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
Merlot
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?

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.

Quarantine Shopping

Wow: who would think that after SARS, MERS, H1N1............that someday soon, we the world would be totally schnockered by another Coronavirus? Not a single one of us medical professionals who worked during those other dangerous events, would ever have thought that less than 10 years later, the whole world would be attacked. Shame on us, right?

But still, one needs to consider shopping for the totally unexpected.

We are quarantine ready
In our locality region,
Pretending I'm isolated
Like a remote Norwegian,
We stocked up all week
Getting ready for the bunker,
Both cars are gassed up
Although one is a clunker.

I shopped twice at Costco
And also, Trader Joes,
We hit the asian markets
Because, who knows?
We need a wide range of sustenance
Amer-asian sourced and all,
In our western remote location
Don't bother to call.

We have a punji stick sidewalk
And a rottweiler garden,
Automatic weapons
Lasered sighted, beg your pardon,
We must protect all our stuff
Because who knows what is coming,
And it's one, two, three
Are the lyrics I'm humming.

But what did I buy?
You might ask a pro,
I've had so many years
To decide, yes or no,
The kinds of things needed
And it ain't toilet paper,
Not if I'm going to die
In the Coronavirus caper.

I want to eat and drink
My favorite foods,
All things delightful
The best of all goods,
According to my plan
After six decades of study,
Salt and chocolate are here
Like an old time buddy.

Ok, sure I must accomodate
Others on hand,
I took their requests
It worked out as I planned,
Because first and foremost
I have to honor my mate,
Should we survive armageddon
Then she's still my date.

The List:
50+ Lbs Rice
25+ Lbs Flour
5 Lbs pasta
6 bottles wine
24 cans beer
4 Lbs Sanders Sea Salt chocolates
1  Gal Costco Ice cream
Tamari sauce
Mixed salted nuts
Lettuce in garden
Drugs galore
Netflix, Prime and digital library

Methanol Cure

You would have to be a cave hermit, to know nothing about the Coronavirus, COVID-19, Beer virus...and the accompanying hysteria. Situations of this nature often lead people to make very poor choices, in respect to their own safety. When ignorance, lack of education, fear, illiteracy, and dependence on various forms of dubious information (rumor, social media, gossip, etc), guide your choices; perhaps drinking Methanol or Bleach (MMS-Miracle Mineral Solution) will work to protect you from whatever ails you.

Did you see the news
Regarding the methanol cure?
Will it protect you from Virus?
In a way, that's for sure,
Because, if you're a believer
You drink it and then you die,
You conquered the infection
On your very first try.

https://nypost.com/2020/03/10/dozens-of-iranians-die-from-alcohol-poisoning-in-attempt-to-fight-coronavirus/

Crazy Milkshake

In the course of looking through archives of prior writings, I found a couple poems from 1985 that had not caught up to the collection. Folks, that's a long time ago, but still, 7 years into my healthcare career I was already battered. As a result, something triggered one of those visceral memories of crazy nonsense and I immediately wrote the following: (Actually, I loved working Recovery, but still.......)

You are driving me crazy

And it's all your fault,

First, you asked for a milkshake

Then complained, it wasn't a malt,

You preferred low-sodium crackers

Then said, they weren't very salty,

Now, I'm beginning to think

Your cognition is faulty. 

For a while I could accommodate

The forgetting and confusion,

After all, you were totally doped up

But now it's a forgone conclusion,

That you are a user of something

Unlisted on your preop discovery,

Totally skewing our assessment

During procedural recovery.

Well, as I mentioned once before

Ones real self is exposed at this time,

When your barriers are drugged

Showing the hidden-under slime,

That slithers beneath the surface

Of your facade of normality,

Now all I have to figure out

Is how to prevent a fatality.

Other nurses like me 

Were injured by folks like you,

Your little monsters inside

That were hidden from view,

By a cheerful outward countenance

"Oh honey, he wouldn't hurt a fly",

Except when he kicked my into the wall

I had a concussion.............might I die?

