Tuesday, October 27, 2020

Obsolescent Productivity


I was thinking about an adaptation I had made to a standard IV tubing setup, to be used during procedures requiring conscious sedation. Ultimately, I wanted to be standing near the foot of the bed where I had a good visual on the patient, and easy access to the injection ports on the tubing. On the supply cart there was an accessory tubing with a stopcock on it and this added about 36" to the overall length of the setup. This allowed for a secure hold on any syringe that I wanted to attach, perhaps with the sedative or pain medication. Additionally, it turned out to be the ultimate accessory for agitated saline/bubble studies during the Transesophageal Echo procedures.

When I joined this crew in 2011, no one set up their kit like this. The whole setup was awkward, particulary when it came to injecting the bubbled saline. 

There is a hospital system that I know of, that practices a profound rigidity in their written and approved procedures for just about every single thing. There is no allowance for deviation, and thus, no incentive for imaginative creativity on the part of the staff. In fact, it is likely that a reprimand and warning would be incurred.


Any organization that demands conformity
Will succumb to the others that allow adaptation,
One that welcomes individuals ideas
Will always develop a better creation.

Rules and demands may promote efficiency
Yet in the long run will inhibit innovation,
A top heavy structure is an unwieldy master
Ultimately leading to a weakened foundation.

As hospital mergers create megacorporations
Innovation relies on the industry at large,
Keep an eye on what your competitors are up to
Then tell a lower Manager it's time to take charge,
One unfamiliar with the day to day workings
Down at the level where things are really done,
Blow a few million dollars on worthless widgets
Then the program will be shelved for cost overrun.

Equipment vendors love contracts with hospitals
Imagine selling ten thousand computers on wheels,
And how about Infusion pumps that fail at five years
Planned obsolescence is the best of all deals,
Now show me the employees that provided the input
To sign off on the equipment they would use next year,
There are none to be found, the top management decided
At the level of the kickbacks, it is clear.

Sunday, October 18, 2020

A Bloody Requirement

Wow, I haven't posted since May! All my summer writings have been posted over at......"Daily Muse".

My remaining contacts with Nursing are the periodical Basic Cardiac Monitoring education sessions, plus the persistent recurrent dreams of patient's bleeding. I worked about 30 years right in the middle of Cardiac - critical care and thus, way too much poorly controlled bleeding. And I have the dreams as proof.

Flashbacks of bleeding

No, never my own,

Billy Bob and Esther

Patient's I have known,

Was it ever my fault?

Yes, a couple of times,

Caught my foot on an Art-line

Was one of the crimes.

ICU is a tangled place of

Wires, tubings and clutter,

Careful maneuvering advised

But what if your patient is a nutter?

Delirium in progress

Thrashing and flailing,

I was kicked in the head once

And I went sailing.

Nightmares of bleeding

Have followed me into retirement,

This burden in my dreams

Must be some kind of requirement.

Friday, May 29, 2020

Cull the Herd

Hopefully the bulk of current healthcare-at-the-bedside workers  are with me on this: the Coronavirus poses a significant risk of shortening life expectancy. No matter where it originated from (which hardly matters in the ICU), it is a bad mofo. I believe that social-body-space distancing, mask wearing in public and hand washing, represent our best defense. This poem speaks to the folks who don't believe these recommendations, nor do they recognize the severe risk of death to themselves, and to their loved ones.

Cull the Herd

Herd immunity?
It will take at least three years,
Culling of the herd
Should be added to your fears,
If you're a big old fella
With diabetes or hypertension,
You better watch out boy;
You've got the Grim Reaper's attention.

Who do I speak to?
All the careless folk,
Who love to tell themselves
The Coronavirus joke,
How it's no worse than the Flu
Of which they already have immunity,
Coronavirus will cut them down
At the first opportunity.

Go ahead with your demonstrations
Shake hands, wear no mask and hug your brother,
Perhaps he will share the virus with you
Which will kill your mother,
But you frequently boast
"Well, ya gotta die sometime",
How about your eight year old daughter
Who caught it during lunchtime?

