Respiratory Therapy 101: Just Keep Breathing

As I mentioned in an earlier post, sometimes music can be very evocative for one reason or another. Sometimes, songs remind you of things, trigger a memory or a thought in the same way that a distinctive smell can.

Tonight, I was listening to music as I packed my bags, readying for the upcoming trip, and my iTunes selected the only song by Blind Faith that’s ever been even remotely popular, Can’t find my way home. It reminded me of a patient I saw once, a long time ago, back when I was a newbie in the field–shortly before I graduated RT school, as it happens. This is the story.

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It was a beautiful spring morning in early May. The cool spring air and the refreshing warm breeze were a lovely change from the long cold snows of winter, and as I sat in the RT office at County Medical Hospital and listened to report I felt a thrill in the air. CMH was the only trauma center for miles around, and in this rural area something exciting was sure to happen. I had a full three days of clinical time at CMH, and so my studential self was in quite a tizzy at all the excitement sure to come.

The time was six fifty-five in the morning. My proctor and I were sitting in the office and drinking coffee, looking at her assigned treatments and plotting our day, when the ER pager in her pocket went off. Before she could look at the screen, the overhead pager went off. “Code 55, Code 55.”

“What is that?” I asked her.

“Trauma in the ER,” she said as she scooted her chair back and stood. “This early in the morning, must be an accident…some guy in a hurry to get to work, or something.” We downed the remainder of our coffees and walked downstairs to the ER, where the trauma team was assembled.

“Oh good, respiratory’s here. We’ll need you. He’s intubated.”  Part of me was filled with that perverse excitement that students get at the misfortune of others as I assumed a position at the head of the bed. My proctor spoke.

“What else do we know about him?”  The recording nurse examined her notes and spoke.

“He was found by a morning commuter who saw his truck off the road. Backwoods EMS was called to assist Rural Rescue with this guy. They tell us that there were long skidmarks on the road, and the patient egressed the vehicle via windshield.  Rural Fire had to come and cut him out of a tree some fifty feet in front of the truck.” The sound of sirens cutting out filled the air, and moments later we could hear the medics coming.

I remember the patient’s entrance vividly. A paramedic backed into the room, and I could see him bagging a bulky fortyish man. His head was split open on the top, and he was covered in old caked-on blood. His ET tube went through his shattered lips and his jaw looked askew. When the medics bagged him, I could see paradoxical chest rise and the dents caused by rows of symmetrical broken ribs. He had an open fracture on one of his arms; his pelvis, reported the EMTs, was moving a bit too much for comfort. But the crowning glory came at the feet of the patient. A rural rescue volunteer was clutching an enormous log that was jutting out of the mans thigh. It had gone through his lower leg and impaled the meat of his thigh, and since “you can’t take it out if you didn’t put it in” is a general rule of Field Medicine the medics had simply cut the branch off the tree and brought it in.

The trauma team burst into action, and my pathetic little student mind blanked out for a while. I remember bagging him through x-rays, setting up his transport vent, walking with the stretcher to the OR.  I remember seeing his x-rays: apparently when he hit the tree he hit it sternum-first and fractured something like four ribs on either side of his chest. Lab results came back eventually and showed him to have a BAC of somewhere in the “dead” range.

My day went on at CMH uneventfully after that. A few nebulizers, some blood gases, some chest PT. Around three in the afternoon the patient was transported to ICU, barely this side of life but less unstable than before. I went home at seven and prepared to return the next day.

The following morning, I was rotated into the ICU. Accident Guy was still in there, chock full of chest tubes and head drains and all kinds of weird things. His head was bolted to a Halo, the neuro drains monitored his ICP and the chest tubes bubbled away beneath him. My proctor and I worked with him on and off throughout the day, but just after lunch the trauma team needed to bring him back to the OR because he was having some sort of abdominal crisis. Once more I walked his stretcher to the ICU, unsure what to make of this guy. He was young for a dying man, only in his early forties. He had a job and was successful enough to afford a new truck to be launched out of at high velocity. And yet, he had been out drinking enough to raise his BAC into the 300 vicinity.  Why, I wondered, would he throw his life away like this?  I would have mused more but there was work to do, and once more I went home puzzled by the life and times of Accident Guy.

I arrived early the next morning, walking through the hospital doors at 6:15 just in time to hear a Code Blue being called in the ICU. I realized with a jump in my belly that it was accident guy. I sped up to the RT lounge and dropped my things in a pile before running into his room to watch. The trauma surgeon was at the head of the bed with an RT, shouting instructions around the room as shocks were given and his already beaten chest was compressed. Time passed by quickly, and after a full forty minutes of the best medicine we could throw at him, accident guy finally died, slipping violently from this world in a way we’d all hoped he wouldn’t.

I stayed in the room as everyone filtered out. It wasn’t my first exposure to death, but it was still more puzzling to me than most. I sighed and crossed my arms, staring at the empty body on the bed and wondering.  A grouchy nurse growled at me. “The asshole deserved it, kid. He was driving wasted. He was a philanderin’ bum. Don’t waste your pity.” Shocked at her callousness, I turned to stalk out of the room, and then– I saw it.

The most heartbreaking thing I have ever seen in my life.

A drawing, carefully made with crayons, depicting a happy family on a sunny day in a field. A big yellow sun shone from one corner and the stickmen had happy smiles plastered on their faces. Across the front of the card, scribbled in blue crayola, was the legend Get better soon daddy! I love you!

There is nothing more heartbreaking than the crushed optimism of a young child. I have never been able to forget that card and I probably never will.

Come down off your throne
And leave your body alone
Somebody must change
You are the reason
I’ve been waiting so long
Somebody holds the key
Well, I’m near the end and I just ain’t got the time
Well, I’m wasted and I can’t find my way home

Come down on your own
And leave your money at home
Somebody must change
You are the reason
I’ve been waiting all these years
Somebody holds the key
I’m near the end, and I just ain’t got the time
Oh, and I’m wasted, and I can’t find my way home

But I can’t find my way home
But I can’t find my way home
But I can’t find my way home
But I can’t find my way home
Still, I can’t find my way home
And, I ain’t done nothing wrong
But, I can’t find my way home