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Friday, August 1, 2008

Imagine: $25million NOT to work

Brett Favre was offered $20 million to NOT work. He was offered $20 million to not sit on the bench and back up Aaron Rogers. He was offered $20 million dollars to not offer assistance to the Green Bay Packers from the bench.

Let's see, he could sit on the bench and make $20 million , or he can do nothing not sitting on the bench. Or he could pray the Packer's GM decides on a trade, and he could make $20 million wearing his body out while running from defenders and throwing passes.

Could you imagine if someone offered you $20 million to do nothing. Your eyes would light up. There is no way in hell you would turn down such an offer. You would be foolish to not take an offer to NOT work.

Imagine. Imagine getting paid $20 million not to pass breathing treatments to people who don't need them. Imagine not doing EKGs on people who have hang nails. Imagine not rushing STAT to preop to do an EKG because the doctor forgot to order one earlier. Imagine getting paid to go golfing instead of doing all that.

Imagine getting paid $20 million instead of getting burned out because you are trying to get all your NOT needed breathing treatments done while at the same time getting the treatments done on the patients who do need them. Imagine making $20 million instead of being stressed out about a critical care patient who should have been intubated 3 days ago but the doctor keeps saying, "Oh, he's fine."

Imagine getting paid $20 million instead of getting yelled at by a doctor because you are calling her for the third time because you think a patient should be intubated. You wouldn't have to worry about NOT saying to the doctor, "He's going to have a heart attack if we do nothing."

The gases were this: pH 7.5, CO2 28, PO2 44, HCO3 28 on 100% FiO2 and BiPAP of 14/8.

So, thirty minutes later when the patient has a heart attack, and the on call doctor is the one who gets the next call: "We have this patient who is laboring. Here, we did the gas for you. It is only slightly worse than the one the day shift RT drew four hours ago, and the doctor said, 'He's fine.'"

So the doctor comes in all ornery. I'm telling you, she is yelling at everyone, including the poor RT who is just minding his business doing his job of getting the intubation equipment ready. Then the RT has to put the Vent in the small room while the BiPAP is still running.

Finally the patient is intubated, and the doctor orders a PEEP of 5. The RT says, "Dr. Marge, the SpO2 is only 80% on the settings you dialed in. The patient is on 100%, and I'm certain that sat is accurate. What do you think about increasing PEEP?"



The room went silent.

All I was doing was making a suggestion. I wouldn't have to deal with these types of doctors, if someone would offer me $20 million. For $20 million, I wouldn't have to hold back things I wished I could say to her. I would just say them, because I would have $20 million. If I lost my job, so what.

But I wouldn't have to hold back, because I would NOT be working. I would be making $20 million to sit at home and blog or golf or do whatever I wanted that didn't involve stress.

Funny thing, though, about Dr. Marge, is I was happy that she came in. I knew she was going to be ornery, and I didn't care. Because I certainly didn't want this patient to suffer another night. While she was ornery to me and the nurses, she saved this patient. She is an A+ doctor in my book. It's just too bad for the attitude. The attitude really stinks.

When someone chews you out like that, you have to do everything in your power just to keep your mouth shut. Which turned out to be a good thing, because she was really cool the rest of the evening. After she calmed down, she told me that increasing PEEP was a good idea, and that she wanted me to do a PEEP study.

I was very impressed. Doctors at Shoreline usually just make up a PEEP number. Dr. Marge actually wanted me to do a PEEP study to find the best PEEP. That's the kind of thing that impresses RTs like me.

So, in a word, I'd take the crabbiness any time, so long as we RTs get the respect we have earned over the years. Dr. Marge is pretty cool. In fact, she is the one who talked the other doctors in getting a ventilator protocol here at Shoreline.

However, the stress of her attitude earlier, and the stress of not knowing what to do when the patent's regular doctor was still on call, I can do without. Yet, the PEEP study was fun. What was even more impressive to me, was when DR. Marge determined a tidal volume based on an actual formula, rather than just making it up. This is the kind of thing that makes me love being an RT.

So, a little frustration here mixed in with some joy. It was pretty much a one-on-one situation with this patient all night. Thank God my other patients were stable, and thank God ER was willing to do their own EKGs this night. And they did so with a smile.

Before Dr. Marge had a chance to leave, I cornered her: "I just want to say thank you very much for coming in tonight. I just didn't feel comfortable letting this lady hang on any more. I also, to be blunt, thought she should have been intubated three days ago."

"I agree with you, Rick." She didn't say, but I'm sure she thought it.

I, however, believe she was grumpy to us because of the incompetence of the other doctor. She had to clean up his mess because he was too lazy to come in and assess the patient.

However much I love my job, despite the fact that I do have to endure stress at times, I would probably still come in to work once in a while, if I was offered $20 million NOT to work.

But, if I'm getting paid $20 million NOT to work, I'd probably have no choice but NOT to work.

Is golf considered work?

1 comment:

Heidi said...

What was the patient's metobolic issue that her ph was so basic? A few months back I had a patient that was so spetic that no matter what we did she was chugging along on the vent and litterally sucking off the set PEEP. Her pH was 7.6 and it didn't look good until the flippin nurse decided to call the dr to get a bicarb drip running...the RN was convinced there was a problem with the alarms on the's RR was in the 40's. She blew her CO2 way down to keep up with the bicarb shifting.

Acid it seems is an easier animal to deal with then when the patient is basic.