The Finger

Over the past ten years quite a few devices have entered the market to help people monitor their heart rhythm at home. Some of them are junk, others work pretty well, some are simple and others ridiculously complicated or too expensive. Personally, I have the AliveCor two finger device that works on Apple IOS or Android, and I have seen the latest iteration of the Apple Watch application which produces a spectacular single lead, real-time tracing. But, you have to have a $1000+ phone and watch, to use it. But over the years, I have discovered that my ability to do a finger palpation of a Radial artery, is as good as any of a variety of techy-devices.

Finger Patent

I should patent my index finger
As an A.Fib detector,
I'll get so much recognition
But that's just conjecture,
Because I'll be bought out
And my finger will be toast,
Device makers are scared of me
Regarding money; they want the most.

I read a lot of studies
Money is spent like crazy,
But I'm beginning to realize
Research vision is hazy,
Focusing on engineering
To make a convoluted machine,
While my Index Finger detector
Is better than anything you've ever seen.

I place my Right Index Finger
On Radial artery Right or Left,
Upstream from the thumb bump
In the anatomical cleft,
With gentle pressure I palpate
And feel the cadence of the beat,
Irregular rhythm is my specialty
And A. Fib is the treat.

After all, you do know
12-Lead ECG,
Is the industry standard
The Bible, the creed,
Required for billing
For codes ICD-9,
With my patented finger
I know I'll do fine.

I can imagine a future
With royalties flowing in,
A simple device that mimics my finger
A bluetooth gadget with spin,
Proving that touch is superior
To the usual scary machine,
There's bound to be a paradigm shift
"Give me the finger", if you know what I mean.

Itchy

Coronavirus vs. Aromavirus:
Sounds similar doesn't it? Well, listen up and I'll explain it all.
Also, this poem is not about me being itchy, but all about the play on words.

Sometimes at home
I have an attack,
I get itchy and red
On my hands and my back,
It seems to happen most often
When my wife does her cooking,
I wonder what could it be?
So now I am looking.

Is it a simple allergy?
A bush, bug, or tree,
Did I eat the wrong thing?
And now it's inside of me,
Was I bitten by a snake
Or some other kind of predator?
I’m searching the Journal of Medicine
And letters to the Editor.

Little raised red bumps
Itchier than heck,
It started on my torso
And now it’s on my neck,
Traveling down my legs
To the bottom of my feet,
I can’t possibly go to work
Until I’ve got this thing beat.

It’s springtime in our region
Could it possibly be a flower?
As a child it was grasses
That held the itchy power,
I was tested for Allergy
Revealing dander and Iris,
The doctor said, sonny
You have Aromavirus.

He told me, “Kid, wear a mask”
Not the Halloween type,
Beware of new plants
And more of that hype,
Plus, I was introduced
To some magical beans,
The first generation
Of Antihistamines.

In High School I discovered
The drugs had more potential,
If I took four or five of them
I felt existential,
If I added something more
I could channel Miley Cyrus,
Then I knew I had conquered
The dreaded Aromavirus.

That doctor was a trailblazer
Naming my condition,
Now it seems once again
There is a similar rendition,
So I’m filing a lawsuit
A play on words, this something new,
Corona sounds too similar
And compensation is due.

Oh, Pharmacist

This is a gathering of several Pharmacy themes, coming together into one poem. Naturally, ideas pooled from real experiences.

The Pharmacist is a special player
A fount of knowledge, not a soothsayer,
Can be sweeter than a Tasmanian devil
When conversations are on the level,
If discussing matters
Regarding toxic ingestions,
The Pharmacist poses
His list of questions,
What’s the body-mass index
Their age and gender,
Was this a single shot of heroin
Or an overnight bender.

There once was a Pharmacist named Maury
All caught up with his power and glory,
He sold dubious potions
And age reversal lotions
From the back of a busted down lorry,

At his job on San Juan Avenue
In the middle of the city,
Pharmacist Maury
Was sitting pretty,
He was controlling and ornery
If you know what I’m saying,
If I needed something STAT
He might start delaying,
Telling me fourteen other people
Are ahead of me in line,
“ But Maury, if we wait
This guy will be dead on the vine.”

