Repeated, again

With Cardiac Arrhythmia's, an individual might have to return for repeat procedures; such as Cardioversion, Ablation, Pacemaker fiddling, Angiograms and so on. It's just the nature of the beast.

Mr. McGinnis
Came back to our store,
He had a prior Ablation
And now he wants more,
Oh, let's do-do it again
He said with a stutter,
But this time I've come
With Atrial Flutter.

Mr. McGinnis
Is a likeable chap,
Friendly, yet stoic
He wears a jaunty cap,
Adventurous, he is
Regarding recreation,
He says, "I've had a month of rest"
Let's do another ablation.

Dr. Oneill
Reviews all the options,
Clarifying clearly
He doesn't do adoptions,
Nor suffer fools gladly
Seeking medical attentions,
"But, if the proof is in the pudding
I will apply my interventions".

Dr. Oneill, in his customary way
Articulates, with nary a stutter,
The EKG, clearly shows evidence
Of Cavo-tricuspid A-Flutter,
Quite simple to fix, in my estimation
Drop in for a day, get it done,
Mr. McGinnis, heartily replies
"Thanks Doc, I'm sure we'll have fun".

2/19/15

Catering to you

We all have had difficult patients, families, co-workers and bad days. Over the course of this job, I have worked in situations, where a patient might come for multiple visits, over weeks, months or years. I understand all the psychodynamics of how the person might feel lost, or have a sense of powerlessness, or whatever................I get it. But why act out towards the folks who are trying their best just to help you? If you don't want to be in the hospital, or you'd rather not be repaired, just go home, Ok? There are many other nice folks we would just love to attend to.

Catering

I'd rather gather bathhouse blankets
Than take care of you,
Working minimum wage
And do the best I could do,
I'd rather dig fire-pits
To roast the slaughtered pig,
Than spend another day with you
With your ego so big.

When you come to the hospital
Please leave your attitude at home,
We're doing the best we can
This is not the church of Rome,
No, we're just medical peons
At your beck and call,
I'll do my best for 12 hours
Just don't call me Paul.

I will treat you respectfully
And look for the same in return,
I'll get you juice, food and TV
Your care is my concern,
But please do remember
Your safety comes first,
If the Doctor writes, "NPO"
I can't cater to your thirst.

You didn't eat since yesterday?
It's a bother, but not critical,
Most of us are overweight
I'm just saying, not analytical,
And fasting can be a benefit
However stressful, it might seem,
When you finally get to eat
Our food will taste like a dream.

I'd rather trim forty acres
Of Star Thistle, in June,
If you ever come back again
That will be too soon.

Themeless not Dreamless

Sometimes something just sticks in my craw and I don't really understand it. But when I begin with some little idea, the concept unfolds. Here I was thinking about all the dumb stuff that Administration threatens employees with, while letting other really important issues go down the tubes. Sure HIPPA is important, but what do we do about the public whipping out their phones to photograph Momma with her pretty blue surgical hat on, or some fool Mother, let's a cellphone in the room with her intubated neonate and the picture ends up on Faceless Book?

Anyway, I'm peeved.

Hospital organizations
Threaten new members,
HIPPA violations?
We'll roast you on embers;

And other fancy rules
Laid out clearly for new-hires,
Will never be enforced
Until the statute retires.

Why do they forcefeed us all
With powerless reminders?
To impress the Regulators
Who are all wearing blinders,
To the reality of the present
Perpetual cost-cutting days,
No more free Soda
Unless the Employee pays.

2/12/15

Assuming the Reigns

Choosing to be a Nurse Manager..........well, I gotta hand it to you. It sounds like a living nightmare; until you go home, and have PTSD nightmares, of what didn't go well that day at work. It's a huge amount of responsibility  (to do it right). Good Luck!

Manager, or
Man ager,
You might feel older
I would wager,
Assuming the reins
Of that wild horse,
Perhaps, you're the one
Who can right the course.

Historical guidance
From a veteran, needed,
Professionalism
Has been impeded,
I was there and I saw it
And it wasn't good,
Perhaps you can fix it;
Our old neighborhood.

Focus your powers
And rally the troops,
Watch out for landmines
And the loopety-loops,
Who lurk in the closets
And whisper sedition,
Clean house if you must
To establish your edition.

