Chapter 2

       The MICU is an U shaped unit. It has two doors as the tops of each U, one negative pressure room, two closed/private rooms, and the rest are open air beds seperated by just a curtain. This gives the caretaker ample viewing of each patient but it decreases privacy of the patient families. I see the positive of both but prefer the private room method. I can do without seeing all patients for the privacy of a family that has a loved in such a horrible place. It really is horrible. Death happens here, more than we admit. I prefer to do my work in private as well, I will tolerate family watching and talking but strangers I will not tolerate. As the head of the unit is a long desk where the unit secretary and charge nurse hold reign. Behind that is the medication dispenser and my little  hole. My spot includes a computer that allows us RRT's to chart what we do, this is the only PC in unit we have. That is basically it, a desk with a few drawers full of respiratory stuff and a computer.

      I always start at room one no matter where I am working. It just my thing. As I prepared to enter one of two private rooms I glanced around the unit. Ten vents is not that bad could be 11. "Hello, how are you today? I'm Alice the nurse for rooms one and two." she said. I was caught off guard. After all I was looking around the unit as I entered. " Hey. I'm Ben. I am the RRT for the unit today." I'm sure my face showed my surprise but I tried to act cool. "Any plans for these two I need to know?" I asked. Alice replied, "I was about to ask the same question. To answer your question, we may want to try a spontaneous breathing trial (SBT) on this fellow here but bed two is sitting tight." Little did she know, I knew even less than here. My predecessor was sleepy and grumpy. Plus I'm not sure they like me very much, a little hazing for the new guy. "Sounds about like what I got." Was all I said and set off to work. I gave the patient a quick once over. He has COPD, emphysema to be exact. His vent settings were minor and I was fairly sure he could be weaned and extubated today. Extubated means removing the breathing tube keeping him tethered to the ventilator. A fairly easy procedure in my mind. Intubation is harder, that's putting the tube into the patients airway and attaching to the ventilator for life support. I wrote down his settings, suctioned out his airway and ET tube(breathing tube), gave him a couple puffs of albuterol and set out on my way.

    Doing my rounds on the other nine patients was much the same, introductions, plans for the day, and doing the work as I call it.  I charted and took a break. I walked into the break room to find Justin and Dave the other RRT's on the floor already on break. An over head PA systems calls us if things get dicey while we are away. The break room is basically is square. It is a touch bigger than a jail cell but does have an exit to an outdoor patio. This is frequented by the smokers of the hospital and those wanting to eat lunch outside on nice days. It also great for stepping out and getting a shot of air if no one else is there to interrupt. "Hey Ben" they said as I walked in. "Whats the word fellas" I replied. "How are the other units?" "SICU has nothing except one vent and maybe a kidney transplant coming later." Justin said. "Med-surg has 5 vents and some odds and ends. Nothing major as of now." That was Dave. The most experienced of us all. He spent most of his career in Kentucky but traveled here after.... well I'm not sure why. Justin on the other had went to the local community college and graduated one year before me but still had 3 months less than me here at Winston Med as most call it.
No one asked so I just started, " I've got 10 vents for now. Think I will extubate one in a few but I have one AIDS patient. He looks like trouble. His peaks are high and his lungs are full of junk. His head CT showed the AIDS was basically rotting his brain. He maybe trouble for me later." Dave asked, "PCP pneumonia?" "Gots to be." said Justin. I just nodded. Last one in and first one out as I heard my name called overhead. "Ben to MICU. Ben to MICU." I always wondered how they managed to get such a generic sound when they called over head. This is the south. Some drawl is to be expected but man they hide it well when they hit the mic.

    PCP pneumonia is caused by a yeast like fungus in the lungs. This fungus has some specialized group name that I will spare you, just know all have it the lungs. It takes a weakened immune system to fester into a deadly infection. It is an opportunistic infection that mainly feasts on cancer and AIDS patients. Nasty bug plain and simple.

   I swiped my badge and entered the unit. "The doctors want you at bed one" said someone as I walked toward my desk. I had no idea who said it or where they were but I just kept on walking and entered the room. "What do you think of extubating Mr. Davis? I believe it should be done and should have been carried out before we ever got here!" he said with a slight neck vein bulge.  That is Dr. Wang. A well respected Pulmonologist who has the ability to get angry fast but it extremely smart. That is a fancy word for respiratory doctor. I basically know as much a pulmonology fellow at the begin but after the research years they surpass the knowledge needed for a RRT. A fellow is a doctor that has done residency and can become general MD but choose to further their education to become a specialist. I was caught off guard and in the cross fire of an angry man who could ruin anyone at this hospital with words. So I just man upped and said, " Let's do it know. I'll collect the proper oxygen equipment and have him off the vent within the half hour. I am not sure why this was postponed but I have no problem doing." I noticed Alice at the corner of the bed smiling. Dr. Wang simply said, " Make it happen. Extubate to 40% face shield is already written." I signed the order in the chart to show I'd read it, I glanced back at last nights orders for fun. No order written for extubation. That was his answer. We just don't extubate folks cause they look like it will work. The MD must write it and we then do it. You know laws and what-not really get in the way of progress but protect people from dying. As I walked off to gather the face shield which is exactly what it sounds like, a shield looking mask that sits on the face to deliver oxygen, I thought of his comment. "Make it happen." Who does he think he is Captain Kirk or worse Captain Picard." Man I shoulda been a weatherman.  "

