Geography is not your forte, is it. February 29, 2008
Posted by keepbreathing in asinine, stupid people.add a comment
We had a foreign patient in our ICU recently. They had come from a great distance to visit the United States but had fallen ill once they arrived here. They will be okay, but the mere presence of someone from far away from an uncommon land has created a stir, with the less-traveled staff asking questions of those who had cared for the patient, or of those of us who have traveled.
Of course, all of this excitement is bound to stir up a few folks who want some attention. In the midst of our discussion about the foreigners today, a very nice but none too swift aide chipped in.
“I’ve got a foreign patient too, today!” she said. This paused the conversation. We all looked at her and exchanged sideways glances with each other. There were no other foreigners in the ICU.
“Who is it?” asked one of the nurses.
“Oh, that guy in 53! He seemed like he was from somewhere weird so I asked him. He told me he’s from Indiana.”
There was a long, awkward silence. The poor aide looked confused.
“Isn’t that where the elephants are?”
:::
I give her an A for effort but an F for geography. Despite the similarities in their names, India and Indiana are in fact two completely different places. Any resemblance of the one to the other is purely coincidental.
Ah, the ER February 27, 2008
Posted by keepbreathing in Coming to an ER near you, Emergency Room, asinine, medicine, respiratory therapy.9 comments
Ah, the ER. Home of the genuine medical emergency. And of late, the whiny, ignorant, unhygienic and entitled.
“Sure,” the attitude goes, “I may be unemployed. I may be undereducated. I may be living off of your tax dollars in my trailer home while sucking down Marlboros and Miller Lite like there’s no tomorrow. But no matter how little I am willing to contribute to society, they owe me. And I will begin to collect my deserved spoils by hauling my fat ass to the ER by ambulance to complain endlessly for hours on end about my minor aches and pains, which surely do not come as a result of my extremely sedentary lifestyle or my ridiculously poor decision-making skills vis-a-vis my personal health; no, my problems come from society at large. Surely nobody would have the balls to hold me accountable for the consequences of my own excesses. And why should they? After all, it’s the duty of the suckers who work hard to subsidize the lifestyle of parasitic creatures like myself!”
Not that I am bitter.
The thing is, on some level I feel bad for these people. These are people who have turned utter defeat into a lifestyle. They not only have lost the desire to even try to live a productive life, they have lost the desire to do anything more than simply exist. They have no tools to work with, no education, minimal experience at anything beyond graft. I really do pity them. I would not want their lives. I truly wish that there was a way to help them.
But on the other hand, simply flinging money at them like a drunken sailor at a stripclub is not going to solve their problems. The problem is much, much deeper than a simple lack of funds; the problem is a lack of motivation to even try. When the system rewards those who don’t contribute, what incentive is there for them to even try?
I’m sure there are angles and shades of gray I’m not even seeing in this situation. But at least I’m trying to think about it. Any input from the audience?
Horoscope: February 25, 2008
Posted by keepbreathing in Uncategorized.1 comment so far
My return to work this week should be interesting. I’ve had a full seven days off. The re-entry from non-work to work after seven days of blissful slackitude will be trying, for sure.
To ease my anxiety, I checked my Onion Horoscope for this week:
Gemini May 21 – June 21
Friction in the workplace continues this Thursday, making you wish someone would finally cut you loose from the belt sander.
I’ve had days that felt like that.
Career Advice: Q&A with a Real Respiratory Therapist! February 25, 2008
Posted by keepbreathing in Career Advice, opinion, religion, respiratory therapists, respiratory therapy, student.3 comments
About a month ago, I got an e-mail from a student who was doing some research on different healthcare-related careers. Originally she had wanted to do nursing, but for a variety of reasons she opted to do some research on other opportunities. As part of that she e-mailed me some questions. They were thoughtful and they seemed to cover the bases pretty well, so I asked her if I could turn them into content here and she said sure. So, time now for…
Q&A With A Real Respiratory Therapist!
Q: How do you like your job as a respiratory therapist?
There is also a lot of emotional stress in the job. We deal with people who are critically ill and who are toeing the line between life and death. Much to my surprise I often find it more emotionally stressful to keep people alive than to let them die, simply because we often wind up prolonging death rather than saving lives. Mostly it’s not too bad to deal with but you’ll need an outlet, like exercise or some sort of hobby.
