…And now, i present to you Dr. Awesome
Mr. Patient has a trach. Mr. Patient has had a trach for a while now, but his mom usually changes it for him. Mr. Patient went to suction his trach and couldn’t get the catheter through, and was able to speak normally without his valve on. (In order to speak, trach patients need to somehow plug up their trachs in order to run air over their vocal cords; while they can always put a finger over the trach, there’s a wonderful invention called a Passey-Muir valve that allows patients to breathe through the trach and speak without needing to cover the trach. If a patient can speak normally without covering the trach in some way, that means it’s awfully clogged.) Mr. Patient asked me if we could change the trach out.
The trachs we use at our hospital have an inner cannula - basically, a tube in the trach tube that can be changed whenever the trach gets gunky. We can change those, or take them out and clean them, and in fact, do it all the time (or at least, we should). The reason trachs have inner cannulas is - among other things - if you pull a trach out and then can’t get the new one back in, your patient can’t breathe. The inner cannula allows us to pull the gunky stuff out without taking out the support of the trach itself or irritating the tissue around the trach opening/in the trachea.
The only problem was, Mr. Patient’s trach didn’t have an inner cannula.
So i paged one of the ICU Residents at random, explained the situation, and asked him, would he have the time to come over and change Mr. Patient’s trach out for us?
Sure thing, Dr. Awesome said. I’ll be right over.
Five minutes later - a blink of the eye, in hospital time - Dr. Awesome walks in. He’s supercool to the patient and to me. “I’m Dr. Awesome, but you can call me Super,” he says to Mr. Patient. “I hear you’re having a problem with your trach.”
Dr. Awesome listens very attentively as Mr. Patient, who’s rather anxious, explains that yes, he’s got this trach, and it’s clogged, and he can’t get the suction catheter in, and the last time he tried to force the catheter in he nearly choked to death, so now he and his mom just change the trach out and clean the old one. Dr. Awesome nods, asks a few questions, listens patiently as Mr. Patient answers, and is very cool and supportive as Mr. Patient freaks out a little bit - after all, there’s nothing more fun than the possibility that we’ll take out Mr. Patient’s trach and then he won’t be able to breathe.
Dr. Awesome checks with me to make sure we’ve got everything, and is again very cool - it’s a double check rather than an “I need this and this” and shows that he trusts me to do my job well. The trach switch occurs on the patient’s terms, and he sticks around afterward to offer support and encouragement until it’s clear Mr. Patient’s okay. All in all it took maybe ten minutes - an eternity in hospital time - but to look at him, Dr. Awesome was willing to be there for an hour if that’s what was needed.
Thank you, Dr. Super Awesome. And do me a favor - when Dr. Asshole gets to you, sit him down and explain that you catch more nurses with honey than with vinegar.
The trees add shade to shade, lights out in the houses, we’ll both be lonely.
“Dear Nurse Bear,
A graduate nurse thinks psych patients are interesting.