Make fair new rules
And stick to your guns,
Establish strong protocols
For your daughters and sons,
The family you inherited
By your audacious deed,
Discover your mentors
To guide you, to Lead.

2/11/15

Bobcats & Rabbits

Good Goat Almighty............! Today was like Bats out of the Cosumnes River Preserve! 45,000 of them at once. That is what it felt like, and what other bystanders commented. It was totally demented.


Oh, my word
How busy can it get?,
Not too much more of this
I can safely bet,
With the resources we have
And that's not counting too much,
Few persons, qualify to float
And if they do, they wouldn't touch,
Knowingly enter
The region we inhabit,
Kind of like Bobcats
Who are chasing a rabbit,
All about the tributaries
Leading to the Den,
Thank goodness, this only happens
Now and then.

2/6/15

Caring Time

Today, we had a boatload of patients, procedures and recoveries. We were super busy, procedures were delayed, it was hard to find beds and we "closers" worked 14 hours total. What made it a good day, was how many good visitors we had, paying attention to their friends and loved ones. Thanks, all.

Families and friends
Who hang out for the waiting,
Are the best that can be
And I'm not overstating,
The appreciation we have
For their vigil with Bob,
Whether they are dressed to the nines
Or just a casual slob.

It's best if they talk
Ordinary conversation,
Perhaps share a tv program
Or a radio station,
I don't like it when visitors
Focus on their gadget-gear,
They might as well go to Starbucks
Because they're not really here.

Being a supportive family / friend
Showing care for Billy-Bob,
Is far more than any kind
Of lazy, boring job,
You are giving of yourself
Unselfish caring time,
Thank you, to everyone
You help everything rhyme.

1/31/15

Drought Solution

Where is all the water? I realized where a good portion of it is, after seeing a response to Lasix the other day. Perhaps our end-of-times drought wouldn't exist, if those perpetrators of Heart Failure, would PLEASE return the water!

A brilliant solution presented itself
After a standard dose of Furosemide,
In California, we're in a massive drought
The plants, and aquifiers and lakes have all dried,
The patient in the spotlight had fluid overload
Short of breath and feeling chest pain,
In the next two hours, I hereby witnessed
Two liters of urine go down the drain.

How many persons in California with Heart Failure?
Holding on to our water, in the midst of a drought,
There ought to be an ordinance, a fine, or citation
Breaking a natural law, there is no doubt,
Wildfires rage with dry tinder conditions
Fish species in danger, when they can't spawn,
And most of you with Heart Failure
Are probably still watering your lawns.

Sure, a little off the track, I will admit
But Lasix and Bumex
Just might do the trick,
To solve our water crisis
In our severe time of need,
Let Go Of Your Water
It's time everyone peed.

1/30/15

Bed Theory

After 31 years of Nursing, I stake my claim, and publish emperic, evidence-based, scientific research.

Even though our new "HIPPA" compliant, one occupant , get-ready and recover rooms are the cats meow, they are small. They are designed for a gurney, but those things are just rolling torture tables. Our 2015 idea, is to have a real bed in there, for those patients who might be with us for more than 4 hours. The following mini-research proves, that providing a comfy bed, does not guarantee patient happiness.

Bed Theory

We theorized the following:
Sometimes our patients have a long wait
For a Cardiac Cath date,
If they had a bed, instead of a gurney,
They might be less inclined
To call an attorney.

A common supposition stated
Bed, compared to gurney, might be rated,
Higher on the satisfaction scale
But still, our patients moan and wail,
Because laying on one, uncompared to the other
They don't know the difference, and the crux of it brother,
What they really want, is nicotine and food
Bed Theorem debunked, hence their bad mood.

1/27/15

Hollywood Star

This old gent was determined to need an Aortic Valve Replacement, secondary to reduction in Valve area and calcification. He had a pile of tests to support the suspected Diagnosis, and eventually qualified for TAVR. Transcatheter Aortic Valve Replacement. If you don't know; at this time, it is reserved for those persons deemed too risky for open heart / sternotomy approach. This is most often as a result of comorbidities, frailty, old-age and the like.

So, he passed all of the prep tests and today was the day of the big event...................except, he didn't really need it after all.

