Breathe Easy With Respiratory Care

Abby Quigley: Going through all the tough days and the good days with them. 

Trevor Lee: Man, I forgot a lot of stuff. I can tell you that. 

Abby Quigley: From the sickest of the sick to home care. 

Trevor Lee: So they can go anywhere, and I can be there for as long as I need to. 

Sam Butler: Welcome back to BroncoTales, episode two of season two, with respiratory care today. You guys want to welcome yourselves. 

Abby Quigley: Hi, I’m Abby. I am a graduate of the Respiratory Care Program on campus. I just graduated this past December in 2023. Before that, I grew up in Coeur d’Alene, Idaho, went and did high school, grew up there, decided to move to Boise for school, and found myself here. And now I work at the NICU at St. Luke’s, downtown Boise. 

Trevor Lee: And my name is Trevor. I’m a clinical instructor here in the on-campus program for the respiratory care department. I’m also a double graduate of Boise State, having graduated from the undergrad respiratory care program, but also the master’s program.

Sam Butler: And what brought you guys both to respiratory care? 

Abby Quigley: I originally came into Boise State as a radiology major, just not really knowing my path. Got my AA in high school and came in like ready to apply to a program. My counselor through the College of Health Science kind of explored the options of different programs that kind of, like backups and stuff like that. Ended up getting into the respiratory program, did some research on it, and just kind of fell in love with the concept of respiratory. And that’s where I found myself in the on-campus program. 

Sam Butler: Do you have a specific part you enjoy the most? 

Abby Quigley: For the program?

Sam Butler: Or just respiratory in general.

Abby Quigley: I love how it’s so specific, but you can do so many things within one system, like the cardiopulmonary system is vast and affects everything in all ages, and it can–you can work really anywhere that you’d like. 

Sam Butler: And for anyone who doesn’t know what the cardiopulmonary system is. 

Abby Quigley: Your heart and lungs. 

Sam Butler: Okay. What about you, Trevor? 

Trevor Lee: Pretty similar, and I think you’ll find that with a lot of respiratory care practitioners. It’s not something anyone was really looking for, but it’s something you find. I was on–you know, kind of going to med school, PA path, but wanted something that had some clinical experience and some background to kind of guide me in that direction. I’m also unique because my sister is also a respiratory therapist, so she kind of introduced the profession to me in that regard. I started practicing for a few years, and started applying to PA school. Then, I realized, like, no, this is actually what I love to do, and I love to teach, and then just kind of everything came together. I love that I stayed in it.

Sam Butler: Yeah, so other than being a PA, what kind of jobs stem out of respiratory care?

Trevor Lee: I can start with this one. 

Abby Quigley: Yeah, go for it. 

Trevor Lee: So, there’s obviously an in-hospital kind of aspect…where you can work on ICU floor cares, but there’s outpatient, like Norco is based in Idaho, where you can do a little bit more of the home care. There are long-term acute care hospitals, like Vibra, that we also staff. But we can work with clinical engineers on developing new therapies and…machines that we can give our clinical expertise to kind of guide their building of them. They’re developing new programs called the APRT, which is another mid-level provider for respiratory–really focusing on the cardiopulmonary aspect, like she was talking about, but lots of different modalities, not just the in-house–like working in the ICU with mechanical ventilators. There really are a lot of different modalities you can work with. If there’s anything you want to add. 

Abby Quigley: Just within the hospital. I mean, you’re not just stuck working in one area. Like, I work in the NICU. I know that Trevor had a lot of past work with all different ages, like adult critical care. You can do pediatric floors. Like, there’s really any age range that you’d like and any like from like the sickest of the sick to home care to outpatient stuff like that. 

Sam Butler: Do you have any specific interesting or like kind of heartwarming stories as to why, you know, you kind of reflect thinking back like this is like, I’m glad I’m here. 

Abby Quigley: Yeah, working with kids is really rewarding. It’s also tough, it takes like a special kind of person for sure. But I’d say up to now, I got to go on a delivery and take care of a baby that was 350 grams, which is point seven pounds, which is like–just shows how insane medicine is. And just like watching kids that are that small, grow and go through all the tough days and the good days with them. Then, watching them go home with their families is like the most rewarding feeling you could ever have, for sure. 

