Friday, February 24, 2012

Over the years, many jobs, and there is one certain thing in common; sooner or later, the new guy or gal, gets jumped in some nasty way. Technically, I'm talking about some sort of verbal assault, but anything counts here, as I am sure many others would attest. It is sort of a “Welcome Wagon” in reverse. I wouldn't say that it's always the playground bully, but certainly, there is that common thread of uncalled-for anger, pressure, coercion, pettiness, which leads to an unexpected attack of some sort.

I'm going to use the Bobcat, as a euphemism, for this kind of unruly behavior


A Bobcat bit me
Late last night,
It was so unexpected
I had quite a fright,
And the fact, that it occurred
On hospital grounds,
Well, that's the kicker
Because the way that it sounds,
Why, no one would believe me
They'd say, “C'mon, you must be kidding,
You must have paid your witness
To support what you're bidding”,
So, for now I'm keeping quiet
But, I'm prepared for the next attack,
And if I spot that Bobcat first
I'll just shoot him in the back.

Don't Need It

Workplace violence
A verbal assault,
I don't need it
For my gestalt,
Because an attack of this nature
Unexpected, unannounced,
Is like a Bobcat attack
I've been pummeled and pounced.

I've seen a Bobcat
When I lived up on the hill,
Carnivorous, I suspect
They eat, what they kill,
So next time, I'll shoot first
And ask questions, later,
There will be Bobcat for dinner
After a pass through the grater.


Tuesday, February 21, 2012

Two entries in one day; now that is really productive, and there does seem to be an undercurrent of commonality.

Syndrome and Disease

Mary has a syndrome
And Bob has a disease,
While Mortimer Snoot
Just had a little sneeze,

Bill has a disorder
A derangement of function,
Betty is almost dead
And requires extreme unction.

All these classical terms
A fancy way to say, “you're sick”,
It sounds like a conspiracy
Let's try and bury you, quick;
Before you figure out
What our medical lingo means,
We want you unconscious
When we pull the wallet from your jeans.

I'm not really picking on anyone in particular, but our success in health-care, does rely on a steady stream of sick and diseased people. And many of us are a part of that screwy, socioeconomic moniker, currently identified as the “1%”. In fact, I would wager that for the most part, when one of the “99%” finds themselves in the hospital, it's a “1% - er” saving their butt. How ironic is that?

Prima Donna and Loving It

We preach preventive medicine
And good life-style choice,
But, surgeries and disease
Bought my Ferrari
And your Rolls-Royce.

You see, after years of study
Toil and sweat,
I welcome your diseases
It helps pay off my debt.

But don't be thinking that I'm greedy
Why, I deserve every perk,
I've worked harder and longer
Than your average jerk,
Showcasing all the facets of
Of my prima-donna existence,
So, bring your diseases to me
And we'll both go the distance.


Sunday, February 19, 2012

I went to ACLS today. There were a few new protocols, and it just seems to get simpler and easier. The drugs have been reduced to Amiodarone, Atropine, Lidocaine, and Epinephrine, for almost all scenarios. I got to thinking about how the approximate 5 year period of change, is probably a really good manufacturing cycle to achieve, and how certain companies are very likely benefiting in the dollar department.

Gin and Tonic

Four decades spent
In a healthcare setting,
Algorithmic procedures
Are just predictable betting,
That change, every few years
After the latest new fangled,
Ideas and data
Are sorted and untangled.

We believe our new techniques
Are better than the old,
We get new machines
And the prior ones are sold,
To that big third world market
Across oceans and borders,
While the medical device makers
Are raking in new orders.

It's sort of a racket
One must question each new way,
I'm betting, obsolete
In two years and one day,
And then Pfifzer and Ballard
St. Jude and Medtronic,
Will be counting their millions
On the beach with Gin and Tonic.


Saturday, February 18, 2012

Back in the day, when I was working in various units, either ICU or on the "floor", I remember taking report from the Recovery Nurse. When the conversation finished, I never called back to the Recovery room, once I had received the patient. Why? Because now, it's my duty, job, and expertise, to determine what needs to be done, and move forward. Why would I hassle the Recovery nurse, now that it is 3 hours post-op, and there is mysterious swelling over a dressing where the new pacemaker is? My response? Betty, take the dressing off, look at the incision, and call the doctor if you think there is a problem.

