‘Protect Yourself’
Talking to an old classmate the other day brought up the memory of a very distinct clinical experience, which most students go through and never forget: my first terminal wean.
"It's depressing, you know. Some of these people you actually want to see taken off the vent, because they are already dead. It's just hard for the family to accept that," said Peggy, who works at a long-term ventilator facility.
"I know, I get disgusted by the sheer number of drug overdoses I seen on a daily basis," I replied.
The particular patient Peggy was referencing was a heroin addict, who essentially overdosed herself into a vegetative state. She was brain dead, but her family was hoping the situation could turn around. The patient was only 30 years old and had two small children.
"It's hard, but you learn to not get involved. Not look at the pictures on the wall of the patient's room," Peggy said.
"I know what you mean. It's kind of cruel, but absolutely necessary, like self preservation. If you don't protect yourself and your emotions, the negative aspects of our job and the things we see on a daily basis will eat you alive," I said.
That short conversation got me thinking about the irony of our job as respiratory therapists. We work so hard to save lives, but in cases like this, when you know it's time to let go, we actually sort of root for the death side of things. Even when the inevitable wean is to happen though, it's still painful.
I remember the face of the old woman I had to terminally wean for the first time. I was in my last semester of RT school, at a large surgical ICU. The therapist I had been following all week--a tough, drill sergeant type--walked me over to the room.
"You know what to do," he said to me, in a low tone.
"So, I just do this like any other extubation?" I asked.
"Exactly the same," he replied as he pointed me into the room.
I approached the ventilator, took her off, and started the procedure. Everything seemed to move in slow motion. "Hallelujah" sung by Jeff Buckley ran though my head. The woman eyes met mine as I withdrew the tube and that stare that is forever etched in my mind. Then as quickly as it started, the procedure ended. The woman held on for an hour or so before finally succumbing to her disease.
I walked out of the room with my head down, trying to comprehend the gravity of the situation.
"That's the hardest part of our job. No one will ever ask you to do anything more difficult," the therapist explained. "It's our job to save lives. That's why terminal weans are so difficult. But you have to take solace in knowing that you did the right thing, and don't dwell on it. The family in that room isn't going back to work today. You are. You have so many more patients that need you at your best. That's why you cannot dwell on it, that's why you have to guard yourself," the therapist explained.
And I believed him.
-- B.J. Smith