I suppose it was bound to happen. You can't go through your life being beloved by everyone you meet. Sometimes, for reasons difficult to understand, or for no particular reason at all, people just don't like you.

I decided to pick up the weekend shift and help a buddy out who had overbooked himself. I was cruising along nicely on Saturday when I got a call about a new admit who needed an ABG and an Eval and Treat. "No big deal," I thought, "this should go smoothly."

This particular patient was not in the best of moods when I went into the room, and by the time I left, neither was I. I won't go into details, other than to say that was the first time I have ever had a patient attempt to get physically violent with me and insult my intelligence for reasons I still can't fathom. And I did find out how hard it is to draw an ABG with someone swinging at you.

For the most part, I would like to think I am easy to get along with and, even if you don't like me at first, the more you get to know me the more you will like me. Am I one of those people who need to be liked by everyone? Maybe, to some extent, but not totally. I just feel that, unless I have given you a legitimate reason not to like me, and in the case of this patient I feel I absolutely did not, then you and I should have no problems -- especially if you are in the hospital and I am trying to help you get better!

Being the optimist that I am, I went back into the room a few hours later to assess the patient's need for respiratory therapy. I took along a big friendly smile on my face and my good manners at their finest.

Long story short, I went to visit this patient a total of three times, and each time my intelligence was insulted, I was cursed at, and was twice literally told to take a hike. I am not a glutton for insults or threats of violence; if I hadn't been the only RT on duty this weekend I would have had someone else go try their luck with this patient.

But since I was the lone RT in town and this patient needed treatment, I kept going back for more. Eventually I figured out that there was a nurse this patient was sweet on and I convinced her to give this patient his breathing treatments.

So ultimately the patient got what he needed, and in an offhand way I got what I wanted, but in the words of Taylor Swift... "Why ya gotta be so mean?"

It has been almost two years now since I graduated school and became a respiratory therapist. Which means it has been almost two years since I have studied something with the goal of testing towards an advancement in my education/career/life. It seems like a disproportionately large amount of my life thus far has been spent in an effort to obtain a degree. I haven't always loved it, but ultimately my scholarly activities have served me well. And so now I am at a crossroad, and have recently gotten that itch to study something again.

I have considered several possibilities:

1) There is a RN bridge program offered at one of the local colleges for RTs with at least 1 year of experience in the medical field. There are two courses of study for this program: two years, one night a week/one clinical a month, or 1 year as a full time student. Doing the full time path is definitely out for me as I have young kids and need to work full time, but I have considered doing the two-year program. The RT director at my hospital is about to finish the second year of the program and will sit for her RN boards sometime next month. Observing her experience with the course over the past two years has lead me to think that this is something that I could do ... but do I want to be a nurse? Short answer: no ... never. I have great respect for the nursing profession and I feel that nurses truly earn every single dime that they make, but I just don't think being a nurse is for me. In the words of one of my RT professors, for me it is "from the waist up only." It would be cool to study nursing and get the other side of things, a more complete picture if you will, however I can't imagine a situation where I would ever want to actually work as a nurse ...  maybe in a busy ER or ICU....\

2) I think ideally I would like to go back to school and become a PA. I have a BA and with another 3 years of medical experience and some prerequisites, I could enroll in an intensive program in another state that would make me a PA in two years. If I were to do this I would approach some of the small hospitals, including the one I work at now, to see if they would pay for me to do this, and I am fairly confident that one of them would. This would be awesome, but I really just don't think it is in the cards right now. I have two, soon to be three, young children and it wouldn't be fair to my wife for me to be gone for two years while I pursue this ... and to be honest, I don't want to miss out on that much of my kids' childhood. So I have kind of put this on the shelf as a pipe dream. Something that I might try to do in my 50s when the kids are out of the house. Maybe in the meantime I can get some of those pre-reqs out of the way...

