Saturday, August 12, 2017

Meaningful Abuse


This story ties in a bit with the poem that follows, because it addresses subtle monetary pressures on our business of care and healing. However, it starts out initially, with some of the usual Nursing nonsense we must put up with.

What bothered me this week?
Now let me think,
When our EMR document
Went on the blink,
Charting froze up
Doctors orders went down,
The Gorilla in the corner 
Sat there with a frown.

Why does it bother me?
Well, it always seems to happen, 
When Billy Bob is bleeding
And then he is crappen,
Which he does with a wiggle
A grunt and a push,
And now the blood and the crap
Flow beneath his tush. 

This type of occurrence
Generates a lot of charting,
Describing the features
Of body fluids departing,
Old boy Billy Bob
Whose daughter, does state,
"When we go to the restaurant
He's a heckuva date".

Back to my story
Regarding the EMR crash,
'Tis a national dilemma
That comes on in a flash,
The system goes down
With no warning or threat,
And leaves us up to our elbows
In excrement and sweat.

Yet, we forge on
Relying on Cerner,
Epic and Allscripts
Athena Health and Turner,
Each worth a billion
Or two in the bank,
While Meaningful Use bucks
Are filling the tank.


https://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives


http://www.medsphere.com/resources/news/news-releases/3402-kern-medical-center-awarded-federal-funds-for-meaningful-use-of

Friday, August 11, 2017

CEO's Making Bank


According to Forbes, WSJ and other monetary reporting entities, if you want to be rich, be a hospital CEO. Here is a fun article that describes how our favorite CEO's are compensated, by each patient day in the hospital.

How much does your hospital CEO
Earn for each hospital client?
If everybody knew
Would you remain so compliant?
Knowing how much your daily cost
Goes directly into his pocket,
You might start to dream about
Hammers, nails and an electric socket.

Read this short article
Yes, why not be informed,
On cold winter nights
It is good to be warmed,
By wild crazy thoughts
and dreams of corrections,
Why dudes get paid so much
And all of their collections.

https://www.axios.com/stay-in-a-hospital-pay-the-ceo-56-a-night-2242870721.html

Monday, July 24, 2017

Weight a Minute


A two hour battle post-anesthesia, takes a lot out of me these days. Thirty years ago, no sweat; I was ready to take on Bluto, for 3 more rounds. Except, well there was the incident when Father Time kicked me in the head and caused a concussion.
Now, about last Friday............



When Bennie the Bruiser
Awoke from his surgery,
He immediately acted out
With assault and perjury,
Whereas, before
He was a mellow, young guy,
Post-anesthesia
He’s Godzilla, on the fly.


It wouldn't be so bad
But he's barely breathing,
Then suddenly gasping
Swearing and seething,
Plus, Bennie is big
Topping two-forty pounds,
If I was Mike Tyson
We might go seven rounds.


Oxygen saturation
Just seventy-five,
Gasping and wheezing
When his parents arrive,
To stand by the bedside
Try to settle him down,
Yep, Bennie the Bruiser
Is a meth-user clown.


Little by little
Maybe he's improving,
Gets some gas up his nose
He's resting, not moving,
Now, it's my turn to bother
Removing Femoral sheaths,
Oops, awakened the demon
Now I’m dodging his teeth.


Four people at the bedside
Trying to control,
As this monster of ceremonies
Takes us for a roll,
Bucking like a bronco
While I prevent bleeding,
Thinking dangerous thoughts
Regarding children and breeding.


At the hour marker
I was proclaimed the victor,
An epic battle it was
With a Boa Constrictor,
Yea, I expect a statue
To be erected in my name,
Constantine the Conqueror
Will just add to my fame


Sunday, July 02, 2017

Vitamin Scarapy


Sometimes when the patient talks, I just stand there and wonder what the heck have they been smoking? Astounding stories of non-compliance, and the predictable outcomes, that prove a total lack of common sense.


I chose the vitamin cure
For my viral cardiomyopathy,
According to Betty Lou
Guaranteed by some expert of psychopathy.

See, those pills and potions
Prescribed by the Cardiologist back then,
Made me feel so lousy
I stopped taking them when,
I heard about the vitamins
Promoted by Chiropractor Jerry,
Plus, I read about it on the internet
Carnitine, and dust from a fairy.

Sure enough, I got better
My ejection fraction came up to fifty,
I rolled along on my merry way
Never saw another doctor, Tom Swifty,
Until just last week
I became short of breath,
Tried Flonase for a week
Until I began to feel like death,
Finally went to the hospital
Emergency room,
Ejection fraction 30 percent
3+  to 4+ Mitral Regurge
Vitamin therapy, badda-boom!

At age 64
She did luck out,
Normal coronary arteries,
That's worth a shout,
While husband/daddy/child
Sitting at the bedside with the Yorky dog,
Seemed to be in support of all this nonsense
Like a frog on a log.

