I went to ACLS today. There were a few new protocols, and it just seems to get simpler and easier. The drugs have been reduced to Amiodarone, Atropine, Lidocaine, and Epinephrine, for almost all scenarios. I got to thinking about how the approximate 5 year period of change, is probably a really good manufacturing cycle to achieve, and how certain companies are very likely benefiting in the dollar department.

Gin and Tonic

Four decades spent
In a healthcare setting,
Algorithmic procedures
Are just predictable betting,
That change, every few years
After the latest new fangled,
Ideas and data
Are sorted and untangled.

We believe our new techniques
Are better than the old,
We get new machines
And the prior ones are sold,
To that big third world market
Across oceans and borders,
While the medical device makers
Are raking in new orders.

It's sort of a racket
One must question each new way,
I'm betting, obsolete
In two years and one day,
And then Pfifzer and Ballard
St. Jude and Medtronic,
Will be counting their millions
On the beach with Gin and Tonic.

Fibril_late;
2/19/12

Back in the day, when I was working in various units, either ICU or on the "floor", I remember taking report from the Recovery Nurse. When the conversation finished, I never called back to the Recovery room, once I had received the patient. Why? Because now, it's my duty, job, and expertise, to determine what needs to be done, and move forward. Why would I hassle the Recovery nurse, now that it is 3 hours post-op, and there is mysterious swelling over a dressing where the new pacemaker is? My response? Betty, take the dressing off, look at the incision, and call the doctor if you think there is a problem.

If you're confused about this, take a visit to a typical Recovery arena; the newly repaired patient arrives, and for the next hour or two, the focus is on the old standard ABC's, equipment, incisions, consciousness and other nuances. If the patient is hypertensive, we're giving Hydralazine, not Lisinopril. If there is tachycardia, it might be IV Lopressor, not oral Metoprolol. So, no, I'm not responsible for giving the patient, their standard daily medications, all right?!?  Criminy!

She's Throwing a Slider

As a Recovery Nurse
There is a particular focus,
A-B-C's and equipment
And some other hocus-pocus,
Perhaps, some particular points
From the Anesthesia provider,
Like, “Don't expect a fastball
Because she's throwing a slider”.

When it's time to report
To the next, receiving nurse,
It can be collegiate and collaborative
But at times it makes me curse,
When questions are asked of me
As I'm poised on your doormat,
Posing irrelevant queries
From some predetermined format.

“What were the closing pressures?”
Nurse B, wants to know,
It's unclear what she's talking about
As this was a Pacemaker show,
Where they cut a pocket in the skin
Put in a pacer and connected wires,
Closing pressures don't apply
Unless you're focused on the tires.

Later on, I get a call
Did I give the afternoon meds?
No, I told you, the patient had nausea
And vomited while in bed,
Then 15 minutes more
You're on the phone again,
Looking for some answers
That were charted, way back when,
That's why we have computers
In this digital, modern age,
Did this patient have their X-ray?
Look at the Radiology page!!!

Recovery takes an hour
Sometimes, a little more,
Wake and shake and breathing
To get them ready for the floor,
So, if daily medications
Were not administered, it's your duty,
Please stop calling me, do your job
And don't complain, that I am snooty.

Fibril_late;
2/17/12

Mr. Anxiety (age 57) came in yesterday, for a Tilt-Table test and then to follow, an EP study trying to induce an arrhythmia. This fellow had experienced one solid episode of passing out while on a treadmill at his gym, with a trip to the ED, and then another “near miss” of pre-syncope. Unfortunately, there was no documented or recorded proof that he had an arrhythmia.

What I found to be more telling, was that he had experienced a major heart-attack at age 48, requiring a 5-vessel CABG, he was at least 70 pounds overweight, taking meds for Lipids, Hypertension and Metformin (while denying he was a Diabetic), had a major anxiety disorder and a job in Sales, which he and the wife claimed was “highly stressful”. And all that he talked about over the course of his ten hour stay, were the symptoms associated with his pre-hospital syncope and the Tilt Table test; over and over and over again.

Both tests were negative; I think he started worrying ten years ago, and instead of embracing life, he just worries about death.  


