No She Didn't

So I was taking care of a patient the other day, and what she said to me just came back to me for some random reason. Let me set the scene first:

It's hot in the hospital. Hot because, well, it's hot. We've had some unseasonably colder days here, so the a/c isn't rocking full time yet, even though it is supposed to be May/ Spring. And these frail little old ladies I go to see have the heat in their rooms cranked up. And I run from room to room to room. Up and working. And yes, it is hot.

So I'm in this room, giving this old bag her breathing treatment. And her room is sweltering. Her nurse is also in there to give her pain meds, and she and I were making small talk. I mentioned I was burning up, and she agreed that it was hot on their unit of the hospital. And the patient looked up at me with a sympathetic smile and said words that had me reeling:

"Ahhhh, menopause. Hot flashes."

"STFU, you old bag!", is what I really wanted to say. But that would get me fired or at least "talked to", and I try to avoid that. But her nurse? God, I am loving this nurse right about now, because she honestly looked at the patient and told her she was crazy, that I just had a baby last year.

Take that, Old Bag.

Menopause, my ass. You're just old. And jealous because I can breathe without torturing some poor, overworked RT.

Patient-isms and the Almighty ED

I am a compassionate person, for the most part. I swear it. If you are my patient, you can bank on the fact that I will do my best to take care of you. Without judgment, without fail. If you, in your lack of medical knowledge, say something that is utterly stupid in the strongest sense of the word, you can rest assured that I am not going to laugh at you in your face.

I’ll wait until I leave the room.

Recently heard by my patients:

“ I need my BEEEEPAP!”

“All I know is that when she was a baby, they had to put her in a plastic bag.” From a mom when asked for the history of her young infant’s delivery. My response? “ You mean they had to BAG her. As in a way for us to give manual breaths. I assure you that they did not put her in a plastic bag.”

“He said I have an internal fart. Something is blocking it from coming out.” Upon hearing that they have a myocardial infarction caused by a blockage of one of the coronary arteries.

“You have to SHUT UP! I have anxiety and the voices in my head said you’re being too loud!” This wouldn’t be funny if the patient were really mentally ill and wasn’t just trying to get some benzos for the weekend.

Of course these are just a few. And they all occured in the ER. This doesn’t include the funny crap we see. Like the stripper who fell off of her pole. Or the arrests. And the drunken people. My job is always, always interesting.

Case in point: just a few short minutes ago, I held in my hot little hands a real-life FBI badge. You know, like the one they flash on tv. Turns out they are just as badass as they seem.

What Have I Done?

Busy busy busy. Still.

Aside from working 60 hours this past week, I also started the journey that is to be my business degree. The online program is supposed to be easy, right? Since I have all of the pre- and co-requisites completed from my other degree, all I have to do is take my business courses and the degree will be awarded and I can move onto the masters. Okay. And this is an accelerated online program, so each class is approximately 5 to 6 weeks long. 2 courses at a time. No breaks for summer, which has me finishing early next fall.

Oh. Crap.

Because I started. I got my glossy new texts and I delved into the world of marketing. And my professor has us completing a paper or presentation literally every 48 hours. Because, in a degree program designed for adults with other obligations like job and family, there couldn't possibly be anything else for me to do other than prepare fictional marketing plans and writing papers to critique the business practices of the establishments I frequent. Along with 10 chapters of reading each week.

Maybe, just maybe, I will lose the little bit of sanity I have left.

Maybe all of my hair will turn gray.

What is more likely is that I will pull myself up by the bootstraps and get it done just like I always do.

And for an extra dose of fun? I submitted my application and resume for a PRN therapist position at a local rehab hospital. And they bit. Hard. As a matter of fact, I simply emailed about the position before I submitted anything and had the interview already scheduled before I had even updated my resume and started the app. A second job. For when I don't get as much overtime as I like. Like that ever happens.

Such is my life as a workaholic student wife mommy. Sometimes when you want it all, that is exactly what you get.

How NOT to Get a Job

Let me set the scene for you: It is 3 AM. I have been busy as all hell because A) people keep trying to die in the hospital and we have had more codes than I thought possible in one shift. And I have the main ICU. And B) I already have 10 ventilators going. 10 patients on life support, and they keep coming because you go to the ICU when you unsuccessfully try to die. Plus I am in charge, and I have one guy who is in a code and I am getting called for all of his patients he can't get to because of that. And C) they are complete bullshit calls. (Example: I got called all the way to the psych unit for a patient "not breathing well at all" and I get there only to discover he has a stuffy nose. That's it. Clear breath sounds, 99% on room air. But he has nasal congestion. Seriously? I have people who aren't breathing without my help and I get called for that???) And so I have come back to the department for a brief second to wolf down a sandwich and a Diet Coke. And the phone rings.

Ringgggg, Ringggggg.

Me:"Respiratory, this is Andrea."

Caller:"Andrea, are you an actual therapist there at that hospital?"

Me:"Yes, I am. How can I help you?"

Caller, to be known from this point on as MORON:"How many therapist do you have there with you?"

Me:"Ummmm, who is this?" I'm kind of creeped out by the question.

Moron:"My name doesn't matter. But I saw you have a full-time night shift position opened. Will you hire a CRT? Because it says the position is for an RRT. "

Me:"Well, we hire therapists with their entry-level credential contingent upon them completeing their advanced practice credential within a year of their hire date....."

Moron:"DOES THAT MEAN I HAVE TO TAKE THAT TEST?!?! I hate taking tests. Tests are boring. And that one is expensive!" (She's sounded very agitated now.)

Me:"Well, there is quite a difference in pay between a CRT and RRT, so it pays for itself pretty quickly." (I'm thinking that this girl is an idiot if she thinks this is the way to get a job. And obviously lazy if she doesn't have the gumption to take the steps to get a credential that will further her career so much.)

Moron:"Okay, whatevs, how many patients do you have right now?"

Me:"Well, in the hospital we have about....."

Moron:"No, not in the hospital. How many patients do you have? Right. now. How many units of the hospital are you covering? And how many therapists do you have there tonight?"

Me:"Well, we have 4, which is standard at night. I have the MICU, and I am covering all of the patients in that unit. There are 10 ventilators running up there right now and....."

Moron:"OH MY GOD! Do they always work you like that??? I heard they did. I work at XXXXX now and I only have 2 treatments to give before 8 in the morning. That's what I'm used to. I don't like to work a lot. Or very hard. Ewwww. And a ventilator? I hate running vents. I haven't run a vent in 10 years."

Me:"Ummmm, we are usually pretty busy here. And since there are only 4 therapists in house at night, all of us may be asked to handle a vent or an intubation, even if we aren't assigned to an ICU..." (Okay, now I think I may be being punk'd. Where's Ashton?)

Moron:"Whatever, I guess I can try it. Where do I fill out an application?"

I had to give her the website where she can apply online. And I had to tell my boss this morning that if anyone calls who works at that hospital, to please not hire them. Who? Who really tries to get a job like that? Especially in our current day where even healthcare professionals are having difficulties finding jobs. I mean, when I applied for my current position, I called. But when I called, I spoke with the director of my department and simply asked, in a polite tone, if they had any available positions for a registered therapist. He asked me a few questions about my experience, and before I had even completed an application, HR had called me to schedule an interview. I actually completed the application and submitted my resume at my interview. But I was polite. And professional. And was eager to work. And motivated. Really.

