Lament of the Non-Nurse

12916468-doctor-wearing-latex-glove-giving-thumbs-down-sign

Healthcare is all about nursing. I understand this. With 77% of non-physician roles in U.S. healthcare being those of the nursing variety, I can understand. They are the backbone of our hospitals. I am not a nurse. I had the option years ago, and I decided that, with poop being my Kryptonite and all, it would not be a wise career choice for me. I opted, instead, to help people breathe for a living. Thus I became the respiratory therapist. That choice has come back to haunt me in several ways.

The first of these started when I wanted somewhere to go from here. Nurses have so many avenues they can take to do this: become an instructor, a case manager, management at their facility, become an NP. What can the respiratory therapist do? Well, aside from becoming a Registered Respiratory Therapist from the entry-level Certified Respiratory Therapist, which I did the month after I graduated from respiratory school, there is nothing. Bachelors programs in respiratory are just starting to emerge, but a BS in respiratory gets us no more job perks, no more pay. You just get to say you have it. The majority of my bachelors-having coworkers got theirs in “health sciences”. Whatever that means. So instead, I opted to finish my BS in business administration with the added concentration of healthcare management. But then what? If there are only a handful of BS programs, there certainly are no masters programs. But my BS is in business anyway, so the MBA was a no-brainer.

So here I am. I am one of the more educated in my department, even in the hospital. My MBA is complete. I did well. I did it. So now what? Now I find a job.

I thought this part would be easy. Well, not really easy, but not this difficult, either. Let’s discuss my situation: I have spent the past eight years of my life working in the toughest in my field–adult critical care, and eventually NICU. To the layperson, let me explain further: I am a member of a critical care team who responds the emergencies in the hospital. We are called in when you or your loved one is at their sickest. We bring our skills, experience, and knowledge to you, make recommendations to the physician based on all of the above. We communicate with other members of the team, with family members, with patients. We assess and decide, then act. Repeat as often as necessary to the point that it is second nature to us.

So what does this tell you about me? Well, it tells you I can effectively communicate with anyone. I have non-English-speaking patients, when I am most certainly unilingual. I have deaf patients, blind patients, patients who are intubated and cannot talk, trached and cannot talk. My job is to find out what is going on with them rapidly enough to act. I have become, over the years, a master lip-reader. But that’s not all. The people with whom I interact each and every day have been anyone from a PhD-holding professor who was ill, down to a man whose education was limited to elementary school before he was put to work out in his family’s fields. On our professional team, we have everyone from housekeepers and registration clerks, who may only have a high school education, all the way up to senior management and physicians with advanced degrees. I. Can. Effectively. Communicate. With . Anyone.

Now for my work. It may involve looking at lab values that seem to others to have nothing to do with the lungs, but actually do. Watching vitals. Seeing how the patient breathes. Assessing vital signs. Looking at patient history to see what clues I can find. Listening to family members who may not speak the same lingo I speak. Look at x-rays, watch for clues. And I look at all of this, and since the physician is not there, I have to decide when we need to be concerned, when to call for more help, what I can do to help. So in a split-second, I have to take in this information from multiple sources–complex information at that, compare it to the knowledge stored in my brain, and formulate a plan on how best to proceed.

And under stress. The patient is either having trouble breathing, or even has stopped breathing, when I have to do all of this. Maybe their heart has stopped. Maybe their oxygen saturation is low. Regardless, I don’t often have the luxury of being able to take my time. I need to make a decision and act now, now, now. And while nurses have anywhere from 2 to 6 patients to care for, when I go into work, I have the respiratory histories of at least a few floors’ worth of patients in the back of my mind or in notes in the margins of my printed work assignment. If you figure the average respiratory rate is 10-20 breaths per minute, and there are usually 30 patients per unit, that it 36,000 breaths for which I am responsible in one hour of work on just one floor of the hospital. And I May have three or four floors. That’s a lot of responsibility and a lot of stress.

And I have done this for years of my life.

And then I got an MBA. So I understand finance and strategy, management and business law, marketing and accounting. I have been educated thoroughly in all of the above from a nationally-ranked program at a well-respected university. Add that to the ability to communicate with anyone, the ability to work under stress, the ability to extract complex information from multiple sources to formulate a plan….Nothing should stop me, right?

Wrong.

