"You've got to fill your heart with pure love."
-Colin Hay

...and Colin Hay always speaks the truth. Tis' the season, so what better topic for this blog than love in the setting of hospitals and the respiratory field?

In my estimation, to be in this field, nursing or yes, even to be a doctor, one must have a huge heart. Miles and miles of heart. After all, ask anyone who's in the field, and nine times out of 10 you'll get the cliche' answer, "I wanted to help people."

I've met some bitter people in my short time in this field, but I believe that no matter where your head and heart is at the moment, that love is still in there. It's Christmas time, so dig down deep and get it.

Sure, it is a bummer that some of us will be spending Christmas in the hospital...but so will a lot of our patients. So, if you may be one of these bitter people clinging to your complaints and general grievances, I urge you to put them down for this one day. Dig deep and get the love out, because EVERYONE deserves a Christmas full of love; hospital or not.

That's what this holiday is about: pure love. So, show it. You'll be surprised how much more you'll enjoy your holiday, even if you are cooped up in the hospital all day. Let us help people with a smile on our faces and joy radiating from us.

And don't worry, if you start to miss complaining and general bitterness, it'll be right there waiting for you on December 26 (should you choose to pick it back up).

Merry Christmas everybody!

B.J.

My cell phone rings while I'm standing in Wal-Mart. The voice on the other end says, "Could you come in early? Stephanie is going crazy."

"I'm on my way" I replied.

Stephanie is prone to going crazy and feeling overwhelmed, so I didn't think much of it. Fifteen minutes later, I would find myself holding a guy's neck together.

Upon entering the department, I noticed our vent was gone (I work at a very small hospital, we have one vent for the time being while our ICU remains yet to be reopened). I immediately headed for the ER, where I found a sea of yellow iso gowns and dried blood. Stephanie was there bagging the patient, to which I asked where the vent was.

"It's not cleaned yet. I just used it on someone else a few minutes ago," she said. 

This was peculiar, as we've not seen this kind of action since the hospital reopened with just an ER and telemetry and psych floor. We're a small community hospital recovering from being bankrupted by a selfish doctor and his faulty company. We successfully reopened our doors in May; about 2 years after the hospital closed its doors. Reopening a hospital that was shut down, and had all of its equipment auctioned off was a feat unaccomplished by any facility in Pennsylvania...until now.

Anyway, back to the action.

I took over the bag while Stephanie went and got the vent cleaned and assembled for its next use. During this time, I got the story of this patient.

54-year-old male, serving time in prison, attempts suicide. That would explain the 2 corrections officers in the corner of the room, a uniform that is all too familiar from my dad's many years doing that difficult job. Turns out this inmate broke his TV, and subsequently used the glass to cut his wrists and gash each side of his neck with deep lacerations.

Inmates get TV?  Who knew? We don't even have a TV in our department yet.

We got the guy on the vent, and there were surprisingly no issues. This guy didn't even trip an alarm once (no, we didn't lock him out from setting off the alarms). I grabbed the guy's neck to hold back the bleeding. After all, the poor phlebotomist's arms had to be tired from holding it for the previous 30 minutes.

Fast forward another 30 minutes, the guy is being Life-Flighted to Pittsburgh, since we have no ICU. If every good story has a moral to it, mine would be the following:

Always wear isolation gear in a code. The inmate had Hep C and MRSA.

(Luckily, I did.)

-- B.J.

Story 1: Pills or Kills?

I walked into the patients room in the ICU, and did some respiratory parameters. The lady was found overdosed on anti-depressants...most likely self-inflicted.

"Wow, everything looks great." I continued to share the good news with the doctor.

"Great! Let's pull the tube," he excitedly announced.

I walked back in the room and explained the situation. I instructed her on the deep breath and cough technique, and subsequently pulled the tube. After some suctioning and cool aerosol mist, the lady looked up at me...

"My son tried to kill me..."

Yeah, I don't even know how to begin to respond to that.

Story 2: "The Curious Case of Lung Leaves"

28 year-old male patient was intubated after an ATV accident. He was in a neck brace, with good respiratory effort. Sure enough, the time came to pull the tube.

Everything was explained to the man, and with his immediate family in attendance, out came the tube. However, something else came with the tube. It appeared to be a piece of that cheap brown paper towel you find in some facilities...but it came from his lungs. Within seconds, RTs, nurses, and doctors alike were developing theories to this odd occurrence. After minutes of speculation, we left the room.

Seconds later, we were back in the room. The patient had begun vomiting up more and more of this paper towel type substance. I then developed my theory.

