Surviving H1N1

Where in the Hell have I been lately?

Well, Organic Chemistry is trying to kill me, I swear. And I have been working like a dog thanks to the pesky H1N1. I havemore updates later, but those will come unde separate cover...

What is it like to be a respiratory theapist in the throes of an early and horrendous flu season? "Suffocating" would be the first word I would choose. Everyone with a cough is in droplet precautions, which means I have to mask up before entering just about any room in the hospital. And we have gotten so out of hand with it! I had a vent patient who was known to have aspiration pneumonia. He had been on the vent for weeks when I went to treat him a few days ago. Imagine my surprise when I see a large "Droplet Precaution" sign on his door in the ICU. Why? Because he has pneumonia, we assume he has swine flu. Ridiculous.

Another example: I was working the ER the other night. The doctor was ordering my services for everyone. After about 5 unnecessary breathing treatments, I asked why a patient in with nausea/ vomiting with 100% clear lungs would need it. His response? Well, I think she has H1N1, so she may wheeze in the future. Again, ridiculous.

People are so panicked. Checking into the ER for sneezing, literally. Entire families checking in together. The ER's are clogged with this stuff, limiting access to care for people who need it most.

It irks me in a big way.

I know the flu sucks. I also know a new strain of anything is scary. But if you are healthy and just having manageable symptoms, there is nothing that can be done for you in the ER that cannot be done at home. So stay there. Tylenol works for fevers, Gatorade and Jell-O work for dehydration. And these are all infinitely cheaper than an ER bill.

Yesterday was the Day I Almost Died.

All I could think was, "Please, do not let me die like this." Curled in the fetal position of my bathroom floor, covered in my own vomit and feces and sweat while some faceless EMT or Paramedic, or both, worked on me. I could hear John's voice in the background, telling them to "please, just hurry. She's had these reactions before. She knows what they are."

Everything had been fine about 20 minutes ago. I had awakened from a nap after working all night. I had a sore throat that had persisited through the last half of my shift, and was still there when I woke up. I took a sample of the Avelox my family doctor had given me the day before I was hospitalized for pneumonia. A couple of minutes later,I ate a candy bar from Evan's school fundraiser. I started having this intense itching all over my back, and I made John scratch all over. Then I had these stomach cramps that were bad enough that I went and sat on the toilet. It was there that I started to feel lightheaded, felt the thickening in my throat, the tightening in my chest. I yelled for John to call 911 as I fell to the floor in front of the toilet and began to vomit. while clear drainage poured from my nose.

I got the terrifying feeling of taking a deep breath, but the air wasn't getting anywhere. In between gasps, I would shout "Please hurry!" to anyone who could hear me. John kept trying to reassure me : "Baby, I hear the sirens. They're closer." I remember telling him I was going to die.

EMS arrived, and I was assaulted with the questions I ask my patients: "Ma'am, what's your name, allergies, date of birth. What happened today, what's your health history, are you on illegal drugs?" I don't know if the words were coming out. I tried to tell him to hurry while trying to answer his questions. Did he really just ask me if was on heroin? John's response: "Dude! She's a registered respiratory therapist!" I smelledthe new plastic of the nasal cannula, asked fo the nonrebreaher instead. "My sat's okay. For my comfort," I croaked. I begged for the Epinephrine I knew was in his bag. The miracle drug that would stop me from having to have an emergency cricothyroidotomy when what little left of my airway was long gone and the only way to get air to my lungs would be through the whole they made in my neck right there on my bathroom floor. More importantly, the miracle drug that would ensure I would be alive when Evan got out of school in just a few short hours. Ahhhh, Evan. Funny how I can be in hell, knowing my life hangs on how many more seconds it takes this EMT to give me the epi when he appars to not be grasping what is going on, to focus on the sound of John's voice somewhere behind me, and through it all, only be able to see Evan's face.

I don't know where it was in the progression of things when the image of my surroundings began to fade and blur around the edges, when I collapsed the rest of the way, still begging for epi, and thinking of my mom and how I didn't want to, but it would be okay to just go ahead and die. That John and Evan would be okay, that my life insurance was adequate. And I just let go.