Chapter 1

           Hello, my name is Ben. The last name isn't important, people have never been able to read or pronounce it. I am a new college graduate and now a Registered Respiratory Therapist, RRT for short, today I start taking care of patients on my own. Since the humid North Carolina summer I have been on orientation. Finally the weather has changed. Fall is the air. I love these crisp western Carolina mornings, man I shoulda been a weather man. 
        Back to the topic at hand,my job. I work at Winston Salem Medical Center. Off orientation and on my own, I will now get to show what I've got. I am not sure proving myself should be my top priority but its pretty high on the list. My job is take care of the breathing issues of a high array of patients. Emergency room duty all the way palliative care, fancy way of saying from in the door to death. Keeping all airways open and people alive should be my top priority.
         Driving to work is easy during a mental monologue. As I approach the time clock I see several people, I am awful with names. They all know me but I kinda know them. I've always thought its easier to learn the new guys name than for the new guy to learn everyone's name. "Hey Ben. How was the weekend?" says Ron. Ron is my boss. He has known my family since I was in the womb. My mom is a nursing supervisor on nights for the Burn Unit. "Ron! Oh it was great I watched football all weekend and went to church. Ate out on Sunday night. You?" I replied. "Thats good. What games did you watch?"He asked. Football talk, love it. Man cannot live on bread alone but ESPN differs on sports. " I watched Wake Forest on Saturday, Panthers vs. Jets, and the Steelers game." From the back of the room someone piped up " That Steelers game was intense." That ended our conversation. 
        After a few more pleasant hellos I received my assignment. I scan for my name, then BAM! Ben-MICU, thats the medical ICU. "Trial by fire."I said. Most laughed knowing I am fresh off orientation and that MICU is the roughest unit most all year. I admit nerves set in but I would never show it. See most of these folks thought I was a rough and tumble RRT veteran when I first arrived here. I finally let the cat out of the bag about mid summer. My first tractor roll over victim reminded me that the patient comes first and to let my pride take a backseat.
           I rolled into the unit at 0645. Report began at 0646, I got the feeling this guy wanted out. 10 ventilated patients, 1 empty bed, possibly 2 CT scan transports and a Hodgepodge of diseases. I set at our desk for a few minutes to collect my plan of attack. I wondered if I should say a quick prayer like Donna always does before a shift. Donna was my training therapist/mentor. I'm a weak christian and i know it so I just gathered my tool, I call my stethoscope my tool, and set out to work.

Happy (belated) Easter

Well that's over. The Holy week is over as is the season. I gave up soda for lent. It was hard, well towards the end it was, I could taste the sweet cherry flavor of my fave cherry Coke. I did manage to teach the child the story of Easter and the last week of Jesus' life. The preachers jaw dropped when my 4.5 year old knew the answers to her Easter questions. Proud papa moment.

Faith is an interesting thing. Faith of a child is needed most times. Our old pastor has this in spades. She does many things without planning or any follow through afterward, faith of a child. She just thinks the stuff will happen. It varies from ordering Easter flowers to shipping hand made dresses to 3rd world countries. The ladies of the church pick up the slack and things get done. I often wonder, is that God working or just lazy and stressed people working to make one functioning person? 

As I get older I think I see things happen and just know that was Gods work. Then times I'm like what's going here? How can this stuff happen? I wonder if the new Pope gets interviewed and asked stuff like that. "Cardinal Smith tell me 3 ways you've seen God work and 2 ways that have made you go huh?" Catholic is the basis of the Christian church. We all have oaths and other mantras that mention them in most denominations. This pope thing was big stuff. Well my 1 Catholic friend told me it was. Either Rome or Israel own all the cool bible stuff and on each big holiday they parade them around. Jesus' burial shroud was in Rome on Good Friday (I think that was the day). I'm sure the Jews have the Arc of the covenant and make every Nazi war criminal glare into it at some point. Indiana Jones reference hope you get it.

So whats the point of all this? I have none. To read my blog requires faith like a child. What will this weirdo say next, how is his body trying to kill him now, what cool rock song will he show this time. Who knows? 
Peace and Love,
Ben

