Hocus Pocus

Memory sure is a strange thing. Currently, I see patient's on a daily basis having Atrial Fib, Flutter, PVC, Vtach ablations, and what not. My memory does not recall, that I was writing about this topic 21 years ago (and studying it as well). But here is the proof.

Hocus Pocus

In this day of modern medicine
There's a topic and a focus,
Preventing sudden death
With a lot of hocus-pocus.

Take a heart, that's sick or injured
With a recent big M.I.,
You want to try to minimize
The risk of ectopie.

You might load them with some Lidocaine
Procainamide, Bretyllium,
Dietary fiber with
Colace and some psyllium,
To regulate conduction
In the bowels and the heart,
It's a basic fact of life
You have to
Let the poor guy fart.

You might try a new religion
If he's blocking without capture,
And if you convert just one more heathen
You will earn angelic rapture,
If you could get one hundred heart attacks
At a summertime revival,
Just think about the impact
On the sudden death survival.

Have you studied early bloomers
Or simple delayed potentials,
Be they premature or missing
And other fine essentials,
Does the corrected Q-T interval
Increase, despite your scrutiny,
Do you double up your bets
When you think their heart may mutiny,
With increasing T-wave ectopy
And ischemic irritation,
It may warrant intervention
Like bedside HIS ablation.

It's really very simple
Though it takes a steady stroke,
It requires a lengthy needle
Then just eyeball where to poke,
Drive the needle to its hub
And shake it all about,
If you do this hocus pocus
The ectopy comes out.

1993

Forensic Files

What with all of the television shows about CSI, Forensic Files, Law and Disorder, and so on, I feel like the Nostradamus of Nursing. In 1993, I posted a poem that addressed that fascinating field regarding the determination of death.

Visual Mortality Acuity

How far away
Can you determine death?,
Can you sense the subtle vibes
Of a beating heart or breath?,
Can you spot a vapor trail
At twenty-seven meters?,
Do you hear the failing heart
By the backfire of its beaters?

Can you hear the death-mans rattle
As you stand outside the door?,
Or is it like the conch shell
With the oceans distant roar?,
I suspect it's just the tailwind
Of a guy who's heaven bound,
Doing solo flying
With the wings that he just found.

Can you measure Rigor Mortis
With a telephoto scope?,
Can you guarantee a suicide
By the tension on the rope?,
Can you call a drive-by shooting
And the bullet riddled brains?,
By the ashen colored skin
As the blood pours down the drains.

When you're driving in your car
And there's a fellow in the gutter,
Can you tell from half a block
If his heart beat has a flutter?
Is he a catatonic Schizo
With a blank and staring look?,
If you've had the proper training
You could read him like a book.

When you've learned to spot a dead man
At any distance you inspect,
You must study proper timing
To be sure you are correct,
Because uniqueness is the key
When determining a stiff,
This application of your senses
May require just a whiff,
Because death is an olfactory
Experience indeed,
A body laying undisturbed
Begins to go to seed,
And the germination process
Is a documented science,
The timing quite predictable
Like a clockwork geared appliance.

What this boils down to, folks
Is a measurable skill,
It's used by Law Enforcement
At the scene of any kill,
So, if you'd like to earn your license
With a handsome annual annuity,
Train for certification
In Visual Mortality Acuity.

1993

Dental Dana 32

The older I get, the prettier things are.

Dental Dana
Got me thinking,
Every time I see her
I get rapid eye blinking,
She's so damned radiant
A pleasure to behold,
Except for one little thing;
She says I'm too old.

But I can't help it
When she peers at my teeth,
Doing a critique of my brushing
And the plaque underneath,
Amidst the environs
In my oral cavity,
Meanwhile, I'm pondering
Immoral depravity.

Oh, Dental Dana
You're the bomb, Baby Blue,
But now, I have to run
Because she's coming with the glue.

Fibril_late;
10/1/14

Rolling the Dice

The latter half of my workshift revolves around the Discharge event; having patient's walk after their period of bedrest. Their Recovery period had been anywhere from one to six hours, and usually they are impatient to get going. But we wise old veterans know, this is not a hurry-up event. Perhaps 10% of them will have some bleeding, and maybe 1% might get light-headed and bradycardic. So, I'm extremely cautious about the whole thing.

