What to do during down time

All the treatments were done and there was finally an opportunity to sit down.  I sat down in front of a computer in the RT Cave and clicked on the Internet, and quickly tuned into CBSsports.com.  My coworker did the same, only she tuned into Facebook.  Our boss said to my coworker:  "Don't you have anything better to do?  What about stocking?"

My coworker jumped out of her seat and proceeded to leave the RT Cave.  What she did I have no idea, yet later I observed stocking is not what she did.  I continued to surf the net, considering that's what I wanted to do.  I worked hard early in the day so I could have this free time, and I was going to take advantage of it.  The funny thing was, my boss never said a word to me.  

Later on I had a discussion with my boss.  She said if she had her way no one would be able to go on the Internet except for work related stuff.  My comeback to that was this:  "If a doctor came in here and went to CBSsports.com or Facebook, would you say anything to that doctor?"

This email says exactly why I blog

So, yesterday I wrote about my very first hate email. Sure I was excited about that, but emails from people who love my blog generate a lot more interest from me. That is, especially when the person sending me the email has no interesting in a med-blog.

Consider this:

"It's the middle of the night, I discovered your blog because I'm up with the flu and a few keywords in google hit your blog. Your blog isn't especially relevant to my situation, I'm not especially interested in things medical but for some reason I can't stop reading. I've just wasted 45 minutes here.Congratulations, somehow you've made all this stuff fascinating. Really great blog."

Now I normally don't post here emails I get, but this one I thought was really cool. Before I read this my ego was at zero. Now it is at 1.25234.

If I were the boss of the RT Cave...

I've been thinking lately how I would run an RT department if I had the opportunity (not that I would want that job.)

The first thing I would do is anything possible to create a mileau where RTs will want to work for this department. Not only will you be challenged, you will be encouraged to participate. You have an idea, come forward! You will not be ignored.

There are many different ways bosses can run their companies, and the one I would choose is the one that involves the worker in every step of the decision process. That way morale stays high because all the workers know they are a part of everthing the department represents.

You see, my goal in life is to be happy. I believe nothing is really complicated, although some people tend to make things complicated. I would not be one of those people.

Surely we'll have rules and guidelines and policies, yet I'd also leave room for individual thought; some leaway; some freedom to move or (for lack of a better word)... to breathe.

RT bosses, admins think on different level as RTs

I can kind of understand why the administration here at Shoreline has been having conniption fits lately, and why they have been clamping down on on us lately, as I come to work today to learn there is an entire patient floor closed due to lack of patients.

As I wrote in a previous post, the size of this hospital is too small to be considered a large hospital, and too large to be considered a small hospital. As we are too small, we don't make enough money to be able to have extra staff on hand, which should explain to you why I have to work alone on nights regardless of whether I have eight patients on my board, or 22.

We are too large to receive government grants. Which is funny, because when I used to work at Death Line Medical Center, which is about 40 miles from Shorline Medical, I never could figure out how they could afford to have two therapists during the day. The RTs there never got called off, even if there was no work. When I worked there I was told, "If you are scheduled, why would the place call you off?"

Well, here at Shoreline, when it's slow, people get called off work. So how could these two hospitals so close together have such a different view on when to call workers off? I'll tell you the answer, Shoreline is located in such the perfect (or imperfect) location where we have just enough more patients than Death Line that we are over the line that would classify us as a small hospital. And, since we are over that line, we do not qualify for government grants.

So I suppose when the patient load is down, like it is today, workers get called off. The surgical floor and the step-down unit have both been closed, and, of course, all the staff that usually works over there are getting called off. While over at Death Line, even though their census is down too, well, they continue to make their paychecks.

That's just the way the medical field is. In September and October, if you remember from my posts, we were so slow for so long I wondered if it would ever pick up. Then from November through May we were so busy all the staff here was getting burned out. Now the cycle has come full circle, and we are excessively slow again.

So, I can see why the administration would make a big deal about a few miss charted treatments. If we were busy all the time like some big city hospitals, then I don't think the administration would have the time to worry about the minor things. If we were small, and the hospital received extra money from the government to cover its debt as is the case with Death Line, I don't think it would matter either.

But, since Shoreline is not small and not big, the administration spends that extra time looking at all the statistics. They get bored and instead of taking care of more important matters, they sit around double checking all our charting to make sure we dotted all the i's and crossed all the t's. The get nit-picky. And sometimes they make decisions that they see as for the better of the institution, yet they forget to involve us in the process.

