COVID Recovery. How I Helped Bob.
[ photo by Caleb Oquendo ]
COVID-19 recovery after hospitalization.
Last week I spent time writing about the patients who were infected with COVID-19 but whose symptoms were not severe enough to require hospitalization. This week I want to move on to one of the first post-COVID patients I provided care to. Let’s call this patient Bob. This was a few months into the COVID-19 pandemic and I was just getting back into the skilled nursing facilities where I provide consultations to the patients receiving subacute rehabilitation.
During the first few months of the shut-down, I was not able to physically go into the nursing facilities as a consultant due to concern for possible spread of the virus from the outside into the facility. During those few months, I provided telephone and video consultations to those patients that needed my services. In the first of June, I was able to return physically to the buildings, and that is when I first met Bob.
Bob’s weeks long COVID recovery journey.
Bob was a gentleman in his mid-seventies. He checked several of the boxes for the high-risk categories for poor outcomes from COVID-19 infection, including age greater than 65, diabetic, history of hypertension, and obese. Prior to being infected with COVID Bob was living independently in an apartment. He was retired and enjoying his life doing his various hobbies around the small town where he lived. His chronic medical conditions were well controlled with medications, so he had believed he was doing alright.
He got sick in late March. Like the majority of people, he wasn’t sure where he picked up the infection. He told me he went down hill quickly. He was admitted to the ICU in respiratory failure and required intubation so that a ventilator would do the breathing for him. He had several complications during his time in the ICU including kidney failure. He had to have several rounds of dialysis for kidney failure, and because he was not able to be taken off the ventilator, he also had to have a tracheostomy. This is when the breathing tube is moved from the mouth and put directly into the trachea (windpipe) through a surgical incision in the neck. He remained in the hospital for approximately six weeks. His kidneys eventually regained some function, but he still could not be taken off of the ventilator. Because most everything else had stabilized, he was then transferred to a long term acute care facility (LTAC).
Slow, steady recovery continues at the LTAC.
At the LTAC, he received a bit more physical and occupational therapy. It was here that he was able to eventually be taken off of the ventilator, as well. Once that happened, he also worked with the speech therapist and eventually was able to start taking food by mouth, though he reported to me he really did not like the initial meals he was given (pureed food and thickened liquids). He remained at the LTAC for a couple of weeks. There were a few hiccups in his time there, but for the most part, he continued to move in the right direction in regards to his COVID recovery.
After a few weeks, he was able to get to the point to where he was ready to move to the next level of care. Because of his prolonged illness and his profound debility, it was not believed he would be able to tolerate the necessary three hours of therapy per day required for acute inpatient rehabilitation, so he was transferred to subacute rehab. That is when I was able to meet him.
Bob makes meaningful progress in subacute rehab.
From the first time I saw Bob, I could hear evidence of him before actually laying eyes on him. He would spend his days in his room listening to the oldies music station on the TV in his room. He said he always listened to this music at home. It helped his mood and gave him motivation for the day. Bob really educated me on his music!
In subacute rehab, it was noted that he was profoundly debilitated. With the slightest amount of activity, i.e. just moving to sit at the edge of the bed, his heart rate shot up in the 120s and he became very short of breath. He was still requiring additional oxygen through nasal cannula. Because of this, the therapists had to move very slowly with him. Over the next several weeks, however, he went from just sitting at the edge of the bed to standing up with his walker to eventually even taking a few steps. He went from not even having the energy to get out of bed to use the bedside commode to being able to walk slowly to the bathroom. This progress did not happen overnight, however. Bob was in subacute rehab for ten weeks.
At ten weeks, he was able to discharge to home, but his COVID recovery was still not fully over. He went home still requiring extra oxygen. He was still needing some extra help with his ADLs, so home health care was ordered for ongoing therapy. He also paid out of pocket for an aide to come and be with him for a couple of hours each day to further assist him. Despite all the extra help still needed, though, Bob was so thankful to have survived COVID-19 and to finally be able to make it back home. The first time I went back to that particular facility after Bob had discharged home, I missed the greeting of the oldies music coming from his room, but the notable silence was a reminder that Bob was home!
Share your thoughts on or specific experience with COVID recovery in the Comments section.
© 2021 Jessica Kluetz, DO