So, you're still nervous?

Feeling nervous, especially as a newcomer, is entirely normal. However, my advice is to refrain from showing your nerves to others. Despite appearing competent and confident, everyone present has experienced similar feelings during their early stages. Those who claim otherwise might be overconfident, or possibly dishonest about their own experiences.

This is precisely what we've trained for, what we've dedicated years to studying. Trust in your experiences, rely on the knowledge you've diligently acquired, and stay steady. You've got this!

Here are some common events that may cause nerves:

• Putting the Etab on upside down. I'm nearing my 30th year in this field, yet there are moments when I still catch myself setting it up incorrectly. When someone points it out, I calmly acknowledge the error and correct it. Remember, mishaps occur. Don't allow such occurrences to deter you.
• Forgetting to plug in the AMBU bag. Or forgetting to turn the flow on. Look, every respiratory therapist will do this at least once. Come up with a system where you check this every time. 
• The vent isn't working right. Okay, so what's wrong with the vent. Go back to the tubing and make sure everything is plugged in right. Is the chest moving? Is the sat good? If those are all good, then maybe the vent is working fine and something else is going on? If not, then calmly take the patient off the vent, have someone bag, and fix the ventilator. If your upline provides you with good equipment, you shouldn't have to worry about this issue. But, sometimes you're going to get a machine that doesn't cooperate. Stay calm. Figure it out. And, if necessary, switch machines. 
• You are called to OB for a newborn baby. And you haven't had one yet. Or it's been over a year. Just remember that every nurse in the room is WAY more nervous than you are. Stay calm and let your training set into action. Have a cheat sheet. Follow your cheat sheet. And stay calm. Or, at the very least, don't let anyone know you are nervous. 

Study diligently during your education. Once you're on the job, consider keeping a cheat sheet handy for tasks you're uncertain about, like setting up a neonatal ventilator or selecting the appropriate ETT for an infant. The better prepared you are, the less stress will impede your progress. 

How Far Would You Go For A Patient?

I had never met him before, and here he was in the hospital with terminal cancer. As I introduced myself, I couldn't help but feel the weight of the situation. Yet, duty called, and I began my assessment, scanning the patient's wristsband like a box of scalloped potatoes in a grocery store.

After swiftly checking his medications, I reached for the nebulizer from the bag hanging on the flowmeter. With practiced hands, I prepared the medicine and started the nebulizer. Then, I carefully positioned the mask over the patient's nose and mouth, securing it with the strap as I gently slipped it over his face.

The TV in his room was tuned to the Tigers game, adding a touch of familiarity to the sterile environment. With the assessment completed and the nebulizer doing its job, I pulled up a chair beside him, and together we watched the game. Despite our brief acquaintance, we sat there like old friends.

I did not mention that the game was a rerun. I've learned not to spoil such moments for patients, especially when they believe they are watching a live game. Stuck in a hospital, sometimes it's comforting to cherish what you have access to—especially if it brings you joy and happiness. Despite it being 10 am, the timing didn't diminish the significance of the moment for him.

Then, he broke the silence. "So, you're a Tigers fan?" he asked.

"Yes, a big Tigers fan," I replied with a smile.

As he struggled to speak through labored breaths, he shared a story with me. His words were punctuated by gasps as he inhaled from the large cannula under his mask. He reminisced about his first time attending a Tigers game, recalling how the price of a ticket was only 35 cents."

A few days had passed, and I found myself becoming quite familiar with him. It's a common occurrence in our line of work - you meet someone, and in just a few days, you learn about their entire life story. On the fourth day, my coworker took over caring for this patient. She came downstairs to the RT Cave, trying to maintain composure as tears threatened to spill from her eyes.

"He's not doing well, John," she said softly. "He and his friend have decided to transition him to hospice care. He expressed a wish to have all the medical interventions removed so that nature can take its course."

