Doing It

f8d17c34937d9c3215bfbbe00f6c78efI would love to give credit where credit is due for the above, but I have no idea where I got it. But this is the post where I finally talk about the other side. Of course, from the title of the post, you probably envisioned a juvenile describing the loss of their virginity, a la American Pie. Well, though I have my childish moments, I am not a juvenile and, though I hate to break this news, the whole virginity thing  went out the window a long time ago, folks.

No, this one is about setting a goal. One that seemed massive at the time. One that seemed highly unlikely. And then it is about reaching that goal. Or at least having the reaching of that goal so close that its taste is on one’s tongue.

I’m going to start the discussion off by telling you (or perhaps reminding you, in case I have mentioned it before and have just forgotten) that my first attempt at higher education was less than successful. My mom was sick. No, I mean, she was really sick, but she didn’t really reveal this to any of us.  So I spent my senior year of high school noticing how Mom was in and out of the hospital more and more. Somehow she convinced me to go to college anyway, but she kept getting put in the hospital.I was the first one in my family to go to college straight out of high school, to be labeled “the smart one”. She was proud, I think, and so I went. On several occasions, I would call home to discover that she was in intensive care. So there I was, a coddled kid away from home for the first time; a music major trying to study something I loved so much when really, I just loved to play and my mom was my biggest fan. And my mom was a home, dying. I couldn’t handle it. I didn’t do well at all. My grades were barely passing. I had gone from the smart kid in honors classes, to the one who couldn’t hack it. When mom finally dies about 2 weeks before final exams, I just dropped out. I couldn’t do it.

It scarred me. Mom’s death did, but the whole experience did also. When my life was calm enough, when I could look back on that time, I wondered about many things. Was I really just stupid? Was it the circumstances of the time in my life? Maybe I wasn’t college material after all. But I saw my life as it was unfolding, and I knew I could do so much more. And I met John, and he saw it, too. And he talked me into enrolling in some classes.

Just a couple of classes. I read that line to him just now. He smiled. He knows what he did just as much as he knew what he was doing then. Just a tiny spark. At a tiny community college where they do more training for careers than anything else. But I had been to a large university before, so I could tell that the classes seemed to be of the same caliber. Still, self-talk does weird things to us. But I enrolled in their respiratory program. I took the weed-out classes that all nursing and allied health students have to take. These careers, these jobs are stable, so these programs are usually turning applicants away. They make some of the prerequisites really difficult to separate the candidates by who will most likely be successful. And I had to take those classes. I aced them all. My classmates would hate me because I would wreck the curve. I literally scored greater than 100% for a couple of them because my professor curved others’ grades and didn’t feel it was fair to not give me the same point advantage. Still, the self-talk continued.

“It’s just a community college, Andrea. When you were at the real university, you sucked. You’re not really smart.”

And so I finished that program. With honors. I was recognized at graduation. I took my boards. I got my license. I started working in my field. And some part of me wanted more.

I wondered if the old dream of medicine could really take flight. I wondered if it was just because it was a community college. And so I enrolled in pre-med classes, to finish my bachelor’s.

And I got pregnant with Zach. And put on bedrest. I had been doing well, too.

More self-talk. Telling me I was silly. Telling me I was foolish. And then I didn’t want to do it anymore. I wanted to ensure my children would grow up in complete financial security with their mother present. I realized I had been given a gift with each of them, and I was taking that for granted. So I did some soul-searching, determining what it was I wanted to do. What I really wanted.

And I enrolled in an undergraduate program. Straight A’s. It was community college all over again. I nailed everything I touched, and I finished summa cum laude. But I did it online. And so I thought to myself, “Yes, but was it really hard? Was it really a challenge? It was just an online program!”

And so I told John that I wanted to go on to my master’s. To my MBA. And I remember when I was telling him this, that my heart skipped a beat. I really wanted it. I meant what I said. But thus far, every attempt at what I have really wanted has either fallen through or been derailed by my own shortcomings. To speak of this out loud was unimaginable, because it gave life to what I wanted. It gave me some accountability to myself. So I looked, and I discovered that the university practically in my backyard had a nationally-ranked MBA program. I applied.

