Some jobs are a matter of life and death.
For COVID-19 patients in intensive care, their lives depend on respiratory therapists such as Brenda Hanning, who works at El Camino Hospital in Mountain View and is director of the Foothill College Respiratory Therapy Program.
Each day when she arrives at work, she puts on protective gloves, a mask, a hospital gown and goggles, then heads into the intensive care unit. Her patients lie in hospital beds, many with breathing tubes inserted through their noses or into their throats. Machines do the breathing for them, pumping air in and releasing it before the next artificially induced breath.
The ventilators are part of a last-ditch effort to survive the deadly coronavirus. Hanning and other respiratory therapists throughout the Bay Area, who some call "unsung heroes," work with patients most in distress from COVID-19 — the ones who have severe pneumonia. Their expertise in guiding patients as they breathe with ventilators that deliver crucial oxygen to their lungs and pump it to the body's organs to prevent failure can mean the difference between recovery and suffocation. Between life and death.
While most patients who get the disease have mild symptoms, Hanning's patients are usually older adults with underlying lung and heart conditions, compromised immune systems, cancer or diabetes who become dangerously ill from the virus. Some will go into respiratory failure and no longer be able to breathe on their own. That's when a respiratory therapist's expertise, sensitivity and experience kick in.
Several times a minute, the computerized ventilator moves breathable air — often a combination of room air and oxygen — into and out of the patient's lungs. Monitoring systems and alarms measure air pressure, volume and flow. Meanwhile, Hanning finely adjusts the machine's parameters to match the individual patient, staying acutely aware of the patient's comfort level and oxygen needs, even if the patient can't speak.
COVID-19 has given her a number of patients to guide back to breathing on their own. What's striking is how effectively the virus attacks the respiratory system, she said.
"For me, it's been interesting how severe the hypoxia (low or lack of oxygen supply to organs) is. The patients don't get better on oxygen. It's different than seasonal flu," she said.
Hanning's work with her patients is not a cure; she can only give patients supportive care, she said. It's a waiting game; a daily ritual of adjusting the ventilator, reading screens, monitoring her patients for incremental changes and running tests on their blood gasses until the patient's body's defenses fight off the disease and it runs its course.
She conducts small trials every day to see if some patients can be taken off the ventilators. "We do spontaneous breathing trials. We take the patient off support and look to see if they can tolerate it," she said.
If their oxygenation is still poor, she turns the machine back on.
Hanning's goal is to get patients off the ventilator and back to their homes. Some patients might get over their respiratory failure, while others do not. Multiple organs might fail. Even a seasoned respiratory therapist such as Hanning, with all of the support and care that she gives, ultimately can't control life or death.
But she does bring hope. With time, she is helping them to need less and less oxygen from the ventilator as their lung function improves. It takes dedication and it takes patience.
"It might be days or weeks," she said.
COVID-19 has changed her work ritual. When she enters the door, Hanning must first check her own temperature for a fever, which is a sign of the illness, and fills out a questionnaire to rule out symptoms. Once cleared, she then dons her protective gear — barriers between herself and the highly contagious disease that has presented new challenges she's never faced in her decadeslong career.
"We were hit really hard a few weeks ago," she said. Anyone who was exposed to a COVID-19 patient was immediately quarantined for 14 days, straining staffing levels. That's eased somewhat with protective gear and new protocols. The hospital has hired "travelers," medical personnel who come from other places to fill in when hospitals are understaffed.
Hanning and the other respiratory therapists at El Camino Hospital are still working many overtime hours. Unlike nurses, they don't have set patient-to-staff ratios.
"We're dealing with every patient that comes in," she said, and their needs are never routine. "One patient can need two times as much work as another."
Find comprehensive coverage on the Midpeninsula's response to the new coronavirus by Palo Alto Online, the Mountain View Voice and the Almanac here.