Respiratory Therapy 101: Just Keep Breathing

Charles Krauthammer weighs in on the healthcare debate and the discussions about end of life care:

Well, as pain and diminishment enter your life as you age, your calculations change and your tolerance for suffering increases. In the ICU, you might have a new way of looking at things.

My own living will, which I have always considered more a literary than a legal document, basically says: “I’ve had some good innings, thank you. If I have anything so much as a hangnail, pull the plug.” I’ve never taken it terribly seriously because unless I’m comatose or demented, they’re going to ask me at the time whether or not I want to be resuscitated if I go into cardiac arrest. The paper I signed years ago will mean nothing.

And if I’m totally out of it, my family will decide, with little or no reference to my living will. Why? I’ll give you an example. When my father was dying, my mother and brother and I had to decide how much treatment to pursue. What was a better way to ascertain my father’s wishes: What he checked off on a form one fine summer’s day years before being stricken; or what we, who had known him intimately for decades, thought he would want? The answer is obvious.

Go look.

Angry rant coming:

Nurses, enlighten me: how does one make it all the way through nursing school without knowing what a tracheostomy is? I mean, REALLY? When a nurse–a registered nurse–asks me “what is that white thing sticking out of Mr. Jones’ neck?” there is a SERIOUS DEFICIENCY in nursing education. I mean, what do you even say to that? I just walked away and shook my head and died a little more on the inside. If I ever get sick, I’ll stay home and die before I subject myself to the half-baked whims of Albuteholic physicians and undereducated nurses. Who is she sleeping with to get a job taking care of patients, because there is no WAY somebody THAT STUPID could possibly get a job in any legitimate way. Unless the government has made it “discrimination” to not hire dumbasses…

I mean, I always feel sort of bad for my patients, but I spent some extra time that day checking on that nurses patients. That genuinely frightened me, that an RN would actually not know what a tracheostomy was. At least she asked, I guess; I could see her hooking the tube feeding up to the trache and the trache collar up to the PEG tube or something.

Sharp exclamation of deliciously sarcastic humour!

Those Wacky Hoosiers done made them a Funny Picture. Well done, chaps. Well done indeed.

Seriously, people. Obamacare is doomed to fail. Our current system isn’t great to some people, but it’s not as roundly craptastic as Obamacare is sure to be. Remember, “equal access to healthcare” is not the same as “equal access to GOOD healthcare.”

Over at the Respiratory Therapy Cave, find this wonderful little snippet:

Reason for stupid orders: Stupid People

Well done, Mr. Frea. Well done indeed. Readers, if you have not lately checked it out, head over to the RT cave; you won’t be sorry.

Thanks to loyal reader CountyRat, who not only provides insightful commentary in the comments but also submits excellent posters. Behold his latest creation:

I’m sure my butt and hands have been featured in numerous radiological studies, but never yet my head.

Thanks, CountyRat!

“What you’re doing here is evil,” you cry out. “You’re trying to take the place of God!”

“Sir, this is a government building!” says the chairwoman, shocked. “There’s no God here.”

Fear it.

I think one of the reasons I speak so bitterly and sometimes have such outrageous and inhuman thoughts is because if I really, truly cared about everyone I saw…if I gave it my all, really poured myself into this work…the tragedy that crosses my path every day would drive me insane.

Sometimes, when I stop and really think about what happens to these people and what they go through, it frightens me, brings me to a scary place where I try to imagine what kind of hell it must be to be totally dependent on overworked and overstressed strangers. To be unable to move oneself, to be restrained to the bed to avoid pulling out uncomfortable tubes, to be confused and sedated and unable to tell night from day.

To be a normal human being one day, to get sick and develop sepsis, to go to surgery and have a non-healing wound, to progress through multiple organ failures. To be critically ill and to have no control, no say in what happens to you every day. To have family members with good intentions and good hearts put you through terrible things. To hear the nurses and RTs and doctors laughing and cutting up and joking, or even worse, to hear them sympathizing outside your room about how miserable your life must be.

There are a lot of success stories out there, but it seems that for each one we save with a happy ending, there are two or three who are just plain f***ed. I can’t make sense of a world that contains so much suffering and pain. There is a duality in this job where one can in the same day relieve the breathing of an asthmatic and then go off to inflict pain on old people for no good reason.

The bottom line, I guess, is that I cope with this madness with a bitter mix of dark humor and willful denial of the problems I have with what I do.

I guess it’s better than drugs.

“Please do not unplug the big power cord labeled VENTILATOR just because it is taking up a spot in the wall that you need to plug your IV pump into, as unplugging the oscillator often leads to sudden and difficult to reverse declines in the being-alive-ness of your patient.”

Yes, it was a bit of a long day today. One on the oscillator, another heading towards it, and a bunch of very old people who are unfortunate enough to have families that believe that dying among the machines is better than dying a natural death at home. I suppose I should not judge them, as I may one day be in their shoes, but it frustrates me that so much of what I do is simply not going to work out in anyone’s favor. A frustrating day.

Patient today tells me, “I feel like I am going to die.”

Then he signs his AMA form, grabs his belongings, and walks out the door. His nurse tries to talk him into staying if he feels that lousy. He stops and turns to her.

“Sweetie, if I’m gonna die, I’d rather be comfortable at home than miserable in this hellhole.”

The nurse thought he was crazy. I thought he was brilliant.

Discuss.

I got this in an email from a reader, who asked not to be named:

“Heard this on a nursing forum and thought you would like it. A very rude patient was demanding many things of her nurse. No manners, no please or thank you. The patient was barking commands at her nurse, and eventually, the nurse lost it.

‘Get me some apple juice!’ the patient demanded.

‘You can say please,’ the nurse reminded her.

‘Your please is in your paycheck!’ screamed the patient. ‘Now get me my apple juice, bitch!’

‘Well,’ said the nurse, cool as a cucumber, ‘your juice is in your refrigerator.’”

I would have about crapped my pants laughing. It’s good to know that some of the nurses out there still have the grapes to stand up to patients instead of caving in to rude and insufferable people because we want better customer service scores.