When Anthony McDermott first arrived at Toronto Rehab's Bickle Centre, his care team on the North 5 Transitional Care Unit (TCU) affectionately called him "Patient One."
As their first post-Intensive Care Unit (ICU) long-stay, COVID-recovered patient, he required a level of care that was unprecedented at the centre.
Having spent five weeks on a ventilator in the ICU, followed by two weeks on a General Internal Medicine Unit at Toronto Western Hospital, he was still relying on a tracheostomy tube, consuming nutrition through a gastronomy tube, or G-tube, and his muscles had atrophied to the point where simply lifting his head took more energy than he could muster.
But his COVID-19 battle scars ran deeper. Barely recognizing the man in the mirror, Anthony, a 62-year-old facilities manager, husband, and father of eight who was used to always being on the move, felt demoralized.
"I knew I was going to live, but I couldn't see a future. I thought, 'this might be the rest of my life,'" says Anthony, who had received his first dose of vaccine before contracting COVID-19.
Supporting Anthony's rehabilitation took teamwork to the next level, says Marianne Ng, Clinical Manager of Bickle's North 5 TCU.
"We've never had a case where all disciplines worked as closely, and contributed as equally, to a patient's recovery."
Their approach paid off. Just five weeks later, Anthony realized his goal of going home, when he walked out of the hospital on his own, toward a future full of possibility.
'With this population, there's no predetermined plan'
By the time Anthony was admitted to Bickle in June 2021, staff on the TCU – for patients who aren't quite sick enough to require acute care, but need time to build strength and endurance – were no strangers to caring for COVID-recovered patients.
In fact, Bickle has played a critical role in UHN's COVID-19 response, flexing intake criteria and opening 36 additional beds since 2020, to support flow and ensure space is available in acute care hospitals, for those who need it most.
Staff have also learned to adapt their therapy approach, to care for a population so new, there's no evidence-based knowledge to build from.
"Rehab generally follows a pretty structured course, but with this population, there's no predetermined plan," says Marianne.
In Anthony's case, his level of vulnerability made creating a care plan even more complex. When he first arrived, he couldn't take more than two steps before needing to sit down. His heart rate would climb, and his oxygen levels would drop.
"It felt like all my muscles had been sleeping, and in trying to wake them up, my body would get angry and shut down," Anthony recalls.
"I worried I'd be in that state forever."
'With Anthony, it was a balancing act'
From nursing and personal support workers, to therapy and wellness staff, 20 different roles made up Anthony's interprofessional team.
Anthony's positive outcome was inextricably linked among those roles. For example, if his tracheostomy tube was removed too soon, it could lead to further respiratory complications and impede swallowing recovery and G-tube weaning, but he couldn't eat if he wasn't strong enough to open a container.
This inter-connectedness made it crucial for the team to talk daily and coordinate their approach to propel Anthony's rehab forward.
In the early days of Anthony's stay, physiotherapist Siobhan McKittrick says she worked elbow to elbow with occupational therapist Kendra Flemming.
At first, it was out of sheer necessity to have more than one person physically supporting him.
But even as Anthony grew stronger, they recognized the need to coordinate therapies.
"Kendra needed to know if he did a lot of walking with me on a Monday, so that she could let his legs rest on a Tuesday, and work on something like getting dressed, instead," says Siobhan.
"We usually create care plans independently of one another. But with Anthony, it was a balancing act to determine how we could make the most of his sessions, without causing him to exert too much energy."
At first, getting out of bed was enough of a workout. But soon, Anthony progressed to taking a few steps in his room, and then moved to the gym, where he worked on posture and balance, using parallel bars.
By the end of his stay, he was walking on his own, using a wheeled walker.
Celebrating victories over the course of a day
With mental health tied so closely to motivation, the role of Spiritual Care was also essential to Anthony's healing narrative.
"I was frustrated and angry," recalls Anthony. "My wife and I were supposed to retire and start travelling, and here I was, in a wheelchair, barely able to breath, with tubes doing the work my body should be doing."
That's when Spiritual Care practitioner Suzanne Robertson was parachuted in.
She says that when a person is in the acute stage of their illness, they're in survival mode. By the time they get to rehab, there's more space and time to emotionally, psychologically and spiritually process what has happened.
"It's a fertile time for meaning-making: 'What has happened to me? What does my life look like now? How has it impacted my identity?'" Suzanne says. "Spiritual Care helps patients explore and understand the intersection of their illness and other parts of their existence."
As someone who was used to always being on the move, Anthony had to learn patience.
"I remember him saying: 'I'm a doer.' So we came up with the phrase that he needs to become a 'be-er,'" Suzanne says. "Part of that was about radically slowing down his thoughts, to be able to recognize and celebrate victories over the course of a day."
And so he did, celebrating the first time he was able to walk from his bed to the bathroom; when his tracheostomy was removed and he could breathe easier; when he swallowed thickened lemon water for the first time – under the watchful eye of his speech-language pathologist, Sam Williams; when he could share a laugh with social worker Lisa Carrington, who also coordinated a safe and successful discharge; and the first loop he made it around Bickle's expansive garden on his own two feet.
Working closely with the interprofessional team, Suzanne was able to help fill the entire picture of Anthony's experience, while ensuring she stayed up to date on his progress, to meet him where he was.
"What I love about working at UHN is that a person's spiritual, psychological, and emotional experience is so deeply valued, and seen as being just as important as their physical journey," says Suzanne.
"That translates to a deep collaboration and relationship between my profession and the rest of the team."
A patient's legacy
Since discharge from Bickle, Anthony remains committed to building strength and endurance in outpatient rehab.
He spends most of his time close to home, walking with Terry and their dog, and exercising every day. He's up to 14 minutes on his elliptical machine, and his goal is to reach 20 minutes.
He's still weaning his G-tube, and there are some days where fatigue hits so hard he can't get out of bed. But they don't happen often, and Anthony says he's continuing to feel better.
And while he credits the team for his ability to once again recognize the man in the mirror, they're quick to point out how they benefitted, as well.
"What's amazing about Anthony was that he was on the frontier of a new illness that we didn't have a lot of information about," says Suzanne.
And that, she says, is his legacy at Bickle. In caring for Anthony, the team was able to deepen their wisdom, knowledge, and expertise, which they will carry with them, as they continue to provide excellent patient experiences.
