “sensitive” topics that might ruffle the feathers of the big birds. By posting on this blog, it becomes readable in the public domain, and thus, I must drop to the level of subterfuge, to disguise my message.

And I do like to dabble in nonsense, and see what comes out of it. Happy New Year!!!

Hush-Hush

This might be my last chance
To put this in writing,
I’m past the moment of boldness
But it’s time for indicting,
Exposing the infractions
Wherever they be,
It could have been you
Instead, it is me.

It’s the duty of the press
To find the rarest detail,
Which is sometimes so obscure
You might think you’re in retail,
Coordinating the castoffs
In the dressing room hamper,
Or getting lost like a rookie
In a Winnebago camper.

To dig up what’s hidden
Requires secret knowledge,
In the realm of the professional
We’re talking about college,
You can’t play in this sandbox
Without having some creds,
And the dress code is such
You can’t show up in dreads.

Details so abstruse
You need a submarine,
To fathom the depths
For the truth to come clean,
A buried conspiracy
Fourteen layers deep,
The story of the year
And we’ve all been asleep.

Money on the bottom
Money on the top,
Dollars without sense
On a roll and just can’t stop,
With reams of regulations
And adjustments to the build,
Hush-hush secret meetings
Between the masters of the guild.

Undercover gatherings
Messages in dead-drops,
Who would ever guess
They congregate in head shops,
Monthly new directives
Provided with pearls and pomp,
Wrapped in shameless packaging
And delivered with a stomp.

The story of the year
You must read between the lines,
Like you, I need to stay employed
And avoid those nasty fines.

Fibril_late;
12/31/10

This was the ultimate in obsessive/compulsive disorder. This 76-ish gentleman, was absolutely, astronomically fixated on his ability, or lack thereof, to have a bowel movement (bm, crap, shit, unload, have a dump behind the stump), or whatever you call it. It was the only thing he could talk about. Every conversation, led back to his bowels. Even if he was telling the story of going to Wisconsin for Christmas, he had to include the agony he experienced on the plane, where he felt “under-pressure” in the little airplane restroom, and he couldn’t take a dump. And, that was just the beginning, regarding why his visit to see the grandchildren, was a disaster. His bowels were constipated.

Yes, that might seem a little overboard, but it is the truth. Now, fit the above scenario, on a fellow with severe, end-stage Pulmonary Fibrosis, COPD, and Asthma, who needs BiPap with 100% Oxygen at all times, just to keep his saturations above 88%. And then, all he can do is talk about his inability to take a dump. Yowza!

Constipated

Collectively, a complicated psychosis
Overwhelming, was his halitosis,
Never had I met someone, so fixated
So sensational it was, as if iron-plated,
Telling his story, to anyone that was near
Incredibly, like it was his career,
Plausibly, it was a legitimate condition
After awhile, it became a long, boring rendition,
Then he revives, and tells me once more
In fourteen different ways how he just can’t score,
On the bedside throne, even though he has been thoroughly Kaexalated
Nothing seems to help, he’s totally constipated.

Fibril_late;
12/30/10

What happens at work, stays at work. We can thank Hollywood for that observation. I write about work, weaving and twisting the experiences, and then share it on this blog. Of course names are changed to protect the perpetrators.........because I don't want that bucket falling on my head. Anyway, here's the latest on the topic.

Always Fresh

I don’t write about work much
Unless I’m there in the flesh,
My mind percolates like the coffee pot
Brewing grounds that are always fresh.

The glaring inconsistencies
Are only obvious when I’m there;
Once I’m gone for three short hours
It doesn’t matter, I’m no longer aware.

So I keep the voice recorder
On hand, in my golden chariot,
To capture those thoughts that are running loose
I’m ready with my lariat.

Once I’m home and sleep commences
I cleanse my mind with dreams,
I’ll return to work another day
To write about new themes.

Fibril_late;
12/29/10

Just so you know, when I write about nurses, whether I use the masculine or feminine (he or she), usually is dependent on the word I need to rhyme with. So, although I previously wrote about the “3G Nurse” who was on her smart-phone too much at work, here I am once again picking on “her” because of the basic need to rhyme properly.