Then I felt a pinch in my arm. When I realized I could beathe just a tiny bit better, I realized it was epi, then the EMT said it was epi. That is when I started to vomit again, and someone thrusted my own bathroom garbage can under my face. When my bowels completely released. They were asking me to sit up, to help them help me to stand. I have no idea how I got on the stretcher. But then I heard the clacking of the wheels, saw daylight and the flashing lights in front of the house. Then I was at the hospital, and there was more epi, more Benadryl. More oxygen and questions. And IV, followed by even more Benadryl, Pepcid, steroids. The cold washcloth as the nurses cleaned me up. I begged hem to close the curtain. "I work with these people", I wailed. And sleep. A sleep deeper than I have ever known. And you wake up and it is all over. "Mrs. F, we are going to send you home on a medrol dose pack and I want you to take Benadryl every 4 hours for tonight. And you must get an Epi-Pen. You need to have one with you at all times, do you understand?"

Once home, more sleep. But this time, I would wake to John and Evan's faces. Feel my son kiss me on the cheek, and hear John tell him that Mommy had been sick while he was at school.

And I thought to myself that, though the hours/ days/ weeks/ months/ years of my life have been or will be consumed by images of scrubs and stethoscopes, textbooks and classes, hopes and goals and ambition, isn't it funny that when the edges started to fade, it wasn't any of that that floated with me just beneath the surface as I resigned to my death. It was John's voice and Evan's face.

I have had anaphylactic reactions before. Only none of them were so memorable. I woke up intubated after one of these episodes, but my only memory of that was feeling nauseous and waking up fighting against the tube. Other times, I sought help before it got to that point. I never felt myself slipping away like I did this past week. A later recounting of the experience to my doctor confirmed that I was dying that day, that I was almost gone. Now there are just a few reminders of it left: bad memories, a bruise on my arm from the EMT's rough injection technique, and fear. Fear that my body can react so violently to something to which I have been exposed my whole life without incident.

Now, because I feel like I need to, here are some links for more info:

The Food Allergy and Anaphylaxis Network

MayoClinic.com-Anaphylaxis

Medline Plus

A Lot To Say and Don't Know Where To Start

This has been the week I almost became my mother.

I remember the faint burning in my chest to tell me that I was coming down with something. I remember the taste of illness in my mouth when I would cough. I don't remember how I got from the onset of a mild chest cold to the panting, dysneic existence I knew the night John rushed me to the emergency room. I just knew I couldn't breathe. I felt like I was dying. And the life of my mother flashed before my eyes, like her choices were manifesting themselves into what was to become of me. Alpha-1 Antitrypsin deficiency. That was all I could think. Genetic emphysema aggravated by several years of just plain ol' self-neglect in the form of Marlboro Lights. The last time I mentioned te disorder to a doctor, I was asked if I wanted to know how I would die. I said no. When death is the culmination of drowning in your own fluids, who wants to know of its appraoch? Certainly not me, so I declined the test. But this time, when I mentioned it to the pulmonologist, he didn't give me a choice. He just nodded and scribbled somethng down in my chart. An hour after he left, a lab tech showed up in my room to draw some blood. No questions asked. No chance to chicken out.

I will not die her death any more than I will live her life. The test was negatve. I have the time and the chance to make the choices necessary to ensure that I will not have the same demise. Those goals I have set for myself? They are still attainable. As I lay in that hospital bed this week, I told myself that, should the test be positive, I would abandon the whole doctor thing. I would instead focus on my son and my husband and live my life leaving well-enough alone.

Instead, I didn't have to make the choice. Instead, I was branded with bilateral pneumonia with secondary areas of atelectasis. In layman's terms? I had pneumonia in both lungs that was bad enough to require a week-long hospitalization, and was horrifying enough to cause some collapse of several lobes of my lungs. In other words yet? I became my patient. And for the first time in my life, I did not want a cigarette. I was scared. I was confronted with my own mortality. So now, here I am making soe major adjustments to my life.


Incidentally, this is what happens to an arm after 15 gazillion needle sticks and IV attempts.

Frailty of Life

So....I really want to blog about the experience I had this morning in a code. An experience so bad that it left me questioning if I want to stay in this world I have lived in for several years: The World of Medicine. A 36-year-old female with breast cancer suffering from complications from a lymphectomy. There were those of us on the ICU team that had been working on her for hours before one of us hit the blue button that would signal the hospital switchboard operator to make the overhead call of "Code Blue", then there was the general crowd that shows up when the code is called. Those of us that knew the story tried to resuscitate the young woman with faces that were streaked with tears. One of my colleagues came to check and see if I needed any help, and saw that I was crying, so he offered to relieve me. Her mother was already there, but we kept her alive until the "rest of her family" got there. When we realized our efforts were futile, the Nursing Supervisor went to get her family. Allowing the family at a resuscitation attempt is kind of controversial. Is it cruel? But studies have shown that families deal better when they see the effort we are putting in to save their loved one. So while I hate it because it does not always allow me the mental distance from the situation, if it helps them, so be it. But nothing prepared me for this. Her weeping husband. And her nine-year-old daughter who was wailing in pain and anguish. I tried to count the number of ceiling tiles in the room. I inspected my shoes. I didn't have to look. By now, my hands hold within them the rhythym of breathing and I can deliver breaths at a steady pulse while intentionally not looking. But this time that didn't stop the tears. This time it was my family I was seeing, no matter where my eyes tried to focus.

