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Thursday, November 12, 2020

5 Things I'm tired of hearing

Things that keep getting repeated. Oh, how it tires us so. Some things that get repeated are not factual. Yet, they get said so much you start to think they are true. Here are 5 things I personally am tired of hearing. 


1. Wear a mask or I will put a tube in you.  The chances of someone getting covid and experiencing getting through it just fine is 99% for those under the age of 70. This is according to the CDC. Those between the ages of 70 with one comorbidity surviving just fine is also at around 99%, and this is according to an English study. Sure, there are a lot of COVID cases in hospitals. Yet the percentage of all COVID cases requiring ventilators is more like 0,00004%. 

2.  We have never been this busy before. If I had a dime for each time I have heard this I'd be rich, because it has happened many times in my 23 years on this job. It has been this busy before, and it will someday get very slow again. That is how it is in healthcare. 

3. If everybody wore a mask we could prevent COVID from spreading. False. All wearing a mask accomplished was stalling while healthcare caught up with the expected demands. It bought time to stockpile ventilators and PPE among other things. In effect, all it did was kick the can down the road. Viruses have been around since the beginning of humankind. And they will continue to wreak havoc from time to time. The truth is that viruses run their course. They ride on humans until the last human with the virus dies. So, searing a mask will not prevent the virus from spreading. 

4.  Isn't this fun. I love taking care of these critical patients. I have never found joy in people getting sick and staying sick despite our gallant efforts to help them. I find much more joy knowing that people are healthy and not in need of my services. 

5.  I was hoping we would intubate. I personally think it's morbid to want to intubate. I think it's morbid to even get excited about it. Sure, it's nice to have a skill. It's nice to be proud of that skill. But to think to intubate first just because you want to use your skills is a morbid view of life. 


Friday, November 6, 2020

COVID-19 Has Created New Roles For Us RTs


COVID-19 has brought about a new era of respiratory therapy. We are showing the world that we are needed. And our roles have expanded beyond being "just" respiratory. As we enter a COVID-19 room, we are now finding ourselves doing janitorial, nurses aide, and nursing chores. 

Today I entered a COVID-19 room. The patient was on a ventilator. The poor nurse was in and out of the room all morning. She finally was able to sit down and eat and chart. And then I came along. I gowned and gloved up, put on my PAPR, and entered the patient's room. Once inside I heard a slight beeping sound. 

It was not my ventilator. It was one of those beeps we have learned to ignore, as they are not our beeps. But being that we are in COVID rooms, we have learned to scope the room once inside to see if there is anything beyond our services that need to be done. 

And here, I saw that the feeding tube thing (RT term for whatever it is), was beeping. I pushed the door open slightly. I saw the Hot Boss standing outside the door. I said, loudly through the blowing of air from the PAPR into my ear, "Something is beeping in here. It is the food thingy-ma-jig." 

The nurse must have heard me. She stood up at the nursing station. Once I saw her, I shouted, "Is it something I can fix." 

I did hear a, "Yes!" But the rest of what she said was muffled by that blowing in my ear. Damn if you can't hear jack crap inside those PAPR hoods. And, I responded with a, "WHAT!"

She mouthed something once again I did not hear. And I think she must have realized I couldn't hear her. She (mask on of course) came to the door. She said, "Bla Bla Bla Bla Bla."

"Aha," I said in return, "I got it." I walked around the bed to the pump that was beeping. I looked around for the "bla bla bla" that she was said I need to do. I pointed to what I thought it was. She nodded, and said, "Yes. It needs to be turned so that it's pointing towards you." I did what she said. Oh, it was a stop cock on the feeding tube line. Yes, that is what it was. The name came to me, finally. And I hit continue on the machine. And the beeping stopped. 

"Did the beeping stop!" I heard the nurse yell. I gave her a big thumbs up. I was happy to have learned something new. I was happy to help her out so she did not have to go into this room again. 

