Have guidelines replaced critical thinking?

I think guidelines and order sets are good in a way, yet more often than not I think they are used as a crutch, or as an excuse to be lazy.  I honestly and truly believe guidelines and order sets have replaced critical thinking.

Guidelines are good in that they help "guide" our thought decision process.  They help us with the critical thinking process given an individual set of circumstances.

A good example here is Basic Life Support (BLS) and Advanced Cardiovasular Life Support (ACLS).  Given a specific emergency situation, and given specific medical training, these programs help people decide what to do in various emergency situations.

That sounds good, yet it's not always good.  For instance, most BLS programs say you should give breaths after so many chest compressions for people in presumed cardiac arrest.  Yet some people get so  intent on making sure they give breaths that they become overwhelmed and do everything wrong.

In this way, the layman's attempt to do BLS right replaces common sense, which would dictate that if you do chest compressions correct you shouldn't have to give breaths.  Common sense also dictates that if you give mouth to mouth breaths you are giving that person less oxygen than is in room air, which is not enough to sustain life.

Common sense would say you treat the patient not the order set, guideline or "ALGORITHM."  Yet there are a ton of nurses, respiratory therapists and DOCTORS who's main focus is on order sets, guidelines and algorithms, and they focus so hard on following these things they don't think.

Those who suffer are the patients, who get less than adequate care.  I can give example of up the ying yang, starting with doctors who order Albuterol on every patient because they were taught in medical school that this drug cures all annoying lung sounds and lung diseases.  Yet an accurate assessment of the patient, with a dose of critical thinking, would reveal that the patient actually needed lasix.

The best example I can think of was once a patient was inadequately breathing yet was still awake.  ACLS guidelines say if you have to put a mask over a patients face so you can give breaths with an AMBU bag you should have a second person hold the mask firmly over the patient's face and have a second person give the breaths.

Yet I was doing both on my own, and the patients sat was 99 percent.  The patient was getting adequate breaths.  Yet the doctor insisted I take my hands off the mask and she held it so tight that air was squeaking out the edges of the mask.  The patient was fighting.  Then all of a sudden the patient's sats were in the 70s and the doctor panicked.  She said it was my fault because I didn't follow the ACLS guidelines.

Yet I disagreed.  I told her it was her reluctance to do critical thinking that caused that patient's sats to suddenly drop, and it was for that reason this patient needlessly died of asphyxia.  She died because she was so intent on following the ACLS guidelines that she failed to think.  She killed the patient not because she had bad intentions, but because she was taught to follow the guidelines.

What we must realize is that guidelines, order sets and algorithms are good, yet they are just that -- guides. Guidelines must not replace the critical thought process.

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How passionate are you about your job?

A good morale is often the key to creating a good work environment.  The higher the morale of  each respiratory therapist the greater the customer service they provide.  Hence, the happier the RT the happier the customer will be.

One study suggests that worker morale is directly related to worker satisfaction.  Hence, study researchers might ask you which of the following describes your mood about your job.  Are you:

1. Passionate about your work?
2. Satisfied with your work? 
3. Engaged in your work?
4. Apathetic about your work?
5. Numb about your work?

Based on responses, studies showed the following:

1. 10-29% are passionate about their work; they are completely engaged
2. 60-80% are satisfied with their work but not engaged
3. 10-20% are disengaged; they just work to get a pay check

Disengaged workers feel there is no hope no matter what they do, so they just do what they are asked to do and that's it.  Disengaged workers tend to be apathetic, such as is the case with respiratory therapy apathy syndrome. 

To keep workers engaged, it's best to involve each member of the department in tasks.  Yes, that means that  you might be asked to do a certain task, such as teaching oxygen therapy to nurses, or becoming a Basic Life Support educator, or making a presentation at your local respiratory therapy conference. 

You also may be asked to write a protocol or hospital policy, or anything that keeps you enganged.  Another technique is to have you write a blog such as the RT Cave.  Surely you may have no control over your work, yet you will have control over your own projects.

The more you do, the more involved you are, the greater your morale will be.  This has a direct impact on your satisfaction, and the happier you are the happier your customers (patients) will be. 

Another way to improve your satisfaction is for your boss to ensure you have the best benefit package possible, make sure you get an annual raise for inflation plus bonuses if possible, and to involve you in departmental decision making.

It also helps to get praise.  It also helps to be listened to.  It also helps when you are respected when you make a recommendation.  It also helps when you have automony to use your experience and education to do what's best for the patient.

Yet doing all these things isn't always possible.  RT bosses get busy, and they get a lot of pressure from their bosses to mak your RT Cave look good on paper.  The end result is you may not get the results you want, and you become apathetic and disengaged.

So, how passionate are you about your job?

(see natural progression of satisfaction)
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The natural progression of satisfaction

I remember way back before I was hired as an RT, back when I had a new job every summer.  I remember observing how the people who worked for five or more years tended to be apathetic and disengaged from their work.  These people spent a lot of time complaining. 

I saw the same thing when I was hired as an RT.  My coworkers acted like they hated their work.  They often complained and were slow to get up when their pagers went off.  I didn't understand this because I was absolutely passionate about my work.  I even remember thinking once I loved my job so much I could work every day.

What I observed was what is referred to as the natural progression of satisfaction.  Most of the people who complained, I observed, were those who had worked for over five years of the same job, doing the same tasks, caring for the same customers. 

Those who were the happiest were those who were new on the job -- like myself.  Little did I know my own satisfaction would remain high for a while, yet it too would slowly dissipate.  Yes, I too became infatuated with apathy and I too became disengaged in my work.

This disengagement results in a reduction in the quality of your work.  It's something bosses want to reduce, and therefore it's been studied by experts. 

When we first get a job there is a new excitement.  We are learning new tasks and we are excited as we get better and faster at it.  We feel as though what we do matters, and the better we are at it the more satisfied we become.  The quality of our work is high.  Our customers are satisfied with our work.

Yet then time happens.  What was once challenging now becomes a redundant procedure.  You become educated and learn some of what you do isn't needed.  You learn shortcuts that make the job easier, and you start to simplify your speech so each customer hears the same things from you.  Instead of treating each customer unique, you treat them all the same.  You, in essence, become an automaton.

What happens is your job becomes routine.  Routines result in shortcuts.  Short cuts cause quality to be diminished.  Instead of feeling the need to run to a code you walk.  You are relaxed when you should feel an adrenaline rush.  When a sense of urgency is replaced by routine this is akin to working in a factory spending the entire day wrapping paper around cigarettes.

Think back to when you first got your job as an RT.  When your pager went off you were eager to see what your message was.  You rushed to complete the job, and you were eager to provide your services.  When you were done you were eager to discuss what you did with your coworkers.  You cared about your work.  You were proud.

Then over time, after learning that many of the patients you care for don't even need to be in the hospital, after realizing most doctors have no clue what a bronchodilator does, and after realizing most nurses want breathing treatments for all dyspnea, the thrill of your job wears out.  You start working just so you can get a day off.  When you do work you can't wait till the end of the day.

We still care about our patients, yet much of our concentration has shifted from what we can do to benefit our patients to just doing your job as fast as you can so you can get back to your game on the Internet.  You are good at what you do, and too good.  The task has become routine.  You take shortcuts, and the quality of your work diminishes.

Many RT bosses have no clue about the natural progression of satisfaction.  Many know about it because they were RTs once too, yet because they are now above it they don't care.  Others learn about it and work hard to try to prevent it.  They want to prevent it because they want quality to remain high. 

Quality comes from pride. So the goal here is to keep RTs proud of their jobs.  This reminds me of a recent encounter I had with my boss.  I was called to assess a patient who had aspirated and was now short of breath, and I advised the nurse that a breathing treatment wouldn't be of any use.