3) Become Mr. RT. By this I mean getting every single credential that an RT can get: AE-C, NPS, ACCS, RRT-PFT, etc. Maybe even getting my BS in respiratory care. These are all things I can do from home at my own pace and would make me as complete an RT as I could possibly be. Respiratory care is something that I truly love, so the prior two options are somewhat bittersweet to me, they would be awesome but I really think I would miss being an RT.

I am not going to rule out any of the above-mentioned options for The Continuing Education of Kevin Johnson ... but I did enroll in the AARC Asthma Educator Prep Course ... so we will see where that goes ...

You know sometimes I feel sorry for smokers. I had this guy come in the other day to see the pulmonologist and before I did his PFT I asked him if he smokes. He hung his head in shame and muttered a bit while shaking his head, "Yeah ... dang it ... I've cut way back though..."

I try to make it a point not to pity nor shame patients of mine who smoke. At this point is there anyone in America left who doesn't know how bad smoking is for your health? So if someone chooses to light up a cigarette should they be looked at with the same contempt and disgust that is usually reserved for someone who abuses animals? Of course not, but I see it all the time. I work with a lady who, if she could get away with it, would punch you in the neck if she saw you puffing on a tobacco pole. I have heard her tell a patient, "Well I don't know why I am bothering to help your lungs when you are going to fill them with smoke the minute you are discharged!"

While I don't agree with her method, I do understand where she is coming from. It is frustrating to spend a week bringing a COPD exacerbation back from the brink of a vent only to see him on the outside cameras taking a drag as he is discharged. But still, by the time we are done with patients they should be well aware of the risks. And if they want to smoke, then let them smoke. I suppose, in a way, it is job security.

I have heard people call for outlawing cigarettes in the name of public health and I just think that is ridiculous. Yes, smoking is terrible and I am all in favor of individuals and businesses being able to outlaw smoking inside their homes and establishments. But to say that noone should be allowed to smoke ever? I mean, what's next? Banning giant sodas in order to combat rampant obesity?

My wife and I are going to have a baby in late August. My plan is to take a few weeks of PTO and stay home with the kiddo once my wife goes back to work. I figure by that time I should have more than enough PTO in the bank to take a nice little baby vacation with some PTO to spare ... unless things stay slow...

We have officially entered that slow time of year: Low census. Now if you work at a busy metropolitan hospital and are reading this, you might be saying, "What is this low census that this crazy, handsome RT speaks of? Why, slow time for us means only 25 patients on rounds instead of 50..."

Well, it isn't quite like that out here in rural America. For example, the other day we had one IS all day... all day! There were only three people in the whole hospital!

So instead of sitting on our collective thumbs, management created this evil *** called Low Census Call. So, when census is low you get sent home and remain on call for the remainder of your shift at a whopping $1 an hour. If you are fortunate enough to get called back in, you do not get "call back pay" -- you come back and resume your shift as if you had never left. So not only do you have a short paycheck, you can't enjoy your day because there is always the threat that you might have to come back in. Don't like it? Well, you can either use up all of your PTO to cover the gap in hours or pack up your family and move 200 miles away to the nearest metropolitan hospital and work there -- they never get put on call!

Thankfully there always seems to be some busy work that needs to be done. Reorganizing the stock room, crash cart checks, updating policies, cleaning (ugh!) ... but it beats having a paycheck that is short a few hundred bucks and/or burning through PTO.

The problem is, though, that census has been low like this for almost two weeks now and the busy work is running out fast. I really want to be able to take a vacation and spend some time with the baby in August, but that vacation is looking slimmer by the day. I was thinking two weeks, now I am thinking one week and maybe working a weekend bailout shift so I can have another week off, which would leave me with almost zero PTO hours to use if I need to stay home with my other two kiddos.

Due to the location of the facility I work at, way out in the middle of NW Kansas, it can sometimes be hard to find full time RTs. Sometimes we have to hire Travelers to fill the gap between when someone leaves until a new crop of RTs graduate from the regional college. This is something that I have gotten used to and, though it is not ideal, it is sometimes a necessity to keep from burning out the regular full time staff.

