Telemetry Interpretation is Subjective…

I must remember that by-line. I worked a shift whereby the patient had been admitted as a Medical Inpatient to the Med.-Surg. unit because of Hypertension and unexplained Syncopal episodes. The patient was an 87 year old female. During my shift I happened to capture the syncopal episode on a tele strip. The patient had been in Sinus Rhythm converting to Irregular Sinus Bradycardia (heart rate of 48) then had a 2-4 beat “pause.” The pause had fibrillatory waves and I was noting ventricular conduction with regular QRS complexes. Each time this happened the patient was monitored by the nurse and had a heart rate. Due to the fact the patient had a heart rate and that I had normal QRS complexes I called this portion of the strip an Agonal rhythm because it would correspond with her Syncopal episodes. Another Tech decided to call this Asystole. I don’t agree with that interpretation because of the scenario described above, while I may concede that it was a bradyastolic rhythm, we as tele’s are not supposed to diagnose and the latter would be a diagnosis rather than an interpretation. I verified my strip interepretation with the Hospitalist and he felt that the overall interpretation ( NSR to Irregular Sinus Bradycardia to Agonal Rhythm) was appropriate. However, because the AM Tech called the rhythm Asystole and tends to be very aggressive and argumentative with my Nurse Manager, Nurse Manager has called for a Sentineal Review of my strips…fortunaely, my ICU Nurse stands by my intrepretation, as does the Hospitalsit. I am just frustrated because I work hard to be good at what I do. Admittedly, I am still in a learning stage and do not have the guidance the day Tele’s get from the Cardiologist regarding interpretations (because he is not there on the graveyard shifts I work), but I constantly feel under attack by a certain Nurse and another Tech (who  both think they are absolutely perfect and don’t realize that they miss things from time to time, too). I feel I am diligent and am continually trying to improve my skills and ECG knowledge base because I don’t feel that the two day course I received will always help me identify dangerous arrhythmia’s….but the lesson learned is to continue to document that any unusual interpretation’s by my part are “confirmed by RN or confirmed by MD.” Thank heavens in this situation I did that!!!

Sex In MY City…

I had the most curious adventure today…I was coming off a graveyard shift and needed to get a new toothbrush and toothpaste. I figured I’d swing by the local Walmart to get these needed items on my way home. So sitting in a knee crunch position trying to decide what toothbrush I wanted a handsome young man approaches me and says: “Excuse me..”  Feeling a little tired, and impatient I am thinking of some snarky comment that would be succinct and to the point in conveying that I do not work at Walmart when his next words were: “are you seeing someone?” I  literally did a double take and said: “Waaahhht?” and the young man , a little more boldly this time said:  “Ma’am are you seeing someone?”   Totally taken aback, I said “Yes.” I wish I would have played along a little more, it would have been fun to say something out of character like: “Yes, I’m seeing you!”

I admired this young man in a way, if that is his pick up line he must get laid date  lot. I wondered why I hadn’t thought of that line when I was 21-ish?

Then I got to thinking about the scenario more and wanted to know the  “back story” of this kid…what would make him bold enough to go up to a stranger and ask: “are you seeing anyone?” I imagined that he only had a month to live and didn’t want to die a virgin, or he was  getting ready to be shipped out to Iraq or Afganastan and wanted to gain a sexual experience from an older woman…or I imagined that he was getting ready to come out of the closet but before he did so had to have a farewell f*ck with a complete stranger…

It was fun to imagine the back story. It was flattering to my almost 40-year-old ego (I’ve only been hit on twice before…once when I was 16 by a lecherous old man; and once from another female when I was about 21).

I am taking a Human Sexuality class and now I am curious as to what causes arousal and desire? What causes people to pair up and become a couple? What makes people feel comfortable and attraced to another enough to ask: “are you seeing someone?”

Evidently, I’ve been doing things wrong…I could have simplified my entire sexual encouters/dating experiences/relationship endeavors had I only listened to my grandmother’s advice…”find, and marry a  nice boy you meet at the grocery store.”

I know people in my rural city are “doing it” because I see the little  peanuts whenever I am floated into OB…but I had no idea that sex in MY city began with a grocery store adventure!