A: The pay varies widely between places and positions. I was a “travel RT” for some time and made excellent money with great benefits. Working as a “staff” RT I’ve found the pay to be decent but behind that of nursing. When I worked in the northeast, the pay was much better than where I’m working now by an enormous factor. Right now it’s a living, but the pay does depend on the region you’re in and the hospital you’re at. Don’t be afraid to ask for what you really want, but don’t be surprised or let down when HR and the RT manager laugh in your face and hand you the bag of peanuts that is your first week’s pay. That’s almost exactly what happened with my current position, but geographical necessity dictates that I stay here until an opportunity arises to return to the higher-paying lands of the northeast.
This concludes our first Q&A With A Real Respiratory Therapist session. If you have a question you’d like to ask me, feel free to fire an e-mail to anonymoustherapist at gmail dot com and I’ll try and get back to you. Thanks to KV for the questions in this session.
Career Choices February 23, 2008
Posted by keepbreathing in Blogroll, Career Advice, Medical Blogs, nurses, respiratory therapy.2 comments
You know, I always wanted to be a pilot. Being an RT sort of just happened to me. And I like it. Just like any other job it has its ups and downs, but on the whole? It’s not too bad. Pretty much I spend my days wandering around in the ICU managing ventilators and sucking mucous and blood out of people like some sort of grotesque underpaid vampire. I do get frustrated by the utter futility of a lot of what I spend my days doing, and more than once I’ve wanted to pound someone elses my head against a wall over and over to let the stress out. But on the whole, being an RT is a decent job.
And I will never, ever have to have a night quite like this one. You have no idea how much that pleases me.
You Might Be an RT if… February 22, 2008
Posted by keepbreathing in Blogroll, humor, respiratory therapists.add a comment
Good post over at G’s Spot. You might be an RT if…
Contrast: February 19, 2008
Posted by keepbreathing in Career Advice, Coming to an ER near you, ICU, asinine, death, ethics, life, medical ethics, respiratory therapy.10 comments
“Mr. D came in last night, somethin’ wrong with his bowels or somethin’. He was a DNR but the ER doc talked the family into trying to resuscitate him and now he’s intubated. He’s septic or somethin’ cuz he’s breathing fast.” I nodded and looked at Mr. D, who was breathing a phenomenal fifty times a minute. His thick and distended abdomen heaved as he worked against the ventilator. His mouth opened in the classic “guppy breathing” posture as he worked.
“Do you know anything else about him?” I asked the night therapist. She eyeballed me quickly and shook her head.
“Nope. I’m off. See you tonight.” I nodded back at her and went to work.
Over the course of the morning, I spent a couple of hours with Mr. D. I put him on our ARDS protocol, ran mixed venous blood samples. I put in an arterial line, which was something of a personal triumph for me because even the Intensivist couldn’t insert one on this gentleman. The nurse and I played with PEEP and pressors and tried to balance oxygenation with perfusion. It was an uphill battle. Finally, at noon, the family asked us to cease our efforts. Mr. D died within three minutes after I extubated him. I was standing outside his room when his wife pulled the curtain back. Her eyes were blooshot. She grabbed me by the arm and began sobbing.
“Is he supposed to turn blue? What should I do?” She burst into tears and began sobbing hysterically all over my sleeve. I looked over her shoulder. Mr. D was bright purple, and as I watched he heaved his last breath and gave up the ghost. He was a family man, worked diligently in his church, served his country in the army for twenty years. Within twenty hours of coming to the ER for serious sudden abdominal pain he was dead. His family was devastated.
Down the hall, I had another patient, a middle-aged ex-IV drug user, unemployed woman who had come to the hospital more than two months ago because she didn’t feel right. She progressed into respiratory failure and got intubated in mid-December. Her family refuses to give her a tracheostomy because “she wouldn’t want that,” yet they refuse to let us withdraw support because she “wants everything done…” except for a trach, evidently. We’ve explained to them how her tube is surely eroding her throat, but they won’t listen. This woman has been on and off the oscillating ventilator, she has been in and out of surgery a number of times, and she is not neurologically intact in any meaningful sense–yet she is not brain-dead. She emits a smell that could stun a musk ox at a hundred yards. She absolutely refuses to die, and her family absolutely refuses to let us withdraw support. She never worked, she spent her life abusing drugs and grunting out babies, and she sits in our ICU and wastes your tax dollars to the tune of 5,000 dollars a day so that her high-quality life of staring into the middle distance and having tubes and lines inserted into her can continue indefinitely. We are no longer treating her for any curable condition; we are now keeping her alive for no reason. If she was aware of what was going on, I’d call it torture, but luckily for her she’s in a persistent vegetative state.Her family visits for about five minutes a day and then pronounces that “The Good Lord will make her better!” and leaves. I suspect that they are attending the church of the idiot pastor, but I can’t prove that.