She said, she likes the Cardiologist
(as long she approves what he's doing),
I wonder if he knows about the vitamins
And whatever she's smoking and chewing,
Because, I wouldn't cover any bets
On her likelihood, of compliance,
After all, she made up her own mind
In stubborn anti-medical defiance.

I asked about her career
She claimed she was a Nutritional Coach,
Good heavens, I wonder what she has been teaching?
Not likely, the scientific approach,
Yep, those vitamins for Cardiomyopathy
Read about them on WebMed dot tv,
Where you can trust a Hollywood star
To say what's best for you and me.


Someone Dies


Here's a pointer; know where your IV lines are going, know if that vein is functional and patent, and know exactly what drug is in your hand and in that line.............before you add anything new. When you have the time, I.D. those lines.

When you’re reaching for the Lidocaine
The Epi or the Atropine,
The Propane or the Methane
Or maybe even Gasoline,
The Wheaties or the Captain Crunch
The chocolate cupcakes for your lunch.

Be sure you check your vital signs
And ensure the patency of lines,
Because in the midst of great surprise
If you’re not careful, someone dies.

Frisky Fireman


A cure for one kind of depression; or, where there's smoke, there might be a fireman to the rescue.

Just Call 9-1-1

I’m alive, I can’t believe it
I had given up to die,
I’d arranged to kick the frame today
No one cared to ask me why,
I have lived a long eventful life
But foresaw a painful death,
Then I was boldly interrupted
When I took my final breath.

A local family member
Discovered I was prone,
He heard me fall upon the floor
And thought he heard me moan,
In truth, I was rejoicing
It was time for me to run,
Well, then that sucker saved me
He dialed 9-1-1.

A gorgeous hunk of Fireman
Drove right up to my door,
Assessed the situation
And figured he could score,
Attached me to a monitor
Announcing an arrest,
Resuscitated me, Oh Lord
With massage upon my breast.

Aroused I was, and more alive
Than I had been in years,
I clutched that fellow to my chest
And nibbled on his ears,
He had a fancy uniform
That I quickly slashed and ripped,
It was barely thirty seconds
Till that Fireman was stripped.

My cardiac arrest
Was instantly converted,
When the fellow aimed his hose at me
Cut loose and really squirted,
I bounded to my feet
Feeling totally renewed,
I’m going to tell my aging lady friends
That they should all get screwed.

Well, I’ve changed my way of thinking
I’m no longer so depressed,
When I need a little excitement
At first, I get undressed,
Then, with a helpless cry
I dial 9-1-1,
My Fireman comes quickly
And boy, we have some fun.

Contagious


I just want a kiss, that's all. That's not asking too much.

You might say I’m isolationist
I have chickenpox and measles,
I keep bubonic squirrels as pets
And rabid wild weasels,
So why not snuggle up to me
And see if you’re courageous,
I just want a little kiss, please
I doubt if I’m contagious.

Thursday, June 29, 2017

Literal


Sometimes I really take things literally.........

Smokefree vs. Free Smoke

Message on display
At the entrance of our Clinic,
Prompted reflection
(I'm a natural born cynic).

Firearms prohibited
Latex in use,
Smoke free environment;
Weird terms of abuse.

I mean, who can argue
About smoking, if it's free,
A heck of an invitation
At a hospital, whoopee!,
And regarding the latex
That's a turn-on for some folks,
A lot of smirking and giggling
With off-color jokes.

Firearms prohibited
That's easy to understand,
If your arm is on fire
I shouldn't shake your hand,
While considering the risk
Of spreading that fire,
In the presence of Oxygen
It could ruin my attire.

What kind of a hospital
Offers these kind of features?
I guess I'm truly blessed
To be a member of these creatures,
If you're possibly interested
Please submit an application,
Smoking is free, no burning arms
Latex in use.....it's a heckuva vacation!



Sunday, June 25, 2017

A Mid Year Resolution


Ok, we just had the Summer Solstice, so why not an old resolution?


It is the week after Christmas
And not much has changed,
The patient’s are still alive
Though, the staff is deranged,
The Care Plans are filed
In the garbage, with care,
Because we finally realized
They work best in there,
The walls have been stripped
Of their bright coloration,
Returned to the original
Theme of sedation,
The nurses are groggy
Their hangovers linger,
The doctors all look
Like they’ve been through the ringer.

Now, the nurses get hungry
And search for nutrition,
Only to discover
Last weeks edition,
Of half eaten cookies
Green, white and red,
A few dared to eat them
And keeled over dead,
Too bad, said the clerk
Who handles our staffing,
You won’t get replacements
Then she hung up, still laughing.