Shadow of Fright

Since his heart attack
At age forty-eight,
He has been a fearful man
Regarding his fate,

He takes Valium and Ativan
Bupropion and Xanax,
His wife calls him her baby
As he relives all of his panics,

He denies that he has Diabetes
Though he's a Metformin user,
Seventy pounds, overweight
He's a lifestyle abuser;

Quite frankly, it was crazy
Listening to his tale,
Regarding the Tilt-table test
And the EP-study fail,
He casts blame on the doctor
But he is blind to his plight,
For ten years he has been living
In a shadow of fright.

Fibril_late;
2/17/12

The years of your career, the many experiences and books of knowledge you assemble that is you...........allow your work day to be a journey of excellence. But what is it that makes any single day stand out, the event that cuts a little groove in your memory blank?; I find it to be the Uncommon Interaction.

Uncommon Interaction

All in one day
The uncommon interaction,
My neighbor's daughter had a Cath
Was the first distraction;

Then retired nurse Betty
Her husband, on the table,
Had been my patient last summer
At my previous stable;

Encounter number three
Caught me completely off guard,
A person I used to work with
In the University yard,
We both exclaimed the same
“What are you doing here,
Man, I'm so surprised to see you
It seems it must be at least ten year”.

Amidst the stress and all the drama
That surrounds me every day,
It's the uncommon interaction
Like an afternoon parfait.

Fibril_late;
2/12/12

Sure, I'm a bit disorganized, and I spread out my papers, all over the place. The deal is, that I like to see it all, and not have to dig through a pile of stuff to find what I'm looking for. If you're a neatnik, then I'm going to drive you crazy.

1st Debris Belt

I have a 1st Debris Belt in Messiness
But Lana, she's got me beat,
Just trying to start an IV
There are throw-away wrappers
Covering her feet.

I have a 2nd Debris belt in Organization
I couldn't follow a list if you paid me,
That's why it's not a good idea
To try to coerce or persuade me.

Then there's my 3rd Debris belt in Entanglement
I can conjure a knot in any shoelace or cord,
Why untie, when I can more easily break it
I'm one of those employees, you can't afford.

Fibril_late;
1/31/12

Pill-bottle safety caps have been around for years. When my kids were young, I could see the value, although, as a good parent, I kept a locked cabinet in the garage for all poisonous substances of that nature. Now that I'm an older person, safety caps, knobs on devices that I must unleash, and other similar designs, are a painful threat to me on a daily basis. Quite frankly, I think it's a conspiracy against all of us with cranky hands.

Pill Bottle

Narcotic security
It's a no-brainer,
Until I need the medication
And can't open the container;
Sure, I understand
There's a crime problem, dude,
But, this bottle is so hard to open
It might as well be glued.

Then take into account
My arthritic right-hand,
If you're asking me
This mechanism should be banned,
Because, just trying to remove
The top, to get a pill,
My hand hurts, I get so angry:
There's an inventor I want to kill.

Press down, hard
Turn counter-clockwise, and lift,
Feel the bones in my hand
Torque sideways and drift,
As a thousand nociceptors
Are activated, and I scream,
Dammit, whose idea was this?
Now I need a surgical team.

I have real pain
And I need some relief,
But all I get from this safety-bottle
Is a world of grief,
So, once again
An engineering braniac,
Has turned a civil citizen
Into a raging maniac.

Fibril_late;
1/29/12

I don't like getting sick. Sure, paid sick-time is good, but it does put a burden on the crew at work, and I should be able to stay healthy, right? But the viral community / army, thinks otherwise. It seems like I'm nailed each year, with some atomic-sized particle, that my immune system doesn't recognize, and about one hour later, I've been ambushed, and then spend the next 7 days, in abject misery. Hows that for the easiest downfall of the most advanced species? Pathetic.

Buffalo Clover

Finally, I acquired my first infection
At my latest job,
What can I say, it's the season
For the free flying, viral blob,
It's so difficult to dodge
An invisible and tasteless microbe,
Thus, it is freely distributed
Around our city and the globe.

Was I careless
With my hand-washing habits,
Hard to say with a virus
That multiplies like rabbits,
I wash several times a day
And several times hourly with the wipes,
And who knows, maybe it was airborne
So hard to avoid that; holy cripes!

Was it a coworker or patient
The Echo-tech or coffee-server,
Was it the computer mouse
Or just a casual observer,
Dropping by
For laughs and diversion,
Whatever it was
I suffered viral conversion.

