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.

Heinous Crimes

Beating, whipping, slapping, spanking, boiling hot water, running in the yard for 2 hours, locked in cages, closets, water-boarded, bottom of foot or lower leg, hit with a flexible rod or branch (switch), starving, hidden from society..........dare I go on? IT IS ALL WRONG. Particularly, against children.

I read about a man
He beat his child to death,
Momma, was at work
When Billy took his last breath,
When she came home after work
She saw him sleeping in his bed,
She claimed in the morning
That she didn't know he was dead.

Beatings for an hour
When homework wasn't complete,
Meals and water withheld
Children not allowed to eat,
Make them run in the yard
For two hours at a time,
In ninety-degree heat
These punishments are a crime.

Dad said, "Never in a million years
did I want this to occur",
I thought I was the best Dad
Loving and pure,
But my kids wouldn't listen
When I cussed, barked or yelled,
Never understanding
Kids just want to be held.

Parents or their surrogates
Most often perpetrate these crimes,
Children beaten and bitten
Hundreds of times,
Men claiming, their own father
Did the same thing, when they were young,
Getting a good whipping
When they stuck out their tongue.

Then going on to say
I leaned my lesson, don't you know?
That's why I do it to my kids
Because now I'm a pro,
I'll teach them a lesson
Beating harder than my old man,
Those kids need a whupping
I gotta do what I can.

These days our domestic animals
Are often better treated,
They are provided a "forever home"
Identification and shots completed,
A soft comfy bed, toys, snacks
And rawhide bones,
Meanwhile little Billy is locked in the basement
Dreaming about ice-cream cones.

Heinous crimes perpetrated
Domestic violence and child abuse,
It is never OK
There's not a single excuse,
To allow for this behavior
It is abhorrent and evil,
A parent, such as described
Is lower than a Boll weevil.*


* Boll weevil: the most destructive cotton pest in North America. Best eradicated via pesticide, or crushing beneath one's heel.


https://americanspcc.org/child-abuse-statistics/

Remember, all we healthcare workers are Mandatory Reporters.