It was by accident that Jerry Czerkasij, a 35-year respiratory therapist, pursued a career in health care.
Czerkasij was in his early 20s and working on a zebra cake line at McKee Foods when his jacket got caught in a conveyor, a machine crushed his left arm and he landed in the trauma unit at Erlanger hospital.
During his time at the hospital, a man kept coming in the unit to tend to a trauma patient who was on a ventilator next to Czerkasij.
"I befriended him, and he turned out to be a respiratory therapist," Czerkasij said. "What he was doing seemed to make a difference, so I decided to switch careers."
Czerkasij dropped his business major and left Chattanooga for Washington, D.C., where he trained to become a respiratory therapist - one of the health care professionals who are on the front lines of the COVID-19 pandemic but often overlooked by comparison to doctors and nurses.
"Nobody thinks about breathing until they can't. Then all of a sudden, if it becomes an issue, that's when we step in," Czerkasij said. "Most people go through their life breathing just fine but those who don't, they know exactly who we are, and a lot of the patients come here and ask for therapists by name."
Czerkasij is a registered respiratory therapist at Parkridge Medical Center, where he's worked for 21 years. He met his wife, a registered nurse, on the fourth floor of the hospital.
Respiratory therapists keep people who need help breathing alive using a variety of machines, such as high flow oxygen or ventilators, and other therapies.
"We're literally life support," he said. "If you look up and see me standing over you, you're having a bad day. And if I can make your day a little bit better, I feel rewarded."
Before the novel coronavirus reached Chattanooga, Czerkasij's job was fairly predictable. He would help treat patients with a wide array of conditions that cause trouble breathing, such as pneumonia, influenza or chronic obstructive pulmonary disease, often called COPD for short.
Now, he's one of the core therapists taking care of COVID-19 patients in the medical intensive care unit at Parkridge, and the day-to-day treatment for a novel disease can change dramatically.
"I've been doing this 35 years. I took care of neonates for 10 years. I've been doing adults for the remainder - 25 years. I've never seen anything like this," Czerkasij said. "This is much more long-term, much more difficult to manage. We've had patients here almost two months on ventilators - you do get to know them and their personalities, and it makes it hard."
Normally, Czerkasij spends his free time golfing, but he hasn't played a round all year. Instead, he's been working on average 60 hours each week. He's on his feet for 12-13 hours per day, along with nurses and patient care techs, moving patients from their backs to their stomachs, administering medications, swapping breathing tubes.
"After a couple of weeks of it, I was just shell shocked. It's very difficult. It's hard, heavy work," Czerkasij said. "I'm not the only one. There's lots, lots of nurses, lots of therapists coming in on their days off to help out."
During the early days of the pandemic, Czerkasij was a bit of a skeptic.
"When the apex of COVID was hitting in New York City, we really didn't have any COVID patients at that time. And so my thought was, 'How bad can it really be?' That's not a question I should have asked," he said. "Because a couple of months later, we had quite a few COVID patients, and quite a few ventilators going, and it was scarier than I thought it could be - how sick these patients are, how difficult they are to take care of."
Ventilators became an early symbol of the pandemic, but they're used now as a last resort, Czerkasij said. The medical team will try everything possible - aerosolized treatments, steroids, antibiotics, remdesivir, different modes of oxygen, other machines that push air into the lungs - before placing someone on a ventilator, which requires the patient to be heavily sedated in order to insert a breathing tube through their mouth and into the airway.
In order to place a patient on a ventilator, called intubation, Czerkasij will assemble the necessary equipment - a bag and mask, appropriately sized endotracheal tube, stylets, intubation scope fasteners, ventilators with appropriate settings, suction equipment, oxygen source, carbon dioxide detector, syringes and lubricants. Although usually the physician will perform the procedure, Czerkasij will sometimes intubate patients himself.
"Being on a ventilator is not something we take lightly. It's not something we want to do. We're very reluctant to do it. We do it because it's a necessary evil at some point," he said, adding that most patients on ventilators are so sedated they don't remember the experience but typically have the side effect of a sore throat.
Fall and the looming influenza season pose a new challenge for Czerkasij. Normally summers are slow for respiratory therapists. Many of the respiratory diseases that cause breathing complications circulate in the colder months. But that hasn't been the case this year.
"Traditionally, in winter time, things pick up. With COVID on top of that, I'm a little apprehensive," he said.
But there are also some silver linings to the pandemic.
"The upside of this whole COVID thing is it brought out the best in so many people," Czerkasij said. "We have so much support from the community, schools would send us cards and notes, and that's the best part of the whole thing."
And perhaps their critical role treating seriously ill coronavirus patients will help raise more awareness around the respiratory therapy profession, said Katie Davidson, program director and assistant professor in the department of respiratory care at Chattanooga State Community College - home of the oldest associate degree program for respiratory therapists in the nation.
"It has brought it more into the front line, where people might possibly use this or want to explore this career path," Davidson said. "I think that's been probably the most exciting part of it for me."
Contact Elizabeth Fite at efite@timesfreepress.com or follow her on Twitter @ecfite.