They weren’t supposed to actually accept me.

And on the eve of my first class, I was so nervous. Walking into my first class, I got butterflies. They were going to laugh me out of there. I wasn’t smart enough. More self-talk. That girl needs to learn when to shut her mouth.

Because I have nailed it. In a few weeks, I start my last semester, which includes my corporate governance capstone. On December 19, I will be able to put MBA behind my name. And for the first time, I can try and try to self-talk myself out of this all I want. The logic counteracts it. I am doing this. I am doing it. And as I prepare to enter my last semester, it is becoming more real. I hope my mom is watching. I hope she can see. Maybe what she saw in me all that time ago was more accurate than what I saw in myself. And I can kind of see what she was seeing.

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.

 

I Can’t Afford It: The Inevitable Rant About PPACA from the Inside

I don’t usually get all political up in here. It just isn’t my thing. I have read countless comments on Facebook about the Supreme Court’s decision about the Patient Protection and Affordable Care Act. That shit is everywhere. And everyone has an opinion. “Everyone is entitled to healthcare…” Yeah, okay. Great. Kumbaya, and all of that jazz. If you are disadvantaged and need medical coverage, and there is a way for you to get it, I am all for it. We have programs like that in the U.S. We have for decades. Yes, they suck a little more than the insurance one pays for electively. If I am out of food, and I go to a food bank to get food for my family, the items I get, though appreciated, are not of the same quality I would buy if I went to the grocery store and shopped for myself. You take what you can get. I’m sorry to sound so blunt, but it’s true.

I’ve said it before and I am going to say it again: I used to not have insurance. John worked at a job that paid him $8/ hr. and the benefits were almost $700 per month. Evan was a newborn. So I took an eq\ually crappy job as a housekeeper at a hospital where the insurance was about $400/ month. I essentially  worked for the insurance When the income got to be too little, I went to work on a degree that would pay me what we need, both in income and in benefits. And I’m not afraid to give you the straight dope, though it is poor etiquette. I gross over 8 thou a month. I bring home about 4K of that. What???? Why? Well, simple, really. I pay over half of my income on taxes and pesky little necessities like medical, dental, and vision insurance. Right now, that is the lay of the land. It is how the shit falls.

So while I am not too keen on spending even more of my very hard-earned money to support those who did not have the wherewithal to go out and do what I did–find a beter job, better benefits—I simply cannot afford it. I am not living high on the hog. We have one car. My husband rides his motorcycle in good weather to save on gas. We try to limit our dining out these days. I clip coupons. We live in a house that is way below our means because it is cheap despite being in a nice, white-collar neighborhood. And though I am off for my neck and shoulder right now, I work every God-forsaken hour my employer will allow me to work in order to make more, to pay more in taxes…you get the drift. I cannot afford more of my tax dollars to go to support your healthcare. I will take care of you when you are ill. I will risk contracting any infectious disease you are carrying because someone has to. But I am not willing to sacrifice the well-being of my children to pay for you and yours. I’m sorry.

And there are other misgivings I have about PPACA. This part is coming from a healthcare professional who works in the trenches, from someone who is wrapping up a degree in business \with a concentration in healthcare management. Hospitals rely on reimbursement. They do. The naional average for Medicare and Medicaid reimbursement revenue is around 60% of hospital revenue. The hospital I work for receives about 80% of their revenue from Medicare and Medicaid. That’s a big ol’ piece of the pie. The pie that determines the amount they can do for their community, the services they provide to their patients. And guess what! For added fun, those coffers are getting pretty shallow. Hospitals are fighting harder for less dollars. And we can expect more and more of these patients. This would seem like even more reason for the PPACA, right? Nope, and here’s why:
The PPACA also has implications for providers. More stringent guidelines to provide more cost- effective care. Nothing wrong with that. One of the yardsticks with which providers will be measured is their readmission rates. Currently, there are a few diagnoses where hospitals are penalized for excessive readmissions. As a part of the PPACA, four more will be added by 2015. One of these is COPD.

