ICU recovery clinic speeds patients’ physical, emotional healing
Published on Monday, May 10, 2021
By: Ruth Cummins, email@example.com
The good news for Derek Carter Sr. is that, after 68 days in a University of Mississippi Medical Center intensive care unit and another two weeks in a regular hospital room, he is a COVID-19 survivor.
The bad news: Sixty-two pounds lighter, the Brandon resident had to learn to walk again, re-master tasks such as tying his shoes, and deal with lingering stress and brain fog that came with a long stay in the Medical ICU.
Carter and others like him have a new resource to clear those hurdles. The Medical Center has created an ICU Recovery Clinic that gives patients the tools they need to regain their lives and well-being as they continue healing from a devastating disease or injury.
“I couldn’t stand. I couldn’t walk. I was agitated,” Carter said of the days after his release and rehabilitation that followed. He came to UMMC’s Emergency Department on Sept. 6, 2020, and just days later, was on a ventilator in the ICU. He finally returned home Dec. 2, 2020.
The multidisciplinary ICU Recovery Clinic, located in the University Physicians Pavilion, focuses on addressing the complex recovery needs of patients who have survived a critical illness. Its care team builds relationships with patients and their families, helping them navigate the health care system and minimize the effects of post intensive care syndrome, or PICS.
The clinic is staffed by Dr. Campbell Sindel, a fellow in hospice and palliative medicine; Dr. Michael Brewer, assistant professor of medicine and surgery; and a broad care team that includes Amy Mayhue, an occupational therapist and assistant director for rehabilitation services; Shelly Poole, a physical therapist and administrator of adult rehabilitation services; Katherine Artman, a critical care pharmacist; and Betsy Gillenwater, a pharmacy resident.
Sindel and Brewer are each board-certified in pulmonary and critical care medicine. Dr. Edward Manning, a professor of neurology, helps Carter and others with neurocognitive issues, including PICS.
“There are very few of these clinics in the United States – probably about 20," Brewer said. "We are No. 17. We are certainly the only one in this state.”
Patients in UMMC’s ICUs are referred and screened for care at the weekly clinic that opened in October 2020. They visit a combination of providers, depending on their recovery needs.
They might get a therapeutic visit from ICU registered nurses who were at their side during what, for many, has been the worst chapter of their lives.
Those nurses include Lauren Boler, who sat down with Carter at the ICU Recovery Clinic during a recent appointment. She and her colleagues help their former patients simply by letting them know how much they’re loved and praising them for pushing through their illness.
“She was the first face I saw when I woke up,” said Carter, who was sedated and intubated for much of his ICU stay. “I remember hearing her voice when I was under – her voice, my wife’s voice and my son’s voice.”
Carter’s wife of almost six years, Elizabeth McCray-Carter, and his adult son, Derek Jr., were allowed to visit him when his condition was most dire. Together, the couple have five children ranging in age from 12 to 24.
“I remember music, too,” Carter said.
“We would turn it on at 7 a.m.,” Boler reminded him.
“I would think I was on the JSU campus, in the stadium,” he told her.
Matt Harris, an MICU nurse, also dropped by.
“You don’t look like the same person!” he told Carter.
“I’m still having trouble with one of my arms,” Carter said.
“Are you able to do what you want at home?” Harris asked.
“I’m getting there!” said Carter, an active-duty sergeant first class with the U.S. Army Reserves.
But not all of his remembrances are good.
“I did know I was in the hospital with COVID, but I didn’t know how much time had passed,” Carter said of waking up with a vent, something that is disconcerting for many patients. “I think about being in the hospital every day.”
“That’s normal,” Sindel said. “You’re reliving those emotions. That’s very real.”
Patients recovering from an ICU stay have mental and emotional challenges that need to be addressed as much or more than their physical comeback, Sindel said.
“We see people with concentration difficulty. For some, balancing a checkbook or participating in a conversation can be stressful. They can develop frustrations that are related to not being able to do what they once could do.”
When her husband returned home from rehabilitation, McCray-Carter said, “he was discouraged, because he’s such a strong man.” But in the weeks that followed, she said he began regaining his independence and building back his strength.
“I’ve got to be patient,” Carter said of returning to his old self.
Most clinic patients bring their significant other or a family member to appointments.
“We’re also giving that caretaker time to be heard," Brewer said. "We understand that critical illness doesn’t just affect the patient.
“There have been family members that we’ve helped with resources, such as counseling to help them work through the emotional and psychological impact they had while their loved one was in the ICU.”
Carter’s team is monitoring his pulmonary function after he spent so much time needing breathing assistance.
“Let me take a listen to you. Take some deep breaths,” Sindel told Carter as she moved a stethoscope over his back and chest. “You sound good today!”
Sindel said she wanted to see him back in two months to be re-evaluated by Physical Therapy.
“We don’t want to have a block of time when you’re not progressing,” she told Carter. “You have my phone number. You call me any time.”
“For me, it was amazing to see a success after seeing so many patients pass away,” Boler said. “So many times, we thought Mr. Carter wouldn’t make it.”
“We proned him so many times,” Harris said.
Some COVID-19 patients are proned, or flipped from their backs onto their stomachs, to take weight off their lungs in hopes of making it easier for them to breathe.
Artman and other critical care pharmacists are a constant on the ICUs, managing patients’ medications and working in tandem with bedside providers.
“Where I sit in the unit was by his bed,” Artman said. “His wife fought for him every single day. I remember the day he woke up. Everybody had to go in and see him.”
Sindel and Brewer said they hope to slowly grow the clinic as more staffing and space becomes available. A visit can last two or more hours.
“We feel like we are making a difference," Sindel said. "We get to know our patients and their stories.”
“We see people at UMMC from all over the state, and from adjacent states, who have had critical illness,” Brewer said. “They might go home to a rural area and are lucky to just have a primary care physician. They wouldn’t have the expertise there that we are able to offer here.”
Carter and his wife have made plans for later this summer, after he progresses more in his recovery.
“We’d like to go on vacation and to make up our anniversary. We missed it last year,” he said.
It’s much easier for Carter and his caregivers to joke with each other now that he’s home and making excellent progress in the Recovery Clinic.
“We were so happy you woke up," Harris told him. "We didn’t care how many times you used your buzzer.
“Don’t come back and see us over there.”