We Didn't Take Pandemic 101 in PT School: Working in the Acute Care and ICU Setting During the COVID-19 Crisis
By Kathy Swanick, PT, DPT.
I am an acute care physical therapist treating COVID-19 patients. Nothing can prepare you for practice in this type of crisis. Aside from worry about exposure due to lack of PPE and potentially bringing this virus home to my family, I am most impacted by the loneliness of my patients and the anxiety of families during their hospital stay — whether due to COVID-19 or another medical emergency.
While I was working in our open-heart intensive care unit, a patient was admitted with an ST-elevation myocardial infarction who had undergone emergent open-heart bypass surgery. His wife called the ICU as she was driving around the parking lot and asked if we could move him in front of a window so that she could see him and he could see her and their little dog. It took some doing, as he had not really been able to walk yet and was on vaso-presser support due to low blood pressure, but his nurse and I were able to get him out of bed and standing in front of the window with a walker. Our nursing assistant ran down to the parking lot so he could show her the right window. There was not a dry eye anywhere, including the security guard in the parking lot. We have the power to do simple things that can bring a bit of happiness to our critically ill patients who can’t visit their families in person.
The story is a great example of how we, as physical therapists and physical therapist assistants, can work with the health care team during the COVID crisis. Initially our hospital system did not include physical therapy as part of the cohort team, primarily to limit exposure and preserve PPE. But as our medical center closed floors to make the isolation units, we became involved. In many cases, these patients had not been out of bed for their entire hospital stay — sometimes for a week or more. There were thrilled to be able to move, to have human contact, and to be provided with activities to improve their strength and mobility so they could return home. In addition, skilled nursing facilities are not accepting patients who have tested positive; thus, it is critical that patients receive physical therapy during their acute care stay.
PTs and PTAs also have the ability to spend time with COVID-19 patients, who are even more isolated than our other medical patients. In addition to three medical floors being closed and isolated with COVID-19 patients, we have two dedicated ICUs where patients are essentially in solitary confinement: The doors are closed, and they do not get to see friendly waves or smiles from staff walking by. One day, I was bringing a chair into a patient's room so that he could get out of bed for the first time. As I was telling him our plan, he said, "I am happy to be able to get up, but I was hoping that chair was for you and you would stay and talk to me for a while."
Another patient who was admitted to the ICU to rule out a COVID-19 diagnosis also had experienced a stroke. While I was mobilizing the patient to the edge of the bed and had her sitting for the first time, her nurse called the family using FaceTime so that they could see their mother’s progress. Unfortunately, her condition deteriorated during the afternoon, but the family was grateful to be able to see their mother sitting up.
The biggest take-home message is that we are part of the medical team. We are essential. We can provide direct patient care and assist our nursing staff. In the ICU we are assisting in proning patients on ventilators and patients on high-flow oxygen in attempts to keep them off of a ventilator. We celebrate every patient that comes off of the vent and is discharged home. It is especially emotional when these patients are also your coworkers who have been exposed and require intubation.
Our rehab team has had to educate others in our essential role with these patients. The chaplain in the ICU even pulled me aside to ask, "What can you do to help them?" My response was that, just like him, we can provide a human touch and hope. We help provide them with the opportunity to perform everyday tasks, such as getting out of bed, walking in the room, and brushing their teeth. As a team we have dedicated ourselves to doing any task that is needed that will improve their quality of movement, enhance their quality of life, and decrease their feeling of isolation.
Kathy Swanick is ICU physical therapist at Lee Health System's HealthPark Medical Center in Fort Myers, Florida.