So we really do have an open night position. And I swear I will die if this girl comes to work with me. Absolutely die. The last thing we need on night shift, where the staffing is bare bones, is someone who doesn't want to do the job.

God help me. What is wrong with people????

First Do No Harm

Primum non nocere.

Of course we all recognize this as the cardinal rule of any medical practice. Nonmaleficence, meaning that it is entirely possible that the best course of action for me to take in an emergency is to actually do nothing. That doing nothing, and thus not causing further harm, may be better than being wrong in a manner that leaves my patient in worse shape. Now take all of that and combine it and roll it into a big ball and realize that I grapple with this in a split second when my patient has stopped breathing. That instant that truly seems like an eternity. The great void between the realization that your  patient is indeed pulseless and apneic, and the pushing of the big blue button that will trigger the calling of a Code Blue. In my career, I have had situations where I go back and think about  a patient and wonder if me reaching any conclusions sooner would have changed an outcome. And thus far, I have had the luxury of being able to say that I don’t feel as if I have harmed anyone.

Last night, I had to face that possibility when, after some aggressive airway management for a patient who wasn’t ventilating well, I witnessed the spiral. First the oxygen saturation starts to drop. And then the blood pressure is low, followed by the slowing of the heart rate. Finally you reach that chasm where the heart ceases to beat, whether it be a pulseless ventricular rhythm or completely asystolic. The patient is dead. Expired. And you can do all you can and whip out everything you have learned in years of education and professional experience in the hopes that it will help. That the heart will resume beating. (Not so much the breathing because, honey, I can make anyone breathe with the right equipment.) But this happened last night. While I was there with my hands on that patient, taking the opportunity to teach a new ICU nurse about ventilator basics. I have never had that happen to me. And after we got her back not once, but twice, and they finally got the stat chest film for which I kept begging, it was determined my patient had a pneumothorax. And so when the family arrived at the bedside and told us to stop all efforts at resuscitation due to patient wishes, in the blink of an eye, my role switched from caring for the patient to caring for the family. To help them find some peace in her death. I did all I knew to do. I extubated her, washed her face, smoothed her hair, tucked her in, and left the room so they could have those final moments with her on her death bed.

And then I went into my back office in the ICU and I cried. Actually I started crying before I got there, prompting fellow ICU staff to follow me to make sure I was okay. I was. I was still breathing. My patient wasn’t. It was the first time in my career where I was physically working with a patient when they went down, and my instantaneous thought was, “Did I do that? Did I hurt her?” Of course after logically recounting the steps to her demise, it is obvious to me that she suffered the pneumothorax before I did anything that could have caused it, and thus I cannot blame myself. But it just did something to me, and I cannot really explain why.

I love my job. Love it. But I have always had confidence in my professional skills and training. I haven’t really doubted myself before this. Well, I have, but not in the manner that I had to stop and think on whether or not I did damage. I have always said that the most dangerous person in healthcare is the one who will not admit that they don’t know everything. So with that in mind, there has always been a healthy dose of fear. There has to be when you are literally running someone’s life support. But that fear cannot be so great that in inhibits one’s performance, one’s ability to be on their toes when a true life-and-death emergency strikes.

Lately, as a senior therapist, I have been mainly working the critical care units. Once in a blue moon, my boss will give me something else so I don’t go insane, but it isn’t very often. And the thing about this is that I am in a teaching hospital. Meaning when there is an emergency and the code team assembles, it really is a team effort. In other areas of the hospital, this may not necessarily be the case because there are more seasoned physicians running the show. But in the ICU’s, you get residents. And the presence of “MD” behind their names has yet to give them the idea that they know all because of their education level. They know that an experienced ICU nurse or therapist has seen a lot and can help them. I work with them on intubations, on managing pulmonary issues. I give crash courses in blood gas interpretation or ventilator management. And in a code, when we get to the point where we have exhausted all possible causes, or in one where the cause is obviously pulmonary in nature, they look to the therapist. Me.

I don’t know what I’m getting at here. I think it is just that I had to think last night that it was possible that I hurt a patient. And even after coming to the conclusion that I did not, the fact that I could have just seemed to linger. And of course this has made me think of my role in the hospital even more than I have before. The pressure. The weight. The responsibility.

I upheld my ethical commitment last night. I did no harm. But I had to come face to face with the idea that I hold lives in my hands when I go to work and clock in at night. That I very well could hurt someone. I think it just caught up with me.

The Catch-All Post

You know that receptacle on the kitchen counter or desk or wherever? It could be a basket or bowl or something, but its sole purpose it to be a place for random crap that people drop. Ours is a large ceramic bowl on the kitchen table. The Catch-All. Ink pens, keys, restaurant coupons, junk mail, my badge and stethoscope from work....You can find anything in there, and I'm sure we aren't the only family with one of those.
Well, this is the catch-all post. Because I don't wanna post a bunch because, well, I'll get to that first.

First of all, I am working like a slave. And it has caught up with me. And I feel like garbage in more ways than one. For starters, my job is getting to me. Last night, I had to withdraw care on a 45-year-old father of 3 who suffered a spontaneous aneurysm that created a massive bleed in his brain. He was gone. Brain dead. And after listening to the wails of his wife and children echo off of the walls of the ICU unit for about 6 hours, the family decided it was time to let him go. I hate doing that. The suffering. The sadness. And aside from that, my face will be in their memories of his death. They won't associate it with pathology. They will see the woman who came in and extubated him on command, knowing he would not breathe once off of the ventilator. And that is seriously some depressing crap. And furthermore, I am sick. Physically sick. I've caught it either from my children, who have both been ill, or from my nasty patients. Because apparently my position in healthcare denies me my basic rights to health and wellness and common courtesy. By this, I mean that multiple times a day, I lean over to listen to breath sounds and a patient coughs directly into my face. With their staph/ enterobacter/ pseodomonas/ tuberculosis/ strep/ gram-negative/ gram-positive shit. Yep, right into the air I am breathing. Nice. Thank You. So now I have it. The dry, hacking cough. The hot cold hot cold hell of a temporarily dysfunctioning internal thermostat. The aches. The stuffy nose. I hate being sick and haven't been since I caught H1N1 from--you guessed it-- one of my patients during my first trimester of Zachy's pregnancy. Being sick makes me a crabby bitch. So enough about that.

Evan is a celebrity around my hospital and his school. Last week, the Cincinnati paper had community event photos and since all of the catholic schools were having special events for Catholic Schools Week, Evan's school was no exception. They had a sock hop and there was a 5x7 photo of Evan on the second page of the paper, cutting a rug like it was nobody's bidness. As a result, people have been saving the clipping for us and I swear we have about 50 copies right about now.

Zachy had his hearing test today with the audiologist. They put these little things in his ears that looked like ear buds, which emitted sounds and measured the vibrations produced by his ear to ensure all was working. They use this in babies because it requires no cooperation at all. It's just measurment. But little Zach kept whipping his head around, looking for the source of the sound, which of course he could not see since it was in his ear. It was entirely too cute. And all is well. No hearing impairment detected. No collection of fluid behind his ear drums. Now we just wait and see what the doctor is going to do. I've checked my insurance benefits, since I doubt we meet the financial guidelines for a state-sponsored early intervention program. I only have to pay 10% and he gets 30 therapy sessions per year. The bad part is that this is 30, total. So if they do OT and speech, for example, they cannot combine to more than 30. We haven't gotten there yet. I really don't think it's all that bad.

