Persistent

Persistent

Atrial Fibrillation is the most common arrhythmia in persons over the age of 50. Current practice addresses either rate control or rhythm control, meaning that some people are relatively asymptomatic, and if they can't be converted to Sinus rhythm, then, keeping their heart rate below 100 is seen as a reasonable approach. However, they require anti-coagulation. Anyway, there is a small subset of patients who are very symptomatic, fail drug therapy, and are referred for an electrical ablation procedure...............sometimes over and over and again. No fun when you are only 58 and otherwise, extremely healthy.

Persistent

Hail to the man
With the most persistent A. Fib,
He returned once again
To visit our crib,
He missed us, he stated
We're like family, so dear,
The best place to be shocked
Yes, that's why I'm here.

Dr. O'Neill is so happy
To see you again,
He loves a good challenge
Which is common in men,
Of the Irish persuasion
From the Emerald Isle,
He resides as the Judge
On this most tedious trial.

Handmaidens and bards
Stand by, as you beckon,
They are all placing bets
On that shock, I do reckon,
Such consummate professionals
This likeable crew,
Saying prayers, fingers crossed
Hats off, saluting you.

Fibril_late;
10/25/12

Halt the Queries

Admission Data-Base

I bet that a lot of nurses just hate having to fill in / data entry / interrogation forms, whatever your hospital calls it, ours being the Admission History. Tedious, tasking, and terrifically boring questions...............oh wait, I think it's a Demographic Survey, now days..........My advice...........just get creative as all get out!

Halt the Queries

Our clients typically visit
For a twelve hour time,
Yet, we interrogate their lives
Like they committed a crime;
How many times do you pee
Do you dribble or leak,
Did you have a "BM" today, sir
Or was it, way back, last week;
Who really needs to know this
Yes, what is the rationale?
That I have to question what is leaving
Every bodily canal?

Many cultures, are offended
When we pose these inquisitions,
An embarrassing interview
Regarding sensitive positions,
So, I make the answers up
And document what I wish,
Does it matter if his BM
Was today, or yesterish?

And then, we have to document
Medicines taken, time and date,
I ask them, what the day was
And I choose the hour eight,
Whether morning or night
Once a day, or more,
This saves me a bunch of time
In this grossly, boring chore.

And half of the time, these folks
Don't have a clue about their meds,
The stress of needing an angiogram
Is screwing up their heads,
And yet, Bob and Betty nurse
Will perseverate and persist,
Confusing this octogenarian
Until, he slugs them with his fist.

Did you have the death of a loved one
Are you suicidal today?
How would that adjust my care?
Are you packing, I might say,
We don't want an angry wing-nut
Shooting up an operation,
Although that clearly does suggest
That we deliver good sedation.

What's the point of all these questions
I don't know, so I modify,
Your bowel status hardly matters
If you're about to die,
And I shouldn't waste your precious time
Delaying care and intervention,
There are times to halt the queries
And really pay attention.

Fibril_late;
10/24/12

Don't Call Me Jacqui

Just a little silliness................but, I'm thinking even you have had a patient that was just a little attractive......isn't that so?

Don't Call Me Jacqui

In the 11th hour
On the eve of the 11th day,
We still had too many patients
And that means double-time pay;

A woman admiring her Pacer incision
A guy, preparing for home,
One fellow waiting for heart-cath
And Betty with mirror and comb.

"It's important to always look good", she said
After lying all day on this frickin' hard bed,
I hope my arthritic knees and titanium hip
Don't lock up when I stand, and cause me to slip;

That would delay my departure, my driver would hiss
He's a snake of a man, but he has a good kiss,
So, please let me up, and sooner if you can
I like you as a Nurse, and hope you're a good man".

I did all that I could, to please that fine lady
I escorted her to the Ladies room, despite Sinus Brady,
And when we were finished, her heartbeat was tachy
She said, "Thank you young man, just stop calling my Jacqui".

Fibril_late;
10/18/12

P

I think this is how quite a few of our patient's feel, when they have just received the news that they have Left Main disease, and they might drop dead if they go home................

