June 23, 2020

Inside a Covid-19 recovery ward, where patients face a 'long and arduous' road back to health

Daily Briefing

    Throughout America, hospital staff are caring for ICU patients who face a "long and arduous" recovery from Covid-19—but despite the challenges patients and providers in Covid-19 recovery wards face, doctors say the wards often can be the "most hopeful place in the hospital," Joseph Goldstein reports for the New York Times.

    How University Hospitals built a smarter ICU

    The effects of long stays in the ICU

    Patients who spend a significant length of time in the ICU with almost any condition typically face a long road to recovery, Goldstein reports, noting that such patients often report experiencing cognitive deficits, muscle loss, and symptoms of mental health conditions.

    Lindsay Lief, a pulmonologist at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, told Goldstein that one-third of patients who are in the ICU for long periods report anxiety, depression, or post-traumatic stress disorder (PTSD). And, according to Lief, these issues likely will "be magnified" among patients with severe cases of Covid-19, who often spend an "unusually long time" in the ICU, with one study suggesting at least two weeks.

    Moving from the ICU to recovery

    At Weill Cornell, 11 North, a former psychiatric ward, has been turned into a Covid-19 recovery center.

    According to Goldstein, some of the patients were sedated in the ICU for weeks as they were treated with ventilators. Many patients in the ward now are experiencing nerve pain and muscle debilitation, and must relearn how to walk, swallow, speak, and more.

    Symptoms of PTSD also are common, according to Alka Gupta, unit director of the 11 North recovery area. "A lot of people told me they felt lost," Gupta said.

    Gupta said some patients were afraid to sleep, because they feared they would wake up and be back on a ventilator. "Many were having nightmares each night and were scared to be alone," Gupta said.

    Other patients are hesitant to be weaned off treatments, because they fear their bodies won't function properly without them. For instance, one patient who no longer needed supplemental oxygen begged for it to be restored minutes after providers turned off the supply, Goldstein reports, adding, "She feared her lungs would fail again."

    Charlie Blueweiss, a 33-year-old patient at 11 North, had spent 15 days on a ventilator. When Blueweiss first woke up, he thought he was in a secret infirmary in an airport perhaps in China, Goldstein reports. Blueweiss also thought someone was stalking him and sending him threatening messages on the various screens throughout his room. But after a few days, Blueweiss' confusion began to fade, and he realized he was in the ICU at Weill Cornell—and the screens were displaying his vital signs.

    Providers moved Blueweiss to 11 North on April 28, but he was still feeling the effects of his stint in the ICU. Blueweiss had a deep sore on his cheek, as well as pain and reduced sensation in his right foot. He also was too weak to sit up and was unable to unclench his right hand, Goldstein reports.

    After arriving at 11 North, Blueweiss spent 90 minutes each day in physical therapy, relearning how to walk. Although Blueweiss looked forward to physical therapy, Blueweiss—like many other Covid-19 patients—didn't participate in group therapy sessions.

    "I think people are kind of reintegrating a little cautiously," Gupta said. "I was a little surprised by that."

    According to Goldstein, doctors say a lot of 11 North's patients seem withdrawn, and many go weeks without seeing their families.

    Blueweiss, for instance, didn't see his wife until 35 days into his hospitalization. When he was able to see his wife, Hannah Cates, at the hospital, she had to learn how to treat Blueweiss' bedsore and discuss whether he would need a walker or wheelchair when he returned home.

    Recovery ward also offers a sense of 'hope'

    But despite the struggles patients face in the recovery ward, the ward also offers a sense of hope to both patients and providers.

    In late May after a six-hour surgery to repair the nerve damage in his arm, Blueweiss went home. As he left, doctors and nurses lined the hallway to clap and cheer him on: a "ritual" Blueweiss had heard "play out a couple of times a week" for other patients who'd recovered, according to Goldstein.

    Given that more than 220 patients died from Covid-19 at Weill Cornell by mid-May, a lot of doctors—like Laura Kolbe, a physician at 11 North—have grown to view the recovery unit as "the most hopeful place in the hospital," Goldstein reports.

    "I think it really does feel like a beacon within the hospital," Kolbe said (Goldstein, New York Times, 6/17).

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