Regardless of my recommendation, 20 minutes later my pager went off with the message:  "Breathing treatment needed on that patient STAT!"  My boss happened to be standing next to me when my pager went off, and I said, "Sometimes instead of thinking nurses just order breathing treatments."

"You should be proud of your job," my boss said.  "You should want to do things you're asked to do."

I said, "I would be proud if my recommendations were respected.  When I recommend one thing and the nurse completely ignores what I recommend, that makes me not proud.  It makes me feel disconnected.  It makes me feel that I don't matter."

So what can my boss do to keep RTs proud of their work?  I think the simplest thing to do is to listen to what we say, and respect what we recommend.  We all spent two years in RT school to become experts on the lungs and how to treat respiratory diseases.  We spend every working day with respiratory patients developing skills. 

I think all that is needed to make an RT proud is to respect us.  All we want is to be treated like the professionals we are.

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Delayed gratification

I am one of many who will contend that one of the problems with our society, and why the economy is doing so poorly lately, is that so few Americans believe -- or even comprehend -- the idea of delayed gratification. 

We live in a society where we want everything, and we want everything now.  We want the best house and the best car and the best toys for our kids and the best toys for ourselves.  Many of us are even willing to mortgage everything we have in order get all this stuff. 

Delayed gratification, defined, means that you do just the opposite:  you wait.  You wait to buy something until you can pay cash for it.  In this way, you can get twice as much and enjoy it twice as much. 

Yet many of us can't wait.  We think we need things right now.  This was the topic of a research project completed in the 1960s and 1970s (and discussed here at science daily) where pre-school kids were given a marshmallow and told if they wait five minutes before they ate it they could have another marshmallow.  "Some of the children resisted, others didn't."

A new study followed up with the kids tested in the original study and the results showed that the same kids who resisted eating the marshmallow when they were kids showed that they were still skilled at delayed gratification as adults. 

Kids who couldn't resist the temptation to eat that marshmallow (or cookie, or candy bar) as kid were equally as likely to be unable to resist the temptation of immediate gratification as an adult.  Which almost makes one wonder if the skills of gratification are inert and genetic as opposed to environmental.

Of equal interest, the study showed this:

Brain imaging showed key differences between the two groups in two areas: the prefrontal cortex and the ventral striatum.

Researchers say this is the first time they've found "specific" brain differences associated with gratification.  This might help them, they contend, to learn more about and how to treat people with addiction -- like addiction to stuff.

I learned about the above study from this article in the Blaze.

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What's better: Hard skills or soft skills?

If you're an RT you've developed skills to help you do your job, and do it well.  If not... well, then chances are you won't go far in this profession.  Some skills can be taught, and are essential to becoming a good RT.  Some skills, however, are learned, and are essential if you want to be more than just an RT.

There are two different types of skills:  hard skills and soft skills.

What are hard skill?  These are skills that can be taught and that you can improve with experience.  These include the following:

1. Setting up and managing ventilators
2. Doing breathing treatments
3. Charting on a computer
4. Performing EKGS
5. Doing ABGs
6. Setting up oxygen
7. Performing a patient assessment

What are soft skills?  These are skills that help you get along with other people, and adapt to different situations, and help you move up the professional ladder.  These are your personal attributes, like:

1. Common sense
2. Empathy
3. Sense of humor
4. Optimism
5. Sociability
6. Teamwork
7. Communication
8. Prioritizing (time management)
9. Leadership
10. Manners
11. Integrity
12. Friendliness
13. Strong work ethic
14. Critical thinking (problem solving)
15. Self confidence
16. Ability to accept criticism
17. Ability to learn from criticism
18. Flexibility (adaptability)
19. Working well under pressure

Since anyone can be taught hard skills, it's soft skills that separate the clan.  Anyone can do a breathing treatment on Mrs. Cox, but only a few can get her to like you.  Anybody can set up a ventilator, but only a few can gain the confidence of rough Dr. Bowersocks.

Anyone can join the gossip tree, yet it takes one with character and integrity to find something better to do.  Anyone can join the complainers, yet it takes one with a sense of humor to laugh it off.  Anyone can be a treatment jockey, yet it takes someone with empathy and good communication skills to truly benefit the patient.

There are a ton of treatments and EKGs to do in a short period of time.  Do you have a sense of urgency to properly prioritize and finish all your work so the next shift isn't overwhelmed?  

Can you get into a conversation with any patient?  Can you have a discussion with the complainers one moment and then an optimistic discussion with your boss the next?  Can you make any doctor or patient happy?  Does everyone like you?  If so, then you have good soft skills.

If your boss ever decides to get rid of a few RTs to downsize the RT department, the people he or she is most likely to keep are those with good soft skills.  Likewise, he's also more likely to consider those with soft skills for advanced assignments that might make you management material.

So anyone can learn hard skills to get you the job, yet learning the soft skills needed to keep your job is something only YOU can work on.  

References:

1. SearchCIO.com
2. Jobs.AOL.com

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Welcome the easy solution with open arms

Dealing with anxieties that come with life can seem overwhelming at times.  Yet if we dig deep down to the basics of life, the solution may be easier than what we might think or feel at the time.

We as humans can take the things that happen to us and allow them to effect our lives.  We might even blame God and lash out at Him. Yet he thinks of us as children (Isaiah 49: 14-15) and welcomes us back with open arms and a smile.

As I sat in church today listening to the Priest, and my daughter was throwing a fit, it tended to make me want to beat the crap out of her.  Yet I didn't.  I did as the Priest described the Lord would do if I were to throw a fit and decide I hated him for letting something bad happen to me.  He would welcome me back with open arms.

This hit home with me only moments after the Priest talked about it, considering my daughter was sitting next to me refusing to sit the proper way, kicking her boots off and putting her coat over her head.  Yet I looked at  what was the #1 priority in my life, which is my relationship with God.

I decided that the most important thing for me to do in life is to keep my relationship with God strong. If you don't believe in God, then you can use God as a metaphor for values and virtues.  If you have values and virtues, if you have a strong relationship with God, everything else will fall into place.

We must not let the little things in life overwhelm us.  We must not let that our kids overwhelm us. We must not let a recession overwhelm us.  We must not worry about that of which really in the end doesn't matter -- like annoying doctors.

As Matthew writes (Matthew 6: 24-34), "This is why I tell you: do not be worried about the food and drink you need in order to stay alive, or about clothes for your body.  After all, isn't life worth more than food?  And isn't the body worth more than clothes?  Look at the bird:  they do not plant seeds, gather a harvest and put it in barns; yet your Father in heaven takes care of them!  Aren't you worth much more than birds?  Can any of you live a bit longer by worrying about it?"

All the stuff we worry about doesn't matter.  What matters most is our relationship with God.  In our times of trouble we must back up, take a deep breath, and reassure our faith with God.


Matthew 6 (24-34
Corinthians 4 (1-5)
Isaigh 49 (14-15)


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Ideas and economies change, but people never do

I hear people say a lot how nice it would be to return to the good ole' days.  Or they say how young kids lack virtues these days.  Yet did you know that these are things people have been saying since the beginning of time?

It's true.  In fact, Plato wrote something similar to the above quotes, and he lived before Jesus walked the earth.  "Not many people are these days," my patient said regarding a discussion on principles and values and virtues.  "Not many people are these days."

Ideas are different, and the things we entertain with are different, and our economy is different, and our wisdom and view of the world is different, yet people are still the same.  People will always be people.

"The divorce rate is higher than it ever has been," another patient said.  Yet that's not true either.  The divorce rate has always fluctuated through time.  Men and women always had affairs, and they have been known through time to get divorced.  It's nothing new. 

People don't change.  What changes are the times.  Economies are better, governments protect our natural rights better, we have more leisure time, and more time and money to enjoy the pursuit of life, liberty and pursuit of happiness. 

People have always been reluctant to eat breakfast.  People have always eaten too much.  In fact, women in the 18th century and before were expected to be overweight.  It was normal.  It was a symbol of status.  It was a sign that you were wealthy.  It was a sign you had enough money to buy food.