 We currently have a traveler working in our Department. He is here until the beginning of May and to be honest I will be sad to see him go...which is something I never thought I would say about a traveler. I think it is because this is his first traveling assignment; he either hasn't become jaded yet or hasn't figured out how being a traveler really works. He has tried to become as regular of an employee as he can be, even though he is always on the net looking for his next assignment. He has been an asset to the department and I've never had to follow him around cleaning up his mistakes, which has not been the case for the Travelers before him.

 My first experience working with a Traveler was not a good one. I was frustrated with what I perceived as the Traveler's lack of giving a crap about my hospital and the little things we did to make sure things ran smoothly: updating report, end of the night supply checks, etc. I can't tell you how many charges I had to go back and correct or how many times I got called back in during the night because a Traveler didn't stock the OB or ER supplies before they left for the night. I brought my concerns to a wise RT vet on staff who simply said, "A Traveler is a traveler..." Meaning that a Traveler is never going to ingrain him or herself into the fabric of your department, they are Travelers for a reason; they go to an assignment and move on.

I understand that this is how it is, and really I can't knock Travelers for this; it would be hard to be motivated to learn the intricacies of every single department when you know that in a few weeks you will move on to another department with new and different intricacies to learn. Two different Travelers had described themselves to me as, "gypsies" and I feel this is probably an apt description for 90% of Travelers out there.

 So to all you traveling RTS...while there are times the day-to-day banalities of the job make me wish I was out there on the road myself, keep in mind someone-who isn't going anywhere- has to come behind you and complete the charges you forgot.

When I am nervous my hands shake. I try to hide it, and have learned to steady myself down to a light tremor, but I just can't shake the shakes. I pride myself on remaining calm in a high-pressure situation: a code, a bad baby, etc., but my hands indicate otherwise. I have been told by a few of my co-workers that they had they not seen my hands trembling they wouldn't have known I was nervous at all, and it has never prevented me from doing my job in any way ... but it still pisses me off!

I know different healthcare providers express nervousness in different ways: a nurse who starts talking much louder than normal, a doctor who sweats profusely, a PA who swears ... but why do my hands have to shake?

It seems like the more I do a certain act the better I get. I remember the first time I drew an ABG I was shaking like crazy. The clinical preceptor I was with told me to take a deep breath and poke on exhalation. I am not sure if it was the influx in O2 or me thinking about something else but my hand steadied and I was able to draw the gas. ABGs have been a piece of cake ever since.

I'd like to attribute it to too much coffee, and I refuse to kick that habit ... me without coffee is much more dangerous than me with a slight shake in my hand while intubating -- I am not a surgeon, after all. And I suppose as long as it doesn't interfere with my job I shouldn't get too upset about it. I just get frustrated after the fact because it is something I can't control.

I was rounding with a doc one time when he was breaking the news to a 96-year-old patient that she had heart failure.

"No," the patient informed the doc, "I refuse to have heart failure..."

I recently found out that I have type II diabetes. My vision had gotten increasingly near-sighted over a two-week span and I could not drink enough fluids. These are classic signs of diabetes, but I just couldn't fathom that I could possibly have the disease so I scheduled an eye appointment and carried on. I am 29 years old and am in decent health; it couldn't happen to me.

Sure, I am not nearly as active as I should be, in fact I hate exercise in general. But I always figured I got enough exercise with my job and I figured there was no harm in being 20 or so pounds overweight ... I mean who isn't? This is America after all!

So when I went into the lab to have a glucose drawn I figured that it would come back normal and I would just go to my eye doctor and get a new pair of specs. A week later and I am still as shocked as I was when our family physician told me that I am a diabetic. He said it was mostly genetics but pointed out a fact I had been in denial of for some time: I haven't taken care of myself over the past few years.