John's dad is apparently engaged. We found out tonight over Facebook. They've been dating for awhile and we like her, so it is great news.

I hate my nasty neighbors and their nasty dogs. Really, I know hate is a very strong word. And I mean every bit of it at this point. It was bad enough that when they open their front door to the common vestibule we share in our duplex, my living room smells like dirty dog for about 15 minutes. And then we had the issue this past spring where their dogs were shitting in little piles on the concrete driveway by the doors of my car. So I have to be hyper-vigilant about where I step when I get out. Pretty tricky if you come home after dark. Or before dawn. And let me remind you that I work nights.Well, now they are doing it again. And for extra fun, they are hiking their legs and peeing on John's Harley as well. John's Harley that is valued higher than my only-2-year-old car. And on the weather cover, which was also expensive and which John touches with bare hands ot get it on and off the motorcycle. Now before you think I am an evil dog-hater, let me tell you I like dogs. I would like to have a dog but seem to be allergic to anything that is green or has fur. But there is such a thing as courtesy. And the lack of it these people have appalls me. Seriously.

So that's all. I told ya. Completely random. But I feel like dirt. See ya on the flip side.

We're Going To Hell

Okay, so we are horrible. We healthcare people. Because in order to do what it is we do everyday in an ICU, we have to make crude and completely inappropriate jokes. It's a defense mechanism, peeps.

And if Ol' Aunt Gertrude is dying, we call that "Catchin' the Jesus Bus". Seriously. So imagine my surprise to find this:

Ha! Hahahahaha. The devil is waiting for me in Hell.

Hell Hath No Fury...

...like Andrea pissed.
Seriously. (I think I may say "seriously" entirely too much. Kind of like the word "like" when I was a kid. Oh well. Roll with it because I am really pissed off.

Zach usually takes a bottle of evil formula at night before bed. One little 6-ounce bottle. Now, let me remind you that my boobs have been through sheer hell in the past (almost) nine months. I seriously cannot believe I have kept this shit up this long. (Oh, yeah, forgot to mention that you should expect profanity in this post because, once again, I am pissed.) Like the days where I found random black bruises on me. Or the plugged ducts. And how could I forget the days where I got as little as 2 ounces in 24 fricken HOURS. I didn't do this crap for fun. And it sure as hell has not gone as planned. I didn't want to take herbal supplements to keep the milk coming. I certainly didn't want to buy a hospital-grade pump. And I really, really had no intention of getting nice and intimate with a piece of equipment every two @#$%&* hours a day for at least a year. Okay, now with that being said...
You may or may not remember the early days when I returned from work a mere 5 weeks post c-section and all was sunshine and roses. We have the lactation rooms with the hospital grade pumps and leather recliners, etc. And if you have to pump, you have to pump. No questions asked. Period.
I have not pumped a single time at work in the past 4 days. And I am still doing the 12-hour shifts. In the wee hours of the morning when my boobs seem to be the most productive. So if I can't pump at work, it is a serious issue. And that issue has been my way of life for 4 days now. So while this time last week, Zach was taking one bottle of formula before bedtime, yesterday he only got one 5 ounce bottle of breastmilk all day. Because just one day of missed pumps is enough to do that to me. Now it is all but gone and I am back to killing myself practically in order to get my supply back up. One of my fave ER docs is working tonight and I am on the verge of asking him for another course of Reglan. It is that bad.
It went like this: I have had the ER, despite the fact that I told my boss that the ER, because of its lack of predictability, its distance from the lactation rooms, and the acuity of the patient population, is really difficult for me to cover while still breastfeeding. And she told me to have my coworkers help me and if anything came up, to let her know. I'm sure she doesn't really want me to do that. I would be in her office daily. Long ago, I stopped having someone cover my cell while I go to pump, which is really what I am supposed to do. It's just easier that way because I don't have to deal with the rolled eyes of my coworkers or have to explain why it is that I need this time to them. But the downside of that is that, when I get a call in the middle of a pumping session, I have to call my coworkers to get the patient seen. And the people I have worked with for the past 4 nights are not the type of people to help. For example, I was so busy in the ER last night that I didn't even get to attempt to pump until almost 7 hours into my shift (8 hrs. since the last pumping session). And when I finally got up there, as soon as I took my stuff out of my bag to get ready to do the deed, my phone rings. And it is a nurse who wants a PRN treatment for her patient because he is short of breath. I call the first coworker, who says she got called to a patient in the ICU. I have no reason to not believe her at this point, and so I call someone else. This someone else just happens to be the first girl's BFF. So the second one syas she is "up in the tower" ( a region of the hospital), not specifying which floor she is on, what she is doing, or anything else. I tell her what I need and her response was, "That doesn't sound urgent." And she hangs up. While it is entirely possible that she was correct in her assumption, we have no way of knowing this until someone lays eyes on the patient and does some sort of pulmonary assessment. And so I try to call a third coworker whose phone is saying he is "out of the zone", which means he is in an area of the hospital where his phone has lost signal. So I call the nurse back and let her know what is going on, and could she please give me specifics on the patient's status. She does and tells me he can probably wait until I am finished. So I start to pump. And literally 2 minutes into it, the phone rings again. 2 minutes. So of course the same therapists who were busy with the first call are still busy. And I have no choice. I stop pumping, throw my parts in my cooler without even washing/wiping them, and I go to the patient. Except on the way, I pass the first two girls, giggling and walking down the hallway. On the complete opposite side of the hospital from where I had assigned them at the beginning of their shifts. Together.It was all of 10 minutes after I had spoken with them and they were too busy to help me see one lousy patient. And so I was very pissed. And after that, I was just too busy to even leave the ER and never had another opportunity.
So tonight I report to work. For the first time all week, I am not in charge and so I do not make out the assignments. I told the one girl I can't do the ER tonight. Not after the issues that have gone on for the past 3 days. If I do, I will probably have no more milk for Zach. That's it. All of that work brought to an end like that. And she ignored me and put me there anyway. And in the morning I don't know what I'm going to do. Raise a stink? Go to HR? Post a printed copy of Kentucky breastfeeding laws on her locker? It's all enough to make me want to put in my notice, but my status as the breadwinner means that I need something else lined up first. Incidentally, my hospital was one of the first to recieve the Unicef designation as Baby-Friendly, meaning it makes extraordinary strides to foster breastfeeding. Pretty rich, isn't it?
Grrrrrrr.

How to Spot a Student

I work in a teaching facility where I am bound to run into any kind of student at any given time. EMT/ Paramedic students in the ER. Nursing students on the med/surg floors. Respiratory therapy students in my own department. Medical students any-fricken-where. You don't have to look too closely to tell they are students because their status as newbs just screams from them.



Let's start in the parking lot. If there is a cheap stethoscope hanging from a rearview mirror in any vehicle, that car belongs to a student. It's almost like a staus symbol. It's supposed to scream, "I work in healthcare and therefore am beyond cool.". Instead, it screams, "I am obnoxious and think I am going to randomly run from my car and into the fray to save a life. As soon as I finish school." I never did this. First of all, cheap stethoscopes are crap. You cannot hear with them. My very first stethoscope was a Littman Master Cardiology. $300. And it lasted me through my entire education and the beginning years of my career. As a matter of fact, I just replaced it last year. I never hung it from anything in my car because sun and cold, both, are damaging. And besides, I'm not that cheesy.



