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.

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

What was she doing during Home-EC class?

Learning the dangers of household cleaners

Or dreaming of smoking grass.

Ten percent bleach, water and vinegar

Should sterilize any sort of edible,

Of course, that means you ignored the warnings

On the label, yes, they are credible,

As the gas fumes emanate

From your Vitamix blender,

Call 9-1-1, Momma

Before you view heaven’s splendor.

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

Unmasked

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.

https://fox5sandiego.com/news/coronavirus/socal-nurses-suspended-for-refusing-to-care-for-covid-19-patients-without-n95-masks/

Doctor Got Fired

I posted on July 18, 2018 an event of post-procedural syncope by a patient who had angiography earlier in the day.
Part of the telling included how Dr. I-Don't-Call-Back, could not be reached for the update on his patient. I learned that about three months ago, that dude got FIRED.

Doctor I-Don't-Call-Back
He finally got fired,
I'm sorry it happened
After I retired,
Because I would have gladly
Added my kick too,
With King Kong's
Size forty-seven shoe.

It was not a question
Of his Interventional skills,
He probably reamed a thousand arteries
Without any kills,
No, the problem was all about
His aberrant personality,
He wouldn't take responsibility
For his lack of morality.

I bet he's still around
At another facility,
He did some good work
With his technical ability,
But sooner or later
If he doesn't change his habits,
Another frustrated manager
Will dream of shooting rabbits.