I'm sleep deprived, but not a slacker

A coworker (not in my department) lectured me recently because she thinks my work is being effected by lack of sleep. She came to this conclusion after having a discussion about me with the nursing supervisor on duty a few nigths ago after I was asked to assess a patient.

"The patient was fine when I assessed her, and she was not in need of any respiratory intervention," I said.

My coworker said, "That's what you say, but the supervisor and I decided you weren't at the top of your game because you were overly tired."

"Why did she say that?"

"Because during the next shift the patient coded and died."

"I'm sorry, but when I assessed her she was fine."

And she was. I auscultated her lungs, and noted in my charting no change from previous assessments. The patient was mentally sound, and showed no such mental changes.

"Well, you need to be careful, and you need to get more sleep."

"Yes maam," I said. She proceeded to lecture me another ten minutes or so, and I stood there like a 1st grader in the principal's office after melting a wax crayon on the heater.

The truth is, it doesn't matter how much sleep I get prior to coming to work a night shift, because I suffer from what a lot of night shift workers suffer from: Chronic lack of sleep.

There is another word for it, "Circadium Rythm Sleep Disorder." When you have this problem you either don't get enough sleep (chronically) or you sleep and you don't sleep sound enough for it to make you totally satisfied.

Either that, or you never quite get caught up on your sleep. It's a chronic disease and it is a documented disorder for people who work nights. And I can honestly say it has never effected my work... PERIOD.

In fact, that patient crashed the next day and it was totally unrelated to what happened to her the night in question. Even if I had foresight and could predict when a person would crash, I couldn't have stopped her event from happening six hours after I went home at the end of my shift.

In fact, the patient coded following surgery that day. So, according to the night shift supervisor, I could have prevented this if I had been less tired. Then again, my assessment must not have been too far off, because both the Internist in charge of the patient, and the anesthesiologist, and the surgeon all approved the patient for surgery.

I wonder if those doctors were lectured about being too tired. Yes, I admit to being chronically exausted (which may also have something to do with having three kids, one of whom is nine-months old, at home), but it does not effect my work.

And yes I do "humor" about stupid doctor orders. But when it comes to taking care of my patients, my patients get 100% of my attention and RT experience. And I don't care what that stupid supervisor says.

Yes I'm sleep deprived, but I'm not a slacker. If there was no thing as politics, I probably would have said that to my boss, and sought out that supervisor and said it to her too. But, being the professional, laid-back, polite, humble, person I am: I said nothing. I bit my lip and said nothing.

To call the Dr. or not to call, that is the dilemma

Here's something you will come across from time to time if you work nights. Of course as all RTs may have noticed by now, there often seems to be no rhyme or reason to "some" doctor orders, nor consistency to how a doctor will respond to a request to change the order.

Consider the following example:

The patient is a 75 YO non-COPD post operative patient with a registered SpO2 of 88% at 3-o-clock in the morning. Mind you, I did say three a.m. The patient is in no respiratory distress, and has no respiratory history. Otherwise, his vitals are normal. The order is for 2lpm. What do you do?

1. Call the doctor and wake him up
2. Increase the oxygen to 3lpm and have the RN call the doctor in the morning
3. Ignore the spo2 and pretend you didn't see it as the patients SpO2 probably always drops while he is sleeping
4. Since the SpO2 has an accuracy of plus/minus two, assume actual reading is 90%

Okay, what's your guess?

Day #1: This night the RT decides to use his common decides "b" is the best solution. The patient is stable and no harm done. If the patient's SpO2 was at a critical level, then a call to the doctor would be warranted, but not in this case.

The next day when the RT arrived at work he was lectured by said doctor who said, "Why do I write orders if you're not going to follow them?"

Day #2: Different patient but same information; different doctor, but this doctor is the spouse of the doctor in the scenario above. What does he do now?

Using the same choices above, since the RT now knows option #2 is not good, he decides to go with option #1 and wake up the doctor. The doctor says, "Why the hell are you waking me up at 3 in the morning to tell me this?"

"Um," says the RT, "Because yesterday, same scenario, your husband told me that I have to call before I increase oxygen to get an order."

"Oh," she says, "Well, then increase it to 3lpm and leave it at that."

"Well, then can we..."

Click. The doctor was no longer available.

"...get an order for protocol just in case... oh, what the heck.

So, what is the best thing to do in a scenario like this? Well, based on my experience, you're damned if you do and damned if you don't, so you might as well wake the doctor up and let her lecture you about how idiotic you are.

Thus, RN Cave Rule #72:

If you think you better call the doctor you better call him. If you think the doctor might yell at your and tell you you are an idiot because he doesn't want to be irritated in the middle of the night, call him anyway.

It's finally slow again.

The hospital industry might just be the most unpredictable of any industry in the world. Of course I'm saying this as a person who works in the hospital industry and hasn't done much of anything else.

Yet, so far this year, Shoreline Medical has gone from extremely slow, to swamped, to slow again. And I can tell you something with utter honesty: when you go from being swamped to all of a sudden being slow, you appreciate every moment of slowness. That's a fact I won't back away from.

Normally my work doesn't effect my home life, but we had a three month rush that was so bad here I had no energy to do anything at home. If there were dishes sitting out I might just leave them out and let the wife gripe at me because I'm sitting around doing nothing but watching TV.

And, with children at home, that's saying a lot. When you have kids, and your wife is watching those kids for five straight days while you work long hours at night and sleep all day, she becomes weary eyed and very eager for an adult conversation and some help around the house.

Yet, after five days of hell at work, the last thing I want to do is anything more than the minimum when I'm on my days off. It's hard. It's the hardest part of this job as an RT. I would hate to work at a larger hospital that is THAT busy all the time. To come home every day with achy feet and weary head would make for a long life.

The last two days, however, were so slow I basically sat around and talked all night, or read books, or surfed the net, or blogged, or cleaned out my locker. It was nice. And, trust me, I appreciated every minute of sitting around. Not for one second was I bored.

I think one of the reason I appreciate it so much is you know -- in a heartbeat -- the good times could end. In a way, the way I felt the past two nights was not unlike a marathon runner in the moments following the race -- relief, joy.

So, for the first time in 12 years, I get to take a scheduled night off tonight. Even while I slept until 5:00 p.m. as I would if I were to work, I think I'm going to go to bed at a regular time tonight, which is right now: 10:16 p.m.

Have a great night

3 types of lethal arryhthmias

Dear RT Cave readers:

I promise I will write something useful soon. It has been extremely "swamped" where I work each of the past six days. We have one vent right now, but we have had up to two on many of the past several days.

And, if I am not mistaken, I have had at least one BiPAP ongoing all 6 of those days, and have set-up at least one BiPAP each of those nights. And add to this ten regular patients on bronchodilator treatments (perhaps three of which actually need them).

And then you have to add constant calls to the ER. And, of course, you have to note that I am the humble night shift RT here at Shoreline medical, so that means I did this all by myself.

Oh, and you also have to add to that some one in in my department has been a god awful something that rhymes with twitch and starts with a b minus the tw. You can figure that one out. I swear you can have a million more important things to do, and
this person still finds something to nag about.

