Ok Ok so I had to ask Arnie to help on this one …. but I think he says it best… when hes moaning and barking at the stupidness of the comments people make.
As an asthmatic we often have to present at Accident and Emergency and normally end up in RESUS in a matter of seconds. When we are there we are lucky if someone there knows us and the protocol, or a nurse/doctor who has seen us before… more often than not though it is someone new, or can be a hospital we have never been to before. Now add this in to the recent stats published by Asthma UK:
- 5.4 million people in the UK are currently receiving treatment for asthma: 1.1 million children (1 in 11) and 4.3 million adults (1 in 12).
- In 2015 (the most recent data available) 1,468 people died from asthma.
- The NHS spends around 1 billion a year treating and caring for people with asthma.
It is shocking that we ALL are facing similar issues which can lead to delays in our treatment when we are taken in either in an ambulance or present at Accident and Emergency. Now, bearing in mind in the past year I have been admitted to hospital so many times I have lost count, I am known to most of the RESUS team and I present the Ambulance crew with a folder that contains a list of hospital admissions, medications, allergies, history etc, I still face a lot of issues when I get in, this is from the amount of people you see in RESUS and the stupid questions/statements that are made by the teams there. For a long time I thought I was alone in this but speaking in forums A LOT of us are facing the same issues.
I know the Doctors, Nurses and Consultants all have a job to do and they need to get questions to things, I know some of it is to gauge how alert we are and if we can talk. I can however tell you, when you are fighting to breathe, hearing some of the following when you are a known Asthmatic….. is more than annoying, it can make us delay going in, it can make us loose faith in you and worst of all, it can make us worse. Here are the some of the things we hear and why they are annoying… plus pretty much the worst thing to say to anyone mid attack.
- “Do you think you could try and slow your breathing down?”, “Could you take deep breaths?” and my personal favorite “Do you think you could slow deep breaths?” “breathe in through your nose, out through your mouth”These are heard on the hour almost every hour…. Don’t you think that me sitting there fighting to breathe alone is hard enough. During an attack my breathing is only happening because I AM MAKING IT HAPPEN. I cannot reinforce this enough. Every breath I take is the maximum breath I can force into my body as I cannot force anything out. Imagine running a 100 meter sprint, then try and breath through a small straw! That is my breathing on an attack. I am not the only one that hears this, we ALL know the breathing techniques, in through the nose and out the mouth, sniff fast when possible to open up the cords, avoid coughing etc. I had one time in RESUS 6 hours into an attack a Consultant walk in and say….. “Your breathing to shallow, breathe deeply and I am sure this will solve it” followed up with “lets get you a paper-bag for you to breathe into”. He put what turned out to be an 11 hour attack down to hyperventilation on a 2 minute assessment and not understanding what had been happening. Please trust us we are breathe the best way we can to ensure that we stay alive.
- So what better to follow number 1 up with but the AWESOME follow on of “Its just a panic attack”, “If you just calm down then you’ll be able to breathe better” , “Your just hyperventilating”, “There is no wheeze, it’s just anxiety” So Doctors, Nurses and Consultants of the RESUS land, I am going to give you a little advice. IT IS NOT A PANIC ATTACK. We hope you can tell the difference and maybe once we have told you once very calmly that it isn’t that you believe us. We know the difference. We may at times seem upset (some of your needle jabbing hurts), we may at times seem scared (especially when you are not listening to us and/or we have been waiting for a nebuliser for 10 minutes), we may even seem anxious ( I know I do when you have decided to put me to sleep and I don’t get to say goodbye to people). In fact I would like to say considering you are stabbing us with needles, medications are pushing out heart rates up, we are sweating, we are tired and in pain, most of us (if not ALL of us) are calm and just waiting for you to do your thing as we focus on breathing.
