This post is dedicated to my father. He was a kind hearted man who worked hard to have a humble and good life for the family. My father and mother have been a great role models for my brother and I. While he was taken away way too sudden and soon, I am blessed to have had him in my life.

Thanks for all you have done for me, dad.

With love,


Thank you -RT Week 2020

Photo by Wilhelm Gunkel on Unsplash

Thank You – RT Week 2020

It is my tradition during RT Week to sit back, reflect, and thank those who have made a positive impact on my respiratory therapy career over the past year.  

As I finish my third and final year as a Director with the Respiratory Therapy Society of Ontario (RTSO), Nancy Garvey’s name comes to mind.  Nancy recruited and mentored me three years ago and I am very grateful to her.  I have witnessed the amazing work of many individuals who not only prevented further financial turmoil but brought stability and growth for the organization. This stability helped the organization to provide resources and advocacy for RTs during the 2019-2020 pandemic.  There are many great people within the organization so it is hard to name just a few for this post: Gino DePinto, Sue Martin, Kelly Hassall, Shawna MacDonald, Sue Jones and Susan Aikenhead.  It has also been nice to begin working with Megan McFarlane, Paula Smith, Greg Donde and Wendy Foote!  Tony Kajnar is also part of the team, and also continues to contribute to our profession in various organizations!

I had a unique opportunity to join a team of panelists in the creation of a joint statement by CTS and CSRT.  Thank you, Carlyn McCoy, Micah Cooperberg and Elizabeth French for this opportunity!

Many RTs volunteered to share their insights and experiences with me over the years and I am very grateful to them! Over the last 12 months, I spoke with  Rachel Nesbitt, Kelly Hassall and Dave Wall.

Thomas Piraino dedicated his evenings for a period of time to RTs, assisting with their questions during the pandemic. I am thankful for the sense of reassurance he brought to me and the RT community. 

As always, a big thank you to my lovely wife, Jessica, who continues to support me in this journey. 

I began this blog to help RTs, and I wouldn’t be here without the help and support of my amazing followers.  Much appreciation and love to you all!

Happy RTing!

Farzad Refahi
Oct. 25th 2020

A Conversation with Dave Wall

David Wall in scrubs, also with OR cap, safety goggles, stethoscope and work lanyard.
David Wall RRT, B.Sc., M.Ed., CCAA

Are you interested to hear insights from someone who is an RRT, an AA, an instructor and volunteer? Then you will greatly enjoy my conversation with Mr. David Wall. I met Dave through Gino De Pinto at a CSRT conference. I also had the opportunity to watch Dave’s great presentation at the same conference. Dave and Greg Donde are the hosts of RT Audio podcast. I reached out to Greg to ask him about Dave.

Dave is a great classmate, friend, co-worker, and mentor.  We graduated together from Fanshawe’s Respiratory Therapy Program in 2006; have worked together in various clinical settings over the years and now teach together. We often throw ideas off each other and have a long list of ambitions we would like to work on over the next few years to improve the program.  Some of these are realistic ideas and others are pipe dreams. Either way, he is always thinking “what’s next”.   I always appreciate the critical feedback that Dave provides when I ask him “can you have a look at this”.   He has an innate ability to break down complex concepts and loves to gamify teaching.  Students always love the annual Sputum Cup which challenges their knowledge, skills, and ability to work together.

Greg Donde. October 2020

Thank you, Greg! I am not going to keep you all waiting any longer. Please enjoy my conversation with Dave!

Let’s start with one of my favourite questions to ask.  I am curious to know how people find out about our profession and why they decided to study respiratory therapy.  How was the journey for you?  

I was in my 3rd year of studies at the University of Guelph where I was completing a physical chemistry course and somewhat frustrated with what I was learning and envisioning how to apply this to my life.  In fact looking back I was just confused on where my life was headed while studying a subject that I enjoyed but one that I wasn’t sure I wanted to do for the rest of my life.  I remember calling my sister who was at the time a Nuclear Medicine Tech in Toronto and I guess I was complaining a bit too much when she abruptly stopped me and said “why don’t you come see me this weekend”.  I took her up on the offer and spent the weekend with her and her room-mates, one of which was an RRT working at Toronto area hospital.  Her room mate was talking about her previous shift and I was immediately intrigued.  I started to look into the profession and felt that everything I was learning was something that I would enjoy.  I finished my degree at Guelph and the following September was enrolled at Fanshawe College to start my journey to become an RRT.  Although I didn’t know or realize it at the time, that weekend visit with my sister and her room-mate changed the course of my studies and set me on the path to the career I find myself honoured to be a part of today.

Once you decided on respiratory therapy as a profession, where did that journey take you?

As mentioned I enrolled in the Respiratory Therapy program at Fanshawe College in 2003.  Upon graduation in 2006 I started my clinical career at London Health Science Center Victoria Hospital (Vic).  This was a great place to obtain employment right out of school.  Working at Vic provided me with a number of opportunities to both challenge myself and engage in the profession.  The staff at LHSC are like a giant family.  Finding myself fortunate enough to become a member of the department was one of the highlights in my early career.  I found myself working in the adult critical care unit, the trauma and emergency department, adult and pediatric wards and in the operating room.  After the first summer working as an RRT, I picked up a second job working casually at Stratford General Hospital.  Working in a smaller community hospital is vastly different then a major trauma hospital but just as rewarding.  At Stratford I was fortunate enough to gain experience in some outpatient services, providing care and services to patients requiring cardiopulmonary diagnostics, ECG’s, Holters, Stress testing, Spirometry, PFT, etc.  This is where I realized the breadth our career has to offer.  Shortly after graduation, a faculty member (shout out to Sandy Annett) at Fanshawe College reached out and inquired if I would be interested in teaching part-time in the RT lab.  This opportunity would change the course of my career once again and I haven’t looked back from trying to position myself to help and prepare the future of our profession.

Your experiences in various roles have exposed you to many RTs. In your opinion, what makes a person a quality RT?

Luckily, I have been surrounded by quality RT’s in my career that have modelled a number of attributes that I believe are a recipe for success.  I suppose the proper answer to this question might be an RT who is a critical thinker and can troubleshoot problems, quickly and with accuracy, or the RT who is engaged in continuing professional development.  Although I 100% agree with those things, I believe that this is what makes us a professional and required member of the healthcare team, this is what we train to do and with experience we can execute this with a high level of proficiency.  However, the attribute that makes a “person” a quality RT in my opinion is someone who cares.  That might sound obvious but I believe that each of us entered into this healthcare career because we truly care for the patients we interact with every day.  Without the “care” part, our practice would come across cold and impersonal.  A quality RT finds a way to connect with their patients and families, providing an individualized approach to what they do and how they do it.  We all have our unique ways of doing this. I think patients expect us to have the knowledge, skill and abilities to perform, but when they realize that you are actually invested in their health and their well-being, that’s when I think something unique happens.

What’s your approach as a preceptor? What advice do you have for preceptors so they can better look after and educate students? 

