Happy new year with the best RT humor of 2007

"Row, row, row, your boat...," Dr. Sam whistled calmly as he felt for the femeral pulse of the limp patient on the ER cot. "Gently down the stream..."

I handed him a bad copy of an EKG fresh off the press. "This is just a rough draft," I said.

He laughed, looked down at the EKG. "Good enough," he said, and returned his equanimitous gaze back upon the patient, and continued humming his happy tune.

Someone laid out a one-liner, and we all laughed. I set my EKG machine to the side and grabbed an ABG kit. "You want one of these I'm sure," I said, looking at the doc.

"Yepper," he said.

Obviously we wouldn't do this if the family were around, and probably not if it were a young person either. And if you were an outsider observing us, you might think we had an odd sence of humor. Truth is, we do. After you work in a hospital a while, you can't help to develop an odd sense of humor.

It is true, that despite what we do for a living, we medical workers still have to live, and we still have to maintain our senses of humor.

So, while the rest of the world is gearing up to watch the rest of the year wind down, I'm sitting here looking up RT humor, some of which I'm printing off. I think I'll post some of these on the bulleton board above where doctors interpret EKGs, and see how long it takes for them to be taken down.

Anyway, I just thought I'd end the new year highlighting some of the greatest medical humor of 2007 that I've found on the Internet. Consider, however, that I've only been doing this since October, so if I missed your brilliant post forgive me.

The following is medical humor at its best, or, since I've only been blogging since October, some brilliant observations I'll throw in here too. These are in no particular order:

1. The seven dwarves of the ICU: It's funny sometimes how unique our patients can be at times. I thought this was a spectacularly funny observation about working in the ICU.

2. Ativan nebs: I put this post up on the board over where the doctors read EKGs in our department, and it is still there 2 months later. Either that means they are avoiding it, or have read it and soon we'll be giving Ativan nebs just because instead of Albuterol just because. Our patients will love us for it, and we'll love the doctors for it, as all those troubled patients will be subdued.

3. The frequent flyer club: This is an absolute must read. Any medical person who has spent time in the ER has made the observation, "Why is he here?" Or, better yet, "The ER seems to be the hangout club of the scum of the earth." This article describes in detail the many different types of frequent flyers.

4. Stereotypical patient: Sometimes when you are working in the hospital you can't help but feel deja vu while walking from room to room. This author paints a humorous picture of the "stereotypical patient."

5. RTs -vs- RNs : This is a serious differentiation between RTs and RNs. After reading this, I spun off the humorous version: What RTs can do that RNs can't.

6. The naked, the fat and the dead: This may not have been meant to be funny, but it cracked me up none-the-less. Don't take offense at this please. I see it as a simple observation.

8. Musants: Doctor humor can sometimes be as bad as RT humor.

9. Physician's Creed: How to take care of pesky RTs : Just so I don't sound like I'm tooting my own horn, I'll quote a comment to this article: "That's possibly the best post EVAHHhhhh."

10. Ways RNs can iritate RTs: I'm sorry, but you can't keep your sanity as an RT if you don't develop a sense of humor. I compiled this and the above Physician's Creed with the help of my cohorts in the RT cave.

11. RCP, RRT, Mr. Bean: This is medical related, well sort of.

12. Weeding out the garden: This is a great analogy about respiratory therapy school.

13. Clinitian resistance to adapting new practices: Not necessarily humor, but a great observation of why RTs are so resistant to change, despite how many of us complain about frivolous orders.

14. Because I could: Here's a little Christmas poem that only a medical person could find humor in.

15. A funny story occured to me...: This is why I became an RT and not an RN.

16. The 11 Rules of Operating Room Etiquette for staff and patients: This is educational and humorous at the same time. It's seems we med workors find humor in just about everything we do.

17. Video of the week: Who thinks of this stuff anyway. Here is a video that is very educational... no, it's not educational, but it's hillarious. If you don't like spiders, you might want to not watch this one.

18. Dr's come in all shapes and sizes: Do you know what kind of doc you have tonight?


19. The dirty, dirty on ER nursing: What does it take to be a nurse? Well, you know I wouldn't be able to handle it, and this article explains why.

20. I heart pulmonologists: There must be something about working with lungs that makes people humorous and fun to work with. Well, you do know all us RTs are... Oh, never mind.

21. I could go on, but I'll stop here. This spot is reserved for all the humor or brilliant ideas not mentioned on this post. Some bloggers write so much funny stuff I couldn't possibly post it all.

Have a great new year.

2007 great year for respiratory therapy blogs

The RT cave has been around for three months now, and it seems to me to be a pretty good success, especially considering when I started doing this I thought I'd be writing to myself. I'm impressed at how big the medblog community is.

I would like to thank all of you who have responded to one or more of my posts by writing a comment, sending an email, or simply using up some of your valuable time here at the RT Cave. You guys provide me the incentive to keep writing.

To end the year, I would like to pay tribute to all respiratory related medblogs I have discovered to date. I see that 2007 was a great year for the RT world as most of these sites were started just this year. We are the beginning of a revolution.\

The following is in no particular order.

1. Respiratory Therapy 101: I was doing research on protocols when I came upon this website. I thought the Anonymous RT did an excellent job of describing what we do "at the head of the bed." He works at a larger, busier hospital than mine, and it's great to read about what I'm missing by working at a small town hospital -- and what I'm not missing.

2. Respiratory Therapy Driven: Djanvk is in the same boat as me, as he has been doing this for 10+ years and works at a small town hospital. It is a challenge to keep finding things to write about when business is slow, but this guy does a wonderful job of it. He provides an excellent feel for what it's like to be an RT, and he also has a great sense of humor, as do most of us RTs.

3. Snotjockeys: A perfect name for a respiratory therapy blog, and an excellent place to get insightful information about respiratory therapy. Julia has written some excellent posts about the challenges facing RTs, and does the medblog world a great service by her medblog reviews.

4. G's spot. I wish every RT was as pleasant as this blogger, because she's written on more than one occasion how much she loves her job. She works nights as I do, and has to struggle with getting adequate sleep, and I can relate to her that way. And yet she doesn't let the lack of sleep effect her job. She gives an excellent feel of the RT job.

5. respiratory therapy student blog: How cool it would have been to have have had the ability to blog when I was in school. We all remember the struggles of working as an RT, doing clinicals, studying late into the night, fitting in some social gatherings, attending classes, and taking tests. And when vacation time came along, we really appreciated them. Great blog from a student perspective. Soon he'll have to change the name of his blog to RTblog.com.

6. Sleepy RT medic: How cool it would have been to have had experience as a medic before going to RT school. That's what this blogger is doing. This blogger also provides an excellent reminder of how difficult it is to hold a job and go to school. Like #5, he provides some good information on things we RTs take for granted once we finish school.

7. Sometimes I breathe: The same can be said of this blogger as the last two, as he provides a good reminder of how hard it is to become an RT. Since these student RT bloggers are still in school, they have access to all the latest information and can provide us older RTs with links to some cool RT related websites.

8. Breathing through school: Another RT student blogger who has recently decided to brave the blogger world. I think this was a good idea for her, because she's provided some neat incite. In one post she describes RT school as "weeding out the garden." While many aspiring RTs will enter, only a few will leave.

9. RTT with ADD: Despite her ADD, this blogger provides more cool incite into being an RT. She once described reading blogs, "as though I'm intruding...intruding into their personal thoughts, feelings, emotions and most of all, their personal space..." That's very true. And one reason why we bloggers should make money for what we do, say $30 a word.

10. Pulmonary Roundtable: Great place to read about, learn from and discuss RT case studies.

11. Respiratory Therapy Blog: He hasn't written in a while, but when you read what he has written you can't help but to learn something. Here's hoping he writes more soon.

12. The Respiratory Terrorist: Ditto. Here's hoping he writes again soon.

13. Any more RT bloggers out there? If I left your RT blog off this list it's only because I haven't found it yet. Leave me a comment and I'll plug your blog in the new year.

Here's a toast (raises glass) to a happy new year.

The RT Cave is living 20 years in the past

You know what I also think is cool is free music downloads off the Internet. I've always been sort of frivolous my whole life, and have found better things to spend my money on than music. Not that I don't like music.

When I was in college, nearly 20 years ago, my friends all had CD and stereo players, while all I had was a few tapes of my favorite artists. It was during those few years that, probably while having a few drinks, I discovered music.

