Mental Misdirection

I rarely write about mental health, other than commenting on patients with crazy, disruptive behavior.

Across the Border

When you're driving home
And it seems like it's the same old way
But suddenly you're lost, and across the border,
To me it appears, it must be something like
The fellow with the Mental disorder.

Derailed thoughts
Like a telegraph line
With its wires crossed.

It doesn't matter if you remember
Where your home is,
You're still going to get lost.

So what can you do?
Find an alternate route
Or maybe get a new map,
Or get a mobile home,
Then you'll always be there.

10/12/82

In Training

Written in 1994; never posted. I worked for a University Medical Hospital for 20 years and don't regret a moment of it. The educational / training going on, with a variety of disciplines and specialties, was invaluable. Anyway, in the midst of that is a daily reality; Doctors in training, under enormous pressure.

Training the Scholars

Cirrhosis caused by too many years
Of IV drugs and a million beers,
Disabled with his Liver disease
He wants a medical miracle please.

On public assistance, he has no job
No health insurance plan to rob,
Sister Euphemia said, “you're in a pickle”
“Don't come to us, if you don't have a nickel”.

So, off to the University joint
We charge triple, that's the point,
All in the name of research and knowledge
You have to remember that this is college.

Last year in Biology, frogs in the Lab
This year an Intern, people on a slab,
Poking around for landmarks  unseen
Unlicensed drivers on every machine.

You chose the lifestyle of abuse and addiction
Now you're begging for help, to reverse the affliction,
You agree to proceed, did you pause to repent?
There's a chance you will die, but you gave us consent.

Your family is angry, they threaten to sue
But you know the truth, the blame is on you,
And it seems like a waste of our healthcare dollars
But then I remember, we're training the scholars.

1994

PTSD

Many nurses do report they have work nightmares, or what I call, Hospital Dreams. Invariably, mine would usually highlight a situation where it would be near the end of my shift, when I become aware that I have a patient that I have not visited during the entire night.

There were other really scary themes; for example, uncontrollable bleeding. Those are factually PTSD, from numerous real-time situations I took part in, working in the areas I spent most of my career in.

Anyway, last night I had two hospital dreams; surely inspired from real history.

Two hospital dreams
In one retirement night,
The usual thing;
Too busy, and making something right.

The first dream:
I was called back to work
To document a Death,
No neuro-responses
No heart beat or breath,
But when I looked under the covers
I discovered a central line,
Sure, there might be a reason
Still secured with some twine.

Although my wisdom is limited
My foolishness knows no bounds,
When I loosened that silly string
There were immediate whistling sounds,
Then some yucky liquid slime
Did gush from that central IV,
On the bedclothes and onto the floor
And a plentiful bit upon me.

Luckily, the clerk at the desk
Had stepped out for moment or two,
I grabbed a clean sheet for mopping the mess
Then shrouded the body, to hide any goo,
I looked for a camera, and found one above me
Thankfully pointing away,
When the Attendant returned, I submitted my notes
And cheerfully announced; Good Day!

Dream second:
I was working in that recent place
Though it looked like an ICU,
There were 38 patients to process
Our staffing was FUBAR too,
One of the patient's required 3 nurses
While over my way, a respiratory arrest,
Thank goodness I thought, K.D. is here
When the worst day happens; we're saved by the Best.
__ __ __ __ __ __ __ _

If you know K.D............you know what I'm talking about; she always saves the day!

Healing Methods

Make room for healing, as long as it is sanitary.

There is something else
Needs saying,
In many hospitals
There's a lot of praying,
Staff members idly
Belching, God Bless,
It usually involves Jesus
But I digress.

Little did they consider
Other ways of healing,
Wu Ji Gong methods
And Reiki, by the feeling,
Ascertained when I paused
Sensing the need,
Feeling the spirit
'Tis possible to read.

No matter what the method
It's hard to measure,
Each person has inside
An inner treasure,
To be treated properly
Be it drugs, prayer
Energy or touch,
Combination therapy
Is recognized as such.

Anesthesia in General

I'm sure everyone has experienced this kind of thing; a solution is derived, to solve a problem, but no research was done. Over time, as the complexity of the "problem" develops, further work around's are devised. When leadership chooses to make do with the process as it has developed, they smile and wave, beaming about their home-made solution. And when outsiders, look at the process, all they care about is...........can you process 38 procedural patients with prep, do-the-deed, and recover, tomorrow?
The outsider doesn't care how it's done (and neither does the Overseer), they only care, that it's accomplished. This is not a good and safe way to solve challenges in a hospital.


A systematic malfunction
Without a doubt,
It never matters
How loud ya shout,
When the powers that be
Refuse to budge,
Is this Anesthesia Recovery?
You be the judge.

