Respiratory therapy.

Yesterday I shadowed several of the respiratory therapists and blood gas techs. It was moderately interesting, though I admit I don't know much about pulmonolgy, so I imagine a lot of what was going on was somewhat lost on me.

The blood gas people were quite fun, despite the fact that drawing arterial blood (generally from the radial artery in the wrist) appears to cause patients significantly more pain than standard blood draws. They try to collect about 2 cc of blood, but they really only need about 0.5 cc to take the measurements. Unfortuntely, I didn't have the opportunity to ask how the ABG analyzer actually worked. Obviously they must calibrate each substance to be tested with a standard, but I couldn't figure out whether it something like a modified GC or actually performed some sort of reaction, or whether it was measuring the stuff indirectly with various wavelengths of light, etc. Actually, not to sound callous, but I don't know if the techs really would have known the specifics, either. I should check my analytical text.

At one point, one of the ABG techs told me, "You have personality...you can't be a surgeon!" I found that amusing.

The other portion of the day was spent in the ICU/CCU and on the floors, delivering various drugs (often inhaled with a nebulizer) and performing pulmonary function tests as per the doctors' orders. The patients in the ICU and CCU weren't so bad, because they were far too ill and out of it to respond to our pokes and prods. The patients on the floor, however, were awake and alert and it was very, very saddening to see them. Several had COPD (Chronic Obstructive Pulmonary Disease) and just listening to their labored breathing made me wince. I have mixed feelings about this disease because the primary cause of COPD is long-term smoking, so many of the afflicted people have only themselves to blame for being sick. That said, I don't enjoy seeing anyone ill for any reason, so I wrestle with the ethics of how to deal with these people.

One poor woman with COPD, after receiving her nebulizer treatment, hacked up a huge chunk of phlegm and promptly vomited all over herself and the respiratory therapist I was following. It didn't help that she had a crowd of crying visitors peering in her door and watching this scene, or that her roommate was simultaneously being told by a rather oblivious group of attendings, residents, and med students that she (the roomie) needed to start thinking about hospice care. Needless to say, I was only too happy to leave that room behind, even though I naturally felt guilty for not being able to do anything more than give the family a sympathetic glance. Sigh.

Having been at the hospital for three weeks now, I know my way around pretty well and am starting to feel more comfortable interacting with patients and their families. Certainly there are still plenty of uncomfortable moments, but they are becoming less frequent and I'm learning more now that the initial culture shock is wearing off. Hopefully things will continue on a good note.