Charlie Blueweiss, 33, woke up believing he was in a secret infirmary in an airport somewhere, maybe in China. He was certain someone was stalking him; threatening messages seemed to keep appearing on screens around him.
As his confusion — which is common among Covid-19 patients who have spent a long stint on a mechanical ventilator — dissipated in the coming days, Mr. Blueweiss began to take stock of his situation. He realized that he was in the intensive care unit at NewYork-Presbyterian Hospital/Weill Cornell Medical Center in Manhattan, and that those screens were displaying his vital signs and medical updates.
The 15 days on the ventilator left a deep sore on one cheek, and he struggled to unclench his right hand. His right foot burned with pain and he was too weak to sit up. He could not unlock his phone to call his wife because his hands were so swollen. When he finally reached her, he asked, “When am I coming home?”
Home, in Queens, would have to wait. On April 28, Mr. Blueweiss was taken in a gurney to 11 North, a former inpatient psychiatric ward at Weill Cornell that had been turned into a Covid-19 recovery ward.
With the peak of the coronavirus crisis in New York City in the past, hospitals and their medical staff are no longer straining under the number of critically ill patients — once so numerous that ventilators, dialysis machines and even sedatives ran dangerously low.
The front lines of the virus fight have shifted from intensive care units to recovery areas like 11 North, and similar units at other hospitals, like Rusk Rehabilitation at NYU Langone Orthopedic Hospital. Here, doctors are finding that for the most severe cases, recovery can be a long and arduous process.
Patients who survive lengthy I.C.U. stays during ordinary times — after heart surgery, car accidents, shootings, sepsis or respiratory failure — often face lengthy recoveries. Some patients report cognitive deficits, including difficulty concentrating. Many struggle to return to their jobs. About one-third have anxiety, depression, or symptoms of post-traumatic stress disorder, said Dr. Lindsay Lief, a pulmonologist at Weill Cornell who works with post-I.C.U. patients.
“In the Covid era, I think this will be magnified,” Dr. Lief said.
She noted that the typical Covid-19 patient in an intensive care unit was generally there for an unusually long time — one study suggested at least two weeks. That means more muscle loss and increased risk of other problems as well.
Even those whose lungs are mostly healed may be quite debilitated after long immobilization in an intensive care unit, where they are administered high dosages of sedatives and sometimes paralytics. Some must relearn to swallow without choking. Others have crippling nerve pain. Others have cognitive deficits, including trouble with words.
Others are traumatized and just not ready to be on their own. “A lot of people told me they felt lost,” Dr. Alka Gupta, the unit director of 11 North, said. “Many were having nightmares each night and were scared to be alone.”
One young woman in an intensive care unit was unable to remember her name for more than a day. A middle-age immigrant opened his eyes and was convinced that a civil war had broken out back in his home country.
Some patients shared that they were afraid to sleep, anxious that they would wake up on a ventilator. Dr. Gupta recalled a patient at 11 North who no longer needed supplemental oxygen, but 10 minutes after the oxygen flow was turned off, she pleaded for it to be restored. She feared her lungs would fail again.
But to the doctors, these patients are the lucky ones. By mid-May, more than 220 patients died of the virus at Weill Cornell alone. Doctors demoralized by death during the pandemic go to 11 North to visit their patients who survived. These are pilgrimages of sorts — the recovery unit is the most hopeful place in the hospital.
“I think it really does feel like a beacon within the hospital,” said Dr. Laura Kolbe, who treated hospitalized Covid-19 patients at the height of the outbreak and now works at 11 North.
The unit’s floor overlooks the East River, Roosevelt Island, and the smokestacks of a power plant in Queens. These days, about 30 patients live there. More than 60 have been discharged.
The sounds are distinctive: some of the loudest coughing you’ve ever heard; the shuffle of footsteps as patients push walkers down the hallway and relearn to walk; and the words of encouragement from Matt Descovich, a physical therapist, urging patients to move another 10 feet, reminding them that they are on a road that leads home.
But home can be a long way off. Mr. Blueweiss figured his stay in the unit would last a week. But in an interview in May, on his 12th day in the unit, he had stopped venturing a guess. “There are certain things that will take time,” said Mr. Blueweiss, who trained as an opera singer and now works for a financial tech company.
A bedsore and nerve pain kept him up at night. He watched television and napped during the day.
The highlight of his days was 90 minutes of physical therapy, when he began to relearn to walk. He had little sensation in his right foot, which undermined his balance and coordination. With each step, his foot pointed downward, threatening to trip him.
One day, he could walk just six feet or so with his walker before needing a rest. Soon it was 50 feet. Then 75 feet. He walked up and down the hallway of 11 North, past the rooms of the other patients, most much older than him. He had little interest in them or desire to socialize. He was not alone in avoiding the group therapy sessions.
This was common, it turned out, to the disappointment of doctors. “I think people are kind of reintegrating a little cautiously,” Dr. Gupta said. “I was a little surprised by that.”
Even among hospital roommates, few relationships have formed. In one room, a man from Turkey with weak and uncoordinated hands kept dropping his phone. His roommate, a nurse from the Philippines who was further along with his recovery, would slowly get out of bed and bend down to retrieve it. Then each went back to talking with his own family on their own devices.
There was so much to say. Most patients had not seen their families since they had been admitted three or four weeks earlier.
Usually updates flow out of the hospital, from the patient to the family. Now it happens in reverse. Many patients have little idea of what happened to them while hospitalized.
Mr. Blueweiss’s wife, Hannah Cates, had been keeping meticulous notes. She filled him in.
Thirty-five days into his hospitalization, Ms. Cates was allowed to visit her husband. Visitors were generally barred, but an exception was made. Ms. Cates needed to learn how to tend to her husband’s bedsore, which involved cutting sheets of calcium alginate — a dressing derived from algae — into small spirals and packing them deep into the wound. When she walked into the hospital room, she was wearing a face mask. Her husband mistook her for a nurse.
“It’s me,” Ms. Cates recalled saying. “I’m your wife. I’m here.”
She stayed for 11 hours. She learned to care for his bedsore, clipped his nails, and filled him in on their two cats. They sat together quietly. They spoke of what he would need when he came home — a cane, a walker, a wheelchair for longer distances, a visiting nurse, and a visiting physical therapist. Just being able to talk it through with her right there made him feel more like himself than he had in a very long time. “I felt, you know, a little more normal,” he said.
In late May, Mr. Blueweiss had a six-hour surgery on his right arm to try to repair the nerve damage.
On May 29, Ms. Cates returned to the hospital to pick up her husband. Doctors and nurses lined the hallway to cheer and clap as he was wheeled out.
From his room, he had heard this ritual play out a couple of times a week. He usually had no idea which patient was leaving. So, lying in his bed, he would imagine it was him. Now it actually was.
(The New York Times)
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