Preceptors play such a big role in a student’s progression.  A good preceptor challenges and inspires a learner to want to be better.  My approach is to acknowledge that learning is a two-way street and that I can learn just as much from the students as they hopefully can learn from me.  I believe it comes down to communication.  Often I find the preceptor may not want to give feedback for fear of upsetting a student, and maybe a student doesn’t want to ask their preceptor a question for fear of looking like someone who isn’t prepared.  However, establishing a relationship that encourages open communication and constructive feedback is important for both parties involved and may break down the barriers that “fear” often promotes.  I recall one of the more influential preceptors I had when I was a student sat me down at the beginning of the shift and simply just introduced themselves, she told me how long she was an RT for, what she loved about the job, what she found challenging and explained how she approached the assignment for the day.  Without knowing it at the time, she broke down the barrier for me to think of her as someone who was evaluating me and judging me (even though she was), instead I felt comfortable enough to ask her questions and seek clarification when I was unsure.  Simple but effective communication is often taken for granted. 

That’s great. Thanks for sharing that! I always view students as my future colleagues who I want to have supportive and open communication with.
What advice do you have for students so they can better maximize their learning during the clinical year?

As for students maximizing their clinical year, my hope is that they have prepared to the best of their abilities to take advantage of the opportunities that are presented to them.   I appreciate that transitioning from a task trainer or simulation lab to the “real world” is nerve wracking but trust that you have a supporting team around you that has the patient’s best interest in mind and will guide you when able.  I think Wayne Gretzky said it best “You miss 100% of the shots you don’t take” meaning you will never succeed if you don’t try.  

Let me change gears to your studies in Anesthesia Assistant (AA). What got you interested in the AA program? 

I started working in the OR early on in my career at Vic.  I volunteered to work in the OR because I wanted to get better skills at airway management.  Working at Stratford General Hospital you were often the only RT on at night and if a trauma or code or elective intubation occurred the RT is often the primary airway manager.  I used the experiences I gained in the OR at Vic to increase my confidence at being able to provide care for patients when I was the individual standing at the head of the bed.  Ultimately, I found I liked the role in the OR, the technical aspect of the equipment was interesting, I liked helping out in A-cases (emergency cases) running rapid infusers or helping resuscitate.  I liked assisting in the thoracic room with placing double lumen tubes, I liked placing arterial and venous catheters, assisting with epidurals and spinals and central lines.  Learning about ultrasounds and transesophageal echos… There always seemed to be something new and exciting that kept me interested.

I was fortunate enough to be working in the OR at Vic when the first AA’s were trained and started practicing.  I saw this as a progression from our established roles and enabled us to elevate what we do as well as demonstrate to the team what we are capable of doing.  I was also fortunate enough to be working at the college with Dennis Hunter, a very influential person involved with bringing the Fanshawe program to life.  Dennis was someone who saw the potential of the role and along with a number of individuals and the CSRT pushed to make it happen.

What are some elements that you enjoy the most? What are some areas that you had to further improve for this role?

I’ve always thought of anesthesia as something between a science and an art form.  When you witness an Anesthetist skillfully deliver and titrate a number of medications to achieve a steady state of anesthesia that is not too deep and not too lite and when finished, reverse everything in a timely fashion it is pretty amazing.   At this point in my career I was fairly comfortable with ventilation, vascular access and airway management, however I knew that to become an AA I would need to improve on my understanding of drug delivery.  With that the biggest area I had to improve upon was my pharmacology.  I knew the common medications and the general indications but when you are holding the syringe, it changes, you’re responsible for dosing, additive effects, side effects, patients’ response, titrating to effect, etc, all of these things that I hadn’t really had to worry about before as an OR RT.  I spent a lot of time learning from consultants and residents and other AA’s about techniques they use in specific situations and why.  Everyone had a bit of a different take on how to provide an effective anesthetic and it was interesting to take all of that in.  I still enjoy learning about pharmacology and anesthesia techniques, I even find myself listening to podcasts related to this topic (ACCRAC – Anesthesia and Critical Care Reviews and Commentary: is my suggestion for anyone interested in a good anesthesia podcast). 

Overtime, I see an increase in the numbers of RTs looking into AA. What advice do you have for RTs who are interested in pursuing this role?

I would suggest to first get yourself into an OR to gain some experience.  Investigate what type of surgeries your hospital is performing and talk with the Anesthetist to find out what their needs are.  If there is an established role, see if you can shadow an AA for a day.  There is a demand for AA’s across the country and I believe it will continue to evolve.  It can be difficult to make the decision to go back to school after you have been out for a number of years.  I was in the same boat.  It was a conversation with a colleague and friend Paul Williams at the 2016 CSRT Conference in Ottawa that started the ball rolling for me.  My situation was unique, our family was growing and I had an opportunity to take a parental leave from the college to be home with our daughter in 2017, my wife and I arranged our schedules so that every Friday I could be back on campus to attend classes to become an AA. My full time job since 2013 has been as an educator in the RT program at Fanshawe, it was strange to go from someone use to being at the front of the class giving the lecture to transitioning back to a student in the AA program.   It was a great experience to be in a class with individuals from all over Southwestern Ontario who brought so many different experiences to the table.  This experience has come full circle as this Fall I am teaching in the AA program along side Paul Williams here at Fanshawe.  I’m excited and proud to be a part of both the RT and the AA programs.

Let’s take a look at your role as an instructor. How did you get involved with teaching?

I was fortunate enough to get into part-time teaching in the RT lab very soon after graduating from the program.  As with most graduates I was eager to pay down some student debt and jumped at the opportunity to be a lab instructor.  Honestly that’s where I thought it would end, I never really expected to make education my focus as a career.  I happened to be in the lab one day when Sandy Annett who was the co-ordinator of the RT program at the time asked if I would like to fill in for another professor who would be off sick for the rest of the term.  The course was Anatomy and Physiology which wasn’t something I studied in depth at University, I of course took the class as an RT student but the next thing I knew I was picking up a text book and getting ready for a lecture on the renal system.  My first lecture was absolutely brutal, I essentially read from my powerpoint slides and completed a 2 hour lecture in about 30 minutes.  I was dead on my feet at the front of the class.  I went home after that lecture and knew that the students deserved better.  I put everything into the next lecture and found it very rewarding to see the students engaged in the class.  I got lucky with contracts as well, it seemed every semester after that there was another opportunity to pick up a course.  Eventually I started to feel like if I wanted to be better and make a go of this as a career I needed to invest in myself.  I enrolled in a Masters of Adult Education at Yorkville and eventually obtained a full-time Faculty position in the RT program at Fanshawe College.  I don’t regret for a second the path my career has taken.

I understand that there are many elements and responsibilities to fulfil as an instructor. To simplify things for me, can you tell me about a “typical” day as an instructor? 

Typically the day will involve prepping for content delivery and either giving lectures or being in the lab or simulations.  There is a lot of desk time that is used for email, office hours for students and program or faculty meetings.  

