Respiratory Therapy 101: Just Keep Breathing

It had been a busy night in the ICU. Between the new admissions and the demands of the older patients, nobody had been able to sit down all night; add that to my workload as the only RT in the house and it was a recipe for stress and disaster. Just as I was sitting down to drink some well-earned coffe, I got called to standby in the ER for a severe respiratory distress patient. I gave ICU a heads-up and went downstairs to wait.

The ambulance pulled slowly into the bay, and their strobes flitted across our faces and my blue coat as we waited. When the rescue techs brought him in, he was whiter than a ghost. His face was ragged and unshaven, his eyes rolling back into his sunken face. His breaths were barely enough to move air; I could see his ribs every time he breathed in. The paramedic was yelling at him: Don’t stop breathing! Come on, stay with me! The man was immediately familiar: he was an old “COPD-er” whose life I had helped save several weeks back when he did this exact same thing to us.

The ER doctor suggested that we try BiPAP, which is a noninvasive sort of mechanical ventilation. I scuttled around and hurried to set up the best machine we had for BiPAP. As usual, there were no supplies and I had no help, so I had to scramble to find the face mask and straps quickly. I managed to strap the mask onto his face when one of the nurses looked at the heart monitor.

“Look at this, guys.” We watched the monitor. His heart rate slowed down. We stood transfixed, watching as time seemed to slow and his heart rate dropped from the sixties through the thirties and into the twenties. Somewhere in those five seconds (it felt longer) the patients wife showed up, which immediately made things worse. She saw her husband on the stretcher, bolt upright, looking like a dead man already. She began to wail and cry. There is no sound like the wail of someone watching their lover die.

The ER doc ordered someone to begin chest compressions. I grabbed an Ambu-Bag and began ventilating the patient with assistance from an ER nurse. The wife was shaking and sobbing; she was screaming “Don’t leave me now! You can’t leave me like this! Not now!” She was shaking and tearing at her hair; she lunged for the stretcher and grabbed his feet as the doctor intubated the patient. Once the airway was secure and the patient was being breathed by me, the doc got out the defibrillator paddles.

We shocked him once. Twice. Three times. His body shook when we paddled him; his limbs twitched when we shocked him. We resumed CPR.

We went on like this for probably fifteen minutes: compressions, shocks, and screams from the wife. Every time the doctor shocked him, he leapt from the table like he wanted to give me a big hug. His eyes lolled back in their sockets, half-lidded and unseeing.

Eventually, the doc looked at the wife and told her

I’m sorry, but there’s nothing else we can do.

She wailed like a banshee. I packed in my airway kit and left. It was unsettling. I had grown attached to the patient during some of his prior visits, despite his gruffness and against all the rules. I couldn’t help but feel shaken. Death is an awful thing to witness, and seeing the anguish of family is the worst thing I can think of offhand.

Later, I told the ICU nurse that she wouldn’t be getting an admission.

“That guy I told you about? He won’t be coming up.”

“Did he get admitted on the floor?”

“No. He got admitted to the morgue.”

Her eyes widened and her mouth flashed me a grin. She jumped, gave me a high-five and said “Yes!” We did a little dance to celebrate not having to do the enormous amount of extra work that an intubated admission would require.

After, we sat around and drank coffee. I still feel guilty. I rejoiced at the death of a human being for no reason. And I was not alone.

We are the people who are supposed to take care of you.

Be afraid.

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