I think working at night
He felt like King of the pile,
With the power to delay
Making us wait for a while,
And I could never figure out
How to play to his good graces,
Never saw the dude smile
Only his control-freak faces.

Other places that I worked
Pharmacists went on rounds,
To be part of the discussion group
Dicing kilograms and pounds,
And the best time to have a Pharmacist
Right at my side,
During a Code Blue situation
Before somebody died,
With that dude on hand
To dispense all those drugs,
Handling the conversions
And refilling our mugs.

Ya, those chaotic scenes
In the University setting,
Sounded like Billy-Bobs club
With everyone betting;
“Hey, pass me a lidocaine
No wait, make that two,
Plus three epinephrines
And an epidural screw.

But there were the times
At other hospital places,
No Doctor or Pharmacist
Arrived to show their faces,
Until the very last minute
A chance to do some billing,
Yep, someone gets paid
Even when there’s a killing.

A Pharmacist in the family
Well that would be handy,
He will know what I mean
When I ask for some candy,
Plus he can probably get it
For pennies on the dollar,
Or sneak them out of the shop
Under a starched linen collar.

Pharmacists are the second
Most trusted professionals,
Good Catholics each one of them
With a guaranteed confessional,
To absolve them of sin
Should they waver from their path,
Like bringing home candy
And cheating on their math.

Monkey Smart

At my previous healthcare organization, we were unionized and that truly is a good thing. However, the downside is, that the pay was divied out based on how many years of experience a nurse had worked. 0-5, 6-10, 11-15, 16-20 and beyond. That was the basis; not talent, motivation, effort, productivity, or even showing up. Regarding that last feature, I probably averaged 3 sick days per year and took a short vacation once a year. Bobby-Joe would call in sick three days a month, take four vacations, beg to be sent home when the daily hours dipped, refuse to keep up with medical knowledge and skills.........and still, if his years of service matched mine (and like me, hadn't killed anybody) then our evaluations were equal. Essentially, even a monkey could do this job.


Today I spent an hour
Shredding old papers,
Those yearly evaluations
The most worthless of capers,
Where the best of employees
Just get a pat on the back,
"Keep up the good work, Bob
You got everything on track".

The stupidity of it all
Is that even the flunkies,
Get paid the same level
Like we're a gaggle of monkey's,
Vying for sweet treats
Plush toys and balls,
Yep, every year is the same
As we bounce off the walls.

You Want Me to Do What?

At Med-school training hospitals, new cycle Interns-Residents are quite often nervous or anxious about doing new things. Sometimes that new Doctor will be bossy, arrogant and argumentative with the new-found sense of power they can wield over others to do a task they themselves, are unfamiliar with. This kind of surly behavior is not welcome to the great society of ICU nurses who know it is their sworn duty, to iron out the creases so readily apparent on the surface of the newly manufactured doctor.

You Want Me to Do What?
No, Doc; you can do that,
A typical Nurse response
To Resident Brat,
Who boldly suggests
Some outlandish proposal;
Dude, if this doesn’t work
You’ll be destined for disposal.

That day Joe Bob had a fever
The 900 pound man,
Laying on two attached beds
Plus a ventilator and a fan,
I needed that Resident
The night guy on call,
He said, you know where to stick it
The suppository Tylenol.

I’m not doing that
Not this nurse, not me,
That’s clearly an experience
For the new Doc on the tree,
To explore the heart of darkness
The depths of the unknown,
Just wear a mask, and 3-foot gloves
I’ll stand by and chaperone.

Rabbits

I am sure every Nurse has discovered something very unusual about a patient, that had been not been communicated during report, or wasn't in the patient history document. The overlooked amputation, the hand with seven fingers, a third breast, or a ginormous schlong; true eyebrow raising discoveries or phenomena.

Rabbits

There was a really big thing
One time, that I saw,
When I lifted the covers
And there ought to be a law,
Where patient's inform us
About their physical anomalies,
Pastor Bob, said
It helps with my homilies.

