Atria Wiggle

If you are a gunslinger Electrophysiologist, it's easy to make the claim that your Atrial Fibrillation Ablation is going to be 100% successful (never fail), but unfortunately, that usually just refers to the day that the procedure was performed. Percentages drop off to about 50% long term success, for having just a single ablation procedure (for long-standing chronic A. Fib).

Sooner or later, those guys who have had their 2nd procedure and three or four cardioversion's are bound to bump into each other on the golf course and begin to compare notes. That's when they can talk about that new dance step, the Atria Wiggle.

Atria Wiggle

Keeping up with the Joneses
The Odgates and Behringers,
High minded folks
And all packing derringers,
Success with their passions
They love wines and juicy rib,
Find they all do agree
They don't like A. Fib.

This singular phenomena
The fibrillating heart,
Strikes many, over fifty
Causes vary, a la carte,
And a few of that bunch
Will find no particular reason,
Their atria wiggle
On a whim and a season.

It is easy to blame        
On many health conditions,
Hypertension and heart attacks
Abnormal valves, in addition,
Holes in the atrium
That were present at birth,
Overeating that results in
Uncontrolled girth.

An overactive Thyroid
Or metabolic issue,
Alcohol, and tobacco
And stimulants on a tissue,
Sick Sinus syndrome
And diseases of the lungs,
Rapturous chanting
With speaking in tongues.

Prior heart surgeries
Viral infections,
Sleep apnea snoring
And emotional affections,
Anger and arguing
Or a near-death event,
Atrial Fib is so sneaky
It is hard to prevent.

Genetics or heredity?
That surely, isn't clear,
Perhaps, as a side-effect
Of those diseases we fear,
But one thing is certain
If you're in this family crib,
Everyone does agree
That they don't like A. Fib.

Fibril_late;
3/7/13

Core Coercion

Core Measures and what they truly mean.

Core Coercion

Core-measures tracking
As it was explained, you will see,
Mr. Billy Bob goes home
Without some med-orders.....
So blame me;
The nurse that did his discharge
After only four hours of attention,
Regardless of his three day stay
Doctors write med-orders, did I mention?

At first I thought, it was the duty
For Doctors to handle this thing,
Or, maybe Case-Manager nurses
Like a score, that they love to sing,
No, it's a dumber-than-dirt doctrine
Appoint the job to the last guy in line,
Instead of the Doctor in charge of the care
Bureaucratic nonsense again, working just fine.

How easy our bosses point their fingers
"Don't you know this could affect our reimbursing?"
In an ominous tone, as if to scare me
"I'm not ready to be fired, are we rehearsing?"
"Oh, nothing like that Bo, you're a valuable asset
Just do as we say, it's all good"
Coercion and extortion, are heavy-handed concepts
But not unusual in this neighborhood.

Fibril_late;
2/14/13

http://www.clinical-insights.com/resources-Apr09CoreMeasures.html

Mepilex Fail

In our facility, when a patient will head off to a procedure where they might be on their back and stationary for greater than three hours, we place a Mepilex pad on their coccyx, to ward off a pressure sore. They work fairly well, but 100% success is impossible. Of course, failure is not an option, and there is a nurse somewhere who will get the blame. Ain't it so?

Mepilex Fail

Mepilex fail
It was bound to happen,
And it doesn't help
When they're fart'n and crap'n,
Plus, never forget
That the onus of blame,
Will fall upon the nurse
In the pressure-sore game.

Mepilex fail
Can you believe it?
If the pressure is too much
Mepilex can't relieve it,
Some folks are too bony
And built like a twig,
Or the opposite problem
And they're just too damn big.

You didn't turn him enough
You didn't pad his bony knees,
You didn't check after he farted
With every cough and sneeze,
And did you lift the Mepilex
With a witness every shift?,
Two nurses have to look
They don't trust us; get my drift?

Another year from now
Three nurses are required,
To prove a fact is factual
Another witness, or you're fired,
Don't doubt me on this matter
I've been in healthcare, long enough,
It's a wonder I'm still breathing
After choking on this stuff.

Mepilex fail
We are hardly the cause,
But don't doubt for a minute
That some contractual clause,
Will be presented to we nurses
At the next bargaining session,
Another Management move
Towards nursing oppression.

