ER Trip #3: Part 2

Part 2: The Respiratory Therapist

**After initially writing this, Liz told me some of the timeline was off during my attack.  I’ve modified the times to reflect what Liz wrote down as things were happening.

After I was settled into a room upstairs my nurse was smart enough to ask how long it had been since my last meal.  I had been feeling a little hungry, looked at the clock and realized 14 hours had passed since that slice of left-over pizza.  They offered me graham crackers and a TV dinner, but Liz needed to go pick up my CPAP from home and hit up Taco Bell drive through for me because she’s awesome.

My first respiratory therapist was great.  It turned out he’s REALLY into sci-fi television and movies and there happened to be a Farscape marathon playing.  He took the time to get to know me a bit, got a sense of my asthma history, suggested a few things, etc.  I have a huge list of medications and of course the admitting doctor didn’t order all of them.  They even substituted Advair 250/50 for Dulera 200/10, but I knew the dosage was way too small.  Mr awesome RT just went ahead and fixed that for me in the computer.  When I asked about other medications I’m supposed to be taking I was told all medications legally have to be ordered by the attending physician, brought up from the pharmacy and administered by a nurse.  This is about the time RT #1 closed my curtain and said he’d be back in 10 minutes (wink wink).  Upon returning he also noticed a 3rd ABG had been ordered which would be my third in less than 12 hours.  He wasn’t interested in putting a 3rd hole in my wrist and I wasn’t interested in receiving one so that was also fixed.

My second respiratory therapist hated using the computer system and wasn’t interested in a Stargate vs Battlestar Galactica discussion, but she was had been treating lungers like myself for thirty years so I couldn’t really hold that against her.  She knows how to take care of her patients.  Lorraine talked to us too about all kinds of stuff and made sure I had everything I needed.  Even though I was prescribed treatments every four hours, she was checking up on me every two hours which is when I actually needed them.  Towards the end of her shift I was definitely feeling the need for another boost around 5pm.  I thought they were coming back at 6:00pm, was having some asthma-brain, but they actually weren’t scheduled until 7:00pm.  Asthma-brain is this weird thing where you get a little fuzzy due to the lack of air.  Liz kept telling me to call the nurses and eventually by 5:30pm we had called and were told they could be there by 6:00pm if that was ok.  I agreed, I didn’t think things were that bad, but knew I really needed it by 6:00pm

In the meantime my hospitalist, the physician assigned to you while you’re in the hospital, came by to check on me.  He could easily tell I wasn’t in good shape and wondered where that breathing treatment was.  We told him it was on the way, he put in an order for some salumedrol and then doubled checked my prednisone dosage.

Six o’clock came and went.  By 6:05pm I was starting to enter the serious-respiratory-distress-zone.  Liz inquired again where my medicine was.  The message was “soon,” but respiratory therapist number three, Josh, didn’t show up until around 6:15pm.  At this point in time I was starting the same type of coughing fit which sent me to the ER in the first place.  My airways were constricted allowing no more than 30% capacity in whenever I breathed and that dull/searing pain was surging through my chest like an Etch a Sketch drawing my lung structure.  In my 22 years of officially having asthma, and regularly scaring people with my attacks, this is what I would call a time for action.  Josh walked into the room looking like he was hung over, and proceeded to spend the next five minutes standing in front of the computer while everyone in the hallway could once again hear me breathing.

Liz: “Could you please get him started on that breathing treatment?  He really needs it.”

Josh: “I just got here ten minutes ago…”

Josh continued to meander across the room at a glacial pace, eventually giving me that treatment around 6:30pm.  All this really did was open my airways enough so I could start wheezing which made me cough more, made my lungs hurt more and as a result made my airways constrict more.  If you’ve ever been in ER/hospital situations they ask you about pain levels on a scale of 0 or 1 to 10.  Low end is obviously nothing or very little and 10 would be someone stealing a kidney without first slipping a rufi in your drink.  I was around the 7/10 level, coughing horribly, wheezing in between ragged breaths, as red as a tomato, crying and thrashing about in the bed.  This is when Josh decided his job was done and started slowing walking out the door announcing he’d be back in four hours.  As absurd as this sounded neither of us did anything as he sauntered out.  Liz quickly found my main nurse, Jeff, appraised him of the situation and asked to get Josh back for a follow-up treatment.  Jeff and Jen, the nurses were changing shifts, got him on the phone and were told…

Josh: I’m not allowed to give him anymore medicine.  I can try to ask my supervisor about it I guess.”

…and refused to come back to my room.  Now I know I can’t expect everyone to adhere to the Marine Corp’s motto of not leaving a man behind, but in two decades of receiving treatment in hospitals, emergency rooms, training rooms and doctor’s offices –  I’ve never seen, experienced nor heard of a respiratory therapist walking out of the room while their patient is going into a full-blown asthma attack.  Jeff and Jen were under strict orders to defer any pulmonary issue to the respiratory therapist on duty and at first weren’t sure to do.  So Liz and I basically took over and “suggested” a plan of action.

  1. Liz got my asthma bag, which Jeff and Jen thought was awesome, out of the corner so I could use my own rescue medications.  At this point I didn’t care about the rule and Jeff also said to feel free and take any of my own meds since it was clear Josh couldn’t do his job.
  2. Liz had Jen check on the salumedrol ordered by my hospitalist.
  3. I asked for some tussionex or cough syrup to control this outrageous coughing which doesn’t stop until it’s suppressed.

Six puffs later on my inhaler got my airways to quit closing and traded the thrashing for shaking.  In the meantime Jeff got me back onto 2L of oxygen, you know – one of those things a respiratory therapist might think to do, and talked with my hospitalist about what to do next.  Someone found Josh, made him come give me another breathing treatment, and I eventually got the salumedrol and tussionex.

Jeff and Jen came back in around 6:45pm to check on me and see what was going on.  I could almost sort of talk, and Liz and I proceeded to inform the nurses about Josh’s performance, what happened, what could have happened if I had not used my own meds, and that we didn’t want Josh back in my room.  Neither Jeff nor Jen did anything to defend the guy and were extremely apologetic.  Jeff’s shift was long over and he had to take off so Jen finished up and went out the door to the main desk in the ward where she immediately began ranting to a co-worker about Josh.  I wasn’t the first person to complain about this guy.

Even though I didn’t want to see this slacker’s face again, Josh was the only person available so I still had to receive my breathing treatments from him through 4am.  Every time he came into the room I eyeballed him.  Instead of acting like a sullen teenager he now called me, “sir,” and bookend-ed everything with a please and thank you.  There were times when I did need extra meds in between the scheduled treatments, but I just puffed on my inhaler because I had zero confidence in Josh doing anything correctly.  The guy didn’t know how to properly get a reading from a pulse oximeter and most of the times he tried listening to my lungs his stethoscope was sitting on top of the heart monitor patches.  To be fair Josh was probably nervous and or scared about what had happened, but there’s no reason my well being should be put in that kind of danger while in a hospital.  It was as if he was following an imaginary checklist of what to do and I was presenting a scenario not covered on his how-to-administer-a-breathing-treatment cheat sheet.  Jen kept coming back to check on me and apologized several times for everything that had happened even though none of it was her fault.  I’m just glad I didn’t end up worse than I was after all was said and done.