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Monday, November 25, 2013

RT Stimulation

Lately the burned out respiratory therapist wrote about his desire for stimulation. He said:

How is it possible that an RRT, working in a busy hospital, can ever want more stimulation? Aren’t the endless phone calls, patients, treatments, new starts, and busywork stimulating enough?
No. They are aggravating but they are not stimulating. Stimulation implies a challenge, a new and exciting and interesting diversion. Stimulation is having six traumas at once come in with the SWAT team following them because the gunfight’s not over yet. Stimulation is trying to intubate someone who has a very challenging airway. Stimulation is a challenge, a test, a chance to learn and grow.
Stimulation is not the ten millionth phone call to come give Mrs. Jones a very dubious albuterol treatment, or a new order to do Chest PT on the patient with broken ribs. That is irritating, not stimulating. It makes me want to scream and throw charts, but it does not challenge me.
And frankly, as much as I talk of the high drama of trauma codes and airway emergencies and all that, the fact of the matter is that even those get boring after a while. I find myself sighing listlessly at intubations, because they bore me. Trauma codes are more drama than trauma. Resuscitations are largely pointless: so what if we do get this 80-year-old with dementia and renal failure and heart failure and diabetes and lung cancer back from the code? Is it worth the effort?
So, I crave stimulation, but I am having a hard time finding it. I am bored to the point of tears. It is boring to distribute albuterol to people who mostly don’t need it. It is boring to stand there and watch them suck down a neb, it is boring to try to teach someone to do an IS, and it is boring to make my Q4 vent checks. New patients are frustrating because I find the orders to be highly inappropriate (Chest PT for pleural effusions? What kind of drugs do these docs smoke?) and I hate having to lie to patients to justify why they need these treatments when they mostly do not.
Burnout RT
As I'm watching someone suck down a neb just because he has an infiltrate and is not short of breath, or just because he had surgery by Dr. Upton, I wonder what the patient is thinking. It's probably something like this:
Is this guy a moron? Why is he giving me a breathing treatment when I'm not short of breath. I'm not going to say anything because I don't want to make him feel bad, so I'll suck it down and keep my mouth shut.

Yeah, that's what I'm thinking the patient is thinking. I feel stupid to give treatments to people I don't think need them. This, to me, is not stimulation. A code is not stimulating either, because I think in most cases the patient doesn't need what the doctor does. I think most intubations are not indicated. I think most often people are intubated because the doctor needs stimulation.

I do, however, find simple things stimulating, such as:
  • Using my brain 
  • Keeping an old person company 
  • Satisfied I made that person's day 
  • When a decision I make saves a life 
  • When a decision I make benefits a person 
  • A good conversation 
  • Educating people (It can be stimulating, so long as it's not an IS instruct, or doing smoking on someone who had no intent on ever quitting) 
  • Blogging (I go to work to get ideas for my blog. I listen to doctors say stupid things, and see them write idiot orders. Folks, nothing written on this blog is made up.) 

So, despite what the burnout RT says, you can still found stimulation at work, if you search for it. Although, if you want to do what you were told in RT school, you might find stimulation lacking.


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