Because I am looking through these jobs, and seeing that many of the leadership opportunities are asking for someone with a nursing background. Why? No idea. We respiratory therapists go everywhere. A nurse may be hired to work in one specific unit. I can go anywhere in a single night, giving me intimate knowledge of the work flow of every patient care area of the facility, from behavioral health up to the ICUs. And I know healthcare. And I know business. At first, I noticed this trend, and I was a little discouraged, but I figured that I would find the right role  But today, I came across a posting for a pulmonary unit. They need a director. Perfect. Except, as I scrolled down reading the job posting, toward the end, it listed a RN as one of the qualifications. They want someone with my clinical experience, an MBA….and a RN.

It is what we all deal with everyday–we non-nursing patient care staff. We are skilled, we are experienced, we are valuable to patient outcomes, but this is the hand we are dealt, and frankly, it sucks. Part of me wants to just go to nursing school for a couple of years so I can say I did. But I shouldn’t have to do this. I have worked hard. I have done well, completing all three degrees with academic honors. I have the experience under my belt. This is just ridiculous.

Nursing is the backbone of healthcare, but I have yet to see a backbone accomplish anything without limbs, without muscle to hold it upright, support it and ensure it can move and flex in the ways needed. And it’s high time that the rest of the body gets some respect.

NICU RT Confessions

So recently, I have been working the NICU more than I have been working with adults. It isn’t my favorite place to work, but I like it. Just so you know, my favorite will always be adult critical care because it is so…familiar. I have spent the brunt of my career (to date) taking care of the sickest of our adults. The NICU is interesting because it is a challenge. The critically ill newborn is not just a small version of a critically ill adult. There are new intricacies, new puzzles to solve. New. My inner geek loves the challenge–the part of me at my core that isn’t happy unless there is something interesting to do, a new challenge to tackle. Some of us went into the field because we wanted to cuddle little babies. I’ll be honest here: that just isn’t me. I like babies, but I like my own. I like kids if they are my own. I can look at your kid and think they are adorable, but I am just too no-nonsense for the goo-goo, gah-gah stuff. But I am a NICU respiratory therapist. Because someone told me I should be. Because I am good at my job.

So I have a whole new and different set of challenges, and oddly enough, several of these have nothing to do with the functioning of a neonate. I have personal challenges. Issues that reverberate to my very soul. And suddenly hardcore, no-nonsense Andi isn’t so tough. So here is my little list. My confessions.

1. That moment when I am called. There is a 30-weeker being delivered by crash c-section and I am needed in the OR, Stat. My heart still skips a beat and I still wonder if I am good enough. Will I know enough? Will I be able to help? What am I walking into?

2. That moment? You know the one, right? Where a new mom is born. And the room quiets except for one little cry. And my emotions are fricken traitors and my eyes get moist. Because to cry is to be healthy. And isn’t that what the parents wanted? And there is a new person in the room. It is absolutely awesome, whether that new person entered via guts and determination of the mother, or whether there was a surgical incision involved. It’s still the same to me. It should be to all of us. And I have just taught myself a lesson: to let go of the issues I have with the way my boys came into the world. They came into the world. That’s all I need.

3. If you name your child something stupid, I will make fun of you behind your back. Sorry, but you kind of deserve it. If we tell you your chosen name for your baby is “interesting”, that means we think it is the most ridiculous thing we have ever heard.

4. I got attached this past spring. I was there for 4 days straight. I was called to the OR for the delivery of a mom who almost died from blood loss. And she could’t see her baby for days. I resuscitated the baby. I kept him alive. I worked my ass off for four days straight. When he was crying because he was hungry, but he couldn’t eat. When he just wanted to be held, but any disruption made his heart rate plummet too low and his oxygen saturation bottom out. And his mommy was too sick to be there. So I leaned over him, with my hand on his little diapered butt and the other hand on the top of his head. Gentle pressure so he felt like he was being held without being held. So he could have some comfort without coding on me. And I was off for awhile. When I returned, I worked with adults. He was gone. He went home. He and mom both recovered. I had done a good job. And it affected me so profoundly that I cannot put it into words. And I still wonder what happened to them. So now I am distant. Forgive me for that. I have to be.

5. Last night, I resuscitated a 33 weeker. Zach’s gestational age. I wanted to tell the scared parents that it would be ok. That before they know it, there will be a robust toddler destroying their home. But I can’t do it. Because every baby is different. And just because it was all ok for us doesn’t mean it will be for them. Their baby came out not breathing. About half of Zach’s size. A heartrate low enough that we had to perform chest compressions. And then I start to wonder. Why us? Why them? And I see Zach’s face and I fight, fight, fight. I become over-invested. Because, while our efforts worked last night, there will be times when they do not. Last night could’ve been one of those times, and I know that my soul would’ve been crushed.