Things go in cycles.  "Kids just don't have the respect for their parents these days."  That was first said thousands of years ago.  People never change.  We are people. 

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It's time to slow down

When you face a personal crisis, one of the first pieces of advice of any personal health expert will be to tell you that you need to is slow down. You need to simplify things. The best way to organize, or re-organize, your life is to simply slow down.

That kind of wisdom goes back thousands of years. It usually take either an expert or a person who is experienced to see that the best way to solve a problem is to slow down, to analyze the problem, and then to tackle it slowly. This allows one to think better. This allows one to see the whole picture.

A great example of this is landing an airplane, or so I hear.. If you are landing a plane and meet resistance, or a draft, what happens next is determined by the action of the pilot. A natural instinct of an amateur is to speed up. They think that by going faster this will allow them to get through the problem.

Yet what happens is he meets more resistance. The ride gets very bumpy. The problem gets worse.

The expert pilot, or the pilot with experience, will know that the best way to respond to a situation like this is to slow down. You slow down and you glide right in and the solution is easy. You land and end of story.

When you or I start to feel a financial pinch, we slow down. We spend less. We try to get our finances under control. This is what we must do or we will fail. We will have to file for bankruptcy.  When our lives get stressful, we don't tack on more tasks:  we slow down. If we speed up we go bonkers.  

Those in Washington are another good example. Washington in recent years is run by amateurs. Most are career politicians.  Most have never worked in the private sector. They see a problem and they want to solve it by spending more and creating more programs. They don't get it.

They don't see that by speeding up in this way they are just creating more friction. They are making the problem worse. In the late 1800s Grover Cleveland was asked to speed up during a recession, and instead he refused. He said something like, "When times are tough we must slow down, not speed up.'

Yet Cleveland was a wise man of the working class before he became President. He understood how to solve problems. He understood the importance of slowing down. Within a year the economy had improved. He stood on the sidelines, did nothing, slowed down, and that was it. Problem solved.

That's how resistance was treated on the national level back in the 1800s. Washington slowed down in the face of adversity. While there were many recessions and depressions in the 19th century, they were only 1-3 years max.

Yet now that our leaders are career politicians instead of working class people who understand how to solve problems by slowing down, they don't know how to lead. A good example here is FDR and Hoover. Instead of slowing down in the face of adversity they sped up. They spent and they created and the Great Depression went on and on and on.

The same is happening today. Instead of George Bush and Obama slowing down, they sped up. The problems of this nation did not get better. The recession lingers on. They do not understand the importance of slowing down; of getting out of the way; of looking at the big picture.

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Trials and trivializations result in character and refined faith

We have all faced trials in our lives where we have said, "Why is this happening to me?"  Or we have said, "Why do I have to endure such pain or misery?"  Yet the challenges we face are never more than what we can handle, and they always make us a better person, even if we don't see it that way at the time.

Character, modesty, humility, wisdom and a refining of our faith are developed through the hardships we face during the course of our lives.  We may sometimes feel as though things could not get worse, or we may feel like things may never get better, yet there is always a way out.

"No testing has overtaken you that is not common to everyone.  God is faithful, and he will not let you be tested beyond your strength, but with the testing he will also provide the way out so that you may be able to endure it" (Corinthians 10:13)

Another great description of the hardships of man is Psalm 77 which was written by the philosopher Asaph.  He describes his cries in the night because something horrible has happened to his life.  He describes his terrible suffering.  We all can relate to Asaph in this Psalm because at some point in our life we all faced a challenge that seemed to be never ending.

We face death and the challenges of death.  We face disease and the challenges of disease not just of our selves but the other people in our lives.  We face failures, such as the inability to get a job or of losing a job.  Since we are presently in a recession, many of us are presently facing the economic hardships that come with a recession.

Asaph writes, "...and my soul refused to be comforted."  Here he is describing how many of us felt during our time of hardship, our time of need.  No matter what we did we couldn't think of anything that would comfort us.  No words of others were comforting.  It seemed you were doomed to live in the miserable world you saw that day.

I remember being in the asthma hospital when I was 15, and even though I was told it would only be for 6-8 weeks, it seemed to last forever.  And then when the 6-8 weeks was up, I was told I would need to stay at the hospital another 6-8 weeks or longer.  I felt trapped.  I felt there was no way out.  I felt that nothing was ever going to get better.  I was depressed. I felt God hated me and was punishing me.

Then in our distress we yearn for the good ole days, as Asaph writes, "I thought about the former days, the year of long ago; I remember my songs in the night."  When I was suffering back then, I remember thinking about what my parent's house looked like.  I remembered my mom's smile and my dad's stern hand.  I remembered playing with my brothers.  I kept thinking of what it would be like to return to those days.  Even though my asthma was bad, I was still happy.

Yet here I was trapped in this hospital where I didn't want to be.  However, I never gave up.  I remember every night after the counselors had us go to our rooms for the night with the lights out, I would crouch down by the little night light on the lower part of the wall and I would open my Bible.  I would pray first off that no one would open the door to come check on me, because I didn't want to get caught.  It's not that I was doing something wrong, it was more I didn't want to explain myself.  And, thankfully, of all the three months worth of days I did this, I never once was caught.

I prayed.  I said every prayer I knew of at the time.  My mom gave me some book marks with prayers on them, and even thought the prayers may not have been relevant to my situation, I prayed them anyway.  I remember one of the prayers was footprints in the sand, and another was the alcoholics creed (although I didn't know it was the alcoholics creed at the time).  It was "God, grant me the serenity to..."

Either way I prayed, and I refined my faith.  Even though I felt trapped, I re-decided it was with a purpose -- to get my asthma better. Yet I was quickly realizing it was more than just asthma.  The challenges I endured at this place with the other kids and the counselors made me a better person overall.

Yes it was hard to see at that time, yet now looking back at it from the mind of the 40 year old me, I see that the challenges I endured at National Jewish Health/ National Asthma Center from January 1985 to July 1985 helped me develop a better character, humility and to become more modest.  Through my suffering, through the challenges that seemed to never want to end, I became a better person, and through my strength and desire not to lose faith, my faith grew to the size of a full blooming tree.

Asaph in his Psalm (versus 10-12) writes that in rediscovering ourselves we must remember all the good things that happened in the past, and all the good things going on in our lives today.  And Lord knows there are many good things going on in your life at all times, even though the hardships seem to overshadow the good things.

Yet I thought of the good.  I thought of how I have such great parents who gave me this opportunity to get my life in order, and my asthma better.  I have such good counselors and friends.  I had a good life overall, and when I got out of the hospital my life was going to be all the better.  Sometimes this was hard to do, yet as often as I was able I tried to think of all the good.

And the most remarkable thing about this entire event is that I did get out one day.  I remember my dad saying late in June of 1985, "Rick, you're coming home. I don't know exactly how I'm going to do it, but you're coming home.  I'm going to hang up now, but I want you to sit by the phone until I call back."

The funny thing was that we were only allowed 15 minutes on the phone, and my 15 minutes was up.  I was afraid my counselor would kick me out of the phone room so someone else could use it.  But for some rare reason (God perhaps) there was no one waiting behind me.  And my counselor wasn't being mean this day, and he allowed me to sit and wait for dad to call back.  My strength and prayer was answered.  The phone rang, "Rick, you're going home."

Another ironic thing is my faith came from inside me.  I didn't much read the Bible back then as I do now, what I knew of the Bible came from Catechism classes.  My faith came from my mom.  And I had never read Psalm 77 and even if I did I wouldn't have understood it anyway.

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Hope versus desire

I wrote last Sunday about the need to teach about absolute truths and not worry about offending doctors and bosses in order to reform the medical field.  We must seek and teach the truth.  Yet since most of us know the truth hurts, we tend to turn a blind eye to it.  We've become apathetic enablers of the un-truth because that route is easiest. Instead we rely on HOPE!  We HOPE it will get better.