I could not get John's face out of my head. Or Evan's voice. My reasons for living. And undoubtably, the husband and daughter were hers. They were robbed by the intricacies and the mysteries of the human body. And like us, I am sure they had plans for their future. The husband had been out of town, and didn't know that he would never see his wife again. I still cannot get the image of his pained, tear-streaked face pressed to her cold, pale, lifeless one. The picture serving as a study in the contrast between death and life. And her death proved something to us all. She was in the MICU, the unit of the hospital to which I have been assigned for going on the past 2 months now. Our MICU is new. State-of-the-art facility and equipment. Staffed with the A-team of the medical world. Even we therapists are a select few. We are all oriented to the unit, but non-hackers weed themselves out. But this morning, nothing we had to offer could have been enough for her. Which is scarier than you could imagine, because it humbles all of us. It shows us that we cannot fix everything with almost unnecessary cruelty. And while we are all there, working our demanding schedules to pay for kids' tuitions or the new family minivan or the plasma tv that society tells us we need, we are forced to face the idea that we are away from the very ones we are doing it all for. That life is frail, and would it be better to be at home, snuggled in bed with our spouses or waking in the morning to sloppy kisses from our young children. Because as we were witnessing at that very moment, life could have other plans for us.

Guilt and Sadness

Before I know it, Summer will be gone. Evan will be back in school. And starting tomorrow night, I am back to the grind. By the time I get off of work on Monday, it ill be time to head to another quarter of classes. And at the end of the Summer, this baby of mine will be 8 years old. I know I will not be getting a break until we are both off for Christmas.

I look at those brown eyes and I miss it all: the sloppy kisses and macaroni and cheese faces after dinner. The cuddling and giggling. Getting his bubble bath ready at night. Making sure he learns math. And I look at the stretch of time ahead of us and I realize that by the time I finish medical school, this little boy will be 13 years old. Is it worth it?

I had a talk with Evan just now, asking him if he wanted Mommy to go to school to be a doctor, even though it is going to take a long time. He looked at me with those big brown eyes and said yes, very emphatically. When I asked him if he would still think I was a good Mommy if I continued to be away, he said yes again. I asked him why he wanted Mommy to be a doctor, and he told me that he has the smartest mommy in the world, and he knows I can do it. So now I am sitting here at my desk typing this, amidst the crepe paper flowers and finger-painted rainbows he has given me from art class in school, and I have found out the truth.

I am so very blessed. For some reason, whatever higher power is out there has decided that I am deserving of this amazing little person in my life. How lucky could I be?

Failure

Sometimes I have the autonomy to override a doctor's orders. Sometimes I do not. This weekend was an example of a time when I did not. It was also an example of the concept that just because we can do something to prolong a life doesn't always translate to we should. A lesson in medical futility and ethics. I have been assigned to the MICU for the past 6 days. The sickest patients in the hospital were once again in my care, as is happening even more frequently now.

A patient was admitted on Wednesday night, and by Thursday, it was well-known that there was nothing we could do for him. The name was familiar to all of us, but none of us could place his face. Disease had ravaged his body until there was little with which to work. I am not going into detail about the disease process or any other fact that can be used to identify this patient because I want to protect him as I am legally obligated to. But he was very, very ill. I watched as a parade of specialists for just about every body system in a human organism came and went from his room, speaking with his family.

I'm sorry. There is nothing more we can do.

We will provide him with comfort while he makes this final journey.

We will allow him to die with dignity.

I made sure he had enough oxygen, then went on to other patients of mine. Patients who were not breathing on their own, hooked to my ventilators. Not much time passed before another specialist came to see the patient. The patient, on top of everything else, had a raging infection. Sepsis. He wanted me to suction the patient, something we don't usually do for the dying patient because it is so uncomfortable for them. I asked him to explain why. His follow-up was that we were going to suction him, and then intubate. Within 15 minutes, the family wants to do everything. Put him through the medical gauntlet. The doctor seeing the patient for his infection bypassed the cardiologists, nephrologist, pulmonologists, neurologist, and oncologist. Told the family we could fix him.

