Tonight wasn't the worst night I've ever had on the job but it wasn't a picnic either. As one person said as we walked out the door, "I feel like I've been pulled through a knothole... by my balls." I so relate, balls or no.
The first four hours were busy. Make no mistake. The first four hours I had I forget how many owner/loaner CPAPS which is usually no big deal except all of mine had treatments which is still not a big deal but I kept getting sidelined by other stuff that needed to be done. Yeehaw!
The last eight I was on Assess & Treat and it.... sucked! I started in at 11pm and, literally, looked up at the clock and was shocked to find it was 3am! That's how busy we were. I had an interesting combination of patients who were all so genuinely needy and understandly high maintenance that nothing else got done. The other A&T's kept piling up. No one's fault, just the way it was but it still sucked.
We had one patient where he seemed short of breath so the nurse called and asked for a treatment but this patient wasn't a normal treatment-needer--no wheezing and too high of a WOB but it took me a little while to figure it out. The person went from satting mid-90's on room air to 2 l/m which kept increasing. There was a respiratory history but nothing that seemed to match the WOB. I had a lot of irons in the fire but I kept checking back. Nothing got better. When I got a second away from the "need-it-NOW"s, I pulled up the chart and found the answer: the pt had peed off less than half of what had been put in. Good old I's/O's.
I told the nurse what I'd found, outlined the increased WOB and O2 demands and asked her to call the doc. It was midnight by then. The O2 was up to 5 liters so I punted a little on the protocol of 50% and pulled a gas.
While I was finishing in the lab, that ward called saying the doc was on the phone wanting to talk to the RT. I hurried down and he asked me to lay out the last couple of hours as I saw them. He'd already talked to the nurse. I went through what I'd done, what I'd seen, and presented the picture as accurately as I could. I gave him the gas. He then asked my opinion, correction, he asked "What do YOU want to do?" I told him I wanted a BiPap order BUT that without something to get the fluid off, the fluid would rush back into the lungs every time I pulled the mask off and that I'd like to see a CXR. He asked if I'd seen the orders he'd already given. I said no and wondered if I'd screwed up somehow. He laughed and told me that he'd ordered stat CXR, EKG, and something else that I can't remember (my brain's still foggy from last night). Then he said he'd also ordered us to BiPap, given a Lasix order, and an order for an ABG. I laughed and said "Well that worked out well, didn't it?" He asked if we had protocols for running the BiPap and when I'd be following up with another gas. I told him yes on the protocols and we pull gasses one hour after getting the settings settled in. He told me to have the nurse call him back with all the results after we got the BiPap gas and that he'd be in at 7am and put this pt top on his to-see list.
Excellent.
And the best part? The last thing he said to me was to thank me for being so interested in his patient and for the early intervention.
Damn! Ya don't hear that every day. I think I stuttered when I said, "You're welcome. That's my job."
On the other hand, I was so busy between that patient and two others that one fell between the cracks. There had been a person who wasn't needing high O2 but the treatment RT told the supe that pt seemed more lethargic than he had two days before when she'd had him. I was asked to "check in on him". Well shit. It didn't happen. So by the 3am treatment rounds he was even more lethargic. When I was asked about it I had to say that I hadn't gotten to him yet. Another RT pulled a gas and he was very acidotic. That guy bought a tube and a move to ICU. I felt pretty shitty about that one. I don't think me getting to him sooner would have changed the outcome for him but I still felt bad that his name was still sitting on my list.
Which brings me to a related topic. How come is it that I have absolutely NO problem at all helping out other therapists, picking up PRN tx's, going to "look" at any pt the nurses call into the dept on, but it friggin' KILLS me to ask for help? There came a point where I had to last night and even though it seemed simple--the supervisor easily rounded up three different therapists to do a couple of A&T's a piece, it felt like failure of the highest degree to me. You know what I mean? By 3am I hadn't eaten lunch, taken a break, sat down except when we switched loads at 10:30pm but there's something in my brain that associates having to ask for help with personal weakness. I NEVER feel that way about anyone else when I'm asked to help but, for me, saying the words "I need help" is the same tas standing on a housetop and screaming "I'm a loser!".
But even though I hate asking for help, I love the people I work with. I say it all the time but I really like my job and I love the people I work with. We're a team and a family. Lousy night but it did have it's feel good moments.
