Wednesday, February 13, 2019

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!

Sunday, February 10, 2019

Cancer Cardiology

As has been my custom for many years, I attend a community Medical CME, get inspired and write some rhymer silliness. Well, I need to keep my own CE's up, and I attended a half day Oncology Update conference just yesterday. Here's what happened; 3 minor moments in time.

Slap a tumor
Is what he said,
Spank a tumor
To make it dead.

Profiling mutations
Sequencing genes,
'Tis incredibly confusing
What it all means.
_ _ _ _ _ _ _ _

Precision Medicine
Who came up with that?
Sounds like "evidence based medicine"
Already in the hat,
Every ten years
We need new terminology,
Describing the same old ideas
It's a type of psychology,
Revered by intellectuals
Providing fodder for conversation,
While statistically the outcomes
Undergo inflation.
__ __ ___ _ __ _

He's a big word man
The words roll off his tongue
Convolutedly idyllic,
Loves to hear himself talk
Hoarding the time,
Thank god I found a way
To make it all rhyme.
_ _ _ _ _ _ 

Sunday, February 03, 2019

Editorial: A Catalyst for Learning

About a year prior to my retirement, Management indicated that it would be a good idea to put together a Unit based Nurse Practice Committee. Other nursing departments in the hospital already had something in place, and because it's trendy nationwide, we should do it too. The theory was good, but the possibility for real change, was deemed unlikely.........not something that Managers like to hear. The problem lies in the reluctance of Management to change their own status quo.

However, me and a couple other nurses that seem to actually care, were appointed to the group. There were the usual topics covered, which would similarly be discussed in general Staff Meetings, and subsequently proven unchangeable, because Management would not act upon our suggestions. Honestly, they did listen, but they are so entirely focused on budget and hours and running the most minimal staffing imaginable, then the things that really need to change, never will. Changing an entrenched egocentric culture, is almost impossible, until the players die or move on.

I have always cared about my skill and knowledge base, to perform at the peak of my ability. I have worked in places that try to promote amidst the staff, those same ideals. However, not all hospitals or nursing units, exhibit that kind of professional interest amidst their staff.

I wanted to engage all of the nurses in our Department, to come forward and define how and where they pursue and acquire, their ongoing professional (personal) education in respect to our Unit based specialties. I suspect that some nurses think that going to Skills Day once a year, and participating in "My Journey" and a few cheapo on-line CE's is adequate, but Lordy, that don't cut it!

Unfortunately, in a city that must have at least 5000 Registered Nurses, the typical CME activity, held at the Hilton or Hyatt, may have at the most, one hundred RN's attending. Sure, LIVE classes are not the only way to go, but to me it tells a story, regarding the lack of dedication for personal professional learning.

My thought was to create a survey, to hand out to all of the nurses in the department and pose the question: How Do You Stay Up to Date?

First off, I think this would be of value to the younger less-experienced nurses, and others who are transitioning into this unique Cardiac Diagnostic area. This could show them how the seasoned Nurses, manage to stay so well informed.

My idea was intentionally simple and generic, but designed to initiate a shared dialogue regarding how to improve the standard of Nursing care and knowledge base, in our particular territory.

Anyway, I'm off the books and did not get the opportunity to bring this to the table, but I think it has value. Thirty years ago, before the world was swamped with the constant stream of instant answers offered by our smartphones...............we nurses who truly wanted to become experts, sought out whatever kind of training, classes, books, master's and so on, and we were willing to pay out of pocket for it. We encouraged our work pals to go to classes as well, and then we talked about it, when we saw each other at work.

Ponder this, as you realize what the workplace looks like today, in almost any patient care area. There is a smartphone in almost every hand, by nearly every medical professional, and maybe 5% of them, are looking at something related to the job at hand.

The professional disconnect is abysmal; but I think a simple survey regarding how Nurses stay up to date, may initiate a conversation, and might possibly become a catalyst for learning.

Stretcher Bearer

These two first lines came to me in the period of lucid dreaming, just before I awakened.

Trial and error
Vials and terror,
Just the kinds of actions
That employ a stretcher-bearer.

Saturday, February 02, 2019

Fractional Shortening

That title has nothing to do with my cooking skills, alright? One thing I often kept on the fringes of my situational awareness, was the possibility and influence of silent ischemia, under physiological stress. Often, this is a sequelae of low ejection fraction; commonly, one begets the other. Anyway,
I do know, that this concept was not a part of everyone's patient assessment skills.

Your Ejection Fraction
Can rule the day,
Do let me explain
It's worth it, I say.

What is the E.F?
It has to do with your heart,
How much blood gets squeezed out
The contractional part,
At the maximum push
On the arterial side,
The Left Ventricle, I mean
How much blood takes a ride.

This cardiac output
How much ejects, every time,
Doesn't empty that chamber
A paradox crime,
Where one might assume
A full on ejection,
But that isn't the case
'Tis a means of protection.

I could describe
A hundred different factors,
With 99 arguments
And other detractors,
Opinions and guesses
Expertise and understanding,
Massive strata of data
Some weak, some commanding.