Every Sunday morning
Delivering the sermon,
He gestures like a hip-hop star
Grabbing his herman,
To emphasize points
In the body of the teaching,
Well, I wish I had known that
Before I went reaching.

At the pre-op appointment
Complete an intake form,
Discover the anomalies
Compared to the norm,
Ask about his medicines
Diseases and habits,
Become well informed
And watch out for the rabbits.

Nostalgia not

Anytime I feel a teensy-weensy bit nostalgic for working with my old pals; all I have to do is go to my blog and read writings from the seven years I spent in the Diagnostic Cardiology unit. There were so many times that we were understaffed, where we truly worried about the safety of our patients, and our unit managers refused to create solutions. Sure, there were instances where the day shift was helped, but there were no evening shift solutions. From what I've heard (since my departure), Recovery area staffing has been improved, because the workload increased upward a couple notches. Cardiac Surgery is doing more catheter based valve repairs and the EP Lab added another performer. Additionally, the outside vendor, added their own EP practitioner too.

My favorite tasks to do were recoveries and special procedures such as TEE, Bronchoscopy, Cardioversions, because those duties were closest to what my years in ICU had been like; highly technical one-on-one care. For nurses that work beyond age 60, I think the most of them have to come to terms with the physical demands of the job, and the potential for more injuries. Also, I had reached my limit on patients bleeding and sequelae of those events; I was bloody well done with it.

Hospital; I'm done. 

I'm not nostalgic
Regarding all that stuff,
For forty long years
I was tough enough,
Responding to emergencies
With expertise,
Now I would rather visit
Mountains, rivers and trees.

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.

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 hoover,

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.

Epilogue

I am now preparing a manuscript, to finally publish, a book that may sell or not. That's what writers always worry about, but I don't. Perhaps because my writings are the equivalent of my 40 year trip in healthcare. Every bit of writing, is tied to a memory. Today I have written the Epilogue

You might think I'm a horrible nurse
You might think I had the curse,
That I talked about, from day-one, Betty
Back when charcoal stools were hot and sweaty.

But you would be wrong, on that account
My freakish writings, held a measured amount,
Of the stress and anguish, that every hard-working nurse
Is forced to carry around, in their favorite purse.

Injection inspection

It isn't often one reads about medication errors offsite of the hospital, where the usual blame is forced upon a distracted nurse. Here is a recent event at a High School, where students were to receive a TB skin test, but sixteen of them, received SQ Insulin instead.

Lock, Stock and Peril

Oops, you got Insulin
For your TB skin test,
To the hospital you went
You must be impressed,
With our professional promise
Regarding safety and health,
Call it our Student Special
Injected with stealth.

Luckily, not one of you
Suffered anaphylaxis,
That would have looked bad
On next year's taxes,
We might have been sued
For every lock, stock and barrel,
Sixteen students got Insulin
With no warning of peril.


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

"Severe anaphylactic reaction to human insulin in a diabetic patient"
https://www.ncbi.nlm.nih.gov/pubmed/17331861

Future Charades

I still have plenty of words to share regarding what it's like to be the Nurse at the bedside; but my drive to expel those words, has diminished, now that I am freshly retired.
I continue to teach the science of EKG Interpretation, but that incurs no stress at all.
Still, I feel that I have an obligation to write, because my pals remain at the Western Front.


Absentee writer
That's me,
A lot of it was stress
Now I'm a retiree,
Am I any happier?
Not sure, just saying,
My thoughts are still professional
There's a balance shift playing.

I still keep up
With scientific curiosity,
Though, considering the old days
There was a degree of monstrosity,
Which changed its morphology
Over the years, and more decades,
What was believed back then
Was like a game of Charades.

If you're still a Clinician
Keep an open mind,
Best Practice isn't always
Give it a decade, and you'll find,
If all of the posturing
And big ideas in play,
Still hold any legitimacy
In that future day.

