Slippage of the Gallant Asthmatic

I have written about the gallant asthmatic on several occasions on this blog, and how every asthmatic should strive to be like him. Yet, I have also written (see here) how perfection in itself is not obtainable.

That said, it should always be the goal of all asthmatics to strive for perfection -- to strive to become gallant asthmatics. The best asthmatics never stop trying.

That said, even the best asthmatics are prone to slippage. Before you read on, perhaps you'll want to freshen up on what slippage is, I wrote about it in greater detail here.

In short, slippage is when you slip out of your normal character. When you do something that isn't you. When the taciturn, well respected uncle gets drunk and runs around outside screaming. That, my friends, is slippage.

Slippage is normal; we all do it from time to time. However, most of the time our slippage moments are harmless. Sure they might embarrass us in retrospect, but they are usually harmless.

But these moments can also be harmful. For example, the teacher who slips out of character and cusses at his student. Not only is this type of slippage stupid, it could cost him his job.

Or consider the well respected member of the community getting drunk and running over the neighbor's kid. That kind of slippage is obviously not good.

Now, consider the asthmatic who has worked so hard to educate himself about asthma, work with his physician, and get on all the right medicines. He then takes all his meds compliantly. He, in essence, has become a gallant asthmatic.

I can provide you two examples of this. First, I wrote about myself and my battle with bronchodilatoraholism. As I became educated I turned into the gallant asthmatic I am today (or, as I said, I strive to be a gallant asthmatic).

Second, I wrote about the Jen, the Sometimer Asthmatic. Jen is the prototypical asthmatic who decided on her own she didn't need to take her meds unless she was having an attack. Then one day her asthma hit her hard, and she learned her lesson. Jen is now striving to be a gallant.

Now for some slippage. I have recently been very busy at work. One day I realized my Advair had nothing in it. Then my Singulair ran out. All of a sudden I was sneezing and coughing and (as a sign of my bronchodilatoraholic past) I found myself puffing on my rescue inhaler more often.

Yes, I was participating in slippage.

My friend Jen came to me today and said, "Rick, you are going to be disappointed in me, but I have let my Advair inhaler go empty. I haven't taken it in two days. And, worse of all, I can tell the difference."

Yes, Jen is participating in slippage.

A little slippage is okay so long as we catch ourselves and quickly get back into our normal character. In my case, and in Jen's case, that normal character is in the mold of a gallant asthmatic.

Sad to say, though, as I wrote above, sometimes slippage can be serious. I had an asthmatic patient recently in the emergency room who, when he was feeling better, told me he slipped up. He forgot to take his medicine for two weeks. "And now this," he said.

He promised me he would never slip up again. Well, I have said that too, and so has Jen.

What makes asthma such a hard disease to live with is that most of the time the asthmatic feels no symptoms. It's easy to forget we have asthma. It's easy to slip into the mould of a Goofus Asthmatic.

To be a Gallant Asthmatic is a never ending battle. To avoid making that unnecessary trip to the ER, we must always strive to be the best asthmatic we can be.

Yet, as we can all attest, a little slippage from time to time is normal. Yet the periods between these weak moments should become further and further apart.

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.