A Respiratory Therapist’s Kaleidoscope: Reflections on Sixteen Years as an RT (Part 3)

Graduating from “respiratory school” brought a great sense of accomplishment along with the reality that I was now required to live like a responsible adult. I was happy to be finished, but also had a nagging sense of dread: was this it? Was this all there was to my life? I was 21 years old by this point. Was this the zenith of my adulthood? Would there be anything else, or would I just work as a Respiratory Therapist and lead a boring, predictable life with few spurts of excitement?

Around the time of my graduation, the college from which I graduated began baccalaureate programs, including one in Respiratory. I decided that I would continue my education and obtain a bachelor’s degree. I thought this would solve my problem: I could still be in school while I worked, and this would give me a few more years to decide what was next in my life.

I was still working part time in the area’s Level 1 Trauma Center, but my hours had picked up considerably after I graduated. I hadn’t accepted a true full-time position there, but was essentially working full-time hours. I started picking up night-shift schedules also, which started at 6:30 pm and ended at 7:00 am the following morning. I was now a full-time student, working full-time hours at the hospital, often at night. I felt tired all of the time. But I was gaining valuable experiences along the way. In addition to all of this, I continued working in the Nuclear Medicine department on occasion to supplement my income.

At the end of September 1999, the stress of working full-time and going to school full-time took its toll, and after talking to a mentor, I dropped out of the baccalaureate program. That evening, while at work, the night shift supervisor asked me how school was going.

“I quit,” I answered. He gave me a curious look.

“You quit?” His face quickly brightened. “That means you can take a full-time position. We have one available in ICU,” he said.

I interviewed for the ICU position, and after I accepted the offer, they started me in ICU right away. There were at least three of us RTs who were responsible for three “pods” of ICU beds. There were about five or six patients in each pod. Pod A was where burn patients were placed.

I will never forget the night that “Curtis” came in. He was an African American man that was burned so badly, his beautiful brown skin was a patchwork of bloody pink and white. I no longer remember the percentage of his body that was burned, but it was high enough that his chances of survival were very slim. We worked to stabilize him; he was intubated and placed on a ventilator right away. Later, when his drug test results came back, we understood why he was burned so badly. He had been high on cocaine, and was smoking in bed. The mattress caught fire, and rather than evacuate, he tried to extinguish the burning mattress by taking it into the nearby bathroom. The mattress overpowered him, knocking him to the ground, and he sustained third-degree burns over much of his body.

When people say that you never forget the smell of burnt human flesh, it is true. To this day, I can smell this man’s burnt flesh as we worked to stabilize him. He lost fingers and toes, and had skin grafts all over his body. He sustained heat inhalation to his airways and lungs, causing them to fill with fluid and nearly drowning him. We had to use special modes of ventilation to overcome the stiffness in his lungs that prevented him from getting adequate oxygen. Statistically, he was a dead man. But he survived.

Curtis slowly improved, after many weeks of skin grafts and close calls with death. As he improved, he was able to spend several hours during the day without being on the ventilator, but then he was placed on it at night so that he could sleep and not struggle to breathe. By this point he’d had a tracheostomy for quite some time, which made these trial periods on and off the ventilator easier to accomplish.

One night Curtis and his Pod were my assignment for the evening. He was now having test trials of going all night long without the ventilator. He had a “cap” on his trach so that he could speak (normally patients with an open trach cannot speak because the trach is placed lower in the neck so that the air goes in and out below the vocal cords). He was getting ready for bed, and I was giving him his last breathing treatment of the evening. He had his television on, but it was tuned to a local rap radio station. All of a sudden, this song came on, and it was one of those songs that was popular at the time, Juvenile’s “Back that A** Up”. Curtis, without missing one beat, began singing and dancing from the waist up in his hospital bed. In a raspy voice, he sang, “Girl, you lookin’ good, won’t you back that thing up; you’se a big fine woman, won’t you back that thing up…” I couldn’t help laughing. This man had been on life support for at least two or three months, having survived several tangos with death, and here he was, singing along with this rap song and grooving to it like nothing ever happened.

Eventually he was moved to one of the step-down floors and I suppose he was eventually discharged home. I’ll never know what life was like for him after he left ICU.

There were two other patients whose memories remain with me, all these years later.