P

Urgency vs. quantity
That's the cat in the bag,
Like the K-Mart blue-light-special
When you're waving the yellow flag.

Six hours of bed rest
"Are you crazy, that's insane?"
I can't pee lying down
That's not how they do it in Spain;
Yes, I should have just stayed there
And not come to visit my daughter,
I'm telling you, I feel just like
The lamb led to slaughter.

I raised them, way back when
Times were different, and that's a fact,
I'm just on a three month visitation
It hasn't been all that it's cracked,
Up to be, I'm telling you
Aren't you listening?
I only came to the United States
To see a Grandson, to attend his Christening.

And now, here I am
In swaddling clothing, in this hospital bed,
The team of doctors are telling me
I need surgery, or I'm as good as dead.

Urgency vs. quantity
It takes on a whole new meaning,
I'm told my options are limited
And that's kind of demeaning,
For a visitor in this high tech country
A leader in so many parts,
I would think that by now
They could just give me a new lambs heart.

What a predicament
I can't make the decision,
I'm going home and screw all my risks
I'm not interested in an incision,
But I still have to pee
So bring me that container,
I don't want to pee in the bed
And that's a no-brainer.

Fibril_late;
10/18/12

Whistle-blower

What does it take to be a Veteran of anything? As a soldier, you've gone to a battlefield, and put your life in harms way. As a nurse, what is it? Some sort of other badge of courage, or perhaps a number of years in a type of specialty? I think that is a possible answer, but how many years, I don't truly know.

One thing that I do know, is that Veterans can see through all the flak and find the truth immediately. This is why Nursing, can become more difficult over time. Morals, ethics, good vs. bad practices and all of that other, "it might affect somebody's life" information, becomes readily apparent and obvious. 

Ethical Committee's..............phooey! The RN at the bedside can tell you what's right!

Unethical

The unethical Doctor Z
Will never get close to me.

With his dubious results
Of cardiac stress,
90% normal Angiograms
And 10% are a mess,
Whereas one of the normals
Will have a serious complication,
This immoral practice
Demands elimination.

Another questionable Heart-cath
The outcome?, disaster,
Dr. Z departs quickly
Nobody, is faster,
Turning over his "care"
To a backup practitioner,
A man with morals and ethics
An old-fashioned Commissioner.

Dr. Z has some issues
Personality, is deficient,
He postures and pretends
As if he, were omniscient,
Claiming all that is worse
From the Lexiscan test,
And with so many normal Angio's
He looks like the best;

Caretaker of constituents
In his tidy territory,
He drives a short Mercedes
Auto-collector?, not his story,
No, I think he's just amassing
The usual dollars, to line his pocket,
If he was an Orthodontist
He'd want to fill your dry-socket.

Do I have the power to challenge him?
Probably not,
He attended good training
But he was no hot-shot,
Knowledgeable, very certainly
He has it all figured out,
The tests he orders, suggest problems
"You need a Heart Cath", he spits out.

The average consumer, won't question
Heck, the information is scary,
"There's a problem with my heart?"
That's like a dead Canary,
Found in the Gold-mine
Down on level 13-C,
Doctor Z suggests an Angiogram
"Heck yes, I want it for me!"

But if the supporting diagnostics
Had been considered in the most thorough light,
Mr. Billy Bob Jorgenson, would have stayed home
But instead, he stroked tonight.

Fibril_late;
10/17/12

Once again they said, "Oh heck, you'll both go home early...........there's not much going on today". Of course, they are the ones that go home at 5pm. Had I worked my normal 10:30am shift, it wouldn't have been a problem. No, because it was a slow day, two of us came in at 9am....................but we didn't leave till 23:30pm. - that's 14.5 Hours on the books.

Blunder

Oh, I wonder
How they blunder
Born asunder
The leaders of our room,
When billing hours are weak
They endlessly tweak
Talking double-speak
All dire and doom.