They thought he needed a TAVR
But it just wasn't so,
He had 14 preparatory tests
And it was all systems go,
Coming in at 5 a.m....
When you're 91, that's a cinch,
And when they started his IV
He didn't even flinch.

Transported to the Hybrid Room
Anesthesia induction, was smooth as expected,
Every monitor known to modern surgery
Insured that he was protected,
From collapsing vital signs and hypothermia
Arrhythmia's, bleeding and more,
His Femoral arteries and veins were cannulated
With everything the Surgeons had in the store.

And then it was time, for the last Aortic measurements
Before they would load that valve on a wire,
Three or four Doctors, scratched their heads and wondered
How did we get to this place, where we call a ceasefire?
And admit to ourselves, that this fellow doesn't need it
The best thing to do, is to send him home today,
Let his family celebrate, wondrous good fortune
And pray to the heavens, there isn't a Copay.

A six hour recovery, that's all he needed
Sleeping the whole time, till he walked to the car,
At 91 years of age, this was another adventure
I think he just earned his Hollywood Star.

1/25/15

Bumped Off

A couple of times a year, I find myself bumping against things to the side of me, as if my radar is busted. It's as irritating as those days, when I have hiccups about 7 times.

It's the middle of my shift
Suddenly, pain in my thumb,
I can barely bend that sucker
I wonder, what's that from?
And then I remember
Bumping the metal door,
Also, caught a finger
Pushing the handle, man, my finger is sore,
And to top it all off
Smacked my other hand,
Against a non-moving bed
I assure you, none of this was planned.

I think my proprioceptors
Are not properly tuned,
If I start bumping my knees
I might be marooned,
Trapped in the hospital
Too lame to go home,
And we don't stock toothbrushes
Not even a comb.

New Stuff Learned

I love going to Medical Education events, because I like to learn new stuff. Also, it's a great place to get ideas for jokes and new poems. I went to a little meal and eat at the country-club, back in October, and my table-mates and I learned about Neurological Disorders, specifically regarding Parkinsons and Tremor. My new pal (yes, you) likes joking around too, and here is what we came up with. Silly cocktail humor.

Chorea: A country near Japan

Leva-Dopa: When the Taxi-driver drops off the dopehead.

Bezel Ganglia - Jewelers Neurons

Parking Sons: A motor vehicle parking business.

Pre-Cursor: Middle schooler who hasn't yet learned to curse.

Vascular Insult: "Your varicose veins, are WAY ugly!"

Blood vessel to Fat guy: "Hey, lighten up, will ya?!? I can't supply all this fat!"

Parkinsonian Features: Short films, just before the Main feature, at the Parkinson Theater.

Stepwives: Exercise Program @ 24 Hour Fitness

Cardinal Rigidity: A high member of the church, and his "little" problem.

Sleep Disorder: Acting out while sleeping.

My Charge-Nurse has executive function dysfunction.

Motor-State: Detroit, Michigan

Are you moody about your anxiety, or Anxious about your moodiness?

A dancing disease vs. Advancing disease.

Don't look at me funny, that's how I manage to stay awake after drinking two glasses of country club wine. 

Smoking and Choking

I will admit, that I like ye olde fireplace fire........but now, I don't like the smoke in the air when it feels like I have Asthma.

And here in the Capitol of Californication, it hardly ever gets cold enough to freeze anything.............so, a lot of people probably don't really need to light the fire...........it's just a warm living-room homey thing.

As soon as I got to work today, I smelled wood smoke coming from the ventilation duct. As the day progressed, I was coughing more and more. Talking with coworkers later on, they too, commented they were coughing, and had burning eyes. My partner called someone in Engineering, and he dropped by.........probably thinking we were talking about burned popcorn.

Engineer of the Night, wasn't very sympathetic to our complaints of things making us cough, sneeze and burning eyes........because after all, "No one else has complained yet".


We got a heckuva response
From the Engineering dude.
If it had been Mark
He would never have been so rude,
When we called about the smoke
Piped in by our new ventilation piping,
The dude said, "It would be too expensive
And no one else complained, only you are griping".

I said, "Well, we are the healthy ones
What about those who can't complain?
Asthmatics, with C.O.P.D.
Respiratory Failure
Just struggling to operate their brain",
No, Engineering dude, once again stated
"I'm sorry, no one else has lodged a complaint",
Denouncing our legitimate concerns
Oh, I held myself back with some restraint.