Whoops, I'm not supposed to complain anymore. Oh, and I forgot that we (I)had an RT student last night too for the first four hours of my shift. And since I love to teach, this kind of added another responsibility to my long list of things to do.

We RTs here at Shoreline like to share our RT humor with our students. Albeit they often aren't sure if we are joking or not. Last night the day shift RT (The sagacious Jane Sage) educated them on the three basic types of lethal arrhythmia's you should be able to recognize on a rhythm strip or EKG.

These Lethal Arrhythmia's are:

1. Too fast

2. Too slow

3. Oh shit

Have a great weekend. And, oh, as soon as my energy level returns to, say, the 50% level, I will write something useful on this blog. So bare with me.

Sincerely:

Rick.

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.

I'm just enjoying the slow season

Last year at this time we had such a low census that we ended up closing one of the floors. It got so bad that the administration almost went into a panic.

This year the same thing has happened. Our census is low, and the admins are in a panic. They are even talking about laying people off.

"Oh, we might never get busy again," I hear at the meetings.

It happens every year. They say the same thing. They get scared, and they try to make us scared. And then, lo and behold, as the winter months come upon us, the business comes.

And then we are busy until the end of the summer vacation season.

So, I refuse to buy into the panic.

Actually, being the lone RT who works nights, I have never been called off. And, considering no one wants to work nights, I don't have to worry.

The RT department is almost exempt from the lay off fears because there are only 10 of us. Still, on occasion, when the census is down to 4-5 patients on treatments, one of the day RTs has to take a day off and use up his vacation pay.

Of course if the census is really low and no RT wants to lose all his time, we sometimes do 8 hour shifts instead of 12.

Still, the day shifters hate working after 9 p.m., so I usually only miss out on the first 2 hours of my shift if anything. And that's fine by me, because then I get to stay home long enough to tuck in my kids.

So, right now we are stuck in the Q#@^t time of the year. Note, I did not say the Q-word. I certainly don't want to jinx myself.

I certainly don't mind the low census because on nights I can do this. But the day RTs don't get to play on the Internet (ha ha).

We do have our rushes. I mean, after all, this is a hospital and people do have mishaps, and people still do code, and people still do have cp and the occasional SOB episode.

But we simply aren't getting a lot of these people admitted right now. Which, if you think of it, is good for them, good for me, and bad for the admins -- hence the boo-hooing.

And the admins hate the low census. Boo hoo, we aren't making money on all the useless breathing treatments.

I suppose some day I might be an admin and I'll be boo-hooing.

Until them, I'm enjoying it.

Anal RTs in the RT Cave

Usually after 9 p.m. I am by myself, and usually, it seems of late, that all the treatments are due right around 10:p.m. when I'm all alone. Since I'm alone, I usually start at 9:30 and chug along, and expect that by 10:30 I'll be done with all my treatments.

However, it usually doesn't work that way. Being in the field of RT, and having that dam beeper, you can never plan ahead as to when it might go off. And just as I start chugging away at my evening treatments is when ER calls. It's to the point now that I can almost bet on it.

Ideally, on nights when we have seven or more treatments due at 10:00, I think we should have 2 RTs working. However, this trend of being busy will end some day (hopefully soon as far as I'm concerned, however the RT bosses are happy by it), and I'll be so slow around 10 p.m. that I'll be looking for things to do.

So, this gets back then to the inability to plan ahead in this job. Unlike my application for overtime two posts ago, you cannot plan for overtime; you cannot plan when you are going to be busy. It can come at any time of the day or night. It can last up to one hour or three months. You never know.

Last Sunday, when I had that Cerebral Palsy patient come in and I had to spend the majority of my time with him that night, I pretty much didn't do any other treatments. I had to rely on the nurses to call me when a patient needed a treatment, and in a few cases they did the treatment for me. It was that kind of night.

Now, in my defense, by Sunday night, the night in question, I had already had the same patients all weekend, and knew who needed treatments and who didn't. So, when I got busy with this one patient, calling in help to do treatments that aren't indicated in the first place didn't seem to me like a good idea. So, instead of worrying about the un-indicated treatments, I focused on the patients who needed my services and was happy to care for them.

Actually, it got so bad at one point that I walked upstairs with a pack of Albuterol amps and handed them out to the nurses in case their patients called for a treatment, or actually got short of breath. As it turned out only one patient called for a treatment, and he was one of the patients who liked his treatments, but did not need them.

So mooring comes. The ventilator that was supposed to be cleaned during the night was still in shambles in the back room. Stock was dwindling in number as I did not do my job of stocking during the night. And not one of the four QID treatments were started.

Now, none of this would have been a concern of the RTs who work with me on my weekend, but since Monday the other weekend core of RTs work, the A-Team we call them (Anal), the little things matter. And, when I gave report, and it came to light the QIDs were not started, my relief said, "So, why didn't you call someone in to do the QIDs? Now they are all due and I have this vent to take care of."

Keep in mind here that she works solo until the 9-9 RT comes in. "Oh, I'm sorry," I said, being political, "It never even occurred to me. None of these people need treatments anyway, so I wouldn't worry about it."

"But these treatments need to get started," she said anxiously. "What am I supposed to do."

"Just take care of the vent. I'm telling you, none of these people need these treatments. They will be perfectly fine to wait until the Jake comes in at 9. Don't worry about them; trust me."

What I said went right over her head. These are the kind of RTs that have to have every treatment done at exactly the time the doctor ordered them. The Q4s have to be done exactly every four hours, and the Q6 treatments exactly every six hours. That's fine with me that's how they run their ship, but it makes for very little flexibility and high stress if ER calls or something else comes up. These people run around ragged and stressed all day.

Me, and the rest of the people who work on my weekend, are more laid back. We assess our patients so we know who needs them, and we give Q4 hour treatments a half hour leeway, and Q6 hour treatments an hour leeway. That is, unless they really need them. Then we don't dink around.

The Anal RTs are well aware that the treatment might not be indicated, but that doesn't matter: if the doctor ordered it Q4, then it must be done Q4. If the departmental policy says that QIDs have to be started by the noc shift, then that is how it must be. Anything else is grounds for anger and anxiety.

My point is, you can't plan ahead in this profession. You can't be so stuck on the idea of doing Mr. Robinson's treatment at exactly 10:10 because the person who worked before you did Mr. Robinson's last treatment at 6:10. It's only the Anal RTs who work this way, and they tend to be stressed to the max when things don't go as planned.

I suppose, though, that we all have our own way of working, and in the end, we all get the job done because we are all elite RTs. It's just that some of us are flexible and prepared for the interruptions, and don't let them bother us, and other RTs, the Anal RTs, have that anxious edge to them unless things go exactly as planned.

They are great people and fun to work with, and when you follow them you know that all treatments are going to be done, and all equipment stocked, and after hours they might be just as fun to hang out with as any other RT. But the anxious edge to them will be apparent, as they say things like:

"Man, you are going to be busy tonight," or "It was swamped today," "You better have brought your running shoes," or, "I think you better call in for help tonight."