One young lady, 17-years old, was the driver of a car that crashed into and became pinned under a semi-truck. She was my patient one night, and I was in her room checking her ventilator. Just then, several male friends of hers came into her room and began singing hymns to her, in that way that only African Americans, who have tasted centuries of suffering, can sing. The boys’ voices blended in a tight harmony so rich with sound and solace that my eyes immediately swelled with tears, and I had to leave the room. I went into the one of the supply rooms and cried silently, trying to compose myself. I wasn’t that much older than this precious soul. To this day, I do not know what happened to her, but her injuries were severe enough that I am pretty sure she did not survive them.

And then there was the other patient. I think he was in his 40s. He was a very tall, thickly built man, with close to 300 pounds on his 6’5″ frame. He had been T-boned by another driver and sustained abdominal injuries so severe that after surgery, they could not close up his abdominal incision because of all the swelling. They put a special film over his incision to keep infection from setting in. His lungs also sustained a lot of trauma, and over a few days, they stiffened and wouldn’t allow the proper exchange of oxygen and carbon dioxide. We had to use special modes of ventilation to try to overcome this problem. Eventually, he was placed on a Stryker bed, which turns so that the patient is face down. The theory is, when a person is lying on their back, the blood pools at the lowest points of the body thanks to gravity. If a person is turned over and made “prone”, then the blood will move more easily to other areas of the body, and this will increase circulation and oxygenation.

We had to “prone” this man every 4-8 hours per doctor’s orders, and because of his large size, it often took eight or ten nurses and RTs to turn him. Also, because of his open abdominal incision, one of the RT supervisors brought in a tire inner tube to place under his abdomen so that his inner parts were not squished when he was prone. We worked so hard to save this man’s life, and he survived his injuries. What I will never forget is how mean this man was once he was finally healthy enough to come off of the ventilator. He was demanding and critical of the nurses who cared for him. This man had no idea how close to death he had come, and how hard and creatively we worked to save his life. He had not one ounce of gratitude for the care he had received.

No one was sad to see him discharged from the ICU.

My time working in the ICU also included the scare of Y2K, when everyone thought that the computer world would come to a screeching halt on January 1, 2000. I had to work in the ICU that New Year’s Eve. I remember it being a quiet night. We had several empty rooms in the three Pods. The patients who were on ventilators had Ambu bags on standby, and we RTs were ready to manually “bag” those patients if the ventilators suddenly shut down at midnight. It never happened, and the ventilators continued humming along.

I continued humming along for another four or five months, but the stress and worry got to me. I constantly went home wondering if I did everything right on my shift, going through each patient and my time with them to ensure I didn’t make any mistakes. Eventually I left my ICU position and worked at my Nuclear Medicine job a lot more as I was getting paid the same amount of money, and it was less stressful. By this point, I was also thinking of going back to school to pursue something different, getting away from Respiratory after a few short years. However, leaving my ICU job would not be the last of my Respiratory journey.

A Respiratory Therapist’s Kaleidoscope: Reflections on Sixteen Years as an RT (Part 1)

This was originally written in the summer of 2014, not long after returning to a job I had had previously.

It is 9 p.m. on a Tuesday evening. My feet ache from being in high-heels all day. My back hurts, reminding me that I am not completely healed from the February 2014 back injury that I sustained at work. Tomorrow is a bit of a homecoming. I’ve been here before. I fell right into the preparation routine, after being out of it for more than two years. I spent time after hours copying the PowerPoint handouts that we will need tomorrow, copying the other handouts that go along with the presentation that I will give, putting the props on the table just like I did more than two years ago when I worked for this Company. Tomorrow will be the first time in over two years since I last taught this class, and tonight’s prep work felt so natural that I kept asking myself it had truly been two years since I was here.

Earlier in the day, when I introduced myself to my students who came to learn how our Company does business, I told them that I had been a licensed Respiratory Therapist for 16 years. I did not know I was old enough to be or have done ANYTHING for that long. In some ways I still feel like I am in my early 20s (except for the lingering effects of the back injury). I stood there in my high heels, asking myself incredulously, “Has it really been that long?” And the answer is yes. It has been a kaleidoscopic journey, one that, for some reason, I feel compelled to share.

I rarely discuss my work with anyone, because when people ask about my occupation, I receive looks of confusion or I am assumed to be a Physical Therapist or a nurse. I am neither. I am a credentialed Respiratory Therapist, currently licensed in three states. Here is how my journey began.

An Unlikely Occupation

It must have been sometime in early 1996, the year I graduated high school. I attended a small boarding academy in central Ohio, and I suspect my guidance counselor was concerned about my future. I was an average student, but I was too distracted by boyfriends and didn’t think much about the future. My guidance counselor talked to me one day about my plans after high school. Most of the kids in my class had already mapped out their college or university plans. I don’t remember doing much college planning with my parents.