I guess, maybe he is a perfect example
Of someone, who takes his job easy,
Don't rock the boat, ruffle the edges
Maybe he gets queasy,
Afraid to pose
Questions of impropriety,
Like piping in particulate-matter smoke
Intolerable to most of our society.

He talked about charcoal filters
Although, I dont know if that's a viable solution,
And anyway, Engineer said it would be too expensive
And "no one else" complained about the air pollution,
Then I begin to wonder, how much do you want to breathe
Is it as important to you, as Valet Parking?
Go find your car later, without much help
Or listen to your loved one, wheezing and barking.

Your Nurses too, are coughing
Like infected banshees, on the roam,
Where, in reality, they are suffering
From neighborhood households, burning loam,
And really folks, do you want
Your caregivers, coughing like deathrow survivors?,
Coming up from the deep-blue sea
Like gasping, deep-sea divers?

But night-time Engineer said
"Well, no one else complained",
I guess he's the wise man in the bunch;
Let's have him Ordained.

1-2-15

Some Data  regarding Smoke Air Pollution:

http://www.baaqmd.gov/Divisions/Communications-and-Outreach/Air-Quality-in-the-Bay-Area/Wood-Burning/Wood-Burning-Rule-Information.aspx

http://www.sparetheair.org/~/media/Files/Communications and Outreach/RedWoodSmoke.ashx?la=en

http://www.epa.gov/airquality/community/details/i-woodstoves_addl_info.html#activity2

http://www.cleanairplus.com/blog/activated-carbon-filters-air-purifiers.html

Our Engineers are in complete support, apparently.

Change is not Coming

Ever hear that old-timey platitude about change? One guy says, "Change comes from within". Another one says, "Become the change that you wish to see"......these are dudes who are not Nurses, working on the front lines of healthcare in the USA.............and you know what I'm talkin' about!

Fill out an A.D.O.
Oh, wouldn't that be grand,
If only I had the time
And maybe it was planned,
But when we are crushed
And fighting for our lives,
All we want is the end
And how soon it arrives.

Fill out an A.D.O.
It sounds great, when it's spoken,
And could it do any good?
Well, I think you're jokin',
Because this is a system wide
Decades long issue,
And Sister Euphemia
Just keeps handing out tissue.

Where can I find an A.D.O.?
It's on a shelf somewhere,
In the back of the break-room
Probably under a chair,
Will I fill it out?
There ain't a snowballs chance in Hell,
The facts will be ignored
Despite the stories we tell.

Because, this is more than local
It's health-care bureaucracy,
This is business, it's about money
A type of Theocracy,
With a God at the top
And she runs a tight ship,
Fill out an A.D.O.?
She'll give you a fat lip.

Fill out an A.D.O.
I can't hear you, La La La,
Union Reps claim they represent
And all that, sis-boom-bah,
No, I'd rather have the form
For an early retreat,
I need a mental health retirement
And everything sweet.

12/30/14

Too tired to think

20 years ago, I worked too much and didn't sleep enough and at the end of a work shift, I might have an addled brain. Now, I'm twenty years older working just 38 hours a week, out of the ICU, but the level of job stress is of an equal comparison. Near the end of a typical insanely busy shift, I sometimes have too many details bouncing around in my brain, like the balls in the Lottery machine. 

Circadian Calamity 

I've been known to brag

That I am infallible,

Master genius at work

Always present, ever callable,

But in the waning minutes

Of my twelve hour shift,

I'm more prone to forget

And suffer memory drift.

But I'm not alone

With this egghead fault,

A Harvard brainiac

Suffering memory halt,

Other nurses I work with

Who are half of my age,

Remark, they, as well

Lose an occasional page.

Eminent researchers

Call it Shift Work Sleep Disorder,

Decreased mental acuity

After crossing the Circadian border,

Key details and facts

Have undergone cancellations,

Call a "Memory Alert"

Block the doors, man the stations!

12-Hour-shift workers

Includes many variants,

Rotating work assignments

You could forget your under-pants,

When your mind gets so befuddled

Sleep deprived and wasted,

You feel like rotten turkey

Unfit to be tasted. 

