The Difference Between Life and Breath
Respiratory therapists are highly skilled practitioners who provide treatment, management and care of patients with breathing deficiencies and abnormalities. I chose to go into this profession not just for the money, as some might think, but because of my own life experiences in having to deal with taking care of my Dad, who died from third stage emphysema and because my son has asthma. Part of my acceptance into the respiratory program at Ivy Tech was to job shadow a therapist for a day. I chose to do this at St. Clare Medical Center in Crawfordsville. I called to set up my appointment for the job shadow and found out I would be shadowing Pam Ehrie, which was good because I already knew her as she helped to care for my Dad and also cared for my son.
I arrived at the Respiratory Department at 10 a.m. on Monday of the following week and Pam came out to greet me with a scrub jacked and a name tag and briefly explained that I would go with her to make her rounds for the day. “Oh yesterday would’ve been a much better day to have come,” she exclaimed. “We had three codes so there was a lot more going on and it wouldve given you a better idea of what we really do.”
“What are codes?” I ask, although I already had a pretty good idea.
“Oh that is when the patient arrives and they are basically gone, not breathing, and we have to recessitate them back to life.” Pam says. “I forget that you are just starting into this, so if there is anything that I say and you do not understand it, just ask me.”
Pam is a rather petite, bubbly individual who stands about five foot tall with shoulder length reddish brown hair and green eyes. She is pretty, with a warm smile that hugs you when you first meet her and a friendly face with kind, gentle eyes. Pam has been a therapist for fourteen years and she also went through her schooling at Ivy Tech. She loves her job, co-workers, and helping others. “It is my passion in life,” she says. She embraces the idea that she is giving a better quality of life to others. She is also the senior Registered Respiratory Therapist on staff at St. Clare Medical Center and she does all of the clinical sequences with the new students at Ivy Tech. She is highly knowledgeable in her position as I have learned in my own experiences with her and not much bothers her, “I have seen it and done it all. But dealing with other peoples bodily fluids is not for everyone, but it has never bothered me. Once you get your gag reflex under control, you’ll be fine.”
Our first patient of the day was Odis McMannomny, he was 78 years old, and has terminal lung cancer that has spread to his brain and glands. We were going to obtain a sputum sample from him, and I had a pretty good idea what that was, but I asked her anyway. “Oh basically I’m going to have him hawker up’ some sputum for us to send to cytology so they can look at the cancer cells. It’s sort of gross, but just get your gag reflex under control and you will be fine. I really don’t think about it anymore, I just do it.”
Before entering Odis’ room we stopped outside for Pam to review his chart and show me the different entries made from the night before. “This one is “no-go” she told me, “which means he will never be going home, he is terminal and will not make it. This isn’t a term used professionally, but it is a term used mostly between therapists.” I thought back to my Dad’s last visit to St. Clare and wondered to myself if that was how they referred to him on his last visit to the hospital, or on the day that he died? When we entered the room Odis was sleeping, or at least his eyes were closed. He was lying in bed propped up on one side by his pillow and you could hear a slight wheezing sound coming from inside him. The room had a faint odor of something that may have soured in the sun and I silently assumed that this was because of the cancer he had and to what degree that he had it. His skin was a pale gray color that just hung on a frame that used to be his body, and his fingernails were discolored a bluish, greenish color by his cuticle. You have to wonder about what he might have looked like before the cancer, as now he looked to weigh about one hundred pounds, basically just skin and bones with deep purple areas around his knees and elbows
“Hi Odis, how are you feeling today?” Pam cheerfully asked.
His eyes fluttered open and he said “Well I’m just not doing too good. I cannot get my breath.” He had a vacant look in his eyes as he tried to focus in on who was talking to him and where he was.
“Odis, this is Tracy and she is a respiratory student at Ivy Tech and she is shadowing me today. Is that alright with you?” Pam asked him.
“Well yes, I spose it is.” Odis said
Pam proceeded to check his vitals and listen to his “lung sounds” with her stethoscope to see if they had worsened over the night. “Here listen, see how it sounds crackly? That is bad. It means that he is not getting enough air in his lungs and it is caused from the fluid and phlegm in his lungs that he cannot get rid of.”
I bent down to listen to his breathing through her stethoscope and heard a lot of wheezy, crackly and popping noises coming from deep within his lungs. Not the smooth, silent, glass like, flow of air you should hear from someone who is healthy.
“Odis we need to get a sputum sample from you for the lab, do you think that you can do that for me? I will help you. Have you been using your flutterer?”
“He needs to use his flutterer,” Pam tells me “It’s to exercise his lungs so that he can get more air in there to help him not to feel so winded, and it will help him to expel some of the stuff that is in his lungs preventing him from breathing better.”
“No, not much. I have no breath to do that thing.” Odis wheezed.
“Well you need to use your flutterer. It will help you to take deeper breaths so you can cough up some of that junk in your lungs. If you do not try to use it you will just struggle to get air into your lungs. Now, I need you to take a deep breath and blow into your flutter to make you cough so we can get our sample.”
“Well ok, but I don’t think I can do it” Odis said with out much interest at all.
Pam held the flutterer to Odis’ mouth and told him to blow as hard as he could. Odis did, and after that he began to wheeze and cough and you could hear a deep rattle in his lungs. Pam encouraged him by patting his back and telling him to cough harder and that he was almost there. I can honestly say it was not pleasant to watch, but it was life and I was going to be a part of it in the near future. Pam grabbed the specimen cup quickly as a huge amount of gray, lumpy sputum came up, out and into the specimen cup.
“Odis, that was great. Now just lie back and rest a bit. Get your breath, and I’m going to fix your pillow for you so you are more comfortable.” Pam said as she started to fluff up Odis’ pillow. She stood there, over him, for just a brief second and “petted” his hair back off of his forehead as a mother would do to a child. It was those kinds of gestures that stood out to me the most. “I’ll be back in a bit to check on you and give you a treatment. If you need anything, just buzz me.” Pam told him as we were leaving the room.
“Ok.” Odis said in a wheezy whisper.
Pam and I proceeded to the nearest nurse’s station with our specimen and the nurses all scattered like bugs when the lights get turned on. Obviously they knew what she was going to do with her specimen as they had seen it before. “Pam, can’t you go do that someplace else, we just had lunch here and would like to keep it.” one nurse says while walking away.
Pam looks up with a smile and says “Well if you can’t run with the big dogs, then stay on the porch! You guys are such wimps! If it wasn’t for us therapists who do you think would be doing this?” she tells the group “Gosh they see a little sputum in a cup and they about barf, its all in a days work!” “I have to put this in the cytology solution so that they can run their tests on it and look at the cancer cells.” As she was telling me this she began to scrape out the gray, sticky, lumpy sample with a tongue depressor used as a spoon into the cytology solution. “Oh this is gross,” Pam says “There’s food and chunks in here, the poor guy can’t even hardly swallow.”
I shadowed Pam for a good part of the afternoon and really began to have a good understanding of what these individuals do. Respiratory therapists are behind the scenes in the hospitals and nursing homes in which they work. They are not doctors, or nurses, and they do not get credit where credit is due. They are highly skilled in the jobs that they do, and they do jobs that many of us would not want because of what is involved physically and emotionally. There are always going to be patients who cannot be saved, or will not live, but it is these therapists who make the difference in the patient’s lives and the quality of life that they have left. It is the respiratory therapists who make the difference between life and breath.