management - got to love 'em ... or laugh at 'em

So about nine months ago we were told two things in staff meeting.

#1 Everybody is working mandatory overtime and we are not paying as much for it as we used too

and

#2 oh, and here is a survey the corporation would like you to fill out concerning our management style.

Now you would think they would separate these two things by, say, a month or two. But our management does not necessarily see the connection of things. Needles to say our department came in rock bottom of the whole damn corporation. Rock bottom.

Einsteins that they are decided the problem was that we, as therapists, didn't feel recognized enough. So how to solve this? Of course! Send out another survey.

Low and behold in my box this morning is the survey. The very first question is something like "what does recognition look like to you?"
I put down, "a really big banner, a 14 and1/2 inch trophy, confetti, and possibly a parade."

Hope it puts an end to idiot surveys. Yeah - I know - wishful thinking.

I hate my job.

Okay not really the job. I hate this hospital and all the f%$#$% PA's who think they are God and don't want to listen to a damn thing any of us have to say.

So here's the scenario. Big freaking fat guy. 400 pounds. (Okay I exaggerate he's only 395). We have to do a lumbar puncture and the PA wants him prone. I strongly suggest that's a bad idea. PA argues with me. I say, "What I'm telling you is he is a big guy and he can't breath proned". I am totally ignored. So we prone the guy. Yeah I know damn stupid of us. I know better. Within seconds dudes blood pressure is 200 over something - he's tachying along at 160, spo2 67 and cyanotic as hell. PA wants to "give him a minute". RN says we have to flip him now! We overrule the PA because how you going to run a code on a prone guy????????

He did recover. But man it pissed me off so bad. I knew it was a bad idea. I told him it was a bad idea. Rn agreed it was a bad idea but no- stupid ass PA has to play big shot and damn near coded this guy.

I hate this job.

My brother loves these hunting / fishing shows. He watches them for hours. I think I could watch them if they were more like this guy....


www.youtube.com/watch?v=KUowyTE-X10

funny stuff this.

still not in Kansas

Weird. Still out of my comfort zone. Getting more comfortable though. Still in the Trauma unit. Weird. so many people WANT to work in this unit. They see it as th pinnacle of their career. Okay maybe flying on the chopper is a smidge higher - and they get cool uniforms. But for most folks working the Trauma unit means you have arrived.
Me. I just don't care. You can have the trauma unit. WAAAAYYY to many egos for my taste. And Heaven forbid a doc actually writes an order in the chart. They discuss things amongst themselves, sometimes letting the nursing staff in on whats going on.... sometimes not. And if I'm lucky - I catch wind of it. I asked someone about this odd thing about not writing orders. I was told trauma surgeons are "too busy to write orders".

Reminds me of a joke. What's the difference between a doctor and god? God doesn't think he's a doctor.

Were not in Kansas anymore....

Well I was pulled from my usual comfortable routine and sent to the trauma unit. Not usually a big deal. But today was travel day. Let me correct that... travel without any notice day. I walk into my first room for my first vent check and the there is an anesthesiologist, a transport tech and several other people. I know I'm going to look dumb but still I had to ask, "Are we going some where?". "yes the OR... now" Okay, okay I stuff my pockets full of all the crap I might ever possibly need and off we go. I leave them in the OR and come back to the unit. Walk through the doors and a nurse assails me, "Are your ready?" Me (looking dumb yet again) "Er, ready for what?" "We are taking bed four to the cath lab... now" Damn. Lucky though, I still have pockets full of all crap I may need. I never really get caught up... but you know eventually you get so behind your on schedule again! The afternoon was a repeat performance. Another transport ... which I actually got told about. And then I am doing my vent check and two nurses are talking "... and when you get back we will..." One more time I look dumb, "Are we going somewhere? " "Yes, CT ... now". You know I should have just walked out and not said a word and when they were ready to roll out the door and realized the guy is connected to a ventilator THEN maybe they would think about giving the RT a heads up!!

But then again. They might not have noticed and extubated the guy.

What do you need ....a banner that says hey I'm dead!!!

So after three apnea tests (all verifying brain death), the cholinergic tests (all verifying brain death), several eeg's (all verifying for brain death) the doc refuses to declare the patient brain dead becasue he may or may not have seen some minute possible, (most likely imagined) millimeter of eye movement. No shit. So we keep the dead guy alive on a vent, all the while giving the wife false hope, and at the same time maxing out her Visa.

