When Anthony George woke up from a coma in an Ontario ICU last summer, he thought the worst of his COVID-19 infection was over, but has since discovered it was only the beginning of a long road to recovery.
“I thought I could just jump out of bed and take off. Little did I know my legs were too weak to do anything. They still are. I could only walk for a while and I would start shaking and have to sit down and rest. Yes, I’m 53 , but I feel like I’m 70,” she said during a recent occupational therapy session.
“I could almost cry at times, but I end up cursing, yelling at myself.”
George was admitted to Biuewater Health Hospital in Sarnia with shortness of breath in June 2021. He spent the next 70 days in a coma in ICU, on a ventilator and feeding tube. He had to be revived several times.
“He also experienced a lot of ups and downs in the ICU and a lot of infections,” said one of his doctors, Dr. Richard Cheong. “He had a very difficult situation.”
George spent another two months in the hospital’s medical and rehabilitation units. Since his release in October, he has attended outpatient rehabilitation sessions twice a week as part of a community reintegration program.
COVID-19 irreversibly damaged his lungs, so he remains on oxygen; the tank whistles as he struggles to do tasks like opening a jar of peanut butter and buttoning his shirt.
“We’re trying to do some of those daily activities that he has a hard time doing or trying to work on some of those things so he can gain a little more independence,” said his occupational therapist, Andrea Duff, as she helped him stretch his back muscles. arm and hand.
discharge does not mean recovery
There are currently nearly 1,200 Canadians in intensive care units with COVID-19. According to compiled statistics Per Health Canada, 21,590 patients have been admitted to ICUs across the country since the pandemic began. Just over 2,500 of them needed ventilators.
George is one of thousands who have been released from the hospital and are struggling to get their old lives back. They are encountering challenges they did not expect, not only for their physical rehabilitation, but also for their mental health.
Experts say surviving any ICU stay is just the beginning of the journey, and they worry that the necessary supports may not be available in a health care system battered by nearly three years of the pandemic.
CLOCK | Serious consequences of long stays in the ICU:
Dr. Margaret Herridge, professor of medicine, critical care, and pulmonary medicine at University Health Network in Toronto, describes the consequences of long ICU stays for those with COVID-19. 1:23
“This has huge implications,” said Dr. Shannon Fernando, a critical care physician and researcher at Lakeridge Health Corporation in Oshawa, Ontario.
“Traditionally, people would give each other a high five when a patient would survive in the ICU with severe critical illness… It’s still a win. But we’re learning more and more about what these patients experience afterwards.”
Studies over the last two decades have found that many have ongoing weakness, chronic pain, and an increased risk of depression, anxiety, post-traumatic stress disorder, he said, adding that the risks increase the longer they spend in the ICU. Patients should be prepared for these challenges before and after their ICU stay, she said.
‘Just don’t be surprised’
Nadine Foster knows all about those Long-term effects on physical and mental health.
Ten years ago, his liver failed. She was in intensive care for six weeks at a Calgary hospital.
When she was finally discharged, she had to learn to walk again because her leg and trunk muscles had deteriorated from being bedridden for so long. During the first year, she was fatigued and had difficulty handling her daily responsibilities.
“When you get out of the ICU, a lot of people just assume it’s like any other hospital stay and you might be tired for a day or two and then get on with your life and that’s not really the case.” Foster said.
“Those kinds of things happen physically and cognitively and sometimes if you’re unlucky like me, mental health lasts for many years,” she said, adding that people thought she was being lazy when she needed a nanny to help care for her. . for her two young children.
Although she was a nurse, Foster was shocked at the toll the experience took on her mental health and that of her children, who struggled with anxiety.
“His mom almost died and she’s in the hospital, that’s a great answer. And then, you know, marriages suffer too. So my husband and I are no longer together.”
He struggled to find help. No one provided resources for her when she left the hospital and her primary care doctor, in theory the best person to go to for ICU aftercare, didn’t know where to direct her.
“Once the doors of the ICU closed, it was like that knowledge was gone and I had to find it all by myself,” she said.
In his research, Foster discovered what is known as Post-Intensive Care Syndrome. He found some of the best research and information from the United Kingdom, Australia, the United States and Scandinavian countries.
Over the years, he has joined various support groups and now also investigate and helps others access help, including applying for disability tax credits and disabled parking passes.
One of his big concerns is that once someone is deemed recovered by the public health system, there can be ongoing problems, and private insurance doesn’t always cover the long-term disability therapies that may be needed.
Foster said there should be more education for patients, family doctors and allied health professionals like physical therapists.
“I’m concerned that there are quite a few people who go unrecognized in terms of what their needs are. And a lot of people are also too scared to go back and ask for help, because their ICU experience was terrifying, right?” she said.
“Don’t be alarmed because things are going to happen to you that you probably didn’t expect and that no one told you about. Yes, just don’t be surprised. The things you’re going to go through will shock you,” she said.
continuum of care
There are more resources now than when Foster was going through her recovery process, but she and other advocates say they are spotty across the country.
With the large number of COVID patients leaving Canada’s ICUs, Fernando is concerned that timely help may not be available for many of them, depending on where they live.
“Even before this pandemic, we were having a hard time meeting mental health demands,” he said.
“If you ask, does the infrastructure exist to deal with the huge burden of patients who are going to have significant psychological sequelae,” a condition that is a consequence of a prior illness or injury, “as a result of their critical illness, I think any of us who we practice in this system can tell you that the answer is probably no,” Fernando said.
Cheong, in Sarnia, says the entire health care system needs to be restructured to provide continuum of care that helps patients return to “baseline” – as close as possible to their quality of life before their death. ICU stay.
“What’s in the hospitals and then what’s in the community when these people come out of the hospital and all of that needs to be fully and comprehensively planned as opposed to being a little bit here, a little bit there,” he said.
So far, Anthony George says he’s getting the physical rehabilitation he needs. In one of his recent sessions, he was lying on a bed, breathing heavily and working to lift a cane over his head on a modified weight bench.
“Take your time, that’s fine, if you need to rest,” Duff told him.
As he struggles with his recovery, he dreams of a time when he can ride his bike again and walk around his community.
“That [the bike] it’s in my apartment and sitting there getting old and rusting like me. If one day I can ride a bike again, he would be the happiest man in the world.”
As for long-term supports, George just hopes they’re available when he needs them.
