A Doctor by any other name...

So what do you call your friendly neighborhood doc? I've found that as I spend more time in the field I'm less formal with the healers of higher learning. I always refer to them as sir, ma'am or just plain doctor in front of patients but at the desk all bets are off.

I don know if it's my moderately cheeky nature, my anarchic attitude or my inability to remember names easily but I call every male doc either man, dude, slick, cuz (short for cousin) or by their first name. I always call women docs by their first name because I can't find a generic nickname that doesn't sound condesending. In fact I've only once been corrected by someone who wanted me to call them by her title and surname. The older docs look a little taken aback by my inpertinence but quickly get used to it. The younger docs tend to embrace it.

The people I always seem to have problems with are the older nurses. I have been told more than once that calling a doctor anything but doctor is disrespectful. I personally believe that calling everyone by first or nicknames fosters teamwork and provides a breeding ground for true interdisciplinary practice. At least that's what I'll say next time I get called on the carpet for it.

And a word to the wise, if you find yourself itching to try this in your own practice don't refer to anyone of Indian descent as Hoss (southern for horse, meaning strong guy). I don't know what it translates to, but it will get you a dirty look.

RT

Hallelujah sons and daughters

Hallelujah sons and daughters.

Big changes and I haven’t felt like blogging. My dad, the reason I got into this business died and left a large hole in my life. My wife lost her job and we had to start traveling to make enough money to keep a house we can’t afford to live in.

Savvy?

I’ve been working at a small surgical hospital that’s part of one of the most prestigious health systems on the east coast. All I have to say is world class medicine, really shitty gloves. I mean really, I understand the importance of having a latex free hospital but do you really have to use the crappiest gloves made. I of course have freakishly large hands, and I’m sure that that increases the failure rate. These gloves are busting like the banking industry.

Too soon?

Anyway, tonight I had to terminally extubate in front of a live studio audience. A woman was brought magically back to life after an indeterminate amount of time down. Unfortunatly she had already walked into the light and we were left with what was left. Instead of grasping to some small glimmer of hope and letting her rot away her family made the very hard decision to let her go. After brain death was determined and we had a family reunion they decided it was time to let go of the flesh that had until recently been their family member. I was kicked back doing as little as possible ( a little charting) the RN called me and asked if I would be so kind as to kill his patient.

Yup.

This has always been the toughest part of the job for me. It hurts to be viewed as the asshole who killed momma/granny/dad/granddad/aunt/uncle/disco/the 1986 Red Sox. Because of the experiences of this past year I have seen it from the other side. Dad and my Granny were both terminally extubated and I didn’t hate the rat bastard who killed them.

I digress.

So I walk onto the unit and find a room overflowing with love, grief and family. I gather my supplies and suit up for action. I walk in and explain who I am and what I’m about to do. None of them move. Not one. Crickets chirp. Someone in the back coughs.

I suggest they may be more comfortable in the waiting room.

Now even the crickets are silent.

I pulled the tube out of someone while 15-20 of her family members stayed in the room. I have to say I was a bit uncomfortable. I offered advanced condolences, offered my services and to answer any questions, and scooted out of the room. I’m really glad there was a lot of family. Many hands make light work and there is no heavier work than grieving. I just wish they wouldn’t pray so loud, it’s making my ears bleed.

MRI naps

The subject today is MRI. I have a few problems with MRIs.

1. Why does it take so damn long?
I guess I just got used to instant results. I love being able to run my own ABGs. I love seeing the change in peak pressure when I put someone in PRVC. I love the sound a patient makes when I do a sternal rub. I'm a instant results kind of guy. I do not love setting in a wheelchair for over an hour trying to find a dance-able beat to the loud MRI machine. Don't get me wrong. I am glad that Downhill Medical Center has the facilities to give the MD exactly the picture they want, I just wish that I didn't have to set in there while it is happening. My ADHD does not approve of me staying in one place for that long. Hell, my ADHD barely allows me to sleep. TGFB!

2. Why is it so damn loud?
I drive a economy car. It gets 35 mpg. It cost $7,500 slightly used about a year ago. It has a muffler. By contrast, according to Wikipedia (it must be true!) "New 1.5 Tesla scanners often cost between $1,000,000 USD and $1,500,000 USD. New 3.0 Tesla scanners often cost between $2,000,000 and $2,300,000 USD." So what? Can't they put an muffler on it. Come to think of it the tech looked like Vin Diesel. Maybe he put one of those "fast and furious" exhaust systems on it. Which brings us back to # 1. Seriously, my ADHD was screaming.

3. Why do I always lose my pen?
When I empty my pockets some shit-bird always steals my pen. At least they leave my wallet.

