Commonly heard phrases at 0300...

So, I realized that we say some of the funniest, dumbest, and honest things during the wee hours of the morning. I thought I would start a list. I will put down the ones I know right now, and add them as I come accross them.

1. "Not it" (when the pager goes off in the room and its not yours)
2. "Tight as a tick" (the lungs you dirty people)
3. "Mama/Sir, did you have any alcohol tonight?" (response) "No!" (+alch in blood)
4. "Why were you smoking with your oxygen on?"
5. "This will only hurt real quick"
6. "No, I'm not 17 and taking care of you, I promise I'm old enough"
7. RN: "the patient is brain dead" Student: "when are they going to wake up?"
8. "Can you check that patients stats?" Me: "well, do you want age? height? weight?" person: "no, their stats!" Me: "you want me to check their sats?" Person: "yes!!!" *SIGH*
9. MD: "Oh! So, you want some sexy vent settings?" (coming from the MD it came from, I grinned ear to ear)

When do you stop searching?

So, I'm 28 (soon to be 29 years old). I've worked the past 8 years as an RT. I have my B.S., hold 4 state licenses, RRT, I taught college for a year, and have worked at a few of the best hospitals on the East coast. You would think...that would be enough. You are sorely mistaken.

Friday, I interviewed at the #1 hospital in the U.S. As you remember from older posts, U.S News does there poll every year, and this makes them #1 for the 20th year in a row. I am speaking of none other than Johns Hopkins. The two days prior to the interview, I was so nervous my stomach wouldn't settle down. It's just like any other interview right? NO, its HOPKINS! hello!? People come from around the world to go here. So with a little self reminding, "you are qualified for this job...right?" "shut up, you are qualified for this job" I dove in.

I spent 4.5 hours between HR and the Respiratory department, (without a tour people). Once there, the Director decided I was going to in fact interview for two positions and not just one. Crap. As I'm sitting with the Director speaking with him, he said something that threw me off alittle. Why? Because it's something that's only ever been in my head. I've never said it out loud, or expressed it to anyone that mattered...but here he is calling me out after 15 mins of meeting me. He said, "You are looking for the up and coming, the bigger and better, the new and exciting, something more challenging" I smiled. He said, "I was you about 16 years ago, and if I didn't find that bigger better, I was going to get out."

I always knew from the start I would need "new and exciting." I am someone who needs to be challenged. Once I've sucked a place dry of everything it has to offer, I look. So, it begs the question, will there ever be somewhere that can constantly give me what I'm looking for? A never ending stream of better, exciting, challenging things to keep me busy? If not, what's my option, settle...or get the hell out?

I hit the ground running out of school. I wanted my resume to look a certain way, and it does. Along with that comes all my clinical and practical experience. I am what they call, "the ideal hire."

Maybe this time, I could stay put? Try and keep my interest peaked and enjoy what the new experience has to offer. Maybe I will bolt after 2 years, claiming, "it just wasn't enough." Who knows, either way, it makes things more interesting.

I am the Trauma Queen

For any of you that ever thought they were a "black cloud" aka shit magnet...I am your match. From the first time I ever laid my hands on a trauma pager, it was done. The ER would be peaceful and calm, and then I would grab my stuff and let the trouble commence.

I used to try and not touch the pager for as long as possible. I would let it lay on the table in front of me, until I HAD to get up and go see a patient. It was like a challenge! "will it wait till I touch it today?" and sadly, most days, it did.

So I started honing my "gut" into how my night was going to go. Yes, I know what you are thinking, trauma is unpredictable, but, there were a few patterns that I just couldn't ignore. Mondays are always the worst, maybe its a East coast thing? My worst nights in the bay, have been on Monday nights. Next, is there a sporting event near by? Cause when I lived in NC near the speedway, do you know how many drunk people fall of their campers? Alot. How is the weather outside? If it just snowed, and the fools around me aren't used to it, should I call out sick? How about the full moon? Do you know that a few MD's actually did a study that showed hospital activity doesn't increase or change around a full moon...I say, go back to your cubicle!!

So, I use all these things to get a gauge on the evening. I also use trauma juju. Laugh if you may. I generally will not let anyone wish me a "good night at work" before a night at work. If they do, I'm guaranteed a night from hell. Don't say "quite" EVER when at work. If it's quite, you be quite too. When someone says, "oh, this is going to be an easy night" I cringe, and promptly remind them they are my trauma backup. I don't ever sit on the trauma stretcher anymore waiting for the pt to arrive. I try and head off anything that could cause the night to go downhill.

