Sunday, April 15, 2007

Back in the early '90's, I made the acquaintance of a fine nurse and nationally recognized educator, named Deborah Tuggle, RN. I attended many of her classes, worked with her a few times at one of the local ICU's and was a contributor of some poems for one of her CCRN classes. I just stumbled over my drafts for those poems and thought I'd do a little
21st-century revising and revisiting. I will load up the whole pie in this entry, as it has been more than a couple weeks since I posted last.

SVT versus TFS

Is it aberration or ectopy
S.V.T. or T.F.S.?
Sometimes I get, so darned confused
I quit, with just a guess,
I get so doggone overwhelmed
I can't recall my name,
Does it really matter in the end
Or would the outcome be the same?
I swear I think my "idiot-factor"
Has increased, by more than double,
Ever since I took that class
From the famous Mrs. Tuggle.

Let's examine a scenario
To illustrate my point,
My shift is all but over
I'm about to leave the joint,
When abruptly, I'm assaulted
By alarms and lights galore,
My patients' heart has gone whacko
(Now I'll have to chart some more),
His rhythm is wide and ugly
So I race down to his room,
My tunnel vision activates
The flashing lights spell doom.

Is he conscious?
Is he dead?
(Is he even in the bed)?
Should I stop a sec and clock him
Or just go ahead and shock him?
No, no….hey, I'm a pro
I've taken Tuggle's course,
He's fine for now….I'll stop and think
My memory, I will force.

I'll check a few key leads
Before I treat this guy tonight,
Is it S.V.T. or T.F.S.
Or Wolff, Parkinson and White?
Does a delta wave announce itself
Or remain concealed and silent?
Is it simply an aberrancy
Or something else more violent?
Is the phenomena reentry
Are the P-waves retrograde?
Does the AV node dissociate
Or do P-waves simply fade?
Is the axis indeterminate
Is it normal, left or right?
Is V1 looking up or down
Is the R-wave broad or tight?
What else was I supposed to check
What else did teacher say?
My God, that woman drives me nuts
I don't care anyway!

There's just, too much to think about
It's too much to recall,
These silly EKG rules
Are just no fun at all!
You know, he looks a whole lot worse
Let's just forget the clues,
I think that I should shock him now
And end these rhythm blues!
So I hit him with some macrovolts
To turn his rate around,
His body jerked right off the bed
He moaned a frightful sound.

Despite his pain and suffering
His rhythm was reversed,
He was mad as hell I zapped him
And announced that I'd been cursed,
In the end, what only mattered
Did I fixed him or did I not?
I halted decompensation
Plus all my nerves are shot!
But was it V-Tach or SVT
Or was it really T.F.S.?
That Tuggle Frustration Syndrome
Is the cause of my distress!

p. hupp; 1991
rev. 2007

Advanced Certification Blues

It's a lot of stress and worry
A major pain in the neck.
Some nurses want to do it
To enhance their weekly check,
Then others seek a challenge
To prove their skills exist,
Or to correct a prior-exam upset
To right the wrongs they missed.

Anxiety commences
Before beginning class,
We're talking, major chunks of money
To ensure you're going to pass,
And what if you should flop
Despite this education,
Your self-esteem will under go
Its' final degradation.

You can see the task is mighty
For the dedicated teacher,
They must ignite your feeble spirit
Like a fire and brimstone preacher,
And cast aside the devils
Of ignorance and fears,
Hoping you'll be back to take
Their class in three more years.

p. hupp 1991
rev: 2007

Balloon Pump

When your heart doesn't want to thump
It's time for an aortic-balloon pump,
It squirts the blood back, retrograde
To reduce the myocardial fade,
It unloads the diastolic side
And improves the coronary glide,
It has many complications, though
You could lose a foot, a leg or toe,
Or if a clot, by chance should travel
Some precious organ might unravel,
It could migrate up into your head
And though we saved your heart,
You'd still be dead.

p.hupp; 1991
rev. 2007

Neuro Learning

You used to think that Parkinsons
Was a place to buy your clothes,
And Babinski was a guy
That manicured your toes,
You thought a Grand-mal seizure
Was a grocery store arrest,
And a thing called quantal squander
Was a competency test.

And by now your cerebellum
Has tremors from the strain,
From cramming unrelated
Facts into your brain,
And you suspect your C.P.P.*
Is dangerously low,
From an obscure malformation
Redirecting neural flow.

But how fortunate for you
Your condition is benign,
All you have to do is study
And memorize each line,
Then the words will fall into place
Into memories, defined,
And despite your greatest worries
You've intellectualized your mind.

p. hupp, 1991
rev. 2007

Addison's Prices

No matter where you're going
No matter where you've been,
Make sure you don't ignore
The system Endocrine.

Back in the days
Of James Madison,
Came the naming of diseases
Like Addison;
One day he was shopping
For some coffee and tea,
He had a jones for some brew
(Though it always made him pee),
But he went into shock
When he saw the prices,
And thus begat
Addisonian crisis!
And hyperkalemia,
And hyponatremia,
Dextrose and saline
For fluid revival,
For long term survival.

