Have you seen this patient???

Disclaimer: This post was written by an anonymous author.  The patient he describes is a generalization.  Any resemblance to persons living or dead is merely coincidental.

Chances are you've seen this patient at a hospital near you. I will provide a picture of him. Let me know if you've seen him.

1. Summer teeth (that's sum 'er there, sum 'er not)
2. The sum he has is not white
3. Gray scraggly beard down to his nipples with bread crumbs on it
4. Hard, crusty feet a dark brown or even black color
5. His toes look like they might fall off
6. His ankles are swollen (edemitous)
7. Strong BO (that's body odor)
8. White stuff in hair. What is it???
9. Dark brown spot on the draw sheet he was lying on
10. Really nice, but very blunt
11. Looks mean, may look intimidting, but sweet as a teddy bear
12. Never wears of shirt
13. Very overweight with a belly the size of a truck
14. Tattoo's at random locations around his bod -- some with boobs
15. Not married. Has girlfriend you don't want me to describe, but she talks about dees and dose things and says "and shit and that" a lot
16. Crumbs all over the bed, and he doesn't care
17. Has a scruffy voice, but speaks softly and is taciturn
18. Pisses in a urinal with the door open and while you are in room
19. His visitors smell of BO, piss and cigarette smoke
20. He snores horrendously loud at night unless his BiPAP or CPAP is on
21. Never complains unless his back "hurts like hell" or his breathing is "miserable."
22. Actually has a neat sense of humor
23. He's a member of the 50-50 club (That's Co2 and PO2)
24. He has Albuterol ordered every 4 hours but never "needs" them and never complains either
25. Clears his throat every few minutes
26. Spits big gobs of thick yellow sputum into a basin he keeps right next to the urinal full of pee which is right next to crackers and cheese
27. His room often is redolent of pee
28. His diagnosis is COPD and CHF and etc.

I am an anonymous author.  Thank you for the opportunity to share my piece.

Sweet lady in a confusing moment

She was out of it. When she fell into a deep sleep she went apneic and her spo2 dropped to 72%. The RN tried to awaken her, but she would not respond. And when she finally did respond, she had no clue who she was nor where.

The doctor, correctly, opted for BiPAP. I was a head of the game and already had the BiPAP ready to go. Keep in mind here this lady was completely either obtunded or out to lunch for over two and a half hours.

So, I go to put the mask on her and she wakes up and is completely defiant about putting "that damn mask on my face." She writhed her head this way and that, grasped with her hands. I had the RN hold her hands thinking she simply wasn't with it and was just reacting. But, as it turned out, she was as alert as my 3 month old in the middle of the night when you expect her to be sleeping.

I was surprised by her reaction here mainly because she was so OTL for so long. I tried to wake her up before I put the mask on, and she never even twitched. So I figured I'd put the mask on real quick and be done with it.

But, that's not how it went down. So here I'm standing watching this lady flail, and screaming how much she didn't want my BiPAP.

I was thinking, "It's amazing what a little scare with the BiPAP mask can do to a person. It can wake up a person, change her mental status."

I pulled back the BiPAP mask; no point in forcing it on someone who is fully awake and defiant. I certainly don't want to traumatize the lady any further. I don't want to be inhumane. I shut off the machine and listen to the discussion between RN and patient.

"We need to put you on the machine because you stopped breathing when you slept," the RN said.

"No I didn't," the patient said.

"Yes you did."

"No. I'm just fine."

"No you are not. You need help with your breathing."

"Well, I'm fine now."

"Yeah, you're fine now, but when you sleep you have trouble breathing."

"So, I'm fine now, so leave me alone."

"So," the RN says, "When you stop breathing again, can we put the mask on you then?"

"Only if I stop breathing for two hours again."

"Well, it doesn't work that way."

"Why not."

"We can't let you go 2 hours without braething."

"Well, I don't want that mask."

"Okay, well, if your heart stops beating, do you want us to put a tube in your throat to help you breath then."

"Why don't you try it now so I can see if I like it or not."

That's where I had to leave the room.

It was a sweet old lady and she was so cute. And she had no clue. The sad part about it is that she had no family, no person to help her make decisions. She should have been a DNR patient I thought. It should have been discussed before now. It may have been. I highly doubt even under the sanest of moments this lady may not have a clue about what we are referring to in an attempt to help her survive another day.

Or are we only seeing a lady in her weakest moments. Perhaps on a normal day she's sharp as a whip. That's the thing about working in the medical field, sometimes we only know what's right before us, yet we have to consider everything -- including that of which we have no clue.

Then again, it may have been the hypoxia talking. Or, better yet (and this is why I backed off instead of forcing it upon her as some might have done), perhaps she was simply overwhelmed by the moment. I mean, what would you think if you suddenly woke up to a huge mask blowing air in your face?

As, an hour later, she let me put the BiPAP on her and hence it is still on with the patient who is sleeping comfortably. It's amazing what a little TLC can do -- and the help of a wonderful nurses assistant.

Sometimes you know what's best for the patient, yet you have to become creative in how best to take the next step.

Susphrine used to be a great asthma drug

When I was in RT school I questioned the head of the RT department about a drug called Susphrin. I remembered it from when I was a kid. Every time I went to the ER I received one shot of Susphrin, watched the clock, and within five minutes I'd be breathing fine.

That medicine saved my life many times when the air passages of my lungs were inflamed and spasming and contorted so that I wasn't able to get rid of air trapped within them. This meicine was great before the days of Alupent and later Albuterol.

Yet, in 1995 when I started RT school, head of the RT department had no clue what Susphrine was. And, to my surprise, when I looked up this asthma wonder drug in the Physician's Drug Reference, it was not there. I googled it, and it was not there either.

For the next 13 years I asked doctor after doctor if they had ever heard of this medicine, and none of them had a clue what it was. I asked a few pharmacists, and I asked nurses and RTs -- none of them had a clue what Susphrine was.