6. There are ugly babies. I’m sorry, but there really are. All that matters is the parents think they are amazingly beautiful. I just don’t tell them the truth.

7. We judge you parents. If you are pieces of shit, we know it. When you go out for “fresh air” and come back to your sick baby, covered in the residue of smoke. When you come back positive for drugs. When baby looks nothing like Baby Daddy but mysteriously like Neighbor, who is Baby Daddy’s BFF. When you are overbearing and, though you mean well, you try too hard and impede the necessary medical treatment of your very sick kid. Secretly, I want to take the baby home with me. I want to tell you that you are a piece of shit. But I cannot. We don’t leave the door to the room open so we can “hear alarms”. Those alarms sound throughout the whole unit. We leave the door open to supervise your ass.

That’s all for now. I have to get ready to go to work. NICU again tonight. More later.

 

Things that Hurt When Your Rotator Cuff is Effed Up


So it would seem that, when one is a passenger in a car and is wearing a seatbelt, and the back passenger car is hit with enough force to throw the car sideways into one’s yard and bend the damned frame, one can suffer some pretty major injuries. And at first, it may seem like just general muscle soreness. And it will hurt a little bit when one makes certain movements, much like if one had overdone it at the gym a couple of days prior. Or maybe one lifted a toddler the wrong way. But when one is stubborn and refuses treatment, thinking it is minor and will just go away, one is making a big-ass mistake.

So yeah, that’s me. I should’ve known something waas wrong, as pulled muscles don’t not get better over almost 2 months. And I don’t go to the gym. The only lifting I do, other than random child-lifting maneuvers, is a fork to my mouth. Still, it hurt to lift my arms to the side. I could lift it straight forward, but not to the side. “Abduct” for my A&P cronies. (Hells, yeah, I remember my terms from Human A&P 101!) I knew I was sore from the accident and my ER peeps warned me that it would take awhile for the soreness to go away. And, incidentally, “awhile” is a relative term. “Awhile” as in a week? A month? Maybe two?

But it wasn’t getting better and John and I had justt discussed that I probably needed to get it looked at. The pain wasn’t excruciating. Just a little annoying. But we forget sometimes. We forget that I am the dumbass who, after having my left knee reconstructed, walked my happy ass in the house without crutches because, hey, it didn’t hurt that bad. I am also the crazy one who had 50+ contractions an hour for months with two pregnancies, and only wanted to go to a hospital if the baby was coming out. My pain tolerance makes me no such a good judge of when something is becoming a problem.

So Friday night at work, hell unleashed. Lucifer came out of his underground shell to teach me that I am not invincible. We had 10 codes in about 5 hours, some of which were simultaneous. Most of them were on my pattients in the ICU. The bad news is that, even if they weren’t, if resuscitation attempts are successful, they are coming to me anyway to keep them alive. There were hours of chest compressions, hours of being hunched over a bed, clasping a mask to patient faces while I bagged patients during CPR. There was lots of pushing/ pulling ventilators and other life support equipment, crash carts, etc. up and down hallways. The shit went on for hours. And let me tell you something about CPR if you have been fortunae enough to never have to use the little outdated Red Cross card you have in your wallet–chest compressions? on a real human? They’re quite a workout. I mean, you’re pumping the chest 100 times per hour at a force that is enough to break ribs. And bagging a patient? Whose body has its own agenda? Well, that kind of takes a little bit of force, too. One day, I swear, I will have Popeye forearms.

So after all was said and done, my entire body was sore. And my arm? Well, it was screaming at me. SCREAMING! Still, I popped some Motrin and went to bed. And went back to work. More ICU fun. And by Sunday, I wasn’t worth crap. I couldn’t lift my right arm to wash or brush my hair. I couldn’t lay in certain positions. I couldn’t even lean against the back of the recliner unless I was positioned just so. When I tried to do homework and struggled, it was time and I went to the ER.

Fuck.

