Blood Saints

 

This is the part where I say a big Thank You to those folks who work in Blood banks and Donation Centers and all of the great work they do. 

And this is the true story of a first-time blood donor.

Blood Saints

To the team 
That took such good care of my wife,
After she was stabbed by that needle
That looked as big as a knife,
Wifey told me she felt good
No problems had occurred,
But then she passed out
When her tea was being stirred.

For a first time impression
That was incomparable,
From her perspective
It was somewhat unbearable,
To get tossed to the floor
Then placed on a mat,
If she had been awake
She wouldn’t agree with that.

Suffice to say
The Blood Saints responded quickly,
As soon as I called out
"She's dizzy, hot and sickly",
As they came to our table
It was lights out for my spouse,
Not a brain cell was stirring
In dear Lhakpa's house.

I got out of their way
They were an efficient crew,
Although I checked for a pulse
That's what good husbands do,
Who are planning the next move
In this kind of game,
Let the rescuers do their thing
So the husband won’t get the blame.

And a great job they did
Over the course of the next hour,
They helped her wake up
So she could drink a whisky-sour,
It was a remedy we never used
When I worked in critical-care,
But those Blood Saints are so powerful
My wife is now breathing air.

Vitalant probably discourages
Monetary awards,
It is not in the bylaws
Nor in the Geneva Accords,
But having worked in the industry
I know the things they appreciate,
Yes, coffee and chocolate
Are never too late.

What Nurses Do At Home

 

We Nurses know how to bend the rules at work, so I know for a fact we do it at home as well. But heaven forbid, there is certainly stuff we won't say in front of our family.

Things I Can’t Tell My Family

Things I can't tell my family
About that toothpaste cap,
I dropped it into the toilet
That's not the same as on my lap,
I didn't want to throw it away
The toothpaste might dry up,
So I placed it in the UV sterilizer
Then I soaked it in an alcohol cup.

I’m pretty sure the e-coli
The clostridium and staphylococcus,
Was rendered completely inactive
Unlike a toilet sourced in Caracas,
And truthfully the cap only dunked
In the water for a tenth of a minute,
I’m absolutely sure it was sterilized
Not an inkling of doubt of what’s in it.

1/23/22

The story that belongs to the next post

 

In 2014 I had a position in a very busy Diagnostic Cardiology unit. We did pre-op and post-op care and recovery for persons having Cardiac procedures such as Angiograms for heart and peripheral studies as well as acute MI emergencies. Our services also included Dysrhythmia ablations, recoveries for Radiology procedures and also procedural sedation for Bronchoscopy. Strangely, we were not designated as an official surgical recovery area, but we did all kinds of recoveries following general anesthesia. It was crazy. We were also doing recoveries following all kinds of catheter-based heart valve replacements like TAVR, MVVR, Watchman, etc. At the time I was hired, I became the 2nd "ICU" experienced nurse for the unit. 

My story here is regarding a fresh-new-just-graduated RN with no prior hospital experience; this person was completely unqualified to work in our unit. I admit it was hard to find qualified nurses to work in our area; people needed a lot of cardiac experience. So I can't understand at all why this person was hired, except that Management was desperate and the newbie seemed sweet and nice. 

On the day of the event I came to work at 0930, immediately hearing a Doctor demanding to talk to the Charge nurse about the nurse who had been present during a Bronchoscopy. One of our Administrative Charge nurses (she made the decision the day before) and the person who was filling in for her, apparently thought it was reasonable to assign the new inexperienced nurse for the Bronchoscopy. No wonder the Doctor was flaming mad!

I did some precepting with this new nurse and that was a role I was commonly assigned and enjoyed. This new person was the type that always replied "Yes" when asked if he knew how to do a task. One busy evening when I was occupied with a new sedation-recovery, the newbie was staying late to help us. I had a patient that needed to ambulate before discharge to go home. A foley-catheter had been inserted during their procedure. I asked newbie if he knew how to remove a Foley-catheter and he replied, “Yes”. I handed him an empty 10-cc syringe which is necessary to remove the sterile water from the inner tip of the catheter that is located in the bladder. Okay; a few minutes later I noticed him standing at the door of the room I was in. He said, “I need some help, the catheter won’t come out”. I wondered about that and followed him into the room. I asked him if he had removed the water from the catheter balloon, since I did see the syringe out of its package at the bedside. Newbie had a vacant look on his face so I knew he didn’t know jack about removing a Foley catheter.

