The COVID-19 pandemic has ravaged the world, as we know it. I still remember the date that the facility I work in closed. March 13, 2020. I work as a respiratory therapist at an outpatient pulmonary rehab program. I was expecting closure for a couple of weeks, if even that. Instead, our closure lasted several months. After we started to open back up, we started getting COVID-19 survivors referred to our pulmonary rehabilitation program. Since we have been “getting back to normal,” what has ensued has been some of the most challenging and unknown roads of my respiratory therapy career.
Patients Present with Severe Shortness of Breath
I received a referral for a patient to enroll in our pulmonary rehab program; we will call him by the name “Frank” to protect privacy. When I received a referral for Frank, there were specific instructions to call Frank’s wife to discuss the program. Unfortunately, Frank was so short of breath he could not talk on the phone. I reassured Frank’s wife that there would be a wheelchair available for him when he attended his appointments. She told me Frank would be unable to walk from getting out of his car to our front door (about 10 feet) without needing to sit down.
From Active to “Doing Nothing”
Frank and his wife came to our facility together for his initial assessment. Frank’s biggest wish was not to have to use oxygen anymore. He was currently using 3-5 LPM continuously. When he was in the hospital and not using a ventilator, he used up to 60 LPM of oxygen.
I told him we would try our best.
Frank was so depressed. He sat silent for most of his assessment while his wife filled out his paperwork for him. I watched her wheel him in the wheelchair through the lobby and out the front door after his appointment, thinking to myself, what am I going to do?
Frank was so sick. He had minor health issues before contracting COVID-19 but did not have any known lung disease. He was very active and traveled all over the world in his spare time. Frank and his wife never sat still.
Now, here he was. Unable to even walk a few feet without getting so short of breath and overcome by coughing spells. He had gone from life as a healthy man in his 70s to sitting and “doing nothing,” as he described it. After Frank was a patient in the program for several days, he confessed to me that he had often thought about just overdosing on his pills and ending it all. He felt like a burden to his family.
Rapid Onset of Breathing Difficulties
I did not sleep much the night I met Frank at his first appointment. I didn’t know if our program could help him. Unlike patients who suffer from other lung diseases, such as COPD, COVID-19 survivors suffer from the rapid onset of shortness of breath. Other chronic lung disease processes usually present with shortness of breath that is progressive. Someone suffering from a chronic lung condition can generally look back and realize they had shortness of breath start several years before coming to pulmonary rehab. A COVID-19 survivor suffering from breathing problems will tell you it happened suddenly. Frequently, survivors will also have scarring on a CT scan of their lungs and a Pulmonary Function Test showing evidence of a restrictive lung disease process. In addition, similar to other health care providers, for the last year, we have been unable to find guidance on how to help survivors of COVID-19. There are no parameters to reference since this is a new virus. However, I knew I had to try something, so we did our best. I take the responsibility of helping improve the lives of the patients we serve very seriously.
Putting a Plan into Action
I enrolled Frank in a small class with other attendees. One of the other patients was also a COVID-19 survivor. We started the program very slow. We followed the same curriculum that we use with our other patients who suffer from lung diseases. Each session, we cover a different educational topic. Patients meet with a Dietitian, Psychologist, and Pharmacist. Through this process, we taught Frank pursed-lip breathing and diaphragmatic breathing. We educated him on lung disease, staying healthy, nutrition, coping with stress. Frank started with very minimal exercise and activity and added a little more time and endurance each day. In addition, most of all, we were Frank’s motivators. We coached, counseled, and did all we could to help him gain confidence.
It was transformational.
After four weeks, Frank was a different person. He walked into our class without a wheelchair. His oxygen use was down to 1 LPM with exercise, he could rest on room air, and his coughing had subsided. His PHQ-9 depression scale score before starting our program was 16. At the end of our program, he scored himself at a 1. He filled out his own paperwork, laughed, and told jokes. It was unbelievable.
Giving Hope to Patients
Frank’s situation reiterated what is essential for all of the patients we serve in the health care industry. We have to give people hope.
We have now had several COVID-19 survivors enroll in our program. Every single person has shared one commonality: they are all scared of what surviving this horrible virus means. They also suffer from survivor guilt.
Pulmonary rehabilitation offers the unique situation of a long-term plan of care. A patient in our program is under our care for at least four weeks. Our pulmonary rehab program also offers a maintenance exercise program, giving graduates of our program the possibility of a lifelong commitment to exercise and wellness. In addition, the opportunity for trust and advocacy exponentially grows when someone is in your care for an extended period.
Frank also mentioned that meeting another survivor helped him on his road to recovery.
Pulmonary Rehab is a Multi-Disciplinary Program
If you are caring for a COVID-19 survivor, or you are a friend or family member of a survivor, a referral to pulmonary rehab is extremely helpful for someone suffering from lung problems. Pulmonary rehab is a multi-disciplinary program offering exercise, education, and the encouragement of independence.
While the COVID-19 pandemic has upended life as it was, we can still offer survivors and all of our patients several things each day. We can encourage healthy choices and exercise. We can provide motivation and compassion. But, most of all, we must give others hope.
Follow up on Frank
Frank continues to improve. He is not using oxygen anymore, and his doctor cleared him to discontinue it. He stops in to see us during our maintenance exercise classes on occasion and even calls on the phone from time to time! Frank keeps busy spending time with his family and traveling. He has maintained an exercise program, and his wife exercises with him to keep each other motivated.
The last time I visited with him, he told me pulmonary rehab helped him realize that life is worth living.
Email newsroom@aarc.org with questions or comments, we’d love to hear from you.
Karissa Brown is a Registered Respiratory Therapist and Pulmonary Rehabilitation Program Specialist. She works for Sanford Health in Sioux Falls, South Dakota.