I know, based on experience working with these guys, that I have to get a good report and organize my own worksheet and make my own judgement as to whether I can handle it by myself or not. Chances are, their anxious statements will be way overblown. Not always, but most of the time it is not as busy as they make it appear.

That, my fellow RTs, is the thought of the day.

A more detailed description of slippage

So long as we are on the topic of slippage (I wrote about it here), perhaps we should expound on this a bit. We are all expected to maintain a certain level of dignity. We are all supposed to maintain a certain level of modesty. We are all supposed to maintain a certain level of respect for our superiors, friends and co-workers.

Slippage: failure to maintain an expected level, fulfill a goal, meet a deadline, etc.; loss, decline, or delay; a falling off -- dictionary.com

When we are out in public, many of us try to maintain a certain level in our appearance. When we go to work, for example, we are expected to look our best, to smell our best, to wear our best smile and personality. We are supposed to be the utmost professionals when we are amongst our co-workers and, most important, our patients.

When things happen that we disagree with, when a doctor orders something we think is going to harm the patient, it is our job to bring this to light in a professional manner. When a doctor orders something stupid, it is expected that we will not complain. It is also expected that we will not complain when we disagree with an administrative decision. We, as expected, will be the utmost professionals and, to put it lightly, just do as we are told.

The gossipers will gossip. The unhappy people will complain. As I am doing my rounds through the hospital I hear these things going on, and I wouldn't necessarily call all of it slippage. There are certain people who are hotheads, and they tend to argue with every single person every single time something meets their disapproval. I would not call that slippage. I would call this disrespectful, perhaps.

When someone does something that is expected of them, it is not called slippage. When the hot head gets hot, it is not slippage because that is the standard that person has set for himself. Sure, he might not be very popular, but his being a jack ass is not slippage. When the complainers complain, when the gossipers gossip, that is not slippage either, unless it comes from an unexpected source.

Slippage, therefore, is when a person does something he that is completely out of character. Slippage might be what you would call it when a person who is normally quiet and reserved bursts out of his shell and tells you all the things he hates about his job; or a person who is respected in the community gets drunk and starts talking about how many women he has gone to be with.

Ah, to find a perfect example, one might simply look at the headlines in the newspaper. When Ted Turner ran his mouth the other day and said the world is going to be destroyed in ten years because the world is overpopulated, I would not call that slippage because we expect such nonsense from him.

Then again, when Mel Gibson rattled on about how he hates the Jews when he was drunk one night, that is slippage. We did not expect such filth from him. Sure, we might have suspected that he held such opinions, but he had made an effort to maintain a certain level of dignity, or respect prior to that one night, and had kept his mouth shut.

When you keep your mouth shut you greatly decrease your chances of slippage. When you do not drink or do drugs, you greatly diminish your opportunities for slippage. However, we all have our moments. I have had my moments. You have had your moments. We all remember our parents, or someone we loved, having their moments too. Our friends definitely have their moments too. That's life.

When our perfect example of equanimity, Dr. Cool head, got ticked off because he was working all weekend and was called every hour on a very stressful weekend at Shoreline Medical, and he blew up at the kind nurse who called him for the first time ever at 4:00 a.m., that would be a good example of slippage. It was totally out of character for him.

I can give you two of my own personal examples of slippage. For example #1, you can see my blog entry from yesterday. For example #2, I can tell you this normally reserved, humble, and greatly respected RT had just spent the greater part of the night with one young lady in respiratory distress and had just headed upstairs to take care of more short-of-breath patients, when he was paged to go back to the ER and set up a holter monitor.

Many times he had thought to himself how ridiculous it was for a doctor to order an outpatient procedure to be done in the emergency room, but, ou of respect, he grumbled to himself but not to the middle person who gave the order, and definitely not to the doctor and, most important, he was the utmost professional in front of the patient.

But not last night. Last night he provided a perfect example of slippage. Last night he stormed down the the emergency room and told the nurses and the doctor point blank that he would not be setting up "that stupid thing that shouldn't even be ordered in the emergency room."

"You mean you don't have a holter monitor," one nurse said.

"No. I have no clue if we have one or not. What I'm saying is I'm not setting one up right now period. I have a sick patient right down here that I've spend the majority of the night with, I have a Q1 hour treatment upstairs, I don't have time to spend a half hour setting up a holter."

"Well, can you just bring the holter down if you have one."

"Are you going to do it?"

"No. That's your job."

Ah, slippage. What alcohol did for Mr. Gibson's mouth being burned out did with mine. Slippage.

Later in the night, after I had reasoned with myself and had reluctantly dedicated a portion of my time to set up the holter (and was the utmost professional with the patient of course), I met these emergency room nurses up in the CCU when they transferred a patient up there.

"Hey, and thanks for your help," I said. "Oh, and sorry I was so grumpy last night."

"Oh, I didn't think you were grumpy," one of the RNs said, smiling.

"Oh yes I was," I said.

"Oh yes he was," said the second RN. "I've never seen him get upset before. He's always so calm and cool."

"It was a little slippage," I said.

We all participate in slippage from time to time. I would like anyone who has not participated in slippage to raise his or her hand. If you haven't' slipped before, that would mean you are perfect. And, as the old saying goes, perfection in itself is a flaw.

Which brings us back to that infamous RT Cave rule: We night shifters never hold what one of us does or says as a result of exhaustion or burnout against one another. Because we all slip from time to time.

So long as we don't slip too far.

A little tounge slippage due to pure exhaustion

I missed an RT Wisdom yesterday. This is my blog, and I have the right to skip a day of blogging if I choose. However it lays there in the back of my mind, that yearning to stop what I'm doing, to rush to the Internet (that awful addiction). Yet there are other responsibilities that preclude fun.

There is no boss here to make me blog every day. And, unfortunately, no profit loss either. I have a post written for yesterday, actually. I just didn't have the time to post it yesterday. It was one of those days. It was one of those nights. It was another night from hell. It was a night with a lot of slippage.

Today, instead of educating anyone on some deep RT Wisdom, I'm going to take a moment to write about slippage. It has something to do with the 2 a.m. syndrome that any of you night shift RTs and RN and DRs will be fully aware of, but you day shifters may well not be aware of.

And, there is this thing called amnesia too, which occurs when a night shifter goes to days for a long enough period of time. He, or she, forgets what it was like to work nights. It's called former night shift suppression syndrome. How's that for a cool name that popped up extemporaneously to my humble RT mind.

When you are so busy at work and your boss has to come in at 2:30 in the morning for two straight days to do all the useless breathing treatments so you can take care of the critical patients, you know your busy.

When you have one person doing the work of two, as this humble RT did Thursday through Sunday, it makes for arduously long nights. And, strangely enough, on the final two days of a long, long, long stretch, even though there were two of us through most of the night these past two nights, the journey was still arduously long -- go figure.

It's amazing how much more you can accomplish when you have fresh legs, body, and an invigorated mind and spirit, as opposed to fatigued legs, burning feet, and wearied spirit. With even fewer tasks at hand, the ability to get all of them done in a timely manner is severely hampered.