It seems crazy when you think about it. My job is to take care of people and encourage good health, and here I am living as unhealthy as anyone: slamming energy drinks to make it through my shifts, eating processed or fast food because I didn't plan ahead and there wasn't enough time in my schedule to eat anything else, not making time to exercise when I got off work because I just wanted to unwind. Believe me I have a million excuses for why I didn't take care of myself while I was taking care of my patients. But no more. I have no more excuses. This was all a much-needed wake-up call.

A doc told me once, "Every good RT always has a stethoscope, a pulse ox and a Christmas tree on them at all times." Now I don't subscribe to the Christmas tree theory; there are Christmas trees on nearly every flow meter in our hospital and I prefer to carry a penlight instead. A pulse ox is a pulse ox as far as I am concerned, as long as I have one on me I am fine ... not too concerned about the brand. But a stethoscope is a different matter.

When I graduated from respiratory school my graduation present from my wife was a top-of-the -ine stethoscope. It has a bronze bell and ear tubes and the tubing is brown. It has a pediatric setting I can switch to if needed and it has K. JOHNSON RRT etched into the bell. When I am at work it is like a faithful canine I take everywhere with me. Without it I would be lost. I have other stethoscopes, I store one at each of my two PRN jobs. They are good ears, but compared to my favored stethoscope, they just don't cut the cake.

I had a student this year who was struggling with breath sounds. We had a patient who had a faint expiratory wheeze and all the student said she heard were diminished breath sounds.

I finally had her try my stethoscope and she was able to pick up the wheeze with no problem and was astonished at the difference in clarity of sound. Her stethoscope was standard issue for students in her program (I have an old pair I keep at one of my PRN jobs) and while they will essentially get the job done, I told her that the first thing she should do upon graduation is buy a good set of ears. I told her she should consider it an investment in her career.

So there I was finishing up the last few treatments of an otherwise un-notable Friday shift when I get a stat call to a patient room where a flight crew is trying to set up their bipap on a patient who is to be transferred to another facility for respiratory failure. Usually when the flight crew arrives, after we have given report, our role in the care of the patient is effectively over ... so I was a bit curious as to why I was being paged, but thought it was probably something minor. I was wrong.

The reason I was paged was because the transport team's bipap wasn't working right and they asked if: 1) They could take our bipap on the transport, and 2) if I would come along on the flight to manage said bipap.

Now, I have always entertained fantasies about being a flight RT at some point in my career, but did I wake up Friday morning thinking that in less than 12 hours I would be part of a transport team? No ... and that is what I love about my job.  

So when they asked if I could "come with" as a member of the transport team, for a brief second I thought I was going to literally squeal ... but I quickly regained my composure.

"Yeah ... yeah, I don't think that would be a problem..." I said.

They gave me the run down of the fixed wing airplane and the situation and we were in the air before I knew it. Throughout the entire flight to the accepting facility I was patient-focused, and time seemed to go by in a flash. We delivered the patient with no problems and were on our way back to the plane in an ambulance when my nerves finally took hold.

I am not sure what kickstarted my anxiety but I think it had something to do with the two flight nurses talking about a chopper that had gone down somewhere in Oklahoma the day before. We got back into the plane and this time I was in the cockpit -- which was actually pretty cool -- but we were forced to reroute to another airfield due to poor visibility. By the time we landed, my fantasies of being a flight RT had ended. During the whole shaky decent into freezing fog, I white-knuckled my seat and muttered prayers to God, while the rest of the crew talked about what restaurants would still be open at that time of night. I knew that this side of being an RT was not for me.

It was an awesome experience and one I would do again if the patient depended on it, otherwise I am going to keep my feet on the ground.

When she came in her sats were in the 70s with a respiratory rate of 28. Even though she had been previously warned against it, she was using her pulse dose portable O2 tank on 5L and it was only pulsing 5 times a minute.

I placed her on O2 continuously at 5L and within minutes her WOB had decreased, her sats had risen to acceptable levels and she looked ten times better. This patient was in the hospital for almost a week for COPD exacerbation, and when she was discharged I made it a point to speak with her, her family and the physician and we all agreed that the pulse dose O2 tank she loved to carry around with her was, in fact, no good for her respiratory health and was not able to meet her O2 needs.

