Respiratory Care Week is the time of year when we get honored for all we contribute to the world of health care. In our pediatric hospital, we tend to have a fun week. From a brownie sundae night, to a smoothie pitch-in, and a Hawaiian themed luau, we celebrated the week in style last year. On Monday, we had a chili cook-off that rivals those in Texas for the strength of the competition.

We also get a gift every year from the department for Respiratory Care Week, and we get featured in the employee newsletter. The banner hung in the lobby opens up a lot of families' eyes as to exactly what it is we do. It's nice to be appreciated and have the focus on us as an important profession.

Not too shabby for a profession that began to emerge only in the 1940's. We've really come a long way from hauling tanks around the hospital. We should all be really proud of our contributions to such a dynamic and amazing career!

We also have a few staff members who started an initiative to bring us together as a department. There was a picnic last year that was a blast! We brought our families and played Frisbee almost as well as we do our jobs... well, not nearly as well, but we should get an E for effort!

As the leaves turn and the weather gets chilly, in Peds we're usually gearing up for RSV season. This year, RSV is sitting on the back burner as we instead gear up for flu season, which promises to be much worse than RSV. There's also a new threat, H1N1, which has people in a tizzy.

Here in Indianapolis, our health department has placed strict boundaries on all hospitals in an attempt to limit the spread of the seasonal flu and H1N1 this season. The only allowed hospital visitors are parents, spouses, or spiritual counselors. There have been several people upset at the restrictions, but mostly I have seen relief that we are taking measures to protect our already compromised patients.

This nasty flu season and the arrival of H1N1 also have health care workers in a debate. To vaccinate or not vaccinate? That is the question on the minds of most of us. There have been rampant rumors and intrigue about the safety and efficacy of the H1N1 vaccine.

I had a friend call me the other night to tell me there were disastrous results of the H1N1 trial in children and pregnant women and she begged me not to get the vaccine. Doing a little digging of my own, I found no evidence that what she had told me was true, only information to the contrary.

I can say that I was very hesitant to get the vaccine as a woman pregnant for the first time. Both my OB and internist begged me to investigate further because they believe the vaccine is not only safe but necessary for me. The more information I got, I realized that the H1N1 vaccine is formulated in the same way as the seasonal flu shot, and all trials are showing it to be safe and effective.

For me, I feel that the risks outweigh the benefits. When the injectable version comes out, I will happily stand in line to receive my vaccine.

Experts have been predicting this will be a very bad season because hospital censuses will be way up and there will be record absenteeism of health care workers due to illness. That should make for a very difficult winter for all of us.

What do you guys think of all of the speculation about the flu season this year? Are you getting vaccinated? Tell me what you think. This is quite a controversial topic and it really will influence all of us. Stay healthy!

It was a really great way to bond as a department, and in the long run, ithas helped us spread synergy, fun, and excitement for our field. We're all looking forward to a great Respiratory Care Week this year!

Have fun, be proud and appreciate the little things. Have a great week!

I started at 14, just one of those rebellious things. When some of my friends eventually gave up the habit by 15 or 16, I stuck with it. At one point, I was up to two or three packs a day during one long summer. We would just all hang out and chain smoke all day and then get up and do it again the next day.

My parents knew (my father was none too pleased), but they didn't give me tons of grief about it. My mom had smoked for years. In fact, that may be one of my earliest memories of her. It is very true that children of smokers tend to smoke themselves.

The fact I smoked became part of my identity. I was many things: happy, funny, nice, creative, clumsy, a smoker. It was just a part of me. It never was a problem until RT school. 

I had several classmates who smoked too. We would all head outside at the slightest hint of a break. One of our instructors would stand just inside the door and from time to time yell out little tidbits to us: "You know you're killing yourselves." Or maybe his classic line: "You keep that up and it's job security for the rest of us."

I never let any of his words actually penetrate into my stubborn head. I just laughed it off and kept puffing. 

