Thursday, September 3, 2009

My First Day as a Respiratory Therapist

After graduating from High School in 1971, I took a job at the local car wash. I was making $1.25 an hour and was pleased to be employed. It was hard work, and fun but I certainly did not see myself wiping down cars for very long. My older brother had just finished a course so that he could become an "Inhalation Therapist". He got a job right away and was making $1.65 and hour. He encouraged me to take the one semester course to become an Inhalation Therapist. I asked him if I too would be making $1.65 an hour. Sure he said, and maybe even more! I was sold.... I did not know what an Inhalation Therapist was, but I was pretty sure it would beat wiping down cars.

So I enroll in the course. Part of the program was learning the practical application of our skills. We would be assigned to a local hospital and would be assigned to follow an actual Inhalation Therapist as he or she went through the daily routine. So a few days a week with our noses in books and a couple days a week seeing the practical application of the skills we were learning.

A large part of the practice is the dispensing of various inhaled medications through various devices. We would also be involved with monitoring of ventilators for post-op care or other situations that would require a patient to be on a ventilator. We would also be drawing blood from arteries to monitor the effectiveness of a patients respiration. And occasionally we would be part of a team that would assemble during emergency situations where a patients breathing or heart had stopped with our duty being to establish an airway and support breathing. Pretty interesting stuff, and you have no way to know how you are going to react to the real settings. It was all just book learning so far.

So I show up late on my first day of "Practical". Instead of being assigned to an Inhalation Therapist, I am left with the supervisor who seems a bit miffed about me showing up late. "Speedy" is what everyone called the supervisor.

So I am hanging out with Speedy as he takes calls, and takes care of paperwork. This is looking to be a pretty boring day. All the other students are out with therapists seeing some action. I did not realize that the fact that I had shown up late and was now languishing in an office watching some guy named Speedy take phone calls would actually lead me to one of the most intense days I had ever experienced.

It was late in the afternoon when Speedy got a call, and after hanging up the phone, he said, "Hey Mike, your in luck! Your going to surgery with me." Surgery? Why are we going to surgery. Speedy explained that he will be doing oximetry readings during an angiogram. He explained it all to me on the way, and requested that I just keep behind him and stay quite. So we scrub up, gown up, and I even get to wear one of the doctor masks.

The patient is awake and obviously a little anxious on the operating table. There is equipment everywhere. Most of it I did not know what it was at the time, and I was pretty overwhelmed.

This particular patient was an elderly gentleman, and had been involved in an auto accident a few days earlier. He had been recovering well but was having some irregular heart rhythms. They hoped to determine with the Angiogram if there is any damage to the heart from the accident. A catheter is inserted through the femoral artery and is advanced up the aorta to the heart, and a blood sample is drawn. Speedy processes the blood in a Radiometer Oximeter that detects the oxygen level in the arterial blood. All is going well, and Speedy processes another blood sample about every 10 minutes. Dyes are being injected through the catheter into the heart and we see live motion pictures of the heart beating and watch the blood that has the dye flow though the heart. I looked on with amazement!

It came on suddenly. Alarms were going off! The patients blood pressure was dropping. He was in tachycardia, Speedy went to the bedside with an Ambu bag to be ready to apply artificial ventilation if necessary. The patient was conscious and was very frightened and was saying "don't let me die, don't let me die!" Speedy was reassuring him that they were not going to let him die. The patients condition deteriorated rapidly.

The patient stopped breathing and his heart stopped beating. The surgeon made the decision to rapidly open the patients chest to do manual compression of the heart. Speedy was forcing 100 percent oxygen into the patients lungs with the Ambu bag while the surgeon rapidly opened up the chest with a large incision on the left chest between two ribs. The ribs were spread open to reveal the left lung. I could actually see the lung being inflated by Speedy's efforts. The surgeon reached in to do manual compressions of the heart with his gloved hand and what happened next was a surprise to everyone. A huge blast of blood exited out of the chest hitting the surgeon and the wall.

"That's it.... were done here" the surgeon stated. Speedy was told to stop the ventilation. I was in a state of shock! I was thinking to myself that I may have just seen for the very first time... a person die.

The autopsy later revealed that the patient had a cardiac tamponade. This is a condition where blood collects between the heart muscle and the thin membrane sack that surrounds the heart. Probably a result of the auto accident, and indeed would be the cause of the irregular heart rhythms. His condition became worse during the angiogram. The burst of blood was the heart wall blowing out when the surgeon attempted manual compression of the heart.

As we left surgery, Speedy asked me if I was okay? Yeah... I think so. He said most days are not like that. My first day introduction to being a Inhalation Therapist was quite an eye opener. It was no longer about me making 40 cents more an hour than if I worked at the car wash. This was dealing with real people and real life and death situations.

I spent close to three decades working as a Respiratory Therapist. There are good memories, and a lot of hard memories. That is another story.... Or maybe a whole book.

As I am no longer working as a Respiratory Therapist, I extend my appreciation to those who continue to do the noble work as health care workers as Nurses, Radiology Technicians, Laboratory Technicians, Respiratory Therapists, Physical Therapists, and all the other ancillary health care workers. Overall these good folks are underpaid, overworked and under appreciated.


HillBillyJedi said...

Wow, let that be a lesson to you young folks... Don't show up late!

Mike- You are a good story teller. Keep 'em coming...

Anonymous said...

Good write up Mike. You do have a way with words. Write that book.

Ordie O. said...

You left out the watermelon and IV tubing.