Joke Disorder

Not highly regarded for my social skills, nor ability to lead perky conversations, I did develop a keen ability to make puns, cynical/sarcastic innuendos , sharp observations, and conveniently, my thoughts frequently rhyme in patterns. There is probably some kind of Psychological disorder, to explain all of that. (no doubt, carefully delineated in the DSM-5)

So, without further ado; new words and definitions:

Alcohol Use, Disorder:

When you tell the Bartender, you don't really want this particular cocktail.

Vernacular Fibrillation:

Making vocal utterances, which make no sense. 

(somewhat like this definition)

Break-out sessions at the Acne Convention 

Diawheaties:  The latest breakfast cereal from Shaker Mills.

Improve your blood sugar management, while

enjoying your old favorite morning breakfast cereal.

Angiobran:

Part Anti-Coagulant, part Fiber supplement.

Prevent blood clots & prevent colonic (clots) obstructions.

Consider the similarities:

Q: A Creamcicle ice-cream treat, and the IV tubing used for hanging a piggyback medication.

A: The Creamsicle........you, suck on dairy;

      The IV tubing set is called, a Secondary.

High Expectations; Low Standards

I'm on the mailing list of various Nurse recruiters. Recently there was an ad placed looking for an RN, at a hospital I recently worked at. The qualifications were: High School diploma or equivalent (G.E.D.); plus satisfactory completion of a formal Registered Nurse program pursuant to the Division of Allied Health Professions or military training that is equivalent to an accredited Registered Nurse program. Wow, those qualifications are kind of weak...........so I got to thinking about Hospital X.

Easy Job at Hospital X

Good old Hospital X
Has a job for me,
Cuz all they ask for
Is a G.E.D.,
Along with a basic
License for Nursing,
You just memorize scripts
And practice rehearsing.

You don't need to know much
Just smile and wave,
Fluff the pillows
And be a good slave,
And if you're ever asked
About your education,
Mumble some credentials
With obfuscation.

At Orientation
They emphasize certain rules,
That are never enforced
I ask, what kind of fools?
Can run a business like that
A hospital, for goodness sake,
Where every employee is on the phone
During the hours they are awake.

In Recovery, after your procedure
You started bleeding,
Joe holds pressure on your artery
At the same time, he's reading,
About the the latest pistol
Using the phone, in his other hand,
Sure doesn't look smart to me
But we can't make him understand,
If the rules aren't enforced
Until a sentinel event,
That means, until it's too late
And there's no chance to repent.

Precious Flower
Works intensive care,
She charts with earplugs on
Watching Vanity Fair,
No attention on the monitor
For yonder patient, Jack,
Work-time hours watching YouTube;
Don't have a heart attack.

Nurse; can you read an EKG?
Not really, but I have a Monitor Tech,
Hope they are not using their cellphone
Wait a minute, let me check,
But aren't these all Heart patient's
Under your care?
There are some things you must know
As important as breathing air.

Sensible policies
Without enforcement,
Can you trust the care
With this kind of endorsement?
While the public is influenced
With colorful advertising,
Unsafe practices are the norm
Broken rules, not surprising.

Yep, good old hospital X
Will hire me soon,
No more Orientation
We’ll just chant and hum a tune,
Because it was clearly a waste
Training twelve turtles,
About best practices
When they couldn’t run hurdles.

Wide and Bizarre

Over the years I have written numerous times about SVT & TVS (or a similar iteration). Depending on the urgency, the disease process, or even the on-site knowledge base, wide complex tachycardia can present a conundrum, in terms of proper naming of the rhythm. In the event that the patient is critically unstable, cardioversion may be the best choice of therapy.

Wide and Bizarre

It's the middle of the night
And you are a newbie,
You're dead asleep
And dreaming about Ruby,
When your pager goes off
For the CCU,
It seems that Billy Bob Borko
Had some dying to do.

The nurse asks, Doc
Will you look at this for me?
Billy passed out
When he was taking a pee,
And you notice his rhythm
Looks wide and bizarre,
Enough room for a semi
And a Mini Cooper car.

Is it SVT or TVS
If you don't know
You won't impress,
The Attending physician
In the morning meeting,
You better talk to the nurse
Before you take a beating.