A few days after discharge, I saw her checking in for an appointment ... with the pulse dose O2 tank tucked snugly under her right arm...

This is not a rant against pulse dose O2 tanks, this is a rant against patients who, despite all evidence and experience, continue to indulge in bad habits contrary to professional medical advice.

I understand that non-compliance is a problem as old as the medical profession itself: I am sure the first caveman-RTs were left dumbfounded by their caveman-patients who were passing out from inhaling too much smoke from the first caveman-fires, while continuing to insist that "smoke make Ugg feel good..."

But man! I really thought I got through to her. I thought she understood why it was a bad idea for her to use that tank and why she needed to switch to E tanks exclusively when she is out and about.

Of course I feel like I get through to a lot of patients and then I see them again ... in the ER:

"Spiriva is the one I take when I get short of air, right?"

"What's a spacer? Oh yeah, that thing...I think my kid puts her crayons in it."

"I mean it this time, I am not smoking ever again!"

(((*sigh*)))

Maybe I am just not convincing enough. Is there some sensibility I need to appeal to? Does anyone out there have any advice on how to make this stuff stick?

Even though it hasn't been that long since I myself was a student (about 18 months) I feel that I have garnered a wealth of knowledge about what it is to work as a respiratory therapist and what it is to work in the medical field in general. So as it comes to that time of year when our hospital sees first year RT students going out on their first clinical rounds I would like to relay some advice based upon my (limited) experience as a clinical preceptor.

In no particular order:

If a preceptor, a doctor, a nurse, or anyone else is looking to bust your chops with some obscure medical question and you aren't sure of the answer, don't try to BS your way through it. Trust me on this one, your best bet is to say, "I am not sure, I will look it up and get back to you." If you do try to bluff your way through it you will inevitably look like a total idiot, because they are waiting for you to slip so they can call you to the carpet. On the other hand, if you take the time to look it up and get back to them with a concise answer to whatever question was asked of you, you will build a positive reputation for yourself.

If a preceptor asks, "Do you want to draw this blood gas?" Your answer should always be "Yes!" For some reason the students who have been at our hospital have this strange requirement that they watch three before they draw one ... this is nonsense. If you have seen one you have seen 100, and drawing on a fake arm in the lab 100 times is no substitute for the real thing ... so just go for it.

Know your drugs! I am not suggesting that any first year student be a walking PDR, and I am well aware that approximately 85% of your RT education is going to come during your clinical visits, but knowing the basic respiratory drugs, and what they do, before you go to your first hospital rotation is a must. Again, I am not suggesting you should have the knowledge of a pharmacist after one semester of respiratory school, but you should know what albuterol, atrovent, pulmicort are and the class of each of those three drugs at the very minimum.

We have all read about it. We are aware of it's existence. It lurks somewhere in the deepest recession of our Eagan's filled psyche; we know it's possible. But, just as a stat IS, it doesn't mean you will ever actually see it. At least that's what you pray...

The docs are aware of it too. Sure the older, more seasoned vets realize that the tales of this phenomenon are greatly exaggerated, but like a Big Foot, they fear it sneaking up on them when they least expect it. And so they write crazy orders like "keep SpO2 < 86%" and "not >2.5L NC"; orders of which no RT shall pass, cyanosis be damned! What mythological creature could drive such smart men and women to such measures of insanity? What is the vile beast lurking in the medulla oblongatas of lungers across this great land that causes such visions?

The dreaded HYPOXIC DRIVE!

Every RT has had it drilled into his or her brain since day one of respiratory school that you should never withhold O2 for fear of knocking out the HYPOXIC DRIVE! But when it comes to reasoning with a physician, reason doesn't always trump "well my med degree says so!" So despite obvious distress, O2 is withheld... And sadly it is the patient who suffers, while the docs stubbornly hold their ground, determined that the pot of gold at the end of the rainbow really does exist.

