And lo, they received it.
God bless Kirkland Signature products. For ye, though the middle class cannot live by bulk shopping alone, they're sure as hell gonna try their damnedest.
Tuesday, March 18, 2008
for the discriminating cheapass
And lo, they asked for a Costco wine.
And lo, they received it.
God bless Kirkland Signature products. For ye, though the middle class cannot live by bulk shopping alone, they're sure as hell gonna try their damnedest.
And lo, they received it.
God bless Kirkland Signature products. For ye, though the middle class cannot live by bulk shopping alone, they're sure as hell gonna try their damnedest.
Thursday, March 13, 2008
Hell is For Heroes
I saw the title to an old Steve McQueen movie, "Hell is for Heroes" and I thought that was a very appropos way to approach ICU nursing. My "in" as it were.
(Bonus: I get to gratuitously mention Steve McQueen in my blog. I really feel there was no other way to link "Steve McQueen" and "ICU nursing." And Steve McQueen = RRRAWR. I'm just saying, okay?)
Okay, moving on.
If you've noticed, I've sort of skirted around the issue of How I Feel About ICU Nursing Now That I'm Actually Supposedly Doing It At Work.
I'm deep in denial mode, actually.
This reticence to discuss my job stems largely out of the sheer mental trauma I'm being subjected to on a daily basis, and I don't mean this in a typically snarky, cavalier way (okay, I sort of do). I'm much less articulate about this particular facet of Heart of Darkness-type work angst, precisely because there's very little that can be made light of some of the kinds of issues I've come across in less than a month on the floor, and yet, it's easy to melodramatize same, and that gets all crusty and old and boring.
Only, what I realize is that there's no way to access the root of all of this without sounding like I need large amounts of psychoactive drugs and talk therapy, myself. So I have to kind of make it funny, so I can survive the daily browbeating of my profession.
But then writing about some of the stuff that really bothers me about working in the ICU--most of which is genuinely as unfunny as it gets--turns out to be funny in a way a Nazi Puppet Show would be funny, which is to say, not funny at all. Largely inappropriate satire, maybe, but not truly "ha ha" funny (unless you're talking Hogan's Heroes. I mean, what's not to like about kitschy inappropriately-themed 1960's comedies, I ask you?)
So, any way, what I'm saying is that I'm Still Working Stuff Out, and Having Issues, so what you're really getting is this hamfisted version of what I'm going through, and it's not really very accurate.
Okay, pointless preamble done.
So, what's it like to be a new ICU nurse?
I think my first, honest and uncensored comment about my new job is "ICU nursing is hard." The follow up comment is, "And no one gives a shit." Sure, we get more respect from our peers and docs, but honestly, at the point you're taking care of brain dead people or people for whom recovery means "we might at some time put a less invasive device in your body in order to continue mechanically ventilating you, but your prognosis essentially remains pretty crappy at best"--who the hell cares?
My days are now spent trying to remember which way to turn eight hundred stopcocks attached to various life-support devices so that I don't inadvertently kill someone by administering a dose of the wrong vasoactive medication, or introducing an air embolism, or haveingthem bleed out, or any one of about five thousand new ICU-specific things I now have the legal capacity to be sued for in a court of law. It's fun times, I'll tell you! In fact, I'm writing a new screenplay for a new ICU nursing themed soap, "As the Stopcock Turns."
Sure, I like the new challenges ("Let's try to keep this poor person hovering between life and death pretty much indeterminately, not because it's the right thing to do, but because it's possible! And look at all the pointless numbers and data we can generate in doing so! Generating numbers in the name of patient care can't ever be pointless, can it?") And the newfound job "status" is swell! It's like I woke up, and the worst bosses of my career converged into one fire-breathing hell demon cackling maliciously, as per Mr. Burns: "You've been promoted to Head Kappo--sure, you're just as disposable as you were before, but now you have even more latitude to brutalize severely incapacitated people pointlessly on official orders before we send you both to your untimtely deaths. Good day!")