Since COVID and the lock down, we have seen a big change in how we deliver theory courses.  The majority of the RT program right now is delivered in an online format.  It has been an adjustment for both the students and the faculty but as any good RT knows when there is a problem there is also a solution.  Our students have been incredibly resilient and hit the ground running with the new learning formats.  We are fortunate enough to have the ability to still deliver our practical experiences face to face.  Our labs and simulations are still going which is a huge benefit for students to gain that experiential type of learning that I strongly believe is ideal for development and progression.  Each day brings something new and even if it’s a course or lecture that you have taught in the past, there are always advancements and new practices, new research that constantly keeps us changing things to meet the standard of practice and the National Competency Framework.

What are some ways you had to change and improve to better fulfil this role? 

One of my early roles in the RT program was to develop a high fidelity simulation course.  We had been using simulation more and more in our program and wanted to structure something to ensure every student was getting equitable learning opportunities.  A component of my masters research was to look at how simulation can be used to bridge the gap between in class and clinical learning.  As a program we felt developing a course in our 4th semester would serve as a capstone to the in class and lab components of the program prior to the students going on to start their clinical practicum.  With support from our division, I enrolled myself in the Simulation Instructor Training Course at the Center of Medical Simulation.  I spent 1 week in Boston learning from some of the industry leaders like Jenny Rudolph and Walter Eppich.  I feel it gave me the confidence to deliver a quality and well rounded experience to our students.  With this I have greatly appreciated and been fortunate enough to learn from other RT leaders such as Karl Weiss and Gino DePinto who have been incredible from the onset with sharing and collaborating when it comes to simulation and education (Thanks guys!).

It is obvious that you care about your role and are very invested in it. What brings you joy in this role? 

I love when you see the “ah ha” moments happen!  When you help someone understand or connect the dots it’s a great feeling.  Our students chose this program and profession and to be able to share in their learning is a great joy.

I know it is hard to summarize all your advice and wisdom in an in an answer but I am still going to ask…What advice do you have for students so they can better maximize their learning?

RT school is no cake walk.  It takes determination, dedication and patience.  I strongly suggest setting up and using a peer group to both lean on in the tough times and learn from.  Learning is a social experience (even if it’s online), there is just as much incidental learning that occurs day to day than intentional learning and being open to every learning opportunity will set you up for success.  You also have to remember to find time for you.  Finding a balance between studying and life is incredibly important.  The last thing that I would suggest is to realize that your professors and preceptors want you to succeed just as much as you do.  Use their experiences and ask questions, be inquisitive, challenge yourself.  Everyone learns in their own way, find what works for you and know that what you are learning isn’t just to get the right answer on a test but rather it is to help the patients you will take care of in the future. 

COVID19 has impacted RTs in every aspect of our field. How have educating students changed due to the pandemic restrictions? 

Following the lockdown, we continued learning using an online delivery.  This term we are again offering all of the theory courses online, while practical labs and simulations are still being offered face to face (with social distancing, universal masking, hand hygiene and increased emphasis on disinfecting and sanitizing equipment and high touch surfaces throughout the day). How we provide online learning varies, but we have made use of video conferencing software, demonstration video’s, online tutorials, drop in sessions, youtube (you can check out my youtube page Vent Jockey), we are committed to make it work and I’m confident our faculty team will!

I am switching gears into career development. What advice do you have for RTs who want to become an instructor?

I think gaining experience in as many avenues of the profession as possible helps.  I felt that my early training at both a large teaching hospital mixed with a community hospital helped. I am not claiming to be an expert in everything our profession offers but by working in an outpatient clinic it helped when a student asked a question about Holters, or PFT’s for example.  I think it is useful when you have done a few and can use your experiences to give advice or even resources to help..  The same goes for working in ICU and ER, wards, OR, labor and delivery, rapid response teams, home care, primary care, etc.  Having those experiences gives you an ability to answer a question related to a specific avenue of practice.  Along with that I think, the more things you try, the more you find out what you like and what you don’t.  If being an instructor is something you are interested in, apply to your local college, see if they have the need for any teachers assistants or part time lab help or even picking up a course in a prep program like prehealth can lend insight into whether you like it or not.  You may also find enjoyment in patient education and be interested in pursuing your CRE or CAE, etc. There are so many ways to be an educator in our profession, stay current, get involved with the profession and put yourself out there.

I’ve read on a post that you stepped up in various ways to help out during this pandemic. What can you tell us about your experience? What are some of the learnings that you can share with us?

When the lock down occurred, we wanted to help as much as possible.  Knowing that there was going to be a potential surge of ICU patients requiring mechanical ventilation, our program with the approval of the college mobilized our fleet of ventilators to be serviced and ready for patient use.  It didn’t seem right to leave them locked up in a lab when there potentially could have been someone who could benefit from them.  Along with that Yvonne Drasovean a colleague and friend asked if I would team up with her, her husband and his coworkers who are Toyota engineers to participate in Code Life Challenge.  This was a challenge to design and produce a low cost, easy to use and easy to manufacture ventilator.  It was an incredible experience to be a part of this multidisciplinary team, to show how working together a team could produce a ventilator in an unrealistic short period of time that actually worked.  We lovingly named the ventilator the Covinator-FT (F for Fanshawe and T for Toyota) and arrangements are being made to have it transported to the RT lab at Fanshawe to hopefully inspire students to be innovative as well.

Here is a picture of the Covinator FT being assembled in the Woodstock Toyota facility

Lastly, I felt obligated to help out at the bedside.  I previously stepped away from the bedside for a few years to focus on my educator role and my family life, but with this pandemic I almost felt guilty being at home knowing that I had some of the skills that could help these patients.  I accepted a job at St.Thomas Elgin General Hospital and worked alongside an amazing staff that work tirelessly to provide the best patient care possible.  I’m happy to continue to work casually at STEGH now while resuming teaching at Fanshawe this term.

Your drive to help out goes beyond Canada. You have volunteered abroad as an RT.  What can you tell us about that experience?  How did that experience impact you?

Our program was fortunate enough to send 3 faculty and 13 students to Guatemala.  It was a life changing experience for myself and all involved.  We worked at four different clinics in rural Guatemala.  The experience ranged from assisting with triaging, assessing patients respiratory status, vital signs, blood glucose, medication profiles, assisting with vaccinations, giving nebulized treatments, making educational material for the clinics and helping out in any way we possibly could.  We stocked shelves in pharmacies, we mopped floors, we participated in physical therapy with some senior patients… whatever needed to be done we were there to try and help.  There definitely was an initial shock by the conditions of some of the clinics and the lack of supplies, but the local staff made the best of what they had, didn’t complain and did what they could for their patients.  It puts things into perspective when you realize what we take for granted in our healthcare system.  I think we all came back from that experience viewing our work environments in a different light.  

Here is a picture of us doing an in home assessment of a pediatric patient in Guatemala  who was too unwell to come to the clinic.  I tried to win her over with a small gift.

