Meet UHN’s Ruane Sale, a respiratory therapist working on the frontlines

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“I never feared my job before the pandemic,” she says.

Ruane Sale began her career as a respiratory therapist (RT) at Toronto’s University Health Network (UHN) straight out of RT school. Fifteen years later, she continues to serve in Toronto General Hospital’s Medical Surgical Intensive Care Unit, a place she calls home in so many ways. “It’s where I’ve grown not only as a respiratory therapist, but as a woman,” says Sale, who, over the last year, has learned not to let fear take over her work and life at home.

We spoke with Sale about the ways she and her family have coped throughout COVID-19, where she finds optimism, as well as the benefits of participating in UHN’s Give A Shift event.

What does a typical day entail for you as a frontline worker at UHN?

In Toronto, we are the COVID-19 unit. We’re the provincial referral centre and the only hospital in the city that manages patients by extracorporeal membrane oxygenation (ECMO) – known as a medical Hail Mary when a patient runs out of options. The ECMO device pumps blood through an artificial lung back into the bloodstream of a patient in order to give their lungs a chance to heal. On a typical day, I manage six to eight ventilated patients on life support, usually working a 12-hour shift. I ensure their stability and, more frequently now with COVID, deal with patients that require proning. This practice asks us to flip a patient onto their stomach for up to 16 hours—assisting in oxygenation of specific areas of the lung. In our unit, we see the sickest of COVID patients, most of who don’t make it.

What are some surprising challenges you’ve faced since the pandemic?

Fear. I never feared my job before the pandemic. This is most apparent when tending to patients in an emergency setting. I’ve always entered a room without question, always thinking about the patient’s needs first. The fear of this virus has changed the practitioner-patient relationship in so many ways. When we enter a room now, there is this wall of fear that we need to address before moving forward. It’s about asking ourselves if we are fully protected first. This fear has dissipated a little over time because in order to serve in the best way I can, I can’t be coming from a place of fear.

How has working on the front lines most impacted you?

The relationship between my work and my family has had a huge impact on me. I have a regimen every day when I get home, from entering through the basement, disinfecting virtually everything I have on me and showering immediately. I used to rush home to see my kids, now I don’t. I’ll often wait until they’re in bed before I get home. Our dynamic has completely shifted. 

There have been moments where I’ve questioned my place in this line of work. The pandemic is the first time in my career where I’ve felt a sense of regret around my choice to be in health care–but at the end of the day, this is who I am, and I love what I do. It can truly shake your mental health. Do I leave in the heat of a war? Absolutely not. But the weight of this pressure is powerful. 

How has UHN built an environment of resilience during such a challenging time?

To me, resilience is about having the ability to bounce back and move forward. I think every healthcare worker naturally has resilience. Every day, even prior to COVID, it’s a vital part of this job. UHN has provided my team, along with many others, the resources to rejuvenate and refocus ourselves with wellness check-ins and on-site spiritual care who are fantastic in our unit. These services have become an incredible source of support to talk through these feelings during such a heighted time of stress. Since day one, our CEO Kevin Smith has maintained an open forum where there is a constant flow of communication with staff and executives at large. In the face of a lot of new changes and unknowns, especially at the early stage of the pandemic, UHN has given us an opportunity to voice our concerns and feel heard. 

Can you tell me about a particular encounter during the pandemic that has stayed with you?

I was caring for a relatively young patient, probably about 30 years old. They were very sick and I knew fairly early on that they weren’t going to make it. We had been informed that they had attended a social gathering despite restrictions and contracted the virus there. This wasn’t very early in the pandemic either, so knowing that this patient went out and knowingly put themselves at risk was both shocking and heartbreaking.

While I stood there at the head of the bed, all of the thoughts I had about maybe seeing a friend or visiting a relative ceased. It was a reminder that such a simple social encounter we would have never thought to be dangerous otherwise, was something that held such serious repercussions. It was a big reminder to keep strong and not let my guard slip – not for any reason that may seem justified in the moment. I want to see this through in the same way I wish many of my patients could. 

The Give A Shift event aims to put participants in the shoes of a healthcare hero for a day—what is one takeaway you hope participants receive from the challenge?

Our hospitals count on fundraising support to fuel UHN on such a profound scale – from patient care to research and education. So in addition to helping support UHN through their fundraising efforts, I hope this event allows people to better understand the work of UHN, as well as  show healthcare workers that we are all in this together.

If you want to show your support for healthcare workers, register (as an individual or team) or donate directly to Give a Shift online at giveashift.ca. The virtual event takes place April 29 to May 2, 2021.