Physician Disagrees.

ImageIn 2002 I sat for the clinical exams for my RRT (Registered Respiratory Therapist) credential. The easiest part, at least for me, were the straight forward questions on the shit that could easily be found Egan’s Fundamentals of Respiratory Care textbook. The shitty part, and the part ironically that would tend to foreshadow what my career in respiratory care looked like, were the clinical simulations. The clinical sims walked you through theoretical scenarios. Some of the patients had blatantly obvious problems like pneumonia, COPD, asthma the stuff you knew you were signing up for as a therapist. It got fuzzy when babies with ambiguous symptoms came rolling through your virtual ED and all you could rely on were your clinical assessment skills. So, Patient Q came barreling through the door with a persistent 3 week dry cough, low-grade fever, and other symptoms that could mean everything yet nothing.

I’d go through a specific symptom, apply the solution that I thought was correct, and would receive the heart stopping response of:

PHYSICIAN DISAGREES

By the 3rd or 4th “disagreement” I thought for sure that I’d killed my virtual patient and shat away the hundreds of dollars that I’d spent on the exam. As it turns out my patient survived because of the choices I made. I walked out of the H&R block testing center fist pumping like 80s Judd Nelson. Now let’s apply that to my real life in respiratory therapy shall we:

I wish I had a nickel for every time I’ve had an opinion that was the “right answer” in the direction of patient care but was summarily ignored by the physician charged with caring for the patient. The difference in real life is that lives will not be miraculously saved by a test that happens to know which care plan is better. In fact …

*Bombshell Alert*

People get very sick and or die because of physician pride, incompetence, or apathy. I wish I could say that I haven’t seen it as many times as I have in this now almost 14 years as a therapist, but it’s true. When a physician would rather Google how to operate a particular type of life support rather than ask the real live person on duty who has experience with the equipment how to proceed (yes, this happened … to ME), then there is a major problem with how the healthcare team functions and the real losers in this game are, as always, patients. Do I blame all physicians? No.

I blame the set up of the healthcare “system”. Doctors are all too often placed in a position where they cannot be vulnerable, where they can’t say “I don’t know” or appear not to, hell where a patient with no medical knowledge whatsoever can waltz into their office and tell them what to prescribe. This type of system sets doctors up to be on the defensive. They have the image of the authoritarian on all things medical to uphold after all. It’s a sucky conundrum and a large chunk of the reason why I didn’t proceed to medical school.

The only solution I see in this age of information where the patient truly is more well versed about their disease process than the doctor, is a more team based approach where the doctor is still at the helm, but know when to trust the advice of specialist that have seen certain things a time or two more that she/he has. I’ve seen this set up before, mainly at teaching hospitals, and from what I’ve experienced it works. Granted, it then places the responsibility for competency in the lap of staff, but I’d rather have my opinion respected and expected than to just be a “knob turner” at the mercy of a doctor who is burned out, apathetic, and just doesn’t want to be called anymore. Mutual respect to the benefit of those we are charged to care for: Is that too much to ask? Me thinkest not.

Rosie.

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Kiss my suppressed anger … please.

About ten years ago I was fired for the first, and prayerfully the last time.  It went a lil something like this:  I worked at No Name Hospital in No Name, South Carolina. It was set to be a busy shift and we were short, so good times were definitely not on the horizon. I’ll keep in mind that it’s been some years since this happened so the details are hazy, but the long and short of it is the therapist that was in charge that day opted to give herself a fairly cushy assignment while giving the other therapists bullshit.  Not uncommon in my line of work, but digressing … I made her aware of this.  We exchanged words, nothing too over the top, but we did.  I took my assignment and proceeded to take on the 12 hours of the shift.  She didn’t call me all day.  She didn’t come through my unit. I didn’t in fact see her until the end of the shift as another co-worker and I were walking out.  I’ll preface the following with the fact that we were black females. My fearless leader for the day was a white female.

Admittedly, me and other said black female threw heavy shade on the way out the door, but nothing that should have ended with me looking for employment.

One day later …

I come to work.  It’s an ordinary day.  Patients are on ventilators. I’m taking care of them.  I’m doing what I do.  The moment I signed my last vent check on my last patient at @4:30pm, (this I remember because I can remember looking at my watch and thinking what the fuck?), I am called to the office.

Mr. D. Whiteman, the manager of the cardiopulmonary department, a man who seemed like he could have been the defensive line for his college football team is sitting behind his desk. He is sweating and clearly nervous.  He asks me to have a seat.  I do.  He then begins to unfurl the most blatant bastardization of facts that I’d ever had pass through my ears up to that point in my life (my son would later best him in this capacity).