The hypothesis–and I say “hypothesis” because we can’t be sure until a specialist sees me–is that my right rotator cuff was injured in the accident. And that, after said accident, my retardation and stubbornness have resulted in a worseniing of the injury. And thus I have to see an orthopedic surgeon tomorrow. But nothing prepared me for the stupid list of things that would hurt, and I was told that, if it hurts, I shouldn’t do it until further notice. So here is a list of the stupid shit I cannot do, and somewhere in cyberspace, there is someone reading this who googled “rotator cuff injury” and ended up on my stupid post. I’ll bet that person is pissed. If that’s you, feel free to leave a comment to let me know.

Bitchypants’ List of Shit That Hurts When Your Rotator Cuff is Effed the Eff UP

Washing my hair

Brushing my hair

Coughing

Liftting a toddler

Picking up a single fucking toy from the floor

Pulling the refrigerator door open

Pushing a anything

Driving

Rotating my torso

Writing-yes, writing–it hurts to push the pen that little amount

Highlighting passages in my text books

Laughing too hard

Putting on a sock and shoe

Getting dressed

Wearing a bra

Reaching for anything

Turning the page of a book

Cutting food with a fork (If you think about it, it involves pushing the fork into the food.)

Laying on my side/ back/ front. I guess I’m supposed to sleep on my head.

Wiping up a spill

Typing for a long period (short bursts are okay.)

…..

I’m sure this list will grow as I try do more and discover whatever it is hurts. I will not be shocked if the orthopedic surgeon immobilizes my arm tomorrow. I will also not be shocked if I end up having my fat ass shoved into the narrow tube of an MRI scanner sometime this week. More later.

It’s What I Do

Ya’ know, when I was 19 years old, my mom passed away. At her funeral, there were these strange women there, crying along with the family. None of my brothers and sisters knew a single one of them. It turned out that they were from the respiratory therapy department at the hospital mom always went to when sick. It was a little hospital. And I remember thinking “how awesome is that to be able to be that invested in your work?”. I guess it stuck wih me. And then later, John talked me into going back to school. I was too smart to not finish my degree, according to him. And so I did. I just wanted something that would support my family. I was going to try nursing, but I couldn’t handle the poop part of it. And I found out my college had a respiratory therapy department. I applied for admission into it. I didn’t think about the times mom’s cough would be productive and I would gag when she would cough into a tissue. I just remembered her funeral, her life, her demise. Along with my interest in medicine.

I became a respiratoty therapist. I never gave any thought to it. I had straight A’s, so how could they deny me admission into the program?

I finished my degree and I ran with it. My first resuscitation after graduating was a 6-month-old baby boy. They found him submerged headfirst in a bucket of mop water that had been left by a bed. We had no idea how long he was submerged. He was supposed to be taking a nap at the babysitter’s house. Of course we didn’t get him back, and I came home from work that day and told John that I had made a horrible mistake, that there was no way I could do this job. Nobody with a heart could. But I went back to work the next day. And the next. And somehow, I stopped being able to keep track of the resuscitations in which I have participated, except for a select few that hit particularly hard. Like the mom who died in childbirth and almost took her baby with her. We were successful at saving the baby, but not the mom. My last picture of that was the NICU door closing on the new widower cradling his new baby girl with a bewildered look as he sobbed for his dead wife. And then there was the little boy who was 3 days older than Evan, who tried to help his stressed Daddy out by taking his ADHD meds himself. Only he took the whole bottle and his heart stopped. And his mother wailed as I stood at the head of the bed, breathing for him until they told me to stop. Or the 35-year-old breast cancer patient who had contracted necrotizing fasciitis after having her lymph nodes removed. Someone thought it was a good idea to let her daughter come back and say good-bye before we called it. Her daughter was Evan’s age, and I can still hear her wailing, “Mommy, don’t leave me.” Those? Those I kept right here with me. They have never left.

It’s interesting isn’t it? For every one we couldn’t help, there were probably 2 that we did help. I don’t remember those. Their faces blur together and disappear into this infinite mosaic of faces that have wafted into and out of my life. My work. Evidence? The grandmother who ran into me and remembered my face as one that did CPR on her newborn grandson. Or the lady who ran into me at the grocery store and remembers me as one who responded to a code on her father. I was just standing there in the produce aisle with my family, with this blank smile on my face because I couldn’t very well come out and say, “I’m sorry, but I haven’t the foggiest who you are.” The successful ones become the equivalent as another Big Mac sold by the McDonald’s worker: I did my job. I’m so sorry I do not remember, and I never dreamed when I started this career that I would reach this point. Pretty much the best I can do is assure you that while I was there, I cared deeply. I still do. But when you are standing there sobbing while we do CPR, I have to block you out. I have to concentrate on my job. And when it was over, I don’t want to remember your sobs because then they stay in my head as a constant reminder of how fragile we all truly are. That it could’ve been my husband, one of my children, me.  And while I am sorry that it is happening to you, to your loved one, I’m truly appreciative that it is not one of mine. I can be selfish like that. I’m sorry. I’m so, so sorry.

