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

The truth is that times are tough. Overtime is looking more and more scarce, and those of us who banked on it to pay the bills are getting a little creative on how to keep the money flowing.  

We recently had an overtime snafu when the shifts were posted 30 minutes earlier than we were told. Some had logged on early to be ready and snapped up all of the overtime before the rest of us had a chance. There were apologies and promises that next time the overtime would be posted at 5 a.m. instead of 5:30 a.m. as the system would only allow even time posting.  

Those of us who missed the boat were upset. How were we going to make ends meet without the overtime we knew and loved (or loved to hate)?  

Then we got the talk from management. Our hospital was doing better than most in this turbulent economy, but was still being hit hard. Overtime would be cut. There would be a hiring freeze and a hold on all bonuses and pay raises. Our snazzy new tower addition is not partially opening in May like it was supposed to, it would be delayed to coincide with the whole tower opening in 2013. Even everyone above the level of VP took a 10 percent pay cut.

Now what? Things have gone from bad to worse. What's a little respiratory therapist to do?

I, for one, have gotten creative. I recently took on a part time gig as a karaoke hostess. The pay isn't comparable to what I would make at the hospital, but it tides us over. Every Saturday that I don't work as an RT, I'm shuffling discs and hopefully trying to not blister people's eardrums as I sing to fill in the gaps.  

I know that it seems a little strange, but it works for me. I get to make money while doing a job that lets me blow off some of my steam from three nights a week saving lives. It's keeping my family afloat in a mostly overtime-free world.

This is my call to everyone who is feeling the pinch. Get creative! I have a friend who started consulting to a home care company on the side. Another friend has taken the lack of overtime as a sign to devote more time to her jewelry-making business. All it takes is a little creativity, and we can get through this.  

Hang in there, we'll make it through. Next time you're in Indianapolis and you venture out for an evening of karaoke, it may be me calling you up to sing "Freebird!"

Stephanie

I think of myself as a nice person. My co-workers describe me as bubbly, friendly and funny. Being very easy-going, I get along with most people right off the bat. But that all changed when I had treatments on a child we'll call Norman.

Norman is a sweet, teenage boy with severe CP. He normally has treatments at home, but they had been beefed up due to his admission for pneumonia. It seemed easy enough, even when the RT who had treated him described Dad as "particular." Not a problem, I consider myself very thorough and tend to get along with difficult parents. I understand their position, I would feel the very same if it were my child in the hospital.

I went in and cheerfully introduced myself. "Hi there, I'm Stephanie with Respiratory. I have some of Norman's treatments tonight." I knew that he had a chest tube on the right side, so I asked Dad how best to pad it during the Vest treatment. He handed me a cloth diaper that they had been using for that purpose and told me which parts to cover and how. I followed his advice and got him set up with his Vest.

Making conversation, I commented that they must have brought their Vest from home as I had never seen one like it in my years at my hospital. He immediately snapped that I must not do home care. I admitted that all of my time as an RT has been spent in the hospital setting and home care equipment was not my forte. I then stated that I was always amazed how the technology for home has evolved over the years.

All was said in a friendly manner, so I was rather shocked when he gruffly said, "You must not have been doing this too long. How long have you been an RT?" 

"Five and a half years."

"Not long enough in my book," he said.

I was floored. I have never had so much hostility directed at me when I was at work. Any attempt at conversation was met with a glare and then silence. What puzzled me even more is that while he was not nice to anyone else by any means, he was certainly not as antagonistic as he was with me. I finished the treatment in uncomfortable silence and dreaded coming back for the next.

I confessed my feelings about how he had acted to my charge person. She told me not to worry about it, he was likely cranky from lack of sleep. She said, "You're super friendly. I'm sure it wasn't you at all."

A different RT had the 1 a.m. treatment and things seemed to go fine. When I went back at 5 a.m., I figured that all would be well. Surely he was asleep after being so exhausted!

Not so. The nurse came in as I was starting and made so much noise that he was awake in a flash. After she left the room, he glared at me for almost a solid 10 minutes before finally going back to sleep.

Wow. I have never felt that uncomfortable in my life. It felt like the longest treatment. What made it really bad was I really liked Norman: He was as sweet as sweet can be. I just couldn't believe how much Dad seemed to hate me.