It was difficult when I went to clinicals as a smoker, but even harder when I graduated and started my professional life. There were several of us RTs who smoked. It wasn't too bad...until they all had the night off and I was the only one working. 

People came out of the woodwork to make comments about my dirty little secret. All of that well-meaning "information" just made me all the more determined to light up. 

Time came and went, and our campus went entirely smoke-free. There were talks of punishments ranging from a ticket to termination for getting caught. I think I lasted a week wearing the patch at work before I would take the patch off and sneak a quick smoke. Soon I was taking that stupid patch off four or five times a night to "just get a little fix." 

Eventually I gave up the patch idea and just hid and smoked. Then I moved out to the open. I knew every spot to go, every security guard who was sympathetic, and every charge person who would get mad or be cool with my repeated breaks.

I always got my work done and never took a lunch break to make up for my time away from the unit, but it had to have gotten old to my co-workers.

It wasn't that I hadn't tried to quit. I tried gum, the patch, an inhaler, cold-turkey, yadda, yadda, yadda. If it was out there, I gave it a try at least once. I truly did enjoy smoking; but eventually all the bad aspects to it would catch up with me and I'd try to quit again. It never worked because I never really wanted to quit. 

Everything changed July 20. I was trying Chantix for the second time...and it worked. Little did I know I was already a few days pregnant. I really do believe finding that out is what has kept me on the non-smoker path.

I may have slipped back into smoking, but wanting to keep my baby healthy has done the trick in keeping me motivated to stay smoke-free. Sure there are days I want one or see someone with one and miss it, but I think my days as a smoker may well be over!

How do you all feel about that story? Had any experience on either side of the fence that you want to share? I would love to hear from both sides. Until next time!

I used to work with a girl that I'll call Britney.  Britney could be a great person to work with, or she could be hands down the worst.  It really depended on what mood she was in. 

She never stayed with the mood she came in with either.  Her moods shifted faster than the National Debt.  People were soon doing their best to become amateur meteorologists.  We'd pass each other in the hall and give mini status reports, "Britney is mild now with a 50% chance of shifting mean-ward in the next hour."

People knew Britney better than they knew their spouses.  They had too.  A run-in with her could ruin your whole week. 

Now Britney had no intention of being mean, she just went where her moods took her.  She could be really nice if that's the mood she was in.  She'd give you the shirt off of her back in that case.  It was just all of the other times that you wished you could've picked another night to work.

The moral of the story is don't be a Britney.  We're all people; we have ups and downs.  We have good days and bad days.  It's just not fair to let your co-workers have to do their best to figure out if your barometric pressure is falling or smashing through the roof. 

We should realize that co-workers spend a lot of time with us, almost as much as our families.  We should treat them nicely and get the same in return.  It's really a win-win situation. 

If you already work with a Britney, take heart.  I did and lived to tell about it.  I just tried my hardest to be nice to her, no matter which mood she was in.  It made things a lot more pleasant than trying to dodge her constantly and I'm sure made her feel better too. 

Let's start the era of better co-worker relations!  

I had a random cough for two weeks after coming home from King's Island. I didn't feel sick or anything, just a wretched cough that made people wonder how many packs I smoked a day.

I went to work on the 14th day, thinking things would be fine. I started feeling crummier and crummier and barely made it through the night. Something was definitely up. Even though I was doing my best not to call a doctor unless I had been run over with a Mack truck, I had to. I knew it was bronchitis and just figured I needed some antibiotics. 

The doc agreed and prescribed antis and a heavy-duty cough syrup. He told me to rest so it didn't get worse and I should be as good as new. I faithfully took the meds until complete and rested like a champ, but I still felt crummier and crummier.

It was eventually time for another call to the doctor. He was alarmed I was getting worse after completing a course of antibiotics and was running high fevers. It was time for a flu swab. When that came back negative (even for H1N1), he decided it was a very bad version of bronchitis and started a much stronger antibiotic and oral steroids. He told me he wouldn't approve of me to go back to work for a few days. 

