Advantage Of Small Town Hospitals

So, I’m sitting at my computer to finish up some charting. I click on the Epic icon. That’s as far as I get before my work phone dings to indicate I got a message. I check the message. It says, “Please come to the ER for a short of breath patient.”

I quickly set my phone into my scrub shirt pocket. I scoop up my stethoscope from the desktop and begin the long trek to the ER. The message did not indicate a room. But it looks like the ambulance crew just dropped a patient off in room 14. So I start there.

I enter the room. The crew and some nurses are moving a patient from the ambulance cart to the ER bed. The patient is sitting up high and wearing a non-rebreather mask. This is a special mask that allows us to give close to 100% oxygen. He is an elderly man who appears to be working hard to breathe. I don't immediately recognize the man under the mask.

No sooner do I enter the room and the patient spots me. I can see his face brighten from under the mask. He motions to me with a long wave of his hand. He said, “Hi John, glad to see you!”

“Hi, Mr. Patient.” I said.

He was a regular

Actually, he was just discharged not too long ago. I remembered right away that he has COPD. He also has mesothelioma, a type of lung cancer caused by asbestos. Another name for it is asbestosis. He also lives on 6lpm by nasal cannula at home. And I know he would benefit from BiPAP. But, from memory, I know he doesn't much care for the mask. He prefers (actually loves) the high flow nasal cannula.

I knew all this before even talking to the patient, and without even looking at his chart. This is one of the advantages of working for small-town hospitals. There’s only 1 or 2 of us therapists. So, we tend to get to know our patients. On the flip side, our patients get to know us. And it’s great for the comfort level.

"It’s always great when I come in here and meet friendly faces,” a patient once said to me. “It makes it so much easier when you don’t feel good.”

I find this to be true with many of our patients. It also makes it easier for me to do my job. It’s nice when you get to know your patients. You get to know what works and what doesn’t work. You get to know what they like and don’t like.

On the flip side, you wish you could do more to help them. You wish you could fix them well enough so they could have better disease control. You wish they didn’t have come in and to be seen by you. But, that’s not always possible. So, that’s where you really get to know people, and friendships develop.

We fixed-up Mr. Patient

“He responds well to BiPAP,” I said to the doctor. He agreed and gave the order. I new Mr. Patient didn’t much care for BiPAP. But, as I set the mask over his face, he did not fight it. He knew it would help him get his breath back, and that it would probably only be temporary.

“Just wear this for a little while to give the doc time to work his magic,” I said.

He nodded, giving a muffled, “I know.”

A few hours later the patient was feeling better. We wheeled him upstairs to a room. He was mumbling something under his mask. I couldn’t hear what he was saying. But, as he talked, he made as if to pull the mask off. I got the message: he wanted a break from the mask.”

“Hold on, I’ll be right back,” I said. I left his side. Sitting at the nurse’s station was the admitting doctor. I asked if I could set the patient on a high flow nasal cannula. “Yep,” the doctor said, “Whatever you want. You are the expert.”

Nice!

And I set off to get the high flow cannula. This is a special nasal cannula device. It allows me to give up to 100% oxygen. using higher flows. It’s nice that you don’t have to wear a mask. So, it’s well tolerated by patients. You’d think the high flow would irritate them, but it doesn’t.

So, I set this up in Mr. Patient’s room. He smiles and says something that I cannot make out. I gently rip off the mask and his smile grows bigger. “Ah, that feels soooo good to have off.” I immediately set the bulky nasal cannula into his nares.

“So much better, “ he said. “Thanks, John.”

It's neat getting to know folks

Many people enter our ER we don’t know. We assess them and ask questions. This helps us determine how best to get them feeling better. Sometimes all that’s needed is a simple breathing treatment. Sometimes it’s oxygen via nasal cannula. Sometimes it’s BiPAP or high flow oxygen. Sometimes, although rarely these days, we have to be even more aggressive.

When you know someone, that makes it all the easier. You know from experience what has helped in the past. You know the patient’s likes and dislikes. And, in many cases, you know what topics the patient loves talking about.

After I have the high flow cannula set up I grab a chair. I set it next to his bed. “So, how are those cute grandkids of yours.” His face once again lights up.

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