LOS ANGELES – Three days after being released from Martin Luther King Jr. Community Hospital, Gilbert Torres returned on a stretcher, a clear tube passing from his nose to an oxygen tank. It was the last place he wanted to be.
But Mr 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, with the aim of treating their lingering physical and mental injuries – and helping them avoid needing to be readmitted.
Several medical centers across the country, including Massachusetts General Hospital, have established similar clinics, a sign of a growing appreciation for the need to tackle the long-term effects of Covid. Other hospitals that already had intensive care follow-up programs added large numbers of Covid patients to their lists: Indiana University Health Methodist Hospital, for example, treated more than 100. And some institutions, like Providence St. Jude in Fullerton, Calif., Have recovery programs that also serve coronavirus patients who have never been hospitalized.
“We devote a thousand percent of our energy to these patients,” said Dr. Jason Prasso, one of the critical care physicians at MLK Hospital who established the clinic there. “We feel responsible for their improvement even after leaving the hospital.”
Long before the pandemic, doctors knew that some patients recovering from serious illness developed a constellation of symptoms known as post-intensive care syndrome which can include muscle weakness and fatigue. Depression, anxiety and cognitive impairment occur in about half of people who have spent time on a ventilator in an intensive care unit, studies show. About a quarter of these patients develop post-traumatic stress disorder. The risk is higher in 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.
Dr Prasso and his colleagues set up the MLK clinic after realizing that many patients whose lives they had fought for were receiving little follow-up care. The hospital is located in a low-income neighborhood where health services, insufficient even before the pandemic, have become scarce.
Since opening in August, the clinic has welcomed more than 30 patients. The visits, which take place on Tuesday mornings and include a physical exam and mental health screening, often involve discussions about housing, food safety, and employment issues that can arise due to long-term symptoms. Patients also receive spiritual care.
The first to enter Mr. Torres’ examination room in February was Rudy Rubio, a hospital chaplain who had visited him often in the ICU. The pastor asked them if they could pray together and offered to get him a Bible.
Mr. Torres, whose parents fled the war in El Salvador, grew up in the neighborhood and worked cleaning large rigs in a Blue Beacon Truck Wash. see a doctor. He had no idea how he contracted the coronavirus or became so ill that doctors had to insert a breathing tube within hours of arriving at MLK. For days before he started showing signs of signs of improvement, they feared he would not survive.
“You were spared,” the clinic chaplain told him. “What are you going to do with this opportunity?”
When Dr. Prasso entered the room, Mr. Torres did not recognize him at first without his gown and helmet. “It was you,” he said when realization dawned.
While the doctor examined him, Mr Torres said he was able to walk short distances, but worried that if he did, his oxygen levels would drop. “It’s a bit of a mind game,” Dr Prasso said. “You may feel short of breath, but your oxygen may still be quite normal.”
The clinic would arrange to get Mr Torres a portable oxygen machine because small tanks were in short supply nationwide, the doctor said. He explained that weaning patients could take from a few weeks to several months; some might need it indefinitely.
Mr. Torres raised another issue. A physiotherapist assigned to visit him had canceled. “A lot of agencies are a little reluctant to enter people’s homes right now because of Covid,” Dr Prasso told him. He said the clinic could instead enroll Mr. Torres in a pulmonary rehabilitation program, so he can work with therapists focused on recovering his lungs.
Mr Torres shared that he was anxious and haunted by memories of beeps from the ICU monitors and a feeling of suffocation. He had barely slept since returning home and had yet to see his 5-year-old son, who was temporarily staying with his grandparents. Mr. Torres was afraid of collapsing in front of him.
“Everything you are feeling is normal,” reassured Dr Prasso. “Just know that what you went through was trauma. It takes time to heal.
The two exchanged memories of when Mr Torres’s breathing tube was removed. “You begged me to take the tube out, and as soon as we took it out you asked to put it back,” Dr Prasso said.
“It was hard to breathe,” Torres said. “I didn’t want to be awake.”
“This guy had a vise on my hand,” Dr Prasso told Torres’ partner Lisseth Salguero, who had joined him in the examination room. Family members, themselves at risk for mental health problems, are encouraged to accompany patients to the clinic. Ms Salguero had developed symptoms of Covid on the same day as Mr Torres, but recovered quickly. Since he had returned home, she had woken up to check Mr. Torres’ oxygen level at night. “I’m happy as long as he’s okay,” she said.
The extraordinary stress of an intensive care stay in the Covid-19 era is often compounded by almost unbearable loneliness. Restrictions on visitors aimed at reducing transmission of the virus can mean weeks apart from loved ones. “I kept asking someone to hold my hand,” Torres recalls. “I wanted a contact.”
The staff have become a de facto family. “You don’t have anyone except your nurses,” Torres said.
For these intensive care nurses, caring for Covid patients while being among the few led to their families leads to deep emotional attachments. Nina Tacsuan, one of Mr Torres’ nurses, couldn’t hold back tears when she saw him at the clinic.
“Thank you for keeping me alive, for giving me a second chance,” Torres told him. “I am grateful.”
“You are my age,” Ms. Tacsuan said. “It was really, really hard all the time.”
Often the experience ends in heartache: By the time Mr Torres was hospitalized, only around 15 percent of Covid patients at MLK treated with ventilators had survived to return home.
Those who survive, like him, inspire the staff to continue. But usually, intensive care workers don’t get a chance to see their old patients once they get better. The clinic changed that.
Ms Tacsuan and charge nurse Anahiz Correa joked that Mr Torres was no longer welcome in their intensive care unit
By the time the transport ambulance picked him up to return home, Mr. Torres said he was feeling much better than when he arrived. He was reunited with his young son, Austin, a few days later, and he kept improving over the weeks that followed.
Mr. Torres visited the clinic two more times, in February and March. Although he ended up refusing outpatient rehabilitation – opting instead to climb the stairs and do other exercises at home on his own – he said he felt good and was glad he was gone.
A social worker there put him in touch with an MLK system primary care physician for further follow-up. An osteopath manipulated her back and taught her stretches to help ease the lingering discomfort of her time in the hospital bed. And last week, on their last appointment, the clinic staff held up a congratulatory banner and shouted “Surprise!” as he entered, to mark his “graduation” from having to use an oxygen tank.
He still needs more strength and endurance to be able to return to his physically demanding job washing trucks, he said, but “I do a lot more things.” And he’s no longer haunted by anxiety, he added. “I feel good.”