Now, I know that sometimes 8 hours, or 12 hours at work can seem like torture because the patient is a whacked-out crazy man, or a person with no short-term memory, but still, it's important to keep in mind, that we have a moral duty to relieve human suffering. I've had countless nights like that and you probably have, too. Try to keep in mind.......it's only 12 hours.........surely, I can remain calm and kind, for just 12 hours. Of course, it's courteous to answer the call-light promptly.

On The Moon

I’m kind of upset
About that nurse over there,
Her patients are calling
And she just sits in her chair,
Checking her email
And talking with others,
Looking at Facebook
To see her sisters and brothers,
Who remain in her homeland
Which is so far away,
Now she’s checking the airlines
To see how much she’ll have to pay,
To travel back home
Six months, next June
While her patients are screaming
It’s like she’s on the moon.

I’m answering those call-lights
And doing her duties,
Both patients are in isolation
And covered with cooties,
But still they have needs
And this is our career,
Where our clients are needy
And not always in good cheer,
They are often in pain
Or they need to take a crap,
Maybe they’re bleeding and vomiting
And it lands in your lap,
Yes, I know it’s disgusting
To have to deal with this wet-work,
But you’re paid to be here
So get off that social network.

With 12 years of experience
Her resume’ looked great,
But she cares more about her social life
Compared to the patients fate,
Now there’s an administrative edict
Regarding use of the computer,
But this chick just doesn’t get it
So, we might as well shoot her.

Fibril_late;
12/28/10

Time for that end of the year review, sort of thing. What do I remember best? What sticks out in my memory...............

Case Of The Year

Most memorable case
Of the year, who knows?
It might have been that fellow
With the dead, gangrenous toes.

I came on that evening
After a "minor surgery" in the room,
His foot was wrapped like a mummy
And there was a cloying smell of doom.

The day nurse was reporting
"Oh, by the way, please don't forget,
Send the dead toe to the Laboratory
I'll be temporarily in your debt".

I gave him a look, in the usual fashion
Right......; you could have had this done,
But why raise a fuss in the moment
When we can all share a bit of the fun.

What kind of packaging
And where do I send it?
Double-bag it, please
And try not to bend it,
It's a special collection
A pathological piece,
Don't place it on ice
And don't send the fleece.

So I got a couple baggies
The red specimen style,
Threw that toe to the bottom
Sealed it, and kept it a while,
Quite the conversation piece
"Hey, look what I've got?"
Billy-Bob's toe
And it's as ugly as snot!

Well, after all the jokes
About the toe-truck, and such,
I sent it to the lab
For that toe's final touch,
A specimen like no other
An unsightly black lump,
What does the Laboratory do?
They call, asking about the stump.

The dead toe scenario
Has a dismal outlook, indeed,
The odds are, the foot will follow
All the way up to the knee,
I've seen men lose two legs
And two arms, before it was over,
After surviving the beaches of Dunkirk
And leaping the cliffs of Dover.

Fibril_late;
12/27/10
_________________________

Revolving Door

Attack of the largest in life
2010 was memorable for sure,
Those super-sized clients of ours
Weren't coming to us for a cure.

But rather, some kind of repair
A secondary causation, due to weight,
Without reducing the underlying problem
We knew they'd be back at a later date.

Bettyjoe Bilotnik
Was admitted four times, I recall,
And it really, was quite surprising
That all of her children were small,
Her mother was built like a toothpick
While Betty's husband was shaped like a blimp,
Pushing Betty in the wide-bottomed wheelchair
Poor old Chester, had a heckuva limp.

Jimmy Johnson from Modesto
Got an ear infection, and an abscess in his neck,
Sepsis knocked him on his can
All 500 pounds of him, on last check,
“Wait, he's just twenty-eight
How in the heck, could he be so sick?”
That's what his sister said
When we had to intubate him real quick,
Because of respiratory failure
He was a smoking asthmatic, to boot,
Oh, he's always been a little heavy
But it never amounted to much; shoot.

