The mysterious domain of the gut

The science of the gut. Most of take our digestion for granted, yet it's like a wild and unexplored jungle, massively influencing our homeostasis.

The GI Tract
Is a mysterious place,
Trillions of organisms
All in a race,
It contains the Microbiome
'Tis a considerable size,
How it influences
That's the surprise;
Overall well-being
And auto-immune,
Far more complicated
Than a trip to the moon,
Influences our thoughts
And can be damaged by emotion,
There are as many moving parts
As the Atlantic ocean;
Teaming with bacteria
And viruses too,
Fungi and spores
And prions, to name a few,
And the multiple constituents
Of the hematological domain,
It could be argued, it is more complex
Than the average human brain.

Not so Basic EKG

Since 2002, I have been teaching Basic Cardiac Monitoring, which is essentially basic EKG. Since some of our students might go on to acquire a Monitor Tech position, we differentiate the actions for the RN and the Monitor Tech. Essentially, we take into account only 2-Leads, of the standard EKG.
There are a couple more advanced classes in our curriculum, but unfortunately, they are not well attended. Perhaps the Critical Care Educators at the hospitals, offer classes of this sort; I don't know.

I'm not on the job
But I am teaching,
Basic EKG
That's what we're preaching,
Laying a strong foundation
Of the standard beginners stuff,
Although, for some of our students
Even the basics are tough.

Our class is comprised
Of new nurses and old,
Echo techs and Sleep Lab
Housekeepers who are bold,
Because they want to change jobs
And Monitor Tech sure looks fun,
Understand, this is a new language
And it will feel like a hit-and-run.

Most of the students
Do pass the exam,
It's comprehensive and detailed
Without a hint of spam,
Phones are not allowed
And calipers are advised,
And the ones that fail
We are sometimes surprised.

They get a second chance
To do it over,
This class was all RN's
A new Tele Unit, fresh as clover,
Enthusiastic students
For most, a review,
They have to be certified
To be a part of the crew.

Almost a Trauma Victim

Retirement: more time for biking; that was what I was thinking. But wait, although the city leaders here claim they are trying to help make biking safe, their traffic calming measures are anything but calming. Anyway, just like my almost terrible accident of three years ago, when I was biking to work, an almost identical event happened yesterday. Yup, a driver staring directly at me, yet not seeing me. Look, I wasn't wearing my Zebra suit this time, OK? Time seemed to slow down, unlike that driver gunning the engine. I ditched and chose the pavement and although I get to grow new skin, I didn't become a Trauma patient with multiple broken bones. Whoopee!


Uncle Razmus

I've really been a slug today
I freely admit it,
Because I crashed my bike yesterday
And that’s what did it.

Uncle Razmus, and his wife
Sure, they looked both ways,
Then he gunned the engine
And I saw the end of my days,
I slammed on my brakes
Because they did not,
I took a header to the pavement
And I’m glad it wasn’t hot

I landed on my left side
In the usual fashion,
That’s my modus operandi
Whenever I’m crashin’,
It’s like I’m on a three year cycle
Where I end up on the street,
Lose some skin and bruise some muscles
Wait another three years; then repeat.

Isn't there some section in the grocery store for nuts?

Well, I'm not certain regarding the inspiration on this one (25 years back), but lots of nutty people do just fine in general society, and then they come to the hospital. I don't remember for sure, but I do know I had fun writing it. It has a pretty good 3-line rhyme.

A Special Kind of Ism

She went into the clinic
For elective surgery
To regulate the flow of her ureters,
It was a simple operation
That had never been performed
To implant some tiny microscopic meters,
See, she had a fascination
You might call it an obsession
For the inner workings of her organism,
She had made it her career
More precisely her crusade
Yes, specifically her special kind of ism,
She calls herself a mystic
Her return, a tidy profit
As she leads a modest crowd of imbeciles,
As a faithful testimonial
They visit doctors frequently
And take a million different kind of pills.

Upon awakening from surgery
She had a bold new vision
It involved uniting people on this planet,
So she called a special meeting
With a couple close advisers
Two old friends, whose names are Sven and Janet,
Now, the couple I just mentioned
Were consultants in brave ventures
Their reputation went before them, broadly speaking,
They had recently returned
From a trip out in the ozone
To discover why the atmosphere was leaking,
But that’s another story
That deserves a later telling
Let’s review the facts before us on the table,
It would be easy to identify
This woman as a nutcase
But as professionals, it’s best if we don’t label.

