Monday, May 30, 2016

Hospital Inconvenience

As has been a long standing convenience (20 years+) for this particular hospital entity, when the census drops, personnel are sent home; as in, "Who would like to go home early today?" This thing is called an HC, or hospital convenience. Naturally, you're not getting paid.........duh! Now just add up all of those hours at the end of the year (what's a few hours lost, here & there, right?) to find more than 100 hours, and that means, $6,000 or so. Multiply that times hundreds of Nurses, and hooboy, this wonderful entity is saving a million bucks+ a year, just by sending people home. Now, isn't that convenient?

H.C. - Hospital Convenience
What an unfair term,
We'll send you home, without pay, Sonny
Return to your house, you worm,
See, I'm just an underpaid servant
A serf that can be sent away,
They sent me home at their convenience
While keeping the money, my pay.

H.C. - Hospital Convenience
A unique and undignified event,
Perhaps a penance for some digression
"Down on your knees boy, REPENT!
Just like those days back in Catholic school
Busted by Sister Euphemia,
H.C - Hospital inconvenience
Without pay; a new kind of ischemia.

Undifferentiated Rhythm

I don't really consider myself an EKG expert, but in a general context, (amongst my peers) I suppose I am. I have been teaching basic Rhythm analysis for almost 15 years, and have studied the science for over 30 years. When I discover a misidentified rhythm in the hospital setting, it causes me some concern, and particularly, when it is a physician making that improper identification. A rhythm such as new onset Atrial Fib or Atrial Flutter, demands immediate therapy, for a patient who presents with the complaint of "just not feeling right". Most of us know, that our current day EKG machines, misread rhythms about 40% of the time. But to have a doctor, look at that Rhythm and call it Sinus Tachycardia, because that's what is printed on the paper (and because their skills must be lacking), is a problem that needs to be corrected.

Undifferentiated Rhythm

That is what the Doctor said, and the Nurse repeated
But one day later, they both were unseated,
When it all turned out to be Atrial Flutter,
And then, when I read the chart
I muttered, stuttered and sputtered.

The patient presented with chest pain
Saying, somethin's wrong with me,
So by the Chest Pain protocol
They performed an EKG,
Where the machine mis-identified
Naming the rhythm, Sinus Tach,
The Doctor agreed, and that was all wack,
Because it was clearly obvious
From Precordial Lead V1,
Flutter waves at 300, right under the sun,
Unfortunately, 2 Doctors, 2 Nurses
And one Monitor Tech,
Couldn't read that EKG
And baby, what the heck?
Proper treatment was delayed
For at least one day, and more,
How can we change this?
It's an overwhelming chore.

Here are the clues:

# 1: New onset Atrial Flutter with a 2:1 conduction ratio, typically produces a heart rate of exactly 150. Rock solid, unchanging 150. That's the clue: 150. 

# 2: Look for flutter waves in Lead II, and V1. They are not always saw-tooth in shape, but may be little pointy things, but when that pointy thing is zipping along at 300........those are flutter waves. 

And # 3: If you are any Doctor, and you think it's Ok to call a tachycardia undifferentiated, then you need to call in a Cardiologist to look at that EKG. Because frankly, not properly identifying Atrial Flutter, or Atrial Fib, is a dangerous misdiagnosis.

In this particular case, after the patient was discharged from the ED to a Med-Tele floor, the first Nurse (and monitor tech) identified the rhythm as Sinus Tach, because that was the report, and what the EKG algorithm identified. Then later, the next Nurse was seen to chart Sinus Tach with PAC's, as the flutter ratio showed some variation. Another EKG was in the chart, where clearly there was a lot of movement artifact, and the machine identified this one as A. Fib (wrong again). Finally, 24 hours later, the patient had a long pause of about 2+seconds, and at last, the flutter waves were clearly seen on the rhythm strip. At this point, the Monitor Tech wrote "Ventricular Standstill" on the the rhythm strip paper. And after that long pause, they called a Rapid Response and transferred the patient to the ICU.

Sunday, May 29, 2016


Sure, we need to keep our patient's clean, right? True, but sometimes we just can't move people around in bed............Why? It might kill them!

Not exactly me,
But to tell the truth
Things are usually where they need to be,
I juggle 6 position constructs
With ease, in my job,
But at the end of my shift, the OCD's might say
Dude, you really are a slob.

That's not it really
My folks, are still breathing and living,
When Natasha argued that she just had to bathe her man
Well, Cardiogenic Shock, is not always so forgiving,
She had to wrap him up later
And send him to the morgue,
In this case
Not the Capital of Luxembourg.

Certainly, in my own way,
Don't bug me about it, Bluto
At least my patient's will see the light of day.

Wednesday, May 11, 2016

Hat Trick

It makes me squirma when I think of Derma!

Dr. K, told me
"Put a lid on it dude",
Regarding my bald head
She wasn't being rude,
And keep the sunscreen near
Like a secret affair,
Your head is too exposed
Without any hair.