And, while this RT finally has a moment to rest and to eat his dinner at 2:30 in the morning of the final night, and his boss is sitting in the other room taking off her coat and hat and is organizing her paperwork, she says, "You know, I'm really tired."

"Ah," I think to my humble RT self, "I'm not going to go there. I'm not going to say one word, even though I wanted to say something like, "You're tired. I just worked the night shift six of the last seven days. You're tired?" At this point, I stifled the slippage.

Instead I smiled and said nothing, because I wanted to keep the peace. I'm cool that way.

However, later on I said, "Man, I think every one in this department is really burned out. I know I am, and I..." She interrupted me before I had a chance to blurt out the rest, which was going to be, "and I know you are too." I had not intended for what followed to occur. I did not intend the slippage.

She interrupted with a lecture, and when the RT is burned out it's one thing, but when the night shift RT is burned out, when this RT has every bone exhausted to the core to the point his body feels like mush -- a wet noodle walking, the fetters normally shackled to his voice box and
tongue loosen, and he simply says what's on his mind. I like to call this 2 a.m. syndrome, because I see it a lot on night shift.

But remember the old RT Cave Rule: Night shift people do not hold it against other night shift people. We know we are tired. We are a team, and therefore we do not get mad at one another. We don't hold grudges. We can't hold grudges.

Boss used to work nights, so perhaps she had a little of this rule left in her, or so I hoped. I prayed the former night shift suppression syndrome did not go to far into her bones, now that she not only advanced to days, but drifted further away when she drifted in the land of The Bosses, where the focus shifted to money. She has, as I describe in this link, become a dragon. And dragons, while they will never admit it, lose their ability to empathize with peon RTs and RNs that they once upon a time worked with. They, like all their fellow dragons, think like dragons.

That aside, what came next was a little slippage.

She said, "I don't buy that. You guys have no right to be burned out. You guys were so slow for so long that I think you simply forgot how it is when you have to work. You forgot how to work. Don't give me this that you guys are burned out. I came in and helped out last night and it felt great. I felt really good about myself. I think you guys forgot how to come in and enjoy yourselves when you have to actually work."

Okay, so here comes the slippage; the 2 a.m. syndrome at full force. It wasn't an angry statement. There was no ulterior motive here, it was simple slippage.

"Um," I thought for a second about not saying anything, but this was the moment I had been waiting for since the last time she brought this up (see this post). I had discussed this with my co-workers, and we all agree on one thing, which is...

"Boss," I said, "if it weren't for all the useless breathing treatments that we do around here, I wouldn't be burned out at all. If it weren't for all the useless breathing treatments on our board, I'd have been able to spend a few minutes with my ventilator patient tonight, or some more quality time with the truly sick people on this board. Instead, I'm running around taking care of people who don't need to be taken care of." There. Got that off my chest. It had been hanging on there for a few weeks.

Her response: "We need those treatments to make money for this department. If we don't make money, you would be out of a job. You guys sit around complaining about getting no work when it's slow, but when it gets busy you complain."

"I never get no work. You know how it is, nobody wants to work night. The lone RT shifter never gets to stay home, not even when it's slow. And I don't mind that really. I certainly don't complain when it's slow. I love it when it's slow. " I get to blog when it's slow.

Like I wrote earlier, she is an administrator, and administrators (dragons) think in terms of money. It's all about money. And which it should be. However, and I didn't say this, but the hospital does not get reimbursed for any of the treatments we do after the initial treatment. We are making no money at all on those treatments.

Despite thinking this, I said, "Look, Boss, I love working. I love my job. I love being an RT. And I love helping people. And I love it that you're here helping me out." Nothing like a little flattery to get you somewhere. "And when I'm waking someone up at 2 in the morning to give them a treatment they don't need, I certainly don't feel joy in that. If anything, I feel stupid." Wow. That was a good line.

"Well," she said. "I don't even want to go there. I don't even want to be having this discussion right now."

"Me neither, Boss, I hate it. I hate that I have to defend myself against the charge that I no longer feel proud of my job, or joy in my work. I feel proud every time I succeed at getting a blood gas, I feel joy every time I suction successfully. I love it when I get to use my brain and determine if someone needs a treatment, an EKG an ABG. I love to use my experiences and my education to benefit poeple. That makes me proud to be an RT. Doing a bunch un-indicated treatments so we make money makes me feel stupid."

"Well," she said, "I'm sorry you feel that way."

"Which is ironic," I forced a laugh so she didn't think I was being too much of a prick, "because I am fully aware the bottom line is money. I understand that completely. It's just that if you want me to feel ultimate joy in my job, or any sort of euphoria, you will talk to the doctors about letting us decide who gets treatments. Heck, if it's slow, I'm sure we'll find a way to add a few extra treatments to the board. And I wouldn't mind doing useless breathing treatments, so long as I decided that.

"It's not that it's hard to slap a neb into someones mouth and give them a treatment. It's that we are swamped right now, we have a lady on BiPap that I've been with for four hours tonight alone, and a vent patient I need to spend time with, and two patients getting Q1 hour treatments who have to have the nurse call me every time they need a treatment because I'm tied up doing frivolous things."

She didn't say anything. Perhaps she was shocked because I'm normally quiet and complain very little. I'm not complaining, though, just stating facts. I ended it there. I couldn't go on anymore if I wanted to. I was drained. I wanted to keep the peace. I had to keep the peace. I did keep the peace. However, the seeds were planted for a later discussion. We went out then and tackled the rest of the shift together as a team.

It was very enjoyable having a fellow RT with me on night shift. It was cool having someone get one ABG while I got the other. It really was. I suppose it's this kind of joy, the companionship of fellow RTs, or the longing for it, that has us night shift RTs ultimately going to days. There is nothing like a good old-fashioned RT teamwork. Nurses are great, but there is nothing like being among our own kind.

That, my fellow blogger friends, is the thought of the day, or thoughts of the day. What do you think? Perhaps I'll have to start a new RT Cave lexicon with all my new definitions.

Preparing for a busy night, hoping for a good night; and a brief review of the new Underdog movie

Another nice thing about working 12 hour shifts is your wife can work on your days off and you get plenty of time to spend with the kids, and they never have to go to day care. Then again, there are times when I only see my wife in passing.

After working 12 last night, she trudged into the house this morning with red eyes, slurring her words, and she said, "Sarah said she feels bad for you. She said it's so busy that she had to have someone come in at two in the morning to help her."

"That bad, hey," I said.

"Yep. As she was talking to us she was paged three times."

After driving the boy to school, my wife went to bed and was out almost instantaneously. That left the girl and I home alone, and we decided to watch a movie we rented called Underdog.

Many of you probably don't remember that old cartoon, but back in the day when cartoons weren't on 24 hours a day, my brothers and I used to look forward to Saturday so we could watch cartoons all day. We would even sacrifice sleep and get up early.

At six in the morning we'd sneak off into the livingroom, click on the boob tube, and watch either Bull Winkle, Johhny Quest or Underdog. We loved those shows, however simple they were. They were good entertainment.

Usually I find myself disappointed when Hollywood gets a hold of a classic. When I was a kid I loved the Dukes of Hazzard, but when I took my son to see the movie I found myself wanting to leave the studio after there was sex in the first scene. I suffered through it. I hope this experience didn't scar my son for life.