All my friends were from Big City, and their tastes in music seemed to be different from us small town folk. In fact, even what they wore seemed to be, well, twenty years ahead of us. They always joked with me that I was 20 years behind the times, which was probably true. I told them I preferred it that way.

But they were still cool. And we still had lots of cool times, especially when we pulled out their CDs to listen to cool tunes. And usually after we had been drinking, and were drunk, we'd pull out Pink Floyd. That was so cool listening to with a good buzz. Probably the only thing better would be Bob Dylin, of which neither of them had.

Those good years of college lasted only 2 years before we parted ways. I never saw those chaps again. I lost complete contact until the advent of the Internet. And I lost complete contact with Pink Floyd and all that great music until the advent of free downloads on the Internet.

So I listened to Floyd, and did a search on the net for my old pals. I found them. That was so cool after 20 years. We were all journalists back then. I almost didn't click on the link to the law firm. None of my friends were lawyers, I thought. Fritz was. How cool.

Ray didn't change at all. He was working for his parent's factory. That's what Fritz and I figured he'd turn out as, despite four years of college -- er, partying. I don't think he ever changed. Cool. Now he lives a few blocks from the Major League baseball team. Cool. Probably still partying, but listening to 2007 tunes -- tunes we'll discover in 2027.

Ray sent me an email: "After all these years you're still listening to Floyd."

"No," I wrote back. "We live in a small town here, remember. We are 20 years behind you guys in the Big City. We are just discovering Pink Floyd here. What you guys showed me back in the 80s was a glimpse of future music. And it's pretty cool."

And now, while I listen to Dylan classics I heard about but never listened to before (it's so cool discovering old classics), I'm thinking how true it is that we are 20 years behind here in small towns.

It's a lot less stressful, living in the past that is. I suppose it's easier for us if we let you guys experiment with the new stuff. You'll reap the rewards of what works, but you'll have to suffer with what doesn't. I think we small city folk like it that way. We tend to be more conservative. We like to avoid all that stress

And, to relate this to respiratory therapy, it's true in our hospitals too.

Think about it. In the Big City hospital that old BiPap machine has been in the back of the closet collecting dust for about 20 years now. We have only recently stopped using it. The same is true with those bulky mist tents. And, while the Big City hospital has been enjoying protocols for a while now, we are still being controlled by doctors.

However they are just starting to show signs of giving up some of that autonomy. It's so cool. And we RTs appreciate it. Well, most of us do anyway.

I wonder when it was that protocols first became the thing at Big City hospitals. Whenever that time was, just calculate 20 years later, and that's when we'll catch up with you guys. Until then, we'll enjoy the past.

Perhaps these free music downloads will allow me to listen to the same music of the Big City folk. I doubt it though. So, whatever you guys listen to in the big city, about 20 years later we'll catch up.

Rapid Response Teams are awesome

I thinkRapid Response Teams are really cool.

I can't even count how many times I've had a patient who doesn't look good to me or the nurses, only for the nurse to call the doctor and the doctor say, "Mumble, mumble, mumble... Give 20 of Lasix, mumble, mumble, mumble."

Click.

That's okay sometimes, but I know there have been many times we've stressed out the rest of the night about the patient, especially if the lasix didn't work. Sometimes these patients end up in the CCU and we saw it coming.

Now if a patient doesn't look good the nurse pages the RRT and an RT, a CCU nurse and the RN supervisor go STAT to the patient's room. We assess the patient and perform procedures and tests we feel are appropriate.

Tonight I had such a call. The patient was sitting on the edge of the bed, arms spread across the bedside table, paradoxically breathing. I arrived and took charge.

"It looks like she's wet." I said before I even assessed the patient. After doing this job for so many years you become good at observations. However, a full assessment would be needed.

"That's what I was thinking." The nurse, Abba, was setting the pulse ox probe on the patient's finger. The sat read 86%. "Her blood pressure is also way high."

Peering up at the monitor, the BP read 192/124. I reached for my handy dandy stethescope and took a quick listen. Happy, the nurses supervisor, and a second nurse arrived and were now standing by my side.

"What do you think? Wet?" Abba asked. She was a good nurse. I had her trained well. A less worthy nurse would have said, "We need a treatment," without further assessment. This was working out just perfect. The way it should be done.

"Yep." I said.

"I think we should do an EKG, ABG and perhaps a treatment." Wow. It feels good using my brain.. A rush of joy filled my veins. Man, it feels so good to use my skills..

I paused a moment. I looked at the patient. Her head was now bowed between her arms so the back of her head stared at the ceiling. It's a miserable feeling not being able to breath. I understood completely.

I paused, however, because I wanted to make sure I wasn't overstepping my bounds. I didn't want to do a bunch of procedures that were not necessary. Rather, I didn't want the nurses in the room to think I was on a power trip like the Air-Flight nurse the other night. I looked at Happy. "Do you agree?"

"Oh, definitely," she said.

As per protocol, the doctor was called before the tests were completed. As I arrived back at the nurses station after running my ABG, the nurse set the phone on the receiver and peered over at me. "He said, 'Mumble, mumble, mumble, give her 20 of Lasix, mumble, mumble, mumble.'"

"As expected," I said, smiling.

"I told him that we did the treatment and the ABG, and he slammed the phone in my ear." She smiled as though she had expected as much. "I guess he doesn't care. So I'll write the order for those."

I said, "Hey, that's fine, because at least now we don't have to stress out about not knowing what her status is. We got all the test results done before the doctor was called. How many times do you sit and worry about a patient the doctor appears not to care about?"

"Not any more," she said, " But I'm glad we did the EKG at least, because her blood pressure is still in the 190s. He didn't seem to care at all about that. And I told him we did the ABGs and he still hung up the phone in my ear. It was almost as though he was annoyed that I even called."

"Well, perhaps we overstepped our bounds a bit. But I think it's great that we have this team. And I think we should always call the RRT before the doctor is called on these patients so we can do the tests we think are needed that the doctor won't order."

"I absolutely agree. I mean, we are the ones at the patient's bedside. We see right up close how the patient is doing, how she feels. The doctor just wants to get off the phone so he can get back to bed."

"Well, to be fair not all doctors are like that, but that one is."

I checked on the patient. She was snuggled under the blankets and the head of the bed was all the way down, a sure sign she was fine now. Despite that, I said, "Mrs. Beer, are you feeling better."

She nodded, turned to look at me, "Yes."

"Did the treatment work for you?"

"Yeah, I'm still a little short of breath, but I feel much more comfortable."

I know you guys are saying: "Why the hell did you give the breathing treatment when you figured the patient was wet? If a doctor did that you'd complain about it."

True. But sometimes pulmonary edema can cause bronchospasm, and sometimes a treatment can help treat that symptom. What I hate is when the treatment is ordered Q4 after the fact, when they are no longer needed. I have no problem trying one treatment.

I checked on her a few times the rest of the noc shift and she was sleeping comfortably each time, which meant the doctor was right on this one.

The patient gave us no further trouble, which was a good thing, because a half hour after I was finished with her, "SIGNAL ONE in CCU!" railed across the overhead speakers.

It was one busy night. But one in which I used my skills. It was awesome.

Merry Christmas

Merry Christmas everyone. My wife and kids were so excited when I woke up today, and that was all the Christmas present I needed. And the entire family is especially happy this year because...

For the first time in 10 years I have both Christmas Eve and Christmas off -- but not without a fight.

I'm going to enjoy them both.

All I wanted was the shot

Growing up with asthma: chapter 4
I sat on the edge of the ER cot with my fingernails pressed deep into the edge of the narrow mattress. My shoulders were high and stiff. Breathing was very difficult now.
The nurse, the lady with the white uniform and funny hat, left the room and said, "I'll be right back with doctor Gadget."

That minute quickly turned into a long time. It probably was only a minute, but when you can't breath, a minute is a long time.

A skinny dark haired man wearing what looked like wrinkled green pajamas entered the room carrying a white bag. I watched as he ripped the bag open, turned and scattered the contents onto the counter. I knew now I was going to feel better soon.

He seemed to be taking a long time. I could hear the clicks and clacks as he put his gadgets together.

Where is the needle? I thought. What's this thing he's working on?

My heart skipped a beat as the nurse brushed her way past him, walked around the bed, and stood behind me and rubbed my shoulders. I know she told me her name earlier, but I couldn't remember.

"Try to relax your shoulders, honey," she said.

