Trau·ma  Junk· ie  ( 'trau-m&  'j&[ng]-kE) n. Slang
  1. One who has an insatiable interest, devotion or addiction to responding and assisting people with serious injury or shock to the body, as from violence or an accident.

An Interview with Freadom of the Respiratory Therapy Cave

You read that right.

He was the first respiratory therapy blog I read, and I could even venture to say that I decided to start my blog after reading his.

If you've never read Freadom's blog, you'll really have to check it out. It's called the Respiratory Therapy Cave and it's full of humor, as well as the serious, "humble perspective from a small-town respiratory therapist."

By the way, I believe that is a pic of him giving a cat a breathing treatment. I guess in small, rural hospitals, they treat pets too?

1. When did you first know you wanted to be a respiratory therapist? How long have you been in the field?

Good question. I had bad asthma as a kid, so I had many run ins with RTs. In high school I really wanted to be an RT, but on career day the person in the RT booth told me I'd have to take chemistry, and I just got done failing chemistry my junior year so that was the last place I wanted to go. So, as I was filling out the only application I ever filled out for college, I opted to cirlce journalism only because I was in journalism class as I was filling it out. When I was 23 I decided I hated snooping on people, and quit my newspaper job. Now I had four years of school and nothing to show for it. So, when I was 24, I decided to go with my initial choice. I had to wait a years to get into the RT program though. I've been an RT 12 years now. [That's interesting. I failed chemistry my junior year of high school, too]

2. A lot of my readers are RT students, so a good number of us might have no idea what it is like to work at a "small town hospital." Can you describe what an average day at work is like for you (if such a thing exists)?

I think moving from a large hospital to a small hospital like this would be like moving from France to the United States. There would definitely a certain level of culture shock. I'm not saying it's bad working here, I'm saying it is different. Like any hospital, business for us RTs goes in streaks. We might be busy for a month or two, and then have hardly any patients for a while. Still, no matter how busy it is, we always have ER to contend with. And who knows what that's going to bring in. Since Shoreline Medical Center is in the middle of the county, it can get pretty hectic at times.

I've written about this on my blog, but I'll sum it up here. At small hospitals the RT bosses have little else to do but nit pick about our charting. If you don't dot all your i's and cross all your t's then you will receive a note that you screwed up. At larger hospitals the bosses have better things to do with their time. The only other problem I've experienced working at a small town hospital is the doctors don't like to give up their autonomy by having a bunch of RT driven protocols. Of course, at the same time, the RT bosses don't want protocols either because that means few procedures, and fewer procedures means less money for the hospital.
We see far fewer trauma and brain injury or cardiac patients because those patients are usually wrapped swiftly in the ER and shipped out to the larger hospital. It's not that we RTs here don't have the skill to take care of these patients, it's that we don't have the cardiologist on duty, the trauma center, and the neurologist these patients need.

And this brings me to the advantages. Since we aren't as busy we get to spend more quality time with our patients (assuming we aren't swamped). I actually have had many qualilty conversations with my patients, even played cards with patients from time to time. We only have one or two RTs on at a time, so we are forced to stay up to date not just on how to take care of the adult COPD and Asthma patients, but the peds and even the bad babies. We have to know it all. Not only that, but we also have to be experts at doing the little things, like PFTs, EKGs and stress tests.

There really is not an "average day," per se. It's more like some days we are swamped and other days we are not. It's kind of a feast or famine business here. Still, when we are really busy we don't have the manpower to function sanely, and when it's slow it's slow. Like right now for instance.

3. Obviously, something for potential students to consider is the burnout factor associated with respiratory therapy. A lot of veteran RTs I know have stopped practicing to pursue other careers, in a sense, because they were burned out for various reasons. How do you avoid burnout?

Is it burnout or irritation? Some RTs get fed up with the politics of hospital life and lack of pay. When it's really busy here, and we have 20 patients the board and ER is swamped, I hear a lot of grumbling of how we aren't able to care for the patients who really need us becaue we have to spend so much time doing the needless therapies. And that's exactly why hospitals need protocols. Most of the time, though, the patient load here is 10 or less. And, when the patient load is low like it is today I get to spend most of my time answering questions like this, blogging, doing my check book, and bantering with my co-workers and favorite patients. It's fun nights like this that help to allay the stress of those really busy stretches which at times seem to last forever. Another added benefit to being an RT, and a good stress reliever, is that we only work 3 12 hour shifts a week. That means we get a lot longer vacation stretches. For example, I am only taking 6 days off from work in January, and I get 21 days off in a row to spend with my family. That, in my opinion, is a great stress reliever, and a great way to get over burnout. The key, though, to limiting burnout is to not work too many days in a row.

