Sure, we always do a Skin Assessment when we admit someone, (and of course 2 nurses sign on it), but now, Sister Euphemia wants us to do a Sin Assessment!?! Can you believe it?

Sin Assessment

Down at Sister Euphemia's place
Everyone working has a happy face;

You might think it's natural
But the water is tainted,
One day I drank so much
I almost fainted,
Swooned, I did
With ever-expanding joy,
I gotta be thankful
Because they do employ,
All sorts of us heathens
That follow a different path,
Sister Euphemia states;
Just give a good bath.

When a new patient arrives
We assess them head to toe,
Using all of our five senses
And technology for the show,
Charting hundreds of check-marks
On many drop-down lists,
If something is wrong
We have to see if it exists.

Now, since this is a Holy
Hospital place,
We evaluate the sins
Of the human race,
And then we'll formulate a care-plan
To wipe clean your dirty deeds,
Medicare demands it
Stating, “address all of their needs”.

Who can argue with that?
And Sister is paying,
We always do what she says
If we want to be staying,
At this heavenly job
Hell, it's Paradise, after all,
If you need to be employed
Why, just give us a call.

Fibril_late;
6/9/11

Gee, it seems like every other week, there's another protocol dropping in our lap. Half of the time, it's a new one, just like the old one, but a little bit different. They want to sell it as new, but it's just a revision. It's "evidence based", but wasn't the other one too, and if so, does that make us just a bunch of liars, in retrospect? If so, I'm going to confession, asap, before Sister Euphemia finds out.


Protocol Prognosticator

Protocols to the left
Protocols to the right,
A protocol for Sepsis
And Neurological blight,
As it was in the beginning
Is now, and never ending,
Protocols are the lifeblood
That experts are recommending.

Protocols are guidance systems
Armed and ready to fire,
Like everything in life, my friend
The circumstance is dire,
Poised upon the precipice
Of critical mass and disaster,
Just fire up that protocol
And you will be the master.

Large-group studies do propose
That if we read statistics right,
Some protocol will save us
In the middle of the night,
Despite apparent random selection
And other wild-cards of duress,
I propose a simple toss of a coin
As a worthy prognosticator, of success.

Fibril_late;
6/8/11

Little Miss Last Century

Wonders never cease. She's one hundred and four; Alzheimers, dementia, blind, living in the nursing home. A GI bleed brought her to the hospital and a visit to Interventional Radiology, where she had a cardiac arrest on the table. Well yes, of course she is a full-code, because her adult kids want everything done. Now she's on the ventilator in our unit, with the family expecting a "full" recovery!?!

One Hundred and Four

One hundred and four years of age
As if that’s not too old,
To perform goddamned heroics
And still the family will scold,
The doctors and nurses,
During that long CPR,
Because Momma is busted
Like a broken down car.

Suffering forty years of old
She went bad, after sixty-five,
It’s a wonder, this woman
Can even claim to be alive,
She has a spongiform brain
And Alzheimers too,
Her children are convinced
That she can still count to 2.

She’s on the ventilator
She had a GI bleed,
Her skin is like tissue
Where the bacteria feed,
Her heart beats a rhythm
Unclassified in the books,
This is not rocket science
Despite how it looks.

She's just an old, worn out woman
She can't tell day from night,
But her family wants everything
And they're willing to fight.

Fibril_late;
5/25/11
__ __ __ __ __ __ __

Grandson

Grandson takes care of her
He's on the county dole,
He's hoping she'll make it to 105
Before he puts her in the hole,
Then he can put all of his attention
On his sadly, stroked-out Mother,
He hasn't been employed in ten years
So he'll be looking for another.

Impaired relatives are his specialty
They can name him in their wills,
Who would ever suspect this caregiver
Who is handing out the pills,
Yes, this grandson, is a piece of work
He's found his niche in life,
Taking care of family members
Instead of taking a wife.

I'd be careful if I went visiting
To the house of his holy endeavors,
Expecting trap-doors in the floors
Controlled by hidden levers,
Incapacitating me in the process
To become, his next bedridden fool,
Suffering to the very end of my days
As his financial-freedom tool.

Fibril_late;
6/2/11
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Little Miss Last Century

Extubated at last
Comfort measures, and a no-code,
Maybe Miss Last-Century
Can finally retire to her abode,
An impending celestial discharge
To be carried gently to her Heaven,
Her grandson stepped out
He's down at the 7-11.

Pain and suffering
And unsavory medical measures,
Are finished at last
She's done with earthly treasures,
She may appear unconscious to us
But she's in direct communication,
As the Divine beckons to her
Her spirit reaches out, with anticipation.

Grandson raises a ruckus
When little Miss Last-Century dies,
Five minutes after her transfer
He's full of anger, that's no surprise,
He lost all precious control
When Grandma finally checked out,
His true nature clearly exposed
Absolutely, there's no doubt.