Six hours of bed-rest
An average time to wait,
Before they have
Their walking date;
So, this young fellow had
His appointed walk,
All was awesome good
When he stood upon the dock.

He was on his way out
Wife and Nurse at his side,
And there he was bragging
About his beautiful ride;
That '67 Mustang
With Holly-Carbs and Lifters,
That he was a member of
The California Drifters,
When all of a sudden
He touched his pants and said;
"I think I might be bleeding
Look, my hand is all red".

Nurse Emma brought him back
Administered Epi and Lido,
Walked him again in one hour
And he bled just like Fido,
So, we laid him again
Held pressure
And invoked the Gods;
Sandbags and D-stat
And pondered the odds.

I bet on Emma
After hearing her stories,
Simple nights of debauchery
And serendipitous glories,
In Reno or Vegas
Or maybe Burning Man,
At that point, last night
I was open to her plan.

Well, third time's the charm
When you're rolling the dice,
And sometimes when you're bleeding
You need more than twice,
When the ultimate goal
Is to send you home safe and sound,
In the future I'll feel luckier
When Emma is around.

Fibril_late;
9/29/14

Fist

The National Institute for Occupational Safety and Health (NIOSH) defines workplace violence as any physical assault, threatening behavior or verbal abuse occurring in the workplace.


You tried to punch me with your fist
To do me harm,
With your Mike Tyson grip
You bruised her arm,
And sure, you "got better"
We can blame the anesthesia,
Conveniently, you won't remember
Claiming, you seem to have amnesia.

But I know better
After thirty years of Nursing,
The drugs tear down the curtains
That hide the violence and cursing,
The evil one inside of you
That you rarely let out,
People who live with you, they know
It's not something they talk about.

Your faithful wife, stands up for you
Asking me, "Sir, are you having a bad day",
Implying, that I am the aggressive one
In the midst of this violent parlay,
Where our whole intent is his safety
In this setting, of saving his life,
But we're dealing with his hidden demons
And his ever-supportive wife.

Violence in the workplace
This is it folks, it isn't fun,
Potential career-ending injuries
Are the proverbial loaded gun,
Whether intentional or not
It hardly matters, when harm is done,
And defensive family members
Probably helped to load that gun.

9/30/14

Just Stay Home

On the recent Saturday, I attended a Cardiology conference. There must have been at least 200 attendees, mostly physicians and a handful of nurses. Sitting behind us, and to the Right about 5 chairs, was a gentleman with a bothersome cough and clearing of the throat. This occured continuously, minute by minute, the entire day long. We professionals are polite endurers of bothersome personal habits and discomforts, so I suspect the majority of us where silently praying the dude would either buy a cough-drop at the commissary, suck on ice cubes, get a beverage at the hotel bar, or just go home. Evidence suggests he did none of these things, much to the displeasure of many.

Sir Coughalot

Sir Coughalot
Should have stayed away,
Coughing continuously
All night and all day,
With little consideration
For others nearby,
Is that cough contagious?
If so, we'll ask why,
Did he bother to attend
And potentially expose,
200 colleagues
With debris from his nose,
Plus, flying projectiles
With each coughing hack,
I think his choice to attend
Looks like a terrorist attack.

Sir Coughalot
Didn't listen to his marm,
She admonished him often
"Remember, do no harm"
But he's here today
Sharing his coughing disease,
Sir Coughalot
"Why don't you go home, please?"

Fibril_late;
9/27/14

Exposed Iceberg

I know about harrassment
And all about assault,
I've delved into my psyche
And considered Gestalt,
But here is a topic
Upon which, I have never written,
And if I dare say the word
I will surely be bitten.

As a writer of medical mayhem
I thought,
That no topic was sacred
Where anything could be bought,
But a situation is present
With Danger supreme,
The iceberg is exposed
Oh, it makes me want to scream.

I'm skirting the swamp
As I don't wish to be beaten,
There is a threat of a lawsuit
And I don't want to be eaten,
The core of the issue
Power and culture,
The best and worst of that
Thrown into a mulcher.

Now, Sister Euphemia
Is at her wits-end,
She's got a bagfull of troubles
That she wishes she could send,
To a secret incinerator
The proverbial compost-bin,
But all she knows is crucifixion
For Original sin.

This is a Tequila Sunrise
Running for too many hours,
While the Pina Colada's
Have become Whiskey Sours,
Whoever mixed those ingredients
Well, that Bartender is long gone,
I ran into her 2 months ago
And she's singing a new song.