My experiences with family members facing the loss of a loved one have taught me something. You must be very careful when you walk into the room of a dying patient. Because any tiny word you utter can be misconstrued as hope. Hope where there is none. And they grab onto to that like a life preserver, and hang on to it. To the layperson, this would seem like a gift to them. Instead it makes it worse. The patient passes away anyhow, after they have thought it was not going to happen. From the minute we know that death is looming, our care shifts from the patient to the ones left to live. Every action becomes about them. Making it easier for them. Never more difficult. The have enough difficulty to face.

We failed that family. We didn't do what we should have done for the patient.

We intubated. I hooked him up to the machine that would breathe for him. I stood at the bedside and cleared mucus from his chin and smoothed down his hair while the ventilator hissed and puffed behind me. In that instant, I realized who he was. One of our regulars, I would always save his breathing treatment for last because we would always end up talking about his military service and kids. Through all of his admissions, he never forgot that my son's name is Evan. He would always light up and ask me if my Evan was still driving me crazy. He always called me his "Breathing Angel" because he said I always seemed to show up in the same instant he was thinking about calling for a PRN treatment. I tried on several occasions to explain to him that it was probably due to the fact that he was due for his medication and less about me. "In fact," I would tell him, "I'm actually really mean in real life." He would always giggle and shake his head, telling me he couldn't believe it.

I almost didn't recognize him through all of the tubes and lines.

Within 5 minutes of intubating him, he tried to go into cardiac arrest. We brought him back. I heard his ribs crack during CPR.

By the time I had reported for the next day, he was on continuous dialysis. We had given him the maximum amout of medication allowed to maintain his blood pressure. Dopamine. Levophed. Vasopressin. I was no longer able to maintain any sort of oxygen saturation on him. We had to insert an arterial line in his femoral artery, in his groin. His body temperatre was 88 degrees. We had him wrapped in heated blankets and a warming system so that only his face was visible. He had a rectal tube inserted that was draining blood. 10 IV pumps going. About the only drug category we didn't have covered was sedation. Through all of it, he didn't need any.

The family still was clinging to the hope that we could fix him. Despite the fact that we told them repeatedly that it was gettting worse. They held fast to that life preserver. I left my shift praying for his death.

By the time I reported for my shift the next day, he had died on his own. It took 6 nurses and me to remove all of the lines and tubes. His body released every fluid in it. There was a piece of tissue that I assumed to be a part of his trachea that came out when I removed the endotracheal tube.

I didn't cry. Instead I hated my job. I was upset that I didn't put my foot down for him and advocate for him. I realize that even if I had, and refused to participate, they would have just called another of the therapists. This was one of those that I could not override.

I still feel like I failed my patient. I wasn't his Breathing Angel anymore.

Swine Flu B.S.

(* I found this pic on the internet. LOL)

I have had the sniffles and a sore throat for the past couple of days. I am obviously not feeling well, and as I cruise the halls of the the hospital while working, and encounter other healthcare professionals, I have heard nothing but the following: "You don't have the pig flu, do you?"

No. I do not have swine flu. Stop asking me. But I do have a patient whom we suspect does, and I will go no further than that. But let's talk about the pig flu, shall we? It has, thus far, caused no abnormal symptoms, save for the standard flu symptoms. And while the global death rate for influenza of which we are accustomed climbs into the thousands and thousands, at last check, swine flu has only caused a couple of hundred deaths worldwide. So why are we freaking out?

Well, this marks one of the first instances where we can catch an illness that has morphed from animals. (Not the first. Remember avian flu???) But everyone is in a dither about this. Everywhere I go on campus, there are signs posted on doors, windows, walls, about prevention of the swine flu. Seriously. Even my husband is not exempt. I mentioned that we had a suspected case, and he practically wanted to red-bag my clothes and burn them when I got home. I wanted them off as soon as possible just because I was dealing with influenza, and I have a child and husband at home who have not had the wealth of vaccines I have had due to my position in healthcare.