On the whole, I'll rather be looking forward to the day when I return to Grumpy Old People World (okay, so Vented, Sedated Grumpy Old People status post coronary artery bypass) because heart surgery, is at least usually, you know, a planned surgery, and I'm finding out there's really no such thing as elective "trauma."
So really, part of what I'm telling you is that taking care of people who resemble Hamburger Helper wasn't really what I signed up for, mentally. In my deepest professional heart of hearts, I signed up for Grandpa Joe Needs His Heart Valves Replaced. Well, He Really Doesn't, But Look, We Just Did it Anyway, Neat, Huh?
And if Grandpa Joe doesn't make it, or develops post-op complications, well, we kind of expected that, because Grandpa Joe had a few years of Methuselah. We weren't expecting much.
I think in nursing, it really all boils down to which kind of futility of care you can wrap your mind around being a willing participant.
(Bonus: I get to gratuitously mention Steve McQueen in my blog. I really feel there was no other way to link "Steve McQueen" and "ICU nursing." And Steve McQueen = RRRAWR. I'm just saying, okay?)
Okay, moving on.
If you've noticed, I've sort of skirted around the issue of How I Feel About ICU Nursing Now That I'm Actually Supposedly Doing It At Work.
I'm deep in denial mode, actually.
This reticence to discuss my job stems largely out of the sheer mental trauma I'm being subjected to on a daily basis, and I don't mean this in a typically snarky, cavalier way (okay, I sort of do). I'm much less articulate about this particular facet of Heart of Darkness-type work angst, precisely because there's very little that can be made light of some of the kinds of issues I've come across in less than a month on the floor, and yet, it's easy to melodramatize same, and that gets all crusty and old and boring.
Only, what I realize is that there's no way to access the root of all of this without sounding like I need large amounts of psychoactive drugs and talk therapy, myself. So I have to kind of make it funny, so I can survive the daily browbeating of my profession.
But then writing about some of the stuff that really bothers me about working in the ICU--most of which is genuinely as unfunny as it gets--turns out to be funny in a way a Nazi Puppet Show would be funny, which is to say, not funny at all. Largely inappropriate satire, maybe, but not truly "ha ha" funny (unless you're talking Hogan's Heroes. I mean, what's not to like about kitschy inappropriately-themed 1960's comedies, I ask you?)
So, any way, what I'm saying is that I'm Still Working Stuff Out, and Having Issues, so what you're really getting is this hamfisted version of what I'm going through, and it's not really very accurate.
Okay, pointless preamble done.
So, what's it like to be a new ICU nurse?
I think my first, honest and uncensored comment about my new job is "ICU nursing is hard." The follow up comment is, "And no one gives a shit." Sure, we get more respect from our peers and docs, but honestly, at the point you're taking care of brain dead people or people for whom recovery means "we might at some time put a less invasive device in your body in order to continue mechanically ventilating you, but your prognosis essentially remains pretty crappy at best"--who the hell cares?
My days are now spent trying to remember which way to turn eight hundred stopcocks attached to various life-support devices so that I don't inadvertently kill someone by administering a dose of the wrong vasoactive medication, or introducing an air embolism, or haveingthem bleed out, or any one of about five thousand new ICU-specific things I now have the legal capacity to be sued for in a court of law. It's fun times, I'll tell you! In fact, I'm writing a new screenplay for a new ICU nursing themed soap, "As the Stopcock Turns."
Sure, I like the new challenges ("Let's try to keep this poor person hovering between life and death pretty much indeterminately, not because it's the right thing to do, but because it's possible! And look at all the pointless numbers and data we can generate in doing so! Generating numbers in the name of patient care can't ever be pointless, can it?") And the newfound job "status" is swell! It's like I woke up, and the worst bosses of my career converged into one fire-breathing hell demon cackling maliciously, as per Mr. Burns: "You've been promoted to Head Kappo--sure, you're just as disposable as you were before, but now you have even more latitude to brutalize severely incapacitated people pointlessly on official orders before we send you both to your untimtely deaths. Good day!")