This may explain why my guidance counselor had this little talk with me – perhaps she feared that I would fall through the cracks and never get anywhere. She told me about a college in southwest Ohio, with programs in Nursing, Radiology Technology and Respiratory Therapy. “You have asthma,” she reasoned with me. “You could relate really well with the patients. It’s a two-year degree so you can start working fairly quickly.” Those weren’t her exact words, but I remembered almost mindlessly agreeing, “Okay, that sounds good.” That summer after graduation, I prepared myself for a new life as a college student, not sure at all what to expect. I remember being worried, because I had always seen myself as an artistic person and as I looked at the requirements for the Respiratory program, with its science and biology prerequisites, I began to think maybe this was not a good idea after all. Later that summer, I discovered that my best friend from high school was also going to this college, also in the Respiratory Therapy program. Somehow that put me at ease; she was much more outgoing than I, and her presence would help me make friends easier. My unlikely journey to college began that August in 1996.

A Respiratory Therapist’s Kaleidoscope: Reflections on Sixteen Years as an RT (Part 2)

In August 1996 I became a college student at a medical arts college in southwest Ohio, and for the next year I took general courses before I was officially accepted into the Respiratory Therapy program in 1997. Each week we attended classes as well as twice-weekly “clinicals”, which were rotations at various local hospitals to gain real-life experience under the tutelage of Respiratory Therapist preceptors.  Our clinical time was spent performing breathing treatments, breathing exercises, chest percussion treatments (to help loosen mucus and clear it from the airways), and later, as we advanced in the program, we learned about mechanical ventilation. Whenever you hear someone saying “They’re on life support”, Respiratory Therapists are usually the ones who are managing the “life support” (aka ventilator).

Once we began our Clinical rotations with mechanical ventilators, the severity of illnesses that we encountered definitely escalated.  I came into contact with patients and their families who relied heavily on the work that Respiratory Therapists do, and I believe that is when I began to understand the importance of my new occupation. I also began to realize that RTs do not serve one age demographic, a point that was brought close to home one day as I cared for a young man who was my age.  He was on a ventilator, and we were utilizing modes of therapy that were not typical, because he was not responding to conventional therapy. I no longer remember what was wrong with him, but I was quite saddened when he passed away, and especially when I learned that his parents had previously lost another son.

In 1998 I was permitted to obtain a limited license to practice Respiratory Care as a student.  I began working at the area’s Level 1 Trauma Center, and although they gave me mostly breathing treatments to do during my shifts, I still had opportunities to spend time with my shift managers in the Emergency Room seeing some incredible situations.  I will never forget seeing a woman who was badly injured in a car crash, to the point where they had to split her chest open because her aorta was torn and she literally bled completely into her abdominal cavity.  As the other medical staff tried hard to resuscitate her, my supervisor and I performed artificial breathing through a tube which was inserted into her trachea (windpipe), using a balloon-like Ambu-bag that we squeezed intermittently to push air into her lungs.  Because her chest was split open, I could literally see her left lung expanding as we ventilated her.  Obviously I felt very sorry for her and did not want her to suffer just so I could see a real-life lung in action. But this wouldn’t be the last time I had encountered horrible situations. Perhaps this is one of the things that people don’t understand about Respiratory Therapists: we are often on the “front lines” of emergency situations in the hospital setting.

Graduation came in 1999, and the last requirement of my program involved spending five weeks at a hospital to complete a Clinical Practicum.  My Respiratory Therapy program had a relationship with Florida Hospital in Orlando, and I was one of two students selected to go there for the practicum.  Again, because of the location and the demographic there, I had the opportunity to experience situations that I had not seen or experienced previously.  After my five weeks in Florida, I returned home to Ohio and a short while later, I sat for my first exam to became a Respiratory Care Practitioner, a Certified Respiratory Therapist (CRT).  Later in December, I sat again for another exam and passed, becoming a Registered Respiratory Therapist. By this point, I had secured a full-time job as an RT in the Critical Care Department of the Level 1 Trauma Center where I had worked as a student.

The sheltered student life was over.

Age With Grace (Or Kick It In The Face)

I’ve never been the type to worry about aging.  I marveled at friends who approached their milestone birthdays with fear and trembling.  To me, the adage held true: “you’re as old as you feel“.  I pretty much believed that, going through my days focusing on other issues, thinking that as long as I exercised and ate healthy I would be okay for a very long time.