And that, my friends, is why some RT departments might develop a low morale from time to time. The admins don't intend for morale to dip, but it just does. It does because the staff feels like the admins are making a big deal out of spilled milk. And, quite frankly, they are making a big deal out of spilled milk. But, as more and more smaller hospitals are merging, or closing their doors, Shoreline has managed to stay afloat -- alone. So, perhaps, this little nit-pickiness is a necessry component of independence.

Now, whether this battle to maintain as an independent hospital works to the advantage to us RTs or not I have no clue. Part of me thinks it would be bad. But, the other part of me thinks that if we merged with Aero Medical Center, that we would all get nice hefty raises so our staff would be paid as well as their staff. As, being a smaller hospital (not small enough, not big enough), the administration here will not even consider the idea of giving us all hefty raises.

But why would they give us raises? All the RTs in this department have been here so long we are all complacent. We have worked here so long, have so many friends here, love it here so much, are comfortable here, that we wouldn't go anywhere else to work. In a way, that's true. I am comfortable here. I love it here. I have many friends here. I'm complacent. And, while I could go somewhere else, I don't. It's far easier to stay here. Besides, if I decided to take another job, at Death Line for example, I'd have to drive. That's wear and tear on my car, and, hell, with gas prices at near $4.00 a gallon, I'm better off staying here, where my drive is only five minutes.

And, with 10 RTs here, and all of us in relatively the same boat as me, the administration can afford to push us a little bit. And this, what I write today, is some of the mentality behind the administration forcing our RT bosses to crack down on our charting, making a big deal of little errors, and make an attempt, as my fellow RTs and I like to put it, to make us perfect.

While I do have a bachelor's degree in business, and an associates in respiratory therapy, I still don't know as much about hospital administration as some of you guys. If I am ever to move up the ladder and become one of them, there is a lot I have to learn. However, I would imagine that my analysis here is not too far from reality.

Usually here at Shoreline the morale is high. Usually, all we little RTs and RT bosses and administrators get along. Some of us get along in close little friendship type relationships, and some of us in good little business relationships. Some of us, like me, have a combo of the two. But on occasion the administration pushes our buttons just because they can. And slowly but surely the morale will decline. The morale will decline until someone gets tired of it all and mossies on into the RT bosses headquarters for a little chit chat.

Then, once the RT bosses realize that they pushed us a little too far, they back off. Then morale starts to climb. Then things get back to normal for a year or so until someone in the administration gets another idea, and the RT bosses, or the administration itself, pushes us over that line again. They will wait just long enough so they think we forgot the last time they tried to cross the line. But we are smarter that: we don't forget.

I've worked here long enough now to know this is how it goes at a hospital that's too big to be small and too small to be big. That's just how it goes.

Tonight I came to work with a self diagnosed acute exacerbation of chronic laziness. I feel this way not just because I had too many days off, but because the patient census is so low again. Now, I'm not making a big deal about this, because I love it when its slow because I get paid to blog, as I'm doing now. And perhaps I blog too much, but you guys can be the judge of that. But the downside of a low census, as I've already explained, is that the admins get all stressed out. And when the admins get all stressed out, so too will the RT bosses. That's just how it goes.

This time around, it was my turn to let the RT bosses know they went too far. I had my little chit chat with the head RT boss. I had to tell him that morale was down. That it was so bad that even people in ER were asking me about the "tension" in the RT Cave.

"What?" he said. "I didn't know tension was that bad?"

Well, guess what? There ain't no tension anymore. While the RT bosses still want to improve our charting, improve the little things, they have backed off. It's like clockwork. I know these guys like the back of my hand.

Sometimes, as I sit here thinking about it, I think I could do that job and better than those guys. I think if I were the RT boss, there would be no lack of communication, particularly because I've worked here on nights for 10 years and I know what it's like to be on this end and I'd have empathy.

Then again, both RT bosses were RTs once upon a time. They are both dragons now.

Then again, I think that once I cross over and become an RT boss, I will slowly but surely turn into one of them. I will slowly turn into a dragon. I will slowly forget about simple RT mindset, and start thinking in terms of money. For RT bosses, money is the bottom line. And money can do a lot of damage to ones mind. Hell, just look at Hollywood for some good examples of that. RT bosses aren't' far removed from that crowd. They get a little wacky sometimes. They don't think rationally. I'd like to think I'd be different if I were an RT boss, but would I?? Who knows.