Her gentle, caring fingers pressed deep into my sore shoulder muscles, and I let my shoulders droop. Easier said than done. I've been trying to relax all night. It was no use. I tensed up. If I could relax my shoulders I wouldn't be here.

She ran her finger along my spine. I let my shoulders droop again. Concentrate. Pretend you are a wet noodle. Go limp. Relax. The words I read in the "Asthma for Kids" book rang out loud in my head. "Breathe in through you mouth and out your nose," she said.

I hated when they said that. I couldn't breath through my nose. I couldn't breath through my nose on a good day. I tried. I sniffed. My nose was full. I wiped it with my arm. I looked at my dad, and he didn't say anything. I looked down at my arm and saw the little streak of snot.

Despite that I couldn't breathe through my nose, I could still smell that clean, fresh hospital smell.

"How long has he been feeling like this?" the doctor said. He was about dad's age, with a big fluffy mustache, and he was standing in front of me pressing his fingers into my neck.

"He woke us up a half 'n hour ago." Dad was sitting in a wood chair by the door. "He was fine before he went to bed."

I thought about how miserable I was at grandmas, and my heart skipped a beat when I thought about how I had decided I was going to tell mom and dad how terrible I felt when we got in the car, but I never did. Dad really doesn't understand. He has no clue. That was the first time I came to that revelation.

"Was he around something he was allergic to?" The doctor asked, and dad shrugged, "Not that I know."

I tried to speak: "I was," gasp, "going to te...," gasp, "tell you last," gasp, "you that--

"Don't try to speak, Rick." The doctor was now poking something into my ear, then he shone a light into my eye. I did not wince. I was a pro at this. I heard air hissing, and noticed the skinny dark haired man was holding something that was steaming.

"Here, hold this," the skinny man said, and he proffered to me that thing that was making steam. It looked like a little cup with a white mouth piece on one end and a white tubing on the other. I had never seen anything like this before. I grasped it in my little hand and stared at it. What am I supposed to do with this? I don't want this. I want that shot. The shot always makes me feel better. "This should make you feel better."

The doctor walked around the bed, and I tried to take as deep a breaths as I could as he listened to me with his stethoscope. I looked at dad and he looked worried. I didn't ever remember seeing him look that way before. Through the doorway I could see the nurses station, but nobody was out there. As far as I knew I was the only patient, which meant that I got all the attention. I didn't' like all these people in the room. I could feel my heart racing.

"My name is Matt, and I'm from respiratory therapy" the skinny man said, "What I want you to do is put this into your mouth, and clench it between your teeth. You can hold it with your hand if you want. I want you to breath normal."

I did what he said. I concentrated on my breathing. I saw everyone was watching me. That made me more nervous than being short-of-breath. I had been short of breath before and I could handle that, but all the attention was new to me.

I watched as the steam disappeared when I inhaled and blew out of the end of the white corrugated pipe when I exhaled. My breaths were short and not very deep, so the steam never completely disappeared before I exhaled again. It was kind of like puff-puff-puff-puff.

"This is what we call a nebulizer. It has medicine in it that should help you breath," he said. "I want you to really concentrate on your breathing."

.The doctor walked around the bed. The man who gave me this neb-you-lizer slid his feet across the floor and moved to the back of the bed. The doctor motioned for me to lie down and he pressed his fingers into my stomach with his gentle hands. As soon as he was done I popped back up to a sitting position. "This should work," he said to my dad more so than to me.

Nobody left the room. They all stared at me as I continued to struggle despite the neb-you-lizer thing. I kept waiting for the relief. The relief never came.

"Give him another one," the doctor said. He patted me on the back. "We'll have you better in no time," he tried to reassure me. I knew this neb-you-lizer wasn't going to work.

I could hear my heart going rap-rap-rap-rap in my head.

The nebulizer started to make a sputtering noise, and the steam was no longer pouring out when I exhaled. Matt from respiratory therapy took the nebulizer from me and walked over to the counter. He reached toward the wall and turned a knob on a flowmeter. The hissing stopped.

He picked up a syringe and a bottle and drew up some of the medicine. He squirted it into the cup. He held up the syringe, eyed it, and squirted some of the liquid into the air. He put the syringe into a second bottle, and squirted that into the cup too. All the while he did this the nurse continued to rub my shoulders and back, occasionally reminding me to "relax, honey. Try to relax your shoulders. Just concentrate on your breathing."

I relaxed my shoulders when I thought of it.

Take a slow breath in, breath out slow. Take a slow breath in, breathe out slow. The words from the asthma book resonated in my head. Take a slow breath in, breathe out slow.

I took a breath in, it wasn't very deep. I blew it out slowly. I repeated this again and again.

"He's pretty calm for someone who can't breath," the nurse said.

I looked at dad. He didn't say anything. He just sat in his chair all relaxed.

I watched as Matt turned the flowmeter on. The air hissed continuously again. The steam was pouring from the neb. He handed it to me. I took it. I clasped it between my teeth, and pressed my palms into the mattress.

"Try to relax." The nurse continued massaging my shoulders. I relaxed as best I could.

"What is this... steam?" I gasped through the mouthpiece.

"It's not steam," Matt said, "It's a mist. You ever go to a waterfall?"

I nodded.

"It's kind of like the moisture that squirts up from the waterfall. It's a mist. What I have in this cup is what I call a magic mist. It usually works fast."

"Not working... fast on me," I assured him.

He turned to look at my dad. "What I have in here is a medicine called Alupent."

"Yeah, he's had these before," dad said.

"I want," breath, "the shot." I didn't care about this thing they made me put in my mouth. My jaw was getting sore.

The doctor looked at my dad, and dad looked back at the doctor as though waiting for the doctor to say something, but the doctor said nothing. The were content to wait, I figured.

"I want the shot!" I said.

"I never heard a kid ask for a shot before," the doctor said. He smiled.

Dad said, "He has responded very well to Susprin in the past. That's what they usually give him when he comes here."

"Oh, really." The doctor listened to me again with his stethoscope. I could hear myself wheezing. I could feel each breath as it didn't want to go in. There was an elephant sitting on my chest. That's the same as I felt since the last time I woke up. I feel worse than I felt last night at grandmas, I decided. Nobody asked me about last night. How could they not ask me? I'm glad, because I don't want them to know.

"All right," the doctor said after what seemed to me to be an eternity. Martha, why don't you prepare 5 of Susprin."

The nurse stopped massaging my back and left the room. I watched as she walked around the nurses station, went out of sight a moment, and then she appeared out of nowhere and re-entered the room with a syringe and a wad of white gauze. I looked at the needle as she held it up to the light and squirted some of the fluid out. It was huge and sharp. I didn't care.

The doctor stepped back and stood next to the chair dad was sitting in. The nurse opened the bottle of alcohol and put the gauze over the opening. The smell of alcohol was strong. That was

The smell of a shot. She rolled up my sleeve and rubbed the cool alcohol onto my shoulder.

"Poke," she said. I could feel the needle as it entered my skin, but I did not jerk this time. I could feel the sting as the medicine entered me. I concentrated on my breathing. I knew it was just a matter of time now. I rush of joy filled my veins. I knew I was going to feel better real soon. It was like a Christmas gift. It was better than a Christmas gift.

"Relax and just concentrate on your breathing," the doctor said. You don't need to tell me that, doc. This is what I wanted all along. Oh, it feels so good.

The nurse was rubbing my shoulders again. I liked it when she did that, but I don't know that it was doing much good. "Breathe slow in through your nose and out your mouth," she said.

I didn't listen to her. I knew what I had to do. I breathed slowly in through my mouth and out my mouth. I felt how hard the air was going in. I felt the agony of each breath. I concentrated on how miserable I was. I wanted to savor the moment, because I knew what was going to happen in...

"It usually takes about 5 to 10 minutes," the doctor said looking down at my dad "Do you feel better yet." He looked at me.

"No." I gasped. I knew it wouldn't be long. I watched the clock on the wall. I don't remember it being there before. It was right over the doctors head. It was so quiet in the room now I could hear it ticking. All eyes were on me.

It was now the five minute mark. I could feel the breath go in half way. It felt so good.

I watched the clock, listened to it tick. Time seemed to go so slow as I watched, waited for my breath to come back. It was now ten minutes since I got the shot. Air was now going in three-quarters of the way.

"This is feeling much better." I smiled.

"Good," the doctor said. "Just concentrate on your breathing."