Home early, you’ll go
Because it’s kind of slow
But what do they know, they go home,
We have patient’s, we stay late
It’s less exciting than a date
I’m a nurse, it’s just my fate,
Looking forward to a drink with foam.

Fibril_late;
10/16/12

Bleeding Janet

Late again
But we didn’t plan it,
We had another
Bleeding Janet.

She stood up and wavered
Sprung a leak and made a puddle,
You know you can’t fix that
With a 5-minute Nursing huddle.

Barring no other
Unexpected complications,
Bed rest for an hour
Delayed our vacations.

Fibril_late;
10/16/12

In the Lurch

Once again
We were left in the lurch,
Prayers don't have much power
In Sister Euphemia's church,
She keeps stoking the boilers
When there are no hands on deck,
And tomorrow morning, on inspection, asks:
"You stayed late, what the heck?"

So, I always pen a note
Make it rhyme, that's my motto,
Though not grossly intelligent
When I'm whack-tired and blotto.

Fibril-late;
10/17/12

Recently, I read an article bringing attention to our practice of identifying new protocols and practices, as being “Evidence Based”. I don’t remember much of the article, but it did ring true in some respect, with my opinion of this overused, naming of new things.

About five years ago, we were instructed in new, (“Evidence Based”), Intensive-Care Insulin Administration Protocols. At the same time, there were other similar protocols instituted for those patients not in the Critical-Care setting.

Here we are five years later, now knowing that those mechanisms and flow-charts for treating elevated levels of blood glucose, were based on some erroneous ideas, resulting in thousands of hypoglycemic episodes. This was not isolated to just our hospital, but in fact, it was happening nationwide. Unfortunately, singular episodes of severe hypoglycemia, are far more damaging than the opposite. Hypoglycemia can cause death and brain damage, in a very short period of time.

So go ahead and call me obstructionist, if you will, as I cast a very suspicious eye upon our newest “evidence-based”, hot off the griddle, it’s the latest and greatest, Glucose Monitoring and Treatment Protocol. Whoopdy-doo!


Repackaged Miracles

The same old theories
Newly renamed,
And we are the Nurses
Soon to be blamed,
For all of the shortcomings
And lack of adherence,
Yes, these tired old formulas
Have a shiny new appearance.

That’s what I’ve noticed
During the last thirty years,
Repackaged recipes
That drive me to tears,
Sure, some of that knowledge
Is rightfully new,
But they sell it to us, saying
“It’s a miracle, sacré bleu!”

If it was truly a miracle
It wouldn’t need fixing,
No, this is Grandma’s old pudding
With a little remixing,
Reformulated ingredients
That taste just about the same,
Pharmaceuticals and committee’s
Why, they all play this game.

Administrators and mid-managers
Tout this latest new way,
But, I’m telling you Brother
We’re the ones who will pay.

Fibril_late;
10/5/12

I admit it; I’m getting a little paranoid regarding sheath pulls. I worry...........even though I have probably done 300.

Over-Responsible

I am over-responsible
That is the bane of my good deeds,
I feel really bad
When somebody bleeds,
Sometimes, not even the person
That I am watching over,
I have this over-reaching sense
That I too, am guarding Dover,
That last bastion of cliff
Before the invaders, bust the perimeter,
When anyone bleeds
It overwhelm my altimeter.

Sure, it was covered
Concerning benefit and risk,
But this is more than just vinyl
Or your average compact disc,
Because these are new times
Where bleeding is on every menu,
Every time your Physician suggests
Why not visit our venue?

Doctor performs his procedure
He has done his good deed,
You come to us for Recovery
We carry the burden of bleed,
Rest assured, we are well trained
To honor the nuances of your vessel,
But I assure you, it's not so simple
Quite often we will wrestle;

To contain your bloody circuit
By squeezing, and pressure,
You might complain about the force
And rarely call it a refresher,
Because we know that it might hurt
And we are Masters of pain,
But hopefully, we have answers
To mollify your brain.

Over-responsible
Is that the sign of any good nurse?
I suppose that it is
But it's a blessing and a curse.