Now, getting back to the size of this hospital. Death Line has remodeled all its rooms so that all patients now get a private room. They have remodeled all the OB rooms so there is a hot tub in all the rooms -- and they are all private too. And they have a brand new ER. I've decided they get to do all that because of the government grants, which they get because they are just a little less busy than us and are qualified by the Fed as a small hospital.

Here at Shoreline, well, we are stuck with an ER that is just too small, especially in the summer when all the visitors flush into the region, and an OB that is way too old for modern times, and patient rooms that are too small for all the modern equipment and two patients per room.

Yet, even while we have this old facility, the admins have managed to keep it looking pretty sharp. While we have an old ER, we have a damn good staff. While we have an old, rickety OB, we pride ourselves in knowing we have a far better staff than Death Line. We take care of our patients as good as the best big hospital, the best small hospital, and the best hospital that is too large to be small and too small to be large.

And, for the most part, except for a few bumps in the road, the morale is high here. We are all one big happy family. All the units work well together, and I know it's not like that at all hospitals, as I've worked for some where there was no click between departments. And since we all know oneanother on a personal basis, because this IS still a small town no matter how the Fed wants to define Shoreline.

So, while the admins at this too big to be small and too small to be big hospital can sometimes get a little anal about little things, things that would be totally ignored in other hospitals, they still do a pretty damn good at keeping this place together.

Hell, all they would have to do is go down into the basement and look at the main computer to see that I've been blogging here all night, and they could make a big deal about it -- but they won't. They won't because I hold this RT Cave up while they are away. I make this place look good (except for my little piddly mistakes).

And besides, because I'm complacent here, because I have kids in the local schools I'm trapped in a way in this small town of Shoreline. I come to work every day not just because I want to, not just because I'm a great RT, but because I have to. I have to because the alternative would mean moving my kids to a new school again, and I don't want to do that.

The admins know this. They know this because this is how it is for about 80% of the people who work here. Because of this, and because they know I love the aura here at Shoreline, an aura the admins helped to create in those many periods of high morale, they know they can get me for a cheap wage. The funny thing is I know this, and yet I'm still here. I know their game. I'm just smart enough to know their game.

So they won't say a word to me any more about this little game they have been playing about being perfect. Because, as I told the head RT boss the other day when I approached him in a civil manner, "I do not have to stay here. None of us have to work here. We work here because we love it here, but we do not have to stay here. So let's move on."

And we will. For the next two or three years the admins will not try to push us over that line. And they better not, because I could just as easily go over to Death Line and work for a better looking yet inferior institution.

Then again, they might call my bluff.

The Dragons of the RT Cave

I feel bad for you that you have to come back to this place, because it's terribly busy.

Despite that omen from one of my co-workers, it has not been busy at all this weekend. In fact it's been wonderful. And, considering I was prepared for a miserable night, I'm enjoying it that much more.

I don't know if I ever mentioned this before, but the Dragons of the RT Cave wake up early to guard the cave. I usually grab my stuff and run when it starts to stir, and pray it doesn't use it's telekinetic powers to find where I'm hiding.

I have no clue why it wakes so early, but when it does I can smell it. Personally, believe it or not, I like our dragons. They're tough, but they hold down the fort rather well. Still, one of the perks of working night shift is you don't have to deal with dragons, as I write in one of my banner slogans, "the dragons are sleeping at night, if you know what I mean."

And keep in mind that not all dragons are bad. We actually have pretty tame dragons here at Shoreline, and they do a pretty good job of keeping us proles in line, and making sure we have all the best technology to work with. Still, a dragon is a dragon.

From Monday through Friday, however, our dragon hops is sniffing the grounds as early as 2 a.m.. So that means I have to pack up my bags and head to better Pasteur's. Well, I suppose I shouldn't say better Pasteur's as our dragon is quite friendly. It's just that a dragon is a dragon no matter how small, and dragons can get mad and rip your head off, or burn you good.

I used to hide out because it tried to eat my head off every time I got close to it, or so I thought anyway. Every time I forgot to dot an i or cross a t it was right there breathing it's fire hot breath over my head -- breathing fire. While some night shift RTs still fear it, not me anymore. Still, it's good to be wary.