4. What is the best and worst part of your job as a respiratory therapist?

I love teaching. I love sharing my asthma experiences with my patients, and teaching them how to avoid being repeat patients. I love it when a decision I made saved a patient's life, or prevented him from needing a ventilator. I love the feeling that I made a difference, even when the person has no clue what I did. I like it when doctor comes to me and sayd, "What do you think we should do?"

I do not like the politics as I explained above. I do not like that some doctors are resistant to giving up autonomy and activating RT Driven protocols. I get frustrated when certain doctors resist the experience and educational wisdom we RTs have to offer. I hate it when I get a great idea and five years later it gets implemented. But that's politics. I hate politics, let alone hospital politics.

5. Most people think respiratory therapists work solely in hospitals, "playing with sputum," but that's just not true. RTs work in home care, pulmonary rehab, flight teams, patient transport, doctor's(pulmonologist) offices, nursing homes, and so on. If you weren't working in a hospital as an RT, where would you work?

You have me stumped with this one. If I could work outside the hospital I'd like to open up an asthma and COPD clinic with a doctor. Of course RTs don't have this option right now, but it may be an option in the future. I'd like to use my skills, personal experience and professional experience to benefit all the people who are new at having a chronic lung condition. I'd like to recommend medicine, and work with these patients on how they can improve the quality of their lives.

6. A lot of people do not graduate high school and decide they are going to be respiratory therapists. In other words, they know they
want to work in the medical field and spend time weighing out their options (RN, RT, MD, etc.) So, what sparked your interest in the medical field?

Well, no one in my family was in the medical field nor did they have the desire. Still, when I was a kid I was in the hospital a LOT. I'd have to say that fate guided me here. I think God wanted me to be an RT. I tried to do something else first (journalism) and that just didn't work out. I think it wasn't supposed to work out. I think I was lead here by the powers that be. That's the only way I can explain it. Because if I had my choice I'd be a teacher, and that's all there is to it. I think, in a way, by my starting this blog and my asthma blog I get to educate about asthma, COPD and RT. It's fate.

7. A few of us in the "RT student blogosphere" (Wow, it feels weird to say that) have just finished our first semester and may not be sure what to expect in the coming semesters. Can you share some of your experiences in respiratory therapy school? What type of student were you? What is one thing you had to learn on your own that you wish they would have taught you in school [I'm sure there are a lot of

In journalism school I got all Bs and Cs and an occasional D and I never studies. I didn't hate school, but I wanted to have fun even more than study. My priorities weren't in the right place. By the time I got to RT school I felt that if I failed this time I was screwed, so I dedicated myself to studying. I became the quentissential perfect student. I got all As except for in Chemistry. I got all As on the Chemistry tests, but lab was on Monday night during Monday Night Football, so I would rush to get my work done so I could get to the game. So, needless to say, my grade suffered a bit. Other than that, I'd sit in all my classes and take notes like you wouldn't believe. My notes were so damn good, often word per word what the teacher said, that other kids would often offer to buy them. My advice to RT students would be to give 110% to your classes. Don't be a slacker. Go home and study instead of partying. You need to have fun, but save that for the weekend after your final exam. Go out with your friends then and tie one on. In the meantime, while your friends are having fun, you should study to pass your classes. When you graduate RT school, there will be plenty of time for fun as you only have to work 3 days a week. I say this because RT school is HARD. It is HARDER THAN RN SCHOOL. There, I said it. It's true. I've had RN friends confirm that for me. If you think it's hard now, it's only going to get worse. By the end you will be so burned out...

I learned a lot on my own. I think a lot of RTs quit learning when they graduate and become lazy RTs. I love learning, but I think most people hate it. Still, as an RT, the wisdom and knowledge is constantly changing, so it's not possible for RT teachers to teach us everything. I think the teachers I had did a swell job and there is nothing they didn't teach us that I needed to know when I became an RT. I don't know if all RT teachers are that way, but mine were.

