Pager says: "BiPAP BEEPING COME SOON! EMILY RN"
On a whim, the RT leaves the patient he's presently treating, and rushes to the room with the BiPAP. Upon arriving he hears the said beeping, and thinks it's not a good sign that it's still beeping. He thinks: "Either the mask is off the patient, or the patient is not breathing."
He looks at the patient and then at the BiPAP and then back at the patient. While he's doing this, the nurse pops into the room and says, "I think you're BiPAP isn't working."
At this, the RT says: "I think your patient isn't working."
He sees that the patient BiPAP rate is 4, and the rate on the monitor was 42. He places a hand on the patient's chest and feels the respirations are simply not efficient. "She isn't generating enough flow to trigger the machine," the RT says. "Get the hospitalist here."
The RT turns up the rate to 14. About then the doctor comes in.
The RT says to the hospitalist, "I realize there's not much you can do considering she's a DNR. I just wanted you to know this was going on."
"Yes," the doctor says. "The family doesn't want anything more than this. We'll DC the ativan and xanax."
RT is thinking, "Hmmmph. How much sedatives has she been given? She's been on xanax the past ten years, but was she given too much? Or, is she simply trying to die?"
Assuming she's trying to die, the family is called by the nurse.
The RT rushes back to the other patient, whose breathing treatment is now stopped. "I'm a nurse," the patient's daughter says. The RT apologizes and apologizes vigorously for rushing away, yet the patient and the patient's daughter are happy as can be. A brief discussion ensues before the RT returns to the BiPAP patient.
The family is now in the room, and tears are flowing. Both daughters hug the RT. One says, "You're her favorite. She loves you. I think she'd like you to know that."
The RT smiles. The RT didn't need to hear that because he had already assumed. He had many great discussions with the patient and the patient's family. Now there are tears flowing in the room as the family waits for this nice elderly lady to stop breathing.
Two hours later the therapist is in the room and no one else is. The patient is now breathing over the rate of 14, and the spontaneous rate is 28. She opens her eyes and looks at the RT.
The RT looks into those eyes, and says, "There are your pretty eyes." She smiles and goes back to sleep.
The family comes back into the room, and they are so thankful and happy. The nurse is thankful and happy. The doctor is thankful and happy. Once again the RT has a successful day outside the RT cave.
The RT wonders if he did something good, or simply prolonged suffering of the patient; it's hard to know for sure; there are no answers to such ethical questions. Regardless, the smiles he creates force him to smile on the way back to the RT cave. He thinks, "It appears this job is more than saving lives; it's creating smiles."