For the First Time in a Long Time

I cannot believe Mother's Day has come and gone. I am that busy. But for the first time in quite a long time, I did not cry. I worked and slept and worked some more instead. And I absolutely treasure the little bead necklace Evan made for me in his first grade class. It is hanging on the rearview mirror of my car. But now I feel guilty. I was so busy that I did not stop and honor my mother's memory.

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.

Thanks, Dodge

I must had it to the people at Dodge. Yesterday, John came to pick me up and informs me that my 6 month old car's check engine light has come on. Huh? What?

So I make an appointment at our local Dodge dealer's service department. Turns out that I have a bad oxygen sensor on my car. But this was the first time I have ever had to have a new car serviced. Despite the inconvenience, it was pretty nice to hear, "I am so sorry for the inconvenience, ma'am. We will take care of it." I kind of like this whole not having to pay for repairs sort of thing.

Tales from Behind The Mist....Of Albuterol

From the "Are You Serious?!" File....

Some true stories from work this weekend.

Phone rings and it is Nurse X: "Andrea, can you come and give the patient in room XXX a breathing treatment?"

Me: "Sure. Whats going on with the patient?"

Nurse X: "I don't know. He wants a Coke. Can you just give him a treatment so he will shut up about the Coke?"


Phone rings and it is Nurse Y: "Andrea, my patient's sat is 85 on 2 liters. Can you come see him?"

Me: "Did you turn up his oxygen?"

Nurse Y: "Yep. To 5 liters." (sounding very proud of herself)

Me: "What's his sat on 5 liters?"

Nurse Y: "I don't know. I left to call you."

Me: "Well, I am in the ER with a full arrest. Go and see what his sat is, and if it still low, put him on a venturi mask at 50% and 15 liters, and I will be there as soon as I can. Do you know how to do that?"

5 minutes later the phone rings. Nurse Y again: "Andrea, I think I broke the venturi mask."

Me: "Get another one and try again. I am still bagging this patient in the ER."

2 minutes later, Nurse Y, again.: "I don't think 50% is going to fix this. We need to go up on his oxygen, not down."

A few minutes later, I head to the room. The patient's sat was 100%. His heartrate was 85. I put him back on his 2 liters and went back to the critically ill patient I left in the ER to deal with this.


Later that night, a full arrest in the ER. We are intubating the patient and I have the nurse behind me at the crash cart hand me an en-tidal CO2 detector to verify proper tube placement.

Doctor X: "That won't work on this patient."
Me: "Well it is habit, so just humor me."
After a few breaths, we get the color change that shows the tube is indeed in the lungs and not the esophagus.
Me: "See, it worked."

After the code, Doctor X comes up to me, and in a gentle voice asks me if I understood why it would not work for that patient.
Me: "Well, it did work. Plus, It is an ACLS standard that tube placement be verified with an end-tidal CO2 detector, and therefore it is the policy of this hospital that we use it after an intubation."

Doctor X: "Well ACLS is wrong. I'm going to write them about that."


Seriously, people. Seriously.

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.

Dealing with the Aftermath

While my professors were really nice about the whole wisdom teeth ordeal, I missed MIDTERM WEEK! I have so much crap to do that I have no time to even breathe. Grrrrr.

2 Less Teeth

I let them do it. I was nervous, and it was a good thing that the sedative works quickly or I would have probably chickened out on this. I looked the surgeon square in the face and asked if he was "prepared for an airway emergency". He gave the nurse the "Do you believe this one" look, to which I responded, "Hey, you know what I do for a living, right?" After that, the last thing I remember is him telling me about the patient he had to trach in the chair. Next thing I know, I am awake and giggling uncontrollably, and the wisdom teeth are gone. Apparently Versed is to blame for the giggles, though I have never seen it have that effect on any of my patients.
Everyone has told me how painful it is to have these boogers removed. I have been pretty sore and not feeling well because I have been taking a low-dose narcotic painkiller. But I have refrained from those for over 24 hours, and now I am feeling the aftermath. But to be honest, after the pain I was having before they were removed, I think this is an improvement. Plus I have the psychological benefit of knowing that I have no more wisdom teeth to cause any problems. All 4 are gone now. I just know that the plan is to work tonight, and I want nothing in my system for that. I have bought a fricken enormous bottle of ibuprofen just for work. I still cannot eat solid foods though. That's okay. The hospital cafeteria has a wealth of frozen yogurts and Jell-O, soups, puddings, etc., to choose from. I'll be a-okay.