Since those days of long ago, the RT dragon and I have helped each other out enough times now that we are on good terms. Still, having been away from the patient floors as long as it has, it's developed that business mentality -- forgot how it is on the floor per se. And, you guessed it, everything has a monetary bottom line. It has grown it's scales. Now it's a full grown dragon.

I don't make many mistakes anymore, but occasionally I still get a note, or, if I happen to be working when it finds out I did something incorrectly, a telepathic call at. Mainly the goofus mistakes are minor things, but a mistake is a mistake no matter how small.

Recently I left a blood gas syringe by the ABG machine.Could the dragons let this one little slip pass without letting me know about it. No. The lab dragon sent a fireball with a message to the RT cave dragon, who snarled and waited for me to be working so it could call me at four in the morning to let me know about it.

But that was last week. Yesterday I'm sitting in the CCU with Scooter the RN, and my beeper goes off.

Just one morning, I think to myself, just one morning I'd like to go without getting a page from the RT dragon. Not that I don't like it, nor that I can't get along with the dragons, because I do, but it's 4:00 in the morning and I'm tired. Doesn't it get that? This is the time of the morning I just want to do my work or, if I have my work done, just sit around. I don't want to be quizzed.

Like a good boy, and wanting to stay on good terms with it, I picked up the receiver and dialed the extension to the RT cave.

"Hello," the dragon said.

"Yeah, this is Rick," I said into the receiver.

"Hey, Rick. No you didn't do anything wrong. But when you get a minute can you come talk to me."

"Sure, I'll be right there." I hung up the receiver.

"Was that your dragon," Scooter said.

"Yep."

"Well, you said it'd call you right at four. You have it pegged."

I laughed. "Yep, you're right." But I don't wanna go. I just wanna stay here and chill.

But, like a good peon, I left the unit and walked through the hospital to the RT cave. As I walked through med-surg I could swear I could smell that a dragon was here. I could feel it; sense it. It has telekinetic powers after all.

"So how was your night," it said as I approached the entryway to the cave.

"Oh, it wasn't too bad. Actually, it was very slow compared to the last several days I've worked. It was a great break."

"That's too bad," it growled, a puff of smoke billowing from its flared nares. "We need to make money, and we don't make money when you're not doing anything."

I had already been up 24 hours, so I had developed that 2 a.m. loose lipped mentality. I said, "Well, it's one thing being busy, but when we're busy doing a bunch of useless breathing treatments it makes me twice as burned out as if I were actually using my brain."

I followed the dragon around while it unchained the doors. It didn't snap around and throw a fireball at me, so I knew I was still in the good, even though I had more than likely crossed the line with my honesty. I never would have done that a few years ago, but, like I said, I was on good terms with it now.

"I think there are a lot of people here who no longer come to work because they love their jobs. They come here just to get a paycheck. When I used to do your job, I used to do it because I loved my job."

I was NOT going to touch that one. (However, my lack of comment here still haunts me today. This is one of those times where I thought of a good comeback after the conversation was over. I will write about this tomorrow). "I love my job, boss." Am I being political by saying that, or truthful, I think.

"I know you do," it said, "but I think that a lot of you guys are just too complacent lately," she said, "I think it gets slow, and then you guys forget how to work." It stopped and looked at me. "Not just you, but all you guys in general. Those treatments are how we make money. "

"Well, boss," I said, "I don't have a problem working, it's just that if we're going to be doing useless breathing treatment just to make money, I think they should be done during the day when there are two RTs on."

It turned around. I hit a button. Smoke was puffing from its little nares. "It's not just you, but all of you guys have been making a lot of little mistakes lately. Here, I'll show you."

I followed it into the dark cave through a corridor in the back. It was dark and horrifying back there, but I followed her anyway. In a way, being in here reminded me quite often of being in the principals office. I watched as it shuffled through papers on it's desk

"Here, see." it grabbed a stack of paper, flitted through them so I could see all the notes and who they were left for.

"I see that even Dale has made mistakes."

She flitted through the stack again. "Yeah, he's made several."

"Oh, I thought he was perfect."

"None of you guys are perfect."

"Well, it seems that's what you bosses are trying to make us out to be." Of course I won't call them dragons to their faces. That would be a violation of one of the RT cave rules. "Look, boss, we aren't' perfect, we are going to make mistakes."

"Well, you shouldn't."

