Insulin for All

What are the odds regarding a medical mistake?
To happen twice in two months; news that isn't fake,
Regarding Insulin injection not on hospital grounds
The community at large is not out of bounds.

Insulin is dangerous, if it isn't needed
Blood sugar dropping completely unheeded,
Brain cells die fast, but it's just teenagers, right?
Maybe no one will notice at the end of the night.

Who packed the supplies before they were used?
The vials look different, how could they be confused?
Who was giving those shots, was it a regular assignment?
Or some dubious cause; the stars were not in alignment.

In the hospital we are advised
Perform two-person verification,
On many dangerous drugs
For self preservation,
Because if you screw up
And somebody dies,
You won’t be saved by your
Tears and your lies.

I’m pretty sure all nurses have medication errors
And some drugs can give you the willies and terrors,
Imagining the outcome with Nipride or Isuprel?
Take it from me, things don’t go so well.

Even a simple vaccination or TB skin test
Deserves the highest of caution, to perform at your best,
For the safety of the customer, as well as your career
Also, turn off your cell-phone, when the public is near.

Sept. 30, 2019: https://www.wishtv.com/news/local-news/students-hospitalized-after-receiving-insulin-during-tb-skin-test/

November 7, 2019:
https://www.kjrh.com/news/local-news/insulin-shots-given-by-mistake-instead-of-flu-shots

QRS Measuring

Basic EKG / ECG monitoring skills and certification, are now standard requirements in many hospitals and clinics. It certainly helps to have some prior exposure to the concepts, but in our class, it is not demanded as a prerequisite.

One of the most difficult skills to acquire, is the accurate measuring of the width of the QRS complex. We haven't been talking about the J-Point all this time, but now I have proposed that it become a part of our curriculum; this is currently under review.

Measuring Q

QRS measuring
It is tough to get it right,
Without proper instruction
Or low light at night,
One needs to understand the process
Of electrical action,
Dynamic to passive
To complete the transaction.

Does the monitor display
Just one line or six?
Are the QRS segments
Where they belong in the mix?
Because sometimes a Q-wave
Doesn’t show in the picture,
Or the R-wave went south
Like an esophageal stricture.

And what about that S-wave?
New students pass it over,
Measuring to the far side of the R
Like a hostile takeover,
Staking a claim
That the QRS is point-oh-four,
On an adult with heart disease
You need to double that score.

An important understanding
Regarding ionic flow,
Depolarizing is fast
And Repo is slow,
Thus, the QRS vectors
Show as quick straight lines,
Whereas repolarization
Has sloppier designs.

Is the ST-segment elevated
Or below the Iso-line?
Both will skew the measuring
So you must carefully assign,
The ending of the QRS
The crux of the problem at hand,
It is time to meet the J-Point
To fully understand.

The J-Point is found
At the S-wave end,
There is a shifting in direction
Like at a corner, then a bend,
It may be subtle or bold
The transition in the flux,
Study carefully the waves
Before you shoot your ducks.

Upright and Bright

Great news regarding the "little blue pill'; it's good for the flowers too.

From MDlinx.com.

Did you know that the little blue pill (sildenafil [Viagra]) can also make cut flowers stand up straight? What is perhaps more amazing is that researchers actually studied this. They found that only 1 mg of the drug (compared with the 50-g dose used by men with erectile dysfunction) dissolved in water can double the life of cut flowers, making them stand up straight for up to 1 week longer than they usually would. The same held true when they tested sildenafil on strawberries, broccoli, and other produce.








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Out of Alignment

After my previous post, where I covered why I'm still writing............to be a voice, that tells the stories; a loyal reader pitched in with a wonderful tale, which in fact, I was a witness to. It was fun writing about it (circa 1991)

Out of Alignment

Oral cavity cleaning
Turns out, is a really good endeavor,
When you are an ICU patient
And you don't want to be there forever,
If we keep your mouth clean
Your bacterial burden will be reduced,
Less chance of acquiring an infection
Where you might be double deuced.

But don't assume it is without risk
What if you have a loosie juicy jaw?
Your Nurse is armed with a toothbrush
Your jaw goes sideways, oops, was there a flaw?
You say," You know, that happens sometimes
And I have to go to the Dentist to get it fixed",
"Honey, we can't do that, but we've got drugs
That can get anything unmixed".