Well, maybe there is one thing. I wish my teachers would have spent more time going over Ventilator Graphics. Since graphics were so new at the time I was in RT school, thought, this was an area that was glossed over. I also wish they would have spend more time going over EKG rythm strips, since most RTs in this part of the U.S. do EKGs. We don't HAVE to interpret them, but it's nice to have that skill.

8. You offer a pretty humorous insight to a problem facing respiratory therapists: the over-use of bronchodilators, for lack of a better phrase. All jokes aside, why do you feel that this occurs?

I think it's lack of education, and maybe sometimes laziness. I think doctors have so much to learn in med school that they gloss over bronchodilator therapy. I don't think doctors are stupid, I just think it's easier to order a breathing treatment for any annoying lung sounds and think it's doing some good than to actually come into the hospital and assess the patient. I think part of the problem is that Ventolin is so safe, and the side effects so minimal, that they sometimes think, "Why not order it? What's it going to hurt Besides, at least I'll have an RT assessing my patient every 4 hours." Likewise, when a nurse is calling every ten minutes saying the patient has an audible wheeze, the doctor eventually gets frustrated and says, "Just have RT give a treatment." So, in that aspect, I think sometimes treatments are ordered just so the doctor doesn't have to be bothered.

Not all doctors do this, but many do. I see it. This is why I think the real resolution to this problem is to have RT Driven Protocols. However, some doctors are afraid to give up autonomy to RTs. At the same time, some RTs are lazy too. And, since there is so much liability involved, it's easier just to let the doctors decide who gets treatments. In the process, and to make things easier for everyone, many patients are ordered on treatments instead of just the few who actually need them.

It keep us in business though. That's the bright side; the irony of it all.

9. I think I saw a respiratory therapist administer a 0.5cc Diuruterol neb treatment last night and I know for a fact that q4h PALbuterol treatments have been given millions of times since October(GREAT LIST, by the way) . Is it possible that the "Top Secret Bronchodilator Knowledge" has been leaked?

I hope so. I hope the list gets posted on the front page of the New York Times some day. Of course that will never happen considering the editor of that paper has no clue what an RT is. "Is that a radiology technician?"

Seriously, I think if doctors can get a good look at my list, they will see how foolish they are for ordering them, and perhaps have a little more empathy for the poor Rt souls who have to give all these treatments.

10. For those of us who are just getting started in healthcare, what are protocols? In a nutshell, why do you think respiratory therapy protocols should be implemented?

I kind of gave some reasons in my previous answers. Protocols give RTs some leeway in deciding what to order for a patient and how often. Treatment protocols allow us to decide who gets treatments. Ventilator protocols allow us to alter the vent according to gases, sats, and ETCO2. A vent weaning protocol allows us RTs to start weaning the patient the moment he is put on the vent. An oxygen protocol allows us to alter oxygen therapy according to the patients condition and his sats. There's no reason a patient should be on 100% oxygen for seven days when a nasal cannula would do the job. The idea is that RTs are at the bedside with the patient assessing him before, during and after each treatment. Since the RT is right there at the bedside and the doctor is five miles away sitting on the edge of his cozy King sized bed in his million dollor mansion, I think it only makes sense to allow the RT this kind of autonomy. Likewise, the RT is educated on bronchodilator therapy in ways that doctors can only dream of. We are the bronchodilator experts. We are the bronchodilator kings. It only makes sense that we decide who gets them and who doesn't. However, let it be known any protocol should allow for a doctor to opt out.

11. How long have you been involved in blogging, and what got you started?

I had no clue what a blog was even when I started the RT Cave. I got started about Oct.
15, 2007. I got started because when it's slow here I needed something to do. I loved to write (hence my journalism background). I wanted to share my RT wisdom and this is how I do it.

12. Do you remember the first medical blog you read? Yes. It was RT 101.

13. You have quite a variety of blogs in your blogroll. I've been reading your blog since July and I don't think I've had a chance to check all of them out. Which ones do you highly recommend?

RT Cave. From the RT Cave I will link my readers to anything pertinent I write anywhere else. If I write anything for my Asthma Blog I will link to it. The RT Cave is meant to be a medical blog, and other than the fact I think the Fed should stay out of the healthcare business, I keep politics off it. That's why I created Freadom Nation so I can blog about politics, history, ethics, philosophy, and anything else that is not medical and not offend anyone on this blog. Still, the only blog I make sure I keep up on a regular basis is the RT Cave.