Still, we measure indices
We compare and predict,
EF influences outcomes
How the heart doth constrict,
The workload, the demand
Regarding MVO2,
Myocardial oxygenation
Just between me and you.

50 to 70 percent
Is the rule,
The range considered normal
As a comparison tool,
The lower it drifts
We wonder what disease,
Caused damage to the heart
Let’s discover it, please.

The lesser the measure
The greater the risk,
Cardiac performance
No longer is brisk,
A threat of sudden death
With a failing pump,
Silent ischemia
A Troponin bump.

Keep a wary eye
When low EF is known,
If you detect subtle changes
Get on the phone,
Have a word with the Doctor
Share your concerns,
Save a life today
And everyone learns.

Sunday, January 20, 2019

Lost Horizon

As I mentioned earlier (back in November), actually achieving the heralded "I'm Retired" battle-cry..............well folks, it ain't easy.............nor painless, as I'm still waiting for confirmation that my Open Enrollment for health benefits has been consummated.

I sent all the damn forms
It wasn't easy,
I'm ninety-nine percent confident
And one percent queasy,
Because chaos and entropy
Are cousins of a sort,
Something always gets screwed up
In any report.

Yes, logic and proportion
Tell a story so pure,
While factual data
Feels so safe and secure,
Yet, that's such a fallacy
Regarding any plan,
Where legions of Gods
Laugh at every single man.

That one-percent solution
Is no solution at all,
It seems that my benefits
Are in a perpetual stall.

Thursday, January 17, 2019

Two weeks P.R.

Yep, two weeks post-retirement. My stress-o-meter has gone from an 88.2, down to about 23. That's right, even everyday life has some ongoing stuff to deal with. But now, everyday is generally relaxed and it feels like this:

The stress is gone
I don't feel frantic,
I feel like I'm floating
In the south Atlantic,
All that chaos and drama
And the overly specific,
Now I'm a piece of coral
In the south Pacific.

Wednesday, January 09, 2019

No Pal Left Behind

Everywhere in all the realms of care; the Buddy System rules.
You figure out who you can trust during times of duress,
and you hold a torch for them, in their time of need.

So, I may be retired, but I remain willing to write the stories that scream to be heard.

Working Rough

I visited my working pals
Their story was the same,
Inadequate staffing
In the Recovery game.

The place that I worked
Had a split personality,
Prepping patients for procedures
Doesn't equate with fair reality,
For those persons assigned
In the Recovery Bay,
Where time and complications
Can take over the day.

The problem is endemic
There is a captain of this ship,
He shakes a lot of hands
Like a mescaline trip,
Smiles, laughs and rainbows
With cookies on Nurses day,
He's always willing to listen
Wiggle his hips and sashay.

Look, don't get me wrong
This hospital is not unique,
Probably ninety percent of them
Have the same party squeak,
Thus, it's really damned hard
To find the jewel in the muck,
When all the dollars and diamonds
Have somehow fallen off the truck.

Coffee can be too much

Coffee can be a purgative. It's so simple.

Drink too much coffee
And what will happen?
A lot of fartin'
And possibly some crappen.

A Week Later

You got it, there's still something stuck in my 17th wisdom tooth, and I can't get it out.
I realize that I'm just a late and jaded Baby Boomer. That's why I suffer all of my delusions. So, don't get excited by anything I write; just let it perc and mantle and simmer for a while.

Work Break

Billy Buckaroo
And Betty Lou Jones,
Those new hires in surgery
Keep using their phones,
We will give them a warning
And a reprimand too,
But, three strikes and you're out
Then goodbye, buckaroo.

During orientation
There was a thirty minute session,
Electronic communications
Definitions, and discretion,
Guidelines reviewed
Personal phone use, and more,
You may use them during your break
Not during work, that's the score.

Administration understands
Folks have become addicted,
To their electronic pacifier
It's easy to get conflicted,
Regarding one's attention
On critical matters, at hand,
Lives hang in the balance
Why don't you understand?!?

Man, our shifts are long
Eight to twelve hours,
Walking, wiping, lifting, standing
And other super powers,
About every ten minutes
My brain needs a rest,
You can't possibly expect me
To continue to do my best,
Without a short me-break
I gotta check on my peeps,
Uh oh, here comes the Supervisor
He gives me the creeps,
Always telling me to shut it down
Remember?, screen time is later,
Now I’m checking on Amazon
For a Boss Eliminator.

You see, with my kind of experience
I barely need to throw a thought,
My eidetic memory
Recalls everything that was taught,
As I cruised through school
I was the best, check my scores,
I barely need to stay attentive
With my usual Nursing chores.

Look, I have to check Facebook
And share all my pictures,
Hey, did I tell you about
That big whale, with all of his strictures,
Oh my Gawd, they were awful
Still, I got the grossest photo,
Wait, you don’t have an iPhone
Just a crappy little Moto?

Well, that’s how it is
Hospitals have to find the groove,
If you don’t like me using my phone
I will gladly move,
‘Cuz I know that Sister Euphemia
Across town, she don’t care,
They're just kidding in Orientation
And trying to give you a scare.