Don't sit around
Debating the cause,
This Addison's beast
Has some serious claws,
So if you treat it rapidly
With the latest regime,
Impending death
Will be yesterdays dream,

Don't be a doubter
A skeptic or a cynic,
Make follow-up appointments
And we'll see you in the clinic.

p. hupp; 1991
rev. 2007


G.I. troubles
What a mess,
Gastric bleeders
I confess,
Turn my stomach
There's no doubt,
When their blood
Comes gushing out.

An acute abdomen
Or ugly bowels,
Causes people
To scream in vowels,
Call the doctor
And sharpen the knife,
It's their only
Chance for life.

Hepato this
And chole that,
Neighbors chat,
Liver function
Out of kilter,
Won't detoxify
Or filter.

Massive ascites
Ain't no fun,
You look like a pumpkin
In the sun,
Tap the belly
Before it blows,
Ascites fluid
All over your clothes,
All day on the crapper,
This is the song
Of the liver-failure rapper.

p. hupp; 1991
ref. 2007


The acidosis diabeatus
Is not a crisis of the fetus,
It's most often those
Who are type one,
In their insulin.

The fatty acids accumulate
Producing a keto-acid state,
A greater than fifteen
Anion gap,
Encourages their
Lungs to flap,
To dissociate carbonic acid
Meanwhile this dude, is totally flaccid.

When the patient
Is dehydrated,
Become concentrated,
Aggressive treatment
Is required,
Before the victims'
Heart gets tired.

Insulin and fluids free
I.V. route most rapidly,
Check the glucose every hour
So the treatment won't go sour.
Discharge plan?
To educate;
To prevent a similar
Repeat date.

p. hupp; 1991
rev. 2007

The Big Test

The night before the test next day
There's a trepidation creeping,
A few will burn the midnight oil
To study, instead of sleeping,
Some others actually go to bed
Yet their sleep will be forsaken,
They'll toss and turn the whole night through
Afraid they won't awaken,
To the din of 17 alarm clocks
Placed strategically around the room,
So they get up in the morning
With a foreboding sense of doom.

What kind of clothes
Do you wear to this test?
Should you go as a slob
Or dress in your best,
If you give it little thought
And leave it up to chance,
Before you leave the house
Make sure you have your pants.

The test is always on Saturday
So you are the only commuter,
You spend the whole drive dreaming
That you owned a mini-computer,
Hidden in the glove-box
With a modem in your ear,
Then you'd be the only scholar
With a perfect score this year.

Outside the somber testing place
Small groups of nurses collect,
Presenting each other with questions
With the hope they will choose what's correct,
When faced with a similar topic
On the test, they will soon undergo,
The moment of truth can be merciless
When you realize how little you know.

The exam is really over?
You can't believe it's finished,
The results will come in about two months
But your worries haven't diminished,
Because now you dwell on the questions
Where you clearly had no clue,
And since the test is behind you
There's not a damn thing you can do.

You might pray to your Gods and your Goddesses
To grant you just one small request,
Sacrifice a lamb and rub that rabbits foot
To guarantee that you passed the darn test.

p. hupp; 1991
rev. 2007

Necrotizing Needlepoint

Perhaps you thought that breathing
Was a commonplace event,
And the term, "A dime sized lesion"
Was just money that you spent,
Did you think that hypoxemia
Was a viral titer test,
Or that tracheal malacia
Was a common household pest?

Did you know that bronchiectasis
Hung out with atelectasis?
Or grasp that wheezing airways
Were often found on stairways?

Don't ignore that pneumothorax
Muffled breath sounds are a clue,
A deviated trachea
Accompanies it too,
Hypoxemia develops
Mental confusion in the head,
You better place that chest-tube quick
Or this fellow will soon be dead.

Hospital-acquired pneumonia
Is the going thing today,
If you never wash your hands
You'll put a lot of them in play,
And the antibiotic resistant bugs
Will thank you for the chance,
To do their necrotizing needlepoint
At the pseudomonas dance.
Joe Camel has retired
But advertisers never quit,
Pre-teen little Bobby smokes
His cool factor is up a bit,
In health class he just snickers
Tarry lungs, no that ain't me,
In forty years he'll curse the beast
We know as C.O.P.D.

p. hupp; 1991
rev. 2007

Blood Cell Party

The white cells attack foreign proteins
The red cells just go with the flow,
The platelets are seen stuck together
On their way to a matinee show,
It's a film about tubules and solutes
Of osmo's and creatinine clearance,
It adds up to only one thing
A very confusing appearance.

The syndrome of I.A.D.H.
The SED rate and left-to-right shift,
Require the proper translation
Before you catch on to their drift,
But sooner or later the meaning
Will find itself well understood,
When these systems are all out of kilter
The outcome won't look very good.

p. hupp; 1991
rev. 2007