How to accomplish absolutely nothing in six hours as an RT

I have been busy all day. Busy busy. Running all over the hospital. And yet, somehow, I have accomplished absolutely nothing.

My first patient was a Bipap setup. The nurse said he was in distress. I walked in and the guy was pale, gray, diaphoretic, looked like death warmed over, and informed me he was nauseated. 

Now, maybe I’m old fashioned, but slapping a tight-fitting positive pressure mask on a nauseated patient seems like a poor life choice. I had visions of projectile vomit firing directly into the mask while the Bipap enthusiastically redistributed it into the lungs.

So I called the doctor and he agreed. No Bipap.

About a half hour later the patient passed away anyway. So that whole mission sort of ended itself.

Then I got called to do an oxygen walk. These are always exciting because sometimes you discover the patient desperately needs oxygen and qualifies for home O2.

This gentleman started at 94%.

Then I walked him.

His oxygen saturation climbed to 98%.

Apparently ambulation cured him.

So that got nowhere fast.

Next stop: ER breathing treatment. The patient had wheezing, shortness of breath, and what appeared to be another heart-failure episode masquerading as asthma. I gave the breathing treatment anyway because that is what we do in healthcare. We obey the sacred ancient traditions.

Shockingly, the Albuterol did not cure the patient’s failing left ventricle.

Medicine remains mysterious.

Then came Room 5.

A nurse informed me the patient needed Bipap immediately because “his gases are worse.”

Now those words will get an RT moving pretty quickly. So I looked at the blood gases.

pH: 7.40
CO2: 72

Which, if you work with COPD patients long enough, basically translates into: “Tuesday.”

The patient himself denied shortness of breath and looked comfortable.

But the nurse insisted he needed Bipap right now.

At this point I was starving. Not hungry. Hangry. The sort of hunger where you start wondering if oxygen tubing is technically edible.

I briefly considered just throwing the patient on Bipap to end the conversation and move on with my life. But instead I did something I hate doing: I interrupted a physician meeting.

I explained the situation.

And lo and behold, the doctor calmly explained he only wanted nighttime Bipap and wanted to see whether the patient qualified for home Bipap.

In other words, this entire panic originated from poor communication.

Later I told a coworker about the exchange and he said, “She’s as dumb as…”

Well. Never mind. We’re trying to be nice here at the RT Cave.

So here I am, six hours into my shift. I have been everywhere in the hospital. I have sweated. Walked miles. Reviewed gases. Dodged unnecessary Bipap setups. Interrupted meetings. Performed sacred aerosol rituals.

And if you really think about it...

I have accomplished absolutely nothing.

Why I'm Leaving Walgreens?

Back in the 1990s, I hated Walgreens.

I honestly don't remember exactly why anymore. I just remember the pharmacists constantly lecturing me about how often I was using my albuterol inhaler. That always bothered me because I had severe asthma. Of course I was using a lot of albuterol. This was before many of the excellent asthma medications we have today. Back then, albuterol wasn't a rescue medication I occasionally needed. It was often the only thing standing between me and an emergency room visit.

Fast forward a few decades.

After my divorce in 2018, I was using Meijer Pharmacy. The problem wasn't the pharmacists. The problem was the wait. Every time I needed a prescription, I felt like I spent half my life standing in line. Eventually I got tired of it.

At the time, I really wanted to switch to Rite Aid. I had used Rite Aid before and always had good experiences there. Unfortunately, there were already rumors that Rite Aid was headed for trouble. As it turned out, those rumors were true. Rite Aid eventually closed, so I ended up going with Walgreens instead.

To be fair, Walgreens in Ludington was pretty good for several years. I had very few complaints.

Then came COVID.

Something changed after that. Whether it was staffing shortages, increased workloads, vaccines, or a combination of everything, the pharmacy became slower and harder to use. The lines got longer. The drive-thru took forever. Calling the pharmacy often meant listening to a phone ring endlessly.

I tolerated it because, frankly, what other choice did I have?

Then Rite Aid closed.

If the lines were bad before, they became even worse afterward.

Recently, my mom asked me to pick up one of her prescriptions at Walmart. I wasn't expecting much. In fact, I had never seriously considered Walmart Pharmacy before.

Then I walked in.

Three employees were working the counter.

No line.

No waiting.

No frustration.

I remember standing there thinking, Well, this is different.

For the first time, I started wondering if Walmart might actually be the better option.

Then came the final straw.