Yep, I was just making it up. Nope. Finally, a few months ago, I realized a major flaw in my memory of this drug. It was spelled with a p. That's right. So I looked it up under the correct spelling, and it was still not in the PDR. However, I did find it under Google. It is also mentioned at Healthsquare.com.

Of course the Susphrine on that site isn't necessarily the same Susphrine I remember. You'll see what I mean when you read my post I link to below. The Susphrine I'm referring to is a longer acting version of Epinepherine, a medicine that is still marketed and used on occasion for severe excaservations of asthma (status asthmaticus).

So, for you asthma history buffs, I finally found that there really is (was) a drug called Susphrin, and I wrote every thing I found out about it (and my experiences with the miracle asthma drug of old) in my asthma blog at MyAsthmaCentral.com.

There, click that last link and you will be morphed over to the article I'm referring to, or just click here.

Susphrine: The asthma wonder drug of old
by Rick Frea Monday, January 12, 2009 @ MyAsthmaCentral.com

There have been treatments for asthma for at least a thousand years. The ancients used jimson weed to relax the muscles surrounding the large airways in the lungs (these are known as anticholinergic agents for you drug nerds out there).

When epinepherine (epi) was first discovered in 1903, it provided instant relief by relaxing the bronchial tubes in the lungs that tense up during an asthma attack. (The Chinese used the herb Ma-huang, the plant species Ephedra sinica, because it mimicked epinephrine.)

Even though there were ways to treat asthma way back then, I couldn't imagine being an asthmatic in those days. In 2004, thr FDA banned products containing ephedra because the risk of injury, illness and death. Jimson weed can be toxic. The problem with epi is that it was a nonselective drug -- it didn't just dilate the bronchioles, it also affected the heart, a bad deal for the elderly and those with bad hearts.

In the 1970s and 1980s when I was growing up with severe, persistent asthma, a new selective medicine called Alupent was available. It was inhaled directly into the lungs and worked quicker and had fewer systemic side effects. Still, epi was more powerful a bronchodilator, so doctors used it in the ER for severe asthma.

Then there was a longer-acting version of epi called Susphrine (or Sus-phrine)that was popular among the medical community in the region where I grew up. I was two when I got my first Susphrine shot in 1972. When my family went on vacation across the country to California in 1976, my doctor wrote a note for mom to carry with her just in case my asthma struck:
"This boy is a known asthmatic undergoing hyposensitization program. If hehas severe asthma attack without fever he will respond well to 0.2cc Susphrinesub q stat; observe 20 minutes. Thank You, Dr. Gunderson."

The years 1980 to 1985 were the asthma years I remember the most. Mom or dad took me to the ER for asthma many times and each time I got a Susphrine shot. One October in 1984, I sat in the ER cot lumbering for air.

An RT in a white lab coat came into my room to give me Alupent. I wanted Susphrine. My chest burned. It felt like a herd of elephants was sitting on me.

About five minutes later, a nurse came in the room to finally give me the shot I needed. It was 3:45. I kept my eye on the clock, watching the red second hand mosey its way round and round. I looked at dad. His hair was disheveled. He had wrinkles from sleep on the left side of his face, and circles under his eyes. Perhaps he was wishing he could trade places with me. I wouldn't wish this on him, though, because he'd probably panic -- I was experienced and knew how to handle this kind of distress.

I peered back at the clock concentrating on each breath. It was 3:47. I thought I could take in a deeper breath, but it was just my imagination. Then, 3:48, I took in a deep breath. Finally. Relief.

A feeling of euphoria rushed through me. I'm telling you folks, there is no better feeling than going from near suffocation to taking a full, deep breath in less than ten minutes. If you go through that even once, you will never take breathing for granted again.
Thirty minutes later I felt like bouncing around the room. The adrenaline was taking its systemic effect. Despite that, I felt like a million bucks.

Susphrine is no longer used in ERs anymore. In fact, it's not even produced anymore, nor is it listed in the Physician's Desk Reference (PDR). Epi is still used on occasion, but it is basically reserved as a last ditch option for stubborn asthma.

Recently, I stopped our big pharmacist as he lumbered down the hall. I said, "Hey, Mike, do you remember an old medicine called Susphrine. When I was a kid, that stuff saved my life more than once."
"Oh, yeah," he said after he racked his brain, "I remember it. We used to use it quite a bit in fact until about 10 to 15 years ago when they took it off the market. Asthmatics loved it." He was the only person I quizzed who remembered the drug.

It's amazing that asthma medicines have improved so much even since I was a kid. Most asthmatics who use their preventative medications compliantly don't even need to make visits to the ER anymore. But, those who do will NOT get a shot of the asthma wonder drug of old, but they'll get new asthma wonder drugs that are proven faster and safer.

Sometimes it's okay to lie to your patients

No, it's not a good idea to teach your kids to lie. But when you are dealing with old people, when you are dealing with sick people, sometimes it is okay to lie.

I know that goes against everything we learn as we are growing up, and it goes against everything taught by Jesus, but there are occasions when you simply cannot tell the truth.

This was the single hardest thing for me to accept when I became an RT. But it didn't take me long to wise up and start the lying.

My grandma was dying of MSA. She loaned me a chalice for my wedding. After my wedding I left it outside the wedding hall, and it was stolen. The last thing I wanted to do was upset my grandma in her sickened state, so my aunt convinced me to tell her it was in my garage.

My aunt Leota was 96 years old and dying. She and my grandma were best friends, and very, very close. She would have been heart broken if she would have learned her younger sister died before her. So her children decided not to tell her.

Many times I have had patients who are sick and dying, and do you want to be the one to tell them the truth. Not me. Then I'd have to sit there and console them, and explain all the detail. That's the job of the doctor not a humble RT. So, when the patient asks what's wrong with him, I lie and say, "I don't know."

A patient asked me why he is getting an Albuterol breathing treatment. "I have never been short of breath in my life," he says. As an RT I lie and say, "It will relax your lungs and keep them open."