A paper was written

Let me read it to you,

Keen observations

And a theory or two,

To correct memory drift

A recurrent event,

A simple 5-step approach

Time well spent.

The best thing I found

When my brain feels like crap,

Stop what I'm doing

Take a break, have a nap,

Find some darkness

Or simply, close my eyes,

And even if I don't sleep

I watch the starry skies,

Behind my closed eyelids

With the ringing in my ears,

I relax in that environment

My mind shifts gears,

Producing relaxation

A restful transformation,

Feeling better, I'll be

When I return to the station.

Sounds like a treatise

Delivered at the N.T.I.,

Where's the documentation?

My competitors cry,

If I don't show some proof

My claims are just fluff,

If my brain remains addled

I'll be shunned, and that's enough.

But will I remember?

Let's not presume,

I suffer memory drift

When I walk across the room,

And forget what I wanted

To do for Mr. Jones,

This Circadian calamity

It rattles my bones.

12/17/14

Terrorist Snot

I don't like coughing, sneezing, and so on..........on the job. Patients have their own problems, and I don't need to contribute to that. Every year about this time, I get my first Respiratory infection, and endure a week of feeling rotten. This year, it was a 2 week attack by Terrorist Snot. I earned enough points to score an Albuterol inhaler and 2 days of "voice rest".

Sufferin' succotash
This ailment won't leave me,
If it goes on much longer
You might have to bereave me,
Because I think it might be
One of those new-age bacteriums,
Cooked up in a lab
By some government mysteriums.

Perhaps I was chosen
At random, to be tested,
If that is the case, then
Someone should be arrested,
Because I have been sick
More days than I can measure,
And fourteen gallons of snot
Is not something I treasure.

Five nights I have coughed
For hours at a time,
And I don't just say that
To make a good rhyme,
I used antihistamines
Antitussives, anti-pain,
Still, I've coughed till my back hurts
A frickin' hacking muscle strain.

I am starting to suspect
This is a terrorist plot,
Bugs tickling my lungs
And the buckets of snot,
I am under attack
From the inside of me,
And I'm telling you, brother
It's impossible to flee.

Was it the Axis of Evil?
It’s too hard to tell,
When I’m launching green golf balls
And I’m feeling like hell,
At this juncture, who cares?
About the source of the sickness,
If the Grim Reaper wants me
He'll be here with a quickness.

Oh, miserable me
Cough-master, I be
My outcome is shrouded in doubt,
I might need a new lung
Because my Left one just flung
Through the door,  'cuz I just coughed it out.

It flopped on the floor
And now I'm feeling quite sore
Losing a Lung isn't easy,
But one thing I'll say
Things might be going my way,
Because now I am one-half as wheezy.

12/15/14

Complicit

It does no good to act like an a**hole, when the option is gratitude and collaboration. You poke your patients with sharp, pointy things, and we are assigned the duty of making sure they don't bleed. Sometimes, spontaneous hemorrhage occurs, and there is no way to prevent it, aside from paralyzing the guy for 5 hours.

Key Point:
Doctor, why not express a "Thank you", because we just saved the life of your patient. Take your nasty, grumpy attitude home and shoot it up with Vodka or something, Ok?

Doctor, dear doctor
Please, won't you calm down,
Blaming, shaming tactics
Make you look like a clown,
You're the leader of the pack
With this issue, you're complicit,
You lanced the artery
The cause of bleeding, more explicit.

I pulled out the catheter
And held pressure long enough,
Dressed the site, gave instruction
I did all the right stuff,
I checked the site often
Yes, everything was fine,
Two hours later, a leak!
Like gushing, bloody wine.

He came pretty close
To punching his ticket,
From our point of view
A bit of a sticky wicket,
A vasovagal episode
Blood pressure down to fifty,
Cut his heart rate in half
Fun to watch?; not so nifty.

Uncommon occurrence
Can happen any minute,
Billy-Jean blows an artery
Next, you're stepping in it,
With blood everywhere
On the bed, the wall
And the floor,
I said, "Holey moley!"
Grabbed a mop, what a chore.

Three nurses responded
Stopped the hemhorrhage, saved the dude,
And what did we get?
A grumpy-assed doctor, being rude,
Because he was complicit
In this bleeding event,
He should have thanked us profusely
Then gone home, to repent.

