In the Mouth of Madness – The Work of a Respiratory Therapist


Respiratory Therapy

Every day that you breathe comfortably is a gift. This, I say with absolute surety, after 14 years as a critical care Respiratory Therapist.  Every hour you live is a chance to learn something; not a fact or a skill, because these are too tangible, too easy to grasp. No, every day is a chance to learn one more thing about human connection and an opportunity to explore the boundaries set for us by our limitations and our fears.

Flash back 10 years ago to the critical care bedside of a tiny infant, connected to my life-supporting equipment. It is my job, on this day, to be in this room, at this moment and to press that button; Yes, THAT button. The button that turns off a machine that made it look like this baby was taking its own breaths. I’m not alone. On this day there is a doctor with me and a nurse nearby outside the door. But it feels like I am alone because no one is making eye contact. No one is saying out loud what I am screaming inside, “Dear God, this is breaking my heart.”  But really, I am glad it is me. This way, I can be so absolutely gentle and kind, yet swift when I remove the tube from her mouth. This way, I get to say goodbye as well before I quietly leave the room.

Nothing could have prepared us for this. There was no didactic course on terminal weaning babies or palliative withdrawal of life support on patients that look and sound exactly like my grandmother. And so, we learn as we go, pushing the boundaries of our fears and sending out ‘feelers’ into our psyche to probe a dark emotion that we were never trained to recognize. We can sustain life beyond expectations but were not taught to embrace death.

As I sat with an elderly gentleman in an ER at 4am a few years ago, I finally started to unravel this tangle of emotions that reared its head repeatedly.  I withdrew a BiPAP mask and then watched caregivers duck back away behind curtains. Pieces of the puzzle fell into place. We are healers. We fix people. We pride ourselves in this ability, boastful and resounding. Death is to be overcome! We shall not surrender… but if we do…when we do, we lose purpose. We feel weak. We feel shame. The dark and tangled emotions of failure, fear, vulnerability, and shame all blended opaque and smeared across our vision. We can no longer see the person we were caring for without the reminder that we were not enough.

So I became enough. Slowly at first but with steady purpose, when there was no family, I became the family. When hands reached out in fear of the unknown, I shrugged off my hesitation and held onto those hands. Fear was overcome by the strength of human connection. In these moments, my practice changed forever and so did I. My rusted old personal boundaries flexed and were broken. Relationships blossomed and life just made more sense. Everything became more real. I have never looked back.

The work of a Respiratory Therapist or any other critical care practitioner is incredibly stressful and exhausting. Finishing a set of 12 hour days and nights, it is all we can do to not run out the hospital doors laughing maniacally on our way home screaming ” No one died…it was a great night!” But on those nights when one of our patients does pass away, we can learn so much in reflection. What if we stepped right around our fears and walked boastfully up to death saying “It’s ok that you are here. Let me help you take them kindly”.  Knowing we are enough. Knowing we did our best.


8 responses »

  1. OMG….you just perfectly penned my thoughts and emotions! I have been an RRT for 12 years and absolutely hate getting “THAT” call. I remember my first time having to do a Palliative withdrawal I went to the bathroom and completely broke down…..I called my mom and told her I felt like I killed the elderly woman even though I knew she was brain dead. But yes…..evey time I clock out knowing no one passed I feel great…..but the days someone does I know I did my part…..and helped them meet their maker with pride and compassion. Kudos to all my fellow Healthcare worker! Oh….Happy Respiratory Care Week to you!

    • Thanks Stephanie. Respiratory Therapists are still so poorly recognized as health care professionals…sometimes I feel like a little sprite that just flits in and out of acute care mysteriously. (Wearing either my white wings or black wings depending on the occasion). Big hugs to you for all of the incredible work you do. Happy Respiratory Therapy Week.

  2. Very well written, thoughful and poignant. Thank you for sharing your stories and lending a voice for ours. As a therapist of 24 years, I often reflect through my career and the many patients of various populations and disease processes I have had the privilege of providing care for, and at times, withdrawing care. Sometimes we portray being stoic and strong, when inside we are wrestling with the human emotion of loss. It is not only important to nourish those connections with our patients and their families but to maintain the human compassion with our own families despite the stresses. This is an important aspect to remember too; our own families must be willing to accept and deal with the pain we experience and be supportive. Thanks again.

    • Thank you for sharing Andrew! 24 years! You must have some amazing stories! Your thoughts about how or work effects our families is so important. I am trying to build self-reflective practices into my daily routine to slow me to process all that we do and see in a day. One great side effect of this habit is not taking so much stress home with me. Everything from journaling, telling stories with co-workers and debriefing can help. Best wishes in the future, & keep up the great work!

  3. I love all the respiratory therapists nurses and Doctors that took extra special care of me in Regina Sask. General Hospital! I spent 3wks in ICU then moved to the respiratory Unit 6F, All together spent 5 and a half months there.They kept me alive and gave me more time..I now appreciate my life a lot more.. one never know what life they have left enjoy every moment you have!

    • Wonderful to hear Dolores! I’m sorry for the very late reply but very grateful for your comments. Every moment is indeed precious and I’m so happy that you have the opportunity for more. Best regards in your days to come…

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