The Scrubs. If you have to wear scrubs as a uniform as a student, For the Love of All That is Holy, wash them first. Nothing says "I don't have a clue" like a pair of scrubs that still have that new sheen to them and come complete with creases down the legs or the sleeves. Just sayin'. We will all know you are a student, and by default, semi-retarded.



That Snazzy Piping. If by chance scrubs are not your uniform and you have an issued uniform (Student Nurses, this is you.), there is no hope for you. There is nothng that says you don't know what you are doing than that horrid piping they insist on having along every seam of every piece of uniform you all are made to wear. The only thing I can say to you is that it will all be over soon.



The Stare. They all have it to varying degrees. This goes for the resident fresh from medical school, looking lost and as if they are playing dress-up in Mommy or Daddy's lab coat, to the nursing student in the ICU seeing a critically-ill patient for the first time. All the way down to the RT students I encounter, who sit in our department waiting to do rounds with their preceptor and looking at all of us like we are Creatures from the Beyond. Nothing says "I am dumb enough to kill your loved one" like that stare.

It's not that I have anything against students. I was one once, and I was just as dumb. I never did the stethoscope thing, though. What I did do was feel uber-cool because I got to wear scrubs and have a steth around my neck. Ha! Those were the days. And then I couldn't wait to get out of school so I could buy cute scrubs in place of the navy ones they made me wear in school. Now, years later, those cutesy scrubs hang in my closet while I wear the OR greens everyday. I also don't feel quite so cool these days. Instead, I've become jaded. It's just what I do. When did it get like that? When did I get hard and bored and so blah about the whole thing? Maybe I need to revert to my student days.

Random

Not much to report from here. We are in the midst of some reorganizing and purging here in the house (as evidenced by Zachy's changing table on its side in the background of this pic!).



John got his second ticket this past week. Apparently he didn't stop long enough at a stop sign around the corner from our house. I think the local police just have an affinity for my car for some reason.



Zach's teeth are just right there. The two front lowers. Gah! I wish they would just break through. Tonight he gnawed on a whole wheat organic teething biscuit for the first time. He isn't particularly fussy or anything. I'm just impatient.



Evan is grounded. Again. He insists on making me be the bad guy. This week, he lied about homework, and so I took away priviledges. So later that night, I went to work and John let him have his Nintendo DS. (Way to back me up, Honey!) So I have confiscated the DS and now take it to work with me. Video games rot your brain, anyway, Evan! Read a book instead.



I am now addicted to the damned DS. Hey, those games can be pretty fun, and it sure does pass the time when I'm pumping at work!



Zach loves "Where is Thumbkin"!



Evan brought home a B in Science on this past report card. Seriously, Evan? Last quarter, he had a 99%. I was secretly disappointed. It was his lowest grade at 92%. Which brings up the grade scale for 3rd grade. This is new for Evan as a 3rd gader, but 95-100 is an A, 90-95 a B, 85-90 a C. A D is anything below 85%, which is considered failing for any grade above 2nd grade at his school. It seems like it should be another planet or something where 84% is failing. Poor kid. Times sure have changed since I was a 3rd grader, and I was in the gifted and talented program where my homework was so difficult that there were times when my mother would crack up laughing when trying to help me because it was too difficult for her! Seriously. So I sort of feel bad for Ev, and haven't been busting his chops about the B since it would be an A anywhere else. And with 92% being his lowest grade, I can't complain. I just know he can do better. Plus, all of the teachers left the same remarks in the comments: "Evan is too talkative in class.", "Evan has trouble paying attention duing class.", and my fave by far, "Evan is a remarkably bright little boy, is engaging and fun, but is entirely too disruptive in class." How can the kid get the grades he gets and be that disruptive? He must get that from his father.

I renewed my PALS this week. Yay, fun! And I also started looking into the home study program for my Neonatal/ Pediatric Specialty credential. That would make my credentials RRT-NPS. What is it about adding more letters after your name that makes you look more important? Anyhow, I don't need the cred to work the NICU, but it would make me look like a rockstar in the neonatal respiratory therapy world. And my boss would have no choice but to pay me a lot more. Which means the whole process, though admittedly rather expensive, will eventually pay for itself. Score.

Evan has been driving us crazy with the Karaoke machine John's mom bought him for Christmas. Apparently it has kids' songs programmed into it. There really is only a certain amount o time one can listen to the instrumental version of "This Old Man" before one goes completely, certifiably insane. Just sayin'.

Zach's hair has started to grow toward the center of his head in hilarious fashion. So from one angle, it looks like a fauxhawk. And from another, a Kewpie doll. Ha!

I guess that's all I have to report.

NICU

I hemmed and hawed and procrastinated until my boss finally asked of my intentions. And then I did it. Hesitantly at first. Maybe a little nervously. And finally with a little more surety to my pen strokes.



I added my name to the list of staff interested in a full-time position in our new Level 3 NICU.

I've known this was coming since before I was pregnant with Zach. I didn't know how the cards were going to fall and which of us therapists were going to get to take on this new role. And how my name has come to be on the growing list has been a sort of journey.

When I first graduated with my RT degree, I swore off kids. Actually, it started before I even graduated. As a student, I was required to prepare a case study each semester. The patient population from which we had to choose changed each time based on the courses we had covered that particular semester. And these were really involved. Day-by-day summaries of care, tests, drugs administered. Appendices involving translations of every drug given, every side effect, every abnormal lab value. I think the shortest one I ever prepared was 60 typed pages. So my very last semester, we had to pick a NICU patient and I picked the preterm baby of a 13-year- old girl. And my baby's meconium tested positive for illicit drugs all the way up to 60 days after her birth. I was appalled. I was broken-hearted. I wanted to kill the mother. And the grandmother. And I wanted to take the baby home with me and give her a good home. I thought then that my heart just could not take doing that every day. And then I graduated. And my very first code as a credentialed therapist was a 6-month-old baby boy. He had been "napping" in a bed next to a bucket of mop water. The babysitter claims that she went in to check on him and found him submerged, head first, in the bucket. We did CPR on him for what seemed like hours, knowing full and well that there was nothing we could do to get him back. I'm not a drinker, but I turned into one that day, and for that day only, when I left work. And again, I swore I never wanted to work with babies. I can treat an adult who did something stupid to ruin their body. But a baby who is ill because of a stupid adult? I find it very hard to keep from being judgemental in those cases. And I took a position at a hospital where I thought I would never have to deal with it. A tiny rural hospital where I was the only night-shift RT. Ha! I guess it was the hospital's location at the midpoint between Cincinnati and Indianapolis, but we had "bad babies" all of the time. I figure it was because the moms didn't have time to get to the big cities and stopped there. But I resuscitated at least one newborn per night of work. That's when I began to carry certifications in NRP and PALS (Neonatal Resuscitation and Pediatric Advanced Life Support) to say that I knew how to resuscitate our smallest patients.

That's also when I learned that, although it wasn't exactly my favorite among my job duties, I was pretty good at it. And then something happened. I ran into a neighbor at our complex pool who kept staring at me. One day she finally approached me and asked if I worked at the hospital and what I did there. When I confirmed, she told me where she knew me. She had watched me resuscitate her grandson through the windows of the hospital nursery. I didn't remember her because I was focused on the baby, but she remembered my face from that night. I thought it was pretty cool, then one random day, she knocked on my door. When I answered, she was standing there with this blue-eyed blond little boy. She guided his hand to mine and said, "You don't know him, but he is alive because of your work." It was the baby. He was 2 then. And that had to be the most rewarding experience of my career to date.