There's a guy at the desk
With arm raised and beckoning,
Don't bother to argue
Or there will be a reckoning,
A teacher of EKG
With 30 years of knowledge,
You're not even that old
After eight years of college.

Sure, he can't name a diagnosis
His license won't allow,
But his barrels of experience
Are available, like free chow,
And any self-realized
Brand new doctor,
Will understand free
Without asking a proctor.

Don’t get your knickers in a twist
If he knows more than you,
Regarding Torsades de pointes
And accessory pathways too,
Just sit down and listen
Maybe take a few notes,
On rounds, in the morning
You might get all the votes.

If the Attending should ask you
To cite an article or source,
Please do be honest
Don’t be the butt of the horse,
Embarrassed to admit
A nurse explained it last night,
Let’s have mutual respect
Because payback might bite.

SVT or TVS,
Beguiles folks
You must confess,
If you’re haven’t learned
The nuances and rules,
Your Attending will know
How to separate the fools.

Patty-Cake

I haven't written on this particular theme in quite sometime, but any bedside nurse will agree, this is a stinky subject. Frankly, I have penned an awful lot of crappy rhymes, over the years.

Poo Poo patty-cake
Practice your ability,
A simple test
Regarding GI motility,
The bane of all Nurses
Having to deal with all that crap,
And please listen to me
We don't want it in our lap.

Don't play the revenge game
When we turn you in bed,
Please don't bear down
And make your face turn red,
Because I'll flip you over
Back on your bottom,
Wink at my pal, saying
This time I got him.

Sure, it's kind of funny
When you rip a loud one,
Only if it's empty
Like an unloaded gun,
Because, if I get splattered
I won't be singing, "You're So Vain",
I'll be thinking Chernobyl
And acid rain.

Too much poo poo patty-cake?
We order a Flexiseal,
A miraculous invention
That's how we deal,
And it helps with the odor
Until emptying time,
Then it's the same old crap
Except, this stuff is slime.

Talk About Sex

Nurses; men or women, it doesn't matter. Somewhere in your career, and probably more than once, a patient will start speaking with sex based innuendo's or blatant, sexual harassment, and you need to shut that down, right at that moment! You might have to come right out and talk "Assault & Battery", where speech alone constitutes (threat) Assault, and laying on of hands / touching you, is Battery (causing harm or injury).  Hopefully a firm professional rebuke will halt this behavior in its tracks.

Anyway; here was my response last year when 64 year old Joe Bob just had to know how soon he and his partner could resume sexual activity.

Talk About Sex

Those patients
Who want to fluster their Nurse,
Talk about sex in some way
To embarrass, or worse,
Is it sexual harassment?
Do we snicker, smirk or wink,
It's usually a guy
And he's talking about his dink.

The dude had an Ablation
For his Atrial Fib,
He asked, "How soon for sex?"
Then I said, ad-lib,
Well, how about a week
That should be prime,
But if you just can't wait
Sex yourself, any time.

Common Sins

Not fake news, just old truth. Joe Bob, somewhere over sixty, had strained his back. He had Aspirin at home, and knew it was pretty good stuff for back pain. He remember it was OK to take two every four hours, but after a while he thought, this isn't really working, so he began to double up on the dosing. After about two weeks, he noticed he was feeling weak......................until he finally had Betty Lou take him to the Emergency Room.

Severe anemia
How was that begun?
One guy was popping Aspirin
When his knee had come undone,
Taking it every four hours
For the past two weeks,
His Hemoglobin was four
He had acquired many leaks.

Maybe you need platelets
Or clotting factors,
Though sometimes blood products
Have their detractors,
Perhaps you have a religious
Belief, where you'll refuse,
A standard life-saving therapy
Guess we'll watch you bleed and ooze.

We medical persons
Shake our heads in wonder,
What happened to common sense
Regarding your Aspirin blunder,
How could you think it was OK
To take it so often, for so long,
No Doctor told you that
You wrote your own song.

Over-the-counter medicines
Gotta be safe, right?
Millions of people use them
All day and all night,
If one or two don't work
Take a couple more,
But if you should overdose?
Please unlock your door.