On July 3, I ordered five prescriptions through Walgreens. Two of them were albuterol medications: an inhaler and nebulizer solution. I paid the extra four dollars to have them delivered. Walgreens advertised delivery in two to three days.

Two weeks later, I still didn't have them.

The website continued to show the prescriptions as "in progress."

I called the pharmacy.

The phone rang.

And rang.

And rang.

Nobody answered.

So I called Walgreens corporate customer service.

They were polite enough, but they couldn't solve the problem.

At that point I found myself asking a simple question:

Why am I still using Walgreens?

If I have to wait thirty minutes in line, wait forever in the drive-thru, struggle to reach someone on the phone, and then wait two weeks for medications that were supposed to arrive in three days, what exactly am I getting in return?

The answer is: not much.

This isn't about one delayed order. Every pharmacy makes mistakes. This is about a pattern I've been watching develop for years.

Good customer service matters.

Communication matters.

When people are waiting for medications—especially medications they rely on to breathe—service matters.

I don't wish Walgreens any ill will. In fact, I remember when they did a pretty good job. But somewhere along the way, the customer experience stopped being good enough for me.

So after years of frustration, I think I'm finally done.

Unless something changes dramatically, my next prescription will probably be heading to Walmart.

And honestly, I should have done it sooner.

So I finally picked up the phone and called Walmart Pharmacy.

"Look, here's my issue," I said, explaining everything that had happened with Walgreens, the delays, the unanswered phone calls, and the missing delivery.

The woman on the other end listened for a moment and then said, "Okay, we'll call Walgreens and transfer your prescriptions over."

I was almost caught off guard by how simple it sounded.

"Is there anything you need from me?" I asked.

"Just your name and date of date of birth and phone number."

That was it.

No arguments. No waiting on hold. No explaining my life story.

A few minutes later, the process was already underway.

Maybe Walmart will be better. Maybe it won't. But at least they're answering the phone.

Right now, that's a pretty good start.

Why Health Insurance Was Invented

We spend a lot of time complaining about health insurance today. Patients hate the premiums, doctors hate the paperwork, and hospitals are constantly fighting over what gets covered. We act like the system is broken, but we’re missing the bigger picture. We assume insurance has always been the standard, but for most of our history, it didn’t exist. It didn’t exist for a simple reason: nobody needed it.

Before the 20th century, if you got sick, the doctor came to your house. They’d look you over, try whatever they could, and you either got better or you didn't. There were no ICUs, no ventilators, and no complex surgeries. Because medicine couldn't do much, it didn't cost much. It was a personal expense, just like groceries. Hospitals weren't treatment centers back then, either; they were mostly places you went to die.

Everything shifted in the early 1900s. Medicine finally started to actually work. We got X-rays, blood transfusions, and better anesthesia. Joseph Lister’s antiseptic techniques changed everything. Hospitals transformed from dying rooms into hubs of life-saving technology. But those advances brought a new reality: high costs. By the 1920s, a hospital stay cost twice as much as it had twenty years before. Hospitals were building new wings and buying fancy tech, but they had a huge problem. They were running on a pay-as-you-go model, and they were lucky to collect 60 cents on every dollar they billed.

Then 1929 hit, and the Great Depression made everything worse. The money dried up, but the patients kept coming. That’s when a guy named Justin Ford Kimball stepped in. He wasn't a doctor; he was a former school superintendent managing Baylor University Hospital’s finances. He noticed teachers were landing in the hospital with huge, unpaid bills they couldn't afford on a teacher's salary. Kimball didn't want the hospital to eat those losses, but he knew the teachers were tapped out. So, he made a deal: if every teacher paid 50 cents a month—six dollars a year—the hospital would guarantee them a set number of hospital days if they got sick.

It worked perfectly. It kept the hospital's revenue steady and gave the teachers peace of mind. It even changed patient behavior because people stopped waiting until they were half-dead to seek care. Other hospitals caught on and copied the model. Before long, these plans all unified under a name you definitely know: Blue Cross.

We need to stop looking at health insurance as some ancient, unchangeable institution. It was a financial hack born out of a desperate crisis. What’s ironic—and what most people forget—is that the American Medical Association and a lot of doctors actually hated the idea at first. They were terrified of third-party interference and wanted to keep medicine a direct, personal transaction between doctor and patient. But once the genie was out of the bottle, it never went back in.