And nurses have helped me to at times. You have an inhaler that needs to be given. I have had nurses since they are in the room already anyway, do the inhaler for me. It is such a big help. So, it's unusual times, so we find we do unusual things to help each other out. 

In the past, I would never touch a urinal. Although, these days, I have held a urinal up to a guy's middle and helped him pee. I will not do the other side though. I do draw the line there. Although, maybe, if I was asked, I might even do that. I don't know though. Would you? 

I have also helped a patient to the commode once. I have emptied garbage bags for environmental services. I have done lots of little tasks to help out. So, you get your work done. You say, "Is there anything else I can do before I leave?" Sometimes the answer is no. Sometimes it is yes. And you do what needs to be done. 

Saturday, October 24, 2020

Things pessimistic respiratory therapists say

There are lots of glass half empty sort of folks in healthcare. They say things like (what they really mean in parenthesis): 

"It was a hell of a night last night/ day." (Meaning, I had a busy end of my shift)

"Welcome to hell." (I actually had to work last night)

"You are going to have a bad night." (I had a bad day, so you better have one too)

"They are going to end up being intubated." (I want to intubate.)

"They are going to die." (Preventing it is requiring too much work on my part.)

"We are going to have a (COVID) surge! Any day now." (They believe everything the fake media says)

"It's only going to get worse." (I want to intubate. I am a pessimistic, negative person)

"We are going to intubate right away (they say this despite the fact the patient hasn't even arrived by ambulance yet. You can use your own judgment what it means.)

"He has only two weeks to live." (only God knows that)

These are all things a glass half full guy like me doesn't want to hear. 


Monday, July 13, 2020

My confession about wearing masks

My confession is I have a hard time wearing masks. Rebreathing my own air is not something that is normal. I do not feel comfortable doing it. I have a bit of claustrophobia. I am a phlegmatic person who would rather wear no shirt and no shoes. Similarly, I would rather not wear that stupid mask.

I believe it does offer some degree of protection. Studies show parents have a 15-20% chance of catching a virus from a sick child. When wearing a mask they have an 8% chance of catching a virus. When not wearing a mask they have a 6% chance of getting a virus. So, wearing a mask (we're talking surgical masks here) you have a 2% reduced risk of catching a virus compared with not wearing a mask at all. (1)

The people who reviewed the study did say the following: "We estimated that, irrespective of the assumed value for the incubation period (1 or 2 days), the relative reduction in the daily risk of acquiring a respiratory infection associated with adherent mask use (P2 or surgical) was in the range of 60%–80%." Keep in mind this is an "estimated" risk reduction, not an actual risk reduction as determined by an in vitro study. So one must question this estimate. And this goes back to my theory that study results are only as good as the people who are reviewing and analyzing. 

Another study shows that masks do help prevent you from spreading the disease. But they are not very beneficial in preventing you from inhaling pathogens like viruses. So, most experts say the reduce your risk of spreading germs if you talk, cough, or sneeze. And, in general, more important to wearing masks is good hand hygiene and social distancing. (2)

So I do wear a mask when I'm around strangers. But not necessarily because I think they do any good. And not because I want to. I do it so others feel good about themselves. I do it so they think something useful is being done. I do it because I'm told. I do it at work so I can get paid.

I cannot, however, wear it for long. I might pretend to be a good wearer. I might have it on my face while I'm at Walmart. But as soon as I'm in a spot where there's no one around I pull it off my face. I pick it up and wipe the sweat off. I wipe my nose.

I have what is called vasomotor rhinitis. This means that eating or high humidity or cool air or any annoying factors make my nose run. So under my mask, I always have a snotty nose. Sure, you can't see it so it does not matter. But it does matter to me. That feeling of hotness and my itchy, runny nose has me lifting up my mask to wipe my nose. Sorry, but it has to be done.

So, you can tell me I have to wear a mask. You might be happy I have one on my face. But the truth is it is not doing me or you much good. And that's what I mean when I say masks are useless.