But I am not the only one. There is a whole profession out there of people who do what I do. And this week? Well, this is our week. National Respiratory Care Week. The hospital and the physicians, the drug reps and vendors, will shower us with food and freebies. And they’ll say thanks for what we do. And we will pat each other on the back for this week. But next Monday, it will be business as usual. People will live. We’ll help them. And some won’t make it. I’ll see an obituary with a familiar name and it will drive me crazy, serve as evidence of our failure. And then I’ll hate my job, but I’ll still go in the next day. And the next.  And the next.

Somewhere along the way, I became a respiratory therapist.

It’s what I do.

It’s who I am.

On Being Hacked, Being Yoko, and Being Tired

Okay, first things first.

Sometimes, when a bitch has a multitude of items on her to-do list, a bitch gets tired. Really tired. John has started classes, which means my work schedule is different. Off Mondays, Tuesdays, and Wednesdays. Which means that from about 6PM on Thursday to about 7:30AM on Monday morning, I’m working. And last night I really did. I clocked in, made out the assignments for the other therapists, and sat down to get report. And the ridiculous bong-bong noise (that my hospital uses to get our attention before announcing a code blue or rapid response) sounds. Okay. Nothing like that kind of start to your day. And so I start booking it across the hospital, only to hear another. And another. And another. And another. 2 Rapid Responses and 3 Codes within about 20 minutes. As soon as I fricken ge there. Fuck. Problem is that the first one was on one of my units, and so I was there when the others were called. And I was in charge. (BIC= Bitch In Charge according to one young coworker of mine.) And we had assistants in our midst, which means they are still students and practice under limited licensure and cannot be in a code without a licensed and credentialed therapist. And it all happened so fast that I couldn’t remember who I put where. And as coworkers checked on me, I would shout over the roar of 20 people in a code room to that coworker at the door that I was fine, but to check on the others for me. As in, “Go! Save Yourselves! Armageddon is COMING and everyone in the joint is trying to friggin’ die on us!” But there is no truer testament to the strength of the team with which I work than this: only one death in all of that, and it was an old woman who was a DNR before she actually tried to die, and her husband couldn’t handle it and changed his mind to resuscitate at the last minute. They weren’t able to. And everyone worked together. Those who didn’t have coding patients went from code to code, rapid respnse to rapid response, helping everyone out. And when it was all over and the dust settled, everyone managed to get their work done, to see all of their patients and hand out breathing treatments and inhalers to all. Not a single patient was missed. But when you start your night out like that, no matter what follows, you feel exhausted. Mentally and physically drained. I could’ve sat on my butt in the office for the remaining 11 hours of my shift and still felt like I was hit by a truck. Gotta love healthcare.

And so I come home. I opened the door at the house and totally forget until right then that I am now Yoko Fucking Ono.

John’s dad said he had this bed that he is getting rid of in his remodeling and streamlining project at his house. Evan has a twin and could use a big bed, so I said why the hell not? We’ll take it. And so yesterday, while I was asleep, he made the long trip up here to bring it to us. But it’s old as hell and I am loving the antique-y-ness of it and want it in our room. But we currently share our room with Zach, and so our room is littered with baby junk. So, while I snored, the guys set it up. In my fucking living room. Yep. Right there in the middle. As a matter of fact, I am laying on the damned thing right now. Because between papers and reading and lectures with no John here to help with the toddler, I have to figure out how in the hell I am going to make this thing fit in our room. (PS-He also brought a treadmill that he bought 2 years ago when he had open-heart surgery–CABGx4 for people of my vocation–and never used. So now I have visions in my head of studying while running, cooking dinner while running, writing papers and blogging while running. And I will soon be a skinny bitch. Yeah.)

Yeah, there I am. Except I'm not asian. Or a hippie. Or married to John Lennon. Though I did marry a John....Hmmm.

