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Short on staff, equipment, two NEK respiratory therapists on getting through the day (and night) amid COVID

A photo of two people in hazmat suits in a corridor
NVRH, Courtesy
/
The construction of the respiratory ICU (RICU) at Northeastern Vermont Regional Hospital in St. Johnsbury.

Respiratory therapists, like many other health care workers, are in very short supply. The job of an RT is to make sure that patients with respiratory problems are getting enough oxygen. And during this COVID surge, they are having to marshal these resources very carefully and imperfectly.

Every day this week, VPR is airing stories from frontline healthcare workers at Northeastern Vermont Regional Hospital in St. Johnsbury.  Today independent producer Erica Heilman talks with Jordan Place and Alexis Starr, who are respiratory therapists at NVRH.

On the day I talked with Jordan and Alexis, they were the only respiratory therapists in the hospital.

Here's Jordan.

Jordan Place: “During the surge, it was just the two of us, which was very hectic, especially since we work and then we're on call during the night. So it's just two individuals managing a whole hospital.”

Erica: “When you say, you say that in the past tense, ‘When there was the surge,’ what does that mean?”

Jordan Place: “Well, I guess today is a calm day for me, and it's the first day I felt like I could breathe. I haven't been able to even sit for the past couple weeks, and today I have actually sat down.

“There was one day that we had the entire ICU was full of COVID. I think we had several on med surg, and we had several waiting in the ER for a while, and just one of us.”

“You have to look at the numbers, see that they're crashing and look at the patient and still smile. You have to pretend. Just tell them that you're doing your best.”
Alexis Starr, respiratory therapist at Northeastern Vermont Regional Hospital

Erica Heilman: “If you had to find a particular patient in your mind, is there someone or is there some exchange that you had with somebody that blew you sideways?”

Jordan Place: “I’d say this patient was about middle-aged. She was sick, we got her better and she went home, but then she came back worse. A lot of these troubles are months on end or weeks on end, and the sucky thing is we stick a mask on them to help push air, and we're trying to make sure that we're giving them the oxygen that they need, and they've got a mask that's stuck to their face for weeks on end. And we had our woman who, she was on it for a while, and we managed to get her down to just a few liters of oxygen. And we were very hopeful and we were just trying to get her back home. And then all of a sudden she was getting worse and worse.”

Alexis Starr: “All of a sudden she went from needing two liters of oxygen to we were giving her every tool that we had.”

Jordan Place: “And I remember sitting there holding her hand, trying not to cry as I watched her oxygen drop.”

Alexis Starr: “You have to look at the numbers, see that they're crashing and look at the patient and still smile. You have to pretend. Just tell them that you're doing your best.”

More from VPR: One St. Johnsbury hospitalist, tired of risking her life at work, pleads with Vermonters to get vaccinated

Erica: “This is a very small hospital. There are three respiratory therapists here?”

Jordan Place: “Yes, there is currently. But for the past two weeks, one has been out. She is now back, thankfully, but we have had to manage as a two-person department during those several weeks.”

Erica: “Why are there so few of you?”

Alexis Starr: “For one, we only have one school in Vermont that does respiratory therapy, and they're down south, and same with New Hampshire. They only have one school, and they’re southern. We're up in the Northeast, and we have no schooling for it. Nobody, first off, wants to come right out of high school or right out of college into a small hospital.”

Erica: “Why?”

Alexis Starr: “Because they feel like they lose clinical skills in certain areas or they don't get a specialty that they want.”

Jordan Place: “The call also intimidates them.”

Alexis Starr: “Also being on call, because a lot of the bigger hospitals have 24-hour coverage, they don't have to take call shifts. You know, they work there 12 hours and they're done.”

Erica: “What are, what is your job in a normal time, and what is your job right now during COVID?”

Alexis: “I think that's a little harder for us because it's …”

Jordan Place: “A normal job, and what we do now, is very similar other than the fact that we're focusing more on more critical patients. And just a bigger load of them is a bigger task. And with a lot of these COVID patients, within a few-hour period, we move through several equipment. So we go from this to that to this within several hours, and that's a really quick amount of time to be jumping up. We were running really low on equipment too, and I was taking people off of equipment to clean it up and stick it on somebody else, because I didn't have the necessary equipment.”

Alexis Starr: “Yeah, we had to, we had to decide who needed it more in that moment.”

"Some days we barely can get up and do the laundry. We have our spots where we, at home, where we are unable to move sometimes. You know, I've fallen fairly deep. And I'm trying to dig myself back out mentally.”
Jordan Place, respiratory therapist at Northeastern Vermont Regional Hospital

Erica: “How are you handling it? Can you see it from a, from outside enough to know how you're handling it?”

Jordan Place: “We're not handling it. We've talked to each other. Some days we barely can get up and do the laundry. We have our spots where we, at home, where we are unable to move sometimes. You know, I've fallen fairly deep. And I'm trying to dig myself back out mentally.”

Alexis Starr: “There's times where one of us is exhausted and we call the other one or we ask them, ‘Hey, I just can't do this right now,’ and we cover.”

Jordan Place: “We work the day, and then we're called during the night. Me personally, I have to come in for an hour, so I actually stay here and I'll be here tonight, down in the basement. I'm a live-in RT. So … we're on for several days and on call. And during that entire time, especially during the surge, we were called in constantly. I had a 20-hour day where I did not sit down for 20 hours.”

Alexis Starr: “Just the other week I was on call for six nights in a row.”

More from VPR: St. Johnsbury hospital staffers on continuing care during COVID: 'We're hanging on with our fingernails'

Erica: “Where do you go? There's some weird little room in this hospital where you go and curl up in a ball? I mean, like, what's your, what's your method?”

Alexis Starr: “Our basement closet. By our EEG room, where our supplies are, that's where we meet and we cry together.”

Jordan Place: “There's a nice little couch that we curl up on. You know, we're both in school trying to better ourselves, and we're way behind on school …

[Their beepers go off]

“Oh, there we go.”

Alexis Starr: “230 needs one. CPAP.”

Jordan Place: “Alright. I’ll go take care of it.”

Alexis Starr: “And somebody needs another CPAP machine.”

[They stand to go]

Erica: “Thank you.”

Jordan and Alexis: “Yeah, yeah. We’ll go see how they are.”

Alexis Starr: “I gotta stop crying all the time.”

Jordan Place: “I know.”

[Door shuts]

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