The Green Light of the Yellow LVAD

An unusual case of congestive heart failure following routine excision of a skin neoplasm

Originally posted to MEDLIB-L on 26 February 2016

Etiology: one of our more brilliant ICU attendings said something that made me think "you're a better drug than lasix, heparin." Then I thought "Kipling." Well, I haven't kippled for years, so that didn't go anywhere. I settled on Milton Hayes. You can see the original text and hear Bransby Williams reciting it here: https://www.youtube.com/watch?v=E1IacBE11Yo. (Text and recording are public domain.)

The alert reader will notice the astonishing lack of punctuation in this work. This is deliberate, to give the reader a sense of the ICU delerium that the patient may be feeling after his rather extraordinary experiences. Or it could be that I didn't feel like figuring out where everything went. You decide.

Released under some form of Creative Commons:
1. You are free to use and redistribute this work without asking my permission.
2. Attribute the work to me, Fred King, if feasible.
3. You are free to modify this work; if you improve it, I'd appreciate a copy. Send it to phred (at) phred (dot) us. Comments are welcome at the same address.


There's a broken-hearted patient in the ICU tonight
There's an ECMO standing vigilant but mum
There's a man with CHF but they hope to put him right
With the promise of an LVAD soon to come

He is only fifty-one, but he toils in the sun
He's a farmer in the fields of gold and green
And while plowing up the rows he saw a mole that grows and grows
For farmers can't be bothered with sunscreen

So he sought a doctor's care, for the mole gave him a scare
From the months and years of working on his farm
And the doctor took a look in her diagnostic book
Actinic keratosis on his arm

I really must insist you need a dermatologist
Said the doctor, go and see one right away
So he found someone to cut, a doctor said to know what's what
And was scheduled for the dawn of the next day

The doctor hadn't had his coffee and his attitude was lofty
I don't need to wash for such a tiny job
The doctor didn't seem to care, worked with hands that were quite bare
And cleaned up with a dirty cotton swab

So the wound became infected and a skin graft was rejected
All because the doctor didn't wash his hands
If he'd washed and gloved and gowned, germs would not have been around
As the proper rule of surgery demands

Though packed with antibiotic his large colon was necrotic
And he had to have a foot of bowel removed
Then he got an ulcer peptic, and his bloodstream it was septic
And the c diff by the smell was quite soon proved

Then he lay in bed a while, in a coma dripping bile
'Til the doctor filled him in on what he'd missed
Your EKG is now abnormal as an outcome of your mormal*
And you need to see a cardiologist

Then they took him to the lab where a doctor named McNabb
Placed catheters that fit to him to a T
His ejection fraction's low and his blood it cannot flow
To all the places that it needs to be

We can make the patient grin if we put an LVAD in
Though a candidate for transplant he is not
His quality of life will improve without this strife
His insurance comp'ny thinks it's worth a shot

There's a broken-hearted patient in the ICU tonight
There's an ECMO standing vigilant but mum
There's a man with CHF but they hope to put him right
With the promise of an LVAD soon to come

*mormal: an oozing sore. See http://www.luminarium.org/medlit/cookport.htm