A short story about the path from CNA to RRT to ECMO specialist
People ask how I ended up in critical care. The honest answer is that it happened one decision at a time, and most of those decisions were made at the bedside by patients I will never forget.
Starting as a nursing assistant
My first job in healthcare was as a CNA. I was young, I was earnest, and I had no idea what I was walking into. The job is unglamorous on paper. Vital signs. Bed baths. Helping people to the bathroom. Turns every two hours. Cleaning up after the messes the human body makes when it is sick or scared or both.
What that work taught me is that the dignity of the patient is a daily choice. The patient who is intubated and sedated still deserves a gentle wash and a clean gown. The patient who is dying still deserves to be turned with care. The patient who is anxious about a procedure deserves a hand on their shoulder and a clear explanation. None of that is in a textbook. All of it shows up in outcomes.
It is also where I first watched a respiratory therapist work. I remember a code on a med surg floor where the RT walked in calm, took the head of the bed, and ran the airway like it was a Tuesday. I asked someone afterward what their training was. The answer started me down a path.
School and the first clinical rotations
Respiratory therapy school is shorter than nursing or medicine and longer than most people expect. The didactic load is heavy because the field sits at the intersection of physiology, pharmacology, physics, and clinical judgment. The clinicals are where the work starts to feel real.
My first ICU rotation as a student was the first time I held a manual resuscitator while a patient was being intubated. I remember the operator at the head of the bed, the nurse pushing meds, the monitor singing, and my own hands shaking the first time I delivered a bagged breath. I went home that night and read everything I could find about pre oxygenation. That habit, of going home and reading about what I did not understand, is the habit that has carried me the furthest in this career.
Becoming an RRT and finding critical care
Passing the boards and earning the RRT credential is a checkpoint, not a finish line. The actual learning happens on the unit, on the night shift, in the rooms where the patient is sick enough to demand that you grow up fast.
I gravitated toward critical care almost immediately. Something about the pace, the team dynamic, and the physiology suited the way my brain works. I wanted to understand why a ventilator was set the way it was set. I wanted to know what an ABG was telling me before the intensivist asked. I wanted to be the calm voice in a room that was anything but calm.
The path to ECMO
ECMO came later. By the time I started training for it I had years of ventilator management, intubations, codes, and bedside time under my feet. ECMO training is intense by design because the therapy is unforgiving. There is a long classroom phase, a simulation phase that runs you through every emergency you might face, and a precepted phase at the bedside with experienced specialists watching every move.
The first time I ran an ECMO patient overnight, I was honest with myself about being afraid and honest with my team about it too. They had been there. They told me what to watch. They picked up the phone when I called. That is what a good ECMO program is, more than anything else, a culture that lets a new specialist grow into the role safely.
What keeps me here
The work is hard. The losses are real. But I have also extubated patients who walked out, transitioned ECMO patients off the circuit and toward home, taught newer therapists who are now better at the work than I am, and stood next to families during the worst moments of their lives in a way I hope made those moments slightly more bearable.
I became a respiratory therapist because of one CNA shift and one calm RT at a code. I stayed because the work is meaningful, the team is real, and there is always more to learn. If you are early in your own path and wondering whether this career is worth it, my answer is yes. Bring your patience, your curiosity, and a willingness to be honest about what you do not know. The rest you will learn at the bedside.