Even more couch time later, I got tired of my house. I pretty much paced the house when I felt OK and went back to the couch when I didn't. Eventually I ran low on several items, so I decided to grab some stuff at the pharmacy. I tossed a few random things in a basket and then went home. 

We've been trying to conceive for almost a year now, so it's not unusual for me to take a pregnancy test every few months or so. I went ahead and took one, thinking it would say "not pregnant" as usual. When I looked at it, I was surprised to see it was missing the very important word "not." Did that really mean what I thought it did?

It did. We're going to be parents in April.

Things have been hectic and so crazy since we found out, but exciting and wonderful at the same time. I know too much about potential complications, so it has been slightly nerve-wracking. So far, I'm trying to just relax and let it be. I apologize that I took so much time away from my blogging, but now you all know why. It's been quite a ride, I can't wait to see what the future will bring!

This Independence Day my husband and I decided to go and watch the fireworks downtown. They had been canceled on July 4 due to rain, but it worked out for me, as it was my holiday to work. On July 5, we set out for the parking garage at my work. It's one of the best views around. I was excited at the prospect of seeing friends from work and getting to introduce my wonderful husband. I just didn't know how special it would truly be.

We parked and started walking toward the top of the garage. Within seconds, I saw a friend that I recognized. She works day shift PICU and she calls me her little sister from all of the quirks that we share. Carol had her little boys and husband with her, who I also recognized. Her son was born with Down syndrome and had spent a good amount of time in our PICU when he had his surgeries. Introductions were made and little Nate smiled at me as if he remembered me taking care of him. We settled in with them and chatted happily while waiting for the festivities to begin.

Looking around, I saw quite a few familiar faces. Some nurses, some RTs, all good people to share the holiday with. As I turned my head, I was blown away to see a mother that I knew. I took care of her daughter Daisy for almost her whole stay. She was born with several heart defects. She had heart block and her average heart rate was somewhere in the 40s. Daisy had a pacer placed at just a few days of life. That was almost the least of her worries. In addition to the several heart defects, she also had PPHN and seemingly never-ending bouts of sepsis. She ended up getting trached and requiring continuous vent support.

She had so many close calls that I didn't know what to think. Her prognosis was never very good, but she always managed to make it through. Obstacle after obstacle, she just kept on defying the odds. She has spent almost her whole first year of life in ICUs, but she managed to make it home.

I saw them from time to time, just briefly when they had appointments or got admitted. It had been quite awhile since I had seen her, so I was about knocked over when I saw her on a Humidivent riding a tricycle on the garage rooftop. She was HUGE! Her smile was enough to light up the sky without the aid of any fireworks. I chatted with mom for a little bit while Daisy was signing up a storm. "She remembers you," her mom translated. "She wanted me to tell you that you were one of her angels."

Wow. It had been years. How did she remember me so well?

The only thing that I can figure is the bonds that hold us tight, patient and caregiver. We may only see how lasting those bonds can be when we're lucky. Lucky like I was on July 5 when I just went to see the fireworks.

Never underestimate the impact you can make in a life in the course of a simple day at work. It's just another day to us, but it can mean everything to our patients. How lucky are we to get the opportunity to change lives every day? I hope all of you realize how important and "angelic" you are. You may mean the difference to someone else.

And for Daisy? I'm just happy she has a chance to grow up. It's because of people like you and me.

--Stephanie

• We are all like puzzle pieces. If you lose one piece, you can't finish the puzzle. We are all needed and all important. Without all the pieces, you don't get to see the pretty picture in the end.
   
• Ignorance is not an opportunity for anger or derision, but an opportunity for education. We all learn something new each day. Maybe it's just someone else's turn to gain the benefit of your knowledge. I bet that one day the favor will be returned when the moment presents itself.
   
