/ by UK HealthCare
We recently joined hospital staff for a few days to document the reality of treating COVID-19 patients in UK HealthCare clinical settings.
This edited interview is part of our ongoing series, “UK HealthCare: Voices from the Front Lines,” highlighting stories and perspectives from our frontline staff who care for the sickest COVID-19 patients since March 2020.
Angela Henning is a UK HealthCare cardiovascular and pulmonary board-certified physical therapist who works with transplant patients and ECMO patients, among other duties.
ECMO is sometimes used to help patients who need a transplant. Can you compare what you can do for someone who's waiting for a transplant versus what you can do for COVID patients who require ECMO?
We have two different types of patients that are waiting for a transplant. We may have a transplant patient who looks like me and you … very mobile, they are already up, just trying to maintain their fitness while they're waiting for a transplant. We may have a transplant (patient) who has to be in the hospital because they're so sick, and they need constant monitoring. Or they could be on an ECMO device, but they're up and ambulatory because they're trying to stay stable, medically stable, so that they can wait to a transplant.
In our cases with our patients who are on ECMO because of COVID, it runs the gamut … They may be very paralyzed and sedated for weeks, sometimes a month or more. A lot of times, we're seeing their status sort of wax and wane, where it seems like they're getting better. Then they take two or three or four steps forward, four or five steps back.
With that, physical therapy and occupational therapy are consulted just to sort of maintain; initially, we're checking to maintain their joints, their ankle joints, their joints in their hands, their fingers to maintain range of motion to be functional. Whenever someone recovers, you have to have a certain degree of flexibility in your ankles and your wrists and your hands.
So, we're running first and foremost to make sure that we maintain that flexibility so after we get someone over a critical illness, (they’re) able to be up and be functional.
Also, any time someone's in the hospital, they run the risk of getting what's called ICU delirium. Anyone who's in the hospital a week or longer has a much higher risk of that. So obviously, our patients with COVID (are) the highest of the highest of the risk for ICU delirium and confusion.
We try to ask them, ‘do you know where you are?’ And if the patient's on the ventilator like a lot of our ECMO patients are, we try to ask them yes and no questions. A lot of times, our patients are so weak that they may not be able to nod their head yes or no. So, we're trying to help them with the motions of yes or no.
You used to see the movies back in the '80s of people being in comas for years on end, and they just get up and walk out of the hospital. That doesn't happen. Every day that we're in bed, we lose about 10% of our muscle mass. So, if you're in bed for a month, the likelihood of you being able to get up and stand and walk unassisted is very, very, very low.
How taxing has this been, this most recent surge where COVID patients are younger and sicker?
Everyone's tired. Everyone was exhausted last winter, and then it seemed like our numbers were down. It seemed like we were having more vaccinations, and then it stalled. It seemed like the vaccination rate stalled. Everything opened back up. And it did seem like everything was getting back to normal.
And then the infection rates increased, and they continued to increase exponentially. Our hospitalizations, we've watched those increase exponentially. And really, honestly, everything that every health care provider feared would happen in May of 2020 is happening (now).
Everything that we thought was our worst nightmare, as far as us not having beds for all of the patients that would need them — and not just COVID patients, but patients who are waiting in EDs because they have broken hips and fractured knees, and they're waiting to get a bed so they can have a hip surgery or a knee surgery — that's going on.
And it's not just ICU beds. It's not just ventilators or ECMO circuits. It's also the nurses to operate those. It's the therapists to take care of the patients because, like I said, we may have an hour to do the really intensive therapy on one of these patients. And there are only so many patients that can be seen in a day like that.
A lot of us are just sad. And I think one of the things that's the saddest is that it seems like people just don't care, that if you're not in the hospital, if you're not a health care worker, it seems like people really just don't care what's going on. It seems like people think what we're seeing and what's going on is made up. They think that all of the secondary effects that come with COVID are almost like health care mistakes or that they are other preexisting conditions. They don't think that they're part of COVID, even though they are part of the systemic effects of COVID.
And again, it's like they very much think that it's just made up, it seems like, or exaggerated. And if you're living it every day, it's just heartbreaking. And it almost seems like a slap in the face sometimes. So, I think that is what's the most disheartening to all of us.
What's the single most important thing that you as someone working in this hospital want people out there to understand about what we're all doing here?
One of the things I really want to get out, period, is that vaccination does help. I worked here in 2014 with the H1N1 pandemic. And then the flu vaccine helps. It decreases severity of symptoms. People who do get the flu don't get as sick if they've been vaccinated.
It's the same thing with COVID. If you get COVID and you've been vaccinated, you don't get as sick. You are likely not going to be in the hospital. And if you are, you're not going to be as ill.
If (patients) survive COVID, just like a lot of ICU survivors, they have debilitating weakness, cognitive effects, disability that can last weeks, months, years … So, we're just trying our best to help each other get through this every day, to help the patients and families get through it.