Fibril_late;
9/27/12

We are undergoing another round of Inspections again; I don't don't know who, nor do I care. It always creates a lot of wasteful nonsense in the hospital. This poem will tell it all.

Expired

Expired ECG Pads
Tell me about that?
Sterility guaranteed
A two year shelf-life
Just for measuring pitter-pat.

A package unopened
For more than two years,
What could go wrong?
Just what are their fears,
It was probably packaged
In a sterile factory some where,
This is like throwing away money
And they're not willing to share.

We live in a society
Where everything is expendable,
No matter how well it is made
And completely dependable,
So I suspect the Regulators
Of durable, medical goods,
Have a conflict of interest
And financial engagements,
With the Manufacturing hoods.

And it all comes to pass
During the times of inspection,
Expired goods are thrown away
Although sterile and under protection,
But Protocols and Policy, from Rules and regulations,
Tell us to bury it in a landfill, with no respect to conservation.

Money down the drain
Products purchased, are now just waste,
That's one heck of an economic policy
Administered in haste.

Fibril_late;
9/26/12

I saw a class offered at our Education Department, designed for Nursing Assistants and Home-Health Aides, with the title: "Nurture the Nurse/Nurture the patient". This was confusing, because here in California, a Nurse is a Registered Nurse, or Licensed Vocational Nurse, and all other permutations of Nursing Assistant, CNA, Medical Assistant, Home-Health Aide......they are not Nurses.

*Per the Business & Professions Code. Division 2. Healing Arts. Chapter 1. General Provisions. Article 7.5. Health Care Practitioners Cal Bus & Prof Code 680 (2003)

So why have the name of Nurse in the title, when this is a class devised for non-nurses?
Seems a bit ambiguous to me.

Furthermore, the class is offered as "free" as long as the student puts forward a "refundable deposit" of forty dollars. I wonder, will they not refund it if I'm in a car accident, or I'm shot, or die in any one of 99 ways? That is a bit worrisome; maybe this is akin to the movie, "Final Destination"?

Last, but not least, the course Moderator is a Clinical Psychiatric Counselor. Just one more reason to avoid that class.

Naturally, I wrote about it:

Psyco-Nurture

A class offered for free
But you pay, a refundable deposit?
If you can't make it to that class
Your money stays in their closet.

Refundable and free
Are nowhere near the same,
They are threatening to charge you
If you somehow miss the game.

Which sounds like negative reinforcement
Hardly inviting, wouldn't you agree?
The Moderator, a Psychiatric Counselor
Offering to psycho-nurture me.

I think I will avoid altogether
The class known as "Nurture the Nurse",
They claimed it was storytelling and healing
But quite frankly, I am averse.

Fibril-late;
9/26/12

We had a fellow last week in to prep for an Ablation procedure. He said he was legally blind, and boisterously good humored, considering he had spend quite a few hours with us; he kept everyone around him laughing too. He also mentioned he was in AA and kept active with local meetings. I told him I'd write something for him, but I never had the chance to follow up.

Cool Sunglasses

I'm an AA blind man
I can no longer see what I'm drinking,
I have these cool sunglasses
People wonder what I'm thinking

I'm a boisterous guy
I make everyone laugh,
Making jokes all day long
To cheer up the staff

I'm legally blind
I don't drive anymore,
It's something of an obstacle
But not really a chore.

I have adjusted well
I use public transportation,
I don't worry any more
About driver education.

Before I stopped drinking
I had a really good excuse,
My stumbling around blindness
Hid my alcohol abuse.

But now that I'm on the wagon
I'm not qualified to drive,
I'll just have to get a pony
If I want to leave my hive.

Fibril_late;
9/23/12
_ _ _ _ _ _ _ _ _ _ _ _ _


Cool Sunglasses II

I'm the AA blind man
What have I got to lose?
My cane and my cool sunglasses
Wait a moment, let me choose.

I'm a blind free agent
I roam wherever I wish,
I carry a spoon and a fork
And my favorite dinner dish.

