The unsung heroes: Respiratory Therapists

By Debbie Moore-Black, RN

October is #Respiratory Therapists week/month!

Working day after day, year after year,in a busy high acuity ICU, we all have become that “second family.”

The public doesn’t hear much about Respiratory Therapists, especially during this Covid nightmare, but they have been the unsung heroes.
So who are the Respiratory Therapists and what do they do?

They are specialized healthcare professionals trained in critical care and cardio-pulmonary medicine. They work therapeutically with people suffering from acute critical conditions and cardiac and pulmonary diseases.
College educated with an Associates degree or a Bachelor’s degree, they put in hundreds of hours in their training with both theory and clinical practice.

We’re a tight fit unit and we all learn our roles and like clockwork, we intertwine in the intricate rhythm of actually saving lives.

Especially during covid, to the forefront stage; ER and ICU nurses and physicians were the focus of a dynamic life saving force.

But If you built a pyramid, the backbone would consist of Respiratory therapists.
Without them, our critical care units would tumble down and fall.
They are the right hand person to the Intensivists intubating a patient stat as the patient loses oxygenation.
They are there to obtain stat ABG’s (arterial blood gas) and assist the nurse and physician in interpreting whether a patient is going into respiratory or metabolic acidosis or alkalosis.
What’s the CO2? What is the bicarbonate level? How do they adjust a ventilator? Should they increase the FiO2 or increase the peep?

The concepts, protocols and intricacies of Respiratory therapists are enormous.
Without the lungs, without the heart, without the Respiratory therapists, we’re just a shell.

Without the respiratory therapists, this well oiled machine, this tight knit family of healthcare professionals would self destruct.

They are precise, professional and educated health care professionals in this pyramid of lifesaving events.

October is respiratory therapists week/month.
You are a vital force in our Heath care system.

You are our heroes and we sing your praises.
Thank you for your teamwork.
For your excellence.
For giving patients another chance at life.
Another chance to breathe again.
Resilience. Strength. Hope. 🫁 🩺

Repressed memories of a tragic ICU assignment. A mommy and her 4 year old son.

By Debbie Moore-Black, RN

Sometimes the most traumatic events that happened when I was young and new and just starting my ICU career; when you least expect it, those repressed memories come glaring at you.

Thinking I had tucked this tragedy away forever, and then within a flash… 25 plus years later, I see that little 4 year old boy, holding his daddy’s hand.
Watching doctors and nurses work on his mommy.

This mother. This wife.
After countless Code Blues, her final moments were asynchronous breathing with the ventilator. We called it “guppy breathing.”

We watched through the patient’s window as the Intensivist explained to the patient’s husband: “I’m sorry. We’ve done everything. Her organs have shut down. There’s nothing more we can do.”

Her husband came into her ICU room. And gave a final kiss to his wife.
Little Benny at 4 years old, knew his mommy was sick. His cheeks turned red. He cried out: “Mommy, mommy.”
As he watched his mommy slip away.

My first assignment in this 24 bed ICU, was this 32 year old female who had pre-eclampsia. During her pregnancy her pre-eclampsia seemed well under control….until the emergency C-section.
After delivering her 6 lb 2 Oz baby girl, she was rushed to the ICU.

Eclampsia. Severe hypertension. 210/112. O2 sats dropping. Patient intubated stat. Central line and arterial line placed. Nipride drip started. Erratic seizure activity. Kidney failure. All systems down.

It was my first week in this very large ICU. I was still in orientation. There was nothing that could prepare me for this assignment.

This patient was internally hemorrhaging. BP out of control. Kidneys shut down. Liver failure.
We gave RBC’s and platelets, one after the other.
This was a 2:1 assignment.

The Intensivist stayed at her side. Screaming out whatever lifesaving measures we could provide. But short of a miracle, nothing was going to work.

I always wondered what happened to that little boy.

That image.

Of him holding his daddy’s hand as they both starred through the ICU window.
A mommy lost forever.

A little baby girl never ever knowing her real mommy. And a husband. Now left with his 4 year old son and newborn baby girl.

Repressed memories.
Sometimes come back to life.
Maybe when you’re strong enough to handle them emotionally.

But that image.
That little boy. With his cap on his head. Holding his daddy’s hand.
Forever lost in translation.

Domestic Violence: May the circle be broken

By: Debbie Moore-Black, RN

My youngest daughter just got married to a fine young man. She was beautiful and radiant.

As I gave my daughter away when the minister told me to, I sat down next to a picture of my deceased husband. He passed away four years ago.

Lisa was our last child. Most likely, she saw the truth.

She saw the way my husband treated me after the other two children had gone off to college.

She always said, “I saw how daddy treated you.”

Though I was happy that my daughter was marrying a good man, I felt my inner sadness for not having a good man in my life at my side.

I should have known better.

I should have known that domestic violence didn’t qualify you as just being physically beaten up and attacked.

There were 30-plus years of mental anguish, intimidation, infidelity and lots of “business” trips.

Though I was happy that my daughter was marrying a good man, I felt my inner sadness for not having a good man in my life at my side.

I should have known better.

I should have known that domestic violence didn’t qualify you as just being physically beaten up and attacked.

There were 30-plus years of mental anguish, intimidation, infidelity and lots of “business” trips.

Though I was sad throughout our marriage and felt emotionally “beaten down.” I didn’t know that this was labeled domestic violence.

I was happy for my daughter.

But I didn’t want to sit next to him — that framed picture.

Even though he was dead. The picture of him in his younger years with our daughter at two years old stared at me.

I always felt trapped. I didn’t know how to move. I didn’t know how to break free of this man. I lived my life through my children.

I always knew my life with this man was null and void. I was naive at first and then just numb.

What a sad existence.

Finally, four years gives you plenty of time to think when you’re by yourself when everything is unwrapped. When the naked truth stands in front of you.

He was there for the children. The plays and concerts and birthday parties and football and chorus and proms and high school and college graduations. But he was never there for me.

I misunderstood what domestic violence was.

I misunderstood that working 60 hours a week as a nurse was domestic violence. I misunderstood that his infidelities followed by “I’m sorry” were meaningless gestures.

I didn’t want to sit next to his picture.

We had scattered his ashes on top of a mountain top — cancer. To his liver. His pancreas. His lungs. His lymph nodes.

He never had cancer before.

I almost wondered if it was karma that attacked him.

This wedding was bitter-sweet.

I wanted a husband with me but a husband that loved me as much as I loved him.

I wish I could scream from the mountain tops.

Domestic violence. Yes, it can be physical violence. A black eye, a fractured arm, a punch in the gut.

But it can also be mental abuse like isolation. Intimidation. Infidelity. Manipulation. Put-downs and constant ridicule.

I grieve my last 30 years to a man I should have never been with.

But the light is shining on my daughter.

A new day. A bright tomorrow. With a young man that respects her. That cherishes her. That loves her endlessly.

May that circle be broken. That circle of sadness, isolation, and unspoken grief.

And may they both live a happy life together full of love and respect.

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