And that is whete the respiratory therapist in me gets all fired up.

COPD. The bain of my existence. My livelihood. But these are the worst patients that CMS can use to penalize hospitals for readmissions. I understand the concept: if we’re doing our job, the patient won’t be readmitted within a certain time frame. The problem is this: while some COPD patients are dream patients, I would say the majority of my patients are non-compliant. They won’t quit smoking while their alveoli fight with each other for every breath. They pick and choose which of their respiratory meds they take and when. (No, inhaled steroids are not going to work if you only take them as needed, and you should not stop taking them just because they don’t work as rescue inhalers.) And toward the end, they could be in and out of the hospital every week. So if hospitals stop getting reimbursed adequately for these admissions, they lose progressively more money as time goes on. That is the same money they use to attract and recruit higher-credentialed staff. The same money they use to provide indigent care. The same money they use to obtain equipment. To maintain equipment.

But my other problem? We all speak of the access to care. Well, if you live in the U.S., you have access to care. If nothing else, you can go to an ER where we have to evaluate you. That is access. What is truly lacking is a way to pay for it.

Is the U.S. healthcare system having trouble? Yep. I don’t blame hospitals or providers. I don’t blame insurance providers. Thete are many pieces of the puzzle, in my humble opinion. Lawsuits. Malpractice insurance. ER abusers ( by this, I mean drug-seekers, etc.). Doctors being forced to practice defensive medicine. (And if you don’t buy that, ask me and I’ll tell you the crackhead story.) Drug patents. And us. Yes, us. We want the latest and best. When a standard x-ray is sufficient, we still want the CT. When a cheap generic drug will work, we want the brand. And doctors are stuck. Patient satisfaction is a reimbursement buzz word, and if they don’t give us what we want, we get upset and don’t stop until we get it. Whatever it is, it may not be the most cost-effective, or even the most effective. We need to leave doctoring to doctors.

So, yes. I am a healthcare professional. I am hopefully a future hospital administrator. And for all of these reasons and more, I am completely against the PPACA. And I will vote accordingly in November.

Just for a Moment

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Just for a moment, I got to put my feet up. A brief 5 minutes over the course of 13 hours of work. And as you can tell from the photo, I got to check my blog. Just for a minute, before ventilators started alarming again and patients started to have trouble. It has been an exhausting weekend. Exhausting. And now it is Monday, and I am off of work only to be immersed in papers and presentations and reading for school. And in sticky handprints and peanut butter sandwiches and vacuuming up Golfish crackers that have been ground into a pulp in the carpet.

Sometimes, when you want it all, when you aspire to have everything, that is exacly what you get.

 

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.

Role Transition

So what’s happenin’? Well, A lot and yet not so much.

The NICU stuff is winding down as we get closer to the day where we will start keeping the really sick babies. When you have a baby at my hospital, they warn you to not let anyone without a specially marked badge in to take care of your newborn. OB staff and NICU staff, as well as Peds staff all have these badges. The core NICU respiratory team is o be no different. So today, I had to go and get a new badge. The special marking? A bright pink stripe. Mine used to have a lime green stripe. How did they know pink is my favorite color? Actually, when I got it, I was appalled. my title is written all extra ginormously and the pink is glaring. Proof?

Pink means "Gimme yo' Baby!"

So not a big deal, I know. it’s the little things. I also renewed my NRP–Neonatal Resuscitation Program for those of you not in the know. It’s the fourth time I’ve taken it and it won’t be my last, as it expires every two years. The video for it cracked me up. They actually included RT’s in the scenarios with the rubber babies. As in, “Call Respiratory Therapy STAT.” And the guy who is supposed to be the therapist shows up and says, in utter robot fashion, “I…am..the…resp-ira-tory ther-a-pist. How…can…I…help?” Yeah, whatever, Dude. That is so not how it goes. I don’t wait to be told what to do. I know my role and get to work immediately. I’ll throw elbows if I have to. Same as wih the adults.