Yet hope is no way to lead the world into the future.  Hope will die with you.  It's good to have faith, yet hope will only lead a nation to destruction because those who hope are not doing.  Those who hope are dreaming of a better world.  Yet if there is one thing we should know as Americans is that dreams do not come true unless we act on them.

Even the Bible teaches that God helps those who help themselves.  Actually I think that's a quote made by some ancient philosopher and changed slightly by Ben Franklin when he wrote Poor Richard's Almanac, yet the idea has a certain truth to it.  The way to prosperity is through individual effort. 

Friedrich Nietzsche once wrote that,  "Hope is the worst of evils, for it prolongs the torments of man."  Hope never solved any problem.  Hope traps people right where they are, good or bad.  When you're hoping you are staying in your home, doing nothing, but thinking -- hoping.

There is no action with hope. There is action with desire.  Desire is when you want something and you go out and get it.  The founding fathers wanted freedom, and they gathered together, fearing death, and went out and sought and obtained freedom.  They didn't do it by sitting at home. They did it by grabbing a pen and a gun and seeking it.

Friedrich Nietzsche's, I think, meant that when you hope you see that something is wrong and you are dreaming of a better world or a better idea.  You are not happy, yet you see a world that is ideal to you and will make you happy. 

When you hope you are unhappy, incontent, miserable or not satisfied.  You are not happy.  Yet your torment continues because nothing is going to be done.  Hope never changes anything.

You can do the best for your child and then hope for the best.  You hope he makes the right decisions, and you hope that God helps him.  Yet God also says that He will help those who help themselves.  The parable of the talents told by Jesus through Matthew (25: 13-30) describes this well.
If you want something, you need to take risks.  God isn't going to help someone who buries his money.  You need to take risks.  There are risks in every thing we do, and nothing can remove the risk out of life.  It's a simple fact.  

So, even though you think there isn't much you can do once your child leaves the house, there is.  For one, you can continue to keep contact with him, and you can continue to set a good example.  You can continue to preach the truth, and you can continue to go to church or whatever good deeds you did when you were teaching your child. 

You must not sit around hoping.  Hope never did anything for anyone.  However, by making a good effort to teach your child, you made an effort.  Then, and only then, can you sit around hoping you made the best decisions and set the best examples.  Only then can you sit around hoping that God watches out for your child.

Hope, as used by most people, is an excuse for not trying.  It's good to have hope after you've made an effort, it's good to have hope after you desire something, yet it's not good just to sit around at your homes and hope things work out.  Because if that's all you're going to do nothing will ever change.

Desire, on the other hand, does change things.  Desire means you want something and you go out through hell or high water to seek what you are after.  Desire is action orientated.  Hope must come before and after desire and effort, but never should you rely on hope alone.  Hope is good, but not alone.

If you desire change in the medical field, for example, if you desire doctors to stop ordering needless breathing treatments, and you desire for the government and insurance companies to stop telling doctors what they have to order in order to get paid, then you have to make an effort. 

Desire should precede effort and hope should follow that.  Yet hope alone will not solve anything.  If you live on hope alone you will always wallow in misery. If you are an apathetic medical care worker because you're burned out because you think doctors are writing stupid orders, or because your hospital quality assurance or Keystone committee has created order sets, then you need to make an effort to seek and teach the absolute truth.  You must make the effort, and then you can hope for the best.

Another person can bring false hope.  Some people want you to feel like despots, to feel miserable, to feel apathetic, and then they want to to sit around hoping things will get better some day.  They want to trap you.  When you are trapped you'll feel there is nothing left but hope -- false hope.

Hope is an emotion.  Emotions don't solve problems.  You can feel sorry for someone, but hoping they make the right decisions isn't going to do any good.  Hope is the bottom feeling of people who think they don't matter in the greater scope of things.  Hope is the cry of those who think they have no control.  Quite frankly, most people don't like not mattering, so they hope.

So you want doctors to stop ordering stupid breathing treatments, or to quit believing in that stupid hypoxic drive hoax,  and so you hope that someday it gets better.  Yet what did you do to create change? 

The people who want to defeat us, the people who want to control us, want us to sit around hoping all day.  They want us to feel hopeless, apathetic, and then they have all the more power over us.  They want you to feel as though your life, your job, has no meaning. 

Heck, how many times have you heard an RT or RN say that 90% of what we do in the medical field has no reason?  Most of what we do wastes time or delays time.  That's what some people in power want.  They want you to hope so you have an excuse to sit around and do nothing but wine and complain.  They want you to feel empty.

Say you're playing a basketball game.  You can have hope that you win, but you can hope all you want because that alone won't bring about victory.  If you want to win you have to have desire, and you have to act on that desire with effort, and then you have to hope you gave it your best  as a team.

We must have family, faith, hope, love and charity.  Yet we must also have desire and we must also have effort.  To make the medical field better, to make the U.S. better, we must have hope, faith, charity, yet we must also have desire and effort. 

I'm not sitting around hoping things get better.  I'm not sitting around hoping the medical field gets better.  I'm not sitting around hoping doctors some day stop ordering stuff that's not scientifically proven to do anything.  I'm creating a better world.  I'm taking action.  I'm sitting here blogging.  What are you doing?


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God, or the 7 basic values

God!  Eighty percent of Americans say they believe in Him.  Rather, 80 percent of Americans say they believe in Jesus Christ.  Yet Jesus and God are one and the same.  And I truly don't think that saying you believe truly means that you really believe. 

I encourage everyone to have a relationship with the Lord because it can help you simplify and find purpose in your life.  However, for those of you who truly don't Believe, when I write about God you can simply use Him (God) as a metaphor for the following virtues:

1. love

2. hope

3. justice

4. forgiveness

5. family

6. service

7. compassion

8. truth

9. faith

Place these virtues above all else and you will find in yourself a simpler, humbler, more purposeful self. 

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The most basic priority will help you become a better prophet

Every one of us has anxieties in our lives, things that we worry about.  This might be especially true when  we are hit by a recession, or the death of a friend or family, or are having trouble with a child.  We might become so wrapped in our anxiety that we lose sight of the big picture.  We might even blame God for our troubles, or wonder why He'd let such things happen.

Sometimes we become so wrapped up in our own anxieties that we leave God in search of answers somewhere else.  We doubt that He exists.  We feel as though he has abandoned us.  Yet with a little soul searching, we usually find ourselves and, like the child who is away from his parents a long time, we yearn for their return.

Yet the Prophet Isaiah (Isaiah 49: 14-15), when the people of Israel felt anxiety and that God had abandoned them, explained, "Can a woman forget her own child, I will never forget you." 

Likewise, when we feel anxiety, it's usually because we are worrying about things of which we have little control.  We worry how we are to put food on the table, or the best clothing on our children.  I presently worry that the mood changes that have effected my 7 year old after the death of her grandma and great grandma in the same day, might linger and effect the rest of her life.

I worry about my other kids, and my relationship with my best friend.  I worry that I might write something on this blog that might offend my boss and get me in the crap shoot.  I worry, like many do, that I might drop dead in a heart beat and never get to see my kids grow up.

Yet Matthew (Matthew 6 (24-34) writes that we should not be worried about the clothes we wear or the food we eat, "after all, isn't life worth more than food?  And isn't the the body worth more than food?" 

I think this passage might be one of my favorites in the Bible, and perhaps the most humbling.  We sit around worrying about these little things in life that seem so big, yet as Matthew continues on, he explains that these things are always provided for by God, or by God's prophets.  God will either provide these things, or one of his little helpers will come along and provide them for Him for you.

Likewise, he is also saying that there is something more important than anything you do in this life.  There is something you should do before you do any worrying, and even before you do any good deed.  Before you become the prophet of the Lord (which is what we RTs are in a way because we are helping people), you must first reaffirm your relationship with your God.

