When then 53-year-old Angela Malik-Stenson walked into the emergency room at the Ottawa Hospital’s General Campus on March 26 after testing positive for COVID-19 a few days before, she told her husband she’d be right out.
Malik-Stenson was having some trouble breathing and thought doctors would hand her a puffer and send her on her way — but that wasn’t the case.
“I was weak and fatigued,” she explained. “It felt like I had the flu at the beginning. My body felt heavy.”
What she thought would be a one-day stay actually turned into a 100 days of fighting for her life.
And part of her recovery and the reason she was able to walk out of the hospital on July 9, had a lot to do with post-COVID rehab, something she didn’t even know existed.
“I thought after leaving the ICU I would be going home,” Malik-Stenson chuckled. “I didn’t know about COVID rehab or that I’d needed it before I was able to go home.”
Malik-Stenson doesn’t know how she caught the virus, although she speculates it happened sometime between March 13 and 15.
And she was only a week away from her appointment to get her first vaccine.
Her husband caught it too, but not nearly as severely as she did. Malik-Stenson, who works as an administrative assistant at a doctor’s office, and her husband, both worked from home. They only went out for necessities like groceries, wore their masks as per OPH guidelines and washed their hands regularly.
“We did everything right,” she said with a hoarse voice to CityNews Ottawa.
(Malik-Stenson was asked if she needed to take breaks in between questions, but told the reporter that she was doing breathing exercises as questions were being asked and "was fine.”)
Nonetheless, Malik-Stenson’s breathing became so laboured at the hospital that she was put on oxygen — this on top of dealing with fever and chills.
In fact, her oxygen level went below 50 per cent (the normal range is between 93 and 100 per cent).
And seven days later on April 3, her breathing became so difficult that doctors had to intubate her. It was also the same day her husband was discharged from the hospital.
Considering she was intubated and put into a medically-induced coma, Malik-Stenson doesn’t remember much. She mostly relies on people’s accounts of what happened.
But it wasn’t enough once a COVID infection took over her lungs. That’s when doctors had to come up with another plan.
She was transported to the Heart Institute at the Ottawa Hospital’s Civic campus and hooked up to an extracorporeal membrane oxygenation machine (or ECMO), a machine typically used for patients recovering from heart or lung failure or heart surgery. The machine pumps and oxygenates a patient’s blood outside the body, allowing the heart and lungs to rest.
She was on ECMO for five weeks.
“If there's one thing I want people to know about this, it’s that it's a horrible [illness]” Malik-Stenson said. “I did everything I could so I’m thinking, ‘Oh, this can’t be that bad.’ Then I’m realizing two months later that I literally could have died. It’s a big wake-up call.”
And sometime during her coma (she’s not quite clear on the date), doctors performed emergency surgery on her lungs.
Then finally, the end of May arrived and Malik-Stenson woke up.
Putting life into perspective
Months of her life were now unaccounted for.
One of the very few things Malik-Stenson does remember, however, was her husband visiting her for their anniversary on June 6.
And while she was unresponsive, she says she recalls hearing her husband reading her poetry at her bedside.
But she doesn’t remember being at the Heart Institute and didn’t even know she had emergency surgery — but she does remember some of the moments after she woke up.
“At that point, I was aware that I had been out for a long time,” she said. “I was awake in the ICU for two weeks but I wasn’t able to talk (she has a tracheotomy), I had a catheter in so I wasn’t peeing on my own and I still had the feeding tube in. But when I was transferred to the acute care ward, they took out the catheter and switched me to diapers because I couldn’t identify when I had to go to the bathroom.”
“It was quite humiliating,” she added. “It certainly puts your life in perspective. I couldn’t have stayed that way — that could have been my full recovery.”
Around this time though, Malik-Stenson was finally able to get her first dose of a COVID-19 vaccine — but it wasn’t the cure, it was simply another means of protection.
The next step: COVID rehab.
Enter Dr. Guy Trudel, a specialist in rehab medicine at the rehab centre at the Ottawa Hospital.
When Trudel met Malik-Stenson, he did an assessment and had her do a series of strength tests. She was very weak in her legs and other areas of her body and couldn’t stand on her own.
For three weeks, Malik-Stenson trained with a physiotherapist and met with an occupational therapist, who helped her find the proper aids that would keep her safe at home.
