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Saturday, December 1, 2007

Grumpiness stays in the RT Cave

For whatever reason business really picked up last weekend. That, coupled with the chronic lack of sleep and family life, brought me to work on Thursday night on the edge of insanity.

While I'm normally pretty equanimitous no matter what I'm doing, I grumped to my co-workers as soon as I saw the increased number of patients on the worksheet. I clicked on the worksheet I-con on the computer and deleted all the diagnosis's and put in my own.

Here's what the new worksheet looked like. I've always been a proponent of writing reason for treatment instead of diagnosis, and that's what I did here:

  • Post-op Bowel: Just because

  • Post-op Bowel: Just because

  • COPD: needs

  • Liver CA/ sepsis: needs

  • Hip Fx: Jealous of room mates treatment

  • Asthma: exaggeration of

  • Pancreatitis: Had a cough once

  • Failure to thrive: Nosocomial COPD

  • Pneum/COPD: needs

  • Hip FX: Bored, needs attention

  • Failure to thrive: had ronchi at admission

"Rick you're grumpy," my co-worker wailed. She was a complacent.

"I'm sorry," I grumbled, "but I'm sick of running around doing these useless breathing treatments when I got patients who need my services. All this crap does is wear me out."

She looked at me stunned. She was surprised at my sudden anger, I could tell. She was knew I enjoyed RT humor, but to complain like this was not normal for me. And, if that's what she was thinking, she was right.

I took a deep breath. "Well, now that I got that off my chest, how about report." That was the end of the outward grumpiness for the most part the rest of the night.

However, when a nurse called me to do a treatment on a CHF patient I had just recently did a treatment on, I was blunt on the phone: "She doesn't need a treatment."

"But," the RN said, "She's short-of-breath and wheezing."

"Did you get her up to the bathroom?" That's the only way she'd get SOB that fast, I knew the type. I know my patients that well.

"Yeah, we got her up to the..."

"Well, that's why she's short-of-breath. All you need to do is let her rest." She's a cardiac patient. She has a weak heart.

"But she's really..."

Right here the professional Rick turned on. I know from experience that all the explaining in the world isn't going to work with this RN. "Hey, I will be right there." I should have just said that in the first place.

Being the consummate professional, I knew that I couldn't let my exhaustion effect my work, and whether the patient was recovered in 2 minutes or not I was going to check on her just to be on the safe side. I think all responsible RTs would do the same.

However, I took my time getting there. I was almost certain she'd be fine with rest, and that she really didn't need a treatment for anything other than an oxygen boost.

When I looked in on the patient she was sleeping comfortably. Even though I believe that if someone is sleeping she's comfortable -- most of the time. I woke her anyway. "Hi Mrs. Dee. I'm sorry to wake you."

"No problem, Rick. How's it going today."

"Wonderful," I lied, and then smiled.

RT Cave Rule #8: A true RT professional never carries a mood into the patient room. It's best to keep it in the RT cave.

"I heard you were winded. Are you feeling better?"

She confirmed she was fine. Then I left the room and hunted down the nurse. I probably could have left it at that, but the political me wanted to make sure things were square with the nurse. After a brief hunt, I found her.

"You called for Mrs. Dee, right?" I said.

"Yeah. She's sleeping now, though," the RN said. This was a very nice nurse, but in the past I've had trouble explaining to her RT facts.

"Uhuh. I woke her up anyway. She's a nice lady."

"Yeah. She was really short-of breath. And she was really wheezy."

"I know," I said. "It was a cardiac wheeze."

She gave me a look I interpreted as the, "you are a prick" look. She was thinking I was just another lazy RT. I know when you're exhausted you see problems that aren't really there, so I considered this and decided I would be best to walk away.

The rest of the night I went from one procedure to the next. You know those nights: every time you sit down the pager goes off. By 4:00 in the morning my eyes are burning and my body felt
like it would melt at any moment. My feet were killing me. All of you guys have been here at some point, or will be. Heck, you city dwellers probably go here every day.

My boss called me. I have no clue why she comes in so early, but she does. I trudged to the RT Cave. "Hey, Boss."

She was blunt: "I saw what you wrote on the treatment sheet, and I changed them for you. If Julie saw those she'd write you up." I could tell she was in a good mood. Hell, why wouldn't she: it was her Friday. She didn't have to work weekends like the rest of us.

"Yeah, I meant to take those off by now, but I just didn't get a chance yet." It was the truth.

"You shouldn't put those on there."

"Who's gonna look at my board? And if they do, they'll learn the truth." I tried to feign a smile, but my face was stayed limp. That's how tired I was.

"You know it's not very professional." She was never shy of saying what was on her mind.

"I don't care," I said. I normally would have said something more professional, but when you're really exhausted your true feelings slip out at times. It was one of those nights. "I'm sick and tired of running around ragged when I shouldn't have to."

"I know," she said calmly, "but you really need to stay professional."

"You're right," I said, and set down at the computer to make my changes. Then I thought what I really wanted to say:

I'll be professional all right. When she writes me up, I'll be real professional in front of the admins and explain to them the truth about what the doctors are making us do. I will. Then they'll really be able to cut back on unecessary costs. It's time one of us spoke up. That's the reason things have gotten so bad is because nobody has the nerve to speak up.

"Was it really so bad," the reasonable part of my mind said, "You love your job."

As all of you RTs know, professionalism is more important than releasing frustration. And that is why we participate in RT humor amongst ourselves. That is our release.

This was a very rare occurrence for me to feel grumpy like this. However, and my point in writing this, is while I felt one way, not one of my patients had a clue I was grumpy. And, hopefully, not one of the nurses did either.

The only people I vented to were fellow RTs. Then, to the best of my ability, I left my grumpiness in the RT Cave. A true consumate professional becomes very good at doing this even in the worst of nights.


mielikki said...

We all have our grumpy days. Our RT cave is so small, and I know most of RT's so well that they can let me know when they are grumpy.
But, I also know the difference between a cardiac wheeze and the lung variety.
Sadly, some nurses never learn. . .

Rick Frea said...

Did you guys notice that the diagnosis of "Failure to thrive." That was a real diagnosis on not one but 2 patients.

mielikki said...

were they elderly, wasting away patients? A few times, I've taken care of old, FTT's. It's very sad. But, they don't usually need resp. treatments. They usually need food, or to be let go. . .

Rick Frea said...

I just never saw that diagnosis on an adult before. Just curious.

I think these people don't need treatments per se, but they are ordered so the patient meets criteria. That's my theory.

Unknown said...

I've only seen "failure to thrive" on neonates not Adults, odd.

On another note our protocol's we use now really take care of useless treatments. It always makes me smile when I change a Q4 neb to just a prn. If it fits in the parameters we have set thats what it is.

Rick Frea said...

We really should create a place where we could share our protocols. I would really like to see what your doctors approved.