You must become one with God.  You must reaffirm your values and virtues.  You must think about:

1. love

2. hope

3. justice

4. forgiveness

5. family

6. service

7. compassion

8. truth

9. faith

10.  gratuity

Mother Theresa, before she would do any acts of goodness, would spend three hours in prayer every day.  I wouldn't expect you or me to spend three hours in prayer, yet a moment of prayer in the morning is often all it takes.  A moment in the morning, a moment before (or after) meals, and a moment before bed.

Once we have reaffirmed our faith, once we have reaffirmed our relationship with God (you can use God as a metaphor for the values listed above if you want), once we reaffirm with ourselves what our mission is in this life, once we reassure ourselves of our purpose, then and only then should you do anything else. 

Yet you should not worry or be anxious.  As Matthew explains, "Look at the birds:  they do not plant seeds, gather a harvest and put it in barns: yet your Father in heaven takes care of them!  Aren't you worth much more than birds?  Can any of you live a bit longer by worrying about it?"

The answer is not.  In fact, worrying is proven to take years off your life. Worrying causes ulcers and asthma and all sorts of bad stuff.  Worrying causes many to resort to gluttony.  It causes us to do things that feel pleasant but are unpleasant in the long run. A good example of this is the gluttony of yours truly when his first three children were in the making and were infants.  It was easy to replace anxieties with food and drink.

Yet with the last child he did the opposite.  While his while was pregnant, instead of resorting to gluttony and gaining weight with her, he did the Body for Life.  It was a sacrifice and it was almost unpleasantly hard, yet the pleasures of that hard work are now paying off. 

I remember when I was at National Jewish Hospital in 1985.  The first three months were fine, because I was told I'd be home at the end of three months.  Yet then I was told I would be there another three months after that.  This effected me for the worse.  I refused to talk to anyone.  I became a lost in my own head.  I became utterly depressed.  Then I turned to God and reaffirmed my faith (I wrote about this here).  I became closer to God than I ever had been before.

I think this faith lasted until about the year 2000 when I got my full time job working nights.  I became so rapt in my own desires and my own family and my own self that I lost my way. Thankfully when I lost my way I'm not referring to doing anything terrible.  Yet I felt as though I had lost my relationship with God.  I hated my boss.  I hated my job.  I felt utterly miserable. 

Yet after a while I decided it was time to return home.  I missed the way I felt when I was close to God.  I missed being that person who never cursed or never said anything negative.  I missed being the person everyone looked up to.  So I searched for God, and, as Isaiah wrote so many years ago, God was right there with open arms. 

The neat thing, soon after I started reading the Bible every day and going to church every week, good things started to happen.  Bad things happened in my life, and I didn't feel empty.  I didn't blame God.  My mother in law died and she was only 50, and I was able to cope with it quite well.  I quit complaining at work (I wrote about this here), and the boss soon placed me in a more positive position within the department.  People started looking up to me.  People who used to hate me were now getting along with me. 

I see something similar in my children.  My grandma once said to me that you, as a dad, will be like a got to your children.  I see what she means when I discipline my children.  They hate me for a short time, and then an hour later they are my best friend again.  They yearn for me to be with them. 

Ironically, as the priest was discussing the above, my daughter was throwing a fit in church.  She was refusing to sit and stand properly.  She put her coat over hear head.  When I returned to home I had no choice but to punish her to her room.  Then I found a book of mine (Stephen Kings Full Dark, No Stars), and saw that it had been written on.  It was my daughter's handwriting.  It said, "I don't believe in god"

I usually view book desecration by kids a good thing.  I think it makes the book more valuable.  Yet what she wrote stung.  It made me wonder about what is going on in her head.  Yet then I think back to when I was an anxious kid, and how did I turn out?  I turned out perfectly normal.  God provided a normal life for me, so why not would God provide a normal life for my daughter.

So worry I quit.  And an hour later my daughter was in the living room sitting next to me, giving me a big hug.  She loved me, and I loved her back.  God made us in His image.  As my love for my daughter will never end, God's love for me will never end.  When became lost and decided to be found, he was right there with open arms.

As Matthew continues, "So do not start worrying: 'Where will my food come from? or my drink? or my clothes?  (These are things that the pagans are always worried about). Your father in heaven knows you need all of these things.  Instead, be concerned about everything else with the Kingdom of God and with what he requires of you, and he will provide you with all these other things.  So do not worry about tomorrow, it will have enough worries of its own.  there is not need to add to the troubles each day brings."

We are all here in this life on a mission.  We all have a purpose.  Yet, we must prioritize.  As Paul explains (Corinthians 4: 1-2), "You should think of us as Christ's servants, who have been in charge of god's secret truths.  The one thing required of such a servant is that he be faithful to his master."

So we must re-confirm with ourselves the basics of life and what is important.  We must remember our values.  We must know what our mission on this earth is, and then and only then must we go out in the real world and do what we were born to do.  In my case, I was born to spend time with sick people and blog.  What were you born to do?

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It's good that we are here

I've seen death for what it really is.  I've seen the road to death. Yet what impresses me more than anything is when a person who is closing in on the pearly gates is okay by it.  I was reminded of this the other day as I entered the room of a 100-year-old man and he smiled.

He was among the most pleasant patients I've ever had.  His smile was bright and cheery as my 2-year-olds.  His vision of death perhaps the same.  He's obviously seen much, and most of those he has spent his time with are now gone.

Yet here he is sitting in this recliner, most of his teeth dark, his skin cracked and wrinkled, his hair white and barely visible along the sides of his head, yet in the moment he is happy he is here.  He has been humbled like no other man in the hospital.  He has seen more misery.  He has seen more happiness.  He has seen more than the 22-year-old man in the room next to him who was crying and agitated because he had to spend "one more night in this dump."

He spoke little.  He closed his eyes when you weren't speaking to him, and when you spoke he opened his eyes and listened.  I was most impressed by this, considering his old ears could still hear, and his eyes could still see, so long as he had his glasses on.

What more did he have to say.  Most people try to accomplish their goals in life, and to share their stories, by the time the predict they will die (some think they will live forever).  I notice COPD patients are often quite willing to talk and to share their life stories.  I've decided they've come to terms that they will die some day, that they will not escape the grim reaper's grip.

Yet when one is 100 years old, they have accomplished any goals they have set for their life, perhaps several years earlier.  They have shared all their stories.  I've rarely met an 80 year old who believes he has nothing else to offer in this world, yet I believe most of us don't expect to be around at 100.  Few of us will be on the journey this long.  It's a rare feet.

Yet he was happy in the moment.  He was happy he was here.  It sort of reminded me of the story that Matthew told in the Bible about how Peter, James and John see Jesus transfigured, his face white as the sun, as he is talking with Moses and Elijah.  They saw Jesus transfigured on Mount Tabor in all his glory, as he truly is.

So Peter says, "It's good that we are here."  He says this about the moment.  He knows he's going to have many trials and trivializations the rest of his life.  He does, as the Bible tells, reject Jesus three times before Jesus dies.  Yet he is happy in the moment.  He, in essence, has stopped to smell the roses.

Seeing the 100 year old man made me want to stop and re-evaluate my life.  Am I truly happy where I am at?  Or am I like the majority of people who spend their entire lives trying to obtain some goal, perhaps something trivial for material gain, and who fails to enjoy what life offers in every moment?

I do think of this often, and perhaps it's a gift because I have asthma and have been close to death's door a time or two as a kid.  I think often that my 12-year-old will only be living with us five more years, and my parents won't life forever.  And that, perhaps, is why I make sure to go to Florida every winter to visit my parents and go to Disney, even though I'm otherwise frugal with my money.

So in the moment I am happy.  I think of this even as I worked my ass off at work the past two days, perhaps doing the work of two or three RTs, and yet when I arrived at work on Tuesday my boss lectured me about how I need to start picking up after myself, and stop leaving my coffee and water cups lying around. I believe he is not happy he is here.