"The patient was in an ATV accident right? Ok, so he wrecks his ATV, and face plants into the ground. While being unconscious, he aspirates some leaves off of the ground. We just never picked it up until now."

It was feasible, because within the little brown pieces of wet paper towel were little veiny stems. I was quite proud of myself, and momentarily considered my intellect on par with Dr. Gregory House.

I was wrong. The man crashed his ATV on pavement. The story is getting more and more curious.

By the way, the man is fine. There was no patient neglect while we all tried to solve this mystery.

Amidst all the theories, one RT asked a family member what the patient had to eat before this accident occurred.

"Kielbasa" she replied.

There's nothing harder than to write a blog about respiratory care when not much is going on. Our patient census is down hospital-wide, and I spend more time doing computer stuff than dealing out nebs.

So, for this entry, please enjoy some random recent observations I've made. Some are bitter, some are hopeful, but all are true.

(Correction, most of these are bitter, but since I'm usually upbeat and optimistic, I get a free pass.)

• Why do docs still intubate? I mean, they should know how, but this should universally be a respiratory thing.
• More places should adopt therapist driven protocols-nothing more frustrating than giving unneeded treatments.
• If you refuse to wear an oxygen mask when your SaO2 is 74% on 6 lpm NC, you're an idiot. I mean, come on! You have got to help yourself a little in order for the rest of us to save your life!
• The 50 previous albuterol treatments haven't healed your broken leg yet, but maybe the 51st one will...
• It's awesome when the respiratory department is promised a new computer, but is instead refused one because "we just got you new beepers."
• I'd rather do a blood gas on a frail, old lady than a big, gruff biker guy. Seriously, man up, dude.
• Wilford Brimley pronouncing it "diabeetus" drives me crazy. Just saying.

Ok, I'm done now. I'll save my other grievances for the next low patient census.

Happy Respiratory Care Week!

-- B.J.

This is moreso for young people coming into the field, as I'm sure those already in it have experienced this injustice.

Attention all youth. I'm calling out to those who are young, just entering the field and nervous. This is yet another thing that isn't exactly taught until you experience it first hand.

In this field, youth goes against you until proven otherwise. Maybe not in this field alone, but all of health care. I'm fresh out of school and have been at my facility for four months now. Being 23, I'm one of the youngest people in the department and hospital.

That one drawback to a smaller, more intimate facility is that everyone knows your story. In my case, everyone knows I'm young, fresh out of school and inexperienced. To some of the "old dogs" of nursing and medicine, this is seen as a temptation to "rough ya up a bit." To test you. To see how quickly you back down.

I've experienced this a number of times, being the subject of quick jabs, having been tested about my knowledge ad nauseum.

However, fellow youngin's never fear -- there is an answer to all of this: Stand your ground.

In situations where you're questioned, NEVER underestimate your knowledge. Don't be afraid to defend yourself, because even though they may have 50 years of experience on you, everyone makes mistakes!

Or, as a senior therapist told me yesterday, "You are here to defend that patient. It is your job to do your best to make sure they get better, and that they are provided the best care possible. It doesn't matter who questions you; you know your field. Just go and do your best and be an advocate for yourself and especially your patient."

So be bold and sure of yourself. That's how you get respect.

-- B.J.

Before I ever got into the health care field, I was languishing in mediocrity, unsure of what I wanted my future to hold. The one thing I took solace in was sitting down at night, and enjoying my medical dramas/comedies (particularly Scrubs). Luckily, it didn't take me too long to put two and two together and have an epiphany: Do what you enjoy. Well, I'm now in health care, living what I enjoy.

Before I started, however, I was watching an episode of the drama Grey's Anatomy; the first episode, actually. Towards the end of the episode, Meredith, after scrubbing in on an advanced surgical procedure, says "...that was such a high. I don't know why anyone does drugs."

It wasn't until I started clinicals in school that I fully realized the honesty of that particular line. Happily, to this day, I still get that high, and I don't see it dissipating anytime soon.

It's that feeling of euphoria that you feel after helping someone, or making a difference. When a code comes in and you actually bring them back. When you have an asthmatic in severe distress thank you after multiple treatments. When a COPD'er finally goes home after weeks in the hospital, after you equip them with home O2. All too often things don't end up in a happy way, it's nice that every now and then, you can catch that high.

Instantly refreshing!

I'm lucky enough to have a cousin in the profession--he taught me how to really read blood gases and see past the numbers; I've never struggled with a single one since. He worked for eight years at a hospital, and is now a clinical ventilatory specialist for a major respiratory care organization.

He told me a story about a doctor who trusted no one, kind of a "if you want something done right, do it yourself" type person. It took my cousin five years to gain that doctor's trust, and now his opinion isn't just appreciated, it's golden.

