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I’ll never forget walking to the ICU on March 12, 2020 to room 2. I am the director of the Center for Speech Swallowing and Voice Disorders at Stony Brook Southampton Hospital, in Southampton, NY, and was going to see Richard, a 57 year-old gentleman who was admitted for respiratory insufficiency due to COVID-19.
All clinical staff were getting close to overload, as the patient census was consistently increasing day by day. The ED was beyond it’s max as patients were being admitted by the hour, with respiratory difficulties due to COVID-19, which at that time we knew very little about. In order to provide an additional perspective of the intensity of our admissions, our hospital which is normally a 97 bed acute care facility with one ICU and one CCU, quickly transitioned to a 125 bed acute care hospital with 3 ICU’s and one CCU/ICU. My entire staff and I were being asked to evaluate patients for swallowing, as well as acute onset of language and cognitive impairments without any evidence of stroke and/or TBI. I kept asking myself… What is this disease all about? Not only is this a respiratory disease process, but as we continued to see patients with this unknown diagnosis, we quickly began to realize that this virus is also causing varying degrees of cognitive and language difficulties in many patients. Little did we know what we were dealing with as would put on our PPE, inclusive of a gown, one N95, and one surgical mask, head covering, face shield, double gloves, and shoe coverings! While trying to ease the anxiety of my staff, I kept asking myself, what was this mysterious virus that we knew nothing about, that was causing people to have such severe respiratory and neurological deficits, and worst of all causing many of them to die! We soon began to learn that we would also begin evaluating and treating patients with swallowing and acute onset of voice difficulties, who had just been extubated due to vocal fold paralysis. Much to our surprise some patients with vocal fold paralysis were never even intubated?
Needless to say, we and especially nurses and physicians, and all hospital employees were soon becoming physically and emotionally fatigued, while we tried to help our patients as well as each other! Even the community participated by sending daily messages as well as food, food, and even more food to cover each shift at the hospital.
Now getting back to Richard. I can remember walking into Richard’s room with a great deal of trepidation, not knowing what to expect, while doing my best to help this man who was only in the hospital for two days, and was already showing signs of severe neurological impairment. Not only had he not been eating since his admission, his cognitive status was quickly declining. As I tried to elicit some observable response from him, I also soon realized that because of his diminished cognitive level, that we would need to consider an alternate nutrition source for him for the near-term, as I would need to make him NPO as it would be unsafe for anyone to try feeding him. When speaking to the medical team regarding the results of my evaluation they agreed to place an NG tube for optimal nutrition. Fortunately for Richard, within a few days, he became more alert and was soon speaking with his family on the telephone, as no family were allowed to visit patients. That being said, I remember being in Richard’s room when his nurse popped her head in to tell him that his mother just called and wanted him to know she loved him. At which point we all began to shed a tear!
I must say that while this last year was an extremely professionally and emotionally challenging one, I would never have wanted to miss participating in this experience. It was one that caused all of us to put our professional knowledge and experience to work helping those in need of our services, while wading through unknown territory, and while at the same time adding new and extremely interesting empirical knowledge of an unknown disease to the profession of speech-language pathology.
In closing I would just like to say, God bless all those patients and families who were affected by this disease and especially those who unfortunately lost their lives.
John Amato, Jr., EdD, CCC
Department of Communication Sciences and Disorders
CW Post College of Long Island University
Director, Center for Speech Swallowing and Voice Disorders
Clinical Assistant Professor of Surgery
Stony Brook Southampton Hospital
ICU: Intensive care unit
TBI: Traumatic brain injury
PPE: Personal protective equipment
CCU: Cardiac Care Unit
N95: A filtering face mask
NG tube: Nasogastric tube