Author: James Gunsalus
School: Santa Monica College
Area of Study: Respiratory Therapy
What inspired you to embark on a career within your chosen healthcare field?
On Halloween 2013, my uncle called me. He said my father had been crushed between two cars and was sped to the trauma unit at Harbor UCLA Medical in Torrance, California, -- 5,500 miles away from the Tokyo newsroom where this bombshell landed on my desk.
He suffered 12 broken ribs, a lacerated liver, and a collapsed lung caused by his stomach being pushed past his diaphragm and into his chest cavity. He was given an emergency tracheotomy and rushed to the operating room.
My uncle was at the scene when it happened. He administered basic life support to my father until paramedics arrived. When he called me in Tokyo from the hospital, he ran through the chaotic details and summarized the situation bluntly: “It’s pretty bad. I think you better come home.”
I got the next flight back.
On the long flight to Los Angeles, I thought about my life so far – my degrees in journalism and economics, two decades in financial journalism and six years of living in Japan. Little did I know at the time that the medics who saved my father’s life, the surgeons who patched him up, and the nurses and respiratory therapists who nursed him back to health would inspire a return to college, and a new career. One where a 50-hour work week produces more than mere words and dollar signs and will improve and even save lives.
Unforeseen events often become a catalyst for action following months or years of deliberation and indecision. This was indeed my situation. After eleven years as a financial reporter in the United States, I was promoted and transferred to Tokyo as an editor. In this post I was drifting further and further from what I had once loved about my job: I was no longer working a beat, meeting strangers, listening to their stories, advocating for those without voices, empowering people with information that changes the way they think and live their lives.
Instead, I found myself in the cold career cul-de-sac of Asian financial journalism, where I hated the neighbors and was having a hard time finding my way out of the neighborhood. As an expat, I was also missing a sense of community. My lack of language ability and the scarcity of meaningful volunteer opportunities exacerbated the feeling that an important part of me was not being fulfilled, in spite of a very good life and enjoyment of all my host country had to offer. I was looking for my next move, and I wanted it to be a meaningful one.
After getting news of my father’s injury, my wife and I immediately packed for a red-eye across the Pacific. My father was still in surgery at the time we’d taken off, ratcheting up the tension of a 12-hour flight with no updates on his condition. Upon hitting the tarmac in Los Angeles, we learned he was on mechanical ventilation and in serious, but stable condition in the ICU -- where he would remain for almost three weeks. As tense and frightening as they were, these were the three weeks that inspired a new direction for me.
Let me interject here that Harbor UCLA is a county hospital. It is one of the best trauma hospitals in the country and if you are at death’s door, but unwilling to enter, this is where you want to be. However, it’s not where you want to stay. County hospitals are the great equalizer when it comes to health care. If you are not dying, you get in line. All are welcome, but the line is long. I point this out only to illustrate the type of workload the caregivers there shoulder every day.
During those three weeks I spent a lot of time with the critical care nursing and respiratory staff who work with the most seriously injured and ill. I could see what a hard job it was, as they were constantly in and out of the room tending to the needs of my father and his three roommates. In spite of the workload and challenges of county health care, they were kind and patient, whether they were running in to check on an urgently beeping alarm or simply adjusting the bed to make one of the patients more comfortable.
Who were these people? I spent many of those days at my father’s bedside finding out. They were young and old, male and female and of many nationalities. They were military veterans, health care veterans and students just entering their chosen fields. While some said they’d always wanted to be nurses, one young man told me this was his second career – he’d earned an information technology degree and then worked in IT for a few years. He said he had found the money good, but the work unrewarding. He’d come from a family with many nurses, and after some research and many long talks with them, he completed the prerequisites absent from his existing degree, made it through nursing school, and loved his job. He never looked back.
He affirmed my observations that the job was a tough one, both physically and emotionally. The hours are long, he said, and people in pain are not necessarily fun to be around. Their families can be difficult as well. The patients are scared, confused and suffering, and sometimes they don’t make it home.