• Everyone is entitled to an off day. When someone isn't quite up to your par, it may just be that today is their off day and maybe they need you to cut them some slack. I can guarantee that we will all have days like that. I don't want someone thinking I'm a complete moron because my brain went on vacation for a night.
   
• Communication is key. It can and will save lives. Good communication is something we should all be working on. Most mistakes are the result of some kind of a communication breakdown. These are reasons to learn from mistakes that have already been made.
  
  
• You should stand up for your patient. You may be all they have, and if you don't advocate for them, maybe no one will. I work in the NICU where these guys can't speak up and stand up for themselves. Their health care team may literally be all they have. Their lives may just depend on how far you go to protect them. There's not a better feeling than knowing that you have done the right things to stand up for your patient.
   
• There is a big difference in theory and practice. The case studies in the books are very one-dimensional. It's a very different thing to see a living, breathing person in front of you that you are responsible for taking care of. Theory guides us through the ideal or unusual situations; experience and critical thinking help us through every day that we work. We should try hard to get new experiences. It really does pay off.
  
  
• Sometimes we just have to kill them with kindness. There always will be the people that will ignore every piece of well-meaning advice, will argue the sky is cerulean instead of blue, and will not realize that anything could make their care better. Those people have huge potential to make you crazy, but just breathe and smile, breathe and smile.

I hope this will be of some help to you in your workplace, and maybe it'll make your days just a little easier. All I have to say is happy July!

--Stephanie

I remember hanging out with my mom when I was growing up as she watched her soaps. There was an endless amount of intrigue and drama as every character dated everyone else and got amnesia and then drove off a steep embankment only to be resurrected again in a year or so. I never did figure out how those same plotlines would work on every show across the board. The one that fascinated me the most was "General Hospital." Didn't those people have better things to do than create drama in their place of work? Like maybe take care of the patients?

Fast forward several years. I now work in one of those settings. I put on my scrubs three days a week and go to the hospital. I always thought that a hospital in real life would be so different than what these soaps showed. There would be a drama-free zone, one in which people did their jobs with a minimum of the histrionics. From what I've seen and what I've heard from other hospitals, that's not the case.

The setting itself can do a lot to up the drama potential. Close quarters, long shifts, and mostly females gathered together every day. Add in the stress of what we do for a living and the cast of characters (nurses, docs, X-ray, etc.) and you have the perfect setting for there to be strife.

How do we declare our hospitals drama-free zones? With every factor that works against us, how do we manage to make it a calm working environment?

We need to realize that we're there to do a job. There's a beautiful thing when co-workers can enjoy each other and have fun at work, but we need to be careful to not let out the dark side in co-worker relations. That's the gossip, the snippy responses, the catty behaviors that only put a wedge in relating with our co-workers. We're not required to like everyone, but professionalism dictates that we're required to treat everyone with respect. You may not want to hang out with that person on days off, but you should at least be courteous and kind.

Being sympathetic also should be a cornerstone of our work behavior. We all have rough patches in our lives or times of complete turmoil. I would want my co-workers to support me in my tough times, so I try to apply the Golden Rule. When they have their bad days, I do my best to just make the night a little easier. We may not be best friends, but I know that sometimes everybody needs a break.

Gossip is likely the worst and most destructive workplace behavior. It's an easy pattern to slip into, but it's hurtful and counterproductive. Nothing reminds me more of my high school days than gossip. The Golden Rule applies here too. If you don't want people talking smack about you, the best way is to not talk about others. No one likes to hear that people are whispering about them. I'm pretty sure that professionals should try their best to not fall into a behavior like gossip.

Last of all, just do your best. Try to remember that you're there for your patients. They need you and only you can take care of them in the way you do. We all have unique and wonderful contributions to make to our workplace; just because someone else has a different contribution doesn't make it lesser or greater. We're all needed. So let's try our best to elevate working relations out of the soap opera level. Trust me, everyone benefits.