That being said, does it always work? No, but for the most part I feel better about going in to it most days. When I was in NC, I had an incident where I had 26 intubated traumas in one night. They were all separate issues (except for the last 3, they were the same car). This was not 26 from a mass casualty or anything like that. This was 26 people of my black cloud hell. It came out to be roughly 2.1 intubations an hour.

My current hospital gets a small taste of this everyday. I can literally, take the ER calm as a clam and make it ground zero. I walked in to the hospital a few months ago and said to the night supervisor, "I have a bad feeling about tonight" He was like, "why would you say that?!" and I said, "my gut is never wrong" Sure enough, I hit the ground running 10 mins later and didn't look back until 0700.

Some nights are better than others, but I love what I do. I am the trauma Queen, and until someone can beat my 26 single injury intubated traumas, I will keep my crown. My gut never lies, too bad they didn't teach me that in Respiratory school.

The Best of the Best...

Every year U.S. News gets down and dirty with the hospital systems of this country. The new numbers are out for 2010-2011. I actually had a good laugh when I saw the rankings this year. In years past, I've seen a few of the hospitals that I've worked at among the top 10 or 20 in the ranks. This year, not even the one I currently work for made top 10 in any category. They push us to be the best, to give the best care, to exceed what's expected....and yet, here we sit.

I'm going to show you a few of the breakdowns from this season:

Pulmonology: 1. National Jewish Health (Denver), 2. Mayo Clinic (MN), 3. Cleveland Clinic (Ohio)
**Being the RT that I am, this was the first breakdown I looked at. Now, I'm going to add a little to this and tell you that, John Hopkins came in at #4, Mass Gen in Boston #5, Duke in NC #6, and at #7 UPMC- Univ of Pitt Medical Center in Pittsburgh, PA. Are they all great hospitals? Yes. Factoid of the night: UPMC has the highest success rate of lung transplant on the east coast at the moment. Above Hopkins, Mass Gen, and Duke...yet it sits at #7 for Pulmonology.

Cardiovascular: 1. Cleveland Clinic 2. Mayo 3. John Hopkins

Neurology and Neurosurgery: 1. John Hopkins 2. Mayo

Kidney Disorders: 1. Mayo 2. John Hopkins 3. Cleveland Clinic

I could keep going, but do we see the trend? There are several different specialities listed, and no...these three aren't the top 3 the whole time, but obviously they are doing something right.

National standards help keep patients safe, control facilities and make hospitals better...but why is it, that year after year following the rules, one outshines the other?

There are lots of reasons. Some for the good and some for the worse.

Maybe if we all excelled for the high standard that everyone did, the polls wouldn't look so outnumbered.

Do you have what it takes?

22 Virtues of Respiratory Therapy: Taken from The RT Cave :) One of my favorite RT sites.

1. empathy: You have to show some sort of understanding of what the pt is going through
2. priority: You have to be good at arranging tasks by priority
3. acceptance: you have to be able to accept that of which you have no control over
4. punctual: You have to pay strict attention to time, and never be late without good reason (yet you must never make excuses).
5. honesty: You have to prove to others that you can be trusted
6. transcendence : Going above and beyond the call of duty. Exceeding expectations
7. political: Know when to speak and when to keep quiet and bite your tongue
8. candid: You have to be open honest and straightforward with patients, doctors and nurses. This has to be balanced with political.
9. cooperation: You have to be able to work with a team to attain a greater purpose
10. perseverance: Regardless of setbacks you trudge forward, even if your boss or a doctor scolds you, you don't let that set you back
11. decisive: Coming to a quick resolution, answer or solution
12. Friendly: Get along well with people
13. Reliable: You are dependable to get your stuff done.
14. Confident: Knowing what you know and not hesitating to do it or say it
15. Competent: Being efficient at the few tasks you're expected to perform
16. Creative: Ability to fix equipment problems in unique ways
17. Insightful: Ability to see the unseen
18. Proactive: Ability to use unsightliness to solve a problem before it occurs
19. Observant: Ability to see what is obvious.
20. Communicator: Ability to share what you know, learn and think.
21. Listener: Ability to comprehend what other speak
22. Equanimity: You must be the calmest one in the room

Top 5

Everyone has their "memorable" patients. I often like to look back on those patients to give me a smile, or remind me that things could be a whole lot worse.