We love to blame insurance companies for the cost of medicine, but the reality is that modern medicine created the insurance industry. Without the high-tech, expensive advancements of the early 20th century, there wouldn't have been a reason to invent this system. When you actually look into it, you realize things aren't the way they are because they’re perfect. They’re the way they are because someone faced a problem and tried to solve it—even if that solution ended up creating the mess we’re dealing with today.

When Dad Stops Being the Entertainer

One of the things I've noticed this summer is that my role as a dad is changing.

When my kids were little, I was the entertainer. Every summer I was looking for things to do with them. We'd go to the beach, the pool, playgrounds, Silver Lake, visit my parents, or just find something to get us out of the house. I genuinely enjoyed it. Looking back, some of my favorite memories are simply spending time with my kids.

Now my daughter is seventeen. This summer she's already gone to four different camps, and she has another one coming up. Half the summer is already over, and she's busy living her own life. Today she finally had an afternoon without anything planned, so I texted her and asked if she wanted to go to the pool.

A little while later she replied, "Dad, can I go to a movie at four with my friends?"

What struck me wasn't that she wanted to go to the movie. It was that she hadn't even seen my text because she had been talking with her friends. She was completely absorbed in her own world.

And I thought, that's exactly what a seventeen-year-old is supposed to be doing.

It made me realize that I don't really have to entertain her anymore. That chapter is coming to an end. Instead of being the entertainer, I'm becoming home base. I'm the person she checks in with before she goes somewhere. I'm the place she comes home to afterward. That's a different role than I had ten years ago, but it's not a bad one.

Sure, there's a little sadness in it. I miss the little girl who always wanted to spend the day with Dad. At the same time, I'm happy for her. She's making friends, she's becoming independent, and she's building a life of her own. That's exactly what I've wanted for her all along.

The funny thing is, this change gives me something too. I have more time to work on projects that I've put off for years. I'm writing my memoir. I have more time to spend with friends. I have time to pursue interests that were harder to fit into life when my weekends revolved around entertaining the kids.

Every stage of parenting has been enjoyable in its own way. I loved being the entertainer. I think I'm going to enjoy being home base too.

When the Chart Lies: The Absurdity of Modern Medical Coding

The doctor looked at me and said, "This patient does not have hypoxemic respiratory failure."

"That's not true," I replied.

The doctor looked confused. I wasn't disagreeing with his medical opinion; I was disagreeing with reality. Because in modern healthcare, it doesn't really matter what the doctor thinks. It matters what ends up in the chart. And somehow, despite the physician examining the patient, reviewing the labs, and making the diagnosis, the patient will probably leave the hospital with "hypoxemic respiratory failure" listed on the final coding summary anyway. Welcome to healthcare in 2026.

As a respiratory therapist, I was taught that respiratory failure actually meant something. There were criteria, definitions, and evidence. If a patient was hypoxemic, that didn't automatically mean respiratory failure. Failure of oxygenation is failure of oxygenation—it is not failure of ventilation, it is not failure of respiratory drive, and it is not failure simply because someone put the patient on two liters of oxygen. Yet, somewhere along the way, we created a system where nearly every patient who needs a light breeze of oxygen is apparently suffering from a catastrophic failure of their respiratory system.

It’s a bizarre dance. A patient comes into the ER. Pulse oximeter says 88%. The nurse applies two liters via nasal cannula. Pulse oximeter now says 94%. The patient is sitting comfortably in bed, talking about the Detroit Tigers.

Doctor: "Mild hypoxemia." Coder: "Acute hypoxemic respiratory failure." Doctor: "No." Coder: "Yes." Doctor: "The patient is stable." Coder: "Respiratory failure." Doctor: "They're watching baseball." Coder: "Respiratory failure."

At some point, the diagnosis stopped belonging to the people actually caring for the patient.

The absurdity doesn't stop there. The same thing happens with pneumonia. A patient comes in coughing. Do they have pneumonia? Nobody knows. Chest X-ray is normal. No infiltrate. No fever. No positive cultures. No convincing evidence of infection. So what’s the diagnosis? Community-acquired pneumonia. Or my favorite: "walking pneumonia." I’ve often joked that "walking pneumonia" means the patient isn’t sick enough to look like they have pneumonia, but we’re going to call it pneumonia anyway.

Doctor: "The chest X-ray is negative." Me: "So they don't have pneumonia?" Doctor: "Correct." Me: "Then what's causing the cough?" Doctor: "I don't know." Me: "So what do we call it?" Doctor: "Community-acquired pneumonia."