--Stephanie

Most of our families are good examples of what family-centered care should be, but there are some that fall into two other groups. Either the parents are not involved at all and don't do anything, or they assume way too much of the responsibility.

We had a family that was the epitome of the "way too much" group. They were given several treatment options for their little one but demanded more chest X-rays and cardiac ECHOs than advised. They were determined that they knew way more in how to treat their child's conditions than we did.

I'm a strong believer in the fact that a parent knows their child better than we do. They're connected by a bond that's unfathomable. Most parents can tell you when something is wrong long before vital signs start to trend in a dangerous direction. They can be an invaluable resource to the clinician.

However, there is a fine line between knowing best and dictating treatment plans against any informed advice. This family wanted us to try treatments that had never been used in children and insisted on so many gases and chest films that it would make your head spin. This child had at least five ECHOs in a two-week period, all unchanged.

Based on their demands, she had aerosols and CPT for weeks after her CXR was clear. If their every request was not met, there would be screaming matches directed at our doctors in the hallway. They would endlessly question each RT that had their child and try their hardest to trap a new RT in an answer that they felt was wrong. Nurses and RTs alike dreaded taking this perfectly sweet child because of the difficulty the parents presented.

Why was there never a line drawn in how much the parents could dictate in our treatment plan? Are we truly like a fast food restaurant where the customer is always right? You go into a store having a pretty good knowledge of what you want and a pretty good idea of the product. Should we really allow individuals with little medical knowledge to come in and dictate care over the advice of professionals in the name of family-centered care?

Let me know what you think. Until next week!

--Stephanie

We were having maybe the craziest night ever when she decided that even though I was insanely busy, I was her personal RT. Never mind that my room was more than enough. Never mind that the RT she did have was in the middle of a retaping bonanza. Never mind that she has a terrible opinion about RTs unless she needs one.

I was flagged down the first time by her waving and yelling: "RT! RT! We need you NOW!" Keep in mind, this is down a hallway that connects four modules. She was two modules away. Thinking it must be emergent for her to shout like that, I ran back there. It was nothing more emergent than a routine chest X-ray. A little irritated, I nonetheless verified the tube position while the film was taken. I even got the little one settled in and comfy again before leaving the room.

I sat down and tried again to work on my charting. I got one more vent round in the computer before I could hear the same nurse shouting at me again. "RT, RT! You, there! RT! We need you NOW!"

It is just in my nature to run when summoned to do so at work. I don't want to be strolling along if I'm truly needed. It is a little bothersome to be called "RT" when I have a name and she knows it. We've been working together for several years now. I never call her "Nurse!" If you're going to call me "RT," at least call me "RRT." I worked hard for that credential.

I bolted for the room ... for a rate change. A simple rate change that was not emergent by any means. Her first comment was, "Well, it took you long enough!" The fellow, who was writing the order for the change, glanced up and said: "I'd say she moves pretty fast. She even did it with a smile on her face." This fellow is not normally someone that I would think would come to my defense. So HAH.

The nurse didn't even notice that great save. She started on a litany of how RTs were so unreliable, they always were busy elsewhere, she could never find one when she needed one (she found me, didn't she?), we were lazy and had a slacker job ... and so on and so on. I barely managed to keep my annoyance in check. The fellow just walked away, rolling her eyes. She even had the nerve to tell me that it was my fault the baby had desatted 10 minutes after I left from the X-ray. How is that my fault?

Usually, when I come across this issue of "RT ignorance," I believe that education is the key. I teach them how much we truly do and how we are just as important as they are. It almost always works ... but never with this nurse. Maybe one day she'll actually listen to my education sessions out of my sheer persistence.

Until that glorious day, I guess I'll just keep heeding the call and attempting to educate her each time. Wish me luck. I think I'll need it!

Stephanie

Earlier this year, I had two very different oscillator experiences. The difference between PICU and NICU can be amazing. I work both but have a preference for (and more experience in) NICU.