I expected the Hollywood version of Underdog to be equally disapointing, but it turned out to be pretty good. It was, in my opinion, very fair to the original show.

Fortunately for this RT who has to work all night tonight, my daughter is still at that glorious age where she likes to do the same thing over and over and over and over and over again, and still get the same enjoyment out of it each time.

That in mind, I'm going to put Underdog back in, turn the volume down, and try to take a nap. Sometimes this works with four year old girls. However, sometimes she likes to make sure I'm alive every ten minutes or so by giving me a big kiss and saying something like, "I love you daddy."

Whatever kind of rest I can get, I'll take it, especially considering I'm not rightly looking forward to going to work tonight. And being my first night back after my bi-weekly mini vacation, I'm bound to be awfully tired.

I can handle it, though. I'll just put on my running shoes, plan for the best and hope for the worse... er, plan for the hope and... well, you know what I mean: prepare myself for worse and hope for a good night.

New types of Vent-'olin discovered at Shoreline

I come into work today and we have 16 patients on the board. Just to give you an idea of how hard us night shift RTs have to work at times, I have to take care of all these patients, plus ER, and plus anything else that comes up during the night.

I've been doing this long enough that I would consider myself an RT expert at prioritizing my therapies. I do this by asking one simple question when I come on duty after a few days off, especially if I don't already know the patients:

"Do any of these patients actually need the treatments?"

I know by now which RTs I can trust in their assessment and which one's tell me that a patient needs treatments when in all reality they don't. Either way, on my first day back I pay extra attention to my assessments, and determine for myself which patients need treatment and which one's don't.

Then I circle the names of the patients who do need them.

Now, that in mind, of the 16 patients I currently have here tonight, I have circled three of the names. That means, if I get busy in ER, or with a code, or if OB has a bad baby or something, I don't have to stress out about 13 of the patients -- they don't need their treatments anyway.

That in mind, my coworker Dale must have been fed up with this, because when I came to work yesterday he handed me a piece of paper. On this piece of paper he had three new 'olins for me to add to my list.

Following is what was written on that piece of paper:

Toolateolin: Most effective treatment for hopeless conditions. Use should be initiated by RN only. Drug has demonstrated no untoward effect when used for pulmonating edema, pneumothorax, cardiac tamponade, severe chest trauma, upper airway obstruction, nor agonal breathing. Like Xoponex, this drug comes in varying doses for cardiopulmonary arrest, v-tach, prolonged apnea, multi system failure, end stage mets, pulmonary infarct, rigor mortis or any other condition threatening imminent mortality.

Tryagainolin: A version of Toolatolin (as described above). Used continuous for prolonged periods should result in relief for all involved,with exception of patient & RT.

Waytoolateolin: A version of Toolatolin (as described above). Used continuous for prolonged periods should result in relief for all involved, with exception of patient & RT.

Note: Repeated use on multiple patients of Toolatolin, Waytoolatolin or Tryagainolin may result in changes. Normally witty RTs may respond to reasonable treatment requests with caustic cynicism. Normally, cynical RTs may respond to idiot requests with unconcealed anger. Normally, angry Rts may become despondent and resort to tears after self mutilating their heads on the closest brick wall

Further precautions: Treatments with Toolatolin, Muchtoolatolin and Waytoolatolin must be carefully documented. Charted comments such as “this treatment was a worthless waste of time” or “patient remained apneic post treatment,” may prove to be uncomfortable for doctors, RNs and RT department supervisors resulting in further enhanced working conditions or threatened continued employment.

After working last night, and seeing for myself just how ridiculously and unnecessarily busy we are here, and getting irritated with all the unindicated breathing treatments, and actually getting so irritated that I wrote on many of the unindicated treatments comments like: "This treatment not indicated," or "no signs of bronchospasm," or, "This pt. not sob before tx, still not SOB after tx," or "treatment had no effect."

Also, after spending half the night in the emergency with a critically ill patient who did not need treatments but nonetheless I had to do several of them on her, I completely understand now what instigated Dale's creativity.

Thankfully this occured before the day shift went home. However, if Jane had already clocked out, I would not have left this critically ill patient to do other treatments that were not indicated. No person is entitled to that kind of stress.

And this, my valueable readers, is exactly why I am a major proponent of bronchodilator reform.

Ever dread going to work one more night?

Do you ever have a day you simply dread going to work? That's about where I sit right now as I write this. My wife worked last night, and she said it is a complete zoo there. And she was not referring to OB, even though they too are busy.

I do feel a certain amount of joy that I will be needed. And I do feel joy knowing that I will provide a solution to some person's problems tonight, be it a patient or a nurse or both. I do feel joy in knowing that I will be really working tonight and earning my keep, as opposed to those many days recently where I had so much time as to watch several TV shows on the Internet.

However, I dread the idea that I will be beeped every time I sit down to chart, and I dread the idea that when I sit down to chart again I will again be paged, and when I sit down to chart again I will be paged. I know this sounds redundant, but that's exactly how my nights have been lately.

I have already promised myself that no matter how frivolous the reason for paging me is, I will not complain. I will be happy. I will smile. (fingers crossed)

Well, I say that, but we'll have to wait and see. Usually when I get irritated at getting paged for stupid things, like a treatment that is not indicated, or an EKG on a patient that came in because she stubbed her toe, I grumble and gripe to myself if at all, and by the time I get to my destination I never say anything to the nurse.

And, expecially when I enter the patient's room, I know that I left my attitude, if I had one, at the door. I'll have to remind myself about this more than once tonight, as I still am burned out from the weekend from hell. And we had a wee bit trouble sleeping last night after sleeping until 1:00 yesterday. Whoops. I shouldn't have done that.

Oh well. I can say oh well, and I can rest pretty assured that I will stay in a relatively good mood tonight if only for the simple truth that I know I will not have to return to work tomorrow for my regularly scheduled final night before my six day off stretch. I say this because tomorrow I'm taking off so that I can leave for Florida Friday morning. Yippee.

Yet, a part of me still dreads that I have to work one more night. The burned out sensation that runs through my veins and has worked its way to through my muscles to the core of my bones, especially in my feet, wants me to stay far, far away from that place.

Songs like "One More Night," will rail through my head, reminding myself that it will be over soon. But soon, sometimes during hellish nights, seems like a long time while it's happening.

Do you ever dread going to work like that? I'm not talking about hating your job, but just wishing you could take that final day off, like a Friday per se for people who work normal eight hour shifts with no weekends.

Ever? I bet you do.

Good co-workers make our job easier

Sorry for the rant in my last post, but it really is the truth. I received some much needed empathy from my RT blogger friends, and I suspected as much. I imagine some of you guys work equally as hard probably on a regular basis.

One person smpathised with me and wrote that it's nice to be around fellow RTs when you have busy nights like this. She said, "There is something comforting about walking past another RT in the same hell and muttering 'Kill me now' under your breath. That smile or quick laugh makes everything okay."