Lord knows the Ventolin will do nothing for that person, but for PR purposes you do justice by honoring and respecting the doctor's ignorant order to do breathing treatments Q4 on the post op patient with perfectly normal lungs.

Another patient with lung cancer is having a coughing jag. "This will help your cough," you say. Well, no it won't. But at least it makes the patient and the patient's family feel like we are doing something.

Once we had a patient who was very confused. She wanted to talk to the police. She was crying and really wanted to talk to the police to report nurse abuse. So, by the request of the patient's daughter, I feigned to be a police officer. It worked . The patient calmed down.

A CHF patient was given Lasix and Ventoin at the same time. The next day he says, "Rick, your breathing treatment cured me." I lie and say, "Yes it did." Of course we know the truth is that the Lasix made him better. But how do you explain that to a sick man.

If I were to be honest, I'd say something like, "No. That treatment isn't going to do anything for you. I have no clue why your doctor would make me waste my time giving it to you."

But, your humble RT does not want to go there. He does not want to make the doctor look bad. So he lies.

Sometimes you can get around lying. Some times I say, "Well, I'm doing the treatment because the doctor ordered it." But to me this is a lazy answer. Why do I think this. Because my grandma taught me that "because" is never an acceptable answer.

Therefore, we come to RT Cave rule #34:

RT Cave Rule #34: Sometimes it's okay to lie to your patients. You may try to get around it, but you will many times decide there is no way to get around it no matter what your morals tell you.

Good advice for hospital administrators

So, in watching the Today Show this morning, I learned that Fortune 500 has named it's top 100 employee friendly businesses in America.

This really was no big deal to me, except when the expert was asked the following question: "What is it that makes these companies so employee friendly?"

The answer: "Most companies put their customers first. All of these companies put their employees first. When your employees are happy, the customers will come."

Aha!!! I have been telling my RT bosses this for years. Finally this has been spoken about some of the most successful businesses. If it works for them, it could easily work for any business -- even a small town hospital.

So providing cheap health insurance, and not involving RNs and RTs in the decision making, has a tendency to frustrate employees. Thus, you create an environment for a revolving door (high turnover rate).

And the people who stay do so becaues they have no choice. A bitter, resentful environment of constant complaining is the result.

Hey, who ever would have thought that if you keep your employees happy, customers would come. Hmmmmm????? Right here at the RT Cave anyone!!

Politics do not belong in the patient's room

There's this old saying that you should never discuss politics with people you are not familiar with. No place does this hold more true than when you are working in a hospital around sick patients.

This brings me to two more RT Cave rules:

RT Cave Rule #32: You can talk about anything with the patient so long as the patient approves of it. In a sense, you will want to baby your patients. A stressed patient heals slower.

RT Cave Rule #33: Never talk politics within earshot of your patients unless you know the patient will not be offended by opposing views. Or, if you don't know the patient, keep your mouth shut. This is especially true of naive and stubborn patients.

It shouldn't' take a genius to figure this out, but a patient's room is his pseudo home. It should be as friendly and safe an environment as if the patient were in his own home. If she is never exposed to an opposing viewpoint at home, she should not be exposed to one in the health care setting.

And, since you have no clue what the setting of her home is, and what kind of people she associates with, you should just keep your mouth shut.

This was a lesson I learned within the first week I was working at Shoreline. We had a nurses assistant named Larry. I watched as he rushed out of a room that I was about to enter. As soon as I entered the room, the patient said, "Do not ever let that man in my room again!"

"What did he do?"

"He's a republican! I hate republicans!" He looked at me with intense eyes. "You aren't a republican are you?"

"Absolutely not." If I was, he would never know.

I might say vague things like, "Yeah, I believe that people are smarter and more capable of solving problems than government. However there may be rare occasions the government may need to step in."

Which is funny, because last night I broke this rule and I was talking politics with the nurses at the nurses station. What I wasn't paying attention to was that the patient in the room by the station were both awake and listening.

The call light went on. The patient said, "I heard what you were saying. Do you like Obama?"

Gulp! "Umm," I said. I was hoping maybe the patient would fall asleep or something as I paused, but he continued staring expressionless. "Well, you can't really judge a person before he ever does anything."

I was impressed with my extemporaneous response there. I did not know this patient, so I certainly didn't want to express like nor dislike for the president.

Then the patient said something totally off the wall, at which time I suspected he was out to lunch. However one never knows for sure what one is capable of thinking.

This is not to say I have never had a great political discussion with a patient before, because I have had many. Yet I suppose I have common sense enough to know how to pick my spots, and how not to tick off a patient.

And, hence, RT cave Rule #'s 32 and 33 come in handy.

Will there be an end to useless medical therapy???

The admins have been talking lately about a state or fed program that will form committees and investigate hospitals for useless therapies and recommend changes as a result.

If they did there job (which I doubt considering it's a gov agency), this agency would get rid of un-indicated breathing treatments, and bring about major change in the RT department.

This could be a major breakthrough in my fight for bronchodilator reform.

We'll have to wait and see. As I learn more about this initiative I'll be sure to let you know.

What % of night shifters do not drink coffee???

I read a post in Time magazine about coffee. It was a long article, so about half way through I nearly quit. The part of the article I read talked up coffee to the point I was thinking I should start drinking it.

Then, for some reason, I decided to read the rest of the post. I'm glad I did, because it brought me back down to reason. Sure, coffee is a natural drug that has many benefits. It does make you feel good. It improves your alertness and mood. It has even been proven to decrease depression and anxiety.

However, once you drink it for a while (get addicted I might as well say), it takes 1-2 cups of coffee just to get up to the happiness of a person who doesn't drink coffee. And then you have to have 2 more to get the happiness (or wakefulness) you used to get with one cup.

So, I decided, I might as well continue not drinking it.

That in mind, I wonder what percentage of night shift workers drink coffee? I'm quite certain I'm in the minority as a non-coffee drinker.