I asked my cousin how he finally convinced the stubborn doctor to trust him. He simply replied, "you have to teach them."

We have two years or more of rigorous pulmonary/ventilatory education, which surpasses the training of anyone else in health care. To put it bluntly, no one knows as much about the lungs as we do. Most of the time, not even doctors. We are the go-to pulmonary experts.

So, every chance you get to speak with a doctor or nurse is another chance to prove your expertise. Prove that you are the best. Gain the trust. I think doctors are more willing than most think to give up the reins a bit.

Apple CEO Steve Jobs once said that "greatness is communicated in everything you do." The way you talk, walk, dress (see Scott Leonard's "Sharp Dressed Man" http://community.advanceweb.com/blogs/rc_1/archive/2008/07/16/sharp-dressed-man.aspx) -- it all presents an aura. So, go be great.

Present a united front of confidence and ability. Gain the trust. It's not only job security; it elevates the profession for all of us. We are far from being tank jockeys anymore, but we're also far from having as much trust and respect as we should merit.

Therapist, go forth and be great!

-B.J.

She was feeling general weakness, and after performing an EKG and literally the hardest blood gas of my short career, it was concluded that their were no major issues. The EKG was fine with the exception of some bradycardia, and you couldn't ask for a better room air blood gas.

The sweet old lady told me about monumental events that have happened during the span of her lifetime (mainly the sinking of the Titanic), and having told these stories to her grandchildren. She told these stories all the while I was searching frantically to find a good pulse to stick and get the gas. The lady treated me as a professional and didn't even complain when I had to re-stick her for the blood gas.

I would see her throughout the night, mainly just popping my head into the room to make sure she was okay and comfortable. She was admitted to the floor.

I was just called up to the Telemetry floor 20 minutes ago and told that room 121W had just been pronounced by the doctor. Sure enough, it was that lady. Aside from the feelings of sympathy for the crying family, and the grief I felt as her therapist and the loss of a great lady, I can't help but think about how quickly things can turn.

...and even scarier than that, how quickly we as respiratory care professionals have to shrug off this "common occurrence" and see the next patient.

I'm sure that anyone reading this has their very own "97-year-old-lady" in their mind. Even though was have to continue our days like clockwork after such a loss, I think it's important to carry a piece of these people with us. It makes us better therapists, and better people.

Until next time.

Keep your eyes and hearts open. Have faith.

-B.J.

Throughout your practice in respiratory care, you meet many different people. It's inevitable, for better or worse, it's something we all realize from our very first patient if not sooner.

As I'm sure some more experienced therapists can attest to, eventually there will be a patient that affects the way you work; someone that weighs heavy on the compassion and generosity factors; maybe someone that you feel the need to go the extra mile for.

IT could be someone you know, a friend of a friend, or just a patient you see all the time (a frequent flier). I've been lucky enough to have a few patients in the short time I've been practicing that have not only influenced me, but have made me more outgoing and changed the way I work. These are the ones that stick with you, the ones that embody every patient you see.

LL was one of these people.

She was a great patient, but an even better person. I was the first to treat her when she came in the ER in the middle of the night. After the treatment, as I was walking out the door, she told me "I'm going to remember you..." She was admitted to our Telemetry floor, and she did remember me. In fact, she did more than remember me- she started to refer to me as her "boyfriend" from then on.

Imagine that- a 79-year-old COPD patient embracing a 22-year-old "Bambi" to the medical field- and I took it as a compliment. My word was now gold with her, and she would make sure to verify anything told to her from the doctor or nurses with me. I would spend more time in her room explaining things to her than the actual treatment. It's odd that someone would completely rely on the word of a young, new respiratory therapist. But I enjoyed it, and made sure I had an answer for all of her questions.

Going into her room every four hours for treatment time, or just going in to see how she was doing, I was greeted to an enthusiastic "There's my boyfriend!", much to the amusement of the nurses and her family. Doing LL's TID ambulations were also quite the sight. Never before have I walked someone that would "strut" up and down the hall to a chorus of "you go, girl!" before. It amazed me. I've never seen someone this old with emphysema have such life.

I think what I'm getting at is, we all have our own unique reasons why we got into the field and why we enjoy it. However, LL is universal. I think we all have (or will have) an LL...and it's the common denominator that we all share. That internal glory we feel from making a difference, and those patients that are intent on making a difference as well, in spite of what is ailing them.

That is why I do it, that's why we all do it: patient care.

Becoming the therapist I want to be often seems like a long impossible road. So I try not to focus on the road or the finish per se; I focus on the small baby steps that are taken that are so important in making me more independent and separating me from that "new grad student" mentality.