Trevor Lee: Yeah, on the adult side, it tends to be, you know, a little bit–I’d say, less…positive in the whole regard. But the most positive things that I got to interact with were like the lung transplants or the heart transplants kind of patients, getting a second outlook on life, getting a renewal of–I mean, something we just every day right now we take for granted, just the ability to breathe without any kind of difficulty and seeing them get a second chance at feeling that and being a part of that is a pretty cool aspect with the job. 

Sam Butler: Speaking of you know, taking stuff for granted, is there anything that you guys after like your education or all of your like knowledge of respiratory care that you avoid or kind of see differently in your everyday life? 

Abby Quigley: I feel like there are lots of things, like when you hear respiratory, you think of cigarettes, and COPD, chronic obstructive pulmonary disease, like the effects of that. But, it goes as far as like traumas, like doing certain things where like–you know, like big fires or something like that can affect your lungs or just like anything–like car accidents, they can lose people’s ability to be able to move their diaphragm and breathe and stuff like that. Just so you see everything differently, I feel like.

Trevor Lee: Yeah, I mean, I don’t really have much to add to that, but I mean, the prevalence of respiratory disease is increasing year by year. So it’s something that’s going to be more prevalent in more people’s lives.

Sam Butler: What else, other than like smoking, vaping, and things of that nature, are becoming or are prevalent in the whole respiratory industry?

Trevor Lee: Socially, those are probably the two biggest ones. I think we’ll start seeing, you know, potentially some long-term effects from COVID, people who had a little bit more serious cases, but made it out of the hospital. I think we’ll start seeing some long-term effects from that, potentially. 

Sam Butler: Such as what? Or are you sure? 

Trevor Lee: Well, I mean, if they were placed on a mechanical ventilator, or if they had like a serious hospitalization. They can still have detrimental effects to their lungs that are going to change the–could cause some long-term fibrotic changes that they might not feel at the present time, but as they age and as it starts to make itself more prevalent. They’ll start feeling the experiences that potentially–I’m thinking this is speculative, but that’s what I would…possibly anticipate.  

Sam Butler: Along with like fire lots of…

Trevor Lee: Yeah. Especially if you have reactive airways, the smoke that we’re constantly seeing in Boise, just increasing definitely could play a part in seeing more–I guess long-term respiratory issues. 

Sam Butler: Yeah, yeah, 

Abby Quigley: We see kids with asthma exacerbations or also known as asthma attacks, and stuff like that, where they come into the hospital because they don’t know how to control it, and stuff like that, with the smoke. It just makes it worse at that moment, and it’s scary.

Sam Butler: And are those kids put on ventilators or are there like–what are the other processes that you guys kind of go through? 

Abby Quigley: It depends on the severity of their kind of reactiveness and their level of asthma. If they have other underlying conditions, some kids can have delays, or if they were previously like a premature baby, they kind of can have like stiffer lungs. They don’t work as well. And they can have reactive airways where they might need hospitalization, intubation, and be placed on a ventilator if their airways close too tightly. 

Trevor Lee: But we really try to prevent asthmatic patients from being intubated, as putting the breathing tube in as much as possible. So we try things like bronchodilators, steroids, and bronchial hygiene, trying to get them to mobilize some of those secretions and prevent any kind of additional work of breathing that they might have. So we try everything we can to prevent them from getting intubated. 

Sam Butler: Can you briefly go into some of those different–like steps before a ventilator–just like what they do?

Trevor Lee: In terms of asthmatic patients or just in general?

Sam Butler: Just kind of in general.

Trevor Lee: So, we can do a thing–we call bronchial hygiene, so we can sometimes put vests on people that kind of shake them and rattle them to try to mobilize some of those secretions. We can use positive pressure, we apply positive pressure to the airway through like a mouthpiece, and try to shake them from the inside out would be the best way to explain it. 

Sam Butler: Like pushing air into their lungs?

Trevor Lee: Yeah, yep. Things like–it’s called cough assist. So, it hyperinflates them with pressure, and then it actually sucks it out like a vacuum. We can do–participate in physical therapy. Anything that you guys do on the pediatric side a little bit differently?

Abby Quigley: Mostly along with that, like–you can utilize like medication that’s nebulized. So, it’s non-invasive. We have non-invasive ventilation also to where it’s kind of a step before having to put a breathing tube in. It’s kind of wearing a mask and allowing them to give some pressure and some breaths to them without actually having to put a tube down their throat kind of that last step before doing that. We have some medicine that will help open up the airways–albuterol, some people take an inhaler form. In the hospital, we usually use nebulizers, but…

Sam Butler: Which is what?