And after a miserable day at work like that, I go home and hug my kids and roll around the floor with them.  I am happy in the moment.  I am happy I am here.

Do you ever have a moment where you think to yourself, "It's good that we are here?"

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The cure for RT apathy is the ABSOLUTE TRUTH

One of the things we have gotten away from in this country is telling people about absolute truths because we are afraid of offending people.  We've gotten away from this in church, courts, school, politics and, you guessed it, the medical field.  The result has lead to many of the problems we face today.

There are two things we are told never to discuss with strangers, and these are religion and politics.  The reason is because we don't want to offend them.  Yet in church, in court, in school, and in politics we should be exploring the truth and teaching about absolute truths.

Yet out of fear of offending someone, we don't do this anymore.  Today we are more interested in keeping the peace than telling the truth.  The reason for this is because the truth can hurt.  And by golly in today's world of political correctness, we are more interested in keeping the peace than teaching truths.

To make matters worse, since we have quit talking about absolute truths, we have become lazy intellectually.  Instead of continuously looking for answers, we settle for what we already know.  And I think there are no better examples of this than right here in the medical field.

For years evidence has been coming out -- and reported right here at the RT Cave -- that the hypoxic drive is real but the hypoxic drive theory is not real.  Evidence supports the idea of giving patients the oxygen they need, and yet doctors continue to underoxygenate COPD patients out of fear they will cause the patent's carbon dioxide to rise and their drive to breathe to become diminished.

Yet in all my years as an RT, I have only seen this happen once.  I've seen CO2 rise slightly, yet that's it.  I have only seen a COPD patient have a syncopal episode following oxygen therapy once.  And he was put on a ventilator and his breathing supported, and he lived on another two years. 

Yet because we RTs are enablers, in that we are more concerned to keep the peace than to risk offending a doctor and stating the truth, this theory continues to be worshiped by many physicians.  Because we are afraid to tell the absolute truth, patients are needlessly suffering.  Because we are afraid to tell the truth, the science world has become lazy in their research because doctors are not pushing for the absolute truth.

Instead, doctors in this country continue to teach and practice based on theories that are older than dirt.  Patients suffer, respiratory therapists and nurses are overworked and burned out (resulting in burnout and apathy), and the entire medical field suffers as a result.  And we RTs and RNs know about the problem and solutions, yet we don't tell the truth because we are afraid of offending physicians.

We need to step up and rise above the fear to educate doctors that bronchodilators treat only a select number of disease processes that result in bronchospasm and not the list of nearly 30 disease process that they order them for. I'm sorry if this makes you made, but Ventolin does not benefit all that wheezes and all that causes shortness of breath. 

Ventolin does not treat inflammation (pneumonia), it does not get into the alveoli (pneumonia and CHF), it does not reduce fluid in your lungs (CHF), it does not treat processes outside the bronchioles (lung cancer, pleural effusion, pulmonary embolus) and it does not treat processes of the upper airway (croup, dry throat), it is not a cure for aging, and it won't prevent death (death rattle). 

Yet speaking these truths may hurt the person you're telling it to.  You Will insult their intelligence.  You may even risk losing respect, and even your job.  You will be called lazy and trying to get out of work.  Yet this is what's needed in the medical field. 

I don't know if you guys know about this, but when Moses escaped Israel, only 20 percent of the Israelites left with him out of fear of the absolute truths that lay out there.  They weren't sure they wanted to make the sacrifice, take the risk of going where no one has gone before.  They were afraid to face the absolute truth. So for this reason only 20 percent of Israelites stood by Mt. Sinai when Moses introduced them to the Ten Commandments.

Yet that's all it took was a small 20 percent to stand up and tell the truth.  All it takes is for a small group to peaceably assemble and say that the medical field is broke and we need to fix it, that we need to find the absolute truths and teach.  We need to put a kingdom of light over the darkness caused by the power of deception.

Related posts:

• Respiratory Therapy Apathy Syndrome (RATS)
• RATS NEST Formed
• Ativan Nebs:  A Treatment Whose Time Has Come
• Respiratory Therapy Depression
• Idealism versus Realism
• RT Idealists versus Ideal Realists
• The Hypoxic Drive Hoax
• 28 Non-Indications For Bronchodilators
• Pneumonia Not Indication for Albuterol
• Cardiac Asthma Should Not Be Treated As Asthma
• Fake 'olins

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God and success

You can disagree with any opinion, yet you cannot disagree with statistics. And every statistic regarding God and success shows that those who believe in God have more successful lives, and have more overall satisfying lives than those who do not believe.

Yes I believe in God. Yet it is also been my belief that even if I did not believe in God I would still raise my children in the world of God; I'd still go to church and have my kids learn about God and Jesus and Christianity. History shows, as the founding fathers new, that individuals function better when they believe in God.

Sure, if you believe in some other God or maybe even the Peanut Butter Ferry or Judas Priest that's fine too. What's important is that kids believe if they are good they will be rewarded in the end of life, and if they are naughty they will be disciplined at the end of their lives.

Likewise, people who are generally good, who live a frugal life and have their priorities in the right place are happier themselves, and they are seen in a more positive light by other people.

I believe this is why the Soviet Union failed, because they tried to get rid of God and religion and churches. The belief here was that in a socialist society, the state is supposed to be the true religion. To benefit all of society, the people are supposed to worship the state. The state knows what's best. The experts in the state know what's best.

It's also why the French Revolution failed, because the french revolution didn't favor the individual, as God would.  God believes all individuals are valuable to a society, including those who disagree with you.  That strong opposing opinions are good for a functioning society.

The French Revolution lead to the bloody slaughter of hundreds because they didn't value the individual.  Those who didn't believe in the revolutionary cause were killed.  It also resulted in the dictator Napoleon.  So as you can see, revolutions don't always result freedom. 

The American Revolution lead to freedom because the founding fathers believed in God, and they believed that the rights of men come from God, and can only be taken away by a government. 

Yet if there's religion, then people will worship the religion. Christianity especially preaches personal freedom, or individual freedom, or individual rights. The Bible preaches that to get to Heaven we must be good on this earth.

People who believe in God live happier lives.  And patients that believe in God are happier patients.  It is my observation that if you have a patient with a life threatening illness, and he or she is in good spirits, chances are that patient is a believer. 

I'm sure that's not always the case, yet as a rule of thumb the most pleasant patients are the ones who believe in God, because just knowing your life will not end when your body expires is somewhat soothing to the mind.

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If you're a fool with your money, don't come crying to me when it runs out

Fools get caught in the money trap!

Last summer it was slow at the RT Cave.  In fact, it was so slow we were losing about half our hours each week.  It didn't bother me so much because my wife and I were prepared for such a lull.  I was actually enjoying the extra time off.  Yet my coworker Paul wasn't prepared.

When he approached me I could tell right away he was distraught.  He said, "You know, Rick, it's unfair that we have to have so many days off lately.  If they complain about me getting a second job I'm going to blow up."

"I don't mean to sound rude," I said, "but you're barking up the wrong tree."

"What?  Why do you say that?  I only worked 24 hours last week. I could work another job and make up for the lack of hours."

"Well, if you didn't spend all your money on everything you wanted when the going is good and the money is flowing in, you wouldn't have to worry about losing hours, and you would need a third job."

His eyebrows seemed to cross and his lips curled, yet he didn't say anything. 

"Look, I said, you wanted to hunt, and you spent a thousand dollars on all that hunting gear that sits in your garage.  You took up fishing and now you have a boat and fishing gear sitting in that storage facility you pay a hundred bucks a month to rent.  If I remember right, that's also where you story your $250 a month camper you bought on a lease.  You have two leased cars in your garage, and you also have two jet skiis, two snowmobiles, two motorcycles and then there's that brand new car you bought for your daughter.  Add that stuff up and add them to all the other toys you have in your brand new home and it's easy to see why you have to work three jobs."