Now, with surgery behind her
More specifically below her
She relished the attention she was getting,
Her followers convinced
That their leader was a Goddess
Divine rapture and ascension, they were betting,
In cases such as this
When we cater to the weirdo’s
We don’t treat them any differently than others,
Because we follow a basic tenet
That our bottom line is care
We treat everyone as though they were our Mother,
And, so spirited was she
That she blessed in groups of three
And cast a good vibration in the air,
Now all who come in through our doors
Will walk upon our blessed floors
And will bear witness to a special kind of care.

Critical Awareness

In Nursing School, and then in practice, we hear a lot about Critical Thinking. It is a tool that develops over time, as the practitioner gains experience, and acquires a deeper knowledge base.
Furthermore, the more experienced Nurse, will eventually attain Critical Awareness, whereby, very subtle cues exhibited by a patient, or even a situation, alerts that Nurse, about impending trouble.

I used to work at night
I have a great respect for the dark,
Getting homeostasis balanced
Is not a walk in the park,
We night-time nurses needed to be watchful
Apprehending subtle cues,
Explosions take time to develop
Better keep an eye out for the fuse.

Accidental Doctor

An Emergency Room draws in the most unusual players; each one must be viewed with a cautious eye.

I had an accident today
I cut my hand while in the yard,
I was taken to Emergency
Down on Stockton Boulevard,
I saw bloody people everywhere
Children screaming in the halls,
Quite an experience, that’s for sure
So different from the shopping malls.

I lost quite a bit of blood
And forgot who I was,
I hit a doctor on the head
Why I did it?, just because,
I put his body in a closet
And placed his name-tag on my collar,
Just a simple street thug
Looking for an easy dollar.

With such an air of dignity
I drew everyone's respect,
I basked in all the glory
When I saw them bow and genuflect,
So involved with saving lives
I didn’t hear the sirens wail,
Till they took me away to raise the dead
Down at the county jail.

Nursing Collaboration

What greater example of genius can be found, than a group of nurses brainstorming ideas, to solve an apparently insurmountable situation. No names mentioned, but factually true; and I remember who my comrades were, what room the patient was in, which hospital............my poems are memory keepers.

Ring Around The Collar

She attacked my poor olfactory nerves

When I checked beneath the covers,

She had colonized a host of creatures

Left by thirty lovers,

In the dark, warm, damp environment

Those bacteria and yeasts

Synergized and incubated

Awesome, unknown beasts.

The Epidemiologist

Was unsure, what to do,

He ordered standard culture sets

On the exudative goo,

And quite frankly, like the rest of us

He was grossed out to the max,

So he didn't even notice

When the slime jumped on his slacks.

A fomite under power

This sad fellow was a dupe,

He should have tossed his clothes right then

Inside the linen hoop,

Instead he took that colony

On rounds with him, that day,

Contaminating everything

In an epidemic way.

Within the fortress of the unit

The nurses launched their fight,

They wrote a mighty care-plan

It was an awe inspiring sight,

The list of interventions

Would win a Nobel prize,

As sure as fresh made cow chips

Will attract three dozen flies.

But none the less, they knew the tricks

To eradicate this beast,

They called the local chaplaincy

To get a Catholic priest,

We need an exorcism

Before we gather by that bed,

Please come and do your demon dance

Or I'm sure we'll be dead.

The Catholic guy, said, my, oh my

Of course, I'll help those nurses,

I'll get a chance to practice

All of my anti-demon curses,

Because it isn't very often

Within the confines of my role,

That I have the opportunity

To really save a soul.

With the exorcism finished

Their job took on some meaning,

It was just another nasty site

Of excretory cleaning,

Engarbed in isolation robes

They were covered head to toe,

And if you turned the lights down

You would see those nurses glow.

Together they approached

Their formation, it was tight,

They stripped back all the bedclothes

And assaulted her with light,

They attacked with four point suction

To vacuum up the slime,

While taking notes in narrative

About the scenery of the crime.

In the background several nurses

Were at work in preparation,

To concoct some deadly mixture

For slime eradication,

And they finally reached consensus

About exactly what to do,

They would mix a triple portion

Of the hospital coffee brew.

It was well known information

That the stuff was nearly toxic,

It could revitalize a Resident

Who by appearance, seemed anoxic,

And the triple dose delivery

Would cause culture overdrive,

This seeping, weeping monster

Would no longer be alive.

The smell was overpowering

When they sprayed the caffeine flux,

It didn't touch the linen

Because they padded her with Chux,

And when the treatment was successful

You could hear those nurses holler,

I wonder if this stuff will work

On ring around the collar.