And finally, I got friggin’ HACKED. Yeah. Fuckers. I got this direct message on Twitter, and I was all what-the-hell-is-this? And I opened it. And it asked me to login to my Twitter account. And it looks all extra legit. So I log in. And nothing. So being the moron that I am, I try again. And again, all the while wondering what is wrong with my Twitter account. Until the next day, when I get some messages from some kind folks who let me know that they are getting spam from me. I was all embarrassed. In today’s technology, being hacked is the equivalent of having leprosy or some shit. I’m waiting for someone to show up and take me to a colony where I will be stripped of my laptop and smartphone and forced to live without so I can do no harm. Immediately, I started losing followers on Twitter. And I have no idea what to do. I changed my password, thinking that might thwart the evil-doers’ plans. I honestly have no clue.

So there you have it. Back to corporate finance.

>First Do No Harm

>

thumbnailCAQ8HU5X

Primum non nocere.

Of course we all recognize this as the cardinal rule of any medical practice. Nonmaleficence, meaning that it is entirely possible that the best course of action for me to take in an emergency is to actually do nothing. That doing nothing, and thus not causing further harm, may be better than being wrong in a manner that leaves my patient in worse shape. Now take all of that and combine it and roll it into a big ball and realize that I grapple with this in a split second when my patient has stopped breathing. That instant that truly seems like an eternity. The great void between the realization that your  patient is indeed pulseless and apneic, and the pushing of the big blue button that will trigger the calling of a Code Blue. In my career, I have had situations where I go back and think about  a patient and wonder if me reaching any conclusions sooner would have changed an outcome. And thus far, I have had the luxury of being able to say that I don’t feel as if I have harmed anyone.

Last night, I had to face that possibility when, after some aggressive airway management for a patient who wasn’t ventilating well, I witnessed the spiral. First the oxygen saturation starts to drop. And then the blood pressure is low, followed by the slowing of the heart rate. Finally you reach that chasm where the heart ceases to beat, whether it be a pulseless ventricular rhythm or completely asystolic. The patient is dead. Expired. And you can do all you can and whip out everything you have learned in years of education and professional experience in the hopes that it will help. That the heart will resume beating. (Not so much the breathing because, honey, I can make anyone breathe with the right equipment.) But this happened last night. While I was there with my hands on that patient, taking the opportunity to teach a new ICU nurse about ventilator basics. I have never had that happen to me. And after we got her back not once, but twice, and they finally got the stat chest film for which I kept begging, it was determined my patient had a pneumothorax. And so when the family arrived at the bedside and told us to stop all efforts at resuscitation due to patient wishes, in the blink of an eye, my role switched from caring for the patient to caring for the family. To help them find some peace in her death. I did all I knew to do. I extubated her, washed her face, smoothed her hair, tucked her in, and left the room so they could have those final moments with her on her death bed.

And then I went into my back office in the ICU and I cried. Actually I started crying before I got there, prompting fellow ICU staff to follow me to make sure I was okay. I was. I was still breathing. My patient wasn’t. It was the first time in my career where I was physically working with a patient when they went down, and my instantaneous thought was, “Did I do that? Did I hurt her?” Of course after logically recounting the steps to her demise, it is obvious to me that she suffered the pneumothorax before I did anything that could have caused it, and thus I cannot blame myself. But it just did something to me, and I cannot really explain why.

I love my job. Love it. But I have always had confidence in my professional skills and training. I haven’t really doubted myself before this. Well, I have, but not in the manner that I had to stop and think on whether or not I did damage. I have always said that the most dangerous person in healthcare is the one who will not admit that they don’t know everything. So with that in mind, there has always been a healthy dose of fear. There has to be when you are literally running someone’s life support. But that fear cannot be so great that in inhibits one’s performance, one’s ability to be on their toes when a true life-and-death emergency strikes.

Lately, as a senior therapist, I have been mainly working the critical care units. Once in a blue moon, my boss will give me something else so I don’t go insane, but it isn’t very often. And the thing about this is that I am in a teaching hospital. Meaning when there is an emergency and the code team assembles, it really is a team effort. In other areas of the hospital, this may not necessarily be the case because there are more seasoned physicians running the show. But in the ICU’s, you get residents. And the presence of “MD” behind their names has yet to give them the idea that they know all because of their education level. They know that an experienced ICU nurse or therapist has seen a lot and can help them. I work with them on intubations, on managing pulmonary issues. I give crash courses in blood gas interpretation or ventilator management. And in a code, when we get to the point where we have exhausted all possible causes, or in one where the cause is obviously pulmonary in nature, they look to the therapist. Me.