We here in Neuro icky u hate this. We begin to hate the paitent. We totally hate the doc. And no one has the balls to over rule the doc and walk in to the wife and say "dammit, man's dead - pull the frggin' plug." For twenty seven days we play this hellish game - only to finally transfer him today to a long term care unit. Can you believe that?

Wht the hell does the doc need to verify brain death??? A friggin banner over the guys head? Does he need the patients ghost to come tap him on the shoulder? Does God himself need to come down and tell him to knock it off?

And what is really chilling is this is a new doc, now working in Neuro a lot (where, by the way there is a LOT of death and end of life decision making) - and apparantly a psycho doc who has end of life issues . God help all his patients from now on.

What happened to personal responsibility?

I was watching a tv the other night. Some documentary on how the health care system fails the "average person". They showed this man ... this whale of a man - 450 pounds I think they said. He was uninsurable (they didn't say why he was uninsurable, just suggested that the wicked evil no good greedy insurance companies wouldn't insure him.) He had diabetes, a bad heart, cellulitis, gangrene in his foot, hypertension, and every other malady that comes along with morbid obesity. My question is this? Why the hell is he 450 pounds and whose fault is that? If he chose to be 450 pounds (which apparently he did) then isn't his health his problem? Why should insurance companies insure you if you have a lifestyle that will inevitably cost them money? And who ultimately pays for that? You and I jack - in one form or another. Either we pay higher premiums to compensate or higher taxes for federally subsidized programs

I had a patient bragging about how good her health insurance is. "They paid for my glasses, They paid to get all my teeth fixed. I only pay 3 bucks for a prescription and only a max of twenty bucks a year. I don't pay nothing for the emergency room or the hospital...." Perplexed I say "wow - what insurance do you have?" She replies "I'm on Medicaid!" I had to bite my tongue because I wanted to scream. So because she has smoked like a chimney and now has advanced COPD at the ripe old age of 40, she is on disability (which we pay for), she gets to sit at home and smoke more while I work my ass off, and they ravage my check to pay for her health insurance to pay for her health problems that SHE caused AND I pay a shitload for my own health care insurance AND she gets better benefits than I do!!!

That is what's wrong with government running health care.

There is no responsibility factor. There is absolutely no incentive to work, stay healthy, or not visit the ER unless it's a real emergency. There are no co pays, and only minimal prescription prices. There is nothing that curbs massive widespread use and abuse.

I don't have any solutions. I just feel used.

This is what I WISH I rode. I really ride something much smaller. And older. But it's still a ride and I LOVE IT! I know I know I'm gonna' end up in the trauma unit - or quad - or something. I do wear all the protective gear and I have taken all the safety classes and I don't go on the freeway. Of course I don't go on the freeway because my 250 won't go fast enough that I'm comfortable - not that I wouldn't go on the freeway if I had the above beautiful machine!

Princess

So I began my shift full of empathy and compassion and a pretty little 18 y/o female who was in an MVA. I thought how much it would suck to have your pretty body disfigured by a four inch long scar along her swan like neck and the smaller incision in her side for the chest tube. She had been in pain with a broken elbow that was going to require surgery. It somehow got to me that someone so young was facing so much.

Then she woke up. Turns out she is quite the little dictator. She ran the nurse damn near ragged by 1000. She ran the cna ragged by 0930. She had the charge nurse pissed by 1030. She wanted what she wanted RIGHT NOW !!! She refused all respiratory therapy (not that I cared) because she was tired, text messaging, hurting, talking to the endless parade of friends that came in, uncomfortable, talking on her cell, texting, talking, phoning, texting, etc etc

Turns out "Princess" did this to herself too! Got drunk off her ass and drove her car (unbelted of course) into a wall.

The second time she snapped at me that she was too busy to do her IS and she didn't need "that piece of shit anyway" my empathy went right out the window.

I love this guy!

Sorry - I can't get it to embed. Working on it. For now cut and paste it into the addresss bar

http://www.youtube.com/watch?v=k9m2FLHlEwA

Not much changes

I had six days off. Lovely! As I was getting ready to come to work this morning it occured to me that I haven't missed this place one damn bit. Haven't missed coworkers, or patients, or the bureaucracy or anything!

So my morning started with a bang. My first pt. is totally crazy. He murmured some incredibly long story through his alcoholic encephalapathic stupor about "dinner....sissssteeer....i feel fine...mumble mumble....driving.... murmur mumble....what the hell is wrong with you people?" I actually don't mind the crazies too much. They amuse me.