The above tale of shade throwing and home going was spun into the following fairytale:

Brunettey Locks & The Two Big BAAAD Coloreds 
by D. Fensless Whitewoman

Once upon a time while working her job to the best of her ability, the fair and innocent Brunettey Locks was headed home to feed woodland animals and contemplate world peace.  Suddenly there was a raucous noise behind her.  It was cackling laughter. “It’s them!,” she thought, “The Two Big BAAAD Coloreds!” she’d been hiding from them all day, but they’d finally caught up with her.

“Eek!”, she thought, “Maybe if I’m really quiet they won’t notice me.” Brunettey locks got reaaallly quiet and walked reaaallly slowly, but to no avail.

“There she is!”, croaked Big BAAAD Colored 1. “Let’s get her!”, the other Big BAAAD Colored groaned. “I’m gonna bust a cap in her ass!”, the perverted urban menace Big BAAD Colored 1 announced. They erupted in beastly laughter then proceeded to chase the chaste and ever fair Brunettey Locks to her vehicle! Guns blazing, big bubbly lips giggling, massive brown thighs rubbing together.

Brunettey locks, by the grace of Billy Ray Cirus Jesus, escaped the wretched beasts, but was shaken to her very core.

The End.

Now … am I being  just a smidge facetious?  Yes. Is the story she told nearly as ridiculous? Yes.  After being told that story I received, courtesy Mr. D. Whiteman’s trembling hand, a piece of paper  to sign.  I was being “suspended”.  In his anxiety about my menacing nature he accidentally pushed my co-worker’s suspension* form in front of me. Both of the Big BAAAD Coloreds were being removed.  Never to return to No Name Hospital in No Name, South Carolina again.

 
*Suspension is a fancy word for “fired”, gentles.  “Suspension”  prevents big baaad coloreds from showin’ out as security escorts them to their cars in utter humiliation in front of all their co-workers!
 

Two weeks ago:

I come down to the emergency room at Current Workplace Hospital after being called for a nebulizer treatment. My patient isn’t there, which I found slightly annoying, so I rolled my eyes and blew out air as annoyed people do.  The calling nurse (we shall call her Nursey Poo) , whom I did not ask for feed back, decides to announce that the patient was there when she called.  To which I reply, “I wasn’t able to get here the moment you called.” To which SHE replied “I didn’t SAY you had to be here right away.”

This is a trap.  She is begging for it.  She’s baiting me even.  I refuse, because thanks to my experience with Brunettey Locks, I am fully aware of what color I am and what a show down like one she’s bucking for would mean for me. I go to follow up with the manager on duty, and before I can do that my patients return.  I treat them, and return to my gripe session about Nursey Poo seeking out a manager to talk to when over storms Nursey Poo to the major desk area of the “busiest emergency department in Major City, NC”™, in a decided rage.

“Are you over here talking about me!?”

“Wah?!”, says Blackey Locks*, “No ma’am, I’m in the middle of patient care and we will not be doing this right now.”

*Blackey Locks = Stacey Rose RRT
 

I walk away, wanting ever so badly to buss her in her mouth so hard that the end result would be her portraying varying forms of The Predator for Halloween the remainder of her life.  I wish I could say it ended here. Nursey Poo follows me into a crowded supply room and proceeds engage me in a shouting match.  My memories of No Name Hospital in No Name, South Carolina in the forefront of my mind, I do not engage.

She rants loud, hard, and fast directly in my face in a manner that my own damn Momma rarely has.  There are references to my “attitude” and the fact that I had the audacity to roll my eyes when I came down stairs. This immediately signals my rage.  I am metaphorically biting my tongue.  I am goin IN, inside my head.  I have called her every form of  bitch conceivable. The only thing coming out of my mouth?

“Ma’am.”

In a manner that a McDonald’s drive thru attendant my try to quell a customer irate about the absence of pickles on their McPig Heart sandwich. I continued at varying octaves and inflections for what seemed like an hour as she let loose. It descended into insanity when she too got on the “Ma’am” train, drowning me out completely.  I then made her aware of the fact that her behavior was threatening.  To which she replied, “Good, you should feel threatened.”

Friends!  Let the record, my own damn record, show that if I had even danced around this kind of behavior there is a significant chance that I would have been looking for a job the next morning, or have spent the evening in the Major City, NC jail. (I’m mean I’ve spent time in there for even less). Nursey Poo was allowed to “cool down” and return to her work. My assignment was changed (to be transparent, I volunteered for this.) I have yet to hear what the repercussions of her action were and at this juncture, I don’t really care. And yes, whether or not anyone wants to admit it I wholeheartedly believe the bias lies in race.