1994

Personal Space in the Community Place

The President of the hospital where I most recently worked, is very much a touchy-feely kind of guy. It's probably a cultural thing, or maybe some psychological personal space nonsense, but he makes a habit of reaching out & touching, without permission. One time, I was concentrating on a computer screen (charting); he came up behind me and placed his hand on my shoulder without warning. I was startled and spun around, only to find his leering face, asking me, how I was, and could he do anything for me. "Ya dude, keep yer paws offa me, Ok?"

Hug & Touch

What's up with those people

Who feel they need to hug and touch,

With complete strangers

They don't know very much.

And maybe they want

To look me straight in the eye,

And other things

I wish they wouldn't try,

If you engage my eyes

You don't know what I'm thinking,

Are you a body language reader?

What's it mean if I'm blinking.

If I cross my arms on my chest

Is it a sign of strength or fear,

Whatever it is

I don't need you near,

If your circle of influence

Crosses my personal space,

You’re way too close to me

If I feel your breath on my face,

If you want to touch my shoulder

My arm or my hand,

You better ask for permission

Why don't you understand?,

Don't sneak up behind me

And put your hand on my shoulder,

There's no telling how I'll react

And as such, you might not grow older.

4/8/19

The Monkey's Paw

At a number of hospitals (over the years), I encountered situations where it seemed like some kind of patient disaster, was bound to happen, just around the corner. My take on it, is that the hospital corporate structure, was more focused on public perception, image, branding, and so on, and not taking the time to be focused on best practices, inside the building. 

Anyway, maybe I'm totally off course..............but give it some thought.

Don’t Ask Why

Without the usual

Irritating factors,

Overloaded circuits

And persnickety actors,

My poetic Muse

Has been unusually silent,

I have not been provoked

Nor caused to be violent.

I visited my pals

Last Thursday night,

It was an easy-going interlude

Not the usual fright,

But the stories they told

Occurring after my exit,

My Gawd it sounded horrible

Way worse than Brexit.

I wonder:

Does anyone care

About sentinel events,

When disasters are lurking

Near the picket fence?

This is like the King’s fresh clothing

Every single day,

It looks good on the surface

But there is Hell to pay.

When one is dealing with sick people

Sometimes they die,

Intervening on 3-vessel disease

We might not ask why,

Sure, we’ll do a risk analysis

As is required, by the law,

Then move on to lunch

Down at The Monkey’s Paw*.

I recommend, that if you haven't read The Monkey’s Paw, a famous little horror story published in 1902, ( you should read it)
authored by W.W. Jacobs. 

CCU

When I worked at the University hospital 88 - 2001, our Cardiac Unit was named CCU (Coronary Care Unit). The 1990's were the years, when the liquid diarrhea's that we now associate with C. Difficele, began to proliferate. The ICU's were becoming a stinky mess, and historically clean Cardiac Units, were not spared.

The Writing on the Wall

I'm really getting tired
Of all this crap I'm cleaning,
It's really not an issue
That the task is so demeaning,
It's more, the risk of splashes
When I clean those potty pans,
While my nostrils scream in agony
And I beg for scented fans.

I'm getting the impression
That something bad occurred,
I've read the writing on the wall
While no one speaks a word,
A change in nomenclature
A shitty point of view,
Chronic Crap, not Cardiac Care
A new meaning for C.C.U.

1993

What is Known

How we write, to avoid HIPPA, and still, explain our stories and yours.

If you gotta talk about your hospital gig; talk to a professional peer.Otherwise, the best person is your ESTL (English as a third language)  spouse. 

I realize, that what I write
May not be clearly understood,
Because I am processing an experience
The could have, should'a, would,
We all go through this method
As we analyze our actions,
I think talking about it has some value
To avoid terminal impactions.

To have a sympathetic listener
Another nurse, for example,
With experiences similar
Not so likely to trample,
Upon feelings and senses
Where we both know the stage,
Don't talk to a Child Psychologist
Regarding abused children, with our rage.

Henceforth, are the times
Where the writing wanders about,
When I rage at the perpetrators
I want to scream and shout,
But instead, I follow the protocols
What agencies to page and connect,
While in my dreams, I call the assassins
Phone numbers, address, and where to intersect.

Every individual person
Faced with outrage and mayhem,
Wonders, why we do pause
And not immediately slay them,
Where we name them as "alleged"
Although we hold the information,
And if they get the best Lawyers
They might earn a nice vacation.