Telemetry Strips…

I recently learned an invaluable lesson…BE OBSERVANT! We usually watch our monitors with all leads on the II lead as the primary lead and wither V or MCL as our secondary, comparison lead. One of the techs changed the viewpoint on the telemonitors so that instead of II being the primary lead observed;  lead V was the primary focus. I didn’t notice this and a patient who was in A-flutter was presenting on the lead V viewpoint as V-Tach. It  alarmed me as I noticed the potentially dangerous rhythm without marching it out. On our monitors, when an alarm is on the observable lead that is primary will populate into a bigger screen…so lead V appeared to be V-Tach. When I printed the strip and showed it to my Nurse she said — “not true V-Tach…make sure to look at  the secondary lead strip…the patient is in A-flutter. You are seeing an abherrant conduction in the primary lead.” I felt like a total f**k up!. I generally DO look at the big picture and compare and contrast both the primary and secondary leads. In this case, I was just finishing with report and not really settled in (or apparently paying attention). SO….now I know to double check my lead setting before making an interpretation; AND, I will ALWAYS make sure that when I report I advise the oncoming shift of any monitor changes I’ve made. This was a great learning opportunity (and the strip will be posted in a day or two — trying to figure out my new scanner).

“Knowledge comes, but wisdom lingers” Lord Alfred Tennyson

This experience gives me both knowledge and a bit of wisdom. For that I am eternally grateful.

Blessings and Light.

Darkness Falls….

Even though the resolution in my school matter was such that my life is not completely ruined, I am experiencing so much self-loathing for my lack of wisdom. Even worse is the fact that I broke a huge facet of my own moral code. I don’t know why I thought it was the right thing to help out this girl…I guess I got pulled into the horrors of her life (her mother is dying, she is in a relationship whereby she is experiencing abuse, she wants to be a student but is having tremendous financial problems and needs to work three jobs just to get by). I felt that all she needed was a helping hand, but my life was such that I couldn’t help her in the right way (i.e. help her figure out her topic, teach her how to research, show her how to cite sources, help her build and develop an outline)..instead, I gave her my paper to use as a resource and she plagerized it.

The result for her was bad…she was expelled. I was merely given a warning. But, once I realized  how much my naivety could have cost me…I feel hate  for being the kind of person that is easily lead astray…I have much darkness inside for not knowing that what I was doing was a wrong course of action.

Because I feel so much disgust over my participation in this type of cheating, I guess I feel that I should not be forgiven, so when I received this letter from my Professor, I was overwhelmed with tears…tears for my remorse and tears for my gratitude. I am grateful that I still have a chance at a future I’ve been working on for some time; and to know tha someone understands the depths of despair I am feeling — well, that is remarkable.

This is an excerpt from my letter: “Missteps don’t mean the end. They just mean you have to make amends and try again. We all go through dark times, and I know you are experiencing some dark things. I just want you to know that you will come out on the other side stronger and with greater resolve. “

I have a long way to go, a lot of work to do to get myself back…to become the person I admire and most want to be. I hope I am able to continually do the right things to be a person of integrity again.

Necessary and Sufficient…

These Cell Biology concepts are so easy they are complex! Still trying to consolidate in my mind all of the complexities, because if I think about the nuances for too long, I feel like I am in a circular philosophical argument…Necessary = a condintion whereby A is said to be necessary for a condition B, if (and only if) the non-occurrence of A guarantees the non-occurrence of B. Sufficient = a condition whereby A is said to be sufficient for a conditon B if the occurrence of A guarantees the occurrence of B. SO, I explained it by illustrating the role of the centrosome –> it has a key role in efficient mitosis but is not necessary for mitosis to occur. “Centrosomes are not required for the progression of mitosis. WHen the centrosomes are irradiated by a laser, mitosis proceeds normally with a morphologically normal spindle….many cells can undergo interphase without centrosomes (thus, deeming them not necessary) .” Interesting…still trying to explain Sufficient. If anyone has a good example pertaing to the cell of Sufficient, or an easier way to make these concepts a little more clear and concise, I would appreciate your input!