What advice do you have for those who are interested to volunteer abroad?

For anyone interested in volunteering abroad, I say do it! It definitely provided me with a heightened global awareness and it somehow makes you feel more connected.  It’s humbling, challenging and rewarding and something I hope to be able to continue with. 

Bringing things back to Canada and Canadian wide volunteering, you are the chair of the simulation network with CSRT.  What can you share with us about your experience?

The CSRT simulation network aims to provide a collaborative forum to foster and inform evidence informed simulation practice across Canada.  It is a place where like minded people can come and gain access to subject matter experts right in our own profession.  It is an impressive group of RT’s participating in this network.  If you are someone who participates in simulation either from a learner standpoint or a developer, this may be a place you find interesting.  COVID put a bit of a pause on our meetings as we all were quite busy, but we have hosted a number of journal clubs, there is a small but hopefully growing repository of scenarios and most importantly there is an opportunity to meet with peers and learn from each other.   

You are one of the co-hosts of the RT Audio podcast.  How did you and Greg, your co-host, decide to start a podcast? How has your experience with it so far?  Where can people find this podcast? 

I listen to and enjoy podcasts and find them to be a great way to learn something new.  Greg and I have flirted with the idea of doing something like this for a while.  We thought that there was a gap in podcast land where there are very few RT specific podcasts.  We only have recorded a few shows but the format is to typically find a guest who has influenced the profession or has an interesting story or can inspire us or just simply is fun.  The feedback from the listeners has been very positive so far even though it is an extremely low budget production (we actually don’t have a budget haha).  We originally thought that it would just be the students who would listen to it, but soon we were getting comments from RT’s across the province.  The host we use has analytic software that lets us see where people are tuning in from and some of the places have surprised us… we’ve had the Philippines, South Africa, a few in New York, it’s kind of a cool realization that a small pocket of people around the world are also looking for RT related podcasts…We are always looking for interesting episodes, so if there is anything you want to hear please let us know and we will see if we can put something together.  Farzad, you are on our radar for a future episode!!!

I definitely enjoy your podcast and look forward to future episodes! I would be honoured to be part of one of your future episodes.
Let’s take a step back and look at the big image. How do you see our field change over the next few years?  Also, what changes do you hope to see?

I think this pandemic has shined a spotlight on what we can do as a profession.  Every RT across the country stepped up and became leaders in their institutions.  I think over the next few years we need to continue to position ourselves to have a strong voice in all things related to respiratory care.  Moving forward I envision more and more advanced practices coming our way enabling us to work under medical directives.  More than ever before RT’s are gaining interest and becoming involved with research and this can only lead to more leadership within our profession.  Continuing education and professional advancement opportunities such as anesthesia assistant, advanced neonatal care, certifications such as the CRE, CAE, CTE keep coming our way.  These are opportunities we need to take advantage of and continue to push ourselves for both our patients and our profession  We make our own future.

Nicely said. I am a big advocate for personal and professional growth at every stage of one’s career!

When you are not focused on the wonderful things that you do for our profession, what do you enjoy to do?

Outside of work, we have a busy family life.  I’m happily married with 3 kids (2 boys and 1 girl).  I coach soccer and hockey and stay involved in a number of their activities.  When we have some down time our favourite thing to do is unwind at the family cottage.  Lately I’ve gotten into audiobooks as a way to relax (Talking to Strangers by Malcolm Gladwell is a must).  In an attempt to stay active I still play hockey in a local beer league.  We love to travel and explore, and hope once things settle down we can book our next trip.

Dave, we are at the end of this conversation. Any final words you like to share with our readers?

I’ve never talked this much about myself and feel as though there isn’t much else to say haha.

Thank you, Dave, for sharing your insight and experiences! I am sure you a role model for many people.

To the readers of this post, thank you for reading all the way to the end. Please share with us your thoughts. If you enjoyed this post, please consider liking and sharing it with others who may benefit from it.

Here is a link to the LFPress with the ventilator loan:

If you like to check out Dave and Greg’s podcast,it can be found on Apple podcast, Spotify, anchorFM, likely some other carriers.

 Happy RTing,

Farzad Refahi
October 5th, 2020

A Conversation with Kelly Hassall

Kelly Hassall

Experiencing asthma and a family history of Berylliosis exposed Kelly Hassall to the importance of respiratory health and set her on a path to become a quality respiratory therapist.  Through this journey, Kelly has tried various roles including clinician, educator, manager, and leader.  I had seen Kelly as a presenter at conferences, however, it was not until my volunteering at RTSO where I officially met her.  She is driven and knowledgeable and has the ability to look at things with a wide lens.  Kelly is well known to the RT community so I reached out to Gino De Pinto to hear his thoughts on our interviewee.   The following introduction is by Gino De Pinto:

I have had the pleasure of knowing Kelly for the past 14 years. We have worked together to educate students through the early days of clinical immersive simulation, help navigate student placements and most recently on various projects with the RTSO. Kelly has always been solution orientated, innovative and a true respiratory therapy leader. Over the past few months this quote from Rosalene Glickman sums up Kelly’s work as a leader in our profession. 

“Every situation – even a disaster – is an opportunity to be your best.”

Rosalene Glickman, Ph.D.,

Our profession was lucky to have Kelly at her best advocating for pandemic pay, organizing timely relevant webinars and providing pertinent resources during the first wave peak of the COVID 19 Pandemic. I’m happy to call Kelly a mentor and a friend.  The RT world would definitely benefit for having more Kellys pushing the profession forward.

Thank you Gino for this lovely introduction.  Now please join me in the interview with Kelly.

Let’s start with one of my favourite questions to ask.  I am curious to find out how people find out about our profession and why they decided to study respiratory therapy.  How was the journey for you?

Having spent a large majority of my childhood learning to control my asthma while watching my father struggle with Berylliosis, I had great respect for the number of health care providers who dedicated their careers to helping those with respiratory ailments have a better quality of life.  I wanted to give back to a community that had given so much to me and my family.  From a young age I knew I was going to work in healthcare specializing in respiratory care and management in some way shape or form.  I had the great fortune of graduating high school the year that Queen’s University and the Michener Institute for Applied Health Sciences started offering a combined Bachelor of Sciences in Life Science and Diploma in Respiratory Therapy program.  I was looking into the Queen’s Life Sciences program as a “stepping stone” to medical school.  This collaborative program seemed like a great fit as an introduction into the management of respiratory health.  Initially, I viewed the profession of Respiratory Therapy as a gateway into the healthcare world, as I learned more about the profession and completed my clinical year, I was inspired to begin working clinically as an RT and decided this was the profession for me. 

Once you decided on respiratory therapy as the profession for you, where did that journey take you?

