Respiratory Therapy 101: Just Keep Breathing

It’s been an awful week and I’m sorry to have been so ridden with angst and whatnot. It’s probably going to continue, but instead of whining and complaining I’ve decided to take a humorous interlude.

So I give you: testicles.

Many times over the last two weeks I’ve seen grown people eating testicles on TV. Mike Rowe on Dirty Jobs was assigned the task of removing sheep’s testicles from their owners with his teeth, after which they were pan fried. Chris Cosentino on the Iron Chef served a dish in Battle Offal that included duck fries, the secret code for duck testicles. And on Bizarre Foods, Andrew Zimmern served several variations on the testes over a series of shows.

This sounds disgusting, and I guess in a certain light it is. On the other hand, though, most everyone who ate them seemed indifferent to them at worst…indeed, several people seemed to like them. If people didn’t know “Hey, I’m getting testes in this dish” they’d probably scarf them down without a second thought. After all, how many of us eat hot dogs? How many of us would if we saw them made? There you go.

So it is with all this in mind that I came up with a thought in the shower this morning. If I were to ever open a fusion restaurant that used heavy amounts of fruit and offal, I think I’d call it The Apple Orchid.

Sometimes I crack myself up.

The blog title isn’t merely a whimsical summary of the world of respiratory care, it is solid advice. Taking a few deep breaths is healthy. It gives you a moment’s pause. It lets you stop, re-think, not say something stupid. Taking a deep breath can relax you, focus you, help you to clear your head. The act of breathing is more than a physiological neccesity for the maintenance of life, it is a tool to help you relax and focus. Feeling stressed? Stop, take a few deep breaths, and try to approach the stress anew. Need to unwind? Skip the booze and try doing some deep breathing exercises. If you want to multiply the benefits of breathing, try some vigorous exercise! A few miles on the road and you’ll be huffing and puffing, and before long you’ll be feeling the endorphin kick…better than sex, some say. 

As much as I advocate for the stress-reducing benefits of deep breathing and running, there are times when it’s just not enough. My stress-reduction measures are failing.  I got back from a two and a half mile run today, but a short conversation later I was back to furious and stressed. 

Nevertheless, there’s only one thing to be done. Sit back, close my eyes, heave a deep breath…and then just keep breathing.

Until I have a good story or something fun to write, here’s some filler. The other day at the hospital somebody was asking me what exactly I do in my spare time. Beyond classwork and reading, the answer is: not much. I’m really not an exciting, party-hearty type of guy. In fact, at a party I would likely be the dorky guy in the corner staring at the bookcase and avoiding conversation out of pure awkwardness, unless the bar was open in which case I’d be the guy who laughed manically at nothing and then fell over.

Anyway, the filler. I was specifically asked what kind of music I listen to. In answer, I give you the Filler, which is a list of the first 17 titles that appear when I shuffle my iTunes library. Here we go:

(1) The Show Must Go On–Pink Floyd–The Wall, Disc 2. A classic which I feel no need to defend.

(2) Barrel of a Gun–Guster– Guster On Ice, Live from Portland, Maine. Does anybody out there listen to Guster? More interestingly, was anybody else actually at this show live in person? I saw this show live when I was in college, the night before they recorded their show. 

(3) Goodnight–Galactic–Coolin’ Off. Galactic is a New Orleans based funk jazz band. I’ve never met anybody else who listens to them, but they kick some funk ass. 

(4) Pretty Fly For a Rabbi–Weird Al Yankovic–Running with scissors. I’m juvenile and I love it.

(5) Supply and Demand–The Hives–Veni Vidi Vicious. Remember the garage band craze a few years ago? Me too. 

(6) Treefingers–Radiohead–Kid A. Say what you will, but I like Radiohead. 

(7) Ten Dollar Man–ZZ Top–Tejas. I used to blast the Tejas cassette while I cruised around late at night, back when I worked as a driver some years ago. 

(8) Pet Shop–Monty Python–The Monty Python Instant Record Collection. This sketch is a classic. Show of hands: how many of you have quoted this in the ER? “This man wouldn’t ‘voom’ if you put four million volts through ‘im! He’s bleeding demised! This…is an ex…patient!”

(9) The Statue Got Me High–They Might Be Giants–20 Years of They Might Be Giants. Total gibberish. I love it. 

(10) Flamenco Sketches–Miles Davis–Kind of Blue. 

(11) Tiny Town–David Byrne–Uh-Oh. Best cover art ever. 

