Friday, November 14, 2008
I have finally experienced the ultimate level of tiredness. An exhaustion you can feel in your bones, your teeth, your hair.
I go to work Wednesday night. It is not the typical work night, as I usually work weekend nights, so I am already out of sorts. I do my twelve hours, not assigned to the ER, but instead to the Surgical Intensive Care unit. I have vent patients in 3 different units of the hospital and spend the night shuffling from one unit to the next, all while weaning a patient in the Post-Anesthesia Care Unit (PACU). Weaning is rather labor-intensive. As in turn down the FIO2, check a blood gas. Turn down the rate, check a blood gas. Turn down the PEEP, check a blood gas. When you get the settings so low that the vent is doing virtually nothing for the patient, you turn the vent to a mode of spontaneous ventilation and let the patient cruise for a bit. Order another blood gas. Looks good? Extubate. So I do all of this. And once 02:00 rolls around, and I am starting to hit my wall, as I do every night, I start counting down the hours until the day shift people come in and I can go home.
But then I remember. Mandatory Inservice. 6 stations of things we do in our scope of practice, but we do so rarely that it is difficult to stay fresh. This is the hospital's way of ensuring that when I have that rare patient who must go to MRI in the middle of the night, I know how to use the primitive ventilator with no metal in it. This wouldn't seem like a big deal to someone who knows nothing about mechanical ventilators. But a vent is not necessarily a vent. The big microprocessor vents are awesome. User friendly. Easy-peasy. And we are all spoiled with those. We forget the fundamentals of ventialtion. How do you dial in a rate if there is no specific way to set a rate? You want the rate to be 12. That means a breath every 5 seconds. In order to get the tidal volume you want, you had to set the flow and inspiratory time. So I-Time can't be changed or you will mess up your volume. I-Time is 0.75 seconds. So to get a total cycle time of 5 seconds, you need to set expiratory time at 4.25. Because TI+TE=TCT=5. Lovely.
But the primitive ventilator is not the only issue. How do you ventilate (safely, without barotrauma) the 1 lb. preemie? What is the best way to complete a protocol on the acute vs. the chronic illness upon admission into the hospital. There is a difference.
So the inservice is mandatory and only being offered on two days. Wednesday and Thursday morning. I intentionally skipped Wednesday's because why would I drive an hour and a half for that? So I planned to go Thursday morning when leaving from my Wednesday-night shift. Completely forgot all about that.
But wait! That isn't it! I also have to do my anual fit testing to ensure that the disposible mask I wear upon entering a TB patient's room will fit me adequately enough to keep me from bringing home the present of tuberculosis to my family and friends. Keep in mind that I failed this fit testing last time. I just do not have much of a nose, and when I would nod my head, as the tester made me, it would create this enormous air leak. Did that mean I got out of seeing TB patients??? Hells to the nah! I am a respiratory therapist! Instead, I had to wear this hood looking thingy. Ridiculous. And it had this fan that worked with it, to circulate the air, so it made this woosh-swoosh sound. I looked like the Ku-Klux-Klan Grand Wizard meets Darth Vader. I refuse to miss the chance to test again, to get the chance to just wear the disposable N-95 mask and not the crazy hood. So I am tired, but I go. And when it gets to the part of moving my head up and down, as in an exaggerated nod, I keep falling asleep with my head in the leaning-back position. Thank God the tester was the mother of one of the other RT's who works night shift. She brought me a very caffeinated a beverage as I was walking out the door. But I Passed.
So I have maneuvered all of the little inservice stations. I have completed the fit testing that is to free me from the Dork-Hood for at least the next year. Now I have to drive home. One and a half hours.
So I know tired now. The tired in your bones, your hair, you teeth. By the time I arrived in my house yesterday morning (I think it was yesterday!) I had been gone for over 20 hours. Blah.