I’ve been extremely fortunate throughout my career to date to work with an amazing assortment of clinicians in a variety of settings.  I completed my clinical year in Hamilton and Toronto and learned a lot from my fantastic clinical instructors, preceptors and clinical experiences.  Immediately after graduation, I began my RT career in the NICU at Mount Sinai Hospital in Toronto.  I worked there in a variety of roles for over 14 years.  In addition to my time at Mount Sinai, I worked at Toronto Western Hospital as a casual for a short period and then shifted my focus to interprofessional education and training.  I began working in the Simulation Center at Mount Sinai Hospital and then joined the faculty at Conestoga College for the first few years of the RT program.  Upon returning to clinical full-time, I decided to enroll in a Master’s of Education program and focus on clinical education while exploring the realm of research.  I’ve lectured for residents and fellows in the McMaster and University of Toronto medical programs as well as a variety of interprofessional colleagues. Somewhere in all there I did work for a brief period of time as a clinical per diem for Masimo.  That role was interesting as I had an opportunity to learn about the American medical system and help out at a few installs across the border.  I also became an NRP, BLS and First Aid instructor which gives me a chance to teach the public as well as a variety of clinicians.  In 2017, I moved to St Joseph’s Healthcare in Hamilton where I currently hold the title of Clinical Resource Leader of Respiratory Therapy and work with an outstanding team.  Throughout this time I’ve also had various opportunities to work with the CRTO, the RTSO and the CSRT in various capacities to promote the profession, assess peers and assist with professional development.

In terms of memorable moments…what happens on shift stays on shift…that being said I am most grateful for the many inspiring leaders and clinicians that I have had the opportunity to work with and learn from.  I’m also extremely grateful for the various opportunities I’ve had to attend conferences and workshops…the most memorable of which would be a tie between an European Conference I attended in Portugal in 2013 (my colleague and I met Jane Pillow and she offered us a chance to work with the sheep in her lab) and the AARC in Las Vegas in 2018 (the keynote was ZDogg…amazing!).  I would also be at a loss if I were not to point out the pride in seeing some former students step up to the plate over the past few months to not only show up to work but go above and beyond with clinical practice suggestions, food drive fundraisers and support of their profession.

Learning about your wonderful journey gave me the same reaction of awe and admiration, which is similar to when I get to meet and listen to inspiring presenters in conferences.  Not surprisingly, you are a frequent speaker at various conferences. 

As you mentioned, you have worked in various roles.  What can you tell me about your clinical roles?  

To me, one of the most amazing things about Respiratory Therapy is how diverse our profession is.  There isn’t a day that goes by that I don’t learn something new.  For years I specialized in Women’s and Infants’ Health.  The first day I stepped into the NICU I was petrified…the patients were so small and it seemed as though I had so much to learn.  Over the years this area of care along with Labour and Delivery became my second home. The challenge of arriving at a delivery never fully knowing what to expect and the many valuable opportunities to work with and learn from the rest of the interprofessional team made the clinical environment engaging and extremely rewarding.  For the most part, the successes would outweigh the challenges.  When I moved to Hamilton I began to spend more time in the adult world and I’ve spent the past three years learning so much from my colleagues.  The day that I observed the ICU team stop rounds to go in and sing “Happy Birthday” to a patient was the day that I realized that it’s not the clinical area or patient population that matters to me, it’s the clinicians working together to provide the optimal care for each person and the environment of respect and trust that this creates that makes the time I spend away from my family worthwhile.

In your opinion what makes a person a quality RT?  

When I reflect on the RTs that have inspired me the most, the traits that come to mind are respect, critical thinking, trust and resilience.  No matter where you are in your journey as an RT, whether it’s a student entering clinical or a 30+ year veteran gearing up for retirement, there’s always an opportunity to learn, to reflect and to adjust your practice.  The clinicians who have inspired me the most are not afraid to admit when they are being faced with a challenge beyond their experience and are quick to seek resources or help.  Instead of backing away from a challenge they often step up and look for ways to find a solution.  They stand up for what they believe in and never throw anyone “under the bus”.  They also take the time to say thank you and to acknowledge the efforts of others. 

How did you get involved with the leadership role?  What are some elements about your role that you enjoy the most? 

I have crossed paths with the realm of leadership in various capacities over the years.  When I was alerted that there was a posting in Hamilton for a full-time RT leadership position it seemed like the right time to try something new.  Fortunately the team at St. Joseph’s Healthcare Hamilton felt that I was the right fit for their needs and here I am.  I enjoy the challenge of getting to know all the various care areas and working with various members of the interprofessional team to ensure that they are supported.  I work with an amazing group of RTs, AAs and Pulmonary Techs.  I rely on them heavily to help me understand the clinical challenges that are being faced in each area and what I can do to support their needs and enhance patient care.  Since joining the team at St. Joseph’s Healthcare Hamilton, we’ve implemented an electronic charting system, moved to Bubble CPAP in our Special Care Nursery, started weekly interprofessional simulation events in our ED, evaluated ventilators and now we’re in a pandemic.  It has certainly been an interesting few years.

I also am extremely grateful to have a fantastic manager who is extremely supportive in assisting me navigate the many considerations that need to be made when trying to optimize support for the RTs while working interprofessionally and collaboratively throughout an organization.  I would be at a loss if I didn’t mention the RT students.  A significant part of my role is to support RT students during their clinical year.  I wouldn’t be where I am today without the support of the clinical instructors who supported me through my clinical year thus it’s nice to have a chance to give back to the profession by supporting the students entering our profession as well.

One of the ongoing themes in your roles is your interest, willingness and involvement in teaching and mentorship.  What advice do you have for RTs and preceptors to better assist students in their growth? Then turning the table, what advice do you have for students for maximizing their learning and growth?

No one enters into this profession to do harm.  Every student who comes through the doors has spent several years preparing for this clinical experience and is striving to achieve a level of competence as an entry to practice RT.  Every student is also a human with past experiences and a life outside of clinical.  When you are with a student, don’t assume.  Ask them what their goals are for the day, let them know it’s okay to say when they don’t know something and provide them opportunities to grow in a safe environment.  They will make mistakes, they will forget things and they will misunderstand…just like we all do throughout our careers.  Be clear with your expectations and timely with your feedback.  It’s impossible to adjust behaviour if you are not aware of the adjustments that need to be made.  

Students, you are not expected to be perfect but you are expected to be engaged and play an active part in your learning.  I would rather work clinically beside the RT who scored 65% on their composite exam but took the time to understand where they lost the 35% and how to do things differently the next time than the RT who scored 85% and never took the time to review the 15% they could have improved upon.  Treat each day as an opportunity to learn not only what you need to know for entry to practice but also what you have an opportunity to understand as a clinician and a part of the interprofessional team.  Identify your opportunities for improvement and ask your preceptors to support you in this.  Be proud of your accomplishments but also realize that just because you do something perfectly once it doesn’t mean that you’ve mastered the skill.  Every patient encounter, every cart check and every patient chart is an opportunity to learn and to grow as a clinician.  Your clinical year is what you make of it.  Choose to make the most of it as it will set the tone for how you choose to engage in your profession and practice for the rest of your career.

