Tuesday 3 November 2015

A "Ted Talk" about my job as a Respiratory Therapist

by Christine



A completely normal conversation with my father-in-law over Sunday dinner sometimes goes like this.  “Hey Christine, how were your shifts at work?  Did you kill any one this week?”
Sometimes, it’s "no"… sometimes, it’s "yes."

For the last 17 years, I have been working at University Hospital as a Registered Respiratory Therapist.  I specialize in the heart and lungs.  I work 12 hour shifts that rotate from two day shifts followed by 2 night shifts.  We are an essential service that operates 24 hours a day, 7 days a week.
I love what I do. It is challenging, exciting, ever-changing and I am helping people who are very sick every day.  I'm a part of a highly skilled team of medical professionals who care for the sickest patients in the hospital.   Best of all, I get to go to work in pajamas! (also called scrubs)



I work with a lot of 'super bugs' (such as MRSA), which is bacteria that is resistant to most or all our antibiotics.  My patients also might have AIDS, hepatitis, herpes, TB, meningitis, pneumonia, influenza, pus on the brain, open & weeping sores, lice, maggots and even bed bugs!  I am adamant about leaving my work at work - for these reasons!
MRSA - methicillin-resistant staphylococcus aureus



The "Ebola suit", with an air exchanger
 filter and pump on my back

The majority of my patients are in the ICU - Intensive Care Unit - which is where all the sickest patients are housed.  I also care for patients in the Emergency Rooms, Operating Rooms and all the inpatient areas of the hospital.
My patients in the ICU are typically heavily sedated - or completely comatose.  My role is to manage and monitor the patient’s breathing and airway.  The goal is to try to get them off life support.   Sometimes I succeed, sometimes I don’t.

I do CPR on average once a week.  Has anyone seen CPR done on a person, not first aid training?  It is tiring, and sometimes we work on resuscitating a patient for more than an hour.  Often, effective CPR breaks ribs and cartilage.  
I also carry a pager as a member on the Code Blue team, so if a patient anywhere in the hospital suddenly decompensates (be it from a heart attack, heart failure, falling unconscious, seizure, stroke, an emergency in the operating room, a car accident, severe head trauma, a suicide attempt, over-whelming infection, high blood loss, drug over dose, respiratory failure and on and on...), three RRT’s are literally running to the patient along with an ICU nurse and two doctors.   

I get to see some pretty cool and amazing stuff at work, I see patients come back from cardiac surgery with their chest still open, because they were too unstable to close it.  You can see their heart moving under the transparent dressing.  I have seen doctors re-open my patient’s chest and hold the dying patient’s heart in his hand, squeezing it to make the blood flow.  I have been there while the doctor drilled holes into my patient’s skull to relieve pressure from fluid and blood accumulating.  But... when my then-6-year-old Hudson was getting four stitches in his head, I nearly passed out!
We respond to these calls of extreme emergency so frequently. We know how to work quickly and effectively to help stabilize a patient who is dying before us.  I work very well in high stress situations, I am able to keep calm and think clearly in intense, time-sensitive situations.  
This training has made me very good at assessing a patient.  When a nurse or doctor pages me to come and assess a patient who they are worried about, it is then that my skills shine.  I have learned to use all the senses God has given me.  I use my ears to hear the breaths of my patient, I use my nose to smell - and believe me, there are no good smells in a hospital!  I use my hands to feel and I use my eyes to observe.   Part of my job is to help identify which patients need to come to the ICU for more intense treatment.   

I regularly see death at work.  In my job I help determine which patients are brain dead.  
It is harder than you think to declare with certainty when a patient is actually dead.  You may say when their heart stops beating, they are dead. But many times - with the right dose of electrical shock, CPR and epinephrine - we can resuscitate a patient; a patient who’s heart had stopped moving.  We had a patient who had CPR done on her for 2 hours in the ambulance while she was rushed down Highway 401 to our hospital.  When she arrived she was put on ECMO (a life support machine that shunts all of the blood out of her body, cleanses it and pumps it back into her body, doing the job of her heart and lungs).  She was like this for days.  She was months recovering, but she came back to visit the staff in the ICU to say thanks.
Brain dead is a term that was defined at Harvard’s Medical School in 1968.  
According to Wikipedia’s definition, brain death is the complete and irreversible loss of brain function.
Today, both the legal and medical communities in the US use "brain death" as a legal definition of death, allowing a person to be declared legally dead even if life support equipment keeps the body's metabolic processes working.  

Just to clarify, this is not the same as a patient who is in a persistent vegetative state.  They are usually able to breathe on their own and their brain stem is still functioning.  So, as an example, my patient who is lying in the hospital bed on a ventilator with her heart beating and her chest rising and falling with lots of signs of life on the patient monitor, she can be legally dead.  If a patient is brain dead, the transplant team comes and determines if the patient’s organs can be used.  Often my brain dead patient will go to the OR and later that day I receive their organ transplant recipient as my new patient.  
Sometimes after the doctor meets with the family of a dying loved one, and no further treatment is deemed possible, it is my job to withdraw life support on my patient and allow nature to take it’s course.  I am the one to 'pull the plug', so to speak.  In some countries, it is against the law to withdraw life support.  What if it were like that here?  We don't have an endless supply of ventilators and dialysis machines - and the space to care for that type of patient. That is a reality.  

I’ll never forget the day Pastor Don Howard came to see one of our church members in the ICU - a patient of mine.  It was determined that she was brain dead and later that day we would be withdrawing life support from her.  He asked me, “Chris, do you think she is still here with us?”   I looked at him and said, “No, this is just a shell. She is gone - her soul has left the building.”  


Finally... I don’t recommend any of you coming in to visit me at work.  But if you do, know that I will be praying for you and using my skills to help you.