It bothered me the rest of the night, despite my co-workers' attempts to make it better. I really had no clue what had made him so irritated. I had done the treatment as if it were my own child receiving it. I try so hard to treat the patients as if they were my own family and the parents as if I was in their shoes.

What had gone wrong?

I had no answers until a few nights later. A good friend of mine had Norman, and while she is a wonderful and friendly person, she tends to be much quieter and less perky. He seemed fine with her and was progressively friendlier to her as the night went on. It had me puzzled why he didn't like me and did like her when we are very much alike.

I was still puzzled when our charge person came to me with the answer. "I have it figured out. He has been fine with the people who don't really talk much, but doesn't like the really friendly ones. He just doesn't want to make conversation," she said.

I doubted her theory until we figured out person-by-person who he liked and who he didn't. All of the people that fell into the ‘liked' category were not talkers. They went in and did their stuff with a minimum of conversation. The ones he didn't like were all talkative, friendly people.

It was cemented when Mae, the friend who had Norman that night, said that she isn't a conversationalist with the parents and he seemed to really like that.

Later he told one RT that he hated it when people came in trying to be friendly. It wasn't so much me as my bubbly nature that irritated him so much.

It made me (and several others on the do-not-like list) feel better that we finally understood him. I now get that just because being perky has served me well so far, it doesn't make it always so.

Has something like this ever happened to you? How have you dealt with it?

'Til next time, still perky and ok with that,

Stephanie

Previously on "Peds' Place": Stephanie's husband considered changing careers and becoming a respiratory therapist, despite not knowing exactly what one does.  In this sequel, he continues weighing his options...

If you haven't read the first part, get caught up by following this link: http://community.advanceweb.com/blogs/rc_7/archive/2009/01/16/my-husband-rrt-part-1.aspx 

The other day, my husband was looking worried again. He has been wrestling with profession choices now for some time and I knew what this look meant. "So, what's on your mind now honey?" I asked.

"I'm not really sure what it is that I want to do yet," he answered.

"What exactly are the things you need in a profession?"

"Well, I want flexibility. I want better hours. I want better pay," he said.

I tried to keep a straight face. "What else, honey?" I asked.

"I want to make a difference in people's lives. I want to be a respected professional. I want to be able to work in a variety of environments. I want to not do the same thing every day."

I really tried to keep a straight face now, but I failed miserably. As I tried to compose myself, he couldn't hide his confusion.

He was worried that these things wouldn't describe respiratory care, but he had described it to a "T." When I told him that, he burst into a huge smile.

"So I'm being worried over nothing? That's a relief," he finally said. Despite his certainty, my husband tends to change his mind quite often.  I suspected this particular discussion was a long way from over.

The other morning I crawled into bed after what seemed like the longest night ever at work, ready to conk out so I could get up and do it all over again. I thought he was asleep until he said, "Honey, I think I want to go into the military." And so it began all over again...

He's come back to the health care idea again, but I can't blame him for his indecision: He's only 25.

Anyone have any ideas on how I can help him sort things out?

How did you decide to go into respiratory?

-- Stephanie 

My husband has known that he wants to go back to school for quite a while now, he's just been unsure on what to go for. He tossed around the idea of nursing school for a long time. I can say that it came as a complete shock to hear him say, "I'm going to major in respiratory like you."  

I almost fell on the floor I was so surprised. His only experience in healthcare was working as a CNA in a German nursing home. I always figured he would go towards the nursing side of the healthcare spectrum.  

I never realized that all the new found interest in respiratory therapy had a purpose. I just thought that he was really interested in the nitty-gritty of what I do for a living. He was actually researching the differences between nursing and respiratory the whole time!  

Once I regained my composure, it was time to assess what he had learned. I asked, "Do you know what exactly it is that I do?"  

I wasn't ready for his answer in a million years.  

"Well, you give breathing treatments. And you change vent settings. Oh yeah, and you beat babies."  

Oh dear. How had he understood CPT as beating babies? I remember calling it pitty-pats, but never beating.  

Once I could speak again, I asked how he had gotten the idea that I beat babies. He answered cheerfully, "I was looking up respiratory web sites and saw that you guys have a technique where you beat the infection out. That's what you do to the babies, right?"  

Without opening up the whole can of worms, I explained exactly what CPT did. Now that we had that straight, I tried to paint him a clear picture of what I do. He looked a little less confused. Mission accomplished.  

