CHESTCOVID-19: Voices From the CommunityRecovering From COVID-19: What I Learned as a Physician and as a Patient

Recovering From COVID-19: What I Learned as a Physician and as a Patient

By: Jafar Abunasser, MD

We often think of critical illness as acute and life-threatening, sudden and vicious. We build our ICUs around this perception: Patient rooms with no doors, a centralized nursing station overseeing the entire space, and the constant alarms. Television and media romanticize the struggle of the dedicated, type A physicians, nurses, and therapists who choose this field, and they celebrate the success when a “critically ill patient beats the odds and walks out of there a new person.”

But that vision is far from reality. Critical illness doesn’t stop when a patient is discharged from the ICU, and I’m glad we’ve started to recognize the chronic critical illness, post-intensive care syndrome, and trauma from which some ICU survivors suffer. I joined a team at the Cleveland Clinic that has spent years building a connected care program to bridge the gap between “surviving” and “recovering.” We focused on developing a program to provide all the necessary services our patients need, from the ICU to long-term acute care hospitals (LTACs) to acute rehabilitation facilities and to the post-ICU recovery clinic.

Until the pandemic arrived.

The hospital I work at most often was designated as a “COVID-19 Hub”—one of several hospitals in northeast Ohio to which the Cleveland Clinic diverted our patients with COVID-19. We wanted to standardize their care, to have dedicated teams caring for them, and even to preserve our personal protective equipment supply. I’m also the Medical Director of one of our LTACs, and I started preparing that site for the inevitable. Needless to say, anxious about it or not, we were very proud to have been entrusted with the task, and I personally was looking forward to being part of the fight.

And then I started to have chills and night sweats. I isolated myself from my family and rushed to the hospital to get tested. My test came back negative, and I was able to breathe a sigh of relief. I even came down to the kitchen and made myself breakfast the next day (to my wife’s dismay). But by that afternoon, I was barely able to get out of bed, and the fever started. The following morning, fueled by plenty of coffee, I found the strength to get to the drive-through testing center, and to no one’s surprise, I tested positive. I was hospitalized for 8 days with a fever up to 103 °F for days on end, I lost 20 pounds, and I couldn’t come back to work for 6 weeks.

I’m very stoic by nature, and sayings like “What doesn’t kill you, makes you stronger” always seemed too cliché for my taste. But I distinctly remember my first day back to work, looking at a long list of LTAC patients who had yet to recover from COVID-19, all delirious, most of them dependent on mechanical ventilation, artificial nutrition, and dialysis, and thinking to myself, “Well, you asked for a fight, so a fight you’ll get.”

By that point in the pandemic, Ohio had started to see its curve level off, so we spent the summer perfecting our protocols, scouring the literature for ways to help, and reengineering our LTAC to prepare for the winter we knew was coming. Our team worked (literally) around the clock preparing the LTAC for a surge, organizing patient flow so we could serve patients with COVID-19 while protecting the rest of our patients and staff from an outbreak. We did walk-throughs to see where infection control procedures could falter, everything down to figuring out the easiest way to get through the double doors without breaking isolation protocol. We were confident, motivated, and ready.

Well...we thought we were ready.

We considered it a “bad” day in the summer months when Ohio would report 1,500 new cases. By mid-December, we registered 10,000 cases a day. Our ICUs were full, but we kept fielding calls from other hospitals asking for help with their sickest patients. So we had to rethink our entire strategy; we had to actively triage our ICU patients every day, in a joint huddle across the Cleveland Clinic enterprise, so we could serve every patient at the location most suited to their needs. I started a “COVID transitional unit,” and I set specific criteria for the ICU patients who we could transfer to my care at the LTAC, freeing up ICU resources for those who needed them most. Over the winter months, our team cared for more than 150 critically ill patients in this unit.

What struck me most was the degree of cognitive dysfunction from which these patients suffered. We were accustomed to prolonged mechanical ventilation, dysphagia, and renal failure, but the prolonged delirium, severe anxiety, posttraumatic stress disorder, and depression with these patients was like nothing I had ever seen.

It’s hard to believe how far we’ve come in 1 year, but the success our program has had is remarkable. Almost 80% of the patients who suffered the need for prolonged mechanical ventilation have been liberated, and more than 50% of our patients are discharged from the LTAC, either to their homes or to acute rehab. Unfortunately, it became very clear that while our patients’ physical recovery was impressive, their psychological and mental disability has lingered in a way that I am sure will affect them for months, or even years, to come.

The biggest lesson I’ve learned from the pandemic? Our work doesn’t end when our patient survives their ICU stay. That’s when the hard work starts.

Bharat Bajantri, MD

Jafar Abunasser, MD, is a Pulmonary and Critical Care Physician at the Cleveland Clinic, and also serves as the Medical Director of the Long Term Acute Care Hospital at Select Specialty-Fairhill. His areas of interest include ARDS, chronic respiratory failure, care of the patient with a tracheostomy, and post-ICU syndrome.

Read more COVID-19: Voices From the Community blog posts:

Working to Reduce Vaccine Hesitancy

Being a Part of Something Bigger Than Ourselves

How COVID-19 Turned Our Hospital—and Patients—Upside Down