RTs save lives and create smiles

Pager says: "BiPAP BEEPING COME SOON! EMILY RN"

On a whim, the RT leaves the patient he's presently treating, and  rushes to the room with the BiPAP.  Upon arriving he hears the said beeping, and thinks it's not a good sign that it's still beeping.  He thinks: "Either the mask is off the patient, or the patient is not breathing."

He looks at the patient and then at the BiPAP and then back at the patient. While he's doing this, the nurse pops into the room and says, "I think you're BiPAP isn't working."

At this, the RT says: "I think your patient isn't working."

He sees that the patient BiPAP rate is 4, and the rate on the monitor was 42. He places a hand on the patient's chest and feels the respirations are simply not efficient. "She isn't generating enough flow to trigger the machine," the RT says. "Get the hospitalist here."

The RT turns up the rate to 14. About then the doctor comes in.

The RT says to the hospitalist,  "I realize there's not much you can do considering she's a DNR.  I just wanted you to know this was going on."

"Yes," the doctor says. "The family doesn't want anything more than this. We'll DC the ativan and xanax."

 RT is thinking, "Hmmmph. How much sedatives has she been given?  She's been on xanax the past ten years, but was she given too much?  Or, is she simply trying to die?"

Assuming she's trying to die, the family is called by the nurse.

The RT rushes back to the other patient, whose breathing treatment is now stopped.  "I'm a nurse," the patient's daughter says.  The RT apologizes and apologizes vigorously for rushing away, yet the patient and the patient's daughter are happy as can be.  A brief discussion ensues before the RT returns to the BiPAP patient.

The family is now in the room, and tears are flowing.  Both daughters hug the RT.  One says, "You're her favorite.  She loves you.  I think she'd like you to know that."

The RT smiles.  The RT didn't need to hear that because he had already assumed.  He had many great discussions with the patient and the patient's family.  Now there are tears flowing in the room as the family waits for this nice elderly lady to stop breathing.

Two hours later the therapist is in the room and no one else is. The patient is now breathing over the rate of 14, and the spontaneous rate is 28.  She opens her eyes and looks at the RT.

The RT looks into those eyes, and says, "There are your pretty eyes."  She smiles and goes back to sleep.

The family comes back into the room, and they are so thankful and happy.  The nurse is thankful and happy. The doctor is thankful and happy.  Once again the RT has a successful day outside the RT cave.

The RT wonders if he did something good, or simply prolonged suffering of the patient; it's hard to know for sure; there are no answers to such ethical questions.  Regardless, the smiles he creates force him to smile on the way back to the RT cave.  He thinks, "It appears this job is more than saving lives; it's creating smiles."

Sometime CPR really does work

So what is it?  One percent?  Actually, I think I saw a study recently that showed that as many as three percent of people who had CPR performed on them lived?  I think it's this percent that lived and had a somewhat normal quality of life afterwords.

Today I had a lady come into the emergency room.  She was in the passenger seat.  Her husband was driving.  She was on the phone talking to her brother.  She dropped the phone.  Her husband saw that something was wrong.  He pulled over.  He had a bystander call 911.  He started CPR.

Within 5 minutes the EMTs arrived.  The patient was in v-tach.  Shocked three times.  Gave four doses of epinephrine.  By the time I received the patient she was intubated and, of course, chest compression and breaths with 100% oxygen were being given.  She had no pulse.  No rhythm.

Ah, and just as the good doctor was about to call it, the patient took in a deep breath, started breathing on her own, and had a good rhythm of the heart.  No, she did not miraculously wake up like they do in the movies.  That, my good friends, never happens in real life.  So all those people who have "CPR but no vent" on their advanced directives are living in a pipe dream.

Anyway, we shipped her to another location and that's all I know of her.  Due to HIPPA I will never get an update.  That's unfortunate, because her follow up would be a good learning experience.

However, we did have a lady a few years ago in the same situation, and two weeks later she came in complaining of dizziness.  It was neat to see that she came out of it just fine.  I will never see this lady again, because she resides in another state and was just in town on vacation with her husband.