I'm going to share with you my top 5 patients of my career thus far. I will start from five and lead you up to my fondest memory. Now, some of these memories are happy/joyful, some are about stupidity. Which each person you take care of, you never know what you are going to get.

5. "John I coded 10 times for this RT but I'm still alive and walking Doe" : This is one of my more recent cases. This patient came in for a typical sickness into the ER. Deteriorated very quickly. Pt ended up intubated and on the ventilator. This is where the coding began. This patient's stay in the hospital total was astronomical. I alone (40 hours a week, night shift), coded them 10 times. There were times when we said to the family, "John will be lucky to make it through the night" Yet, John kept going. Every time was harder than the next. A few months after admission, a very aggressive course of treatment..I recently watch John walk around the nurses station. After I picked my jaw up off the floor, I went over and said, "well, you look awesome" which received a  large smile from the patient. They got discharged shortly after that. Wonders never cease to amaze.

4. "Hick I shot my neighbor over dog food Hillbilly" : Get ready to laugh. I'm hanging out in my trauma bay one night. It was a warm southern night, which always brings out the crazy. I heard the medic phone ring, and my ears perked up. The medic kept breaking up, and after the MD's many "repeat that" I just stopped listening. As the trauma was paged out, and I started prepping the trauma bay for intubation the ED doc comes in and says, "well, its a status post gunshot due to Alpo." I stopped what I was doing and said, "umm, excuse me?" As it turns out, two people were involved, one more injured than the other. Hick 'A' and Hick 'B' were neighbors. Hick 'B' was trying to help their neighbor out and bought Hick 'A' some dog food. Well, as both neighbors and medics will tell you this is how it went. Hick 'A' did not like the brand of food Hick 'B' bought, so he shot Hick 'B' in the foot with a 22 rifle. Well, Hick 'B' pretty pissed off, went inside, came out and shot Hick 'A' with a shot gun in the chest. *Sigh* Moral of the story, don't buy anything for your neighbor.

3. "Joey my RT saved my ass when I self extubated myself Wiredshut" : This is one of two patients that are near and dear to my heart. This was during my first year post school. I'm called to the ER to do an ABG on a patient before surgery. All seemed well. Family and patient seemed very nice. Who would have thought that post-op I would learn about their entire lives. Out of surgery Joey came to me, nasally intubated, with his jaw wired shut. So began the process of getting him off the ventilator. Did I mention, his leg was fixated and arm was casted? With the wire cutters looming over his bedside, I began my process. He woke up, calm and collected and listened to everything I told him. The tube remained in for 4 days, until Joey got a hold of it at 0200 and pulled. He began choking, coughing, and gasping. His mom, came into the hall and yelled for me. As I hit the room, all I could think was "don't cut the wires." Cutting his wires meant more surgery and more time. I pulled the tube the rest of the way out, fished a catheter down to suction him out, sat him straight up, and the "you will take deep breaths and do what you need, because I'm not cutting your wires" Jump 2 weeks: out of ICU and on the floors. Recovery was going well. Mom, Dad, Oldest Brother, Youngest brother and sister...I knew them all. Spent time off shift, hanging out. Who does that? Someone who becomes invested in their patients and families.  Jump 3 weeks: Joey is home, getting PT, doing well. His mom called and asked if I would come and visit. So, I spent my Saturday afternoon hanging with them. I still get a Christmas card every year from his Mom. Joey went on to college and is now in med school. He wants to be the people that once helped him. We send emails back and forth. He was the patient that taught me never to panic. Always check out the options and there is always a better one than panicking.