So how is an RT to fight this bogus fear? How are you experienced RTs out there in respiratory world combating these rediculous orders? I have not been an RT for long, but have already had to fight this battle twice and both times was unsuccessful to the detriment of the patient...

Any tips?

I work in a rural setting: a 25-bed, critical care access hospital that serves a population of between 5,000-6,000 people. We don't have an ICU, we have a SCU -- Special Care Unit -- where we would put a patient who is considered ICU status. We can't call it an ICU because of our critical care access status and we can't keep anyone in there longer than 72 hours. We don't ever have patients on vents longer than it takes to stabilize them until the transport team can take them away to a bigger hospital with more resources than our facility. So needless to say if there is some fancy new mode of ventilation or cutting edge respiratory modality, chances are I will read about it in a medical journal long before I will, if ever, get the chance to use it.

I spend a good deal of my time doing breathing treatments on the elderly, PFTs, EKGs in the ER and a whole slew of out-patient stress tests and cardiac and pulmonary rehab. I spend a lot of my time hoping for something big to hit so I can get that adrenalin rush that I assume is constant in a metropolitan medical facility ...

And then there are days like last Thursday....

Thursday started off with normal neb rounds, nothing too fancy: an old lady with the flu, a few pneumonias, and a few home meds who were in with no respiratory issues. And then came the stat page to OR for an emergency C-Section. I won't get into details, other than to say the kiddo was discharged a week later no worse for the wear, but one baby code blue and I had more than enough adrenalin to get through the day. I went to draw an ABG on a patient who had been admitted with suspected respiratory failure, a fact the ABGs would confirm. I put the patient on BiPAP and was then called to the ED for a stat gas on another suspected respiratory failure. The gas confirmed what her presentation indicated and we intubated and placed the patient on a vent until she was shipped. No sooner had she gone out the door then the patient we had earlier put on BiPAP coded and would eventually be intubated, put on a vent and shipped. This was all before lunch and I still had three PFTs to do, and a stress test.

Being a respiratory therapist in a rural setting definitely leaves something to be desired in terms of critical-patient volume and the latest and greatest in respiratory modalities, but it has it's share of excitement and has made me a more rounded RT.

Every healthcare worker in America is aware of the fact we are in the midst of one of the worse flu seasons in years. My small community in Kansas has not been exempt. Between the flu and RSV I have worn more masks and PPE garb, and have subsequently sweated my ass off in more sweltering patient rooms  than I care to recall. So far, knock on wood, my family and I haven't had so much as  a sniffle or a sore throat. I contribute practicing good hand hygiene and wearing recommended PPE when entering patient rooms as paramount in my fight to stay healthy, but I also want to give a big shout out to the flu shot that my employer made me get this year.

This is a trend that has become somewhat commonplace for people working in healthcare, and somewhat controversial as well. The organization I work for (which includes a clinic, hospital and senior living) mandated that all employees, everyone from those on the floor to those working in the office, had to get a flu shot this year or wear a mask when around patients. Of course there was outrage, and from those with knowledge to know better ... nurses were among the loudest complainers. I actually heard a nurse say this: "Don't ya know the flu shot gives you the flu ... I got the flu shot last year and had a sore throat for a week, ah-hyuk..." 

There were some who opted for masks but the majority complied. I always get a flu shot, so it was no big deal for me. We weren't the only hospital in the region to institute such requirements. One major hospital in the area has a policy that their workers either get the flu shot annually or they are fired. This seems a little harsh ... but I can understand it. The flu shot is to protect your patients, not just yourself.

I am not for "forced" anything, but I find it totally acceptable that one requirement to work in a healthcare facility is to get a flu shot annually. This really seems like a no-brainer and I question the presence of brains for those who refuse and fight so adamantly against it. You absolutely have the right to refuse the flu shot but your employer also has the right to refuse to allow you to work if you are going to put your patients in danger.