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.