Almost everything I deal with is bullshit. Doctors write bullshit orders that have nothing to do with the illnesses of their patients. Nurses make bullshit calls based on assessments they haven’t really done. RTs make bullshit complaints about petty things. Patients bullshit us all the time.

The biggest and most prolific of all  bullshitters, though, has to be The Administration, whose job it is to spool out endless steaming piles of bullshit. Policies and procedures that make it harder to do our jobs well are sprinkled with words like quality and compassion and care. This sounds nice but it is pure, unadulterated bullshit: the policies in question are designed to make things more cost-effective, not to add any dimension of humanity to our care. The Administration wants us to be assembly-line workers, not human beings taking care of other human beings. But they try to hide it behind a strategic wall of bullshit.

I, for one, have had enough of it. I can see through the bullshit, and I am sick and tired of it. THAT is the root cause of my problems.

Therefore, I diagnose myself–and possibly a million other healthcare workers–with Bullshit Burnout. If you read this blog, chances are you may have Bullshit Burnout yourself.

• Do you find yourself rolling your eyes when administrators or managers speak?
• Do you find yourself wondering if you’re the only one who hasn’t ingested the corporate kool-aid?
• Do you find yourself skeptical of all things told to you by any patient, especially by any patient family member?
• Do you find yourself doubtful of the capabilities of your co-workers?

If you answered “yes” to more than one or two of these questions, I suspect that you, too, suffer from Bullshit Burnout. The only known cure at the moment is large quantities of time off mixed with a fair amount of ethyl alcohol. What a pity.

Sounds like compassion fatigue which often goes hand in hand with burn out.
Self Test for Compassion Fatigue
____ I have felt weak, tired, rundown as a result of my work.

Every day.

_____ I have felt depressed as a result of my work.

Very much so. I have trouble dealing with my work, especially since it became clear that much of what I do is unindicated or meaningless.

_____ I am unsuccessful at separating my work from my personal life.

Unfortunately, I have been bringing it home. A few mental health call-ins have helped me to see that I’ve been bringing it home way too much. I need a better outlet.

_____ I feel little compassion toward most of my co-workers.

Yep.

_____ I feel I am working mostly for the money.

Oh yes.

_____ I have a sense of worthlessness/disillusionment associated with work.

This is true, but in all fairness, probably 10% of what we do is useful; the rest is either not indicated, contraindicated, or futile.

_____ I have thoughts that I am a failure.

I don’t hate myself, I hate my job.

_____ I have thoughts that I am not succeeding at achieving my goals.

My goals are not work-related for the most part. I gave up on career advancement or having RT goals a long time ago. Maybe that’s a “yes” answer here.

_____ I have felt that some of my clients dislike me personally.

All the time. I have these paranoid thoughts: “this guy must hate me. ‘What’s this guy doing coming here with this stupid treatment again?’”

_____ I have felt trapped by my work.

Yep.

_____ I have felt that what I do is unimportant in the long run.

In all fairness: it is. As I mentioned, at least 90% of this crap is futile.

_____ I have felt detached from my clients and my co-workers.

I dislike my patients and my co-workers wear me down.

This test is not scored with numbers, it is simply meant to help you think about
compassion fatigue.

It seems I have problems. Maybe a few more days off are in order.

I like the idea of my job–the potential to help people and do the right thing and try to improve a few lives, even if temporarily. I like the idea of being able to help someone who needs it. I like the idea of solving problems and curing patients.

The problem is, we do none of these things in practice. Maybe 5 or 10 percent of what I do is indicated. The hospital I work for is insanely “corporate” and so things like patient care are lost to things like having a million committees or firing employees who clock in five minutes late.

I find myself increasingly bitter towards patients who are on my service. This is not their fault, but the fact that they have been ordered on useless or unindicated therapy enrages me, and I find myself being snappy and irritable with them. I despise visitors and want them to leave. I am crotchety with the nurses.

In short: I have a whopping, mega-bad case of burnout. I have been taking it out on people close to me. I have let it interfere with my personal life.

I am going to call out all week for mental health reasons. I need a break, and I think I need to change jobs. I’ll let you know.