On to more important things. I've been trying to come up with interesting ways to squeeze the bag during the MRI. I've tried the right handed and left handed power pump and the amazing two handed human ventilator. After my hands tired I did the funky chicken with the bag under each arm. When my wings gave out I tried the official Suzanne Somers thigh master technique. I was just getting bored enough to start the stomp the ambu bag when the door swung open and Vin told me I didn't have to go to ICU but I couldn't stay there.

It could have been worse. There's nothing like a good MRI nap. One hour where you don't have to do anything but breathe for one patient. Your mind tends to wander and you find yourself coming up with stupid names for your bagging technique.

I take it all back, I love MRIs.

RT

Protocols

Who's got them? I know that as a fledgling therapist I have come into the business at a time when the protocols are already written. The old-schoolers have fought for the respect needed to allow us to change Granny's nebs to while awake so we don't have to wake up a sleeping COPDer. They bravely stood up to the docs and said,"We can be trusted not to mess it up too badly!" So what have us kids done?

What I mean is this. I work in a hospital with world class protocols. I can order or change any respiratory med. Unless the doc opts out I can change orders for CPT. If I get called to a patient's room I can can stick them for a ABG, start a neb, order a chest X-ray, interpret the film and blood and call the doc with my recommendations. Many times my recommendations are for lasix, narcan or ativan.

Where is the push to open up our protocols further? Respiratory therapists are able to give these and many other meds. We are able to decompress tension pneumos and insert emergency cricothyrotomies. In fact RTs in my state working in transport can do some pretty amazing things including intraosseous placement and ej placement. They advance the practice of respiratory care.

This is your call to arms. What can you do to advance the practice of respiratory care? How can you prove to the docs that we can't screw it up too bad. If for no other reason do it to piss off that really lazy guy in your department. He'll get called that much more often.

Back by popular demand

Well...one person mentioned me briefly. I promise to try for at least a weekly post in the future.

I've been settling into my job at Downhill Medical Center and Resort for the Undead. It's been a transition that I wasn't ready for.

Don't get me wrong, I love the autonomy that we have here. My problem is that we have a large university medical center down the road from us. So while they get all of the stabbings, shootings, MVAs, ecmo babies, blunt force trauma, general trauma, heart transplants and "Hey ya'll, watch this" stunts we get the leftovers. I would say that octogenerians, ODs and belly surgeries gone horribly arwy makes up 80% of our vent business. In fact, it's so bad we have a long-term care facility within our hospital so they don't have to take a long bumpy ambulance ride to the vent farm.

I am by no means complaining. I love my job and wouldn't trade it. However there are times when I would love to see a good trauma roll in the door. You don't know what you will miss until you give it up.

Respiratory Terrorist

People love me here, even though I can be an asshole.

Hard to sleep

I promise this is mostly related to the practice of respiratory care, and here's how.

Respiratory care also encompasses sleep medicine.

A diagnosis that may be arrived at during a sleep study is Restless Leg Syndrome.

RLS may be treated by Mirapex .

Mirapex may cause uncontrollable urges to gamble and have sex.

So I was delivering quality respiratory care the other night when a commercial for Mirapex came on. I was checking my vent and only half paying attention to what was on the TV. My attention was caught by a voice saying something to the effect of "... talk to your doctor if you have uncontrollable urges to gamble or have intercourse..."

HUH? I asked my patient, "Did that say what I think it said?"

Damn Diprivan.

So two days later I'm setting on the couch with my lovely wife speaking of things of great consequence. On pops the Mirapex commercial. I quickly hush her (bad idea) and intently watch the commercial. There it is! They actually said that this drug may cause increased urges for sex. Now, having just hushed my wife (and knowing I could look forward to a dry spell) I was wondering how I could make this information work for me.

Upon further research, I found that there is a class action lawsuit (big surprise) to benefit the people who have been hurt by Mirapex. I also found that this medication could cause sleeplessness. I guess so. If you're up all night tending to your pleasure/reward-seeking activities there is little time for sleep. Obsessive eating, gambling, shopping, and scrogging are not condusive to a restful night's sleep. I feel that I personally have been caused emotional distress by them and would be happy to settle out of court for free samples. I wonder if they will dissolve in my wife's next cocktail? Bwhahahaha.

RT

Bodies

So Body Works is in my town and I really want to go see it. I really think it would be interesting to see the human body in this way. My wife on the other hand thinks it's morbid and defiantly something she can miss. Now, in the course of my short professional life I've seen most of the important internal organs right up close. Why would I want to see more dead people? It's like a CPA going home and doing their taxes. What do you think doing these jobs do to us. Does it desensitize us to the point where we can say, "It's just another dead body?" What does that say for humans, or individuals? Sorry I'm being like this, I almost got in a fight today and that always makes me wax philosophical.

http://www.bodyworlds.com/en.html

RT