It surely wasn't spiritual
I didn't see the light,
But there were four days
When I nearly coughed all night,
A seven day trip of misery
I suppose I escaped unharmed,
Not like I was blessed
But rather, just charmed.

Infection number one
I'm glad it's over,
I did score some tasty cough syrup
It's better than buffalo clover.

Fibril_late;
1/26/12

Today, reading old writings from years past. The big hiedy-ho moment? When I realized nothing is changing in Nursing. Way back in the training period of '81-83, having to write by hand, those silly care-plans.....knowing at that moment, that P.O.C. really stood for piece of crap.............About every 10 years, I check the landscape, and we're still dragging around that POC anchor. You find me a nurse, who thinks these POC things really have value (not just something that gets audited, so that's why we do it), and I'll show you a nurse who wants to join management, because they groove on these concepts.

On that cynical note, here are my words from around 1993:

The Care-Plan Stomp

As nurses of these modern times

We're guided by the rules,

The policies and procedures

Designed by greater fools,

And every working moment

We must document our actions,

Despite the ever present risk

Of paperwork impaction.

The bedside nurse's duties

Are defined by job-description,

A lengthy boring manual

That's written in Egyptian,

There's a universal format

We call the P.O.C.,

Officially named the Plan of Care

It's a Piece of Crap, to me.

There isn't any doubt

There was once a worthwhile goal,

But in the interpretation process

It's been lost in some black hole,

Burying the spirit

By the wording of the plan,

It astounds the simple logic

Of any thinking man.

In the unit that I work

The P.O.C. is simple,

We're training adolescents

How to cultivate a pimple,

So all we have to document

Is how they wash and eat,

We write, “Alteration in Nutrition”

And right there, I claim defeat

Each and every problem

We address by intervention,

If we documented properly

We'd be forced to place attention,

On the paperwork itself

Instead of sick old Joe,

Who'd be swirling down the drain

With a documented glow.

I've worked in many hospitals

I'm care-plan oriented,

But the way this thing is going

I'll soon become demented,

And the hospital will be forced

To pay me Workmans Comp.,

Because I suffered mental injury

Performing the care-plan stomp.

Fibril_late;

circa: 1993

Almost every day, there will be a period of several hours, where all hell breaks loose. There will be too many patients, that need to be prepared for procedures, and we will be temporarily short on staff members. It is a stressful part of the job, because we are trying to make this journey-in-a-day, as comfortable as we can, for those people we are serving. It is the nature of our business, and it involves crucial resources.

Crucial Resources

This is a real-time journal
Written soon after,
The raccoons and the bats
Took residence in the rafters,
At least, that's how it seems
Some days in this church,
When we're short on crucial resources
Way out here on our perch.

Ours is not a job
Of bright lights and glitter,
I prefer a shotgun
To get rid of those critters.

Fibril_late;
1/18/12

I am thrilled when I learn something new, and when it happens at work, perhaps I'll perform at a higher level tomorrow; at least that sounds good, right? But when that "teaching moment" is delivered by Dr. X, and he is renowned for his arrogant persona of superiority, well, it feels more like the sting of a wasp. And even moreso, because I didn't learn anything; it was old news.


Good Learnin'

Unexpected outcomes
Do arise,
Awarded to me
Like a secret surprise,
Not because of carelessness
Or lack of attention,
No, it's like a betting game
At a gamblers convention.

Dr. S said
A teaching moment, this is,
Perhaps he'll come back later
And hit me up with a quiz,
But I was thinking, honestly
He was prob'ly still in prep school,
When I pulled that first sheath
Twenty years ago, fool.

Well, yes sir, I'm open
To good learnin', if you will,
But cut me some slack
And don't send me a bill.

Fibril_late;
1/18/12

Really, I'm proud of my ICU heritage, the good reputation that goes along with it, and so on. I don't jump in front of speeding bullets, but rather, I just reach out and grab them.................slow them down, hum a catchy tune, and we have a Latte' together, before readjusting our viewpoint on who the target really is.

Plenty of stress and angst are expelled, but at the end of the party, the dust settles, and Joe-Bob dances off into the sunset ith his best lady.

And here is the reason why:

Statute 57

I'm going to do things for you
That other's won't do,
When they are complaining
About Rule Forty-two,
Of the 54th Congress
And Statute 57,
I'll be saving your shirt
In EP eleven.