I do miss that being the lone night shift RT at Shoreline. I have to give so much credit to my co-worker Jane Sage who works the 9 a.m. to 9 p.m. shift. Even though she was as burned out as me, she stayed until 11 p.m. every night this past weekend, even though she had to be back to work at her regular time the next day. Having her there was literally a stress saver.

And as Dee Brown walks into the RT Cave in the morning and observes me playing a game on the Internet and smiles instead of complaining that I didn't start all the QIDs or do any of the morning EKGs, I feel joy. We are a team. We RTs stick together in our frustration when we have hell nights.

Yet, while I work the bulk of my hours as the lone RT, I know that I have many wonderful RNs here at Shoreline to say "shoot me." We are equally busy. While I walk the 20 miles on my own, the RNs may be caught in a pile of poop provided by just one patient. Those nights can be equally hellish.

One really great thing about working at a small town hospital, and I think one of the reasons I've stuck with this particular hospital as long as I have, is that the RNs have a certain degree of empathy for us RTs when we are busy -- and vise versal.

There have been two ocassions I walked down to ER this past weekend alone and dropped a handful of Duoneb amps on the counter and said, "You guys are on your own." While I might have been blunt, they had empathy for me and did not complain.

There were several occasions when the ER nurses did my EKGs without as much as a grunt. And there was one time I was in ER and a nurse did my EKG just to be nice. She knew it was my fourth swamped night in a row.

I smiled and said, "This is the happiest I've been all weekend. You ER nurses are the best."

Of course if I were in the unit it would be, "You CCU nurses are the best." You know what I mean. You have to be political.

And politicalness is important when you are the lone shift RT, because when the nurses like you, they can make your job a heck of a lot easier than if they didn't -- and vice versal I suppose. However, I pride myself in knowing that I get along with all people. It's better that way.

One of my co-workers who recently resigned used to buy pizza every Saturday night of his weekend on. Once I asked him why he did this, and smiled and said, "If I make a mistake I want to have many friends to back me up."

Last night the nurses organized a pot luck, and all I had the energy to bring was a bag of chips. And my co-worker and I were so burned out we ate the whole bag while giving report.

However, the nurses weren't going to let me skip out on the midnight meal. Midnight meals are cool; a big stress reliever. Even while I had only a moment to munch, the aura of the moment, the hanging out with my co-workers in the lunch room, was all the comfort an RT needs.

Grrrrrr

Nothing like a little Calvin and Hobbes to sum it up for me.

But that headline there about sums up my weekend from hell. And I still have six hours left.

It's one thing to be busy just in ER. It's one thing to be busy just on the patient floors. It's one thing to be busy just in the critical care. But when they are all paging you one after the other all weekend long, it's.... Grrrrrr.

Every person who could posibly have gotten sick this weekend did. I've taken care of everything from sick kids (see my last 2 posts) to adult vents.

Actually, about the only thing I haven't had is a code, but I have had at least five occasions when a patient has come close. And even a code would be better than trudging from one room to the next, from floor to floor to...

Come to think of it. Is there a reason that emergency rooms and critical care units are so far apart in hospitals. That's how it's been at all the hospitals I've worked at.

I think they do it this way to wear out us RTs. I don't think hospital builders think of how far RTs have to walk. No wonder my feet are killing me. I read one place that an RT walks on average 20 miles a day. I bet there's some validity to that.

And, here's another observation, whenever I have a ventilator in the unit (not like they put them anywhere else, but you know what I mean), ER is almost always busy. It's like clockwork. Just as you start a treatment in the unit, ER calls. Then you get to ER, and CCU calls you back.

Then when you sit down to have something to eat, they both call you at the same time, and then you get a third page that a patient on the floor needs (wants) a treatment.

I suppose it wouldn't be so bad if there were two of us, but it's just me. And, for whatever reason, I never call in help. It's not so bad being swamped the first two nights, but by the third night, when things still haven't slowed down, you start to drag your feet.

I'm sure you guys know what I'm talking about.

Now, on the fourth night, I'm... Grrrrr. I'm a freight train coming through, get out of my way. If you order a stupid procedure, I might slip up and tell you what I think. I will try to hold back, but I don't know if I will be able to.

And, if those two RSV kids in ER right now end up getting admitted, I think I might break down and cry.

Okay, so I won't do that. But I could.

That pretty much sums up how I feel right now as the lone night shift RT.

Grrrrr...

Working nights solo can be challenging at times

I came into work last night anticipating on working on my fantasy baseball rankings, and it ended up being reminiscent of how it used to be here at Shoreline every night: busy.

My co-worker normally stays until 9 p.m., but all I had were a bunch of 10 p.m. treatments I figured I'd knock off in no time. But, lo and behold, as soon as he left all hell broke lose. Every patient who could possible go bad did.

And, as what usually happens when you have ten treatments due and two patients in failure, the emergency room paged: "We need another now treatment on room 1," the pager read, "and then Q30 minutes after that."

"This is completely ridiculous," I grumbled under my breath, and then looked up at the middle-aged lady I was currently giving a treatment to and watched as her body jiggled up and down as she laboriously struggled to move air.

I didn't know what else to do, so I dropped the pager. This reaction prevented me from whipping it across the room. I looked at my patient, and watched as she closed her eyes and rested her head on the pillow. She was pooping out. I decided right then and there I was not going to leave her.

I grabbed the phone on the endtable and dialed ER. When the unit secretary answered, being political was the last thing on my mind.

I grumbled, "Dr. Krane really wants Q30 minute treatments on this lady?"

"That's what she ordered," Diane said very politely.

"You have got to be kidding me," I said. "I already gave two treatments to that lady,and neither of them were indicated. And now she wants this."

"Well," she said, "You'll have to take it up with the doctor."

"If you guys think she needs the treatments, then you guys are just going to have to do it, because I'm swamped up here."

And that was the truth. Not only was this lady failing, so to was her neigbor. And that's not to mention all my treatments were due, and so was my vent check, and someone on East kept paging me because the Vision BiPaP keeps beeping.

A half hour later ER paged again: "Duoneb needed in ER."

They know I can't get down there right now. Why are they paging me agian?

I grabbed the phone. The unit secretary answered, and I asked to speak with an RN.

Moments later a female nurse said, "Hello."

"Listen," I said, "could you guys do me a real big favor and do that treatment for me. I'm really swamped up here."

"We would," she said, "but the doctor ordered Duoneb."

"How about if you just give Albuterol."

"Because the doctor ordered Duoneb." She was not going to give up.

"I'll be down there soon with some Duoneb for you." I was not in the mood for a debate, so I hung up.

If that's not the dumbest thing an RT ever heard. If a treatment is ordered because a patient is short-of-breath, why make them wait 20 minutes for an RT to give Duoneb when a vial of Albuterol is right there in the med cart just because the doctor ordered Duoneb.

However, I handled it. With excellent RN and RT care both my critical paitents averted a vent thanks to a wonderful drug called Lasix. I knocked off all the treatments, including ER. And, while doing all this, I was being paged various times for odd procedures like setting up suction, which you'd think RNs would know how to do.

And, just as I sat down in the RT Cave to eat my dinner, ER paged again: "EKG and ABG in ER."