Fibril_late;
1/30/13

State of Fear

At the hospital yesterday, the “State Regulators” were onsite. I don’t have a clue what they are regulating, but all Managers got excited, trying to make the hospital look spic and span, clear the hallways, shuffle papers, and definitely looked worried and anxious. Blood pressures were up, and more chocolate was consumed.

State of Fear

The State is here
The State is here,
So we're all in
A state of fear;
Hide your children
Hold them dear,
All bets are off
When the State is here.

Buff the floors
Wipe the tables,
Rumored protection
Mentioned in fables,
Handed down
By Management bosses,
Behave and be good
Or you'll be counting your losses.

Put away the chocolate
Hide your coffee drinks,
Wash hands every hour
Don't spit in the sinks,
Know all your answers
If State officers query,
We are threatened and dishonored
Mercy me!; It's so scary.

The State is here
The State is here,
Now, bombs away
You better stand clear.

Fibrillate;
1/29/13

Lemons and Limes

Don't press too hard, on the ancient Bard.

Lemons and Limes

I was traumatized
I'm telling you,
First vasovagal
And then, Code Blue,
But we pulled him back
Before he fell off the cliff,
Though he was gray as a ghost
And partially stiff.

I was doing a groin press
Family at the bedside,
When his heart began to cruise
Towards the dead-side,
I said, "Please step out
There is something we must do",
Then, two minutes later
We launched Code Blue.

He did pass out
Gave up his breath,
And without blood pressure
He was contemplating death,
But we don't allow that
In our garage,
Though we performed about a minute
Of Cardiac massage.

Close to the edge
Counting heavenly sheep,
This old codger thought
He only went to sleep,
Actually, quite surprised
With the crowd around his bed,
His family, the worried ones
That Uncle was almost dead.

"What the heck just happened"
Queried, Doctor Who,
"Last time, I saw my patient
He didn't need Code Blue",
So I ran the blow by blow
I told him several times,
Sometimes you get sour lemons
When you think you're buying limes.

Fibril_late;
1/29/13

DTMS*

At work, we are undergoing another Infusion Pump swap. The pumps that were acquired about four years ago (another vendor), turned out to be finicky chumps. And as always, new products demand user education. Nowadays, educators for nurses, are typically a nurse pulling an extra gig, in addition to their job back home. This can be kind of fun; a change of pace, a broadening of one's resume, and so on. However, I suspect that the majority of these trainers do not undergo any (or little) professional-speaking training, to prepare themselves for this "Clinical Educator" excursion.

So, once again, I was forced to become a victim of another, grammatical-phraseology crime.

DTMS*                       * [Does That Make Sense]

Professionals at a class
Do not need to hear,
Repeating over and over
Stupid phrases, to the ear,
"Does that make sense?"
Each sentence-ending posit,
Forty-seven repetitions
Before I threw him in the closet.

Plus, he had some mannerisms
Likely, patterned from his work,
He said, "I'm a NICU nurse
(A tiny-baby clerk),
He'd say, "Never, never, do this
Because, it's bad, bad, bad,
As if speaking to his child
This moronic, half-wit Dad.

Product educators, please take note
Do train, for professional speaking,
Repeating the same thing time and again
Sounds like a rocking chair squeaking,
"Does that make sense?"; repeated over and over
At the end of each sentence, yes, forty-seven times,
Reveal you're a victim of popular culture
And just another perpetrator of grammatical crimes.

Fibril_late;
1/14/13

Tip

I'm starting the New Year with a hot tip!...........$4 that is, for some damn good nursing care.

Tip

I was handed a tip
After a pacemaker redo,
My Five-star attentiveness
Was a four dollar coup.

A new battery acquired
Could make her older than a century,
And a nurse accepting money?
They might throw me in a penitentiary.

A four dollar tip
To refuse, would be rude,
"For a cup of coffee", she suggested
Good aroma, steamy brewed.

Fibril_late;
1/9/13

Senseless

As a parent of 3+3, and as a Nurse of thousands, I am shocked, appalled, and deeply saddened by the recent death of innocent's at Sandy Hook School, in Connecticut. There is no such thing as closure, to those directly affected..........but sadly, we will hear that term bandied about in days to come. There is merely recovery, and moving on. That is what one does, when your child or loved one is abruptly taken away.