You will weep and moan
And smack the side of your head,
Realizing your foolish actions
Made them dead,
Or, maybe you won’t
You will blame it on the Democrats,
Deep state, Cabal, CNN
And mysterious Fat Cats.

You know the saying
You’re a part of the problem or the solution,
Will St. Peter or Beelzebub?
Offer absolution;
Stay tuned, old buddy
You get to choose,
Your survivability
But will your family lose?

Wednesday, May 13, 2020

At Home PCI Kit

In the April 9, 2020 Journal of American College of Cardiology, is an article reporting a reduction of admissions for STEMI during the recent COVID crisis. One assumption being proposed, is that patient's are afraid to come to the hospital, fearing they might catch the virus.

In my current state of being retired, I have a lot of time to imagine possible solutions. Here is my latest genius solution.

The Do It At Home PCI Kit

Here's the way I see it
And how the data was reported,
If you're having a STEMI at home
You need a hospital to thwart it,
Yet in these viral days of our lives
The hospital might seem too crazy,
We fix your heart, you catch the bug
You die and we look lazy.

A retired old Nurse
He worked in Cardiac Care,
All of the old and new ideas
Are in his brain somewhere,
He spends his retirement hours
Inventing Rube Goldberg devices,
A STEMI repair is just plumbing; and
You won’t believe the results and the prices.

You can do it at home with the PCI Kit
Assembled from household goods,
You will need a source of electricity
So you can’t do this out in the woods,
And it’s helpful to have an assistant
In case you pass out or you’re bleeding,
And not only that, if you work with a mirror
It will reverse the instructions you’re reading.

Call right now to Amazonabon
One kit delivered in an hour to you,
Review the supplies that you need
Not satisfied?, then nothing is due,
It’s advisable to examine the kit
And carefully read each instruction,
You might think it ought to be easy
But remember, this ain’t liposuction.

It’s important to have good lighting
A comfortable couch or a bed,
With a suitable selection of pillows
Under your feet and your head,
Having an assistant to aid you right then
Is like having a Musketeer,
Anxious? and you poke the wrong vessel
And the pipe cleaner comes out your ear.

Supplies found in the Kit
Dental floss - waxed
Ultrasonic toothbrush handle
Olive oil
Pipe cleaners
Disposable gloves
Sewing needles-8,9 or 10
Stat-Seal Powder
6 Rare earth magnets

__ __ __ __ __ __ __ __ __

When You Are Ready:

Assemble the list of items: Place in order of use, on a clean towel at the bedside.

Wash your hands and wear a mask…………….if you don’t have one, just hold your breath during the times of puncturing.

Thread the two sewing needles with a five foot piece of dental floss (waxed is best) and lubricate with Extra Virgin Olive Oil (if there are no extra virgins available, no sweat)

Don your gloves (don’t ask me why it’s Don, if you like, use Dawn)

The usual site of puncture, if you’re old school, is the Femoral artery. You have to pull down your underwear to expose the area. Your assistant might be embarrassed at this point and run away. Therefore, it is better to be new-school and choose the Radial artery at your wrist, (and if you are alone) use your non-dominant arm for access.

Sterilize your intended puncture site: Hopefully, you have some alcohol on hand or some really good soap. Minimally, you can use the Merlot, which was included in the instructions.

You may have consumed a glass of Merlot already, to aid in the numbing of the puncture site. There is some disagreement about that, as the developing intoxication might alter your aim, but the jury is out on that detail. Suffice to say, the Radial artery is very superficial, and this writer assures you, (having done 5000 arterial punctures himself) if you can’t cannulate a radial artery, you don’t deserve to survive anyways.

Regardless of which arterial site you puncture, you may note a bright red sticky substance squirting out; that’s when you shout "Hurray, I hit the artery". At this point, I suggest you apply some digital pressure a little upstream from the puncture site to slow the leak. If you did use the (highly recommended) sewing needle with floss attached, you are finished with one of the most anxiety provoking moments, the gushing blood. Here you can apply some of the Stat-Seal powder to slow the gushing blood to a drip.

