Respiratory Therapy 101: Just Keep Breathing

Out on the medical floor, I had 24 patients on therapy today.

2 of them actually needed their treatments.

This is what burns RTs out.

In anticipation of a CNN-Panicked crowd storming the ER with a bad case of OMG TEH SWINE FLUZ, here’s the official RT 101 Guide To The Swine Flu**:

(1) You will not get Swine Flu from eating that BLT. Unless you’re Jewish, Muslim, or a member of another group that forbids the eating of pork, dive right on into that tasty tasty pork chop or BLT or side of bacon…unlike heart disease, you won’t get swine flu this way.

(2) You will not get swine flu because you saw a Mexican at the store, because a Mexican cuts your grass, or because your brother-in-law went to Mexico on vacation two years ago. I know that Mexiphobia is a popular thing these days (thanks Lou Dobbs), but really, the Mexicans I’ve met are just regular people who aren’t carrying anything abnormal.

(3) That congested cough you have every morning is not swine flu, it’s smokers cough. You’ve had it for fifteen years. It’s a sign that your body tries to heal the alveoli you’re killing while you’re asleep. It’s not abnormal…and it is decidedly not swine flu. Get Out Of My ER.

(4) Swine Flu is not a conspiracy designed by the New World Order to implant everyone with microbiotic control chips. Although it wouldn’t surprise me if CNN was surreptitiously giving it to people just to feed the fires of No-Context, No-Info Sound Byte Cable News.

So when do I worry?

You don’t. If you’ve got the sniffles, drink plenty of water and lay low for a few days. Unless you have influenza-style symptoms such as sudden onset shortness of breath, new onset congested cough, fevers, chills, vomiting, nausea, and the usual Flu Cluster, you shouldn’t worry. And remember, 80 people dead here and there does not a pandemic make when there are 6 billion people on earth. When Texas wakes up and dies of the flu I’ll worry. Until then, turn off the TV, go get some fresh air, and for God’s sake, stay the fuck out of the ER*.

*Unless you’re dying, or have a legitimate medical complaint.

**Not medical advice. I am not a physician. Do not take medical advice from random strangers on the intertubes.

Apparently, fat people the morbidly obese People With Extra Weight are saying that Fat Discrimination is now a civil rights issue.

They’re saying that policies like making extra large airline customers buy two seats are discriminatory and need to be stopped.

As a semi-frequent flyer, all I have to say about that is: it’s a civil rights issue when your extra-large slab of fat spills over into my seat and I have to spend the duration of my flight making chums with the yeast growing beneath your pannus. Although if you lobbied the airlines to make the seats a little bigger and charge everybody a little more, I’d be cool with that; those tiny seats are not comfortable for anybody.

That is all.

Shouldn’t a family member who makes a knife threat be, you know, escorted away by police rather than sternly talked to by a nurse manager and then GRANTED FULL VISITATION PRIVILEGES?

WTF, mate. WTF.

PROFANITY ALERT: If profanity disturbs you, skip this and go look at kittens.

Breaking from my usual day off routine of “sit at home and avoid the outside world,” I went out with some friends and family on my last day off to see the world.

Holy crap is it scary out there.

We went to a local Theme Attraction Place that has rides and attractions and so on. I must say I enjoyed the rides and the attractions very much, and 90% of the other guests seemed like regular (perhaps somewhat younger than me) people. But 10% of the people there…were just really fucking fat.

I don’t mean “a skosh overweight,” or “maybe a few pounds extra there” or even “that dude’s got a spare tire.” I don’t even mean “Yeah, that guy’s kind of fat.” After all, this is Life and we’re all human. Very few people have “perfect bodies,” many of those who do will lose them over time, and most of the rest of us will gain weight as we age. I’m cool with that. Fatness is part of life and one in which I will probably partake to one degree or another as I age.