So I trudged down there and find a 9 YO girl laboriously breathing. It's not often that we have to take care of a little kid here, and it's always a little bit of a shock to see such a little person lying there in my need, instead of an adult.

For the record, I never did an ABG on a kid before. In all my years doing this, I was never asked to. I took my time, kept my cool, succeeded, and walked the gas to lab. I expected it might be a little off, but here's what the results were: pH 6.90, CO2 17, HCO3 2.7, PO2 162 on 2lpm.

Gulp!

The RNs and I were tossing out possible diagnosis' from sepsis to cancer, but as soon as the doctor saw the gas she said, "We need to get a sugar."

That's when you think, "It was so obvious. Why didn't I think of that?"

The little girl's sugar was sky high.

There was nothing else for me to do with this patient, so I headed back to the cave thinking I'd put my aching feet up, when my beeper went off again.

That's how it was all night until about 4:00 when I finally made it to the cave to chart. And my boss just happened to be there. And, instead of asking me how I was doing, she provided me with some criticism about how we RTs have been making too many mistakes filing EKGs lately.

"Yes maam," I said. I really wanted to tell her to just leave me alone, but I didn't want to get into defense mode. I don't know about you guys, but 4:00 in the morning when I'm on my first day back to work, completely exhausted and swamped, is not the time I want to receive criticism from anybody.

"Wow," she said, smiling. "You are the only one who didn't blame someone else."

I looked at her stunned. I had expected many reactions from her, but this reaction caught me completely off guard. "Really," I said.

Instead of charting, which I didn't want to do anyway, I participated in a nice discussion with The Boss. And, as any of you night shift workers can attest to, when you are exhausted this late in a night shift, you tend not to hold anything back.

"You know," I said, "I never thought I'd say this, but I think that I've finally reached the point that I would like to go to days when a position comes open. I think I am just burned out from ER is what I'm saying."

She gave me a look I didn't know how to read. "I used to like ER when I worked nights."

"You know, boss, I really love taking care of vents and critical patients. That's why I love the CCU. And I love taking care of the critical patients in ER, it's just... I'm tired of the B.S. down there.

She gave me another look I could read. I don't want to say she rolled her eyes, but it was close to that. And then the subject conveniently changed. She was thinking this: "We make money on all those useless doctor orders."

It's neat how the mindset changes when you no longer have to actually do the stupid doctor orders.

And, just as my morning treatments were due, the the beeper went off.

Actually, this is how it used to be all the time here. While we are a small hospital, we have a large area we cover. I wonder if this is the start of a new trend, or an aberation.

Either way, working nights solo can be a challenge. But stupid doctor orders do not take precidence over critical patients.

It's time to form that fantasy baseball team

One of the things I do to stave off boredom when the patient load is low is by participating in fantasy sports.

I noticed about six years ago my brother was rooting for the wrong team.

"No I'm not," he said, "I have Terrell Owens on my football team."

"Well he just caused the Lions to lose," I said.

"Rick, you should join a team next year, it's fun."

"I'm not doing anything that will cause me to root for that team."

The next year he convinced me to "just try it," and now I'm hooked. In fact, not only do I play fantasy football, I play fantasy baseball as well.

Fantasy sports is neat in that it causes you to look at sports in a whole new way. And, most important, even when your team is doing poorly, you can still get enjoyment out of the game.

While I used to just watch the Lions on Sunday, I now find myself sitting on the couch with a bag of Doritos every Sunday during football season flipping through the channels and keeping up on my players. It's fun.

Fantasy baseball is different in that I hardly find myself watching any games except for the Tigers, but when I have a Yankee pitcher on my team, I now find myself cheering for the Yankees, of whom I hate.

I don't watch every baseball game like some sporting geeks do. In fact, I don't really watch any games other than the Lions. And that's the neat thing about fantasy baseball -- you don't have to watch the games.


Like I said, fantasy sports has you seeing sports in a whole new light.

With all the acquisitions my Tigers have made in the off season, I'm starting to get Tiger fever; I'm starting to get baseball fever; and fantasy baseball fever. I got the bug.

For any of you baseball fans out there who have access to the internet and the bosses don't care or aren't around, this is a great way to keep your mind busy.

Not working hard and appreciating it

I woke up early today, and the first thing that popped into my mind was the image of a little boy we had taken care of a while back. I decided as soon as I got to work I was going to check on him via his mother's blog.

Now here I sit. It is freezing cold here in the RT cave. Even with the thermometer turned up to 85 I can still feel a draft coming from the window. And, considering we only have seven patients on our RT list, I have plenty of time to sit here at this computer, which sits on a table right in front of that window with the draft.

Seven patients seems like a lot these days, considering when I came in Thursday night we only had 2 patients. By the end of that night we were up to a whopping three patients, the third of whom actually took up some of my time during that night, but it was still a major task staying awake by morning.

Last night our patient load escalated all the way up to four, but two were QID and one Q4 W/A, so I ended up not giving any of them treatments all night because I'm certainly not going to wake a patient up whose sleeping comfortably. So, what I ended up with was a hell of a lot of time on my hands.

By six in the morning, after spending the majority of the night right here completing some projects and, of course, just a little blogging, I was feeling very sleepy. This wouldn't bother me so much if I were actually doing something, but since I was sitting around so much I needed tooth picks to keep my eyes open, and what I looked forward to more than anything was going home for no better reason than to give my butt cheeks a rest.

I really haven't had an interesting case worth writing about lately, which is unfortunate because I have the time to write. The ironic thing is, if I worked at a larger hospital like some of you other RT and RN bloggers out there, I'd probably have many interesting cases to write about, but no time to write. So, I suppose, that's life.

Last night around six, eyes burning, I slouched back in a chair behind the critical care desk and had a real philosophical discussion about God. It seems when you are most tired, like say after 2 a.m., is when these discussions occur. The discussion seemed really enlightening at the time, and I thought I might write about it later, but, for the life of me, I can't remember the details.

Oh, I suppose this might have something to do with the fact that at around 6:30 it seemed the discussion rested mostly between my two RN co-workers, and I decided to rest my eyes a minute. I will do this just a few minutes, I thought, and then I'll go out and do my QID treatments."

I opened my eyes and looked up at the clock: it read 6:55. My co-workers were still rapt in their discussion. I don't think they even had a clue I had fallen asleep.

Here I sit; the cool draft causing me to shake slightly as I click away these words. I'll eat my lunch soon, finish off my two treatments, and then I'll end up right back here for a few hours unless the emergency room finds other things for me to do.

And I feel fortunate nonetheless. When I have nights like this, at work, I think of how many 18 hour days my dad put in, and his dad before him. And I think how many people have sacrificed their lives over the years so I can have this. I thank them.

Thinking of this makes me appreciate all the more how wonderful a life I have, especially to have a great job like I do.

This reminds me of the little boy again, so I clicked on his mother's blog.

He was transferred from out services to the Big City hospital and placed on an ECMO machine within a few days. If you're not familiar with ECMO, that's a machine that removes the blood from your body and oxygenates it, giving your lungs and heart a rest and time to heal.