"I am totally happy with
Something new, really fun,
Bartending was Ok
But I needed a gun,
To keep the help-staff and patrons
Under control and out of trouble,
When I had the chance to jump ship
I got out of there on the double."

Then she went across town
Another, bartending gig,
It was like going to the Hilton
On a ship just as big,
Run by regimented officers
Steeped in duty and decorum,
Every decision she had to make
Needed to be reviewed by a forum.

Two years were enough
On that formulaic farm,
Where policy's and procedures
Come first, before harm,
Where one must toe the line
Or be keel-hauled by the boat,
A grand salary isn't enough
When crap is shoved down your throat.

And at the Heavenly Hilton
The Pina Colada's suck,
They are subsidized heavily
And only cost a buck,
Mixed with probiotics
This contaminated culture,
Isn't fit for consumption
Not even by a vulture.

So, one must tread carefully
Speak in code, and watch your back,
At any given moment
We might come under attack,
There's a culture war in town
This is a dangerous place,
A Pinot Noir of mystery
That I'd rather not embrace.

Fibril_late;
9/15/14

My Latest Rant

Recently I noticed a "new" paper form in my workplace, named the "Just Culture Event Investigation".......(something like that). Apparently it is used when some type of Audit has been done, and an error was identified. What bothers me, is that since it is a new idea, why was I not made aware of this tool?

Frankly, I think the naming of the process is stupid. "Just Culture Event"? 

1.) At first, I thought it was some kind of notice for a concert, or something like that; a Cultural Event. Perhaps a time to celebrate that dubious thing called, "Adversity". Well, adversity might be truthful, because if my Boss person, lays this form on me, I feel like I am in a situation of adversity, as in, bad luck, trouble, suffering, and misery.  

2.) Second bothersome thing to me:

I don't know who the Auditor was. So, as I showed proof that my audited error, was incorrectly identified, why don't I have the opportunity to educate that person (the Auditor) and show them the error of their auditing method. In other words, that Auditor person should be served with their own "Just Culture Event Investigation" form.

What my Boss person said, when I pointed out the true error of the Audit: "Oh, then I'll just tear this one up". But I think that it is very likely, that there is an accounting somewhere, that shows I made an "error of omission" in my charting. That won't be corrected, because the Auditor won't be aware of their own error. 

Because of all of this, I decided it was prudent and necessary that I perform some research on "The Just Culture". I am not surprised that big business has jumped on this and turned it into a money making scheme, with similarities to, "The Seven Pillars", "Project Redesign" and other nonsense. 

It dates back to around the year 2001.  

Patient Safety and the "Just Culture": A Primer for Health Care Executives.

Marx D. New York, NY: Columbia University; 2001.

Review Excerpt:

Written prior to the acceptance of open disclosure or general policy support of it, the primer thoughtfully outlines the complex nature of deciding how best to hold individuals accountable for mistakes. Four key behavior concepts serve as the structure for the paper: human error, negligence, reckless conduct, and knowing violations. How they are applied to various situations in health care and how the individuals involved should be disciplined provide thoughtful reading.

And finally it slithers down to my workplace, thirteen years later. 

https://www.justculture.org/the-role-of-event-investigation/

http://www.health.ny.gov/professionals/patients/patient_safety/conference/2007/docs/patient_safety_and_the_just_culture.pdf

http://en.wikipedia.org/wiki/Blame

Same old sh*t slathered on white bread

Fibril_late;

9/15/14

Dental Dana 31

Dental Dana
Oh, what else can I say?
That I'm too frisky
But she never wants to play,
How she's so professional
With her knowledgeable smile,
How she twitches an eyebrow
It's her own particular style.

Other Hygeinists
They're good, so don't get me wrong,
But they aren't humming
The Dental Dana song,
Her mysterious aura
Well, it just vibrates in the room,
And when she supines me in the chair
My heart skips a beat, badda boom.

Dental Dana
What a chick, what a queen,
She's infused with something special
If you know what I mean.

Fibril_late;
9/15/14

Demise

Always here

Our ultimate demise,

Although medical science

Seeks more tries,

To prolong our natural life

And I can’t argue with that,

I’m just beyond sixty

And I want 30 more, in nothing flat.