I’m sort of nervous about the change in roles. I’ll still be taking care of adults, too. But I will be on my own with the sick preemies and it worries me. I will see what could have been with both of my boys, and I will be crying a lot. Maybe this makes me less fit to care for this patient population. Maybe it makes me more fit. I guess it’s a matter of opinion. But someone saw me fit to be placed on the team. And so I shall do my best for the little ones while I see Zach’s and Evan’s faces the entire time.

Addicted…

To ugly running shoes.

Yeah, I am. It started a couple of years ago. I had worked a gazillion 12-hr shifts in a row. Plus, by day, I had been traipsing allover the University of Cincinnati’s campus for pre-med stuff. (PS-how in the blue hell did they design that campus to where literally everyplace you walk is uphill??? It defies the laws of reason.) The end-result of twelve days of work in a row, assigned to the ICU during the perils of flu season, plus school-schlepping all day with only brief bursts of sleep when I was absolutely about to die of exhaustion was that my poor feet were swollen and painful to even touch. I limped into a sporting goods store and told a bewildered salesman that I didn’t give two shits about the shoe’s looks or price–if it was comfortable, I would buy it. he reached somewhere up toward the heavens and procured this hideously ugly pair of running shoes. They were mesh and pleather, and the pleather was silver–not dull, matte silver, but mirror-like silver. They had big black stripes down the side of some sort of rubber and huge patches of pink gel-like shit in the inch-thick soles. The pleather trim was white–with fucking pink paisley designs. They were the ugliest shoes I have ever seen in my life. And I put them on. And I literally teared up because they felt so good on my feet. John was jabbing me in the ribs with his elbow and hissing, “Andrea, damnit, stop crying. You’re embarrassing me!” Yeah, whateves. So I told the guy to give me the other one, I was going to wear them out of the store. And I gasped when I saw the price: $190.00 with tax. For those ugly bastards. So I tried the cheaper versions of the same brand. Incidentally, the cheapies were cute, not ugly–why is that? But none of them worked. And I finally just paid the money. Best money I ever spent, I swear.

I wore the hell out of my ugly shoes. They were Asics. Very high-end running shoes. And they worked for about 8 months or so before the sheer amount of running I do at work made the insides of them die a painful death. The outsides still look like new to this day. As ugly as the day I bought them. But since then, I have devoted my time to finding the proper replacement. And no pair of Asics I have bought since has ever lived up to those ugly mofos. They all do fine for trips around the block or to the aprk. Even for long walks, runs, or hikes. But never to my hellish work environment. Never.

Until now.

I was googling “ugly running shoes” in the hope of finding them online to buy another pair. And I encountered something that made me gasp with their ugliness. Another pair of Asics. High-end. $140. And though they weren’t the same, I figured their price and brand gave me a better shot of finding something comparable. So I ordered them online. The mens and womens’ versions were both equally disturbing.

I am not kidding. Excet that the photo doesn’t do them justice: the yellow is less green or yellow and more that painfully neon color of a yellow highlighter.And the Asics stripes glow in the dark. Really. John, having not seen them until they arrived at the house, gasped in horror when he saw them for the first time. And he hates when I wear them because you cannot miss them. So people stop and comment.

Turns out there are scads of people out there who love ugly running shoes as much as I do. At work, at the grocery store, at restaurants…People love my shoes. Or are lying to me, and making a big production out of stopping my and offering unsolicited lies. Either way, it doesn’t matter. Because these shits are as comfortable as if I swathed my feet in clouds. And the mesh top is actually so airy that you can see my socks through them.

So I will never buy cute running shoes again.

And John can bite me. Because my feet don’t feel like they’re breaking anymore.

And I am a respiratory therapist.

And it is flu season.