I worked New Year's in NICU and had two oscillators. Both were stable, chronic kids that had just figured out that they liked high frequency and decided to stick with it. They were both on normal-ish settings for NICU, MAPs of 18-20 and Delta P's in the low to mid 30s with a hertz of 8. It was status quo, and we had no bumps in the road that night.

The next weekend, I was in PICU with yet another oscillator. This one was an 8-year-old girl and her setting blew my mind. She was on a MAP of 45, a Delta P of 120 and a hertz of 2. I was totally shocked with how huge those seemed.

She had a whole body wiggle going on, not just down to the hips like we're used to. In spite of these high settings that had even PICU core therapists shaking their heads, her blood gases were terrible. Her CO2s were in the 90s no matter what we did. She has a leak around her cuff, had been suctioned thoroughly, and had a very stable CXR with good tube position. We had figured pneumos or an effusion, but there was no evidence of either one. We were all stumped. They only thing to do was go up on her settings.

We turned up the MAP to 48 and the Delta P to 130, but it only made the tiniest dent in her CO2. We deferred to the next shift as they came on. They had no other ideas, and I went home puzzled.

When I came back that night, I got in report that her CO2s had stayed high until 10 a.m. and then just dropped to the 60s. No rhyme or reason, they just went down and stayed down.

Until 10 p.m. Then, they shot back up into the 90s and we couldn't get them down no matter what we did. It was a frustrating night for all of us in PICU. Sure enough, day shift came on and we went home again.

Around 10 a.m., her CO2s just dropped to the 60s again for no reason. Not wanting to look a gift horse in the mouth, day shift just let it be and counted their blessings.

I was off the next few nights but heard the same thing was happening. CO2s would shoot up into the 90s around 10 p.m. and back down to the 60s around 10 a.m. This pattern repeated for almost a week. No one ever did figure out what caused it, she just stopped having yucky gases all of a sudden and was weaned to conventional ventilation and then eventually off.

She went home less than two weeks after her battle with the oscillator. I guess as much as we do know about medicine, we still don't know it all. Her prognosis was grim, but she fought through and walked out of the hospital.

This just goes to show the amazing resiliency of children and the fact that one machine can be worlds apart in two different areas.
--Stephanie

--Stephanie

I am happy to say that I have five days off. They are so earned after last night.

I'm pretty sure that we may have had the craziest night I have ever seen. We had seven RTs in NICU, and we could tell at shift change that it wouldn't be enough. Now that's when you know its going to be crazy! We started a jet at shift change and then started another 45 minutes later in the same room. There were then mass retapings, occupying all but two of us. Did I mention they sent us another person? Thank heavens because we needed her more than we knew.

Nothing wanted to work right, vents alarming and babies bradying left and right. We were running. Even our "dirty" RT who only had our isolation baby worked her tail off. She ended up adding a continuous neb and Q4 CPT to the mix, making her one baby a full (and busy) assignment in itself.

I got a little one from an outlying hospital with "TTN" that they had bagged the whole way to us. He crumped in the elevator to the ambulance and they were unable to get him intubated. We immediately intubated him and started him on conventional vent. During that, they wanted continuous nebs on my other child.

When I went to give surfactant, I turned around to get my assistant. By the time I turned my head back around to my patient, his sats and BP were starting to bottom out. The nurse started pushing fluid fast and we ran for the nitric. More fluid and more fluid and soon we were running for the oscillator too. The first one (which had checked out just fine) wouldn't pressure up for anything. We furiously checked for leaks, changed caps and still nothing.

Our clinical specialist (in a beautiful Hail Mary play) went for the last one we had ... but no circuits. She ran down and then up four flights of stairs to grab more and was so out of breath that she couldn't even punch the code in to get the door to our equipment room open. I think she could have qualified for the Olympic trials at the pace she was running.

