A respiratory therapist may not be the medical professional you’d be most eager to need.
It would mean you’re having difficulty breathing.
But if that’s already the case, a respiratory therapist is exactly the person you’d want to have on your side.
COVID-19 brought this and more into clear focus. A profession that was, perhaps, underappreciated — or, at least, not as well-known as some others — became heroic.
We recently spoke to Jerin Juby, manager of respiratory care at Thomas Jefferson University Hospitals, and one of his senior respiratory therapists, Jerome Taylor, about their work.
Jerin, tell us about respiratory therapy and what respiratory therapists do.
It is a specialized health-care practice. The therapists, all of whom have an associate’s degree or a bachelor’s degree, are board certified, are licensed by the state, and are trained in clinical care and cardiopulmonary medicine. We are on staff at the majority of hospitals in the U.S.
We primarily work with patients with acute clinical conditions — mostly cardiac and pulmonary disease states, but also other conditions. We work with COPD patients and pneumonia patients. We see patients from just weeks old to 100 years old. They have primary issues with breathing as a common factor.
Many patients require additional support, so we spend a lot of time working with mechanical ventilators, or breathing machines. We also help patients with many other devices that give them oxygen and air, including nasal cannulas and masks. Basically, when a patient comes into the hospital with shortness of breath, we are there to help them, to pick the right device that they should go on. Eventually, we help wean them off the machines, as well. We are there for the whole process.
Once the patients leave the hospital, we have teams that follow up with them and help them with their needs at home. We answer questions about breathing exercises or medication and help them make follow-up appointment with the pulmonologists.
How did COVID-19 change everything, Jerin?
COVID-19 was probably one of the most challenging experiences I have ever had. In our initial days of COVID-19 last March, we were concerned about the news that was coming out of New York, highlighting a lack of ventilators.
Would it happen here in a week or two? Would we run out of ventilators? Not only that, but who would manage the shortage? Which patients would get ventilators, and which would not? And if there was a significant increase in patients, would there be enough respiratory therapists to take care of them? We worried, ongoing. What is going to happen in two weeks, in four weeks? What would it look like? How could we manage?
As the pandemic was building and people were getting sick and places were closing, would we have enough supplies — from oxygen tubing to ventilator supplies to masks — and if not, how would we manage that?
Just to put our staffing into perspective, at our main hospital in Center City, we have about 110 respiratory therapists, compared with several thousand nurses. The respiratory therapists were working 12 hours straight, every day of the week, just to manage the pandemic. It was not only grueling, it was really challenging emotionally. People had children at home. They had elderly parents. Taking care of COVID-19 patients, we were right there, right next to the nose, next to the mouth. No one knew how bad this was going to be. Everyone worried, what if I get it? What if I get really sick?
But looking back on 12 months of this journey, if I consider the bright side of things, I have to say that we showed a lot of persistence in getting through these challenges. Everyone — the whole team — came together to fight this. We actually really saw our teams clinging together, backing each other up, supporting each other, through the whole process. We felt as one. We are together and we are fighting this.
Jerome, how do the respiratory therapists care for COVID-19 patients when they are admitted to the hospital?
When they come into the emergency room, they may have a hard time breathing. If so, we set them up on oxygen. We may start with the lowest flow, then increase to higher concentrations of oxygen, as needed. We also set patients up with CPAP devices, which is the next step before intubation and being put on a ventilator. The ventilator would be the highest form of support the patient would need.
We will be with them. We assist with transports to different units, to the different tests they may need. We support them through the whole gamut of their breathing, whether it’s routine shortness of breath or complete respiratory failure.
It is an awesome job. I’m glad I picked the profession. To stand there, when a patient cannot breathe, to see the distress on their face. ... When you see them start to feel better, it makes you feel like you accomplished something.
The worst part is when we can’t get them to feel better, and they have to go onto a ventilator. You sit back and say, “Oh, I wish I could do more.” We just have to wait and see if they get better.
Jerome, how do the respiratory therapists help COVID-19 survivors recover lung function?
That actually takes a long period of time. We still don’t know the full extent of how bad their lungs might be. I recently had a patient who had COVID-19 at the beginning, and X-rays show that his lungs still look as bad as they did then. And he’s considered recovered. You see the damage the lungs sustain from COVID-19.
If the patient is on a ventilator, we help them recover lung function by — when it’s time — removing the tracheal tube from their throat, putting them on oxygen and encouraging them to take deep breaths. We help them position their bodies to make sure they get the most air into their lungs. Many people have heard of proning — putting a patient on their stomach, which helps increase the air space in the lungs. There are more airways in the back. We have to physically move some patients who cannot move themselves. It definitely can be a workout.
Then, hopefully, we’re working on getting them out of here.
All the time — from when they’re on a ventilator to regular supplemental oxygen to being off of supplemental oxygen — we are monitoring their oxygen levels, their heart rate, their respiratory rate, their general appearance. That can tell you more than the numbers alone. How much are they working to breathe? Are they in distress? You can see the veins in their neck fully distended as they gasp for air. When you see that, you know you need to intervene.
Jerome, what motivated you during this difficult time? How did you manage to keep going?
First, my motivation was simply to stay healthy and get home at the end of the day. It was as simple as that. But you have to respect the science. Protect yourself, wear a mask, your gown, your gloves, everything like that.
It was very stressful at the time. But you were not alone. We had to encourage each other, to work as a team. When you got busy, you knew your coworkers had your back. We just kept hoping for a vaccine. Now, it feels like it’s not as bad anymore.
Overall, my patients motivated me. We work with these patients, sometimes for months. You connect with them. You feel it could be your wife, your husband, your kids, your grandma, your grandpa. It definitely affects you. I tell them, “We’re going to try to help you feel better, to help your breathing.” We encourage them. Patients are happy to see you in there. Often, they’ll encourage you. Those patients make you feel good.