But he added that he felt the job itself was making him a better person through the experiences he had every day, both good and bad. He said that being part of a team of people that bring an emergency patient back to life is an amazing thing. Watching someone leave the hospital in better condition than they arrived, and learning from patients, doctors and colleagues outweighed the difficulties of the job. I envied his sense of satisfaction.
The things he loved about his new career path fulfilled him in a way his office work had not. This was a message I was ready to receive.
After almost three weeks in the ICU and step-down unit, my dad came home with a tracheostomy, a lot of pain and a lot of healing to do. Before releasing my father into our care, his respiratory therapist advised my sister and me to observe techniques and ask questions about how he and other RTs maintained his airway. This was because the hole in his neck would also be coming home with us, until it was of an appropriate diameter for surgical closure.
In the two months that followed, I became confident at suctioning and cleaning his airway, and maintaining humidity levels. Out of concern for his safety, fear of hurting him and natural curiosity, I purchased an anatomy quick reference guide during his first week in the hospital and took notes on all his medications to find out more about them and what they were supposed to do. I wanted to understand where my dad was and what was possible for him as he healed and regained strength.
His injury became quite a trailhead for exploring the science and medicine involved in his recovery. I wanted to have a better grip on the situation when talking to his doctors. I wanted to ask the right questions. I wanted to know more and could feel the limits of my grasp of chemistry, physiology and biology. Even though the circumstances of the situation were grim, this exploration was exciting and rekindled an enthusiasm for learning that I hadn’t felt for a while.
I was also surprised by my feelings about caring for my dad. I really wanted to help him fix a bad situation. And watching his recovery made me feel good beyond knowing he was going to be okay. It was a feeling of reward that came from giving him what he needed to ultimately heal himself. Prior to his accident, I’d had a fair share of exposure to sick relatives -- some terminal. I’d watched my mother succumb to lung cancer six years prior, following her father’s death from the same illness 16 years earlier. But they had fairly short periods of acute care and hospice after living with cancer for quite a while. While I stayed with my mother a few times during chemo treatments for support, my father did most of the heavy lifting as a caretaker.
Caring for another person so intimately was very new to me. Helping him in the bathroom, helping him shower, helping him get dressed, getting him fed and cooking food he could actually eat: these were things we hadn’t shared for a long time and our roles as father and son were reversed. All told, he was a pretty good patient and recovered amazingly fast considering the extent of the injuries. He now has just a faint pucker on his neck where the trach tube was and a zig-zag of scars across his torso.
In the ICU, watching professional caregivers do their work; in the ICU waiting room, watching families struggle with loss; and in my father’s home, bringing him back to health, I knew that my time and remaining years of work should better spent. Helping people reclaim their lives with the tools of medicine, care and compassion was a job I wanted and an educational path I was excited to set upon. These experiences were enough to inspire the sacrifice and energy it takes to make a career change of this magnitude.
My father has since recovered fully and in some ways, is leading a more active 70-year-old life than he was before the accident. He has started taking yoga classes and touring vineyards. In my forties, I am now embarking on something new, too. In the past year and a half, I fulfilled all the math and science prerequisites my earlier degree was lacking and was accepted into Santa Monica College’s respiratory therapy program. Some twenty years after leaving university behind the first time, I am completing my first semester in December with a combined GPA of 3.5. I am on course to complete the program in June of 2017.
Becoming a student again after all this time wasn’t easy. Transitioning from being a boss to being my own boss without the structure of employment was a challenge – school was my new job. It was a job I’d struggled with in the past and was unsure the skills I’d developed over the years would ease those anxieties.
The challenge increased with the accelerated summer and winter anatomy, chemistry and microbiology courses I took to complete my prerequisites in time for the fall 2015 respiratory therapy cohort. At times I wondered if leaving what was familiar had been a mistake, but academic successes and the energy of truly understanding the material carried me through.