I had an 80 year old I gave a nebulizer to. We chatted about the weather, the summer, etc. I asked if there was anything she needed before I left. she said "Yes, will you ask the nurse to bring in my baby?" I did a double take my brain saying what? WHAT? she said "Yes I gave birth to the sweetest baby girl yesterday. I think I will name her Susan".

Freaks me out when I didn't know they were crazy.

Not my best day.

Do you ever have days when you feel like your life is one long spiral downward? And no matter how hard you fight you are just getting sucked down. Maybe it will be almost a relief to be sucked to the bottom - it's got to end there - right?

Okay I get really down when I work in rehab too much. I mean waaay down. I see all these lives shredded. A young man with a 1 year old baby. He's girlfriend is going to take care of him. Yep that's what she says. His dad tells us on the side - he is pretty sure that is not going to happen. Dad was right. Girlfriend had no idea what is involved in taking care of a quad. She cannot raise a one year old and take care of the quad too. She is gone now.

Another young man. Drunk off his ass and tried to drive home. Ended up eating dirt with his face out the window. His young sweet wife (also with a small child at home) is way past the "Please God let him live" part. He lived he is a quad as well. Now she is in the anger "why did you F*#@! up our life?" It's not just h is life that is fubar. So is hers and the her kids'. You have got to give her credit. She is sticking around. But there is all this tension in the room. She knows what she is facing. But how can you get pissed at a quad?

Then you get the 40 female with anoxia, the 35 year old stroke who will never walk, the 20 something paraplegic who will never again feel what it's like to make love.

Dante should have seen this before he wrote his masterpiece. This is several different types of hell.

Hmm ... murder? or too much CSI

So I am hanging around in the ER with my recently intubated - now ventilated patient. Waiting for the ICU to give us thumbs up to transport her. This felt like a run of the mill OD pt. to me. All of a sudden there is a shy knock on the door. I never had anyone knock on the trauma room doors before. Since I'm alone in the room (except for sleeping ventilated beauty there) I get up and open it. There is this guy with three camera's around his neck, a official looking ID tag, and a backpack. He says he's from the ME's office and needs to come in and take pictures. Hmmm- problem here - patients not dead. I told him to go find the nurse.

It really got me thinking though. How many patients have I had that we thought were routine OD? Husband/ wife/ boyfriend/ girlfriend tells us that the patient is a drug user, pt. has positive tox screen, so we just believe they got carried away this time. Wouldn't that be a fairly easy way to murder someone? Is that what happened this time? Why is the ME office interested in this patient? Kind of freaky.

IPPB Makes me laugh

I got an order to do IPPB yesterday. Haven't seen that in a while. So I dug the relic machine out and headed to the woman's room. Very nice very proper elderly woman. Surrounded by family. A family with money evidently. She is propped up in bed wearing a bed jacket. (Just like in movies from the 50's). Daughter is carefully doing the her hair just so. Patient has makeup on - the works. This extraordinarily proper family is having quiet conversations about golf, the market, and some social event.

So I get the machine rigged up, explain how to use it and we go to work. About a third of the way through the treatment - the lady rips off with the biggest fart I have ever heard. The family stops - there is no movement - nothing - as they try to decide how to handle this incredible embarrassment. The woman handles it quite well. She looks at me and days, "My goodness, that oxygen just goes right through you!"

The family busts out in one huge guffaw. I laughed the rest of the day.

How to tell if your pt. is a loser

My pt says to me, "these hospital beds are not very comfortable (pronounced comfurtble), the one's at the homeless shelter are better. But these beds are better than the ones in jail. They ain't comfortable at all".
Next time I get real sick I'm going to the homeless shelter ... the beds are better.

Don't you sometimes hate family's?

Big dude- bad brain -bad heart - eveything else is not so good either. I am in a new unit today. One I don't often work in. The big dude has had the same two therapists for the last week. I am new - (in this unit) so family equates that with new = incompetent. They keep asking me assinine questions like "Well, the therapist yesterday didn't have to change is oxygen level - why are you changing it?" "The therapist yesterday didn't have that peak pressure thing that high - what are you doing that it is so high today?" And even more snide remarks like "Maybe they shouldn't let the regular therapists have a vacation - hahaha".

I want to answer - well see your husband is a human - not a mannequin. Lungs get worse, bodies get tired, fluids get out of whack, stuff happens. So shut the crap up - or get out of the unit - and let me do my job.

Today - I hate familys.

Don't piss off the chick that may need to breath for you....