All  of a sudden
There arose such a clatter,
As all of the dentures
Began to chatter,
Some silver, some gold
Some, even acrylic,
They chattered in harmony
A scene quite idyllic,
Because the ghost of this Christmas
Can’t exit our floor,
We all ate so much
He’s stuck in the door.

So what the Hell, we’ll be haunted
Till Easter, I’m sure,
Our floor will be famous
For a new kind of cure,
We’ll scare the old devil
Right out of their hearts,
And the ones we can’t cure
We’ll sell them new parts.

A New Year’s resolution
“Let Us Optimize Your Health”,
Be it cure or consumption
So we can maximize our wealth!

Tumbling Dominoes


One could keep reincarnating every 25 years as an ICU Nurse, and find the same old problems. We unleash new names for the same disorders, apply similar drugs, wring our hands, and have the same outcomes. Sepsis, Sudden Cardiac Death, 1st MI.........at least 50% mortality. Folks, when the Grim Reaper comes for you, we're not much help. But if YOU are willing to help....go for it.

She has been here several weeks
And had every kind of tube,
Can you believe, she was admitted
For just a Jiffy Lube,
Her heart was sort of sluggish
And her blood was quite anemic,
And so, like tumbling dominoes
Her brain became ischemic,
Combative and demonic
Obesity berserk,
She started busting up the place
And nearly killed the Clerk.

She was dosed with Midazolam
MS and Ativan,
Enough to kill an elephant
It knocked her on her can,
But side effects are side effects
And some can lead to death,
We finally had to silence her
But we took away her breath,
She earned the ventilator
The prize behind, Door Number Three,
It includes a year of tubing
And a Therapist for free.

Her respiratory failure
Brought on Shock and R-D-S,
Why, in just a couple hours
She became a total mess,
Reversible?, it’s possible
But, that’s not the likely course,
We can treat her up the yin yang
But can’t replace her life force,

The woman was a time-bomb
Just waiting to explode,
She had multi-system plug up
From a life on lipid road,
Her triglycerides set records
That will stand for many moons,
She had a steady diet
Of booze and macaroons,
Her husband was no better
He paid the grocery bill,
You couldn’t make them understand
This method of life would kill.

Now, lying here before us
Is a body, life supported,
And we’re rushing around like maniacs
Because her heart beat just aborted,
Thus, it seems a little pointless
To apply our super science,
To a person who spent years
In stubborn, health defiance!

Let the dying die


I wrote this, at least 25 years ago; and the issues and dilemma's of dying are still the same. We do make progress, but death must happen.

Time to Give In

What more can we do for this man
Despite all of our science, he’s dying,
We have done all that we possibly can
His family, so anxious and crying,
But alas, the time comes
When it’s time to give in,
To continue the treatment
Would be a merciless sin,
Prolonging the suffering
With no hope of reprieve;
Let the dead go their ways
So the living can grieve.

Monday, June 19, 2017

The Virtues of Floating


Here is a classic from 20+ years ago. Look, must nurses don't want to float off to another unit. They suffer anxiety regarding their skill set, and feel out of place, and worry about what the folks in that other unit might say about them.

Fortunately, since 2012, I have not been required to float.

I like my job now, well enough
But mind you I’m not gloating,
It has a dirty side to it
The multi-unit floating,
By and large the frequency
Is few and far between
But when it’s time to do your stint
It can be a messy thing.

Now, consider this my friend
You’re floated to Emergency,
The last place that you want to be
If suffering from urgency,
The place is non-stop madness
All bloody night and day,
Those nurses must be crazy
Because they don’t get combat pay.

Or maybe you’re more fortunate
And floated down to Burn,
You’ve got some guy with roasted flesh
And you’re afraid to turn,
Him over in the bed, in case
His skin grafts crack or flake,
Because you know that you’ll be crucified
Then roasted at a fiery stake.

Neuro ICU is like
A foreign land to me,
A lot of spinal action
And labile ICP,
The unsedated wild men
Are screaming out in pain,
They were motorcycle maniacs
And now have scrambled brains.

Is floating any better
In the Medical ICU?
Where microorganisms
Stick to you like glue,
Where charcoal spewing overdoses
Ruin all your clothes,
And G.I. bleeding alters
The function of your nose.

The Surgical Intensive Care
Is different in some respect,
The doctors are fanatics
About the drainage you collect,
Specific gravitation
And countless pus filled drains,
Provides ample entertainment
For all their busy brains.

In CCU it’s different
You must take a vow of silence,
The nurses aren’t restrained
But barely stoop to violence,
The patient are well mannered
But sometimes give you crap,
Just charge the paddles to 100
Then, defibrillate their lap.

All in all, the general feeling
To float, I’d rather not,
To save a lot of misery
Why not have me shot,
Or hang me by my fingernails
And whip me with barbed wire,
You’d better find another fool
I’d prefer to walk on fire.