Dr. K. appears
Predisposed, to do good,
Protect the Derma of life
Just like we all should,
Residing in the tropics
Fair-skinned Europeans,
Not to be confused with
Northern Koreans.

Sure, that made no sense
This topic is skin deep,
While trying to rhyme it
I know I've lost sleep,
But the takeaway message
Is, protect at all cost,
Or with each visit to Dr. K.
You'll buy some Nitrogen frost.

Pension Apprehension

As the stock market has gone up and down for the last 80 years in a somewhat predictable cycle, countless folks get wigged out regarding their retirement funds. Who knows whatever crystal ball they are consulting over at Hugs Marijuana Dispensary on Stockton Blvd; it just won't do anything to relieve their apprehension.

She has apprehension
Regarding her pension,
Every day she's checking
With excessive attention,
Did my stocks go up
Did the NASDAQ go down,
Point spreads and derivatives
Should I smile or frown?

Her apprehension
Is causing hypertension,
But she skips her pills
And, I forgot to mention,
That she loves salt
Fried food and cake,
A stroke is scheduled tomorrow
Just before she comes awake.

Too bad, Betty
You didn't pay attention,
You'll never enjoy a penny
From your well deserved pension,
Because, Bobby your hubby
Has a girlfriend on the side,
And as your beneficiary
He'll be happy you died.

Dental Dana 46

This scrumptious Dental diva is a force to be reckoned with, and I think that after reading this one, you'll get the whole picture.

Dental Dana
She advises,
Don't pinch me sir
I don't like surprises,
Just keep your hands
On the arm of the chair,
And whatever you do
Don't caress my hair.

Dental Dana
Is a business-like babe,
If you mess with her
It's Abu Ghraib,
A notorious prison
In a far away land,
It's a promise, she said
If you touch me with your hand.

Dental Dana
She's the rave,
Don't mess with her
Or it's autoclave,
Which I have heard
Is steamy and hot,
But I suspect
First; I'll be shot.

Dental Dana said to me
If you touch me again
I'm a bumble bee,
Just let me do my job, good sir
Or you can swallow this diamond burr.

I said Dental Dana
Won't you scratch my back?
Just about that time
She lanced my plaque,
Typically scraped
And reduced by sanding,
So now, I'm thinking
We have an understanding,

She then, replied
Sir, take note,
If you touch me again
I'm drilling your throat,
Giving you an emergency
Wrap your mind around that
And stop grabbing at me.

Sunday, May 08, 2016


I went to a Cardiology conference yesterday, and as usually noted, the average age in that room must have been at least age 50. Younger nurses don't go to conferences on Saturday mornings. It is just too easy to get your continuing education hours from the Internet, cheap and simple, basket weaving and macrame. So essentially, it was a room full of retired, or almost ready to retire old nurses.

A field of experts
Or experts in a field,
Everyone with a niche
Their knowledge conjealed,
A recognition of faces
A nod or a wave,
What's happening, where ya been?
Did you remember to behave?

All of us older ones
Amazed, we're still in the game,
But what's the alternative
Everything else seems too tame,
And though retirement seems attractive
It could be boring as hell,
And give up a good paycheck?
Might seem like a bombshell.


Skin Doctors

I went back to the Dermatologist for a reevaluation, and sure enough, they whipped out the Liquid Nitrogen and sprayed it at me again. Then, I was so bold as to have them examine something below my lip, and out came the scalpel. Suffice to say, that although these youngsters look innocent, they are flat out Dangerous!

As I mentioned before
In that previous silly rhyme,
In case you weren't listening
I'll repeat it one time,
How the specialist of skin
Called a Dermatologist,
Gets up close and personal
And that is the gist,
Of my every close encounter
When they poke and prod my skin,
Spouting 6 syllable words
For my covering, so thin,
But I guess there are layers
Albeit, rarely exposed,
That's where all the action is
To keep homeostasis closed,
From the outside environment
What's beneath, the event horizon,
If your skin is torn asunder
There's no telling what flies in.

Well, that's another story
Regarding thermoregulation,
Not to be included
In my current oration,
No, that's on Channel 10
With Dr. Whodayaknow,
Between pills and new potions
On that dog and pony show.


If the area beneath a tooth is aching like the dickens, get off to the Doctor, will ya? If you have poorly controlled Diabetes, you haven't seen a Dentist in 7 years, and in general, you're noncompliant with your health.............your toothache is a death sentence. And frankly, if you don't go to the ER, until there is pus seeping from your eyes from that abscess, it's pretty clear, you are destined to leave the planet.

Cultivating an abscess
A tooth unattended,
Bulging eyes with purulent pus
Not recommended,
Paranasal sinuses
Infected with goo,
Seeps into the brain
Sticks there like glue.

Grossly septic
Bacteria in command,
You need a breathing tube
Your head a swollen gland,
Suffice to say, your consciousness
Has gone off the deep end,
This out of control infection
Is too late to apprehend.