I don’t know what I’m getting at here. I think it is just that I had to think last night that it was possible that I hurt a patient. And even after coming to the conclusion that I did not, the fact that I could have just seemed to linger. And of course this has made me think of my role in the hospital even more than I have before. The pressure. The weight. The responsibility.

I upheld my ethical commitment last night. I did no harm. But I had to come face to face with the idea that I hold lives in my hands when I go to work and clock in at night. That I very well could hurt someone. I think it just caught up with me.

>On Coming Back and Letting Go

>Work has been so strange lately. It’s not even Hell Season yet. For those of you who don’t realize what that is, Hell Season usually hits around November and lasts through March or April–in other words, flu season. In other words, the best of times and worst of times to for a respiratory therapist. The best because I will earn about 3 times more than I usually do in the off season because the hospital is usually full of respiratory patients and the overtime is there for the taking. And I am opportunistic. Sick people need our care, staffing has to be up to accomodate them, and I am all about more moola! On the downside, I have not yet maneuvered Hell Season as a Nursing Mom. I had another night last night where I went 8 hours without pumping because I was just too busy, and this is way before it is supposed to be as such. Will my boobs survive? I don’t know. We shall see. But you can expect more posts about work.

So anyway…

Last night I got a call from an RN friend from the SICU, warning me that I should start heading that way, that my patient was getting ready to code. I get there and he is off of his ventilator and the nurse is bagging him. I take over and am bagging him when we lose his pulse. The big blue button is pressed to alert the troops, and the rest of the code team arrives. We resuscitate this patient for over 50 minutes. During that time, we get his pulse back only to lose it again. His wife is brought in to say her goodbyes and also to see that we are doing everything. She is obviously very distressed and calls his daughters. And we call it: Time of Death 04:46. The rest of the team leaves the room except for me and his assigned nurse. I tell the nurse to turn the oxygen off from the connection on the wall and the loud hiss of it stops and there is silence. I detach the bag from his endotracheal tube and lay it on his chest. And then I hear it: noisy breathing. I look down and he is spontaneously breathing. And not the agonal, uncoordinated breathing of the dying. No, this man is breathing. So I try to discreetly get the nurse’s attention, who calls the resident back in. And they check him. Good pulse, good blood prssure. Just like that. He came back. The Lazarus Syndrome. I’ve heard of it happening may times. This was just the first time it happened to me. So we hook him back up to the ventilator and tuck the blankets back around him and leave the room with out resuscitation equipment. Just like that, as if nothing had happend. Totally bizzare.

Meanwhile, in an adjacent unit of the hospital, there is a patient who is breaking my heart. An elderly gentleman who knows he is dying and has signed a DNR order. And he begged me and begged me to help him die, and all I could offer him was treatment to prolong his life. I have to tell him both sides: that it could be considered life-saving treatment, but that it also could be short-term to help him through until he can breathe a little easier. And bless him, he doesn’t want it and I can see that, but I think he is worried about what I want to hear more than he is about how he wants to die. And it breaks my heart. He keeps asking the nurse and I to just make it go quicker, and I can’t. We ask if he wants us to call in his family and he says no. “I’ve been married for 64 years to the love of my life,” he says, “and I don’t want her to go through this. Just call her when I’m gone.” True selflessness. He wasn’t worried about her being there to hold his hand. Instead he took the hands of a young nurse and a respiratory therapist, both strangers to him, and that was enough for him. I had to stand there and do nothing while he started to slowly slip away. I couldn’t call a code or intubate or breathe for him. There were no chest compressions or life-saving cardioactive drugs. And now I can’t get him out of my mind.

We spend years of our lives learning how to save a life. That’s what I do. Well, the biggest part of what I do, anyway. I’m sorry if that sounds like the swagger of a cocky healthcare provider with a God complex. It really is just the fact of my occupation. And they teach us of the legalities of our role: what constitutes extraordinary measures, medical futility and more. But then there is the side of this for which they do not prepare us: standing by and doing nothing. Holding a hand as our patient dies when we are trained and geared toward doing anything and everything to prevent it. And in that moment, just like my patient, I have to let go. One would think that the resuscitations and other life-saving moments would be the greatest challenge, but they really aren’t for me. What happened with this guy–well that is the hardest part. Having the ability to keep him breathing an his heart beating and not doing it. Letting go.