Medicine becomes much easier when we stop worrying about whether the patient actually has the disease. The same thing happens with COPD. A patient who never smoked, has no pulmonary function testing, and no evidence of fixed airway obstruction suddenly has COPD because they wheezed. Asthma? Sure, why not. No testing, no demonstration of reversible airway obstruction, no methacholine challenge—but they wheezed once in 1997. Good enough.

The real problem isn't just the diagnosis itself; it’s what happens afterward. Every diagnosis gets counted. It enters the statistics. It becomes part of the data. Researchers count it, government agencies count it, and hospital quality programs count it. Future providers see it and repeat it.

This isn't just an administrative annoyance; it creates a dangerous medical history. When a patient leaves the hospital with a diagnosis of "respiratory failure" that they never truly had, that label follows them like a digital shadow. The next provider—perhaps an urgent care clinician or a specialist—sees that diagnosis in the electronic health record and assumes it’s fact. It triggers a cascade of unnecessary monitoring, redundant testing, and potential medication adjustments based on a phantom illness. We aren't just inflating statistics; we are polluting the patient’s clinical record with misinformation that can cloud judgment for years to come.

Soon, the data shows more respiratory failure, more pneumonia, more COPD, more asthma, and more diabetes than may have actually existed. Then we wonder why healthcare statistics seem so detached from reality. The diagnosis becomes true simply because somebody typed it into a computer.

The crazy part is that I don’t really blame the doctors, the coders, or even the hospitals. The system rewards it. Government regulations, reimbursement formulas, quality measures, audits, and documentation requirements have created a world where uncertainty is unacceptable. "I don't know" isn't a billable diagnosis. "Mild hypoxemia without respiratory failure" doesn't fit neatly into the boxes. "Shortness of breath of uncertain cause" doesn't fit neatly into the boxes. The system demands a diagnosis, so a diagnosis appears. Everyone follows the rules. Everyone checks the boxes. Everyone documents appropriately. And somehow, the patient ends up with diseases they never actually had.

So, when a physician tells me, "This patient does not have hypoxemic respiratory failure," and the chart later says they do... who am I supposed to believe? The doctor, or the computer?

Because these days, I’m not entirely sure the doctor gets the final vote.

The Two Paths

Lately I've been thinking about life as two paths.

Not two perfect paths. Not good versus evil. Not healthy people versus unhealthy people.

Just two roads that most of us travel back and forth between.

Path #1 is the health path.

You don't have to be a fitness model to be on this path. You don't have to spend two hours a day in the gym. You don't have to count every calorie or refuse a piece of birthday cake.

You simply make health a priority.

You exercise regularly. You move your body. You try to eat reasonably well most of the time. You get enough sleep. You take your medications. You pay attention to your weight instead of pretending the scale doesn't exist.

You can still have a drink. You can still enjoy pizza. You can still have dessert. The difference is that those things are occasional passengers in the car, not the ones holding the steering wheel.

Path #1 isn't always exciting. In fact, some days it's downright boring. Nobody gets excited about going for a walk, drinking water, or getting on the elliptical for fifteen minutes.

But over time, Path #1 usually leads to more energy, better health, a healthier weight, and a longer, more active life.

Path #2 is the neglect path.

Exercise becomes something you'll start tomorrow.

The drinks come easier. The portions get larger. The naps become more frequent. The walks become less frequent. The scale slowly moves in the wrong direction.

As a respiratory therapist, I've spent nearly thirty years taking care of patients suffering from the consequences of Path #2. Smoking. Obesity. COPD. Heart disease. Diabetes. Sleep apnea. High blood pressure.

The problem with Path #2 isn't that it's miserable.

The problem is that parts of it are actually very enjoyable.

The extra drink is enjoyable.

Skipping the workout is enjoyable.

The cheeseburger tastes good.

Sleeping in feels great.

That's why the path is so seductive.

Path #2 asks for very little today, but quietly takes a lot from you tomorrow.

One drink becomes two.

Two become four.

A missed workout becomes a missed week.

A few extra pounds become fifty.

The road feels smooth at first, but the farther you travel down it, the harder it becomes to turn around.

As I write this, I know exactly which direction I've been heading.

I'm overweight. I don't exercise as much as I should. I enjoy alcohol more than I should. I've spent years telling myself that tomorrow will be the day I get serious again.

The frustrating part is that I know what Path #1 feels like because I've been there before.

