Profile of a respiratory therapist

May 26, 2020

When a patient is admitted to a hospital to be treated for COVID-19, one of the first healthcare professionals they will probably see is a respiratory therapist.

If the patient is sick enough to be admitted with the disease, he or she is likely having trouble breathing and it's a respiratory therapist's job to insert the tube that connects them to a ventilator.

That can be frightening.

"You can see it in their face and in their eyes," said Nicole Smallwood, a respiratory therapist at UR Medicine's Strong Memorial Hospital.

Since the coronarivus started spreading locally, Smallwood estimates that she has treated dozens of people infected with the virus, ranging in age from their thirties to their seventies.

They don't all need to be intubated. Some patients just require breathing treatments with an oxygen mask.

"And then there's people we see," she said, "they're almost deceiving because they look okay and then we'll get their labs and their x-rays and we're just, like, 'Oh my gosh, they will probably crash on us very soon based on what we're looking at,' so we have to act fast before that happens."

The way Smallwood describes her typical day treating COVID-19 patients, it sounds like she's in constant motion.

Under all that PPE is Respiratory Therapist Nicole Smallwood at Strong Memorial Hospital.
Credit Photo Provided / WXXI News

She says she is one of two or three respiratory therapists assigned to an intensive care unit. At the peak of the pandemic there were as many as 20 patients in each unit.  The therapists work as a team, along with doctors and nurses, to consider which patients are the most critically ill, and who will be able to be weaned off their ventilator.

That's a big moment. Smallwood remembers placing a valve in the trachea of one patient who had not been able to speak in weeks because he had a tube down his throat.

"I said, 'I'm gonna put this little cap on and you're gonna try and talk to me.' Then I said, 'Okay, can you say hi?' His face was priceless," she recalled. "He was so relieved, so happy in his face, saying 'Oh my God, I can talk, I can actually talk back to you.' He was just so relieved that he could just have a conversation with me. That was the epitome of just a great day."

In stark contrast to that, there have been other days, too many of them, when Smallwood has had to help patients who were not able to defeat the COVID transition to death.

When the decision is made to withdraw life support, a respiratory therapist is the person called to do it.

"It's very difficult," she said.  "I try and tell myself this person is going to a better place where they're not going to hurt or suffer like this anymore. I do look at them and I do my own prayer for them."

Smallwood is dedicated to her work and says she will be prepared for any future waves of cornavirus peaks, if they come, as long as she takes care of herself, even if it has to wait until her 25 minute drive home from work.

"I listen to my relaxing music and sometimes I just sob and cry," she said.

Smallwood and her colleagues say something else lifts their morale and keeps them going: Support from the community. People have sent thank you notes, food and water, and personal care packages to the hospital.

These gestures make Smallwood feel recognized and appreciated.                  

"I would say before this pandemic, the majority of the world probably had no idea what a respiratory therapist was, or did, or even maybe that we existed," she laughed.