20ish female, heroin od, potty mouth, bad attitude, nearly combative. I vote we kick her ass out on the street and let her deal with her own self induced aspiration pneumonia secondary to heroin od. She won't take her treatments, fights with the RN every time she to check her artline, or even touches her. Becomes verbally abusive to nearly everyone that walks in her room. F ing this and F ing that and you F ing bitch......

Don't give me any sob story about drug addiction is a disease. That is bull and utter nonsense. Drug addiction is a choice and this choice galls me on so many levels. Level one is why the hell do we substitute an patients illegal but self paid for abuse (heroin) for a legal but taxpayer paid for abuse (methadone). Then because they have this terrible bullshit "disease" they are also on disability and medicaid. So we (the good taxpayers of this country) pay for their lifestyle, their addiction, AND their health care.... so they can come in here and call me an f ing bitch .... when in fact..... I paying for her f ing life!!!!!!

Dumb doctor.

So I am in the ER. Doc wants a blood gas but SHE wants to draw it. Okay dokay. I give her a syringe. I stand by and watch while she farts around forever digging in this nice gentleman's arm. Finally she gets blood - DARK blood that doesn't pump up well. "Hmm," I say, " I think you may have gotten venous". "No I don't" she almost screams at me. I'm thinking Yeah right, okay, I will run it and we'll see. Yep sure enough. Venous results. Textbook venous results. I show them to her and before I can speak she says "OMG this man has a PE. We need to intubate and......" I am standing in a time warp thinking "What? Are you a freaking idiot? How am I going to tell idiot here, these are venous?"

Luckily doc number 2 walks up, looks at the results, says "Those are venous". Idiot Doc looks at me and says. "Yeah - these are venous you'll have to draw them again." Imiiplicating I screwed up.

Right- I'll draw them. And I'll get arterial you jackass.

I watched "Martian Child" on dvd. LOVED it! It was fabulous. M#1s watched the first part with me and thought the kid was really from mars. Apparantly m#1s is not much in to thought provoking movies.

Jumping the gun there.

So we had an interesting occurance yesterday. We had a lady flown to us who had apparantly fallen off a stool at a slot machine. Massive head bleed. (Okay that's not the interesting part). She was basically PBAB (that pine box at bedside).
The organ revovery folks, the aggressive little critters that they are, called the patients son, IN ANOTHER FREAKING COUNTRY, and asked if he would consider donation of her body. The son, a physician himself was understandably upset since the attending doc had not called to tell him of his mothers demise - since we weren't sure she WAS brain dead yet.

Next day we do apnea tests and all the neurological brain death criteria and yep she's brain dead all right. But it kind of freaked me out that organ grubbers were so concerned about harvesting that they kind of skipped over several steps. Like making sure the family knew she was dead.

The attending was quite upset about the whole thing in rounds. I said "kind of reminds you of a Monty Python sketch doesn't it?" and I launched into "Bring out your dead. bring out your dead - I'm not dead yet" Thee doc looks at me. And busts out in the biggest roar of laughter I have ever heard out of him. Good thing.

And I could have gone to Hawaii.....

So MH (my husband) and I decide we need a little family trip. A little family trip. Yep. So M#1S (My number one son - yeah I only have one but I call him that anyway) is not happy but we cajole him into it. Now my family doesn't take vacations like Disneyland or New York. We take little local trips generally to the mountains. MH likes mountains and he can't travel far. So MH and I find this theoritical dude ranch on line with sweet little cabins tucked into the big piney Uintah mountains (that's Utah folks). It looks beautiful and scenic and cool and quiet. There is even a cafe on the ranch so I don't have to do the cooking. Nice. We book it. More cajoling for M#1S and we are ready.

At work though, a friend of mine tells me she has booked a condo on Maui for a week and if I get a plane ticket I can come stay in her condo for free! Free. Hmmm. I have the money (thank you US government), I have a week off from work (thank God - and I mean that literally not as profanity), but I also have the family trip planned. Yep. Family trip. Family ALWAYS comes first with me. ALWAYS. (Besides M#1s won't be home that much longer) so bye bye Hawaii hello Hanna Utah.

We drive and drive and drive and drive and finally get to said theoritical "dude ranch". Theoritcal being the optimum word. I hang out in the dude ranch bar/office while this woman goes and tells another family she has inadvertantly given them our cabin and they should be in the deluxe cabin. They don't want to switch so we get the "deluxe" cabin. Now I don't know what their version of deluxe but this sure as hell ain't even close. She gives me a key the size of a postage stamp - I am not kidding.