Since then, as I have added years of experience under my belt, I have developed this love-hate relationship with caring for babies. First of all, if I am involved in their care, it is usually because they are pretty damned sick. That alone is sad enough. And then I find it hard to keep from seeing my own children in their little faces. I can treat dying adults all of the time. But the kids? The babies are the ones I take home with me. The ones I internalize and carry with me. The ones who form the emotional challenge behind my work.

So I have done some soul-searching. And I have determined that I am tailor-made for the job. My reactions to the sick babies shouldn't exclude me from the role of NICU therapist, but should actually be a qualifying factor in my selection for the job. Because over the years, I have become hardened to adults. But not kids. Never the babies. And after 2 horrendous pregnancies, I realize that I am the type of person I would want caring for my critically ill baby--someone who actually cares about them, who will cry when they suffer and celebrate when they are well. And when I look at the mom of a premature baby and say that I get it, I really do. As for the challenging logistics of the job? I am the type of person who is always looking to learn more and more. And if I am not challenged, I lose interest. What better patient population for me than our most challenging, most fragile? And as for my nervousness, I think it is healthy. You have to be a little nervous when dealing with any critically-ill patient, yet still be confident enough to do your job. Because no matter how sure of yourself you may be, no matter how arrogant and cocky, the critically-ill human body has a way of knocking you on your ass and showing you that you aren't as great as you originally thought. In that aspect, a healthy bit of nervousness keeps you on your toes.

And so my name is on the list. And I'm scared. And I know I'll cry. And there will be days when I hate my job. But I am also excited. We shall see...

I Don't Even Want To Go Back There

Last night, we got a call to take a ventilator to the NICU for a baby. I was in charge and didn't have the NICU but rather the MICU. The girl who had it, though, wanted me to help her, and so I did. Shortly thereafter, I got called for a vent for the mom, who was to be going to the MICU. She didn't make it. Code Blue, Labor and Delivery OR. And so I went. She coded in the same OR where I delivered Zach. On one of my doctors. When it became apparent we weren't going to get her back, we called the husband and her parents back so they could say goodbye. Her father wrapped his arms around my neck and sobbed for his young daughter. I thought he was going to fall and I was worried I didn't have the strength to hold him up. My scrub top was wet with his tears. And I proved to myself that I am tougher than I know I am. In more ways than one.

She died. Her beautiful, full-term baby girl is a picture of health.

And right now, I don't know if I can stomach going back to that place. Right now, I hate my f###### job.

Lessons Learned

Somedays, I absolutely love my job. And like most people, there are day where I hate it. And then there are sometimes where the love and the hate are one in the same. Yesterday was one of those days...
A patient who broke my heart into a million little pieces. I was called to intubate this elderly woman who had been discovered down in her home. Without heat. She hadn't had the resources to pay her electric bill and her core body temperature was 74 degrees. She was in that shape for days before she was discovered by a relative. And the family! So guilt-stricken, not only because she had asked to borrow the money and they told her they didn't have it, but because nobody had checked on her in days.
A patient who made it all to real for me. A nice-looking, clean-cut guy. Dressed casually in a fleece and a pair of jeans, much like I do on winter days. I was sitting at a computer in the ER, charting away, when he came up and handed me this folded piece of paper, asking if he could use the phone to call these people. I unfolded the square of paper, soft and worn so that it was about to split where the creases had been, and dialed the number for him. It was for the emegency cold shelter the city sets up for the homeless on freezing nights. My first thought, considering his manner of dress and the way he spoke, was that he was calling for someone else. Since he carried on the conversation right there at my desk, I couldn't help but hear his end of the conversation. He had been carrying the paper around with him, too proud to use it, until it just got too cold and he had no choice. I heard him tell the person on the phone that he hated to take a bed from someone who needed it more, and so he had never used their services. But on that night, he didn't have a coat, either, and so he couldn't sleep on the streets. He even offered to sleep on the floor to take as little space as possible, if he could just sleep indoors that night.
The patient who was a reminder. I got called to the NICU for a preemie. 23 Weeks, 3 days. She or He wasn't delivered yet, but mom was dilated and her membranes had ruptured. They were doing an ultrasound because they suspected placental abruption, in which case an emergency c-section would have to be performed. They were trying to send her across the river to the OB Mecca where I was sent many times during both of my pregnancies. Apparently OB Mecca was full to bursting and so had to triage. This means they were only accepting patients to which they could provide the most help. 23 weeks is on the cusp of viability. 24 is the magic number, and so they turned her away. Her doctor had to explain to her the odds of the baby surviving with any quality of life intact. At a certain point of gestation, we automatically resuscitate, no questions asked. 23 weeks is not that point. And the mom had to make the decision that we were going to let her baby die peacefully in her arms.
People ask me all of the time how it is that I do my job. I usually tell them that for every single one we cannot save, there are several we can, so there is a balance. And for the ones we cannot save? I get to go in that room with that patient who is terrified of death, and I get to do something, anything, to make it a little easier for them. And then there are nights like yesterday.
Heart-breaking, soul-crushing nights. Nights where I take each and every one of them home with me. These happen to be the nights I get something out of my work.
The hypothermic woman reminded me to hold my loved ones closer. To never, ever take them for granted.
The homeless man, at a time when I am financially drained from the year we have had, reminded me that I may not be able to buy myself anything and everything I want right now, but I have a warm home filled with love on these cold, cruel nights of winter.
And the mom. Oh, the mom. She brought every contraction back. Every hospitalization for not one, but two pregnancies. I swear I could feel the needles in my hips. I could feel my belly torque and twist deep down. I was 18, 19, 20, 21, 22 weeks pregnant all over. I was in fear for my babies' lives all over again. But this time, instead of the depression that follows each time I deal with a preemie since my return to work, something very different happened. In the same instant those horrible things were brought into my mind, my head filled with other images. Evan's first cry, first step, first day of kindergarten. Those nights this past summer where the pregnancy was over and I spent five blissful weeks just getting to know Zachary. Zach curled into my chest, deep asleep. His beautiful smiles and giggles. Candles on birthday cakes and tiny baby feet. The smell of baby lotion and the sounds of John playing with our boys. Squeals of delight at a new milestone conquered. I was reminded of what could've happened to us and of what didn't happen. Of what we've survived and what we've escaped. And while I know that my last pregnancy did something to me emotionlly, I am on the way toward healing.

We are, all of us, just minutes from a moment that could destroy us. That family never dreamed they would never speak to their mother again. I'm sure the polite, clean-cut man never dreamed he would be homeless. And I'm sure that mom never dreamed she would have to make the call to allow her baby to die. Any of this could happen to me. Instead of letting this consume me and depress me, I am choosing to let this be a lesson learned: to appreciate everything I have, to love the family I have, and to focus not on the ways in which my children came into this world, but the moments I have had with them since.

A Donut?