I continued watching the clock, and concentrated on my breathing. After a few more ticks I took in a deeeeeep breath. It went in all the way.

Finally!

I took in another deeeeep breath.

Yes! It felt so good to breath. I took in several more deep breaths.

"It sure is a great medicine, isn't it?" Mike said, smiling. I looked at dad. He was smiling too.

I took another deep breath. "Yep, I can breathe."

I released my grip on the cot.

"Ahhhhhhh, it's a miracle."

The best Christmas gift may simply be a smile

We know sometimes we have a tendency to shoot the middle person. While this isn't something I personally do on a regular basis, I've had my lapses like the best of them.

It's the Christmas season, and a perfect time of year to remind ourselves that the middle people are just doing their jobs.

Who are the middle people who need to be recognized?

1. Unit Secretaries: Most of them are very nice people who simply have the bum luck of having to call us RTs about new orders. It's not their fault that you "were just down there" or "that treatment is not indicated."
2. Nurses: Again, most of them are great people, many of whom are our friends. They are often overwhelmed and simply trying to do the best for their patients.
3. Supervisors: They have to tell you when you make mistakes. It's their job.
4. Schedulers: This is the most unappreciated job in the world. Need I say more.

However we might become frustrated with these people, they are simply just doing their jobs. And, we must note, that without them the hospital would not function. In essence, they are the strings that hold the hospital together.

'Tis the season to show appreciation for these hard working people.

Regardless of how busy you are this Holiday season, no matter how much your inner voice is shouting for you to grumble and gripe, smile instead and be happy.

Quite often the best Christmas gift you can give is a simple smile, or at least a friendly voice over the phone.

Scientists develop new cure for asthma, allergies

We are now in the year 2039 and you click on the compuTV to hear an aging Anderson Cooper reporting on a new medication approved by the FDA that is predicted to "end asthma and allergies as we now know it."

You learn that the new medication is called Allergycure, and it is a one time injection to neonates within the first week of life that works to mature the immune system in any child with the "faulty gene" that, if triggered, causes allergies, asthma and/or eczema.

The goal of this therapy is to prevent these diseases. Studies on mice and pigs showed that Allergycure had an efficacy rate of 90% over 10 years. However, whether or not the medication will prevent the "faulty gene" from being triggered later in life is yet unknown.

Despite the prospects of eliminating asthma, a controversy has evolved. While the medicine is predicted to prevent asthma, there is the risk that it might actually cause asthma in 6% of neonates who do not have the "faulty gene." So it is paramount that each new child is tested for the "faulty gene" prior to getting Allergycure.

Likewise, Allergycure has also caused flu like symptoms in 6% of the neonates who get it, and, in studies, 20% of those patients ended up on ventilators with severe pulmonary complications and 2% died. Overall, 98% of those tested with Allergycure never acquired asthma and never had any side effects.

After an intense debate in the Senate, a bill making it mandatory that all newborns with the "faulty gene" be given Allergycure passes by a vote of 85 to 15.

"Yes, there are some complications to Allergycure that must be worked out," said Senate Majority leader Alec Baldwin Jr. "But this bill will prevent millions from suffering from asthma, prevent the need for spending billions on asthma medications and hospital stays, and eliminate thousands of annual deaths from "faulty gene" related diseases."

In a ceremony on Christmas Eve, President Will Smith signed the bill saying, "This is a great day for pulmonary medicine in America, and perhaps the greatest Christmas gift to current asthma sufferers. What we have proven by me signing this legislature is that gene therapy may some day cure the most severe diseases that ail us, not just asthma"

Along with neonates, the bill allows for all current sufferers of allergies, eczema or asthma to voluntarily report to their doctor to receive the medication. However, there is no guarantee that the medicine will work for them.

Dr. Emery Yoe of National Jewish Medical and Research Center said, "Allergycure can be given to current asthma and eczema patients to prevent any further allergy complications? This might be great for patients with mild cases, but it will not cure asthma, especially if the patient has permanent lung damage from previous asthma attacks."

He said, for example, that if a person is exposed Rhino virus, he will still get a cold and his body will still attack the virus, and this may result in bronchospasm. The same will hold true if a person already diagnosed with asthma is exposed to bacteria; Allergycure will not prevent your body from fighting off the infection.

Some children, Yoe explained, will still develop asthma. "While science is advancing fast in this area, you will still have a few children born with immature lungs that lend them to being susceptible to developing asthma later in life, and you will still have some children exposed to certain bacteria or, for example, the Rhino Virus, where they will develop pulmonary complications and lend to the inevitability of asthma later on. And even though some will still develop asthma, they will not have allergies, which will bode well for them."

He said that research is still being conducted to "completely eliminate asthma, although it may take some years. Yet, still, Allergycure will mean great things to many."

On this great day, Will Smith proclaimed in his speech to the World, "Scientists predict that by the year 2049 there will be no children under the age of 10 with asthma, and all other asthmatics will have 2,600,000 fewer asthma attacks, saving the economy over $300 billion in medical costs. And, most important, preventing milions from suffering.

"And," he continued, "scientists predict that by the turn of the next century, asthma will be completely eliminated. This is something we can breathe easy about."

Asthma: A cure may be on the horizon

Despite the vast improvement in medical technologies that have improved the quality of life of asthmatics, scientists still know very little about why certain people develop asthma. But new research may yet lead to a cure.

What they do know is that asthma rates since around 1900 have skyrocketed. In fact, just within the past 20 years asthma rates have increased over 250%.

For many people, asthma, allergic rhinitis (hay fever) and dermatitis (eczema) go hand in hand. In 2006 the faulty gene that causes these diseases was isolated, which brings about hope that some day a cure may be found.

Despite the fact that only people with the "faulty gene" can develop asthma, eczema or allergies, the reciprocal is not true: not all people with the faulty gene will develop these illnesses.

Children who were exposed to Rhino virus had a 6% less chance of developing allergies, and those exposed to dogs had a 50% less chance, and those exposed to farm animals such as pigs, grew up in large families, had cats as pets, spent time in day care were also less likely to develop allergies.

Likewise, in less developed nations where children have a greater likelihood of being exposed to "poor hygiene", asthma rates are almost insignificant. Thus, asthma is basically a disease of the developed world: the United States, Western Europe, Australia and New Zealand.

In 1989, these and other observations led to one scientist developing the hygiene hypothesis, which simply states that by not being exposed to bacteria, viral infections and endotoxins has increased the likelihood that children with the "faulty gene" will develop some form of asthma.

According to Dr. Joseph Mercola, "exposure to certain types of infectious agents and endotoxins is essential for maturation of the immune system, and that less exposure leads to an imbalance of certain types of immune responses."

And this leads to the body developing antibodies against innocuous allergens and basically attacking itself, and causing the owner of the body to suffer.

Right now the goal is to prevent and treat the symptoms. Someday, however, there may be an outright cure for asthma, or at least a way to prevent future children from getting the disease.

The good and ridiculous of TV

“You must lose weight, lots of weight, or you will die within a year.”

That’s the good.

Okay, so it’s not so good if you are the one being told this by your doctor. But it is good for America that this 750 pound man is allowing TLC to do a documentary on him so kids have a chance to see up close how much life sucks when you don’t take care of your body.

I also love the show my wife calls, “the fat people show.” More accurately, I think that would be “The Biggest Loser.”

On this show, a bunch of really fat people get together on a ranch with a couple trainers and literally work their asses off trying to lose that weight. This show is great because the fat people don’t get to cheat by taking pills, getting liposuction, or any of the weight loss surgeries like gastric bypass (I'm not implying those things are bad).

Nope. They all lose their weight the old fashioned way: they work it off. They diet, they run, they lift weights, they run up steps and hills.

I like documentaries like “Hogan Knows Best” and “The Ozbournes.” I don’t want my kids to grow up and be like them, and that’s why I want my kids to watch these shows. The way the Ozbourne kid’s treat their parents is pathetic, especially with their f-this and f-that’s.

And the way Ozzie acts is a reason #1 not to do drugs.

Likewise, watching the greatest wrester of all time running around his neighborhood chasing noisy dogs and complaining about his neighbor’s complaining about the noisy dogs makes the champ look like a retard. All the more reason not to become rich and famous and have too much time on your hand.

Hello. Get rid of the dogs.