We drive up to find our cabin. and you cannot believe this place. There is no sweet little cabins tucked into big pines. There are crap little cabins nearly butted up against each other in a small circle - the circle being pretty much tucked into a white trash trailer park (no I am still not kidding). The scenery in the middle of this circle is a line of garbage cans overflowing with trash and flies - and oddly enough a large sign proclaiming this to be bear country. (Maybe this is an announcement to the bears - as this looks like a freaking bear buffet).

We open the lock on the cabin - the lock is also the size of a postage stamp. M#1S says - looking at the lock "Well- I feel safe". We walk into our "deluxe" cabin. It is 100% plywood. No paint No real walls - just plywood. (Unless you count the graffitti as paint) and 2 teeny tiny windows. The floor is filthy. The beds are encased in the same plastic we use for body bags at work - and filthy. No way I am even sitting on one of these beds, let alone sleeping on one. There is one circa 1940's sofa with several tears, worn spots and stains. If this is deluxe what the hell are the bottom of the line cabins like?

M#1S - who abhors profanity, looks around and says "I am not staying in this shit hole". Out the front door and through the garbage dump there is screeching and yelling. One of the cabins on that side is occupied by a mutant family. There are 10 to 12 people sitting around an empty fire pit (It is 83 degrees). This group , obviously a product of serious inbreeding, are all commanded by a 400 pound she slug who seems to sit her rather large rear end in a rather small folding camp chair and screeches commands to anyone in sight.

Yeah - we turned around, turned in the key, took a loss and found somewhere else to stay. We found rooms above a cafe in Tabiona. They were clean and quiet and comfortable. We did go up into the Uintah's caught some fish, bonded, had some fun .... but dammit.... I gave up Hawaii for this !!!!!!

This has been how my weekend at work has been.

With apologies and really a lot of thanx from fathairybastard.blogspot.com

Guess what I ate?

So I saw my daughter and her husband last night. They are spending the night at our house but I work so I won't see them today. (they live and go to college in a small town 2 hours north of us).

We wanted a treat so my lovely dark eyed daughter and I went to Albertsons picked up ice cream, whip cream, hot fudge, and brownies. Then we made huge BROWNIE SUNDAE'S!
(love it- love it - love it).

Now I am at work misssing my lovely dark eyed daughter and my sweet baby boy (okay he's really a teenager and he hates it when I call him that), and my husband.

I am in one of the units I really enjoy working in but yesterday and today I have been getting creamed. My illustrious supervisor (yeah - that's facetious - he's a jerkwad) gave me twice the list yesterday that anyone else had AND a first year student. I felt so bad for her. I couldn't teach her a damn thing I was trying so hard to keep my head above water. by afternoon I pretty much turned over care of one of my vent patients to her as this pt was already brain dead so I figured she couldn't kill her anyway. (this was after I was comfortable she could do a vent check, a treatment in line, and suction). I KNOW it's against policy but what was I supposed to do? It's not like my jerkwad supervisor would get off his illustrious ass and get up here and help.

I am so beat today. I am struggling to get through the shift. Good thing the floor stock kitchen has unlimited supply of Coke. If I can just get through today though - I am going on vacation!!!! Yippee skippee!

More about me

I am a Respiratory therapist. I have been for a long time now. I came from a smaller hospital to this hospital so freakin' big it has it's own zip code. I generally hate it here but I have too many years with the company to split now. So I spend my time thinking of new businesses to start to make a crapload of money so I could get out of here. That and messing around alot on the internet.

Which is another odd thing. We have mandatory overtime here. But even on overtime I seem to have plenty of time to surf the web, start a new blog, etc. which makes me wonder - if I am not busy - and no one else wants help - which suggests that they are not busy either - why the hell am I here?

But the problems in my department - and they are many ..... that's another post.

This is fun!

It is soooo cool to see your stuff in print on the web! (I know I am such a dweeb.) An hour ago I was a little down. Now I am starting to get giddy!

oh yeah - wordspell

What a concept. Perhaps I should have use it on the first post.

Why I did it.

I so feel the need to have a place to express all the things I feel. I cannot be very vocal at work. (I work at a big freakin' hospital- with big freakin' rules - a big freakin' staff and not an ounce of humor in the whole place. I cannot e very vocal at home. I am married to a sick guy who has been sick so long it's probably scewed his perception of reality.

When I was young (a bizillion years ago) I wrote. And I wrote okay. I even won a couple of awards. I have not been able to write when I tried it lately. The words are stifiled and stuttery. They no longer flow.

This is really not intended to be a blog for anyone but me. I don't care if anyone reads it. It is meant to be therapy for me. maybe in the future I will release it for others