Perhaps a poll is in order. Still, I bet I'm in the minority as one of the few night shif workers who do not drink coffee.

Just a thought about the inauguration

Here I am watching the presidential inauguration on the Today Show for some reason, and my wife made a good point. She said the broadcasters said some presidents are always late (Bill Clinton) and some always early (George W. Bush), but so far the Obama's are inconsistent. "That's quite unusual," said Tom Brokaw.

It's not unusual as far as I'm concerned. But I have kids, and therefore I understand that some days they can be easy to get dressed and cart off, and other days one can be a bull head and difficult to get off to school.

But no one said, "Well, he's probably discliplining his kids." That's what this RT dad did this morning anyway.

So then the cameras were on the hotel for at least 20 minutes, and the announcers kept telling us they were waiting for the Obama's to exit the building and get into the limousine. Then, finally they got on the limo, and it was a mere 20 second ride.

That was so exciting.

Obama says he's going to fix our health care system. I wish him the best of luck. However, I hope he keeps this advice in mind: "Sometimes doing nothing is better than doing something stupid."

Can you imagine how great Bush feels about now. Man, I bet he's having palpitations, just yearning for the moment this is all over. He's going to be so happy to be out of the limelight. He even admitted as much.

Obama, on the other hand, is walking into the most stressful, most criticized, job in the world. And he's doing it with little kids. It's hard enough raising kids with the stress of a normal job, one of which I don't have to think about my work when I'm not working.

So he's walking out into the crowd of a billion people. He has a serious expression on his face. I bet he's thinking, "Man, I have to pee real bad."

Just a thought.

Few of us appreciate our time on this planet

I was busy last night.

A patient asked me, "Are you busy?"

I said, "Yes,"

She said, "Good. Time goes by so much faster when you are busy."

I hate it when people say that cliche. I'm so tired of hearing it. The truth is, time goes by at the same speed whether you are busy or not. The only way time speeds up is if you are traveling at a high rate of speed or...

You see, if I'm not busy doing RT stuff at work, I'm busy doing other things. I'm not the kind of person who can sit around wasting time -- being bored, playing games, gossipping.

No. That's not for me. And it's moments like this that have me wondering if I really am a rare breed. Most people probably are bored when they are not busy. I'm never bored. When it's slow, I find productive, mind entertaining things to do -- like reading, like blogging, like thinking.

Most people, I suppose, would rather be busy doing senseless things than thinking and reading and blogging. And that's why people like me --- and you guys -- are a rare breed.

Perhaps that explains why few people blog.

"Are you busy?"

"Yes."

"Great. Then time will go by faster."

Who would want time to go by faster? Only those who don't appreciate every single moment.

Yep. The faster time goes by, the less you can accomplish in your life. Or do you not have any goals like I do.

Am I the only person who has goals? I have things I want to accomplish before I die. Every moment I think: If I died right now, some things would go undone, some things would never be accomplished.

Some of us appreciate our time on this planet, but I have a distinct feeling that most people have no clue why they are even here, and it's those people who would say things like, "time goes by a lot faster when you are busy."

A thought about life

As Scott and I were working out this evening trying to make our bodies stronger and healthier so we can be around when our kids are old, we couldn't help thinking of the two people in the critical care unit we worked on last night who tried to take their own lives.

"It's hard to believe someone would do that," he said.

'nough said.

The conundrum of overdose patients

I was going to write about why it's been so slow lately, but considering I set up three ventilators within the first two hours of my shift tonight I'll delay that discussion for another night.

Then again, all the ventilators were set up on patients who overdosed on one medication or another, so all of these patients should be home sleeping comfortably in their own beds instead of couped up with a tube in every orifice.

But there are certain things that are beyond our control.

Overdose (OD) pts are often a conundrum. It's not like they suffer from a disease we can cure with our tubes. However they can receive help via social workers and psychologists. Still, the ultimate determination of how they will do in the future may reside in themselves. Although the brain and how people use it is not my expertise.

Both the ODs we have this night are intentional. One is a repeat offender, and thus frustrating. Does she try to take her life because she perceives it as miserable, or is she seeking attention again and again, considering she has failed yet again. Many times when someone fails, I can't help but think they are simply seeking help.

The saying goes that suicide is a permanent solution to a temporary problem. I think of life as a special privilege -- an honor per se. Life is rare. And to simply waste it, to me, seems frivolous. And even if I had a suicide thought, I'd have too much empathy for my wife and kids and brothers and parents and grandparents who'd be distraught over my death. I could never go through with it.

But, as I've read, some people get so depressed they lose the ability to reason. But, as I said, the mind is not my forte.

Either way, here sit late Sunday evening, rather busy. The RT Bosses and those who pay the checks are happy. And, to be honest, it's really nice to have some real challenging patients for a change.

That said, minus the slight rush in the ER tonight, I should be as slow as I was the past three nights. Yet I'll take what comes my way and be happy about it.

Contemplating large versus small hospital

It's been an arduous task to find inspiration for blog writing recently with a new baby and other children who need the attention of this father and RT. And yet, as I finally get back to work after three weeks off, I find that the patient load is still nearly non-existent. And, thus, the vacation -- in a way -- continues at work.

Yet it's still work of course. (When you are some place you don't want to be at 1:34 in the morning just so you can make money it's work).

It's ironic the way a hospital like this, that has seen it's busy days, can be so slow, yet I read the writings of other Rt bloggers, like the anonymous RT over at Respiratory Therapy 101, writing about how busy it is where he works to the point that he has no time to teach his student.

In an email to me about a year ago he pretty much summed up the difference between a large hospital and a small one like where I work: "There are definitely advantages to both paces though: a fast-paced place makes the day go by and lets you see a lot of intriguing things, but a slower-paced place has a friendlier atmosphere and you can often get to know your patients and co-workers better."

