The handoff at St. Luke's in Cedar Rapids happens at 18:45 in a back hallway by the pyxis. The day RT, Marlene, hands Dana Vossberg a printed census on yellow paper.
Twenty-three patients tonight. Four ventilators in the medical ICU. Two BiPAPs on the step-down floor. A heated high-flow on a kid in pediatrics, but pediatrics has their own RT until 23:00.
Dana is thirty-four. She has been a registered respiratory therapist for eleven years. She makes 38.40 an hour on nights, plus a 4.25 shift differential, plus weekend pay when the shift falls Friday or Saturday.
"It's a good wage for here," she says. "It's not a good wage for what we do."
She does her first rounds with a stethoscope around her neck and a black canvas tool bag over one shoulder. The bag holds a manometer, spare circuits, a backup pulse ox, and four granola bars.
In bed 4, a 71-year-old man on a Hamilton C6 ventilator after a COPD exacerbation. She checks the tidal volumes, the peak pressures, suctions him through a closed inline catheter. Yellow sputum, moderate amount. She charts it on the tablet clipped to the foot of the bed.
In bed 7, a woman post-op from a Whipple, weaning on pressure support. Dana drops the support from twelve to ten. She will check again in an hour.
“In bed 7, a woman post-op from a Whipple, weaning on pressure support.”
At 21:14 the overhead pages a Code Blue on 4 South. She runs. The bag valve mask is already on the patient when she gets there. She takes over the airway, bags him while the doctor intubates, then tapes the tube at 22 at the lip and walks with the bed to the ICU.
He does not make it. He is pronounced at 22:08. His wife arrives at 22:41. Dana is no longer in the room by then; she is back on 3 East with the woman who keeps pulling off her BiPAP.
"Mrs. Halloran. Please. We need this on you." The mask hisses. The straps go back over the ears.
Mrs. Halloran is eighty-six and has CHF and does not want the mask. Dana sits with her for ten minutes and explains it, again, in the small calm voice she uses for frightened patients and her own children when they wake at night.
Dana has two kids, eight and five. Her husband works days as a diesel mechanic at a Mack dealership. They overlap for forty minutes at 06:30 every morning at the kitchen table.
"My five-year-old thinks I work in a place where people sleep," she says. "Which, technically."
At 02:30 there is a lull. She eats a granola bar at the RT desk and reads two pages of a paperback. The desk is in a closet-sized room with a label maker, a coffeepot that has been on since the Bush administration, and a calendar from a medical supply rep.
At 03:11 the ER calls for a BiPAP setup on a forty-year-old in pulmonary edema. She wheels a V60 down two floors and has him settled in seven minutes. His sats come up from 84 to 94 on 40 percent.
"That one feels good," she says, walking back to the elevator. "That one I can see working in real time."
She does an arterial blood gas at 04:40 on the man in bed 4. She draws it from the radial line, runs it down the hall to the analyzer herself because the tube system is broken again. The pH is 7.31. She adjusts the rate up by two.
The day shift comes in at 06:45. She gives report standing up, the yellow paper now covered in her handwriting. Three new admits. One death. Two extubations attempted, one successful.
She walks out into the parking ramp at 07:22. The sun is on the river. She drives a 2019 Honda CR-V with a child seat in the back.
"Twelve hours," she says. "That's it. That's the job. You go in, you watch people breathe, you go home."
