Praise, Exhaust, Defeat...all in one week!!!

This last week was a busy one for me, I left for Texas Sunday night after working 10 hours at work, I drove 12 hrs to be with my dad when he had his Left upper lobe removed on Tuesday. I arrived Monday morning exhausted from lack of sleep and I got about 4 hours of a nap, woke up and visited with my grandmother and my father. When my mother got home from work, we had dinner and basically just visited that whole night. Tuesday morning, dad had to be at the hospital at 5:30 am so my mother drove him up there and Grandma and I slept in to arrive at about 10 am. Dad was still in surgery when we arrived and mom hadn't heard anything up to that point. About 11 ish, the surgeon came out and informed us that he had came through it all okay and the worst part of the surgery was cutting through the old scar tissue from the last operation he had. He did mention that the mass was larger than they thought and it had been sent off to pathology. When the reports come back, they'll know more. Once they opened him up though, everything went smoothly. He was to stay in recovery for about an hour and then he would be transferred to ICU. I asked the surgeon how it went extubating him and the surgeon stated that he was extubated prior to leaving the O.R. Which was good news for me. I asked the surgeon what condition the other lung lobes were in and the surgeon stated that the other lobes were pretty beat up from smoking but he believed that dad would be able to come off the oxygen soon. I was astounded to hear 1.) that he was extubated without problems and 2.) that he would be able to come off the oxygen before he was released from the hospital.

Around 1:30 pm we were able to go see my dad in the ICU, when we arrived, he was "eating" lunch....woah....isn't that a bit too soon?? But he did manage to eat a full plate of food. Later we found out that he did get a bit nauseous from eating too soon. But at that point, there were no other complications.. The chest tube appeared to be draining adequately and he was putting out an acceptable amount of urine. His saturations were good on 3 lpm O2 and his HR and BP was stable.

After visiting with him for about an hour, we left the hospital and told him we would be back at the next visiting hour. We skipped the next one though as it was to begin at 5 pm and we came back at the 8 pm visit to find that dad's BP had gone down considerably and that the chest tube was at about 1200 cc's. His Hb was about 6 and they were wanting permission to transfuse 2 units of PRBC's. They ended up transfusing 3 units and sent down labs afterwards. His BP was stable again and his Hb was up. So we left around 11 pm to go home and get some rest.

The next day, he remained stable and they transferred him to the step-down unit. They gave him some ativan to help with the detox from the alcohol and by that evening, dad was pretty testy!

He wasn't happy with much. His pain levels though were controlled pretty well with the epidural and he was more aggravated by the constant flow of traffic by the nursing staff...RN's, CNA's, Pain Management Nurses, RT's etc...

He just wanted everyone to come in at the same time so that in between he could rest.

I showed him how to use the incentive spirometry correctly and he voiced that he thought that was a "game" useless in his recovery for lung re-expansion...I told him that he needed to hold his breath for 10 seconds and then cough afterwards...he said, "The respiratory therapist didn't tell me anything about needing to cough or hold my breath!" I told him otherwise and coached him through it. He wasn't a happy camper!!!

The next day brought even more ill temper from him, though he did comment that he got some rest the night before. I didn't get to spend too much time with him that day but some is better than none.

Grandma and I packed that night to leave on Thursday so I could be back to work yesterday (Friday). We drove straight through getting updates from mom throughout the whole trip.

In short, they did another scan and it showed that they didn't get all the cancer, but dad is just too weak to go through anymore, so they are keeping him in the hospital through the weekend and they will discuss it more early next week. Dad's been weaned off the oxygen all but 1/2 lpm during times of exertion.

I dropped Grandma off at her place and got her settled in, then I drove home.

I returned back to work yesterday, it was pretty busy, but I made it through. Then, all Hell broke loose today! I arrived to see that the board was being made out roughly so-so...then, everything was re-arranged all to hell...I ended up with nearly 50 points....some of them being in ICU!!! WTF???

Everyone else had around 25 - 38 points and I have nearly 50?? Shit!!!

I hightail it outta there to get started on what could be a disaster (for only me) and I run over to the ICU to see where to begin. I inform my other ICU partner that I have 2 other sections and we decided for me to start with the other sections and then run up there after I'm finished...I forget my phone & pager, so I have to run back to the office then back to the ICU to pick up my stuff, then to the elevators...

Another RT who had the ER today was being truly considerate by offering to help Thank GOD!! so we hurried up and knocked out the treatments on the 2 other floors, then I headed back to the unit...since I'm fairly new at this place, none of the ICU people really know me...so all of a sudden, while trying to help with ventilator changes, I become (invisible) ........the doc pushes my hand out of the way of the vent so that she could make the changes herself.........??? WTF??? Am I not an RT?? Do I look like I'm stupid?? Then she doesn't like what the patient is doing to the vent, so she decides that the problem must be with the HME...so the nurse offers to go get a new HME....WTF??? Am I not standing here??? oh brother......


so I'm like, whatever....and I went out to find my fellow RT and when I find him, I'm like...so since I'm not needed in that room, what can I do for you?? He says, "What?" so I told him how I was pushed aside during that whole nightmarish incident and he said, "oh yeah, we're staffed with the "know-it-alls" today!" I guess I should have been warned...I'm like well, didn't they say they wanted a gas?? He said, "yeah" I said, well, let them get it, they can run it and you and I can go get some breakfast............ LOL... cause by that time, I was starvin....

So, the day just kept getting worse...by that I mean, I just kept getting more ignored...I was in a patient's room and she's intubated on the vent and she's trying to talk to me, since in my previous job I was good at reading lips, I totally understood her when she said she had been sweating in bed all day and she wanted a bath...so I go to her nurse and tell her what her patient wants and she just freakin looks at me like I'm retarded.........

whatever, I'm just letting you know.....that was about 2:30 pm and the patient didn't get her bath until about 4:30 pm...I was pretty pissed off!!

Then, while giving report, I'm really stupid in that this place has set protocols for breathing treatments...while I was learning about the protocols I never got anything strange in orientation, so now, here's my first strange order....the patient was placed on bronchodilator protocol, so I went to evaluate the patient and found out through the family and the patient that she had been getting treatments at her home facility twice a day, at 9 am and 5 pm...well, we don't have a protocol like that, so I "add-libbed"....well, I find out in report tonight that we can't do that...if her nebs weren't listed in her "home med sheet" then we had to protocol her out by "our" standards...so now, the oncoming therapist is pretty much shaking her head...I apologized for my ignorance and she said it was alright, but its not alright with me...

I feel super defeated tonight.......

For the last 2.5 years I worked in a place where I had freedoms to do a great deal with my patients and here, I have no freedoms and I have to solely wait on doctor's orders be it for protocol or not...well, I disagree...not every patient needs treatments just because they're bedridden and they don't have available chest x-rays...

Here, because they're bed-ridden and don't have available chest x-rays they get to be 4 times daily breathing treatments...how about giving them incentive spirometers, teaching them how to effectively move around secretions should they have any and PRN treatments???

Am I just plain stupid??? I guess I must be!!

I know one thing, I'm exhausted!!!

Y'all have a great weekend...
kT