True. Another advantage to working for a smaller hospital is there is less staff. That means that you do not specialize in any one particular area. You are it. That means that you have to be the Ventilator expert in the critical care, the Intubation expert in the emergency room, the breathing treatment pawn who has to make sure all treatments are done on time, the Incentive spirometry expert, the ABG expert and anything else that might come up. You will never set your feet in one department.

You have to walk (well, all RTs do this). You have to climb stairs. You might even find yourself in the ambulance setting up an adult vent, and five minutes later in OB setting up a vent on a newborn infant, and then doing a breathing treatment on a patient in MRSA isolation, and then rushing to a code way downstairs in CT (arent' those the worst?).

Oh, and along with taking care of adults and adult vents, you also have to be able to swiftly and seamlessly shift your mindset over to pediatric care and neonatal care in a heartbeat. One moment you might be setting up a ventilator on an adult head bleed, and the next you might be setting up a newborn on a ventilator with a tital volume of 4 in pressure control.

The concept of taking care of neos and peds and adults is the same, but the way they are each set of on ventilators is different. The worse part about taking care of sick neonates and pediatrics at a small hospital is not setting them up on a ventilator, it's the fact that you hardly ever set them up. Therefore you have to practice and be ready. And, if needed, you need to have your cheat sheet available.

Still, 90% of the time, when you have a bad baby -- as I did last night -- you will not have your cheat sheet available. For some reason you will have set your clipboard down and not have it with you. The nurse -- if she wasn't so panicked -- would hear you curse, or do the Homer Simpson, "Doh!" You will then have to go by the wisdom you have wrapped up in the back of your mind.

The anonymous is RT right, though, that working for a small town hospital allows more time for the small things like spending quality time with our patients. However I'm sure there are times that the best RTs can find time to do this in larger hospitals too. This is where prioritizing and protocols come in handy (of course some doctors can hamper those things too I bet).

Keep in mind, however, that if we RTs have more time for small things, the RT Bosses also have more time to make a big deal when the small things are not charted properly. After all, in a small town hospital patients are harder to come by, and that means money is often on shorter supply (hence the difference in wages). And that can be the most frustrating part of the job -- along with the dreaded hospital politics (of course there's politics with every job don't forget.)

Sometimes I think I would like the change of pace of working for a large hospital. It's not that I would like feet that burned in the morning, but knowing that I will only have to work one area of the hospital one night instead of everything and everywhere. It would be nice knowing that I didn't have to work ER EVERY night. It would be nice to JUST do ABGs, or JUST intubate, or JUST work the critical care. Just once that would be nice.

It would be also nice, as the anonymous RT wrote, to see more things. Instead wrapping and stabilizing the head trauma and the head bleed or massive MI, it would be nice to keep those patients and see how things turn out.

But keep in mind --all you RTs who receive the patients we smaller hospitals ship, it's equally hard to stabilize and ship. The hardest part is HIPPA, and never getting an update on how the patient is doing, or at least how well we did at packaging the patient up. (However I've never heard a complaint either).

Most larger hospitals -- as far as I know -- tend to be more up to date when it comes to the latest equipment and technology and wisdom. We small town hospitals -- I honestly think -- tend to be 10 years behind. We still use the Bird IPPB for example (thankfully not as often anymore) while the larger hospitals sent those things to Ethiopia 12 years ago. Plus you guys get paid better (unless you own us).

There are many times I look forward to going to work just so I can relax. Can you imagine that? I bet no RT from a large hospital would ever be caught dead saying that. Yes. As I said, it's pretty hectic around my house right now with that new baby. And coming to work with only four patients and a (fingers crossed) slow ER of late is something to look forward to (why the heck is it so slow lately? That's a discussion for tomorrow night perhaps).

So, here I sit listening to Aerosmith on the radio, looking out at the patient and staff parking lots nearly empty of cars as most of the beds are NOT filled with respiratory patients. I'm leaning back in my chair with my feat up on the top of the computer typing away on my frivolous and for the most part senseless RT blog -- and getting paid for it. That's something you'd never hear a large hospital RT saying either.

But I work alone. You can't do this on day shift at a small hospital either. You have to hide out. But only until the bosses leave. Ah, the advantages of working for a small town hospital are tremendous. If you can find something to do; if you like to gossip (which I don't); if you like to socialize (which I'm not so good at); if you like to blog (ah, there you have me), if you like to read (you got me there too).

This is one of the nice things about capitalism is you get to choose between so many different environments -- big or small, busy or slow, friendly or not so friendly. And, at times, all hospitals share all four environments, as we sometimes get as busy as a large city hospital. But not lately. Lately it's been slow as a frozen snail. Yet I'm not complaining.

That, my friends, is the thought of the day.

Respiratory Blog Carnival: A Source of Inspiration

The Trauma Junkie over at Surviving RT School is working on starting a respiratory therapy carnival that he will aptly title: A source of Inspiration.

So, what the heck is a blog carnival. According to Wikipedia, "Carnivals provide an aggregation of recent posts by (a blog) community on a given topic, and the host provides a level of editing and annotation that helps readers find posts they are interested in. Writers who submit their articles to blog carnivals are rewarded with traffic (if the host decides to give them a link and, perhaps, a positive review)."

Perhaps you've heard of Grand Rounds or Change of Shift.

To learn how you can participate in this carnival, and to find out more information about "A Source of Inspiration," click here and I will morph you over to Surviving RT School.

Keep in mind that anyone can contribute: RTs, RNs, doctors, patients and anyone else.

Back at it

It's hard to get motivated to work after being off three weeks, but when you only have four patients the move is that much easier. It makes me wonder if perhaps the slow economy has made people too poor to become sick.

I have a ton of emails and questions I will go through in the next few days and respond or answer. Bear with me, though, as it might take me some time to get caught up.

We actually planned on going to Florida, but our 2 month old baby girl decided she didn't want to go. Even though I didn't get to enjoy the warm weather -- and it was 90 degrees the day we were gonna go to Disney -- I vowed I wouldn't write in order to clear my head.