My confidence partly came from comparing my current self with my 20-something self a decade ago.  I was overweight then, not so healthy, eating lots of junk even though I was a vegetarian.  My husband, who was my boyfriend back then, fondly reminisces of that time with me as our “traveling fat couple” years.  My knees ached a lot from eating too much sugar, my menstrual cramps were strong and painful at times, and my general health was not so great.  In 2006, while in my late 20s, the weight began to drop as I was finishing my bachelor’s degree and preparing for my wedding at the same time.  In January 2010, I jumped into the vegan world, which brought further improvements to my health.

Once I turned 35, though, I was confronted with the aging process. My belief “you’re as old as you feel” was unexpectedly challenged.

I was relatively sure that I wouldn’t have to deal with gray hair for quite some time. I never looked for them, and none came to my attention. My husband was the one who noticed my first gray hairs when I was 35, which is ironic because he is not the most observant guy when it comes to changes in my hair.

I also noticed my metabolism change … significantly. I’ve never been thin, but I’ve been pretty healthy since 2006. However, I’ve noticed that doing the same type and amount of exercise no longer has the same effect. I have a muffin top now; I’ve never had one of those. My arms are getting flabby. I’ve always had big hips and a very round butt, but I’ve always been much smaller above the waist. Once I turned 35, and ever since, I’ve noticed extra padding above the waist.

Perhaps the worst reminder of the aging process came last year, in February 2014, when I injured my back while at work. Up until this injury, I had considered myself to be a pretty strong girl, certainly not weak. I was used to carrying decent loads and politely declined help from men when they offered it. I was used to hauling heavier oxygen equipment in and out of my car and into patients’ homes when necessary. The back injury not only weakened me physically, but mentally as well. I began to see myself in a very different way.

Part of the reason for this is because the recovery took such a very long time. Even 15 months later, I am still not 100% recovered. Before the injury, I used to be able to bend over with legs straight (no bend in the knees), feet together, and put my palms mostly flat on the ground in front of my feet. Now I am lucky if I can get my fingertips to touch in front of my feet with slightly-bent knees. A week ago, I held a 10-pound baby for 20 minutes while standing, and my back ached the rest of the day. Not only that, but long workdays sitting in a chair causes aches. Long car trips (and I do lots of these for work), not exercising and eating crappy food will also exacerbate my injury. It has been like this off and on for the last 15 months, except it was much worse for the first six to ten months after the injury.

I thought I would have until my 60s before I needed to worry about gray hair, weakening muscles, lower metabolism, and menopause-induced weight-gain. Perhaps these “premature” reminders are here to jolt me out of abeyance. Maybe I’m just getting a sneak-peak into what could be in my journey ahead if I don’t take better care of myself. I thought I was doing okay, but maybe all of these indicators are a slap from reality – “No, you weren’t doing okay.”

Whatever the case, though I am often tempted to feel sorry for myself, I know that ultimately doing so will not help. It’s time to kick aging in the face and show it how strong I really am … even if I’m bluffing a little.

(C) 2014. Please do not use without permission.
(C) 2014. Please do not use without permission.

Springtime Sonata

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I returned home yesterday from traveling a few days in central Illinois, where the air temperature was in the lower- to mid-80s, and farmers were zooming around their dusty fields in their tractors, preparing the soil for planting. When I had left our little corner of Michigan on Wednesday morning, the trees had an abundance of shy, green buds waiting to pop open. Trillium dotted the landscape at a local county park amid a minimalist-green backdrop. Upon my arrival home, instead of shy, tentative buds, I was greeted by fully-foliaged trees, and a bush in our back yard that was so abundant with small, white blossoms that it looked like popcorn had popped all over it.

Spring is very much on my mind these days; not just meteorological spring, but also personal seasons of spring, where lessons are learned after the winter seasons of life. I recently read a journal entry from 3.11.15, written while working in southern Indiana. Spring fever was apparent as I wrote these words:

“Maybe it’s the weather, that glorious thaw beginning to relax the icy grip of winter. Perhaps it’s the extra sunlight in my retinas. It could be the recent victories, benchmarks of progress: [my husband] getting accepted into the PhD program, and [my husband] fighting the battle to graduate in May – and against some serious opposition – he won! Also, a general rapport with [my husband] that has sustained itself over many months – we bicker at times, but end of up humoring our way out of a deceleration into madness.