A few days later, he was looking troubled after coming home from work. When I asked him what was wrong, he said that there had been a claim coming through work for a CPAP machine. He asked if it was related to what I did for a living. When I told him that it was, he looked even more unhappy.  

"How am I ever going to learn all of this stuff? You're so knowledgeable about your profession, how will I ever get there? How am I going to get the terminology down?"  

My husband is incredibly intelligent. He speak three languages, cites politics as a favorite interest, and knows tons of facts about pretty much everything. And he's worried about the terminology?  

"They teach you everything you need to know. I didn't know anything about medicine until I went to school. Just think about how I got to where I am. The same way you will!"  

That seems to ease his mind a little, but we will see where this will lead us.

To be continued...

Complaining about holiday rotations?

Why is it that even though we know we'll have to work holidays as a hospital RT we still complain about it?  

I am not exempting myself by any means. I was very upset to have to work the first Christmas after I got married. I was super jealous that my husband got to go to his dad's annual Thanksgiving feast while all I had was a pitch-in at work. I'm still bummed that I have to work New Year's while my best friend found someone to trade her New Year's for a weekend.

The truth is, it's kind of nice to be there for our patients and families on days when they would rather be at home too. They don't even get the benefit of a holiday rotation.

I remember one Christmas in the NICU when I got to spend time with so many families that were so grateful to have us there. We played holiday music and got the little ones dressed up un their best little outfits for pictures with Mom and Dad. We snacked on cookies brought by the most amazing baker/nurse I have ever seen. We really had a great night.

One Thanksgiving I got a card from a special family that was a turkey made from their little girl's handprint, saying how thankful they were for a great team to take care of their little ‘turkey.' It was one of the cutest things I have ever gotten and it has a permanent home in my memory box.

One New Year's we had sparkling grape juice and toasted each other as we watched the ball drop. Some of the people I was with then are still close friends today.

This year, let's be thankful that we have the gift of an amazing profession that allows us to make such a positive impact in people's lives. Let's realize that we are a gift as well as the amazing people we get to help.

Happy holidays to everyone!

Stephanie

I laughed the whole thing off, thinking it wasn't possible. Not in a hectic hospital. No way-so I thought.

The very next night, I worked with a nurse who was celebrating her birthday at work. Since I had the room that night, I was invited to all the festivities. Her fellow nurses brought in enough food to feed an army. There were two (count ‘em, TWO!) birthday cakes. There were dips, sausages, cheese and crackers. There was an amazingly addictive concoction called a cheese ball, even though it was not a ball in any sense of the word. The food was enough to knock your socks off but, in addition, there was a nurse I'll call Angel.

Angel made flavored coffees all night, creamed and sugared to perfection, and poured them into cups on which she artfully drew the drinker's name. She fixed cheese ball crackers for everyone, and even fed you one if your hands were tied up with the monster they call computer charting.

The birthday nurse-we'll call her Laura- was very happy at how her working birthday had turned out. She was fed and attended to like a princess. I even took off my nail polish, which she deemed "hideous-soooo the wrong color for you!" She's very lucky we're good enough friends for me not to take offense to her hating my nail polish!

Then Angel upped the ante. She pulled out a lotion that smelled like heaven in a butterscotch factory and gave everyone back massages, then kindly rubbed the lotion into our hard-working hands.

It clicked for me then: it was possible to have an amazingly happy work environment! I scoffed at Grey's Anatomy for being unrealistic when all along it was really possible. I left work feeling better than when I came in. We spend so much time being stressed and irritated with each other that we forget why we're really there. We should be a team, a team that constantly works not only with each other, but for each other. We're there for the patients, a goal we accomplish better when we're happy. It may sound like we spent all night in birthday celebration, but our babies were taken care of even more lovingly and skillfully than usual. We were happy and it showed.

The moral of the story is that when we're better to our co-workers, everyone reaps the benefits. I'm sure the babies loved the mellow, happy vibe in the room that night!

Everyone needs an Angel in her life. We should all try to be the angel in someone else's too.

-- Stephanie

I'll never forget what it was like to be a new grad. Every day at work was a new experience, and the being on the floors seemed like a whole new world. I learned the fine art of time management there. It's where I encountered my first real trach change and first real emergency. I learned who I could go to with questions and who couldn't be bothered.  

Fast forward five years.

Now I'm a person that has experience, who can be asked questions, and can work in all areas of the hospital competently. How the times change.  