Of course this discussion didn't really happen, yet if I were completely honest with some of my coworkers, friends and family members I'd be having this discussion with many of them.  They complain about not being able to pay their bills, and yet they spend money like it were never going to stop coming in.  They never prepare for the inevitable recession or slow time.  And in the hospital, business has its normal cycles of up and down, just like the economy.

Our politicians want you to spend your money unwisely, and that is why -- I think -- it isn't taught in school how to wisely spend your money.  This is also the reason for bubbles when the economy is good (Internet Bubble, Housing Bubble, etc.) and it's also the reason people panic when the bubbles inevitably burst.

The same can be said of governments.  If those in Washington were as wise with their money as the frugal citizen, America would not be billions of dollars in debt.  If state governments wouldn't have been unwise with our money in the 1990s, they wouldn't be fearing bankruptcy.  Industries who plan and prepare and spend frugally wouldn't need bailouts.

If your work hard and spend your money wisely and go into hard times, then I'll feel sorry for you and maybe even help you out.  Yet if you are a fool with your money, don't come crawling to me with your sob stories. 

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The world revolves around social people (extroverts)

There's this old saying that the squeaky wheel gets the grease.  I think it's common wisdom that extroverts tend to be squeaky wheels more so than introverts.  Therefore, I've concluded that the world revolves around extroverts.

Consider singing in school.  Many extroverts love singing, so they think everyone should sing.  Yet you have the introvert or shy kid who doesn't feel comfortable, yet he's still pressured into singing. You can see him way in the back, if you look close, and he's probably lip sinking.  His face might be red.

The introvert may have allergies and asthma, and this coupled with his shyness has other kids picking on him, maybe pounding him in the chest or something like that.  This happens because he's not talkative, and not social as the extroverts are.

You have TV shows like iCarly and all the actors are extroverts.  They make fun of people who have allergies and might be, well, shy.

Looking at our history we only had one president who was an introvert, and he only became president because he was vice president when Warren G. Harding was killed (or committed suicide).  The president I'm referring to was Calvin Coolidge, or silent Cal.

Extroverts in Washington don't have time to read their history or their economics 101 courses, so they make laws without really knowing what their doing.

You have doctors who do things they were taught (like not oxygenating COPD patients) based on theories from the 1930s, and even though we know better now the old methods are still worshipped.  We introverts try to stop this, yet it continues to go on.

The world is run by extroverts, I surmise, and introverts are just along for the ride, forced to live in an extrovert world.  You dance, we watch.  You talk, we read and learn.  We know, yet you feel and believe. 

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The human aspect of working in a hospital

I'll be honest that I'm not the best respiratory therapist.  Obviously there's a lot of respiratory wisdom and experience stuffed in my cranium, yet sometimes it takes a moment to sort through it all and come to a decision.  That's why I never would make a good doctor.

Yet, I suppose, it takes all kinds to make an institution run smoothly.  I'm usually silent when there's a lot of people around, and my voice is soft.  Yet one on one with my patients and the patient's family is where I excel.  I also have a knack for fine tuning machines so they work well for patients and keeping them comfortable.  I often go out of my way and use my soft skills keep people happy. 

So I'm good at PR.  I think that's a good asset because many RTs and RNs and most doctors tend to lose the human aspect after so many years of doing this job.  I've had many patients and family members thank me wholeheartedly for taking the time explaining things, or taking the time to give a patient on a BiPAP a break from the mask even though the doctor didn't order it.  One time I even brought a patient a burger, and another patient one of my books because she looked bored and said she loved to read. 

Just recently we had a patient who needed the BiPAP to take a deep enough breath to blow off CO2 and to oxygenate.  The doctor ordered not to take mask off no matter what.  Yet that doctor isn't sitting by the side of the bed with the crying patient whose face is aching and sweaty under the mask.

So I gave her a break.  The doctor later told me I wouldn't have done it if I had seen the x-ray.  Yet I said I did see the x-ray and I wasn't taking her off with the intention of keeping her off.  I did it for three reasons:

1.  To give her a rest
2.  To prove to her she needed it, because she quickly got short of breath.
3.  To allow her to rest her face, take a drink of water, blow her nose

You see, that's where I excel.  Then I explain to the patient the BiPAP is not long term, and while it's uncomfortable, it's much better than a tube in your throat.  If you had a tube in your throat you wouldn't get any breaks.

I think some folks become apathetic and lose sight of the human element.  Doctors order for Q4 breathing treatments without considering the patient also needs to sleep to get better.  They order for no breaks of the BiPAP mask, and they put catheters in patients who can just as easily pee in a can.

They rip the patient's gown down right in front of the family, and they say what's going on without making sure the patient and the family understands what's happening, or they blow up at you right in plain view of the patient. 

The family and the patient are stressed, and then I come into the room and explain everything in a simple method that boosts my ego a bit and has everyone in the patient's room feeling better -- a little better anyway.

You can shut the door, or pull the curtain, or explain things.  You can listen to the patient's stories or you can watch a ball game with the patient.  You can ask the patient if he needs anything and actually go out of your way to get it or do what they want.  You can fetch a nurse and reassure the patient.  You can make sure the patient's not in pain or the patient is breathing fine.  Yet you can't be assured anything will get done unless you do it yourself.

You can check on a COPD patient every two hours instead of every 4-6 just to assure the patient that you're right there and available -- that you're keeping an eye on him.  Family likes this too.  You can be proactive by assessing the patient and preventing the patient from crashing.

When you're at a code for a patient in bed one you can talk to the patient in bed two.  You can assure her that her room mate is a little sick but will be okay.  And then you can do a follow up with the patient in bed two to let her know what happened.  A little reassurance goes a long way.

All it takes to make someone happy sometimes is just a little notice of the human element.  Sure you have a job to do.  Sure that patient becomes just another part on the human assembly line, yet a person is still a person no matter how small as Horton the Elephant would say.  People get scared and anxious.  Hospitals are scary.  And I have the ability to take some of that edge off -- all of us can take that edge off.

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The true meaning of Christmas

I remember going to Grandma and Grandpa Frea's house on Christmas Eve and seeing a million presents scattered from the Christmas tree to the fireplace mantle, alongside the fireplace and lined up all the way along the wall and up the staircase. I remember the excitement as we kids looked over all the boxes looking for something that was ours.

Of course in the end, after a long, long wait, there was only one box sitting alongside me when the gifts were handed out. Then Santa would show up and bring another small gift. I remember opening the package and receiving a great big firetruck with ladders and all. The excitement was real.

Then we'd ride home. It was dark and the stars were abounding. On the way home we listened to Christmas tunes on the radio, and listen as dad talked about how neat it was to see all the stars, "A great night to see Santa Clause," he said. And we kids were rushing to get as close to the window as we could to see the sleigh.

"I see it right there," dad said.

"I don't see it," I said with my face plastered against the cold glass, my brother David half way on my lap with his face pressed on the glass too.

Then we'd rush into the house, through squishy snow, pull our snow pants and boots off, and rush to get our pajama's on. The goal was to fall asleep as fast as we could so we could get up and see how many presents we had.

Of course then I wouldn't be able to sleep. I lay there looking on my dresser at the firetruck. I lay there past midnight. "What was that!" I'd jump up and look out the window. "Was it Santa?"

Then finally, after the longest night ever, waking up and rushing to the living room. Bobby and David were already up and sitting under the Christmas tree. Mom had said last night not to touch anything until she got up, yet Bobby and David already had the presents sorted by person.

There were a ton of presents, and this time instead of the entire Frea family, there was only THIS frea family of a mom and a dad and five boys. So the chances of many of these toys belonging to me was pretty good.