(12) Winter: I. Allegro non molto.–Leonard Bernstein–The Four Seasons, Vivaldi. Delicious!  

(13)  Subterranean Homesick Android–Radiohead–OK Computer. Not only is the song title a delicious play on an old Bob Dylan song, the music and the words are quite a lot of fun. 

(14) Friends–Led Zeppelin–Led Zeppelin III. The under-appreciated side of LZ. Their softer stuff was quite enjoyable, if less well known than the harder rock. On second thought…does it count as “softer?”

(15) Interstellar Overdrive–Pink Floyd–Piper At The Gates of Dawn. Early Jammin’ Floyd. 

(16) Maggie’s Farm–Bob Dylan–The Essential Bob Dylan. 

(17) Fired–Ben Folds–Rockin’ the Suburbs. I like Ben Folds, he’s got an interesting style. 

So, that’s the beginning of my playlist…what’s on yours? Any comments on mine?

I was in the ER yesterday flirting with talking to my favorite nurse. I sat on the edge of her desk and we discussed the day’s happenings. I talked at length about the goings-on in the cardiac unit, and she told me of her intriguing patients, one of whom happened to have an eleven-centimeter bulge in her aorta that was ready to explode.

Midway through the conversation, we heard rustling from the sheets on the other side of the curtain. She stuck her head behind the curtain, and before I could even blink she had sprung from her seat and rushed to the bedside. 

“Nonono, nononono! Don’t do thaaaat!” I stood and looked, and to my horror the patient with the eleven-centimeter aneurysm ready to pop was pulling herself up in the bed by grabbing the handrails and pushing with her feet–the exact sort of thing that could cause the damn thing to explode, which would sort of kill her instantly.

“I just want to sit up!” the patient exclaimed. 

“You can sit up, but we need to help you. You need to let us do all the work.”

“You guys are serious about this, aren’t you?”

There was a slight pause. I looked at her abdomen. You could almost see the aneurysm. The nurse and I both spoke at the same moment.

“If that thing goes, you’re gonna die.”

The patient released the handrails, slowly straightened her legs, and laid back gently. The nurse and I passed a sigh of relief back and forth, and then counted to three and gently shifted her up in the bed. My favorite spoke.

“We’re not trying to scare you but this is serious. I’ll stand here and move you all day, just don’t be pushing and pulling like that. I actually like you, don’t want to see anything bad happen, ya know?” The patient nodded, then closed her eyes and rested her head. I looked at her abdomen. How had she even made it in here? A bigger bump on the road, a fall at home, even an accidental elbow at the store could have killed her.

I’ll be honest, I’m not too coherent and I’ve forgotten where I’m going with this. Something about the nurse and how the nice patients are always sick but the mean ones are never sick enough, or maybe something about bonding through trauma. I don’t even know and I’m too lazy to save this, so I’m just going to publish it and hope for the best. I’ve got some filler coming later in the day, and then maybe later this week something interesting will happen. We’ll see I guess.

…or do the little guys from Scrubbing Bubbles look like something out of a bad acid trip?

I mean, the products look fine, but I’m always vaguely frightened that the bubble men will turn on me and scrub me to death. The paramedics will find my raw, scrubbed, sterile body in the shower, fist clenched around the shower curtain and eyes wide in horror, the sinister chuckles of the soap men emanating fromthe cupboard beneath the sink.

Perhaps I need some sleep. It’s been a long, long weekend.

12 hours in the cardiac ICU today. Three open-heart recoveries, four old cardiac patients, and a couple of medical patients. Between patient care, chasing down supplies, and socializing in the ER and the other ICU’s I racked up a whopping nine -and -three -quarters -miles. I know us respiratory people tend to move about a lot, but ten miles in a shift? I’d never have expected to rack up that kind of mileage. I guess all the back and forth adds up…and it explains why the sensation I get when I sit down after arriving home in the evening is so similar to the sensation of sitting down in my car after a lengthy hike in the woods.

So anyway, looking at the numbers–feel free to check the math, as I tend to make and carry through mistakes– I drank about 24 ounces of coffee today, a 12-ounce coffee in the morning and another 12-ounce coffee in the afternoon. Since there are 128 fluid ounces in a gallon, we can say I drank approximately 0.19 gallons of coffee. 0.19 gallons of coffee into 9.75 miles runs out to about 51.3 miles per gallon, making me the hybrid car of the respiratory therapy world. This is impressive compared to some of my colleagues, who will guzzle down two or three 24-ounce Enormo-Coffees in the course of a day, giving them a less efficient 19 to 20 miles per gallon…sort of the GMC Yukons of the respiratory therapy world.