Well, my head is clear. So, here we go, refreshed and ready to write some more. Of course if work stays this slow (fingers crossed behind back), I might actually stay refreshed.

The best diet: Moderation

So you've made the new years resolution to lose weight and eat healthy and now you're struggling with trying to stick with it. If you're like me, your effort is about in the 50% range. The workout is going great, but for some reason I don't think having bacon for lunch and dinner isn't exactly a healthy diet.

But I'm on vacation. Yep, that's my excuse. The goal is to eat healthier starting today, but my idea of eating healthy is not to go on one of those ridiculous crash diets -- been there and done that and failed that. Nope. I'm going to do the diet my grandpa John recommended to my mom when she was a kid. It's simple: Anything in moderation is good for you.

I'll call it the Moderation Diet.

The best diets I've read about say that eating a lot of food three times a day as Americans have traditionally done is not good. The best way to keep your metabolism going is to constantly have a supply of nutrients for your body to burn up, and the best way to do that is to eat several small meals a day. So I try to eat every 2.5 to three hours, when I'm being healthy (which should be all the time but, again, that's easier said than done.)

Home style breakfasts are not good for you. By home style I mean eggs and bacon and omelets. Those things are "okay" in the moderation diet once or twice a week, but definitely not every day. And you should "try" to limit yourself to one egg and not two. I had breakfast with an overweight man a few weeks ago, and he had four eggs. If he eats like that every day, it's pretty obvious why he has a weight issue.

The thing is, though, you can't just buy into one of these crash diets and think that you are going to be able to maintain that for life. I honestly think the companies that sell these diets rely on people buying them and not sticking with it. There may be 1 or 2 out of 20 who can motivate themselves to a crash diet (eating chicken for every meal for example), but I highly doubt many of them are married with three kids running around.

Of course it also helps to have a pal to work out with. This is mainly important for those days you don't feel like working out. It's good to have someone motivating you.

It's good to have a wife (or husband) who is on the same diet page as you. When my wife was pregnant and making bacon and eggs every day for breakfast, it was hard to avoid eating what she cooked. Plus her desserts were way to good to avoid.

Likewise, the pal (friend or wife) who is on the same page as you can motivate you on the "bad" diet days, and vice versal.

I've learned that if you give up all the things you like you will crave them strongly, and it's that craving that will set your diet up for doom. If you love beer, go ahead and have one or two once or twice a week. If your friends go out, go ahead and go with them. But don't do this every day.

If your daughter has a birthday party, go ahead and pig out. If your aunt millie has an 90th birthday party, go ahead and pig out. You need those kind of "off" days during any diet. Likewise, you should take a day or two off each week that you do not excercise. Your muscles need a break too.

My wife once lost 20 pounds while eating one piece of chocolate a day and otherwise doing the body-for-life diet. She actually stuck with that diet a long time. I lost weight once when I was in college and I went to the bars on the weekends. You have to find a routine that works for you and stick with it, and continue sticking with it.

Easier said than done I know.

So, this time around it's moderation.

Direct marketing is a scam. Don't buy into it!

They are advertised all over TV, especially at the beginning of the new year. They are gimmicks that say they will help a person get rid of fat, lose weight, gain a six pack, obtain trimmer hips and so forth.

My mom bought a few of these gimmicks in her day, and I doubt she used them for a month and they are probably still somewhere collecting dust in her basement. My wife bought a weight loss kit once, and was fortunate enough to sell it on ebay at a profit. She never used it.

The point here is that direct marketers know that the #1 new years resolution is to lose weight, and they target these people big time. They know that 99% of the people who buy their products won't be using them a month from now. That way, next year they can target a new product to the same person.

Ah, so they say that it's guaranteed. They say if you do not lose 10 pounds in a week they will give you your money back. They know you won't make the effort to do so. They aren't stupid. If that were the case they'd go broke.

I know this because I have an advertising major. I know that the best way to direct market a product is to offer something "free" with it, like a pedometer or something like that that really costs 50 cents but they say it's a $5.00 deal you get "absolutely free." And they also have to put in some kind of guarantee.

Look, folks, these are all gimmicks to get you to buy their product, no matter what it is. My advice to you is to not buy anything from a direct marketing campaign. If you are truly committed to losing weight, buy some credible workout equipment, a treadmill perhaps, and make the commitment.

That's my advice for the month.

A simple vacation

Sometimes it's nice just to get away from it all. Yet sometimes getting away from it all is not going anywhere at all.

The neonate wasn't keen on traveling, so anything involving the vehicle was out of the question.

It was sad to say, "Sorry kids, but we aren't going to travel 24 hours to get to your grandparents this year."

Yet, while the kids are away at school, the days we would normally have spent in the warm weather are just as relaxing here at home, so long as we can stay away from the normal routine.

It's hard, though, to not do the things you want to get away from when you are supposed to be on vacation. And Disney World is a heck of a lot more fun than blogging (oops, I'm not supposed to be doing this either. See what I mean, this is hard.)

But, when one has kids, sometimes these are the sacrifices one must make. If you have kids, I'm sure you know what I mean.

It's July and we're beyond the half way point in the year 2009 (already!) Perhaps it's time we reconsider our new years resolutions we made seven months ago. Are you still sticking with it??!!

Five things that could get in the way of a healthy you (and how to get around them!).
by Rick Frea Wednesday, January 07, 2009

So you've come to grips with your asthma. That's great! I know you're committed to living healthier with this chronic condition, but here are five things that could get in your way (and how to get around them!).

1. Frustration: You decide to work out with your friend, jogging with him and you realize that you simply cannot keep pace. You decide to run faster, and that causes your chest to get tight and you become short of breath and have to quit. You decide it's easier not to excercise.

Don't let this happen to you. Know you have a chronic lung disease, and that you must excercise regardless of this fact. There are many advantages to excercise, including improved self esteem, stress relief, and the fact that it strengthens your heart and lungs and makes you feel less winded.