Abby Quigley: It’s like an aerosolized medication, and it could be done with a mouthpiece. Usually, in pediatrics, we use a mask because they don’t tolerate just using a mouthpiece. It can be used in a couple of different ways.

Sam Butler: And we were talking about secretions, Trevor. Is that good? 

Trevor Lee: They do have a–you know, antimicrobial effect to them, and they’re really good for hydration and like lubrication of the airways, but too much of a good thing is sometimes bad. Especially when you can’t mobilize them and cough them out, they can cause a lot of increased work of breathing. 

Sam Butler: And, I kind of want to switch notes kind of back to the academic side. What did both of your journeys kind of look like, and how did you like the programs here?

Abby Quigley: Like within the program?

Sam Butler: Yeah, here at Boise State. 

Abby Quigley: Yeah. So, I started in 2021. And so, just kind of in the Delta variant of COVID, it was really busy. We didn’t get to do our first semester of clinicals because the hospitals were just bombarded with patients. And so we got a kind of late start on clinicals. And we got to kind of catch up in our second semester. But it was mostly like–when you meet everyone for the first time, you’re wearing masks, and you’re like…just trying to connect with these people and get on the same page. 

The schooling is rigorous, but there’s no lack of support. I feel like within the program, there’s faculty, like, pretty much 24 seven. If you were to have any questions, emails–back and forth are very quick, and they’re willing to come in and help you and stuff like that. But just like the clinical experience is super unique for the program, too. You get so many hours in the hospital, hands-on all the units, you get to–like do Norco, like we were talking about, get to go there for a day. You’re in adult ICUs, neonatal, pediatric ICUs, and all the things. So, our schooling kind of follows along with our clinical experience, which is cool.

We get to apply what we learned in the classroom in real life. And, then we get to the choice to choose an internship where we–the last semester, get to choose a unit that we would like to work in. So we get to do 180 hours, and really just focus on what we really love to do, which was really important, I feel like. And then I’m actually in the master’s program as well, I just started. So I feel like that’s a good start, being in the on-campus program, meeting the professors, and then working with them in the next step. 

Sam Butler: And is that clinical portion two years?  

Abby Quigley: It’s along with the program. So, in the five semesters, you get to do clinicals the whole time, which is cool. 

Trevor Lee: To the best of my knowledge, we’re the only program that you do clinicals in the very first semester you’re in the program. So, we do kind of…an intro to clinicals, about 10 10-week course where you learn to talk to patients, how do you assess patients, and how do you go through the safety checks of interacting with a patient. Then week 11, students are getting ready right now to start doing clinicals because–next week is going to be week 11. They’re going to be doing hands-on patient skills and patient care for the first time. That can be a pretty intimidating notion. So, I know they’re looking forward to doing it, but they’re probably pretty anxious, but they’re gonna do great. 

Sam Butler: And, how is your time here as a student? 

Trevor Lee: I mean, it’s changed quite a bit. I didn’t have the internship. I wish I had, because I think it’s a great–I haven’t heard anybody have like really a negative experience. Well, it’s a great way to get jobs for job placement. It’s a great way to go–even if people want to work, the students want to work in Boise. A lot of them still leave. They go to places like Duke, Vanderbilt, Boston Children’s, and Seattle Children’s; they go all over. And Alyssa, our clinical director of clinical education, does a fantastic job of setting those up and making sure they can happen. 

Sam Butler: And these are the internships?

Trevor Lee: Yeah, the internships. So it’s that last semester, 180 hours of–you know, intense direct patient care. But then they come back, they do a lot of their schoolwork that semester completely online. So they can go anywhere, and they can be there for as long as they need to. They can apply for jobs or tech positions, which is kind of like an intermediate between student and professional. So they can again, continue to build those skills. I think it’s a really unique opportunity. We really try to empower and support our students as much as possible so they can…achieve the goals that they want. So, I think that’s what can really help set us apart as part of our program. Not a lot of programs outside of Boise State are doing. So, again, just a really unique, cool thing. I think we’re doing. 

Sam Butler: How has the transition from after your master’s to being a faculty member kind of changed your outlook?

Trevor Lee: In terms of like the profession–man, I forgot a lot of stuff. I can tell you that. That first year was a big shock, like re-learning a lot of the things, and then being able to explain it is just–to understand it and to explain it to somebody else so that they can understand it is dramatically different. And, just learning how to…grow into that has been…challenging, but a really rewarding kind of experience. 