“So, this guy here has active TB. He’s been hacking like a motherfu–”

“Excuse me. Did you say, ‘active TB?’”

“Yeah, he has active TB.”

“Is that his nurse in there?”

“Yes.”

“With no respirator?”

“…well, she says it hurts her face, so she’s not going to wear it.”

*long pause*

“Excuse me again. I think I need to make a few phone calls. Does anybody know the number for employee health?”

You’d think that those of us who work in the ICU environment would maybe have a smidgen of common sense, but evidently we do not.

“Because It’s occupied, God-Dammit!” came the reply through the locked door.

I’ve never answered an easier question in my life.

*phone rings*

“Respiratory Care Services, this is KB, How may I help you?”

“Is this Respiratory?”

“Yes. That is what I meant when I answered the phone and said, ‘respiratory.’”

“Well, you need to come see Mrs. Jabba in room 510. She says she can’t breathe.”

“The reason that Mrs. Jabba cannot breathe is that she has eighty pounds of unwashed, disgusting flab compressing her ribcage from above.”

“She says she needs a treatment.”

“When I offered her a treatment ten minutes ago, she was too busy shoveling gravy-laden chicken fingers and potatoes into her mouth. Well, mostly her mouth. Quite a bit got into the cleavage and the fat rolls, too. It looked like someone had ax-murdered a thanksgiving turkey in there.”

“…please just come give the treatment.”

“Is she wheezy, or just breathing hard because of the previously mentioned eighty pounds of flab compressing her ribs? I think that you and I both know that this isn’t going to work.”

“Alright, alright, I get it. It’s pointless to do the treatment. Please come do it anyway.”

“Fine.”

——-

Phone calls like this happen every day. I used to just acquiesce and give the treatments without question, but lately I can’t help but spread the misery around a little bit more. I can’t wait for this vacation that’s coming up. I need it more than ever.

Anybody else out there whose URL has changed? I try to follow you all, but I’ve had a little less time lately.

While I was drawing a blood gas today I took a knee to the ribcage, with a significant amount of force behind it. It knocked the wind out of me, but the force also knocked me forward and drove the needle into the patient’s skin way beyond the hub, and I swear I felt bone.

I probably shouldn’t, but I take some small comfort in knowing that while he may have hurt me, he also hurt himself. Perhaps some carvings on the bone will serve as a reminder that assaulting the man with a needle in your wrist is maybe not a super idea.

When I came in in the morning, he was intubated but wide awake, huge glasses perched atop his nose. The massive eyewear and the long ET tube gave him the appearance of some kind of odd moth with a long proboscis.I introduced myself, explained out weaning process, and turned the old man over to CPAP/PS. I let him chuff away for half an hour and drew and ABG; given the nominal ABG results and some acceptable parameters for weaning, the physician decided to extubate the old man.

I readied my equipment, prepared the patient. “When I tell you COUGH, I want you to cough strong for me and that tube’s going to come right out of your mouth.” The old man nodded and I pulled the air from his ETT cuff and shouted at him. “COUGH! COUGH! SPIT IT OUT, DON’T SWALLOW FOR GOD’S SAKE!” The man hacked as I slid the tube out of his mouth and his nurse applied a yankauer suction device to his mouth. A few touch-and-go moments later and the old man was stable, holding his O2 sats on room air and breathing easily.

Later in the day as I gave him a nebulizer treatment, he expressed some concern to me that he was not doing well. I listened to his concerns and then talked with him, building him up, explaining to him that simply getting off the ventilator was a huge success. I explained to him that for an 85-year-old man to be able to pull 2500-plus on his spirometer was indeed impressive. I gave him a PEP device to encourage him to continue his deep-breathing exercises. I spent extra time and effort with him, talking him up and encouraging him.

At the end of the last treatment of the day, I told him I was leaving and that he’d see somebody else overnight. As I turned to walk away from him, he spoke.

“Hey kid.” I turned around. He was propped up in bed on a mound of pillows, looking like nothing more than a wisp of hair atop those huge glasses.

“Sir?” He spoke not, but instead closed his fist and held it up. It took me a moment before I realized that he was making the Fist Bump at me. I closed my fist and popped knuckles with the old man. He smiled and the two of us laughed.

It made my day.