Respiratory Therapy 101: Just Keep Breathing

This is a story that will stay with me for the rest of my life. No matter how I try to forget this little gem, it will always remain locked inside of my brains somewhere, just waiting to come out. Anybody who’s offended by the fact that people have genitals should stop reading this right now.

It was a cool day in the early fall in the Great North Woods. I was working an extra shift at Our Lady of Immaculate Grace, a day shift for a change, and the effect of the sunlight and the odd hours (for me) were combining to make my day an exercise in caffeine-driven medicine. Luckily for me, the day was turning out to be on the slow side, and so it was that I was sipping a steaming cup of coffee and admiring the gorgeous fall day through the window of an empty room when I felt the pager vibrate at my hip. I swallowed my coffee and glanced at the screen.

PLEASE CALL ER 8120

I put down my coffee and picked up the phone in the patient room. The ER phone rang once, twice, three times. Finally the secretary answered.

“Emergency.”
“Respiratory.”

“Hang on.” There was a thud as her phone hit the desk. I heard a distant who needs respiratory? Some muffled speaking responded and the secretary returned to the phone. “They need a blood gas in room one as soon as possible.”

“I’ll be right down.” I hung up the phone, chugged the remainder of my coffee and went to find the student. After all, if I can get paid to have somebody else do my work in the name of learning, why not? I wandered into the ICU and found the student checking one of our vintage 1980’s PB-7200 vents.

“Want to get a blood gas?” The student looked up and nodded. I found his preceptor and told them I was stealing him for a few minutes, and then the student and I marched through the halls, twisting around bends and descending stairs until we were in the basement ER of Our lady. On the way I explained the ER to the student.

“There’s a board behind the desk that has all the patient information on it, so you can copy their names and stuff before you have to do anything. Make sure you get a blue-card* stamp on them and check your orders.” We entered the ER through the Secret Staff Entrance and I went to examine the board. Something was off: under the DIAGNOSIS column for room 1 was the legend priapism. I turned to the secretary.

“Hey, you said room one, right?”

“Yeah. Here’s the chart.” I grabbed it from her and examined the cover sheet. The box for ABG was checked off. I figured that somebody had forgotten to write in a new diagnosis and shook off my doubts. I grabbed a blood-gas kit, beckoned to the student and went to the room. I knocked on the doorframe, pushed the curtain back…and saw what was quite possibly the last thing I was expecting to see.
A middle-aged man was reclined on the gurney. His legs hung over the foot of the gurney and he was on his back staring intently at the ceiling while a white-coated urologist peered intently into his disturbingly tented johnny. I stopped dead in my tracks and blinked once, then twice. I glanced at the student, who had his head cocked to one side and seemed perplexed by the scene before us. The urologist ceased his peeping and turned to us, eyeing the student and me over the top of his reading glasses.

“Ah, respiratory. Good. I need you to get a blood gas–” here he pointed at the unfortunate patient’s engorged member–”on this.” He rolled his stool back to let us in and gestured at the johnny-tent.

There was a long and awkward pause. Dare I say that my posture stiffened a bit? The student, on the other and, was wilting into a flaccid pile of collegiate awkwardness in the corner. I stared at the urologist, and he stared back at me. The patient stared at the ceiling and probably tried very hard not to think about what the urologist had just asked me to do. The atmosphere was a bit tense, to say the least. Finally I spoke.

“I’m sorry, you want me to do…what?”

“I want you to get a blood gas. On his…you know. On his priapism.”

“You want me to what?!” I turned bright red in embarrassment and shock. Nothing in the world could have prepared me for this. I never learned about this in RT school; our blood-gas models were plastic arms, not fake penises. I was deeply and truly shocked that someone would ask me to stick a needle into another man’s genitals. Perhaps I have not spent enough time in the city but this truly seemed unusual to me. The urologist, not sensing my confusion, simply nodded at me, saying: of course I want you to do that. Just another day in the life, right? I stammered out an objection.

“I…um…no! No, I absolutely will not do that. That is so not even in my scope of practice to be jamming this needle into that man’s penis.” The patient, already tense, turned white at the mention of this act. The urologist’s resolve seemed to harden at this point: my denials of service served only to infuriate him.

“You will so! I need a blood gas on it to see how long it’s been like this. He says maybe four hours, but I need a CO2 and a lactic acid to be sure. And you’re the people who draw blood gases, right? So do it already! You just put the needle into the corpus cavernosum and you’re there. Easiest thing in the world. Simpler than wherever you usually get them.”

“That’s as may be, but no way. Absolutely not. Nyet, nein, nay, no. If you get me the blood I will run it but I am not going to do that. I’m going to go wait by the nurses station and you can bring me the blood to run.” I left the syringe on the table, turned on my heel and left. I wanted to apologize to the patient but the embarrassment would have been unbearable for both of us.

It was a brief wait before the Urologist brought out a tube of blood for us to run. The CO2 was pretty high; the lactic acid was 17, an astonishingly high number indicating that he’d had a problem going on for quite some time now. The urologist was pleased with these results, and evidently solved the problem by draining all of the blood from the penis through some sort of needle. I was curious to see exactly what was done…but not that curious.

:::

To read the tales of a real-life urologist, see Keagirl’s blog! She’s been busy with Sudoku lately but hopefully will be back soon.

*The blue-card stamper was a machine in which a plastic card with patient demographics was inserted between a sheet of paper and a gigantic stamping machine. It is a precursor to the more modern adhesive patient labels.