And yes, for you dunderheads who want to get me into trouble for writing about a patient, I did alter enough details so even the most anal person will have no clue which patient I'm referring to here.

She gave me the bird

I walked into her room and she showed her utter respect for me by placing her hand up in front of her face, and then, slowly, purposefully, and with a big smile on her face, she fully extended her arm high up over her head, and extended her middle finger.

Believe it or not, that was her way of showing respect for me. I worked damn hard the other day to get her off the vent, and she passed the weaning screen with flying colors, was awake and alert, and chomping at the bit to get off the vent. Then the doctor came in and basically gave me the big, "Rick, she's not coming off the vent."

Ahhhhhhhhhhhh!!!!! That was the first time I ever begged to extubate. "RICK! I am NOT EXTUBATING that lady today!!!!!"

So she needlessly stayed on the vent an extra day. She was awake and alert, able to read a newspaper, sit on the edge of the bed, watch TV, write notes on her sheet of paper, and the doctor refused to extubate.

She was one of my favorite patients ever. She showed her appreciation for my friendship and my hard work with the bird. Yep, that one event made me proud to be an RT. I smiled and had a nice long discussion with her about books.

Neil Cavuto chooses to enjoy life, despite illnessess

I so happened to be in a patent's room tonight and Neil Cavuto was giving his daily "common sense" editorial. Jack Kevorkian had been on his show he evening before, and told Cavuto life sucks, and Cavuto basically has no clue about what it's like to suffer.

"Just once," Cavuto said, "I'm going to do this just once." He was referring to himself: he wanted to respond to what Kevorkian said by talking about himself, and that he does know what it's like to suffer.

What he said thereafter was very interesting to me, especially considering I work with people who don't such good fortune, and yet find a way of enjoying life regardless.

Here's what Cavuto said on his April 22, 2010, show's common sense editorial, "I don't know Jack":

"I know everyone's focused on how Jack Kevorkian helped so many die, but I was much more interested in why he was so down on living.

"He said it was tedious and empty — often painful and lonely. And then, the not-so-good-outlook doctor said, it was over. Hard to be happy, Kevorkian told me, when so much in life is not; especially for those dealing with illness and pain.

"I strongly disagreed. I said life is not miserable; that I wasn't remotely miserable.

"He just smiled; Jack all but saying I didn't know jack. That I couldn't know, I wouldn't know. Easy for me to smile, he said, when I have so much for which to smile.
"Some of you agreed:

"Kevin Myler, New York City: "Listen to Dr. Death, Mr. Good Life. Get out of your perfect world and feel some pain. It'd do you good not to feel so good."

"Sarah Emerling, Boston: "I like you, Neil, but Dr. Kevorkian is right. You have lived a sheltered life. Walk in my shoes before you start lecturing anyone on skipping in theirs."

"Larry Mahan, Lebanon, Missouri: "Neil, you are a young man, I'm sure have a nice family… everything is good. I am now 60… I have two herniated discs, pinched sciatic nerve… renal cell carcinoma… borderline emphysemic now too… you will just have to be there someday… no way can you understand…"

"You're wrong, Larry. And Sarah, and Kevin. And you too, Dr. Kevorkian.

"You're all wrong saying your woes define your life and your attitude about life. And you're wrong assuming mine is a sheltered life, unaware of your pain and unsympathetic to those in pain.

"I am not here to win your sympathy; just this once — and I promise, just this once — your attention. I know pain better than you think and illness better than you know. It's public record, but for the record, let me be clear and go on the record. Again, just this once.

"I have multiple sclerosis; a pretty tough neurological disease for which there's no cure. And I got it only a few years after beating back a pretty serious cancer for which it once looked there might not be a cure.

"Again, I'm not trying to win points, just make this point: Illness doesn't define who I am or how I feel. It's shaken my life, but it hasn't sapped one iota of my enthusiasm for life.