14. Say a respiratory therapist or RT student has just started their
first blog. What advice do you have to help them gain readers and
contribute to the blogosphere?

I'm still figuring it out. I don't even know how to make my own header, which is something I'd love to do some day. Basically I got all the ideas for this blog from reading other blogs like yours. I would by no means consider myself a blog expert.

15. I know that you post regularly on at least one other blog (besides
the RT Cave). Tells us a little about those blogs. What are the links
to your other blog(s)?

I write an asthma blog for Health Central.com. I usually have one post a week, which is sometimes turned into a comic by a well known comic artist called Dash Shaw. I think he even draws comics Marvel comics. So, I'm pretty honored to get a chance to work with him. I write a lot of useful information there, but I tend to be lighthearted and comical like I am here at the RT Cave.

Here is a link to my comics: http://www.healthcentral.com/asthma/respiratory-therapist-comics.html. Here is a link to my asthma blog: http://www.healthcentral.com/asthma/c/52325. I still write for Freadom Nation, but I've been slacking there lately since I have these medical blogs I prefer to keep up. Due to lack of time, I don't put the effort into that blog as I do to my medical blogs.

16. What is your favorite...
Book: The Eyes of The Dragon by Stephen King
Movie: The Lord of the Rings
TV Show: "Married with Children"
Holiday: Christmas and 4th of July
Quote: "Love many, trust few, always paddle your own canoe."
Band/musical artist: Aerosmith, AC/DC, Guns-n-Roses, Garth Brooks.

17. I work nights so I know that kills your social life (like I ever
had one, LOL). Blogging takes a big chunk of time too. What do you do
when you're not at work or writing blog posts?

I have three kids and a wife. That takes up all of my spare time. Well, let me rephrase that. My spare time is what's left over when my wife and kids are in bed and I'm not working, at which time I blog or sleep. I also like to play Nintendo games, such as Madden 2008. I'm undefeated in season #2 on my way the the Football Hall of fame. I love sports, particularly the Lions, Tigers, Pistons and Red Wings. I watch as many of those games as I can. I also collect baseball cards with my son.

18. If you weren't a respiratory therapist, what would you be? Why?

I would be a history/ political science teacher. I'd also like to have more time to write. I think there's a novel in me if I could simply quit my job.

19. If you could go back in time and trade places with anyone, dead or
live, who would it be and why?

Well, not Teddy Roosevelt because I'd hate to suffer with asthma and have nothing but coffee to take for it. I would trade with Ben Franklin. I think that man is one of the most impressive of all time. Well, with the exception that he was so busy with his career that he slacked as a family man. Still, I would love to walk around with his IQ racked up in a ball inside my head. Ben Franklin was fascinating.

20. Save money wasn't an issue and you could travel anywhere in the world. Where would you go?
I'd move to Florida in the winter and come back here to Michigan in the summer. That's a humble goal I have anyway for when I retire. If I could do that now I'd be thrilled.

21. Clear up one misconception that you believe other medical professionals hold regarding respiratory therapists.

We are professionals who work right alongside nurses and doctors to benefit the patient. We make important decisions, manage the vent and clear the airways so that you can breathe when things clog up your pipes or stop the flow of air. We are not ancillary staff. I think most nurses fully respect RTs. I think most doctors do too. I just wish doctors had a little more respect for the profession and allow us more autonomy. Come on docs, allow us to utilize our skills!

22. Do you have any advice for current RT students? What about those already in the field?

Study hard in school so you have a plethera of wisdom to pull from when you are in crunchtime. Yes, you can have a cheat sheet, but you sometimes don't have access to it when you are with your feet on the ceiling and your vent is beeping and you can feel the doctors warm, hotdog breath wafting over your right ear while the nurse is panicking on the other side of the bed and the patient flailing.

For those already in the field, keep up on your skills and education. If you slack even for one minute you are showing doctors that we really cannot be respected as a profession. Yet if we keep working hard, do what we are allowed to do to the best of our ability, and impress doctors with our RT wisdom when appropriate, I think we will one day get the autonomy we RTs deserve.

Be sure to check out the Respiratory Therapy Cave when you get a chance.

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