Maybe it is just me. I don't get worked up about MRSA or TB or influenza. I use precautions when dealing with these patients because I want to protect my other patients and my family by not becoming a vessel of illness. But most of this stuff is just common sense. Wash your hands, especially after touching something that a gazillion others touch, like door knobs, light switches...Make your loved ones and friends throw away their dirty tissues instead of laying them around. Sneeze or cough into a sleeve of tissue, then wash your hands anyway. Stay away from hospitals if you can. We try really hard, but hospitals are full of sick people. Those of us in their employ have someone in infection control to ensure we are protected. We try to protect visitors and patients too, but some people just do not listen. (Case in point: the suspected TB patient who SNUCK out of her room for a smoke!) Do not, by any means, be the idiot who has your 2 year old cruising the halls barefooted. No doubt, they are treading on c. diff and MRSA and VRSA and streptococci and anything else you can think of that settles to the floor of a busy ER.

So why am I not scared, other than reasons I just mentioned? There is not one single part of me that does not believe that I do not have MRSA all over me. If I were to get sick enough that they were to test me, I am sure I am completely colonized with it. I have had my flu vaccine, and I wash my hands before entering a room and before leaving. (That's a lot, for those of you who do not realize what it is that I do.) And in between those frequent washes, I sanitize. When someone is going to be coughing in my face, which is pretty much all of the time, I wear a mask. If I am going to get something on me, I wear a gown. When I get something on me when it was not anticipated, I bag my laundry, and either turn it in to the disinfecting gurus at the hospital or I wash it seperately with peroxide, then wash it again, by itself. And I wear gloves pretty much all of the time. My son and husband do not come to visit me at work. Common Sense, really. All of it.

Quit freaking out over swine flu. Because each year, as we get vaccines for new stuff, there will be other new stuff to emerge from which we are not protected. Viruses and bacteria are a clever sort. The morph and evolve too. Are we going to panic about every single one of them? Really? Calm down, says the Respiratory Therapist soon to have a degree in Molecular Biology. It'll really be okay.

Being Seen

I have had the most interesting weekend at work.

For the first two shifts of the weekend I had the ER, along with some general med-surg floors. I had to confront death head-on for a couple of patients. I lost one battle and am still in the process of losing another.

A 75-year-old man comes in as a full cardiopulmonary arrest. We are doing CPR, and they let the family back. I hate that. Hate it. I have to remain detached and professional to do my job effectively. But this little old lady comes limping back with her family, as we are doing CPR on her husband of over 50 years. They have had this life together, and I feel like we are taking that away from her when there is nothing we can do to save the man. As I watch her cry, I am finding it hard not to cry. The doctor calls time of death and I help her limp to the bedside, where she gives him a kiss on the cheek and crumbles with grief.

The next night, another full arrest comes in. That is what these patient's are to us. The full arrest in bed 18 or 8 or wherever they land. Not a name. She comes in already intubated, so the task of ventilating her falls to me. I am tweaking the vent to find a way to ventilate her that works best with her natural patterns of ventilation. I have my back turned to the door, turning knobs on the vent. I turn around for some unknown reason and see this sweet guy from housekeeping there behind me. In that instant I assume he is at work until my eyes take in his street clothes. He looks at me with these wide eyes, and I just know. I ask him if it is his mom, and he just nods. He stays in the room while we do all sorts of medical procedures to the woman. She is nude from the waist up for an EKG, and all I could think of was my relationship with my son, so I reach over and cover her breasts with a sheet. Later I go down to the smoking area for a much needed break for coffee and a Marlboro Light. He is down there smoking too. Before this, he and I would joke about college football. He would tease me about my hatred of Florida. He was always quick to offer a smile. Before that, I don't think either of us were very aware of what the other does in the hospital, other than these huge badges that go along with our picture badge that is designed to quickly reveal to patients just who we are. Mine says "Respiratory Therapist" in bright green. His says "housekeeping" in pale blue. But that night, in his grief, he saw firsthand what it is that I do. Never again in his eyes will I be the joking girl who loves Buckeye football.
We are sitting there talking. Once again, we are just two people down in the smoking area. There is no whoosh of a ventilator in the background or a beep of a monitor. He looks at me and gulps down tears as he thanks me for all of the hard work I do, not only for his mom, but for all of the other patients I see on a nightly basis. I get choked up by that. Because every night, I whisk in the room in response to a call that someone somewhere in the hospital has stopped breathing. I do my job and slip quietly away unnoticed by the patients' loved ones. I stay under the radar. They will never remember my name like they will the nurse who takes care of their loved ones. Or the doctor charged with their care. They don't know that I am the girl who stands over their family member, with my back breaking and the hot exam lights forming beads of sweat on my brow, breathing for them when they cannot. I am fine with that. I know what I do, and somewhere inside of me, despite self-criticism, I know I am good at my job. That has always been enough for me. It is okay to be the unseen. But that night, I was seen. And the reality of what it is that I do for a living settled with a big thunk somewhere inside of my soul. I see hundreds of patients nightly. I never remember names-- only faces. In that instant, a myriad of faces come back to me. I worry myself daily if I have been a success at the tasks I have undertaken. Did I do well on Exam X at school? Will I get into medical school? Does my time away from home to pursue these goals I have set for myself do harm to my husband and son? Am I truly making a contribution to this world in which we live? In that instant, the housekeeper from the hospital gave me my self-worth on a silver platter, showing me that this is who I am. That I have touched lives, even when I didn't realize I was doing anything more than earning money to support my family. And for some reason, at that point in time, my thoughts went to my mother. Is she watching me now? Does she see the hard work I do? Is she proud? What is this work I do really about? My confrontation with the housekeeper had such an impact on me. I am still the nineteen year old girl who lost her mom too soon to lung disease. And I have been battling lung disease ever since. It will not win. I am too tough to allow that to happen. It is like the housekeeper took a large mirror and held it to my face for me to see, saying "Here. Look at her. This woman, who works hard to fight for the lives of others. This woman who is capable and tough and smart, who can do whatever she deems fit in life, who will reach the dream she has set for herself, who is Pauline's daughter and John's wife and Evan's mom. She is you." I need to be thanking him.