Patients return from
From a Procedural lab,
They were intubated
On a padded slab,
Given Etomidate
And Propofol,
Fentanyl and midazolam
But that's not all.

But don't let me bore you
With persnickety details,
We pat ourselves on the back
Rescuing the fails,
When Pulmonary Edema
Happened in a flash,
A Code Blue call
Made everyone dash.

Take Joe Bob with bad kidneys
And a failing heart,
Slip in a pacemaker
So he can't depart,
But that's a misnomer
Breath is essential,
The surgical sedatives
Inhibit the potential.

Deep sedation
Is akin to anesthesia,
An LMA or oral airway
May look like paraplegia,
Demanding a nurse
Stands guard, no leaving,
Inviting aspiration
With imminent bereaving.

But, ask the Great Wizard
Do we recover Anesthesia?
Heck, delivering Yak twins
That would be easy-ya,
Than getting a straight answer...
How about a shake of the head,
Perhaps there will be a moratorium
When someone ends up dead.

Unearthing an old favorite

Here's one from 1992; nothing has changed. Actually, in my most recent job, I was no longer in a position to be administering paralytics like Pavulon or Rocuronium. It's just as well; having to do the hourly TOF's (train of four) was a bit tedious.

Mortal Irritation

Your mortal irritation
Is making me insane,
This pathological nightmare
Is curdling my brain,
If you continue this behavior
I'll be driven to extremes,
When pushed beyond my breaking point
I make up tortuous schemes.

The paralytic agents
Are the drugs I like the best,
If you irritate me one more time
I'll put them to the test,
And whether I sedate you
Depends upon my mood,
The more you irritate me
The more likely, you'll be screwed.

There are periodic rumors
That I'm approaching burnout,
But every time I work
There's a special nut-case turnout,
So for mortal irritation
I will paralyze for free,
And if anyone needs sedation
Why surely, that is me!

Cancer Cardiology

As has been my custom for many years, I attend a community Medical CME, get inspired and write some rhymer silliness. Well, I need to keep my own CE's up, and I attended a half day Oncology Update conference just yesterday. Here's what happened; 3 minor moments in time.

Slap a tumor

Is what he said,

Spank a tumor

To make it dead.

Profiling mutations

Sequencing genes,

'Tis incredibly confusing

What it all means.

_ _ _ _ _ _ _ _

Precision Medicine

Who came up with that?

Sounds like "evidence based medicine"

Already in the hat,

Every ten years

We need new terminology,

Describing the same old ideas

It's a type of psychology,

Revered by intellectuals

Providing fodder for conversation,

While statistically the outcomes

Undergo inflation.

__ __ ___ _ __ _

He's a big word man

Multi-syllabilic,

The words roll off his tongue

Convolutedly idyllic,

Loves to hear himself talk

Hoarding the time,

Thank god I found a way

To make it all rhyme.

_ _ _ _ _ _ 

Stretcher Bearer

These two first lines came to me in the period of lucid dreaming, just before I awakened.

Trial and error
Vials and terror,
Just the kinds of actions
That employ a stretcher-bearer.

Fractional Shortening

That title has nothing to do with my cooking skills, alright? One thing I often kept on the fringes of my situational awareness, was the possibility and influence of silent ischemia, under physiological stress. Often, this is a sequelae of low ejection fraction; commonly, one begets the other. Anyway,
I do know, that this concept was not a part of everyone's patient assessment skills.

Your Ejection Fraction
Can rule the day,
Do let me explain
It's worth it, I say.

What is the E.F?
It has to do with your heart,
How much blood gets squeezed out
The contractional part,
At the maximum push
On the arterial side,
The Left Ventricle, I mean
How much blood takes a ride.

This cardiac output
How much ejects, every time,
Doesn't empty that chamber
A paradox crime,
Where one might assume
A full on ejection,
But that isn't the case
'Tis a means of protection.

I could describe
A hundred different factors,
With 99 arguments
And other detractors,
Opinions and guesses
Expertise and understanding,
Massive strata of data
Some weak, some commanding.

Still, we measure indices
We compare and predict,
EF influences outcomes
How the heart doth constrict,
The workload, the demand
Regarding MVO2,
Myocardial oxygenation
Just between me and you.

50 to 70 percent
Is the rule,
The range considered normal
As a comparison tool,
The lower it drifts
We wonder what disease,
Caused damage to the heart
Let’s discover it, please.

The lesser the measure
The greater the risk,
Cardiac performance
No longer is brisk,
A threat of sudden death
With a failing pump,
Silent ischemia
A Troponin bump.

Keep a wary eye
When low EF is known,
If you detect subtle changes
Get on the phone,
Have a word with the Doctor
Share your concerns,
Save a life today
And everyone learns.