I got called to a patient's room the other night by a nurse who was in a complete panic. So I go. I walk in the room to see 4 nurses surrounding the patient's bed, and immediately hear the sound. Not a wheeze or a crackle. Nope, this sounded like a foreign body obstruction. Stridorous. Horrible. All of the people in the room look like deer caught in headlights. And I instantly take in my surroundings. The room literally looks like a wasteland of half-eaten food. Cookies, a pastry, cups of Jell-o, pudding, applesauce. The one nurse is grasping a suction catheter, which I take from her while asking what the patient had eaten and when. And it went like this:

"Eaten??? Nothing! She's NPO!"

NPO, to you laypeople, is Non pour os: Nothing by mouth. Meaning she isn't allowed to eat. But I can smell bullshit a mile away, and her nurse gets very, very defensive suddenly. So I do my business with the suction catheter, threading it through her left nare and into her throat. Down the hatch I go while asking again. One more chance to 'fess up, but nobody bites. And then I start suctioning food out of her airway that looks, strangely enough, identical to the half-eaten donut on her bedside table.

Mind you, I have suctioned some gross stuff out of people. A whole green bean. A macaroni elbow. Vomit. The worst was shit--literally--from a patient with a fistula between the airway and GI tract. But a donut? With the powdered sugar still intact? Seriously? Of course the nurse was still denying that the patient ate anything, even with the evidence right under our noses.

Until we got the patient to MICU and, upon intubation, found the rest of the donut, the donut's wrapper, and for extra fun, a wadded up tissue In her fricken trachea. But she didn't eat anything.

Only in my line of work...

Speaking of weird airway discoveries: this is why they ask you if you have dentures before surgery/ intubation. And you should learn fom this poor schmuck and tell the truth! (Side note: yep, this was at my hospital. Not on my shift, thank God! A coworker removed the identifying info from the image so there is NO infringement on the patient's right to privacy!)

It's What I Do

One week out of the year, we celebrate my profession, and this is that week. National Respiratory Care Week. Not many people know what I do. Or understand it. I have been asked on several occasions if it requires college. Ummmm, yeah, it does. I have been asked, while delivering an inhaler to a patient, if that is all I do all day at work. Ummmm, nope. Even nurses get confused. So in honor of RC Week and my profession, I thought I would sum it up as best I can.

• I have resuscitated patients anywhere from as young as 22 weeks gestation to 99 years old. The most difficult are always the ones I relate to my own life. The child Evan's age who decided to help his dad by getting his own medicine...and took the entire bottle. The 6-month-old drowning victim. The 34-year-old woman who died of breast cancer, and while we were breathing for her and doing chest compressions, while her body was still warm, her 8-year-old daughter and husband were brought into the room to say goodbye. I can still hear that one: the young husband wailing, while the little girl draped herself over her mother screaming "Mommy, don't go!" Fresh tears still spring to my eyes, years later.
• The coolest moment for me was when I participated in a code of a patient fresh from open-heart surgery and I literally held his heart in my hand. This also had to be the scariest. Runner-Up? The day we delivered a baby in the ER parking lot in the backseat of a Chevy Equinox.
• The most rewarding experience of my life was when, at a time I was having horrendous personal issues, I met a little blue-eyed, blond-headed 2-year-old boy and found out from his mother that I was the one who resuscitated him. Suddenly everything had a new meaning after that encounter.
• My proudest moment? Evan had to sum up what I did for his class at school during a Career Day. He really didn't have the words, at such a young age, but wrapped it up to one sentence, according to his teacher: "My mommy saves lives."
• Yes I give inhalers. I also give breathing treatments. And manage oxygen. And life support. When a family decides they have had enough, I am the one who has to "pull the plug". I have seen countless deaths, but I have also seen real life, in all of its glory.
• My hands hold within them the rhythym of human breathing. I can take one look at a total stranger and determine immediately the size of their trachea and about what amount of air they need per breath.
• I can intubate with the best of them.
• I am horribly out of shape, but yet for some reason, when a code is announced, can manage to run from one end of the hospital to the other without getting winded in the slightest.
• I'm the one who eventually sees you when you have done something remarkably stupid. Example: the 23-year-old who trashed his lungs and eventually died after being on a ventilator for a month--all because he tried to get high by putting Jagermeister in his baby sister's nebulizer and inhaling it.
• When I ask you if you smoke and you tell me no, I already know if you're lying to me. I don't ask to be judgemental. I ask because I need to know how best to treat your lungs.
• Seeing me walk into a room is never a good thing. My presence means someone is not breathing well. Or not at all. Or their heart isn't beating, or is at risk of stopping.
• I have gotten hurt for the sake of my patients: the 500-lb. man who had me straining my back to help lift him to a chopper so the National Guard could transport him since he was too big for the ambulance, the ICU bed that was rolled over my foot because I couldn't move since I was breathing for the patient.

My job is beautiful and amazing. Heartbreaking and soul-crushing. It can boost you up and also wear you down. It is exciting at times and boring at other times. And I wouldn't trade it for the world.

The Most Dangerous Person in Healthcare

I have always said that the most dangerous person in healthcare is the one who will not admit that they do not know everything. Plain and simple. We all have our dumbass moments. This goes for doctors, nurses, therapists, techs. None of us are immune. At some point in someone's career, they will encounter a new patient who is a bit more challenging or has a condition with which we have not had much experience, or will be exposed to a new type of procedure or a newly-developed better way of doing things. It is the nature of the work we do.

With that being said...

We all also have our moments of, well, cockiness. We know when we are right. The good doctor/ nurse/ therapist, when faced with these moments, will admit that they could possibly be incorrect, but they feel confident that they are correct, and they will assert themselves with the other members of the healthcare team. The beauty of this job is that there are almost always tests that can be done to confirm our hunches. One has to find that delicate balance of speaking up and advocating for the patient when they think they are correct, yet still be humble enough to know that the human body is design at its greatest and we will never understand every single miniscule thing.

And then there are new grads.

The newly degree-holding, newly licensed, newly credentialed beasts that they are. We all were new grads once. Yes, me too. But I don't ever recall a time where I had this sort of issue. I can reflect back on my time when my role switched from being a college student completing patient care under the licensure of my preceptors and instructors, to being a big girl with my own license and credentials. Yeah, I felt like a million bucks the first time I signed my name. Andrea, RRT, RCP. Those capital letters behind my last name to let people know I was qualified just seem to do something to people. For me? I was scared to death. And I made a career move that would later serve me well in my transition of roles: I took a position at a small hospital where there was only one therapist staffed at night---me. I didn't have the luxury of hanging back timidly while the more experienced took over. I was in the thick of it: full arrests coming into the ER, asthmatic kids, emphysematous grandparents, and neonates needing resuscitations. And so I got over my fear. And became confident in my skills and my education and my abilities while realizing that there is no way, in that tiny hospital, I encountered every curve ball the human body can throw our way. Stellar career move. The best thing I coud have done for myself starting from scratch, even though it wasn't intentional. Truthfully, I started out with a salary and benefits package that was pretty obscene for someone with such a lack of experience, and that is what drew me in. It was only later, when I discovered I belong in a big hospital and I am charged with more critical care that I made the realization that the first role I had made me a better therapist.

