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learning to take it seriously

I’ve had asthma ever since I was a baby, I think. I won’t lie and say that it didn’t factor into my decision to get into respiratory, either — I wanted to have control.

I’d always hated games with running. I remember hating tag in elementary school — I could never outrun anybody. Eventually my chest would get tight and hurt, and I’d cough and feel like I couldn’t breathe. I’d have to stop and then I’d get tagged, and I couldn’t tag anybody else. So I just didn’t play.

Mom put me in soccer. I hated it instantly, with its constant running after the ball. Other sports seemed like more of the same. This continued until I was about 13, when I walked into the doctor’s office (by myself) and demanded some kind of testing. I got a Ventolin inhaler and a referral for some testing. The testing showed airway obstruction with reversibility — a hallmark of asthma.

I had a problem, though. My parents had never taken me seriously about this (“You’re just out of shape” is something I heard a lot) and I had some real misconceptions about severity and proper treatment. I ended up at one point taking a steroid inhaler but I ended up with a lot of hoarseness of the voice (I later learned this is a common side effect) and eventually stopped taking it. I had no idea how severe I was.

It wasn’t until I was older, several years older, and looking to get into respiratory, that I had a second spirometry and learned to interpret what it means. I was a bit taken aback by the degree of impairment it showed — I had always thought I was relatively mild, that my asthma was “well controlled” with just my Ventolin inhaler to take when I needed it. (The truth was, my asthma had always been poorly controlled, and would remain poorly controlled for years afterwards.) It was the first opportunity I’d had to print out a copy of the testing and show it to my parents — “See, I’m not making this shit up” — and interpret it for them. I showed my family physician a copy — he was a bit tickled and compared it to the one I’d had done before — and he immediately adjusted my medication to better control things, seeing that my lung function had declined significantly since the one I’d had previously. It would be a few more years before I would learn that this was a bad sign, a negative effect of poor control, that poor control would sabotage my lung function slowly until I ended up like somebody who’d smoked for years.

Even after I’d gotten into respiratory, denial is somewhat of a strong impulse. I see these people who are wheezing and struggling, I do PFTs on the asthmatics who have even poorer control than I do (and perhaps, still smoke,) and I get the groove carved into my brain that this is what ‘severe’ looks like. My daily symptoms, my inability to participate in any kind of real ‘cardio’ without symptoms, my exacerbations which would have me wheezing for weeks on end, those didn’t register as ‘severe’. I had had poor breathing for so long that attacks didn’t frighten me. I could breathe through them and limit my activity. I could suck on cough drops and take my Ventolin only when the coughing was paroxysmal, with me gagging, doubling over, seeing stars.

Beginning work as an RT probably was the best thing for my asthma. I had peer pressure from coworkers when my tight cough manifested itself at work. I figured out something that worked for my symptoms — and ended up taking a fairly large dose of it to remain in some semblance of ‘control’ — but wasn’t exactly compliant with it. (I’m not alone, rates of nonadherence to medication are really high and is the main reason for severe exacerbations in asthmatics.) It wasn’t until I sought investigation for allergy testing that I got appropriately slapped for this.

Little did I know, the allergy specialist I was booked to see is also an asthma specialist. I didn’t expect my (terrible) spirometry to be put on display in his office, but there it was. I also didn’t expect to have to detail, in mortifying detail, my lack of adherence to my prescribed medication regimen.

I endured, hanging my head, my scathing lecture about how I should know better, about how my spirometry was all chronic changes, about how he should not have to belabour this point, about taking it seriously. I don’t know if it was internalized ignorance, I don’t know if it was mostly denial, but I do know I took this guy seriously.

I went home with a renewed conviction to take this seriously. I was adherent to the medication regimen properly for the first time since ever, and around about six weeks of this I had an epiphany. I could breathe. I could breathe and I was simultaneously amazed at how used to not being able to breathe a person could get. I had always thought that constant symptoms were normal, and I had a high tolerance for feeling awful all the time.

During this time, I took up running. I had always resigned myself to never being able to run. I amazed myself and conquered running, and found that after a small uphill battle training period I began to enjoy it. I began to become very sensitive to changes in how I felt and I learned to respond quickly to symptoms instead of suffering through them. When I had a significant exacerbation, I went to the doctor and went on Prednisone, instead of digging my heels in, instead of deciding that a month of feeling terrible was worth not having to take five days of oral steroids. I was shocked at how fast I felt better from the bronchitis that had me exceeding the recommended dose of bronchodilators.  I found the side effects were not as terrible as I had been led to believe.