 Unfortunately, there were quite a few more events just like that, where he had originally said, “Yes, I understand how to do that”. One day he had been assigned to administer sedation for a Cardioversion and the patient became apneic. He didn’t know what to do. Well of course he didn’t; he was untrained, unqualified and had not even had a procedural sedation class. But who was in Charge? Mother-Charge-nurse who loved him. 

Inexperienced

 

What nonsense! This decision
To assign to the neophyte,
Be the Bronchoscopy nurse
Like an untrained boxer in a fight,
Who has had no previous training
What’s there to know? Just make a fist,
Well, the Doctor surely noticed
And he was properly pissed.

I heard about the plan yesterday
When Ma Boss made that dumb decision,
And she wasn’t even here today
To witness the failure of her vision,
Her favorite little acolyte 
Won’t speak up to say, “Not me,
I know that I’m not qualified
I’ve never done it, can’t you see?”

What a team they make, these two
Like mother and son,
The two of them are dangerous
When all is said and done,
She ignores his weakness
And he says “yes” to everything,
Boldly going where he should not
While mother coos and sings.

When I arrived the Doctor was fuming
And spoke his pretty piece,
I totally agreed with him
About the boiling grease,
Then I volunteered my services
For the next bronchoscopy,
An expert for that procedure
Of course, that would be me.

Advanced airway skills?; check
Expert cardiac of course,
Highly trained in procedural sedation
I could anesthetize a horse,
Code-Blue master of renown
A crash and burn magician,
Or just assign the newbie nurse?
Ya, that’s our public mission.

Well, there were no complications
At Bronchoscopy number one,
But I’m sure if that had happened
Mother would still have coddled her son. 

What Every New Nurse Should Know

 

Your first Nursing Instruction in the Hospital.

On Admission
 
The most important thing
That we explain,
It's not the heart
It's not the brain,
It's not the
End of life decision,
It's the wired remote
To the television.
 
What is more important
Than our Nursing role?
The channel-choosing
Volume control,
But heed my warning
You better listen, right now,
That Nurse-call button?
Don't teach them how!

Remember Tamiflu in 2009?

  

Here we are again with another Fluish dilemma. I wrote about it in 2009.

Tamiflu
 

I got myself to thinking
Why they call it Tamiflu,
The aggravating aching joints
Are what come over you,
When you fail to take precautions
In the presence of the beast,
I'm warning you be careful
Cover your ears to say the least.
 
The Tamiflu vaccine
Is highly recommended,
It offers wide protection
In the case that you're dead ended,
In the hallway near the kitchen
By the linen cart and more,
The Tamiflu vaccine, my friend
Will even up the score.
 
It was tested in the morning
It was trialed in the night,
Yes, the Tamiflu protection
Was clearly out of sight,
A shield of cosmic ions
Floats gently around your face,
So the Tamiflu infection
Can not violate your space.
 
Supplies are currently limited
While demand is ever growing,
The Tamiflu is spreading
Despite everybody knowing,
That the best way to prevent it
Is avoidance at all cost,
If Tamiflu gets a hold of you
Why surely you'll be lost.

How I was Blessed One Time

Gesundheit !

I wonder sometimes
What stories I'll tell,
On my way to Heaven
Not heading for Hell,
Some might think I am crazy
The things that I'm saying,
But if you are religious
I know that you're praying.

At work that one night
I performed some good feat,
The nurse that I helped said
God bless you, Pete,
And it caused me to wonder
If she somehow had the power,
Bestowed on her by God
To bless me that hour.

I didn't notice any difference
That a blessing could have made,
Perhaps the blessing is in storage
To be sometime later played,
To my better advantage
In a time of greater need,
Like when I stick myself with a needle
Causing me to bleed.

What makes people think
They can randomly send a blessing,
As personal agents of God
It's almost depressing,
Because that's what the whackos say
Before they poison their flock,
It fills me with trepidation
As I prepare for the blessing shock.

Who knows what it means
When you're blessed for a sneeze,
Though I've always preferred
"Gesundheit", if you please,
That kind German wish
To offer me good health,
But I'd really prefer ten dollars
And wish me good wealth.

 

Heavy Lifting

 

In the trenches of bedside nursing everything is like the movie scenario presented in "Groundhog Day". The same events happening over and over and over and so on, until somebody realizes the way to get out. 

Nursing exists in its own Groundhog Day. I've been writing about the same topics every decade with only nuances of change. I have a lot of poems regarding the difficulty (logistics) of Nursing care with very weighty people. However, it is worth noting that in 1978 when I began a healthcare career in a hospital, the prevalence of morbid obesity was quite low. (Major medical center in Los Angeles).

