Thursday, April 28, 2011

I have not disappeared.

You deserve to know how my last day in the hospital went.

First I was dealing with an intoxicated woman who I extubated in the morning. Second I was dealing with an intubated preemie. Not what I envisioned for the last day.

I was kept busy running between the NICU and ICU - and kept afloat with the promise I would be able to leave at 1.

Success - we extubated the baby. Now only to clean the vent and I wouldn't have to deal with that part of the hospital ever again. Ever tried pushing a Babylog down the hall? It's a little top heavy. I hit a bump and the vent did a faceplant. I was kind of in shock, said a few choice words, and then looked around to see who was watching. No one around. I struggled to get the vent back into a vertical position and survey the damage. It wasn't good. The entire front was smashed, and hanging a little off center. Eventually I worked up the nerve to push it downstairs and own up to the damage. Biomed says there is a 50% chance the vent will make a full recovery. I told them to take it off my pay.

Finally I stopped in to check on my extubated lady. She was not too impressed with me. I was just trying to encourage her to breathe deeply and cough, you know, to prevent being intubated again. Crazy me! Her response - "F*** you. You F**king B**ch. I am going to F**king kill you." Yikes. I looked at her restraints, they seemed to be in good shape. I looked at my watch - 1:05. I wished the nurse good luck and didn't look back.

So that was that. The end of my practicum year. Just like that.

We went to Hawaii for the weekend - which was fully amazing, and I want to live there. And now I am packing because I am moving.

Start date of work is May 9th. New adventures to be had! I plan on keeping the blog and updating it frequently. If I had adventures while fully supervised, just imagine how crazy it will be when they let me out on my own!

I will continue to be a Peon of Respiratory Therapy.

Wednesday, April 20, 2011

Just another day.

I had a lovely weekend in the ICU. It wasn't too busy, which was nice because I am winding down (which is ridiculous and dumb - because I should be winding up).

At some point a lady in full renal failure needed to be intubated. I fully volunteered which was crazy and amazing. Unfortunately I accidentally stabbed myself in the eye with the ET tube. The end with the cuff. No one knows how it happened. And the tube went in the patient anyway - first try, great view. It was a total rush and I felt invincible. This is likely going to be the first and last time I ever intubate in an ICU, since the hospital I will be working at doesn't let RTs intubate. And then I tried an artline (which I couldn't get, and neither could anyone else) and I was glad to try because... the hospital I will be working at doesn't allow RTs to do artlines. Damn residents having all of the fun. BOO.

Then. we were called to a code. A patient that I had been watching deteriorate all day. Not to worry - the Dr had also been watching the patient deteriorate all day - it's not like I was being negligent. We did CPR for about 20 minutes. I got into a semi-argument with my preceptor about when to give breaths. Per ACLS, once an advanced airway is in place you are just to give breaths every 5-6 seconds. Per my preceptor every thirty seconds give 2 breaths. Even the Dr called him on it but it was still awkward and weird. And irritating.

One shift left tomorrow. One free shift ever. Ever.

Saturday, April 16, 2011

Finish Line

First of all I would like to give a huge shout out to my classmate who is running the Boston Marathon on Monday. You are awesome and I am so glad that we met at RT school.  Isn't it surprising where life leads you and the people you meet and who becomes your close friends.

I am reaching my own finish line. I have 5 (possibly 3!? depending on how the hours are added up) shifts left and that seems completely unbelievable. I remember my first days at the hospital - they can basically be summed up like this:

  • set up the ventilator? right now? like a patient needs it? OMG.
  • you want me to an ABG on this totally stable patient? (freaking out)
  • assist the intubation? Like someone has the laryngoscope already in some dudes mouth and is my job to get the tube ready or bag them up? OMG OMG OMG
  • Trach care - don't even get me started on trach care. Does this hurt? Can you talk? Are you not talking because you have a trach in or are you brain damaged?
  • Lactate of 17? WTF.
Ok so basically anything freaked me out. Assess the patient? No way. BiPap = Scary. Basically the only thing that I have ever really truly felt comfortable doing from the beginning was suctioning.

I always felt a little less mentally prepared than many of my classmates for the hospital setting. I know many of them barged into the hospital armed with all of their knowledge and skills from the many competencies we were subjected with at school. They seemed to have no fear, which was ok because I had more than enough fear for everyone.