On the whole, I'll rather be looking forward to the day when I return to Grumpy Old People World (okay, so Vented, Sedated Grumpy Old People status post coronary artery bypass) because heart surgery, is at least usually, you know, a planned surgery, and I'm finding out there's really no such thing as elective "trauma."
So really, part of what I'm telling you is that taking care of people who resemble Hamburger Helper wasn't really what I signed up for, mentally. In my deepest professional heart of hearts, I signed up for Grandpa Joe Needs His Heart Valves Replaced. Well, He Really Doesn't, But Look, We Just Did it Anyway, Neat, Huh?
And if Grandpa Joe doesn't make it, or develops post-op complications, well, we kind of expected that, because Grandpa Joe had a few years of Methuselah. We weren't expecting much.
I think in nursing, it really all boils down to which kind of futility of care you can wrap your mind around being a willing participant.
Tuesday, March 04, 2008
All your bedalarms are belong to us.
In a brief statement last night, senior officials at Hospital of Lost Causes, nestled in its home town of Some Poor Shithole, America, revealed their "Every Patient Left Behind" campaign--a facet of their 5 Million Deaths and Counting JCAHO approved marketing scheme--to increase morbidity and mortality in their elderly patient population, and streamline what they call "door-to-morgue" time.
"Basically, what we were finding is that patients have a one thousand fold risk of death or disfigurement by complication if admitted under any number of our substandard services, but that that risk dramatically increased when patients underwent coronary angiogram under my care," said Dr. PoPo Schneiderfrast, one time winner of the Douchebag Dildo Award and hospital director of the newly established MOR-ICU. The MOR-ICU is modeled after the assumption that since patient decompensation and eventual expiration occurs so frequently and disturbingly quickly under Schneiderfrast's supervision, a lesson or two in patient mismanagement could be learned from what Hospital of Lost Causes employees jokingly refer to as their Angel of Death.
Schneiderfraust further explains the "MOR-ICU" concept: "We also found that we were really spending more resources on post-mortem care, and felt that since so much of our funding goes to keeping our patient-death lawsuits out of the press, we'd do just about anything to cover up our sloppy shit-for-care in any way possible before an error is even committed, much less discovered. Also, the MOR-ICU protocol streamlines the time, money and energy it takes to get a patient from the ambulance bay doors to the morgue (thus the moniker "M[orgue]-ICU) in just under 12 hours. I think it benefits everybody, from our overworked risk management team to the bedside nurse."
Will good nursing care be under-evaluated in this new plan? Fear not, says Director of Corpse Care Services, and co-manager of the TRY-CU and BUNK-U, Alesio Bitchtits. "It's so much easier to manipulate and punish nurses now that we have this new "Every patient left behind" campaign. I'm really delighted by the new and manifold ways it's now possible to implicate nursing in just about every patient death hospital wide, no matter who or what the real culprit. I'm just thrilled." Bitchtits further says that the program involves a "rigorous application of root-cause analysis, and due to the new, executive-approved algorithm, virtually every patient death now involves some component of nursing care, whereas under the older hospital policies, there was always a small margin of doubt as to whether or not the nurse named in the affadavit was really ever an employee of Hospital of Lost Causes at any time."
Boasts Bitchtits, "Our nurses are really, really good at writing death notes. We have some of the best post-mortem documentation in the country."
RN Clinical Nurse Specialist Theresa Lotsaspaghetti says she's working hard on a newly modified BRA [Breathe, Rest, Ambulate] protocol for recently deceased patients. Her new brain-child, LAZARUS (Let's Ambulate Zombies And Resucitate Ugly Saggies) is a novel way of approaching the challenges inherent in preventing hemodynamic stasis in patient's suffering from what she calls "a modified organic state." Says Lotsaspaghetti, "Of course it's challenging to get dead people to walk around, but if Jesus did it, so can we."
Risk management lawyers for Hospital of Lost Causes were not immediately reached by phone, and no one was answering the phones at any of the nursing stations hospital-wide.