2011

After a long overdue meeting with my advisor, it appears that this will be the year that I enter medical school, if all goes as planned. I am a little bummed that it is not going to be 2010. I have to keep reminding myself that, while I am a senior, I have only been in college for 2 years, then transferred. I am actually right on track with the pre-med issue. It is just that I completed a senior-level's worth of courses in two years. And (phew!) I can postpone my MCAT until next spring.
Next fall is going to be brutal. I start my Biochemistry sequence ( 1, 2, 3), my Organic Chemistry series (1, 2, 3), and my final math for all time, Calculus series ( Calc 1, 2, and 3). Somewhere along the way, I need another lit course, and another phiolsophy course (planning for "Ethics and Medicine", even though I have had a Bioethics course). In spring of 2010, it is all about my MCAT and applying to med schools. Somewhere in this journey, I need to move across the river so I am more likely to get an in-state seat at UC COM. (And a $60K discount on medical school.)

Everything I have planned, worked for, dreamed of is laid out right before my eyes. For the first time, I am starting to believe I am really going to do this. My dream is coming true.

On a separate note, Evan is dying to see the new Hannah Montana movie. He's got the soundtrack, and forces us to listen to it in the car. Instead of being irritated, I heard this song and cried.

Miley Cyrus - The Climb (Rockamerica) @ Yahoo! Video

On Land and On Sea

Seriously? Not the ER?

I knew it. Just knew it. I am at work the other night, working with S (name withheld to protect the innocent), and he laughs and tells me that every night he is working, I am The ER Therapist. Fine by me. I really do, though I gripe about it, love the ER. That is the only place in the hospital where I actually get to see my patients, use my full assessment skills (yes, I have those), and actually, at some point, come across everything within my scope of practice. The part I do not like about being assigned to the ER for a shift comes in the middle of the night. From 2100-2300, you have just the ER. But at 2300, all of the 1100-2300 people leave and the hospital's arsenal of RT's whittles down from 7 or 8 to about 4. Your assignment changes and you usually, on average, have about 4 other units of the hospital along with the ER. This can be okay, on nights that are not so busy. But during Respiratory Season (Haha! November through March when flu/ RSV hits!) this is not the case. You could be clear across the hospital and be paged to the ER to meet a full arrest. You have to break out in a run to get there in time. ER patients always come first. This may be to the dismay of a nurse on a med-surg floor who thinks her patient is your only patient, but is still the case nonetheless. I am always the ER therapist. It's fine. They know me down there, and I like to think that they like me.

I was very shocked this past week. I worked 6 12's in a row, only to find that I was not assigned to the ER for a single one of them. For the past 3 work nights, I had the SICU and Cardiac Surgery Recovery (CSR) Unit. I would run into people from the ER as I made my way around the building, and they actually had thought I had taken a vacation because they had not seen my face around. Ha! No asthmatic kids. No croup or RSV. My patients were intubated and silent, other than the occasional vent alarm or monitor beep. It was actually kind of nice.

Baby Steps Toward My Dream

I started the process today. I completed my online application to the University of Cincinnati, arranged for my official transcripts to be sent for my transfer, and am working on the financial documents as we speak.

