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Wednesday, July 22, 2009

RT Cave Rule #36: "Come on! Come on!"

I first met Dr. Stevens in one of the most stressful and inconvenient places for a code to take place: the small cat scan room. On the way I took the time to grab my little black airway box and was a few seconds behind the nursing supervisor in arriving. Before even entering the room I could hear the ominous sound of air rushing through the Ambu-bag.

"Come on! Come on!" the anesthesiologist was saying as he was hovering over the head of the bed of the patient of whom he was bagging. "I need a size 8 ETT already," he said with an irritable expression while holding out his hand and wiggling his fingers impatiently.

I set the black bocks down, ripped off the white lock, and fumbled for the right tube. I found it and set to check the cuff...

"Come on! Come on!"

There's only so fast I can get things done here! I thought to say, but held my tongue, knowing such comments only cause more trouble than it's worth. I took the time grab a syringe, inserted it into the cuff line, and pushed air into it. As usual the cuff was fine.

Come on! Come on!" his fingers wriggling like a little boy waiting for the clown in a parade to toss a lump of candy in his direction. "Come on! Come on!"

I grabbed the surgilube, but cast it aside in favor of handing it to the doc. If you want it lubed you can spit a lug on it, I thought. I pushed my way to the head of the bed and held pressure against the patients crichoid, felt the tube slip through the vocal cords, an made my way to grab the tube to secure it, which is usually my job at this point.

"Secure the tube already! Come on! Come on!" He was holding onto the tube, not willing to let go of it. That's a trait of that only anesthesiologists have. All other docs, as far as I've ever seen, are more than eager for RTs to take over grip of the entdotracheal tube.

I pushed my way through the crowded room where all seven folks now peasant were shoulder to shoulder. I grabbed the airway protector and rushed back to the bed. Due to the crowd, the steaming hot pressure down my spine, sweat now dripping from my forehead, this took about a minute to accomplish, way to long for Dr. prick over there.

"Come on already! We need to get this airway secure!"

I secured the tube. The patient was saved. I took over the airway. I thanked the doctor for all his hard work. He told me rudely I need to be quicker. I smiled told him he did a great job with this patient to boost his ego.

Three years later I stood over the head of the bed bagging a patient in the critical care. The
man with pneumonia in the one cancerous lung he had left was breathing at that rapid, deep rate people starving for air usually do, screaming, "I...," gasp, "need...," gasp, "AIR!"

He had that ominous, distant look in his eyes. I had no choice but to start breathing for him. Knowing Dr. Stevens, or Dr. Come on as I call him behind his back, I had three tubes ready with three syringes connected to the cuff pilot, and a stilet in each freshly lubed tubes ready to slide into the gullet of the patient.

Dr. Come on asked for the size eight and I handed it to him. "Give the succs now!" he ordered to the nurses.

"It's coming," I heard Arny say as he rushed into the room drawing up the medicine as he worked his way to the head of the bed.

"Come on! Come on!" Chanted the doc with the vexed countenance I had gotten to know so well over the years. "Come on! Come on!"

At last it was not just me he became vexed, impatient with. Now it was the nurse that was at the root at his sudden mood change. Or, I now wondered, was he always this way, going home perhaps to be irritated with his wife for not lighting his cigarette fast enough.

Yet, upon leaving the room, I said, "Thanks for coming, Dr. com... Dr. Stevens. You saved us from being worried about this patient the rest of the night."

And this made me think of RT Cave Rule # 36, of which we will also include under Dr. Wisdom in case such a doctor might wish to learn what RTs think of their needless irritability:
RT Cave Rule #36: It is not necessary for doctors to get irritated with RNs and RTs for doing the jobs they are prepared and fully qualified to do during a code. Getting irritated only makes those around you more stressed in a situation that is already stressful."

Most doctors, in my opinion, are very patient and very cordial during a code, especially codes that are in places of the hospital we usually don't have coded (like small rooms), and codes on the young, codes on prominent members of the community, and those we know.

Yet there are those, like Dr. Come on, who are impatient to wait the extra 55 seconds for the RT to check the cuff, and for the RN to draw up the right dose of medicine.

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