Not being one who is directly involved, but only a person over-inundated with what we pass as "news reporting", I must speak out in the way I know how.......and I will continue in this theme for the week.

Senseless

Another day of tragedy
East Coast, West Coast
And in between,
Horrific stories
Rapidly unfolding
One more bloody
Media scene.

NPR, jumps on it
"Substitute all our programming today",
The sad and somber music
Appears so scripted and ready to play,
And I wonder, are we so inured
To the senseless tragedies
That unfold, with such regularity,
That even NPR
Already has a musical score
To accommodate solace and clarity.
;
12/14/12
_ _ _ _ _ _ _ _ _ _

Children

Children, as reporters
Of tragedy
In the aftermath,
Victims of media
Those vultures
Of a bloody bath.....

Children, the innocent
Victims
Of disaster,
Reporters will
Rape their souls
To collect the news, so much faster.

"How did you feel
Were you frightened
And scared?",
"The monster
Was hunting us
I wondered, would we be spared"............

But these are not the words
That a six year old speaks,
No, he was prompted by adults
Who are media freaks.

Six year old children recorded
On YouTube and Twitter,
Their words and faces remembered
Amidst the gore and the glitter,
Of newsworthy lights
And Connecticut mayhem,
Stored on distant massive servers
In society's brain stem.

What are we creating
With our instant-news mentality?
Just more photo-op disasters
And some over-the-top fatality.

Children as reporters?
In of itself, a style of crime,
They need love within a cocoon
Not celebrity and prime-time.

12/15/12
_ _ _ _ _ _ _ _

Days of Mourning

Days of mourning
A nation at a standstill,
Soul searching silence
Like ghosts in a landfill,
Wondering, "Why are we here
Amidst garbage and decay?",
These are the ways of guns
And their time-fuse delay.

Bought for protection
Purchased for fun,
Even I do remember
Being in the woods with a gun,
But now, as an adult
I'm aware of their danger,
Held in the hands
Of an unpredictable stranger.

Just who is unpredictable?
That is the crux,
What should be done about it?
Answers that would fill trucks.

There is no pure solution
Our Constitution allows,
For each and every one of us
To bear guns and not plows,
As crazy as that might seem
The 2nd Amendment, declares it so,
A guarantee for times of mourning
And burying on the plateau.

Odarepsed;
12/16/12
_ _ _ _ _ _ _

Eulogies

Eulogies for the children
And the school staff, who died trying,
Moved me to tears
Like my own family dying,
In essence, this truth
Is one I wish to embrace,
Children and their teachers
In innocence, show their face.

Innocence, what is it?
'Tis but, purity in action,
Surrounded by complexity
Where innately, those distractions,
Cloud our vision and purpose
Till our children show the way,
Innocence is their guiding light
Let's not forget this precious day.

Odarepsed;
12/17/12

Mandates

I couldn't make this one rhyme; just consider it prose.

Staff Mandates

This week at work we are advised of the new policy regarding the recording of IV Infusion Start and End Times:

1.) Safe Patient Care Mandates That We Document Our IV Infusion Times.

**: This is confusing to me, as it is not clear whether "mandate" is being used as a verb or a noun. Is "Safe Patient Care", in of itself, the name of some policy, or what? It seems to me, there might be some important punctuation missing in the above statement; perhaps a comma after Care.........who knows?

2.) In Order To Receive Payment And Credit For What We Do, IV Start and Stop Times Must Be Documented.

**Ah, now I'm less confused. This memorandum is less about safe patient care, and more about BILLING. And we sure know by now, that Billing is a true reflection of safe care, right? (hardly). In other words, we take your money and now you are safer? Furthermore, this suggests that our patients are less safe, if we didn't document, and more safe, if we Bill them.

3.) We Are Currently Losing > $1 million dollars in Revenue, Per Year, By Not Documenting Our Stop Times.

**Further proof, that this policy is not about safety and patient care; it is all about the Revenue.



Mandate:

• noun:   the commission that is given to a government and its policies through an electoral victory
• noun:  an authoritative command; especially : a formal order from a superior court or official to an inferior one.
• noun:  a document giving an official instruction or command
• verb:   assign authority to
• verb:   make mandatory

Fibril_late;
12/15/12

Morale

I was trying to read the latest monthly satisfaction scores, posted on the wall in our break-room, but it was like Greek to me; too many acronyms, avatars, percentages and mumbo-jumbo. Who cares anyways? The "boss" (who?) always highlights with a yellow maker, the score that shows how we're screwing up. Boy, that sure is encouraging isn't it? What a morale booster!