He said, 'But I have one last wish: I want to go outside and have a beer.' With determination in his eyes, he requested to have the high-flow cannula removed after this wish was complete once this was done. My coworker shared with me the nurse's concerns about the feasibility of fulfilling his wish, given his high oxygen requirements and deteriorating condition.

However, my friend was resolute. She declared, 'I will do it. I will make his wish come true.'

He was so happy," my friend recounted later. "He said to me, 'You are an amazing person.'"

Several hours later, I found myself back in the patient's room, alongside my coworker, ready to fulfill this man's final wish. The nurse assisted the patient in pivoting from the bed to the wheelchair, while we wrapped a blanket around him to ward off the chill of the 55-degree weather. Despite the relatively mild temperature, ensuring his comfort remained a priority given his condition.

As the moment arrived, my friend swiftly set up one oxygen tank behind the wheelchair, while I carried the second tank, ensuring we were fully prepared for any eventuality.

At that moment, his friend arrived, carrying his Tigers hat and a 16-ounce Bush Light, ready to accompany him on this memorable journey. She tenderly placed the hat on his head, and his eyes lit up at the sight of the beer. Carefully, he placed it on his lap, a symbol of comfort and camaraderie in his final moments.

A second nurse held the door while we wheeled this dying man and his tanks out onto the back deck of the intensive care unit. As he reached for his beer, the sound of the can opening echoed through the air. With trembling hands and labored breaths, he struggled to hold the can, his skin glistening with moisture from the exertion of breathing. Ignoring all this, he smiled. 

"I love beer. I love the Tigers. I love being outside. I love life" he declared between sips, pausing to take in the moment. "And I think you guys are so special for doing this for me. You guys are great."

There he sat, drinking his beer and relishing the outdoor air. I stood by, silently witnessing him enjoy his last wish. It was a moment filled with both happiness and sadness, like tasting something both sweet and salty simultaneously. 

And finally, the time had come. My friend, who was leading this expedition, gently announced, "Okay, we have to go inside now." With a sense of reverence, we wheeled the man and his oxygen tanks back into the hospital and to his room. His friend grabbed his beer so she wouldn't spill it, and the nurse assisted him in pivoting from the chair to the bed, while we each lent a hand, ensuring he was settled and his pillows fluffed for maximum comfort given his grim situation.

As we worked to make him as comfortable as possible, I noticed something remarkable. Amidst the flurry of activity, he quietly asked, "Can I have my beer?" His friend, ever attentive, handed him the beer she had taken from him just before the nurse helped him onto the bed.

A few hours later, he peacefully slipped into Heaven's embrace, surrounded by the love and care of those who had become his guardians in his final moments.

The best part of the job

As I stroll through the lobby, a warm smile greets me. "Are you respiratory?" a kind lady asks.

"Yes," I reply.

With gratitude in her voice, she shares a touching memory from 2015. Her husband, once in a coma for seven days, was breathing on his own thanks to our intervention. She recalls how I explained the significance of the purple marker on the ventilator and encouraged deep breaths. Her appreciation fills the air, reminding me of the profound impact our work has on people's lives.

Such moments are the heartwarming highlights of this job. We dedicate ourselves to our work, striving for excellence without seeking recognition. Yet, it's touching when someone remembers and acknowledges our efforts with such genuine gratitude.

As the lady in the waiting room smiles, I'm reminded once again of the power of compassion and connection in our work.

----

Later, I meet her husband, the former patient, who greets me with a beaming smile. "Is this the former patient?" I ask, looking at his wife.

"It sure is," she replies.

Although he couldn't recall our encounter, he expresses profound gratitude for the care he received during his time here. He said his memory faded until his last few days as a patient, after which he was transferred to a nursing home for rehabilitation.

"And here I am," he exclaims, exuding joy, "as happy as ever." he adds, gesturing toward his wife, whose radiant smile mirrors his own. 

