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| I was assigned to the ER yesterday at work. About halfway through the morning, we took one of those patients that make you go "hmm." The patient was a fiftysomething from a local nursing home. He was infected with MRSA, C-Diff, and drug-resistant Pseudomonas. He had a fulminant pneumonia and was coughing thick yellow stuff out of his ET tube. Apparently, his white count had recently dropped and he was confirmed to have full-blown AIDS. So, to recap. FBA patient. In nursing home. FBA is a death sentence already; having FBA in a nursing home is an even worse one. Anyway, this particular patient had no healthcare proxy and was incapable of making his own decisions. As such, he was fully resuscitated: when his heart rate dropped into the forties we gave him atropine, when it shot up into the high 100's we shocked him, and so on. Right now he is lingering in one of our ICU beds upstairs. My question is: why? Why would we do this? This patient is going to die. Not next year, not in a few months, but in the immediate future. We all know this, and it seems to me that the compassionate thing to do would be to make him comfortable and let him slip into oblivion. But instead, we have placed him on full life support: ventilator, vasopressors, minimal sedation for his blood pressure, and so on. We are using drastic measures, and for what? It's not like we can "save his life" or anything: he is going to die. All the lines and tubes we have put into him are highways for infection, and with FBA those cures are going to kill him. It is a strange, sad world that we live in. RT 101 | |
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| The other day, I had to do a terminal wean on a patient who not half an hour earlier had been coded and extensively worked up in the emergency department at a cost of many thousands of dollars. In a tragically ironic way, the patients family had decided that they wanted everything done up until we actually did it, whereupon they suddenly changed their minds and asked us to stop doing everything that they had demanded that we do not an hour earlier. The therapist who had been caring for the patient got squeamish and made up an excuse to ask me to do the wean, which was fine. Terminal extubations are not for everyone, but I don’t usually mind doing them, and as such my squeamish comrade went to eat some lunch while I killed her patient. The nurse shooed out the dozen or so family members who were in the room, and as soon as they were out of the room I slipped the ET tube out of the patient and shut off the ventilator. The patient didn’t do much more than grimace a tiny bit when I removed the tube. I wiped her mouth off and suctioned her mouth some, then cleared away all of the tubing and accessories to keep them from the family’s mind. The nurse looked concernedly at the patient. “Is she even breathing?” Terminal weans seem to go one of two ways: either the patient dies straightaway within a few minutes, or the patient lives forever and makes us all look like a bunch of idiots. Keeping this in mind, I observed the patient for a moment and put a gloved hand on her sternum. My hand didn’t move a millimeter. “Nope.” The nurse tucked blankets around the patient as I peeled my gloves off and beat feet out of the room, dodging the family members crowding around the door and zipping away to the relative sanctuary of the breakroom, where I joined my squeamish friends in lunch. Time passed. I went out of the breakroom and went about my business. I was on a different end of the unit than Terminal Wean Lady, and so I didn’t pay her much mind until a trip to the supply room brought me past her room. I glanced in and saw a bunch of people crowded around the frail old womans body. Poor folks. They can’t bear to leave her even though she’s dead. I grabbed my supplies and went back to the office. Squeamish therapist grabbed me and asked about the dead one. “Hey, how’s my extubated lady doing?” she asked. She seemed unusually gleeful. “Dead,” I replied. No sense mincing words. “No! She’s alive! She’s doing pretty well actually.” I cocked an eyebrow. “She was dead when I left the room, anyway.” “Well, she started breathing again a few minutes after you left and she’s actually not doing that bad. Isn’t that funny!” I laughed a fake laugh with Squeamish Therapist, and then went on my way, feeling a shameful anger that my prognostication had been proven wrong–however short-term my incorrectness would prove to be. After all, all of our patients will be dead someday…we can solve a lot of problems in medicine, but times inexorable march will always win in the end. What really bothers me about this is that I just know that when I go back to that unit, the lady I terminally extubated will be reintubated and on all kinds of drips because she was looking so good after they pulled the tube out the first time! Nothing is worse for a patient and a family than having the carrot of false hope dangled before them, to be followed by the sharp blow to the head of the stick of reality. That’s life for you, I guess. (Just Keep Breathing)
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| Last night I was sitting in the blood gas lab hiding from my obnoxious co-worker, when much to my surprise there was a knock on the door. This rarely happens: other RTs will simply burst in screaming, and the nursing staff have yet to realize that this is where we go to avoid them. I opened the door and saw Nurse Lynn, who is a very small nurse. She wanted to know if I could come out on the floor and “help them with a combative patient”. Apparently the entire hospital security staff was busy with a flood of inebriated combative people in the ER, and the floor staff desperately needed some help. Because I’m a sucker, I agreed to see what I could do. ( More ) | |
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| I remember doing my student respiratory therapy work way back when I was but a wee lad. I was assigned to one of the larger hospitals in the area, which was very exciting for me since most of my contact experience to that point had been in smaller suburban hospitals. The Big Hospital had a lot to offer students: interesting cases from all over the state, brand new technology, staff people who were smart and willing to teach, and a spectacular cafeteria made every day at The Big Hospital well worth the hour-plus commute. ( Read On )More shameless self-promotion | |