Here I address the claim that hospitals are looking out for us and providing Lift Equipment and making it available to everywhere in the hospital (but not everywhere at any given moment)

Buxom and Girth

Dear Bertha with the buxom bosom

Had sepsis, pneumonia and shock,

To keep her alive we infused 30 liters

Adding four-stone in four hours on the clock,

Each turn in the bed for her skin care

‘Twould take the muscles of three mighty nurses,

Pausing to share a reflection

And sort out their favorite curses.

With a gnashing of teeth and straining of spine

These three groaned in triplicate unity,

Knowing quite well if they busted their backs

The hospital would deny with impunity,

Management argues we have the equipment

To maneuver the oversized clients,

They blame us for slack or impatience

Without truly understanding the science.

Suffice to say we nurses are tougher

From the keelhaul we had this past decade,

Throw anything at us and we will just cuss

We don’t succumb to the brute or the blade,

Better to back Nurses than Wall Street

Unlike a bitcoin account, we add worth,

Protect the nurses who are the backbone of the workforce

In this arena of buxom and girth.

Prognostic Lament

 

Perpetual pandemic? Not likely. However, it is going on far longer than the average bear can tolerate or understand. I read the tea leaves today and this is what came through via Haiku. 

Please Bro, make it stop
Covid is such a bummer,
So tired of the idiots.

Price-Check Incontinence

 

When you work in healthcare, whether you take care of babies or adults, the likelihood is that you (like the rest of us) have had it up to your ears in bodily secretions. I won't write the names of these things because I would rather not trigger a seizure or panic attack in my audience. 

While reviewing the past forty years of writings I realized that the fullest category of poems is that which talks about all the gross stuff. Here is a new one:

Holy crap!
I don't know why I never looked this up before,
How much does a Flexi-Seal cost?
Don't ask; it will blow you out the door.

Heck, those things were flying off the shelf
Back in the MICU,
When 60% of the patients had C-diff
And if you didn't wash your hands enough
So would you.

When I "Googled" Flexi-Seal
It was in the #1 position,
The second listing was Flex Seal
Like the runner up at the audition, 
The first one requires a Doctor's order
And the patient is charged over four hundred bucks,
Whereas Flex Seal costs fifteen dollars
Leaving enough money left over for
Seventeen, 30-per-pack, Chux. 

Nurses are really smart
When faced with adversity they show no fear,
They could easily imagine how to configure a garbage bag
Along with Flex Seal, to the average patient's rear,
Once again my genius ingenuity
Is proven to be without bounds,
Oh, wait a second, I have to get out of here
I think I hear the Sheriff with the hounds.

NurseMart.........just another .99 Cent Store

 

I am a multi-decade ICU nurse and retired from the hospital for three years. Yes folks, I do miss it and I cringe at the reports of what current nurses are experiencing. I know what you know; one of the primary reasons regarding staffing shortages (as are reported today) has to do with the sucky treatment of nurses by hospital administrations. The following is what I wrote in 2008 (and probably ten years earlier too).

If only we were in the business
Like the local grocery store,
We'd earn a flat percentage
For every pill and chore,
Every spoken word of teaching
Every gesture of compassion,
There'd be seasonal variations
Like the latest winter fashions.
 
For special big events
There could be a bonus format,
It would beat the present system
Where we're treated like a doormat,
For example, we could compensate
Events like CPR,
If you succeed and bring them back
You win the big cigar.
 
Your patient was combative
He tried to stab the Candy-Striper,
She’s the daughter of the CEO
You win the keys to his Dodge Viper,
Or you work an extra night shift
Like it’s really no big deal,
Seven patients with infections
Every one of them with difficele,
By morning you’re exhausted
And finally feeling old,
Your boss comes in, says, “Way to go”
And hands you coins of gold.
  
There would be no nursing shortage
If these silly thoughts were true,
Pay us like celebrities
It is long way overdue!

2008

Careful with those words, Boss

I am a certain kind of writer because I pay attention to the usage of words and terms. During my 40+ years in healthcare I paid close attention to the things that were being communicated to me. As a result, I have laughed a lot.

If you work in the hospital you must know about the Johns Hopkins Appraisal Tool for Fall Risk Assessment. At the most recent facility I worked at, it was identified as the Johns Hopkins Tool. If you are a warm blooded adult, you may be aware that there are alternative definitions for the term "tool". Sometimes I wonder who is sitting on the panel of professionals, when they all agree on the naming of something. It reminds me of the acronym of SBAR (Situation, Background, Assessment, Recommendation); now consider what FUBAR alludes to: Effed Up Beyond All Repair. 

Johns Hopkins Tool

I don't think I want to know
About Johns Hopkins tool,
I may be a Nurse
But I'm not a fool,
To be poking around
In his business that way,
I'd rather read a report
Than see that tool, any day.
 