“Maybe it’s the way the roads stretch out before me, long and fluid, leading to possibilities. It could be the hike through [the local county park] on Sunday, trudging through more than two feet of old snow, followed by [a long-time friend], whose face took on a ruddy, healthy look, contrasting nicely against the backdrop of the white, brown, and gray winter landscape.

“It’s possible that returning to and working on my blog, in addition to visiting and writing in my journal after a short dry spell, has something to do with it…

“…or maybe it’s because my back hasn’t been hurting lately – I’m back to that elusive place where it almost feels like it was never injured last year, and that’s a beautiful victory – for now.

“One last possibility is that it’s my new morning devotional time, reading Jo Ann Davidson’s ‘Glimpses of Our God’, seeing her passion illuminating the fabric of her words. Plus I’m really pausing to pray to God in the morning, in addition to the conversations that I normally have with Him throughout the day.

“Or it could be a combination of all these things. “I’m waking up to a joy that I haven’t had for a long time, and the messed-up pessimist in me is struggling to believe that I’m even in this current place.

“I am, as they say, ‘waiting for the other shoe to drop”, as if I don’t deserve this current rest area along the way. I’m enjoying the scenery, the sunshine on my winter-weary soul, the progress and laughter with my husband, being outdoors (with longtime friends, no less!), the writing, the diminution of my almost-constant back pain, the joy of rediscovering God. So why can’t I just sit here, soak it all in? Thank God for all of it? Because I know this can’t remain this way. And already I’m preparing myself for that giant shoe to drop, the way that small tree crashed suddenly onto the hood of my Toyota Corolla last July while driving on I-80 in Illinois. I’m waiting for it so I’m not surprised by the disappointment. Yes, it’s cliché, but I’ll say it anyway: I’m still learning to pause and just enjoy this moment. I couldn’t appreciate all of these ‘sparkles’ if I didn’t have to dig through so much to dirt to get here:

  • “The cold, brittle winter to appreciate the slide into warm, majestic spring.
  • Working through four years of supporting my husband’s studies to see him progress to the next important step in his life, and mine.
  • Navigating some challenging communication in order to understand one another and get past the snags of conflict.
  • The illness that I had three weeks ago that dropped me back to ‘sedentary’ status – now I appreciate health even more than I thought I could.
  • The back injury in February 2014 that plagued me for most of this last year, which also caused me to take exercise and dependence on God more seriously.”

These are the thoughts I wrote on that day in March. With the wisdom of hindsight, I know the growing process is worth it. For now, I’ll bookmark this moment of clarity and revisit it when the next shoe decides to drop.

Not Having Children

I read this post and caught my breath. It’s another fascinating and very personal perspective on the complexities of NOT having children.

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Note: I wrote this essay fourteen years ago. This Mother’s Day, I find I am ready to share it.

NOT HAVING CHILDREN

I married when I was forty.

It was amazing at that age how many people asked me if we were going to have children. No, I’d say, We’re not having children. What is amazing to me now is that I thought I was lying. Keeping a secret.

Of course we would have children. Forty is still young.

I’m lucky. Lucky in my career, first of all. I am immodest enough to know that my business success is largely due to brains and hard work, but I am also honest enough to know that a part of my success is the result of just too much time on my hands. I work hard because I have no place better to be. I’m not so much ambitious as…

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Peeking my head out from under the snow drift…

I’ll never forget what a friend said to me a few years back when I was crying to her about my sadness over leaving a job I loved. She asked me what my least favorite season was, and without hesitation I answered that it was winter. She looked at me and said, “You are going through a winter season in your life. Hang in there, because all winters eventually come to an end.”

It would take two years before that particular “winter” season ended, but she was right. I  never forgot her words. I remember them each time I find myself dipping into a “season” that leaves me feeling the brittle, skeletal coldness that only a winter can bring.

At the very end of 2013 I decided to give blogging a try. Actually, I started this blog four months before that winter solstice of my soul faded into a glorious springtime. My contributions here have been anemic at best. As I’m sitting here in early March, feeling the damp cold in my feet, after being buried in seven inches of Kentucky snow, I wonder when the real spring will arrive, and I look forward to the green and warmth that signals the end of another long, hard winter.

Likewise, here at Taciturn Alchemy, I have decided to take the Blogging101 courses offered by WordPress, finally resolving to pick this thing up off the ground after laying in abeyance for over six months. My hope is to finally peek my head out from under the snow drift of my life that has kept me afraid of failing at something I was hoping I’d love. I’m ready to move from the winter of my blogging into spring. I’m still learning that winter can’t last forever…