So back to other new grads...
Where in the blue Hell did they come from? And in case someone from my work comes across my blog, let me clarify that I am not speaking of one in particular, or even one discipline. It is a New Breed. Gone are the days when they bow to the more experienced like we did. And no field is exempt. Gone are the days where they emerged from college, looking scared and timid. When they valued the input of those who have been practicing for as long as they have been alive. Yes, we all sign our name with the same credentials, but in my department, we are blessed to have some pretty experienced therapists in our midst. And I will be the first to say that if any one of those ever have something to teach me, I am all ears. They have seen more than I have seen, done more than I have done. But the new grads of today? They don't have that humility, that attitude. And this goes for all: doctors, nurses, therapists, techs. I can remember when it was that time of year and the first-year residents showed up at the hospital. You could always spot them with their scared-to-death stare with eyes as wide as dinner plates. And they knew that, even with MD behind thir names, they still did not know as much as an ICU nurse or RT who had been in their field for years. They would humbly ask me to tutor them on ABG interpretation or help them intubate the tricky airway. Not anymore. A few weeks ago I had a code where the first-year tried and tried to intubate, causing trauma to the patient's airway and allowing the patient to get too hypoxic between attempts to where I finally had to yell at her to stop and let me deliver some breaths. And she looked at me, aghast, stating that she was a doctor. Yes, she was, but that was MY patient.

The sad thing is that I am exactly where you find these arrogant beasts these days--night shift. Day shift positions in hospitals are pretty coveted and snatched up by those with more seniority. The vacant positions are almost always on nights. And so I am stuck. Night shift is very, very young. And maybe it is that I have been doing this for enough years that I am starting to develop the salty crust of experience. Maybe it really is that new grad these days are arrogant SOB's. Whatever he cause, it is leaving me feeling old and weary and seasoned in a way I didn't feel before.

On Coming Back and Letting Go

Work has been so strange lately. It's not even Hell Season yet. For those of you who don't realize what that is, Hell Season usually hits around November and lasts through March or April--in other words, flu season. In other words, the best of times and worst of times to for a respiratory therapist. The best because I will earn about 3 times more than I usually do in the off season because the hospital is usually full of respiratory patients and the overtime is there for the taking. And I am opportunistic. Sick people need our care, staffing has to be up to accomodate them, and I am all about more moola! On the downside, I have not yet maneuvered Hell Season as a Nursing Mom. I had another night last night where I went 8 hours without pumping because I was just too busy, and this is way before it is supposed to be as such. Will my boobs survive? I don't know. We shall see. But you can expect more posts about work.

So anyway...

Last night I got a call from an RN friend from the SICU, warning me that I should start heading that way, that my patient was getting ready to code. I get there and he is off of his ventilator and the nurse is bagging him. I take over and am bagging him when we lose his pulse. The big blue button is pressed to alert the troops, and the rest of the code team arrives. We resuscitate this patient for over 50 minutes. During that time, we get his pulse back only to lose it again. His wife is brought in to say her goodbyes and also to see that we are doing everything. She is obviously very distressed and calls his daughters. And we call it: Time of Death 04:46. The rest of the team leaves the room except for me and his assigned nurse. I tell the nurse to turn the oxygen off from the connection on the wall and the loud hiss of it stops and there is silence. I detach the bag from his endotracheal tube and lay it on his chest. And then I hear it: noisy breathing. I look down and he is spontaneously breathing. And not the agonal, uncoordinated breathing of the dying. No, this man is breathing. So I try to discreetly get the nurse's attention, who calls the resident back in. And they check him. Good pulse, good blood prssure. Just like that. He came back. The Lazarus Syndrome. I've heard of it happening may times. This was just the first time it happened to me. So we hook him back up to the ventilator and tuck the blankets back around him and leave the room with out resuscitation equipment. Just like that, as if nothing had happend. Totally bizzare.

Meanwhile, in an adjacent unit of the hospital, there is a patient who is breaking my heart. An elderly gentleman who knows he is dying and has signed a DNR order. And he begged me and begged me to help him die, and all I could offer him was treatment to prolong his life. I have to tell him both sides: that it could be considered life-saving treatment, but that it also could be short-term to help him through until he can breathe a little easier. And bless him, he doesn't want it and I can see that, but I think he is worried about what I want to hear more than he is about how he wants to die. And it breaks my heart. He keeps asking the nurse and I to just make it go quicker, and I can't. We ask if he wants us to call in his family and he says no. "I've been married for 64 years to the love of my life," he says, "and I don't want her to go through this. Just call her when I'm gone." True selflessness. He wasn't worried about her being there to hold his hand. Instead he took the hands of a young nurse and a respiratory therapist, both strangers to him, and that was enough for him. I had to stand there and do nothing while he started to slowly slip away. I couldn't call a code or intubate or breathe for him. There were no chest compressions or life-saving cardioactive drugs. And now I can't get him out of my mind.

We spend years of our lives learning how to save a life. That's what I do. Well, the biggest part of what I do, anyway. I'm sorry if that sounds like the swagger of a cocky healthcare provider with a God complex. It really is just the fact of my occupation. And they teach us of the legalities of our role: what constitutes extraordinary measures, medical futility and more. But then there is the side of this for which they do not prepare us: standing by and doing nothing. Holding a hand as our patient dies when we are trained and geared toward doing anything and everything to prevent it. And in that moment, just like my patient, I have to let go. One would think that the resuscitations and other life-saving moments would be the greatest challenge, but they really aren't for me. What happened with this guy--well that is the hardest part. Having the ability to keep him breathing an his heart beating and not doing it. Letting go.

The Scary Part

We people who work in healthcare often do our jobs without really thinking of personal risk. I am no different. As I typed that last statement, I got a vision of me helping to load a patient into a chopper while bagging with one hand and trying to hold the stretcher up with another. No small feat considering the patient weighed over 500 lbs, and I seriously am lucky that I didn't sustain a more serious back injury other than a puilled muscle. Or I can tell you of walking into the rooms of countless tuberculosis patients, getting parts of my pinched into bed rails, my foot run over by an ICU bed during a patient transport. Skinned and scraped knees from doing CPR in a parking lot. I even got H1N1 while pregnant with Zach. It happens. I take care of some pretty sick people. What is the realest threat? Bloodborne pathogens. HIV, Hepatitis, and more. I had managed to escape. I have spent years of my life poking needles into people's arteries and yet to have a needlestick.

Until this past Friday night.

I was taking care of a patient covered in tattoos and piercings, which are both risk factors. He was unresponsive and I was told he was unable to move his left side. Yet when I popped the needle into his left radial artery, he jerked so quickly that the needle promptly left his artery and went straight into my left middle finger. The wheels of handling an employee exposure were set into motion immediately as the house supervisor was present when it happened, when I blurted out "Oh SHIT!" and pulled my hand away with my blood already pooling up underneath the latex glove. Then another nurse walks into to alert staff that according to family, they guy also has a history of illicit drug use.

Double Shit.

Of course I had paperwork to complete and had my labs drawn. They did a rapid HIV screen on the patient. It was a Friday night, so I was told that they would have to page an on-call employee health person, but I would have my results by the end of my shift at 7 AM. Nope.

Through a long chain of events, I finally got an answer 36 hours later. But this was after my making many phone calls, including to my family doctor. I didn't know what to do. You see, hepatitis and HIV are both passed directly through breastmilk. I couldn't feed Zach until I had an answer. They tried to tell me that the risk of me getting anything was low, and while that is true, a chance of one in a million is still too high for me when it comes to my precious baby.