Speaking of too much time, look at how spoiled some of these Hollywood actors have become. If having spoiled rich actors and singers on the headline news instead of actual news is drawing young kids to the news, then great. I want my kids to see what happens when you don’t take responsibility for your actions.

Did you see Paris Hilton crying when she was told she had to go BACK to jail. Look, driving drunk is bad. Driving drunk a second time is even worse. And, just because you are a rich celebrity is no reason for you to get away with breaking parole.

Grow up Paris. Yes. I want my kids to hear about what she did, and see how stupid she looks when she’s acting like the spoiled brat she is.

American Idol is good for America. I love Simon Cowell. I know many people say they hate him because he is “so mean.” But, all he’s doing is telling these kids what their mommies and daddies should have told them long ago, “You can’t sing.”

American Idol is exactly what happens when teachers use positive reinforcement rather than simply telling kids the truth. I mean, when you get a job and you suck at it, what boss is going to say, “Well, you got all the mail delivered to all the wrong mailboxes, but, hey, you at least tried. I’m confident you’ll do better tomorrow.

Heck no. You are fired.

You can have "feelings" for the people who hear that on Donald Trump’s show, but it’s good practice for the real world.

The Real World on MTV is about the dumbest show on earth, but its still a good lesson on how not to live.

The History Channel is awesome. So too is Discovery, National Geographic, The Animal Network, and all the news networks, even if they are bias. Hey, at least you can’t help learning something from watching any of these channels.

Kids cannot go wrong with the Cartoon Network, Nick and Disney. Sure, Sponge Bob Square Pants may not be all that education, but neither was Bugs Bunny when I was a kid and we still enjoyed it. Speaking of Bugs, has he finally gone off the air?

Square Pants is criticized today like Bugs was in the 1940s when a conservative America complained about too many guns and falling from high cliffs.

While the cartoon networks are good clean fun for kids, so to are ESPN and Fox Sports for adults -- and kids too. When I was a kid I craved to watch all the Tiger games, and instead had to listen to the great Ernie and Paul. Not that I didn’t like Ernie and Paul, but TV is so much better.

I even like the Food Network, because my wife loves to cook. And, I’m getting fatter by the day because of it. Gosh, I suppose, the way my belt is tightening up, I might be my own good example for my kids of what not to do.

The ridiculous would be MTV. What ever happened to the M part. You know what I mean. They used to play music 24-7 when I was a kid.

Any gossip channel is ridiculous. CSPAN is great, but so boring it’s not something anybody would waste their time watching. Why not simply watch a news network to learn the same thing. Okay, so the news network is bias. Well, if you have the time, go for it.

The CBS, ABC and NBC evening news. Why do we need them anymore?

I don’t want to dwell on the ridiculous, because so many people do this all day, and it gets old.

But I think you get my drift.

Let’s get back to the good.

TLC, I think it was TLC, had a show my daughter calls “The baby show.” You know, it’s the one they show women having babies. In the information age, you can’t keep things from your kids the way my parents did.

I let her have the remote, and all of a sudden she’s watching an this adult show. I mean, not just one day, but every day.

“Want me to turn the channel for you?”

“Now, I like this.”

Okay, no big deal. I think.

Later that night:

“Spread your legs apart, Mommy, and let my baby sissa out.”

I suppose, in the old days, we’d be concerned about all this.

Not in 2007.

Why do we keep learning?

Sometimes I think "What good is going to do me to keep studying and learning the way I do?"

I am always studying respiratory stuff, for example, and it's not likely I will ever be more as an RT than I am right now. The chance of moving up the ladder are slim to none, especially considering the boss where I work is the same age as me, and he's doing a good job.

I'm certainly not going to move to another town, and RT head jobs are rare anyway.

So, my question is, why do I keep myself so informed, especially when the doctors here at Shoreline want me to be no more than a button pusher. They have made it clear they don't want to utilize my "untapped" potential.

Why do I read history? Why do I read up on politics? I mean, it's not like I have more than one vote, and that I'm going to make a stand against some issue. And my knowledge and opinion of these things has made no difference in the amount of money I make.

No matter what I do, where I am in life, I have always enjoyed learning. Yes, I have made some bad decisions, but obtaining a bachelor's degree in business that I do not use, or an associates in journalism that I do not use, is NOT one of my mistakes.

My mistake was that I obtained my degrees in the wrong order. By the time I got my RT degree I had no energy left to do more. And then the family came.

The knowledge I've obtained is always good, as I can always use it one way or another. For example, my journalism gave me the ability to write, and my advertising degree taught me to keep things pithy.

But, this takes me back to: "So, why do I study?"

I've come up with 4 reasons:

1. Learning itself is fun and entertaining
2. It's fun when people ask me questions about things because they know I keep up.
3. If the opportunity comes up, I'll be ready. Who knows what awaits me in my future.
4. My son emulates me, and when I see him reading, when he asks me question to stump me, I feel joy in knowing I'm having a positive influence on him
5. Perhaps I can use this knowledge in the next life.

I think it was Socrates who believed it was important to continue learning all the way to the end, because he believed he would use the knowledge in the next life. I believe this is also stated in the bible, although I'd have to do some research to find it.

As an RT I see people reading when I know very well they know they are going to die soon. Sometimes I ask myself, "Why is this person reading? What good is it going to do them?"

Now I know. It's the same reason why my parents and grandparents never stopped being a good example even after their kids had grown.

I suppose you could ask, "Why do I blog when so few read what I write?" As I think of that I come to the same conclusion as above.

My grandpa was diagnosed with cancer. He was in pain months before he died. However, when he died he was making a list of things to do.

My grandma had MSA and her body slowly weakened, but even after she was almost limp in a wheelchair she verbalized poems for my aunt to write down. She lived to the end.

I see this all this all the time with my patients. I respect that.

The bottom line, though, is reading is fun, and learning is fun, blogging is fun, and, more than likely, I'll continue to do it until the day before I die. Think about it.

We are all vulnerable

Today is my 8th day off in a row. It hasn't actually been the most ideal vacation since it took spending 3 nights in the hospital to get days off, but I'm feeling quite refreshed none-the-less.

Even though I wasn't even close to deathly ill, I came home last Thursday and appreciated my wife and children more so than I normally might. My job allows me to spend quality time with my family, but I spent even more quality time with them.

I suppose I came home with a growing appreciation for what little I have. Not that I didn't appreciate it before, but I appreciate it more so now -- at least for a while.

I also feel vulnerable. I think that's a normal feeling people get after spending a few nights in the hospital. By vulnerable I mean not feeling as though I'm going to live forever, and I need to take care of myself so I'm still around when my kids have kids and their kids have kids.

Perhaps all people who work in a hospital have some sense of vulnerability, since we see what happens to people when they don't take care of themselves on a daily basis. Despite this, however, we still tend to turn a blind eye to this. For lack of a better word, we become numb to it.

We become numb to it despite all the people who tell us, "If I'd have known I was going to live this long I would have taken better care of myself."

Yet, how many among us still continue to smoke, to drink on a regular basis, or eat excessively? How many among us are going to fill up on all that candy sitting around the nurses stations this year? How many among us are still going to pig out at all those Christmas parties until we are bloated?

The truth is, most of us will. And even while I had been working out in an attempt to get in better shape before becoming an in-patient last week, I had been slacking to some extent. Yes, I am in better shape than most people my age, but I am still overweight. I am still vulnerable.

We all can think of many among us who smoke, drink and eat and be merry all day long or at least "socially" and never seem to have any consequences to this. While I do all of these (except smoke) on occasion, I have learned I have bad genes that won't allow me to not suffer any consequences.

Not that this would have prevented my most recent hospital visit, because my doctor said it was simply, "luck of the draw" that I got H. Pylori in my small intestine. But still, people with good genes would not have been hit this hard.

There is no way anyone of us can be perfect. There is no way to avoid all the temptations proffered to us this time of year, so long as we are aware of what we are doing; so long as we are aware of our vulnerability.

I think it's this vulnerability that we feed when we educate our patients on what they need to do to improve their lives. While most of these people will follow what we say to a tee while they are still feeling "vulnerable" after their release from the hospital, they will soon forget, as most of us forget too as time passes by.

They will forget until they get sick again. They will forget until they get so sick they are forced to change their lifestyle, because their disease process will no longer allow them to smoke, or to drink, or to eat excessively.

It is important to enjoy life. It is also important to at least be aware that we are also not impervious. We are all vulnerable.

Click here for my experience with vulnerable.