Black women are simply not allowed their anger, not in its full capacity.  We’re always being asked to stifle or suppress it in some way, especially in the professional setting.  Professional black women are held to particularly high standard of decorum at the work place. No matter if any real level of wrong that might have been done to us, no matter if we, like any damn body else, are having a bad day.  We don’t want … no we can’t afford to be viewed as an angry black woman … God. Forbid.  Other women’s anger could get them called a bitch, odds are not to their face. It may even get them a stern talking to by the powers that be, but a black woman’s “attitude” signals inherent danger. A danger that, gone unchecked, could dissolve the universe creating a gaping black hole in the galaxy. (Well maybe this is slightly true … but that’s another post.)

Immediately post face off, I wanted Nursey Poo’s job.  I wanted her first-born. I wanted her to experience levels of suffering that would make Jean Valjean shudder.  Then, like all feelings, my anger passed and I got to what the root of what I really wanted.  I wanted the ability to experience frustration and even full-out anger without fear of retribution.  Now should I have carte blanche to show my ass in the manner that Nursey Poo did? Hell no.  That type of behavior is inexcusable for anyone.

Alas, I’m not sure when or if ever we’ll get to an America where we can escape the stigma of our stereotypes.  Hell, maybe that kind of world wouldn’t be as interesting, but one where our feelings didn’t unnecessarily put us at risk at loosing our livelihood or worse.  That’d be a world I’d sign up for.

Rosie.

I’m not justifying this level of crazy, BUT when people don’t know how to STFU …

http://youtu.be/mZjgi-tQR9o

A Letter to the Respiratory Therapist

Dearest RT,

I have often said that we are the red headed step children of the health care industry. Not yet able to enjoy the respect that comes with longevity of similar careers like nursing, we are still after decades of existence a bit of an enigma to everyday people. Some might have noticed our name yelled during episodes of their favorite hospital drama. After all the business of saving lives is complete the heroic MD yells with deep conviction

“Call respiratory and tell them to bring a vent!”

As he clutches an endotracheal tube that is nowhere near secure in a patient that isn’t even being bagged. As if we’re off somewhere slamming down doughnuts as we wait for vents to be called for.

What everyday man often doesn’t know is we would have been there from the word go. Nor do they know that in many cases it us who often secures the airway , initiates “life support”, and then asks that the MD get called so we can tell them what we did. Little does the everyday man know how hard we work to cover anywhere between 10-25 patients per therapists per shift while having to be prepared to drop it all and see about the emergencies (and quasi emergencies whenever summoned.) We are often unappreciated, misunderstood, and unfortunately mistreated by those whose team we’re supposed to be on. Yes, red headed step children.

Notice I said “often” not always, as there are those times, hospitals, and situations where all the stars align and therapists are truly made to feel a part of the team. Our experience and knowledge are valued. People actually know our names instead of yelling “RESPIRATORY!” down the hallway behind us. I have been fortunate in my now almost 12 year career to have enjoyed these circumstances and I’m truly grateful for these times.

When it’s bad though, it’s really really bad. I have worked in places where therapists have been reduced to the role of nothing more than a button pusher or knob turner having their clinical skills and knowledge completely disregarded by people who often don’t fully understand the purpose and action of therapies they’re requesting then being told or shown by their own management that we have to “take one for the team.” To understand this I have to go back to the point that the general public and alas some healthcare professionals have no clue, or worse, no respect for what we do. I don’t pretend to know how to change this other than to keep doing what we’re doing. Do it well. Do it consistently, stay educated in the field and stand our ground in the face of adversity and ignorance. Combat ignorance with education and open dialogue, and maybe…just maybe, things will change.

I write this letter from a place of appreciation and love for everything this career has done for my life and the many wonderful people it has placed in it. My patients! The reason why I can do what I do in the first place. The good ones, the mean ones, the in-between ones, but especially the pleasantly confused ones whose shenanigans make my night whiz by. The nursing staff who I’ve saved lives side by side with, cried with in tragedy, and even laughed with in tragedy (cause you gotta laugh to keep from cryin’ right?). The MDs, who don’t let their egos get in the way of what is best for a patient, who once they understood that I knew what I was doing allowed me to DO MY JOB! The unit secretaries, radiology, lab techs, pharmacy, environmental, hospital security without you guys there is no us, because we are ALL critical to lives of the patients we care for whether we know, or are told that or not.

I’m in the process of stepping back from this career that has been a defining part of my life since I was pregnant with my son and into one as a writer. Eventually, (if all goes well) I won’t be practicing much if at all. However, everything I learned while a therapist will carry me in to the tough business of the written word. After all what can thicken your skin or grow you as a person more than dealing with life, death, and every manifestation of the human being on a daily/nightly basis? I promise to one day write our story that people may continue to come to better know and understand who we are. I promise to tell our story to the best of my rotten ability!

To all my fellow RTs:

Your name is NOT “respiratory”. Your knowledge and experience matter even when those around you would make you feel that it doesn’t. Go forth, give nebs, save lives, be as BRILLIANT as you are, and smile because you are somebody!

With Love,

Stacey Rose RRT, RCP