Sam Butler: Do you see yourself continuing as an educator or maybe going back to the hospital? 

Trevor Lee: So I do work, I teach part of our clinical. I am in the hospital teaching, but I also work as a PRN once a month at a local hospital.

Sam Butler: What about the future–we kind of already talked about, like with COVID, but any other kind of underlying factors that are gonna play a bigger part in respiratory care in the future?

Trevor Lee: I’ll start this one. 

Abby Quigley: Yeah, go ahead. 

Trevor Lee: So, I get talked about–we have the advanced practitioner respiratory therapist kind of starting to emerge. There are a couple of schools that have adopted it. And then, several of them have been placed in the position. It’s kind of letting that shift and mold what that’s going to be. It’ll be exciting to see what that’s going to turn out to be. And just the new advances of technology, I think, are going to be the most interesting. 

Abby Quigley: Yeah. 

Trevor Lee: And exciting parts to see. 

Sam Butler: In terms of machinery?  

Trevor Lee: And software, I think like, AI is going to—I think it’s going to aid our job a lot in terms of what we can do and how we can help patients. I mean, that’s kind of where I see it going. 

Sam Butler: Do you have like an idea of what it could help diagnose or analyze? 

Trevor Lee: Probably mostly like if we’re not seeing or identifying patient needs–like in terms of mechanical ventilation when a patient’s on a ventilator, if we’re not meeting some of the criteria, we can get more instant feedback rather than some speculative work, if that makes sense. That’s where I see it improving mostly. I just don’t ever see a reality of whether you’re never gonna have somebody hands-on with the patient. There might be some advances where you have to do…maybe less than you did, but it’s always gonna provide–need human expertise to take. 

Sam Butler: And just there to confirm. 

Trevor Lee: Yeah, confirm. That’d be a better way to say it. Exactly.

Abby Quigley: Yeah, probably technology is the one that I can see. Obviously, it’s advanced every–always, it’s always advancing. But I–we’re already like seeing new stuff in the last year that I’ve been working, just new ventilators, new settings, new research, and even like not technology-wise, just people are like researching more about respiratory after COVID. I feel like there was a heightened interest in kind of like, what is the cardiopulmonary system? Why does it do what it does? Especially in the neonatal world with preemie babies, there’s just so much more information coming out that we didn’t know before.

There’s like–the survival age now is like 22 weeks–when it was like 20 years ago, 28 weeks. That was a preemie baby, but now we just have protocols and things that we’re just learning so much about that we can apply and just help aid all those steps to make sure we’re doing the right thing. 

Sam Butler: Do you see yourself staying in the NICU? 

Abby Quigley: For now, yeah. I really, really love the NICU. After I graduate with my master’s, I don’t see myself leaving bedside right away, kind of just keeping it,. There are so many opportunities for online teaching and stuff like that. And so if I wanted to maybe help with like an online course or something like that. And, I’d love to go into upper hospital management one day and maybe do like something along those lines. 

Sam Butler: Yeah, do you guys have anything else? I have one last question, but before that.  

Trevor Lee: No, nothing that’s popping in my hands. 

Sam Butler: Well, this one might be a tough one, but do you have any long-term goals? You kind of just mentioned one or like five-year goals, kind of either–however, if you have any. 

Abby Quigley: Do you want me to go first? I kind of explained that, obviously, completing my master’s is like a huge goal of mine. I’d be the first person in my family to ever get a master’s degree…

Sam Butler: Congratulations.  

Abby Quigley: So that’s really important–thank you–and I just think that would be a great step in kind of opening the doors to a lot of different things–teaching, management, and all those kind of things. I know that I want to keep working bedside, but I want to get my neonatal pediatric certificate as well in respiratory. It’s another exam that you can take. It’s like a specialty course to go along with my license. And, hopefully become a preceptor to kind of help students as well would be a goal of mine.

Trevor Lee: So, my five-year-plus track is staying in education, and then probably going to get my doctorate in education. Then, just try to keep putting out graduates like Abby, who are fantastic and killing it. 

Sam Butler: That’s the goal. Awesome. Well, thank you, Trevor. Thank you, Abby, for being on the show with us. 

Abby Quigley: Thank you. 

Trevor Lee: Yeah. Thanks, Sam. 

Sam Butler: Yeah, I learned about respiratory care.

Abby Quigley: Perfect.

Trevor Lee: Thanks.