- We have talked about being stabbed with needles and I think the next couple of sentences are always heard…“Hi I need to do an ABG test on you, don’t worry I always get the first time” which is normally followed with “Sharp scratch”. Ok people let me tell you about ABG’s………. an arterial blood gas test is a blood gas test of blood taken from an artery that measures the amounts of certain gases (such as oxygen and carbon dioxide) dissolved in arterial blood. An ABG test usually involves a radial artery puncture using a thin needle and syringe and drawing a small volume of blood. This is normally take from your wrist and it is the most painful thing I have EVER experienced. It is rarely got the first time, they have to dig about the site to find the artery and hit nerves, tendons and sometimes even bone. These have made me cry, scream in pain (something if you know my pain threshold is pretty impressive), in fact I have at some points refused them. So Doc… we know it isn’t a sharp scratch, in fact I prefer you not to tell me when you are about to do it, just bloody do it, PLEASE do not tell us you always get it first time, as every person is different, just let it be awesome if you do. If you don’t get it after 2/3 times ask someone else … or get the ultrasound, my arteries are stabbed a lot, they know it is coming, they will not play ball.
- “Do you think you could do a peak flow?”, “your not doing the peak-flow right” The peak flow test (peak expiratory flow test or PEF) measures how fast you can breathe out, so you can see how well your lungs are working. So Doc… I am going to give you a heads up I am in RESUS as I can’t breathe… how do you think my lungs are working right now? I know I didn’t do X years to study to be where you are, but I have lived with this for a long arse time. If I am in RESUS having an attack, I am going to tell you my lungs are not working at all well. Please do not try and get me to blow into one especially 3 times, I can barely breathe as it is. Oh and heads up….. this will not help you diagnose an asthma attack, it is useful to predict and see trends if one is coming, it is also useful to have a reading to see how you are after an attack and if you are good to be discharged but please please please stop trying to get us to do one during and attack we will just throw it at you.
- “your stats are fine, so don’t worry”, “your stats are fine this isn’t an attack” or the one I hear a lot…. “your stats are great, I don’t think this is your asthma, maybe a panic attack”.… normally just before my stats will plummet. So, when we get into RESUS we are hooked up to machines left right and center. These are some of the wires that check Heart Rates, Oxygen SpO2 levels, resp, Blood Pressure and the like. Now I am like MANY asthmatics, our Sp02 levels will show as pretty ok, maybe about the 95% mark. But time and time again this has not matched with my blood gases, or in a few seconds dropped significantly.
- This often comes with “I can’t hear a wheeze, are you sure you have asthma?” Or other useful comments on wheezing. Well I am going to rock your world… I am an asthmatic, I know a lot of them, not all of us present with an wheeze, in fact I love it when I do… normally I have silent chest more than anything as I cant move any air in/out of my lungs. A wheeze is a possible sign but not a must have to show an asthma attack, oh and when we do have a noisy one please don’t ask us to “quieten the wheeze so you can hear” guess what? We have no control over the wheeze. we can’t make it stop any more than we can make it appear.
- “My that’s a lot of medication. Are you sure you need all that?” I love this one, an despite handing them a list of medications with timing and dosage the constant questions on it all, including why you take them…. this is all whilst you are in a pretty bad way with an attack. On the ward we are used to medication reviews, but right now… please don’t start trying to review the crap we need to take, please just deal with what is going on. If you need to check if we took it all then yep go ahead, but please don’t start advising us.
This is by far not everything but most of the time we just have to roll our eyes and just not let it get to us, it is even worse on the wards if you are in a place where you are told “it is just asthma”, or told time and time again that your symptoms are not part of the check box. Guess what hospital team we already know that, that’s why I am on all the medications, why you ventilate us so much and why when we are trying to tell you something please listen. We have been through this a billion times, we are trying to help you and we are working with you….. but you need to listen. No one wants ABG’s or Arterial Lines put in, no one wants to be ventilated or struggle for 6/7 hours to breathe, none of us want to do back-to-back nebulisers and none of us really want to be asked/told anything above.
What would help is you putting on a fan or trying to cool us down, maybe hold our hand if no one is there during an ABG or Art Line, maybe just maybe be there when we are tired and say it is going to be ok. We know you have a really hard job to do and we do thank you for saving our lives countless times.
I would like to thank the support networks we have on the forum for some of the above gems, but also it really has highlighted that considering the amount of people with Asthma, how we all present slightly differently that the medical services are still very rigid in how they approach asthmatics. If you have any more gems about things said in RESUS please let me know and I will add them to the list … it is funny how we all experience the same.