What Does a Respiratory Therapist Do?

What It's like Working in Intensive Care.

What Does a Respiratory Therapist Do?

I wanted to be a Certified Nurse Midwife. That's an R.N., (at least), who then goes on to midwifery school, and catches babies. I had attended a handful of home births as a doula. It was my passion!

I started school in my early thirties following the end of a sad marriage. My son was 5. I began community college three months after leaving his father. My first aim was to get that R.N., so I visited the guidance counselor at the college and was directed to all the pre-nursing classes that are required, the pre-requisites. It was only 18 months later, when I was ready to enter a program, that I learned that there was a two-year wait for the nursing program! I should have put myself "on the list". For some reason, I did not get that information in my visit to the guidance counselor! I was so naïve.

My school friend approached me on the day that I learned that I was not going into the nursing program. She spoke of an orientation for a respiratory therapy program. "What's a respiratory therapist?" I asked.

I had a specific financial agreement with my soon-to-be ex-husband. There was a time limit. Not wasting time, My 4.0 GPA (I have to brag, because I was an indifferent student growing up) got me into the Respiratory Therapy Program.

The RRT is equal to the R.N. as far as education goes, I mean that both have all of the same science prerequisites, and then they get into their programs, where they separate into their specialties. However, our specialty is complementary with nursing but separate and different. Nurses have to know a good deal about ALOT.

RRT's know ALOT about one thing: The cardiovascular system, (the heart and lungs), specifically, the lungs. Their normal function down to the cellular level, diseases of the lungs, modalities of treatment of those diseases, drugs that improve breathing when lungs are sick. The proper use of oxygen. (It's a drug! It has good effects and sometimes not so good effects.) When a patient is in trouble, nurses and RT's are side by side over their patient. The nurse is dealing with blood pressure, or heart rate and rhythm. The RT is keeping the patient's airway clear and ensuring that they breathe, either with the big machine ventilator, or the handheld one.

I have always believed that my spiritual beliefs protected me, an empath, working where people die nearly every day. People you took care of and some you have bonded with because diseases of the lungs generally take a long time to kill you. Sometimes, as nurses will testify, you bond with their families. This happens in the ICU, "Intensive Care Unit," quite a bit.

An "RT" working in the ICU is often the last person to touch a dying patient. Usually, the patient's RN is also there, on the other side of the bed, giving meds through the IV and taking orders from the doctor. Sometimes the RN is busy with another patient who is fighting for their life and he or she comes in and administers the morphine to help the patient relax and has to leave. There I am, alone with this spirit and this body. My next actions will allow them to separate. Sometimes I believe that the patient is not ready to die, but frequently, I believed they were ready to leave the used-up body that was causing them so much misery.

A person who is "ready to go" is usually someone who has been sick for a long time or someone whose illness came on fast and furious, like a vicious cancer for example, where the odds are not in their favor and only pain lies ahead. Those ones were a little easier for me because I knew I was doing that person's will when I disconnected them from the machine that was breathing for them. I moved with the utmost reverence. I spoke softly to the usually by now, sleeping patient, telling them what I am doing, "taking that nasty tube out of your throat" and encouraging them to relax now, (after I suction their "breathing tube" one last time, so that I don't make a huge mess when the tube is removed, seconds later. I promise that nobody enjoys that process, the body resists it, the suctioning). But it's a cruel-to-be-kind kind of thing. Nurses are our sisters/brothers here as well. We share so much knowledge and experience and respect. Nurses know all about cruel-to-be-kind, it's their calling card. I often shared that space with them, though. That's what RT's do: We partner with nurses, and their aides, doctors, x-ray and CT techs, lab techs, dietary, and physical therapists to care for our mutual patients. I think of them as sister professions because they do go hand-in-hand. All allied health professionals were my tribe, for a long time.

ICU personnel have NO QUALMS about taking control of a life-threatening situation. That's what we do. It is what we are TRAINED to do. When others would faint or throw up or run out, we RUN IN, we know what has to be done, each profession knows their role, and we work together and do it. And we trust each other's expertise. We take control and often can convince the patient's body to behave, at least, for a while. Some days we actually catch something potentially serious so early that we save a life, and, for me, if that patient wants to be saved, it's a wonderful rush. Especially when you are young in your practice. Emergencies bring a rush of adrenaline too. (Some of us are adrenaline junkies!)

What else does an RT do? A lot if they are lucky enough to work in a place where their practice isn't limited to treating asthma patients in the ER or regular pulmonary patients on the floors of the hospital, "slinging nebs" we called it. (This means giving patients nebulizer treatments, in which liquid lung medicines are made into a mist that the patient breathes in so that their lungs will relax and let them breathe more comfortably).

Like nurses, RT's can specialize: Take care of tiny sick newborns, perform breathing tests on chronic lung disease patients, (to find out how much good lung they have left). They can specialize in helping sick kids, kids with chronic illnesses, (a sub-specialty there), or adults with chronic illnesses, like Cystic Fibrosis for example. RT's always exist in ER's because, if you can't breathe, it's an emergency, believe me.

And who best to help with breathing? Why, an RT by God. Like RNs we are specially trained to treat emergencies. For the RT it's all about the airway, usually the patient's natural airway. However, we are known to provide and manage artificial airways when necessary. We are specially trained to know when they are necessary and to communicate with RN's, CNAs, x-ray techs and MD's and work together to place said artificial airway (EX: trach tube or endotracheal tube). Those ET and Trach tubes connect a patient to a ventilator when they cannot breathe for themselves because of their illness. The MD and RT usually work together and consult together about different respiratory therapies that might help the patient recover enough to be able to breathe on their own again. That is always the goal. Although it is not always possible.

That's a taste of what RT's do, but by far, not all. Like nurses, RT's and doctors can tell hair-raising stories because we have all been there too! And we have unique gallows humor that we are trained NOT to let people see because they will think us disrespectful. But, truthfully, often the sad thing is, we learn to laugh at what might make us cry. Most really do care about what we do, even when we laugh at our dark humor. If you ever see or hear an intensive care medical professional's gallows humor, try to visualize that old icon of the theatre, two masks, one black, one white. I don't remember which is which, but one is smiling, the other is crying. No, we are not actors. You miss the point entirely if that's what you think I am saying.

We experience the entire spectrum of human emotion doing what we do. It is EXHAUSTING, both physically and mentally and sometimes spiritually. But there are rewarding days.

If you really want to be financially secure, I suggest going with RN instead of RT. In my experience, Nurses are always paid better than RT's (in my opinion, a sad situation).

Another way that RNs and RTs are equal? Both can use their profession as a ticket to anywhere! Both can be "travelers", meaning they work on contract, usually for about 13 weeks at a hospital, to help with staffing issues that are often temporary. This is optimally a single, childless but seasoned professional who gets to write their own ticket!!!! If you really like taking care of people, try respiratory therapy. I know of two who went on to become RNs. It's pretty easy to switch over, you'll just be the airway specialist in your class!

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Annmaree Rockhold

Worked in hospitals and intensive care units as a respiratory therapist 20 yrs.

See all posts by Annmaree Rockhold