As part of the hospital’s recognition of us RTs during the Respiratory Care Week festivities last week, the hospital gave out little RT pedometers which clip to our belts. After a few initial mishaps (setting my stride length to 48 inches, which as an astute coworker pointed out would give me “a goddamn giant stride…you could leap midgets in a single step!”) I figured out how to work the little thing and I’ve been watching it for the last few days to see what kind of mileage I can get. So far the results have been surprising: Saturday I walked a total of seven and a half miles in my twelve hour shift, and today I put on seven and a quarter. I had an odd assignment this weekend and so my results may be skewed, but I’d be willing to wager that my daily mileage averages a solid five miles.

I’m thinking of keeping track of how many miles per gallon of coffee I can get, too. That would be an interesting calculation! And yes, I am dorky enough to use the phrase “interesting calculation” in a totally non-ironic manner. 

As another experiment, tomorrow I may give my pedometer to an ER nurse I’ve been friendly with lately and compare our distances. I’ll have to adjust the stride because she’s somewhat less tall than I am. If your eyes aren’t glazed over already, they probably will be later on whenever I follow up on this highly exciting storyline.

It’s been a crazy week at the hospital. It hasn’t been crazy in the way of having outstanding patients, but crazy in the way of having a lot of ridiculous stress. Stress in my personal life has continued; I will spare you the details, but it’s enough to make work seem like a vacation…I’ll spare you the details of that as well. 

Moving on, work has been getting stressful too. Our patient load is unusually low for this time of year but it is beginning to pick up. However, instead of staffing appropriately and giving us the resources we need to do our jobs, they’ve been running us with a skeleton crew and giving therapists enormous workloads spread over huge territories. In addition to all that, they’ve decided that micromanaging is not enough, and they must pico-manage us instead. We are being hounded constantly about productivity and the managers, who apprently do not have enough to do, are actually going through paperwork and looking for uncrossed T’s and undotted I’s. Therapists are being written up for minor infractions, such as not signing the ABG control log. They are demanding that our floor therapists, who go out with upwards of 30 patients, have “thorough and complete” reports on all of their patients…which may not seem unreasonable, but they give us no time during the day to compile patient data, and we have only about 15 minutes for report, meaning they expect us to give detailed reports on patients in 30 seconds or less. I like our managers as people, but they seem to have no management acumen and I have no confidence in their abilities. Their communication is terrible…I suspect that if they communicated better, a lot of problems would be resolved. 

It wasn’t all bad, though. It was Respiratory Care Week last week, and the hospital went out of their way to recognize us. We had lunch-and-learn lectures, food, and small gifts from the hospital, which actually does make me feel appreciated. I even got a respiratory care pedometer; today alone I put on seven and a quarter miles going back and forth through the hospital. I’m trying to focus on the positive: the therapists as a group are skilled individuals who are good to work and socialize with. We provide good care for our patients. I have some good friends in the ER and around the units. 

I guess it’s important to remember that even when it’s bad, it’s not that bad. After all, even if I’m having a rotten day, I’m on the right side of the bedrails…and that in itself is enough to make me feel better.

There is some minor chaos unfolding here in Keepbreathingland. I will probably be a bit light on content until things resolve. Until then, I’ll throw you some good links. From the ever eloquent Dr. Shadowfax over at Movin’ Meat, we have a lesson on how to be persuasive:

“Okay sir, before you go up I’ve just got some paperwork to complete. Do you have a next of kin?”
“Um, yeah, my sister.”
“Great. What’s her phone number? We’ll be needing to call her later. Do you have a mortuary or funeral home selected, or should we just have your sister pick one?”
“Um, I don’t think -”
“No problem, we’ll just have her pick one. Now, in a few hours, you’re not going to be able to breathe any more, and if we’re going to keep you alive, we’ll have to put you on life support. Do you want us to do that, or should we let you suffocate?”
“That sounds bad — I don’t want to suffocate.”
“Right, then, the ventilator it is. But a few hours after that, your blood pressure is going to go really low and your heart will stop. Do you want us to pound on your chest and shock your heart to try to bring you back? It won’t work, of course, but I just need to let the ICU doctor plan how to handle it when the time comes. So should we do CPR or not?”

Hey, whatever works, right?