No, what I’m talking about are these people that weigh six times what even an overweight person weighs. These are the people that stall the Electric Fat Guy Scooters at the store. These are the people who are so fat they cause minor gravitational anomalies. These…are the humongous, morbidly obese, disturbingly large people that immediately make me think BACK INJURY in all caps in my head.

What really bothered me about these fat people was that they all had on Fat Guy Shirts. Shirts that said things like I’M THE BIG DAWG or FAT MAN MAKES THE RULES or WHAT ARE YOU LOOKING AT, SKINNY? My wife asked me why they all had those shirts on, and all I could come up with was it’s easier to buy a shirt and lower your standards for self-image than go to the gym or to stop eating like a Clydesdale. Actually, on reflection Clydesdales probably have healthier diets.

So this all got me to thinking. Morbid obesity is still on the rise last I heard. Perhaps these fat people’s attitudes were something I could profit from. Also based on my observations this weekend, rude shirts are increasing in popularity; if it wasn’t a fat guy with a shirt that said WOMEN LIKE IT BIG it was a prostitot with a shirt that said YOUR BOYFRIEND WANTS ME. Think about the intersection of these two things: there’s potential to make some money here.

What I’m going to do is, I’m going to start a line of extremely rude shirts for extremely fat people. They will come in sizes XXXL, XXXXL, Shamu, and That’s No Moon. For slogans, I’m thinking “FAT FUCK” would be a good one; also, for the men wishing to impress the ladies, BIG BONES MEAN BIG… would be a hit. I could take a page from the Ghetto Booty style and the Ironic school of style all at once and sell enormous shirts with SEXXXY emblazoned in glittered sequin along the front.

Alright, that’s enough. I’m sorry everybody, I just had to vent. That was probably pretty offensive but I feel better now. I’d like to close this by reiterating that obesity and overweightness are part of life. Everybody will gain weight with age. It happens. My issue is with people who have made fatness a lifestyle, who are grossly overweight to the point that hospitals are required to install special equipment to accomodate them.

But even when we go off the rails like I just did, it’s important to remember that these are human beings. They deserve some dignity and respect just for that. They’re alive and breathing* like the rest of us, and I feel guilty for making light (ha!) of them. My apologies, readers. I’ll resume my usual respectful nature soon.

*Some are breathing through traches or CPAP masks, but breathing nonetheless.

I would call myself an experienced therapist. Not yet salty or seasoned, but experienced enough to “get” things most of the time. Most of the time when dealing with families and patients I’m just numb to the madness, the suffering, and the general air of unease in the hospital.

But this one guy, from this one family, just broke my heart. He was in poor health himself, not looking too well…pale, a little disheveled, red in the eyes. His wife had met an unfortunate and untimely fate the nature of which I’ll spare you; suffice it to say she was in a PVS, not technically brain-dead but not alert or with any hope of meaningful life.

No matter how long you’ve been doing this, I think there’s something fundamentally human about seeing true grief. Not the fake grief we see every day, as in “Dayum, gramma died an’ now we ain’t got a social security check no more,” but true grief, the why-have-you-forsaken-me grief.

This poor mans sobs when he finally realized that he would never get his wife back…I hope I never have to experience that kind of horror in my life.

I was reading through the material for one of my hospital’s mandatory CE courses when I came across this piece of information:

The accuracy of medication histories in hospital medical records came under scrutiny in a study that assessed 122 patients over the age of 65. The study compared the written medical record to a history obtained directly from the patient. The medication analysis focused on prescription medications and not over-the-counter medications. Overall, 60 percent of patient records had at least one error and 18 percent had three or more errors (an error was defined as either failure to record use of a medication or recording a medication that was not used).

Interesting. I do not doubt that medication errors aplenty have happened within our healthcare system: nurses and RTs are chronically understaffed and overworked. Floor nurses with six or seven patients can not realistically provide excellent care to all of their patients while doing all of the things they are mandated to do. RTs with twenty or thirty patients can not do an adequate job of effectively assessing and treating all of their patients in a timely manner. Errors happen. Documentation is flawed and easily forged.

