Television’s Joe Friday, in the late 1960s television show “Dragnet,” described police work as “a glamorless, thankless job that’s got to be done.” He could just as easily have been discussing the life of your average respiratory therapist. In hospitals all across the country when someone needs assistance breathing, whether it be in the form of treatments or extreme assistance with a mechanical ventilator, it’s the respiratory therapist that comes running. Literally. When you have four minutes before brain damage sets in, you need to get there quickly. You run!

Your average respiratory therapist in an average hospital has a lot in common with police officers too. They’ve been bled on, spit on, coughed on, sneezed on, and yes, urinated and defecated on while doing their job. They’ve worked 12- and 16-hour shifts, eating hospital cafeteria food, usually gobbled in 10-minute breaks between emergencies. They’ve walked an average of two miles a day while doing their job and they’ve run between the ICU, Emergency Room, and patient care floors trying to take care of far more patients than they can reasonably handle. This, of course, is due to the fact that hospitals have had to cut staff because Medicare pays so poorly. In spite of the fact that many could make a higher hourly wage as a welder or selling insurance, they continue to toil away in the hospital corridors because deep down these folks love patient care. They love the feeling they get when patients get well and go home.

Respiratory therapists rail at television programs that show nurses managing mechanical ventilators and calling them “respirators.” As every good respiratory therapist knows, respiration is the process of gas exchange that goes on in the lung. Ventilation is the process of moving that air into and out of the lungs. And mechanical ventilation is what happens when someone is intubated and placed on a ventilator. Media routinely get this wrong, but it’s not like they get a lot right these days.

Therapists are on the front lines of the COVID-19 battle. They not only manage the mechanical ventilator (which involves measuring parameters like the amount of gas forced down the endotracheal tube, and the amount exhaled) they help suction secretions out of the patient’s lungs. As the virus attacks the lungs the body’s natural defense kick in, producing mucous in large amounts. That has to come out of there before it dries and blocks the lung. Therapists do that. Every time they disconnect the patient from the ventilator to suction, the virus is aerosolized and sent flying across the room. Even with masks and protective equipment, they’re exposed.

This is a job I did for 13 years before I went to law school. It was a job I loved because I loved helping people. I loved the struggle against death and disease, and I loved most of the people I worked with. We worked hard. We played hard. We never thought much about the risk.

When AIDS (later HIV) became the disease du jour in the 1980s we all donned gloves and adopted universal precautions and just went on caring for sick people. We didn’t weigh the risk. We just waded into the ICU and did our best. In 1990 I gave up my stethoscope for the law books not because I didn’t love what I did, but because I felt I could help more patients and more therapists by becoming an attorney. But every time I hear that ambulance siren or see the paramedics heading back to the hospital, part of me wishes I was there waiting for them.

Today’s therapists arguably have it worse than the therapists of the 1990s. While the HIV we worried about requires body fluid transfer (usually blood or seminal fluid) COVID is transmitted by droplet infection. A speck of moisture you cannot even see without a microscope can give you the virus. It can come in through your mouth, nose or eyes.

And if that wasn’t enough, there are far more people being mechanically ventilated today. We used to believe that no therapist should have more than four ventilator patients to care for in any given shift. Today’s therapists are caring for 10 or 12 in a shift. Mechanical ventilators, as noted earlier, do not run themselves. Volumes must be measured. Lung compliance must be calculated. Sputum must be removed, and for some patients that may mean suctioning every 15 minutes. Pulse oximeters (devices that use infrared light to measure oxygen saturation) must be checked, and blood gases must be drawn to ensure that the patient is being adequately ventilated. Therapists run these blood gases and then make ventilator changes as needed. In most cases, they work on a “protocol” which enables them to make the changes without a physician’s order. But for some patients, a physician must be contacted on every measurement.

When patients suffer terminal events therapists are a part of the “code team” and if the patient is not intubated, they put the tube down into the lungs. They use resuscitator bags (sometimes called Ambu® bags) to breathe for the patient while another therapist does chest compressions. It may not seem like hard physical work, but it wears on you during a 16-hour shift.

In spite of all this, you’ve likely never heard of them and likely don’t know much about what they do. Television shows many of their duties performed by nurses, and while nurses can do most of these things, in most hospitals, they do not. They have other things to do, and they count on their therapists. On many a 12-hour shift I helped nurses turn and bathe patients because I was an extra body and I had a few minutes of extra time to help. Health care is teamwork.

These professionals have been working non-stop, many of them 60 and 70 hours a week, since March. They’re tired, they’re burned out, but they keep on going to the hospital because that’s what respiratory therapists do.

So, if you’re inclined to random acts of kindness, sending tins of popcorn or other snacks to the Respiratory Care (or in some cases, Cardiopulmonary) Department of your local hospital is an excellent idea. You may not know them (and you don’t want to meet them professionally) but you can still do something nice for them.

And if you’re of a mind to do something nice for the entire profession, in the form of writing a check, the American Respiratory Care Foundation (ARCF) is an excellent recognized research-related charity that helps fund clinical research in the field of pulmonary medicine. It can be located online.

By way of full disclosure, the author is a member of the Board of Trustees of the American Respiratory Care Foundation.