"Basically, what we were finding is that patients have a one thousand fold risk of death or disfigurement by complication if admitted under any number of our substandard services, but that that risk dramatically increased when patients underwent coronary angiogram under my care," said Dr. PoPo Schneiderfrast, one time winner of the Douchebag Dildo Award and hospital director of the newly established MOR-ICU. The MOR-ICU is modeled after the assumption that since patient decompensation and eventual expiration occurs so frequently and disturbingly quickly under Schneiderfrast's supervision, a lesson or two in patient mismanagement could be learned from what Hospital of Lost Causes employees jokingly refer to as their Angel of Death.
Schneiderfraust further explains the "MOR-ICU" concept: "We also found that we were really spending more resources on post-mortem care, and felt that since so much of our funding goes to keeping our patient-death lawsuits out of the press, we'd do just about anything to cover up our sloppy shit-for-care in any way possible before an error is even committed, much less discovered. Also, the MOR-ICU protocol streamlines the time, money and energy it takes to get a patient from the ambulance bay doors to the morgue (thus the moniker "M[orgue]-ICU) in just under 12 hours. I think it benefits everybody, from our overworked risk management team to the bedside nurse."
Will good nursing care be under-evaluated in this new plan? Fear not, says Director of Corpse Care Services, and co-manager of the TRY-CU and BUNK-U, Alesio Bitchtits. "It's so much easier to manipulate and punish nurses now that we have this new "Every patient left behind" campaign. I'm really delighted by the new and manifold ways it's now possible to implicate nursing in just about every patient death hospital wide, no matter who or what the real culprit. I'm just thrilled." Bitchtits further says that the program involves a "rigorous application of root-cause analysis, and due to the new, executive-approved algorithm, virtually every patient death now involves some component of nursing care, whereas under the older hospital policies, there was always a small margin of doubt as to whether or not the nurse named in the affadavit was really ever an employee of Hospital of Lost Causes at any time."
Boasts Bitchtits, "Our nurses are really, really good at writing death notes. We have some of the best post-mortem documentation in the country."
RN Clinical Nurse Specialist Theresa Lotsaspaghetti says she's working hard on a newly modified BRA [Breathe, Rest, Ambulate] protocol for recently deceased patients. Her new brain-child, LAZARUS (Let's Ambulate Zombies And Resucitate Ugly Saggies) is a novel way of approaching the challenges inherent in preventing hemodynamic stasis in patient's suffering from what she calls "a modified organic state." Says Lotsaspaghetti, "Of course it's challenging to get dead people to walk around, but if Jesus did it, so can we."
Risk management lawyers for Hospital of Lost Causes were not immediately reached by phone, and no one was answering the phones at any of the nursing stations hospital-wide.
Rabelais a day... keeps the lawsuits at bay.
Bear with me while I share some of my off-the-cuff hospital humor in the form of wicked satire.
Promotional Flyer for the Newly opened BUNK-U floor at our favorite hospital: Hospital of Holy Terrors!
Come join the latest in our innovational new approach to substandard care!
We here at Hospital of Lost Causes truly believe that our commitment to the worst possible outcomes for our patients is of paramount concern. To that end, on the heels of our wildly unsuccessful venture in mismanaging and misappropriating resources and finances, namely, the TRY-CU, our team of incompetent and lazy motherfuckers in upper management have developed the BUNK-U.
Says Chief Head Giver Phoot Puut Evans, "We knew that our sentinel events and near misses was usurping that of hospitals in war torn areas like the Gaza Strip, and we decided to capitalize on that. Knowing our nurses are amongst the most beleaguered, down-trodden, and easily suspectible to brain-washing, we implemented a truly atrocious yet unique plan to set them up to fail in yet another egregious fashion. By creating the BUNK-U, we believe our hospital deaths related to falls and accidental strangulations will increase by at least 500%, a margin of error that would impress even Satan Himself."