However, I have a problem with asking patients to verify what has happened to them. In many cases I am sure patients remember clearly what happened to them: a huge number of patients are lucid and coherent. But even a lucid, coherent patient is going to have a hard time remembering exactly which of their thirty pills was given to them by whom at what time of day. A lucid patient with a lot going on emotionally, who was tired because of their hospital stay, may still give inaccurate but well-intentioned data. Factor into that the fact that a massive number of patients in the hospital are mentally ill, incompetent, illucid, demented, just plain angry, or actively psychotic, and you have the makings of some pretty inaccurate reporting. For example, if I walk into a room and a patient complains that they haven’t had a treatment in days, and then they say the EXACT SAME THING when I walk in again four hours later, how accurate are they? Not very.

Plus, even lucid patients may have hidden motives to report one way or another. Some people want to report what they know the surveyor wants to hear. Some people are angry and will obscure the truth or lie, claiming they were maltreated in order to make the hospital look bad.

The only time I would trust a patients statements about the care they received would be when they were communicating emotionally, e.g. “you guys treated me real good,” or when a patient is a Documentor, one of those guys who records everything that happens in a little spiral notebook. And while some Documentors are patients who are interested in their care and taking an active role in their recovery, some Documentors are angry old men who want to sue you. Differentiating can be difficult.

The bullet point to all this: any survey that relies on patient perception as opposed to hard data is going to be hugely flawed and, in my mind, immediately suspect. Asking patients about their opinions or perceptions is important so that we can improve their experience at the hospital; but when it comes to factual information, patient perceptions should be treated as inaccurate at best and as barefaced lies at worst. Medical errors happen, no doubt about it. But instead of asking people what happened to them, we should rely more on verifiable facts to tell us what happened, using patient-given information only if the patients are lucid and capable of good recall.

Ultimately, to reduce medication errors the only system that will work is a system of bar-code scanners that scan patients, then administrators, then meds. A pain in the tuckus to be sure, but a necessary evil.

A question ocurred to me tonight: Why am I paying thousands of dollars a semester for an education to get a degree I don’t even want to advance in a profession that I don’t want to stay in forever? I was sitting here looking at my homework for one of my classes that I absolutely despise because it’s 100% new-age “society is to blame” drivel, and it ocurred to me that I was paying a university good money to make me take classes that I care nothing about to achieve a degree that will get me nowhere. Compare that with $6,000 for community college tuition to get my AS in Respiratory Therapy, and…

Maybe this whole “college” thing is a farce anyway. Most degrees don’t seem to prepare people for the jobs they actually get. I have a friend who paid $100,000 for a degree in “The Classics,” mostly mythology and ancient history, who now makes $12 an hour transcribing articles for a medical journal. I have another friend who spent similar amounts of cash to get a BA in Psychology who now works as a special-education teacher making $30k a year. He lives with his parents.

On the other hand I have a friend who buckled down for six years and got a doctorate in physical therapy. She’s making good money in a field she loves, and her hard work has paid off with a solid job and a good paycheck. Another of my old school chums is completing her MS in Speech-Language Pathology.

So what’s the lesson here? It seems that getting an AS or AA in an applied field pays off with a mediocre job, a mediocre paycheck, and a stable life. Getting an MS or doctoral degree requires a lot more time and effort but seems to pay off. The outliers: baccalaureate degrees, which seem to have an unpredictable hit/miss thing going on where it  might pay off, but it might not. I guess I’m taking my chances with this whole BA thing, but I have to wonder: am I just throwing my paychecks down the drain?

I should’ve just gone to flight school.

Loyal readers! I have set up a brand-spanking new Respiratory Care Store through CafePress. Go forth and buy my merchandise!

More content to come soon.

Instead of giving my patients their millionth ineffective Albuterol neb, I’m going to take a cue from Second Shift and just open the doors to their rooms and scream “ALBUTEROL!”