#Expert Perspective: A tale of two cities: How one respiratory therapist combated COVID-19 — and his own fears — in Savannah and Boston

When the first cases of the novel coronavirus arrived in Chatham County, Georgia, Rafael Agosto, who has been a respiratory therapist at St. Joseph’s/Candler Hospital in Savannah for 17 years, had to recalibrate his approach to lung care. 

“Initially, it was kind of wild because we didn’t know what to expect and how to manage any of these patients,” said Agosto. “What are we looking for, and how do we treat this?”

The primary role of a respiratory therapist is to assist patients who have trouble breathing by administering oxygen, managing ventilators and measuring lung function, among other methods. COVID-19 symptoms include fatigue, fever, cough and shortness of breath, and at the onset, Agosto and his colleagues raced to stabilize patients who tested positive for the precarious disease.

“We were trying to keep them oxygenated,” he said. “It was sort of like pneumonia, but we wouldn’t treat it like a normal pneumonia because it’s like a deadly pneumonia. Patients were declining very fast so you didn’t have time like you normally would with other patients. And they were of all ages. That’s what was so scary.”

While grappling with patient care, Agosto and his co-workers were also dealing with fear for their own safety with exposure to the virus in such close proximity.

St. Joseph’s/Candler, Agosto’s employer since he graduated with a B.S. in respiratory care from Georgia Southern University’s Armstrong Campus in 2003, made it a priority to outfit the health care workers with proper personal protection equipment (PPE), Agosto said.

“That was scary but they made sure we had what we needed,” he explained. “Safety was the number one key. So the proper PPE, it was everything. We had all of it. A face shield, goggles, scrub cap and masks. They were not comfortable at all. At least here when I wore them I had downtime, but in Boston, holy moly, my face was bruised.”

Agosto registered for a four-week rotation with a crisis nurse staffing company that placed him at Good Samaritan Medical Center in Brockton, Massachusetts, a suburb of Boston. COVID-19-related deaths in Massachusetts were outpaced only by New York and California, and Brockton was the second hardest-hit community in the state.

“The reason I went was the opportunity to help patients, number one, and to learn how they were managing their ventilator patients there so it could help here,” he explained.  

On April 19, Agosto reported to the facility, suited up for his first 12-hour shift.

“I was in complete shock when I got in there,” Agosto said. “The ICU was full. Every single floor was possible for COVID.”

The hospital averaged 80 to 90 cases throughout his stay, and the intensive care unit remained full. Days were hectic and taxing; lunch was an afterthought. His focus was on keeping patients off of ventilators, as global reports show that more than half of ventilated coronavirus patients don’t survive.

Yet, “it started becoming hard to get them off ventilators,” and his group often didn’t have a choice but to put patients on 100% oxygen.

Stress didn’t let up, but Agosto found moments of solace in interactions with patients.  

“I would walk into patients’ rooms and they all kept telling me the same thing — they’re scared,” he said. “Because they don’t know anything. It’s like a ghost town because the nurses are running around. Patients felt they weren’t being seen much.”

In response, Agosto offered his undivided attention. 

“That’s one thing that made me feel really good,” Agosto continued. “Just to sit there and talk with them for a few minutes. Or just listening to them. That’s what we’re here for, and they were appreciative.”

Agosto returned to Savannah healthy and with a new oxygen delivery device to share with his co-workers at St. Joseph’s/Candler. His manager ordered the devices to serve local patients. 

“The most important thing I took out of this is that it’s serious, and people are doing everything they can,” Agosto said. “They’re putting their lives in jeopardy for the patients, and I’m glad I had the opportunity to do that.” 

The accomplishment of his goals in a time of crisis and his continued dedication as a respiratory therapist leave Agosto fulfilled.

“I didn’t get sick,” he said. “I helped as much as I possibly could. I did what I wanted to achieve. I’m so happy and blessed because I still love my job.”

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Barry Joyner, Ph.D., is the dean of Georgia Southern University’s Waters College of Health Professions - simply click on his icon to arrange an interview today.