Your contributions to the respiratory therapy field include volunteering work. We are both volunteers at the Respiratory Therapy Society of Ontario (RTSO) and I have seen you serve in various roles. You are the current co-chair of the leadership committee and the past-president! I definitely appreciate all your hard work and have learned a lot under your leadership.   How did you hear about RTSO and what made you decide to volunteer with this organization in the first place?  

Why thank you for those kind words Farzad.  Words cannot express how grateful I am that our paths have crossed.  The RTSO is a team and we all learn from each other as we grow together.  I learned about the RTSO when I was in RT school.  I happened to enter into the profession during an interesting time when there was quite a bit of tension between the CRTO and the RTs.  The RTSO was the collective voice of the RTs during this tension and the clinical environment and opportunities that I benefited from were in part due to the work of the RTSO.  When you graduated from RT school in Ontario you joined the RTSO…it was just accepted that you supported the society that advocated for you.  Then there was the membership merger piece between the CSRT and RTSO…it was a great deal as you could join your provincial and national society and get your insurance all at the same time.  At some point that ended…I’m not sure exactly when…but eventually it was brought to my attention that I was not a RTSO member any more and that the society needed volunteers to keep all the great things they were doing going.  Anyone who knows me knows that it takes very little to convince me to help for a cause that I believe in so when Sue Martin asked me to help out on the Leadership Committee I was more than happy to do so.  Things just sort of evolved from there…at no point did I ever expect to be put into the role of President position in the midst of a pandemic…but it happened.  When the expectations of the unanticipated change in roles exceeded the time and energy I had to give the rest of the executive was there to step up and help out…just as I hope many other RTs will be inspired to do in order to keep the society going.

What have you got out of your experience?

My work through the RTSO has renewed my sense of pride in our profession and opened my eyes to all the amazing things RTs are doing across the province and the country.  If there is anything that truly stands out in my mind it’s our provincial response to this pandemic as RTs.  We were faced with something novel and unknown and we worked together (and continue to work together) to support each other in doing what needs to be done safely and effectively.  It’s also opened my eyes to the true importance of working together across the continuum of care.  Due to the massive expanse and scope of our profession, it is very easy to become focused in the care area within which you work.  There is so much to be gained by breaking down these silos and sharing information, resources and experiences between the various areas of care.  Just as the patient experience extends from hospital to home, so should our approach to supporting the respiratory needs of our patients.  Our provincial society truly is our opportunity to unite as RTs across the province to share concerns, thoughts, resources and supports.  It is a mechanism through which we can unite and systematically work together to get concerns addressed at the Ministry level as well as a mechanism for addressing concerns that are central to our practice in our province.  I would also be at a loss if I didn’t mention the incredible amount of collaboration and assistance that has been provided to the RTSO by the CSRT and CRTO as well.  While it is important to recognize the differences between the various organizations, it is also important to acknowledge the tremendous amount of collaboration between the RTSO, CSRT, CRTO and various other organizations such as the CTS and the ORCS that enables our profession to move forwards and enhance patient care.

Why should RTs consider volunteering with RT organizations? 

Your profession needs you.  It’s as simple as that.  You chose to enter into the profession of Respiratory Therapy out of any other allied health profession out there.  Take a moment and ask yourself why.  Why RT?  I’m going to take a wild guess and suggest that it wasn’t so that you could miss out on long weekends, sport a variety of bodily fluids on your shoes, rock the N95 imprint on your face and score an unlimited supply of nasopharyngeal swabs.  So what exactly was it?  What makes you leave your house every single day, fill out your screening tool and walk into work while everyone else is barricaded in their homes?  

A profession doesn’t just magically go from moving oxygen tanks around a hospital to becoming the clinical experts in respiratory care and management.  It was the ambition of the RTs before us that expanded our role across the continuum of care and opened doors and opportunities for roles that our nursing colleagues or others would be glad to fill.  The role that you walk into every single day is a role that has been built by the dedication, inspiration and drive of the RTs before you.  It’s up to us to keep that momentum going, to use our experiences, ideas and energy to continue to provide opportunities for our profession to grow, for our voices to be heard and our clinical expertise to be acknowledged. There are over 3500 RTs in Ontario.  If we all did our part just think of what we could accomplish for our profession and the respiratory health of our loved ones. 

What can you tell us about your experience during COVID19, as a clinician and leader? What are some of the learnings that you can share with us?  

That’s a great question….one that I’m not really sure how to answer just yet.  I would say that the thing that comes to the forefront of my mind is that as crazy as this all may seem at times with all of the unknowns, I am grateful and I am proud.  I’m proud of our profession for stepping up in less than ideal times to use our skills and resources to figure out how to approach the various aspects of this pandemic.  I’m proud of our families for supporting us in what we need to do and sacrificing time at home with us so that we can ensure the health and safety of others.  I am grateful for the generosity of the communities that have provided support in whatever way they can whether it was a painted rock, a baby monitor, ear saver, a meal or a donation to our food drives.  While no one can argue that clinical skill, PPE and equipment are necessary to get us through this pandemic, I believe that kindness and understanding have helped us make it this far and play a huge role in us seeing this to the end.

COVID-Simulation with Paramedics. Kelly Hassal and Dr. Erich Hanel

How do you see our field change over the next few years?  Also, what changes do you hope to see?

Another great question Farzad.  From a provincial standpoint, I hope to see a restored focus from the Ministry of Health and the public on the importance of respiratory care and respiratory health.  I would like to see the profession of Respiratory Therapy brought to the forefront as experts in respiratory care and management across the continuum of care.  That would mean a greater presence in home and community care as well as an opportunity to engage in initiatives within long term care and retirement homes.  I would like to see funding for research for initiatives such as research into PTSD among Respiratory Therapists and supports to ensure that the mental health of our colleagues is at the forefront.  I would also like to see the Allied Health Fund restored to support the continuation of education and training for our colleagues.  From a professional standpoint, I would like to see continued collaboration between RT leaders throughout the province and the country to share resources and experiences to address challenges and concerns.  I would also hope to see increased engagement of frontline staff members in the various respiratory-related organizations and societies throughout the province and country.  

When you are not contributing at work and volunteering positions, how do you enjoy your time?

Outside of work and volunteering I’m the proud mother of two amazing children and the wife of an extremely understanding non-healthcare husband.  We also adopted a kitten in February of this year and we are extremely fortunate that he’s easy going as he’s constantly being picked up and cuddled.  When we’re not running between activities, we love to spend time outside hiking, creeking, canoeing and riding bikes.  Any other summer would be filled with BBQs, family gatherings and festivals as well.  I also like to bake and quite often thank my colleagues for the great work they do with cupcakes and other treats.  I also used to really enjoy travelling…I look forward to getting back to that someday.

Any final words to the readers?

Thank you.  Thank you for everything you do every day to ensure that you and those around you get through this pandemic.  Take care and stay safe.