I really don't care
About Johns Hopkins tool,
I learned all about that stuff
Way back in school,
And if he wanted us to know
Don'tcha think he'd send a letter,
Nope, I don't want to see it
'Cuz it don't get any better.
 
You see, I don't understand
How seeing Johns Hopkins tool,
Will make me any smarter
And I'm already cool,
So what could be the point
Of this mandatory class?
It better not be something
About Johns Hopkins ass!

New Poem - Old Problem

 

Bullying, harassment, threatening behaviors definitely do occur in the Tribe of Nursing. There were numerous times over the years where I experienced bullying and/or harassment. Most of those times I blatantly ignored it and went on my way. My method to deal with it was to become better qualified and more valuable, such that I received a more favorable status. 

Now, I can put up with harassment about three times and then, I fight back. The event described in the poem below did result in a conference with my Nurse Manager and Charge-nurse regarding my outburst of aberrant behavior. Fortunately, my nurse adversary was just acting the way she frequently did with other persons. I was the catalyst for her soon-to-be, future departure.

I was better than some
No worse than others
Perhaps the same as a mythical creature,
All the tools that I owned
I brought to the table,
Some complained about a singular feature,
I might propose, a better solution
And offer it up with a question,
Apparently that ruffled 
A couple chicks feathers
Upsetting their delicate digestion.

After absorbing a singular attack
From a colleague at work one night,
I silently decided enough is enough
The next time I will openly fight,
And sure as sure in a couple more weeks 
During night-to-dayshift-report,
Bianca the weirdo demanded details unneeded
I exploded like a gun at the fort.

I slammed the chart on the table
‘Twas like a gunshot in a crowded mall,
All heads turned in our direction
As if waiting for the bodies to fall,
And fall they did, when I demanded 
"Bianca, just take my report",
I felt a silent collective agreement
Bianca’s harassment did abruptly abort.

When DNR is revoked for a few hours

 
Many times I witnessed this sorry state of affairs; the person who is identified as DNR and then, he or she is not allowed to die. Yes, it is true. A DNR designated patient is coerced / urged / guided to undergo some kind of safe surgery and the surgeon declares that the DNR designation is "suspended" during the surgical procedure. This is where doctors think they are gods; where nothing could possibly go wrong that they can't handle. Oops, Mr. Billy coded on the table and the team can't possibly let him die. Well, the primary reason for that has to do with the Physician, the medical practice and the hospital reputation status. It doesn't look good when patients die during surgery. And there you go, Mr. DNR was not allowed to die and quite likely his QOL is now worse than it was preop. In fact, he might suffer fifty times more on the way to his natural death.

Free Resuscitation

When I got too old
To drive my car,
My doctor made me
A DNR,
But when I went in
For my surgery,
They offered resuscitation
Completely free.

That's a heck of a deal
The surgeon said,
If you crump on the table
We'll bring you back from the dead,
Because we don't want people dying
In our operation room,
It's bad for our reputation
It's a flippin', dollar doom.

But worry not, sir
There ain't nobody better,
We operate by the book
Down to the last letter,
And the gist of all this talk
Is about risks and regulations,
You'll come through with flying colors
And standing ovations.

So you did poorly, after surgery
Well, it's clearly not our fault,
We performed what we promised
And you didn't tell us to halt,
When you had the opportunity
Before morbidity and mortality,
Would get the upper hand
And you'd become a fatality.

You should have put your foot down
And stayed a DNR,
Before you let that doctor
Be the driver in your car.

RASS Revisited

 
As the years go by every medical worker must go to hospital orientations or get introduced to new solutions, blah, blah, blah. Man, a huge amount of money is blown on these things and no matter who you work for they will sell it like it's a new pathway to Jesus. 

The one and only………..(no, I’m joking, there are at least fifty of these ridiculous acronym directives that are jammed down our throats). And believe me when I tell you, the primary objective is to audit your performance, while the secondary objective is to guide a metric for billing. 

Here is one of my all-time despised directives:

Richmond Agitation-Sedation Scale.

Never in my career, in any Nurse-to-Nurse report did Betty Lou say to me, Patient Billybob has a RASS of minus two, positive. Instead, I was told that; Billybob is totally whacked out, slugging and spitting at his caregivers between bouts of profound somnolence and manic, murderous mayhem. And incidentally, I told the Doctor the same thing. 

So why is there a RASS? To audit us, of course, you fool! It probably fits in somewhere on that down-home favorite, the APACHE score.