They got it checked out in record time and he was oscillating with nitric. Finally, our baby was a little happier, but he still bought himself 20 of dopamine with dobutamine on standby. All of my suspicions that he was PPHN had been confirmed. Our blood gas was not pretty and put the ECMO team on alert. We upped his settings and more fluid. Our next gas drew a crowd in anticipation ... and dread. I was ready to calculate my oxygen index.

Hallelujah! Our values had stabilized and we were in the clear with a PO2 of 203. One more retaping, a round of chest X-rays and it was time to give report. That was one of the fastest nights I have ever had.

I truly have to say that I have some of the most amazing co-workers. They banded together in a way that was stunning. We worked together like a single unit. I even had a nurse pull me aside to tell me that she was amazed how RTs worked so well as a team. She had never seen anything like it.

To be honest, neither had I. We are a pretty strong team, but last night was raising the bar to the stratosphere. I am so proud and so thrilled to be part of something that was simply amazing. How lucky are we to get the opportunity every day to be something special? We are in such a dynamic and awe-inspiring profession that I thank my lucky stars that I ended up as an RT. It's just incredible to be able to have nights like that.

Here is my call to every RT out there: Give yourself a pat on the back. You are an expert. You change lives every day you put on your scrubs and go to work. You are the first two items in the ABCs. The next time you have a wild night (or day) at work, just think about how amazing it is to do what we do. I'm proud of all of you!

--Stephanie

Things like alveolar capillary dysplasia and Cornelia de Lange syndrome are floating through her head. I can't say I know how it feels. I've never had children, but I was a wreck when my sister was pregnant with both of my nieces. I truly don't think I could breathe easily until she hit 36 weeks in either pregnancy and I knew all fingers, toes and heart chambers were accounted for.

So how do I ease her mind? We see the worst of the worst and we both know these complications and syndromes don't happen often. It's just hard to separate that from how much of the "uncommon" we see.

One dear friend has the most adorable son born with Down syndrome. Another friend had a 28-week preemie and saw him on the oscillator. And there's another girl whose son has Duchenne.

I'm an honorary aunt on this one, so it's my job to help out through it all. Any ideas on how to make her worry less? How have you handled things when it hits close to home?

Stephanie

There is a family at work that I have gotten close with. Understandably, they want nothing but the best for their baby.

Their daughter is five and a half months old and has had one of the rockiest starts I have ever seen. So far, she has defied the odds, but it seems that her odds have recently grown worse. Her mom (we'll call her Betty) is doubtful that the recent pronunciation of fixed pulmonary hypertension with cor pulmonale is the end of the line for her little one. She is certain that there must be other things that we can try and has spent countless hours researching alternatives like inhaled iloprost and calcium channel blockers.

I am acting as the mediator, a person who understands her concerns and supports her. When she is doubtful of what step they have taken next, I've tried to explain their line of thought to her. We have discussed tests, signs and end-of-life issues. I have talked to her about chest CTs and pulmonary consults, nitric oxide and bronchodilators. I am ready to support their decision if or when they decide to start end-of-life care.

Sometimes I think that we need more mediators. Physicians and clinicians can sometimes be confusing, technical and detached despite their best efforts. Sometimes parents can feel ill at ease with clinicians that are brilliant but cold. If there were more mediators, I think we could bridge that gap.

What really got me was that when I was talking to Betty, she thanked me for caring even though I wasn't at work. Caring isn't limited to three 12-hour shifts a week. I am invested in my patients and their families.

I know that some RTs keep a distance to protect themselves, but I can't. I have been the scared family member, I have been confused by "doctor-speak." I have discussed treatments and researched alternatives. I have had to make the hard decision to withdraw support. It is a terrible place to be, even worse when you feel like the people who are caring for your loved one don't truly care. I don't want any of my families or patients to feel like that. Ever.

As for Betty and her little one? Only time will tell. I will, however, do my best to make it easier for everyone involved. 

-- Stephanie