"Sure, there are many days I wish my voice could be stronger, my legs sturdier, and my eyesight clearer, but I can't count on these things. Only that living is worth dealing with all of these things.

"Jack is right: I don't know jack about misery, but that's only because I choose not to be miserable."

I think this is similar to something I wrote about having asthma, as you can read here.

And, believe it or not, I received emails noting to me the following, "How could you be so stupid to find so many good things about a disease such as asthma."

The answer is similar to Cavuto's, in that I "choose" to find something good even in those things which I don't particularly want. Life is what you choose it to be, and I choose to enjoy it regardless.

I think most people are this way, and not so pessimistic as Jack is.

Biking with oxygen for the COPD cause

I wrote about Breathin Stephen and how he runs marathons despite his severe persistent asthma. I also wrote about Mike McBride and how he also runs marathons despite being an oxygen dependent COPDer.

Now we have Mark Junge, 66, who is also an oxygen dependent COPDer who is riding his bike on an "arduous" trek around the U.S. He said his wife drives the care and he rides his bicycle. In total, according to a column he wrote for the Wyoming Tibune Eagle Online, he has trekked 7,000 miles.

Of course he's doing this for the exercise, but he also has a purpose:

"Our mission is to alert the public to the problem of chronic obstructive pulmonary disease, or COPD, a catch-all term for lung ailments that many people do not recognize.Ever since that first transcontinental trip, I have noticed another pattern: The number of COPD victims is increasing.New York pulmonologist Dr. Neil Schachter writes that in little more than a decade, COPD will be the third-deadliest disease in the world behind circulatory problems and cancer. He estimates that COPD already affects 35 million Americans."

He also writes:

"Awareness of COPD comes when you see older men and women walking around with canulas attached to their noses, carrying oxygen bottles in backpacks or pushing carts with metal tanks. Some are not so obvious because they have transtracheal tubes implanted in their necks. Others camouflage their oxygen-dependency with custom eyeglasses.But I suspect that most oxygen-dependent folks are hidden from public view in homes or healthcare facilities. They are a segment of the population that is out of sight and out of mind, except to those who care for them."

He notes that he would also like to get the word out to to other COPD patients who are oxygen dependent that they can get out and exercise, and all they need is to talk with their care providers and get portable oxygen.

"It's pretty obvious that people who would benefit from portable oxygen do not get enough encouragement to be mobile in their lives...," he writes. "Mobility means freedom. Freedom means improved physical and mental health that lead to productivity. Individual productivity leads to societal productivity and so forth and so on."

What folks like Breathin Stephen, Mike Mcbride and Mark Junge do for the COPD and severe asthma community is show the rest of us chronic lungers that exercise is a must, and no lung condition should stop you from getting out and walking, jogging or biking. Just do it!

Related posts:
congratulations breathin' stephen and mike
breathin stephen's greatest accomplishment
2 chronic lungers in boston marathon

I'll never forget Mrs. Flowers and her quilt

Way back in October of 2008 Karen over at COPDnewsoftheday.com asked me to write a post for her blog about the relationship between RTs and COPD patients in honor of RT Care week. I was honored by her request, and thought instantly of Mrs. Flowers.

The following was first published October 2008 at COPDNewsoftheday.com:

Mrs. Flower
by Rick Frea: October 21, 2008 @ COPDNewsoftheday.com

I was told in report that Mrs. Flower in room 202 was diagnosed with COPD and was having a very difficult go of it. She was only 60. The person who gave me report was concerned that she might be ventilator bait.

So I wasn’t surprised when I was paged STAT to Mrs. Flower’s room early in my shift.
Upon entering her room I immediately observed she was in agonizing respiratory distress. She was gasping like a fish out of water as she sat on the edge of the bed leaning on the table to breathe. Next to her on the bed was an Afghan she had apparently been working on.

“I feel so miserable,” she said, “I… can’t breathe.”

“I know what you’re going through,” I said as I mixed up a breathing treatment.

“NO YOU DON’T!” the patient said.

