Friday, October 26, 2012



Atrial Fibrillation is the most common arrhythmia in persons over the age of 50. Current practice addresses either rate control or rhythm control, meaning that some people are relatively asymptomatic, and if they can't be converted to Sinus rhythm, then, keeping their heart rate below 100 is seen as a reasonable approach. However, they require anti-coagulation. Anyway, there is a small subset of patients who are very symptomatic, fail drug therapy, and are referred for an electrical ablation procedure...............sometimes over and over and again. No fun when you are only 58 and otherwise, extremely healthy.


Hail to the man
With the most persistent A. Fib,
He returned once again
To visit our crib,
He missed us, he stated
We're like family, so dear,
The best place to be shocked
Yes, that's why I'm here.

Dr. O'Neill is so happy
To see you again,
He loves a good challenge
Which is common in men,
Of the Irish persuasion
From the Emerald Isle,
He resides as the Judge
On this most tedious trial.

Handmaidens and bards
Stand by, as you beckon,
They are all placing bets
On that shock, I do reckon,
Such consummate professionals
This likeable crew,
Saying prayers, fingers crossed
Hats off, saluting you.


Wednesday, October 24, 2012

Halt the Queries

Admission Data-Base

I bet that a lot of nurses just hate having to fill in / data entry / interrogation forms, whatever your hospital calls it, ours being the Admission History. Tedious, tasking, and terrifically boring questions...............oh wait, I think it's a Demographic Survey, now days..........My advice...........just get creative as all get out!

Halt the Queries

Our clients typically visit
For a twelve hour time,
Yet, we interrogate their lives
Like they committed a crime;
How many times do you pee
Do you dribble or leak,
Did you have a "BM" today, sir
Or was it, way back, last week;
Who really needs to know this
Yes, what is the rationale?
That I have to question what is leaving
Every bodily canal?

Many cultures, are offended
When we pose these inquisitions,
An embarrassing interview
Regarding sensitive positions,
So, I make the answers up
And document what I wish,
Does it matter if his BM
Was today, or yesterish?

And then, we have to document
Medicines taken, time and date,
I ask them, what the day was
And I choose the hour eight,
Whether morning or night
Once a day, or more,
This saves me a bunch of time
In this grossly, boring chore.

And half of the time, these folks
Don't have a clue about their meds,
The stress of needing an angiogram
Is screwing up their heads,
And yet, Bob and Betty nurse
Will perseverate and persist,
Confusing this octogenarian
Until, he slugs them with his fist.

Did you have the death of a loved one
Are you suicidal today?
How would that adjust my care?
Are you packing, I might say,
We don't want an angry wing-nut
Shooting up an operation,
Although that clearly does suggest
That we deliver good sedation.

What's the point of all these questions
I don't know, so I modify,
Your bowel status hardly matters
If you're about to die,
And I shouldn't waste your precious time
Delaying care and intervention,
There are times to halt the queries
And really pay attention.


Wednesday, October 17, 2012

Don't Call Me Jacqui

Just a little silliness................but, I'm thinking even you have had a patient that was just a little attractive......isn't that so?

Don't Call Me Jacqui

In the 11th hour
On the eve of the 11th day,
We still had too many patients
And that means double-time pay;

A woman admiring her Pacer incision
A guy, preparing for home,
One fellow waiting for heart-cath
And Betty with mirror and comb.

"It's important to always look good", she said
After lying all day on this frickin' hard bed,
I hope my arthritic knees and titanium hip
Don't lock up when I stand, and cause me to slip;

That would delay my departure, my driver would hiss
He's a snake of a man, but he has a good kiss,
So, please let me up, and sooner if you can
I like you as a Nurse, and hope you're a good man".

I did all that I could, to please that fine lady
I escorted her to the Ladies room, despite Sinus Brady,
And when we were finished, her heartbeat was tachy
She said, "Thank you young man, just stop calling my Jacqui".



I think this is how quite a few of our patient's feel, when they have just received the news that they have Left Main disease, and they might drop dead if they go home................


Urgency vs. quantity
That's the cat in the bag,
Like the K-Mart blue-light-special
When you're waving the yellow flag.

Six hours of bed rest
"Are you crazy, that's insane?"
I can't pee lying down
That's not how they do it in Spain;
Yes, I should have just stayed there
And not come to visit my daughter,
I'm telling you, I feel just like
The lamb led to slaughter.

I raised them, way back when
Times were different, and that's a fact,
I'm just on a three month visitation
It hasn't been all that it's cracked,
Up to be, I'm telling you
Aren't you listening?
I only came to the United States
To see a Grandson, to attend his Christening.

And now, here I am
In swaddling clothing, in this hospital bed,
The team of doctors are telling me
I need surgery, or I'm as good as dead.

Urgency vs. quantity
It takes on a whole new meaning,
I'm told my options are limited
And that's kind of demeaning,
For a visitor in this high tech country
A leader in so many parts,
I would think that by now
They could just give me a new lambs heart.

What a predicament
I can't make the decision,
I'm going home and screw all my risks
I'm not interested in an incision,
But I still have to pee
So bring me that container,
I don't want to pee in the bed
And that's a no-brainer.


