Respiratory Therapy 101: Just Keep Breathing

There was an awkward situation in the ER today.

I was called to give some breathing treatments to a young lad who was not familiar with the English language. His family was unfamiliar with the language as well, and the hospital had been having some difficulty locating a translator for this particular language. I explained what I was going to do with pantomime and gestures as best I could, and then I popped the kid on a treatment. RT department policy is to not leave patients unattended while on treatments, so I made myself comfy and leaned back against a wall.

In situations like this, I never know where to look, so I simply watched the patient breathe while the family watched me and conversed quietly among themselves.It was an uncomfortable silence: they weren’t 100% sure what I was up to, and I was 100% unsure what they were discussing. The air was thick with uncertainty.

Suddenly, a small girl broke away from the pack. She had a rubber glove that was blown up with a happy face on it, and she stopped about a fooot away from me.

“(something!)” she said to me, and tossed the glove.

I caught it and tossed back, and she laughed and jumped in the air and threw the glove again. I made a stuipd face and tossed the glove back to her, and every time she caught it she laughed with delight. The family watched nervously at first, but soon they were speaking with her and laughing along as she and I tossed the glove back and forth.

Soon enough the treatment was done. I don’t know that it did the patient any good, but I feel like I made a difference with the family on a more basic level than that. Catch is played the same no matter which language you speak…it was fun.

…when you are actually surprised to see a patient who truly needs therapy.

I would venture to say that as many as four out of five calls for “patients in respiratory distress” are pure BS. A similar number of patients ordered on treatments are inappropriately ordered. Many patients take home meds that we should continue in the hospital; many patients truly need their therapy; but much more often than that we find the patients who are on treatments for no discernible reason.

Often, the reason for the treatments or orders is not “the patient wants or needs a treatment” so much as it is “we want you to come look at this patient.” But because nurses are afraid to ask us to come assess patients, they tell us the patient is in distress or they get a lazy physician to order some treatments for some inappropriate reason. Or, physicians just want to cover themselves and so they write for treatments.

The thing that gets me is, I don’t mind being called to assess a patient. I would much rather get a call saying “hey, can you just look at this guy and tell me what you think about his breathing?” than a call saying “I wasn’t sure what was going on so I got an order for albuterol.” I’d much rather a physician write for “RT to evaluate patient” than that they write “Albuterol Q4.”

Just had to vent. It’s been a frustrating week, with many inappropriate orders and much conflict. Maybe a happy story later.

…have been greatly exaggerated.

I am alive and well, but I’ve been on a small vacation. More stories and nonsense to come soon.

….this is freaking funny:

It’s Wilford Brimley as a cat. I can’t stop laughing.

Back when I was in RT school, I was not confident about my success as an RT. I worried that the stress of dealing with the seriously ill coupled with the odd hours and the mass of knowledge required would cause me to be an abject failure as a respiratory therapist.

Because of my fear of failure I drew up emergency backup career plans. I had not done well in school prior to going to RT school. I am not the kind of person who can easily spend a lot of time studying because I tend to be easily distracted. I am smart, but not necessarily motivated, and that’s a bad combination because being smart doesn’t matter if you’re lazy.

So anyway, in the midst of RT school I drew up an emergency backup career plan. At the time I was working as a courier for a local company that specialized in business-to-business deliveries across the state. I’d pick up short evening shifts and longer weekend runs, spending 12 to 14 hours on the road going back and forth from company to company. In a single day I could go all the way from the Tip Of Civilization in the northern realms of the state down to the more developed areas in the southern parts of the state. The job was a lot of fun. It was simple; bring things from point A to point B and get them there on time. I rather enjoyed it.

And so it was that I decided that if I couldn’t be a respiratory therapist…if for some reason the world of breathing did not pan out for me…I would become…

…a truck driver.

It’s a demanding job, but it’s an important one: after all, everything gets where it is in the back of a truck, from medical equipment to produce. It’s not easy. It’s stressful and commands long hours. But dealing with stress, long hours, and jerks are all skills that those of us in medicine have anyway.