But don't come to me
About productivity,
I don't give a rats ass
'Cause that just isn't me,
Particularly when
I saved your shirt on One/13,
You do the billing, and
I'll keep it clean.

Fibril_late;
1/13/11

This is so sad, let the poem speak for itself. It's true, and it was only yesterday.

MJ Trumps Life

Michael Jackson's power
Revealed, I''ll show the truth,
A decadent influence
Of all ages, not just youth;
I will tell you about this
So-called, Michael Jackson Immortal,
Wife of Cardiac patient
At deaths-door portal.

Husband, renal transplant
Just three years ago,
Hypertension, Diabetes
And CVA times four,
Chest pain and short of breath
Today, M-I ruled in,
But MJ Immortal?
Tickets for wife, that's her sin.

I have an appointment
She alluded to me,
Cardiologist, stopped by
I have tickets, you see,
I'll call in the morning
I trust your professional hand,
It's Michael Jackson Immortal
I'm sure you understand.

Cirque de Soleil
We can't blame them, for sure,
It's Michael Jackson Immortal
And he's way past a cure,
But he influenced so many
And they behave like the crazies,
MJ is long dead
And he's pushing up daisies.

Mr. CVA, M-I, Diabetes
He's screwed,
His wife thinks Michael Jackson
Is her number-one dude.

Fibril_late;
1/11/12

In the past, I have written that I didn't enjoy doing baths. Two reasons: (1) I didn't have to do much of that for the first 25 years of my career; call it avoidance, or just good luck (2) Getting up close and personal, with those personal body parts of strangers,.......just call me cautious, all right?

So now, new job and no bath's...........what a relief!

Like Heaven

I have performed one bath
Since August 27,
Take it from me.........
It feels just like heaven,
It's not that I don't like
Squeaky, clean tissue,
But just who is doing that bath
That's my issue.

Most of our client's are walk-ins
They bathe at home,
Whether they use a loofah
Or Lavender foam,
I don't really care
I'm just glad it wasn't me,
Two baths back
On August 23.

Our client's go home
Most often, today,
But if they stay the night
They still go away,
Off to another floor
Because we close at eleven,
Just another reason why
This place is like heaven.

Fibril_late;
1/11/12

This is the first story for 2012, but it's really a sequel to "Blackhole" posted on December 31. So, to understand this, just read that one also.

A Bloody Emergency

I almost think I am psychic
And causality, is my gig,
I wrote of my likes and my hates
What happened, is prophetically big,
I went to work the next day
As if to test my creed,
I became intimately involved
In a hemorrhagic bleed.

The candidate for this disaster
Had an A. Fib Ablation, that day,
Three puncture sites times two
Long-term outcome is good, one would say,
But in the short term risks are present
The patient shouldn't wiggle and squirm,
Repeating over and over, “please, don't move your legs”
But the guy was like an undulating worm.

I accept that he didn't enjoy supine
I understand he had chronic bone pain,
But with prior experience, he knew what to expect
He was not a novice, in this lying-flat game,
An hour went by, he was stable and awake
'Twas almost time for his move to the floor,
We carefully turned him, he yelled and he strained
And his artery blew, oh, the gore.

Prophetic I was
Oh, a seer I be,
I'd rather run from any task-list
For a bloody emergency.

Fibril_late;
1/7/12

It's wonderful knowing everything, but don't be a fool, knowing isn't loving. What do I mean? Enjoying all the various tasks that one knows about, is the kicker. We all have favorite things that we enjoy doing, some of those that we excel at, and a few others that we suck at. If you're my manager, and you know I'm not so good at something, that I hate doing it, and it's very likely that I won't get through it, without screwing the pooch somewhere, why give me that assignment? The person following me is just going to get angry, that once again, I screwed up on this "not so difficult" task. Why throw me into that black hole in the first place?

Black Hole

Why I don't like
One particular job,
You must be neat and exacting
But I am a slob.

I can't seem to keep track
Of all the finicky parts,
The nuances and particulars
Where it ends and where it starts.

I become anxious and distraught
And I lose all control,
What should take two or three hours
Becomes a timeless black hole.