I am petrified. It seemed almost surreal as my mouse pointer hovered over the blank space on the application for admission where I was to indicate my career objective. P-H-Y-S-I-C-I-A-N. As I typed out the letters associated with my lifelong dream, a montage played through my head. Mom telling me all those years ago that "Medical school is for the rich, Andi". The choice I made an age ago to major in music instead of Biology, based on my love for music. Years and years of wondering if I was wasting my life and my abilities. The day I surrendered my higher education when my mother died. Going back to school after all of those years away,only to complete my respiratory education with such ease that I knew, just knew, that I could be doing more. Tearing up after a conversation with the Dean of Admissions for UC's College of Medicine, when he told me I was the perfect candidate for med school. And the struggles...all of the strugglees John and I have faced together. This is my dream, not only for my career, but it is also my way away from all of it.

It all seems so scary to me right now. When I had to select my major, I sat there staring at the "Molecular Biology" link. It seemed to taunt me, as if to say "You think you can??? I dare you to try."

Before you think I have crossed that line, that I am going insane, let me say that I know the link was saying nothing more than "Molecular Biology". But clicking on it, adding it to my application, and then finalizing the app was the scary part. The little ominous window popped up to let me know that that was the point of no return.

I want this more than anything. Every fiber of my personality screams "Medicine". If I could not go to medical school, I do not know what I would do. I cannot see myself doing anything else. I can't even see doing what I currently do for the rest of my life.

So here we go.

Huh?

So I had the ER again last night. Busy, busy, busy. There are significantly fewer therapists at night than during any other time period throughout the day, and last night we were ever shorter staffed. Lovely. Crazy-busy. And I am running all over the hospital, and one of the seasoned nurses asks me if they were to create a full-time ER RT position, where I would exlusively work nothing but the emergency department on the weekends, would I consider accepting. I said I would. Actually, my exact response was "Sure!". But as the clock was approaching go-home time and we were intubating yet another end-stage COPD patient, I was left wondering wtf I was thinking. My status as an adrenaline junkie and my gluttony for punishment momentarily overcame my rationale. And I think I was just basking in the compliment. I mean, when I started there, I was told the ER RNs would run me over until they were convinced that I knew my stuff. Now their faces light with smiles when, at the beginning of my shift, I walk through those ER doors. I guess I have proved my worth.

Allowing a Connection

"I'm dying.", he said. " And I don't want to."

I had to stop. I couldn't not stop. I could hear the tears in his voice.

Here's the thing: I try not to feel while I am at work. I know to the average layperson, this will seem terrible. Because I wear the badge of "healthcare professional", I am supposed to be this all-feeling, caring, compassionate individual. To a degree, I am. But I am also human. On a daily basis, actually multiple times per day, I see patients as they face death. I cannot allow myself to feel. If I did, it would be my downfall. So when I am at work, it is all science. In other words, let me help you physically overcome your disease. If the disease is going to win, I will at least go down swinging for you. I win the fight many, many times. But I lose, also. And then I have to go home to my family, intact, and play the role of Mommy.

There are some situations where I cannot turn it off. Well, I can almost always turn it off. It is just that sometimes, after I have turned myself off to what is happening, the emotions of it all catch up with me later on, when all is calm. The first time I had to resuscitate a baby, John knew immediately that something profound had happened to me at work. I walked in the front door, enveloped Evan in my arms, and automatically started to cry. But while I am at work, I cannot allow myself to shut down. I am a professional.

So here I am with my patient. And he is dying. I have just finished giving his bronchodilator treatment. I've replaced his oxygen cannula, and have turned to leave his room in the intensive care unit when I hear those tears in his voice. He has end-stage COPD. Not only does he have to face the fact that he is dying, but he is doing so with the full realization that his actions caused the condition. He is ashamed. He is sad. He is guilty. But mostly, I hear fear: fear for himself, fear for the loved ones he will leave behind. And in his voice, I also hear my mother. You see, we never truly get over the loss of a mother. Never. Enough time has passed for me since my mother's passing that I can carry on with my life without you ever knowing that she died. But she died of COPD. And I became a respiratory therapist. My ability to disconnect keeps me safe from ripping open the wounds.

