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

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! Yet if we choose to, when we choose to, 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.

CB