"At no other hospital I've ever worked at did I ever receive one note, and I know I screwed up many times. I guess the feeling there was, if I make a mistake, and I have to go to court, then it's on my shoulders."

"Well, I guess we have higher standards here."

"I know. We do. And I think it's good. But I think sometimes you guys go overboard. Look, you guys got Paul and Steve up on the edge. They're to the point they hate you. I mean, I know it's not you, you're just doing what you're told, but since you're the one leaving all the notes, you're the one they are going to hate."

"My boss," she said, "makes me do this. He wants me to keep track of every note I write, and if I write six notes then I have to write you guys up for now on. That's why I called you here. I want you to be more careful."

"Boss, if you do that, then you'll have to fire us all. We aren't perfect. You're just opening up a can of worms."

"Hmm, worms, that sounds delicious," said the dragon. Just kidding. She said, "I just do what my bosses tell me."

"Well, if you write us up for every notes, then that means we'll get a verbal warning, and then, the third time, we get fired. By the end of the year you'll have a 100% turnover rate of RTs. We'd all be fired."

"Why is it you have to argue with everything I say." She beamed at me. I jumped back. There was no fire, but I could see it was close to exploding.

"I don't mean to, but we have a right to disagree with you. There's more than just one opinion in this department, and I think we are having a good discussion. There's no way you can make progress, in my opinion, without discussing. Don't you think?"

"You have a good point."

Whew. "Well, I think your bosses should come down here and work like we do, and they'd see how not easy it is to be perfect. They are so far removed from the real work, it's easy for them to make such frivolous policy for you. If they had your job, they wouldn't do what they make you do. "

"That's very true. They wouldn't. And, when Gary had my job, he didn't do any of this. He has me going over every chart, every day, writing down every little mistake I find. It's very exhausting, especially when I have to hear it from... well, not you, but Steve and Paul."

"Gary only has you doing all this stuff because you act as a shield. When us RTs get mad at you, you get the brunt of the spears. Your bosses feel no pain."

"Wow," she said, and smiled. "You hit the nail on the head."

The RT Dragons: They are abounding.

The doors to the RT cave are still open

The Respiratory Therapy Cave opened its doors to the blogging world just over three months ago, and we have reached our first milestone: 10,000 page impressions.

This technically speaking is not a big deal, except for when I started this blog I figured I'd just be writing to myself. I never expected to pick up regular readers, let alone have 10,000 page impressions three months later.

When I started this I had no clue what a blog even was. By looking at statistics a few days ago, I know now that I was not in the minority, as 92% of Americans that have access to the Internet do not blog. Or, if they do blog, they don't know they are doing it.

In three months I've learned quite a bit about the blogging world, and still have a lot more to learn. I'm still not quite sure what RSS feed is, but I know I use it. I thought I was simply out of the loop, but yesterday I asked my brother, who creates web sites, what RSS feed was and he said he had no clue either.

As far as I know, I'm the only person in Shoreline County who blogs. Not one person I've asked at work blogs.

My brother said people who blog are nerds. I thought that was kind of ironic considering he spends 12 hours a day in front of a computer. If anyone is a nerd, it's him. Hear that Lucky, you're a nerd.

I think it was some character on the Simpson's who defined nerd on a recent episode. NERD: Not Even Relatively Dorky.

So I digress, As far as I know, I am the only person in Shoreline who blogs. That's why I'm not too worried about my boss finding out I'm writing about her on this site. Well, I haven't written anything bad about her yet, but I could.

When I started this I figured I would write something, oh, maybe once a week if not every two weeks. Somehow, to this point, I've managed to find something to write once a day. On days I'm tired I think the writing tank will run dry, but when I'm wide awake ideas flow form my pen like balls on a billiards table.

Am I interesting? Is my writing unique? Is my writing any good? I don't care.

That's the neat thing about having my own blog: I can write about whatever I want.

As a former marketing and journalism student I know I could better target my writing to one specific audience and gain more readers, but that's not the point of this blog.

The point of this blog is to have fun writing about things I'm passionate about. If people are entertained, or learn something in the process, that's a bonus. If I wrote for any other reason than to entertain myself this would cease to be a hobby, and would become another job.

That I definitely don't want.

So I had no clue I'd be here three months later. I thought I'd write a few weeks and then move on to something else. So, for the fact that I'm still here, I have to thank all of you who have clicked on my blog.