Baby steps, like the first successful unsupervised blood gas...

Baby steps, like reassuring an entire family and educating them...

...or like the baby step tonight: My first code, all the while being the only therapist in the entire hospital.

There's not much to say, it wasn't an epic code when people ran in slow motion and Hollywood doctors refused to give up on the patient, all the while dramatically giving a pericardial thump at just the right time to bring the patient back from the light.

Unfortunately, the patient was gone before he ever arrived at the hospital, and was declared dead eight minutes into treatment. But you never realize how well you were taught until you have to fly on your own without a safety net.

Bag O2, 15 lpm. That tube looks awfully low. Check for chest movement. The stomach is moving. Listen for bilateral breath sounds...present. CO₂ detector is yellow, good. Watch EKG rhythm. Perform compressions. Stop, check for pulse. No pulse, continue, etc.

It all almost comes naturally in high stress situations.

While I'm not "there" yet, I continue to take my baby steps to becoming what I want to be. And I'm glad that you'll all be along for the ride.

-B.J.

Wednesday June 11th 2008 à D-Day

I pulled into the parking lot 2 hours early. I was determined to be on time for my 9:00 am appointment. If there was a chance of me not walking home a certified respiratory therapist, it wouldn't be on a technicality like arriving late for the test. I decided to stay in the car and study even more for the test. As each minute escaped me, I frantically tried to cram 18 months of info into the remaining time.

8:55...time to walking into the testing center and register. Everything in the test center seemed ominous, most likely due to my nerves and fear of failure.

I sat down at the computer. It has become a requirement that before taking the test you must take a digital picture of yourself that will remain onscreen at all times, and will be printed out on your score sheet. I've never looked more nervous or tired as I did in that picture.

Endless minutes passed, and the test was taking much longer to finish than any pre-test I had taken before...this did not add to my small amount of confidence.

Question 159.......

Question 160.............

The test is over. Please go to the front desk.

Now the 20-foot walk from the computer to the front desk is what I like to call "The Walk of Shame." It doesn't matter how confident you were taking the test, there's always doubt in those few steps.

I reached the receptionist and handed her my scrap paper. She said she would go to the back and get my results. I politely nodded.

"ON NO!!!! ANOTHER ENDLESS STRETCH OF TIME STANDING BETWEEN MYSELF AND THE UNKNOWN!!!" rang out in my head. The friendly receptionist took about 20 seconds to return, of which I'm sure I paced the building 30 times in that time frame. The lady returned and handed me the results page.

When things accumulate for 18 months and lead to one test, or one moment of time, it becomes overly strenuous. I now feel like I know what it's like to be at the Super Bowl, on a much smaller scale, of course.

I exited the exam center into the bring noon sun. I entered my smoldering hot car and looked at the books and random papers scattered in my passenger's side.

18 months, and I achieved my new beginning. I passed the test.

Some advice for those going to take the test, whether it is now or 18 months from now. It's all a mind game. Phase everything out.

You already have the skills you needed all along.

-- B.J.

P.S. Tell me -- was your test experience as harrowing as mine?

The most nervous build-up of my life.

18 months of strenuous studying, information overload, banning together with fellow classmates to try and make sense of it all...

It all comes down to this...

In the final weeks of school, we were encouraged to apply for a temporary permit. Most hospitals in the area would allow us to work on a permit, and it afforded us valuable extra time to study for the CRT (although we were adamantly and repeatedly reminded to not wait too long to take the CRT or RRT).

Coming out of school, I was hired casually at a mid-size town hospital, and in the weeks to follow, I was hired at a new upstart hospital full time. Not particularly new, but a few years prior, the facility has shut its doors and had not re-opened until now.

The re-growing popularity of this hospital made it crucial that myself, and my five co-workers be able to devote our time to getting the hospital, and our department up and running.

One hitch: I was scheduled to take my CRT exam in one week.

Typically, that's what directors like to hear. However, failure to pass the CRT would make my permit null-in-void.

Fail the CRT = Lose my permit = Not being able to work = the department and my co-workers suffer.

The pressure was on.

In the days that followed, I learned the ways of the department, how things are done and went about treating patients. I found the new job an excellent fit, as the entire staff is great and I even get to work with two of my former classmates. Everyone was supportive and plenty of words of encouragement regarding the test ensued. Everyone was sure I'd pass the test...except for me. The sheer amount of material overwhelmed me, and no matter how much I studied, it never seemed to be enough.

Next: Test day arrives ...

So you've taken all of the pre-requisite courses, passed the entrance exam and gotten ahead of the long waiting lines that most respiratory therapy programs seem to accrue nowadays. You've made it! Congratulations! It's all downhill from here...