My chance of screwing up?
If you're a betting man, odds are good,
But that raises the question, dear Leader
Why not assign it to someone who could,
Just breeze through it dandy and efficient
There are several who work at our station,
I'm not trying to dodge, but rather support
No mistakes, for that big operation.

I'm accustomed to procedures, fast-paced situations
Quick assessment of resources and need,
I like doing different stuff, all the day long
If it's a hemorrhage, I'll help stop the bleed,
But give me a task, with a 50 step checklist
That must be done, an exact, certain way,
I guarantee, Boss, that will be your mistake
It will seem like it takes me all day.

From a management side, I get the point
Everyone should know everything,
But let's be honest, we all have our talents
I can chant, but I surely can't sing,
And they know damn well I will jump in the fire
When others are running for the door,
I'm willing to be here, any time, day, or hour
Just don't assign this particular chore.

Fibril_late;
12/31/11

Things were pretty slow the day after Christmas, a Monday, such that there were no procedures or "preps" on our roster. However, we still had a couple of people on call...........me and you. I received the dreaded phone call about 0835, right in the middle of a cool dream about the mini-mountains outside of Escondido, Cal, and the "hidden" Buddhist monk gathering at their amphitheater, that I discovered. What a dream to leap out of!

Anyway, no matter how I look at it.................'twas easy money.

Just a Wiffle and a Doodle

On-call Monday
The Christmas day, after,
Awakened at 8:30
By the phone, no, not laughter,
A 9:15 clock-in
Betty-Lou was in charge,
Oh, the dread in my heart..........
Just glad it wasn't Large Marge.

A couple of Echocardiograms
Were awaiting on my plate,
Scheduled two hours apart
One is bound to be late,
But then, the second one was cancelled
He was hypertensive and tachy,
Hyper-fluid dynamics
Results unclear and just wacky.

Three more hours of doodles
Help and assistance to share,
I got home about four
Easy work, completely fair;
Short hours, extra pay
Who could complain about that,
On-call is just a wiffle
When it's my turn at bat.

Fibril_late;
12/26/11

In the realm of post-Interventional Angiography, we see our fair share of predictable adverse events. We take all the steps that we can to avoid these happenings, but what can you do, when the universe is gunning against you?

This is the story about crazy Betty and the dancing Russian.

He Fainted, She Bled

She bled, she Bled
But she's not dead,
But I have to admit
She was out of her head;

He slept four hours
But when given the chance,
He passed out cold
After his little dance;

Predictable events
That I'd rather not see,
After a Cardiac Cath
But it happens to me,
When Billy Bob - Betty Lou
Get out of bed,
One of them fainted
And the other one bled.

Fibril_late;
12/20/11

Expensive Replacement

Double-time
But I was still screwed over,
Sending me to Neuro on Saturday
As the float-pool rover;

Look!: An extra nurse
To use, as they will do,
If you think that's cool
Just let it happen to you;

I'm an expensive replacement
I've already clocked, 43 hours,
But when they're desperate
They'll use all of their powers,
To coerce this unfortunate
And available nurse,
My buddies get 6 hours of call
And I earned the curse.

Fibril_late;
12/16/11

__ __ __ __ __ __ __ _

Dissent

Well, it wasn't too bad
But it just wasn't right,
Float-pool nurse on the weekends
Sleep well, nighty-night,
Time-and-a-half, that's ok
But it was a sentence
Not consent,
If they propose this again
I'll buy a boat and cement.

Fibril_late;
12/17/11

It's a fact......I'm aging. Sure, everybody knows it might come to be, but wait until it happens to you. One day, you're a happy-go-lucky 20-something and then BAM!, your back aches at 4am, your teeth are in cup, and all your body parts are drooping south. It's horrid. I didn't sign up for this.......apparently, this business was hidden and buried in the very small print, in those pages of the instruction manual, that were eaten by the rats.

Deaf, Dumb and Blind

When I was younger
I studied mind over matter,
But as I get older
It's about mind over bladder.

Back when I was twenty
I pondered psychic meditation,
Now I'm almost sixty
With atrial fibrillation.

As a young man
I practiced altered states,
Now I'm pushing sixty
I lost hair and gained some weight.

Life is such a laugh
My early endeavors
Were fantastic in my mind,
Now I'm approaching an age
Where I worry
That I'm deaf, dumb and blind.

Fibril_late;
12/5/11