Years ago, I followed the Body-for-Life program and got into some of the best shape of my adult life. I exercised consistently. I ate better. I felt better.

I know what that version of me looks like.

The problem isn't knowledge.

The problem is making the turn.

Because life isn't really about choosing one road forever.

Every day is a series of turns.

A workout is a turn toward Path #1.

A walk is a turn toward Path #1.

Choosing not to have that extra drink is a turn toward Path #1.

Ignoring your health is a turn toward Path #2.

The good news is that no single decision permanently puts you on either road.

You can make a bad choice today and a better one tomorrow.

You can spend years heading in the wrong direction and still turn around.

And maybe that's the lesson I've been trying to remind myself of lately.

The goal isn't perfection.

The goal is simply to make more turns toward the life you want than the life you don't.

As respiratory therapists, we care for people from both paths.

We've all seen the lifelong fitness enthusiast who exercised regularly, maintained a healthy weight, never smoked, rarely drank, and seemed to do everything right—yet still became ill. Life doesn't guarantee outcomes, no matter how carefully we live.

But we also care for many people who have spent years drifting down Path #2. Some smoked. Some drank heavily. Some stopped exercising. Some gradually gained weight. Others simply became overwhelmed by life and let their health slide further and further down the priority list.

The lesson isn't that Path #1 guarantees perfect health or that Path #2 guarantees disease. Life is more complicated than that.

The lesson is that while we can't control everything that happens to us, we can influence the odds. Every healthy choice nudges those odds in our favor. Every unhealthy habit nudges them the other way.

As therapists, we see the consequences of both chance and choice every day. That's one reason I keep reminding myself that health isn't about perfection. It's about making more turns toward Path #1 than Path #2.

Morphine Nebulizers Show “Remarkable Impact” on Hospital Atmosphere, Early Reports Say

Hospitals across the country are reporting a noticeable shift in unit atmosphere following the quiet introduction of aerosolized Morphine therapy, commonly referred to as “morphine nebs.”

The treatment, which began as a conceptual extension of earlier “Ativan neb” programs, was initially explored as a way to address severe dyspnea and patient discomfort. What administrators did not anticipate, however, was the broader impact on staff workflow and overall unit tone.

“We were focused on patient comfort,” said one hospital director involved in a pilot program. “What we found was that the entire environment changed. Patients were more at ease, families were calmer, and the number of urgent pages dropped almost immediately.”

Patients receiving the treatment described a sense of relief that extended beyond breathing alone.

“It wasn’t just that I could breathe better,” said one patient recovering from advanced lung disease. “It was that I didn’t feel like I was fighting anymore. Everything just… slowed down.”

Respiratory therapists say the change has been noticeable from the moment treatments began.

“Before, we were running from room to room,” one RT said. “Every call was ‘short of breath,’ whether it was bronchospasm or not. Now, when it’s appropriate, we’re addressing the discomfort directly. The difference is obvious.”

Nursing staff report similar observations.

“You walk onto the floor and it just feels different,” one nurse said. “Less tension. Fewer alarms. Fewer call lights going off every five minutes. You actually have time to think.”

Family members, often a source of concern and anxiety during hospital stays, have also responded positively.

“I used to feel like something was wrong all the time,” said one patient’s daughter. “Now I can sit here, and he looks comfortable. That changes everything.”

Some facilities have noted an unexpected secondary benefit: a reduction in non-urgent respiratory therapy consults.

“We’re seeing fewer ‘just come check on them’ calls,” one administrator said. “It turns out that when patients are comfortable, a lot of those concerns resolve on their own.”

Not everyone is convinced. Critics emphasize that morphine is not a bronchodilator and does not treat underlying pulmonary pathology.

“This is not a replacement for appropriate respiratory care,” one physician noted. “It’s a comfort measure. It has a role, but it needs to be used thoughtfully.”

Facilities participating in these programs stress that point as well.

“We’re not treating bronchospasm with morphine,” said Dr. Pierce. “We’re treating distress. And those are not always the same thing.”

For respiratory therapists, the shift has been both practical and philosophical.

“It forces you to think about what you’re really treating,” one RT said. “Is it the lungs, or is it the experience the patient is having?”

Early data remains limited, and further study is expected. Still, hospitals involved in the rollout say the initial results have been hard to ignore.

“It’s calmer,” one nurse said simply. “That’s the best way to describe it.”

As one respiratory therapist summarized, “When the patient is comfortable, everything else tends to fall into place.”