It has been my pleasure sharing this interview with you all.  Once again,  thank you, Kelly, for taking the time to share your experiences and insights with us all!

To the readers of this piece, what are your thoughts and reflections? If you have enjoyed this interview, please share with others! Thank you for joining me on this journey of learning!

Farzad Refahi
August 23, 2020

Rachel Nesbitt

I have the pleasure of sharing my interview with Rachel Nesbitt with you. Over the past few years, I have had the chance to know more about her and feels like she has taken on a different adventure each year: working in Canada, abroad, in medical sales or everything required in a hospital and much more. Rachel also tells us about her medical missions toward the end of the interview along with some great photos. Without further ado… meet Rachel!

How did you find out about the field of respiratory therapy?

I went into Respiratory right from high school.  I really had no idea what I was getting into. I just knew I wanted something in health care but not to be in post-secondary for the next 15 years of my life.  Just like most of the general public, I thought the only ones who worked at the hospital were nurses or Doctors. After learning what an RT really is, you start to realize you really DO know lots of people in the field, I just thought they were nurses growing up.

Why did you choose to become an RT?

“I didn’t choose the RT life, the RT life chose me.” 
The RT’s I went to school with (shout out to Fanshawe Class of ‘06), the RT’s I’ve worked with over the years, and every CSRT conference I’ve ever been to, really make me believe that we are on a special level together and fit like a puzzle. Like each one of us found our calling no matter what brought us into the RT world. This is exactly what I’m supposed to be doing and can’t imagine what my life would have been like without the world of Respiratory.

What are some of your memorable moments working as an RT so far?

I started off my RT career with a bang! In my 3rd year clinical,  I was very pregnant with my now 14-year-old daughter Jacey.  There were 2 weeks at the end of the year where you went back to Fanshawe to take your ACLS and write exams. I wasn’t due for another 6 weeks so thought I had plenty of time. On the first day of ACLS I started having severe back pain. It wasn’t labour it was a kidney stone! So I was admitted to the hospital.  I received a phone call from the school saying unfortunately if I didn’t write this series of exams I couldn’t graduate with my class. So the next day I signed myself out AMA and met Mrs. Annett at the school and wrote all the exams. Turns out if you don’t overthink those exams, you ace them! While the rest of our class was enjoying their 3rd-year farewell party I was busy having a baby! My class, my preceptors in clinic and Mrs Annett were so supportive, it’s one of my favourite memories.  2 weeks after delivery I started my orientation at LHSC- Victoria hospital.
I worked at LHSC for 10 years. There I was trained in adult ICU/wards and ER. After 2 years, I trained in Pediatrics IUC and worked for year. Peds wasn’t my flavour so moved to the Operating room where I felt so at home! I loved assisting anesthesia and everything about the OR.  I always thought I would I would work at Vic until I retired. The RT’s there were my best friends and like family to me.
In 2016 my husband was offered a job that made me rethink my path.  I had to quit my position at LHSC and moved across the ocean to Grand Cayman.  Initially, there were no jobs for an RT so I went back to school to take a course for medical injectables. I got a job at a cosmetic clinic working with a dermatologist to do Botox and fillers. Well the RT life knew I belonged in that world so not even 2 weeks after I was in Cayman I was contacted by the government hospital and offered a job.  I was thrilled to be back in the hospital doing what I loved but this was a very different role than the OR.  At Health Service Authority in Grand Cayman there had been 1 RT for many years but they were expanding so I made a department of 2. We are “Jack of all trades” much like many rural hospitals at home. It was a lot of firsts for me. I was now doing chest physio, sleep studies (Doing and scoring both level 1 and 3), PAP therapy, PFT, home oxygen and NICU.  I spent a lot of time self-learning and taking any courses I could find online.  And if I was ever stuck, I had my amazing friends at LHSC for an “overseas consult”. I never realized how many avenues there were in Respiratory. After a year in paradise, we moved back home to London where I figured I’d try another new RT path. SALES. I was so nervous to make the jump. I wasn’t sure I could do it. It was so out of my comfort zone.  I took a territory sales rep job at VitalAire. The first 6 months were really difficult trying to navigate through but then it just seemed to click. I got the hang of it and to my surprise did really well! I spent the next 2 years in sales there but then was offered a position as manager for southwestern Ontario. I managed 4 branches and 30 staff for just over a year.  I can’t begin to explain how much I learned and grew in that 4 years of my career. I am still so amazed at how far our profession has come.  RT’s are not one-trick ponies! There are so many opportunities in our field and I feel like I want to experience them all!

What can you tell us about the medical sales role? What’s a typical day in this role?

Starting in sales was very intimidating. When I started, I felt so out of place like everyone else on the sales team knew so much more than I did since I was “just an RT” and not a salesperson.  Then I realized I was the only one putting myself in that box.  Sales were all about making relationships and earning trust from clients.  And when you work in sales of respiratory equipment or services, who better to make those relationships with RT’s than another RT!!?! 

I was most comfortable on days I went to visit RT departments…felt natural to carry a conversation with them.  It’s always nerve-wracking when you have to go into a new doctor you’ve never met. It’s hard enough to get a moment of their time so you don’t want to blow it.  But after a while I realized, I’m an RT! I know all things respiratory. I am the expert in my field and I have knowledge to share with these physicians. Once I learned that I gained confidence and those appointments became easy too.

I covered Southwestern Ontario so each week I would plan my visits to different doctors offices, Hospitals and sleep labs. Some days were fun and easy, like a visit to an RT department to say Hi and show presence. Some days are more difficult when you have to put out fires if things didn’t go as planned and you have to do damage control.  Some days were cold calls with no appointments and just spreading the word of your company and services. I love to talk and to teach so my favourite days were when I got to do lunch and learns.

Your current role involves various responsibilities.  What’s a typical day for you?

Currently, I have a cushy Monday to Friday 7-3 gig with an every other Friday night shift thrown in.  From 7-9 I start in the ICU for rounds and vent adjustments and weaning. Then outpatient appointments start at 9am, so could be a CPAP start, PFT or level 3 sleep study. At 11am the other therapist comes in and she takes over the rest of the outpatient appointments.  I go back into the ICU or med/surg ward to start the chest physio patients. On Tuesdays and Thursdays, we have a half-day pulmonology clinic which means back to back spirometry for 3 hours.  Throw a NICU vent in here and the whole day is a write-off! Usually, our prem babies would be transferred overseas to Miami Children’s, however, with COVID we’ve been holding on to a lot more of our wee ones. On Friday nights we do our level 1 in house sleep studies.  Since there are 2 of us, we alternate every other one. We are not a 24-hour service.  Anesthesia is on call for overnight vent issues. There is plenty to keep us busy on this little Island! 

How did you decide to work in Cayman Islands?   What can you tell me about the experience?

Living and working on a small island has its ups and downs.  In a dept of 2, you really don’t have the same opportunities to bounce ideas off coworkers. I really depend on our nursing staff and physicians here.  And in turn they really respect the role and are always looking for input which feels nice to be appreciated.  