Honestly, I didn't have a clue what would happen when I opened the door to the RT Cave to the blogging world. So far, it's been a cool ride.

Relearning what we learned and learning more

After I had worked in the hospital for about five years I realized I had forgotten many of the basic things I was taught in school. The old saying that if you don't use it you lose it rang true with me.

One day we had a new RT hired here right out of RT school and he was still studying for his exams. He asked me if I knew what the alveolar air equation was. Of course I knew what it was, but I couldn't think of the formula nor how to apply it for the life of me.

Then one day I was called to talk to the hospital's lawyer because a man who was diagnosed with pneumonia died of something else "coincidentally" and the hospital's lawyer wanted me to be a witness to testify that the patient had obvious signs of pneumonia.

The lawyer said, "How often do you take care of pneumonia patients?"

I said, "I would say that probably about half of all our patients have pneumonia. So we take care of pneumonia patient's quite a bit."

"So you should be an expert in identifying pneumonia."

"Yeah, I guess."

"Okay, to make the jury impressed with your knowledge, I want you to rattle off the signs of pneumonia as fast as you can, like they are second nature to you."

"Okay," I said.

"So rattle them off."

"Ummm, pain with deep inspiration, brown sputum, isolated crackles, ummm..." My mind went blank. I could think of no more, however I knew there were more.

"No problem," he said, "When I talked with your co-worker he rattled off a list. I want you to memorize them in case we go to court."

I looked at the list; studied it. I added a few more signs that my co-worker missed, and the lawyer wrote them down.

I went home, looked up signs of pneumonia in one of my RT books, and discovered that we had both missed a couple more signs.

That was the day I decided I was going to re-learn what I had forgotten that I learned in school. I think you lose it not just because you don't use it, but because you get so used to just doing whatever the doctor tells you to do.

Not only that, but when you're a new RT, you are focused so much on just doing your job and doing it right, you tend to forget the most basic of RT knowledge.

When I was in school I took all the best notes. In some classes I wrote nearly word per word what the teacher said, and then went home and re-wrote all my notes into the computer and printed them off for studying.

But once I passed my registration test I put the boxes of RT class notes in the trash. Man that was dumb. So, instead of reviewing my great notes, I had to start from scratch. Thank God for the Internet.

Fast forward: I relearned what I learned once before and then I learned some more.

It's cool when a nurse calls you to assess the patient, and you know what is wrong right off the bat by your assessment. It's cool when you see signs not of bronchospasm, but of a pulmonary embolism. Or you see a reason to worry that this patient is at high risk for PE, or ARDS, or DIC.

Or, you look at the chart, and at the labs, and learn that the patient is probably a CHF patient as opposed to pneumonia based on the BNP of 30,000. And that the patient is in renal failure, confirmed by the high BUN and creatinin, and GFR of only 18.

Or you assess the patient and observe a high respiratory rate, high heart rate, normal BP, and learn the patient is on an antibiotic and you are the first to think sepsis. You talk with the nurse to see if she agrees with you, and when she does she calls the doctor, and a crisis is nipped in the bud.

In an ideal world you'd think anybody would be able to spot a sign of an illness and know right away what is wrong with the patient, but we all know it doesn't work that way in the real world. That's why we work as a team.

For that reason we at the RT Cave continue to do research on the Internet, to read the opinions of other RTs on the Internet, to listen intently when a doctor or nurse is patient enough to explain something we had no clue about that might come of some use at a later date. Who knows, we might be able to impress someone some day.

Being a small hospital, our bosses can't afford to send us to many RT seminars, or so they claim. But when we get the chance we go. When there is a free in service, and I'm not working, I'll be there with my pen and pencil -- especially if there's a free lunch.

While I'd like to think that this is the way all RNs and RTs think, I have had people tell me, "Why? You are an RT, so why do you need to know about sepsis? Why do you need to know about lab values other than ABGs? Why do you need to know about hemodynamics?

And sometimes I hear things like, "Well, I'm not getting paid anything extra, so I'm not going to learn anything new."

That's fine. I don't have a problem with people thinking that way. That's their choice.

That type of thinking isn't good enough for me though. I want to be more than just a body passing nebs, or doing some odd procedure.

One more night to go...