Then there is the part that had me, for a day and a half, facing the scariest part of my job. What did I come into contact with? What if I caught something? What of my family? It was absolutely, positively nerve-wracking. And every possible scenario raced through my brain in the time it took me to find out that the man was negative for everything. Now all I have to do is make sure that there wasn't anything latent in my blood. And I will have to be tested several times over the next year to make sure I stay negative for everything. But for the first time in my career, I had to stop and think about what it is I truly do on a daily basis. And it scared me to death.

Customer Service

The latest thing in healthcare (well, over the past few years, anyway) is "customer service". The basic idea is that you have a choice on where you receive health care services, and we want your business. This is great, generally speaking, but it brings with it some problems.

When you are sick, you go to a hospital because we know what we are doing. We can figure out what is wrong with you and know how to fix it. If we cannot fix it, we know ways to at least make you more comfortable. A hospital, however, is not a hamburger joint or a shopping mall. We want you to be involved in your care, to be able to make informed decisions, and more. You have the right to accept or decline any treatment offered. But here is the clencher: You cannot always have it your way. We are not Burger King.

So let's look at our customers. Generally speaking, the "customer" is the patient. The problem is the patient is ill, may be in pain, depressed, irritable, you get the picture. We get drug seekers who want nothing more than their Dilaudid or morphine and get quite disgruntled when their doctor orders them up some Tylenol. We get hypochondriacs who think every twinge indicates the need for horribly invasive procedures. And we get people like my patient the other night.

It was 4 AM, and I was the charge therapist. I was not assigned to this particular unit of the hospital, but I was carrying the ER pager when a very distraught nurse called. Turns out she had an asthmatic patient who said he was having an asthma attack and she was not getting an answer from their therapist. I looked up the man's meds and said I would be up right away. By the time I looked him up, retrieved his ordered medications and made it to his room across the hospital, a measley 4 minutes had passed. To put this time in perspective, we have 20 minutes to respond to a STAT order before anyone asks questions. To make my time even more impressive, we had just had a rapid response call and a code blue.
As soon as I walk into the patient's room (a patient who appeared to be in no respiratory distress, by the way) I was getting screamed at for taking 4 minutes. He accused me of trying to kill him. Seriously? I grabbed his spacer and the inhaler out of my pocket and started to give it to him. A word about the spacer: we use them not only to increase efficacy of medications, but also because they have a one-way valve that means we can use the same inhaler on multiple patients getting that particular drug. This saves money for the hospital and patient because a 200-dose inhaler doesn't go to waste on a 3-day hospitalization. But this guy didn't want to use the spacer and started to argue while I was trying to explain its necessity. He ripped the spacer/ inhaler combo from my hands, took off the spacer and threw it at my face, and continued to take 5 puffs of the inhaler in the most ineffective way imaginable. Since this was a new inhaler, I could not leave it with him. Thinking he was done, I reached out my hand to get the inhaler and this is when he scratched up both of my arms and took a swing. By this time, all of the commotion had aroused a family member of a patient across the hall, and she had emerged from her room to witness the entire ordeal. I ended up having to call security to get the med back--I can't leave it with the guy, even though it is now garbage by that point. I am responsible for its administration. So security gets there, and asks why he is hitting staff members. This is when the patient says I hit him, that I was doing nothing to help him, that he never took any dose off of the inhaler, blah, blah, blah. When security asked him why they should believe him, his response? With and evil smirk, he said "Because I am the patient." Then he proceeded to threaten to call hospital authorities on me.

Of course his plan was foiled. He actually left red welts up my arms and a mark the distinct shape of his closed fist on my upper arm. And there were witnesses. My supervisor and department director saw all of these the following morning before I left for my shift. But this man is still in the hospital and has had security called to his room for one conflict after another nightly for 2 weeks.

This is what we deal with. This is what happens when some people get too much power. I knew I was in the right, so he didn't get what he wanted from me. But what of the other people he has been terrorizing? People who are afraid to lose their jobs or are afraid of frivolous lawsuits give in to this sort of behavior. (Yeah, he threatened that too, by the way, when in truth, because he was mentally competent, I could've been the one pressing charges on him for assault.) All in the name of customer service. Of keeping the patient happy. Even knowing I did the right thing, I was still a teensy bit worried. Customer service is such a big issue that when the customer complains (i.e. the patient) it is a Big Fricken Deal.

With all of this being said, I usually do what it takes to keep my patients happy. I fetch ice water or snacks when it is not against medical orders. I tuck them in with warm blankies. I leave the door open or shut to their specifications, and much more. None of these fall under the specifications of my job. It's just something I do. Again, customer service.

But....If the mantra of customer service is "the customer's always right", then my experiences have shown me that this has no place in healthcare.

To My Smallest Patient

To My Smallest Patient,I wish I had a name by which to address you, but to me, you will forever be emblazoned in my mind as Baby Boy. I got the call that you were arriving at 11:30, and made the necessary logistical preparations. Airway equipment ready. Ventilator ready. Suction supplies ready. But the transition from your mom's nine centimeters of dilatation and your arrival into this harsh world took all of 10 minutes. I thought I was ready.

I won't forget how I held your feather-light head in the palm of my hand as your chest fluttered like a baby bird's. How you tried to protest the things we were doing to you but just weren't strong enough to cry. The bones of your tiny face felt so fine as we pried you open to insert tubes to sustain you. My hands shook as I breathed tiny puffs of air into your fragile body. My tears burned the backs of my eyes as I held them in. It is unprofessional to be that affected. Yet I could not help but think that if I did my job correctly, I would never know the outcome. Will you suffer lifelong disabilities because you came into the world so soon? Or would you grow up to lead a normal life? To run the 50 yard dash in gym class and dance with your date at your senior prom?

I will never know. My role is to be anonymous. Your mother never saw me. I was waiting for you in the NICU as she was pushing you into this world, far removed from the drama of her work. And you will never know me for being the one there to take over your vital functions when your own body was unable. You will grow to remember your first date, your first bicycle, your first kiss. I am the one who gave you your first breath. Anonymously.

I did what I had to for you. And then I left you in hands more capable than mine. Hands that do this multiple times a day. I gathered my ventilator and dirtied equipment as they took you away in your plastic box, and it was all high-fives and pats on the back from the team who essentially kept you alive. And I left. And as the elevator doors closed, creating my sanctuary, it was then that I cried.

I cried for you as you endured more pain than anyone should. And I cried for your mom and the tough journey she has ahead of her. I cried for myself and the career I love so much that takes so much out of me. And I cried out of gratitude for the healthy sons I have at home. Either one of them could have been you, as you lay there while people who do not know you fought for your life.

Perhaps the greatest gift is that you will not remember the feel of the endotracheal tube as it slid into place, of the cold blade of the laryngoscope as it pried you open. The needle sticks and chest compressions on still-soft bones. You won't remember my face as you felt these things. And you will never know that we had to keep you from your mother out of medical necessity.

You gave me a great gift last night. You showed me that I can do this. That it is time to shift my career to a different objective, to take on the role of helping other moms and babies who are in the throes of surviving what I did. So thank you, Baby Boy. It is my most sincere hope that I helped you last night instead of hurt.

Lovingly,
Andrea, RRT



Image credit: http://rds.yahoo.com/_ylt=A9G_bF4b8VZMS1oAlLyjzbkF/SIG=1392epco2/EXP=1280852635/**http%3a//babyelandaily.com/2010/04/20/premature-baby-awareness-march-of-dimes-discount/

Obviously, I cannot take a picture of my patient for my blog. He deserves his privacy and so does his mother.