Yes, we surely operate
A revolving door of care,
Without our frequent-flyers
I'd hardly know what to wear.

Fibril_late;
12/27/10

Working with the super-sick people, it's easy to lose sight of the breadth of the healing process. Additionally, when working my typical one day on-two off, it's only the one out of twenty patients that sticks around more than two days. Now, as I ponder the dichotomy of my existence, sitting here with a boot on my leg for 8 weeks, the life-cycle of the healing process, unfolds before my eyes.

Healing

Healing progresses
In its own good time,
More than a nickel
But less than a dime.

The days go by
Kind of slow and boring,
Like the baseball game
Where nobody’s scoring.

Hit the ball, catch the ball
Beat the runner to the bag,
Like a double dose of Ambien
Or Chloroform on a rag.

But who needs excitement
When bones are on the mend,
It’s like the new Spring garden
With little vegetables to tend.

Watching them grow
If you sat there all day,
Would be slower than snot
Is all I can say.

The mending of bone
Takes much longer than expected,
You can’t really feel it growing
But it must be protected.

In that respect, my foot
And lower leg, as well,
Should I fall over or stumble
It will surely hurt like hell,
So I keep it secure
Like hiding my loot,
What used to be a cast
Has now become das boot.

So I busted some bones
To earn an eight-week sleeper,
But I’d rather do that
Than meet the grim reaper.

Fibril_late;
12/25/10

I admit it, I haven't been very productive lately. Part of the reason is that I joined the ranks of the injured, when I walked into an open drain hole in a sidewalk, in the dark. That's right, so lay on the sympathy please. Anyway, that story is being told over at (http://odarepsed.posterous.com/) which is my altered ego site. Anyway, it could have been worse.

Hummer

Getting injured
Is a bummer,
But, better to fall in a hole
Than be thumped by a hummer.

Fibril_late;
12/16/10

How many shifts in the past week where I have not had time, nor have there been enough staff on hand, to have breaks at work? I talked to a family member of a patient one night, who couldn't quite understand, how a nurse could be so busy, as to not have time for a break. She said something to the effect, that break-time was "mandated" in California, so of course, we must certainly always have time for a dinner-break. I think I finally got through to her, that an unstable patient, might trump my need for a food break, if there were no other nurse available to fill in.

Well anyway, this job is horribly stressful at times, despite my training in spiritual enlightenment practices and black magic.

No Immunity

Encountering another ridiculous
PTSD opportunity,
I'm once again reminded
I have no professional immunity,
To protect me from experiencing
Overloaded situations,
Despite my secret talismans
And psychic affirmations.

Like a passenger in a canoe
In some Class-5, crazy water,
Some nights at work I feel the same
As a lamb led to the slaughter.

Fibril_late;
11/24/2010

We all know by now, that Nursing is not getting any easier. It is way more complex than when I touched my toes in this turbid pond, 27 years ago. Heck, back then I had been an RT, and that discipline is incredibly more complex too.

I know so much more now, but I am ever the more frustrated with all of the crap we have to put up with in terms of management policies (or lack thereof), bureaucracy and regulatory agencies, medical equipment designed by cloistered lab engineers who don't know Jack about real-life usage, and so on. There is plenty to bitch about.

At the same time (and all wrapped up in our daily experience), I know we perform amazing feats of caring and healing, which are interwoven and incorporated into the very fabric of our lives. And that's the clincher; it's difficult to “come down”, after successive days at work, to process all of the experiences, frustrations, successes and losses, and merge smoothly into the ordinary home-life. I believe that this is a common theme among the public service industries like Nursing, Police, Fire, Military and the like.

Sometimes just a bitter cup of coffee, helps me to cross the bridge back to reality.


A Cause and a Curse

It's my usual way
After two crazy days
To unwind at the local brew shop,
Skimming the papers
While jotting down words
Disengaging my feelings with a chop.

It's that Karate killer instinct
Trying to sort, slash and bury
The experiences of this overworked nurse,
Saving people who are dying
And babysitting the rest
It's a career with a cause and a curse.

Fibril_late;
11/1/10