The staff at The Salvation Army Toronto Grace Health Centre (TGHC) call  Smiljka B., currently in the hospital’s rehabilitation program, Mrs. B. The informality is a testament to the trust Smiljka has developed towards the  interprofessional health care team and their collaborative efforts in helping  her gain back her independence.

Mrs. B was admitted to the Trillium Health Partners (THP) facility in Mississauga in October 2019, complaining of pain in her waist. The interprofessional health care team there diagnosed her as suffering from lumbar spinal stenosis, a narrowing of the spinal canal that results in the compressing of the nerves travelling through the lower back into the legs. She was further diagnosed with a fracture in her spine, which required an operation on her neck.

Her post-operative recovery was complicated by a bout of pneumonia, as well as by chronic obstructive lung disease. Suffering from respiratory failure, she was transferred to the intensive care unit (ICU) at THP for ventilatory support. In aid of this, she required a tracheostomy. Mrs. B spent the next four months in the ICU, where the interprofessional  health care team attempted to wean her off a mechanical ventilator.

Mrs. B eventually stabilized and was placed on a nocturnal ventilator. Doing well on this, she was transferred to the TGHC for treatment in its RECOVER Program for Chronic Critical Illness in June 2020.

During her stay at TGHC, Mrs. B began a weaning process to remove the nocturnal ventilator. This is done by decreasing the degree of ventilator support and allowing the patient to assume a greater proportion of their own ventilation — spontaneous breathing trials are combined with a gradual reduction in ventilator support.

During this period, Mrs. B was confined to her bed; a mechanical lift was required to transfer her to a wheelchair or the commode. To aid in her rehabilitation, a physiotherapist (PT) and an occupational therapist (OT) worked on bed exercises with her in order to prevent further functional loss.

Over time, her bed exercises were advanced so that she could, with assistance from the rehab team, do standing exercises. She eventually gained enough strength to pivot into her wheelchair, and a short time later, she was able to take steps toward her wheelchair. She also began to develop the strength to move using only the walker — an achievement that allowed her to reach another level of independence.

By February 2021, Mrs. B was being weaned off her nocturnal ventilator. Both her trach and her urinary catheters were removed, and she left the ventilator program and was transferred to the TGHC’s rehabilitation  program for more intensive rehabilitation. By late March 2021, Mrs. B, benefitting from the help given to her by the rehab team, was able to walk with a walker seventy metres — two times further than she could in early February 2021.

Mrs. B still requires oxygen therapy. The rehab team continues with rehab therapy, following her with portable oxygen while she walks with her  walker. Her immediate goal, one shared by the rehab team, is to be able to walk with her walker while supporting her oxygen tank herself.

A  psychotherapist and an OT with mental health training provide Mrs. B with mental health therapy, helping her to recognize her achievements to date and encouraging her to look forward to gaining back her independence. A chart hanging on the wall beside Mrs. B’s bed indicates her goals and  records her recovery milestones.

Discussing her treatment, Mrs. B comments on how grateful she is for all that the interprofessional health care staff at the TGHC have done for her: “At first,” Mrs. B says, “after my operation, I felt discouraged and did not want to accept that perhaps I wouldn’t walk again. When I came to the Grace, they raised my hopes and encouraged me to walk and to gain back my independence. The health care team was patient and willing to work with me. I love them!”

Mrs. B continues to work towards her goal of  returning home.