By Todd Giller, CRT, EMT_P I started as a hospital and nursing home RT back in the days of subacute ventilator units in the early 1990’s, working on LP10s and occasionally LTV portable vents. I also did a lot of agency and part-time work in hospitals all over the Miami, Broward and Palm Beach, Florida area. I enjoyed being an RT. I relished the independence and the challenge of helping people in all kinds of situations. I truly enjoyed the flexibility and the opportunity to make a difference. Up to this point in my career, I had limited experience with CPAP and Bi-level therapy, especially the way it is used today. Around 1997 I was offered an opportunity to do Home DME. I was never trained in Home DME but I felt comfortable with my skill set and figured it would be a fun challenge. I had no clue how it would change my life. At first, I was doing an asthma education program for kids. It was fun, but then I started to do CPAP and Bi-level alongside other home ventilators. We also did phototherapy for infants with high bilirubin levels and apnea monitors for kids at risk of SIDS and esophageal reflux. I fell in love with this work almost from day one. But that does not mean I did not have some growing pains. I had to teach myself most everything as there was nobody else to teach me. It was a little painful, but I loved the challenge, and I learned a lot of the nuances quickly. The first Bi-level I ever worked with was a Respironics BiPAP ST. It was big and heavy and it had dials to adjust just like a regular ventilator. The first CPAP I set-up was a Sullivan (which later became Resmed) and the Puritan Bennett machines. We used to set up some of the machines that had an actual water manometer tube. The machines weren’t digital yet. Mask technology was very limited and very uncomfortable compared to what is available today. I did love the challenge of going all over the tri-county area sometimes driving up to 300 miles in one day to see all my patients and to get the job done. My day ended when the last patient was seen. Some days were more than 16 hours long. I loved it (for the most part). I learned a lot about people and about myself. I discovered that people’s happiness had little to do with their environment. I learned that for the most part, we are all the same. We all suffer from similar ailments. It is not the problem that is bad, but the way we think about it that matters. My work took me to very interesting locations. I remember going to a stilt house in the Florida Keys where I met a transgender gynecologist and his/her wife. I would also experience very different socio-economic situations sometimes within minutes of each other. I remember setting up a quadriplegic man on a ventilator in a penthouse on South Beach and the very next stop was a very humble apartment in Overtown not even an hour later. It gave me a unique perspective on the human condition. I realized that perspective is so important. I also realized that when people felt they have no control over their lives, it created a lot of problems in doing my job. I realized that a big part of what I had to do was help people to understand what was going on with them, what their choices are, as far as handling the situation, make recommendations through education and discussion about how to gain some control over their problem. This approach requires a lot of observation of their situation and attitudes toward it. My goal has always been to give people the tools they need to have the most positive outcome by empowering them with education and choice. Each person is very different and has different education and aptitude as well as learning style. I quickly found that getting to know them as quickly as possible was key. I also realized some people are more willing to help themselves than others. Some would need extra help, others almost none. So the challenge every day was to get the job done. Get it done to the best of my ability and I never would cut corners no matter how busy I was. I quickly realized I was alone and needed to spend the time with each individual that was needed. I found that it would save me more time in the future if I gave them the care they need today. Some of the patients were real characters. I had one guy ask me if he could but vodka in the water chamber. I will never forget some of the animals I had the pleasure to encounter. The birds always made me laugh. I had one patient in West Palm Beach that had about 8 dogs and an African Grey parrot that thought he was a dog. He ran on the floor with them and barked just like them. I had a few singing birds too. One bird bit me when I tried to put a mask on his owner. Thankfully no dog bites. My job was always an adventure. Driving around all day you see a lot of things as well some not so fun. I do love the freedom of being on the road all day. My patients always came first. When I was in school my teacher always told us to not think of them as patients, think of them as family members. Always think of them as your brother, sister, mom, or dad. As long as you do that you will always do a great job. Even though today I rarely do in-house setups I will always love the work. One time I went to the Broward County Jail to set up a CPAP on the medical floor. That was an interesting place to work. Another time I had to set up a machine on a yacht in Jupiter Beach. That was fun. It has never felt like work because I love the challenges and the people. When you go to someone and show them how they can change their life by taking a few suggestions, it is a wonderful experience. To go to someone’s home the first time and meet a very sleepy cranky person, but a few months later the person is happy and alert. There are not too many jobs that you get the opportunity to see the results of your efforts. That is what truly made me a believer. So much so that when I realized that I too had sleep apnea, I decided to try out the therapy as well. I have been using my machine for over 5 years, and I love it. I sleep great and feel better during the day. It is great to have the understanding from the patient’s perspective now. My patients, I feel like the fact that I also use it. I feel it puts them at ease to understand I know exactly where they are coming from and what they are going through. When I first started, the percentage of patients that were compliant with therapy was very low, only about 33% but the measure of usage was only based on the number of hours recorded on the machine. So it was not that accurate. Today compliance is usually a lot higher, over 50%. The machine not only knows if the patient is wearing the mask while the machine is running, but it measures leak, AHI, and periodic or obstructed events. The machines are now are all digital and have internal modems that can be tracked remotely via the internet. Today I work for a national supplier and monitor patients in many states. I carry and maintain multiple state licenses, and I still get the opportunity to help my patients directly. We have some patients come into the office, and I still do some in-home set-ups (though only about one or 2 of those a month). It is still challenging, rewarding and there’s never a dull moment. The patients are still characters and still challenge me in new ways all the time. Just when you think you have seen every problem, they find a new one you have never seen before. The one thing I can say about what I do is it has always evolved over the years. Over the years I have had to adapt to changing circumstances. I wouldn’t change a single thing. It is still fun, and I look forward to going in every day. Even though my work is now mostly in the office, I still find it challenging and enriching. I learn something new all the time and I love getting to work side by side with other professionals. It is nice to have a wonderful team here at US MED LLC. We are the largest mail order diabetic supply company in the United States. The company has many divisions like Brace, Urology, Respiratory and CPAP (my department). In today’s fast-paced internet world I am glad to still be of service to my patients using the latest technology and personal experience to improve outcomes. I still have the heart of a Road Warrior even though I am not in the fight like I used to be. I am truly grateful that I have chosen to do this work (or maybe this work chose me. LOL) It is not for everybody but it sure is an adventure. Todd Giller CRT, EMT_P is an RT Supervisor for USMED LLC. He has been a CPAP Specialist for over 23 years. Todd resides in Sunrise, Florida.