The BUNK-U, Hospital of Lost Causes "new" unit ("And by "new," we mean we had to kick out a colony of resident rats in the basement kitchens to make room for it," quips Project Director Boscoe "Dirty Balls" Boballino, is a 91 or maybe 92 bed unit that features hospital beds stacked two or three high. The goal is to "economize on space, safety, and increase the amount of unnecessary work and patient deaths" according to a confidential memo.
Chief Executioner of Operations, Janky Cracka Fool, gave this canned and completely insincere statement about the new plan: "We here at Hospital of Lost Causes are really proud of our bizarre and notorious reputation for completely ridiculous and frankly, atrocious levels of hazardous, toxic, and unsafe practice and policy, and I think the BUNK-U epitomizes what we're all about."
Credited with the idea for BUNK-U, and five time winner of the Seymour Koffins Award (Hospital of Lost Causes' dubiously prestigious nursing award which replaced the Florence Award in 2005) is The Nurse Formerly Known as Soviet Reject Tech. In halting English, Ms. Soviet Reject states somewhat incomprehensibly, "For my RN III project, I take look at amount of surgilube and correlated that to fall risk angel sign. Then, I come up with BUNK-U idea, which work very well in my home town in Siberia. Everybody now send me death threat! I feel so lucky; it's just like being back in Victory Retraining Camp in my homeland."
One nurse, who spoke on the condition of anonymity and appeared to be in critical but stable condition herself, merely said cryptically, "We are Legion!" Other nurses around the unit wandered aimlessly about with a tell-tale " thorazine shuffle." Although they had patient assignments on multiple floors, these nurses, who appeared to be on suicide watch themselves and often were chained together in groups by the ankle,merely gave furtive looks of sheer terror when approached by our reporters, and refused to comment further than repeating, sycophantically, either the hospital's mission statement or the meaning of the R.A.C.E. acronym. Nurses seemed to have an obsessive compulsive tic, checking bed alarms every five minutes or so. In fact, one nurse was found to be totally preoccupied with her seventeen patients' bed alarms, and seemed only to be able to repeat the phrase, "All your bedalarms are belong to us."
Teressa Lotsaspaghetti, former neurological disease nurse and newly appointed Clinical Nurse Specialist for the BUNK-U explains that "I did a study that showed the more you ambulate and check bed alarms, the better and more productive a nurse you are. Even though these nurses have been working continuous shifts for weeks, we feel that the constant movement not only prevents thrombus formation, but also promotes a feeling of communist solidarity so important to good work ethic, and consequently, excellent care for our patients."
When asked where Hospital of Lost Causes saw their BUNK-U vision going in the future, Alesio Bitchtits, newly elected manager of the BUNK-U said, "We're not sure what the Final Solution to the Healthcare Problem is going to be, but I believe we're working hard on honing our skills of eternal damnation, and I think we have an exciting purgatorial future ahead of us."
Patients were not immediately available for comment on the new BUNK-U arrangement, officials said.
Promotional Flyer for the Newly opened BUNK-U floor at our favorite hospital: Hospital of Holy Terrors!
Come join the latest in our innovational new approach to substandard care!
We here at Hospital of Lost Causes truly believe that our commitment to the worst possible outcomes for our patients is of paramount concern. To that end, on the heels of our wildly unsuccessful venture in mismanaging and misappropriating resources and finances, namely, the TRY-CU, our team of incompetent and lazy motherfuckers in upper management have developed the BUNK-U.
Says Chief Head Giver Phoot Puut Evans, "We knew that our sentinel events and near misses was usurping that of hospitals in war torn areas like the Gaza Strip, and we decided to capitalize on that. Knowing our nurses are amongst the most beleaguered, down-trodden, and easily suspectible to brain-washing, we implemented a truly atrocious yet unique plan to set them up to fail in yet another egregious fashion. By creating the BUNK-U, we believe our hospital deaths related to falls and accidental strangulations will increase by at least 500%, a margin of error that would impress even Satan Himself."
The BUNK-U, Hospital of Lost Causes "new" unit ("And by "new," we mean we had to kick out a colony of resident rats in the basement kitchens to make room for it," quips Project Director Boscoe "Dirty Balls" Boballino, is a 91 or maybe 92 bed unit that features hospital beds stacked two or three high. The goal is to "economize on space, safety, and increase the amount of unnecessary work and patient deaths" according to a confidential memo.