A long agonizing, miserable night with asthma

Growing up with asthma: Chapter 3

I had been short-of-breath like this before, and even had dad take me to the hospital once or twice, but this episode was happening right now. I could make it through the night, I was sure I could.

Time had passed, but I was unsure of how much. I might have slept, but I wasn't sure if I really did. I didn't have a clock. I looked out the window and it was pitch black. How long until the sun comes up? I hope it's not long.

I could hear myself wheeze.

Mom and dad and my brothers were long asleep, and I tried to rest with my head high on the head board.

My mind wandered. For a short while I must have fallen asleep, and when I woke up I was reminded of my misery.

Was I breathing okay for a while, because I sure feel like I can't breath now? How could I have fallen asleep like this? Why couldn't I have just slept until the sun was up so mom would be up and I could tell her. I should have just told her last night.

On the ride home I thought I was feeling better, and dad and mom seemed so happy listening to Christmas music. It was easier just keeping quiet. That was stupid. Stupid!

I'm going to tell her now, I've made up my mind. I can't handle this anymore.

A tear trickled down my cheek.

Calm down. I have to calm down and I'll be fine. I rested my head on the headboard again, and tried to concentrate on anything other than my breathing. I thought of Christmas. I thought of all the presents I'd get.

I woke up again from a nightmare wheezing and sweating. I fell back to sleep and dreamed I was at Doctor Gustafson's office breathing fine. Then I woke again. I looked at the window; it was still dark out. Oh, come on! Why can't it be morning already?

It struck me then that I was still tight. I tried to concentrate on other things, but it was no use now. The time had come for me to tell someone. Mom's going to be mad. I don't care anymore. I can't stand this.

I knew now that I needed to go to the hospital. I needed that shot that I knew would make me feel better instantly.

I sat on the edge of the bed, placed my arms at the edge of the bed by my sides, held my shoulders high, and tried to force air into my lungs: it would only go in half way, if that. I tried again and again and again: it was no use.

I through my fist through the air. I hate this!

I stood and opened the window. The air out there was cold, but refreshing. I still couldn't breathe though. This worked earlier. Why not NOW?

I stood, leaning hard against the window, peering into the pitch black backyard for what seemed a long time, and, when relief still didn't come I made a final decision: this is it, I HAVE to go.

(For part IV click here)

Here's my advice for hospital patients

Based on my own experience as an in-patient earlier this week, I've come up with a few bits of good advice for anyone going to the Emergency Room, or who might be a potential hospital in-patient.

1. Know your rights as a patient
2. Make sure you have someone with you.
3. If you think a therapy might be ridiculous, you may be right
4. Know you have a right to refuse therapy.

As you know from reading earlier posts on my blog, there are a lot of frivolous doctor orders pertaining to respiratory therapy. Knowing this, I ask nurses all the time if they get stupid orders, and usually they tell me they do, but can never think of anything off hand.

With no disrespect to doctors, I know they have a tendency to write orders out of habit and not necessarily because they are all necessary. Now that I've been that patient, I saw first hand what some of these frivolous orders are.

After I was told I was going to be admitted, and after I was stoned on phenergin, my ER nurse approached me carrying a foley kit. "The bad news is we don't have a male working who can put this in."

"I...don...crrrr..." slipped from my lips. I was trying to tell her that I didn't care who put the damn thing in, it wasn't going to happen.

Thank God I followed patient rule #1, because my wife was sitting right there and refused for me. She made sure the nurse was aware that we had a pact that the only time anyone would stick a foley in me is if I end up on a vent.

I like to call it a DNC order: DO NOT CATH.

"Why do you need to put a foley in him," my wife asked. "He can get up and pee."

"I don't know," the nurse said, and tossed it aside.

My wife added, "Just make sure you keep good track of your pee."

That was the end of that. In retrospect, I think this RN wanted me to refuse; that she knew it was a dumb order, but out of respect for the doctor she couldn't come right out and say it. I suppose this was not unlike me when I know a patient doesn't need a treatment.

Later that night, after I was admitted to the floor, a nurse woke me from a sound sleep. "I have to put these on you."

"What?" I said, groggily.

The RN said, "Sequential compression devices (SCS) to prevent you from getting clots."

"What do I need those for?" I know what they are for, but why do I need them?

"It's protocol to prevent clots." Clots? I can flip myself over no problem. And I didn't get clots when I slept in my own bed just last night.

"Okay," I said, "I'll try it." Why the hell am I agreeing to this? This is ridiculous.

Those damn things made my legs sweat, were excessively loud, and were extremely annoying. Not only that, but they made it nearly imposible for me to sleep on my side, which is how I like to sleep. These are coming off as soon as that nurse gets back in here.

"Why do I need these things again?" I said when she checked on me a half hour later with a syringe in her grasp. I proffered my arm.

"We have a standing protocol that all patients have to get these to prevent clots." She inserted the syringe into the IV.

"Every patient has to have these?"

"Yes."

"Well, that's ridiculous.

"I know." She's agreeing with me. That's it. She knows it's a stupid order.

"I thought it was just respiratory therapy that got stupid orders." Okay, shut up man; you're crossing into grumpy patient category.

She didn't say anything, finished her work on my IV. The machine beeped momentarily as she pressed a few buttons, and then she stood by the side of the bed.

What? Are you waiting for my order. "Then take these things off. I'm a young guy and I don't think I have a problem with clots."

"Okay," she said, and pulled the blankets from over my feet without hesitation. She's not argueing with me. That's reassurance enough. I heard the rip of the valcro as she stipped those things I couldn't remember the name of off.

I felt fresh air upon my ankles. Ah, that feels good. I rolled over and within a few moments was having pleasant dreams again.

"Do you think I need those things," I said to my wife when she arrived after breakfast the next morning.

"No," she said, "but I know sometimes doctors write orders just out of habit."

"I kind of figured that."

"You know you almost agreed to a foley last night? You were lucky I was here."

"Thank God for you."

She told me she remembered a time when she was working in OB when the doctor ordered a cath on a lady. She approached the doctor. "Why does this patient need a foley?"

"Oh," the doctor said, "I just wrote it out of habit. I'll DC it."

Dr. Tree said nothing about me not having a foley when he checked on me that morning. I wondered if he even knew he ordered it.

I'm home

I'm back home. Other than Monday when I was feeling miserable enough to go to the ER it really wasn't too bad a visit. As an RT at Shoreline I like to think we excell at customer relations, and as a patient I got to see first hand how great we are.

On Tuesday Doc Tree did a scope of my stomach and all I remember was how great it felt to be drugged up. I remember lifting my head off the pillow feeling really good.

"Don't fight it," a voice said.

"I want to enjoy it," I said, but it probably came out as, "ee ooo iiii."

Next thing I remember is I'm waking up. "When you guys going to get started?"

"We're done."

"I'll do this any time you want to practice," I was told I said. "I'm going to grade all you guys on a scale of 1-10. I give all you nurses a 10 and Dr. Tree a 20."

I wonder what else I said that nobody wants to tell me.

"You were pretty funny," my wife reassured me.

The rest of that day I was in happy land, so I didn't care about being there. I slept most of the day and night except for when they were drawing my blood every 6 hours or waking me up every 4 hours for vitals. And everybody was great.

The next day I felt great, but learned my hemoglobin dropped from 12.4 to 9.4 since I arrived on Monday and Dr. Tree wasn't going to let me go. I didn't get grumpy until Wednesday when I was looking forward to going home and the doc told me my a.m. hemoglobin had dropped to 8.6

Even though I had a list of things I wanted to discuss with him, all I said was, "Okay." I was feeling too grumpy to discuss things at this point. Like I wrote the other day, there is nothing worse that when you feel fine and they won't let you go home.

And, as I do when I'm working grumpy (which isn't too often), I keep it to myself. I wanted to say, "This is bullshit," to the nurse, but she was nice and I didn't want to ruin her day too. Besides, she was orientating and was only on her second day.

My bad luck

I think I jinxed myself all this talk about being a patient, because I am one right now. I'm bored out of my mind, so I snuck out of my room to the RT cave. The worst part about being in the hospital is when you feel better and you still have to stay here "one more night."

All last weekend when I was working I wasn't feeling the best, and before I left work Monday morning I was really feeling miserable. The ER staff complained that I was taking too long to get down there, but I just didn't feel like rushing down there.