Between teaching breathing exercises to a post-op patient, or education on a new PAP therapy machine, or showing a family member how to work the oxygen concentrator, I feel patient education takes up a large portion of our day. 

 We fall under the nursing manager of Critical care who is really amazing and easy to talk to and trusts our judgment. We currently are working on the Methacholine protocol so we can start that next month which we pulled from the AARC guidelines. Many of our others like home oxygen qualifications, we use Ontario guidelines. 

There is a regulatory body here which is called the Council Professions Allied with Medicine (CPAM). We need to renew our license every 2 years. 

The biggest challenge for me was adapting to insurance-based medicine.  Having to ask for funds or insurance cards before every appointment or thinking twice before you use a supply knowing the patient may have to pay out of pocket for it. 

 International moves and immigrating are not easy! You live year to year hoping your next work permit will be approved so you can stay.  Work permit holders children have to attend private school which is expensive but this is a tax-free island so it washes out.  It’s strange to just walk out with your salary every month tax free! 

I’ll put my plug in here… We are currently hiring 1 RT to join me here in Cayman! If you’re a jack of all trades or at least willing to learn, send me a message! 

Can you give an example of working in the insurance-based medicine?  How would you a clinician approach this? What are the ways clinicians provide patient care when additional testing is not an option?

When a hospital relies on insurance coverage to get paid, almost everything needs to be pre-approved especially in an outpatient setting.  When we get a referral from a physician for a sleep study or PFT, we send that to a preapproval team who contacts the insurance company. The insurance either gives the go ahead or patient to pay out of pocket. When an in- patient has insurance, it is very rare that things wouldn’t be funded and things are less stressful.  When a patient has no coverage at all, it is very hard to see. For example, pre-COVID, many cruise shippers come to port here, fall ill and need ICU care and medivac back home.  Most don’t realize that OHIP or Medicare don’t cover your medical out of province or country and the family is stuck with having to pay for bills of up to 50K. Please, please, please always get travel insurance my friends! 

How was/is your experience with COVID?

Wow COVID. The word makes me shiver.  I think about the countless hours I spent working with management in preparation for what could devastate a little island like ours.  We have an 8 bed ICU. Which means maybe 15 vents if I use our home vents, ER vents and transport vent. There is a private hospital on the other side of the island which has about another dozen vents. We are lucky that this is not a third world country and our government was able to procure extra vents just incase. They even opened an emergency field hospital in anticipation of COVID overload. Cayman was well prepared and quick to act shutting boarders down early which allowed for the virus to be very well controlled here. To date, we’ve had 201 confirmed cases in a population of 65000. 1 death and 194 fully recovered. We did not see the critically ill that the rest of the world saw.  We had plenty of practice with every vent that came into ICU treating as suspected with full PPE until swab came back negative, but we only saw 1 true COVID vent!!! And I was able to extubate him in about 5 days on being on vent. We had a separate unit called Respiratory Care Unit which housed all our confirmed COVID patients that required hospitalization. The open style ward was able to hold 8 at a time which was all we luckily needed and the field hospital was not used.  Those with oxygenation issues we maintained on high flow nasal cannula with Airvo or Maxventuri units. The staff were always in Full PPE and only confirmed COVID patients in the unit. With only 6 active cases currently and zero in hospital we are very happy to say the restrictions have eased. We had weeks of mandatory isolation, only essential staff allowed out of your house to go to work. And essential here was legit essential. Hospital workers, grocery store staff and police. You were only allowed to grocery shop on your name day. Last name A-L Monday, Wednesday and Friday. M-Z Tuesday, Thursday and Saturday with a hard lockdown on Sunday no one allowed out.  Police had roadblocks and checked licenses everywhere you went.  This was the first time I really regretted keeping my Maiden name as I couldn’t go anywhere with my family lol. Our boarders remain closed and masks are law anywhere in public space. I will be forever thankful when I never have to hear the word COVID again! 

How do you see our field change over the next 10 years?

I think the RT world already has so much to offer its just what opportunities will you cease?! We’ve got RTs in clinical, management, research, sales, marketing, and education. Don’t be afraid to branch out and try something new. I’ve discovered that door opens 10 more.

What advice do you have for those who are thinking about working in another respiratory care setting but are unsure?

When I went to work in Sales/management I kept my job Casually at Vic.  That allowed me to work weekends and keep up my clinical skills (plus socialize with my peeps!)

Putting work aside for a moment, how do you enjoy your time over there?  

Beach, Brunch and repeat! 

Also any chance I get, even though its work-related, I LOVE medical missions. It gives you the opportunity to travel and see the world while also seeing how medicine works in other countries.  You come back feeling appreciative of what we have and the luxuries our hospitals have. PLEASE PLEASE PLEASE if you ever get the chance, GO! You will never regret it.  It will be the most humbling experience of your career I assure you. 

Any recent medical missions that you can tell us about?

I’ve been to China twice and Peru twice for medical missions.  My most recent mission was Peru in 2018. This is a team put together by the fearless leader Peter Allen, a perfusionist at University hospital in London.  These are cardiac missions where a full surgical and post-op team travels to perform and teach cardiac procedures.  It’s a multidisciplinary team of perfusionists, ICU nurses, Surgeons, anesthesia, scrub nurses, RTs, and physio from around Ontario. We are always welcomed with open arms. We spend 1 full week performing surgeries which usually fits in 6-8 procedures depending on the difficulty.  There is usually 3-4 RTs on the team and we split the shifts day/evening. 1-2 in the OR in the morning setting up for the case and assisting with induction. And the afternoon crew worked in ICU to receive and wean the post-op patient.  

The first time I traveled to Peru there was a young woman who was a teacher.  She had cardiac complications from pregnancy and they were unable to get her off the vent.  While we waited for our post op patients, we spent time in the other ICU sharing our weaning protocols. Every day we worked with her and by the end of the week, she was more off the vent than on. I’ll never forgot how happy my heart was when I received an email from her that she was home, fully recovered and decannulated! When I returned in 2018, she came to the hospital to see me and I was so happy to see her.  I still stay in touch with her to this day.  Missions are where you really feel like you make a difference.

The local teams always work hand in hand with us.  We teach them the tricks we know and I can say I’ve learned some pretty amazing things from them too.  I’ve made some wonderful friendships on these journeys and am still in contact with a lot of them. 

And my favourite part is the time spent outside of the hospital at the local orphanage in Peru.  We take turns going each day to help sand, paint, sew curtains or help in any way we can.  After the kids get home from school, we help them with homework and play. Seeing those smiles and personalities is priceless. I’ve always fundraised before I go to make sure we can leave behind some money to help with expenses. Jose and Gloria who run the orphanage are always sending updates. They are truly heroes in my eyes. 

I would like to thank Rachel,, for telling us about her journey! Did you enjoy this interview? Make sure you like and share this post with others!

Farzad Refahi
July 19, 2020