Chief Executioner of Operations, Janky Cracka Fool, gave this canned and completely insincere statement about the new plan: "We here at Hospital of Lost Causes are really proud of our bizarre and notorious reputation for completely ridiculous and frankly, atrocious levels of hazardous, toxic, and unsafe practice and policy, and I think the BUNK-U epitomizes what we're all about."
Credited with the idea for BUNK-U, and five time winner of the Seymour Koffins Award (Hospital of Lost Causes' dubiously prestigious nursing award which replaced the Florence Award in 2005) is The Nurse Formerly Known as Soviet Reject Tech. In halting English, Ms. Soviet Reject states somewhat incomprehensibly, "For my RN III project, I take look at amount of surgilube and correlated that to fall risk angel sign. Then, I come up with BUNK-U idea, which work very well in my home town in Siberia. Everybody now send me death threat! I feel so lucky; it's just like being back in Victory Retraining Camp in my homeland."
One nurse, who spoke on the condition of anonymity and appeared to be in critical but stable condition herself, merely said cryptically, "We are Legion!" Other nurses around the unit wandered aimlessly about with a tell-tale " thorazine shuffle." Although they had patient assignments on multiple floors, these nurses, who appeared to be on suicide watch themselves and often were chained together in groups by the ankle,merely gave furtive looks of sheer terror when approached by our reporters, and refused to comment further than repeating, sycophantically, either the hospital's mission statement or the meaning of the R.A.C.E. acronym. Nurses seemed to have an obsessive compulsive tic, checking bed alarms every five minutes or so. In fact, one nurse was found to be totally preoccupied with her seventeen patients' bed alarms, and seemed only to be able to repeat the phrase, "All your bedalarms are belong to us."
Teressa Lotsaspaghetti, former neurological disease nurse and newly appointed Clinical Nurse Specialist for the BUNK-U explains that "I did a study that showed the more you ambulate and check bed alarms, the better and more productive a nurse you are. Even though these nurses have been working continuous shifts for weeks, we feel that the constant movement not only prevents thrombus formation, but also promotes a feeling of communist solidarity so important to good work ethic, and consequently, excellent care for our patients."
When asked where Hospital of Lost Causes saw their BUNK-U vision going in the future, Alesio Bitchtits, newly elected manager of the BUNK-U said, "We're not sure what the Final Solution to the Healthcare Problem is going to be, but I believe we're working hard on honing our skills of eternal damnation, and I think we have an exciting purgatorial future ahead of us."
Patients were not immediately available for comment on the new BUNK-U arrangement, officials said.
Monday, March 03, 2008
as seen on t.v.
GSW victim:
[wheeled up on guerney; lying in blood soaked sheets]
So, have you been watching t.v.?
NURSE:
No, should I be?
GSW victim:
Can we turn on the t.v.?
NURSE:
[redressing chest tube incision, distracted by, you know, tending to the gun shot wound]
Why?
GSW victim:
I wanna see if I'm on the news yet.
NURSE:
[chuckling good naturedly]
No, sir, I don't think you've been on the news yet.
GSW victim:
[apparently extremely disappointed]
Damn. That sucks.
NURSE
[thinks to self]
As opposed to the bullet that pierced one of your major organs?
[wheeled up on guerney; lying in blood soaked sheets]
So, have you been watching t.v.?
NURSE:
No, should I be?
GSW victim:
Can we turn on the t.v.?
NURSE:
[redressing chest tube incision, distracted by, you know, tending to the gun shot wound]
Why?
GSW victim:
I wanna see if I'm on the news yet.
NURSE:
[chuckling good naturedly]
No, sir, I don't think you've been on the news yet.
GSW victim:
[apparently extremely disappointed]
Damn. That sucks.
NURSE
[thinks to self]
As opposed to the bullet that pierced one of your major organs?
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