“Oh yes he does,” someone said from behind me. I turned and saw that it was Tes, a nurse who took care of me back when I was having bad asthma several years earlier. “He has asthma. He KNOWS what you are going through.”

Mrs. Flower looked up at me and managed half a smile, which disappeared in a heartbeat as she concentrated on her breathing. Yet she seemed to mellow at the thought there was a fellow chronic lunger in the room.

With the permission of the doctor, I gave her two breathing treatments. Suddenly, she was breathing normal again — well, normal for her anyway.

Mrs. Flower became one of my favorite all time patients. When she was feeling better — and even when she wasn’t –she’d always be working on an Afghan. When I entered the room she’d stop and take her treatment, and we’d talk.

There were nights I would talk to her for hours not just about COPD and asthma and breathing, but about other things as well. I eventually got to know many of her family members, and she even got to know mine through my descriptions and pictures, as I got to know about her past through her stories and pictures.

Through my 11 years as an RT, there have been many Mrs. Flowers’. Each time I get to know about their entire lives in a few short minutes while I’m helping them breathe better with a bronchodilator breathing treatment.

After she was in the hospital several days, I said, “Well, I’m going to be off the next few days. I’m sure you’ll be home before I get back. So, I hope the next time I see you is in a grocery store.”

She laughed and said, “Absolutely.”

But she came back. At first her return visits were infrequent, maybe once a year. She’d joke and say, “I’m just in for my yearly recharge.”

I think it was about her third visit that I found out she was still smoking, so I discussed with her — as a friend more so than an RT — how much I wanted her to never smoke again.

I explained to her that if she stopped smoking now she won’t be able to undo the damage to her lungs, but it won’t get any worse. She might even improve the quality of her life, and decrease her hospital stays.

She smiled cheek to cheek and promised me she would never smoke again.

Three weeks later she came back for another visit. I didn’t ask her if she was still smoking because I trusted what she told me before. And she went home after a few weeks with our same old good-bye lines.

But eventually she was visiting me more often, and then it got to the point that I said to her, “You might as well move in your dresser you’re here so often.”

She smiled. Even though she was getting sicker, she was still the same pleasant person to talk with, and she continued to work on her afghans.

She went home again. Two days later I finally saw her at a grocery store. Only she was not shopping. She was sitting in her van — smoking.

My heart sank. Of all the things I have seen as an RT, that one moment for me was perhaps among the most disappointing. Here I thought Mrs. Flower was making a gallant effort, and all along she kept right on smoking. No wonder her COPD kept getting worse.

It was kind of a defeatist feeling. I thought I have all this knowledge in my mind that I enjoy sharing, and for a long time after that I couldn’t get myself to share any of it. I thought, “What’s the point.”

Two days after I saw her in the parking lot she was a patient again. This time she was very sick.
She looked defeated. The disease was winning, and she knew it. She was having trouble breathing even while she lay there in her bed. Yet, she still smiled as I entered her room, and stopped whittling long enough to take her treatment and talk.

Out of respect for her, I never said a thing about seeing her smoke. I decided if anything she needs to have her dignity. And I remember when I was a kid trying to stop my grandpa from smoking, and he’d always say, “I’d rather die young doing something I love than to live a long miserable life not doing what I enjoy.”

I thought grandpa died young when he was 70. But he was making a list of things to do when he died, a sign to me that he went out happy.

I thought grandpa’s words rang true here. By smoking, Mrs. Flower was doing something she truly loved to do. I respected that. Yes she was destroying her lungs, but I understood. I didn’t like it, but I respected her.

“You know,” she said one day, “I hope your kids never smoke. It sounds like a cool idea when you are young and think you’re going to live forever, but it catches up to you eventually.”

“When you started smoking,” I reassured her, “The knowledge wasn’t out there. Now-a-days if a kid starts smoking, there is no excuse for it because the education is out there.”