I'm burned out today, as this is my 8th day in the past 12 that I've worked. I have to admit I haven't been necessarily busy, but nonetheless I feel the usual burn. Usually when I feel this way the powers that be find a way to keep me busy, and that seems to be the case so far tonight.

I have a lot that I want to write about, but the right words just don't seem to want to display themselves on this screen. And then when I do get into a groove ER pages me and I have to drop my train of thought and rush down there. I certainly don't want to make them wait because I'm blogging -- God forbid.

I'm sitting here writing about nothing and I still can't get words out. We here in the RT cave have a nice view of the parking lot, and I'm sitting here watching the snow pour down on my car. I'd say there's at least a six inch blanket of snow covering it now. In the morning I'm going to have to go out there and freeze.

However, I'd rather be out there and on my way home to snuggle under my warm blankets than in here right now. The clock seems to go slow when I'm burned out. I find that to be true no matter how busy I am.

Tomorrow, Friday, is my first day off of six in a row, and that's something to look forward to. Carrie has to work the next three days in OB, but that will give me quality time to spend with the kids. Rather, I'm going to play Zelda on my son's Nintendo DS, and the kids can entertain themselves.

I kind of lost interest in games the past 10 years or so. Rather, I suppose I grew up. But now that my son is old enough to be interested in the same games I used to like, I've found myself playing them on occasion again. I think JJ thinks it's cool. Of course, I am a cool dad. I hope he understands than when I ground him from his Nintendo DS so I can play it.

He's way ahead of me in the game, so that means I'll have to stay up all night tomorrow night until I catch up with him. If that's not enough, I'm going to have to make him read for two hours on Saturday, and when he's done with that he can clean his room. That will give me plenty of time to catch up, or maybe even get ahead of him.

My daughter? Well, she can watch movies all day. That's the best baby sitter I've ever known. I don't know how dad's got by without that baby sitter all these years. Then again, prior to me most dads probably didn't have jobs that allowed them to spend so much quality time with their kids.

Well, it's still snowing. And, by golly, ER hasn't called me in... 30 minutes now. Wow. I thought Dr. Krane would have called me for a fourth treatment on that man with a cold in room A. Oh well, if she calls me I'm going to smile while I'm giving it, because I know in seven hours I'm going to have a nice stretch off.

Have a good day (night).

The RT Cave in the year 2020

An elderly nurse with short, dark hair and a scowl implanted on her red face glared at the small crowd of students as they passed the nurses station on 2 East at Shoreline hospital. The year was 2020.

"Stay away from the nurses station, kids," Mr. Yankshire ordered. "They have lots of work to do." He directed the kids down the hall and stopped in front of a large picture window with "In case of emergency break glass" written in large white letters on it.

"Okay, now this is an interesting display." The teacher pointed at the young man with dark hair and white lab coat behind the glass. He was visibly sleeping in a recliner amid an array of equipment. Mr. Yankshire rapped on the glass, cleared his throat, and rapped on the glass again. The man behind the glass stirred, but did not wake.

"Who's that, Mr. Yankshire?" A young poc-faced boy asked.

"That, my students, is the respiratory therapist." To the left of the window is a small sign that read "Respiratory Therapy Cave: Rick Frea on duty." Under the green sign is an intercom box with a red light under it. Beneath that is a hammer hanging from a chain. To the right of the window is a large white metal door with no knob, and Mr. Yankshire pounds on it.

The man behind the glass finally opens his eyes. "Oh, hey, Roger. How's things going today?"

"Great," Mr. Yankshire said. "We were wondering if we could have a tour."

"What you see is what you get," said the respiratory therapist. He waved a hand to indicate all his equipment. "To my left are my ventilators, and to my right is my breathing treatment machine." He jerked a hand through the air over his head. Mr. Yankshire heard an audible click. He looks to his right and noticed the light on the intercom had changed to green.

"Hello. Hello." A tinny voice shoots from the intercom.

Questions pop from the mouths of the six high schoolers: "What is a ventilator?", " I don't see no breathing treatment machine?", "You get to sleep on the job?"

"Um," the teacher scratches his head, "well, let's be nice. We'll let the RT explain himself. Rick, would you be willing to tell us about your job."

The RT winced, then reached a hand into the air and appeared to pull a cord Roger knew was there but was certain the kids didn't see until just now by the expressions on their faces. There is a click behind him and then a misting sound. "Okay," the RT said, "Now look in the patient room behind you."