Morale

Medicare won't pay us
Because you didn't smile,
Mrs. Smith said you were grumpy
When you were wiping her piles,
Because it just doesn't matter
That we cured her Leprous sores,
Reimbursement rules hospitals
With satisfaction scores.

Medicare won't pay us?
Quite naturally, our Chief,
Knows his bonus is in question
Along with the Chardonnay and beef,
Anxious and worried
He sends out letters forewarning,
Let's improve those satisfaction scores
Or careers will be in mourning.

With numbers to guide us
One might think we'd be the best,
But personally, I don't understand
The breakdown of the test,
Percentages and Avatars
Of statistical reporting,
After sniffing at the details
I'm left sneezing and snorting.

How is it good for morale
To keep reporting how we fail?
Highlighting the low scores
This news, soon goes stale,
It might be better to emphasize
All those things we do best,
Proud and happy warriors
Work stronger towards their quest.

I know this represents
A paradigm shift,
And it's obvious that health-care
Hasn't adjusted to the drift,
Where employees are honored
Each and every day,
Instead they threaten and bully us
And it just doesn't play.

Most certainly unwanted
Reprimands and scolding,
Reminders of our failures
Praise and bonuses, withholding,
Telling us, that we're the cause
Of reimbursement losses,
No, our highly paid leaders
Just aren't the best bosses.

Medicare won't pay us?
I don't give a damn,
But I'll do the best in my job
Because that's who I am.

Fibril_late;
12/09/12

Streamline

Editorial:

Streamline

Sustain our Mission
That's what the CEO says,
Celebrated by streamlining reductions
Please take a complimentary PEZ,
On your way out the door
We'll miss you, Honey-Pie,
Have your family send us a memo
When you shrivel up and die.

Employees are expensive
Cull the ones that are trouble-makers,
Keep the ones who generate income
The movers and shakers,
Those young Nurses
Friendly, attractive and skilled,
Sell them on our family value benefits
Family-leave, a free car-seat; they'll be thrilled.

Retire the old curmudgeons
Yes, anyone over fifty,
With twenty years in health-care
They are unpredictable and shifty,
Troublemakers, each one of them
They could rip us to shreds,
Sending letters to the local news
Regarding short-sheeting our beds.

The takeaway message as always; trim the sails
Tighten our belts, let's get more efficient,
Always spoken by the man in the pulpit
The guy at the top, he's omniscient,
With a compensation package
Pushing nine million, well-paid leader,
Urging austerity with a twinkle in his eye
Light some candles; burn the incense and cedar.

Fibril_late;
12/2/12

Stepped in a Puddle

Patient's acting badly; yelling, screaming, cursing, hitting, biting, scratching, downright dangerous. And then, thirty minutes later apologizing, as if their scientific medical diagnosis is to blame. Give me a break; that's just a very lame excuse to accommodate bad behavior.

Stepped in a Puddle

Dementia
Just ain't what it used to be,
You scream, bite, scratch and snarl
I can charge you with assault and battery,
Then, later on, you come around
And apologize for your bad behavior,
Telling me, "It's because I have Alzheimer's
I'm a sinner, I'm nobody's savior".

Twice in the past month
Patient's acting like nasty creatures,
Post-operative ugly, rabid attitudes
All kinds of undesirable features,
Then later on, sweet as a peach
Apologizing, pandering for my attention,
Declaring, "I've got mental illness"
As if they deserve some honorable mention.

It's all too touchy-feely for me
I'm supposed to say (per the Huddle)
"Thank you, for letting me be your Nurse",
Sure, I smile and wave, even though
You were a mofo-monstrous, Godzilla curse,
While your outside-caregiver shrugs shoulders
Sitting there at the side of the gurney,
If I could satisfy my secret thoughts
By god, I would need a cidal-attorney.

They don't talk about that in our Huddles
It's just as well, how I hate that whole construct,
Although I love the words that might rhyme
With chucked, plucked and bile duct,
Which coincidentally, reminds me of last night
Where I was subjected to your spitting and cursing,
Huddle me, fuddle, I stepped in a puddle
This is the bane of good Nursing.