His resilience and gratitude serve as a poignant reminder of the transformative journey he had undertaken. It reaffirms the profound impact we have on individuals' lives, even when the details may fade from memory.

Getting Away From Our Religious Roots Has Caused Chaos

What we presently experience in Western civilization is largely built upon Christian morals. And these morals were learned by trial and error over thousands of years. These morals encompass fundamental principles such as 'do not commit murder,' 'do not steal,' and 'do not covet thy neighbor's wife,' as well as guidelines regarding marriage and premarital sex, among others.

These rules were widely accepted as they were believed to align with divine will, with deviation understood to lead to chaos in both individual lives and society as a whole. Much like parents teaching their children not to touch a hot stove, these moral guidelines were adopted without question and ingrained in society.

Religion historically addressed these issues, effectively removing them from societal discourse. It conveyed the message akin to 'do not touch the stove,' promising a good life in return and facilitating the development of individuals into productive members of society.

This underscores the significance of religion in maintaining societal order. As a wise person once shared with me, 'Even if you choose not to believe in God, instilling the teachings of the church in your children is crucial.' Early civilizations recognized the importance of adherence to rules for societal harmony, realizing that values advocated by the Church were effective in this regard.

This recognition of religion's importance is exemplified by a notable event shortly after the founding of our nation. Thomas Jefferson and John Adams, despite not adhering to traditional religious beliefs, acknowledged the historical precedent of religion in fostering societal stability. They concluded that promoting religion was essential for the nation's cohesion, leading to phrases like 'In God We Trust' on our currency and prominent displays of the 'Ten Commandments.'

This approach proved effective, contributing to the nation's unity and orderliness for the first two centuries of its existence.

Then their was a fundamental shift!

In the early 20th century, a significant shift began occurring as people began questioning traditional rules rather than accepting them blindly. Instead of adhering to principles such as "do not touch the stove," they adopted an attitude of experimentation, asking questions like, "What will happen if I touch the stove? Let's find out." This shift towards questioning and experimentation gradually gained momentum, resulting in ongoing attempts to remove God and religion from society. The sentiment became, "Let's get rid of the rules because, hey, it's all about my own personal happiness, and those darned rules just get in the way."

Today, when we observe the chaos in our own nation, we can see the consequences of this shift.

It's evident that certain societal issues, once minimized through generations of wisdom, have resurfaced with increased prevalence. Instances of suicide and euthanasia have seen a significant rise in recent years, which, in my view, correlates with a departure from religious principles that emphasize the sanctity of life. This shift away from religious values has also contributed to a growing acceptance of practices like abortion, essentially the taking of innocent life. These were practices prevalent in the pre-Christian Pagan world but were largely curbed for thousands of years following the spread of Christianity worldwide.

Drug abuse continues to plague the West, a persistent issue for several decades. Additionally, pornography has become widespread in availability, usage, and addiction, with effects similar to drug addiction. Moreover, it detrimentally impacts relationships between men and women, reducing women to mere objects and fostering disconnection from others.

This societal shift affects crucial aspects of a functioning society such as marriage and childbearing.
The rising number of childless women and the significant proportion of individuals choosing alternative family structures contribute to these challenges, indicating a decline in efforts to form traditional family units essential for societal stability.

Observing the chaos prevalent in our world today, characterized by an increase in crime and murders, and leaders seemingly neglecting the importance of securing borders, underscores the wisdom of early civilizations. They recognized the stabilizing influence of religion, a sentiment echoed by our founding fathers who emphasized the significance of religion in maintaining order within our nation, a belief that has been proven correct time and again.

And this is why it is so important to find a church, especially where children are involved. 

I Started Out As A Journalist

In high school, I attended a career day where I had the opportunity to speak with a respiratory therapist. When I asked about the program requirements, specifically questioning the necessity of taking chemistry, he affirmed that it was a requirement. Given my struggles with chemistry at the time, I made the decision to explore another path. With a passion for writing, I ultimately chose journalism.