The Hospital Blues

Since when do hospitals call and ask for money? That shiny beacon of health in Winston on Hawthorne Hill as they call it is now soliciting. The audacity! Calling former patients for donations because your care was so stellar.  Do they call families of the unfortunate souls who did make it out of the hospital? What is next, calling former employees? The same employees the stiffed for numerous years to hit the bottom line? That place deserves the sour name it has now gotten in the NC triad. I asked a guy at church a few weeks ago what his job at the beacon was, he honestly looked frightened. Like I was gonna gun him down or hit him in the Sunday school hallway. Health care is failing in America. This place is an example of how, tens upon tens of VP's getting fat checks and bonuses. Paying millions to bring in a new CEO, just to bring him in from Texas. His salary is added to that hush hush bonus. The allied health workers lived in fear for 2 years while all this transpired. X-ray techs got canned, nurses hours got cut, nurses got canned or reassigned, respiratory therapists got canned and had schedules/hours "trimmed". Fancy focus groups formed to lead us into a new golden age. Plus no raises for 3 cycles! Pay freezes and hiring freezes are not the new golden age. Yes the depression was at full force during this time period but as stated above the VP's did not seem to mind. I forgot to mention doctors were purged. The best ones, the ones with demands and great ideas, fired. Some without even being told, he had to read his job ad online. I left to find a place I'd be appreciated and paid for my input and ideas. Surprisingly just a few miles away this problem did not exist. I was shown just how poorly that hospital was run. I do not miss that place, I do not regret leaving, I do feel sorry for my friends employed there. I do hope one day they call and ask me for money or a review of their services/reputation. Any medical center that goes from having 10 specialties in the top 25 in The US world news hospital report to having 2 in the top 50  within a year is in deep trouble.

Hospitals are today's factories. In the days of our grandparents a HS diploma would get a job at a local factory making something for a honest wage, a livable wage. Today a HS diploma gets you a PT job at Sheetz for minimum wage and you may have to drive 25 miles round trip to get there at $3.75 a gallon. Money gone! For 3 years at a community college anyone with a C average can become some form of healthcare worker. Now yes it is harder than that to get in most programs, but if you look hard enough you will become something. Most jobs at a hospital start out at near $17 an hour in this state. Most can just be a warm body at said job, do the minimum, don't screw up and get that honest wage. To me this is wrong. Just another example of how America is broken. Working at any allied health job should be a privilege not just a pay check. How do we fix the American work force? I do not know but I know that a job at a hospital should not be the only job in town that pays you well(unless you work in Winston Salem at the trauma center). 

This may or may not make any sense to anyone, I just had to spill it all out. I have been pondering this for awhile and needed to say it. If you get it, good. If you don't, then its just the ramblings of a disabled former healthcare worker.

This song should sum up the American dream

sneak peak

Hello readers. I have 2 posts i am currently writing in my wandering mind. One is about the evil empire on hawthorne hill here in Winston Salem and the other is on faith. However, I am flaring right now and don't feel like doing anything other than breathing. I am in immense pain and its not getting better. This may take awhile to work its course. I have 12 days until Easter and hope to be better by then, we will see.

Drown

Sorry folks! I've been in no mood for blogging. The end of winter has me in the dumps. I am ready to move onto summer. I am also trying to overcome phase 1 of disability acceptance. I am stuck in denial/isolation. I so try and move past it but it just drags me back down each cold day.

I have had a few interesting social media debates these past weeks. One was on medical spending and its place in economy downfall. It was had between myself, a ECMO attending, and another Respiratory therapist. The doctor sided with big business but offered a great debate. We RRT's sided with the regular joe. The hospital bills are just one great atrocity, the pay of certain staff and underpay of others is part two. I feel that PharmD , Pharmacists, are way over paid and CNA's , nurse aides, are under paid. The education between these 2 jobs is great but $8 an hour for the hardest job in a hospital is too low. over 100k a year is too high, some make up to $100 an hour at your local CVS, to count pills most of the day. Yes they do more than that but you will never see one lay hands on a patient, provide any life saving service, or generally leave the pharmacy of the hospital. France has a great medical system in place. Cuba does too, oh no I sided with the reds and the frogs!!!!! In the mid to late 2000's an anesthesia doctor made about 90k a year in France and lived as well as anyone would ever need. In USA they get at least 20k more a year. Why? Ask the government. Medical overhaul is a good thing. Getting peoples salaries under control is just a small part. Am I saying pay doctors like a person with just 4 years of education? NO! We have eliminated the middle class by allowing doctors and VP's of banks,hospitals, and big business to get raises while we the average American maintain on the same amount we had in 2008. It was great debate and we each made points that made the other kinda say thats right. It ended in a stalemate.

The other was about the great evil. ABORTION!!!!! This was a twitter war. Fanatical Christians ruin the Christian name. People slam Planned Parenthood like its a Nazi death camp. They do abortions, yes. Would I want my wife to have one? No. Would I tell her what to do with her body ever? No. Would I as a man try and ever tell any woman what to do with their bodies? No. I am secure enough in my religion and masculinity to admit those things. PP* does many things and abortion is just 3% of those things. Cancer screens, STD treatments, and basic health care for poor all rank higher on the pie chart than the the A word. People don't care! They see one thing and focus all the hate on it. I debated with a progressive tone and my enemy surrendered.

I hope to to get my ideas out more via this blog. I stated 2 posts ago that I was now going for quality and quantity. This will maintain but I hope to blog more than every 3 weeks. Until next time....

Social Distortion

I started Twitter this week. I have enjoyed it. I have also be banned twice in a week. Aggressive following, whatever that is. I have a learning curve and they do not allow such things. My cognition is off a bit and while I learn the ropes of this media source I keep getting nagged and booted. I don't get it! AHHHH whatever! Who needs it? 

Happy note my Deacs beat the #2 ranked team today. AWESOME!