Physiotherapy in a Pandemic

Guest Post Written by Danielle Pierce, Registered Physiotherapist

Foreword by Nelin Krull, Registered Physiotherapist & Co-Owner of Myofascial Release Mississauga

May is National Physiotherapy month in Canada and we would be remiss if we did not take this opportunity to address the effects the pandemic has had on our profession over the last year. For our practice, like many others we have had to shut our doors to our patients for a period of time and luckily as essential workers we were able to open them back up again outfitted in what I liked to call “hospital standard” PPE.

You see, before we opened this practice I was an acute care Physiotherapist at our local hospital. I worked in the surgical department and emergency department and also spent some amount of time in pretty well all other areas of the hospital so I became very familiar with the infection control standards.

When the first wave of the pandemic started I often thought of my colleagues working in hospital and what they must have been going through. While I had a decent idea of what that might be like, it is hard to describe to others.

And so in honour of Physiotherapy month, I have asked my dear colleague Danielle Pierce, Registered Physiotherapist to share her experience of what it’s like being a Physiotherapist during a global pandemic caring for COVID patients. She has recently had the opportunity to share some of her experience briefly on the radio through 98.1 CHFI, but she has more to say and we think it’s important to share. So here she is in her own words:

Danielle Pierce, Registered Physiotherapist

In the first wave of the pandemic I had a lot of people ask me if I was still working. It was a normal part of casual conversation in those days, akin to asking about the weather. When I said “yes, I work in the hospital!” (with anxiety, fear, courage and pride hidden between the lines of my answer), a lot of times people would hit me back with an unintended blow. “But you’re a physiotherapist, aren’t you?” It took a lot of composure to avoid reacting to the gut punch they didn’t realize that they had just delivered. I didn’t have the energy to go on a full explanation of the importance of my role during polite small talk. I’d smile and say “oh, I’m essential!” and leave it at that.

That first wave was scary. At that time, COVID was an unknown beast, and as physiotherapists in the hospital setting we were furiously researching as much as we could from the experiences of our colleagues overseas. We watched as cases soared in Italy and New York, reading about nightmarish conditions in their hospitals and we braced ourselves, preparing for the worst. Thankfully with the changes the hospital made (delaying surgeries, redeploying staff, etc) we were able to continue to meet the needs of our patients, and we slowly carved out the role of physiotherapy in addressing the effects of this new virus.

I still remember the first COVID patient I ever treated in the ICU. The treatment was completely ordinary as far as an ICU physio treatment goes, but my heart was beating out of my chest and I must have checked my PPE integrity 5 times before entering the room. I was determined to be there for the patient and treat them just as I would anyone else— but I’m human and I was scared! I had seen colleagues fall ill with the virus, and at the time we had staff members and their family members admitted to the hospital as a result. Policies were changing rapidly at that time, COVID outbreaks on inpatient units were common... it was a lot to take mentally. My strategy to keep it together was to focus solely on the patient in front of me at all times— completely avoiding the big picture or thinking too far ahead. I knew my patients needed me and that’s what kept me going.

Most people don’t know what “ICU COVID care” is. ICU level patients with COVID usually start on high flow oxygen, and if their lungs can’t keep up they may need to be intubated. The team inserts an artificial airway, and the ventilator becomes their lungs, breathing for the patient. Intubated COVID patients need a ton of medications to be able to tolerate this— they sedate them, artificially raise their blood pressure to be able to support basic organ function, and paralyze their muscles completely. At this point it is a waiting game... the ICU team works hard to save their lives, and as physios and allied health professionals we monitor closely, anxiously waiting to try to give them their life back.

After a patient has been artificially paralyzed for almost a month, they are profoundly weak. As they come off the paralytics and sedation they start to wake up and try to participate in therapy but they have very little reserve in terms of muscle strength. Their lungs are incredibly fragile. Some come off the ventilator well, but some require a tracheostomy (breathing tube in their throat) before being able to start breathing on their own. Survival is just the beginning— they need to be able to live, breathe, and perform basic functions on their own again. Each patient has specific goals that give quality back to their lives, and as a physiotherapist I am determined to help them get there.

The fear I used to feel melted away a long time ago... now I get excited to go into these patients’ rooms, turning their survival into something so much more. I get to work with these patients to help them claw their way back to functioning and breathing on their own again. I help them regain the strength to stand on their own two feet for the first time since they arrived in ICU. I get to help them take their first steps with assistance. I’m able to say “you walked today!” and watch the pride light up their eyes. I get to celebrate with them, seeing true hope and happiness in their faces for the first time in a LONG time. Not everyone gets better, and some people take a much longer time to regain their strength... but my physio colleagues and I are there fighting with them each step of the way.

A lot of people don’t know what physiotherapists do in hospitals. If you’re not in healthcare, I don’t blame you— it’s difficult to understand. The vast majority of people have never even heard of “chest physiotherapy”, where we use our hands on patients’ rib cages to loosen secretions and assist patients to clear mucous out of their lungs. We are rostered for oxygen titration and deep airway suctioning, where we use a catheter to suction mucous directly from the airways when patients are too weak to cough them out fully. It’s so far from the physio that people are familiar with that it can be hard to imagine that it’s the same profession.

When you think of the large team that it takes to care for a patient with COVID-19, you might not immediately think of the physiotherapists in this group— but I assure you, we are there. I feel so proud to be able to directly make a difference in the lives of these patients who have battled SO hard for so long. I am a cheerleader, a personal trainer, an advocate, a friend. There are patients that I will never forget, who have touched me more than they will ever know. They gave me courage to overcome my initial fears and move past them. They give me the strength to continue to show up every day. They give me hope. I can’t imagine not being there for them, doing my small part to make such a huge difference in their recovery.

To those who question (or have never considered) the value of physiotherapists in the recovery of COVID patients— I can assure you, I am essential.

We agree Danielle!