So you see, I do ramble
As the words lead me on,
Exposing my experiences
What is known and beyond.

Fontius Pilate

Like Pontius Pilate (some kind of Testament of recognition), I am a persecutist of Font. Just so you know; my font and text handling is atrocious. I write in a consistent matter and don't murder the English language (unless it suits me), but my Font management is a failSorry

Let them go

No lead in here..........I lost another font war.

Why go on? When your body has failed, Why send a letter? That never is mailed, Why own a comb? If you've lost all your hair, You can't hold your breath If there isn't any air, Why go on reading? If it isn't making sense, Can you say you have a farm? If it doesn't have a fence. Why prolong the suffering? Of the one you love the most, Are your grief and loss so great? You are clinging to her ghost, Sit beside her, hold her hand Feel her pain and you will know, That love is giving and receiving; And love is letting go. _ _ _ _ _ _ _ _ _ _ _ _

While on the same topic of dying; here was the opposite approach, as shown by this loving and attentive family.

Humbled

"This Lady is fun" Her daughter said to me, The portrait on the wall Displayed her lovingly. She held her mother's hand And gently stroked her hair, It felt like I was standing In a sanctuary there. Her husband gazed into her eyes And only saw her beauty, He'd gladly suffer all her pain In love, and not for duty. The part I played seemed minor In the drama on this stage, I felt just like a footnote At the bottom of the page. "My Mother is the strong one" Her daughter said to me, And in a moments silence I was humbled by the three. 1994

Continuity vs Chaos

This is about that darn dream again; yet, it is relevant in one aspect. In the course of my career, I wanted different patient's every day. I believed I was more attentive that way, because the situation was new and different. I discovered, that if I had the same patient more than two days, I was likely to start making some assumptions based on prior information, and I might under assess the patient.

Many nurses want the same patient's day in and day out; plus, there is some institutional hype regarding "Continuity of Care", that is often touted to the public at large.

I awoke from that same old dream
A nursing unit drop-in,
It could have been a lot more fun
If Betty took me shoppin',
When I arrived, they made me Charge
So I chose the fractured leg,
Everyone gave me the stink-eye
While one of them even begged.

He said:
I wanted the patients that Peggy had
Like our hand-off from night till this morning,
He almost incited a riot
So I glared, as if sending a warning,
And as usual, I was so busy
I ignored my own patient, again,
This is my hospital nightmare
Last count, at one hundred and ten.

Mental Misdirection

I rarely write about mental health, other than commenting on patients with crazy, disruptive behavior.

Across the Border

When you're driving home
And it seems like it's the same old way
But suddenly you're lost, and across the border,
To me it appears, it must be something like
The fellow with the Mental disorder.

Derailed thoughts
Like a telegraph line
With its wires crossed.

It doesn't matter if you remember
Where your home is,
You're still going to get lost.

So what can you do?
Find an alternate route
Or maybe get a new map,
Or get a mobile home,
Then you'll always be there.

10/12/82

In Training

Written in 1994; never posted. I worked for a University Medical Hospital for 20 years and don't regret a moment of it. The educational / training going on, with a variety of disciplines and specialties, was invaluable. Anyway, in the midst of that is a daily reality; Doctors in training, under enormous pressure.

Training the Scholars

Cirrhosis caused by too many years
Of IV drugs and a million beers,
Disabled with his Liver disease
He wants a medical miracle please.

On public assistance, he has no job
No health insurance plan to rob,
Sister Euphemia said, “you're in a pickle”
“Don't come to us, if you don't have a nickel”.

So, off to the University joint
We charge triple, that's the point,
All in the name of research and knowledge
You have to remember that this is college.

Last year in Biology, frogs in the Lab
This year an Intern, people on a slab,
Poking around for landmarks  unseen
Unlicensed drivers on every machine.

You chose the lifestyle of abuse and addiction
Now you're begging for help, to reverse the affliction,
You agree to proceed, did you pause to repent?
There's a chance you will die, but you gave us consent.

Your family is angry, they threaten to sue
But you know the truth, the blame is on you,
And it seems like a waste of our healthcare dollars
But then I remember, we're training the scholars.

1994

PTSD

Many nurses do report they have work nightmares, or what I call, Hospital Dreams. Invariably, mine would usually highlight a situation where it would be near the end of my shift, when I become aware that I have a patient that I have not visited during the entire night.

There were other really scary themes; for example, uncontrollable bleeding. Those are factually PTSD, from numerous real-time situations I took part in, working in the areas I spent most of my career in.