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| In an effort to reach out the The Little People, the CEO of our hospital came down for a visit with the staff to discuss some of our morale problems and explain to us why all of the money for equipment and salaries had gone to the remodeling of the admin building. The visiting of the little people by the CEO is a remarkable event because in our hospital there is a caste system: the upper caste is the administration and their squads of support people, the middle caste is filled with the janitors and the people who clean up after the orgies that administration holds in their wood-paneled leather-furnished office suites, and at the bottom is the untouchable caste, those of us who deal with the actual patients. So naturally, when someone from the upper caste decides to grace us with their presence, we go like the peons that we are supposed to be. In addition to the joy of meeting upper management, we also get free donuts. Moving like an elephant among a flock of ducks, the CEO waddled and huffed and puffed his way through the many halls of Our Lady, nodding at the Little People in their colorful scrubs and acknowledging in a more meaningful sense the managerial staff and those physicians who hadn’t yet threatened to kill him. After a lengthy processional, he finally reached the conference room stuffed full of anxious people awaiting their donuts and their leader. As he entered the room to the sound of applause muffling our mumbled threats, he looked for a place to sit and set his eye on one of the aging chairs that us little people are given. With a spectacular “Ooof-dah!,” the CEO flopped down in this most ancient swivel chair. Before continuing, it is important to note that the CEO had told our managers to tell us that we didn’t have the equipment we needed because the capitol budget had been stretched to a breaking point. The previously mentioned remodeling of admin and fiduciary misconduct by the executive compensation committee had left us with little cash for needed supplies such as saline and band-aids. Among the things we had desired were new lab equipment, new beds for the patient, and new chairs for the staff that don’t threaten to damage your reproductive abilities when you sit down. Back to the meeting. Because the swivel chair was approximately 20 years old and had survived a long and abuse-filled career, and because the CEO is a tad hefty, when he sat down a number of things happened. An unsettling creaking filled the room. The CEO began to list, and with a sudden look of fear and panic he lurched forward to try and regain his balance. At that exact moment there was an enormous SNAP and the CEO tumbled backwards, ass-over-teakettle, legs in the air and he hits the ground with an enormous THUD. In between the peals of laughter in the room and the shouts of “Man overboard!” and “Beached whale!,” my favorite supervisor in the entire world smirked, looked at the CEO, and said: “Does this mean we can have the capitol budget for a new chair now?” Shameless Self Promotion | |
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| My my, it's been a long time since I have been away. Any parties curious about what I've been up to should look here: http://www.serialprocrastination.blogspot.comBecause it's where I've been updating recently. That is all for now. | |
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| All you ever wanted to know about BOOP, which may well be the best-named diagnosis ever. More RT madness may be found at the other blog. | |
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| Well, this whole internet journal thing seems to have taken an unexpected turn (see the last few entries which may technically be psychoses), but as with other recent events I think I am just going to go with it.
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So I'm down in Lowell, MA now. Last night I decided, with some help from family and friends, that it was time to flee Maine before a combination of sheer boredom, anxiety and bad weather killed me to death. So at about 1:30 this morning I hit the long road southbound and drove myself here. When I arrived, the storm was just beginning, and within an hour of my arrival here there was probably 3/4 of an inch of snow. This morning, looking out my windows and into the apartments across the way or into the liquor store parking lot, it appears that we have a fair bit of snow...the TV news talking heads tell me that we have eleven inches or so on average. Thankfully, the snow seems to be slowing, and the weatherman says that this evening the skies will clear.
Tomorrow, I need to go to Concord and then to Nashua, NH to report for duty. I'm a tad bit nervous about the whole thing but I'm sure it will all work out. Further updates will occur as events warrant. | |
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| By jove I am one tired man. I slept like crap last night, which you laready know if you read this, and today I had a busy day. Leah and I tripped out to my grandmothers house and ate lunch, following which her mother took one of the mice and we had some dinner there.
Dazed from stress pileup, insomnia, and general moving irritability, I drove home through a blinding and hypnotic snowstorm and began to hurl things into boxes more or less at random. My kitchen contains ten thousand plastic bags of dry food...more than I had ever thought I would conceivably have...and several boxes mostly full of kitchenware. I had to remove and de-install my water filter, which is more challenging than it sounds, and also packed several boxes of random crap. There's still an astonishing amount of random shit laying around the house, but it grows less by the day. At some point in there Melissa called me, which was a nice escape from the horrors of moving and packing.
I have made myself a promise: I must not accumulate this much shit ever again. In two years, if I have not used my storage stuff, I will donate it all to charity and close the unit. I like the concept of being highly portable: three to four bags is an ideal amount of stuff to bring with, that being tiny and portable.
Tomorrow: Lab in the morning for Aureus. Pick up moving van at 0900, load. Call recruiter at some point and cover all bases. Go to hospital: resign, have stuff notarized. Drive moving truck to Gorham. Unload. Drive to storage. Unload again. Return truck. Come home, re-evaluate, PANIC.
I will update more tomorrow. | |
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