The Respiratory Resolution

Respiratory Made Easy- Understanding Codes: The Basics

Bj Smith — Fri, 30 Oct 2009 18:41:00 GMT

If you're anything like me, you enjoy a good trauma case or a code. Helping patients with breathing treatments, O2 rounds, ambulation, etc. are all great things-- but there's nothing like the rush you get from an emergent situation. There are so many...(read more)

Fighting the Urge to Be Ordinary

Bj Smith — Mon, 26 Oct 2009 17:33:00 GMT

" Real leaders are ordinary people with extraordinary determination " -Unknown We are all born ordinary. We're all genetically the same, more or less. However, not everyone's intentions and drive are the same. When I was nearing the end of my stay as...(read more)

The Respiratory Resolution: Studying for the Math Portion of an RT program

Bj Smith — Wed, 14 Oct 2009 21:12:00 GMT

The first edition of "The Respiratory Resolution" comes from a recently accepted RT student named Keshia. She asked: I was recently accepted into the RT program and very excited, however, I am very nervous about the math portion. Do you have any suggestion...(read more)

The Respiratory Resolution

Bj Smith — Tue, 06 Oct 2009 16:04:00 GMT

Since my last blog post, I've been very pleasantly surprised at the amount of people reaching out to me for advice and thoughts on the respiratory profession! People seem to share a lot of the same concerns, and I felt like we needed a refuge for these...(read more)

Sage Advice for Students

Bj Smith — Mon, 17 Aug 2009 17:45:00 GMT

I always enjoy speaking with respiratory students. It's actually one of my favorite things about being in the profession. Below is an email I received from "John, SRT" on some of his fears, thoughts, and questions. I would like to encourage any students...(read more)

That Blowy Thing

Bj Smith — Mon, 06 Jul 2009 17:45:00 GMT

It's funny to think back to your "early days" of respiratory. I distinctly remember the very first patient I ever talked to. See, back then, it was a monumental feat for me to even speak to the patients -- that's how nervous I was. It happened in my second...(read more)

Year One

Bj Smith — Thu, 11 Jun 2009 16:47:00 GMT

It's been one year since I got my first job in respiratory, and what a year it's been. It's also the anniversary of starting my blog here at ADVANCE . All throughout school, multiple therapists told me that I will learn more in my first year of actually...(read more)

Building Confidence

Bj Smith — Mon, 18 May 2009 16:58:00 GMT

A friend of mine just got her first nursing job, and she starts tomorrow. She was in nursing school while I was in respiratory school, both of us working our way through school at a small grocery store. She said how nervous she felt (something she's quite...(read more)

An Update on Unemployment

Bj Smith — Tue, 07 Apr 2009 15:17:00 GMT

It's so hard to think of something to blog about when it seems like you're out of the "hospital loop." Where I was once enjoying 16-hour shifts and the chaos of getting STAT pages on opposite sides of the hospital, my life is pretty relaxed right now--and...(read more)

Reflections on Unemployment

Bj Smith — Wed, 18 Mar 2009 13:41:00 GMT

Being unemployed seemed like a blessing in disguise at first. I mean, who wouldn't want to receive an unemployment check to stay home and catch up on the little odds and ends that accumulate when you are on a strict, busy schedule of day and night shifts?

Sure, there are people who like to be busy all the time--I'm one of them. But I defy anyone to deny that it's nice to be paid to take it easy for a little while.

Truth is, after a few weeks, you start to miss it. Marathons of "Unsolved Mysteries," morning pancakes, "Halo" and movies cannot compare to the rush of being in the ICU, even on a slow day.

I miss it all, from talking to the staff over morning coffee (and my AMP energy drink), seeing familiar faces and doling out countless aerosol treatments. I even miss bugging doctors all day to change their orders.

So please do me a favor. While you're at work this week, take a moment and soak it all in. Stop, take a deep breath. Live it! Every tiny bit, the dynamic and mundane things, and appreciate it. Then project that positive feeling to your patients.

These are heavy times, but don't let it weigh you down!

B.J. Smith

‘Protect Yourself’

Bj Smith — Tue, 03 Mar 2009 13:25:00 GMT

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

Faith in Medicine, Part 2: Faith in a Facility

Bj Smith — Wed, 18 Feb 2009 13:38:00 GMT

"You don't have to go home, but you can't stay here." I got a call from my mother while in the middle of vacation informing me that I was coming home unemployed. Now, for many, this would be a shock. Not so much for me. For those who follow this blog, I've stated on a few different occasions some specifics about my chosen hospital. Please allow me to be slightly redundant and catch everyone up:

Brownsville General Hospital was bought out my some greedy doctors and run into the ground. The small hospital officially closed its doors in early 2006.
Almost immediately, the former administration worked frantically to reopen the hospital (a feat which was never achieved before in Pennsylvania health care history.)
Plagued by financial woes from the start, the hospital struggled all the way to the reopening. Falling under new health codes and having to repurchase all auctioned off medical equipment delayed the reopening significantly.
On May 22, 2008, the hospital reopened with a bare crew of people and just an Emergency Room, and Telemetry and Psych units.
June 9th, the newly renamed Brownsville Tri-County Hospital hired an attractive, intelligent, young Respiratory Therapist: Me.

Flash forward to present day, skipping over late paychecks, bounced paychecks and a lot of what I deemed "guerrilla therapy" (Read: practicing respiratory therapy in a condition of little to no money being spent, while still providing quality care. The most common form involves a lot of "borrowing" and "testing" equipment, because your department has none of its own.). Not that guerrilla therapy is a bad thing, I think all hospitals could stand to spend less; imagine how health care costs would change if every facility cut back a little bit ... but I digress.