For a long time I thought I was alone in this. But the other day, another therapist originally from my area and I were working in the BICU* together and got to talking about what other jobs would be out there.

“You know, it sounds crazy, but I always thought I could be a trucker if all else failed.”

“That’s not crazy. I actually thought the same thing. You go to school for three weeks, learn the ropes, and then go over the road. The pay’s the same as or better than what we’re making here.”

“That’s true.”

“I drove for a while when I was running homecare. They didn’t need any clinical RTs so they got me a class B license and sent me on the road with supplies.”

“Did you like it?”

“Loved it. Once the kids are a little older I might go back to it, get my class A and a hazmat and hit the road.”

….So, dear readers. What were your alternative career plans? I don’t know a lot of RTs who always wanted to be an RT; most people sort of fall into it. What were your backup plans? What else would you do if being an RT suddenly was no longer fulfilling?

*The BICU is the Burnout ICU. It contains our most hopeless and awful patients. While it can be interesting sometimes, right now it’s full of patients that make you want to quit.

I know we are not supposed to judge our patients. I know we can’t know about their lives and we haven’t walked a mile in their shoes and yada yada yada, but this is real life. Some people are so degenerate and disgusting that I honestly find myself asking, why are we taking the time to save this person? Is the supposition that all lives are really worth saving at any cost valid?

In a word: no.

I’ve seen a lot of cases that made me uneasy, a lot of people who I honestly didn’t want to treat. But this one put me over the edge and sent me screaming into the abyss.

The patient is a female between 25 and 35 years of age. Presents with Pneumocystis Carinii pneumonia. Severe IV drug use history. She has known herself to be HIV+ for many years. Five children, all born post-HIV with minimal prenatal care with no child sharing fathers. No job, no insurance except Medicaid. Her family threatens healthcare providers. Her case is complicated by bizarre gastric colonizations that neccesitate drastic abdominal surgery.

After three months in the ICU, numerous operations, hundreds of radiological and laboratory studies, and enough medication to give every child in Indonesia a separate prescription, the hospital bill totals in the hundreds of thousands of dollars. Who’s going to pay that bill? The care isn’t free. I am not a volunteer and neither are any of my colleagues. The medication is not free, nor is the equipment we are using to keep her ingrateful self alive. The money to pay for her care will come from the government, who will take it from your paycheck. You and I are paying for her care. Why?

Before you accuse me of being heartless, consider this. The patient is an enormous public health risk. She has had unprotected sex with at least five men since becoming aware of her diagnosis of HIV, as evidenced by her five children by different fathers. She has ruined her childrens chances of having a successful future by naming them in a poorly spelled fashion after recreational chemicals and acts of violence. She has not worked a day in her life, subsisting instead on handouts, again from you and me. Her parents, elderly people, are being forced to care for her children because she is incapable of providing them anything.

In summary: she is an active public health risk. She has never contributed to society. She has in fact spent her entire life leeching off of people who make an honest living. Nobody forced her to live this way; she does not have an inborn handicap. She chose this lifestyle and now she has to live with the consequences.

I don’t see why we’re bothering. She’s hopeless. Sometimes the best thing to do is to do nothing at all, and I think it’s high time we took that action in this case.

Glenna over at G’s Spot has a post up about a hospital security guard in her area who was killed by a patient in police custody who kicked him in the back of the head.

I continue to maintain that some people do not deserve our treatment. Healthcare is not a right, especially not if one is going to assault the employees of the hospital. Gangsters, inmates, and violent felons do not deserve treatment, especially not if they are going to be violent towards hospital workers. I fail to see why we should treat people whose continued existence is a threat to society, especially since the money that the government confiscates from my paycheck is going towards their treatment. I am going to be impolitic here and say that the cheapest way to treat a lot of these people would be to dump them in the corner of the parking lot and let them rot as a warning to others.

I don’t mind treating the homeless, the working poor, and people who are just down on their luck. I don’t mind treating stupid people even though they sometimes frustrate me. I have no issues treating people of different religions, different races, different orientations or different politics from me.

But when somebody is destructive enough to kill a hospital security guard, I really don’t understand why we would waste the time and money to treat them.