Sheila Mackie, RRT
Respiratory therapy was not my first career, but I am grateful I chose it. Although every respiratory therapist should consider working in an acute care setting early in their career, there are many options if or when you may burn out or want to avoid working weekends and holidays. I have worked as a hospital, long-term care, home care therapist, clinical educator, and respiratory sales rep.
Of all my positions, my most rewarding job was as a hospice homecare respiratory therapist. Hospice care focuses on the care, comfort, and quality of life of a person with a severe illness approaching the end of life. At some point, it may not be possible to cure a serious disease, or a patient may choose not to undergo specific treatments. Therefore, hospice focuses on the patient’s comfort as well as their loved one’s needs in caring for them.
Although hospice was pioneered by British nurse Dame Cicely Saunders in England in 1967, it was not established nationally in the US until 1977. Dame Saunders believed that focusing on curing illnesses was not always the best approach for those facing terminal illnesses. Instead, she proposed a new model of care that prioritized comfort and quality of life for the patient and their family.
Often people ask me the difference between hospice and palliative care. Although both are similar as they focus on the patient’s need and quality of life, palliative care differs as it offers pain and symptom management for people of any age and at any stage in a severe and chronic illness. Palliative patients can continue to undergo treatments that may cure or reverse their illness’s effects by helping control pain and symptoms.
President Regan signed the Hospice Medicare benefit into law in 1983. Individuals enrolled in Medicare and certified by their doctor as having a terminal illness with a prognosis of six months or less are eligible to receive hospice care. Hospice organizations may provide care in various settings, including the patient’s home, a hospice inpatient facility, or a nursing home.
I was fortunate to work for a company that provided durable medical equipment to hospices and offered respiratory therapy as part of the contract package. My role was to set up patients on CPAP/BiPAP, suction, and humidification for trach patients, help with their oxygen needs at home or if they traveled, and educate hospice nurses and delivery technicians on respiratory equipment.
As an RT, I especially liked helping patients, families, and nurses with oxygen. Nurses are generally not trained in detail on home oxygen, so navigating the different systems can be difficult. Often families are responsible for the care and maintenance of the home equipment and are frequently afraid of oxygen. It was gratifying to clarify and put their minds at ease.
Friends and family would always question why I wanted to work with people at the end of their lives, remarking, “It is so sad.” Sometimes it was very sad, especially if the patient was a young person or a child. Sometimes I did cry when leaving a patient’s home or learning of their death. But, for the most part, it was fulfilling to make a real difference in people’s lives almost daily.
As I trained the delivery techs, I would remind them that their work was essential and that how they did their job could also make a difference for patients and families.
Many people prefer to die at home surrounded by family and friends, so contributing to this process can be a beautifully rewarding experience. It was a privilege to be there to aid in the patient’s comfort at the end of their life.