I recently came back to the hospital that I started as a new grad. I had been there up until December of 2007 when we had to move to Kentucky for my husband's job transfer. He was transferred back in June and I started back in July. I had only been gone six and a half months. I, in essence, had to start over. Working in general care was a challenge for me as a green new grad. Now it seems like a delay in my way back to where I felt I belonged.  

Why the frustration? It seems like it's hard to start over gracefully. I hope that I have succeeded in that more often than not. The frustration is still there though. I just hope that I'm doing my best to make it a smooth transition back. These people have seen me at my best, seen me at my worst, and all in between. They have guided and coerced me, forced me to become the good therapist that I know I am.  

I guess my time on the floors is my way of giving back a bit. Reminding me of my roots. Learning to not feel entitled to an ICU position.  

It gets to be easy to forget where you started and how much you have changed in the process. New grads, you have a wonderful opportunity to see yourselves grow and flourish. Maybe my time starting over again is a way to remind me where I came from.  

Where have you had to start over? What have you learned from all of it? We all reap the benefit of experience, no matter where you are. Let me know about your experiences with starting over. I think it would help so many of us out.

-- Stephanie

No other specialty allows me to work with cystic fibrosis, former preemies and asthmatics all in the same day. I see the way that we end up imprinted on the hearts of our chronics. I also see how they imprint themselves on our hearts.

I got a call last night from the family of a former patient of mine, a little girl I took care of from birth to discharge at almost her first birthday. It was so nice to hear the familiar voice of her mother as she gave me the latest update on her little one. She's two now, still trached and vent dependent at night. Her recent sleep study showed that she wasn't quite ready to come off of the vent at night, but she has made huge strides. 

I feel like I have grown with this family-our lives our intertwined. Families like this one make it feel like more than a job, it's my life's work. We all rejoiced together when she was able to wear a Passy-Muir valve during the day instead of the vent. They called to tell me how happy they were when I got married. I went to her second birthday party and refused to let her squirm off my lap. She blew me kisses as I left that made my heart melt.

I'm sure that those who work with adults have their own version of this bond, but I think there is nothing like watching a child who didn't have a chance grow up and thrive. Against all odds, she has made it and I was instrumental to her survival.  What a feeling that is.

Does anybody else have a story of a patient or family that has touched you? I would love to hear it!

‘Til next time...

Stephanie

I hear this all the time.  I was meeting a neighbor the other day when we discovered that she was also an RT, had been doing adult critical care her whole career.  Those were her exact words to me.

I felt the same way once upon a time.  Let me give you a little background on how I went from "there is no way I can work with kids" to "there is no way I could work with adults".

When I was in school, almost all of our clinical rotations were in an adult setting.  I flourished.  I was a pro at adult vent settings and COPD skewed blood gas results.  With my peds rotation looming, I felt more and more fear that I would "break" one of those fragile children.  I walked in the first day a basket case. 

My PICU time was assigned first and I breathed a small sigh of relief.  That was scary territory, but not as nearly as terrifying as the NICU with their tiny premature babies.  How can you touch children that weigh less than your hand?

The PICU people were great.  They understood my fear and made me jump in anyway.  I finished those two weeks feeling like a champion.  I still didn't want to work with kids, but at least I knew that I could.

Walking into the NICU scared me more than anything .  I was shaking so badly that it was almost impossible to take report.  Just the thought of me having to handle a pocket-sized neonate almost sent me running.   My preceptor Mike was fun and very understanding and I eventually started to relax. 

My first task was to switch a preemie from a nasal cannula to nasal prong CPAP.  This involved sliding a tight hat onto a tiny baby's fragile head.  I almost had a nervous breakdown.  Mike talked me through the whole thing, completely cool and collected.  I was done before I knew it. 

I couldn't believe that I had done it! I had held that tiny little body in my hand and we both emerged unscathed! It was that moment that I knew that I would never want to set a 700 ml tidal volume again.  Against all odds and against all fears, I was a peds girl! 

I started working for that very same hospital as soon as I graduated and I've never looked back.  I was once the inexperienced girl who was horrified by the thought of 3.0 ET tubes and isolettes, but never again.  What is even funnier is that I mostly work in the NICU now.  I guess life has a funny way of knowing us better the we know ourselves, right? How did you find your niche? I'd love to hear about it.