About a year later, after several frequent visits, I learned from reading the paper that she had passed. It was sad, but so is life when you work in the hospital. Yet she no longer had to fight, and she passed the way she wanted: in her own home.

A few days later I was paged to the lobby. “There’s a man here to see you,” the front desk clerk said.

“Who would want to see me?” I thought as I set down the receiver.

In the lobby was Mr. Flower. He held in his hand an Afghan I watched Mrs. Flower make. He said, “This is for you. She finished it just before she passed away, and she wanted you to have it.”
Now I think of Mrs. Flower each and every time I snuggle up in that afghan.

Still, I wonder how many more lives she would have touched with her stories, or how many more afghans she would have made and given away as gifts if she had a few more years to live.

He knew no life without her

She was 91 year old mother, grandmother -- wife. Her hair was ruffled to a degree she never in her adult life ever let anyone see, yet I was seeing it. Her skin was pale, no makeup. Her kith and kin may not even recognize her.

She looked up over the BiPAP mask, the machine that was supposed to give her wet lungs time to heal. Her eyes were circled with signs of anxiety and sleeplessness. In her weary eyes I saw all the years of cooking apple pies, hugs and kisses, and love.

On the other side of the bed, holding her frail hand, was the great man she was married to for 75 years; the only man she had ever loved. If ever there was a sign of soul mates, this was it. A feeling of sorrow rushed through my veins as I couldn't help feeling sorry for him.

Although, in a discussion the day before with this man, he said, "Whatever happens it's what God intends. Whatever happens, we had 75 great years together." He smiled then. There was no smile now. He was somber. The decision was made.

I listened to the sigh of the machine as it assisted her with a breath, and the hiss as she inhaled through the mask; the tubing, the machine's exhalation port. The cycle continued again and again. Yet it was my job now to end it. "It's time for her to go home," her husband said.

A vision of yesterday rocked in my head. Dr. Adams walked into the room, shook the old man's hand. I imagine Dr. Adams was thinking the same thing I was thinking now, that for a 93 year old he looks healthy, perhaps not a day over 80.

The husband said to Adams, "I promised her I wouldn't let her suffer, and she hates that thing. I think it's time to take it off. It's time to let her go."

Dr. Adams sighed, said, "With more time we might be able to nip this thing. We can give her body time to heal."

The old man said, "It's time. Let's just do it."

I unleashed the Velcro straps that supported the mask around her head and lifted the mask off her face. She sighed, smiled, looked up at me, took my hand, held it tight, and lipped, "Thank you."

I held her hand what seemed like five minutes, and then I left the room. It was time for her husband to say goodbye -- her best friend. He did not know life without her. What was he going to do. Would he be able to cope? Those thoughts rushed through my somber mind.

Outside the door I turned and looked back: he had his head on her chest, his hand gently caressing her face. They were together as one. Oblivious of the circumstances, they were happy.

I got busy and never saw him again. At around three in the morning I got a page to call critical care. Instead of calling I walked there, and as soon as I looked into her room I knew what the page was for.

Congratulations Breathin' Stephen and Mike

In my haste I almost forgot to inform you guys that Breathin' Stephen has become the first hardluck asthmatic ever to not just participate in but cross the finish line at the Boston Marathon.

Of course I first wrote about Breathin' Stephen on his way to the Boston Marathon in early April. On April 20 Breathin Stephen, formally known as Stephen Gaudet, trekked the 26 mile stretch and completed it in 7.5 hours.

I also wrote about Mike McBride, a chronic oxygen dependent emphysema patient who walks marathons pulling a cart with oxygen tanks (Read a better article about him here).

These two inspirational chronic lungers finished the Marathon together.

On his blog, Breathin' Stephen, Stephen writes: "Mike Mc Bride and I crossed the finish line at the Boston marathon in under the time limit, making us the first registered athletes with documented severe lung disease to do so!"

He added: "I’m grateful for being given an opportunity to take part in this race. It was truly a dream come true and an experience I will never forget. I hope that other people with lung disease, will see by my example, that anything is possible if you try hard enough."