I feel pretty good for my age

My weight is Ok, just a little more than I intend,

More exercise is needed

It’s not something I can pretend,

To make it dematerialize instantly

After all, work is required and such,

My pretty baby is in favor of it

But she’s not willing to hand me a crutch.

Demise, my bad habits

Although, I’m not so sure what they are,

I have a pretty good diet

Forty years, an anti-meat Czar,

That’s gotta have some value

In the , “It’s good for ya”, category,

I like raw vegetables

Not so much cooked, that’s the story.

I don’t smoke anything

Nor snort, mainline or whoof,

I don’t eat fish or fowl

Or anything on hoof,

Fermented grapes and hops

Oh, surely I do,

Probably just about as much

As the rest of all of you.

So, if Scientists find ways to prolong

The quality of life, in its length,

I’d like to sign up for that

While I work on my strength.

Fibril_late;

9/15/14

Medical Assistants

Responding to a recent "letter to the Editor".........sort of..........here is my take on the necessity of Medical Assistants.

Medical Assistants

Medical Assistants

Without them, the system would come to a stop!

A necessary cog in the gears of countless Clinics

They are the lubricant

That runs a slick shop,

Vital signs and medical records

Everything operating smoothly or not,

Honor, your Medical Assistants

Or brother, your Clinical Practice is shot. 

Fibril_late;

9/14//14
 Stagnation

East Coast steve

Is really right,

My creative words

Are missing their bite,

Stagnation

That's the word for me,

No excuses count

Stagnated, I be.

Ashlee, blog-comment

Helped show me second sight,

Of course, I had to respond

She put me in a favorable light,

So, Quid Pro Quo

And do unto others,

A Medical Assistant Hi-ho

As if written by their Mothers.

Fibril_late;

9/14/14

Gravestone

It seems like the most common reason for suicide, or "ending it all", has to do with an emotional disturbance. Sure, persons with intractible pain from some sort of horrid acquired disease fit in the category, but they represent the smallest fraction of life-enders. No, it's those emotions that are the culprit........they lead us astray and into, complicated thinking conundrums.

She had stress

And definitely sorrow, 

So much, she wondered

Will I know a tomorrow, 

That isn't a repeat

Of my miserable day to day,

If my life is like that

I don't think I want to play.

She had a lot of pain

And too many goodbyes,

It's kind of overwhelming

When everyone dies,

Those that mattered so much

At the same time, oh, it hurts,

No Emergency Broadcast System

Has those kind of alerts. 

But wait a minute.....Living

Sure beats being dead,

No matter what kind of nonsense

You have placed in your head,

Because I have met old ones

With seven major diseases,

They don't want to leave

Even the worst of the sneezes. 

Waking up in the morning

On the top side of dirt,

Sure, that seems kind of morbid

But, no matter how you hurt,

You could still make someone happy

And perhaps, alleviate THEIR pain,

Wake up under the gravestone?

Baby, you missed the plane!

8/6/14

Crashed

Would you believe it? The older we get, the more a bicycle crash hurts! Ouch, I say.

Crashed my bike
And now I'm hurtin',
It wasn't fun
Of that, I'm certain,
Worked the next day
Should have not,
My aches and pains
Need Icy-Hot.

Crashed my two wheeled
Transportation,
Just before
I made the station,
Made a left turn
Should have gone right,
Now I can barely walk
Or ride tonight.

Severely hampered
Range of motion,
I need Left leg
Hip, and shoulder lotion,
With Vicodin and
A cold Blue Moon,
I might be feeling
Better soon.

My Vastus Lateralis
Hurts,
Damaged
Capillary spurts,
Creating one big
Hematoma,
While my gut spits out
A foul aroma.

Did I contuse
My G.I. tract?
I'll get worried
If my stools are blacked,
That happened before
In two-thousand-six,
When I crashed because
Of those Asian chicks.

Crashed my bike
And my body too,
Every biker accepts
It happens out of the blue,
So hard to predict
This fickle finger of fate,
First crash of the year
Worse than a blind date.

Fibril_late;
7/18/14

Dental Dana 30

Dental Dana

Yes, she’s the best,

Better trained

Than all the rest,

She’s got that

Mesial Lingual down,

And her enamel skills

Are way uptown.