If you're confused about this, take a visit to a typical Recovery arena; the newly repaired patient arrives, and for the next hour or two, the focus is on the old standard ABC's, equipment, incisions, consciousness and other nuances. If the patient is hypertensive, we're giving Hydralazine, not Lisinopril. If there is tachycardia, it might be IV Lopressor, not oral Metoprolol. So, no, I'm not responsible for giving the patient, their standard daily medications, all right?!?  Criminy!

She's Throwing a Slider

As a Recovery Nurse
There is a particular focus,
A-B-C's and equipment
And some other hocus-pocus,
Perhaps, some particular points
From the Anesthesia provider,
Like, “Don't expect a fastball
Because she's throwing a slider”.

When it's time to report
To the next, receiving nurse,
It can be collegiate and collaborative
But at times it makes me curse,
When questions are asked of me
As I'm poised on your doormat,
Posing irrelevant queries
From some predetermined format.

“What were the closing pressures?”
Nurse B, wants to know,
It's unclear what she's talking about
As this was a Pacemaker show,
Where they cut a pocket in the skin
Put in a pacer and connected wires,
Closing pressures don't apply
Unless you're focused on the tires.

Later on, I get a call
Did I give the afternoon meds?
No, I told you, the patient had nausea
And vomited while in bed,
Then 15 minutes more
You're on the phone again,
Looking for some answers
That were charted, way back when,
That's why we have computers
In this digital, modern age,
Did this patient have their X-ray?
Look at the Radiology page!!!

Recovery takes an hour
Sometimes, a little more,
Wake and shake and breathing
To get them ready for the floor,
So, if daily medications
Were not administered, it's your duty,
Please stop calling me, do your job
And don't complain, that I am snooty.


Friday, February 17, 2012

Mr. Anxiety (age 57) came in yesterday, for a Tilt-Table test and then to follow, an EP study trying to induce an arrhythmia. This fellow had experienced one solid episode of passing out while on a treadmill at his gym, with a trip to the ED, and then another “near miss” of pre-syncope. Unfortunately, there was no documented or recorded proof that he had an arrhythmia.

What I found to be more telling, was that he had experienced a major heart-attack at age 48, requiring a 5-vessel CABG, he was at least 70 pounds overweight, taking meds for Lipids, Hypertension and Metformin (while denying he was a Diabetic), had a major anxiety disorder and a job in Sales, which he and the wife claimed was “highly stressful”. And all that he talked about over the course of his ten hour stay, were the symptoms associated with his pre-hospital syncope and the Tilt Table test; over and over and over again.

Both tests were negative; I think he started worrying ten years ago, and instead of embracing life, he just worries about death.  

Shadow of Fright

Since his heart attack
At age forty-eight,
He has been a fearful man
Regarding his fate,

He takes Valium and Ativan
Bupropion and Xanax,
His wife calls him her baby
As he relives all of his panics,

He denies that he has Diabetes
Though he's a Metformin user,
Seventy pounds, overweight
He's a lifestyle abuser;

Quite frankly, it was crazy
Listening to his tale,
Regarding the Tilt-table test
And the EP-study fail,
He casts blame on the doctor
But he is blind to his plight,
For ten years he has been living
In a shadow of fright.


Sunday, February 12, 2012

The years of your career, the many experiences and books of knowledge you assemble that is you...........allow your work day to be a journey of excellence. But what is it that makes any single day stand out, the event that cuts a little groove in your memory blank?; I find it to be the Uncommon Interaction.

Uncommon Interaction

All in one day
The uncommon interaction,
My neighbor's daughter had a Cath
Was the first distraction;

Then retired nurse Betty
Her husband, on the table,
Had been my patient last summer
At my previous stable;

Encounter number three
Caught me completely off guard,
A person I used to work with
In the University yard,
We both exclaimed the same
“What are you doing here,
Man, I'm so surprised to see you
It seems it must be at least ten year”.

Amidst the stress and all the drama
That surrounds me every day,
It's the uncommon interaction
Like an afternoon parfait.