Breathe Easy

When the pandemic first struck – what seems like a million years ago now – governments were in a mad rush to get their hands on ventilators, the machines that help keep people alive by assisting their breathing. This shortage during the first wave of COVID-19 last spring has been more than compensated for by the additional machines Canada purchased for the second, which started in the fall. But what has been missing from the story are the people trained to operate the equipment.

The unsung heroes of the pandemic, respiratory therapists are the specialists whose job it is to keep patients breathing, assisted or unassisted, during a health emergency. Typically, they can be found behind the scenes, helping patients with pulmonary disease or those with underdeveloped lungs, like preemies in a hospital neonatal unit. There are an estimated 12,000 RTs in Canada, but until now, their presence has largely gone unappreciated by the public.

“I wouldn’t say it’s an invisible profession by any means, but unless you have a respiratory condition, you’re not likely to encounter one. But certainly the pandemic, like SARS before it, has raised awareness,” says Kevin Taylor (MBA ’10), chief executive officer of the College of Respiratory Therapists of Ontario, a regulatory and licensing body for respiratory therapy based in Toronto. “When you get a ventilator, you also get an RT. You now can’t help but notice them.”

Farzad Refahi (BSc ’08) is one.

A York student of kinesiology whose original goal was to become a physiotherapist, Refahi ended up taking a three-year advanced diploma in respiratory therapy at the Michener Institute after witnessing an RT at work on a friend with ALS, a disease causing weakness of the lung muscles. Respiratory therapy is a regulated profession and the instruction was rigorous, geared to patients requiring cardio-respiratory support.

As a licensed RT, Refahi can administer respiratory medications and assist patients in breathing using ventilators in intensive care units and emergency departments. He can work in operating rooms to ensure a patient’s airway is protected and breathing is optimized, and in diagnostic laboratories to assess the presence and severity of respiratory disorders. Lab work especially interests him, which in 2017 led Refahi to join Markham Stouffville Hospital as the organization’s first full-time RT in its Pulmonary Function Lab. Having risen through the ranks, Refahi, at age 35, is today the lab’s lead technical specialist.

He’d remain there if it weren’t for COVID-19. But when infection numbers surge, Refahi, like many of his colleagues in the medical profession, need to be ready to answer the call. During the first wave of the pandemic, Refahi was deployed to the Acute Care side of the hospital, where he worked for one long five-month stretch. “This is what we signed up for as clinicians,” he says. “As RTs, we run in when things go south, but this virus has had us running off our feet. The news of back-ordered filters and supplies, compounded by rumours of ventilators being held at the border, has tested our resilience more than anything.”

Standing inches from a patient’s face, gingerly threading a tube down the trachea – a process known as intubation, a scary word that has become part of most people’s vocabulary during the pandemic – the work of an RT is inherently risky. To stay safe and not get infected himself, Refahi wears personal protective equipment (PPE) while working long days at the hospital. His workload has increased exponentially since the coronavirus came to Ontario last year. But he’s not complaining.

“I’m genuinely passionate about my job,” he says. “The hardest thing about it is not the hours. It’s seeing whole families affected by the virus – multiple family members hospitalized at the same time, not knowing about each other’s conditions, as they were all in medically induced comas. And then when patients pass, which is always hard, they pass alone, due to the necessary restrictions placed on visitors to the hospital brought on by the pandemic.” It gives new meaning to the words “unprecedented times.”

But if ever he feels overwhelmed – or even just plain scared – Refahi thinks back on his years at York, drawing on what he learned, not only in the classroom but also as a lifeguard at the Tait McKenzie Centre on the Keele campus, where he worked part-time as an undergraduate. As part of his training, he had to learn CPR and swim laps to build up his stores of strength and stamina. Refahi has travelled greater distances since then, but what he learned then still holds up today: “Take a deep breath, then rely on your training to keep you afloat,” he says. “It’s an approach that’s seen me through some difficult days.”  ■