Sometimes the contrast between my patients astounds me.
Thank you: chapter two February 18, 2008
Posted by keepbreathing in Blogroll, Doctors, Medical Blogs, links.1 comment so far
I’ve thanked other bloggers on here before when they make especially good or amusing points. Today, I will be thanking Panda Bear MD. He has summed up most of what I do for a living in one delightful paragraph (bold emphasis added):
…So let me just state that In the United States, we are terrifically over-doctored. Much of what we spend is to overtreat either self-limiting things or to throw marginally effective therapy, at least in regard to decreased mortality, at chronic medical problems, most of which are lifestyle related. Either that or we burn through money like drunken sailors on futile end-of-life care for people who have absolutely no quality of life unless we are now measuring quality by how long you can lay motionless in your own urine before a minimum-wage nursing home caregiver decides to roll you around a little. Let me give you a few examples of typical patients to illustrate the many ways in which your money is squandered.
“There, you see? She blinked! I love you Grandma!”
I see this patient or some variation at least once on most shifts. An incredibly frail, some might say cadaverous, woman, somewhere in the neighborhood of ninety who has been in a nursing home for a decade and was doing all right with her end-stage renal disease, advanced senile dementia, and congestive heart failure until about a year ago when something broke loose during dialysis and she suffered a stroke, turning her from a demented elderly lady who had broken her hip twice to a demented, aphasic, ancient lady; completely immobile except when indifferently turned by the staff of the warehouse in which she is stored. Because she can no longer swallow the surgeons obliged her family with a PEG tube (to pour liquid food directly into her stomach) and to protect her airway she breathes humidified oxygen through a tracheostomy (a hole in her neck, with another tube sticking out of it). On a philosophical level we can debate the nature of quality of life but I’m going to go out on a limb here and suggest that laying in your own feces on eroded bed sores is not much of a quality of life. In other words, we’re not talking about a hale and hearty nonagenarian who will live to be a hundred provided she can avoid being admitted to the hospital. This is a patient who is living on borrowed time, one who will not last another six months despite our best efforts and yet, in those last six months we will spend large sums of money on her, probably more than the total spent in her whole pre-stroke life, in an inexplicable quest to stave off death, spending money at an increasing rate the closer she gets to actual “reaper” death and not the living death to which she is condemned.
Thank you, Panda Bear MD! Your writings have both amused me with their wit and saddened me with their truth. Because I’m too lazy to write anything of my own tonight, I’ll leave you dear readers with a link to another excellent article by Dr. Bear entitled How I Am Learning to Throw Money Away With Both Hands and a Big Shovel.
Moo February 16, 2008
Posted by keepbreathing in respiratory therapists, technology, work.add a comment
So we implemented our new computerized charting system and joined the 21st century this week at Sunny Flats. It has been an interesting week to be sure.
Reactions seem to be split between two basic camps: adaptable people who realize that this is the way of the future whether we like it or not, and cave men.
Even those of us who are in the first camp realize that this is not a panacea. There have been problems. We have had issues with the system, issues with the way that our flowsheets run, and issues with time management and inefficiency within the new system. However! Our managers have been readily available to help us should we need it, and the computer systems people have been around to make changes. In the first week alone, we’ve modified several of our flowsheets and added several new features to the program. As we continue to use it, it continues to evolve and change for the better. And eventually, when the rest of the hospital “Goes Live” with this, it will make things much more efficient.
But those in the second camp, the Cave Men, are dragging us all down. These are not people who are simply frustrated; I understand that there is a lot of frustration with any big change and I expect people to complain. But there are some people who are so vehemently opposed to the new system that they are actually becoming toxic employees. There is talk of mutiny, talk of jobs at lower-tech hospitals and talk of simply refusing to adapt. The Cave Men are causing problems. But I suspect that within a month most of them will have either shut up and stopped whining, quit in disgust, or been fired.
So it’s been an interesting week. We’ll see how the next week goes.
And Now: Music! February 14, 2008
Posted by keepbreathing in Uncategorized.8 comments
Happy Valentines Day, everyone!
Because I love you all, here is an excellent parody of a song. The song: DNR, sung to the tune of Nickelback’s “Rockstar.”
A friend of mine sent me this and I loved it so much I had to share. Thanks man!
