Twin Cities clinic prepares COVID-19 survivors for the long haul

The first thing Greg Beaudoin wondered after 54 days on a ventilator, most of it in a medication-induced coma, was who was the blurry figure standing at his bedside?

"Greg," a woman said, taking his hand. "My name is Sue. I'm your wife."

More questions emerged in the following days as the mental fog slowly lifted and the Inver Grove Heights man realized that COVID-19 had robbed him of two months of living and left him with physical disabilities, some of which may be permanent.

Why can't I move my hands? Will I regain full sight in my left eye? Is my career as a respiratory therapist over?

That's where M Health Fairview's ICU Survivorship Clinic stepped in. The program gives patients extended time with intensive care doctors to address the toll COVID-19 has taken on them and to prepare them for the mental and physical challenges ahead.

"It was good to hear someone say, 'I can tell you the good, the bad and the very bad,' " said Beaudoin, recalling his videoconference with the doctors this summer. " 'Anything you want to know.' "

Two intensivists with M Health Fairview were in the process of creating the clinic for all critically ill patients when the pandemic arrived, and they realized it could help the many patients whose severe COVID-19 resulted in lingering health problems and related stress.

The goal is to set expectations for recovery for those patients and link them immediately with the therapy and resources they will need after their hospitalizations, said Dr. Sakina Naqvi, a Fairview pulmonologist and critical care physician who co-created the clinic. "A lot of these patients have breathing issues, scarring of the windpipe, because they have been on ventilators for so long."

Researchers aren't sure how many COVID-19 patients end up being so-called long haulers, with symptoms lasting more than a month after initial infections. A small Italian study found more than 80% of hospitalized patients had lingering problems after COVID-19, but a September report in the Journal of the American Medical Association cited British research and estimated a rate closer to 10%.

The U.S. Centers for Disease Control and Prevention reported in July that 35% of all symptomatic COVID-19 patients still had lingering symptoms two to three weeks later, but Dr. Greg Vanichkachorn of Mayo Clinic in Rochester said that is to be expected.

If problems persist for four weeks or more, he said, he becomes concerned that they could be chronic or long-term.

Mayo also has a survivorship clinic, and Vanichkachorn launched a rehab clinic for post COVID-19 syndrome. Guidance up front is critical, Vanichkachorn said, because patients can cause more damage if they push their recoveries too hard. Inflammation and breathing problems can resurface in their weakened lungs.

"Doing too much too quickly can actually do quite a bit of harm, and actually make you feel worse. It's something we saw with SARS previously," he said, referring to the 2003 global pandemic. "The idea of 'no pain, no gain' is exactly what you don't want to do."

Beaudoin admits to being impatient with the slow recovery, despite regular physical and occupational therapy three times each week in Woodbury.

The 59-year-old suspects he was infected in April while working as a respiratory therapist with patients seeking to regain lost breathing capacity. At the time, protective supplies were limited and there was little known about the SARS-CoV-2 virus.

Beaudoin's wife called for an ambulance as her husband's breathing grew labored and coughing got worse. Beaudoin said goodbye to his wife and dog — not realizing that he would soon be placed on a ventilator and not regain consciousness until June.

Because of restrictions to prevent viral transmission, Beaudoin's wife and grown children couldn't visit him at Bethesda Hospital in St. Paul, but they often spoke to him and prayed outside his window. A unit coordinator at St. Joseph's hospital, Suzanne Beaudoin couldn't regularly visit her husband even when he was transferred into a long-term care bed one floor below her at work.

Complications included problems with Beaudoin's gall bladder and high blood pressure, which resulted in an imaging scan after 40 days in care and the discovery that he had suffered a stroke. Surgery was needed after secondary bacterial and fungal infections further damaged his lungs.

The family celebrated after a throat surgery helped wean Beaudoin off the ventilator, but they then discovered that he lost mobility in his hands and only had a sliver of vision in his left eye. His cognition and thinking slowed as well.

"If my wife would say, 'set the table,' I would be thinking, 'how many plates and how many forks and spoons?' " he said. "So my thinking is way, way, way down."

Naqvi said the survivorship clinic started small with about 40 patients so far, and that expansion is difficult because intensive care doctors are so busy with the pandemic's recent surge.

She said doctors often lose track of these patients after they are moved out of the ICUs to general medical beds, so the consults can boost their spirits by reconnecting them with patients such as Beaudoin when they are healthy enough to go home.

"It's very rewarding for us," she said.

Beaudoin said the doctor's answers helped, even if they weren't positive, and normalized his dark feelings and visions about his time in a coma. Naqvi told him the lost mobility in his hands might not be due to his stroke but to his frequent placement in a prone position in his hospital bed to support his lungs. That stomach-down position might have put pressure on an IV line in his wrist and damaged a nerve.

Beaudoin isn't sure he will be able to practice as a respiratory therapist after 35 years in the profession because he would be working around people with infections that could damage his weakened lungs. He has training as an asthma educator, though, and might pursue more of that work.

Adjusting to vision loss is hard, he said. "I've walked into a lot of door frames."

His emotions can swing from bitterness to joy and even to guilt when he considers that he recovered from an illness that has killed others. While the sickness lingered for months, the decline was abrupt.

"I used to run through the woods with my dog every night last winter — literally every night," he said, thinking back to his life before COVID-19. "There was never really a chance to grieve for who you used to be. I never got to say goodbye to that guy."

This is the second in a series on Minnesota hospitals' response to the surging COVID-19 pandemic.

Jeremy Olson • 612-673-7744