I wear it well while standing in line. I wear it well when I walk through crowds. I wear it fine during the short time I'm in a doctor's office. I wear it fine when I'm in inpatient rooms. But, even there I find myself poking at it. And I am quite certain I am not the only one to do this.

Again, some studies show surgical masks "might" help protect against the spread of viruses. But no study has ever been done on your homemade mask. So, even while it might make you feel like you are doing something, wearing it is not scientifically proven. You are wearing it at your own risk.

Of course, for many people in this world, "it feels good" is just as good as science. And if you're one of those types, I'm fine with it. And I'm sorry, but I'm not staying home if I don't wear a mask. I need food and clothing and to live my life just as much as the rule-followers who insist on wearing masks.

 I bring this up because some people are dicks. I had a friend who told me he went to Meijer the other day. He wore his mask like a good boy, he said. When he was in an area where no one was around, he moved the mask from his face so he could wipe the sweat off of it. And as he did so, this one lady lectured him, "You get that mask back on!"

My friend is a very phlegmatic and amiable person. But he said that comment by that lady made him so mad. He said he wished he had a comment to say right then. But he didn't. He put his mask on and went where that lady wasn't and then removed the mask and wiped his face.

I am sorry, people, but you cannot remove the risk from life. We can protect ourselves from nasty viruses the best we can. But we must continue living our lives. And when your nose needs to be scratched, and you cannot stand it, then remove your mask and scratch it. That is your inalienable right.

References.

1. McIntyre, et al, "Face Mask Use and Control of Respiratory Virus Transmission in Households," Imerg. Infect. Dis, 2009, Feb, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2662657/, accessed 7/10/2020

2.  Pappas, Stephanie, "Do face masks really reduce coronavirus spread? Experts have mixed answers." Live Science, 2020, June 2, https://www.livescience.com/are-face-masks-effective-reducing-coronavirus-spread.html, accessed 7/10/2020

Friday, July 10, 2020

My Politically Incorrect COVID Answers

The yellow mask offers scanty protection.
The orange mask offers some protection.
The other mask offers protection if you have a trach. 
We receive lots of questions about COVID. So, here's a list of these questions followed by my humble answers.

1. Does wearing a mask mean I'm rebreathing my carbon dioxide?  No. Carbon dioxide is small enough to fit through the mask with no problem. It filters viruses and particles, not carbon dioxide.

2.  Can a mask cause my oxygen level to drop? No. Same reason as above. Oxygen has no problem getting through any mask.

3.  Do surgical masks protect me from getting COVID? Studies show that they do reduce your risk. They may reduce your risk from 10-15%. Some studies show the provide a little more and some a little less. The more secure and tightly fitting the mask is to your face the more protection it offers.

4.  Do surgical masks protect me from spreading the virus? Yes. They can help reduce the amount of virus aersolized into the air when you cough, sneeze, talk, or laugh. Some particles may still be admitted into the atmosphere, but still it reduces the amount of aerosolized COVID or other respiratory pathogens. Note, it does not prevent, hence the reason for social distancing.

5.  Do homemade masks offer any protection against COVID? At the present time there are no studies no homemade masks. I think the general consensus at this time (remember, a consensus is not science) is that homemade masks act as a shield and they may provide more protection than not wearing them. We'll have to see what future studies have to say on this subject.


Wednesday, July 8, 2020

My politically incorrect thoughts on Covid-19

There is so much written COVID I haven't touched on it much. It's a virus. As all viruses do, they run their course. There is little that can be done to stop it. Sure, we can slow the spread by wearing masks and social distancing. We can prevent the spread by doing a permanent lockdown as some have suggested. But, lacking a vaccine, we can't stop it from running its course (and there is no guarantee we will ever get a vaccine).

Speaking of lockdown, it was a good idea at first. My governor of Whitmer here in Michigan. I supported her when she first locked our state down. The goal of the lockdown was to keep the blue curve (shown in picture) below the line of healthcare capacity. This was to prevent hospitals from being overwhelmed.