I can detect all the scents 
Of my favorite meal,
I tap with my cane
And go where I feel,
The safest right way
Through a shadowy path,
I might slip in my shower
But never my bath.

Legally blind
And I no longer drink,
Alcohol, that is
Or my neighbors raise a stink,
Apparently I bothered them
In drunken days, past,
Now I sip, lemon juleps
And raise my glass at half mast.

I'm an AA blind man
Everybody's best friend,
He who laughs last
Will be there in the end,
When I hang out with people
Why not make them happy too?
So, why not join my party
There's enough for me, and more for you.

Fibril_late;
9/22/12
_ _ _ _ _ _ _ _ _

Blind Man Pondering

Blind man, pondering the seat on the corner
If I sit there, will I look like Little Jack Horner?
There he was, counting his curds and whey
If I leave my hat on the sidewalk, what will I have at the end of the day?

No, although I may be blind, I'd rather be working
Pushing a broom; sweeper, or maybe soda jerking,
Although, that's old terminology, perhaps fifties and before
I'd rather be a blind-man with a job, than a panhandler making a score.

And I'm the AA blind man, so cut me some slack
I'm no beggar or panhandler, don't be making that attack,
I work and I'm accounted for, I pull my own weight
If you'll pay me some attention, let's go on a date.

Sure, I wear these cool sunglasses, they shield my eyes
I'm legally unseeing, I can only imagine the sunrise,
But as blind as I may be, I'm still a functional professional
A hell of a lot more secure, than that guy in that confessional.

Fibril_late;
9/22/12

Those of you who read this blog know I have a pet peeve regarding the use of our English language, whether it is the over-use of our technical lingo, slang, sloppy speech, and other stuff. The word "closure", and the way it is commonly being employed in our every day language, has finally driven me over the edge. I never want to hear it again..................and hope that I never say the word, myself.

Closure

I think it's time to stop using
The term of “closure”
Can't we please?
It only seems appropriate
If I cough or sneeze,
Because closure will protect you
From my nasty bugs and germs,
Can't we please stop using “closure”
And try some other terms?

If my child died to murder
There's no such thing as closure,
I won't forgive, I can't forget
I'll lose my happy composure,
Because closure suggests I shut the door
And washed my hands of pain,
But murder and all those heinous crimes
Forever leave their stain.

Newscasters; stop the use of it
The talking heads who sputter and spit
Reporting: “Closure is only what the family is seeking”,
That isn't true I'm telling you
What they really want is a pitchfork screw
To render that murderer painful hours shrieking.

Suffering tenfold in a similar manner
There's not a murderer anywhere
Who is that kind of planner,
And that is why the death penalty
Never works, because we wait.........,
Twenty frickin' years
For an electrocution date.

That isn't closure
After the prison door slammed shut,
A father whose child was murdered
Always feels it in his gut.

Because Buster Bob the monster
Will live for twenty years with television
Three square meals, a roof over his head
Free medical care, including state-paid heart surgeries
Education in the prison library, no property taxes,
No car insurance, no grocery bills
Free clothing, and
Maybe even see his own sweet (not murdered) children
On the State-guaranteed conjugal visits.


This isn't closure
In any sense of the word,
Let's stop using that pointless term
It reeks of spoiled curd.

Fibril_late;
9/19/12

He was just what we needed in our little unit; ICU, experienced, congenial, the clients loved his banter, but his expectations were too high. How high, you ask? Well, that's easy..........he just expected to come to work for three full days a week. And now he's leaving because he can't pay his bills..........Sister Euphemia calls that, Hospital Convenience.

The Gig Looked So Good

Your recent assignment
Was short and too brief,
Sometimes something so easy
Fails to bring us relief,
What with unforeseen factors
Clearly, not advertised,
Unfulfilled promises
No mercy?; not surprised!

Unfortunate, more so
Because the gig looked so good,
Just do what you love
And be all that you could,
Such a wonderful slogan
But somethings missing, I'm afraid,
When you do what you love
You expect to be paid.