Now, take hold of the Ultrasonic (toothbrush) handle and turn it on. Your assistant will have several rare-earth magnets stacked together, and move them slowly up your arm, in the direction of your heart. The vibrating toothbrush handle needs to be moving in tandem, immediately next to those magnets. The vibratory ultrasonic wave will help to keep the needle in the middle of the artery. Slide up the arm, under the clavicle and then take a sharp turn down toward the heart. It gets a little tricky then, but if you just happen to have an iPhone with a visual Ultrasound attachment, then this will be a piece of cake. Otherwise, you just have to use the back and forth approach to hit the desired arterial take-off on the Coronary ostium; sooner or later, you’ll hit it. More than likely, if you send the needle down the wrong artery, you will actually have an upsurge in pain and symptoms, because you are now disrupting flow down one of the remaining open arteries.

The objective is to find the blockage and attack it a few times with your magnetically directed sewing needle and hopefully pass thru the fresh blood clot. When that happens, a little bit of fresh blood will pass the obstruction and the chest pain should be reduced immediately. At that point grab hold of the nearby tail of the dental floss, and with the help of your assistant, together you can floss the passageway through the previous blocked artery.

If it doesn’t seem like the flossing method is working well enough, pull it half-way back, cut the floss and tie in a long piece of pipe cleaner with a floss tail. Use the magnets again to navigate through the artery, pipe-clean with the same back-and-forth method.

Do realize that although this method has saved a number of lives, we CAN NOT guarantee success, because in the hospital they have machines that will blow your mind. However, you might catch COVID and never go home.

When it seems like the Elephant is no longer sitting on your chest, withdraw your tools. Apply direct pressure to the puncture site with more Stat-Seal, for at least fifteen minutes and wrap it tightly with a clean Scrunchie.

While finishing off the bottle of Merlot: Call your doctor and leave a short message; say something like this: Doc, this is Barney; you may not believe me, but I had a STEMI last night at home. Luckily, I ordered (1 hour shipping) from Amazonabon, the “You Can Do It (yourself) At Home PCI Kit With Common Household Items”.
Damn brother, this thing really worked! How come you never suggested it?

Sunday, April 26, 2020

Cavalier Ablations

Paroxymal A.Fib, SVT, ,Brady & Tachycardia's, ectopic beats: When an arrhythmia has either failed drug therapy, has become too bothersome or is indeed life-threatening, then ablation should be considered. While the procedures themselves, done by highly experienced operators, are relatively risk free.............those risks include major bleeding, serious vascular complications, stroke, cardiac tamponade, emergent open-heart surgery and even death. Sometimes those complications occur with persons, who could have made a safer and less invasive choice. The process should be this; Primary medicine to Cardiologist, and lastly, a possible referral to an EP specialist. Many times, stable arrhythmia's can be managed without a trip to the ED or the operating room; what the patient needs is education.

Flecainide saved me
From the Ablator's tools,
Waiting a decade or two
Will expose some of the fools,
Who claim to be magicians
When indeed they are not,
They'll zap or freeze anything
Just to say they're a hotshot.

They act very cavalier
Claiming it’s safe and routine,
Minimizing the risks
Do you understand what they mean?
When they quote a low percentage
Of bleeding, death or stroke?
Percentages based on one-hundred
Statistically, it’s a bad joke.

When bad things happen
During procedures that
Weren’t absolutely needed,
But the hotshot advised
And the patient heeded,
Believing that advice
Without attempting a safer avenue,
If a terrible outcome happens?
The doctor will say,
“We did all that we could do”.

A number of arrhythmias occur
In folks without heart disease,
Some of them require ablation
But not everyone, if you please,
Patient education regarding
Triggers, cause and termination,
Might avoid intentionally scarring one’s heart
And paying for a Doctor’s vacation.

If the average Joe can learn
To replace the oil or change a tire,
I’m pretty sure we can teach him
How to stop his arrhythmia without a freezing wire,
Without running the risk
Of perforating his heart,
Let’s educate and give him that chance
Before the Ablation needs to start.