Anyway, last night I had two hospital dreams; surely inspired from real history.

Two hospital dreams
In one retirement night,
The usual thing;
Too busy, and making something right.

The first dream:
I was called back to work
To document a Death,
No neuro-responses
No heart beat or breath,
But when I looked under the covers
I discovered a central line,
Sure, there might be a reason
Still secured with some twine.

Although my wisdom is limited
My foolishness knows no bounds,
When I loosened that silly string
There were immediate whistling sounds,
Then some yucky liquid slime
Did gush from that central IV,
On the bedclothes and onto the floor
And a plentiful bit upon me.

Luckily, the clerk at the desk
Had stepped out for moment or two,
I grabbed a clean sheet for mopping the mess
Then shrouded the body, to hide any goo,
I looked for a camera, and found one above me
Thankfully pointing away,
When the Attendant returned, I submitted my notes
And cheerfully announced; Good Day!

Dream second:
I was working in that recent place
Though it looked like an ICU,
There were 38 patients to process
Our staffing was FUBAR too,
One of the patient's required 3 nurses
While over my way, a respiratory arrest,
Thank goodness I thought, K.D. is here
When the worst day happens; we're saved by the Best.
__ __ __ __ __ __ __ _

If you know K.D............you know what I'm talking about; she always saves the day!

Healing Methods

Make room for healing, as long as it is sanitary.

There is something else
Needs saying,
In many hospitals
There's a lot of praying,
Staff members idly
Belching, God Bless,
It usually involves Jesus
But I digress.

Little did they consider
Other ways of healing,
Wu Ji Gong methods
And Reiki, by the feeling,
Ascertained when I paused
Sensing the need,
Feeling the spirit
'Tis possible to read.

No matter what the method
It's hard to measure,
Each person has inside
An inner treasure,
To be treated properly
Be it drugs, prayer
Energy or touch,
Combination therapy
Is recognized as such.

Anesthesia in General

I'm sure everyone has experienced this kind of thing; a solution is derived, to solve a problem, but no research was done. Over time, as the complexity of the "problem" develops, further work around's are devised. When leadership chooses to make do with the process as it has developed, they smile and wave, beaming about their home-made solution. And when outsiders, look at the process, all they care about is...........can you process 38 procedural patients with prep, do-the-deed, and recover, tomorrow?
The outsider doesn't care how it's done (and neither does the Overseer), they only care, that it's accomplished. This is not a good and safe way to solve challenges in a hospital.


A systematic malfunction
Without a doubt,
It never matters
How loud ya shout,
When the powers that be
Refuse to budge,
Is this Anesthesia Recovery?
You be the judge.

Patients return from
From a Procedural lab,
They were intubated
On a padded slab,
Given Etomidate
And Propofol,
Fentanyl and midazolam
But that's not all.

But don't let me bore you
With persnickety details,
We pat ourselves on the back
Rescuing the fails,
When Pulmonary Edema
Happened in a flash,
A Code Blue call
Made everyone dash.

Take Joe Bob with bad kidneys
And a failing heart,
Slip in a pacemaker
So he can't depart,
But that's a misnomer
Breath is essential,
The surgical sedatives
Inhibit the potential.

Deep sedation
Is akin to anesthesia,
An LMA or oral airway
May look like paraplegia,
Demanding a nurse
Stands guard, no leaving,
Inviting aspiration
With imminent bereaving.

But, ask the Great Wizard
Do we recover Anesthesia?
Heck, delivering Yak twins
That would be easy-ya,
Than getting a straight answer...
How about a shake of the head,
Perhaps there will be a moratorium
When someone ends up dead.

Unearthing an old favorite

Here's one from 1992; nothing has changed. Actually, in my most recent job, I was no longer in a position to be administering paralytics like Pavulon or Rocuronium. It's just as well; having to do the hourly TOF's (train of four) was a bit tedious.

Mortal Irritation

Your mortal irritation
Is making me insane,
This pathological nightmare
Is curdling my brain,
If you continue this behavior
I'll be driven to extremes,
When pushed beyond my breaking point
I make up tortuous schemes.

The paralytic agents
Are the drugs I like the best,
If you irritate me one more time
I'll put them to the test,
And whether I sedate you
Depends upon my mood,
The more you irritate me
The more likely, you'll be screwed.

There are periodic rumors
That I'm approaching burnout,
But every time I work
There's a special nut-case turnout,
So for mortal irritation
I will paralyze for free,
And if anyone needs sedation
Why surely, that is me!