I think I have finally outgrown this. After a 3 month hiatus from the ICU (due to Children's Hospital, PFT lab, Sleep Lab, and home care) I have returned with my skills intact. I spet the past two days in the ICU effectively alone. And it was fine. I managed the vents, and took care of the problems. It was totally fine. Granted nothing crazy happened, but I felt totally prepared, like if something crazy happened I would know what to do. I know all the steps. I know how to prepare for an intubation. I know how to set up and insert an artline. I can do the things that are required of me in a calm and calculated manner. 

Well I guess one less than optimal thing happened. But it wasn't my fault. I assisted a bronch on an elderly gentleman with a trach. It was absolutely the most swollen, irritated lungs I have ever seen. Mostly the bronch went ok, even though I forgot to hook up the suction and also it was being performed by a resident. After the bronch, however, my patient proceeded to cough up frank blood all effing day. He had blood all over himself, and then he would desat to the 50's and then I would suction thick and clotted plugs out of his lungs, and his sats would improved. At one point he gestured me into his room. He wrote this on his note pad - "please call the Dr. - I am ready to die." He was still alive when I left the hospital. Apparently the last thing he wrote on his notepad was - "I am packing it in." And he was dead by 10 pm. Unbelievable.

Also another one of my patients passed away. Actually 2 of them. That's always a little depressing, but expected. 

Today was really quiet, but had a disproportionately high amount of ABGs. I think I did 10 today. I got every single one of them - even the lady who had a BP of 60/30. She had two pokes - and both of them were completely by landmark because I could not feel a pulse at all. Skilled - right here.

Addendum: You know what won't help heart failure? Ventolin. For the love of god stop paging me and just give your patient some Lasix.

Thursday, April 14, 2011

World's Oldest Man Dies

Oh wow - I can't even imagine living this long. Good for him!!



http://www.theglobeandmail.com/news/world/americas/worlds-oldest-man-dies-in-montana-at-114/article1986262/

Big test = Good bye school.

So I have written the last test I will write at school. I am done. For better or worse :)

There were so many questions on this test that I never would have known the answer to because I never would have studied it. For example:

What is the shape of Klebsiella. (RODS for the love of god the answer is rods)

Also - if there is a question about protease/anti protease - the answer is lung disease. Honestly that is all I can remember now - a 6 hour test, in two parts - and that is all of my memories! There were some really tricky case studies, in which I actually had no idea what was wrong with the patient. Like that ever happens in real life :P

And then after we all went out for a beer! I have 7 shifts left and then I will be back at home full time and I can't wait. I am so excited and so nervous to start my new job as a casual RT at the hospital! Mostly I am excited to get some new scrubs - that are not red.

Taken at my favorite beer drinking location - Post Exam

Monday, April 11, 2011

Rewards

Once again I have been rewarded for my terrible school habits. My paper/poster - this one here - is finally marked. I got a really fantastic mark on it, thus reinforcing my terrible behavior and ensuring that I will continue to procrastinate long into the future.

New challenge? Studying for a 3 year cumulative exam which take place tomorrow. Blerg.

Stolen from an article somewhere:

Live in rooms full of light
Avoid heavy food
Be moderate in the drinking of wine
Take massage, baths, exercise, and gymnastics
Fight insomnia with gentle rocking or the sound of running water
Change surroundings and take long journeys
Strictly avoid frightening ideas
Indulge in cheerful conversation and amusements
Listen to music



Aulus Cornelius Celsus (c. 25 B.C.-c. 50)





Saturday, April 9, 2011

The Walk in Clinic.

I have been sick for weeks now. I thought it was strep throat, and then it turned into a head cold. And then it turned into what I was sure was a sinus infection. I have spent way too much money on remedies that google suggested I have. The best one being:


with a close second being my sickness fallback:


Nyquil and I have a very close and dangerous relationship spanning many years. I used to use it just to fall asleep - but now I reserve it specifically for nasty, nasal clogging illnesses. This sickness alone I drained an entire bottle. 

Anyway - after weeks of illness, and sleeping in for work twice (thank god for the most patient home care boss I have ever met. Well I have only met one - but this one is really nice) I finally found time to drag myself to a walk in clinic. 

