ICU worker help former COVID-19 patient mend
LOS ANGELES — Three days after being released from Martin Luther King Jr. Community Hospital, Gilbert Torres returned on a stretcher, a clear tube snaking from his nose to an oxygen tank. It was the last place he wanted to be.
But Torres, 30, who had just spent two weeks on a ventilator in the intensive care unit, was not there because his condition had worsened. He was there to visit a new outpatient clinic for COVID-19 survivors, intended to address their lingering physical and psychic wounds — and to help keep them from need- ing to be readmitted.
Several medical centers around the country, including Massachusetts General Hospital, have created similar clinics, a sign of an increasing appreciation of the need to address the long-term effects of COVID. Other hospitals that already had ICU aftercare programs have added large numbers of COVID patients to their rolls: Indiana University Health Methodist Hospital, for example, has treated more than 100. And some institutions, like Providence St. Jude in Fullerton, Califor- nia, have recovery programs that also serve coronavirus patients who were never hos- pitalized.
“We put a thousand per- cent of our energy into these patients,” said Dr. Jason Prasso, one of the intensive care doctors at MLK Hospital who created the clinic there. “We feel accountable for them getting better even after they leave the hospital.”
Well before the pandemic, doctors knew that some patients recovering from critical illness developed a constellation of symptoms known as post-intensive care
syndrome that can include muscle weakness and fatigue. Depression, anxiety and cognitive impairments arise in about half of people who have spent time on ventila- tors in an ICU, studies suggest. About a quarter of these patients develop post-traumatic stress disorder. The risk is higher among those who have had respiratory failure, long hospital stays and treatment with drugs to sedate or paralyze them — all common in the sickest coronavirus patients. A new, peer-reviewed study of 45 former intensive care patients with COVID-19 at Mount Sinai Hospital in New York found that more than 90% met criteria for the syndrome.
Prasso and his colleagues created the clinic at MLK after realizing that many patients whose lives they had fought to save were getting little follow-up care. The hospital is in a low-income neighborhood where health services, inadequate even before the pandemic, have grown more scarce.
Since opening in August, the clinic has seen more than 30 patients. Visits, which happen Tuesday mornings and include a physical exam and a mental health screening, often entail discussions of housing, food security and employment problems that can arise because of long-term symptoms. Patients are also offered spiritual care.
The first to walk into Torres’ examination room in February was Rudy Rubio, a hospital chaplain who had visited him often in the ICU. The pastor asked if they could pray together and offered to get him a Bible.
Torres, whose parents fled war in El Salvador, grew up in the neighborhood and worked cleaning big rigs at a Blue Beacon Truck Wash. Although he was morbidly obese — a risk factor for severe COVID — he enjoyed running and biking and rarely needed to see a doctor. He had no idea how he contracted the coronavirus or became so sick that doctors needed to insert a breathing tube within hours of his arrival at MLK. For days before he began showing signs of improvement, they feared he would not survive.
“You were spared,” the chaplain told him at the clinic. “What are you going to do with this opportunity?”
When Prasso entered the room, Torres did not recognize him at first without his protective gown and helmet. “It was you,” he said when the realization dawned.
The clinic would arrange to get Torres a portable oxygen machine because small tanks were in short supply nationally, the doctor said. He explained that it could take anywhere from a few weeks to several months for patients to wean off; some might require it indefinitely.