For the first time since I was a child, losing her mother, I am powerless with this patient. I cannot stop what is happening to him. I can intubate and place him on machines that will keep him alive, but I cannot grant him the ability to truly live. I've seen the chest films. I've looked through his chart. And I know that nothing I can do will help him. So as his wife sleeps peacefully in the corner of the room, I sit with him. I hold his hand, and we cry together as I tell him about my mother and he tells me about his wife. To him, I am the other side. I am the one left to live, and he is the one afraid to leave. I tell him the truth. I miss her every day, but the degree to which I do became less and less debilitating each day. I explain how I reached the point where I can see the influence she has had on my life, shaping me into the person I am. How I can see her in my son's smile, even though the two of them never met. I tell him how she lives on inside of me.

My day finishes. I am no longer on hospital time, but rather my own. I hold his hand as he drifts off to sleep. He seems more at peace, somehow less afraid. But later on, in my home, as I close my eyes to try to sleep off the night I had, all I can see is my mother's face. Swimming in my tears I never shed.

Warning: Rant!

I do not like this man. I cannot put my finger on it, and in our day of prejudices and stereotypes, I have been very careful to make sure it is not for an impure reason. I am all for a minority to be in the White House. I think our country may need it. We have to move forward and grow, and the next step is someone other than a white male moving into the White House. Yay for progress and diversity!

But this man? He is too slick, too polished. He gives rousing and heartfelt speeches and has the ability to say all of the things the American people are wanting to hear. But where is the evidence backing of all of these la-ti-da plans for change? Who is going to pay for all of the programs he is wanting to institute? Middle class people. Me! I am going to pay for it.

Well here is what I have to say about it: People, if you cannot get health insurance, go out and find a job that provides it to you. If your skiils/ education level do not allow this, then change them. It sucks out there, and I had to do what my family needed me to do. We were poor. We had no way to move up. I sucked it up and took 24 credit hours per semester while helping my husband through school, raising a kid and running a household in order to get a job and credentials that would ensure my ability to have the things I need, and to provide my son and husband with the things they need.

We live in the United States. There are so many programs and resources to pay for vocational training or higher education that you can literally get paid to go to school. So suck it up and do it. If for some reason, you are disabled and cannot work or obtain the education to better yourself, than taxpayers like me will be glad to continue to foot the bill for your medical needs to be met. We have been for years. If for some reason you lost your job, as I did recently, we will continue to provide you with federal programs to get food. But to completely reform the government to provide handouts is unnecessary. I say give people a hand up and the tools they need to provide for themselves down the road. We do not need to create more sponges.

And medicine? Yep, we medical people are sheer evil. We want nothing more than to take your money. We will let you die if you don't have the coverage. No, WRONG! I am on the code team at work. I make decisions in the blink of an eye how I am going to help a patient in crisis. The patient is not wearing a gown with "Uninsured" stenciled across the chest. And honestly the only time I have ever looked at a patient's insurance information is to provide them with the best care. For example, the patient has insurance x and needs a test, and insurance x requires a specific diagnosis or criteria to pay for the test, and the patient does not meet the requirements...the test is thousands of dollars. What would you do? Well patients have the right to refuse or accept any procedure. So you let the patient know "Hey, you need this test for x reason, but your insurance will not cover it. Do you still want the test?" It is a courtesy, not a refusal to treat. Other than that, I do not give two shits about my patient's insurance information.

So are we now gonna talk about the costs of healthcare? Pharmaceuticals take a fortune to develop. So, yes, they are expensive. Healthcare professionals themselves are expensive. Look at me, for example. I had to attend college, to the tune of thousands of dollars. I had to take credentialing exams to the tune of thousands of dollars. I have to obtain licensure in every state in which I touch a patient. That is expensive. I have to attend classes and maintain competencies in my field each year. That is not only expensive, but time consuming. So while I would love to do my job for free, I have a family to support, and it takes time and effort to maintain my legal ability to do my job. So I do not come at minimum wage. They have to pay me to compensate for that. Now consider that my hospital employs over 50,000 people, most of which have some sort of credential associated with their name. Do that math. Then consider the equipment they need to allow us to do our jobs. The stethoscope I use to listen to your breath sounds was $300. The ventilator I run costs more than most houses. And we run several of them at a time, so do that math. Then think of all of the little things we use, and all of the disposable equipment we have to use in the name of sanitation. And the upkeep on the high ticket items. And this is just my department of the hospital. So I guess my point is that healthcare is expensive. There is no way to avoid that. We cannot just go revamping the healthcare system in an effort to change that. It will not work unless we all want to live in poverty to absorb the cost of a publicly-run healthcare system. Because someone is going to have to pay for it. And besides, do you really want a disgruntled governement employee to determine if your child gets the surgery he or she needs? I don't.