Sweet, little Miss Last-Century
We suffered too, there by your side,
Administering your care so gently
Until the day that you died,
Rejoicing in our own ways
That you cast away the shackles of Earth,
A little piece of advice to you
Take a long rest, before your rebirth!

Fibril_late;
6/3/11

On the theme of old nurses again..........I'm one of them.

Diagnosis: Aging

It's a strange world I live in
As nurses, we're getting older and aging,
Body parts moving around
And other battles are waging.

High blood pressures
And gall-bladders perturbed,
Crazy habits that we had when we were younger
Now just leave us disturbed.

Quite a few things we used to eat
That we no longer can do,
Most of us have gotten fatter
And a few of us can't chew.

And now we stand around the water cooler
Chewing the fat,
Talking about our body image
Because that's where it's at.

Like some kind of one-upmanship
My disease is worse than yours, Mabel,
Then she talks about her high blood
Diabetes and psoriasis
And man, I don't want to be at her table

We compare our doctors
Our therapies and our medicine,
You think yours is better than Einstein
And mine is better than Edison.

Some talk about their family's
And their irritating habits,
Others exaggerate their problems
Like reproducing rabbits.

This is life after 50
We’re all drifting downhill,
The diagnosis of Aging
Is one bitter pill.

Fibril_late;
5/15/11

I heard the term, "hostile abdomen", while attending a seminar yesterday. I immediately recognized it as the perfect line to a new poem; have a look.

Hostile

He had a hostile abdomen
An angry bowel,
A devilish duodenum
And a gall-bladder scowl,
His kidneys were complaining
His pancreas perturbed,
His liver was livid
And his spleen was disturbed.

All in all, his hostile gut
Was threatening to rebel,
His appendix was the renegade
Leading them all to Hell.

Fibril_late;
5/15/11

By and large (sometimes, very large) here in the nation of California, we are generally, a baby-boomer nurse constituency. So what happens around the proverbial water cooler? Yes of course, we talk about our own aches, pains, disorders, changing shapes and so on. And just like our patient population, we would all benefit if we could only improve our choices of food. Anyway, that's my diagnosis.

Diagnitis

When Diverticulosis
Becomes Diverticulitis,
You'll know your diagnosis
Has become a diagnitis.

Your doctor advises
Take no nut,
Because they won't exit
Out your butt,
Instead they'll fester
In your gut.

Sage advice
One would think,
That's nuts and bolts
And the kitchen sink,
Don't be chewing
On that chunky stuff,
Your gut will protest
And scream, “Enough!”

Pain will ensue
And you'll visit your doctor,
He'll advise colonoscopy
With a GI proctor,
Inviting all sorts of
Differential diagnoses,
Scaring the crap out of you
With your diverticuloses.

Get a clue now
And change your diet,
But if you don't want to
Please keep quiet.

Fibril_late;
5/13/11

The PoGlobin Index

It speaks for itself:

PoGlobin Index

An anomaly last night
Caught my ever-sharp attention,
There were laboratory values
That deserved a special mention,
The potassium was high
And the hemoglobin low,
In fact, their numbers matched
I saw the light, and it did glow!

A new prognostic indicator
Struck me on the head,
When the “K” and Hemoglobin match
You might soon be dead,
In the telling, what the value read
Was a gentle seven-point-two,
But those of us, who know the stuff
See the Reaper, coming for you.

Values incompatible
Organ systems halt,
Prognostic probes and platitudes
Propose a deep gestalt,
Code-status lurks beneath the waves
With nurses standing by,
Will we flail another suffering horse
Or wave a fond goodbye?

The new PoGlobin Index
Could revolutionize our field,
Retrospective analyticals
Would have a tool, that they could wield,
In the ever growing science
Of hindsight recognition,
PoGlobin Index data
Would be like gold to statisticians.

I am sure my future practice
Critical-this, and that beyond,
Whether here in good old USA
Or there, across the pond,
Will build upon this moment
Of genius in the rough,
PoGlobin Index was my baby
Building my fortune and that's enough.

Fibril_late;
5/3/11

Nightmare*

My nightmare came true
During that 12-hour shift,
I had a one-to-one patient
Plus two others, get my drift?

My dream came to life
On that 12-hour trip,
I was a desperate crewman
On my own sinking ship.

No, I couldn't do the things
That needed to be done,
I couldn't load the bullets
Into my gun.

I couldn't shoot the captain
Of this crazy ship of fools,
Because our leader was missing
Having broken all the rules.

I couldn't do my duties
That needed to be done,
But nobody died
So I guess, somebody won.

Fibril_late;
5/3/11

(* It's a recurring nightmare that I've had for years, where I've “forgotten” a patient for an entire shift.I'm sure it is a symptom of work-related PTSD, but still, to act it out in reality, is disconcerting).

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