It was not an easy maneuver
To get her jaw in alignment,
It took Morphine and Valium
And group consensus refinement,
Ultimately, the ENT resident
Straddled the patient
Right there on the bed,
Pulled out his Home Depot vice-grips
And rearranged her head.

Betty woke up and her jaw was working
The ENT resident was gamely twerking,
And sweet little Vanessa, the toothbrush dame
Knew that someday this episode would earn her some fame.

Tell Your Story

People keep posing; "Dude, you're retired, why are you still doing stuff". Well, I did finish at Hospital X, and I am of the age, but my brain and passion hasn't turned off at all. Therefore, I keep writing new material because it is needed.

I needed to keep writing
Because that is what I do,
In the setting of duress
Whether around me, or you.

Maybe I could have written blues songs
And sang my heart out in seedy bars,
No, I went to college
Instead of renovating old cars,
And got an education in medicine
On a caregivers level,
Partly because my name wasn't BB
Or a brother named Neville.

Still, I heard all of the songs 
That humanity could sing,
Amidst life and suffering
And the other thing,
Where a transition is made
For the dearly loved one they miss,
The saddest thing of all
When there is no one to offer the last kiss.

That is why I keep writing
There is a heck of a lot more to say,
If you have some kind of experience
Let me know; I'll write about it today.

Questionable Emotions

Just like the poem X-Tensive and Zanzibar, just below this one, I discovered I had not written a Q poem. I am astounded, that in 40 years of healthcare related poems,  somehow I missed on Q, X & Z. 
Well Q had an answer to that.

All of us bedside nurses know about patients who don't communicate their needs well, but by golly, they sure know how to express emotions. Unfortunately, that does not guarantee we understand what the heck they are so excited about.

Questionable Emotions

Quietly suffering

The stoic fellow,

The gruff and manly

Everything a bellow,

Whimper or cry

At the drop of a hat,

Or the expressionless

Psychologically flat.

Trying to analyze the meaning

With or without words,

Is akin to interrogating

Exotic birds,

Unfamiliar, without context

Like pain, potty or position,

Grasping for meaning

Before I call the physician.

X-Tensive

Hypertension should never go untreated. Sure, we all know that, but many folks out there treat high blood pressure with the same respect as use of seat belts. They figure, "well, I feel all right now, I'm safe, so what's the big deal". How about death, dummy?

You have heard about Hypertension
It's a killer that's for sure,
Be careful what you read sir
No herb can promise a cure;
Unless that plant should kill you
Then your hypertension is gone,
You'll be sleeping six feet under
Over at Forest Lawn.

What you need is a decent doctor
One of modern medicine,
Preferably a well trained scholar
As bright as Thomas Edison,
Don't go to that guy on Craigslist
Offering chelation care,
The only thing cured will be his wallet
While you suffer a stroke, getting there.

Hypertension therapy
Usually requires medication,
You might need to lose weight and quit smoking
With commitment and motivation,
But if you consider no treatment
You better learn what your risks are Pop,
Get a couple million dollars of life insurance
For your family when you blow your top.

Flat Line

I realized I had not even a single "Z" poem, to round out an alphabetical collection I'm putting together. Here it is:

Zanzibar

Zanzibar;
I never wrote about that,
Could have been a great code word
As the vital signs went flat,
When Betty Sue checked out
Without any warning,
The family looked shell-shocked
In unexpected mourning.

It was a memorable transfer
From a hospital nearby,
Famous for screw-ups
Sending sick folks to die,
To save their reputation
Although, how could it be worse?
A death sentence hospital
The place had a curse.

Betty Sue landed
In cardiogenic shock,
There weren't many hours
Left on her clock,
And sadly, she didn't make it
To the end of our shift,
Zanzibar showed up
If you catch my drift.

Upon arrival we noticed
IV's, two weeks old,
Central-line insertion sites
Growing with mold,
It was truly disgusting
The level of substandard care,
She barely lasted six hours
It was a Zanzibar affair.

Zanzibar
Has acquired a definition,
Unexpected flat-line
Completing the mission.

Truths and Tweets

This isn't one of those blogs that hauls in a seven figure influencer income; not a chance. I'm thrilled when I can see that five to ten people take a look at anything I post. That's my style; subterfuge and secrecy.