What would have been our final paycheck never actually arrived; hospital-wide, no one got paid. Now, in what is probably the most remarkable event of the story, only a few people quit.

We were flat-out told by administration that pay was not guaranteed, but almost everyone stuck around. It wasn't because we were rich, or because we loved the administration of the hospital. We cared about our patients. If we weren't there to watch over them, who would? I suppose I can't speak for everyone, but that was my logic. So we continued working without pay.

Unfortunately, six unpaid days later, the hospital went bankrupt. Now, I'm sure every hospital would love to have such a dedicated staff (and one who works for so cheap!), but there is the question I pose to you, which is not so different from the last blog with faith playing a part in terminal weaning: When does faith end and naivety begin?

Was everyone -- myself included -- naive to think the hospital could survive? It's noble to sacrifice for the good of your patients and facility, but at what point does it become a detriment to yourself and your family?

Let me know what you think!

-- B.J.

P.S. Got some really terrific replies on the last blog! Thanks for reading and giving your input!

Faith in Medicine Pt. 1

Bj Smith — Mon, 02 Feb 2009 12:23:00 GMT

In what is sure to be a controversial and re-visited entry, this week I am going to focus on a case that ties into religion and medicine.

When I was a student in my last clinical rotation, we had a trach patient in the ICU in terrible condition. COPD, pulmonary edema and on a vent to boot. The vent was the only thing keeping this poor man alive, and his wife was approached in regards to ending the life support.

The lady was a good, godly woman who wouldn't do anything to prolong her husband's suffering. My clinical partner even shared with me that this woman used to be his Bible School teacher.

The woman chose to continue mechanical ventilation with the faith that a miracle would happen. She truly believed that her husband would take a turn for the better.

That is all that I am going to tell at this point. What I would like is for you, the reader (particularly the students-brush off those ethics books), to share your opinion below.

Do you feel the woman is justified? Is she shielding herself from the inevitable truth? At what point should we accept reality and let go of our faith?

We've all seen or read about medical miracles. They happen; unexplainable by science or medicine. We've seen prayer affect things or unexplainable healing. Is it wrong to hold out for a miracle?

Let me know what you think.

B.J.

'Slow Night'

Bj Smith — Wed, 21 Jan 2009 12:17:00 GMT

Nothing quite like a 16-hour shift when the hospital is dead. Thank God for my laptop, which allows me to get some other work done.

The cool thing about our profession is that things can turn around instantly. There's really no way of predicting how the day will go. In the midst of the almost-midnight calmness of our department, I get a call for a continuous neb. Continuous neb turns into BiPap. BiPap turns into ventilator. Ventilator turns into me spending two and a half hours in a hot room, working my butt off on this "slow night." Coming out of the room, covered in sweat and mucus (pulmonary edema shooting out of the tube, always a fun thing to happen in the middle of a double), the ER doc approaches me.

"Hey, thanks for your help. I think she's going to do well," he said.

"Yeah, the gas looked great. I think the tube will be out tomorrow morning," I replied.

I may be new to this, but in my experience, it's not too ofen you get a "thank you" from a doctor. Especially not for just doing what your job. But there's nothing more gratifying for me than a doctor looking at me and asking me "What do you want to do?", and then thanking me afterward.

So sometimes it's nice to hurry up and enjoy the "slow nights."

-- B.J.

Hands: Remembering an Unsuccessful Code

Bj Smith — Mon, 05 Jan 2009 13:18:00 GMT

As I sit here typing, my hands are shaking. Furthermore, every chart I've signed or every thing I've written looks like an eager three-year-old just got their hands on their very first ink pen.

I just got back from an unsuccessful code.

Doesn't matter how many you do, they all have that mix of adrenaline and nervousness, mixed up in your gut and taking a toll out on your hands. It doesn't help when you've been doing compressions through the whole code either. My hands are mush right now.

The person we just coded happens to be the mother of a young fellow employee at my hospital. This person also happens to be a patient I've seen more than once. It's always rough when something like this happens, and unfortunately, it's like the third or fourth time a relative of a fellow employee has coded (maybe I'm unlucky, maybe it's a more common occurance than I realize). We always feel an obligation to do everything possible to bring people back, but when there's a connection like this, those obligations seem heightened. Maybe compress a little harder, faster...push a few more meds. Often it seems like it's all been for nothing.

When this particular patient was pronounced, amidst the tears and expressions of sorrow to this young girl, we all had to suck it up and move on rather quickly. We see multiple patients, so most times there's not too much down time to mourn/unwind after an event like this. So I headed out to the telemetry floor to start my morning rounds.

Luckily, despite the heaviness one might be carrying after such an event, there's often little moments that happen that help us get through the day.

I walked into the next patient's room.

"Hi, are you ready for your breathing medicine?" I asked.

"Sure."

I started to squirt the Unit Dose DuoNeb into his neb.

"Hey, let me ask you something," he spoke up. "Where do they get those cooks in the cafeteria at? I'm not complaining, and I don't want you to say anything to anyone, but that spaghetti was awful! I couldn't even finish it."

I stood there in mid laugh appologizing for the horrendous food, as the patient was also laughing.

"Let me tell you something, bud," he said. "If the food here was as good as your care, I'd rent a room."

Finally my hands stopped shaking.

-- B.J.