Full-time, 72-hours
Promised on paper,
Until hospital convenience
Revises that caper,
Sending you home
With a kick to your colon,
Shortened hours and compensation
Your salary has been stolen.

Yes, Sister Euphemia
Runs a tight ship,
Watch out for her ruler
Because she won't take no lip,
Punishment to be reckoned
Meted out by each Captain,
Worse than any Blues
Sung by Eric Clapton.

Fibril_late;
9/13/12

So busy, it seemed like a barrel of monkeys had rolled into our unit, spilled out and had their way with us. To top it off, JS and myself, were the closers of the night...............leaving 2 hours late. Cha-ching!

Monkey Zoo

That was a fun one
Yesiree,
Just like a Spider Monkey
Jamboree,
Jibbering, jabbering
Monkeys on the run,
Out of control
Something must be done.

Sometimes I feel like
I'm the monkey king,
Surrounded by the chaos
That a hoard of monkey's bring,
But then the vision ends
I'm just a monkey too,
Stuck in the middle
Of this Spider Monkey zoo.

Fibril_late;
9/11/12

I revisit this topic regarding an idiotic Hospital policy regarding what things we are allowed to
have in our work area; the one that denies us Staff members from having any food or drink, when at the same time, we allow the public to eat and drink whatever they want. And yes, this is the very same shared room that I am talking about.

Though I understand that it is a result of some big muckety-muck JCAHO regulation, it clearly makes no sense, in the way that it is interpreted.

Yesterday, an Anesthesiologist was interviewing a patient for the upcoming heart surgery, and this doctor had brought along his own coffee from the cafeteria (safety top included). This coffee cup was perched on the counter, at our intake desk. Our Unit Manager walked in, and tossed the beverage into the trash. When the physician went to find his coffee, quite naturally he was peeved that somebody had ditched it. Contrast that to the patient's and their families, who walk in with beverages, and the fact that we feed them lunch and dinner, with hospital food, in this very same room.

And when Management, sort out their "DOC" surveys (a measure of Employee Satisfaction) is it any wonder why the peons aren't happy? I'm willing to bet it has something to do in the way that we are treated, n'est pas? (isn't it so? )

Zero Tolerance

Each time they institute
Zero-tolerance measures,
They stifle our goodness
And bury our treasures,
It fosters maladaptation
And promotes discontent,
Employee satisfaction?
Nonexistent; we dissent.

Fibril_late;
9/7/12

I suppose it happens a lot of places, although I'd never heard about it until I caught up with this particular employer. I have worked at many hospitals in the past 30 years, and most of them didn't ask their employees to stay home without pay. They will say that it's all about the budget..........but workers don't need to hear that; we just come to work to care for sick people. And no matter how fun, fulfilling, thrilling, "gee, everybody is fanastic", the workplace might be, if you send people home every week, I'd say that might be the #1 reason, that employee satisfaction scores are consistently rating low. Duh!

Another HC

Oh, SNAFU me
Another HC
This is no way to treat
A loyal worker,
Stay home without pay
And have a nice day,
This is fodder
For the closet berserker.

Some day, like a camel
Not sweet like Dorothy Hamill
The last straw will break the back
Of this creature,
Not knowing what's in store
This Berserker will roar,
Rage and anger expressed
What a feature!

"Going Postal", you'll remember
An inferno from an ember,
What's the trigger?
Perhaps, loss of wages?
Over and over again
Just stay home, if and when,
Horrific consequences -  (HC)
Someone rages.

This kind of employer
Creates a destroyer,
It can't win the best
Workplace, of the year,
Treat your employees like dirt
Don't pay them and they hurt,
Hospital convenience, they say
Oh, I sneer.

Yes, SNAFU me
I think I'll jump from a tree
With a rope 'round my neck
Because I'm broke,
When I was hired, they said "Honey
We'll pay you lots of money"
Then they keep me home, unpaid
What a joke!

Fibril_late;
9/3/12