There were big toys. There was a wagon and a tricycle that more than likely belonged to Dan and Tony. And there were big boxes and little boxes. Then we looked at the fireplace mantle and there were five big stocks stuffed full of stuff. And Bobby handed each one of us ours.

I sat on the couch with mine next to me, salivating at the candy cane sticking out of the top. Little Danny already had his open and sticky white saliva dribbling down his chin. Finally mom came out carrying little Tony, and she said, "I guess I wasn't sleeping past 7 a.m. today with all this commotion.

Before I knew it all my presents were open, and I wasn't completely satisfied. I wanted to get Star Wars figures and what I got was a stiff statue of a Star Wars figure. I wanted little Hot Wheels, and I did, but I was upset that my brother David got better ones. He got a big Hot Wheels truck. In fact he got two.

Later mom said she made a mistake, because I was supposed to get one. Yet David would not give me what was mine. He claimed them both for himself.

As I got older the presents became fewer. I would get one box and that was it. David and Bobby would also get one. Dan and Tony would also get one or two little things. Grandma and Grandpa went to Florida. So the Christmas of 1978 seemed to be one of my best Christmas memories ever.

Until 2010. Now I have my own family, and I woke up and saw all the Christmas presents under the tree and was the happiest man in the world because I knew not one of the gifts was for me. They were all from me, but not for me. I learned that the gifts themselves was not the purpose of Christmas, but the happy looks on the people who received them.

The greatest gift was not material possessions, but humility and family. And I also realized for the first time since 1978 why there seemed to be so many presents under the tree that year and not so many later on. I realized that it was not the gift but the age of the kids.

As kids grow older they prefer electronics and games and even clothing, and this results in fewer gifts. Likewise, as kids get older they realize the true meaning of Christmas, and don't expect as much (well, sorta). When kids are little we parents find joy in giving the first Tricycle to the little ones, and the first Wagon.

It was those BIG toys that made this year seem like there were so many gifts. Yet the same amount was spent on the BIG toys for my two little kids 2 and under, as on the really tiny boxes for the bigger kids of seven and 12.

And then my kids put two little boxes in front of me, and I understood why it was that my parents always said not to give them presents. And why it was that they always waited until last to open their gifts.

This was because I didn't need any gifts. In fact, it mattered not that I even opened mine, except I knew it would make my kids happy and my wife happy. They bought me a radio because they knew that would make me happy. And it did.

Yet what really made me happy was that every one in this room was here today and was happy because of me. It was because of my hard work as an RT and my dedication to my wife and kids. It was because of humility and Jesus.

I made a video of my seven year old opening up her package, and when she found out Santa gave her a DSI her joy was unquestionable. She was ecstatic. My 2 year old was excited about a simple sucker she got in her stocking, even though she had several other larger packages yet to open.

My 12 year old was upset that my daughter got a DSI and he didn't, even though he already had one. He was unhappy. Truly, he had yet to realize the purpose of Christmas. To him, Christmas was getting stuff. Yet I said nothing, because I remember how happy I was when I was his age to get stuff and I still grew up to realize the true meaning of Christmas.

This year, at 40, I realized the true meaning of Christmas. It's not materialism: it's family. (This was written on Christmas Day 2010).

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RT Idealists versus RT Realists

Some of my coworkers get annoyed that I'm always questioning need.  I'm always asking patients if they're really short of breath, and I'm always asking if they feel better after a bronchodilator.  And when a patient says he feels the same after a treatment and has never been short of breath, I chart as much.  I chart:  No difference with bronchodilator therapy.

When I have a patient with an SpO2 of 86 percent and the doctor orders for me to decrease that patients oxygen based on the hypoxic drive hoax, I ask why?  When I proposed a breathing treatment protocol to the staff and they cast it aside based on fear it would result in loss of work, I asked why they came up with that belief?  I asked if they have any proof protocols result in loss of work?  

One of my coworkers said a protocol would just result in more paperwork, and I asked why he thought that?  Another said doctors would never go for it anyway, and I asked why not?  Why do you think that?  

My coworkers seem to know everything?  They know what will pass and what will fail before we even propose it.  They should be our public leaders, because then the world would be perfect.  We would just do things because...  why?  Well they happen to know all the answers. 

The truth is they don't have all the answers.  The truth is they are idealists, and the reason they are annoyed with me is because I'm a realist.  Idealists do things based on feelings and emotion, and
realists ask questions and do things based on the truth and proven facts.  Idealists throw everything at every problem and hope something sticks -- order sets. Realists solve problems with protocols that encourage point of care critical thinking.

Idealist doctors solve problems by covering their bases by ordering everything -- cook book medicine.  Realists don't waste their time doing things that aren't proven to work for that patient, or that don't make sense; or at least they get annoyed when forced to do something they know isn't useful or scientifically proven to work.

Idealists are your political people who say things just to make people happy, and they do things that they know don't make sense just to keep a smile on a doctor's face -- and to boost that doctor's ego.

Realists questions doctors.  Realists question stupid orders.  Realists are hated because they are always asking questions instead of keeping their mouths shut and doing their job the way idealists
do.

Idealists solve problems based on feelings and emotion which results in doing things that aren't proven and are often useless, such as creating order sets where every patient is given Albuterol.  Realists don't waste their time doing things that are needless because they take the time to think.

Instead of thinking, idealists call respiratory or order breathing treatments.  This results in useless procedures and causes the RT to run around ragged all day to get all this work done.  It results in burnout and apathy or RATS.  Since Idealists control the world right now because their ideas sound good on the surface, the healthcare system is in trouble.  

I would consider myself a realists.  It's why people get annoyed with me.  We grumble and gripe at new breathing treatment orders because we know Idealist in the healthcare system order things for no  other reason than ignorance.

Idealist:  See idealism.  A person who believes perfection is possible.  They believe a euphoric world is possible.  They are always making rules and policies in an attempt to create an ideal world, even if there is no proof their rules and policies will work -- even if there are facts that what they want to do won't work.  They believe if there is a problem something must be done, even if that means taking away personal rights and discouraging individual thought and choice.  They believe one or two experts can decide what's best for everyone, and it's these experts who create ordersets, policies and guidelines that everyone has to follow.  Even if they are wrong they won't admit it.  They may have screwed the heck out of the healthcare industry with their policies, but they won't admit it.  They are the ones who passed Obamacare in an attempt to create equality in healthcare.  They are the ones who created DRGs that resulted in the boom in the diagnosis of asthma and pneumonia. They are the 
ones who decided to give away free healthcare to the poor and have caused ERs to become flooded with people who don't need to use the ER.  Their policies have improved patient care and reduced the cost of Medicare and Medicaide, yet it's increased hospital costs and caused apathy and burnout among the masses.  They are the reason for increasing healthcare costs and the nonexistent healthcare crisis.  Idealists don't like it when you come up to them and are truthful (yes, the truth hurts). If you go to them with the truth they will get angry and toss vitriol at you and make you out to be the enemy.  They say that when you question their realist ideals you are cconfrontational. You are causing confrontation. Yet if you're afraid of confrontation you're an enabler.  The idealist at the bedside sees a patient who's short of breath with an audible wheeze and thinks bronchodilator before even assessing the cause.  Their goal is euphoria in the healthcare industry; an ideal system by their definition of ideal.  A scientist will not take this route.   Perfection.

Realist:  See realism.  Judgemental.  Basing decisions on proven fact and science.  They ask questions like:  Does this make sense?  Is this science we're dealing with?  Does this patient really need a bronchodilator?  Is the U.S. healthcare system really as bad as they say it is?   If the answer is no, then we don't do it or don't mess with it or don't waste our time.  If it's moronic and doesn't make sense, we try to find a better solution such as protocols.  They are the ones at the bedside doing the clinical assessments and critical thinking to determine the cause the the best solutions.  They base their solutions on science and proven facts as opposed to feelings and "it sounds good."  They are often feared and hated because the truth hurts before it makes you better.  

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