Little did I know this little bacteria decided to settle in my Duodenum and cause a bleed there. No wonder I was feeling so miserable, all this blood was filling up my stomach, and when I woke up on Monday it all came out both ends -- frank blood.

I wabbled into ER, bipased the front desk and triage because I work here and I can, and I said, "I need a stat IV and something to keep me from puking."

Well, here I sit all day, perfectly fine, watching TV all day. My Hemoglobin is hanging around 9.0, so my doctor won't let me go home. My kids weren't too thrilled about that. Neither was I, to be honest.

"How the hell did I get that?" I asked the doc.

"Just luck of the draw," he said.

"You mean bad luck," I said.

Well, I get spoiled here anyway. More later.

A tough evening in a smoke filled room

Growing up with bad asthma: Chapter 2

In 1980 most people didn't think twice about smoking in front of others, let alone what harmful effects it might have on kids. My family was no different.

Grandpa was sitting on the day bed of his sitting room, a cigarette dangling between two fingers. I watched as the smoke swirled above his hand, polluting the air. In a way I enjoyed the smell of cigarette smoke, but my lungs hated it. My throat burned. My head ached. My chest was tight.

Someone flatuated, and grandpa laughed. I watched as his body bobbed up and down as he did so, and then he put the cigarette to his lips, inhaled, and blew his smoke across the room where it lingered in the stale air. No one seemed to notice this but me.

I heard a smack, and I turned and saw that Uncle Ted, who was sitting on a bench by the window with his baby girl on his lap, was cringing away from his wife, who sat next to him. She was blushing. He was laughing. I assumed she smacked him.

Uncle Tommy was sitting in a faded leather chair facing oposite me, and all I could see of him was his foot as it dangled over the thick arm of the chair . I could hear his laughing over the laughter of the others.

I was standing in the doorway trying to breathe air from the hallway that was barely fresher than that in the room. My shoulders were high. I was calm. I was breathing slowly, but with difficulty. I did not want anyone to know I was in distress. I was ten-years-old.

Aunt Mable, who had been curled on the floor near her brother Ted, stumbled across the room and darted past me into the hallway, laughing the whole way. I could hear her laughing all the way down the stairs, only to cease with the slamming of a distant door.

My Great Aunt Dolly, who was sitting on the tile in front of the crackling fire in the fireplace, was rolling side to side with laughter. Aunt Torri was sitting on the floor between the leather chair her brother Tommy was slouching in and the TV, was laughing so hard she fell over onto her side.

My dad and mom were sitting on the bed to the right and left of grandpa. Mom had a smile on her face, but she wasn't laughing. I was hoping she had had enough of the foolishness of dad's siblings and would want to go home, but she made no effort to move. She looked comfortable wrapped in one of grandma's afaghans, and more than likely was in no hurry to go back out into the blizzard that was raging outside.

I wanted her to look at me at least and notice I was miserable, but she didn't do that either. I was on my own. I certainly wasn't going to ruin the evening by telling them I wanted to go home.
After the laughter boiled down there was silence in the room a moment, then my dad said, "You should have seen dad in action today," he was smiling cheek to cheek, peering at his dad, who chuckled, and puffed on his cigarette.

I heard a bang from down the hall, and turned and saw my brother Devin rush from a room. "Come on, Rick. We're gonna play hide and seek downstairs."

"I can't." I whispered, hoping no adult heard me. The last thing I want to do is explain why I don't want to play. I turned back around, and saw that none of the adults I could see were paying attention to me anyway. They were all looking at dad. Good.

"So anyway," dad said, "It was the God Damned ugliest car you'd ever seen." He cowered as mom reached around grandpa and made to slap him. Grandpa, it seemed anyway, pretended not to notice.

"Watch your mouth, Brett!" She meant business. There was no swearing when mom was around.

"It was a Gremlin," dad continued, " if that's not the dumbest name for a car to begin with, and it was light green with this ugly orange stripe down the side."

I watched as grandpa dumped the butt of his cigarette in his beer can, and I felt a moment of joy because, I assumed, the air would be fresh now for a while. Then I heard the flicker of a match, and smoke billowed into the air where Aunt Torri was sitting. She blew out the match and a new cloud of smoke wafted up to mingle with the cigarette smoke. For a brief moment the sulfurous incense of the match seemed to mask that of the cigarette smoke.

She set the wasted match into an ashtray and tossed the match book to Aunt Dolly, who proceeded to pluck a Marlborro from a basket, and then she handed the same match book to my dad, who burried it in his grasp. I took a difficult breath of hallway air, but couldn't prevent myself from breathing in some of the smoke that was now lingering thick and fog-like in the room.

Dad said, "And dad said, 'Son, ain't that the the God damned ugliest car you'd ever seen?' and I laughed because that's exactly what I was just thinking. And here it we had just parked it in the middle of the showroom." He plucked a cigarette from a pack in his breast pocket, and stuffed it into his mouth.

I heard a another bang behind me, turned, and watched as my brothers rushed from a room, down the stairs. "Come on, Rick!" The shout of one of my brothers reverberated through the house.

"Anyway, it wasn't five minutes later," dad continued, talking with the unlit cigarette dangling from from his lips, "and this costumer came in. Dad," he paused, seemed to snicker off a laugh, and lit a match. "Dad walked this guy over to that ugly Gremlin and said, 'Now, aint that the most beautiful car you'd ever seen."

Slow breath in through the mouth and out the mouth. It was very thick air, so it seemed. My chest burned as I inhaled.

Laughter filled the room.

Dad cooly chuckled as he lit his cigarette, took in a deep breath, and blew smoke across the room. He chuckled again, then added, "He sold that car less than an hour later." Even mom joined in the laughter this time. But not dad and grandpa; they were too cool to laugh. They both smiled as they puffed on their respective cigarettes.

Time passed. Listening to the stories of the adults made me forget my conundrum, if not for a short while. Then it all came back to me as I heard mom's voice.

"Do you want to sit up here," mom said to Aunt Dolly, who sat Indian style on the floor. Yes, get up mom, and come over by me

"No," Aunt Dolly said, "I'm doing just fine here on the floor. Besides, it feels good by the fire." Oh, she just wants to sit by the fire. Come on mom! Look over here! I felt a sting through my arm as I hit the door frame with my fist.

I heard grandma's voice from the part of the room I couldn't see from where I stood, and then watched as she walked around the leather chair, past me and down the hall. I heard a door shut.

I felt a breeze as Devin rushed into the room. He had a fresh beer for grandpa. Kr-chick went the beer tap. Grandpa tossed a quarter into the air and it plopped onto the floor. Devin bent to pick it up. Grandpa took a swig of his beer. Moments later my older brother Bear popped into the room with more beers, and handed them out to the men in exchange for quarters.

"No running!" I heard grandma say from behind me as Devin rushed past me again and down the stairs. Grandma came into the room with a box. She sat on the floor and set the box next to her and removed the lid. She started handing out pictures.

Oh, come one, I thought as mom took a pile of pictures and slowly flipped through them, I just want to go home. Come on! Can we just go! COME ON!

Once she was done handing out pictures, grandma came and stood by me. "Why aren't you playing with your brothers?" Then, as though she had come up with an answer to her own question, she said, "Come with me."

I followed her through the room, over legs and around chairs, to a connecting room where her bed was. My cousins Tommy Jr and Tocca were playing with something on the other side of the bed, giggling all the while. On this side of the bed were cousins Jewels and Jan lying on the floor coloring in a Bugs Bunny coloring book.

Grandma walked me around the bed, and moved a few things around the top of an antique dresser. She was looking for something, and now she found it. She picked up the object and proffered it to me: it was a wooden puzzle. “I picked this up at a yard sale the other day," she said, "I was thinking of you.”

She told me I could sit on her bed and play with it. However, she had already told all the other kids they were not allowed on the bed. That was her rule.

You're letting me on your bed because you feel sorry for me, I thought, and opted to not get on the bed.

"Go ahead, Rick, it's a fun puzzle."

Knowing I had no other options, I hopped onto the bed and pretended to play with the puzzle. It was hard to feign at this point that I was not short-of-breath, but I managed.

As soon as grandma was back in the other part of the room I heard a boom, a rush of laughter, and noticed Uncle Tom was rolling around the floor wresting with Torri. At first I thought they were really fighting, but then I realized they were both holding their guts. They were laughing.

I started playing with the puzzle, but stopped as my brothers rushed into the room in a loud furry and jumped onto the bed.