Just because you have asthma should not be an excuse not to excercise. And, as stated at National Jewish Health, "When asthma is well controlled, people with exercise-induced asthma should be able to participate in any sport."

If you have trouble excercising with asthma, the following advice from National Jewish Health may help you:

• Talk to your doctor about pre-medicating yourself prior to excercise
• Participate in sports or activities with short bursts of exercise, such as baseball, softball, volleyball, tennis, downhill skiing, golf and some track and field events
• Sports that require continuous activity like swimming, cycling, distance running and soccer also can be enjoyed by people with exercise-induced asthma.
• A good warm-up and cool-down period are often helpful.

2. Irritation: Those doggone allergies can be very irritating. You decide to join your buddy in a walk around the park, but the pollen drives you crazy. So you decide to go to your buddy's house to use his equipment, and you find you are allergic to his dog. You put a treadmill in your own basement, but you are allergic to your basement too. You decide it would be easier just to sit in your recliner and watch TV in a room you're not allergic to.

You can do prevent allergy symptoms. The first thing you should do is find out what exactly you are allergic to (you have to see your doctor) and avoid those triggers. Many allergists recommend getting rid of carpets, pets and plants, and dusting and vacuuming your home often. Here's a post about the top 5 things you need to get rid of to prevent triggering your allergies.

Still, those pesky allergens have a way of sneaking up on you and causing trouble. Plus, many times it's nearly impossible to avoid allergens. Fortunately, there is medicine available that might help you, and you can discuss which one might work best for you with your doctor. Many doctors recommend Singulair for allergic asthmatics because it blocks the chemicals released during an allergic reaction that cause asthma symptoms. However, check out this link for other options.

3. Forgetfulness: You keep telling yourself you will be compliant with your meds, but you have a bad track record.

To solve this problem you may want to click here, or go to your local pharmacy, and get a pill organizer. I find these work really nice for making sure you take all your meds.

Even better, and if possible, you should talk to your doctor about changing your asthma medicine regime so all your medicines only need to be taken once or twice a day. That way, the only time you have to take your meds is when you get up in the morning and just before bed.
4. Socializing: You are a socializer and you don't want to quit. You have many friends, you like to have fun, and you don't want your asthma to get in the way.

Regardless, the places your friends hang out are filled with asthma triggers that continue to cause you trouble. You go to the bar on the weekend and the next morning -- along with your possible hangover -- you can't breathe very well.

But you are stubborn. You don't want to change your way of life.

First it must be noted here that there are some social situations that you might simply have to avoid, like those crowded, non-vented, smoke-infested bars or your chain-smoking Aunt Millie's house, or your uncle's moldy cabin. Come on! It's only common sense that you need to avoid those places.

Still, you do not have to avoid all the things you love to do just because you have asthma. For the most part, preventative medicines should help you live a normal life (again, if you don't take preventative meds, see your doctor).

But, if that alone doesn't do it, and you don't want to quit having fun, there are a few other tricks you may want to incorporate into your life:.

• Do not smoke.
• Tell your friends not to smoke around you (if they are truly your friends they should respect your wishes.)
• Do not drink too much. Drinking dries out your lungs and can trigger asthma symptoms.
• Try to have social outings at your home so you can control the atmosphere.
• Smoke free bars or restaurants are always nice.

5. Stress: You worked out all weekend long and you feel good about yourself, but then you return to work and your boss stresses you out, and this makes your asthma worse. In the past you have used this as an excuse to quit.

Not this year. It is true stress can cause asthma, and it's true stess is often used as an excuse to pig out, but this stress can be managed. Click here and I will morph you to a nice article called, "10 Tips for Managing Stress to Avoid Asthma Attacks."

All right, so you've made the committment to a healthier living, and now you're aware of the five things that might get in your way (and some tips to avoid them). Now it's time to start living healthier. No more excuses.

Happy Birthday to me

It turned out nice that I forgot to get the mail yesterday, because I walked out to the mailbox and got my only birthday card on my birthday. I never was a fan a sending cards, but sometimes all it takes is something little to make an "old man" happy on his birthday. Wow, who would have thought 39 years could creep up on a person so quickly.

You get to a point that one day you wake up and realize that things aren't the way they used to be, and they aren't the way you envisioned them. You have an epiphany of sorts, and reality sets in.
And you realize that old saying your mom always said might have some truth to it: "The older you get the faster time goes."

I remember when I was ten thinking that I didn't want to grow up. I'm sure most kids don't do this, but I literally stopped and smelled the roses. I remember savoring the moments.

Now, as an adult, the moments have gone by and in another lifetime, another 39 years, I will be 78. Wow. I take a deep breath and sigh. Better yet, I'm going to savor the day with my wife and kids.

Which brings me to another point. As a kid I loved to get materialistic birthday presents and mom insisted we kids didn't spend our money on anything for her birthday. That the best gift we could give is to simply be good.

Now, as an adult, I understand fully what mom meant. A wonderful day and a happy birthday to me was not the materialistic gift my wife and children didn't get me, but the smiles and hugs and "happy birthdays" they presented me with upon my awakening.

On a side note, I posted this picture because I am the baby.

My grandpa was 80 when he held me. Mom said, "We named him after you, dad. His name is Richard Stephen too." He smiled big and Auntie Virgie snapped this picture. Grandpa died three months later, living just long enough to hold me.

My grandma told me she was bringing this picture to me when I was 10, but she lost it. 28 years later my Auntie Virgie found it for me. It was a great birthday gift.

Happy birthday to me.

It's time to excercise!!!

My latest blog posting over at my asthma blog is titled, "Come on asthmatics, it's time to exercise!" While I direct this at asthmatics, it actually could be directed at any person, particularly those with a chronic illness.

There are so many benefits to exercising, even if it's in the form of a simple walk as Breathin Stephen can attest to, that it is the number one thing that should be recommended by doctors, once the chronic condition is stabilized.