12/19/14

Way to Busy

Oh good grief! Another day of the same old sandwich.

Perhaps my perspective
Of imagined disaster,
Means I'm getting old
And no longer so much faster;

But still:

It seems like the funny stuff
Within the context of my job,
Has very little to do
With patient, Billy-Bob,
But more with situations
With my coworkers, and such,
Tired old nurses, that feel
Like a worn out clutch.

Unit Standard concepts
That don't make any frickin' sense,
We can't work as fast as they want
Even the highly trained dogs
Can't  jump that fence,
Yet, they will be the ones scrutinized
Held to the Policy intent,
And should we ever complain
They'll say we are exhibiting dissent.

I suffer intellectual overload
Some days I can barely function,
Quick; find me a Priest
Because I need Extreme Unction,
I am very nearly close
To the end of this frayed old rope,
Overwhelming nonsense
And I'm giving up hope,
In the course of this workday
Beneath this burden of need,
Oh, find me some Hemlock
To perform my final deed.

11/20/14

Mirrors and Tissues

The kitchen sink, the cyclone, and Godzilla all get thrown at us after 5pm.......

Mirrors and Tissues

Forgo the trip to Tacoland
It wasn’t very clearly planned,
Three wrong turns
From misdirection,
Stuff like this
Won’t pass inspection.

Perpetual
Understaffing issues,
Can’t be fixed
With mirrors and tissues,
High-fives!
Missing four good fingers,
The boss goes home
Our animosity lingers.

The beating goes on
Every day after five,
Sometimes I wonder
If we’ll get out alive.

12/4/14

Charades

Historically speaking, our new hospital addition required about 12 years to achieve, from an idea, a donation, a break-the-ground ceremonial shovel, knock down a school, move houses, find a place to put a new school, batter heads with local leaders............until finally, doors were opened 8 months ago. And yesterday, as I stumbled and traipsed throughout a meandering path of new destruction (while I sipped my Latte') out come this minor missive:

First came the years
Of ballyhooed construction,
Celebrated with pomp
And parades,
Now we must undergo
Years of destruction,
Exposing our Brand
Of dignified charades.

**
According to the article in the Business News Journal, the whole kit and caboodle, costs $170 million dollars!

Dramatic Duress

Do you ever work with the over dramatic player of work stress? Maybe it's you or Billy-Bob over there. Whatever, the at-work-temper-tantrum type, or the one who has to leave the Unit every hour for something (and claim it's always legitimate)........is a tough one to work with. They make a fuss about something, and baby, they are always very dramatic in the telling.

You know about PTSD
It's in our neighborhood,
Everyone in service to others
Would like to avoid it if they could,
But it comes with the service
And leaves us in pain,
PTSD grooves
Forever furrowed in our brain.

But, I'm all over that
I have my mind on another thing,
No one is talking about it
It's a little bit like a bee sting,
Once you have lived it
You won't forget,
You'll wish you avoided it
There's guaranteed regret.

Dramatic Duress syndrome
I see it every day,
Some persons that I work with
Really know how to play,
The Dramatic duress card
When they feel over-stressed,
They come to a standstill
They need a break, a snack, a rest.

It's a cross-gender malady
With an all-ages potential,
Some people never get it
It has a vague differential,
Men and women alike
The old and the young,
Exposed to Dramatic duress?
You'll feel like you've been stung.

Bystanders are disturbed
By the wailing and moaning,
Adult temper tantrums
Deserve immediate stoning,
Yet, the perpetrators prevail
Professionals, it's their right,
Practicing Dramatic duress
All day and all night.

Is there a cure for this?
Not that I've heard,
Birds of this feather
Will just give you GERD,
Try to ignore them
And turn a deaf ear,
Collective agreement says
"I wish they'd disappear!"

_ _ _ _ _ _ _

Dramatic Distress

Dramatic distress
Some people display,
When they are trying
To have things their way

Dramatic impress
Is their method and plan,
Get everyone's attention
Like an earthquake in Japan.

Dramatic finesse
Self-trained, she's a master,
Oh, what would I give for
My Stokes-Adams blaster,
Holstered on my hip
For situations such as this,
A dramatic departure

With flame and a hiss.