“You can’t be on here,” I said. They didn’t listen. A moment later all the boys were on the bed, and I was sitting on the floor. My chest was now itchy tight, and I could feel the wheezes. I really had to work at making them not audible. I sat leaning against the wall behind the leather chair.

I could smell the smoke over the smell of antiques, and I could feel my throat burning. I made to wipe snot away from my nose, wiping it on my sleeve, eyeing grandma as I did so, knowing she'd say something if she noticed. My nose burned.

I poked my head around the leather chair hoping no one would notice me, and listened to the lighthearted conversations and the laughter. I didn't care about that stuff, what I was interested in most was my mom. I knew she usually would get to the point she'd want to leave and would hint to dad it was time. Usually she would do this and nobody else would want to go.

This day, when I really wanted to leave, she didn't say anything. She just continued looking at her pictures.

"You want to look at these?" I looked to my right and saw Torri was holding the stack of pictures to me.

"No thanks," I half grunted. I wanted to, boy did I want to look at pictures, but I wanted to go home even more. I thought if I were home I'd be able to breathe fine.

I was wrong.

(For part III click here)

The real RT Cave; it's the new cure all

I often type in Respiratory Therapy Cave when I'm looking to get to this blog. One day I noticed that there were other RT caves. I looked into it and found something interesting.

It was observed in the 18th century that people who worked in salt mines in Europe did not get respiratory illnesses. Soon, people with respiratory illnesses would travel hundreds of miles to sleep in one of these caves.

It was later determined that breathing the salt aerosols prevented respiratory illness, and worked as palliative therapy to improve respiratory illnesses such as asthma, COPD, pneumonia, allergies, CF, rhinitis, etc. One sight claimed that breathing in salt aerosols is a natural cure for many of the diseases that ail us, including cardiac, skin rashes, etc.

Now, it's too difficult and too costly for people to travel to one of the natural salt caves, so fake salt caves were invented to give people easier access to them.

Not only that, some companies decided that was still too inconvenient, and invented a machine that allowed people to use salt therapy right in their homes via salt lamps. You have them running all day in your home and, wallah, you are receiving continuous salt aerosol therapy.

One company invented a salt pipe, which is a "handy device of self-care based on age-old Salt Therapy. It is a salt inhaler... for providing convenient way to improve and maintain your breathing at your home. (It) provides an affordable and a convenient way to obtain the advantages of salt crystal therapy.

I have might doubts as to the verity of this, considering all the sights I found about it were companies seeking to make a profit. Not only that, I'm sure if it were true, I'm sure we'd be using those salt pipes right here in the hospital.

When doctors get wind of this, Halotherapy might be the wave of the RT future. This therapy, called Halotherapy, is known to be safe and effective. It is a "cure all" just like Ventolin. Once doctors catch on to this we'll be pulling out the pipe after we put the neb in its bag.

It looks like this is the cure for respiratory illnesses we've been looking for. But, why don't we learn about this in respiratory school? Why don't we learn about it from the NBRC, or read about it in respiratory journals? Why do we not learn about this when it would benefit so many people?
The answer is simple: it would put us out of a job.

It's a conspiracy.

Update 3-2-2011

Salt therapy is now catching on in the U.S. For more information click here.

Asthma patients: I've been there, done that

Growing up with bad asthma: Chapter 1

Though this is not why I became an RT, I can tell you that I have more empathy for my patients than most of my coworkers here in the RT cave. Unless you are like me, I probably have more empathy than you too.

I say this not because I'm a more loving person, but because I've been there, done that.

When I was a kid I visited the ER for asthma attacks fewer times than I should have, and I spent at least 2 weeks a year as an in patient more often than I wanted.

In the next few weeks I plan on publishing some pithy posts about what it's like to grow up with bad asthma. If you ever had similar experiences as me, I'd love to hear about it because I know I'm not the only one.

It is abnormal to be short-of-breath (SOB). I know I'm stating the obvious, but I think it's important to state that mainly because I was SOB many times as a kid and nobody noticed. Therefore I suffered unnecessarily. Why? Because it's abnormal; and people who have never been SOB don't think to recognize that someone else is SOB. Why would they?

My parents rarely recognized that I was SOB when I was a kid, and I never thought to tell them. I mean, think about it, I was just a kid, how was I supposed to know it was not normal to be SOB. Therefore, I suffered more than I should have. I didn't go to the ER many times that I should have, especially when I was really little.

I remember one time I was about 8 YO I was really SOB on vacation, and my parents didn't bring my medicine. Actually, they left the responsibility on me, and I forgot. But, in retrospect, they were my parents so they should have made sure I had my medicine. Right?

No parents are perfect. I'm not trying to make my parents look bad. I'm just stating the truth here as I remember it. My memory could be flawed.

I didn't want to ruin everyone else's vacation, so I sucked on cough drops all night. I remember I almost choked when I fell asleep with one in my mouth.

Even when I got older, and my rescue inhaler ran out, I would be reluctant to tell my mom I needed a new inhaler because, well, she just bought me this one 2 weeks ago, and it was supposed to last 6 weeks, or at least a month.

Then I finally got the nerve to tell her I needed a new inhaler, but didn't tell her I was SOB because I didn't want her to know. Now was that stupid or what? But I was a kid.

I remember staring out the window waiting for mom to come home. Dad was home and he had no clue as he watched his football game or took a nap. My brothers were playing in the dusty basement, but that's probably how I got SOB in the first place, so I didn't want to go back down there to play with them now, even though they kept pressuring me to do so.

I remember staring out the window for hours waiting for her. I was calm, because I was good at hiding I was having trouble. And, so you don't think my dad was a bad guy for not observing I was in trouble, I was really good at staying calm and not letting others know. I was a professional asthmatic.

And when I went to bed that night, my inhaler was right there in my grasp. It stayed there even after it was empty a week later, and my stress about telling my mom it was empty was renewed.

Here's my favorite story: I remember when I was a teenager going outside and playing football when smoke was billowing from neighborhood chimneys and having an asthma attack while playing and not quitting. I didn't want to disappoint my brothers.

I would take breaks occasionally, walk into the house gasping for air, try not to make it obvious to my parents as I walked through the house to my bedroom, take a quick treatment, and go back out for more punishment. I might repeat this 2 or three times.

I just wanted to be normal. I wanted to play football. I was needed to make the teams even, and refused to be the one to disappoint. I was not a quitter. Stupid? Maybe. But I had fun playing football and I don't regret it.

Today I'm on preventative medicines and live a normal life. I think there is no excuse for anyone not living a normal life. Asthma should rarely be used as an excuse not to do something, especially with all the new medications. However, that doesn't mean you shouldn't avoid certain things, like a dusty basement, or a friends house that has a pet you're allergic to.

Then again, even the best of us asthmatics conveniently forget we have asthma sometimes, and do things we know we shouldn't, like clean a dusty basement, or visit that brother who has 6 cats and 2 dogs and a huge musty basement you know very well you're allergic to.

While I'm on preventative medicines, I still use my Albuterol at least 2-3 times a day. However, when I clean my basement because no one else will, I often have a reaction, and that entails me to abuse my inhaler for 2-3 days until I get back to normal.

I know some of you will cringe at this and tell me I should go to my doctor instead of treating myself, but if you've had this disease as long as me, you learn how to treat yourself. Who wants to go to the doctor every time you have an attack. Not this guy.

I know there have been occasions I should have at at least seen my doctor, but I'm so used to it I just suffer through it. My wife teases me that one of these days I'm going to be an end state COPD patient on oxygen. It's possible I suppose.

And I've never missed work because of it. I might if I was a construction worker, or if I worked in a musty, dusty factory, but I was smart and became an RT where I get to work in a nice, clean environment.

So, when I find an inhaler hidden in a side table drawer of an asthma or COPD patient, I'm not one to tell them they can't have it. I might educate them, but I won't take it away. And this is one of the reasons I wrote Rescue bronchodilators: Here are my unfettered answers to all of your questions about them a few weeks ago.

Just now I was called down to ER to care for an asthma attack. The order was: Duoneb now and then in one hour. I cringed. What a stupid order. I'm nice and just give the treatments as ordered, but it's not at all how I would deal with this patient. I wonder if that doctor has ever been SOB.

So, when I say I understand my patients, I really mean it. When I say I know when a patient needs a treatment, I really mean it. When I say Ventolin is a safe medicine, I really mean it. I've been there, done that.

For part II click here.