At this point Malik-Stenson was wheelchair-bound, and started to work on getting her strength back; to walk and feed herself again, bathe, go to the bathroom — even for simple things like tying her shoes and getting out of bed.
After a bit, she was able to progress to a two-wheel walker, then to a four-wheel walker — and when her rehab came to an end, she was able to walk out using only a cane.
“Going pee in a diaper is not a very pleasant thing for a 50-year-old. It’s not something you’d ever think you’d have to ring a bell to get someone to come change your diaper. It took me until almost my very last week before I was able to go to [the bathroom] on my own.”
How rehab works
As Trudel explains, there are two streams of COVID rehab: the first being for critical care patients — also referred to as long COVID rehab (for long-haulers) — and the second for people with COVID but didn’t have a need to stay in the hospital and still have some bothersome symptoms — also referred to as acute rehab.
“According to what we know thus far, it’s that an intervention that is a multi-disciplinary intervention targeting the main symptoms delivered here with our team that includes other doctors — physiotherapist, occupational therapist, dietitian, physiologist and a nurse — is what is needed,” Trudel said. “Some have great recovery — more than we expect — and some have little recovery. Lots is still unknown with the different evolutions of COVID.”
Typically patients will spend an average of five weeks in rehab. Their rehab starts as soon as the patient has shown that they’re medically ready.
When patients first start rehab, Trudel says, they can usually tolerate a bit of activity.
A session will last anywhere from three to four hours.
During a session, the team helps patients gain their strength back, helps them with their breathing (the lungs, Trudel says, are a big problem with COVID) and provide therapy to help them deal with any feelings of depression and/or anxiety, among other things that will help them successfully and safely transfer back home.
Although Trudel says the first wave of the pandemic was perhaps the most challenging time for the rehab centre, the latest wave saw a change in demographic of patients requiring the care.
“The last wave was busy,” he said. “Initially, during the first wave, older people were the ones severely affected by it, and now it’s younger and younger because by now the elderly have been vaccinated and the virus has moved on to a different population.”
Whoever the patient, though, Trudel says it’s gratifying to see the progress they make from their first to their last day in rehab.
“That’s why I picked rehab as a profession,” he chuckles. “You end up knowing the patient and their family and what their motivation will be to give it this fight, because it’s going to be a big fight for them.”
“It’s always a nice moment when they can transfer on their own, they don’t need anybody — the first time they can walk on their own not needing anyone next to them, and then building up from there. That is what’s most gratifying for me,” he added.
Trudel believes COVID rehab is a permanent fixture now — as long as COVID is around, so is the rehab.
For long-haulers, though, their future is a little more uncertain. Symptoms of the illness are very persistent — although the trajectory for eventually getting better is there, it’s a very slow process, Trudel explains.
“We’ve responded really well to this challenge. I need to congratulate all the team members who were able to switch gears and learn about the [illness] and apply their talent and devotion, too.”
The reality of recovery
It’s been about three weeks since Malik-Stenson left the hospital. Even though she is back home, her recovery isn’t over yet.
Just like others in her position, Malik-Stenson’s future is still unknown. For now, she doesn’t have a return to work plan in place as her brain is still pretty foggy. Will she be on unemployment or switch to long-term disability after her Employment Insurance runs out? Again, it’s all up in the air.
But she is making progress every day — like in her lung capacity, which has now climbed up to 70 per cent — but she does admit that some days feel slower than others. She also has no idea if her lungs are permanently damaged from the illness.
Pain in her lungs, back and ribs are also still persistent, and she’s also still waiting for circulation to properly come back to her fingers and toes also.
She still has another three weeks of physiotherapy to go.
“Eventually I hope to be back to normal, but I was told I’ll have another year before I see considerable improvement,” Malik-Stenson explained. “One of the things I’m really looking forward to is seeing my friends… I’m looking forward to going back to just doing the laundry and walking up and down the stairs, going out for a Saturday night for a couple of drinks and dances. It’s so simple.”
It’s been a tough go, she says through a shaky voice, but a go she says she’s happy to have overcome.
“To have a hug from my sister in Calgary — the would be really nice,” Malik-Stenson said. “That would be really nice.”