She wrote how she was informed by the doctors that there was a chance the boy would survive, but it would be a long and difficult road.

Going on an ECMO machine is nothing like the ECMO machine used in an episode of ER that I watched two nights ago, where the patient was put on an ECMO machine right in the emergency room and taken off five hours later. This boy's doctor said it would be a minimum of three weeks.

I know very little about ECMO other than what I was taught in a brief two hour lesson when I was in RT school. I did see one once when I was an RT student at a large University pediatric hospital in our state, and what I remember is a roomful of machines, IV's and other machines and, right in the middle, this tiny patient.

In doing my research, I learned that there were other children who had swallowed kerosene and survived. Two I read about were placed on ventilators, and another was on an ECMO, and all three of them survived.

This mother was well aware of this, and this gave her hope.

I read today the child passed away.

Now I didn't know this child, as I don't know probably 99% of the people who walk through these doors, but it's very nice when a family keeps us updated on people we cared for, even patients we stabilize in a few short hours and ship out.

While I feel for the child, and especially the mother, this situation acts as a reminder to us all how fragile life is. It provides me a greater appreciation of how wonderful a life I have, and how great a job we have, even while I sit here freezing.

I'm going to be written up -- I hope

I'm going to be written up, and I'm happy about it.

About seven hours into my shift I had a patient with a bad heart of whom the ER doc had already decided to ship. I had a bad feeling about this patient, so I decided to hang out in ER until the patient was secured into the ambulance, and the ambulance was gone.

Leaning against the wall, being cool, I casually looked down at the counter and saw that someone had written something on a note pad. This is what it said: "Respiratory did not respond to do an EKG after 2 pages."

I smiled, stood by coolly, and pretended I didn't see it. Most ER nurses understand that I am the only RT on duty, and that my other patients are just as important as ER patients, but this new nurse, her name is Mary, hasn't figured that out yet.

During my recent stay in the hospital, she was the only nurse who didn't treat me like royalty. In fact, when she was my ER nurse, that was the first time I had met her. Now I'm quite certain that not only is she a bitch from the patient POV, she is also a bitch from this side too. She is a rare and unfortunate scar on an otherwise awesome staff here at Shoreline.

Despite my opinion, which is subject to change once I get to know her, I continued to treat her with respect, and I continued to coolly smile at her each time I passed her. And, to my surprise, she was quite nice to me the rest of the night. She even smiled once.

As you guys know from a previous post, I have a proposal for ER EKGs that I have yet to take to the powers that be here at Shoreline. If I get written up here, I am going to use this as a prime opportunity to state my case for STAT reform.

Instead of paging me "EKG in ER" I think I should be paged "STAT EKG in ER" or "Just because EKG in ER" so that I can prioritize appropriately. However, I did tell this to a nurse once, and she paged me STAT for every EKG, because, as she said, "All ER EKGs are STAT."

"No they are not," I said.

"Everything ordered down here is STAT."

"That's not necessarily true." And I proceeded to give her many examples: Treatment for sputum induction, treatment on a not SOB patient, pre-op EKGs, etc.

I said, "If you start paging me STAT to all EKGs, then I'm going to get numb to the word STAT. It's not fair to my patients on the floor if I drop what I'm doing every time I get a STAT page, especially when the EKG in ER isn't needed."

When this nurse I do not like paged me the first time, and to my defense, I was with another patient. I did get the page. I was tied up in another room. And, since about 80% of ER EKGs are done just because, I figured I'd finish up what I was doing before going down to ER. And, lo and behold, I received a second page three minutes later, and still decided to finish up what I was doing.

I was swamped all night.

Okay, yes I could have called. I am at fault there. However, most of the time I call to say I'm going to be a while getting down there, I get down there 20 minutes later to find the EKG is still not done, so why bother calling.

Now, you might be thinking, "If they thought to page you a second time, didn't you think that perhaps they thought the EKG needed to be done urgent?"

No. The reason I didn't think that was because ER always pages me three minutes after the initial page, especially if I don't get down there right away. I get tired of it, especially when I drop what I'm doing and the patient has an EKG ordered for a hang nail or something stupid like that.

I'm the kind of RT who gets along with everybody for the most part. I never complain. In fact, just last night I walked into a room to do a STAT EKG on a patient who was being packed up to be shipped to the CCU, and I observed the patient's NC was hooked up to a tank.

"Is that tank even on," I said while hooking up my leads.

"Yeah, I'm sure of it," the young nurses aid reassured me.

I casually unplugged the tubing from the tank and hooked it to the flowmeter, and turned the flowmeter on. Then I checked the O2 tank. Yes, it was on to 2lpm, but there was something she didn't notice: the tank was empty.

Now, instead of jumping all over her and telling her she was a stupid ass like some people might do, I used this as a teaching opportunity. She probably thinks I'm going to write her up. I won't.

Why won't I write her up? Because I know that some day I'm going to do something stupid. We are a team. We need to stand up for one another.

This ER nurse however. I am very confident that once I get her trained I will get along with her just fine, so long as there is any humanity in her. In the meantime...

I hope she writes me up.

I'm in for a long night here in the RT cave

I came into work tonight and found only five patients on the board, and I went out to check on them at 10:00 and they were all sleeping. Thus, I have no treatments scheduled until morning, and still they are only prn, W/A and QID, so I don't have to do anything.

Wow, this is the life. This is why you go to college. This is why you'd work for a small town RT cave so you can have nights like this. While some people might be b-o-r-e-d, I think only pinheads get bored. I hope what I find to do doesn't get me into trouble.

So, unless one of my patients crash, or unless ER needs me (and that ER doc who loves to order Duoneb on every patient is working), I'm in for a good night, if not a long night.

If something exciting happens I'll be sure to report it.

I appreciate nights like this

Well, it's back to work today. I called work a couple hours before I actually needed to be here for some unrelated matter, and was informed there were now only six patients on the board and I could come in late if I wanted.

"Sure, I'll come in late." How could you turn that rare opportunity down? The night shift RT never gets to skip a day of work like the day shifters do on occasion when it's slow, but we are occasionally allowed to come in 2 hours late so long as the 9 a.m. to 9 p.m. RT didn't go home early.

"I wanna get all my hours in," she said. I have no problem using my vacation hours, because I have more than I'll ever use (pending I don't get mangled by a bus or something).

"Yep, sounds good. I'll just be puttin' up a Christmas tree, so if you need me call."

And that's exactly what I did. What a perfect night to go in late. Watching my 4 YO girl and 9 YO boy getting all excited about the Christmas tree reminded me so much of when I used to get excited about it when I was a kid.

Then, as we were pulling ornaments out of the box, I found one that I was given in 1979. I remember being really excited when I got it, and, looking at it now, it didn't seem like much. It's neat how your perspective changes over the years.

"I'm the same age as you were then, dad," my son informed me.

"Oh here, you hold it and touch something I touched when I was your age," I said and laughed.

"Wow, this is cool," he joked.

Now I'm at work and I finished my three treatments I needed to do before 5 a.m. Once I'm done with this I think I'll watch a couple TV shows on the Internet.

After what happened the last night I worked, I very much appreciate nights like this