An Apple a Day


I have unearthed a trove of ancient writings..........

An apple a day
Keeps the Doctor away,
But if you’re always pissed
Just see a Psychiatrist,
If your insides hurt in earnest
I suggest a good Internist,
And if your ankle had a twist
Go question a Podiatrist.

If you see your brain emergin’
Find a capable Neurosurgeon,
If your birth control was in omission
You’ll need to find an Obstetrician,
Should your bladder leak, oh, golly gee
You ought to see Urology,
If your busted femur needs a rod
You’ll need to visit an Orthopod,
And if you suffer from seismology
You better go to Radiology.
_ _ _ _ _ _ _

To Buy a Cure

I drank a lot of alcohol
And blew a lot of smoke,
My liver said, the hell with this
And my lungs began to choke,
My heart is doing double time
And my renal function is poor,
Oh, if I had a billion bucks
I would try to buy a cure.

My bones look like Swiss cheese
That I used to eat on rye,
The ultraviolet rays I worshiped
Wrecked my one good eye,
My libido was revoked
And my sex drive was recalled,
Because, when I raced my engine
It overheated, then it stalled.

The flukes in my intestine
Are thirty meters long,
While a host of other viruses
All sing a little song,
Hail, hail the bugs are here
Crawling in my belly
Coming out my ear,
Hail, hail this guy is dead
What the Hell do we care
As long as we’ve been fed.

And thus, my body fails me
I can feel the hangman’s noose,
I wonder if there is a connection
To this lifetime of abuse.
_ _ _ _ _ _ _ _

Jamming on the Joules

She died, she died
There’s no denying it
We tried,
To save her broken body
And fix her busted heart,
We tried a lot of crazy things
But couldn’t make it start.

We gave her Digitalis
Some Quinidine and more,
Dobutamine and Dopamine
And even Inocor,
A trial run of Nipride
To reduce her afterload,
But she bottomed out her pressure
On the rollercoaster road.

She had total akinesis
With a low ejection fraction,
And to complicate these matters
Had arrhythmia distractions,
At first we gave some Lido
Then Pronestyl and the joules,
She was jamming on 360
As if to say, You fools,
For every problem that you treat
I present another three,
Because the Reaper is standing at the door
He has come to set me free.
_ _ _ _ _ _ _

Humble Student

Talking about conduction
Regarding the upper and the lower,
The former is the faster
And the latter is the slower,
See, sometimes there is a stimulus
Lost in its own travels,
And before you get a chance to breathe
That impulse just unravels.

It can follow any pathway
If the guidance system is shot,
If you fail to snare that sucker
The rhythm will be naught,
So be sure, oh, humble student
To heed the wise instructor,
Because a heart without a rhythm
Is like a train with no conductor.
_ _ _ _ _ _ _ _ _ _ _

Serious Impactions

Oh, Mr. Jones you fail to see
The error of your actions,
A diet low in fiber leads
To serious impactions,
On top of that I’ve noticed
You don’t drink enough to spit,
Now you find you can’t eliminate
You’re so full of it.

There is but one consensus
Your innards must be reamed,
We’ve got a new technique
We’re gonna have you steamed,
It involves a high tech nozzle
Inserted in your gut,
Then we tape a hefty garbage bag
Securely to your butt,
The countdown then commences
As we hoof it down the road,
We have to go some distance
Just in case you might explode.

You know, we’re not to sure
About your chances of survival,
But the competition is fierce
With a scientific rival,
Who is working on a similar
Device to clear the crap,
It’s a vibratory mechanism
Placed upon your lap,
It bombards the microvilli
With microsonic hits,
It has a lifetime warranty
And guarantees the shits.

We apologize, posthumously
We didn’t clear your load,
Unfortunately, Mr. Jones
Indeed, you did explode,
Rest assured, you are remembered
For serving all mankind,
And all of those that follow you
Who find they’re in a bind.
_ _ _ _ _ _ _ _ _ _ _ __ ___

Phaht

Phaht, is but a word
That conjures up many visions,
It confronts a lot of people
With everyday decisions,
Phaht, a simple concept
That shares a lot of weight,
It can generate emotions
That stretch from love to hate.

Phaht, an easy word
That requires little breath,
Yet is powerful enough
To influence life or death.

Phaht, a weighty subject
No matter what your view,
Be cautious when you speak of it
Some day it might be you.
__ __ __ __ _ _ _ _ _ _ _

Niacinamide

Did you ever take
Too much niacinamide,
In minutes you discover
You are scratching off your hide,
It somehow makes you itch
On a scale that's microscopic,
It gets around quite quickly
In the system circulopic,
Blessedly its half-life
Is fifteen minutes short,
If not, I would worry
That the flesh would just abort.
_ _ _ _ _ _ _