Only a few folks check in
I examine those details,
In no way does it sway me
I don't consider wins or fails,
No, it's all about camaraderie
Maybe someone is reading my writing,
In my way, I am sharing community
Don't give up, it might just be the lighting.

I have read about, the nurses that quit
Realizing the first year, this job is tough,
Without support and analysis
Hazing perhaps, old crews can be rough,
I experienced some of that nonsense myself
I conquered it, I made sure that I knew more,
Than anyone that I might encounter
Trying to force me out of the door.

Whatever the reason
Thanks for reading my words,
Ideas fly over to me
Like wisecracking birds,
If I take the time to feed them
Sugar water and various treats,
They might sing to me in truths
Telling stories with short little tweets.

New CPR

CPR, a lot of tries, very little advanced.

Evidenced Based New CPR

Over the years

There have been a lot of changes,

Regarding CPR

With many rearranges,

First, it was the drugs

That were tried and rejected,

When we discovered

Few were cardio-protective.

As a result we said

Back to the drawing board,

Accept one new drug

And leave the rest in accord,

So that meant Amiodarone

Epinephrine and Atropine,

Adenosine as a special

For a certain kind of tachyzine.

Next it was compressions

That slamming on the chest,

Who could be fast enough

And who did it best,

Carefully tested results

Regarding heart chamber pressure,

Without a steady MAP

Joe Bob isn't any fresher.

Lastly, respirations

Not so important any more,

It's all about the hemoglobin

Carrying out its chore,

We can all live without oxygen

Longer that we think,

Because our blood is carrying it

What was already in the sink.

Sure, it has some importance

But what we learned, was better,

Hyperventilation

Was far worse, to the letter,

And that was always a risk

When Barry was working the bag,

He would ventilate like a crazy man

Overcompensate, what a drag.

Labs would be drawn

And an A.B.G.

The p.H. would be 7.7

The Doc would say, "Oh, goodness me",

Knowing that now

We needed to halt all breaths,

Which doesn't look good in the records

When investigating the deaths.

Finally, a solution was discovered

In regards, to delivering breaths,

We could fake out any observers

The ones who are tracking the deaths,

By reverting to the mouth-to-mouth

By appearance, no breath shall it miss,

In reality, Jerry from Respiratory

Has the duty of Emergency Kiss.

Smacking away at those lips

Pretending to blow like a louver,

Counting out the expected ratio

With the compressor; he's the prime mover,

Carrying on like he's important

An integral player in this event,

Just hoping this silly charade

Will earn him some points of intent.

I have watched the total endeavor

I had ACLS in 1984,

That's a whole bunch of time

I renew soon, it’s a regular chore,

There were a bunch of diversions

And many of them, that did miss,

But who would have ever guessed
It would be Epinephrine and just a kiss.

Wish List

I like making lists, no telling why, but it probably enhanced my critical decision making over the years. As a result, I'm the type to have my favorite list of Jazz artists, all the books I've read for the past 20 years, all the addresses I have lived at, and all the cars I've owned. My own private fixation.
And sure enough, I have an ever expanding list of the favorite nurses (and persons of other departments) that I worked with over the years. The A-Team, if you will. And that's what I miss, since I changed my work status.

Wish

I wish we could have worked together longer
With you, I felt so much stronger,
When there was some kind of task that made me feel queasy
Having you as my partner, made it seem easy.

Synergy, that is the name
The best kind of partnership
When playing the game,
Plus, a mesh of fine skills
Experience and know-how,
We could accomplish anything
In the here and now.

With our many years of ICU
Each one of us, knew what to do,
Under any condition, without hesitation
But to have a partner, is the best situation,
Sharing the tasks, in the most efficient way
To insure that Joe Bob would see the light of day,
To listen to our silly jokes and laughter
Tomorrow, and hopefully, the day after.

I don’t have any doubt
We saved quite a few lives,
Events I’d rather not remember
Stored in the archives,
But knowing, you and I
Had the power and moxy,
To overcome the toughest
With spirit and epoxy.

Yep, that’s what I miss the most
Finishing the game at the goalpost,
With the ideal team mates at my side
Agreeing; that was one heck of a ride.