Fibril_late;
11/28/12

One Forty-One

One day recently, at about the 8th hour of work and just before my dinner break, I had an episode of Atrial Fibrillation. Newsflash: this doesn't go well with work No, I pretty much had to sit down, and wait for it to go away...........which it did about an hour later.

One Forty-One

Atrial Fib at work
It isn't much fun,
Doubling my heart rate
To one forty-one,
I took a Toprol
Drank some fluids, took a seat,
But as soon as I got up
The same irregular beat.

It's not conducive to working
When it's banging away,
Blood pressure shoots up
I need a break and delay,
Hoping the medication
Will kick in and perform,
Then maybe, after dinner
I'll return to the norm.

What was the trigger?
I'm not really sure,
A long busy day
It went by in a blur,
Some aggravating encounters
Contributed, I suspect,
Of these modifiable risks
I must shield and protect.

We educate our clients
"Take your pills, exactly how",
Because ninety percent of them
Don't know Pepcid from puppy-chow,
Whereas, I adjust my meds
To keep my pulse regulated,
The value of that
Can not be over-stated.

Fibril_late;
11/17/12

Sick Cat

Virus vs. Bacterial

At home, everyone has the usual first-of-the-season viral cough and sneeze. Several of those guilty, are not so careful with their hand washing and what not, despite my observance and counsel. What can ya do?

Me, I managed to capture my own, nasty bacterial bug, (probably at work), and lodge it in my lungs. Subsequently,  it fermented and percolated for 3 days, and then KaPow!!! it slammed me down with a vengeance. Three days of fever, short of breath, wheezing and malaise. I've had to endure the nastiest antibiotic ever, Doxycycline (very tough on the GI tract). Oh well, it actually works, so I can only whimper.

All in all, I was one sick cat.

Sick Cat

Oh, woe is me
How ill, I was,
I hang with sick people
Just because,
I chose healthcare
In the unemployment line,
Now thirty years later
I'm spitting up brine.

Causality
A case in point,
Stories begin
At a universal joint,
A bend in the road
Allowing straight, to twist,
Now I'm hacking up loogies
As big as my fist.

I saw the Doctor, after that
Quite frankly, I was one sick cat,
It felt like fur balls in my throat
He said it looked, like a cashmere coat,
He asked if I was purring
I stated, I was wheezing,
Although, I didn't have
A runny nose or sneezing,

I had a 2-view X-ray
Which naturally was clear,
But luckily my doctor
Reads the literature each year,
He nailed it on the head
A need for antibiotics,
I wasn't one of those malingerers
The sinus psychotics,
They ask for "just a Z-pac
Because it always works",
Of course it does, you fools
That's a simple clean and jerk,
The remedy didn't do a thing
Placebo, that's the name,
Appease the masses with a pill
That's the pharmaceutical game.

Sick cat feels a little better
Day after day,
No more fur balls in my throat
But too tired to play.

Fibril_late;
11/9/12

Persistent

Persistent

Atrial Fibrillation is the most common arrhythmia in persons over the age of 50. Current practice addresses either rate control or rhythm control, meaning that some people are relatively asymptomatic, and if they can't be converted to Sinus rhythm, then, keeping their heart rate below 100 is seen as a reasonable approach. However, they require anti-coagulation. Anyway, there is a small subset of patients who are very symptomatic, fail drug therapy, and are referred for an electrical ablation procedure...............sometimes over and over and again. No fun when you are only 58 and otherwise, extremely healthy.

Persistent

Hail to the man
With the most persistent A. Fib,
He returned once again
To visit our crib,
He missed us, he stated
We're like family, so dear,
The best place to be shocked
Yes, that's why I'm here.

Dr. O'Neill is so happy
To see you again,
He loves a good challenge
Which is common in men,
Of the Irish persuasion
From the Emerald Isle,
He resides as the Judge
On this most tedious trial.

Handmaidens and bards
Stand by, as you beckon,
They are all placing bets
On that shock, I do reckon,
Such consummate professionals
This likeable crew,
Saying prayers, fingers crossed
Hats off, saluting you.

Fibril_late;
10/25/12