Since I spent time in an asthma hospital when I was a kid I have always tried to exercise regularly, but there are times I slip like the rest of the normal people out there. My wife and I recently had a baby, so during the pregnancy it was hard to discipline myself to stay away from all the delicious desserts.

Still, I'm not making a resolution, I'm making a commitment. Perhaps my readers will care to join me. It's time to excercise.

Come on asthmatics, it's time to excercise!
by Rick Frea Wednesday, December 31, 2008 @MyAsthmaCentral.com

If you have asthma it is paramount that you exercise, because the benefits of exercise coupled with a healthy diet not only help you lose weight, but it can help you better manage your asthma.

Even if it's just a simple walk, exercise has many benefits. According to the Mayo Clinic:

• Makes your heart and lungs stronger.
• Increases your energy level.
• Increases your stamina and decreases fatigue
• helps you sleep better and improve your concentration
• helps you combat chronic disease
• Improves your mood, confidence and self esteem
• Reduces stress and anxiety
• Improves your immune system, which improves your ability to stave off nasty viruses and the flu.

Take a look at yourself in the mirror. Do you have extra fat around your waist? Do you have a pot belly? Did you get winded as you walked back from the mirror to your computer to read this? Be honest. Your asthma may cause you problems, but being out of shape may be compounding the problem.

Sure, if your asthma is out of control, or if you have a cold, you should lay low. But once you have your asthma under control, which should be easy to do once you see your doctor and get yourself on a good asthma management plan, you should be ready to exercise.

If you have exercise-induced asthma, then you can premedicate as directed by your physician. Come one! No excuses!

When I was 14 my asthma was so bad I had no choice but not to exercise. But after I was shipped to an asthma hospital in Denver, as soon as they had my asthma even somewhat controlled they had me in the gym doing aerobics.

Even back then, in 1985, it was well known the advantages of exercise as a tool to control asthma. Even Teddy Roosevelt, back in the 1860s when there were no bronchodilators to control asthma, was encouraged by his doctor to exercise to improve his body size and improve his lung function. Hey, this isn't new wisdom.

Even the best of us have our lapses, though. And, like many of you, life sometimes takes over and exercise doesn't happen. So, even though I learned the benefits of exercise at a young age, I still -- like many of you -- had to learn the hard way.

As a kid I was able to eat whatever I wanted and never gain wait. As I grew older, and kept eating the same, all this eating eventually caught up with me (sound familiar?). By the time I was 28 I was winded with minimal exertion and I was 40 pounds over weight. Worst of all, my asthma was getting worse.

I just got a new job as an RT near my hometown. I packed my clothing, hauled dusty boxes to my new home, and caught a cold. My chronic asthmatic lungs, incapable of handling all this at once, started shutting down.

A few days later, a sweet old lady COPD patient of mine said to me while she was puffing on her breathing treatment: "You look worse than I feel."

"Oh, I'm fine," I huffed. I was lying. I was not fine. I was not just winded I was tight. Between patients that day I kept puffing on my rescue inhaler.

When I finished working that day I went to the ER. I was so bad I was admitted to a room right next to the same COPD patient who told me I looked bad just a few hours earlier. I was so bad I needed a breathing treatment every hour for three days.

Many of my co-workers visited me with sympathy. But then Sahara came into my room. Sahara so happened to be an RT who took care of me when I was a kid, so she knew me well.

She said, "You did this to yourself, Rick."

"What?" I said.

"You heard me. You did this to yourself. Look at yourself in the mirror some day, Rick. You are way overweight. You can't hope to manage your asthma if you are that overweight. And you know better. You've had this disease your whole life."

She continued, "Every time I see you you are eating a Big Mac or a Whopper. You don't eat right, and I'm certain you don't exercise. You need to take care of yourself or you're going to end up back in here again."

My face must have been beat red as she beamed at me with intense eyes. I said nothing. I couldn't breath. I could hear myself wheeze. I just wanted her to go.

I told my friends what she did, and they all agreed that she was a terrible person to say all those things. Later, I was discharged from the hospital and my good friend Sammy, who was overweight too and a fellow asthmatic, came to my home and said, "I've been going to the health center for about a month and I've never felt better."

"I'm not going there," I said. "I can't do that kind of working out. Besides, I hate working out. Working out is for chumps."

"Just come one time and see if you like it. They have a trainer who will work with you."

I reluctantly went. I hated it. I hated lifting weights, and I hated the aerobics. I felt miserable the next day. I was sore.

"I'm not ever doing that again," I chanted.

Lo and behold, I did keep going, and within a month I had so much energy I started going to the health center twice a day. I had lost 10 pounds, and, best of all, I no longer felt winded with minimal exertion.

A few months later not only was I working out, I was jogging. That's right. Never in my life had I been able to jog without it bothering my asthma.

So I'm living proof that asthma should never stop you from exercising. Also, I'm proof that excercise can make your asthma better. So long as you are a gallant asthmatic, so long as you premedicate yourself if needed, you should be able to do it.

My wife teases me when she says, "You don't jog, you wog."

Wog defined: a very awkward looking jog.

Okay, so make fun of me if you wish. The point is that I get outside and I exercise. I do it because it is a simple fact that exercising is good all the way around. Coupled with a good asthma management plan, exercise has helped me avoid the ER for asthma for ten years now.

So you've decided to make getting your lungs in shape your New Years Resolution. Here are some tips from the American Lung Association:

• Never exercise if you are having breathing difficulties before starting.
• When it's cold exercise indoors, as cold air can trigger asthma.
• Exercise in places that have low quantities of asthma triggers
• Premedicate yourself as directed by your physician.
• Pace yourself.
• Warm up your body and muscles
• Cool down for 10 minutes when you finish.

If you have a busy schedule and don't have time: MAKE THE TIME. Trust me, a fellow asthmatic: the more you work out, the more time you'll find to do all the things you want to do in a day as your energy level increases.

Come on asthmatics! There is no better time than right now to strengthen your lungs, your heart and your body. It's time to exercise.