I'll be writing more about this in the coming days. In the meantime, I think this is a worthwhile accomplishment worth cheering about.

To read more about Mike McBride's Boston Marathon accomplishment click here for a great article written at Just Respiratory.

To read more about Breathin Stephen, click here and I will morph you over to his blog.

Breathin' Stephen, the Hardluck Asthmatic, completes Boston Marathon
by Rick Frea Monday, May 04, 200MyAsthmaCentral.com

He did it! On April 20 Breathin' Stephen, our Hardluck asthmatic who did the unimaginable and qualified for the Boston Marathon, trekked the entire 26-mile course in 7.5 hours, and crossed the finish line.

Stephen Gaudet, who's daily FEV1 measures about 37% of normal, is an amazing asthmatic who struggles with dyspnea on a daily basis, and yet he refuses to use that as an excuse to quit. He is an inspiration to all of us asthmatics that we can live normal lives with this disease, and even do the unimaginable.

Amazingly, Stephen was not the lone chronic lunger racing that day, as a good friend of his, Mike McBride, walked right alongside him for most of the race. What makes Mike's story so impressive is that he is an oxygen dependent emphysema patient who has to lug a cart of oxygen tanks behind him (click here to read about Mike and check out a picture of him with his tanks).

Stephen described on his blog, Breathin Stephen, a morning that started out on a chilly 33 degree and foggy day with a forcast of light rain in Hopkinton, Massachusettes. Yet as the morning drew closer to the 9:00 start time, the weather warmed to a pleasant 47.

In the moments before the start he and Mike were inundated by the media from all sides. He wrote, "There were tons of Satellite TV trucks and News Vans parked out front. We were interviewed by several News organization... Everyone was waving microphones and cameras in our faces trying to find out what our story was."

At five minutes to nine he, Mike and about 18 other mobility impaired set to start the race ahead of the other marathoners. And everything seemed to go really well until about mile 21 when Stephen's leg muscles started to cramp up.

Yet he did not stop walking.

By mile 23 he encountered another familiar obstacle:

"The city of Boston was finally in site and you could actually see the finish area. It was at this point I knew I would finish the race within the time limit. The problem now was that weather had gone from a pleasant 53 degrees to about 40 degrees in a matter of moments. In addition, the wind was picking up ,making it feel even colder. For the last 3 miles, I thought I was going to freeze to death. To make things worse, the constant headwind was aggravating my lungs, making me wheeze. By mile 25 , I was definitely feeling like I had done a marathon."

Yet he did not stop walking.

"As we entered the final 1/4 mile stretch to the finish line," he continued, "it was starting to get dark outside and I could tell that we were probably going to be the last 2 people to finish the race. But, believe it or not, even at this late hour, there were huge crowds of people lining the streets that waited to see us finish.

"Then in the last 100 yards or so, my emotions hit me like a tons of bricks. It finally dawned on me of what I had just accomplished. In the span of just 3 years, I had gone from an old out-of -shape COPDer who could barely walk a city block, and who was basically written off by the medical establishment, to achieving what many people said was silly, crazy and impossible. I was about to finish the Boston marathon!
"As I set foot on the finish mat, I couldn't control it any longer..... and the tears just gushed out. (I hope no one saw.) I did it ! Me.....I did it !"

Later, he said, "I knew this would be an important race for me, but I had no idea just how big a deal this would turn out to be. The media response to my ( our ) participation in this race, has been overwhelming to say say the least

On his blog he summed the experience up best: "I'm grateful for being given an opportunity to take part in this race. It was truly a dream come true and an experience I will never forget. I hope that other people with lung disease will see by my example, that anything is possible if you try hard enough."

I added the bold for emphasis. After writing this post, I'm going to have a hard time accepting from any asthmatic the words "I can't." If Breathin' Stephen, the Hardluck asthmatic, can trek 26 miles in 7.5 hours despite the obstacles he faces, any asthmatic can do it.

(To read more of Stephen's experience and check out pictures click here).