What does it take to be a Veteran of anything? As a soldier, you've gone to a battlefield, and put your life in harms way. As a nurse, what is it? Some sort of other badge of courage, or perhaps a number of years in a type of specialty? I think that is a possible answer, but how many years, I don't truly know.

One thing that I do know, is that Veterans can see through all the flak and find the truth immediately. This is why Nursing, can become more difficult over time. Morals, ethics, good vs. bad practices and all of that other, "it might affect somebody's life" information, becomes readily apparent and obvious. 

Ethical Committee's..............phooey! The RN at the bedside can tell you what's right!


The unethical Doctor Z
Will never get close to me.

With his dubious results
Of cardiac stress,
90% normal Angiograms
And 10% are a mess,
Whereas one of the normals
Will have a serious complication,
This immoral practice
Demands elimination.

Another questionable Heart-cath
The outcome?, disaster,
Dr. Z departs quickly
Nobody, is faster,
Turning over his "care"
To a backup practitioner,
A man with morals and ethics
An old-fashioned Commissioner.

Dr. Z has some issues
Personality, is deficient,
He postures and pretends
As if he, were omniscient,
Claiming all that is worse
From the Lexiscan test,
And with so many normal Angio's
He looks like the best;

Caretaker of constituents
In his tidy territory,
He drives a short Mercedes
Auto-collector?, not his story,
No, I think he's just amassing
The usual dollars, to line his pocket,
If he was an Orthodontist
He'd want to fill your dry-socket.

Do I have the power to challenge him?
Probably not,
He attended good training
But he was no hot-shot,
Knowledgeable, very certainly
He has it all figured out,
The tests he orders, suggest problems
"You need a Heart Cath", he spits out.

The average consumer, won't question
Heck, the information is scary,
"There's a problem with my heart?"
That's like a dead Canary,
Found in the Gold-mine
Down on level 13-C,
Doctor Z suggests an Angiogram
"Heck yes, I want it for me!"

But if the supporting diagnostics
Had been considered in the most thorough light,
Mr. Billy Bob Jorgenson, would have stayed home
But instead, he stroked tonight.

Once again they said, "Oh heck, you'll both go home early...........there's not much going on today". Of course, they are the ones that go home at 5pm. Had I worked my normal 10:30am shift, it wouldn't have been a problem. No, because it was a slow day, two of us came in at 9am....................but we didn't leave till 23:30pm. - that's 14.5 Hours on the books.


Oh, I wonder
How they blunder
Born asunder
The leaders of our room,
When billing hours are weak
They endlessly tweak
Talking double-speak
All dire and doom.

Home early, you’ll go
Because it’s kind of slow
But what do they know, they go home,
We have patient’s, we stay late
It’s less exciting than a date
I’m a nurse, it’s just my fate,
Looking forward to a drink with foam.


Bleeding Janet

Late again
But we didn’t plan it,
We had another
Bleeding Janet.

She stood up and wavered
Sprung a leak and made a puddle,
You know you can’t fix that
With a 5-minute Nursing huddle.

Barring no other
Unexpected complications,
Bed rest for an hour
Delayed our vacations.


In the Lurch

Once again
We were left in the lurch,
Prayers don't have much power
In Sister Euphemia's church,
She keeps stoking the boilers
When there are no hands on deck,
And tomorrow morning, on inspection, asks:
"You stayed late, what the heck?"

So, I always pen a note
Make it rhyme, that's my motto,
Though not grossly intelligent
When I'm whack-tired and blotto.


Saturday, October 06, 2012

Recently, I read an article bringing attention to our practice of identifying new protocols and practices, as being “Evidence Based”. I don’t remember much of the article, but it did ring true in some respect, with my opinion of this overused, naming of new things.

About five years ago, we were instructed in new, (“Evidence Based”), Intensive-Care Insulin Administration Protocols. At the same time, there were other similar protocols instituted for those patients not in the Critical-Care setting.

Here we are five years later, now knowing that those mechanisms and flow-charts for treating elevated levels of blood glucose, were based on some erroneous ideas, resulting in thousands of hypoglycemic episodes. This was not isolated to just our hospital, but in fact, it was happening nationwide. Unfortunately, singular episodes of severe hypoglycemia, are far more damaging than the opposite. Hypoglycemia can cause death and brain damage, in a very short period of time.

So go ahead and call me obstructionist, if you will, as I cast a very suspicious eye upon our newest “evidence-based”, hot off the griddle, it’s the latest and greatest, Glucose Monitoring and Treatment Protocol. Whoopdy-doo!

Repackaged Miracles

The same old theories
Newly renamed,
And we are the Nurses
Soon to be blamed,
For all of the shortcomings
And lack of adherence,
Yes, these tired old formulas
Have a shiny new appearance.

That’s what I’ve noticed
During the last thirty years,
Repackaged recipes
That drive me to tears,
Sure, some of that knowledge
Is rightfully new,
But they sell it to us, saying
“It’s a miracle, sacré bleu!”

If it was truly a miracle
It wouldn’t need fixing,
No, this is Grandma’s old pudding
With a little remixing,
Reformulated ingredients
That taste just about the same,
Pharmaceuticals and committee’s
Why, they all play this game.

Administrators and mid-managers
Tout this latest new way,
But, I’m telling you Brother
We’re the ones who will pay.