RASS

Remember
Acquire
Stupid 
Stuff,
As if we didn’t
Have to do enough.

Always remember
To do that RASS, mutt,
Or some invisible Auditor
Will kick your butt.

At first there was AIDET
And then there was NO PASS,
Ask any honest nurse
They’re all a pain in the ass,
And don’t forget that Apache Score
One more shackle
To grapple with on your shift,
I doubt the CEO must do it
Do you get my drift?

Is management forced
To use precious time?
To pull up Apache
And make everything rhyme,
A non-productive part
Amidst every day duty?
Makes me feel like calling
Death Cab For Cutie.

2007.......2021

The Family

 

Here it is 2022 and I will admit that end-of-life decision making algorithms and comfort-care medical orders have laid the path to reduced suffering. However, sometimes there is family baggage, dysfunction and outright animosity toward the poor dude that is at death's door. I have witnessed on numerous occasions, family members fighting over what they will "get" when Daddy dies, all the while Daddy is over there in the bed heavily sedated and on life-support devices. 

A dying patient's family, can
Do more harm than good, I assure you, man,
While contesting the contents of his will
They're hovering closer for the kill.

They may be harboring hidden guilt
About the time the milk was spilt,
Then clutch at every thread of life
And claim it's for his loving wife.

When life-support, becomes death denial
He feels like he's been put on trial,
He wonders what his crime must be
The poor fool had a family!

(1992)

A High Stakes Game

 

Dang, I wrote this back in 1991..........and the same game is on.

High Stakes Game

We keep them here for days on end
And try to make their organs mend,
We attack their cells with mighty drugs
To try to kill all sorts of bugs,
That naturally were acquired here
This ain’t no place for the sick, I fear.

Pardon me, I was only rambling
About life and death, it’s just like gambling,
In a high stakes game for those that dare,
Who bet their lives in Critical care.

Flashbacks of Bleeding

 

If you ever stop here to read my writings, you may have noticed that I have been revisiting my past a bit since I divorced the Hospital in 2019. I'm not finished with Nursing, because I still teach about Heart Rhythms.

And I still write new stuff!

Flashbacks of bleeding 
No, never my own,
Billy Bob and Esther
Patient's I have known,
Was it ever my fault?
Yes, a couple of times,
Caught my foot on an Art-line
Was one of the crimes.

ICU is a tangled place of
Wires, tubing's and clutter,
Careful maneuvering advised
But what if your patient is a nutter?
Delirium in progress
Thrashing and flailing,
I was kicked in the head once
And I went sailing.

Nightmares of bleeding 
Have followed me into retirement,
This burden of dreams seems like
Some kind of payback requirement,
But I know better than that
This is called PTSD,
Repetitive traumatic experiences
If you’re a hospital nurse, it will happen to thee.

Figure it out early on
Find a pal to listen to your stories,
No reason to brag
All about you and your glories,
No, just unload all the crap
The pain, the suffering and more,
Maybe twenty years from now
PTSD won’t knock on your door.

Crazy Function

 

I graduated Nursing school in 1983 and immediately began working on Cardiac Care units and within a year I was working in all manner of ICU's. My interest in heart rhythm's began before Nursing school, during my career as a Respiratory Therapist, when I took a semester class for basic EKG in Fall of 1978 (Pierce College in Los Angeles). As a novice RT working in the Cardiac Surgery ICU, I figured I better be able to read a Heart Monitor while I was screwing around with the ventilators. 

Anyway, my fascination with EKG rhythm's goes a long ways back and with my current historical review of writings I am getting reacquainted with quite a number of cardiac poems I forgot about.

Crazy Function   (1992)

I have some crazy function
Down in my AV Junction,
The impulse is forgotten
Because the path is getting rotten,
At last a beat gets through
I’m unsure, what it will do,
Aberrancy or retrograde
If refractory, it just might fade,
Back into covert hiding
Until my AV-Node is more abiding.

A Spirit of Visions

 

An old favorite of mine regarding the Tribe of Nursing.

The camaraderie of nurses
That I mentioned once before,
Is like the glue that binds the book seams
And the hinges on a door.

Like the sands of ancient deserts
And the waves of mighty seas,
The gale force winds of a hurricane
And a forest of time tested trees.

It draws from a source of great power
It plays host to a spirit of visions,
It shoulders the pain of all brotherhood
While bearing the weight of decisions.

There’s a loneliness shared by its members
As the givers and takers of pain,
It rests on the heart with a heaviness
We bleed life, in a bottomless drain.

But the law of abundance sustains us
The cup that we pour is refilled,
After quenching the thirst of so many
There’s enough left for us, that we’ve spilled.

1992