She knows your Dentin

And your pulp,

And exactly how

To make you gulp,

After filling your mouth

With seventeen tools,

Then saying, “Yes, I’ll go out with you

“Oh, April Fools!

How clever and coquettish

That dental lassie,

No doubt about it

She’s really classie,

And she’s got the creds

To name her price,

Do I have the nerve

To ask her twice?

Fibril_late;

6/25/14

Post-Vacation

Two weeks off.........I changed briefly, the job changed not at all. But not to worry, I had no expectations of that happening.

Berserking

Post-vacation, back to work

Another usual day,

Unpredictable berserking

For unsubstantial pay,

A bystander might disagree

Saying, Nurses are just highly paid waiters,

But this is like diving into a placid pond

To find it inhabited with gators.

Knowing how to tread water won't be enough

Olympic endurance required,

Hand-to-hand combat with battle awareness

And prepared for artillery fire,

Yes, these are the skills that will serve you best

After the day shift, waves their goodbyes,

At 5:31, all Hell will break loose

And we do what we do

So nobody dies.

7/17/14

Complications

My first day off on vacation, flying east on the plane, and I'm still downloading data from work into a poem; what a way to relax!

Turbulence

Versus laminar flow,

Creating eddies where

Velocity slows,

With platelet aggregation

Plus an endothelial trigger,

Clot formation should begin

Or blood loss gets bigger.

A late complication?

Toes fall off,

When you blast out

A sneeze or a cough,

Secondary

To the distal thrombus,

Near the bifurcation

Of the plantar rhombus.

Interventions and complications

Are like evil cousins,

Preferably avoided as long as possible

Sometimes showing up in dozens,

One must be always vigilant

Keep an eye out for those slippery snakes,

And after a few exposures

You'll have what it takes.

Fibril-late;

7/2/14

Results

Get the job done; rescue the babe, prevent death. Simple and succinct; 30 years of proof.

I'm not the most
Compliant sort,
I break the rules
I do report,
Shave the corners
Skim the till,
If I can get away with it
Yes, I will.

I get the job done
Fast and quick,
Why, should I waste time
If you are sick,
You need a fix
Right away, right now,
I'm the road-runner
Not the cow.

So, mooooove on over
If you're in my way,
Pick up the pieces
I toss from the sleigh,
Study and sort
Why they weren't needed,
Thank your goodness
That I interceded.

We can tally what's missing
To make pretty how it looks,
As I deliver great results
And gently cook the books.

Fibril_late;
6/26/14

Dental Dana 29

That Dental Dana
Sure is foxy,
I'm gonna stick to her
Like good epoxy,
Because she has what it takes
To get me to floss,
And I  love those dresses
She buys at Ross.

Dental Dana
She's quite the number,
I may look like sawdust
But I feel like lumber,
Every time I'm seated
In that Dental chair,
My eyes do follow her
Everywhere.

She shakes her head
Then dulls her tools,
She knows what to do
For us silly fools,
Who always make trouble
When she is around,
Dental Dana is dangerous
That's what I found.

Fibril_late;
6/20/14

Nepotism

Inexperienced = Dangerous

What nonsense, this decision
To assign to the neophyte,
Be the Bronchoscopy nurse
Like a boxer in his first fight,
Who has had no previous training
What's there to know? just make a fist,
Well, the Doctor surely noticed
And he was properly pissed.

Sure, I knew about it yesterday
When Mother made that dumb decision,
And she wasn't even here today
To see the failure of her vision,
And her favorite little newbie
Won't speak up, to say, "Not me,
I know that I'm not qualified
I've never done it, can't you see?"

What a team they make, these two
This mother and her son,
The two of them are dangerous
When all is said and done,
She can not see his weakness
And he say's "yes", to everything,
Boldly going, where he should not
While mother coos and sings.

When I arrived, the Doctor fumed
And spoke his pretty piece,
I totally agreed with him
About the boiling grease,
Then I volunteered my services
For the next Bronchoscopy,
An expert for that procedure
Of course, that would be me.

Advanced airway skills?; check
Expert Cardiac, of course,
Highly trained in procedural sedation
I could anesthetize a horse,
Code-Blue master, of renown
A crash and burn magician,
Or just assign, the newbie nurse
Ya, that's our public mission.

Well, there were no complications
At Bronchoscopy number one,
But I'm sure if that had happened
Mother, would still have coddled her son.

Fibril_late;
6/18/14