Mr. Yankshire turned and saw a mist coming from the room. He lead the students through the mist and into the room.

"Holy cow!" one female student exclaimed.

"Well, good morning to you all," the patient said. He was an elderly man with a hunched over back. He was sitting on the edge of the bed leaning on the bedside stand, and he was breathing in deeply the mist that filled the room.

"What is this?" a student asked.

"That, my students, is a a mist from the breathing treatment machine." Mr Yankshire pointed to a vent above the patent's head. "It's coming from that vent there."

"What's a breathing treatment?"

"Well, we'll let Mr. RT explain that to you." And, with that, he lead the students out of the room and back to the window with "In case of emergency break glass" written on it.

"Pretty interesting, hey?" The Rt said. He was smiling. "This is the best job in the world. You see, when a patient is short of breath I pull a cord from a respective room and give that patient a breathing treatment."

A chorus from the students rang out. "Cool."

"Or, better yet, I give a treatment at any doctors whim. It's easy as pulling a cord." He laughed at his pun.

"How does it work?"

"It's kind of like a giant mist tent from..." the RT stopped as he laughed at himself again, then stopped abruptly as he seemed to realize nobody was laughing with him.

"What's a mist tent?" The poc-faced student asked.

"It's an ancient device RTs used to use to, um," he scratched his head, "Oh, I guess that's ancient history. This is how we give breathing treatments today." He waved his hand again through the air and Mr. Yankshire could see the strings waving through the air over the RTs head.

"I didn't see those before. What are those?" It was a female student this tiime.

"These are breathing treatment cords. If a patient in room 207 is needs a breathing treatment, I pull cord number 206. It's easy as..."

"Okay, step back students." Mr. Yankshire interrupted, and motioned his students to the side as a man in a suit rushed to the window. He pushed the button by the intercom, and an audible click is heard. Mr. Yankshire observed the light by the intercom had turned red.

"We need a breathing treatment in 210," the man said, and rushed past the students as though they didn't exist. Mr. Yankshire noticed his name tag said Dr. Brown. Mr. Yankshire turned and peered into the window. He noticed the RT was still be talking, but could not be heard.

"Yeah, he is a prick," an elderly lady in scrubs grumbled as she walked up to the RT window. "That Rick Frea is a prick. All respiratory therapists are pricks." She pressed the button by the intercom; it clicks. The light turns from red to green.

The respiratory therapist could be heard again: "...and the old IPPB machine was used on that old show "Emergency" back in the 1960s as a vent. Funny thing is, we used that machine as a vent up until, oh, I'd say about 2000."

"Will you shut your lazy crank!" The nurse grumbled.

"Well, hey, nurse Ratchet." The Rt gave a friendly smile and waved at the nurse.

"Dr. Brown wants a treatment in 210," said the nurse.

"Does he wasn't Scrubblin-Bubblin Ventolin or Preventolin Ventolin."

"How the hell am I supposed to know."

"Scrubblin-Bubblin it is." The RT reached up and pulled a cord. A click and a mist was heard down the hall. Mr. Yankshire looked down the hall and could see a mist coming from one of the rooms.

"That must be 206," Mr. Yankshire said. "You can see the mist from here, students."

"Ah, what a great career this is," said Rick Frea. His smiled radiated cheek to cheek. "You guys definitely should invest two years to become this." He leaned his head back and pulled a lever on the side of the chair so his feet are now up. "This is the life."

Roger figured Nurse Ratchet wasn't her real name, but the old nurse turned to look at the students. Her large lips were turned down; she was tapping her foot. The students stepped back until they were against the wall. "RTs are useless dummies. They aren't needed here unless there is an emergency, hence the writing on the window."

Mr. Yankshire watched as the kids eye's rotated from the cranky nurse's eyes to the window, which read "In case of emergency break glass."

"Damn RTs!" A young lady in scrubs rampaged from what seemed like mid-air, shoved Mr. Yankshire aside, grabbed the hammer, and threw it into the glass, which shattered into a million pieces inside the RT cave.

"Oh come on! What NOW!" he grumbled as he stumbled out of the chair, shards of glass falling onto the floor as he did so.

The young lady said, "We need you STAT in 210. You're treatment didn't do any good. The wet rhales persist."

The RT crunched his way across the pieces of glass and clambered through the window. "Some things never change." He sighed, and calmly sauntered to his emergency. "Some things never change."