Down the Road

My forty years in the hospital, 35 years in ICU settings; there were crazy, ridiculous, shifts with people dying a lot and the overwhelming feeling that we couldn't do enough. But those experiences were sporadic, and let's say, not more than one day per week. So, what is happening now to nurses in my profession, is unfathomable. Reading about it is painful, and it drives home to me, how important it is for those agents of good, to talk about it with others who can empathise. PTSD is real, and every one of these workers today, in this crisis time; we want you to survive this, and live long long healthy lives. Whether you need a grief or anger Counselor, do it sooner than later.

Down the Road

During the years that I worked
I wrote very much,
Trying to alleviate the emotions
That get close enough to touch,
A form of escapism
I could call it that,
Working with folks critically ill
Is enough to knock one's psyche flat.

Nowadays PTSD
Is better understood,
One should intervene early
If you want to do any good,
It is difficult to settle it
Miles down the road,
You can pay a lot of dollars
On some ICD-9 codes.

Wednesday, April 22, 2020

What Happens in the Kitchen

Today, April 22, there are some articles circulating (a couple, repeated over and over) regarding the incidence of calls to the Poison Center. These are persons calling in for Chemical Exposures at home; specifically, sterilizing home grocery items. One of them refers to a person, who left her vegetables soaking in vinegar, warm water and 10% bleach. This person called EMS for difficulty breathing and was transported to an Emergency site.

Clean your vegetables with Bleach?
Well, I sure wouldn't do it,
Not because I know it's bad
But when I do D-I-Y, I always screw it,
Still, it makes me wonder
Were they messing around under the bleachers,
During Home-EC class
Regarding ammonia and bleach from the teachers?

Ten percent bleach, water and vinegar
Should sterilize any sort of veggie,
Of course, that means you ignore the poisonous
Worst ever edible wedgie,
As the gas fumes emanate
From your designer kitchen,
Call 9-1-1, momma
It's not about your bitchen'.

Another produce-cleaning survivor
When all she needed was soap,
The best thing you can do is
Gift her, "Pope-on-a-Rope".

Monday, April 20, 2020


Although I'm no longer working ICU and I'm not in the hospital, I'm still capable of being totally ticked off at the ridiculous decisions that hospital managers and administrators make. Case in point, are the directives that Nurses are not allowed to have the necessary PPE to protect themselves. I recall working in ICU's in the Los Angeles area during the early acute phase of the Aids epidemic. This was when the transmission of disease was poorly understood, and it was unclear if it included airborne precautions. Thus, we wore the similar garb as is recommended for COVID; except, it wasn't rationed.

Regarding certain hospitals sending Nurses off the job, because they voiced complaints of unsafe work conditions.

Working at a hospital
That disallows masks,
N-95 for the most
Dangerous of tasks,
For those nurses who work
Placing their lives on the line,
They should be replaced by administrators
And see if they like it fine.

I worked at that hospital
Back in 1985,
I guess if it was last month
I might not be alive,
And around that time
It was the AIDS epidemic,
We had to garb up like moonmen
Just like this pandemic.

The masks were not rationed
Nor any of that other stuff,
The infection was a mystery
Nobody knew enough,
Until later on
We learned it wasn’t airborne,
Then the nurses relaxed
And went back to making popcorn.

There was a subtle fear
Of mystery and the unknown,
I think our hospital administrators
Would shit a brick if they were alone,
At the bedside
In today’s COVID ICU,
Heck, every nurse should grab one of those fools
And show them what to do.

Of course, it might take two nurses
One on each arm,
Dragging Edmundo
Into the arena of harm;
Don’t let him wear a mask
As he accompanies you,
During the next emergent intubation
I’m sure he’ll lend a hand too.

I’m pretty certain
This method would be effective,
To change administrators minds
They might be a little more protective,
Regarding the well-being
Of every employee and caregiver,
If this doesn’t work
Send them up the river.