I know now that I was playing with fire. I don’t entirely know why I did it, if it was denial or if it had more to do with not wanting to be seen as malingering. I do know that if I hadn’t done something about it, it very well could have killed me or left me critically ill. Now, I make it my mission to knock some sense into those like me, those lulled into the fog of thinking they’re not as severe as they really are, those that think they’re in control when they’re really not. Somebody saved my life once, by making me take this seriously. I feel the need to pay it forward.

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what I am

I knew I wanted to help people, to be in healthcare. I remember being a small child, having medical textbooks and laypeople books on medicine taken away from me, because it was apparently somehow inappropriate for a child to be looking at electron microscopy photos of sperm and other such human structures. I ate all that I could find about medicine and such up. I have vivid memories of being a small child of less than 5 years old, desperately sad that I had lost my Fisher-Price medical kit. My mother always thought I would be a doctor, or somesuch. I chose respiratory therapy instead.

I remember being in the end of junior high school, the age when they made us take computer-based courses to see what we were most interested in. I didn’t need a computer based course to tell me what I was most suited to. I knew I wanted something medical, something with adrenaline, something exciting, something where I saved lives and fixed equipment and did a little bit of everything. I knew nursing was not it for me… I was not into the task-based system, I preferred very much to be thinking on my feet, solving problems, to be the one-of-a-few, the few like me.

I have worked in several different configurations. The one-of-none, the one-of-a-few, the long-term-care situation, the acute-care critical-care situation, the one-of-many, where I had years and years of experience to draw on, and the one-of-none, where it was just me, my pulse oximeter, my stethoscope and myself to survive throughout the weekend.

School, practicum, was gruelling and the hardest thing I’ve ever done. Officially the most difficult thing I’ve ever put myself through. That said, it was worth it, infinitely so, to be able to have the coolest job in the world.

I remember being a young kid — I didn’t understand the chest pain and shortness of breath that, to me, became associated with games of ‘tag’ and other things where I had to run (soccer, etc.) I grew to hate sports, gym class, all of these things, because I intimately associated them with chest tightness, burning sensations, a tight barky cough, the taste of blood, and feeling like I was going to die. I had a friend at the time who had asthma, and she encouraged me to get what she called an “asthma test.” I followed her instruction, and thus began my foray into the world of respiratory therapy.

My initial spirometry showed that I was indeed asthmatic, and that my parents’ claims that my distress had more to do with being “out of shape” than anything else were incorrect. I wanted to know, most of all, I wanted to know what else it was that they did not know, I wanted to know everything.

I joined a student shadowing program. I shadowed respiratory therapists. I found every single individual stitch of what they did completely fascinating. In the words of my supervisor, I “talked the talk”, and despite the fact I was being paid essentially minimum wage to restock gear, I was so happy I could have died.

I’m a few years out of school, but not so much as to be one of the 20- or 30-years-out crew that nothing ever flusters. I enjoy where I work, because the endless variety and complete independence I get kind of caters to my more cowboyish nature. I have been told by my manager (a nurse) that respiratory therapists tend to be introspective, self-analytical, very cognizant of their own failings, and 100% accountable. I don’t find this at all to be a bad reputation to have as a professional.

I enjoy my professionalism, my professional-ness. I enjoy having physicians come to me and ask me advice. I enjoy giving them advice, knowing that I (now) have the skills and ability to do so in a non-threatening non-intimidating fashion, to be able to teach the baby physicians, the noobiest of the noobs, to teach the nurses, to teach… really, whoever wants to learn. I love being able to show what it is that respiratory has to offer, that much as we may not come with eight or twelve year long university degrees, we do come with an incredible depth of knowledge, and we are more than willing to share.

I love being the ambassador of my craft. I find this to be a uniquely rewarding experience; helping professionals otherwise unfamiliar with what I do to understand that I am not here to usurp them, but rather, to offer guidance so that they may better perform their jobs.

I enjoy specializing. I enjoy being a specialist. I enjoy especially being a specialist in life support, specifically in ventilation, in this esoteric art that only an RT can appreciate. I enjoy, although less joyfully, the unique role I play in the ethical discussion of who is best suited to have their lives supported — to be a willing and robust participant in what is uniquely both the extending of life, and the prolonging of death.

I hope to blog in this place once a week, if not more. I hope to share my stories and the stories of friends like me, the stories of other respiratory therapists, the stories of the (arguably) most unknown health profession on earth. I hope to share the perils and pearls and pitfalls, the ethics and ethos, the ideology, the guiding principles, the heart and soul of the respiratory therapist.

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