Allow me to digress once again. Speaking of hospitals being overwhelmed, the fact we had to talk about this is a testament to how unprepared we were. There is no telling what diseases are out there. There are many diseases we don't know about. And anyone of them could spread at any given time. And yet, despite this truth, our entire healthcare system was unprepared. They didn't have enough personal protective equipment (PPE), such as masks, gowns, etc. They didn't have enough ventilators. So, I know many people like to blame the government for not being prepared.

And trust me it wasn't. But, the truth to the matter is the government stockpile is only a backup. It should only be used in the case of an emergency. As it was in due time, as many ventilators were sent to where they were needed. Still, it was the hospital system that was unprepared. They are at fault for not being prepared. And we can't point fingers at any one hospital either, as it appears all (or almost all) were equally unprepared.

Still, our governor here in Michigan went a little overboard. I have friends who say she did this for political purposes as she wants to be Biden's vice-presidential candidate. However, when my friends bring this up I say things like, "You cannot prove intent. A person's intent is not even permissible in court unless there is ample evidence. For instance, for a person convicted of murder to be charged with first-degree murder, the intent has to be proved. You have to prove someone intentionally killed someone. And that is difficult to do, and why so few people are convicted of first-degree murder. So, it's not possible to prove our governor's intent for having the strictest lockdown in the country. So let's not go there.

The fact is she did keep the lockdown in order way longer than it was necessary. Why? Only she knows. She was asked by the republican congress in Michigan to show her science why she prolonged the executive orders longer than our Congress approved it for. And, by the way, the lockdown was approved by our Congress until about May 1st. They did not approve of it after that. Meaning it her extended lockdown was illegal. And this is still in the courts for some reason. The fact this was not rushed through the courts has me thinking they are equally as liberal as our governor.

And politics doesn't matter to me. We supported Whitmore regardless of her politics at first. But the fact she held the state in lockdown after May 1st is something we ought to question. Why? Because as of May 1st hospitals were prepared. By this time we had plenty of PPE. By this time we had plenty of beds and ventilators. We had all we needed to handle any surge that might happen.

Speaking of the surge, allow me to digress again. Those models that predicted a surge were not scientific models. It was not science. Science either is or is not. Those models are used to help our government, to help researchers, etc., make decisions. They are computer modulated data. This means they are only as useful as the information entered into them. If the data put into them is flawed, so too is the data going out. The initial data showed that way more people would be inflicted, and way more would be dead than actually occurred. And every model after that was wrong too.

The same types of models are used to prove global warming. And that is usually my argument against any "proof" that global warming exists: "The only evidence they have is computer modulated date. It predicts and is rarely accurate. It's not science. Although, global warming advocates say it's science. Now, I'm not advocating for or against global warming, I'm just saying.

So, back to the death rate due to COVID. Initially, we thought the death rate was 5%. If it was that high, it was worth shutting the country down. But, the truth to the matter is the death rate is between 0.3 and 0.5%. So, was that worth shutting the economy down? Was that worth destroying the best economy we ever had? I'm not sure it was. I think history will look back on determined if this was actually needed. Was our response overdone? You decide. And these are my unabridged thoughts on COVID. More to come in the coming days.

Wednesday, May 27, 2020

What's it like having a defibrillator?

Your question. What's it like having a defibrillator? Does it shock you a lot?

My answer. I have had a few patients with defibrillators. Although, I think this answer would come best from someone who has a defibrillator. Obviously, to get one is a very stressful decision. But, it certainly beats the alternative. And it has helped so many live longer and better despite a heart condition. That said, below is an answer from someone living with one.

A patient's answer.  "No it has not shocked me yet. It's also a pacemaker. It's paced my heart several times but I don't feel it. If the defibrillator goes off its because my heart stopped or gone into severe arrhythmia. Then I will feel it. I hear it's like getting kicked by a horse. Hopefully I'm unconscious by then. It will probably go off if I have a seizure. I just make sure I stay on my medicines. It's all good!