Uh...not quite.

I was accepted into the respiratory care program in August 2006. It was a brand new program, which essentially made myself and the other 24 students guinea pigs, testing a brand new, unproven program in a brand new area. Through five semesters (18 straight months), we've all experienced growing pains, miscommunications and various issues. The program was especially hard, and most of us in the class attributed the difficulty to all the bumps in the road that we were experiencing. Surely, if we didn't have to worry about all of the outside stuff, we could focus on the subject matter and it would become easier.

Uh...not quite.

The minor issues were resolved quickly...but the program was still hard. How could this be? Everything was resolved; shouldn't it be smooth sailing now?

You, as a new student are about to take the beginning steps to something important. If you run the race, and finish, your reward will be a career -- but not just a career. This is a career that affords you the opportunity to make a difference on a daily basis.

Now that I'm about to graduate, the words of my teachers come to mind constantly.

"The program is hard for a reason."

"The program is hard for a reason."

"The program is hard for a reason."

My advice for you, the new student, is to enjoy the struggle. Going through the difficulties of the RT program will not only make you a better therapist, but a better person.

So chin up, shoulders back and keep your nose in the 50 lb. Egan's book. Understand that hurdles are in the program for a reason. Learn from your mistakes, learn from the therapists in the field, and keep a healthy supply of coffee/Red Bull in your system. After all, "The program is hard for a reason..."

...but not impossible. Just persevere, because it's all worth it in the end.

Thank you Matt Vancamp, Renee Dennis, Marshall Harding, and every therapist that has taken on the courageous job of showing me how it's really done and what it takes to make a good therapist.

Sincerely,

B.J. Smith

Which of the following are attributes consistent with the character and job title of Respiratory Therapist?

I. Knowledge

II. Skill

III. Analytical Thinking

IV. Motivational Speaking

1. I and II

2. I, III, and IV

3. III and IV

4. I, II, III, IV

I have recently come to the conclusion that in respiratory care, or almost any health care profession, it is equal parts knowledge, skill, analysis and motivational speaking. Sure, in a perfect world, every patient is cooperative, pleasant and full of great stories. However, sometimes we come across patients that don't understand the severity of their condition, patients who are lazy or unfortunately, patients who have given up all together. This is when it is essential that we, as therapists, motivate the patient.

Motivational speaking is not exactly a course they teach before they throw you out into the wide world of clinicals, but it rings true. I have seen it more than a couple times in the profession, and any good seasoned therapist becomes great at it.

A 40-year-old woman was admitted into the ICU, post-op abdominal surgery. I could tell before entering the room, just from the look on her face that she was in no mood to deal with me or my respiratory exercises. She was ordered a Duoneb, 2 ccs of Mucomyst, incentive spirometry and chest physiotherapy via a Flutter device. Nevertheless, I put on my confident face and entered the room.

The woman took the nebulizer treatment with little complaining, only rolling her eyes four or five times as I explained to her what the "rotten egg" smell was all about. Then time for the incentive and flutter--little to no effort. Upon seeing this, the therapist I was assigned to shadow entered the room.

I understood the pain this woman must be feeling, but it was imperative that she put effort into the exercise. Lying in bed, not working your lungs at all can lead to atelectasis, pneumonia and even a mild case of mechanical ventilation.

And that's exactly what the therapist stressed. In a firm, yet compassionate way, she explained all the ways things could go wrong and that the patient would see a lot more of us RTs should her pulmonary status get worse. And she finally explained that if we couldn't get a sufficient cough that we would have to suck out the mucus in a MUCH more uncomfortable way (NT suction).

I failed to mention that the family of this patient was in the room for all of this, and in times like these, it's not such a bad thing. Sure, sometimes families can sometimes make an ABG stick a little tense, or some families may not even like the prospect of an "inexperienced" student treating their loved one; but all families have one thing in common--they want their loved one to get better. So, as I said, having the family hear all of this only reinforced the motivation, and dare I say, "nagging."

With the fear of greater consequence and family support, we grabbed the flutter device again. "Hold your belly, and exhale strongly into this device. I know it hurts, but you can do it!" assured the therapist.

For the next two weeks, I visited that patient for the Q4 Duoneb, Mucomyst, incentive and flutter specialty. Upon entering the room every time, I was greeted with a smile from the family, and an eye roll from the patient.

"Here we go again. I know you can do this," I said, as I handed her the flutter.

I came across these a while back when I was browsing through the groups section on the site Facebook.com. I would like to share them with you...all credit goes to the original writers.

(Read original post.)