When a hospital patient has a breathing problem, the services of a respiratory therapist are needed. Recently we were visited by a respiratory therapist, and after all the news during COVID about people on ventilators and the hospitals needing additional ventilators, I was anxious to hear about her work. I found her story very insightful.

Chrissy Archibald has been a respiratory therapist for 10 years and works at the Maine Medical Center in Portland. She likes her work. “I like helping people. People feel anxious when they come to the hospital and have faith in our ability to help them.”

A ventilator is needed when a person cannot breathe on his own. The patient is anesthetized and the respiratory therapist assists the doctor in putting the breathing tube in place. The tube is inserted through the mouth, down the trachea to the lungs. The process of inserting the tube is called “intubation.” Throughout the time the ventilator is needed, the patient is kept comfortable with sedative medication, and the hands are restrained so the tube won’t accidentally get pulled out.

Archibald keeps a close watch on patients while they are on the ventilator. She monitors oxygen levels in the blood, which are indicated on the machine, and she also takes blood samples and sends them to the lab for an even more accurate reading. The monitor on a ventilator also records how many breaths a patient takes per minute, how deeply the patient is breathing, and the level of carbon dioxide leaving the patient’s lungs.

Patients on a ventilator are unable to talk and they feel sleepy from the sedation, but they can hear. Naturally, they feel anxious about what is happening, and Archibald takes time to set their minds at ease. I could feel her compassion as she told me how she calms her patients – “I talk to them. I tell them where they are, what has happened, and that the tube in their mouths is there to help them breathe. I hold their hand and tell them they are safe. I tell them the hospital has talked with their family or friend and I relay to them whatever messages we get – a person who will be coming to visit, maybe even someone who will be taking care of their dog. They need to hear words that comfort.” While she was telling me this, I thought about the special gift it takes to carry on a one-way conversation, a gift of caring.

We’ve all heard a lot about COVID patients needing to be on ventilators, but many others require it too. People who have open heart surgery and other surgeries often need it for a few hours. Victims of bad accidents, and people who have pneumonia, sepsis, or stroke may need it for a more extended time. Archibald said, “We try to take people off the ventilator as quickly as possible to prevent them from getting an infection or pneumonia, which can occur if germs get in the tube.”

Archibald said, “Some patients start with 100% oxygen and I gradually combine it with air as the patient improves and I can reduce the oxygen amount, but whatever the starting level, the reducing process has to be very carefully monitored to do it safely. I feel good when a patient no longer needs the ventilator support and when I remove the tube, I joyfully say, ‘Let’s hear your voice.’” And what a joyful moment that has to be for the patient!

Some cases aren’t joyful. Archibald sees a lot of people die. The ventilator is the machine used for life support, and many of her cases are end-of-life situations. She said, “That can be hard to see and emotionally testing for me, especially when it’s a young person who hasn’t had a full life. It’s so hard to see families going through the loss of a teenager, and such a difficult place for the family to make the decision to stop life support. I try hard to compartmentalize my emotions by staying focused on my job so I can work with difficult situations and not take on the emotions of it. I don’t work in the pediatric intensive care unit because I can’t stop from putting myself in the parents’ shoes.” Archibald is the mother of a two-year-old and a six-year-old.

The decision of when to stop life support is also difficult for the family of an elderly parent, and some families feel guilt about making the choice to stop support and instead have their loved one go through aggressive support measures when there is no hope. Archibald says it helps the family so much when patients have filled out a Directive Care Form. It guides the health care team and the family to make decisions according to the wishes of the patient, and it removes guilt from the family and allows the loved one to die in peace.

Archibald finds satisfaction in her work. Her job is a very important one. Patients’ lives are in her hands. She says, “It’s a challenging job that requires a lot of critical thinking, and I’m fortunate to work with a good team of doctors and nurses.”

I believe we get the best job done from people who like their work, rather than from people who are doing jobs just to get a week’s pay, and it’s especially critical to have dedicated people in positions where our lives depend on them. Thanks to a visit from Archibald, I learned about the important role of a respiratory therapist and the ventilator she operates, also the importance of the Directive Care Form, something Gerry and I just added to our to-do list.

Carole Gariepy lives in Phillipston.

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