My decision to pursue journalism felt somewhat like drawing a ball from a lottery bucket, and the ball I selected had "journalism" written on it. That chance moment guided my college choice and set me on the path of studying journalism.

At this time I wasn't the best student. I loved to learn, but had yet to master the art of making what I learned stick in my head. Actually, what I lacked was organization and self discipline. So I mostly got B's and Cs and the occasional D. And I made it through the 2 year associates's degree program. 

We had a school newspaper called the Torch. And I was a writer for one trimester, and this was where I learned the skill of being a reporter. And, being that I am an introvert and have social anxiety issues, it was difficult for me to motivate myself to get interviews. Plus, since I was naive about the world at this time (after all, I was only 18), sometimes I misunderstood what I was being told in interviews. So, this made it a bit challenging for me as a reporter. 

Despite the initial challenges, I persevered and found my footing. During the first trimester, my roommate assumed the role of editor for the Torch, and I was fortunate enough to be appointed as the assistant editor. Little did I know, this would become the most impactful position in my college career.

As the assistant editor, my responsibilities included meticulously reviewing all articles in the news section, a task that significantly contributed to my growth. Critiquing the work of others allowed me to identify flaws, ultimately enhancing my own writing. This role served as a crucible for improvement.

As I became more acquainted with my colleagues and overcame my initial hesitation in communication, especially over the phone, I gradually became more adept as a reporter. This increased comfort translated into a significant improvement in my writing style. I adopted a concise paragraph structure, a stylistic choice that would later carry over into my blog posts.

Although working as a journalist on a college campus presented its challenges, I am grateful for the experience. It not only equipped me with valuable skills but also played a pivotal role in shaping the writing techniques I now employ in my current endeavors.

What Causes RT Grumpiness

Sometimes we RTs are busy. And sometimes we are not. And there are two different types of busy. There's the type of busy that involves things that make you feel proud of the job you do. And then there's the type of busy where you're busy because doctors are writing a bunch of stupid doctor orders. 

Let's say someone comes in severely short of breath. And you are a part of the team that helps that patient feel better. This creates a sense of pride and joy. It makes you happy that you have the job that you have. This is the good type of busy. 

But, then you have those days when you are unable to sit down all day becasue you are running from room to room doing breathing treatments for heart failure, cough, no cough, heart failure, pneumonis, influenza, COVID and rickets. And just as you sit down, you get a text that there is an outpatient EKG. And as soon as you are done, and you sit down, you get a page for a STAT EKG on a preop patient.

If a patient has COVID, they get automatic QID breathing treatments. Same for influenza and pneumonia. Of course then you have to gown, glove and wear a mask in every patient room. And then when you are done you ask, "Do you feel any better?" And the patients all say, "NO!" 

Yep. You know what I mean. At the end of the day your feet are burning and you are irritated as all get out. This, my friends, is what causes RT burnout. This is what causes RATS, otherwise knows as Respiratory Therapy Apathy Syndrome. 

My Greatest Fear As An RT

There's an old saying that there's nothing to fear but fear itself. Although, I think this saying is poppycock. How can you be afraid of being afraid? A better saying is: 'There's nothing to fear but not being prepared.'

So, this brings me to my greatest fear as a respiratory therapist. It is... spilling that coffee that is sitting on the patient's bedside table.

What did you think I was going to say?

And, as soon as I walk into the room, I prepare myself. I say, 'John, you will not spill that coffee.' It's challenging, especially as I move past the bedside table to plug in the treatment to the flow meter. I worry that my jacket might brush against the coffee and spill it.

Or, worse, that I would forget it was there and knock it over because I wasn't paying attention.

In my 28 years on this job, I've only done it once. And, it wasn't a cup of coffee; it was one of those narrow vases holding a flower. It shattered all over the floor, and I had to apologize. Then, I had to go on a hunt for a new flower vase.

What were you thinking I was going to say? What is your greatest fear as an RT?