Once I got comfortable with the school work, I started to wonder what it would be like to be in a hospital not just as a patient or relative. I knew that taking care of my dad was a far cry from the ordered chaos of emergency and acute care. I started looking for ways to get hands-on experience.
The most significant factor in feeling certain about this work is the time I’ve spent volunteering in the hospital. In spring of 2014, I won a position in UCLA Health’s Care Extender program. This year-long internship trains volunteers to rotate through departments at UCLA Santa Monica Hospital and UCLA Ronald Reagan Hospital in Westwood. I’m currently working in Santa Monica Hospital’s ICU where I am able to observe procedures and help staff and patients. I’m thoroughly enjoying the rotation and have also worked in geriatrics and oncology. With the program I’ve observed doctors administer multiple types of cardiac catheters and arterial lines, intubations, and bone marrow and tumor biopsies. I’ve helped staff care for dying patients and prepare them after dying. These experiences continue to test my desire to work in acute care.
On all counts, the Care Extender program has validated my new career path and put flesh and bone on the math and science of the classroom. So much so, I am an active member of the program’s recruitment committee. To deepen my involvement with Care Extenders, I have taken on an additional research project within the program. In January I am slated to join a group of Care Extender volunteers working with hospitalist Dr. Russell Kerbel, who is conducting research on sepsis and non-invasive ventilation at UCLA. In this work I expect to help write and compile data as well as gain insight to the research and practices that improve hospital care.
Where will your ACLS or PALS certification take you? Write about where you are in your career goals now and where you see yourself in five, ten and fifteen years.
Upon graduating in 2017, I aim to promptly complete my board exams with a high enough score to qualify for a Registered Respiratory Therapist designation and seek work in the Los Angeles metropolitan area. As an RRT, I intend to continue volunteering and would like to work toward obtaining an asthma educator certification early in my career. Asthma is a significant burden and drag on poor families and the educational success of children living with asthma. Volunteering and networking in those communities to connect them with the resources they need is a priority for me. Having watched relatives die from lung cancer, I would also like to work with the American Lung Association or local hospital smoking cessation programs. I hope to be involved with both of these activities within my first five years.
Moving forward in the decade range of my career, I aim to be credentialed as an adult critical care specialist in order to work in emergency and critical care settings. Being able to observe and talk to RTs working in the UCLA ICU has shown me that this is where much of an RTs most meaningful work and learning is done.
I would also like to work toward a neonatal/pediatric specialist certification. Beyond the emotional challenges of this type of work, the technical aspects of working with children in medicine is a challenge I am eager to take. Caring for babies is delicate work with little margin for error. Using this certification will allow me to help manage life support for babies with hearts no bigger than a man’s thumb and whose lungs are not yet able to produce surfactant – incredibly delicate work using sophisticated ventilation techniques. This certification would also allow me to work in air transport, which I also think would be exciting.
Fifteen years on, I expect the career-scape for respiratory therapy to be much different than it is now – one where responsibility and opportunity will increase. In California efforts are being made to expand the roles RTs play in the acute care setting. In mid-2015 the state passed a bill that will allow qualified RTs to administer prescribed narcotics and is crafting legislation that will mandate insurance coverage for in-home respiratory care.
I hope to grow my career and leverage changes like these, by continuing my education and staying current with evidence-based therapies that make RT’s relevant. I also hope to be a mentor as others have mentored me. The RTs and nurses I work with at UCLA as well as the kindness people have shown me throughout my career in journalism have been a great inspiration.
If there is one insight I’ve gained at this point in my education and career it’s that service to others is a worthy path to knowing myself. To that end, a career that improves the lives of patients and their families is one I would like to have. The life support skills of my uncle and the team of professionals that saved my father’s life helped inspire my career in healthcare, where I can test my limits, continue to learn and help others along the way.
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