Wednesday, July 9, 2008

- Douchebag ho!

Let me preface this with the following - 95% of the RTs I know are about awesome at thier jobs. A lot of time I'd rather have a solid RT at my back as opposed to some of the ER Docs I've seen...understand, this RT I discuss is NOT one of you.

It's another day in Backwater Parish and I am cleaning my pocket knife. Just as I dab a tiny bit of oil onto it the phone rings. It is Terminally Anxious Dispatcher.

"You're not going to like me," she says. Fuck. This is going to be retarded.

"We got a call at MRSA Manor for a breathing problem...looks like it's in the vent wing."

"They're already at the gold standard of care for the patient!"

"I know, I know. I told you you weren't going to like me."

We make the drive over as we get notes. I tilt the MDT toward myself, and sigh in disgust at the display:


Wow. Sure, the patient may be having breaths in-between the mechanical respiration, but hell, you just turn the fucking knob to SIMV instead of A/C, right? Problem solved. We get called out to the vent farm at MRSA Manor pretty often. I'm not sure if being incompetent is a prerequisite for getting hired, but I'm almost positive that at some point Satan is involved.

We bring all our gear in and walk to the back. We are stopped by the RT at the patent's door. The RT's at MRSA manor are usually at least baseline competent...except for this one. She's infamous in Backwater Parish, but I've yet to tangle with her.

"She gon need a treatment and they cleaning her," she yelps in a shrill, annoying tome. My ear bleeds a little. "She messed herself!"

She takes a closer look at our stretcher. "Where ya'll vent at? The patient gotta go out on a vent!"

We have this problem at MRSA Manor a lot. They don't understand that taking the time to set up our vent, connect the patient to it, let the patient have the recommended time to get adjusted, transfer them over to our stretcher and then take them the short distance to the hospital takes about 10 to 15 minutes minutes longer than it does for me to hook my BVM to oxygen and ETC02 and leave. By the time I get done setting it all up the patient would already be in the ER, on the other vent.

"We're going to bag her."

She blinks, then repeats, in EXACTLY the same tone and rhythm as before, "The patient gotta go out on a vent!"

A headache is beginning to crystallize. "No, she doesn't. We're going to bag her. It's a lot faster. If she's sick, it's the best way to get out quick."

She does not flinch, but rather leads us into the room. There is water all over the floor from a leaky air conditioner, and two tired looking CNAs are eyeing the RT dubiously. She points to the patient.

"See, she's on a vent. The patient gotta go-."

"I know she's on a vent. I see the vent. The big, loud vent, that is beeping."

"It always beep!"

The RT leaves. I get vitals. The patient is satting ok, but the lungs sound like someone just dumped a few gallons of Steen's Syrup (shit, I guess that would be Ms. Butterworth or something, for all you Yankees) into the trach just before we got there. The patient sats are in the upper 80's.

My partner finishes making preparations as I review the paperwork and call the hospital to tell them to get ready. Apparently, at some point, the RT comes back in to give the patient her breathing treatment, because when I look up again the patient's pulse ox reads less than 50. Silent terror makes her eyes bug as her lips begin to turn ever so slightly partner doesn't even talk, just hands me the BVM she has just connected the ETCO2 to. I cinch it down onto the trach and bag.

The ETCO2 reads 79.

The RT looks up. "What you doin'!? I'm about to give them a treatment!"


My monitor is still reading a sat of fifty-ish. The RT goggles at me, then at the monitor, then back at me. She opens her mouth, and the biggest chunk of stupid I've heard so far this day clunks out into our world: "Your machine WRONG."

To my credit, I do not hand over the bagging to my partner and cudgel the RT to death with the oxygen tank. I just give her enough rope to hang herself.

"Hook her up to your machine."

"You machine is wr-!"


She stares at me sullenly, and grabs her portable sp02 out of her labcoat, putting it on the patient.

It does not even pick up.

"Let's go." I began to wheel out of the room, and brush past the RT, who stands there glaring at us. With some good ventilations from the BVM her sats rise instantly and the CO2 drops to a lower level of 58...not the best, but good enough for now.

5 minutes later I am at the hospital, and the patient is on their vent.

Keepbreathing, where the hell are you when I need you?


PS - I know I've all this serious bullshit up here lately, so I promise my next post will be the tale of my misadventures out in New Orleans last weekend. Ok? Is that ok? OK.


NJ EMS said...

KILL KILL KILL!!!!!! I would of snapped!

Rogue Medic said...

I think I've met some of the northern members of her clan.

You don't seem to like the beeping vent.

"It always beep." Elsewhere, it seems that RTs are the only ones who can consistently get the vent to stop beeping.

NJ EMS said...


That's just wrong.




Are you trying to steal her job? That's her specialty.

keepbreathing said...

We have a couple of branches of MRSA Manor around here, and it seems like that's where they send the RTs who aren't smart enough to work in a hospital or in home health. I mean, there must be a smart RT in a nursing home somewhere, but I've yet to meet one.

I was on an ambulance transfer from our ICU to the local Vent Farm (also known locally as the Stepdown Morgue) a few weeks ago, and the RT who took my patient was not only completely uninterested in the patient but seemed not to really "get" how to set it up. It's frightening.

RCP Student said...

I would like to say "thank you" to the douchebag ho for making the rest of us RTs look like idiots. Thank you.

Rogue Medic said...

RCP Student,

We've got plenty of our own exemplary idiots in EMS, too.

Anonymous said...

So why do they say the US has the best healthcare in the world??? I thought it was just the delivery system that was messed up.

Peri-Care said...

An RT dropped an o2 tank on my foot yesterday.

My big toe quickly turned a lovely shade of purple, but was sadly outdone by the neighboring toenail, which turned black before falling off.

Loving Annie said...

God save us from the willfully ignorant. You should have beaten her to death with the oxygen tank. At least her replacement might have had an IQ over 70...

chris in se tx said...

OK, I hate to sound like an idiot, but what is an "RT"??? My 1st guess was Radiology Tech, but obviously that's not it....

Rogue Medic said...

Respiratory Therapist.

There are several other designations, same as with EMS - EMT, medic. critical care tech, . . .

Usually the RT is the person to straighten out any vent problems, to recognize airway problems before anyone else, but as with EMS, there are some who do not deserve their license.

The Respiratory Terrorist said...

God help us. It seems that there are so many RTs out there who are trying to make us educated, intelligent, logical respiratory care practitioners look bad. None of MY RTs would have shed a tear if you had put her out of our misery. That being said thank you for taking care of the patient instead of succumbing to your more primal urges. Kudos.

Bianca Castafiore said...

One of my fondest memories is of waking in the ER (or ED, if you're WhiteCoat) on a vent. The move to ICU entailed a short elevator ride. Unfortunately, there was not room enough on said elevator for the guerney, the several ivacs, the attendant medicos, and the vent itself. The vent tubing detached from "my" tubing and left me sucking... nothing. I could move no air. The RT and I just stared at each other for the whole trip. He did not bag, nothing. As soon as the elevator released us, he scrambled -- but too late... I was completely freaked. Hence, I was snowed forthwith! But please, dear medicos, do pay attention to that bug-eyed look! And, of course, thanks for saving all of our sorry asses 'n all.