I gave the lady my information. And I waited. and waited. All told I only was there for 2 hours - which is a roaring success as far as I am concerned.

While I was waiting, the girl next to me suddenly divulged that she just needed 2 stitches removed. She had tried to do it herself, but just couldn't figure it out. I was like - SERIOUSLY? Come here, I can take out your stupid stitches. But lucky for both of us, she got in next.

Then. An asthmatic came and sat down next to me. She took her newly obtained symbicort (i could tell because it was red) out of the bag and tried to use it. It was a disaster. She didn't know anything about it! So what could I do but teach her everything I know about symbicort. I told  her how you have to twist the bottom of the turbuhaler until you hear a click, inhale deeply and hold. She was surprised that I knew this. 
I told her I was a respiratory therapist. This is only a half-lie, I am nearly really a respiratory therapist!! Then I told her about how she should rinse her mouth or she would get thrush - and then she was really impressed with this medicine that some doctor in the ER had prescribed. 

I felt pretty good about having performed my good deed for the day. Little did I know I was about to be punished.

For the next 30 minutes the asthmatic lady went on and on about living in New York City, and driving in the Holland tunnel, and throwing money at the toll booth, and getting out of your car in the tunnel to talk to people you knew during rush hour traffic. I didn't buy this at all - "You knew people in the tunnel? I bet that didn't happen very often." She assured me it did, but then she qualified by saying it might just be people you recognized from prior times in the tunnel. 

And on.
And on.

And thank god I got called to see the Dr. next. 

Tuesday, April 5, 2011

You haven't seen anything until....

A diabetic came into the ER. He was suicidal and had try to kill himself by taking too much insulin. It didn't work. As a rule, I don't think that is the quickest, most effective way to put an end to your suffering. Unless you would like some more suffering, in the form of hospital treatments. He was given tons of dextrose. He was mostly fine, albeit a little cranky and uncomfortable.

And oh yes. He cut off his own toes. Not all of them, just the second toe on each foot. Clean off. I'm guessing there must have been some infection or gangrene to those toes and got sick of looking at it. It was very bizarre and disturbing. For me. But at least he was protecting his airway. And I was still sick, so I went back to the break room and waited for something else to happen. It never did.

So now I'm into my home care rotation. I LOVE home care. I love visiting people in their homes, and seeing them in the office to fit them with a CPAP mask or help them with any other concerns they may have. I have three more days of that.

Then I have to get down to some serious studying for our final. There's a lot I've learned over the past 3 years that seems to escape me at precisely the moment that I could use it the most!

The thing that seems to have the most trouble sticking in my mind is Gas Laws. I am terrible at them, and get them wrong on every test. Every one.

I found this good resource for brushing up on them - Chemtutor Gas Laws. Enjoy :)

Saturday, April 2, 2011

Still Sick.

I am still sick. In fact I had to call in sick today - which is not good news. With only one month left of practicum I am increasingly worried about getting all of my hours in. As it stands right now (based on calculations in my own spreadsheet *nerd*) I can afford to miss exactly 0 more hours of work. This is assuming I get 8 hours of credit for our final exam. I'm not sure if we do, and I may actually be in the negative. In which case I'll have to pull some double shifts or something. Dear god. I'm suddenly regretting missing 2 of my PFT shifts.

Oh well, nothing I can do about that today - from the couch. So instead I'm working on my last homework assignment and watching Mystery Diagnosis on TV. I like to try and diagnosis the patient before the TV show does. I'm successful about 25% of the time - usually when there is some sort of Respiratory connection. I was right on top of Methemogoblinemia and also Alpha 1-antitrypsin. Recently on Untold Stories of the E.R. I heard them shout, "Where's the RT?" So that made my day. Kind of like when Canada is mentioned on an American TV show.

And sometimes when I have some down time I like to read things on the internets. One thing I found that caught my eye was this article - How to Have Hobbies in College. As years have gone by I find that I have no hobbies. All I do is study, and do work (bookkeeping) and when I am not doing either of those I am spending my time in a way that can't really be defined (sleeping, talking, eating, watching tv). Recently someone asked me what I liked to do for fun.... and I couldn't answer. How embarrassing. Honestly I think I enjoy just doing nothing. But for those of you who would like to have better time management in order to fit in some fun, the article lays out a good plan.

Cough cough sniffle.