Respiratory Therapy 101: Just Keep Breathing

“Congratulations. You survived your first biopsy.”

Not thrilled about that one.

The odds are stacked in my favor. I will quite probably be fine. But because I spend my days working with people who have had the odds crap on their lives, I am frightened. Intellectually, I know that I will probably be fine. People my age don’t typically get skin cancer. But on another more visceral level, I am terrified. I think of the patients I have seen who have struggled with unlikely illnesses. I can’t get the thought out of my mind that something is wrong with me. It worries me…and I don’t get worried often. It bothers me to be worried about something so small and so unlikely to be a problem. It’s a never ending cycle of anxiety. The spectre of cancer looms large in the back of my mind.

The growth that scared me into seeing a doctor came on fast. It was not there one moment, and then one day I scratched an itch on my side and went: when the hell did I get a mole there?

On closer inspection it was raised, uneven, and asymmetrical. I watched it for a couple of days and it continued to grow…slowly, but surely.

Less than two weeks later, I found myself on the chair beneath the bright lights of dermatology*, having my skin examined in detail by a sweet blonde dermatologist who peered carefully at my skin from beneath small glasses. She asked me if I spent a lot of time in the sun (no.) She asked me if I had any family with cancer (not that I know of.) She circled and photographed a number of moles on my back and chest, and she marked two on my side for biopsy. She combed through my hair and found two more that were “concerning” to her, and then she laid me down and had the nurse numb me up. They injected lidocaine into my head and then had me lay flat so they could numb my side. I was afraid that the lidocaine would fail; but I felt not a thing as the derm swiftly scalped me. Moments later small and threatening chunks of my flesh were floating in some sort of substance to preserve them for the pathologist and I was sitting up, noting with interest the blood coming from the first biopsy site. The dermatologist spoke.

“We’ll call you within two weeks if there’s anything abnormal. If there’s nothing to worry about we’ll mail you a letter. Either way I will be seeing you in a few weeks.” She flashed me a smile and then left. Her nurse gave me a packet of papers and a prescription and an appointment to come back. My skin was sent off to be peered at by smart people who I am sure will say that it’s fine.

I know it’s nothing. I just can’t stop thinking about it. I will sleep better when the pathology results come in.

*A phrase I am borrowing from the dermatology nurse, who was very nice.

Sorry folks, but my muse has fled for the time being. The combination of the summer work drought, the political issues going on within the hospital, and some events in my personal life have combined to drain me of what energy I usually have for blogging. I promise I’ll stick around and as soon as anything interesting happens, I’ll let you know.

Meantime, I’m poor. Send money. And inspiration.

I got into the elevator last night after work to head up to the RT office to fill out some paperwork. I walked to the appropriate elevator bank and hit the UP button.

I waited impatiently. A young couple came around the corner. The female looked at me.

“Which way do we go to get to the ER?” she asked me.

“That would be down and then to your right,” I answered. There was an awkward pause as we continued to wait for the elevators. I noticed that the male was holding one of his hands in the other.

“Hey, dude. Maybe you know. Are they gonna need to stitch this?” Before I could object and explain that I am neither a doctor nor a person who normally stitches things, he unfolded his hands and thrust his thumb at me. A significant chunk of flesh was hanging off of the end of his thumb, just baaaarely holding on by a small piece of skin. I looked with interest as the chunk of flesh wobbled. Blood dripped down his hand. The guy continued talking. “Because dude, I don’t want stitches, man. I’ll just take it freaking off if they’re gonna have to stitch it. I’ll just do it at home, you know? Because stitches hurt man!”

I explained to the dude that it was possible that he would require some stitching to get his thumb back to normal. I also explained that if he chopped it off himself or if he didn’t at least let someone look at it, he was likely to get some sort of infection. It took some persuading but he promised to go to the ER and let them do whatever they would do for him.

At that moment an elevator dinged and we all walked in. The dude covered his thumb back up and waited patiently as the elevator went up. The door dinged and opened up on my floor. I stepped out and turned around.

“Good luck, guys.”

“Hey man, thanks for your advice.” I nodded, and as the doors closed…

…I could just see the dude giving me the thumbs up. With a twist.

Via Vitum Medicinus, I have been introduced to the wonderful world of Science-Based Medicine. Written by a group of experienced physicians, SBM analyzes “the relationship between science and medicine.” There is a lot more to that than it may sound like. Science and evidence are often forgotten in modern practice in favor of provider preference and/or laziness.

I can’t tell you how often I find myself doing things as an RT simply because an ordering provider is stuck in their ways. While the hospital I work in is fairly advanced and actually has an evidence review committee to oversee our practices and make sure that they’re backed by current research and evidence, we have a number of providers who consistently ignore the evidence in favor of their own preferences, most of them in the ER, where fear of litigation and the ability to simply check boxes instead of actually writing orders leads many physicians to order nebulizers and ABGs on people who have absolutely zero indication for either one.

Anyway, VM is always a good read, and Science-Based Medicine looks like hours of fun. Head on over and check them out.

It seems to me that for whatever reason, respiratory therapy departments are almost always given the least desirable office space in the hospital.

Where I work now, we have been “homeless” for years and years. For some time the department was decentralized and as such there was no need for an office, but about five years ago we coagulated back into a centralized department. On forming into this new department, we were promised office space on a disused medical floor at the top of the hospital, and construction promptly began on our new office space. There would be windows, workstations, and a small lounge. It would be Respiratory Therapy Paradise, and we were excited.

Until that time came, we were given a conference room which we would use for shift report. Across the hall was a small office which stored our mailboxes and lockers; down the hall was a converted patient room which our managers shared. But the medical floor that we were on hated us. RTs are often loud and social people, especially during shift changes. RTs tend to be outspoken. The nursing staff intensely disliked sharing space with us, and eventually they lobbied hard enough for us to be moved.

While that was going on, the ER stole our promised space on the top floor. Ostensibly they use it for “observation” patients, people who have been admitted but who have not yet been assigned a room. Realistically, nobody knows what they do with it.

So we had no office. Our managers searched long and hard and found a section of the hospital that was unused, in between the ICU and the operating room. We moved our supplies and our space in there and settled in…until there was a Major Mechanical Malfuntion and the floor was condemned. The hospital is working on it but suffice it to say we were moved again, this time to a large space formerly owned by the NICU on the third floor.

After a few months there it was discovered that our office space was chock full o’ asbestos, and we needed to move. The hospital administrators were reluctant to spend a lot of money on us, so…

…we have been moved from our spacious (if asbestos laden) office space to a storage closet. Yes…our 120-therapist department has been moved from a spacious office space to a storage closet that is scarcely large enough to hold four or five people comfortably.

This is a trend most places, it seems to me. The first place I worked we had a random empty space between units. I have worked in departments that had little more than a blood-gas machine and an alcove. I have worked in departments that shared space with PT/OT/ST, spent time with departments that had no office space but who were forced to spread themselves out over hundreds of tiny stashes. The nicest place I ever worked at had an RT office in a quiet corner between the ER and the ICU with a nice big window looking out over the forest, but that was an aberration in a long string of random offices.

Why is it that we always get the crap office space, RTs? Don’t we deserve better? Wouldn’t life be easier if we could have one centralized office in the hospital with all of our supplies, our lockers, and a small lounge? It seems to me that we are constantly being screwed, office-wise, and I am wondering why.

I guess it’s just ancillary life. Sigh.