2. "Stanley I was the first person to make my RT cry Sweetikins" : There once was a patient who hated all the staff. Even though his wife was with him 24/7, he hated the hospital. One morning, I walked into his room, sucked it up and said "ok, no more goofing around, you want to go home? you will do your treatments" I then put the biggest smile on my face and waited. He stared at me, looked at his wife, turned back and smiled at me for the first time I had ever noticed. He said, "ok, but just for you." I told him "we'd see about that." Mr. Sweetikins was slowly dying of Parkinson's with a host of other issues on this admission. So began the process over the next few days where he would only take treatments and meds...from me. Since I don't work 24/7 it became an issue in my head. So, my bestestok, new person, you will be nice and smile at her too", after some mumbling, he said "ok, feisty girl" So, we traded on and off. His wife was grateful for the company as well. One night shift 3 weeks into this, I went into his room around 0100 for a treatment. He looked at me like he had never before. He said "no treatment" and began to pull off his oxygen and monitor. His wife looked at me helplessly. I watched as she crawled into bed with him. He died a few hours later and I cried. I cried a lot. My bestest and I sent flowers to the funeral. We were both unable to attend. Stanley was the first patient to make me cry, show me how to understand when someone is "ready to go" and how to stick it out even when the patient hates everyone. You just might be the someone they don't hate.

1. "Jane I made my RT fall in love with Trauma Doe" : Simple and quick. I fell in love with trauma on a Friday afternoon. This patient came in to the ER, talking...and went down in front of us. The injury was blunt force trauma, so we cracked the chest. After I had secured the airway, I was told to "hold the lung!" and I remember thinking, "are they shitting me?" Nope, not at all. I reached into the chest cavity and held the lung back while they worked on the heart. I got the trauma bug and never looked back.

I know that was lengthy, but it sums up my top 5 so far, they've all helped make me the RT that I am in one way or another.

RT VS RN

It's been awhile since I've written, the hospital has been overly insane. There has been an influx of sickness and crazy. When you combine the second of the two, you get a Level 1 trauma center on divert atleast twice daily. I've been spending my last month and a half at our smaller hospital in the hood. Gun shots have happened right outside, stabbings are very common in the ED, and we have the psych ward. Our staffing hit the wall, so I agreed to spend some time away from the large ED to support the other branch. This week is my last week here, and I will be returning to my glorious world of trauma drama.

That being said, I have found the biggest thing about being in a smaller setting (1000 beds vs 241 beds), is the RT vs RN battle. I have worked in some of the best hospitals on the east coast, and yet, it never changes. Before anyone gets mad, let me say...there are some RN's that love their RT's, but on the flip side, there is a war. Let me break a few things down.

1. I have my B.S., as do you, you are not superior to me
2. I know how to do an overview of the patient (vitals, history, etc) as well as you.
3. When you call and tell me you hear wheezing, I won't believe you. I think your stethoscope is set on perma wheeze, and you need to learn what fluid sounds like.
4. If your sat jumps from 83% to 95% in less than 5 secs, it wasn't real. I will not draw a blood gas or put them on a 100% mask.
5. If you call me for a PRN tx and they are sleeping when I get there without distress, I will not wake your patient.
6. Albuterol is not the fix all drug!! No, it won't stop coughing. No, it won't get rid of fluid.
7. Call me "Respiratory" one more time instead of my name and I will call you "that stupid nurse that has the patient"
8. Just because the patient "feels funny" and you don't know what to do, do not tell them to ask for a tx. When I come to assess them, and see they don't need one...I will chart accordingly and then be irritated at you.
9. Lung CO2 and Total CO2 are two different things!! please don't call me when the lab results for the total CO2 come back high.
10. If you call the MD about a respiratory issue before talking to me, you will be on my shit list.
11.Don't ever touch my vent, unless you want me to titrate my patients sedation on your IV pumps. If they are desating, and you want to give them an "O2 boost" fine..otherwise, hands off.
12. When you constantly ask for unnecessary things, the respiratory department will talk about you
13. COPD, Asthama and CHF are three different things
14.Please make sure the O2 is connected to the wall BEFORE you call and tell me the patient is desating. When I get there, and the O2 is disconnected, I will be irriated and write you up.
15.If you don't know how to setup an O2 device..ask, please don't put a NC at 15LPM or a NRB at 4LPM.

These are the things that I've encountered at this 241 bed hospital. Have I encountered them at others? Yes. Will it always cont? Yes. It's part education, part ignorance, and part "you are just respiratory." For those of you that think your RT's are not important, I want you to think twice. I love my job, I love what I do. I pride my self in my level of education and hard work. Working as a team with everyone is an important part of the hospital environment.

Next time your patient is going down the drain and needs intubated, just remember your RT is going to show up to help save that patient, not to be a fly on the wall.