As COVID-19 patients have filled hospitals, one particular job in Intensive Care Units has faced the daunting task of keeping those patients breathing. Respiratory therapists are playing a crucial role in patient care during this epidemic.
That’s Megan Macduff’s job.
Macduff, 28, has been a respiratory therapist for two years — the last year and a half at Massachusetts General Hospital. She said that before things got bad, they moved all the children out of the pediatric intensive care unit at MGH, knowing they’d need the space for COVID-19 patients.
"It was unsettling how quiet it was,” she said. “There was a sense of kind of like we were going into battle and we were preparing for that.”
Macduff is a U.S. Army combat veteran who served in Iraq in 2011.
“I will say that it's a very similar feeling walking into this pandemic as I had when I was flying in a helicopter over Baghdad, Iraq, entering the country," she said.
That quiet is over. MacDuff’s job now is to get air into patients’ lungs, even when they can’t do it themselves.
Over two days last week, Macduff recorded herself with her phone, capturing the routine responsibilities, sudden emergencies and occasional victories that she and her colleagues face as they help patients fight for their lives.
Most of the patients in the ICU are on ventilators, she said. Under ordinary circumstances, she'd check on each patient at least three times in a 12-hour shift. But with the number of patients she has, it’s down to two checks a shift.
"At one point we were down to one check,” she said. “That's how busy we are.”
In recent days, she said the patient-to-respiratory-therapist ratio has gotten better.
"Today I have eight,” she said last Tuesday. “I'm getting one in. It's better than 14."
The ICU began accepting pediatric patients again — including a child who was hit by a car.
"It's been a long three hours between the pediatric trauma and running over to one of our adult COVID patients who dropped his volumes, desaturated,” she said Tuesday afternoon, sounding tired. That means the patient’s oxygen level dropped dangerously — something all too common in COVID patients.
The days are long. Macduff lives about an hour away, so she's staying at a hotel near the hospital most of the nights between back-to-back shifts.
On Tuesday evening, she ate a cold dinner and thought about her two children — a five-year-old and an 18-month-old — who are at home, waiting for her work week to be over.
Sleep is hard to get — both in the hotel and at home with two little ones
"Good morning,” she recorded into her phone Wednesday morning. “I am waking up, walking over to shift and I am exhausted. I couldn't fall asleep last night. It was lot of anxiety about what happened during the day. So sometimes it's just hard to fall asleep. But here I am ready to start a new day.”
Macduff’s days in the ICU are filled with the sounds of alarms. Some have a lower pitch and signify things that are lower priority. Others sound more urgent, and are intended to draw immediate her attention to a malfunctioning ventilator or some other emergency.
On Wednesday, Macduff helped a patient who’d had a tracheostomy - a hole in the neck that lets him breathe.
"To wake up to a tube in your neck is pretty devastating,” she said. “And you can tell that these patients are discouraged, a little defeated and a little sad.”
But this patient had been on a ventilator in the ICU for over a month. The tracheostomy helps wean him off it, so he can move out of the ICU to another floor of the hospital.
"His mental status has improved,” she said. “He's responding, and happy that he gets to leave here and it's one step closer to going home."
As the patient’s bed was pushed out of the ICU, the doctors, nurses, therapists, and cleaning staff stood at the door and cheered.
This is a big accomplishment for the patient, Macduff said, and for her and the rest of the team caring for him. She helped him breathe on his own. And with each new patient she sees, she hopes for more moments like this one.
